Chapter 55 Jiang Xiaoyu in the Valley of the Evil (Additional updates from the leader’s awesome daddy)
“Director Chi, the patient’s film is very typical, it should be late-stage cancer.” Gu Huaiming apologized, “It might be a needle biopsy. It's not deep enough. I'll go back and take a look and make one myself."
"Okay, if you have a new specimen, just call me."
Director Gu held the picture of the specimen under the microscope. Returning to the ward, he thought about it for a long time, but in the end he did not contact Dr. Zou.
What the patient’s family members fear most is not that the patient is seriously ill and will not be cured, but that one moment they give hope and the next moment they are disappointed.
It's like an emotional roller coaster, and even good people have to be torn to pieces.
Many family members of patients are driven crazy by this kind of disappointment and hope, causing many medical disputes.
Although Dr. Zou was his own doctor and did not consider medical disputes, Gu Huaiming was still cautious and did not tell her an uncertain answer.
After hesitating for a while, Gu Huaiming picked up the phone and called Luo Hao.
"Dr. Luo, I am Gu Huaiming."
"Director Gu, are the pathology results out? Is it inflammatory?" Luo Hao asked directly.
Gu Huaiming really didn’t know where Luo Hao’s inexplicable confidence came from.
But okay, Luo Hao guessed it right this time.
"You guessed it right, Dr. Luo, Director Chi found no tumor cells under the microscope."
Luo Hao held his mobile phone and smiled slightly. The diagnosis on the system panel in front of him had changed.
Although it was still a preliminary diagnosis and the content was still a space-occupying lung lesion, the differential diagnosis had changed.
In the past, Talaromyces marneffei infection was ranked first in differential diagnosis, but with the improvement of test results, the diagnosis of adult immunodeficiency diseases mediated by anti-interferon-γ autoantibodies has been mentioned first. .
Luo Hao became more and more confident.
The system is really easy to use. As expected, I pissed off so many old people, and it took me another two years to open it after I insisted on returning to the mine.
No matter what happens in the future, as far as this case of "late stage lung cancer" is concerned, the system's diagnostic assistant AI is simply too smart.
"Director Gu, have the fungal beta-D-glucan test results come out? Is it a strong positive?" Luo Hao asked.
Gu Huaiming opened his computer workstation and pulled up Dr. Zou's grandfather's test sheet.
Just as Luo Hao "guessed", the fungal β-D-glucan test result was strongly positive.
“Strongly positive, yes.”
“I think it is not a malignant tumor, but an inflammatory change. As for what disease caused the inflammatory changes, we still need to look at it again. "Luo Hao's voice came, and Gu Huaiming's eyebrows wrinkled.
Dr. Luo Haolo is so arbitrary?
Who gave him the courage to directly conclude that it was not a malignant tumor!
Of course Gu Huaiming does not want the patient to have a malignant tumor, but the doctor must be objective and neutral.
It must be that little guy Luo Hao hopes that Dr. Zou’s grandfather will be okay, Gu Huaiming thought in his heart.
"Dr. Luo, since it is not a malignant tumor, what do you think it is?"
Luo Hao fell silent at this time.
Gu Huaiming shook his head. Luo Hao was indeed as he had guessed, and he had no idea at all.
"Director Gu." Luo Hao's voice interrupted Gu Huaiming's thinking.
"Say, Dr. Luo."
"I asked about the medical history last night. The patient had a history of eating bamboo rats and was considered to be infected by Talaromyces marneffei." Luo Hao said , "But today I have a new perspective."
"Talcobacter marneffei infection?" Director Gu suddenly became energetic. He completely ignored Luo Hao's last sentence and focused on the infection caused by Talarobacter marneffei caused by bamboo rats.
He has met several patients with Talaromyces marneffei infection. Looking at the symptoms and looking at the films, they are indeed manifestations of late-stage cancer.
Coupled with the fact that the patient had a history of eating bamboo rats, the fungal β-D-glucan was strongly positive, the pathological examination found no cancer cells, etc., a thought flashed through Director Gu’s mind in an instant. lightning.
The previous haze dissipated, revealing a clear sky.
Gu Huaiming has begun to favor the diagnosis of Talaromyces marneffei infection as correct.
Unknowingly, Director Gu's lips raised.
"Director Gu, I'll contact Xiehe Gene Laboratory for a test."
"No need." When Gu Huaiming heard that it was Xiehe, he felt a little disgusted.
