Heparin assay and protamine titration.

By utilizing the fact that heparin and protamine sulfate directly neutralize each other, it is possible to quickly detect excess levels of protamine (anti-heparin activity) by back-titrating a plasma specimen with predetermined amounts of heparin. The approach suggested allows for the simultaneous definition of low levels of heparin, and incorporates an equally rapid and accurate measurement of high heparin concentrations. The methodology presented employs heparin assays using the "Protopath" technic. The concept appears to be applicable to other test systems currently designed to monitor heparin activity.

Bacterial colonization of human milk.

Because human milk is being used more and more for feeding neonates, many hospitals are struggling with the issue of culturing. The literature indicates that human milk is hardly ever sterile. Since there has been much debate concerning protocols and frequency of culturing milk specimens, we evaluated our facility's protocol, the aim of which was to assure clean collection and transportation of the mothers' milk. We studied two large sectors of patients; private and nonprivate (service). Both sectors had a similar contamination rate with the same type of organisms. Private pediatricians generally ordered more cultures per patient than did the service (nonprivate) pediatrician. We challenge the need for all these cultures, which increase the patients' cost.

The cardiac profile.

The clinical laboratory furnishes information valuable not only in the diagnosis of myocardial infarction (MI), but also in screening for possible causes of ischemic heart disease through definition of the lipid status of individuals. Accordingly, the panels used in the study of hyperlipidemia as a possible cause of ischemic heart disease are reviewed, including the determination of serum cholesterol, triglycerides, and electrophoretic development of the lipoprotein pattern. The results of an on-going study of more than 500 patients admitted to the emergency room of a general hospital with symptoms of "chest pain" are presented--including the electrocardiogram, enzyme tests, and isoenzyme patterns, in conjuction with the clinical picture. The relative diagnostic value of test procedures is considered, convering the pre-enzymatic period, current test panels, and possible future approaches. It is concluded that the laboratory's position in providing data for diagnosis of MI would be enhanced through development of procedures with as great or greater specificity than the isoenzyme patterns of creatine kinase and lactate dehydrogenase, currently the most specific indicators of MI, but which have results available in two to five minutes.