Back in 2002 as a doctor

Page 910

"Secondly..."

Director Zhang thought a lot, so she was the most prepared, and began to talk about the diagnosis basis.

Behcet's disease is a rheumatic and immune disease, which is rare. Director Zhang can speak clearly and clearly, which shows his profound knowledge.

A few minutes later, Director Zhang finished speaking and looked at Mr. Huang.

"Huang Lao, just now you said that it was caused by Takayasu arteritis, and I think it is caused by Behçet's disease."

Huang Lao smiled slightly and looked at Director Xu of the Department of Rheumatology and Immunology.

"I think what Director Zhang said makes sense. I'll see the patient later." Director Xu said with a smile.

"Zhou Congwen, tell me." Huang Lao said.

Zhou Congwen put his hands on the desk, glanced at Director Zhang, then at Director Xu, and said, "The main sign of Behcet's disease is the mouth-eye-appreciation system triple reaction."

"Professor Zhou, Intestinal Behcet and Neurobehcet may not have the mouth-eye-appreciation system triple reaction." Director Zhang saw that the patient had no oral ulcers, and she interrupted Zhou Congwen with a smile.

"Indeed, Director Zhang is right." Zhou Congwen said, "32.2% of patients with Behcet's disease in the cardiovascular system are not accompanied by the mouth-eye-appreciation system triple reaction."

Director Xu of the Department of Rheumatology and Immunology frowned, looking straight at Zhou Congwen.

How did he get this data?

But Mr. Huang was right next to him, and Director Xu immediately realized that this was the old man's clinical experience.

Just when he was puzzled, Zhou Congwen continued, "From this point of view, Director Zhang's diagnosis is possible."

Director Zhang smiled.

Of course, it is more than possible. She thinks that the patient is Behcet's disease. She is more curious about what Zhou Congwen will say next.

"but."

Sure enough, Zhou Congwen's butt arrived soon.

Director Zhang focused.

"According to the patient's clinical signs, Behcet's disease can be ruled out, which is impossible." Zhou Congwen smiled slightly.

"!!!"

Chapter 1564

"The patient has been hospitalized for 3 days. I believe Director Zhang has seen the patient during his ward rounds."

"And then?" Director Zhang was a little upset. Although Zhou Congwen was smiling when he spoke, he directly denied his diagnosis.

In Director Zhang's view, this is a kind of contempt, and even a hint of challenge.

If Mr. Huang hadn't been sitting there as Zhou Congwen's background board, Director Zhang might have lost his patience and was going to have a fit.

At the same time, a flame of fighting rose in Director Zhang's heart.

"Just now I went to see the patient with the boss, and there is no change near the needle point of the patient's infusion, so Behcet's disease can be initially ruled out." Zhou Congwen said when Director Zhang was in a daze.

"Ok?"

"Acupuncture experiment?" Seeing that Director Zhang was going to make a fool of himself, Director Xu immediately took over the conversation and gave the correct answer.

"Yes." Zhou Congwen smiled, "A normal acupuncture test is to puncture the skin in the middle of the patient's forearm flexion side, and observe the skin reaction at the needle puncture site 48 hours later. Usually, a positive reaction is a local red pimple or pimple. Accompanied by white herpes, it is considered a positive result."

"Although it's just a spot drip, it's not considered a normal acupuncture test, but there were no papules or maculopapular rashes on the patient's skin, the acupuncture test was negative, and there was no triple reaction, so it is not considered to be Behcet's disease."

"What Director Zhang said is also reasonable. Many patients with Behcet's disease in the cardiovascular system do not have a triple reaction, but there are still positive acupuncture tests."

Zhou Congwen's smile remained unchanged, as if wearing a mask.

What he said was not complicated, and could even be said to be simple, but Director Zhang's diagnosis was completely overturned by such a few simple words.

All the directors present looked at Zhou Congwen with serious eyes.

Director Zhang is so sure that she must have seen similar patients. Although the patient in front of me is not as weird and serious, it is clinical experience.

To say that the directors here before regarded Zhou Congwen as a surgical beast raised by Huang Lao, and there were still at least ten years before he matured and reached the peak of combat effectiveness, so now they have unknowingly regarded Zhou Congwen as a surgical beast. real opponent.

In the past, Director Xu of the Department of Rheumatology and Immunology took the initiative to solve similar cases, but this time Zhou Congwen took over the role of Director Xu, directly denying Director Zhang's diagnosis from the perspective of rheumatology and immunity.

