Chapter 995: The Doctor Acts Like a Doctor

Typical pathological manifestations are the main basis for diagnosing Castleman disease. Now the basis for diagnosis is very clear, so the diagnosis is naturally clear.

Castleman disease was discovered by Dr. Castleman in 1956, so it was named after him. This disease is also called giant lymph node hyperplasia. It is between benign and malignant tumors. It is a rare reactive lymphoproliferative disease with different clinical manifestations and pathological characteristics. The most prominent feature is the manifestation of huge lymph node masses in the abdomen and chest.

The cause is currently unknown, but a large number of studies have shown that the occurrence of Castleman disease is related to infection with human herpes virus 8 and human immunodeficiency virus, immune system dysfunction, excessive secretion of interleukin 6 and other factors.

Its pathogenesis is still unclear, mainly manifested as invasion of lymphatic tissue. The main clinical pathological changes are reactive hyperplasia of lymph nodes caused by chronic inflammatory cell stimulation, which leads to single or multiple lymph node enlargement in patients.

According to the number of affected lymph nodes, it is divided into unicentric and multicentric types. The unicentric type means that there is only one lymph node or one area of ​​lymph node enlargement. As the name implies, the multi-center type means that the disease involves more than one lymph node and more than one area.

The mono-center type is more common in people in their thirties and forties, and is common in the head and neck. Systemic symptoms are less common. This type can be treated with surgery, and the prognosis is relatively good.

The multi-center type is more common in people in their fifties and sixties, and is manifested by multiple lymph node enlargement and multi-organ involvement, accompanied by long-term fever, weight loss, night sweats, general fatigue and other systemic hypermetabolism symptoms, hematocytopenia, hyperimmunoglobulinemia and other systemic symptoms. This type is often complicated and has a poor prognosis.

The diagnosis of this disease relies on pathological biopsy. If it can be surgically removed, it should be surgically removed as much as possible; if the surgery cannot be completely removed, the preferred treatment method is chemotherapy.

Director Jiang personally came to the ward with the pathology report. When Fu Xiaotao heard the name of his disease, he felt relieved. Regardless of whether the disease can be cured, at least now he knows what disease he has, and it is better to know clearly than to be confused.

At this time, Fu Xiaotao's parents also had hope in their hearts. They had been feeling sad and regretful about their son's illness, but now they finally figured out what the disease was. If things continued like this, would there be a chance of cure? Now at least they could have a hope. Before, they didn't even know what the disease was, so how could they talk about hope?

But things are always not as good as imagined. Fu Xiaotao suffered from Castleman's disease, which was multi-center. The prognosis of this type of patients was very poor. It was said that few people lived for more than two years, so the news brought by Director Jiang was mixed.

After the diagnosis was made, the next step was treatment. The difficulty of internal medicine was not in treatment, but in diagnosis. The difficulty of surgery was easy, but the difficulty was in surgery.

For surgeons, the general diagnosis was relatively easy to figure out, but for the same disease, the surgical results of different doctors varied greatly. But internal medicine doctors are different. They have to spend a lot of energy on diagnosis. Once the diagnosis is made, there are guidelines for the remaining treatment methods, and everyone is similar.

Even rare diseases have their own treatment guidelines, but general treatment guidelines are usually lagging behind. However, for safety reasons, most doctors are willing to follow the guidelines, regardless of whether they are effective or not, because doing so is not wrong no matter what the result is. Once new methods outside the guidelines are used, they may get into trouble if they are not careful.

"Use cetuximab to treat first and see the effect. If it doesn't work, use chemotherapy." Director Jiang told Fu Xiaotao.

"Chemotherapy? Is this a tumor?" Fu Xiaotao's parents immediately became alert.

Director Jiang explained: "This is a disease between benign tumors and malignant tumors. We have at least figured out what the disease is and how to treat it. As for the treatment effect, no one dares to draw a conclusion now."

"Try it!" Fu Xiaotao's mother was more calm. Compared with the previous confusion, now it is a great improvement.

But Fu Xiaotao's father is not so optimistic. He thinks the current situation is even worse. Before, he didn't know what the disease was, at least he was troubled, but he couldn't say he was desperate. Now he knows what the disease is, and the hope of cure is very slim. Now he feels desperate.

