As an important organ in the abdominal cavity, the adrenal gland, like other organs, is subject to various pathologies.
When organic lesions appear and are likely to worsen or even become cancerous, or when the lesions themselves have affected the body's hormone levels and medical treatment has limited effect, modern surgery will intervene. The most common and direct method is to remove the diseased adrenal glands. 【1】
However, the adrenal gland plays an important role in maintaining body fluid and electrolyte balance and maintaining normal blood pressure and heart rate. Resection, especially bilateral resection at the same time, will bring many side effects.
Therefore, bilateral adrenalectomy has extremely strict indications. 【2】
Once you undergo a total adrenalectomy, you will need to take hormones for life after surgery. However, replacement therapy by simply taking medication is ultimately a mechanical increase in hormone levels, which cannot be compared with the ability to regulate normal gland secretion.
The most obvious one is the pituitary gland, which regulates systemic hormones. The absence of the adrenal gland makes it difficult to suppress the adrenocorticotropic hormone (ACTH) secreted by the pituitary gland. Long-term stimulation will cause pituitary gland disease. 【3】
At this time it is very important to maintain adrenal levels.
To deal with organ loss, the surgical approach is generally to choose transplantation. But the vole was too small, and it was impossible to perform an adrenal vascular anastomosis. Moreover, Kawei made the decision temporarily and did not preserve enough blood vessels when the adrenal gland was removed.
Therefore, we can only do "planting" here, rather than transplanting in the traditional sense.
However, compared to the implantation surgery used to hedge against complications after double adrenalectomy, Kawei at least does not need to deal with the diseased tissue on the adrenal glands, skipping the preparation stage and doing it directly. 【4】
For patients who still have some usable adrenal tissue, surgeons have found a way to perform autologous transplants after removal.
"The anesthesia will still last for a while, let him lie down for a while." Kawei took a piece of wet gauze soaked in warm saline and covered Torre's abdominal incision, and said, "Let's peel off the fat around the adrenal glands first. Then......"
At this time, Mattick and Koch seemed to enter the experimental building.
The two people must have had some different opinions on some content in the chemistry class. Before the door was opened, the extremely poor sound insulation effect brought the conversation between the two into the ears of Kavi and Savarin.
"I admit that Germany's chemical capabilities are much stronger than Austria's, but that only stops at the level of dye research and development." Mattick said, "But now that Austria has methylene blue, there has been improvement in dye research and development."
Koch didn't seem to care: "I have been to that dye factory. Unfortunately, the chemist who developed methylene blue was an Englishman and a student of a German. And the German's name was August Wilhelm von Hofmann, now professor of chemistry at the University of Berlin..."
"I know, and you will tell me next that Hoffmann's teacher was also a German, named Justus von Liebig. He was the man who proposed the theory of organic groups and became a textbook. I must know him." [5 】
The two opened the laboratory door side by side, and Mattick's retort continued: "But this has nothing to do with methylene blue having an Austrian chemical patent."
"It's just one of the dyes, not..."
The conversation came to an abrupt end when the two discovered that Kavi was in the laboratory.
"Mr. Kavey!" Koch was very excited, "Why are you here?"
"I just happened to come here to do an experiment." Kawei glanced at the two of them and quickly withdrew his gaze, "Since you are here, come and have a look together. You don't need to do the surgery, but you need to understand the purpose and content of the experiment. "
Due to the information blockade, the just-concluded Countess' surgery has not been discussed enough among ordinary people, and its status is not as high as that of cesarean section. But within the medical community, this operation involved three of the most famous surgeons in Austria and made several innovations, which was an unprecedented shock.
Koch was just a doctoral student in Germany who had not yet graduated. His experience, skills, and nationality were not enough for him to get on this stage, but Kawei still helped him. Taking such experiences with him during his study tour will also pave the way for him to return to work in China in the future.
So Koch uses the honorific here.
Kawei didn't think about it that much, because it would be awkward to find other pathology experts when Ingenac was already taking the lead. Among young doctors, there are only a few who can keep up with Yingenatz's pathological experiments.
Since everyone was of similar skill level, interpersonal relationships were naturally more important, so Kawei chose Berget and Koch.
Facts have also proved that the two are fully capable of conducting experiments on stage.
