godfather of surgery

Chapter 1135 Crash Phone Call

After Yang Ping came back from the Department of Neurology, he kept thinking about this question. This case seemed strange no matter how he looked at it.

With such obvious symptoms of central nervous system infection, how come the examination results show no biochemical abnormalities and no pathogens are found in the cerebrospinal fluid? This is a bit inconsistent with diagnostic logic.

Even for the rare amoebic meningitis, as long as you grasp the symptoms and think of the disease, you can put the cerebrospinal fluid under a microscope, find the protozoa and make a diagnosis immediately. However, now several times the protozoa have not been found in the cerebrospinal fluid.

If the current symptoms are symptoms of central nervous system infection, then his initial symptoms are more like hereditary epileptic seizures, and his epileptic seizures are very similar to those of patients on his grandfather's side, which is another significant feature of a genetic disease. However, the genetic lineage is Y chromosome inheritance, which excludes him.

When it comes to catching the symptoms, the evidence becomes problematic again.

What is the problem? What is not clear?
Could it be that the two diseases are superimposed on each other?

Generally speaking, medical diagnosis follows monism: using one disease to explain all of the patient's symptoms.

In fact, the underlying logic of monism is probability theory. Since the probability of two diseases combined is much lower than that of one disease alone, monism takes precedence and emphasizes the use of monism to think about diagnosis.

But since the underlying logic of monism is a matter of probability, it is not absolute. Things with low probability do not completely not happen. Could this patient's disease be a combination of two diseases? And for some reason, the two diseases caused the evidence to show abnormalities?
Since it is a difficult and complicated problem, we should break through conventional thinking and think with unconventional thinking. Since monism encounters difficulties, we might as well use dualism or even pluralism to solve the problem.

If this is the case, the problem is easy to explain. The two diseases are superimposed on each other, and there is some rare interfering factor behind both diseases. This interfering factor may be the same factor or may not be the same factor. There is no way to figure out what it is now.

There is no need to figure it out for now, we just need to figure out the two superimposed diseases.

Yang Ping immediately called Director Xu: While conducting genetic testing, continue to take cerebrospinal fluid to look for pathogens. He felt that the two diseases were mixed together and there were infectious factors.

Director Xu was also deeply inspired by this point of view and suddenly realized that if dualism is used to explain this case, the diagnosis will not be so passive in thinking.

Anyway, empirical treatment has been started there, so Yang Ping put the matter aside for the time being. He went to see Sisi, Ning Yu, and Luo Jin, who are currently volunteers for experimental treatment of the K virus.

All three of them recovered well, and the tumor cells were cleared to a certain extent. According to this treatment effect, after two or three treatments, the tumor cells in their bodies can be completely eliminated. This treatment effect can only be achieved by cell therapy for specific blood tumors.

The trial team has even more confidence in this new treatment, and teams in several laboratories are full of energy and hope to complete the Phase III clinical trial as soon as possible. This is their first biological agent to be marketed, so they naturally feel a great sense of accomplishment.

Ning Qi originally thought that her brother would need another life-and-death crisis, but she didn't expect the treatment to be so easy. After a few days of hospitalization and an IV drip, the problem was solved. She became more interested in Yang Ping's black technology and planned to continue to increase her donation to Yang Ping's scientific research fund.

In the treatment of tumors, Yang Ping finally made a breakthrough. This is the second major scientific research success after space-guided genes, and this success is also world-class.

However, he knew that the K virus could only treat a limited number of tumors, only two or three. He now had to consider how to expand the K virus and how to make it sensitive to certain tumors. This required comprehensive research on the tumor cells and then installing the corresponding modules on the K virus. The technology was very complex and required a lot of experiments to verify.
-
It has been quite busy these past two days. Yang Ping needs to arrange a second K virus treatment for Sisi, Ning Yu and Luo Jin, so he has no time to pay attention to the patient in the neurology department.

On the third day after the consultation, Director Xu called and said that the patient had started to have a high fever, with the highest temperature reaching 39.5 degrees Celsius, and was now in a coma.

Director Xu was in a dilemma as to whether to continue the empirical treatment. What if something went wrong and the patient's life was in danger? Treating the patient like this without sufficient evidence could easily get him into trouble.

So in fact, doctors also have differences in strategic capabilities. Good doctors can grasp the right direction strategically, while ordinary doctors have no strategic planning when treating patients.

Yang Ping pulled out the little boy's medical records again. He wanted to re-examine the case and sort out the whole process.

