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PubMed2002

Expression of the recombination-activating genes in extrafollicular lymphocytes but no apparent reinduction in germinal center reactions in human tonsils.

V(D)J recombination in lymphocytes is mediated by 2 recombination-activating genes, RAG1 and RAG2, which are expressed during lymphocyte development in bone marrow and thymus. Prompted by studies reporting re-expression of the RAGs in germinal center B cells, the expression of RAGs and terminal deoxynucleotidyl transferase (TdT) in human lymphoid tissues was examined using in situ hybridization and immunohistochemistry, respectively. Here it is shown that RAGs and TdT are not reinduced in germinal center reactions. However, RAG(+)/TdT(+) cells are frequently present in extrafollicular areas of tonsils mainly at the boundary between lymphoid tissue and fibrous scaffold. Phenotypic analyses suggest that these cells are B cells. Finally, it is shown that RAG(+)/TdT(+) cells are found more frequently in tonsils than in other peripheral lymphoid tissues. This may reflect an increased influx of RAG(+)/TdT(+) cells as a result of higher antigenic stimulation at this site. Alternatively, this observation may indicate that the tonsils are an additional site of lymphocyte ontogeny.

Adolescent↗
PubMed1989

Hemorrhagic tonsillitis.

Eleven patients with acute and/or chronic tonsillitis, who presented with a spontaneous tonsillar hemorrhage are reported and discussed. Two patterns of hemorrhage were noted: 1. diffuse, parenchymal bleeding and 2. localized bleeding from dilated surface vessels. Pharyngeal culture for group A beta-hemolytic Streptococcus was positive in six patients (55%). Monospot, heterophile antibodies, complete blood cell count, prothombin time, partial thromboplastin time, and viral studies did not consistently demonstrate any abnormality. Two patients, however, did have an elevation in liver enzymes. In five patients, the bleeding stopped spontaneously; in five patients the bleeding was controlled with local chemical cautery. In two patients, Avitene was used for hemostasis. One other patient's bleeding was controlled by electrocautery while the patient was under anesthesia for endoscopic evaluation of hemoptysis. Two patients required blood transfusions; one of these patients had a history of factor IX deficiency. Four case histories are discussed in detail to illustrate the varied clinical presentation and some pitfalls in diagnosing and managing this rarely reported complication of tonsillitis. Possible mechanisms for the pathophysiology include increased tonsillar blood flow, necrosis of tonsillar surface cells, and trauma to dilated surface vessels. No common bacterial or viral etiology could be determined in this rare, but potentially serious, complication of tonsillitis.

Acute Disease↗
PubMed2006

The correlation among obesity, apnea-hypopnea index, and tonsil size in children.

BACKGROUND: The correlation between obesity and severity of obstructive sleep apnea (OSA) is well established in adults, but data are inconsistent in children. We hypothesized that there is a significant correlation between the degree of obesity and the severity of OSA in children. METHODS: We retrospectively reviewed records of weight, height, history, and polysomnography of all 1- to 15- year-old children referred to our sleep laboratory. Children with known anomalies and repeated polysomnography were excluded from this study. Obesity was defined as body mass index z score (BMI Z score) > 1.96. The correlation between BMI Z score and apnea-hypopnea index (AHI) was assessed. Possible confounding factors, ie, age, gender, and tonsil size, were adjusted by multiple linear regression. RESULTS: Four hundred eighty-two children were included in this study. Obese children had a significantly higher AHI (median, 1.5; interquartile range [IQR], 0.2 to 7.0) than the AHI of nonobese children (median, 0.7; IQR, 0.0 to 2.5). BMI Z score was significantly correlated with log-transformed AHI (Ln[AHI]) [r = 0.156, p = 0.003]. BMI Z score and tonsil size were still correlated with Ln(AHI) even after adjusted for other confounding factors (p = 0.001). CONCLUSION: Degree of obesity as measured by BMI Z score and tonsil size are significantly related to severity of OSA as reflected by the AHI, although the correlation is mild.

Adenoids↗
PubMed1975

A comparison of free amino acid components in the human adenoid and palatine tonsil.

Free amino acids in the tissue of the palatine tonsil and the adenoid were analyzed using a JEOL 6-AS Type Auto-Analyzer, and comparative examination was made on 26 kinds of amino acids discovered. Of these, 23 amino acids showed significantly high values in the palatine tonsil, but hydroxyproline and tryptophan showed somewhat higher values in the adenoid. These results suggest that the metabolism in the palatine tonsil is more active than in the adenoid.

