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Mathur P, Sharma S, Mittal P, Yadav RK, Barolia D. Heteropagus twins: six cases with systematic review and embryological insights. Pediatr Surg Int 2022; 38:963-983. [PMID: 35567628 DOI: 10.1007/s00383-022-05135-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Heteropagus twinning (HT) is a rare anomaly. Six new cases along with a systematic review are described. METHODS Six cases of HT managed at two tertiary care teaching hospitals over the last 26 years are described. A PubMed search with words: Heteropagus AND/ OR parasitic twins from 2001 to 2021 hit 183 articles. 36 were added from non-PubMed sources. Finally, 120 cases including 114 from 69 articles and 6 new cases were analysed. RESULTS Of the new cases, 2/6 had an antenatal diagnosis. Five were males. 4 autosites had omphaloceles. Split notochord and 2 parasites attached to a single autosite were encountered. 5/6 autosites survived. On systematic review, the most frequent variant seen was rachipagus (n = 50) followed by omphalopagus (n = 46). Limbs were reported in 75 cases. Congenital heart disease was seen in 17/120(14.2%) autosites. Omphalocele and meningomyelocele were the most common extracardiac anomalies in autosites. Weight along with the anatomy and position of heteropagus twins was a better determinant of the mode of delivery than weight alone. Mortality was reported in 12 cases. CONCLUSION Autosites in HT generally carry a good prognosis, however, final outcome depends mainly on associated major cardiac anomalies. Meticulous antenatal assessment and preoperative planning are of paramount importance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Praveen Mathur
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, 302004, India
| | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Mittal
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, 302004, India.
| | - Raj Kumar Yadav
- Department of Radiodiagnosis, SMS Medical College, Jaipur, India
| | - Dinesh Barolia
- Department of Pediatric Surgery, SMS Medical College, Jaipur, Rajasthan, 302004, India
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Zewdie K, Negash S, Bizuneh Y, Woldemichael F, Temesgen F. Rachipagus parasitic twins: A case series and review of literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Philipo GS, Nagraj S, Bokhary ZM, Lakhoo K. Lessons from developing, implementing and sustaining a participatory partnership for children's surgical care in Tanzania. BMJ Glob Health 2020; 5:e002118. [PMID: 32206345 PMCID: PMC7078648 DOI: 10.1136/bmjgh-2019-002118] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 12/15/2022] Open
Abstract
Global surgery is an essential component of Universal Health Coverage. Surgical conditions account for almost one-third of the global burden of disease, with the majority of patients living in low-income and middle-income countries (LMICs). Children account for more than half of the global population; however, in many LMIC settings they have poor access to surgical care due to a lack of workforce and health system infrastructure to match the need for children's surgery. Surgical providers from high-income countries volunteer to visit LMICs and partner with the local providers to deliver surgical care and trainings to improve outcomes. However, some of these altruistic efforts fail. We aim to share our experience on developing, implementing and sustaining a partnership in global children's surgery in Tanzania. The use of participatory methods facilitated a successful 17-yearlong partnership, ensured a non-hierarchical environment and encouraged an understanding of the context, local needs, available resources and hospital capacity, including budget constraints, when codesigning solutions. We believe that participatory approaches are feasible and valuable in developing, implementing and sustaining global partnerships for children's surgery in LMICs.
