Effects of pepsin and pepstatin on reflux tonsil hypertrophy in vitro

There is evidence that pepsin can aggravate tonsil hypertrophy. Pepstatin is a potent inhibitor of pepsin activity and could protect patients against reflux tonsil hypertrophy by inhibiting pepsin. We examined the effects of pepstatin on the development of tonsil hypertrophy to investigate pepsin’s role in the pathogenesis of tonsil lesions. We investigated whether pepstatin suppresses pepsin-mediated lymphocyte proliferation in tonsil hypertrophy. Forty-nine children with tonsil hypertrophy and twenty-two adults with tonsillitis were recruited to the study prior to surgery. Tonsil tissue from each patient was harvested and assessed for changes in the number of lymphocytes and macrophages in the presence of pepsin and pepstatin. We found that the proportions of CD4- and CD14-positive cells were significantly lower (p < 0.05), but that the proportions of CD19- and CD68-positive cells were significantly higher (p < 0.05), in children than in adults. There were significantly more CD4-positive cells after pepsin treatment, but these numbers were reduced by pepstatin. The levels of both interleukin-2 (IL-2) and interferon gamma (IFN-γ) increased significantly in response to pepsin, but were reduced when pepsin was inhibited by pepstatin. The level of IL-10 is reduced in pepsin-treated CD4 cells and the level is restored by pepstatin. IL-2 blocking reduced the increased CD4 cell number by pepsin. But, an additive or a synergic effect is not founded in combined with IL-2 blocking and pepstatin. Pepsin-positive cells did not co-localize with CD20 and CD45 cells, but they were found surrounding CD20- and CD45-positive hypertrophic tonsil cells. Pepsin-positive cells co-localized with CD68-positive cells. It is probable that pepsin from extraesophageal reflux aggravates tonsil hypertrophy and pepstatin exerts a protective effect by inhibiting pepsin activity.

Age-related tonsillar regrowth in children undergoing powered intracapsular tonsillectomy

OBJECTIVES

To review our experience with intracapsular tonsillectomy using powered instrumentation (PIT) in the management of tonsillar hypertrophy.

DESIGN

Retrospective database review of pediatric patients undergoing PIT.

METHODS

The medical records of 636 patients under 11 years of age who underwent PIT performed by the senior author (RFW), predominantly for obstructive sleep disturbance, were reviewed. Data were subsequently analyzed from 559 of these patients for clinical evidence of tonsillar regrowth, post-operative tonsillar hemorrhage, and post-operative dehydration due to pain. Specific information for possible correlation of age at the time of surgery and any increased rate of regrowth was primarily examined.

RESULTS

There were a total of 33 patients who had clinical evidence of regrowth. Children less than 5 years of age had 5 times the incidence of regrowth (p<0.001). Out of the group that exhibited regrowth, 5 patients exhibited evidence of recurrent upper airway obstruction and underwent a complete tonsillectomy. The age of this complete tonsillectomy group ranged from 1.1 to 2.7 years. Out of all patients undergoing PIT, there was 1 incident of delayed post-operative dehydration due to emesis but not due to pain. There were 2 incidents of delayed post-operative tonsillar bleeds. All three complications were self-limited and did not require re-hospitalization.

CONCLUSIONS

PIT is a safe procedure with a small risk of tonsillar regrowth being age related. The incidence of postoperative complications following PIT is relatively low (0.54%).

Changes in the properties of secretory granules in the palatine gland acinar cells of the postnatally developing rat

This study was designed to examine whether or not phospholipid is contained in the secretory granules of the rat palatine gland acinar cells, and if present, to examine the movements of phospholipid in the secretory granules during postnatal development. The palatine glands of male Wistar rats aged 0 to 56 days were used. Acid-hematin staining showed a few positive acinar cells with a faint reaction in the acini on day 0, numerous positive cells with an intense reaction on day 7, a weakening reaction in the cells on day 14, and almost no reactivity on day 35 and after. In contrast, alcian blue staining showed acinar cells with a weak reaction on day 7, a gradual increase in the reaction from day 14, and the presence of many cells with an intense reaction on day 28 and after. Electron probe microanalysis (EPMA) revealed a higher density of phosphorus in samples on day 7 than on day 56. These findings suggest that developing rat palatine gland acinar cells contain phospholipid in the secretory granules, being particularly more conspicuous around postnatal day 7, but that the amount of phospholipid decreases as the cells change to mature mucous cells.

