Comparative study of test kits for measurement of rheumatoid factors by the latex fixation test.

The performance of 14 test kits for the measurement of rheumatoid factors by the latex fixation test was investigated; all results were expressed in IU/ml. Reproducibility and properties of control sera were also studied. It was found that half of the kits did not satisfactorily detect rheumatoid factor levels lower than 25 IU/ml. Most kits performed reasonably well in practice. Positive control sera only rarely met strict requirements. The relative costs did not always have a clear correlation with the quality of the results. The variation caused by differences between kits became acceptable when the results were expressed in IU/ml.

Urinary C-peptide: a useful tool for evaluating the endogenous insulin reserve in cohort and longitudinal studies of diabetes in childhood.

Increasing research into the remission phase of type I diabetes mellitus stresses the importance of a non-traumatic and reliable method for the evaluation of endogenous insulin production. We compared 24-h urinary C-peptide excretion (UCE) with plasma C-peptide values before and after stimulation with 1 mg glucagon in 24 type I diabetic children. Fasting plasma C-peptide values and stimulated plasma C-peptide values showed a linear correlation with 24 h UCE. Mean plasma C-peptide levels correlated inversely with the exogenous insulin dose. A slightly better correlation was found between the exogenous insulin dose and 24 h UCE. Control data of 24 h UCE were obtained from healthy siblings. A linear correlation with age was found up to 10 years of age above which UCE values seem to reach a plateau. This effect of age, as well as the frequency of sampling was taken into account in the derivation of 95% reference intervals for UCE. The measurement of 24 h UCE appears to be a useful parameter to assess endogenous insulin production in diabetic children, provided that age is taken into account.

The time of separation of the umbilical cord.

The time of separation of the umbilical cord was studied in 911 neonates. The mean time of separation was 7.4 days (SD 3.3, range 1-29 days). We sought a possible relationship between the time of cord separation and various factors in the perinatal period. Cord separation was delayed when antibiotics needed to be administered to the neonate because of sepsis, when the infant was born prematurely, delivered by Caesarean section or had a low birth weight. The cord separated slightly earlier in female than in male infants. None of the infants studied suffered from omphalitis and it would appear that "delayed" separation of the cord is not always necessarily accompanied by severe leucocyte dysfunction.

Effects of ovarian inhibin on pulsatile release of gonadotrophins and secretion of LHRH in ovariectomized rats: evidence against a central action of inhibin.

Intraperitoneal administration of bovine follicular fluid (bFF) decreased plasma concentrations of FSH in ovariectomized rats after 2-3 h, while plasma LH and prolactin were unaffected. In untreated ovariectomized animals the concentrations of these hormones were found to show pulsatile variations. Concomitant occurrence of peak values of LH and FSH was found in about 40% of the pulses. No pulses of FSH were observed after i.p. treatment with bFF or partly purified preparations of inhibin from bFF, but the pulsatile release of LH and prolactin remained similar. Infusion of bFF into the lateral ventricle of the brain did not alter the concentrations of FSH, whereas administration of bFF into the pituitary gland diminished the plasma concentrations of FSH. Anaesthesia (urethane plus xylazine) did not prevent the occurrence of the pulses of FSH and LH, but it reduced the pulse amplitude and clearance. During this anaesthesia, the concentrations of LHRH in the hypophysial stalk plasma decreased by 30% after administration of bFF, but did not alter after treatment with partly purified preparations of inhibin. It is concluded that the inhibin-like activity in bFF suppresses pulsatile FSH secretion in ovariectomized rats by an action on the pituitary gland, but has no effect on the pulsatile release of LH and prolactin.

Peptic ulcer and gastric carcinoma: diagnosis with biphasic radiography compared with fiberoptic endoscopy.

