Chief Luo was speechless.
He was speechless not because the local diagnosis was wrong. Because in the Imperial Capital, it was common to see the wrong diagnosis of lower-level hospitals. Even if he saw dozens or hundreds of patients every day, if he did not encounter a single wrong diagnosis, Chief Luo himself would find it a very magical day.
But... This was an electromyogram. Even Little Zheng understood it?
Chief Luo didn't say anything. He just looked at Zheng Ren with a questioning look in his eyes.
Zheng Ren nodded slightly and said, "According to the performance of the electromyogram, I think it might be..."
"Hmm?" Chief Luo sensed Zheng Ren's hesitation. Could it be a rare disease?
"It's mitochondrial encephalomyopathy," Zheng Ren said softly.
The patient's family member was stunned. Mitochondria? What the hell was that? It sounded very strange.
Not only her, even Chief Luo was stunned.
Chief Luo was very cautious. He did not directly answer Zheng Ren. After a few seconds of silence, he picked up his phone and made a call.
"Hello, this is Luo Shan. I have a patient here who came with a local electromyogram. It's suspected that there's an error in the local diagnosis. Please take a look. Okay, I'll ask the patient's family to look for you. Write down your diagnosis. Thank you."
After saying that, Chief Luo instructed the patient's family to go to the electromyography room to look for a certain chief before returning.
The patient's family was full of doubts but still followed Chief Luo's instructions and left with the electromyography. As they walked, they tried to remember the term 'mitochondrial encephalomyopathy'. However, they could not remember it clearly now. They only vaguely remembered the word 'mitochondria'.
Chief Luo didn't allow him to bring other information, saying that it was troublesome.
However, Zheng Ren knew that he might have to ask him many questions.
When the patient's family went out, Chief Luo deliberately went to the door and said a few words to appease the other people who came to see the patient. Then, he closed the door and looked at Zheng Ren, asking, "Boss Zheng, how did you diagnose it?"
Chief Luo's tone was not heavy but there was a sense of seriousness and academic vigor in it.
Zheng Ren knew that to get Chief Luo's approval. Now was the make or break moment.
Previously when the Crohn's disease patient was diagnosed, his judgment was the same as Chief Luo's. He could display a part of his ability, but it was not enough.
Academics were only close to academics. Of course, there was also the matter of peers being enemies. Moreover, the probability of them being close to each other was higher.
In other words, if he did not have some skill or had not done research within the Imperial Capital, it would be difficult for him to even gain a foothold.
He could not really rely on the few beds given by Department Chief Kong to win the Nobel Prize, right?
Of course, he could also apply to the higher-ups and get the health department's support. However, if that was the case, the timeline would be extended infinitely. Moreover, the Imperial Capital Hospital did not belong to the health department.
Zheng Ren did not want that.
He pulled himself together, smiled, and said, "Because there is a problem with the patient's electromyography and according to the patient's family, the patient is prone to fatigue. If I'm not wrong, they should definitely be extremely prone to fatigue."
"How did you guess?" Chief Luo adjusted his glasses and stared at the young man with a swollen nose and slightly funny face. He did not hesitate to ask this question.
"Because of intestinal obstruction." Zheng Ren said, "I came from the hospital below. There are not many doctors in the local hospital who know about mitochondrial encephalomyopathy. Uh... Sorry, I got off topic as I was talking."
Chapter 754 - Finding Fault
Zheng Ren smiled and stood up. He bent his back slightly and asked Chief Luo to sit down while he stood in front of Chief Luo.
He was young and capable, but he was not arrogant and domineering. Chief Luo was very satisfied with Zheng Ren's performance.
Zheng Ren then said with assurance, "In smaller hospitals, the diagnosis of intestinal obstruction is usually done through abdominal dialysis or according to clinical symptoms. According to the patient's family, there were a few times when the diagnosis of intestinal obstruction was made but the inpatient department overruled the diagnosis. I guess this means that the intestinal obstruction will be resolved when we go to the inpatient department and it will be the type that will recover on its own without medication."
