Tear Film and Drainage after Selective Punctal Occlusion Using Polydioxanone Plugs in Dry Eye Patients

Purpose@#To assess changes in the tear film and delayed tear drainage after upper or lower, or combined upper and lower, punctal occlusion using dissolvable polydioxanone plugs in patients with dry eye. @*Methods@#In total, 40 dry eye patients (80 eyes) were enrolled: four groups of 10 (20 eyes) with no, lower, upper, and lower and upper punctal occlusions. Dissolvable polydioxanone plugs were placed. The tear break-up time (tBUT) and the tear meniscus height (TMH) were measured, and the Schirmer I test and dye disappearance test (DDT) were performed at baseline and 2 weeks after the procedure. @*Results@#Compared to the control group, all three test groups exhibited significant changes in the tBUT, the DDT test, and the TMH after polydioxanone plug placement (all p < 0.05). The group with both upper and lower punctal occlusions exhibited more delayed tear drainage than the other test groups. A lower punctal occlusion significantly delayed tear drainage to a greater extent than did an upper punctal occlusion (p = 0.010). @*Conclusions@#In dry eye patients, a polydioxanone plug improved the tBUT and TMH, and the DDT score. The tear drainage delay increased in the order: both, lower, and upper punctal occlusion(s).

Depression, Anxiety, Somatization Disorder, and Adjustment Disorder in Older Patients with Exudative Age-related Macular Degeneration

Purpose@#The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease. @*Methods@#The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index. @*Results@#A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant. @*Conclusions@#Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.

Depression, Anxiety, Somatization Disorder, and Adjustment Disorder in Older Patients with Exudative Age-related Macular Degeneration

Purpose@#The aim of this study was to analyze the prevalence of depression, anxiety, somatization disorder, and adjustment disorder in older patients diagnosed with exudative age-related macular degeneration (AMD) and to evaluate the relationship between exudative AMD and psychological disease. @*Methods@#The 2016 Health Insurance Review and Assessment Service-Aged Patient Sample was applied in this study. The subjects were divided into two groups: AMD patients undergoing intravitreal injection treatment and a control group. Comorbidities were evaluated using the Charlson Comorbidity Index. @*Results@#A total of 1,319,052 subjects were selected, of which 3,134 were in the exudative AMD group receiving intravitreal injections. The average age of the subjects was 74.7 ± 6.7 years, and 41.8% were male. In patients with exudative AMD, the prevalence of depression, anxiety, somatization disorder, and adjustment disorder were 16%, 20%, 0.5%, and 0.4%, respectively; in particular, the prevalence of depression and adjustment disorder were significantly higher than in the control group. In multivariate regression analysis, exudative AMD was a significant factor of depression (odds ratio [OR] 1.2, 95% confidence interval [CI] 1.08-1.31, p < 0.001) and adjustment disorder (OR 2.47, 95% CI 1.47-4.18, p < 0.001). However, the association between AMD and anxiety or somatization disorder was not statistically significant. @*Conclusions@#Exudative AMD showed a significant association with psychiatric disease, such as depression, and requires close clinical attention.

Pseudopapilledema Combined with Idiopathic Papilledema in a Child Receiving Growth Hormone Treatment

Purpose@#We report a case of pseudopapilledema combined with idiopathic papilledema in a pediatric patient receiving growth hormone treatment.Case summary: An 11-year-old girl without any underlying disease presented with bilateral transient visual obscurations, a dark-adaptation disorder, and helplessness that developed while she had been on growth hormone therapy for 3 months at a local clinic. Reduced visual acuity (from 20/20 to 20/25) was observed on physical examination and bilateral optic disc edema on fundus examination, growth hormone was immediately discontinued. Four weeks later, fundus examination revealed papilledema of both eyes with mild red-green dyschromatopsia. Recombinant growth hormone-associated idiopathic papilledema combined with pseudopapilledema was suspected. Although growth hormone, had been discontinued, we scheduled further observation of the papilledema. @*Conclusions@#Papilledema was observed on fundus examination during growth hormone treatment and four weeks after discontinuation thereof. The symptoms improved, but mild papilledema combined with pseudopapilledema remained.

