scholarly journals Heteropagus Twins with Hepatobiliary and Gastrointestinal Connectedness and Complex Cardiac Malformation in Autosite

2019 ◽  
Author(s):  
Aaron Teel ◽  
Benjamin Kwan ◽  
Mousumi Bhaduri
Keyword(s):  
Management Plan ◽  
Conjoined Twins ◽  
Left Hemithorax ◽  
Prenatal Mri ◽  
Parasitic Twin ◽  
Prenatal Imaging ◽  
Supernumerary Limbs ◽  
The Right ◽  
Incomplete Cleavage ◽  
Embryonic Death

Introduction: Heteropagus twins are a set of conjoined twins with one being grossly abnormal, the ‘parasite’, and the other being relatively normal, the ‘autosite’. Case Report: A pair of heteropagus twins were initially identified on prenatal ultrasound and subsequently confirmed using prenatal MRI at 25 weeks gestational age. Prenatal imaging identified supernumerary limbs, accessory small bowel loops in the parasitic twin, a hypoplastic left heart in the right hemithorax of the autosite, and a shared liver and bowel between the two. Delivery occurred at 38 + 5 weeks gestation via C-section with an APGAR score of 9/9 for the autosite at both 1 and 5 minutes. MRI confirmed an interconnected autosite-parasite liver that was herniating into the left hemithorax as well as continuous autosite-parasite bowel loops. The patient underwent surgical management including resection of the parasitic twin and repair of the congenital heart defect and is now thriving. Discussion: Heteropagus twins include a spectrum of clinical entities from nonconjoined twins to intact conjoined twins. The predominant theory regarding etiology is an incomplete cleavage of a monozygotic embryo at approximately 2 weeks gestation. Following differentiation, ischemia-induced atrophy leads to the embryonic death of the parasite and hemodynamic changes in the autosite to support parasite tissues. The use of antenatal and postnatal imaging is crucial in establishing the diagnosis, management plan, and longterm prognosis secondary to the congenital cardiac malformations and degree of interconnectedness. Conclusion: This is the first reported case of heteropagus twins with co-existing hepatobiliary and gastrointestinal continuity.

scholarly journals Comorbidity between Klinefelter syndrome and diaphragmatic hernia. A case report

2014 ◽  
Vol 132 (5) ◽  
pp. 311-313
Author(s):  
Carolina Melendez Valdez ◽  
Stephan Philip Leonhardt Altmayer ◽  
Adyr Eduardo Virmond Faria ◽  
Aline Weiss ◽  
Jorge Alberto Bianchi Telles ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Ultrasound Examination ◽  
Klinefelter Syndrome ◽  
Age Groups ◽  
Left Lung ◽  
Left Lobe ◽  
Imaging Studies ◽  
Left Hemithorax ◽  
Prenatal Imaging ◽  
The Right

CONTEXT: Intrathoracic cystic lesions have been diagnosed in a wide variety of age groups, and the increasing use of prenatal imaging studies has allowed detection of these defects even in utero.CASE REPORT: A 17-year-old pregnant woman in her second gestation, at 23 weeks of pregnancy, presented an ultrasound with evidence of a cystic anechoic image in the fet al left hemithorax. A morphological ultrasound examination performed at the hospital found that this cystic image measured 3.7 cm x 2.1 cm x 1.6 cm. Polyhydramnios was also present. At this time, the hypothesis of cystic adenomatoid malformation was raised. Fet al echocardiography showed only a dextroposed heart. Fet al magnetic resonance imaging produced an image compatible with a left diaphragmatic hernia containing the stomach and at least the first and second portions of the duodenum, left lobe of the liver, spleen, small intestine segments and portions of the colon. The stomach was greatly distended and the heart was shifted to the right. There was severe volume reduction of the left lung. Fet al karyotyping showed the chromosomal constitution of 47,XXY, compatible with Klinefelter syndrome. In our review of the literature, we found only one case of association between Klinefelter syndrome and diaphragmatic hernia.CONCLUSIONS: We believe that the association observed in this case was merely coincidental, since both conditions are relatively common. The chance of both events occurring simultaneously is estimated to be 1 in 1.5 million births.

scholarly journals Patients in intensive care unit for COVID-19 pneumonia: the lung ultrasound patterns at admission and discharge. An observational pilot study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Persona Paolo ◽  
Valeri Ilaria ◽  
Zarantonello Francesco ◽  
Forin Edoardo ◽  
Sella Nicolò ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lung Ultrasound ◽  
Low Cost ◽  
Low Frequency ◽  
Specific Pattern ◽  
University Hospital ◽  
Left Hemithorax ◽  
Significant Difference ◽  
The Right ◽  
B Lines

Abstract Background During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease. Methods We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern. Results Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17). Conclusions LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.

