Gou is practicing medicine in the clinic

Chapter 287 The proliferative nature of blood vessels and the use of the Bronze Medal

I'm not too sure about this.

He can only make a comprehensive diagnosis based on the known information and the patient's medical history, age, and work nature.

Some examinations done after the patient was admitted showed that a single nerve should be involved.

Although the patient's palm could not be straightened, he could feel the pain in the tiger's mouth, and the strength of the muscles innervated by other nerves in the left upper limb was normal.That means the patient's cause may lie in the radial nerve.

It has little relationship with the musculocutaneous nerve, dorsal nerve, and palmar nerve.

The lesion has now been identified as being on the radial nerve, but the specific cause and other conditions are unknown.

The MRI showed no abnormalities in the patient's cervical spine, which is a good thing.

The possibility of cervical spine compression and disease can basically be ruled out.

The spinal nerves should be fine.

In this way, the lesion area shrank a bit.It is basically locked in a small area of ​​the radial nerve of the left upper limb.

"If you want to confirm this, you must conduct a more in-depth examination. Neuropathy can be partially detected by electromyographic testing. But for this case, just checking an electromyographic signal is definitely not enough. The rest is intuitive and The only efficient way to check is surgical exploration.”

Li Jingsheng's brows frowned slightly.

The patient's condition is constantly analyzed.

Surgical exploration has never been easily accepted by patients and their families, and even doctors try to avoid it.

Because it is an invasive examination.

It would be fine if the disease was detected, but God knows what would happen to the family and the patient if the disease was not detected?
If you encounter someone who is unreasonable, call the hospital’s complaint hotline, then call the competent department, and then talk to a media reporter.

In short, it’s all kinds of trouble.

Doctors often find themselves in a particularly passive position.

Some things cannot be explained clearly without reason.

Therefore, when doctors consider examination methods, if both examination methods have the same diagnostic significance, one is an MRI that costs two to three thousand yuan, and the other is a surgical exploration that costs several hundred yuan.

Doctors would choose the former without hesitation.

If nothing else, everyone is afraid of getting into trouble.

"Anyway, I'm just a medical assistant. If I answer the question wrong and lose points, there will be Director Zhong as well." Li Jingsheng thought like this, and without any further hesitation, he decisively applied for surgical exploration.

And the specific exploration locations are stated.

After applying, the results came out quickly.

After surgical exploration, it was found that the main trunk of the radial nerve had an hourglass-like lesion, and the entire nerve was almost completely severed.

It seems that requesting surgical exploration is correct.

Such deep nerve ruptures are difficult to detect with imaging tests.

No wonder the electromyographic signal along this route disappeared.

Now the cause of the disease has been basically found out.

He was secretly relieved, but if he wanted to diagnose the specific cause, he had to continue investigating.

How was this radial nerve severed?
Did the patient suffer a nerve tear due to excessive exertion at work?

Obviously unlikely.

Generally speaking, after millions of years of evolution, the structures of various tissues and organs of the human body have become very scientific and reasonable.

For example, the most important spinal nerves are protected inside the spine.

The brain is protected inside the skull.

Our heads have even evolved into an oval shape to reduce damage from head impacts.

Another example is blood vessels. All that can be seen on the surface are veins.

Blood vessels that will cause rapid blood loss and death after being scratched are basically hidden deep in the blood vessels.

Even if the patient exerts some force at work, it is impossible to tear the radial nerve alone.

This broken area also does not fit into the easy-to-tear area.

After Li Jingsheng carefully looked at the pictures of the intraoperative exploration, he found no obvious compression of the radial nerve near its rupture.

However, during the intraoperative inspection, it was discovered that there was a section of nerve edema about eight to nine centimeters long on the elbow, which was slightly adherent to the surrounding tissue.

Moreover, both ends of the diseased nerve segment were strangulated and thinned like a band, almost interrupted.

It can be seen that there is a certain degree of torsion at both ends of the nerve at the point of strangulation.

Then you can also see obvious proliferation of blood vessels around the nerves.

There are two or three smaller blood vessels that even cross the nerve.

Is it because these small blood vessels cross each other and cause the nerve to twist and narrow?

After analysis and deduction, he ruled out this possibility.

