ABSTRACT
PURPOSE: To determine the causative virus in acute retinal necrosis (ARN) syndrome in a series of patients by calculation of modified Witmer coefficients. DESIGN: Noncomparative case series. PARTICIPANTS: Ten patients with ARN syndrome from four medical centers. METHODS: Aqueous samples, vitreous samples, or both were collected prospectively during surgery from patients with a clinical diagnosis of ARN syndrome. Serologic measures of intraocular and serum antibodies to potentially causative viruses were measured by enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Modified Witmer coefficients (immunoglobulin G and immunoglobulin A) for herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), varicella zoster virus (VZV), and cytomegalovirus (CMV), as well as adenovirus type 2, were calculated from aqueous or vitreous samples, or both. RESULTS: Intraocular antibody measurements were strongly suggestive of a single diagnosis in 9 of 10 patients tested. Modified Witmer coefficients demonstrated intraocular antibody production to HSV in five patients and antibodies to VZV in four patients, and the measurement was inconclusive in one patient. No patients were positive for adenovirus or CMV. Strain-specific antibody titers demonstrated that all HSV-positive patients were reactive only to HSV-2. Herpes simplex virus type 2 was found predominantly in younger patients with ARN syndrome (mean age, 21.2 +/- 10 years; range, 17-39 years), whereas VZV was more commonly seen in older patients (mean age, 40.8 +/- 12.2 years; range, 29-58 years; P = 0.033). Immunoglobulin A testing confirmed immunoglobulin G testing in all patients examined. CONCLUSIONS: Although VZV is thought to be the most common cause of ARN syndrome, HSV-2 is an important cause of ARN syndrome, particularly in younger patients. Because infection with HSV-2 has important medical ramifications, these results suggest that determination of a causal agent should be considered in some cases of ARN syndrome.
Subject(s)
Eye Infections, Viral/virology , Herpes Genitalis/virology , Herpesvirus 2, Human/isolation & purification , Retinal Necrosis Syndrome, Acute/virology , Adolescent , Adult , Aged , Antibodies, Viral/blood , Aqueous Humor/immunology , Aqueous Humor/virology , Enzyme-Linked Immunosorbent Assay , Eye Infections, Viral/immunology , Eye Infections, Viral/surgery , Female , Herpes Genitalis/immunology , Herpes Genitalis/surgery , Herpes Zoster Ophthalmicus/immunology , Herpes Zoster Ophthalmicus/surgery , Herpes Zoster Ophthalmicus/virology , Herpesvirus 2, Human/immunology , Herpesvirus 3, Human/immunology , Herpesvirus 3, Human/isolation & purification , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Male , Middle Aged , Retinal Necrosis Syndrome, Acute/immunology , Retinal Necrosis Syndrome, Acute/surgery , Vitreous Body/immunology , Vitreous Body/virologyABSTRACT
Pentazocine was administered intravenously to 18 subjects, surgical patients and volunteers, ranging in age from 22 to 90 years. When divided into a young group (10 subjects, age 22-48 years) and an elderly group (8 subjects, age 60-90 years), the total clearance decreased as function of age from 22.14 +/- 4.114 to 11.68 +/- 3.593 ml/min/kg, and the elimination half-life increased from 2.5 +/- 0.71 to 4.11 +/- 1.187 hours. No change in the apparent volume of distribution was observed. Implications of change in clearance and half-life on dosage regimen design are discussed.
