Baby with 8 limbs (Ischiopagi)

 

An Indian toddler, Lakshmi Tatma, 2, born with a rare condition called isciopagus, which is where a child is born with four arms and four legs, was recovering in the intensive care unit early Wednesday (November 7, 2007) after surgeons in the southern city of Bangalore, India successfully completed a mammoth 27-hour operation to remove her “parasitic twin,” head surgeon Dr. Sharan Patil said.
Speaking to reporters, Patil said Lakshmi Tatma is being monitored closely after a team of some 30 surgeons removed her four additional limbs, she is “stable and sound.”


The operation was conducted by specialists in pediatrics, neurosurgery, orthopedics and plastic surgery. Without it, doctors say, Lakshmi would be unlikely to survive beyond early adolescence.

“Every step of it was successful,” Patil said of the operation. “There was no set back what so ever. The team worked through the night relentlessly.”

Later in the day the girl’s parents were slated to visit her, he said.

The task began early Tuesday and went through the night, with surgeons working eight-hour shifts.

The conjoined twin stopped developing in the mother’s womb, and has a torso and limbs, but no head. It was joined to Lakshmi at the pelvis.

When Lakshmi was born into a poor, rural Indian family, villagers in the remote settlement of Rampur Kodar Katti in the northern state of Bihar believed she was sacred. As news of her birth spread, locals queued for a blessing from the baby.

Her parents, Shambhu and Poonam Tatma, named the girl after the Hindu goddess of wealth who has four arms. However, they were forced to keep her in hiding after they were approached by men offering money in exchange for putting their daughter in a circus.

The couple, who earn just $1 a day as casual laborers, wanted her to have the operation but were unable to pay for the rare procedure, which has never before been performed in India.

After Patil visited the girl in her village from Narayana Health City hospital in Bangalore, the hospital’s foundation agreed to fund the $200,000 operation.

Planning for the surgery took a month, Patil said, and Lakshmi spent that month in the hospital.

“We are quite optimistic,” “We expect that she should be able to walk normally and lead a normal life.”

Many villagers, however, remain opposed to surgery and are planning to erect a temple to Lakshmi, who they still revere as sacred.

Patil said Lakshmi’s parents are “very practical” and knew the risks of the medical treatment. Asked about the belief she is a reincarnation of the goddess, he said, “She’s a very charming young girl, and I’m sure she’ll grow up and be something special.”

UDATE AFTER SURGERY: LAKSHMI WLAKS AND GOES TO SCHOOL

She was born with a unique body – eight limbs and two torsos fused at the hips.

Now Lakshmi Tatma, the Indian toddler whose plight touched the world, has grown up and started school.

Two years after a ground-breaking operation to separate her from a parasitic twin, Lakshmi is a lively and bubbly four-year-old.

She loves playing cricket with her older brother, has a tendency to boss around her newfound friends and remains firmly a daddy’s girl.

‘When I think of the way she was, never in a million years would Lakshmi have been able to go to school or have the life she does today,’ said her mother Poonam, 26.

‘All the things she’s capable of now were impossible two years ago.

‘I often try to think what she might be like today if she hadn’t had the operation – she couldn’t even sit up before and now she runs around like other children.’

Born in a dusty farming village in India’s poorest state, Lakshmi was revered as a deity and worshipped from birth.

Villagers, who believed she was the reincarnation of the Hindu goddess of wealth and fertility, would seek her blessing daily and leave gifts at her bedside.

But Lakshmi’s resemblance to her mythological namesake came at a terrible price. She could not walk, stand, or even sit.

The little girl was joined to a headless parasitic twin that had stopped developing in her mother’s womb. Doctors were convinced she could not have survived into adulthood.

Now fully recovered from the 27-hour operation to save her, Lakshmi is almost unrecognisable from her former self.

Beneath the surface, however, lurk a series of medical problems that threaten her future and will require years of surgery.

Six months after the complex operation to remove Lakshmi’s parasitic twin, doctors discovered she had developed scoliosis, or a curvature of the spine.

Without a complex operation to correct her spine doctors have warned her back will be forced into increasingly severe deformities as she grows, possibly leaving her disabled.

Separately, Lakshmi requires an operation to ‘detether’ her spine after it was discovered she was born with abnormal tissue connecting the spinal cord to her nervous system.

In a further operation orthopaedic surgeons must perform a procedure to ‘close her hips’, which are set too far apart and result in an unusual ‘gaited’ walk.


Finally, plastic surgeons will need to find a way to create buttocks for Lakshmi, which did not form in the womb because of the unique way she was connected to her parasitic twin. In the same operation surgeons will have to fix related problems with her bladder and intestines.

‘Lakshmi has come such a long, long way but we’re very scared for the future,’ said her mother Poonam.

‘At one time we never imagined she would look so healthy, so we are very grateful for all the help we’ve had.

‘But we can’t bear the thought that all this help could be undone if we can’t find a way to get the extra operations she needs.

‘The charity that looks after her cares for 500 other children as well. It does not have the funds to pay for these operations and we have no money either.

‘The hospital that operated on her before has promised to help but they cannot correct her spine because it is such a specialised operation.