The patient, Yongqian, a 14-year-old boy, was admitted to the hospital one day after having convulsions without obvious cause. He had several convulsions after admission.

He started to have fever today, with the highest temperature reaching 39.5℃, accompanied by headache, dizziness, sudden coma, and several convulsions, each lasting 1-2 minutes. He also had stiffness of his limbs, unresponsiveness to calls, and urinary incontinence.

The most recent physical examination showed: body temperature 39.5℃, respiration 48 times/min, heart rate 98 times/min, blood pressure 90/62 mmHg, shallow coma, cold extremities, mottled skin, no response to calls, equal-sized and round pupils on both sides, about 4 mm, sensitive light reflex on both sides, rigid limbs, no rash on the body. The patient had a soft neck, no resistance, dyspnea, inspiratory concave sign, no palpable superficial lymph node enlargement, no cyanosis of the lips, pharyngeal congestion, large tonsils on both sides, coarse breath sounds in both lungs, dry rales in both lungs, strong and regular heart sounds without murmurs, flat and soft abdomen, no enlargement of the liver and spleen, normal bowel sounds, high muscle strength and muscle tone in the limbs, and a patency of the urinary catheter.

Yang Ping also glanced over the laboratory test results: white blood cells 12.60×109/L; red blood cells 4.62×1012/L; hemoglobin 125.00 g/L; platelets: 187.00×109/L; neutrophil percentage 89.70%; lymphocyte percentage 2.90%; monocyte percentage 7.30%; erythrocyte sedimentation rate 18 mm/1 h; prothrombin time 15.4 s; prothrombin normalized ratio 1.38; activated partial thromboplastin time 19.6 s; thrombin time 11.5 s; alanine aminotransferase 12 U/L; aspartate aminotransferase 21 U/L; AST/ALT ratio 1.62; total bilirubin 17.0 μmol/L; direct bilirubin 7.9 μmol/L; indirect bilirubin 9.6 μmol/L; total protein 67.8 g/L; albumin 42.5 g/L; globulin 25.3 g/L; potassium 3.21 mmol/L; sodium 132.0 mmol/L; creatine kinase 640 U/L; creatine kinase isoenzyme 30 U/L; lactate dehydrogenase 340 U/L.

Imaging examination: CT (brain plain scan) showed that the gyri were slightly widened and the sulci were slightly narrowed, which suggested the possibility of cerebral edema. Magnetic resonance imaging (brain plain scan + brain magnetic susceptibility imaging) showed a slightly high signal shadow in the T2 fluid attenuated inversion recovery sequence of the right parietal sulcus, which suggested the possibility of meningitis changes in combination with the medical history.

Combining these test results, Yang Ping can now completely believe that his judgment is correct. How can a hereditary disease cause a fever? So he still has an infectious disease, but the pathogen has not been found yet.

At that time, the symptoms of this central nervous system infection were atypical and in the initiation stage, so it was easily masked by epileptic seizures. Now the symptoms of central nervous system infection are very obvious, and even if there is no evidence of pathogens, it can be diagnosed based on clinical symptoms.

It was correct to treat it as primary amoebic meningitis. If we hadn't bought those two days, the mortality rate would be 97%. So no matter if it is an amoebic infection or not, it must be treated as such. Even if it is wrong, it is not a big deal. Once the treatment opportunity is missed, it will be too late to regret.

"Continue with empirical treatment." Yang Ping gave his opinion.

It’s only been two days since the anti-amoebic treatment began, so how can we tell if it’s effective?
As for his epilepsy symptoms, they are very similar to the symptoms of the patients on his grandfather's side. Before the results come out, we will temporarily treat the symptoms. There is a question of priority here, and we need to focus on the severity and urgency of the problem now.

With the support of Professor Yang, Director Xu has become much bolder. In addition to symptomatic treatment, she now treats the patient completely according to the amoebic meningitis and continues with the original treatment plan. In fact, in this case, the use of this empirical treatment also requires sufficient courage and the understanding of the family members.

In medicine, many times it is not about the heart. No matter what your starting point is, if the result is like this, you are responsible.

Fortunately, the patient's family was quite understanding and trusted Sanbo Hospital. His parents agreed with Director Xu's treatment plan. With Yang Ping's support, Director Xu had no obstacles.

