The cases discussed in each department are generally roughly reviewed by showing movies on the big screen, so that everyone can know in their hearts.

Then, in order, one case at a time, the details are discussed.

The members of the expert group in the front row are all old and stubborn, and they are known for their academic rigor, which makes the young doctors in the back have a strong sense of pressure.

For some difficult cases, all departments should send people to participate, and the departments with strong relevance participated in the speech, and the unrelated departments could also open their eyes by listening to others' speeches.

This kind of discussion is relatively preferred by physicians over surgeons.

The level of the surgeon is high, and he mainly competes in surgery, and is not very interested in the scene of moving his mouth.

However, internists are different, and internists prefer to reason about incurable diseases, and the more difficult it is, the more level it is displayed.

The surgeon looked at the film, and in a word: surgery!

In the face of diseases, internists cite a wide range of information, from basic to clinical, from textbooks to cutting-edge papers.

Internal medicine and surgery are two ends of the same coin, but I don't know when it started, and they despise each other a little.

The physician thinks that the surgeon knows about surgery all the time, and he can't even look at an electrocardiogram.

The surgeon thinks that the physician cannot cure any disease, unlike the surgeon, who simply moves the knife with his hands.

So, this mix of medical and surgical cases is very interesting.

In particular, there are areas where medical and surgical intersections, such as some tumors.

Surgeon: So much nonsense, cutting is, removing the tumor, doing a lymph node cleaning, how can it be good if it is not cut.

Physician: Just know what to do! All the organs of the whole body are cut off for you? Don't be in a hurry, let's take our time to treat, chemotherapy, radiation, see which one is sensitive, first the last wave, then a targeted therapy, and finally what biological therapy and immunotherapy will assist and adjuve.

The experts organized this kind of mixed discussion to avoid everyone from falling into a fixed mind, and the medical and surgical departments communicated with each other, and many incurable diseases appeared to be open-minded.

ENT patient, 64 years old, female, left sinus foreign body remaining, the diagnosis is clear, as for how the screws to fix the denture "smuggled" past, I don't care for the time being, the treatment method: find neurosurgery cooperation, and take out the screws.

Urology patient, male, 36 years old, yinjing continued to have an erection, after the fever a week ago, various drugs were ineffective, the erection could only be eliminated by spinal anesthesia, and once the anesthetic passed, there was a tendency to erection, in order to avoid causing necrosis of the cavernous body, the Department of Urology asked the anesthesiology department to install a pump for spinal anesthesia and continue to carry out anesthesia.

In this case, the urologists are purely here to find a sense of existence, they have already obtained the diagnosis themselves, and they are here to discuss, but to share with you the process of their diagnosis and treatment.

There are many fewer incurable diseases in surgery than in internal medicine, so such cases are taken out to raise the surgical line.

"Director Cha, tell me your opinion."

Director Lu of the Department of Urology named Director Cha of the Department of Nephrology.

Although he is also an expert in sewerage, he is still good at urology in the area of male function.

Nephrology is mainly for the medical treatment of kidney diseases, such as uremia.

Hitting the shortcomings of the other with one's own strengths is a routine that both medicine and surgery like to use.

Director Cha pondered for a moment: "Have you taken any medicine recently?" ”

"Nope!"

"Have you checked male hormones?"

"Normal!"

"How's the blood picture, consider sickle cell disease?"

"This aspect has been checked, ruled out!"

"Does Yinjing have a blood clot?"

"Nope!"

Director Cha was also a little embarrassed, thought about it and said, "Is there a magnetic resonance of the spine column?" Whether to consider spinal cord injury, such as tumor invasion. ”

Director Lu, who has always been full of confidence, was suddenly discouraged: he was broken! It is caused by a spinal cord tumor, which causes the spinal cord center to be overexcited.

There is also a famous saying in diagnostics: the rare manifestations of common diseases are far more common than rare diseases.

In fact, making a diagnosis of a disease, like breaking the eucalyptus, is a process of logical reasoning, grasping the symptoms and signs and auxiliary examinations, removing the false and retaining the true, peeling back the cocoon, and revealing the truth step by step.

The Department of Nephrology also showed its own case: male, 48 years old, considering renal bone disease, appeared 15 years ago with double kidney stones, took eight stones, and the stones were taken and long, 7 years ago because of kidney failure caused by kidney stones for hemodialysis, and then felt bone pain all over the body, getting worse and worse, and gradually appeared joint deformity, visual model lake, tooth loss, subcutaneous induration and other symptoms.

There are also several patients in the family who resemble kidney stones, one of whom died of uremia at the age of 10 due to kidney stones.

