MEDICAL BAG
This month’s casebook of curiosa presents two successful separations of conjoined twins, a Lithuanian metal muncher and a chronic snoozer
TWINS SEPARATED
Surgeons at the Soroka Medical Centre in Beersheba, Israel, have separated one-year-old conjoined twins who were connected by the back of the head. The twin girls, who have not been named, were separated in a 12-hour operation that involved dozens of experts from Israel and elsewhere. Such a separation has only been performed on 20 occasions and this was the first time it had been done in Israel. To carry out the operation, the surgeons created a 3D virtual reality model of the girls to map out every move, and implanted inflatable silicone bags beneath the girls’ scalps. These were gradually expanded to stretch the skin so that there was enough available to cover their heads after their skulls had been reconstructed. The operation was a complete success, with both girls breathing and eating on their own. The twins are expected to be able to lead completely normal lives as individuals.
In October, Jordan’s chief surgeon announced that the Amman Specialised Hospital had successfully performed the country’s first operation to separate conjoined twins – a pair of seven-month-old boys from Yemen. Doctor Fawzi al-Hammouri said it was “a rare and delicate” procedure requiring 25 surgeons and advisors. Although the eighthour operation was carried out in July, the announcement of its success was delayed because the babies still required “intensive care, artificial respiration and intravenous feeding for a long time… We wanted to wait until we were sure 100 per cent that things went smoothly,” said Doctor al-Hammouri. He described the twin boys, Ahmed and Mohammed, as being in “excellent health” and having every chance of going on to lead healthy lives. “The danger has disappeared,” he said. BBC News, 6 Sept; france24.com, 3 Oct 2021.
COME AGAIN
For those old enough to remember Peter Cook and Dudley Moore’s ribald, gross and extremely funny Derek and Clive albums from the 1970s, a research article published recently by US scientists provides a startling example of ostension in relation to one of their sketches. The article, with the title A Curious Case of Rectal Ejaculation, describes the case as follows: “A 33-yearold male with a history of illicit drug use presented with five days of testicular pain. He also
LEFT: The twin girls following the 12-hour operation. BELOW LEFT: They had previously been joined at the head.
noted a substantial amount of urine and sperm passage from his rectum in addition to pneumaturia and fecaluria (gas and fæces in the urine) for the past two years.” Medical investigation revealed that the understandably anonymous man was suffering from a longstanding urinary tract infection and a CT scan showed there was a swelling in his left testicular tube and a gas-filled structure in his prostate that was connected to his rectum. According to the doctors, this situation was probably the result of the man’s hospitalisation two years previously when he spent three weeks in a coma as a result of an overdose of cocaine and the hallucinogen phencyclidine and had to be catheterised. This procedure seems to have caused “significant trauma”, resulting in the fistula that connected his prostate and rectum. It’s existence only became apparent after his discharge from hospital, but he did not report it to doctors until he began to suffer the testicular pain. Surgery to close the fistula and deal with the other damage resolved the problem, and amazingly the individual recovered fully, with, as the paper puts it “only mildly reduced antegrade ejaculatory volume over several months”.; cureus.com, 20 Aug; , 23 Sept 2021.
REWILDING THE GUT
In recent years, fæcal transplants, the replacement of a person’s gut bacteria (gut microbiome) with those of someone else by means of injecting treated fæces into the bowel, have become an accepted treatment for a limited number of medical conditions. At the same time, the movement to rewild our environment by reintroducing locally extinct
species to landscapes where they once roamed has gained pace. Now, some researchers are attempting to combine the two to “rewild their gut” by collecting fæcal samples from hunter gatherer peoples and transplanting them to the guts of Westerners. They are doing this in the belief that autoimmune diseases, obesity, and other afflictions of the developed world are caused by an unhealthy modern gut microbiome. Their solution is to replace it with the microbiome of hunter gatherers, which they view as more like that of our palæolithic ancestors, and so healthier.