Histological analysis of palatopharyngeal muscle from children with snoring and obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is an upper airway obstruction that occurs during the sleep. One of the suggested mechanisms involved in this process is a neuromuscular abnormality of the palatal muscles. Whether children with OSAS develop into OSAS adults, or children and adult OSAS are two distinct disorders occurring at different ages are questions to be answered. Here, we made the histological analysis of palatophryngeal muscle in 34 oral-breathing children of both genders, aged 5-12 years old, with hypertrophic tonsils and adenoids. According to the polysomnographic study the participants were divided into children without sleeping disorders (group I) and children with primary snoring (group II) or apnea (group III). The main histological findings were fiber size variability in 70% cases from groups II and III and in 71% from group I; perimysial connective tissue infiltration in 48% children from groups II and III and in 71% from group I; intracytoplasmatic mitochondrial proliferation in 63% cases from groups II and III and in 57% cases from group I. Muscle necrosis was only observed in one case, in association with subglandular inflammation. Others findings observed in all groups included fibers with internal architecture alteration, such as moth-eaten and lobulated fibers, type 2 fiber predominance, and small areas of fiber type grouping. The presence of similar histological findings in the palatopharyngeal muscle in children with primary snoring or apnea but also in children without sleeping disorders indicate that such changes could be a normal histological feature of this muscle rather than a neurogenic or myopathic pathology.

Histological studies on the ontogeny of bovine palatine and pharyngeal tonsil: germinal center formation, IgG, and IgA mRNA expression

The development and distribution of lymphocyte subsets in calf palatine and pharyngeal tonsil were examined. During prenatal development, B cells were distributed in the subepithelial area, and T cells and MHC class II(+) cells were found in the deep layer of B-cell area, respectively, in both tonsils. At neonatal stage, lymphoid follicle containing a few CD4(+) cells have been formed in both tonsils. IgG(+) and IgA(+) cells were found in the parafollicular and epithelial area. At 3 months old, many germinal centers were recognized in both tonsils. CD4(+) cells and IgG mRNA expression were detected in light zone of germinal centers. Many IgG, and IgA mRNA expressions also could be detected in the parafollicular and subepithelial area of both tonsils. The data suggest that both tonsils have an important role of local immune defense against invading antigen after birth. The comparison of the histological characteristics of tonsil and Peyer's patch during ontogeny is also discussed.

Development of the palatine tonsil in conventional and germ-free piglets

Palatine tonsils, like the Peyer's patches, are considered to be major inductive sites for the mucosa-associated lymphoid tissue (MALT), providing sampling and effector functions for the upper respiratory tract. Consistent with this, they have the architecture required of a classic inductive site (B-cell follicles, immunoglobulin class switching and the presence of naïve and memory T-cells). Here we show that much of this architecture develops after birth in the neonatal piglet, the numbers of T-cells, B-cells and accessory cells increasing with age. Conventional piglets also had higher levels of activated and memory T-cell subsets than germ-free piglets, consistent with development occurring as a result of microbial stimulus. The results suggest that the microbial environment influences the development of the tonsil immunological architecture. Given the role of the tonsil in induction of mucosal responses, this raises questions as to the effectiveness of the tonsil in dealing with colonising organisms in the neonate.

