Improvement of human tumor cloning assay by suspension of fibroblasts into the bottom layer of agarose.

Twenty-nine human tumors were cultured on a soft agarose cloning assay under three conditions: (1) standard (control); (2) standard with varying numbers of mitomycin C-treated 3T3 Swiss mouse embryonic fibroblasts suspended into the bottom layer of agarose; and (3) standard with varying concentrations of conditioned medium derived from those same fibroblasts. Suspension of 1 X 10(5) fibroblasts into the bottom layer of agarose was found to significantly increase the number of colonies formed over control specimens, as did cultures with 30% conditioned medium. In addition, compared with control, both of these techniques increased the number of specimens which would allow optimal vitro chemotherapy sensitivity testing. Specifically, growth of at least 30 colonies per plate increased from 7% of specimens treated under control conditions to 36% and 52% of specimens treated with 30% conditioned medium and 1 X 10(5) fibroblast-supplemented agar, respectively. This data indicate that 3T3 Swiss mouse fibroblasts improve cloning efficiency when suspended in the bottom layer of agarose or when used to produce conditioned medium. As a consequence, these techniques may permit a better opportunity to define the role of the cloning assay for cancer chemotherapy.

Acute epiglottitis in the adult.

Acute epiglottitis may be fatal when diagnosis is delayed. The literature stresses data that does not help to predict impending airway obstruction in patients who present with a sore throat, the most consistent presenting symptom among patients with acute epiglottitis. In this review of 80 cases of epiglottitis in adults, almost all patients who presented within eight hours from onset of symptoms required airway intervention, while the majority of those who presented more than eight hours after onset of symptoms never developed acute upper respiratory obstruction and were treated medically or had supportive treatment only. Artificial airway was indicated in all patients who had drooling. There were no fatalities in this series, however, we recommend keeping all patients with acute epiglottitis in an intensive care unit for at least 24 hours after admission.

Combined therapy for stage III-IV head and neck cancer: preliminary results.

As part of a combined modality treatment program using chemotherapy, surgery, and/or radiotherapy, 25 patients with previously untreated stage III or IV head and neck cancer received initial combination chemotherapy. Pathologically confirmed complete remission was noted in nine patients (36%). The overall objective major response rate (with all patients included in analysis) was 68%. The chemotherapy regimen included bleomycin, cisplatin, vinblastine, methotrexate, and 5-fluorouracil. A novel concept of drug scheduling was used, based on chemotherapy-induced improvement in RBC deformability. The underlying concept is that improved RBC deformability results in improved capillary blood flow and thereby, increased drug delivery to tumor cells. Treatment resulted in moderate hematologic and renal toxicity with no treatment-related deaths. This exceptionally high, pathologically confirmed complete response rate will hopefully provide a mechanism by which combined modality therapy can adequately be tested for its ability to prolong survival of patients with advanced head and neck cancer.

Actinomycotic osteomyelitis of the facial bones and mandible.

Actinomyces israelii is a part of the human oral flora and thus is more commensal than pathogenic. Oral trauma, accidental or purposeful, can precipitate its introduction into the soft tissues, to which infection is usually confined. The case presented is one in which, over a span of two decades (1956 to 1977), the extraction of a mandibular tooth resulted in a chronic actinomycotic osteomyelitis, destroying first the mandible, then both maxillae, and then the right zygoma, with decreased vision and proptosis despite repeated medical and surgical intervention. Adequate treatment required removal of the sequestrum and excision of all infected granulation tissue, scars, and involucra until healthy bone was exposed. Intravenous penicillin was administered for 2 weeks, followed by a 6-month course of oral penicillin. The patient was followed for 4 years and remained disease free.