Back in 2002 as a doctor

"How did Mr. Chai make the diagnosis?" Zhou Congwen asked.

"A month ago, I was diagnosed by the Chai General Association. It was said to be pneumonia, but the patient was advised to undergo other examinations, including biopsy." Lu Tiancheng talked about the medical history, and it became much smoother. There are risks, so only bronchoscopy was done to get pathology."

"Is the test result okay?" Zhou Congwen asked.

"It's okay." Lu Tiancheng said, "but I..."

"Tian Cheng, if you have anything to say, just talk about it, you don't need to be so out of touch." Zhou Congwen said.

Lu Tiancheng looked at Zhou Congwen who was sitting on the chair, his youthful face was full of youthfulness.

Although he has been studying in the Second Hospital of Medical University for some time, he is also familiar with the working process of the medical team and integrated into it as soon as possible.

But after all, Lu Tiancheng was the one who "watched" Zhou Congwen grow up, so he was always in a daze.

After being silent for a second, Lu Tiancheng focused his attention and said seriously, "I have seen a similar film, and the respiratory medicine diagnosis was also pneumonia. After more than a year of treatment, it did not improve, but worsened. Show me the film, That's what I diagnosed too."

"After a period of time, the patient had passed away when I returned to visit."

"I don't know what the disease is, but I simply think that the diagnosis of pneumonia is problematic."

As Lu Tiancheng said, he paused, "But I always feel that the sudden death of the patient may be due to my diagnosis at the time, so I want to ask your opinion."

Zhou Congwen took out a piece of paper, drew an image of a lung on it with a ballpoint pen, and then outlined the image Lu Tiancheng was talking about with a few simple strokes.

"That's it."

Lu Tiancheng said, "Yes."

That's what he said, but he was quite surprised.

The image that Zhou Congwenxin drew was exactly the same as the image he saw.

But when the patient just arrived, Zhou Congwen must have never seen the film, Lu Tiancheng was sure of this.

"Is this the wheat circle sign?" Xiao Kai asked suspiciously.

"Hehe, Shen Lang, look, this is clinical experience." Zhou Congwen laughed.

In a word, the other three were speechless.

These words were spoken in a tone full of old directors and experts, which did not match Zhou Congwen's young face at all.

"Professor Zhou, do you also think there is a problem?" Lu Tiancheng immediately asked respectfully.

"Well, go and have a look." Zhou Congwen got up.

"Professor Zhou, I just said something, Mr. Chai seems a little unhappy." Lu Tiancheng called Zhou Congwen to stop, and talked about things other than the medical treatment just now.

"Oh, let me take a look at the film first." Zhou Congwen didn't care about the general opinion of the hospitalist, and took the person out directly.

Although Lu Tiancheng felt a little bad, after all, Zhou Congwen didn't say anything, and he couldn't stay out of it.

Interpersonal relationships are very complicated, and many things are unavoidable, so Lu Tiancheng had no choice but to bite the bullet and follow Zhou Congwen back to the office.

"This is a rare form of Langerhans cell histiocytosis." Mr. Chai was talking to the patient's family.

The film is hung on the film reader, and the finger is pointing at the image, full of confidence.

Langerhans cell histiocytosis?With such an awkward and professional name, Lu Tiancheng almost believed it.

Zhou Congwen didn't shy away from it, and walked over directly.

"Boss Chai, I'm busy."

"Professor Zhou, there is a video of the consultation, can you take a look at it?" Mr. Chai caught a glimpse of Lu Tiancheng behind him, and already knew what happened.

But if he could not give Lu Tiancheng face, he must give Zhou Congwen face.

How about your own director?Still not being honest, I yelled at Professor Xiao Zhou mouthful when meeting each other.

Even the hospital beds were "occupied" by Zhou Congwen, and Director Zhang didn't even dare to fart.

Is this kind of person one can offend?Mr. Chai has a clue in his heart.

"From my point of view, Langerhans cell histiocytosis is a rare disease, and Mr. Chai's diagnosis level is very high." Zhou Congwen said.

Mr. Chai was ashamed.

Zhou Congwen looked at the film while tucking up his crew cut hair.

The family members of the patient did not understand why the young doctor acted like an old expert.Because he didn't understand, he didn't dare to question, and just watched quietly.

Zhou Congwen looked at it for about 1 minute, scanned the three CT images of the lungs before and after, and began to ask about the medical history.

