"Yes." Zhao Yunlong said.
He immediately picked up his cell phone and sent a WeChat message to the doctor on duty, asking him to send the ultrasound pictures and reports.
A few minutes later, the phone rang. He glanced at it and handed it to Zheng Ren.
According to the cdfi report, the patient's tricuspid regurgitation jet area has exceeded 8 square centimeters, which is considered severe tricuspid regurgitation.
The pulmonary artery pressure and other indicators are abnormal, but they are not consistent with tricuspid regurgitation.
This is indeed a bit strange.
Generally speaking, the heart valve is like the bow of the door of an old house in the past. After it is opened, it will be pulled back to prevent blood from refluxing.
This situation is most common in the elderly due to muscle atrophy and weakness and aging of the valve arch, resulting in lax valve closure.
If you are young, it is more common in congenital heart disease, infection, intravenous drug injection, etc.
Zheng Ren asked about the patient's medical history again, and found that he did not have any medical history related to the above. This is also something strange about Zhao Yunlong, so he is planning to discuss it within the department tomorrow.
You can't go on stage directly if you don't understand the disease.
Once on the operating table, if there is an undiscovered disease, the surgeon will face more troubles. As an old surgeon, Zhao Yunlong would understand this.
I would rather not go on stage than to find out everything.
Therefore, he acted very cautiously.
Su Yun also took a look, with countless questions swirling in his mind. This patient was really abnormal.
I don't want Zhao Yunlong to drink more. It would be strange if Zhao Yunlong is hungover and talks arrogantly during the ward rounds and internal consultations in the department tomorrow, and he will be scolded by the chief director.
"Have the other test sheets come out?" Zheng Ren held his chin in thought and suddenly asked.
"I asked the other side to send all the pictures over." Zhao Yunlong said.
This time, Zhao Yunlong directly created a group and asked the doctors on duty to send pictures to the group.
Looking at the test results, Zheng Ren and Su Yun finally became honest.
Especially for Su Yun, the black hair on his forehead was vaguely moving in the wind, as if his brain was running at high speed, causing slight changes in the air flow.
Zheng Ren looked at the report sheets one by one and immediately discovered the problem.
The patient not only had changes in cardiac steatosis, but also had severe fatty liver, and the liver was larger than that of normal people on B-ultrasound.
This is strange.
The patient is only in his thirties. Even if he drinks too much and eats a lot of fatty meat, he is unlikely to develop severe fatty liver, which will also lead to an enlarged liver.
This, like tricuspid regurgitation, is not a problem that young people of this age should have.
Zheng Ren thought hard and compared various data. After ten minutes, he slowly said: "Get a blood acylcarnitine spectrum test tomorrow."
"Huh?" Zhao Yunlong was stunned for a moment.
"Based on the patient's test values and the clinical symptoms you mentioned, I suspect primary carnitine deficiency." Zheng Rendao: "Cardiomyopathy, lipid deposition myopathy, fatty liver, plus the patient's blood sugar is only 3mmol/ l, can make approximate judgments.”
Zhao Yunlong was a little confused. He knew about this disease, but he had never seen it clinically.
Su Yun was thoughtful. After thinking for a few seconds, he asked, "Can the hospital do the testing for the slc22a5 allele?"
"Yes, but it will take time."
"Is there anyone else in the patient's family who has a similar situation?"
"When asking about the medical history, the patient's account was unclear. I have asked the patient's father and mother to come over and I will ask him in person tomorrow." Zhao Yunlong is very meticulous in his clinical work. He can think of everything Su Yun can think of, and he can do it early. It's arranged.
"The boss is right. It is considered to be primary carnitine deficiency. Surgery is not recommended. It is enough to give levocard intravenously for a period of time and then take it orally. Right, boss." Su Yun asked.
"Yeah." Zheng Ren nodded.
This is a fatal disease, but as long as it is detected in time and supplemented with diet and L-carnitine, the quality of life will not be affected.
"Free carnitine is significantly reduced. If it is less than 10 μmol/l, plus the reduction of various acylcarnitines, it can basically be judged." Zheng Rendao: "When the genetic test returns, start supplementing with L-carnitine, and the symptoms will be relieved. . ”
Fang Lin felt a little emotional when he heard Zheng Ren and Su Yun solving Zhao Yunlong's questions one by one.
The rising star of the Imperial Cardiothoracic Surgery Department is not called that for nothing. Su Yun was able to diagnose, so he was not surprised. But this diagnosis was given by Mr. Zheng first, and then Su Yun deduced it and found several evidences.
Mr. Zheng is indeed very strong.
Regardless of whether it is right or wrong, it is enough to be able to propose the next step that needs to be checked and try and make mistakes step by step. Many people, including myself, looked at these test sheets with dejection.
"Old Zhao, I'm going to Izang later, do you still want to drink?" Su Yun asked.
"I have something to do tomorrow." Zhao Yunlong insisted.
"Tch, that's disappointing."
"Who knew we would admit such a patient today." Zhao Yunlong ignored Su Yun's disdain at all and seemed to be used to it. He was thinking about the patient's condition, and the more he thought about it, the more correct Zheng Ren was.
It is very likely that it is primary carnitine deficiency. After using L-carnitine, the patient's symptoms of tricuspid regurgitation will be relieved, and no surgery is needed to treat it.
This was discovered early. If it had been a few years or ten years later, or the patient would have had an acute outbreak and developed metabolic acidosis plus hyperammonemia, the person might have died immediately.
Even if it is not gone, the possibility of cure is not high if treatment is given in the future.
This disease is similar to diabetes and requires long-term medication. However, compared with complications, long-term use of L-carnitine seems to be nothing.
After eating for a while, and after a "drinking consultation", everyone's interest dropped. Especially since Zhao Yunlong refused to go to Izang for a drink, Su Yun found it even more boring, so they chatted for a while and then left.
They each called a car to go home.
The night was shrouded and the lights were dim. Zheng Ren sat in the car and took out his mobile phone to tell Xiaoyi that he was going back.
On the other side, Xie Yi and Chang Yue had already laid down and were in the water.
Chu Yanran was on duty tonight. Over in Haicheng, someone was injured in a car accident and was undergoing emergency surgery. She didn't have time for Shui Qun, Chu Yanzhi told everyone.
"Boss, how many people do you think will come to see you for tips surgery tomorrow?" Su Yun suddenly asked.
"Who knows." Zheng Ren didn't care.
"I guess someone will invite you to give a lecture tomorrow. Are you ready?"
"It's not necessary at all, just go if you need it. On your side, it's true that you have prepared the agreement."
"There's no problem with the agreement. What do you think about the lecture fees and the money for throwing knives?"
"Uh..." Speaking of money, Zheng Ren really wasn't prepared to ask for it. But he knows that free things are generally not cherished.
I want to promote the learning of tips surgery as soon as possible, but there are still a few nodes on my side that have not been cleared up. Furthermore, we must find detailed ways to increase the enthusiasm of doctors in other hospitals so that they can apply tips surgery into clinical practice as soon as possible.