Conjoined twins 95801 224820394 2008-07-10T15:46:50Z Islaammaged126 5679128 /* Conjoined twins in history */ new set of conjoined twins {{refimprove|date=May 2007}} {{redirect|Siamese twins}} {{Infobox_Disease | Name = {{PAGENAME}} | Image = Chang-eng-bunker-PD.gif | Caption = A painting of Chang and Eng Bunker, circa 1836 | DiseasesDB = 34474 | ICD10 = {{ICD10|Q|89|4|q|80}} | ICD9 = {{ICD9|759.4}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = ped | eMedicineTopic = 2936 | MeshID = D014428 | }} '''Conjoined twins''' are {{ml|Twin|Identical_twins|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.<ref>[http://www.scielo.br/scielo.php?pid=S1807-59322006000200013&script=sci_arttext Importance of angiographic study in preoperative planning of conjoined twins</ref> Approximately half are [[stillbirth|stillborn]], and a smaller fraction of pairs born alive have abnormalities incompatible with life. The overall survival rate for conjoined twins is approximately 25%.<ref>The craniopagus malformation: classification and implications for surgical separation. James L. Stone and James T. Goodrich. Brain 2006 129(5):1084-1095 [http://brain.oxfordjournals.org/cgi/content/full/129/5/1084 Abstract and free fullt text PDF]</ref> Approximately 75% of conjoined twin pairs are female.<ref>[http://www.scielo.br/scielo.php?pid=S1807-59322006000200013&script=sci_arttext Importance of angiographic study in preoperative planning of conjoined twins</ref> 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 cell]]s (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]]&ndash;[[1874]]), [[China|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.<ref>[http://www.guardian.co.uk/comment/story/0,3604,368509,00.html Comment: Hate that dare not speak its name | Guardian daily comment | guardian.co.uk<!-- Bot generated title -->]</ref> 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.<ref>[http://www.bbc.co.uk/dna/h2g2/alabaster/A369434 BBC - h2g2 - Twins - A369434<!-- Bot generated title -->]</ref> == Conjoined twins in history == [[Image:Nuremberg chronicles - Female Siamese Twins (CLXXXIIv).jpg|thumb|200px|left|Conjoined twin sisters from the ''[[Nuremberg Chronicle]]'' ([[1493]]).]] [[Image:Conjoinedtwinslarcomuseum.jpg|thumb|Moche ceramics depicting conjoined twins. AD 300 [[Larco_Museum|Larco Museum Collection]] Lima, Peru.]] 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.<ref>Berrin, Katherine & Larco Museum. ''The Spirit of Ancient Peru:Treasures from the [[Larco Museum|Museo Arqueológico Rafael Larco Herrera]].'' New York: [[Thames and Hudson]], 1997.</ref> 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]]&ndash;[[1488]], although the dates vary); the pygopagus Helen and Judith of [[Szőny]], [[Hungary]] ([[1701]]&ndash;[[1723]]), who enjoyed a brief career in music before being sent to live in a [[convent]]; and [[Rita and Cristina Parodi|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]]. [[Image:Bunker Grave.jpg|right|thumb|150px|Grave of Eng and Chang Bunker near [[Mt. Airy, North Carolina]]]]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 [[kidnap]]ped 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. The life of [[Abd Manaf ibn Qusai]] includes a legend that he separated his conjoined sons with a sword. 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]]&ndash;[[1922]])); *[[Lucio and Simplicio Godina]] of Samar, [[Philippines]] ([[1908]]&ndash;[[1936]]); *[[Daisy and Violet Hilton]] of [[Brighton, East Sussex]], [[England]] ([[1908]]&ndash;[[1969]]); *[[Mary and Margaret Gibb]] of [[Holyoke]], [[Massachusetts]] ([[1912]]&ndash;[[1967]]); *[[Yvonne and Yvette McCarther]] of [[Los Angeles]], [[California]] ([[1949]]&ndash;[[1992]]); *[[Ladan and Laleh Bijani]] of [[Shiraz]], [[Iran (Persia)]] ([[1974]]&ndash;[[2003]]); *[[Ronnie and Donnie Galyon]] of [[Ohio]] ([[1951]]&ndash;), currently the world's oldest living conjoined twins. *[[Lori and George Schappell | Lori and George (formerly Reba, born Dori) Schappell]] of [[Reading, Pennsylvania]] ([[1961]]&ndash;), 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]]&ndash;), 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.