The patient developed a cough three months ago due to fatigue, coughing up a small amount of yellow-white sputum, not much, accompanied by pain in the right chest area, which was related to respiratory movement, without fever, night sweats, weight loss, chest tightness, and shortness of breath.

After feeling unwell, the patient had been seen in three hospitals including the First Medical University and the Second Medical University, and the diagnosis was the same—pneumonia in the upper middle lobe of the right lung.

The patient's condition did not improve after two intermittent intravenous antibiotics, but worsened.

"How much sputum is coughing up every day now?" Zhou Congwen asked after listening to the patient's family member's medical history.

"A lot, probably... There are two wastebaskets."

It seemed absurd to hear him associate the quantity of sputum with the quantifier of wastebasket, but none of the doctors present laughed.

The patient coughs up a lot of sputum at home, and it is good to be able to use the wastebasket to calculate it. More patients' family members don't know what to ask.

"President Chai's diagnosis is reasonable." Zhou Congwen finally concluded.

A flower blossomed on Mr. Chai's face.

This is a compliment from Professor Zhou!Mr. Chai waited for Zhou Congwen's gaze to leave him, and glanced at Lu Tiancheng, feeling proud.

"Pulmonary Langerhans cell histiocytosis is most common in young people, more male than female, associated with smoking, histopathologically characterized by mixed infiltration of Langerhans cells and eosinophils, 10-15% of patients have pulmonary External involvement."

"Although the patient's age does not match, here it is." Zhou Congwen said, clicking on the gaps in the film.

"It's different from the hollows you usually see. This one is called the Cheerios sign, and it looks like the donuts sold in the market."

"At the beginning of the chest CT, it can be manifested as centrilobular nodules with clear borders or stellate shapes. These nodules may appear hollow, similar to the films we saw."

"A diagnosis of pulmonary Langerhans cell histiocytosis is reasonable and likely."

As he spoke, Zhou Congwen took off the film and put it in a film bag.

"President Chai, what should we do next?"

Mr. Chai was still happy, and blurted out, "We should do a biopsy of pathological tissue."

"Well, are you sure?" Zhou Congwen asked.

"It doesn't seem necessary, Professor Zhou." Mr. Chai hesitated, "Sputum culture and bronchoscopic exfoliated cell examination did not find any problems."

"Pulmonary lymphangioleiomyoma and lung malignant tumors also need biopsy for differential diagnosis." Zhou Congwen said, "I suggest doing one."

Chapter 1196 Tension to plasmolysis

Xiao Kai heard some clues from Zhou Congwen's words.

But Zhou Congwen didn't speak in detail. He didn't deny Mr. Chai's statement, but only left a sentence, "Receive the hospital, Mr. Chai, and call me if you have any difficulties in piercing."

Although they are not in the same group, Chai can always distinguish between big and small kings.

My director is like a dog, so I have nothing to say.Perhaps, this is also a way to get Professor Zhou's attention?

What if he is appreciated by Professor Zhou and can enter the medical team of the academician workstation.

After Zhou Congwen left, Mr. Chai asked the front line to accept patients, and various cumbersome procedures were quickly advanced.

"Boss Chai, that's amazing."

When he was free, Xiao Kai chatted with Mr. Chai with great interest.

"hey-hey."

Mr. Chai was a little excited to be recognized by Professor Zhou Congwenzhou. He glanced at Lu Tiancheng who was looking up books not far away, and he was naturally very proud.

"I'm also an old clinician. I haven't heard of the hyperplasia you mentioned." Xiao Kai "sincerely complimented me."

"It's pulmonary Langerhans cell histiocytosis." Mr. Chai corrected him.

"That's right, I've only read about it in books, but I haven't encountered it in actual work." Xiao Kai said with a smile, "If I saw this patient, I would definitely think it was inflammation, and at most it was a tumor."

"I just thought about it. Professor Zhou said that my diagnosis is correct, so I have confidence." Mr. Chai said "modestly".

Xiao Kai scratched his head, did Zhou Congwen say that it must be the disease?

According to Xiao Kai's cognition, Zhou Congwen did not say that Mr. Chai's diagnosis was wrong in front of the patient's family.

I don't think what cell hyperplasia is the correct diagnosis.

Mr. Chai misunderstood everything from the beginning to the end, and he was self-righteous and felt that he was right.