Fu Xiaotao is different from his parents. When he went for a checkup, he saw Luo Jin's picture in the corridor. Fu Xiaotao knew Luo Jin's inspirational story. The spiritual power of role models is infinite. Fu Xiaotao is definitely like Luo Jin. As long as there is a glimmer of hope, he will fight for it 200%.

"Just treat it according to your method. Can I see Professor Yang again?" Fu Xiaotao asked.

Director Jiang said: "I will contact him for you. He is very busy and the time is uncertain for the time being."

——

For Castleman disease, Wen Ruzheng's confidence is justified, because there are only a single digit of cases reported for this disease. Although the number reported is a single digit, it is far from this number in the population, because most doctors do not know this disease, that is, this kind of patients have never figured out what disease they have.

When the dedicated Dr. Wen was studying pathological knowledge, he had to read a lot of literature from morning to night every day, and then for some rare diseases, he was familiar with the pathological characteristics, whether in text or pictures. Unexpectedly, this rare disease also let Wen Ruzheng encounter it. This is a once-in-a-lifetime opportunity, but everything was shattered by Yang Ping in less than a minute.

Wen Ruzheng estimated that the time it took Yang Ping to look at the pathology slides was really not more than a minute. Even if he guessed, it wouldn't be so fast.

The next morning, when the shift was over in the pathology department, Wen Ru was reporting this valuable classic pathology slide to everyone. He should have been extremely proud, but now he was listless, and the whole reporting process seemed dull and boring.

This is definitely not Dr. Wen's usual image, because when he explains pathological slides, especially the extremely valuable pathological slides, Dr. Wen is very happy and eloquent, and he does not repeat anything for three days and three nights.

Today, Dr. Wen took such a rare pathological slide and used boring language for more than ten minutes to talk about it. What's going on?

Everyone speculated that Dr. Wen must have suffered some kind of blow, but what else could defeat a man who once dared to run naked?

Falling out of love must be lovelorn. Dr. Wen may have encountered an unprecedented failure in his pursuit of the female doctor in the oncology department. Falling out of love is a painful thing, especially in the short term. Colleagues all speculated this, because for those who spend all day in the hospital Dr. Wen, who studied pathological slides from morning to night in the science department, could not think of anything that would make him so depressed.

After the early shift, Director Guan asked his colleagues about Wen Ruzheng's situation in a subtle way, and how the good-spirited young man had turned into a wooden person. Everyone agreed that the problem lay in personal relationships.

In order to relieve the knot in Dr. Wen's heart, Director Guan called Wen Ruzheng into his office, closed the door, and poured him a glass of water. Wen Ruzheng took the cup and put it on the table without saying a word.

"Xiao Wen, you are still young. Don't block the forest with a tree. It's pointless to lock yourself in a small space. Every young person nowadays has not been in love for a few times. I was not like that at that time. I have been in love for a few times. Only one can do it.”

Director Guan used himself as the protagonist of the story and fabricated some so-called experiences to enlighten Dr. Wen. He mainly felt that this would make Dr. Wen more sympathetic and would have immediate results.

"A man is a man who can take things and let them go. I was in a worse situation than you at that time. I chased a beautiful girl for several years, and finally she married someone else. Look, am I not living a good life now? Have I ever been depressed?"

Wen Ruzheng raised his head and looked at Director Guan: "Decades have passed since your incident. Of course you are fine now."

"No, it's the latest thing!" Director Guan blurted out.

Wen Ruzheng immediately steeled himself and stared at Director Guan. Director Guan felt frightened for a moment, but at least the boy's eyes were bright now: "Is everything okay? I figured it out."

"I've always thought clearly. I wasn't afraid of running naked last time. How could I be afraid this time? I just don't understand. Professor Yang doesn't usually go to the pathology department. How can he be so powerful? How can he see it?" Wen Ru was taking a sip of water and said.

Director Guan was confused: "Aren't you lovelorn? Running naked? What are you running naked?"

"I lost my bet with Professor Yang yesterday. I still ran naked, but this time I had to be naked, really naked." Wen Ruzheng said his problem.

"Aren't you lovelorn?" Director Guan was particularly embarrassed.

"No! If nothing happens, I'll go work first." Wen Ruzheng stood up.

"Xiao Wen, the things I just said were all fabricated, and they were all meant to enlighten you."

