Determinants for the syncytium-inducing phenotype of HIV-1 subtype F isolates are located in the V3 region.

The HIV-1 syncytium-inducing phenotype is determined by virus replication and the presence of cytopathic effects in MT-2 cells. There is a strong correlation between the syncytium-inducing/MT-2-tropic phenotype and positively charged amino acids at positions 306 and 320 in the V3 loop for HIV-1 subtypes A, B, D, and E. In contrast, a lack of correlation between signature amino acids and syncytium formation in MT-2 cells for subtype F viruses from Romania has been reported. Virus phenotype and V3 loop amino acid sequences from Romanian HIV-1 subtype F isolates were further investigated in the present study. While the determinants of MT-2 tropism are clearly harbored in the V3 loop of subtype F isolates from Romania, the induction of syncytium formation occurs in the presence or absence of positively charged amino acids at positions 306, 320, and/or 324. However, the net positive charge of V3 loop sequences derived from syncytium-inducing viruses was higher than that of the nonsyncytium-inducing isolate.

HIV-1 diversity in Romania.

OBJECTIVES: To evaluate the prevalence and the dynamics of HIV-1 subtypes in Romanian adults and children, and to investigate the origins of the nosocomial epidemic. DESIGN: A total of 1000 serum and plasma samples, from adults (n = 579) and children (n = 421) who were diagnosed as being HIV-1-infected during 1990-1997 in 39 of the 41 Romanian districts, were serotyped. Viral DNA was isolated from blood samples of 84 patients and the viruses were genotyped. METHODS: Serotyping was performed with a peptide subtype-specific enzyme immunoassay (SSEIA), based on in vitro competition for antibody binding between the representative V3 peptides of the different clades (A-F). Proviral HIV-1 DNA was genotyped by heteroduplex mobility assay or by sequence analysis of the C2-V3 env region. RESULTS: SSEIA showed that 93% of the samples from horizontally infected children were serotype F, 1% were serotype B, and the remaining 6% were uninterpretable. In vertically infected children, 74% of strains were serotype F, 10% were serotype A, 3% were serotype B, and 3% were serotype E. Serotype F was also the dominant subtype in adults (68%), but serotypes A, B, C, D and E were also detected. SSEIA gave indeterminate results in 7% of cases. A strong correlation (90%) between serotyping and genotyping for subtype F was found. Analysis of the relative incidence of the different serotypes over a 7-year period (1990-1997) showed a stable distribution. CONCLUSIONS: Subtype F largely dominates the epidemiology of HIV-1 infection in both children and adults in Romania, although other major subtypes are present. The predominance of subtype F in Romania may be a future potential source of HIV-1 variability in Europe.

Characterization of HIV type 1 from Romanian children: lack of correlation between V3 loop amino acid sequence and syncytium formation in MT-2 cells.

The biological properties and amino acid sequences of the third variable domain (V3 loop and flanking regions) of the env region of 34 HIV-1 isolates obtained from Romanian children were analyzed. Unambiguous nucleic acid sequences were obtained from 31 isolates. The derived V3 amino acid sequences were highly homologous (93-100%) and clustered with the HIV-1 subtype F Romanian consensus. Five of the 31 isolates presented a syncytium-inducing phenotype in MT-2 cells and established continuous viral replication in various CD4+ cell lines (rapid/high phenotype). The V3 sequence from one of these isolates showed a slightly lesser degree of homology with the consensus sequence. The presence of positively charged amino acids at positions 306 and 320 has been strongly associated with the ability to induce syncytia in MT-2 cells, whereas negatively or uncharged amino acids at these positions are present in non-syncytium-inducing isolates (slow/low phenotype). There was, however, no correlation between phenotype and amino acid sequence in the five syncytium-inducing isolates; negatively or uncharged amino acids were conserved at positions 306 and 320 for all 31 isolates in sequences obtained from PBMCs. A tendency toward a more positive net charge in the V3 loop of syncytium-inducing isolates was noted. These data confirm the recent observations that HIV-1 isolates from Romania not only cluster in subtype F, but also show a high degree of interpatient homogeneity in the V3 region.(ABSTRACT TRUNCATED AT 250 WORDS)

Perinatally lethal short rib-polydactyly syndromes. 1. Variability in known syndromes.

Thirteen newborns with lethal short rib-polydactyly (SRP) have been reviewed, 11 with SRP type III (Verma-Naumoff) and 2 with SRP type II (Majewski). In the former group there were three sets of siblings. The excess of males with SRP type III (Verma-Naumoff) is confirmed in this present study. A high frequency of phenotypic females including sex-reversed constitutional males with SRP type I (Saldino-Noonan) is in marked contrast to these findings in SRP type III. Possible hypotheses include variable expressivity in non-Majewski short rib-polydactyly syndromes with sex-reversed and constitutional female cases tending to show more severe phenotypic expression both in terms of major anomalies and skeletal dysplastic effects.

