A hundred days after signing in, the first surgery shocked the world!

"Dr. Lin, what do you think?" just after talking about the patient's situation, the first director asked.

Lin Feng thought for a while, and said in a deep voice: "According to the situation you have described, the patient's condition is most likely caused by hypothyroidism. I recommend doing an electromyography first to see if there is peripheral nerve damage. "

"Dr. Lin, the electromyography has been prepared!"

"The results showed significant nerve damage in both lower limbs. "

As soon as the words fell, a doctor spoke.

Lin Feng nodded.

Difficult patients will have weakness and numbness in the lower limbs.

The nerves are damaged, there must be a problem.

So that hypothyroidism can also be excluded, obviously it has nothing to do with it, and it is not eaten by thyroid hormones.

It should be a disease of the nervous system.

"Dr Lin, we previously speculated that the patient may have Guillain Barré syndrome. The first director spoke again.

"I don't think so!" Lin Feng shook his head.

For their speculation that it is Guillain-Barré syndrome, Lin Feng is not surprised.

When this disease occurs, there will also be numbness in the limbs, as if burning, burning, numbness, tingling, etc., which is very uncomfortable.

And some patients also have autonomic dysfunction, manifested as skin flushing, tachycardia, swelling of hands and feet, and possibly even impotence.

It feels very similar to the patient's current symptoms.

But there is one point that cannot be ignored.

That is, the patient has a large amount of ascites, pleural fluid!

This is a condition that does not occur in Guillain-Barré syndrome, it is only peripheral neuropathy and cannot cause serositis.

As far as electromyography is concerned, the performance is very typical, it looks like Guillain-Barré syndrome, coupled with the patient's gradually worsening weakness in both lower limbs, everyone thinks that it is more like Guillain-Barré syndrome can also be understood.

As Lin Feng shook his head, everyone looked at him in unison.

I hope to get a different perspective from him.

After a pause, Lin Feng said, "POEMS syndrome!"

"What?"

"What kind of disease is this?"

“....."

The director of the first seat and the hematology department on the side, the two frowned.

I don't understand why Lin Feng said this disease.

Looking at the reaction of the doctors around you, you can know that everyone is obviously unfamiliar with it, or they don't know about this disease.

POEMS syndrome, in fact, is the combination of the first letters of several English words, P (polyneurpathy) multiple peripheral neuropathy, O (organomrgaly) organ enlargement, E (endocrinopathy) endocrine disorders, M (monoclonalimmunoglobul) monoclonal immunoglobulemia, S (skin changes) skin changes, which is a multi-system involvement of paraneoplastic syndrome.

This disease is really a rare disease, almost one in a million, which is comparable to the probability of winning the jackpot.

As the director spoke.

Only then did everyone understand what Lin Feng was talking about.

Instantly.

In the conference room, everyone fell silent.

After the director and the hematology department looked at each other, the hematology department said: "Dr. Lin, your speculation may also be correct!

With the words of this titan, everyone echoed.

Looked at.

Lin Feng did not refute it, after all, there was really no way to confirm it, and this was only his own speculation.

After all, he also couldn't overrule the possibility that the patient had Guillain Barré syndrome.

Then he said, "I understand, but I have reservations!"

Although the words were very polite, there was clearly some-for-tat smell in the room.

Looked at

The director hurriedly said: "Dr. Lin, POEMS disease is also very likely, but I recommend that you first rule out the diagnosis according to Guillain Barré syndrome! First, everyone is familiar with this disease and can be diagnosed quickly; second, it can also ensure the safety of patients!

Lin Feng nodded.

Immediately everyone began to move.

To rule out the diagnosis, the patient was first arranged for a lumbar puncture, and if evidence can be found in the cerebrospinal fluid, then the diagnosis of Guillain Barré syndrome is more certain.

This disorder can lead to the manifestation of cerebrospinal fluid protein-cell separation.

However, the results disappointed everyone, the patient's cerebrospinal fluid protein content is high, but there is no so-called protein-cell separation phenomenon.

Of course, the diagnosis of Guillain Barré syndrome can not only look at the cerebrospinal fluid, as long as the clinical manifestations are consistent, you can try to shock with high-dose immunoglobulin to see how effective it is.

For this statement, Lin Feng also agrees.

The girlfriend is very anxious, so good to be alone, how come to the hospital has become like this.

Even if the doctor's advice is agreed, pulse immunoglobulin therapy is used.

Expectant therapy is effective.

Unfortunately, the reality is disappointing.

5 days of gamma globulin down, like a stone sinking into the sea, can not set off a little wave.

The patient's girlfriend was on the verge of crying.

The doctor originally planned to use a replacement plasma treatment regimen, but this regimen required many conditions, and finally changed the relatively easy treatment regimen, high-dose glucocorticoid pulse therapy.

Glucocorticoids are still very helpful in treating autoimmune diseases.

The reason why it is not used at first is because domestic and foreign guidelines do not recommend it for treatment.

But they think that guides are dead and people are alive.

Then explain it to the patient.

At this moment, the patient is already crying without tears, and he is paralyzed in bed, so he naturally wants to cure himself as soon as possible.

For the doctor's advice, there is no disagreement.

He also believes that doctors don't harm themselves.

With the patient's signature, hormone therapy began the same day.

After 2 days, the patient's muscle strength improved.

Everyone was excited.

Or the effect of hormones is better, and it is a pity that expensive immunoglobulins are lost.

However, the subsequent results again disappointed everyone.

A course of hormones is used up, but the patient's muscle strength does not continue to recover, just a little better than before the medication, and still cannot go to the ground.

It had to be discouraged.

I had to organize a consultation again, but this time Lin Feng was not invited.

at the meeting.

Experts listed all the symptoms of the patient.

Abnormalities in kidneys, endocrine, peripheral nerves, autonomic nerves and other aspects are considered to be a rare disease.

However, nothing came of it.

Finally, he invited Lin Feng over again.

This time, Lin Feng did not listen to any medical report and went directly to the ward.

As soon as I walked to the ward, I heard the patient's girlfriend ask the doctor why the patient was so dark, and the skin was very white before, whether it was caused by some side effect of the drug.

There is also the patient's feeling that there is some ghosting of things, and the strength is not very good.

Hearing this news, Lin Feng immediately stepped forward to examine the patient.

It was found that the ends of the limbs were significantly blackened, not only the ends of the limbs, but also around the areola.

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