Conjoined twins

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Conjoined twins Classification and external resources
A painting of Chang and Eng Bunker, circa 1836
ICD-10	Q89.4
ICD-9	759.4
DiseasesDB	34474
eMedicine	ped/2936
MeSH	D014428

Conjoined twins are identical twinshttp://en.wikipedia.org../../../../articles/t/w/i/Twin.html#Identical_twins whose bodies are joined in utero. It is a rare phenomenon; it is estimated to range from 1 in 50,000 births to 1 in 200,000 births, with a somewhat higher incidence in Southwest Asia and Africa.^[1] Approximately half are stillborn, and a smaller fraction of pairs born alive have abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 25%.^[2]

About 70% to 75% of conjoined twin pairs are female. 

Two contradicting theories exist to explain the origins of conjoined twins. The older and most generally accepted theory is fission, in which the fertilized egg splits partially. The second theory is fusion, in which a fertilized egg completely separates, but stem cells (which search for similar cells) find like-stem cells on the other twin and fuse the twins together.

Perhaps the most famous pair of conjoined twins was Chang and Eng Bunker (1811–1874), Chinese brothers born in Siam, now Thailand. They traveled with P.T. Barnum's circus for many years and were billed as the Siamese Twins; due to their fame and the rarity of the condition, the term came to be used as a synonym for conjoined twins, although in recent years the term has fallen out of favor and is considered a pejorative term.^[3] Chang and Eng were joined by a band of flesh, cartilage, and their fused livers at the torso. In modern times, they could have been easily separated.^[4]

Contents 1 Conjoined twins in history 2 Legendary conjoined twins 3 Types of conjoined twins 4 Separation 5 References 6 See also 7 External links

[edit] Conjoined twins in history

The earliest known documented case of conjoined twins dates from the year 945, when a pair of conjoined twin brothers from Armenia were brought to Constantinople for medical evaluation. It was here that they were determined to be acts of God and the birth of conjoined twins was considered a proof that the male's sexual prowess was truly twice that of the average man. However, the Moche culture of ancient Peru depicted conjoined twins in their ceramics dating back to AD 300.^[5] The English twin sisters Mary and Eliza Chulkhurst, who were conjoined at the back (pygopagus), lived from 1100 to 1134 and were perhaps the best-known early example of conjoined twins. Other early conjoined twins to attain notice were the "Scottish brothers", allegedly of the dicephalus type, essentially two heads sharing the same body (1460–1488, although the dates vary); the pygopagus Helen and Judith of Szőny, Hungary (1701–1723), who enjoyed a brief career in music before being sent to live in a convent; and Rita and Cristina of Parodi of Sardinia, born in 1829. Rita and Cristina were dicephalus tetrabrachius (one body with four arms) twins and although they died at only eight months of age, they gained much attention as a curiosity when their parents exhibited them in Paris.

Several sets of conjoined twins lived during the nineteenth century and made careers for themselves in the performing arts, though none achieved quite the same level of fame and fortune as Chang and Eng. Most notably, Millie and Christine McCoy (or McKoy), pygopagus twins, were born into slavery in North Carolina in 1851. They were sold to a showman, J.P. Smith, at birth, but were soon kidnapped by a rival showman. The kidnapper fled to England but was thwarted because England had already banned slavery. Smith traveled to England to collect the girls and brought with him their mother, Monimia, from whom they had been separated. He and his wife provided the twins with an education and taught them to speak five languages, play music, and sing. For the rest of the century the twins enjoyed a successful career as "The Two-Headed Nightingale" and appeared with the Barnum Circus. In 1912 they died of tuberculosis, 17 hours apart.

Giovanni and Giacomo Tocci, from Locana, Italy, were immortalized in Mark Twain's short story "Those Extraordinary Twins" as fictitious twins Angelo and Luigi. The Toccis, born in 1877, were dicephalus tetrabrachius twins, having one body with two legs, two heads, and four arms. From birth they were forced by their parents to perform and never learned to walk, as each twin controlled one leg (in modern times physical therapy allows twins like the Toccis to learn to walk on their own). They are said to have disliked show business. In 1886, after touring the United States, the twins returned to Europe with their family, where they fell very ill. They are believed to have died around this time, though some sources claim they survived until 1940, living in seclusion in Italy.

Conjoined twins who appeared in the public eye during the 20th and 21st centuries include:

• Rosa and Josepha Blazek of Bohemia (modern-day Czech Republic (1878–1922));
• Lucio and Simplicio Godina of Samar, Philippines (1908–1936);
• Daisy and Violet Hilton of Brighton, East Sussex, England (1908–1969);
• Mary and Margaret Gibb of Holyoke, Massachusetts (1912–1967);
• Yvonne and Yvette McCarther of Los Angeles, California (1949–1992);
• Ladan and Laleh Bijani of Shiraz, Iran (Persia) (1974–2003);
• Ronnie and Donnie Galyon of Ohio (1951–), currently the world's oldest living conjoined twins.
• Lori and George (formerly Reba, born Dori) Schappell of Reading, Pennsylvania (1961–), American entertainers;
• Ganga and Jamuna Shreshta of Nepal, conjoined twins who were separated in a landmark surgery in Singapore in 2001;
• Krista and Tatiana Hogan born in Vancouver, British Columbia (2006–), craniopagus conjoined twins;
• At Guntur, India the following pairs were successfully operated: Ram & Laxman 1992, Anjali & Geetanjali 1993, Rekha & Surekha 1998 and Veena & Vani 2004;
• Abigail and Brittany Hensel, (1990-), born in Carver County, Minnesota, United States of America, dicephalic conjoined twins.
• Lotti and Rosemarie Knaack (craniopagus) born in Hamburg, Germany.
• Masha and Dasha Krivoshlyapova (ischiopagus tripus) Moscow, Russia (1950-2003).
• Sarah and Abbey (Pygopagus) born in New Zealand in 2004 and separated successfully later that year.
• Mohamed and Ahmed Ibrahim, born in a small Egyptian town on June 2, 2001, separated in a 34-hour operation at Children's Medical Center Dallas on October 12, 2003
• Lakshmi Tatma is an ischiopagus conjoined twin born in Araria district in the state of Bihar, India. She had four arms and four legs, resulting from a joining at the pelvis with a headless, undeveloped twin. Some of the local villagers have hailed her as the reincarnation of Lakshmi, the multi-limbed Hindu goddess. In November 2007 she successfully underwent surgery to separate her spinal column and kidney from that of her twin.^[6]
• Jade and Erin Buckles, United States

