Detection of Epstein-Barr virus in tonsillar tissue of children and the relationship with recurrent tonsillitis

Recurrent tonsillitis has been the subject of much investigation. Events considered to predispose to or cause recurrent tonsillitis (RT) include the misuse of antibiotic therapy in acute bouts, alterations in the microflora, structural changes in crypt epithelium and certain viral infections. Epstein-Barr Virus (EBV) infection usually occurs in early childhood and can persist in palatine tonsil lymphocytes to induce tonsillitis at a later date. We have examined the presence of EBV in palatine tonsils in order to assess the relationship between this virus and recurrent acute tonsillitis. Tonsils were obtained from 85 patients, 2--14 years old (mean 5.6 years old) who underwent tonsils and adenoid (T&A) removal because of recurrent tonsillitis (RT) or T&A hypertrophy (TH). Tissues specimens were processed for non-isotopic in situ hybridization (ISH) using EBER 1/2 oligonucleotides (EBER RNA). The indications for surgery were RT in 42 patients and TH in 43 patients. In 25 out of 85 cases (29.4%) a positive EBER RNA reaction (15 RT and 33 TH) was found. The chi(2)-test showed no statistically significant difference in frequency of positive results between RT and TH group. We conclude that tonsils of children can be colonized by EBV and that the virus may be implicated in RT and TH.     

Tonsillectomy in children under 3 years of age

A retrospective study was performed on 190 children younger than 3 years who underwent tonsillectomy either alone or in combination with other surgical procedures at the Children's National Medical Center, Washington, DC, over a 5-year period. The average age was 2 years 4 months and average weight was 12.8 kg. The most common indication for surgery was upper airway obstruction with apnea. One hundred sixty-two of 190 patients were discharged on the day following surgery. Complications were seen in 20 (10.5%) patients, 16 requiring prolongation of hospital stay and 4 requiring readmission. However, apart from one child with cerebral palsy who had multiple post-operative complications, no other child required reintubation, blood transfusion, or return to the operating room. It is concluded that age should not be a factor in determining whether or not to proceed with a tonsillectomy.     

Complications of adenotonsillectomy in children under 3 years of age

Adenotonsillectomy in children may be performed safely on an outpatient basis in the majority of cases without an increase in complication rates. However, very young children comprise a unique patient subpopulation with regard to adenotonsillar surgery. Surgical indications in older children tend to be dominated by chronic recurrent infections, whereas younger children usually require surgery for chronic upper airway obstruction related to adenotonsillar hypertrophy. This study was undertaken to evaluate the adenotonsillectomy patient population under 3 years of age. Complication rates related to airway problems, hemorrhage, and dehydration were determined. Children under 3 years of age demonstrated an increased incidence of postoperative airway complications, manifested by oxygen desaturation and transient upper airway obstruction. It is recommended that adenotonsillectomy be performed on such patients on an inpatient basis with close postoperative monitoring including pulse oximetry.     

Cricotracheal resection in children 2 years of age and younger

OBJECTIVES: We examine the surgical outcomes of cricotracheal resection in children 2 years of age and younger. METHODS: We performed a retrospective case study involving a single tertiary care children's hospital. All patients who underwent cricotracheal resection from 1993 through January 2006 were included. Patients 2 years old and younger were compared to patients more than 2 years of age (range, 2 to 44 years). The primary outcomes measured were decannulation and complication rates. We used chi2 analyses for categorical variables to detect differences in proportions, Student's t-tests for continuous data, and logistical regression to explore for confounding. Significance was set at alpha = .05, 2-tailed. RESULTS: Fifteen children 2 years of age or younger were identified. Most patients underwent a single-stage operation (n = 12). The overall decannulation rate was 87% (2 failures). Two patients younger than 2 years had postoperative complications, including 1 patient who developed anastomosis dehiscence. When compared to the patients over 2 years of age, patients younger than 2 were more likely to undergo a single-stage procedure (p < .01). Additionally, the cricotracheal resection was more likely to be their first attempt at airway reconstruction (p = .002). Complication and decannulation rates were similar in both groups. CONCLUSIONS: Cricotracheal resection can be performed safely and effectively in children less than 2 years old.     

Epstein-Barr virus infection of epithelial cells derived from primary cultures of adenoidal tissue

Summary Epithelial cells derived from primary cultures of adenoidal tissue were exposed to Epstein-Barr virus (EBV) from the throat washings of a patient with infectious mononucleosis (IM) and P3HR-1 and B95-8 cell strains. They were then examined for EBV-specific antigens by immunofluorescence. EBV from both the P3HR-1 cell strains and the throat washings of the IM patient infected the epithelial cells at the 6th and 9th days, respectively. Although the EBV-antigen-positive cells did not increase in number and disappeared at the 12th day after infection, EBV antigens of the virus's replication cycle could still be detected in the epithelial cells shed from cell culture layer at this time. However, the virus obtained from the cell-free 12th day's culture medium was incapable of transforming cord blood lymphocytes.Offprint requests to: M. Furukawa     

Mast cells and histamine in adenoid tissue and middle ear.

