This doctor has a system

Chapter 312 301. Rare arteriovenous fistula

Colleagues carried him out of his home on a stretcher.

Seeing the seriousness of the situation, Shui Hongguang was frightened. He quickly contacted the expert in the province to transfer him to another hospital. The other party still said that the bed space was tight and suggested that he continue to be treated in the local hospital.

"I think myelitis is getting worse. You can try increasing the hormone dose." The other party said on the phone.

Shui Hongguang received another hormone infusion in the hospital. At that time, he felt that his symptoms had been relieved a lot, but when it was time to eat, he found that he could not even pick up chopsticks.

This is so scary!
Shui Hongguang's wife is a high school teacher and she was the first to realize the seriousness of the matter.

The two fell in love very much when they were young, and it was love at first sight. At that time, Shui Hongguang was just a young doctor and his family conditions were very poor. His wife married him without hesitation despite the pressure.

In the past few years, the two of them played the piano and played the piano in harmony, but then they stopped.

That's how feelings are. Once the passion fades away, all that's left is just feathers.

One time, his wife accidentally found him alone with a beautiful woman in the house. Shui Hongguang explained that the woman was giving him a massage at the time.

"You know, I have cervical spondylosis." He defended.

But why both parties had to take off their clothes during the massage, he has never been able to explain.

Maybe it's too hot.

Later, more problems arose between the two, from repeated quarrels at the beginning to now being separated in two places.

When his wife found out he was sick, she didn't take it seriously at first, thinking that it would be nothing if he died.
But when I really saw him like this, my heart softened.

"Are you stupid?!"

"You're still in this situation and you're still hanging on? Go to the provincial hospital as soon as possible!"

Shui Hongguang quickly contacted other people, and finally came to the Provincial People's Hospital through Dean Guo's relationship.

He was first admitted to the Department of Neurology. After seeing the MRI, the doctor in charge initially determined that it was myelitis. She thought that the amount of hormones used before was a little low, so she gave him some more.

Shui Hongguang was scheduled to undergo lumbar puncture and magnetic resonance imaging the next day, and the final results ruled out myelitis.

This suddenly made everyone a little confused. After working for a long time, it turned out that it was not myelitis.

Seeing that the diagnosis was at an impasse, the patient's condition seemed to be worsening, and the doctor in charge was a little anxious, so he decided to organize a hospital-wide multidisciplinary consultation.

Call everyone to come over and think of a solution.

Gao Feng was the first to arrive, because the Department of Neurology is just downstairs from the Department of General Medicine and can be reached by taking the stairs to the next floor.

Gao Feng first went to the ward to check on the patient. Shui Hongguang's mental state was very poor. His experiences these days made him feel scared.

"This is Director Gao of our General Medicine Department," the doctor in charge introduced.

Shui Hongguang forced himself to smile and Gao Feng nodded to him while conducting a careful physical examination.

"Let me take a look at his MRI examination again." After Gao Feng finished speaking, he was about to leave the ward. At this time, the nurse came in pushing a trolley. It seemed that she was going to give the patient an infusion.

"What kind of medicine?" he asked casually.

"Methylprednisolone sodium succinate 80mg." The nurse replied.

Methylprednisolone sodium succinate is a glucocorticoid drug, which is what we often call a hormone. It has anti-inflammatory, anti-viral, anti-immune, anti-shock, and anti-allergic effects.

It is commonly used clinically to treat rheumatoid arthritis, lupus erythematosus, nephritis, allergic rhinitis, thyroiditis and tumors.

"Don't lose yet." Gao Feng hesitated and said, "Let's wait until we finish the consultation."

The nurse was stunned for a moment and subconsciously looked at the doctor in charge, who nodded.

"Director Gao, is there any problem?" the doctor in charge asked while taking the patient's MRI examination.

"I always feel that there is something wrong, but I can't explain it at the moment." Gao Feng replied.

He carefully looked at the patient's cervical and lumbar spine MRI examination, and still felt that something was wrong, but he just couldn't remember what went wrong.

Soon, all the directors involved in the multidisciplinary consultation arrived.

Director Wang of the Medical Education Department still attaches great importance to today's consultation. After all, the patient is the director of a grassroots county hospital and a medical and health worker. Now he has a physical problem.

I come to the Provincial Hospital for treatment because I believe in the quality of the Provincial People's Hospital. If the patient can recover and be discharged smoothly, that would definitely be the best.

