P–336 The role of endoplasmic reticulum stress in endometriosis; preliminary results

Study question

Can X-box binding protein 1 (XBP–1) be used in evaluation of endoplasmic reticulum (ER) stress in endometriosis patients?

Summary answer

High levels of XBP–1 among endometriosis patients indicate an association between ER stress and endometriosis.

What is known already

ER is responsible for protein folding, lipid synthesis, and calcium homeostasis. ER stress occurs due to the accumulation of unfolded or misfolded proteins in the ER. ER stress causes the activation of several signal transduction cascades, defined as the unfolded protein response (UPR). In the studies conducted with ectopic endometrial tissue and cells, it was reported that UPR plays a role in the pathogenesis of endometriosis. The XBP–1 is a transcription factor involved in UPR, where it regulates ER stress-mediated apoptosis. XBP–1 is also responsible for endometrial cell migration, which is also a part of the pathogenesis of endometriosis.

Study design, size, duration

This prospective case-controlled study was conducted at University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital Department of Obstetrics and Gynecology between March 2020 – August 2020. A total of 60 subjects were included in the study. All patients gave their written informed consent before their enrollment in the study.

Participants/materials, setting, methods

30 endometriosis patients aged 18–45 years were included in the study group. Patients with a history of ovarian surgery, endocrine, autoimmune and metabolic disorders, and hormonal treatment during the previous three months were excluded. 30 healthy subjects without endometriosis were included in the control group. Endometriomas were measured with transvaginal ultrasonography and pain was evaluated with visual analogue scale (VAS). XBP–1 levels were determined from serum samples using Human XBP–1 ELISA Kit (Elabscience Co., USA).

Main results and the role of chance

The mean age of the control group was 28.33±2.49, and the study group was 27.76±2.45 (p = 0.374). The mean endometrioma volume in the study group was calculated to be 9.9± 9.05. The mean XBP–1 level in the control group was 1008.31± 329.05, whereas this level in the study group was significantly higher (2710.65±1484.13, p < 0.001). When the study group was divided according to VAS scores into two groups, the mean XBP–1 level, and endometrioma volumes were significantly higher in the group with VAS scores > 6 (p < 0.001 and p = 0.03 respectively). A receiver operating curve (ROC) analysis was conducted in the study group. The area under the curve AUC for XBP–1 levels was 91% (95%CI: 0.86–0.96, p < 0.001) for the cut-off value of 1279.52 with a sensitivity 87.2%, specificity 86.7%, PPV: 90.4%, NPV: 82.5%, +LR: 6.5, -LR: 0.1. The AUC for VAS scores >6 was 96.2% (95%CI: 0.93–0.98, p < 0.001) for the cut-off value 2227.71, with a sensitivity 90% and a specificity 91.1%, PPV: 87.1%, NPV: 96.1%, +LR: 10, -LR: 0.1.

Limitations, reasons for caution

A limitation of this study was the methodology of serum sample collection. Since there are no data available on the timing of sample collection with regard to the menstruation cycle of the subjects, samples were collected at the first consultation of the patients without considering the date of their cycle.

Wider implications of the findings: In this study, XBP–1 levels in the endometriosis group and also among patients with VAS scores of > 6 were significantly higher. This association between XBP–1 and endometriosis and the positive correlation with pain indicates that XBP–1 can be a potential biomarker, especially in the presence of severe pain symptoms

Trial registration number

NCT04440397

P–424 Evaluating the relationship between endoplasmic reticulum stress and recurrent pregnancy loss in a young population cohort

Study question

Does endoplasmic reticulum (ER) stress evaluated by X-box binding protein 1 (XBP–1) among patients aged 18–30 years play a role in recurrent pregnancy loss (RPL)?

Summary answer

High levels of XBP–1 observed in patients with known RPL indicate that ER stress plays an important role in RPL.

What is known already

Female reproductive tract undergoes dynamic changes during oogenesis which require protein synthesis, folding, maturation, which take place in the ER. ER is also responsible for destruction of unfolded/misfolded proteins. Excess accumulation of these faulty proteins leads to ER stress, which actives unfolded protein response (UPR). XBP–1 is a transcription factor involved in UPR and regulates ER stress-mediated apoptosis. Regulation of ER homeostasis is important in folliculogenesis, oocyte maturation and embryogenesis. It is also known that ER stress has a positive correlation with age and it is associated with age-related diseases.

