The cases discussed in each department are generally played through movies on the big screen, so that everyone can have an idea.
Then we will discuss each case in detail in order.
The members of the expert panel in the front row are all die-hards who are known for their rigorous scholarship, which makes the young doctors behind them feel a strong sense of pressure.
They proposed the weekly routine discussions in the hospital. For some difficult cases, they would discuss them. In principle, all departments would send people to participate. Departments with strong correlations would participate in the speeches. Non-related departments could also listen to other people's speeches.
Eye-opening.
Relatively speaking, physicians like this kind of discussion more than surgeons.
The level of surgeons mainly competes in surgery, and they are not very interested in the scene of moving their mouths.
But internists are different. Internists prefer to reason about difficult and complicated diseases. The more difficult it is, the more proficient it is.
The surgeon looked at the film and said: Operate!
Physicians face diseases and cite extensive evidence, from basic to clinical, from textbooks to cutting-edge papers, and they speak clearly and logically.
Medicine and surgery are two ends of the same body, but I don’t know when they started to despise each other.
Physicians feel that surgeons know how to perform surgeries all day long and don’t even know how to read an electrocardiogram.
Surgeons feel that physicians can't cure any disease, unlike surgeons who can simply use the knife and knife.
Therefore, it is very interesting to discuss cases where medicine and surgery are mixed.
Especially when it comes to areas where medicine and surgery intersect, such as some tumors.
Surgeon: There’s so much nonsense, just cut out the tumor and do a lymph node dissection. How can it be better if you don’t cut out the tumor?
Physician: Just cut it! Cut off all the organs for you? Don’t worry, we will treat it slowly, chemotherapy, radiation, see which one you are sensitive to, first a wave, then a targeted therapy, and finally what kind of biological treatment?
Immunotherapy to assist.
Experts organize this kind of mixed discussion to prevent everyone from falling into a stereotyped thinking. By communicating with each other between medical and surgical departments, many difficult and complicated diseases can become more open-minded.
A 64-year-old otolaryngology patient, a female, has a foreign body in the left paranasal sinus. The diagnosis is clear. As for how the screws that fixed the denture were "smuggled in", I don't care for the moment. The treatment plan is to contact a neurosurgery to cooperate and operate to remove the screws. p>
A patient in the Department of Urology, male, 36 years old, has a persistent erection. It has been like this since he had a fever a week ago. Various drugs are ineffective. The erection can be eliminated by spinal anesthesia. Once the anesthetic is over, the erection tends to return. In order to avoid causing cavernous necrosis
, the urology department asked the anesthesiology department to install a spinal anesthesia pump to continue anesthesia.
In this case, the Department of Urology is purely looking for a sense of presence. They have already obtained the diagnosis themselves, and they are discussing it here. They are just sharing their diagnosis and treatment process with everyone.
There are far fewer difficult and complicated diseases in surgery than in internal medicine, so cases like this are presented to raise the profile of surgery.
"Director Cha, tell me your opinions."
Director Lu from the Department of Urology named Director Zha from the Department of Nephrology.
Although they are both experts in sewerage, the urology department is still good at male function.
The Department of Nephrology mainly focuses on the medical treatment of kidney diseases, such as uremia.
Using one's own strengths to attack another's weaknesses is a tactic that both physicians and surgeons like to use.
Director Zha pondered for a moment: "Have you taken any medicine recently?"
"No!"
"Have you checked male hormones?"
"Normal!"
"How are your blood tests? Have you considered sickle cell disease?"
"I checked this aspect and ruled it out!"
"Does Yinjing have blood clots?"
"No!"
Director Zha was also a little confused. After thinking for a while, he said: "Is there any MRI of the spine? Should we consider spinal cord damage, such as tumor invasion?"
Director Lu, who had always been full of confidence, was suddenly discouraged: He broke it! It was caused by spinal cord tumors, which caused excessive excitement of the spinal cord center.
There is also a famous saying in diagnostics: rare manifestations of common diseases are far more common than rare diseases.
In fact, diagnosing a disease is a process of logical reasoning, just like diagnosis. We must grasp the symptoms, signs and auxiliary examinations, remove the false and retain the true, peel off the cocoons, and reveal the truth step by step.
The Department of Nephrology also presented its own case: male, 48 years old, considering renal bone disease. He developed double kidney stones 15 years ago and had to remove the stones eight times. The stones grew longer after removal. He suffered from renal failure due to kidney stones 7 years ago.
After undergoing hemodialysis, I later felt bone pain all over my body, which became more and more severe. Symptoms such as joint deformity, blurred vision, tooth loss, and subcutaneous induration gradually appeared.
There are several patients with similar kidney stones in the family, one of whom died at the age of ten due to uremia caused by kidney stones.
