In a pediatric and in an adult group of patients with hematuria and normal creatinine clearance overnight urine examination was carried out on 2 nonconsecutive days by means of phase contrast microscopy by two independent observers working in two different institutions. In this way it was possible to distinguish between patients on the basis of dysmorphic (glomerular) and isomorphic (nonglomerular) red cells in urine and to correlate the findings with the final diagnosis. A clear-cut indication (more than 80% of isomorphic and/or dysmorphic red cells) was obtained in 163 patients (102 of pediatric age) and final diagnosis of hematuria correlated with red-cell microscopy findings in 96.4% of glomerular diseases and in all cases of nonglomerular origin. Mixed hematuria (50–75% of dysmorphic red cells) was found in 2 cases of renal tuberculosis, 2 cases of polycystic kidney disease and in 1 child with viral meningoencephalitis with a bladder stone. The data indicate that the method is safe and accurate but further experience must be gathered for the many etiologies of glomerular and nonglomerular diseases hitherto not studied.

The incidence of the tumor markers was studied in 140 patients aged between 18 and 84 years who had been on dialysis for 4–188 months. Neuron-specific enolase increased in 81 cases, CA-50 carbohydrate antigen in 44, while α-fetoprotein was within the normal range. Carcinoembryonic antigen (CEA) with 2 monoclonal assays was increased in 7 cases. When polyclonal assays were used, CEA was found to be elevated in 12 cases with one set and in 72 cases with another kit set. The data point (1) to the potential usefulness of these markers for the detection of malignancy and possibly neuropathy in uremia; (2) to the importance of renal tubules in the metabolism of proteins, glycoprotein and peptides, and (3) to the activation/inhibition in various enzyme systems in the uremic state.

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Abstract. The effect of an acute protein load (2 g kg‐1bodyweight [BW]) was studied in nine type 1 diabetic children. Patients were maintained on two different dietary regimens. In study one, patients were on a high protein diet providing from 2.7 to 1.8 g of protein/kg of BW per day. In study two, patients were reevaluated after three weeks of a diet providing from 1.0 to 1.2 g kg‐1 of BW per day of protein. In study one (High Protein Diet), we failed to observe any rise in GFR and RPF following the protein meal (137 ± 21 basal vs. 110±14 and 472±93 basal vs. 494±93 ml/1.73 m2 of SA min‐1 at 60 min. This is in contrast with results from seven age matched controls consuming a free diet, which showed a significant rise in both GFR and RPF. In study two (low protein diet), basal GFR was significantly reduced. However after the protein load, both GFR (92±11 vs. 126±18 ml/1.73 m2 of SA min‐1) and RPF (467±83 vs. 705±102 ml/1.73 m2 min‐1) rose significantly (P<0.05 vs. basal). The data indicate that: 1 short term protein restriction reduces significantly GFR in type 1 diabetic children; 2 diabetic children maintained on an high protein intake show an altered haemodynamic response to protein ingestion; 3 a normal response to protein ingestion can be restored by short term dietary protein restriction.

LIMITATIONSColonoscopy subjects the patient to inconvenience and some discomfort. It is time-consuming for the operators and occupies x-ray facilities for long periods, though we estimate that even in the most difficult cases we have used under 45 seconds of screening time. The instrument is costly, requires careful maintenance, and is subject to wear and tear which may lead to damage of the fibre bundle or of the mechanical parts. For these reasons it seems likely that colonoscopy will be a specialist service provided in a few centres. Examination of the whole colon is not to be recommended as an occasional procedure for those with a limited interest in endoscopy.We wish to thank Sister B. Quaid for her skill in preparing the patients and are indebted to Dr. A. C. Young, Mr. A. G. Parks, and Dr. J. E. Lennard-Jones for their advice and support. References 1 Dean, A. C. B., and Shearman, D. J. C., Lancet, 1970, 1, 550. 2 Salmon, P. R., Branch, R. A., Collins, C., Espiner, H., and Read, A. E., Gut, 1971, 12, 729. 3 British Medical Journal, 1972, 3, 281-282 Haematoma of the rectus abdominis muscle has been mistaken for a variety of abdominal lesions and only about one in five cases is correctly diagnosed. They usually occur at the site of anastomosis of the superior and inferior epigastric arteries. The main symptom is severe abdominal pain of sudden or gradual onset. Nausea, vomiting, fever, and prostration may be present, and a tender, fixed mass can usually be felt in the abdominal wall, which is guarded or rigid. Discolouration of the skin over the lesion is a rare and late sign.Factors commonly causing or predisposing to haematoma of the rectus abdominis muscle are listed in the Appendix. We report here four cases in which the condition was seen in patients undergoing either peritoneal dialysis or haemodialysis, and we believe this is the first time such an association has been recorded. Case 1The patient was a 45-year-old woman who had been undergoing haemodialysis for 15 months. She had persisting ascites due to constrictive uraemic pericarditis which had developed before she started dialysis. Owing to a septicaemia from infection of her shunt with Pseudomonas aeruginosa a Cimmino-Brescia arteriovenous fistula had been made one month previously.Before cannulating the fistula preparatory to haemodialysis the patient's blood pressure, pulse, respiration, and temperature were found to be normal. The abdomen was moderately distended owing to ascites, and the spleen was palpable two finger-breadths be!ow the left costal margin. Haemodialysis was started with R.S.P. Travenol equipment. Heparin 5,000 U was given as a priming dose followed by 600 U hourly. After five hours she complained of sudden, left-sided abdominal pain, especially under the costal margin. On examination the abdominal wall felt turgid and there was tenderness and guarding. A mass occupied the left upper quadrant, and splenic thrombosis was suspected. Dialysis was discontinued and protamine given to counteract the effect of heparin. ...