Multifrequency electromagnetic geophysical tools for evaluating the hydrologic conditions and performance of evapotranspiration barriers.

Surface barriers are designed to isolate subsurface contaminants for 1000 years or longer, functionally limiting water infiltration and removing the driving force for contaminant transport to groundwater. Cost-effective monitoring is challenging because of the long design life for surface barriers, spatial limitations and finite lifetime of in situ sensors, and performance metrics related to drainage. Hence, ground-penetrating radar (GPR) and electromagnetic induction (EMI) tools were evaluated for use in performance monitoring of surface barriers. GPR and EMI were used to non-invasively interrogate the Prototype Hanford Barrier (PHB), an evapotranspiration-capillary break barrier established in 1994 at the Hanford Site, in southeastern Washington State. Both geophysical methods were evaluated for providing indirect estimates of subsurface moisture content conditions that were compared to point scale measurements from borehole neutron logs. Surveys were performed during characteristically wet and dry periods to observe a range of hydrologic states of the barrier soil. Although EMI surveys were expected to show seasonal changes associated with changes in the bulk conductivity of the barrier soil layers, the effectiveness of the method was limited by the effects of metallic infrastructure embedded in the barrier. GPR estimates of volumetric water content were typically within 2-3% of the highest water contents from neutron probe measurements for both wet and dry periods, providing reasonable estimates of water content. Given that PHB monitoring data over the past 25 years has demonstrated its success in limiting deep drainage, GPR was found to be a cost-effective method for demonstrating continued barrier performance, with a greater capacity to quantify moisture content distributions over much larger areas relative to point measurements.

Immune complexes, serum proteins, cell-mediated immunity, and immune regulation in patients with squamous cell carcinoma of the head and neck.

A collaborative study of the humoral and cellular immune status of patients with carcinoma of the Head and Neck (H&N) was conducted at the West Virginia University (WVU) hospital. In addition, blind-coded serum panels were supplied on H&N cancer patients being treated at the National Cancer Institute (NCI). Serum protein analysis of the WVU study groups revealed that at the pretreatment sampling, the alpha-1 acid glycoprotein (AGP), total complement, and IgA levels were significantly elevated. The AGP levels and total complement levels declined to normal levels in the post-treatment period, whereas the IgA levels remained elevated throughout the entire observation period. Levels of serum immune complexes (SIC) were measured in both the WVU and NCI H&N cancer populations using the polyethylene glycol (PEG) precipitation method. In both survey populations all cancer groups had significantly elevated levels of SIC when compared to any of the control populations. The SIC levels never returned to comparative normal values even in cases after successful treatment. A subpopulation of the WVU-H&N cancer study group underwent a short course of intravenous hyperalimentation prior to their treatment regimen. These patients demonstrated a transient decrease in their SIC levels as well as a concomitant increase in their in vitro cell-mediated immune (CMI) correlates. The analysis of in vitro CMI correlates of the WVU study group using both polyclonal mitogens and specific antigens demonstrated a significant depression in these parameters pretreatment and post-treatment. In addition, it was observed that the time course for elevation of selected serum proteins (i.e., IgA and SIC) correlated with concomitant drops in CMI activity. Investigations were also conducted into the effects of immune complex-rich serum fractions upon selected in vitro CMI correlates. Significant blockage of a normal donor leukocyte migration-inhibition assay was demonstrated. Also, a similar inhibition of the ability of normal human lymphocytes to form high affinity rosettes was accomplished with serum from H&N cancer patients.

Pathophysiology of serous otitis media.

The likelihood that a single mechanism of immune injury is the sole cause of serous otitis media is quite small. Solid evidence is presented to suggest that type I and III immune injuries are very important, and type IV may also play a role in causing and potentiating serous otitis media in man.

The immunocompromised human host: diagnosis and treatment.

The immunocompromised human host may be subject to recurrent infection and/or malignant transformation. Signs and symptoms of depressed immunity generally reflect the degree of compromise. The laboratory diagnosis of the immune compromised host is presented. A review is given of the clinical manifestations and appropriate current therapy.

Viral and epidemiologic studies of idiopathic sudden hearing loss.

The relationship between viral seroconversions and idiopathic sudden hearing loss (ISHL) is studied. Compared with our control group, the incidence of viral seroconversions is greater among ISHL patients, both for single and multiple viral infections. There was a significantly greater number of patients with seroconversions to mumps, rubeola, varicella-zoster, cytomegalovirus, and influenza B. We were unable to find a relationship between viral seroconversion and type or degree of hearing loss, vertigo, or chance for recovery. The incidences of viral conversion and sudden hearing loss track one another closely, suggesting that viral infection is a major cause of ISHL. During this 3-year study in Boston, ISHL was most prevalent in the spring.

