Separation Of Twins Research Articles

Emergency Transplantation of Free Flap between Separated Thoraco-Omphalopagus Conjoined Twins.

Emergency Transplantation of Free Flap between Separated Thoraco-Omphalopagus Conjoined Twins.

Staged separation of craniopagus twins

Craniopagus twins are rare and account for up to 6% of all conjoined twins. No hospital will encounter many such twins and the opportunity to develop expertise is limited. We have dealt with 2 such sets and illustrate our approach by reference to our most recent set. We believe that detailed imaging allows precise delineation of the anatomy and facilitates detailed planning of the surgery. When venous drainage from the 2 brains is connected, we believe that staged separation is preferable as gradual alteration of hemodynamics may be safer than a single-stage procedure.

Anesthetic management for separation of thoracopagus twins with complex congenital heart disease: a case report.

Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration.

Don LaRossa, M.D., 1941 to 2014.

Don LaRossa, M.D., 1941 to 2014.

Art for twins: Yorùbá artists and their statues/twin research studies: twins' education and conceptions; diurnal preference; inherited eye diseases; ultrasound counseling when twins are conjoined/popular twin reports: twin sisters (the film); rare pregnancy; diet test; French twins reared apart and reunited.

The Yorùbá of Nigeria are well known for their high twinning rate and the statues they create to commemorate deceased twins. An impressive collection of this artwork was displayed at the University of California's Fowler Museum in Los Angeles between October 13, 2013 and March 2, 2014. An overview of this exhibit is provided. Next, twin research on maternal education and conception, diurnal preference, inherited eye diseases, and ultrasound counseling for couples with conjoined twins are briefly summarized. This article concludes with a discussion of media-based items related to twins. The topics include an award-winning twin film, a rare pregnancy, a diet test, and the separation and chance reunion of monozygotic female twins.

An Epigastric Heteropagus Twin with Ruptured Giant Omphalocele

We present a case of heteropagus twins attached to the epigastric region. The neonate also had ruptured giant omphalocoele with most of gut and liver lying outside the abdominal cavity. Patient had uneventful surgery for separation of twins and repair of ruptured omphalocoele.

Twins and Kindergarten Separation

Should principals enforce mandatory separation of twins in kindergarten? Do school separation beliefs of principals differ from those of teachers, parents of twins, and twins themselves? This survey questioned 131 elementary principals, 54 kindergarten teachers, 201 parents of twins, and 112 twins. A majority of principals (71%) believed that twins should be separated in kindergarten, while only 49% of teachers, 38% of parents, and 19% of preschool and kindergarten twins agreed. Additional survey results describe reasons for separation beliefs held, perceived trauma of kindergarten separation, positive and negative reactions to school separation, and percentage of kindergartners separated. Representative belief statements of twins, categorized into themes, supplement the report. Administrative bias and discrimination against twins are discussed. Recommendation is that principals should avoid making unilateral twin placement decisions.

A case report of conjoined twin(PYGOPAGUS) separation

We report successful separation of PYGOPAGUS twins. Meticulous planning and multidisciplinary approach are the core aspects in the management of Pygopagus conjoined twins. Early elective separation versus delayed separation of the conjoined twins improves the survival from 40% to 80% . Preoperative assessment of sickle cell disease, cross-circulation and organ sharing between twins proved valuable for planning sedation and analgesia and allowing detailed scripting of the complex anesthetic induction sequence, airway management, complex neurological monitoring and post operative intensive care related issues. Fusion of lower back, spinal cord , nerve roots , and rectal and genitourinary tract was a major surgical challenge related to potentially adverse neurological outcomes, bladder /bowel dysfunction and intact long term survival. Post operative critical care issues such as pain , prone ventilation, sickle cell sequalae, cerebrospinal fluid leak and meningitis, wound infection and colostomy care, nutrition, and other potential complications are discussed in detail in this report. We emphasize the role of pediatric intensive care, preoperative planning with multidisciplinary team, and staged surgical intervention and a good postoperative care in the successful management of complicated variants.

