If you prepare a medical history questionnaire according to the etiology, this seems easy, but it requires skill to do it, and you need to turn all possible causes into specific events.
This has the advantage that no important information will be missed, but it also has the disadvantage that it casts a wide net and is not targeted.
Yang Ping thought in his mind that the medical history was concealed or omitted, but the physical signs existed objectively.
The objective fact of this patient is - necrosis, progressive necrosis of the limbs, starting from the right hand and right hip, with the right hand and right hip being the most obvious.
Why are the right hand and right hip the most obvious places for necrosis?
This person is right-handed, not left-handed.
The right hand and right hip are connected, the hand is exposed, and the hip is generally covered by clothes and pants, so it should not be at the same level of exposure.
There is a possibility that this situation will occur, that is, the source of the disease is picked up with the right hand, and then placed in the pocket of the right pants, so that the right hand and right hip become the same level of exposure.
Could it be?
Grasping this characteristic, Yang Ping had an answer in his mind, but medicine pays attention to evidence.
"Have samples of the necrotic tissue been taken for pathological examination?"
Yang Ping feels that pathological examination is a magical method. Although these cells are necrotic, you can see the changes in the cells under the microscope and find out how the cells died.
"The pathological specimens were not collected so quickly. Director Guan will go out for a meeting and will not return until tomorrow. The pathologist is inexperienced and dare not issue a report."
Director Tan is very experienced. Taking pathological specimens is a necessary process. How could he make a stupid mistake?
It is not only when tumors are considered that specimens are taken for pathological examination. If the tissue is necrotic, pathological examination can also provide a lot of information to confirm the diagnosis.
It's just that as an orthopedic surgeon, he doesn't know how to read pathological slides. Otherwise, Director Tan would go to the pathology department himself and read the pathological slides himself.
To make a clear diagnosis, medical history collection is the front-end work, while pathological examination is the final work at the back.
Since the director of the pathology department is out, the doctors under him are afraid to issue reports, which means that this disease is still relatively rare. However, everyone is a clinician. In addition to seeing a few slides when studying, the only contact with the pathology department after joining the work is the application for pathology examination.
The slip and the pathology report.
Doctors in pathology departments and clinical departments usually only know each other by name, but do not know the person.
"Then we can only wait until tomorrow to see what the pathology report says." The director of the general surgery department was helpless.
And even if Director Guan comes back, it may not be able to promote anything.
"Should I go down and take a look at the pathological slides?" Yang Ping decided that pathological examination would be a breakthrough.
Can you read pathological slides? Can a clinician read pathological slides? Don't be funny, okay?
Everyone looked at this young talent and didn't know what to say.
"Let's go down and have a look."
Yang Ping whispered to Song Zimo and Xu Zhiliang beside him that after the operation, there was plenty of time. Since it was a discussion for everyone, everyone should think and act according to their own ideas, and finally put it together.
The two generals nodded, and at Yang Ping's request, they often went to the pathology department to view biopsies.
"How about we continue the discussion and let's go to the pathology department?" Yang Ping asked Professor Zhang to leave temporarily.
Professor Zhang agreed: "How about you guys go and take a look?"
Yang Ping, Song Zimo and Xu Zhiliang left temporarily. The pathology department is in another building. That building is full of auxiliary departments, such as laboratory department, imaging department, pathology department, electrocardiogram, etc.
The three of them didn't waste any time and rushed to the pathology department in a hurry.
Doctors have a natural interest in difficult and complicated diseases, so the three of them felt like they were getting blood. The fatigue from a day's surgery was certainly gone.
There was no night shift in the pathology department. The three of them rushed to the pathology department and they were already preparing to close the door.
Dr. Wen, the last doctor to leave, was about to turn off the lights and lock the door when he saw the three men coming to kill them fiercely.
Dr. Wen subconsciously blocked the door and took a closer look: "Professor Yang? Dr. Song? Dr. Xu?"
"What are you doing?" Dr. Wen was very surprised.
"I'm sorry to delay you from getting off work. We want to come over and take a look at a patient's pathology slides?" Yang Ping said quickly, I'm sorry to delay you from getting off work.
"oh!"
Dr. Wen opened the door and turned on the light, and welcomed the master of Sanbo Hospital into the office. At this time, the pathology department was empty, including the large examination room, microscopy room, immunohistochemistry, etc., all studios were empty, and the computers were turned off.
.
Dr. Wen was very happy to hear that the three of them came to see the pathology slides. He usually likes to mess with pathology slides alone and is very interested in these boring things.
Wouldn’t it be wonderful to have people with similar interests now?