Since there are only pictures, what you see is definitely not as intuitive as the surgical exploration in person.

But it is impossible for these three small blood vessels to cause such serious lesions to the radial nerve.

It must be mentioned that the blood vessels of the human body are not static.

Like the roots of a tree, they can continue to grow and change.

For example, the most important heart of our human body.

Many people must have eaten pig heart. It is hard to chew and many parts are particularly tough.

This is because the heart is made of two blood vessels.

When the baby is still in the mother's belly, he does not have a heart at first.

The two blood vessels fuse together and slowly undergo a series of complex growth and changes to form a human heart.

This technology is already being studied abroad.

A new artificial heart is created using the patient's own blood vessels.It is then transplanted into the patient's chest.

Unfortunately, so far, there is still no success.

The embryonic development process of a baby cannot be completely imitated by artificial technology.

Perhaps in the near future, when this technology achieves a major breakthrough and it is possible to use two large blood vessels in the human body to create an artificial heart, there will be good news for patients with heart disease.

You know, replacing an artificial heart now not only easily costs one million yuan, but also requires an external power supply.

No matter where the patient goes, he has to carry at least two batteries on his back.

A spare piece.

Because the battery is exhausted, the patient's artificial heart will stop beating.

This limitation is too great.

Foreign countries currently believe that the most ideal site for artificial heart gestation is the human thigh.

Take the femoral artery and a large vein, and use a series of methods to make them fuse, proliferate, and change.

It's just that this experiment violates many regulations such as human rights in the law, and there is no way to experiment on humans.

Maybe there is, but it's only done secretly in the laboratory.

Just like the cloning technology that was very popular in the past.

If this technology is used in medical treatment, it can also solve the problem of organ transplant shortage.

It was also banned because it violated the law.

With the development of mankind to this day, there are too many new technologies worth exploring.

Li Jingsheng thought carefully about the reasons for the proliferation of these three small blood vessels.

Is it because of blood vessel proliferation caused by neuropathy?
Considering that a nine-centimeter-long radial nerve in the patient's left upper limb was edematous, strangulated, and even almost completely ruptured, he determined it to be neuropathy.

Rather than being caused by vascular disease.

"It is necessary to check the patient's pathology again!"

There was no hesitation this time, and he had already found out this step. He also wanted to find out what caused such a serious neuropathy in the patient.The results came quickly.

Pathological examination revealed that inflammatory cells, mainly lymphocytes, infiltrated the nerves, and narrowing of the blood vessel lumen and partial obturator cords were found.

Neuroedema is accompanied by axonal thinning, and the number is significantly reduced.

After reading the pathological examination results, Li Jingsheng finally understood why the three small blood vessels had proliferated.

Because blood vessels have a replacement mechanism.

It is also a life-saving mechanism.

For example, in some patients, when the large blood vessels of the heart are blocked or narrowed, there will be problems with the blood supply to the heart.

As the body adjusts itself, some small blood vessels connected to this large blood vessel will gradually begin to thicken, and then replace most of the blood transfusion function of this large blood vessel.

Such patients may experience symptoms such as palpitation, shortness of breath, and fatigue.

After going to the hospital for an examination, I discovered that my ancestors had accumulated good deeds over many lifetimes, and the major arteries had been blocked.People would have suffered a myocardial infarction or sudden death long ago, but this blood vessel around the aorta saved the patient's life.

Although they try to become thicker, they still cannot meet the blood supply requirements of the aorta.

But it can replace [-] to [-]% of the blood transfusion capacity of the aorta.

As a result, the patient only feels fatigue, palpitation, and shortness of breath, but his heart does not stop.

This patient's radial nerve was damaged by inflammatory cells, mainly lymphocytes, which caused the surrounding blood vessel lumen to become narrow and even partially obliterated. This forced the three small blood vessels to proliferate and supply blood across the diseased radial nerve.

At this point in the investigation, the cause has been basically identified.

But there is no way to find out the more detailed cause.

At least he didn't have the conditions to investigate further.

Perhaps until later generations of scientists conduct more in-depth research, they will be able to discover why those inflammatory cells, mainly lymphocytes, appear to damage nerves.

Just like the initial malignant tumor, it is also an unknown disease.

Li Jingsheng also defined this disease as an unknown disease.

The etiological diagnosis he wrote was that the left radial nerve showed an hourglass-shaped lesion, and surgical treatment was recommended.

Then the surgical plan was given.

Submit your answer.

"His grandma's, two points deducted."

Zhong Hu patted his thigh there with an expression of great annoyance.

"Damn it, Xiao Li, why are you three points taller than me?"

Zhong Hu saw on the big screen that the ranking of his group jumped directly from more than 20 to No. 4.Tied with the top three for first place.

The advantage of this team fighting method is that only one person can answer correctly.

Zhong Hu was deducted two points for either a missed diagnosis or unnecessary excessive examination.

As for Li Jingsheng, he scored one point more than the full score, which is a bonus point.

"Maybe the examination items I applied for are more intuitive! Have you checked the patient's pathology?"

"What kind of pathology are you checking? After I applied for surgical exploration, I have discovered the cause of the disease. Direct surgery can solve the problem for the patient. If you still check the pathology, isn't it like taking off your pants and farting?"

Director Zhong Hu's temper and impatience are actually not suitable for being a doctor.

But he happened to become a doctor, and he was also a powerful chief physician.

Hard work can sometimes overcome adverse conditions.

"Look at the patient's pathological examination. I have never seen this disease before. You are well-informed and experienced, so you may have seen it before."

Li Jingsheng asked Director Zhong Hu to check the patient's pathological examination results.

As for ranking fourth, tied for first place with the first three teams, he seemed extremely indifferent.

If you get too many gold medals, that's all.

"I've never seen this kind of disease before. Lao Chen, Xiao Hu, have you ever seen this kind of disease?"

Zhong Hu is only about ten years older than Hu Jia, and he actually calls him Xiao Hu.

After all, he is the deputy chief physician.

Fortunately, colleagues in the department have long been accustomed to his personality.

After seeing it, Chen Anchen and Hu Jia both said they had never seen this kind of disease.

"There are too many unknown diseases. This should be a rare and unknown disease that mainly damages bones and nerves."

Chen Anchen said seriously.

The more experienced a doctor is, the more unknown and strange diseases he has seen.

The answers to the first question ended quickly, and there were a total of eleven orthopedic surgery teams who received extra points.This shows that these people have no problems in the direction of diagnosis and application for inspection items.

The answers in other aspects are also quite satisfactory.

The competition entered the second phase, which was similar to the previous bone trauma competition.

The participating teams are also required to provide surgical plans first, and then the judges will give scores.

The team with the highest score has priority for surgery.

The team of Li Jingsheng and Zhong Hu had good luck and got the qualification for surgery in the first round.

Li Jingsheng basically didn't worry about the answers this time. Director Zhong Hu answered them all alone.

It also shows that Zhong Hu’s professional level is indeed very strong.

It is definitely wrong for him to despise Professor Wu so much, but he is really capable.

……

The operation was successfully completed in more than 40 minutes.

The process went fairly smoothly.

Li Jingsheng's suturing and separation techniques both played a big role in the operation.

As for the incision, Zhong Hu didn't give him the chance to get started.

Originally, his incision technique was the strongest.

Back in the rest area, the four members of the team waited patiently for the final ranking.

"Fuck, let me take the seventh place."

After Zhong Hu saw the final rankings decided, he cursed.

Fortunately, the sound in the arena is relatively noisy and others cannot hear me.

Otherwise, it would be too damaging for a chief physician to use foul language when he opens his mouth.

"Director Zhong, congratulations! You have won our hospital's third bronze medal."

Chen Anchen smiled and congratulated him.

"Oh, I'm still a little bit behind. At least I have to get a silver medal to be successful! I'm afraid I'll be laughed at by Wu again when I go back."

Zhong Hu said this, and the smile on his face still proved that his team could successfully win the bronze medal, which made him very happy.

It's just that the psychological expectations were a little worse.

"What right does he have to laugh at you? If you dare to laugh, just smash the bronze medal trophy into his face."

Chen Anchen and Professor Wu also refused to deal with them.

Speak with some aggression.

"Haha, that's a good idea. The bronze trophy is only of so much use."

Zhong Hu looked at Li Jingsheng with a smile.

"Xiao Li, and two girls, went on stage to win the award together."

(End of this chapter)