Chapter 356 One sentence decides life or death!

After saying these words, the atmosphere in the conference room became cheerful again. The doctors from Linhai No. 1 Hospital who were protecting the calf turned their heads again and discussed their opinions lovingly.

At this time, Xu Qiu nodded.

The conference room was quiet again, waiting for the next words.

"No wonder……"

When Xu Qiu heard that it was diagnosed by a junior doctor, many of her doubts were cleared up.

No wonder Linhai International Friendship Hospital is focusing on Creutzfeldt-Jakob disease!

Generally speaking, rare diseases are difficult to diagnose. In the industry, it generally takes several months to years of seeking medical treatment before the case can finally be solved in a higher-level hospital.

It is quite rare for a hospital like the International Friendship Hospital to treat patients with Creutzfeldt-Jakob disease upon arrival.

But now Xu Qiu understands.

In the medical industry, the older you get, the more cautious you become.

Medical students regard all symptoms as cancer because their knowledge reserves are too little and they can only relate them to the key points of the exam.

As for residents and attending doctors, although they have a certain amount of knowledge...

But doctors at this stage often have extremely high scientific research pressure. They spend all day immersed in literature, and their minds are filled with thoughts of coming up with a rare disease as the topic of my thesis. When they see a patient with an unknown cause, his eyes light up.

For this reason, after Dr. Liu proposed Creutzfeldt-Jakob disease, the originally clueless diagnosis had a direction, and the patient happened to be right, so the label of Creutzfeldt-Jakob disease became more and more solid.

However……

Look at the questions with the answers in mind and keep checking the answers. How can you not make mistakes!

…

"Dr. Xu, our hospital has made a film, you can check it out." Director Huo reminded.

Xu Qiu nodded and turned the next page of the PPT, which happened to be the DWI sequence and FLAIR sequence that had been done in the outer hospital.

Everyone was sighing, such a typical lace sign, it really looks like it!

But Xu Qiu gave a straightforward negative answer, saying: "How can you diagnose Creutzfeldt-Jakob disease with only a few films?"

Director Huo felt his throat was blocked.

Although Xu Qiu's voice was not harsh at all, he still felt the pressure.

Xu Qiu continued: "According to the existing guidelines, do you remember the diagnostic criteria for Creutzfeldt-Jakob disease?"

Director Huo: “There are three standards.

Confirmed diagnosis, clinical diagnosis and suspected diagnosis.

At present, when we reach the stage of clinical diagnosis, the main symptoms are progressive dementia, typical electroencephalogram changes during the course of the disease, and/or cerebrospinal fluid 14-3-3 protein positivity, in addition to myoclonus, visual or cerebellar impairment, Any two of the following four conditions: pyramidal or extrapyramidal system dysfunction, akinetic mutism...

Judging from Professor Yan's performance, except for the 14-3-3 protein, which will take several weeks to get the results, everything else is in line. "

Xu Qiu nodded.

This is indeed what textbooks and clinical guidelines say, but——

"You forgot the most important thing."

Xu Qiu turned to the next page, and there was a line written on it: "Excluding other diagnoses."

Director Huo's pupils shrank.

The diagnosis of rare diseases requires the exclusion of other diseases, which he naturally knows.

They have been very cautious in Professor Yan's research and judgment. They have basically ruled out all common neurological diseases, and Creutzfeldt-Jakob disease is the last clue.

Is there a problem?

"The electroencephalogram is indeed abnormal..."

Director Huo took out the medical records he had brought with him and said while flipping through them: "DWI and FLAIR also have lace signs, which happen to be the parietal and occipital lobes most commonly affected by Creutzfeldt-Jakob disease... there shouldn't be any problems!"

Xu Qiu circled two sequences of lace signs on the PPT and emphasized: "Take a closer look."

Director Huo stared at it for a long time before holding back a few words: "Isn't it Hua Fian Zheng?"

"Yes, but what about the strength and weakness of the two sides?" Xu Qiu almost gave the answer directly.

Director Huo suddenly woke up and quickly compared the signal strength of the two sequences. He quickly said: "There is a difference. The lace here in FLAIR is more obvious and the intensity is higher than that in DWI."

He paused, "What does this mean?"

To be honest, Creutzfeldt-Jakob disease is very rare in China.

Mad cow disease has not been seen in more than ten years, and not a single case of variant Creutzfeldt-Jakob disease has appeared in Daxia. Let clinicians figure out a disease that they will never encounter once in a lifetime. Remember today, in a few weeks You can also forget everything.

Not only Director Huo, but also Director Shen Nei Shen, Director Neurosurgery Lin, and the Director of the Infectious Diseases Department in the conference room all lowered their heads in silence, fearing that Xu Qiu would single them out and ask questions. sentence.

As for the other attending doctors, they were scratching their heads, not looking very smart.

"The relationship between strength and weakness determines whether it is Creutzfeldt-Jakob disease."

Xu Qiu knocked on the table, drew everyone's attention, and said: "Currently, the Creutzfeldt-Jakob disease diagnosed by the academic community, without exception, has better results on DWI than FLAIR.

Professor Yan is just the opposite. "

Director Huo's eyes widened in shock.

Director Shen and others also had experienced expressions.

"Then... what should it be?" Director Huo's heart skipped a beat. Sure enough, it wasn't Creutzfeldt-Jakob disease. The key was that it was completely different from other neurological diseases.

Xu Qiu seemed to have read through his thoughts and said calmly: "Of course it's not a neurological disease."

Everyone in the conference room was surprised. They were not from their department after doing this for a long time?

Brain surgery for tumors?

Or infectious diseases or immune system diseases?

Just then, there was a knock on the door.

Standing at the door was Director Zheng of the Department of Cardiac Surgery, who was holding several newly released reports.

"It's confirmed, there is indeed aplastic anemia, simple aplastic anemia." Director Zheng said, handing the list to Xu Qiu.

Xu Qiu nodded, called up the patient's medical records, and then put the newly made blood routine, bone marrow examinations and other tests together.

At this time, everyone, including Director Huo, noticed that six or seven years ago, Professor Yan had sought medical treatment for "dizziness, fatigue, and skin bleeding spots", and was later diagnosed with aplastic anemia.

Linhai First Hospital gave a more specific category: simple red blood cell aplastic anemia.

Director Huo patted his head and said, "We have also noticed aplastic anemia. Didn't that hospital cure it in the end?"

Xu Qiu: "It has been cured, but it still hasn't shown up. How do you judge?"

"This..."

"The method of judgment is very simple, trace the root cause.

Find the root cause, remove it, and it will be cured.

Is the cause of this patient's aplastic anemia clear?"

Director Huo was a little flustered, "No, it's not written."

"No, it doesn't exist."

Xu Qiu continued, "There are many causes of simple aplastic anemia, including drugs, infections, etc. These causes are easy to rule out, but there is no conclusion in the medical record. There is only one possibility - the cause is unknown."

"The cause is unknown?!"

In the conference room, all doctors focused their attention and their brains were working fast.

No matter how blunt their clinical intuition is, Xu Qiu has said this, and they can guess the cause of simple aplastic anemia, which is most likely the real cause of Professor Yan's disease!