godfather of surgery

After Lankoping's preoperative examination was completed, all the results came out quickly.

A discussion about her case started in the conference room, and Professor Deng from the outpatient clinic was also invited to participate in the discussion.

This is not a small informal discussion, but a very substantiated discussion that will be recorded and eventually filed in the medical record.

Because this afternoon happened to be the time for routine medical record discussion,

"Let's discuss this case, because we will use a new surgery that has never been used before to relieve the patient's symptoms." Yang Ping got straight to the point.

Penguin disease is not considered a rare disease. According to U.S. statistics, there are 10-3 penguin disease patients out of 5 people. Our country does not have statistics on this, so we can only speculate based on the data from the United States. We have approximately There are 4 to 7 penguin disease patients. This is a terminal illness and a more terrifying disease than ALS.

The doctor in charge of the bed is Dr. Zhou, a regular trainee. He reports the medical records.

Formal medical record discussions usually start with a young doctor speaking, that is, in order of professional title from lowest to highest, and are finally summarized by the department director.

"Hereditary cerebellospinal ataxia is a truly terminal disease. There is no precedent for surgical treatment of this disease in the world. As for drug treatment, the only effective drug currently known is the Japanese drug tartirelin. Other methods, For example, there is no evidence that acupuncture, massage, and traditional Chinese medicine are effective.”

Li Guodong is considered an outstanding person among young people. He now wants to take Yang Ping's doctorate, so he studies very hard and is the first to speak in every case discussion.

Indeed, the only drug currently proven to be effective in relieving the symptoms of penguin disease is tartirelin, a pituitary hormone-releasing stimulant drug and the world's first approved oral thyrotropin-releasing hormone. In addition to its endocrine effects , also has certain effects on the central nervous system, including increasing locomotor activity, antagonizing reserpine-induced hypothermia, and antagonizing pentobarbital-induced sleep, etc.

Thyrotropin-releasing hormone present in the brain co-localizes with other neurotransmitters or neuromodulators and exerts the function of neurotransmitters or neuromodulators to achieve neuroprotective effects.

One of the main symptoms of hereditary cerebellospinal ataxia is progressive loss of motor coordination, and dopamine in the brain is involved in the regulation of the motor system.

Thyrotropin-releasing hormone and its analogs have been shown to change the metabolism of acetylcholinesterase and dopamine, thereby activating the dopamine system and strengthening the regulation of the motor system, so they can improve the symptoms of ataxia.

Tartirelin is a synthetic analog of thyrotropin-releasing hormone, but its excitatory effect on the central nervous system is 100 times that of the body's own thyrotropin-releasing hormone, and its duration of action is 8 times that of thyrotropin-releasing hormone. .

It is this powerful effect that makes it the only effective drug for penguin disease.

Dr. Zhou, who is in charge of the bed, said: "The patient's family asked someone to buy it in Japan. She has already taken this medicine. She has taken three brands - Jg, sawai, and Tanabe Mitsubishi. In the end, she felt that Tanabe Mitsubishi was the best. Taking it may be due to the original pharmaceutical company, but this medicine can only relieve symptoms. The patient herself said that if it were not for this medicine, she would probably not be able to speak or type now. However, as the condition worsens, this kind of medicine will It’s also less effective because it can’t stop the progression of the disease, it can only relieve symptoms.”

The doctor in charge of the bedside said while showing the empty box of medicines, which Fang Liu brought over for the doctor to record the medicines.

"Dr. Li, you just said that she had acupuncture and massage and used traditional Chinese medicine? It didn't work?"

Dr. Zhao asked. Dr. Zhao Wenbo is a postgraduate student in rotational medicine who came to the Institute of Surgery not long ago. He also wants to take the Ph.D. in Yang Ping. This young man likes traditional culture very much, especially traditional Chinese medicine. He is deeply dissatisfied with traditional Chinese medicine. Just now Li Guodong openly said that Chinese medicine was not good, and he felt very unhappy.

"Yes, this is what the patient's family said personally. Dr. Zhou should know, not me. Indeed, acupuncture, massage, and traditional Chinese medicine are ineffective against this disease." Li Guodong insisted on his opinion.

Dr. Zhou nodded: "That's what the patient's family said."

"She has not found a real Chinese medicine doctor. She cannot arbitrarily say that Chinese medicine is useless. There are many experts in Chinese medicine among the people, and the academics now have a unique reputation." Dr. Zhao defended.

"It is a romantic fantasy that masters are among the people. Chuanwu does not mean that masters among the people have been among the people for so many years. In the end, the masters among the people, Teacher Lei and Teacher Ma, came out." Li Guodong said casually.

