Sternocleidomastoid muscle-clavicle myoosseous flap for single-stage reconstruction of postoperative tracheal defects in patients with invasive thyroid tumor. Three case reports.

In this report, we present 3 cases with thyroid carcinoma with tracheal invasion. In all cases, the tracheal defects were simultaneously reconstructed using a sternocleidomastoid muscle-clavicle myoosseous flap. We were able to close the tracheostomas without trouble, and no stenotic lesions or late complications were noted. This myoosseous composite flap has proved itself to be a reliable material for laryngotracheal reconstruction in some cases with thyroid carcinoma.

[Tonsillectomy and osteoarthritic disease].

We investigated the clinical outcome of tonsillectomy in 89 cases out of 100 cases of sternocostoclavicular hyperosteosis (SCCH) and 18 cases of rheumatoid arthritis (RA) who went through the operation more than 3 months before in our hospital between April 1984 and May 1993. The effect of tonsillectomy was associated with a decrease in the degree of pain. The symptom improvement was defined as a degree of pain less than 50% of the pre-operative level. The rates of improvement were 80.9% (72/89) in SCCH and 66.7% (12/18) in RA, whole 79% of SCCH patients had pustulosis palmaris et plantaris, a known focal infection of the tonsil. Eight of nine (88.9%) patients and eleven of 13 (84.6%) patients who were positive for the tonsillar provocation test and the annulation test, respectively, showed improved SCCH postoperatively. These results suggest that focal infection of the tonsil may be one of the etiologies of SCCH and RA.

[Efficacy of tonsillectomy for improving skin lesions of Pustulosis palmaris et plantaris--evaluation of 289 cases at the Department of Otolaryngology of Sapporo Medical University].

In recent years, Pustulosis palmaris et plantaris (PPP) has been described as one of the representative second lesions of focal tonsillitis in Japan. We selected 289 cases of PPP, treated with bilateral tonsillectomy at our department over the past 12 years for this clinical evaluation. In 211 of those 289 tonsillectomy cases, follow-up was done for more than 3 months after operation. Prior to tonsillectomy, 196 cases suffered from PPP only, 90 cases had the complication of osteo-arthral lesions such as sterno-costa-clavicular hyperosteosis (SCCH), rheumatoid arthritis, and soon, whereas only 3 cases showed simultaneous lesions of Psoriasis vulgaris. The efficacy of tonsillectomy for improving the skin lesions was classified into 6 grades, mainly based upon individual evaluation by each patient as follows; disappeared, remarkably improved, improved, slightly improved, unchanged, and worsened. According to our 211 cases, post tonsillectomy improvement of skin lesions was very obvious, with disappearance occurring in 54.3% of cases and remarkable improvement in 21.4%. Age of onset and the duration from onset to tonsillectomy showed no association with effectiveness. However, the shorter the duration from onset to tonsillectomy, the fewer days were required for improvement of the skin lesions. The rate of improvement of PPP rose in conjunction with the number of days after tonsillectomy. We conclude that it requires 12 months, at minimum, to determine the efficacy of tonsillectomy as a treatment for PPP.

[Investigation of the immune response in tonsillar lymphocytes against streptococci in patients with pustulosis palmaris et plantaris].

The purpose of this study was to clarify the etiological role of immune responses in tonsillar lymphocytes of the patients with pustulosis palmaris et plantaris (PPP). In order to determine their immune response to S. pyogenes T4, S. pyogenes T12, S mitis, S. salivarius, S. sanguis I, S. sanguis II and S. pneumoniae, tonsillar lymphocytes from patients with PPP, CT, and sleep apnea syndrome (control) were cultured with formalinized streptococcal cellular antigens. Blastoid transformation was investigated by [3H] -thymidine uptake, while antistreptococcal antibody production were measured by an enzyme-linked immunosorbent assay (ELISA). The results were as follows. 1. Tonsillar lymphocytes from PPP patients underwent blastoid transformation and accelerated the production of immunoglobulin G following the addition of S. sanguis I, S. sanguis II S. mitis, S. pyogenes T4, and S. pyogenes T12, while those form CT patients and controls did so only with S. pyogenes T4 and S. pyogenes T12. 2. The spontaneous production of specific IgG against various streptococci, including S. sanguis I, S. sanguis II and S. mitis by tonsillar lymphocytes from patients with PPP was already higher than that from CT patients and controls. The specific IgM production was also increased above that in PPP patients without any antigens. 3. S. sanguis I, S. sanguis II and S. salivarius antigens stimulated antigen-specific IgM production in tonsillar lymphocytes from PPP patients. 4. The levels of specific IgG production against S. sanguis I and S. sanguis II by tonsillar lymphocytes from PPP patients showed a relationship with the serum levels of the PPP patients. These results suggested that the sensitization of alpha-streptococci, especially S. sanguis, in the tonsillar lacunae may lead to the specific production of anti-S. sanguis antibodies in patients with PPP, and these may be involved in the pathogenesis of PPP.

[Investigation of the bacterial flora in the tonsillar lacunae and serum levels of streptococcal antigen-specific antibodies in patients with pustulosis palmaris et plantaris].

