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Our study hypothesized that cytokines or chemokines induced in tonsils by infectious stimulations play an important role on the exacerbation of the glomerular injuries in patients with IgA nephropathy (IgAN). Tonsils from six patients with IgAN diagnosed by renal biopsy were studied after getting their written informed consents Tonsils from six patients with tonsil disorders with non-renal disorders were examined as controls. Tonsillar mononuclear cells (TMCs) were isolated and resuspended with RPMI 1640 with 10% FCS. These cells were incubated for 48 h with staphlococcus enterotoxin-B (SEB) or lipopolysaccaride (LPS). The levels of IL-6, IL-8, IL-12 and MCP-1 in the supernatants were measured by solid-phase enzyme-linked immunosorbent assay (ELISA) kits. The actual cytokine concentrations were calculated by determining the standard curves. The experiments were performed in duplicate, and the mean value was calculated. We found that tonsillar mononuclear cells of IgA nephropathy produced mesangial proliferative chemokines (MCP-1, IL-8) in higher amounts compared to tonsils from non-IgA nephropathy. This result suggests that upper respiratory tract infections such as tonsillitis may be one of the risk factors of the aggravation in patients with IgA nephropathy.

The growing number of macrolide-resistant strains of Streptococcus pyogenes is an increasing problem worldwide. This study evaluated 300 clinical isolates obtained from the upper respiratory tract. Minimal inhibitory concentrations (MICs) of erythromycin (EM), azithromycin (AZM), and clindamycin (CLDM), serotypes, and macrolide resistance genes of mefA, ermB, and ermTR were determined. The genetic relationship of EM-resistant and susceptible strains were also analyzed by pulsed-field gel electrophoresis (PFGE). Twenty-nine (9.7%) EM-resistant S. pyogenes were identified. Of the 29 strains showing resistance to EM, 22 isolates (7.3%, MIC 3.13-12.5 microg/ml) expressed the mefA gene. The predominant serotypes among the mefA-positive isolates were T12, emm9 or T25, emm75-1. The two isolates (0.1%) that possessed the ermB gene were highly resistant to EM (MIC100 microg/ml). The remaining five strains (1.6%) possessed the ermTR gene (MIC 3.13-100 microg/ml). Restriction fragment polymorphism analyzed by pulsed-field gel electrophoresis (PFGE) by SmaI and ApaI digestions showed several clones among the mefA-positive S. pyogenes. Our findings suggest that the mefA gene is the predominant mechanism for macrolide resistance and that this gene is horizontally transmitted among M phenotype strains of S. pyogenes. Consequently, macrolides would not be the first drug of choice for treatment of tonsillitis and other S. pyogenes-related diseases. Physicians and researchers need to take into consideration the macrolide resistance of some strains of S. pyogenes.

Palatine tonsils are located on the strategic site at an entrance of both the gastrointestinal tract and airways. The tonsil has a double-sided face, i.e., a bright side as an immune organ for protection against microorganisms from outside and a dark side as an infectious organ such as tonsillitis. Numerous studies have reported that the tonsil has immune functions; however, the mechanism of recurrent bouts of tonsillar infections remains to be addressed. In order to understand the immune mechanism in tonsillar lymphocytes, we examined co-stimulatory factors, CD80 and CD86, on tonsillar lymphocytes, which have been shown to be prerequisite for antigen-specific T cell activation in immune responses. We investigated the expression of CD80 and CD86 on B cells from tonsils with recurrent infections more than four episodes per year (the infectious group), from tonsils with chronic tonsillitis less than three episodes per year. The numbers of CD80- and CD86-postive B cells were significantly lower in the infectious group than in the less-infectious group (p

The concept that altered antigens in the squamous epithelium of the palatine tonsil may serve as a source of autoantibodies for diseases of the palms and soles, i.e., pustulosis palmaris et plantaris (PPP), has been considered for a long time. To study the role of tonsillar mononuclear cells in the onset of PPP lesion, we developed a xenogeneic transplantation model, human skin/severe combined immunodeficiency (SCID) chimera and reconstituted the chimera with human lymphocytes from PPP patients.

Beta-catenin is an undercoat protein of cadherin, a cellular adhesion molecule. Beta-catenin also functions as a transcriptional activator downstream of the Wnt signaling pathway. Intracellular beta-catenin is regulated by the formation of a complex with APC (adenomatous polyposis coli) protein. The activation of this pathway by stabilization with beta-catenin has been shown to be an important step in the development of colorectal carcinoma, which is mainly caused by inactivating mutations in the APC tumor suppressor gene or by activating mutations in exon 3 of the beta-catenin gene. This study was conducted to clarify the contribution of beta-catenin accumulation and the mutation of the beta-catenin gene to the carcinogenesis of head and neck cancer. Beta-catenin accumulation was examined immunohistochemically in 49 frozen or formalin-fixed, paraffin-embedded samples of head and neck tumors. We also performed a direct sequence analysis of APC and beta-catenin to examine the cause of beta-catenin accumulation. Genomic DNA was extracted and purified from fresh tissue samples of head and neck cancers. We examined the APC mutation cluster region in 15 samples and analyzed beta-catenin exon 3 mutations in 31 cases. Twelve out of 49 (24.5%) cases exhibited beta-catenin accumulation in our histochemical study. The 5 year survival rate was 0% in the beta-catenin accumulation group, compared to 50% in the non-accumulation group, (p < 0.01). This finding strongly suggests that beta-catenin may play an important role in the carcinogenesis or progression of head and neck cancer. One of the 15 cases exhibited an APC missense mutation that led to the replacement of amino acids; this case died in 12 months. Regarding the beta-catein mutation, non of the 31 samples exhibited a gene mutation in beta-catenin exon 3. Thus, the rate of APC and beta-catenin mutation in head and neck cancer may be very low.

Pustulosis palmaris et plantaris (PPP) has been considered as one of the typical tonsillar focal infections, based on the marked clinical improvement of the skin lesions after tonsillectomy. Despite the accumulation of data showing the clinical efficacy of tonsillectomy for this skin lesion, fundamental etiological and pathophysiological issues have yet to be addressed. One primary obstacle hindering investigators has been the lack of an appropriate animal model for this human skin disorder. In the early stage of PPP, it has been reported that lymphocytes, predominantly CD4+ T lymphocytes, infiltrate the palmar and plantar skins. However, the origin and mechanism of infiltration by these lymphocytes is not clear and there are very few reports on whether tonsillar mononuclear cells react directly with the skin. We have been intrigued by the ability to engraft human cells onto severe combined immunodeficiency (SCID) mice, together with the opportunity for long-term graft survival and ability to adoptively transfer various human immunocompetent cells. In this review, we addressed the existing deficiencies in our understanding of the relationship between tonsils and PPP by using emerging transplantation technology involving SCID mice.

The lining of the middle ear cleft is normally a thin modified respiratory type mucosa. Normal mucosa of the middle ear is devoid of salivary type seromucous glands. Middle ear adenoma is a rare tumor that seems to be derived from the middle ear mucosa. This tumor has been previously described under a variety of names because of its different nature and biological behavior. We herein report a case of middle ear tumor that shows adenomatous and neuroendocrine features. A 64-year-old woman presented with a history of hearing loss, tinnitus and stuffy feeling of the right ear. The patient was treated two times for ear polyp. She finally underwent a tympanomastoidectomy and there was no evidence of recurrence 18 months after the procedure. Histopathological examination displayed cuboidal and columnar cells, arranged as glands, trabeculae and solid sheets. Neuroendocrine differentiation was revealed by immunohistochemical staining with polyclonal antibodies against neuron specific enolase and chromogranin antigens.

Pustulosis palmaris et plantaris (PPP) has been considered as one of the typical tonsillar focal infections, based on the marked clinical improvement of the skin lesions after tonsillectomy. In early-stage of PPP, it has been reported that lymphocytes, predominantly CD4-positive cells, infiltrate the palmar and plantar skin. However, the origin and mechanism of infiltration by these lymphocytes is not clear and there are very few reports on whether tonsillar cells react directly with the skin, possibly due to the difficulty of establishing adequate animal models. In this study, we established an experimental animal model of mice with severe combined immunodeficiency (SCID) and observed the, reaction of the tonsillar lymphocytes (TL) or peripheral blood lymphocytes (PBL) of patients with PPP to their own plantar skin by transplanting the lymphocytes and skin of the patient into the mice. The results revealed that TL infiltrated the skin to a significantly greater extent than PBL, Most of these lymphocytes were T lymphcicytes, and no B lymphocytes were detected in the transplanted skin. Strong expression of LFA-1 and ICAM-1 was observed in the skin after the TL transplantation. These results suggest that TL have a strong affinity for the skin in PPP. and that the adhesion molecules may play an important role in the infiltration by lymtphocytes of the skin.

