Chapter 242 Ask the Radiology Department to work overtime, move
The human nervous system is the most mysterious and unpredictable. Sometimes even a small abnormal discharge can have a huge impact on the patient.
Epilepsy, abnormal sinus node discharge, etc. are the most common neurological abnormal discharge diseases.
The vagus nerve and sympathetic nerves in the human body are sometimes even like naughty children. When problems occur in them, neurological diseases may occur.
The patient had 24-hour EEG monitoring in another hospital, and no major abnormalities were found.
Moreover, after a brain CT scan, tumors can be basically ruled out.
"I have seen the patient's blood test results. The white blood cell count is normal, but the eosinophil count is slightly elevated."
Zhou Can did not rush to tell his diagnosis, but began to talk about some abnormalities he had discovered.
"There are so many reasons for the increase in eosinophils! For example, common allergic diseases, bronchial asthma, urticaria, drug allergies, allergic purpura, etc. can all cause an increase in eosinophils. Skin diseases and cancer can also cause... Wait, you don't suspect that the patient is infected with parasites, right?"
Director Shang suddenly realized the direction of Zhou Can's suspicion.
High eosinophil counts are mainly seen in allergic diseases or parasitic infections, including schistosomiasis, ascariasis, and hookworm disease, all of which will show abnormalities in this indicator.
However, this patient's eosinophil level was only slightly elevated, and the patient had undergone stool testing, and parasites had been discovered long ago.
Therefore, not only Director Shang, but also other doctors ruled out the possibility of parasitic infection as soon as they saw the results.
Besides, parasitic infections usually present with a variety of symptoms.
Rather than simply irregular vomiting.
"I think the patient is most likely infected with a parasite, and it is a very scary but easily overlooked parasite. They often parasitize in snakes and frogs."
Zhou Can said with a smile.
Only he, a resident intern, dared to chat and laugh with the chief physician in this way.
Even kept it a little suspenseful.
"Doctor Zhou suspects sparganosis?"
Xie Lin asked urgently.
"Yes, it is this insect. Of course, I only have a preliminary suspicion and I am not sure. The details will have to wait until further examination to be confirmed."
Zhou Can was not completely sure, he just suspected the disease.
After all, the patient has already had a brain CT scan, and if there really is sparganosis, it is entirely possible that it could be discovered.
“That shouldn’t be possible!”
Director Shang's expression became more serious, and his brows were furrowed.
He had read all the medical records and brain CT scans of the patient in other hospitals. Although he was not very good at brain diseases, with his decades of experience in diagnosis and treatment, he would definitely be able to find any abnormalities in the brain CT scans.
"Did you notice that the patient repeatedly raised his right hand to scratch his head? Just before the patient left, I took a close look and found that a small part of his scalp was slightly raised and then fell back. Under normal circumstances, the scalp cannot have such movements. Considering that his wife said that he had the habit of scratching his head before the accident, I particularly suspect that it was a parasite moving under the scalp layer."
Zhou Can continued to explain the basis for his diagnosis.
Director Shang secretly admired this boy's meticulousness and keen observation.
After listening to him, he pondered for a moment, looked up at Zhou Can and said, "Even if there are parasites in the patient's brain, it may not be sparganosis. Why do you conclude that it is this kind of parasite?"
Every doctor looks at the problem from a different perspective and has a different diagnostic approach, so the final diagnostic results vary greatly.
There are so many parasites that can infect the human body.
Too many to count.
However, Zhou Can directly targeted the sparganum, which made Director Shang particularly curious.
"Well... probably from several aspects! The infection site is in the brain. Although parasites such as schistosomiasis, ascariasis, and cysticercosis can also enter the head, the symptoms they cause are not consistent with the size. Only the sparganosis has the most outstanding latent ability. Before causing obvious symptoms, its existence is not detected at all. Even if there are symptoms, it is easy to misdiagnose as a disease such as brain glioma."
Sparganosis is very different from roundworms.
They have very high requirements for the living environment. They don't like to stay in the dirty intestines, but try to enter the host's brain through channels such as the blood.
Being in a 'high' position, not only does the living environment remain clean, but it is also not easy to be discovered.
Ascaris is much more low-end. As long as there is a slight disturbance, the patient will go to the hospital to check the feces and immediately find eggs and larvae. Sometimes there are even more adult worms in the patient's body, and live worms can be directly pulled out when defecating.
This will undoubtedly greatly increase the risk of them being discovered.
Sparganosis is hidden in the brain and does not pass through the digestive tract at all when eating, drinking, defecating or urinating, so the risk of being discovered is much smaller.
