Chronic Tonsillitis and IgA Nephropathy: Findings From a Nationwide Japanese Cohort Study.

RATIONALE & OBJECTIVE: Little is known regarding the association between chronic tonsillitis and the onset of IgA nephropathy (IgAN). In the present study, we examined the potential relationship between chronic tonsillitis and a subsequent risk of developing IgAN. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 4,311,393 individuals without a history of IgAN identified between January 2005 and May 2022 within a Japanese nationwide epidemiological database, the JMDC Claims Database, representing health claims to over 60 insurers. EXPOSURE: Comorbid chronic tonsillitis based on diagnosis codes. OUTCOME: IgAN occurrence. ANALYTICAL APPROACH: Cause-specific Cox proportional hazards analysis adjusting for potential confounding factors was employed to estimate hazard ratios (HRs). RESULTS: Comorbid chronic tonsillitis was identified in 12,842 individuals, constituting 0.3% of the cohort. The cohort had a median age of 44 years (IQR, 36-53), and males accounted for 57.9%, with a follow-up of 1,089 days (IQR, 532-1,797), during which 2,653 cases of IgAN developed. Cumulative incidence curve showed a higher cumulative incidence of IgAN in individuals with chronic tonsillitis compared with their counterparts without this condition. Multivariable cause-specific analysis further demonstrated that individuals with chronic tonsillitis had an elevated risk of developing IgAN, with HR of 2.72 (95% CI, 1.79-4.14). LIMITATIONS: Potential residual confounders, and lack of consideration for ethnic distinctions. CONCLUSIONS: Using a large-scale epidemiological dataset, these findings suggest a relationship between chronic tonsillitis and an elevated risk of IgAN development in the general Japanese population. PLAIN-LANGUAGE SUMMARY: IgA nephropathy (IgAN), the most prevalent form of primary glomerulonephritis worldwide, is associated with unfavorable long-term kidney survival and life expectancy. Despite the substantial implications, the early detection of IgAN still remains challenging due to its commonly asymptomatic clinical presentation. Consequently, the exploration of risk factors assumes a critical research priority. Prior studies have reported the potential role of tonsilitis in the pathogenesis of IgAN. In this study, we assessed whether chronic tonsillitis was associated with the subsequent development of IgAN using a nationwide epidemiological dataset incorporating over 4,000,000 individuals. Within this large-scale cohort, our findings revealed an association between a history of tonsillitis and a greater risk of developing IgAN. These findings should heighten awareness of the potential susceptibility of people with chronic tonsilitis to IgAN.

[Compression elastography as a new method of ultrasound imaging in the differential diagnosis of chronic tonsillitis]. / Kompressionnaya elastografiya kak novyi metod ul'trazvukovoi vizualizatsii v differentsial'noi diagnostike khronicheskogo tonzillita.

Chronic tonsillitis remains as an urgent problem in modern otorhinolaryngological practice, which requires improving the diagnostic methods of this pathology. OBJECTIVE: To increase the diagnostic information content of objective methods for differential diagnosis of different forms of chronic tonsillitis. MATERIAL AND METHODS: The study involved 97 patients who were divided into two groups: the 1st group (39 patients) - with a simple form; the 2nd group (58 patients) - with a toxic-allergic form of chronic tonsillitis. To assess the structure of the palatine tonsils, patients underwent ultrasound in the compression elastography mode. RESULTS: According to results, patient with simple form of chronic tonsillitis in 64.1±7.68% cases had rigid structure of palatine tonsils, while toxic-allergic form is characterized by an elastic structure of the tonsils (58.62±6.47%). CONCLUSION: The ultrasound compression elastography helps to value efficiently the pathology of the palatine tonsils and conduct a differential diagnosis of clinical forms of chronic tonsillitis.

[Chronic tonsillitis and periodontal diseases]. / Khronicheskii tonzillit i zabolevaniya parodonta.

