Chapter 43 Difficult and complicated diseases
Yang Ping lay down in the duty room to rest. No matter how noisy it was, he could still fall asleep. This unique skill allowed him to recharge his energy anytime and anywhere.
When I woke up, there was a lot of fruit on the bedside, which my brothers had saved and washed cleanly. Yang Ping ate an apple and washed his face. Reminds me of the case discussion at 3pm.
At 2:40, Yang Ping arrived at the demonstration classroom. There were already many people waiting inside. Xiao Wu, Zhang Lin, and Fang Yan all greeted him, pointed to the empty seats that had been prepared, and motioned for him to come and sit quickly.
The demonstration classroom is also the conference room of the department, where case discussions are held. Except for emergency surgeries, everyone is required to participate, and the difficult and fatal cases of the week will be discussed.
For young doctors, this is a rare learning process, and for senior doctors, this is a time to showcase their talents. How the surgery is performed can be seen clearly on the stage; how the theoretical knowledge is performed can be seen through the discussion of medical records. At this time, everyone closed the door, started arguing, kicked their noses, raised their eyes, and slapped the table. That was legal.
Song Zimo came in, sat next to Yang Ping, and whispered: "Last time, the blood vessels of the premature baby were too brittle. I got a newborn mouse and used drugs to brittle the blood vessels. After practicing for many days, I can barely suture now. Please give me some guidance.”
Yang Ping said in surprise: "You didn't take a nap at noon, and you were practicing operating under the microscope?"
Song Zimo said: "Yes, you are not a senior brother for nothing. You must teach me when you have time. Next time you have a baby, let me do it. Do you know the truth?"
"Your call of senior brother carries enough weight!" Yang Ping said.
However, Song Zimo has enough talent and hard work, and his mind is broad enough. This person is arrogant, but can face the gap. It is a blessing to have such colleagues. Now, whenever he is free, Song Zimo will take the initiative to assist in Yang Ping's surgery.
"Okay! I'll set the stage for you next time." Yang Ping said.
Song Zimo put his arm around his shoulders: "How is that equipment nurse? Is there any progress?"
Yang Ping shook his shoulders and shook his hand: "Why are you so gossipy? Why don't you look at the occasion?"
Song Zimo said: "I am no longer a human being. When I am a senior, my life experience must be imparted. Don't hide your methods." ”
Yang Ping sneered and said: "Forget it, who doesn't know you Song Zimo, if you turn around and smile while walking on the street, someone will immediately have arrhythmia."
People were already coming in one after another. Director Han came in. Song Zimo stood up, did a chest expansion exercise, walked to Director Han and sat down next to him. He is Corey's secretary and keeps records.
Everyone gathered in groups to show that the classroom was packed to the brim. Several senior directors sit in the first row, with a bottle of mineral water in front of each person. There is a projector in the doctor's office, and a high-definition screen here.
"Everyone, be quiet. There are no deaths this week. There are a few difficult cases. Let's discuss them. This week it's the turn of Director Ouyang's team to start--"
The residents in Director Ouyang's group began to report medical records.
"XXX, male, 14 years old, has suffered from recurring pain and swelling in the joints of his limbs for 3 years. 3 years ago, with no history of trauma and no obvious trigger, he developed pain and swelling in the left wrist joint, which later gradually developed to bilateral shoulder joints, elbow joints, and right joints. Lateral wrist joints, bilateral hip joints, knee joints, and ankle joints were diagnosed and treated in many hospitals - past history: 4 years ago, an old fracture of the left wrist scaphoid underwent open reduction and internal fixation with bone grafting, and the fracture healed. Remaining functional impairment - physical examination: swelling and tenderness of limb joints - auxiliary examination: bilateral shoulder joints, elbow joints, wrist joints, hip joints, knee joints, and ankle joints MRI showed synovial swelling and joint effusion -"< br>
After the resident doctor reported the medical history, Dr. Jin, the attending physician under Director Ouyang, added: "This child's family conditions are relatively good. He has traveled a lot. Famous professors from well-known hospitals across the country have seen him a lot, including traditional Chinese medicine and Western medicine, internal medicine and surgery. He just keeps having swelling. It hurts, and it’s difficult to walk normally now. I’ve been to many hospitals, but the problem hasn’t been solved. Let’s discuss how to get a clear diagnosis and treatment.”
Dr. Jin, the old attending physician, is in his forties, a few years younger than Director Ouyang. Based on his seniority, he should have been the chief physician. But he is rigid and never does any fraud. So far, he has been unable to write a paper or get a project, so now he is not even admitted as deputy chief physician. In fact, the real level is the level of a complete chief physician.
After Dr. Jin finished adding, several young doctors began to scratch their heads. This kind of atypical case was the most troublesome and most tested the doctor's diagnostic ability, which is precisely the weakness of surgeons.
