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. He didn’t have any social activities all day, and basically read Chinese in his spare time.
I have read all the orthopedic monographs in English, the papers are updated every day, and I follow the international cutting-edge, but I have never heard of this disease.
He thought about what Yang Ping said, and it did make sense. 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. In theory, it is completely possible.
Possibly.
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. 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. The 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 hematogenous spread of metal ions, so the natural time lags. In addition, the time is also consistent with the inference,
The swelling and pain in multiple joints occurred after this operation. I am just speculating at the moment and there is no sufficient evidence. You can try to remove the two screws and 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 is quite satisfactory.
"There are so many young men, why don't any of them say anything?" Director Han said.
Usually the discussion starts with junior doctors, gradually escalates, and finally Director Han concludes. But today, this case is so rare that everyone has diagnosed it as a "difficult and complicated disease". How disheartened and frustrated they are.
This cruel diagnosis shocked doctors across the country.
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. The rest was
Let’s see how to verify the inference.
"Well, I agree with senior brother, no, Doctor Yang." Fang Yan said.
Xiaowu also nodded: "I agree with this opinion, I can't seem to think of anything else."
Zhang Lin raised his hand and spoke in a calm manner: "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?"
Provides quick relief."
Director Han praised Zhang Lin: "He is very thoughtful. Everyone puts forward any ideas they have, makes bold assumptions and carefully verifies 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 joint 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 senior brother was abruptly taken away by Yang Ping, no one seems to be able to shake the position of 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. p>
"Even if there are metal ions, it doesn't necessarily prove that it is the cause." Tianyuan said.
The discussion began to escalate, and Director Ouyang said: "Our clinic first solves the actual problem, removes the screws, and observes 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 topic."
Director Ouyang is actually quite handsome. His back is as straight as a soldier's back when standing in a military posture. His hair is mixed with black and white, which makes him have a unique charm. Dr. Jin also belongs to this lean type. His group is the same as that of Director Bai.
That group forms a clear contrast.
Director Bai weighs 180 kilograms on the chair. If Corey's chair wasn't of good quality, it might be overwhelmed and fall apart. His attending physician is also a heavyweight. It looks weird for two people 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 spoke 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 I haven’t seen any relevant papers 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, in fact, it is the ability of logical reasoning. A skilled doctor diagnoses diseases like peeling off cocoons, 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 many.
The reason could not be found. After routine examination and treatment, the patient was discharged. The reason why Union Hospital cannot shake its position as the 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, and it all depended on the doctors' own combination. resources to carry out pioneering work. There are countless such examples.
A patient with hyperthyroidism caused a loss of bone calcium throughout the body and was diagnosed with advanced bone cancer in many hospitals. The patient did not give up and went through all the trouble to go to Xiehe's outpatient clinic. The professor looked at it for a long time and said: I don't have enough experience to do this.
Conclusion, 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 several months for you to say: I don’t know? He almost didn’t get angry on the spot. The patient just said a word of “Concord” and left happily. A week later, after thinking about it, the patient still said,
Go find that professor.
At that time, international research on hyperthyroid bone mineral disease had just started, and many people did not know about this disease. The professor desperately searched for information after work and discussed on the phone with colleagues at home and abroad. A week later, the diagnosis was made
: It’s hyperthyroidism, not bone cancer.
No matter what kind of disease this patient has in the future, he will go to Xiehe for treatment. He would rather wait for several months to go to Xiehe 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 all intact. How many times did his mother do that every day?
The time of each breastfeeding session is clearly recorded. How rigorous this is."
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 done research and published papers, but they were in German and in the journal of an obscure medical school, so it is difficult for people to search for them."
Everyone looked at the German thesis like lightning. Could it be that this guy could read the German thesis?
"Xiao Yang, where did you see this German paper?" Director Han asked.
"I just heard it from a professor before, so I wrote 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 followed the process just discussed, punctured and aspirated the joint fluid to look for metal ions, and surgically removed the screws
, explain clearly to the patient." Director Han concluded.
Two screws caused severe synovitis in the limb joints for three years? Is it true?