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1.
Medicine (Baltimore) ; 100(4): e24490, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530268

RESUMO

RATIONALE: Conjoined twins are a rare complication of monochorionic pregnancies and an extremely rare condition in spontaneous triplet pregnancies. We report a case of conjoined twins in a spontaneous monochorionic triplet pregnancy. The conjoined twins might have suffered from twin anemia-polycythemia sequence, which was reported to be extremely rare. PATIENT CONCERNS: A 26-year-old woman conceived spontaneously with an obstetric history of invasive mole 4 years ago. DIAGNOSES: We initially misdiagnosed her as having monochorionic triamniotic triplets at 10 weeks of gestation. However, we confirmed conjoint twins with the monochorionic diamniotic triplet pregnancy at 12 weeks of gestation and classified them as omphalopagus. INTERVENTIONS: As the woman decided to continue the pregnancy, regular and careful antenatal care was conducted. OUTCOMES: Unexpectedly, she had a stillbirth 3 weeks later and had to terminate the pregnancy at 15 weeks of gestation. After abortion, the diagnosis of omphalopagus was confirmed in the induced fetuses. Moreover, the skin colors of the conjoined twins were different: one was plethoric, and the other was pale. Additionally, the parents agreed to examine the chromosome of the fetuses, and the results were normal. CONCLUSION: Dichorionic triplet and monochorionic triplet pregnancies have a poorer prognosis than trichorionic triplet pregnancies. Surgery is the main therapy for conjoined twins; however, most conjoined twins in triplet pregnancies cannot survive, including omphalopagus twins. The conjoined twins may have suffered from twin anemia-polycythemia sequence, which could probably not be diagnosed intrauterine. Transvaginal probe and 3-dimensional ultrasound may be helpful for clarifying the diagnosis in early pregnancy.


Assuntos
Trigêmeos , Gêmeos Unidos , Aborto Eugênico , Adulto , Feminino , Humanos , Gravidez , Gravidez de Trigêmeos , Natimorto , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal
5.
Curr Opin Anaesthesiol ; 33(3): 381-387, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32371638

RESUMO

PURPOSE OF REVIEW: A number of high profile conjoined twin separations have been extensively covered by the world media. Anaesthesia for conjoined twins is a procedure rarely experienced by paediatric anaesthetists. The increased survival of the twins has prompted discussion as to the most appropriate selection of patients, teams and hospitals to provide exceptional anaesthetic care. RECENT FINDINGS: The number of conjoined twins presenting for surgery remains low with many infants not surviving foetal or early neonatal life. Anaesthetic management of less common conjoined infants such as craniopagus twins has highlighted the benefit of careful patient selection, extensive preoperative investigations and meticulous multidisciplinary team planning. The role of simulation of possible adverse perioperative events has been highlighted. Three dimensional anatomical models and virtual reality systems have permitted surgical planning in advance of actual intervention. A number of legal and ethical concerns have been reported especially in the setting of emergency separation where surgery is likely to contribute to death of one of the twins. SUMMARY: There appears to be an expanding role for international teams with extensive separation experience becoming involved in international teleconferencing to improve patient management in low-resource countries. Whether the perioperative outcome is better when the conjoined twins are transferred to major centres for surgery or teams operate in the twin's country of origin remains to be seen.


Assuntos
Manuseio das Vias Aéreas , Anestesia/tendências , Cuidados Críticos , Gêmeos Unidos/cirurgia , Manuseio das Vias Aéreas/tendências , Criança , Cuidados Críticos/tendências , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Ressuscitação
6.
AJNR Am J Neuroradiol ; 41(6): 951-959, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32439641

RESUMO

Craniopagus twins are a rare congenital malformation in which twins are conjoined at the head. Although there is high prenatal and postnatal mortality for craniopagus twins, successful separation has become more common due to advances in neuroimaging, neuroanesthesia, and neurosurgical techniques. Joined brain tissue, shared arteries and veins, and defects in the skull and dura make surgery technically challenging, and neuroimaging plays an important role in preoperative planning. Drawing on our experience from consultation for multiple successful separations of craniopagus twins, we discuss what radiologists need to know about the anatomy, classification, imaging techniques, and surgical management of craniopagus twins.


