Back in 2002 as a doctor

Page 470

Chapter 0807 Medical disease requiring surgery

Director Tang of the Respiratory Department first bowed respectfully to Mr. Huang after speaking, and then turned sideways to get out of the way.

"Is there any intractable disease?" Elder Huang asked gently.

Director Tang was taken aback, not knowing how to answer in embarrassment.

"Director Tang, the boss likes to see patients with difficult and miscellaneous diseases, and has rich clinical experience in this field. Feel free to tell me what is difficult to diagnose." Zhou Congwen smiled.

Director Tang glared at Zhang You, then bowed and said, "Old Huang, there is indeed a patient with a problem, not from our department. The patient lives in the kidney because of kidney failure."

Huang Lao nodded slightly, and stood on the spot with his hands behind his back.

"The patient had a chest X-ray, and the report was very strange—multiple cloud-like high-density shadows in both lung fields. Further examination revealed multiple snowflake-like high-density shadows in both lungs on chest CT."

"So the Department of Nephrology asked me for a consultation. I didn't understand it. I asked Director Zhang to discuss it together to see if it was a tumor and whether it was possible to have a thoracic surgery."

Director Tang's voice became smaller and smaller. Obviously, she also knew that the theory of surgery could disgust Zhang You, but she definitely couldn't justify it in front of Mr. Huang.

Sure enough, Zhang You said in the next second, "It has nothing to do with our thoracic surgery department. It cannot be treated with surgery. Director Tang, you still come to me. This is a bit too much."

"I took a look at the film, and it really doesn't necessarily have anything to do with surgery." Huang Lao suddenly said lightly.

"..."

Zhang You looked at Huang Lao dumbly.

The diffuse high-density shadow in both lungs, whether it is a tumor or something else, definitely does not belong to the surgical management.

Taking a step back, it is really a tumor - multiple high-density shadows mean that metastases have occurred and surgery is inoperable.

Moreover, Zhang You didn't think it was a malignant tumor after seeing the film.

Seek rheumatism and immune consultation for this kind of weird disease, just know that if you have a headache, treat your head and feet, and treat your feet, so ask yourself to do something!

So Zhang You hung up Director Tang's three calls today, not wanting to talk to her at all.Zhang You thinks menopausal women are really difficult and unreasonable.

But he never expected Huang Lao to say this.

"When encountering clinical difficulties, don't worry about arguing, and talk about it after you understand it." Huang Lao said leisurely, "Director Tang, right?"

"Yes yes yes." Director Tang said a series of yes words.

"Then you take me to see it? From your description, I think it may require surgery to treat it."

"Old Huang, wait a moment, I'll go get the film."

Zhou Congwen immediately said, "Let's go and see the patient, or else we'll have to make trouble."

Director Tang was a little dazed, she never expected that Mr. Huang would be such a "good thing", and she never thought that Mr. Huang would give such an unreliable statement that he could have surgery.

This is a bit of a joke.

But out of respect for the seniors in the medical field, Director Tang didn't dare to say anything, so he could only respectfully take Huang Lao to the nephrology department.

Zhang You was very puzzled. He looked at Huang Lao's back and his mind was confused.

Lao Huang will definitely not be confused. It is said that Zhou Congwen brought a bunch of new equipment for one-stop bypass surgery this time. In addition, Zhang You witnessed Huang Lao's improvement of the classic crush surgery not long ago, so the option was directly ruled out.

The problem now is patient data.

Zhang You had watched the film carefully, and he knew very well that it had nothing to do with surgery.

Director Tang also didn't have a good Chinese New Year, plus menopause, so he insisted on pulling himself to understand the illness.

It has nothing to do with surgery. What do you do with yourself?

However, Mr. Huang said something that Zhang You didn't expect - surgery may be needed for treatment.

Impossible, Zhang You fell into a state of chaos in an instant.

On one side is Huang Lao, the supreme authority in cardiothoracic surgery, and on the other side is his own years of clinical experience.

