Chapter 754： Picking disease
Zheng Ren smiled and stood up, bowed slightly, let Director Luo sit down, and he stood in front of Director Luo.
Young, capable, but not arrogant, Director Luo is very satisfied with the performance of Zheng Ren.
Zheng Ren immediately said: "The following hospital, diagnosis of intestinal obstruction, generally with standing abdominal perforation or according to clinical symptoms. According to the patient's family, several times diagnosed intestinal obstruction, but the inpatient department overturned the diagnosis. I Guess, this means that to the inpatient department, the intestinal obstruction is solved. And it is the kind that you have no medication and you are good."
Director Luo listened quietly and did not interrupt Zheng Ren’s words.
"So, I guess the patient's intestinal obstruction is only short-term and temporary. Coupled with the patient's family, the patient is easily tired, I have guessed whether the patient is affected by both skeletal and smooth muscle. If this is the case, then The possibility of mitochondrial myopathy is greater."
Dr. Shen listened to it...
He has seen Zheng Ren’s surgery and knows that Zheng’s boss has a very high level of intervention. A little six months ago, the opening of the ophthalmic artery made Dr. Shen open his eyes.
At that time, I almost got a screen and was given training by the director of the hole.
It is possible that Zheng Boss can get the nomination for the Nobel Prize. Dr. Shen thinks this is quite reasonable.
However, is his diagnosis of rare diseases so good?
Mitochondrial myopathy? What kind of ghost is that? Dr. Shen suddenly lost his mind.
As a medical doctor, he did not understand the dialogue between Zheng Ren and Director Luo. His face was a little red.
"So, you saw the EMG?" asked Director Luo.
"Local hospitals are basically headaches and headaches. But EMG tests... I am blunt, in local hospitals, the amount done is very small, and it is usually done by neurology."
"Oh? Then?"
"Because I didn't listen to the patient's family's history of going to the neurology clinic, I guess it is a myocardiogram examination by an emergency doctor when a muscle weakness occurs." Zheng Ren said calmly: "This kind of examination is blind. But when it comes to luck, it touches the key."
Take a chance...
Director Luo felt very angry and funny to Zheng Ren. This little guy spoke really is very frank.
When a doctor, who wants to admit to taking a chance?
However, it is limited to the level of science and the level of diagnosis. Even in the Imperial City, many diseases are diagnosed with luck, not to mention local hospitals.
Especially the particularly rare diseases such as mitochondrial myopathy.
This disease has nothing to do with the Department of Gastroenterology, so Director Luo did not study it. What he is curious about is how the little doctor in front of him diagnosed him.
Can the Nobel Prize candidate be so powerful in interdisciplinary diagnosis?
Things seem to start getting more and more interesting.
"EMG, there are abnormalities, but abnormal radio waves are not obvious.
Electromyography is the most common type of narrow EMG in a local hospital. The percentage of multiphase waves generally does not exceed 20%, but there are several stages with slight overshoot. Different muscles have different normal range of values, but in the short time of doing myoelectricity, the later period has gradually returned to normal. ”
At this time, not only Dr. Shen, even Director Luo is a bit embarrassed.
What is Zheng boss talking about?
"The report only writes conclusions, such as interference phase, mixed phase, simple phase, and pathological interference, but if you look at the waveform, you will find that the waveform is wrong at the very beginning." Zheng Rendao.
Silence, when Zheng Ren did not speak, the director’s office was silent.
Soon, Zheng Ren’s voice broke the silence again.
"My judgment is that the EMG is problematic, not neurogenic, but a change in the muscle itself. This speculation is consistent with the generalized weakness of the patient's family, the EMG changes, and the smooth muscle is also There are occasional changes in the disease, only mitochondrial myopathy."
Zheng Ren said very surely, unconsciously, Director Luo has already believed.
Because of the meticulous logic, it is also because of the aura of the Nobel Prize candidate.
Mitochondrial myopathy is a group of multisystem diseases that are mainly caused by brain and muscle involvement caused by a rare mitochondrial structure or dysfunction.
It is usually hereditary in the mother, more common in women, and the onset time is not certain. It is possible from infant to old age.
Since muscle and brain tissues are highly dependent on metabolism such as oxidative phosphorylation, regardless of whether nDNA or mtDNA alone or both are involved, the clinical symptoms are often systemic.