In the afternoon, Director Xu called again, and seemed very excited. She told Yang Ping: Ameba-like motile bodies were found under low-power microscopy in the cerebrospinal fluid; several trophozoites with active pseudopods were found under high-power microscopy; covered with a cover glass, cedar oil was added, and wet mount observation under an oil microscope clearly showed the movement of pseudopods of amoeba trophozoites extending and endoplasm flowing in. The volume of trophozoites is about 10~35μm, oval, elongated or irregular, with vacuoles or contractile vacuoles and particles of varying sizes in the cytoplasm, and one nucleus can be seen, with thick and dense nucleoli and no chromatin.

Director Xu read out the results of the cerebrospinal fluid smear test over the phone word for word, explaining that everyone's decision at the time was correct. If the medication had not been used according to experience, the patient might have missed the best time for treatment and eventually died.

Now, if the most appropriate medicine is used at the best time, it is entirely possible for the patient to survive.

After the fifth day of treatment, the patient's condition began to improve, and other symptoms improved, except that epilepsy still occurred.

Yang Ping sorted out the case and gradually became clear in his mind. His speculation was correct. This was a case that could not be explained by monism, because it was a mixture of a special genetic disease and primary amoebic meningitis. First, the genetic disease attacked, and then slowly the symptoms of amoebic meningoencephalitis appeared. The two were intertwined, two rare diseases intertwined, and this extremely low probability made experienced doctors completely confused.

A week later, except for epileptic seizures, all other symptoms had disappeared, and he became one of the very few patients who could survive primary amoebic meningitis.
-
At the research institute, the second treatment of Sisi, Luo Jin and Ning Yu began. After accumulating experience from the previous few times, Yang Ping now decided to start the treatment with three people together.

Yang Ping was very conservative in the dosage of this second treatment. Because of previous experience, he reduced the theoretically estimated dosage a little to ensure safety. Now that the disease is under control, there is no need to be too radical.

The treatment this time was very mild. Sisi did not even have a low fever. After the injection of the K virus, it was just like an ordinary drug drip. Yang Ping suspected that this biological agent modified with adenovirus as a template had the same adaptive ability as the virus, and it had the ability to iterate and mutate in the body.

This situation also occurred in previous tests. The results of the first test were good, but the results of the second test were very poor. This was because the virus had completed iterative mutations in the body, and its abilities in some aspects had become stronger, while its abilities in some aspects had also weakened. This was also the reason why the biological agents were later modified.

Sisi's second treatment should have cleared a lot of tumor cells. Luo Jin started treatment later, so his progress was not as fast as Sisi's. Ning Yu's condition was the mildest, because he was sent in for treatment as soon as he showed signs of recurrence. So after two treatments, the examination found that his tumor cells had been completely cleared.

Ning Yu is the first patient cured by this new therapy, and his name will go down in medical history.

The case reports of the three cases were published in the journal "Medical", which caused an immediate sensation and the whole world went crazy about it. Self-translated versions of the journal "Medical" in various languages ​​flew everywhere and everyone rushed to buy them. Even some ordinary people who were not doctors or medical researchers also joined the ranks to buy the journal "Medical".

The phone at Sanbo Research Institute is bombarded with calls every day from patients or their families who are asking for advice on new treatments. There is really no other way, and the doctors at the institute can only pick up the phone and put it on their desks.

When Yang Ping introduced the space-guided genetic theory, it only caused a sensation in the medical academic circle, and ordinary people had no interest in this high-sounding medical theory.

But this time it was different. The paper on the clinical treatment of K virus came to the fore, like a whirlwind. Cancer patients and their families around the world were excited. They saw hope.

"Professor? What should I do? I never thought a paper would cause such a sensation."

Tang Shun looked helpless.

Yang Ping looked at the phone on the table and couldn't help but smile bitterly, because all the phones in the institute are like this now. Except for the internal emergency phone, as long as it can receive and make external calls, as long as the microphone is put down, the phone will be busy 24 hours a day until it collapses.

Even Yang Ping's director's office phone number was not spared. I don't know where these people got the phone number.

The cell phones of some doctors in the research institutes also began to be used gradually. Because the calls could not be connected, these people got the doctors' private cell phone numbers from somewhere and called them directly. The doctors had to turn off their phones. Communication between diagnosis and treatment in the same ward relied on shouting, and communication between different wards relied on the hospital's internal telephone.

"It should be better after a while!" Yang Ping had no choice.

Lu Xiaolu asked: "How do they know our cell phone numbers?"

Tang Shun smiled and said, "As long as there is enough market demand, someone will definitely do it."