Nineteenth Century Medical Guide

Chapter 176 173. Angels and Demons

As an important organ in the abdominal cavity, the adrenal gland, like other organs, will suffer from various lesions.

When organic lesions appear and may further deteriorate or even become cancerous, or the lesions themselves have affected the body's hormone levels and the effect of medical treatment is limited, modern surgery will intervene. The most common and direct way is to remove the adrenal glands that have already been lesions. 【1】

However, the adrenal gland is responsible for maintaining the balance of body fluids and electrolytes, and maintaining normal blood pressure and heart rate. Resection, especially bilateral simultaneous resection, will bring many side effects.

Therefore, bilateral adrenalectomy has extremely strict indications. 【2】

Once you have undergone bilateral total adrenalectomy, you need to take hormones for life after surgery.However, the replacement therapy of simply taking medicine is ultimately mechanized to increase the hormone level, which cannot be compared with the regulation ability of normal gland secretion.

The most obvious 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 pathological changes in the pituitary gland. 【3】

At this time, it is very important to maintain the level of adrenal glands.

To deal with the loss of organs, the surgical method is generally to choose transplantation.However, the voles are too small to perform adrenal vascular anastomosis, and Carvey made a temporary decision, and did not retain enough blood vessels when removing the adrenal gland.

Therefore, we can only do simple "planting" here, rather than transplanting in the traditional sense.

However, compared with the implant surgery used to hedge against complications after double adrenalectomy, Kavey at least does not need to deal with the diseased tissue on the adrenal gland, and can directly skip the preparation stage and do it directly. 【4】

For patients who still have a usable portion of adrenal tissue, surgeons have found a way to perform autologous implantation after removal.

"There is still a period of anesthesia, let him lie down for a while." Carvey took a piece of wet gauze dipped in warm saline and covered Torre's abdominal incision, "Let's peel off the fat around the adrenal gland first, Then."

At this moment, Mattick and Koch appeared to have entered the laboratory building.

The two probably had 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 Carvey and Savarin.

"I admit that Germany's chemical capabilities are much stronger than Austria's, but that's only at the level of dye research and development." Mattik said, "But now that Austria has methylene blue, it has already improved in dye research and development."

Koch didn't seem to care: "I've been to that dye factory, and unfortunately the chemist who developed the methylene blue was an Englishman who was a student of a German. And the German's name was August Wilhelm von Hoffmann, now Professor of Chemistry at the University of Berlin"

"I know. Next you will say that Hoffmann's teacher is also a German named Justus von Liebig. He is the big guy who put forward the theory of organic groups in textbooks. I must know him." [5 】

The two pushed open the laboratory door side by side, and Mattik's rebuttal continued: "But this has nothing to do with the fact that methylene blue has an Austrian chemical patent."

"It's just one of the dyes, and it's not"

The conversation came to an abrupt end when the two found out that Carvey was in the lab.

"Mr. Carvey!" Koch was excited, "Why are you here?"

"Just came over to do an experiment." Carvey glanced at the two of them, and quickly withdrew his gaze, "Since you are here, let's 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 countess operation that just ended was not discussed enough among ordinary people, and its status was not as high as the cesarean section.But within the medical community, this operation has dispatched the three most famous surgeons in Austria today, and made several innovations, and the shock is unprecedented.

Koch is just a doctoral student in Germany who has not yet graduated. His experience, skills and nationality are not enough to make him on this stage, but Carvey still helped him.Bringing such experience with him during his study tour can also pave the way for him to return to work in China in the future.

So here Koch used the honorific title.

Carvey didn't think too much about it, because it would be embarrassing to find other pathologists when Ignatz was already in the lead.Among the young doctors, there are not many who can keep up with Ignatz's pathological experiment ability.

Everyone has a similar level, so it is natural that interpersonal relationships are more important. Carvey chose Bergert and Koch.

Facts have also proved that the two are fully capable of performing experiments on stage.

"What I want to study this time is the adrenal gland." Carvey cut to the chase, "Anatomically, the location of the adrenal gland has been clearly defined, including the surrounding tissues and blood vessels. What I want to study now is its function, that is, it exists in humans and animals. internal meaning."

"Great subject"

"The method is to observe the daily life of the voles after removing the glands. These two are the adrenal glands of the voles." Carvey said, shaking the beaker.

"What a small adrenal gland."

The two had a general understanding of the next experimental project, but doubts 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 there is still no way to perform a good operation under such circumstances, then there will be no place for him in this laboratory.

"good question!"

"Because I don't have time for the rest, Savarin has to complete the operation." Carvey 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 astonished, just like Savarin who was standing aside in a daze.The surgical operation Carvey proposed sounds like no big deal, but it is completely beyond the comprehension of the three of them.

"It's no big deal," Carvey said. "It's not exactly putting it back, it's kind of going back."

After finishing speaking, he removed the wet gauze on Torre's abdomen, and compared the length of the lower abdominal muscle after the incision: "Before planting, the adrenal gland must be sliced ​​into thin slices with a razor blade."

"cut?"

"Why cut it?"

"Can it still be used after being cut?"

With the development of surgery, 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, is more primitive.

"There is some basic knowledge of surgery and physiology that needs to be applied here."

Carvey is like a teacher, patiently answering the confusion of the three: "First of all, it is physiology. The tissues in the human body need to be supplied with nutrients, just like we need to eat. In terms of anatomical structure, both adrenal glands have lost blood vessels. , and the adrenal gland is surrounded by an envelope that blocks nutrient intake. In this case, in order for it to remain active, this barrier has to be removed."

