Clin Chem Lab Med
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In severely ill patients low concentrations of the corticosteroid binding globulin are typically found; the aim of this study was to quantify directly free bioactive cortisol concentrations in the sera of postoperative cardiosurgical patients. Serum samples of 12 consecutive patients undergoing aortocoronary bypass surgery taken preoperatively and on the postoperative days 1 to 4 were analyzed. Total serum cortisol was quantified using liquid chromatography-tandem mass spectrometry with an on-line sample extraction system and tri-deuterated cortisol as the internal standard, and free serum cortisol was measured after over-night equilibrium dialysis. ⋯ On the fourth postoperative day, median free cortisol was still significantly increased compared to baseline sampling (p < 0.05), whereas median total cortisol was not. A median of 5.7% (IQR 5.4-7.0%) of total cortisol was found as free cortisol on the preoperative day, 21.2% (IQR 18.9-23.5%) on the first postoperative day and 10.5% (IQR 9.8-14.0%) on the fourth postoperative day. It is concluded that during the postoperative period the free-to-bound ratio of cortisol is highly variable and that during the acute phase response direct quantification of free bioactive cortisol concentrations seems to be biologically more appropriate than the measurement of total cortisol concentrations.
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Comparative Study
Diagnostic value of various urine tests in the Jordanian population with urinary tract infection.
We compared the performance of leukocyte esterase and nitrite reductase dipstick tests with microscopic examination and uroculture in cases with clinically suspected urinary tract infection (UTI). We studied urine specimens from 504 Jordanian patients which were obtained by the mid-stream clean catch method and analyzed for bacteria. All samples were subjected to culture. ⋯ The probability of growing a urinary pathogen correlated with urinary WBC counts and allowed prediction of the presence or absence of bacteriuria by counting urinary leukocytes. A combination of pyuria and urine dipstick testing appears to be a very useful marker for the diagnosis of UTI. Urine culture can be omitted if both tests are negative.
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Most equations used for calculation of the base excess (BE, mmol/l) in human blood are based on the fundamental equation derived by Siggaard-Andersen and called the Van Slyke equation: BE = Z x [[cHCO3-(P) - C7.4 HCO3-(P)] + beta x (pH -7.4)]. In simple approximation, where Z is a constant which depends only on total hemoglobin concentration (cHb, g/dl) in blood, three equations were tested: the ones proposed by Siggaard-Andersen (SA), the National Committee for Clinical Laboratory Standards (NCCLS) or Zander (ZA). They differ only slightly in the solubility factor for carbon dioxide (alphaCO2, mmol/l x mmHg) and in the apparent pK(pK'), but more significantly in the plasma bicarbonate concentration at reference pH (C7.4HCO3-(P), mmol/l) and in beta, the slope of the CO2-buffer line (mmol/l) for whole blood. ⋯ Over the whole range of base excess (-30 to +30 mmol/l) and PCO2 (12 to 96 mmHg), mean accuracy (deltaBE, mmol/l) was greatest in the simple equation according to Zander and decreased in the following order: +/-0.86 (ZA); +/-0.94 (ZA, r(c)); +/-0.96 (SA, r(c)); +/-1.03 (NCCLS, r(c)); +/-1.40 (NCCLS); +/-1.48 (SA); and +/-1.50 (pK'). For all clinical purposes, the Van Slyke equation according to Zander is the best choice and can be recommended in the following form: BE= (1 -0.0143 x cHb) x [[0.0304 x PCO2 x 10pH-6.1-24.26] + (9.5+1.63 x cHb) x (pH -7.4)] - 0.2 x cHb x (1-sO2), where the last term is a correction for oxygen saturation (sO2). Hence, base excess can be obtained with high accuracy (<1 mmol/l) from the measured quantities of pH, pCO2, cHb, and SO2 in any sample, irrespective of whether venous or arterial blood is used.
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The objective of this study was to establish reference intervals for thyroid stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyronine (TT4) and total triiodothyronine (TT3) on the Architect i2000 analyser (Abbott). Serum samples were obtained from apparently healthy adults (n=217, age 18-90 years) excluding individuals taking oral contraceptives or under hormone replacement therapy. The second group were ambulatory euthyroid patients (n=323) excluding those with a history of thyroid disorders. ⋯ For FT4 and TT4 no consistent pattern of correlation with age was detectable when the three study groups were analysed independently. The reference intervals for thyroid hormones determined in this study differ considerably from values found in other European and non-European countries. This underlines the need for population-specific reference ranges.