Of course, Sun Lien is not so good that he can immediately diagnose what is wrong with this poor little girl. But he is very sure that Li Yuhan, who is now readmitted to the hospital, has not been completely cured. She was readmitted to the hospital three days ago and her symptoms are worse. In half a day, she had more than ten convulsions in a row.

A little girl can have a nervous system infection four times in three years? Sun Lien vetoed the possibility of her experiencing some kind of infectious neuroinflammation again directly from her mind. Unless the child's brain-blood barrier is a sieve and his immunity is alarmingly low, it is unlikely that he will have four infectious neurological inflammations in three years.

It is clear that there were problems with two cases of viral encephalitis at the First People's Hospital of Changning City and three diagnoses at the Second Central Hospital of Ningyuan City.

"Sister Mei, do you mean to let this patient be treated in our hospital, or simply transfer to our fourth hospital?" Sun Lien pondered for a moment and asked his own question, "If it is transferred to the hospital, it will be easy to do, I will contact the hospital directly." ”

Mei Ying looked a little entangled, she originally wanted this patient to be the first shot of Zhongfu Hospital's fame, but the Kaminai and Infectious Diseases departments of her own hospital had conflicting opinions on this case. Kaminai thinks that this may be some kind of autoimmune disease, and at least he should pull the nephrology department to get started. The Department of Infectious Diseases, on the other hand, believes that multiple episodes mean that the lesions in the brain are persistently infectious, and they tend to favor tuberculous encephalitis, which is due to the patient's most recent admission to the hospital with a normal CT scan, only due to repeated use of hormone pulse therapy and continued oral prednisone.

The two departments disagreed, the diagnosis was delayed, and Lin Yuhan's condition continued to develop. Her seizures continued, and she was now able to sleep almost exclusively under the effects of diazepam. Looking at such a poor child, Mei Ying, as a doctor and a woman, is really a little unbearable.

"I came with this case to ask for reinforcements. Mei Ying thought about it, and finally sighed and said, "If you have any opinion, Xiaosun, and it can still be determined in two days, and our hospital can treat it now, then leave the person behind." If not...... Then go to the Fourth Courtyard. I'll do the parent's job. ”

With this words, Sun Lien was much easier, he put down his chopsticks and said, "No problem, I'll go see the patient first." ”

Wang Caifeng didn't show her dissatisfaction that her son was going out as soon as he came home, but she praised Sun Lien's decision, "Go quickly, you can help if you can." ”

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If you can help, you can help, this is the most simple expression of goodwill of the Chinese people. In the face of natural disasters, most of the people in various places say "I can't help much" when they actively donate, which is also the most simple expression of goodwill.

Sun Lien ate eighty percent full, which is just right for an emergency doctor. If you are too full, you will be sleepy, and if you are not full, you will be prone to hypoglycemia. He drove Mei Ying to the current Zhongfu Hospital. Her cousin was left behind - Hu Jia was in charge of the care here.

"I'm sorry for you. In the car, Mei Ying sighed, "I really have a bit of a headache this time, I've never seen this kind of patient." ”

Although Mei Ying was the head of the department before, she was only the director of the obstetrics and gynecology department. In the past, the carton factory hospital was not large enough, and the gynecology and obstetrics departments were not separated. If the surrounding residents have a choice, they would rather go to the farther maternal and children's hospital or the First People's Hospital. The obstetrics and gynecology department of the carton factory hospital was basically idling.

From this point of view, Mei Ying lacks the experience to handle and coordinate the operation of the entire hospital. She even lacks the experience to coordinate more than two departments to work simultaneously.

But Mei Ying is still more professional than many deans who have been parachuted from other positions, and she understands the challenges and risks faced by front-line doctors better than these deans. At the same time, it also resonates more with the professional future and personal ambitions of these doctors.

Mei Ying is bound to be a good hospital manager in the long run, but she needs some extra help now.

"Actually, I haven't seen many patients like this. Sun Lien said while driving the car, "More than three consecutive misdiagnoses, don't talk about this kind of thing...... I haven't even heard of it. ”

"Do you think it's a continuous misdiagnosis?" Mei Ying didn't think about it here, she always felt that these four times were probably some kind of missed diagnosis - the doctors at Changning First People's Hospital and Ningyuan Second Central Hospital probably missed some kind of underlying disease, and it was this condition that caused Li Yuhan's three episodes.

"It's definitely a serial misdiagnosis. Sun Lien is confident in his judgment, "All four seizures were epileptiform symptoms, and all of them were accompanied by obvious pyramidal tract damage and meningeal irritation. If it had been an infection, she would have died of other complications. ”

Meningeal irritation and pyramidal tract damage are serious symptoms that can be catastrophic when they occur in a teenage girl. But Li Yuhan behaved ...... It's not very serious.

