The diet structure of the peasant woman who had a cesarean section did not change much during the year, and her family also lived together and ate the same things. The only difference from her family was that she received herbal treatment from Graz Hospital, and then she had pregnancy + cesarean section.
The peasant woman's specific symptoms were not mentioned in the medical history given by Besim and Orji, but the "curative effect" of the herbal medicine existed objectively.
Kawei had just seen the patient in the morning. Her body had fully recovered and her previous symptoms had almost completely disappeared. This can be explained by being separated from the source of the herbal poison, but it is too outrageous that the incision is not infected. I had thought before that a certain operation during the operation solved the infection, but Kawei never dared to believe it.
Now he realized he had overlooked an important surgical step: staining.
Kawei was doing pathological slices in his hands, thinking about the entire operation process in his mind.
The entire operation is divided into upper and lower parts.
The first half was a cesarean section. From the surgical incision approach, delivery of the child to hemostasis, everything was exactly as Kawei required. The liquid used was physiological saline, the anticoagulant was purchased from Kawe Pharmaceuticals, and the oxytocin was also purchased from Kawe Pharmaceuticals.
The lower part was a hysterectomy. The surgeon was Kawei. The instruments used were nothing but a copper tube. The only variable that could be considered a variable was dyeing.
Speaking of dye, we actually have to start with the incident where Orgi was seriously injured a month ago.
At that time, Orji violated the principle of confidentiality of doctor-patient privacy, which led to death. The father of the woman in the incident ran a dye factory. It can be seen from the reaction of the lovelorn man that this dye factory is not small, and this bottle of blue dye was made by a young man in the factory.
As far as Kawei knows, there are only two blue dyes that can clinically alleviate the symptoms of poisoning.
One is Prussian blue, which treats heavy metal thallium poisoning.
Kawei had already studied 19th century chemistry in college textbooks and knew that the existence of thallium had not yet been discovered. If there is no discovery, there will be no industrial application, and the chance of heavy metal poisoning in herbal medicines will be very low. Moreover, the symptoms of the peasant woman are somewhat different from those of thallium poisoning, lacking neurological symptoms such as numbness of the limbs.
The other is methylene blue, which treats nitrite poisoning.
Nitrite is very common, usually produced after green plants decay, and it is normal to appear in herbal medicines. As for whether methylene blue can be used to treat antibacterial infections, Kawei is not impressed.
Because various types of antibiotics had long been available when he was working, and not many doctors would learn how these antibiotics were invented.
Kawei is also a pragmatist and is not interested in history. The only history of antibiotics he has come into contact with is penicillin during World War II. But even if I have been exposed to it, I only saw the introduction twice. I only know that the inventor is named Fleming, and I don’t know the rest of the date and history.
Now that there are compounds that may inhibit infection, we must seize the opportunity and conduct enough experiments to verify it.
"As expected of the operating room of the Municipal General Hospital, a complete set of specimen preparation materials is hidden."
Koch was very familiar with pathology and specimen preparation. He had already taken out fixatives, slides, dyes, paraffin, wax molds, alcohol lamps and microscopes from the cabinet, and was waiting for Carvey to hand over the cut gao pellet tissue to him for processing. Fixed, stained, embedded and sectioned: "Dr. Kavey? Doctor Kavey, what's wrong with you?"
"Oh, it's nothing, I was just thinking about the specimen."
After all, he was undergoing surgery now. Kawei put aside the matter of the dye for the time being, took out the Fernand medical record he had prepared before, and gave a brief description of the Gao pill [1].
Then he handed the newly cut specimen materials into Koch's hands: "This is the tissue of the pill itself - specimen 1, followed by the tumor tissue - specimen 2, and then the two junctions. Sectioning – Specimen 3.”
"There are actually specimen descriptions and numbers..." Koch was very excited. "I have seen many surgeries, but I have never seen him treat specimens as carefully as Dr. Kawei."
