Predictors of Post-chemoradiotherapy Pulmonary Complication in Locally Advanced Non–Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#We investigated the clinical effects and predictive factors of severe post-chemoradiotherapy pulmonary complications (PCPC) in locally advanced non–small cell lung cancer (LA-NSCLC). @*Materials and Methods@#Medical records of 317 patients who underwent definitive concurrent chemoradiation (CCRT) for LA-NSCLC were reviewed retrospectively. PCPC was defined as an event of admission or emergency department visit for acute or subacute pulmonary inflammatory complications, including pneumonitis and pneumonia, within 6 months after CCRT initiation. Patient characteristics, baseline lung function tests, radiation dosimetric parameters, and laboratory tests were analyzed to investigate their association with PCPC. Prognostic endpoints were disease progression rate (DPR) and overall survival (OS). @*Results@#PCPC was reported in 53 patients (16.7%). The OS of patients with PCPC was significantly worse (35.0% in 2 years) than that of patients without PCPC (67.0% in 2 years, p < 0.001). However, 2-year DPRs were 77.0% and 70.7% in patients with and without PCPC, respectively, which were not significantly different (p=0.087). In multivariate logistic regression, PCPC was independently associated with grade ≥ 1 hypoalbuminemia during CCRT (odds ratio [OR], 5.670; 95% confidence interval [CI], 2.487 to 13.40; p < 0.001), lower diffusing capacity of carbon monoxide (DLCO) (per mL/min/mmHg; OR, 0.855; 95% CI, 0.743 to 0.974; p=0.022), and higher lung V5 (per 10%; OR, 1.872; 95% CI, 1.336 to 2.699; p < 0.001). @*Conclusion@#PCPC might be a clinical endpoint to evaluate complications and predict the survival of patients subjected to CCRT for LA-NSCLC. Hypoalbuminaemia, DLCO, and lung V5 might predict PCPC in LA-NSCLC.

Clinical Outcomes of Emergent Laparotomies in Hypotensive Patients: 9-years Experience at a Single Level 1 Trauma Center

Purpose@#The prognosis of an emergent laparotomy in hypotensive patients is poor. This study aimed to review the outcomes of hypotensive patients who had emergent laparotomies and elucidate the risk factors of mortality. @*Methods@#Patients who underwent an emergent laparotomy from January 2011 to December 2019 were retrospectively reviewed. The exclusion criteria included initial systolic blood pressure > 90 mmHg, aged < 19 years, and cardiac arrest before the laparotomy. Patients were categorized into survival groups (survived or deceased). Univariate and multivariate analyses were conducted to determine the risk factors of mortality. The time from the laparotomy to death was also reviewed and the effect of organ injury. @*Results@#There were 151 patient records, analyzed 106 survivors, and 45 deceased. The overall mortality was 29.8%. Liver injury was the main organ-related event leading to an emergent laparotomy, and most patients died in the early phase following the laparotomy. Following multivariate analysis, the Glasgow Coma Scale score [odds ratio (95% confidential interval) 0.733 (0.586-0.917), p = 0.007], total red blood cell transfusion volume in 24 hours[1.111 (1.049-1.176), p < 0.001], major bleed from the liver [3.931 (1.203-12.850), p = 0.023], and blood lactate [1.173 (1.009-1.362), p = 0.037] were identified as risk factors for mortality. @*Conclusion@#Glasgow Coma Scale score, total red blood cell transfusion volume in 24 hours, major bleed from the liver, and lactate were identified as risk factors for mortality. Initial resuscitation and management of liver injuries have major importance following trauma.

An Evaluation of the Effect of Performance Improvement and Patient Safety Program Implemented in a New Regional Trauma Center of Korea

