Neutrophils are hyperactive in recurrent tonsillitis

The pathogenesis of recurrent tonsillitis has not been fully explored. Most studies in this field have focused on pathogenic bacteria whereas less research has been done concerning the host defense. In earlier studies it was shown that there is an active cellular defense in the tonsillar surface secretion, consisting of phagocytes, and therefore in this study the possibility that this defense is altered in patients with recurrent tonsillitis was explored. Neutrophils were obtained from tonsillar surface secretions in eight patients with recurrent tonsillitis and eight healthy volunteers and the capacity of the neutrophils to respond to chemotactic stimuli was examined in an in vitro system. A significantly higher fraction of the neutrophils obtained from the patients with recurrent tonsillitis responded to chemotactic stimuli compared to those obtained from the healthy volunteers. It is concluded that there is a hyperactive cellular defense in the tonsillar surface secretion in patients with recurrent tonsillitis. This finding and its significance in the pathogenesis of recurrent tonsillitis are discussed.     

The treatment of streptococcal tonsillitis/pharyngitis in young children

Pharyngitis is common in children, accounting for nearly 12 million visits annually in the United States. Streptococcus pyogenes or group A streptococcus (GAS) is the most common bacterial cause of pharyngitis for which antibiotics are indicated. Antibiotic treatment of streptococcal pharyngitis virtually eliminates the presence of bacteria from the pharynx and thus removes the risk of subsequent rheumatic fever. GAS is spread from person to person via respiratory droplets with a short incubation period of 2∼5 days. GAS pharyngitis peaks in the late winter and early spring months when children are predominately indoors for school and sports. Colonization is also higher in winter months, and while up to 20% of school age children are colonized with GAS in their throat during this time, colonization has not been shown to contribute to the spread of disease. In low- and middle-income countries and other situations in which crowding is common (e.g., schools), outbreaks of pharyngitis are common. GAS pharyngitis can occur at all ages and it is most common in school-aged children with a peak at 7∼8 years of age. Pharyngitis caused by GAS is rare in children <3 years of age and becomes much less common in late adolescence through adulthood.     

MBL2 genetic polymorphisms in Italian children with adenotonsillar hypertrophy

We investigated the role of the polymorphisms in the first exon of MBL2 gene in the susceptibility to recurrent tonsillitis in a selected group of Italian children and healthy controls. Significant difference has been observed in MBL2 genotype and allelic frequencies between children with recurrent tonsillitis and healthy controls matched for sex and age. Children characterized by a "low MBL" producer genotype, namely 00, are more prone to recurrent tonsillitis when compared to the healthy controls. To our knowledge this is the first report on the role of MBL2 polymorphisms in adenotonsillar hypertrophy and our results shown that presence of MBL2 00 genotype could be used as a prognostic marker in subjects with adenotonsillar hypertrophy.     

腭扁桃体中β-防御素的表达及意义

目的 :检测人β 防御素 (hBD) 1,2mRNA在慢性扁桃体炎组织和正常对照组织中的表达 ,分析腭扁桃体在天然免疫中的作用。方法 :应用逆转录聚合酶链反应技术检测 10例扁桃体炎组和 8例正常对照组中hBD 1和hBD 2mRNA的表达。结果 :hBD 1mRNA在扁桃体炎组和正常对照组中均有表达 ,且两组间差异无统计学意义 (P >0 .0 5 )。hBD 2mRNA在正常对照组中仅有微弱表达 ,而在扁桃体炎组中表达明显增强 (P <0 .0 5 )。结论 :扁桃体通过表达hBD在天然免疫中发挥重要作用。     

微波治疗儿童扁桃体炎对免疫功能的影响

目的：探讨微波治疗儿童扁桃体炎对免疫的影响。方法：对所选择的儿童给以微波治疗,分别于手前1周内及术后1个月抽取静脉血2ml,采用免疫比浊法检测血清IgA、IgG、IgM浓度。结果：术后1个月血清IgA、IgG、IgM浓度较术前差异无统计学意义。结论：微波治疗儿童扁桃体炎安全、简便、有效,对儿童机体免疫无影响。     

