Endometriosis in monozygotic twins

OBJECTIVE: To describe the occurrence of endometriosis in monozygotic twins. DESIGN: Postal questionnaire plus confirmation of disease status. SETTING: Twins were recruited via the American Endometriosis Association and the National Endometriosis Society of Great Britain and via British gynecologists. RESULT(S): Fourteen twin pairs were concordant for endometriosis, and two were discordant. Nine pairs of twins had moderate-severe endometriosis. CONCLUSION(S): These findings contribute to the growing body of literature that suggests endometriosis has a genetic basis.     

Multicore disease in twins

Multicore disease in identical twin boys presented in infancy as generalized weakness and torticollis. Motor milestones such as sitting, standing, and running were delayed, although by the age of 6 years marked improvement in muscle strength had occurred. Serum enzymes were normal. Muscle biopsy revealed multifocal areas of decreased oxidative enzyme activity. Ultrastructurally, these areas were characterized by myofilament disruption and Z-band streaming.     

Fetal testing in twins

Mivacurium has a short duration of action because it is rapidly hydrolysed by plasma cholinesterase. There is ongoing controversy concerning the antagonism of mivacurium-induced neuromuscular block, firstly because of its short spontaneous recovery time, and secondly because the metabolism of mivacurium may be inhibited by anticholinesterases. We therefore compared neostigmine and edrophonium reversal of deep and moderate mivacurium-induced blocks. METHODS: After approval by the local ethics committee, 48 ASA class I and II adult patients were investigated during nitrous oxide-fentanyl-thiopental anaesthesia using train-of-four (TOF) stimulation and monitoring of the isometric force of adduction of a thumb. The patients received 0.2 mg/kg mivacurium i.v. Neuromuscular transmission was allowed to recover spontaneously in 10 patients (group SP). In 2 other groups the neuromuscular block was antagonised by administration of 0.04 mg/kg neostigmine (group N5; n = 9) or 1.0 mg/kg edrophonium (group E5; n = 10) when T1 had recovered spontaneously to 5% of control. In two other groups the neuromuscular block was antagonised with the same doses of neostigmine or edrophonium in 10 patients (group N25) and 9 patients (group E25), respectively, when T1 had recovered spontaneously to 25% of control. RESULTS: Neostigmine or edrophonium administered when T1 had recovered spontaneously to 25% of control shortened the recovery time (time from administration of ant-agonist to a T4/T1-ratio of 0.7) significantly from 10.7 +/- 2.2 min (mean +/- SD) in the SP group to 5.1 +/- 2.0 and 5.3 +/- 1.5 min in the N25 and E25 groups, respectively (P < 0.05). The corresponding recovery times in the SP, N5, and E5 groups were 15.9 +/- 2.9, 10.0 +/- 1.9, and 7.7 +/- 2.2 min, respectively. The difference between the SP and E5 groups was significant (P < 0.05). The recovery indices (time from 25% to 75% recovery of T1) of 3.0 +/- 1.3 and 1.7 +/- 0.9 min for the E5 and E25 groups, respectively, were shorter than those of the SP group at 6.1 +/- 2.0 min (P < 0.05). CONCLUSIONS: Two theoretical reasons, the very rapid onset time and the fact that it does not inhibit plasma cholinesterase, suggest edrophonium to be the preferred antagonist of a mivacurium-induced blockade. These two characteristics are reflected in our results: only edrophonium was able to shorten the recovery index significantly and, administered at a profound level of mivacurium-induced neuromuscular block, only edrophonium was successful in shortening recovery time significantly. Therefore, edrophonium should be the anticholinesterase of choice to antagonise a mivacurium-induced neuromuscular block.     

Sarcoidosis in identical twins

Identical twin sisters who developed sarcoidosis at an interval of one year are reported. Case 1. (elder sister) A 22-year-old female was admitted to our hospital for examination of cervical lymph node swelling. Her chest roentgenogram showed bilateral hilar lymphadenopathy and the diagnosis was confirmed histologically by scalene node biopsy. Case 2. (younger sister) In 1987, at age 23, a routine chest roentgenogram showed bilateral hilar lymphadenopathy and the diagnosis was confirmed histologically by transbronchial lung biopsy. The occurrence of sarcoidosis in identical twins suggests that a genetic factor might be involved in the pathogenesis.     

Auditory lateralization in monozygotic twins

In an attempt to investigate whether auditory lateralization has a heritable component, 20 monozygotic (MZ) twin pairs were examined with four different dichotic listening tests known to produce reliable right-ear advantages (REAs) in right-handers. Ten twin pairs were concordantly right-handed (MZ-RR), and ten twin pairs were discordant for handedness (MZ-RL). Intraclass correlations for MZ twin pairs were weak or nonexistent for ear advantage, but relatively strong for overall correct scores and mean reaction times, measures unrelated to laterality scores. These results support the hypothesis that auditory lateralization, as measured with dichotic tests, is nongenetic in origin. A comparison of MZ twins and right-handed siblings (n = 20) showed that right-handed siblings exhibited strong REAs, whereas left-handed siblings (n = 20) and MZ twins showed weak or absent REAs, indicating that twins may be atypically lateralized with respect to auditory lateralization.     

