As soon as Kawei saw the pair of slightly swollen things on Fernan's chest, he felt a strong sense of sight.
But you can't tell the problem just by looking at it, and the way Fernand is sitting on the bed with his breasts in his arms is not conducive to judgment. If you want to know clearly, you have to stand up straight, which makes it more intuitive to look at, and you can further rely on palpation to make differential diagnosis.
Of course, this is a very personal matter.
The two plains suddenly bulge into a hillside, which will definitely attract many curious eyes. Fernand seems to be very open-minded, even willing to enter the operating theater for lithotripsy for bladder stones, but he still hesitates when faced with them.
He looked around at the patients who had lived together for so long and felt really embarrassed: "Dr. Kawei, what on earth is going on?"
Kawei knew he was in a dilemma: "Let's fasten the buttons first."
"It was not obvious after the operation. I thought it was just a side effect after the operation, so I didn't take it to heart. I thought it would be fine in a few days. But after so many days, they became bigger and bigger... ." Fernan suddenly lowered his voice and whispered, "It feels like a woman's when you pinch it."
The interns on both sides were surprised at first, but after he mentioned it, they couldn't help laughing.
"Is this funny?" Kawei turned around and said to them, "You laugh twice and you can make him shrink back? You don't even think about your identity!"
Both of them were rich young men in formal attire. They looked a year or two older than Kawei, but there was no room for rebuttal in front of each other. Before passing the medical school graduation examination, hospital internship means obeying: "Teacher, what should I do next?"
Unlike other hospitals, the Municipal General Hospital has many patients and poor people, and there are no curtains between the beds. There is really no privacy for direct examinations. Fernan was in a special condition and could walk and run, so Kawei simply took him to the examination room.
Judging from the shape, there is obvious growth on his chest. But he himself is not fat, and this pair of things should not be as simple as fat.
Because men's suspensory ligaments of the breast are not well developed, the sudden growth of the breast glands in a short period of time will pull the skin down [1].
Just now, Fernan held his chest in his mouth and his field of vision was narrow, so he couldn't see clearly. Now he stood up straight and unbuttoned his shirt again. Everyone except Kawei couldn't help but exclaimed: "What a good guy." ..."
Not only were they swollen and protruding outwards, but they even drooped a little. Kaki's instinct was that they must be male breast hyperplasia.
"Mr. Fernand is 26 years old?"
"Well, I'm 26."
Kawei nodded and basically ruled out physiological hyperplasia [2], followed by pathological hyperplasia. The fundamental reason is the disorder of sex hormones in the body, and the ratio of androgen: estrogen decreases. It may be that there is less secretion of androgen (gao pills), it may be that there is too much estrogen (adrenal gland), or there is not enough inactivation of estrogen (liver).
If we want to dig deeper into the root of the disease, those are the ones that fit Fernand's situation, the most likely of which is liver problems after drinking a lot of alcohol.
But now there are no blood or imaging tests, so I can't make a judgment. I can only do a physical examination first.
"It's very soft. There are no nodules. They should all be mammary glands." Kawei was doing palpation and said to the two interns behind him, "Do you all know the mammary glands?"
"Well, I know, I taught it in anatomy class."
"This is the abnormal hyperplasia of male breast glands. It is not commonly seen. Come and try it."
Kawei gave up the examination position, and the two hands on Fernand's chest turned into four: "Use the pads of your fingers to feel, follow the order I told you, and slowly look for any nodules." nodules or other tumors. If a female patient seeks treatment, this method must also be used to determine whether it is a nodule or a tumor." [3]
Fernan felt very uncomfortable: "Doctor, what are you doing..."
"Teaching hospital, if you keep patiently, you will be fine soon." Kawei continued to explain the key points of palpation. "After touching a hard object, you should check its size, texture, whether it can move, and whether the edges are smooth. You should also ask Is there any tenderness...Oh, by the way, please be sure to bring the nurse with you during the examination."
The two interns were very studious and the entire inspection lasted 3 minutes.