Chief Luo listened quietly and did not interrupt Zheng Ren's words.
"So, I guess the patient's intestinal obstruction is only short-term and temporary. In addition, the patient's family said that the patient is prone to fatigue, so I had a guess as to whether the patient's skeletal and smooth muscles are affected. If that's the case, then the possibility of mitochondrial encephalomyopathy is higher."
Chief Resident Shen was stunned when he heard that...
He had seen Zheng Ren's surgery before, so he knew that Boss Zheng's standard of interventional surgery was quite high. Less than half a year ago, that eye artery surgery had opened Chief Resident Shen's eyes.
At that time, he almost licked his screen and was even reprimanded by Department Chief Kong.
With Boss Zheng's skill, it was possible for him to be nominated for a Nobel Prize. Chief Resident Shen thought that this matter was quite reasonable.
However, was he also so good at diagnosing rare diseases?
Mitochondrial encephalomyopathy? What the hell was that? Chief Resident Shen was at a loss.
As a medical doctor, he didn't understand the conversation between Zheng Ren and Chief Luo at all. His face was a little red.
"So, you looked at the electromyography?" Chief Luo asked.
"In local hospitals, it's basically a headache for doctors. But the examination of electromyography... Forgive me for being blunt, but in local hospitals, it's very rare. Usually, only the neurology department does it."
"Oh? And then?"
"Because I didn't hear from the patient's family that they went to the neurology department for medical treatment, I guessed that it was an electromyography test prescribed by the emergency department's doctor during a major muscle weakness attack," Zheng Ren said frankly. "This kind of test is relatively blind, but it touches on the key factors by relying on luck."
Relying on luck...
Chief Luo felt annoyed and amused by Zheng Ren's straightforwardness. This little guy was really quite frank when he spoke.
As a doctor, who was willing to admit that they were trying their luck?
However, due to the limitations of scientific standards and diagnostic standards, the diagnosis of many diseases also required luck even in the Imperial Capital, let alone with other local hospitals.
This was especially true for rare diseases like mitochondrial encephalomyopathy.
This kind of disease had nothing to do with the gastrointestinal department, so Chief Luo did not study it. What he was curious about was how the junior doctor in front of him had diagnosed it.
Could a candidate for the Nobel Prize be so good at cross-disciplinary diagnosis?
Things seemed to be getting more and more interesting.
"There are abnormalities in the electromyography, but the abnormal electrical waves are not obvious. The electromyography is the most common type of narrow electromyography in a local hospital. The percentage of multiphasic waves usually does not exceed 20%, but there are a few stages where it is slightly exceeded. Different muscles have different ranges of normal values but during the short period of electromyography, the later stages have gradually returned to normal."
At this moment, it was not only Chief Resident Shen, even Chief Luo was a little absent-minded.
What was Boss Zheng talking about?
"The report is written with a single hand, such as interference phase, mixed-phase, pure phase, pathological interference, etcetera. But if you look at the waveform, you will find that the first few seconds of the waveform were wrong," Zheng Ren said.
Silence. When Zheng Ren stopped talking, there was silence in the chief's office.
Soon, Zheng Ren's voice broke the silence again.
"My judgment is that there is a problem with the electromyography. It is not neuronal, but a change in the muscle itself. This speculation is consistent with the symptoms of general weakness described by the patient's family. There is a change in the electromyography, and the smooth muscle will occasionally change. This can only be caused by mitochondrial encephalomyopathy."
Zheng Ren said it with certainty. Before he knew it, Chief Luo had already believed it.
That was because of the meticulous logic and the sanctity of the Nobel Prize candidate.
Mitochondrial encephalomyopathy was a group of rare mitochondrial structural or functional abnormalities that resulted in multiple system diseases that mainly involved the brain and muscles.
It was usually inherited from the mother's side and was mostly seen in women. The onset of the disease was also uncertain. It was possible from infancy to old age.