Pseudopapilledema Combined with Idiopathic Papilledema in a Child Receiving Growth Hormone Treatment

Purpose@#We report a case of pseudopapilledema combined with idiopathic papilledema in a pediatric patient receiving growth hormone treatment.Case summary: An 11-year-old girl without any underlying disease presented with bilateral transient visual obscurations, a dark-adaptation disorder, and helplessness that developed while she had been on growth hormone therapy for 3 months at a local clinic. Reduced visual acuity (from 20/20 to 20/25) was observed on physical examination and bilateral optic disc edema on fundus examination, growth hormone was immediately discontinued. Four weeks later, fundus examination revealed papilledema of both eyes with mild red-green dyschromatopsia. Recombinant growth hormone-associated idiopathic papilledema combined with pseudopapilledema was suspected. Although growth hormone, had been discontinued, we scheduled further observation of the papilledema. @*Conclusions@#Papilledema was observed on fundus examination during growth hormone treatment and four weeks after discontinuation thereof. The symptoms improved, but mild papilledema combined with pseudopapilledema remained.

Prenatal Exposure to Drugs and Allergic Diseases in Offspring

Recent studies reported increased risks for the development of allergic diseases in children after prenatal exposure to drugs. The mechanisms by which drug exposure may actually cause allergic diseases are not known. It has been suggested that these drugs promote transplacental allergen transfer to the fetus, resulting in the preservation of allergens. If transferred to the fetus, these allergens could induce a Th2-dominant immune response and allergic sensitization of the fetus. The development of the fetal immune system is influenced by the allergic state of the mother. Maternal IgE can cross fetal membranes, and a Th2-dominant phenotype in the mother can promote an allergy-prone phenotype in the fetus. The fetal immune system starts early in development but mainly matures in later trimesters. Maternal use of antibiotics during pregnancy may prove to be a risk factor for persistent wheezing and allergy development in early infancy. Paracetamol exposure during pregnancy was associated with allergic rhinitis, its use until 6 months of age was associated with allergic sensitization and a history of asthma in girls. Exposure to proton pump inhibitors (PPIs) and Histamine 2-antagonists (H2As) has been associated with an increased risk for the development of atopic dermatitis, asthma, allergic rhinitis, and especially with the development of multiple allergic diseases. Our reviews showed it is necessary to prescribe such drugs under the consultation of an expert physician and to try and reduce exposure as much as possible to prevent offspring allergies in the case of mothers with a history of allergic diseases.

Appropriate Body Temperature Measurement Method for Parents of Infants

PURPOSE: The purpose of this study is to find a method for parents to easily and accurately measure their infant's body temperature following instructions and to recommend such method as the standard for parents at home. METHODS: Parents of 120 pediatric patients who were brought to the emergency room or well-baby clinic of a general hospital in Seoul were informed of correct ways to measure children's body temperature using digital and infrared thermometers. They were then asked to measure their children's body temperature. We observed and assessed the accuracy of the technique for each measuring method. Difficulty of each method was evaluated by the feedback from parents after the measurement. The correlation was analyzed between axillary, tympanic, or forehead temperature and rectal temperature, and the differences of accuracy and difficulty were compared between the measurement methods. RESULTS: Better accuracy was observed when parents measured the tympanic (87.5%) or axillary temperature (83.3%), rather than the forehead (76.7%) or rectal temperature (47.5%) (p<0.05). More parents indicated ease of use when they measured the forehead (89.2%) or tympanic (80.0%) temperature, rather than the axillary (60.0%) or rectal temperature (5.8%) (p<0.05). The axillary, tympanic, and forehead temperatures correlated well with the rectal temperature when measured accurately by parents (r=0.974, 0.976, 0.942, respectively). CONCLUSION: As parents measured the tympanic temperature using an infrared thermometer with the most accuracy and ease, using this method is recommended as the standard method to measure infant's body temperature at home.

