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Jaulim A, Aydın A, Ebrahim F, Ahmed K, Elhage O, Dasgupta P. Imaging modalities aiding nerve-sparing during radical prostatectomy. Turk J Urol 2019; 45:325-330. [PMID: 31509505 DOI: 10.5152/tud.2019.19007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/23/2019] [Indexed: 12/22/2022]
Abstract
Nerve-sparing robot-assisted radical prostatectomy has decreased the post-surgical complications of prostate surgery, but has not eliminated it. The ability to view the microstructure will enable better surgical decisions and lead to better post-surgical outcomes. An ideal imaging modality should provide rapid image acquisition, be low cost, and be specific to the tissue being examined. This article aims to review the current literature to compare three main techniques: multiphoton microscopy (MPM), optical coherence tomography, and confocal microscopy, to see which of these techniques may be best applied in surgical procedures in the future. Embase and Medline were used as the primary databases. Combinations of various key words were used while researching the literature. These included: "Radical prostatectomy," "nerve-sparing," "nerve mapping," "multiphoton microscopy," "Confocal microscopy," and "Optical Coherence Tomography." Thereafter, the relevant results were selected and used in the review. Although optical coherence tomography is a low cost and compact modality, it lacks cellular resolution, while confocal microscopy offers great cellular resolution but lacks depth. MPM, on the other hand, provides sufficient depth and produces high-resolution images. The limitation of MPM is its lack of portability, however the advent of dual-modality MPM may be a way forward.
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Affiliation(s)
- Adil Jaulim
- Cancer Research UK Cambridge Institute, University of Cambridge; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Abdüllatif Aydın
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK.,The London Clinic Centre for Robotics, London, UK
| | - Farheen Ebrahim
- Department of Surgery, Colchester General Hospital, Colchester, Essex, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK
| | - Oussama Elhage
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK.,The London Clinic Centre for Robotics, London, UK.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital, King's College London, UK.,The London Clinic Centre for Robotics, London, UK.,Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Cassidy LD, Young ARJ, Pérez-Mancera PA, Nimmervoll B, Jaulim A, Chen HC, McIntyre DJO, Brais R, Ricketts T, Pacey S, De La Roche M, Gilbertson RJ, Rubinsztein DC, Narita M. A novel Atg5-shRNA mouse model enables temporal control of Autophagy in vivo. Autophagy 2018; 14:1256-1266. [PMID: 29999454 PMCID: PMC6103714 DOI: 10.1080/15548627.2018.1458172] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 01/23/2023] Open
Abstract
Macroautophagy/autophagy is an evolutionarily conserved catabolic pathway whose modulation has been linked to diverse disease states, including age-associated disorders. Conventional and conditional whole-body knockout mouse models of key autophagy genes display perinatal death and lethal neurotoxicity, respectively, limiting their applications for in vivo studies. Here, we have developed an inducible shRNA mouse model targeting Atg5, allowing us to dynamically inhibit autophagy in vivo, termed ATG5i mice. The lack of brain-associated shRNA expression in this model circumvents the lethal phenotypes associated with complete autophagy knockouts. We show that ATG5i mice recapitulate many of the previously described phenotypes of tissue-specific knockouts. While restoration of autophagy in the liver rescues hepatomegaly and other pathologies associated with autophagy deficiency, this coincides with the development of hepatic fibrosis. These results highlight the need to consider the potential side effects of systemic anti-autophagy therapies.
