Sep 5, 2008

Health - Six of History's more unusual surgical miracles (G.Read)

On June 11, a 6-year-old Texas girl had the entire right half of her brain removed to stop devastating seizures; amazingly, her memory and personality are expected to remain intact. But this is just one of many incredibly delicate and difficult surgeries performed in recent history. From a doctor who operated on himself to surgeons who execute complicated procedures on the tiniest fetuses while they are still in the womb, here are six of the most unusual surgical miracles in modern history.
1. Surgery to Remove Half a Child's Brain. On June 11, 6-year-old Jessie Hall of Aledo, Texas, had the entire right side of her brain removed by neurosurgeon Ben Carson at Johns Hopkins Children's Center in Baltimore. The rare procedure is called a hemispherectomy, and though drastic, it was considered the best possible treatment for Jessie, who suffers from Rasmussen's encephalitis, a progressive degeneration of the cerebral cortex that causes uncontrollable seizures. Though doctors do not fully understand how, the remaining half of the brain in such cases typically takes over many of the functions previously performed by the removed half. Jessie may be permanently paralyzed on her left side, but there is usually no effect on personality or memory. Johns Hopkins does about 12 of these surgeries each year, mostly on children between the ages of 5 and 10. When surgeons were first developing the procedure, they tried to fill the empty cavity on one side of the skull, in one case using sterile ping-pong balls, but they later realized that the brain's own cerebrospinal fluid eventually fills the space.
2. The Four-Day Operation. From Feb. 4 to Feb. 8, 1951, Gertrude Levandowski of Burnips, Mich., underwent a 96-hour procedure at a Chicago hospital to remove a giant ovarian cyst. It is believed to be the world's longest surgery. Levandowski weighed 616 pounds before the surgery and had a girth of 9 feet. After the growth was removed, the 58-year-old weighed a more manageable 308 pounds. During the operation, surgeons tapped the cyst to slowly drain the fluid from it, wanting to prevent a rapid drop in pressure that could affect her already strained heart. It took four days to get about 200 pounds of fluid out of her body. They then removed the cyst, which weighed about 150 pounds.

3. Surgery in Utero:Kylie Bowlen was 22 weeks pregnant when doctors at Melbourne's Monash Medical Centre in Australia operated on her unborn child to repair a very rare condition in which amniotic bands had wrapped around the baby's ankles, cutting off blood supply to the lower legs (the web-like bands are part of the amniotic sac). Normally doctors wait until 28 weeks to do surgery on a fetus, but without intervention, the baby would have lost both her feet. Surgeons inserted a 2-millimeter operating telescope into Kylie's womb and used a laser and electric current to cut the bands on the baby's left leg, thereby saving it. Unfortunately, the right leg was already infected and inoperable. At the time, the baby, later named Leah, was only approximately 7 inches long. Leah was born Jan. 24, 2008, eight weeks after the operation and two and a half months premature. When she was 4 days old, doctors operated to repair her right leg, which had been dangling from a tiny artery. The procedure is believed to be the earliest in-utero surgery of its kind ever performed. Doctors are hopeful that Leah will be able to walk.
4. Surgeon, Operate on Thyself. In 1921, Evan O'Neill Kane of Kane, Penn., wanted to prove that ether—the primary general anesthetic at the time—was being used far too often when less-dangerous local anesthetics could be substituted. As his test case, the good doctor used himself, removing his own appendix using only local anesthetic by propping himself up on the operating table with a mirror over his abdomen. With three other doctors in the operating room as backup, Kane made the large incision needed to remove the appendix and his assistants sutured him up. (This was before new techniques allowed doctors to make small 'Band-Aid'-size incisions for appendix removal). The doctor recovered nicely. Then, in 1932, at age 70, Dr. Kane performed an even more complicated surgery on himself to repair an inguinal hernia. Because of the close proximity to the femoral artery, it was a particularly delicate operation—Kane performed it in just under two hours. Reportedly, he was relaxed and joking even as he sutured within millimeters of the important blood vessels.
5. Saving Face. A French man suffering from a rare condition that causes extremely disfiguring tumors got a new face and a new lease on life in January of 2007. Thirty-year-old Pascal Coler had had dozens of previous operations to reduce massive tumors caused by a disorder called neurofibromatosis, yet he could barely eat and had become a recluse because of the bulbous deformities. The disorder is a rare genetic condition called Von Recklinghausen's Disease; experts have speculated that Joseph Merrick, nicknamed 'The Elephant Man,' was suffering from it 100 years ago.
After a 16-hour operation, Laurent Lantieri, head of plastic surgery at Henri-Mondor Hospital near Paris, reported that the surgical team had replaced "almost all" of Coler's face (lips, cheeks, nose and mouth), with that of a donor. Coler, who has recovered well, does not look like the anonymous donor because his underlying facial bone structure remains intact. This is the third face transplant ever done, and doctors at Henri-Mondor say it is the most extensive. (In 2005, a French woman received a partial transplant—new lips, a nose and a mouth—after the lower half of her face was mauled by a dog. In 2006, a Chinese man had a partial face transplant to repair damage done during a bear attack.)
6. Twice Born. Six months into her pregnancy, Keri McCartney and her husband, Chad McCartney, of Laredo, Texas, found out that their baby had an enormous and deadly tumor growing out of her tailbone. An ultrasound revealed the noncancerous, grapefruit-sized growth, which was draining the baby's blood supply and would have killed her. In a risky and rare procedure, surgeons at Texas Children's Hospital in Houston anesthetized McCartney to relax her womb, moved her uterus entirely outside her body, opened it, and then lifted about 80 percent of the baby's tiny body out, leaving just the head and upper torso inside. During the four-hour procedure, surgeons had to remove the tumor as quickly as possible, because too much exposure to air could have sent the baby into cardiac arrest. They then returned the fetus, which weighed about a quarter of a pound, to the womb and closed the amniotic sac, hoping to retain as much of the precious amniotic fluid as possible. The baby was born 'again' 10 weeks later, on May 3 of this year. Doctor's say she's perfectly healthy and her parents have named her Macie Hope McCartney

No comments: