Clostridium sordellii is an infrequent human pathogen. It has been demonstrated to be occasionally responsible for myonecrosis or gas gangrene. Interestingly, in the obstetric literature, some cases of postpartum maternal deaths have been associated with C sordellii infection causing a rapidly lethal toxin mediated syndrome. This is the first reported case of postpartum death in a 29 year old woman, in which a toxigenic C sordellii was isolated from the patient's blood antemortem during the fatal toxic shock, strongly indicating its role in this rare syndrome. (7 Clin Pathol 1997;50:259-260) Keywords: Clostridium sordellii; shock; toxin; postpartum. Case report A caesarean section was performed in a 29 year old woman, gravida 1, for cervical dystocia in the 41st week. The postoperative course was normal. Two days after delivery the patient was afebrile but complained of generalised weakness, dizziness in an orthostatic position, and pain in the epigastric region followed by hypotension (80/50 mm Hg), sinus tachycardia (1IO beats/minute), and low urinary output. The patient was given fluids and steroids but hypotension proved refractory. The abdomen was painful and tender. Ultrasonogram showed hyperperistalsis and anechoic areas scattered in the abdominal cavity; blood analysis showed noticeable haemoconcentration and hyperproteinemia. Laparotomy revealed a substantial amount of serosanguineous fluid, the peritoneum was lifted by a jelly-like retroperitoneal tissue, the appendiceal apex was hyperaemic and adhered to the rear parietal peritoneum, and the right adnexa appeared oedematous and thickened. Gall bladder, duodenum, stomach, ileum, ascendens, and transverse colon appeared thickened and ischaemic. Pancreas, spleen, and liver were normal. The patient underwent appendectomy and removal of the right adnexa, and was treated with antibiotics (intravenous cefotaxime 1 g three times a day.). Peritoneal exudate and blood were collected and cultured. Although clinical conditions partially improved, after a few hours the hypotension became refractory, her skin was pale and cool with cyanotic extremities, her temperature was normal, haematocrit was 57.6%, haemoglobin was 246 g/l, white cell count was 115 x 109/1; a decrease in total protein concentration (26 g/l), and calcium concentration (64 mg/l) was also observed. Because of serious cardiac conditions the patient was moved to an intensive care unit where she died six hours later. Clinical Pathology Microbiological studiesBlood was collected during laparotomy while the patient was on antibiotic therapy. Bactec 26A and Bactec 27A broths (Becton Dickinson Italia, Milan) were used to grow aerobes and anaerobes, respectively, in an automatic Bactec NR 730. Subcultures were performed using Schaedler agar (Difco Laboratories, Detroit, Michigan) supplemented with vitamin K for anaerobes, and mannitol salt agar, desoxycholate agar, Colombia blood agar and Sabouraud agar (Difco) for aerobes and yeasts. The peritoneal fluid was inoculated into thioglycollate and ...

A real-time reverse transcriptase-polymerase chain reaction (RT-PCR) method for detection of cytokeratin 20-positive cells in blood characterized by two novel features was developed and tested on 99 patients with colorectal cancer, 110 with breast cancer, and 150 healthy subjects. To optimize the specificity and sensitivity of the method, two novel features were used. First, a primer overlapping two adjacent exons was generated to inhibit nonspecific amplification both in healthy donors and cancer patients; second, a non-end-point first-round amplification was used to increase sensitivity. The number of firstround cycles was chosen to reach the highest level of sensitivity while conserving quantitative characteristics. PCR efficiency increased from 88.9% in singleround RT-PCR to 99.0% in nested real-time RT-PCR. To establish sensitivity and specificity of the method, HT29 cells were serially diluted with normal blood. Detection limit improved from 100 HT29 cells (singleround RT-PCR) to 1 to 10 cells (nested real-time RT-PCR) per 3 ml of whole blood. None of the healthy subjects was positive, whereas 22 and 29% of all colorectal and breast cancer patients, respectively, had cytokeratin 20 cell equivalents in blood. The association between cytokeratin 20 cell equivalents and metastasis was statistically significant for breast (P ‫؍‬ 0.026) but not colorectal cancer patients (P ‫؍‬ 0.361). Negativity of all 150 healthy controls examined confers diagnostic potential to the method. Cytokeratin mRNAs are potential markers for detection of epithelial cells in blood. Several reports indicate that cytokeratin 20 (CK20) mRNA in blood acts as a specific cancer cell marker in patients with frequent cancer forms of epithelial origin such as breast 1-5 and colorectal cancer.6 -9 Many breast cancer patients develop metastasis after locoregional and systemic treatment even in the absence of dissemination as assessed by conventional diagnostic tools. Approximately 30 to 50% of colorectal cancer patients who have undergone curative resection have recurrences with fatal outcome.10,11 Most recurrences occur in patients with TNM (tumor, nodes, and metastases) stage II and III cancers, but patients with stage I lesions also have appreciable risk. In these patients, cancer cells were disseminated either before or during surgery of the primary tumor.12-14 Although the relationship between circulating tumor cells and the development of recurrent cancer is not fully understood, it is generally assumed that enhanced dissemination of cancer cells in blood contributes significantly to the development of metastasis. [15][16][17] The detection of circulating metastatic cells would be of great value for the assessment of the metastatic risk.18 Currently, the most powerful prognostic information in cancer patients is obtained from conventional histological assessment of regional lymph nodes. 19 -23 Because 20 to 30% of colorectal cancer patients without metastasis in lymph nodes die from distant metastases or local recurrence within 5 years 24...

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Although the (13)C-UBT is the most accurate among the available noninvasive tests, our results show that an H. pylori stool test using monoclonal antibody might be an excellent alternative.