godfather of surgery

Chapter 616 The Universal Pathological Slice

If a medical history questionnaire is compiled according to etiology, it seems easy, but it also requires a level of practice, and all possible etiologies must be turned into specific events.

This has the advantage that no important information will be missed, but it also has the disadvantage of casting a net all over the sky and not being targeted.

Yang Ping thought in his heart that there were concealments or omissions in the medical history, but physical signs were objective things.

The fact that this patient exists objectively is—necrosis, progressive necrosis of extremities, starting from the right hand and right hip, and the right hand and right hip are most obvious.

Why is the right hand and right hip the most obvious site of necrosis?
This person is right-handed, not left-handed.

The right hand is connected to the right hip, the hand is exposed, and the hip is generally covered by clothes and pants, so it should not be at the same exposure level.

There is a possibility that this situation will occur, that is, the causative agent takes it with his right hand and puts it in the pocket of the right trousers, so that the right hand and right hip become exposed at the same level.

Could it be?
Grasping this feature, Yang Ping had an answer in his heart, but medicine pays attention to evidence.

"Has a sample of necrotic tissue been taken for pathological examination?"

Yang Ping thinks that pathological examination is a magical method. Although these cells are necrotic, you can see what changes have occurred in the cells under the microscope, and figure out how the cells died.

"The pathological specimens were taken, but it was not so fast. Director Guan went out for a meeting and will return tomorrow. The pathologist is inexperienced and dare not issue a report."

Director Tan is very experienced, taking pathological specimens is a necessary process, how could he make low-level mistakes.

Specimens are not taken for pathological examination only when tumors are considered. Pathological examination can also provide a lot of information for such tissue necrosis to confirm the diagnosis.

It's just that as an orthopedic surgeon, he doesn't know how to read pathological slides, otherwise Director Tan would personally go to the pathology department and read the pathological slides by himself.

To make a clear diagnosis, medical history collection is the front-end work, while pathological examination is the last work.

Now that the director of the pathology department is out, the doctors under him dare not issue a report, which means that this disease is still relatively rare, but everyone is a clinician, except for reading a few slices while studying, the contact with the pathology department after joining the job is the application for pathology examination The bill and the pathology report.

Doctors in the pathology department and clinical departments usually only hear their names, but don't know them.

"Then we can only wait until tomorrow to see what the pathology report is." The director of the general surgery department was also helpless.

And even if director Guan comes back, it may not be able to play a role in promoting.

"Shall I go down and look at the pathology slides?" Yang Ping decided that the pathology examination was a breakthrough.

Will you look at pathology slides?Will clinicians look at pathological slides?Don't be funny, okay?

Everyone looked at this young talent and didn't know what to say.

"Let's go down and see."

Yang Ping whispered to Song Zimo and Xu Zhiliang next to him, anyway, after the operation, there is plenty of time, since it is a discussion, everyone should think and act according to their own ideas, and finally gather together.

The two generals nodded. At Yang Ping's request, they often went to the pathology department to look at the slides.

"Why don't we continue discussing, let's go to the pathology department?" Yang Ping asked Professor Zhang to leave temporarily.

Professor Zhang agreed: "Should you go and have a look?"

Yang Ping, Song Zimo, and Xu Zhiliang left temporarily, and the pathology department was in another building, which was full of auxiliary departments, such as clinical laboratory, imaging department, pathology department, electrocardiogram, etc.

The three of them rushed to the pathology department without wasting time.

Doctors have a natural interest in difficult and miscellaneous diseases, so the three of them feel a little bit like a chicken blood, and of course the fatigue of a day's operation is gone.

The pathology department does not need to be on night shift. The three rushed to the pathology department, and the department was already about to close.

Dr. Wen, the last doctor to leave the scene, was about to turn off the lights and lock the door, watching the three men come over aggressively.

Dr. Wen subconsciously blocked the door and took a closer look: "Professor Yang? Dr. Song? Dr. Xu?"

"Who are you?" Dr. Wen was very surprised.

"I'm sorry to delay you from get off work. We want to come over to see a patient's pathology slide?" Yang Ping hurriedly said, it's very embarrassing to delay his get off work.

"Oh!"

Dr. Wen opened the door and turned on the light, and welcomed the master of Sanbo Hospital into the office. At this time, the pathology department was empty. The examination room, microscope examination room, immunohistochemistry, etc., all the studios were empty, and the computer was turned off. .

Dr. Wen was very happy to hear that the three of them came to see the pathology slides. He usually likes to fiddle with the pathology slides by himself, and he is very interested in these boring things.

