Role of culture and toxin detection in laboratory testing for diagnosis of Clostridium difficile-associated diarrhea.

Two variations of an egg yolk agar base medium containing cycloserine, cefoxitin, and fructose (CCFA), one with 250 micrograms and other with 500 micrograms of cycloserine/ml of agar medium were compared to study the effect of the cycloserine concentration on recovery of Clostridium difficile from stool samples. In addition, the role of prior anaerobic reduction of these media in the detection of Clostridium difficile-associated diarrhea (CDAD) was tested. Each medium was studied over a two-month period, with outcome compared between the testing periods and to historical data from our institution.

Pyogenic granuloma in Barrett's esophagus mimicking esophageal carcinoma.

A 31-year-old white man with a history of testicular carcinoma and lymphoma developed severe reflux esophagitis with stricture formation requiring repeated dilatation. Barrett's esophagus was histologically confirmed. The Barrett's mucosa was observed endoscopically and became polypoid, mimicking an esophageal carcinoma.

Undifferentiated small cell carcinoma of the urinary bladder.

We have reported a case of small cell carcinoma of the urinary bladder in a 65-year-old white man with a smoking history. He had radical cystectomy, but died 6 months after initial diagnosis. The patient terminally had liver metastasis, confirmed by fine needle aspiration and radiographic evidence of intra-abdominal and right adrenal gland metastasis.