Abstract 12430: Vicious Circle Between Progressive Right Ventricular Dilatation and Pulmonary Regurgitation in Patients After Tetralogy of Fallot Repair? Right Heart Enlargement Promotes Flow Reversal in the Left Pulmonary Artery

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Atsuko Kato ◽  
Christian Drolet ◽  
Shi-Joon Yoo ◽  
Andrew Redington ◽  
Lars Grosse-Wortmann
Keyword(s):  
Pulmonary Artery ◽  
Tetralogy Of Fallot ◽  
Left Lung ◽  
Pulmonary Regurgitation ◽  
Left Pulmonary Artery ◽  
Flow Reversal ◽  
Left Hemithorax ◽  
Forward Flow ◽  
Lung Area ◽  
The Right

Introduction: The left pulmonary artery (LPA) contributes more than the right (RPA) to total pulmonary regurgitation (PR) in patients after tetralogy of Fallot (TOF) repair, but the mechanism of this difference is not well known. We hypothesized that unilaterally increased pulmonary vascular resistance (PVR), resulting from lung compression by the enlarged and levorotated heart leads to greater PR in the LPA. This study aimed to analyze the interplay between heart and lung size, mediastinal geometry, and differential PR. Methods: This is a single-center retrospective analysis of 50 magnetic resonance studies in patients after TOF repair. Patients with more than mild discrete branch pulmonary artery stenosis were excluded. Blood flow was measured by phase-contrast velocity encoding within the branch pulmonary arteries. On the axial image with the largest total cardiac surface area, cardiac angle (α) between the thoracic anterior-posterior line and the interventricular septum, right and left lung areas as well as right and left hemithorax areas were measured (Figure). Results: There was no difference in LPA and RPA diameters. The LPA showed significantly less total forward flow (p=0.04), smaller net forward flow (p=<0.001), and greater RF (p=0.001) than the RPA. Left lung area was smaller than the right (p<0.001). RVEDVi correlated with LPA RF (R=0.48, p<0.001), but not with RPA RF. Larger RVEDVi correlated with a larger α angle (R=0.46, p<0.001), i.e. a more leftward cardiac axis and with smaller left lung area (R=-0.58, p<0.001). LPA RF, but not RPA RF, correlated inversely with left lung area indexed to the left hemithorax area (R=-0.34, p=0.02). Conclusions: An enlarged and levorotated heart - as a result of PR - is associated with smaller left lung size, and augments diastolic flow reversal in the LPA, presumably via increased left PVR. By imposing a further volume load on the RV, LPA regurgitation may thus close a positive feed-back loop of PR and RV dilatation.

scholarly journals BLADDER RECONSTRUCTION DURING SEPARATION OF A CONJOINT TWIN ISCHIOPAGUS TRIPUS

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
Fajar Effendi ◽  
Safendra Siregar ◽  
Jupiter Sibarani
Keyword(s):  
Urinary Tract ◽  
Pelvic Floor ◽  
Conjoined Twins ◽  
Team Work ◽  
Lower Limbs ◽  
Pelvic Floor Reconstruction ◽  
Unique Challenge ◽  
Left Ureter ◽  
Ischiopagus Tripus ◽  
The Right

Objective: Conjoined twins represent one of the rarest congenital anomalies occurring with a varying incidence of about approximately 1 : 50.000 - 1 : 200.000 births. Ischiopagus conjoined  twinning (Fuse at the hip region) is even rare representing only 6% of all conjoined  twins. Here we report our experience in lower urinary tract reconstruction during separation of a conjoined twin ischiopagus tripus in Hasan Sadikin Hospital, Bandung. Case(s) Presentation: Two years old female conjoined twins, weighing in total of 8 kilograms, were brought to our hospital. The twins were fused  at  the lower  halves of  their bodies with two separate lower limbs at the right side and a fused left lower limb. External genitalia were absent. From CT Angiography we found four kidneys, two in each child with two separate bladders, with right ureter of baby A and left ureter of  baby B enter the  right bladder, while left ureter of  baby A and  right ureter of  baby B enter the left bladder. There was one cloaca that drains urine and feces. During the separation surgery, we performed ureteroneocystostomy and temporary ureteral stenting, followed by cystostomy. The pediatric surgeon performed bowel separation by stapling technique, pelvic wall separation, ileostomy, and pelvic floor reconstruction. The orthopedic surgeon performed femur separation, pelvic floor reconstruction, reconstruction of the pelvic ring, and femur reconstruction. The patients underwent defect closure, which performed by plastic surgeon. The operation was successful, without any complication to the kidney and the urinary tract of both babies. Discussion: Ischiopagus conjoined twins are the most complex conjoined twins and occur in only 6% of all conjoined twin cases. Ischiopagus is usually located along the axis with the head located on the opposite side. This case usually has one umbilicus and the two bodies are fused below this level, the union occurs in the lower abdomen and the pelvis. The internal organs that usually coalesce in cases of ischiopagus conjoined twins are liver, lower gastrointestinal, and genitourinary. The fused gastrointestinal part is the ileo-colic part of terminal ileum (Meckel's diverticulum). Conclusion: The separation of conjoined twin is a unique challenge due to its complex anatomy and physiology. Although advancement in imaging and monitoring has improved the survival rate separation can be successfully achieved only with meticulous planning and team work.