Is the South Tower of 912 worse than the Shuai Mansion? Or is 912 West Hospital now worse than Xiehe?
Luo Hao, a bastard boy, a poorly raised wolf cub, was born with the concord mentality of looking down on all the doctors in the world.
"Gu..."
"I will do a comprehensive inspection first and then contact you." Gu Huaiming said flatly.
"Okay." Luo Hao didn't insist, and agreed according to Gu Huaiming's words, "Director Gu, you must tell me if there are any results."
"Don't worry, I will be there on the first day. I told you immediately.”
After hanging up the phone, Gu Huaiming didn’t even dare to tell his boss about Luo Hao’s suggestion.
If the boss hears this, he will inevitably be unhappy again.
The elderly man was very likely to be diagnosed with Talaromyces marneffei infection. Director Gu immediately began to find experts from the Department of Respiratory Medicine, Rheumatology and Immunology, and the Department of Infectious Diseases to come to the West Building for hospital-wide consultation.
All the information is in front of him, and the opinions given by top experts after consultation coincide with Gu Huaiming's ideas.
Talanobacter marneffei infection!
Then continue the examination and make a clear diagnosis.
Really, Gu Huaiming complained, I wonder if eating bamboo rats can make them sick easily.
He clearly remembered that he had received a patient when he was young. The X-ray showed that he had late-stage cancer and was accompanied by progressive weight loss. The patient was already extremely thin.
There is no way to do surgery, only chemotherapy.
However, the effect of chemotherapy is very poor, but people always survive. The cancer seems to be in the advanced stage forever.
Finally, out of desperation, the family brought the patient to 912 for a visit.
After many examinations, the patient was diagnosed with Talaromyces marneffei infection, and his condition improved after symptomatic treatment.
Although this case has nothing to do with cardiothoracic surgery, Gu Huaiming remembers it and will always ask the patient if he has a history of eating bamboo rats.
If it is really an infection caused by Talaromyces marneffei but surgery is performed, it will be a lot of fun.
Inspections are in progress.
At 30℃, Talaromyces marneffei appears in the form of hyphae, while at 37℃, it appears in the form of yeast.
It is easier to change from the yeast form to the hyphae form. It only takes 1 to 2 days to grow broom-like branches and produce red pigment.
Two days later, under the microscope in the laboratory, there was still no specimen and no change.
Gu Huaiming then began various examinations - taking bone marrow smears, lung tissue biopsy specimens, skin effusion smears, intestinal mucosal biopsy tissue, omentum biopsy tissue, lymph node biopsy tissue, and performing periodic acid staining, After Wright's staining or hexaamine silver staining, microscopic examination, and fungal culture.
However, whether it is the ELISA method to detect Talaromyces marneffei cell wall mannoprotein MP1P antigen in peripheral blood, or the indirect immunofluorescence method to detect Talaromyaceae marneffei specific antibodies in peripheral blood;
Or use dot blot ELISA, latex agglutination test, or lateral flow immunochromatography to detect TM antigen in urine, and the results are all negative!
Gu Huaiming was exhausted mentally and physically.
It only took 2 days to go from full of confidence to extremely disappointed.
Dr. Zou’s side is full of good news: the patient with aortic dissection is offline and will be transferred out of the intensive care unit in one day.
But there has been no progress in my own inspection.
Gu Huaiming brushed his face again and invited directors and experts from relevant departments to sit down and share their opinions.
2 days ago.
Everyone thinks that the patient is very likely to be infected by Talaromyces marneffei, but now faced with the results of comprehensive and over-medical examinations, experts have become silent.
All examination results excluded Talaromyces marneffei infection and malignant tumors.
But what is that?
The one-hour and forty-minute consultation was inconclusive.
Gu Huaiming was helpless.
He thought of Luo Hao and muttered in a low voice, "Do you really want to go to Xiehe?"
"Director Gu, what are you talking about." An expert said unhappily, "With these examinations, will they be able to make a diagnosis if I go to Union Medical College?"
"Sigh." Gu Huaiming shook his head, "That's it for today. Thank you for your hard work. I'll tell Dr. Luo."
"By the way, I heard that Dr. Luo had a little incident a while ago. What happened next?" asked the director of the Department of Rheumatology and Immunology.
Gu Huaiming had already dialed Luo Hao's phone number.