Preliminary study on the immunogenicity of a newly developed GCC Tdap vaccine and its protection efficacy against Bordetella pertussis in a murine intranasal challenge model

PURPOSE: Active reduced dose tetanus-diphtheria-acellular pertussis (Tdap) vaccination for adolescents and adults is necessary because waning immunity after primary diphtheria-tetanus-pertussis vaccination is related to the recent emergence of pertussis. This study was conducted to compare the immunogenicity and protection efficacy against Bordetella pertussis between a new GCC Tdap vaccine and a commercially available Tdap vaccine in a murine model. MATERIALS AND METHODS: BALB/c mice were immunized with two doses of diphtheria-tetanus-acellular pertussis (DTaP) vaccine for priming and a subsequent Tdap booster vaccination. According to the type of booster vaccine, mice were divided into four groups: commercially available Tdap vaccine in group 1 and GCC Tdap vaccines of different combinations of pertussis antigens in groups 2 to 4. Humoral and cell-mediated immune responses and protection efficacy using a murine intranasal challenge model after booster vaccination were compared among the four groups. RESULTS: Every group showed significant increases in antibody titers against pertussis antigens such as pertussis toxin, filamentous hemagglutinin, and pertactin after booster vaccination. Spleen cells showed both Th1 and Th2 cell-mediated immune responses stimulated by pertussis antigens in all groups without any significant difference. In the intranasal B. pertussis infection model, bacteria were eradicated in all groups five days after challenge infection. CONCLUSION: This preliminary study did not show significantly different immunogenicity or protection efficacy of the new GCC Tdap vaccines compared to the commercially available Tdap vaccine, although a more extensive study is necessary to assess the differing efficacies of the new GCC Tdap vaccines.

Amyotrophic Lateral Sclerosis - Cell Based Therapy and Novel Therapeutic Development

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by the predominant loss of motor neurons (MNs) in primary motor cortex, the brainstem, and the spinal cord, causing premature death in most cases. Minimal delay of pathological development by available medicine has prompted the search for novel therapeutic treatments to cure ALS. Cell-based therapy has been proposed as an ultimate source for regeneration of MNs. Recent completion of non-autologous fetal spinal stem cell transplant to ALS patients brought renewed hope for further human trials to cure the disease. Autologous somatic stem cell-based human trials are now in track to reveal the outcome of the ongoing trials. Furthermore, induced pluripotent stem cell (iPSC)-based ALS disease drug screen and autologous cell transplant options will broaden therapeutic options. In this review paper, we discuss recent accomplishments in cell transplant treatment for ALS and future options with iPSC technology.

Intakes of Iron and Folate and Hematologic Indices According to the Type of Supplements in Pregnant Women

Adequate amounts of nutrients during pregnancy are essential for maternal, fetal and child health. This study was conducted to investigate the intakes of iron and folate and the effect of supplements on anemia status during pregnancy. One hundred sixty five pregnant women completed questionnaires which included food frequencies and supplement use, and blood tests for hematologic indices. Pregnant women were divided into four groups based on the type of supplements; single nutrient group (S), multivitamins & minerals group (M), Single nutrient + multivitamins & minerals group (S+M), and no supplement group (N). Mean iron intake was 11.1 mg from food (46.3% of Recommended Nutrient Intakes, RNIs) and 66.8 mg from supplements. Mean folate intake was 231.2 microg from food (38.5% of RNI) and 822.7 microg from supplements. In the N group, the subjects who consumed iron and folate less than EAR were 85.7% and 95.2%, respectively. The subjects consumed iron more than UL were 81.0% in the S group, 88.9% in the M group, and 97.4% in the S+M group, and the subjects consumed folate more than UL were 4.8% in the S group, 1.6% in the M group, and 25.6% in the S+M group. The mean values of hemoglobin and hemotocrit in the M group were significantly higher than those in the N group. Despite the relatively high socio-economic status of the participants, overall intakes of iron and folate from food were far below the RNIs, suggesting that a supplement is needed for adequate nutritional status during pregnancy. A multivitamin supplement seems to be more effective than a single nutrient supplement such as iron or folic acid in the prevention of anemia. Further research is required to define the appropriate amount of supplemental iron and folic acid for Korean pregnant women.