Adenoids↗
PubMed1981

Incorporation of radioactive free fatty acids into glycerolipids of subcellular fractions from human tonsil lymphocytes.

Human tonsil lymphocytes were cultured with phytohemagglutinin (PHA) for 1-72 hr. Throughout the culture periods studied, PHA stimulated similarly the synthesis of triacylglycerol, phosphatidylcholine and phosphatidylethanolamine from radioactive free fatty acids. There was no significant difference in the stimulation of cellular uptake of different labeled fatty acids tested (palmitic, stearic, oleic and arachidonic acids). Human tonsil lymphocytes were shown to be composed of heterogeneous cell populations with respect to the activities of cellular uptake of free fatty acids. The cells were subfractionated after being labeled with radioactive fatty acids for 6 hr. We found that the light and heavy plasma membranes, which are known to occur in human tonsil lymphocytes, are distinctly different from each other with respect to the labeling patterns of glycerolipids and also to the response to PHA. In the light plasma membranes, the labeling of phospholipids relative to that of triacylglycerol was much less than that of heavy plasma membranes and other organelles, though radioactivity of phosphatidylcholine per mg protein of light plasma membranes was the highest of any other organelles. Furthermore, the stimulation of phosphatidylcholine synthesis by PHA appeared most markedly in the light plasma membranes in comparison to other subcellular fractions.

Cells, Cultured↗
PubMed2002

A case of lymphoepithelioma-like carcinoma arising from the palatine tonsil.

Lymphoepithelioma is the designation that has been given to describe undifferentiated squamous cell carcinoma variants of nasopharyngeal neoplasms (World Health Organization type 3), and a strong association with Epstein-Barr virus (EBV) infection has been established. Outside the nasopharynx, lymphoepithelioma-like carcinomas (LEC) are exceedingly rare in other head and neck lesions. This report features a rare case of LEC of the palatine tonsil occurring in a 60-year-old Japanese man who presented with a three-month history of a neck mass. The surface of tonsils were smooth, not ulcerated macroscopically, and the ipsilateral tonsil showed only slight enlargement on radiological findings. Diagnosis of lymphoepithelioma was finally made based on the pathological review of the tonsillectomy specimens, preceded by a cervical lymph node biopsy. The patient was treated with irradiation and adjuvant chemotherapy. RNA in situ hybridization as well as polymerase chain reaction (PCR) techniques, and serological testing did not demonstrate an association with EBV infection. The clinical presentation, pathological features and association with EBV are described with a review of the literature.

Carcinoma↗
PubMed2002

Developmental study of the anal tonsil in the laboratory shrew, Suncus murinus.

The laboratory shrew, Suncus murinus, which lacks such gut associated lymph organs as the appendix and Peyer's plates, was recently demonstrated (Kubo and Isomura, 1996) to possess a pair of anal tonsils at the end of its rectum. The present paper deals with the development of this lymphoid organ as observed by light and electron microscopy. The anal tonsil was characterized by the initial postnatal development. On neonatal Day 1, a pair of epithelial crypts formed at the dorsal boundary between the anus and the ostium urogenitoanale. On Day 2 after birth, lymphocytes began to accumulate in the subepithelial mesenchymal tissue under the crypt. From Day 3 on, the lymphocytes increased to form a lymph nodule, from which, on Day 5, some lymphocytes began to penetrate into the crypt epithelium. The crypt and the nodule were fused together between Days 6 and 8. A germinal center-like structure was observed on Day 20 after birth. Around Day 40, the invading cells comprised cellular units consisting of large and small lymphocytes and plasma cells. High endothelial venules were observed in the parafollicular area at this time. These findings indicate that the anal tonsil originates from an accumulation of lymphocytes in the mesenchymal tissue close to a particular epithelium of the crypt, presumably in response to antigens in foods; the tonsilar structure is then gradually completed by fusion of the lymphoid and epithelial elements. This paper further reports on an electron microscope finding on Day 8 where the anal tonsillar crypt epithelium was seen to contain some basal-granulated cells of the open type.

Animals↗
PubMed2001

Failure of penicillin to eradicate group A beta-hemolytic streptococci tonsillitis: causes and management.

