Amígdalas y adenoides: defensa ante agentes patógenos y su implicancia estomatológica / Tonsils and adenoids: defend to pathogenic agents and their stomatological involvement

La función de las amígdalas siempre ha sido discutida, desde afirmar que no tenían funcionalidad, hasta la actualidad que se plantea un papel inmunológico, con actividad linfocitaria de defensa, debido a la localización de linfocitos en el tejido de las amígdalas. Este artículo de actualización pretende describir desde la embriología, histología, fisiología, patología y estomatología, el rol que desempeñan las mismas en su papel inmunológico ante la acción de agentes patógenos. Se destaca la acción conjunta de las amígdalas palatinas, amígdalas faríngeas o adenoides, amígdalas peritubarias, amígdalas linguales y todo el resto de tejido linfático que conforman el anillo linfático faríngeo o anillo de Waldeyer, ya que cumplen un rol determinante en la defensa del organismo (AU)

The function of the tonsils has always been debated, from stating that they had no functionality, to the present day that an immunological role is proposed, with lymphocyte defense activity, due to the location of lymphocytes in the tissue of the tonsils. This update article aims to describe from embryology, histology, physiology, pathology and stomatology, the role they play in their immunological role against the action of pathogens. The joint action of the palatine tonsils, pharyngeal or adenoid tonsils, peritubal tonsils, lingual tonsils and all the rest of the lymphatic tissue that make up the pharyngeal lymphatic ring or Waldeyer's ring is highlighted, since they play a decisive role in the defense of the organism (AU)

Inflammatory markers in palatine tonsils of children with obstructive sleep apnea syndrome / Marcadores inflamatórios em tonsilas palatinas de crianças com síndrome da apneia obstrutiva do sono

Abstract Introduction Obstrutive sleep apnea syndrome is characterized by repeated episodes of upper airway obstruction, associated with intermittent hypoxia and hypercapnia, and the main risk factor in childhood is adenotonsillar hypertrophy. The lymphocytes in these structures are responsible for local and systemic immune responses. Objective Verify the levels of the inflammatory markers, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, CRP and α1-GP, in the tonsils of children with and without obstructive sleep apnea syndrome. Methods This cross-sectional prospective study included 34 children with complains of snoring, difficulty breathing during sleep or recurrent tonsillitis. Patients underwent to a complete otorhinolaryngological examination, nasal endoscopy and polysomnography and were divided into two groups with 17 children each: obstructive sleep apnea syndrome group and control group. All underwent an adenotonsillectomy. Cytokines were measured in the collected tonsils (ELISA and Multiplex methods). Results Statistically significant increasing were observed between IL-8 and IL-10 cytokines of patients with obstructive sleep apnea when compared to the control group; also between c-reactive protein and α1-GP of the tonsils cortical region in children with obstructive sleep apnea syndrome when compared with the medullary region. There were no statistically significant differences for the remaining inflammatory mediators. Conclusion After the analysis of the levels of pro and anti-inflammatory markers (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, CRP, α1-GP) in the tonsils, we observed higher levels of markers IL-8 and IL-10 in pediatric patients with obstructive sleep apnea syndrome.

Resumo Introdução A síndrome da apneia obstrutiva do sono é caracterizada por episódios repetidos de obstrução das vias aéreas superiores, associados a hipóxia intermitente e hipercapnia, e o principal fator de risco na infância é a hipertrofia adenotonsilar. Os linfócitos nessas estruturas são responsáveis por respostas imunes locais e sistêmicas. Objetivo Dosar os marcadores inflamatórios, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, PCR e α1-GP, nas tonsilas de crianças com e sem síndrome da apneia obstrutiva do sono. Método Estudamos prospectivamente 34 crianças que se queixavam de ronco, dificuldade para respirar durante o sono ou tonsilites recorrentes. Os pacientes foram submetidos a exame otorrinolaringológico completo, endoscopia nasal e polissonografia e foram divididos em dois grupos com 17 crianças cada: síndrome de apneia obstrutiva do sono e controle. Todos foram submetidos à adenotonsilectomia. As citocinas foram medidas nas tonsilas coletadas (métodos ELISA e Multiplex). Resultados Com diferenças estatisticamente significantes, observou-se aumento das citocinas IL-8 e IL-10 em pacientes com apneia obstrutiva do sono em comparação ao grupo controle, assim como aumento dos níveis de proteína C reativa e de α1-GP na região cortical das tonsilas de crianças portadoras de síndrome da apneia obstrutiva do sono em comparação com a região medular. Não houve diferenças estatisticamente significantes para o restante dos mediadores inflamatórios. Conclusão Após a análise dos níveis de marcadores pró e anti-inflamatórios (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, PCR, α1-GP) nas tonsilas, observamos níveis mais altos de marcadores IL-8 e IL-10 em pacientes pediátricos com síndrome da apneia obstrutiva do sono.

