Cases reported "Twins, Conjoined"

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1/61. 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.
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2/61. 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.
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3/61. The Ibadan conjoined twins: a report of omphalopagus twins and a review of cases reported in nigeria over 60 years.

    An omphalopagus set of female conjoined twins, undiagnosed prenatally, who presented as obstructed labour needing operative delivery is reported. Their anatomic characteristics and clinical features, including overwhelming sepsis in twin II which forced early separation, and those which led to their demise are described. Twelve other cases reported in nigeria over the past 60 years are reviewed with reference to the aetiology and epidemiology of conjoined twinning and the determinants of successful surgical separation.
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4/61. 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.
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5/61. Parasitic omphalopagus complicated by omphalocele and congenital heart disease.

    Conjoined twins occur in approximately one of every 50,000 to 200,000 births. Atypical or parasitic conjoined twins result from the embryonic death of one twin, which leaves behind body parts vascularized by the primary twin. Omphalopagus refers to conjoined twins joined at the level of the umbilicus. The authors report a case of atypical omphalopagus involving an acardiac, acephalic, parasitic twin and a host twin with a large omphalocele, transposition of the great arteries, and aortic coarctation. The authors briefly review reported cases of parasitic omphalopagus and emphasize the role of intensive neonatal care, preoperative planning, and staged surgical intervention in the successful management of complicated variants.
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6/61. biliary tract anomalies in thoraco-omphalopagus conjoined twins.

    Thoraco-omphalopagus conjoined twins were separated urgently on the ninth day of life because of bowel obstruction and impending intestinal perforation. Preoperative studies clarified the cardiac, intestinal, and hepatic parenchymal anomalies, but the precise biliary anatomy remained obscure. Operative cholangiogram through the single gallbladder visualized only the extrahepatic biliary anatomy in twin A. At reoperation for abdominal patch removal, exploration in twin A found biliary atresia. Because of the unusual duodenal anatomy and extreme short bowel, the authors elected to treat the biliary atresia in twin A with an appendix portoenterostomy. Twin B had no gallbladder and a profoundly hypoplastic biliary tree. Both twins have normal bilirubin and liver function at 18 months of age. The anatomic details of 8 additional cases of complex biliary tract anomalies in thoraco-omphalopagus conjoined twins are reviewed. In all cases, the complex biliary anatomy has been associated with conjoined duodenum. In most cases the preoperative technetium 99m HIDA scan has been inconclusive or misleading.
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7/61. Perineal reconstruction of female conjoined twins.

    BACKGROUND/PURPOSE: Conjoined twins are some of the most challenging patients faced by surgeons. Pygopagus and ischiopagus twins present particular gastrointestinal and genitourinary reconstructive challenges. This study reviews the authors' experience with the perineal reconstruction of these types of conjoined twins. methods: Retrospective analysis was performed for 3 sets of female conjoined twins undergoing separation between 1999 and 2001. Particular attention was given to the separation and reconstruction of the distal gastrointestinal and urogenital structures. RESULTS: Three sets of female conjoined twins underwent successful separation 2 pygopagus, one ischiopagus tripus) with 5 surviving infants. The sixth infant died of congenital anomalies incompatible with life. Four of the 5 surviving infants had diverting enterostomies. Two of these enterostomies have been closed. Perineal reconstruction consisted of anoplasty (5 of 5), vaginoplasty (4 of 5), and urethroplasty (4 of 5). Although fecal and urinary continence are not completely measurable at this age (<3 years), all 5 survivors void spontaneously. Three infants with intestinal continuity have apparently normal defecation without the need of a bowel regimen. CONCLUSIONS: With careful preoperative planning and a multidisciplinary team of pediatric surgeons and urologists, satisfactory reconstruction and functional outcome of the female perineum can be achieved in conjoined twins.
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8/61. spinal cord involvement in pygopagus conjoined twins: case report and review of the literature.

    INTRODUCTION: Pygopagus conjoined twins are joined at the rump and have union of the gastrointestinal and genitourinary systems as well occasional involvement of neural elements. CASE REPORT: We report a case where the terminal spinal cords were fused, despite which there was only a minor motor deficit in the lower limbs after separation. The pre-operative and intra-operative findings are described and issues of long-term follow-up discussed. DISCUSSION: Seven other cases reported in the literature with varying degrees of involvement of the spinal cord and cauda equina are reviewed.
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9/61. Final stage surgical treatment of the conjoined twins of Masasi, tanzania: case report.

    A set of female pygopagus conjoined twins, Agnes and Helen, were born to Margaret Paulo, 22, primigravida, at Masasi in Southern tanzania on 2/4/98. They were referred from Ndanda Mission Hospital to Muhimbili Medical Centre (MMC) on 28/5/98 and from MMC to the Children's Hospital, Cape Town, south africa, where they were successfully separated by Prof. H. Rode and his Team on 28/10/98. Upon separation each Twin had an anorectoplasty and a sigmoid colostomy, with which they returned to tanzania after post-operative recovery. The colostomy closures were performed at MMC by Prof. J.K. Shija, assisted by Dr. P.J. Ngiloi, on 11/3/99 (Helen) and 18/3/99 (Agnes), after completion of Anorectal treatment. They were discharged from MMC on 16/4/99, in satisfactory condition.
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10/61. The separation of Guatemalan craniopagus twins.

    CASE REPORT: The particularities of the surgical procedure for the separation of craniopagi twins performed at UCLA in 2002 are presented. The main difficulty for the neurosurgeons was that the twins shared a common sagittal sinus and that one of the sisters had a poorly developed collateral venous system, thus anticipating a set of postoperative clinical problems. During surgery, the response of the brain to the progressive occlusion of the venous bridges was monitored with EEG and Doppler ultrasound. One of the sisters had a large intracerebral hematoma that was evacuated and later developed hydrocephalus, which was treated with a ventriculoperitoneal shunt. OUTCOME: One of the sisters had a basically uneventful recovery while the other contracted E. coli meningitis 8 months after surgery, thus impairing her motor and cognitive development. DISCUSSION: The details and intricacies of the anesthesia and plastic surgery are also outlined.
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