INTRODUCTION: Chronic tonsillitis is a multifactorial immunopathological process that contributes to the development of tonsillitis-associated pathology. In turn, this tonsillitis-associated pathology potentiates and aggravates the course of chronic tonsillitis. In the literature, there are data on the possible influence of oropharyngeal loci of focal chronic infection on the body as a whole. One of such foci that can aggravate the course of chronic tonsillitis and maintain sensitization of the body are periodontal pockets formed during the inflammatory process in periodontal tissues. Highly pathogenic microgranisms of periodontal pockets secrete bacterial endotoxins, stimulating the immune response of the human body. Bacteria and their waste products cause intoxication and sensitization of the whole organism. A vicious circle is formed, which is quite difficult to break. OBJECTIVE: To study the effect of chronic inflammatory process in periodontal disease on the course of chronic tonsillitis. MATERIAL AND METHODS: 70 patients with chronic tonsillitis were examined. Together with a dentist-periodontist, an assessment of the state of the dental system was carried out, according to the results of which all patients with chronic tonsillitis were divided into 2 groups: with and without periodontal diseases. RESULTS: In patients with periodontitis, highly pathogenic flora is found in periodontal pockets. When examining patients with chronic tonsillitis, it is important to assess the condition of the dental system, to calculate dental indices, the key of which are periodontal and bleeding index. It is necessary to recommend comprehensive treatment for patients with CT and periodontitis by otorhinolaryngologists and periodontists. CONCLUSION: It is necessary to recommend comprehensive treatment by otorhinolaryngologists and dentists to patients with chronic tonsillitis and periodontitis.

[The role of tonsillectomy in the treatment of chronic tonsillitis]. / Vliyanie tonzillektomii na kachestvo zhizni patsientov s khronicheskim tonzillitom.

The problem of chronic tonsillitis remains one of the urgent problems of modern otorhinolaryngology. The article discusses the statistics and complications of chronic tonsillitis, provides indications for tonsillectomy and its main complications. OBJECTIVE: Generalization and systematization of data on the impact of surgical treatment on the quality of life of patients with chronic tonsillitis. MATERIAL AND METHODS: Search for literary sources, carried out using the search engines of the RSCI, PubMed, Web of Science, and eLibrary. RESULTS: A review of literature sources demonstrates a significant improvement in the quality of life of patients after tonsillectomy; however, data from some studies show a trend towards a decrease in the number of planned tonsillectomies and an associated increase in the detection of local purulent-septic complications.

Is Helicobacter pylori colonization associated with chronic tonsillitis? - A meta-analysis and systematic review.

PURPOSE: The aim of this study was to investigate the correlation between Helicobacter pylori colonization of tonsillar tissue in chronic tonsillitis and in noninfectious hyperplastic tonsils. MATERIALS AND METHODS: All included studies investigated the presence of Helicobacter pylori in tonsillar tissue removed for infectious or noninfectious factors. Included studies must have used an accepted method of testing for Helicobacter pylori. We pooled six eligible studies to perform a traditional meta-analysis. RESULTS: Six studies were included, including 462 patients. Helicobacter pylori does have a significant role in chronic tonsillitis compared with noninfectious indications for tonsillectomy for children population. Detection methods had effects on results. CONCLUSION: The positive rate of Helicobacter pylori in chronic tonsillitis group was significantly higher than that in simple noninfectious group for the pediatric population, but not for adults. We suspected that chronic tonsillitis is likely to be relevant to Helicobacter pylori.

Role of Palatine Tonsil and Epipharyngeal Lymphoid Tissue in the Development of Glomerular Active Lesions (Glomerular vasculitis) in Immunoglobulin A Nephropathy.

