Chapter 186 183. "The Emperor" and his adoptive father

In the eyes of laymen, surgery may be a discipline that can cure diseases by hand, but only after entering this industry can you feel the feeling of powerlessness. Even in modern times, there are a lot of medical devices and a lot of drugs, but there are not many surgeries that can really make patients feel rejuvenated.

Many surgical plans will cause inconvenience in patients in life, and some will cause many complications, infection, bleeding, perforation of organs, weakening of functions, etc.

The reason why it is called a complication is that this is a postoperative condition that has little to do with the surgeon. Perhaps superb surgical technology can reduce the chance of occurrence, but it cannot truly reduce it to 0.

All doctors can do is to try to avoid risks before or during the operation.

The ventricular peritoneal shunt that needs to be done now is the choice Kawei made after weighing the pros and cons. Perhaps this choice is not good in modern times, but the options in the 19th century were really limited.

Ventricular peritoneal shunt is actually not a modern surgery. It is closer to the 19th century when tracing history [1]. However, in the diagnosis and treatment of modern craniocerebral trauma, it is still a commonly used intracranial hypertension treatment method.

This treatment method is a typical treatment method that does not cure the root cause, because it cannot remove the cause of cerebral edema, but simply reduces intracranial high pressure.

But for Mrs. Santini, that was enough.

The reason why neurosurgery chooses palliative care is largely because the nerve tissue is different from other organs. If you touch it too much, it will cause nerve damage. Even a small amount of bleeding can endanger the patient's life. It is obviously not worth the cost to cause greater trouble for a disease that can be palliative.

Medicine is not only about removing the pain, but also about making the patient live like a person.

This was especially true in the 19th century when technology was lacking and no means to save lives.

From a simple surgical point of view, if it is handed over to a senior doctor who specializes in mental surgery, the operation of ventricular abdominal diversion is not difficult and the process is not complicated. But now that the main surgery has fallen into Kawei's hands, the difficulty must be increased by a step.

The emergency surgery department has not had any neurological surgery. When encountering cranial and brain trauma, especially when the neurosurgery cannot tell too many people, Kawei has to come on stage. However, there is no knife in the Shenwai. Compared with other surgery departments, the fault tolerance rate here is very low. What you eat is not only the proficiency of the surgery and the ability to avoid risks, but also the extremely accurate operation technology.

The former can be made up with experience, but the latter is very practical.

Kawei's skill and proficiency will naturally not have any problems. Unfortunately, he has been away from the high-intensity emergency room for a long time and will definitely be unfamiliar with his hands, so he is not less stressed than Masimov at all.

This pressure will naturally be reflected in his expression, behavior and language, coupled with the rare quiet operating room environment, which makes him return to his original appearance in the emergency surgery department, the only operating room emperor.

"All surgical instruments must be strictly disinfected, and there is also a catheter. I will use this tube later, and the other end is to be stuffed into the patient's abdominal cavity."

"."

"No! All tube lumens must be disinfected, not only the surface, but also the inside, all must be disinfected!!!"

Although Kavi's voice was not loud, his temper was even more stinky than usual Masimov, and he didn't like anything: "Don't show the gaps in the gloves, wrap them tightly. Wear the mask and disinfectant, which is not enough. Take two more bottles! It's only been around ten o'clock, so I'm cheering up!"

Since entering the operating room, Masimov felt something was wrong.

Not only Kawei's temper, but also this weird craniocerebral surgery that is about to begin.

If cesarean section and breast cancer are the products of a flash of inspiration after the experience of their parents, appendicitis is the result of persistence, and hysterectomy + repair of surrounding organs is a collection of superb surgical techniques, then the current craniocerebrosine drilling seems very mysterious.

Because craniocerebral drilling is almost impossible to see in Vienna, in fact, not many surgeons in Europe are proficient in drilling, because it requires a bunch of patients who require drilling to practice for the doctor. In fact, this is almost impossible.

If he learned it from his father, then his father is so powerful and too invisible. Why have he never heard of such a character before?