If something goes wrong here, it will definitely look bad on everyone's face.

"I see that the patient's blood sugar is very high, and his glycation level is 9.8." Director Cao of the Department of Endocrinology was the first to say, "Such a high blood sugar level is unacceptable."

Director Cao's dress was as exquisite as ever, and his white neck was very eye-catching. Gao Feng took a few more appreciative glances. The latter seemed to be slightly aware of it, and he quickly looked away.

"He has been taking hormones these past few days, and his blood sugar has been higher than usual." The doctor in charge explained, "I have temporarily added insulin to him, but this morning his blood sugar was 19mmol/l two hours after a meal."

Generally speaking, blood sugar level 2 hours after a meal should not exceed 11.1mmol/L. Shui Hongguang's was obviously above the normal value.

"We can come over and bring him an insulin pump to stabilize his blood sugar first," Director Cao said.

"But the patient's current condition probably has little to do with blood sugar."

Diabetic neuropathy will occur after high blood sugar for a long time, with distal symmetrical neuropathy as the main manifestation.

For example, damage to sensory nerves can manifest as numbness, pain, itching, and hyperesthesia of the skin in the areas innervated by the nerves.

Among them, numbness is the most common and manifests as symmetrical, glove-like or sock-like loss of sensation in the distal parts of the limbs, and a feeling of cotton on the soles of the feet when walking.

The pain is spontaneous burning pain and electric shock pain. The pain can be aggravated at night, cold or friction, and can manifest as sciatica, trigeminal neuralgia, and brachial plexus pain.

But the patient had no such symptoms.

"The patient's heart function is okay. There are no major problems with the echocardiogram. The electrocardiogram only shows ST segment depression in some leads." Director Xin Guoyu of the Department of Cardiology said, "His condition should have nothing to do with the heart."

"The patient's condition is quite strange." Director He of the Department of Neurosurgery said, "I found that his condition seemed to have worsened after the administration of hormones and immunoglobulins."

"The patient's symptoms were not serious when he underwent cervical spine MRI. He just felt a sense of pressure on his shoulders."

"He gradually developed obvious symptoms of limb weakness after infusion of hormones and immunoglobulins." Immune globulin generally does not cause this situation. As for hormones, they are more widely used clinically and are part of the treatment process of many diseases. Used in all.

Shui Hongguang uses methylprednisolone sodium succinate, which is a medium- and long-acting glucocorticoid. Long-term use may cause a series of side effects such as gastrointestinal bleeding and osteoporosis, but short-term use is still very safe. .

It's really inappropriate for him to be in this situation.

Gao Feng's eyes suddenly lit up. He agreed with Director He's opinion. In fact, he was aware of this situation at the beginning.

Director Li of the imaging department asked the bedside doctor to open the patient's magnetic resonance image.

"His imaging findings do look a lot like myelitis, but lumbar puncture and magnetic resonance imaging are negative. This situation is still rare."

After he finished speaking, he subconsciously looked at Gao Feng, who was obviously more accomplished in imaging than him.

"Director Gao, do you have any advice?"

"Well" Gao Feng hesitated, "I remembered a disease, but I'm not sure."

"Hurry up and let everyone discuss it." Director Wang from the Medical Education Department urged. After everyone talked for a long time, there was no progress, and he was a little anxious.

"Could it be an arteriovenous fistula at the craniocervical junction?" Gao Feng said.

"Arteriovenous fistula?" Everyone immediately started discussing among themselves.

What kind of disease is craniocervical junction arteriovenous fistula?In short, it is a "short circuit" where the arteries and veins are directly connected at the junction of the head and neck.Blood no longer flows through capillaries, and the resulting edema can compress the spinal cord.

This is a rare disease that often occurs in middle-aged men. The male-female incidence ratio is 3:1, and the main age distribution is (57±10) years old.

The clinical manifestations of arteriovenous fistulas are diverse, including subarachnoid hemorrhage, spinal cord edema, brainstem dysfunction, radicular pain, and cranial nerve palsy.

It is currently believed that the main cause of spinal cord edema or brainstem dysfunction caused by arteriovenous fistulas at the craniocervical junction is increased venous pressure.

"The use of hormones is strictly prohibited in this disease." Gao Feng continued, "Hormone treatment can cause temporary fluid retention, which can lead to congestion of the drainage veins, thereby aggravating spinal edema. Patients can show an acute decline in spinal cord or brainstem function."

