This Week in The New England Journal of Medicine

March 22, 2001

Paternal and Maternal Components of the Predisposition to Preeclampsia

A multigenerational data base in Utah was used to assess whether preeclampsia during a pregnancy was more likely if either the father or the mother had been born of a pregnancy complicated by preeclampsia. The 298 men born of pregnancies complicated by preeclampsia were twice as likely to have a child who was the product of a pregnancy complicated by preeclampsia as 596 men born of normal pregnancies. Similarly, the 237 women born of pregnancies complicated by preeclampsia were three times as likely to have preeclampsia during their pregnancies as 474 women born of normal pregnancies.

There may be more complete birth and related records in Utah than nearly anywhere else. The finding that there are both paternal and maternal contributions to the development of preeclampsia is most likely valid and may direct more studies of the contribution of male factors to the occurrence of this disorder.

Related Editorial

Biventricular Pacing in Patients with Heart Failure

About one third of patients with chronic heart failure have intraventricular conduction delay. The conduction delay can diminish ventricular performance by causing asynchronous cardiac contraction. In this study, restoration of coordinated contraction with the use of multisite biventricular pacing resulted in improved exercise tolerance, oxygen consumption, and quality of life in patients with chronic heart failure.

Chronic heart failure is debilitating and difficult to treat. In patients with intraventricular conduction delay, biventricular pacing, which results in more synchronized ventricular contraction, is a promising new approach. However, biventricular pacing is limited by technical difficulties, and longer-term follow-up will be essential.

Stem-Cell Transplantation with Nonmyeloablative Conditioning for Chronic Granulomatous Disease

Chronic granulomatous disease is due to an inherited mutation that disables the oxidase enzyme of phagocytes, thereby increasing susceptibility to infection. Ten patients with this disease received a hematopoietic stem-cell transplant from an HLA-identical sibling after preparation with an immunosuppressive regimen that did not ablate the recipient's bone marrow. After a median follow-up of 17 months, seven of the patients are alive and have sufficient donor neutrophils to protect against infection.

This study exemplifies a new approach to the transplantation of hematopoietic grafts. It is applicable not only to chronic granulomatous disease but also to other disorders caused by mutations that lead to a deficiency of vital proteins; however, it is not without risk.

Related Editorial

Vaccination of Japanese Schoolchildren against Influenza

In Japan, the strategy for controlling influenza was to vaccinate schoolchildren so as to prevent the spread of the virus to the elderly and others at high risk. This analysis of five decades of data shows that in Japan there was a substantial reduction in excess deaths during the winter months from 1962 to 1987, when most schoolchildren received the vaccine. Since this vaccination program was relaxed, there have been increases in the winter rates of excess deaths from all causes and from pneumonia or influenza.

This report describes a unique experiment, since Japan is the only developed country in which the program of influenza vaccination involved schoolchildren rather than the elderly. The trends observed suggest that during the years when vaccination was mandatory, it led to effective herd immunity against influenza in Japan. Roughly 1 death was prevented for every 420 children vaccinated.

Current Concepts: Spontaneous Dissection
of the Carotid and Vertebral Arteries

Spontaneous extracranial dissections of the carotid and vertebral arteries usually arise from tears in the intima. These dissections have a characteristic presentation and are an important cause of ischemic stroke in young and middle-aged people.

Mechanisms of Disease: Cytokine Pathways
and Joint Inflammation in Rheumatoid Arthritis

Rheumatoid arthritis is a common disorder that causes considerable chronic morbidity. This article reviews the roles of cytokines in the pathogenesis of rheumatoid arthritis -- information that has led to the development of several recently approved anticytokine therapies.