Masimov has also discussed this issue with Ignaz, Olgi and Watman before.

There are indeed many famous surgeons in Lombardy, but I have never heard of anyone who is so proficient in abdominal surgery. Few people can do cesarean section. He also needs to have appendectomy, hysterectomy, bladder and ureteral repair and breast cancer removal. Now he also needs to have skull drilling.

Because I was thinking about Mrs. Santini's surgical treatment plan, I didn't feel very strong.

But when the surgical plan was determined and Kawei entered the surgical theater, he looked like a doctor with decades of surgical experience directing his assistants to do things, the indescribable sense of separation became more and more obvious.

Who is his father???

A surgeon specializing in abdominal surgery can still think of the diversion after the craniocerebral borehole. Is there such a powerful guy in Italy???

The last neurologist who was familiar with Masimov was a French doctor Sharco, but his research was limited to peripheral nerves. For example, hysteria, muscle atrophy, multiple sclerosis, tremor paralysis, etc., did not reach the level of the brain. [2]

If it has something to do with your brain, is it that Broca?

He is a surgeon and has dissected many brains, but the other party is an authentic French graduated from the University of Paris. Moreover, the scope of surgery he is proficient in is actually similar to that of Watman, and is limited to the maxillofacial area. Maybe he will have some gynecological operations, but Masimov is very clear that he will not have abdominal surgery at all [3]

No, it's Italy, his father is Italian!

Judging from the way Kawei is so familiar with the brain, he can rely on many anatomists. After all, he is an adoptive father, so it is normal for him to have fluctuations in his age.

The Lombardy region of Italy is indeed the first to study and establish psychiatry and neurophysiology. Milan, Naples and some surrounding areas have built asylums. [4]

Could it be Lombroso? [5]

I have indeed cut a lot of brains and have done a lot of research on brains, but I remember he was only 30 years old. Maybe he looks quite young now, but 17 years ago he was only 13 years old and was still in middle school. How do you adopt Kawei??

etc!

The razor used to shave in Masimov's hand became slower and slower.

Why don’t I think about Lonbrose’s teacher?

Who are there?

Morseli? People are in Naples.

Bifi? I was in Pavia last time when I met him, so I probably wouldn't go to Milan.

Bellingerry? Alas, poor Bellingerry died 18 years ago.

Who else???

By the way, the one who proposed the name of the ventricle seems to have some research on the stomach.

Masimov knows many Italian surgeons, but there are too many people, and some names may not be remembered. Among these people, none of them seem to have studied the brain and are proficient in abdominal surgery.

However, this is not the strangest.

What Masimov couldn't accept the most was that he read a lot of medical books related to his brain. No matter whose books it was, surgical treatment for headaches was basically only one step, which was to drill holes to release stress.

He didn't know why he had to use a tube to diversion after drilling, and he didn't know why the diversion must enter the abdominal cavity.

There is indeed some fluid in the ventricle of the brain. Removing these fluids can indeed reduce intracranial pressure, but is it necessary to do this level of surgery? And can this kind of diversion liquid be really done by surgery?

He had a headache thinking, and felt that he would become crazy if he pursued the operation and Kavi's adoptive father's name.

"Teacher Masimov, what's wrong with you?"

Only when facing Masimov did Kave realize that he was still an ordinary surgeon, not the former director of emergency surgery: "The surgery is almost ready, let's start."

"Oh." Masimov carefully shaved off Mrs. Santini's last strand of hair, "Just shaved it all, right?"

"Um"

Kawei looked at his bare scalp and soon discovered the temporal bone on the left. The naked eye can see that this bone under the scalp is different from the skull in other places. The tumor not only squeezes brain tissue inward, but also erodes the outer temporal bone outward.

Masimov also saw Kavi's prompt and found the place: "Is this?"

Kavey nodded, but said nothing, but came to Mrs. Santini with a smile and comforted her: "Madam, the operation will be completed soon, and the headache should be better at that time."

"real???"

