The benefits of polychemotherapy in advanced (Stage III) non‐small‐cell bronchogenic carcinoma remain uncertain. In attempt to answer the important question whether treatment improves well‐being and survival in these patients, we did a prospective, randomized, single‐blind study to compare polychemotherapy to a placebo. Thirty‐nine consecutive patients were enrolled. Twenty received a drug combination consisting of: methotrexate, doxorubicine hydrochloride (Adriamycin), cyclophosphamide, and lomustine (CCNU) (MACC). The other group (19 subjects) received a placebo physically comparable to MACC. The two groups were initially comparable in terms of age, sex, clinical status, and tumor burden. In the treated group, seven patients had a radiologic response (more than 50% reduction in the tumor size), and the tumor stabilized in an additional five subjects. There were no responders in the placebo group. Median survival was 30.5 weeks for the MACC group compared to 8.5 weeks in the placebo group (P < 0.0005, Gehan‐Wilcoxon). We conclude that polychemotherapy (in this case MACC) significantly benefits patients with advanced non‐small‐cell lung cancer.

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SUMMARY Echocardiographic examination, performed in a 12-year-old boy who had signs of mitral regurgitation, showed the presence of an abnormal mass of echoes in the left atrium and mitral orifice. These were initially interpreted as representing an atrial myxoma. Surgical exploration showed that the tumor originated from the posterior leaflet of the mitral valve, and, microscopically, the lesion was diagnosed as a fibrolipoma.The clinical and echocardiographic features of this unique type of cardiac tumor are discussed.PRIMARY TUMORS OF THE HEART are rare in infancy. The most frequent type is probably the rhabdomyoma which, in most cases, is associated with tuberous sclerosis.' 3 Few reports have appeared in the literature regarding primary tumors of heart valves in children.4 ' This report describes the clinical, echocardiographic and anatomical-pathological features of a fibrolipoma of the posterior leaflet of the mitral valve (PML) in an asymptomatic 12-year-old boy. Case ReportThe patient is a 12-year-old male who was referred to the pediatric cardiology department in October 1977 for evaluation of a heart murmur discovered at the time of an emergency room visit for a fracture of the right wrist. The child was asymptomatic with respect to the cardiovascular system and there was no history of rheumatic heart disease.On physical examination, the patient was welldeveloped and healthy looking. was 90/60. Peripheral pulses were normal and equal in all four limbs. On palpation of the precordium, the apex was displaced to the sixth left intercostal space at the anterior axillary line. On auscultation, the first heart sound was of normal intensity and the second heart sound was normally split. At the apex there was a grade 3/6 soft pansystolic murmur radiating to the axilla. Also at the apex, there was an S3 followed by a low frequency grade 2/6 diastolic rumble without presystolic accentuation. There was no opening snap. The lungs were clear to auscultation. The liver and the spleen were not enlarged. The ECG showed signs of left atrial enlargement. On the chest x-ray, the heart size was normal, with a slight prominence of the left ventricle and dilatation of the left atrium. There was prominence of the pulmonary veins in the upper third of the lungs, suggesting the presence of pulmonary venous congestion. Complete blood count, erythrocyte sedimentation rate and protein electrophoresis were all normal.Echocardiography ( fig. 1