Thanks to more than 200 years of research on physiology and pathology, physiology and pathology have always been required courses in medical schools. With the upgrade of microscopes, the identification of tumor cells has gradually become an advanced course in medical school. The doctors participating in the consultation now have a basic understanding of tumor cells.
Of course, the current research on tumors is very shallow, and it is impossible for everyone to be able to tell the truth at a glance.
But as long as a few authorities take the lead, others will soon follow. After all, there are gaps among the experts participating in the consultation, and clinical medical consultation is not a democratic election. The final decision does not depend on the headcount ratio, but on those few.
"They are indeed tumor cells."
Massimov nodded first, then Waterman and Jacob. After the last few pictures came into Mosier's hands, he had to let him nod: "The individual is extremely large and irregular in shape. I also think it is tumor cells."
"From a morphological point of view, it is indeed consistent with the characteristics of tumor cells."
"It seems that everyone agrees that there are tumor cells in Mr. Edem's urine." Waterman collected the drawings. "Do you have any other questions? If so, ask as soon as possible, otherwise this section will be over. ”
The doctors around him whispered to each other, but no one was willing to speak.
"Since you have no objections, then..."
At this time, Jacob, who was not far away, suddenly spoke: "It's boring when no one talks during the consultation. Since you all have no opinions, how about I say a few words."
"Teacher please."
"Relying on a microscope to examine urine sediment is indeed a good method." Jacob is very sure of Kawei's innovation. "Being able to do this has actually surpassed 90% of the doctors here. There is no threshold for this detection method. , the cost and price are also low, I think it can be promoted in major hospitals."
After some appreciation, Waterman thought this was just the beginning: "What next?"
"Originally, I thought this examination was somewhat flawed. There should be some difference between 'finding tumor cells in tissue' and 'finding tumor cells in urine'."
Jacob explained: "But now that I think about it, I feel that I didn't think it through properly. The urine is sealed in the human body before leaving the body. If there are tumor cells in the urine, then the entire urinary tract should be susceptible to disease."
"So you still agree with Dr. Carvey's judgment?"
"I agree." Jacob replied with a smile, "At least I agree now. I am looking forward to the next cystoscopy and hope to see it."
"I agree."
"I agree too."
On the basis of pathology and Jacob's diagnosis, the diagnostic method of first looking for tumor cells to determine the nature of the disease, and then relying on endoscopic observation of the tumor location is very straightforward and easy to understand.
With the results of microscopy as an objective basis and the affirmation of several experienced experts, the transition from microscopy to endoscopic examination seemed natural. And these "experts" who were invited to come for consultation seemed to have no room to interfere in the face of such diagnostic logic.
But the consultation at that time was not like the consultation in modern hospitals. Everyone had a set of established diagnostic criteria, and every year major medical associations continued to revise them through large amounts of data.
At that time, the diagnosis was almost entirely based on medical experience. A pathological examination was performed in advance for suspected tumors. The angle was indeed tricky.
"Since everyone should have no objection to the diagnosis of suspected tumors, I am going to start the cystoscopy." Kawei showed his new cystoendoscope to everyone in the bladder and asked, "What do you think about this section of my review?" Is there any objection to the diagnostic method?"
Asking this is the same as not asking.
According to the experts on the stage, treating hematuria is nothing more than prescribing some drugs that can stop the bleeding, and then go home and wait for it to heal.
If the condition does not improve, the second time they will often increase the dose of the first drug and give him some heavy metals at the same time. After these two steps, the patient's hematuria may be ready for industrial upgrading, and other symptoms will appear one after another.
By this time, the tumor has almost reached the mid-to-late stage. Even in modern times, it requires the cooperation of an entire surgical team and a little bit of luck.
"Do it, Dr. Carvey."
"We'll just wait for the results."
...
At this time, Kawei was performing a cystoendoscopy demonstration on the cadaver, and in the preparation room next to the surgical theater, Edem was receiving help from two assistants to complete the preparations for the endoscopy as quickly as possible.
"Did Mr. Edem fast this morning?" Herman asked.
"Well, I didn't eat anything."
"Do you feel the need to pee now?"
"Not yet."
Heman nodded and asked Damirgang to come over and help: "Let's do a simple disinfection first. You may feel a little uncomfortable. This is normal. Don't be too nervous."
"Disinfection?" Edem didn't expect this step. "What is disinfection?"
