Both Raynaud's phenomenon and the presence of antinuclear antibodies are uncommon features of malignant disease and the association of both with a malignancy extremely rare. The case is reported of a 78 year old woman who presented with Raynaud's phenomenon and positive antinuclear antibodies related to adenocarcinoma of unknown primary site.Raynaud's phenomenon is a vascular disorder characterised by episodes of abnormal digital vasospasm in the hands and sometimes in the feet. These episodes occur in response to cold or emotional stress and produce one or more colour changes. The most common sequence is an initial pallor followed by cyanosis and rubor, but incomplete episodes are more common.' The prevalence in the general population has been estimated as 4-10%.2 Raynaud's phenomenon as an isolated condition is classified as primary, and secondary when an underlying cause can be identified.' The presence of antinuclear antibodies in these patients was often associated with connective tissue diseases3 and only in rare cases with malignancies.4 We report a patient with Raynaud's phenomenon and a high antinuclear antibody titre related to neoplasia.

Transverse myelitis is one of the most serious neurological complications occurring in the course of systemic lupus erythematosus. We describe two lupus patients, with transverse myelitis, one of whom had associated optic neuritis. In both, magnetic resonance imaging of the spinal cord showed an abnormal signal. In one case a good response to steroid and immunosuppressive therapy was observed; the other case failed to improve despite the therapy applied.

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203Letters to the editor weight' during the past three months. Physical examination disclosed a moderately ill woman.Skin and mucosae were pale. A 2-5 cm,