The influence of tonsillectomy on cell-mediated immune response

In order to ascertain the influence of a possible immunoregulatory effect of tonsils on the organism, phytohaemagglutinin (PHA) and concanavalin A (Con A) stimulation and the suppressor index in peripheral blood lymphocytes were determined in the pre-operative and postoperative course. Consistent statements on a possible effect of the tonsil can not be made from the results obtained.

Local regulation of blood flow

H+ and K+ ions participate decisively in the local regulation of blood flow. Variation of their extracellular concentration changes the membrane potential of vascular smooth muscle cells and tension via electromechanical coupling. The effect of K+ ions can be primarily attributed to a change of K+ equilibrium potential and electrogenic pump rate, the effect of H+ ions to a change of Na+ and K+ permeability of the cell membrane. Shifts of external proton and/or cation concentrations cause changes of the binding properties of the polyanionic macromolecules in vascular connective tissue. Thus, the extracellular concentration of various cation species can very fast and drastically in the tight mesh-work of connective tissue fibres close to the membrane of vascular smooth muscle cells. Especially, the K+ adsorption with extracellular acidification as well as the cooperative K+ binding as consequence of a conformational change induced by Mg++ ions are of great importance for membrane hyperpolarization and vasodilatation.

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.

Factors of tonsillar involution: age-dependent changes in B-cell activation and Langerhans' cell density

Incorporation of radioactive thymidine as well as morphological and autoradiographical investigations performed with isolated B and T lymphocytes of the tonsil show that first of all B cells are activated or proliferating. The combination of autoradiography with cytochemistry was the only means of detecting a few activated T cells. With increasing age the number of activated B cells decreases. A reduced number of Langerhans' cells acting as antigen receptors in the epithelium of the crypt is assumed to be one cause of this phenomenon. Tonsillar involution originates from both a decline in the antigen receptors and in the depletion of B-cell activation. Malfunctions in these processes give rises to pathogenic factors in chronic tonsillitis.

Immunological aspects of the focus problem and the genetic type of haptoglobin

The frequency distribution of the genetic type of haptoglobin in adults affected with a long-term tonsillitis conforms with the standard rate of incidence. In case of a chronic tonsillitis with the suspicion of focus Hp 2-2 is underrepresented. A genetic disposition to the focus disorder which is caused by a slighter immune response is discussed.

[Plastic surgery of soft tissue defects of the hand]

The primary closure of defects of the hand is mandatory. In case of exposure of deeper structures a flap procedure is necessary. Random and axial pattern flaps and also tissue transplantation with microsurgical anastomoses are demonstrated in this paper.

[Modified technic of distal joint tenodesis]

A suggestion for a modified technique of tenodesis of the distal interphalangeal joint which always leads to a secure tenodesis by using one part of the superficial flexor tendon.

Biochemical characterization of the proliferation pool of lymphatic cells in the human tonsil and demonstration of the age-dependent pool size reduction

The DNA and RNA content and also the thymidine and uridine incorporation kinetics were determined in peripheral lymphocytes and lymphatic cells of the tonsil. The existence of a proliferation pool of lymphoid cells in the tonsil could be established by the comparison of all data. An age-conditioned reduction of the pool size was assumed from the uridine incorporation rate which takes place faster than the organo-specific cell decrease likewise conditioned by age in the tonsil. The abscess tonsil could be explained as a pathological state with considerable reduction of proliferation.

The permeability of 51Cr between cerebrospinal fluid and internal ear

Radioactively labelled chromium was instilled in the cerebrospinal fluid of guinea pigs. After different intervals, the radioactivity of inner ear fluids was measured and compared with those of other regions. The results lead to kinetic information about the permeability of 51Cr between cerebrospinal and inner ear fluids.

Evidence for selective proliferation and histological localisation of B lymphocytes in the human tonsil

Tonsil lymphocytes are labeled in vitro by 14C-thymidine and, respectively, 14C-uridine. The cells are separated by E-rosetting technique, and the fractions are characterised as B and T lymphocytes. Specific radioactivity was highest in the B lymphocytes, and large Lymphocytes are enriched in this fraction. The B lymphocytes are located in the germinal centres, the perinodular tissue contains T lymphocytes. The results indicate a selective proliferation of B lymphocytes in the germinal centres.

[Lymphocyte sub-populations and immunoglobulin concentrations in palatine and fancial tonsils (author's transl)]

The number of B- and T-lymphocytes as well as the cytological composition and concentrations of IgG, IgM, and IgA are compared in children's palatine and fancial tonsils. The B-lymphocytes prevail in both organs. IgG is the main immunoglobulin and IgM and IgA follow in their concentrations. No significant differences between palatine and fancial tonsils were detectable at all investigated parameters. Evidence as to the biological equivalence of the organs is disclosed.

Characterization of clinical tonsil stages by their T-cell count. Immunopathological description of tonsils after a peritonsillar abscess

The T-cell counts in five different clinical tonsil stages are compared. No particularities were observed, with the exception of the condition after a peritonsillar abscess. The differences existing between the individual groups are discussed as age-dependent. A considerable increase in T-cells is found in the abscess tonsil compared with other tonsils and the T-cell count in blood. Its pathomechanism is discussed.

Cell fractionation and cytological analysis of human lymphatic cells from tonsil and blood

No differences could be detected in the discontinuous density gradient when comparing the distribution pattern of tonsillar cells and peripheral lymphocytes. When the Kiel nomenclature is applied, the presence of centrocytes, centroblasts, lymphocytes and plasma cells in the tonsil is shown by a cytological analysis. The biological importance of these results is discussed from the point of cellular proliferation and tonsillar function.

Proliferation of cells and intracellular c-AMP content: comparative investigations of autologous lymphatic cells from palatine tonsils, nasopharyngeal tonsils, and blood

The c-AMP content and thymidine incorporation were determined in tonsillogenic, adenoid, and peripheral lymphatic cells. A significant c-AMP decrease with simultaneous increase of the thymidine incorporation compared to the blood lymphocytes was noted in the tonsillogenic and adenoid cells. The negative regulative effect of c-AMP on cell proliferation and the function of tonsils at this processes are discussed.

Description of age-depending cellular changes in the human tonsil

The growth and ageing of tonsils is described by means of the behaviour of the cell count, T cell count, DNA, and organ weight. Proliferation of cells and the influx of recirculating T lymphocytes cause hyperplasia up to the age of 17 approximately, later on the cell count and organ weight decrease again. The number of T cells in cell suspensions from the tonsil is lower than that of blood. Due to the proliferation decrease of B cells and the accumulation of recirculating T lymphocytes, the T cell count in the tonsil increases with advancing years. The tonsil function decrease as a result of this population shift. No influence of the differentiation of T cells by the tonsil can be detected.

A metabolic disorder similar to Zellweger syndrome with hepatic acatalasia and absence of peroxisomes, altered content and redox state of cytochromes, and infantile cirrhosis with hemosiderosis

A patient with a cerebro-hepato-renal syndrome was investigated. The visceral manifestations were those of the Zellweger syndrome (ZS); however, the child exhibited muscular hypertonia and survived into the 2nd year of life. Ultramicroscopically, hepatocytes were lacking peroxisomes, but, contrary to findings in one patient with ZS [2], contained smooth endoplasmic reticulum. No catalase was found by histochemistry or spectroscopy. Mitochondria showed normal succinate and glutamate respiration, and normal coupling of respiration to the phosphorylation potential. The cytochrome (cyt) content was diminished to one-third with an abnormally inversed redox pattern of the respiratory chain in the controlled state, cyt b being 5%, cyt c 23% reduced. The oxygen affinity of cyt a3 was normal. These findings exclude a defect in the nonheme iron protein region of the respiratory chain as described in ZS [2], but point to a functional abnormality of cyt b in out patient.