Because of the high dependence of muscle and brain tissue on oxidative phosphorylation and other metabolism, regardless of the nDNA, mtDNA single defect, or both, clinical symptoms were often systemic.
But because the degree of involvement of each enzyme system was different and the clinical performance had a different emphasis, they were artificially divided into two major types of mitochondrial diseases, namely mitochondrial myopathy and mitochondrial encephalopathy.
The patient in front of him should be a manifestation of mitochondrial myopathy.
This was a relatively mild form of mitochondrial encephalopathy, which could easily lead to the patient's death.
"Are these all guesses and inferences?" Chief Luo said softly.
It seemed like he was asking Zheng Ren a question, but it also seemed like he was talking to himself.
Zheng Ren's words sounded very confusing, but Chief Luo could understand bits and pieces.
Due to his professional nature, Chief Luo's first thought was to try 'finding fault'!
Without solid evidence, this was the biggest problem.
However, the examination brought by the patient's family could not provide a definitive diagnosis. If they really suspected that it was mitochondrial encephalomyopathy, they could go for a genetic test to confirm the diagnosis.
However, this was only one possibility. Zheng Ren's tone was too positive.
"No, Chief Luo." Zheng Ren pointed to the patient's information and said, "I frowned when I saw you reading the radiographic films just now. You saw the abnormality too, right?"
"It can't be said to be an abnormality. It may be a false image, but the patient's intestinal smooth muscle group does seem to have a problem within some of the images," chief Luo said.
"Yes, it's an abdominal CT scan. In fact, it has already provided more reliable evidence," Zheng Ren said. "In terms of imaging, mitochondrial myopathy..."
Speaking of CT scans, Zheng Ren's attitude was different from when he talked about electromyography.
Chief Resident Shen knew that Boss Zheng did 64-slice CT scans with 3D-image reconstruction that were considered masterpieces.
After he left half a year ago, Department Chief Kong immediately organized everyone to learn how to reconstruct 64-slice CT scans with 3D-image reconstruction of the liver and quickly spread them out in the clinic.
This kind of examination had long been used in the clinic. However, no surgeon had ever done it before. All the CT rooms had done it according to the software.
In the beginning, everyone had some complaints, but Department Chief Kong used his iron fist to suppress all the different opinions.
When they really did in-depth research, everyone... At the very least, Chief Resident Shen realized the benefits of the 64-slice CT scan with 3D-image reconstruction...
Many tumor-releasing factors and reconstructed abnormal hyperplastic blood vessels could be directly displayed by 64-slice CT scans with 3D-image reconstruction, which increased the level of detail during surgery itself
Chapter 755 - Was Out Of His Expectations
After half a year of clinical practice, Chief Resident Shen could clearly feel that the efficiency of interventional surgery for liver cancer was different from before. It was not just small nodules of liver cancer. For larger liver cancer that could not be removed by surgery, 64-slice CT scans with 3D-image reconstruction were performed before surgery and the effect of the surgery was particularly good.
Little Zheng's level of imaging was really high.
It was just that... as a doctor of imaging, Chief Resident Shen's face was filled with tears after listening to a few words.
Chief Resident Shen could not understand the diagnosis of a rare disease like mitochondrial encephalomyopathy. However, Zheng Ren could still explain it with his own words despite not being a specialist.
But... Chief Resident Shen could not even understand the CT imaging performance?
Abdominal CT mainly looked at the organs, but Little Zheng was telling Chief Luo about the differential diagnosis of the intestinal wall using abdominal CT...
This was a problem of standard. Chief Resident Shen was a little dazed when he saw Zheng Ren and Chief Luo discussing abdominal CT in front of the radiographic film viewer.
Initially, he was only taking Little Zheng around, but Little Zheng had unexpectedly started discussing the case with Chief Luo.
Looking at the situation, it gave Chief Resident Shen a 'misconception' that the two had become old friends in less than an hour.
It was really...
