1/8. The management of severely malformed newborn infants: the case of conjoined twins.The birth of 'Siamese' twins in August 2000 whose parents refused to consent to surgery for separation required English courts to decide whether the twins could lawfully be separated despite that refusal when one twin would certainly die as a direct surgical result. The Court of Appeal unanimously upheld the trial judge's decision to authorize surgery, taking account of principles of family law, criminal law and human rights law. Parental duties to the viable twin were found consistent with the justification of allowing, without intending, natural death of the non-viable twin. The right to human dignity of both twins supported the justification of separation surgery. The decision did not elevate physicians' choices over parents', but subjected both to the law. The hospital was found entitled to bring the case to court, but not obliged; it could have declined surgery in conformity with the parents' wishes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Separation of craniopagus joined at the occiput. Case report.Siamese or conjoined twins have intrigued both the physician and layperson for centuries. The craniopagus type (joined at the head) is exceedingly rare, with an incidence of one in 2.5 million births. Most clinicians never see a case of craniopagus, and those who do rarely see more than one. The authors present a case of the craniopagus type of conjoined twins born and recently separated in Brisbane, australia. The prenatal diagnosis, subsequent investigations, separation, and outcome are presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Long-term results of 10 conjoined twin separations.BACKGROUND/PURPOSE: From 1978 to 2000, 10 pairs of conjoined twins were successfully separated with 14 surviving twins. Six were separated emergently because of the death or impending death of their respective twins. All of the remaining 4 sets required at least one emergency operation on at least one twin before subsequent separations. methods: A 6-item questionnaire was developed to interview this unique cohort. The question design was open ended to maximize opportunity for patient/family response. Families were administered the same questionnaire in face-to-face interviews. The physician-author asked questions related to physical health and disability, whereas the social worker-author asked questions related to developmental, educational, psychosocial, and family functioning. RESULTS: The first 4 surviving twins have graduated from college. The 1981 twin completed high school. The remaining 9 twins are in classes appropriate for their age. All 14 twins have required operations subsequent to initial discharge, particularly to correct urological, orthopedic, neurosurgical, as well as pediatric surgical problems. CONCLUSIONS: In utero diagnosis of conjoined twins by ultrasonography compels physicians and parents early in the pregnancy to make decisions concerning possible surgical separation and the alternative of pregnancy termination. The case reports presented offer additional information for physicians and parents to make informed decisions at a crucial time by illustrating long-term physical and psychological outcomes of 14 surgical survivors.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/8. Conjoined twins: report of a case and review of the literature.Conjoined twins, known to the layperson as Siamese twins, are a rare and catastrophic obstetric event. With the approximate incidence being 1 in 50,000 births, few physicians practicing obstetrics will have the unfortunate occasion to manage this biologic anomaly. Should this event occur, early diagnosis, close prenatal management, and the proper route of delivery will assure the best possible outcome for mother and both babies. The author describes the anatomic types of conjoined twins, the prenatal diagnosis and management, the route of delivery, and the overall statistical expectation. Under the best of circumstances, a good outcome is rarely achieved, but the obstetric goal should be a healthy mother and two salvageable babies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Conjoined twins.Conjoined twins, otherwise known as Siamese twins, have fascinated physicians and laymen alike for centuries. The minimal diagnostic criteria for conjoined twins is the fusion of some portion of mononuclear or monozygotic twins.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Separation of conjoined twins: a case study in critical care.Conjoined twinning, one of the rarest and perhaps most fascinating congenital malformations in children, presents a major challenge to the healthcare team. This article describes a case study of the course of female omphalopagus twins. Favorable anatomy and the combined expertise of nurses, physicians, and supporting hospital staff during perinatal, neonatal, surgical, and postoperative care and management led to the successful separation of these conjoined twins.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Neonatal intensive care: decision making in the face of prognostic uncertainty.This article discusses ethical decisions faced by parents and physicians in evaluating neonates. The role of the neonatal nurse is to be caretaker of the most vulnerable. The nurse assumes the role of safeguarding the infant's well-being, necessitating both parental engagement and work within an interdisciplinary team.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Utilization of magnetic resonance imaging in autopsy planning with specimen preservation for thoraco-omphalopagus symmetricus conjoined twins.Conjoined twinning is a rare obstetric event that has fascinated physicians and laypersons alike for centuries. When this event occurs, early diagnosis, close prenatal management, and the proper route of delivery will assure the best possible outcome for mother and affected infants. magnetic resonance imaging (MRI) is used both as an ancillary technique to the sonography for the antepartum diagnosis and in the preoperative planning for the surgical separation of conjoined twins. This report describes the MRI findings in conjoined twins of the thoraco-omphalopagus symmetricus type, a condition incompatible with extrauterine life. The twins were delivered at 21 weeks gestation. The MRI was used to evaluate the anatomic nature of the internal anomalies. These findings were then used to develop an autopsy approach plan that preserved the external phenotype. After dissection, the specimen was preserved by using polyethylene glycol and ultimately prepared for use as a teaching specimen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |