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Conjoined twins

Tara L Braun, Kristy L Hamilton, Laura A Monson, Edward P Buchanan, Larry H Hollier
Tissue expansion is a well-established surgical method that has been creatively applied to the management of many congenital and acquired pediatric conditions, including the removal of giant congenital melanocytic nevi and the separation of conjoined twins. Careful preoperative planning and patient follow-up are required to achieve the proper results and minimize complications. Special considerations for pediatric patients are present during each step of the process, from patient selection to postoperative care...
November 2016: Seminars in Plastic Surgery
Adonis Pino, Arlenis Pérez, Aine Seavers, Guillermo Hermo
Caudal duplication (dipygus) is an uncommon pathologic of conjoined twinning. The conjoined malformation is classified according to the nature and site of the union. We report the presence of this malformation in a female crossbreed puppy. The puppy was delivered by caesarean section following a prolonged period of dystocia. External findings showed a single head (monocephalus) and a normal cranium with no fissure in the medial line detected. The thorax displayed a caudal duplication arising from the lumbosacral region (rachipagus)...
2016: Veterinary Research Forum
Nicole K Yamada, Janene H Fuerch, Louis P Halamek
The resuscitation of conjoined twins is a rare and complex clinical challenge. We detail how patient-specific, in situ simulation can be used to prepare a large, multidisciplinary team of health care professionals (HCPs) to deliver safe, efficient, and effective care to such patients. In this case, in situ simulation allowed an 18-person team to address the clinical and ergonomic challenges anticipated for this neonatal resuscitation. The HCPs trained together as an intact team in the actual delivery room environment to probe for human and system weaknesses prior to this unique delivery, and optimized communication, teamwork, and other behavioral skills as they prepared for the simultaneous resuscitation of two patients who were physically joined to one another...
November 10, 2016: American Journal of Perinatology
Jeffrey G Trost, Lawrence O Lin, Sarah Jane Clark, David Y Khechoyan, Larry H Hollier, Edward P Buchanan
BACKGROUND: Conjoined twins are a rare medical phenomenon that offers a unique challenge for medical professionals. The complex anatomy of conjoined twins dictates their survival and amenability to separation, making each case different in terms of medical management, surgical planning, and patient outcomes. Thoraco-omphalo-ischiopagus twins, joined from the thorax to the pelvis, are one of the rarest orientations recorded in the medical literature, and successful separation of this subset of conjoined twins has not been documented...
November 2016: Plastic and Reconstructive Surgery
Sunita Kulhari, Amit Rastogi, Ashish Kanaujia, Poulomi Biswas, Prabhat Kumar Singh
Craniopagus conjoined twins are rare, and the chance that an anesthesiologist might face the challenge of providing anesthesia for this condition is very rare. The incidence of conjoined twins ranges from 1 : 50 000 to 1 : 200 000 births. We describe the anesthetic management of a pair of premature craniopagus conjoined twins posted for emergency surgery prior to their separation.
December 2016: Paediatric Anaesthesia
Barrett Cromeens, Jennifer L McKinney, Jeffrey Leonard, Lance Governale, Judy Brown, Christina Henry, Marc Levitt, Richard Wood, Gail Besner, Monica P Islam
Conjoined twins occur in up to 1 in 50,000 live births with approximately 18% joined in a pygopagus configuration at the buttocks. Twins with this configuration display symptoms and carry surgical risks during separation related to the extent of their connection which can include anorectal, genitourinary, vertebral, and neural structures. Neurophysiologic intraoperative monitoring (NIOM) for these cases has been discussed in the literature with variable utility. We present a case of pygopagus twins with fused spinal cords and imperforate anus where the use of NIOM significantly impacted surgical decision making in division of these critical structures...
October 1, 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
V Sans-Coma, C Rodríguez, M A López-Unzu, M Lorenzale, B Fernández, L Vida, A C Durán
As far as is known, this paper gives the first description of a two-headed shark embryo belonging to an oviparous species, Galeus atlanticus (Carcharhiniformes: Scyliorhinidae). The specimen was detected among 797 embryos intended for cardiovascular studies, which represents a defect incidence of 0·13%. Each head had a mouth, two eyes, a brain, a notochord and five gill openings on each side. The two heads fused behind the gills. On the single body, there were four anticipated dorsal fins, two anterior, right and left and two posterior, right and left...
