Chapter 157 154. The question and answer time begins

The dietary structure of the peasant woman who had a cesarean section did not change during the year, and her family also lived with each other and ate the same food. The only difference from her family was that she received herbal treatment from Gretz Hospital, and then she became pregnant + cesarean section.

The medical history given by Besim and Orgi did not mention the specific symptoms of peasant women, but the "efficacy" of herbal medicines exists objectively.

Kawei had just seen the patient in the morning. Her body had recovered completely, and her previous symptoms had almost disappeared. This can be explained by the fact that it was free from the source of herbal poison, but it was too outrageous to have no infection in the incision. I had thought before that it was a certain operation in the operation that solved the infection, but Kawei never dared to believe it.

Now he realized that he had overlooked an important surgical step: staining.

Kawei was doing pathological slices in his hand and thinking about the entire operation process in his mind.

The entire operation is divided into two parts.

The upper part is a cesarean section. From the surgical incision, the child’s delivery to the hemostatic operation, it is exactly the same as Kawei’s requirement. The liquid used is normal saline, the anticoagulant used is bought by Kawei Pharmaceutical Factory, and the oxytocin used is also bought by Kawei Pharmaceutical Factory.

The lower part is hysterectomy, and the main surgery is Kawei. The equipment used has nothing but a copper tube. The only thing that can be considered variable is dyeing.

Speaking of dyes, we actually have to start with the fact that Orgi was seriously injured a month ago.

At that time, Orgi violated the principle of confidentiality of doctors and patients, causing death. In the incident, the woman's father opened a dye factory. From the reaction of the man who broke up, it can be seen that the dye factory is quite large, and this bottle of blue dye was written by a young man in the factory.

As far as Kawei knows, there are two types of blue dyes that can relieve the symptoms of poisoning in clinical practice.

One is Prussian blue, which treats heavy metal thallium poisoning.

Kawei has studied chemistry in university textbooks for the 19th century and knows that thallium has not been discovered yet. Without discovery, there will be no industrial application, so the chance of heavy metal poisoning in herbs is very low. Moreover, the symptoms of peasant women are also somewhat different from thallium poisoning, which lack neurological symptoms such as numbness in limbs.

The other type is methylene blue, which is treated with nitrite poisoning.

Nitrite is very common, usually produced after green plants decay, and it is normal to appear in herbs. However, Kavi has no impression of whether methylene blue can be used for the treatment of antibacterial infection.

Because he had a long time in his work, there were many antibiotics, and not many doctors would learn how these antibiotics were invented.

Kawei is also pragmatic and is not interested in history. The only antibiotic history I have been exposed to is penicillin from World War II. But even if I have been exposed, I still look at the degree of introduction. I only know that the inventor is Fleming, and I don’t know the rest of the date and passage.

Now that compounds that may inhibit infection have appeared, we must seize the opportunity and conduct sufficient experiments to verify.

"It is worthy of being the operating room of the Municipal General Hospital, and there is a complete set of specimen making materials hidden."

Koch was very familiar with pathology and specimen production. He had already taken out the fixative solution, slides, dyes, paraffin, wax molds, alcohol lamps and microscopes from the cabinet. He waited for Kawei to hand over the cut gao pill tissue to him for fixed dyeing, embedding and sectioning: "Doctor Kawei? Doctor Kawei, what's wrong with you?"

"Oh, nothing, I'm just thinking about the specimen."

Now, after all, during the operation, Kawei put the dye aside for the time being, took out the Fernan medical record that he had prepared before, and gave a brief description of this gao pill [1].

Then the few parts of the sample materials that had just been cut were handed to Koch: "This is the tissue of the gao ball itself - specimen 1, next is the tissue of the tumor - specimen 2, and then the slices at the two intersecting positions - specimen 3."

"There are even specimen descriptions and numbers." Koch was very excited. "I have seen many surgeries and have never seen such detailed treatments as Dr. Kavi treats specimens."

"Can the pathological specimens be done?"

"Yes, I used whiskey as fixative liquid in the laboratory, and the color was a bit weird, but now it seems that I don't need it." Koch looked at a bottle of transparent liquid with the words [alcohol] at hand. "With a higher concentration of disinfectant alcohol, it looks more reliable than amber wine."

"It's not just the color, this bottle of alcohol has a higher ethanol concentration and better fixation effect."

Koch nodded, remembered the things he learned in his heart, and asked again, "What is this bottle?"

Kawei looked at another bottle of solution marked with [xylene] and said, "This is the transparent agent I also found in the dye factory for microscopy, which can quickly bring paraffin into tissue cells. You first fix it with alcohol for two minutes, wash it, dye it, wash it water, then use xylene, and finally use paraffin molds to embed it." [2]

Pathology has gradually shown signs of clinical diagnosis from the development of the last century to its current level, and more and more surgeons have begun to use pathological examination results to judge the type of disease.

Especially when encountering tumors, the special mutated structure of tumor tissues and cells can easily make conclusions.

Of course, due to the limitations of the production level of pathological specimens, it is also necessary to see the cells in the specimen clearly. The cutting plane is not neat enough, the tissue section is not thin enough, the staining is not sufficient, the staining is too heavy, the dehydration is not enough, the fixation is not enough, etc. can all affect the imaging of the specimen under the microscope.

Watman was a little surprised: "Can this thing bring paraffin in quickly?" [3]

"right."

Three other chief surgeons, including Masimov, were also surprised: "There is such a good thing?"

It is quite difficult to master advanced surgical pathology. Ordinary doctors only know that they need to do pathological sectioning. The production process is often to cut a small piece of tissue and then try to cut it thinner. What can be observed depends on the knife skills.

