Six-month-old conjoined twin sisters separated in Haiti

On Friday, May 22, physicians and nurses separated a pair of six-month-old conjoined Haitian twins, the first such operation ever performed on Haitian soil.

Henri Ford, Md, chief of Surgery, Children's Hospital Los Angeles, holds formerly conjoined twins Michelle and Marian three days after their separation surgery in Haiti.

Credit: Image courtesy of Childrens Hospital Los Angeles

On Friday, May 22, an 18-member team of physicians and nurses from Children's Hospital Los Angeles (CHLA) and Keck Medicine of the University of Southern California (USC) led an international collaboration to separate a pair of six-month-old conjoined Haitian twins, the first such operation ever performed on Haitian soil.

Marian Dave-Nouche Bernard and Michelle Dave-Nouche Bernard, born as one on Nov. 24, 2014, were separated after a seven-hour surgery at University Hospital of Mirebalais (HUM), in Mirebalais Haiti, a poor rural community in the country's Central Plateau, about 36 miles northeast of the capital city of Port-au-Prince.

"The girls are doing fantastic," said surgical team leader Henri Ford, MD, MHA, the Haitian-born surgeon in chief at Children's Hospital Los Angeles and vice dean for Medical Education, professor and vice chair for Clinical affairs, Department of Surgery, Keck School of Medicine of USC. "It was an extremely exhilarating day; not only did our preparations pay off and the surgery succeed in spectacular fashion, but this was also a time to put politics aside and celebrate our national pride."

Marian and Michelle -- "omphalopagus" twins since they are connected at the abdomen -- are actually triplets (sister Tamar is healthy and normal). The two sisters had faced each other since birth, but recuperated in separate beds in HUM's neonatal intensive care unit. They were ready to be discharged 12 days after surgery. "We anticipate Marian and Michelle will recover fully and go on to lead healthy and happy lives," Ford says.

Conjoined twins occur in roughly 1 in 200,000 births and omphalopagus twins represent about 30 percent of all conjoined twin births. As triplets, these girls are considered even rarer, occurring 1 in an estimated 1 million births. Fused together by the breastbone (or xiphoid bone) in the lower portion of the sternum, Marian and Michelle also had attached livers that would be separated during the procedure.

It took the international surgical team almost seven hours to separate the conjoined twins.

The mother, Manoucheca Ketan, 35, gave birth to all three of her daughters at HUM after carrying them for 36 weeks. The twins shared a crib until 10 a.m. on May 22, when Ketan and her husband, David Bernard, 31, watched as their infant daughters were wheeled into surgery as one. Ten hours later, after the surgery, the parents wept when they next saw the twins -- resting in separate cribs.

By then, the girls were already feeding on formula and breast milk. "It was an extraordinary moment," Ketan said, describing her reaction when she first laid eyes on her separated daughters. "When I first met Dr. Ford, he told me he was confident we could separate my children, but I didn't know how it would turn out when the day started. Now I am feeling a lot of joy and want to recognize and thank the hospital for everything."

The complex surgical procedure got underway within 24 hours of the arrival of the 18-member surgical team of surgeons, anesthesiologists and nurses from Children's Hospital Los Angeles. The Los Angeles team was joined by 12 medical staff from Centres GHESKIO, Hospital Bernard Mevs-Project Medishare and Hopital Universitaire de Mirebalais (HUM), led by Dr. Maclee Jean-Louis, director of Surgery at HUM. The group comprised what Ford described as an international medical "Dream Team."

The family received free treatment from HUM, which is supported by the Haitian Ministry of Health and Partners in Health, an international health organization. Keck Medicine and CHLA covered the travel expenses of the medical team and donated supplies to ensure the success of the operation.

Anticipating a six- to eight-hour procedure, doctors made the first incision along the abdominal wall that connected Marian and Michelle at 1:14 p.m. At 2:50 p.m., the girls were surgically separated to a burst of applause from the team and Marian was moved to an adjacent table. Donning red caps, Marian's team of six doctors and nurses hovered over her to close her incision, while Michelle's team worked in yellow caps -- ironically reflecting the colors of USC. "The mom gave them red and yellow bands months ago to identify them," Ford explains. "They were destined to be separated by Trojan surgeons."

Michelle was wheeled out of the surgery suite at 4:45 p.m., followed by Marian at 4:58 p.m.

