The result of wearing a high and strict waist is very bad. The CSF pressure of the lumbar puncture is as high as 216 mm, which is nearly 30% higher than the upper limit of the reference value. At the same time, the report of the blood routine was also sent to the emergency room, and the platelet ratio was slightly lower by 10%, at 86.0×109/L, and the creatine enzyme (CK) 981.0U/L was nearly five times higher than the reference value, and if calculated according to the lowest reference value of 18 U/L, it was nearly 55 times higher. Lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase were also more than twice the reference value.

"The conclusion of viral meningitis is not very problematic. Li Xiuming, a neurologist who came to the consultation, affirmed Xu Yourong's judgment. "Such a high level of creatine, coxsackie group B virus infection?" Dr. Li Xiuming carefully read the rigorous blood test report, shook his head, "but coxsackie group B virus should not have central nervous system damage, nor should there be epilepsy." ”

"Central nervous system and epilepsy may be atypical symptoms due to high intracranial pressure. Xu Yourong was also reading the inspection report. The three of them were sitting in a small conference room in the rescue room, exchanging opinions with each other. During the consultation, the most important thing is for everyone to speak freely. The most important thing in brainstorming is not the correctness of the opinion, but to propose as many possibilities as possible. In this way, when the diagnosis is ruled out later, there is at least some suggestion.

Sun Lien thought about it for a moment, "The patient's previous treatment can help us rule out the possibility of bacterial infection. Now, it is indeed viral meningitis that is the most likely. Intracranial pressure is corrected with mannitol first, followed by ribavirin to control possible viral infection. ”

"I recommend adding polyene phosphatidylcholine. Xu Yourong added with some concern, "The patient's liver function indicators are not very good. If coxsackievirus infection is present, the liver may be affected. If liver function is abnormal, the usefulness of ribavirin may be limited. Not to mention that ribavirin can also cause an increase in blood bilirubin. It may affect our ability to monitor the patient's liver. ”

"Yes. Sun Lien began to gradually get used to reconsidering Xu Yourong's suggestion. "Let's get treatment first. Even if treatment doesn't work, it can at least provide more clues to the diagnosis. ”

There was good news from the policeman Lao Wu Tou, who had contacted Gao Yan's family. They will rush to the hospital as soon as possible. And Sun Lien returned his attention to the old man Zhou Xiufang.

The results of the examination are another bad news. A large number of plasma cells appeared in Zhou's blood smear. According to the measurement, the plasma cell content in the blood of the elderly is as high as 5.7×109/L, and given that the elderly have no previous history of multiple myeloma, according to the WHO definition, the elderly can be directly diagnosed with primary plasma cell leukemia (PPCL).

Primary plasma cell leukemia is a rare variant form of malignant plasma cell myeloma that researchers classify as mature B-cell tumors — a rare disease that Sun has only heard of by name.

Zhou Xiufang's PPCL is obviously an acute leukemia, and the disease that usually requires bone marrow puncture to determine has now spread to the blood circulating in her body. At the same time, it also indicates that the disease has progressed to a relatively advanced stage, and for Zhou Xiufang, the fortunate thing is that her PPCL antibody is CD56+ antibody, a type of primary plasma cell leukemia with a slightly better prognosis.

After the results came out, Professor Li from the Department of Hematology immediately called Zhou Jun, and after a long period of tossing and turning, the Department of Hematology finally adjusted a hospital bed for the old man. Zhou Jun was running the hospitalization procedures with his father, Comrade Zhou. Fortunately, the ward adjusted by the hematology department is a single-room special care ward, and Comrade Lao Zhou can live in it to accompany the bed together. Otherwise, the old lady's own third-degree heart failure alone can't be dealt with, and you can't expect the old people who are even difficult to move to take care of themselves with a plastic basin, right?

Before transferring the elderly person to a specialist ward, the emergency unit needs to stabilize the condition of the elderly person. In addition to giving oxygen and continuous pleural effusion drainage, Sun Lien gave Zhou Xiufang captopril and indapamide after consulting Wang Jianpei, a mutton powder enthusiast in the Department of Cardiology. The two drugs were used in combination to control Zhou Xiufang's hypertension and congestive heart failure. At the same time, according to the suggestion of Professor Li of Hematology, early treatment and intervention of Zhou Xiufang's PPCL were carried out with ralidomide.

With the continuous pleural drainage, Zhou Xiufang's mental condition has improved significantly. The old lady lay on the hospital bed, looked down at the tube inserted in her side ribs with difficulty, and waved Sun Lien.

"Are you my attending doctor?" the old lady breathed oxygen, and spoke with a little difficulty. Although his voice was weak, he said quite clearly, "This is the Fourth Central Hospital, right? Where is Zhou Jun?"

"Mr. Zhou is helping you with the hospitalization procedures. Sun Lien held the old man's dry hand, "I am your attending doctor, my name is Sun Lien." ”

"Xiaojun is your teacher?" the old lady held Sun Lien's hand a little harder, "Do you know what kind of disease I have?"

Sun Lien was stunned for a moment, then nodded.

"Pleural effusion, weakness. The old lady smiled bitterly, "Congestive heart failure?"

"You've been given the right treatment. You're in much better shape now. Sun Lien comforted, "If you feel uneasy, I'll call Teacher Zhou in?"

Zhou Xiufang patted Sun Lien's hand, "Old lady, I'm not old and confused, I'm progressing too fast, it's not congestive heart failure caused by coronary heart disease." She glanced at Sun Lien and said with some dissatisfaction, "You also graduated from medical school, right? She lifted her chin slightly, and nodded at the medicine next to the bed, "Ralidomide is not a cure for heart failure. Do I get MM? or MDS?"

MM is multiple myeloma and MDS is myelodysplastic syndrome. Both are the main conditions for which ralidomide is indicated.

"Primary plasma cell leukemia. Sun Lien could only answer honestly. "However, immunological testing confirms CD56 antibody manifestations, and this typing is the best prognosis......"

"I've been studying multiple myeloma for two decades, and I know what the consequences are. I just didn't think that I would get this disease when I got old. Zhou Xiufang was lying on the hospital bed, looking at the ceiling with her eyes, as if her eyes had passed through the floor and reinforced concrete, and she was looking at the clear blue sky that would be revealed after the snow stopped. "Really...... Interesting. ”

She turned her head, looked at Sun Lien and said, "Little comrade, please go and call Zhou Jun in." I have something to tell him. ”

The old man's eyes were clear and firm, as if he had already made a decision.

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