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Affiliation(s)
- Godfrey Sama Philipo
- Biostatistcs and Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Shobhana Nagraj
- Oxford University Global Surgery Group, University of Oxford, University of Oxford, Oxford, UK
| | - Zaitun M Bokhary
- Department of Paediatirc Surgery, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
| | - Kokila Lakhoo
- Oxford University Global Surgery Group, University of Oxford, University of Oxford, Oxford, UK
- Department of Paediatirc Surgery, Muhimbili National Hospital, Dar es Salaam, Dar es Salaam, United Republic of Tanzania
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Kelani AB, Moumouni H, Issa AW, Younsaa H, Fokou H, Sani R, Sanoussi S, Denholm LJ, Beever JE, Catala M. Notomelia and related neural tube defects in a baby born in Niger: case report and literature review. Childs Nerv Syst 2017; 33:529-534. [PMID: 28083641 DOI: 10.1007/s00381-017-3337-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Notomelia associated with neural tube defects are rare diseases. CASE REPORT A baby was born in Niger with multiple congenital embryonic malformations on the posterior midline. The most rostral malformation was an accessory limb (polymelia) at the level of the lumbar vertebrae composed of two long bones, a foot and three toes. Accessory male genitalia were present at the base of this malformed accessory limb which had no apparent motor or sensory innervation. The second malformation was a sacral vestigial appendage with an adjacent dermal sinus opening onto the posterior midline and extending internally to the dura through a defect of the vertebral arches. From the published literature and this particular case, we conclude that notomelia is a rare clinical sequela of a neural tube defect (NTD) and is correctly classified as a dysraphic appendage. CONCLUSION The recent occurrence of three similar cases in the same ethnic group from Niger, three from consanguineous parents, suggests that genetic factors are likely to contribute significantly to the genesis of this syndrome, consistent with a recent report that mutation of the bovine NHLRC2 gene resulting in a V311A substitution at a highly conserved locus in the NHLRC2 protein is, when homozygous, causally associated with several forms of polymelia including notomelia, with heteropagus conjoined twinning and with other NTD-related embryonic malformations. Detailed genome-wide studies of children with dysraphic appendages are indicated.
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Affiliation(s)
- A B Kelani
- Département de Chirurgie, Faculté des Sciences de la Santé (FSS), Université Abdou Moumouni (UAM), Niamey, Niger
- Service de Neurochirurgie, Hôpital National, Niamey, Niger
| | - H Moumouni
- Département d'Embryologie, FSS, UAM, Niamey, Niger
| | - A W Issa
- Service de Neurochirurgie, Hôpital National, Niamey, Niger
| | - H Younsaa
- Service de Chirurgie Générale, Hôpital National, Niamey, Niger
| | - Hmu Fokou
- Service de Chirurgie Générale, Hôpital National, Niamey, Niger
| | - R Sani
- Service de Chirurgie Générale, Hôpital National, Niamey, Niger
| | - S Sanoussi
- Département de Chirurgie, Faculté des Sciences de la Santé (FSS), Université Abdou Moumouni (UAM), Niamey, Niger
- Service de Neurochirurgie, Hôpital National, Niamey, Niger
| | - L J Denholm
- NSW Department of Industry, Orange NSW, Australia
| | - J E Beever
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - M Catala
- Sorbonne Université, UPMC Université Paris 06, UMR7622, F-75005, Paris, France.
- CNRS, Institut de Biologie Paris Seine (IBPS) - Developmental Biology Laboratory, UMR7622, F-75005, Paris, France.
- INSERM, ERL1156, F-75005, Paris, France.
- Fédération de Neurologie, Groupe hospitalier Pitié-Salpêtrière-APHP, F-75013, 47-83 Bd de l'Hôpital, 75651, Paris Cedex 13, France.
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Parasitic twin--a supernumerary limb associated with spinal malformations. A case report. Acta Neurochir (Wien) 2016; 158:611-4. [PMID: 26811301 DOI: 10.1007/s00701-016-2710-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
We describe a case of rachipagus parasitic twin with spinal cord malformations (lipomyelomeningocele and tethered cord) in a 7-month-old Ethiopian infant. The parasitic mass had a well-formed foot, ankle and lower leg and a small sinus that resembled an anus. Magnetic resonance imaging scans revealed spinal malformations including a distal syringohydromyelia. The mass was successfully resected and the dural attachment was closed. Histopathological examination confirmed the diagnosis. Postoperatively, the child had unchanged, intact neurological function in both lower limbs. Almost all rachipagus parasitic twins are associated with spinal malformations. They should, therefore, be operated on by surgeons experienced in myelomeningocele surgery.
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