Several directors and doctors from the Department of Circulatory Internal Medicine glanced at Zhou Congwen, then turned to Director Xu.

Director Xu also became more cautious. He pondered for a few seconds, then smiled, "Old Huang, I'll take a leave of absence to see the patient."

Director Xu's attitude immediately corrected.

The others didn't speak, and the inpatient took Director Xu to the ward to check on the patient.But it took a long time to look at it, a full 10 minutes before Director Xu came back.

The longer the time, the more serious Director Xu is.

912's rheumatism immunity is as strong as Xiehe's rheumatism immunity, ranking among the top three in China.

Under normal circumstances, when Director Xu stepped in, there was a high probability that he would have the correct answer.

It took him a full 10 minutes, and it is estimated that the physical examination and medical history were done very meticulously.

When he came back, he sat down and said with a smile, "Professor Zhou's opinion is very good. The acupuncture test should be negative. I asked about the medical history and made a suggestion. Mr. Huang, please take a look."

"Let's talk." Huang Lao nodded.

"Kawasaki disease was first reported by Dr. Tomisaku Kawasaki in Japan in 1967 and named after him. This disease is an acute fever and rash pediatric disease with systemic vasculitis as the main lesion. The peak age is 5 years old The following infants, males more than females, adults and children under 3 months are rare."

Kawasaki disease?

The other directors had almost never heard of this disease, so they were taken aback.

The patient is a 46-year-old female patient, but why did Director Xu bring out a disease of infants and young children?

"Ask about the medical history. The patient had a fever and rash when he was a child. The existing white blood cell count increased, platelets increased, and C-reactive protein increased..."

Director Xu began to talk eloquently.

He spoke with great confidence for 5 minutes, and finally concluded, "The most serious complication of Kawasaki disease is its effect on the cardiovascular system, leading to coronary artery dilation and myocardial damage."

"Although Kawasaki disease is also called mucocutaneous lymph node syndrome in children, some patients have had sequelae for a long time, and the problems left over from that year can be found out in adulthood."

"I think the patient is an aneurysm with coronary intima injury caused by Kawasaki disease."

"For differential diagnosis, first of all, Yersinia infection, hemolytic streptococcal infection, staphylococcal infection, Chlamydia pneumoniae infection, viral infection, such as measles, influenza, EBV, HIV, Candida albicans infection, leptospirosis and so on to identify each other.

Secondly..."

Director Xu looked at Zhou Congwen and Huang Lao while talking.

Although he looked so confident, Director Xu could see some clues from Huang Lao's eyes. The more he spoke, the less confident he became, and the more he spoke, the lower his voice.

Just halfway through the talk, Director Xu's self-confidence completely disappeared, although he thought that the diagnosis of Kawasaki disease should be fine, and Mr. Huang was listening to himself carefully, without any change in expression or movement.

however!

He couldn't go on talking at all, so he just stopped.

"Ahem." Director Xu cleared his throat, "Old Huang, am I right?"

"Huh? I'm listening. Why did you say something wrong just halfway through?" Mr. Huang raised his eyelids to look at Director Xu, and smiled kindly, "Continue."

"..." Director Xu was completely speechless.

Although Mr. Huang was very kind and kind, he felt that Zhou Congwen sitting next to Mr. Huang was like a knife, with a cold light.

This was just a hospital-wide consultation and did not involve any troubles, but Director Xu's usual self-confidence disappeared for some reason.

"Old Huang, I think the diagnosis of Kawasaki disease is quite reliable, so I won't say more. Would you like to share your opinion?"

"Zhou Congwen, tell me."

Huang Lao still said the same thing just now.

"Then I'll just say a few words." Zhou Congwen put his hands on the table, looked at Director Xu, and smiled.

Director Xu suddenly remembered a legend.

The year before last, Mr. Huang performed an operation on a one-day-old child, and specially called Zhou Congwen from Jianghai City.It is said that the newborn calf bowed to Director Xu of the anesthesiology department before the operation, and said his apology first.

What this matter means, old clinicians understand.

This meant that the operation went well, Director Xu of the anesthesiology department was not scolded, and if the operation did not go well, the operating room might not be in trouble.

Under the shroud of this legend, Zhou Congwen's smile seemed a bit "insidious".

Chapter 1565

"Head nurse, shouldn't the directors talk about their opinions in the consultation of the whole hospital, and then watch the patients go back to make a plan? Why come out one at a time, and one at a time, like that." The doctor asked the nurse to take a look asked the closed doctor's office door.