‘All we want is for her to be a normal child. She has had her operation but even now she can’t walk or move normally. Her feet don’t come together properly and when she walks it hurts.’

Despite the threat to her future, Lakshmi’s life today is a world away from the circumstances of her birth.

Born to impoverished parents in the frequently lawless state of Bihar, in India’s volatile northeast, Lakshmi faced an uncertain future until a wealthy doctor heard of her plight and offered to operate on her for free.

Orthopaedic surgeon Dr Sharan Patil, owner of the Sparsh Hospital in Bangalore 2,000 miles south, travelled to Lakshmi’s remote village in 2007 to meet the child and offer her parents the chance of a lifetime.

After more than a month planning the separation, Dr Patil’s team attempted the first operation of its kind in the world.

Hundreds of journalists camped outside the hospital throughout the 27-hour surgery.

Lakshmi’s fame, having spread from her tiny village around the world, prompted Sucheta Kriplani Shiksha Niketan (SKSN), a charitable school looking after disabled children in the desert state of Rajasthan, to offer her parents a place to live and the chance of an education for Lakshmi and her brother Mithilesh.
Dr Bhairoon Singh Bhati, the secretary of SKSN, said: ‘Lakshmi is a special case for us. She’s a very challenging case because you can never tell from her medical history when she might next fall ill.

‘Her scoliosis is an example of the problems Lakshmi faces because we had no way of knowing she would develop a curvature of the spine.

‘Similarly, despite all the problems she still faces we have no way of knowing what may crop up in the future.

‘The biggest difficulty caring for Lakshmi is that she’s a unique case – there’s never been a child like her before so we have nothing to refer back to.’

Under Dr Bhati’s guidance Lakshmi has started school, joining her elder brother as the only members of their family to ever receive an education.

Her father Shambu, 28, said: ‘I believe with all my heart that Lakshmi is indeed a goddess. The operation removed her extra legs so that she can lead a normal life but she is not a normal child.

‘She’s special, I think anything is possible for her. I’d like her to be educated so she can become a teacher. Then she can pass on what she knows to other children.’

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Baby with craniofacial duplication (Diprosopus)

Ask anyone along the dusty, pothole-filled road heading to the tiny village of Saini, and they’ll know who she is. The one with four eyes. The one with two mouths. The one with two heads.

They are not ashamed of the extraordinary looking little girl, the villagers who live near her, the young parents, the overprotective local doctor. That’s because while she may only be 2½ weeks old, she is far more famous than any resident of this part of the country has ever been. She is famous because she was born with a condition known as facial duplication. She has one body and two faces.

“At first I was a little bit afraid,” Vinod Kumar Singh, the 24-year-old father of the girl who still does not have a name, told ABC News. “But then I accepted whatever God gives.”

In this case, God has given what many in this rural part of India consider a reincarnation of Ganesh, the Hindu God who is half person and half elephant. At first, hundreds of locals came to Saini to touch the girl’s feet, dance at her bedside and offer the family money, thinking she was as divine a person as they would ever see.

“People from corner to corner from all India and all abroad come here to take the knowledge about this child,” said Harsharan Singh, the village math teacher. “It’s a gift of God… Some people say she is like a goddess. They call the baby a face of a goddess.”

Her two faces and the single dimple on their shared cheek are as placid as any baby’s. She is the first child of a farming family, one of about 100 people living in a village 40 miles outside New Delhi. Here, the average income is less than $2 a day, and the locals either work the field or support those who work the field in any way they can.

During a recent visit by ABC News, villagers fanned the baby, swatting dozens of flies away so she could sleep. The village, like so many in India, is modest. There is no electricity, there are no toilets, and there is no technology.

The parents did not know that anything was wrong with their daughter until she was born. Tens of millions of pregnant women in rural India do not receive prenatal care.

“They’re not aware enough that they should come in for treatment,” said Dr. M. Ashmosd, the resident medical officer of nearby Saifi Hospital, where the girl was born.

Ashmosd was part of the team that delivered her vaginally. Still, he does not know the details of the baby’s condition because the parents have not agreed to let the hospital perform a CT scan or an MRI on her head.

“I’ve told them we’re ready to do the CT scan for free. But they have ignored me,” he told ABC News.

Experts in the United States who have performed surgeries on children with similar conditions say they can’t know what the baby’s prognosis will be without scans.

“A brain MRI would be illuminating, to say the least. Without it we only can presume about what could be possible or what her quality of life would be with or without reconstructive surgery,” Jorge Lazareff, the director of pediatric neurosurgery at UCLA Hospital in Los Angeles, told ABC News.

The parents and the villagers have turned inward. Visited by a dozen media outlets, they at first refused to allow an ABC News team to ask any questions or shoot any video, accusing reporters of “making stories for their own profit.” Eventually, they relented, but the local doctor refused to allow the mother to speak and interrupted an interview with the father.

“She is very normal,” Dr. Brigdal Nagar yelled, pointing at an ABC News reporter and shoving Vinod Singh aside. “We don’t need the media here. She’s not an abnormal baby. It’s just that she has two faces. And she’s living a very normal life. And if she dies in the future, it’s as God wishes.”

