Chapter 135 132. A good pair of guys

When Kawei saw the pair of slightly bulging things on Fernan's chest, he felt a strong sense of intuition.

However, you can't see the problem by just looking at it. Fernan's chest-holding posture on the bed is not conducive to judgment. If you want to be clear, you have to straighten your body, which makes it more intuitive to look at it, and you can further rely on palpation to make differential diagnosis.

Of course, this is a very personal matter.

The two plains suddenly protruded into small hills, which would definitely attract many curious eyes. Fernan looked very relaxed and even had bladder stones willing to go to the surgical theater for lithotripsy, but hesitated when facing them.

He looked at the patients who had lived with him for so long, and was really embarrassed: "Doctor Kavey, what's wrong?"

Kawei knew he was in a dilemma: "Let's tie the button first."

"It's not obvious after the operation. I thought it was just a side effect after the operation, so I didn't take it seriously. I thought it would be better in a few days. But so many days have passed, and they have become louder and louder," Fernan suddenly lowered his voice and whispered, "The feeling of pinching it is the same as that of a woman."

The interns on both sides were surprised when they first saw it. After he mentioned it, he couldn't help laughing.

"Is this funny?" Kavi turned around and said to them, "You can retract these two pieces of flesh by laughing? Don't think about what you are!"

Both of them were rich young masters in formal clothes. They looked one or two years older than Kavi, but there was no room for refutation in front of the other side. Before they passed the medical school graduation assessment, the hospital internship obeyed: "Teacher, what should I do next?"

Unlike other hospitals, the Municipal General Hospital has many patients and many poor people, and there is no curtain in the bed room, so there is no privacy when doing a direct examination. Fernan's situation is special and he can walk or run, so Kavey simply took him to the examination room.

Judging from the shape, there was obvious hyperplasia on his chest. But he was not fat himself, so this thing should not be as simple as fat.

Because men's ru atrial suspense ligament is not well developed, the sudden growth of breasts in a short period of time will pull the skin down [1].

Just now, Fernan was holding his chest, his vision was narrow, and he couldn't see clearly. Now when he stood up straight and unbuttoned his shirt again, everyone except Kawei couldn't help but exclaim: "Good guy."

Not only do they expand outward, they even sag a little, and Kavi can basically be a male breast hyperplasia.

"Mr. Fernan is 26 years old?"

"Yeah, it's 26."

Kawei nodded, basically excluding physiological hyperplasia [2], and the next step is pathological hyperplasia. The fundamental reason is the disorder of sex hormones in the body, and the ratio of androgen: estrogen decreased. It may be that there is less secretion of androgen (gao pill), or there may be more estrogen (adrenal glands), or less estrogen inactivated (liver).

If you want to dig deeper into the root of the disease, those are the ones that meet Fernan's situation, the most likely one is liver problems after drinking a lot of alcohol.

But now there is no blood or imaging examination, so there is no way to make a judgment, so I can only do a physical examination first.

"It's very soft, without nodules, it should be all the glands of the breast." Kawei said to the two interns behind him while doing palpation, "Do you know all the breasts?"

"Yeah, I know, I've taught it in anatomy class."

"This is the abnormal hyperplasia of male breasts. It is rare in normal times. You can try it too."

Kawei gave up the examination position, and Fernan's two hands on his chest turned into four hands: "Use the belly of your fingers to feel it, slowly in the order I said, looking for small nodules or other tumors. If a female patient seeks treatment, this method must be used to determine whether it is a nodule or tumor." [3]

Fernan felt very uncomfortable: "Doctor, what are you doing?"

"Teaching hospital, bear it, it will be fine soon." Kawei continued to explain the key points of the palpation, "After touching the hard object, you must check its size, texture, whether it can move, whether the edges are smooth, and ask if there is any tenderness. Oh, by the way, please bring a nurse with you during the examination."

The two interns were very studious and the entire examination lasted for 3 minutes.