Placental pathology in discordant twins

OBJECTIVE: The aim of this study was to evaluate placental abnormalities in relation to birth weight discordance in dichorionic and monochorionic twins. STUDY DESIGN: The maternal charts and placental abnormalities of 147 structurally normal twin pairs with cords labeled at delivery were reviewed. The placental weight belonging to each twin was determined by measuring the length, width, and thickness in each of the two placental disks. Placental weight, chorionicity, infarction, abruptio placentae, decidual vascular abnormality, villous fibrosis and hypovascularity, chronic villitis, and intraplacental thrombi were also assessed. Birth weight was discordant if > or = 20%. The data were analyzed with chi 2 and analysis of variance after log transformation of skewed discordancy values. RESULTS: Of the 147 twin pairs, 99 were dichorionic and 48 monochorionic. Placental weights were known for 91 dichorionic and 40 monochorionic twins. Of the lighter cotwins in dichorionic twin pairs 36.3% (33/91) belonged to the heavier placenta, 49.5% (45/91) belonged to the lighter placenta, and 14.3% (13/91) had an equal share of the placental weight with the heavier sibling (p < 0.05). In 42.4% (42/99) the lighter dichorionic twin had more placental lesions than the heavier twin, in 38.4% (38/99) the same number of lesions were present in both placentas, and in 19.2% (19/99) the heavier twin had more placental lesions. There was linear correlation between percent discordance and number of placental lesions in the lighter twin. In dichorionic twins 18 of the 99 (18.1%) were discordant. In 77.8% (14/18) the lighter twin had more placental lesions than the heavier twin, in 16.7% (3/18) the number of lesions was the same in both, and in 5.6% (1/18) the heavier twin had one more lesion than the lighter twin (p < 0.05). In monochorionic twins, regardless of birth weight discordance, no differences in placental abnormalities were observed. CONCLUSIONS: In dichorionic twins significant birth weight discordance was attributable not to differences in placental weight but to a greater number of placental lesions in the lighter twin than in the heavier twin (p < 0.05). This did not hold true for monochorionic twins.     

Duodenal atresia in dizygotic twins

The authors report duodenal atresia occurring in both members of dizygotic twins who showed no signs of Down's syndrome, and both had normal chromosomal constitutions. They both had the two unlinked end type of atresia in the second portion of the duodenum, and direct end-to-end duodenoduodenostomy was carried out. Their postoperative courses were smooth, and both babies were discharged 32 days after birth. Their mother underwent pituitary adenoma removal and partial parathyroidectomy for multiple endocrine neoplasia (MEN-type I). She had been given hormonal supplement therapy after surgery and became pregnant after exogenous gonadotropin therapy. Environmental factors may be responsible for some cases of duodenal atresia.     

Disseminated candidosis in premature twins

A unique case of disseminated candidosis in premature twins is presented where twin A developed disease soon after birth and died prior to the administration of antifungal therapy. On the other hand, twin B developed infection on the 26th day of birth but survived, though with sequelae (hydrocephalus), since he was promptly and accurately diagnosed and treated.     

False Memories in Schizophrenia.

In prior studies, it was observed that patients with schizophrenia show abnormally high knowledge corruption (i.e., high-confident errors expressed as a percentage of all high-confident responses were increased for schizophrenic patients relative to controls). The authors examined the conditions under which excessive knowledge corruption occurred using the Deese-Roediger-McDermott paradigm. Whereas knowledge corruption in schizophrenia was significantly greater for false-negative errors relative to controls, no group difference occurred for false-positive errors. The groups showed a comparable high degree of confidence for false-positive recognition of critical lure items. Similar to findings collected in elderly participants, patients, but not controls, showed a strong positive correlation between the number of recognized studied items and false-positive recognition of the critical lure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delivery of twins

Reconstruction of the nose provides many challenges owing to its differing subunits and varied surfaces. In this article, the nasal anatomy, anesthesia, and some of the reconstructive options available to the dermatologic surgeon are reviewed. These reconstructive options are based on the subunit and depth of the defect. This subunit approach may provide a framework of decision making and options that will help the dermatologic surgeon in reconstruction of defects on this unique anatomic structure.     

Mild combined immunodeficiency in identical twins

Fourteen adult cats were exercised on a motor-driven treadmill 5 days each week for 6 weeks to determine the effect of exercise conditioning on the intrinsic contractile state of the myocardium. The exercise program was sufficient to produce a cardiovascular training effect manifested by slower exercising heart rates and resting heart rates after atropine by the end of the 6th week. The mechanical function of the isolated right ventricular papillary muscle from exercised cats was compared with that of 17 sedentary adult cats. There were no significant differences between exercised and control cats in in heart weight-body weight ratios, resting and active lenght - tension relations, maximal rate of isometric force development at the peak of the length-tension curve (Lmax), time to peak force at Lmax, maximal force development with paired stimulation and norepinephrine, or force-velocity relations. These results indicate that the intrinsic state of feline myocardium is unaffected by exercise conditioning.