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Epilepsy is often an excessive synchronous abnormal discharge of brain neurons. Checking the EEG can not only make a diagnosis based on the appearance of spikes, sharp waves, spike-slow waves, or sharp-slow complex waves on the EEG.
Moreover, it can provide certain diagnostic basis for doctors to judge the type of epileptic seizures and the location of abnormal discharge.
Zhou Can stared at the patient's EEG and examined it carefully.
Even compared with the EEG done before the patient was admitted to the hospital.
Soon, he found that the peaks of the two EEGs were significantly different.
The sharp wave part unexpectedly accelerated a lot.
In addition, the scattered abnormal waves on the second EEG increased significantly.
"Xiao Zhou, tell me about your diagnosis!"
Director Wen may also want to find out Zhou Can's bottom line.
He wanted to see other performances of this regular training doctor besides implantation.
The focus of other people's eyes also converged on Zhou Can's face.
"I'm just a novice, so it's better not to express my opinion! Don't make me laugh."
Zhou Can had just joined Director Wen's medical team, and felt that it was better to keep a low profile.
If you talk too much, you will lose it. This is the way his parents taught him to deal with people since he was a child.
"Say, just say it with confidence and boldly, don't have any worries!"
Director Wen insisted that he speak.
How could such a good opportunity be easily let go.
This kind of difficult case analysis can test a person's comprehensive diagnostic ability.
"Then I'll make a fool of myself."
Zhou Can no longer hides it.
"I compared the EEG before and after the operation, and the difference is quite large. Both the speed of sharp waves and the number of scattered abnormal waves have greatly increased compared with those before the operation."
Director Wen nodded slightly after listening.
It is not bad that a Gui Peisheng can discover so many abnormalities in a very short period of time.
"Go on!"
He gestured to Zhou Can.
"Judging from the before and after comparison of the EEG, the operation not only failed to solve the problem, but made the condition worse."
As soon as Zhou Can said this, the whole office became extremely quiet in an instant.
Many people looked at him in surprise.
This Gui Peisheng is really young, what can he say, what can't he say, doesn't he have a B number in his heart?
Can you say that if you turn a corner and scold Director Wen for not doing a good job in the operation?
Director Wen originally had a smile on his face, but now his smile froze.
Although he hasn't lost his temper yet, everyone can already feel the anger burning in Director Wen's heart.
He didn't immediately slap the table and scold Zhou Can, just because of his status.
"Go ahead!"
Director Wen's tone has obviously become much colder, with a strong bite.
Looking at Zhou Can's gaze was icy cold.
A person who does not know how to respect superior doctors is not worth cultivating.
It doesn't matter how powerful you are.
"Let's look at the comparison of brain CT scan results before and after surgery. Obviously, the surgery has completely removed the original lesion. With all due respect, this kind of malformed vein and blood vessel removal near the internal capsule can be done so thoroughly, and It did not cause any damage to the patient's internal capsule, which is beyond the level of ordinary chief physicians."
"At least it's something an expert neurosurgeon can do."
Zhou Can suppressed first and then raised.
Just a few words triggered a round of warm applause.
Director Wen's gloomy face suddenly became brighter, and when he looked at Zhou Can, his eyes were smiling again. And it's a little thicker than before.
His whole body was like a scorching June day, and he was even more comfortable after drinking a glass of rock sugar water.
It has to be said that the tactic of suppressing first and then promoting is much better than directly praising the other party.
Zhou Can actually didn't want to flatter Director Wen.
Just tell the truth.
Maybe even he himself didn't expect to get unexpected results.
Emotional intelligence is something that is very important to cultivate from an early age.
Slowly implanted in the bone, it is difficult to overturn the boat when talking and doing things.
At least Zhou Can has encountered many crises since he entered Tuya Hospital's regular training, all of which were successfully resolved by his high EQ.
Whether it is Vice President Bai or Shangguan Yan from the Second Affiliated Hospital of Tuya, they have turned enemies into friends with him and are grateful to him.
If it is handled by someone else, it is likely to be another result.
"Haha, the difficulty of this operation is indeed not small, but you said that at least an expert-level supernatural doctor can complete it, which is a bit exaggerated!" Director Wen is not without a city.
It's just that under Zhou Can's offensive, no matter how deep the city is, it's not as happy as Canman's innocent laughter.
Because he was really, really happy.
It was like drinking honey in my heart.
After the operation had complications, Director Wen was under tremendous pressure. I was even more worried about being ridiculed for not doing a good job.
Now, Zhou Can has spoken a fair word for him, and even publicly stated the highlights and key difficulties of this operation.
Do you think he would be unhappy to hear that?
This is not only a recognition of his surgical ability, but also a high praise for Director Wen's best surgical field.
It's much more true than some people's ramblings.
"I am not exaggerating. The risk and difficulty of excision of the malformed veins and vessels near the internal capsule is second only to the operation near the brainstem. Many chief physicians of Shenwai do not dare to perform this operation. Those who can do it well , even less.”
