The underdeveloped conjoined twin, Islaam, was attached to Manars head and was facing upward. Islaam could blink and even smile, but doctors determined she had to be removed, and that she could not survive on her own. Manar was featured on an episode of The Oprah Winfrey Show and in the British documentary series Body Shock. Manar died on March 26, 2006, fourteen months after the surgery, just days before her second birthday, due to a severe infection in her brain. On January 20, 2021, a baby was born with two heads, at the Elias Hospital in Bucharest, Romania, but died some hours after being born. History
Only ten cases of craniopagus parasiticus have been reported in the medical research literature. Of those cases, only four have survived birth. The first case on record is that of Everard Homes Two-Headed Boy of Bengal, whose skull is preserved at the Hunterian Museum at the Royal Society of Surgeons. Terminology
In the past, the use of terminology when describing parasitic twins has been somewhat inconsistent. By definition, a parasitic twin is joined to another twin in a certain anatomical location or position on the developed twins body. The underdeveloped twin is termed the parasite, and the developed twin is termed the autosite. The autosite can have some abnormalities, as well. For the most part, however, it has developed enough that it can live on its own.
Labial fusion is a medical condition of the female genital anatomy where the labia minora become fused together. It is generally a pediatric condition. Presentation
Labial fusion is rarely present at birth, but rather acquired later in infancy, since it is caused by insufficient estrogen exposure and newborns have been exposed to maternal estrogen in utero. It typically presents in infants at least 3 months old. Most presentations are asymptomatic and are discovered by a parent or during routine medical examination. In other cases, patients may present with associated symptoms of dysuria, urinary frequency, refusal to urinate, or post-void dribbling. Some patients present with vaginal discharge due to pooling of urine in the vulval vestibule or vagina. Complications
Labial fusion can lead to urinary tract infection, vulvar vestibulitis and inflammation caused by chronic urine exposure. In severe cases, labial adhesions can cause complete obstruction of the urethra, leading to anuria and urinary retention. Pathophysiology
The primary contributing factor to labial fusion is low estrogen levels. A vulva with low estrogen exposure, such as that of a preadolescent, has delicate epithelial lining and is therefore vulnerable to irritation. Conditions causing irritation, such as infection, inflammation and trauma, cause the edges of the labia minora to fuse together. The fusion typically begins at the posterior frenulum of the labia minora and continues anteriorly.Most labial adhesions resolve spontaneously before puberty as estrogen levels increase and the vaginal epithelium becomes cornified. Diagnosis
The condition can be diagnosed based on inspection of the vulva.