The two collided with each other, no sparks were produced, but Zhang You's head was hit so hard that he couldn't think, he even walked in a trance, and he narrowly missed hitting the door.

"Director Zhang, slow down." Deng Ming held the thermos cup in one hand, and supported Zhang You with the other.

"Director Deng, I'm sorry." Zhang You was extremely embarrassed, and quickly explained, "I was thinking about what Huang Lao said just now."

"Oh, go see the film and then see the patient." Deng Ming said lightly.

"Director Deng, I can assure you that no surgical treatment is possible, but..." Zhang You said hesitantly.

"Hehe, that's not necessarily true." Deng Ming smiled, obviously he knew what Huang Lao meant.

Zhang You was stunned for a moment.

If Mr. Huang had Alzheimer's disease, it was absolutely impossible for Deng Ming.

Deng Ming and Zhang You are almost the same age, when they are in the prime of life...but it doesn't make sense.

Zhang You fell silent, and he followed suspiciously, carefully thinking about his own situation when watching films and seeing patients.

In the end, Zhang You determined that the patient definitely did not need surgery!

But Zhang You is not stupid, this kind of questioning of Huang Lao's face-to-face will definitely not be said.Thinking of later, Zhang You even admired Deng Ming.

This kind of impostor, black and white is really thick-skinned, no wonder he can be the director of cardiothoracic surgery of 912.

When he came to the Department of Endocrinology, Mr. Huang watched the film first.

Zhang You also took a look at the film by the way, and confirmed his thoughts in his heart.

But at this moment, Zhou Congwen suddenly said, "Boss, your diagnosis is correct. I think the patient must be treated with surgery."

"..."

Zhang You was silent in his heart.

Ordinarily, people like Deng Ming and Zhou Congwen belong to technical talents, so the minimum level of shame is still required, the minimum level of aloofness is still required, and the minimum level of objective diagnosis is still required.

However, Zhou Congwen even pointed out that a deer is a horse, and recklessly followed Huang's old saying.

Zhang You felt that there was darkness in front of him.

"Don't rush to draw conclusions, just go to see the patient first." Mr. Huang changed into a white suit, bowed his hands behind his back, and was led to the ward by the director of the endocrinology department.

"Director Zhang, let me tell you that it has something to do with you."

"How is it possible!" Director Zhang Youtong Tang still had an idea, he lowered his voice and said, "If the patient has surgery, I'll eat up the medical records!"

"Tch, you speak as if you are very capable." Director Tang said, "Elder Huang and Zhou Congwen both said that."

"..." Zhang You closed his mouth at this time, and silently followed behind to see the patient in the ward.

The confusion in his heart became more and more intense, and Zhang You even felt that the whole world had changed color, completely opposite to the world he knew.

When he came to the ward, Mr. Huang rubbed his hands while asking a doctor.

With a very careful heart, Zhang You knew that Mr. Huang rubbed his hands to increase the temperature of his hands and avoid the patient's discomfort.

This also proves that Mr. Huang is sane.

Could this be a compliance test?Zhang You was taken aback for a moment, and a strange idea popped up in his mind.

But in the next second, Zhang You didn't see Mr. Huang taking out the stethoscope like a cardiothoracic surgeon, but...he lifted the patient's trousers up.

For a moment, Zhang You was shocked.

0808 - Calcification Defense

The patient had extensive skin ulceration and purpura on both lower extremities, and the surface was covered with black eschar.

Zhang You also had a physical examination before, but it was only auscultation and interrogation.A serious cardiothoracic surgeon who looks at a patient's thigh for nothing.

This is a male patient. If it is a young and beautiful female patient, it may be complained.

However, Mr. Huang looked at it without hesitation, and saw skin ulcers, purple spots, and black eschar covering the surface.

Although it can be seen that there must be a problem with the patient as long as he is not blind, Zhang You is still confused, completely ignorant of the relationship between the multiple high-density shadows in the lower limbs and the lungs.

"How long?" Huang Lao asked kindly.