Despite the fact that group A beta-hemolytic streptococci (GABHS) is always susceptible to penicillin, bacteriologic failure occurs in up to 20% of the patients treated with penicillin, and half of these cases are also a clinical failure. Various theories have been offered to explain this phenomenon. One explanation is that beta-lactamase-producing bacteria (BLPB) "shield" GABHS by inactivating penicillin. Beta-lactamase-producing bacteria were recovered from over 75% of the tonsils of patients who had tonsillectomy for recurrent infection. The absence of interfering aerobic and anaerobic organisms in many patients may also lead to failure of penicillin therapy in these individuals. Other explanations include noncompliance with a 10-day course of therapy, carrier state, re-infection, bacterial interference, GABHS intracellular internalization, and penicillin tolerance. Penicillin is still considered the antibiotic of choice for the therapy of GABHS tonsillitis. However, antibiotics other than penicillin were found to be more effective in eradicating the infection. These included cephalosporins (of all generations), clindamycin, macrolides, and amoxicillin-clavulanate. These agents were more effective than penicillin, especially in treating patients who failed previous penicillin therapy. Treatment of tonsillitis in patients who failed penicillin therapy is aimed at the eradication of the the BLPB that protect GABHS from penicillin, while preserving the oropharyngeal "protective" organisms. This review will describe the scientific and clinical data that demonstrate and explain the phenomena of beta-lactamase production and bacterial interference.

Antibiosis↗
PubMedDate not supplied

IgA immunocytes in tonsils.

Dimeric IgA-forming cells were studied by a secretory component (SC) affinity test on 20 palatine and 7 pharyngeal tonils from children. This study also included an investigation on the immunoflurescent localization of IgA immunocytes and IgA and SC deposits. The results showed that IgA immunocytes capable of binding SC in tissue sections are present in both palatine and pharyngeal tonsils. However, the number of cells positive for the SC affinity test was significantly lower than that of IgA immunocytes not binding SC. IgA immunocytes were located mainly in the subepithelial area, medullary portion, and occasionally the intraepithelial layer. SC determinants were detected only in some epithelial cells of the pharyngeal tonsils. The findings of the present study suggest that the pharyngeal tonsils share in the local immunological mucosal resistance regulated by secretory IgA, although its activity might be limited.

Adolescent↗
PubMed1983

Tonsil and pustulosis palmaris et plantaris. Mainly in respect of complement.

Since the tonsil is one of the immunological organs, a concept whereby the relation between the tonsil and pustulosis palmaris et plantaris (hereafter abbreviated PPP) can be explained by a specific immunological mechanism, has been favoured. It must be pointed out, however, that there have been a considerable number of clinical findings which are irreconcilable with this concept. The present authors have therefore observed the relationship between the tonsil and PPP, from the point of view of non-specific in vivo factors, such as complements and endotoxins. This theory of the authors was motivated by the clinical fact that the serum complement titres of some patients with PPP were changed by performing the tonsillar provocation test, and that in such cases their skin rashes were aggravated after provocation. Thereafter, the distribution of the complemental components in the tonsillar tissue was examined with the immunofluorescence technique and it was found that they were localized mainly in the epithelium of the tonsillar crypt. In other words, the region where the complement system in the tonsillar tissue is active is the crypt. It was further found that the lacunar debris in the tonsillar crypt possesses a strong complement-activating activity. In particular, it was discovered that the action is stronger in bacteria and endotoxins within the lacunar debris. In recent years, the activation of complements associated with the surface layer of the skin has been emphatically considered to be the mechanism causing the onset of aseptic pustules in patients with PPP.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗
PubMedDate not supplied

Phenotyping of mononuclear cells from tonsils and corresponding biopsies using a cytofluorimeter. A comparative study.

A series of B, T, natural killer cell (NK) and monocyte-specific monoclonal antibodies was used to determine the distribution of lymphocyte subpopulations in cell suspensions obtained from whole tonsils as well as their corresponding biopsies. The majority of the mononuclear cells stained with OKB-7 and anti-Dr. A consistent lower percentage of the B lymphocytes stained with OKB-2. The T lymphocytes were composed of a majority of OKT4+ lymphocytes. Only a minority of the lymphocytes stained with Leu-7, whereas Leu-llb+ lymphocytes were virtually absent. A significant proportion of the mononuclear cells stained with OKM-1. There was a highly significant correlation between the distribution of the cells stained with the different monoclonal antibodies obtained from the whole tonsil and the corresponding biopsy (r2 = 0.95). This study shows that biopsies offer a reliable source to study the lymphocyte subsets in tonsils and that cytofluorimetry can be applied to study the lymphocyte distribution in this organ.