She didn't say what it was, but the head nurse knew it.

"I don't know, Mr. Huang is here today, and it should end soon." The head nurse looked at the door suspiciously and said, "But have you seen Mr. Huang's closed disciple? The one named Zhou Congwen."

"Is it the different place mentioned in the operating room? I heard it a long time ago. It is said that Mr. Huang really dotes on him. He chased him around in our compound with a broom. Many people knew about him before Zhou Congwen came. "The doctor ordered the nurse to say with a smile.

"Hahaha, I'm still young, don't say that." The head nurse laughed, "It's a pity that I have a girlfriend, if I don't have one..."

"Don't think about it, it's just the single girls in our department who might be looked down upon."

The head nurse really wanted to introduce women to the girls under her command, which was an instinct of the head nurse.

But Mr. Huang's closed disciple, No. 1 in the World Cardiothoracic Surgery Competition for two consecutive years, surrounded by these auras, Zhou Congwen is definitely not an ordinary person, and his vision should be very high.

"You said that Mr. Huang brought Zhou Congwen to the consultation. Would you like to introduce him to the other directors and refresh your face?"

"It should be. Dean Deng has made it clear that he must continue to go up, and Mr. Huang is doting on this young man. He must pave the way first."

"But why is it so strange today." The head nurse also felt strange. She looked at the door of the doctor's office and was not in the mood to work.

Suddenly, the door opened, and the director of heart intervention came out with a serious expression.

Taking advantage of the moment the door opened, the head nurse saw Zhou Congwen sitting next to Mr. Huang, with a warm smile on his face, whispering something.

Zhou Congwen's smile was in stark contrast to the seriousness of the director of cardiac intervention.

This is... the head nurse's heart moved, and she greeted her enthusiastically.

"Director Jiaqing, you go to see the patient." The head nurse greeted and said nonsense.

"Yeah." Director Feng Jiaqing frowned and rushed to the ward.

"What's the matter today? Why didn't you come out to see the patients together, one by one like sliced ​​soup."

"Zhou Congwen...is amazing." Director Feng Jiaqing said in a low voice.

"Ah?" The head nurse never expected Feng Jiaqing to say such a sentence.

"Today is Zhou Congwen's tongue-in-cheek battle with Confucianism. You Director Zhang and Director Xu who are immune to rheumatism have already lost." Director Feng Jiaqing said in a strange tone, "I...my diagnosis was also said to be wrong."

Although Director Feng was a little embarrassed, he still told the truth.

"Ah!" The head nurse groaned again, she never expected Zhou Congwen to be so powerful.

"Elder Huang said it earlier." The head nurse guessed.

"I don't think it's possible." Director Feng said, "The two of them just saw the patient. Our diagnosis failed beforehand. Who knows what everyone's diagnosis is."

"What did Zhou Congwen say?"

"You Director Zhang diagnosed Behcet's disease, and Director Xu diagnosed Kawasaki disease. I think it looks like giant cell arteritis."

A series of rare disease diagnoses, none of the head nurses are familiar with, and even sound strange.

She thought for a while, and asked with dew on her face, "What did Zhou Congwen say?"

"He said that although giant cell arteritis is a typical large vasculitis, it most often involves the temporal artery, causing tenderness, weakened pulse or nodules, leading to headaches and dyskinesia of the masseter and tongue muscles.

Although the patient is a middle-aged woman, the lesion did not involve the temporal artery and the onset occurred before the age of 50, so it is not considered for the time being. "

The head nurse was dumbfounded, she didn't understand the relationship between temporal artery inflammation and age at all.

Curious in her heart, she accompanied Director Feng to see the patient. The patient and the patient's family members were obviously a little confused. After a while, an old doctor came to see them, and they couldn't sit still.

Director Feng confirmed that the patient did not have temporal arteritis, asked a few insincere words, and left the ward thoughtfully.

The head nurse didn't go in. She watched Director Feng Jiaqing enter the ward and told the nurse, "It's a bit strange today."

"What's the matter, head nurse."

"Director Feng is usually domineering. Although he is doing interventional surgery, he is not used to anyone other than Mr. Huang during the consultation in the whole hospital. I remember one consultation. During the endocrine consultation, he dumped the medical record clip and hospitalized the endocrinologist. Heads were all broken and there was a lot of bleeding."