Zhou Qiao pondered for a few seconds and suggested: "Let's do another MRI, I am considering skull fasciitis, but further examination is needed." ”

"Cranial fasciitis? What is this disease? "Everyone looked at each other, and they hadn't heard of it at all.

Zhou Qiao said with a smile: "Cranial fasciitis is a rare non-neoplastic disease characterized by fibrous mother and myofibroblast proliferation.

It typically presents as a solitary, fast-growing, solid, painless mass on the scalp that sometimes penetrates the skull and invades the meninges, causing a range of site-related clinical symptoms.

On imaging, it usually appears as a lytic bone defect with or without a sclerosing margin.

Because of the local invasion characteristics of the disease and the rapid growth of the disease, it may be misdiagnosed, but skull fasciitis is usually regarded as a special type of nodular fasciitis, and the prognosis is often good, and after surgical resection, it is generally not easy to recur. ”

"It is different from general nodular fasciitis, which is generally only located in the soft tissues of the scalp or the skull, and the vast majority of cranial fasciitis occurs in infants and young children, and there are no more than 10 cases in adults, of which it is more common in men, and the ratio of men to women is about 2:1."

"This disease was first reported in the 80s of the last century, and there are only more than 100 cases recorded around the world, so it is not surprising that you don't recognize it."

"Its origin is not well understood, but it is generally thought to have originated in the capular aponeurosis, loose connective tissue under the aponeurosis, deep and superficial fascial layers, and periosteal or fibrous membranes covering the sutures or halophylum surfaces."

"It has been hypothesized that local trauma can promote fibroblast and myofibroblast reactive proliferation, which in turn leads to the formation of skull fasciitis. Some of the patients reported so far do have a history of trauma or birth injury, but most patients have no history of trauma. ”

In other words, the patient's small lump may not have anything to do with his fall. It's just a coincidence that everyone was misled. ”

"Because this disease is very rare, there are few cases and few experiences in clinical practice, which leads to problems such as high missed diagnosis, high misdiagnosis, and difficulty in medication. It's not for nothing that rare diseases are often referred to as 'medical orphans'. It's remarkable that you've been able to be vigilant and not jump to conclusions. Zhou Qiao said with a smile.

……

Listening to Zhou Qiao's eloquent conversation, everyone was ashamed and couldn't help but marvel, and gave a thumbs up and praised: "Why is Dr. Zhou so knowledgeable?" ”

"Yes, at a young age, his profound knowledge seems to be better than all of us combined!"

"Dr. Zhou is excellent! I've seen many geniuses, but none of them can compare to Dr. Chou. ”

Zhou Qiao waved his hand modestly, thought about it, and lied: "My teacher is an academician, a Nobel Prize winner!" He also studied the mechanism of this disease and once told me. ”

Yes, it's on Academician Domitri.

This is also the advantage of having a cheap teacher, if there is anything that can't be explained in the future, let Teacher Domitri take the blame. Anyway, it's impossible for people to call for verification, right?

Even if you want to make a phone call, most people don't have the qualifications.

Academician Dominory is not only a master of the academic world, but also a rich man among the rich, and it is really difficult for ordinary people to intersect with him.

Zhou Qiao's detailed explanation was recorded by a caring doctor with a mobile phone, and then spread on the hospital's internal forum for everyone to learn. Because there are still many doctors who have not been on the scene.

This is also the reason why Sequoia Tree Hospital often listens to Zhou Qiao's explanations, listens to experience, and develops habits.

Of course, such a "confidential" content, as President Joachim Langley has specially explained, is limited to internal communication in the hospital, and everyone should pay attention to confidentiality.

After some doctors in other departments have learned, they can be regarded as having insight in this area, and then the information of this case will be sorted out, and the next time they encounter this situation, they will not miss the diagnosis and misdiagnosis.