Hematuria is an essential symptom of immunoglobulin A nephropathy (IgAN). Although the etiology of hematuria in IgAN has not been fully elucidated, it is thought that the rupture of the glomerular basement membranes caused by intra-capillary leukocyte influx, so-called glomerular vasculitis, is the pathological condition responsible for severe hematuria. Glomerular vasculitis are active lesions that exist in the glomeruli of acute phase IgAN and it is important because it is suspected to make the transition to segmental glomerular sclerosis (SGS) as a repair scar lesion in the chronic phase, and the progression of SGS would eventually lead to glomerular obsolescence. Worsening of hematuria concomitant with acute pharyngitis is common in patients with IgAN; therefore, elucidating the relationship between the immune system of Waldeyer's ring, including the palatine tonsil and epipharyngeal lymphoid tissue, and the glomerular vasculitis may lead to understanding the nature of IgAN. The epipharynx is an immunologically activated site even under normal conditions, and enhanced activation of innate immunity is likely to occur in response to airborne infection. Hyperactivation of innate immunity via upregulation of Toll-like receptors in the interfollicular area of the palatine tonsil and epipharyngeal lymphoid tissue, followed by enhanced fractalkine/CX3CR1 interactions, appears to play an important role in the development of glomerular vasculitis in IgAN. As latent but significant epipharyngitis is present in most patients with IgAN, it is plausible that acute upper respiratory infection may contribute as a trigger for the innate epipharyngeal immune system, which is already upregulated in a chronically inflamed environment. Given that epipharyngitis and its effects on IgAN are not fully understood, we propose that the so-called "epipharynx-kidney axis" may provide an important focus for future research.

ANTIBODIES TO MICROBIAL ANTIGENS AND CYTOKINES IN THE CELLS OF THE PALATINE TONSILS AND SERUM OF CHILDREN WITH PALATINE TONSILS HYPERTROPHY AND CHRONIC TONSILLITIS.

OBJECTIVE: The aim: The aim of the study is to compare the class G antibody content in serum and tissue lysate from tonsils of children with hypertrophy and chronic tonsillitis to: streptolysin-O of Str. haemolyticus, protein-A of S. aureus, proteoglycans of Klebsiela spp., as well as to compare the content of interleukins 1ß, 10, TNF-α, γ-IFN and lactoferrin in serum and tissue lysate from tonsils of children with hypertrophy and chronic tonsillitis. PATIENTS AND METHODS: Materials and methods: We studied tonsils of 33 children aged 4-18 years with hypertrophy of palatine tonsils (HPT) and with chronic tonsillitis (CT). The content of interleukins 1ß, 10, TNF-α, γ-IFN and lactoferrin in tonsil lysate and serum was determined by immunofluorescence assay. Antistreptolysin O was studied by neutralization test of micromethod; class G antibodies to protein A of S. aureus and proteoglycans of Klebsiela spp. were studied by treponema pallidum hemagglutination assay. All the results were statistically processed using U-test (Mann-Whitney-Wilcoxon test) and Fisher's z-transformation. RESULTS: Results: The serum and tissue lysate from tonsils of patients with HPT showed significantly high level of antibodies to streptolysin O in comparison with similar studies of substrates from patients with CT. Anti-inflammatory cytokine IL-10 was detected only in the serum of patients with CT. The TNF-α concentration in the lysates of tonsils in the group of patients with HPT was 2 times higher than in the group of patients with CT. The γ-IFN concentration was significantly lower both in the serum and in the lysates of tonsils of patients with CT. The content of lactoferrin in the lysates of patients with CT was 3 times higher (P<0.05) than in the lysates of patients with HPT. CONCLUSION: Conclusions: The results indicate a significant difference in the state of antibodies to microbial antigens and cytokines production in case of HPT and CT. In tonsils with HPT, there predominate reactions of antibody production to bacterial antigens and antiviral reactions like a high-level cytokines TNF-α and γ-IFN in tissue lysate of palatine tonsils.

[The problem of chronic tonsillitis as a priority area of scientific research of the Department of Otorhinolaryngology named after acad. B.S. Preobrazhensky]. / Problema khronicheskogo tonzillita kak prioritetnoe napravlenie nauchnykh issledovanii kafedry otorinolaringologii imeni akad. B.S. Preobrazhenskogo.

