Some faults with external and internal quality control programs.
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Biomedical subjects
Publications and source records attributed to D B Tonks.
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A colorimetric method is described for determining total serum iron and unsaturated iron binding capacity (UIBC) of serum using Technicon AutoAnalyzer II equipment. The determination of UIBC has been fully automated by means of a simple modification to the Sampler II module, whereby 2 double probes permit the simultaneous aspiration of a sample and of a measured volume of the iron saturating solution. No manifold changes are needed when changing from serum iron to UIBC.
A rapid, semi-automated method for determining hexoses which are bound to components of whole blood; e.g., hemoglobin, is described. The method is an improvement on similar lengthy manual methods (1,2) in which 5-hydroxymethylfurfural is produced and measured. Heating of diluted blood samples at 15 lb./sq.in. above atmospheric pressure in a pressure cooker for 20 minutes is shown to give the same results as those obtained with other methods in which 2-5 hours heating at atmospheric pressure is specified (1,2,3). The trichloracetic acid precipitation step needed in the manual methods is avoided by continuous flow dialysis on a Technicom Auto Analyzer II system. Various experimental factors have been studied and comparisons made with a commonly-used ion-exchange resin column technique. Two different methods of calibration, one using pure 5-hydroxymethylfurfural standards, and the other using patients' samples with pre-determined, known values as standards, are presented.
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A revised automated method was used to determine ascorbic acid in one hundred random patients' serum samples, and a range of concentrations between 0.7--2.5 mg/dl (0.040--0.141 mmol/L) was found. Volunteers taking a 2000 mg dose of ascorbic acid orally were found to have attained serum levels of ascorbic acid less than 2.8 mg/dl (0.159 mmol/L) in a period of 120 minutes. Five and ten mg of ascorbic acid or its oxidation products were added to 100 ml of pooled serum and the following components were estimated on our SMA 12/60: calcium, inorganic phosphorus, glucose (Trinder), urea, uric acid (phosphotungstate), total protein, albumin (BCG), total bilirubin, cholesterol (enzymatic), alkaline phosphatase, LDH (UV), and SGOT (UV), as well as glucose on a separate Technicon AA-II analyzer (ferricyanide method). With the 10 mg amounts the following analyses were found to be influenced significantly: glucose (Trinder), glucose (ferricyanide), uric acid, cholesterol and total bilirubin; the last of these by the oxidation products only. However, deviations produced for all but one of these tests were less than their allowable limits of error and were therefore considered to be clinically insignificant. The exception was the enzymatic glucose method of Trinder which was sensitive to a plasma ascorbic acid level as low as 2.0 mg/dl (0.114 mmol/L).
The crystallographic method of Prien and Frondel for the qualitative analysis of renal calculi has been employed for seventeen years. The method was supplemented by occasional chemical tests. Advantages of the crystallographic method over other procedures are the ability to identify specific minerals even in trace amounts, the capability to analyse very small stones, and the rapidity with which analyses can be performed. Data are presented for 1653 calculi.
We assessed the reported presence of creatine kinase-BB isoenzyme in the serum of patients with chronic renal failure. Our study showed that the blood of these patients contains a fluorescent material with an electrophoretic mobility similar to that of the BB isoenzyme on cellulose acetate strips. The fluorescing material is, however, completely distinct from BB isoenzyme and its nature is as yet undetermined.
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The levels of glycosylated hemoglobin (GlHb), fasting plasma glucose (FPG), urine glucose, serum triglycerides, cholesterol, and HDL-cholesterol were monitored in several hundred patients attending an adult diabetic clinic. Thirty-five percent of the patients were being treated with insulin, 30% with diet alone, and 20% with sulfonylurea. Therapy was changed during the study in the remaining 15%. The levels of GlHb and FPG were significantly lower in the patients treated with diet alone than in the other groups. The overall coefficient of correlation (r) between FPG and GlHb was 0.64, with the highest r (0.70) for the diet group and the lowest r (0.55) for the insulin group. A follow-up study showed that in about 50% of the patients GlHb and FPG levels changed in different directions from one visit to the next. The absence of glycosuria was noted in two-thirds of the patients, while in 78% of the patients GlHb values were above the normal range. A weak but positive correlation was found between GlHb and serum triglycerides and cholesterol. There was no significant correlation between GlHb and HDL-cholesterol. The HDL-cholesterol levels were significantly lower in male than in female diabetic subjects, but no significant difference was found between the diabetic and nondiabetic subjects of the same sex. The results of this study suggest that (1) although there is a positive correlation between GlHb and FPG, the two tests cannot be used interchangeably in the evaluation of diabetic control; and (2) in the majority of the patients the absence of glycosuria tends to create the false assurance of satisfactory blood glucose control.
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