godfather of surgery

Chapter 995: The Doctor is a Doctor

Typical pathological manifestations are the main basis for diagnosing Castleman disease. Now that the diagnostic basis is very clear, the diagnosis is naturally made clear.

Castleman disease was discovered by Dr. Castleman in 1956 and is named after him. This disease, also known as giant lymphadenopathy, is between benign and malignant tumors. It is a rare reactive lymphoproliferative disease with different clinical manifestations and pathological characteristics. The most prominent feature is the manifestation of huge lymph node masses in the abdomen and chest.

The cause of the disease is currently unknown, but a large number of studies have shown that Castleman disease is related to infection with human herpes virus-8 and human immunodeficiency virus, immune system dysfunction, excessive secretion of interleukin-6 and other factors.

Its pathogenesis is still unclear, and it mainly manifests as invasion of lymphatic tissue. The main clinical pathological change is the reactive hyperplasia of lymph nodes caused by chronic inflammatory cell stimulation, which leads to enlargement of lymph nodes in one or multiple parts of the body.

According to the number of affected lymph nodes, it is divided into unicentric and multicentric types. The unicentric type means that only one lymph node or one area of ​​lymph nodes is enlarged. As the name suggests, the multicentric type means that the disease involves more than one lymph node and more than one area.

The monocentric type often occurs in people in their thirties and forties, often in the head and neck area, and systemic symptoms are less common. This type can be treated with surgery and has a relatively good prognosis.

The multicentric type is more common in people in their fifties and sixties, and is characterized by multiple enlarged lymph nodes and involvement of multiple organs, accompanied by symptoms of systemic hypermetabolism such as long-term fever, weight loss, night sweats, and general fatigue, as well as systemic symptoms such as hematocytopenia and hyperimmunoglobulinemia. This type of disease is often complicated and has a poor prognosis.

The diagnosis of this disease relies on pathological biopsy. If the tumor can be removed surgically, it should be removed as much as possible. If the tumor cannot be completely removed surgically, chemotherapy is the preferred treatment method.

Director Jiang came to the ward in person with the pathology report. When Fu Xiaotao heard the name of his disease, he felt relieved. No matter whether the disease could be cured or not, at least now he knew what disease he had. It was better to know clearly than to be confused.

At this time, Fu Xiaotao's parents also felt hopeful. They had been feeling sad and regretful about their son's illness, but now they finally figured out what the disease was. If the disease continued to develop in this way, would there be a chance of cure? Now at least they could have some hope. Before, they didn't even know what the disease was, so how could they have any hope?

However, things are never as good as imagined. Fu Xiaotao suffered from a multicentric type of Castleman's disease, and the prognosis for patients with this type of disease was very poor. It was said that few people survived more than two years, so the news that Director Jiang brought was mixed.

After the diagnosis is clear, the next step is treatment. The difficulty of internal medicine is not in treatment but in diagnosis. The diagnosis of surgery is easy but the difficulty lies in the operation.

For surgeons, the general diagnosis is relatively easy to figure out, but for the same disease, different doctors can have very different surgical results. Internists are different, as they spend a lot of energy on diagnosis. Once the diagnosis is clear, there are guidelines to refer to for the rest of the treatment, and everyone is pretty much the same.

Even rare diseases have their own treatment guidelines, but general treatment guidelines are usually lagging behind. However, for safety reasons, most doctors are willing to follow the guidelines, regardless of whether they are effective or not, because there is nothing wrong with doing so no matter what the results are. Once new methods outside the guidelines are used, one may get into trouble if one is not careful.

"Use cetuximab first to see the effect. If it doesn't work, then use chemotherapy." Director Jiang told Fu Xiaotao.

"Chemotherapy? Is this a tumor?" Fu Xiaotao's parents immediately became alert.

Director Jiang explained: "This is a disease between benign and malignant tumors. We have at least figured out what the disease is and how to treat it. As for the effectiveness of the treatment, no one dares to draw a conclusion yet."

"Let's give it a try!" Fu Xiaotao's mother was quite calm. Compared to her previous confusion, she has made great progress now.

But Fu Xiaotao's father is not so optimistic. He feels that the current situation is even worse. Before, he didn't know what the disease was, so at least he was worried, but not desperate. Now he knows what the disease is, and the hope of curing it is very slim, so he is now desperate.