Assuntos
Encéfalo/diagnóstico por imagem , Neuroimagem/métodos , Procedimentos Neurocirúrgicos/métodos , Crânio/diagnóstico por imagem , Gêmeos Unidos/cirurgia , Encéfalo/anormalidades , Feminino , Humanos , Imageamento Tridimensional/métodos , Período Pré-Operatório , Crânio/anormalidades , Gêmeos Unidos/classificação
7.
Ann Thorac Surg ; 110(4): e327-e329, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32224240

RESUMO

Conjoined twins are rare congenital malformations known to be associated with cardiac abnormalities. Management of transposition of the great arteries with an intact ventricular septum in this subgroup of patients is challenging, especially in the presence of multiple comorbidities. Prevention of left ventricular involution until the patient is stable for an arterial switch operation is a real challenge. We report a case of early ductal stenting to keep the left ventricle well trained in a separated conjoined twin who eventually underwent an arterial switch operation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças em Gêmeos , Stents , Transposição dos Grandes Vasos/cirurgia , Gêmeos Unidos , Função Ventricular Esquerda/fisiologia , Septo Interventricular/cirurgia , Pré-Escolar , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Transposição dos Grandes Vasos/diagnóstico , Septo Interventricular/diagnóstico por imagem
8.
Pan Afr Med J ; 35: 8, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32117523

RESUMO

Conjoined twins are a rare malformation of monozygotic and mono-amniotic twin pregnancies. We report the case of a patient in whom dicephalic conjoined twins was diagnosed in the antenatal period at 37 week amenorrhea. Fetal prognosis is very poor and, if the diagnosis has been made early, it most often requires therapeutic abortion. The purpose of this case study was to remind clinicians of this very rare disease, of the importance of ultrasound as an essential diagnostic tool to implement a strategy to manage patients in the postpartum period and of prognosis which is most often very guarded.


Assuntos
Feto/diagnóstico por imagem , Gêmeos Unidos , Ultrassonografia Pré-Natal , Feminino , Feto/anormalidades , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Gravidez de Gêmeos , Adulto Jovem
9.
Fetal Diagn Ther ; 47(2): 165-170, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31434071

RESUMO

Preterm birth remains a major complication of fetal laser surgery (FLS) due to twin-to-twin transfusion syndrome (TTTS). OBJECTIVES: We tested the hypothesis that neonatal outcomes in fetuses born at >24 weeks are worse in TTTS survivors compared to uncomplicated monochorionic diamniotic (MCDA) twins. METHODS: 196 patients with TTTS treated with laser therapy and 91 uncomplicated MCDA gestations were compared. Neonatal outcomes included respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death. Risk factors assessed were TTTS, maternal age, maternal body mass index, race, premature prolonged rupture of membranes, stage of TTTS, parity, and gestational age (GA) at delivery. RESULTS: GA at delivery was lower in the TTTS group (31.0 ± 4.6 vs. 33.5 ± 2.4 weeks, p < 0.001). RDS and TTN occurred at higher rates in the TTTS than in the uncomplicated MCDA group. After multivariate logistic regression, the only factor significantly associated with the composite adverse outcome was GA at delivery (OR 0.61; 95% CI: 0.58-0.7). CONCLUSION: TTTS twins treated with FLS are deliver 2.5 weeks earlier than uncomplicated MCDA twins. Respiratory complications were significantly higher in TTTS twins and were mainly the consequence of the early GA at delivery.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia , Terapia a Laser , Gêmeos Unidos , Gêmeos Monozigóticos , Adulto , Displasia Broncopulmonar/etiologia , Bases de Dados Factuais , Feminino , Transfusão Feto-Fetal/diagnóstico por imagem , Transfusão Feto-Fetal/mortalidade , Transfusão Feto-Fetal/fisiopatologia , Fetoscopia/efeitos adversos , Fetoscopia/mortalidade , Idade Gestacional , Humanos , Recém-Nascido Prematuro , Terapia a Laser/efeitos adversos , Terapia a Laser/mortalidade , Gravidez , Nascimento Prematuro/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Fatores de Risco , Taquipneia Transitória do Recém-Nascido/etiologia , Resultado do Tratamento , Adulto Jovem
10.
Surgery ; 167(2): 259-263, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30792012

