Krafft's Anomaly Notes

This is not the symptom that was expected before coming.

The fever type of tuberculosis patients mostly manifests as a low-grade fever, and even some patients do not show fever symptoms or feel insignificant.And this kind of fever, the kind of fever that made Professor Brimer hesitate to say in the discussion, came from the body without obvious incentives, and it appeared unconsciously when Kraft was concentrating on the physical examination.

"Your Excellency, can you hear me?" Kraft stretched out two fingers and moved them left and right in front of the Duke's eyes. He noticed that his eyes tracked the fingers at a narrow angle, and at the same time, he trembled and wandered uncontrollably. What variable sensory stimuli are acting on the vestibular receptors, inputting information that makes it impossible for the eyeballs to adjust to the corresponding position anyway.

"." There are unformed words behind the lips, which disintegrate into meaningless syllables before the mouth, and mix into a disturbing dumb disorder like a spell in an irreversible disorder.

Without a thermometer, Kraft put his hand on the patient's forehead to measure.Although the fever is fierce, it is still in the middle-heat range in terms of body sensation, and it has not risen enough to cause such a sharp disturbance of consciousness and function, and such synchronization should not occur.

This overturned the previous first reaction, the disturbance of consciousness was not the result of fever, but two concurrent symptoms.

Facing the changes, Wilbert and Fernand did not show panic and surprise. Obviously, this is not the first time such an attack has occurred, and it is self-limiting.Kraft pressed the arteries in his wrist, the sudden beating was fast and weak, just like the declining respiratory system trying to maintain compensation by increasing the diastolic frequency.

It's a stupid strategy that goes from compensating to decompensating very quickly after using up all the reserves, and then the organ kills itself without intervening.

The fever is gradually getting worse, the twitching of the trunk and limbs seems to have acquired independent will, and they are performing high-frequency contractions that do not form effective movements, similar to trembling in the ice and snow in winter, which is exactly the case.This means that the thermoregulatory point is shifted up, the body perceives the current body temperature as hypothermia, and the skeletal muscles produce a lot of heat by shivering, and the two behave similarly.

That being the case, something must have affected the thermoregulatory center.There are many, infectious factors and non-infectious factors, but generally speaking, acute fever is more common in the former.

Kraft also thinks so, although it is a bit far-fetched to say it, lacking rigor and various laboratory test evidence he relies on, and it is consistent with the lesion theory of Professor Linden who has just despised.

But this is what made him discover a sense of déjà vu, that there are one or more infection lesions, which repeatedly release exogenous heat sources such as endotoxin or the pathogen itself, and then through a series of "specifically speaking, it is annoying It's going to die, but anyway, it's the mechanism of leukocytes releasing endogenous pyrogens, crossing the blood-brain barrier, and acting on a certain place in the hypothalamus through a series of reactions" to cause fever.

This is reasonable, not only tuberculosis, the immunity has been weakened after long-term consumption, and a concurrent infection has occurred in this body.

What is it?
In the absence of etiology, no one can answer this question for him, and then there is another question, what is the disturbance of consciousness, it does not seem to be caused by fever, but the etiology is in Another manifestation of this body.

Kraft tried to change the title, "My lord, can you hear me?
The call was answered, and Duke Westminster raised his eyelids slightly, indicating that he was still able to respond to the outside world, instead of completely losing consciousness.He even tried to fight against the disordered body, and manipulated his tongue to make a sound to prove his normality, but what he uttered was only content that no one could understand, and the words did not match the words.

This made the old Duke feel a little indignant. He raised his trembling hands and tried to write something. The inaccuracy seemed to be struggling with some invisible enemy. However, these actions failed to achieve his purpose after all, as if those Words are cursedly erased and cannot be conveyed.

"We have tried to record these contents, and Brimer thinks that we can analyze the information related to the disease from it." Fernand couldn't help reminding.Seeing that the internal affairs officer looked hesitant, he spoke out to prevent him from continuing to guide the Duke, "But his research has not made any progress so far. It may really be that the disease has blinded the spirit, and it is meaningless."