A potential role for arginase in recurrent infections and hypertrophy of tonsillar and adenoidal tissue

Since arginase has been found to be an arginine-depleting and nitric oxide synthase-regulating enzyme, the present study was devised to examine hypertrophied and infected tonsil and adenoid arginase activity in relation to a metabolic arginase-nitric oxide pathway and its association with disease processes. Tissues were taken from 32 children undergoing adenotonsillectomy. There was a statistically significant difference between the two tissue enzyme activities, with tonsillar arginase activity being higher than the corresponding adenoidal tissue (P < 0.005). This suggests a potential role for tissue arginase activity as an outcome module and a contributing factor in chronic recurrent infection and hypertrophy of tonsillar and adenoidal tissues. Received: 8 October 1998 / Accepted: 22 April 1999     

Clinical immunological study of T lymphocytes and EA rosette forming cells in tonsils

Summary Tonsillar E and EA rosette forming lymphocyte subpopulations were studied in 120 tonsillectomized patients. T cell ratio was usually lower in the tonsils than in the blood. EA binding cells were studied with indicator systems of human or rabbit antibody sensitized red cells, respectively. Poorly sensitized human RBCs (EA_rabbit) bind much better to tonsillar cells than to blood lymphocytes and so this system proved to be specially suitable to study tonsillar EA binding cells. Increase in E and EA_rabbit rosette forming cell frequencies were found with the age of patients. Decrease in percentage of T cells and EA_rabbit rosette binding cells were found with high frequency of acut tonsillitis and with clinical symptoms of chronic local inflammation.The variation of these lymphocyte subpopulations with the local tonsillar inflammatory processes suggest a considerable clinical immunological role of local T cells and of this portion of Fc receptor positive lymphocytes.This work was supported by the Scientific Research Council, Ministry of Health, Hungary (Grant No. 6-07-0304-01-2/M)     

Prevalence of rheumatic heart disease in patients with recurrent tonsillitis and elevated anti-streptolysin O titers

IntroductionPatients with elevated anti-streptolysin O (ASO) titers (ASOT) and recurrent tonsillitis episodes are known to be at higher risk for rheumatic heart disease (RHD). However, there is no data regarding prevalence of RHD in this high risk population. In this study, we aimed to screen ambulatory patients with elevated ASOT and recurrent tonsillitis episodes using echocardiography for identification of RHD. We hypothesized that prevalence of RHD is higher in this patient group compared to general population.Methods102 patients (10.33 ± 4.01 years, 50.98% female) who were diagnosed with recurrent tonsillitis and had elevated ASOT were included this study. Echocardiographic evaluation was performed by an experienced cardiologist.ResultsEchocardiographic examination revealed definite RHD in 2/102 (1.96%) patients and borderline RHD in 3/102 (2.94%) patients.ConclusionOur study demonstrates a high prevalence of RHD in patients with recurrent tonsillitis episodes and high ASOT. Screening with echocardiography is beneficial to improve the detection rates of subclinical RHD in such high-risk populations.     

Predisposing factors and management of complications in acute tonsillitis

Conclusion: RPA and NF was diagnosed with a sensitivity/specificity of 100%/94% in patients with acute tonsillitis and without suspicion for disease complication after ENT examination, but an age >35 years and serum CRP >15.5mg/dl.

Background: Acute tonsillitis represents a frequent disease in the otorhinolaryngology. Some patients exhibit disease aggravations resulting in (descending) peritonsillar abscess (PTA, dPTA), para-/retropharyngeal abscess (PPA, RPA), or necrotising fasciitis (NF). The study analyses the underlying predisposing factors.

Methods: The retrospective cohort study includes a total of 1636 patients comprising 852 outpatients with acute bacterial tonsillitis, 279 in-patients with acute bacterial tonsillitis, 452 patients with PTA, 31 patients with dPTA/PPA, 12 patients with RPA, and 10 patients with NF. Patients were analysed for disease-related data.

