The Godfather of Surgery

"Help him out?"

Zhang Lin is worried that the intern will fall down again.

If there are three longs and two shorts, no one can afford this responsibility. It is better to have less than one more thing.

The intern shook his head stubbornly and insisted on staying in the operating room. As a surgeon, he had to face more exciting scenes in the future, and he had to pass this level.

Song Zimo seemed to see himself back then, holding on to the wall of the Magic Six Emergency Center, swaying and spinning.

He understands the psychology of the intern best at this time, for fear of being expelled from the surgery profession because of this incident. Even if his heart is upset, he must pretend that nothing has happened to tell everyone: I can do it!

"Let him stay, be careful, feel free to tell me if you feel uncomfortable, it's nothing, it's a natural habit after watching too much." Song Zimo encouraged the intern and told Zhang Lin not to ask him to go out.

Zhang Lin naturally did not dare to disobey Song Zimo's words. No one could shake Song Zimo's position as the second brother in Keli.

In the past, Zhang Lin and Xiao Wu often dreamed of competing for the position of the third brother. Since Xu Zhiliang joined, they have completely cut off this idea.

This stammer is not only a little paranoid, but the key is that the brain is still working. Zhang Lin even suspects that this person's mouth can't keep up with the speed of the brain, so he stutters.

The excision of gout nodules is no different from the excision of surface tumors. The first-level surgery is the first-level surgery.

However, it is very difficult to maintain the normal healing of the surgical incision after surgery. Every detail must be pursued to the extreme, hemostasis must be thorough, and the layered suture must be tight, so that no leakage occurs.

Once leaked, the interstitial fluid mixed with uric acid crystals, endlessly, seeps out of the gap of the surgical incision, resulting in the incision eventually failing to heal.

"Lime" is impossible to clean, it is almost everywhere, it has penetrated into cartilage, synovium, joint capsule, ligament, tendon, almost every tissue around the joint is eroded by it, and this erosion has no boundaries.

As long as the clumps of "lime" are removed, a large amount of normal saline is washed repeatedly, and the white turbid "lime" water flows from the suction device to the suction tube into the collection bottle.

The excess skin and fascia were trimmed, the incision was fusiform, and negative pressure drainage was placed at the surgical site for some giant gouty nodules.

After hard work, more than 40 gout nodules in the body were gradually removed, and the operation was over.

The patient is back to normal in appearance, no longer an annoying "monster" with both lower limbs amputated from the knees, the result of years of gout indulgence.

In the future, if he can insist on taking medicine and control uric acid within the range of 180-300 μmol/L, he still hopes to live a normal life, and some of the uric acid crystals deposited in the body will gradually dissolve.

The intern resisted the discomfort and finally stabilized himself. Although his face was ugly, he did not fall down after all. He pretended to stand in the operating room with ease, declaring that he could be a surgeon.

"Fatty, you haven't had gout for a long time, have you?"

Zhang Lin took the opportunity to ask when Fatty Liang was free.

"I haven't had an attack for a year. One tablet of allopurinol a day is as punctual as washing my face and brushing my teeth. Now uric acid is stably controlled in the early 200s."

"My father-in-law also has gout. Do you have any good suggestions for medicines?"

The lecture time is short, and many things are still not fully understood.

"Do HLA-B*5801 gene screening, if it is negative, allopurinol is the first choice. Don't think it is cheap, thinking that it is not a good product. If the HLA-B*5801 gene is negative, there are no other contraindications, allopurinol is definitely The best, whether it is efficacy or safety, is the best. According to the latest guidelines of the American College of Rheumatology on gout, the recommended first-line drug is allopurinol. In my country, given the high proportion of HLA-B*5801 gene positive in Han nationality , I don't make a first-line recommendation, but if it is confirmed that the HLA-B*5801 gene is negative, allopurinol is the first choice." Liang Fatzi is unequivocal, he has already researched these drugs rotten.

"It makes sense. The elderly have high blood pressure or something. Febuxostat should be cautious. I will let him do HLA-B*5801 genetic monitoring when I have time. It seems like a few hundred dollars? If it is negative, I will let him change it. Allopurinol." Zhang Lin got a clear opinion, so he was relieved.

Xiao Wu also wrote it down, hoping that his father-in-law's HLA-B*5801 genetic test was negative.

"Go over the bed!" Xu Zhiliang threw the gloves that he took off into the yellow collection bucket and gave an order.

As Zhang Lin's superior doctor, Xu Zhiliang is full of majesty.

Hearing the call of the superior doctor, Zhang Lin immediately cheered up, and together with Gu Peisheng and the intern, lifted the patient and transferred the patient from the operating bed to the flat car.

The two amputated limbs were packed in plastic bags and labeled, and the cleaners in the operating room came in, completed the handover operation, and sent the short limbs to the pathology department.

"It's best to go to the pathology department for three months, stand by the sampling table in the giant examination room, eat meat buns, and watch the teacher decompose the liver, stomach, intestines, etc., you can pass the test." Song Zimo patted the intern's Shoulder.

The intern felt nauseated for a while, and when he heard this scene, he felt sick to his stomach, not to mention eating steamed buns while watching.