Complication of septorhinoplasty. Benign or malignant?

Routine septorhinoplasty on an unchanging nasal hump and deflected nasal septum resulted in subcutaneous respiratory epithelium, possibly surgically misplaced with a fibrotic host response. Progressive growth of the lesion over midface resulted in severe cosmetic deformity. Findings from repeated early biopsy specimens were benign. Removal of entire mass (44 g) failed to definitely resolve a tentative diagnosis of mucoepidermoid carcinoma, grade 1. A study will be made from a nationwide sample. Prevention, treatment, and final diagnosis are the ultimate objectives.

Epstein-Barr virus, fatal infectious mononucleosis, and Hodgkin's disease in siblings.

Epstein-Barr virus (EBV) infection in a family resulted in a fatal disseminated heterophil negative infectious mononucleosis syndrome in a nine-year-old girl. This was followed closely by a similar disease process in her six-year-old brother which evolved over a one-year period into Stage IIIB Hodgkin's disease. Finally, three years after the index EBV case in the daughter, the mother was diagnosed with a non-Burkitt's-type undifferentiated lymphoma that proved rapidly fatal. The EBV involvement in the sister and brother was well documented serologically and virologically. The pathologic diagnosis was established and confirmed by more than one pathologist. There was no obvious evidence for either a specific or general immune defect in any of the family members tested. The progression of the six-year-old boy's EBV infection from a benign, yet disseminated disease process into a histopathologically confirmed case of Hodgkin's disease offers a strong suggestion that this virus was not behaving solely as a passenger. Especially relevant is the fact that the boy never fully recovered from his EBV infection and essentially became persistently infected with the virus as evidenced by his EBV-EA serology and virology results.

Lymphomatoid granulomatosis and Epstein-Barr virus.

A case report of a patient with lymphomatoid granulomatosis presenting initially as a reactivated Epstein-Barr virus infection is presented. Epstein-Barr virus is proposed in the possible role of establishing of an immunologically compromised state that may have set the stage for dissemination of this disease process. Of interest is the fact that successful chemotherapeutic management of the disease was accomplished using prednisone and cyclophosphamide. Furthermore, this clinical success was reflected in a decreasing Epstein-Barr virus early antigen-antibody titers accompanied by increasing antivirus capsid antigen titers; hence, it appears that laboratory markers of the response of lymphomatoid granulomatosis to treatment are available in the form of soluble immune complexes, antibodies to Epstein-Barr virus-coded antigens early antigens, Epstein-Barr nuclear antigens and/or virus capsid antigens as well as the active E rosette assay for T-cells. Finally, these data, although supporting the role of Epstein-Barr virus in the pathogenesis of lymphomatoid granulomatosis, suggest the need for further study in additional patients to verify the results.

An unusual intranasal anomaly of the lacrimal drainage system.

A newborn infant presented with a mass in the medial canthal area. Radiologic evaluation demonstrated this to be an abnormality in the nasolacrimal system. Examination of the nose showed a large cystic structure totally occluding the right naris. Surgical excision of the entire cyst was required to alleviate the patient's recurrent mucoceles of the lacrimal sac and epiphora. The need for nasal examination and more thorough evaluation in cases of recurrent obstruction is emphasized in evaluating patients with congenital obstruction of the nasolacrimal drainage system.

Association of Epstein-Barr virus with acute exudative tonsillitis.

This report is concerned with acute exudative tonsillitis as a pathologic response to the Epstein-Barr virus (EBV). The concept of a bacterial-viral etiology etiology for tonsillitis has been suggested, and previous studies implicate EBV as a major pathogen in exudative tonsillitis. A prospective study of 16 patients with this diagnosis was conducted. EBV serologic data plus viral and bacterial throat cultures were compiled and evaluated. EBV as a casual agent alone or concurrent with other organisms was seen in 56% (9) of the patients under study. EBV activation was associated with infection by other organisms in 19% (3) of the cases. The overall total incidence of EBV in association with severe acute exudative tonsillitis was 75% (12). The data further documents EBV as a significant causal or associative agent in acute exudative tonsillitis.

Early antigen titers in pediatric patients with acute cervical lymphadenitis.

Eight pediatric patients with acute cervical lymphadenitis or neck mass, alone or in association with nonspecific upper respiratory complaints, were screened for the presence of a primary or reactivation Epstein-Barr virus infection. All were found to have elevated antibodies to the early antigen (EA) and 75% (6) of these were found to be reactivations. Only one had a positive heterophile. Half of the patients had elevation of the EA-specific IgA, and 75% (6) had elevation of viral capsid antigen-specific IgA. All had elevated levels of soluble immune complexes. There was not a direct relationship between the EA titer or soluble immune complex level and severity of disease.

