There are strong evidences suggesting that Thl and Th2 lymphocytes develop from the same Thlymphocyte precursor under the influence of environmental or genetic factors acting at the level of antigen presentation, but it remains to be answered whether it is possible to change the cytokine profile of established or ongoing Th1 and Th2 response. The purpose of this study is to reveal whether it is possible to reverse the cytokine profile of human Th lymphocytes by the modulation of antigen presentation. Using a multiparameter flow cytometric assay that allows simultaneous determination of surface CD4 and intracellular IFN-r or IL-4, we have studied the emergence of Th1 or Th2 lymphocytes in response to tetanus toxoid exposure and the patterns of cytokine synthesis in established T lymphocyte clones. Th2 populations arising after 4 wk of stimulation in IL-2, PHA, tetanus toxoid and irradiated autogeneic peripheral blood mononuclear cells as antigen presenting cells (APC) could give rise to IFN-r-producing Th1 lymphocytes when stimulated in IL-2 plus PHA in the absence of antigen and APC. These IFN-r-producing Th1 lymphocytes nearly disappeared and IL-4-producing Th2 lymphocytes predominated again when cultured again in the presence of antigen and APC. In contrast, prolonged culture in the absence of antigen and APC induced relative predominance of IFN-r-producing The lymphocytes. The cytokine profile of long-term Th2 population arising originally from the repeated stimulation in the presence of antigen and APC appeared more homogeneous and less reversible, although they could convert to Th1 lymphocytes when cultured without antigen and APC. These findings may explain that the polarized Th response is reversible depending on the presence of antigen presentation.
Antigen Presentation* ; Antigen-Presenting Cells ; Clone Cells ; Humans ; Interleukin-2 ; Interleukin-4 ; Lymphocytes ; T-Lymphocytes, Helper-Inducer* ; Tetanus Toxoid

No abstract available.
Hydralazine*

OBJECTIVE: The purpose of this study was to analyse clinical manifestations and laboratory findings in childhood patients with polyarticularonset juvenile rheumatoid arthritis (JRA). METHODS: Eleven cases of polyarticular JRA who were diagnosed and treated in the Department of Pediatrics, Seoul National University Children's Hospital from June 1988 to May 1995 were investigated for clinical manifestations and laboratory findings. RESULTS: 1) There were 6 males and 5 females and their ages of onset were 4 years to 15.1 years(mean 10.9 years). 2) Systemic manifestations were not observed, but low-grade fever was noted in 5 patients. 3) The involvement of joints was symmetric in 9 patients and asymmetric in 2 patients. 4) The most commonly affected joints were knees and ankles, followed by proximal interphalangeal joints of hand, shoulder, elbow, temporomandibular joint, and other joints. 5) Roentgenographic changes of joints were detected in 6 patients and bone scan in 7 patients showed increased uptake in the involved joints. 6) The main laboratory findings observed were microcytic and hypochromic anemia (64%), thrombocytosis (82%), elevated eryhtrocyte sedimentation rate (100%), positive or increased C-reactive protein(100%), positive rheumatoid factor(RF) (18%), positive antinuclear antibody(ANA) (27%). RF was positive in 2 girls with later age of onset and the pattern of immunofluorescent ANA were all homogeneous. 7) Nonsteroid antiinflammatory drugs (NSAIDs) were used most frequently and steroid with or without sulfasalazine was tried in 4 patients unresponsive to NSAIDs. 8) At last follow-up, 6 cases(55%) were classified as functional class I, 4 cases(36%) as class II, and 1 case(9%) as class III. CONCLUSION: These data showed the clinical manifestations and laboratory findings of polyarticularonset juvenile rheumatoid arthritis in Korean children.
Age of Onset ; Anemia, Hypochromic ; Ankle ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis, Juvenile* ; Child ; Elbow ; Female ; Fever ; Follow-Up Studies ; Hand ; Humans ; Joints ; Knee ; Male ; Pediatrics ; Seoul ; Shoulder ; Sulfasalazine ; Temporomandibular Joint ; Thrombocytosis

No abstract available.
Duodenal Ulcer* ; Vagotomy*

No abstract available.
Mucocutaneous Lymph Node Syndrome*

We report a case of dilated pare of Winer occuring in a 33-year-oid female patient. Dilated pore belongs to adenoma or organoid group of benign hair differentiation tumors. The patient has had a giant comedone on the right submandibular area for 1 month. Histopathologic features revealed rnarkedly dilated pilar infundibulum lined by epidermis that is atrophic near the ostium but hypertrophic deeper in the cystic cavity. Three months after excisional biopsy, there was no recurrence.
Adenoma ; Biopsy ; Epidermis ; Female ; Hair ; Humans ; Organoids ; Recurrence

Chronic granulomatous disease (CGD) is an inherited immunodeficient disease characterized by recurrent infections and granuloma formation. Granulomatous obstruction of esophagus is one of the rare complications of CGD. The use of steroids and antimicrobials for esophageal obstruction by granuloma in CGD patients has been controversial due to the possibility of concomitant inapparent infection. We report a case of esophageal obstruction in an 8-year-old CGD patient showing the poor response to antibiotics therapy. However, dramatic improvement of symptoms and radiologic findings of esophageal obstruction were achieved after steroid therapy. One month after discontinuation of steroid, esophageal obstruction recurred and the patient was re-treated with steroid. After that time, he experienced one more recurrence of esophageal obstruction. This symptom subsided after antibiotics therapy without steroid and he has been followed up to the present without further relapse.
Anti-Bacterial Agents ; Child ; Esophageal Stenosis ; Esophagus ; Granuloma ; Granulomatous Disease, Chronic* ; Humans ; Recurrence ; Steroids

No abstract available.
Laparotomy*

No abstract available.
Kidney Pelvis* ; Metaplasia* ; Ureter*

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. Several recent findings that there are activating mutations in the KIT and PDGFRA (platelet-derived growth factor receptor-alpha) genes of GISTs provide the rationale for using targeted therapies such as imatinib or sunitinib. Sunitinib, an oral multitargeted receptor tyrosine kinase inhibitor that inhibits kinases such as KIT, PDGFR (platelet-derived growth factor recepter), and VEGFR (vascular endothelial growth factor receptor), was recently approved for the treatment of imatinib-refractory GIST. Sunitinib is generally well tolerated and has an acceptable toxicity profile; an adverse event such as bowel perforation is rare. We present a patient with imatinib-refractory GIST who was successfully treated using sunitinib, but developed bowel perforation. The mechanism involved in bowel perforation associated with sunitinib is unknown. However, we presume that in our patient, the dramatic reduction in disseminated peritoneal metastases and bowel invasion of recurrent GIST during sunitinib treatment might have resulted in the bowel perforation.
Endothelial Growth Factors ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Humans ; Intestinal Perforation ; Neoplasm Metastasis ; Phosphotransferases ; Protein-Tyrosine Kinases ; Imatinib Mesylate