<ref>{{cite web|url=http://news.bbc.co.uk/1/hi/world/south_asia/7080326.stm|date=2007-11-06|title=Many-limbed India girl in surgery|publisher=BBC News}}</ref> *[[Jade and Erin Buckles]], United States. *Carmen and Lupita Andrade, born Dicephalus Tetrabrachius Dipus (2 heads, 4 arms and 2 legs) in 2000. Separation was not possible. == Types of conjoined twins == Conjoined twins are typically classified by the point at which their bodies are joined. The most common types of conjoined twins are: * '''Thoraco-omphalopagus''' (28% of cases)<ref name=embryology>[http://www.ncbi.nlm.nih.gov/pubmed/15278382 The embryology of conjoined twins], 2008-06-21 </ref>: Two bodies fused from the upper chest to the lower chest. These twins usually share a heart, and may also share their [[liver]] or [[digestive system]].<ref name=duplicata>[http://www.thefetus.net/page.php?id=1494 Duplicata incompleta, dicephalus dipus dibrachius], 2008-06-20 </ref> * '''Thoracopagus''' (18.5%)<ref name=embryology/>: Two bodies fused from the upper [[thorax]] to lower belly. The [[heart]] is always involved in these cases.<ref name=duplicata/> * '''Omphalopagus''' (10%)<ref name=embryology/>: Two bodies fused at the lower [[chest]]. Unlike thoracopagus, the heart is never involved in these cases; however, the twins often share a [[liver]], [[digestive system]], [[diaphragm (anatomy)|diaphragm]] and other organs.<ref name=duplicata/> * '''[[Parasitic twins]]''' (10%)<ref name=embryology/>: Twins that are asymmetrically conjoined, resulting in one twin that is small, less formed, and dependent on the larger twin for survival. * '''Craniopagus''' (6%)<ref name=embryology/>: Fused [[skull]]s, but separate bodies. These twins can be conjoined at the back of the head, the front of the head, or the side of the head, but not on the face or the base of the skull.<ref name=duplicata/> Other less-common types of conjoined twins include: * '''Cephalopagus''': Two faces on opposite sides of a single, conjoined head; the upper portion of the body is fused while the bottom portions are separate. These twins generally cannot survive due to severe malformations of the brain. Also known as janiceps (after the two-faced god [[Janus (mythology)|Janus]]) or syncephalus.<ref name=duplicata/> * '''Synecephalus''': One head with a single face but four ears, and two bodies.<ref name=duplicata/> * '''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. <ref name=duplicata/>[http://www.collphyphil.org/virt_tour/museum_8.htm] * '''Xiphopagous''': Two bodies fused in the [[Xyphoid process|xiphoid cartilage]], which is approximately from the navel to the lower breastbone. These twins almost never share any vital organs, with the exception of the liver.<ref name=duplicata/> A famous example is Chang and Eng Bunker. * '''Ischiopagus''': Fused lower half of the two bodies, with [[Vertebral column|spines]] conjoined end-to-end at a 180° angle. These twins have four arms; two, three or four legs; and typically one external [[genitalia]] and [[anus]].<ref name=duplicata/> * '''Omphalo-Ischiopagus''': Fused in a similar fashion as ischiopagus twins, but facing each other with a joined abdomen akin to omphalopagus. These twins have four arms, and two, three, or four legs.