godfather of surgery

Chapter 43 Difficult and Miscellaneous Diseases
Yang Ping lay in the duty room to rest, no matter how noisy he was, he could still fall asleep. This stunt allowed him to recharge his energy anytime, anywhere.

When I woke up, there was a lot of fruit on the bedside, all of which were kept by my brothers, and they were washed clean.Yang Ping ate an apple and washed his face.Reminds me of the case discussion at [-]pm.

At [-]:[-], Yang Ping arrived at the Shi classroom, and there were already many people waiting. Xiao Wu, Zhang Lin, and Fang Yan all greeted him, pointing to the vacant seats that were ready, and motioned for him to come and sit.

The demonstration classroom is also the meeting room of the department, where case discussions take place.In addition to emergency surgery, all are required to participate, and the death cases of difficult cases in a week are brought out for discussion.

For young doctors, it's a rare learning process, and for senior doctors, it's a time to showcase their talents.How about the operation, the stage is clear; how about the theoretical knowledge, the discussion of the medical records will tell the difference.At this time, everyone closes the door, fights with each other, and slaps the table with their noses and eyes. That's legal.

Song Zimo came in, sat next to Yang Ping, and said in a low voice, "Last time, the premature baby's blood vessels were too brittle. I got a new-born white mouse and used medicine to make the blood vessels brittle. I practiced for many days, and now I can barely sew it up. Please guide me."

Yang Ping said in surprise: "You didn't take a nap at noon, and you were practicing under the microscope?"

Song Zimo said, "Yeah, your senior brother is not for nothing, you must teach me when you have time. Next time there is a baby, let me do it, can you tell me the truth?"

"Your senior brother's weight is big enough!" Yang Ping said.

However, Song Zimo's talent and diligence are enough, and his mind is broad enough.This person has arrogance, but can face the gap.It is a blessing to have such colleagues.Now, whenever he is free, Song Zimo will take the initiative to help Yang Ping's surgery.

"Okay! I'll give you a set next time." Yang Ping said.

Song Zimo put his arms around his shoulders: "How about that equipment nurse, is there any progress?"

Yang Ping shook his shoulder and shook his hand: "Why are you so gossipy? Why don't you look at the occasion?"

Song Zimo said: 'I am no longer a human being. As a senior brother, life experience should also be taught, and the means should not be hidden and tucked away. "

Yang Ping sneered and said, "Forget it, who doesn't know about you Song Zimo, if you walk down the street and smile back, someone's rhythm will be arrhythmia immediately."

People have come in one after another, Director Han came in, Song Zimo got up, did a chest expansion exercise, walked over to Director Han and sat down.He's Corey's secretary and takes notes.

Everyone gathered in groups to show that the classroom was overcrowded.Several chief directors sit in the first row, each with a bottle of mineral water in front of them. The doctor's office is a projector, and here is a high-definition screen.

"Everyone, be quiet. There are no deaths this week. There are a few difficult ones. Let's discuss them. This week, it's Director Ouyang's turn to start-"

The resident physicians in Director Ouyang's group began to report their medical records.

"XXX, male, 14 years old, has repeated pain and swelling of the limbs and joints for 3 years, 3 years ago, no history of trauma, no obvious incentive, pain and swelling of the left wrist joint, and then gradually developed to bilateral shoulder joints, elbow joints, right Lateral wrist joints, bilateral hip joints, knee joints, ankle joints, diagnosed and treated in many hospitals - Past history: 4 years ago due to an old fracture of the left carpal navicular bone, open reduction and bone grafting were performed, and the fractures healed afterward. Remaining dysfunction -- Physical examination: swelling and tenderness of the limbs and joints -- auxiliary examination: bilateral shoulder joints, elbow joints, wrist joints, hip joints, knee joints, ankle joints MRI showed synovial swelling, joint effusion -- "

After the resident doctor reported the medical records, Dr. Jin, the chief physician under Director Ouyang, added: "This child's family conditions are relatively good. He has traveled a lot, and has seen many famous professors in well-known hospitals across the country. Pain, even normal walking is more difficult now, and I have visited many hospitals, but the problem has not been solved. Let’s discuss it and see how to confirm the diagnosis and treatment.”

Dr. Jin, the old attending doctor, is in his 40s, not a few years younger than Director Ouyang. According to his seniority, he should have been the chief physician.But he is rigid and never cheats, so far he has not been able to write a thesis or get a project, so now he is not even admitted as the deputy chief physician.In fact, the real level is the level of the chief physician.

After Dr. Jin added, several young doctors began to scratch their heads. Such atypical cases are the most troublesome and test the doctor's diagnostic ability, which is precisely the weakness of the surgeon.

