I can see the status bar

第650章 认真（8月18日三合一6K2大章求订阅）
Of course, Sun Li'en was not so good that he could immediately diagnose what was wrong with this poor little girl.But he was very sure that Li Yuhan, who was admitted to the hospital again, had not been completely cured.She had been readmitted three days earlier with more severe symptoms.In half a day, she twitched more than ten times in a row.

Can a little girl suffer from four nervous system infections in three years?Sun Lien directly rejected the possibility of her experiencing some kind of infectious neuroinflammation again from his mind.Unless the child's brain-blood barrier is a sieve, and his own immune system has been appallingly low, it is absolutely impossible to have four infectious neurological inflammations within three years.

Obviously, there were problems with the two diagnoses of viral encephalitis at the No.1 People's Hospital of Changning City and the three diagnoses at the Second Central Hospital of Ningyuan City.

"Sister Mei, do you mean that this patient should be treated in our hospital? Or should he be transferred to our fourth hospital?" Sun Lien pondered for a while, and asked his own question, "It would be easy to transfer, I will directly Just contact the courtyard."

Mei Ying seemed a bit conflicted. She originally wanted this patient to be the first shot in the name of Zhongfu Hospital, but Shennei and the Department of Infectious Diseases of her own hospital had serious conflicts of opinion on this case.Shennei thought that this might be some kind of autoimmune disease, and he should at least get involved with the department of nephrology.The Department of Infectious Diseases believes that multiple attacks mean that the lesions in the patient's brain are persistently infectious, and they tend to have tuberculous encephalitis—the CT of the patient's latest admission was normal, only because of repeated use of hormone pulse therapy and continuous oral doses Caused by Nisson.

The two departments disagreed, the diagnosis was delayed, and Lin Yuhan's condition was still developing.Her seizures are still ongoing and she is now barely able to sleep soundly without the help of diazepam.Seeing such a poor child, Mei Ying, as a doctor and a woman, really couldn't bear it.

"I brought this case because I want to ask for reinforcements." Meiying thought about it, and finally sighed, "If you have any opinion, Xiao Sun, it can still be confirmed within two days, and our hospital can treat it now." Yes, then let the person stay. If it doesn’t work...then transfer to the fourth courtyard. I will do the parent’s work.”

With this in mind, Sun Li'en would be much easier to deal with. He put down his chopsticks and said, "No problem, I'll go see the patient first."

Wang Caifeng didn't show any dissatisfaction at all that her son was about to go out as soon as he got home. On the contrary, she praised Sun Lien's decision, "Hurry up and help if you can."

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Help if you can. This is the simplest way for the Chinese people to express their kindness.In the face of natural disasters, when people from all over the world actively donate money, most of them say "I can't help much", which is also the simplest expression of goodwill.

Sun Lien ate [-]% full, which is just right for an emergency doctor.If you eat too much, you will easily feel sleepy, and if you don't eat enough, you will easily suffer from hypoglycemia.He drove the car and took Meiying to the current Zhongfu Hospital.Her cousin was left behind - Hu Jia took care of her here.

"I'm sorry to trouble you." In the car, Mei Ying sighed, "I really have a headache this time, I've never seen this kind of patient."

Although Mei Ying used to be the director of the department, she was only the director of the obstetrics and gynecology department.The carton factory hospital was not large enough in the past, and there was no division of obstetrics and obstetrics.As long as the surrounding residents have a little choice, they would rather go to the Maternity and Children's Hospital or the No.1 People's Hospital that is farther away.The obstetrics and gynecology department of the carton factory hospital was basically idle.

From this point of view, Mei Ying lacked experience in coordinating the operation of the entire hospital.She even lacks the experience of coordinating more than two departments and performing simultaneous work.

However, Mei Ying is still more professional than many deans who have been parachuted from other positions. She understands the challenges and risks faced by front-line doctors better than these deans.At the same time, it also resonates more with the professional future and personal ambitions of these doctors.

In the long run, Meiying will certainly be a good hospital administrator, but she needs some extra help right now.

"Actually, I haven't seen this kind of patient much." Sun Li'en said while driving, "Misdiagnosed more than three times in a row, let alone seeing this kind of thing... I haven't even heard of it."

"Do you think you have been misdiagnosed consecutively?" Mei Ying didn't think about it. She always thought that these four times were probably some kind of missed diagnosis—the doctors at Changning No. 1 People's Hospital and Ningyuan Second Central Hospital probably missed something. Potential illness, and it was this illness that caused Li Yuhan's three attacks.

"It must be a series of misdiagnoses." Sun Lien is very confident in his judgment, "The four seizures are all epilepsy-like symptoms, and they are all accompanied by obvious pyramidal tract damage and meningeal irritation. If it is caused by infection, She died long ago from other complications."

