After the preoperative examination of Linköping was perfected, all the results came out quickly.

A case discussion about her took place in the conference room, and Professor Deng from the outpatient clinic was also invited to participate in the discussion.

This is not a small, informal discussion, but a highly corroborated one, which is recorded by a person and finally put on file with the medical records.

Because this afternoon is the time for routine medical record discussions,

"Let's talk about this case because we're going to use a new procedure that we've never used before to relieve the patient's symptoms." Yang Ping got straight to the point.

Penguin disease is not a rare disease, according to the statistics of the United States, there are 3-5 penguin disease patients in 100,000 people, and our country has no statistics on this, so we can only refer to the data of the United States imperialism to speculate that we have about 4-70,000 penguin disease patients, which is a terminal disease, a more terrible disease than ALS.

The doctor in charge of the bed is Dr. Chow, who reports the medical records.

Formal medical record discussions are generally initiated by the young doctors, i.e., from the lowest to the highest according to the title, and finally summarized by the department head.

"Hereditary cerebellar spinal ataxia, this disease is a real terminal disease, there is no precedent in the world for surgical treatment of this disease, as for drug treatment, the only known effective drug is the Japanese drug tatirelin. Other methods, such as acupuncture and massage, have not been shown to be effective. ”

Li Guodong is an outstanding among young people, and he now wants to take Yang Ping's doctorate, so he studies very hard, and he is the first to speak in every case discussion.

Indeed, the only drug that has been shown to be effective in relieving the symptoms of penguin disease is tatirelin, which is a pituitary hormone-releasing stimulant and the world's first approved oral thyrotropin-releasing hormone, which, in addition to endocrine effects, also has certain effects on the central nervous system, including improving motor activity, antagonizing risepin-induced lowering of body temperature, and antagonizing pentobarbital-induced sleep, among others.

Thyrotropin-releasing hormone present in the brain colocalizes with other neurotransmitters or modulators to exert the function of neurotransmitters or neuromodulators to achieve neuroprotective effects.

One of the main symptoms of hereditary cerebellar-spinal ataxia is progressive motor coordination dysfunction, while dopamine in the brain is involved in the regulation of the locomotor system,

Thyrotropin-releasing hormone and its analogues have been shown to alter the metabolism of acetylcholinesterase and dopamine, thereby activating the dopamine system and strengthening the regulation of the locomotor system, so it can improve the symptoms of ataxia.

Taltirelin is a synthetic analogue of thyrotropin-releasing hormone, but its excitatory effect on the central nervous system is 100 times that of the body's own thyrotropin-releasing hormone, and the effect lasts 8 times longer than that of thyrotropin-releasing hormone.

It is this potent effect that makes it the only effective drug for penguin disease.

Dr. Zhou, who was in charge of the bed, said: "The patient's family has bought it in Japan, she has already taken this medicine, she has eaten three brands - Jg, sawai, Tanabe Mitsubishi, and finally felt that Tanabe Mitsubishi has the best effect, and has been taking it, probably because of the original pharmaceutical factory, but this medicine can only relieve the symptoms, the patient himself said, if it were not for this medicine, she is now estimated to be unable to speak, can not type, but as the more serious the disease, the effect of this medicine will be worse, because it cannot prevent the development of the disease, only relieve the symptoms." ”

The doctor in charge of the bed said while showing the empty box of medicine, which Fang Liu brought over to record the medicine for the doctor.

"Dr. Li, you just said that she has done acupuncture and massage, and has used traditional Chinese medicine? Void? ”

Doctor Zhao asked, Dr. Zhao Wenbo is a graduate student of the Department of Surgery who came to the Institute of Surgery not long ago, and he also wants to take Yang Ping's doctorate, this young man likes traditional culture very much, especially traditional Chinese medicine, and he is in pain with traditional Chinese medicine.

"That's right, this is what the patient's family said personally, Dr. Zhou should know, not what I said, indeed, acupuncture and massage Chinese medicine is ineffective for this disease." Li Guodong insisted on his opinion.

Dr. Zhou nodded: "That's exactly what the patient's family said. ”

"She didn't find a real Chinese medicine, and she can't arbitrarily say that Chinese medicine is useless, many Chinese medicine masters are among the people, and the academic school is now unique." Dr. Zhao defended.

"What master is in the folk, that's a romantic conjecture, Chuanwu is not shouting that the master has been in the folk for so many years, and finally there are folk masters Mr. Lei and Mr. Ma." Li Guodong said casually.

