crazy scalpel

The three of Pang's father and son were a little embarrassed to see Xie Ke after entering the door, just like Li Qiuhua.But this time they came here specifically for Xie Ke's reputation, so no matter how embarrassing they were, they had to speak up boldly.

The first to speak was Pang Fu's eldest son, Pang Da, who was a tall and burly man.

Pang Da scratched his head: "Thank you, divine doctor, I'm really sorry for what happened last time, it's all our fault..."

"I'm not a genius doctor, but an ordinary doctor, so don't call me that. Since the last incident didn't cause any loss, I don't need to mention it again. Your positive attitude towards treatment is also very desirable, but in the future If you have any questions, you should discuss it with the doctors first, and don’t be too impulsive.” After speaking to Pang Da, Xie Ke smiled at Pang Fu old man: “It’s been two or three months since the old man was discharged from the hospital, why are you visiting the outpatient clinic again? Is there anything else uncomfortable?"

Old man Pang is only in his 60s this year, perhaps because his life was not easy in the past, so he looks very old.His hair is gray, his teeth have almost fallen out, his mouth leaks when he opens his mouth, and he can't speak his native dialect clearly. His youngest son, Pang Tian, ​​helped him translate: "I was fine after being discharged from the hospital, but recently I started to have a bit of a headache. Now, it will suddenly convulse, a bit like the epilepsy your doctor said, very similar to the condition before the operation..."

Pang Da explained: "We know that you are very busy here, so we went to other hospitals to take pictures first. The doctors in other hospitals said it was a meningioma, and we also said that we had already undergone surgery here, and they said it was possible. It’s because the operation was not done cleanly, or a new tumor has grown.”

Xie Ke took his film and looked at it. Judging from the CT image, the tumor was round, with clear borders, and a ring-shaped low-signal zone at the edge, which was residual subarachnoid cerebrospinal fluid.The base of the tumor has a characteristic manifestation of dural enhancement - meningeal tail sign.

This tumor is not small, and it looks complete, and it is easy to find. Xie Ke believes that it is definitely not the one that Deputy Director Bian missed.He opened the medical record system to search for the pre- and post-operative films taken by Pang Fu when he was still in the city's No. [-] hospital, and found that there was no such tumor.

Is it really new?

The cause of meningioma is also not clear, but one thing is almost certain, it is related to the arachnoid, because it can occur in any part of the arachnoid cells.At present, most scholars believe that some factors such as craniocerebral injury, radiation exposure and virus infection act on arachnoid cells, induce cell chromosome mutations, or accelerate cell division, thereby contributing to cell degeneration.

Because meningiomas are generally benign tumors with slow growth and slow course of disease, they can be cured as long as they are discovered and surgically removed, and the prognosis is very good. Therefore, both doctors and patients are usually optimistic when encountering this disease.

For example, Pang Fu recovered relatively well after the surgery, otherwise his son wouldn't be shaking his prestige in the ward just because he took a little more antibiotics.

Is it really a relapse?

This is not impossible, but if the meningioma recurs, the growth time is too short!

The meningioma that Pangford had been removed had grown for at least several years. Because the growth of the tumor did not threaten the adjacent neurovascular vessels at first, it was never discovered.Later, as the tumor grew larger, the intracranial pressure increased accordingly, and then the headache occurred, which was confirmed by CT scan.

Xie Ke opened Pang Fu's medical records, which were very clean.Except for a meningioma in a city hospital, Pang Fu had never been hospitalized, and he had no record of even minor ailments. Of course, he had never had a formal physical examination.

Although it is very strange that Pang Fu re-grows a tumor that is almost exactly the same as the original meningioma, but judging from the film, there is really no problem.But Xie Ke felt that it would not be such a coincidence. Excluding the computer inspection, Xie Ke found that apart from his teeth leaking and his accent, he could speak clearly and fluently. The upper and lower limbs on the right had weak muscles. Everything else is normal.

However, Pang Fu's cheeks were swollen, and his mouth also had a peculiar smell. It was obvious that he was a smoker for decades.

Xie Ke's heart moved, and he asked, "Have you never given a patient a full-body examination?"

Pang Tian hurriedly said: "What I have done is this time. I have done it with all my heart and soul. My dad has no problems in other places."

Xie Ke listened and nodded, "In that case, let's go to the hospital and prepare for another operation. Are you still the deputy director of Yue Bian?"

Pang Tian quickly shook his head: "No, we came here this time to put my dad in the hospital and find a better doctor to operate on him. The other is, is this really a meningioma? Why did it grow back so quickly? One? If it is dismissed this time, will there be a third time? Dr. Xie, you have helped Li Qiuhua like that. I think you must have medical ethics. Tell us, is my dad’s situation right? Didn't the deputy director clean it up?"

It's not that Pang Tian wanted to file a lawsuit, but that he had wrapped a rather substantial red envelope for Deputy Director Bian. If this was the last surgery and he hadn't cut it clean, he would have to find a way to get back the extra surgery fee. Come some.

Xie Ke: "It looks like a meningioma, but the growth rate is a bit too fast, so I can't be sure. If there is no problem after the whole body examination, I think it's best to do another MRI scan of the brain to see Could it be multiple or malignant. Last time you had surgery because the tumor was found in the CT scan, and you didn’t have a comprehensive examination. Also, if you still can’t find other useful information after a full scan of the brain, I would like to recommend it You do a laboratory test, that is, blood and cerebrospinal fluid. Your father's intracranial pressure has not increased significantly, and he can receive a lumbar puncture."