Physical examination showed that the patient's eyesight was reduced, multiple teeth were missing, the skin of the limbs was induration with pigmentation, the nails of the hands and feet were deformed, and the joints between the fingers, between the toes, ankles, knees, elbows, and shoulders were enlarged and deformed. Slit-lamp examination revealed calcium salt deposition around the cornea of the left eye. CT abdomen shows nephrocalcinosis in both kidneys. On X-ray, it was found that the phalanges were extensively destroyed, the epiphyseal was dense, and the soft tissues at the ends of the fingers and toes were calcified.

Director Zha and Director Lu are both doctors, both are engaged in academics, and they are keen on this kind of technical competition.

You can slap the table behind closed doors, and when you walk out of this door, everyone is a good brother.

"What do you think, Director Lu, what do you think?" An old expert in internal medicine in the expert group deliberately provoked trouble.

Director Lu stared at the screen and looked at the medical records, operating every day, who knows what kind of disease this thing is, the debate between the knife and the pen is congenitally insufficient.

After holding back for a long time, Director Lu didn't look out of the door.

Director Cha's case is a real incurable disease, and the papers have been written by graduate students and are ready to be published in the New England Journal of Medicine.

Surgical veteran, you have to be able to see that I am the director when you are the director!

Director Zha sneered in his heart.

"What do you think, publish it?"

The old expert in internal medicine stood up and shouted.

The director of the Department of Urology is all here, how can we see that the Department of Urology and Nephrology are still somewhat related.

"Orthopedics?"

The old expert's eyes turned around and saw Yang Ping behind Professor Zhang: "Professor Yang of the Department of Comprehensive Surgery, you can talk about it." ”

How can there be such a name, if you can't say it, listen to the face.

The brothers of the surgeon complained about Professor Yang.

Yang Ping actually paid attention to this case just now, because it was really interesting.

Director Cha, Ph.D., has been a visiting scholar in the United States for a year, and he is still very popular.

"Professor Yang, let's talk about my opinion!"

Yang Ping got up, you pulled me out to break your golden bell jar by yourself, not my initiative.

"The skin biopsy showed a large amount of calcium salt deposits, and when viewed with a polarized light microscope, it is estimated that a large number of diamond-like crystals can be seen to deposit calcium oxalate crystals, focusing on primary hyperoxaluria, and further genetic testing, if so, there may be heterozygous mutations in the AGXT gene."

One in a million to three possible rare diseases, kept secret for so long, just to pretend to be forced at the hospital meeting at this time, and was broken by a few words from you?

Surgery pulled a game back.

Director Cha instantly restrained his smile, is this okay?

Yang Ping looked at the time, there was still something in the department, and he was leaving, and there were still several doctors in his department.

———

Two weeks have passed.

The list of international clinical trial bases for the new technology of chiropractic orthopedics will be announced immediately, and there is only one place, and the University of Tokyo Affiliated Hospital is the most prepared, and the identity of the first brother of the New York Special Surgery Hospital is the most conducive to the promotion of the new technology to the world.

And the conditions given by the Germans are the most tempting, what kind of duke fund, it is 100 million euros at every turn, and money is such a thing, as long as it is legal and reasonable, the more the merrier.

In the conference room of the General Surgery, everyone gathered around the conference table, and August, Robert, and Takahashi were very nervous.

This base of cooperation is very important to them, although for different reasons.

Yang Ping didn't speak, Song Zimo exchanged glances with Yang Ping, and took out an agreement from his bag.

There is still something else, you should hurry up and take it out for others to sign, Yang Ping urged in his heart.

Don't be in a hurry, usually you always pretend to be forced, I will be the foil, this time you will be the foil, Song Zimo is not in a hurry.

"Dr. Robert!"

Sure enough, it was me, and Robert was relieved that the trip was successfully completed.

"Congratulations to New York Special Surgery Hospital for becoming our clinical trial base, you look at the agreement." Song Zimo handed over the agreement.

The Americans took the agreement and began to look at it line by line, with a smile on their faces.

The Japanese and Germans, on the other hand, were so disappointed that they shook hands with the United States and said that after celebrating, they would have to fight again the following year.

After reading it, Robert signed, put away the contract, and was in high spirits.

Song Zimo slowly took out another agreement from his bag: "Doctor Takahashi, in view of the very thorough preparation of the Affiliated Hospital of the University of Tokyo, we have specially added a base to you, congratulations!" ”

The feeling that Takahashi had lost and regained, August's heart was sour, he was like a candidate who made a mistake in the assessment of the college entrance examination, and found that the real score was much lower than the estimated score.

Song Zimo was unhurried: "Congratulations to the two!" ”

"But Mr. August, you don't have to be discouraged, because of your sincerity, we have increased the number of places again, and the Harrachen Orthopedic Hospital is the third base."

Song Zimo slowly took out the agreement from his bag and pushed it in front of Auguste.

August couldn't believe that he didn't fall off the list and finally got this base.

The overseas layout of the lateral external fixator of the spine column has been completed, and if new technologies are launched in the future, these three bases will also be borrowed to go to the world.