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Affiliation(s)
- Liam D. Cassidy
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Andrew RJ. Young
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | | | - Birgit Nimmervoll
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Adil Jaulim
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Hung-Chang Chen
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | | | - Rebecca Brais
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Thomas Ricketts
- Cambridge Institute for Medical Research, Department of Medical Genetics, Cambridge, UK
| | - Simon Pacey
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Maike De La Roche
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | | | - David C. Rubinsztein
- Cambridge Institute for Medical Research, Department of Medical Genetics, Cambridge, UK
- UK Dementia Research Institute, Cambridge Biomedical Campus, Cambridge Biomedical Campus, Cambridge, UK
| | - Masashi Narita
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
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Jaulim A, Srinivasan A, Hori S, Kumar N, Warren AY, Shah NC, Gnanapragasam VJ. A comparison of operative and margin outcomes from surgeon learning curves in robot assisted radical prostatectomy in a changing referral practice. Ann R Coll Surg Engl 2018; 100:226-229. [PMID: 29484935 PMCID: PMC5930106 DOI: 10.1308/rcsann.2018.0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction The aim of this study was to explore the impact of increasing proportions of high risk referrals on surgical margin outcomes of a surgeon's learning curve in robotic prostatectomy. Methods All patients in this study underwent robot assisted radical prostatectomy (RARP) performed by three different consultant urological surgeons. Data collected included preoperative clinical stage, Gleason score and prostate specific antigen levels, which were used to risk stratify patients according to National Institute for Health and Care Excellence criteria. Oncological clearance was assessed by overall and stage specific positive margin status. Comparisons were made between each surgeon for the first and second 50 consecutive cases. Results For the three surgeons, there was a progressive increase in the proportion of high risk cases referred accompanied by a corresponding decline in low risk disease (p<0.001). Postoperative pathology also showed an upward trend in pT3 cases across the three eras. There was no statistical difference in overall positive margin rates between the surgeons. The overall rates were 12%, 20% and 23% for the first 50 cases, and 32%, 36% and 21% for the second 50 cases for the three surgeons respectively. Conclusions Our series demonstrates an upward trend in the risk profile of men referred for robotic prostatectomy over a nine-year period. Despite this, there was minimal impact on pathological and surgical outcomes among our surgeons, who were at the initial stages of their RARP learning curve. Our results suggest that there is no requirement for an active case selection bias against patients with high risk disease for surgeons newly embarking on their RARP learning experience.
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Affiliation(s)
- A Jaulim
- Cambridge University Hospitals NHS Foundation Trust, UK
- *Contributed equally
| | - A Srinivasan
- Cambridge University Hospitals NHS Foundation Trust, UK
- *Contributed equally
| | - S Hori
- Cambridge University Hospitals NHS Foundation Trust, UK
- *Contributed equally
| | - N Kumar
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - AY Warren
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - NC Shah
- Cambridge University Hospitals NHS Foundation Trust, UK
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Voss J, Pal R, Ahmed S, Hannah M, Jaulim A, Walton T. Utility of early transperineal template-guided prostate biopsy for risk stratification in men undergoing active surveillance for prostate cancer. BJU Int 2018; 121:863-870. [PMID: 29239082 DOI: 10.1111/bju.14100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the accuracy and utility of routine multiparametric magnetic resonance imaging (mpMRI) and transperineal template-guided prostate biopsy (TPB) after enrolment in active surveillance (AS). PATIENTS AND METHODS From April 2012 to December 2016 consecutive men from our single institution, diagnosed with low- or intermediate-risk prostate cancer on transrectal ultrasonography-guided biopsy, were offered further staging with early mpMRI and TPB within 12 months of diagnosis. Data were collected prospectively. Eligibility criteria comprised: age ≤77 years; Gleason score ≤3 + 4; clinical stage T1-T2; PSA ≤15 ng/mL; and <50% positive biopsy cores. RESULTS A total of 208 men were enrolled, including 196 with Gleason score 3 + 3 and 12 with Gleason score 3 + 4 disease. The median (range) number of TPB cores was 50 (17-161), with a mean TPB core density of 1.2 cores/cm3 prostate volume. A total of 83 men (39.9%) underwent histopathological upgrading after TPB, including 76 men (38.8%) with Gleason score 3 + 3 disease and seven men (58.3%) with Gleason score 3 + 4 disease. Of these, 26 (31.3%) were found to harbour primary pattern Gleason grade ≥4 disease. In all, 24 (28.9%) upgraded cases had Prostate Imaging Reporting and Data System (PI-RADS) score 1 or 2 lesions on mpMRI, including five men with Gleason score ≥4 + 3 disease. Of these, 14 (58.3%) had a prostate-specific antigen (PSA) density of ≥0.15, including four out of the five men with Gleason ≥4 + 3 disease. Overall there was a change in prostate cancer management in 77 men (37.0%) after TPB. CONCLUSIONS Early TPB during AS is associated with significant upgrading and a change in treatment plan in over a third of men. If TPB was omitted in men with a PI-RADS score <3 and a PSA density <0.15, 12% of those harbouring more significant disease would have been misclassified.