"It's just a set of very simple preparations." Herman smiled and didn't want to explain too much, "This is what Dr. Kawei prescribed."
Before Edem felt anything, he got on the hospital bed next to the other party and took off his pants: "Okay, since it's Dr. Kawei's prescription, you just do it."
The preparation work was not difficult, but because Edward and two guards supervised the whole process, Kawei was afraid that ordinary assistants would be busy, so he asked Herman and Damirgaon to complete it. Over the past few months, the two of them have become Kawei's gold medal assistants. They have seen disinfection thousands of times and it is not difficult to do it.
But for Edem, who had seen this scene for the first time, he always felt indescribably awkward.
"Hiss... this feels so weird." He watched the gauze ball lightly brushing over the little guy's surface. His body couldn't help but tremble, he moved back, and he couldn't help but ask, " What did you use? Can this be applied on this?"
"Don't worry, Mr. Edem, it's diluted carbolic acid. We'll clean it again with warm water after wiping it. There will be no problem."
Herman asked him to return to his previous position. While comforting him, he held the gauze ball with the hemostatic forceps in his hand and gently swayed it back and forth, like a painter: "The disinfection will be over soon. All you need to do is wait for the card to close." Just news from Dr. Wei."
"oh oh......"
Edem looked calm, but still felt a little uneasy: "I remember that the previous surgeries didn't seem to have this step."
"Not to mention the past, even now, there is no such preparation work in the surgical theater in Paris. This is a disinfection measure that has only become popular recently and is limited to Vienna." Herman saw that he was a little nervous, "The main purpose is to reduce the risk of surgery. Chances of incision ulceration after completion.”
"So that's it."
The disinfection area is centered on a certain little guy, and the surrounding radius of 10cm needs to be wiped clean. This is really strange in the eyes of outsiders. Edward knew from his face that Edem was full of doubts, and explained: "Don't worry, this is already very popular in the surgical theater in Vienna."
"Is that so?"
"I often go to various hospitals in Vienna to watch surgeries, and I came here before to see Dr. Kavi perform Justina's surgery." Edward stepped forward to comfort him, "No matter who it is, even their Ludwig Old Marshal, you have to do this before the operation."
"I see." After hearing Ludwig's name, Edem finally felt at ease and asked, "This... By the way, what did you call this just now?"
"disinfect."
"Oh, yes, disinfection! Disinfection shouldn't have any impact on the body, right?" Seeing that the carbolic acid completely covered his lower body, Edem asked, "For example, normal walking, or excretion, or in I will display my power in front of the ladies."
The three of them all moved their attention from his little thing to his face: Xiongfeng? ? ?
"What's wrong? Can't you be heroic in your 60s?"
Edem never married, but the women around him were like a revolving door, changing almost every few months. Sometimes, for the necessary stimulation of art, the number of people will increase to a certain extent.
So this 63-year-old man has never been married, but he has several children.
Edward originally thought that after 60, he should take a break, but who would have thought that he is still maintaining this relationship now: "It's nothing, as long as you are happy."
"So, this doesn't affect my work, right?"
"Don't worry, it won't affect you."
...
At 2 p.m., the cystoscopy on the body was completed.
Judging from the results, the examination was quite successful. At least I could see the inside of the bladder clearly through the observation hole using the built-in oil lamp. However, there are still many deficiencies in the operation of the endoscope. This may be due to the decay of the urethral tissue structure of the corpse, and deviations occurred during the insertion of the endoscope several times.
"I think the lens of this kind of endoscope is not round enough and can easily cause urethral damage." A doctor from the College of Surgery said, "Although other treatments and examinations of the urethra will also cause damage to a greater or lesser extent, this is the inspection after all. It’s hematuria, and it’s easy to confuse lesion bleeding and injury bleeding.”
"Yes, the endoscope is definitely thicker than the catheter, and the damage to the urethra will be greater."
"I think it's better not to do endoscopic surgery and go directly to surgery."
"It's true that direct surgery is better."
Seeing that they were all interested, Kawei explained: "The location where tumors can occur is not only the bladder, but also the kidneys. If you are not sure of the location and just perform surgery, do you want Edem to get an extra knife?"
“What about endoscopy injuries?”
“Injury is inevitable, and damage is controllable.”
"It was inserted into the prostate just now, so it can't be considered controllable, right?"
