When Yang Ping and Director Zhu were outside just now, they had already had a heated discussion.
Several international celebrities agree that this is damage to the spinal cord blood supply. If the spinal cord blood supply is really damaged, it is impossible to restore the blood supply with surgery. The only option is conservative treatment, using some drugs to improve blood circulation.
Its natural development cannot escape paralysis in the end.
Spinal dural arterial fistula leads to insufficient arterial blood supply and increased venous pressure, which in turn causes spinal cord edema. These symptoms are consistent with damage to the spinal cord blood supply.
Moreover, it is not something that ordinary spine surgeons or radiologists can do to determine whether the blood supply of the spinal cord is damaged based on MRI and CT. Only top spine surgery experts have this ability to judge.
Therefore, this game-within-a-game case can be considered a high-level game. Ordinary doctors have ordinary ways to enter the game, and senior doctors have their own ways to enter the game. This is the reason why many experts cannot solve the problem. Diseases are sometimes so mysterious. p>
Several big names finally cracked the game with their rich knowledge, but they didn't know that after breaking the game, they entered the game. They thought they had broken the game, but in fact they entered a new game, and this new game is even more difficult to crack, because the people who entered the game had no idea.
So there is no possibility of breaking the situation.
"We can try to perform DSA digital subtraction angiography on the main blood supply vessels of the spinal cord to find damaged blood vessels, such as those caused by excessive ligation of the intercostal arteries during the operation. We can try to repair them. There is currently no necrosis and degeneration of the spinal cord, and there is
Opportunity." August was more positive than Milton.
"This is a huge and complex project. The scale and complexity are beyond your imagination. If it is a scientific research topic, it can be tried, but there are many obstacles in clinical cases and the implementation of immature ideas." Milton remained conservative.<
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"If you are transferred to our Suntang Hospital, we have more advanced equipment than DSA for examination to determine the location and extent of blood vessel damage to evaluate whether it is suitable for surgical repair. If surgical repair is required, our spine surgery has experience in this area."
Kobayashi Atsushi is very confident.
They really have a set of equipment that is more advanced than DSA. It was jointly developed by the University of Tokyo, its affiliated hospitals, and Toshiba. Juntendo was lucky enough to get an experimental machine.
"When it comes to examinations, our hospital also has better vascular examination technology than DSA. Computerized X-ray dynamic simulation imaging technology can perfectly reconstruct the entire human body blood vessel image." Auguste did his part.
August comes from the Orthopedic Hospital Harlachen in Munich, Germany. The spine surgery of this hospital is at the top level in the world. He is a little unhappy because the Japanese are said to be advanced before them.
Several big names were invited to this consultation, as well as a professor from the Twin Cities Spine Center in Minnesota, USA. It coincided with the spine surgery academic conference being held in the hospital, so he declined the consultation invitation.
The arrogance of the British was shattered by the Germans and Japanese. They each said that they have a more advanced inspection equipment. These equipment should be in the experimental research stage and have not yet been widely used.
But Milton can't come up with such equipment. Cutting-edge equipment is almost monopolized by these guys. Most of the cutting-edge medical equipment in Milton's hospitals now comes from these two countries.
To detect the location and status of damaged blood vessels, it is not possible with ordinary equipment. More sophisticated imaging equipment and technology are required.
Several doctors from other countries basically did not speak and became the foil of several big names to make the scene appear grand.
"Dr. Yang from China has not spoken yet. Let's listen to Dr. Yang's opinion." Dr. Lin took the opportunity to introduce Yang Ping.
Yang Ping was looking carefully at the images on the screen when he suddenly heard Dr. Lin's introduction and immediately withdrew his attention.
Everyone turned their attention to him. He was just a young doctor. Maybe some insurance company was just trying to make up for it and just found a doctor to deal with it.
Moreover, I didn’t see this doctor at all during the discussion, and I don’t know when he entered the venue.
"Sorry, everyone, I have at most half an hour to stay here." Milton was still more of a gentleman and reminded that the meeting would either end within half an hour, or he would leave early.
Yang Ping looked around, very calmly, and said: "Actually, this case is very simple, not very complicated. Everyone has seen less of it, so it's a bit at a loss."
All meetings were held in English, and Yang Ping was no exception.
As soon as these words came out, and they came out of Yang Ping's mouth, he had the unique confidence and calmness of a "man from the earth" who could see through time and space at a glance.
Let all the experts in the room be stunned at once, simple?
Such a complicated case was compressed into two easy words in his mouth---simple!
Milton, August, and Atsushi Xiaobayashi were all authorities in spinal surgery. Someone actually said such a thing in front of him. Professor Milton shrugged, treating it as a silly joke; August rested his elbows on the table.
He held his chin with one hand and listened carefully; Atsushi Kobayashi was a little disdainful, thinking it was just flattering and trying to find a sense of presence.
"Please help me retrieve the patient's images, both CT and MRI are needed!"
Dr. Lin immediately ordered the doctor in charge of computer operation to retrieve the patient's images.
Yang Ping walked towards the screen directly opposite the oval table and pointed at the pictures on the screen: "Slow down, just these pictures, and the MRI ones, yes, keep these pictures."
After selecting the pictures, he pointed at the screen with his electronic pen: "This is a typical case of a game within a game. The white game is a black game. You are trapped in the white game and cannot extricate yourself, while the patient is trapped in the black game and cannot be rescued."
I don’t understand the game within the game. I have never heard of such a case in medicine. Everyone shook their heads and shrugged, looking helpless.
