godfather of surgery

Chapter 44 The Trouble With Two Screws

Everyone has never heard of this disease, including Song Zimo and Dr. Jin.

Dr. Jin cast a surprised look, thinking to himself, this kid reads more books than my old Jin.I thought he was a surgeon, but I didn't expect the theory to be so solid.I don’t have any entertainment for a day, I basically read books in my spare time, and I have read books in Chinese and English. Orthopedics monographs have been read over and over. The papers are updated every day, and I follow the international frontier. I have never heard of this disease.

He pondered what Yang Ping said, and it did make sense.Those with metal implants will release metal ions to some extent. These ions are sent to various joints by blood circulation. If the synovium is allergic to them, it is easy to produce an inflammatory reaction, which is completely possible in theory.

Song Zimo lightly touched Yang Ping next to him with the tip of his elbow: "Senior brother is a senior brother. You have thought of such a terrible disease. How did you know about this disease?"

"I forgot, I heard others say it." Yang Ping said lightly.

Director Han nodded: "Well, being able to make this diagnosis shows that the scope of reading and learning is relatively wide. You can talk about it in detail."

Yang Ping said: "This patient had a history of carpal navicular fracture surgery 4 years ago, and used two metal miniature countersunk screws. These two screws have not been removed. The location of the disease is more in line with the inference, the first is the left wrist joint, Then there are other joints. The synovitis of the left wrist joint is considered to be caused by the direct release of metal ions, so it occurs earlier, while other joints are caused by the blood dissemination of metal ions, and the natural time lags behind. The swelling and pain in multiple joints occurred after this operation. I am only speculating at the moment, and there is no sufficient evidence. You can try to remove the two screws and see if the symptoms will gradually ease."

"I agree with Dr. Yang's opinion. Remove the two screws. Even if not, it will not have any adverse effect on the patient." Tian Yuan's opinion is quite satisfactory.

"There are so many young men, how come none of them speak." Director Han said.

Usually the discussion starts with junior doctors and gradually escalates, and finally Director Han concludes.But today, this case is too rare, and everyone has made a diagnosis of "difficult and miscellaneous diseases". This is how disheartened it is, and this diagnosis is so cruel that doctors across the country are dumbfounded.

Everyone was silent just now, and they couldn't pry their mouths open. When Yang Ping said this, everyone's mind was opened. Although no one had heard of this disease, Senior Brother Yang said yes, it was this disease, and the rest was See how to verify the inference.

"Well, I agree with Senior Brother, no, Dr. Yang's opinion." Fang Yan said.

Xiao Wu also nodded: "I agree with this opinion, it seems that I can't think of anything else."

Zhang Lin raised his hand and pretended to be old when he spoke: "I have an immature idea, these metal ions make their metabolism too slow, can we use a chelating agent for metal ions to speed up the removal of metal ions, so that the symptoms will be reduced. Quick relief."

Director Han praised Zhang Lin: "I have a lot of ideas. Everyone has any ideas. They make bold assumptions and verify carefully."

Zhang Lin was praised, and he was immediately refreshed, as if he had suddenly grown a little taller.

Song Zimo said: "You can do joint puncture and extract the synovial fluid to test for metal ions to see if they can be detected. If metal ions can be detected, see if the composition of the implant screw is consistent."

Song Zimo is still Song Zimo. Although Yang Ping's position as the senior brother was abruptly taken away, it seems that no one can shake the position of the second senior brother.

"Well, this idea is very good. The joint fluid puncture and extraction fluid to find metal ions is not difficult for the laboratory department, but it is really not possible. It can be done in the laboratory of the Medical University." Dr. Jin praised, and he has always been optimistic about Song Zimo.

"Even if there are metal ions, it does not necessarily prove that it is caused." Tian Yuan said.

The discussion began to escalate. Director Ouyang said: "We first solve the actual problem clinically, remove the screw, and observe whether the follow-up symptoms will gradually ease. Diagnostic treatment is clinically permitted, not to mention that it is beneficial to the patient. As for the other, It can be studied slowly, this is indeed rare and can be studied as a topic."

