Out of 111 Clostridium difficile strains, 108 produced sporesin numbers of more than 105/ml and the remaining three did not produce any spores in brain heart infusion medium. The germination frequency in the medium without lysozyme varied widely from strain to strain, ranging from less than 10-8 to 100, and in 77 of the 108 strains the germination frequency was 10-5 or less. The spores, when treated with sodium thioglycollate and then inoculated into the medium containing lysozyme, germinated in all of the 108 strains at a frequency of 10-0.5 or more. The spores of two strains germinated at a frequency of more than 10-0.5 in all methods. Spores of C. difficile strains were fairly highly heat-resistant; D100c values ranged from 2.5 to 33.5 min.Clostridium difficile is a major cause of antibiotic-associated pseudomembranous colitis of man (1). Ionesco (3) investigated the conditions for germination of C. difficile spores and found that germination frequency of the spores was quite low, but moderately increased in the presence of lysozyme, and that complete germination of the spores required treatment of the spores with sodium thioglycollate and inoculation of the spores into a medium containing lysozyme.The present study was undertaken, with a large number of C. difficile strains, to establish the relationship between the germination of C. difficile spores and the addition of lysozyme with or without sodium thioglycollate treatment, and to determine the heat resistance of the spores.

A case of secretory carcinoma of the breast in a 61-year-old woman is described. She came to our hospital complaining of a bloody nipple discharge. The physical examination revealed a 2.8 x 2.1-cm, firm, irregular lump with bloody nipple discharge in her left breast. Mammography demonstrated an irregular mass and ultrasonography showed an irregular hypoechoic mass accompanied with a cyst. Ductgraphy was done. It showed a dilated mammary duct leading to the cyst which was partially occupied with carcinoma. A cytologic smear of the nipple discharge and fine-needle aspiration cytology revealed similar findings, and both findings were malignant. A modified radical mastectomy was performed. A pathological examination revealed secretory carcinoma of the breast which had spread inward and outward from the cyst. In addition, the nipple discharge flowed from the cyst through the dilated mammary duct. The patient is presently alive and well 2 years after the operation. Secretory carcinoma is an extremely rare tumor of the breast and 48 cases have been reported in Japan. The present case is the first known case of secretory carcinoma demonstrating a bloody nipple discharge to come from a cyst which has been invaded by carcinoma.

We report a patient with paraneoplastic pemphigus associated with a thymic tumour. Immunoblot study using affinity-purified gamma-catenin protein revealed that his serum recognized gamma-catenin (plakoglobin) in epidermal, thymic tumour and mouse bladder extracts.

A 47-year-old woman presented with facial spasm, swollen fingers and Raynaud's phenomenon due to cerebrovascular disorder and mixed connective tissue disease (MCTD). Although she was positive for both antineutrophil cytoplasmic antibodies against proteinase-3 (PR3-ANCA) and anti-U1 RNP antibodies, she did not meet the American College of Rheumatology classification criteria for Wegener's granulomatosis (WG). Physical and histopathological examinations revealed severe systemic atherosclerosis without any of the traditional risk factors. Elevated levels of malondialdehyde-modified LDL and antioxidized LDL autoantibodies, which are considered to be key factors in the pathogenesis of atherosclerosis, were also detected in the serum of this patient. In this case, systemic atherosclerosis might have been linked to these autoimmune reactions.

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