DALLAS – Once-conjoined twins Ahmed and Mohamed Ibrahim were doing remarkably well during the first day of their separate lives, although doctors were wary of declaring success too quickly.

Dr. Jim Thomas, who is overseeing their post-operative care at Children’s Medical Center Dallas, said Monday that neither boy has suffered any serious setbacks.

“The longer that you go without the appearance of complications is always taken as a positive sign,” he said during a news briefing. However, “to let your guard down is a mistake,” he emphasized.

The 2-year-olds remained in critical but stable condition in the intensive care unit at Children’s. They are being kept in a medically induced coma to reduce brain swelling.

The boys were born in Egypt joined at the crowns of their heads and have been in Dallas since June 2002. A team of more than 50 doctors, nurses and other staff separated the twins over the weekend in a 34-hour operation. Doctors had indicated Sunday evening that they were nearly finished after 33 hours, but Mohamed’s closure took slightly longer.

The twins are being cared for in adjoining intensive-care nurseries at the hospital, resting on specially designed air mattresses that gently rock them to prevent bedsores. They breathe through mechanical ventilators, and receive medications to stabilize their blood pressure and help prevent infection. Doctors have placed shunts in both boys’ spines to drain excess fluid.

The boys’ parents had an emotional reunion with their sons Sunday night.

, Thomas said. Their mother wept at the sight of them and “was clearly moved,” he said. “The dad was so overwhelmed, he almost hesitated at the doors, and took his time, just gathering himself up to walk in.”

The two nurses from Cairo who have cared for the boys almost since birth “were quite moved by the events of the last three days,” and are visiting frequently, Thomas said, as are family members and close friends.

Thomas said that when he saw the boys immediately after separation surgery they “appeared to be in truly remarkable condition considering the ordeal they had just come through.”

However, doctors are not yet declaring the separation a complete success.

“It’s really an hour-to-hour, almost moment-to-moment thing right now,” he said. The greatest worry is about infection to their surgical wounds. To lower that danger, the boys are getting three types of antibiotics.

Surgeons had enough excess tissue from a five-month expansion process to fully cover Ahmed’s head, while Mohamed has two areas on his temples that remain exposed. Those places are covered by special dressings, he said. Neither boy has bone covering the top of his brain, and both face perhaps years of extensive reconstructive surgeries.

Although the separation procedure risked injury to the boys’ brains, scans so far indicate that excessive swelling, hemorrhage and other complications have not occurred.


“The neurosurgical team is quite pleased with what they see,” Thomas said. The surgeons have returned to their normal practice, but continue to check the twins’ progress every few hours, he said.

True to their very different personalities, the two boys have not had identical medical courses, Thomas said. Mohamed, usually the feistier twin, was more physiologically volatile, and “bedeviled some of the anesthesiologists,” Thomas said. Ahmed, the more reflective of the duo, has been “quite stable, unflappable.”


During the coming days, doctors will gradually try to wean the toddlers off the sedating drugs and allow them to wake and breathe on their own. “If they respond favorably, we will continue to drop the dose of medication,” Thomas said.

Only then will doctors begin to have an idea whether the procedure left the twins with brain damage. However, neurosurgeons are encouraged by the fact that the separation surgery proceeded without major hitches.


Once the boys’ condition is stable and they are breathing on their own, the pair will be transferred to Medical City Dallas Hospital, where most of their medical care has been centered.

The twins’ progress is being closely watched worldwide, especially by doctors involved in such previous surgical feats.

“I want to wholeheartedly congratulate everyone involved in the surgery,” said Dr. Jorge Lazareff of the University of California, Los Angeles, who led a neurosurgical team that separated twin girls joined at the head in August 2002. “They all have my admiration and best wishes.”



(c) 2003, The Dallas Morning News.

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Distributed by Knight Ridder/Tribune Information Services.

AP-NY-10-13-03 1908EDT



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