Gou is practicing medicine in the clinic

Chapter 385: Giant lymph node hyperplasia, surgical treatment does not require investigation of the cause
"It's a female patient, surnamed Luo. She said she went to your clinic yesterday to see a doctor. She had long-term fever, dizziness, and fatigue. I checked her blood routine results and found that the anemia was particularly severe."

When Director Xue said this, Li Jingsheng knew who he was talking about.

It turned out to be the woman who had been burning for eight years!
Unexpectedly, she eventually went to the second hospital to see a doctor.In fact, the cause of her disease is as complicated as hers. If possible, she should go to a top-tier hospital like People's Hospital or Qiaobang Hospital.

However, she still listened to the advice. At least she came to a big hospital and registered a specialist number.

Although this 'expert' is a bit watery.

After all, he is the chief physician.

It must be mentioned that although the Second Hospital is also a third-level hospital, it can be called a large hospital.But its chief physician is at least two levels different from that of the People's Hospital.

There is a big gap in the level of medical skills, medical status, and social status.

Most of the chief physicians in People's Hospital can take the double promotion route.

What is the double promotion route?
It's like Li Jingsheng, whose medical and academic titles were promoted at the same time.

Is it okay to only raise one of the lines?It definitely works.

But the upper limit is basically locked.

Not to mention the evaluation of outstanding youths, outstanding youths, and Yangtze River scholars, even wanting to become a first-level director or second-level professor in the industry is very difficult.

Academically, most people have reached the top when they reach the second level of professor.

First-level professor is a bit like a special title for the higher level of the ancient cabinet bachelor.Often they are both academicians.

Ordinary professors are not qualified to appoint this first-level professor.

Even many academician candidates are second-level professors.

Therefore, academically speaking, second-level professors have basically reached the top.This is also a good reference standard when going to the hospital to call a specialist.

If the introduction column says second-level professor and first-level chief physician, it goes without saying that he must be a very awesome person.

This kind of expert account, if it is a large hospital, starts at least 300 yuan.

Many are priced at 600 yuan, and a few are even priced at more than 900 yuan.

There are expert accounts that cost 200 or [-] yuan, but they are very rare.This kind of person is often rarely diagnosed, and it is very likely that he is an academician or a candidate for academician.

Spending more than 1000 yuan to register with them is definitely worth it if the disease is particularly difficult to treat.

For example, if the family members of the paralyzed female patient who lives in Li Jingsheng Clinic were willing to take her to a top hospital in the imperial capital or Shanghai and register with a top special-needs expert, the cause of the disease might have been discovered long ago.

When signing up for such a top expert account, you should pay attention to his introduction column. Generally, he will write about the diseases he is good at treating.

The one written at the front is his best.

The latter ones may just be dabbling.

If you do not choose the right expert who specializes in your disease field when registering, it is common for hundreds of dollars to be wasted.The actual loss must be greater, because some inspections may also be arranged.

But because it was not his area of ​​expertise, he might not be able to diagnose the cause in the end.

Therefore, be sure to read the expert's personal introduction column when registering.

Nowadays, appointments are basically made online, which is very convenient.It is clear at a glance which doctor specializes in which field of disease.

Some doctors may have a broad coverage and write a long list of multiple disease areas that they are good at treating.

You can choose this kind of doctor for common diseases. If it is a complicated disease, you should pay attention to avoid pitfalls.

You can bite off more than you can chew and don't say it must be right.

At least a person's energy and time are limited, and no matter how talented he is, he cannot specialize in multiple fields at the same time.

Dual-disciplinary directors like Lian Tao are already rare.

"Dr. Li, do you remember which patient it is?"

Director Xue saw Li Jingsheng's expression and knew that he had remembered it.

"Well, I know who it is. The cause of her disease is quite complicated. I asked her to go to a large hospital for a urine routine check. It would be best to do an inguinal lymph node puncture and pathological testing."

"Both of these examinations have been done. Dr. Li will eat first. When you finish eating, we will discuss it later."

Director Xue has prepared packed meals for him.

"Haha, then I won't be polite. This is the first time that you have to pay for a meal when attending a consultation. Thank you, Director Xue, for your hospitality."