Villagers have tried to make her life as normal as they can. The visitors who welcomed the baby’s birth are no longer coming around. She is surrounded by only her family and their friends.

But perhaps she is too protected. Because the parents won’t agree to allow the hospital to perform a CT scan, there is no way to know exactly what she is suffering from, no way to know if her life is in danger.  There is no way to tell whether she has two spinal columns, whether there are multiple internal organs, or whether she will survive until the CT scan is completed. “She’s normal right now,” Dr. Brigdal said. “But in the future she might face problems.”

Lazareff was slightly more optimistic, writing by e-mail that “I presume that there is no reason for her not [to] live a long life. Stress on presume.”  As for the parents, they are a bit overwhelmed by all the attention. They are overwhelmed by the terrifying thought that they have to raise a child who is so visibly different.  “She’s just a simple baby,” Vinod Singh says, before admitting with a touch of sadness, “she’s not well.”  If she survives, despite the odds, she might match her reputation.

“If everything below the neck is fine, and she could keep her head up, then she could walk around and live,” said Henry Kawamoto, a Los Angeles-based specialist in facial plastic surgery. “And if she did that, she really would be a goddess.”

UPDATE:

Lali’s two middle eyes suffered from corneal opacity due to abnormal anatomy of the facial muscles, which prevented her from properly closing those eyes. (Before, it was wrongly blamed on camera flashes.)

Cleft palate caused difficulty feeding her under village conditions. A poor diet of bottle-fed sugar solution and diluted milk, allowed to drip down her throat because she could not suck properly because of the cleft palate, weakened her condition, and vomiting and infection started. Admission to hospital was delayed by discussion (including taking her back home from hospital) among her extended family and her village’s headman. Finally her parents, alarmed at her illness and dehydration, defied her other relatives and took her back to hospital, where under proper medical treatment including antibiotic and a saline drip she started to improve, and stopped vomiting, and started drinking milk and defecating normally; but 6 hours later, at two months old to the day, she died of a heart attack. She was buried in her village, as is usual in Hinduism with children who die very young. Later a temple was built at the village in her memory.

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Frontiers

Not very long ago, the feasibility of mapping the distinguishable regions of the human brain in relation to their functional roles seemed remote. With the tremendous advances in neuroscience in the past two decades, however, the opportunity now exists to approach the integrated understanding of brain structure and functioning necessary to clarify the neurobiological basis of human thought and emotion and to discern the mechanisms that underlie sensory perception and locomotor functions. Many of the intricate anatomical connections of the brain are being defined in great detail. New capabilities have emerged to identify and describe the biochemical, molecular, and genetic mechanisms that determine brain structure and functions. The activity of the human brain during mental activity can be measured and visualized. It is even becoming possible to monitor simultaneously the activity of many neurons within complex neural networks during discrete behaviors. The challenge now is to establish a comprehensive initiative that will increase the ability of neuroscientists to make discoveries about the brain and to apply this knowledge to the many mental and neurological disorders that affect humankind.

The progress made in this area has occurred primarily through the concerted efforts of increasing numbers of individual investigators, working mostly in small groups on highly specific projects. The body of information gained through such efforts has grown in a piecemeal fashion; it has now reached a point of limitation, in terms of its usefulness, because the mass of information is so great and its dissemination so poorly coordinated that critical data are often difficult to recover and define. Indeed, this approach to neuroscience research, which was so successful in the past, may soon limit advances in the same way that a single surveyor who charts a field cannot hope to map a continent without a coordinated plan involving other mappers. A Brain Mapping Initiative could identify those aspects of information exchange infrastructure that are critical to addressing a broader goal, one that will include the advantages of single-investigator projects and yet also yield the benefits of a larger, coordinated program. The Brain Mapping Initiative is intended to subsume all the proposed aspects of a National Neural Circuitry Database outlined in the charge to this committee. It is also designed to express explicitly the goals of the proposed effort and reflect more adequately the complex of electronic and digital resources that will be required.

A consensus is emerging that the initial steps can now be taken toward the global task of understanding brain structure and functioning. The impact of digital computer technology began in the physical sciences three or four decades ago and led to such current large-scale efforts as the supercollider, space telescope, and interplanetary probes. In neuroscience, the increasing availability of new enabling technologies is likely to have similar, far-reaching impacts. The development of high-density memory chips and the latest generation of microprocessors provides a key stimulus to accelerated development of image analysis graphics and image manipulation—a set of capabilities known as visualization computing (McCormick et al., 1987). The emergence of parallel processing, scientific visualization workstations, and high-capacity digital communications may provide the technical support needed to conduct coordinated projects in neuroscience.

A comprehensive, coordinated effort to understand basic organizational patterns of brain connections needs to be undertaken. This effort should include a definition of the chemical identity of neuronal populations and a description of neuronal structure and neuronal circuit organization in each region in sufficient detail to clarify the computational processes involved. The pace of future advances in neuroscience will depend on critical choices, which need to be made now, regarding the handling of information to be gathered in the future. At issue is whether neuroscientists will embark on a large-scale effort to develop and integrate new forms of technology for acquiring and managing information.

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The final frontier…

Is never final.

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