Meningeal irritation and damage to the pyramidal tracts are serious symptoms, and when they occur in a teenage girl, the consequences are often disastrous.But what Li Yuhan showed...wasn't very serious.

In all fairness, light coma and more than ten convulsions in half a day are very serious symptoms, but compared with disability, intellectual impairment or even death, they are already very mild.

"So I think that the previous three times, including this one, were not infections." Sun Lien parked the car in the parking lot, and then said to Mei Ying, "From the current situation, I am more inclined to autoimmune diseases Or some kind of congenital disease."

Meiying got out of the car and took Sun Lien to the newly renovated Zhongfu Hospital. She walked quickly, "I'll take you to meet her current attending doctor first, and then we'll go directly to the ward to see the patients. "

Sun Lien nodded, this is the normal process.As the regular training doctor of Ningyuan Fourth Hospital, his place of practice was limited to the Fourth Hospital.Theoretically speaking, it is also a violation of the rules to see a doctor in his own Zhongfu Hospital.But fortunately, I didn't intend to take all of Li Yuhan's treatment directly, and received all of Li Yuhan's treatment contents on me.As long as there is a correct diagnosis, other doctors can continue to take over and start treatment.

"Dean Mei, you're here." The doctor who treated Li Yuhan was a forty-something deputy chief physician. The first time he saw Mei Ying, he greeted her as if he had seen a savior. I still insist on the judgment of infection..."

"They are engaged in infection, of course everything is infected." Mei Ying smiled and comforted the deputy chief physician in front of her, "Old Qian, let me introduce to you, this is Dr. Sun Lien Sun. General Hospital of Ningyuan Fourth Hospital A doctor from the diagnosis center." She specially emphasized the words "comprehensive diagnosis center" and said, "Dr. Sun happened to come to Changning today, and I asked him to come over and give advice and make a consultation."

"Oh, a doctor from Ningyuan No. [-] Hospital." Deputy Director Qian put on a happy face, "Is Zheng Guoyou okay? He is now the deputy director of the emergency department of your hospital?"

"Director Zheng is in the Department of Orthopedics." Sun Lien corrected the statement of Deputy Director Qian in front of him, "Last year he had a heart attack, but the problem was not serious. Two stents were installed. They have been doing well recently."

Deputy Director Qian's expression became friendly now, "Very good, very good, Dr. Sun... is Director Zheng's student?"

"I studied with Director Liu Tangchun." Sun Lien continued to smile, completely ignoring the doctor in front of him who was certified as a code, "I heard from Dean Mei on the way here, you think it's the autoimmune system disease?"

"I have this suspicion, but the inspection has not been completed yet." Deputy Director Qian showed some embarrassment, "The patient's family members still have some distrust of the hospital. It is difficult for us to communicate with them."

Mei Ying frowned when she heard this, this was a difficulty she had never encountered before.The reason why I was able to persuade Li Yuhan and her parents to come to the little-known Zhongfu Hospital for treatment was because of the promise of "free treatment".After falling ill many times in two years, Li Yuhan's family has changed from "better than passable" to "difficult" today.Now that her daughter is ill again, the family who were attracted by the free treatment should not be uncooperative.

"Let's go talk to the family members." After a brief discussion with Sun Lien, Mei Ying decided to change the scheduled plan and directly took Sun Lien and Deputy Director Qian to talk with Li Yuhan's parents.

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The ward where Li Yuhan lived was a family-style single room.The room is painted in pink, and there are some cartoon murals that seem to be liked by children.The room has a set of sofas and wooden beds for the escorts to take a nap, and is also equipped with TV and other equipment.

Such wards are not unavailable in public hospitals.But the price is extremely high, not to mention, it is also very popular and hard to order.Meiying and Zhongfu Hospital seem to be planning to take the high-end route, and such single wards have basically become the mainstream configuration in Zhongfu Hospital.

"Mr. Li." After Meiying knocked on the door of the ward, she saw Li Yuhan's father with a sad face. She smiled slightly, looked at Li Yuhan who was on the bed beside her and asked, "How is the child feeling today?"

"Still... smoke." Li Yuhan's father lamented, "Doctor Mei, can I take my child out of the hospital?"

"Discharged?" Mei Ying asked back in surprise, and she glanced at Li Yuhan on the bed again, "Is her condition not improving?"

Li Yuhan's father lowered his head and said after a long silence, "I... don't know if the child will be cured like this. What if, like her sister, she still can't be cured in the end, we can't bear it. In this way, it's better to go home..." His voice became smaller and lower, and his head lowered lower and lower.It was as if an invisible mountain was pressing heavily on his neck, making it difficult for him to breathe.

"Since we promised free treatment, we will definitely not charge you a penny." Mei Ying said in a deep voice, "And we are also actively organizing treatment..." Before Mei Ying could finish speaking, she stood standing Sun Li'en next to him suddenly said, "You said just now that the child's sister was also sick?"