Wouldn't it be wonderful if you have similar interests now!
The pathology department is a lonely Qingshui yamen, with no money, and very lonely. The doctor of pathology is even more lonely and lonely. He looks at the slices under the microscope all day long, and his eyes hurt all day long. Cells are in his eyes all day long. When I get off work, I see pedestrians on the road with colorful cells all over their bodies.

"Which patient?" Dr. Wen turned on all the lights, and then turned on the air conditioner.

"Trauma orthopedics, Zhang Tiejun!" Yang Ping announced his name.

Xu Zhiliang sent a small note with his name and hospital number written on it.

"Zhang Tiejun?"

Dr. Wen became more interested. He immediately picked out several pathological slides of Zhang Tiejun from the storage box, and carefully placed one of them under the microscope.

"Professor Yang, Director Guan said that you not only know how to read pathological slides, but also have a very high level. I don't believe it. In China, surgeons can read pathological slides. I have never encountered it. You are here for this patient. Then you Take a look, what is this?"

Dr. Wen was sitting next to him, like an examiner waiting for Yang Ping to look at him, and his words were not pleasant.

Fortunately, Yang Ping, Song Zimo, and Xu Zhiliang are also academic men of the same kind, and they are not so particular.

This guy has been studying this slice for a whole day and figured out what it is. He just waited for Director Guan to come back tomorrow to send a report. Because it was too rare, he had to wait for the director to sign it before sending it.

"have a look?"

Yang Ping was also polite, and sat down in front of the microscope.

Dr. Wen pointed to the slice: "Look!"

It's like the prelude to a fight between two hooligans: two strokes?Over two strokes!
Just take a look, the slides in the system space are worthless anyway, I don’t know how much I saw at the time, this is the basic skill.

Dr. Wen crossed his legs and worked for so long, and it has never been so fun.

Yang Ping adjusted the microscope and began to look at the pathological slides.

This is a multi-head microscope. Xu Zhiliang and Song Zimo are also sitting beside the microscope and come into view.

The multi-head microscope is convenient for teaching and discussion. Everyone can see the same field of view through different eyepieces around the microscope.

Under a microscope with a power of [-] times, Yang Ping is carefully observing the enlarged cells.

Looking at pathological slides is a test of patience. You must be able to calm down and read slowly to find out some characteristic changes of cells.

For example, the nuclei, the nuclear membrane and nucleolus can be seen under the light microscope, and their shape, position, size, staining, etc., are the basis for judgment.

The vision under the mirror is like an abstract picture, and only those who understand pathology can see the mystery.

"Old Wen, why don't we - have a bet?" Xu Zhiliang moved his eyes away from the eyepiece and put his arms around Dr. Wen's shoulder.

Song Zimo attacked from the other side: "Yes! Looking at you like this, it seems that you already know it?"

"What's the bet? If Professor Yang can diagnose this pathology section, I'll run around the hospital three times topless?"

"Why don't you say you're naked? Are you clueless?" Xu Zhiliang challenged.

Nude?

Dr. Wen is a little timid. Professor Yang's reputation in Sanbo Hospital is a demigod. If he really sees it and runs around naked for three times, will he still be a human being?
It's not that I don't have confidence in my own diagnosis, but that Dr. Yang is a little confused, amazing!

"Old Wen, you actually know how to play tricks. You said you ran three laps topless. Look at the morning joggers in our hospital. Many of them are wearing shorts and running topless. What kind of a gamble is this?" Song Zimo said in a contemptuous tone.

Dr. Wen was very anxious: "I'm topless and running in briefs, not even swimming trunks or boxers."

"Red underwear? Triangular ones? How about it, do you dare?" Xu Zhiliang asked forcefully.

Yang Ping over there kept frowning and sighing.

Dr. Wen took a look at Yang Ping's embarrassed look, and spit out like a nail: "That's it, there is nothing you dare not bet on."

"Well, are you ready, what time?" Song Zimo asked again.

"It's when I get off work for lunch at noon tomorrow." Dr. Wen went all out.

"it is good!"

"Then what if you lose?" Dr. Wen's disdainful eyes were full of confidence.

I don't dare to brag about other things, I still have a few brushes in pathology, and amateurs can't always be professional.

"Follow you?" Song Zimo was very relaxed.

Dr. Wen raised Erlang's legs higher: "If you lose, at the next hospital meeting, when you two see me, call Teacher Wen three times loudly and respectfully?"

"It's a deal!" Song Zimo agreed.

It's really fun, Dr. Wen stretched his neck: "I, Wen Ruzheng, can tell from my name, I promise what I say, and I am a gentleman!"

Yang Ping was still looking at it, because the slices were not one piece, and many specimens were taken.