In fact, Li Guodong did say it casually, because he himself was very opposed to the argument that "masters are in the people", and when he heard Dr. Zhao say this, he replied.

Unexpectedly, this sentence annoyed Dr. Zhao: "What you said seems to be a pseudoscience of Chinese medicine, isn't this the same tone as the black Chinese medicine outside?" ”

Li Guodong was a little inexplicable: "You mean that I can only say that Chinese medicine is effective, not ineffective, that effective is correct, and that ineffective is black Chinese medicine?" I just said that the feedback of patients and their families is that Chinese medicine is very good, but it is definitely not a panacea. ”

"Since you said it is effective, you have to come up with evidence, you can't say a word, she didn't find the right doctor, it's like passing on martial arts, what kind of talk is playing, you will know if you can go to the ring and fight." Li Guodong added.

Dr. Zhao is a guy who deducts his hat at every turn, especially for traditional Chinese medicine, he can't say that it is not good at all, otherwise he will say that he is not patriotic, and traditional Chinese medicine is black, so that Li Guodong usually does not dare to chat with him, let alone talk about the topic of traditional Chinese medicine.

Li Guodong usually likes to rigorously lay out evidence in discussions, and the evidence that Dr. Zhao can't help but come up with is how many years ago, a certain relative was cured of a terminal illness by an old man.

Li Guodong asked again: Your relative's name, residence, when and where he was treated, how he was diagnosed at that time, how to evaluate whether he was cured, we will go to follow-up, this kind of case is an oral legend for ordinary people, but it is a valuable resource for our doctors, maybe we can find clues to solve medical problems.

Just threw out the question of Chuanwu, and Dr. Zhao was also anxious:

"Chuanwu comes from the battlefield, and many moves are taken from people's lives, how can people play when they wear boxing gloves?"

"Do you think that Mr. Ma and Tyson have taken off their gloves and have not restricted any moves, who will die first?"

Dr. Lee was also-for-tat, but he was not impatient.

The less anxious Dr. Li was, the more anxious Dr. Zhao became, his face was already swollen and red, and the other young doctors were also sweating, and some people had already pulled Dr. Zhao's clothes.

What is this discussing, how to say it and digress, Song Zimo knocked on the table: "Attention! This is a case discussion, don't discuss irrelevant things, about Chinese medicine and Chuanwu, you will discuss it privately after the meeting. ”

"Well, I don't want to discuss this with you, you don't understand it if you talk too much." Dr. Zhao threw a sentence.

Li Guodong never spoke again, he was actually just defending his point of view and didn't want to quarrel.

Xu Zhiliang said loudly: "Zhao-doctor, also-talking? ”

"Professor, do you want to be treated surgically?"

Song Zimo asked Yang Ping, these boys are not in the right atmosphere today, how can they start the game, Song Zimo simply came to discuss it in reverse, and directly asked the professor's opinion.

Yang Ping nodded: "My idea is very simple, since cerebellar atrophy, no matter what the pathogenesis is, it currently has compression, and there are also problems with blood vascularity, we grasp the clear problem, excision of the arachnoid membrane of the cerebellar medullary cistern, release of the cerebellum and brainstem arachnoid membrane, dural reduction, posterior cranial fossa decompression, bilateral occipital muscle flap cerebellar surface application, to achieve the dual effect of cerebellar decompression and increase blood supply, theoretically speaking, this can improve cerebellar blood flow." ”

Because no matter what the reason, no matter which causes cerebellar atrophy, we can see from the objective image pictures that there is compression of the cerebellum, there is insufficient blood supply, and the release of compression helps to protect the existing blood vessels, so that the blood vessels that are on the verge of death can be partially restored, and the muscle valve transplantation with vascular pedicle, the blood vessels of the muscle valve can slowly grow into the cerebellum, which can increase the new blood vessels of the cerebellum. ”

"I don't know how many links we play in the physiological chain of the disease, but it is definitely useful."

After Yang Ping finished saying his thoughts, Professor Deng bowed slightly: "What if you don't use this method of thinking?" ”

Professor Deng's question made everyone readjust their thinking, yes, the only effective drug is not effective now, and other than that, any method is ineffective, that is, there is no way to go, unless a new path is opened.

"So, there is no other way, but to try a new method, otherwise you can only wait for death, the new method is theoretically effective, even if it is really ineffective after surgery, decompression and muscle flap transplantation will not aggravate the symptoms of the patient, it is completely worth a try, this trial has opened up a new way for the surgical treatment of genetic cerebellar spinal ataxia."

Professor Deng very much agrees with Yang Ping's new method, and at this time, we must dare to break through this disease.

