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Neurosurgery, a subject so far unexplored by medical scientists is developing very fast in the world. However, in Bangladesh the growth is going at a snails pace as it could not cope with the expenses and the technological advances.
   Though the private sector has come up in cardiac care development only a few private clinics can claim that they have a proper set up for neurological care.
   Dr Prem Pillay, Consultant Neurosurgeon of Mt Elizabeth and Gleneagles Hospitals of Singapore has been coming to the country for more than 10 years but apart from the once a year official visit, he also comes if sponsored by someone or some organisation. He said that though there has been development of services in the last few years, the advancement has not been to the level due to the lack of latest machineries.
   Computed Tomografic Scan (CT-Scan) is now a 20-year old technology and its cost is going down with time. Now, lower middle-class people can afford the diagnostic test whereas PET scan, which is a new version of body scan capable of detecting a cancer the size of a pin costs around Singapore Dollar 3000. ‘Fortunately, more people will go for a PET scan that will cost $300,’ said Dr Pillay.
   Neurosurgery refers to surgery of the brain, spine and nerves and in Bangladesh neurosurgeons have to remain busy with head injury patients as over 70 per cent of the patients come to them following accidents or trauma. This is followed by stroke and brain tumour.
   In government hospitals, trauma patient load is so high that concentration on other forms is impossible but private hospitals are coming up with good quality neurosurgical care. ‘Some of the neurosurgeons working in Bangladesh have the potential to carry out complicated brain surgeries but technological and hospital support need to be improved,’ Dr Pillay observed.
   Micro-Neurosurgery is a field developing fast in the developed world and here there is a use of an operating Microscope that allows smaller openings to be made to reach the brain, spine and nerve problems and to aid delicate surgery on these parts.
   A cianiotomy (cutting the skull bone) is done to treat various problems in the brain such as brain tumours, anerysms (vascular dilatation), blood dots, abscesses and head injuries and the goal of neurosurgery is to effectively treat the brain or spine disease completely with minimal side-effects.
   Dr Pillay says, ‘Currently, brain and spine surgery is made more effective and safer with the use of computer aided neurosurgery or computer aided microsurgery (CAN/CAM) technology. This provides sophisticated navigational information to the neurosurgeon through a special microscope needed in brain and spine surgery.’
   In the procedure, a special sticker (Fiducial markers) will be stuck on the head or spine in the area of problem or lesion. One will then go for a special MRI or CT scan that will be used for surgical planning.
   Earlier, MRI was for diagnostic purposes. During the scan various cuts of the head/spine are imaged in different views (top/bottom front/back. side/side)
   Once the images are loaded onto the computer workstation, whole head or spine is reconstructed in 3-drmensions (3-D). The lesion in your brain (tumour, abscess, blood dot etc) and critical areas of the brain/spine e.g. major blood vessels, the optic nerve can be similarly reconstructed in 3-dimensions and a neurosurgeon can determine the safest access to your lesion with minimal damage to critical brain/spine areas. This allows him/her to make a smaller opening (craniotomy) in your brain or smaller spinal access
   Robotic brain micro-surgery is also available in Surgiscope. Human hand is big and cannot manipulate finer instruments which are 100 times smaller than a tea spoon but a robotic hand can do the work though they are manipulated by a human hand from a distance.
   Using state of the art CAN/CAM technology, brain/spine surgery is now more accurate, less invasive and safer with minimal damage to normal brain or spinal nerves
   After surgery, patients may be in the ICU and then can be discharged usually within 24-72 hours. With any type of surgery the most common risks are internal bleeding, infection and anaesthetic risks. Computer-guided Micro-neurosurgery helps the Neurosurgeon to minimise these risks.
   Being diagnosed with a brain tumour is frightening and devastating. However, now-a-days with modern technology there are treatment options available and this includes a non-invasive method called Radio-surgery. With this method no opening needs to be made in the head.
   Radio-surgery makes use of high energy beams, x-rays, gamma-rays and proton beams to damage the DNA of the tumour cells; this damage eventually causes the cells to stop dividing.
   Stereotactic radio-surgery achieves a high radiation dose with precision to the brain lesion (tumor) in a single treatment and is done as a day-surgery procedure. When a tumour volume is large the radiation, if given in a single treatment may be too damaging to the surrounding healthy orain tissue. So, in these cases the radiation doses can be divided up and a small fraction of the total dose is given on each working day over several weeks. This minimizes the side-effects to the brain and is especially important if the tumour is near a critical brain area like the brain stem optic nerve.
   Radio-surgery damages the DNA of the cells and stops them from dividing and if a tumour stops dividing and growing, it invariably becomes inactive. If treatment is successful, the tumour may decrease in size, disappear or remain the same and no increase in size means that the tumour is not growing.
   Dr Pillay said that the government of Bangladesh should take initiative to develop neurosurgery facilities in the country and added by stating that if the private sector developed then the service would improve.

