godfather of surgery

Chapter 337 The Almighty

Zhang Zhe’s child is actually chronic osteomyelitis. Chronic osteomyelitis does not need pathological examination to confirm the diagnosis. It can be diagnosed based on medical history, physical examination and imaging examination.

It's just that any organs and tissues cut out during the operation must undergo pathological examination, which is a medical routine.

Song Zimo just took this opportunity to study the pathological manifestations of this rare focal chronic osteomyelitis, and also to see if the operation really completely removed the lesion.

To this end, Song Zimo asked the pathology department to make dozens of pathological sections of the entire bone plug that was taken out, so that the entire bone plug could be carefully observed.

Under the microscope, the pathological sections are cut into concentric sandwiches under a low-power microscope. The center of the necrotic bone is surrounded by infected bone tissue, and the outermost circle is normal bone tissue.

Under a high-power microscope, the field of view is like an abstract painting. In the necrotic and infected bone tissue, a small amount of infiltrating lymphocytes can be seen, while normal bone tissue has no lymphocytes.

Judging from these dozens of pathological slices, each one is similar to a sandwich structure, that is, Yang Ping made an accurate judgment based on the patient's images, and planned the diameter of the trephine used in the operation. The entire problem bone tissue is removed.

Even with a surgical robot, it cannot be so accurate, because the surgical robot cannot replace the clinical judgment of the surgeon before the operation, it is just a passive tool.

Song Zimo, Xu Zhiliang and Gao Qiao, the three of them surrounded the multi-head microscope at the same time and continued to look at it.

This kind of viewing of pathological slides, Yang Ping's auxiliary inspection training in the system space, has received devil-like training, not to mention looking at pathological slides, he has personally done every process of making pathological slides, and is very proficient.

Now he just wants to pass on some experience to Song Zimo and Xu Zhiliang, so that they can also master how to read pathological slides. He hopes that one day, they will be better than pathology experts.

Xu Zhiliang does not have as much contact with pathological slides as Song Zimo. When he was a PhD student, he did experiments and saw some, but he had little contact with them after clinical practice.

Takahashi has received systematic and standardized training in pathology, but after engaging in trauma surgery, he has not had much contact with it.

Song Zimo received a call from Tang Fei. She brought Fujiwara Miyuki to the door of the pathology department, and they also wanted to come in to have a look.

Fujiwara Miyuki got along very well with Tang Fei during this time, and she also wanted to follow Yang Ping so that she could get in touch with more cutting-edge technologies.

Song Zimo went out to pick up the two of them, and they sat beside them quietly. Miyuki Fujiwara greeted Yang Ping, who responded with a smile.

The microscope examination room was quiet, and the doctors at the workstations were all seriously looking at the pathological slides. Occasionally, some people went out to the bathroom, almost jogged out, and trotted in. After entering, they continued to sit at the workstations and read the pathological slides without taking a break.

If the daily tasks cannot be completed, they will be piled up until the next day, and a lot of specimens will be received the next day. This way, the accumulation will only increase. Moreover, it is difficult to recruit pathologists, and most medical students like it. Clinically, few are willing to study pathology.

Therefore, the pathology department of a large hospital is not as competitive as the clinical department, to the point where non-doctors are not allowed to knock on the door, and even postgraduates in the pathology department have the opportunity to enter.

A young doctor got up suddenly: "Did you see Director Guan and Director Shi?"

"I should look at the frozen section next door. Several specimens have just been sent to be frozen." Another doctor replied.

"This kid's, please help me take a look, there should be nothing wrong with it." The young doctor asked another senior doctor for help.

The senior doctor went over to look at it for a while: "It seems to be nothing, and I can't see it. Let's talk about it when the two directors come over."

Yang Ping rested beside him, heard the doctor's confusion, and offered purely technical help: "May I help you?"

The senior doctor looked up, looked at Yang Ping, and was dubious: "Why don't you take a look?"

Just curious, does this orthopedic doctor really read pathology slides?It was still a pathological section of the gastrointestinal tract, and I didn't have any hope of whether he would really look at it.

The senior doctor gave up his seat, Yang Ping sat down and looked at it for a while: "Lymphocyte infiltration can be seen in the squamous epithelium of the esophagus, which is likely to be Crohn's disease. Are there any slices from other parts? If gastroscopy and colonoscopy biopsy also have similar changes, which can be diagnosed as Crohn's disease."

The pathologists who were concentrating on their work all raised their heads, and Song Zimo, Xu Zhiliang, Takahashi, Tang Fei and Fujiwara Miyuki also looked at Yang Ping.

"Look at what I'm doing, that's what's going on, the infiltration of esophageal squamous intraepithelial lymphocytes is a mild manifestation of Crohn's disease in the esophageal mucosa, and there are other sections of the digestive tract? Or, let me help you take a look ?” Yang Ping did not expect that he would attract so many eyes when he opened his mouth.

A doctor of orthopedics, sitting in the microscope examination room of the pathology department, instructs other pathologists to look at the slides. The senior doctor just now must have ten years of experience. It is strange if he is not surprised.

The senior doctor was stunned for a while, then picked out two slides from a large slide box, and handed them to Yang Ping.

Yang Ping put the slides under the microscope one by one, and after reading it, he said: "Focal enhanced gastritis of the gastric mucosa, focal active inflammation in the mucosa of the terminal ileum, there is no doubt, the diagnosis is Crohn's disease."

At this time, Director Guan and Director Shi came in, and the young doctor told the two directors in confusion that Director Shi had rich experience after all, and every time he encountered a difficult problem, he still asked him to help.