Less Stress, More Success

2005 ◽  
Author(s):  
Marilee Jones ◽  
Kenneth R. Ginsburg ◽  
Martha M. Jablow
Keyword(s):  
Time Management ◽  
College Admissions ◽  
Management Plan ◽  
Handling Stress ◽  
Authentic Self ◽  
Self Confidence ◽  
Building Resilience ◽  
The Right ◽  
Anxiety Depression ◽  
Admissions Process

The college admissions process is an ideal time to help teens learn to manage stress...before they show up in your office with complaints of anxiety, depression, or the results of risky behavior. Is your teen stressing over college admittance? Are you? Cowritten by a former top college admissions dean and a leading pediatrician, this first-of-its-kind book delivers strategies for surviving the admissions process while strengthening parent-child relationships, managing the stress of applying to college, and building resilience to meet challenges today and in the future. Less Stress, More Success is just what parents and teens need to thrive during this important rite of passage into adulthood. For Parents: How to encourage true high achievement, rather than perfectionism, Important dos and don'ts about the admissions process and how you can most effectively help your child, Why and when some forms of "helping" undermine your teenager's self-confidence and chances of admission, How to turn deadlines into opportunities to learn time-management and organization skills, How you can encourage positive strategies for handling stress and building resilience. For Teens: How to evaluate campus culture to find the right fit for you, Ways to manage your parents and your friends, Tips for the college interview, Letting your true, authentic self come through in your admissions essay, How your body handles stress...and what you can do to feel better and stay healthy. Includes a Personalized Stress Management Plan!

Executive Function Deficits Among ADHD Students in Classroom Learning

2021 ◽  
pp. 211-219
Author(s):  
Ashwini Deshpande Nagarhalli
Keyword(s):  
Executive Function ◽  
Neurodevelopmental Disorders ◽  
Externalizing Disorders ◽  
Management Plan ◽  
Planning Problem ◽  
Hyperactivity Disorder ◽  
Students With Adhd ◽  
Set Up ◽  
The Right ◽  
Executive Function Deficits

Attention deficit hyperactivity disorder (ADHD) is one of the widely prevalent externalizing disorders from the category of neurodevelopmental disorders. With the constant rise in the diagnosis of a number of cases presenting ADHD or ADHD-like symptoms, the need to understand issues as experienced by the student requires the right interventions for effective management. The core challenges in the area of academics and overall presentation lie with the executive function deficits that the child has. Hence, addressing those and working on skills like attention, working memory, response inhibition, goal setting, planning, problem solving, and organization has to be considered as part of the management plan. The current chapter explores evidence-based issues and strategies to be targeted in the classroom set up for students with ADHD. It also highlights some classroom-specific strategies, which can be focused by the teachers and remedial therapists.

scholarly journals Studenica Marble: Significance, Use, Conservation

2019 ◽  
Vol 11 (14) ◽  
pp. 3916 ◽  
Author(s):  
Nevena Debljović Ristić ◽  
Nenad Šekularac ◽  
Dušan Mijović ◽  
Jelena Ivanović Šekularac
Keyword(s):  
Middle Ages ◽  
Cultural Landscape ◽  
Landscape Management ◽  
Sustainable Use ◽  
Management Plan ◽  
Practical Implementation ◽  
Architectural Elements ◽  
National Heritage ◽  
Architectural Structures ◽  
The Right

