I run a clinic in the United States

Chapter 277: A small achievement of "A living person has no calculation" (please subscribe, please vote)

Zhou Qiao thought for a few seconds and suggested: "Let's do another MRI. I am considering cranial fasciitis, but further examination is needed to confirm."

"Cranial fasciitis? What disease is this?" Everyone looked at each other, having never heard of it.

Zhou Qiao said with a smile: “Cranial fasciitis is a rare non-tumor disease characterized by the proliferation of fibroblasts and myofibroblasts.

Its typical clinical manifestation is an isolated, rapidly growing, solid, painless mass on the scalp. The lesion sometimes penetrates the skull and invades the meninges, thereby triggering a series of site-related clinical symptoms.

On imaging, it usually appears as an osteolytic defect with or without a sclerotic border.

Because the local invasive nature and rapid growth of this disease are similar to some malignant tumors, it may be misdiagnosed. However, cranial fasciitis is usually regarded as a special type of nodular fasciitis. And the prognosis is often better, and recurrence is generally less likely after surgical resection. "

"It is different from general nodular fasciitis. Cranial fasciitis is generally located only in the scalp soft tissue or skull, and the vast majority of cranial fasciitis occurs in infants and young children, with no more than 10 cases in adults, among which It is more common in men, and the male to female ratio is about 2:1."

"This disease was first reported in the 80s, and there are only more than a hundred cases recorded around the world. It's not surprising that you can't recognize it."

"Its origin is not clear yet, but it is generally believed that it may originate from the galea aponeurosis, the loose connective tissue under the aponeurosis, the deep and superficial fascia layers, and the periosteum or fibrous membrane covering the surface of the bone suture or phylum."

"Some people have put forward a hypothesis that local trauma can promote the reactive proliferation of fibroblasts and myofibroblasts, and then lead to the formation of cranial fasciitis. In the currently reported literature, some patients do have a history of trauma or birth injury. , but most patients have no history of trauma.”

"In other words, the patient's small lump may have nothing to do with his fall. It was just a coincidence before and everyone was misled."

"Because this disease is very rare, there are few clinical cases and little experience, which leads to problems such as high missed diagnosis, high misdiagnosis, and difficulty in medication. It is not surprising that rare diseases are often called 'medical orphans.' It makes sense. You can arouse vigilance and not jump to conclusions easily, which is actually quite remarkable." Zhou Qiao said with a smile.

……

Listening to Zhou Qiao's eloquent talk, everyone felt ashamed and couldn't help but marvel and gave thumbs up: "How come Dr. Zhou is so knowledgeable and talented?"

"Yes, at such a young age, his profound knowledge seems to be greater than all of us put together!"

"Dr. Zhou is excellent! I have seen many geniuses, but none of them can compare to Dr. Zhou."

Zhou Qiao waved his hands modestly, thought for a while, and lied: "My teacher is an academician and a Nobel Prize winner! He also has research on the mechanism of this disease and once told me about it."

Yes, I blame Academician Domitri.

This is also the advantage of having a cheap teacher. If there is anything that cannot be explained in the future, Teacher Domitri will take the blame.Anyway, it’s impossible for someone to call me for verification, right?
Even if they want to make a phone call, most people are not qualified to do so.

Academician Domitri is not only a leader in academia, but also the richest among the rich. It is really difficult for ordinary people to interact with him.

Zhou Qiao's detailed explanation was recorded by a thoughtful doctor on his mobile phone, and then spread on the hospital's internal forum for everyone to learn from.Because there are still many doctors who have not arrived at the scene.

This is why Sequoia Hospital often listens to Zhou Qiao’s explanations, and has gained experience and formed a habit.

Of course, such "confidential" content, President Joachim Langrei has specifically stated that it is limited to internal communication within the hospital, and everyone must pay attention to confidentiality.

Some doctors from other departments gained some knowledge in this area after studying, and then organized the information on this case so that next time they encounter this situation, they will not miss or misdiagnose it.

When the test results came out, Zhou Qiao further confirmed that it was the disease. However, for final confirmation, pathological examination and immunohistochemical examination were still needed.

This requires surgery, cutting out samples, and sending them for pathological testing.

Anyway, no matter what, surgery is required.

If it were at the Iris Clinic, Murphy or Stephanie could do this surgery, but here, only Zhou Qiao does it himself.

He quickly formulated a surgical plan and then explained to the patient, such as the specific condition, the necessity of surgery and the general surgical plan, as well as the prognosis and a series of possible subsequent treatment measures, as well as various risk descriptions.

This is also what it should be. Regardless of the size of the operation, the risks must be clearly listed.

Then, the patient signs, and preparations for the operation begin immediately.

One advantage is that there are not many patients who need surgery at Sequoia Hospital now, and Zhou Qiao is in a hurry to leave, so he can arrange it immediately.No need to wait for a long time.

The patient called his family and his old mother rushed over to take care of him.

When everything was ready, the operation began.

Since it is a head surgery that requires debridement of the skull, this operation falls under the category of neurosurgery.

The patient's mother heard that it was a rare disease, cranial fasciitis. While she was waiting anxiously outside the operating room, she couldn't help itching her hands. She took out her mobile phone and searched for this strange disease. Then, she was shocked.

Of course, you cannot read the information on the Internet. A casual glance will reveal terminal illnesses, or various troublesome sequelae and complications.

For example, this mother searched for a picture of cranial fasciitis and almost vomited.The picture is so disgusting.

In addition, post-operative care is extremely complicated. It is said that if you are not careful, you will become infected and suffer other serious symptoms. In short, once you are caught by this disease, the consequences will be endless.

Little did she know that this was the action of Zhou Qiao, a top celebrity.