Fu Xiaotao is different from his parents. When he went for a check-up, he saw a picture of Luo Jin in the corridor. Fu Xiaotao knew Luo Jin's inspirational story. The spiritual power of role models is infinite. Fu Xiaotao is definitely like Luo Jin. As long as there is a glimmer of hope, he will fight for it 200%.

"Just treat it according to your method. Can I see Professor Yang again?" Fu Xiaotao suggested.

Director Jiang said: "I'll contact him for you, but he's very busy and the time is uncertain for now."
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Wen Ruzheng's confidence in Castleman disease is justified, because there are only single-digit cases of this disease reported so far. Although the reported cases are in single digits, the number of cases existing in the population is far from this number, because most doctors do not recognize this disease, which means that these patients have never figured out what disease they have.

When the dedicated Dr. Wen was studying pathological knowledge, he read a lot of literature from morning to night every day, and he was very familiar with the pathological characteristics of some rare diseases, both in text and pictures. Unexpectedly, Wen Ruzheng would encounter this rare disease. This was a once-in-a-lifetime opportunity, but everything was shattered by Yang Ping in less than a minute.

Wen Ruzheng estimated that it took Yang Ping no more than a minute to look at the pathology section. Even if he guessed, it wouldn't be that fast.

The next morning, when the pathology department was handing over the early shift, Wen Ru was reporting to everyone this extremely valuable classic pathology section. He should have been extremely proud, but now he was listless and the whole reporting process seemed dull and boring.

This is definitely not Dr. Wen's usual image, because usually when Dr. Wen explains pathological sections, especially the extremely valuable ones, he is very excited and eloquent, and he will not repeat a word for three days and three nights.

Today, Dr. Wen took such a rare pathology slide and just spent more than ten minutes talking in a boring way to finish it. What happened?

Everyone guessed that Dr. Wen must have suffered some kind of blow, but what could possibly defeat a man who once dared to run naked?

It must be a broken heart. Dr. Wen may have suffered an unprecedented failure in his pursuit of the female doctor in oncology. A broken heart is a painful thing, especially in the short term. Colleagues all speculated so, because for Dr. Wen who spent all day in the pathology department studying pathology sections from morning to night, no one could think of anything that would make him so dejected.

After handing over the shift in the morning, Director Guan asked his colleagues indirectly about Wen Ruzheng's situation. How could such a spirited young man become like a piece of wood? Everyone agreed that the problem lay in his personal feelings.

In order to resolve the knot in Dr. Wen's heart, Director Guan called Wen Ruzheng to his office, closed the door, and poured him a glass of water. Wen Ruzheng took the cup woodenly and put it on the table without saying a word.

"Xiao Wen, you are still young. Don't block the forest with one tree. It's meaningless to lock yourself in a small space. Nowadays, all young people have had several relationships. I was the same at that time. I had several relationships before I was successful."

Director Guan used himself as the protagonist of the story and fabricated some so-called experiences to enlighten Dr. Wen. He thought that this would make it easier for Dr. Wen to resonate with the story and produce an immediate effect.

"A real man should be able to take it and let it go. I was even more miserable than you at that time. I pursued a beautiful girl for several years, but in the end she married someone else. Look, I am living a good life now. Have you ever been depressed?" Wen Ruzheng looked up at Director Guan: "It's been decades since your incident. Of course you are doing well now."

"No, it just happened recently!" Director Guan blurted out.

Wen Ruzheng immediately perked up and stared at Director Guan, who felt uneasy for a moment, but at least there was light in this boy's eyes now: "Are you okay? Have you figured it out?"

"I've been thinking it through. I wasn't afraid when I ran naked last time, so why should I be afraid this time? I just can't understand how Professor Yang, who doesn't usually hang out in the pathology department, can be so good? How can he see it?" Wen Ruzheng said after taking a sip of water.

Director Guan was confused: "You are not heartbroken? Running naked? What are you talking about?"

"I lost the bet with Professor Yang yesterday and had to run naked again. But this time I had to be naked, really naked." Wen Ru was speaking out his problem.

"Aren't you heartbroken?" Director Guan was extremely embarrassed.

"No! It's okay, I'll go to work first." Wen Ruzheng stood up.

"Xiao Wen, everything I just said was fabricated. I just wanted to enlighten you."

"I know!"

"Don't take it personally, it's all fiction."

