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 were a lot of fruits on the bedside. These were all left by the brothers and washed cleanly. Yang Ping ate an apple and washed his face. He thought of the case discussion at three o'clock in the afternoon. p>
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 week's difficult cases and fatal cases are discussed.
For young doctors, this is a rare learning process. For senior doctors, this is the time to show off their talents. How the surgery is performed can be seen clearly on the stage; how the theoretical knowledge is, can be seen through the discussion of medical records. At this time, everyone closes the door.
It is legal to argue with each other, kick your nose and slap your eyes on the table.
Song Zimo came in, sat next to Yang Ping, and whispered: "The blood vessels of the premature baby last time 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 details?"
"Your name as a 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 he can face the gap. It is a blessing to have such colleagues. Now, as long as he is free, Song Zimo will do Yang Ping's surgery.
Take the initiative to help on stage.
"Okay! I'll set the stage for you next time." Yang Ping said.
Song Zimo put his arm around his shoulders: "How is the equipment nurse doing? 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. As a senior, I have to pass on my life experience. 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 sit next to Director Han. He was Corey's secretary and had to take notes.
Everyone gathered in groups to show that the classroom was packed. Several senior directors sat in the first row, with a bottle of mineral water in front of each person. There was 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 resident doctors 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 triggers, he developed pain and swelling in the left wrist joint, which later gradually developed to bilateral shoulder joints, elbow joints, and right wrist 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, ankle joints MRI showed synovial swelling and joint effusion -"<
/p>
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, and has been seen by well-known professors from well-known hospitals across the country, including traditional Chinese medicine and Western medicine, internal medicine and surgery, but he has always been swollen.
It hurts, and now it is difficult to even walk normally. I have been to many hospitals, but the problem has not been solved. Let's discuss it and see how to make a clear diagnosis and treatment."
Dr. Jin is the old doctor. He is over 40 years old. He is a few years younger than Director Ouyang. Based on his seniority, he should have been the chief physician. But he is rigid and never cheats. So far, he has not been able to write a paper or get an award.
topic, so now I am not even a deputy chief physician. In fact, the real level is the full chief physician level.
After Dr. Jin finished adding, several young doctors began to scratch their heads. This kind of atypical case is the most troublesome and tests the doctor's diagnostic ability, which is precisely the weakness of surgeons.
Many orthopedic surgeons put the X-ray on the reading light and say: do an operation! Why bother to use your brain to make a diagnosis? Isn’t it clear on the X-ray? Diagnosis is the business of physicians.
"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 job in surgery, but also
At the same time, we must have good clinical thinking skills. Now let’s discuss what diagnosis this patient should make and how to treat it,” Director Han said.
There are many diseases for which the cause cannot be found medically. Diagnosis is like a detective solving a case. Based on the medical history, physical examination and auxiliary examination, and following certain logical thinking, one can follow the clues to identify the disease. There are cases that cannot be solved, and there are also diseases that cannot be detected.
.
Normally, case discussions start with junior doctors and gradually escalate. In today’s case, the junior doctors were 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."
"There are all kinds of diagnoses, synovitis, rheumatoid arthritis, autoimmune arthritis, reactive arthritis. How about the next 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, hardworking and uncomplaining. 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 transient synovitis cases 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, listen, entering the system does not take up time anyway. In reality, it takes a moment. 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, especially rare ones, and even case reports about these synovitis. p>
Synovitis is actually only a symptom diagnosis, not a cause diagnosis. Just like fever, many diseases can cause fever, and it is necessary to find the cause of the 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 directly help with diagnosis, and then he could show off coolly.
Even though I had to work so hard to search for information, fortunately, the search function of the system library is relatively powerful, and I finally found many papers, one of which caught Yang Ping's attention.
Five years ago, a paper written by an Austrian doctor was published in a humble medical journal. It was written in German. The system function is quite considerate and can actually help translate the paper.
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 reaction. This disease is extremely rare. Yang Ping searched and found that no one else has reported it except this Austrian doctor.
This is interesting. Yang Ping studied the paper in detail. Didn't this child undergo left carpal navicular surgery 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?
This child's symptoms are very similar to those mentioned in the paper, but they are just assumptions without any evidence. However, after searching again and again, this is really the only one that is close. After checking again, no suitable information was found, and Yang Ping retrieved it from the system.
Come out.
"Yang Ping, Song Zimo, what are you two hiding there? Tell me a few words!" Director Han saw that everyone was silent and directly called them by name.
Director Han called the name, it would be inappropriate not to mention it.
Song Zimo patted Yang Ping: "Brother, come on!"
Yang Ping secretly scolded this guy. At this time, the senior brother’s shout 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.
