Chapter 954 Literacy

Thinking requires knowledge as content. If you lack this knowledge in your head, you naturally cannot think.

Although Zhang Lin and Xiao Wu almost lost face because of their recklessness just now, now that no one can figure out what disease this is, they naturally feel much more comfortable, at least their image in the students' minds has not been damaged too seriously.

"Isn't this a special bone tumor? The tumor will erode all the bone?" Li Guodong guessed.

The reason why the word "special" was added before the tumor is that in Li Guodong's mind, no bone tumor will have this kind of performance, whether it is a primary tumor or a metastatic tumor.

The learning and research atmosphere of the Institute of Surgery is very good. For example, in this case discussion, everyone will speak freely, whether it is right or wrong, it doesn't matter, even if it is a little outrageous, it will not be laughed at or criticized.

Generally speaking, the speeches in case discussions are gradually upgraded from junior doctors to senior doctors, because senior doctors are more knowledgeable and experienced than junior doctors. If senior doctors speak first, it is easy to cause junior doctors to have no room to play.

A department boss like Yang Ping was naturally the last one to speak and summarize, so that everyone could discuss freely. Otherwise, if he gave the answer at the beginning, the discussion would not continue.

"Well, I also think that this should be a special tumor, but there is no bone tumor that behaves like this in our existing knowledge." Doctor Zhao Wenbo also agreed with Li Guodong's opinion.

Li Guodong and Zhao Wenbo are sworn enemies. It is rare for them to agree at this time. If they usually argue with each other, these young doctors will doubt their lives.

Especially in the debate about traditional Chinese medicine, Li Guodong and Zhao Wenbo started to argue with each other as soon as they opened their mouths, because their views were completely different. Zhao Wenbo was a fan of traditional Chinese medicine, but Li Guodong always poured cold water on him, so the two quarreled every two days about this matter.

There was no way for the two to argue about this case, because if they wanted to argue, they must both know the case, otherwise they would lose the basis for the argument. Now that neither of them understood, they naturally stood in the same camp.

"It could also be a special infection, a virus or bacteria infection, or osteomyelitis caused by other microorganisms, which erodes the bone and causes a large amount of bone absorption."

A graduate student boldly put forward his own statement.

"Is there any virus or bacteria like this? I haven't seen any papers on this."

Another graduate student expressed doubt.

"Extreme manifestation of necrosis after stress shielding or bone blood supply damage? Is it possible?"

This idea is very innovative.

"Impossible, stress shielding only causes osteoporosis. Even if blood supply damage causes a large amount of bone necrosis, how can necrotic bone absorb so much, let alone so much in a year."

"Is there something wrong with the X-ray? Will the image be distorted due to transillumination?"

A graduate student stood up and approached the projected X-ray to see it more clearly.

Although the question is naive, it is also a question. The most important thing about the spirit of science is questioning and exploration. Without the spirit of questioning, it is impossible to achieve scientific results.

"The X-rays we reviewed several times are the same."

Song Zimo called up another X-ray, which is similar to this one.

Senior doctors like Zhang Lin Xiaowu are all confused, not to mention the graduate students, trainees and interns. Graduate students are better, after all, the specialist theory is orthopedics, and the trainees and interns are in a rotation state, and the breadth and depth of specialist knowledge are far from enough.

Any specialist knowledge requires a long time of accumulation. Without accumulation, the basic knowledge in the textbook can do nothing. The textbook only plays a role in professional enlightenment.

"This is strange. Is it possible that it is related to the metal material? The patient has a special physique and reacts to the metal material in a special way, which eventually leads to bone absorption."

Xia Shu put forward his own views. He is a doctor of cardiac surgery and knows nothing about orthopedics, so he is just watching the fun from the side for the time being.

Dr. Jin, who was sitting next to Xia Shu, had just been studying the medical records. Now he looked up and said:

"Let me say a few words. This patient's femoral shaft absorption, I think it is idiopathic osteolysis, which is a rare disease. Currently, there are only about 200 cases reported worldwide. In the literature I have read, apart from osteolysis, I really can't think of another disease that can make a large section of the femur disappear."

Idiopathic osteolysis?

This diagnosis is very simple, with only a few words, but no one has heard of this disease, nor has it been seen in the literature, and knows nothing about this disease.

Song Zimo and Xu Zhiliang have also thought of osteolysis, because for rare diseases, they have already undergone special studies in this area, while Zhang Lin Xiaowu and others have not yet entered this learning stage and have not been exposed to this knowledge, so naturally they will not think of it.

