Lupus erythematosus is an autoimmune disease, and the course of the disease starts from the onset to death is a true incurable disease.

However, at the moment of continuous development of medicine, even if the cause cannot be cured, there are sometimes solutions. Try to control the development of the disease and prevent the damage caused to the human body by the disease symptoms. The survival rate of lupus erythematosus has been greatly improved, and the survival rate in ten years can be as high as more than 80%.

However, more than ten years ago, this was still an extremely troublesome disease.

Apart from some patients with atypical and mild symptoms, a large number of patients with systemic lupus erythematosus are suffering from inflammation symptoms that affect the whole body. Skin erythematosus rash, headache, peripheral neuritis, various types of alveolar interstitial inflammation, anemia, fatigue, lymph node enlargement, systemic edema, skin itching, myocarditis, endocarditis, pericarditis...

Almost everything you can consider is likely to be harmed by the autoimmune army.

"System lupus erythematosus should also be misdiagnosed," said Qi Jing. "The patient has no other symptoms of SLE except for coughing. Moreover, the most common SLE alveolaritis, bronchioles and interstitial lung inflammation, are not supported in Wang Pingshi's chest radiograph."

These orthopedic doctors don’t know much about SLE and have no say. However, infection is a common complication in surgery, and there is too much pneumonia that has been bedridden for a long time.

Qi Jing's words obviously caused quite a lot of controversy.

Several doctors in the audience disagree with Qi Jing's writing. After a low voice, they said, "It's not appropriate to write "Infection worsens?". I remember that the patient's cough disappeared after taking hormones. It was a very obvious non-infectious lung inflammation. How can we say that the infection worsens?"

"Yes, non-infectious lung inflammation is the most common type of pneumonia caused by autoimmune diseases."

"If you use reverse thinking to reverse the problem, I think Sle's judgment is fine."

"Yes, if it is really infected, how can the cough disappear after using hormones for so long?"

These are actually what Qi Jing was first interested in this case. If there was no such link, Wang Pingshi's illness would be simpler.

Qi Jing glanced at them and asked, "According to your opinion, will the disease be cured if the symptoms of cough disappear?"

Several people looked at each other and thought it was not difficult to judge, and it was not even a problem: "Isn't it?"

"It's not that it's cured, but that the symptoms have been relieved, which means that the general direction of treatment is not wrong."

This is a typical surgical thinking, or the kind that I just started. Perhaps because of the fierce competition in the department, these surgeons in the audience added all their skills to the operation. They have great skills in their hands, but internal medicine is not just about bone separation and steel nail removal. It is useless to rely on their hands, but they have to rely on their brains.

After hearing this, Qi Jing could only look at the ceiling and breathe a long breath of turbid air: It's too difficult.

Fortunately, there are more than these young doctors in the office. Deputy seniors like Huo Zhiye have actually left the introductory stage of surgery and still understand Qi Jing's meaning. There are so many clinical diseases that it is impossible to have one-size-fits-all, and there will always be some unexpected situations.

"A general surgery, the patient had stomachache, and gastroscopy was gastric cancer." Qi Jing vacated a clearing space to draw a simple halfling, then drew a circle on his stomach, giving an example, "The operation was very successful, and most of the stomach was removed, but is that done?"

"It's over..."

"Isn't it the end of the operation very successfully?"

Huo Zhiye understood Qi Jing’s meaning, looked back at them, frowned and scolded: “Pig brain, that’s cancer! Cancer surgery is that simple?”

After such a scolding, these doctors realized that cancer is not a fracture, it is not as simple as treating pain, and lymph node dissection is required, and radiotherapy and chemotherapy are required after surgery.

"Now that the gastrectomy is, what should I do?" Qi Jing turned and became a senior surgeon, saying, "Do you have to open the gastrectomy to see how big the cancer is, whether there is infiltration around it, whether there is rupture and bleeding, and whether there is any surrounding lymph node metastasis? If all these are fine, can you ensure that the patient is cured?"

