11/42. An unusual case of heteropagus twinning.A 3-day-old boy baby presented with a cystic umbilical swelling covered mostly by skin and partly by amnion. On the surface, an early embryo-like structure was attached (facial features and limb buds). The deeper aspect of it was composed of large cystic and tubular structures and solid organs resembling liver and spleen. It was labeled as acardiac amorphous parasitic twin, the first of its kind to be reported.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
12/42. Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review.After an unsuccessful midwife-assisted delivery in which a head was born but delivery could not be advanced, episiotomy performed at Sanliurfa Maternity Hospital allowed vaginal delivery of female conjoined twins. Visual and x-ray examination showed two heads, two vertebral columns, two feet, two arms, and fusion at the level of the pelvis. The baby was born dead, but the mother made an uneventful recovery. Parapagus (anterolaterally joined) dicephalus (two-headed) twins account for only 11-13% of all conjoined twins, and they rarely survive. Complex malformations of hearts, lungs and abdominal organs, duplication of the tracheae, upper gastrointestinal tract and spinal column, and either double or single versions of other organs have been reported in parapagus dicephalus cases. The incidence, anatomical, embryological, diagnostic, prognostic, obstetrical, perinatal, and ethical aspects of conjoined twins are reviewed, with a focus on parapagus dicephalus conjoined twins.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
13/42. Diagnosis of conjoined twins before 16 weeks' gestation: the 4-year experience of one medical center.BACKGROUND: Descriptions of the rarely occurring condition of conjoined twins are sparse. methods: We report a case series of four conjoined twin pregnancies diagnosed up to 16 weeks of gestation. One was in a quadruplet in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) pregnancy of cryopreserved embryos and the others were spontaneous conceptions. Three were thoracopagus and had increased nuchal translucency (NT) or big nuchal cysts and one was omphalopagus. RESULTS: All the three affected twin pregnancies were terminated by cervical dilatation and uterine evacuation. In another case, selective fetal reduction, shortly followed by embryo reduction to singleton was performed. Histological analysis of one case revealed dissimilar gender. No further cytogenetic or molecular studies were conducted by parental request. The pathophysiology of increased NT, subcutaneous edema or nuchal cysts in thoracopagus conjoined twins, the possible embryonic events that may lead to dizygotic conjoined twins and the clinical management of conjoined twins in sets of multiple gestation are discussed. CONCLUSIONS: The current case series illustrates that there are many problems related to this rare, but intriguing, accident of nature that still need to be overcome.- - - - - - - - - - ranking = 3keywords = embryo (Clic here for more details about this article) |
14/42. fetus in fetu and fetaform teratoma in 2 neonates: an embryologic spectrum?OBJECTIVE: The purpose of this study was to describe the imaging and pathologic findings of 2 cases of complex neonatal abdominal masses and to discuss the probable common embryologic etiology of fetus in fetu (FIF) and fetaform teratomas. methods: Two male neonates had complex cystic abdominal masses, 1 of which was diagnosed prenatally, and both had abdominal sonography. One patient also had abdominal computed tomography. Both patients subsequently underwent surgical resection, with pathologic and genetic analysis of these masses. RESULTS: One patient had typical imaging, pathologic, and genetic findings of FIF. The second patient had a well-formed mass that was diagnosed pathologically as a teratoma yet had most of the criteria for FIF that have been set forth in recent embryologic literature. CONCLUSIONS: Recent concepts regarding the origin of FIF suggest that it is part of a spectrum of monozygotic twinning gone awry, ranging from conjoined twins at one end to fetaform teratomas at the other. The imaging and pathologic features of these 2 cases serve to reinforce this concept.- - - - - - - - - - ranking = 6keywords = embryo (Clic here for more details about this article) |
15/42. early diagnosis of conjoined twins by real-time three-dimensional ultrasound--case report and review of the literature.In 1:50 000 to 1:100 000 births, conjoined twins occur, caused by incomplete division of the embryonic disc more than 13 days after fertilisation. We present a case of cephalothoracopagus janiceps, a very rare form of conjoined twins, which was diagnosed at 13 weeks of gestation. Three-dimensional and colour Doppler ultrasound enabled precise prenatal visualisation of the fusion of the foetal head and chest up to the umbilicus. We could demonstrate the presence of two foetal hearts connected by an arterio-arterial shunt as well as two pairs of upper and lower extremities. After the clear 3-D presentation of the anomaly, making the poor prognosis visible, the mother decided to have the pregnancy terminated. autopsy confirmed the prenatal diagnosis.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
16/42. Separation of pyopagus conjoined twins: a new zealand neurosurgical experience.Conjoined twins represent a rare form of incomplete embryonic separation. They are classified into eight different subtypes, with 18% representing pyopagus conjoints. history is scattered with accounts of the various types of conjoints and it is only recently that strategies have been devised to enable surgical separation of such twins. It is estimated that approximately 20 cases of separation of pyopagus twins have been performed. We provide a historical look at pyopagus conjoint twins and report our neurosurgical experience of australasia's first separation of pyopagus twin girls.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