Some anti-bacterial agents have been reported to have immuno-potentiation effects and to show synergy in their anti-inflammatory effects. To study the immunomodulatory effect of Levofloxacin (LVFX), one of the new quinolones, we investigated the influence of LVFX on the production of cytokine in human tonsillar lymphocytes. Palatine tonsils were obtained from 10 patients (5 males and 5 females, ages 15-26 y. o.) who were tonsillectomized for the treatment of recurrent tonsillitis in the Department of Otolaryngology, Wakayama Medical College. Informed consent was obtained from all patients to use their tonsils for this study. The tonsillar lymphocytes were stimulated by Staphylococcal enterotoxin B (SEB, 100ng/ml) and were divided into two groups according to the incubation time with LVFX (5μg/ml or 50μg/ml), the 24 hour-group and the 48 hour-group. Production of cytokines (IL-lα, IL-1β, IL-8, IL-12, IFN-γ, and TNF-α) in the supernatant was measured by solid-phase ELISA. TNF-α production of tonsillar lymphocytes was markedly sup-pressed in both groups incubated with 5μg/ml and 50μg/ml of LVFX (p

We have recently been confronted with refractory upper respiratory infections with an increasing prevalence of penicillin (Pc)-resistant S. pneumoniae. There has been a broad consensus that acute otitis media (AOM) is caused by migration of pathogens from nasopharynx and proliferation in the middle ear space, and thus it is, very important to study the bacterial environment in the nasopharynx as the source of middle ear infections. Eighty pneumococcal isolates from the nasopharynx of children with acute otitis media were evaluated by polymerase chain reaction (PCR) for mutation of Pc-binding protein (PBP) genes. The results showed mutation of all three PBP genes, pbp 1a, pbp 2x, and pbp 2b, in 30% of the isolates, while 74% were found to possess various PBP gene mutations, mostly in one-year-old children. Of the 46 isolates whose minimum inhibitory concentration (MIC) of Pc was < or = 0.06 microgram/mL, 43% were found to possess a pbp 2x mutaion, which affects cefem resistance. We genotyped each pneumococcal isolate from the nasopharynx of children with recurrent AOM by pulsed-field gel electrophoresis (PFGE). In 9 of 11 pairs (82%) of consecutive AOM episodes, the nasopharyngeal isolate in the second episode was different. In addition, discrimination of each isolate based upon the mutation profile of its PBP genes in 8 pairs (72%) of consecutive AOM episodes showed that the isolates were different, and there was little difference between the results of PBP gene mutation and PFGE analysis. These findings suggest that most nasopharyngeal isolates from children with AOM possess PBP mutations and that children with increased numbers of drug-resistant bacteria in their nasopharynx during AOM has been colonized or recolonized by different strains during each episode. We therefore emphasize that clinicians should assess the antibiotic susceptibility of nasopharyngeal isolates from children during each episode. PBP gene mutation analysis of S. pneumoniae is useful not only in providing valuable information on the antibiotic susceptibility of each strain but for assessing changes in causative strains in the sequential episodes of pneumococcal infection.

Warthin's tumor is a well-defined salivary gland neoplasm consisting of epithelial and lymphoid components. However, malignant transformation is extremely rare. Such a patient who developed squamous cell carcinoma within a Warthin's tumor of the parotid gland is described and possible pathogenesis is discussed.

症例は13歳, 男児.進行性神経疾患で低栄養状態のため当院小児科に入院中であったが, 肺炎を併発し, 長期人工呼吸管理が必要になったため気管切開術が施行された.術後21日目, 突然大量の気道出血が出現した.気管腕頭動脈瘻と診断し, 緊急手術を施行した.胸骨正中切開と右頸部襟状切開でアプローチし, 3×4mmの動脈瘻に対しては腕頭動脈切除術, 人工血管置換術, 6×8mmの気管瘻に対してはdebridementの後, 縫合閉鎖術を施行した.術後1週間目に縦隔洞炎を併発したため人工血管を摘除し, 縦隔洗浄後大胸筋及び胸鎖乳突筋で動脈縫合閉鎖部を被覆した.その後, 縦隔洞炎は遷延化したが, 術後4ヵ月目には感染症状も消失した.気管腕頭動脈瘻の治療は, 緊急手術が必要であり, 術式は気管瘻の縫合閉鎖, 腕頭動脈切除術が有用と思われた.また, 人工血管を用いる場合は, 縦隔洞炎の発症を考慮し胸郭外ルートによるバイパス術が必要と思われた.