"I know!"

"Don't take it to heart, it's all fiction."

"I know!"

"Don't go out and talk nonsense about this!"

''I know! "

''It's really fiction! "

''I know! "

——

Yang Ping had encountered this disease for the first time in reality. However, when reading literature in the system space, Yang Ping had seen this disease and then seen experimental subjects suffering from this disease, so he also Not too unfamiliar.

The system space gave Yang Ping a lot of time, and Yang Ping spent all of it on studying. If the system gave Yang Ping the greatest support, it must be sufficient time. In just one nap, he might have studied several times. sky.

We must go all out for every case. Now that we encounter this kind of case, Yang Ping begins to think about treatment options. Fu Xiaotao's condition is very serious. All current chemotherapy options are not very effective, and the side effects of chemotherapy drugs themselves are very serious. , some of which are carcinogenic.

In medicine, many treatment options are making slow progress, because medical breakthroughs are very difficult, and each medical specialty is extremely professional. It is difficult for a person to master the knowledge of this major in his lifetime, let alone transcend it. Specialties span disciplines. Precisely because doctors are always limited to a narrow specialty, it is difficult to innovate. If we can break out of this limitation, innovation will become relatively easy.

Yang Ping reviewed the treatment methods for this disease. An American expert created cocktail therapy, which uses seven chemotherapy drugs. It is said to be the most advanced method in the world. In fact, Americans have a good spirit of innovation and deserve our attention. They can learn many things and come up with bold ideas and put them into practice.

For the pathogenesis of Castleman disease, Yang Ping summarized many literatures. It is generally recognized that interleukin 6, the messenger of the immune system, is the most critical part of the pathogenesis. When the lymph nodes secrete excessive interleukin 6, the immune system is abnormally hyperactive, causing a strong local or systemic inflammatory response. Therefore, from the pathological essence, this is an inflammatory response, so the use of glucocorticoids is effective, but glucocorticoids only inhibit the inflammatory response, which is a temporary solution, not a permanent solution. That is, it can only treat sewage, but cannot treat the source of pollution.

After thinking for a while, Yang Ping did not get any valuable new information. He decided to reorganize the information on this disease to see if he could find something new.

Song Zimo knew that Wen Ruzheng was a stubborn person, and was afraid that he would really run naked without wearing underwear, so he specially called Wen Ruzheng: "We are just joking, don't take it seriously."

But Wen Ruzheng didn't think so. The more he thought so, the more he felt that this was underestimating himself: "I, Wen Ruzheng, am upright and I always keep my word. How could it be a joke? Don't worry, I will choose a time to fulfill my promise, and I will never compromise."

This Wen Ruzheng is really stubborn. According to him, he will definitely fulfill his naked run this time, and he will fulfill it without any compromise. This time it is a real naked run, the kind of naked run.

When Song Zimo told Yang Ping the news, Yang Ping could only sigh: Hey - Dr. Wen is a man, Yang Ping can only say this.

Because there are more surgeries today, Yang Ping got off work at more than eleven o'clock in the evening. At the door of the hospital, Yang Ping happened to meet Wen Ruzheng. Wen Ruzheng saw that Yang Ping didn't say anything, but just made a gesture to say hello.

He held a stopwatch in his hand, staring at the road in front of the hospital, as if he was doing some kind of test, and he looked very serious, so Yang Ping didn't want to disturb him.

The next morning at around six o'clock, when Yang Ping went to work, he saw Wen Ru doing the test again, still holding a stopwatch in his hand, staring at the road. What does this guy mean, why is he so nervous, why is he holding a stopwatch in his hand in the evening and morning, Yang Ping didn't care about these.

In the doctor's office, the doctors were working and chatting at the same time. Zhang Lin's news was always the most timely. He told everyone that Wen Ru was testing the flow of people on the four roads around the hospital all night yesterday, so as to decide when to run naked. Because the gambling agreement did not allow underwear, but the time was chosen by him, so he was using scientific and rigorous statistical methods to accurately measure the flow of people around the hospital.

It is said that measuring for one day cannot explain the problem. He will measure it every few days, and measure it many times in a row, and finally get a stable and accurate data. After getting the best time for running naked, he will start to announce the time of running naked.

It is worthy of being Dr. Wen, who works like a doctor.