Zhou Can continued to praise Director Wen.
Director Wen's name was not mentioned once throughout the whole process.
But Director Wen was very useful after hearing it.
Therefore, flattering is really a technical job. It is definitely not a simple compliment to the other party, you are so handsome, you are so capable, you are really rich...
The most brilliant flattery is to talk into the heart of the other party.
Get deep recognition from the other party.
"According to the abnormal points of the postoperative EEG and the results of the CT scan, I think there are only two possibilities for the patient's epilepsy to worsen. The first is cerebral hematoma. The second is that there are other lesions that have not been discovered."
Cerebrovascular malformations are often not single, but multiple.
Doctors with rich experience in diagnosis and treatment often ask to start from the patient's neck arteries and veins to check upwards.
"Excellent words!"
Director Wen admired Zhou Can's diagnosis from the bottom of his heart.
If it was Dr. Zou or Dr. Tang Li who made the diagnosis, he would not think there was anything wrong with it.
Because they are all experienced attending physicians.
Regardless of their poor interventional skills, their academic and diagnostic skills are not bad.
Among the attending doctors outside the gods, they can even be ranked in the forefront.
It is really amazing that a regular training doctor can have such a superb diagnostic ability.
"Doctor Zhou, I really didn't see it. Not only did you do a good job in implantation surgery, but your level of pathological diagnosis is far superior to mine. The three of us will have to learn a lot from you in the future."
The three graduate students all smiled at Zhou Can.
This is a show of favor.
"It's really good to be able to differentiate the two causes. But if you want to cure the patient's epilepsy, you have to focus on the final focus. Can Dr. Zhou make a more accurate diagnosis?"
Dr. Zou hid his knife with a smile.
It is not easy for a regular trainer to diagnose the approximate cause of the disease.
Zhou Can was required to answer more precisely. Isn't this forcing him to make a fool of himself?
As the attending doctor, Zhou Can suppressed him in the operating room. Now in the consultation and discussion within the group, Zhou Can stole the limelight again.
Dr. Zou inevitably had some unfriendly thoughts.
Suppressing newcomers has always been the favorite thing for all the old people.
Seeing the tricks, Zhou Can pushed the opponent's persecution away with a few light words.
Then the conversation changed.
"Dr. Zou's question must already have an answer. Why don't you share it, so that we rookies who have just entered the industry can learn a lot."
He in turn took Dr. Zou into his army.
Dr. Zou's status is much higher than his, and there is really no way to evade it as easily as he does.
"Uh... well! I personally think that there are more vascular lesions in other parts."
Dr. Zou stammered, indicating that he was not well prepared.
I certainly don't have an accurate diagnosis in mind.
Now I can only answer imitatively.
"Doctor Zou, I heard that the approximate lesion area can be determined by looking at the EEG. Can you tell me which part of the blood vessel is lesioned? And is the lesion serious?"
a graduate student asked.
This buddy definitely has no intention of helping Zhou Can deal with Dr. Zou.
This question is purely driven by a strong desire to learn.
"Hmm... um... Personally, I think it should be near the thalamus! As for whether the vascular disease is serious, everything depends on the results of the examination."
Dr. Zou's answer reveals a serious lack of self-confidence.
And still ambiguous, not exact.
If you want to give the patient surgical treatment, this diagnosis result is of no use at all.
The location of the lesion is not clear, and the condition of the lesion is not clear, almost all of them are based on guesswork. Can that meet the indications for surgery?
"The lesion is in the thalamus, which can basically be ruled out. According to my treatment experience, the vascular lesion that causes epilepsy has never appeared in the thalamus. The thalamus is more of an endocrine organ. Its lesions often only cause There may be major changes in systemic endocrine disorders."
Director Wen directly shot Dr. Zou's diagnosis result.
There is no room left.
Medicine is inherently rigorous, prudent, and free from ambiguity.
"Let's focus on checking the patient's preoperative cerebral angiography. See if you can find the lesion. Of course, the postoperative hematoma mentioned by Dr. Zhou is also very likely. Postoperative CT scans can also be checked repeatedly. , to be scrutinized."
Director Wen gave everyone a general direction.
However, the specific location and cause of the disease have not yet been determined.
Everyone you say, I discuss in a word.
Everyone expresses their views.
While studying the films taken by the patient, Zhou Can carefully recalled the specific symptoms and various manifestations of the patient.
In the end, he came to a surprising conclusion.
"Director Wen, do you think the patient may have a cavernous hemangioma?"
Zhou Can raised his head and asked.
"Not ruled out!"
Director Wen is not a god, at best, he has richer diagnostic experience than them, and has more profound medical knowledge in cerebrovascular and neurological aspects.