Li Jingsheng took the lunch box with a smile and began to eat politely.

"Can you show me the test results first?"

In fact, he has almost diagnosed this patient.

Just by looking at the test results, you should be able to quickly diagnose the ultimate cause.

"No problem! I know you are a busy person. I would like to thank you for taking time out of your busy schedule to help with the consultation! Next time I have a chance, I will treat Dr. Li to a good meal. In the hospital, the conditions are limited and I can only Can I treat you to a work lunch?"

Director Blood personally brought him the test results.

"Director Xue, please don't be polite. For us doctors, it's good to have a hot meal. Besides, orthopedic surgery and orthopedic surgery are brother departments. As long as conditions permit, they should support each other."

Li Jingsheng's words "brother's department" instantly brought the doctors in the consultation room closer to him.

The eyes looking at him also softened.

While eating, he checked the patient's urine test results.

Protein+.

Sure enough, as he had inferred, there was something wrong with the patient's urine.

Proteinuria is positive, which is the main cause of weight loss and anemia in patients.I can't believe that she had proteinuria for more than eight years.

Protein is one of the most important nutrients for the human body.

It is continuously lost from the urine, and the body cannot absorb sufficient nutrients, and symptoms such as weight loss and anemia will naturally occur.

When proteinuria occurs, the first thing to suspect is whether there is a problem with the kidneys.

Because the two kidneys of the human body are like two super filters, they can remove waste water and harmful substances from the body.

This is why uremic patients need to go to the hospital for dialysis.

Because after kidney failure, there is a problem with its filtration, and it can no longer excrete toxic and harmful substances from the body.It even includes water retention, leading to edema of the lower limbs, facial swelling, etc.

Dialysis works instead of the kidneys, filtering out harmful substances in the blood to ensure the normal functioning of the body.

Kidney failure is a devil that is irreversible once it starts.

It progresses and requires dialysis more frequently.There is only one final treatment path, and that is kidney transplantation.

Today, major hospitals are in very short supply of kidneys.

The vast majority of patients wait in line for 100 years but still cannot get a kidney.Therefore, young people must take good care of their kidneys.

Especially for people who don't like to drink water, using drinks instead of drinking water or other unhealthy lifestyles will cause kidney damage.

There are also some young people who, out of vanity, choose to sell their kidneys on the black market in order to buy a good mobile phone or to make money.

A kidney costs 4 to 2 yuan, but the actual cost is just over [-] yuan, less than [-] yuan.

I think the money is easy to come by.

I have two kidneys anyway, so it doesn’t matter if I sell one.

This is extremely short-sighted and foolish.

Both kidneys work together, and they relieve each other's work stress.If one kidney is removed, the remaining kidney will have to bear the workload of two kidneys every day and will be more likely to break.

By then, the outcome can be imagined.

After Li Jingsheng read the urine test results, he then checked the patient's lymph node biopsy results.

Lymphoid follicles and sheet-like mature plasma cells are seen.

Isn't this lymph node hyperplasia?

And it is a huge lymph node hyperplasia.

No wonder when the patient was diagnosed yesterday, both malignant tumors and benign tumors were ruled out. He was a little confused in the diagnosis.

Now that I saw the biopsy results, I felt a sudden realization.

It turned out to be giant lymph node hyperplasia.

"Dr. Li was able to conclude that there was a problem with the patient's urine based on just one blood test result, which is really admirable. After I discovered that the patient had urinary protein, I did some additional imaging tests on her.

X-ray examination revealed the presence of osteolytic lesions.

Later, a bone marrow puncture was performed.The bone marrow smear found a large number of plasma cells in the patient's bone marrow. At that time, I suspected that it was multiple myeloma, and it was multiple.But after lymph node biopsy was taken later, the cause became more complicated and confusing. "

The blood director has actually done so many tests on the patient.

Li Jingsheng felt sorry for the patient for two seconds.

Sometimes I really don’t know what to say.

The patient was reluctant to do even a urine routine and a stool routine at the Chengnan Health Service Station.

Finally, I went to a big hospital and had a lot of tests done.