October 9, 2016: Journal of Fish Biology
María Paz Bidondo, Boris Groisman, Agostina Tardivo, Fabián Tomasoni, Verónica Tejeiro, Inés Camacho, Mariana Vilas, Rosa Liascovich, Pablo Barbero
BACKGROUND: Diprosopus is a subtype of symmetric conjoined twins with one head, facial duplication and a single trunk. Diprosopus is a very rare congenital anomaly. METHODS: This is a systematic review of published cases and the presentation of two new cases born in Argentina. We estimated the prevalence of conjoined twins and diprosopus using data from the National Network of Congenital Anomalies of Argentina (RENAC). RESULTS: The prevalence of conjoined twins in RENAC was 19 per 1,000,000 births (95% confidence interval, 12-29)...
October 5, 2016: Birth Defects Research. Part A, Clinical and Molecular Teratology
O S Hassan
No abstract text is available yet for this article.
September 2016: Ultrasound in Obstetrics & Gynecology
Nancy L Segal
The 2016 Satellite Meeting of the International Society of Twin Studies took place on June 20 in Brisbane, Australia. The host institution was the QIMR Berghofer Medical Research Institute. An overview of selected presentations and activities is provided. This synopsis is followed by a brief tribute to the recent passing of our esteemed colleague, Dr Irving I. Gottesman. Next, there are summaries of research on monozygotic twinning after single embryo transfer, a twin study of mononucleosis susceptibility, cerebral injury following twin-to-twin transfusion syndrome surgery, and a correction and clarification regarding an article by Segal (2016) on the Brazilian Twin Registry...
October 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Muhammad Saad Yousuf, Faisal Shamim, Samie Asghar Dogar, Fauzia Anis Khan
Anesthetic management of the conjoined twins in the radiology suite presents some unique problems for anesthesia. We report a case of 3-month and 10-day-old xiphopagus twins undergoing computed tomography scan under general anesthesia. The issues in their management in radiology included the unknown effects of anesthetic agents on circulation because of sharing of organs, duplication of staff, equipment in a limited space, placing the children on the scan table, airway control and ventilator management, and changeover of equipment during procedure...
October 15, 2016: A & A Case Reports
Per Gunnar Fjelldal, Monica F Solberg, Tom Hansen, Tone Vågseth, Kevin Alan Glover, Harald Kryvi
BACKGROUND: There is a gap in knowledge regarding the cardiovascular system in fish conjoined twins, and regarding the cardiovascular morphogenesis of conjoined twins in general. We examined the cardiovascular system in a pair of fully developed ventrally conjoined salmonid twins (45.5 g body weight), and the arrangement of the blood vessels during early development in ventrally conjoined yolk sac larvae salmonid twins (<0.5 g body weight). RESULTS: In the fully developed twins, one twin was normal, while the other was small and severely malformed...
2016: BMC Developmental Biology
Rodolfo A Elizondo, Jason K Au, David R Roth, Oluyinka O Olutoye, Darrell L Cass, Chester J Koh
Conjoined twins are seen in approximately 1/500,000 live births, and therefore surgical management of urologic anomalies in conjoined twins has not been extensively reported. Various degrees of sharing of the urinary tracts and genitalia can be seen in different types of conjoined twins. Detailed preoperative imaging, including magnetic resonance imaging, computed tomography, and voiding cystourethrogram, is essential to define the anatomy and planning of a successful separation. We describe the urologic presentation, evaluation, and treatment of thoracoomphalopagus conjoined twins...
June 28, 2016: Urology
Keiko Watanabe, Masanori Ono, Mayu Shirahashi, Toshiyuki Ikeda, Kazumi Yakubo
Conjoined twins are a rare phenomenon, occurring in 1% of monochorionic twin gestation, with an incidence of 1 : 50 000 to 1 : 100 000. Many conjoined twins have abnormalities incompatible with life, so early prenatal diagnosis is very important for optimal management of both pregnancy and delivery. We report a case of dicephalus parapagus conjoined twins, sharing a single heart, diagnosed at 12 weeks' gestation. With early ultrasound diagnosis, we were able to provide appropriate and timely prenatal counseling to the family...
