[The clinical chemistry findings].
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Biomedical subjects
Publications and source records attributed to K Rommel.
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Specific pathogen free guinea pigs were treated with varying dosis of fluocortolone for 15 days. The treated animals showed the same per cent weight gain as the controls. The total hydroxyproline content of the skin and the hydroxyproline content in different collagen fractions was the same in treated and untreated animals. Thus fluocortolone seems to have no specific effect on the synthesis or the breakdown of collagen in the guinea pig skin. Also the physical development of the animals, kept under defined conditions, failed to show a catabolic effect of of fluorcortolone.
Parameters of collagen metabolism were investigated in guinea pigs, both untreated and treated with glucocorticoids. One series consisted of animals housed under normal conditions, the others of SPF animals from the same strain. There are marked differences in certain parameters, including the hydroxyproline content and the reaction of the collagen to glucocorticoids.
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In a workshop conference of the German Society for Clinical Chemistry, clinical chemical parameters, which are important in preventive medicine, were discussed for three common diseases, diabetes mellitus, gout and chronic liver diseases. In addition the analytical and diagnostic reliability was evaluated for each of these parameters.
Widely used methods in diagnostical and experimental gastroenterology like measuring the protein-and DNA-content and the activity of alkaline phosphatase and sucrase of intestinal mucosa were adapted to a microliter system and partly automatized. With "artificial" control material a system for statistical quality control was established. Lastly the results on up to three years experience with this control system were presented showing an imprecision within run below 5% and an in-imprecision between run below 8% in all methods.
A screening study for coronary disease, chronical bronchitis, diabetes mellitus, hypertension, peripheral circulatory disturbance and overweight is described. 2429 persons aged over 40 years and working in two factories were studied. Typical laboratory tests, a short standardised examination by a physician and a questionnaire were used. In a 10 per cent sample the questionnaire was repeated by an interview and the serum was sent to the laboratory not only by mail, but also by a special car transport in a cooled transport box. The results of the laboratory tests are presend according to age, sex and factory. The family doctor had to be informed in nearly 70 per cent of the men and about 60 per cent of the women because of at least one suspicious symptom or sign. There was a pathological value of glucose in the urine in 14.7 per cent, a rise of glucose in the blood (above 113 mg per cent) in 5.7 per cent, of triglicerides (above 181 mg per cent) in 12.6 per cent, of cholesterol (above 264 mg per cent) in 15.4 per cent, of uric acid (male above 7.7 mg per cent, female above 7.1 mg per cent) in 6.8 per cent, of creatinine (above 1.3 mg per cent) in 6.4 per cent and the presence of albumin in urine in 2.2 per cent of the cases.
The exactitude of some widely used laboratory tests (triglycerids, cholesterol, glucose, uric acid, creatinine) is examined in a situation relevant for practising physicians. Different statistical methods for reporting errors are compared. Accuracy and precision are useful measures for the quality of analytic procedures. They are not sufficient for medical judgement for a single patient, since sampling procedures, type of sample or transport and storage of sample are not considered in accuracy and precision. Such sources of error can largely devaluate the quality of accuracy and precision and of the analytic procedures. Error coefficients are proposed as a new method of reporting laboratory errors. The mathematical model starts with an analysis of variance and total error, technical error and transport error are defined. The study shows that the error introduced by transporting serum via postal service compared to that conveyed in a cooled transport box by a special car is considerable. It is nearly impossible for a physican to use single laboratory value for a rational decision "normal-not normal" if the values are based on samples which are sent by postal service and if the values lie in the broad borderline between the normal and pathological area. This is especially true for creatinine (transport error 47.0 per cent) and uric acid (transport error 38.7 per cent), but not so much for cholesterol (22.9 per cent), triglicerids (14.3 per cent) and glucose (13.3 per cent). Variables with high transport error like creatinine should not be used in screening programs, as long as the transport is made by postal service and the method is not improved. The agreements between the answers of a questionnaire and of an interview are analysed with the same patients (n=235). These agreements lie between 98.7 per cent and 61.7 per cent depending on the single question. The exactitude of medical questionnaires is in the same size order as the exactitude of laboratory tests-at least when the sample is sent by postal service.
In the preceding articles a preventive screening model in two factories was described, the results were given and the exactitude of laboratory tests presented. In this paper the relations are studied between all the observed variables. Contingency-tables and the x2-statistic are used. For the 57 observed variables-(laboratory variables, e.g. triglicerides, cholesterol, glucose, uric acid, creatinine and questionnaire-items designed to screen for angina pectoris, myocardial infarction, claudicatio intermittens and bronchitis)-all possible contingency tables between two variables were calculated (1596 tables). The significant connections are reported in form of a hypothesis-matrix. There exists no statistical correlation between laboratory tests and questionnaire-items. The anamnestic questionnaire cannot be replaced by laboratory tests and vice versa. Nearly all items of the questionnaire are correlated. There are some correlations between laboratory tests, blood pressure and smoking habits.
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Fourteen non-diabetic male patients undergoing partial gastrectomy for ulcer disease were investigated with oral glucose tolerance test using a 100 g mixture of oligosaccharides. Partial gastrectomy had been performed between 1 and 3 years ago. Compared to seven healthy male control subjects, patients had significant higher blood glucose levels at 30 and 60 min and a more rapid descent, so that at 120 and 180 min no differences were found between patients and control subjects. With the usual criteria (blood glucose levels at 120 and 180 min) the non-diabetic patients with partial gastrectomy showed normal test results.
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The influence of the bacterial flora of the intestine and of cytostatic drugs on the intestinal xylose and glucose absorption in the rat is studied by a perfusion technique in vivo. Conventional, germfree and decontaminated animals show no different xylose absorption rates while the galactose absorption is decreased in germfree and decontaminated animals compared to conventional rats. Three days after a single injection of cytostatic drugs the xylose absorption is diminished in conventional and decontaminated animals compared to untreated rats. In germfree rats no effect of cytostatics on the xylose absorption can be proved. The galactose absorption is unchanged after cytostatics in conventional and decontaminated animals, but increased in germfree rats.