godfather of surgery

Chapter 954 Literacy

Thinking requires knowledge as content. If you lack this knowledge in your head, you will naturally not be able to think.

Although Zhang Lin and Xiao Wu almost lost face because of their rash advances, now no one can figure out what kind of illness it is, so they feel much better. At least their image in the minds of the students has not been seriously damaged.

"Isn't this a special kind of bone tumor? The tumor has completely eroded the bone?" Li Guodong guessed.

The reason why there is a special feature in front of the tumor is because in Li Guodong's mind, no bone tumor will behave like this, whether it is a primary tumor or a metastasis.

The learning and research atmosphere at the Institute of Surgery is very good. For example, in case discussions like this, everyone can speak freely and it doesn't matter whether what they say is right or wrong. Even if what they say is a little outrageous, they will not be laughed at or criticized.

Generally speaking, speeches in case discussions are gradually upgraded from junior doctors to senior doctors, because senior doctors have more knowledge and experience than junior doctors. If senior doctors speak first, it is easy to As a result, junior doctors will have no room to perform.

A department boss like Yang Ping is naturally the last one to give a summary, so that everyone can discuss freely. Otherwise, the answer will be given at the beginning and the conversation will not be continued.

"Well, I also think that this should be a special tumor, but according to our current knowledge, there is no bone tumor that behaves like this." Dr. Zhao Wenbo also agreed with Li Guodong's opinion.

Li Guodong and Zhao Wenbo are mortal enemies. It is rare for the two to have the same opinion at this time. If they usually argue with each other, these young doctors will doubt their lives.

Especially when it comes to the debate about traditional Chinese medicine, Li Guodong and Zhao Wenbo are at each other's throats as soon as they open their mouths, because their views are completely different. Zhao Wenbo is a fan of traditional Chinese medicine, but Li Guodong always pours cold water on him, so the two argue about this matter every day. shelf.

There is no way for the two of them to argue about this case, because if they want to argue, both of them must know the case, otherwise the basis of the argument will be lost. Now that neither of them understands it, they are naturally in the same camp.

"It may also be a special infection, a viral or bacterial infection, or osteomyelitis caused by other microorganisms, which erodes the bone and leads to massive bone resorption."

One graduate student boldly put forward his own statement.

"Is there any virus or bacteria like this? I haven't read any papers on this."

Another graduate student expressed doubt.

"Extreme manifestations of necrosis after stress shielding or destruction of bone blood supply? Is it possible?"

This idea is very innovative.

"It's impossible. Stress shielding can only cause osteoporosis. Even if blood supply damage leads to a large amount of osteonecrosis, how can the necrotic bone absorb so much, let alone absorb so much in one year."

"Is there something wrong with the X-ray? Will the image be distorted due to transillumination?"

A graduate student stood up and approached the projected X-ray to get a better look.

Although the question is naive, it is still a question. The most important thing in the scientific spirit is questioning and exploration. Without the spirit of questioning, it is impossible to achieve results in science.

"The same goes for the X-rays we reviewed several times."

Song Zimo pulled out another X-ray, which was similar to this one.

Senior doctors like Zhang Lin Xiaowu have puzzled faces, not to mention those graduate students, regular trainees and interns. Graduate students are a little better. After all, the specialist theory is orthopedics, and regular trainees and interns are all in the same field. In the state of rotational medicine, the breadth and depth of specialist knowledge are far from enough.

Any specialized knowledge requires a long period of accumulation. Without accumulation, you can't do anything with the basic knowledge in textbooks. Textbooks only serve as professional enlightenment.

"This is strange. Is it possible that it has something to do with the metal material? The patient has a special constitution and has a special reaction to the metal material, which ultimately leads to bone resorption."

Xia Shu put forward his own opinion. He is a doctor of cardiac surgery and knows nothing about orthopedics, so for the time being, he is just watching the excitement.

Dr. Jin, who was sitting next to Xia Shu, had just been studying medical records. Now he raised his head and said:

"Let me say a few words. This patient's femoral shaft is resorbed. I consider idiopathic osteolysis. This is a rare disease. There are only about two hundred cases reported in the world. In the literature I have read, except Osteolysis, I really can’t think of another disease that can cause large sections of the femur to disappear.”

Idiopathic osteolysis?

This diagnosis is very simple, with only a few words, but everyone has never heard of this disease, has not seen it in the literature, and knows nothing about this disease.

Song Zimo and Xu Zhiliang have also thought about osteolysis, because they have already gone through specialized studies on rare diseases, while Zhang Lin Xiaowu and others have not yet entered this learning stage. Without exposure to this knowledge, naturally they will not think.

