godfather of surgery

Genetic testing at Sanbo Hospital is usually sent to the Genetics Laboratory of Nandu Medical University. This laboratory is a national key laboratory, and its director Lin Lan is Su Nanchen's fiancée.

Soon, Lankoping's genetic test results came out. Lankoping belongs to SCA3 type. This type of hereditary cerebellospinal ataxia is the most common in my country.

Spinocerebellar ataxia, the abbreviation of the English name is SCA. If strictly defined, it should be a group of degenerative changes in the cerebellum, brainstem, and spinal cord caused by genetic mutations, with progressive motor coordination impairment and balance disorders as the main causes. Clinical manifestations of genetic disorders of the nervous system.

At first, doctors thought that the inheritance mode of this disease was autosomal dominant inheritance. However, as the research on this disease deepened, they found that its inheritance mode is not limited to autosomal dominant inheritance, and there are many inheritance modes: Autosomal recessive inheritance, X-linked inheritance, mitochondrial inheritance.

Not only are there many ways of inheritance, but there are also many types of genes. Researchers have so far discovered a total of 33 types of hereditary cerebellar ataxias, most of which are caused by abnormal repeated expansion of the trinucleotide copy number of the corresponding gene exon. Caused by polyglutamine. The pathological changes are neuronal cell loss and gliosis. Mutated proteins containing polyglutamine are deposited in the nucleus to form intranuclear inclusions. Although the basal ganglia, optic nerves, peripheral nerves, etc. can also be involved, the location of the disease is limited. Mainly in the spinal cord, brainstem, and cerebellum.

Li Guodong himself reviewed a large amount of information and compiled a table that lists various genotypes, the symptoms corresponding to each type, and a literature summary of various treatment methods.

Not only that, Li Guodong also wrote a detailed review about this disease and retrospectively summarized the previous literature.

Li Guodong even sorted out a large number of failed drugs and methods and compiled them in his own review.

He gave the review to Yang Ping to read. Yang Ping was very satisfied after reading it. This kind of scientific thinking is very important for future work. As a doctor, you need a rigorous work attitude.

When everyone had free time, they gathered together again to discuss Lankoping’s surgical plan.

"Professor Yang, I have been thinking about why we don't directly use arterial bypass technology. I analyzed these MRI films for a long time last night. The blood vessel diffusion images in them show that the blood supply in these places is indeed obviously insufficient. Why don't we use it like the heart? Arterial bypass technology is used to improve the blood supply here, no matter what the cause is, I think it should be effective."

Li Guodong is very diligent and has been studying these MRI images.

His question resonated with everyone, and Song Zimo and Xu Zhiliang were also thinking about this issue. If vascular bundle transplantation will increase the damage to the cerebellum, vascular bypass will not. It can be performed on the surface of the cerebellum or in the original blood vessel routing gap.

"Yes, I am also thinking about this issue. Li Guodong raised this question well." Song Zimo responded.

Xu Zhiliang also followed up: "I - I was also thinking of - asking this."

"It seems that everyone has thought of it together. I am now considering whether to use cerebellar artery bypass surgery, but to perform cerebellar artery bypass surgery, our doctors will have to do a lot more work and the risks will also increase a lot. We need to perform cerebellar blood vessels Research, study all previous results on the anatomy of cerebellar blood vessels, determine the precise divisions of cerebellar blood vessels, and what blood vessels are innervated by the ischemic areas you just mentioned, we need to figure out, and then we can plan how to bypass them."

Yang Ping happened to be researching this issue as well, and by the way, he chatted with everyone in detail. It seems that everyone is indeed very attentive. "Do you still remember who was the first doctor to complete coronary artery bypass surgery?" Yang Ping asked everyone.

"Dr. Favaloro from Argentina!"

Song Zimo, Xu Zhiliang and Li Guodong answered at the same time.

They have very clear memories of these things. Only people who are very interested in medicine will pay attention to medical history. Otherwise, the anatomy, physiology, pathology, biochemistry, etc. have already confused people. How can they still have the energy to read the history of medicine? .

"When Dr. Favaloro was studying at the Cleveland Medical Center in the United States, his roommate Sones was the father of angiography. Sones happened to be developing cardiac coronary angiography technology at that time. Dr. Favaloro has always liked cardiac surgery, so he was particularly fascinated by coronary artery disease. Angiography pictures. Whenever Sones completes coronary angiography every day and new pictures come out, Dr. Favaloro will spend several hours studying these coronary angiography pictures and the relationship between blood vessels and myocardium. He is influenced by his friend Sones' research on angiography. , Favaloro firmly believes that coronary artery bypass graft surgery can treat coronary artery stenosis or blockage."

"Dr. Li Min, do you know what major Dr. Favaloro did before he applied to study in Cleveland?" Yang Ping suddenly asked Li Min, who was listening intently.

Li Min didn't know this story, so he shook his head.

"Dr. Favaloro was a general practitioner who had been working as a rural doctor in Argentina. When he was 40 years old, he applied for further studies at the Cleveland Medical Center in the United States and was approved by Cleveland. At the age of 45, he completed the world's first case in Cleveland. Coronary artery bypass surgery." Yang Ping briefly introduced this legendary figure.

What an inspiring story. Li Ming became very interested in Dr. Favaloro's story.

Yang Ping continued: "Dr. Favaloro's first coronary artery bypass surgery patient recovered very well after surgery, so some new warlocks will still perform well even if they have not been clinically tested as long as they have undergone sufficient research in theory. The effect is huge, as is the fontan surgery in cardiac surgery, and the effect was obvious in the first case."

Yang Ping's initial surgical plan was to use a muscle flap transplant with a vascular pedicle, which is more reliable and will result in slower postoperative effects.

This may be a good thing for doctors, reassuring that the surgery is less risky, but for patients, immediate results build strong confidence.

In order to build Lankoping's confidence, Yangping decided to change the surgical method. The decompression method remained the same, but the faster and more direct arterial bypass was used to improve blood supply.

''Even if there are monographs and papers on neurosurgery, the research on the blood supply of the cerebellum should not be as accurate as the blood supply of the heart, right? Song Zimo asked.

Yang Ping nodded: "This is one of our difficulties. Just like Dr. Favaloro studied the relationship between coronary arteries and myocardium, we have to re-study the arterial blood supply vessels of the cerebellum, because all previous related studies have never thought of using it. It is used to guide cerebellar artery bypass grafting, so naturally it will not be as in-depth as heart research."