The article summarizes data on many years of versatile research on the problem of chronic tonsillitis, which were conducted at the Department of Otorhinolaryngology named after acad. B.S. Preobrazhensky Medical Faculty of the Russian National Research Medical University N.I. Pirogov. The research results are presented in the context of the history of the department and the formation of the problem of chronic tonsillitis.

[Clinical and morphological picture of chronic tonsillitis and its pathogenetic relationship with periodontal diseases: literature review]. / Kliniko-morfologicheskaya kartina khronicheskogo tonzillita i ego patogeneticheskaya svyaz' s parodontopatiyami: obzor literatury.

The article is devoted to the study of chronic tonsillitis from the point of view of the clinical and morphological picture of the disease, histological changes in the palatine tonsils in various forms of CT. The authors raise the question of studying the assessment of the effect of conservative therapy on the morpho-functional state of the palatine tonsils. The article focuses on the study and influence of extratonsillary oropharyngeal loci of focal infection, such as periodontopathies, on the course of chronic inflammation of the palatine tonsils. The association of periodontitis with CT and various somatic diseases has been demonstrated. The necessity of further study of the cause-and-effect relationships of CT and periodontal diseases, as well as a more in-depth study of the morphological picture in CT using immunohistochemical methods of research, which will allow us to develop new principles for the diagnosis and treatment of this disease, is justified.

[Modern approaches to the surgical treatment of chronic tonsillitis]. / Sοvremennye pοdkhοdy k khirurgicheskοmu lecheniyu khrοnicheskοgο tοnzillita.

At the moment, all over the world there are a large number of various methods of surgical treatment of chronic tonsillitis. In particular: classical tonsillectomy, cryosurgical method for removing the palatine tonsils, shaver tonsillectomy, monopolar and bipolar tonsillectomy, tonsillectomy with an ultrasonic scalpel, bipolar dissection using cutting instruments, laser tonsillectomy, coldablation. This article analyzes the existing methods, describes the fundamental technique for their implementation, as well as their advantages and disadvantages. Given the abundance of various surgical approaches to the treatment of chronic tonsillitis, there is a need for studies aimed at comparative study of their clinical and microbiological efficacy, including the postoperative period.

[Mechanism of Shengjiang Powder in treating chronic tonsillitis in children based on network pharmacology and molecular docking].

Based on the network pharmacology and molecular docking method to explore the molecular mechanism of Shengjiang Powder in treating chronic tonsillitis in children. This research first based on the Traditional Chinese Medicine System Pharmacology(TCMSP) and the Bioinformatics Analysis Tools for Molecular Mechanism of Traditional Chinese Medicine(BATMAN-TCM), the effective active ingredients of the drugs contained in Shengjiang Powder were screened out by the pharmacokinetic(ADME) parameters, the targets were predicted, and then chronic tonsillitis disease in children targets were obtained by GeneCards database. Afterwards, the target protein names were standardized by the Uniprot database. The drug targets were matched with the disease targets to obtain the potential therapeutic targets of Shengjiang Powder. Cytoscape 3.8.0 software was used to screen out and construct the network diagram of "drug-components-core targets-disease". DAVID database and R language were used to conduct the enrichment analysis of core action targets. Finally, AutoDock software was used to conduct molecular docking between drug components with a high network medium value and core action targets. According to the findings, after standardized treatment, a total of 79 active ingredients of Shengjiang Powder were obtained; it was predicted to get 1 261 potential targets, 268 potential targets for treatment of chronic tonsillitis in children, and 29 core targets; and 81 entries of GO enrichment were determined(P<0.05), including 63 biological processes, 7 cell components, 11 molecular function items, 24 KEGG pathway enrichment items(P<0.05), mainly including cell cycle, inflammatory factors, viral infection, immune regulation and other signaling pathways. The results of molecular docking showed that main active components in Shengjiang Powder had a stable binding activity with the core targets. This study revealed the mechanism of Shengjiang Powder in the treatment of chronic tonsillitis in children, mainly by resisting virus, inhibiting inflammation, regulating immunity and other means to play a synergistic effect, so as to provide a theoretical basis for rational clinical application.