[Diagnosis and therapy of candidiasis in the premature infant]. / Diagnose und Therapie der Candidasepsis bei Frühgeborenen.

Extension of intensive care seems to have increased the risk of systemic candida infection. We report the incidence of systemic candida infection in 8 low-birth-weight infants (gestational age 27-32 weeks, birth weight 710-1,550 g). All infants required respiratory treatment. Various silastic catheters were inserted. Antibiotic therapy was started on the first day of life, usually a combination of ampicillin and gentamycin. Candida septicaemia was diagnosed at the age of 8-69 days of life based on blood and urine cultures, in two children at autopsy. There were no specific clinical symptoms in regard to candida infection. Sonographic technique revealed hydronephrosis in 3 infants due to candida mycelium. Antimycotic therapy included amphotericin B (dosage 0.44-1.0 mg/kg X day) and 5-fluorocytosine (80-100 mg/kg X day) as well as a monotherapy of 5-fluorocytosine (100-200 mg/kg X day). Four children were treated successfully. We like to advice a regular search for candida in urine, blood, tracheal secretion, stool and skin in low-birth-weight infants under intensive care conditions. If antimycotic therapy is started in time, therapy can be successful.

Effect of nutrition on tissue carnitine concentrations in infants of different gestational ages.

To investigate the effect of nutrition on tissue carnitine concentrations in infants of different gestational ages, specimens of muscle, heart, liver and kidney obtained at autopsy from 62 infants were analyzed for total acid-soluble carnitine content. Immature infants had smaller carnitine tissue reserves than term infants. Parenterally alimented premature infants (greater than 10 days old) had lower carnitine levels in heart, liver and kidney than those dying within 24 h after birth. Infants who received oral or intravenous carnitine had larger carnitine tissue reserves than those who did not. These data suggest that both gestational age and exogenous carnitine supply affect tissue carnitine reserves.

[Kimura' disease with localization at the neck (author's transl)]. / Kimurasche Krankheit mit Lokalisation am Hals.

This disease is discussed in the past mostly in the dermatological literature, the ENT specialist is little aware of its existence. The condition is characterized by subcutaneous, painless nodules occurring most frequently in the region of the ear, parotid gland, cheek and lateral neck. The lesion must be differentiated from disease of the lymph nodes, especially malignant tumours. The pathologic diagnosis is based upon a hyperplasia of angiolymphatic tissue and marked blood eosinophilia. The prognosis appears to be favourable. A case is presented together with the clinical picture and histopathological findings. The differential diagnosis and treatment are discussed.

[A case of olfactory neuroblastoma and Marcumar therapy (author's transl)]. / Uber ein Olfaktorius-Neuroblastom und Marcumar-Therapie.

Although nasal polypectomy is a frequently performed procedure in ENT Clinics, tissues taken may only seldom be histologically examined. We have recently uncovered an esthesioneuroblastoma during a routine polypectomy, and believe that even slightly changed "polyps" or fleshy or pinkish-gray appearing "polyps" seen with dicumarol therapy may mask tissue malignancy.

[Pure gonadal dysgenesis. Case report with unusual anatomical and endocrine findings]. / Die reine Gonadendysgenesie. Ein kasuistischer Beitrag mit ungewöhnlichen anatomischen und endokrinen Befunden.

The syndrome of pure gonadal dysgenesis (PGD) cannot always easily be distinguished from other disorders of gonadal development. Relations are evident with Turner's syndrome, females with hypoplastic ovaries, male pseudohermaphroditism, mixed gonadal dysgenesis and the vanishing testes syndrome. The case is reported of a 40 year old female with primary amenorrhea, alopecia, eunuchoid features, XY karyotype with normal breast development and sexual hair after estrogen therapy. On laparotomy streak ovaries were found at ovarian site. Pathohistological examination revealed on the left side wolffian duct remnants such as ductuli deferentes and epididymis besides sparse Leydig-(hilus-)cells and on the right side only a rudimentary fallopian tube with subendothelial accumulation of hyperplastic Leydig-(hilus-)cells. Serum-testosterone elevation above the normal female range (630 ng/dl) persisted following gonadectomy (151 ng/dl). Ectopic Leydig-(hilus-)cells were regarded responsible for the continuing testosterone production. The present case lies on borderline between PGD and mixed gonadal dysgenesis because remnants of wolffian duct derivatives suggest unilateral fetal testicular activity; classification as PGD however was justified in purely female body features and lacking evidence of testicular tissue.

[Dissecting aneurysm of the splenic artery (author's transl)]. / Aneurysma dissecans der Arteria lienalis.

A case of a dissecting aneurysm of the splenic artery is presented. Although aneurysms of the splenic artery are common, a dissecting aneurysm has been mentioned infrequently in the available literature. Clinical aspects, confirmation of the diagnosis by celiac arteriography and surgical therapy are described. The pathogenesis is discussed briefly. The necessity of clinical awareness in cases of obscure abdominal pain is emphasized.