tv Our World BBC News July 20, 2019 9:30pm-10:01pm BST
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this is bbc world news, the headlines: iran has released footag. it says shows the moment its troops seized a british—flagged oil tanker in the gulf, with speedboats surrounding the vessel and revolutionary guards descending to the deck from a helicopter. british airways has cancelled all flights to cairo for a week because of unspecified security concerns. the airline said the move was a precaution to allow for further assessment of security. forensic experts have extracted bones from a burial chamber at the vatican in an attempt to solve the disappearance of a 15—yearold girl emanuela orlandi in 1983. and events are being held around the world to mark the 50th anniversary of the apollo 11 moon landing.
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at this hour, in 1969, the eagle module first touched down on the moon's surface at ten o'clock reeta chakrabarti will be here with a full roundup of the days news. first on bbc news its time for our world. in two brains one skull — safa and marwa are twin girls who were born joined at the head, then brought from pakistan to london's great ormond street children's hospital for highly complex operation. for highly complex operations. safa and marwa are identical twins joined at the head. theirfamily from pakistan want doctors to separate them. great torments to in london is one of the world with the expertise to do it. what we need to achieve is effectively two and twist
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the rain and that is pretty difficult to do. but it is perilous. the bbc was given unique access to chart the complex medical and ethical choices made. this is the day, the moment of truth, everything has to be perfect. in the hope of giving the girls independent lives. safa and marwa are 21 months old and we re safa and marwa are 21 months old and were born in pakistan. they have come to london's great ormond street hospital with their mother zeinab, grandfather and uncle, and under the ca re of grandfather and uncle, and under the care of euro surgeon drjeelani.m is clearly difficult to go through life when you join together like that so it does make a very persuasive case in favour of
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attending this operation. the family are very clear on that. life being separate is better than being joined together. if we felt there wasn't a very high chance of doing it safely, we would be thinking it carefully about whether we should do it or not, andl about whether we should do it or not, and i think the whole team feel there is an excellent chance of successful separation here. the twins father died just before they we re twins father died just before they were born, and then it took more than a year of fundraising before a donor stepped in to cover the medical gusts. safa and marwa are what is known as craniopagus twins which means joined at the head. their scale is one long
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tube. the twins share many key blood vessels, separating these will be a major challenge. both twins brains have a distorted appearance, one half is pointing up into the other girl's skull cavity. every last detail of their extraordinary anatomy has been recreated digitally. plastic surgeon david dunaway will be in charge of rebuilding the skulls after the neurosurgeon mrjeelani has separated the twins brains. they showed me how 3d modelling has helped them to prepare. this hemisphere, the right hemisphere of the brain, is standing up so this is projecting into the other child's skull. we need to arm twist the brains and that is difficult, pretty difficult to do in the head. actually being able to touch and hold things makes so much difference
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to understanding how things are, and we have spent a lot of time just sitting, looking at these models and going through the what ifs. numerous models of their brains and shared skull have been created using this sd skull have been created using this 3d printer. the whole process takes two days. this one will help surgeons plan how best to divide the layer of skin on the girls' scale once they are separated. and they're not just using once they are separated. and they're notjust using physical models, this is surgery without scalpels. absolutely incredible, this is exactly what we wanted. virtual reality has helped plan how to divide the twins' arteries and veins. now we can
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divide the twins' arteries and veins. now we can see divide the twins' arteries and veins. now we can see whole lot of detail that we have been able to access previously. this is clearly the way of the future. we are using this technology for highly complex place but many other routine operations that we do, brain tumours, blood malformations, this would be hugely, hugely beneficial for those cases as well. 0k, have we got everybody here? yes? so we have one case today, safa and marwa, two kids, one case. the surgery so complex it will happen in three stages over several months, and then twins were to be physically separate until the final operation. —— won't be physically separate until the final operation.
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the aim of the first operation is to separate the twins' shared arteries. at present, each child is supplying the other‘s brain with blood. at present, each child is supplying the other's brain with blood. one, too, and three, come out. what we are doing now is the two arteries that are going from 120 the other. we can see the artery but to do anything to it, we will use the microscope. —— going from one twin to the other. the archery going from safa to marwa's brain has been clamped. but every time this has been done, there is a risk of brain
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damage. ok, so the brain is looking good. the twins have been in theatre now for more than seven hours, and there are still several hours of this operation to go. so far, everything is going to plan and both girls are doing well. while one team works with the twins, another led by david dunaway, constructs a frame made from pieces of the girls style which can be attached in subsequent operations. this would be our rigid key so it will hold their heads together. what we need to do is make sure the twins are rigidly together. being older, they are pretty active, so being older, they are pretty active, so whatever we do really has to be strong enough to resist the twisting and bending forces that they will be putting on their heads. the first
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operation lasts 15 hours. zeinab has seven more children back in pakistan, aged five to 16. all of them were born at home, but with this pregnancy, she was advised to deliver in hospital. it wasn't until five days after delivery by cesarean section that zainab was introduced to her daughters, initially by photo. zainab says the twins have distinct personalities.
