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PubMed1977

Quadruplet hallucinations. Phenotypic variations of a schizophrenic genotype.

This article provides an in-depth analysis of hallucinations in monozygous quadruplets concordant for schizophrenia. Since all four are genetically identical, deviations among them with regard to various aspects of hallucinations probably represent the effects that nongenetic factors can produce in hallucinating schizophrenics. Concordance probably represent the effects of genetic factors. We present here findings based on this research strategy, and a brief review of the literature on hallucinations.

Adult↗
PubMed1978

Anaesthetic considerations in caesarean section for quadruplets.

A case of a caesarean delivery with epidural analgesia of a term parturient with quadruplets is presented. Maternal considerations of hypotension, respiratory embarrassment and aspiration of gastric content and foetal considerations of prematurity and impaired placental function are discussed relative to the use of general anaesthesia or epidural analgesia.

Adult↗
PubMed1990

The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data.

Multifetal gestation is associated with increased frequency of maternal complications and higher perinatal morbidity and mortality. The need for contemporary data on the outcome of multifetal gestations is further underscored when selective reduction is considered. The present study details the obstetric management, neonatal outcome, and follow-up data of 24 triplet, five quadruplet, and one quintuplet pregnancies delivered in a perinatal center. The early neonatal mortality rate was 31.6, the late neonatal mortality rate was 21, and the perinatal mortality rate was 51.5. Survival to discharge was 93%. The incidence of respiratory distress syndrome was 43%, bronchopulmonary dysplasia 6%, retinopathy of prematurity 3%, intraventricular hemorrhage 4%, and cerebral palsy 2%. Follow-up from 1 to 10 years shows that only one child is moderately handicapped, whereas 99% have no significant medical problem. Early diagnosis by ultrasonography, meticulous antenatal care, early hospitalization, delivery by cesarean section, and on-site availability of a neonatologist for each baby at the time of delivery are the probable major determinants of improved outcome.

Child Development↗
PubMed1986

Quadruplet pregnancy in IVF.

The frequency of multiple pregnancy following IVF with the presently accepted methods is ten times higher than in natural cycles, and is identical to that following induction of ovulation with HMG. In spite of the fact that multifetal pregnancy exposes both fetus and mother to certain dangers, most couples joining IVF programs expose themselves to, and generally accept the risk of, multiple pregnancy, since this is their last resort for having a baby of their own. We report such a case of quadruplet pregnancy after the IVF procedure and review the literature.

Abortion, Induced↗
PubMed1994

A case of quadruplet pregnancy containing complete mole and three fetuses.

A case of a quadruplet pregnancy containing a complete mole and three fetuses is reported. A 29-year-old Japanese woman who had received clomiphene therapy was delivered of a complete mole, one dead and two living fetuses, and three placentas. Deoxyribonucleic acid fingerprint analysis proved the androgenesis of molar tissue and the trizygosity of the three fetuses.

Adult↗
PubMed1998

In utero intraventricular hemorrhage and growth discordancy in a quadruplet pregnancy.

With the advent of real-time ultrasonography, there have been a number of reported cases of in utero fetal intraventricular hemorrhage. The most frequent etiology for this uncommon event is iso/allo-immune thrombocytopenia; however, other risks have also been identified. This is the first report of an in utero diagnosis of intraventricular hemorrhage in a multiple gestation. Severe growth discordancy in this quadruplet pregnancy was an associated finding.

Adult↗
PubMed2004

Genetic and environmental interactions in determining the early lexicon: evidence from a set of tri-zygotic quadruplets.

A set of tri-zygotic quadruplets, three girls and one boy, participated in weekly observations from 1.2 to 1.10 (years;months), a period of transition from prelinguistic gesture to 50 words. In the study, one girl served as a genetic mate to her identical twin and a biological risk mate to her fraternal sister. The biological risk mates achieved milestones in lexical development at similar times; however, the genetic mates demonstrated more similarities in pattern of lexical development and in the modality of their word productions. Degree of similarity changed over the observation period. Imposed upon the natural experiment was a within-subject manipulation of the social environment: The experimenters modelled a core vocabulary via the gesture + verbal modalities to the children during each visit. The modelling resulted in increased rates of word learning for three of the children; the child with the greatest biological risk, the boy, derived the greatest benefit. The findings provide unique support for a dynamic, multi-factorial model of lexical development involving the interaction of genetics, the biological environment and the social environment. Furthermore, they illustrate the robustness of early lexical development in the face of biological risks.

