godfather of surgery

Chapter 463 Will Monkeys Have Lumbar Disc Herniation?
"Help him out?"

Zhang Lin was worried that the intern would fall down again.

In case something goes wrong, no one can bear the responsibility, one thing more is worse than one thing less.

The intern stubbornly shook his head and insisted on staying in the operating room. As a surgeon, he will have to face more exciting scenes in the future, and this level must be passed.

Song Zimo seemed to see himself back then, leaning on the wall of the Moliu emergency center, shaking and spinning.

He understands the intern's psychology best at this time, and he is afraid that he will be kicked out of the surgery profession because of this incident. Even if his heart is overwhelmed, he must pretend that nothing happened to tell everyone: I can do it!

"Let him stay. Be careful. If you feel uncomfortable, tell him at any time. In fact, it's nothing. After watching too much, you will naturally get used to it." Song Zimo encouraged the interns and asked Zhang Lin not to tell him to go out.

Zhang Lin naturally didn't dare to disobey Song Zimo's words. No one could shake Song Zimo's status as the second brother in Keli.

In the past, Zhang Lin and Xiao Wu often dreamed of competing for the position of the third brother. Since Xu Zhiliang joined, they completely cut off this idea.

This stuttering is not only a little paranoid due to hard work, but the key is that his brain is still working. Zhang Lin even suspects that this person's mouth can't keep up with the speed of his brain, so he stutters.

The resection of gouty nodules is no different from the resection of body surface tumors. The first-level surgery is the most primary surgery.

However, it is very difficult to maintain the normal healing of the postoperative surgical incision. Every detail must be pursued to the extreme, bleeding must be thorough, and layered sutures must be tight without leakage.

Once leaked, interstitial fluid mixed with uric acid crystals will seep endlessly from the gap of the surgical incision, resulting in the incision being unable to heal eventually.

"Lime" is impossible to clean, it is almost everywhere, has penetrated into cartilage, synovium, joint capsule, ligament, tendon, almost every kind of tissue around the joint is eroded by it, and this erosion has no boundaries.

As long as the lump "lime" is removed, a large amount of normal saline is washed repeatedly, and the white turbid "lime" water flows from the suction device to the suction tube into the collection bottle.

Excess skin and fascia were trimmed, the incision became fusiform, and negative pressure drainage was placed at the surgical site for some huge gouty nodules.

After hard work, more than 40 gout nodules all over the body were gradually removed, and the operation was over.

The patient was restored to normal in appearance, no longer a disgusting "monster", with both lower limbs amputated at the knees, the result of years of indulgence with gout.

In the future, if he can persist in taking the medicine and control the uric acid within the range of 180-300 μmol/L, he still hopes to live a normal life, and some of the uric acid crystals deposited in the body will slowly dissolve.

The intern suppressed the discomfort and finally stabilized himself. Although his face was ugly, he did not fall down after all. He pretended to stand in the operating room relaxedly, declaring that he could be a surgeon.

"Fatty, you haven't had gout for a long time, right?"

Zhang Lin took the opportunity to ask Fatty Liang when he was free.

"I haven't had an attack for a year. I take one tablet of allopurinol every day, which is as punctual as washing my face and brushing my teeth. Now my uric acid is stably controlled in the early [-]s."

"My father-in-law also suffers from gout. Do you have any good advice on medicine?" Zhang Lin said, and Xiao Wu also listened attentively.

The lecture time is short, and many things are still not fully understood.

"When doing HLA-B*5801 gene screening, if it is negative, allopurinol is the first choice. Don't look at it as cheap, thinking that it is not a good product. If the HLA-B*5801 gene is negative and there are no other contraindications, allopurinol is definitely The best, both in terms of efficacy and safety, is the best. According to the latest guidelines of the American College of Rheumatology on gout, the recommended first-line drug is allopurinol. In view of the high proportion of positive HLA-B*5801 genes in Han Chinese , no first-line recommendation, but if it is confirmed that the HLA-B*5801 gene is negative, allopurinol is the first choice." Fatty Liang is unequivocal, he has already researched these drugs thoroughly.

"It makes sense, the elderly have a little bit of high blood pressure or something, febuxostat is more cautious, I will ask him to do HLA-B*5801 gene monitoring when I have time, it seems a few hundred dollars, right? If it is negative, I will ask him to change it Allopurinol." Zhang Lin was relieved when he got a clear opinion.

Xiao Wu also wrote it down, hoping that his father-in-law's HLA-B*5801 gene test would be negative.

"Get over the bed!" Xu Zhiliang ordered by throwing the gloves he took off into the yellow collection bucket.

As Zhang Lin's superior doctor, Xu Zhiliang is full of majesty.

Hearing the call from the superior doctor, Zhang Lin immediately cheered up, and together with Gui Peisheng and interns, lifted the patient and transferred the patient from the operating table to the flat car.

The two amputated limbs were packed in plastic bags and labeled. The cleaners of the operating room came in, completed the handover operation, and sent the short limbs to the pathology department.

"It's best to go to the pathology department and stay for three months. Stand by the material collection table in the giant examination room, eat meat buns, and watch the teacher decompose the liver, stomach, and intestines. You will pass the test." Song Zimo patted the intern's Shoulder.

The intern felt nauseous for a while, and felt nauseous when he heard this scene, let alone eating buns while watching, what a high level of cultivation that is.

