Chapter 754: Finding Fault
Zheng Ren smiled and stood up. He bent his back slightly and asked Chief Luo to sit down while he stood in front of Chief Luo.
He was young and capable, but he was not arrogant and domineering. Chief Luo was very satisfied with Zheng Ren’s performance.
Zheng Ren then said with a.s.surance, “In smaller hospitals, the diagnosis of intestinal obstruction is usually done through abdominal dialysis or according to clinical symptoms. According to the patient’s family, there were a few times when the diagnosis of intestinal obstruction was made but the inpatient department overruled the diagnosis. I guess this means that the intestinal obstruction will be resolved when we go to the inpatient department and it will be the type that will recover on its own without medication.”
Chief Luo listened quietly and did not interrupt Zheng Ren’s words.
“So, I guess the patient’s intestinal obstruction is only short-term and temporary. In addition, the patient’s family said that the patient is p.r.o.ne to fatigue, so I had a guess as to whether the patient’s skeletal and smooth muscles are affected. If that’s the case, then the possibility of mitochondrial encephalomyopathy is higher.”
Chief Resident Shen was stunned when he heard that…
He had seen Zheng Ren’s surgery before, so he knew that Boss Zheng’s standard of interventional surgery was quite high. Less than half a year ago, that eye artery surgery had opened Chief Resident Shen’s eyes.
At that time, he almost licked his screen and was even reprimanded by Department Chief Kong.
With Boss Zheng’s skill, it was possible for him to be nominated for a n.o.bel Prize. Chief Resident Shen thought that this matter was quite reasonable.
However, was he also so good at diagnosing rare diseases?
Mitochondrial encephalomyopathy? What the h.e.l.l was that? Chief Resident Shen was at a loss.
As a medical doctor, he didn’t understand the conversation between Zheng Ren and Chief Luo at all. His face was a little red.
“So, you looked at the electromyography?” Chief Luo asked.
“In local hospitals, it’s basically a headache for doctors. But the examination of electromyography… Forgive me for being blunt, but in local hospitals, it’s very rare. Usually, only the neurology department does it.”
“Oh? And then?”
“Because I didn’t hear from the patient’s family that they went to the neurology department for medical treatment, I guessed that it was an electromyography test prescribed by the emergency department’s doctor during a major muscle weakness attack,” Zheng Ren said frankly. “This kind of test is relatively blind, but it touches on the key factors by relying on luck.”
Relying on luck…
Chief Luo felt annoyed and amused by Zheng Ren’s straightforwardness. This little guy was really quite frank when he spoke.
As a doctor, who was willing to admit that they were trying their luck?
However, due to the limitations of scientific standards and diagnostic standards, the diagnosis of many diseases also required luck even in the Imperial Capital, let alone with other local hospitals.
This was especially true for rare diseases like mitochondrial encephalomyopathy.
This kind of disease had nothing to do with the gastrointestinal department, so Chief Luo did not study it. What he was curious about was how the junior doctor in front of him had diagnosed it.
Could a candidate for the n.o.bel Prize be so good at cross-disciplinary diagnosis?
Things seemed to be getting more and more interesting.
“There are abnormalities in the electromyography, but the abnormal electrical waves are not obvious. The electromyography is the most common type of narrow electromyography in a local hospital. The percentage of multiphasic waves usually does not exceed 20%, but there are a few stages where it is slightly exceeded. Different muscles have different ranges of normal values but during the short period of electromyography, the later stages have gradually returned to normal.”
At this moment, it was not only Chief Resident Shen, even Chief Luo was a little absent-minded.
What was Boss Zheng talking about?
“The report is written with a single hand, such as interference phase, mixed-phase, pure phase, pathological interference, etcetera. But if you look at the waveform, you will find that the first few seconds of the waveform were wrong,” Zheng Ren said.
Silence. When Zheng Ren stopped talking, there was silence in the chief’s office.
Soon, Zheng Ren’s voice broke the silence again.
“My judgment is that there is a problem with the electromyography. It is not neuronal, but a change in the muscle itself. This speculation is consistent with the symptoms of general weakness described by the patient’s family. There is a change in the electromyography, and the smooth muscle will occasionally change. This can only be caused by mitochondrial encephalomyopathy.”
Zheng Ren said it with certainty. Before he knew it, Chief Luo had already believed it.
That was because of the meticulous logic and the sanct.i.ty of the n.o.bel Prize candidate.
Mitochondrial encephalomyopathy was a group of rare mitochondrial structural or functional abnormalities that resulted in multiple system diseases that mainly involved the brain and muscles.
It was usually inherited from the mother’s side and was mostly seen in women. The onset of the disease was also uncertain. It was possible from infancy to old age.
Because of the high dependence of muscle and brain tissue on oxidative phosphorylation and other metabolism, regardless of the nDNA, mtDNA single defect, or both, clinical symptoms were often systemic.
But because the degree of involvement of each enzyme system was different and the clinical performance had a different emphasis, they were artificially divided into two major types of mitochondrial diseases, namely mitochondrial myopathy and mitochondrial encephalopathy.
The patient in front of him should be a manifestation of mitochondrial myopathy.
This was a relatively mild form of mitochondrial encephalopathy, which could easily lead to the patient’s death.
“Are these all guesses and inferences?” Chief Luo said softly.
It seemed like he was asking Zheng Ren a question, but it also seemed like he was talking to himself.
Zheng Ren’s words sounded very confusing, but Chief Luo could understand bits and pieces.
Due to his professional nature, Chief Luo’s first thought was to try ‘finding fault’!
Without solid evidence, this was the biggest problem.
However, the examination brought by the patient’s family could not provide a definitive diagnosis. If they really suspected that it was mitochondrial encephalomyopathy, they could go for a genetic test to confirm the diagnosis.
However, this was only one possibility. Zheng Ren’s tone was too positive.
“No, Chief Luo.” Zheng Ren pointed to the patient’s information and said, “I frowned when I saw you reading the radiographic films just now. You saw the abnormality too, right?”
“It can’t be said to be an abnormality. It may be a false image, but the patient’s intestinal smooth muscle group does seem to have a problem within some of the images,” chief Luo said.
“Yes, it’s an abdominal CT scan. In fact, it has already provided more reliable evidence,” Zheng Ren said. “In terms of imaging, mitochondrial myopathy…”
Speaking of CT scans, Zheng Ren’s att.i.tude was different from when he talked about electromyography.
Chief Resident Shen knew that Boss Zheng did 64-slice CT scans with 3D-image reconstruction that were considered masterpieces.
After he left half a year ago, Department Chief Kong immediately organized everyone to learn how to reconstruct 64-slice CT scans with 3D-image reconstruction of the liver and quickly spread them out in the clinic.
This kind of examination had long been used in the clinic. However, no surgeon had ever done it before. All the CT rooms had done it according to the software.
In the beginning, everyone had some complaints, but Department Chief Kong used his iron fist to suppress all the different opinions.
When they really did in-depth research, everyone… At the very least, Chief Resident Shen realized the benefits of the 64-slice CT scan with 3D-image reconstruction…
Many tumor-releasing factors and reconstructed abnormal hyperplastic blood vessels could be directly displayed by 64-slice CT scans with 3D-image reconstruction, which increased the level of detail during surgery itself