Comparison of urine dipsticks with quantitative methods for microalbuminuria.

We describe a new dip- and read dipstick that detects urine albumin at concentrations of 10 mg/l and above and urine creatinine at concentrations of 300 mg/l and above. The albumin assay is based on a high-affinity, dye-binding technique while the creatinine assay is based on the peroxidase-like activity of copper creatinine complexes. With these two-test dipsticks, urines from normal adults supplemented with albumin and creatinine were correctly identified to within +/- 15% of the expected value for both analytes; the between-day coefficients of variation ranged from 7.1% to 16.1%. We tested 275 patients' unmodified urines by the Bayer and Boehringer Mannheim Micral-Test albumin dipsticks and for albumin with the Beckman Array on the same specimens. We also analyzed 42 selected urines from the group of 275 for albumin by another quantitative immunochemical method and by electrophoresis plus a total protein method to estimate the albumin concentration. The quantitative immunochemical methods appear to underestimate the urine albumin concentrations; in these 42 urines measured as negative, i.e., < ca. 16-20 mg/l, by one of the quantitative method but positive by the Bayer dipstick, 33 of these were positive by the electrophoresis/total protein assay combination. The Bayer albumin dipstick correctly identified urines as having < 16 mg/l or > or = 16 mg/l at an 80% rate. At a cutoff of 20 mg/l, the rate increased to 87%. We also determined the urinary albumin/creatinine ratios on the 275 patients using the Bayer two-pad dipstick and found agreement 84% of the time with the same ratio obtained from a quantitative immunochemical method for albumin and a rate-Jaffe method for creatinine; an albumin/creatinine ratio (mg/g) of 30 was used as the discrimination point. Albumin stability studies performed on the Beckman Array patients with six fresh urines showed small but consistent decreases at -20 degrees C but not at 4 degrees C after one month of storage. The albumin in contrived urines, as estimated by electrophoreses/total protein and by the dipsticks did not change at these storage conditions. Boric acid at 1 g/l as a urine preservative had no effect on the measurement of albumin by any of the methods described here nor of the assay of creatinine. Other urinary proteins present at abnormal excretion rates did not interfere with the Bayer albumin dipstick. Abnormal concentrations of bilirubin, citrate, creatine, ascorbic acid, albumin, hemoglobin and myoglobin in urine did not interfere with the creatinine dipstick measurements. The first four of the above did not affect the Bayer dipstick results for albumin.

Communication disorders: what to look for, and when to refer.

Communication impairments, with or without a swallowing disorder, are common among older adults. Aphasia, which is usually caused by a focal lesion, can affect spoken and written language, auditory comprehension, and reading ability but by itself does not affect intellectual and cognitive abilities. A cognitive-communicative impairment is related to underlying cognitive deficits in memory, attention, or visual perception and is seen with traumatic brain injury and nontreatable dementia. Voice and speech impairments such as dysarthria and apraxia of speech may lead to self-imposed social isolation and depression. Dysphagia may accompany a communication disorder or exist independently. As a primary care physician, your in-office workup can help diagnose a communication disorder and identify candidates for referral to an otolaryngologist and/or speech-language pathologist.

Nature of spelling errors in transcortical sensory aphasia: a case study.

The nature and extent of spelling errors in a patient with transcortical sensory aphasia were investigated. The two experimental conditions required the patient to spell monosyllabic and polysyllabic words both verbally and in written form. Analysis of the spelling errors revealed partially preserved knowledge of the visual image of a word as a whole, as well as preserved knowledge of temporal order. Our patient's error patterns in both conditions were more similar than dissimilar. These findings in conjunction with results reported in the literature indicate that patients exhibiting different aphasia syndromes use separate spelling strategies.

Plasma phenylalanine: tyrosine ratios during high-dose methotrexate-citrovorum "rescue".

We have measured phenylalanine and tyrosine in the plasma of patients with osteogenic sarcoma undergoing chemotherapy with high-dose methotrexate (HDMTX) citrovorum factor rescue (CFR). During 14 treatments in six different patients, the phenylalanine to tyrosine ratio (PHE/TYR) at 21 to 38 hours was elevated over pretreatment levels. The observed increase in plasma phenylalanine is attributed to inhibition by MTX of the phenylalanine hydroxylase system of the liver, which is not folate-dependent and thus is not corrected by administration of CV. A post-infusion increase in PHE/TYR of 571% after 22 hours in one patient and of 410% after 30 hours in another were associated with marked MTX toxicity. The greatest increase in PHE/TYR seen in a patient who did not experience toxicity was was 249% in 21 hours. Thus, in this group of patients, there appears to be a correlation between evidence of clinical MTX toxicity and the magnitude of the percentage increase in PHE/TYR in the plasma, which indicates inhibition of a liver enzyme and thus reflects the intracellular concentration of MTX.

The significance of isolating low numbers of mycobacterium tuberculosis in culture of sputum specimens.

Because fewer than five Mycobacterium tuberculosis colonies were isolated from single sputum specimens from several patients with little clinical evidence of pulmonary tuberculosis, we reviewed all of our low colony isolates (LCIs) from an 18-month period. Thirty-one patients had 35 LCIs and were separated easily into groups that either appeared to have tuberculosis by clinical criteria or appeared to be uninfected. Patients in the "tuberculosis likely" group reasons such as concurrent antituberculosis therapy or an interstitial location of their pulmonary lesion to account for their LCIs. In contrast, patients in the "tuberculosis unlikely" group were all culture-negative when reevaluated two to four months after their first culture, and they had no evidence of tuberculosis on chest x-ray film despite having received no antituberculosis therapy. Half had negative tuberculin reactions, without generalized anergy. Epidemiologic study showed that most had been cultured the same day as patients with smear-positive tuberculosis, and the possibility of cross-contamination was investigated.