The rheumatology and immunology clinic is extremely popular today.
The most popular animal in the zoo is usually the panda. Especially when the panda starts to eat, tourists visiting the zoo will gather from all directions, then hold up their mobile phones together and look at the black, white and black panda in front of them.
The big fat man gnaws on apples or special steamed buns.
And today's Rheumatology and Immunology Clinic of the Fourth Central Hospital... is probably similar to a giant panda standing on one leg and playing skipping rope, and it also speaks human language, and fluently said the mouth-filling part of "Report the Name of the Dish".
They came to see the excitement and see a "foreign doctor" wearing a white coat who was treating patients.
Speaking of foreign doctors, the first name that comes to the minds of Chinese people must be Bethune. That great internationalist warrior resolutely came to China in the most difficult period and stayed here forever. This story almost always tells the story of Bethune.
Everyone in China knows it.
With Comrade Bethune as his foundation, Dr. Pascal, who has white skin, immediately received the buff of "improvement in favorability". However, because some professional terms require special explanation, and at the same time, he has to use legal prescription rights and make it easier for patients to understand, etc., Pascal
When the doctor was visiting, the Department of Rheumatology and Immunology specially assigned a young doctor with excellent English proficiency to serve as a translator.
With increased favorability, translation, and Dr. Pascal's American medical practice of slowly talking to patients about their illness and trying to explain the cause in as much detail as possible, Dr. Pascal's popularity suddenly exploded during the week when the emergency room was closed.
, has become the most sought-after doctor in the outpatient department of the Fourth Central Hospital.
Many people in Ningyuan have heard the news that a foreign doctor with a good attitude and high standards has come to the Fourth Central Hospital!
Dr. Pascal has been to China many times through Médecins Sans Frontières projects and often treated patients in China. But in the past, he and other doctors formed more treatment teams and took the initiative to visit places with inconvenient transportation. Although everyone was very
Enthusiastic, but after all, the number of people in a small village with inconvenient transportation is limited. Even if everyone comes together, it can only be seen in one or two days. But Ningyuan... is a big city with a population of several million.
Since Sun Lien and Xu Yourong were quarantined for observation, Dr. Pascal has started his outpatient life. On the first day, everyone was still not sure how to deal with him. There were very few patients who came to see him, and occasionally there were a few other patients.
There are patients whose doctors are unsure or who want second advice.
The next day, some well-informed patients gradually came to the door. Pascal's skills were indeed good, and he had well arranged treatment plans for these patients. But more importantly, he had more time and was used to using
Spend more time treating patients. Chinese doctors have too many patients to treat. Even if a patient can receive less than five minutes of consultation time, there will still be a lot of people queuing up. Sometimes even
I registered in the morning on the first day, but when the outpatient clinic closed in the afternoon, there were still more than a hundred people who had not been treated.
On the third day, more patients began to choose to visit Professor Pascal's clinic, and from this day on, Professor Pascal's lunch time began to have the same quantum uncertainty as other doctors. Who knows when they will be found?
He had free time! He could only take advantage of the time when he had finished seeing the first patient and the next patient was about to enter the room, and quickly lowered his head to take a bite of the sandwich prepared by his wife.
Today is Dr. Pascal's eighth day out in the clinic.
Dr. Pascal rubbed his somewhat hot head. He felt like he was back in college this week. Every patient's situation is different, and everyone's response to treatment is also different. He is
He needed to deal with dozens or hundreds of different patients in one day and work out appropriate treatment plans for them. This kind of workload was simply impossible to complete with his original treatment style. So he also started
Gradually, he changed his work style and began to move closer to the Chinese doctors whom he did not agree with before. He used the fastest speed and the most direct style to deal with every patient who came to him.
"Consultation?" The translator responsible for assisting him raised his eyebrows, turned around and asked, "Lao Pa, the emergency department wants to invite you..."
"I'll be there soon!" Dr. Pascal stood up and hurried towards the emergency room. To be fair, Pascal was already doing very well. But this kind of outpatient clinic with no end in sight really made him a little scared.
.In the name of consultation, even just going out for a walk is relaxing for him.
