5th October 1997


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The Healing Cut

That delicate drill

By Roshan Peiris

"You mutt, where is your brain?" is an exasperated question directed at some people. The brain, all buff- coloured 750 gms of it, is cossetted comfortably within the skull.

OperationThe operation performed by the Chief Consultant Surgeon Dr. Sunil Perera at the National Hospital was on a strapping young boy of nineteen years.

He was haemorraging in the middle of his brain due to a blood clot, blocking an artery.

The brain surrounded by cerebro- spinal fluid is attached to the spinal cord through the brain stem.

There are four ventricles in the brain and the cerebro- spinal fluid comes between the third and fourth ventricles through what is called the arachnoid granulations and goes down to the spine and is absorbed.

For this patient one of his arteries in the brain had a weak point on its wall and hence developed what is termed aneurism where the artery at that point blows up like a balloon and a blood clot forms. This hinders the flow of the cerebro- spinal fluid at the point where the artery ruptures.

The patient develops awkward symptoms such as sleepiness, inability to communicate or in the latter stages being unable to sit up even in bed.

So the team of surgeons bypass the clot, diversify the process by a long white thin tube, 90 centimeters long (and costing 12,000 rupees) being inserted on the top of the aquiduct.

The tube takes the fluid to the abdomen, which has also to be cut, and so the cerebro- spinal fluid goes through the arachnoid granulations and gets absorbed.

The operation begins with the assistant surgeon Dr. Jayantha Herath making an outline on the shaved skull with blue- hued methelin.

Dr. Shiranee Hapuarachchi, the chief anaesthetist administers a general anaesthesia but the assistant surgeon intermittently injects local anaesthesia in small quantities to the patient, so that the pressure on the brain is reduced and the bleeding is slowed down.

After that a sterilised gauze covers most of the skull leaving a small area for the skull to be drilled by a surgical handsaw. An oxygen mask is also fixed on the patient and a nasal tube is fixed for feeding.

Iodine disinfectant is applied and the Chief Surgeon Dr. Sunil Perera begins the drilling skillfully to make an opening through which one can see a small part of the buff- coloured brain.

A retractor keeps the skin around the hole away and Savlon is sprayed and Saline is used to clear the spot of bleeding so that the surgeon can see.

The diathermy machine cuts some of the skin and the surgeon inserts the white long tube into a previously made cut in the abdomen.

The tube bypasses the blocked artery and the blood clot and the fluid flows into the abdomen and is absorbed.

The operation may seem simple but actually it is a delicate one done by a team of doctors commited to their job.

Besides the doctors mentioned there is the assistant anaesthetist Dr. Rohini Ranwala and the chief nurse, a male P.S. Gunasekera.

The air conditioning in the operating theatre had failed and their wasn’t even a ceiling fan, only- an apology for one-a small pedestal fan while the doctors worked hard in the heat. Most of them work around eight hours in the theatre.

The Sunday Times thanks the surgical team and the Management of the National Hospital for their cooperation.

Your Health

Get rid of that debt, with a long nap

by Dr.Sanjiva Wijesinha

How much sleep does a human being really need for a day?

Over two thousand years ago, Aristotle gave the following recommendation: "seven hours for a man, eight hours for a woman and nine for a fool.’’

There certainly are variations between individuals, but most scientists believe that a healthy adult needs at least seven-and-a-half-hours a night. If we do not get adequate sleep each night, we accumulate what is known as a ‘’sleep debt’’.

The sad fact is that the spread of electric lighting during the 20th century has changed the way our bodies function. As our grandparents used to tell us (and as we ourselves found out during the infamous CEB strike last year) in a world without electric lights people used to go to sleep when darkness fell and wake up with the light of dawn - thus sleeping nine or ten hours a night.

Today, because of the widespread use of artificial light, we live as if it is high noon all the time. The television programme that we must not miss, the vital test match being broadcast live at an unearthly hour from some far away part of the world, the report that we have to work on till 3 a.m. because it has to be handed in first thing in the morning - all these serve to deprive us of our normal requirements of sleep.

If we cut our sleep by one hour each night, the effect after a week on our bodies - our alertness, mood, intellectual powers and physical performance - is similar to our having missed a whole night’s sleep. All that we ourselves might feel is a bit of tiredness or a bit of grumpiness - but there is often a significant deterioration in our performance, whether it is in the classroom, at the operating table, in the factory or behind the wheel.

And recent research has also shown the importance of sleep in maintaining the body’s immune system that protects us from infections and cancers.

About one in five people in today’s ‘’round-the-clock’’ world work on night shifts. Doctors, nurses, pilots, service personnel, police and security officers, heavy vehicle drivers, certain factory workers - all these are forced to work what is known as ‘’the graveyard shift’’ between midnight and dawn. Combined with an accumulated sleep debt, keeping awake to work during hours when even the devils have gone to sleep makes a person very vulnerable to fatigue.

A major problem is that these shiftworkers have to catch up on their sleep at home when the rest of the family is wide awake - so their daily period of sleep is usually interrupted and much shorter in length than the minimum they need.

Few of us realise the importance of sleep in our lives. The simplest solution if you are deprived of sleep is to somehow find the time to sleep on it. It takes a good long nap to clear away the debt that you build up each week.

Of course the trick is to halt the build-up of sleep debt in the first place. If you can’t sleep properly during the night, you must catch up on your sleep during the day. There is no point working a series of night shifts and trying to live a ‘’normal life" during the day time.

If Aristotle had been living today, he might have added to his three recommendations - "and six only for the biggest fools.’’

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