Nineteenth Century Medical Guide

Chapter 417 413. Can you slow down?

Once both parties have the desire to trade and clearly know what the other party needs, the entire conversation process will become much smoother.

Kavi naturally had no attachment to the bodies of the experimental dogs, and he disposed of them harmlessly after the experiment. Not to mention just one, as long as Hag asked, it would be no problem to give all the dog bodies to Hag.

Finally, under Kavey's promotion, Hager ordered two more dogs. As for whether the final specimen work would be named "Traces of Genius", that was not Kavey's concern.

All he cared about was getting a few more blood vessels from Fernan's body in return.

The Natural History Museum closed at 18:30 in the evening.

The museum staff used a specimen transfer pulley to pull Fernando out of the carbolic acid. It took Kavi 20 minutes to remove a whole abdominal aorta and two common carotid arteries from Fernando's abdomen and neck.

Then, Hag used the prepared oil-based label paper and thumbtacks to mark the cut locations with numbers.

The next day, three new explanations of the symbols appeared in the column of explanations of the number labels that were originally arranged in order. Hager did not give any explanation, and the administrator of the venue also did not know anything.

Although only a small number of people noticed or cared about this, and the vast majority of customers came to visit out of curiosity and did not care about what the specimens themselves had experienced, the sudden changes still caused quite a stir.

Many newspapers and magazines focusing on biology and nature reported on this. The Paris Medical Journal even put this news and Bertha’s physical condition together on the front page. [1]

In addition, reporters from several local newspapers also paid attention to this matter. However, since the opening of the World Expo, Paris has been full of various strange stories and there is really no spare space to digest them.

In comparison, it is the media professionals who have no pressure to submit articles who are more able to grasp the key points.

"Paris newspapers are all mediocre, reporting all kinds of rubbish! What about the masterpiece of the Anglo-American Transatlantic Cable Company, the efforts made by the Egyptian crown prince to develop cotton cultivation during the American Civil War, and even the model of the workers' housing can be used to fill an entire page!!!"

Varela was so angry that he dropped the newspaper in his hand with a look of disdain: "If you have this spare time, you might as well keep a close eye on Kavi and do a series of surgical reports. When he is on the operating table, I will watch him connect the contents of the previous reports one by one, and see the stunned look on the world's face. Just thinking about it makes me feel good."

"This is Paris, and it's during the World Expo. How could they leave space for serialization? If there was such a grand event in Vienna, would you give up so many exhibition halls and only care about Kavi?" Greg, who was sitting across the table, took a sip of coffee and shook his head slightly. "This coffee is still not as good as the one in Vienna. It always feels a little off."

"You can't say that. You have to look at what kind of surgery Kavi had." Varela picked up the glass of milk. "The diameter of the abdominal aorta is almost as big as this glass."

"Times have changed, Mr. Varela. Put aside your surgical concerns." Greg pushed the medical journal in front of him. "Professional matters should be reported by professionals. After all, we are laymen."

Varela picked up the medical journal, glanced at it, and put it back.

He couldn't help but raise his hand to unbutton his shirt collar, letting the cool breeze of early summer in Paris blow into his body, and then put the remaining half of the croissant and the coffee into his mouth: "I have finished taking the photos of the specimens that the newspaper wants. Where are we going next?"

Greg adjusted his glasses, put the photos, manuscripts and postcards into an envelope, and then put them into the suitcase. Then he unfolded the map of the World Expo and chose a pavilion he had never been to: "Let's go to the Arc de Triomphe first. I heard there are a lot of interesting things there, and then go to the American Pavilion."

"Okay, let's go quickly."

Contrary to popular belief in the media, Cavi's large blood vessel transplant experiment had already begun as early as the early morning of June 6, when the first batch of experimental dogs were sent to the medical school.

The experimental method drew on the experience of many predecessors, including the animal artery transplantation experiment conducted by French surgeon Jabré in 1896 (failed); the dog vein transplantation experiment conducted by French doctor Gluck three years later (failed); the autologous vena cava transplantation in dogs successfully completed by Austrian surgeon Gutareff in 1908, as well as a large number of animal large blood vessel transplantation experiments conducted in China over the past fifty or sixty years.

