Survival of herpes simplex virus in water specimens collected from hot tubs in spa facilities and on plastic surfaces

Several health spas were closed temporarily because of possible nonvenereal spread of herpes simplex virus (HSV) in spa water at these facilities. We collected water specimens from two health spas and studied them for (1) the presence of HSV; (2) bromine (Br2), chlorine (Cl2), and pH levels; and (3) the ability of HSV to survive in water. No HSV could be isolated from the spa water specimens. Spa water had high levels of Cl2 and Br2, tap water specimens had low levels of Cl2, and distilled water had no detectable Cl2 or Br2. The addition of spa water to laboratory stock virus immediately inactivated the virus. The HSV survived four hours in the tap water and 24 hours in distilled water. The survival of HSV appeared to be related to the free halogen content of water. To approximate the conditions of survival of HSV on plastic-coated benches and seats in spa facilities, HSV was placed on plastic surfaces in a humid atmosphere at 37 to 40 degrees C. The virus was found to survive up to 4.5 hours under these conditions. The survival of HSV from human lesions may be different due to the presence of tissue secretions and proteins. Furthermore, transmission may require other factors, such as rubbing of skin or penetration through abrasions. However, survival of significant amounts of virus for 4.5 hours on plastic surfaces suggests that fomites such as these may be nonvenereal routes of HSV transmission.

Evoked electromyography and idiopathic facial paralysis

The purpose of this study was to standardize and evaluate the results of evoked electromyography (EEMG) in normal patients and in patients with acute idiopathic facial paralysis. A comparison of the amplitude of response to EEMG from one side of the face to the other in 288 normal patients yielded a great variability in results. The amplitude difference was not greater than 50%, and therefore a difference of less than 50% was considered normal. Test-retest variability of the percentage difference in amplitude in 10 subjects showed a 10% variation in seven patients and up to a 20% variation in the remaining three patients. Fifty patients with acute idiopathic facial paralysis were seen within 14 days of onset. A favorable prognosis was based on an EEMG amplitude of more than 25% of the normal side. With this criterion EEMG was accurate in predicting complete recovery in 36 (92%) of 39 patients. When EEMG was 25% of normal or less, incomplete recovery occurred in 9 (82%) of 11 patients. The response was 0% to 10% in six patients; four had a poor recovery and the remaining two had a fair recovery. The technique, interpretation of results, avoidance of pitfalls, and shortcomings of this test are discussed.

Acute Bell's palsy: prognostic value of evoked electromyography, maximal stimulation, and other electrical tests

Thirty-seven patients with acute Bell's palsy who had complete unilateral facial paralysis were selected for this study. Evoked electromyography, conduction latency, electromyography, and nerve excitability testing was done by one author while the maximal stimulation test was done by another on each patient. The patients were examined within ten days of onset of facial paralysis and evaluated six months after onset to determine the degree of recovery of facial motor function. The results of the tests were correlated with the degree of recovery of facial motor function in each patient. Evoked electromyography and maximal stimulation tests were the most accurate electrical tests for predicting the course of acute facial paralysis when they were performed serially within the first ten days after onset. When the results of the maximal stimulation test were equal on the involved and uninvolved sides of the face, there was a 92 percent chance of complete recovery of facial function on the involved side. In those patients in whom the response to the maximal stimulation test was markedly reduced or absent, there was an 86 percent chance of incomplete recovery of facial function. When the response to evoked electromyography on the involved side was 30 percent or greater of that on the normal side, 84 percent of the patients had complete recovery of facial function; however, when the response was 25 percent or less of normal, there was an 88 percent chance of incomplete recovery. The results of evoked EMG and the maximal stimulation test agreed in 89 percent of cases in predicting the ultimate outcome of facial paralysis.

Glycopeptides of the type-common glycoprotein gD of herpes simplex virus types 1 and 2