Speaking of this, it would be unreasonable if these orthopedic doctors could not react anymore, because the bone cancer specially treated by orthopedics is actually the result of metastasis of other cancers.

There are many in situ carcinomas that have been removed in time and intactly, and in situ carcinomas that are not serious at all. Some in situ carcinomas have even shrunk, but they have emerged from the bones soon.

Cancer cells are so cunning, and now it seems that Wang Pingshi's condition is the same.

"You mean that the lung infection in bed 19 has been transferred to the bone?"

"this......"

After Qi Jing's explanation, these doctors in the First Hospital began to slowly accept his concept. However, due to the lack of knowledge about infection, they had only one impression: tuberculosis bacteria.

After a round of discussion, I finally returned to tuberculosis bacteria.

"But is this tuberculosis?"

"This tuberculosis is too strange. The tuberculin test is positive, but the treatment of isoniazid and rifampicin is ineffective. Could it be tuberculosis bacteria that are resistant to both of these drugs?"

Xie Zongpei, who had been silent for a while, spoke: "If you consider respiratory infection and treat the medical history as a complete whole, it looks like nokaria."

"Norka?"

“What Noka?”

Listening to the puzzled voices around him, Xie Zongpei did not ask them but looked at Qi Jing: "Student, do you know Nokargen?"

Qi Jing nodded. As a storied figure in the domestic infectious disease department back then, Nokarcia was naturally the subject of his research: "Nokarcia is a Gram-positive bacteria that can cause local blood dissemination of suppurative infection."

Xie Zongpei did not expect that the child knew so well about a rare pathogenic bacteria. He was surprised and naturally could not lose face in orthopedics. He took out some of Wang Pingshi's previous examination reports and read them again, and said while reading: "This bacteria is rare in China and the detection rate is not high."

The chief director has worked in clinical practice for so many years and is naturally knowledgeable.

This is how knowledge reserves are. You may not be able to remember them in normal times, but after explanation or reminder from others, those dusty memories will emerge one by one from the water.

"That was more than ten years ago. When I was a deputy senior, I went to the orthopedic department of a US hospital for more than half a year." Xie Zongpei said, "A patient had a lung infection and had some lesions in the bones and lacrimal glands. After a long time of examination, the bacteria that was detected was nocaria."

The young doctors before did not know the severity and complexity of Wang Pingshi's condition, and would refute Qi Jing's words. But now after hearing the bacteria that Xie Zongpei said, he finally realized that this case was beyond their ability.

How can I continue to talk about a bacteria that I don’t know whether it is positive or negative for Gram?

Not only them, including Huo Zhiye, the deputy seniors also have no impression of Nokargen. After all, it is not the content taught in textbooks. After entering the clinic, they rely entirely on communication with colleagues and encountering related cases. There are not many cases of orthopedics encountering bone infection, and among them, they have only seen one tuberculosis.

Nokarcium became the stepping stone to continue Wang Pingshi's case discussion, and those who don't understand will be ruthlessly abandoned. Even the initiator of the discussion, Huo Zhiye, was not spared at this time, and could only sit aside and watch.

"The nokarcia mentioned by Director Xie is indeed very likely."

Qi Jing has also considered this bacteria before. It is chronic infection. The first thing that attacks the respiratory system, and then passes through the blood source to transfer to various parts of the body. The most common ones are the brain and bones, which look very similar to Wang Pingshi's situation.

"In addition to attacking bones and brain, nocaria also enters the skin and forms subcutaneous nodules and abscesses."

Xie Zongpei pulled out several more pieces of paper from the medical record, the most important of which was a record sheet for treating ulcers of the waist lump: "Wang Pingshi did have this situation before, and there is basically an 80% chance."

The chief director said so. Although the doctors around him would not flatter him, they would not have any objections.

And the most important thing is that the patient's condition is indeed similar to the Nokarcia mentioned by Xie Zongpei, and they have no reason or ability to refute this amount of knowledge.

"Director Xie, do you want to do another phlegm culture and a throat swab?" Li Xin picked up the pen again and prepared to fill out another one on the doctor's order.