Li Yuhan's father raised his head. Regarding this question, he obviously didn't want to think about it carefully, but the young man in front of him was wearing a white coat, and he was probably a doctor.He took two deep breaths and replied, "Yes."

"This is not recorded in the medical records." Sun Lien took out the medical records in his hand, and after quickly flipping through them, he said dissatisfiedly, "How is this medical history collection done?"

"We..." Deputy Director Qian looked a little embarrassed, "When we asked before, the patient's family did not mention this matter."

"You didn't ask, we..." Li Yuhan's father sighed, "Her sister died at the age of eight... The child's mother was greatly stimulated, and we tried not to mention it afterwards."

"What's the problem with her sister?" Sun Lien started to ask about the medical history while the iron was hot. Although it is very sad that an eight-year-old child died young, if the relationship between the two cases can be found, it might be possible for this 14-year-old child to die. The year-old girl fought her way out. "Is this also the convulsion?"

"She smoked too... but it's not because of that." Li Yuhan's father took a deep breath, "At first, her eyes were not very good, and she had an operation on the retina. Later, she thought it would be fine, but the child When her grandma was sending her to school...she suddenly died when she was walking on the street. She was taken to the hospital...the doctor couldn't save her."

This description is a bit empty, but Sun Lien was keenly aware of something wrong in it, "Retinal surgery?"

"That's right... it's the detachment of the retina." Li Yuhan's father showed a painful expression, "Do I have to ask this?"

"This may be of great help to our diagnosis." Sun Lien wrote it down in the notebook he carried with him, then walked to the bedside, and began to observe the 14-year-old girl in front of him.

Regardless of the status bar, Sun Lien could tell that there was something wrong with this child at first sight.As a 14-year-old girl who is about to enter puberty, her height is a bit too short.

"How tall is she?" Sun Lien looked at her status bar while asking about the situation.

"Li Yuhan, female, 14 years old, hyperlactic acidemia (10347.42.51), hairy body (9872.21.14), poor exercise tolerance (8873.29.17)"

"1.4 meters." Li Yuhan's father is very clear about his daughter's height, "She is a little shorter than children of the same age."

"Dean Mei, please check to see if the child has heavy body hair." Sun Lien stepped back a little to make room by the bed, and at the same time closed the curtain beside the bed thoughtfully for Mei Ying.After about tens of seconds, Mei Ying's voice came from inside, "The child's body hair is heavier on the back—was it like this before she took hormones?"

Sun Li'en spent a few minutes explaining what hormones are to Li Yuhan's father, and then got a positive answer, "She was like this when she was a teenager."

Sun Li'en nodded, he probably has a direction.But this diagnosis could not be resolved in a short time, "Where is the mother of the child?"

"She's at home." Mei Ying replied on behalf of Li Yuhan's father, "She has been with the child since she was admitted to the hospital. I asked her to go back and rest for a while."

"The mother of the child, please come over here. I have some questions to ask." Sun Li'en nodded, and without saying anything, he led Mei Ying and Deputy Director Qian out of the ward with a bewildered expression.

Mei Ying asked urgently, "Do you have a direction?" Sun Lien's question in the ward was clearly targeted.And it's not the kind of targeting that "locks the problem in a certain department". From the point of view of the problem, Sun Li'en is already highly suspicious of the disease.

"Until there is no conclusive evidence, this can only be a guess." Sun Li'en replied, "Her symptoms are not typical, that's why she was diagnosed with viral encephalitis twice." He paused and continued Asked, "Can the current equipment in our hospital do genetic testing?"

"It can't be done." Now it's Deputy Director Qian's turn to speak, "There is no corresponding equipment in the genetic inspection institute. If you want to know whether there is a mutation at a certain genetic point, you can only take a sample and send it outside. company to do testing." He looked at Sun Lien and asked hesitantly, "Do you suspect it's a genetic disease?"

"At present, this is the most likely possibility." Sun Li'en nodded, without hiding his thoughts on diagnosis, "The child's sister also had a history of convulsions, I think this is a major reminder."

"So you want to invite the child's mother to the hospital?" Mei Ying suddenly realized, "Do you think this is some kind of maternally inherited disease...mitochondrial encephalomyopathy?" As soon as she asked this question, she immediately started shaking her head, " No, this child has no hemiplegia, no mental retardation..."

Sun Li'en nodded to confirm Mei Ying's guess, "I doubt it too. That's why I said her symptoms are not typical. This mutation point is probably not a traditional one."

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Thanks to the old stuff's continuous high pressure and the training of Dean Wu Youqian, Sun Li'en's sensitivity to genetic diseases is so high that he doesn't look like an emergency doctor.