Xiao Kai saw that Boss Chai looked smug, and his whole body was several pounds lighter, as if he was about to ride the wind to go home, so he couldn't bear to interrupt his dream.

"Dean Xiao, you graduated from Union Medical College, don't you know about pulmonary Langerhans cell histiocytosis?" Mr. Chai asked.

"..." Xiao Kai was speechless.

It’s fine to talk about yourself in everything, but Xiao Kai can’t accept that if you extend from yourself to your alma mater, you will have doubts about Xiehe.

"The wheat ring sign is actually very obvious. Although it is not seen much clinically, but after seeing it once, you can immediately remember it when you encounter it in the future."

As he spoke, Mr. Chai leaned back, proudly +1, "What is clinical experience!"

"Hahaha." Xiao Kai yelled.

After the patient is admitted to the hospital, relevant examinations are completed.Because of the wheat circle sign, each cavity is connected to the bronchi, so Mr. Chai is still forced to do a biopsy by himself, but respectfully asks Zhou Congwen to do it.

The difficult operation became easier under Zhou Congwen's hands. The puncture tissue was sent for pathological biopsy, but Mr. Chai was still nagging that it was unnecessary.

Of course, he didn't dare to say this in front of Zhou Congwen.

After get off work, Xiao Kai intended to leave Lu Tiancheng behind after everyone dispersed after having supper at [-]:[-] in the evening.

"Dean Xiao, what did Professor Zhou say?" Lu Tiancheng knew what Xiao Kai was going to say when he left him, but he never dared to ask, and now he looked at Dean Xiao anxiously.

"I've finished laying the groundwork, you can just say it directly." Xiao Kai said, "I will definitely agree. Professor Zhou is different from those old directors who cherish their brooms."

"Agreed?" Lu Tiancheng was a little excited.

"Well, it happens to be the next round of sleeve cutting, but are you ready?" Xiao Kai asked seriously.

are you ready……

Lu Tiancheng must be ready, but once faced with a major event that determines the direction of his life, how could he not tremble.

"Doctor Lu." Xiao Kai looked at Lu Tiancheng kindly, like the vice president facing his subordinate doctors, "Your surgery is all right. I saw Professor Zhou's intention to teach you cuff cutting before." . Every time he does a sleeve cut, he will yell whenever you have time."

Lu Tiancheng felt his mouth dry, so he nodded vigorously.

"I've seen you do training usually, and your techniques are more sophisticated than Peng Yiming and Li Ran. But the foundation at the beginning is a little weak. I'm talking about the foundation of laparoscopic surgery. You got in touch early, but you have developed some bad habits. .”

"But it doesn't matter. With Professor Zhou around, you should also put your heart into it. You will basically get rid of your bad habits. There must be no problem."

Xiao Kai did Lu Tiancheng's ideological work.

It was visible to the naked eye that Lu Tiancheng was nervous, but he didn't realize it himself.

In Xiao Kai's view, Lu Tianxiang was like a freshman undergoing surgery for the first time, full of expectations and apprehensions.

When the pressure from the outside world was transmitted to his body, Lu Tiancheng's endocrine system started to function, secreting a large amount of adrenaline.

The concentration of hormones is even higher than that of the cell fluid.

The water in the cell fluid will seep out of the cell through the protoplasm layer, and the volume of the vacuole will shrink. Due to the limited flexibility of the cell wall, the protoplast will continue to shrink after the cell wall stops shrinking.

Under such action, the cell membrane and cell wall of Lu Tiancheng in the microscopic world will gradually separate, and the gap between the protoplast and the cell wall will be filled with all kinds of tension just secreted.

To put it simply, Lu Tiancheng was already nervous to the point where the walls were separated.

Because he knew that in Zhou Congwen's medical team in the Second Hospital of Medical University, the importance of the first operation he performed could not be overstated.

If you do it well, or if you do it well, Zhou Congwen will recognize him and let him have surgery in the future.

If you can't do it, then forget it, there is nothing to complain about, I can only say that I am not a surgeon.

Lu Tiancheng understands the importance of this.

"Relax, look at Shen Lang." Xiao Kai smiled and comforted Lu Tiancheng, who was already separated, "Shen Lang can be said to be very talented, and he usually doesn't do his job properly."

"But Shen Lang and Professor Zhou Congwen Zhou have a good relationship, and they belong to their own people around them." Lu Tiancheng said distressedly.

"Look at me." Xiao Kai took out a cigarette and handed one to Lu Tiancheng.