Child Language↗
PubMed2001

Concurrent IVF and spontaneous conception resulting in a quadruplet pregnancy.

Blastocyst transfer of just one or two embryos has been used to help limit the number of high-order gestations. In this case report we describe the occurrence of a quadruplet pregnancy after the transfer of only two blastocysts during IVF. Sonographic examination showed four fetuses and what appeared to be quadriamniotic/quadrichorionic sacs, suggesting that a concomitant spontaneous conception had occurred. Definite confirmation of zygosity was obtained by genetic testing using DNA microsatellite polymorphism determinations after the birth of one boy and three girls at 32 weeks gestation. Although this event has not been reported previously, the possibility of its occurrence should be kept in mind. IVF patients with patent Fallopian tubes should be cautioned against intercourse late in their controlled ovarian stimulation, especially if they would decline multifetal reduction.

Adult↗
PubMed2000

A 39-year followup of the Genain quadruplets.

The Genains, a unique group of monozygotic female quadruplets, all developed a schizophrenic disorder by age 24. They have been studied since the 1950s, because of the rarity of this occurrence (estimated to be one in 1.5 billion) and because their illnesses varied in severity. The identical inheritance would tend to rule out genetic differences as the cause of the neuropsychological differences; however, we cannot disentangle the effects of early brain injury and harsh punitive treatment as factors accounting for the differences in the severity of their disorders. We conducted neuropsychological examinations of the Genains at age 66, compared their test profiles, and contrasted certain test scores at 66 with those at ages 27 and 51. Test results indicate generally stable (or even improved) performance over time and support the notion that cognitive decline is not a degenerative process in schizophrenia. The Genains remind us of the exquisite interaction among variables that must be understood before additional, satisfactory progress can be made in preventing the development and predicting the course of schizophrenia.

Adult↗
PubMed1988

The Genain quadruplets.

The Genain quadruplets are a unique set of monozygous women who are concordant for schizophrenia but discordant for the severity of their disorder. They were studied by David Rosenthal and colleagues at the National Institute of Mental Health in the late 1950's when they were in their twenties and again in 1981 when they were 51. They are faring about as well now as they ever have in their adult lives. The results of psychological tests, some of which were repeated more than 20 years apart, are discussed, as are the effects of medication on attention and memory. The differential response of the Genains to neuroleptic drugs, as well as certain other findings in the 1981 study, leads to a different conclusion about the discordant severity of their disorder from that reached in 1963 by Rosenthal and Quinn. These observations emphasize the value of long-term followup studies in genetically related individuals, with repeated assessments of the same functions.

Adult↗
PubMedDate not supplied

First trimester twin-to-twin transfusion syndrome in a trichorionic quadruplet pregnancy--a diagnostic challenge.

We report the prenatal diagnosis of twin-to-twin transfusion syndrome (TTS) at 11 weeks' gestation. The diagnosis was made in a trichorionic quadruplet pregnancy which was conceived after in vitro fertilization and intracytoplasmic sperm injection for male subfertility and transfer of 3 embryos. Growth discordance, oligo/polyhydramnios and abnormal arterial and venous Doppler flows were demonstrated in 2 monochorionic fetuses, while the remaining 2 dichorionic fetuses were unremarkable. Selective fetocide of the donor by intracardiac injection of potassium chloride was followed by the spontaneous demise of the recipient. The pregnancy course remained uneventful until 32 weeks of gestation when the patient developed preterm labor. Two healthy preterm babies were delivered by cesarean section. The diagnostic problems of this early manifestation of TTS are discussed.

Blood Flow Velocity↗
PubMedDate not supplied

Monochorionic quadramniotic quadruplets: sonographic workup.