Many orthopedic surgeons hang X-rays on the reading lamp and say: do an operation! Doliso, how can you use your brain to make a diagnosis? Isn't it clear on the film? Diagnosis That's the physician's business.
"It is very necessary to discuss this case. Usually we treat these atypical cases of joint pain and leave them alone if we cannot find the cause. I always say that a surgeon should not only do a good operation, but also do a good job. At the same time, we need to have good clinical thinking skills. Now let’s discuss what diagnosis and how to treat this patient.” Director Han said.
There are many diseases whose causes cannot be found medically. Diagnosis is like a detective solving a case. It is based on medical history, physical examination and auxiliary examination, and follows certain logical thinking to follow the clues to identify the disease. There are cases that cannot be solved, and there are diseases that cannot be detected. Usually case discussions start with junior doctors and gradually escalate. In today's case, the junior doctor was confused and speechless.
"Endocrinology, metabolism, nutrition, blood, rheumatism, etc. have all been checked. Everything imaginable has been checked. X-rays, color ultrasound, CT, and MRI have all been done. Dozens of MRIs have been done."
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"There are various diagnoses, including synovitis, rheumatoid arthritis, autoimmune arthritis, and reactive arthritis. How about one simple diagnosis: difficult and complicated diseases?" Dr. Jin saw that no one was talking, so he added it himself to avoid being left in the cold. .
He is relatively knowledgeable, like an old scalper, who works hard without complaining. Director Ouyang has such a general as him. He has not performed emergency surgery for many years. Dr. Jin comes to do major emergency surgery every time.
"Reactive arthritis is a big problem. If it cannot be detected, it is called reactive arthritis. This does not ask about the history of urinary tract or intestinal infections." Director Ouyang said.
"In clinical practice, there are many cases of transient synovitis for which no cause can be found. This is indeed difficult to diagnose, otherwise others would not be so angry as to diagnose a difficult and complicated disease." Director Bai said.
"Have you taken a synovial biopsy by puncture?" Director Tian asked.
Dr. Jin replied: "It was done in a hospital in Imperial Capital, and the medical examination showed inflammatory synovial tissue."
Yang Ping half-squinted his eyes and leaned on the chair. Song Zimo said, "Why don't you say a few words? Don't you often win by surprise?"
Yang Ping listened, anyway, entering the system does not take up time. In reality, it takes an instant. Now that I have adapted to this switch mentally, I can enter and exit the system anytime and anywhere.
Open the window and find the newly added library function. Yang Ping clicks on it and enters the system space. He begins to desperately search for books, journals, papers about these synovitis, especially rare ones, and even case reports.
Synovitis is actually only a symptom diagnosis, not a cause diagnosis. Just like fever, many diseases can cause fever. It is necessary to find the cause of fever and treat it.
Yang Ping thought to himself that the system was really torturous. It provided such a large library, so it would be much easier to just help with the diagnosis, and then he could show off coolly.
Even though he had to work so hard to search for information, fortunately, the search function of the system library was relatively powerful, and he finally found many papers, one of which caught Yang Ping's attention.
Five years ago, an Austrian doctor wrote a paper, published in an obscure medical journal, written in German. The system functions are quite considerate and can actually help translate papers.
This paper mentioned that metal ion-reactive joint synovitis usually occurs when there are implants in the body, such as steel plates, artificial joint replacements, and sometimes even metal dentures. The reason is that the joint synovium is sensitive to metal ions and produces inflammatory response. This disease is extremely rare. Yang Ping searched and found that no one else had reported it except this Austrian doctor.
This is interesting. Yang Ping studied the paper in detail. Didn't this child have surgery on the left carpal navicular bone 4 years ago? The X-ray showed that there were still metal screws left. Could it be that the metal ions released by the metal screws entered the blood? Redeposition of joint synovium, causing synovitis?
The child's symptoms are very similar to those mentioned in the paper, but they are just assumptions without any evidence. But after much searching, this is really the only one that comes close. After checking again, no suitable information was found, and Yang Ping came out of the system.
"Yang Ping, Song Zimo, what are you two hiding there? Say a few words!" Director Han saw that everyone was silent and directly called the names.
Director Han called the names, it would be inappropriate not to mention them.
Song Zimo patted Yang Ping: "Senior brother, come on!"
Yang Ping secretly scolded this guy. At this time, the senior brother's scream was sweeter than anyone else's.
After getting on the sedan, Yang Ping sat up straight. He couldn't lose his identity in front of these brothers, so he said with a thoughtful look: "Well, I listened to the medical records carefully, and I think this is metal ion reactive arthritis. It is a very rare disease and there are not many reports at present. ’
Metal ion reactive arthritis, no, I’ve never heard of this disease, is there such a disease? There are no textbooks.
(End of chapter)