Lin Ge was still full of hope for Boss Zheng who showed up uninvited.
Boss Zheng is indeed awesome, but can he have any good ideas for this kind of clueless consultation? Hope so.
Lin Ge looked at Boss Zheng expectantly.
"I agree with Professor Gu. It's systemic lupus erythematosus, and the diagnosis is relatively clear." Zheng Ren said in a deep voice.
"Boss Zheng..." The director of gynecology was startled.
The doctors in gynecology and obstetrics departments are the same team in smaller hospitals. Although they are in different departments in 912, the gynecology department has a deep understanding of obstetrics.
The intrauterine interventional surgery that Boss Zheng just completed is no less than a fantasy for obstetricians and gynecologists.
But that was not just spreading rumors. Boss Zheng was so confident that he even dared to perform live surgery directly.
He is so powerful that even the gynecology director of 912 has the deepest admiration and even awe for Boss Zheng.
Professor Gu said the same thing with an attitude. But when it came out of Boss Zheng's mouth, it changed into a different attitude.
The director of gynecology hesitated for a moment, and instead of scolding Boss Zheng in a condescending manner, he acted like he was all ears.
“I read the disease course record and it was recorded that after the application of immunotherapy, the patient developed symptoms of palpitation and shortness of breath.
Acute left ventricular insufficiency was considered, and after diuretic and cardiotonic treatment, the patient's asthma and shortness of breath improved, but the palpitations gradually worsened. A review of the UCG showed that the LVEF was 36% and the pulmonary artery pressure was 35 mmHg. "
Zheng Ren did not look at the medical records and said with a smile: "So far, the diagnosis still considers systemic lupus erythematosus. There is no evidence that the heart valves, cardiac conduction system, and coronary arteries are involved, so the heart failure may be caused by systemic lupus erythematosus involving the myocardium. Caused by.”
"The patient's condition has worsened and can be treated according to systemic lupus erythematosus," the director of gynecology asked.
Ringer was also confused, and the doctors in the office were also confused.
“I have several considerations when cardiac function impairment worsens under the use of hormones and immunosuppressants.
First, the original treatment plan is not strong enough. I agree with Professor Gu that shock therapy can be given to save the function of important organs.
Second, water and sodium retention after hormone application aggravates cardiac insufficiency, and similar symptoms may also occur.
third,… "
Everyone in the room fell silent.
It is indeed difficult to diagnose and treat rheumatism-immune diseases. Even experienced clinicians may not have access to rheumatism-immunity.
The related diseases are complex and the treatments are diverse, which is why Su Yun said that when he encounters a disease that he cannot understand, he goes directly to rheumatism and immunity.
As for high-level doctors in the rheumatology and immunology department, most of them will stand on the top of the mountain of medical technology with disdain, look at other disciplines from a bird's eye view, and say disdainfully, "Can they also treat patients?"
Boss Zheng, a doctor in the interventional department, is sitting here talking with great firmness and confidence, which is really confusing.
"There seems to be something wrong with the lungs." Someone asked in a low voice.
"The patient's bilateral lung textures are significantly thickened, which is an imaging finding." Zheng Ren said confidently after hearing the question.
"At this time, we need to determine whether the thick layer of lung texture is a lung infection induced by the application of steroids; or whether it is a manifestation of systemic lupus erythematosus in the lungs.
Of course, I just took a look at the patient.
The patient had an indwelling nasogastric tube due to intestinal obstruction, still had vomiting and coughing, was bedridden, was taking steroids, and had aspiration, so inhalation pulmonary infection could not be ruled out. "
This is the straight story. It is very similar to what the professor of respiratory medicine told me before. It is suspected of evading the important and taking the easy.
But Zheng Ren changed the subject and said: "But fever, pulmonary symptoms and worsening cardiac insufficiency appeared at the same time, and the high-resolution chest CT did not show a clear infection focus in the lungs. Anti-infection is ineffective, and it is more likely to be systemic lupus erythematosus." Due to activities.”
"It is written in the medical record that the patient is suspected of having Raynaud's phenomenon. I think this is one of the basis for Professor Gu's judgment."
"If you're worried..." Zheng Ren began to pursue the rationality of clinical diagnosis.
Under normal circumstances, the diagnosis of rheumatic and immune diseases is relatively erratic. In the patient's case, it is best to undergo a cystoscopy to take a tissue biopsy. But the urology department also said that the condition of the bladder wall was not suitable for biopsy.
The best way is to undergo a kidney tissue biopsy.
"I suggest that the patient's family should be persuaded to do a kidney biopsy." Zheng Ren said firmly: "The problem can be determined after the biopsy."
Lin Ge felt like a big black pot was coming towards him overwhelmingly.
The reason why diagnostic treatment is required is because the patient's family believes that nausea, vomiting, diarrhea and kidneys have nothing to do, so they insist that it is a problem of gynecological surgery.
Need a biopsy
If someone else had said that a needle biopsy was necessary, Ringer would definitely not believe it. This kind of operation is a trigger that may lead to intensification of conflicts. Once there is no positive finding, it is hard to say how the emotions of the patient's family members will change.
But if Boss Zheng said that, Lin Ge began to think about how to explain to the patient's family.
"If the patient's family agrees to the kidney biopsy and the result is positive, more radical treatment can be used." Zheng Ren thought for a while and said: "Methylprednisolone 1 g, once a day pulse therapy + intravenous immunoglobulin 20 g, Treatment is once daily. This is followed by a pulse of cyclophosphamide 1.0 g and hydrocortisone succinate 300 mg daily."
This dose…
A wrong judgment could lead to death.
Lin Ge looked at Boss Zheng with a frown on his face, wondering if the dose of medicine was so large.
After taking 0.2g of cyclophosphamide for one day, the patient's myocardium was severely damaged. But Boss Zheng actually gave a dosage of 1g, this... this...
It's not easy to explain.
Lin Ge thought about lightning. When he thought of using a lethal dose of medicine, he still had to be cautious about this.
He raised his head and glanced at Boss Zheng. His gentle and steady smile gave Lin Ge almost unlimited confidence.
There was silence in the office. Professor Gu looked at Zheng Ren with surprised eyes. This dosage was the most extreme dosage he had ever imagined.
Although he had just said that high-dose shock therapy would be required, Professor Gu knew that it was basically impossible for him to use such an extreme amount of medicine to give the patient.
This amount of pulse therapy is usually used after systemic lupus erythematosus has been confirmed by needle biopsy. Before that, Boss Zheng had definitely said the dosage...
The courage of this little boss Zheng is too great. Is he an interventional doctor or an expert in rheumatology and immunity
After pondering for a while, Ringer closed the notebook and forced a smile, "Well, let's ask the patient's family to go to the medical office, and I will discuss with them about doing a renal biopsy."
Ringer was forced to have no choice.
It is estimated that there will be an arduous battle on the medical side.