SUMMARY Biopsy samples were taken from the gastric mucosa of 50 patients attending a gastroscopy clinic; blood was also taken for serological studies. A campylobacter like organism was grown from 31 patients (62%) and the organism was seen in sections from 27 biopsies. Antibody was found in 31 patients by complement fixation and in 27 by bacterial agglutination. There were strong positive correlations between the presence of the organism, detectable antibody, and histological gastritis. Antibody to the campylobacter like organism was comparatively uncommon in patients without gastritis and in samples from blood donors and antenatal patients.In 1940 Freedberg and Barron,' using silver staining techniques, found spirochaetes in the gastric mucosa of 13 of 35 patients who underwent partial gastric resection for ulcers or carcinoma. The organisms were rarely seen in the absence of ulceration. More recently, the presence of unidentified curved bacilli on the gastric mucosa of patients attending for gastroscopy was reported by Warren2 and Marshall,3 also using silver stains. The presence of these organisms was associated with histologically demonstrable gastritis. From some of the patients they isolated the organism on moist chocolate agar incubated at 37°C in a microaerophilic atmosphere suitable for the growth of Campylobacter jejuni. These bacteria had a superficial morphological resemblance to the known species of campylobacter, but with up to five sheathed flagella arising from one end of the organism. The importance of the presence of these bacteria in the stomach is uncertain. We report here the results of a study of 50 consecutive patients attending a gastroscopy clinic. We have extended the original observations by using serological methods to detect antibody at the same time as examining the material by culture and histology. Material and methodsBiopsies were taken from the antral mucosa of each patient undergoing gastroscopy. Samples were placed in formalin for histology and in nutrient broth (Oxoid No 2 CM67) for transmission to the Accepted for publication 23 May 1984 microbiology laboratory. Specimens were cultured within 2 h of collection. A sample of serum for antibody tests was collected from each patient. For comparison, serum from blood donors and antenatal patients was also examined. PATIENTSThe indications for gastroscopy were symptoms referable to the upper gastrointestinal tract. On gastroscopy, most patients had evidence of ulceration or gastritis; about one third had no abnormality. Only one patient had a carcinoma. The average age of the patients was 53 years (range

Summary The extracellular matrix protein tenascin (TN) is overexpressed in a number of solid tumours. This, however, is the first study to examine TN expression in ovarian tumours. TN protein was examined in frozen sections of 50 human ovarian tumours by immunohistochemistry. Malignant and borderline tumours showed a significantly greater incidence and intensity of stromal staining than benign tumours (P<0.0001 and P=0.038 respectively). Seven omental metastases were also examined and showed a strikingly similar protein distribution to their primary tumour counterparts. The expression pattern of different RNA isoforms, created by alternative splicing of the primary transcript, was identified using reverse transcription-polymerase chain reactions (RT-PCR). The smallest TN RNA splice variant (284 bp) was found in all tumours examined, while the appearance of larger molecular weight transcripts (-490 and 556 bp), as major forms, was predominantly limited to malignant tumours, with 9/12 malignant tumours showing this pattern compared with 1/6 benign tumours. These data suggest that malignant ovarian tumours have increased expression of TN compared with benign tumours and this may be associated with induction of specific isoforms.

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Two patients with systemic lupus grythematosus who developed progressive multifocal leukoencephalopathy (PML) are described. Although the time of PML onset could not be determined with certainty, it probably developed after steroid-induced immunosuppression. However, high-dose corticosteroids appeared to produce transient amelioration in the neurologic disorder. We suggest that PML is an important addition to the list of conditions to be considered in the differential diagnosis when a patient with systemic lupus erythematosus develops neurologic abnormalities.The neurologic manifestations of systemic lupus erythematosus (SLE) are well-recognized, though their pathologic basis is still poorly understood. Various pathogenetic mechanisms have been suggested, including cerebral vascuhtis and antineuronal antibodies (1) and, recently, anticardialipin antibodies (2). There are no accepted criteria for the diagnosis of cerebral lupus and, consequently, no agreement among investigators regarding its incidence, which may be as high as 75% of patients at some stage in the illness (3,4). CASE REPORTSPatient 1. In 1960, an anemic 36-year-old woman with a history of Raynaud's phenomenon since childhood was found to have a renal calculus associated with hypercalciuria, impaired urinary concentration, and a mild compensated renal tubular acidosis. The Westergren erythrocyte sedimentation rate (ESR) was 120 mm/hour, serum gamma globulin levels were increased, and a test for antinuclear factor (ANF) was weakly positive.In 1965, during the sixteenth week of her second pregnancy, she developed acidosis and a "butterfly" facial eruption; lupus erythematosus (LE) cell preparations and ANF were strongly positive. On medical advice she submitted to pregnancy termination by hysterectomy, after which her metabolic disturbances reverted to normal levels and her facial eruption regressed.In 1971, she complained of visual disturbance accompanied by left retroorbital pain and was found to have left eye visual acuity of 6/18 with a central scotoma. Optic atrophy was identified, and the episode was attributed to retrobulbar neuritis. In addition to the cutaneous facial changes typical of SLE, the skin of her hands manifested a bound-down appearance suggestive of early sclerodactyly. She had an ESR of 12 mm/hour, a normal value for creatinine clearance, and a normal chest radiograph. LE cells were identified, ANF and homogeneous antibodies were strongly positive. Mitochondria1 and smooth muscle antibodies and the Wassermann reaction were negative. Serum gamma globulins were increased. There was a mild but persistent proteinuria, and renal biopsy showed histo-

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