"More than two months."

"Does it itch?"

"Fortunately, the broken skin and scab will be fine as long as you don't scratch it. But it hurts very much, and the whole body hurts." The patient asked a little confused.

Mr. Huang stretched out his hands to touch the skin of the patient's lower limbs, a few times with force, and then he said a few words of comfort and turned to wash his hands.

He didn't even have an auscultation!

Zhang You noticed the lack during Huang Lao's physical examination... In fact, it can't be called a lack. After seeing the patient's lower limbs with skin ulcers, purple spots, and black eschar on the surface, Huang Lao seemed to have come to a conclusion.

Is there any relationship between the lower limbs and the high-density shadow of the lungs?

No, absolutely not!Zhang You racked his brains to figure it out, but the answer was yes.

It is possible to have a heart attack, but the patient has double lung disease. Could it be the skin ulcer caused by insufficient oxygen?wrong!

Is it the skin ulcer caused by diabetic foot?Not right either!

Is it caused by parasites...

wrong!

wrong! !

wrong! ! !

Zhang You denied his diagnosis one after another.

Mr. Huang washed his hands slowly with the six-no hand washing method, wiped them clean, and returned to the office.

"I think the laboratory tests are incomplete, please check the blood calcium and blood phosphorus."

"No trouble, no trouble." Several directors said in a panic when they heard Mr. Huang's polite words.

Zhou Congwen pulled out a chair for his boss. After Mr. Huang sat down, he leaned over and asked, "Boss, it's the calcification defense."

"Yes."

Zhang You was taken aback when he heard this, and it was obvious that Director Tang was also taken aback when he heard the diagnosis.

The two looked at each other, seeing deep confusion in each other's eyes.

I must have heard it wrong, Zhang You sighed inwardly.

His son was playing a game called "Legend" recently, and what he heard every day was words like attack and defense.

Mr. Huang is an octogenarian, still thinking about playing games?And this is seeing a patient, and he can't forget to talk about it!

"Should I call a bedside ultrasound right now?" Zhou Congwen asked again.

"No need." Mr. Huang closed his eyes slightly, and said lightly, "wait for the results of the urgent investigation first, give it a quick reminder, it will be out in 20 minutes, don't worry. Just in case you miss it, the doctor in the B-ultrasound room will make an empty trip ,Why bother."

Zhang You was even more confused after hearing the conversation between Huang Lao and Zhou Congwen. He moved to Director Deng's side in doubt, and asked in a low voice, "Director Deng, what did Huang Lao say? Why didn't I understand?"

"Calcification defense, haven't you seen it?" Deng Ming asked back.

This time Zhang You heard the diagnosis clearly, the calcification defense...but as if he didn't hear it, he shook his head in embarrassment.

"It shouldn't be..." Deng Ming was a little strange, but he glanced at Zhang You with the gaze of a junior doctor, and smiled slightly, "Calcification defense is a rare disease, and it is a serious and fatal disease of chronic kidney disease, especially dialysis. complication."

"..." Zhang You was speechless.

"The incidence rate is very low, about one in 1. It is estimated that the provincial capital has not been in the dialysis machine for a long time. It may not be able to treat [-] patients in total. It is normal if you have not seen it, it is normal."

Deng Ming was very considerate and helped Zhang You bring a ladder and let them go down the ladder.

"What is that?" Zhang You was a little ashamed, but curious about Dasheng in his heart, he continued to ask.

The director of nephrology also came over, "Director Deng, is calcification defense a rare disease?"

Deng Ming nodded, but did not explain. He just said, "Let's wait for the test results and see the situation first. After all, it is not a definitive diagnosis."

Soon, the emergency laboratory test report.

Blood calcium was 2.29mmol/l, blood phosphorus was 1.68mmol/l, PTH was 686.7pg/ml, and hypersensitive C-reactive protein was 24.2mg/l.

"Almost, call a B-ultrasound to take a look." Zhou Congwen whispered to his boss.

"En." Huang Lao responded.