The Department of Pathology is a lonely Qingshui yamen, with no money and very lonely. A doctor of pathology is even more lonely and lonely. He spends all day looking at slices under a microscope, which makes his eyes dazzled and his neck hurts. Cells are all in his eyes all day long, sometimes every day.
After work, I saw pedestrians on the road covered with colorful cells.
"Which patient?" Dr. Wen turned on all the lights and then turned on the air conditioner.
"Trauma and Orthopedics, Zhang Tiejun!" Yang Ping reported his name.
Xu Zhiliang sent a small piece of paper with his name, hospitalization number and other information written on it.
"Zhang Tiejun?"
Dr. Wen became even more interested. He immediately picked out several of Zhang Tiejun's pathological slides from the film storage box, and carefully placed one of them under the microscope.
"Professor Yang, Director Guan said that you can not only read pathological slides, but also have a very high level. I don't believe it. In China, surgeons can read pathological slides. I have never encountered it. You are here for this patient, then you
Take a look, what is this?"
Dr. Wen sat next to him with a stern look, like an examiner waiting for Yang Ping to look at him, and his words were not pleasant to listen to.
Fortunately, Yang Ping, Song Zimo, and Xu Zhiliang are also academic men of the same type and are not so particular.
This guy has been studying this slice all day long to figure out what it is. He is just waiting for Director Guan to come back tomorrow to send out the report. Because it is too rare, he has to wait for the director's signature before sending it out.
"have a look?"
Yang Ping was not polite and sat down in front of the microscope.
This chapter is not over yet, please click on the next page to continue reading the exciting content! Dr. Wen pointed to the slice: "Look!"
It's like the prelude to a fight between two gangsters: Two moves? Two moves!
Just take a look, the glass slides in the system space are not valuable anyway, I don’t know how many I looked at at that time, this is a basic skill.
Dr. Wen stood with his legs crossed. He had been working for so long and it had never been so fun.
Yang Ping adjusted the microscope and began to look at the pathological slices.
This is a multi-head microscope. Xu Zhiliang and Song Zimo are also sitting next to the microscope and entering the field of view.
Multi-head microscopes are convenient for teaching and discussion. Everyone can see the same field of view through different eyepieces around the microscope.
Under a 400x microscope, Yang Ping is carefully observing the magnified cells.
Looking at pathological slides requires patience. You need to be able to take your time and calm down to find out some of the characteristic changes in cells.
For example, in the cell nucleus, the nuclear membrane and nucleolus can be seen under a light microscope. Their shape, location, size, staining, etc. are all the basis for judgment.
The view under the mirror is like an abstract painting, and only one who understands pathology can see the mystery.
"Old Wen, how about --- we --- bet on something?" Xu Zhiliang moved his eyes away from the eyepiece and put his arm around Dr. Wen's shoulders.
Song Zimo attacked from the other side: "Yes! Looking at you like this, you seem to have already figured it out?"
"What are you betting on? If Professor Yang can make a diagnosis on this pathology slide, will I run around the hospital three times naked?"
"Why didn't you say naked? Are you unsure?" Xu Zhiliang asked provocatively.
Nude?
Dr. Wen is a little timid. Professor Yang has a reputation as a demigod in Sanbo Hospital. If he really finds out and runs naked for three laps, will he still be a human being?
It's not that I don't have confidence in my diagnosis, but Dr. Yang is a bit unclear and amazing!
"Old Wen, you actually know how to cheat. You said you would run three laps shirtless. Look at the morning jogs in our hospital. Many of them are wearing underpants and running shirtless. What kind of bet is this?" Song Zimo said in a contemptuous tone.
Dr. Wen was very anxious: "I am topless and running in only briefs, not even swimming trunks or boxer briefs."
"Red underwear? Triangular ones? How about it? Do you dare?" Xu Zhiliang pressed.
Yang Ping over there kept frowning and sighing.
Dr. Wen glanced at Yang Ping's troubled look and spat like a nail: "That's it, why don't you dare to gamble."
"Okay, when are you ready?" Song Zimo asked again.
"It will be during lunch after work tomorrow." Dr. Wen risked his life.
"good!"
"Then what if you lose?" Dr. Wen's disdainful eyes were full of confidence.
I don’t dare to brag about other aspects. I still have a few skills in pathology. Amateurs can’t always do as well as professionals.
"It's up to you?" Song Zimo was very relaxed.
Dr. Wen raised Erlang's legs higher: "If you lose, at the next hospital meeting, when you two see me, call me Teacher Wen loudly and respectfully three times?"
"It's a deal!" Song Zimo agreed.
It was really fun. Dr. Wen moved his neck and said, "As you can tell from my name, I, Wen Ruzheng, am a true gentleman and a true gentleman!"
