Doctors Plan Separating Conjoined Twins in Dallas [Egyptian nationality]

DALLAS (Reuters) - After conjoined Iranian twins died a few days ago during surgery to separate their brains, the medical world is focused on two bright-eyed Egyptian boys who are joined at the head and likely to be the next pair to undergo the highly risky operation.

Two-year-old Ahmed and Mohamed Ibrahim are joined at the crown of their heads and may have separation surgery as early as the next few months.

The two boys share a band of curly hair that circles the area where their heads are fused. They cannot stand because of the way their bodies are joined, and the two of them are about six feet in length from the toes of one twin to the toes of the other.

The Iranian twins Laleh and Ladan Bijani, 29, died on July 8 from massive blood loss after a 52-hour operation by 28 specialists at Singapore's Raffles Hospital.

Doctors have said the youth of the Egyptian boys in Dallas gives them an advantage of surviving surgery. As children, they have greater plasticity than adults, making it easier for their bones and tissue to undergo the strain of the operation and recover.

"The boys have been with us in the U.S. for a year, and that year has been nothing but intensive diagnostic testing and planning for the upcoming surgery," said Sue Blackwood, director of the Dallas-based World Craniofacial Foundation, a charity that is overseeing the operation.

The boys share large veins that drain blood out of the brain called venous sinuses. They also share some brain material, which could be divided without causing much harm, but if their circulatory systems are not properly separated, it could kill them, doctors say.

If they are not separated, the boys will likely never be able to walk because of their way their bodies are joined.

In April, the boys underwent a procedure to have balloon-like devices inserted into the areas where they will be separated. The pouches were also inserted into their thighs in order to expand tissue there that will be removed and used to keep their brains from being exposed after separation surgery.

Dr. Kenneth Salyer, a leading facial and cranial surgeon who is treating them, has said separation would be exceedingly hazardous. However, after a year of testing, planning and consultations, the medical team was confident it could be done.

He also said successes in these types of cases -- as measured by surviving the surgery with no neurological damage -- have been few.

Guatemalan twin girls, who are about the same age as the Egyptian boys, were separated at the skull a year ago at a hospital in Los Angeles. The girls have suffered some setbacks, but survived their operation.

The parents of the Egyptian twins have said they are sure that the only way to bring normalcy to the lives of the boys is through separation surgery.

Ahmed and Mohamed were born in a small town 500 miles south of Cairo on June 2, 2001, and have been under medical care almost all of their lives. The two boys are healthy, alert, playful, and are starting to learn a few words.

Conjoined twins account for about one of every 2.5 million births and twins joined at the head account for about 2 percent of all conjoined births.

Dr. Mark Siegler, the director of the MacLean Ethics Center at the University of Chicago, said some of the ethical points to consider in separation include the ability of successfully performing the surgery, having the right team in place, having a highly ethical institution behind the surgery and having the informed consent of the patients or their parents.

"So much comes down to the point of, as a scientific and technological matter, is it the judgment of the operating surgeon that there is a reasonable hope that this operation can be done successfully," Siegler said.

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3 posted on 07/13/2003 12:18:56 PM PDT by Support Free Republic (Your support keeps Free Republic going strong!)

why is it that we only see reports of people living in second or third world countries undergoing this kind of surgery? Its never AMericans, or Canadians or Brits or French or..... well you get the idea. Do these types of mutations happen more often to these other coutries? Surprising if they do, considering how chemical and radiation laden our lives are (according to the left anyhow)!!!

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