There was a beeping sound, and Gu Huaiming took the time to reply, "It's okay, it's all over a long time ago. Luo Hao is a very clever guy, and the procedures are very complete. It's basically..."
"Hello, Director Gu." Luo Hao's voice came out.
Several experts had knowing smiles on their faces.
"Dr. Luo, we have done all relevant tests for Talaromyces marneffei infection, and there are no positive signs." Gu Huaiming had no choice but to tell the truth.
"Director Gu, I have read all the recent examination results. The patient may have a typical intractable disease." Luo Hao said, "I have some considerations of my own, which are not very comprehensive."
"You're welcome, Dr. Luo, tell me." The director of the Department of Rheumatology and Immunology interrupted Luo Hao directly.
"Hello, Teacher Zhu, you are here too." Luo Hao greeted.
“You’re welcome, please tell me your opinion.” asked the director of the Department of Rheumatology and Immunology.
“The first consideration for difficult and complicated diseases is rheumatic and immune diseases, but if you are here, I won’t think so.”
"You can try genetic testing. I think the patient may have interferon-γ receptor deficiency."
"Huh? What defect?" Director Gu and Director Zhu of the Department of Rheumatology and Immunology asked in unison.
“Interferon-γ receptor deficiency disease.”
Some people have already taken out their mobile phones and started searching for related diseases.
Using a mobile phone to see a doctor is for ordinary people to scare themselves.
Anyone who can get out of Baidu is the unscrupulous traffic who has paid advertising money.
But serious doctors definitely don’t use Baidu. They log on to professional websites to search for relevant papers and other information.
"Director Gu, Teacher Zhu, I think it's better to send the specimens to Xiehe's genetic testing laboratory." Luo Hao said, "I've already finished talking about that, can you think of it?"
Director Gu frowned.
“Are you sure?” Director Zhu of the Department of Rheumatology and Immunology asked.
Doctors who only specialize in rheumatology and immunology have always despised doctors from other departments who "don't know how to treat patients". Now he wants Luo Hao to teach him to be a doctor, which makes it difficult for Director Zhu to accept
"It should be confirmed." Luo Hao said, "General interferon -γ receptor deficiency affects developing infants and AIDS patients, but patients with genetic defects also occasionally develop the disease.”
“This disease is so complex that it cannot be confirmed by clinical testing. Guess, a genetic test can be used to confirm the diagnosis. "
Luo Hao said while looking at the confirmed diagnosis given by the system diagnostic assistant AI - interferon-gamma receptor deficiency.
Having passed the system certification, do you still have any questions?
Luo Hao was convinced and explained in a calm tone, "There is no abnormality in the patient's general immune function in the laboratory examination.
Further examination found that the child was induced by exogenous IFN-γ and had heterozygotes with no clinical manifestations. The ability of peripheral blood mononuclear cells to produce TNF-α decreases. "
Experts from 912 related departments started with smiles on their faces. They were indulging in the little guy and wanted to see the legendary Valley of the Wicked. What has Jiang Xiaoyu become now?
But as Luo Hao spoke in more and more detail, became more and more confident, and became more and more professional, the experts began to become serious.
Thirteen minutes later, Luo Hao finished speaking.
"To sum up, I think it is very possible to diagnose interferon-gamma receptor deficiency."
The experts looked at each other.
Previously, no one could perform a clear analysis and diagnosis like Luo Hao when initially diagnosing Talaromyces marneffei infection.
After all, it is only a preliminary diagnosis, and no one can be sure that it is an infection caused by C. marneffei. However, Luo Hao is extremely confident in diagnosing interferon-γ receptor deficiency.
"Okay, Dr. Luo." Gu Huaiming had no choice but to respond, "I will send someone to collect the specimens and send them to Xiehe Gene Laboratory. Leave me a message later and let me know who to send the specimens to."
After hanging up the phone, Gu Huaiming was thoughtful.
“Dr. Luo’s basic skills have not been delayed since he returned home.” One person said.
"Yes, it's strange. Not only was there no delay, I feel that Dr. Luo is much stronger than before."
"Could it be that there are particularly many patients in his hometown?"< br>
Opinions vary.
All experts know Luo Hao and are quite interested in him.
This stems from the fact that a long time ago, a few big guys happened to have the idea of recruiting students one year.
At their age, they should have stopped thinking about accepting students. Even if they have the title of doctoral tutor, they will never teach people step by step. They are basically taught by senior brothers.