"No, I just don't think so." Kraft temporarily ended the examination, rearranged the patient's shirt, adjusted the body position, and smoothly completed the servant work that was about to step forward.

"What should be paid attention to is not only the content of the words, but the patient can still speak at this time, but the words are not expressive."

【Wernicke's aphasia】

It’s time to look at the dysfunction and guess the damaged part again. Facts have proved that the Duke’s brain dysfunction at this time is not widespread and indifferent.On the contrary, he reserved part of the monolingual function area, showing a state of being able to hear, not understand, and expressing confusion.

"We've had cases where patients who have damaged 'here' in the head, unlike other people who have suffered a head injury that makes them dumb, retain their ability to speak, but can no longer utter a correct sentence. ’” Kraft explained, pointing to the superior posterior pole of the temporal bone.

Very well, now Wilbert's face is no longer restrained. As the internal affairs officer of the castle, he does not lack the brain that can associate this knowledge. Now this brain feels a little uncomfortable to continue to stay by Kraft's side. And it inevitably showed a slight repulsion and frightened expression on the face.

Fernan just nodded noncommittally. He has already passed the age of being restricted by disciplines, and he has an understanding of anatomy, and he is willing to accept the statement that a certain lesion causes a certain corresponding symptom.

"This shows that during the attack, this area of ​​the patient's brain is damaged, and it is temporary and reversible." But this made him unable to explain further, why there is an intermittent specific area Dysfunction, in parallel with febrile symptoms?And it seems that the motor function area of ​​the limbs is also affected at the same time.

"Then what should we do?" Wilbert's internal affairs officer didn't understand much, and he looked at his master worriedly.The Duke of Westminster's symptoms were violent, but the duration of neurological dysfunction was not as long as that of simple febrile convulsions. After a while, he was able to control his fine movements better. He reached for the steaming chamomile tea, and Wilbert hurriedly Step up and help him hold the cup.

"The situation is very complicated. This is not a simple wasting disease." Kraft froze the atmosphere in the room with one sentence, but he didn't want these people to think that he could have any good solutions. "I think that in the original lung On the basis of wasting disease, another disease infection was combined, and there were multiple lesions in the brain."

"I need to know roughly how often these episodes occur and how long they last."

"Well, roughly once a week. The attack time and length are basically the same as this time." Fernan answered without any hindrance, and his observation and recording awareness far surpassed that of other people of his generation. Just bring it."

"What about the severity? Has there been any change?" Kraft touched the Duke's forehead again. The heat remained, out of sync with the neurological symptoms. "Also, have you monitored the duration of this fever?"

"It's very difficult. It's often mixed with the hotness of wasting disease itself. It lasts at least half a day, and the whole story is unknown."

Indeed, pyrogens released into the blood are not cleared so quickly.Kraft was deep in thought. He had an idea, but it was all guesswork.And it was predictable that if he kept thinking like this, there would be no answer.

The scene was a bit stiff, the consulting experts were discussing endlessly, the family members were full of worries, and the patient was struggling to wake up from the chaos, and poured a sip of chamomile licorice tea with honey into his throat dried by the hot and dry air.

"Knight Kraft, it seems that you haven't learned much from your parents." The dry voice came from the Duke who regained control of his vocal chords and mouth.The two brooding professors hurriedly apologized personally.

"I understand. You mean that I have two diseases in my body, one is the lung wasting disease that will kill me, and the other, it seems that it will not be for the time being."

"Yes, but actually the other one might be more deadly, I'm not sure if it's related to lung wasting disease, or something in its own right. It probably forms foci in your body that periodically release toxins" Although he didn't quite understand what the Duke meant, Kraft recounted the discovery just now with a good attitude.

However, the patient interrupted him nonchalantly, "I want to treat lung wasting disease first."

"But it's not clear whether the other will affect the treatment." Kraft thinks it should be reconsidered, and it is too risky to start treatment hastily.

"Treat the wasting disease first."

"It may even lead to more serious consequences" This must be explained.

