Yuzuru Abiko

Secretion and dynamics of Herpes simplex virus in tears and saliva of patients with Bell's Palsy

Objective For clarification of the direct relationship between the reactivation of herpes simplex virus and the development of Bells Palsy, a detection of the virus genome by deoxyribonucleic acid diagnostics and a quantitative analysis of its time-course change are both needed. The authors detected the HSV genome in specimens from patients with Bells Palsy, quantified its number of copies, and examined time-course changes. Subjects and Methods The subjects were 16 patients with Bells Palsy. The tear fluid and saliva from the submandibular gland and the parotid gland were separately collected from the affected and unaffected sides twice or more. A total of 244 specimens were subjected to extraction of deoxyribonucleic acid, polymerase chain reaction, and microplate hybridization. Results Herpes simplex virus-1 deoxyribonucleic acid was detected in 38 specimens (11.8%) from 5 patients (31%). The high detection (28.5%) was obtained within 2 weeks after onset. Detection at 3 weeks and later (2.8%) was significantly lower (p < 0.05). In three cases, deoxyribonucleic acid was also found on the unaffected side in the initial phase of the disease, but detection on that side (18.9%) was significantly lower than on the affected side (83.8%) (p < 0.01). The number of copies of the herpes simplex virus-1 genome was large on the affected side and early after the onset of the disease. Conclusions The reactivation of herpes simplex virus-1 on the affected side is involved as a pathogenic factor of Bells Palsy. A reactivation of herpes simplex virus-1 may be generated even on the unaffected side in the early phase of the disease. Herpes simplex virus deoxyribonucleic acid was not detected in any of the examined specimens collected from the remaining 11 cases. The need for constant study to clarify other causative factors of Bells Palsy remains.

Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence.

Objective: To show the significance of various factors when predicting the outcome of facial nerve paralysis.

To what extent do evaluations of facial paralysis by physicians coincide with self-evaluations by patients: Comparison of the Yanagihara method, the House-Brackmann method, and self-evaluation by patients

Objectives To understand to what extent evaluations of facial paralysis by physicians coincide with self-evaluations by patients. Study Design Prospective clinical study. Patients One hundred thirty-one patients (68 male patients and 63 female patients) with facial paralysis were included in the study. Interventions The relationship between the evaluation of facial paralysis using the Yanagihara system, the House-Brackmann grading system, and self-evaluation by patients was studied. Main Outcome Measures The paralysis scores and grade determined by physicians using the above two systems were well correlated with the self-evaluations by patients. Results The evaluation of subjective symptoms differed among individuals. Even patients who were evaluated as either completely paralyzed or cured according to the Yanagihara and House-Brackmann methods did not always rate their subjective symptoms as being consistent with these scores. Conclusion Evaluations with the two systems correlated significantly with self-evaluations by patients on the whole. These two methods of evaluation are considered appropriate not only for physicians but also for patients. In contrast, some discrepancies were observed. This point should be taken into account in routine patient care.

Impaired specific cellular immunity to the varicella-zoster virus in patients with herpes zoster oticus

The possible involvement of depression on cellular immunity in reactivation of varicella-zoster virus (VZV) in herpes zoster oticus was investigated. The subjects comprised 59 cases of herpes zoster oticus, 33 cases of herpes zoster sine herpete (ZSH) with facial paralysis, and 205 cases of Bells palsy. The transformation rate of lymphocytes to phytohaemagglutinin in herpes zoster oticus tended to be lower than that in Bells palsy. In skin tests with purified protein derivatives of tuberculin, the positivity rate in herpes zoster oticus was significantly lower than that in Bells palsy (p < 0.015). In skin tests using VZV antigen the positivity rate in herpes zoster oticus and ZSH were significantly lower than that of Bells palsy (p < 0.001 and p < 0.015, respectively). Thus, it was noted that cellular immunity, especially specific cellular immunity against VZV, was significantly depressed in herpes zoster oticus and ZSH. We consider that depression of specific cellular immunity plays an important role in triggering reactivation of VZV and onset of these diseases.

Malignant lymphoma of the tonsil

Abstract Thirty patients with lymphoma of the tonsils were treated in the Nihon University Itabashi Hospital between January 1991 and December 2001. Good prognosis was obtained in stage I tonsillar lymphoma with either radiation or chemotherapy. The 5-year survival rate in stage II disease was 76% with either full cycle chemotherapy or induction chemotherapy followed by radiation. In the latter instances, locoregional recurrences increased but did not impair survival. Otolaryngologists should play an important role in improving survival by diagnosing primary tonsillar lymphoma and by detecting early local recurrences.

Detection and Quantitative Analysis of Herpes Simplex Virus DNA in Tear and Saliva of Patients with Bellʼs Palsy

herpes zoster with facial palsy, VZV-DNA was detected. In 1 patient, 4 of 5 saliva samples were PCR positive. No VZV-DNA was found in the other 25 patients analyzed. HSV type I-DNA was found in the saliva samples of 2 patients with Bell’s palsy. In 1 of them, all saliva samples were positive. Serological analysis of this patient showed that he suffered from a primo HSV-1 infection. The percentage of HSV-DNA positivity was similar to that found in our initial study. Of the 24 patients with Bell’s palsy, 6 had a high anti HSV-titer in the first sample tested in the CF-test, 1:64 or higher. Only 1 patient showed a twofold increase in CF-titer. In the other patients, no change in HSV titer was found. In conclusion, we were struck by the fact that 3 out of 4 patients with herpes zoster and facial paralysis were VZV-DNA positive in their saliva, and contained both IgM and very high antiVZV IgG-titers in their serum but no HSV-antibodies. In the patients with Bell’s palsy, Only 1 of 5 patients serologically negative for HSV, showed serological indications for VZV reactivation. In 6 patients, high CF-titers for HSV were found in the first serum sample. In two other persons, HSV-I DNA was detected in their saliva. Our data therefore appear to confirm: (a) Murakami’s findings on VZV in patients with herpes zoster complicated by facial paralysis, and, (b) the Finnish, but not the Japanese, study on the detection of HSV-DNA in the saliva from patients with Bell’s palsy.