The results of the highly rigorous lumbar puncture were very bad. The cerebrospinal fluid pressure of the lumbar puncture was as high as 216mm, which was nearly 30% higher than the upper limit of the reference value. At the same time, the blood routine report was also sent to the emergency room, and the platelet ratio was slightly lower than 10%, at 86.0x109/
l, Creatase (ck) 981.0u/l is nearly five times higher than the reference value. If calculated based on the lowest reference value of 18u/l, it is nearly fifty-five times higher. Lactate dehydrogenase,
The three indicators of alanine aminotransferase and aspartate aminotransferase were also more than double the reference value.
"The conclusion of viral meningitis is not a big problem." Li Xiuming, a neurologist who came for consultation, affirmed Xu Yourong's judgment. "With such a high creatinase, is it a Coxsackie B virus infection?" Dr. Li Xiuming said seriously.
Reading Gao Yan's blood test report, he shook his head and said, "But Coxsackie Group B virus should not cause central nervous system damage, nor should it cause epilepsy."
"The central nervous system and epilepsy may be atypical symptoms caused by high intracranial pressure." Xu Yourong was also reading the examination report. The three of them were sitting in the small conference room of the emergency room, exchanging opinions with each other. During the consultation, the last
What is needed is for everyone to speak freely. The most important thing in brainstorming is not the correctness of the opinions, but to propose as many possibilities as possible. This way, when the diagnosis is ruled out later, there will at least be some hints.
Sun Lien thought for a while, "The treatment the patient received before can help us rule out the possibility of bacterial infection. Now it seems that viral meningitis is indeed the most likely. Mannitol is first used to correct the intracranial pressure, and then ribavir is used
Lin controls possible viral infections."
"I suggest adding polyene phosphatidylcholine." Xu Yourong added with some worry, "The patient's liver function indicators are not very good either. If it is coxsackie virus infection, it may affect the liver. If the liver function is abnormal,
The effectiveness of ribavirin may be limited. What’s more, ribavirin can also cause an increase in blood bilirubin, which may affect our monitoring of the patient’s liver condition.”
"Okay." Sun Lien gradually became accustomed to reconsider Xu Yourong's suggestions. "Let's get treatment first. Even if the treatment is ineffective, it can at least provide more clues for diagnosis."
Good news came from police officer Old Wu. He had contacted Gao Yan's family. They would rush to the hospital as soon as possible. Sun Lien returned his attention to the elderly Zhou Xiufang.
The test result was another bad news. A large number of plasma cells appeared in Zhou Xiufang's blood smear. According to the measurement, the plasma cell content in the old man's blood was as high as 5.7x109/l. Considering that the old man had not had multiple myeloma before,
Medical history, according to the definition of WHO, the elderly can be directly diagnosed with primary plasma cell leukemia (PPCL).
Primary plasma cell leukemia is a very rare variant of malignant plasma cell myeloma, which is classified by researchers as mature B-cell tumors. It is a rare disease that Sun Lien has only heard of by name.
Zhou Xiufang's ppcl is obviously an acute leukemia. A disease that usually requires bone marrow puncture to determine has now spread to the blood circulating in her body. It also shows that the disease has progressed to a relatively advanced stage, and for Zhou Xiufang, unfortunately,
Fortunately, her ppcl antibodies showed CD56+ antibodies, a type of primary plasma cell leukemia with a slightly better prognosis.
After the results came out, Professor Li from the Department of Hematology immediately called Zhou Jun. After a lot of fuss in the Department of Hematology, he finally adjusted a bed for the elderly man. Zhou Jun was going through the hospitalization procedures with his father, Comrade Zhou.
Fortunately, the ward adjusted by the hematology department is a single-room special care ward, and Comrade Zhou can live in it and stay with her. Otherwise, the old lady’s grade three heart failure alone cannot be treated, and we cannot rely on the elderly who have difficulty even moving.
Just take care of yourself with a plastic washbasin, right?
Before transferring the elderly person to a specialist ward, the emergency room needs to stabilize the elderly person's condition. In addition to providing oxygen and continuous pleural effusion drainage, Sun Lien, after consulting with director Wang Jianpei, a mutton powder enthusiast in the Department of Cardiology, gave Zhou Xiufang
Captopril and indapamide were prescribed. The two drugs were used in combination to control Zhou Xiufang's hypertension and congestive heart failure. At the same time, according to Professor Li of the Department of Hematology, lenalidomide was used to treat Zhou Xiufang's ppcl in the early stages.
Treatment and intervention.
As the pleural drainage continued, Zhou Xiufang's mental condition improved significantly. The old lady lay on the hospital bed, looked down at the tube inserted in her side ribs with difficulty, and waved to call Sun Lien.
"Are you my attending doctor?" The old lady was breathing oxygen and had a little difficulty speaking. Although her voice was weak, she spoke quite clearly, "This is the Fourth Central Hospital, right? Where is Zhou Jun?"
"Teacher Zhou is helping you with the hospitalization procedures." Sun Lien held the old man's withered hand, "I am your attending doctor, and my name is Sun Lien."
"Xiaojun is your teacher?" The old lady held Sun Lien's hand and pressed a little harder, "Do you know what kind of disease I have?"
Sun Lien was startled, then nodded.
"Pleural effusion, whole body weakness." The old lady smiled bitterly, "Congestive heart failure?"
"We have given you corresponding treatment methods. You are in much better condition now." Sun Lien comforted you, "If you feel uneasy, can I call Teacher Zhou in?"
Zhou Xiufang patted Sun Lien's hand and said, "Old lady, I'm not an old fool yet. My progress is too fast. It's not congestive heart failure caused by coronary heart disease." She glanced at Sun Lien and said with some dissatisfaction, "You are also a doctor.
You graduated from the hospital, right? After all, I am still your senior." She raised her chin slightly and clicked on the medicine placed next to the bed, "Lalidomide is not a medicine for heart failure. Is it MM? Or is it MM?
mds?”
mm is multiple myeloma, and mds is myelodysplastic syndrome. Both are the main diseases for which lenalidomide is applied.
"Primary plasma cell leukemia." Sun Lien could only answer honestly. "However, immunological examination confirmed that it was a manifestation of CD56 antibodies. This type of classification has the best prognosis..."
"I have been studying multiple myeloma for 20 years, and I know what the consequences are. I just didn't expect that I would get this disease when I get older." Zhou Xiufang was lying on the hospital bed, looking at the ceiling, as if her vision was through the floor.
and steel concrete, looking at the blue sky revealed after the snow stopped. "It's really... interesting."
She turned her head, looked at Sun Li'en and said, "Little comrade, please go and call Zhou Jun in. I have some things to tell him."
The old man's eyes were clear and firm, as if he had already made a decision.