Clinical characteristics and courses of congenital muscular torticollis / 소아과

PURPOSE: Congenital muscular torticollis (CMT), a common musculoskeletal disorder in infants, is characterized by the rotation and flexion deformity of the neck caused by sternocleidomastoid muscle shortening. We investigated the clinical courses and perinatal risk factors of CMT. METHODS: Less than 6-month-old patients (98; M:F = 60:38) diagnosed with CMT between February 2007 and August 2008 were classified into 2 clinical subgroups, namely, SMT (sternocleidomastoid tumor) and POST (postural torticollis). All the patients were physically and neurologically examined prospectively and their cervical X-rays and ultrasonographies were obtained. Their medical histories about perinatal problems were recorded. Of the 98 patients, 45 with normal range of motion were taught passive physical exercises and 43 were referred to the Department of Rehabilitation for undergoing manual stretching therapy. RESULTS: The mean age at initial assessment was 2.2 months (SMT: 1.4+/-1.0, POST: 2.7+/-1.6). SMT presented earlier than POST. All ophthalmologic examinations and cervical X-rays were normal. SMT was associated with higher incidence of caput succedaneum and cephalhematoma. POST was highly associated with plagiocephaly. Mean duration of rehabilitative physical therapy was 3.7 months (SMT: 4.6+/-2.5, POST: 2.6+/-1.9). POST resolved earlier than SMT. Of the 88 patients with follow-up, 87 had total resolution and only 1 had residual torticollis. CONCLUSION: All the patients received early treatment with passive stretching exercises. CMT was associated with perinatal problems and had various risk factors such as obstetrical problems.

Clinical characteristics and courses of congenital muscular torticollis / 소아과

PURPOSE: Congenital muscular torticollis (CMT), a common musculoskeletal disorder in infants, is characterized by the rotation and flexion deformity of the neck caused by sternocleidomastoid muscle shortening. We investigated the clinical courses and perinatal risk factors of CMT. METHODS: Less than 6-month-old patients (98; M:F = 60:38) diagnosed with CMT between February 2007 and August 2008 were classified into 2 clinical subgroups, namely, SMT (sternocleidomastoid tumor) and POST (postural torticollis). All the patients were physically and neurologically examined prospectively and their cervical X-rays and ultrasonographies were obtained. Their medical histories about perinatal problems were recorded. Of the 98 patients, 45 with normal range of motion were taught passive physical exercises and 43 were referred to the Department of Rehabilitation for undergoing manual stretching therapy. RESULTS: The mean age at initial assessment was 2.2 months (SMT: 1.4+/-1.0, POST: 2.7+/-1.6). SMT presented earlier than POST. All ophthalmologic examinations and cervical X-rays were normal. SMT was associated with higher incidence of caput succedaneum and cephalhematoma. POST was highly associated with plagiocephaly. Mean duration of rehabilitative physical therapy was 3.7 months (SMT: 4.6+/-2.5, POST: 2.6+/-1.9). POST resolved earlier than SMT. Of the 88 patients with follow-up, 87 had total resolution and only 1 had residual torticollis. CONCLUSION: All the patients received early treatment with passive stretching exercises. CMT was associated with perinatal problems and had various risk factors such as obstetrical problems.

Risk Factors Influencing Growth in Children with Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: The objective of this study was to identify risk factors for growth delay of infants with atopic dermatitis (AD) and to evaluate the nutritional adequacy of therapeutic elimination diets. METHODS: We studied 67 infants with AD aged from 6 to 23 months, who were managed with conservative treatments for more than 3 months in Samsung Medical Center, and compared with 56 normal age-matched infants. Height and weight for age and weight for height were converted to Z score to evaluate their growth. Basic characteristics including birth characteristics, heights and weights of parents, and socioeconomic status of parents were surveyed by the questionnaire. The 24-hour recall method, assessment of all foods eaten on the day prior to the interview, was performed to evaluate dietary intake. A P value <0.05 was considered to be significant. RESULTS: The mean Z scores of height and weight (-0.10+/-1.10 and -0.41+/-0.91, respectively) in male patients were decreased more than those in healthy age-sex-matched controls, (0.44+/-0.77 and 0.07+/-0.77, respectively) (P=0.032 and 0.039 for each) while female infants did not show any difference. Severity of AD, socioeconomic status of parents, duration of breast feeding, and birth characteristics were not different between patient and control groups. Zinc levels of both groups, especially patients, was lower than recommended dietary allowances (RDA). CONCLUSIONS: Infants with AD were shorter than control group, while they did not show nutritional problems. Our study suggests that longitudinal growth assessment should be performed on infants with AD and it may be helpful in counseling about the prognosis of growth.

