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Egyptian Twins Doing Well After Separation Surgery

Aired October 13, 2003 - 13:04   ET


MILES O'BRIEN, CNN ANCHOR: Let's go back to Dallas and that news conference we were talking about just a few months ago.

DR. JAMES THOMAS, DIR. OF CRITICAL CARE, CHILDREN'S MEDICAL CENTER: ... the status of Ahmed and Mohammed Ibrahim. Ahmed returned to the ICU about an hour before Mohammed. At their arrival, both boys appeared to be in truly remarkable condition, considering the ordeal that they had just come through.

As has already been reported, both were in and continue to be in drug-induced comas too minimize the risk of brain swelling. Both are on mechanical ventilators and both require low doses of medication to keep their blood pressures within the normal range.

Throughout the night they both remained on an even keel. And this morning we've been able to decrease further the blood pressure medications. Starting at about 10:00 a.m. the boys underwent routine follow-up CAT scans of their brains. Both Ahmed's and Mohammed's brain scans looked good. There is no hemorrhage and minimal residual brain swelling. The neurosurgery team is quite pleased with what they see.

Once back from CTs, from the CAT scan, Mohammed is slated to undergo placement of a drain, a spinal fluid drain in the lower part of his back. Ahmed had a similar drain placed preoperatively. Otherwise, the plan for the rest of the day is to allow the boys to continue their post-operative recovery.

Both Mom and Dad were up late last night. Mom was awake this morning and accompanied her boys to the CAT scanner. I've got see Dad, but I've heard that he rested well. The boys' Egyptian nurses, Wafla (ph) and Nagla (ph), have been visiting frequently and are quite moved by the events of the last three days.

All of the physicians and staff members involved in the boys' care would like to thank those who have e-mailed and written with their prayers and word of encouragement.

And now I'd be happy to field a few questions.

QUESTION: At what point will they come out of the drug-induced coma given that everything is going as well as it is?

THOMAS: The plan as it stands now is probably in the next two and a half to three days to begin to decrease the dose of this -- of the barbiturate -- and see how they respond. And if they respond favorably, to continue to drop the dosing of that medication.

If they are not ready as determined by a couple of things that we follow in the ICU, we'll put the medication back up to the former dose and wait another day or two.

QUESTION: There seems to be more surgery like this, more cases like this that seem to be coming out more and more. Why would you suppose that is? More conjoined twins being separated?

THOMAS: I don't really know the answer.

QUESTION: (OFF-MIKE) I mean, is each surgery building on the last? Is there more information? Are the teams learning more from each case?

THOMAS: Well, clearly, -- clearly the surgeons that undertake these procedures speak to the surgeons who have done the procedures before. And I think there is gradual accumulation of the collective experience. But I can't really address the nature of the phenomenon itself.

QUESTION: What's the medication they're getting for their blood pressure and what exactly does it do?

THOMAS: OK. Let's see, Ahmed is on a drug called Epinephrine which is also known as adrenaline. And what that does is -- well, the barbiturate that is used to put them into a drug-induced coma actually decreases the ability of their heart to pump as strongly as it normally would. And so the medication is used simply to counteract it. It allows the heart to pump more strongly.

And Mohammed has an in addition to...

O'BRIEN: We have been listening to that news conference. We're going to continue to monitor it.

But in the meantime we want to bring in Dr. Sanjay Gupta who himself is a neurosurgeon as well as being a correspondent for us and was taking some fairly good notes there. Read the tea leaves for us. On the way it's presented to the lay-public it seems like things are good.


O'BRIEN: Did you see anything in there that would cause any concern?

GUPTA: Well there are a lot of things at play, still, here. There's no question about that. One of the things that's important to remember is they got these CAT scans they talked about right after the operation. They're not looking for anything sort in terms of function, but rather if there's been a catastrophic event, such as a major bleed or something like that, they would certainly see that on the CAT scan. That hasn't happened.

But think of it like this, Miles. There's sort of going to be layers of concern. And as you get further and further out from the operation, the layers will get less significant. Right now they're still looking for life-threatening things. I wouldn't say they're by any means out of the woods even in terms of their survival yet. Things look optimistic, certainly better than the cases that you and I have talked about recently. But still, there's a lot at play here.

O'BRIEN: So that issue of function, that's a question that's answered very much later and is down the road. That has nothing to do with the CAT scans we heard about?

GUPTA: That's right. They did a year's worth of planning for this operation. I'll give you one example of sort of the intricacies. We've got the brain model here.

One of the twins actually has the left side of their brain in part on the back attached to the right side of the brain of the other twin. That's important because the left side of the brain is more responsible for speech, for your ability to understand speech, deliver speech, things like that. Where as the right side of the brain is not as significant in that particular area of the brain.

So one of the twins is possibly going to have more of a neurological impact from this operation. The good news is they're 2- years-old. Their brains are still sort of hard wiring.

O'BRIEN: So there is the ability to regenerate of whatever, if that's the correct term?

GUPTA: Right.

O'BRIEN: The one we all are recalling, of course, is the Iranian adult twins in Singapore who unfortunately both died after the surgery. And we talked a lot about how it was much more perilous for adults to go through this. Give us a sense of how the statistics stack up for younger children vis-a-vis adults.

GUPTA: Well you know the statistics still aren't very good. I mean we're dealing with a rare operation. We talked about this, recently, because of all the -- I don't know if there are necessarily more cases, but we've been talking about them a lot more.

That had been the first time with the adults that had before been done before. And people were pretty concerned about that. The brains are already formed, they're not going to regenerate or recircuit any of their the hard wiring. But, the kids, they have a better chance at that.

But still, Miles, statistics are against both twins surviving these situations. Statistics are more likely than not that one of the twins would have a significant problem.

O'BRIEN: So tremendous risk still in there for these neurosurgeons. This is the ultimate, isn't it?

GUPTA: This is where the rubber hits the road sort of surgery. And you know we were listening to the ICU doctor there as well, the internal -- critical care doctor. One of the things that they're balancing here -- this just gives you a small example -- they're putting the patients, the two twins into a barbiturate coma. That essentially puts the brain to sleep, decreases swelling, things like that.

But it lowers blood your pressure significantly. So they actually have to give blood pressure-raising medications, not to lower the blood pressure, but to actually raise it. And there's a sort of fine walk that they're going to have to do over the next several days here.

O'BRIEN: You've got to be careful you don't end up chasing your tail in this, right?.

GUPTA: That's right. Exactly. And they'll probably wake them up in a few days and see how they look. And if not so good, more barbiturates for a while.

O'BRIEN: Really? All right. Dr. Sanjay Gupta, watching this for us. Thanks very much. Appreciate it.


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