However, many microbiome researchers are sceptical, pointing out that people were not necessarily healthier in the palæolithic period and that there is no evidence that contemporary hunter gatherers’ microbiome is the same as that of palæolithic peoples. They also question how useful a hunter gatherer’s gut bacteria would be to someone living a Western lifestyle, and indeed, whether they would even last long before something like the original gut bacteria population reasserted itself. Dr Rachel Carmody of Harvard University says: “Trying to manipulate the microbiome to improve human health is premature.” There are also ethical concerns, with Dr Keolu Fox of the University of California, San Diego, suggesting that rewilding the gut with samples from hunter gatherer communities is “predatory and imperialistic”. NewYork Times International Edition, 21 Jul 2021.
SCREW LOOSE
Surgeons at Klaipeda University Hospital in Lithuania removed a kilogram of nails, screws, nuts and knives from the stomach of a man admitted with severe abdominal pain. Some of the items removed were up to 10cm (4in) long. The man had apparently started swallowing metal objects over the previous month after giving up alcohol. “We’ve never seen anything like it,” said Algirdas Slepavicius, head surgeon at Klaipeda Hospital, while his colleague Sarunas Dailidenas called it a “unique case”. FT readers are likely to differ, as we have covered numerous cases of pica, as the compulsive swallowing of non-food items is called, over the years (see, for example, FT385:22-23). BBC News, theguardian.com, 2 Oct 2021.
OLFACTORY MYSTERY
A woman diagnosed with congenital anosmia – an inherited inability to smell – at age 13 unexpectedly began to smell things when she was 24. A brain scan had revealed that she lacked the parts of the brain that process odour information from the nose, the olfactory bulbs, so this ought not to have been possible. Over a period of several weeks, though, she began to smell things like lavender, garlic and manure and found the sensation strange and unpleasant; on one occasion, it was so overwhelming that it caused her to faint. Researchers at the University of Dresden investigated, presenting the woman with 32 smells to determine which she could sense, and found she could detect about half of them, including orange, mint, smoke, turpentine, ginger and lilac, but not coconut, banana, leather, liquorice or cocoa. They then got her to sniff rotten egg smells and rose perfume while they monitored her brain activity and confirmed that her brain really was responding to the odours; but a new scan showed she still completely lacked olfactory bulbs, leaving medics puzzled. A 2019 study from Israel’s Weizmann Institute had found five women who could also smell without olfactory bulbs, which suggests the brain can find alternative ways to process smell, but they were unable to explain how. Even though none of these had suddenly developed the ability as adults, researchers speculate that this is also the case with the Dresden patient, but that her ability to sense smells had been hormonally supressed until she was adult. She is now undergoing odour exposure therapy to help her adjust to her new sense and has begun to enjoy smells like curry by associating them with pleasant activities like eating. New Scientist, 17 Sept 2021.
NO TUMOUR
Kim Slater, 30, from Bristol has all the symptoms of a brain tumour but does not actually have the tumour. She gets headaches and vision distortion, is often so dizzy and nauseous she cannot get out of bed, and is slowly going blind. The symptoms are caused by idiopathic intercranial hypertension (IIH), a disease that results in increased pressure in the cerebrospinal fluid around the brain and causes it to react as if the pressure was being caused by a solid tumour. When the pain was at its worst, Kim said it “was exhausting and I often got confused, couldn’t speak properly and would forget things because of brain fog.” There is no known cure for IIH, which affects one in 100,000 people and also increases the risk of strokes, aneurisms and heart problems, but it can be alleviated by having a shunt installed to channel excess fluid from the brain to the stomach. Metro, 8 Sept 2021.
DOZY DEVI
Pukharam Devi, from Bhadwa in Rajastahan, India, sleeps for three weeks out of every four due to axis hypersomnia, a chronic neurological condition. Devi, 42, first experienced symptoms 23 years ago, when he used to sleep for five or six days before waking up, but over time, his life has been gradually taken over by sleep. He has two children, but has slept through most of their lives. Twice a day, he is shaken violently to wake him enough to eat, but he does so with his eyes closed. His family bathe him in bed and he does not get up to visit the toilet. Although he sleeps almost constantly, he never feels rested. “I feel achy and fatigued and I have headaches,” he says. Lichmi, his wife, says that “even on days when he is awake, he is very lethargic, and his eyes are halfclosed.” Times, 22 Jul 2021.