Director Ouyang is actually quite handsome, with a straight back, like a soldier's back when standing in a military position. His hair is half black and white, but he has a unique charm.Dr. Jin also belongs to this lean type, and his group is in marked contrast to Director Bai's group.

Director Bai weighed 180 catties on the chair. If it wasn't for the good quality of Corey's chair, it might have been overwhelmed and fell apart. The attending doctor under him was also a heavyweight. It seemed weird for the two of them to sit together.

"At present, in the metal-on-metal artificial hip joint, the metal ions generated by friction enter the blood circulation, and many people are studying whether it is harmful to the human body. However, few people study the ions released by metal implants, because the ions released It's almost negligible." Director Bai spoke full of energy.

Director Ouyang added: "I have also checked a lot of literature on this, but have not found any relevant papers. A few years ago, a classmate of mine was a visiting scholar in Europe and mentioned that there were European doctors studying this aspect, but I can't remember the specifics. , but I haven't seen any relevant papers published."

Everyone is very active. You say a word, and I say a word, but they are not bluster, but have certain ideas.Rigorous clinical thinking is very important, in fact, it is the ability of logical reasoning.A brilliant doctor, diagnosing a disease is like stripping a cocoon, clear and logical.

Combining everyone's opinions, the outline of thinking is relatively clear. Director Han said: "Why is this case brought up for discussion? I just want to say two words, be serious. We should take any problem seriously, don't think it's just a joint pain? A lot? I can't find out the reason. After a routine examination and treatment, the hospital is discharged. The reason why Xiehe Hospital cannot be shaken as the big brother in the medical field is because of its strictness. This biggest tradition has continued to this day.

The first case of AIDS in my country was diagnosed by Concord, and a wonderful book can be written about this process.At that time, everyone had never seen this disease, and could only learn about it through literature reports, and there were no mature biological reagents for diagnosis. It was entirely up to doctors to combine resources and carry out pioneering work.There are countless such examples.

A patient with hyperthyroidism, which caused the loss of bone calcium throughout the body, was diagnosed with advanced bone cancer in many hospitals.The patient did not give up, and went to Xiehe's outpatient clinic for a long time. The professor said, "I am inexperienced and can't draw a conclusion yet. I have to check the information. You don't need to register in a week, just come to the outpatient clinic to find me."

At that time, the patient was so angry that he waited for a few months for you to say: I don't know?Almost didn't get angry on the spot, the patient left a sentence of concord and that's all, luckily left.A week later, the patient went back and forth and went to the professor.

At that time, the international research on hyperthyroid bone mineral disease was just starting, and many people did not know this disease.After get off work, the professor desperately searched for information and discussed with his colleagues at home and abroad on the phone.A week later, the diagnosis was made: it was hyperthyroidism, not bone cancer.

No matter what kind of illness this patient has in the future, he will go to Xiehe to see him, and he would rather wait a few months before going to Xiehe.

In the past, the Secretary of the World Health Organization's Children's Fund visited my country and mentioned that he was born in the Union Hospital in the 30s. As a result, the Union Hospital retrieved his birth medical records. His footprints at birth were well preserved, and his mother several times a day The time of breastfeeding is clearly recorded.What kind of rigor is this. "

Director Han spoke earnestly and talked a bit too much: "I thought everyone would find this case boring and not worth discussing, but today everyone spoke actively and enthusiastically, which shows that everyone is thinking seriously. Indeed, this case is very rare, a Austrian doctors have done research and published papers, but it’s in German, and it’s in an obscure medical journal, so it’s hard to find it.”

German papers, everyone's eyes are on the radio, can this guy still read German papers, right?

"Xiao Yang, where did you see this German paper?" Director Han asked.

"I just listened to a professor before, so I wrote it down." Yang Ping smiled.

"No matter how you get it, it's worth remembering something so unpopular and applying it when you need it. This patient just follows the procedure discussed just now, puncturing the synovial fluid to find metal ions, and surgically removing the screws. , explain clearly to the patient." Director Han finally concluded.

Two screws caused severe synovitis in joints of extremities for three years?Is it really?
Everyone can't wait.

(End of this chapter)