This even includes bone marrow aspiration.

This is why many patients are afraid of entering big hospitals.Because there is no shortage of patients in large hospitals, and doctors will not quarrel with you.

It takes a long time to register and wait for a consultation. After entering, the doctor consults and then prescribes the tests he thinks are needed.Directly ask the patient to pay the fee and do the examination.

Patients are not given any room to bargain.

Moreover, if the patient has a lot of examination items or is not familiar with the diagnosis process, he may not be able to finish all the examinations in a day in the hospital.

When the test results were finally received, the doctor had left work early.

"Director Blood, I think the patient's myeloma can basically be ruled out. Because no myeloma cells were found in the patient's bone marrow smear. Although plasma cells were found, and the number was as high as 0.2, the patient did not have bone pain or bone destruction. .The number of monoclonal immunoglobulins in the serum was significantly less than 10g/L. These do not support that the patient is myeloma."

When Li Jingsheng examined the patient, he did not touch the bones specifically.

However, a little inspection can confirm that the patient's bone has not been damaged.

He even thought that bone marrow puncture was not necessary.

Maybe every doctor has a different approach to diagnosis!

Many older doctors like Director Xue make formal diagnoses.

To put it nicely, it means doing things strictly according to the process; to put it badly, it means being outdated and rigid.

The development and progress of medicine are very rapid.

Many treatment plans and diagnostic criteria that may have been considered correct ten years ago have been eliminated or even wrong ten years later.

If this patient was replaced by Li Jingsheng, three examinations would be enough.

Do a routine stool check and then a lymph node biopsy.

The female patient's thyroid gland does not have enlargement or other abnormalities, and her bone quality is normal. How about a bone marrow puncture?

Of course, although Director Xue is an orthopedic surgeon, he does not know the quality of bones by touching them.

Naturally there is no comparison with Li Jingsheng.

"Yes, I basically ruled out this disease later. But I think the bone marrow test is of great diagnostic significance. The patient's bone marrow hyperplasia was obviously active, plasma cell proliferation was abnormal, and binucleated plasma cells and multinucleated plasma cells could be seen. Then her The red blood cells are arranged in a thread-like pattern, which is very helpful for further diagnosis."

Director Xue also heard the profound meaning in Li Jingsheng's words.

Thought the bone aspiration was a bit over the top.

He quickly explained so as not to be underestimated.

Although the business of the Department of Orthopedics is not very good, it has not reduced to the point of random inspections or excessive inspections.

"I followed these clues and later checked her chest CT, and found a large mass with a diameter of more than 4cm at the right hilus, with smooth and neat edges and a lobulated shape. The density was uniform and dense."

The blood director is afraid that he will have to go through all the examinations on the patient.

However, this time the chest CT revealed a large mass at the hilus, which surprised Li Jingsheng.

Because he listened to the patient's heart and lung sounds and they were all normal.

This means that the auscultation is normal, but it does not necessarily mean that there is nothing wrong.

It also gave him a wake-up call, and he will definitely remember this lesson during the diagnosis process in the future.

"Can you show me the film?"

"no problem."

Director Xue directly put the film on the viewing board.

After Li Jingsheng looked at it carefully, he breathed a sigh of relief.

This female patient from a relatively poor family was finally not in bad luck.

What she fears most is that she has a tumor in her lungs.

The prognosis of lung cancer is actually not good.It is almost unimaginable to have such a malignant tumor in the lungs.

The patient may live less than three months.

"The right main bronchus passes directly through the mass at the right hilus. I auscultated the patient's heart and lung sounds and found no obvious abnormalities. In addition, the density of the mass was uniform and dense with smooth edges. I thought it might be an enlarged lymph node. "

Li Jingsheng expressed his own views.

"The results of our consultation just now are consistent with Dr. Li's view, and we also believe that this is just an enlarged lymph node. We have not yet reached a unified conclusion about what kind of disease the patient has. Dr. Li can tell you your diagnosis. ?"

Director Xue only had a few discussions with Li Jingsheng before he discovered that this young man was even more powerful than the legend said.

The strength is extremely strong.

