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CNN Live Today

Successful Separation

Aired October 13, 2003 - 09:59   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DARYN KAGAN, CNN ANCHOR: We begin this morning in Dallas, Texas, where 2-year-old Egyptian twins faced their first day alone. They are surrounded by doctors, watched by the world, but no longer physically connected to each other. On this morning after the marathon surgery to separate the boys, their condition is listed as critical, but stable, an assessment that captures the hopes and fears surrounded their survival.
Our medical correspondent Dr. Sanjay Gupta, a neurosurgeon himself, is here to talk about the expertise of what it takes them to do what they did...

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Yes, I got my model, 26 hours in the making to separate these twins, seven hours to actually close the procedure but, a year in the planning. We learned a lot about these sorts of operations recently, several sorts of these cases recently. This case in some ways was similar, in some ways a little different.

Let me show you this model here, get a little bit of a better sense. I don't know if you can see that or not. If we have a camera that can -- there is a model, basically there's some veins connected at the back of the brain here. These veins are actually intertwined in the two twins. What is sort of more striking about this particular situation is the left part of the brain of one of the twins, this area back here, connected to the right brain of the other twin. A little bit more stuck together, that was their word, not mine, in terms of actually separating those two parts of the brain. It's going to take some time to actually be ale to tell how that's going to do. People, obviously, want to know exactly what the condition of these twins are going to be neurologically afterwards.

I want to give you a small example as well about how just intricate the planning was for this sort of operation, even though after the past several months, there was a procedure known as tissue expanders actually being done on these twins, these little expanders -- I don't know if we have some of the pictures there, but basically the pictures of the twins showing the little bumps in the forehead there, actually these little expanders put underneath the skin to actually create more skin so that skin can be used to actually close the twins procedure.

They are in a barbiturate-induced coma. That's is what we're hearing from Dallas. Let's get the latest on the twins' condition twin. Dr. James Thomas is director of the critical care at the Dallas hospital, where the operation was performed.

Thanks for joining us, doctor.

DR. JAMES THOMAS, CHILDREN'S MEDICAL CENTER: Thank you.

GUPTA: Give us a sense, bring us up to date. How are things going for the twins over the last several hours?

THOMAS: Things have gone well. They have done really quite well through the course of the evening. They remain on multiple support modalities, but they've responded quite well and things -- we really couldn't expect them to go any better than they have.

GUPTA: Everyone is used to seeing the pictures of the twins now before the operation. They are obviously in a much different state now, obviously they are separated, but from a -- you're a critical care doctor. Give people a sense of the monitors and all the various things that are going now on to monitor these twins right now.

THOMAS: We have monitors in arteries, in veins. We have monitors in their brains to measure the pressure. We have drains that go up their spinal cord to relieve the pressure in the spinal fluid. And they are on medications to support the blood pressure and they are also on, of course, mechanical ventilators to breathe for them. So they have a lot of drains, and tubing and foreign bodies.

GUPTA: When I listened to you earlier you were talking about the wounds themselves and trying to prevent the break down of these wound. You are using a special bed. Tell us about that a little bit.

THOMAS: This is a bed made by KCI Corporation. It's an air-bed that levitates these children and minimizes the creation of any pressure points and the development of ulcerations in the skin, bed sores.

GUPTA: That's a pretty fascinating thing. And so their heads are actually suspended in a way there with little pressure on them, is that right?

THOMAS: Their entire bodies, yes.

GUPTA: That's fascinating.

This is an unusual operation. Your a critical care doctor down in Dallas. Has this operation been performed there, first of all? And second of all, what sort of unique considerations are you giving to these twins after the operation?

THOMAS: Well, there have actually been a number of separations of conjoined twins in Dallas, eight now at the Children's Medical Center alone. But this is the first time that an operation of this magnitude with twins joined at the head has ever been performed. And I think the considerations are those that you would see in any child having had major neurosurgical procedure for as many hour they were in, and we're concerned about post-operative infection and post- operative brain swelling.

GUPTA: They are in a barbiturate-induced coma. When are you going to allow them to wake up a little bit from that?

THOMAS: I think the neurosurgeons and we are planning to take a look at them in the next two, two and a half or three days, and depending on how they respond, we will either lighten up the coma even more or put them back into the coma for another day or two.

GUPTA: OK, sort of take it as -- final question, $2 million is the number being thrown around in terms of the cost of this sort of thing, $125,000 I think raised by the charities so far. First of all, why is that so expensive? I know it's a complicated operation. That seems like a lot of money.

