Chapter 258 Less than 300 cases worldwide
After saying that, Teng Guihua realized that something was wrong with her and immediately covered it up: "I'll just ask, just ask."
There was a trace of imperceptible joy on her face, which Yang Ping caught in his eyes. Perhaps the physical examination training in the system space made his observation skills stronger than ordinary people.
You read that right, my daughter's condition has worsened. Shouldn't she be anxious or even crying? Why is she still a little happy?
"I'll do it!" Teng Guihua also squeezed to the bedside to help Fang Xiaoyun massage her legs.
Fang Xiaoyun's colleague Chang Juan stepped aside a little and showed a disgusted expression. The weasel was sending New Year greetings to the rooster, which was not a good intention.
But she is Fang Xiaoyun's mother after all. This time she didn't force her for money, she just came to see her daughter. As a colleague, it was hard to say anything.
This mother is quite fashionably dressed, has heavy lipstick, and has a pungent perfume that can be smelled through the mask.
There are many rings and bracelets on her hands and necklaces on her neck.
After reading Fang Xiaoyun, Professor Zhang told Yang Ping to observe closely. He also wanted to go to the outpatient clinic. He said that a patient's test results came out and he was very anxious. He had been waiting for him and he went to explain to the patient.
It was already after get off work hours, and the old man still went to explain the condition to the patient, which was really tiring.
The old man was eighty and still couldn't find time to spare. The hospital arranged for him to go to the clinic one day a week, but he refused and insisted on going out five days a week.
After Professor Zhang left, Yang Ping retrieved all Fang Xiaoyun's case data for research.
Any abnormality must have an explanation, otherwise there will be a knot in my heart and I will feel unhappy.
This kind of abnormality would be fine in the eyes of others, but Yang Ping was not willing to let it go easily.
"What? You're not off work yet?" Xiao Su put her bag next to the computer, sat down with Yang Ping, and massaged Yang Ping's shoulders.
The two agreed to have dinner together, take a walk after dinner, and play tennis for a while.
"This patient's spinal cord edema continues to not subside, and the peak period lasts too long, which is very abnormal-" Yang Ping explained to Xiao Su.
"Look slowly, I'll accompany you." Xiao Su sat next to her, rubbing Yang Ping's shoulders with her hands.
Doctor, it's important to have an understanding partner.
Otherwise, a few days of consecutive emergency surgeries can turn the family into a mess.
"Watch the movie carefully and don't worry about me. My father is a doctor and my mother is a nurse. I have been used to it since I was a child." Xiao Su smiled slightly.
Yang Ping looked at them one by one, not missing any clues, and carefully inspecting every part.
It doesn't matter if you sacrifice some rest time. It's better if you don't find the problem. If you find the problem, you can deal with it in time. If it is delayed, it will affect the patient's life.
"The spinal cord compression has been completely relieved, there are no signs of embolism in the arteries supplying blood, and the dural veins are slightly thicker than normal."
While Yang Ping was watching, he told Xiao Su that Xiao Su was very interested. He liked to hear Yang Ping talk about his condition.
The dural veins were slightly thickened. This was Yang Ping's intuitive feeling after watching too many images in the system space.
If the blood vessels are slightly thicker or thinner, nothing can be found at all, and even a slight difference cannot explain the problem.
Yang Ping compared the MRI and CT films taken before surgery, on the first day after surgery, and one week after surgery.
The dural veins in the same area became thicker every time. Although this change was very subtle, Yang Ping still caught it.
Moreover, changes in spinal dural veins are positively correlated with spinal cord edema. The thicker the veins, the more severe the spinal cord edema.
If it weren't for my devilish training in the system space, how could I have seen this almost negligible change.
Spinal dural arteriovenous fistula?
No, there are less than 300 cases reported in the world. For such a rare disease to occur at the same time as spinal tuberculosis complicated by paraplegia, and superimposed together, this is the probability of a lightning strike.
However, the more Yang Ping looked at it, the more he pointed to this disease, which was almost certain.
If so, spinal arteriography must be performed as soon as possible. The angiography time is very long, taking several hours.
There are many blood vessels in the spinal cord, and their distribution is very complex. There are bilateral vertebral arteries, common carotid arteries, thyrocervical trunks, costocervical trunks, and 12 pairs of 24 intercostal arteries. These blood vessels may be the site of fistula formation.
During angiography, the X-ray exposure time is long, which is a great test for both the patient and the surgeon.
The most troublesome thing is that because the structure of the blood vessels around the spinal cord is complex, perhaps because of inadequate techniques, even if all the above blood vessels are angiographed, the problematic blood vessels cannot be found.
Contrast media also increases the risk of spinal artery embolism, especially the anterior spinal artery that was anastomized in the previous surgery. The condition is complex and multiple conflicting risks are intertwined.
Without the patient's full understanding and cooperation, the next step of examination and treatment cannot be carried out in this case.
"Dural arteriovenous fistula? Emergency DSA digital subtraction angiography should be arranged immediately." Yang Ping told Xiao Su.
I couldn't eat dinner in the evening, and my walks and tennis were useless.
"What are you eating? Let's order takeout!" Xiao Su was not dissatisfied.
Looking at Yang Ping's attitude, if DSA is diagnosed and emergency surgery is required, it would be great to do the surgery together!
There was no need to explain, the two of them had a tacit understanding, and Xiao Su immediately went to arrange takeout for dinner. Everyone was preparing to pack their things and get off work. Song Zimo and Tang Fei greeted Yang Ping and said they were about to get off work.
"Fang Xiaoyun, spinal dural arteriovenous fistula!"
Yang Ping responded to Song Zimo.
Song Zimo stopped immediately: "Emergency DSA?"
"Well, after the diagnosis is confirmed, perform surgery immediately and contact the interventional operating room, which should be able to do hybrid surgery."
