For this case of cobalt poisoning, both the director level and the Gui Peisheng are very interested.

In particular, I am more interested in the diagnosis process of this case, because it gives you some inspiration.

Why did the patient go through many hospitals and see many doctors, from his medical experience, these hospitals are all big hospitals in the province, and some of them are heavyweight experts in rheumatology, immunology and oncology, but unfortunately, they have not obtained a clear diagnosis, and they came to the cardiovascular department of Sanbo Hospital, and the symptomatic treatment lasted for two weeks, but they still did not get a diagnosis.

At that time, he was admitted to the CCU because of severe heart failure, and after rescue treatment, his vital signs were stable and transferred out of the CCU, at this time, the cardiologist was helpless and could only use the last resort to -—— the whole hospital for consultation.

The orthopedic department was the most active after receiving the consultation order, and the chief resident physician decided to touch the situation in advance, and as a result, the incurable diseases were directly solved.

Why did everyone fail to think of a diagnosis even if they wanted to break their heads before, but orthopedic surgeons easily cracked it.

As Director Tan said, the problem lies in the blind spot, whether it is rheumatology and immunology experts or oncology experts, they are only limited to their own specialty, and they have been playing in circles within their own specialty.

Almost all tests related to infections, tumors, rheumatism, immunity, etc., are done, but the concentration of metal ions in the blood is not checked.

Because I can't think of this piece at all, I lack knowledge in this area.

Yang Ping sat in the first row and didn't speak, he listened quietly to everyone's discussion, Director Zhao had long noticed Yang Ping's arrival.

Now Yang Ping can't keep a low profile, he is almost a god existence in Sanbo Hospital, no matter what, Director Zhao will let Yang Ping come out and say a few words, even if Director Zhao lets him go, how can so many young doctors let him go.

"Our Professor Yang is also from orthopedics, can Professor Yang tell us a few words about this case?"

Director Zhao took the microphone and walked in front of Yang Ping.

The young doctors in the venue all looked at Yang Ping with blank eyes, waiting for him to speak, because every time Yang Ping could always say something similar to the axioms and theorems of mathematics, which was very useful.

Just say a few words, Yang Ping walked to the podium, and Director Zhao handed him the microphone.

He thought about it for a while, what to say, the case has been cracked, the diagnosis and treatment are clear, let's talk about how to think in the face of incurable diseases.

Some of the young doctors at the venue had already taken out their notebooks and started to take notes, especially graduate students and trainees, most of whom were going to leave Sanbo Hospital after completing their studies, and they might not have so many opportunities to listen to Professor Yang's lectures in the future, so they especially cherish this opportunity now.

"Let me talk to the young doctor for a few words, in fact, the incurable diseases we encounter are roughly divided into several categories: one is that the symptoms are atypical, the second is beyond the scope of knowledge, and the third is that there is no current medical cognition, no matter what the situation is, the most important thing is to grasp the important clues of the disease, so we must have comprehensive knowledge, Director Zhao just said, usually read more books and learn, once there is a blind spot in knowledge, some clues will be lost, and important clues are very important in the diagnosis, he is like the thread on the clothes, grab the thread and pull, The entire stitch was easily removed. ”

"Traditional Chinese medicine attaches great importance to the role of clues in diagnosis, experienced old Chinese medicine practitioners when they encounter incurable diseases, they will chat with the patient after looking and hearing and asking, and talk about everything around the condition, which seems to be idle chat, but in fact, they are waiting for that thread, chatting and chatting, and the clues will naturally pop up, and the old Chinese medicine doctor will have a flash of inspiration, immediately grasp the clues, follow the vine, and obtain the final syndrome differentiation and treatment of the disease."

"This is the secret of the old Chinese medicine to see a doctor, I don't tell the general people, we Western medicine should learn from the secret of Chinese medicine, when facing incurable diseases, we repeatedly look at the medical records, repeatedly improve the medical records, look at the patient's previous medical information, contact the patient more, ask more about the medical history, maybe ask the thread will pop up, and the diagnosis of incurable diseases will be the thread."

"Also, when we diagnose diseases, we first consider common and frequent diseases, but don't miss rare diseases, every time we diagnose a disease, all possible diseases in the mind, how to go through it, according to our pathophysiology classification of the cause of the disease to go through, so as to form a rigorous and comprehensive habit of thinking, will not be so easy to miss important clues, especially before the diagnosis, every abnormality may be a clue, anyway, in the face of so many threads, which one is the clue, Mention each one and try it. ”

Sure enough, it was Professor Yang, and a few words casually were the golden rule, and this thread theory was really full of philosophical truths, and the young doctors took this thread theory down seriously.

