ABSTRACT
Clinical trials of anticytokines in sepsis have not been as straightforward as had been anticipated from results in animal models of sepsis and the role of cytokines in sepsis is now in question. Retrospective analysis of the results of a phase III trial of interleukin-1 (IL-1) receptor antagonist suggests that sepsis-induced adult respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), renal dysfunction, and shock are valuable markers of patients in whom IL-1 is a pathogenic mediator and in whom IL-1ra can reduce mortality. A re-examination of the effects of IL-1ra in animal models of sepsis supports the validity of this analysis. A new phase III clinical trial will confirm or disprove the hypothesis that IL-1 is a mediator of pathology, and IL-1ra is a valuable therapy for sepsis complicated by ARDS, DIC, renal dysfunction, or shock.
Subject(s)
Interleukin-1/physiology , Receptors, Interleukin-1/antagonists & inhibitors , Sepsis/drug therapy , Sialoglycoproteins/pharmacology , Disseminated Intravascular Coagulation/etiology , Double-Blind Method , Humans , Interleukin 1 Receptor Antagonist Protein , Kidney Diseases/complications , Kidney Diseases/etiology , Placebos , Respiratory Distress Syndrome/etiology , Sepsis/complications , Sepsis/mortality , Shock/etiology , Survival RateABSTRACT
Clinical features of 152 patients with herpetic keratitis after a five-year observation period were analyzed. When compared with dendritic ulceration, geographic ulcers that had been symptomatically present for a longer time were more likely to have been treated with a topical steroid and took longer to heal. After treatment of the corneal ulceration, 40% of the patients experienced a recurrent herpetic ulcer, 25% experienced disciform or irregular stromal keratouveitis, 5% experienced ocular hypertension, and 6% had a decrease in visual acuity caused by corneal scarring. Recurrent ulcerative herpetic keratitis occurred more frequently in men and in patients who entered the study with a history or previous herpetic ulceration.
Subject(s)
Corneal Ulcer/therapy , Keratitis, Dendritic/therapy , Adolescent , Adult , Aged , Antiviral Agents/therapeutic use , Child , Corneal Ulcer/etiology , Debridement/methods , Female , Follow-Up Studies , Humans , Intraocular Pressure , Male , Middle Aged , Prognosis , Random Allocation , Recurrence , Trifluridine , Vidarabine/therapeutic use , Visual AcuityABSTRACT
A small group of glaucoma patients with scotomata were compared with normal coevals. Plots were obtained of the error of each measurement as a function of retinal illumination. A statistical analysis shows the limitations of perimetry as a monitor of the progress of glaucoma. The significance of the data is discussed.
Subject(s)
Glaucoma/diagnosis , Visual Fields , Humans , Light , Middle Aged , Photometry , Visual Field TestsABSTRACT
Osmolal, electrolyte, and other responses in peripheral blood were recorded after water loading of patients with ocular hypertension and chronic simple glaucoma, and with a small group of younger normal subjects. The osmolal responses of the ocular hypertensive group were significantly greater than for the glaucoma group, and further differences in plasma potassium concentration were also found. Drinking habits may exert a significant influence in ocular hypertension. The relative contributions to the diagnostic category of the variables recorded was evaluated by discriminant analysis, and the application of this retrospective approach to the assessment of new patients is discussed.