The physical examination revealed that the patient had decreased vision, multiple missing teeth, hard nodules and pigmentation on the skin of the limbs, deformed fingernails, interdigital joints, interdigital joints, bilateral ankle joints, knee joints, elbow joints, and shoulder joints.
All showed enlargement and deformity. Slit-lamp examination revealed calcium salt deposition around the cornea of the left eye. Abdominal CT showed nephrocalcinosis in both kidneys. Under
Terminal soft tissue calcification.
Director Zha and Director Lu are both Ph.D.s, academics, and keen on this kind of technical competition.
You can bang the table behind closed doors, but when you walk out of this door, we are all good brothers.
"What do you think, Director Lu? What's your opinion?" An old internal medicine expert from the expert team deliberately stirred up trouble.
Director Lu stares at the screen to read the medical records and performs surgery every day. Who knows what kind of disease this thing is? The person holding the knife is arguing with the person holding the pen.
After holding it in for a long time, Director Lu didn’t see the door.
Director Cha’s case is a truly difficult and complicated disease. The paper has been written by graduate students and is ready to be published as a case study in the New England Journal of Medicine.
Surgery veteran, you must be able to see that I am your director!
Director Zha sneered inwardly.
"If you have any opinions, please post them?"
The veteran expert in internal medicine stood up and shouted.
The director of the Department of Urology is holding back here. How can we see that the Department of Urology and the Department of Nephrology are somewhat related.
"Orthopedics?"
The old expert turned his eyes around and saw Yang Ping behind Professor Zhang: "Professor Yang of General Surgery Department, please tell me."
How can you name someone like this? It would be a loss of face if you couldn’t say it.
The brothers in the Department of Surgery expressed their dissatisfaction for Professor Yang.
Yang Ping actually paid attention to this case just now, because it is indeed interesting.
Director Zha, a Ph.D., has been a visiting scholar in the United States for a year and is still very impressive.
"Professor Yang, tell me your opinion!"
Yang Ping stood up, you pulled me out on your own to break your golden bell, it was not my initiative.
"The skin biopsy shows a large amount of calcium salt deposition. Use a polarized light microscope to look at it. It is estimated that you can see a large number of diamond-like crystal deposits of calcium oxalate crystals. The focus is on primary hyperoxaluria and further genetic testing. If
Yes, there may be heterozygous mutations in the agxt gene."
A rare disease with a probability of 1 to 3 in a million has been kept secret for so long just to show off at the hospital meeting, but you exposed it with just a few words?
Surgery comes back.
Director Zha immediately stopped smiling. Is this okay?
Yang Ping looked at the time. There was still something to do in the department and he wanted to leave. There were still several doctors in his department here.
———
Two weeks have almost passed.
The list of international clinical trial bases for the new ridge orthopedic technology will be announced soon. There is only one place. Tokyo University Affiliated Hospital is the most prepared, and the status of the first brother of the New York Hospital for Special Surgery is most conducive to promoting the new technology to the world.
The conditions offered by the Germans are the most attractive. The Duke's Fund can easily be 100 million euros. As long as money is legal and reasonable, the more the better.
In the General Surgery Conference Room, everyone gathered around the conference table. August, Robert and Takahashi were very nervous.
This base for cooperation is very important to them, although the reasons are different.
Yang Ping didn't speak. Song Zimo exchanged glances with Yang Ping and took out an agreement from his bag.
There is something else, so you should hurry up and take it out for others to sign, Yang Ping urged in his heart.
Don't be in a hurry. Usually you show off and I act as foil. This time you act as foil. Song Zimo is unhurried.
"Dr. Robert!"
As expected, it was me. Robert was relieved and the mission was successfully completed.
"Congratulations to the New York Hospital for Special Surgery for becoming our clinical trial base. Please take a look at the agreement." Song Zimo handed over the agreement.
The Americans took the agreement and began to read it line by line, unable to suppress the smile on their faces.
The Japanese and Germans were very disappointed. After shaking hands with the United States and expressing their celebration, they could only fight again next year.
After reading it, Robert signed and kept the contract, looking very happy.
Song Zimo slowly took out another agreement from his bag: "Dr. Takahashi, since the University of Tokyo Hospital is very well prepared, we have specially added a base for you. Congratulations!"
The feeling of regaining Takahashi made August feel sour in his heart. He was like a candidate who made a mistake in estimating his score in the college entrance examination and found that the real score was much lower than the estimated score.
Song Zimo took his time and said: "Congratulations to both of you!"
"But Mr. August, you don't need to be discouraged. Because of your sincerity, we have increased the number of places again, and Harlachen Orthopedic Hospital is the third base."
Song Zimo slowly took out the agreement from his bag and pushed it in front of August.