Yang Ping took the water brought by Xiao Su, and Xiao Su said with a smile: "It seems that everyone can't get off work. I have ordered all the takeaways."
Song Zimo and Tang Fei immediately gave up get off work. Song Zimo handed the backpack to Tang Fei: "Put it away for me. I'll call Fatty Zhang Lin, Xiaowu, and several other people over. We have work to do tonight. There are less than 300 cases in the world. We stepped on it, is it true?”
"Ninety percent of it is true, prepare for DSA and surgery." Yang Ping stood up.
If the two diseases are superimposed and occur at the same time, both can cause spinal cord edema and paraplegia. One disease can cover up the other. What a low probability.
Zhang Lin, Xiao Wu and Fatty saw that Yang Ping hadn't gotten off work yet, so they didn't dare to get off work on time for fear of being asked to do something.
Several people were having a "meeting" in the duty room. After receiving a call from Song Zimo, they all came out without any delay.
Several of them had no idea about spinal dural arteriovenous fistula and had never heard of it.
At this time, Professor Zhang called with a hurried tone: "Xiao Yang, where are you? We are going to do a DSA of the spinal arteries on Fang Xiaoyun in the emergency department. It is very likely that there is a spinal dural arteriovenous fistula!"
"I'm making arrangements!"
"I'll be in Corey right away!"
The phone was not hung up in time, and the old lady's voice came from inside: "Oh -, I just came back, the rice is all ready, go have a bite to eat before you go, it's good to have two or three bites to fill your stomach -"
Professor Zhang has rich experience, and he also thought of this rare possibility.
Song Zimo is contacting the interventional operating room. There are several operating rooms that can perform hybrid surgery.
But at night, I don’t know if there are enough people to help with DSA. I need the help of an interventional doctor with very good skills.
Everyone split up. Xiao Su and Zhou Can needed to get the right instruments, prepare microscopes, determine the interventional surgery room, and send them all there.
After DSA is performed, the diagnosis is confirmed, and the operation is performed directly in the interventional operating room. Sometimes angiography is required during the operation to find vascular fistulas, and post-operative angiography is required to confirm whether the arteriovenous fistulas have been properly treated.
Yang Ping reported to Director Han, who also said he would come immediately. He was not worried about Yang Ping's skills, but was giving Yang Ping a platform and taking risks. After all, Yang Ping was the attending physician.
After checking Zhang Lin's informed consent form, making slight modifications, and printing it out, Yang Ping took Zhang Lin to talk to Fang Xiaoyun to obtain her understanding and cooperation.
Teng Guihua is in the ward, and Fang Xiaoyun's colleague Chang Juan is also there. She may be worried that this mother will do something unfavorable to Fang Xiaoyun.
Yang Ping felt that Fang Xiaoyun was fine. This mother might be the biggest obstacle to communication. Fang Xiaoyun was an adult. In order to save trouble, Yang Ping decided to bypass this weird mother.
"I want to talk to the patient now. You go out, Zhang Lin. Call the nurse to come in and take them out." Yang Ping's words were unquestionable.
"I'm her mother, you can't talk about anything in front of me." Teng Guihua noticed something unusual.
Yang Ping waved his hand: "Go out, didn't you hear clearly? I don't want to waste time. Fang Xiaoyun is an adult and has the ability to act independently. You don't need to be present."
Although these words were crude and direct, it was a waste of time to argue with her at this time.
Chang Juan is more aggressive: "Just go out when the doctor says. There is so much nonsense. Xiaoyun, let's go out. We will listen to the doctor and don't think too much."
Colleagues pushed her mother out, and when the nurse came in, Zhang Lin closed the door and examined the female patient, or if she wanted to talk alone behind the closed door, a third party such as a nurse or female doctor must be present to avoid unnecessary disputes.
"Dr. Yang, what happened?" Fang Xiaoyun asked a little scared.
Yang Ping said calmly: "Fang Xiaoyun, it has been a week since your operation, and the strength of your legs is getting weaker and weaker. This is not normal. We suspect that in addition to spinal tuberculosis, you also have a dural arteriovenous basket. This is a rare condition. There are currently less than 300 cases of this disease reported in the world. It is very likely that it occurred just after the surgery and became the cause of the worsening paralysis of your lower limbs. I am not 100% sure, but I am 90% sure that I need to do a spinal arteriography now. , look for each blood vessel one by one, you may find it, or you may not find it. If you find it, do the surgery immediately to deal with it. This time, you have to do the surgery from behind. Are you willing to believe us and cooperate with us? If this disease is not discovered and treated in time, it will cause permanent paralysis.”
This disease is acute, has a poor prognosis, and causes venous stasis, causing irreversible spinal edema and subsequent extensive arterial embolism.
"Don't be afraid. You can decide your own affairs. Your body is your own. You don't need to consider other factors." Yang Ping added, his tone was firm but gentle, and he spoke clearly.
Fang Xiaoyun is an ordinary rural girl. Before she graduated from junior high school, she was scolded by her mother to work part-time. She worked as a general worker in a factory. Later, after someone introduced her, she went to a foot bath shop to get acupoint massage.
All her money over the years has been used to support her family. All she bought were cheap clothes. She couldn't bear to replace a Redmi phone after using it for several years.
But at the critical moment, the girl had a clear idea. She thought about it and nodded: "Dr. Yang, I listen to you in everything. Thank you for your hard work. You should check and perform surgery."
"Just say this. We will make arrangements immediately. I will tell you the details of the operation——."
After speaking and signing, Yang Ping stood up and the nurse opened the door.
I thought it would take a lot of effort to convince Fang Xiaoyun, but I didn't expect it to be easy. This girl understands things very well.
Perhaps, her decisiveness can save herself.
(End of chapter)