2016: Case Reports in Obstetrics and Gynecology
Donald J Harvey, Ali Totonchi, Arun K Gosain
BACKGROUND: Attempted separation of craniopagus twins has continued to be associated with devastating results since the first partially successful separation with one surviving twin in 1952. To understand the factors that contribute to successful separation in the modern era of neuroimaging and modern surgical techniques, the authors reviewed and analyzed cases reported since 1995. METHODS: All reported cases of craniopagus twin separation attempts from 1995 to 2015 were identified using PubMed (n = 19)...
July 2016: Plastic and Reconstructive Surgery
Monica Mihaela Cîrstoiu, Florin Mihail Filipoiu, Elvira Brătilă, Costin Berceanu, Florin Cătălin Cîrstoiu, Vlad Andrei Budu, Ioan Alexandru Bulescu, Octavian Munteanu
Cephalopagus is a rare variety of conjoined twins. They are fused with their heads, thoracic and upper abdominal cavities. The exact mechanism for development of conjoined twins cannot be clearly explained. It appears that there is an alteration in the normal developmental process of monozygotic twins, which fail to separate from each other. We present the morphology of a cephalothoracopagus, revealed through anatomical dissection, emphasizing the arrangement of the viscera in the thoracic and abdominal cavities...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
Maria Tozzi, R Scott Van Zant
PURPOSE: Describe the rehabilitation, including two episodes of inpatient rehabilitation, early intervention, and outpatient services, of conjoined twins. CASE DESCRIPTION: The patients were 14-month-old female ischiopagus tripus twins that received 3 months of rehabilitation (mobility, feeding, communication, developmental skill training, developing adaptive equipment, educating caregivers) preseparation surgery. Surgery occurred at 24 months. At 27 months, the twins were admitted to inpatient rehabilitation, receiving 4 months of rehabilitation promoting strength, endurance, gait training, feeding, communication, developmental skill training, orthotics, adaptive equipment, and caregiver education...
April 13, 2016: Physical & Occupational Therapy in Pediatrics
Sureyya Burcu Gorkem, Mehmet Serdar Kutuk, Selim Doganay, Tamer Gunes, Karamehmet Yildiz, Mustafa Kucukaydin
The aim of this study is to evaluate perfusional changes in brain and placenta of omphalopagus conjoined twins and to compare them with singleton fetuses by using diffusion weighted imaging and apparent diffusion coefficient. Fetal MRIs of 28-week-old omphalopagus conjoined twins with a shared liver with two separate gallbladders and portal and hepatic venous systems and three singleton fetuses with unilateral borderline ventriculomegaly at the same gestational week as control group were enrolled retrospectively...
2016: Radiology Research and Practice
Alain Ségal
The author presents an autograph manuscript sent from Laval by Dr Hubert to Paris Academy of medicine in which he reports the birth of a freak who died at birth during a difficult delivery. This freak is, according to our contemporary classifications, a thoraco pagus who represents from 70 to 73% of symmetrical conjoined monmphalic twins. The address mentioned is that of the first location of the Academy. He gives explanations concerning both the Academy and Dr Hubert, a Parisian MD who was a regular contributor...
July 2015: Histoire des Sciences Médicales
Anca Maria Panaitescu, Fred Ushakov, Anjali Kalaskar, Pranav P Pandya
OBJECTIVES: This study describes the prenatal diagnosis of body stalk anomaly (BSA) in a large series of affected pregnancies and proposes an algorithm for the differential diagnosis of abdominal wall defects in the first trimester. METHODS: This was a retrospective study of all the cases of BSA diagnosed in our tertiary unit between 2009 and 2015. In all cases, we performed a detailed ultrasound examination with particular emphasis on the appearance of the amniotic membrane and content of the amniotic sac and the coelomic cavity...
March 1, 2016: Fetal Diagnosis and Therapy
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