"This surgery took less time than previous conjoined twin separations we have performed at CHLA, since there was no pelvic attachment," explains James Stein, lead surgeon during the separation and associate chief of surgery at Children's Hospital. Stein, an associate professor of surgery at Keck School of Medicine, has now separated six pairs of conjoined twins. "There are surgeries that require the expanded expertise of a place like CHLA, but the twins' anatomy and our team's expertise allowed us to undertake the surgery in Haiti, and compile the appropriate resources to do the surgery there safely."

Ford said that by doing the operation in Haiti, the children would benefit emotionally from the proximity of their parents and the surgery could be done more cost-effectively than if it were done in Los Angeles.

After completing the first ever surgery in Haiti to separate conjoined twins, part the international team takes a break in the surgery suite at University Hospital in Mirebalais.

During the seven-hour operation, the girls underwent 11 separate procedures, with only a few minor complications. Early on, surgeons and anesthesiologists encountered a "cross circulation" -- when fluids, blood and medication pass through one twin's liver to the other without benefiting the first.

Michelle's heart rate elevated, but the surgeons -- Stein, Ford and Aaron Jensen, MD, along with CHLA anesthesiologists Duc Nguyen, MD, and Joanna E. Green, MD -- remedied the situation by expeditiously separating the livers and individually hydrating the girls intravenously.

Doctors also removed an ovarian cyst in Michelle and surgically inserted patch material in both girls to reconstruct their abdominal walls after separation. They also formed new belly buttons for the twins, whose midline vertical scars should nearly disappear over time, Stein says.

One moment during the operation seemed to sum up the enormity of the procedure for Ford. "Their lower chests were connected so we had to remove a piece of the sternum, the breastbone, and then you could see their lungs and their hearts beating," he recalled.

Once the girls were moved to intensive care, a team of intensivists led by a graduate of CHLA's pediatric residency program, Peggy Han, MD, now an attending intensivist at Weill-Cornell, and neonatal intensive care unit nurses worked with HUM staff to oversee the twins' recovery. Volunteers from two other U.S. hospitals would fly in later to join the team and help oversee care after the CHLA team departed. Forty-eight hours after surgery, the girls were breathing independently, and after 72 hours they were being fed with a combination of breast milk and formula, Ford says.

Ford started recruiting his team back in September after his first conversation with the twins' doctors at HUM. Ford and team members would make almost monthly trips to Haiti between the November births and the May 22 surgery, checking up on the health of the girls and making sure that the proper human and material resources or equipment were available to safely do the surgery at HUM. By March, the team was set and the girls, strong and healthy, were scheduled for the May procedure.

Hours after the surgery, the Haitian media reported on the milestone operation and, three days postoperatively, the famous twins were paid a visit by Haitian First Lady Sophia Martelly and Minister of Health Florence Guillaume.

In the coming weeks, the girls will recover from their incisions and undergo physical therapy to help strengthen neck muscles weakened due to facing in a single direction for such a long time. "The girls look great; we don't expect any more surgeries," Stein says. "This was all about planning and organization. The amazing part for all of us is conducting seven hours of surgery, and then seeing two kids side by side, when they used to be just one. It's just awe-inspiring."

"I liken the entire international team of surgeons, anesthesiologists, intensivists, respiratory therapists and nurses to a symphony orchestra," says team leader Ford, who no doubt would make Gustavo Dudamel proud.

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Story Source:

The above story is based on materials provided by Childrens Hospital Los Angeles. Note: Materials may be edited for content and length.

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30-year-old Russian man volunteers for world's first human head transplant

 In February, Medical News Today reported that an Italian surgeon is to announce updated plans to conduct the world's first human head transplant within the next 2 years. Now, a 30-year-old Russian man is set to become the first person to undergo the procedure.

The HEAVEN-GEMINI procedure - which is estimated to take 100 surgeons around 36 hours to complete - will involve spinal cord fusion.

Dr. Sergio Canavero, of the Turin Advanced Neuromodulation Group (TANG) in Italy, first spoke of his plans to carry out the first human head transplantation in July 2013 - a project named HEAVEN-GEMINI.

At the American Academy of Neurological and Orthopedic Surgeons' 39th Annual Conference in Annapolis, MD, in June, Dr. Canavero will present updated plans for the project, addressing some of the previously identified challenges that come with it.

