Characteristic sulfur granules on histopathology make the
diagnosis of actinomycosis  and . High suspicion is the main point for making a diagnosis, as radiological imaging is not diagnostic, as seen in this case. Management of the disease with medical drugs should be tried first. Rifampicin, isoniazid, pyrazinamide, and ethambutol are the basis of breast tuberculosis treatment ,  and . Surgery should be reserved for medical treatment-resistant cases. In endemic areas, tuberculosis should always be considered in the differential diagnosis of an inflammatory breast mass. “
“Conjoined twinning selleck chemicals llc is a rare occurrence with an incidence of about 1 in 50,000 pregnancies, 60% of which result in stillbirth . There is an approximate find more 2–3:1 female to male predominance . The classification of conjoined twins is complex, but is usually based on degree and anatomic location of the fusion . Parapagus twins always share a conjoined pelvis with one or two sacrums and a single symphysis . Dicephalic parapagus
twins share a common thorax and account for approximately 3.7% of all conjoined twins . A 37-year-old Caucasian female, para 1–0–2–1 was referred to our department at 27 weeks gestation for evaluation of conjoined twins. The patient was a late registrant for care at 22 weeks gestation and her initial ultrasound was performed at 26 weeks gestation showing polyhydraminos and a dicephalic fetus. The patient denied any pertinent past medical or surgical history and any history of drug or toxin exposure. Both 2D and 3D ultrasound were performed on a Voluson 730 scanner
(General Electric Health Care, Milwaukee, Megestrol Acetate WI) with a 4–7-MHz transducer at our institution with findings consistent with dicephalic conjoined twins with acrania (Fig. 1 and Fig. 2). Two spines were identified and appeared parallel (Fig. 3) with fusion in the thoraco-lumbar region with associated rachischisis. Cardiac imaging was difficult secondary to fetal positioning and was incomplete. There was no apparent duplication of the abdominal organs and a single 2 vessel umbilical cord was present. The largest diameter of the dicephalic presenting part was 8.8 cm, equivalent to a 35 week singleton biparietal diameter (Fig. 4). Given the findings of an assured non-viable fetal condition, the option of pregnancy termination was offered. The patient was admitted later that day and underwent an induction of labor after cardioplegia with laminaria and pitocin augmentation. She had a spontaneous vaginal delivery of a stillborn, dicephalic female fetus in cephalic presentation. The family declined chromosomal analysis, but desired a limited autopsy. Her postpartum course was uncomplicated. Permission for autopsy, excluding head, was obtained from the parents on the day of delivery. External examination was notable for a dicephalus dipus dibrachius female fetus (Fig. 5). Both fetal heads demonstrated acrania.