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Guatemalan Twins Separated Last Year Return for More Operations

Aired May 22, 2003 - 19:31   ET


DARYN KAGAN, CNN ANCHOR: Well if last year's operation to separate conjoined Guatemalan twins seemed like a miracle, today there is a sobering reminder of the limits of the cutting edge of medicine. Both twins returned to the U.S. today because of new problems and persistent old one. Our medical correspondent Elizabeth Cohen has details.

ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT (voice-over): They warmed hearts around the world. Maria Teresa and Maria de Jesus Quiej Alvarez were considered a surgical success story when they left UCLA in January heading home to Guatemala. The girls were separated in a 23-hour surgery at UCLA in August. And now the twins, who will turn two in July, are back at UCLA because they've both taken a turn for the worse. They left Guatemala City Thursday morning and arrived in the evening in Los Angeles.

On Wednesday, Maria de Jesus had a convulsion according to the Guatemalan pediatrician in charge of her care. She then developed a fever and high white blood cell count. Doctors are doing a tests to see if she has an infection. The doctor, Ludwig Ovalle, also said the wound in her head where she'd been separated from her sister this not healed properly.

And the doctor said Maria Teresa is in even worse shape. In April she developed meningitis and the Guatemala doctors replaced a valve that had been put in her head to drain fluid because they feared it was the source of the infection. Maria Teresa now has hydrocephelus or fluid on the brain, and her condition has not improved since her valve replacement surgery.

Doctors at UCLA Mattel Children's Hospital are not commenting on the girls' conditions.

Elizabeth Cohen, CNN, Atlanta.


KAGAN: Well still a lot more questions about the girls' cases. A perfect person to ask is Dr. Sanjay Gupta. Not only our medical correspondent, but a practicing neurosurgeon. Good evening. Thanks for being with us.

First of all, tell us about these valves. Why would the girls of just one of the girls have to have a valve?

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Maria Teresa, right after her operation, right where the operation was performed, actually separating the two brains, developed some fluid on the brain. The name for that fluid is actually subdural hematoma. The name's not that important. But basically what it means is this fluid accumulates between the outer layer of the brain and the brain itself.

Now there's a drain, actually it looks like a drain, it's a silastic catheter, actually comes through that fluid and comes outside the brain and there is a valve to try and regulate how much fluid is drained at any given time. If someone actually sits upright they may drain a lot more fluid than they intend to, so they put a valve to regulate that.

KAGAN: And her's got infected. Is that a common problem with these things?

GUPTA: It is a pretty common thing. This is a -- you know, as far as pediatric nursery goes, this is one of the most common complications of one of these types of drains, also called the shunt. These things do get infected, they do need to be replaced, that is pretty common, I say 20 to 30 percent of the time.

KAGAN: We did say off of the top that this surgery was considered a miracle and you did see what they did to separate these girls. It is incredible.

But are you surprised that they're having challenges at this time?

GUPTA: Yes, I'm really not surprised and I think that there was optimism surrounding the operation when it was done back in August of last year. And every single one of these operations, and there's not that many, is a little bit different. These two girls, for example, only shared 10 percent of their brain. You can see the scans there...

KAGAN: What does that tell us?

GUPTA: OK, what you're looking at there, and it's hard to tell, but basically that is two brains that are actually connected. But they were connected at the top of their heads. You can certainly see that when you look at the two girls themselves. This is an MRI scan that shows that as well. It's a little bit better scan there.

But anyways, 10 percent of their brain was actually conjoined or connected. That bodes well or better than some of the babies who have 50 percent or 60 percent of their brain connected. So there was a lot of optimism.

But these sorts of problems are not unexpected. They do occur in these sorts of situations. Again, the infection of the drain, the -- Maria Alvarez actually having problems now with seizures. That can be due to fevers, it can be due to meningitis, which is an infection of fluid around the brain, all these sorts of things. But they're also fairly correctable problems. KAGAN: So is this their future? A future of medical problems?

GUPTA: It's hard to tell. I think that it's going to be quite a while yet. The doctors at the time said they expected these two girls to meet their milestones within the first several years. That probably is a little bit optimistic.

Maria Alvarez has not really healed the back of her head yet which is probably where her infection's coming from. That can be a big procedure. There was no skin there. They babies were connected. So actually they had to take skin from other places. That may involve several grafting procedures down the road.

I think they've got a road in front of them still, a few years probably before they start to catch up, if they do.

KAGAN: They're tough little girls. We saw that the first round.

GUPTA: Sure, they really are.

KAGAN: Dr. Sanjay Gupta. Thank you very much.

GUPTA: Good to see you.



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