When the examination results came out, Zhou Qiao further determined that it was this disease, but for final confirmation, it was still necessary to pass pathological examination and immunohistochemical examination.

This requires surgery, cutting out the sample, and sending it for pathology testing.

Anyway, no matter what, it's going to be surgical.

If it was at the Iris Clinic, this operation could be done by Murphy or Stephanie, but here, only Zhou Qiao did it himself.

He quickly developed a surgical plan, which he then explained to the patient, such as the specific condition, the need for surgery, and the general surgical plan, as well as the prognosis and a range of possible subsequent treatments, as well as a description of the risks.

This is also the proper meaning of the procedure, regardless of the size of the operation, the risks must be clearly listed.

Then, the patient signs off, and preparations for the surgery begin in full swing.

One advantage is that there are not many patients who need surgery in Sequoia Tree Hospital now, and Zhou Qiao is in a hurry to leave, so it can be arranged immediately. You don't have to wait long, long.

The patient called his family and his elderly mother rushed to take care of him.

When everything was ready, the operation began.

Since it is a head surgery that requires debridement of the skull, this surgery falls under the category of neurosurgery.

The patient's mother heard that it was a rare disease, what kind of cranial fasciitis, and when she was anxiously waiting outside the operating room, she couldn't help but itch her hands, took out her mobile phone and searched for this strange disease, and then, she was shocked.

Of course, you can't read the information on the Internet, and if you look at it casually, it will be a terminal illness, or all kinds of troublesome sequelae and complications.

For example, the mother searched for a picture of skull fasciitis and almost threw up. The picture is too disgusting.

In addition, postoperative care is extremely complicated, and it is said that if you are not careful, you will become infected and complicated by other serious symptoms.

She didn't know that this was the shot of the top famous Zhou Qiao.

Zhou Qiao's debridement is a perfect progression, although the parts of the skull fasciitis that require debridement are different, and the techniques are different, but Zhou Qiao's debridement is all-encompassing, a reason, and a hundred reasons, and he is used to drawing inferences from one case to another, pushing through the old and bringing forth the new, so Zhou Qiao's action will basically not leave sequelae and complications.

He often does it all at once, and he doesn't need to enter the palace twice or three times.

During the operation, a white and soft mass located on the surface of the skull on the right side of the patient's frontal bone can be clearly seen.

It was removed and cleaned thoroughly without injuring the vital structures around the lump.

The surgery was not without success.

The assistant who assisted on the side carefully packed the tissue removed by Zhou Qiao into a sample bag and sent it for testing.

It is about a small pile of gray and gray mixed with gray-red, about 1.0cm× 1.0cm×0.6cm, and the red part inside is a little bloodstain.

The cut surface is gray and white, solid, and the core part is brittle.

The reason why it's a small pile of pieces, rather than a whole piece, is because when you cut it, it breaks into pieces.

It's like archaeology, when digging, you have to dig from the surface little by little, clean up little by little, and let the field be exposed. What if you dig into it with a knife at the beginning, what if you hurt healthy tissues?

After the test, the pathology laboratory expedited the microscopic examination.

Dr. Zhou is in a hurry to go back to San Francisco, and it is said that the air tickets have been booked, so how can he be delayed? The Americans are inefficient, and they are also divided into occasions. Or rather, look at people.

Believe it or not, the big boss said a word, and the people below immediately farted and worked overtime. Sometimes, the big boss doesn't even need to speak, and the roll kings below will start to roll up.

Where there are people, there are rivers and lakes. In the American workplace, if you don't feel the volume, you don't feel the workplace fighting, it's because you are not important and you have not entered the inner circle.

Maybe most of the Chinese people who go to the United States to study are academic talents, and they are not good at that kind of twists and turns, or they know it, but they don't like it. Those who are good at this have stayed in the country.

In the Luoya Group, many middle and high-level people are African-American or Indian-American, but there is only one Chinese Chen Zhining.