Study design, size, duration

This prospective case-controlled study was conducted at University of Health Sciences Turkey, Istanbul Kanuni Sultan Suleyman Training and Research Hospital Department of Obstetrics and Gynecology between March 2020 – September 2020. A total of 70 subjects were included in the study. All patients gave their written informed consent before their enrollment in the study.

Participants/materials, setting, methods

38 patients aged 18–30 years with a history of RPL were included in the study. Patients who had miscarriages due to fetal abnormalities, patients with infections, endocrine or genetic disorders, smokers, alcohol and/or drug abusers, with acute/chronic inflammatory diseases, patients using steroids, anti-inflammatory and antioxidant medications were excluded from the study. Age-matched 32 healthy subjects without RPL were included in the control group. XBP–1 levels were determined using Human XBP–1 ELISA Kit (Elabscience Co., USA).

Main results and the role of chance

The mean age in the control group and in the study group were 25.21±3.3 and 25.26±2.6, respectively and they were statistically similar (p = 0.324). When groups were compared according to thyroid stimulating hormone (TSH) levels and body mass index (BMI), which are additional risk factors of RPL both groups were statistically similar (p = 0.642 and 0.942, respectively). As expected gravidity and abortus numbers were significantly higher in the study group (p < 0.001). A mean XBP–1 level of 1233.41± 3902.97 was determined in the control group. The mean value of the study group was calculated to be 2251.49± 9621.12. Mean XBP–1 level in the study group was significantly high (p < 0.001). A receiver operating curve (ROC) analysis was conducted in the study group. The area under the curve was found to be 87% (95% CI: 79% - 95%). The specificity was 75%, sensitivity was 89%, positive LR was 3.5, negative LR was 0.15, positive predictive value was 80% and negative predictive value was 87% for the cut-off XBP–1 level at 1364.68 pg/mL.

Limitations, reasons for caution

Small sample size is an important limitation of this study. In addition, evaluating XBP–1 only in serum samples does not let us drive any conclusions on the local changes of ER stress. Studies with larger samples sizes and studying XBP–1 levels in tissue samples of endometrial material is needed.

Wider implications of the findings: The significantly high levels of XBP–1 in RPL patients younger than 30 years, indicate higher ER stress in this group even when age dependent increase in ER stress is calculated out of the equation. XBP–1 can be a promising marker in evaluating patients with a fertility wish for RPL risk.

Trial registration number

NCT04455256

A new single-layer structure of MBene family: Ti2B

In this manuscript, we have carried out a combined study of density functional theory and Monte Carlo (MC) simulations for a thorough examination of a single-layer (SL) Ti₂B structure. On the basis of first-principles, spin-polarized density functional calculations, we showed that a free standing SL-Ti₂B structure is dynamically and thermally stable. The atomic structure, phonon spectrum, electronic and magnetic properties of the SL-Ti₂B structure are analyzed. In order to determine ground state, the structure of Ti₂B is optimized for four types of spin oriented configurations, namely ferromagnetic (FM), antiferromagnetic Néel, antiferromagnetic Zigzag and antiferromagnetic Stripy and non-magnetic states. We found that the spin configuration FM corresponds to the ground state for SL-Ti₂B. We also found that the Raman-active modes are softening in the antiferromagnetic cases. On the basis of these results, MC simulations show that the magnetic susceptibility, thermal variations of magnetization, and specific heat curves of Ti₂B exhibit a phase transition between paramagnetic and FM phases at the Curie temperature of 39.06 K. While SL-Ti₂B possess a little out-of-plane magnetic anisotropy, it has not any in plane magnetic anisotropy energy.

Synthesis and catalytic applications of palladium N-heterocyclic carbene complexes as efficient pre-catalysts for Suzuki–Miyaura and Sonogashira coupling reactions

A new palladium complex series with N-heterocyclic carbene (NHC), pyridine and phosphine ligands, PdCl₂(L)NHC (2a–c)(L = NHC), PdCl₂(L¹)NHC(3a–c)(L¹ = pyridine), PdCl₂(L²)NHC(4a–c)(L² = triphenylphosphine) was synthesised and fully characterized.

