To ascertain the value of maternal serum free beta-human choriogonadotropin subunit measurement in Down's syndrome screening and to compare its effectiveness when screening with a variety of biochemical markers, we have evaluated maternal serum free beta-human choriogonadotropin, total human choriogonadotropin, alpha-fetoprotein and unconjugated oestriol in a large multicentre study of over 2800 unaffected cases and 90 affected cases, the largest collection of Down's cases ever reported. Of all the markers identified to date, free beta-human choriogonadotropin is the marker of choice for use in Down's syndrome screening. When used in early gestation (14-16 weeks) in combination with alpha-fetoprotein and maternal age, it will allow the detection of 77% of Down's cases. A side-by-side comparison with the performance of total human choriogonadotropin shows the superior detection efficiency of free beta-human choriogonadotropin. Unconjugated oestriol adds nothing further to the detection rate compared with the use of alpha-fetoprotein and free beta-human choriogonadotropin alone, and its use results in a 1% increase in false positive rate. We conclude that unconjugated oestriol has no value in Down's screening. The superior detection rate obtained using free beta-human choriogonadotropin is a result of superior detection of Down's cases in women under 30 years old, where the free beta-human choriogonadotropin combination detects 100% more cases than does the total human choriogonadotropin combination.

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Proximal tubular type metaplasia of the epithelium of Bowman's capsule is described in a fit young adult male. This form of metaplasia is unlike those previously described and could cause initial confusion if encountered in a percutaneous renal biopsy.

Macroglobulinemia has been reported in association with malignant lymphoma and chronic lymphatic leukemia on many occasions, and pulmonary lesions have been described in Waldenstrom's macroglobulinemia. We record here the first case of macroglobulinemia associated with a primary pulmonary lymphoma. Biopsy material from the lung was examined by light microscopy, immunofluo‐rescence, and electron microscopy. This correlated study showed the tumor to present a moderately pleomorphic pattern with lymphocytoid and plasmacytoid cells interspersed with reticulum cells, mast cells, and immature blast cells. Many of the tumor cells were actively engaged in protein production and had a well‐developed endoplasmic reticulum. Macrophages with complex lysosomal bodies were identified, and these could be correlated with globular bodies seen on light microscopy, and with cytoplasmic inclusions seen by im‐munofluorescence. Immunoelectrophoresis of the serum identified an I(MK monoclonal component. Clinical remission and regression of the lung mass has been obtained with continuous chlorambucil therapy.