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after a month, the twins are back in theatre. this is safa's brain, it looks happy. this time, the surgeons will separate the network of brain which drain blood from each twin's brain, but disturbing this equilibrium could also do permanent damage. a portion of each twin's brain is being supplied by the other twin so there is a real risk of causing a stroke at the time of surgery, so that is something that is playing heavily on us. there is something deep down that i cannot see at the moment. the more the
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surgeons tried to divide the vessels that link and nourish them, the more u nsta ble that link and nourish them, the more unstable the twins to come. the pads are on. down. marwa's heart begins to fail. the anaesthetist managed to stabilise the girls so the operation can continue. because marwa is the wea ker continue. because marwa is the weaker twin, surgeons decide to give her a key shared fame. the operation lasts 20 hours. i'm relieved, there was a chance we were going to potentially lose marwa during the
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surgery is. it has been a big operation but hopefully, if they wa ke operation but hopefully, if they wake up, as we hope they will, it has gone well. yes. but shortly after surgery, safa suffers a stroke. there was a period on tuesday evening where we felt that we were very close to losing safa, and that, she stayed in that critical state for, for 48 to 72 hours after the surgery. it was a very difficult time for the girls, theirfamilies, very difficult time for the girls, their families, and the very difficult time for the girls, theirfamilies, and the entire very difficult time for the girls, their families, and the entire team looking after them.
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in a break from their work at great ormond street, the two lead surgeons are in ireland to meet another set of twins. it's eight years since they last saw ritaj and rital. it's hard to believe that these sisters, born in sudan, were once joined at the head. thank you! you are very welcome. back then the surgeons feared the girls might die unless separated. and this was rital and ritaj just one month after surgery. each parent able to hold a child in their arms. i hope that they will get a normal life and be treated as normal human beings. their father is now a doctor in ireland. we are now sitting here with two healthy twins, just like what i hoped at that time. so it's a great moment
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in my life as well. so the dream came true? exactly, yeah. i'm a very proud dad now. that was a very hard time. and at the same time it was a happy time because of the conclusion. rital has some learning difficulties. by the long—term outcome of the twins' separation has been hailed as a major success. the surgeons believe it's because it was done in the first year of life. what we put the two kids through and the brains through is a lot. the younger brains and the younger circulations are better adapted. everything is easier. a one—year—old's regenerative capacities are so much better. the skin heals better, it stretches better, bone grows in better. they're setting up a charity so that
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funds are available to pay for early intervention in future cases and for research into the best way to separate conjoined twins. it's january 2019. i think the last two months after their last operation on the brain has been a little bit of a stormy time for safa and marwa. they've had ups and downs with infections and temperatures and marwa's heart is having work quite hard for both of them and that's causing her a few challenges. but they're hanging in there. and they're both reasonably well. the next challenge for the surgeons is to ensure each twin will have enough skin to cover their skull when they're eventually separated. they do this by encouraging the skin to expand. the tissue expanders are balloons
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that sit underneath the skin and they have a tiny little port attached to them through which we can inject saline. so the idea now is that we will gradually inject the tissue expanders and they will blow up like a balloon and the skin over the top of them will stretch. and it's a very, very effective technique of making more skin out of the skin we have available so that when we come to separate safa and marwa there's enough skin to cover both of their heads. these are rare cases leave a lasting impact on the surgeons. if i may, i haven't asked david's permission to say this. but the last separation that we did, when the kids were finally separated, and everyone was overjoyed and so on and so forth, and people were happy, and i looked at david and he had tears in his eyes. and he denies it to this day, but he did at that time. yeah. ithink...
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everybody has been so invested in this for so long. it is a surprisingly emotional thing, i think, when they finally come apart. and when that experience of them actually leaving the operating theatre as two separate people is quite indescribable. at last, four months since the first surgery, the day of separation. two forceps. all laid out. so this is safa's brain that's marwa's brain. if you do give me a seven. little by little, the bone and the tissue which joins them is cut. so they are separate apart from that piece ofjewellery.
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and then, after seven hours, the final connection is severed. fantastic. 0k. done. it's in a very emotional moment. we've been working a long time to get them here. they've been through so many operations and now it's worked. you still have four, five hours to do? yeah, we have to put them together now. so we've taken them apart and now we have to reconstruct their heads. marwa is still in the operating theatre through here, while safa has been moved just next door.
