Corticosteroid, alkylating agents, like cyclophosphamide and chlorambucil, have been used to treat idiopathic nephrotic syndrome for more than fifty years, changing the outcome of these children. However, with long-term use of steroid, especially high dosages, they have unbearable side effects. Newer agents like cyclosporine A, levamisole, tacrolimus, mycophenolate mofetil, have been used to spare those unwanted side effects. In the choice of drugs, the benefits obtained will have to be evaluated against possible side effects, with drug cost also taken into consideration. Though most steroid sensitive nephrotic children may run a relapsing course, have a good prognosis with many becoming non-relapsers or infrequent relapsers in adulthood, the treatment approach should aim at using the minimal amount of drug required to keep patient in remission to tie them over childhood. As for steroid resistant nephrotic syndrome children, especially for focal segmental glomerulosclerosis (FSGS), because of possible grave prognosis of going into end-stage renal failure, more aggressive approach should be adopted, including the use of strong immunosuppressants, such as, cyclosporine, tacrolimus, or mycophenolate mofetil if necessary. The long-term goals of treatment, other than those of physical and medical conditions, should also consider the growth, education, and psychological impact of the disease and side effects of drugs on the child, especially during an adolescent period, so as to allow them having normal development into adulthood.
Child ; Cyclosporine ; therapeutic use ; Drug Therapy, Combination ; Female ; Humans ; Levamisole ; therapeutic use ; Male ; Nephrotic Syndrome ; drug therapy ; Prednisolone ; therapeutic use ; Tacrolimus ; therapeutic use

Only a few cases of Acanthocephala infections have been reported in humans, and Moniliformis moniliformis is the most common species around the world. We report here a case of infection with M. moniliformis, which passed in the stool of a 2-year-old girl in Iran. The patient had abdominal pain, diarrhea, vomiting, and facial edema. According to her mother, the patient had habit of eating dirt and once a cockroach was discovered in her mouth. In stool examination, eggs of M. moniliformis were not found. She was treated with levamisole and the clinical symptoms reduced within 2 weeks. The specimen contained 2 pieces of a female worm with a total length of 148 mm lacking the posterior end. The spiral musculature of the proboscis receptacle and the shape of the trunk allowed its generic determination. Previously 2 cases of M. moniliformis infection were reported in Iran. This is the 3rd case of M. moniliformis infection in Iran.
Animals ; Anthelmintics/therapeutic use ; Child, Preschool ; Feces/parasitology ; Female ; Helminthiasis/drug therapy/*parasitology/pathology ; Humans ; Iran ; Levamisole/therapeutic use ; Moniliformis/anatomy & histology/*isolation & purification

OBJECTIVETo evaluate the incidence of precore mutation in HBeAg negative HBV infected patients and the therapeutic effect of the immune therapy (levamisole + HBV vaccine + dipyridamole) on patients chronically infected by HBV with precore mutation.

METHODSThe precore region of HBV from the HBeAg (-) chronic hepatitis patients was sequenced and the patients suffered from HBV with precore mutation were treated with immune therapy.

RESULTSThe precore mutation rate was 10/12. The therapeutic effect of the immune therapy on the precore mutation patients (5/7) was better than that on the HBsAg(+), HBeAg(+) patients (2/11), P less than 0.05.

CONCLUSIONThe precore mutation rate was quite high in the HBsAg(+), HBeAg(-) patients we studied. The immune-therapy has some therapeutic effects on the patients with precore mutation. But the number of cases was too small, further study is needed.

