I can see the status bar

Chapter 96 Decision (25)

The result of wearing high and strict waist is very bad.The cerebrospinal fluid pressure of lumbar puncture was as high as 216mm, nearly 30% higher than the upper limit of the reference value.At the same time, the blood routine report was also sent to the rescue room. The platelet ratio was slightly lower by 10%, at 86.0×109/L, and the creatinase (CK) 981.0U/L was nearly five times higher than the reference value. Calculated at 18U/L, it is nearly 55 times higher.The three indicators of lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase were also more than double the reference value.

"The conclusion of viral meningitis is not a big problem." Li Xiuming, a neurologist who came for consultation, affirmed Xu Yourong's judgment. "Such a high level of creatinase, Coxsackie group B virus infection?" Dr. Li Xiuming carefully read Gao Yan's blood test report, shaking his head, "But Coxsackie group B virus should not cause central nervous system damage, nor Must have epilepsy."

"The central nervous system and epilepsy may be atypical symptoms caused by high intracranial pressure." Xu Yourong was also reading the examination report.The three of them were sitting in the small conference room in the rescue room, exchanging ideas with each other.During the consultation, what is most needed is for everyone to speak freely.The most important thing in brainstorming is not the correctness of opinions, but to propose as many possibilities as possible.In this way, when the diagnosis is ruled out later, at least there can be some prompts.

Sun Lien thought about it, "The treatment the patient received before can help us rule out the possibility of bacterial infection. Looking at it now, it is indeed the highest possibility of viral meningitis. First use mannitol to correct intracranial pressure, and then use ribavir Lin controls a possible viral infection."

"I suggest adding polyene phosphatidylcholine." Xu Yourong added with some concern, "The patient's liver function index is not very good either. If it is infected by Coxsackie virus, it may affect the liver. If the liver function is abnormal, The effectiveness of ribavirin may be limited. What's more, ribavirin can also cause increased blood bilirubin. It may affect our monitoring of patients' liver conditions."

"Yes." Sun Lien gradually got used to reconsidering Xu Yourong's suggestions. "Let's get treatment first. Even if the treatment doesn't work, at least it can provide more clues for diagnosis."

Good news came from the policeman, Old Wutou, who has contacted Gao Yan's family.They will come to the hospital as soon as possible.Sun Li'en turned his attention back to old man Zhou Xiufang.

The inspection results were another bad news.A large number of plasma cells appeared in Zhou Xiufang's blood smear.According to the measurement, the plasma cell content in the blood of the old man is as high as 5.7×109/L. Since the old man has no history of multiple myeloma before, according to the definition of the WHO, the old man can be directly diagnosed as primary plasma cell leukemia ( PPCL).

Primary plasma cell leukemia is a very rare variant of malignant plasma cell myeloma, which is classified into mature B cell tumors by researchers—this is a rare disease that Sun Lien has only heard of its name.

However, Zhou Xiufang's PPCL is obviously an acute leukemia, a disease that usually requires bone marrow puncture to be confirmed, and now it has spread to the blood circulating in her body.At the same time, it also shows that the progress of the disease has reached a relatively advanced stage. For Zhou Xiufang, the luck of the misfortune is that her PPCL antibody showed CD56+ antibody, a type of primary plasma cell leukemia with a slightly better prognosis.

After the results came out, Professor Li from the Department of Hematology immediately called Zhou Jun. After a long time in the Department of Hematology, he finally adjusted a hospital bed for the old man.Zhou Jun is going through hospital procedures with his father, Comrade Zhou.Fortunately, the ward adjusted by the Department of Hematology is a special care ward with single rooms, and Comrade Zhou can live in it and accompany him in bed.Otherwise, the old lady’s third-grade heart failure alone cannot be dealt with. You can’t expect the elderly who have difficulty even moving to take care of themselves with a plastic washbasin, right?
Before transferring the elderly to a specialized ward, the emergency room needs to stabilize the condition of the elderly.In addition to oxygen inhalation and continuous drainage of pleural effusion, Sun Lien gave Zhou Xiufang captopril and indapamide after consulting with director Wang Jianpei, a mutton powder enthusiast in the Department of Cardiology.The two drugs were used in combination to control Zhou Xiufang's hypertension and congestive heart failure.At the same time, according to Professor Li's suggestion of hematology, lenalidomide was used for early treatment and intervention of Zhou Xiufang's PPCL.

As the pleural drainage continued, Zhou Xiufang's mental condition improved significantly.Lying on the hospital bed, the old lady looked down with difficulty at the tube inserted into her side ribs, and waved for Sun Li'en.

"Are you my attending doctor?" The old lady was breathing oxygen, and it was a little difficult for her to speak.Although his voice was weak, he spoke quite clearly, "This is the Fourth Central Hospital, right? Where is Zhou Jun?"

"Ms. Zhou is helping you with the hospitalization procedures." Sun Lien held the old man's withered hand, "I am your attending doctor, and my name is Sun Lien."

"Xiaojun is your teacher?" The old lady held Sun Lien's hand a little harder, "Do you know what disease I have?"

Sun Lien was startled, then nodded.

"Pleural effusion, I feel weak all over." The old lady smiled wryly, "Congestive heart failure?"

"You have been treated accordingly. You are in a much better condition now." Sun Lien comforted, "If you feel worried, I will call Teacher Zhou in?"

Zhou Xiufang patted Sun Lien's hand, "Old lady, I'm not too confused. I'm progressing too fast. It's not congestive heart failure caused by coronary heart disease." She glanced at Sun Lien and said dissatisfiedly, "You are also a medical doctor. Graduated from the hospital, right? I’m still your senior.” She raised her chin lightly, and ordered the medicine next to the bed, “Lalidomide is not a medicine for heart failure. Do I have MM? MDS?"

MM is multiple myeloma and MDS is myelodysplastic syndrome.Both are the main indications for lenalidomide.

"Primary plasma cell leukemia." Sun Lien could only answer honestly. "However, the immunological examination confirmed the expression of CD56 antibody, and the prognosis of this type is the best..."

"I have studied multiple myeloma for 20 years, and I know what the consequences are. I just didn't expect that I would get this disease when I was old." Zhou Xiufang lay on the hospital bed, looking at the ceiling, as if her eyes passed through the floor and the ceiling. Reinforced concrete, looking at the blue sky exposed after the snow stopped. "It's... interesting."

She turned her head, looked at Sun Li'en and said, "Little comrade, please go and call Zhou Jun in. I have some things to tell him."

The old man's eyes were clear and firm, as if he had already made a decision.

　Post two chapters first to see the situation.There are five chapters today
　　
　
(End of this chapter)