The two people originally wanted to speak later, but Lao Jin solved the mystery in advance. It seemed that Lao Jin had read a lot of books. Lao Jin was already in his early forties and was still an attending physician. Director Ouyang, who was at the same time as him, was already a doctor. The team leader of the Department of Orthopedics.

Lao Jin has always given people the impression that he is calm, hard-working, and focused on clinical business for a long time. Apart from reading and studying, he has almost no other hobbies, including drinking and socializing.

Lao Jin once suffered a loss during an operation to remove foreign bodies. Later, he spent a lot of time studying the removal of foreign bodies. He retrieved all the images and pictures of foreign bodies from Sanbo Hospital since its establishment and studied the learning materials about foreign bodies. He designed various methods and procedures for the diagnosis and localization of foreign bodies. Later, when many hospitals encountered foreign bodies that were difficult to remove, they would refer patients to Sanbo Hospital. Song Zimo followed Lao Jin to learn how to remove foreign bodies, and he also became a A master at removing foreign objects.

"Also called Gorham-Stout syndrome, the most obvious manifestation is the spontaneous destruction and resorption of one or more bones. The cause of osteolysis is currently unknown. Except for osteolysis, no other known disease has this kind of disease. Image performance, Dr. Song and Dr. Xu’s opinions,” Lao Jin added.

Song Zimo and Xu Zhiliang nodded at the same time. Song Zimo said: "Indeed, among the known diseases, only osteolysis meets this imaging manifestation. However, bone resorption in osteolysis is generally slow, and it is all absorbed within one year. The speed is still very fast.”

"This is the first time I have encountered such a case!"

Lao Jin has already given the diagnosis, but everyone's minds are still blank. They can understand what the diagnosis means literally, but they have no idea about the disease. There is a complete lack of relevant knowledge about the cause, pathology, clinical manifestations, diagnosis, treatment and prognosis. "This is also the first time I have encountered it. I have read relevant papers before, and I have studied rare orthopedic diseases, so I know about this disease." Lao Jin said modestly.

"Lao Jin is Lao Jin. Osteolysis is a truly rare disease. There was one case that took eight years to get an accurate diagnosis. The diagnosis was finally made at the First Affiliated School of Nandu Medical University." Song Zimo still admires Lao Jin. , his down-to-earth learning spirit has never changed.

It took a lot of effort for Lao Jin to know about this disease. He had studied all the rare diseases announced by the International Health Organization many times before, consulted a large number of documents and books, and was very familiar with these rare diseases. Otherwise, how would it be possible to understand this disease? Medicine is factual science. If you don’t know, you can’t explain it at all, and you can’t talk nonsense.

"Lao Jin——you——are so powerful——"

Xu Zhiliang also admired Lao Jin.

In medicine, any diagnosis with the word "idiopathic" means that the cause of osteolysis has not yet been clarified. There are many things that are currently unknown in medicine about osteolysis, including treatment methods that are immature and uncertain. middle.

"How can such a large section of bone dissolve just like it is? I can't figure it out."

Li Guodong was very confused.

"There are so many things in medicine that we can't figure out. Otherwise, medicine is still in its infancy. Has the mechanism of colds been clearly understood? It seems that we haven't." Zhao Wenbo's sperm gene was awakened again.

For this rare disease, without systematic training in this area, it is impossible to obtain a correct diagnosis. This is also the reason why it took eight years for a case to be diagnosed. The knowledge stored in the minds of most doctors is common. diseases and frequently-occurring diseases. As for rare diseases, even if there is some knowledge, it is sporadic and extremely limited.

Therefore, once they encounter a truly rare disease, in most cases doctors will deal with common diseases and frequently-occurring diseases. If they cannot cure them, there will be no hope.

Since 2008, the World Health Organization has designated the last day of February every year as International Rare Disease Day. In this way, it draws people's attention to rare diseases. There are currently more than rare diseases. The number of people suffering from rare diseases in my country There are about million, which shows that this absolute number is still very large.

The rare diseases we are more familiar with include phenylketonuria, thalassemia, osteogenesis imperfecta, etc. Osteogenesis imperfecta is commonly known as porcelain dolls and glass dolls. Most rare diseases are related to genetics, because each person has about 5- 10 defective genes. If both couples have the same defective genes, there is a possibility of giving birth to these rare genetic diseases.

"Osteolysis is just a descriptive diagnosis. As for the cause, there is currently no way to find it." Song Zimo said.