To be sure, shallow coma and more than 10 convulsions in half a day are very serious symptoms, but they are very mild compared to disability, intellectual impairment and even death.

"So I don't think the previous three times, including this one, are infections. Sun Lien parked the car in the parking lot, and then said to Mei Ying, "As far as the current situation is concerned, I am more inclined to autoimmune diseases or some kind of congenital diseases." ”

Mei Ying got out of the car and took Sun Lien to the newly renovated Zhongfu Hospital, her pace was fast, "I'll take you to meet her current attending doctor first, and then let's go directly to the ward to see the patient." ”

Sun Lien nodded, this is the normal process. As a regular physician in the Ningyuan Fourth Hospital, his practice place was limited to the Fourth Hospital. Theoretically, it is also a violation to treat people at their own Zhongfu Hospital. But fortunately, he didn't plan to directly take care of all the treatment content of Li Yuhan and receive it to himself. As long as there is a correct diagnosis, other doctors can continue to take over and start treatment.

"Dean Mei, you're here. The doctor who treated Li Yuhan was a deputy chief physician in his forties, and when he saw Mei Ying for the first time, he greeted him as if he had seen a savior, "The infectious disease department still insists on the judgment of infection......

"They're just infected, of course, everything is infected. Mei Ying smiled and comforted the deputy chief physician in front of her, "Old Qian, let me introduce to you, this is Dr. Sun Lien." Doctor of the Comprehensive Diagnosis Center of Ningyuan Fourth Hospital. She deliberately emphasized the six words "comprehensive diagnosis center" and said, "Today, Dr. Sun happened to come to Changning, and I asked him to come over to help come up with ideas and do a consultation." ”

"Oh, the doctor from the Ningyuan Fourth Hospital. The deputy director Qian changed his face to a happy face, "Zheng Guoyou is okay? He is now the deputy director of the emergency department of your hospital?"

"Director Zheng is an orthopedic department. Sun Lien corrected the statement of the deputy director Qian in front of him, "Last year, he had a heart attack, but it was not a big problem, and two stents were installed. It's been pretty good lately. ”

Deputy Director Qian's expression changed to cordial, "It's good, it's good, Dr. Sun...... Is it Director Zheng's student?"

"I studied with Director Liu Tangchun. Sun Lien continued to smile, completely ignoring the doctor's certification in front of him as if he had a code, "I heard Dean Mei say on the way here, do you think this is an autoimmune disease?"

"There is this suspicion, but it has not been fully examined. Deputy Director Qian looked a little embarrassed, "The patient's family still has some distrust of the hospital now. It was difficult for us to communicate with them. ”

Mei Ying frowned when she heard this, this was a difficulty she had not encountered before. The reason why she was able to move Li Yuhan and her parents to come to the little-known Zhongfu Hospital for treatment was because of the promise that "the treatment would be free". After multiple episodes in the past two years, Li Yuhan's family has changed from the original "passable" to the current "difficult". Now that their daughter is ill again, it is unlikely that the family, who was attracted by the free treatment, should not be uncooperative.

"Let's go talk to the family. After a brief discussion with Sun Lien, Mei Ying decided to change the scheduled plan and directly took Sun Lien and Deputy Director Qian to talk to Li Yuhan's parents.

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Li Yuhan's ward is a family-oriented single room. The walls of the room are painted in pink, and there are cartoon murals that look like children will probably love. The room has a set of sofas and a wooden bed for the escort to take a nap, as well as a TV and other equipment.

Such wards are not absent in public hospitals. However, the price is extremely high, and it is very sought-after and difficult to book. Mei Ying and Zhongfu Hospital seem to be ready to take the high-end route, and such a single ward has basically become the mainstream configuration in Zhongfu Hospital.

"Mr. Lee. After Mei Ying knocked on the door of the ward, she saw Li Yuhan's father with a sad face, she smiled slightly, looked at Li Yuhan on the hospital bed on the side and asked, "How does the child feel today?"

"Or ...... Draw out. Li Yuhan's father sighed, "Doctor Mei, can I take the child out of the hospital?"

"Discharged?" Mei Ying asked with some surprise, she glanced at Li Yuhan on the bed again, "Her condition hasn't improved, has it?"

Li Yuhan's father lowered his head and said after being silent for a while, "I...... I don't know if the child can get better if he is treated like this. In case it is the same as her sister, we can't stand it if we can't save it in the end. Rather than this, it is better to go home......" His voice grew quieter and his head lowered. It was as if an invisible mountain was weighing heavily on his neck, making it difficult for him to breathe.

"Since we promised free treatment, we won't charge you a penny. Mei Ying said in a deep voice, "And we are also very active in organizing treatment...... Before Mei Ying finished speaking, Sun Lien, who had been standing next to her, suddenly spoke, "You just said that the child's sister was also sick before?"

