godfather of surgery

Chapter 595 Surface Warriors
The cases discussed in various departments are usually shown in a movie on the big screen, so that everyone can know what they know.

Then, in order, each case will be discussed in detail.

The members of the expert group in the front row are old and stubborn, known for their rigorous academic research, which makes the young doctors in the back feel a strong sense of pressure.

The weekly routine discussion of the whole hospital was proposed by them. For some difficult cases, they will be discussed. In principle, all departments will send people to participate. The relevant departments will participate in the speech, and the unrelated departments can listen to other people’s speeches. Eye-opening.

Relatively speaking, physicians like this kind of discussion more than surgeons.

The level of surgeons is high and low, and they mainly compete with each other in surgery, and they are not very interested in the scene of moving their mouths.

But physicians are different. Physicians prefer to reason about difficult and miscellaneous diseases in a cocoon-like way.

The surgeon looked at the film and said in one sentence: surgery!

In the face of diseases, physicians cite extensively from sources, from basic to clinical, from textbooks to cutting-edge papers, and speak clearly and logically.

Medicine and surgery are two ends of the same body, but I don't know when it started, and they despise each other a bit.

Physicians feel that surgeons know how to operate all day long, and they don't even know how to read an electrocardiogram.

Surgeons think that physicians can't cure any disease, unlike surgeons who simply use a knife and a knife.

Therefore, it is interesting to discuss cases where medical and surgical procedures are mixed together.

Especially in the areas where internal medicine and surgery intersect, such as some tumors.

Surgeon: So much nonsense, just cut it, remove the tumor, do a major lymph node dissection, how can it be better if you don’t cut it.

Physician: I know everything!Whole body organs are cut off for you?Don't worry, let's treat slowly, chemotherapy, radiation, to see which one is sensitive to, first a wave, then a targeted therapy, and finally some biological therapy, immunotherapy to assist.

The experts organized this kind of mixed discussion to prevent everyone from getting stuck in a fixed pattern of thinking. Internal medicine and surgery communicate with each other, and many difficult and miscellaneous diseases appear to be open-minded.

An ENT patient, 64 years old, female, with a foreign body in the left sinus. The diagnosis is clear. As for how the screws that fix the denture "smuggle" past, I don't care for the time being.

A patient in the Department of Urology, male, 36 years old, Yinjing continued to have an erection, which happened after a week of fever, and various drugs were ineffective, and the erection could only be eliminated by spinal anesthesia. Once the anesthesia was over, the erection tended to return. In order to avoid necrosis of the cavernous body , Department of Urology asked the anesthesia department to install a spinal anesthesia pump for continuous anesthesia.

In this case, the Department of Urology is purely looking for a sense of presence. They have already obtained a diagnosis, and they are here to discuss it, but to share with you the process of their diagnosis and treatment.

Compared with internal medicine, surgical intractable diseases are much rarer, so take out such cases to raise the face of surgery.

"Director Zha, tell me your opinion."

Director Lu from the Department of Urology named Director Zha from the Department of Nephrology.

Although they are both experts in sewers, they are still good at urology in terms of male function.

Nephrology mainly focuses on the medical treatment of kidney diseases, such as uremia.

Using one's own strengths to attack the other's weaknesses is a routine that both medicine and surgery like to use.

Director Zha pondered for a moment: "Have you taken any medicine recently?"

"no!"

"Have you checked your testosterone?"

"normal!"

"How's the blood picture, any consideration for sickle cell disease?"

"Check this aspect, rule it out!"

"Does Yinjing have blood clots?"

"no!"

Director Zha was also a little troubled, thought for a while and said, "Do you have an MRI of the spine? Is it possible to consider spinal cord injury, such as tumor invasion."

Director Lu, who had always been full of confidence, was immediately discouraged: He solved the case!It is caused by spinal cord tumors, which lead to excessive excitation of the spinal cord center.

There is also a famous saying in diagnostics: the rare manifestations of common diseases are far more common than rare diseases.

In fact, making a diagnosis of a disease, like solving a case, is a process of logical reasoning, grasping the symptoms and signs and auxiliary examinations, eliminating the false and preserving the true, stripping away the cocoon, and uncovering the truth step by step.

The Department of Nephrology also showed its own case: male, 48 years old, considering renal bone disease, had double kidney stones 15 years ago, removed the stones eight times, and the stones were removed and took a long time, 7 years ago because of kidney stones caused renal failure. After hemodialysis, I felt bone pain all over the body, which became more and more serious, and gradually appeared joint deformities, blurred vision, tooth loss, subcutaneous induration and other symptoms.

There are also several patients with similar kidney stones in the family, and one of them died of uremia at the age of ten due to kidney stones.