——

Yang Ping was already preparing to go to Europe, and August asked Marcus to actively prepare.

The spiral-shaped model of the spine was placed on the desk, and Yang Ping stared at the model and fell into thought.

This is a tricky orthopedic curve because of the spiral shape of three-dimensional space, and the orthopedic needs to be considered from three levels, and the factors considered are more complex.

For example, the heart and lungs of the thoracic cavity, the gastrointestinal tract and the internal organs of the abdominal cavity, because they have been adapted to the deformed space formed by the spiral ridge column for more than 20 years, and now they have to be corrected, and those complications will occur after surgery.

At present, the digital medicine laboratory of Nandu Medical University can only model simple chiroplasty, and cannot take into account the concurrent impact of thoracic and abdominal organs.

And machines don't have the imagination to solve problems creatively.

That is, the computer can only solve the problem within the existing framework, and cannot solve the problem creatively.

With the orthopedic spine of the spine, all soft tissues, which can tolerate stretching and which cannot be tolerated, indicate that the tissues that can tolerate need to be released in advance, and these should be considered.

If this spinal column deformity is successfully orthopedic, the external ridge fixator will be virtually pushed to the top of the world.

To do the best orthopedics, it is necessary to obtain a thin-slice scan of all organs, from the neck to the chest and abdomen, and then reconstruct the morphological position of the internal organs, as well as all the surrounding adhesions.

In this way, it is possible to demonstrate the changes in the position of all organs during the orthopedic process and to measure the extent of their adhesion stretching.

Therefore, this spinal column orthopedic is no longer as simple as considering the deformation of the spinal cord, but also considering the changes associated with many organs.

Otherwise, it is easy to cause unpredictable complications.

Yang Ping constructs these diagrams in his mind, and then tries to simulate the spinal column orthopedics, which are accompanied by changes in the organs, although the orthopedic process is slow, but this change can also produce complications.

For example, whether the aorta will be torn, and whether the heart will break through a certain threshold due to changes in external pressure, and acute heart failure will occur.

This is also the reason why all the top doctors in the world, including Auguste, dare not operate.

The more deeply understood the doctor, the more he knows the terrible consequences.

This patient's cardiac function is graded as grade 4 and worst, and he is basically unable to perform any activities, and may cause significant discomfort such as wheezing and dyspnea when sitting or lying down in a resting state.

In orthopedic procedures, disturbances to cardiac function should be considered.

"Doctor O"

Yang Ping pushed open the door.

Auguste, who got the contract, was obviously much more relaxed, and he came running in a hurry.

"Have your patient do the most detailed thin-slice CT scan, starting from the base of the skull and going all the way up to the coccyx, with the thorax and abdomen in the middle being the focus, and I want to know the morphological position and state of all the organs, and then do an anatomical and functional MRI."

Yang Ping instructed Auguste.

August was very positive when he heard that the professor was worried about his case, which meant that the professor was preparing for a trip to Germany.

In the doctor's office, the intern, a fan of Qin Xiaowei, held a mobile phone and surrounded several people.

"Brother Xiao Wei has to climb the rock wall of more than 900 meters with his bare hands, you see, like a knife, it's so dangerous, it's similar to the Chief Rock that Alex climbed, it's such a dangerous rock."

"He has even signed an agreement for organ donation, and this time he is ready for everything."

"It is said that the insurance company did not dare to insure, and in the end, the subsidized advertiser promised that if something happened, there would be a huge amount of compensation."

"In the past, those were pediatrics, but this time it was really a big move, and now this matter will be quickly pushed to the hot search, and then the whole network will be broadcast live."

"It is said that the shooting is not a drone, it is the shooting team to follow, these photographers are all rock climbing masters, they hang on the rope, and they have been shooting with Brother Xiaowei, it is really exciting, my heart is beating now."

"If you fall down, you won't be saved, there's protection down there, right?"

"There is no protection, no pitons can be played on the rock wall, no mats can be laid on the ground, and Xiao Wei Ge refuses to bring a parachute, saying that carrying a parachute bag reduces his physical flexibility."

Yang Ping saw several interns gathered together.

The intern looked up and saw Yang Ping, very nervous, Yang Ping said, "I'll take a look!" ”

The intern handed over the mobile phone, this is a promotional video of the heat before freehand rock climbing, it is the editing of several videos of "Extreme Thief", "Freehand Rock Climbing", and then a close-up of the cliff that Qin Xiaowei is preparing to climb, indeed, this kind of precipitous cliff, just looking at it makes me nervous, let alone climbing.

The promotional video of Hollywood is like a blockbuster, and at the end of it is a few big words: Surface Warriors!

For this kind of outdoor extreme sports, Yang Ping can only express respect!

They are challenging the impossible in another way.

The first is the latest.