Quercetin prevents 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced testicular damage in rats

The protective effect of quercetin on 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-induced testicular damage in rats was investigated. Twenty-two rats were equally divided into four groups; first group was kept as control and given corn oil as carrier. In second group, TCDD was orally administered at the dose of 2 μ (kg week)(-1) for 60 days. In third group, quercetin was orally administered at the dose of 20 mg (kg day)(-1) by gavages, and in fourth group TCDD and quercetin were given together at the same doses. Although TCDD increased the formation of thiobarbituric acid reactive substances (TBARS) significantly, it caused a significant decline in the levels of glutathione (GSH), catalase (CAT), GSH-Px and CuZn-Superoxide Dismutase (CuZn-SOD) in rats. In contrast, quercetin significantly increased the GSH, CAT, GSH-Px and CuZn-SOD levels but decreased the formation of TBARS. In addition, sperm motility, sperm concentration and serum testosterone levels were significantly decreased but abnormal sperm rate and testicular damage were increased with TCDD treatment. However, these effects of TCDD on sperm parameters, histological changes and hormone levels were eliminated by quercetin treatment. Our results show that administration of TCDD induces testicular damage (oxidative stress, testes tissue damage, serum hormone level and sperm parameters), and quercetin prevents TCDD-induced testicular damage in rats. Thus, quercetin may be useful for the prevention and treatment of TCDD-induced testicular damage.

Role of exogenous melatonin on adriamycin-induced changes in the rat heart

AIM

The protective effect of melatonin on adriamycin (ADM)-induced cardiotoxicity was investigated in the rat heart. Melatonin is a pineal hormone with free radical scavenging activity on oxidants; therefore it may decrease the ADM-induced oxidative stress and cardiotoxicity so that therapeutic efficacy might be enhanced.

MATERIALS AND METHODS

Wistar rats in 4 groups were treated with saline (control), melatonin (MEL), adriamycin (ADM) and melatonin plus adriamycin (MEL+ADM).

RESULTS

Adriamycin given at a single dose of 15 mg/kg significantly increased lipid peroxidation products as measured by thiobarbituric acid reactive substances (TBARS). Melatonin (5 mg/kg bw) given 2 days before and 7 days after ADM treatment reduced TBARS level. Adriamycin significantly reduced superoxide dismutase activity which was elevated by melatonin treatment. Additionally, ADM significantly increased catalase enzyme activity while melatonin normalized the ADM induced alteration in activity of catalase.

CONCLUSIONS

The combined use of ADM and melatonin reduces the threat of cardiomyopathy. Melatonin seems to hold promise as a therapeutic treatment and can be recommended as an adjunct in antitumor therapy as a safe and effective protection against acute ADM-induced cardiotoxicity.

The femoral route revisited: an alternative for pectoral pacing lead implantation

We describe the implantation via the femoral vein of a dual-chamber pacing system with lumenless, catheter-delivered pacing leads in a patient in whom subclavian access on both sides was obstructed. (Neth Heart J 2010;18:42-4.).

Effects of tibolone on blood flow resistance and intima-media thickness of the carotid arteries: effect of time since menopause

OBJECTIVE

The aim of this prospective study was to evaluate the effects of tibolone on carotid atherosclerosis in healthy postmenopausal women.

METHODS

Twenty-five healthy postmenopausal women were included in the study. Patients received tibolone 2.5 mg daily for 6 months. Resistance indices of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA) and vertebral arteries, and intima-media thickness of the CCA were measured both at baseline and at the end of the study with ultrasonography.

RESULTS

No significant differences were observed in the resistance indices of the CCA, ICA, ECA and vertebral arteries, as well as intima-media thickness of CCA at 6 months in comparison with baseline. Tibolone significantly improved the intima-media thickness of the CCA of women who were less than 18 months since menopause.

