Nineteenth Century Medical Guide

Chapter 278 274. No matter how small the inspection is, it is full of various details
In the history of medical development, it is never easy to make a breakthrough that is recognized by most doctors.

There are too many pioneers, even if they hold the truth in their hands, even if they shout their discoveries hoarsely, they still cannot break the original stable medical system.Breaking the inherent cognition requires not only knowledge, courage and perseverance, but also some external things.

External force does not dominate, but it can play an auxiliary role of icing on the cake, greatly reducing the time required for medical development.

Even though Kavey's external strength was insufficient before, he never had much say in the fight against infection.But compared to the earlier Semmelweis, at least he was not isolated by the people around him, and he was surrounded by the support of the Municipal General Hospital and Ignatz.

A large number of operations and the types of operations gradually developed allowed him to gain a firm foothold in Vienna.

Tracheectomy, inguinal hernia, bowel repair, cesarean section, ventricular shunt, gallbladder cancer, cleft lip, breast hyperplasia, breast cancer, hepatosplenectomy, intervertebral disc herniation
These operations put Carvey on a level that did not belong to this age group. At the same time, others followed suit and saw the feasibility of surgery.With the passage of time, after the overall decline in the postoperative infection rate in the Municipal General Hospital was found, anti-infection has gradually become the standard equipment for the surgery of the Vienna Hospital.

More than half a year has passed, and all surgeons in Vienna know about disinfection, and everyone is willing to do it.

With such a status, Kavey's resistance to selling technology abroad will naturally become smaller.

The nominal host of this conference is Watman, but it has always been dominated by Carvey, whose main role is to downplay the responsibility for diagnosis and surgery.If the time goes back half a year ago, Carvey may not even be eligible to enter the venue.

In fact, those who opened their mouths to refute and put forward different opinions were also "outsiders" who were not familiar with him.Those who have worked with him and are familiar with his abilities naturally have three points of trust.Even if they really have doubts, they still hope to see what new things Carvey has come up with and what kind of changes they can bring to surgery.

"Bladder anatomy is the basis of lithotripsy. Based on your surgical experience, it is impossible for you not to know."

They are all surgeons who can operate on their own, follow the principle of seeing is believing, and no one will admit the results of examinations that have not been judged by their own eyes.At the same time, this is the perfect opportunity for them to observe the inside of the bladder of a living person for the first time.

"The palm of the left hand is upward, the middle finger and the ring finger clamp the YJ coronal sulcus and lift upward, straightening the urethra." Carvey said while doing it, "Then use the thumb and index finger to separate the urethral opening, hold the mirror in the right hand, and slowly enter."

"Yeah, what does that have to do with a cystoscopy?"

"Not bad." Edmu's forehead was covered with fine sweat, and he always had a strange feeling when he saw the thick cystoscope entering his body, "Dr. Carvey, I need to confirm one thing, I am Not the first patient to be examined?"

"I also looked at it just now, and the opening of the ureter is very clean."

Ginger is still old and hot. Carvey briefly explained the theoretical basis, and Jacob has already thought of clinical practice.

".I'll try my best to cooperate."

With the help of the flame, the black mirror tube suddenly shone with the luster that metal should have, and at the end of the mirror, Carvey finally saw the scene inside the bladder: "When examining a living person, the same as the corpse just now It’s different, we can’t rush to find the location of the lesion, but we have to prepare the bladder first.”

Everyone left their seats and leaned towards the operating table.

This is true, the only one who feels commonplace is probably the modern Kavey.

Lifting the YJ is to eliminate the first bend of the male urethra. After entering, the cystoscope body can be lifted to make it vertical to the horizontal abdomen.

Edm's face was full of question marks: "Relax? How to relax?"

Jacob tried it once, and asked, "Does this mean the lesion is inside the bladder?"

Seeing that he was a little nervous, Carvey patted his stomach lightly with his hand: "Even if you hold your hands tightly, your head, neck and shoulders should be free, but your stomach should be relaxed. Otherwise, the sphincter spasm will make it difficult to get into the mirror." trouble."

"Empty the urine before the endoscopy, in order to prevent the colored urine from interfering with the vision," Jacob said, "and now what should be done is to inject enough water into the bladder to remove the shrinkage. open the bladder."