The reason why a consultation is a consultation is because it is a place for everyone to express their opinions. Unlike Maruna, who has a very poor foundation, the questions just raised were all good, and he seemed to be pressing forward step by step, but in fact he was considering the patients.
Although Kawei always felt that their surgical methods, which frequently cut off the wounded's hands and feet, should not be so tolerant of the urethra, but from a personal perspective, these questions were also helpful to him.
"I do not deny this colleague's assessment, and I also acknowledge that injuries can occur during endoscopy."
Kawei calmed down and explained: "But what I need to clarify is: First, the mouth of the mirror is not as sharp as you think, and it is arc-shaped around it. Second, the mistake that just occurred was just a problem with the internal structure of the corpse. , and the prostatic hyperplasia was obvious, causing urethral stricture. He may have had difficulty urinating before his death, which Dr. Mosier can prove.
But Mr. Edem had no similar prostate symptoms, and his urination had always been smooth. I believe that it is safe to insert an endoscope into the bladder as long as sufficient paraffin oil is applied. "
This passage was very clearly stated, and the reason for the accident that just happened was found. Many doctors on the stage had already begun to nod.
But this consultation is far from over.
Surgeons who deal with the urinary system all the year round are called sewer workers. They are more or less like plumbers and vascular surgeons, and sometimes they can always come up with some crooked ideas.
"Dr. Kawei, I personally think that cystoscopy is very valuable during examinations." Mosier first affirmed the endoscopic examination, and also raised his own question, "I think it is possible to change the way in which the endoscope is introduced. .”
"Change? How to change it?" Kawei was a little surprised, "The bladder has only one outlet."
"You can build one yourself."
Kawei looked at the endoscope at hand and frowned: "Teacher, you mean to make a hole in the patient's lower abdomen to connect the bladder and the skin?"
"Yes, it only needs to be 1-2cm in diameter, and the distance won't be too long."
Kawei can guess why he made this suggestion. After all, he often undergoes prostate surgeries, and most of the patients he encounters are those with urine retention after prostatic hyperplasia. Such patients feel very uncomfortable when their urine is blocked in the bladder, and they need to be catheterized to urinate as soon as possible.
But the urethra is blocked by the prostate, and it is not easy to catheterize, so Mosier often chooses a method of urinating that bypasses the urethra.
This is called percutaneous suprapubic cystocentesis in modern times, and the method is the same as what he just said.
"Teacher Mosier, there is nothing wrong with Mr. Edem's prostate," Kawei said. "I don't think it's necessary to put such an excellent urethra in front of you and open a hole in the bladder instead."
Mosier, of course, has his own reasons: "Urethra injury will affect urination, but suprapubic incision will not have such an impact. Moreover, the time to enter the bladder is very short, take away the endoscope and bandage it briefly, and the created fistula will be able to heal itself." heal."
"This is indeed a good advantage." Kawei questioned, "but there are not many people who can pull out the puncture tube and heal it on its own."
Mosier's expression was not very good: "It's true that the proportion is not high, about 60-70%."
"The ratio is pretty good, but percutaneous incisions can cause ulcers. The old man is too old to withstand such trouble."
Not far away, Massimov suddenly said: "If the incision is small, the chance of ulceration will not be too high. If disinfection is used, it may be less than 10%. By the way, how long will it take for the incision to heal after the tube is pulled out? ?”
"It will heal in 3 days."
"Three days is not a long time."
"This method sounds very good."
Kawei still feels that his method is better: "Urethral injuries heal much faster under the wash of urine than lower abdominal incisions. It might be over in one day, and there will be no impact on the urethra at all."
"It can only be said that each has its own advantages."
"No!" Kavi sighed, "From the perspective of damage, each may have its own advantages and disadvantages. Of course, I don't admit it myself. Let's just assume that they each have their own advantages and disadvantages. But has Teacher Mosier forgotten another perspective? ?”
"Another angle?"
"Functional perspective."
Kawei said: "The endoscope is made of metal and cannot be bent or bent. Because once it is bent, the field of view in the bladder will be lost. So from the beginning, the range that the cystendoscope can see is very limited. In order to To determine the location of the tumor, we can only distinguish it by the color of the urine in the bladder and the color of the urine that has just flowed into the bladder..."
Mosier then realized the huge disadvantage of percutaneous access to the bladder: "You mean you can't see the ureteral opening."
"Yes, you can't tell the source of the hematuria without seeing the opening."