"Can you do pathological specimens?"
"Yes, I used whiskey as the fixative in the laboratory. The color was a bit weird, but now it seems that it is no longer needed." Koch looked at a bottle of transparent liquid labeled [Alcohol] at hand, "With a higher concentration Antiseptic alcohol looks more reliable than amber wine."
"Not just the color, this bottle of alcohol has a higher ethanol concentration and a better fixation effect."
Koch nodded, keeping what he learned in mind, and asked hurriedly: "Then what is this bottle?"
Kawei looked at another bottle of solution labeled [xylene] and said: "This is a transparent agent for microscopy that I also found in the dye factory. It can quickly bring paraffin into tissue cells. You first fix the two with alcohol. Minutes, wash with water, dye, wash with water and then use xylene, and finally use paraffin mold for embedding..." [2]
From the development of pathology in the last century to today's level, it has gradually shown signs of clinical diagnosis, and more and more surgeons have begun to use pathological examination results to determine the type of disease.
Especially when encountering tumors, the special mutated structures of tumor tissues and cells allow people to easily draw conclusions.
Of course, limited by the production level of pathological specimens, you also need to rely on luck to see the cells in the specimens clearly. The cutting plane is not neat enough, the tissue sections are not thin enough, the staining is insufficient, the staining is too heavy, the dehydration is not enough, the fixation failure, etc. can all affect the imaging of the specimen under the microscope.
Waterman was a little surprised: "Can this thing bring in paraffin quickly?" [3]
"right."
Three other chief surgeons, including Massimov, were also surprised: "There is such a good thing???"
It is quite difficult to master advanced surgical pathology. Ordinary doctors only know how to do pathological biopsy. The production process usually involves cutting off a small piece of tissue and then cutting it as thinly as possible. What can be observed depends on the skill of the knife.
However, human hands definitely have their limits, and human tissue is very soft. There is no problem in cutting off a small piece with a knife, but it is an impossible task to cut into a thin slice while maintaining the arrangement of cells.
That's why paraffin embedding is available.
Generally, it takes time for paraffin embedding to penetrate into the cell tissue. If time is not enough, the central area in the center of the specimen tissue will often become messy under the cutting of the blade.
The xylene discovered by Kawei seemed to perfectly solve this problem.
Xylene is soluble in ethanol and paraffin, and can quickly enter the tissue after staining to bring out the residual ethanol, and then bring in the paraffin added from the outside to support the specimen tissue and ensure that it will not be squeezed during cutting.
"If there is such a good thing..." Orgi, who was sitting beside the operating table, couldn't sit still. He stood up and walked to the pathology preparation table, "Can you sell me a bottle?"
"Dr. Orji is so impatient?" Kawei smiled and told Koch some precautions when preparing specimens. He looked back at him and explained, "Whether xylene is useful can wait until the specimens are done to see the effect." , if you are satisfied with it, I will give monthly members a chance to buy at a special price, and those who pay annual membership can receive a bottle of gift for free.”
“There’s actually a discount?”
“Is it too late to buy a membership now?”
More than ten years have passed since xylene was first discovered, and there has yet to be a mass production solution suitable for current industrial production levels. Even if it does appear, it will be difficult to achieve mass production in the first time with Austria's low industrial production level.
Basic materials that are already sold by the ton in the 21st century were purely rare goods in the 19th century, and quantities of less than 100ml could be sold for hundreds of crowns.
Kawei was very grateful, and he also hoped to use this opportunity to advertise his own pharmaceutical factory: "If you are concerned about the xylene, high-concentration alcohol, and dyes used in pathological slices, the oxytocin used in surgery, If you are interested in anticoagulants, you can go to the Karachi Pharmaceutical Factory located in the town of Baden on the outskirts of Vienna. Large quantities will give you preferential treatment..."
tomato
.....
As the world-recognized father of microorganisms, Koch, who is about to graduate from his Ph.D., has very solid laboratory technical abilities. Whether it was fixation, staining or final embedding and sectioning, he could do a great job.