RESUMO

BACKGROUND: Three-dimensional printing is an additive manufacturing method that builds objects from digitally generated computational models. Core technologies behind three-dimensional printing are evolving rapidly with major advances in materials, resolution, and speed that enable greater realism and higher accuracy. These improvements have led to novel applications of these processes in the medical field. METHODS: The process of going from a medical image data set (computed tomography, magnetic resonance imaging, ultrasound) to a physical three-dimensional print includes several steps that are described. Medical images originate from Digital Imaging and Communications in Medicine files or data sets, the current standard for storing and transmitting medical images. Via Digital Imaging and Communications in Medicine manipulation software packages, a segmentation process, and manual intervention by an expert user, three-dimensional digital and printed models can be constructed in great detail. RESULTS: Cardiovascular medicine is one of the fastest growing applications for medical three-dimensional printing. The technology is more frequently being used for patient and clinician education, preprocedural planning, and medical device design and prototyping. We report on three case studies, describing how our three-dimensional printing has contributed to the care of cardiac patients at the University of Minnesota. CONCLUSION: Medical applications of computational three-dimensional modeling and printing are already extensive and growing rapidly and are routinely used for visualizing complex anatomies from patient imaging files to plan surgeries and create surgical simulators. Studies are needed to determine whether three-dimensional printed models are cost effective and can consistently improve clinical outcomes before they become part of routine clinical practice.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Coração/diagnóstico por imagem , Medicina de Precisão , Impressão Tridimensional , Dextrocardia , Humanos , Gêmeos Unidos
11.
J Pediatr Surg ; 55(3): 576-578, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31711741

RESUMO

Rowena Spencer (1922-2014) was the country's first woman pediatric surgeon. She was one of four women in her medical school class at Johns Hopkins (1943-1947), the first woman intern in surgery at the Johns Hopkins Hospital working under Alfred Blalock (1947-1948), the first woman to train in pediatric surgery at the Children's Hospital of Philadelphia working under C. Everett Koop (1948-1949), the first woman to complete a surgery residency at Charity Hospital in New Orleans (1953), and the first woman to join the surgery faculty at Louisiana State University in New Orleans (1953). She was an expert on conjoined twins, writing a substantial text on the subject. She died in Alexandria, Virginia, in 2014 at the age of 91. This biographical essay, written by a patient, shares a family's memories of Spencer over a period of nearly 6 decades. It also shares her reflections on her patients, her career, and the profession of pediatric surgery.


Assuntos
Pediatras , Feminino , História do Século XX , História do Século XXI , Hospitais Pediátricos/organização & administração , Humanos , Philadelphia , Especialidades Cirúrgicas/organização & administração , Gêmeos Unidos/cirurgia , Virginia
13.
BMJ Case Rep ; 12(12)2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31826902

RESUMO

Conjoined twins are a rare outcome of conception associated with numerous anomalies involving multiple organ systems. Musculoskeletal abnormalities like vertebral anomalies, sacral agenesis, foot deformities and hip dysplasia have been described in literature. We describe two cases of pyopagus twins with congenital talipes equinovarus and congenital vertical talus deformity which have not been described previously in this type of conjoined twins. The orthopaedist should look actively for such deformities in this patient population and be wary of the difficulties associated with their management.