Histone mRNA in situ hybridization in assessing proliferative activity of normal and malignant cells

Proliferative capacity is an important determinant of tumour biological behaviour. For research and diagnostic purposes, immunohistochemical techniques are usually applied in the assessment of tissue proliferative status. An interesting alternative for these studies is a detection of histone mRNA. As the synthesis of histones is tightly coupled with DNA replication during S-phase of the cell cycle, histone mRNA level is a specific marker of S-phase cells. Furthermore, a short-lived transcript guarantees accurate estimation of S-phase cell pool at the moment of tissue fixation. The progress in molecular biology techniques during the last decade made possible the use of in situ hybridization, especially its non-radioactive version, in routine laboratory services. This technique can be successfully applied to detection of histone mRNA in routinely processed tissues. Advantages and limitations of such approach in tumour proliferation studies are discussed.

Developmental study of the anal tonsil in the laboratory shrew, Suncus murinus

The laboratory shrew, Suncus murinus, which lacks such gut associated lymph organs as the appendix and Peyer's plates, was recently demonstrated (Kubo and Isomura, 1996) to possess a pair of anal tonsils at the end of its rectum. The present paper deals with the development of this lymphoid organ as observed by light and electron microscopy. The anal tonsil was characterized by the initial postnatal development. On neonatal Day 1, a pair of epithelial crypts formed at the dorsal boundary between the anus and the ostium urogenitoanale. On Day 2 after birth, lymphocytes began to accumulate in the subepithelial mesenchymal tissue under the crypt. From Day 3 on, the lymphocytes increased to form a lymph nodule, from which, on Day 5, some lymphocytes began to penetrate into the crypt epithelium. The crypt and the nodule were fused together between Days 6 and 8. A germinal center-like structure was observed on Day 20 after birth. Around Day 40, the invading cells comprised cellular units consisting of large and small lymphocytes and plasma cells. High endothelial venules were observed in the parafollicular area at this time. These findings indicate that the anal tonsil originates from an accumulation of lymphocytes in the mesenchymal tissue close to a particular epithelium of the crypt, presumably in response to antigens in foods; the tonsilar structure is then gradually completed by fusion of the lymphoid and epithelial elements. This paper further reports on an electron microscope finding on Day 8 where the anal tonsillar crypt epithelium was seen to contain some basal-granulated cells of the open type.

Linear dimensions of the upper airway structure during development: assessment by magnetic resonance imaging

The upper airway undergoes progressive changes during childhood. Using magnetic resonance imaging (MRI), we studied the growth relationships of the tissues surrounding the upper airway (bone and soft tissues) in 92 normal children (47% males; range, 1 to 11 yr) who underwent brain MRI. None had symptoms of sleep-disordered breathing or conditions that impacted on their upper airway. MRI was performed under sedation. Sequential T1-weighted spin echo sagittal and axial sections were obtained and analyzed on a computer. We measured lower face skeletal growth along the midsagittal and axial oropharyngeal planes. In the midsagittal plane the mental spine-clivus distance related linearly to age (r = 0.86, p < 0.001). Along this axis, the dimensions of tongue, soft palate, nasopharyngeal airway, and adenoid increased with age and maintained constant proportion to the mental spine-clivus distance. Similarly, a linear relationship was noted for mandibular growth measured along the intermandibular line on the axial plane and age (r = 0.78, p < 0.001). In addition, the intertonsillar, tonsils, parapharyngeal fat pads, and pterygoids widths maintained constant proportion to intermandibular width with age. We conclude that the lower face skeleton grows linearly along the sagittal and axial planes from the first to the eleventh year. Our data indicate that soft tissues, including tonsils and adenoid, surrounding the upper airway grow proportionally to the skeletal structures during the same time period.