Studenica marble is the stone used in creating the mediaeval Serbian cultural heritage. This is a historical overview of the importance and use of stone from prehistoric times to the Middle Ages, when the most imposing religious architectural structures were built. The significance of Studenica marble is particularly manifested in the Virgin’s Church at the Studenica Monastery. For its marble façades and artistic architectural elements, among other things, the church was inscribed in the UNESCO World Cultural and Natural Heritage List in 1986. Through centuries, the Virgin’s Church suffered multiple destructions. In order to restore the marble façades properly and its architectural elements, the marble deposits where the stone was once quarried had to be located anew. When the stone material characterisation had been performed, the right stone was selected for the complex conservation works on the churches in Studenica and Sopocani. A practical implementation of the research results raised the awareness of the marble deposits in the Studenica vicinity, being also part of the national heritage. The Studenica Monastery Cultural Landscape Management Plan envisions preservation of the deposits and their sustainable use for restoration purposes in the future.

scholarly journals Difference in accuracy of lung sliding identification between the right and left hemithorax

Critical Care ◽  
2012 ◽  
Vol 16 (S1) ◽  
Author(s):  
R Daoust ◽  
E Piette ◽  
J Lambert ◽  
A Denault
Keyword(s):  
Left Hemithorax ◽  
The Right ◽  
Lung Sliding

A rare cause of respiratory insufficiency: case presentation

Open Medicine ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. 141-143
Author(s):  
Camelia Diaconu ◽  
Bianca Paraschiv ◽  
Răzvan Lungu ◽  
Daniela Bartoş
Keyword(s):  
Respiratory Failure ◽  
Left Lung ◽  
Condensation Process ◽  
Acid Base Balance ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Left Hemithorax ◽  
Breath Sounds ◽  
Base Balance ◽  
The Right

AbstractWe report the case of a 73 year old woman who presented for progressive dyspnea. Her medical history included thyroidectomy 15 years ago, myocardial infarction, recurrent paroxysmal atrial fibrillation and femoral fracture two weeks previously, conservatively treated. Physical examination revealed absent breath sounds in the left hemithorax, up to the apex, and crackles in the right hemithorax. The acid-base balance showed acute hypoxemic respiratory failure. The chest X-Ray revealed left diaphragmatic paralysis. Thoracic CT-scan was performed, which excluded the pulmonary embolism and revealed left diaphragmatic relaxation, ascension of the splenic angle of the colon, stomach and spleen up to the projection of left lung hilum, and right postero-basal alveolar condensation process. Diaphragm dysfunction can be caused by various disorders, including phrenic paralysis. This pathology should be considered in the differential diagnosis of acute respiratory failure.

Nutritional stress and pre-implantation mortality in Merino sheep, (1964–7). General discussion and conclusions

1970 ◽  
Vol 74 (1) ◽  
pp. 199-204 ◽  
Author(s):  
T. N. Edey
Keyword(s):  
Body Weight ◽  
Left Ovary ◽  
Fertilization Failure ◽  
Normal Length ◽  
Body Weights ◽  
Embryonic Loss ◽  
Long Cycles ◽  
Significant Regression ◽  
The Right ◽  
Embryonic Death

SUMMARYCollation and re-analysis of the results obtained in separate experiments investigating prenatal mortality in Merino ewes over a period of 4 years have made it possible to draw the following general conclusions:Data from the control groups indicated that in 3 out of 4 years basal prenatal loss averaged approximately 25%, which agrees with a number of other estimates in the literature. Higher losses of ova in 1965 than in the other 3 years could not be partitioned accurately between fertilization failure and prenatal mortality.Submaintenance nutrition apparently caused embryo mortality in 1964, and possibly in 1967, when underfeeding from day 7 to 37 was followed by an unusual number of long cycles; however, there was no evidence of increased mortality in 1965 and 1966.Losses of ova shed as twins were significantly greater than amongst those shed as singles in 1964 and 1967. The higher loss of twin ova was clearly associated with the treated groups in 1964.In each of the 4 years the left ovary produced more ova than the right, and when the 4 years' data were combined, survival of ova shed by the left ovary was significantly better than of those shed by the right. The type of twin ovulation, i.e. whether the two ova came from one ovary or two, had no consistent effect on prenatal mortality.In 3 years there was no significant regression of prenatal mortality on body weight at mating. However, in 1965, when body weights were relatively low, there was a significantly negative regression. It is possible that there is a critical body weight below which poorer prenatal survival can be expected.Ewes which suffered embryonic loss followed by a delayed return to service subsequently conceived less readily than those having a cycle of normal length following fertilization failure or early embryonic death. It is postulated that in some cases this may be because ovulation occurs while resorption is still incomplete. For some ewes having long cycles after embryonic death, anoestrus or removal of the fertile rams precluded subsequent conception in that season. This was an added reason for the season's lambing performance of ‘long cycle’ ewes being much worse than that of ewes re-mated after normal length cycles.

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