Yang Ping was still looking at it, because there were not just one slice, and many specimens were taken.
"It's really not me who is embarrassing you. Not to mention that you are amateurs, but you are PhDs in pathology. You may not be able to see this in this section unless you have special training in this situation." Dr. Wen leaned back in his chair, full of confidence.
This kind of disease is probably the only one Sanbo Hospital has encountered in more than ten years. If Yang Ping could really see it, I would actually run around the hospital three times in my underwear.
The more Dr. Wen thought about it, the more confident he became.
These pathological sections were taken in a very standardized way. They were taken from painless parts and depths. There were skin tissues, fascial muscles, muscle tissues, some that had just changed, and some that were completely necrotic.
Although Director Tan cannot read pathological slides, his medical quality is indeed very high. General surgeons are not so strict in taking pathological materials.
Yang Ping read all the pathological slides and did not miss any changes.
The microscopic pathological manifestations of the right hand and right hip were similar: all skin, fascia and muscle cells were necrotic and massive disintegration.
The bone marrow specimen obtained by puncture of the greater trochanter of the right femur showed that all cells of all lines in the hematopoietic tissue had disappeared.
Bone marrow samples taken from the distal ends of the right radius and ulna showed that all cells in the hematopoietic tissue lines had disappeared.
Bone marrow aspiration in the necrotic area of the left upper limb and left lower limb showed that a large number of cells of various lines in the hematopoietic tissue had disappeared to varying degrees.
The local skin and skin appendages, subcutaneous tissue and skeletal muscles of the left thigh suffered extensive necrosis and diffuse bleeding, but the arrector pili muscle in the dermis remained.
A large number of epidermal cells in the skin of the left finger and palm showed vacuolar degeneration and necrosis, and formed vesicles of different sizes, resulting in separation of the epidermis and dermis, diffuse bleeding in the dermis, neutrophil infiltration, sweat gland epithelial cell degeneration, necrosis, and subcutaneous tissue
Diffuse internal bleeding and necrosis of a few fat cells.
Thanks to Director Tan's good medical literacy, these pathological slides are very good and cover almost all diseased areas.
Although Director Tan did not know what the disease was, he arranged very rigorous examinations, especially the pathological biopsy and bone marrow puncture at several locations, and there was no leakage.
After Yang Ping read all the slices, he had a rough answer in his mind.
"How is it?" Dr. Wen was a little nervous.
Yang Ping said nothing, his expression serious.
Dr. Wen felt completely at ease and didn't notice anything.
"Look at it!"
Yang Ping asked Song Zimo and Xu Zhiliang to also take a look at this rare case.
The discussion in the Department of Traumatology and Orthopedics continued, and Professor Zhang called Yang Ping to ask how the situation was.
Yang Ping said they would go up in a moment and already had the answer, and asked Professor Zhang not to leave the meeting.
Got an answer?
Dr. Wen panicked, but Yang Ping didn't say anything.
"Dr. Wen, can you come with us to the Department of Traumatology and Orthopedics later? This case is being discussed there, so you can also talk about the pathology." Yang Ping invited Dr. Wen to go with him.
Dr. Wen readily accepted it. As long as he talked about pathological knowledge, he could do it for three days and three nights without repeating it.
"You should be aware of it, right?"
Yang Ping asked Dr. Wen.
He was very proud: "Of course, I am also planning to write a paper."
"That's good, I won't say it later, I'll let you do it." Yang Ping's expression was calm.
Saying that, you can also see that Dr. Wen has doubts about whether it is true or false.
"You just look at pathology slides all day long and don't hear anything happening outside the window. For such a big matter, you have already made a clear diagnosis, but you don't send a report and are going to close the door and get off work?" Yang Ping was very dissatisfied.
Dr. Wen was confused and didn't know what Yang Ping meant.
"How about it? Did you see anything? Time is tight. We will go back to the orthopedic trauma department right away. If we really can't see anything, let's look back. You probably haven't seen this kind of slice, but I think I mentioned it to you." Yang Ping urged.
Two people.
"You are as timid as a mouse. How many days will your director not reply? How many days are you planning not to send out a report? Do you know that people may continue to be victimized during this period?" Yang Ping said with a stern face.
Dr. Wen's heart skipped a beat and his hair stood on end. Why did he not think so much?
Not only did Yang Ping see what the pathological diagnosis was, he was also more responsible than himself.
I usually just watch the microscope and take responsibility for the pathological sections, and never think about anything else.
PS: It has been modified, thank you all! Today at 2 o'clock in the afternoon, the Qidian client's best-selling selection will be recommended. Please give more encouragement by counting votes! Bow and salute!