One year after a neurosurgeon separated them by cutting through a section of brain, Carl Aguirre says "Wow!" as he whizzes a toy truck off the tray of his high chair and his brother Clarence holds his nose to let his mother know his diaper is dirty.
After "starting their life over," the formerly conjoined 3-year-old Filipino boys have been amazingly free of significant complications, doctors say. Clarence is about to take his first steps and therapists say Carl will soon follow.
"When they emerged from the OR as separate boys, it was almost as if that was their second birth," said Dr. Robert Marion, the boys’ pediatrician. "Their motor skills are what you’d expect of a 1-year-old. They’re starting to walk. They’re playing appropriately in the way that a 1-year-old would. Their speech, also, is like that of a 1-year-old."
Until last Aug. 4, when they underwent the fourth in a series of major operations at the Children’s Hospital at Montefiore Medical Center in the Bronx, Carl and Clarence had been unable to sit up, stand straight or see each other’s face. Joined at the top of their heads, they were limited to lying on their backs, which stunted their development and subjected them to chronic pneumonia caused by inhaling food.
"They were going to die," Marion said. "And now seeing them with unlimited potential, it’s the most gratifying experience I’ve ever had in medicine."
The boys and their mother, Arlene, came to New York in 2003, when Montefiore agreed to take the boys’ case for free — it has cost more than $3 million so far — and the Blythedale Children’s Hospital in Valhalla agreed to donate housing and therapy.
The Children’s Hospital team of neurosurgeon Dr. James Goodrich and plastic surgeon Dr. David Staffenberg separated the boys in a gradual "staged" approach, pushing apart their brains and dividing the blood vessels in four operations from October 2003 to August 2004. In between, the boys were given time to heal. It was a departure from the more common single marathon operation.
During the final operation, the surgeons found that the boys’ brains, which scans had indicated were abutting but separate, were actually shared and seamless at one point. Dreading whatever complications he might cause, Goodrich studied and consulted and finally found a place to cut where veins seemed to go in opposite directions.
"I am not a religious person," Goodrich said last week. "But I do think there was something guiding us along there."
Marion said Carl suffered some seizures in the month after the separation, but Goodrich said his principal fears — neurological problems and liquid on the brain — did not develop.
During a reporter’s recent visit to Blythedale, Clarence walked proudly, holding onto a therapist with one hand and pushing his stroller with the other. He was so energetic that at one point he stepped out of his pants and staffers had to find him a belt.
Meanwhile, Carl stood, a bit unsteadily, to play a bead game on a table.
Later, the boys laughed as they tumbled down a padded slide together. Though their skulls have not yet been reconstructed — doctors don’t want to interrupt their therapy — and specially designed plastic helmets haven’t fit well, the doctors say the boys’ heads are protected well enough by their bandages even for horseplay.
Arlene Aguirre tried to hide while she watched her sons’ therapy session, because when they see her the boys want to do nothing but cuddle.
"Both of them want my attention all the time," she said. "But it’s very exciting that I have to deal with two children. ... Before the separation, I was thinking: ’Will I ever see them again?’"
She said she is encouraged when she hears Clarence say "yogurt" and call his brother by name. Carl says "walk" and "mama" and both boys use sign language to convey such phrases as "please more eat."
Aguirre said she expects to move from Blythedale soon and set up a household with the boys, and hopes to eventually return to the Philippines.
"My friends and family, I want to share the boys with them," she said. "It will be so exciting to go back there, holding one boy with each hand."
The success of the operation has brought honors for Goodrich and Staffenberg, although Goodrich says the best prize he’s received is a Montefiore parking space. They are constantly invited to speak or write about the procedure, which has been published in journals for neurosurgery, plastic surgery and anesthesia
He said he initially tried to keep an emotional distance from the boys, but confessed "you can’t go through something like we did and not get attached. You can’t be around them and not love them."
Staffenberg said he recently came up behind Clarence, who was walking down a hallway while holding a therapist’s hand.
"Clarence turned around and looked at me and put his other hand out for me," Staffenberg said. "I don’t think at any point during all the surgery I would have imagined that kind of situation. When you get the moment when they reach out for your hand, it’s unbelievable."作者: 幽幽草 时间: 2007-5-24 17:06 标题: 托业考试阅读模拟题文五
Thousands of rockets, mortars and anti-aircraft ammunition have been seized in central Afghanistan in the largest cache of militant weapons discovered in months, a government spokesman said Sunday.
