Currently only limited information is available as to why dominant IgA isotype responses are supported by mucosal T cells in IgA effector tissues. The aim of this report was to summarize our recent findings regarding the characterization of Th [interferon (IFN) γ and interleukin (IL)-2] and Th2 (IL-4, IL-5 and IL-6) cytokine- producing CD3⁺ αβ and γδ T cells in salivary glands, which are the major mucosal effector tissues in the oral region. CD3⁺ T cells were isolated from salivary gland- associated tissues (SGAT) which consist of the submandibular gland (SMG: -46%), the periglandular lymph nodes (PGLN: -72%), and the cervical lymph nodes (CLN:-90%). When SMG CD3⁺ T cells were examined by Th1 and Th2 cytokinespecific ELISPOT and RT-PCR assays, high levels of both cytokine-specific spot-forming cells and mRNA for IFN-γ, and for IL-5 and IL-6 were noted as representative Th1 and Th2 cytokines, respectivety. In contrast PGLN and CLN contained fewer of these cytokine producing T cells when compared with SMG CD3⁺ T cells. Since CD3⁺ T cells contained both αβ and γδ T cells, it was important to examine precise profile of cytokine production by these two subsets of T cells. When these two fractions of T cells were isolated from SMG, αβ T cells were mainly committed to IFN-γ, IL-5, and IL-6 expression, while only the latter two cytokines were produced by SMG γδ T cells. Although SMG αβ and γδ T cells were committed to produce selected cytokines, these T cells were capable of producing an array of additional Th1 (IL-2) or Th2 (IL-4) cytokines following stimulation via the T cell receptor- CD3 complex. Taken together, the results show that freshly isolated CD3⁺ T cells from SMG contain activated γδ and αβ T cells which are programmed to produce IL-5 and IL-6. Thus, SMG, an example of IgA effector tissues, can be characterized as a Th2- dominant site. However, although both γδ and αβ T cells express cytokine profiles consistent with a Th2 phenotype, only the latter subset with a CD4⁺/CD8^- phenotype provided effective help for mucosal B cell responses in vitro.

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Apoptosis is a distinct type of cell death that differs fundamentally from degenerative death necrosis and timed induction of apoptosis appears to play an important role in normal cell turnover and development. Accumulating evidence suggests that apoptosis is a critical event in the negative selection process that functions to prevent autoimmunity in the thymus and bone marrow. Recently, apoptosis has also been suggested to play an important role in the selection of B cells which produce high- affinity antibodies with immunoglobulin variable region gene mutations in the germinal center. In the present studies, we examined the distribution of apoptotic B cells in human tonsils using the TdT-mediated nick end labeling method. Apoptotic cells were abundantly observed in both the dark, and the basal light zones, and less in the apical light zone in the germinal centers. Apoptotic cells were also scarce in the mantle zone located over the germinal centers and in areas outsid the lymph follicles, such as the lymphoepithelial and interfollicular areas. Most of the B cells in the dark zone, but not the light zone, expressed a proliferating cell antigen, Ki- 67 . Together with the finding by others that affinity maturation of B cells in association with the immunoglobulin variableregion gene mutations begins to occur in the dark zone, the apoptosis in the dark zone appeaers to occur by two mechanisms, one as a response to overproliferation of B cells and one as a negative selection low affinity or nonfunctional B cells that are generated through the affinity maturation process of B cells. The basal light zone lacked Ki-67⁺ cells and seemed to be the main site of affinity maturation. Thus, the apoptotic cells in this region are probably under the selection process. The apical light zone contained many activated T cells and B cells expressing differentiation/activation antigens, CD23 and CD86, suggesting that this area is the site of B cell differentiation to memory B cells or preplasma cells which subsequently migrate outside the germinal centers. Thus, it is reasonable that there are few apoptoic cells in this region.