[Small salivary glands in the paratonsillar space in children]. / Malye slyunnye zhelezy v paratonzillyarnom prostranstve u detei.

THE AIM OF THE STUDY: Was to study the changes in the small salivary glands in chronic tonsillitis and paratonsillar abscess in children. A histological examination of the palatine tonsils of 22 children aged 5 to 14 years old who had a paratonsillar abscess and 18 children suffering from chronic tonsillitis was carried out. Fragments of small salivary glands, located both superficially, in the mucous membrane between the stratified squamous non-keratinizing epithelium and the lymphoid tissue of the palatine tonsils, and between the muscles of the amygdala were found in 42 of the 80 (52.5%) tonsils studied. Along with the unchanged glandular structure, 26 (61.9%) samples revealed areas of destruction foci in small salivary glands with signs of inflammatory and compensatory regenerative activity. The presence of separate interlobular ducts of the salivary glands with pronounced periductal lymph - macrophage infiltration was noted. The subepithelial lymph-macrophage infiltrates found in the lamina propria are associated with the exit of the excretory ducts of the salivary glands to the surface of the mucous membrane. Many thin-walled veins are surrounded by perivascular lymphocellular infiltrates. The inflammatory and post-inflammatory changes in the small salivary glands revealed by us in children with chronic tonsillitis do not exclude their participation in the pathogenesis of paratonsillitis. At the same time, inflammation in the salivary gland can be both primary, as a result of its infection with live microorganisms from the tissues of the tonsil, and secondary, due to the compression of the excretory ducts by the edematous tissue of the tonsil in acute tonsillitis.

The importance of intracellular bacterial biofilm in infectious diseases.

Various bacterial species, previously known as extracellular pathogens, can reside inside different host cells by adapting to intracellular modes by forming microbial aggregates with similar characteristics to bacterial biofilms. Additionally, bacterial invasion of human cells leads to failure in antibiotic therapy, as most conventional anti-bacterial agents cannot reach intracellular biofilm in normal concentrations. Various studies have shown that bacteria such as uropathogenic Escherichia coli, Pseudomonas aeruginosa, Borrelia burgdorferi,Moraxella catarrhalis, non-typeable Haemophilus influenzae, Streptococcus pneumonia, and group A Streptococci produce biofilm-like structures within the host cells. For the first time in this review, we will describe and discuss the new information about intracellular bacterial biofilm formation and its importance in bacterial infectious diseases.

An analysis of the histomorphometric and clinical significance of mucosal biofilm in tonsil tissue of the children with a history of recurrent/chronic tonsillitis in both the mother and father.

PURPOSE: The aim of this study is to analyse the histomorphometric and clinical features of the mucosal biofilm in tonsil tissue of children with a history of recurrent/chronic tonsillitis in both the mother and father. METHODS: This study enrolled 82 children (between 3 and 14 years of age). These children were divided into two main groups according to the present of recurrent/chronic tonsillitis. Patients in group 1 were divided into four subgroups (A, B, C, D) according to the history of recurrent/chronic tonsillitis in mother and/or father. 30 patients in group 1 were underwent tonsillectomy and the 52 patients in control group (2) have not had history of recurrent/chronic tonsillitis. To that end, among children with a history of recurrent/chronic tonsillitis certain changes in the volume and thickness of mucosal biofilm in tonsil tissue have been exhibited with respect to it is histomorphometric and clinical significance. RESULTS: The children with a parental history of recurrent/chronic tonsillitis in group A, an increase in the thickness and volume of mucosal biofilm samples was detected according to the other subgroups (B, C, D). Parents history of group A patients statistically significant differences were detected with respect to halitosis symptoms, attack age of the first tonsillitis and resistant fever despite antibiotic treatment for children under the age of 3 years. CONCLUSIONS: This study showed that children under the age of 3 years of age with a history of recurrent/chronic tonsillitis in both the mother and father, halitosis symptoms, attack age of the first tonsillitis and resistant fever despite antibiotic treatment are collectively linked.