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Affiliation(s)
- James Voss
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Raj Pal
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Shaista Ahmed
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Magnus Hannah
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adil Jaulim
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thomas Walton
- Department of Urology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
OBJECTIVES To explore current delays in diagnosis of retinoblastoma (Rb) and effect on outcome with comparison to a study from the 1990s. SETTING Primary, secondary, tertiary care: majority from South of England. PARTICIPANTS A retrospective analysis of 93 new referrals of sporadic (non-familial) Rb to a specialist Rb unit in London, UK from January 2006 to February 2014. PRIMARY AND SECONDARY OUTCOMES International Intraocular Retinoblastoma Classification, lag times including parental delay and healthcare professional delay, patients requiring enucleation and requirement of adjuvant chemotherapy postenucleation (high-risk Rb). RESULTS During the study period, 29% presented via accident and emergency (A&E). The median referral time from symptom onset to visiting primary care (PC) was 28 days and PC to ophthalmologist 3 days (range 0-181 days). The median time from local ophthalmologist to the Rb Unit was 6 days (0-33). No significant correlation was found between delay and International Classification of Retinoblastoma grade (p>0.05) or between postenucleation adjuvant chemotherapy and enucleation groups (p>0.05). Less enucleations (60%) are being performed compared with the previous study (81%) (p=0.0015). CONCLUSIONS Parents are attending A&E more compared with the 1990s and this may reflect the effect of public awareness campaigns. More eyes are being salvaged despite a similar number of children requiring adjuvant chemotherapy. High-risk Rb and Group E eyes do not correlate with increased lag time in the UK. Other determinants such as tumour biology may be more relevant.
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Affiliation(s)
- Marcus Posner
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Adil Jaulim
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, London, UK
| | - Marina Vasalaki
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- The Western Eye Hospital, Marylebone, UK
| | - Khadija Rantell
- Education Unit, UCL Institute of Neurology, Queen Square, UK
| | - Mandeep S Sagoo
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - M Ashwin Reddy
- Retinoblastoma Unit, Department of Ophthalmology, Royal London Hospital, Barts Health NHS Trust, London, UK
- Moorfields Eye Hospital, London, UK
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Abstract
Adult ingestion of caustic substances is an unusual but serious surgical problem, with injuries likely to be more extensive than those in the corresponding paediatric population. After initial stabilisation and airway management, clinicians are presented with a complex multisystemic problem, frequently requiring a multidisciplinary approach involving several surgical disciplines and associated therapies. A new multidisciplinary team was convened to discuss complex ingestion injury in adults and established techniques were used to bring forward a proposed treatment algorithm. An algorithm may potentially improve clinical efficacy and risk in the management of these complex patients.
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Affiliation(s)
- M Rollin
- University College London Hospitals NHS Foundation Trust , UK
| | - A Jaulim
- University College London Hospitals NHS Foundation Trust , UK
| | - F Vaz
- University College London Hospitals NHS Foundation Trust , UK
| | - G Sandhu
- Imperial College Healthcare NHS Trust , UK
| | - S Wood
- Imperial College Healthcare NHS Trust , UK
| | - M Birchall
- University College London Hospitals NHS Foundation Trust , UK
| | - K Dawas
- University College London Hospitals NHS Foundation Trust , UK
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Chatziralli IP, Jaulim A, Chatzirallis A, Moschos MM. Subconjunctival haemorrhage as an indication of gastrointestinal bleeding. Clin Exp Optom 2015; 99:93. [PMID: 26346714 DOI: 10.1111/cxo.12268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Adil Jaulim
- Royal Derby Hospital NHS Foundation Trust, Derby, East Midlands, UK
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Abstract
INTRODUCTION Ganglioneuromas are benign tumours of the sympathetic ganglia and the adrenal glands medulla. We describe a case of a fit and well 18 year old Caucasian male patient who initially presented to primary care with intermittent episodes of painless frank haematuria as well as some non-specific right-sided loin pain. PRESENTATION OF CASE In this 18 year old man, initial ultrasound investigations at a 'one stop haematuria' clinic revealed the presence of an echogenic solid mass of 120×110×90mm around the upper pole of the right kidney. A CT scan of the abdomen proved inconclusive to further determine the aetiology of the mass. Following a local multidisciplinary meeting (MDT) an MRI of the abdomen was undertaken which confirmed the presence of a large right adrenal mass. A biopsy was taken to determine the histology of the mass confirming a mature ganglioneuroma. The patient subsequently underwent surgery within 6 weeks of having presented to his general practitioner. CONCLUSION AND DISCUSSION The surgery was uncomplicated and excision of the mass was made via a thoraco-abdominal approach. The patient recovered well post operatively and was discharged home within 8 days with outpatient follow-ups organised.
