Immunomodulation therapy in children with chronic hepatitis B.

PURPOSE: The aim of this study is to investigate the effects of HBsAg vaccine and levamisole on virological indicators in naive patients suffering from chronic hepatitis B (CHB) and in healthy carriers of hepatitis B. METHOD: Vaccination and treatment with levamisole were applied to 93 minor patients in total, 43 of them inactive CHB carriers and 50 patients suffering from CHB. RESULTS: 15 (30%) of 50 patients who had high ALT values in the beginning of the study had normal values after treatment. In nine (12%) patients, posttreatment ALT values were higher than pretreatment values, and six (10%) patients showed HBV-DNA loss. In spite of the presence of 50 (54%) HBeAg-positive patients before treatment, 17 (34%) patients proved to be HBeAg-negative after treatment. HBeAg sero-conversion was seen in 10 (20%) cases. In two (2%) patients, HBsAg sero-conversion occurred. CONCLUSION: It was found that treatment with levamisole and vaccine had positive effects on CHB patients and healthy carriers with respect to HBV DNA loss, HBeAg sero-conversion and ALT normalization. The viral load increases and ALT increases that occurred in certain cases were thought to be related to the early immune response. It was determined that combined levamisole and vaccine therapy had no additional positive effect.

Immunomodulatory effects of HBsAg vaccine and levamisole in chronic hepatitis B and hepatitis B carrier children.

BACKGROUND/AIMS: Pathogenesis of chronic hepatitis B and hepatitis B carrier status is related to deficiencies in the immune system. Thus, treatments regulating the immune system are under discussion. The aim of this study was to investigate the effects of HBsAg vaccine and levamisole on lymphocyte subgroups and immunoglobulins in children with chronic hepatitis B and hepatitis B carriers. METHODS: A total of 93 naive children (43 chronic hepatitis B carriers, 50 chronic hepatitis B patients) were treated in three groups with HBsAg vaccine, levamisole or levamisole plus HBsAg vaccine. Levamisole (ketrax) was delivered as 2.5 mg/kg/day per os, three times per week for three months; the vaccine (Gen HevacB) was administered subcutaneously as 20, 30, 40 microg at one-month intervals. Both medications were delivered at same dosages in the combined group. The examinations were performed at pre-treatment and at the end of the third month when the treatment concluded. RESULTS: After treatments, CD3, CD4 and CD4/CD8 significantly increased and CD8 significantly decreased in chronic hepatitis B patient groups, except in the levamisole treated group. IgG and IgA were significantly decreased in all groups of chronic hepatitis B patients. CONCLUSIONS: It was found that HBsAg vaccine induced cellular immunostimulation in children with chronic hepatitis B; however, levamisole did not. The immune cells of hepatitis B carriers did not manifest a significant change in any treatment group. Although there was no change in B-cell, significant decreases were determined in immunoglobulins (IgG, IgA), especially in chronic hepatitis B patients.

Plummer-Vinson syndrome and dilation therapy: a report of two cases.

Plummer-Vinson syndrome is known as the association of postcricoid dysphagia, upper esophageal web, and iron deficiency anemia. Although correction of iron deficiency may result in resolution of dysphagia and sometimes disappearance of the webs, dilation therapy is usually necessary to remove webs and relieve dysphagia. We report two cases of Plummer-Vinson syndrome. Both patients presented with significant and longstanding dysphagia, sideropenia, glossitis and koilonychia. Our two patients had occasional choking and aspiration episodes at eating and endoscope did not pass through at the level of the upper esophagus. Patients' esophagograms revealed the presence of webs in part of the post-cricoid region. Both patients were treated with esophageal bougienage or balloon dilation, and iron supplementation. The patients were examined periodically for two years after the initial treatment and found to be in good general condition.

Hydatid cyst: a rare cause of ascites.

A 26 year old woman with ascites was admitted for further investigations. A diagnosis of hydatid cyst disease was suggested on the basis of a combination of abdominal ultrasonography, computerised tomography and latex agglutination tests. This diagnosis was confirmed following surgical intervention. Hydatid cyst disease is a rare cause of ascites and we review the etiology and clinical features of this condition.

Plasma exchange therapy in HELLP syndrome: a single-center experience.

BACKGROUND/AIMS: The aim of this study was to investigate the effectiveness of plasma exchange therapy in patients with various forms of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. METHODS: During a three-year period, 13 patients with HELLP syndrome were treated with one or two sessions of plasma exchange after delivery. Diagnosis of hemolysis, elevated liver enzymes, and low platelets syndrome was made according to Sibai's criteria, and the severity of illness was categorized according to platelet counts. Among patients, nine were in class-1 and the remaining four were in class-2. Patients with very high levels of aspartate aminotransferase (AST) (>2000 U/L) and lactate dehydrogenase (LDH) (>3000 U/L) were defined as fulminant type (2 cases). RESULTS: Rapid improvement in platelet counts was observed after treatment with plasma exchange. All patients survived except the two fulminant hemolysis, elevated liver enzymes, and low platelets syndrome cases. CONCLUSION: In our study, plasma exchange therapy was effective in patients with severe hemolysis, elevated liver enzymes, and low platelets syndrome, but fulminant cases did not appear to respond to this therapy.

Pill esophagitis caused by telithromycin: a case report.

A large number of oral drugs have been reported to cause pillinduced esophagitis in the medical literature. To our knowledge, this is the first reported case in which telithromycin was the cause of pill-induced esophagitis. In this report, we describe a male patient who admitted to the hospital with dysphagia and retrosternal pain after taking telithromycin (Ketek for acute sinusitis. He had a history of swallowing the film tablet with at least a glass of water and lying down immediately after taking the drug. An upper endoscopic examination demonstrated a deep ulceration of 1 cm diameter in the middle of the esophagus surrounded by relatively normal mucosa. Lansoprazole 30 mg was started. His symptoms improved seven days after cessation of the drug. The esophagus was completely normal in control endoscopy after two weeks. Telithromycin may cause esophageal lesions; therefore, patients should be educated by physicians about the drug's side effects and should drink at least 100 ml water after swallowing the medication. Drug administration should be in the upright position.