OBJECTIVE: We raise the issue of scanning multifetal pregnancies of higher order as early as possible. A rare case of monochorionic/quadramniotic pregnancy seeking multifetal pregnancy reduction and its clinical management is presented. METHODS: Transabdominal scanning at 16 weeks was performed correctly diagnosing the monochorionic quadruplet pregnancy. RESULTS: Suspecting vascular connections between the placentae, the fetal reduction was declined. The patient was delivered at 31 weeks. The 4 female neonates survived with slight ventilatory assistance. CONCLUSION: Multifetal pregnancies in general, but those of higher order in particular, have to be scanned as early as 8-10 weeks to correctly and easily assign their chorionicity and amnionicity. The case of a monochorionic/quadramniotic pregnancy and its clinical course are presented.

Adult↗
PubMedDate not supplied

Caudal analgesia for quadruplet delivery.

During the period January 1969 to November 1974, in a total of 39,800 deliveries, there were two sets of quadruplets. Both parturients had been taking ovulation-inducing drugs. Maternal problems were distended abdomen and heavy uterus, causing supine hypotension and lordosis; toxemia of pregnancy; increased possibility of hemorrhage before, during and/or after delivery; edema of the back; mental depression. The fetal problems were prematurity; intrauterine growth retardation; increased possibility of transfusion syndrome and prolapsed cord; increased obstetric manipulation. An adequate number of obstetricians, pediatricians, anesthesiologists, and nurses, necessary equipment, and blood and blood components should be available. Early hospitalization is necessary. Close observation of the patient before, during, and after delivery is essential. The patient should stay on her side throughout the labor. General anesthesia may add to fetal depression and increase the possibility of uterine atony. Spinal or lumbar epidural anesthesia may be difficult because of the associated lordosis and back edema. Caudal block allowed intrauterine manipulation; provided adequate analgesia, permitted high FIO2 administration, and did not interfere with voluntary bearing down when required.

Adult↗
PubMed1994

Schedule effects of noncontingent reinforcement on attention-maintained destructive behavior in identical quadruplets.

Noncontingent reinforcement (NCR), a response-independent schedule for the delivery of reinforcement, has been found to be effective in reducing behavior when the reinforcer delivered is responsible for behavioral maintenance. In this study, dense and lean schedules of response-independent attention were compared to determine whether it is necessary to begin with a dense schedule before fading to a lean schedule, or whether treatment would be as effective using a lean schedule at the outset. The subjects were 5-year-old identical quadruplets diagnosed with mental retardation and pervasive developmental disorder who displayed destructive behavior that was maintained by social attention. NCR was selected partially because it is not very labor intensive and could be implemented by a single mother simultaneously with all 4 children. Using a combination multielement and multiple baseline design, it was found that (a) a dense schedule of response-independent reinforcement (i.e., fixed-time 10 s) resulted in immediate and dramatic reductions in destructive behavior with no evidence of an extinction burst, and (b) an equivalent reduction in destructive behavior was achieved with a lean schedule of response-independent reinforcement (fixed-time 5 min) only after a systematic fading procedure was implemented. The findings suggest that the effectiveness of NCR may be dependent on the use of a dense schedule initially, and that systematic fading can increase the effectiveness of a lean schedule.

Attention↗
PubMed1983

The Genain Quadruplets at age 51: report of handwriting assessment.

A set of monozygotic female quadruplets developed schizophrenia at age 26 and were treated at the National Institute of Mental Health for several years. Using graphic material of these unusual subjects, this study demonstrates how handwriting, statistically in graph forms, expresses the developmental stages before (at age 16), during the acute phase of the disease (age 26 to 28) and 25 yr. later (age 51) when they functioned outside a hospital setting in various degrees of competency.

Adolescent↗
PubMed1989

Quadruplets following cessation of clomiphene citrate. A case of sustained effect.

We report a case of quadruplet birth in a young oligomenorrheic woman, who had been prescribed clomiphene citrate for two consecutive cycles. She conceived following cessation of treatment and an intervening menstruation. Ultrasonic follow-up which concurred with the last menstrual period dating indicated multiple ovulation as a sustained effect of clomiphene citrate medication.

Adult↗