[edit] Legendary conjoined twins

• An example described in Abd Manaf ibn Qusai

[edit] Types of conjoined twins

There are several different types of conjoined twins:

• Diplopagus: Conjoined twins joined equally with near complete body, only sharing a few organs.
• Heteropagus: Conjoined twins joined unequally usually resulting in a parasitic twin.
• Thoracopagus: Bodies fused in the thorax. The heart is always involved in these cases; when the heart is shared, prospects for a long life, either with or without separation surgery, are poor (35-40% of cases).
• Omphalopagus: Joined at the lower chest. The heart is not involved in these cases but the twins often share a liver, digestive system, diaphragm and other organs (34% of cases).
  • Xiphopagous: bodies fused in the xiphoid cartilage, e.g., Chang and Eng
• Pygopagus (iliopagus): Joined, usually back to back, to the buttocks (19% of conjoined twins).
• Cephalopagus: Heads fused, bodies separated. These twins generally cannot survive due to severe malformations of the brain. Also known as janiceps (after the two-faced god Janus) or syncephalus.
  • Cephalothoracopagus: Bodies fused in the head and thorax. In this type of twins, there are two faces facing in opposite directions, or sometimes a single face and an enlarged skull.[1] These twins also generally cannot survive. (Also known as epholothoracopagus or craniothoracopagus.)
• Craniopagus: Skulls fused, but bodies separate (2%).
  • Craniopagus parasiticus: A second bodiless head attached to the head.
• Dicephalus: Two heads, one body with two legs and two, three, or four arms (dibrachius, tribrachius or tetrabrachius, respectively.) Abigail and Brittany Hensel, 18-year-old conjoined twins from the United States, are of the dicephalus tribrachius type, with their third arm having been removed while they were very young.
• Ischiopagus: Anterior union of the lower half of the body, with spines conjoined at a 180° angle (6% of cases). Or with the spines separate but both the pelvises forming a single big ring which includes two sacrums and two pubic symphyses.
• Ischio-omphalopagus:The Twins are conjoined with spines in a Y-shape. They have four arms and usually two or three legs. These cases can be challenging because the twins often share reproductive and excretory systems.
• Parapagus: lateral union of the lower half extending variable distances upward, with the heart sometimes involved (5% of cases).
• Diprosopus: One head, with two faces side by side. A malformation of a single embryo, not true conjoined twinning.

In some cases, parts of the brain have been known to be shared between conjoined twins joined at the head.

[edit] Separation

Surgery to separate conjoined twins may range from relatively simple to extremely complex, depending on the point of attachment and the internal parts that are shared. Most cases of separation are extremely risky and life-threatening. In many cases, the surgery results in the death of one or both of the twins, particularly if they are joined at the head. This makes the ethics of surgical separation, where the twins can survive if not separated, contentious. Dreger found the quality of life of twins who remain conjoined to be higher than is commonly supposed.^[7] Lori and George Schappell are a good example.

[edit] References

[edit] See also

• List of twins
• Parasitic twin
• Polycephaly
• Brothers of the Head, a film about conjoined twins that have a rock band
• Stuck on You, a 2003 film starring Matt Damon and Greg Kinnear.
• Amber Dhara, a Hindi serial on Sony Entertainment Television about two conjoined twin sisters first airing on September 24, 2007.
• Sisters (film) (1973)

[edit] External links

• Video about cojoined twins
• Official Saudi Website of Conjoined Twins
• National Guard Hospital- Suadi Arabia
• Types of conjoined twins
• Conjoined Twins-Photo
• A social history of conjoined twins
• The site of the medical Saudi team responsible for the numerous successful separation surgeries
• Eng and Chang - The Original Siamese Twins; The University of North Carolina at Chapel Hill, The North Carolina Collection Gallery
• The Human Marvels: A Historical Reference Site run by J. Tithonus Pednaud, Teratological Historian
• http://www.msnbc.msn.com/id/14359862/
• Ronnie and Donnie Galyon
• Clara and Alta Rodriguez, joined at the pelvis and successfully separated in 1974 at Children's Hospital of Philadelphia by surgeons including C. Everett Koop
• National Library of Medicine: Selected Moments in the History on Conjoined Twins
• The novel "First Person Plural" by Andrew W. M. Beierle, about dicephalus conjoined twins, one gay one straight
• gmanews.tv/video, Saksi: Conjoined twins born in Baliuag, Bulacan - 01/31/2008
• Emedicine article

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