The arms were to be used to subvert crucial legislative elections on Sept. 18, Defense Ministry spokesman Gen. Mohammed Saher Azimi said.
The raid in Ghazni province’s Khogyani district Saturday netted some 2,000 surface-to-surface rockets, 3,000 mortar rounds, 500 artillery shells and 100 boxes of anti-aircraft bullets, he said.
"The enemy planned to use them to sabotage the elections," Azimi said. "This was a very important operation to prevent the killing of civilians."
He declined to give any other details about the find, including whether the Taliban were suspected to have stockpiled the cache or whether anyone had been arrested.
Afghan officials have warned that the Taliban and al-Qaeda have launched a joint campaign to disrupt the September elections — the next key step toward democracy after a quarter century of war. Since March, a major upsurge in fighting has left more than 800 people dead, more than half of them suspected insurgents, according to U.S. and Afghan officials作者: 幽幽草 时间: 2007-5-24 17:06 标题: 托业考试阅读模拟题文六
Astronauts take out the trash
Astronauts on Sunday exchanged supplies for trash that has accumulated on the international space station since shuttles were grounded after the 2003 Columbia tragedy. They also prepared for a second spacewalk set for Monday.
Space shuttle Discovery, which docked at the orbiting outpost Thursday, became the first shuttle to return to orbit last week. Among the mission’s goals: Resupply the station and remove the mounds of trash that have accumulated in recent years.
"It is kind of just like working in your closets and your garage," station flight director Mark Ferring said. "It’s a lot of work."
The astronauts are unloading 15 tons of cargo. They expect to return to Earth with 13 tons of trash and other items that are no longer needed on the station.
When the station’s two-man crew awoke Sunday, they were told that their seven Discovery guests would remain at the station for an additional day.
"Hopefully it is not going to be like the relatives who miss their flight and have to stay another day," Charles Hobaugh, who works in the station’s mission control, told crew members by radio.
A ninth day at the station was approved late Saturday, days after NASA decided to ground future shuttle missions because an almost one-pound piece of foam broke free of Discovery’s external fuel tank. The piece of foam missed Discovery, but was a haunting reminder of Columbia.
A 1.67 pound chunk of foam shed from Columbia’s external tank hit the shuttle’s left wing and caused a hole that allowed the searing gases of re-entry to melt the wing from the inside out. The shuttle disintegrated over Texas as it returned to Florida. All seven astronauts died.
NASA spent hundreds of millions of dollars over 2{ years redesigning the external tank, but said last week it did not solve the problem and more work is needed.
Bill Gerstenmaier, the station’s program manager, said Discovery will leave the station in much better shape than when it arrived. Water will be left behind, as well as laptops, wash cloths, a printer, dry wipes, floppy disks, food and nitrogen.
"We are going to be in very good shape through the end of the year," Gerstenmaier said.
Shuttles are needed for the supplying and continued construction of the station.
When NASA’s shuttles were grounded in 2003, the agency began relying on Russian vehicles to deliver supplies to the station. However, the Russian cargo ship Progress cannot haul the weighty items the shuttle can. The next delivery by Progress is scheduled for September.
Gerstenmaier said station managers prepared for a scenario in which there would be no shuttle flights this year. Despite that, he said the grounding of future shuttle missions opens the station to risk.
"We are still susceptible to some large failure of some component that can only be delivered by the shuttle that we don’t have a like spare on station," he said.
Among the tasks Discovery’s astronauts performed for the station was the reconfiguring of a gyroscope, which failed in March. Four gyroscopes, each weighing 660 pounds, are intended to steer the station, but only two have been working in recent months.
On Monday, during their second spacewalk, Discovery astronauts Stephen Robinson and Soichi Noguchi, planned to replace the other failed gyroscope, which has not worked since 2002.
The pair planned to go over procedures for installing the gyroscope on Sunday with astronaut Andrew Thomas, who was set to direct Monday’s replacement.
As they began spacewalk preparations Sunday, Robinson informed Mission Control’s Stephen Frick that things might proceed slower than anticipated.
"If you saw what our mid-deck looks like right now, you’d see why," Robinson said as his colleagues transferred items between the shuttle and station. "It’s a high traffic zone."
"I’m afraid it would be a little too frightening," Frick responded with a chuckle.