Adolescent ; Adult ; Child ; Combined Modality Therapy ; DNA, Viral ; blood ; Dipyridamole ; therapeutic use ; Hepatitis B Vaccines ; therapeutic use ; Hepatitis B virus ; genetics ; isolation & purification ; Hepatitis B, Chronic ; therapy ; virology ; Humans ; Immunotherapy ; Lamivudine ; therapeutic use ; Levamisole ; therapeutic use ; Middle Aged ; Mutation

OBJECTIVES: To determine the effectiveness and toxicity when levamisole was added to the adjuvant combination chemotherapy in patients with operable gastric cancer. METHODS: After en bloc resection of gastric cancer without gross or microscopic evidence of residual disease from April 1991 to December 1992, 100 patients were randomized to 6 months of 5-fluorouracil 1,000 mg/m2/day administered as continuous infusion for 5 days, cisplatin 60 mg/m2/day as intravenous infusion for 1 day with or without levamisole (50 mg every eight hours P.O for a period of three days every 2 weeks for 6 months). This chemotherapy treatment was begun within 2 to 4 weeks after the surgery. The chemotherapy consisted of discrete 5-day courses administered at 4-weeks intervals. All 100 patients are assessable. RESULTS: The fifty patients were assigned to each treatment group. There was no statistical difference and no bias in the distribution of characteristics of the 100 evaluable patients between the two groups. A total of 274 courses of treatment were given in the levamisole group and 260 courses of treatment in non-levamisole group. Eleven patients in each group did not finish planned 6 courses of treatment mainly due to non-compliance. At median follow up of 39 months, 32 patients relapsed 19 in the levamisole group and 13 in the non-levamisole group (p = 0.284). Twenty five patients died of relapsed diseases, 15 in the levamisole group and 10 in the non-levamisole group. The levamisole group tended to show more risk of overall death rate and recurrence than the non-levamisole group. However, this result was not statistically significant at 3 years. The treatment was well tolerated in both treatment groups. The grade 2-3 toxicities were nausea/ vomiting (levamisole, non-levamisole group; 31.7%, 29.3% of treatment courses respectively), diarrhea (7.6%, 8.4%), mucositis (11.6%, 12.3%), and leukopenia (9.8%, 9.6%). CONCLUSION: Levamisole had negative effects on disease-free survival and overall survival when added to adjuvant combination chemotherapy of cisplatin and 5-fluorouracil in patients with operable gastric cancer. Both treatment arms were generally well tolerated and the toxicity profile was similar with or without levamisole.
Adjuvants, Immunologic/administration & dosage* ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use* ; Antineoplastic Agents, Combined/adverse effects ; Cisplatin/administration & dosage ; Comparative Study ; Female ; Fluorouracil/administration & dosage ; Human ; Levamisole/administration & dosage* ; Male ; Middle Age ; Stomach Neoplasms/mortality ; Stomach Neoplasms/drug therapy*

In a patient receiving 5-fluorouracil and levamisole, neurologic deficits suggest the cerebral demyelinating syndrome as a differential diagnosis. The authors report a patient diagnosed as multifocal inflammatory leukoencephalopathy for which thallium-201 ((201)Tl) single photon emission computed tomography (SPECT) and proton magnetic resonance spectroscopy (MRS) were employed as noninvasive diagnostic tools. (201)Tl SPECT study was negative and proton MRS showed an increase of choline and lactate and well preserved N-acetylaspartate. These findings support histopathologic findings of multifocal inflammatory leukoencephalopathy revealing demyelination with relative axonal sparing in the patient.
Adjuvants, Immunologic/adverse effects/therapeutic use ; Antimetabolites, Antineoplastic/adverse effects/therapeutic use ; Aspartic Acid/*analogs & derivatives/metabolism ; Axons/pathology ; Biopsy ; Brain/pathology ; Brain Neoplasms/secondary ; Choline/metabolism ; Colorectal Neoplasms/drug therapy/pathology ; Diagnosis, Differential ; Fluorouracil/adverse effects/therapeutic use ; Human ; Lactic Acid/metabolism ; Leukoencephalopathy, Progressive Multifocal/*diagnosis/etiology ; Levamisole/adverse effects/therapeutic use ; Magnetic Resonance Spectroscopy/*methods ; Male ; Middle Aged ; Neoplasm Metastasis ; Thallium Radioisotopes/*diagnostic use ; Tomography, Emission-Computed, Single-Photon/*methods