Even if it was his first time getting xylene, he could quickly understand how to use it and perfectly integrate this step into the entire specimen preparation process.
Kawei placed considerable trust in Koch and left all the pathology work to him, while he took Amor and Herman to start the second round of surgery:
"Next is a small-incision bilateral mastectomy. In fact, the surgical effect is similar to that of ordinary breast cancer removal, but the incision is much more beautiful. The first thing we need to do is to determine the location of the incision. My choice is on both sides of his head. Below, make a curved incision.”
"Under your head? That's Ruyun..."
Corrigor couldn't help but nod: "If you want to hide the incision on your broad chest, there is only one place, just like the two oases in the Sahara Desert in North Africa."
"But the problem is how to get it."
The surgery is actually quite simple under modern electrosurgical operation. No major blood vessels are involved. As long as it is handled normally, it is an outpatient surgery that only requires local anesthesia. After entering the minimally invasive era, this kind of minor surgery has developed to the Anchor rotary cutting machine [4] that destroys and aspirates in one piece, and there is no need to make a percutaneous scalpel incision anymore.
Of course, even without such a machine, this operation can be easily completed with just some basic surgical instruments.
However, before the operation, Kawei still needed to explain it to them, so that the operation would not end too quickly and they would not be able to see the process clearly.
"Although his bilateral mammary glands appear to be significantly hyperplasia, with a diameter of about 10cm, it seems difficult to remove them. But we should note that even if the male breasts are hyperplasia, they are very thin, and the arc-shaped incision next to your head is more like a small fan. The window and the surrounding skin are elastic enough, so the operation is almost not difficult.”[5]
Having said that, when it comes to operation, there are still many details that should be paid attention to.
Small incisions will give patients a satisfactory postoperative look and feel, but at the same time small incisions can also lead to a series of problems.
One of the most important questions is that after incising the skin under your head, will the blood supply of your head itself be affected? How will ruyun's skin heal after excessively curved incisions? How to determine the length of this incision?
Corigo and Waterman, who specialize in plastic surgery, have already thought of similar questions, and Kawei answered these questions for them immediately:
"We choose the incision below your head. In order to ensure blood supply, the length of the incision should not be larger than 1/2 circle." Kawei took the scalpel, cut it at the location he mentioned, and then said naturally, "And in When making an incision, the lower incision on your head should be chosen instead of the upper incision. Do you know why?"
Heman was stunned and looked at Amor beside him.
Amor was new here and had just graduated from medical school. He didn't know that he still needed to answer questions on the operating table. He was a little at a loss: "No, I don't know..."
"Herman, what about you?"
"I, I guess..."
"Guess?" After just a few words, Kawei had already made the incision, "I wonder if other people here know? Since it is a public display of surgery, everyone can speak freely. It doesn't matter if you are wrong. If you are right, today The surgery ticket fee will be fully refunded.”
Herman apparently didn't know why.
Because according to the direction of breast growth after hyperplasia, the upper incision is definitely more convenient, but Kawei still chose the lower incision. The only explanation that can be given is that the most important blood supply during surgery is blood supply.
"To prevent damage to Ruyun's blood supply?"
"Well, not bad." Kawei raised his head and glanced at Koch, who answered the question not far away. He confirmed his answer, but was still not satisfied. "But this statement is too snake-proof and cannot be regarded as an answer."
As he spoke, Kawei had already exposed the breast tissue under the incision. He used his left thumb and middle finger to pull the gland, and his index finger touched the gap. He used scissors to probe in and slowly cut open the surrounding fascia: "The operation time on one side is up to 20 seconds. Minutes, after the operation is over, the Q&A will also be over, so please seize your precious time."
[Ye Chu just took a nap in the afternoon, and my head is a little dizzy. I will wait until I have something to eat before writing this chapter. Sorry for that.]
