March 7, 2002
Birth Defects after Assisted Conception
Intracytoplasmic sperm injection and in vitro fertilization are being used increasingly to treat infertility. It is not known whether infants conceived with these types of technology have a higher risk of birth defects than infants conceived naturally. This study found that infants conceived with intracytoplasmic sperm injection or in vitro fertilization had a risk of a major birth defect diagnosed by one year of age that was twice as high as that in naturally conceived infants. These increased risks persisted after adjustment for potentially confounding factors and did not appear to be attributable to increased surveillance for birth defects among these infants. Intracytoplasmic sperm injection and in vitro fertilization are associated with an increased risk of major birth defects, a fact that should be discussed with patients planning to have these procedures.
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Low and Very Low Birth Weight in Infants Conceived with Assisted Reproductive Technology
The increased risk of low birth weight among infants conceived with assisted reproductive technology has been attributed in large part to the higher rate of multiple gestations associated with this technology. This study used population-based data to compare the rates of low birth weight in infants from singleton and multiple gestations conceived with this technology with the rates in the general population. Infants conceived with assisted reproductive technology accounted for 0.6 percent of all infants born in the United States to mothers 20 years of age or older in 1997, but they accounted for 3.5 percent of low-birth-weight and 4.3 percent of very-low-birth-weight infants. The use of assisted reproductive technology accounts for a disproportionate number of low-birth-weight and very-low-birth-weight infants, mostly because of increases in multiple gestations but also because of increases in the rate of low birth weight among singleton infants.
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Hepatocytes and Epithelial Cells of Donor Origin in Recipients of Peripheral-Blood Stem Cells
Male cells were sought in biopsy specimens of liver, skin, and gastrointestinal tract from six women who received a transplant of peripheral-blood stem cells from a brother. In all three types of tissue, small numbers of epithelial cells or hepatocytes containing the Y chromosome were seen. With double staining, cytokeratin (a marker of epithelial cells) and the Y chromosome appeared to be present in the same cell. These studies add to the evidence that stem cells can differentiate into multiple lineages. The results must be viewed in the light of the difficulty of ensuring that the sex-marked cells were not simply donor lymphocytes. Mindful of this caveat, the authors argue persuasively that blood contains such versatile cells.
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Levofloxacin Resistance in Pneumococcal Pneumonia
This report describes four patients with pneumococcal pneumonia in whom empirical treatment with levofloxacin failed. In these patients, the isolates of Streptococcus pneumoniae were resistant to levofloxacin, and in two of them the resistance appeared to have been acquired during the current course of treatment with fluoroquinolones. These case reports are cause for concern because fluoroquinolones such as levofloxacin are now being used in some patients for the empirical treatment of community-acquired pneumonia. Currently, fluoroquinolone-susceptibility testing of pneumococci is not routinely performed. Routine susceptibility testing may be needed, however.
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Images in Clinical Medicine: Massive Air Embolism in a Neonate with Pulmonary Hypoplasia
At birth this baby girl was found to have left pneumohydrothorax and marked pulmonary hypoplasia that was treated with mechanical ventilation. After continued deterioration, she received high-frequency oscillatory ventilation. Her intraarterial pressure wave form dampened, and surgical exploration revealed air, but no blood, in the carotid artery.
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Medical Progress: The Antiphospholipid Syndrome
The antiphospholipid syndrome is an autoimmune disorder of hypercoagulability characterized by the presence of autoantibodies to various phospholipids or phospholipid-binding proteins. The autoantibodies include anticardiolipin antibodies, lupus anticoagulant antibodies, and antibodies to
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Clinical Problem-Solving: Where Are You From?
A 52-year-old man with human immunodeficiency virus infection who had emigrated from Guyana 15 years earlier presents with fever. He has a long history of anemia and thrombocytopenia but no history of opportunistic infections.
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Sounding Board: Ooplasmic Transfer
Ooplasmic transfer is a novel approach to the treatment of infertility due to recurrent failure of oocyte implantation after in vitro fertilization. To restore oocyte viability, ooplasm from a normal donor is removed with a micropipette and injected into an oocyte from the infertile woman. The resulting oocyte, which is fertilized by intracytoplasmic sperm injection, contains mitochondrial DNA from both women. The author discusses the potential benefits and risks, as well as the ethical aspects, of this new approach to the treatment of infertility.
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2-glycoprotein I (a phospholipid-binding protein). These autoantibodies have both procoagulant and anticoagulant effects, but the procoagulant effects predominate, resulting in syndromes of venous and arterial thrombosis and pregnancy loss. 
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