These days, Kawei’s focus is on experiments, and he wants to get experimental data as soon as possible to support his own medicine before Nora’s cesarean section. But he has not ignored the patients in the ward, and he is there every day during ward rounds.

, and the postoperative observation has not stopped.

Of course, this is just observation.

Kawi has taken over or indirectly taken over five patients. Except for Laszlo, who has completely recovered, and Morazo, who has improved a lot, the only ones left to rest in the ward are Eston, Mrs. Gale and Alphonse.

The sutures were removed from Mrs. Gale's lip seven days after the operation. The wound has already healed, but it will take some time for the swelling to completely subside. Although Alphonse's butt has not completely healed, it has grown well, at least not like other surgeries.

Later, the patient developed ulcers.

Ignatz has already discussed the idea of ​​a new cleft lip surgery with Mrs. Gale, and only needs to perfect a few details before it can be used on Mrs. Gale's children.

Among them, the most gratifying thing for Kawei is Eston. After half a month of rest, the swelling in his calf has subsided and the wound has healed well. Such long-distance and multi-needle sutures can actually maintain no ulcers. This was not possible in the 19th century.

It is unthinkable in the medical environment of the mid-life.

And Eston's fracture is also developing in a good direction.

There is almost no displacement of the fracture. From the appearance, both lower limbs still maintain symmetry, the broken ends should be well aligned, and there is no neuromuscular damage.

This means that as long as Eston continues to lie in bed for a period of time and insists on rehabilitation training, he will have a pair of calves as strong as other people of his age after he is discharged from the hospital.

At this point, Kawei has welcomed his sixth patient after time travel.

29-year-old Fernand is a butcher who sells meat. He has quite serious bladder stones. Not only does it cause severe pain, the huge stones also cause quite annoying urethral obstruction. The reason for seeking medical treatment is that he hopes to get rid of it once and for all.

A disease worse than death.

After a brief examination, Ignatz discovered that in addition to the stone symptoms, Fernand was also very dissatisfied with the appearance of the penis itself. This dissatisfaction gave rise to strong anxiety, which seriously affected his status at home and marriage.

happiness.

Ignatz still has a conservative attitude towards circumcision.

However, after considering hygiene reasons, he decided to comply with Fernand's wishes and made a complete surgical plan: first perform lithotripsy, and then perform further circumcision.

This slightly disrupted Kavi's pace.

Because intracorporeal stone fragmentation does not require body surface disinfection, it is enough to ensure that the instruments are disinfected. Circumcision requires very thorough disinfection, otherwise ulceration will occur in such a critical part, and the consequences will be disastrous.

And there is no need to bandage the broken stones in the body, but the bandaging after circumcision is very particular...

"Don't be too surprised. This is the preoperative preparation that my assistant Mr. Kawei has constantly improved. Before, he used alcohol and alkali soap, but now he has added a more special thing, bleaching powder. In addition, there are also

Gauze cooked at high temperature, cotton bandages, and ointment used to cover the wound after surgery."

What Kawei brought into the surgical theater was a complete set of medicine bottle boxes and dressing storage boxes [1].

In addition, just like the laboratory, he also brought several wash basins to hold disinfection supplies.

There were many medical students and surgical colleagues in the theater, and handwashing caused a lot of discussion. But after Ignatz described the current conditions of the five patients, regardless of whether they had any grudges in their hearts, they finally chose to remain silent.

"I don't think the circumstances of these five patients are a coincidence."

Ignatz also followed Kawei's example and disinfected his arms in turn:

"This is very rare in surgery where the chance of wound ulceration exceeds 50%, even to the point of being almost abnormal. Especially the recovery situation of Count Morasso's inguinal hernia surgery, it is difficult for me to use one or two words to describe everything these days.

If there are any changes, I will publish an article related to this surgery in the Vienna Medical Journal.

Before that, I still hope that you can show as much scientific curiosity and desire for exploration as possible, and be more encouraging and tolerant of this young man's attempts to actively explore the boundaries of surgery. After all, science is full of chance, but once chance becomes inevitable

, which will take surgery to a deeper level."

The effect of disinfection, coupled with the new cleft lip repair procedure that was sent before, earned Kawei the endorsement of Ignatz.

With his endorsement, Kawei’s own weird disinfection method was completely recorded in the record books by many viewers. Of course, many people will put a question mark next to it, and there will also be people who directly put a cross, but in the spirit of black

Red is also the principle of red, and being remembered is a kind of progress.

Apart from being a bit pungent, alcohol and bleaching powder didn't have much disadvantages. They made some complaints before entering the actual surgery.

“Since the 18th century, surgery has made amazing progress, surgical methods have been constantly innovated, and surgical instruments have been constantly updated.”[2]

Ignatz took out a set of surgical instrument boxes related to the urinary system [3], opened the flip cover, and took out a long curved tube [4]: ​​"To deal with huge bladder stones, we have been using methods that were still popular in the 18th century.

Lithotomy, from the early lithotripsy more than 20 years ago, can now achieve precise lithotripsy..."

"Teacher, can I ask a question?"

"Excuse me."

"What method was used in the early days of gravel crushing?"

Ignatz smiled and shook the metal urinary tube in his hand, "It's just to rotate the tube at high speed and use the hard end to knock the stones that are more brittle in comparison. The process is painful, but it's better than nothing."