"Furthermore, the symptoms caused by other parasites are quite diverse. For example, Schistosoma japonicum, the eggs of which are deposited in the liver, intestines or bladder and reproductive organs, leads to egg granulomas and fibrosis. Adult worms can also cause weight loss, anemia, abdominal pain, liver enlargement, potbelly disease, etc. These symptoms are very obvious and can be easily diagnosed. Only sparganosis hides in the human body and develops in an indecent manner, making it very difficult to detect."
"Finally, patients often attend various social events and inevitably eat all kinds of delicacies. Frog and snake meat are very popular specialties. If you eat too much, the chance of infection will increase greatly."
If you walk by the river often, you will get your feet wet.
If you often eat frog meat and snake meat, even if it is cooked, as long as the boiling time is too short or it is not cooked thoroughly, the sparganum may survive. After eating it, don't think that stomach acid can kill it. Almost all parasites have strong abilities, such as resistance to high temperature, acid and salt corrosion, and low oxygen.
It can be said that if they did not have these outstanding abilities, they would not be qualified to be parasites.
Some people think of killing them with stomach acid, or eating them into the stomach and excreting them out of the body with the help of peristalsis of the digestive tract. It is best not to have such fantasies.
Their survival ability and adhesion ability are both extremely strong.
"Based on the above information and comprehensive diagnosis, I now suspect that it is the sparganosis that is causing the trouble."
Zhou Can's analysis is thorough, reasonable, and extremely practical.
Director Shang and Huang Xinggui both nodded repeatedly, not to mention the two female graduate students Xie Lin and Luo Jingyi. Even Qiu Chengyu, whose "good thing" was ruined by Zhou Can, had to admire Zhou Can's diagnostic ability.
It’s really too strong.
As a graduate student, he can hardly compare with her.
"The examination room should not be closed yet, right?"
Director Shang turned around and asked Huang Xinggui.
"Probably not yet. The general medical and technical departments have to get off work at six o'clock." Huang Xinggui seemed to know what Director Shang meant. He was also full of anticipation and excitement. "Director Shang, are you going to give the patient another head imaging examination now?"
"That's right! Many things can be delayed, but illness cannot be delayed. This patient's condition is so serious, so early diagnosis and treatment are needed."
Director Shang not only has superb medical skills, but also has a kind heart.
He couldn't wait a moment longer when he thought about finding out the cause of the patient's illness as soon as possible.
"Immediately call the imaging department and ask the CT room staff to work overtime. After I communicate with the family, I will immediately apply for an examination. You can also go with me to see the dynamic examination of brain imaging to increase your diagnosis and treatment experience."
All trainees will generally rotate to the medical technology department for one month of training.
The purpose is to increase clinical experience in ultrasound, CT, X-ray and other projects, including examination principles, methods, techniques, key points in reading films, etc.
Zhou Can has not yet rotated to the medical technology department for regular training. He plans to complete his regular training in the internal medicine department and then work in the medical technology department for a month.
I guess the 36-month regular training would have expired by then.
It’s just right to go back to the emergency department and start working officially.
Director Shang is a decisive person and he immediately went to communicate with the family.
Zhou Can and three graduate students went along.
On the one hand, they can help find the family members and wonder whether they have arrived at the inpatient department. On the other hand, senior doctors communicate with family members, and many of the conversation skills are worth learning for novices.
I didn't expect the woman to be so fast.
Maybe because she had been taking her husband to seek medical treatment and medicine for a long time, she was familiar with all the procedures of the hospital. Even if she changed hospitals, she could complete the hospitalization procedures quickly.
At this moment, under the arrangement of the nurse, her husband has been settled in a temporary bed.
This temporary hospital bed is a folding bed that is easy to store.
It is smaller than an ordinary hospital bed.
It can just accommodate one adult lying on it.
However, for patients, as long as they can have a bed and be admitted to the hospital, they will be very happy.
I don't care at all whether the bed is comfortable or not.
A hospital is not a guesthouse or inn. The purpose of patients coming to the hospital is to get treatment.
When you go to a hotel with your girlfriend to book a room, you definitely want to enjoy the room, and you need a big, comfortable bed.
"Is he doing okay?"
Director Shang walked to the bedside and asked the woman.
"Thank you for your special help. My husband's condition is relatively good and not much different from usual. I am so grateful to you and the medical staff in the inpatient department for being able to be admitted to the hospital so quickly."
The quality of the women is very high.
I would like to express my sincere gratitude to Director Shang.
She was flattered when Director Shang brought four young doctors to the bedside to check on her husband's condition.
"It's not easy for you to come here from other provinces. As doctors, we will help as much as we can."
Director Shang chatted with the family for a few words, and then the time was right, so he changed the subject.