These are all the things Kavi remembers about vascular transplantation. Later, autologous and allogeneic vascular transplants were gradually replaced by artificial blood vessels that were constantly improving.

Before starting the experiment, you need to decide on the preparation method.

Cavi lived in the 19th century, when science and technology were backward and without the experimental conditions of his predecessors, blood vessel preparation and preservation became extremely difficult. Many preparation methods that had been used in history could not be implemented, and they had to be modified and tried one by one.

There are two commonly used methods for blood vessel preparation and storage. One is soaking in solution reagents, and the other is rapid freezing and low-temperature drying.

Refrigeration technology is just beginning, and it is too backward. The process is complicated and the temperature does not meet Kawi's requirements. Because of the lack of major antibiotics (penicillin + streptomycin + first-generation cephalexin + metronidazole) in the solution soaking, Kawi can only add several more solvents that can block bacterial infection on the basis of retaining the original maintenance solution, and try to find the most suitable one.

Originally, formaldehyde was also a good choice. 1867 was the year when German chemist Hoffmann invented the artificial synthesis of formaldehyde, but it was still some time before formal industrial production.

Therefore, the reagents used in the final preparation were paraffin oil, high-concentration ethanol, and the same serum maintenance solution mixed with methylene blue for antibacterial. Compared with formaldehyde, anhydrous ethanol, dry ice, and weak alkaline antibacterial maintenance solution, these can only be regarded as crude versions.

That's why he needed Fernan's blood vessels as a reference to see the possibility of carbolic acid, and also to see if the blood vessels after being soaked for so long could still be a substitute for transplantation. After all, there is immune rejection, and even if the antigens are processed cleanly, xenotransplantation is still a bad choice.

In fact, the effect that the preparations used are intended to achieve is nothing more than keeping the intercellular matrix from being changed or denatured, while maintaining a sterile state to prevent infection after transplantation and affect the service life of the blood vessels.

实验预计进行约50次血管切取手术，样本数量在150-200之间。每一种制备方法需要分成3天后、9天后、15天后和60天后四种，分别进行血管移植。待血管移植成功后进行临床观察，然后分批在术后1、3、5、7、9、11及一年以上予以处死，最后对血管移植后组织变化进行切片观察。

“Here’s the record sheet.”

"Why are there only three?" "Storing for two months means that the first experiment will be in three months. I am not naive enough to let Besagan wait for three months before the operation. At least such a naive idea should not appear in the current experimental plan. The blood vessel samples that have been stored for two months will be stored for now and recorded separately later."

Kavi continued, "There is also a postoperative complication observation record form. When filling it out, write down the time of surgery. New situations may arise in the experiment at any time. If necessary, you can make modifications at that time."

Savarin, who was in charge of the experimental dogs, nodded and said, "What about the death records?"

"It's the same as always. If someone dies during surgery, you can draw up a record." Kavi briefly thought about the possibilities. "Generally, it's death during surgery, severe postoperative thrombosis, hemorrhagic shock, peritonitis, pulmonary embolism, mesenteric embolism, lung infection. About these."

Everyone took notes and the first batch of dogs were sent to the operating table.

Blood vessel extraction is much simpler than the subsequent transplantation operation, but it still needs to be performed as sterilely as possible. In order to reduce the impact of external factors on the experiment, Holt had to ask the University of Paris Medical School to clear the top floor of the laboratory building and give the entire floor to Kavi. One of the laboratories was converted into an operating room, and entry required changing into clean clothes, a hat and a mask, which was more stringent than the operating theater.

"I will not be involved in removing the blood vessels. You guys can do it." Kavi briefly introduced the process. "After bleeding to death, remove the entire aorta, peel off the tissue around the blood vessels, rinse the tube with saline, and keep the side branches for a while. Then cut it into 5cm small sections and immerse it in the preparation reagent."

"understood."

从6月5日上午开始，直到6月7日卡维拿回费尔南的动脉标本，实验小组已经完成了178份血管样本收集。它们被细分成了16个小组，按照制备储存的时间长短顺序分别进行实验。

Early in the morning of June 6, Kavey began the first allogeneic dog abdominal aorta transplant surgery.

