Back in 2002 as a doctor

"Drainage first, wait for the drainage to take a film and see." Lu Tiancheng said vaguely, and did not directly answer the patient's question.

You can't say that you don't understand in front of the patient, it would be too stupid to do that.

Lu Tiancheng was puzzled, sighed and stood up.

He squatted for a long time, and when he stood up, his legs felt weak, and he almost fell to the ground.

Walking out of the ward with black lines and question marks on his forehead, Lu Tiancheng became more and more confused after reading it. He had no judgment on the patient's condition.

"Boom, boom, boom~" Lu Tiancheng knocked on Zhu Jun's door.

"Master, it's me."

"Enter."

"Patient 12's pleural effusion is still dark." Lu Tiancheng reported in the simplest way.

"Observe and take a look, don't worry." Zhu Jun saw black pleural fluid during his rounds early in the morning, but he remained calm and didn't say anything, let alone squatting on the ground to observe.

"Oh." Lu Tiancheng sighed, it seemed that Director Zhu didn't know either.

He glanced at it, and Director Zhu was reading a book wearing flower glasses.

It turned out that Master was not idle and was also looking for answers.

Lu Tiancheng turned around helplessly and left. Instead of going to the ward or the doctor's office, he came to the duty room and took off his white clothes and shoes and lay on the bed wondering what was going on.

The clinical symptoms he had never encountered before were certainly not described in the surgical book, and Lu Tiancheng quickly gave up looking for the answer by himself.

He took out his mobile phone, pondered for a long time, and finally made a call.

"Such a high level of radiation! What the hell! Quickly take it off and give it to the staff, don't force me to call the police!"

When Li Qinghua's voice came, Lu Tiancheng was startled.

The gentle and refined Li Qinghua seldom speaks so harshly.

"Qinghua, what's the matter?" Lu Tiancheng asked immediately.

"Wait a minute, I have something to deal with here, and I'll call you later." Li Qinghua and Lu Tiancheng also spoke more casually, they had something to do at hand, and they hung up the phone after explaining a word.

Lu Tiancheng could feel the busyness on Li Qinghua's side, and he felt particularly uncomfortable.

Originally thought that his biggest competitor had lost his desire to compete for power because of a serious illness, and lived in the Third Hospital just for the administrative level of a director.

Li Qinghua resigned himself to depravity, and Lu Tiancheng always thought that he took advantage of it.

Unexpectedly, after Li Qinghua went to the Third Hospital, not only did he not degenerate, but he did well, which brought more and more pressure to Director Zhu.

Lu Tiancheng was in a complicated mood. He silently held the phone, not knowing what he was thinking.

After a long time, a phone call came.

"Tian Cheng, I'm sorry, I have a patient who was deceived and got a stone that was said to be cured, but the radiation from that thing exceeded the standard by more than 300 times."

"..." Lu Tiancheng was startled.

"Wearing that stone is equivalent to taking more than 200 chest X-rays every day. Isn't that nonsense. The patient started to have nosebleeds after wearing it for a day. Fortunately, he found it early. That's it, and he yelled at me." Li Qinghua is not Complaining, but just stating a fact.

"You're quite busy." Lu Tiancheng said.

"It's okay. It's not busy at this time. It's usually busy when Teacher Chen is invited to come on weekends."

"Qinghua, I've encountered something here, I'll ask you." Lu Tiancheng told about the black pleural effusion.

"Black pleural effusion? Isn't it precipitated bloody fluid?" Li Qinghua asked suspiciously.

"Probably not. We've seen too much bloody fluid, so it's definitely not that color. The hemolytic reaction doesn't look like it either, I don't understand it." Lu Tiancheng said honestly.

"Wait a minute, what did you say from Congwen?"

Zhou Congwen!

In front of Lu Tiancheng's eyes was the appearance of the young doctor from the Third Hospital.

"Tumor markers, melanoma? Is it possible?" Li Qinghua's voice was very soft and a little distant. He should have put down the phone and was talking to Zhou Congwen.

Lu Tiancheng pricked up his ears and listened carefully to the voice over there.

"Malignant melanoma accounts for only 5% of all metastatic lung cancers, and only 2% of these melanoma patients have pleural effusion."

Melanoma is melanoma, it is not black, okay, Lu Tiancheng thought to himself.