Facial nerve palsy after sagittal split ramus osteotomy in severemandibular prognathism: a case report

Risk Factors of Moderate to Severe Atopic Drmatitis in the First 6 Months of Life / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to analyze the risk factors of moderate to severe atopic dermatitis (AD) in the first 6 months of life. METHODS: Children aged less than 6 months with AD were divided into two groups according to Six Area, Six Sign Atopic Dermatitis (SASSAD) Score. Children with scores of less than 14 were classified as Mild AD (n=90) and above 15 as Moderate to Severe (Mod-severe) AD (n=44). These patients were fed with breast milk or cow's milk formula, and no allergenic food was given except rice and some vegetables. We analyzed the gender, feeding patterns, family history of allergy, number of siblings, total IgE and specific IgE to common food allergens (egg white, cow's milk, soy, wheat) by CAP assay (Pharmacia, Uppsala, Sweden). RESULTS: Total IgE was 180.6+/-44.7 U/mL in mod-severe AD and 32.2+/-6.1 U/mL in mild AD (P=0.002). Specific IgE to egg white, soy and wheat (19.03+/-4.48 U/mL; 7.07+/-0.40 U/mL, 4.68+/-1.89 U/mL in mod-severe AD; 1.78+/-0.43 U/mL, 0.09+/-0.03 U/mL, 0.15+/-0.11 U/mL in mild AD; P< 0.05) were associated with mod-severe AD, but cow's milk (4.34+/-2.50 U/mL in mod-severe AD; 0.80+/-0.44 U/mL in mild AD) showed no statistical difference. Gender, feeding patterns, family history and number of siblings were not significantly associated with mod-severe AD. The total IgE level and egg white specific IgE level significantly increased as the duration of breast feeding increased (P< 0.05). CONCLUSION: Mod-severe atopic dermatitis in the first 6 months of life is associated with sensitization to food allergens, which might be transferred via breast milk.

Etiology and Clinical Features of Viral Lower-respiratory Tract Infections in Children in Winter, 2003 / 소아과

PURPOSE: This study was performed to characterize the etiology and clinical features of acute viral lower-respiratory tract infections (LRI). METHODS: Etiologic agents and clinical features of acute viral LRI were studied from October. 2003 through March. 2004 in hospitalized children with LRI (253 cases) at Samsung Cheil Hospital. The viruses were identified by indirect immunofluorescent method. Medical records of patients with proven viral LRI were reviewed retrospectively. RESULTS: Ninety two cases (36.4%) were confirmed as viral infections. The identified pathogens were respiratory syncytial virus (RSV, 76.0%), adenovirus (ADV, 12.0%), influenza virus type A (INFA, 9.8 %), influenza virus type B (INFB, 1.1%) and parainfluenza virus (PIV, 1.1%). Eight four point eight% of patients were younger than 2 years of age. Clinical diagnosis of LRI were pneumonia (56.5%), bronchiolitis (35.9%), tracheobronchitis (4.3%) and croup (3.3%). The clinical symptoms and signs were cough (98.8%), rhinorrhea (82.6%), fever (70.7%), rale (67.4%), wheezing (29.3%), chest retraction (28.3%) and cyanosis (4.3%). The severe respiratory symptoms and signs were more common in RSV-infected patients, even cyanosis could be observed. Seventeen point four percent of patient had fever of 38.5degrees C or higher and their most common etiologic agent was INFA (66.7%). Twenty three point nine percent had fever more than 5 days and common etiologic agent was INFA (77.8%). The elevated WBC count (> 14x10 (3)/microliter) was in 14.1%, and common etiologic agents were INFA (22.2%) and ADV (18.2%). C-reactive protein (CRP > 4.0 mg/dL) was increased in 13.0%, and common in ADV (63.6 %). Increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) was detected in 10.9%, and the most common etiologic agent was RSV (12.9%). CONCLUSION: The common agents of acute viral LRI were RSV, ADV and INF, respectively. Because the etiologic agents present variable clinical features, it may be helpful to treat and to evaluate acute viral LRI that we should understand their etiologic variability.