Li Yuhan's father raised his head, he obviously didn't want to think about this question carefully, but the young man in front of him was wearing a white coat, and he probably was also a doctor. He took two deep breaths and replied, "Yes." ”

"This is not documented on the case. Sun Lien took out the case in his hand, and after quickly flipping through it, he was a little dissatisfied, "How is this medical history collection done?"

"We ......," Deputy Director Qian looked a little embarrassed, "When we asked before, the patient's family didn't mention it. ”

"You didn't ask, we ......," Li Yuhan's father sighed, "Her sister died when she was eight years old...... The child's mother was very irritated, and after that we tried not to mention it. ”

"What's wrong with her sister?" Sun Lien began to ask for a medical history while the iron was hot, although the death of an eight-year-old child was a very sad thing, but if the relationship between the two cases could be discovered, maybe it would be possible to fight for this fourteen-year-old girl. "This is the same type of convulsions?"

She smoked too...... But it's not because of this. Li Yuhan's father took a deep breath, "She didn't have good eyes at first, and she had an operation on the retina. Later, I thought it would be fine, but when the child was sent to school by her grandmother...... Walking down the street, she suddenly couldn't. Taken to the hospital...... The doctor didn't save him. ”

This description is a bit empty, but Sun Lien is still keenly aware of something wrong in it, "Retinal surgery?"

"Right...... It's a retinal ...... Abscission. Li Yuhan's father showed a somewhat painful expression, "Do you have to ask this?"

"This may be of great help to our diagnosis. Sun Lien made a note in the notebook he carried, then walked to the bedside and began to observe the fourteen-year-old girl in front of him.

Don't look at the status bar first, the first time you see this child, Sun Lien can see that there is something wrong with her. As a fourteen-year-old girl who is about to enter puberty, she is a little too short.

"How tall is she?" Sun Lien asked about the situation as he looked at her status bar.

"Li Yuhan, female, 14 years old, hyperlactic acidemia (10347.42.51), body hair (9872.21.14), poor exercise tolerance (8873.29.17)"

"One meter four. Li Yuhan's father is very clear about his daughter's height, "She is a little shorter than children of the same age." ”

"Dean Mei, please see if the child has heavy body hair. Sun Lien stepped back a little, making way for the space next to the bed, and at the same time intimately closed the curtain next to the bed for Mei Ying. After about a few tens of seconds, Mei Ying's voice came out from inside, "The child's body hair on her back is heavier - she used hormones like this before?"

Sun Lien spent a few minutes explaining to Li Yuhan's father what hormones are, and then got an affirmative answer, "That's how it was when she was a teenager." ”

Sun Lien nodded, he probably had a direction. But this diagnosis did not come down for a short time, "Where is the child's mother?"

"She's at home. Mei Ying replied for Li Yuhan's father, "She has been with the child since she was admitted to the hospital, and I asked her to go back and rest for a while." ”

"Ask the child's mother to come over for a moment, I have some questions to ask. Sun Lien nodded, and without saying anything, he walked out of the ward with Mei Ying and Deputy Director Qian with a confused face.

Mei Ying asked with some urgency, "Do you have a direction?" Sun Lien's question in the ward was obviously targeted. And it's not the kind of "locking the problem to a certain department", judging from the problem, Sun Lien has a disease that is already highly suspected.

"This can only be a guess until there is conclusive evidence. "Her symptoms are not typical, which is why she has been diagnosed with viral encephalitis twice." He paused and continued to ask, "Can the current equipment in our hospital do genetic testing?"

"I can't do it. Now it was Deputy Director Qian's turn to speak, "There is no corresponding equipment in the genetic examination institute, if you want to find out whether there is a mutation at a certain gene site, you can only take samples and send them to an outside company for testing." He looked at Sun Lien and asked with some hesitation, "Do you suspect that it is a genetic disease?"

"At the moment, that's the most likely. Sun Lien nodded, not hiding his diagnostic thoughts at all, "The child's sister also has a history of convulsions, I think this is a major reminder." ”

"So you're going to ask the child's mother to come to the hospital?" Mei Ying suddenly realized, "You think it's some kind of matrilineal genetic disease...... Mitochondrial encephalomyopathy?" As soon as she asked the question, she immediately began to shake her head, "No, this child has no favoritism, no intellectual developmental disabilities......"

Sun Lien nodded in affirmation of Mei Ying's guess, "I doubt it too." So I said her symptoms weren't typical. There is a good chance that this mutation site is not a traditional site. ”

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Thanks to the constant high pressure of the old thing and the training of Dean Wu Youqian, Sun Lien is now more sensitive to hereditary diseases than an emergency doctor.

