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G R Corey

Publications and source records attributed to G R Corey.

At least 55 records · Page 3Linked to original sources
PubMed1997

An evaluation of the Duke criteria in 25 pathologically confirmed cases of prosthetic valve endocarditis.

Six studies have compared the sensitivity of the Duke criteria with that of the Beth Israel criteria for the diagnosis of infective endocarditis without attempting to distinguish between native valve and prosthetic valve cases. After reviewing clinical data from 372 cases of suspected prosthetic valve endocarditis, we selected 25 cases in which pathological confirmation of prosthetic valve endocarditis was obtained. By using the Duke criteria and then the Beth Israel criteria, we reassigned a diagnostic classification to these 25 cases on the basis of clinical parameters alone. Using the Duke criteria, we correctly classified 19 cases (76%) as definite endocarditis and rejected none, while the Beth Israel criteria correctly classified six cases as probable endocarditis (24%) and rejected five cases (20%). Similar to previous investigators who examined the diagnostic sensitivity of the Duke criteria and Beth Israel criteria, we found that the Duke criteria appear more sensitive than the Beth Israel criteria in pathologically confirmed cases of prosthetic valve endocarditis.

Drug Resistance, Microbial↗
PubMed1997

Bacillus cereus necrotizing cellulitis mimicking clostridial myonecrosis: case report and review of the literature.

We describe a case of rapidly progressive necrotizing cellulitis in an immunocompromised farmer caused by Bacillus cereus, and review 15 additional cases of serious soft tissue infection due to this organism reported in the English language literature. These cases illustrate the potential for B. cereus to cause fulminant soft tissue disease indistinguishable from that caused by clostridia.

Bacillaceae Infections↗
PubMed1996

Negative predictive value of the Duke criteria for infective endocarditis.

With use of new Duke criteria, 405 episodes of suspected endocarditis were previously classified as "definite," "possible," or "rejected" endocarditis. To determine the negative predictive value of the Duke clinical criteria for the classification of suspected endocarditis, chart review and follow-up were performed for the 52 episodes in which the diagnosis of endocarditis was rejected. Three of 52 episodes were reclassified to possible endocarditis; 49 episodes in 48 patients met the criteria for rejected endocarditis. Of these 49 episodes, 31 (63%) had a firm alternate diagnosis other than endocarditis, 17 (35%) had resolution of the clinical syndrome leading to the suspicion of endocarditis with < or = 4 days of antibiotics, and 1 patient had no evidence of endocarditis at surgery. Echocardiograms recorded in 3 patients with rejected endocarditis had evidence of oscillating valvular masses, and blood cultures were positive in 13 episodes; none of these patients had evidence of endocarditis at follow-up. Follow-up or outcome information was available in all 49 episodes. Excluding the 5 in-hospital deaths, mean duration (+/- SD) of follow-up was 39.9 +/- 28.8 months (range 0.5 to 108.0); in living patients, mean time to final follow-up was 56.2 +/- 25.2 months (range 25.0 to 108.0). One patient had possible infective endocarditis at autopsy. No patient in our series whose diagnosis of endocarditis had been rejected had proven endocarditis. Therefore, the negative predictive value of the Duke clinical criteria for endocarditis is at least 92%.

Adult↗
PubMed1996

Resistant enterococci: a prospective study of prevalence, incidence, and factors associated with colonization in a university hospital.

OBJECTIVE: To determine the prevalence of gastrointestinal tract colonization with antibiotic-resistant enterococci at ward entry and to study the incidence and risk factors for nosocomial acquisition of colonization with resistant enterococci. DESIGN: A prospective cohort study conducted between February 1 and March 15, 1993. METHODS: Rectal cultures were obtained within 24 hours of admission or transfer onto the study wards and repeated at weekly intervals and at the time of discharge. Patients harboring antibiotic-resistant enterococci at the time of admission or after admission were compared to patients who were not colonized with these organisms. Clinical and epidemiologic risk factors for colonization were abstracted prospectively by daily chart review. Following a univariate analysis of risk factors associated with colonization, a multivariate statistical analysis using three separate models was done. SETTING: A 1,125-bed, tertiary-care teaching hospital in North Carolina. PATIENTS: A total of 350 patients admitted to two general medical wards and the medical intensive care unit during the study period. RESULTS: Antibiotic-resistant enterococci were isolated from 52 patients: 19 were colonized at admission to the study, and 33 later acquired resistant strains. At the time of admission, 5.4% of the patients were colonized with ampicillin-resistant enterococci (ARE), including 1.1% that were colonized with vancomycin-resistant enterococci. Prior hospitalization was associated with colonization with ARE at admission (P = .01). Independent risk factors for nosocomial acquisition of ARE included treatment with more than three antibiotics, empiric use of antibiotics, use of third-generation cephalosporins, and the use of enteral tube feedings. Antibiotics used prophylactically were not associated with resistant enterococcal colonization. CONCLUSIONS: Our data help to elucidate the epidemiology of gastrointestinal tract colonization with resistant enterococci. We hypothesize that surveillance and control programs will be more likely to succeed if targeted at patients receiving more than three antibiotics, empiric antibiotics, and enteral tube feedings (Infect Control and Hosp Epidemiol 1996;17:36-41).