"No, no hurry."

Xie Zongpei smiled and looked at the watch. Although the meeting was getting closer and closer to the afternoon meeting, he enjoyed the feeling of going back and forth during the case discussion. And he knew very well that in Wang Pingshi, the only one who could compete with him was probably the child in front of him.

Xie Zongpei looked at Qi Jing standing on the stage and couldn't help but ask: "Classmate, what do you think of my diagnosis? Is it more reliable than osteoporosis caused by side effects of hormones?"

Qi Jing nodded in agreement with his statement, but his eyes did not turn over, but solidified on the record board: "It's really much more reliable, and the Chief Director is worthy of being the Chief Director."

"Can you be more suspicious?"

Xie Zongpei was very satisfied with his performance, full of confidence in his words, and he also had the energy to play roles with Qi Jing: "After the x-ray, throat swab, and sputum culture were reported, we will slowly discuss the treatment methods of nocaria."

Unlike the commonly used diagnostic treatments in emergency rooms, what he said is the most reliable treatment method and a very standardized infection treatment process. However, Qi Jing did not agree: "Director Xie, Noka's judgment is very interesting, but Wang Pingshi should not be a Noka infection."

"Not Noka?"

Xie Zongpei's face, which had a smile a second ago, sank again.

Although he said he was 80% sure about Nokaria, he had actually thought it was this bacteria in his heart. Because it was so similar in terms of symptoms, he first had respiratory infection and then transferred to the bones and subcutaneous skin. This was the case with the patient in the United States back then. Although there was no subcutaneous lump, symptoms of bone damage were indeed found in the bones.

"What about the reason?" After repeated refutation, Xie Zongpei couldn't calm down anymore, "There is no reason, you can't talk nonsense."

"The reason is actually quite small. The main problem is that nocaria causes subcutaneous lymph node lumps, not really skin lumps."

Qi Jing looked at the medical record in front of Xie Zongpei and said, "Director Xie can take a look at the patient's general external emergency clinic dressing change records in 2001. It clearly states that the patient had a subcutaneous lump. After the ulcer, a large amount of brown-gray necrotic tissue could be found inside. It took him half a year to get rid of the medicine."

As Qi Jing's explanation continued to progress, Xie Zongpei's brows became tighter and tighter.

Until the end, this young doctor who looked about the same age as his son gave Xie Zongpei the last blow: "And the most important point is Director Xie, Nokarcia is a suppurative infection. After entering the bones, it is caused by abscess cavity. It is impossible to have only simple damage."

"Abscess?!"

He had seen patients with nocaria infection, but this was just a case. After hearing the consultation results, he was transferred to an infectious disease hospital. Xie Zongpei did not participate in the final treatment. Although there were reports on nocaria in China, the first diagnosis of this type of patients was in the respiratory department, and then the respiratory department distinguished and treated directly, which could not be reached at all in the orthopedic department.

After a few words, Xie Zongpei's knowledge that had been hidden for more than ten years was shattered.

This is no longer a question of whether to fight or not. He could not make a judgment on Qi Jing's explanation. After thinking for a long time, he could only make a decision, which was called a consultation.

After being questioned, Xie Zongpei lost his confidence and could not judge the authenticity of what Qi Jing said. At this point, he could only ask for help from external forces: "Xiao Li, go and ask the director of the respiratory department and the director of the dermatology infectious disease department to come for consultation together."

Li Xin nodded repeatedly, got up, walked to the phone and dialed the phone number.

The consultation phone number was called on the side, and the heated discussion here continued. Xie Zongpei still felt that his Nokaria had a chance of winning. Even if the suppurative infection caused by Nokaria was different from the one shown on the chest x-ray, it could not be completely ruled out.

"Director Xie, I don't think I need to call a consultation." Qi Jing smiled awkwardly.

In fact, he wanted to say that it was useless for these two people to come, but he felt that saying this would probably be driven out, so he temporarily closed his mouth and didn't say it.

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Chapter completed!