When Fernan buttoned his shirt again, he asked, "What should I do now?"

"Take off your pants first."

“???”

"Hurry up."

Fernan really doesn't understand why the above is bigger and needs to be checked below, but since they are all men and doctors' requests, there is no time to worry about it. The results of the examination were expected by Kawei, and the size and shape of the two-sided gao pills are fine: "It seems that the problem is the liver." [4]

Fernan pointed to his upper right abdomen: "Mr. Alphonse often talks to us about his liver, and I heard that it can be compared with the most plump foie gras."

"This is not a good thing." Kavey picked up the medical record and made some records.

"That's right, I feel disgusted when I think about my internal organs being similar to the food on the table." Fernan said so, but he was still curious, "Is my liver the same as his?"

Kavey stopped writing and explained, "If his foie gras, then his lemon should be similar to black bread."

“???”

"You've drunk too much."

"It's okay." Fernan didn't think there was any problem with drinking. "Sadimo and Laguret next door drank much better than me, and they didn't see them like this."

"Come on, touch my stomach."

Kawei signaled him to lie on the examination bed, bent his legs, put his four fingers together with his right hand, and palpated with the ends of the middle fingers: "Inhale, inhale, continue inhale. OK, now exhale, exhale, slowly exhale and then inhale." [5]

Decades of clinical experience allow him to feel the texture of the liver through simple touch. This is not the feeling that a normal liver should have [6]. Fortunately, there is no mobility voice or drum sound, and there is no effusion in the abdominal cavity.

"Doctor, how about it?"

"The liver is a bit big and the texture is a bit hard," Kavey said, "but it's softer than the black bread I just mentioned."

"That's all right?"

Kavey sighed. Considering the current medical level [7], he really couldn't tell the truth about early cirrhosis: "It can be said that, it's not easy to cure it. If you want to live longer, I still hope you can quit drinking."

"How can that work!"

"If it doesn't work, I won't cure you little thing. You'd better ask Gao Ming." Kavey pointed to his chest and said, "But I think there are not many doctors in Vienna who can completely cure it."

“Can’t it be cut off?”

"Yes, just cut it off together." Kawei shook the quill in his hand. "If it is not cut properly, a large piece may be dented. If it is infected and ulcerated again."

Fernan was very concerned about his appearance, and when it came to this point, he had completely cut off other thoughts: "If Dr. Kavi could really remove them and not affect their original appearance, I could try to quit drinking."

"It's not a try, you have to quit now!" Kawei's attitude was very firm, "There is no rush to surgery. You have just completed the lithotripsy and need to rest for a while. Wait for another half a month and wait until your physical strength recovers."

"Ah? Have to wait?" Fernan was in a dilemma. "If it grows, the clothes will be almost impossible to stop them."

Kawei really admired his courage: "Don't want to wait? Then don't blame me for dying on the operating table."

"Okay, wait a little longer."

"I'll write you a date. Pay attention to their size. If there is any further change, come to me." Kawei wrote a few precautions into notes and handed them to his hands. "Remember, don't drink anymore."

Fernan should be caused by liver damage caused by alcohol. The liver is hard but it does not become smaller but increases a little, which is caused by early cirrhosis.

Of course, these are all information brought by palpation, and they are not considered real diagnosis. All Kawei can do is to urge him to drink less alcohol. In fact, even if it is really clear that it is a liver problem, he does not have medicine in his hands, so treatment is almost impossible.

All Kawei could do was minimize his pain.

Relying on quitting alcohol to delay liver damage and removing those two annoying little things is a way to improve his quality of life. However, it is not easy to quit drinking, and family needs to work together. Unfortunately, he has never seen Fernan's family before.

After the rounds, Kawei went to see several women who needed to have a cesarean section. One of them was approaching the due date and the operation time was set the day after tomorrow.

It was still early to leave the hospital, so he did not rush to go home, but went to see Laslow first.