If Mei Ying continued to ask, Sun Lien would directly pinpoint Lin Yuhan's illness to MELAS syndrome.This is a branch of mitochondrial encephalomyopathy, and it is also a neurological disease that is least likely to be thought of by neurologists.

MELAS patients mostly develop before the age of 40, and the median age of onset is around 16 years old.And most patients have obvious symptoms such as hemiplegia and mental retardation.Like Lin Yuhan, the age of onset is 12 years old, and there are almost no reports of mental retardation and hemiplegia.

The reason for the previous misdiagnosis is also very simple. Lin Yuhan's symptoms are not typical enough, and Changning City No. 1 People's Hospital and Ningyuan Second Central Hospital only conducted an MRI examination on her.Especially in the Second Central Hospital, their misdiagnosis was actually the most serious error—the abnormal signals of acute disseminated encephalomyelitis MRI in the brain mostly accumulated white matter, and Lin Yuhan's imaging showed that her lesions were mainly concentrated in the cortex.Due to the lack of careful comparison and dynamic observation of her cranial imaging changes, the Second Hospital not only missed the most important MRS spectrum analysis of MELAS, the lactic acid peak, but also misdiagnosed her as acute disseminated encephalomyelitis.

Thinking of this, Sun Li'en felt more sympathy for the God of the Second Courtyard.The reason why they failed to perform multiple MRI examinations, needless to say, Sun Lien could guess it himself - the financial situation of the patient's family members did not allow it.They also want to solve the problem at once, and try not to hit the poor family's financial situation again.

Lin Yuhan's mother rushed to the hospital soon, and revealed more valuable medical history information under Sun Lien's inquiry.

Lin Yuhan's grandmother died of myocarditis, and Lin Yuhan's mother had poor endurance and often suffered from panic attacks.She was also diagnosed with myocarditis at the age of 26 and received corresponding treatment.

"Give samples to the patient and her mother, and send them for testing." After sending Lin Yuhan's mother away, Sun Lien put down his pen and said to Mei Ying who was beside him, "Give them a genetic analysis of mitochondrial DNA mutation points, and use Lin Yuhan's hormone therapy Stop. Give her levocarnitine, coenzyme Q10 and B vitamin supplements. For epileptic seizures...continue oral lamotrigine. As long as her hyperlactatemia is under control, oral lamotrigine enough."

Deputy Director Qian, who was stunned from the beginning to the end, finally came to his senses, and began to issue medical orders according to Sun Lien's suggestion.And Mei Ying asked incredulously from the side, "How do you know?"

"A reasonable guess." Sun Li'en smiled, but he was far from as relaxed as he appeared.Running your brain at full capacity can be very tiring, especially with the status bar open. "Exclude all possible options, and the rest is the correct answer."

"It's not so easy." I don't know if he is going to excuse himself, Deputy Director Qian said, "It will take a lot of work to determine the disease as a genetic disease, but MELAS syndrome can be diagnosed so quickly. Dr. Sun is amazing."

"Actually, I didn't do anything special." Sun Lien sighed, "Luck is a large part of the reason for the smooth diagnosis this time. If Lin Yuhan's father hadn't mentioned his daughter who died young, I might Still have to play around with autoimmune diseases."

Sun Li'en said this is really not polite, no matter how talented a doctor is, he needs to have enough evidence to pinpoint the cause.After being admitted to the hospital four times in a row, Lin Yuhan's parents never mentioned that they had a child. This is not just a simple mistake in collecting medical history in other hospitals.Maybe they even lied to the doctor to avoid talking about this painful subject.

Sun Lien didn't want to judge the right or wrong of the parents' actions, he was just a little thankful that Lin Yuhan's gene mutation was not the same as that of regular MELAS syndrome patients.Fortunately, Lin Yuhan's father slipped his mouth when he was sad.

And fortunately, I still have a status bar to rely on.

"I've heard it from a doctor from a fellow association before." Sitting in his seat, Sun Lien recalled a conversation he had with Yuan Ping'an.

"What's so great about our Tongxie Neng? We all ask about the medical history, prescribe the same medicine, and treat the same." Yuan Pingan, who went to the countryside to support him, said with emotion to Sun Lien on the phone, "But patients with difficult and miscellaneous diseases are willing to go to the same association. Xie ran, and Tong Xie is able to take care of other people's diseases. Why do you think this is?"

Without waiting for Sun Lien to answer, Yuan Pingan gave the answer in his mind, "Actually, it's just two words, 'serious'. Our Tongxie is the best hospital, and it is the hospital that covers the whole medical system. There is no other way for patients who have been referred many times in the hospital to come to Tongxie. So we must be serious. Seriously collect medical history, analyze carefully, and study carefully... There is nothing magical about Tongxie. It depends on these two It's just words."

(End of this chapter)