Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm2, which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.

Conjoined twins are rare, and each set of conjoined twins has a unique conjoined anatomy. It is necessary to perform separation to increase the chance of patient survival. Tissue expansion is an advanced technique for providing sufficient soft tissue and skin for wound closure. We report the successful application of rapid tissue expansion in 10-month-old xipho-omphalopagus conjoined twins in Vietnam. A tissue expander was placed on the anterior body between the sternum and umbilicus with a baseline of 70 mL sterile saline (0.9% NaCl). The first injection into the tissue expander began on the 6th day after expander insertion, and injections continued every 2 days with approximately 30–70 mL per injection according to the expansion of the skin. The expander reached 335 mL after six injections and within 10 days. In order to prepare for surgical separation, expansion was completed on the 15th day after insertion. The expanded skin area was estimated to be 180 cm2, which was sufficient to cover both patients’ skin deficiencies. The twins presented for surgical separation 6 days following the completion of tissue expansion. Both babies were discharged in good health 1 month after separation.

Background: Shigella-induced diarrhea has been considered a major health problem leading to high morbidity and mortality. This disease can lead to dire consequences; however, the true burden of the disease, including the costs and sequalae associated with shigellosis is not yet known. Objectives: (1) To describe the health seeking behavior and the way of payment of population when suffering Shigella; (2) To identify and analyze the direct household costs associated with the treatment of diarrhea due to Shigella. Subjects and method: 290 patients of all ages with positive Shigella diarrhea admitted to public health facilities in Nha Trang, Khanh Hoa province in the period from August 2002 to January 2004 were included in the study. The subjects were divided into three age groups, the first 0-5, second 5-18 and the last one was over 18 years old. Patients and their relatives were interviewed at three stages - day 7, day 14 and day 90 - to obtain all the required information. Results: 134 of 290 patients (47%) paid for using the other health care services before admission to the study\u2019s facilities. The average direct cost per episode for the patients at group aged 0-5 was 129,000 VND, group aged 6-18 was 59,267 VND and over 18 years old was 173,531 VND; it was 131.960 VND for three groups. Comparison with the average household expenditure for health care, it was higher in the poorer group and it was lower three times than the richest group. The average direct medical cost per episode was higher the average direct non-medical cost per episode for all groups. Conclusions: The average direct cost per episode of Shigellosis treatment was rather high especially the average direct cost for the treatment at the health facility. It was also high compared with the average expenditure for health per capita so that it becomes large economic burden for households.
Direct cost ; Shigella ; treatment

Freshwater snails of the family Lymnaeidae play an important role in the transmission of fascioliasis worldwide. In Vietnam, 2 common lymnaeid species, Lymnaea swinhoei and Lymnaea viridis, can be recognized on the basis of morphology, and a third species, Lymnaea sp., is known to exist. Recent studies have raised controversy about their role in transmission of Fasciola spp. because of confusion in identification of the snail hosts. The aim of this study is, therefore, to clarify the identities of lymnaeid snails in Vietnam by a combination of morphological and molecular approaches. The molecular analyses using the second internal transcribed spacer (ITS2) of the nuclear ribosomal DNA clearly showed that lymnaeids in Vietnam include 3 species, Austropeplea viridis (morphologically identified as L. viridis), Radix auricularia (morphologically identified as L. swinhoei) and Radix rubiginosa (morphologically identified as Lymnaea sp.). R. rubiginosa is a new record for Vietnam. Among them, only A. viridis was found to be infected with Fasciola spp. These results provide a new insight into lymnaeid snails in Vietnam. Identification of lymnaeid snails in Vietnam and their role in the liver fluke transmission should be further investigated.
Animals ; Cluster Analysis ; DNA, Ribosomal Spacer/chemistry/genetics ; Fasciola/*isolation & purification ; Lymnaea/*anatomy & histology/genetics/*parasitology ; Molecular Sequence Data ; Phylogeny ; Sequence Analysis, DNA ; Sequence Homology, Nucleic Acid ; Vietnam