Nineteenth Century Medical Guide

Chapter 296 292. Seeing is not necessarily believing
The operation just now made Kawei show good theoretical knowledge and surgical ability, and he gained a firm foothold in front of several surgeons in the main palace hospital.

He also had some reflections on not being able to see the bleeding location at the beginning.

In radical gastrectomy, spleen injury does exist, but the probability is not high, accounting for 20% of all iatrogenic injuries.With the further development of radical gastrectomy and the addition of laparoscopy, the chance of spleen injury is further reduced.

In fact, in the era he traveled through, the chance of spleen damage caused by total gastric resection in junior high school was already very low, and it would be dealt with immediately.If you add in the partial distal gastrectomy performed by Cedieu and did not perform splenic lymphadenectomy, the chance of splenic injury is even lower.

After all, total gastrectomy + splenic lymph node dissection is the risk factor for intraoperative spleen injury.

But even if the location of the bleeding is found now, and it is known that something went wrong during the dissociation, it is still too early to perform gastrectomy for the current level of surgery in Paris.

This includes overthrowing the entire surgical process and preparing brand-new surgical instruments, as well as highlighting many surgical details, making good drug reserves, monitoring vital signs, and blood transfusion.Only by doing these things well can there be a chance to try gastrectomy.

The massive bleeding during the operation is vivid. Even in modern times, radical surgery for gastric cancer is by no means a completely safe operation.

So at the postoperative discussion meeting, Carvey didn't make many suggestions.

Firstly, he hoped that they would focus on the returned bed 97, and secondly, the news brought by Edward's sudden visit surprised him a little.

"Is the war over?"

"So you don't know either."

Edward laughed a few times, and finally got a lot of balance in his mind, so he simply changed the question to a more suitable question for Carvey: "How is the Main Palace Hospital? It's not worse than your Municipal General Hospital, is it?"

"That's natural, the surgery in Paris has developed better." Carvey generously admitted the gap, of course not because of his magnanimity, but because he is confident enough, "But if you only look at the surgical technology, there is still improvement. Space."

Edward is well aware of Kavey's strength, and has no objection to this: "I heard that the obstetrics department won't give you surgery?"

"I'm not too sure either."

"Don't worry." With the backing of Nasan, Edward spoke with more confidence, "I will put pressure on the obstetrics department and try to arrange the cesarean section this week."

"You're not going back to Vienna? Didn't you agree to leave tomorrow?"

"That was before coming, now the battle is over"

Edward only went through a cutscene in the main palace hospital. After learning that Carvey had stabilized the scene, he felt a lot more confident, and returned home with peace of mind.

Carvey didn't leave so quickly. The post-operative discussion was over at five o'clock, followed by the night rounds that belonged only to the main palace hospital.Because of the arrival of Carvey, the focus of night rounds is also very clear, that is, the four beds 13 (hemorrhoids), 24 (bladder stones), 62 (sebaceous cyst), and 97 (appendicitis) given by Cedieu.

"Bed 13 is a patient who came two days ago. Hemorrhoids are a bit serious and have affected the defecation function." A young surgical intern reported, "I have been using enemas for the past two days, and the results are good. The surgery is scheduled for the day after tomorrow."

Cedieu nodded and looked at Carvey: "Doctor Carvey should be able to perform hemorrhoid surgery?"

"No problem, as long as he really has hemorrhoids." Carvey said, "I personally have a question mark on the diagnosis of hemorrhoids."

Cedieu frowned: "You don't think so?"

"The patient has never had this kind of situation in his statement, but recently he has had constipation and bleeding, and the symptoms are very atypical. If possible, I would like to have an examination." Carvey took out a glove from his pocket, " After all, other things can grow in the rectum besides hemorrhoids."

"Other?"

This time the questioner was replaced by Peon, the bed doctor standing behind the intern doctor: "It's not that I haven't checked his gang door, there are indeed serious hemorrhoids outside."

"But hemorrhoids don't cause serious excretion problems." Carvey pointed to a passage in the medical record, "Here it says 'four days of unresolved stool'."

"That's because he didn't have an enema," Paion explained.

"Can't defecate without an enema?" Carvey just thought it was funny,

"."