"I think that although the patient has swollen lymph nodes in the hilus, the patient's symptoms are mild and there is no difficulty in breathing. In addition, a large number of lymph nodes are found in the patient's groin, so I am more inclined to giant lymph node hyperplasia."

When a patient has a mass in the hilus and is a plasma cell type patient, it is very easy to have a fever.

This also explains why the patient continued to have a low-grade fever for eight years.

Although the type of disease has been basically clarified, the real cause needs to be further inferred and investigated.

Giant lymph node hyperplasia is also known by many names.

For example, vascular lymph node hamartoma, multicenter angiolymphoproliferation, etc.

From these names, it is not difficult to see that it is closely related to blood vessels.

"Do you agree with Dr. Li's diagnosis?"

Director Blood looked at several other doctors in the department.

"I support Dr. Li's diagnostic point of view."

"I also think that giant lymph node hyperplasia is the most likely cause. But what is the specific cause of this disease? If the specific cause is not found, it will be difficult to use medicine!"

Several leading doctors in the Department of Orthopedics agreed with Li Jingsheng's diagnosis.

After checking this step, it is not difficult to determine what the disease is.

The difficulty lies in identifying further causes.

"Since everyone supports this disease, it can basically be concluded. Dr. Li, you helped us determine the type of disease when you came here. Can you help us find out the cause of the disease? "

Director Xue is a veteran, and a high hat has been placed on Li Jingsheng's head.

It is very likely that they had already discussed it before Li Jingsheng came.

However, the cause of this disease is really difficult to find out.

"No, no, no, I'm just throwing ideas around. In fact, teachers have already had the answer. As for the cause of this disease, I have checked some literature. The cause is very difficult to find out. But like her current situation, treatment should not be difficult. .”

After Li Jingsheng finished speaking, he paused for a moment.

"Speaking!"

Director Xue was waiting to hear his opinion.

"Simple drug treatment is ineffective and difficult to reduce the size of the tumor. Drugs such as nitrogen mustard and methotrexate generally have poor effects after use. I recommend transferring to cardiothoracic surgery for surgical treatment."

Li Jingsheng can be regarded as helping the cardiothoracic surgery department to win business.

The Department of Orthopedics is in short supply of inpatients. When encountering such patients, they may not be willing to let them go.

He paused just now, also wanting to see Director Xue's attitude.

"Surgical treatment should be a last resort, right? If the cause can be found, targeted drug treatment will definitely be better."

Director Xue was really reluctant to let go of the fat piece of meat.

"Director Blood, you also know the situation of this patient. Her family is very poor. If she is hospitalized and the cause of the disease is slowly investigated, she may be forcibly discharged. You don't know that she first went to the Chengnan Health Station, where After a week of treatment, I couldn’t even bear to do regular bowel movements.

When she came to my clinic for a check-up, she told me with a tearful voice that her mother-in-law and father-in-law had spent a lot of money on treatment, and a lot of money on funeral arrangements, and now the family still owed foreign debt.

Therefore, I suggested that she be transferred directly to cardiothoracic surgery to cut through the knot quickly. Surgery may be the best treatment for her. "

Li Jingsheng fought for the most favorable treatment plan for her.

If Director Xue still disagrees, that would be looked down upon.

"I'm afraid that the cardiothoracic surgery department may not be willing to accept it!"

said an orthopedic surgeon.

Everyone is understanding and reluctant to let this patient go, but they cannot say so clearly.

"I can contact you on your behalf. It has now been found that there is indeed a large mass in the patient's right lung, which is in line with the indications for surgery. I think the cardiothoracic surgery department will agree to accept it."

If the surgery cannot be performed, they may not accept it.

In a situation like hers, the indications for surgery are obvious and she would most likely accept it.

"Okay, please contact Dr. Li on your behalf. If the cardiothoracic surgery department is willing to accept the patient, we will help the patient to be transferred there."

Director Xue made the decision.

I don’t know why he suddenly relaxed.

Maybe he also saw that there was nothing he could do.

Li Jingsheng has a close relationship with Director Zhang and others from the Department of Cardiothoracic Surgery, and they often perform surgeries together. This kind of thing is just a phone call away.

(End of this chapter)