It is only because of the different degrees of involvement of various enzyme systems that the clinical manifestations are different, artificially dividing mitochondrial diseases into two categories, namely mitochondrial myopathy and mitochondrial encephalopathy.
This patient should be the manifestation of mitochondrial myopathy.
This is a relatively mild, easily ill-caused encephalopathy.
"Is it all speculation and inference?" Director Luo said softly.
Like asking Zheng Ren, it is like talking to himself.
Zheng Ren’s words, I don’t understand, it sounded like a cloud, but Director Luo heard a little taste.
Out of professional nature, Director Luo’s first thought was to “pick up the fault”!
There is no hard evidence, this is the biggest problem.
However, the examinations brought by the family members of the patients simply cannot provide a definitive diagnosis. If you suspect that it is mitochondrial myopathy, you can check the genetic test to confirm the diagnosis.
But this is only a possibility, Zheng Ren’s tone of speech is too certain No, Director Luo. "Zheng Ren pointed to the patient's information and said: "I just frowned when I saw you reading this film. You are also seeing an abnormality. ”
"Can't be said to be abnormal, it may be artifacts, but the patient's intestinal smooth muscle group, the image of some positions seems to have problems." Director Luo said.
"Yes, that is, abdominal CT, in fact, has provided relatively reliable evidence." Zheng Rendao: "mitochondrial myopathy, in imaging..."
Speaking of the CT film, Zheng Ren’s attitude and EMG are different.
Dr. Shen knows that Xiao Zheng’s boss is doing 64-row 3D CT, which is a must.
Before he left for a half year ago, Director Kong immediately organized everyone to learn the reconstruction of the liver 64-row three-dimensional CT, and quickly spread it in the clinic.
This type of examination has long been used clinically. But before, there were no surgeons to do it. The CT room was based on software.
At first, everyone had some diarrhea, but Director Kong suppressed all dissent with an iron fist.
After a really in-depth study, everyone... At least Dr. Shen recognized the benefits of 64-row 3D CT 3D reconstruction.
Many tumor-releasing factors, re-established abnormally proliferating blood vessels, can be directly displayed with 64-row CT three-dimensional reconstruction, increasing the level of detail of the operation.
Young, capable, but not arrogant, Director Luo is very satisfied with the performance of Zheng Ren.
Zheng Ren immediately said: "The following hospital, diagnosis of intestinal obstruction, generally with standing abdominal perforation or according to clinical symptoms. According to the patient's family, several times diagnosed intestinal obstruction, but the inpatient department overturned the diagnosis. I Guess, this means that to the inpatient department, the intestinal obstruction is solved. And it is the kind that you have no medication and you are good."
Director Luo listened quietly and did not interrupt Zheng Ren’s words.
"So, I guess the patient's intestinal obstruction is only short-term and temporary. Coupled with the patient's family, the patient is easily tired, I have guessed whether the patient is affected by both skeletal and smooth muscle. If this is the case, then The possibility of mitochondrial myopathy is greater."
Dr. Shen listened to it...
He has seen Zheng Ren’s surgery and knows that Zheng’s boss has a very high level of intervention. A little six months ago, the opening of the ophthalmic artery made Dr. Shen open his eyes.
At that time, I almost got a screen and was given training by the director of the hole.
It is possible that Zheng Boss can get the nomination for the Nobel Prize. Dr. Shen thinks this is quite reasonable.
However, is his diagnosis of rare diseases so good?
Mitochondrial myopathy? What kind of ghost is that? Dr. Shen suddenly lost his mind.
As a medical doctor, he did not understand the dialogue between Zheng Ren and Director Luo. His face was a little red.
"So, you saw the EMG?" asked Director Luo.
"Local hospitals are basically headaches and headaches. But EMG tests... I am blunt, in local hospitals, the amount done is very small, and it is usually done by neurology."
"Oh? Then?"
"Because I didn't listen to the patient's family's history of going to the neurology clinic, I guess it is a myocardiogram examination by an emergency doctor when a muscle weakness occurs." Zheng Ren said calmly: "This kind of examination is blind. But when it comes to luck, it touches the key."
Take a chance...
Director Luo felt very angry and funny to Zheng Ren. This little guy spoke really is very frank.
When a doctor, who wants to admit to taking a chance?