Though researchers have seriously questioned the feasibility of Dr. Canavero's plans, it seems the first human head transplantation is a step closer to becoming a reality; Valery Spiridonov, a 30-year-old computer scientist from Vladimir, Russia, is the first person to volunteer for the procedure.

Spiridonov has Werdnig-Hoffman disease - a rare genetic muscle wasting condition, also referred to as type 1 spinal muscular atrophy(SMA). The condition is caused by the loss of motor neurons in the spinal cord and the brain region connected to the spinal cord. Individuals with the disease are unable to walk and are often unable to sit unaided.

Spiridonov was diagnosed with Werdnig-Hoffman disease at the age of 1 and told MailOnline that he volunteered for HEAVEN-GEMINI because he wants the chance of a new body before he dies.

'"I can hardly control my body now," he said. "I need help every day, every minute. I am now 30 years old, although people rarely live to more than 20 with this disease."

Donor body will be attached to recipient's head through spinal cord fusion

Dr. Canavero told CNN he has received an array of emails and letters from people asking to be considered for the procedure, many of which have been from transgender individuals seeking a new body. However, the surgeon says the first people to undergo the procedure will be those with muscle wasting conditions like Spiridonov.

The procedure - which is estimated to take 100 surgeons around 36 hours to complete - will involve spinal cord fusion (SCF). The head from a donor body will be removed using an "ultra-sharp blade" in order to limit the amount of damage the spinal cord sustains.

"The key to SCF is a sharp severance of the cords themselves," Dr. Canavero explains in a paper published earlier this year, "with its attendant minimal damage to both the axons in the white matter and the neurons in the gray laminae. This is a key point."

The spinal cord of the donor body will then be fused with the spinal cord of the recipient's head. Chemicals called polyethylene glycol or chitosan can be used to encourage SCF, according to Dr. Canavero. The muscles and blood supply will then be sutured.

The recipient will be kept in a coma for around 3-4 weeks, says Dr. Canavero, during which time the spinal cord will be subject to electrical stimulation via implanted electrodes in order to boost the new nerve connections.

The surgeon estimates that - with the help of physical therapy - the patient would be able to walk within 1 year.

Spiridonov admits he is worried about undergoing the procedure. "Am I afraid? Yes, of course I am," he toldMailOnline. "But it is not just very scary, but also very interesting."

"You have to understand that I don't really have many choices," he added. "If I don't try this chance my fate will be very sad. With every year my state is getting worse."

Spiridonov talks more about his decision to participate in HEAVEN-GEMINI in the video below:

Dr. Canavero branded 'nuts'

Dr. Canavero has previously admitted there are two major challenges with HEAVEN-GEMINI: reconnecting the severed spinal cord, and stopping the immune system from rejecting the head. But he claims that recent animal studies have shown the procedure is "feasible."

Unsurprisingly, however, researchers worldwide are highly skeptical of the proposal. Talking to CNN, Arthur Caplan, PhD, director of medical ethics and NYU Langone Medical Center in New York, NY, even called Dr. Canavero "nuts."

Caplan said the procedure needs to be conducted many more times on animals before it is applied to humans, adding that if the technique is feasible then Dr. Canavero should be trying to help paralyzed patients before attempting whole body transplants.

And talking to New Scientist earlier this year, Harry Goldsmith, a clinical professor of neurosurgery at the University of California-Davis, said the project is so "overwhelming" that it is the chances of it going ahead are unlikely.

"I don't believe it will ever work," he added, "there are too many problems with the procedure. Trying to keep someone healthy in a coma for 4 weeks - it's not going to happen."

Spiridonov says he is well aware of the risks, though he is still willing to take a chance on Dr. Canavero.

"He's a very experienced neurosurgeon and has conducted many serious operations. Of course he has never done anything like this and we have to think carefully through all the possible risks," he told MailOnline, but adds that "if you want something to be done, you need to participate in it."

Though it not been confirmed when the procedure will be performed, Spiridonov says it could be as early as next year.

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Surgical Errors Occur More Than 4,000 Times A Year In The U.S.

Events that should never occur in surgery ("never events") happen at least 4,000 times a year in the U.S. according to research from Johns Hopkins University.

The findings, published in Surgery, is the first of its kind to reveal the true extent of the prevalence of "never events" in hospitals through analysis of national malpractice claims. They observed that over 80,000 "never events" occurred between 1990 and 2010.

They estimate that at least 39 times a week a surgeon leaves foreign objects inside their patients, which includes stuff like towels or sponges. In addition surgeons performing the wrong surgery or operating on the wrong body part occurs around 20 times a week.