Many orthopedic surgeons hang X-rays on the reading light: Surgery!Doriso, why bother to make a diagnosis, isn't it clear on the film?Diagnosing that is the business of physicians.

"It is very necessary to discuss this case. Usually, we treat these joint pains, some atypical cases, if we can't find the cause, we will leave it alone. I always say that a surgeon should not only do a good operation, but also At the same time, we must have good clinical thinking ability, and now let’s discuss what diagnosis and how to treat this patient.” Director Han said.

There are many illnesses for which medical reasons cannot be found.Diagnosis is like a detective solving a case. According to the medical history, physical examination and auxiliary examination, according to a certain logical thinking, follow the clues to identify the disease.There are cases that cannot be solved, and there are diseases that cannot be detected.

Usually case discussions start with low-level doctors and gradually escalate.In today's case, the junior doctor is confused and speechless.

"Endocrine, metabolism, nutrition, blood, rheumatism, etc. have all been checked. As long as I can think of it, I have checked everything. X-rays, color Doppler ultrasounds, CTs, and MRIs have been done, and dozens of MRIs have been done."

"There are all kinds of diagnoses, synovitis, rheumatoid arthritis, autoimmune arthritis, reactive arthritis, there is a simple diagnosis: incurable diseases?" .

He is quite knowledgeable, like an old scalper, hard-working and hard-working. Director Ouyang has him as a general. He has not done emergency surgery for many years. Every major emergency surgery is done by Dr. Jin.

"Reactive arthritis is a big bag, and what can't be found is called reactive arthritis. This one does not ask about the history of urinary tract or intestinal infection." Director Ouyang said.

"In clinical practice, there are many transient synovitis, and the cause cannot be found. This is indeed difficult to diagnose, otherwise others will not be so angry to come up with a diagnosis of intractable diseases." Director Bai said.

"Have you taken a synovial biopsy by puncture?" Director Tian asked.

Dr. Jin replied: "It was done in a hospital in Imperial Capital, and the medical examination showed inflammatory synovial tissue."

Yang Ping half-squinted his eyes and leaned on the chair, Song Zimo said, "Why don't you say a few words, don't you often win by surprise?"

Yang Ping listened. Anyway, entering the system does not take up time. In reality, it is a momentary thing. Now that I have psychologically adapted to this kind of switching, I can enter and exit the system anytime, anywhere.

Open the window and find the newly added library function. Yang Ping clicks in and enters the system space. He starts desperately searching for books, journals, and papers about these synovitis, especially rare ones, even case reports.

Synovitis is actually only a symptom diagnosis, not a cause diagnosis.Just like fever, many diseases can cause fever, and it is necessary to find the cause of the fever and treat it.

Yang Ping thought to himself, the system is really tormenting, providing such a large library, it is better to directly help with diagnosis, how easy it is, and then he can pretend to be cool.

I had to work so hard to check the information. Fortunately, the retrieval function of the library of the system is relatively powerful. Finally, many papers were searched, and one of them caught the attention of Yang Ping.

Five years ago, a paper written by an Austrian doctor was published in an obscure medical journal, written in German.The function of the system is more intimate, and it can actually help translate papers.

This paper mentions - metal ion reactive joint synovitis, generally there are implants in the body, such as steel plates, artificial joint replacements, and some even metal dentures. The reason is that the joint synovium is sensitive to metal ions, resulting in Inflammation.This disease is extremely rare. Yang Ping searched and found that no one else had reported it except this Austrian doctor.

This is interesting. Yang Ping studied the paper in detail. This child did not have left carpal navicular surgery 4 years ago. The X-ray showed that there were still metal screws left. Could it be that the metal ions released by the metal screw entered the blood, Redeposit joint synovium, causing synovitis?
The symptoms of this child are very similar to those mentioned in the paper, but it is only an assumption without any evidence.However, after checking, this is really the only one that comes close.After checking again, no suitable information was found, and Yang Ping came out of the system.

"Yang Ping, Song Zimo, what are you two doing hiding there? Say a few words!" Director Han saw that everyone was silent and called them by name.

Director Han called the name, which is not inappropriate.

Song Zimo patted Yang Ping: "Senior brother, come on!"

Yang Ping secretly scolded this guy. At this time, his brother called him sweeter than anyone else.

Catching the ducks onto the sedan chair, Yang Ping sat up straight. He couldn't lose his identity in front of these brothers, so he looked thoughtful: 'Well, this, I listened carefully to the medical records, and considered this to be metal ion reactive arthritis, It is a very rare disease, and there are not many reports at present. '

Metal ion reactive arthritis, no, I have never heard of this disease, do you have this disease?There are no textbooks.

(End of this chapter)