1/50. Diprosopus (partially duplicated head) associated with anencephaly: a case report.Craniofacial duplication (diprosopus) is a rare form of conjoined twin. A 16 year old mother with a twin pregnancy delivered one normally formed baby boy and one diprosopus male. The malformed baby was 33 weeks of gestation with a single trunk, normal limbs and various degrees of facial duplication. Of the following structures there were two of each: noses, eyes, ears (and one dimple), mouths, tongues and, with bilateral central cleft lips and cleft palates. This was associated with holoprosencephaly and craniorachischisis. Internal organs showed no duplication. There were multiple congenital anomalies including diaphragmatic hernia, small lungs, two lobes of the right lung, ventricular septal defect, small adrenal gland and small left kidney with short ureter. The body also had a short neck, small chest cavities and kyphosis. X-ray revealed duplication of the vertebral column. The case presented here represents a type II of diprosopia of Rating (1933) and is the least common type reported. We also reviewed 22 recently reported cases of diprosopus. In addition to facial duplication, anencephaly, neural tube defect and cardiac malformations represent the more common congenital abnormalities associated with diprosopus. The pathogenesis of diprosopus is not well understood. Factors that play a role in diprosopus are probably similar to those factors (genetic, environmental and abnormal placental circulation) which affect monozoygotic twins as observed in this case report. Early ultrasonography diagnosis of diprosopus permits one to consider a vaginal therapeutic abortion.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/50. Scintigraphic evaluation of craniopagus twins.Craniopagus twinning is a rare congenital abnormality, occurring at a frequency of 4-6 per 10 million births. A case is reported in which separation was successful for both twins. The importance of pre-operative radionuclide assessment of crucial organ function (liver, kidneys, heart, brain) and crossed circulation is stressed. The scintigraphic results were in keeping with radiographic, operative, and clinical findings. The routine use of radionuclide studies in the investigation of conjoined twins is recommended in order to delineate individual organ function, degree of fusion and measurement of cross-circulation.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
3/50. Morphological and cytogenetic studies on conjoined twins.Two cases of monoamniotic conjoined male twins, born at term after normal pregnancies, are reported. The first case, a bicephalus, shows hypoplastic and malformed left-side organs, absence of the left umbilical artery, and two communicating hearts, the left one with three cameras. The second case, a pygothoracopagus, consists in a twin "parasite", with no head but with two upper and two lower limbs, slightly less developed than those of the formed twin. The left eye of the formed twin is double than the right one and contains two eye apples -- one well-formed and the other rudimentary. There is a rudiment of a second mouth on the left cheek. The umbilical cord contains five blood vessels |
one umbilical vein and four umbilical arteries. The cytogenetic study of the pygothoracopagus reveals aneuploidy, more pronounced in the "parasite" than in the formed twin. |
4/50. An unusual case of epigastric heteropagus: parasite with a rudimentary heart.Parasitic or heterotopic conjoined twins are exceedingly rare, and these cases are referred to as "heteropagus" when there is a parasitic attachment in a nonduplicated fashion to any portion of the body. Epigastric heteropagus twinning refers to the attachment of the parasite to the epigastric region of the autosite. An unusual epigastric heteropagus case is presented with a rudimentary cardiopulmonary and also nearly complete gastrointestinal and genitourinary system of the parasite, and an organogenetic and vascular status of the previously reported cases are reviewed. The current case might be unique for the parasite having a cardiopulmonary development--although rudimentary--and this might be the reason that it has more complete organogenesis than the cases that have been presented previously in the literature.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
5/50. Thermocoagulation for selective reduction of conjoined twins at 12 weeks of gestation.Conjoined twins occur rarely. Most of the prenatally diagnosed cases are terminated either because of extensive organ sharing or because of the presence of major structural abnormalities. We present a case of omphalopagus conjoined twins diagnosed at 10 weeks of gestation with selective reduction performed at 12 weeks. The twins were conjoined at the umbilicus with vascular communication demonstrated at the conjunction. Twin A was normal but twin B was growth restricted and hydropic. Thermocoagulation of twin B was performed at 12 weeks by passing an insulated electric wire through a 18-gauge needle placed close to the fetal heart. Reassessment at 15 weeks showed that twin A was growing normally with a small dead twin B attached at its umbilicus. Twin B was subsequently sloughed off from this attachment and could be seen lying free in the amniotic cavity at 17 weeks. Twin A was delivered at term and was healthy. A small scar could be seen just above the umbilical cord insertion. This case represents the first antenatal example of selective reduction of conjoined twins by thermocoagulation.