CONCLUSION

Overall, these results demonstrate no significant effects of tibolone on either intima-media thickness or blood flow resistance in the carotid arteries in postmenopausal women. However, the results suggest that tibolone may have a positive effect on the vascular system if commenced within 18 months since menopause; this warrants further investigation.

Comparison of colour Doppler indices of pelvic arteries in women with bilateral hypogastric artery ligation and controls

The aim of this study is to compare the blood flows of bilateral uterine, ovarian and arcuate arteries in patients who underwent bilateral hypogastric ligation (BHL), with the controls having similar characteristics. The S/D, the RI and the PI were measured on uterine, arcuate and ovarian arteries in 7 women with BHL and compared with 10 controls. There were not significant differences between the Doppler indices of the two groups. In conclusion, our study suggests that BHL preserves pelvic function and fertility.

Abdominal paravaginal defect repair in the treatment of paravaginal defect and urodynamic stress incontinence

We evaluated the morbidity, complications and outcomes in 42 patients who underwent abdominal paravaginal defect repair (PDR) for vaginal wall prolapse due to a paravaginal defect and the prolapse of other pelvic organs. Out of a total of the 42 patients, 32 underwent PDR and concomitant pelvic reconstructive procedures, and 10 patients underwent PDR plus anti-incontinence surgery and concomitant pelvic reconstructive procedures. The mean patient age was 44.5 years. The mean follow-up period was 40 months. One bladder injury and two hemorrhages occurred intraoperatively. The cure rate of anterior vaginal wall prolapse was 92.9%. Of the 20 patients with urodynamic stress incontinence (USI) who underwent PDR alone, the rate of recurrence of USI was 20%; however, there was no recurrence in the 10 patients who underwent PDR plus the anti-incontinence procedures. Paravaginal repair is a safe and effective procedure for the surgical correction of a paravaginal defect, but has limited applicability in the surgical correction of USI.

Modulation of DMBA-induced biochemical changes by organoselenium compounds in blood of rats

The protective role of two synthetic organoselenium compounds 1-isopropyl-3-methylbenzimidazole-2-selenone (SeI) and 1, 3-di-p-methoxybenzylpyrimidine-2-selenone (Sell) was examined against the 7,12-dimethylbenz[a]anthracene (DMBA)-induced changes in biochemical parameters in blood of rats. Albino Winstar rats (150-200 g body wt) were treated with single dose of DMBA (50 mg/kg body wt) and organoselenium compounds (25 micromol/kg) for 4 weeks at two days internal. Blood was taken from the anaesthetized rats ventricle from their hearts for biochemical analysis. Administration of DMBA resulted in elevation of urea, uric acid and creatinine levels as well as AST, ALT and LDH activities and decrease in levels of total proteins, albumin and globulin. SeI and SeII caused a significant (p<0.05) decrease in urea, uric acid and creatinine levels and alanine aminotransferase (ALT); aspartate aminotransferase; (AST) and lactate dehydrogenase (LDH) activities and significantly increased the levels of total protein and albumin (p<0.05). These organoselenium compounds are likely to be beneficial in human health.

Blue nevus with an unusual presentation: two patients with endocervical location

OBJECTIVE

To report two cases of endocervically located blue nevus.

SUBJECT

Case report.

SETTING

University of Abant Izzet Baysal, Duzce, Turkey.

SUBJECT AND METHOD

Blue nevus is a benign lesion, which is usually found on the skin, rarely on mucous membranes. In two patients the endocervical location of blue nevus was described.

CONCLUSION

Blue nevus when located on the cervix may be confused with other benign or malignant lesions.

Protective effect of melatonin on experimental spinal cord ischemia

STUDY DESIGN

Experimental animal model to assess ischemic spinal cord injury following occlusion of the thoraco-abdominal aorta.

OBJECTIVES

To measure whether melatonin administered to rabbits before and after occlusion exerts an effect on the repair of ischemia-reperfusion (IR) injury.

SETTING

Medical Biology Laboratory, Inonu University, Malatya, Turkey.

METHODS

Rabbits were divided into three IR treatment groups and one sham-operated (ShOp) control group. The three treatment groups had their infrarenal aorta temporarily occluded for 25 min, while the ShOp group had laparotomy without aortic occlusion. Melatonin was administered either 10 min before aortic occlusion or 10 min after the clamp was removed. Physiologic saline was administered to the control animals. After treatment, the animals were euthanized and lumbosacral spinal cord tissue was removed for the determination of relevant enzyme activities.