After learning that the war between Pu'O had begun, this Hungarian rich businessman had been dealing with Franz, hoping to quell the war with his own strength. For a businessman like him, although war can also be profitable, it is far less comfortable than usual.

He was optimistic about Prussia before, but now that he has learned about Austria's preparedness, he feels that Austria's chances of victory should be greater. Once the Prussians and Austria wins, the Austro-Hungarian line that had previously matched the team will go from equal talks between the two places to Hungary's counterattack, which is very unfavorable to Hungary.

If Hungary does not agree to the conditions, the merged talks agenda will be put on hold indefinitely.

Because the Austrian Emperor is more willing to advance westward to achieve substantial German unification rather than playing a small game of eastward expansion with a group of foreigners, the merger of Austria-Hungary is a helpless move to maintain the image of a great power.

"War is probably inevitable." Laslow slept on a recliner, enjoying the spring sunshine, "You should have received the Count's order."

Kawei stood aside, drank the milk tea that the butler had just delivered, and nodded: "In a few days, I have to report, write a name, and then be familiar with some internal rules of the military doctor. I don't know when I have to follow you."

"I guess it's July and August." Laslow sat up, "if Chino could be more powerful, the time could be delayed until September."

"I don't know how many people will die, but it would be great if I didn't fight."

"It's hard." Laslow sighed, "We can't decide the development of things. At this point, it depends on who will take action first. All I can do is to suppress Franz's hand so that he doesn't rush to take action."

"Not to talk about this for now."

Kawei came here not to talk about the Pakatan Harapan War, but to his own surgery and scientific research: "You recommended my rubber factory before, can you make gloves?"

"I asked, there is no big problem." Laslow also took a sip of milk tea, stood up and moved his shoulders, "It's just that rubber is very expensive, the original cost is not low, plus the shape you want."

"Money is not a problem." This time, Kawei used this sentence, "As long as the quality is passed."

Laslow smiled: "I didn't expect that there are people who use rubber as gloves. What do you want to do?"

"Rubber gloves are convenient for disinfection and cleaning. With the same disinfection and cleaning process, rubber gloves are definitely cleaner than hands." [8]

"I don't understand the medical treatment. I will definitely help you with the gloves you want." Laslow began to get into his own topic. "The previous patent has been approved, and the pharmaceutical factory has started construction. It is expected that sufficient oxytocin will be produced in April."

Kavey nodded and looked at Laslow who was looking at him: "Well then?"

"And then? And of course it's your blood anticoagulant." said Laslow, "You don't think our pharmaceutical factory only makes this one medicine, right?"

"I said the anticoagulant after the operation, and it needs some technical support to use it."

Laslow finally revealed the nature of a businessman: "What I want is to make money. Since I have helped you open a pharmaceutical factory and have met so many conditions for you, should you speed up some progress here? Time doesn't wait for anyone, my Dr. Kave."

Kawei understood what he meant: "The paper is already rushing, and I will translate it into texts from several countries and submit it to some medical journals."

"No, not enough!" Laslow reminded, "How much time will it take to go back and forth? When your method is spread in the medical community, the war will be over long ago."

"I know there will be no news in a few months, and it depends on luck to be favored by journal editors, so I thought of another good idea." Kawei gently tapped the small wooden table beside the two of them with his fingers. "Since war is inevitable, since there will be major casualties in the war, and I have been summoned to be a military doctor."

Laslow frowned slightly and immediately understood the meaning of Kavey's words: "You mean to rely on war to use autologous blood transfusions and then sell the anticoagulant to Franz?"

"When I go back, I will write a plan for autologous blood transfusion and send it to the Military and Political Department as we report it." Kawei said with a smile, "This is a good thing that can save a large number of wounded people in the empire, and it can also inject a considerable amount of funds into our small pharmaceutical factory."

Laslow raised his milk tea cup and finally smiled at the corner of his mouth: "It's indeed a good thing, a great thing!"
Chapter completed!