IgM, IgG, IgA serum levels and lymphocytes count before and after adenotonsillectomy

Tonsils and adenoids are involved in both local immunity and immune surveillance for the development of immune defense mechanisms. A number of investigators have found decreased immunoglobulin levels after adenotonsillectomy while others have failed to find significant changes. The effects of adenotonsillectomy on the cellular immunity of children have not been investigated extensively. To observe the change in humeral and cellular immune systems before and after operation in patients undergoing adenotonsillectomy. The study comprised 102 patients; all of the patients underwent adenotonsillectomy. The levels of IgG, IgA, and IgM were measured for humoral immunity and the percent of CD7 and CD19 positive cells were determined in blood samples taken from these patients 24 hours before operation and also 2 and 8 weeks after the operation. The results were subjected to statistical analysis. The present study shows that the serum level of IgA would rise few weeks after the operation. Changes in the IgM and IgG level were not statistically significant postoperatively. In addition, no significant change was detected in B lymphocyte count before and after adenotonsillectomy. In our study, there was a slight decrease in the T lymphocyte count in the early stage of post operation, which returned to normal preoperative value after 8 weeks. Several immune system parameters maintain its normal status several weeks after adenotonsillectomy

Estudo do efeito de distintos períodos de fixação em formalina e métodos de recuperação antigênica na técnica de imuno-histoquímica / Study of the effect of different fixation times in formalin and methods of antigen retrieval in immunohistochemistry

Avaliou-se a influência do tempo de fixação em formalina neutra tamponada a 10 por cento e dos diferentes métodos de resgate de sítio antigênico induzido pelo calor [heat induced epitope retrieval (HIER)] para a imunoexpressão dos anticorpos anti-antígeno nuclear de proliferação celular (PCNA) e anti-AE1AE3 (citoqueratinas), empregados por apresentarem imunocoloração nuclear e citoplasmática ou submembranosa. Foram estudadas cinco tonsilas provenientes de amigdalectomias realizadas no Hospital São Paulo da Escola Paulista de Medicina da Universidade de São Paulo (UNIFESP/EPM), as quais foram seccionadas em 0,5cm² cada, fixadas em formalina, por períodos de tempo de seis, 12, 18, 24 e 48 horas e embebidas em parafina. Foram feitos cortes com 4mim em lâminas silanizadas. Para o estudo imuno-histoquímico utilizamos os anticorpos anti-PCNA e AE1AE3, empregando os três métodos de resgate de sítio antigênico: banho-maria, microondas e panela de pressão. A positividade na imunoexpressão do PCNA foi avaliada através da relação núcleos corados/total de núcleos x 100. A intensidade da coloração resultante foi avaliada através da utilização dos programas Corel Photo Paint 9 e UT Morph 2.0. Com relação à recuperação antigênica, concluímos que, para o anticorpo anti-PCNA no material fixado nos períodos de nosso estudo, os melhores resultados foram obtidos com o uso do microondas. O aumento do tempo de fixação interferiu na queda da imunopositividade do PCNA, em especial após o período de 24 horas. Em relação ao parâmetro intensidade de coloração para AE1AE3 nenhum dos métodos foi superior. A metodologia estudada para a análise semiquantitativa na intensidade da reação coincidiu com os resultados obtidos na avaliação criteriosa de cada uma das lâminas.