"After you left, I discussed and analyzed your husband's condition with several doctors. In the end, based on the increase in eosinophils and the fact that he kept scratching his head, we suspected that he might be infected by parasites. If you agree, I will immediately request a brain CT scan for him to see if we can find the real culprit."
After hearing this, the woman was stunned for a moment, and then she showed a happy expression.
"I agree. Of course I agree! I chose to bring my husband here for medical treatment because I trust you and this hospital. Thank you for your concern for my husband's condition. Thank you!"
The woman bowed to Director Shang, Zhou Can and others.
Especially when he looked at Zhou Can, his eyes were filled with deep gratitude.
With her intelligence and rich social experience, it is not difficult to guess that Zhou Can must have made a great contribution to the rapid progress in the diagnosis of her husband's illness.
Because when she was leaving with her husband, Zhou Can specifically asked about the thing that was bothering her husband.
At that time, she stared at the right side of her husband's head for a long time.
At this moment, one of the diagnostic bases proposed by Director Shang was that the patient was always scratching his head.
After the inspection application was completed, the woman paid the bill directly via her mobile phone.
Zhou Can and others helped transfer the patient to the CT room.
While the woman was waiting outside for the results, Director Shang took Zhou Can and others into the CT room to watch the dynamic images of the patient's brain.
The attending physician Huang Xinggui also came to watch with a strong learning attitude.
This is a very rare accumulation of diagnostic experience.
At first, the brain images showed no abnormalities. Time passed by minute by minute.
With so many people being exposed to radiation and such a huge effort being made, if the problem is not detected, doctors from other departments will probably laugh at us.
Outside the CT room, the patient's wife was waiting anxiously.
She was praying for a miracle.
In the more than one year since her husband fell ill, she has supported the family with her weak shoulders for more than 400 days and nights. Life has been very difficult. She always fantasizes about a miracle.
"It's moving, it's moving, look at this part, there's a string moving!"
Luo Jingyi has sharp eyes and was the first to notice the abnormality in the patient's brain dynamic images.
The head of the strip moved twice and then returned to calm.
"Oh my goodness, it is indeed a parasite. But this guy is too cunning. It moves only after a long time. If it is lurking when taking a brain CT scan, it is really difficult to detect its existence. This time, we can finally give the family a very good explanation. I saw that woman in her thirties, taking her husband to seek medical treatment everywhere, and I felt really bad."
Director Shang said something from the bottom of his heart.
Not to mention him, how could Zhou Can, Xie Lin and others feel good?
It's just that everyone's abilities are limited, and we are all mortals. No matter how uncomfortable we are, we can only keep it to ourselves. No one can diagnose the cause of the patient's illness, let alone cure the patient.
The heavy door of the CT room was opened, and Zhou Can and others pushed the patient out of the CT room, each with a triumphant smile on their face.
The cause of the patient's illness was finally diagnosed.
There is hope this time.
"Doctor, how is it? Have you found out?"
The woman came forward with anticipation and a nervous look on her face.
"Good work pays off. Congratulations. By observing the patient's brain images, we can basically determine that he is most likely infected by parasites. But we can't confirm the diagnosis yet. We can arrange for him to have surgery to remove the abnormal organisms in his brain, and then do a biopsy to confirm what kind of worm it is."
Director Shang said to her.
Normally, once infected with sparganosis, it is difficult to kill them with drugs.
A commonly used treatment method is to perform surgery to remove the worms and then inject drugs locally to consolidate the therapeutic effect and prevent recurrence.
From this we can also see that the old doctor's words were flawless, as he had clearly found out what the parasite was.
However, because the diagnosis could not be confirmed, Director Shang only said that it might be a parasitic infection.
Never mention what kind of bug it was.
There is no affirmative statement from beginning to end. At the same time, the emotions of the family members can be taken into consideration, so that they will not feel disgusted.
This is very worth learning for newcomers.
"Great! I knew that coming to Tuya would definitely lead to a miracle. It seems that my sixth sense is very accurate. Professor Shang, can you arrange the surgery for my husband now?"
She wished she could cure her husband's illness immediately.
"Well... it's definitely not possible now. We are the Department of Gastroenterology here, and we are not capable of performing his surgery. We can only invite experts in neurosurgery or general surgery to come for joint diagnosis and treatment. In addition, anesthesia interviews and risk assessments are required before the operation. It will be very fast if we can arrange the surgery tomorrow."
Director Shang explained it to her patiently.
I can understand the family members’ anxiety.
However, the hospital has its own regulations, and this involves the joint diagnosis and treatment of multiple departments, so Director Shang can only do his best to coordinate and make requests.
The uncles in the neurosurgery department are all extremely proud and not so easy to coordinate.