17/42. Conjoined twins in a trichorionic quadruplet pregnancy after intracytoplasmic sperm injection and quarter laser-assisted zona thinning.OBJECTIVE: To describe the occurrence and management of conjoined twins (CTs) in a trichorionic quadruplet pregnancy after the transfer of three embryos obtained by intracytoplasmic sperm injection (ICSI) that had undergone assisted zona hatching (AZH) using a noncontact laser. DESIGN: Case report. SETTING: Private and public IVF centers. PATIENT(S): A 38-year-old nulliparous woman. INTERVENTION(S): IVF, diagnosis by two-dimensional, three-dimensional, and four-dimensional ultrasound, selective termination at 12 weeks gestation. MAIN OUTCOME MEASURE(S): Clinical follow-up and delivery. RESULT(S): After diagnosis, counselling, and selective termination, the subsequent prenatal course was uneventful, and two healthy boys were delivered by elective cesarean section at 38 weeks gestation. CONCLUSION(S): Monozygotic twinning (MZT) and CTs could complicate multifetal pregnancies obtained by assisted reproduction techniques. The relationship between CTs, IVF, and AZH should be better studied to fully understand the mechanisms that lead to MZT (with the possible role of AZH) and CTs in MZT, in particular. Three-dimensional and four-dimensional ultrasound improve prenatal assessment of the condition. Selective embryo reduction is a safe procedure for the management of these pregnancies.- - - - - - - - - - ranking = 2keywords = embryo (Clic here for more details about this article) |
18/42. Unique anomalies in cephalothoracopagus janiceps conjoined twins with implications for multiple mechanisms in the abnormal embryogenesis.The anatomic features of female conjoined twins with the Janiceps type of cephalothoracopagus are described. Abnormalities included bilateral clefts of the alveolar arches, shared rudimentary mandible, high, arched clavicles, multiple rib deformities, single shared foregut and small intestine, absent large intestines, omphalocele, multicystic kidneys, hypoplastic lungs, interconnected aortas and neck vessels, single ovary with elongated uterus in each twin, displaced labia, abnormal segmentation of the vertebrae, spinal dysraphism, diastasis of the symphysis pubis, malrotated lower extremity, bilateral posterior dislocation of the hips, and club feet. There were two hearts with internal anomalies. Both spinal cords had a myelocele in the lumbar region. The abnormalities noted in previous reports of conjoined twins of this type are reviewed and compared. We propose that factors associated with conjoining, dysgenetic (developmental) defects, and deformations resulting from crowding in utero all may have been important in the abnormal development in this case.- - - - - - - - - - ranking = 4keywords = embryo (Clic here for more details about this article) |
19/42. Prenatal ultrasonographic diagnosis of thoracopagus conjoined twins.Conjoined twins are a rare obstetric event occurring 1/50,000 to 1/60,000 deliveries as a result of incomplete fission of the embryonic disc before the third week of pregnancy. They belong to the monochorionic-monoamniotic type of monozygotic twins and are classified according to the area of union, the most common site being the chest and upper abdomen (thoracopagus). Reported are two cases of thoracopagus twins in which the diagnosis was made prenatally by ultrasound in the second trimester of pregnancy. The most significant ultrasound findings included the demonstration of a single cardiac activity, the inability to separate the fetal bodies at their ventral portion, and a face-to-face fetal position. The pregnancies were allowed to continue until term with no significant prenatal complications, and an elective cesarean section was performed to avoid a traumatic delivery. In both cases the infants died during the first week of life because of cardiorespiratory insufficiency. The ultrasound criteria for the antenatal diagnosis of conjoined twins are reviewed, concluding that the careful ultrasound examination of all identified sets of twins, specially in those cases in which no separating membrane is demonstrated, is the cornerstone in making the prenatal diagnosis. In addition, ultrasound plays a crucial role not only in the diagnosis, but also in establishing the degree of conjoining, which is essential for planning an appropriate obstetrical and perinatal management.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
20/42. Parasitic conjoined twins with omphalocele and tetralogy of fallot.Human parasitic twins are very rare. Here we report a unique case of a partial twin attached to the host in the midline at the forehead, chin, chest, and epigastrium. The parasite lacked thoracic organs and major neural tube derivatives. However, it had small peripheral nerves and ganglia within perirenal and pericolonic connective tissue. Also present were a well-developed small intestine, colon, and appendix with normal submucosal and myenteric plexuses. These findings may represent either the initial presence of a neural tube that later regressed or migration of autosite neural crest cells. The parasite had a mature, functioning kidney with its ureter opening to skin and complete absence of urinary bladder or genital organs. This raises questions about the embryological development of the ureteric bud, which is an outgrowth of the mesonephric duct. The host had tetralogy of fallot and omphalocele containing the parasitic kidney and bowel. Parasitic twinning occurs at 3 weeks of gestation, tetralogy of fallot at 3-7 weeks, and omphalocele at 6-10 weeks. A single noxa acting at 3 weeks could have caused sequential malformations that initially seem unrelated.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
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