Severe tinnitus in 32 patients wtih senile deafness was treated with Lipoprostaglandin E1 10μg i. v. once a week. The tinnitus score was significantly decreased from 10 to 3.9±2.4. Slight to marked improvement was recorded in 90.6% of the patients. Early treatment, within 4 weeks of the onset of tinnitus, was more effective than later treatment. There were 4 patterns of improvement. No severe side effect was observed.The results of this study suggest that Lipoprostaglandin E1 is very useful in the treatment of tinnitus.

Spindle cell carcinoma is a relatively rare tumor occurring usually in the upper respiratory and/or digestive tract, and less frequently in the maxillary sinus. Recently we treated a patient with spindle cell carcinoma of maxillary sinus.The patient was a 65-year-old male. The initial pathologic diagnosis was well-differentiated squamous cell carcinoma.He received immunochemotherapy (balloon-occluded arterial infusion of CDDP and recombinant interleukin-2) as a neoadjuvant, followed by radiation. The tumor was partially reduced in size, but total regression was not achieved. The residual tumor was surgically removed, and postoperative irradiation was applied to a total dose of 60 Gy.Six months later, however, the tumor reappeared and grew rapidly. Definitive surgical treatment was performed. Pathologic examination revealed that the recurrent tumor consisted of carcinoma and sarcomatous, spindle cell compartments. Differential diagnosis included carcinosarcoma, malignant fibrous histiocytoma, and spindle cell carcinoma. Immunohistochemical techniques were used to distinguish between epithelial and mesenchymal properties in a sarcomatoid area. Keratin was found in sarcomatoid parts, so the tumor was diagnosed as spindle cell carcinoma.The spindle cell carcinoma reappeared within 3 months and leukocytosis in the peripheral blood paralleled tumor growth. A tumor cell line (OKK-HK) was established from this spindle cell carcinoma. Granulocyte colony-stimulating factor (G-C SF) was detected (1255 pg/ml) in the supernatant of cultures of this cell line.This spindle cell carcinoma responded well to the local administration of WPG (biological response modifier). However, the patient died of respiratory failure.

We investigated viral infections in the tonsils, pharynx and renal tissues of patients with IgA nephropathy using cell culture, polymerase chain reaction (PCR) and immuno-fluorescent techniques, and measured antibody titers against numerous types of viruses. Neutralization tests found no significant inhibition of growth of adenovirus-1, 2, 3, 4, 5, 6, 7, 11 or 19, Coxsackie virus-A7, A9, A16, B1, B2, B3, B4, B5 or B6, or RS virus. Swabs of the oral cavity of patients with IgA nephropathy were cultured with Hel cells, MDCK cells, FL cells, BHK-21 cells and RD-18S cells. No cytopathic effect was detected in any of these cell cultures. We failed to detect the presence of herpes simplex virus-1 and -2, varicella-zoster virus, cytomegalovirus and Epstein-Barr virus (EBV)-1 and -2 in tonsils, renal tissues and mouthwashings from patients with IgA nephropathy. On the other hand, EBV alone was detected with the PCR technique, in mouthwashings from 6 out of 14 patients with IgA nephropathy (42%). Immunohistological and serological analyses were done to examine the relationship between EBV and IgA nephropathy. No evidence was obtained that EBV-infected B lymphocytes were producing IgA. It seems unlikely that the viral infections examined in this study play a significant role in the pathogenesis of IgA nephropathy.

Olfactory neuroblastoma with papilloma was diagnosed by immunohistological and electronmicroscopic examinations. Modified intensive combined indution chemotherapy with arterial infusion of cyclophosphamide, vincristine, pirarubicin and cisplatin as recommended by Sawaguchi et al was strikingly effective in this patient with olfactory neuroblastoma which was resistant to radiation therapy.

