Chapter 44 The Trouble Caused by Two Screws
No one has heard of this disease, including Song Zimo and Dr. Jin.
Dr. Jin cast a surprised look and thought to himself, this guy has read more books than I, Lao Jin. I thought he was a surgeon, but I didn't expect his theory to be so solid. I didn’t have any social activities all day, and in my spare time I basically read books, both in Chinese and English. I read all the orthopedic monographs. The papers were updated every day. I followed the international frontiers, but I had never heard of this disease.
He thought about what Yang Ping said, and it did make sense. Those with metal implants will release metal ions to some extent. These ions are sent to various joints by blood circulation. If the synovial membrane is allergic to them, it is easy to produce an inflammatory reaction. It is theoretically possible.
Song Zimo gently touched Yang Ping next to him with the tip of his elbow: "Senior brother is senior brother. You have thought of such a terminal disease. Where did you know about this disease?"
"I forgot, I heard others say it." Yang Ping said lightly.
Director Han nodded: "Well, being able to come up with this diagnosis shows that the scope of reading and studying is relatively broad. You can talk about it in detail."
Yang Ping said: "This patient had a history of surgery for carpal scaphoid fracture 4 years ago, and two metal mini-countersunk screws were used, but these two screws have never been removed. The location of the disease is more in line with the inference, first the left wrist joint, Then there are the other joints. Synovitis of the left wrist joint is considered to be caused by the direct release of metal ions, so it occurs earlier, while other joints are caused by the blood spread of metal ions, so the time is naturally delayed. In addition, the time is also consistent with the inference. The swelling and pain in multiple joints occurred after this operation. I just speculate that there is no sufficient evidence to try to remove the two screws to see if the symptoms will gradually reduce.”
"I agree with Dr. Yang's opinion. Remove those two screws. Even if not, it will not have any adverse effects on the patient." Tian Yuan's opinion was quite satisfactory.
"There are so many young men, why don't any of them say anything?" Director Han said.
Discussions usually start with junior doctors, gradually escalate, and end with Director Han’s summary. But today, this case is so rare that people are diagnosing it as a "difficult and complicated disease". They were so frustrated that they made this diagnosis so cruelly that doctors across the country were dumbfounded.
Everyone was silent just now and couldn't pry their mouths open. When Yang Ping said this, everyone's thinking opened up. Although no one had heard of this disease, Senior Brother Yang said it was, so it was this disease, and the rest was Let’s see how to verify the inference.
"Well, I agree with senior brother, no, Dr. Yang." Fang Yan said.
Xiaowu also nodded: "I agree with this opinion, and I can't seem to think of anything else."
Zhang Lin raised his hand and spoke in a calm tone: "I have an immature idea. These metal ions metabolize themselves too slowly. Is it possible to use a metal ion chelating agent to speed up the removal of metal ions, so that the symptoms will disappear?" Can be relieved quickly ”
Director Han praised Zhang Lin: "He is very thoughtful. Everyone puts forward any ideas they have. They make bold assumptions and carefully verify them."
Zhang Lin was praised and immediately became energetic, as if he had suddenly grown a few points taller.
Song Zimo said: "You can do a joint puncture and aspirate the synovial fluid to detect metal ions to see if they can be detected. If the metal ions can be detected, see if they are consistent with the composition of the implant screws."
Song Zimo is still Song Zimo. Although the position of the senior brother was abruptly taken away by Yang Ping, no one seems to be able to shake the position of the second senior brother.
"Well, this is a good idea. Aspirate synovial fluid to look for metal ions. This is not difficult for the laboratory. If it doesn't work, you can find a laboratory at a medical university to do it." Dr. Jin agreed. He has always been optimistic about Song Zimo.
"Even if metal ions are present, it doesn't necessarily prove that it is the cause." Tian Yuan said.
The discussion began to escalate. Director Ouyang said: "We will first solve the actual problem in the clinic, remove the screws, and observe whether the subsequent symptoms will gradually ease. Diagnostic treatment is allowed clinically, not to mention that it is beneficial to the patient. As for other things, We can study it slowly. This is indeed rare and can be studied as a subject. "Director Ouyang is actually quite handsome. His back is straight, like a soldier's back when standing in a military posture. His hair is mixed with black and white, which makes it a unique look. charm. Dr. Jin also belongs to this lean type. His group is in obvious contrast with Director Bai's group.
