ABSTRACT
Conjoined twining is one of the most fascinating and challenging situations which a pediatric surgeon may face in his career. Only few surgeons may have the opportunity to share in separation of such cases. In this report, we aim to share our experience with the successful separation of ventrally fused male conjoined twins (omphaloischiopagus). The case was thoroughly studied via preoperative cross-sectional imaging modalities (magnetic resonance imaging [MRI] and computed tomography [CT] angiography), complemented by data obtained from reviewing similar cases in the literature. A clear delineation of the complex anatomy was achieved preoperatively which proved to be well consistent with the operative findings. A detailed description of the operative procedure to divide/redistribute the shared abdominal/pelvic organs between both twins is provided. To the best of our knowledge, this is the first report to describe the detailed and unique internal anatomy of a common central phallus associating ischiopagus conjoined twins. The penis was centrally located in the perineum in between both twins with an open urethral plate. This common phallus had a peculiar configuration with four crura anchoring ischial bones of both twins together.
ABSTRACT
BACKGROUND: Thyroid disorders may decrease the threshold for developing myopathy. Nonthyroidal illness syndrome (NTIS) is a common form of thyroid dysfunction in critically ill patients who are prone to the development of intensive care unit-acquired weakness (ICUAW). We therefore tested the hypothesis that patients with abnormalities in thyroid function are at a higher risk of developing ICUAW. METHODS: We assessed blood samples from patients admitted to the ICU for ≥7 days for thyroid functions. Patients were classified into 4 categories (euthyroid, hyperthyroid, hypothyroid, and NTIS). Patients were then evaluated daily for ICUAW development. Patients with ICUAW were considered as cases, whereas patients who did not develop ICUAW served as controls. We compared demographic and clinical variables, such as APACHE II score; length of ICU stay; free T3 (FT3), free T4, and thyroid-stimulating hormone levels; incidence of the four categories of thyroid function; and other risk factors for ICUAW. Logistic regression was used to determine independent risk factors for ICUAW. RESULTS: This case-control study included 114 patients: 57 cases (ICUAW) and 57 controls. FT3 levels were significantly lower in the cases (2.13 ± 0.96 mU/L) than in controls (2.69 ± 1.07 mU/L; P=0.004). There were no significant differences between cases and controls regarding the incidence of all categories of thyroid function. In univariate analysis, five independent variables had P < 0.25 (sepsis, vasopressors, mechanical ventilation duration, NTIS, and FT3 levels). Among these variables, multiple regression showed that only FT3 level (CI = 0.157-0.82, P=0.015) was an independent risk factor. CONCLUSION: The study revealed an inverse association between ICUAW incidence and FT3 levels.
