The examination of the urinary deposit has long been accepted as a useful procedure in the diagnosis of renal disease. As usually performed, however, the value of the information that it affords is limited by the inaccuracy of the method employed, since the deposit derived from the untimed random sample of urine is not susceptible of quantitative study. This latter is essential, for example, in the diagnosis of chronic pyelonephritis, in which it is well known that, at least until renal destruction has become gross and renal failure is at hand, the urinary deposit is commonly small and inconstant. Repeated cultures may be necessary before a growth is obtained.In the course of an investigation of pyelonephritis we employed a method more sensitive than usual for the culture of urinary deposits, and, since this inevitably might have increased the frequency with which contaminant or saprophytic organisms appeared, we felt it necessary to check the significance of our cultural methods by attempting to correlate them with an accurate count of the cells excreted in the urine.The best-known method of quantitative estimation of the constituents of the urinary deposit is that of Addis (1925). This, however, seemed to us to suffer from various disadvantages. The method makes it necessary for female subjects, who have to be catheterized, to hold their urine for 12 hours. Moreover, the time over which the urine is collected allows a proportion of the cells in the urine to break up: this point is discussed below. Finally, the number of elements actually counted by the Addis technique is so small that it is multiplied by a factor of one million in order to arrive at the presumed excretion rate; errors of sampling and of counting thus figure largely in the final result.More recently, Rofe (1955) has described a method in which the leucocytes and epithelial cells excreted in the urine are counted after staining. We considered this method to be rather too elaborate to be suitable for routine use. It is the purpose of this paper to present a reliable, simple, and rapid method of counting the leucocytes and non-squamous epithelial cells in the urine. Although the primary purpose of this paper is to report the cell excretion in normal subjects, a few counts obtained from patients with renal infection are included. Of these patients those with the lower cell counts had deposits which by the usual method of examination showed little or no deviation from normal.The cellular excretion rates were determined as follows. The subject emptied the bladder as completely as possible and the time was carefully noted. Three to four hours later, the time again being noted, the bladder was emptied by catheter in the female, and naturally in the male, avoiding preputial contamination. No restrictions were placed on fluid intake, but diuretics were not given. The specimen obtained was measured, and within two hours of collection it was thoroughly shaken. Precipitated phosphates were dissolved by adding a few drops of glacial acetic acid, and 10 ml....
1. A case of auto-immune hemolytic anemia complicated by megaloblastic erythropoiesis is described. The possible mechanism is discussed. 2. The direct Coombs test is a useful adjunct in the diagnosis of megaloblastic anemias.
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