Immunohistochemical analysis of CD71, CD98 and CD99 activation antigens in human palatine and nasopharyngeal tonsils

Tonsils [palatine and nasopharyngeal] are immunologically active tissues. Due to their anatomical location, they are considered to be the initial defense barrier against the antigens entering into the respiratory and gastrointestinal tract. Tonsils act against these antigens by producing and activating the lymphocytes, which are responsible for the immune response. In order to get information regarding the distribution of cell surface antigens on the epithelial, stromal and lymphoid cells of these organs, we performed immunohistochemical staining by using antibodies against CD99, CD71 and CD98 activation antigens. Tissue samples of 20 patients undergoing tonsillectomy and adenoidectomy who presented with recurrent tonsillitis and adenoid hypertrophy in the Otorhinolaryngology Department, Hacettepe University Medical Faculty Hospital, Ankara, Turkey in 2001, were obtained as partial tissue samples apart from pathological examination. Tissues were immunostained by the indirect immunoperoxidase method. Strong CD71 reactivity in macrophages was observed as an indicator of the active role of the macrophages in immunoresponse in the chronic inflammation reaction. The CD98 reactivity on the proliferative basal layer of epithelium was a usual finding, as its detection in epithelial neoplasms and proliferative states is well known. We did not observe any reactivity of CD98 in nasopharyngeal tonsil epithelium and lymphoid cells of either nasopharyngeal or palatine tonsils. The CD99 reactivity was observed in the T-cell dependent area. We determined some topographic difference in the expression of some activation antigens in the epithelial, stromal and lymphoid components of the palatine and nasopharyngeal tonsils. Further detailed studies directed to determine the role of these antigens in tonsils would help to understand the role of these molecules in inflammatory events

Quantitative assessment of T. and B lymphocytes population pre and post tonsillectomy

T and B lymphocytes were quantitatively estimated in the peripheral blood of 50 patients pre tonsillectomy and three months postoperatively by E-rosette and E-A rosette tests, respectively. There was a statistically significant decrease in E-rosette and E-A rosette percentage postoperatively. Age and sex of patients had no statistical significant effects on the results. The results may give an idea about the importance of the tonsils as a tissue sharing in the immunological mechanism of the body and this may direct the attention of the ENT surgeon to put the immunological factor in consideration during taking the decision of tonsillectomy

Imunofisiologia do anel linfatico de Waldeyer / Imunnophisiology of Waldeyer's linfatic ring

O anel linfatico de Waldeyer (ALW), descrito pelo anatomista alemao Wilhelm Von Waldeyer, consiste em um aglomerado de tecido linfoide localizado de forma a circundar o istmo da orofaringe e a transicao entre a naso e orofaringe. Seus componentes sao tonsila faringea (adenoides), localizada na regiao mediana mais superior da parede superior da rinofaringe, estendendo-se lateralmente ate o ostio tubareo, encontrando o tecido que ai forma a tonsila tubarea. Abaixo e laterlamente a estes componentes, na abertura da orofaringe, encontra-se a tonsila palatina. O anel e completado pelas tonsilas linguais, que ocupam quase toda a extensao mais posterior do 1/3 posterior da lingua

Amigdalas e inmunidad. Relación clínico inmunológica en pacientes amigdalectomizados / Tonsils and inmunity. Relation clinical and inmunological in tonsillectomy patients

Determinamos los niveles séricos de las inmunoglobulinas IgG, IgA, é IgE, en 20 pacientes atópicos, en edades entre los 4 y 13 años y un grupo control de 20 personas normales. Se estudiaron los niveles antes y después de la adenoidotonsilectomía; encontrándose que la IgA, IgG é IgE tenían valores muy altos antes de la operación y dos meses despúes bajan bruscamente la IgA é IgG, manteniéndose iguales los niveles de IgE. De los 20 pacientes operados, 6 desarrollaron exacerbación de las crisis de asma; y dos de ellos mejoraron. La presencia de una deficiencia de IgG é IgA con elevación de IgE antes de una adenoidotonsilectomía, debe ser tomada en cuenta como contraindicación quirúrgica: debido a que estos pacientes con toda seguridad desarrollarán infecciones repetidas del tracto respiratorio alto y bajo después de la operación