Marty Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine, said:

"There are mistakes in health care that are not preventable. Infection rates will likely never get down to zero even if everyone does everything right, for example. But the events we've estimated are totally preventable. This study highlights that we are nowhere near where we should be and there's a lot of work to be done."

The researchers believe that this finding could help ensure that better systems are developed to prevent these "never events" which should never happen.

The study examined data from the National Practitioner Data Bank which handles medical malpractice claims to calculate the total number of wrong-site-, wrong-patient and wrong-procedure surgeries.

Over 20 years. they found more than 9,744 paid malpractice claims which cost over $1.3 billion. Of whom 6.6% died, while 32.9% were permanently injured and 59.2% were temporarily injured.

Around 4,044 never events occur annually in the U.S., according to estimates made by the research team who analyzed the rates of malpractice claims due to adverse surgical events.

Many safety procedures have been implemented in medical centers to avoid never events, such as timeouts in the operating rooms to check if surgical plans match what the patient wants. In addition to this, an effective way of avoiding surgeries that are performed on the wrong body part is using ink to mark the site of the surgery. In order to prevent human error, Makary notes that electronic bar codes should be implemented to count sponges, towels and other surgical instruments before and after surgery.

It is a requirement that all hospitals report the number of judgments or claims to the NPDB. Makary did note, however, that these figures could be low because sometimes items left behind after surgery are never discovered.

Most of these events occurred among patients in their late 40s, surgeons of the same age group accounted for more than one third of the cases. More than half (62%) of the surgeons responsible for never events were found to be involved in more than one incident.

Makary comments the importance of reporting never events to the public. He stresses that by doing so, patients will have more information about where to go for surgery as well as putting pressure on hospitals to maintain their quality of care. Hospitals should report any never events to the Join Commission, however this is often overlooked and more enforcement is necessary.

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Plastic Surgeons Launch Skin Healing Gel

New 'Miracle' Skin Healing Cream Now Available to the Public

The wait is finally over as five of the UK's leading plastic surgeons launch HEAL: a revolutionary new healing gel originally created to soothe and reduce inflammation of the skin following surgery (thereby shortening recovery times), but which has also proven to effectively treat everyday injuries such as sprains, sunburn, bruises and scars, making it the ideal medical product to have in the home for all the family to use. The innovative preparation, now available for purchase online, has been developed by The Firm, a specialist skincare group formed by some of the best-known names in plastic and cosmetic surgery including Peter Butler, Martin Kelly, Patrick Mallucci, Simon Withey and Norman Waterhouse of London Plastic Surgery Associates (LPSA). Together, they combine their specialist knowledge in skin anti-ageing, healing and nanotechnology to bring products to the public that actually work.

Each surgeon at The Firm has specific expertise in skin healing: Peter Butler carried out his experimental research on skin ageing and transplantation in the United States (Harvard). Martin Kelly has an MD in antioxidant skin therapy, Patrick Mallucci wrote a thesis on nanotechnology delivery systems and both Simon Withey and Norman Waterhouse have published widely on skin repair in plastic surgery. With a combined clinical experience of over fifty years in treating skin wounds after surgical procedures, they are well equipped to understand the healing process of the skin. In addition, The Firm drafted top French chemist Colette Haydon to perfect the formula in order to achieve the optimal effect, which offers a triple method of action: anti-inflammatory, bruise-solving and scar maturation.

According to Mr Butler, who leads the UK Facial Transplantation team and whose skincare research is internationally acclaimed;

"HEAL was created because no single product existed that combines all the elements of reducing bruising and inflammation as well as accelerating the healing process. This unique gel combines all of this and is completely different to any other 'off the shelf' products that claim to have healing effects on the skin, as they do not contain enough of the active ingredients needed to have an effect. The difference with HEAL is that the key ingredients are present in the right formulations to ensure they penetrate the skin's surface and actually have a dramatic effect on the end result".

Mr Mallucci added; "Over the last three years with the help and expertise of leading French chemist Colette Haydon we have developed HEAL which has a unique combination of active ingredients Arnica Montana and Madecassoside, for the first time ever packaged in a liposomal system, which delivers the agents to where they are needed most - to the deeper layers of the skin. The nanotechnology is designed to deliver the products of HEAL with maximum efficiency to the damaged area".