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The palatine tonsil is the most important element of Waldeyer's ring as a defense mechanism against various microorganisms. The neutrophils are the initial active participants in bacterial infection and inflammation, but its interaction with other cellular participants is poorly understood. To clarify this point, the effects of culture supernatant from human tonsillar cells on peripheral neutrophil functions were investigated. Supernatants from tonsillar cells incubated in the presence or absence of a streptococcal preparation, OK-432, enhanced chemiluminesecence, adherence and chemotaxis of human peripheral neutrophils. The factor productivity of tonsillar cells from patients with chronic tonsillitis of varying severity and palmoplantar pustulosis (PPP) was also investigated. Tonsillar cells from patients with severe tonsillitis and PPP incubated with culture medium alone produced a much greater amount of active factors compared with those from patients with mild tonsillitis. When tonsillar cells were incubated in the presence of OK-432, augmentation of factor production by the addition of OK- 432 was less in the former cases compared with the latter cases, suggesting that factor production from tonsils is correlated with the course of inflammation in thin organ.

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Based mainly on clinical evidence, it has been established that focal tonsillar infections affect certain skin diseases. In such disorders as pustulosis palmaris et plantaris (PPP), there has been significant improvement of clinical manifestations following tonsillectomy. However, the pathophysiological mechanism of PPP due to focal tonsillar infections is still unclear. Recently, various reserches with immunological approaches suggest that PPP may develop when tonsillar lymphocytes are sensitized with epithelial antigens of the tonsillar cypt, which has features common to that of palmoplantar skin in the course of chronic inflammation. Tonsillar lymophocytes from PPP patients have the ability to produce anti-keratin antibody and dermatogenicity.

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Nasopharynx associated lymphoid tissue (NALT) in rats appears to be equivalent to the human adenoid and tonsil, and to have a role in mucosal immune responses of the upper respiratory tracts. We examined the antigen-specific immunoglobulin (Ig) contents in nasopharyngeal lavage fluid and antigen specific Ig production by NALT lymphocytes in rats immunized by various routes. A significant increase of antigen-specific IgA level, as well as the IgG level, was noted in the nasopharyngeal lavage fluid of immunized animals. OA-specific IgG spot forming cells (SFC) in NALT lymphocytes was higher than those in spleen lymphocytes in locally immunized rats, whereas inverse relationships were noted in generally immunized rats. These OA-specific IgG SFC were remarkably incerased in NALT, but not so increased in the spleen following nasal booster challenge. However, the numbers of OA-specific IgA SFC in freshly obtained lymphocytes were very low in both NALT and spleen even after the topical antigen challenge. OA- specific IgA SFC were revealed to be increased after in vitro stimulation with lipopolysaccaride (LPS). A preliminary study showed that further incerase of antigen-specific IgA as well as IgG production by NALT lymphocytes occurred in the presence of TGF-β and IL-5.

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The nasopharyngeal mucosa is considered to be the first defense line of the respiratory and gastrointestinal tract, protecting them from invading antigens. The local immunity of the nasopharynx has been proven to be present in the nasopharyngeal mucosa as well. In the present study, the local immune response of the murine nasopharyngeal mucosa was examined when it was stimulated with repeated nasal antigen challenges of protein antigen together with cholera toxin. In another study, the distribution pattern of 1E8 antigen, which is expressed on the surface of antigen- presenting dendritic cells, was also examined in human palatine tonsils, employing an immunostaining procedure. The results, taken together, suggest that the nasopharyngeal mucosa can be an afferent limb to provoke immune response of the nasopharynx and the effector site of mucosal immunity upon antigenic stimuli. Moreover, lymphocyte aggregates seen in submucosa (nasal-associated lymphoid tissue) might be considered to be an inductive site of mucosal immunity, as are Peyer' s patches. 1E8 antigen distribution in human palatine tonsils indicated that 1E8-positive dendritic cells play an important role in the antigen presentation in there.

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We describe two patients who presented with diseases of the vascular tissue in the oral cavity and pharynx. One case was a 17-year-old boy with angiokeratoma of the oral cavity. It was difficult to determine whether it was benign or malignant since he had a history of this same oral disease in his childhood and on this occasion he also complained of a rapidly growing tumor in the left submandibular region.
The other case was a 12-year-old girl with angiocentric T-cell lymphoma originating from the tonsil and extending to the parapharyngeal space, and showed a rapidly fatal outcome. A reason for the rapidly fatal outocome is the difficulty in the diagnosis of this disease because of the many kinds of pathological features described by Jaffe.
In this report, the clinical findings of these 2 cases and the diagnosis, and therapy of diseases of vascular tissue in the oral cavity and pharynx in our clinic are also discussed.

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The epithelial-myoepithelial carcinoma (EMC) is a rare biphasic type of neoplasm that comprises less than 1 percent of salivary gland neoplasms. EMC, the origin of which is considered to be the intercalated duct, is a low-grade malignancy. Two cases of epithelial-myoepithelial carcinoma are reported. A 61-year-old woman (case 1) complained of a mass in the left infraauricular region and underwent extended total parotidectomy following postoperative irradiation therapy of 60 Gy. This patient has been followed-up on an outpatient basis and is free from local recurrence. A 49- year- old man (case 2) complained of a mass in the right palate region. The patient was treated with irradiation therapy and chemotherapy but died 9 months after the original diagnosis.
Analysis of 127 cases reported in the literature shows a mean age of 61.6 years and a preponderance of woman patients, with a peak incidence of occurrernce in the seventh decade of life. EMC may arise in any salivary tissue, but it has a predilection for the parotid gland.
We conclude that surgical resection should be the primary mode of treatment for EMC. Total parotidectomy is advocated for tumors in the parotid gland. Simple enucleation or shelling out of the tumor should be discouraged, because this is a cause of local recurrence and, in some instances, may result in distant metastasis.

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We experienced a 46-years-old woman, whose chief complaints were a feeling of palsy accompanied with dull pain from the occiput and neck on the left side to the upper arm, a feeling of enlargement extrusion of tonsilla palatina of the left side, and a feeling of throat caput aberratio. Her styloid process was long at 51.30mm (the left side), diagnosis of elongated styloid process was made, and ablative operation of styloid process was performed. The consequence was good, and her chief complaint resolved entirely.
Panoramic radiography was useful for observation of the styloid process. We devised the instrumentation method for determining the true styloid process length. The styloid process length of group I (nose and paranasal sinus disease, 52 cases) was 32.16mm±5.93mm and that of group II (feeling of throat caput aberratio nephrocalcinosis, 5 cases) was 44.14mm±7.20mm. Comparison of the styloid process dimensions of group II and group I showed that there was a significant difference by the critical rate less than 5%.

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The innervation in human taste buds of the foliate and circumvallate papillae was studied immunohistochemically using two neuronal markers in patients with Alzheimer' s disease (AD) and their control (ADC) patients. Antisera to protein gene product 9.5 (PGP 9.5) and neuron-specific enolase (NSE) were used in immunofluorescence and streptavidin-biotinperoxidase complex studies. The antiserum to PGP 9.5 stained a greater number of intragemmal nerve fibers in taste buds than that of NSF. PGP 9.5 immunoreactivity was strictly localized in the nerve fibers, whereas NSF immunoreactivity was observed not only in the nerve fibers, but also in taste bud cells. Furthermore, quantitative analysis in AD and ADC patients demonstrated that the mean number of PGP 9.5-immunoreacive intragemmal nerve fibers in taste buds of the foliate and circumvallate papillae decreased significantly in AD patients. These results indicated that PGP 9.5 is a suitable molecular marker of extrinsic innervation in human taste buds, and that the decreased innervation may account partially for the decrement in the chemosensory capacity in AD patients.

