Chapter 122 General Conference
Synovial chondromatosis of the knee joint has been seen a lot, but so many cases are rare.
Xiao Wu took off the film to avoid causing the secret phobe any further discomfort. He admitted the patient to the hospital and completed the preoperative examination and surgical arrangements.
Yang Ping continued to study the punctures of Huaqiaolou patients, and repeatedly simulated punctures with the help of images constructed in his mind to adjust the angle of punctures in order to hit the target with one hit.
Song Zimo didn't take a break at noon and stayed in the laboratory practicing arthroscopy. Tang Fei called him lunch from the cafeteria. He ate it in the dining room of the department and continued practicing in the afternoon.
It is said that at the Department of Orthopedics of Trauma, he would practice until after ten o'clock every night, and sometimes until twelve o'clock, as long as there was nothing special to do.
The three-dimensional CT and MRI reconstructions of the Huaqiao Tower patients have been completed. Thin-layer scanning showed that the reconstruction results were very clear. Director Han compared Yang Ping's paintings with the reconstructed images on the electronic reader. There was almost no big difference in the spatial structure. Yang Flat pictures are more expressive.
Director Han looked at the time and saw that it was already half past four. He put down what he was doing and took Yang Ping to the Overseas Chinese Building to attend the conference.
In the conference room of the Internal Medicine Department of Huaqiao Building, several directors had already arrived, as did Director Zhao of the Medical Department. Everyone gathered around the oval table to discuss Mr. Ning's condition privately in advance.
Director Kong asked Director Han and Yang Ping to sit down. Each seat on the table was equipped with a high-definition tablet computer. This is the terminal of the mobile medical record system. The patient's medical records and auxiliary examination results can be accessed on the tablet computer. The screen of the tablet computer The resolution is much higher than ordinary ones, just to be able to see the details of the image clearly.
Director Kong's calls continued, and people came in one after another, including the major directors in the hospital and several professors from outside the hospital. Director Zhuang from the Department of Internal Medicine also came to help accompany the experts from outside the hospital.
"This is attached to the second courtyard--"
"This is from the First Affiliated Hospital——"
"This is from the cancer hospital——"
Several directors came over and took their seats one by one. Director Kong and Director Zhuang made arrangements with ease and without any neglect or omission. The two brothers from the Overseas Chinese Building were also considered figures in the scene.
The consultation naturally involves seeing the patient. Someone has already proposed to see the patient first. Director Kong takes people to the ward to see the patient, and Director Zhuang helps accompany the patient.
Everyone used this time to reminisce about old times. These experts are familiar with the directors of relevant departments of Sanbo Hospital. They often get together during meetings, and some of them are even senior brothers.
We are usually very busy, so it is rare to see each other. Except for academic meetings, it is this kind of large-scale medical meeting where we can chat for a few words and talk about our respective current situations.
Only Professor Su Qingyun from Appendix 1 has not arrived yet. He is the main expert of this meeting. Although the patient has liver cancer, the problem to be solved now is caused by spinal metastases. Su Qingyun is the chairman of Orthopedics of Nandu Province and an academician. The popular candidate is naturally the most important expert in this consultation. The meeting was postponed from three o'clock to five o'clock just to wait for him.
Su Qingyun was still the dean of the First Affiliated Hospital and was very busy with work. It was a great honor to be able to take the time to come over. Everyone was talking privately about who this patient was. Professor Su was invited to come forward in person. In normal times, some external hospitals would send students for consultations even if he was invited. join.
There are still a few minutes left, and Professor Su has not yet appeared. Yang Ping had met Professor Su before. There was an academic conference held in the Municipal People's Hospital. Professor Su went there. It was from a distance, not as close as now.
Professor Su has published more than a dozen articles in top international orthopedic journals such as AJAM and JBJS. The impact factor is extremely high, so he is at the top level in China and has a place internationally.
Some people raised their wrists to look at their watches, some looked towards the door, and some whispered to each other, but they all waited patiently.
"Speak boldly later, don't have stage fright, academic matters, one is one, two is two, there is nothing to be modest about." Director Han told Yang Ping in a low voice.
At five o'clock sharp, Professor Su came in under the guidance of Director Kong, followed by a young doctor who looked very similar to Professor Su.
As soon as Professor Su came in, he greeted everyone with a smile: "Sorry! Everyone has been waiting for a long time!"
In fact, he was not late, he came in just on the hour, but others came earlier.
Professor Su is in his fifties and does not look old at all. He wears glasses and a Chinese tunic suit with a white shirt. He has an elegant temperament and shows off his elegant demeanor. His strong aura comes from his long-term high academic position.
Everyone came up to shake hands with him. When shaking hands with Director Han, Professor Su stayed longer: "Brother Han, long time no see."
Seeing Yang Ping next to Director Han, Professor Su asked: "Who is this?"
"Doctor Yang, my student!" Director Han introduced.
Yang Ping shook hands with Professor Su. "The young man has an extraordinary temperament, and Professor Han is famous for his sharp vision. He has not recruited doctors for many years, but he would rather be short-term than inexperienced. It seems that he has picked a good candidate." Professor Su said with a smile.
"This is Dr. Su!" Director Han introduced the young man next to Professor Su.
"Su Nanchen!" The young man next to Professor Su shook hands with Yang Ping.
"Yang Ping!" Yang Ping could feel his confidence and calmness.
