The operation just now showed Kawei's good theoretical knowledge and surgical ability, and he gained a firm foothold in front of several surgeons at the Palace Hospital.
He also had some reflections on not being able to spot the bleeding location from the beginning.
During radical gastrectomy for gastric cancer, spleen injury does exist, but the probability is not high, accounting for 20% of all iatrogenic injuries. With the further development of radical gastrectomy and the addition of laparoscopy, the chance of spleen injury has been further reduced.
In fact, in the era when he traveled back in time, the chances of spleen damage caused by total gastrectomy in the top three universities were very low, and they would be dealt with as soon as possible. If we also include the distal partial gastrectomy performed by Cediyo without splenic lymphadenectomy, the chance of spleen damage is even lower.
After all, total gastrectomy + spleen lymph node dissection are the risk factors for intraoperative spleen injury.
However, even if the bleeding location is now found and it is known that there was a problem during dissociation, it is still too early to perform gastrectomy according to the current surgical level in Paris.
This includes starting over the entire surgical process and preparing new surgical instruments, as well as focusing on many surgical details, preparing drug reserves, monitoring vital signs, and blood transfusions. Only by doing these things well can you have a chance to try gastrectomy.
The severe bleeding during the operation is vivid. Even in modern times, radical gastric cancer surgery is by no means a risk-free operation.
So during the post-surgery meeting, Carvey didn’t offer much advice.
Firstly, he hoped that they would focus on the still-97 bed, and secondly, he was a little surprised by the news of Edward's sudden visit.
"The war is over?"
"It turns out you don't know either."
Edward laughed twice, and finally felt a lot more balanced in his heart. He simply changed the question to a question that was more suitable for Kawei: "How is the Main Palace Hospital? It's not worse than your Municipal General Hospital, right?"
"That's natural. Surgery in Paris has developed better." Carvey admitted the gap generously, not because of his magnanimity, but because he was confident enough. "But if we only look at surgical techniques, there is still improvement." Space."
Edward was very aware of Kawei's strength and had no objection to it: "I heard that the obstetrics department won't allow you to operate?"
"I'm not too sure either."
"Don't worry." With Naisan as his backing, Edward said with more confidence, "I will put pressure on the obstetrics department and try to arrange a cesarean section this week."
"You're not going back to Vienna? Didn't you agree to leave tomorrow?"
"That was before I came here. Now the battle is over..."
Edward only went to the main hospital for a formality. After learning that Kawei had stabilized the situation, he felt a lot more confident and returned home peacefully.
Kawei did not leave so quickly. The post-operative discussion ended at around five o'clock, followed immediately by the night rounds that only belonged to the Main Palace Hospital. Because of Kawi's arrival, the focus of the night rounds was also very clear, which were the four beds 13 (hemorrhoids), 24 (bladder stones), 62 (sebaceous cyst), and 97 (appendicitis) that Cedillo had previously given.
"Bed 13 is a patient who came two days ago. The hemorrhoids are a bit serious and affect the bowel function." A young surgical intern reported, "I have been doing enema for the past two days and the effect is good. The surgery is scheduled for the day after tomorrow."
Cediyo nodded and looked at Kawei: "Doctor Kawei should be able to perform hemorrhoid surgery, right?"
"No problem, provided it really is hemorrhoids." Kawei said, "I personally have a question mark on the diagnosis of hemorrhoids."
Cediyo frowned: "You don't think so?"
"The patient stated that this has never happened before, but he has recently experienced constipation and bleeding. The symptoms are very atypical. If possible, I would like to do an examination." Kawei took out a glove from his pocket, " After all, there can be other things growing on the rectum besides hemorrhoids.”
"Something else?"
This time, the person asking the question was Peang, the bedside doctor standing behind the intern: "It's not like I haven't checked his vagina. There are indeed serious hemorrhoids outside."
"But hemorrhoids do not cause serious excretion problems." Kawei pointed to a paragraph in the medical record, "Here it says 'no bowel movements for four days'."
"That's because he didn't get an enema," Paion explained.
"If you don't need an enema, you won't be able to defecate?" Kawei only found it funny.
"..."
Kawei put on the gloves he brought and asked the patient to lie on his side. Before other doctors could bring the dilator [1], he applied oily enema fluid to his fingers. Under the surprised expressions of the other French doctors, they slowly inserted it into the anus of the 13th patient.