Carvey put on the gloves he brought, and told the patient to lie on his side. Before the other doctors delivered the gang expander【1】, he applied an enema with grease on his fingers.Under the surprised expressions of other French doctors, they slowly stuffed it into the anus of the 13-bed patient.

"If it's just a simple problem of hemorrhoids, it should feel like a tender growth with high mobility and no severe pain. Old man, open your mouth and breathe, don't hold your breath, yes! Take it easy."

"I'm relaxing, but it hurts a bit."

The old man enjoyed the enema very much, but he still resisted the intrusion of hard objects: "I don't think so. Hiss, hey, it hurts!!!"

Carvey quickly withdrew his strength, but did not pull out his fingers. Looking back at several French colleagues, he shook his head and said, "The tumor is too hard, and its mobility is also very low."

This is indeed not a characteristic of hemorrhoids. Even a French doctor in the 19th century who knew little about tumors at least knew what hemorrhoids felt like: "Could it be a tumor? No way, hemorrhoids can be seen in the mouth of the gang."

Carvey has long been used to them openly discussing tumors around patients, and the low average life expectancy makes tumors look nothing terrible.

"If Dr. Peon doesn't believe you, you can try it yourself." Carvey performed a systematic anal examination on the anatomical structure around the rectum. There is no cord, the tenderness is strong, the lumen is narrowed, and the prostate gland is enlarged, but it is not serious."

Compared with noble physicians, surgeons are vulgar but still care about their own cleanliness, and are still resistant to digital examinations.

In their cognition, as long as they use the magnifying glass + speculum to see the internal situation clearly, there is no need to use fingers.But after seeing Carvey doing this, Cedieu had to admire the young doctor's decisiveness.

Counting the postoperative discussion just now, he has already unconsciously leaned towards Kavey's judgment, and he seemed a little angry at his student's failure to detect the tumor: "How did you do the inspection? When you saw hemorrhoids outside, you just directly Judging that the tumor inside is also a hemorrhoid?"

"I did expand and check, it shouldn't be a tumor."

Peon took the dilator [2] from Cedieu, took another candle, and opened the patient's gang door again: "There is indeed a tumor inside, but the surface is smooth, and it looks congested. Then count the The external hemorrhoids at the mouth of the gang, how could this be cancer?"

"In medicine, seeing may not be believing." Carvey still wiggled the index finger he used just now, "Surgery should be based on touch."

touch
All kinds of dilators were invented because he was unwilling to touch them, but now that he has seen them all, he still needs to use his fingers to check them, Paion's heart is filled with reluctance.It's a pity that he can't decide this matter, the chief director's order is above all else: "Pione, try."

"Teacher, I"

"Doctor Carvey has tried everything, what are you afraid of?" Saidie said, "He is the baron of the Austrian Empire, isn't he more noble than you, a commoner?"

Paion was forced to scratch his head, and in the end he could only take the pair of gloves with some yellowish-white mucus and a little blood stains from Kawi's hand, and then stuffed his fingers into them.

Once he accepts this inspection method, regardless of his personal disgust, Paion can still feel the advantages brought by the sense of touch from a medical point of view.There is no need to consider the lighting, and there is no need to repeatedly change the viewing angle to carefully judge the boundary of the tumor, and there is no need to worry about missing some subtle mucosal changes.

Because this kind of subtle change appears to the naked eye, it is easy to distinguish in the sense of touch.

"Ah, it hurts, it hurts to death!"

"It's really hard, and the border is not as smooth as I saw." Paion pulled out his finger, asked Albaran to bring the glass slide, and carefully wiped the mucus from the glove on it. No tumor cells could be found."

"Okay." Albaran dipped a piece of paper next to the glass slide, marked the bed position, and then quickly ran to the microscope room.

The problem with the diagnosis made Cedieu very embarrassed. After Paion finished the finger examination, he also stepped forward to try it. From the touch alone, he could basically judge that it was a tumor. At least he had never seen such a hard one. hemorrhoid.

"I'm really sorry, Dr. Carvey, to make you laugh."

"Originally, the disease is not static, and it is normal to make mistakes, which is why we insist on ward rounds."

"That's what I said, but forget it." Cedieu felt that it was not very meaningful to repeatedly review the mistakes he had made. "If it is really rectal cancer, then I have to be the chief surgeon of the operation. Dr. Kawei , if possible, I hope you can be my assistant."

