Nineteenth Century Medical Guide

Chapter 277 273. "Expert" Consultation (2)

Benefiting from more than 200 years of research in physiology and pathology, physiology and pathology have always been compulsory subjects in medical schools.With the upgrading of microscopes, the identification of tumor cells has gradually become an advanced course in medical schools. The doctors participating in the consultation have a basic understanding of tumor cells.

Of course, the research on tumors at this stage is very shallow, and it is impossible for everyone to tell the truth at a glance.

But as long as a few authorities take the lead, someone will soon follow suit.After all, there are gaps among the experts participating in the consultation. Clinical medical consultation is not a democratic election.

"It is indeed a tumor cell."

Massimov nodded first, followed by Waterman and Jacob. After the last few pictures were in Mosier's hands, he also had to make him nod: "The individual is extremely large and irregular in shape, I also think it is tumor cells."

"From a morphological point of view, it does match the characteristics of tumor cells."

"It seems that everyone agrees that there are tumor cells in Mr. Erdem's urine." Watman collected all the drawings, "Do you have any other questions? If you have any questions, ask them as soon as possible, otherwise this section will just go on like this gone."

The surrounding doctors communicated with each other in low voices, but no one was willing to speak.

"Since you have no objection, then."

"So you still agree with Dr. Carvey's judgment?"

At this moment, Jacob, who was not far away, suddenly said, "It's so boring if everyone doesn't talk during the consultation. Since you don't have any objections, why don't I say a few words."

"Another angle?"

"I do not deny this colleague's assessment, and I also admit that damage can occur during endoscopy."

Edward originally thought that after 60, he should take a break, but who knows that he is still maintaining this relationship: "It's nothing, as long as you like it."

"It can only be said that each has its own advantages."

"Disinfection?" Edm didn't expect this step, "What is disinfection?"

"I often go to various hospitals in Vienna to watch operations, and I came here before to see Dr. Carvey perform Giustina's operation." Edward stepped forward to comfort him, "No matter who it is, even their Ludwig Old Marshal, you have to do the same thing before the surgery."

"At first, I thought this test was flawed. There should be some difference between 'finding tumor cells in tissue' and 'finding tumor cells in urine'."

"Sounds like a good idea."

But the consultation is far from over.

"Don't talk about the past, even now, there is no such preparation work in the surgical theater in Paris. This is a disinfection measure that has only recently become popular, and it is only limited to Vienna." Herman could see that he was a little nervous, "The main purpose is to reduce the risk of surgery. The chance of incision ulceration after the end."

By this time, the tumor has almost reached the middle and late stages. Even in modern times, it needs the cooperation of a whole surgical team and a little bit of luck.

"It's really a good way to rely on a microscope to examine urine sediment." Jacob is very affirmed of Carvey's innovation, "The ability to do this has actually surpassed 90% of the doctors present. There is no threshold for this detection method." , and the cost is low, I think it can be promoted in major hospitals.”

"Has Mr. Edham fasted this morning?" Herman asked.

Carvey still thinks his method is better: "Under the washing of urine, the urethral injury heals much faster than the lower abdominal incision. It may end in one day, and it will not affect the urethra at all."

Carvey looked at the endoscope at hand and frowned: "The teacher means to make a hole in the patient's lower abdomen to communicate between the bladder and the skin?"

Surgeons who have dealt with the urinary system all the year round are called sewer workers. They have more or less the shadow of plumbers in vascular surgery, and sometimes they can always come up with some crooked ideas.

After some appreciation, Waterman thought it was just the beginning: "And then?"

"What's the matter? Can't you be heroic in your 60s?"

Judging from the results, the inspection was considered a success, at least with the help of the built-in oil lamp, the inside of the bladder can be seen clearly through the observation hole.However, there are still many deficiencies in the operation of endoscope penetration, which may be due to the decay of the urethral tissue structure of the corpse, and deviations occurred when the endoscope port was inserted several times.

"Hiss, this feels so strange." He watched the gauze ball lightly brushing over the little guy's surface, couldn't help shivering, moved back, and couldn't help asking, "What do you use? Can this stuff be painted on here?"

"The ratio is not bad, but the percutaneous incision will still cause incision ulceration. The old man is old and cannot stand such a toss."

So this 63-year-old man has never been married all his life, but has several children.

"Well, I didn't eat anything."

Edm looked quite calm, but he was still a little uneasy: "I remember that the previous surgery didn't seem to have this step."