Background@#This study examined the impact of the performance improvement and patient safety (PIPS) program implemented in 2015 on outcomes for trauma patients in a regional trauma center established by a government-led project for a national trauma system in Korea. @*Methods@#The PIPS program was based on guidelines by the World Health Organization and American College of Surgeons. The corrective strategies were proceeded according to the loop closure principle: data-gathering and monitoring, identification of preventable trauma deaths (PTDs), evaluation of preventable factors, analysis of findings, and corrective action plans. We established guidelines and protocols for trauma care, conducted targeted education and peer review presentations for problematic cases, and enhanced resources for improvement accordingly. A comparative analysis was performed on trauma outcomes over a four-year period (2015–2018) since implementing the PIPS program, including the number of trauma team activation and admissions, time factors related to resuscitation, ventilator duration, and the rate of PTDs. @*Results@#Human resources in the center significantly increased during the period; attending surgeons responsible for trauma resuscitation from 6 to 11 and trauma nurses from 85 to 218. Trauma admissions (from 2,166 to 2,786), trauma team activations (from 373 to 1,688), and severe cases (from 22.6 to 33.8%) significantly increased (all P < 0.001). Time to initial resuscitation and transfusion significantly decreased from 120 to 36 minutes (P < 0.001) and from 39 to 16 minutes (P < 0.001). Time to surgery for hemorrhage control and decompressive craniotomy improved from 99 to 54 minutes (P < 0.001) and 181 to 135 minutes (P = 0.042). Ventilator duration and rate of PTDs significantly decreased from 6 to 4 days (P = 0.001) and 22.2% to 8.4% (P = 0.008). @*Conclusion@#Implementation of the PIPS program resulted in improvements in outcomes at a regional trauma center that has just been opened in Korea. Further establishment of the PIPS program is required for optimal care of trauma patients.

Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls

Objective@#Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality. @*Methods@#From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality. @*Results@#Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality. @*Conclusion@#Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

Retropharyngeal lymph node-sparing radiotherapy in patients with oropharyngeal carcinoma

Purpose@#In radiotherapy for head and neck cancer, it is crucial to define the appropriate treatment volume to determine treatment outcome and toxicity. We examined the feasibility of omitting elective high retropharyngeal lymph node (RPLN) irradiation in patients with oropharyngeal cancer. @*Materials and Methods@#We performed a retrospective review of 189 patients with oropharyngeal squamous cell carcinoma who were treated with definitive or postoperative radiation therapy between 2009 and 2016. Of them, 144 (76.2%) underwent ipsilateral RPLN irradiation up to the superior border of the C1 vertebral body, while the other 45 (23.8%) were irradiated up to the transverse process of the C1 vertebra. High RPLN-treated and spared group were propensity matched based on key clinical variables. @*Results@#During the follow-up period, only three patients (one in the high RPLN-treated group and two in the high RPLN-spared group) developed RPLN recurrence. There were no significant between-group differences in 5-year locoregional failure-free survival (82.8% vs. 90.6%; p = 0.14), distant metastasis-free survival (93.1% vs. 93.3%; p = 0.98) and RPLN failure-free survival (99.3% vs. 95.0%; p = 0.09). In the matched groups, high RPLN-spared patients received a lower mean ipsilateral parotid gland dose (mean, 20.8 Gy vs. 29.9 Gy; p < 0.001) and had a lower incidence of chronic xerostomia (grade 0, 43.5% vs. 13.0%; p = 0.023) at 1 year after radiotherapy compared with high RPLN-treated patients. @*Conclusion@#Omission of ipsilateral high RPLN irradiation seems safe, and reduces the incidence of chronic xerostomia in patients with oropharyngeal squamous cell carcinoma.

An Evaluation of the Effect of Performance Improvement and Patient Safety Program Implemented in a New Regional Trauma Center of Korea

Background@#This study examined the impact of the performance improvement and patient safety (PIPS) program implemented in 2015 on outcomes for trauma patients in a regional trauma center established by a government-led project for a national trauma system in Korea. @*Methods@#The PIPS program was based on guidelines by the World Health Organization and American College of Surgeons. The corrective strategies were proceeded according to the loop closure principle: data-gathering and monitoring, identification of preventable trauma deaths (PTDs), evaluation of preventable factors, analysis of findings, and corrective action plans. We established guidelines and protocols for trauma care, conducted targeted education and peer review presentations for problematic cases, and enhanced resources for improvement accordingly. A comparative analysis was performed on trauma outcomes over a four-year period (2015–2018) since implementing the PIPS program, including the number of trauma team activation and admissions, time factors related to resuscitation, ventilator duration, and the rate of PTDs. @*Results@#Human resources in the center significantly increased during the period; attending surgeons responsible for trauma resuscitation from 6 to 11 and trauma nurses from 85 to 218. Trauma admissions (from 2,166 to 2,786), trauma team activations (from 373 to 1,688), and severe cases (from 22.6 to 33.8%) significantly increased (all P < 0.001). Time to initial resuscitation and transfusion significantly decreased from 120 to 36 minutes (P < 0.001) and from 39 to 16 minutes (P < 0.001). Time to surgery for hemorrhage control and decompressive craniotomy improved from 99 to 54 minutes (P < 0.001) and 181 to 135 minutes (P = 0.042). Ventilator duration and rate of PTDs significantly decreased from 6 to 4 days (P = 0.001) and 22.2% to 8.4% (P = 0.008). @*Conclusion@#Implementation of the PIPS program resulted in improvements in outcomes at a regional trauma center that has just been opened in Korea. Further establishment of the PIPS program is required for optimal care of trauma patients.