Palmoplantar pustulosis (PPP) has long been regarded as a tonsillar focal infection because tonsillectomy is so effective in its treatment. Immune mechanisms of focal infection have been discussed mainly with regard to humoral immunity as an autoimmune disease. The present immunological study demonstrates the expression of HLA-DR antigen in tonsillar epithelium. The patterns of the HLA-DR antigen appearance in the epithelium were categorized into 4 types, and the intensity was compared between hypertrophic tonsils, recurrent tonsillitis, and tonsils with PPP. In addition, paired fluorescent staining, a combination of CD3 and anti-HLA-DR antibodies, was performed. The activity of intraepithelial T-lymphocytes was determined as an index of the HLA-DR antigen expression. In an age matching study, HLA-DR antigen appeared in high intensity in tonsils with PPP. A close correlation was found between the appearance of HLA-DR antigens and activation of infiltrating T-lymphocytes. These findings suggest that the tonsillar epithelium plays an important role in focal infection.

The human palatine tonsils and the nasopharyngeal tonsil were considered the defense mechanism against ingested or inhaled foreign pathogens. The current findings suggest that the tubal tonsils possess abilities of active transportation of foreign antigens, and will act as inductive and effector sites in the mucosal immune system. Our results also indicated a significant difference in roles of immune responses among individual tonsillar organs, suggesting functional sub-compartmentalization.To address the function of tonsils in inducing local immune responses, we evaluated the antigen uptake of tubal tonsils and the induction of specific immune responses in a small laboratory animal with both tubal and palatine tonsils, i.e. Suncus murinus.S. murinus were injected with 2 x 10(6) CFU of FITC-labeled Staphylococcus aureus via the right tympanic cavity. The distribution of the FITC-labeled S. aureus was examined under a fluorescent microscope. S. murinus were also immunized with 100 microg of ovalbumin (OVA) mixed with 2 microg of cholera toxin (CT) via the right external ear meatus every 2 days for 2 weeks. One week after the final immunization, sera, pairs of tubal and palatine tonsils, and the neck lymph nodes were obtained to evaluate the induction of specific immune responses.The FITC-labeled S. aureus particles were detected in tubal tonsils and also in cervical lymph nodes. Total IgA-producing cells and OVA-specific antibody-producing cells were identified in the immunized tubal tonsils. Trans-external ear meatus immunization of tubal tonsils also evoked systemic antibody responses.

The term apoptosis stands for a mechanism of controlled cell deletion which maintains the homeostasis of living bodies. In palatine tonsil, apoptosis seems to be mainly observed in lymphocytes which have accomplished their immunological role. In this study, we demonstrate the presence of apoptotic cells in palatine tonsil using a histochemical technique, and we compare the number of apoptotic cells in inflammatory and non-inflammatory conditions using an image analyzing system. In the mantle zone, fewer apoptotic cells were observed than in the germinal center. Under inflammatory conditions, apoptotic cells were increased in the interfollicular space. Apoptosis may play an important role in the immunological equilibrium of tonsils by eliminating hyperreactive clones.

This report is a preliminary exploration of the concept of a "Tonsillectomy Index" (TI) as an objective tool for quantifying the indications for tonsillectomy for recurrent acute tonsillitis (AT). The TI is derived by multiplying the number of episodes of AT by the number of years during which the episodes of AT occurred. Our objective in this study was to investigate whether there is a relationship between the natural history of AT, the immunological functions of tonsils and our proposed TI. For the natural history of AT, we medically followed 11 children with a history of AT for 5 years. When TI was equal to or greater than 8 (TIor =8), the children suffered a significantly greater number of episodes of AT. For the immunological portion of our study, we enrolled 36 children and 46 adults undergoing tonsillectomy for either AT (study group) or tonsillar hypertrophy (control group, CG). We analyzed the co-stimulatory signals, CD80 and CD86 on tonsillar B-lymphocytes. The expression rates of CD80 and CD86 in the AT group with TIor =8 were significantly decreased compared to those with TI was less than 8 (TI8), as well as with those in control (tonsillar hypertrophy) group. Our preliminary findings suggest that when the TIor =8, the tonsils have deteriorated immunologically and spontaneous resolution of recurrent AT is less likely to occur, hence tonsillectomy is appropriate. TI may be a useful tool for surgical decision making.