When Fernand buttoned up his shirt again, he asked, "What should I do now?"
"Take off your pants first."
"???"
"hurry up."
Fernand really didn't understand why he had to check the bottom when the top was enlarged, but since they were both men and it was a doctor's request, there was no time to worry. The results of the examination were as expected by Kawei. There was no problem with the size and shape of the gao pills on both sides: "It seems that the problem is the liver." [4]
Fernand pointed to his upper right abdomen: "Mr. Alphonse often talks to us about his liver. I heard it is comparable to the fattest foie gras."
"This is not a good thing." Kawei picked up the medical record and made some notes.
"That's true. The thought that my internal organs are almost the same as the food on the table makes me unappetizing." Fernand said this, but he was still curious, "Is my liver the same as his?"
Carvey paused and explained: "If his is foie gras, yours should be about the same as brown bread."
"???"
"You must have had too much wine."
"It's not bad." Fernand didn't think there was anything wrong with drinking. "Sadimo and Lagurete next door drink much more than me, and I haven't seen them like this."
"Come on, rub your belly for me."
Kawei motioned him to lie down on the examination bed, bend his legs, put the four fingers of his right hand together, and use the ends of the two middle fingers to perform palpation: "Breathe in, breathe in, keep breathing in... Okay, now breathe out, breathe out, Exhale slowly...come again, inhale..."【5】
Decades of clinical experience allowed him to feel the texture of the liver through simple touch, which is not what a normal liver should feel [6]. Fortunately, there was no moving dullness or drumming, and there was no fluid accumulation in the abdominal cavity.
"Doctor, how's it going?"
"The liver is a little big and the texture is a little hard," Kawi said, "but it's a little softer than the brown bread I just mentioned."
"That means it's okay?"
Kawei sighed. Considering the current medical level [7], there is really no way to tell the truth about early cirrhosis: "It can also be said that it is not easy to cure. If you want to live longer, you should still I hope you can stop drinking.”
"How can that be done!"
"If it doesn't work, then I won't treat you little thing. You'd better hire someone else." Kavi pointed to his chest and said, "But I don't think there are many doctors in Vienna who can completely cure it. .”
"Can't it be cut off?"
"Yes, just cut off the penis together." Kawei flicked the quill in his hand, "If it's not cut properly, there might be a big dent, and if it gets infected again... ..."
Fernand is very concerned about appearance. For this reason, he has completely given up other thoughts: "If Dr. Carvey can really remove them without affecting their original appearance, I can try to quit drinking."
"It's not about giving it a try, it's about quitting now!" Kawei's attitude was very firm. "The operation is not urgent. You have just completed the lithotripsy and you still need to rest for a while. Wait for another half month until your physical strength recovers."
"Ah? You still have to wait?" Fernand was embarrassed, "If it grows any longer, my clothes will almost be unable to stop it."
Kawei really admired his courage: "Don't want to wait? Then don't blame me for dying on the operating table."
"Okay then, just wait."
"I'll write you a date. You should pay more attention to their size. If there are further changes, come back to me." Kawei wrote a few notes into notes and handed them into his hand. "Remember, don't drink anymore." ”
Fernan may have suffered liver damage caused by alcohol. The texture of his liver was hard, but it did not become smaller but rather enlarged. It was an early stage of cirrhosis.
Of course, these are all information brought by palpation and cannot be regarded as a real diagnosis. All Kawei can do is urge him to drink less. In fact, even if it was really clear that it was a liver problem, he didn't have any medicine, so treatment was almost impossible.
All Kavi could do was minimize his pain.
Delaying liver damage by quitting drinking and getting rid of those two annoying little things is the way to improve his quality of life. It's just that it's not easy to quit drinking. It requires family members to work together. Unfortunately, he has never met Fernan's family members.
...
After the ward rounds, Kawei went to see several women who needed cesarean section. One of them was approaching her due date, and the operation time was scheduled for the day after tomorrow.
After leaving the hospital, it was still early, so he did not rush home, but went to see Laszlo first.