"no problem."

After getting an affirmative answer, Sedijo took out a small notebook, wrote down the experience of the ward rounds just now, and told the surrounding doctors: "This is Paris, the main hospital, and the surgical center! We should not make mistakes! In the future Whenever it is necessary to check the ganglia and rectum, in addition to the enlarged gangster inspection, a digital examination must also be done."

Being able to make changes immediately made Carvey admire his work attitude very much. If possible, Carvey really wanted to give him some positive feedback.

It is a pity that among the remaining three patients given, the proportion of misdiagnosis is still very large.

"The 24-bed patient, male, has frequent urination, urgent urination, painful urination, and difficulty urinating." This time, the doctor in charge of the bed was replaced by the first assistant, Ju Yong, and directly stuffed the medical record into Kavey's arms. "I don't think it looks like bladder stones. I still need to do a bladder exploration to confirm."

If it is a serious bladder stone, you can touch a hard mass by palpation from the abdomen. Even if it is a little smaller, you can use bimanual palpation to touch the stone after emptying the bladder.

It's a pity that Ju Yong has done it, and the 24th bed does not have these signs.

"There are no signs, but you still wrote about bladder stones."

Although Cedieu is the chief director, the Department of Urology has been separated from the Department of Surgery, so he was not as strict as he was with Paion when he asked: "Do you have any evidence?"

"I didn't find any stones by palpation, and the patient didn't have hematuria, so I tried to observe his urination." Guyon explained, "He does have interruptions in urination, which indicates that the stones in the bladder are more active and will follow. Sudden obstruction of the bladder neck and urethra due to a change in position."

This is a key point in the diagnosis of bladder stones. Although it is of little significance in front of modern imaging, it was one of the few important signs that could diagnose bladder stones at that time.

"Interrupted urination can indeed be diagnosed." Cedieu glanced at Kawei and asked, "What does Dr. Kawei think?"

Carvey always felt that something was wrong, because the stones that could block the urethra would never be too small, and the patient was thin, so he should be able to feel it by palpation.I asked him a few more questions casually, and the answers were very perfunctory. No matter how I looked at the patient, he was not a person who was willing to communicate with other people.

"There's nothing much to ask. I've already asked some questions. He doesn't want to talk too much, and he doesn't have family members to accompany him. That's the only way to go." Ju Yong was also very helpless, and wrote down the time of urethral exploration in the medical record. "There are 97 surgeries scheduled in the morning, so he will tentatively schedule them tomorrow afternoon."

Carvey didn't want to waste time on this kind of examination that everyone would do, but now that the obstetrics department doesn't let go, it's good enough for Cedi Yoken to provide patients.

"Ok."

Compared with the first two patients, the diagnosis of bed 62 is basically clear, it is sebaceous gland swelling, and it is not difficult to do it.Even Cedieu directly decided to remove him from Kawei's operation list.

"The last one, bed 97." Paion brought the medical records, "The second day of lower right abdominal pain, the diagnosis is appendicitis."

The girl in bed 97 is going to be much more normal, at least her parents are by her side, and she is not in a state of being unable to communicate.

"How do you feel?" Carvey asked this time.

"It's okay." The girl was very shy, covering her stomach with her hands, and she seemed to be fine. "It hurt for a while, but now it's getting better."

It's a pity that this sentence didn't get her mother's approval: "Don't be kidding, I was sweating from the pain just now, and my mouth was still screaming in pain, why did it suddenly recover? Are you sure?"

"But I'm really well now." The girl's face was pale, and she pressed her stomach tightly with both hands, and retorted, "There's nothing to lie about!"

Carvey has already seen some tricks. Whether it is the location of the pain or the abnormal behavior of the girl, it should not be explained by appendicitis: "I need to do an examination to confirm the diagnosis. Just lift the clothes to expose the stomach."

The girl's parents didn't understand, and asked, "Didn't the diagnosis be made yesterday? Isn't she appendicitis?"

"That can only be regarded as Dr. Peon's suspected diagnosis, and we will make adjustments based on follow-up examinations." Carvey stood beside the girl with a smile, rubbed his hands, and explained, "The examination is very convenient, just a few presses Down my stomach, it will be over soon, it won't be too long."

(End of this chapter)