In fact, after reading Pang Fu's medical records, Xie Ke found that the original diagnosis of Deputy Director Bian was too arbitrary.When the outpatient was referred, it was indeed thought that there was a possibility of meningioma, but it was a bit of a joke to make a diagnosis based on only one CT scan without distinguishing it from other possible diseases.Of course, judging from the film, it does match the characteristics of a meningioma, but for some unknown reason, Deputy Director Bian did not ask for scans of other parts of the brain and other inspections. This is not like the usual practice of Deputy Director Bian—no matter Whether it is useful or not, he is never soft when he starts the inspection list.

Xie Ke glanced at Pang Tian, ​​is it because the red envelopes are already rich enough to save some money for the patient?

Pang Tian didn't know that Xie Ke was guessing him in his heart, and he guessed it right. He nodded immediately when Xie Ke said that he needed to be checked: "Yes, it's all up to you. Doctor Xie, please help my father take a closer look. , the diagnosis must be correct, otherwise my dad will definitely not be able to bear such frequent craniotomies when he is old."

It took a long time to do the MRI, and Pang Fu felt dizzy after he came out.Xie Ke got the results of the examination very quickly, but no matter how he checked, he couldn't see any clues on the brain images.There are some signs of osteolytic changes in the skull, but it seems so slight that it can't be ignored.

Xie Ke's heart skipped a beat, it seems that he guessed it right.Osteolytic changes on the skull illustrate necrosis of bone cells, which are then engulfed, ablated, and expelled from the body!

This is definitely not meningioma. Meningioma originates from endothelial cells and fibroblasts of arachnoid granules, and has absolutely nothing to do with bone cells!

Xie Ke arranged for Pang Fu to be admitted to the hospital, and said to him: "There is a clue, and some cerebrospinal fluid needs to be taken for examination in order to confirm the diagnosis. Please work hard, old man."

Both Pang Da and Pang Tian said: "Check it when it's time to check, Dad, we will take care of it."

It happened that Wen Xudong was also there. He felt very strange when he saw Xie Ke bring the father and son in again, so he pulled Xie Ke aside and asked, "What's going on? Wasn't Pang Fu's operation very successful?"

Xie Ke glanced at him, thinking that as long as the cerebrospinal fluid is detected, the diagnosis can be confirmed, so there is nothing to hide: "A new tumor has grown in the place where the operation was performed..."

Wen Xudong interrupted him exaggeratedly: "What? It relapsed? Hey Xie Ke, how can you tell me how you are? Although you are very famous now, it is true, but in this case, the original doctor in charge Take it, unless the patient has some dissatisfaction. How can you cut off someone halfway like this?"

Xie Ke: "No..."

Wen Xudong pulled him, looked left and right for no one, and said, "This can be regarded as an unspoken rule in the industry. Think about it, if Director Bian asked you to operate on a patient who had been operated on by Director Bian, why don't others know about it?" You think my uncle didn’t do it well? You’re just being too honest, don’t you know? Now because you are famous, many patients like to join in the fun and insist on asking you for surgery. In fact, my uncle has much more experience in this kind of operation than you , you say it yourself, don't you?"

Xie Ke: "Deputy Director Bian has more experience than me, but..."

Wen Xudong: "Don't let it go, if you relapse, you should transfer it to my uncle."

This man in a suit named Pang Tian is said to be very rich. Last time he caught a loophole because of the dosage of the medicine, so Wen Xudong didn't get the benefits he gave him, and he was greedy for a long time.Wen Xudong knew the red envelope received by his uncle, and the thank you fee alone was tens of thousands!It was almost worth the sum of the operation fee plus medical expenses!

Because of a small medical fee, he lost a huge red envelope. This can be said to have picked up sesame seeds and lost watermelon. He regretted it!So this time he has to take good care of him no matter what, and he must not lose the big because of the small!

Xie Ke has his own team, and he is related to Zhu Ming, Wang Lei and others. If Xie Ke is allowed to perform the operation, Wen Xudong will definitely miss the money.So he still thought about asking Xie Ke to let the patient out.Wen Xudong knew that Xie Ke generally did not accept red envelopes, so he didn't think that Xie Ke would have any reason to hold on to this patient.

However, he underestimated Xie Ke too much.Although Xie Ke usually does not participate in office wars, he will never give in on things related to medical treatment.

Xie Ke looked down on people like Wen Xudong, with high-mindedness and low-handedness, and he was always looking for money.It's not that surgeons shouldn't love money, but that you should at least do your job well first.Xie Ke himself is very rich now, so he is generally unwilling to accept red envelopes from others, but he does not look down on other people who are willing to accept red envelopes.Shayk will not challenge this normal social rule as long as he does not deliberately hint or ask for it from the patient.

However, if you take advantage of others, you have to do things well. You must have a sense of responsibility.

Wen Xudong belonged to the kind of people who just collect money and do nothing, or in other words, he does things too casually.Otherwise, as the nephew of his deputy director, and came in two years earlier than Wang Lei, how could there be only one resident doctor now?

It is true that Wang Lei stayed after being favored by Cai Tianqiao, but Cai Tianqiao was not interested in fighting for power and profit, and he generally didn't care about scientific affairs.As long as Wen Xudong was able to win a little bit, Bian Shunyuan took advantage of the situation and pushed him to the general position of the hospital.

It is true that Wen Xudong can't let go of anything except money. He interrupted what Xie Ke was about to say several times, but he didn't see Xie Ke's serious expression clearly.

Xie Ke finally couldn't take it anymore, and yelled at him directly: "It's not a meningioma recurrence!"