Adolescent↗
PubMed1988

Specialization of tonsils as analyzers of the human immune system.

On the basis of current knowledge on the structure and function of tonsils, in agreement with the author's concept on "panautoprotection" in the human body, an attempt at characterizing tonsils as analyzers of the immune system is made. It is suggested that adequate signals for these analyzers are high-molecular substances penetrating orally and nasally. It is emphasized that tonsillar specialization as immunological analyzers refers mainly to the structure of their surface epithelium, the latter being considered as a peripheral component of these analyzers. In evolution, antigen sensitive cells have developed, i.e., the so-called M (membranous) cells. The phenomenon of reticulation in adenoid and tonsillar epithelium is associated with the presence of M-cells in its surface. It is submitted that M-cells may produce immunologically relevant proteins, designated as tonsillopeptides, which can play a role in the formation of lymphoid cells with specific immunological competence. It is presumed also that all possible immunological interactions mediated by the whole range of cellular and humoral factors of immunity in cooperation with the autonomous nervous system may take place in tonsils.

Humans↗
PubMed1988

Structure of the crypt epithelium in human palatine tonsils.

Material from human palatine tonsils from a group of 18 tonsillectomised patients aged 22 months to 8 years was studied by LM, TEM and SEM. Special attention was focused on the structure of the epithelium lining the tonsillar crypts. This is of a dynamic nature in the living organism. In contrast to the stratified squamous epithelium covering the oropharyngeal surface of the tonsil it was often reticulated and invaded by non-epithelial cells. However, it was not uniform throughout. When studied by LM and TEM, adjacent patches of epithelium varied in degree of reticularity. The reticulated epithelium was either covered by a thin layer of squamous cells, or this was disrupted in places where non-epithelial cells passed through. Hence the intact surface, as seen on the SEM, is not a reliable indication of the nature of the underlying structure of the epithelium. Small blood vessels were frequently observed in association with the reticulated epithelium. They formed numerous finger-like projections surrounded by a sleeve of subepithelial connective tissue, and also a fine capillary network within the epithelial thickness. It is proposed that such an organisation of the crypt epithelium offers favourable means for the capturing and processing of antigens by the palatine tonsils.

Blood Vessels↗
PubMed1988

Chlamydia trachomatis: a currently recognized pathogen of tonsillitis.

The authors investigated whether or not Chlamydia trachomatis could be isolated from tonsillar crypts in order to establish directly the relationship of the organism to the tonsillar infection. In 17 of 65 (26.2%) cases with tonsillitis, C. trachomatis was recovered from tonsillar crypts. Ten of the 17 Chlamydia-positive patients were attended for recurrent sore throat and 5 for lingering tonsillitis. Thirteen of the 17 cases had serum antibody to C. trachomatis. We also isolated this microorganism from one of 18 persons complaining of a lumpy throat. Eleven of the 18 Chlamydia-positive patients had pertinent histories of oro-genital sexual activity, and pharyngeal infection apparently resulted from direct inoculation. The available data suggest that tonsillitis, the most common problem in otorhinolaryngology, may be caused by C. trachomatis more often than has been suspected.

Antibodies, Bacterial↗
PubMed1988

Surgery of the tonsils and adenoids in relation to secretory otitis media in children.

One hundred and fifty children aged between 2 and 9 years with bilateral SOM were allocated at random to three groups: Adeno-tonsillectomy (47 cases), adenoidectomy (47 cases) and neither procedure (53 cases). A further 42 children were allocated to either adenoidectomy or no surgery. In all only one ear was treated at random by myringotomy and insertion of a ventilation tube. The unoperated ear was examined six weeks, six months, nine months, one, two and three years post-operatively for otoscopic clearance of the effusion, impedance change and improvement in mean hearing threshold. Thus the effects on middle ear status of adenoidectomy alone and in combination with tonsillectomy were assessed. There was a significant clearance of middle ear fluid, change from no peak to peak impedance measurement and hearing gain as a result of both procedures with a late trend favouring the combined operation. Neither pre-operative tonsils size nor the number of attacks of tonsillitis affect outcome. However there is a relationship between age and radiographic post-nasal space airway size with clearance of the effusion one year after surgery. These findings permit recommendation for adenoidectomy with improved expectation for resolution of SOM if cases are selected with reference to these two variables. They also suggest in which cases the operation should not be recommended. Despite the trends in outcome favouring combined operations, the extra morbidity associated with the addition of tonsillectomy does not at present justify recommendation for removal of the tonsils in addition to adenoidectomy for cases with SOM. Tonsillectomy in these children should be assessed on grounds of tonsillar pathology per se and not on the status of the middle ear.