August couldn't believe that he didn't fail and finally got this base.
The overseas layout of spinal column external fixators has been completed. If new technologies are launched in the future, these three bases will be used to go global.
——
Yang Ping is already preparing to go to Europe, and August asks Marcus to actively prepare.
The spiral ridge model was placed on the desk. Yang Ping stared at the model and fell into thinking.
This is a tricky scoliosis correction, because of the spiral shape in the three-dimensional space, the correction needs to be considered from three levels, and the factors to be considered are more complex.
For example, the heart and lungs in the chest, the gastrointestinal tract and internal organs in the abdominal cavity, because they have adapted to the deformed space formed by the spiral ridge column for more than 20 years, and now if they are corrected, complications will occur after surgery.
At present, the digital medicine laboratory of Nandu Medical University can only model simple ridge orthopedics, and cannot take into account the concurrent impact of thoracoabdominal organs.
Moreover, machines have no imagination and cannot creatively solve problems.
That is to say, computers can only solve problems within the existing framework and cannot solve problems creatively.
Along with the correction of the ridge column, all soft tissues must be considered, which ones can tolerate stretch and which ones cannot. The tissues that can tolerate it need to be released in advance.
If this ridge deformity is corrected successfully, the ridge external fixator will be virtually pushed to the top of the world.
To achieve the best correction, it is necessary to obtain thin-section scans of all organs from the neck to the chest and abdomen, and then reconstruct the shape and position of the internal organs and all surrounding adhesions.
In this way, the changes in the positions of all organs during the orthopedic process can be demonstrated and the stretching range of their adhesions can be measured.
Therefore, this ridge correction is no longer as simple as considering the deformation of the spinal cord, but must also consider the accompanying changes in many organs.
Otherwise, unpredictable complications may occur.
Yang Ping constructed these pictures in his mind, and then tried to simulate ridge correction, which would cause changes in the organs. Although the correction process is slow, such changes can also cause complications.
For example, will the aorta be torn? Will the heart break through a certain critical value due to changes in external pressure and cause acute heart failure?
This is also the reason why all the top doctors in the world, including August, dare not operate.
The more understanding a doctor has, the more terrifying the consequences will be.
This patient's heart function classification is level four, which is also the worst level. He is basically unable to perform any activities. In a resting state, sitting or lying down, it may cause obvious discomfort, such as wheezing and difficulty breathing.
During the orthopedic process, interference with cardiac function must be considered.
"Doctor Austria"
Yang Ping opened the door.
August was obviously much more relaxed after getting the contract, he ran over in a hurry.
"Ask your patient to do the most detailed thin-section CT scan, starting from the base of the skull and ending at the coccyx. The chest and abdomen in the middle are the focus. I want to know the morphological position and status of all the organs, and then do a combined anatomy and function.
NMR."
Yang Ping ordered August.
August was very positive when he heard that the professor was worrying about his case, which meant that the professor was preparing for his trip to Germany.
In the doctor's office, the intern, a fan of Qin Xiaowei, was holding a mobile phone and surrounded by several people.
"Brother Wei has to climb a rock wall of more than 900 meters with his bare hands. Look, it's like a knife cutting it. It's so dangerous. It's similar to the El Capitan rock that Alex climbed. It's such a dangerous rock."
"He has even signed the organ donation agreement. This time he is ready for everything."
"It is said that even insurance companies are afraid to insure it. In the end, the sponsoring advertisers promised that if something goes wrong, there will be a huge compensation."
"In the past, these were just childish matters, but this time it's really a big move. This matter will be put on the hot search now, and it will be broadcast live on the entire network."
"It is said that the filming was not done by drones, but by the filming team. All of these photographers are rock climbing experts. They were hung on ropes and followed Xiao Wei to take pictures. It was really exciting. My heart is beating now." p>
"There is no way to save if you fall here. Is there protection below?"
"There is no protection. Piton nails cannot be drilled on the rock wall, and mats cannot be laid on the ground. Moreover, Brother Wei refused to bring a parachute. He said that wearing a parachute bag would reduce the flexibility of the body."
Yang Ping saw several interns gathering together.
The intern looked up and saw Yang Ping, very nervous. Yang Ping said: "Let me take a look!"
The intern handed over his mobile phone. This was a promotional video to create excitement before free-handed rock climbing. It was a clip of several videos of "The Thief" and "Free-handed Rock Climbing", and then a close-up of the cliff that Tan Xiaowei was preparing to climb. Indeed, this kind of dangerous rock climbing
The cliff makes me nervous just looking at it, let alone climbing it.
The promotional video looks like a Hollywood blockbuster, ending with a few big words: Surface Warriors!
Yang Ping can only express respect for this kind of outdoor extreme sports!
They are challenging the impossible in another way.