However, human hands must have limits, and the human body tissue is very soft. It is no problem to cut a small piece with a knife, but if you cut it into a thin slice and maintain the arrangement between cells, it is an impossible task.

That's why paraffin embedding is found.

It takes time for general paraffin embedding to penetrate into cell tissue. If time is not enough, the central area in the center of the specimen tissue will often become very messy under the cutting of the blade.

And the xylene discovered by Kavi seems to solve this problem perfectly.

Xylene is dissolved in ethanol and paraffin. After dyeing, it can quickly enter the tissue and bring out the remaining ethanol. Then, the paraffin added on the outside is brought in to support the specimen tissue and ensure that there is no extrusion during cutting.

"If there is such a good thing," Oergi, who was sitting next to the operating table, couldn't sit still, stood up and walked towards the pathology preparation table, "Can you sell me a bottle?"

"Doctor Olgi is so impatient?" Kavi smiled and told Koch about the precautions when making specimens. He looked back at him and explained, "Is xylene used to wait for the specimens to see the effect together? If you feel satisfied, I will give monthly members a chance to buy them at a special price, and members who pay annual fees can receive a free bottle of gifts."

"There are actually discounts?"

“Is it still time to buy a membership now?”

More than ten years have passed since xylene was first discovered, and no mass production plan suitable for the current industrial production level has emerged. Even if it really appears, it is difficult to achieve mass production at the first time with Austria's low industrial production level.

In the 21st century, the basic materials sold were already seldom sold in the 19th century, but they could be sold for hundreds of kroners in less than 100ml.

Kavey was very generous, and at the same time he also hoped to take this opportunity to advertise his own pharmaceutical factory: "If you are interested in the xylene used in pathological sections, high concentrations of alcohol, dyes, oxytocin and anticoagulants used in surgery, you can go to the Karachi Pharmaceutical Factory located in Baden town in the suburbs of Vienna, with a large amount of more than 100%"

As the world-recognized father of microorganisms, Koch, who is about to graduate from a PhD, has very solid laboratory technical capabilities. He can do well whether it is fixation, dyeing or final embedding slices.

Even if it was the first time he bought xylene, he could quickly understand the use method and perfectly embedded this step into the entire specimen production process.

Kavey gave Koch considerable trust and handed over all the pathology work to him, while he took Amor and Herman to start the second round of surgery:

"The next one is a small incision bilateral mastectomy. In fact, the surgical effect is similar to that of ordinary breast cancer resection, but the incision is much more beautiful. The first thing we need to do is to determine the position of the incision. My choice is to make an arc incision below his bilateral head."

"Below your head? It's ruyun."

Corigo couldn't help but nod: "If you want to hide the incision in your wide chest, there will be only that place, just like two oasis in the Sahara Desert in North Africa."

"But the question is how to get it."

The operation is actually quite simple under modern electrocution operation. There is no large blood vessel involved in the middle. As long as it is normal, it is an outpatient surgery that only requires local anesthesia. After entering the era of minimally invasiveness, this small operation has developed into an Anke rotary incision machine [4], which no longer requires percutaneous scalpel incision.

Of course, even without such a machine, the operation can be easily completed with just some basic surgical instruments.

However, before the operation, Kawei still needs to explain it to them so that the operation can't be seen clearly if it is over too fast.

"Although his bilateral breast glands look obvious, with a diameter of about 10cm, it seems difficult to remove them. But we should note that even if the male breast glands are hyperplasia, they are very thin, and the arc-shaped incision next to your head is more like a small window, and the surrounding skin is elastic enough, so the operation is almost no difficulty." [5]

That's it, but when it comes to operation, there are still many details to pay attention to.

Small incisions will bring a satisfactory postoperative visual experience, but at the same time, small incisions will also cause a series of problems.

One of the most important questions is whether the blood supply of the head itself will be affected after cutting the skin below the head? How will the ruyun skin heal after excessive arc incisions be made? How to grasp the length of this incision?

Corigo Watman, who specializes in plastic surgery, has already thought of similar questions, and Kavi also answered them in a timely manner:

"We chose the incision below the head. In order to ensure blood supply, the incision length should not be greater than 1/2 of the turn." Kawei took the scalpel, put the knife at the position he said, and then said naturally, "When making the incision, we should choose the incision below the head, rather than the upper incision. Do you know why?"

Herman was stunned and looked at Amor beside him.

Amor is a newcomer and has just graduated from medical school. He didn't know that the operating table still needs to answer questions. He was a little overwhelmed: "No, I don't know."

"Herman, where are you?"

"I, I guess."

"Guess?" After saying a few words, Kawei had already made the incision. "I don't know if the others here know? Since it is a publicly displayed surgery, everyone can speak freely. It doesn't matter if they say it wrong. If they say it right, the full ticket fee for the surgery today is refunded."

Herman obviously didn't know the reason.

Because according to the direction of breast growth after hyperplasia, the operation of the upper incision is definitely more convenient, but Kawei still chose the lower incision. The only explanation is that the most important blood supply in the operation is the blood supply.

"Is it to prevent the blood supply of Ruyun from Ruyun's head?"

"Yeah, that's not bad." Kavey looked up at Koch, who answered the question not far away, affirmed his answer, but was still not satisfied. "But this statement is too big and cannot be considered an answer."

While speaking, Kawei had exposed the breast tissue under the incision. He used his left thumb and middle finger to pull the gland, touched the gap with his index finger, and slowly cut the surrounding fascia with scissors: "One side of the operation takes up to 20 minutes. After the operation is over, the question and answer will be over. Please seize the precious time."

[I just took a nap at night and my head was a little dizzy. I'll write this chapter when I eat something. I'll forgive me]
Chapter completed!