But it was a coincidence that year.
Some people even speculate that it is because of the chain reaction caused by sunspot explosions.
Luo Hao had good luck. His college entrance examination scores ranked first among medical students in the country, which attracted the attention of the big guys who had their thoughts.
After all, we are at Union Medical College, and the big guys from Union Medical College were the first to arrive.
It’s strange that the other big guys shouldn’t have gone to Xiehe to grab people, but that year they just took a fancy to Luo Hao.
It was like love at first sight.
Therefore, the name Dr. Luo is remembered by many people in the circle.
In addition, Luo Hao did not stay in any hospital in the imperial capital after graduation, which made the urban legend even more exciting and bizarre.
Now I encountered a weird rare disease. After listening to Dr. Luo's explanation, everyone came up with an idea - it turns out that there is really no love for no reason in this world.
Even though Luo Hao’s reasons for diagnosing interferon-γ receptor deficiency were not very sufficient, everyone present appreciated his clear logical thinking and clinical analysis techniques.
Back then, the big guys tried to rob people to no avail, so in the end they had to compromise with each other.
Some people laughed at themselves and said that these big guys were the villains in the Valley of the Wicked and wanted to teach Jiang Xiaoyu what they had learned throughout their lives.
Luo Hao is Jiang Xiaoyu.
Looking at it now, Luo Hao is quite a bit authentic.
"Director Gu, let me know the results when they come out." Director Zhu of the Department of Rheumatology and Immunology stood up and said, "You must tell me as soon as possible."
"Get into a group and tell us directly in the group. "Some people have already started to set up a group.
Gu Huaiming sighed.
Do you really want to go to Xiehe?
Forget it, just go.
Xiehe has invested considerable energy in the diagnosis and treatment of many rare diseases.
For example, malignant hyperthermia, a rare disease caused by anesthesia, has been studied most thoroughly in China by Union Medical College.
Specific medicines are also available at Xiehe.
Is interferon-γ receptor deficiency a disease? It's not that 912 can't diagnose when they arrive, it's just a little slower. Gu Huaiming makes excuses for 912 in his heart.
But if you want to get the results as quickly as possible, you have to go to Xiehe Gene Laboratory.
……
……
"Sister Zou, thank you." Luo Hao bowed slightly to express his gratitude.
“It should be done, you’re welcome.” Dr. Zou said calmly, “Dr. Luo, do you think my grandfather’s diagnosis is correct?”
“Let’s see the results, I’m already urging you. , we will know in about 12 hours. But no matter what rare disease it is, it is definitely not cancer," Luo Hao said firmly.
Dr. Zou breathed a sigh of relief.
The old man is already old. It doesn’t matter even if he has a genetic disease. Symptomatic treatment is all.
As long as the cancer is not in the advanced stage, the elderly have a very high probability of living a long and healthy life.
"I will send the patient to the general ward. Sister Zou, take a good rest and don't be in a hurry to go back." Luo Hao said, "Believe me, we will wait for the genetic test results tomorrow."
"Okay, I'll go back to the hotel to take a shower and have a good sleep. If I go home in this state, I'm afraid I won't be able to help and will become a burden." Dr. Zou laughed at himself.
Luo Hao sent the patient back to the general ward.
The transfer from the ICU to the general ward 3 days after the biggest cardiothoracic surgery was almost a miracle for the mine manager.
This is thanks to Director Gu Huaiming's surgery and Dr. Zou's postoperative care.
One cannot exist without the other.
After transferring the patient out of the ICU, this patient has come to an end. Luo Hao’s attention is focused on interferon-gamma receptor deficiency disease.
Interferon-gamma receptor deficiency is similar to Cthulhu. It is indescribable and cannot be diagnosed through medical history. It can only be diagnosed by luck in the genetic laboratory.
So there are very few diagnoses of this disease, and those who can be diagnosed accurately are the lucky ones.
If the diagnosis given by the diagnostic assistant AI this time is correct...
Thinking of this, Luo Hao felt a little excited in his calm heart.
That means you have a sharp weapon!
An invincible weapon!
Luo Hao urged his friends in the group to hurry up and get the results.
It didn’t take 12 hours, but the results came out 10 hours later. The diagnosis was clear, it was interferon-γ receptor deficiency!
Diagnostic assistant AI is really a magical tool!
Luo Hao was particularly pleased.