But before the thought disappeared, Zhou Congwen's voice came intermittently again.

"Fontana Masson's staining method can stain the pigment in the cytoplasm of tumor cells black, which indicates that there is melanin in the cytoplasm of tumor cells."

"However, in patients with melanoma, the possibility of black pleural effusion is not very high, only about 10% at most."

Uh... really?Lu Tiancheng had already half believed what Zhou Congwen said that he had a nose and eyes.

"Qinghua, Qinghua!" Lu Tiancheng shouted hastily.

"Ah? What's the matter?" Li Qinghua asked.

"It's not a tumor patient. There is no metastatic tumor in the lungs. The patient was hospitalized because of pleural effusion." Lu Tiancheng said helplessly.

"Congwen, not a tumor patient."

"Is there a film? Take a look at other inspection materials as well."

"Tian Cheng, is there a movie?" Li Qinghua asked afterward.

"Qinghua, you know..." Lu Tiancheng was a little embarrassed, he lowered his voice and said, as if Director Zhu Jun was lying at the door and eavesdropping on his phone call.

"Oh, then I see."

"It's inconvenient. Let Zhou Congwen talk about what he's thinking about. I'll check it later." Lu Tiancheng made a very excessive request.

Li Qinghua was obviously in a dilemma. He was silent for a few seconds before he said to Zhou Congwen, "Congwen, a patient at the People's Hospital. You know the situation, and it's inconvenient. Besides the tumor, what else are you thinking about?"

Chapter 0456

"If there is no film and information, should I see a doctor or tell a fortune?" Zhou Congwen pondered.

Lu Tiancheng's face turned red.

Let Zhou Congwen give a diagnosis without saying anything, which is simply too much.

If someone said this to him, there are actually many similar things. Lu Tiancheng felt that he would not answer at all, and he was too lazy to talk to those people.

Alas, this is what the doctor asked, Lu Tiancheng was very ashamed.

Seeing a doctor or telling a fortune, these words slap Lu Tiancheng across the face.

But if he was asked to go to the Third Hospital to find Li Qinghua and Zhou Congwen with the film and materials, once Director Zhu found out, he would definitely swear at him.

Lu Tiancheng could predict the outcome of the patient with black pleural effusion—it must be transferred to a higher-level hospital.

He sighed and regretted calling Li Qinghua.

I don't say anything, just mention black pleural effusion, and I want an almost certain diagnosis. Isn't this a joke?

Just as he was about to say sorry, Lu Tiancheng heard Zhou Congwen's voice on the phone.

The sound is a little far away, a little floating, it should be far away from the phone.

"The first possibility is infection."

"Ah? Infection? Black pleural fluid?" Li Qinghua asked in surprise.

Lu Tiancheng was equally astonished, across the phone, he wanted to crawl over along the radio waves and grab Zhou Congwen's neck to ask him what he thought.

"In 1984, American scholars reported a case of black pleural effusion, which pointed out that there was Aspergillus niger infection."

"In 1992, Chest magazine reported a patient with invasive pulmonary aspergillosis. Under bronchoscopy, there was a cavity in the posterior segment of the apical bronchus, which contained a black mass. The biopsy results showed that the black substance was necrosis tissue, calcium oxalate crystals, Aspergillus hyphae."

"Calcium oxalate crystals, closely associated with black pleural fluid."

"This is a possibility, and there is the melanoma just mentioned. If it can be ruled out..." Zhou Congwen began to ponder as he spoke.

Lu Tiancheng was completely speechless.

As soon as he thought it was impossible, Zhou Congwen slammed two clinical case reports on his face.

Moreover, Chest magazine is not very strong overall, but it is the top journal in the branch of chest medicine.

How much is the impact factor, it seems to be at least 15 or more!

Lu Tiancheng suddenly lost his mind when Zhou Congwen was meditating. Zhou Congwen is really good. Just ask him casually, and he can tell a related report in the Chest journal.

"What's more, a large amount of blood flowed into the patient's pleural cavity. Prussian blue staining of the pleural effusion revealed a large number of macrophages with iron-containing yellow deposits. From this, it can be judged that the pleural effusion turned black, which may be the result of hemolysis."

"Tiancheng said that he didn't think about bleeding." Li Qinghua interrupted Zhou Congwen, and provided Lu Tiancheng's opinion.