Edm didn't feel anything, got on the bed next to the other party, and took off his pants: "That's fine, since it's prescribed by Dr. Carvey, you just do it."

"I agree too."

The three of them shifted their attention from his little thing to his face in unison: Xiongfeng? ? ?

"Change? How to change it?" Carvey was a little surprised, "The bladder has one and only one outlet."

"It will heal in 3 days."

Mossier's face was not very good: "It's true that the proportion is not high, around 60-70%."

"Injury is inevitable and damage is manageable."

"We'll just have to wait for the result."

"Oh, yes, disinfection! Disinfection shouldn't have any effect on the body, right?" Seeing that carbolic acid completely covered his lower body, Edm asked, "For example, walking normally, or excreting, or Show me my majesty in front of the ladies."

The preparation work was not difficult, but because Edward and two guards supervised the whole process, Kavi was afraid that ordinary assistants would be in a hurry, so he let Herman and Damirgang complete it.In the past few months, the two have already become Kawei's gold medal assistants, and they have seen the disinfection thousands of times, and it is not difficult to do it.

Although Carvey always felt that their surgical methods of cutting off the hands and feet of the wounded should not be so tolerant of the urethra, but from a personal point of view, these questions are also helpful to him.

"It was inserted into the prostate just now, so it can't be considered controllable?"

Edm has never married, but the women around him are like a revolving lantern, almost changing every few months.Sometimes, for the sake of artistically necessary stimulation, the number of people will increase by a certain degree.

But for Edm, who saw this scene for the first time, he always felt a kind of indescribable awkwardness.

"Don't worry, Mr. Edham, it's the diluted carbolic acid. After wiping, we'll wash it with warm water again. There won't be any problem."

Carvey can guess why he made this suggestion. After all, he often performs prostate surgery, and most of the patients he encounters are patients with urinary retention after benign prostatic hyperplasia.It is very uncomfortable for such patients that the urine is blocked in the bladder, and it is necessary to catheterize and urinate as soon as possible.

"I agree." Jacob replied with a smile, "At least for now, I agree. I am looking forward to the next cystoscopy and hope to see it."

At that time, the diagnosis was based almost entirely on the experience of practicing medicine. The pathological examination of the suspected tumor was done in advance, and the angle was really tricky.

This is called percutaneous suprapubic bladder catheterization in modern times, and the method is the same as what he just said.

But Mr. Erdem has no similar prostate symptoms, and urination has always been smooth.I believe it is safe to insert an endoscope into the bladder provided sufficient paraffin oil has been applied. "

"Do it, Dr. Carvey."

Of course, Mossier also had his own reasons: "Urethral injury will affect urination, and the suprapubic incision will not have such an effect. Moreover, the time to enter the bladder is very short. Take away the endoscope and bandage it, and the created fistula will be self-contained." heal."

Jacob explained: "But now that I think about it, I feel that I have not considered it properly. The urine is sealed in the human body before it leaves the body. If there are tumor cells in the urine, the entire urinary tract should be likely to be diseased."

"I agree."

"Is that so?"

"disinfect."

"No!" Carvey sighed, "From the perspective of damage, maybe each has its own advantages and disadvantages. Of course, I don't admit it myself, so let's just treat them as having their own advantages and disadvantages. But did Mr. Mosier forget another angle? ?”

With the results of microscopic examination as an objective basis and the affirmation of several old experts, the transition from microscopy to endoscopy seemed to go with the flow.And these "experts" who were invited to come for the consultation seemed to have no room to intervene in the face of such diagnostic logic.

Carvey calmed down and explained: "However, I need to clarify: First, the mirror mouth is not as sharp as you imagined, and the surrounding is arc-shaped. Second, the mistake just now is just a problem with the internal structure of the corpse. , and the prostatic hyperplasia is obvious, resulting in urethral stricture, and he may have had difficulty urinating before his death, which Dr. Mosier can prove.

"Mr. Mosier, Mr. Erdem's prostate is fine." Carvey said, "I don't think it's necessary to open a hole in the bladder instead of using such an excellent urethra."

"Don't worry, it won't affect you."

According to the level of these experts on the stage, hematuria is nothing more than prescribing some drugs that can stop the bleeding, and then go home and wait for it to heal with peace of mind.

The disinfection area is centered on a certain little guy, and the surrounding radius of 10cm needs to be wiped clean. It is indeed strange to do so in the eyes of outsiders.Edward could tell from the expression on Edem's heart that he was full of doubts, and explained: "Don't worry, this item is already very popular in Vienna's surgery theater."