RESULTS

Malondialdehyde levels, indicating the extent of lipid peroxidation, were found to be significantly increased in the nonmelatonin treated (IR) group when compared to the ShOp group. Melatonin, whether given to pre- or post occlusion groups, suppressed malondialdehyde levels below that of the ShOp group. Catalase (CAT) and glutathione peroxidase (GSH-Px) enzyme activities were increased in the IR group compared to the ShOp group. Melatonin given preocclusion resulted in a significant decrease in both CAT and GSH-Px enzyme levels. The superoxide dismutase (SOD) enzyme activity was decreased in the ischemia-reperfusion treatment group. However, the melatonin treatment increased SOD enzyme activity to levels approximating that of the ShOp group.

CONCLUSION

To our knowledge, this is the first study that shows the effects of melatonin administered both pre- and postischemia on induced oxidative damage to injured spinal cords. Our data also expands on reports that melatonin administration may significantly reduce the incidence of spinal cord injury following temporary aortic occlusion.

Predictors of outcome after acute ischemic stroke

The aim of this study was to determine which variables should be the predictors for clinical outcome at discharge and sixth month after acute ischemic stroke.

METHODS

Two hundred and sixty-six consecutive patients, each with an acute ischemic cerebrovascular disease, were evaluated within 24 h of symptom onset. We divided our patients into two groups; 1 - Independent (Rankin scale RS < or = 2) and, 2 - Dependent (RS>3) and death. Baseline characteristics, clinical variables, risk factors, infarct subtypes and radiologic parameters were analyzed.

RESULTS

Canadian Neurological Scale (CNS) on admission <6.5 [odds ratio (OR) 22] and posterior circulation infarction (OR 4.2) were associated with a poor outcome at discharge from hospital whereas only a CNS score <6.5 (OR 14) was associated with a poor outcome at 6 months.

CONCLUSIONS

Severity of neurologic deficit is the most important indicator for clinical outcome in acute ischemic stroke both at short-term and at sixth month, whereas posterior circulation infarction also predicts a poor outcome at discharge.

Remarkable substituent effects on antimicrobial activities of 1,3-diorganylimidazolidinium salts

In vitro antibacterial and antifungal activities of a series of 25 diazolidinium salts, 1,3-diorganylimidazolidinium (1), together with 1,3-dialkylpyrimidinium (2), were evaluated against standard strains: Escherichia coli (ATCC 25922), Staphylococcus epidermidis (ATCC 12228), Staphylococcus aureus (ATCC 29213), Enterococcus faecalis (ATCC 29212), Enterobacter cloacae (ATCC 13047), Pseudomonas aeruginosa (ATCC 27853) and Candida albicans (ATCC 10239). Selective and effective antibacterial activity against one gram-negative (P. aeruginosa) and two gram-positive (E. faecalis and S. aureus) bacteria were found in salts 1a, 1i and 1j, in contrast to modest to poor activity observed in the rest of the salts. The enhanced antibacterial activity is clearly linked to the introduction of two bulky mesityl or mesitylbenzyl substituents on the nitrogen atoms of the imidazoline skeleton, while the side chain of the backbone of the molecule has no influence.

The effect of testosterone replacement treatment on immunological features of patients with Klinefelter's syndrome

Although the effects of androgen deficiency in the immune system have long been appreciated, little is known about the immunological features of patients with Klinefelter's syndrome (KS). On the other hand, interest in androgens as a possible treatment for some autoimmune diseases is growing. In the present study, some immunological parameters were evaluated in 26 patients with KS prior to androgen replacement treatment (ART) and the results were compared with those in 19 healthy control subjects. Patients were then treated with testosterone for 6 months and the pre- and post-treatment findings were compared. Serum levels of IgG, IgA, IgM, C3c and C4 were measured by nephelometry and lymphocyte subsets and CD4+/CD8+ ratios were examined by flow cytometry. IL-2 and IL-4 levels were measured by ELISA. Pretreatment levels of the serum IgA, IgG, IgM, IL-2 and IL-4 of the patients were higher than those of the controls and were all decreased significantly following ART. The pretreatment absolute numbers and percentages of CD3+, CD4+, CD19+ cells and CD4+/CD8+ ratios of patients with KS were higher than those of the controls and were all decreased with ART. Percentages of CD8+ cells were increased significantly, while C3 and C4 levels were both significantly decreased after ART. It is concluded that the lack of testosterone in patients with KS enhances cellular and humoral immunity and that ART may suppress this.