"If it's just a simple hemorrhoid problem, it should feel like a tender growth with high mobility and no severe pain...Old man, open your mouth and breathe, don't hold your breath, yes! Relax."
"I'm relaxing...but, it hurts a little."
The old man enjoyed the enema very much, but he was still resistant to the intrusion of hard objects: "I don't think so... ugh, ugh, it hurts!
! "
Kawei quickly withdrew his strength but did not pull out his fingers. He looked back at several French colleagues, shook his head and said: "The tumor is too hard and the mobility is very low."
This is indeed not what a hemorrhoid should have. Even a French doctor in the 19th century who didn't know much about tumors at least knew what hemorrhoids felt like: "Is it a tumor? No way, you can clearly see hemorrhoids in your mouth... ..."
Kawei has long been accustomed to them openly discussing tumors around patients. The low average life expectancy makes tumors seem nothing to be afraid of.
"If Dr. Peang doesn't believe it, you can try it yourself." Kawei did a systematic anal finger examination of the anatomy around the rectum. "The entrance to the rectum is not narrow, and the tumors on the intestinal wall do not feel fluctuating. There is no cord, tenderness and strong yang, lumen is narrowed, and the prostate is enlarged, but it is not serious."
Compared with noble physicians, surgeons are vulgar but still care about their own cleanliness and are still resistant to digital examination.
In their understanding, they can see the internal situation clearly with a dilator + speculum, there is no need to use fingers. But after seeing Kawi doing this, Cediyo had to admire the young doctor's decisiveness.
Including the post-operative discussion just now, he had unconsciously leaned towards Kawei's judgment. He seemed a little angry that his student failed to detect the tumor: "How did you do the examination? When you saw hemorrhoids outside, you just Do you think the swelling inside is also a hemorrhoid?"
"I did have an expanded examination, it shouldn't be a tumor..."
Peang took the dilator [2] from Cedieu, brought another candle, and opened the patient's anus door again: "There is indeed a mass inside, but the surface is smooth and it looks congested. Then count External hemorrhoids in the ganglia, how could this be cancer?"
"In medicine, seeing is not necessarily believing." Kawei still moved the index finger he used just now, "Surgery should focus on touch."
touch......
All kinds of dilators were invented just because he didn't want to touch them. Now that he has seen them and still has to use his fingers to check them, Peon's heart is full of reluctance. It's a pity that he can't make the decision on this matter. The chief director's order is more important than anything else: "Peang, give it a try."
"Teacher, I..."
"Dr. Kawei has tried it, so what are you afraid of?" Saidillo said, "He is a baron of the Austrian Empire. Isn't he more noble than you, a commoner?"
Peang was forced to scratch his head. In the end, he could only take the gloves with some yellow-white mucus and a little blood stains from Kawei's hand, and then stuffed his fingers into them.
Once he accepted this method of examination and put aside his personal aversion, Payon could still feel the advantages of touch from a medical perspective. There is no need to consider lighting or repeatedly change the viewing angle to carefully judge the boundaries of the tumor, and there is no need to worry about missing some subtle mucosal changes.
Because this seemingly subtle change can be easily discerned by touch.
"Ah...it hurts, it hurts so much!"
"It's indeed very hard, and the border isn't as smooth as I thought." Peang pulled out his fingers and asked Albaran to get a slide, and carefully smeared the mucus on his gloves on it, "Go for a microscope examination and see if it can Tumor cells cannot be found.”
"Okay." Albaran dipped a piece of paper next to the slide, marked the bed, and then quickly ran to the microscope room.
There was a problem with the diagnosis, which made Cediyo very embarrassed. After Payon completed the finger examination, he also stepped forward and tried it. From the touch alone, he could basically tell that it was a tumor. At least he had never seen one that was so hard. hemorrhoid.
"I'm so sorry, Doctor Carvey, for making you laugh."
"Diseases are not static, and mistakes are normal. This is why we insist on ward rounds."
"That's what I said, but... forget it." Cediyo felt that there was little point in reviewing the mistakes he had made. "If it is really rectal cancer, then I have to be the chief surgeon of the operation. Take charge. Doctor Carvey, if possible, I hope you can be my assistant."