Suicidal intent as a risk factor for mortality in high-level falls: a comparative study of suicidal and accidental falls

Objective@#Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality. @*Methods@#From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality. @*Results@#Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality. @*Conclusion@#Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

Retropharyngeal lymph node-sparing radiotherapy in patients with oropharyngeal carcinoma

Purpose@#In radiotherapy for head and neck cancer, it is crucial to define the appropriate treatment volume to determine treatment outcome and toxicity. We examined the feasibility of omitting elective high retropharyngeal lymph node (RPLN) irradiation in patients with oropharyngeal cancer. @*Materials and Methods@#We performed a retrospective review of 189 patients with oropharyngeal squamous cell carcinoma who were treated with definitive or postoperative radiation therapy between 2009 and 2016. Of them, 144 (76.2%) underwent ipsilateral RPLN irradiation up to the superior border of the C1 vertebral body, while the other 45 (23.8%) were irradiated up to the transverse process of the C1 vertebra. High RPLN-treated and spared group were propensity matched based on key clinical variables. @*Results@#During the follow-up period, only three patients (one in the high RPLN-treated group and two in the high RPLN-spared group) developed RPLN recurrence. There were no significant between-group differences in 5-year locoregional failure-free survival (82.8% vs. 90.6%; p = 0.14), distant metastasis-free survival (93.1% vs. 93.3%; p = 0.98) and RPLN failure-free survival (99.3% vs. 95.0%; p = 0.09). In the matched groups, high RPLN-spared patients received a lower mean ipsilateral parotid gland dose (mean, 20.8 Gy vs. 29.9 Gy; p < 0.001) and had a lower incidence of chronic xerostomia (grade 0, 43.5% vs. 13.0%; p = 0.023) at 1 year after radiotherapy compared with high RPLN-treated patients. @*Conclusion@#Omission of ipsilateral high RPLN irradiation seems safe, and reduces the incidence of chronic xerostomia in patients with oropharyngeal squamous cell carcinoma.

Retrosternal Hemorrhage after Cardiac Compression

No abstract available.

Splenic Autotransplantation after Blunt Spleen Injury in Children

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

Safety and Efficacy of Type-O Packed Red Blood Cell Transfusion in Traumatic H emorrhagic Shock P atients: Preliminary Study

PURPOSE: A new unmatched type-O packed red blood cell (UORBC) storage system was established in Ajou University Hospital Trauma Center. This system was expected to deliver faster and more efficient transfusion. METHODS: On March 2016, a new blood storage bank was installed in the trauma bay. Sixty patients who received UORBC from March 2016 to August 2016 were compared with 50 traumatic shock patients who received transfusions at the trauma bay in 2015. Time of transfusion, mortality, adverse transfusion reaction and change of systolic blood pressure were reviewed. RESULTS: Transfusion time from arrival at the hospital was significantly shorter in 2016 (14.07±11.14 min vs. 34.72±15.17 min, p < 0.001), but 24-hour mortality was not significantly different (13.3% vs. 20.8%, p=0.292). Systolic blood pressure significantly increased after UORBC transfusion (92.49 mmHg to 107.15 mmHg, p=0.002). Of the 60 patients who received UORBC in trauma bay, 47 (78.3%) patients had an incompatible ABO type, but no adverse transfusion reaction was notated. CONCLUSION: UORBC allows early blood transfusion and improved systolic blood pressure without significant adverse reactions.

Pneumoperitoneum from Subcutaneous Emphysema after Blunt Chest Injury

Pneumothorax and pneumomediastinum can cause pneumoperitoneum, which does not require surgery. There are unverified theories pertaining to how air passes through the diaphragm. We report a case of pneumoperitoneum caused by blunt chest injury that was successfully managed with conservative care. Although the pneumoperitoneum was caused by thoracic injury, we believe that the air did not pass through the diaphragm, but instead came from the abdominal wall, as in subcutaneous emphysema.

