End of life
Gary Chan Kok Yew in Health Law and Medical Ethics in Singapore, 2020
Singapore is experiencing an ageing population with increased average life expectancy. The provision of long-term and palliative care in Singapore is mainly drawn from the voluntary welfare organisations and charity sector on an ad-hoc basis and supported by grants from the Ministry for Social and Family Development. Death in a sense defies definition. From the philosophical perspective, it is a state of non-existence which falls outside our human-describable experience. The Singapore Academy of Medicine published guidelines for the determination of brain death “in the deeply comatosed patient” in 1985. Doctors, family members and the loved ones of patients who are suffering from terminal illnesses may have to confront thorny issues. Difficult decisions arise when the patient is in a coma and tied to a life support system. Moving on to the case of conjoined twins, it is noted from the outset that the majority of conjoined twins are stillborn.
Conjoined Twins: Experience in an Irish Tertiary Centre
Published in Journal of Obstetrics and Gynaecology, 2014
Conjoined twins are rare, with a reported incidence of 0.19 per 10,000 pregnancies in Europe. We discuss four spontaneous conjoined twin pregnancies presenting to a tertiary referral centre from 2005 to 2011, diagnosed on antenatal dating ultrasound. The cases were monitored closely throughout pregnancy by a multidisciplinary team, with serial surveillance, including ultrasound, fetal echocardiography, magnetic resonance imaging, amniocentesis and further referral to cardiology and paediatric surgery specialists, where indicated. Three female sets were determined antenatally to be not surgically separable; these infants were managed palliatively following a live birth. The male set of conjoined twins was accepted for surgical separation at Great Ormond Street Hospital, London, which was successfully performed electively at 4 months. Of interest, all four parents reside within 20 km of each other, representing a possible cluster of cases. The incidence of conjoined twins in our local population is approximately 0.63 per 10,000 over an 8-year period from 2005 to 2012. This case series highlights a cluster of conjoined twins, managed to viability and delivered in a tertiary referral centre.
DIPROSOPUS CONJOINED TWINS: Radiologic, Autoptic, and Histologic Study of a Case
Published in Fetal and Pediatric Pathology, 2010
Maria D’Armiento, Jessica Falleti, Giuseppe Maria Maruotti, Pasquale Martinelli
Conjoined twins are a rare and intriguing nature's phenomena; diprosopus or craniofacial duplication is the rarest with a reported incidence of 1 case in 180,000—15 million births. We present a radiologic, autoptic, and histologic study of a 37-week-old male diprosopus twin in a dichorionic pregnancy of a 26-old-year woman. Diprosopus malformation is part of duplication involving face and cranium like janiceps and dicephalus. Our case also shows partial duplication of the stomach with ectopic pancreas. Most studies are required to understand the exact mechanism of this malformation.
Rehabilitation of Conjoined Twins Pre- and Postsurgical Separation
Published in Physical & Occupational Therapy In Pediatrics, 2017
Maria Tozzi, R. Scott Van Zant
Purpose: Describe the rehabilitation, including two episodes of inpatient rehabilitation, early intervention, and outpatient services, of conjoined twins. Case Description: The patients were 14-month-old female ischiopagus tripus twins that received 3 months of rehabilitation (mobility, feeding, communication, developmental skill training, developing adaptive equipment, educating caregivers) preseparation surgery. Surgery occurred at 24 months. At 27 months, the twins were admitted to inpatient rehabilitation, receiving 4 months of rehabilitation promoting strength, endurance, gait training, feeding, communication, developmental skill training, orthotics, adaptive equipment, and caregiver education. Presurgical WeeFIM was 18/126 (twin A) and 19/126 (twin B), and 28/126 (both twins A&B) postsurgical. Prior to surgery, patients performed supine to sit transfers with supervision. Outcomes: Following surgery, each twin sat and performed bed mobility independently. Twin B performed wheelchair mobility and supported standing at anterior surface with assistance. Discharge WeeFIM was 42/126 (twin A) and 45/126 (twin B). Twins performed floor mobility by scooting, stood at an anterior surface with assistance (maximum for twin A, minimal for twin B), and propelled a manual wheelchair indoors (minimal assistance for both twins A & B). Conclusion: Rehabilitation of conjoined twins improved presurgical functional status and addressed the unique functional needs of each twin postseparation.
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