"Director Xu, is this arteriovenous fistula in the craniocervical junction a disease that belongs to your department?" asked a director.

Director Xu of the Department of Neurology shook his head, "I have seen one case in my many years of working. It was when I was a young student at X He."

"This disease requires surgery or interventional embolization. The key to surgical resection is to completely cut off the beginning of the drainage vein."

"The surgical methods for arteriovenous fistulas with and without subdural supply arteries are slightly different: for arteriovenous fistulas without subdural supply arteries, the surgical goal is to cut off the dilated nerve root vein; while for arteriovenous fistulas with subdural supply arteries, the surgical goal is to cut off the dilated nerve root veins; For arteriovenous fistula, not only the dilated nerve root vein must be cut off during the operation, but also the intradural blood supply artery should be cut off.”

I have to say that the Provincial Doctor is really capable of producing many people, and being the director of a hospital of this level has a lot of experience.

Although Director Xu had not diagnosed the disease, when he mentioned the name of the disease, disease-related knowledge and treatment methods immediately emerged in his mind, and his usual knowledge reserve was average.

"How can we be absolutely sure that this is the disease?" Director Wang from the Medical Education Department asked, "Are there any invasive tests needed?"

"Whole cerebral angiography is the gold standard." Gao Fengyan answered concisely and concisely.

"Let me contact my teacher." Director He of the Department of Neurosurgery said, "They should have done this before."

Director He's mentor is from Beijing No. [-] Hospital. He is the leader in neurosurgery in China, as everyone here knows.

He took his cell phone and recorded the MRI images on his computer, then started making calls.

"Xiao He, what's the matter with you?" An old voice came from the phone. It seems that Director He's mentor must be quite old.

"Teacher, it's like this. We have a patient here who feels like an arteriovenous fistula in the craniocervical junction." Director He said, "I want you to take a look."

"Did you do magnetic resonance imaging and cerebral angiography?" the other party asked.

"I have an MRI, but I haven't done a cerebral angiogram yet."

"Then send it over and I'll take a look."

After 5-6 minutes, Director He's phone rang.

"It's an arteriovenous fistula. My teacher said it's very typical on imaging."

"Great, we finally have a clear diagnosis for the patient." Director Wang of the Medical Education Department was very happy, "Then let's arrange the surgery as soon as possible so that the patient can recover and be discharged as soon as possible."

"This" Director He's face looked a little embarrassed.

"What's wrong?" Director Wang was very surprised.

"I guess we can't do this here." Gao Feng said aloud when he saw Director He couldn't open his mouth.

"Can't do it?" Director Wang was a little incredulous. "Is this operation very difficult?" He was really surprised. Every time when they encountered problems in the past, people might say that this operation was very risky and it might be difficult to perform. Die on stage or something like that
But it is still very rare to say clearly that it cannot be done.

"The incidence of this disease is too low, and we have never performed it here." Director He told the truth, "Neuroendoscopy combined with fluorescence contrast imaging may be needed during the operation."

"That's it." Director Wang understood what he meant. He had never really done it before, so it was definitely not appropriate to rush forward.

At this position, if it is not handled properly during the operation, the patient can die on the spot, which is no joke.

"Then transfer him to another hospital quickly."

The bed doctor quickly informed Shui Hongguang of the consultation results, who was both happy and depressed.

I was happy that the diagnosis was finally clear, but I was depressed that I had such a terrible disease.

Treating the arteriovenous fistula at the craniocervical junction is not a small operation, and the risks are quite high.

And not everything will be fine after surgery. The symptoms of weakness in the lower limbs may not disappear even after surgery, and long-term rehabilitation treatment is required.

"Our neurosurgery director He's mentor is very good at this. You can go directly to the capital to find him." said the doctor in charge.

"It's probably not possible to go to my teacher. You have to go to my senior brother." Director He said from the side. The instructor is too old now. Not to mention the trembling hands and blurry eyes, even standing next to the operating table for 20 minutes is probably enough.

No matter what, Shui Hongguang still actively handled the discharge. Since the problem could not be solved here, he had no choice but to run to the capital.

There was nothing he could do about it. Even though he was the director of a county hospital, his identity changed immediately after he got sick.

When you enter the hospital, you are a patient, no different from anyone else.

(End of this chapter)