Ctbp2-mediated β-catenin regulation is required for exit from pluripotency

The canonical Wnt pathway is critical for embryonic stem cell (ESC) pluripotency and aberrant control of β-catenin leads to failure of exit from pluripotency and lineage commitments. Hence, maintaining the appropriate level of β-catenin is important for the decision to commit to the appropriate lineage. However, how β-catenin links to core transcription factors in ESCs remains elusive. C-terminal-binding protein (CtBP) in Drosophila is essential for Wnt-mediated target gene expression. In addition, Ctbp acts as an antagonist of β-catenin/TCF activation in mammals. Recently, Ctbp2, a core Oct4-binding protein in ESCs, has been reported to play a key role in ESC pluripotency. However, the significance of the connection between Ctbp2 and β-catenin with regard to ESC pluripotency remains elusive. Here, we demonstrate that C-terminal-binding protein 2 (Ctbp2) associates with major components of the β-catenin destruction complex and limits the accessibility of β-catenin to core transcription factors in undifferentiated ESCs. Ctbp2 knockdown leads to stabilization of β-catenin, which then interacts with core pluripotency-maintaining factors that are occupied by Ctbp2, leading to incomplete exit from pluripotency. These findings suggest a suppressive function for Ctbp2 in reducing the protein level of β-catenin, along with priming its position on core pluripotency genes to hinder β-catenin deposition, which is central to commitment to the appropriate lineage.

Efficacy of Uncross-Matched Type O Packed Red Blood Cell Transfusion to Traumatic Shock Patients: a Propensity Score Match Study

A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7–16] minutes vs. 44 [29–72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4–19] days vs. 5 [0–19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.

Feasibility of single-incision laparoscopic appendectomy in a small hospital

PURPOSE: This study aimed to compare clinical outcomes for single-incision laparoscopic appendectomy (SILA) and conventional laparoscopic appendectomy (CLA) for the treatment of acute appendicitis and to assess the feasibility of performing SILA in a small hospital with limited surgical instruments and staff experience. METHODS: Retrospective record review identified 133 patients who underwent laparoscopic appendectomy from December 2013 to April 2015. Patients were categorized according to the type of appendectomy performed (SILA or CLA). Patient characteristics and surgical outcomes were compared between the 2 groups. Postoperative complication rates were compared using the Clavien-Dindo classification. Postoperative pain was assessed using a visual analog scale immediately postsurgery; at 12, 24, 36, and 48 hours postoperatively, and at 7 days postoperatively. RESULTS: Record review identified 38 patients who had undergone SILA and 95 patients who had undergone CLA. No significant differences in clinical characteristics were found between the 2 groups. There were no significant differences in operation time, time to flatus, or length of hospital stay. Overall complication rates were not significantly different between the 2 groups. No complications worse than grade IIIa occurred in the SILA group. Postoperative pain scores were not significantly different between the 2 groups at any time point. CONCLUSION: We found comparable surgical outcomes for SILA compared to CLA. Even in a small hospital with limited surgical instruments and staff experience, SILA may be a feasible and safe technique.

Comparison of Surgical Outcomes between Robotic and Laparoscopic Gastrectomy for Gastric Cancer: The Learning Curve of Robotic Surgery

PURPOSE: Laparoscopic gastrectomy is a widely accepted surgical technique. Recently, robotic gastrectomy has been developed, as an alternative minimally invasive surgical technique. This study aimed to evaluate the question of whether robotic gastrectomy is feasible and safe for the treatment of gastric cancer, due to its learning curve. MATERIALS AND METHODS: We retrospectively reviewed the prospectively collected data of 100 consecutive robotic gastrectomy patients, from November 2008 to March 2011, and compared them to 282 conventional laparoscopy patients during the same period. The robotic gastrectomy patients were divided into 20 initial cases; and all subsequent cases; and we compared the clinicopathological features, operating times, and surgical outcomes between the three groups. RESULTS: The initial 20 robotic gastrectomy cases were defined as the initial group, due to the learning curve. The initial group had a longer average operating time (242.25+/-74.54 minutes vs. 192.56+/-39.56 minutes, P>0.001), and hospital stay (14.40+/-24.93 days vs. 8.66+/-5.39 days, P=0.001) than the experienced group. The length of hospital stay was no different between the experienced group, and the laproscopic gastrectomy group (8.66+/-5.39 days vs. 8.11+/-4.10 days, P=0.001). The average blood loss was significantly less for the robotic gastrectomy groups, than for the laparoscopic gastrectomy group (93.25+/-84.59 ml vs. 173.45+/-145.19 ml, P<0.001), but the complication rates were no different. CONCLUSIONS: Our study shows that robotic gastrectomy is a safe and feasible procedure, especially after the 20 initial cases, and provides a satisfactory postoperative outcome.