Antibiotic Sensitivity to the Major Causative Organisms of Acute Urinary Tract Infection in Children / 소아과

PURPOSE: We studied the changes in antibiotic sensitivity to the causative organisms of urinary tract infection (UTI), in order to provide useful information on the choice of adequate drugs in the treatment of UTI. METHODS: We retrospectively analyzed the major causative organisms and their antibiotic sensitivities in 69 patients diagnosed with UTI in the Department of Pediatrics, Samsung Cheil Hospital from 2002 to 2003. RESULTS: The frequency of UTI was the highest in infants younger than 1 year of age (88.4 percent). The male to female ratio was 3.05: 1. Escherichia coli was the most frequent organism (78.3 percent), followed by Klebsiella (116 percent), Pseudomonas (2.9 percent), Proteus (2.9 percent), Enterobacter, Morganelle, and Enterococcus (1.4 percent) in descending order. Antibiotic sensitivity of gram negative organisms was above 90 percent against imipenem, amikacin, 80 percent against aztreonam, cefepime, ceftriaxone, 50-70 percent against gentamicin, trimethoprime-sulfamethoxazole (TMP/SMX), and 23 percent against ampicillin (23.4 percent). CONCLUSION: Antibiotict sensitivity of gram negative organisms was high to amikacin and third generation cephalosporins but low to ampicillin, gentamicin and TMP/SMX. The use of ampicillin or TMP/SMX, as the first choice of the empiric and prophylactic treatment for UTI, should be reconsidered and investigated further.

Usefulness of the Transcutaneous Bilirubinometer in Neonatal Jaundice / 소아과

PURPOSE: To test the usefulness of a new jaundice meter, the JM-103(Minolta/Hill-Rom Air-shields, Japan) which uses a new probe to compensate for different skin pigmentation or thickness, and displayed actual bilirubin level instead of an index number as in the previous model, the JM-102, we compared transcutaneous bilirubin(TCB) with plasma bilirubin(PB) in newborn infants. METHODS: TCB was measured on 114 newborn infants aged 3 to 6 days with jaundice meter JM- 103, using one to five flashes. TCB was measured on the forehead(glabella; TCB-F) and on the chest(sternum; TCB-C) of the same infant at the same time. PB was measured by American Optical bilirubinometer within 30 minutes after TCB measurement. TCB was compared with PB, and the difference of TCB according to the using preset numbers of flashing times was studied. RESULTS: There was significant correlation between PB and TCB, regardless of the measuring site and the numbers of flashing during measurement. CONCLUSION: The New transcutaneous bilirubinometer, the JM-103 would be a useful screening device in neonatal jaundice.

Outcome of Surviving Twins with Antenatal Death of the Co-Twin: Comparison with Normal Twins

PURPOSE: In twin pregnancies with single fetal death after 20th weeks, the surviving co-twin has an ischemic change of multiple organ, neurological abnormality, high perinatal morbidity and mortality. The purpose of this study was to evaluate the clinical status and the outcome of live co-twins and to compare them with the normal viable twins. METHODS: A retrospective analysis by evaluating medical records was done for those twin pregnancies with single fetal demise after 20 weeks (n=20) during January 2000 to June 2003 at Samsung Cheil Hospital. Normal viable twins (n=847) born during the same study period were used as a control group. RESULTS: 867 of 31, 219 live deliveries were documented as twin births. 20 twin pregnancies were complicated by the death of one fetus after 20th weeks. In these 20 twin pregnancies, two surviving co-twins died after birth. There was an increased incidence of monochorionic placenta, prematurity, VLBW (very low birth weight), admission rate in neonate and mortality among the surviving co-twins as compared to the normal viable twins (P<0.001). However, there was no significant difference between surviving co- twins with dichorionic placenta and normal viable twins. CONCLUSION: The perinatal morbidity and mortality of surviving twins were higher than the normal twins in the monochorionic twins whose co-twin's death occurred after 20th weeks suggests that chorionicity of placenta might be an important factor to predict the outcome of surviving co-twin's.

Case report of olfactory neuroblastoma