In 53 cases of non-invasive or submucosal invasive well differentiated carcinoma of the bladder observed for 4 to 101 months cytogenetic analysis by the direct technique (non-culture) has been performed repeatedly. Markers, abnormal chromosomes, have been found in 33 patients and recurrence has developed in 32 of these 33 patients, resulting in 9 deaths. All but 1 of the 20 patients without markers have been observed for up to 8 years and have remained free of recurrence. In this 1 recurrence, 8 months post-diagnosis, the mode changed from 69 to 92, evidence of dedifferentiation and development of a new tumor in a bladder prone to neoplasia. Based on our over-all cytogenetic experience with 165 patients with carcinoma of the bladder a simplified classification is presented. This classification, built on measurable characteristics of early carcinoma, including the presence or absence of marker chromosomes, allows accurate prognostication and, thus, provides the foundation for development of standard therapy.

A 10-year evaluation of chromosomal analysis of bladder tumors is reported. Emphasis is placed on the presence of chromosomal markers and their importance as prognostic indicators in patients with papillary bladder tumors.

INTRODUCTIONWater-insoluble lipids circulate in serum bound to specific proteins as a mixture of soluble macromolecular lipoprotein complexes3 that, over the full density range, are characterized by gradually changing physicalchemical properties such as size, density, and lipid composition and by differences in the nature of the protein moieties (apolipoproteins) .1*3According to present concepts, nearly all long-chain dietary triglycerides absorbed by the intestinal mucosa, as a mixture of fatty acids and monoglycerides, are transported to serum by way of the thoracic duct lymph.4s6Approximately 95 % of the exogenous fatty acids are transported as resynthesized triglycerides, and only negligible amounts as phospholipids (three to four percent) and cholesterol esters (one to two p e r~e n t ) .~~' Triglycerides and cholesterol esters combine with phospholipids, free cholesterol, and proteins, most probably in the intercellular spaces of the epithelium cells, and enter the lymphatic channels in the form of chylomicrons and other lipoproteins.8 With the exception of chylomicrons, virtually nothing is known about the chemical composition and physical-chemical properties of human chyle lipoproteins. It has been surmised9J0 that they are not formed like chylomicrons in the intestinal cells but are derived mainly from the liver lymph. However, in Vitro experiments with mucosal cells isolated from the dogll and intestinal slices from the rat12 have shown that radioactive amino acids could be incorporated into the protein moieties of both chylomicrons and higher-density lipoproteins. It has been found13 that, in the anesthetized cat, liver lymph contributes about 30% of the total thoracic duct lymph volume and approximately 40 % of the total protein, the remaining thoracic duct lymph being derived almost entirely from the intestinal tract. Furthermore, it has been shown, in the same study,13 that only the intestinal lymph fatty acids, phospholipidi and cholesterol show large increases during fat $ Lipoprotein terminology and abbreviations used : chylomicrons, lipid-protein particles of alimentary origin ( SC > 5,000 ; minimum diameter approximately 200 mp) ; VLDL, very low-density lipoproteins, lipoproteins of density < 1.006 g/ml and SC 20-5,000 ; LDL, low-density lipoproteins, 8-lipoproteins, lipoproteins of density 1.061.063 g/ml and SC 0-20 : HDL, high-density lipoproteins, a-lipoproteins, lipoproteins of density 1.063-1.021 g/ml ; VHDL, very high-density lipoproteins, d > 1.210 g/ml. 1 792Annals New York Academy of Sciences absorption, with a characteristic appearance of an additional prealbumin lipoprotein component. Thus it seems, especially during absorption, that the contribution of lipoproteins from the liver lymph is not sufficient to account for all of the soluble lipoproteins with flotation coefficients lower than Sf 400 present in thoracic duct lymph. Since chyle lipoproteins represent the transitional form of transport of dietary fats from the site of their absorption into the systemic circulation and ulti...

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