<ref name=duplicata/> * '''Parapagus''': Fused side-by-side with a shared [[pelvis]]. Twins that are '''dithoracic parapagus''' are fused at the abdomen and pelvis, but not the thorax. Twins that are '''diprosopic parapagus''' have one trunk and one head with two faces. Twins that are '''dicephalic parapagus''' have one trunk and two heads, and two (dibrachius), three (tribrachius), or four (tetrabrachius) arms.<ref name=duplicata/> * '''[[Craniopagus parasiticus]]''': Like craniopagus, but with a second bodiless head attached to the dominant head. * '''Pygopagus (Iliopagus)''': Two bodies joined back-to-back at the [[buttocks]].<ref name=duplicata/> ==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.<ref>[http://www.amazon.com/gp/product/0674018257 ''One of Us: Conjoined Twins and the Future of Normal''] by Alice Dreger, [[Harvard University Press | Harvard]], 2004</ref> [[Lori and George Schappell]] are a good example. ==Conjoined twins in popular culture== * The [[1973]] [[independent film]]] ''[[Sisters (film)|Sisters]]'' features conjoined twins who were previously separated. * The [[2005]] [[mockumentary]] ''[[Brothers of the Head]]'' follows conjoined twin brothers who form a rock band. * The [[2003]] film ''[[Stuck on You (film)|Stuck on You]]'' stars [[Matt Damon]] and [[Greg Kinnear]] as conjoined twins. * The [[Hindi]] serial ''[[Amber Dhara]]'', which aired on [[Sony Entertainment Television]] India from [[September 24]], [[2007]] to [[April 24]], [[2008]], was about two conjoined sisters named Amber and Dhara. ==References== {{reflist}} {{refbegin}} * [http://news.bbc.co.uk/2/hi/health/medical_notes/q-s/895922.stm Conjoined twins], BBC News World Edition, 25 August, 2000 {{refend}} == See also == * [[List of twins]] * [[Polycephaly]] == External links == {{commonscat|Conjoined twins}} * [http://noticiero.zoomblog.com/archivo/2008/02/13/siamesas.html Video about cojoined twins] * [http://conjoinedtwins.med.sa Official Saudi Website of Conjoined Twins] * [http://www.ngha.med.sa/ngha/en National Guard Hospital- Suadi Arabia] * [http://zygote.swarthmore.edu/cleave4a.html Types of conjoined twins] * [http://www.scribd.com/doc/264082/Conjoined-Twins-Photo Conjoined Twins-Photo] * [http://zygote.swarthmore.edu/cleave4b.html A social history of conjoined twins] * [http://www.conjoinedtwins.med.sa The site of the medical Saudi team responsible for the numerous successful separation surgeries] * [http://www.lib.unc.edu/ncc/gallery/twins.html Eng and Chang - The Original Siamese Twins; The University of North Carolina at Chapel Hill, The North Carolina Collection Gallery] * [http://www.thehumanmarvels.com/ The Human Marvels: A Historical Reference Site run by J. Tithonus Pednaud, Teratological Historian] *http://www.msnbc.msn.com/id/14359862/ * [http://www.phreeque.com/galyon_brothers.html Ronnie and Donnie Galyon] * [http://profiles.nlm.nih.gov/QQ/B/B/Y/Q/_/qqbbyq.pdf 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]] * [http://www.nlm.nih.gov/hmd/conjoined National Library of Medicine: Selected Moments in the History on Conjoined Twins] * [http://www.andrewbeierle.com The novel "First Person Plural" by Andrew W. M. Beierle, about dicephalus conjoined twins, one gay one straight] *[http://www.gmanews.tv/video/17437/Saksi-Conjoined-twins-born-in-Baliuag-Bulacan gmanews.tv/video, Saksi: Conjoined twins born in Baliuag, Bulacan - 01/31/2008] * [http://www.emedicine.com/ped/topic2936.htm Emedicine article] {{Phakomatoses and other congenital malformations not elsewhere classified}} [[Category:Conjoined twins| ]] [[Category:Twins]] [[cs:Siamská dvojčata]] [[de:Siamesischer Zwilling]] [[es:Siameses]] [[fr:Frères siamois]] [[ko:결합 쌍둥이]] [[id:Kembar siam]] [[it:Gemelli siamesi]] [[he:תאומים סיאמיים]] [[nl:Siamese tweeling]] [[ja:結合双生児]] [[no:Siamesiske tvillinger]] [[pl:Zroślak]] [[ru:Сиамские близнецы]] [[simple:Conjoined twins]] [[sl:Zraščena dvojčka]] [[fi:Siamilaiset kaksoset]] [[sv:Siamesiska tvillingar]] [[th:แฝดติดกัน]] [[zh:連體嬰]]