"What I want to study this time is the adrenal gland." Kawei got straight to the point. "Anatomically, the location of the adrenal gland has been clarified, including surrounding tissues and blood vessels. What we want to study now is its function, that is, its existence in humans and animals. Meaning within the body.”
"What a big subject..."
"The method is to remove the glands and observe the daily life of the vole. These two are the adrenal glands in the vole." Kawei said, shaking the beaker.
"Such a small adrenal gland..."
The two had a general understanding of the upcoming experimental project, but questions also arose: "Since the adrenal gland has been removed, why is the incision still open?"
The main reason for doing this must be Savarin, because he is not the leader of the next experiment, and he has to stabilize the other party's emotions. If the operation still cannot be performed under such circumstances, then there will no longer be a place for him in this laboratory.
"good question!"
"Because I don't have time to continue, the operation has to be completed by Savarin." Kawei explained, "In order to remove possible uncertainties in the experiment, I have to put the cut adrenal gland back."
“Can this be put back???”
Koch and Mattick were as surprised as Savarin, who stood aside blankly. The surgical operation proposed by Kawei didn't sound like a big deal, but it was completely beyond the understanding of the three of them.
"It's not a big deal." Kawei said. "To be precise, this is not putting it back, but planting it back."
After speaking, he lifted off the wet gauze on Torre's abdomen and compared the length of the abdominal muscles under the incision: "Before planting, the adrenal glands must be cut into thin slices with a blade."
"Cut?"
"Why the incision?"
"Can it still be used after being cut?"
With the development of surgery today, although many drugs and technologies are still lacking, the concept of transplantation has long existed. Just like repairing a clock, replacing broken parts with new ones can restore normal operation.
On the contrary, the concept of planting, which is similar to plant cultivation, seems more primitive.
“Some of the most basic knowledge of surgery and physiology needs to be applied here.”
Kawei was like a teacher, patiently answering the three people's confusion: "First of all, it's physiology. The tissues in the human body need to be supplied with nutrients, just like we need to eat. And in terms of anatomical structure, both adrenal glands have lost blood vessels. , and there is a capsule around the adrenal gland, which blocks nutrient intake. In this case, in order to keep it active, this barrier must be removed.”
After speaking, Kawei chose the smallest pair of surgical scissors from the instrument box: "Fortunately, Mr. Laszlo's foundry is very powerful, otherwise it would be really difficult to deal with such a small adrenal gland."
According to the requirements for autologous transplantation of human adrenal glands, the surrounding fat tissue needs to be removed from the isolated adrenal gland, and then the diseased tissue in the adrenal gland must be removed, and then the remaining usable part should be cut into 1-2mm thick slices with a knife.
Now Kawei's conditions are limited, and the vole's adrenal gland is too small, so he has to make do with it.
With the help of a microscope, he reluctantly cut the two adrenal glands into seven thin slices with tweezers, scissors and a scalpel, and then reopened the gauze on Torre's body: "Choose the thickest part of the subcutaneous muscle and use scissors to cut away some muscles, and then put them in one by one..."
The entire process was completed under the operation of Kawei's hands and tissue tweezers. Both the imagination and the precision of the operation exceeded the imagination of the three people.
"Will this really work?" Koch couldn't understand. "It looks like growing potatoes in a vegetable garden."
"Yeah, dig up the soil and bury the seeds in it." Mattik agreed. "Sewing the skin is like covering it with soil."
"Whether it will be successful or not will have to be observed after the operation." Kawei quickly sutured the skin incision, and then used gauze to bandage the wound. "We all know the average heart rate of voles."
"Becoming an Immortal in One Step"
"400 beats a minute."
"There are individual differences, but overall that's the number."
Savarin quickly released Torre's limbs and found a clean small cage for him to use as a single room to rest after the operation. Kawei took off his gloves, washed his hands, and then prepared to write a simple experimental procedure for them.
"If I guess correctly, cutting off both adrenal glands will gradually slow down their heart rate, so the observation direction after the operation is daily life and heart rate."
In fact, he wanted to calculate blood pressure, but the design drawings of the human blood pressure monitor had just been sent to Laszlo's company, and the finished product had not yet been produced. The field mouse really didn't dare to use it. Therefore, in the absence of a set of data, Kawe hopes to add other observation items.
