Objectives: Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. Methods: A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. Results: Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. Conclusions: Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.

Summary. Treatment with ancrod (‘Arvin’) or streptokinase (‘Kabikinase’) was allocated randomly to 34 patients with deep vein thrombosis of the leg. In all the diagnosis was confirmed by venography. Treatment was given for 4 days and venography was repeated in 32 patients.‘Blind’assessment of venograms performed before and after treatment showed that there was significantly more lysis of thrombi in the streptolunase treated group (P< 0.0005). The majority of patients in each group showed some clinical improvement but there was little or no appreciable difference in symptoms and signs between the two groups 3 mth after treatment. Sidc effects were more common with streptokinase treatment than with ancrod.

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737 first discovered to be hypertensive two months before her myocardial infarction. The third patient was a single girl from the Continent who had taken oral contraceptives for three years. We have no previous medical records about her. We do not consider that our report of 22 women under the age of 45 years with acute myocardial infarction represents "a small amount of inadequate information" upon which to base recommendations. It is the largest series yet assembled and we were particularly careful not to draw overemphatic conclusions.-We are, etc.,