"It's really not that I make things difficult for you. Not to mention your amateurs, you are doctors of pathology. This section may not be able to see it unless you have special training for this kind of situation." Dr. Wen leaned back in his chair, full of confidence.

This kind of disease, Sanbo Hospital probably encountered this one in more than ten years, Yang Ping can really see that I really ran around the hospital three times in underwear.

The more Dr. Wen thought about it, the more confident he became.

These pathological slides are very standardized. They are taken from painless parts and depths, including skin tissue, fascial muscle, and muscle tissue, some just changed, and some completely necrotic.

Although Director Tan does not know how to read pathological slides, his medical literacy is indeed very high. Generally, surgeons are not so strict in taking pathological materials.

Yang Ping read all the pathological slides and did not miss any changes.

The pathological manifestations of the right hand and right hip under the microscope were similar: the skin, fascia and muscle cells were all necrotic and disintegrated in large quantities.

The bone marrow sample obtained by the puncture of the greater trochanter of the right femur showed that all the cells of hematopoietic tissue disappeared.

The bone marrow samples obtained by puncture of the right radius and distal ulna showed that all the cells of hematopoietic tissue disappeared.

Bone marrow puncture in the necrotic area of ​​the left upper limb and left lower limb showed that a large number of cells of various lines of hematopoietic tissue disappeared to varying degrees.

There was extensive necrosis and diffuse hemorrhage of the local skin and skin appendages, subcutaneous tissue, and skeletal muscle of the left thigh, but the arrector pili muscle in the dermis remained.

A large number of vacuolar degeneration and necrosis of the epidermal cells of the left fingers and palms, and the formation of vesicles of different sizes, resulting in the separation of the epidermis from the dermis, diffuse hemorrhage in the dermis, neutrophil infiltration, degeneration and necrosis of sweat gland epithelial cells, and subcutaneous tissue Diffuse internal hemorrhage, a small number of fat cells necrosis.

Thanks to Director Tan's good medical literacy, these pathological slides are very good, covering almost all lesion areas.

Although Director Tan didn't know what kind of disease it was, the inspections he arranged were very strict, especially the pathological slides, and the bone marrow puncture of several parts did not leak.

After reading all the slices, Yang Ping had a rough answer in his mind.

"How?" Dr. Wen was a little nervous.

Yang Ping didn't speak, his expression was serious.

Dr. Wen was completely at ease in his heart, and he didn't see anything.

"Look at it!"

Yang Ping asked Song Zimo and Xu Zhiliang to take a look at it too. It was a rare opportunity for such a relatively rare case.

The discussion in the Department of Traumatology and Orthopedics continued, and Professor Zhang called Yang Ping to ask how the situation was going.

Yang Ping said that they would go up later, they already had an answer, and asked Professor Zhang not to adjourn the meeting.

Have an answer?

Dr. Wen panicked, but Yang Ping didn't speak.

"Dr. Wen, can you go with us to the Department of Traumatology and Orthopedics later? This case is being discussed over there, so you can just talk about the pathology." Yang Ping invited Dr. Wen to go with him.

Dr. Wen readily accepted, as long as he talked about pathological knowledge, he could do it for three days and three nights without repetition.

"You should know it in your heart, right?"

Yang Ping asked Dr. Wen.

He was full of air: "Of course, I'm going to write a paper."

"That's good, I won't say it later, let you say it." Yang Ping's expression was flat.

That being said, you can also see the name, whether it is true or not, Dr. Wen has doubts in his heart.

"You just look at the pathology slides all day, and you don't hear anything outside the window. For such a big event, you have already made a clear diagnosis, but you don't issue a report, and you are going to close the door and go to get off work?" Yang Ping was very dissatisfied.

Dr. Wen was at a loss, not knowing what Yang Ping meant.

"How about it? Did you see anything? Time is tight. We'll go back to the Orthopedic Traumatology Department right away. If we really don't see it, we'll look back. You probably haven't seen this kind of slice, but I seem to have mentioned it to you," Yang Ping urged. two people.

"You are as timid as a mouse. Your director will not return for a few days, and you plan to not issue a report for a few days? Do you know that people may continue to be victimized during this period?" Yang Ping sullenly.

Dr. Wen's heart skipped a beat, his hairs stood on end, why didn't he think so much?
Not only has Yang Ping seen what the pathological diagnosis is, but he is also more responsible than himself.

I usually just guard the microscope and be responsible for the pathological slides, and never think about other things.

PS: It has been modified, thank you everyone!At [-] o'clock this afternoon, the best-selling selection and recommendation on the starting point client, I implore everyone to give more votes and encouragement!Bow and salute!

(End of this chapter)