THOMAS: Well, this figure doesn't actually come from Dallas. This figure comes from UCLA, where they separated the Guatemalan girls a year ago. That's not a quote from here. Here, we really don't have a sense of how much the cost would be had somebody had to fork over all that money.

But the foundation that you mentioned has raised over $150,000 to cover what we call the hard costs of the procedure. A lot of the people involved have donated their time, and so those don't represent real costs.

GUPTA: OK, Dr. James Thomas in Dallas. I know you had a long night. The surgeons are probably asleep as well. We're try and talk to them later on.

Thank you for joining us. We're going to follow the story all week. Appreciate your time.

KAGAN: I have a couple of questions for this doctor, a couple of brain questions. First of all, I know that you were talking with the doctor about putting these boys in a coma. I know that's something you do, putting people into a coma, your patients. Why do you do that?

GUPTA: This is a controlled setting. And basically, what you want to do in this sort of situation is make sure the brain is in the state of sleep, so it's not demanding as much in terms of blood flow, in terms of oxygen. That's a good state for the brain to be in. After a big operation like that, you want to try and let the brain cool down a little bit. A barbiturate. Essentially, it's the same medication that's used to control seizure, and one of the medications basically. You put in high doses of that to actually make the patient into a coma.

KAGAN: And then also you were talking about one of the twins, Mohamed, his left hemisphere got a little bit stuck. What kind of challenges? What does that part of the brain do, and what kind of challenges might that present down the road?

GUPTA: That's a really good question. It's an interesting question as well, because you have the left side of the brain of one of the twins connected to the right side of the other. This happens in a lot of cases, certainly with the Bijani twins and the two Marias as well. The left side of the brain more responsible for speech, for your ability to express yourself, for your ability to understand speech. The right side of the brain, that area more responsible for spatial relations, things like that.

Speech considerations, very hard to test obviously in a young child, a 2-year-old child. So sometimes it's hard to tell exactly how they are going to do in terms of their speech long term. If you had to guess, you would say the person who had the left side of the brain more affected is going to have a slower neurological recovery perhaps from all of this.

The good news is, though, that young kids, their brains aren't hard-wired yet. They've got a lot of developing to do. That certainly works in their favor.

KAGAN: And we'll be following it. Dr. Sanjay Gupta, thank you for that.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired October 13, 2003 - 09:59   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: We begin this morning in Dallas, Texas, where 2-year-old Egyptian twins faced their first day alone. They are surrounded by doctors, watched by the world, but no longer physically connected to each other. On this morning after the marathon surgery to separate the boys, their condition is listed as critical, but stable, an assessment that captures the hopes and fears surrounded their survival.
Our medical correspondent Dr. Sanjay Gupta, a neurosurgeon himself, is here to talk about the expertise of what it takes them to do what they did...

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Yes, I got my model, 26 hours in the making to separate these twins, seven hours to actually close the procedure but, a year in the planning. We learned a lot about these sorts of operations recently, several sorts of these cases recently. This case in some ways was similar, in some ways a little different.

Let me show you this model here, get a little bit of a better sense. I don't know if you can see that or not. If we have a camera that can -- there is a model, basically there's some veins connected at the back of the brain here. These veins are actually intertwined in the two twins. What is sort of more striking about this particular situation is the left part of the brain of one of the twins, this area back here, connected to the right brain of the other twin. A little bit more stuck together, that was their word, not mine, in terms of actually separating those two parts of the brain. It's going to take some time to actually be ale to tell how that's going to do. People, obviously, want to know exactly what the condition of these twins are going to be neurologically afterwards.

I want to give you a small example as well about how just intricate the planning was for this sort of operation, even though after the past several months, there was a procedure known as tissue expanders actually being done on these twins, these little expanders -- I don't know if we have some of the pictures there, but basically the pictures of the twins showing the little bumps in the forehead there, actually these little expanders put underneath the skin to actually create more skin so that skin can be used to actually close the twins procedure.

They are in a barbiturate-induced coma. That's is what we're hearing from Dallas. Let's get the latest on the twins' condition twin. Dr. James Thomas is director of the critical care at the Dallas hospital, where the operation was performed.

Thanks for joining us, doctor.

DR. JAMES THOMAS, CHILDREN'S MEDICAL CENTER: Thank you.

GUPTA: Give us a sense, bring us up to date. How are things going for the twins over the last several hours?

THOMAS: Things have gone well. They have done really quite well through the course of the evening. They remain on multiple support modalities, but they've responded quite well and things -- we really couldn't expect them to go any better than they have.