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for the first time, the survival of each of the twins is not dependent on the other. and that'll make it easier for the two surgical teams to regulate their heart rate, blood pressure, and other vital signs. safa and marwa's brains used to have a distorted shape. but four months ago a plastic sheet was inserted between them and by gradually tightening the pressure it has largely corrected their appearance, essential before their skulls can be rebuilt. this means both teams can begin reconstruction. the patchwork of skull pieces are shared between theatres. so a piece for me, a piece for you. to have enough to cover their heads, each fragment must be divided in two. the skull is very usefully designed in three layers. so there is an inner layer of very thick, tough bone, an outer layer of thick,
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tough bone, and in between it the bone is like a honeycomb, so you can split the bone, it's half the thickness, but it means we should be able to cover nearly all of the head with bone afterwards. this shows the jigsaw of bone fragments that were pieced together to form the skull of marwa on the left and safa on the right. the gaps have been seeded with bone cells. and in the months to come these should slowly close up. the final task of the 17—hour operation is to stretch the skin over their reconstructed skulls. it's a pretty amazing day, isn't it?
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everything is good. thank you. oh, what a day. they have been quite amazing throughout, actually. they're great family and i think they draw strength from one another. and they seem to be getting through it very well. we asked mum who she would pick up first, whether it was safa or marwa? and the answer was both — with support! so, ah, yeah... the road to recovery for the twins is slow, but four months after separation, safa and marwa are beginning to make progress. # hello, safa. # hello, marwa. # how are you today? the twins have daily physiotherapy. it's hoped this will help them reach some basic milestones —
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learning to roll, sit, and hold their heads up. # twinkle, twinkle, little star. # how i wonder what you are... safa has not fully recovered from her stroke. we made the decision that the bulk of the common vessels go to marwa, the weaker twin. and because of the decision safa suffered a stroke. so what i really want to see is the weakness safa has at the moment, and she has a weakness in her left arm and left leg, improves. so for me the big moment's going to be when she walks and when she uses her left arm properly. because, you know, i have given her that weakness and for me that's a hard thing. nearly a year since they were admitted to hospital, the girls are leaving great ormond street.
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the family will stay in london until the twins are strong enough to return to pakistan. the donor who paid for the surgery is continuing to support them. they are clearly going to face some challenges. but i think, overall, it's a positive outcome for them. they are going to need support, but they have a chance of leading a happy life. whatever hurdles safa and marwa may face in years to come, they will at least do that as a separate, independent girls.
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twins still, but conjoined no more. hello, there, the weather is forecast to become a lot hotter next week, vertically across parts of england and wales. before we get there, though, on sunday, sunny spells for the most part but we will have heavy rain working into the north and west, that rain is courtesy of this area of low pressure with weather fronts sneaking all the way back into the atlantic, the rain is really going to be quite heavy and persistent across the north west. the rain will move into northern ireland on sunday before spreading to western scotland, the isle of man and
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cumbria as well. after hazy spells of sunshine to start the day across east of scotland and much of england and wales, it will turn claudia, still with some bright and sunny spells around. a bit cooler compared with saturday across the north west and the cloud and rain really developing through the day. as we go through sunday night and into monday, there will be further pulses of heavy rain, particularly targeting western scotland with the rainfall totals building up. there is the potential for localised flooding. further south, we will have a bit of cloud to start on monday but that will mount well with spells of sunshine —— melt away with spells of sunshine —— melt away with spells of sunshine —— melt away with spells of sunshine. highs on monday of 28 or 29 degrees across parts of england and wales and a warm 25 in northern ireland. the change in our weather is due to changes in the jet stream. it starts to get more amplified so a trough into the at least hint —— eastern atlantic, a
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ridge of high pressure builds to the west of europe and is really setting the scene for some very high temperatures to build in. so, tuesday, not of dry weather and sunshine, the brighter condition spreading to scotland with a rain easing here and northern ireland should stay dry and sunny and warm as well. with a clear blue skies for many adverse through the afternoon, it will become increasingly hot, temperatures up to 30 degrees around birmingham area, similar temperatures for cardiff, 32 or so for london, 25 in edinburgh. the heat is with us until wednesday, but more the flow of the landing across northern ireland and western scotla nd northern ireland and western scotland so temperatures never get quite as high here and there is the risk of a few thundery showers as well but for england and wales it gets eve n well but for england and wales it gets even hotter, we could see temperatures climbing as high as 34 celsius in the very warmest parts on wednesday and similar temperatures in the forecast as well for thursday, with a heat really staying with us, but italy across england, potentially sparking a few thundery
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showers. i never get that hot for western scotland and northern ireland, here more typically temperatures in the low 20s. the major question remains how long the speu major question remains how long the spell of hot weather is going to stick around. the main scenario is that eventually probably now on friday we will start to get the jet strea m friday we will start to get the jet stream changing and bringing cooler and fresher atlantic air across the uk by friday. but there is still a chance that we could get this low developing roundabout iberia, and that stops the progression of the atla ntic that stops the progression of the atlantic air and instead we continue the feed of hot air coming in from europe so it could be that the hot air holes on a little bit longer. most likely scenario is that the weather becomes less hot as we go through friday with thundery downpours, there is still the potential of the hot weather lasting perhaps next weekend. that is your latest weather. goodbye for now.
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