Santini has been tortured by a headache for a week, and her spirit is on the verge of collapse. What tortures her even more is the fear of the mental hospital hidden deep in her mind: "They all say I'm crazy, I really can't control myself, I don't want to go to the Crazy Tower." [6]

"Don't worry, I won't send you there."

"If it doesn't work, I'll tell me earlier, I really don't want to live anymore. It hurts so much!"

"It's okay." Kavi knew it wasn't good, "Give me an hour, and it's over."

"good"

Amor was not around, and Kawei was worried about the nurses and assistants here, so he had to do it himself: "Including the anesthesia time, the operation may take more than 1 hour. Everyone cheered up and could go home early to rest after it was over."

Kawei has always been a director of surgery who loves teaching. Although his attitude is not very good in the face of these "students" in front of him, he still hopes to give these people more knowledge and learn more about craniocerebral surgery.

"First of all, before the operation officially begins, we still need to understand the basic anatomy of the brain." [7]

Kawei asked them to prepare an anatomy picture in advance, hang it in front of the operating table with a blackboard, and said while doing anesthesia: "The inside of the craniocerebral is not completely substance, but has a certain cavity. This has been confirmed and named by many anatomists, which is the ventricle. The ventricle is brain (spine) fluid, which is also the goal we need to divert this time."

While speaking, Mrs. Santini had already fallen asleep

"Give me carbolic acid and alcohol, I need to disinfect my wife's body." Kawei took the disinfection bowl and wiped her head with a stained cotton cloth. "This operation has a very wide range, and the disinfection range must be fully covered from the head to the abdomen" [8]

In addition to disinfection, the operation preparation also has towels. Unfortunately, St. Mary's Hospital does not have disinfection sheets from the Municipal General Hospital. In order to prevent infection, Kave could only operate directly on Mrs. Santini's head after disinfection.

However, before operation, the patient's eyes and ears need to be protected from slipping, bleeding, splashing bone meal or other accidental damage to the eye and ears.

"Give it, scalpel."

Masimov took a box of drills and took Kavi's help [9], and asked, "In the past, they only had a craniotomy, why did it take so much trouble to do so many links this time?"

"The headache is due to high intracranial pressure, and the method is to open a hole to release intracranial pressure." Kavey took the scalpel and first marked the back corner of Madame Santini's occipital bone with a quill [10]. "But after drilling open the head, many problems will arise, such as the most common infections and brain tissue that bulges outward due to pressure."

Although Masimov is skeptical about the infection, many surgeries of Kori have begun to try to disinfect them completely.

What does it mean to just bloated brain tissue?

“This is actually easy to understand.”

Kawei put down the quill, cut a 3cm cut with a blade, then pressed the drill bit to the marking position, and began to choose the drilling angle: "The brain tissue is like a very loose meat paste. It was originally wrapped in a cloth bag, which is quite good. But now the pressure of the cloth bag increases. Once a gap is made in the bag, what will happen?"

".The meat paste will be squeezed out by this pressure."

"That's right."

Kawei held the skull drill in one hand and carefully pressed on Mrs. Santini's head with the other hand, and began to hold her breath and force as if she was opening a hole for the coconut green: "Once it is restricted, the brain tissue will naturally be pressed outward, and the patient's nerve function will definitely be damaged at that time."

This is actually a heartless saying, because in this era, no one knows what functions the brain has.

The first doctor to clarify the functional division of the brain was German neurologist Brodmann. The partition time was in 1909, also known as Brodmann partition. Kawei must have known this partitioning method, which is the basis of the foundation, but he did not know the time.

In the middle and late 19th century, the brain partition was replaced by the 42 partition of the skull, which is phrenology. [11]

However, Brodman's brain partitioning was not achieved overnight. His achievements were based on the brain theory of many anatomists and surgeons. Among these people, one's name suddenly jumped into Masimov's mouth.

"This is also taught by your adoptive father."

Kawei was stunned for a moment, not taking this seriously, and nodded without thinking too much: "Yes, he has had experience in drilling and has tried it."

Masimov suddenly interrupted him and asked, "Is his adoptive father not Verga?" [12]
Chapter completed!