ABSTRACT
OBJECTIVE: To describe a case of conjoined twins after intracytoplasmic sperm injection (ICSI) and transfer of a single day 2 embryo. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 30-year-old woman underwent ICSI with a transfer of a single day 2 embryo. INTERVENTION(S): Vaginal ultrasound examination was performed during early pregnancy. RESULT(S): The diagnosis of conjoined twins was made by vaginal ultrasonography at 9 weeks' gestation. The conjoined fetuses were diagnosed as thoracopagus twins with a single beating heart shared between the thoraxes. Extensive ultrasound examination suggested an extremely poor prognosis, Therapeutic termination was performed at 11 weeks. CONCLUSION(S): Given that single embryo transfers are able to shed light on the real incidence of conjoined twins developed on day 2/3 or on day 5/6, this is of interest mechanistically. Thus, it should be taken into account when trying to determine the true incidence of conjoined twins and ultimately trying to understand why these anomalies occur. The importance of early expert vaginal ultrasonography in pregnancies resulting from assisted reproductive technologies is emphasized.
Subject(s)
Embryo Transfer/adverse effects , Sperm Injections, Intracytoplasmic/adverse effects , Twins, Conjoined/pathology , Abortion, Therapeutic , Adult , Counseling , Early Diagnosis , Female , Gestational Age , Humans , Pregnancy , Treatment Outcome , Ultrasonography, Doppler, Color , Ultrasonography, PrenatalABSTRACT
Cystic duct carcinoma is known to have a better prognosis compared to its location in other biliary ducts. Only one case with a survival over ten years has been previously published. The authors report a case of survival over 13 years without recurrence or metastasis. Preoperative diagnosis of cystic duct tumor was carried in a 66-year-old male. Under the diagnosis of carcinoma of the cystic duct, the patient underwent en bloc resection of the gallbladder, cystic duct, hepaticocholedochus and lymph node dissection. A Roux-en-Y hepaticojejunostomy was performed. Histological examination revealed a moderately differentiated adenocarcinoma of the cystic duct. Five months later the patient underwent second look surgery for benign obstruction of the hepaticojejunal anastomosis. The patient is still doing well 13 years later without any local recurrence or metastasis. To our knowledge, this is the longest disease-free survival ever published in the literature. This case sustains that better and longer survival is possible with a real chance of potential cure if radical surgery is performed.
