A STUDY ON THE TONSIL WITH FOCAL INFECTIONS -WITH SPECIAL REFERRENCE TO THE NEWLY DEVISED TONSILLAR CRYPTSCOPE AND THE ARCHITECTURE OF VESSELS IN CRYP

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1 A STUDY ON THE TONSIL WITH FOCAL INFECTIONS -WITH SPECIAL REFERRENCE TO THE NEWLY DEVISED TONSILLAR CRYPTSCOPE AND THE ARCHITECTURE OF VESSELS IN CRYPTS- KEIJI FUJIHARA, M.D. Department of Otolayngology, Wakayama Medical College, Wakayama It is well known that inflamed human palatine tonsils have many surface crypts showing characteristic lymphoepithelial symbiosis, which play an important role in immune response. The cryptepithelia are rich in blood vessels. This proliferation of blood vessels is said to be the initiation of various kinds of immune responses. We devised a tonsillar cryptscope in order to observe the tonsillar crypt. Scopy with the cryptscope confirmed seven characteristic types of capillary vessels. The cryptscopic figures showed different patterns in tonsillar diseases such as hypertrophic tonsil, recurrent tonsillitis and tonsil with focal infection (palmoplantar pustulosis and psoriasis vulgaris). In this study the significances of tonsillar cryptscopic figures were investigated through the study of three dimensional structures of blood vessels and immuno-histology. In order to understand the structure of capillary vessels in details, human palatine tonsils were studied using corrosion casting techniques with a scanning electron microscope. Horseshoe type capillary vessels corresponded to the curved capillary vessels in the epithelium. This type of capillary vessel was observed in the epithelia covering the interfollicular area. The tonsillar blood vessels, along with closely related substances in the epithelium and the parenchyma, were immuno-histologically examined. Where the lymphocytes had densely infiltrated the epithelium, the basement membrane became thickened and often disrupted ; the endothelial cells were also enlarged. Adrian et al reported that lymphocytes invaded from the capillary vessels within the epithelia. Thus it was suggested that the horseshoe type was related to lymphocyte invasion of the epithelia. With the Arthus reaction in the rabbit tonsil, some resin leakage through the vessel walls around the crypt was observed in the three dimensional structure of capillary vessels. Immune complexes positive to anti-c3 and anti-igg antibodies were found in the crypt epithelia of human tonsils with focal infection. The small bleeding spot was therefore attributed to the Arthus reaction. The tonsillar crypt scope is a useful instrument. It allows us to get information about various histological conditions of the cryptepithelia macroscopically without resort to tonsillectomy. Key words: G Aâ Ž ¾, G ŒŒŠÇ \ z, Œ^ džqœ ¾ Æ u Ì,ŒuŒõ R A

10 13) Curran RC, Jones EL: Immunoglobulin containing cells in human tonsils as demonstrated by immunochemistry. Clin Exp Immunol 28: , ) Marta EP, Marilyn MJ, Y Mustafa: Structure of the crypt epithelium in human palatine tonsils. Acta Otolaryngol(Stock h)suppl 454: 53-59, ) Pober JS, Gimbrone MA, Cotran RS et al : la expression by vascular endothelium is induced by activated T cells and by human y-interferon. J Exp Med 157: 1339, ) Stern DM, Bankl, Nawroth PO et al : Self regula- tion of procoagulant events on the endothelial cell surface. J Exp Med 162: 1223, ) Hodd KC et al : SEM of micro corrosion casts with special attention on arterio-venous differences and 20) Fioretti A : Die Gaumenmandel. Darstellung der Velag, Stutt-gart, 1961, pp ) Fujihara K, Kimura T, Tabata T et al: The newly devised tonsillar cryptscope for clinical use. Laryngoscope 98: , ) Murakami T : Application of the scanning electron microscope to the study of the fine distribution of the blood vessels. Arch Histol Jpn 32: , application to the rat's cochlea. SEM 3: , 28) Duijvestijn AM, Eveliene H, Steven TP et al : High 11) Schlingemann R0: Monoclnal antibodies PAL-E endothelial differentiation in human Lymphoid and specific for endothelium. Labo Invest 52: 71-76, inflammatory tissue defined by monoclonal antibody HECA-452. Am J Patho 130(I): , 1987, 12) Schmedtje JF, Batts AF: Immunoglobulins and blood vessels in the tonsillar crypt epithelium. 29) Kelemen G : Pathway of the tonsillar lymphocyte. Ann Otol Rhinol Laryngol 82: , Arch Otolaryngol 38 : , ) Nopanitaya W et al : An improved plastic mixture for corrosion casting of the gastrointestinal microinvasion system. SEM 3: , Biologie and Physiopathologie. Georg Thieme 25) Umetani Y : Postcapillary Venule in Rabbit Tonsil and Entry of Lymphocytes into its Endothelium, Arch Histol Jap 40 : 77-94, 1977.

30) Kelemen G : Histological test of tonsillar activity based on the reticuloepitnelial interplay. Arch Otolaryngol 59: 263-281, 1954.

11 30) Kelemen G : Histological test of tonsillar activity based on the reticuloepitnelial interplay. Arch Otolaryngol 59: , ) Boenninghaus H : Uber den Retikulierungsvorgang am Epithel der Tonsille and die dabei auftrenden eranderungen an der Gitterfaserstrunktur. V Z Laryng Rhinol 34: , ) P. Brandtzaeg, Immunopathological alterations in tonsillar disease. Acta Otol Suppl 454: 64-69, th Asia-Oceania Congress of Oto-Rhino-laryn gological Society, 14th World Congress of Otor hinolaryngology Head and Neck Surgery c:za Ltz.

EVALUATION OF MAGNETIC RESONANCE IMAGING (MRI) IN DIAGNOSIS OF ACOUSTIC NEUROMA-COMPARATIVE STUDY WITH PLAIN X-RAY AND CTS- KIMIHISA NOMURA, M.D., MAK

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