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/50. Separation of omphalopagus conjoined twins using combined caudal epidural-general anesthesia.PURPOSE: To describe the anesthetic management of newborn omphalopagus conjoined twins undergoing a series of diagnostic and surgical procedures which culminated in successful separation at one month of age. CLINICAL FEATURES: Evaluations of the extent of shared organ systems were carried out without the need for anesthesia. The twins were anesthetized twice, once for insertion of skin expanders, and later for surgical separation. Various airway management techniques were utilized. To facilitate surgical separation, caudal epidural catheters were inserted in an effort to provide both operative and post-operative analgesia. In addition, prior to the induction of anesthesia, the extent of cross-circulation between twins was assessed. CONCLUSION: Caudal epidural catheters can be used to provide both operative and post-operative analgesia. Early extubation, another benefit of regional analgesia, was not achieved because both twins developed respiratory failure in the immediate postoperative period. Testing for the extent of cross-circulation between twins proved valuable, allowing for detailed scripting of the complex induction sequence and airway management.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/50. Conjoined twins: multiorgan system evaluation by multidetector CT and 3D volume rendering.Conjoined twins, though uncommon, continue to present some of the most challenging questions for current diagnosis and therapy. The myriad of presentations demands a thorough multisystemic imaging evaluation before fully informed therapeutic and ethical decisions can be made. We present an unusual case of asymmetric omphaloischiopagus conjoined twins who were evaluated by multidetector CT and 3D volume rendering. This single technique can provide a large amount of information from a single study that can negate the need for some other imaging tests and can complement those other tests that remain necessary. We would suggest that when a CT examination is considered to evaluate this condition, an imaging interpretation that is independent of acquisition plane and that has multisystem versatility should be considered.- - - - - - - - - - ranking = 4keywords = organ (Clic here for more details about this article) |
8/50. Separation of xiphi-omphalo-ischiopagus tetrapus twins with favorable internal anatomy.Conjoined twinning is a rare occurrence, and ischiopagus variety is even more rare. So far, only 20 cases have been reported. The incidence is 1 in 500,000. Because of its rarity and variable anatomy, no definite line of treatment can be adapted. time of operation and mode of treatment have to be tailored according to the local circumstances and organ sharing in each individual pair. The twins in this report were xi phi-omphalo-ischiopagus tetrapus conjoined twins. Although several internal organs were fused and shared, they were complete mirror image sets for each twin. In this case report, details of anatomy and more importantly, preoperative investigations, preparations, and organizational aspects that were designed to suit local conditions are described. Operative details, postoperative care, and short and long-term progress also has been highlighted.- - - - - - - - - - ranking = 3keywords = organ (Clic here for more details about this article) |
9/50. Free allogeneic muscle transfer for cranial reconstruction.An allogeneic muscle transfer was used to cover a large cranial defect in one of a pair of craniopagus twin separated a decade ago. Both separated twins died, 7 months apart, with the twin that had received the transfer dying first. The cause of death was generalised cytomegalovirus infection. An autopsy showed extensive brain necrosis caused by vascular insufficiency, a result of the abnormal vascular anatomy at birth. The muscle allograft showed no signs of rejection. Progress in immunosuppressive treatment over the last decade, which has enabled successful allogeneic nerve grafts and composite-tissue transplantations, might make muscle transplantation for the coverage of large defects, with and without functional demands, feasible in the future.- - - - - - - - - - ranking = 0.01802214299118keywords = nerve (Clic here for more details about this article) |
10/50. Successful separation of thoracopagus conjoined twins.The first successful separation of thoracopagus conjoined twins in Eastern Saudi arabia with 2-year follow up is presented. physical examination and radiographic studies revealed a conjunction that extended from midsternum to a common umbilicus. The shared internal organs included liver and pericardium. The separation was performed at the age of 4 months. The resulting chest wall defects in both twins were covered by dacron-reinforced silastic prosthesis. The abdominal wall defect was primarily closed in the "left twin," and covered with a dacron reinforced silastic sheet in the "right". Primary skin closure was achieved in both, following extensive mobilization of the skin. The musculoskeletal deformities in the neck, chest and vertebral column showed marked improvement 20 months after separation.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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