"Of course there is."

"Uh, I'm sorry." Carvey suddenly explained, "Maybe I was too vague. I'm referring to the anatomy of the internal structure of the bladder, not the location of the surrounding organs and blood vessels."

As long as you have seen Carvey's operation, you will know the meaning of this sentence:
[A new knowledge point appears, please take a pen and paper to record it, and if you miss it, it will be gone. ]
Carvey asked Bergett to prepare rubber hoses and syringes, and asked, "I don't know if you have done any bladder dissection?"

With a slightly embarrassing cry, the entrance to the mirror ended. 【3】

Of course, the 19th century had just ended anesthesia-free surgery, and Carvey believed in their capacity.

Edm tried Kavey's request, trying to get used to the feeling, and asked, "How troublesome?"

Kavey nodded, and further raised the YJ with his left hand, and continued to push down the lens mouth with his right hand to push it forward.The external sphincter will be forced to open under this downward pressure action, and the entire cystoscope can reach the prostate of the urethra smoothly.

"It may not be the first one, but it must be the first one with a successful inspection."

"Because the inside of the shrunken bladder is full of deep and shallow folds, the area that is actually displayed in the field of vision is very limited. Only by stretching the bladder can you see the complete inner wall of the bladder. That's why you emphasize the internal structure of the bladder and Let the assistant hold the rubber tube."

"It's coming, it's coming, hiss. Give it a go!"

This process has already caused Edmu a lot of pain, his face flushed, and his hands tightly clenched the bed sheet.If Herman hadn't been standing behind him, he might have moved back and screwed up the whole check.

"Um, yes, they are all magical drugs that allow you to sleep and wake up to find that everything is fine." Carvey explained, "But in comparison, I prefer ether, which is less toxic and safer. "

"How do you relax your muscles when it hurts so much?"

If it can be used in the adult male bladder under non-invasive conditions, the cost of inspection will be greatly reduced.Not only is the inspection process simple, doctors are more willing to use it, and patients are more likely to accept it, which is imperceptibly promoting the development of endoscopy.

Endoscopy has not made much progress since the development of Boscini in the early 19th century, and the development of medicine and surgery has not reached the point where endoscopy is required.This makes endoscopy very tasteless, and the only ones that can be used are the anorectal, YD and ear nose with short distances.

"Yes." Carvey looked at Mosier who had been questioning himself before, "Mr. Mosier, I have thoroughly cleaned the bladder just now, and there was no serious damage when the cystoscope entered the urethra."

"Isn't the bladder just a cystic organ?"

"You need to relax."

Carvey injected cold water into the rubber tube to stop the bleeding and flush the bladder at the same time. Only by thoroughly cleaning the inside of the bladder can the surrounding structures be seen clearly: "Mr. Jacob's urology skills are really profound, and I offended you by asking the question just now. "

"I asked Mr. Erdem to empty the urine before the examination. What should be the state of the bladder now?" Carvey glanced at everyone, "Should it be in a tight state? It is a cystic structure, just like being Crumpled paper bags instead of steam pots with a fixed structure, because air can't exist without urine."

"Of course not."

"I see."

Carvey's examination techniques are not considered proficient. After all, modern cystoscopy is performed by full-time urologists, and many details can only be known after having done it.However, he has inserted the most basic urinary catheters before, all under the premise of non-anesthesia, and the operation skills can be used for reference.

"Wonderful!"

"There's no offense." Jacob drew several sketches on the paper with a pen, and at the same time quickly recorded various precautions, "Your cystoscopy examination this time is better than my random words just now. Much more."

"Where is Mr. Massimov?"

Seeing that he still didn't understand, Kavi gave Herman a look behind him.The latter also understood, clenched his fist with his left hand, and kept poking the joint between the index finger and thumb with his right hand, and said at the same time, "It's probably like this."

"Internal anatomy?"

"How?" Jacob asked very concerned.

"Don't talk about it, it's not that I haven't undergone surgery, I just had an examination." Edm was familiar with the road, took off his pants, quickly lay down on the bed, and assumed a very standard lithotomy position, "Come on. "

"So you can't see the inspection process?"

