Chapter 148 145. Clean incisions and uterine prolapse

If we look at infection from a macro perspective, it is an endless bloody battle between the human immune system and the army of microorganisms. Every immune cell and every complement protein are charging forward for this war, and microorganisms will continue to die to seize the human body.

As Kavi's first cesarean section woman and his first surgical patient, Nora enjoyed the benefits of preoperative disinfection. After the operation, her incision was very clean, and her body's immunity was suppressed by her body's immunity.

There are too many factors that can influence the outcome of perioperative infection.

Nora's ending is related to the operation. The operation time is very short, and there is not much bleeding during the operation. The process is turbulent, but it is all under the control of Kawei. The smooth operation + disinfection + Nora's own body is healthy enough, which is the result of an incision without infection.

In comparison, the situation of the peasant woman is completely different from hers.

First of all, the peasant woman's weight increased after pregnancy and was obviously obese. The abdomen where the incision was located was the worst hit area for her fat accumulation. As long as there was a slight infection, fat liquefaction would definitely occur after the abdominal surgery. [1]

Secondly, the trauma of this operation was much larger than that of Nora at that time. The abdominal incision was large enough and the operation time was longer. Not only did the ureter be broken, the bladder was ruptured, and the fracture after the hysterectomy was also connected to YD.

The most important thing is that there is still a lot of bleeding.

Although the blood was re-entered from the rubber tube into her body, she could bring back some bacteria and microorganisms after staying outside the body for a while.

Moreover, the large amount of blood is a real lack of immune cells, which can be refilled through manufacturing in the future. But now it is the first day after the operation, and it happens to be stuck in the window period, and the infection should have occurred.

Based on her pelvic basis of chronic gynecological diseases, even if she has preoperative disinfection and clean rubber gloves, the sections off the section should not be so clean during the operation. After all, this is a dirty surgical theater, and the doctors around the operating table do not wear masks.

It’s not that Kavi didn’t believe in Orgi’s judgment, but that he didn’t believe in his eyes, and even his own eyes couldn’t believe 100%.

On the first day after the operation, microorganisms invaded the body less than 24 hours. If there is an infection, it has just begun. It is not so serious that it can be seen clearly on the surface of the body. Perhaps the infection is hidden in deeper tissues, but it has not been revealed.

At this time, you need to gently squeeze the skin around the incision to see if it seeps out below the tissue

There is nothing.

Kawei pressed the skin, and his fingers felt only the negative pressure drainage tube hidden under the skin, and there was no soft feeling after infection.

What's going on???

"She urinated very smoothly and there seemed to be no sign of urine leaking in her abdomen."

Orgi thought Kavi came here to care whether the ureter suture was smooth. At least there was a metal tube inside, and anyone would be worried. But Kavi only thought about the incision, as if there was no chance of failure in ureter suture: "Doctor Kavi, what's wrong with you?"

"Oh, nothing." Kawei looked at the peasant woman in good condition and asked Orgi, "I want to see her medical records."

"Medical records, get the medical records."

Kawei rescued his serious injury, and the soon-to-be-failed surgery was also the one that Kawei saved. Olgi had no airs of director in front of him. For both public and private, he hoped to find the key to success from Kawei: "Remember to bring her previous medical records in gynecology."

Kawei's judgment was not wrong. The peasant woman had many symptoms of gynecological infection three years ago: swelling, pain, itching, and increased secretions.

The doctor prescribed some herbs, vegetable juices and intermittent hydrotherapy [2], but it may be because of problems with the use method, or the belief is not pious enough, and the inflammation of the peasant woman has not been cured.

Seeing this, Kawei had to sigh that such a reproductive organ did not cause the fetus to have a miscarriage was also said to be lucky, but even the membrane was not broken before the operation, which was simply a miracle. [3]

"Doctor Kavey, is there anything wrong with her medical record?"

Of course there are problems, a lot of problems! In his eyes, such simple diagnosis and treatment records cannot be considered medical records at all.

Kavi smiled and shook his head: "No problem."

"She was seeing a famous gynecologist in our hospital." Olgi explained, "Maybe the treatment methods prescribed will have some differences in the effectiveness, but his diagnosis ability is first-class, and the conclusion will definitely not be wrong."

"So it was caused by her inconsistent life?"

Olgi nodded, pulled Kavie into the corridor and whispered: "Although the patient has always denied that this happened, who knows the facts? The newborn child doesn't look very much like her husband."

The hat of "indiscretion in life" is indeed heavy and is a defilement of chastity for any woman.

But Kawei had no mind or energy to change the diagnosis conclusion, because the gynecologist's judgment on "infection" was not wrong. It was indeed a "harmful substance" in the environment that invaded the peasant woman's body that caused these symptoms.

What he wants to know most now is the reason why the infection did not affect the incision of the surgical procedure: "Her condition did not improve before the operation?"

“Always like this.”

"Doesn't that mean that these treatments are ineffective for her?"

"It can't be said to be invalid," Olgi explained. "At least she lived to be pregnant and had a child, at least she has lived to this point and has not deteriorated further. Based on my own experience, her body is recovering."

Kawei listened to this passage and didn't know what to say, so he could only continue to move the topic to another surgical incision: "By the way, how about the suture mouth in YD?"

“The stump is pretty good too.”

"Not even there."

Kawei fell into deep thought and really couldn't understand why this happened.

Having handled so many cesarean sections of women, Kawei also had some understanding of the physical condition of these poor women.

If the peasant woman had a good body like Nora and could fight infection, the infection in the pelvic cavity should not have been postponed to this day and would have returned to normal. But if the body's resistance was worse than that of Nora, the surgical incision would not be so beautiful.