However, it is limited to the level of science and the level of diagnosis. Even in the Imperial City, many diseases are diagnosed with luck, not to mention local hospitals.
Especially the particularly rare diseases such as mitochondrial myopathy.
This disease has nothing to do with the Department of Gastroenterology, so Director Luo did not study it. What he is curious about is how the little doctor in front of him diagnosed him.
Can the Nobel Prize candidate be so powerful in interdisciplinary diagnosis?
Things seem to start getting more and more interesting.
"EMG, there are abnormalities, but abnormal radio waves are not obvious.
Electromyography is the most common type of narrow EMG in a local hospital. The percentage of multiphase waves generally does not exceed 20%, but there are several stages with slight overshoot. Different muscles have different normal range of values, but in the short time of doing myoelectricity, the later period has gradually returned to normal. ”
At this time, not only Dr. Shen, even Director Luo is a bit embarrassed.
What is Zheng boss talking about?
"The report only writes conclusions, such as interference phase, mixed phase, simple phase, and pathological interference, but if you look at the waveform, you will find that the waveform is wrong at the very beginning." Zheng Rendao.
Silence, when Zheng Ren did not speak, the director’s office was silent.
Soon, Zheng Ren’s voice broke the silence again.
"My judgment is that the EMG is problematic, not neurogenic, but a change in the muscle itself. This speculation is consistent with the generalized weakness of the patient's family, the EMG changes, and the smooth muscle is also There are occasional changes in the disease, only mitochondrial myopathy."
Zheng Ren said very surely, unconsciously, Director Luo has already believed.
Because of the meticulous logic, it is also because of the aura of the Nobel Prize candidate.
Mitochondrial myopathy is a group of multisystem diseases that are mainly caused by brain and muscle involvement caused by a rare mitochondrial structure or dysfunction.
It is usually hereditary in the mother, more common in women, and the onset time is not certain. It is possible from infant to old age.
Since muscle and brain tissues are highly dependent on metabolism such as oxidative phosphorylation, regardless of whether nDNA or mtDNA alone or both are involved, the clinical symptoms are often systemic.
It is only because of the different degrees of involvement of various enzyme systems that the clinical manifestations are different, artificially dividing mitochondrial diseases into two categories, namely mitochondrial myopathy and mitochondrial encephalopathy.
This patient should be the manifestation of mitochondrial myopathy.
This is a relatively mild, easily ill-caused encephalopathy.
"Is it all speculation and inference?" Director Luo said softly.
Like asking Zheng Ren, it is like talking to himself.
Zheng Ren’s words, I don’t understand, it sounded like a cloud, but Director Luo heard a little taste.
Out of professional nature, Director Luo’s first thought was to “pick up the fault”!
There is no hard evidence, this is the biggest problem.
However, the examinations brought by the family members of the patients simply cannot provide a definitive diagnosis. If you suspect that it is mitochondrial myopathy, you can check the genetic test to confirm the diagnosis.
But this is only a possibility, Zheng Ren’s tone of speech is too certain No, Director Luo. "Zheng Ren pointed to the patient's information and said: "I just frowned when I saw you reading this film. You are also seeing an abnormality. ”
"Can't be said to be abnormal, it may be artifacts, but the patient's intestinal smooth muscle group, the image of some positions seems to have problems." Director Luo said.
"Yes, that is, abdominal CT, in fact, has provided relatively reliable evidence." Zheng Rendao: "mitochondrial myopathy, in imaging..."
Speaking of the CT film, Zheng Ren’s attitude and EMG are different.
Dr. Shen knows that Xiao Zheng’s boss is doing 64-row 3D CT, which is a must.
Before he left for a half year ago, Director Kong immediately organized everyone to learn the reconstruction of the liver 64-row three-dimensional CT, and quickly spread it in the clinic.
This type of examination has long been used clinically. But before, there were no surgeons to do it. The CT room was based on software.
At first, everyone had some diarrhea, but Director Kong suppressed all dissent with an iron fist.
After a really in-depth study, everyone... At least Dr. Shen recognized the benefits of 64-row 3D CT 3D reconstruction.
Many tumor-releasing factors, re-established abnormally proliferating blood vessels, can be directly displayed with 64-row CT three-dimensional reconstruction, increasing the level of detail of the operation.
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