A polymerase chain reaction (PCR)-based genotyping of the penicillin-binding protein (PBP) genes pbp1a, pbp2x and pbp2b was used to characterize Streptococcus pneumoniae isolated from the nasopharynx of children with acute otitis media (AOM). Mutations were observed in pbp1a, pbp2x and pbp2b genes in 36.5% of the strains. Decreased susceptibility to beta-lactam antibiotics was closely associated with the frequency of mutations in the three PBP genes. Of penicillin-intermediately-resistant S. pneumoniae strains, 54.5% appeared to be genetically similar to penicillin-resistant S. pneumoniae strains. Of penicillin-susceptible S. pneumoniae strains, 33.3% had mutations in the pbp2x gene and showed relatively high MICs to cephalosporins. Strains with mutations in the three PBP genes were often isolated from children < or = 2 years old. Evaluation of mutations in PBP genes using PCR will prove useful for studying the epidemiology of antibiotic resistance.

To evaluate qualitative diagnosis of stapes lesions by 3-dimensional computed tomography (3D-CT) combined with superselective image processing (3D-SS) of stapes, we studied helical 3D-CT on a phantom model of the temporal bone. Two stapes models were used-1 made from the bone filler, Celatite, consistent in bone density but changing in cross sectional area, and the other made from an apacerum rod used in quantitative computed tomography (QCT), consistent in cross sectional area but changing in bone density. These stapes models were put into a skull phantom and analyzed by helical 3D-CT. The influence of the tympanic cavity conditions on CT images of stapes was evaluated by filling the phantom model with Vaseline following 3D selective reconstruction. In all stapes models, lowering the lower CT window width threshold resulted in an enlarged cross-sectional area of the model. The higher the bone density, the lower the increase in cross-sectional area in the image. The stapes model with lower density had greater influence on the imaging by tympanic cavity conditions and was likely to be misdiagnosed as showing higher bone density. Based on the experimental study, 3D-SS by helical 3D-CT appears to be a useful measure for qualitatively diagnosing stapes lesions.

Pustulosis palmaris et plantaris (PPP) is a pustular skin disease that is closely related to tonsillar focal infection. Patients with this skin disease have shown marked improvements of skin lesions after tonsillectomy. In this study, we evaluated the role of adhesion molecules in the pathogenesis of tonsillarfocal infection related to PPP. The results were that tonsillar lymphocytes of patients with PPP adhered to vessels in the dermis, to vessels running through the dermal papilla, and to vessels in the epidermis at the base of pustules. The adhesion of tonsillar lymphocytes to endothelial cells were significantly blocked by anti-LFA-1 antibody. An immunohistological study revealed that cells infiltrating the dermis expressed LFA-1, whereas ICAM-1, the ligand of LFA-1, was detected on endothelial cells and keratinocytes. It is interesting to note that cells infiltrating the dermis of the erythema stage or the pustule stage of PPP expressed ICAM-1, and the vessels in these stages expressed E-selectin. ICAM-1 was also detected on vessels in the dermis of skin that seemed to be macroscopically normal. These results suggest that tonsillar lymphocytes may have an affinity for the skin of PPP-expressing adhesion molecules such as LFA-1, ICAM-1, and E-selectin. These adhesion molecules seem to be easily activated, not only in skin lesions of PPP, but also in macroscopically normal areas resulting in cellular infiltration and pustule formation.

It is known that transcatheter intraarterial drug delivery presents a higher concentration of drug in the tumors than intravenous administration only. In our field, a transcatheter arterial infusion from superficial temporal artery into tumor site has been commonly used for the treatment of head and neck tumors.Recently, the intraarterial infusion under its temporary occlusion has been employed in the patients with hepatic tumors using double lumen balloon catheter. In this study, it was intended to use not only intraarterial infusion-occlusion system from superficial temporal artery, but also to reduce the systematic side effects of the drugs recirculating from regional area by means of direct hemoperfusion with charcoal filament.The concentration level of anti-cancer drugs in the tissues received infusion-occlusion chemotherapy was significantly high. The hemoperfusion with chacoal filament, to eliminate the drugs in the blood recirculating from regional areas, worked successfully showing significant adsorption within 180 minutes after infusion.We believe that a new system of intraarterial drug delivery by means of balloon occluded arterial with hemoperfusion proposed in the present study will be much effective for chemotherapy of head and neck tumors.

Magnetic resonance imaging (MRI) was used in the diagnosis of head and neck tumors. The advantages and the problems of MRI are discussed and compared with those of X-ray computed tomography.MRI provides more detailed information about the nature and the depth of in-filtration of tumors, not only because of the excellent soft-tissue contrast, but also because multiple directions can be used. An additional benefit is the much easier identification of cervical vascular structures by MRI.