The diagnostic value of biphasic radiographic examination of the stomach and duodenum was compared with that of fiberoptic endoscopy in a prospective, blinded study of 385 patients with dyspepsia. This investigation was directed at gastric malignancies and peptic ulcers. Methodologically there is no absolute standard for a study of this kind because histologic examination is useful for detection of cancer but inadequate for ulcers. As an alternative, kappa indexes and the sensitivity and specificity, as derived by Hui and Walter, were calculated and compared. For the detection of gastric carcinoma, radiographic and endoscopic findings had almost perfect agreement beyond chance. For gastric ulcers, radiography and endoscopy had substantial agreement, which became perfect if small ulcers (less than 5 mm) were excluded. For duodenal ulcers, radiography had a lower sensitivity than endoscopy; this disagreement disappeared if small ulcers were excluded. Both methods have equal merit; choice of the initial diagnostic procedure will therefore depend on cost, discomfort to the patient, and risk of complications.

Abnormal pattern of cell proliferation in the entire colonic mucosa of patients with colon adenoma or cancer.

Using autoradiography after 1 h of pulsed labeling with tritiated thymidine in endoscopic biopsy specimens from normal-appearing mucosa, cell proliferation was determined at six predetermined sites of the whole colon in patients with neoplastic disease of the large bowel and was compared with that of subjects without macroscopic colonic pathology. The labeling index (the percentage of cells incorporating [3H]thymidine) was 8.6 +/- 0.5 (mean +/- SEM) in 13 patients with colon carcinoma (p less than 0.001 vs. 16 control patients whose labeling index was 4.9 +/- 0.2) and 9.1 +/- 0.4 in 11 patients with a large adenoma in the colon (p less than 0.001 vs. controls). Twenty-one patients with one or more small adenomas (diameter less than 1 cm) had a moderately increased cell proliferation compared with controls (labeling index 6.2 +/- 0.3, p less than 0.02 vs. controls). In patients with neoplastic disease an enlargement of the proliferative compartment was found, whereas 6 patients with Crohn's colitis had values for labeling index and a distribution of labeled cells along the crypt comparable to that of control subjects. An increased cell proliferation was found along the entire colon under each of the neoplastic conditions studied. These findings indicate that although neoplastic lesions develop in a limited area of the colon, the entire large bowel may be at risk for tumor growth.

A comparative study of five different methods for the determination of 3-methoxy-4-hydroxymandelic acid in urine.

Five different methods for the determination of 3-methoxy-4-hydroxymandelic acid (vanilmandelic acid, VMA) in urine were compared: a GLC-FID catecholamine metabolite profiling method, an HPLC method with electrochemical detection, the method of Pisano et al. [1962) Clin. Chim. Acta 7, 285-291), a one dimensional paper chromatographic method with diazotized p-nitroaniline staining and the commercially available Bio-Rad VMA by Column Test. The comparison consisted of an imprecision study, a linearity check, a recovery study, a split sample comparison and an interference study. The best results of the imprecision study (n = 8) were found with the Bio-Rad and the HPLC method (within-run imprecision had a coefficient of variation (CV) of 5.1% and 1.4%; between-days CV of 5.9% and 6.0% respectively for values of 32.4 mumol/l and 24.5 mumol/l). The Pisano method had the poorest within-run CV (14.6%) and between-days CV (16.8%) for a value of 23.2 mumol/l. All methods showed good linearity. The mean recovery of the HPLC method was 101.3%; the mean recovery of the other four methods ranged from 93.9%-96.0%. The split sample comparison showed that the accuracy of the HPLC, the GLC and the Pisano method is comparable. The accuracy of the paper chromatographic method and the Bio-Rad method had a positive bias compared with the HPLC method. Especially the positive bias of the Bio-Rad method can be very large. The HPLC method was not influenced by the compounds tested in the interference study, whereas the GLC method in some cases only suffered from overloading problems. The Pisano and the Bio-Rad method were most influenced by the interfering compounds tested. We conclude that the HPLC and the GLC methods are superior to the other three VMA methods. From an analytical point of view HPLC is the method of choice for determining 3-methoxy-4-hydroxymandelic acid in urine.