The road to the rise of great doctors

Chapter 14 The Trick of Fate

Liu Dong is very familiar with specialist physical examinations of the male reproductive system.

Not only because of the systematic study of theoretical knowledge in school, but also because of the detailed explanation by the teacher holding the model during the internship, and more because, after learning this, when there is no opportunity to practice, including Liu Dong Almost all the boys were a little worried about whether they might have a problem, so they secretly checked it many times by themselves, compared it with the map, and searched for a lot of explanations, and did not relax until they confirmed that there was no problem.

After that, the group of unmarried men also touched it a few times from time to time to check if there was any problem.

When examining the patient, Liu Dong touched it and found something different.

The lower part of this male patient was slightly hollow. After gentle palpation, he found that the balls on both sides were very small to the touch and soft in texture. The vas deferens on both sides could be touched and there was no induration, which was normal...

I asked the patient a few more questions and found out that he had never suffered from "mumps" (mumps) when he was a child.

Blood has been drawn for sex hormone testing and chromosome testing, and the results are expected to be received tomorrow morning.

I continued chatting with the patient and learned that he was an adult this year and had just gotten married. He was seeing a doctor with his wife because of infertility.

His wife went to the obstetrics and gynecology department of the fertility center, and he came to the urology department.

Liu Dong first affirmed the patient and said: "What you are doing is right. Both men and women may cause infertility. It is safest to look at it together."

Then with a few words of encouragement, the patient was allowed to leave.

Liu Dong and Wang Jie discussed diagnosis and treatment, and were about to separate and act separately.

Then I saw Song Wei, the attending physician from Wang Jie's group, walking in. He had finished the consultation and heard that there was a patient, so he came over to take a look.

After discovering that the patient had left, Song Wei said to Wang Jie: "You come and report the medical history, physical examination, and diagnosis."

Ward-round examinations like these often exist in teaching hospitals. The purpose is very simple. It is to see whether the intern doctors have mastered the disease knowledge well. If the answers are correct, the teaching teacher will also feel free to pass on some of the patient's materials and small operations. Wait for it to be handed over to her, but she will still pay attention to the doctor's instructions and operations.

But if it is the kind of "bastard" who always answers the wrong question many times, or doesn't know what to ask, then the teaching teacher can only consider himself unlucky, and dare not do anything except simple execution tasks. Hand it over and limit the authority of the intern doctors by doing everything personally and doing the work themselves.

There is no small matter in medical treatment. This is all summed up from many lessons and cannot be careless.

Wang Jie skillfully reported the medical history and physical examination results, as well as the preliminary diagnosis of "Klinefelter syndrome." However, regarding treatment, she only answered the general treatment principles.

Song Wei saw that Liu Dong was always beside him. After Wang Jie couldn't answer, he asked him directly and said, "I hear Xiao Zhu praising you every day. This is also a characteristic disease of our department. Please add some information."

Liu Dong said with a smile: "Teacher Song is overrated. Klinefelter syndrome is a chromosomal disease. The chromosomes of normal people are 46 XY. But the chromosomes of patients with Klinefelter syndrome have an extra X. Most of them are 47 XXY, and a few are 46XY/47XXY.”

"The egg is the male reproductive organ. In patients with Klinefelter syndrome, there are three types of interstitial cells (secreting androgens), spermatogonia, and supporting cells (secreting male germ cell regulatory factors) in the egg before puberty. Important functional cells undergo degeneration and apoptosis. Problems occur before adulthood. Except for a few chimeric patients who have a small number of male germ cells in their male secretions, most of these patients cannot find male germ cells. Naturally, you can’t have children.”

"You continue, what should these patients do if they want to have a baby? What should they do after giving birth?" Song Wei then asked, "I know you still want to develop in surgery. If you answer well, you can explain it to me. Ichisuke.”

Liu Dong quickly climbed up the pole and expressed his gratitude.Then he said: "The absence of male germ cells in male secretions does not mean that there are no male germ cells produced in the eggs. The site where male germ cells are produced in the human body is in the seminiferous tubules. The first line for patients with Klinefelter syndrome The hope is that the spermatogenic function may remain in this production site.”

"I have heard Teacher Zhu mention it a long time ago. Teacher Song, you are very good at micro reproductive surgery. You have found male germ cells for countless families with oligozoospermia and azoospermia, and helped them realize their dream of having their own children. It is called a miracle." Ours is the 'Guanyin Guanyin'." After Liu Dong answered the question, he continued to praise Song Wei for his much talked about deeds.

Song Wei was beaming when he heard this. After Liu Dong stopped speaking, he laughed at himself: "It's not as exaggerated as you said. They are all doing medical work and serving the people. Only people in the obstetrics and gynecology department can be called the 'Guanyin Guanyin'." We are also the 'misters of men's medicine', and we still call ourselves so."

After a pause, he continued: "What you said is basically correct. There are two more points that need to be added. First, the timing of the operation. Since you also mentioned that the 'hidden pearl' is hard to come by, then try to find it now and use it now." , the advantage is that if you use it directly, it has the strongest vitality and the largest quantity. If you don’t use it, you can only freeze the semen. The biggest advantage of using it directly is to avoid freezing the semen, because the frozen semen may lose part of its vitality and quantity when it is thawed.

"But the disadvantage is that the woman is also ready. If it can't be taken out, what should I do in advance? It may still not be able to take out the sperm after another operation, so you can apply in advance for volunteers to donate in the male germ cell bank, also known as sperm. If the donor sperm cannot be removed by surgery, the donor sperm will be used directly for in vitro fertilization; or the woman will freeze her eggs or waste one ovulation.

"Second, patients with Klinefelter's syndrome have chromosome problems. After surgery, they found male germ cells. So will IVF babies inherit this chromosomal abnormality? There is data on this, and it is theoretically possible. Yes, just like when his own parents had normal chromosomes, and then during the formation process, an extra chromosome occurred. But the probability is very small, the proportion is less than 5%. And the data also shows that most of the sexes found through the microscope Chromosomes are normal. Prenatal screening after pregnancy will also confirm whether there are chromosomal abnormalities. Therefore, patients should be informed of the benefits and risks, be prepared, and tolerate it once, without leaving any regrets."

Song Wei said with emotion: "It's fate that plays tricks on people. Doctors help open the ajar window when God closes the door for the patient."

Liu Dong and Wang Jie looked at each other and smiled: "Teacher Song, you are so talented!"

Song Wei coughed twice and said in a serious tone: "We are the in-laws department that has the closest connection with the reproductive center. The patients and family members of Klinefelter syndrome that I have dealt with before are generally not that overly pessimistic, and even a little more... Funny and humorous. Clinical work can be quite interesting sometimes.”

"Liu Dong, are you interested in studying for a postgraduate degree in andrology? Although the money is not much, it is quite interesting. This patient's surgery is expected to be arranged this Thursday. Then you can come and experience the microsurgery." Song Wei joked An invitation was sent to Liu Dong.

　I tried my best and saw that it was under review, and then I kept changing, changing, changing...so it was repeated.

　　After passing it, I deleted other duplicate chapters.
　　
　
(End of this chapter)