Results: While leucocytes do not distinguish the sub-groups, C-reactive protein demonstrated a significant increase resulting in the highest level for RPA and NF (p?p?p?=?0.002) or RPA/NF (p?p?相似文献   

Overcoming penicillin failures in the treatment of Group A streptococcal pharyngo-tonsillitis

The causes of penicillin failure in eradicating Group A beta-hemolytic streptococcal pharyngo-tonsillitis (GABHS PT) are described. These include the presence of beta-lactamase producing bacteria that "protect" Group A beta-hemolytic streptococci (GABHS) from penicillins; the absence of bacteria that interfere with the growth of GABHS; co-aggregation between GABHS and Moraxella catarrhalis; and the poor penetration of penicillin into the tonsillar tissues and the tonsillo-pharyngeal cells. The use of antimicrobials that can overcome and modulate these phenomena and achieve better cure of the infection is described.     

Parapharyngeal abscess: diagnosis,complications and management in adults

Parapharyngeal abscess may cause life-threatening complications. Peritonsillar abscess and tonsillitis may result in parapharyngeal abscess. Since the introduction of antibiotics, the incidence of parapharyngeal abscess secondary to tonsillitis and peritonsillar abscess has decreased dramatically. We present five cases of parapharyngeal abscess resulting from tonsillitis and peritonsillar infection extending to the parapharyngeal space in adult patients. Two were complicated by mediastinitis despite early treatment by wide spectrum antibiotics. We believe that early diagnosis and aggressive antibiotic treatment with early surgical drainage in cases associated with pus collection are the key points in preventing serious and fatal complications. We emphasize the diagnostic role of computerized tomography (CT) scan and the importance of early and proper drainage of these abscesses.     

盐酸克林霉素与喜炎平注射液对急性化脓性扁桃体炎患儿的疗效

目的　探讨盐酸克林霉素（简称克林霉素）单独使用及与喜炎平注射液合用治疗小儿急性化脓性扁桃体炎的安全性及有效性。方法　选取100例急性化脓性扁桃体炎患儿为研究对象,随机分为观察组（n=50）和对照组（n=50）。对照组仅给予克林霉素,观察组给予喜炎平联合克林霉素。比较两组患儿临床症状消失时间、血清促炎因子表达水平及临床疗效。结果　观察组患儿体温复常时间、咽喉疼痛消失时间、扁桃体充血消退时间及脓性分泌物消失时间均显著短于对照组,组间差异具有统计学意义。观察组患儿血清白介素-6（IL-6）、白介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）等促炎因子表达水平显著低于对照组,组间差异具有统计学意义。观察组治疗有效率显著高于对照组（98.0% vs 78.0%）,组间差异具有统计学意义。结论　喜炎平联合克林霉素治疗小儿急性化脓性扁桃体炎的效果优于单纯克林霉素治疗,抑制机体促炎因子表达是其可能作用机制。     

Trends in the indications for pediatric tonsillectomy or adenotonsillectomy

Objective

To report trends in the indications for pediatric tonsillectomy or adenotonsillectomy.

Methods

To identify current indications, (1) a retrospective chart review analyzed all indications for procedures performed by a pediatric otolaryngologist on patients aged 0-3, 4-10, or 11-18 years, and (2) a cross-sectional survey to members of the American Society of Pediatric Otolaryngology asked for approximate percentages of children in the same age groups receiving procedures for obstruction, infection, or another indication. To assess changing indications over time, (3) a literature review was performed.

Results

(1) Chart review: 302 patients aged 5 months to 18 years (average: 6.34; median: 6) were analyzed. For the 0-3-year age group, obstruction was an indication in 100.0% of cases, and infection in 2.6%. For the 4-10-year age group: 91.9% and 13.4%, respectively. For the 11-18-year age group: 84.6% and 33.3%. (2) Survey: 120 surveys were returned (40% response rate), and 63 surveys were appropriate for analysis (21% completion rate). For the 0-3-year age group, obstruction was the primary indication in 91.8% of procedures and infection in 7.5%. For the 4-10-year age group: 73.2% and 25.3%, respectively. For the 11-18-year age group: 43.0% and 54.2%. (3) Literature review: 11 articles consistently illustrated a rise in obstruction and a decline in infection as an indication since 1978.