Quantitative analysis of CD1a (T6) positive Langerhans cells in human tonsil epithelium

Fifty-one human palatine tonsils of both sexes and 4-54 years of age were studied for quantitative analysis of Langerhans cells in the epithelium using CD1a (T6), which is a specific immunological marker for Langerhans cells and indeterminate cells. Cryo-sections were stained using the avidin biotin peroxidase method. Using light microscopy, CD1a-positive dark brown cells with dendritic processes were identified as Langerhans cells, which were located in the epithelium, subepithelial tissue, follicles and interfollicular areas. The Langerhans cells were counted only in the tonsil epithelium per zone of 1.1 mm length of basement membrane. For each biopsy, 25 such zones were studied. The mean number (SEM) of Langerhans cells per zone of tonsil epithelium was found to be 37 (+/- 0.5). In the male, it was 36 (+/- 0.7) but in the female, it was 38 (+/- 0.2). In different age subgroups, the mean number (SEM) varied between 40 (+/- 1.7) and 14 (+/- 1.1). In the age subgroups of 11-15, 16-20, and 21-25 years, the mean number showed significant sex differences. Since the 11-15, 16-20, and 21-25 age subgroups in the female showed an increased number of Langerhans cells, it is concluded that the immunological role of the palatine tonsils is increased during puberty and adolescence. In the female, there was a negative correlation (r = -0.196, p < 0.01) between age subgroups and mean numbers, but in the male there was no correlation (r = 0.008). Overall, in all the 51 biopsies together, there was a negative correlation (r = -0.017, p < 0.01) and significant (p < 0.001) sex and age differences.

An immunohistochemical study of bovine palatine and pharyngeal tonsils at 21, 60 and 300 days of age

An immunohistochemical study was performed on three groups of young cattle (21, 60 and 300 days of age). Tonsils (palatine and pharyngeal) and mucosae (nasal and oral) were removed. Eight monoclonal antibodies (specific for CD3, CD2, CD4, CD8, WC1, cell-surface IgM, cell-surface IgG and MHC class II molecules) and an avidin/biotin complex method on frozen sections were used. The immunological cytoarchitecture of bovine tonsils is similar to that of human tonsils. Nevertheless, these lymphoid tissues are not fully developed during the first weeks of life: T and B dependent areas not well-differentiated, few germinal centres, few intra-epithelial WC1+ T lymphocytes. In contrast, at 2 months, tonsils possess all the elements of a mucosa-associated lymphoid tissue (MALT). Tonsillar or mucosal epithelium is infiltrated by a large number of CD8+, WC1+ T lymphocytes and cells which express MHC class II molecules. Between 21 and 60 days, the number of WC1+ T lymphocytes increase markedly in the tonsillar epithelium. These results accredit the hypothesis that the presence of antigens has an effect on the localization of these lymphocytes at these sites.

Human vascular adhesion protein 1 (VAP-1) is a unique sialoglycoprotein that mediates carbohydrate-dependent binding of lymphocytes to endothelial cells

The regulated interactions of leukocytes with vascular endothelial cells are crucial in controlling leukocyte traffic between blood and tissues. Vascular adhesion protein-1 (VAP-1) is a novel, human endothelial cell molecule that mediates tissue-selective lymphocyte binding. Two species (90 and 170 kD) of VAP-1 exist in lymphoid tissues. Glycosidase digestions revealed that the mature 170-kD form of VAP-1 expressed on the lumenal surfaces of vessels is a heavily sialylated glycoprotein. The sialic acids are indispensable for the function of VAP-1, since the desialylated form of VAP-1 no longer mediates lymphocyte binding. We also show that L-selectin is not required for binding of activated lymphocytes to VAP-1 under conditions of shear stress. The 90-kD form of VAP-1 was only seen in an organ culture model, and may represent a monomeric or proteolytic form of the larger species. These data indicate that L-selectin negative lymphocytes can bind to tonsillar venules via the VAP- 1-mediated pathway. Moreover, our findings extend the role of carbohydrate-mediated binding in lymphocyte-endothelial cell interactions beyond the known selectins. In conclusion, VAP-1 naturally exists as a 170-kD sialoglycoprotein that uses sialic acid residues to interact with its counter-receptors on lymphocytes under nonstatic conditions.