HEAL combines a triple method of action which works to soothe the closed wound - using Arnica, Haloxyl and Glistin, to reduce heat sensation and discomfort; repair the damage - using Collaxyl protein fractions to promote cellular repair and optimise scar healing with Silicone. For the past two years The Firm have tested HEAL in their clinical practice, London Plastic Surgery Associates where every year hundreds of patients have undergone facelift, rhinoplasty and breast surgery. The feedback from their patients has been overwhelming, with:

- 94% of patients reporting that HEAL was very soothing to bruised areas
- 82% of patients reporting that HEAL reduced swelling after surgery
- 85% of patients reporting that HEAL highly effectively reduced post-surgery bruising
- 97% of patients would continue to use HEAL in the future and recommend the product to others

Fiona Kent, a 37-year-old Executive Personal Assistant - who had a Rhinoplasty and Chin Augmentation last year - says;

"I was amazed at how soothing and comforting the product felt on my tender skin after my operation and it reduced bruising within days. It smells divine and has a consistency that sinks into the skin. HEAL is truly amazing and is certainly a product that I will always have in the home."

HEAL is available online at http://www.healgel.com and costs £28 for a 30 ml jar.

About The Firm

The Firm is a specialist group developing a new brand of skincare, created by founding Partners of thriving practice London Plastic Surgery Associates (http://www.lpsa.co.uk). The Firm draw on their expertise and worldwide acclaimed research to bring to the public skin healing solutions that work. All surgeons are members of the British Association of Aesthetic Plastic Surgeons (BAAPS) and BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons). The Firm is based at 30 Devonshire Street, telephone 0207 908 3777.

London Plastic Surgery Associates

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What Is Mesotherapy Treatment?

Mesotherapy treatment is a non surgical cosmetic solution aimed at diminishing problem areas in your body such as cellulite, excess weight, body contouring, and face/neck rejuvenation, just to name a few. It is administered via numerous injections containing various types of FDA approved medicines, vitamins, and minerals.

-- It is introduced into the mesoderm, the layer of fat and tissue underneath the skin.
-- The content mixture of the injection varies in accordance with each unique case and specific area to be treated.
-- Mesotherapy can also assist in reducing pain, and in replenishing hair loss in both men and women.

It's a Revolution!

The immediate weight loss results associated with liposuction cannot be compared to the results of mesotherapy treatments. Liposuction is by far the most effective and quickest method available for fat reduction; however, mesotherapy is less expensive and less invasive.

Mesotherapy vs Liposuction

-- Mesotherapy is a relatively painless procedure due to the use of anesthetic creams applied to the area prior to injection, while liposuction often results in some pain after the surgery, as well as during the healing weeks that follow.

-- Mesotherapy causes virtually no scarring although swelling and light bruising may appear in the area for a few days; liposuction can cause scarring ranging from moderate to severe.

-- Sedation is not necessary with mesotherapy, and the patient can walk out of the office a few moments after the treatment.

Though it is new to the United States, mesotherapy has been widely used for the last 30 to 40 years in France. The reviews in the U.S. are outstanding, though controversial, as many doctors firmly believe that cosmetic surgery is the better option.

The following outline is a standard estimate of what each mesotherapy treatment entails
(the number of injections and amount of medication varies from patient to patient):

Fat Reduction/Weight Loss: Usually 2 to 4 treatments (injections) are required at intervals of 2 to 4 weeks. Depending on the problem area, the number of procedures could increase. Because mesotherapy treatments for weight loss do not produce drastic changes, it is generally recommended for patients who require a little fat reduction in specific areas, as with body contouring.

Cellulite Reduction: Approximately 3 to 4 treatments are necessary at intervals of 3 to 4 weeks. While cellulite treatment is the least effective of the mesotherapy options, it is nonetheless successful in dealing with mild degrees of cellulite.

Lower Blepharoplasty: 1 or 2 treatments are recommended at 6 week intervals (at times the second treatment is not necessary). For Lower Eye Belpharoplasty, the patient should take cortisone prior to the procedure, and the swelling could possibly last for up to 6 weeks.

Facial Rejuvenation: 4 treatments are required at 2 to 3 week intervals. It is one of the most popular mesotherapy treatments, as satisfied patients notice a substantial improvement in their facial appearance.

Needless to say, mesotherapy treatments are here to stay. Many people are welcoming this simple, non-surgical procedure into their arms…or thighs….or face.

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