Thermographic differential diagnosis of acute tonsillitis and exacerbation of chronic tonsillitis.

OBJECTIVE: The aim: To elaborate the thermosemiotics of acute and chronic tonsillitis during exacerbation. PATIENTS AND METHODS: Materials and methods: 48 patients with acute tonsillitis and 19 patients with chronic tonsillitis were examined during disease exacerbation. Thermographic examination was carried out by the medical thermometer TI-120. Statistical processing of data was carried out with computer program "Microsoft Excel" and "Statistica for Windows" v. 6.0, StatSoft Inc. (USA). RESULTS: Results: Symmetry, homogeneity and isotherm are normal thermographic features of the skin. Presence of hyperthermia in carotid triangle, on the palms were revealed in patients with acute tonsillitis. In chronic tonsillitis in the stage of exacerbation, a moderate overall «warming up¼ of the neck and projections of the submandibular lymph nodes was also observed. The average temperature indices of the knee joints were statistically significantly higher than the corresponding values in healthy people °C (P<0.01). CONCLUSION: Conclusion: Only in patients with acute tonsillitis clear strong positive correlation between the temperature of half of the submandibular area and warming in the center of the palm - r = 0.812 ... 0.859 (P<0.01) and in the middle of the tenar on the corresponding side - r = 0.790 ... 0.827 (P<0.01) was observed. Only in the case of chronic tonsillitis, in the stage of exacerbation, the temperature difference over the knees and the lower part of the femur is always greater than 0.5 ºC.

Influence of magnesium on the state of the cardiovascular system in children with chronic tonsilitis.

OBJECTIVE: The aim of the study was to evaluate the condition of the cardiovascular system and the effect of the combined preparation of magnesium and vitamin B6 in children with secondary cardiomyopathy on the background of chronic tonsillitis. PATIENTS AND METHODS: Materials and methods: 100 children at the aged of 13-17 years were surveyed, including 60 patients with secondary cardiomyopathy with chronic tonsillitis. And the group I consisted of 45 children receiving standard treatment, group II - 15 patients who, along with standard treatment, received the drug magnesium. The control group consisted of 40 healthy children. To assess the condition of the cardiovascular system and vegetative regulation, we performed electrocardiographic examination (ECG), exercise test and ECG control, cardiointervalography with clinoortostatic test. The concentration of magnesium in the serum was determined by atomic absorption spectrophotometry. Also, we have provided the requirements of the principles of bioethics and drafted a protocol in accordance with the basic principles of the Helsinki Declaration. RESULTS: Results: In addition to the standard treatment of children with magnesium drug, there was a significant decrease in the frequency of sinus arrhythmias, disorders of the intraventricular conduction, and the processes of repolarization, extrasystole, sinus suchchardia were not observed in any of the patients. The normalization of magnesium in the serum of patients was observed. CONCLUSION: Conclusions: Supplementation of combination therapy with magnesium and B6 helped to improve myocardial electrophysiology and cardiac output, as well as to normalize the serum magnesium in children with secondary cardiomyopathy.

Clinical and laboratory peculiarities of children's state with chronic tonsilitis on type 1 diabetes.

OBJECTIVE: The aim: Improvement of early diagnostics quality and efficiency of chronic pharyngeal diseases (CPD) treatment in children with DM-1 by studying the clinical and laboratory features of the disease course and complex therapy administration. PATIENTS AND METHODS: Materials and methods: A comprehensive examination of 707 children with diabetes mellitus-1, aged 3 to 18, was conducted, which determined clinical and laboratory features of their state in the presence and absence of chronic tonsillitis (CT). RESULTS: Results: Using microbiological and cytological examination of the palatine tonsils (PT) crypts, the leading role of microbial associations in the pathogenesis of HT in the formation of immune inflammation was determined, their influence on the local immunity indices was defined. Significant disturbances of the microcirculatory bed (MCB) in the presence of HT in children with DM-1, direct correlation between CPD and the presence of vascular glomeruli, changes in the retinal capillary structure (r = 0,332; p <0,05) according to biomicroscopy bulbar conjunctiva (BMBC) data were determined. The study of psycho-emotional state in children with CT and DM-1 was conducted, along with applied psycho-corrective program, which significantly reduces the manifestations of aggressiveness, aggression, and frustration reactions in them. CONCLUSION: Сonclusions: A non-invasive complex of the study of PT state on changes of local immunity indices, microbiocenosis and cytological data for correction of CPD course was developed, which allows to obtain faster compensation of CT and contributes to patients' quality of life improvment.