"I can make decisions about my own body."

Well, the Duke understood what he meant, but he still insisted.

"Young knight, I even thought you were older than Fernando." The Duke stood up on the shoulder of the internal affairs officer, and it was only then that Kraft noticed that he was much taller than he thought, "Simple, I just need to A cure, a chance to gamble on the possibility of surviving until next winter."

"Your Excellency, I must point out that you are unlikely to win in the presence of complications." Kraft seemed to understand the logic of this idea. It's not like he hadn't seen this kind of behavior in Old Wood before. A relationship with a physical obstacle is considered a duel, and the victory criterion is based on overcoming the obstacle to complete the objective, including but not limited to lame bear hunting.

No matter what the risk-benefit ratio is, as long as it is possible, they will definitely do it.

To put it bluntly, it is brave, but to put it another way is reckless.But it's easy to understand why they chose that way. People who live in this position are all senior members of the Survivor Deviation Association. They have won their bets all their lives, and their bodies have never let them down.

"And potentially losing life expectancy under current palliative care."

"Your duty is only to make feasible suggestions for me, not to recommend options, Knight Kraft. I will bear the results and consequences of the decision myself."

The speech is harder than armor, so I know that if I don't hand over the treatment plan today, I will definitely not be able to escape.

"Okay." Kraft took a deep breath, like holding his breath before opening the attic of an old object and taking out the dusty old antique, "Let me introduce artificial pneumothorax to you."

【Artificial pneumothorax】

This is really an old antique.

"This treatment is based on current surgical findings in humans. Our lungs are actually surrounded by membranes on both sides, and the space between them is normally sealed, like a dry water bladder with a cork on it."

"The risk is to inject air into the space between the two membranes, inflate it, and compress the lungs." In the narrative, Kraft moves his hands from the sides to the center, indicating the process, "until the lungs The chest collapses, the range of motion is compressed and rest is obtained, the body fluid circulation is sluggish to limit the spread of the disease, and the eroded lung cavity is also squeezed to heal."

"There is no doubt that this is a risky, invasive, and incurable therapy. If you must persist, then I will continue to complete the examination and plan the treatment for you." This is the first time he hopes that the risk Telling can scare off patients.

"Why not?"

It seems that the first time is always difficult.

At the duke's insistence, the inspection went ahead.

Holding the mentality of "everything is like this" and "I can't help it anyway", Kraft started the rest of the physical examination. He had to carefully evaluate the situation in the lungs that were riddled with holes, and indirectly understand the cardiopulmonary function. If the results are not good, it is inevitable to consider using a spiritual sense.

Due to the lack of tools, he had to stick the auricle to the patient's chest to listen. This inconvenience prompted him to work overtime to make the original stethoscope within three intercostal spaces.

[Go back and count this in their tuberculosis project funding]

In order not to use his mental senses, Kraft carefully compared the results of auscultation and percussion, trying to be as accurate and reliable as possible.However, the objective effect still proves that the pursuit of new machines by the predecessors of radiology for many years is indeed due to the insurmountable gap between machines and humans.

Kraft still wanted to hold on for a while.Write down another auscultation result, move to the other side, and lean against the right shoulder blade, roughly the position of the seventh and eighth intercostal spaces. Here, in the percussion just now, there is a sound between the skin drum and the hollow urn, which means There may be a cavity near the chest wall, the size of which requires caution.

Listen with your ears, a musical rale breaks into your ear canal.He didn't quite recognize the voice.

To be honest, for a person who rarely sees such a degree of tuberculosis, it is too difficult to make an accurate judgment once.And Kraft hesitated for two breathing cycles, still puzzled.

To be on the safe side, he decided to percuss again.As usual, stick the second joint of the left middle finger, tap with the right middle finger, and wait for the sound feedback echoing in the empty space.

There was a low and muffled sound, muddy and thick, but it was not the drumming feeling that reverberated in the hollow jar in memory.

"What's the situation?" Kraft knocked again in disbelief, still with a solid voice, "How could it be solid?"