Ampicillin Resistance↗
PubMed1995

International health and internal medicine residency training: the Duke University experience.

OBJECTIVE: To evaluate the impact of the Duke University Medicine Residency International Health Program (IHP) on program participants and to evaluate the relationship of the IHP to the residency program. SUBJECTS AND METHODS: The Duke University Medicine Residency Program classes of 1988 to 1996 participated in a questionnaire-based survey. All program participants (n = 59), a group of nonparticipants (n = 138), and residents who had not yet had an opportunity to participate (preparticipants; n = 106). RESULTS: The overall response rate to the questionnaire was 93%. Participation exceeded expectations and had a strongly positive impact on personal and professional lives of the majority of the participants. Participants reported a significant positive impact on their training in internal medicine and their knowledge of tropical medicine. A minority of nonparticipants identified a positive effect in these areas due to conferences and interactions with their participating colleagues. Participants who changes career plans during residency tended to move toward areas of general internal medicine or public health, in contrast to nonparticipants who tended to change areas of subspecialty or chose private practice. The IHP was identified as a significant factor for selection of the Duke Medicine Residency by 42% of the preparticipant group. Nearly all of the respondents (99%) indicated that the IHP should be continued. CONCLUSION: The IHP has a measurable positive impact on the participants, as well as on the Medicine Residency Program.

Career Choice↗
PubMed1995

Consultation in university-based and community-based infectious disease practices: a prospective study.

Infectious disease physicians in university and community practices completed a standard data form following each of 1,366 inpatient consultations during a 7-month period. The rate of consultation was higher in the university practice than in the community practice (3.4 vs. 1.8 per 100 discharges, respectively). Known or suspected bacterial pathogens accounted for more than half of all consultations in both practice groups. The three organ systems most commonly affected by infection were pulmonary (20% in university practice vs. 19% in community practice), skin and soft tissue (13% in university practice vs. 20% in community practice), and musculoskeletal (12% in university practice vs. 16% in community practice). Bloodstream infection, pneumonia, unexplained fever, osteomyelitis, urinary tract infection, and cellulitis were the six most common disease processes that led to consultation in both practice groups. The percentage of patients with noninfectious diseases and the percentage for whom a change in antimicrobial therapy was advised was nearly identical in both practice settings. Physicians in private practice performed more consultations on weekends (20% vs. 11% in university practices, P < .001) and between 6:00 P.M. and 7:00 A.M. (15% vs. 6% in university practices, P < .001). The scope and diversity of the work of consultants in community practices are nearly identical to those of their colleagues in university-based practices.

Communicable Diseases↗
PubMed1995

Cytomegalovirus pericarditis: a case series and review of the literature.

Cytomegalovirus (CMV) commonly infects both normal and immunocompromised hosts. Although it usually produces an asymptomatic infection to mild illness, CMV has the potential to significantly injure many different organs. Reports of CMV causing pericardial disease, however, are limited and documentation of infection by growth of the virus from tissue or fluid is rare. As part of a prospective trial of subxiphoid pericardial biopsy in 57 adult patients with large pericardial effusions, three culture-proven cases and one serologically confirmed case of CMV pericardial disease were discovered. Subsequently, CMV was grown from the pericardium of an infant with congenital heart disease. A review of the documented cases of CMV pericarditis is provided along with a discussion of the pathogenesis and significance of this perhaps not so uncommon disease.

Adult↗
PubMed1995

The diagnosis of Plasmodium falciparum infection using a new antigen detection system.

With the widespread emergence of drug-resistant Plasmodium falciparum infection, febrile patients in the tropics can no longer be empirically treated with inexpensive yet effective antimalarials. The substitution of newer and more costly drugs brings with it the need for rapid, accurate, and inexpensive diagnostic procedures so that directed therapy can be used. We report a field trial comparing standard microscopic malaria diagnosis and quantitative buffy coat analysis to a new P. falciparum antigen detection system. The ParaSight F test (PFT) was found to be easy to learn, rapid to perform, and highly accurate. If confirmed, the use of the PFT in endemic areas may aid in the identification of patients requiring therapy for drug-resistant malaria.