"The observation time is 7-14 days, and some kidney powder is mixed into the feed to increase nutrition." Kawei briefly explained the key points that need to be paid attention to, "In terms of drinking water, some drink water and some drink saline. Observe first... ..Observe for six days first, mainly focusing on weight, eating status, activity status, and muscle strength of the limbs."
"Then what?" The three of them took notes.
"We started to stop feeding on the seventh day," Kawei said, "but we still have to give him water, otherwise he will die soon."
"What is this for?" Savarin was a little nervous.
"I guess you won't see much difference in six days, so I want to put them in some difficult environments to observe their stress response ability." Kawei said, "The fasting time is set at about two days, which is the ninth day. Observe their movement, resting postures and daily activities every day.”
The three people nodded: "We need to compare between groups."
"It also needs to be compared with before fasting."
"knew."
Seeing that the three of them were ready to start work, Kawei quickly stopped them: "Don't worry, the experimental project is only halfway through, it's not over yet."
"besides?"
"For some voles that are strong enough, just fasting is not enough to defeat them." Kawei glanced at the existing tools in the laboratory, and the stress environment they could do was very limited. "When the time comes, use the maximum Put ice water in a metal basin. Remember, it is ice water and the temperature should not exceed 5 degrees Celsius.
"What is this for?"
"Throw them in."
"..."
"demon!
! "
This is the case with animal experiments. Only their sacrifices can bring rewards to the human world. Kawei was not prepared to make any more excuses: "What you have to record is the time you keep swimming until you drown. The comparison is between removing the adrenal glands and not removing them." Differences in swimming ability between."
Savarin still hoped to save it at this time: "Can it be evaluated by running speed?"
"Running speed?"
"They have gone through the fasting stage, so they will definitely pounce on the food as soon as they see it." Savarin explained, "If you calculate the running time, you should be able to..."
"No! This is not objective enough!" Kawei rejected his suggestion. "Each vole has a very different interest in food. Although they are very hungry, some vole reaction is slower and the difference cannot be intuitively reflected. But drowning is different. , what we record is the persistence time in the water, which can more objectively reflect their physical stress level."
"Too torture..."
"After drowning, you need to fish them out as soon as possible and perform simple resuscitation." Kawei put his fingers on his chest and said, "I have said before, it is just a simple press. Then watch them leave the ice water. Later recovery, compare the differences between the groups.”
This experiment was much more complicated than the previous oxytocin experiment, and the subsequent requirements for the voles were also much stricter.
"After all observations are completed, the remaining surviving voles will be put to death." Kawei coldly pronounced the fate of dozens of male rats in the cage.
"If you withstand the experiment, you will be executed?"
"Of course he will be executed."
"Why?"
Savarin understood the purpose of Carvey's experiment, the necessity of surgical removal of the adrenal gland, and all the subsequent experimental projects. But he didn't understand why the voles that survived the experiment were still killed after the experiment.
Since they have made contributions to medicine, wouldn't it be better to let them live quietly?
More importantly, this was not necessary when the oxytocin experiment was conducted.
"Oxytocin doesn't require cutting out the adrenal glands."
"What does this have to do with cutting off the adrenal glands?" Savarin said. "Those who survived the experiment must be healthy control groups. There is no need to execute them!"
Kawei breathed a long sigh of relief: "You lack the most basic experimental rigor."
Savarin didn't understand: "Right? What does rigor have to do with executing them?"
"Can you guarantee that all subsequent bilateral adrenalectomies will be perfect?"
Kawei raised a question that he couldn't avoid: "Don't say it's you, even I can't guarantee it. There are differences in operations, but the last thing allowed in experiments is differences, so I have to increase the number of operations to eliminate these differences. .
But that's not enough, because you still can't be sure that you actually removed all the adrenal glands as required by the experiment. How do you say it should be determined? Should we follow the surgical procedure and cut into the abdominal cavity for observation? Or should we observe during the operation? "
The surgical incision was only 3cm. For Savarin, barely removing the adrenal gland was his limit. It is obviously impossible to fully expose all the structures around the kidneys and then repeatedly observe whether the location of the adrenal glands has been completely removed.
Savarin already had an answer on his lips: "Only...only after execution and further autopsy." [6]
[I have to go to the emergency room first, so I’ll finish this chapter slowly in the middle of the night]