Director Bai weighed two hundred kilograms on the chair. If Corey's chair hadn't been of good quality, it might have been overwhelmed and fell apart. His attending physician was also a heavyweight, so it looked strange for the two of them to sit together.
"Currently, many people are studying whether the metal ions generated by friction in metal-on-metal artificial hip joints enter the blood circulation and are harmful to the human body. However, few people are studying the ions released by metal implants, because the ions released It’s almost negligible,” Director Bai said with great enthusiasm.
Director Ouyang added: "I have also checked a lot of literature on this and found no relevant papers. A few years ago, a classmate of mine was a visiting scholar in Europe and mentioned that there were European doctors studying this area. I can't remember the details. , but no relevant papers have been published.”
Everyone is very active, you say something, I say something, but they are not random words, but have certain ideas. Rigorous clinical thinking is very important, which is actually logical reasoning ability. A brilliant doctor diagnoses a disease with clear organization and strict logic.
After everyone's opinions were combined, the outline of the idea became clearer. Director Han said: "Why is this case brought up for discussion? I just want to say two words, seriously. We should take any problem seriously and don't think it's just a joint pain? There are so many The reason could not be found. After routine examination and treatment, he was discharged. The reason why Union Hospital cannot shake its position as a big brother in the medical field is because of its rigor. This is the biggest tradition that continues to this day.
The first case of AIDS in my country was diagnosed by Union Medical College. This process can write a wonderful book. At that time, no one had ever seen this disease and could only learn about it through literature reports. There were no mature biological reagents for diagnosis. It was all up to doctors to combine their own resources and carry out pioneering work. There are countless examples of this.
A patient with hyperthyroidism caused bone calcium loss throughout the body and was diagnosed with advanced bone cancer in many hospitals. The patient refused to give up and went to Xiehe's outpatient clinic after all the troubles. The professor looked at it for a long time and said: I don't have enough experience to draw a conclusion on this. I have to check the information. You don't need to register in a week, just come to the outpatient clinic to see me.
At that time, the patient was very angry and waited for a few months for you to say: I don’t know? He almost didn't get angry on the spot. The patient just said "Concord" and left happily. A week later, after much deliberation, the patient went to see the professor.
At that time, international research on hyperthyroid bone mineral disease had just begun, and many people did not recognize this disease. This professor worked hard to check information after get off work and discussed on the phone with colleagues at home and abroad. A week later, the diagnosis came: hyperthyroidism, not bone cancer.
No matter what kind of disease this patient has in the future, he will go to Xie Xie for treatment. He would rather wait for several months to go to Xie Xie for treatment.
When the Secretary of the World Health Organization and Children's Fund visited our country, he mentioned that he was born in the Union Medical College Hospital in the 1930s. As a result, the Union Medical College Hospital retrieved his birth records and found that his birth footprints were well preserved. How many times did his mother do this every day? Breastfeeding times are clearly recorded. What kind of rigor is this. ”
Director Han spoke very thoughtfully and spoke a bit too much: "I thought everyone thought this case was boring and of little value for discussion, but today everyone spoke actively and enthusiastically, which shows that everyone is thinking seriously. Indeed, this case is very rare. Austrian doctors have researched and published papers, but they are in German and in an obscure medical journal, so it is difficult for everyone to search for them. ”
Everyone looked at the German paper with radiant eyes. Could this guy still read the German paper, right?
"Xiao Yang, where did you see this German paper?" Director Han asked.
"I just heard it from a professor before, so I took it down." Yang Ping chuckled.
"No matter how it is obtained, it is worthy of praise to be able to remember such an unpopular thing and apply it when needed. This patient will follow the process just discussed, puncture and aspirate the joint fluid to look for metal ions, and surgically remove the screws , explain clearly to the patient," Director Han concluded.
Two screws caused severe synovitis in a limb joint for three years? Really?
Everyone can't wait.
(End of chapter)