Cytokine and immunoglobulin spectra of tissue extracts from tonsils of children with hypertrophy and chronic tonsillitis.

OBJECTIVE: The aim: To compare the content of α and γ-interferons, interleukins 1ß ,4, 10, IgA, IgG, as well as the level of the general forms of immune complexes in tissue extracts from tonsils of children with hypertrophy and chronic tonsillitis. RESULTS: Results: In tissue extracts from tonsils with CT, there is a predominance of inflammation factors, potential sensitization, and the development of immunopathological reactions. The presence of inflammation is indicated by elevated levels of interleukin-1ß, immunoglobulin G. High levels of interleukin-4 may indicate that both HPT and CT have a tendency to increase sensitization to microbial and other antigens. CONCLUSION: Conclusion: The results indicate a significant difference in the qualitative and quantitative state of inflammation factors and allergy in case of HPT and CT. In tonsils with CT, there predominate both simple and allergic inflammations, as well as immunopathological reactions.

[Conducting bilateral tonsillectomy in patients after kidney transplantation. Clinical observation]. / Provedenie dvustoronnei tonzillektomii u patsientov posle transplantatsii pochki. Klinicheskoe nablyudenie.

The experience of performing bilateral tonsillectomy under general anesthesia for two patients with a transplanted kidney receiving immunosuppressive therapy is presented. In both patients after surgery, pain and inflammatory changes in the postsurgery wound were minimal. However, in the postsurgery period, infection was observed in patients, this required the prescription of systemic antibacterial drugs. On the background of immunosuppressive therapy, the clinical course of chronic tonsillitis proceeded without severe symptoms, despite the decompensation of the chronic process in the tonsils. Due to severe concomitant renal pathology and with a transplanted kidney, such patients need to be examined and treated in a multidisciplinary hospital. Indications for surgical treatment of these patients should be substantiated together with nephrologists, otolaryngologists and anesthetists.

[The state of regional lymph nodes in chronic tonsillitis according to ultrasound]. / Sostoyanie regionarnykh limfaticheskikh uzlov pri khronicheskom tonzillite po dannym ul'trazvukovogo issledovaniya.

Despite the variety of chronic tonsillitis clinical symptoms, none of the known signs of this disease is typical for it. PURPOSE OF STUDY: Is development of a method for differential diagnosis of complicated (toxic-allergic) and uncomplicated (simple) forms of chronic tonsillitis. METHODS: 147 patients were divided into 2 groups: 1) 61 (42%) - with a simple form and 2) 86 (58%) - with a toxic-allergic form of chronic tonsillitis of the II degree. Patients underwent ultrasound examination of regional lymph nodes, to determine their localization, quantity (single, multiple), shape, size and structure. RESULTS: According to ultrasound data, it was revealed that for the simple form of chronic tonsillitis the following characteristics of the lymph nodes were typical - bean-like form, single, clear contours, homogeneous central parts and reduced vascularization; for the toxic-allergic form of chronic tonsillitis, the following characteristics of lymph nodes were revealed - oval shape, lymph nodes conglomerates, hypoechoic central parts, increased vascularization and irregular shape of the gates. CONCLUSION: The proposed method allows to quickly and efficiently conduct differential diagnosis of chronic tonsillitis. This technique is easily reproducible in the conditions of any (outpatient, inpatient) medical facility using standard equipment for ultrasound examination, does not require the use of any drugs.