The operation was not easy. Dogs are much smaller than humans, and their blood vessels are much smaller. The surgical approach was through the flank, and the field of view was much smaller than that of humans. Of course, the most critical point was that Kawi needed to make his experimental team members learn this operation.

A total of 178 blood vessel samples means 178 blood vessel transplant operations. Even if Kavi was a robot, he would be exhausted.

However, Koch, Savarin, and Orbach were not good at surgery, and being assistants was already their limit. Fortunately, the young doctors and medical students designated by Hott were already in place, and Peon and Albaran from the Hospital Main would come to help during breaks. Of course, it was Landreth who completely relieved Kavi of the pressure.

"Dr. Landreth, I didn't expect you to come." Kavi quickly asked Albaran to give up his position as an assistant. "It's much easier to teach you than to teach them."

"I have never done experiments on dogs, so I am not very familiar with dog anatomy." Landreth finished the preoperative preparations and walked onto the operating table. "But I know the general techniques. Give me two tables to warm up my hands."

"no problem."

The surgical anesthesia is very simple, just ether anesthesia. The surgical incision is a paramedian incision on the left side of the abdomen, with a length of about 10cm.

The operation is mainly fast, and the trunk skin muscles, external oblique muscles, internal oblique aponeurosis, internal oblique muscles, and transverse abdominal muscles are incised to quickly enter the abdominal cavity.

The intestines are then pushed toward the right upper abdomen, and the retroperitoneum is divided to expose the renal and common iliac arteries.

The abdominal aorta is between these two main branches.

Free ligation is used to cut off the surrounding small branches, and the upper and lower ends of the abdominal aorta are clamped with vascular clamps to temporarily cut off the blood flow. 2-4cm of the aorta is cut off and then replaced with the standby blood vessel stored in the preparation reagent. The cut aorta can be put into the preparation reagent bottle and become a new experimental sample.

"It is important to note that the caliber of the transplanted blood vessel should be as consistent as possible with that of the recipient blood vessel. A transplanted blood vessel with a caliber that is too large will cause a tumor-like bulge, and a caliber that is too small will cause anastomotic stenosis, neither of which is a good thing." Kavi quickly performed an everted continuous mattress suture on the posterior wall of the blood vessel. "Doctor Landreth, do you understand?"

"Yes, I understand."

"That's good. Cut the thread." Kavi asked Landreth to cut off the silk thread soaked in paraffin oil and continue suturing the anterior wall of the blood vessel. "After the suturing is completed, we need to trim the edges to reduce the formation of blood clots in the blood vessels. Doctor Landreth, what's wrong with you? Keep cutting the thread!"

"Oh"

For Landreth, the problem of large blood vessel transplantation only comes down to two points: one is the method of blood vessel preparation, and the other is the technology of large blood vessel anastomosis.

The former is a textual description that anyone can remember after reading it once, or at least copy down. The latter is a real technical experience. Even if you have seen the process and learned the operation techniques, it is not so easy to become proficient. Moreover, suturing itself has a lot of complications. If the suture is not tight enough, it will leak blood. If the suture is too tight, it will cause stenosis of the lumen.

He came here this time just to learn the technique of vascular anastomosis.

In the past, it would not be too difficult for him to learn with his surgical talent. If one machine didn't work, he could use two or three. Once he learned it, he would just practice a lot and develop muscle memory.

But now that Kawi had undergone several similar operations, he could sew up the blood vessels faster than before. Landreth couldn't even distinguish the anatomical structure of the inner and outer membranes of the blood vessels, and the suturing was almost complete.

  How to learn this?

"Can you please slow down a bit?" Landreth knew it was awkward to say this, but after much hesitation, he still spoke out his grievances. "This is my first time suturing a large blood vessel, and it's a dog's abdominal aorta, with a bunch of organs and tissues around it. How can I learn from your fast needlework and help you share the pressure of the experiment?"

"Every second counts, Dr. Landreth."

Kavi didn't even wait for him. He slowly loosened the vascular clamp and made a simple peripheral exploration when he saw that the anastomosis was fine. Then he handed the abdominal closure to Albaran: "Today's goal is to complete 11 operations. If you want to go home and sleep before 0: tomorrow, you have to hurry."