Back in 2002 as a doctor

"Director Feng, call for a bedside ultrasound." Zhou Congwen and the director of nephrology said.

"Where to check?" Director Feng didn't know the meaning of calling the bedside ultrasound at all.

"thyroid."

"!!!"

"!!!"

"!!!"

The three directors gave an exclamation mark.

Originally, the patient was admitted to the hospital and found multiple high-density shadows in the lungs. Malignant tumors were ruled out through breathing and chest consultation.

But when Mr. Huang came, he first checked the blood calcium and phosphorus, and then checked the thyroid gland. What's the reason for this?

"The patient is very likely to have abnormal parathyroid hyperplasia, which is secondary." Zhou Congwen simply explained, "See if the hyperplasia is obvious, and then check whether surgery is needed."

Director Cui of the Department of Nephrology beckoned his hospital chief to call with his eyes, and then looked at Zhou Congwen and Mr. Huang kindly.

Zhou Congwen coughed lightly, "Let me tell you briefly, do you like it, boss."

Huang Lao didn't speak, just nodded.

Zhou Congwen has a deep foundation in diagnostics. Although it sounds surprising, it is true.

"Calcification defense is a rare disease, and the specific mechanism of action is still unclear.

It is a serious and fatal complication of chronic kidney disease, especially dialysis.According to foreign literature reports, the morbidity of calcification defense in dialysis population is about 1/45. If not treated in time, the mortality rate within 80 year is [-]%-[-]%. Sepsis is the main cause of death. "

"Calcification defense is an extremely painful ischemic skin and soft tissue lesion caused by calcification of tiny arteries and thrombus formation in the dermis and subcutaneous fat tissue. Arterioles."

"The patient's skin was ulcerated and purplish, and the surface was covered with black eschar. Pain and itching appeared in the skin lesion half a month ago, and the duration and frequency of pain increased progressively."

"Serum calcium is 2.29mmol/l, blood phosphorus is 1.68mmol/l, PTH is 686.7pg/ml, and high-sensitivity C-reactive protein is 24.2mg/l, all of which suggest that it is a rare calcification defense.

If you do a whole body bone scan, you can see the uneven local thickening and calcification of the skin of the patient's lower legs, and the linear calcification of the calf blood vessels. "

Seeing Zhou Congwen talking eloquently, Zhang You became more and more confused.

What do you, a cardiothoracic surgeon, know so much about a rare disease of a dialysis patient in the department of nephrology?

"Director Zhang, shall I tear up the medical records for you to eat later, or are you going to swallow the whole book in one gulp?" Director Tang whispered in Zhang You's ear after he understood.

Chapter 0809 daily values

Zhang You was squeezed by Director Tang and gave her a vicious look.

The more it is like this, the more you can't be cowardly, or you will be squeezed to death, Zhang You knows this very well.

"I said it has nothing to do with thoracic surgery." Zhang You emphasized.

"No way, how did I remember that from the beginning it was talking about surgery, not thoracic surgery or breast and breast surgery." Director Tang ran on Zhang You, feeling very good, and continued to listen to Zhou Congwen's talk.

"The surgical operation mentioned by the boss just now means that such patients may have hyperparathyroidism, which belongs to the secondary type, and can be treated with cinacalcet first. If the effect is not good, seek consultation from thyroid and breast surgery to remove the hyperplasia of the parathyroid glands."

"It's basically like that."

Zhou Congwen glanced at several directors in the office after he briefly spoke.

Director Tang raised his hand like a student.

"Director Tang, tell me."

"The high-density shadows in the lungs are calcified deposits?" Director Tang asked.

"Yes." Zhou Congwen said with certainty, "It belongs to the calcified deposits on the alveolar wall. The particularly obvious black lung image can basically be judged to be the calcified defense caused by long-term dialysis of renal failure after seeing the chest X-ray. Imaging findings Quite typical, once you see it, you will never forget it."

The calcified deposits should be white. Why is it called black lung? Director Tang and Zhang You are both experts in lung diseases. They thought of the answer as soon as they thought about it, and didn't continue to ask.

It's just... Zhou Congwen said that it was a typical symptom and he could make a definite diagnosis just by looking at the film, which made it difficult for Zhang You to accept.

"The patient's current diagnosis is - calcification defense combined with metastatic pulmonary calcification, suspected hyperparathyroidism."

"I will see the B-ultrasound in a while, and the follow-up treatment is symptomatic, and surgical intervention may be required."

"The patient's condition is very serious." Director Cui of the Department of Nephrology asked.