Assuntos
Deformidades Congênitas do Pé/terapia , Manipulação Ortopédica/instrumentação , Gêmeos Unidos , Moldes Cirúrgicos , Feminino , Deformidades Congênitas do Pé/fisiopatologia , Humanos , Lactente , Manipulação Ortopédica/métodos , Resultado do Tratamento
14.
Radiographics ; 39(7): 2146-2166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31697621

RESUMO

The twin birth rate is increasing in the United States. Twin pregnancies can be dichorionic or monochorionic (MC). MC twins account for 20% of twin pregnancies but 30% of all-cause pregnancy-related complications. This article describes the imaging findings that establish chorionicity and amnionicity. Ideally, these are established in the first trimester when accuracy is high, but they can also be determined later in pregnancy. Complications unique to MC twin pregnancy include twin-twin transfusion syndrome, twin anemia polycythemia sequence, twin reversed arterial perfusion sequence, and selective fetal growth restriction. The US features, staging systems, and management of these complications are reviewed, and the consequences of MC twin demise are illustrated. Ongoing surveillance for these conditions starts at 16 weeks gestation. Monoamniotic (MA) twins are a small subset of MC twins. In addition to all of the MC complications, specific MA complications include cord entanglement and conjoined twinning. Radiologists must be able to determine chorionicity and amnionicity and should be aware of potential complications so that patients may be referred to appropriate regional specialized centers. A proposed algorithm for referral to specialized fetal treatment centers is outlined. Online supplemental material is available for this article. ©RSNA, 2019.


Assuntos
Âmnio/diagnóstico por imagem , Córion/diagnóstico por imagem , Gravidez de Gêmeos , Ultrassonografia Pré-Natal/métodos , Âmnio/cirurgia , Córion/cirurgia , Doenças em Gêmeos/diagnóstico por imagem , Doenças em Gêmeos/terapia , Feminino , Morte Fetal , Doenças Fetais/diagnóstico por imagem , Terapias Fetais , Transfusão Feto-Fetal/diagnóstico por imagem , Transfusão Feto-Fetal/cirurgia , Fetoscopia , Humanos , Terapia a Laser , Gravidez , Trimestres da Gravidez , Gêmeos Unidos , Gêmeos Dizigóticos , Gêmeos Monozigóticos , Ultrassonografia Doppler em Cores/métodos
15.
Twin Res Hum Genet ; 22(5): 419-424, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31608853

RESUMO

This article explores some rare sides of twin research. The focus of this article is the sad plight of the Dionne quintuplets, born in Canada in 1934. However, several other studies belong in this category, such as Dr Josef Mengele's horrifying twin research conducted at the Auschwitz concentration camp, Dr John Money's misguided attempt to turn an accidentally castrated male twin into a female, Russian scientists' cruel medical study of conjoined female twins and Dr Peter Neubauer's secret project that tracked the development of separated twins. Reviews of current twin research span twins' representation of self-image, twins with Kleine-Levin Syndrome, heteropaternal twinning in lemurs and factors affecting risk of dental caries. Media coverage includes a pair of high-society models, a book about the 'Winkelevii' twins, Super Bowl twin teammates, a family with three sets of fraternal twins, a twin sister surrogate and a near presidential twin.


Assuntos
Cárie Dentária , Síndrome de Kleine-Levin , Lemur , Estudos em Gêmeos como Assunto/história , Gêmeos Unidos , Animais , Canadá , Feminino , História do Século XX , Humanos , Masculino , Fatores de Risco
16.
Proc Inst Mech Eng H ; 233(12): 1327-1332, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31554483

RESUMO

We describe the use of virtual reality technology for surgical planning in the successful separation of thoracopagus conjoined twins. Three-dimensional models were created from computed tomography angiograms to simulate the patient's anatomy on a virtual stereoscopic display. Members of the surgical teams reviewed the anatomical models to localize an interatrial communication that allowed blood to flow between the two hearts. The surgical plan to close the 1-mm interatrial communication was significantly modified based on the pre-procedural spatial awareness of the anatomy presented in the virtual visualization. The virtual stereoscopic display was critical for the surgical team to successfully separate the twins and provides a useful case study for the use of virtual reality technology in surgical planning. Both twins survived the operation and were subsequently discharged from the hospital.