Conclusions

Obstruction has become a more prominent indication than infection for pediatric tonsillectomy or adenotonsillectomy in children, especially younger children. Infection becomes a more prominent indication as age increases. Data may not be absolutely reflective of all pediatric otolaryngologists or other otolaryngologists that treat children. Comparing studies is difficult owing to the variety of surgical procedures focused upon and terms used to define indications.     

Enzymatic study of tonsil tissue alkaline and acid phosphatase in children with recurrent tonsillitis and tonsil hypertrophy

Objective

Indications for tonsillectomy in recurrent tonsillitis are defined according to the number of episodes of acute bacterial infections in a year. However, little is known about the tonsil immune competence status in patients presenting with recurrent tonsillitis with either hypertrophied or atrophied tonsils, or in patients presenting with obstructive sleep apnoea. In this study we examined the tonsil immune status in children with 3-5 acute recurrent infections a year and in children with obstructive sleep apnoea by comparing the activity of tonsil and adenoid tissue nonspecific alkaline and acid phosphatase.

Methods

Specific activity of tonsil and adenoid tissue nonspecific alkaline and acid phosphatase was investigated in children who underwent tonsillectomy and adenoidectomy for recurrent infection (72 children) and for obstructive sleep apnoea (10 children). Tissue enzyme activities were measured using p-nitrophenylphosphate as a substrate. Tissue samples were examined by the haematoxylin-eosin histological technique. Statistical analyses were performed using SPSS v. 16 software.

Results

The tissue nonspecific alkaline phosphatase activity was similar in hypertrophied tonsils in the recurrent infection group and in the obstructive sleep apnoea group (3.437 ± 1.226 and 3.978 ± 0.762 U/mg of protein, respectively). The enzyme activity in both hypertrophied tonsil groups was significantly higher as compared to atrophied tonsils in the recurrent tonsillitis group, p = 0.021 and p = 0.006, respectively. The enzyme activity was significantly higher in the adenoids compared to the tonsils from all three groups. Contrary to this, no significant differences were noticed for tonsil and adenoid acid phosphatase activities among the groups.

Conclusion

Similar acid phosphatase activity in all three groups implies that all three groups have preserved antigen presenting cell activity. In patients with hypertrophied tonsils similar tissue nonspecific alkaline phosphatase activity suggests preserved B cell tonsil immune activity, regardless of the pathology. Patients with atrophied tonsils had significantly lower alkaline phosphatase activity, indicating relative tonsil B cell immune deficiency. Thus, different immunological status in patients presenting with hypertrophied vs. atrophied tonsils could point to a different underlying pathophysiologic mechanism of the disease.     

Investigation of oxidative stress in patients with chronic tonsillitis

Objectives

Oxidative stress has been implicated in numerous pathological conditions including chronic tonsillitis. The aim of this study was to assess levels of lipid peroxidation, evidenced by formation of thiobarbituric acid reactive substance (TBARS), level of total sulfhydryl groups (TSH), and carbonyl content in patients with tonsillar hypertrophy (TH) and recurrent tonsillitis (RT), before and after tonsillectomy.

Methods

In this study the serum and tonsillar tissue levels of TBARS, TSH and carbonyl content were investigated in 35 patients with TH and RT, before and 1 month after the operation, compared to 30 age-matched controls.

Results

In both TH and RT groups, a significantly higher serum TBARS levels were observed before and 4 weeks after tonsillectomy in comparison with healthy subjects. The serum level in TH patients after operation was even higher compared to the levels before. There was statistically significant difference in serum TSH levels between patients with RT before operation compared to the control group. After tonsillectomy the serum levels of TSH were higher compared to control groups and TH and RT patients before operation. Carbonyl content was attenuated only in TH patients after tonsillectomy. In tonsillar tissue, significantly lower level of glutathione content (GSH) has been observed in RT related to TH patients.

