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BMJ (Clinical Research Ed.) Dec 1990
Topics: Carotid Artery Diseases; Hemorrhage; Humans; Palatine Tonsil; Pharyngeal Diseases; Tonsillitis
PubMed: 2271822
DOI: 10.1136/bmj.301.6763.1233 -
Journal of the Royal Society of Medicine Mar 2016
Topics: Humans; Palatine Tonsil; Pharyngitis; Tonsillectomy; Treatment Outcome; Unnecessary Procedures
PubMed: 26980410
DOI: 10.1177/0141076815607265 -
Archives of Pathology & Laboratory... Dec 2013Lymphangioma of the palatine tonsil is a rare, benign lesion that presents as a tonsillar outgrowth and causes symptoms related to irritation and airway obstruction.... (Review)
Review
Lymphangioma of the palatine tonsil is a rare, benign lesion that presents as a tonsillar outgrowth and causes symptoms related to irritation and airway obstruction. Histologically, the mass has abundant dilated lymphatic channels amid a fibrous stroma with lymphoid and adipose elements. There are several theories regarding the pathogenesis of these lesions, and the appropriate diagnostic classification is controversial. Because a lymphangioma may resemble a true neoplasm of the palatine tonsil clinically, the lesion must be removed for accurate histologic diagnosis and to rule out malignancy. Lymphangioma of the palatine tonsil is treated with surgical excision and has no recurrence once completely resected.
Topics: Diagnosis, Differential; Humans; Incidence; Lymphangioma; Neoplasm Recurrence, Local; Palatine Tonsil; Pharyngeal Neoplasms; Tonsillectomy
PubMed: 24283866
DOI: 10.5858/arpa.2012-0678-RS -
Bosnian Journal of Basic Medical... Nov 2013The purposes of the present study were to determine the distribution of cells producing cytokines: tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in...
The purposes of the present study were to determine the distribution of cells producing cytokines: tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in different morphological sections of tonsils in patients with tonsillar hypertrophy (TH) and recurrent tonsillitis (RT), to analyze the level of production of these cytokines in TH and RT and evaluate the potential of peripheral blood lymphocytes for production of interferon-γ (IFN-γ) and interleukin 4 (IL-4). Analyzed materials consisted of the tonsils after tonsillectomy and blood taken from patients right before tonsillectomy (study group) and blood taken from healthy donors (control group).We used histological and immunohistochemical method, morphometric methods for the quantification of TNF-α and IL- 6 producing cells and immunological methods for determining the concentration of IFN-γ and IL-4. Most of TNF-α producing cells are settled in the subepithelial region (55%). Numerical density of TNF-α producing cells in the crypt epithelium, subepithelial and interfollicular region was significantly higher in RT compared with TH. The concentration of IFN-γ is three times higher in RT then in TH. After the stimulation of peripheral blood lymphocytes in culture there was no significant increase in concentrations of IL- 4. The index of stimulation of IFN-γ was the highest in the RT, and of IL- 4 in TH. The production of Th1-type cytokines (TNF-α and IFN-γ) is higher in RT compared with TH. In both forms of tonsillitis, production of Th1-type cytokines is higher in relation to the production of Th2-type cytokines (IL-6 and IL-4).
Topics: Adolescent; Adult; Case-Control Studies; Child; Chronic Disease; Cytokines; Female; Humans; Hypertrophy; Immunohistochemistry; Interferon-gamma; Interleukin-4; Interleukin-6; Male; Palatine Tonsil; Tonsillitis; Tumor Necrosis Factor-alpha; Young Adult
PubMed: 24289758
DOI: 10.17305/bjbms.2013.2330 -
Biomedical Papers of the Medical... Dec 2019The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this...
OBJECTIVES
The palatine tonsil is a significant part of the secondary immune system. Tonsillitis and idiopathic tonsillar hypertrophy (ITH) are the most common pathologies of this component. Although there are studies on their pathogenesis, there is insufficient study of the role of antioxidant agents. Glutathione S-transferase (GST) isozymes contribute to the antioxidation reactions in the tissue via the glutathione pathway. The purpose in this study was to reveal the levels of the GST enzyme activity and protein expression of GSTP1 and GSTA1 isozymes in patients with tonsillitis and tonsil hypertrophy, and to investigate their role in the pathogenesis of these diseases.
MATERIALS AND METHODS
Sixteen patients with recurrent tonsillitis and 5 patients with ITH and were included in the study. Cytosolic extracts were prepared from post-tonsillectomy tissues of both patient groups and GST enzyme activities were measured.
RESULTS
The expression of GSTP1 was found to be significantly higher than GSTA1 in tissue samples of patients with ITH and recurrent tonsillitis (P<0.001). Increased GST activity and GSTP1 isozyme expression were shown in patients with recurrent tonsillitis compared to the idiopathic tonsillar hypertrophy study group. There was a positive correlation between the expressions of GSTP1 (P=0.040; r=0.47).