Assuntos
Cirurgia Assistida por Computador/métodos , Gêmeos Unidos/cirurgia , Realidade Virtual , Feminino , Humanos , Lactente , Tomografia Computadorizada por Raios X
18.
Croat Med J ; 60(4): 301-308, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31483115

RESUMO

Conjoined twining is a rare medical phenomenon, with an overall prevalence of 1.47 per 100 000 births. This report describes a successful separation of xypho-omphalopagus conjoined twins complicated by unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma. Significant extrauterine twin-twin transfusion syndrome caused by unbalanced shunting is an extremely rare, and probably under-recognized, hemodynamic complication in conjoined twins necessitating urgent separation. Progressive deterioration with a poor outcome can be prevented if the condition is recognized in a timely manner.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fígado/cirurgia , Gêmeos Unidos/cirurgia , Feminino , Humanos , Recém-Nascido , Gravidez
19.
Surgery ; 166(5): 854-860, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31402130

RESUMO

BACKGROUND: Conjoined twins are rare developmental anomalies. There is a paucity of literature other than case reports and small case series. The aim of this study was to examine national outcomes and identify predictors of mortality in newborn conjoined twins. METHODS: We reviewed data on newborn conjoined twins from the Kids' Inpatient Database (1997-2012). RESULTS: A total of 240 patients were identified for a nationally weighted incidence of 1 per 100,000 live births. The majority of conjoined twins were female (n = 190 [81%]). The most commonly associated anomalies were cardiac (n = 87 [36%]), gastrointestinal (n = 41 [17%]), and abdominal wall (n = 32 [13%]) defects. Fifty-six (23%) patients underwent operative procedures, including 28 (12%) neonatal separation surgeries. The overall mortality rate was 61%; most deaths occurred within 24 hours (99 of 146 [68%]) to 48 hours (129 of 146 [88%]) after birth. Mortality was higher in female compared with male children (66% vs 38%, P = .025), premature compared with full-term children (72% vs 44%, P = .007), and in children with extremely low birth weight (95% vs 59%, P = .002). Congenital diaphragmatic hernias were seen in 15 (6%) patients and were uniformly fatal (100% vs 58%, P = .029). Mortality was highest in hospitals not designated as children's hospitals (72%) compared with children's hospitals (44%) (P = .007). CONCLUSION: Conjoined twins are rare anomalies who are susceptible to extremely high perinatal mortality, especially in female children, those who are premature, or those who have low birth weight. These data support caring for these complex patients at hospitals equipped to care for this fragile population.


Assuntos
Anormalidades Múltiplas/mortalidade , Mortalidade Hospitalar , Hospitais Pediátricos/estatística & dados numéricos , Gêmeos Unidos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
20.
Indian J Pathol Microbiol ; 62(3): 430-432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31361232

RESUMO

Conjoined twins are a very rare complication of monozygotic twinning, most common being thoracopagus. Here we report about two cases of thoracopagus male twins illustrating the autopsy details of one case and the prenatal magnetic resonance imaging (MRI) details of another case. While the first case was misdiagnosed as separate twins on antenatal USG, only to be later confirmed as thoracopagus twins after birth, the antenatal MRI done in the second case helped in accurate detection of thoracopagus twins. Bilateral peripheral cortical cysts with dysplasia was noted in one of the twins of the first case, which has not been reported earlier in conjoint thoracopagii. Early prenatal diagnosis of conjoined twins is essential for better counselling of parents regarding post natal surgical management or termination of pregnancy. Importance of prenatal MRI for accurate detection of these cases is thereby highlighted.


Assuntos
Diagnóstico Pré-Natal , Gêmeos Unidos/patologia , Adulto , Autopsia , Feminino , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Gravidez , Gêmeos Unidos/cirurgia
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