Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.

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potential routes for a multisynaptic itch reflex from the substantia to the nucleus of the trigeminal nerve in the medulla.The transmission of nerve impulses that give rise to a spinal reflex may be blocked by local anaesthesia. Our patients have not complained of itch since we added a small amount of bupivacaine to our intrathecal heroin preparation (1-0 mg freeze-dried heroin and 0-25 mg bupivacaine plain in 1-0 ml saline; pH 6-183, specific gravity 1-004 at 37°C).On this evidence an enkephalinergic reflex may well provide a credible alternative to histamine release as an explanation for facial itching associated with intraspinal administration of opiates. The reflex might be relayed at a central level by a medullary itch centre having a close functional link with the spinal nucleus of the trigeminal nerve.

SUMMARY The presence of Campylobacterpylori, histologically diagnosed gastritis, and antibodies to C pylori were determined in a series of 113 patients undergoing endoscopy. Paired biopsy specimens from the fundus, body, and antrum were collected from 59 patients and from the antrum of 54 patients. The presence of Cpylori was confirmed by either culture or silver stain in 30 of 59, 31 of 59, and 54 of 103 biopsy specimens from the fundus, body, and antrum, respectively. Ofthe specimens which contained C pylori 20 of 30 (66%) from the fundus, 25 of 31 (80%) from the body, and 54 (100%) from the antrum showed gastritis. Cpylori and gastritis were shown in seven of nine (78 1 %) of patients with gastric ulcers and in nine of 11 (82%) of patients with duodenal ulcers. Using an enzyme linked immunosorbent assay (ELISA) technique to detect IgG antibody to C pylori, all patients with histologically diagnosed gastritis and organisms present had titres of > 640; eight of 39 (21 %) ofpatients without gastritis and without organisms gave similar titres. Hence the presence of C pylori was associated with gastritis and with raised titres of IgG antibody. Spiral organisms have been described in the stomach of man and other animals by several authors since the 1920s.`5 Following the reports of Warren6 and Marshall7 there has been an increase in interest in the organism which these authors named C pyloridis and which has since been redesignated C pylori.8 These Campylobacter-like organisms and others9 have been isolated from gastric biopsy specimens using techniques which were developed for the isolation of intestinal campylobacters.Despite the profusion of short reports there have been few detailed substantiative prospective studies, especially in Great Britain. We therefore present the results of our study in which 113 patients were investigated endoscopically, histologically, bacteriologically and serologically. Part of this study was designed to determine the distribution of Campylobacter-like organisms in infected or colonised stomachs, an aspect which has not clearly been established. The survey was also undertaken so that we could substantiate the association of these organisms with histologically diagnosed gastritis, gastric, and duodenal peptic ulceration. Furthermore, we inves-