If Mei Ying continued to ask, Sun Lien would directly locate Lin Yuhan's illness to MELAS syndrome. This is a branch of mitochondrial encephalomyopathy and one of the least likely to be thought of by neurologists.

Most patients with MELAS develop before the age of 40, and the median age of onset is around 16 years. Moreover, most patients have obvious symptoms such as hemiplegia and intellectual developmental disorders. Like Lin Yuhan, the age of onset is 12 years old, and there are almost no reports of any intellectual disability and hemiplegia.

The reasons for the previous misdiagnosis were also very simple, Lin Yuhan's symptoms were not typical, and the First People's Hospital of Changning City and the Second Central Hospital of Ningyuan City only performed an MRI examination on her. Especially in the Second Central Hospital, their misdiagnosis is actually the most serious - the abnormal brain MRI signal of acute disseminated encephalomyelitis accumulates mostly white matter, while Lin Yuhan's imaging proves that her lesions are mainly concentrated in the cortex. Due to the failure to carefully compare and dynamically observe the changes in her cranial imaging disease, the second hospital not only missed the lactate peak of MRS spectroscopy, which is the most important MRS spectroscopy for the discovery of MELAS, but also misdiagnosed her as acute disseminated encephalomyelitis.

Thinking of this, Sun Lien had more sympathy for the gods of the Second Academy. The reason why they failed to perform multiple MRI examinations, needless to say, Sun Lien himself could guess - the patient's family's financial situation did not allow it. They also want to solve the problem at once, and try not to hit the poor family's financial situation again.

Lin Yuhan's mother quickly rushed to the hospital and revealed more valuable medical history information under Sun Lien's questioning.

Lin Yuhan's maternal grandmother died of myocarditis, and Lin Yuhan's mother had very poor endurance and often had panic. She was also diagnosed with myocarditis at the age of 26 and was treated accordingly.

"Take a sample of the patient and her mother, send it for testing. After sending Lin Yuhan's mother away, Sun Lien put down his pen and said to Mei Ying on the side, "Give them mitochondrial DNA mutation site gene analysis and stop Lin Yuhan's hormone therapy." Give her levocarnitine, coenzyme Q10 and B vitamin supplements. What if you have a seizure...... Oral lamotrigine is continued. As long as the hyperlactic acidemia in her body is controlled, oral lamotrigine is sufficient. ”

Deputy Director Qian, who had been stunned from beginning to end, finally reacted and began to give medical advice according to Sun Lien's advice. Mei Ying asked incredulously on the side, "How do you know?"

"Reasonable speculation. Sun Lien smiled, he was actually far from being as relaxed as he appeared. It's very tiring for your brain to run at full capacity, especially when the status bar is open. "Eliminate all possible options, and all that's left is the correct answer. ”

"It's not that easy. I don't know if I plan to excuse myself, Deputy Director Qian said, "It will take a lot of effort to identify this disease as a hereditary disease, and it will be able to diagnose MELAS syndrome so quickly...... Dr. Sun is amazing. ”

"I didn't really do anything special. Sun Lien sighed, "The reason why this diagnosis went smoothly is due to luck accounting for a large part of the credit. If it weren't for Lin Yuhan's father mentioning his daughter, who died young, I might have had to fight a few times about my own immune system. ”

Sun Lien is really not polite when he says this, no matter how talented a doctor is, he needs to have enough evidence to lock down the cause. After four consecutive admissions, Lin Yuhan's parents did not mention that they had a child, which is not just a mistake in collecting medical history in other hospitals. Maybe they even lied to the doctor in order to avoid talking about this topic that made them sad.

Sun Lien didn't want to judge the rights and wrongs of the parents' measures, he was just a little lucky, and he was glad that the location of Lin Yuhan's gene mutation was not the same as that of regular MELAS syndrome patients. Fortunately, Lin Yuhan's father slipped out of his mouth under sadness.

And I'm glad I still have a status bar to rely on.

"I've heard a doctor from the Association say it before. Sun Lien sat in his seat and recalled a conversation between himself and Yuan Ping'an.

"What great ability can we do with the association? We all ask for the same medical history, prescribe the same medicine, and treat the same treatment. Yuan Ping'an, who went to the countryside to support, said to Sun Lien on the phone, "But patients with incurable diseases are willing to run to the association, and the association is able to take care of other people's diseases." Why do you say that?"

Without waiting for Sun Lien to answer, Yuan Ping'an himself gave the answer in his mind, "In fact, it is just two words, 'serious'." We are the best hospital and the hospital that is the one that covers the entire healthcare system. All the patients who have been referred many times in the local hospital come to the association, and there is no way to do it. So we have to be serious. Carefully collect medical history, carefully analyze, and carefully study...... There is nothing magical about Tongxie. It's just those two words. ”