Adolescent↗
PubMed1994

Mycoplasma hominis septic arthritis: two case reports and review.

Mycoplasma hominis is normally a commensal of humans. When the organism is pathogenic, it primarily causes disease in the genitourinary tract. Septic arthritis caused by M. hominis is a rare condition that occurs chiefly in the postpartum period, in immunosuppressed hosts, or in patients who have recently undergone urinary tract manipulation. Arthritis caused by M. hominis is clinically indistinguishable from septic arthritis caused by other bacteria. Diagnosis is often delayed because infection with this organism is not suspected or because it grows slowly, if at all, in routine culture media. Appropriate therapy often leads to a good outcome, although relapses and resistance have been reported.

Aged↗
PubMed1994

Clostridium septicum abscess in hepatic metastases: successful medical management.

Clostridium septicum bacteremia is frequently associated with hematologic and colonic malignancies and neutropenia. It frequently produces 'metastatic' gangrene with excessive mortality. Standard therapy usually includes surgical debridement and antibiotics. We present a patient with metastatic breast cancer treated with high-dose chemotherapy and bone marrow transplantation. She was treated successfully with antibiotics alone despite developing Cl. septicum bacteremia and gas in hepatic metastases. The pathophysiology of this infection is reviewed.

Adult↗
PubMed1994

The use of a polymerase chain reaction as a diagnostic test for Rocky Mountain spotted fever.

A polymerase chain reaction (PCR) for amplifying ribosomal DNA of Rickettsia rickettsii was performed on blood clots and urine samples from 10 patients with suspected Rocky Mountain spotted fever (RMSF) and five controls with nonrickettsial diseases. The results of this PCR-based procedure were positive in four of the five patients with probable RMSF, but reamplification was required in three patients. Rickettsia rickettsii was grown from the blood of two of these four patients. The urine from one patient was also PCR-positive. These results confirm earlier findings that the PCR can detect R. rickettsii, but the need for reamplification indicates that the lack of sensitivity is a serious limitation in the usefulness of the PCR as a clinical diagnostic test.

Bacteremia↗
PubMed1993

Etiology of large pericardial effusions.

PURPOSE: To determine the effectiveness of the preoperative evaluation and overall diagnostic efficacy of subxiphoid pericardial biopsy with fluid drainage in patients with new, large pericardial effusions. DESIGN: A prospective interventional case series of consecutive patients admitted with new, large pericardial effusions. PATIENTS AND METHODS: Fifty-seven of 75 consecutive patients admitted to a university tertiary-care center and a university-affiliated Veterans Administration Medical Center with new, large pericardial effusions were studied over a 20-month period. Each patient was assessed by a comprehensive preoperative evaluation followed by subxiphoid pericardiotomy. The patients' tissue and fluid samples were studied pathologically and cultured for aerobic and anaerobic bacteria, fungi, mycobacteria, mycoplasmas, and viruses. RESULTS: A diagnosis was made in 53 (93%) patients. The principle diagnoses consisted of malignancy in 13 (23%) patients; viral infection in 8 (14%) patients; radiation-induced inflammation in 8 (14%) patients; collagen-vascular disease in 7 (12%) patients; and uremia in 7 (12%) patients. No diagnosis was made in four (7%) patients. A variety of unexpected organisms were cultured from either pericardial fluid or tissue: cytomegalovirus (three), Mycoplasma pneumoniae (two), herpes simplex virus (one), Mycobacterium avium-intracellulare (one), and Mycobacterium chelonei (one). The pericardial fluid yielded a diagnosis in 15 (26%) patients, 11 of whom had malignant effusions. The examination of pericardial tissue was useful in the diagnosis of 13 (23%) patients, 8 of whom had an infectious agent cultured. Of the 57 patients undergoing surgery, the combined diagnostic yield from both fluid and tissue was 19 patients (33%). CONCLUSIONS: A systematic preoperative evaluation in conjunction with fluid and tissue analysis following subxiphoid pericardiotomy yields a diagnosis in the majority of patients with large pericardial effusions. This approach may also result in the culturing of "unusual" infectious organisms from pericardial tissue and fluid.

Biopsy↗
PubMed1993

Disseminated infection with rapidly growing mycobacteria.