"Cavernous hemangioma is a hidden vascular disease, even through CT or even the most advanced digital subtraction angiography, it is difficult to find it. To check it out, I think it is necessary to apply for a head MRI examination for the patient. "
Zhou Can thinks that the possibility of cavernous hemangioma is very high.
On the contrary, cerebral vascular arteriovenous tumors can basically be ruled out.
If there is really an arteriovenous tumor, no matter how small it is, it should have been detected long ago.
"The hospital's MRI examination resources are quite tight, and the examination fee is quite high. Will the family members accept it?" Tang Li asked with some concern. "During the ward rounds, the family members of the 22-bed patients were very difficult to talk to. Now the patient's condition has not been alleviated after the operation, but the epilepsy has worsened. It is a bit far-fetched to explain it with a postoperative complication. The family members also extremely distrust us."
Her concerns are not unfounded.
The doctor-patient relationship is already highly tense.
Especially after such a crisis of mistrust, the situation is even worse.
Moreover, the patient has already undergone two additional postoperative examinations, and now he needs to undergo an expensive head MRI. The family members may really demolish the ward.
"Our doctors are not gods. We have indeed removed the diseased veins of the patient. There are only two reasons for the exacerbation of epilepsy, either hematoma or other vascular diseases. So many examinations have been done, and preoperatively After repeated discussions, common vascular lesions cannot be hidden now. Only cavernous hemangiomas called invisible vascular lesions are most likely to occur."
"If you want to give the patient further treatment, you can't get around this threshold. To be honest, if you have a postoperative hematoma, you can find it out on a CT scan. However, after the postoperative CT scan, no hematoma was clearly found. Therefore, I think it is very important. Need an MRI."
Compared with CT scans, MRI examination results are clearer and more precise.
Back then, it was the advent of nuclear magnetic resonance that allowed many tumor diseases to be easily diagnosed by doctors.
It has unique advantages that ultrasound, X-ray, and CT do not have.
Director Wen bowed his head in thought.
As the chief physician, he must have his own thinking.
Zhou Can's opinion is more of a reference.
The doctors in the group have a word for you and me, and continue the discussion.
Slowly, there are more and more opinions that agree with MRI.
We adopted the method of exclusion.
Rule out some possible situations one by one.
In the end, the possibility of cavernous hemangioma was considered extremely high.
Because cavernous hemangioma has a characteristic, its blood vessel wall is ultra-thin. During the operation, it is indeed possible to cause it to rupture and bleed.
Head color Doppler ultrasound can also have certain diagnostic significance.
It's just that the family members have already made such a fuss.
Every examination application issued by the doctor is cautious.
Otherwise, the family members will think that the doctor is deliberately making money, not to mention that the operation has no effect, and the patient will be asked to do all the examinations again after the operation.
"After careful consideration, I decided to apply for a head MRI examination for the patient. Tang Li, your communication skills have always been good and you are very friendly. Can you communicate with the family members?"
A medical team should have all kinds of talents.
Maintaining good communication with family members is also important.
"Okay, I'll go and communicate with the family right away."
She readily agreed, and seemed quite confident.
When female doctors and nurses communicate with their families, they have certain natural advantages.
Easier to be accepted by family members.
Also softer.
"It's enough to communicate frankly. Tell the family members the specific results of the discussion, and let them understand that the patient's epilepsy has worsened, and there is indeed a possibility of dual lesions."
Director Wen gave guidance.
There are many more complex diseases that are prone to dual focus.
It's like finding a mouse at home, which means that there may be more mice in the whole community.
…
Half an hour later ~www.mtlnovel.com~ Tang Li communicated with her family and came back.
Her face looked relaxed, and she even had a slight smile on her face.
The description is pretty good.
"The family members have agreed to undergo an MRI examination. After communication, their trust in us has also increased a lot. Now I hope that the lesion can be found!"
What worries her the most is that the MRI examination still has no results.
At that time, the trust established again will be completely lost.
Families will no longer have any trust in the hospital.
After a long wait, good news came again.
The patient underwent a head MRI examination and found a large area of abnormal blood vessels in the brain.
The doctors in the medical technology department are actually not weak in watching movies.
They can pinpoint the problem more precisely.
Mark the size of the lesion area, the nature of the lesion, etc.
Director Wen couldn't wait to take the NMR film and examine it carefully against the light.
An excited smile appeared on his face little by little.
"Okay, great! It really is a cavernous hemangioma. This harmful thing is really deep enough! It almost ruined the old man's reputation for the rest of his life." He was so happy that he even used the word "old man" up.
The doctors under him couldn't help smiling.
"Xiao Zhou, your performance is very good. Seriously, if you hadn't carried out rigorous analysis and insisted on giving patients head MRI examinations, I really couldn't make up my mind. Our team officially invites you to join, and I will apply for you to open the group Account, you can check the cases in the group at any time in the future. If you have a good diagnosis result, you can also give me feedback at any time."
It's really not easy for Director Wen to give Zhou Can a high degree of affirmation in public for such a face-saving person.