Picking up the phone, Luo Hao called Gu Huaiming.
"Director Gu, the results have just come out. Dr. Zou's grandfather has been diagnosed with interferon-gamma receptor deficiency."
"What?" Gu Huaiming couldn't believe it.
"It's interferon-gamma receptor deficiency. The error in the genetic test results should be very small. I've already urged a reexamination."
"Uh..." Gu Huaiming was stunned.
Luo Hao actually gave the correct diagnosis.
He did not doubt that Luo Hao's words were lies. No doctor would joke about such a thing.
The authenticity is unquestionable.
“For treatment, I recommend switching to Union Medical College. Union Medical College has a research group that specializes in projects for patients with interferon-γ receptor deficiency. Do you think it’s okay?”
Director Gu heard the word "you" in a trance.
Luo Hao is very familiar with him, and he regards him as his boss's close disciple. The elder brother takes care of the younger brother, teaching him all his skills.
Luo Hao usually calls himself "you", where did "you" come from.
I am not that stingy. In terms of diagnosis and treatment of some rare diseases, Union Medical College is strong.
Forget it.
Director Gu shook his head helplessly, "Okay, I will transfer the patient to you as soon as your verification results come out."
"Director Gu, I will send Dr. Zou back to the Imperial Capital today. The patient has been transferred to the general ward. Thank you.”
“You’re welcome.”
The two exchanged a few words indifferently, hung up the phone, and Gu Huaiming announced the results in the group that had just been established a few days ago.
Contrary to expectations, Gu Huaiming thought that the diagnosis of interferon-γ receptor deficiency would cause huge shock and everyone would actively discuss it.
But the group was deserted, as if no one saw the message he sent.
After waiting for another ten minutes, Gu Huaiming couldn't help but send a message.
【Have you seen the results? 】
[See, I have never studied this disease, so I don’t dare to show my disgrace. 】
This was said by Director Zhu from the Department of Rheumatology and Immunology.
Then everyone copied and pasted this sentence and started swiping the screen.
I am speechless.
Gu Huaiming suddenly felt a little interesting. Usually Director Zhu’s words are very arrogant, probably because no one knows how to treat doctors except me.
I never thought you, Lao Zhu, would have such a day!
Director Gu thought for a while. He didn't call. Instead, he went directly to his boss's house and reported the recent events to his boss face to face.
I think the boss would be very happy to know that Luo Hao not only did not neglect his studies after returning to his hometown, but instead worked hard and diligently.
……
……
Luo Hao looked at the system panel with a smile.
The diagnostic assistant AI is really easy to use, and not just easy to use!
Although it is not possible to give a direct diagnosis, various examinations are still required, but it can find the truth among the complexity.
Awesome!
I am one step closer to returning to Xiehe.
Dr. Zou was not excited when he told Dr. Zou the good news. In the past few days of contact with Luo Hao, Dr. Zou had developed a strong sense of trust in Luo Hao based on his professional judgment.
This is the doctor’s intuition.
After sending Dr. Zou away, Luo Hao breathed a sigh of relief.
Unexpectedly, Dongxue admitted a patient that day, and it took so many days to barely solve the problem.
Relaxing, Luo Hao turned his attention to the long-term main mission.
Among the two members of the medical team, Cui Mingyu has a lot of trouble every day. He has done more surgeries than himself. Luo Hao was very satisfied with this.
And another member...
Chen Yong is holding his mobile phone, chatting on WeChat with a happy face and an afterimage on his finger.
Luo Hao frowned.
If this is the case, wouldn’t the “establishment” of the medical team be given to Chen Yong in vain?
I've been busy recently, and Chen Yong took the opportunity to be lazy. It's too much! !
"Chen Yong, what are you busy with?" Luo Hao asked with a smile.
"Is something wrong?" Chen Yong asked angrily without raising his head.
"Test you a question. If you learn how to ask it, you can ask the girls."
"What interesting questions can you have?" Chen Yong could not hide his disdain for Luo Hao.
"There was a green frog who was still watching TV at 7 o'clock in the morning. Suddenly there was a knock on the door 7 times. It turned out that it was the frog's good friend who brought a surprise breakfast.
He brought the most popular breakfast of seven kinds of frogs. Likes to eat: chocolate pie, cheese, chocolate candies, bread, fried rice, milk, live flies!
What do you think the frog should open first?"
"What do you think? Once again.”
(End of this chapter)