Biopsy specimens from middle ear mucosa of patients with secretory (SOM) and chronic (COM) otitis media as well as specimens of adenoid and tonsil tissue were studied for mast cells. Effusion fluid, nasopharyngeal secretion and supernatant of crushed adenoid tissue were analyzed for histamine with a radioenzymatic method. Astra blue (AB) safranine stained highly significantly more mast cells than did toluidine blue. Mast cell counts in SOM and COM were similar. There were significantly more mast cells in adenoid subepithelial tissue than in middle ear mucosal subepithelial layer. For epithelium the counts were within the same range in adenoids and middle ear mucosa. Histamine concentrations were significantly higher than plasma levels for SOM fluid and nasopharyngeal secretion. Crushed adenoid tissue showed values over 100 times higher than the histamine level in the secretion.     

Prevalence of ear diseases in children under 7 years of age in Orenburg]

Incidence rate of otitis media in children under 7 years of age by the number of outpatient consultations in Orenburg, implications of some social factors in this rate and in growing number of cases of chronic otitis media are analysed.     

Detection of Epstein-Barr virus in the tonsils in infectious mononucleosis

Tonsils of 50 patients with infectious mononucleosis were examined for the presence of Epstein-Barr virus nuclear antigens (EBNA) and in 11 cases for the presence of Epstein-Barr virus (EBV) nucleic acid sequences. In tonsillar tissue of 42 patients less than 1 to 40 per cent EBNA-positive cells could be demonstrated by anticomplement immunofluorescence. 10 out of 11 tonsils examined by in situ hybridization contained less than 1 to 50 per cent cells with EBV nucleic acid sequences. The histological examination indicated that cells labelled by in situ hybridisation are in the majority proliferating B-lymphocytes and to a small extent cells of tonsillar epithelium.     

鼻、鼻窦恶性肿瘤中EB病毒和人乳头状瘤病毒的检测

目的：探讨ＥＢ病毒和人乳头状瘤病毒（ＨＰＶ）与鼻、鼻窦恶性肿瘤的关系。方法：用聚合酶链反应（ＰＣＲ）方法检测,３２例鼻、鼻窦恶性肿瘤组织蜡块的ＥＢ病毒和ＨＰＶ（ＨＰＶ６、１１、１６、１８、３３型）基因,分析其与病理分型及ＴＮＭ分期的关系。结果：３２例中检出ＥＢ病毒１２例（３７．５％）,ＨＰＶ２１例（６５．６％）,其中混合感染６例,５例均未检出。与之对照的１０例鼻息肉中未检出ＥＢＶ和ＨＰＶ。ＴＮＭ分     

Mucosa-associated lymphoid tissue in middle ear and Eustachian tube in children

The presence of mucosal lymphoid follicles with germinal centers, so called mucosa-associated lymphoid tissue (MALT), in the Eustachian tube (ET) and middle ear (ME) was investigated in 23 human temporal bones containing the entire ET obtained from 23 children, 3 months to 10 years old at death. Greater numbers of MALTs were found in specimens from children with otitis media (OM) than from those without OM. MALT showed a wedge-shaped distribution through the ME and ET: in all 3 specimens that had MALTs in the ME, these tissues were seen throughout the ET; in all 4 specimens with MALTs in the bony portion of the ET, these tissues were present both in the tympanic and pharyngeal portions of the cartilagines ET; all 7 specimens that had MALTs in the tympanic half of the cartilagines ET had MALTs in the pharyngeal portion of the cartilagines ET as well. Furthermore, MALTs were noted in the pharyngeal portion of the ET in more than half of the specimens without OM but in none of the MEs of specimens without OM. These results support the hypothesis that persistent and recurrent inflammation in the nasopharynx spreads through the ET to play a role in the pathogenesis of chronic OM in children.     

Detection of Epstein-Barr virus DNA in salivary gland tumors]

To evaluate the relations between salivary gland tumors and Epstein-Barr virus (EBV), the levels of EBV-related antibodies were examined, and detection of EBV nuclear antigen (EBNA) and EBVDNA in tumor tissue was attempted by the anti-complement immunofluorescence technique and polymerase chain reaction, respectively. The mean VCA-IgG antibody level was increased to 925 (80-2560) in Warthin's tumor, 496 (40-2560) in mucoepidermoid tumor, and 206 (40-640) in pleomorphic adenoma. The positive rate of EA-IgG was high in Warthin's and mucoepidermoid tumors. VCA-IgA antibody was positive in 2 of the 7 cases of Warthin's tumor. EA-IgA antibody was negative in all cases. EBVDNA was detected in 7 of the 7 cases of Warthin's tumor, 3 of the 5 cases of mucoepidermoid tumor, and 2 of the 26 cases of pleomorphic adenoma. A relationship between Warthin's tumor and EBV was suggested by the 100% detection rate of the viral DNA.     