】
"no problem."
After receiving an affirmative answer, Cediyo took out a small notebook, wrote down the results of the ward rounds just now, and informed the surrounding doctors: "This is Paris, the Palais-Dieu Hospital, and the surgical center! We should not make mistakes! In the future Whenever the anus and rectum need to be examined, in addition to dilation of the anus, a digital examination must also be performed."
Being able to make changes immediately made Kawei admire his work attitude very much. If possible, Kawei really wanted to give him some positive feedback.
Unfortunately, among the remaining three patients given, the proportion of misdiagnosis is still very large.
"Patient in bed 24, male, suffers from frequent urination, urgency, pain, and difficulty urinating." This time, the doctor in charge of the bed was replaced by Juyong, the first assistant just now, who stuffed the medical record directly into Kawei's arms. "I don't think it looks like bladder stones. I still need to do a bladder exploration to confirm."
If it is a severe bladder stone, a hard mass can be felt by palpation from the abdomen. Even if it is a slightly smaller one, the stone can be palpated with bimanual examination after emptying the bladder.
It's a pity that Juyong has done it, and bed 24 does not have these signs.
"There are no physical signs, but you still wrote bladder stones."
Although Cediyo is the chief director, the Department of Urology has been separated from the Department of Surgery, so he is not as strict as he was with Payon when he asked: "Do you have any evidence?"
"I did not find any stones by palpation, and the patient had no hematuria, so I tried to observe his urination." Juyong explained, "He did have interruptions in urination, which indicates that the stones in the bladder are more active and will occur with time." Sudden obstruction of the bladder neck and urethra due to changes in body position."
This is a key point in the diagnosis of bladder stones. Although it is of little significance in the face of modern imaging, at that time it was one of the few important signs that could diagnose bladder stones.
"If urination is interrupted, a diagnosis can indeed be made." Sediyo glanced at Kawei and asked, "What does Dr. Kawei think?"
Kawei always felt that something was strange, because the stones that could get stuck in the urethra were never too small, and the patient was thin, so he should be able to feel it during palpation. I asked him a few random questions, but the answers were all perfunctory. No matter how I looked at the patient, he was not a person willing to communicate with other people.
"There's nothing to ask. I've asked some questions a long time ago. He doesn't want to talk more, and there are no family members to accompany him, so we have to do this." Ju Yong was also helpless and wrote down the time of urethral exploration in the medical record. "There are 97 surgeries scheduled in the morning, so he will tentatively schedule it for tomorrow afternoon."
Kawei didn't want to waste time on this kind of examination that everyone would do, but now that the obstetrics department is not letting go, it would be good for Cedi Yokan to provide patients.
"All right."
Compared with the first two patients, the diagnosis of bed 62 is basically clear, that is, sebaceous gland swollen, and there is no difficulty in doing so. Sediyo even took the initiative and removed him from Kawi's surgery list.
"The last one, bed 97." Peang brought the medical record, "The pain in the right lower abdomen was the second day, and the diagnosis was appendicitis."
The girl in bed 97 is much more normal. At least her parents are around and she is not unable to communicate.
"How do you feel?" This time it was Kawei who asked.
"It's okay." The girl was very shy and covered her stomach with both hands. She seemed to be fine. "It hurt for a while before, but it's getting better now."
Unfortunately, this sentence was not recognized by her mother: "Don't be kidding me. I was sweating from the pain just now, and I was still shouting that it hurt. Why did it suddenly feel better? Are you sure it's okay?"
"But I am indeed feeling better now..." The girl's face turned pale, and she pressed her stomach with both hands and retorted, "There's nothing to lie about!"
Kawei has already seen some clues. Whether it is the location of the pain or the girl's abnormal behavior, it should not be explained by appendicitis: "I need to do an examination to confirm the diagnosis. Just lift my clothes and expose my belly."
The girl's parents didn't understand and asked: "Didn't the diagnosis come out yesterday? Doesn't she have appendicitis?"
"That can only be regarded as a suspected diagnosis by Dr. Payon. We will make adjustments based on follow-up examinations." Kawei stood beside the girl with a smile, rubbed his hands, and then explained, "The examination is very convenient. It only requires a few presses." Lower your stomach, it will be over soon, it won’t be long.”
