Yang Ping was resting in the duty room, no matter how noisy it was, he could still fall asleep, and this stunt allowed him to recharge anytime and anywhere.

When I woke up, there was a lot of fruit on the bedside, which was left by the brothers, and it was cleaned. Yang Ping ate an apple and washed his face. Remembering the case discussion at three o'clock in the afternoon.

At 2:40, Yang Ping arrived at the classroom, there were already many people waiting inside, Xiao Wu, Zhang Lin, and Fang Yan all greeted him, pointed to the empty seats that had been prepared, and motioned for him to go over and sit down.

The demonstration room is also the meeting room of the department, where case discussions take place. Except for emergency surgeries, they are required to participate, and the difficult cases and deaths of the week are brought out and discussed.

It's a rare learning process for young doctors, and it's a time for veteran doctors to showcase their talents. How the operation is, it is clear at a glance on the stage; What is the theoretical knowledge, the discussion of the medical record will be clear. At this time, everyone closed the door, quarreled with each other, kicked their noses and slapped the table, that was legal.

Song Zimo came in, sat next to Yang Ping, and whispered: "Last time, the premature baby, the blood vessels were too brittle, I got a birth mouse, brittle the blood vessels with drugs, practiced for many days, and now I can barely stitch it up, so I have time to guide it." ”

Yang Ping said in surprise: "You didn't take a nap at noon, practicing under the microscope?" ”

Song Zimo said: "Yes, your senior brother is not in vain, you must teach me when you have time." Next time there's a baby, let me do it, you're going to do it? ”

"Your senior brother is heavy enough!" Yang Ping said.

However, Song Zimo's talent and diligence are enough, and his mind is broad enough. This person has pride, but he can face the gap. It's a blessing to have such a colleague. Now, as long as he is free, Song Zimo will take the initiative to help Yang Ping's operation.

"Okay! Next time, I'll give you a table. Yang Ping said.

Song Zimo put his arm around his shoulder: "That instrument nurse, how is it, has there been any progress?" ”

Yang Ping's shoulders shook and shook off his hand: "Why are you so gossipy?" Don't look at what occasions? ”

Song Zimo said: 'I'm not a human being, as a senior brother, life experience must also be taught, and the means should not be hidden. ”

Yang Ping sneered and said: "Forget it, who doesn't know you Song Zimo, walking down the street and looking back and smiling, there are people who immediately have arrhythmia." ”

People have come in one after another, Director Han came in, Song Zimo got up, did a chest expansion exercise, walked to Director Han and sat down. He's Corey's secretary and has to take notes.

Everyone gathered together as a group to show that the classroom was crowded. Several big directors sit in the first row, each with a bottle of mineral water in front of them, and the doctor's office is a projector, and here is a high-definition screen.

"Let's be quiet, there are no deaths this week, there are a few difficult ones, let's take them out and discuss them, this week it's Director Ouyang's turn to start--"

The resident doctors in Director Ouyang's group began to report their medical records.

"XXX, male, 14 years old, recurrent pain and swelling of the joints of the limbs for 3 years, 3 years ago, no history of trauma, no obvious cause, pain and swelling of the left wrist joint, and then gradually developed to bilateral shoulder joints, elbow joints, right wrist joints, bilateral hip joints, knee joints, ankle joints, diagnosis and treatment in many hospitals--Anamnesis: 4 years ago, he underwent open reduction and bone graft internal fixation for the old fracture of the scaphoid bone of the left wrist, and the fracture healed, and no functional impairment was left --Physical examination: swelling and tenderness of the joints of the limbs--Auxiliary examination: bilateral shoulder joints, MRI of elbow, wrist, hip, knee, and ankle showed synovial swelling and joint effusion--"

After the resident doctor reported the medical records, Dr. Jin, the attending officer under Director Ouyang, added: "This child's family conditions are relatively good, he has traveled a lot of places, well-known professors from well-known hospitals across the country have seen a lot, and he has seen a lot of traditional Chinese medicine, Western medicine, internal medicine and surgery, but he has been swollen and painful, and now it is difficult to even walk normally, and he has seen many hospitals and has not solved the problem." Let's discuss how to determine the diagnosis and treatment. ”

Dr. Jin, the old doctor, is in his forties, not a few years younger than Director Ouyang, and according to his seniority, he should have been the chief physician. But he is rigid, never cheats, and so far he can't write a paper or get a topic, so now he hasn't even been the deputy chief physician. In fact, the real level, the complete chief physician level.

Dr. Kim added, several young doctors began to scratch their heads, this kind of atypical case is the most troublesome, the most testing of the doctor's diagnostic ability, it is precisely the diagnostic ability that is the surgeon's weakness.