CONCLUSION
Increased GST activity and GSTP1 isozymes were demonstrated histologically in the pathogenesis of ITH and recurrent tonsillitis. We believe that the data of changes in antioxidant capacity, obtained from studies with more extensive and larger samples, would support our findings.
Topics: Adolescent; Child; Child, Preschool; Female; Glutathione Transferase; Humans; Hypertrophy; Male; Palatine Tonsil; Proteins; Tonsillitis
PubMed: 30765895
DOI: 10.5507/bp.2019.002 -
Immunologic Research Dec 2021A potential connection between tonsillectomy and the development of various cancer types has repeatedly been reported in the scientific literature, but many studies have... (Review)
Review
A potential connection between tonsillectomy and the development of various cancer types has repeatedly been reported in the scientific literature, but many studies have contradicted these observations. Thus, we have no clear evidence, neither to firmly support nor to refute the above-mentioned connection. Here, I suggest that the main reason for the lack of clearer evidence is that the investigations have so far mainly used incorrect sample groups. I propose that individual differences in the tonsils' involvement in immune reactions should be taken into account to solve this long-standing puzzle.
Topics: Humans; Incidence; Neoplasms; Palatine Tonsil; Tonsillectomy
PubMed: 34523058
DOI: 10.1007/s12026-021-09230-3 -
The Cochrane Database of Systematic... Aug 2017Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than other surgical methods. However, the superiority of coblation is unproven.
OBJECTIVES
To compare the effects of coblation tonsillectomy for chronic tonsillitis or tonsillar hypertrophy with other surgical techniques, both hot and cold, on intraoperative morbidity, postoperative morbidity and procedural cost.
SEARCH METHODS
The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2017, Issue 3); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 April 2017.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of children and adults undergoing tonsillectomy with coblation compared with any other surgical technique. This review is limited to trials of extracapsular (traditional) tonsillectomy and excludes trials of intracapsular tonsil removal (tonsillotomy).
DATA COLLECTION AND ANALYSIS
We used the standard Cochrane methods. Our primary outcomes were: patient-reported pain using a validated pain scale at postoperative days 1, 3 and 7; intraoperative blood loss; primary postoperative bleeding (within 24 hours) and secondary postoperative bleeding (more than 24 hours after surgery). Secondary outcomes were: time until resumption of normal diet, time until resumption of normal activity, duration of surgery and adverse effects including blood transfusion and the need for reoperation. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
MAIN RESULTS
We included 29 studies, with a total of 2561 participants. All studies had moderate or high risk of bias. Sixteen studies used an adequate randomisation technique, however the inability to mask the surgical teams and/or provide adequate methods to mitigate the risk of bias put nearly all studies at moderate or high risk of detection and measurement bias for intraoperative blood loss, and primary and secondary bleeding. In contrast most studies (20) were at low risk of bias for pain assessment. Most studies did not report data in a manner permitting meta-analysis.Most studies did not clearly report the participant characteristics, surgical indications or whether patients underwent tonsillectomy or adenotonsillectomy. Most studies reported that tonsillitis (infection) and/or tonsillar hypertrophy (obstruction) were the indication for surgery. Seven studies included only adults, 16 studies included only children and six studies included both. Pain At postoperative day 1 there is very low quality evidence that patients in the coblation group had less pain, with a standardised mean difference (SMD) of -0.79 (95% confidence interval (CI) -1.38 to -0.19; 538 participants; six studies). This effect is reduced a SMD of -0.44 (95% CI -0.97 to 0.09; 401 participants; five studies; very low-quality evidence) at day 3, and at day 7 there is low quality evidence of little or no difference in pain (SMD -0.01, 95% CI -0.22 to 0.19; 420 participants; five studies). Although this suggests that pain may be slightly less in the coblation group between days 1 and 3, the clinical significance is unclear. Intraoperative blood loss Methodological differences between studies in the measurement of intraoperative blood loss precluded meta-analysis. Primary and secondary bleeding The risk of primary bleeding was similar (risk ratio (RR) 0.99, 95% CI 0.48 to 2.05; 2055 participants; 25 studies; low-quality evidence). The risk of secondary bleeding was greater in the coblation group with a risk ratio of 1.36 (95% CI 0.95 to 1.95; 2118 participants; 25 studies; low-quality evidence). Using the median of the control group as the baseline risk, the absolute risk in the coblation group was 5% versus 3.6% in the control group. The difference of 1.3% has a 95% CI of 0.2% lower in the coblation group to 3.5% higher. Secondary outcomes Differences in study design and data reporting precluded the identification of differences in the time to resumption of normal diet or activity, or whether there was a difference in the duration of surgery.Although we could not feasibly compare the costs of equipment or operative facility, anaesthetic and surgical fees across different healthcare systems we used duration of surgery as a proxy for cost. Although this outcome was commonly reported in studies, it was not possible to pool the data to determine whether there was a difference.Adverse events other than bleeding were not well reported. It is unclear whether there is a difference in postoperative infections or the need for reoperation.