Computerized tomographic scan findings in facial fractures associated with blindness.

A retrospective study of 379 consecutive patients who underwent operative repair of facial fractures at the West Virginia University Medical Center was carried out. Blindness developed in at least one eye in 21 (6%) of the 379 patients studied. Le Fort II and Le Fort III fractures, frontal bone and frontal sinus fractures, severe fractures of the zygoma, and fractures of the orbital floor were associated with fractures of the lesser sphenoid wing and optic canal in 5 of the patients studied. These 5 patients had indirect optic nerve injuries, as determined by CT scan and clinical criteria, which included visual loss with afferent pupillary defect and an otherwise normal ophthalmologic examination. In addition, one other patient who was not one of the 379 patients who underwent operative repair gradually developed ipsilateral blindness as a result of indirect optic nerve injury following minimal frontal bone trauma without a fracture. The usual mechanism of injury was trauma at the level of the orbital roof. The principal findings on CT scan were those of fracture of the lesser sphenoid wing and subdural hematoma of the optic nerve sheath. The association between sphenoethmoid sinus hemorrhage and fracture of the optic canal (31%) in cases of facial trauma has been presented. The indications for optic nerve decompression have been discussed. To the authors' knowledge, there is no previous report of an optic canal fracture as diagnosed by computerized tomography in the literature.

Nasal glioma.

An 11-month-old girl had a congenital extracranial frontonasal glioma. The tumor was attached to the left membranous septum and excised by a simple ellipse and stalk dissection. The tumor is considered to arise from ectopic neuroectodermal tissue projected through the foramen cecum into the developing nasofrontal cranium and sequestered there on closure of the cranial sutures. Light microscopy demonstrated tumor tissue composed of fibrocollagenous septae separating interspersed glial cell islets and scattered hypoplastic skeletal muscle cells. Electron microscopy disclosed slender but differentiated muscle cells. No neuronal components could be identified. The heterotopic neuroglial nodules seemingly grew and differentiated by intermingling with either growing mesodermal cells or striated muscle cells or by transformation of some neuroglial elements into striated muscle cells. This extranasal glioma would best be classified as a benign congenital extranasal neuroectodermal tumor.

Biologic and molecular characterization of the IgG serum blocking factor (SBF-IgG) isolated from sera of patients with EBV-induced infectious mononucleosis.

Our laboratory has previously reported the isolation of a serum blocking factor (SBF) from infectious mononucleosis (IM) patients. The SBF has been purified by a combination of Sephadex QAE-50 ion exchange and Sephadex G-200 molecular sieve chromatography. This material was found to be devoid of soluble immune complexes, and immunochemically and biochemically was characterized as IgG and, hence, termed SBF-IgG. The SBF-IgG was shown to significantly (alpha = 0.05) suppress antigen specific (Influenza A-1[H1N1]) in vitro lymphocyte stimulation (LS) as well as leukocyte migration-inhibition (LMI) reactivity. Also, the SBF-IgG significantly suppressed the in vitro.LS response to phytohemagglutinin. In addition, the SBF-IgG when bound to normal donor lymphocytes significantly reduced the high affinity E-rosette (HAR) reactivity at 29 degrees C. A purified T lymphocyte subpopulation of normal donor lymphocytes specifically bound SBF-IgG, and the latter could be r covered using glycine-HCI. It appears that SBF-IgG is a nonspecific antibody; it binds neither lymphokines nor specific antigen, but apparently elicits its in vitro vitro cell-mediated suppressive effect at the level of the T lymphocytes.

Epstein-Barr virus infection and neoplasia.

Once acquired, Epstein-Barr virus (EBV), a latent virus, remains in the body for what appears to be the lifetime of the human host. Circumstantial data suggest EBV is involved in clinical disease including malignancies far more often than previously recognized. A serologic test for early antigen (EA) is more specific for diagnosing active EBV disease than the monospot or heterophile test. A case study of active Epstein-Barr infection is reported showing persistently elevated early antigen titers prior to and following malignant transformation.

The implication of viruses in idiopathic sudden hearing loss: primary infection or reactivation of latent viruses?

Seventy-seven paired serum samples from patients with known idiopathic sudden hearing loss (ISHL) were surveyed using viral serologic methods. Fifteen different viruses and Mycoplasma pneumonia were the agents tested. We determined an incidence of 65% (49/77) of documented significant seroconversions to one or more of the agents surveyed. Multiple agents were involved in 24 of the 49 positive cases we studied. Influenza virus Group B in 14 (18%) and rubeola in 12 (16%) were the most prevalent, followed by Herpes simplex type 1 in 6 (8%), mumps in 6 (8%), influenza Group A3 in 6 (8%), rubella in 5 (7%), and cytomegalovirus (CMV) in 5 (7%).