It's not that she doesn't want to use Chinese, but even because of Zhou Qiao's relationship, she also deliberately paid attention to some Chinese within the group, but many people are too "straight", and sometimes they can't even understand some of the "confrontations" and "hints" in the words. Luo Ya could only give up.

Then, it is worth mentioning that Luo Ya negotiated with the Chinese delegation on the cooperation of nuclear power plants some time ago, and only then did she thoroughly understand the scheming and strategy of the Chinese, and only then did she understand that the real masters who are good at fighting are estimated to be in the Chinese official.

The results of the case examination showed that the mass was composed of proliferative spindle cells, with a disorderly arrangement, some of which were striated, the cytoplasm was basophilic, the nucleus was elongated to oval, the nucleoli were indistinct, and the interstitial myxoid degeneration, vitreous degeneration, acellular atypia, and pathological nuclear division were identical. Reactive osteogenesis may be seen locally.

The brittle part is bone, or calcification.

Immunohistochemistry showed that spindle cells were positive for smooth muscle actin and vimentin, Calponin, bcl-2, CD34, CD99, S-100 protein, SOX-10, STAT6, β-catenin, and desmin were negative, and the Ki-67 positive index was 10.7%.

The data before and after the summary of the back, in the end, it was naturally diagnosed with skull fasciitis, which confirmed Zhou Qiao's previous judgment.

Everyone was not surprised, carefully studied the course of the disease, and summed up the experience.

After the operation, the chubby young man was transferred to the intensive care unit, and the next day, to the general ward of neurosurgery.

During this period, there are naturally nurses who follow the doctor's instructions for nursing, such as routine cefuroxime anti-inflammatory, calcitonin, blood routine, monitoring body temperature, blood pressure, heart rate, blood oxygen saturation, etc.

Discharge from the hospital is just around the corner.

Due to the special nature of this case, it is still necessary to follow up regularly in the future, one is to pay attention to the patient's health, and the other is to collect follow-up information and data to improve the course of the disease.

And Zhou Qiao, who had already been personally escorted by Luo Ya, took a flight from Houston to San Francisco.

After a long absence, Zhou Qiao is finally back.

The four girls were overjoyed, and everyone looked at Zhou Qiao's gaze, and they all felt like they were going to eat him.

Zhou Qiao's heart sank, indeed, he had left the four girls at home for too long and too long. When you come back, you'll have to make up for them.

It's just that with one enemy and four enemies, and the other four are open for a long time, Zhou Qiao felt a little pressure.

Suddenly, at this time, the system that had not appeared in my mind for a long time popped up the golden virtual panel again:

"Congratulations to the host for achieving the small achievement of 'living people are not counted', the clinic and individuals have treated more than 10,000 critically ill patients and benefited more than 100,000 patients. Reward a Tier III Transformation Elixir, and further increase your physical, mental, and all attributes by 100%! ”

While Zhou Qiao was overjoyed, his mind was racing, 10,000 people? 100,000 people? Are there so many?

I couldn't help but secretly think that I, Murphy, and Stephanie together might only have about a thousand surgeries above the third level that I had done in reality...... Well, it is estimated that the X virus in East Africa, which has developed vaccines and special drugs, accounts for the majority.

The system popped up a dialog box again: "Since the Tier III Transformation Elixir is extremely precious, may I ask whether the host will exchange it for physical goods, or will it directly release the medicinal properties in the body?" ”

Zhou Qiao: "Just release it." ”

Immediately, a stream of heat flowed through his body, and Zhou Qiao suddenly perked up, looking at the eyes of the four women, full of confidence.

Now my brother can finally handle it. I'm not afraid of you!

The fourth girl, looking at Zhou Qiao's confident gaze and sunny and bright smile, suddenly, they were all thrilled and became extremely looking forward to it.

Thank you to the bigwigs who voted for the monthly ticket.

Everyone, come here for more monthly passes, thank you!

(End of chapter)