Sigh, it was said that gold would always shine. Boss Zheng was a piece of real gold. Wherever he was, as long as there was a bit of light, he would dazzle in front of everyone.
If he wasn't convinced, he really couldn't do it.
After half an hour, the two of them hadn't finished discussing the CT scan of the abdomen. Moreover, looking at the situation, they had already started mixing in the knowledge of pathophysiology, genetics, and other subjects from imaging science.
Chief Luo's interest was getting higher and higher, unable to stop himself.
The patient's family came back with an electromyogram, interrupting the discussion of the case.
"Chief Luo, the doctor in the electromyogram room said that there is a problem with the electromyogram. What line should we consider..." the patient's family asked with a hint of tears on their faces. "He wrote it on the back of the list. I can't understand it."
Chief Luo nodded. He took the electromyography and flipped it to the back. There was the electromyography report and the diagnosis opinion written by the Department Chief of the electromyography department.
'Consider ME.' ME was the abbreviation of mitochondrial encephalomyopathy.
It really was true. Chief Luo looked at the line of words and was silent for a minute. Finally, he smiled.
Chief Luo was also very curious. He specially arranged for the patient to go to the relevant department for an urgent investigation. He wanted to follow this patient all the way to see if the diagnosis was true.
The patient's family left after thanking Chief Luo profusely and followed Chief Luo's arrangements to do a genetic test.
Seeing that there were preliminary results here, Zheng Ren took his leave. After all, there were still so many patients lined up outside. Chief Luo could not be delayed for too long.
Chief Luo sent Zheng Ren out of the door. He patted Zheng Ren's shoulder and said, "Boss Zheng, if you have time, come over when you can. I'm going out to the clinic on Monday. Other than ward rounds, I have time."
Zheng Ren immediately agreed politely.
This time, he had won a big victory at the dock, which was a pleasant
surprise.
"Boss Zheng, on your face..." Chief Luo asked when he finally said goodbye.
Although it was the first time they met, the two of them felt very familiar with each other. Chief Luo didn't feel that he was being rude. He just wanted Zheng Ren to behave himself and be careful. If anything happened, it would be a big loss.
Zheng Ren touched the bruise at the corner of his eyes, lowered his head, and said in a low voice, "I just came back from the frontline yesterday."
"Chief Luo was stunned for a moment and patted Zheng Ren's shoulder hard.
"Chief Luo, I'll be leaving first," Zheng Ren said.
"Go back and have a good rest. If there's anything I can do for you, just say it!" Chief Luo said without hiding it.
There was still a distance between professional mutual appreciation. However, a casual sentence completely touched Chief Luo's heart. He agreed to Zheng Ren without any reservations.
This was really a surprise. Zheng Ren bowed, then grinned and said goodbye to Chief Luo.
"Boss Zheng, you..." Walking out of the gastrointestinal department, Chief Resident Shen said with heartfelt emotion, "You're too amazing."
Zheng Ren smiled.
This was normal. Zheng Ren had expected that academics would be close to academics.
Before he came, Zheng Ren had thought about it. The cooperation with the gastrointestinal department had to be based on equal cooperation. To achieve this, he had to get Chief Luo's approval.
However, Zheng Ren did not expect it to go so smoothly.
Although Chief Luo's final question and unreserved support were unexpected, it was also within reason.
It seemed like it had been a long time since the System had issued a mission that added luck value. Only at this moment did Zheng Ren suddenly understand the importance of his luck attribute.
After chatting with Chief Resident Shen for a while, his phone rang.
Chief Resident Shen held his phone in embarrassment. Zheng Ren smiled and said, "You're busy, don't worry about me."
"Hello."
"Yes, where are you? Okay, wait a moment." Chief Resident Shen covered his phone and looked at Zheng Ren. "Boss Zheng, I came to visit a fellow countryman. She came to see the doctor and has been considered to be diagnosed with b.r.e.a.s.t cancer."
The Surgeon's Studio c1-799 Page 357