Bcl-2 expression in the thymus and periphery

Bcl-2 proto-oncogene is expressed in normal lymphoid tissues and its role has been suggested to involve the selection of B and T cells. Here we report three-color flow cytometric studies on the expression of bcl-2 protein in the thymus and periphery. Bcl-2 was expressed in the majority of T and B cells and down-regulated only in the CD1+, CD3- to low, CD4+8+ thymocytes, and the B cells that are in cell cycle in the tonsil and lymph node. In contrast, the CD2+, CD1-3-4-8-19-, early T cells, and mature single positive cells in the thymus, as well as the tonsilar and lymph node T cells, irrespective of their cell cycle status, expressed bcl-2. These results are consistent with the notion that bcl-2 is down-regulated in the T and B cells that are in the process of generating new antigen receptors and subject to subsequent positive selection.

[The shape of the nasopharynx in youth: statistical study]

The particular shape of the nasopharynx in the child can influence morphology and physiopathologic behaviour of the mucosa. In such a perspective, it appeared interesting to evaluate the kind and the entity of its variations by means of nuclear magnetic resonance (NMR) in 50 patients (age range: 2 months-16 years). The results show that the nasopharyngeal shape (represented either by bending radius and shape factor) varies in a statistically significant way during the considered age range, while the dimension of the pharyngeal tonsil remains constant in the studied cases. The statistically significant shape variation of the tonsil appears, so, related to its involvement in the shape variation of the whole nasopharynx.

Ultrastructural study of postnatal development of the tonsillar crypt epithelium of the musk shrew, Suncus murinus

An ultrastructural study was made of the postnatal development of the tonsillar crypt epithelium in the musk shrew, Suncus murinus. On day 3 after birth, a particular kind of large lymphoid cell was first seen to move through the basement membrane into the epithelium. The next migration was that of lymphocytes, which passed through holes in the basement membrane. On days 5 to 7, the lymphocytes formed clusters, and pale epithelial cells of low electron density appeared. The cell clusters and pale epithelial cells fused on day 10. By day 14, these epithelial cells extended cytoplasmic projections to the surface of the epithelium, which had many heterophagic vacuoles and some microvilli-like structures. These findings suggest that the lymphoepithelial relationship is important for the organization of the immunological microenvironment in tonsillar crypt epithelium of the neonatal musk shrew.

Development and immunophenotyping of the pharyngeal tonsil (adenoid) in cattle

Immunoperoxidase staining and electron and light microscopy were used to characterize the development of the pharyngeal tonsil in 98 cattle aged between 30 days of gestation and 12 years. The rugae of the pharyngeal tonsil were poorly formed before 95 days of gestation. Microvillous (M) cells associated with intra-epithelial leucocytes (lympho-epithelium) were scattered among ciliated and goblet cells covering most of the surface in post-natal animals. Intra-epithelial leucocytes were rare in fetuses, but ciliated and M cells could be distinguished. Leucocytes of the lamina propria started to accumulate at approximately 120 days of gestation. A loose accumulation of mononuclear cells progressed into a B-cell rich upper and T-cell rich lower layer, with typical lymphoid tissue organization in post-natal animals and lymphoid involution in aged cattle. Primary lymphoid follicles formed at 5 months of gestation, but germinal centres did not form until 2 to 4 weeks after birth. Except for null cells, the relative number of cells staining for each leucocyte phenotype or MHC class II antigen increased with age, especially during the neonatal period. The early development, strategic location and specialized structure of the pharyngeal tonsil suggest an important role in modulating inhaled antigens in cattle. Fetal and neonatal calves had minimal lymphoid tissue priming, as indicated by lack of secondary follicles, low MHC class II expression and few intra-epithelial leucocytes. The phenotypic differences may be relevant to the increased susceptibility of calves to infectious diseases shortly after birth.

[Embryogenesis of the human tongue]

Developmental peculiarities of the tongue as a whole and its main structural elements (muscles, membranes, glands, lingual tonsil) have been studied in 120 human embryos and fetuses 5-week-old--9-month-old. Transmissive electron microscopy, electron histochemistry (for estimation of 5'-nucleotidase activity), staining of semithin slices with toluidine blue and aniline++ pink have been applied. Problems on migration of myogenic elements in the developing tongue have been discussed. Ultrastructure of gustatory bulbs of the human fetus tongues has been investigated. A complete formation of the tongue takes place by the 8th-9th months of the prenatal development.

