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May 24, 2001
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Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy
Because of the rarity of the disorder, little is known about subsequent pregnancies in women who have had peripartum cardiomyopathy. In this study of 44 women who had had peripartum cardiomyopathy, later pregnancies were associated with symptomatic deterioration and reduced left ventricular function both in the 28 women who had recovered normal cardiac function before the subsequent pregnancy and especially in the 16 women with persistently decreased cardiac function before the pregnancy (3 [19 percent] of whom died).
These data were collected through a survey of many cardiologists, supplemented by interviews with the cardiologists or the women themselves. Although information for many women was probably incomplete, it seems clear that a subsequent pregnancy can have a deleterious effect on cardiac function in women who have had peripartum cardiomyopathy.
see page 1567 (editorial, page 1629)
Related Editorial
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Salmonella enterica.
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An Outbreak of Fluoroquinolone-Resistant Salmonella Infection
Eleven patients from two Oregon nursing homes were identified as infected with fluoroquinolone-resistant Salmonella enterica (through nine urine cultures, one stool culture, and one wound culture). The index patient probably acquired the resistant organism during a hospital stay in the Philippines. Transmission occurred either directly or through contact with contaminated surfaces at the nursing homes. Treatment with fluoroquinolones in the previous six months was associated with an increased risk of infection.
This is the first outbreak of fluoroquinolone-resistant salmonella infection in the United States. The outbreak was nosocomial and involved person-to-person transmission, features that are unusual for salmonella infections. More nosocomial outbreaks of fluoroquinolone-resistant salmonella infection may occur in the future.
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Keratin 8 Mutations in Patients with Cryptogenic Liver Disease
In about 10 percent of patients who undergo liver transplantation, the cause of liver disease is not known. This study examined a possible association between cryptogenic liver disease and mutations in keratins, which are cytoskeletal proteins found in epithelial cells. Mutations in the keratin 8 gene were found in 5 of 55 patients with cryptogenic liver disease, but not in control patients.
This study adds to a previous report of a mutation in the keratin 18 gene in a patient with cryptogenic liver disease. Thus, mutations in keratin genes probably account for cryptogenic liver disease in some patients. The mechanism may be related to interference with the normal response of keratin filaments to stress.
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Pedigree of Family 2.
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Permanent Neonatal Diabetes Mellitus Due to Complete Glucokinase Deficiency
Two unrelated infants who had marked hyperglycemia at birth and who required ongoing insulin therapy were found to be homozygous for different missense mutations of the glucokinase gene, which encodes the enzyme in pancreatic beta cells that phosphorylates glucose. Other members of each family had later-onset hyperglycemia and were heterozygous for the same glucokinase mutation.
In pancreatic beta cells, glucokinase is the sensor of extracellular glucose concentrations that determines insulin secretion. Heterozygosity for mutations of this enzyme cause the syndrome of maturity-onset diabetes of the young, as occurred in these families. The onset of diabetes at birth in children who were homozygous for glucokinase mutations further demonstrates the key role of this beta-cell enzyme as a determinant of insulin secretion.
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Is the Placebo Powerless?
Placebos have been reported to help patients with many diseases, but the quality of the evidence has not been rigorously evaluated. The authors of this review analyzed clinical trials in which patients were randomly assigned to either placebo or no treatment; most trials also included a group of patients assigned to active treatment. They found little evidence that placebos had powerful clinical effects. However, placebos had small but significant benefits in studies with continuous subjective outcomes and for the treatment of pain.
Placebos are sometimes considered important medical treatments, but the findings of this study suggest that, outside the setting of clinical trials, there is little or no justification for the use of placebos.
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Abnormal Pap Smear.
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Clinical Practice: Screening for Cervical Cancer
Screening for cervical neoplasia reduces the incidence of and mortality from cervical cancer. This article emphasizes the benefits of periodic screening for cervical cancer but also makes clear the controversies regarding the age at which screening should begin and end, the frequency of screening, and the role of newer techniques.
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Measuring Ankle-Brachial Index.
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Drug Therapy: Medical Treatment of Peripheral Arterial Disease and Claudication
Peripheral arterial disease is common, and its principal symptom, claudication, can be disabling. This review summarizes the epidemiologic features, clinical manifestations, and nonsurgical treatment of peripheral arterial disease, including modification of risk factors (smoking, hyperlipidemia, and hypertension), exercise, and antiplatelet drugs.
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