Cytodiagnostic urinalysis was tested to determine its utility in the differential diagnosis of acute renal failure (ARF). Fifty-one patients with acute renal failure were included and evaluated clinically with regard to the etiology of the renal failure, whether underlying chronic renal failure was present, and if dialysis was required. Urine specimens were macroscopically examined and subjected to a multiparameter reagent-strip analysis. Papanicolaou stain was done on cytocentrifuge preparations and the number of blood cells, renal cells, and casts examined in a standardized fashion. The results showed that the 34 patients with acute tubular necrosis (ATN) of either ischemic or toxic origin had a higher number of collecting duct cells, and a higher total number of casts than the 17 non-ATN patients. Twelve patients requiring dialysis had a higher number of different types of casts (granular, waxy, leukocytic, broad casts) as well as more renal cells (mainly necrotic) than the 39 patients who did not require dialysis. A significant positive correlation was found between the magnitude of rise of serum creatinine and a number of cytodiagnostic parameters. We conclude that cytodiagnostic urinalysis may be valuable in addition to other tests in the evaluation of patients with acute renal failure.

Pap smear collection devices have been the focus of increasing attention for their perceived role in the reduction of false negative results in Pap smear screening of cervical cancer. New devices are available on the market aimed at improved cellular yield and enhanced cellular preservation. While controversy remains regarding the definition of the "adequate" Pap smear, it has been generally accepted that the adequate Papanicolaou smear consists of a thinly prepared smear which is properly labeled and rapidly fixed. Adequate and relevant patient history should accompany the specimen. The adequate Pap smear should consist of the following: a sufficient number of well preserved epithelial cells that have been collected under direct visualization ' and an endocervical component (defined as either metaplastic cells or endocervical cells) in a premenopausal woman who has a cervix.2Conversely, an unsatisfactory smear is one which does not contain adequate numbers of cells, is poorly preserved or is obscured with inflammatory or hemorrhagic exudate so as to interfere with cytologic interpretation. The Bethesda System format of cervical vaginal cytologic reporting seeks to clearly define what constitutes a satisfactory cervical-vaginal specimen and makes allowances for specimens which may yield valuable information despite problems which may interfere with but not prevent interpreta-Lake City, UT 84117. tion such as air drying artifact, inflammation, or other factors which can be determined by the individual laboratory. The designation "less than optimal" has met with much discussion by the cytologic community and still allows for a great deal of variation between laboratories, a seemingly contradictory goal of the attempt to standardize nomenclature for Pap smear reporting.To date, no one sampling method or collection device has enjoyed universal acceptance or been shown to produce adequate Pap smears in all types of clinical settings and in all patient populations. Previous studies have rated the effectiveness of various sampling devices and made recommendations for decreasing the number of inadequate smears by advocating one particular type of spatula, brush, or other instrument or a combination of devices. MI The cytopathologic interpretation of smears made using the various Pap smear sampling devices requires allowances for artifacts and morphologic changes directly attributable to sampling techniques. Comparative studies and clinical validation must occur as new sampling devices are developed and marketed. Literature accompanying these devices must include details on intended applications, proper use, and contraindications of each sampling device because of the potential for litigation against the manufacturer, the clinician, and the laboratory.This symposium was convened to discuss the following aspects pertaining to Pap smear sampling devices: design rationale, clinical utility, diagnostic and interpretative considerations, and legal implications associated with their use or misuse.The target area of Pap smear sa...

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Urinary cytodiagnostic evaluation was performed on 50 consecutive patients with non‐Hodgkin's lymphomas. In 14 patients (28%) the urine sediment contained characteristic lymphoma cells. The groups with or without a positive urine cytology were comparable with respect to type of lymphoma, stage and course of disease, and recent treatment with chemotherapy. However, those with a positive urine cytology were more likely to have clinical evidence of kidney disease (43% vs 8%), although this was rarely attributed to disseminated lymphoma. In fact, in three patients, a positive urine cytology was the sole or presenting evidence for disseminated lymphoma. Although the groups with or without a positive cytology were similar with regard to physicochemical urinary findings, there were marked differences in the frequency of microscopic abnormalities. All patients with a positive cytology had evidence of renal parenchymal necrosis, renal tubular injury, or pathologic cast formation as compared with only 56% of those with a negative cytology. Thus, urinary cytodiagnostic evaluation may provide an important adjunct in the staging and evaluation of patients with malignant lymphomas.