Zhou Qiao's debridement is a perfect level. Although cranial fasciitis requires different parts of the body and the techniques are different, Zhou Qiao's debridement is all-encompassing, clear and clear, and he is always able to draw inferences about other cases. , bringing forth the new from the old, so Zhou Qiao’s action will basically leave no sequelae or complications.

He usually does it all at once, without the need to enter the palace twice or three times.During the operation, a white, soft mass located on the skull surface of the patient's right forehead could be clearly seen.

Remove it and clean it thoroughly without damaging the important structures around the mass.

The operation was not smooth.

The assistant assisting at the side carefully put the tissue removed by Zhou Qiao into a sample bag and sent it for inspection.

It was about a small pile of gray and white mixed with gray and red, about 1.0cm × 1.0cm × 0.6cm. The red part inside was a little blood.

The cut surface is gray and solid, and the core is crisp.

The reason why it is a small pile of broken pieces instead of a whole piece is because it is broken into pieces when it is cut.

This is like archeology. When digging, you have to dig from the surface bit by bit and clean it bit by bit to expose the field.If you dig in all the way from the beginning, what if you injure healthy tissue?
After submitting for examination, the pathology laboratory expedited a microscopic examination.

Dr. Zhou is in a hurry to return to San Francisco. It is said that the air tickets have been booked, so how can he delay?Americans' inefficiency also depends on the occasion.In other words, looking at people.

Believe it or not, with just one word from the big boss, the people below will immediately start working overtime.Sometimes, the big boss doesn't even need to speak, and the roller kings below will start to curl up.

Wherever there are people, there are rivers and lakes.In the American workplace, if you don’t feel involved or involved in workplace struggles, it’s because you are unimportant and have not entered the inner circle.

Maybe most of the Chinese who go to study in the United States are academic talents and are not good at twists and turns, or they know it but don't like it.Those who are good at this stay in China.

In Luoya Group, many middle and high-level executives are African-American or Indian-American, but there is only one Chinese-American, Chen Zhining.

It's not that she doesn't want to use Chinese people. She even paid special attention to some Chinese people within the group because of Zhou Qiao's relationship. However, many of them are too "straightforward" and sometimes they don't even understand some of the "confrontation" and "confrontation" in the words. hint".Luo Ya could only give up.

Then, it is worth mentioning that Luo Ya negotiated with the Chinese delegation on nuclear power plant cooperation a while ago. Only then did she fully understand the Chinese people’s intentions and strategies, and realized that the real masters who are good at fighting are probably all in Chinese official.

The examination results of the case showed that the mass was composed of proliferating spindle cells, arranged in a disorderly manner, some in storiform pattern, with pale basophilic cytoplasm, elongated to oval nuclei, indistinct nucleoli, and myxoid degeneration of the interstitium. Hyalinous degeneration, no cellular atypia and pathological mitotic figures.Reactive osteogenesis is seen locally.

The brittle part is bone, or calcification.

免疫组织化学检测显示：梭形细胞呈平滑肌肌动蛋白和波形蛋白阳性，Calponin、bcl-2、CD34、CD99、S-100蛋白、SOX-10、STAT6、β-catenin、结蛋白阴性，Ki-67阳性指数10.7%。

After summarizing the data, it was naturally diagnosed as cranial fasciitis, which confirmed Zhou Qiao's previous judgment.

Everyone was not surprised, carefully studied the disease process information, and summarized their experience.

After the operation, the fat young man was transferred to the intensive care unit and the next day to the general neurosurgery ward.

During this period, nurses naturally followed the doctor's instructions to provide care, such as routine anti-inflammatory treatment with cefuroxime, checking calcitonin, routine blood tests, monitoring body temperature, blood pressure, heart rate, blood oxygen saturation, etc.

Discharge is just around the corner.

Because this case is special, regular follow-up visits are still needed in the future. Firstly, we should pay attention to the patient's health. Secondly, we should collect follow-up information and data to improve the disease course information.

As for Zhou Qiao, Luo Ya had already seen him off personally and took a flight from Houston to San Francisco.

After a long absence at Iris Clinic, Zhou Qiao finally returned.

The four girls were beaming with joy. When everyone looked at Zhou Qiao, they felt like they wanted to eat him.

Zhou Qiao felt a chill in her heart. Indeed, the four girls had been left alone at home for too long.After coming back, I have to make up for them.

However, with one against four, and the four opponents were Jiu Kuang, Zhou Qiao felt a little pressure.

Suddenly, at this moment, the system that had not appeared in my mind for a long time popped up the golden virtual panel again:

"Congratulations to the host, for achieving the small achievement of 'No living person counts'. Clinics and individuals have treated more than 1 people with critical illnesses, and the cumulative number of benefited patients has exceeded 10. As a reward, a level III transformation potion will be given to improve physical, mental, and all aspects of The attributes are further improved by 100%!"

Zhou Qiao was overjoyed and thought, 1 people? 10 people?Are there so many?

I couldn't help but secretly think that myself, Murphy, and Stephanie combined may have only performed about a thousand level [-] or higher surgeries in real life... Well, I guess the X-virus in East Africa has developed a vaccine and special effects. Medicines account for the majority.

The system pops up a dialog box again: "Since the Level III transformation potion is extremely precious, should the host exchange it for a physical substance, or should the drug be released directly into the body?"

Zhou Qiao: "Just release it."

Immediately, a wave of heat flowed through his body, and Zhou Qiao suddenly became energetic. He looked at the four women with confidence.

Now I can finally cope with it.I’m not afraid of you anymore!

The four girls, looking at Zhou Qiao's confident eyes and sunny, cheerful smile, suddenly felt their hearts beat with excitement and became extremely expectant.

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(End of this chapter)