[Standardized counting of particles in the urine: a comparison between flow cytometry, cell chamber counting and traditional sediment analysis]. / Standardisierte Partikelzählung im Urin: Ein Vergleich zwischen Durchfluss-Zytometrie, Zählkammer und traditionellem Urinsediment.

We compared the number of particles in the urine with flow cytometry and manual methods: cell chamber and standardised sediment analysis. The correlation (r) between the KOVA-cell chamber and the flow cytometer UF-100 was 0.966 for erythrocytes, 0.935 for leukocytes and 0.902 for squamous epithelial cells. Similar results were obtained by a standardised preparation of the sediment. Today, the estimation of the cell number in the sediment analysis is still common. The KOVA cell chamber system is a cheap alternative for microscopy, whereas automation with flow cytometry is only used for large laboratories. Reference values were established under optimal conditions (erythrocytes < 14/microliter, leukocytes < 16/microliter) with a cut-off of 20/microliter.

Urine analysis performed by flow cytometry: reference range determination and comparison to morphological findings, dipstick chemistry and bacterial culture results--a multicenter study.

AIM: To validate whether quantitative flow-cytometric analysis of particulate matter in urine would allow for accurate and rapid enumeration of red blood cells (RBC), leukocytes (WBC), squamous epithelial cells (EC), casts, and bacteria, a Sysmex UF-100 analyzer was tested in a multicenter study. MATERIAL AND METHODS: At first, reference values were established and found to be < 14 for RBC, < 16 for WBC, < 9 for EC, < 2 for casts and < 173 for bacteria, respectively (counts per microl; 97.5 percentile). Due to the wide use of dipstick and microscopic sediment analysis in routine urine diagnostics, comparative studies on 950 random urine samples were performed. Bacterial counting combined with WBC enumeration was further compared in 266 routine urinary microbiologic cultures. RESULTS: Good correlations were found comparing UF-100 results of RBC (r = 0.89), WBC (r = 0.94), and EC (r = 0.74) with Fuchs-Rosenthal Chamber (FRC) counts. However, some misclassification of casts (r = 0.32) could be observed. Correlations of UF-100 with dipstick and sediment testing was significant (p < 0.001), but the scatter of the latter two methods is too wide to consider them as quantitative methods. Promising results further revealed that the analyzer has a good negative predictive value (NPV) for microbiologically negative cultures, especially for cultures with bacterial counts of 10(5)/l (NPV = 95%). CONCLUSION: The analyzer is capable of providing rapid and reliable urine analysis of cellular particles avoiding the known imprecision of dipstick and sediment methodology. Thus, when used in an algorithm, combined with dipstick or quantitative urine chemistry analysis (for hemoglobin, esterase, protein, glucose, etc.), this analyzer might serve as a rapid and accurate screening tool in routine urine analysis, thereby reducing manual reviewing rate as well as the number of missed samples, compared to screening with dipstick alone.

Intermittent microalbuminuria in children with type 1 diabetes mellitus without clinical evidence of nephropathy.

Microalbuminura (MA) was determined in 127 children and adolescents (age 3-21 years) with type 1 (insulin-dependent) diabetes mellitus. Patients with clinical evidence of long-term complications or macroproteinuria were excluded. Urinary albumin excretion was measured in a nocturnal 12-h collection and correlated with the albumin/creatinine ratio of a urine sample freshly voided on the morning immediately following the collection. The patients were divided into group A (n = 83, age less than 16 years, duration of diabetes 1-13 years, mean 4.4) and group B (n = 44, age greater than 16 years, duration of diabetes 1-19 years, mean 8.7) and compared with appropriate controls. MA above 15 micrograms/min was present in 11 of 83 (13.3%) patients in group A and in 7 of 44 (15.9%) in group B. In a repeat urine collection at least 3 months later elevated MA persisted in 1 of 11 (group A) and in 4 of 7 (group B) patients. There was no correlation between increased MA in a 12-h urine collection and the albumin/creatinine ratio in a subsequently voided urine sample. MA was not strictly dependent on age, sex, duration of diabetes, haemoglobin A1, mean arterial blood pressure, plasma creatinine, creatinine clearance or serum beta-2-microglobulin. Further systematic studies and careful follow up are necessary to appraise whether intermittent MA is indeed an early manifestation of incipient kidney disease in children with type 1 diabetes.

Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations.

Nailfold capillary microscopical and hormonal investigations were carried out in 25 patients with cirrhosis of the liver and in 20 age- and sex-matched controls. Several structural and functional capillary microscopical parameters were significantly different between the group of cirrhotics as a whole and the controls; no capillaroscopic feature helped to distinguish cirrhotics with spiders from those without. Serum estradiol and total testosterone were comparable in cirrhotics and controls; free serum testosterone was reduced in male cirrhotics, particularly in cirrhotics with spider nevi. The estradiol/free testosterone ratio was highest in male cirrhotics with spiders. Cirrhosis, thus, leads to both structural and functional effects on the cutaneous capillary system whether or not spider nevi are present. The presence of spider nevi is accompanied by an increased serum estradiol/free testosterone ratio in male cirrhotics. It remains to be determined whether the hormonal alterations described do indeed play a role in spider nevi formation.

Sex-related differences in hematological values. A study on the erythrocyte and granulocyte count, plasma iron and iron-binding proteins in human transsexuals on contrasexual hormone therapy.

Hematological data known or supposed to be influenced by individual sex hormones were evaluated in 18 untreated transsexuals (TS) and in 20 castrated or non-castrated TS on androgen and estrogen treatment, respectively. Profiting from a situation of clinically controlled hormonal sex-transformation it was tested, whether the circulating erythrocyte and granulocyte mass and iron metabolism are linked to a male and female sex-hormone constellation. The erythrocyte and granulocyte counts were significantly higher in untreated males and treated female-to-male TS than in untreated females and treated male-to-female TS. The unexpected finding of sex hormone-dependent granulocyte fluctuations was corroborated by parallel concentration changes of lactoferrin, a granulocyte-derived plasma protein. Iron metabolism as judged from plasma iron, total iron-binding capacity and serum ferritin was unaffected by sexual transformation. Plasma iron and the total iron-binding capacity did not differ significantly in untreated and treated TS of either type. The serum ferritin concentration, however, was significantly lower in untreated as well as in virilized females than in untreated and in feminized males, but was not significantly changed by long-term androgen or estrogen treatment. The present study demonstrates the potential of human transsexualism as a model for the study of sex-related biological processes.

[High incidence of unexplained hypoalbuminemia in an internal medicine practice]. / Hohe Inzidenz ungeklärter Hypalbuminämien in einem internistischen Krankengut.

The frequent observation of hypoalbuminemia in patients without hepatic disease or renal protein loss led us to compare different methods of direct and indirect serum albumin measurement. One hundred patients were randomly selected and analysed retrospectively and the serum albumin was related to clinical, hematological and biochemical parameters. 51Cr labeled albumin was injected intravenously in 6 healthy volunteers and 8 patients with hypoalbuminemia to obtain further information on the pathogenesis of hypoalbuminemia. The results obtained by the method using bromcresol purple were almost identical with those obtained by immunological methods. On the other hand, serum electrophoresis gave results that were a mean 14% higher than those with the method using bromcresol purple. Nearly half of the patients selected randomly, generally without signs of liver disease or renal protein loss, were hypoalbuminemic. There was no correlation with the age, sex, blood sedimentation rate, serum orosomucoid, hemoglobin, aminotransferase or the prothrombin time. 51Cr labeled albumin showed normal disappearance in four patients and an accelerated disappearance in another four patients. Hypoalbuminemia is a common finding in internal medicine which is underestimated in incidence and extent when serum electrophoresis is used. There is no correlation with the age and the hematological or chemical parameters measured. Both reduced synthesis and/or increased loss or catabolism are important factors in the pathogenesis of hypoalbuminemia.