The ontogeny of human lymphocyte recirculation: high endothelial cell antigen (HECA-452) and CD44 homing receptor expression in the development of the immune system

In the present report we have studied the expression of a lymphocyte homing receptor, the CD44 antigen, and of HECA-452, a high endothelial-specific antigen, during the development of the human immune system. We found that prothymocyte immigrants of the thymus already expressed the CD44 antigen. Similarly, the first peripheral T lymphocytes in fetal lymph nodes, tonsils and gut-associated lymphoid tissue were also CD44+. Cortical thymocytes and germinal center cells were CD44-. CD44 antigen expression was, thus, not limited to mature recirculating lymphocytes. This suggests that CD44 may not only be involved in recirculation of mature lymphocytes but also in the migration of prothymocytes to their site of maturation, i.e. the thymus. High endothelial venules (HEV) were not demonstrable at the early onset of lymphocyte immigration into the developing lymphoid organs. However, when large-scale influx of lymphocytes occurred, it paralleled HEV development. HECA-452 antigen expression preceded the morphological transformation of endothelium into a HEV phenotype. Expression of this antigen therefore, independently reflected the specialized nature of high endothelium. In a patient with complete DiGeorge's syndrome normal HEV developed, indicating that the presence of T lymphocytes is not a requirement for HEV development. Interestingly, a subpopulation of venules located in the thymic medulla near the cortico-medullary junction expressed the HECA-452 antigen. These vessels, which had flat or intermediately high endothelium, are probably involved in lymphocyte migration to the thymus.

Postnatal development of mucosa-associated lymphoid tissues in chickens

The postnatal development of chicken mucosa-associated lymphoid tissues of the eyes, lungs, and intestines were investigated with monoclonal antibodies specific for either all leucocytes, B lymphocytes, mononuclear phagocytes, IgM, IgG, or IgA. Attention has been paid to the relation of lymphoid infiltrates with their surrounding mucosae, the segregation into B-cell and T-cell areas, development of germinal centers, and secretory immunoglobulins. Abundant secretory IgM and IgA was detected in the epithelium of the Harderian glands in the orbits, even though they lacked large leucocyte infiltrates with germinal centers. Lymphoid tissues in the mucosae of lungs and intestines developed separate B-cell and T-cell areas. The proventriculus, Meckel's diverticulum, and Peyer's patches generally contained germinal centers from 12 weeks of age on. Because chickens as young as 2 weeks old had germinal centers in bronchus-associated lymphoid tissue and cecal tonsils, these areas were probably highly stimulated by antigens. Isotype-specific monoclonal antibodies were used to detect IgM-, IgG-, and IgA-bearing follicular cells in the same germinal center.

Formation of lymphoepithelial tissue in the sheep's palatine tonsil

Formation of lymphoepithelial tissue was studied in 1-, 10- and 21-day-old sheep. From each of the animals one of the tonsils was fixed in 4% glutaraldehyde for light- and electron microscopy while the other was frozen in liquid nitrogen for immunohistochemistry. These examinations revealed sequential histological events during the formation of reticular epithelium. (i) Appearance of a distinct epithelial cell indicates the initiation of the reticulation. The electron density of these epithelial cells is much lower than that of the common keratinocytes but the presence of cytoplasmic tonofibrils and desmosomes provides evidence that they are of epithelial origin. They may represent the precursors of M cells. Their appearance may be followed by expression of Ia+ molecules on the surrounding keratinocytes showed by isolated Ia+ areas in the epithelium. (ii) In the mesenchyme underneath the Ia+ epithelial areas, Ia+ dendritic-like cells emerge which immigrate through the basement membrane into the epithelium establishing a provisional dendro-epithelial tissue. In this stage of the reticular epithelium's formation large Ia+ areas are shown by immunostaining, which include the epithelium and mesenchyme. The origin of the Ia+ dendritic-like cells is uncertain but their distribution and dense accumulation underneath the epithelium suggest that they are transformed tonsillar mesenchymal cells. Similar cell transformation of mesenchymal cells takes place in the bursa of Fabricius prior to development of lymphoepithelial tissue. (iii) The M cell precursors together with the Ia+ dendritic-like cells adapt the epithelium to be suitable for receiving a large number of lymphoid cells. Immigration of the lymphoid cells into the epithelium transforms the dendro-epithelial tissue to a real lymphoepithelial one.