Dr. Jin said: "Yes, in fact, I also obtained this diagnosis by using elimination thinking. After excluding causes such as inflammation, infection, tumor, osteoporosis, etc., only osteolysis can be explained. Apart from osteolysis, I have never seen this diagnosis so far. Judging from the cases and the literature I have read, there is no other case with such large-scale bone resorption. Professor Huang Zhong from Nandu Affiliated No. 1 diagnosed a case of osteolysis. At that time, the patient also had a femoral surgery, and the fracture never healed. , the fracture gap became wider and wider. The patient went to many hospitals without getting a diagnosis, and underwent many bone grafting surgeries, all of which failed. It was eight years after the onset of the disease that he received a diagnosis from Professor Huang Zhong of Nandu Affiliated One. At that time, Professor Huang was still writing a thesis. Case report.

"Then how to treat it?" Zhang Lin asked.

Dr. Jin said: “First use zoledronic acid or denosumab for medical treatment to prevent further bone resorption and increase bone density, and then consider femoral prosthesis implantation to replace the resorption defective bone. , but I’m wondering if I can try Ilizarov bone lengthening surgery?”

"The biggest characteristic of this disease is bone resorption, which occurs over a large area. Originally, the absorption and formation of bone are balanced. Once the balance is broken, the balance changes. It will tend to one side. The current disease is that the balance is seriously tilted towards bone resorption, so if you use-- bone lengthening technology-- I'm afraid it won't work. The necessary condition for bone lengthening-- is to be able to generate bone, Irizha Love also uses the principle of distraction to stimulate bone formation." Xu Zhiliang stammered.

Although it was difficult to hear Xu Zhiliang speak, everyone was used to his stuttering now, so it didn't matter. Especially Zhang Lin. He almost had a myocardial infarction when he first heard Xu Zhiliang speak. Later, he gradually adapted to it, and it was nothing. If Xu Zhiliang suddenly stopped stuttering one day, Zhang Lin would be a little uncomfortable.

"So you must first use anti-osteoporosis drugs such as zoledronic acid or denosumab to block bone resorption and increase bone density before subsequent treatments can begin." Dr. Jin stared at the projected X-ray.

"Ilizalov's bone traction theory itself stimulates bone growth. Can it stimulate bone growth in patients with this kind of osteolysis? If it can, it can block bone resorption and lengthen the bone."

Song Zimo's thinking was broadened. In fact, questioning, criticism and debate are the spirit of academics. Without questioning, criticism and debate, there will be no academic progress. The real thing will become clearer with more debate.

"Everyone is always struggling to find a suitable topic. Isn't the topic right now? The Ilizarov technique treats osteolysis. If it succeeds, we will find a new method to treat osteolysis." Yang Ping just likes everyone arguing with each other like this. If everyone doesn't speak and is lifeless, it won't be interesting.

"The professor also means osteolysis?"

After all, Lao Jin obtained the diagnosis using the elimination method, not a direct diagnosis, and the diagnosis was also descriptive, not etiological diagnosis, so he could not be 100% sure.

"Among the known diseases, this is the only one that can be explained. We can perform bone puncture on the patient to obtain bone tissue for pathological examination. Under the microscope, we can see abundant sinusoidal capillary fibrous tissue proliferation, and lymph nodes can also be seen. Cell infiltration or osteoclasts, these pathological manifestations have certain characteristics.”

Song Zimo immediately said: "The increase in vascular endothelial factor in the blood may also be a sign, but the current supporting evidence is still insufficient, but we can also test it."

The gap, this is the gap.

Zhang Lin and Xiao Wu can't keep up with their pace, because they really lack relevant knowledge in their heads. Their studies have not yet reached this point. They have not conducted systematic study and research on rare diseases. Currently, for the diagnosis of rare diseases, they It's like a blind cat catching a mouse. When you come across something that you happen to know, you vaguely think it looks like it, and then you quickly check the information. If it matches, you make a diagnosis. In this way, if you are right, you will be happy. If you are not right, it does not matter. It is a rare disease anyway, and it is normal that you cannot diagnose it yourself.

Looking at the current diagnosis of rare diseases by several experts, others have systematic theoretical knowledge of rare diseases and are familiar with a small number of clinical cases. Their analyzes and insights are not at all a matter of luck like my own.

"When we have time, we will hold several training courses on these rare diseases, so that everyone will not be so confused." Yang Ping turned to Song Zimo and said.

Song Zimo nodded: "I will sort it out first, print out a material for everyone to study on their own, and then intersperse this knowledge with regular weekly lectures to give everyone a thorough understanding of rare diseases. Zhang Lin, please organize it." "

"Ok!"

Teacher Zhang responded and said that he must eliminate illiteracy as soon as possible. Next time he encounters this rare disease, he can also show it in front of the students.

PS: I have been too busy during this period and have not been able to update properly. Sorry! I'm a little less busy now, so I'll try my best to keep updating regularly, thank you all!