GUPTA: Everyone is used to seeing the pictures of the twins now before the operation. They are obviously in a much different state now, obviously they are separated, but from a -- you're a critical care doctor. Give people a sense of the monitors and all the various things that are going now on to monitor these twins right now.

THOMAS: We have monitors in arteries, in veins. We have monitors in their brains to measure the pressure. We have drains that go up their spinal cord to relieve the pressure in the spinal fluid. And they are on medications to support the blood pressure and they are also on, of course, mechanical ventilators to breathe for them. So they have a lot of drains, and tubing and foreign bodies.

GUPTA: When I listened to you earlier you were talking about the wounds themselves and trying to prevent the break down of these wound. You are using a special bed. Tell us about that a little bit.

THOMAS: This is a bed made by KCI Corporation. It's an air-bed that levitates these children and minimizes the creation of any pressure points and the development of ulcerations in the skin, bed sores.

GUPTA: That's a pretty fascinating thing. And so their heads are actually suspended in a way there with little pressure on them, is that right?

THOMAS: Their entire bodies, yes.

GUPTA: That's fascinating.

This is an unusual operation. Your a critical care doctor down in Dallas. Has this operation been performed there, first of all? And second of all, what sort of unique considerations are you giving to these twins after the operation?

THOMAS: Well, there have actually been a number of separations of conjoined twins in Dallas, eight now at the Children's Medical Center alone. But this is the first time that an operation of this magnitude with twins joined at the head has ever been performed. And I think the considerations are those that you would see in any child having had major neurosurgical procedure for as many hour they were in, and we're concerned about post-operative infection and post- operative brain swelling.

GUPTA: They are in a barbiturate-induced coma. When are you going to allow them to wake up a little bit from that?

THOMAS: I think the neurosurgeons and we are planning to take a look at them in the next two, two and a half or three days, and depending on how they respond, we will either lighten up the coma even more or put them back into the coma for another day or two.

GUPTA: OK, sort of take it as -- final question, $2 million is the number being thrown around in terms of the cost of this sort of thing, $125,000 I think raised by the charities so far. First of all, why is that so expensive? I know it's a complicated operation. That seems like a lot of money.

THOMAS: Well, this figure doesn't actually come from Dallas. This figure comes from UCLA, where they separated the Guatemalan girls a year ago. That's not a quote from here. Here, we really don't have a sense of how much the cost would be had somebody had to fork over all that money.

But the foundation that you mentioned has raised over $150,000 to cover what we call the hard costs of the procedure. A lot of the people involved have donated their time, and so those don't represent real costs.

GUPTA: OK, Dr. James Thomas in Dallas. I know you had a long night. The surgeons are probably asleep as well. We're try and talk to them later on.

Thank you for joining us. We're going to follow the story all week. Appreciate your time.

KAGAN: I have a couple of questions for this doctor, a couple of brain questions. First of all, I know that you were talking with the doctor about putting these boys in a coma. I know that's something you do, putting people into a coma, your patients. Why do you do that?

GUPTA: This is a controlled setting. And basically, what you want to do in this sort of situation is make sure the brain is in the state of sleep, so it's not demanding as much in terms of blood flow, in terms of oxygen. That's a good state for the brain to be in. After a big operation like that, you want to try and let the brain cool down a little bit. A barbiturate. Essentially, it's the same medication that's used to control seizure, and one of the medications basically. You put in high doses of that to actually make the patient into a coma.

KAGAN: And then also you were talking about one of the twins, Mohamed, his left hemisphere got a little bit stuck. What kind of challenges? What does that part of the brain do, and what kind of challenges might that present down the road?

GUPTA: That's a really good question. It's an interesting question as well, because you have the left side of the brain of one of the twins connected to the right side of the other. This happens in a lot of cases, certainly with the Bijani twins and the two Marias as well. The left side of the brain more responsible for speech, for your ability to express yourself, for your ability to understand speech. The right side of the brain, that area more responsible for spatial relations, things like that.

Speech considerations, very hard to test obviously in a young child, a 2-year-old child. So sometimes it's hard to tell exactly how they are going to do in terms of their speech long term. If you had to guess, you would say the person who had the left side of the brain more affected is going to have a slower neurological recovery perhaps from all of this.

The good news is, though, that young kids, their brains aren't hard-wired yet. They've got a lot of developing to do. That certainly works in their favor.

KAGAN: And we'll be following it. Dr. Sanjay Gupta, thank you for that.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com