Antibacterial and antifungal activities of complexes of ruthenium (II)

Twenty ruthenium (II) complexes (1-5) were evaluated for their in vitro antibacterial and antifungal activity against Enterococcus faecalis (ATCC 29212), Staphylococcus aureus (ATCC 29213), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Candida albicans and Candida tropicalis. Compounds 1d, 1e, 1h, 1i and 1j showed more pronounced antimicrobial activity against Gram-positive bacteria and fungi as compared to the nitrogen donor ruthenium complexes; hydrophobic substituents were significantly more effective. None of the compounds 1-5 exhibited antimicrobial activity against the Gram-negative strains Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 27853) with the concentrations ranging between 12.5 and 800 micrograms/ml.

The Monostrut prosthetic valve. Predictors for valve-related events during an eight years' experience

All postoperative complications, including transient ischaemic attacks (TIA) and cerebrovascular accidents (CVA) of 259 patients, in whom a total of 301 Monostrut tilting-disc valves were implanted between January 1985 and December 1991 were evaluated retrospectively. The follow-up was maximally 8 years, with a mean of 3.5 years, and totaled 914 patient-years. In this study we found no mechanical deterioration of the Monostrut valve and demonstrated the elimination of valve thrombosis in patients receiving adequate anticoagulation. The actuarial probability of being free of thrombo-embolism was 94.7% +/- 1.7% and free of anticoagulant related hemorrhage 95.4% +/- 1.5% at 8-years. In comparison with earlier reports by others, our findings show a lower ratio of thromboembolic and hemorrhagic events. We demonstrated a correlation (p < 0.05) between thrombo-embolic and hemorrhagic complications. In addition, a lower incidence of CVA's (0.22 per 100 patient-years), but a higher incidence of TIA's (0.66 per 100 patient-years) in comparison with the general Dutch population was found. At eight years follow-up, all patients were in Class I or II of the New York Heart Association Classification. Although the overall valve related event-free survival at eight years was only 47.9%, 93.5% of the patient were satisfied with their operative result. Predictive factors for late mortality were the occurrence of paravalvular leakage (p < 0.01), the age of the patient at the time of operation (p < 0.01) and the number of diseases coronary arteries (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Antibody-forming cell assays of avian paramyxoviruses: the serotype-specific response of mice

Mice were immunized with eight different serotypes of avian paramyxovirus (PMV). The number of splenocytes that formed antibody to PMV-infected Madin-Darby bovine kidney cells was determined by immunoperoxidase staining. Microscopic examination revealed brown plaques of cell surface or inclusion body-like antigen comprising the glycoprotein or nucleoprotein-polymerase complex, respectively. The IgG response to virus glycoprotein was priming-dependent and 99% serotype-specific, a value which exceeds that of PMV typing using avian serology. The response to inclusion body-like antigens was more variable and less priming-dependent and suggested cross-reactivities between PMV-1 and PMV-3 or -9. The primary IgM response also included a 1 to 10% non-specific antibody response to host antigens revealed by neuraminidase treatment.

A rapid enzyme-linked semi-microwell assay for the enumeration of antibody-forming cells to viral and bacterial antigens in domestic animals

Details of an enzyme immunoassay for the enumeration of antibody-forming cells are given with examples of its application to immunization with viral (Newcastle disease virus) or bacterial (Haemophilus pleuropneumoniae) pathogens of domesticated species. The assays showed reciprocal specificity when compared to another virus (avian paramyxovirus serotype 3) or another bacterium (Bordetella bronchiseptica) and were used to show the class specificity of avian AFC and the effect of passive antibody transfer on porcine AFC induction.

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).