The physical examination revealed that the patient had decreased vision, multiple missing teeth, multiple skin sclerosis with pigmentation on the extremities, deformed fingernails, interphalangeal joints, interphalangeal joints, bilateral ankle joints, knee joints, elbow joints, and shoulder joints. Both appeared enlarged and deformed.Slit-lamp examination revealed calcium deposits around the cornea of ​​the left eye.Abdominal CT showed bilateral nephrocalcinosis.Extensive destruction of the phalanx, dense epiphysis, and calcification of the soft tissue at the end of the fingers and toes were found under X-ray.

Director Cha and Director Lu are both Ph. Ds, academics, and are keen on this kind of technical competition.

You can shoot the table with the door closed, and when you walk out of this door, everyone is a good brother.

"What's your opinion, Director Lu, what's your department's opinion?" An old internal medicine expert in the expert group deliberately provoked.

Director Lu stared at the screen to read medical records, and performed surgery every day. Who knows what kind of disease this thing is, the debate between the knife and the pen is inherently insufficient.

After holding back for a long time, Director Lu didn't see the gate.

The case of Director Zha is a real intractable disease, and the papers have been written by graduate students, and they are going to be published in the "New England Journal of Medicine" as individual cases.

Surgeon, if you can see it, I will be your director!
Director Cha sneered inwardly.

"What's your opinion, please publish it?"

The veteran internal medicine expert stood up and shouted.

The director of the Department of Urology is holding back here. How can we tell that the Department of Urology and Nephrology are somehow related.

"orthopedics?"

The old expert turned around and saw Yang Ping behind Professor Zhang: "Professor Yang of General Surgery, tell me."

How can there be such a roll call, if you can't say it, it will be a shame.

The brothers of the surgery complained for Professor Yang.

In fact, Yang Ping paid attention to this case just now, because it is really interesting.

Director Zha, Ph.D., has been a visiting scholar in the United States for a year, and he is still very arrogant.

"Professor Yang, talk about your opinion!"

Yang Ping got up, you pulled me out to break your golden bell cover by yourself, not on my own initiative.

"The skin biopsy showed a large amount of calcium salt deposition. Look at it with a polarized light microscope. It is estimated that a large number of diamond-like crystal deposits-calcium oxalate crystals can be seen. The primary hyperoxaluria should be considered, and further genetic testing should be done. , if yes, there may be a heterozygous mutation in the AGXT gene."

Rare diseases with a possibility of one to three in a million have been kept secret for so long, just to pretend to be coercive at the meeting of the whole hospital at this time, and you broke it with a few words?
Surgery came back.

Director Zha restrained his smile instantly, is this all right?
Yang Ping looked at the time, there was still something to do in the department, he was about to leave, there were still several doctors here in his department.

---

Almost two weeks have passed.

The list of international clinical trial bases for the new technology of spinal orthopedics will be announced soon, and there is only one place. The Affiliated Hospital of the University of Tokyo is the most well-prepared, and the status of the first brother of the New York Hospital for Special Surgery is the most conducive to the promotion of the new technology to the world.

And the conditions offered by the Germans are the most attractive. The duke fund can cost [-] million euros at every turn. As long as money is legal and reasonable, the more the better.

In the general surgery conference room, everyone gathered around the conference table, August, Robert and Takahashi were very nervous.

This base of cooperation is very important to them, although for different reasons.

Yang Ping didn't speak, Song Zimo exchanged glances with Yang Ping, and took out an agreement from his bag.

There is something else, you should quickly take it out and sign it for others, Yang Ping urged in his heart.

Don't worry, usually you always pretend to be aggressive, and I will be the foil, this time you will be the foil, Song Zimo is not in a hurry.

"Doctor Robert!"

Sure enough, it was me, Robert was relieved, and the mission was successfully completed during this trip.

"Congratulations to the New York Hospital for Special Surgery for becoming our clinical trial base. Please take a look at the agreement." Song Zimo handed over the agreement.

The Americans took the agreement and began to read it line by line, with a smile on their faces that could not be suppressed.

The Japanese and Germans were very disappointed. After shaking hands with the United States and expressing their celebration, they could only fight again in the coming year.

After reading it, Robert signed and accepted the contract, and he was in high spirits.

Song Zimo slowly took out another agreement from his bag: "Dr. Takahashi, since the Affiliated Hospital of Tokyo University is very well prepared, we specially added a base for you, congratulations!"

The feeling that Takahashi was lost and regained made August feel sour in his heart. He was like a candidate who made a mistake in the college entrance examination score and found that the real score was much lower than the estimated score.

Song Zimo said unhurriedly, "Congratulations, both of you!"

"But Mr. August, you don't need to be discouraged. Because of your sincerity, we have increased the number of places again. Harlacing Orthopedic Hospital is the third base."

Song Zimo slowly took out the agreement from his bag and pushed it in front of August.