The two originally wanted to speak later, but they didn't expect that Lao Jin solved the mystery in advance. It seems that Lao Jin has read a lot of books. Lao Jin is already in his early 40s and is still a chief physician. Director Ouyang, who is at the same time as him, is already the head of the group in the orthopedics department.

For a long time, Lao Jin has given people the impression of being calm, hardworking, and long-term clinical business. Apart from reading and studying, he only performs surgery and has almost no other hobbies. Drinking and socializing are non-existent.

Lao Jin once suffered a loss in a foreign body removal operation. Later, he spent a lot of time studying foreign body removal. He retrieved all the images of foreign bodies in Sanbo Hospital since its establishment and studied them. He also studied the learning materials about foreign bodies, and then designed various methods and procedures for foreign body diagnosis and positioning. Later, many hospitals pushed patients to Sanbo Hospital when they encountered difficult foreign bodies. At that time, Song Zimo followed Lao Jin to learn foreign body removal and became a master of foreign body removal.

"It is also called Gorham-Stout syndrome. The most obvious manifestation is the spontaneous destruction and absorption of one or more bones. The cause of bone dissolution is currently unclear. Among the known diseases, except for osteolysis, no other diseases have such imaging manifestations. What are the opinions of Dr. Song and Dr. Xu?" Lao Jin added.

Song Zimo and Xu Zhiliang nodded at the same time. Song Zimo said, "Indeed, among the known diseases, only osteolysis meets this imaging manifestation. However, the bone absorption of osteolysis is generally slow. This one is completely absorbed in one year, which is still very fast."

"This is the first time I have encountered such a case!"

Old Jin has already said the diagnosis, but everyone's mind is still blank. They can understand the meaning of the diagnosis from the literal meaning, but they have no concept of this disease. The cause, pathology, clinical manifestations, diagnosis, treatment and prognosis are completely lacking in relevant knowledge.

"This is the first time I have encountered it. I have read relevant papers before, and I have studied rare diseases in orthopedics, so I know this disease." Old Jin said modestly.

"Old Jin is Old Jin. Osteolysis is a truly rare disease. There was a case that took eight years to get an accurate diagnosis, and it was finally diagnosed at the First Affiliated Hospital of Nandu Medical University." Song Zimo still admires Old Jin very much. His down-to-earth learning spirit has never changed.

Lao Jin spent a lot of effort to know this disease. In the past, he had read all the rare diseases announced by the World Health Organization many times, consulted a lot of literature and books, and was very familiar with these rare diseases. Otherwise, how could he know this disease? Medicine is a factual science. If you don’t know it, you can’t say it at all, and you can’t make nonsense.

"Lao Jin--you--this is amazing--"

Xu Zhiliang also admired Lao Jin.

In medicine, any diagnosis with the word "idiopathic" means that the cause has not been figured out yet. There are many unknown things about this kind of osteolysis in medicine, including the treatment method is immature and uncertain.

"How can such a large section of bone dissolve? I can't figure it out."

Li Guodong was very entangled.

"There are many things in medicine that I can't figure out. Otherwise, how can we say that medicine is still in its infancy? Has the mechanism of cold been figured out clearly? It seems not." Zhao Wenbo's nitpicking gene was awakened again.

For this kind of rare disease, if there is no systematic training in this area, it is impossible to get a correct diagnosis when encountering this disease. This is also the reason why a case was diagnosed after eight years. Most doctors have knowledge of common and frequently occurring diseases in their heads. As for rare diseases, even if they have some knowledge, it is sporadic and extremely limited knowledge.

So once they encounter a real rare disease, in most cases, doctors are struggling with common and frequently occurring diseases. If they can't get it out, there is no more.

Since 2008, the World Health Organization has designated the last day of February each year as the International Rare Disease Day, using this method to draw people's attention to rare diseases. There are currently more than 7,000 rare diseases, and the number of people suffering from rare diseases in my country is about 20 million. It can be seen that this absolute number is still very large.

The rare diseases we are more familiar with include phenylketonuria, thalassemia, osteogenesis imperfecta, etc. Osteogenesis imperfecta is commonly known as porcelain dolls and glass dolls. Most rare diseases are related to genetics, because each person has about 5-10 defective genes. If the defective genes of both spouses exist, there is a possibility of giving birth to children with these genetic rare diseases.

"Osteolysis is just a descriptive diagnosis. As for the cause, it is currently impossible to find it." Song Zimo said.