"What are you doing?" The patient who was waiting for treatment at the door stared curiously at Pascal, who was running all the way. "What's the disease of the man inside? How did you scare away the foreign doctor?"
"Well..." Dr. Pascal looked at Yang Jianqiang's test results, frowned for a long time and then shook his head, "His low CD4 should be mainly due to the effects of immunosuppressants. It is not caused by some unknown disease."
Sun Lien had already expected this answer. Yang Jianqiang is currently undergoing new CT and MRI. The main reason why he invited Dr. Pascal for consultation was actually to see if the triple immunosuppressive regimen Yang Jianqiang is currently using is still available.
There is room for further adjustments. If the activity of Yang Jianqiang's immune system can be increased within the scope of ensuring the safety of bone marrow transplantation, it will be possible to use his own immune system to mark unknown pathogens that cause disease.
"This... is almost impossible." Dr. Pascal poured cold water on Sun Lien's whims. "The reason why such a combined immunosuppressive regimen is used clinically is because the inhibitory effect of a single drug is not ideal. To achieve what we want,
To achieve the desired level of inhibition, the dosage of a single drug will become very large. This will undoubtedly increase the chance of patients suffering from organ damage and other side effects. The most important reason for using a combined immune regimen is through the interaction between the three drugs.
It can improve the effect of immunosuppression." He sighed and continued shaking his head, "If the immunosuppressant is reduced or even stopped, I even think that his immune system will recognize the pathogen you are looking for.
Just kill all the bone marrow cells transplanted from the allogeneic body. Then cause a cell storm, and finally your patient will die of high fever and respiratory failure."
"But there have been some changes in the patient's condition." Sun Lien specifically pointed to the column of cerebrospinal fluid pressure level. "His cerebral pressure was still at a normal level when he was admitted to the hospital to collect cerebrospinal fluid. However, after our doctor adjusted his immunization plan, he
Suddenly, intracranial pressure increased."
"It may be a side effect caused by the mycophenolate mofetil he used..." Dr. Pascal suddenly stopped. He shook his head and rejected his idea, "No, even if the lymphoma squeezes the brain,
It shouldn’t have appeared so soon.”
One of the rare side effects of mycophenolate mofetil is that it may cause lymphoma and non-melanoma skin tumors. But Yang Jianqiang only started using mycophenolate mofetil 24 hours ago. Even if he was unfortunately infected
Without this rare side effect, disease symptoms would not appear on him so quickly.
"His immune system is in a suppressed state, so it is not an allergic reaction caused by methylprednisolone. Basiliximab only reacts with T cells and should not cause problems in the central nervous system." Dr. Pascal
The more I thought about it, the more confused I became, and I even started to wonder if I had misremembered the side effects of these drugs.
According to normal logic, condition a in a system changes, and then the result b output by the system also changes. Then people will naturally think that the change in result b is caused by condition a. But according to existing knowledge, condition
It is absolutely impossible for a change in a to cause such a difference. No wonder Dr. Pascal is confused. It is like adding only salt when cooking, but the food tastes sweet.
"I'm wondering... is it because after we adjusted his suppression program, the new suppression program is not as effective as the previous one." Sun Lien slowly expressed his conjecture, "This made his immune system slightly more active than before.
A little. And could this be the reason for the change in symptoms before and after?"
"If your guess is correct..." Dr. Pascal took a breath of air, "then his infection may have reached a very serious stage."
The emergency CT image came out. During this examination, the imaging department discovered eight low-density edema areas, which are eight shadows.
"It's definitely not a tumor. It's not bacterial encephalitis either." The radiologist and Liu Pingchuan who came for consultation agreed. These eight areas of mild edema are located relatively close to the ventricles, which resulted in relatively obvious changes in cerebrospinal fluid pressure.
"Anyway, this is at least a beginning." Liu Pingchuan patted Sun Lien on the shoulder, "What are you going to do with the subsequent diagnosis?"
After thinking for a long time with a frown, Sun Lien suddenly asked Dr. Pascal, "Is there any disease that may be transmitted through bone marrow transplantation?"