"Do you feel like peeing now?"

"You can build one yourself."

"Indeed, direct surgery is better."

"Dr. Carvey, I personally think that cystoscopy is very valuable in inspection." Mossier first affirmed the endoscopy, and at the same time raised his own doubts, "I think it is possible to change the way of sending the endoscope .”

"Not yet."

"What about the damage from the endoscopy?"

Asking this question is the same as not asking.

"I think it's better not to do endoscopy and go straight to surgery."

"It's just a set of very simple preparations." Herman smiled, and didn't want to explain too much, "This is prescribed by Dr. Carvey."

On the basis of pathology and Jacob's two major foundations, the diagnostic method of first finding tumor cells to determine the nature of the disease, and then observing the location of the tumor with an endoscope is very straightforward and easy to understand.

"I think the lens of this kind of endoscope is not smooth enough, and it is easy to cause urethral damage." A doctor from the School of Surgery said, "Although other treatments and examinations of the urethra will also cause more or less damage, but this is after all. It's hematuria, and it's easy to confuse focal bleeding with injury bleeding."

"Please, teacher."

Herman nodded, and asked Damirgang to come over to help: "Do a simple disinfection first, you may feel a little uncomfortable, this is normal, don't be too nervous."

"So, it doesn't affect my work, does it?"

Seeing that they were all interested, Carvey explained: "The location of the tumor is not only the bladder, but also the kidney. If you don't know the location, you can directly operate. Do you want Edm to suffer an extra knife?"

The reason why a consultation is a consultation is because it is a place where everyone expresses their opinions.Unlike Maruna, who had a very poor foundation, those questions were raised well just now. It seemed that he was pressing every step of the way, but in fact he was thinking about the patient.

"Yes, it only needs to be 1-2cm in diameter, and the distance will not be too long."

"Three days is not too long."

Herman let him return to the position just now, and while comforting him, held the gauze ball with the hemostat in his hand, and gently swung it back and forth, like a painter: "The disinfection will be over soon, and the next step is to wait for the card A message from Dr. Wei will do.”

"This is indeed a good advantage." Carvey questioned, "But there are not many people who can pull out the puncture tube and heal on their own."

If the condition does not improve, the second time they often increase the dose of the first drug, and let him take some heavy metals at the same time.After these two steps, the patient's hematuria may have been ready for industrial upgrading, and other symptoms will appear one after another.

This passage was expressed very clearly, and the reason for the accident just now was found. Many doctors on the stage had already begun to nod their heads.

Massimov not far away suddenly said: "If the incision is small, the chance of ulceration is not too high. If disinfection is used, it may be less than 10%. By the way, how long will it take for the incision to heal after the tube is pulled out?" ?”

At 2 p.m., the cystoscopy on the cadaver was completed.

"oh oh."

"I see." After hearing Ludwig's name, Edm finally felt relieved and asked, "That's right, what did you call this just now?"

"Since everyone should have no objection to the judgment of the suspected tumor, I'm going to start the cystoscopy." Carvey showed his new bladder endoscope to everyone in the bladder and asked, "What do you think about my section? Is there no objection to the diagnostic method?"

But the urethra is blocked by the prostate, and it is not easy to catheterize, so Mosier often chooses to bypass the urethra to urinate.

But the consultation at that time was not like the consultation in modern hospitals. Everyone had a set of established diagnostic criteria, and every year major medical associations constantly revised them based on a large amount of data.

"Yes, the endoscope must be thicker than the catheter stick, and the damage to the urethra will be greater."

"So it is."

At this time, Carvey was performing a bladder endoscopy demonstration on the corpse, and in the preparation room next to the operating theater, Edem was receiving the help of two assistants to complete the preparations before the endoscopy as soon as possible.

"Functional angle."

Carvey said: "The endoscope is made of metal, it cannot be bent, and it cannot be bent. Because once bent, the field of view in the bladder will be lost. So from the beginning, the range that the endoscope can see is very limited. In order to To determine the tumor site, we can only distinguish it by the color of the urine in the bladder and the color of the urine that has just flowed into the bladder.”

Only then did Mossier realize the great disadvantage of percutaneous access to the bladder: "You mean you can't see the opening of the ureter."

"Yes, you can't judge the source of the hematuria without seeing the opening."

(End of this chapter)