Disseminated infection with the rapidly growing mycobacteria Mycobacterium chelonae and Mycobacterium fortuitum is uncommon. Only eight cases were diagnosed at Duke University Medical Center (Durham, NC) over the last 14 years. We identified 46 other cases by review of the medical literature since 1960. We categorized these 54 cases into three groups according to underlying disease and outcome. Group 1 comprised patients with no identified immune defect, a kidney transplant, collagen vascular disease, or chronic renal failure; these patients usually presented with skin involvement and responded well to antimicrobial therapy (survival rate, 90%). Group 2 comprised patients with cell-mediated immune deficiency, lymphoma, or leukemia; they presented with widespread, multiorgan involvement and severe illness. The survival rate in this group was only 10%. Patients in group 3 (who had other underlying diseases) had intermediately severe illnesses and intermediate responses to therapy. These groups provide the basis for an understanding of disseminated infection secondary to rapidly growing mycobacteria and of the profound effect that unresolved immunosuppression has on survival.

Adolescent↗
PubMed1993

Postoperative pubic osteomyelitis misdiagnosed as osteitis pubis: report of four cases and review.

Osteitis pubis is a painful inflammatory process resulting in bony destruction of the margins of the symphysis pubis. Despite six decades of speculation, the pathogenesis of, criteria for diagnosis of, natural history of, and optimal therapy for osteitis pubis remain controversial. We present four cases of postoperative pubic osteomyelitis that were initially thought to be typical cases of osteitis pubis. These cases illustrate that pubic osteomyelitis can mimic the principal features of osteitis pubis including characteristic pelvic pain and gait disturbance, symmetrical bony destruction of the symphysis pubis, absence of fever, a long interval between surgery and onset of symptoms, lack of response to antimicrobial therapy, and apparent spontaneous cure. We believe that many previously reported cases of osteitis pubis were actually cases of unrecognized pubic osteomyelitis. We advise an aggressive diagnostic approach to cases of apparent postoperative osteitis pubis including biopsy and needle aspiration of the symphysis pubis guided by computer-assisted tomography. If cultures of biopsy specimens are not diagnostic, open biopsy of the symphysis pubis is recommended.

Adult↗
PubMed1993

Mycoplasmal pericarditis: evidence of invasive disease.

Although the pathogenic mycoplasmas usually infect the respiratory and urogenital tracts, these organisms also can cause disease in remote sites. Such infections are difficult to diagnose because of both the fastidious nature of the mycoplasmas and the failure to consider their presence. Pericarditis is an uncommonly diagnosed and rarely confirmed example of invasive mycoplasmal infection. As part of a prospective study of large pericardial effusions, we discovered two cases with Mycoplasma pneumoniae infection. Subsequently, two cases of pericarditis due to Mycoplasma hominis and one due to Ureaplasma urealyticum were diagnosed. For all five patients, cultures of pericardial tissue and/or fluid were positive. In addition, four of the five patients either were immunocompromised or had undergone cardiac surgery previously. Appropriate antibiotic therapy was uniformly effective. We report here our experience with mycoplasmal pericarditis, provide evidence of an invasive pathogenesis for this syndrome, and suggest that pericardial disease caused by these organisms may not be an uncommon finding when sought in an aggressive manner.

Adult↗
PubMed1993

A prospective trial of subxiphoid pericardiotomy in the diagnosis and treatment of large pericardial effusion. A follow-up report.

OBJECTIVE: This study was designed to determine the cause of large pericardial effusions and evaluate the efficacy of subxiphoid pericardiotomy. SUMMARY BACKGROUND DATA: Despite great advances in the techniques used to diagnose pericardial effusions, much controversy remains concerning their cause and the optimal treatment of these effusions. METHODS: In a prospective consecutive case series, 57 patients underwent a thorough preoperative evaluation followed by a subxiphoid pericardiotomy. All tissue and fluid was exhaustively evaluated. Postoperatively, all patients were followed for a least 1 year. RESULTS: Surgery was performed under local anesthesia in 77% of patients, and the complications of surgery were minimal. Pericardial tissue and fluid established or aided in establishing a diagnosis in 81% of patients. Infection and malignancy were the leading causes; the condition in only 4 patients remained undiagnosed. Follow-up revealed recurrent effusion in nine (16%) patients, but only five (9%) required further surgery. The mortality rate at 30 days was 12%, and at 1 year, it was 37%. Fourteen of the 21 deaths occurred in patients with malignancies. CONCLUSIONS: These data show that the cause of most large pericardial effusions can be determined by a thorough evaluation accompanied by subxiphoid pericardiotomy. In addition, subxiphoid pericardial biopsy and window creation is safe and effective in the treatment of these effusions.

Biopsy↗