Everyone is conservative and clinging to the defects, so human beings are still slash-and-burn, how can they progress.

However, the key to the application of this new method is the cooperation of patients and their families, otherwise it will be difficult to explain once it fails, but fortunately, Lan Xueping and Fang Liu have great confidence in Yang Ping, so Yang Ping will decide to try the new method.

A physician who uses a new method with uncertain results on a patient who lacks trust is committing suicide for his or her own career.

No doctor would do this, and neither would Yang Ping, trust is the cornerstone of risk-taking.

I''ve also checked a lot of literature, and it's true that there is no precedent for surgical treatment of penguin disease, we don't have any experience to draw on, and we can't do animal experiments, so we can only analyze it theoretically, and I support the application of new methods. ”

Song Zimo is absolutely supportive of any new method of Yang Ping, which can be said to be brainless support, because many experiences have shown that in front of Yang Ping, his brain is completely insufficient.

"I -—— agree!"

Xu Zhiliang is similar to Song Zimo, first agree, and then slowly ponder.

Xia Shu is a newcomer, he is a doctor of cardiac surgery, and he has no experience in this neurosurgical disease for the time being, so he can only say: "I don't know much about this disease, and I only checked some literature temporarily, and I can't come up with an idea for the time being, and I don't know whether to agree or disagree." ”

He's kind of abstaining, what an honest man.

At this time, how could Mr. Zhang be absent, he cleared his throat: "We are a surgical institute, and we have an unshirkable responsibility for these difficult problems, and relieving the pain of patients is the meaning of our work. ”

The tone was sonorous and powerful, with a posture of giving up who else, if you didn't know Mr. Zhang's nature, you would be directly moved by his speech now.

"Dr. Zhang, are you specifically—telling—your opinion on this disease?" Xu Zhiliang is Zhang Lin's senior doctor.

What do you think?

Zhang Lin hasn't thought about it yet, why does Lao Xu always not cooperate, but he is also an old partner.

"Well-ah-—— this-that-about this disease, I think so, as long as you grasp the key link of the problem, things can be solved, but where is the key link of the problem, the key link of the problem is the link that can help the problem be solved, which are complementary to each other, so -——"

"Dr. Zhang, this is a case discussion, pay attention to the occasion."

Song Zimo had to knock on the table again to maintain order, and Zhang Lin had to stop: "Oh! ”

"If you -—— have a muscle flap transplant, the muscle flap — just on the surface of the cerebellum — and the blood vessels -—— certain right or wrong can grow into the cerebellum? It would be a little safer to have a vascular bundle implanted. Xu Zhiliang was very curious.

"Muscle flap transplantation allows blood vessels to grow into the cerebellum, as we see in the various flap transplantation procedures for orthopedic surgery. If vascular bundle implantation is used, it does improve blood vascularity faster, but it has some damage to the cerebellar parenchyma, although the damage is minimal, but for the cerebellum that has already atrophied, I try not to increase the damage to it. ”

Xu Zhiliang understood the truth.

"Actually, the surgical procedure is posterior fossa decompression and revascularization?" Song Zimo saw the essence of it.

"yes, that's it." Yang Ping nodded.

In fact, as Professor Deng said, what else can be done? Since it's theoretically useful, it's totally worth trying.

Because there was no precedent for surgery in this case, the discussion was a bit laborious, and most of the young doctors could only listen and could not speak.

After the meeting, Dr. Zhao still didn't give up and went to Li Guodong to theorize, Li Guodong didn't want to reason with him, it was meaningless.

"Li Guodong, you wait, let's talk."

After the meeting ended, Dr. Zhao stopped Li Guodong, who had a big head and knew what Dr. Zhao was going to say next.

"You seem to have an opinion on Chinese medicine?" Dr. Zhao asked.

Li Guodong didn't answer him: "Let's talk about it later, I still have several dressings." ”

Dr. Zhao grabbed Li Guodong's clothes: "Li Guodong, I'll talk for a few minutes, don't delay your business, we can't be fooled, we must resolutely protect our traditional culture, and become the backbone of protecting Chinese medicine, Chinese medicine has protected us for 5,000 years, far from being comparable to Western medicine, many modern Western medicine treatment methods can find the source in Chinese medicine, such as artemisinin, in fact, it also comes from Chinese medicine -——"

''Yes, you're right, I'm going to say the wrong thing now, now review!'' ”

Li Guodong was reluctant to dwell on this matter anymore.

Dr. Zhao let go of his hand pulling his clothes.