Intentional delay of aftercoming siblings in multiple gestation is an infrequent occurrence in obstetrics. After delivery of an immature twin, conventional treatment calls for induction and delivery of the aftercoming sibling. However, several case reports have documented the feasibility of an expectant management. And also, as in our case, an aggressive treatment consisting of cerclage, tocolysis, and broad-spectrum antibiotics has been shown to prolong pregnancy. We experienced an unavoidable delivery of a nonviable first twin after premature rupture of membranes at 16 weeks' of gestation. The placenta was left undisturbed. Twin B was confirmed to be alive within the intact second sac. Tocolysis was started and cervical cerclage was done directly after delivery of twin A. Pregnancy was successfully prolonged, which enabled the second fetus to remain in utero and grow for another 145 days. To our knowledge, this was the longest interval between deliveries in a twin pregnancy reported in the literature. A healthy 3,050 gm male was delivered by cesarean section at 37 weeks' of gestation. Below we present this case in detail and discussed with respect to the aggressive approach undertaken to prolong gestation.
Anti-Bacterial Agents ; Cerclage, Cervical ; Cesarean Section ; Female ; Fetus ; Humans ; Male ; Membranes ; Obstetrics ; Placenta ; Pregnancy* ; Pregnancy, Twin ; Rupture ; Siblings ; Tocolysis ; Twins*

OBJECTIVE: To determine the life expectancy and causes of death of the children with Down syndrome(DS), longitudinal follow-up study was done for 29 cases of DS who were born at CHA hospital located in Seoul During the period from July 1991 to Dec. 1994. METHODS: 29 cases were divided into groups according to the presence of congenital heart disease (CHD) and leukemia. CHD group was subdivided into DS with complete AVSD(atrioventricular septal defect) and DS without complete AVSD. Survival curves were calculated by kaplan-Meier product limit method. Each group were compared by log rank test. The factors affecting mortality rate were analyzed by Cox's proportional hazard regressional model. RESULTS: There were no statistical differences in mortality rate between groups with CHD(35.3%) and without CHD(33.3%)(p=0.7373). Statistical difference was not observed between CHD subgroups with AVSD and with CHD other than AVSD. There were significant statistical difference in mortality rate between groups with leukemia and without leukemia(p=0.0001). CONCLUSION: The factor affecting mortality rate of DS was the presence of leukemia regardless of presence of CHD in our study cases with DS.
Cause of Death ; Child* ; Down Syndrome* ; Follow-Up Studies ; Heart Defects, Congenital ; Humans ; Kaplan-Meier Estimate ; Leukemia ; Life Expectancy ; Mortality ; Seoul ; Survival Analysis*

Between December 1994 and October 1996, 57 premature infants with evidence of a hemodynamically significant PDA associated with cardiopulmonary compromise underwent indomethcin therapy(Group I, n=48) or surgical ligation(Group II, n=9) because of indomethacin failure. The gestational age(29.6+/-3.1weeks vs. 28.1+/-1.6weeks) and birth weight(1,413+/-580gm, 1,098+/-235gm) showed no significant differences between the two groups. Medical management included fluid restriction, diuretics, and indomethacin therapy(one or two cycles). Surgical ligation was done at the neonatal intensive care unit(NICU) without moving the patient to the operation room. There was no complication associated with the operation. There were 9 deaths in Group I(19%, 9/48) and 2 deaths in Group II(22%, 2/9). The main causes of deaths were persistent bronchopulmonary dysplasia with sepsis(n=8) and intrapulmonary hemorrhage(n=3). The rate of medical treatment failure including death and complication in premature infants whose body weights were less than 1500gm was higher(41%, 15/38) than in premature infants whose body weights were more than 1500gm(16%, 3/19). Early surgical ligation of PDA may be applicable in the premature infant with a large size, low birth weight(<1500 gm), or associated intracardiac anomalies. Perfoming the operation in the NICU may be safe in stead of moving the patient to the operating room.
Body Weight ; Bronchopulmonary Dysplasia ; Cause of Death ; Diuretics ; Ductus Arteriosus, Patent ; Humans ; Indomethacin ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Ligation ; Operating Rooms ; Parturition ; Treatment Failure

PURPOSE: We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). MATERIALS AND METHODS: A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed. RESULTS: After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). CONCLUSION: This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.
Arm ; Chemoradiotherapy ; Compliance ; Disease-Free Survival ; Drug Therapy* ; Humans ; Induction Chemotherapy ; Methods ; Nasopharyngeal Neoplasms ; Propensity Score* ; Radiotherapy ; Recurrence ; Republic of Korea ; Retrospective Studies* ; Standard of Care ; Treatment Outcome