At this time, Yang Ping was answering the phone in the corner, and Huang Jiacai, the magic capital, called.

"The spinal external fixator has been delivered to the Guilin laboratory. We need to take time to go to Guilin. It is estimated that the operation on forty monkeys will take two days. Fatty, you can also go together. Is the monkey's anesthesia okay? Xiaowu, you arrange it. Let's go." Hanging up the phone, Yang Ping arranged a mission to Guilin.

"Let's go after get off work this Friday? Young Master Song and I will go with you, Lao Xu and Zhang Lin will guard the ward. Next time, we will switch between get off work, leaving work on Friday and returning on Sunday evening. I will let them prepare skins one day in advance." Xiao Wu is in charge of outreach , outreach activities for these research activities also fall within his scope of work.

The so-called skin preparation is to remove the hair from the surgical site and clean the skin.

The body hair of monkeys is much more lush than that of humans, and skin preparation is also a heavy task. For 40 monkeys, all the body hair on the backs must be removed with an electric razor.

"There are anesthesia equipment and medicines there. I have shown you the list of equipment and medicines. Is there any problem?" Xiao Wu asked Fatty Liang.

Anesthetize the monkeys, forty at a time, this is the first time.

The dosage of anesthesia can only refer to the human body, and it can be adjusted according to the weight of the monkey. Fatty Liang also consulted Huaxi’s tutor in advance. The tutor is researching a new type of local anesthetic and is currently in the animal experiment stage. experience of.

Scientific research is hard work, especially some basic scientific research. It is very hard, hard and tiring. There is no money, so naturally no one wants to do it.

But basic scientific research is the most important, just like the foundation of a building, without a solid foundation, the building is futile no matter how beautiful it is.

Forty monkeys, after surgery, were implanted with external fixators. The external fixator was adjusted every day after the operation. The number of screws, how many times a day to rotate, and how many scales to rotate at a time must be meticulous.

This is not enough. Regularly taking X-rays, MRI, and CT of the monkeys, analyzing these image data, taking some tissues under the microscope, performing histoembryological analysis, and dynamically observing the firmness of the fixation pins of the external fixation frame, If there is a problem in the middle, record and analyze the problem.

These work will be done by the doctors sent by Concord, who have good scientific research literacy.

The patient woke up from anesthesia and returned to the ward. Although there was gauze all over his body, there were no bumps under the gauze.

If all goes well, after 14 days, he can wear a prosthesis to train his walking ability.

Back in the ward, Yang Ping had nothing to do. He transferred the monkey images sent from Guilin to read. Xiehe's laboratory in Guilin is fully equipped. The quality of these images is very high. The frontal and lateral X-rays of the entire spine and CT 3D reconstruction , MRI of various sections, the shooting is very standard.

In order to get the best image picture, the laboratory staff thought of a lot of ways, they designed an X-ray transparent frame, the monkey was fixed on the frame, and then checked.

These little guys won't let you check in a regular manner. Even if they are fixed on the shelf, some pictures need to be photographed many times to get them.

"You said that the monkey's X-ray is really similar to the child's?"

"Darwin did not say that humans evolved from apes."

"Look, a few physiological bends are not very obvious?"

"Yeah, why is the physical curvature not so obvious."

Zhang Lin and Xiao Wu also watched around.

"The image data here includes not only the 40 monkeys we experimented with, but also many previous experimental monkey data. The physiological curvature of the spine is formed after people walk upright. Although monkeys can stand upright for a short time, they crawl on all fours most of the time. , so the spine does not have the typical human physiological curvature." Yang Ping explained to them.

Prof. Qin Sihe, an orthopedic expert, once wrote a paper analyzing the formation and correction of deformities from the perspective of evolution.

"Do you think monkeys have lumbar disc herniation?" Zhang Lin asked Xiao Wu.

Xu Zhiliang was surprised by Zhang Lin's question: "You are a crooked--right--right, today--how--raised---so profound."

It's not that you face the wall every day to give speeches, why are you stammering now?

Zhang Lin dared not speak in anger.

"Look, these are the spinal MRIs of old monkeys. Look, the three lower intervertebral discs in humans degenerate the fastest. In old age, they must be dehydrated and show low signal, but monkeys don't seem to have this problem." Yang Ping And call up some information to show him.

"So--your question--if it's not-- I'll call you Teacher Zhang." Xu Zhiliang really felt that this question was profound.

"Or, after our retractor monograph is completed, the next topic will study the difference between monkey and human lumbar disc degeneration?" Xiao Wu suggested.

"Actually, from the perspective of evolution, the human intervertebral disc is a defective product. It has not had time to evolve well enough to adapt to human upright walking, so it is prone to problems." Song Zimo is also thinking about this issue.

Yang Ping partially agrees with this point of view: "Degeneration is irresistible. The degeneration of the human motor system always starts from the parts where the stress is concentrated, such as the lower lumbar spine and the knee joint, which are the parts of the stress concentration, and the anatomy and the function are adapted. , but these places have not been strengthened anatomically."

To solve clinical problems in medicine, one must start thinking from the basics.