UMEROUS TYPES OF ADJUVANT CHEMOTHER-N apy are being used on cancer. Of these, 4 are discussed in this paper: (1) systemic administration of the drug at the time of operation, (2) instillation of anticancer agents into the lumen of the colon, (3) intrabronchial cancer chemotherapy, (4) irrigation of wounds with anticancer compounds. SYSTEMIC ADMINISTRATION OF DRUGS AT THE TIME OF OPERATIONMost of our experimental work with the procedure of administering drugs systemically at the time of operation was carried out with nitrogen mustard and thio-TEPA.Experimental data: Utilization of adjuvant chemotherapy in human beings at the time of operation came as the result of animal experiments performed in 1955.4 I n these initial experiments, utilizing nitrogen mustard, 110,000 Walker-256 cells were inoculated into a large mesenteric vein of Sprague-Dawley rats. After one minute the syringe was detached from the needle and a second syringe containing 0.5 mg. of nitrogen mustard per kg. was injected. An equal number of control rats were injected with cancer cells without nitrogen mustard. At the end of 4 weeks both groups of animals were autopsied and the livers examined. In this initial experiment 97.4y0 of the control group of animals developed liver tumors while only 19.4% of the animals receiving nitrogen mustard developed liver tumors.Satisfactory results also were obtained with thio-TEPA, utilizing 110,000 and 220,000 cells injected into the portal vein and intraperitoneally. When the thio-TEPA was injected into the portal vein one minute after 110,000 cells were inoculated intraperitorieally the "takes" in the control animals were 90% compared to 7.1% in the treated animaIs.9 When

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Measures to control both local recurrence and distant vascular spread have been analyzed in depth under 8 major categories. The control of vascular spread is advocated by early distant ligation of the vascular trunks and in right hemicolectomy by starting the dissection in the gastro‐colic area rather than to the right of the ascending colon; the latter should minimize the possibility of dissemination of cancer cells into the systemic circulation. Local spread can be minimized by isolating the tumor segment from the wound and abdomen. Essentials of this technique, which should be a standard part of colon surgery include isolation of the malignant tumor segment, wide excision of the mesentery, irrigation of each lumen of the bowel with distilled water or half strength Dakin's solution, and excision of each end of the bowel crushed by the crushing clamps before beginning the anastomosis. Current concepts of the role of cancer detection, polypoid lesions and other factors influencing prognosis also have been reviewed.

Zinc protoporphyrin (ZPP) measurement is a required test under the Occupational Safety and Health Administration's lead standard. However, there is no mention of the influence of hemoglobinopathy on the ZPP test value. We undertook a retrospective laboratory review of 382 employees at the Argonne National Laboratory who had been subjects in a lead surveillance program since 1982. A total of 321 samples were analyzed, after female subjects and samples with abnormally high bilirubin levels were excluded. A group with low mean red blood cell volume (MCV; less than 80.0 fL) was compared with a group with normal MCV (greater or equal to 80.0 fL). A statistically significant difference was noted in ZPP (P < 0.007) and total bilirubin (P < 0.0003) values of two groups. There was no statistically significant difference noted in age, lead levels, or iron levels between the two groups. Abnormally high ZPP levels may occur in individuals with hemoglobinopathies. Only a minor part of this elevation could be explained by the higher bilirubin levels.