Caudal duplication syndrome

Caudal duplication syndrome is a rare entity in which structures derived from the embryonic cloaca and notochord are duplicated to various extents. Its prevalence at birth is less than 1 per 100,000. The term caudal duplication encompasses a spectrum of anomalies and is often used to describe incomplete separation of monovular twins or referred to as part of the spectrum of anomalies associated with conjoined twinning. It usually includes multiple rare malformations and duplications of distal organs derived from the hindgut, neural tube, and caudal mesoderm. It was postulated that the disorder is related to misexpression of one or more of the distal HOX genes, potentially HOX10 or HOX11, leading to abnormal proliferation of caudal mesenchyme. The malformations are usually diagnosed by anomaly scan in the second trimester. Here we report the case of a baby presenting on the first day of life with complete duplication of caudal structures below the dorsolumbar level.

Thoraco-omphalopagus conjoined twins: impact of ultrasound assessment on successful surgical separation

In this case report, we present a case of thoraco-omphalopagus conjoined twins who were successfully separated and had long-term survival. We performed ultrasound assessment and found that the twins shared the liver and that the fusion site of their liver had gross communication of blood vessel. Ultrasound cardiogram examination showed that the anomalous vessels that connected their hearts drained from the number 1 infant to the number 2 infant. The ultrasound assessment has significant impact on the successful surgical separation of the thoraco-omphalopagus twins.

To separate or not to separate? Parental decision-making regarding the separation of twins in the early years of schooling

In recent times concerns about possible adverse effects of early separation and advocacy for individual rights have resulted in a movement away from organizational level policies about the separation of twin children as they enter school. Instead, individualized approaches that focus on the twin children’s characteristics and family perspectives have been proposed. This study, conducted in Australia where all but a few families had choice about the class placement of their twin children, questioned parents ( N = 156) about their placement decisions. Results indicated that most parents opted for placement together in the early years of schooling. The choice to separate twins at school entry was associated with parent identification of risk in the twin relationship, while being kept together was associated with parent identification of absence of such risk. The findings are discussed in light of the current evidence against separation, and suggest that parent choices regarding the separation of twin children in the early years are informative to educational policy and practice.

Conjoined Twin Separation

The separation of conjoined twins presents a unique challenge to many pediatric surgical specialties. A multidisciplinary approach is essential for successful twin separation, and plastic surgeons are critical members of this surgical team when soft-tissue requirements preclude simple closure. In this article, the authors review multiple techniques available to plastic surgeons for providing adequate soft-tissue coverage in this unique clinical situation and present lessons learned from their experience at The Children's Hospital of Philadelphia with seven conjoined twin separations performed between the years 1980 and 2007. Successful separation was accomplished in six of the seven conjoined twin pairs, expander complications requiring reoperation occurred in three twin pairs, and skin grafting was required because of insufficient expansion in two twin pairs. The techniques found to be critical to successful separation include maximal extracavitary tissue expansion with smooth-wall remote port tissue expanders, protection of expanded skin through pressure-reducing strategies, fluorescein vascular territory mapping, the use of frozen banked autogenous skin for salvage, and the use of supplemental nutritional support. The overall success of conjoined twin separation depends on the experience and preparedness of the treating team and the resources available at the pediatric specialty center. Multiple techniques are available to plastic surgeons to optimize success in this challenging clinical situation. Therapeutic, V.

Monochorionic diamniotic conjoined twins

Monochorionic diamniotic (MCDA) conjoined twins are extremely rare. In monochorionic monoamniotic (MCMA) conjoined twins, the embryonic disc failed to undergo complete separation at 15-17th day of gestation. Conversely, MCDA conjoined...

Organ Donation: A Twin-Based Perspective / Research Reviews / Media Coverage

Monozygotic cotwins are ideal organ donors for one another due to their genetic identity. The present report treats this topic differently, from the perspective of a monozygotic twin who donated her deceased twin sister's organs following her sister's untimely death. This discussion is followed by reviews of recent research concerning increased twinning rates in the United States, availability of informative kinship pedigrees, and twin discordance for physical activities. Noteworthy news items include ethical issues surrounding conjoined twin separation, a genomic discovery for diseased twins, China's One-Child Policy, a striking New Yorker Magazine cartoon, and twin delivery complications.