"It's not heavy." Deng Ming smiled. "The most recent case of calcification defense was from a rural area. When we saw it, the patient lost four toes on his left side."

"..."

"At that time, the patient came to 912 not because of anything else, but because his toe fell off inexplicably and the bleeding was very little. The local doctor was terrified, and some people said it was a supernatural phenomenon." Deng Ming held the thermos cup and sipped Take a sip.

"It fell off inexplicably?!"

"Subcutaneous nodules, ulcers, dry gangrene, and necrosis and detachment of peripheral limbs. Because the blood vessel walls are blocked, so there is not much bleeding." Deng Mingwen said, "Walking and walking, toes fell off One, that's what the patient said at the time."

"..."

Several directors have never seen such a serious patient, nor have they seen such a bizarre medical record.

"Treat the symptoms. The patient is probably fine. From now on... Director Cui." Deng Ming looked at the director of nephrology.

"Director Deng, yes, yes." Director Cui bowed 30°.

"I'll leave you a phone number. I'll send a text message to the director of the Nephrology Department of our hospital in a while and talk to him. If you don't understand anything during the treatment, please contact our director."

"Good good."

"Hehe, it's all right, it's all the patient's business, don't feel disturbed." Deng Ming smiled.

The bedside B-ultrasound came, and the result was as Huang Lao guessed, the patient had parathyroid hyperplasia.

According to Zhou Congwen, you can take drugs to control it first, and if it is not ideal, then please consult with breast and breast surgery to see if it can be treated surgically.

In addition, Deng Ming left Director Cui the phone number of the director of the 912 Department of Nephrology, and everyone had nothing to continue to ask.

If the diagnosis is clear, then the treatment... Mr. Huang must not follow from the beginning to the end. After all, the treatment of internal medicine is a very long process, and a clear diagnosis is enough.

"If there is nothing else, I will send the boss and Director Deng back first." Zhou Congwen said to several people after seeing what happened here.

"Old Huang, thank you, thank you." Director Cui kept thanking him.

"It's okay." Huang Lao said lightly, "Read more, you are all directors, and you don't belong to the grassroots hospitals. There are tens of millions of people around you. You should know about some rare diseases."

Mr. Huang said it very gently, as if he was telling his children and grandchildren about the principles of life, which made the directors feel ashamed.

"A few days ago, a relative of a nurse in our department gave birth to a baby in another place. The baby was in a breech position, and his neck was always crooked after birth. The local doctor diagnosed that he was born with torticollis, and he needed surgical treatment when he grew up. crying."

Huang Lao stood up while talking, took off the borrowed white clothes and returned them to Director Cui.

"Later, they took the child and let me take a look. It was born with torticollis, and the patient had a typical birth injury. The neck was injured during childbirth and a mass was formed. I pressed it for three days, and the child recovered."

"Fortunately, there was no delay. If we don't deal with it in a few days, it is estimated that there will be problems for the rest of our lives."

Mr. Huang walked away with his back bowed, and casually babbled about a misdiagnosis, telling several directors that his back was covered with white hair.

Ordinarily, it is not a big sin not to be able to diagnose an extremely rare disease like calcification defense, but although Mr. Huang said the same thing very gently, the several directors seemed to have been scolded by the head teacher, and lowered their first sentence I dare not say.

"Patients come to the provincial capital because they trust you, and you cannot live up to this trust."

Zhou Congwen smiled, this is the boss's daily values.

Taking a peek at Deng Ming, seeing that his expression was normal, he probably already developed a tolerance to the values ​​instilled by the boss, and didn't take it seriously at all.

Still the same, Zhou Congwen felt a little happy.

"Go back and read more books." Mr. Huang waved his hand and bid farewell to several directors.

"Mr. Huang, I'll see you off." Director Cui stepped forward and said to Mr. Huang with a guilty expression on his face.

Huang Lao didn't refuse either, and walked forward with his hands behind his back.Zhou Congwen walked a few steps quickly and pressed the elevator.

"Then there are all kinds of auxiliary examinations. Even if you don't know how to do them, you still need to know who can do them well in the hospital." Huang Lao saw that the elevator didn't arrive, so he continued to grind, "Last year, an acquaintance of the patient's family came to see me. , the best doctor in the local hospital did a B-ultrasound, and it was judged to be breast cancer, and I needed an operation. After I came, I gave a B-ultrasound, what breast cancer is a cyst.”

"Puncture under the guidance of B-ultrasound, after taking it out, harden it with alcohol, and the patient will be fine. But the only regret is that the patient is too intolerable to alcohol, and the hardened alcohol made the patient drunk for 3 days."

