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Wednesday, January 17, 2007

Specialists speculate on Castro's health

Specialists speculate on Castro's health
His advanced age is a factor, surgeons say
Staff and wire reports
Posted January 17 2007

The "grave" complications a Spanish newspaper reports are afflicting
Fidel Castro are survivable and don't necessarily mean he is on the
verge of death, say specialists in South Florida and elsewhere who
reviewed the article.

Castro has had at least three failed operations and complications from
an intestinal infection, and the Cuban leader faces "a very grave
prognosis," the newspaper El Pais reported Thursday.

The newspaper cited two unidentified sources from the Gregorio Maranon
hospital in the Spanish capital of Madrid. The hospital employs surgeon
Jose Luis Garcia Sabrido, who flew to Cuba in December to treat the
Cuban dictator.

Dr. Floriano Marchetti, an assistant professor at the University of
Miami Miller School of Medicine's division of colon and rectal surgery,
said Tuesday he has no way of confirming the information in the El Pais
article, but if it is true, it is possible that Castro can recover.

"It's a messy situation, and quite serious, but this per se is not
malignant, and potentially he can survive this," Marchetti said.

The newspaper report said the 80-year-old Castro's health problems began
during the summer with severe bleeding caused by a condition called
diverticulitis, which occurs when pouches or weakened spots in the
intestines become infected, perforated, or blood vessels there burst.

One published report said Castro had suffered from diverticulitis at
least once before about 20 years ago.

Diverticulitis stems from another condition called diverticulosis --
bulges or pouches in the digestive tract -- that is fairly common in
people over 60, and seldom causes symptoms. In the elderly, the
prognosis for this kind of infection is generally very poor, the El Pais
article said, with a mortality rate as high as 90 percent.

"Castro would definitely qualify as critically ill," said Dr. Roshini
Rajapaksa, a gastroenterologist at New York University School of
Medicine, referring to the report.

In a younger patient, even the severe complications Castro has
reportedly suffered are not necessarily fatal, but Castro's advanced age
could be a major factor.

"When you're in your 80s, any complication can be fatal," said Dr. Joel
Weinstock, director of the gastroenterology department at Tufts Medical
School.

According to the newspaper account, when the bleeding began, doctors
removed a portion of the large intestine and reconnected the colon to
the rectum, the paper said. But fecal matter found its way into his
abdominal cavity, causing a serious infection called peritonitis.

In a second surgery, doctors drained the infected area, removed more of
the colon, and performed a colostomy, in which an opening is created in
the abdominal wall for fecal matter to pass through and be collected in
a plastic bag attached to the skin.

A third surgery became necessary when an inflammation developed in
Castro's gallbladder, a common but serious complication called
cholecystitis, which sometimes occurs after such surgeries. A drain was
placed there, but it failed and had to be replaced, according to the report.

El Pais said that in December, when Garcia Sabrido visited, Castro's
abdominal wound was leaking more than a pint of fluids a day, causing "a
severe loss of nutrients." The Cuban leader was being fed intravenously,
the report said.

Marchetti said Castro is likely being treated with antibiotics to stem
infections. "Eventually, if he survives, potentially, he would have
another operation to put the bowel back together," he said.

Marchetti said at the same time doctors perform reconstructive surgery
that would allow Castro to void fecal matter naturally again and close
the site of the colostomy, they would also likely remove the gallbladder.

The El Pais report was denounced by a Cuban diplomat in Madrid. "It's
another lie and we are not going to talk about it. If anyone has to talk
about Castro's illness, it's Havana," the diplomat said, speaking on
condition of anonymity.

Cuba has released little information on Castro's condition since he
temporarily ceded power in July to his brother, Defense Minister Raul
Castro, and the El Pais report was not made public in Cuba, where the
government runs the media.

A statement attributed to Castro was released on Dec. 31, saying his
recovery was "far from being a lost battle."

Cuban officials told visiting U.S. lawmakers last month that Castro does
not have cancer or a terminal illness and will eventually return to
public life.

Staff Writer Nancy McVicar contributed to this report, which was
compiled from Sun-Sentinel wire services.

http://www.sun-sentinel.com/news/local/cuba/sfl-acastro17jan17,0,5427063.story?coll=sfla-news-cuba

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