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In our clinic, from July 1986 to June 1995, 33 patients with oropharyngeal cancer underwent reconstruction at the resected region. No postoperative complications were observed in the 15 patients who underwent reconstruction at the oral cavity and mesopharynx; however, recurrence was observed in 2 cases at the primary region, 1 case at the resected side in the cervical region, and 1 case at the contralateral side in the cervical region. In 18 patients in whom pharyngoesohagectomy was performed, reconstruction was performed with gastric pull-up in 6 patients and with transplantation of the free jejunum in 12. No major complications were observed in these 18 patients; however, recurrence was detected in 1 case in the gastric pull-up group and in 2 cases in the free jejunum group.Free tissue transplantation is thought to improve the prognosis in oropharyngeal cancers.

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It has been reported that malignant parotid tumors show low signal intensity on MRI. In the present study, we compared T2-weighted images in MRI with histopathological findings in the 18 cases of malignant parotid tumors.
Results indicated that monotonous growth of malignant cells such as malignant lymphoma show high signal intensity, and that malignant tumors like acinic cell carcinoma containing growth of connective tissue in places reveal scattering of low signal intensity areas in the high signal intensity area. Results also showed that tumors as adenocarcinoma and squamous cell carcinoma with mixed proliferation of tumor cells and connective tissue showed heterogeneous and isointensity of T2- weighted images.
Therefore, it is likely that the amount and growth pattern of connective tissue may have a key role of influence on the signal intensity of T2-weighted images in the malignant tumors.

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metastasis from gastric cancer have Been reported in Japan, and we present a seventh case of tonsillar metastasis from gastric cancer in this paper.
A 59-year-old man complained of abnormal sensation in the pharynx 2 years after surgery for gastric cancer. The left palatine tonsil was swollen elastic-hard and coated with whitish fur-like covering. Histopathological examination revealed that the lesion was metastasis from gastric cancer (adenocarcinoma). He died 2 years and 6 months after operation in spite of curative operation.

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Acute epiglottitis in children is very rare in our country. On the contrary, we have a higher frequency of acute epiglottitis in adults, which necessitate emergency care. In this paper, we report our experience with 31 cases of acute epiglottitis in adults between the years 1981 and 1995. A discussion of the pathogenesis, diagnosis and treatment of adult epiglottitis is presented. The cases showed a male predominance with 19 men and 12 women. According to the age distribution, there were 3 cases in the second decade of life, 5 cases in the third decade, 8 cases in the forth decade, 8 cases in the fifth decade, and 7 cases in the sixth decade. Acute painful dysphagia was observed in all cases. Two patients with severe abscess formation received inappropriate treatment at private clinics. Detected pathogens were distributed in a wide range including normal flora to Haemophilus influenzae, which suggest pathogenesis may be depend on several factors including fundamental body conditions such as diabetes or catching cold.

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Two young patients with T4 nasopharyngeal carcinoma who had been treated with multiple courses of planned chemotherapy are reported. In addition to radiotherpy, 21 courses and 15 courses of cisplatin or carboplatin-based chemotherapy were accomplished in case 1 and case 2, respectively. Although recurrent primary lesions appeared, both patients survived over 54 months. The efficacy of multiple courses of planned chemotherapy for T4 nasopharyngeal carcinoma is discussed.

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We treated a patient suffering from adenoid cystic carcinoma of the sublingual gland showing an interesting clinical course. When the patient first noticed unmbness numbness on the left half portion of the tongue about 10 years ago, she visited a local hospital. The patient was treated under the diagnoses of glossalgia and glossitis. Although the examination performed in this hospital did not reveal any abnormalities of the tongue, floor of the mouth and oral mucosa, the palpation disclosed a hard tumor at the site of the lert sublingual gland. The patient complained of imperception and hypogeusia of the lrft half of the tongue. Under general anesthesia, the patient underwent excision of the tumor. The palpable tumor was located at the site of sublingual gland, and no metastasis to the cervical lymph nodes was recongnized. The remarkably contracted submandibular gland showed no signs of infil-tration of tumor. The lingual nerve, however, was considerably shollen and infiltrated with tumor cells. The patient has been placed on a postoperative clinical course.