We have carried out detailed structural studies of the glycopeptides of glycoprotein gD of herpes simplex virus types 1 and 2. We first examined and compared the number of N-asparagine-linked oligosaccharides present in each glycoprotein. We found that treatment of either pgD-1 or pgD-2 with endo-beta-N-acetylglucosaminidase H (Endo H) generated three polypeptides which migrated more rapidly than pgD on gradient sodium dodecyl sulfate-polyacrylamide gels. Two of the faster-migrating polypeptides were labeled with [(3)H]mannose, suggesting that both pgD-1 and pgD-2 contained three N-asparagine-linked oligosaccharides. Second, we characterized the [(3)H]mannose-labeled tryptic peptides of pgD-1 and pgD-2. We found that both glycoproteins contained three tryptic glycopeptides, termed glycopeptides 1, 2, and 3. Gel filtration studies indicated that the molecular weights of these three peptides were approximately 10,000, 3,900, and 1,800, respectively, for both pgD-1 and pgD-2. Three methods were employed to determine the size of the attached oligosaccharides. First, the [(3)H]mannose-labeled glycopeptides were treated with Endo H, and the released oligosaccharide was chromatographed on Bio-Gel P6. The size of this molecule was estimated to be approximately 1,200 daltons. Second, Endo H treatment of [(35)S]methionine-labeled glycopeptide 2 reduced the molecular size of this peptide from approximately 3,900 to approximately 2,400 daltons. Third, glycopeptide 2 isolated from the gD-like molecule formed in the presence of tunicamycin was approximately 2,200 daltons. From these experiments, the size of each N-asparagine-linked oligosaccharide was estimated to be approximately 1,400 to 1,600 daltons. Our experiments indicated that glycopeptides 2 and 3 each contained one N-asparagine-linked oligosaccharide chain. Although glycopeptide 1 was large enough to accommodate more than one oligosaccharide chain, the experiments with Endo H treatment of the glycoprotein indicated that there were only three N-asparagine-linked oligosaccharides present in pgD-1 and pgD-2. Further studies of the tryptic glycopeptides by reverse-phase high-performance liquid chromatography indicated that all of the glycopeptides were hydrophobic in nature. In the case of glycopeptide 2, we observed that when the carbohydrate was not present, the hydrophobicity of the peptide increased. The properties of the tryptic glycopeptides of pgD-1 were compared with the properties predicted from the deduced amino acid sequence of gD-1. The size and amino acid composition compared favorably for glycopeptides 1 and 2. Glycopeptide 3 appeared to be somewhat smaller than would be predicted from the deduced sequence of gD-1. It appears that all three potential glycosylation sites predicted by the amino acid sequence are utilized in gD-1 and that a similar number of glycosylation sites are present in gD-2.

Studies of nucleotides of growth-plate cartilage: evidence linking changes in cellular metabolism with cartilage calcification

The objective of this study was to examine the nucleotides of chick growth-plate cartilage and to measure the concentration of adenine nucleotides in the pre-mineralizing and mineralizing zones. Nucleotides were isolated from the two regions using a rapid-freezing technique and the concentration of individual components was ascertained by HPLC. The actual values of ATP, ADP, and other nucleotides in cartilage was low. The lowest values were recorded in the mineralized zone. In this latter zone the energy charge ratio and the ATP/ADP ratio were depressed. This was probably due to 02-related inhibition of mitochondrial oxidative activity. Additionally, the percentage of octanoate, a short-chain fatty acid that accumulates when aerobic metabolism is disturbed, was found to have increased in the calcifying zone. These findings suggest that calcification of cartilage is associated with hypoxia-related modulation of chondrocyte metabolism.

Evaluation and treatment of congenital facial paralysis

An approach to the evaluation and the preferred methods of treatment of congenital facial paralysis is presented. The expected results from testing procedures and the limitations of their usefulness in acquired v developmental palsies are discussed. We recommend that the auditory brain-stem response test be included in the initial evaluation of patients with congenital facial paralysis.

Facial nerve decompression complications

Every structure contained within the temporal bone in close proximity to the facial nerve is at risk during intratemporal bone surgery on the facial nerve. We present a review of the causes of injuries to these structures and of ways to prevent such injuries. This review includes information drawn from pertinent literature, from the author's experience managing 139 patients undergoing temporal bone surgery for a variety of facial nerve disorders between 1974 and 1981, from an analysis of 43 of our patients whose hearing was evaluated before transmastoid facial nerve surgery and again 6 months after surgery, and from the experiences of colleagues. We found that the most frequent complication of intratemporal facial nerve surgery is auditory involvement. An air-bone gap of 15 dB or greater was noted in 14% of the 43 patients studied and a sensorineural loss, primarily at the 4000 and 8000 cycles, occurred in 51% of these patients. A decrease in discrimination of 15% or greater was noted in 7% of patients, and a shift in speech reception threshold of 15 dB or greater was noted in 16% of the patients. Twelve percent of the patients had tinnitus following surgery and 5% required a hearing aid as a result of a combined sensorineural and conductive hearing loss which occurred in their better hearing ear as a result of surgery. Structures less commonly injured during transmastoid decompression of the facial nerve included the facial nerve itself, the chorda tympani nerve, the balance function of the labyrinth, the cochlea, the ossicles, the sigmoid sinus and superior petrosal vein, the middle meningeal artery and the stylomastoid artery, the dura, and the brain. We review all of these complications, as well as discuss the incidence of cerebrospinal fluid leak and infection which also may result from this type of surgery.

Granular cell tumor arising in myelinated peripheral nerves. Light and electron microscopy and immunoperoxidase study

The histologic, immunohistochemical and ultrastructural characteristics of two granular cell tumors arising from the right recurrent laryngeal and left facial nerves are described. S-100 protein was detected both in the nuclei and cytoplasm of the granular cells using the peroxidase-anti-peroxidase method. The ultrastructural findings in both cases support a Schwann cell derivation of the granular cells. It is suggested that the granularity of cells of granular cell tumor may represent a lysosomal disorder affecting most frequently neoplastic and nonneoplastic Schwann cells and occasionally other cells.