Giant Mesenteric Cystic Lymphangioma Originating from the Lesser Omentum in the Abdominal Cavity

A 48 year old woman was diagnosed with a huge cystic mass in her abdominal cavity. She complained of significant abdominal discomfort due to the mass. The abdominal computed tomography revealed a giant multi-lobulated mass, measuring 26x12 cm in size, adjacent to the lesser curvature of the stomach. In the operation field, the mass was found to originate from the lesser omentum, including the right and left gastric vessels and the vagus nerves, and to invade the lesser curvature of the stomach. For curative resection, distal subtotal gastrectomy with mass excision followed by gastroduodenostomy were performed. This mass was pathologically diagnosed to be a mesenteric cystic lymphangioma; in fact, the largest ever reported. The patient had no complications during the postoperative period and was discharged from the hospital on the seventh day after surgery.

Laparoscopy Assisted Subtotal Gastrectomy in Gastric Cancer Patient with Situs Inversus in Korea

Situs inversus totalis is a congenital condition in which there is complete right to left reversal of the thoracic and abdominal organ. According to an increase in minimally invasive treatments, laparoscopic surgery for patients with situs inversus totalis has also been increasing. We performed laparoscopy-assisted subtotal gastrectomy on a 60-year-old gastric cancer patient with situs inversus totalis. He was diagnosed with early stage gastric adenocarcinoma at antrum of the anterior wall. We experienced some technical difficulties because of the position and anatomic variation of major vessels. However, the subtotal gastrectomy was completed with D1+ beta lymph node dissection followed by extracorporeal gastroduodenostomy. The patient was discharged six days after operation without any complications. The pathologic report showed that tumor invasion was limited to the submucosa and one lymph node was positive for metastasis. We believe our experience is the first reported case of laparoscopic gastric cancer surgery for situs inversus in Korea.

Group B Streptococcal Colonization Rate in Korean Pregnant Women / 대한산부인과학회지

OBJECTIVE: To evaluate the colonization rate of the group B streptococcus (GBS) in Korean pregnant women and their neonates, and the antimicrobial susceptibility of isolated GBS. METHODS: From March 2005 to May 2005, pregnant women who visited 3 obstetric clinics in Goyang-si and Paju-si for antenatal care after 35 weeks of gestation were enrolled. According to Centers for Disease Control and Prevention (CDC) guideline for collecting and processing clinical specimens for group B streptococcal culture, specimens were obtained from the lower third of the vagina and perianal areas, and then inoculated on Todd-Hewitt broth. The test for antimicrobial susceptibility was performed by a disc diffusion method. RESULTS: Of the 273 pregnant women, 13 (4.8%) had a positive culture from at least 1 site (vaginal culture 6, perianal culture 3, both 4). No GBS colonization was found in their neonates. The antibiotic resistance rate was 53.9% (7/13) for erythromycin and 61.5% (8/13) for clindamycin. CONCLUSION: In this study, the colonization rate of group B streptococci in Korean pregnant women was found to be lower than those reported in USA, Western Europe, and other Asian countries. The antibiotic resistance rate for erythromycin and clindamycin was higher than those reported in other countries. Further evaluation was needed to establish the screening and chemoprophylaxis guideline for Korean pregnant women.

A case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome / 대한산부인과학회잡지

Nearly 100% of monochorionic twin pregnancies have vascular anastomoses and a fourth of those has clinical features of twin-to-twin transfusion syndrome. Cerebral palsy, microcephaly, porencephaly, and multicystic periventricular leukomalacia are serious antenatal neurologic complications associated with vascular communications in monochorionic twin gestation. It is most likely that such neurological damage is caused by intrauterine cerebral ischemic necrosis. The intermittent blood flow reversal or sudden hypotension in one twin, or emboli of thromboplastic material originating in the dead fetus could cause in utero cerebral damage in the other twin. In this report, we present a case of antenatal periventricular leukomalacia in monochorionic twin pregnancy complicated with twin-to-twin transfusion syndrome.