"I know!"

"Don't go out and talk about this!"

''I know!"

''It's really fiction! "

''I know!"
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This was the first time that Yang Ping encountered this disease in reality. However, when he was reading literature in the system space, Yang Ping had seen this disease and had also seen experimental subjects suffering from this disease, so he was not too unfamiliar with it.

The system space gives a lot of time, and Yang Ping spends all of it on studying. If you were to say what the greatest support the system gives Yang Ping is, it must be ample time. Even if he takes a nap, he might have already studied for several days.

Every case requires all efforts. Since he encountered this kind of case, Yang Ping began to think about the treatment plan. Fu Xiaotao's condition is very serious. All current chemotherapy plans will not be very effective. The chemotherapy drugs themselves have great side effects, some of which are carcinogenic.

In medicine, many treatment plans progress slowly because medical breakthroughs are very difficult, and each medical specialty is highly professional. It is difficult for a person to master the knowledge of his or her profession throughout his or her lifetime, let alone cross specialties and disciplines. Precisely because doctors are always confined to a narrow profession, innovation is difficult. If they can break out of this limitation, innovation becomes relatively easier.

Yang Ping reviewed the treatment method for this disease. The cocktail therapy created by an American expert uses a combination of seven chemotherapy drugs. It is said to be the most advanced method in the world. In fact, Americans have a good spirit of innovation, which is worth learning from. They can come up with bold ideas for many things and put them into practice.

Regarding the pathogenesis of Castleman's disease, Yang Ping summarized numerous literatures. It is generally recognized that interleukin-6, a messenger of the immune system, is the most critical link in the pathogenesis. When the lymph nodes secrete excessive amounts of interleukin-6, the immune system becomes abnormally hyperactive, causing strong local or systemic inflammatory responses. Therefore, from the pathological essence, this is an inflammatory response, so the use of glucocorticoids is effective. However, glucocorticoids only inhibit inflammatory responses and only treat the symptoms, not the root cause. In other words, they can only treat sewage but cannot treat the source of pollution.

After thinking for a while, Yang Ping did not gain any valuable new information, so he decided to reorganize the information about the disease to see if he could find anything new.

Song Zimo knew that Wen Ruzheng was a stubborn person, and was afraid that he would really go streaking without wearing any underwear, so he called Wen Ruzheng and said, "We are just joking, don't take it seriously."

But Wen Ruzheng didn't think so. The more he thought so, the more he felt that this was an underestimation of himself: "I, Wen Ruzheng, am a man of integrity. I always keep my word. How could this be a joke? Don't worry, I will choose a time to fulfill my promise, and I will never compromise."

Wen Ruzheng is really stubborn. According to him, he will definitely carry out his naked streak this time, and he will do it without any reservation. This time he will really streak naked, without any clothes on.

When Song Zimo told Yang Ping the news, Yang Ping could only sigh: Alas - Dr. Wen is a man, that's all Yang Ping could say.

Because there were many surgeries today, it was already past eleven o'clock in the evening when Yang Ping got off work. At the door of the hospital, Yang Ping happened to meet Wen Ruzheng. Wen Ruzheng saw Yang Ping and did not say anything, but just made a gesture to say hello.

He was holding a stopwatch in his hand, his eyes fixed on the road in front of the hospital entrance. He seemed to be doing some test, and he looked very serious. Yang Ping didn't want to disturb him.

The next morning at around six o'clock, when Yang Ping went to work, he saw Wen Ru doing the test again. He was still holding a stopwatch in his hand and his eyes were fixed on the road. What did this guy mean? Why was he so nervous? Why was he holding a stopwatch in his hand both in the evening and in the morning? Yang Ping didn't care about it.

In the doctor's office, the doctors were working and chatting at the same time. Zhang Lin's news was always the most timely. He told everyone that Wen Ru was testing the flow of people on the four roads around the hospital all night yesterday, so as to decide when to run naked. Because the bet stipulated that underwear was not allowed, but he could choose the time, so he was using scientific and rigorous statistical methods to accurately measure the flow of people around the hospital.

It is said that one day's measurement cannot explain the problem, so he measures it every few days, and measures it many times in a row, and eventually he will get a stable and accurate data. After getting the best streaking time, he will start to announce the streaking time.

As expected of Dr. Wen, he works like a doctor.

(End of this chapter)