Measurement of tonsillar blood flow in normal and pathological conditions by the use of the 133Xe clearance technique

By using the 133Xe clearance technique, we measured the blood flow to the human palatine tonsil in 10 normal volunteers, 11 patients with chronic tonsillitis, and 11 with hypertrophic tonsils. We found that the mean blood flow was 30.08 +/- 5.39 ml/ 100 g per min in normal tonsils, 17.06 +/- 3.72 in chronic tonsillitis and 49.50 +/- 9.30 in hypertrophic tonsils. Our results show a statistically significant decrease in blood flow in chronic tonsillitis (P less than 0.01) and a significant increase in hypertrophic tonsils (P less than 0.01) when compared to the normal controls. The difference between the blood flow in chronic tonsillitis and hypertrophic tonsils was also statistically significant (P less than 0.01). In all three groups studied, no statistically significant difference was observed in the blood flow to the right and left tonsils (P greater than 0.05).

Tympanometric findings in patients with adenoid hyperplasia, chronic sinusitis and tonsillitis

Tympanograms were done on 120 patients with adenoid hyperplasia, chronic sinusitis and chronic tonsillitis to measure the middle-ear pressure as a parameter to eustachian tube function. The results were compared with those obtained in 50 normal subjects. The statistical significance of the mean values of middle-ear pressure is very highly significant in patients with adenoid hyperplasia, significant in chronic sinusitis group and insignificant in patients with chronic tonsillitis, as compared to the normal control group. Hence, eustachian tube dysfunction is maximum in patients with obstructing adenoids, less in chronic sinusitis and least in chronic tonsillitis.

Autonomic nervous system in human palatine tonsil

The autonomic nervous system in the human palatine tonsil was studied systematically as follows: 1) Using the radio binding assay method, the presence of beta-adrenergic receptors and muscarinic-cholinergic receptors was demonstrated in the tonsil. 2) Using high performance liquid chromatography, the quantity of catecholamines in the tonsillar tissue was determined for the first time. 3) The distributions of sympathetic and parasympathetic nerves in the tonsillar tissue were demonstrated by fluorescence- or enzyme-histochemistry. 4) Cases of habitual tonsillitis were compared with cases of simple tonsillitis concerning the quantities of beta-adrenergic receptors and catecholamines. As a result, the difference in quantity of beta-adrenergic receptors between the two was insignificant, but the quantity of catecholamine was greater in the former.

Theoretical and clinical aspects of the tonsillar function

A general review of the state of the art in tonsillar function research is given. A proliferation of B lymphocytes, evoked by antigens and/or polyclonal activators, occurs in the tonsil. Such a process, i.e. the supply of B cells to the organism facilitating a number of immune reactions, is to be considered the main function of the tonsil. The formation of antibodies must be regarded as a by-effect caused by an intratonsillar defence mechanism; it is helpful in safeguarding the structural and functional integrity of the organ. A model of the tonsil on the basis of cybernetics is derived from the results obtained and from the histological structure of the organ. Tonsillar involution is characterized by a decline in B cell proliferation, eventually leading to a weakening of the intratonsillar defence mechanism. Genetic disposition and defective functioning of the intratonsillar defence mechanism are discussed as pathogenetic factors in tonsillitis.

Tonsils and adenoids. When is surgery indicated?

The efficacy of tonsillectomy and/or adenoidectomy in the management of urgent problems such as cor pulmonale, acute airway obstruction, or functional impairment of nasal respiration, speech, or swallowing is unquestioned. However, relative indications for surgery such as odynophagia, otalgia, or otitis media with effusion are more controversial. The limitations and risks of tonsillectomy and adenoidectomy in these patients are explored.

[Effect of the functional state of the internal organs on the pharmacokinetics of benzylpenicillin in angina]

The levels of benzylpenicillin on its intramuscular administration in doses of 100000 or 200000 units, as well as the renal and hepatic functions and the antibiotic binding by the host protein components were studied in 44 angina patients and 29 healthy persons. The benzylpenicillin levels were always markedly higher in the angina cases than those in the healthy persons. The ratio of the free and protein bound fractions of the antibiotic in the above groups was practically the same. At the same time the amount of benzylpenicillin excreted with the urine was higher in the angina patients than in the healthy persons approximately by 2 times. The study of the function of the internal organs revealed a marked decrease in the daily diuresis in all the angina patients and microhematuria in the 1/4 of the cases. The impairment of the renal function was determined by the laboratory methods practically in all the patients. On the basis of the data obtained it was concluded that the increased benzylpenicillin levels in the angina cases were connected with a decreased capacity for inactivating this substance by the liver enzymatic systems due to the changed function of this organ. The fact of the increased antibiotics levels in the host is considered as a positive phenomenon providing inhibition of the disease causative agents resistant to usual concentrations of the drug.