Then Yang Ping explained to everyone the problems related to metal plants.

Metals are widely used in medicine, especially in orthopedics, most of the plants in the spine and joints are mainly metals, such as spinal fixation, artificial discs, artificial joints, etc.

When metal is implanted in the human body, abrasion causes metal particles and metal ions, which are microscopic, and they are dispersed in the surrounding soft tissues, causing local reactions that activate macrophages and inflammatory responses.

Metal ions will enter the blood circulation, and then travel throughout the body, deposited in the terminal organs, some metal ions themselves are toxic, such as heavy metals represented by cobalt metal; Some metal ions are deposited in the organs, causing damage to the organs; There are also some metal ions that have the potential to cause cancer in the human body, such as high levels of titanium that may have a potential high risk of carcinogenesis.

These are all problems that must be faced, medical treatment methods have always been double-sided swords, we use one side of the sword to heal at the same time, but also to study the damage caused by the other side of the sword.

In fact, in 1973, in the British Medical Journal (BMJ), Dr. Coleman reported in the journal that the levels of cobalt and chromium in blood and urine increased after total metal hip arthroplasty, thus pointing out that the long-term effect of chromium accumulation in the body needs to be studied urgently.

Cobalt poisoning is not only seen in artificial joints, but also sometimes in patients with dental implants, because some dental implants also contain cobalt-chromium-molybdenum alloys, which can also easily cause cobalt poisoning once overworn and exposed to the cobalt metal inside.

In the setting of vitamin B12 deficiency and protein and alcohol intake, the symptoms of cobalt poisoning are more pronounced, especially in alcoholics.

When cobalt enters the bloodstream and travels throughout the body, it can damage various organ systems, such as the nervous system, cardiovascular system, respiratory system, digestive system, thyroid gland, lymphatic system, etc., thus causing a series of symptoms.

There are so many of these symptoms that it's hard to think of any disease that has so many symptoms without grasping the key thread of artificial hip replacement.

Time is limited, Yang Ping briefly chatted with everyone.

Several departments in the back have also come up with some difficult cases, with Yang Ping's "thread theory" as a guide, in the face of these difficult cases in the back, the young doctors are obviously bold and positive, they pay attention to the medical records very seriously, and often ask the reporter a lot of questions.

There is an incurable disease in the Department of Gastroenterology, and a trainee of the Department of Gastroenterology, with his superficial interdisciplinary knowledge, grasped a thread that everyone ignores, and successfully deduced the diagnosis, which surprised the doctor who made the report.

——

After the meeting, it was already evening in China, but Germany began to reach the morning, and Song Zimo and Xu Zhiliang briefly reported the previous day's itinerary by video.

Zhang Lin and Xiao Wu's surgery has not yet been completed, they have improved their surgical speed through these days of experience, and now they can do four or five surgeries a day.

Dr. Li Min called in the locker room, looking very anxious, and Yang Ping didn't know what was going on.

"Professor Yang, can I take a week off?"

Li Min put down the phone and said to Yang Ping in a pleading tone.

Yang Ping wondered if something was going on in his house: "Is there something wrong?" Can we help? ”

Li Min said very anxiously: "After our old dean had an emergency operation last night, he had an acute attack of lumbar intervertebral disc herniation, and his left sciatica had a night's errand. ”

During this period of Li Min's study, the old dean endured low back pain, and contracted the operation of the entire hospital alone, several young doctors lacked work experience, and they couldn't do surgery at all, and it was difficult to do a good job even with a handle, Li Min called the old dean, and the old dean said that he was okay every time, and said that he was in good spirits, and his waist did not hurt and his legs were numb.

But yesterday Li Min called the old dean, and the tone of the old dean's speech was wrong, but the old dean still said that it was okay.

Li Min had doubts, so he called other colleagues in the hospital early this morning, and the colleagues said that the old dean had sciatica for several days, and he rolled in bed every night.

"Did you use mannitol and dexamethasone?"

Li Min knew that every time the old dean had a seizure, he always used dehydration drugs and hormones to cope with it.

"I used it, but it still didn't work, I went to see him just now, he bit a towel in his mouth, we persuaded him to go to the county to check it out, and he didn't agree." My colleague was also in a hurry.

