Treatment of bone weakness in patients with femoral neck fracture by fluoride, calcium and vitamin D.

Twenty-three of 46 patients, aged 56 to 95 years, with fracture of the femoral neck (FNF) completed the first trial of 10 months treatment with oral sodium fluoride 60 mg and calcium 1800 mg on alternate days and 1 micrograms of vitamin D1 daily. Pre-treatment and post-treatment biopsy specimens and microradiographs of the iliac crest and metacarpal and spinal radiographs were evaluated together with biopsy material from seven untreated age-matched controls with FNF. In 17 patients the treatment improved the amount and quality of trabecular bone. Cortical thickness increased in nine patients and there were no losses of amount or mineralisation. The treatment was well tolerated by most patients and there were no major side-effects or signs of bone demineralisation. The study also revealed an unexpected rapid post-fracture deterioration of bone tissue in untreated FNF patients; thus there is an increased risk of further fractures which calls for the use of an effective treatment to increase bone mass.

Cytologic bile examination in the diagnosis of biliary duct neoplastic strictures.

Cytodiagnosis of the bile is not frequently thought of as a method of obtaining a histopathologic diagnosis of the cause of a neoplastic biliary duct stricture. However, cells surrounding the biliary ducts are continuously exfoliated into bile and become available for cytologic examination whenever bile is collected. Nineteen patients with obstructive jaundice are reported. In seven of 15 with neoplastic biliary duct strictures, cytodiagnostic examination showed tumor cells. There were no false-positive results. The sensitivity of bile cytodiagnosis in this series was 47%, its specificity was 100%, and its accuracy was 58%.

Toxoplasmosis presenting as brain abscesses. Diagnosis by computerized tomography and cytology of aspirated purulent material.

A patient with brain abscesses caused by Toxoplasma gondii is described. Presence of brain abscesses was confirmed by computerized tomography, and T. gondii was identified as the etiologic agent in cytologic preparations of aspirated purulent material from one of the abscesses.

The cytodiagnosis of malignant lymphomas and Hodgkin's disease in cerebrospinal, pleural and ascitic fluids.

One hundred twenty-six fluids from 98 patients with malignant lymphomas have been examined cytologically. The overall accuracy was 88 per cent with only one false positive in 126 fluids. False negatives were highest in the cerebrospinal fluid, which may reflect poor exfoliation of malignant lymphoma cells when the leptomeninges are involved. We have found exfoliative cytology to be an accurate method of diagnosing lymphomatous involvement of the leptomeninges, pleura and peritoneum and when a cytologic diagnosis of involvement by lymphoma is made it is almost as accurate as a histologic diagnosis. Nuclear characteristics and selected histochemical methods will allow classification of many types of lymphoma in bytologic preparations.

Cytology of the cerebrospinal fluid in patients with Hodgkin's disease or malignant lymphoma.

The cerebrospinal fluids (CSF) of 18 patients with Hodgkin's disease and 33 patients with malignant lymphoma were evaluated for the presence of malignant cells. The CSF cytology was correlated with the neuropathologic findings at surgery or autopsy. In the 51 patients included in the study there were seven false-negative CSF cytodiagnoses. Methods to improve detection in the false-negatives will be discussed. There were two false-positives. Explanations for the two false-positive cytodiagnoses will be presented. It is concluded that cytological examination of the CSF in patients with Hodgkin's disease and malignant lymphoma is a useful and reliable diagnostic tool.