There are a lot of orthopedic surgeons, and the X-ray is hung on the reading lamp: open the knife! Dorisso, why do you still use your brains to make any diagnosis, isn't it clear in the film? Diagnosing is the business of an internist.

"This case is taken out and discussed, it is very necessary, usually we treat these joint pain, some atypical cases, can not find the cause will be over, I always say, a surgeon should not only do a good job in surgery, but also have good clinical thinking ability, now let's discuss, what is the diagnosis of this patient, how to treat." Director Han said.

There are many diseases that cannot be found in medicine. Diagnosis is like a detective solving a case, based on medical history, physical examination and auxiliary examinations, according to a certain logical thinking, follow the vine and find the melon, and clarify the disease. There are cases that cannot be solved, and there are diseases that cannot be detected.

Usually, case discussions start with junior doctors and gradually escalate. In today's case, the junior doctor was confused and couldn't speak.

"Endocrine, metabolism, nutrition, blood, rheumatism, etc. have all been checked, as long as you want to get it, X-ray, color ultrasound, CT, MRI have all been done, and dozens of MRI have been done."

"There are all kinds of diagnoses, synovitis, rheumatoid arthritis, autoimmune arthritis, reactive arthritis, and there is a simple next diagnosis: incurable disease?" Dr. Kim saw that no one was talking, so he added it himself, so as not to be cold.

He is more knowledgeable, just like an old scalper, hard-working, Director Ouyang has a general like him, and he has not had an emergency operation for many years, and every time a major emergency operation is done by Dr. Jin.

"Reactive arthritis is a big basket, and if it can't be detected, it's called reactive arthritis, and this doesn't ask for a history of urinary tract or intestinal infection." Director Ouyang said.

"There are many transient synovitis clinical, and the cause cannot be found, which is indeed difficult to diagnose, otherwise others will not be angry to make a diagnosis of an incurable disease." Director Bai said.

"Did you take a synovial biopsy?" Director Tian asked.

Dr. Kim replied, "I did it in a hospital in the imperial capital, and the examination showed inflammatory synovial tissue. ”

Yang Ping half-squinted his eyes and leaned back in his chair, Song Zimo said, "Why don't you say a few words, don't you often win by surprise?" ”

Yang Ping listened, anyway, it doesn't take time to enter the system, in reality it is a momentary thing, and now psychologically he has adapted to this kind of switching, and he can enter and exit the system anytime and anywhere.

Opening the window and finding the newly added library function, Yang Ping clicked into it and entered the system space, where he began to desperately search for books, journals, and papers about these synovitis, especially rare, and even case reports.

Synovitis is actually a symptom diagnosis, not a cause diagnosis. Just like fever, many diseases can cause fever, and it is necessary to find the cause of fever and treat it.

Yang Ping thought to himself, the system is really tormenting, providing such a large library, it is better to directly help make a diagnosis, how easy, and then he can pretend to be chic.

It took so much effort to check the information, but fortunately, the retrieval function of the library in the system was relatively powerful, and finally many papers were searched, and one of them caught Yang Ping's attention.

Five years ago, an Austrian doctor wrote a paper published in the Journal of an obscure medical school, written in German. The function of the system is more intimate, and it can actually help translate papers.

The paper mentions that metal ion reactive joint synovitis is generally caused by internal plants in the body, such as steel plates, artificial joint replacements, and even metal dentures, because the joint synovium is sensitive to metal ions and produces an inflammatory response. This disease is extremely rare, Yang Ping searched it, and no one else really reported it except for this Austrian doctor.

This is interesting, Yang Ping studied the paper in detail, didn't this child have surgery on the right carpal scaphoid 4 years ago, and the X-ray showed that there were still metal screws left, could it be that the metal ions released by this metal screw entered the blood, and then deposited the synovial membrane of the joint, causing synovitis?

The child's symptoms were similar to those mentioned in the paper, but they were only hypothetical and there was no evidence. But after checking and checking, this is really the only one that is closer. After checking again, no suitable information was found, and Yang Ping came out of the system.

"Yang Ping, Song Zimo, what are you two hiding there doing, say a few words!" Director Han saw that everyone didn't speak, so he called the names directly.

Director Han named him, it's not inappropriate.

Song Zimo patted Yang Ping: "Senior brother, come on!" ”

Yang Ping secretly scolded this guy, at this time, the senior brother called sweeter than anyone else.

Catching the duck into the sedan chair, Yang Ping sat up straight, how could he not lose his identity in front of these brothers, so he looked thoughtful: "Well, this, I listened carefully to the medical records, considering that this is metal ion reactive arthritis, a very rare disease, and there are not many reports at present." ’

Metal ion reactive arthritis, no, I haven't heard of this disease, do you have this disease? There are no textbooks.