Li Min was very anxious about the old dean's body, he wanted to ask for leave to go back for a few days, Yang Ping happened to come in, and he mustered up the courage to ask Yang Ping for leave.

"How long has your old dean been herniating in his lumbar disc? What tests have been done? Have you ever had a CT or MRI? ”

Yang Ping felt the need to ask a few more questions.

Li Min shook his head: "We only have an X-ray machine in our hospital, and he has only done an X-ray machine, which shows that multiple vertebral bone hyperplasia, waist 4/5, waist 5/sacral 1 space stenosis." ”

This matter may not be so simple, even if Li Min goes back, with the medical conditions in the mountainous area, I am afraid it will not be of much use, Yang Ping thought for a while and said: "Li Min, this way, you don't have to go back for the time being, your old dean has to check it well, and I will arrange an ambulance to pick him up from you and bring him to our hospital for treatment." “

This is definitely the best, but Li Min still has to go back, the old dean came to the provincial capital for treatment, the hospital is almost empty, a few young doctors can't do anything, and they have to go back to take charge.

"But-—— I still have to go back-—— only I am familiar with the old director in the hospital, and the others are novices who can't go out."

Li Min was very embarrassed, this was the embarrassment of the township hospital in the remote mountainous area, the young man jumped away after being a little skilled, and either found a relationship and transferred to the county seat or a surplus township, or simply resigned and went to work outside.

Yang Ping felt that things were very easy to do: "In this way, I will send two doctors to your top for a period of time, you will pick up the old dean with the ambulance, and the doctor I sent to the top shift will also go with the ambulance." ”

It was not easy for Li Min to get a learning opportunity, Yang Ping didn't want to delay his time, and besides, he couldn't solve this matter on the spot when he went back.

Hearing Professor Yang's arrangement, Li Min was very grateful, if it can be like this, what else can be said, the old dean has been sick for so many years, he is a doctor, but he has not been examined, when the disease attacked, he has just endured it, relying on a few painkillers to maintain, if he can be received here to systematically check and treat, of course it is a good thing.

"Thank you, Professor Yang!" Dr. Li Min was very moved.

"It's okay, I want to think about who to send." Yang Ping pondered the candidates for support in the countryside.

Zhang Lin and Xiao Wu can't leave for the time being, and it's not appropriate to go to one of them, and letting them separate will greatly reduce their combat power.

Yang Ping thought about it, Xia Shu's master's and doctor's degrees are all cardiac surgery, while Dr. Jin and Dr. Wen, both master's and doctor's degrees are orthopedics, not to mention obstetrics and gynecology surgery, even if it is general surgery, it is estimated that they will not be able to cope with it.

The more doctors, the more the technology focuses on a small area, so it is impossible to cope with it when going to the township hospital, although the patients handled by the township hospital are not complex and difficult, but it is more complicated.

You must find a doctor who has experienced the systematic training of the Institute of Surgery, Li Guodong is good, although he is young and still a resident doctor, but at least he has been trained by surgical research.

Yes, Li Guodong was sent to go, he has participated in almost all kinds of surgeries in the trauma emergency center, and has undergone primary training in various specialties of the Institute of Surgery, let alone going to a township hospital and a prefecture-level hospital, he can completely run his business independently.

Immediately, Yang Ping changed into his hand clothes and came to the operating room with Li Min, who was doing surgery on the stage.

"Guodong, assign you a task, now there is an emergency, Li Min's old dean is sick and bedridden, and now he has to be brought to our hospital for treatment, once the old dean is brought to our hospital, their hospital will lack a doctor who can take charge of the business, Li Min can't go back now, so I plan to send you to the countryside to go to the hospital where Li Min works for medical support, and you are about to leave, and the time of return is to be determined, is there a problem?" Yang Ping said to Li Guodong.

This kind of task may be reluctant to be someone else, but Li Guodong is very happy to go to the countryside to support, isn't this his own independent door? Like Zhang Lin Xiaowu, he can handle patients independently and operate independently, even if the operation in a township hospital is simple, he is also an independent surgeon.

Besides, Li Guodong is single now, and he doesn't have a girlfriend to tie him up, so he can leave when he says he can.

"No problem!" Li Guodong immediately agreed.

"Okay, I'll call the ambulance in the emergency department now, you can get off the operating table now, change someone to pull the hook, and set off with Li Min." Yang Ping is crisp and neat, without dragging the mud and water.

Another doctor in the operating room who was observing immediately brushed his hands and took over from Li Guodong.