Microvascular tissue transfer is recommended by plastic surgeons for defects following radical ablation of head and neck tumors. After experimenting with microvascular anastomosis of the femoral vessels of guinea pigs, we performed reconstruction of head and neck defects following radical surgery for six oral and hypopharynx cancer with three free jejunums, three forearm flaps and one free latissimus dorsi myocutaneous flap.Radial forearm flaps are very suitable for intraoral reconstruction because of their pliability, thin, hairless skin and long vessel pedicles. Even in patients who had had high doses of irradiation or several cervical operations, the forearm flaps were useful and successful.Free jejunum transfer was very effective for hypopharyngeal cancer, since wide resection of the cervical esophagus and hypopharynx was possible. Two of our three patients had no complication after the operation. One patient had a small fistula at the pharyngo jejuno junction, but it healed spontaneously within two weeks. The average time from the operation to the beginning of oral feeding was ten days in our three patients.We consider that microvascular tissue transfer is preferable and useful following surgery for head and neck cancer.

The serum levels of IAP in patients with tumors of the head and neck were determined by single radial immunodiffusion. It was previously reported that the IAP level in these patients was commonly higher than normal. Statistical analysis of 58 patients revealed that the increase of IAP corresponded not only to the clinical stage of the tumor, but also to the probability of tumor recurrence. In addition, it was apparent that the IAP was significantly related to the PPD skin reaction representing delayed hypersensitivity and T-cell population capable of E-rosette formation.The evidence suggests that the determination of serum IAP is useful in understanding the immune defense of hosts against tumors.

In this study, two experiments were made to investigate the immunological pathogenesis of PPP, a skin disease of so-called focal infections. One was the immunohistological study on tonsils with PPP and recurrent tonsillitis. In the investigation, monoclonal antibodies against T lymphocytes and anti-immunoglobulin antibodies were used to reveal the distribution of T and B cell subsets on frozen sections of tonsils. But no difference between tonsils with focal infection and recurrent tonsillitis was observed in the distribution of T and B cell subsets. The other was the identification of a common antigen between tonsillar epithelium of PPP and hand-sole skin by use of one monoclonal antibody against PPP-tonsillar epithelium, which was made in our laboratory. Monoclonal antibody ATE-3 was in IgM, and recognized about 35 kilo dalton molecular weight protein of a tonsillar epithelium of PPP. This antibody reacted with the basal layer cells of the tonsillar epithelium and the suprabasilar cells of plantar skins of PPP. But ATE-3 did not react with normal tonsillar epithelium and normal plantar skin.

The three-dimensional structure of capillary vessels in the human palatine tonsil using corrosion casting techniques was investigated and compared to recently developed cryptscopic images. The postcapillary venules and arterioles were distinguishable from the nuclear impressions on their walls. The configuration of vessels around the micropores of crypts is similar to the images from the cryptscope.

We evaluated the titers of anti-cefotiam antibodies in the sera of 44 patients before and after the intravenous administration of cefotiam. The anti-cephalosporin antibodies were detected using the passive hemagglutination inhibition test. Only three of 44 patients became positive for the antibody after the administration of cefotiam, though none of the patients showed no symptoms. It is possible that cephalosporin can induce immunological reactions based on the hapten mechanism.

It is reported that the levels of serum IAP and IS are useful parameters to evaluate the prognosis along with the clinical course of tumor bearing patients. Serum IAP and IS were examined in 149 patients with head and neck cancer. The level of serum IAP and IS increased in patients with not only advanced stages, but also poor prognosis. In general, the patients with death or recurrence had higher levels of serum IAP and IS than those with good prognosis. It is concluded that serum IAP and IS well reflect the immunological condition and clinical course of patients with cancer and may be one of the useful parameter for them.

Recombinant Interleukin-2 (rIL-2) was administered locally to 20 patients with head and neck cancer. 800 thousand units of TGP-3 were injected around the tumor mass every day for about 4 weeks. Complete response (CR) was obtained in two cases with lip cancer and one with lingual cancer showed partial response (PR), and minor response (MR) in oral floor cancer. No recurrence of tumors was observed in the two cases of lip cancer. Chemotherapy was performed with rIL-2 in cases responding only insufficiently to rIL-2. It was interesting that arterial infusion of anticancer drugs subsequent to local administration of rIL-2 resulted in a dramatic decrease in tumor size in a short time. It is suggested that local administration of rIL-2 may play an important role in multimodal treatment for head and neck cancer.