Cytogenetic analysis of ten primary non-small cell lung carcinomas (NSCLC), including five adenocarcinomas (ADC), three squamous cell (SQC), and two large cell (LCC) carcinomas has been carried out in an attempt to determine karyotype changes involved in the early stage of disease. The tumors were all aneuploid and exhibited complex karyotypes with multiple structural and numerical abnormalities. Clonal structural rearrangements were identified and in particular loss of material from the short arm of chromosome 9 had a 90% incidence. This loss was due to non-reciprocal translocation, deletion, or chromosome loss. Breakpoints were in the region 9q13 to p22. Other chromosome regions that were non-randomly involved are as follows: I cen to p13, 3p, 5q11 to q13, 6p, 6q15 to q27, 7p, 8p, 11q12 to q23, 13p, 14p, 15p, 17p, and 19p. While a primary cytogenetic change in NSCLC has not been identified conclusively, our findings implicate loss of material from 9p as a potentially important event.

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Two cell lines have been isolated from separate samples, taken at the same time, from the peripheral blood of a case of myelomonocytic leukaemia. One of these (CESS-B) is a typical B cell line obtained after treatment of the peripheral blood white cells with Epstein-Barr virus (EBV). The second line (RC-2) is a monocyte-macrophage type, originally isolated by 5 months continuous culture in the presence of colony stimulating factor (CSF). Subsequently, after further culture, this line has become autonomous (RC-2A), no longer requiring CSF for maintenance of proliferation, whilst retaining the characteristics of the original line.

In the next decade, "better" management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost-effectiveness model for children with Wolff-Parkinson-White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. This type of analysis can be used for other forms of chronic disease in children.

During a chromosome survey of mentally retarded children with epicanthic folds, an 8-yearold girl was found to have an extra medium-sized, satellited, acrocentric chromosome in a percentage of cells in peripheral blood, bone marrow, and skin. However, she did not show any of the clinical abnormalities associated with D-trisomy (Patau et al, 1960). Therefore clinical and cytogenetic studies together with special investigations performed on this child are described.Case Report The proposita J.M. was born on 21 June 1960 by a breech delivery, to a 38-year-old mother and a 46-yearold father, who were unrelated. Her birth weight was 3040 g. Apart from an early threatened miscarriage treated with progesterone, the pregnancy was normal.Clinical examination of the proposita at the age of 8 years showed profound mental retardation, epicanthic folds, and a mild degree of microcephaly (Fig. 1). On psychological testing she was found to be hyperactive and to have an IQ below 20. Radiology of the skull was normal. The Guthrie test for phenylketonuria and urine amino-acid chromatography were negative. The red cell phosphohexokinase level was within the normal range, ie, 16-9-24-6 micromoles ofsubstrate/min/3-2 g Hb (Baikie et al, 1965). Abnormal projections from the nuclei of the polymorphonuclear leucocytes as described in D-trisomy by Huehns, Lutzner, and Hecht (1964b) were not present.Fetal haemoglobin, estimated when the proposita was aged 7 years, was found to be 9 3O% by the alkali denaturation method (Singer, Chernoff, and Singer, 1951) and, at the same time using the acid-elution technique of Kleihauer, Braun, and Betke (1957), 55% of the erythrocytes were shown to contain some fetal haemoglobin. However, subsequent tests by alkali denaturation in the same laboratory over a period of 3 years showed wide variation even in replicates. The measurement had a

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