The incidence of conjoined twins as reported in a worldwide epidemiological study is 1.47 per 100,000 births. It varies from 1 in 45,000-200,000 births. Conjoined twins following assisted reproduction are even rarer and we report one such case. A 36-year-old woman who conceived by intracytoplasmic sperm injection, was referred to the feto-maternal unit for nuchal translucency scan. A diagnosis of thoracopagus conjoined twins was made on ultrasound at 12 weeks 3 days of gestation. The couple was counseled in detail and they opted for termination. Pregnancy was terminated medically and the ultrasound diagnosis was confirmed. Assisted reproduction techniques involve a risk of conjoined twins and the present case report supports this. Early diagnosis of conjoined twins and determination of the type of fusion is possible. This aids in discussing the prognosis and counseling the couple regarding options of termination or continuation of pregnancy.

747avidly protein bound persists in the tissues. We could not implicate the subcutaneous injection techniques in the patients (Cases 3-9) who developed indurated pruritic transient lesions within hours of injection. Contact sensitization to cresols is recognized,5 and we suspect that all local and one of the systemic reactions seen in our patients resulted from hypersensitivity to the chlorocresol preservative. Intradermal skin testing with chlorocresol-preserved heparin gave immediate responses, whereas in only one (Case 1) of the tests with preservativefree heparin (Weddel) was there a reaction.We suggest that in cases of apparent heparin sensitivity treatment may be able to continue without adverse reaction after cautious challenge with chlorocresol-free heparin.We are grateful to Professor J. Richmond for helpful criticism, and to Mrs. E. C. Baxter reported. Probably this condition is not recognized and passes unnoticed. A salient feature of the reported cases is that in most of them disorders of the oesophagus could be shown. These ranged from diverticulal to strictures,2 spasm, and carcinoma.3 In most cases syncope occurred mainly as a result of atrioventricular heart block, but sinus bradycardia and sinus arrest have also been reported,3 and in one case' both sinoatrial and atrioventricular block as well as signs of other disturbances of the sinus node were recorded. We report a case of what we suggest be termed deglutition syncope characterized by repetitive syncopes during swallowing due to heart block. Case ReportA 43-year-old man with a past history of rheumatic fever during childhood had for several years suffered from suddenly occurring retrosternal pain, which occurred mainly during meals but also spontaneously. On many occasions he had fainted, but usually the pain was accompanied only with dizziness. Drinking of carbonated beverages regularly provoked such attacks, but no other food could be pointed out as of particular significance. The general examination, including x-ray examination and endoscopy of the oesophagus, was uneventful except for a left anterior hemiblock in the electrocardiogram (E.C.G.). He was monitored in the ward, and on a couple of occasions a marked variation of the heart rate was observed. Over a short period of time the heart rate could vary from 44 to 80 beats/min, showing chaotic atrial activity. A provocation test letting the patient drink carbonated water resulted in a conspicuous sinus arrythmia and bradycardia (see fig.). E.C.G. registration with an oesophageal lead produced atrioventricular blockade. Because of these defects of the conduction system of the heart we decided to implant an on-demand pacemaker. A control later on with inhibition of the implanted pacemaker and with the patient simultaneously drinking carbonated water showed the occurrence of an asystole lasting 3 7 seconds. CommentLocal changes of the oesophagus have been considered the cause of an enhanced sensitivity of the nervous receptors so that a vagovagal reflex might be put at work with resulta...

No abstract

No abstract