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Expression of T cell receptor (TCR) Vβ genes in infiltrating lymphocytes in pustulosis lesion on plantaris of patient with palmoplantar pustulosis (PPP) was studied.
Primers for 25 different human TCR Vβ families were employed to analyze TCR Vβ gene rearrangement in these skin lesions. A limited number of TCR Vβ genes were expressed in those lesions, and especially the lymphocytes expressing Vβ 6 were found in six of six, Vβ 7 and Vβ 8 in four of six, and Vβ 1 and Vβ 20 were three of six. The restricted presence of TCR genes in pustulosis may indicate that a specific antigen in those regions plays an important role in this skin disease.
Further analysis of the function of those lymphocytes may present new evidence of focal infection of tonsil with PPP.

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Herein, we discuss the surgical approaches for en bloc resection of the high parapharyngeal space tumors in the 26 cases we experienced during the last 10 years. The parapharyngeal space was divided into high and lower regions based on the level of the inferior margin of the lateral plate of the pterygoid process on the coronal CT.
Surgical approaches which reach the high parapharyngeal space tumors were transoral in 2 cases, transcervical in 2, mandibular swing alone in 6, infratemporal alone in 5, and combined infratemporal and lateral facial approach in 8, infratemporal and mandibular swing in 2, and infratemporal and transpalatal in 1.
There were 11 cases of primary tumors in the high parapharyngeal space, eight of which were benign, and one of the three malignant tumors recurred at the primary site but there were no deaths. There were 15 cases of tumors which involved areas adjacent to the parapharyngeal space, ten of which were malignant. One had bone metastases and death occured in five of the malignant cases.
We recommend the transcervical or mandibular swing approach for benign tumors, and combined infratemporal fossa with middle fossa craniotomy and mandibular swing or lateral facial approach for both malignant cases and cases of adhesion of the lateral pterygoid muscle which is one of the antero-superior borders of the parapharyngeal space.

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An in vivo study was performed to evaluate the use of the pulsed-dye lasers for the fragmentation of salivary calculus. Optimal fragmentation was achieved with a pulseddye laser with a pulse width of 1.4μm and a wavelength of 504nm.
Further studies on the particle sizes were conducted, and a new sialoendoscopic technique was developed. Fifteen patients with sialolithsis of the submandibular gland were treated. Under continuous endoscopic monitoring laser induced shock-wave lithotripsy was performed. In six patients, complete fragmentation and removal of the salivary stones was and in another 50% fragmentation was performed and salivary flow was restored. This approach to laser lithotripsy of salivary stones with endoscopic monitoring represents a novel method that permits treatment on an outpatient basis, without the use of anesthesia, and with minimal inconvenience to the patient.

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Dermoid cyst in the oral floor is usually found in the anterior portion of the floor of the mouth at or on either side of the midline. Dermoid cyst located at a unilateral oral floor is rare. A dermoid cyst at the right oral floor and submandibular region seen in a 44-year-old woman is reported here in. Clinically, displacement and difficulty in the function of the tongue were not recognized. On palpation, the cyst was a noted beneath the intact oral floor mucosae. A CT scan revealed a low density cystic lesion located in the right submental region between the mylohyoid muscle and the genioglossus muscle. Both Tl-weighted and T2-weighted magnetic resonance images showed a high intensity that was homogeneously enhanced with Gd-DTPA. U1trasonogram also demonstrated a homogeneously high echoic component in the cyst. The patient was operated upon and the cystic lesion was totally removed through the mouth. The lesion was histologically diagnosed as dermoid cyst. Biochemical analysis of the cyst showed lactate dehydrogenase levels to be half and triglyceride levels to be twice of these substances in the serum. Anaerobic condition in the cyst may contribute to the growth of dermoid cyst.

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