Dr. Jin said: "Yes, in fact, I also used the elimination thinking to get this diagnosis. After excluding inflammation, infection, tumor, osteoporosis and other causes, only osteolysis can explain it. In addition to osteolysis, from the cases I have seen and the literature I have read, there are no other cases with such large-scale bone absorption. Professor Huang Zhong of Nandu Hospital Affiliated to the First Affiliated Hospital diagnosed a case of osteolysis. At that time, the patient also had a femoral surgery, but the fracture did not heal, and the fracture gap became wider and wider. The patient went to many hospitals but did not get a diagnosis. He had undergone multiple bone grafting surgeries but all failed. Eight years after the onset of the disease, he was diagnosed by Professor Huang Zhong of Nandu Hospital Affiliated to the First Affiliated Hospital. At that time, Professor Huang also wrote a paper as a case report.

"How to treat it?" Zhang Lin asked.

Dr. Jin said: "First, use zoledronic acid or denosumab for drug treatment to prevent further bone resorption and increase bone density, and then consider femoral prosthesis implantation to replace the absorbed bone defect with a femoral prosthesis. But I wonder if we can try Ilizarov bone lengthening to treat it?"

"The biggest feature of this disease is bone resorption, large-scale resorption. Originally, bone resorption and generation are balanced. Once the balance is broken, the balance will tilt to one side. Now this disease is that the balance is seriously inclined to bone resorption, so if we use bone lengthening technology, I'm afraid it won't work. The necessary condition for bone lengthening is bone generation. Ilizarov also uses the principle of traction to stimulate bone generation." Xu Zhiliang spoke stutteringly.

Although it's hard to listen to Xu Zhiliang, everyone is used to his stuttering now, so it's nothing. Especially Zhang Lin, at the beginning, he almost had a myocardial infarction when listening to Xu Zhiliang speak, but later he slowly adapted to it, and it was nothing. If Xu Zhiliang suddenly stopped stuttering one day, Zhang Lin would be a little uncomfortable.

"So we should first use anti-osteoporosis drugs such as zoledronic acid or denosumab to block bone resorption and increase bone density, and then the subsequent treatment can be carried out." Dr. Jin stared at the projected X-ray.

"Ilizarov's bone traction theory itself stimulates bone growth. Can it stimulate bone growth in patients with osteolysis? If it can, it can block bone resorption and prolong bone."

Song Zimo's thinking has been broadened. In fact, questioning, criticism and debate are the spirit of academia. Without questioning, criticism and debate, there can be no academic progress. The more you debate, the clearer the truth becomes.

"Everyone is always struggling to find a suitable topic. Isn't the topic in front of us now? Ilizarov's technology for treating osteolysis. If it can be successful, everyone has found a new method to treat osteolysis." Yang Ping just likes everyone to argue with each other like this. If everyone is silent and lifeless, it will be meaningless.

"Does the professor mean osteolysis?"

After all, Lao Jin used the method of elimination to get the diagnosis, not a direct diagnosis, and this diagnosis is also a descriptive diagnosis, not a causal diagnosis, so he dare not be 100% sure.

"Among the known diseases, only this disease can explain it. We can perform bone puncture on patients to obtain bone tissue for pathological examination. Under the microscope, we can see abundant capillary fibrous tissue proliferation in the shape of blood sinusoids, lymphocyte infiltration or osteoclasts. These pathological manifestations have certain characteristics."

Song Zimo immediately said: "The increase of endothelial factor in the blood may also have certain characteristics, but the supporting evidence is still insufficient, but we can also test it."

Gap, this is the gap.

Zhang Lin and Xiao Wu can't keep up with their pace, because they really lack relevant knowledge in their minds. Their learning has not reached this stage. They have not systematically studied and studied rare diseases. At present, for the diagnosis of rare diseases, they are blind cats catching mice. When they encounter something they know, they vaguely feel that it is similar, and then they quickly check the information. If it matches, they will make a diagnosis. In this way, if they guess right, they will be happy. If they don't, it doesn't matter. After all, it is a rare disease, and it is normal that they can't diagnose it themselves.

Look at how the top experts diagnose rare diseases. They have systematic theoretical knowledge of rare diseases, and are familiar with a small number of clinical cases. They also have some analysis and insights, which are completely different from my luck-based routine.

"When we have time, we will hold a few training courses on these rare diseases, so that everyone will not be so confused." Yang Ping turned to Song Zimo and said.

Song Zimo nodded: "I will sort it out first, print out a copy of the information for everyone to study on their own, and then insert this knowledge in the weekly regular lectures to give everyone a thorough literacy on rare diseases. Zhang Lin, you organize it."

"Yes!"

Teacher Zhang responded that literacy must be done as soon as possible, and next time he encounters such a rare disease, he can also show it in front of the students.

PS: I was too busy during this period and failed to update normally. Sorry! Now I am a little less busy, and I will try my best to keep updating normally. Thank you!