Conclusions

Oxidative stress, in patients with tonsillar hypertrophy and recurrent tonsillitis, is still present 1 month after the removal of tonsillar tissue. Antioxidant therapy, during the recovery period after tonsillectomy, could be optional treatment.     

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

ObjectiveAlthough tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection.MethodsThis double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study.ResultsIn both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001).patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups.Moreover, Compared pain scores in all times across two groups, no significant difference was found.In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up.ConclusionOur study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.     

Ultrastructure of blebbing phenomenon and phagocytosis of blebs in laryngeal carcinoma

Summary The epithelial-connective tissue junction of invasive squamous cell laryngeal carcinoma was examined electron microscopically. The pleomorphic cytoplasmic protrusions known as blebs were observed on the lateral and basal surfaces of malignant keratinocytes. These blebs were pinched off from the malignant epithelial cells and were then observed in the connective tissue or in the intercellular spaces. After the pinching-off process some blebs were seen to be closely surrounded by pseudopods of phagocytizing histiocytic cells in the lamina propria or by adjacent malignant keratinocytes in the intercellular spaces. Since blebs are believed to be intact parts of viable cells this engulfment can be interpreted as cytophagocytosis. During cytophagocytosis the zeiotic blebs exhibited varying degrees of enzymatic digestion. The process of blebbing was discussed in respect to cellular locomotion of malignant keratinocytes during tumor invasion. This phenomenon seems to occur only in the preliminary stages of malignant tumor growth in the larynx.The technical assistance of Mrs. S. Csegezi, Mrs. L. Polasek, and Mr. G. Raffesberg is gratefully acknowledged.     

获得性免疫缺陷综合征合并慢性扁桃体炎患者Th1及Treg应答水平及意义

目的　探讨获得性免疫缺陷综合征（acquired immunodeficiency syndrome,AIDS）合并慢性扁桃体炎患者外周血和扁桃体组织中Th1/Treg应答情况。方法  采用RT-PCR检测了外周血和扁桃体T-bet /Foxp3的表达;同时采用免疫组织化学法检测T-bet/Foxp3以及CD4/CD8细胞的数量;采用全血胞内细胞因子染色方法,分析CD4+IFN-γ+T/CD4+CD25+ Foxp3+细胞表达水平。结果  FACS检测AIDS伴慢性扁桃体炎患者CD4+IFN-γ+T细胞表达（20.65±7.14）%显著低于健康对照（39.13±13.30）%和慢性扁桃体炎患者（36.89±10.05）%;CD4+CD25+Foxp3+细胞表达（7.38±2.63）%则明显高于健康对照（4.31±2.14）%和慢性扁桃体炎患者（4.79±2.23）%;CD4 细胞计数（104.5±60.96）显著低于健康对照（663.9±170.3）和慢性扁桃体炎患者（546.4±151.9）;CD8细胞计数（580.5±130.7）显著高于健康对照（364.7±69.85）和慢性扁桃体炎患者（443.0±150.5）;RT-PCR检测AIDS伴慢性扁桃体炎患者T-bet表达（4.831±2.61）显著低于健康对照（20.12±11.31）和慢性扁桃体炎患者（9.83±3.54）;Foxp3表达（102.5±47.42）显著高于健康对照（57.28±25.19）;免疫组化检测AIDS伴慢性扁桃体炎患者扁桃体组织中T-bet表达（80.20±2.20）显著高于慢性扁桃体炎患者（31.9±2.82）;Foxp3表达和慢性扁桃体炎患者差异无统计学意义;CD4细胞 (42.09±4.09）显著低于慢性扁桃体炎患 者（80.93±3.42）;CD8细胞（80.45±2.81）显著高于慢性扁桃体炎患者（37.57±3.11）。结论　患者外周血和扁桃体组织中存在明显不同的Th1/Treg免疫反应,Th1/Treg失衡在AIDS伴慢性扁桃体炎患者致病机制中起着重要作用。