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Affiliation(s)
- A Jaulim
- Department of Urology, Royal Derby Hospital, Derby, United Kingdom.
| | - N Nkwam
- Department of Urology, Royal Derby Hospital, Derby, United Kingdom
| | - S Williams
- Department of Urology, Royal Derby Hospital, Derby, United Kingdom
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Abstract
BACKGROUND Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. METHODS Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search. RESULTS Treatment modalities were analyzed. CONCLUSIONS There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).
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Ghorbanian S, Jaulim A, Chatziralli IP. Diagnosis and treatment of coats' disease: a review of the literature. ACTA ACUST UNITED AC 2012; 227:175-82. [PMID: 22440929 DOI: 10.1159/000336906] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/17/2012] [Indexed: 01/10/2023]
Abstract
Coats' disease is an idiopathic, ophthalmic condition characterized by retinal telangiectasis, intraretinal and subretinal exudation, which can lead to retinal detachment. It is mostly unilateral, progressive and affects mainly males during childhood, although adult cases have also been described. In this review, we make an update of the literature about Coats' disease, emphasizing on diagnosis and treatment, including the most recent treatment modalities, i.e. anti-vascular endothelial growth factor agents.
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Affiliation(s)
- Samim Ghorbanian
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Hannen RF, Michael AE, Jaulim A, Bhogal R, Burrin JM, Philpott MP. Steroid synthesis by primary human keratinocytes; implications for skin disease. Biochem Biophys Res Commun 2010; 404:62-7. [PMID: 21094146 DOI: 10.1016/j.bbrc.2010.11.059] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 11/14/2010] [Indexed: 12/27/2022]
Abstract
Cortisol-based therapy is one of the most potent anti-inflammatory treatments available for skin conditions including psoriasis and atopic dermatitis. Previous studies have investigated the steroidogenic capabilities of keratinocytes, though none have demonstrated that these skin cells, which form up to 90% of the epidermis are able to synthesise cortisol. Here we demonstrate that primary human keratinocytes (PHK) express all the elements required for cortisol steroidogenesis and metabolise pregnenolone through each intermediate steroid to cortisol. We show that normal epidermis and cultured PHK express each of the enzymes (CYP11A1, CYP17A1, 3βHSD1, CYP21 and CYP11B1) that are required for cortisol synthesis. These enzymes were shown to be metabolically active for cortisol synthesis since radiometric conversion assays traced the metabolism of [7-(3)H]-pregnenolone through each steroid intermediate to [7-(3)H]-cortisol in cultured PHK. Trilostane (a 3βHSD1 inhibitor) and ketoconazole (a CYP17A1 inhibitor) blocked the metabolism of both pregnenolone and progesterone. Finally, we show that normal skin expresses two cholesterol transporters, steroidogenic acute regulatory protein (StAR), regarded as the rate-determining protein for steroid synthesis, and metastatic lymph node 64 (MLN64) whose function has been linked to cholesterol transport in steroidogenesis. The expression of StAR and MLN64 was aberrant in two skin disorders, psoriasis and atopic dermatitis, that are commonly treated with cortisol, suggesting dysregulation of epidermal steroid synthesis in these patients. Collectively these data show that PHK are capable of extra-adrenal cortisol synthesis, which could be a fundamental pathway in skin biology with implications in psoriasis and atopic dermatitis.
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Affiliation(s)
- Rosalind F Hannen
- Centre for Cutaneous Research, Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.
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Salh B, Fegan C, Hussain A, Jaulim A, Whale K, Webb A. Pulmonary infection with Nocardia caviae in a patient with diabetes mellitus and liver cirrhosis. Thorax 1988; 43:933-4. [PMID: 3222767 PMCID: PMC461569 DOI: 10.1136/thx.43.11.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The first reported case of pulmonary infection with Nocardia caviae in Britain occurred in a 67 year old woman, in whom diabetes mellitus and liver cirrhosis probably contributed to impaired cell mediated immunity. She was successfully treated with gentamicin 60 mg eight hourly and sulphadimidine 500 mg six hourly for six months and then with sulphadimidine 2 g/day for a further three months. When Nocardia caviae is isolated from the sputum of a patient with chronic respiratory infection and fever, effective treatment should be started promptly.
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Affiliation(s)
- B Salh
- Department of Chest Diseases, Monsall Hospital, Manchester
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