The purpose of this study was to clarify the relationship between bacterial flora in tonsillar lacunae and antistreptococcal antibody in sera of the patients with pustulosis palmaris et plantaris (PPP). Since the pustules develops or worsens after tonsillitis in many patients with PPP, a pathogenic role of tonsillar bacteria is suggested, but no significant association has been proven so far. In this study, the aerobes in the tonsillar lacunae were identified and quantitated in 15 adult patients with PPP and 9 adult patients with chronic tonsillitis (CT). In addition, serum streptococcal antigen-specific antibody levels in 40 adult patients with PPP, 18 adult patients with chronic tonsillitis, and 11 healthy volunteers (controls) were examined by enzyme-linked immunosorbent assay (ELISA). The results were as follows. 1. A total of 53 strains (17 species) of aerobes were isolated and identified from the tonsillar lacunae in patients with PPP, while 35 strains (12 species) of aerobes were found in the patients with CT. 2. S. salivarius and S. pneumoniae were the dominant aerobes isolated from patients with PPP or CT. 3. Although the rates of isolation for Staphylococcus and S. pneumoniae were lower in PPP patients than in CT patients, the rate for S. sanguis I was higher in PPP patients than in CT patients. 4. The percentage of alpha, gamma-streptococci to total aerobes in PPP patients was higher than in CT patients. 5. The IgG antibody titers against S. sanguis and S. mitis, and the IgM antibody titers against all streptococci investigated in PPP patients were higher than those in both CT patients and controls. 6. Moreover, both the IgG antibody titers against S. pyogenes T4 and S. sanguis I and the IgM antibody titers against S. sanguis I and S. sanguis II of the patients in which PPP markedly improved after tonsillectomy were higher than those in which PPP showed less improvement postoperatively.

Tonsillectomy-induced changes in anti-keratin antibodies in patients with pustulosis palmaris et plantaris: a clinical correlation.

Titers of anti-keratin antibodies (AKA) involving IgG and IgM fractions were determined by a solid-phase enzyme-linked immunsorbent assay (ELISA) and were found to be significantly higher on average in patients with pustulosis palmaris et plantaris (PPP) than in normal controls. Positive rates of IgG-AKA and IgM-AKA in sera of PPP patients were 50% and 66%, respectively. Following tonsillectomies, patients with high IgM-AKA titers that decreased after surgery were found to benefit by a marked improvement in their skin lesions. There was a close relationship between the degree of this improvement in the skin lesions and the changes in IgM-AKA titers after the operation. These results suggest that PPP may be a tonsil-related immunological skin disease.

Non-Hodgkin's lymphoma of Waldeyer's ring and nasal cavity. Clinical and immunologic aspects.

Twenty-nine cases of non-Hodgkin's lymphoma of Waldeyer's ring (W-NHL) and nasal cavity or paranasal sinus (N-NHL) were studied for tumor-surface marker phenotype and histopathologic correlation with clinical features. Immunostaining procedures on tissue sections by using xenoantisera and monoclonal antibodies to human B- and T-cells enabled the authors to demonstrate precise surface marker phenotypes of tumor cells and, moreover, the histologic localization of normal or neoplastic B- and T-cells in preserving the original structure of lymphoid organs or tumor tissues. In 22 cases of W-NHL, 19 (86%) had B-cell markers and 3 (14%) had T-cell markers, whereas 6 of 7 cases (86%) of N-NHL had T-cell markers. Tumor cells in T-cell lymphomas in W-NHL and N-NHL reacted with antibodies to peripheral T-cells except one case of W-NHL. Rappaport "histiocytic" subtype was heterogeneous with respect to both surface marker characteristics and morphologic features, i.e., seven had B-cell markers and four had T-cell markers, and they were all subdivided into "large cell" or "large cell, immunoblastic" in Working Formulation and "large cell" or "pleomorphic" in Lymphoma Study Group classification. The actuarial survival curve for all T-cell lymphoma patients was characterized by a rapid initial decline and a subsequent plateau, which contained two of the long survivors. In contrast, the B-cell lymphoma group had a more graded decline. The median and actuarial survivals of the T-cell lymphoma group were far inferior to those for the lymphoma group that expressed B-cell markers.

Cell-size distribution of human tonsillar lymphocytes.

Cell-size distributions of human tonsillar lymphocytes (TL) and adenoid lymphocytes (AL) were determined using a computerized cell-size analyser. In comparison with peripheral blood lymphocytes, TL, and AL comprised a greater number of large lymphocytes. Child TL were characterized by an enrichment of not only B-lymphocytes but also of large lymphocytes. A decrease in the number of large B-lymphocytes with advancing age was considered to be indicative of the morphological profile of tonsillar involution.

Amino acid transport in human tonsillar lymphocytes with regard to patient's age and tonsillar diseases.

Amino acid transport in human tonsillar lymphocytes was investigated in 32 patients of various ages and with different tonsillar diseases. Tonsillar lymphocytes appeared to possess at least four different transport systems for neutral amino acids including the activated Na+-dependent A system transport. The transport activity of neutral amino acid was significantly higher in child cases than in adult cases. In adult cases with focal tonsillitis, tonsillar lymphocytes were taken from patients with rheumatoid arthritis (RA) and skin diseases as secondary lesions who showed good improvement of the skin lesions after tonsillectomy. These lymphocytes were revealed to have more activated Na+-dependent transport than those from patients with skin diseases who showed poor improvement of the skin lesions after the tonsillectomy, and those from patients with recurrent tonsillitis. The characteristics of amino acid transport in human tonsillar lymphocytes and changes influenced by age and tonsillar diseases are discussed.

Spontaneous DNA synthesis in tonsillar lymphocytes and its clinical implications.

Spontaneous DNA synthesis (SDS) in tonsillar lymphocytes was investigated in 58 cases by [3H]-thymidine incorporation under a certain culture condition without any mitogens. Tonsillar lymphocytes showed an extremely higher uptake of [3H]thymidine than peripheral blood lymphocytes. Cells exhibiting SDS were mainly B cells, but, however, they needed the helper functions of T cells and glass-adherent cells to synthesize DNA. SDS in tonsillar lymphocytes decreased with age and was lowest in the 21-30 year age group. SDS in cases with complications such as chronic sinusitis, nasal allergy or secretory otitis media was significantly higher than that in cases with no complications.