A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
(3) Calcium Oxalate.--Characteristic of calcium oxalate are colorless,
glistening, octahedral crystals, giving the appearance of small
squares crossed by two intersecting diagonal lines--the so-called
"envelop crystals" (Fig. 47). They vary greatly in size, being
sometimes so small as to seem mere points of light with medium-power
objectives. Unusual forms, which, however, seldom occur except in
conjunction with the octahedra, are colorless dumb-bells, spheres, and
variations of the octahedra (Fig. 34). The spheres might be mistaken
for globules of fat or red blood-corpuscles. Crystals of calcium
oxalate are insoluble in acetic acid or caustic soda. They are
dissolved by strong hydrochloric acid, and recrystallize as octahedra
upon addition of ammonia. They are sometimes encountered in alkaline
urine.
[Illustration: FIG. 34.--Various forms of calcium oxalate crystals
(Ogden).]
The crystals are commonly found in the urine after ingestion of
vegetables rich in oxalic acid, as tomatoes, {107} spinach, asparagus,
and rhubarb. They have no definite significance pathologically. They
often appear in digestive disturbances, in neurasthenia, and when the
oxidizing power of the system is diminished. Like uric acid, their
chief clinical interest lies in their tendency to form calculi, and
their presence in fresh urine, together with evidences of renal or
cystic irritation, should be viewed with suspicion, particularly if
they are clumped in small masses.
(4) Leucin and Tyrosin.---Crystals are deposited only when the
substances are present in considerable amount. When present in smaller
amount, they will usually be deposited if a drop of the urine be
slowly evaporated upon a slide. They generally appear together, and
are of rare occurrence, usually indicating severe fatty destruction of
the liver, such as occurs in acute yellow atrophy and
phosphorus-poisoning.
The crystals cannot be identified from their morphology alone, since
other substances, notably calcium phosphate (Fig. 38) and ammonium
urate, may take similar or identical forms.
_Leucin crystals_ (Fig. 35) are slightly yellow, oily-looking spheres,
many of them with radial and concentric {108} striations. Some may be
merged together in clusters. They are not soluble in hydrochloric acid
nor in ether.
[Illustration: FIG. 35.--Leucin spheres and tyrosin needles
(Stengel).]
_Tyrosin_ crystallizes in very fine colorless needles, usually
arranged in sheaves, with a marked constriction at the middle (Fig.
35). It is soluble in ammonia and hydrochloric acid, but not in acetic
acid.
[Illustration: FIG. 36.--Cystin crystals from urine of patient with
cystin calculus (X250).]
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