August couldn't believe that he didn't fail the ranking and finally got this base.

The overseas layout of the external fixation system for the spine has been completed. If new technologies are introduced in the future, these three bases will also be used to go to the world.

-

Yang Ping is already preparing to go to Europe, and August makes Marcus actively prepare.

The spiral spine model was placed on the desk, and Yang Ping stared at the model in deep thought.

This is a tricky scoliosis correction, because of the spiral shape of the three-dimensional space, the correction needs to be considered from three levels, and the factors to be considered are more complicated.

For example, the heart and lungs in the thoracic cavity, the gastrointestinal tract and viscera in the abdominal cavity, because they have adapted to the deformed space formed by the spiral spine for more than 20 years, and now they need to be corrected, and those complications will occur after surgery.

At present, the digital medicine laboratory of Southern Metropolis Medical University can only model simple spinal orthopedics, and cannot take into account the concurrent influence of thoracic and abdominal organs.

Moreover, machines have no imagination and cannot solve problems creatively.

That is to say, computers can only solve problems within the existing framework, and cannot solve problems creatively.

Along with the correction of the spine, all soft tissues, which can tolerate stretching and which cannot, and the tissues that can tolerate it need to be released in advance, these must be considered.

If this spinal deformity is successfully corrected, the external fixator of the spine will virtually be pushed to the top of the world.

To achieve the best correction, it is necessary to obtain a thin-slice scan of all organs from the neck to the chest and abdomen, and then reconstruct the shape and position of the internal organs, as well as all the surrounding adhesions.

In this way, the changes in the positions of all organs during the orthopedic process can be demonstrated, and the stretching range of their adhesions can be measured.

Therefore, spinal orthopedics is no longer as simple as just considering the deformation of the spinal cord, but also the accompanying changes of many organs.

Otherwise, it is easy to cause unpredictable complications.

Yang Ping constructed these maps in his mind, and then tried to simulate spinal correction, and the organs would change accordingly. Although the correction process was slow, such changes would also cause complications.

For example, whether the aorta will be torn, whether the heart will break through a certain critical value due to changes in external pressure, and acute heart failure will occur.

This is also the reason why all the top doctors in the world, including August, dare not operate.

The more a doctor who understands deeply, the more terrible the consequences will be.

The patient's heart function classification is level four, which is also the worst level. He is basically unable to carry out any activities. In a resting state, sitting or lying down may cause obvious discomfort, such as wheezing and dyspnea.

In the process of orthopedic surgery, the disturbance of cardiac function should be considered.

"Doctor O—"

Yang Ping pushed open the door.

August, who got the contract, was obviously much more relaxed, and he ran here in a hurry.

"Let your patient do the most detailed thin-slice CT scan, from the base of the skull to the coccyx. The chest and abdomen in the middle are the key points. I need to know the shape, position and state of all organs, and then do a combination of anatomy and function. NMR."

Yang Ping ordered August.

Hearing that the professor was worrying about his case, August was very positive, which meant that the professor was preparing for the trip to Germany.
-
In the doctor's office, the intern, Qin Xiaowei's fan, was holding a mobile phone, surrounded by several people.

"Brother Wei wants to climb a rock wall of more than 900 meters with his bare hands. Look, it's like cutting with a knife. It's so dangerous. It's similar to the El Capitan that Alex climbed. It's such a dangerous rock."

"He has even signed the organ donation agreement, this time he is making all the preparations."

"It is said that insurance companies dare not insure it. In the end, the sponsoring advertiser promised that if something goes wrong, there will be a huge compensation."

"In the past, those were all pediatrics. This time it's really a big move. Now it's going to be a trending topic, and it will be broadcast live on the whole network."

"It is said that the shooting is not a drone, but a shooting team. These photographers are all rock climbers. They hang on the rope and follow Xiaowei to shoot. It's really exciting. My heart is beating now."

"If you fall, you won't be saved. Is there protection underneath?"

"There is no protection, no pitons can be drilled on the rock wall, no mats can be laid on the ground, and brother Wei refuses to wear a parachute, saying that wearing a parachute bag will reduce the flexibility of the body."

Yang Ping saw several interns gathered together.

The intern looked up and saw Yang Ping, very nervous, Yang Ping said: "Let me see!"

The intern handed over the mobile phone. It was a promotional video before freehand rock climbing, clips of several videos of "Girl Thief" and "Freehand Rock Climbing", and then a close-up of the cliff that Qin Xiaowei was about to climb. Indeed, this kind of The precipitous cliff makes me nervous just looking at it, let alone climbing it.

A promotional video like a Hollywood blockbuster ended with a few big characters: Surface Warriors!

Yang Ping respects this kind of outdoor extreme sports!

They challenge the impossible in another way.

(End of this chapter)