Acoustic Impedance Tests↗
PubMed1989

Acute tonsillitis in young men: etiological agents and their differentiation.

Group A beta-hemolytic streptococci were found in 38% of 257 young men in military service with acute tonsillitis. Of the 108 patients tested also for viral antibodies, 42% showed a 4-fold rise in antibody titers. Adenovirus was the most frequent (31%) nonstreptococcal agent, followed by Epstein-Barr virus (6%), and influenza virus (5%). Non-group A streptococci were isolated in about the same proportion (18%) as in healthy control subjects. Other data also suggested that these bacteria were carried and not true infecting organisms. Group A streptococci and adenovirus occurred in mixed infection in 9% of the 108 cases. In group A streptococcal tonsillitis compared to others, white blood cell counts were higher (13.3 vs. 8.3 x 10(9)/l, p less than 0.01), C-reactive protein was higher (70 vs. 48 mg/l, p less than 0.01), tonsillitis was more often non-exudative (p less than 0.05), and the duration of fever was shorter (2.2 vs. 3.5 days, p less than 0.01), while there was no difference in the height of the fever or erythrocyte sedimentation rate.

Adenoviridae Infections↗
PubMed1990

Effect of amoxycillin/clavulanic acid on the aerobic and anaerobic tonsillar microflora in the treatment of recurrent tonsillitis.

30 patients with recurrent tonsillitis were treated with amoxycillin/clavulanic acid (500 mg/125 mg) t.i.d. for 10 days. The most often isolated potential aerobic pathogenic bacteria were Staphylococcus aureus, Streptococcus milleri and Haemophilus parainfluenzae. Group A streptococci were isolated from 7 patients. Anaerobic cocci and Bacteroides species were the dominating anaerobic bacteria isolated from the tonsils. Tonsillar cultures were taken before antibiotic treatment started, on days 11-12, day 30, and day 90. Beta-lactamase producing aerobic and anaerobic bacteria were present in 13 patients prior to treatment, on days 11-12 in 18 patients, on day 30 in 15 patients, and on day 90 in 13 patients. Group A streptococci were eradicated in 6/7 patients. In the aerobic tonsillar microflora, the numbers of viridans streptococci decreased during treatment but were normalized after 30 days. Only minor changes in the numbers of other aerobic microorganisms occurred during the investigation. The effect on the anaerobic microflora was minor and no new colonizing microorganisms were isolated during or after antibiotic treatment. All patients except one were cured on days 11-12. Five patients had another episode of tonsillitis during the observation period of 3 months. The antibiotic treatment was well tolerated in most patients and mild adverse events such as nausea, vomiting and diarrhoea were observed in 3 patients.

Adolescent↗
PubMed1996

6-day amoxicillin versus 10-day penicillin V for group A beta-haemolytic streptococcal acute tonsillitis in adults: a French multicentre, open-label, randomized study. The French Study Group Clamorange.

We compared the efficacy and safety of amoxicillin 1 g b.i.d. for 6 days and penicillin V 1 MU t.i.d. for 10 days in the treatment of group A beta-haemolytic streptococcal (GABHS) tonsillitis in adults. 342 patients with acute tonsillitis and a positive test for streptococcal antigen were included in a multicentre, randomized, open-label study; 338 patients were evaluable in an intention-to-treat analysis, and 234 with a positive throat swab culture in a per-protocol analysis. In the per-protocol analysis, the GABHS eradication rate at the end of treatment was comparable in the two groups: 92% (115/125) on amoxicillin and 92.7% (101/109) on penicillin (p = 0.95), as were the clinical success rates of 96% and 95.4%, respectively (p = 0.92). At the follow-up visit (day 28-32), 90.8% of patients treated with amoxicillin and 92.6% of those treated with penicillin V were free of GABHS (p = 0.85). Sore throat disappeared significantly faster on day 2 (p = 0.039) in the amoxicillin group. The intention-to-treat analysis gave similar clinical results. Tolerability was good in both groups. The efficacy and safety of amoxicillin 1 g b.i.d. for 6 days were not statistically different from those of penicillin V 1 MU t.i.d. for 10 days in the treatment of streptococcal tonsillitis in adults.

Acute Disease↗