Lithotomy under anesthesia is much better."

"That's it?" The student put his hands together and made a gesture similar to a spinning bamboo dragonfly.

"Yes, rub it quickly and repeatedly to make the curved end swing."

"..."

"It was indeed a bit rough, so we quickly came up with a new method, which I will describe in detail later. For now, let's help Mr. Fernand guide the urine that has been stored for most of the day...

..”

Kawei lifted up Fernand's baby, and Ignatz slowly inserted the catheter into it: "When using this kind of catheter, you will definitely encounter resistance from the urethral wall. At this time, you can consider

Use an ointment mixed with essential oils to lubricate the wall of the tube, which can reduce resistance and damage to the urethral wall."

While talking, the front of the catheter encountered some resistance.

Seeing this, Kawe straightened the baby as much as possible to reduce the bending of the urethra. With the lubrication, the resistance was quickly overcome and the tube entered the bladder smoothly.

Ignatz looked at the gurgling yellow urine and couldn't help but said: "Although Mr. Fernand has already fallen asleep, I still have to congratulate him here. The catheterization went smoothly and no bladder puncture was needed.

"【5】

Fernand's urethral obstruction lasted for a long time, and the urine output should have been more than 1,200 ml.

In the 19th century, there was no limit on the amount of urine that could be catheterized [6]. Carvey also knew that once the bladder bleeds, it would be regarded as inadvertent bloodletting, which would become an advantage in the process, so he did not say much.

"Very good, bleeding after catheterization." A smile appeared on Ignatz's lips, "The operation went very smoothly, and God is also helping Fernand."

Kawei took out the urethral dilation tube that he had found from a device company to make from the side (see 17-2): "Teacher, No. 6?"

"If it's not enough, just give me the biggest one."

Ignatz smiled and took the No. 12 dilation tube and continued: "Although the original plan is lithotripsy, in order to be responsible for the patient, we still need to try to remove the stone first. If the stone is really too big,

We will choose lithotripsy as a last resort, after all, broken stones can cause damage to the urethral mucosa."

In fact, urethral dilation is inherently an injury. Due to the inflammatory response after injury, this type of dilation will only aggravate postoperative urethral stricture.

Fernand may have developed a stricture first because the inflammatory reaction caused by the urinary tract infection stimulated the urethra. The narrow urethra would further put him in a state of chronic urinary retention. Over time, the urine retained in the bladder formed

A large number of crystals formed and finally condensed into stones.

But there was no way, Kawei couldn't tell Ignatz so many truths that he couldn't understand on the operating table, so everything had to be done slowly.

Remove the stone first [7], and if it becomes narrow later, we will talk about it later.

However, the stone removal process was not smooth. Even with the thickest No. 12 dilation tube, Fernand's urethra still could not bear the huge size of the stone, and in the end the stone had to be broken up in the bladder.

Depending on the size of the bladder stone, the instruments used for lithotripsy are slightly different.

If it is a small stone, there are lithotripsy forceps [8] in Ignatz's box. Because the jaws need to be opened before they can be used, there are certain restrictions. If it is a large stone, the jaws of the lithotripsy forceps are not large enough.

You need to use some big guys.

Without B-ultrasound, no one could estimate the size of the stone. Considering that large instruments would cause certain trauma to the urethra, Ignatz chose to use forceps first.

It has to be said that Kawei's homemade ointment helped a lot during this operation. It was repeatedly inserted in and out of the already narrow urethra without causing much resistance, and Ignatz used it very smoothly.

This smooth feeling will be fed back to the surgeon, making him more relaxed and the surgery will become more comfortable.

"Kavi is ready, help drag the two little things...Okay, I seem to have caught one, it's quite big." Ignatz's posture was like pinching briquettes, with both hands

He held the handle of the pliers tightly with his hands, and heard a crisp sound as the jaws closed, "I'll look for anything else, and crush these small ones by the way."

Kawei knew very well that if it was just a small stone, it would not be enough to make Fernand suffer so much.

If Ignatz could do some palpation of the lower abdomen with his hands, he should be able to estimate the size of the stone, but unfortunately he did not. Like those physicians, Ignatz also regarded it as a good idea to try not to touch the patient before surgery.

The standard of a doctor’s superb skills.

He prefers direct observation to touching with his hands, so this kind of "downgrading" thing still has to be done by Kawei: "Teacher, his bladder is so hard."

Ignatz looked up at Kavi, and his hand "happened" to be placed on Fernan's lower abdomen: "Can you feel the stones here?"

"I don't know if it's a stone." Kawei gave up his position and gave a gift in return, "It just feels different from a normal person's lower abdomen. After the teacher said this, it does feel very similar."

This remark was suspected of being flattering. Although it was of no use, Ignaz found it helpful.

After the bladder is emptied, the shrunken bladder wall wraps around the surface of the stone. With a little force, the stone can be felt. The volume has exceeded the clamping range of the lithotripter forceps, unless the urethra can be dilated to the thickness of two fingers.

"It's too big... It's better to replace it with a new set of gravel crushers."

What Ignatz is talking about is a fixed pressure crushing device. Unlike the transverse force exerted by lithotripsy forceps, this device exerts longitudinal pressure on the stones. Because the force is longitudinal, there is no need to expand the urethra.

, but the source of power is slightly different from that of gravel pliers.
To be continued...