"I tried the urine that did go into the bladder and there was no blood."

"The muscles relax."

"Okay." Carvey let go and handed over the job of holding the mirror to Damirgang, "Mr. Edem, how do you feel now?"

"That's good! That's good!!!" Edm looked up at the ceiling contentedly, "This is really a wonderful experience, haha~~~ I must write it in my diary!" [ 4]

"No!" The old man shook his head slowly, "I can't see how boring the inspection process is."

Edm looked up to see the whole process clearly, but found that he could not see enough while lying on his back, and missed the opening scene.Just as he was about to yell for help, Herman brought a pillow and raised his head and back.

"Mr. Jacob is really amazing. In just a few seconds, he explained the details of the operation that I have been thinking about for three days." Carvey took the rubber tube from Bergett and slowly moved it along the body of the mirror. Put it in the bladder, and connect the syringe, "But I still want to ask one more question."

"It's like sticking a bayonet into a plank."

Carvey tried to ask: "Are the cystic organs still full after the urine is emptied?"

Before the others knew what Carvey wanted to say, Jacob and Mosier successively guessed the reason for doing so.

Before the curved cystoscope was made of spiral steel and 1936 lenses in 48, only rigid mirrors could be used clinically. 【1】

Jacob looked at him and asked, "Is that the reason?"

If the check fails, the push by Jacob alone is still limited.But if the examination is successful, coupled with the next operation, it will push the already top urology department in Vienna to a new level.

Of course, all this seems to be going well, but it all needs to be based on the results of the inspection.

"It's really uncomfortable." Carvey reminded again, "You will feel like you are being"

Erdem sat on the operating table in a hospital gown and asked, "Ether is the same thing as chloroform?"

A burst of lightning-like pain suddenly came from his lower body, and he couldn't help but tremble, and his body reflexively wanted to lean back: "This is really powerful, too powerful."

"It's so far away, I can't see clearly."

Carvey moved the mirror lightly, and said lightly: "I didn't see the tumor, maybe the distance of the mirror body is too long, or maybe the tumor is closer to the bladder entrance. However, I can clearly see the urine entering the bladder. The fluid was clean without blood, but the bladder that I had cleaned had bloodshot eyes."

"I understand." Mosier nodded, "I also think the location of the lesion is inside the bladder."

The step of informed consent was omitted, and Damirgang sterilized the cystoscope just now, and handed over the fully lubricated mirror to Carvey.

But considering Edm's age and status, he still hopes to persuade this very curious old French man: "For medical advice, I still hope to use ether anesthesia, which can relieve pain, as long as sleep It'll be fine once you sleep."

"No need!" Edm grabbed the bed sheet with both hands, and specially called Herman to his side, "Young man, hold my shoulder from behind. That's right, that's it, Dr. Carvey, I'm ready, bring it on!"

"Thank you. Ahh!!!"

Carvey stopped his hand. At this time, the mirror port has passed through the urethral bulb [2], and the sphincter is further down: "How? If you feel uncomfortable, you can also use ether now. I have the best in the world here. anesthetist."

"what is the problem?"

"I'm very happy to bring you a good memory." Carvey smiled and removed the cushion, and let him sleep peacefully before announcing to everyone, "Now Dr. Damirgon will lower the height of the cystoscope, and Dr. Bergett will Put fuel at the light source and light it."

"I really can't see it."

"Ok."

"Why do you have to open it?"

Rigid mirrors cannot be bent, and women will not be affected because the urethra is short and straight during the examination.But for men with a long and curved urethra, the straight hard mirror will make the examination extremely painful, which is thicker and more unacceptable than the previous urethral dilator.

Now that he has passed the prostate, Kavey no longer has the caution he had just had.Based on the principle that long-term pain is worse than short-term pain, the body of the mirror is further lowered to minimize the curve of the posterior urethra, and then the mouth of the mirror is pushed into the bladder.

"I can still see it clearly, it is indeed the same as what you said."

"Dean?"

"Don't ask, of course I support you."

Carvey let out a long sigh of relief, walked up to Edem, and said, "Mr. Edem, I think we need to discuss the timing of the operation."

(End of this chapter)