AUTHORS' CONCLUSIONS
The coblation technique may cause less pain on postoperative day 1, but the difference is small and may be clinically meaningless. By postoperative day 3, the difference decreases further and by postoperative day 7 there appears to be little or no difference. We found similar rates of primary bleeding but we cannot rule out a small increased risk of secondary bleeding with coblation. The evidence supporting these findings is of low or very low quality, i.e. there is a very high degree of uncertainty about the results. Moreover, for most outcomes data were only available from a few of the 29 included studies.The current evidence is of very low quality, therefore it is uncertain whether or not the coblation technique has any advantages over traditional tonsillectomy techniques. Despite the large number of studies, failure to use standardised or validated outcome measures precludes the ability to pool data across studies. Therefore, well-conducted RCTs using consistent, validated outcome measures are needed to establish whether the coblation technique has a benefit over other methods. In the included studies we identified no clear difference in adverse events. However, given the rarity of these events, randomised trials lack the power to detect a difference. Data from large-scale registries will provide a better estimate of any difference in these rare outcomes.
Topics: Adult; Catheter Ablation; Child; Humans; Hypertrophy; Pain, Postoperative; Palatine Tonsil; Postoperative Hemorrhage; Randomized Controlled Trials as Topic; Sodium Chloride; Tonsillectomy; Tonsillitis
PubMed: 28828761
DOI: 10.1002/14651858.CD004619.pub3 -
International Journal of Infectious... Aug 2023Unnecessary and inappropriate antibiotic use is an increasing global health challenge. In limited resource settings, prophylactic antibiotics are still often used in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Unnecessary and inappropriate antibiotic use is an increasing global health challenge. In limited resource settings, prophylactic antibiotics are still often used in (adeno)tonsillectomy (AT), despite evidence against their effectiveness. This study aimed to investigate the effect of prophylactic amoxicillin, given after AT in children.
METHODS
This is a secondary analysis from a two-center, double-blinded, randomized controlled, non-inferiority trial to study the effect of prophylactic amoxicillin on post-AT morbidity. Children aged 2-14 years with recurrent chronic tonsillitis and/or obstructive sleep apnea were randomly assigned to receive either placebo or amoxicillin for 5 days after the operation. Pre- and postoperative samples were collected for polymerase chain reaction (PCR) analyses to detect the five most important pathogens known to be common causes of tonsillitis. PCR results were compared before and after surgery as well as between placebo and amoxicillin.
RESULTS
PCR results were obtained, 109 in the amoxicillin group and 115 in the placebo group. In the amoxicillin group, 91% of patients had at least one positive PCR test before surgery and 87% after surgery. In the placebo group, the respective percentages were 92% and 90%. In both groups, a decrease in the total number of pathogens was found after surgery.
CONCLUSION
Prophylactic amoxicillin given after AT in children did not show a clinically relevant effect with respect to the number of oropharyngeal microorganisms as compared to placebo.
Topics: Humans; Child; Tonsillectomy; Amoxicillin; Palatine Tonsil; Tonsillitis; Anti-Bacterial Agents
PubMed: 37116578
DOI: 10.1016/j.ijid.2023.04.409 -
Stem Cells (Dayton, Ohio) Oct 2019Since the discovery of stem cells and multipotency characteristics of mesenchymal stem cells (MSCs), there has been tremendous development in regenerative medicine. MSCs... (Review)
Review
Since the discovery of stem cells and multipotency characteristics of mesenchymal stem cells (MSCs), there has been tremendous development in regenerative medicine. MSCs derived from bone marrow have been widely used in various research applications, yet there are limitations such as invasiveness of obtaining samples, low yield and proliferation rate, and questions regarding their practicality in clinical applications. Some have suggested that MSCs from other sources, specifically those derived from palatine tonsil tissues, that is, tonsil-derived MSCs (TMSCs), could be considered as a new potential therapeutic tool in regenerative medicine due to their superior proliferation rate and differentiation capabilities with low immunogenicity and ease of obtaining. Several studies have determined that TMSCs have differentiation potential not only into the mesodermal lineage but also into the endodermal as well as ectodermal lineages, expanding their potential usage and placing them as an appealing option to consider for future studies in regenerative medicine. In this review, the differentiation capacities of TMSCs and their therapeutic competencies from past studies are addressed. Stem Cells 2019;37:1252-1260.
Topics: Humans; Mesenchymal Stem Cells; Palatine Tonsil; Regenerative Medicine; Tissue Engineering
PubMed: 31287931
DOI: 10.1002/stem.3058 -
Brazilian Journal of Otorhinolaryngology 2016Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an...
INTRODUCTION
Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain.
OBJECTIVE
To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis.
METHODS
A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5mg Tramadoli hydrochloridum+325mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers.
RESULTS
Indications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed.
CONCLUSION
Patients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density.
Topics: Acute Disease; Adult; Female; Humans; Male; Pain Perception; Pain, Postoperative; Recurrence; Tonsillectomy; Tonsillitis
PubMed: 26948105
DOI: 10.1016/j.bjorl.2015.11.010