In fact, Li Guodong did say it casually, because he himself was very opposed to the argument that "masters are among the people". When Dr. Zhao said this, he replied.

Unexpectedly, this sentence angered Dr. Zhao: "You are talking as if Chinese medicine is pseudoscience. Isn't this the same tone as the Chinese medicine outside?"

Li Guodong was a bit inexplicable: "You mean I can only say that traditional Chinese medicine is effective, but I cannot say that it is ineffective. If it is effective, it is correct, and if it is ineffective, it means that traditional Chinese medicine is bad? I am just talking about the feedback of patients and family members based on facts for this specific case. How can I call it traditional Chinese medicine? Hei, I think Chinese medicine is pretty good, but it’s definitely not a panacea.”

''Since you say it's effective, you have to provide evidence. You can't say a word. She didn't find the right doctor. It's like practicing martial arts. You're just talking about it. You won't know if it works in the ring. "Li Guodong added another sentence.

Dr. Zhao is always quick to criticize people, especially Chinese medicine. He cannot say anything bad about Chinese medicine, otherwise he will say he is unpatriotic and Chinese medicine is bad. This makes Li Guodong afraid to chat with him, let alone the topic of Chinese medicine.

Li Guodong likes to present evidence rigorously in his usual discussions. The evidence that Dr. Zhao always brings up is that a certain relative was cured of some terminal illness by some old man many years ago.

Li Guodong asked again in detail: Your relative's name and residence, when and where you were treated, how you were diagnosed at that time, and how you evaluated whether it was cured. We will follow up. This kind of case is an oral legend for ordinary people, but for us doctors It is a valuable resource, and you may find clues to solve medical problems.

The question of Chuanwu was just raised, and Dr. Zhao was also anxious:

"Chuan Wu comes from the battlefield, and many of his moves cost people's lives. How can they perform with gloves on?"

"Do you think who will die first if Mr. Ma and Tyson take off their gloves and do not restrict any moves?"

Dr. Li also responded tit-for-tat, but in a calm and unhurried manner.

The less anxious Dr. Li is, the more anxious Dr. Zhao is. His face has turned red. Other young doctors are also sweating. Someone has already pulled Dr. Zhao's clothes.

What on earth was being discussed? Why did it go off topic while talking? Song Zimo knocked on the table: "Attention! This is a case discussion. Do not discuss irrelevant matters. Regarding the issues of traditional Chinese medicine and martial arts, you can discuss them privately after the meeting."

"Well, I don't want to discuss this with you. You won't understand if I talk too much." Dr. Zhao threw something over.

Li Guodong never spoke again. In fact, he just defended his point of view and did not want to quarrel.

Xu Zhiliang said loudly: "Doctor Zhao, are you still talking too much?"

"Professor, do you want surgery?"

Song Zimo asked Yang Ping why these guys started fighting in the beginning because the atmosphere was not right today. Song Zimo simply went the other way and asked the professor for his opinion directly.

Yang Ping nodded: "My idea is very simple. Since cerebellar atrophy, no matter what the pathogenesis is, it is currently compressed and there are problems with blood supply. We seize the clear problem and remove the arachnoid of the cerebellomedullary cistern. , Brainstem arachnoid release, dura mater tension reduction, posterior cranial fossa craniectomy for decompression, and bilateral occipital muscle flap with occipital artery applied to the cerebellar surface, achieving the dual effects of cerebellar decompression and increasing blood supply. Theoretically, this can improve the blood flow to the cerebellum."    ''Because no matter what the reason is, no matter what causes cerebellar atrophy, we can see from objective images that there is oppression on the cerebellum and insufficient blood supply. Relieving the oppression will help Protect the existing blood supply and restore the part of the blood supply that is at risk of death. With muscle flap transplantation with a vascular pedicle, the blood vessels of the muscle flap can slowly grow into the cerebellum, which can increase new blood supply to the cerebellum. "

"We don't know where the link in the physiological chain of the disease is, but it is definitely useful."

After Yang Ping finished speaking his thoughts, Professor Deng nodded slightly: "If you change your thinking, what can you do if you don't use this method?"

Professor Deng's question made everyone re-adjust their thinking. Yes, the only effective drug is not effective now. Apart from that, any method is ineffective, that is, there is no way to go unless a new way is opened.

"So, there is no other way but to try a new method, otherwise we will have to wait for death. The new method is theoretically effective. Even if it is really ineffective after surgery, decompression and muscle flap transplantation will not aggravate the patient's symptoms. It is completely worth it. This trial opens up a new way for surgical treatment of genetic cerebellospinal ataxia."

Professor Deng strongly agrees with Yang Ping's new method. At this time, we must dare to make breakthroughs for this disease.