Separation of thoraco-omphalopagus twins in a rural secondary hospital: Perioperative management

Providing anaesthesia for the separation surgery of conjoined twins presents unique challenges to the managing anaesthesiologists. The low incidence of such surgeries and anatomical variations in each type of conjoined twins makes each separation surgery a unique experience. This report features the anaesthetic plan and challenges faced in performing the separation surgery of a set of thoraco-omphalopagus twins in a rural secondary hospital in a remote location in India.

The Bioethics of Separating Conjoined Twins in Plastic Surgery

The incidence of craniopagus twins approximates four to six per 10 million births. Although rare, surgical separation of conjoined twins poses significant technical and ethical challenges. The present report uses the case of craniopagus twins AD and TD to examine the bioethical issues faced by a multidisciplinary medical team in planning the separation of craniopagus twins. AD and TD are craniopagus twins conjoined at the head. TD's head is conjoined to the back of AD's head. Neurologically, AD has the dominant cerebral circulation. TD has two normal kidneys, whereas AD has none. AD depends on TD's renal function and, on separation, will require either a kidney transplant or lifelong dialysis. This case report reviews one approach to analyzing and solving complex ethical dilemmas in pediatric plastic surgery. The principles reviewed are (1) autonomy and informed consent, focusing especially on the role of children in the informed consent process; (2) beneficence and nonmaleficence, two intricately intertwined principles because separation could potentially cause irreversible harm to one twin while improving the quality of life for the other (as separation is not a life-saving procedure, is it ethical to perform a procedure with unknown surgical risk to improve children's quality of life?); and (3) justice (is it fair to allocate excessive medical resources for the twins' separation?). The present report explores the ethics behind such decisions with respect to the separation of conjoined twins.

Successful separation of the conjoined thecal sac with an epidermal cyst in pygopagus twins

Pygopagus conjoined twins are very rare, and half of all pygopagus twins have other anomalies. This report describes the successful surgical separation of pygopagus twins who had a conjoined thecal sac and an epidermal cyst. Meticulous preoperative planning, development of a model simulator, multispecialty teamwork, and a staged surgery contributed to a successful outcome.

Anaesthesia for the separation of conjoined twins

Thoraco-omphalopagus is one of the most common type of conjoint twins accounting for 74% cases of conjoint twins. We report the anaesthetic management for successful separation of thoraco-omphalopagus conjoint twins, both of them surviving till date. We highlight the responsibility of anaesthesia team in anaesthetising the two individual patients simultaneously, need of careful monitoring and anticipation of complications like massive blood loss, hypotension, hypokalemia, hypoxia and hypercabia. Detailed description of successful management is reported.

Passion and Technology: Separation of Egyptian Conjoined Twins

Advances in technology in the last 30 years have exponentially improved accuracy in the diagnosis, treatment, and delivery of technically advanced surgery. Craniofacial surgery has become safer and more precise by using 3‐D models. These models are produced by using CT scan and MRI data which is stereographically or digitally implemented to provide anatomical reconstruction, which serves as a road map for the surgical team. Accurate pre‐operative sequencing, timing, and approaches can be planned out in detail before the surgery is performed.Dismal results over the last 400 years have prompted some critics to condemn surgical attempts at separation of craniopagus twins. Alice Dreger says, “They shouldn't be separated; society needs to change its attitude about deformity.” Very few craniopagus twins have been successfully separated, and functioned in society.Two Egyptian boys attached extensively at the head, shared their brain at the motor cortex. Their skulls were fused completely and shared their mutually conjoined head anatomy.Extensive studies, including complete anatomic body models with 3‐D brain, venous system, and other vital anatomic structures, were produced from CT and MRI data. Ultimately, a complete step by step 36 hour operation was planned and executed, leading a team of 50 medical caregivers. This on‐going story will be relayed in detail during this presentation.

Population-Based Research: Breastfeeding Multiple Birth Infants / Twin Research Reviews and News: Perceived Aging in Twins; Separation of Conjoined Twins; School Placement Legislation / Twins in Education, Fashion and Humanitarian Events

The health benefits of breastfeeding are well known. However, less is known about the frequency and duration of breastfeeding in twins. A population-based study of maternal factors associated with the early cessation of breastfeeding in preterm and term twins is reviewed. This is followed by research reviews and news concerning aging in twins, conjoined twin separation and school legislation for multiple birth children. Twins and quadruplets who have distinguished themselves in the areas of education, fashion design and humanitarian efforts are highlighted.