Dental development and the pharyngeal lymphoid tissue

Because the teeth are housed and develop within the jaws, skeletal development of the maxilla and mandible is a primary factor in the consideration of any problems pertaining to the developing dentition. Growth of the posterior nasal choanae, the maxilla, and the nasopharynx should be evaluated as a unit in assessing the favorable or unfavorable character of the nasopharyngeal region. Both large and small adenoidal tissues should be examined in light of the morphologic character of the nasopharynx (be it small, large, narrow, or wide) and related to the developing maxilla. Variables in size and location of the maxilla and the pharynx will play an important role in the impact that lymphoid tissue will have on the patency of the nasopharyngeal isthmus. Synchronized growth between the normally developing adenoids and the migration of the maxilla away from the cranial base will produce a balanced environment that precludes nasal obstruction by the presence of adenoids. With time, the changes in spatial relationships between the posterior border of the maxilla and the posterior pharyngeal wall plus atrophy of the adenoidal tissue will generally minimize or eliminate the problems of nasal obstruction and mouth breathing. Growth data may be used to evaluate the status, assess progress, measure comparability, determine inheritance patterns, and confer individuality. Unit-trait inheritance of the teeth, alveolar processes, maxilla, mandible, soft-tissue profile, tongue, pharynx, and lymphoid tissues may well produce more definitive answers to the question of the developing dentition and the pharyngeal lymphoid tissue. Finally, at present, no clinician can categorically state that enlarged tonsils or adenoids per se are responsible for abnormal dentition in the absence of other factors.

Human tonsillar T lymphocytes: an immature or activated T-lymphocyte population

In this study we compare the phenotype and the enzyme content of T lymphocytes purified from tonsils and from circulating blood before and different times after in vitro activation with PHA. The phenotype was studied with the following panel of monoclonal antibodies for the presence of activation antigens: OKT9, OKT10, anti-Dr, and Tac antigen. The enzyme content was studied by estimation of the LDH isoenzyme distribution and the enzymes of the purine metabolism ADA and PNP. In addition, the in vitro responsiveness of the T lymphocytes from tonsils and blood to human recombinant interleukin 2, to the lectins PHA, Con A and PWM was also studied. The LDH isoenzyme pattern expressed as B:A ratio decreases progressively after in vitro activation of T lymphocytes. The B:A ratio is already significantly different as early as 12 hr after activation, at a time that OKT9 and Tac are already expressed, but before the expression of OKT10, HLA-Dr, and the onset of the DNA synthesis. Tonsillar T lymphocytes exhibit also a significantly lower B:A ratio, but the activation antigens are not detected on their surface, except for the Tac antigens by means of a sensitive protein A rosette assay. Tonsillar T lymphocytes have a better responsiveness to lectins and recombinant II-2 than the corresponding circulating T lymphocytes. Therefore we are in favor of the hypothesis that tonsillar T lymphocytes contain activated T lymphocytes.

Tonsils and adenoids: why the dilemma?

Enlarged tonsils and adenoids have been implicated in dentofacial development and in the developing facial configuration. The growth pattern and the role of these lymphoid tissues are controversial, as are the benefits to be gained by their surgical removel. The diagnosis of enlarged tonsils and adenoids and of mouth breathing is not based on well-defined criteria.