Complications of adenotonsillectomy in children with OSAS younger than 2 years of age

The most common sleep disorder in children is obstructive sleep apnea syndrome (OSAS). The majority of children with OSAS improve following tonsillectomy and adenoidectomy (T&A). T&A as an outpatient procedure in children is very common. Young age in considered risk factors for postoperative respiratory complications. The purpose of this study is to analyze our experience with postoperative T&A complications in patients younger than 2 years of age. A total of 39 T&A were performed in children younger than 2 years of age. OSAS diagnosis was confirmed by overnight polysomnography (PSG). All the patients were hospitalized and monitored by overnight pulse oximetry monitoring. Post-operatively there was marked improvement in respiratory function in all the patients comparing pre- and post-operative nadir oxygen saturation (P<0.05). Complications were documented in seven patients (20%). Five of the complications occurred in children older than 1 year of age. Bleeding occurred in two patients (5.7%). Three patients (8.6%) had dehydration, one patient (2.9%) had hypercarbia and one patient had laryngospasm. In this study there was a low incidence of peri- and post- operative respiratory complications in children younger than 2 years of age who undergo T&A for OSAS. Identification of OSAS severity may be an important factor in determining the risk of T&A in a young child.     

Alteration of adenoid tissue alkaline and acid phosphatase in children with secretory otitis media

OBJECTIVE: The role of pharyngeal lymphoid tissue in etiopathogenesis of secretory otitis is not yet defined. The influence of tonsillar and adenoid mass, weight, obstruction of naspharyngeal orrifitium, bacterial reservoire or some immunological events are of scientific interest. Tissue nonspecific alkaline phosphatase (TNAP) and acid phosphatase (ACP) are enzymes detected in lymphoid tissue, TNAP as characteristic of B cells, ACP as a characteristic of macrophages and folucullardentritic cells. These enzymes interfere in cell metabolism by removing 5' phosphate group from nucleotides and proteins. Specific activity and kinetic properties were studied in palatinal tonsils and adenoids of children with secretory otitis (OME) and compared with children with recurrent tonsillitis without ear involvement. METHOD: Adenoid and tonsillar tissue of l7 children with OME and 30 children with recurrent tonsillitis were subjected to biochemical investigation using method of releasing of p-nitrophenol from p-nitrophenylphosphate (pNPP). Kinetic parameters as Michaelis-Menten constant were calculated by non-linear regression estimation method. RESULTS: Specific activity of adenoid alkaline phosphatase was lower in children with OME in relation to children with recurrent tonsillitis (t=5.733507, p<0.01). Specific activity of adenoid acid phosphatase was also lower in children with OME (t=3.655456, p<0.01). pH optimum for both enzymes was the same in these two groups of children. Michaelis-Menten constant for both enzymes was significantly higher in adenoid of children with OME than in children with recurrent tonsillitis suggesting lower enzyme affinity for the substrate. CONCLUSION: Differences in specific activities and kinetic properties of adenoid alkaline and acid phosphatases between children with OME and children with recurrent tonsillitis without OME were verified in this study. The results of the study are not able to explain the alteration of alkaline and acid phosphatase characteristics but could point to some possible and specific role of nasopharyngeal lymphoid tissue in pathogenesis of secretary otitis.     

Detection of Epstein-Barr virus DNA in formalin-fixed paraffin-embedded tissue of nasopharyngeal carcinoma using polymerase chain reaction and in situ hybridization.

The polymerase chain reaction method for amplification of DNA in formalin-fixed, paraffin-embedded tissue sections was used to detect Epstein-Barr virus DNA in nasopharyngeal carcinomas from Japanese patients. Thirty-one cases of nasopharyngeal carcinoma and 8 cases of lymph node metastasis of nasopharyngeal carcinoma were studied. Detection rates of Epstein-Barr virus in various types of nasopharyngeal carcinoma according to the World Health Organization classification were as follows: 10 of 10 undifferentiated carcinomas, 8 of 13 nonkeratinizing carcinomas, and 5 of 7 keratinizing carcinomas. Eight lymph node metastases, for which the primary was positive for Epstein-Barr virus, also contained Epstein-Barr virus DNA. By in situ hybridization using a biotinylated Epstein-Barr virus probe, it was clearly demonstrated that Epstein-Barr virus DNA was localized in the nuclei of the neoplastic cells. The clinical features of nasopharyngeal carcinoma with or without Epstein-Barr virus were not different. These results demonstrate that nasopharyngeal carcinoma in Japanese patients is closely associated with Epstein-Barr virus infection, similar to nasopharyngeal carcinoma of other endemic and nonendemic areas.