[The effect of hormonal contraceptives and pregnancy on iron metabolism, plasma lactoferrin levels and granulocyte count in women]. / Der Einfluss hormoneller Kontrazeptiva und der Schwangerschaft auf Eisenstoffwechsel, Plasmalactoferrinkonzentration und Granulozytenzahl der Frau.

Plasma iron, total iron-binding capacity, transferrin, serum ferritin, plasma lactoferrin and the number of circulating granulocytes were determined in 51 healthy, non-iron-deficient women. Blood was sampled at three stages of the menstrual cycle of 6 women with spontaneous menstruation and of 6 on low-estrogen hormonal contraception. Furthermore, 39 pregnant women were studied at three stages in the second half of uncomplicated pregnancy (13 women per stage). Women on oral contraceptives differed from those with spontaneous menstrual cycles in that they did not show a drop of plasma iron at menstruation, and, on the average, they had slightly higher serum ferritin concentrations, lower plasma-lactoferrin levels and a decreased number of circulating granulocytes. No significant difference was found with respect to total iron-binding capacity and transferrin concentration. In pregnancy, a progressive increase of total iron-binding capacity and transferrin, and an intermittent decline of serum-ferritin, followed by a rise shortly before delivery, were observed. Plasma lactoferrin increased in parallel with the number of circulating granulocytes. An attempt is made to separate findings that have to be attributed to a direct hormonal effect on iron metabolism from those that may depend on other factors.

[Can carboxyhemoglobin determination be performed in family practice?]. / Ist die CO-Hämoglobin-Bestimmung in der hausärztlichen Praxis durchführbar?

Carboxyhemoglobin concentrations were measured in venous (EDTA) blood samples from 16 cigarette smokers. The determinations were carried out up to 72 hours after venipuncture in blood stored at 20 degrees C and 37 degrees C and after hemolysis and storage at 20 degrees C. No special precautions to avoid exposure of the samples to room air were taken. Comparison of these determinations with an "ideal" reference value (immediate determination, no O2 access) indicates that changes in COHb concentrations are minimal for the first 48 hours (range of mean concentration changes: -0.28% COHb to +0.19% COHb). It is concluded that COHb determinations in venous blood samples yield reliable results for practical diagnostic purposes, even without time-consuming and costly conservation procedures.

Creatine kinase and creatine kinase MB in endurance runners and in patients with myocardial infarction.

Following a 100 km race creatine kinase (CK) creatine kinase MB (CKMB) activities were serially measured in well trained athletes and compared with enzyme activities in patients with acute myocardial infarction (AMI). The half-time of disappearance of CK (CKt1/2) was 1.75 +/- 0.70 days in runners who trained within the 1st week after the race, and was 0.81 +/- 0.18 days in patients with AMI, P less than 0.005. CKt1/2 in runners was shorter (1.17 +/- 0.28 days) when no training was performed in the first postrace week. CKt1/2 was linearly correlated with age (P less than 0.01) in the runners but not in the patients. CKMBt1/2 was 1.30 and 1.11 days in two runners and 0.56 +/- 0.10 days in patients with AMI (P less than 0.05). In line with histologic and enzymatic findings in skeletal muscle of long distance runners as reported by other workers, our kinetic data provide further evidence that CK and CKMB are released from muscular compartments in runners other than those in patients with AMI.

Creatine kinase and MB-fraction after a long distance race.

In 18 well-trained athletes creatine kinase (CK) and the CK-MB isoenzyme were measured immediately after a 100 km race and 10 days later for control purposes. The CK was 1970 +/- 1505 U/l (mean +/- SD, range 481--5558 U/l) after the race and 50 +/- 23 U/l on the control day (p less than 0.001). The CK-MB fraction was 72 +/- 70 U/l (range 14--228 U/l) and 8.6 +/- 2.3 U/l (p less than 0.01). The ratio CK-MB/CK was 3.4 +/- 1.1% and never exceeded 6%. The study indicates that elevated CK and CK-MB are a common finding after a long distance race. CK-MB/CK ratios up to 6% may be observed.