"On the surface, this case was caused by a cyst compressing the spinal cord, and then intraspinal cyst resection was performed. The operation accidentally damaged the spinal cord blood supply. After the operation, the neurological symptoms were temporarily relieved due to the cyst resection, and delayed symptoms occurred due to the destruction of the spinal cord blood supply.
The neurological symptoms have worsened, and everything is flawless. The entire diagnosis and treatment process can be recorded in textbooks, and no one will question it even after many years." Yang Ping paused.
Doctor Lin took the opportunity to present a bottle of mineral water, and Yang Ping took a sip.
Continue: "But in fact, it is absolutely not the case. When we cut open this case, there is a rare case hidden inside---"
Yang Ping's eloquence has also improved, and explaining a case is like telling a story.
"This rare case is --- spinal dural arteriovenous fistula. You solved the white problem and did not find the black problem. The black problem continued to do evil and gradually worsened, so the neurological symptoms in both lower limbs worsened. The white problem covered up the black problem.
The spinal cord blood supply damaged by surgery has become its scapegoat, blocking everyone's bright eyes. Everyone has been led into a trap by it unknowingly, but they don't know it."
"It's so exciting, God, are you sure you are talking seriously?" August exclaimed. He had never heard of such a strange opinion before. It was so new.
"There is no basis! Spinal dural arteriovenous fistula must be diagnosed by DSA or more advanced vascular imaging technology. CT and MRI cannot be diagnosed at all. This patient does not have such examinations, how do you diagnose it?" Kobayashi Atsushi sneered, the world
There are currently no papers or monographs on the use of CT and MRI to diagnose spinal dural arteriovenous fistulas.
Milton shook his head: "No, no, no, there are less than 300 cases of spinal dural arteriovenous fistula reported worldwide. CT and MRI cannot be diagnosed at all. DSA and comprehensive superselective angiography of the spinal arteries are required. Even so, there is still a diagnosis.
There is a possibility of failure. I think your speech should be at least professional and prudent."
"Whether it's right or wrong, we heard different voices. This is very important. Most of the time, the truth is in the hands of a few people. Continue, I am very interested." The old German man hates the arrogance of the British.
"Yes, the fistula cannot be directly seen from these pictures, but if you look at these MRI and CT pictures, there are several pictures that are very clear. These are CT blood vessel images, and this is MRI using the blood vessel flow voiding effect to obtain images. Both
There is one thing in common, which I call the truncation effect: starting from a certain point, there is discontinuous diameter expansion at the proximal end of the vein, but there is no such phenomenon in the artery. This is the characteristic of arteriovenous fistula, indicating that a certain point
There is a fistula connection between arteries and veins, arterial and venous communication, and congestion in the veins. This congestion causes the veins to dilate, and the expansion loses its smooth transition. The venous congestion then causes spinal cord edema. The two conditions are superimposed, causing the diagnosis to fall into a maze.
." Yang Ping pointed to several pictures.
From the perspective of medical knowledge, everyone lacks this knowledge and cannot support or refute Yang Ping's words.
"Then, by doing a DSA on the patient and superselective angiography of the spinal cord blood vessels, won't Dr. Yang's diagnosis be confirmed?" August has always had a strong interest in this case.
The British still seemed conservative: "Superselective angiography takes a long time and may fail. Do you believe what he said?"
"We have more advanced technology than DSA that can verify this diagnosis." Atsushi Kobayashi has always suggested that patients transfer to Japan.
"Actually, there is no problem with the diagnosis of this patient. We just need to make the diagnosis clear in a familiar way. We can do another DSA. This requires a lot of super skills from doctors. There is also a more critical issue - surgery.
This arteriovenous fistula is in a relatively hidden position and requires very high requirements for blood vessel processing. The operation must be very delicate. It is best to leave this patient to my team for treatment. It is difficult for others to have such surgical experience."
Yang Ping said it truthfully. This arteriovenous fistula treatment can neither ligate the blood vessels nor separate the blood vessels and then repair the fistula opening like ordinary fistulas. For the safety of the patient, I am afraid that I really have to do it myself.<
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"What this doctor said lacks basic evidence support, and the surgery is something that only you can perform. Which hospital do you come from? What kind of research are you engaged in? What research results have you obtained?" Atsushi Kobayashi was not polite.
"I am Yang Ping from Sanbo Hospital in China. You will be able to see my thesis soon. I have no intention of saying anything. This operation is really difficult. It is very likely that there will be real spinal cord blood supply destruction after the operation. That will
It is a disastrous consequence that cannot be undone. I don’t want to see this scene.”
Yang Ping was very calm. He said everything he needed to say. He walked down from the podium and took a sip of water.
For every patient, he will go all out to strive for the best results for the patient.
This patient actually has a triple game. Yang Ping only talked about the two games. Let them accept the two games first, and then explain the third game later. For those who have not fully understood some of the two games, he rashly talked about the third game.
Bureau, too brain-consuming.
Why did Yang Ping insist on doing the surgery himself? This is because when surgically treating an arteriovenous fistula, several arteries that block the access must be ligated or electrocoagulated.
However, these arteries are routinely regarded as useless in surgical approaches and can be ligated or electrocoagulated. In fact, these arteries are the main blood supply vessels for a certain segment of the spinal cord.
The mutation, the strange mutation, makes this case weird and shocking every step of the way!
If it weren't for Yang Ping's powerful ability in the system space, I'm afraid no one would be able to solve this triple problem. Like most difficult and complicated diseases in the world, the truth will never be revealed.
Everyone began to whisper and discuss in low voices, not knowing what to do next.