Cholesterol is one of the body’s fats (lipids). Cholesterol and another lipid, triglyceride, are important building blocks in the structure of cells and are also used in making hormones and producing energy. To some extent, the cholesterol level in blood depends on what you eat but it is mainly dependent on how the body makes cholesterol in the liver.
   Having too much cholesterol in the blood is not a disease in itself, but can lead to the hardening and narrowing of the arteries (atherosclerosis) in the major vascular systems.
   For the sake of simplicity, there are two sorts of cholesterol: a ‘good’ sort called high density lipoprotein (HDL) and a ‘bad’ sort called low density lipoprotein (LDL).
   
   What is the cholesterol count?
   When the cholesterol level is measured in a blood sample (taken after the patient has fasted for several hours), the levels of all forms of cholesterol can be calculated. Cholesterol levels in the blood rise slightly with age, and women generally have a higher HDL-cholesterol level than men.
   In the UK, the average total cholesterol level is 5.7mmol/l.
   The levels of total cholesterol fall into the following categories:
   l ideal level: cholesterol level in the blood less than 5mmol/l.
   l mildly high cholesterol level: between 5 to 6.4mmol/l.
   l moderately high cholesterol level: between 6.5 to 7.8mmol/l.
   l very high cholesterol level: above 7.8mmol/l.
   However, it is now recognised that the significance of any particular cholesterol level cannot be assessed without taking into account the ratio between good and bad cholesterol (either total-cholesterol/HDL-cholesterol ratio or LDL-cholesterol/HDL cholesterol ratio) or the presence of other cardiovascular risks, such as smoking, diabetes and high blood pressure (hypertension). It is possible for someone to have a high level of total cholesterol and still have a relatively low cardiovascular risk because of an absence of other risk factors or because their family history is free from coronary disease.
   Anyone with an established track record of cardiovascular disease such as angina pectoris, a previous myocardial infarction, coronary angioplasty or coronary bypass surgery should seek advice to keep their total cholesterol level below 5mmol/l or their LDL below 3mmol/l.
   
   What cause high cholesterol levels?
   Cholesterol levels can run in families. If the inherited cholesterol levels are very high, this is called familial hypercholesterolaemia (FH) or familial combined hyperlipidaemia (FCH) where the triglyceride levels are very high as well. Levels can also be influenced by the part of the world you live in: cholesterol levels in northern European countries are higher than in southern Europe and much higher than in Asia. It is known that the relationship to food is significant, but there is no doubt that genes also play a part. High cholesterol is also seen in connection with other diseases, such as reduced metabolism (due to thyroid hormone problems, for example), kidney diseases, diabetes and alcohol abuse.
   
   What are the symptoms of high cholesterol in the bloodstream?
   You cannot tell if you have a high cholesterol level, but a high level in conjunction with other adverse factors increases the risk of developing atherosclerosis and cardiovascular disease.
   Atherosclerosis results in narrowing of the arteries. This does not occur suddenly, but builds up over many years during which cholesterol and fat have been deposited in the artery walls. The result is that the arteries become constricted and hardened, their elasticity disappears and the volume of blood able to travel through them is reduced.
   The symptoms are therefore the consequences of cardiovascular disease. They depend on the degree of narrowing, the likelihood that the plaque is going to rupture (vulnerability), and the organ supplied by the affected arteries.
   In the brain, an atherosclerotic carotid or cerebral (brain) artery might block with clotted blood (thrombus) or a smaller intracerebral vessel may rupture causing a local haemorrhage. Both these circumstances result in a stroke (cerebrovascular accident or CVA).
   In the heart, narrowed coronary arteries cause angina, and ruptured plaques cause coronary thrombosis (myocardial infarct), which may lead to reduced heart function (heart failure) if a significant amount of heart muscle is damaged.
   Carotid arteries in the neck can become narrowed and may lead to clots forming in the neck and floating downstream into the brain, causing a stroke (CVA) or recurrent temporary strokes (transient ischaemic attacks, also known as TIAs).
   Leg pain on exertion can be experienced due to atherosclerosis in the arteries that supply the lower limbs (intermittent claudication). If a major peripheral vessel to a lower limb blocks suddenly, an acutely ischaemic leg will occur which may be limb-threatening. In the worst cases of chronic lower limb atherosclerosis, this can lead to a leg so starved of blood that it cannot survive and requires amputation.
   It is common in those people most affected to have the disease in several arteries throughout their circulation including the aorta (the main artery in the chest and abdomen, the renal (kidney) arteries and the mesenteric (intestinal) vessels.
   
   What can be done to prevent vascular disease?
   High cholesterol is only one of many risk factors in the development of hardening of the arteries. These factors include:
   l smoking: recent research shows that middle-aged women and men who smoke have a much higher risk of suffering a heart attack. The risk drops in the years following giving up smoking.
   l diet: food is another important factor. A Mediterranean diet made up of bread, fruits, vegetables and small amounts of lean meat, fish, and olive oil is recommended.
   l alcohol: moderate consumption reduces the negative effect of the LDL-cholesterol and increases HDL-cholesterol. Too much raises blood pressure and damages the liver, having an adverse overall effect.
   l exercise: even on a small scale this can reduce the chance of coronary artery disease. Hard physical exercise increases the blood’s ability to break up blood clots.
   l body weight: it is important to avoid obesity, especially when the fat is around the stomach.
   — Discovery Health