As he spoke, Huang Lao sighed leisurely.

Deng Ming smiled and explained to Zhou Congwen, "The patient said before the operation that he could not drink alcohol, but he was not allergic to alcohol. The boss deliberately used a lower amount of hardened alcohol. As a result, the patient fell into a drowsy sleep after the operation, scaring the family."

"If it wasn't on 912, it might have been a medical dispute." Zhou Congwen said with a smile.

Chapter 0810 what posture has not seen!

Listening to Mr. Huang's "reprimand" and sending him away, Director Cui of the Department of Nephrology looked at the red flag car that disappeared into the night, and let out a long breath.

"I didn't expect Mr. Huang's diagnosis level to be so high." Director Cui murmured.

Zhang You doesn't think so.

Mr. Huang's diagnostic skills should be high. At an octogenarian age, to put it bluntly, Mr. Huang has seen more dead people than young doctors have seen living people. Can he not have rich clinical experience?

He kept wondering what happened to Zhou Congwen.

Zhou Congwen, a rare disease that occurs in [-]/[-] patients with kidney failure and dialysis, knows all about it!

Going through it again, this patient is really not simple.

Diseases with a probability of one in ten thousand can also be said to be rare diseases, but with the addition of kidney failure and dialysis, there are not many in the country.

Director Deng has been with Mr. Huang all the time, and since he is the chief director of 912, he knows that the illness is nothing serious.

But what about Zhou Congwen!

He has been in the Third Hospital of Jianghai City. You must know that there is no dialysis machine in that place.

When he came to the academician's workstation, Zhou Congwen had to do dozens of operations a week. Zhang You didn't believe that he had time to read books on nephrology and know what the hell is the calcification defense.

It's really weird. Zhang You wanted to break his head and didn't know what was going on. For the first time, he believed that there was such a person in this world that he knew from birth.

"Fortunately, I met Mr. Huang." Director Tang also expressed emotion, but then teased Zhang You, "Director Zhang, you must not deny your account of the medical records."

"It has nothing to do with our thoracic surgery department, and I'm not wrong." Zhang You categorically denied it.

"Mr. Huang has been talking about surgical intervention. Why do you classify it as thoracic surgery?"

Zhang You glanced at Director Tang, thinking that Mr. Huang is the master of cardiothoracic surgery, who would have thought that the surgery he was talking about was nail and breast surgery.

"I'm still old, and I've seen a lot." Director Tang said with emotion.

"That's not necessarily true." Director Cui said, "A few days ago there was an incident in Northern Henan. A child with anemia went to see a doctor, and he specially registered an expert account. The old expert who saw the doctor was hired from outside. I asked and said It is already 72 years old."

"and after?"

"He diagnosed the child with leukemia and suggested chemotherapy. As a result, half a year later, the child was weak and did not get better, and his health became worse and worse. The worse the treatment became, the family sold their property and took the child to the Affiliated Hospital of Zheng Medical University. The result was a diagnosis of Most common general anemia."

"I'll go... that's all right?!" Director Tang was stunned.

She has seen leukemia misdiagnosed as general anemia, but she has never seen general anemia misdiagnosed as leukemia.

A young man was diagnosed with leukemia, a malignant disease... Especially after the reform, there was a series called "Blood Suspicion" in the imported series, which became a national drama, and Momoe Yamaguchi also became a smash star in China.

In the TV series, Momoe Yamaguchi was diagnosed with leukemia, so everyone has a deep understanding of the disease.

"It's not over yet." Director Cui sneered, "Go home and ask for a list of hospitals, type it out and see, it's all fucking nonsense."

"What? Is it illegal?"

"It's routine to do 501 times a day, what the hell."

"!!!"

Zhang You shook his head with his hand, and he didn't know which daredevil was responsible for it.

It is routine to do 501 times a day, and it is a joke to say it.

Suddenly remembering what Huang Laogang said, the cold wind for nine days seemed to be a bit more piercing.

"Sigh, if you don't understand the disease, it can be said that your level is poor. But it's a bit unconscionable to do this." Director Tang said a little angrily.

"Let's not talk about others, are there few similar things in our hospital? Some time ago, a 15-year-old child with appendicitis was given two bottles of levofloxacin a day!"

"It's not for me, why are you staring at me?"

"Oh." Director Cui sighed.

"What happened next?" Zhang You asked.

"I scolded the doctor in charge of the bed and closed the door." Director Cui said with a straight face, "I did this kind of unconscionable thing, and there is no ass hole in having a child."

Zhang You shrugged, this matter has nothing to do with him, he just doesn't want to do interventional surgery.