These two are contradictory in themselves, what is the problem???

Kavey pointed to the signature on the medical record and said, "Dr. Olgi, I would like to meet this gynecologist if I can."

The infection cannot disappear for no reason. Kawei did not use any special means during the operation, and preoperative disinfection was limited to the body surface, so the problem should be before the operation. However, Kawei did not see any problems in the medical record, so now we can only ask about the formulas of those herbal medicines.

"Herbs?" The gynecologist named Besim was making a pessary for uterine prolapse in his office. "The ones you asked were bought from the medicinal shop, nothing special."

"What drugs have you put in specific?"

Seeing that he was a fellow traveler and Olgi brought him, he was not shy about the effect of the herbs itself: "I don't know how to do it, but the ingredients should be calendula, burdock and some chrysanthemums. I remember these. As for whether they added ingredients in it, I don't know.

Anyway, many patients think it works after taking it, as long as the patient thinks it works."

“It really works?”

"Of course, some patients will be cured by drinking three bottles of lower abdomen. Some secretions can be cured." Besim's tone of affirmative opening and closing low, and soon softened. "But the medicine still depends on people, and some patients are not so effective."

Kawei looked at the small medicine bottle he handed over, which contained a slightly orange-red potion. He intuition told him that the color was not simple: "Can I buy a bottle?"

"Just give me money, 3 kroner a bottle." Besim suddenly thought of something and looked up and asked, "By the way, where are you from? Why are you so interested in gynecological medicine?"

"He is Kavi, Dr. Kavi Hines." Olgi introduced with a smile, "Gynecology and obstetrics are originally a family, and I should have read the report."

"Oh, it's Dr. Kavey." Besim put down the tools in his hand, stood up and shook hands. "Everyone around him said you were very young, but I didn't expect that you would be so young when you saw you today. It's rare to be proficient in cesarean section at such an age. Compared to this, my student is far behind."

Perhaps due to deviations in gynecology concepts, Besim still classifies gynecology in the category of internal medicine, and diagnosis and treatment are mainly based on medication and some strange therapies.

On the contrary, the student he mentioned had thought about using surgical methods to treat some gynecological diseases that could not be cured by drugs.

"The child Denefer likes to make some novel things. He has just graduated from medical school and has not learned the basic knowledge of medicine."

Olgi had an impression of the young gynecologist: "You mean that Belgian boy? I still remember him. A week ago, I went to me to ask some uterine anatomical questions, saying that surgery should be used to treat uterine prolapse."

Besim sighed and shook his head: "I felt strange when I heard this idea, so I didn't agree to him."

"Haha, no wonder he came to me to have the opportunity to dissect the body, saying that he only touched the uterus and not other organs." Olgi had a good impression of him, "If it weren't for the preparation for the cesarean section, I might have really given the body to him."

"It makes you laugh."

"I heard that he has always had good academic performance and loves gynecology, so he will definitely become a good doctor."

"Oh, I hope so. In fact, if no one was willing to do gynecology, I wouldn't have recruited him as a student."

Strictly speaking, Denever and Begter are graduates of the same class. They followed Besim to study gynecology from their master's degree. The most researched in the doctoral stage is uterine prolapse. This may not be common in modern times, but it was a common disease in the 19th century. [4]

The solution is nothing more than a pessary to hold the loose and fallen pessary. The effect is limited, but at least it can prevent the cervix from being exposed.

Besim was willing to follow this concept of treatment, but in Denef's eyes, doing so would not cure the root cause. Looking at the women in the ward who were suffering from uterine prolapse, he was eager to find a good solution once and for all.

I have to say that he has good surgical thinking. Since taking medication cannot be treated and pessary care only delays the development of symptoms, he starts with the anatomy. He found that it may be that the broad ligament on both sides of the uterus caused the uterus to prolapse. If a part of the loose broad ligament is cut off, the falling uterus may be able to lift up again.

After having this wild idea, Denever thought about this surgery.

This idea took shape during the doctoral stage and was opposed by almost all gynecologists, including his teacher. However, these opposition voices failed to dispel his idea. Finally, after watching Kawei's cesarean section, he completely strengthened his determination to take action.

Besim looked up at the time: "It happened that the two of you are here today. Should you go see his surgery together?"

"Surgery? What kind of surgery?"

“Uterine prolapse repair.”

"What? Dr. Besim, aren't you kidding? Did you really let him go for surgery?" Orgi smiled and praised him, but he certainly felt that it was inappropriate when he really came to this point. "Surgery is not kidding. Every surgeon needs to go through long-term and arduous training, not to mention that this is a complicated open operation."

"I know"

"Didn't you just say you didn't agree? Why did you agree again?"

"He has practiced on the sow more than a dozen times, and he has had two chances of dissection on the body, and the results are pretty good."

These are just Besim's excuses, and the real reason is that Denefer's determination also inspired his desire to cure the disease: "He has been discussing the possibility of uterine prolapse surgery with me since he graduated, and spent so much time practicing, and it was impossible for me as a teacher to dispel his enthusiasm."

"Anatomy is dissection, surgery is surgery, it's different."

When Olgi saw him looking at Kavi, he immediately said, "No, Dr. Besim, Kavi is different. It is difficult for such a surgical genius to appear in the whole of Austria and Europe."

Besim has made up his mind that as the chief physician of the gynecological ward, he has the right to make this decision.

He looked at Kavey and Olgi and knew that the opportunity was rare: "Both doctors had successfully undergone cesarean section and were very familiar with the anatomy around the uterus and the attachment. If possible, I hope to invite both to watch this broad ligament shortening surgery for the treatment of uterine prolapse."
Chapter completed!