When Director Han was in Shanghai, he and Professor Su were both outstanding figures in the young generation of orthopedics. However, when Director Han moved from Shanghai to Nandu, he wanted to start his own business again. Naturally, he could not compare with Professor Su academically. However, The foundation is still there.
The two of them cherished each other, exchanged a few simple greetings, and then took their seats.
"That's Professor Su's son. He graduated from the eighth-year program of the Union Medical College and is a young talent with a first degree in orthopedics. After graduation, he studied at the Minnesota Twin Cities Spine Center and the New York Hospital for Special Surgery. He will be your strong force in the Southern Division of the Golden Knife Award. opponent; in the national competition, he is a rare super strong opponent, and he is also an all-around player," Director Han said in Yang Ping's ear.
A tiger's father has no dog's son. Dr. Su is not only a talented person, he also graduated from the Concordia Eight-year College. The difficulty of passing the Concordia Eight-year College is no worse than that of Tsinghua University. Those who can get into the exam are basically top academic figures, among the top few in the province's college entrance examination. famous.
Professor Su must have high hopes for his son, otherwise he would always carry such meetings with him. Carrying him with him would allow him to see the world, participate in more exchanges, and even help him build a reputation and connections.
Everyone sat down, and the consultation began. Director Zhao presided over it, and the doctor in charge of the bed reported the medical history.
After the medical record report was completed, Director Kong added: "Dear experts, respected Professor Su, please take time out of your busy schedule for consultation today. The problem that this patient currently needs to solve is the severe pain in his chest. Thank you all!"
"Is it convenient for us to see the patient first?" Professor Su suggested.
Director Kong took everyone to the ward to see the patients. Professor Su personally asked about the medical history and performed a physical examination. Other professors also selectively asked about the medical history and performed a physical examination according to their own needs.
After seeing the patient, everyone washed their hands and returned to the conference room.
Director Xu of the Sanbo Pain Department spoke first: "This patient was admitted to the hospital the day before yesterday. From admission to now, we have been following up on pain management. According to the ladder principle of tumor analgesia, this patient has been taking morphine for three months. During this hospitalization, I used an extreme amount of morphine, 30 mg/time, twice/day, but it could only relieve the pain in the liver area, and the pain in the chest was still severe. After admission, a comprehensive examination was performed, and the heart, lungs and aorta were ruled out. According to the nerve location, the chest pain caused by the chest pain is in the area innervated by the anterior branch of the thoracic 2 nerve. According to the CT and magnetic resonance images, the thoracic 2 nerve root happened to be violated and compressed, so we think it is caused by the thoracic 2 nerve root. Unfortunately, , spinal anesthesia and analgesia cannot be performed here. Once respiratory depression occurs, the consequences will be serious, so we are encountering difficulties and need your help.”
"Have you considered using an implantable analgesic pump, implanted into the spinal canal, using morphine as the main drug in the analgesic pump formula, and releasing it regularly, so that it can provide analgesia without causing anesthesia in the plane or affecting breathing? ." said the director of the pain department of Annex II.
After the director of Appendix 2 finished speaking, the director of the pain department of Appendix 1 said: "It is not realistic to implant an analgesic pump in the spinal canal. An extremely large amount of morphine has been used to suppress pain in the liver area. This kind of radicular pain, according to our experience, , morphine is almost ineffective. We have used it before at lower levels. If the nerve root is healthy and there is no tumor invasion, it will be effective. In this case, where there is already tumor tissue invasion and stretching, morphine is ineffective and anesthetics must be used for nerve block. ”
The director of the pain department in Appendix 2 had a different opinion: "Nerve block is too difficult and almost impossible. Usually we perform nerve block around the sheath. Even if it is punctured into the sheath, the anesthetic will leak out. This kind of To block, it is necessary to ensure that all the anesthetic is in the nerve sheath and cannot leak out, otherwise it will cause anesthesia in the plane and inhibit breathing, and only a ventilator can be used to assist breathing. ”
After a brief silence, the professor from the cancer hospital spoke: "Would you consider localized surgery, leaving other areas untouched, entering from the posterior approach, and only removing the tumor tissue that is compressing and invading the nerve roots, releasing the compression, liberating the nerve roots, and the pain will disappear naturally. ”
"The family refuses the surgery, even if it is a limited surgery!" Director Kong explained.
"We are not willing to have surgery, but we also want to solve the problem. This is posing a problem for us." said the director of the Orthopedics Department of Attachment 2.
The Department of Orthopedics of the Second Department ranked second in Nandu Province. A long time ago, the Orthopedics Department of the First and Second Department were evenly matched. Since Professor Su Qingyun became the director of the Department of Orthopedics, the Department of Orthopedics of the First Department began to take the lead, from overpowering to being far behind.
Symbolizing the highest risk orthopedic surgery, scoliosis correction, Appendix 1 has more than 300 surgeries per year, ranking first in the country, while Appendix 2 only performs nearly 100 surgeries, ranking in the second tier.
Regarding bone tumors, Annex 1 has an independent large-scale bone tumor area, while Annex 2 currently does not have an independent large-scale bone tumor area.
So naturally, Fu 2 Orthopedics was resigned to being inferior and regarded Fu 1 as the big brother.
Spinal analgesia was unavailable, nerve block was not feasible, and the family members refused the surgery.
Is this discussion no longer possible?
The discussion fell into silence again.
(End of chapter)