Everyone is stuck in the old ways and clings to the old ways. If human beings are still cultivating agriculture through slash-and-burn farming, how can they make progress?

However, the key to the application of this new method is the cooperation of patients and their families, otherwise it will be difficult to explain if it fails. Fortunately, Lan Xueping and Fang Liu had great confidence in Yang Ping, so Yang Ping decided to try the new method.

A doctor who uses a new method of uncertain efficacy on a patient who lacks trust is tantamount to committing career suicide.

No doctor would do this, and neither would Yang Ping. Trust is the cornerstone of adventure.

''I have also checked a lot of literature, and there is indeed no precedent for surgical treatment of penguin disease. We have no experience to draw from, and we cannot conduct animal experiments, so we can only analyze it theoretically. I support the application of new methods. "

Song Zimo absolutely supports any of Yang Ping's new methods, which can be said to be brainless support, because many experiences have shown that his brain is completely insufficient in front of Yang Ping.

"I agree!"

Xu Zhiliang is similar to Song Zimo. He agrees first and thinks about it later.

Xia Shu is new here. He is a doctor of cardiac surgery. He has no experience in this kind of neurosurgery disease. He can only say: "I don't know much about this disease. I just checked some literature temporarily. For the time being, I I can’t make up my mind, and I don’t know whether to agree or disagree.”

He abstained from voting, what an honest person.

Why was Teacher Zhang absent at this time? He cleared his throat: "We are a surgical institute, and we have a duty to deal with these difficult problems. Relieving the patient's pain is the meaning of our work. Since there is no way, we will open a way."

His tone was sonorous and powerful, and he looked like he would give up on me. If everyone hadn't known Teacher Zhang's true nature, they would have been directly moved by his speech.

"Dr. Zhang, can you tell me specifically what you think about this disease?" Xu Zhiliang is Zhang Lin's superior doctor.

Specific views?

Zhang Lin hasn't thought about it yet, why is Lao Xu always uncooperative? After all, he is also an old partner.

"Well - ah - this - that - this is what I think about this disease. As long as we grasp the key link of the problem, the problem can be solved easily. But where is the key link of the problem? The key link of the problem It is the link that can help solve the problem. They are complementary to each other, so--"

"Dr. Zhang, this is a case discussion, please pay attention to the occasion."

Song Zimo had to knock on the table again to maintain order, and Zhang Lin had to stop: "Oh!"

"If - perform muscle flap transplantation, the muscle flap - is just applied to the surface of the cerebellum, and the blood vessels - are you sure it can - grow into the cerebellum? Do you want to - implant the vascular bundle? This will Be safe." Xu Zhiliang was very curious.

"Muscle flap transplantation can completely allow blood vessels to grow into the cerebellum. Please refer to the various muscle flap transplantations in our orthopedic surgery. If vascular bundle implantation is used, it will indeed improve blood supply faster, but it will cause certain damage to the cerebellar parenchyma. Although the damage is minimal, I try not to increase the damage to the already atrophied cerebellum."

Xu Zhiliang understood the reason.

"Actually, the surgical procedure is posterior fossa decompression and blood flow reconstruction?" Song Zimo saw the essence of it.

"Yes, that's it." Yang Ping nodded.

In fact, as Professor Deng said, what else can we do? Since it works in theory, it's totally worth trying.

Because there is no precedent for surgery in this kind of case before, it is a bit difficult to discuss. Most young doctors can only listen and cannot speak.

After the meeting, Dr. Zhao still didn't give up and went to Li Guodong to argue. Li Guodong didn't want to argue with him, it was pointless.

"Li Guodong, wait a minute, let's talk."

After the meeting, Dr. Zhao stopped Li Guodong. Li Guodong's head was so big that he knew what Dr. Zhao was going to say next.

"You seem to have opinions on Chinese medicine?" Dr. Zhao asked.

Li Guodong did not answer him: "Let's talk about it later, I still have several dressing changes."

Dr. Zhao grabbed Li Guodong's clothes: "Li Guodong, I will chat for a few minutes without delaying your business. We cannot be fooled by others. We must resolutely protect our traditional culture and become the backbone of protecting traditional Chinese medicine. Traditional Chinese medicine protects our five thousand people." Years ago, it is far beyond what Western medicine can match. Many modern Western medicine treatments can find their origins in Traditional Chinese Medicine, such as artemisinin, which actually comes from Traditional Chinese Medicine--"

''Yes, you are right. Now I am suddenly enlightened. I said something wrong in the meeting. I will reflect on it now! "

Li Guodong didn't want to dwell on this matter anymore.

Dr. Zhao let go of his hand holding the clothes.