A community-based tuberculosis case-finding and short-course chemotherapy program was conducted in a suburb of Manila and featured 1 month of daily isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) followed by 7 months of twice-weekly, high dose, directly observed INH + EMB + PZA. Church-affiliated lay workers obtained 1,990 sputum specimens from subjects who complained of chronic cough or wasting symptoms; 207 of the specimens were positive on Ziehl-Neelsen smears. On culture, 176 yielded a significant growth of M. tuberculosis. Of these 176 patients, 144 were selected to enter the study; 10 were lost because of withdrawal or death and four (2.7%) because of drug toxicity. This left 130 patients who were followed long-term. Remarkably, 80% (104) were initially shedding drug-resistant organisms; 26% (34) were resistant to one drug, 30% (40) were resistant to two drugs, and 24% (30) were resistant to three or more drugs. Responses to therapy corresponded closely to the extent of drug resistance: 80% (48 of 60) of patients with drug-susceptible or single resistance had a favorable outcome; 43% (28 of 65) were resistant to two or three drugs, and 0% (0 of 5) of those were resistant to four or more drugs. Notable findings of this study were the success of a community-based program in conducting prolonged, directly observed treatment, the unexpectedly high prevalence of multiple-drug-resistant organisms in this population, and the inadequacy of INH + PZA + EMB during the continuation phase of therapy in this setting.

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A total of 419 patients with progressive liver disease, in nearly all cases metastatic from gastrointestinal primaries, were treated by intrahepatic arterial infusion with 5-FU. Three-fourths of these patients h a d had prior trials with intravenous 5-FU for 1 or 2 months to several years a n d had been switched to the infusion upon the development of progression. Catheters were placed percutaneously a n d the patients infused with 5-FU a t a dose of 20 to 30 mg/ kg/day X 4, then 15 mg/kg/day x 17, a t which point the catheter was removed a n d the patient sent home o n weekly i.v. doses a t 15 mg/kg. Toxicity, morbidity, a n d mortality were minimal with the intrahepatic arterial infusion treatment a n d the rigid criteria of improvement were met by 55% of the study cases. T h e survival rate of those patients who responded to the treatment was greater than the survival rate of those who failed t o respond.Cancer 1975. ATlENTS WITH PROGRESSIVE LIVER METASTASESP of gastrointestinal origin have a poor prognosis. Although the survival time of cases with liepa tic spread from large bowel cancer has been reported to be longer than with metastases from other gastrointestinal primaries,fi the mean survival time of those with untreated liver involvement is only 5 to 7 rnonths.4~~ Approximately 15% to 20% of patients with colorectal cancer have responded to 5-fluorouracil (5-FU);1-2 however, no effective intravenous treatment has been developed for those patients who fail to respond to 5-FU. These considerations have led to a continuing interest in the treatment of liver metastases with intrahepatic arterial infusion therapy.G-7~*.9 The favorable results of our earlier study with intraarterial infusion with 5-FU in 200 patients have encouraged us to expand that experience.3 MATERIALS AND METHODSThree-fourths of the 419 patients treated over the past decade with intrahepatic arterial infusion had prior trials with intravenous

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