"Why don't you take a break, Teacher Shi." Director Guan couldn't bear it. Just now Director Shi saw several frozen sections, and his eyes were red.

"It's okay, let me take a look." Director Shi was very persistent.

The old director sat down and read all three slides carefully before speaking: "Lymphocyte infiltration can be seen in the squamous epithelium of the esophagus, focal enhanced gastritis in the gastric mucosa, focal active inflammation in the terminal ileum mucosa, Crohn's disease!"

The old director raised his head, took out his sunglasses and put them on: "The pathological changes in this case are so slight that most people can't see them. This is what my teacher taught me when I was a visiting scholar in the United States. Please write down this set of slides and arrange a small visit." Class, I will tell you about it.”

The pathologist immediately turned his attention to Yang Ping again, this time with adoring eyes. He only looked at one slide, then deduced the pathological manifestations of the other two slides, and said the most likely diagnosis. The other two slides were directly diagnosed, and it took only 2 minutes.

As a pathologist, I am dissatisfied with this ability to capture images under the microscope.

An orthopedic doctor is better than a pathologist when he reads the pathological slides, and what he sees are the slices of the gastroenterology department, so he can't let people live.

Song Zimo was also amazed. If he hadn't been dragged down today to look at the pathology slides together, how would he know that this guy has such a high level of pathology slides? He's so versatile!

"Dr. Yang from the orthopedics department just saw it and said it was Crohn's disease. I still don't believe it." The senior doctor said.

"Oh?"

Director Shi was very surprised. He stood up, picked two more slides from the box, and put one under the microscope: "Dr. Yang, help me take a look?"

Look?Still not watching?

Yang Ping was not very polite either, no matter if he really wanted to ask himself to read it or to test himself, it was hard to refuse, so he took a second look and said, "Serrated adenoma of the intestine (SSP)!"

Director Shi immediately showed Yang Ping another one, and Yang Ping quickly announced the diagnosis: "Pan's cell metaplasia."

"The quality of the slide is not good, and only a cross-section can be seen. It would be great if the full-thickness structure of the flattened mucosa can be seen." Yang Ping added.

Director Shi took off his sunglasses: "Young man, it's a waste not to engage in pathology. From a cross-section, we can see intestinal serrated adenoma (SSP) and Paneth's cell metaplasia. The national pathologist wrench index. Indeed, the slide's The quality is not good. If it is a high-quality endoscopic biopsy specimen, you can see the whole layer of the entire mucosa, but we often cannot do it. Intestinal serrated adenoma and Paneth cell metaplasia are determined by observing the crypt base. Only The crypt base can only be displayed on the whole layer of the mucous membrane, and the changes in the crypt base cannot be observed, so ordinary doctors cannot make a diagnosis."

Director Shi turned to all the pathologists and said: "The quality of pathological slides has a very important impact on pathological diagnosis. To make a satisfactory slice, every step of taking material, embedding, slicing, staining, and sealing There are very high demands.”

"When I was a visiting scholar in the Department of Pathology at the Massachusetts Institute of Technology, their endoscopic biopsy specimens could see the flattened full-thickness mucosal structure. In contrast, our domestic endoscopic biopsy sections often only see a horizontal section."

"It made me suddenly understand why we seldom diagnose colonic serrated adenoma (SSP) and rarely see Paneth cell metaplasia, which is more important in the diagnosis of inflammatory bowel disease. It is not a problem of disease spectrum, but a slide A question of quality."

"Of course, there is a problem of machinery and equipment, but it is more of a problem of professionalism and professional ability."

"A perfect slice is very important. Not only is it pleasing to the eye, but also the pathological changes can be seen at a glance, ensuring the quality of pathological diagnosis to the greatest extent."

"Young man, what do you think is the problem with these slides, and what needs to be improved?" Director Shi asked Yang Ping, he wanted to see how much this young man understood.

Yang Ping can only point out objectively: “During the preparation process, this specimen curled up during dehydration, the tissue was not erected during embedding, the color matching of HE staining was not very coordinated, and there were holes and glue overflow on the mounting slide. If these steps are improved It should be better."

Director Shi almost applauded: "That's very good. For example, all the colors of HE staining are coordinated perfectly, and the infiltration of intraepithelial lymphocytes can be accurately found under a low-power microscope, and it will not be invisible under a high-power microscope; including When burying the tissues upright, all the tissues are neatly arranged like soldiers in line, which can ensure that the full-thickness structure of the mucosa can be cut out when slicing.”

"Young man, have you done pathology before?" Director Shi was curious about how he knew so much knowledge.

Yang Ping didn't intend to show off, but just wanted to share the knowledge he had with everyone, so that everyone can improve and do better next time. The most troublesome thing is to explain: "When I was studying, I was more interested in the pathology department. So study hard."

Not only can I read pathological slides, but I am also familiar with the process of making pathological slides. I can tell at a glance where the shortcomings of a slide are and where the problem is. This is not as simple as interest.

If the IQ is calculated based on the full score of 160, Takahashihara estimated that Dr. Yang's IQ would start at [-].Now I feel that Dr. Yang's IQ is going to break through the rhythm of [-] points.He has received professional and systematic training in pathology, and he can't match Yang Ping's occasional interest.

Seeing Yang Ping sitting there, calm and calm, Fujiwara Miyuki didn't know why, but suddenly had an inexplicable intuition that there was loneliness hidden in Yang Ping.

Perhaps, that is the height of genius.

(End of this chapter)