Malignant external otitis: CT evaluation

Malignant external otitis is an aggressive infection caused by Pseudomonas aeruginosa that most often occurs in elderly diabetics. Malignant external otitis often spreads inferiorly from the external canal to involve the subtemporal area and progresses medically towards the petrous apex leading to multiple cranial nerve palsies. The computed tomographic (CT) findings in malignant external otitis include obliteration of the normal fat planes in the subtemporal area as well as patchy destruction of the bony cortex of the mastoid. The point of exit of the various cranial nerves can be identified on CT scans, and the extent of the inflammatory mass correlates well with the clinical findings. Four cases of malignant external otitis are presented. In each case CT provided a good demonstration of involvement of the soft tissues at the base of the skull.

Herpes zoster oticus: surgery based upon prognostic indicators and results

We studied 28 patients with herpes zoster oticus prospectively over the six-year period between August 1974 and June 1980. We found that the results of measuring tear production, submandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis--either unfavorable or favorable--for spontaneous return of facial function. When the test results were 26% or more of normal, 100% of the patients had complete recovery without treatment; when the test results were 25% or less of normal, 69% had incomplete recovery: 19% had fair and 50% had poor recovery. Of the 31% with complete recovery, 4 were operated upon. The natural history of herpes zoster oticus in patients with a poor prognosis was improved if a transmastoid extralabyrinthine subtemporal decompression of the labyrinthine segment of the facial nerve was performed within 10 days of onset of the paralysis. The decision to perform this surgery was based upon the results of the prognostic tests mentioned above.

Bell's palsy: surgery based upon prognostic indicators and results

We studied 164 patients with Bell's palsy prospectively over the six-year period between August 1974 and June 1980. We found that the results of measuring tear production, submandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis--either unfavorable or favorable--for spontaneous return of facial function. When the test results were 26% or more of normal, 90% of the patients had complete recovery of function; these patients were given a favorable prognosis on the basis of the results of tests described above. The natural history of Bell's palsy in patients with an unfavorable prognosis could be improved if a transmastoid facial nerve decompression to the labyrinthine segment were performed. The results were better with this approach than with supportive or steroid therapy or transmastoid vertical-horizontal surgical decompression of the facial nerve.

Relation of particle dimension to carcinogenicity in amphibole asbestoses and other fibrous minerals

In 72 experiments, durable minerals in the form of particles on respirable size and of wide chemical and structural varieties, were implanted in the pleurae of outbred female Osborne- Mendel rats for periods of more than 1 year. The incidence of induced malignant mesenchymal neoplasms correlated well with the dimensional distribution of the particles. The probability of pleural sarcoma correlated best with a number of fibers that measured 0.25 micro or less in diameter and more than 8 micrometer in length, but relatively high correlations were also noted with fibers in other size categories having diameters up to 1.5 micrometer and lengths greater than 4 micrometer. Morphologic observations indicated that short fibers and large-diameter fibers were inactivated by phagocytosis and that negligible phagocytosis of long, thin fibers occurred. The wide variety of compounds used in these experiments suggested that the carcinogenicity of fibers depended on dimension and durability rather than on physicochemical properties.

Facial paralysis in children: differential diagnosis

The differential diagnosis in 170 patients between birth and 18 years of age is reviewed. There are a number of obvious physical findings and historical features that allow one to make a diagnosis rather quickly. Pain, vesicles, a red pinna, vertigo, and sensorineural hearing loss suggest herpes zoster oticus. Slow progression beyond three weeks, recurrent facial paralysis involving the same side, facial twitching, weakness, or no return of function after six months indicate a neoplasm. Bilateral simultaneous facial paralysis indicates a cause other than Bell's palsy, such as Guillain-Barré syndrome, pseudobulbar palsy, sarcoidosis, and leukemia. Recurrent facial paralysis associated with a fissured tongue, facial edema, and a positive family history should suggest Melkersson-Rosenthal syndrome.

Image deblurring methods using the Weigert effect

Two simple methods are described to improve the quality of images blurred by either defocusing or a uniform rectilinear motion of the photographic plate during the exposure. They both consist of simultaneously recording on a silver chloride emulsion two incoherent images of the input blurred signal, perpendicularly polarized and conveniently slightly shifted. The strength of anisotropy induced in the plate is proportional to the difference between the intensities of the images, i.e., to the derivative of the input signal. In the case of defocusing, the two images are radially shifted and one reconstructs, after exposure, the contours of the input signal. In the case where the degradation is due to a uniform rectilinear motion, the two images are laterally shifted and the reconstructed signal consists of two images of the original object.