At this time, Yang Ping was answering the phone in the corner, and Huang Jiacai from the magic city called.

"The external fixator of the spine has been delivered to the Guilin laboratory. We are going to Guilin in time. The operation on the [-] monkeys is estimated to take two days. Fatty, you can go with me. Is the anesthesia of the monkeys okay? Xiaowu, you can arrange it." Let's go out soon." Hanging up the phone, Yang Ping arranged to go to Guilin.

"Go there after get off work this Friday? Mr. Song and I will go with you. Lao Xu and Zhang Lin will stay in the ward. Next time, we will switch. We will leave after get off work on Friday and return on Sunday night. I will ask them to prepare their skins one day in advance." Xiao Wu is in charge of external relations. , the outreach activities of these scientific research activities also belong to the scope of his work.

The so-called skin preparation is to remove hair from the surgical site and clean the skin.

The body hair of monkeys is much more luxuriant than that of humans, and skin preparation is also a arduous task. Forty monkeys have to use electric shaver to remove all the body hair on their backs.

"There are anesthesia equipment and drugs over there. I have shown you the list of equipment and drugs. Is there any problem?" Xiao Wu asked Fatty Liang.

Forty monkeys were given anesthesia at a time, which was the first time.

The amount of anesthetic can only be adjusted according to the weight of the monkey according to the human body. Fatty Liang also consulted Huaxi’s instructor in advance. The instructor is researching a new type of local anesthetic and is currently in the stage of animal experiments. The instructor has a wealth of knowledge about the anesthesia after the experiment. experience of.

Scientific research is hard work, especially some basic scientific research, which is very hard, hard and tiring, and there is no money, so naturally no one is willing to do it.

But basic scientific research is the most important, just like the foundation of a building, without a solid foundation, no matter how beautiful the building is, it is futile.

Forty monkeys were implanted with external fixators after the operation, and the external fixators were adjusted every day after the operation. Which screws, how many times a day, and how many scales were rotated at a time, must be meticulous.

This is not enough. We need to take X-rays, MRI, and CT of the monkeys on a regular basis to analyze the image data, take some tissues for microscopic analysis, and conduct dynamic observation of the firmness of the external fixation pins. If there is a problem in the middle, record and analyze the problem.

These tasks will be completed by doctors sent by Xiehe, who have good scientific research literacy.

The patient woke up from anesthesia and returned to the ward. Although the whole body was covered with gauze, there were no raised bumps under the gauze.

If all goes well, after [-] days, he can wear a prosthetic to train his ability to walk.

Back in the ward, Yang Ping was fine, and read the monkey images sent by Guilin. Concord’s laboratory in Guilin is well-equipped, and the quality of these images is very high. Anteroposterior and lateral X-rays of the entire spine, and CT three-dimensional reconstruction , MRI various cross-sections, shooting is very standard.

In order to obtain the best imaging pictures, the staff of the laboratory thought of many ways. They designed an X-ray transparent fixing frame, fixed the monkey on the frame, and then carried out the examination.

These little guys will not ask you to check them in a proper manner. Even if they are fixed on the shelf, some pictures need to be projected many times to get them.

"You said that the monkey's X-ray is really similar to that of a child?"

"Darwin didn't say that man evolved from apes."

"Look, how many physiological bends are not obvious?"

"Yes, why is the physiological curvature not so obvious?"

Zhang Lin and Xiao Wu also gathered around to watch.

"The video data here include not only the 40 monkeys in our experiment, but also a lot of their previous experimental monkey data. The physiological curvature of the spine is formed after people walk upright. Although monkeys can stand upright for a short time, most of the time they crawl on all fours. , so the spine does not have typical human physiological curvature." Yang Ping explained to them.

Professor Qin Sihe, an orthopedic expert, once wrote a thesis, analyzing the formation and correction of deformities from the perspective of evolution.

"Do you think monkeys have lumbar disc herniation?" Zhang Lin asked Xiao Wu.

Xu Zhiliang was very surprised by Zhang Lin's question: "You're a crooked--right--right, today--how--raised--so deep."

It’s not that you face the wall every day to give speeches, why are you stuttering now?

Zhang Lin dared not speak out.

"Look, these are spinal MRIs of old monkeys. Look, the three lowest intervertebral discs in humans degenerate the fastest. In old age, they must be dehydrated and show low signal, but monkeys don't seem to have this problem." Yang Ping Called out some information to show him.

"So——your question——if you hit it right, I will call you Mr. Zhang." Xu Zhiliang really felt that this question had a deep meaning.

"How about, after the completion of our retractor monograph, the next subject is to study the difference between monkey and human lumbar disc degeneration?" Xiao Wu proposed.

"Actually, from the perspective of evolution, the human intervertebral disc is a defective product. It has not evolved well enough to adapt to human upright walking, so it is prone to problems." Song Zimo is also thinking about this issue.

Yang Ping partly agrees with this point of view: "Degeneration is irresistible. The degeneration of the human body's motor system always starts from the parts where the stress is concentrated, such as the lower lumbar spine and knee joints. They are all places where the stress is concentrated. Anatomy and function are compatible , but these places have not been anatomically strengthened."

To solve clinical problems in medicine, we must start thinking from the basics.

(End of this chapter)