After speaking, Carvey chose the smallest pair of surgical scissors from the equipment box: "Fortunately, Mr. Laszlo's foundry is strong, otherwise such a small adrenal gland is really difficult to deal with."

According to the requirements of human adrenal gland autologous planting, the isolated adrenal gland needs to remove the surrounding fat tissue, and then remove the diseased tissue in the adrenal gland, and then use a knife to cut the remaining usable part into 1-2mm thick slices.

Now Carvey's conditions are limited, and the adrenal gland of the vole is too small, so he can only make do with it alive.

With the help of a microscope, he barely 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 some muscles, and put them in one by one."

The whole process was completed under the operation of Carvey's hands and tissue forceps. Both the brain hole and the precision of the operation have exceeded the imagination of the three.

"Can this really work?" Koch couldn't understand, "It looks like growing potatoes in a vegetable garden."

"Yeah, dig up the soil and put the seeds in." Mattick agrees. "Sewing the skin is like putting soil on it."

"Whether it is successful or not, you have to observe slowly after the operation." Carvey quickly sutured the skin incision, and then used gauze to bandage the wound. "You all know the average heart rate of voles."

"1 jumps in 400 minute."

"Individuals are different, but in general this is the number."

Savarin quickly loosened Torre's limbs, and found a clean small cage for him to use as a single ward for him to rest after the operation.Carvey took off his gloves, washed his hands, and prepared to write a simple experimental procedure for them.

"If I'm not mistaken, cutting out both adrenal glands will gradually slow down their heart rate, so the direction of observation after the operation is daily life and heart rate."

In fact, he still wanted to include blood pressure, but the design drawings of the human blood pressure monitor had just been sent to Laszlo's company, and the finished product hadn't been produced yet.So in the absence of a set of data, Carvey hopes to add other observation items.

"The observation time is 7-14 days, and some kidney powder is mixed in the feed to increase nutrition." Carvey briefly talked about the key points that need to be paid attention to, "In terms of drinking water, some drink water, and some drink normal saline. First observe for six days Well, it’s mainly weight, eating conditions, activity conditions, muscle strength of limbs.”

"And then?" The three of them took notes.

"The feed was cut off on the seventh day." Carvey said, "but water must be given, otherwise he will die soon."

"What is this for?" Savarin was a little nervous.

"I guess there is not much difference in six days, so I want to put them in some difficult environments and observe the stress response ability." Carvey said, "The fasting time is set for about two days, which is the ninth day. Observe their movement, resting postures, and daily activities every day."

The three nodded: "There must be a comparison between the groups."

"It also needs to be compared with before fasting."

"understood."

Seeing that the three of them were ready to start work, Carvey quickly stopped them: "Don't worry, the experimental project is only halfway through, and it's not over yet."

"and also?"

"For some voles who are physically strong enough, fasting alone can't defeat them." Carvey glanced at the existing tools in the laboratory, and the stress environment that can be used is very limited. 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!!!"

Animal experiments are like this. Only their sacrifices can bring rewards to the human world. Carvey is not prepared to make more excuses: "What you have to record is the time you kept swimming until you drowned and sank. The comparison is to remove the adrenal glands and not Differences in swimming ability between resections."

Savarin still hopes to save it at this time: "Can you use the running speed to evaluate it?"

"Running speed?"

"They have gone through the fasting phase, so they will definitely rush to the food as soon as they see it." Savarin explained, "If you calculate the running time, you should be able to do it too."

"No! This is not objective enough!" Carvey rejected his proposal, "Each vole has a very different interest in food. Although they are very hungry, some voles just react slower, which cannot intuitively reflect the difference. But drowning is different. , what we record is the persistence time in the water, which can objectively reflect their physical stress level."

"Too tortured."

"After drowning, you still need to fish them out for simple resuscitation." Carvey put his fingers on his chest and said, "I said before, it's just a simple press. Then watch them leave the ice water After recovery, compare the differences between several groups."

This experiment is much more complicated than the previous oxytocin experiment, and the follow-up requirements for voles are also much stricter.

"After all the observations are over, the remaining surviving voles will be executed." Carvey coldly pronounced the fate of dozens of male mice in the cage.

"If you withstand the experiment, you will be executed?"

"Of course it 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 items.But he didn't understand why the voles that survived the experiment were still executed after the experiment.

Now that they have made contributions to medicine, wouldn't it be better to let them live in peace?
More importantly, this was not necessary when doing the oxytocin experiment.

"Oxytocin doesn't need to cut out the adrenals."

"What does this have to do with removing the adrenal glands?" Savarin said, "Those who can survive the experiment must be healthy control groups, and there is no need to execute them!"

Carvey breathed a sigh of relief: "You lack the most basic experimental rigor."

Savarin didn't understand: "Precise? What does rigor have to do with executing them?"

"Can you guarantee that all subsequent bilateral adrenalectomies will be perfect?"

Carvey raised a question he couldn't avoid: "Don't say it's you, even I can't guarantee it. There are differences in operations, but the most unacceptable thing in experiments is differences, so I want to increase the number of operations to dilute these differences.

But that's not enough, because you still can't be sure that you have actually removed all the adrenal glands as the experiment requires.You said, how should it be determined?Is it possible to cut into the abdominal cavity for observation according to the surgical procedure?Or do you mean observe during the operation? "

The surgical incision is only 3cm. For Savarin, barely removing the adrenal gland is already his limit.It is obviously impossible to fully expose all the structures around the kidney, and then repeatedly observe whether the position of the adrenal gland has been completely removed.

Savarin already had an answer on his lips: "Only... only after execution and a further autopsy."【6】

[I have to go to the emergency room first, this chapter will be done slowly in the middle of the night]

(End of this chapter)