"Oh, if this is the case... Did the patient commit suicide by taking medicine? However, the method of gastric lavage with activated charcoal is rare now. Even if it is suicide, most of them are normal gastric lavage. The possibility of activated charcoal appearing in the chest cavity due to tracheal fistula is not high. what is that."

Uh... and this way!Although Lu Tiancheng knew that the patient did not commit suicide by taking medicine, but by gastric lavage with activated charcoal, Zhou Congwen's words gave him more ideas.

It's amazing, even knowing about activated charcoal gastric lavage, Lu Tiancheng was a little emotional.

This method should be very old, and it is the rescue method used by Director Zhu Junzhu's generation.I don't know, how did Zhou Congwen know.

"By the way, definitely not. I think that based on Dr. Lu's clinical experience, activated charcoal gastric lavage should be possible, so this option is ruled out."

Sweat, Lu Tiancheng felt that Zhou Congwen was secretly rubbing... No, he was crazily mocking his lack of IQ.

"By the way, ask Dr. Lu to check the patient's pleural effusion and check for amylase."

"Regular pleural fluid...amylase? Why?"

Li Qinghua just wanted to ask whether it is a routine pleural effusion examination or to go to the pathology department to check the exfoliated cells, but Zhou Congwen said that he would check the patient's pleural effusion for amylase.

For a moment, both Lu Tiancheng and Li Qinghua thought that Zhou Congwen had said something wrong, and it should be to check for exfoliated cells.

Lu Tiancheng and Li Qinghua were taught by the same master. They have worked under the same roof for many years. They even have similar ideas. At the same time, they expressed doubts about Zhou Congwen's test of amylase on pleural effusion.

There are usually two types of amylase in clinical examination.

Blood amylase is the main type of amylase in serum, which belongs to glycoside chain hydrolase, and mainly comes from pancreas, etc. In addition, it also secretes a small amount from organs such as proximal duodenum, lung, uterus, and breast during lactation.

Amylase plays an important role in the digestion of polysaccharide compounds in food.Determination of serum amylase activity is mainly used for the diagnosis of acute pancreatitis.

Then there is urinary amylase.

Compared with the increase of urinary amylase and serum amylase, the data changes come later.

Under normal circumstances, it can only increase 12 to 24 hours after the onset of acute pancreatitis, and the decline is relatively slow.In the acute attack of chronic pancreatitis, there may be a moderate increase.

In addition, pancreatic cancer, pancreatic injury, acute cholecystitis, etc., the activity of urinary amylase will also increase.

Clinically, these two kinds of examinations are generally the items frequently checked in general surgery and gastroenterology.

To test amylase for pleural effusion, this is unreliable no matter how you hear it.

"Congwen, the inspection department doesn't seem to have this inspection item." Li Qinghua said.

"If not, then mark it as urine when sending the specimen."

"..."

Lu Tiancheng was stunned.

"Forget it, don't let them dare to release the inspection report. Then let Dr. Lu take the sample to find a familiar laboratory doctor, and say to see if there is amylase in it. Smuggling personal relationships, this is no problem.

I said, Director, I don’t have any information, and I can’t see the patient yet. Just guess like this, you used to play like this in the People’s Hospital? "

Hearing Zhou Congwen's little sarcasm to himself, Lu Tiancheng's old face turned red.

But he couldn't tell Zhou Congwen's fault, it was his own fault.Zhou Congwen gave several directions for thinking, but Lu Tiancheng felt that they were all ridiculous.

Especially the amylase one, it sounds unreliable.

After a few polite words with Li Qinghua, Lu Tiancheng hung up the phone and began to think about what he just said.

The possibility of infection is not high. The patient's blood routine data is normal, and he has no symptoms of fever. Judging from the feeling, it should not be an infection.

Neither is tumor, nor is gastric lavage with activated charcoal for suicide. Could it be pancreatitis?

Thinking of this, Lu Tiancheng was amused.

For pleural effusion caused by pancreatitis, this diagnosis is impossible. Besides, if it is pancreatitis, blood and urine amylase should be checked instead of pleural effusion amylase.

Moreover, the patient did not feel discomfort in the upper abdomen.

Nonsense, really nonsense, Zhou Congwen... Alas, he was mocking himself for not knowing anything, so he was talking nonsense.