After the wealthy Hungarian businessman learned about the impending war between Prussia and Austria, he had been dealing with Franz, hoping to use his own power to quell the war. For businessmen like him, although war can also be profitable, it is far less comfortable than usual life.
Romance
He was optimistic about Prussia before, but now that he understands Austria's war preparations, he feels that Austria has a greater chance of winning. Once the Prussian-Austrian war begins and Austria wins, the Austro-Hungarian line that was previously used as a bridge will change from equal talks between the two places to Hungary's backlash. The situation will be very unfavorable to Hungary.
If Hungary does not agree to the conditions, the merger talks agenda will be shelved indefinitely.
Because the Austrian emperor was more willing to move westward to obtain substantial German unification than to play a small game of eastward expansion with a group of foreigners, the merger of Austria and Hungary was a helpless move to maintain the image of a great power.
"I'm afraid war is inevitable." Laszlo was sleeping on a deck chair, enjoying the sunshine of the spring evening. "You should also have received the order from the count."
Kawei stood aside, drinking the milk tea just delivered by the butler, and nodded: "In a few days, I have to report, write down my name, and then become familiar with some of the internal rules of military medicine. I don't know when I will have to follow. ..."
"I estimate it will be in July or August." Laszlo sat up. "If Chino can be more forceful, the time can be postponed to September."
"I don't know how many more people will die. It would be better if there was no war."
"It's difficult." Laszlo sighed, "We can't decide the development of the matter. At this point, it depends on who takes action first. All I can do is hold down Franz's hand to stop him from rushing. Take action."
"Let's not talk about this for now."
Kawei came here not to talk about the Austro-Prussian War, but for his own surgery and scientific research: "You recommended my rubber factory before, can it make gloves?"
"I've asked, it's not a big problem." Laszlo also took a sip of milk tea, stood up and stretched his shoulders, "It's just that rubber is very expensive, and the original cost is not low, plus what you want modeling......"
"Money is not an issue." Kawei used this sentence this time, "As long as the quality passes the standard."
Laszlo smiled: "I didn't expect anyone to use rubber to make gloves. What on earth do you want to do?"
"Rubber gloves are easy to disinfect and clean. With the same disinfection and cleaning process, rubber gloves are definitely cleaner than hands." [8]
"I don't understand medical care. Anyway, I can definitely help you get the gloves you want." Laszlo started to get down to his topic, "The previous patent has been approved and the pharmaceutical factory has started construction. It is expected to be produced in April. Plenty of oxytocin.”
Kawi nodded and looked at Laszlo who was looking at him: "Well...then what?"
"Then? Then of course it's your blood anticoagulant." Laszlo said, "You don't think our pharmaceutical factory only makes this kind of medicine, right?"
"I told you after the operation that anticoagulants need some technical support before they can be used."
Laszlo finally showed his true nature as a businessman: "What I want is to make money. Since I helped you open a pharmaceutical factory and met so many of your conditions, shouldn't you speed up the progress here? Time waits for no one. My Dr. Carvey.”
Kawei understood what he meant: "The paper is already on the way. I will translate it into several languages and submit it to some medical journals."
"No, it's not enough!" Laszlo reminded, "How much time will it take to go back and forth? By the time the medical community spreads your method, the war will be over long ago."
"I knew there wouldn't be any news within a few months, and even whether I could be noticed by those journal editors would depend on luck, so I thought of another good idea." Kawei tapped lightly with his fingers. The small wooden table next to the person, "Since war is inevitable, since war will cause heavy casualties, and I was recruited to be a military doctor..."
Laszlo frowned slightly and immediately understood the meaning of Kawei's words: "You mean to rely on war to use autologous blood transfusions, and then sell anticoagulants to Franz?"
"When I get back, I will write a plan for autologous blood transfusion and send it to the Military Affairs Office together with the report." 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 save our little The pharmaceutical company has injected a large amount of capital."
Laszlo raised the milk tea cup and finally smiled: "It's indeed a good thing, a great thing!"
