494 Enter the health care group

Li Haiyang was quickly diagnosed, and afterwards, Su Yang transferred him to other departments. His problem was not particularly anxious. It was a slow diagnosis, so it was more appropriate to go to other departments for treatment.

After finishing the procedures of that guy, Su Yang returned to the office and had not even sat down. With a whoosh, Cao Jia ran in, and was in a hurry.

"Boss, is that Li Haiyang really an autologous ectopic spleen transplant?" she asked in surprise.

"Yes, it's confirmed. I just transferred him to Director Huang!"

"But - but how did you diagnose it? I heard that Director Huang and his team did not have 99mtc-sulfur colloid spleen imaging!" Cao Jia became more and more puzzled.

Su Yang has said before that spleen imaging of 99mtc-labeled radiocolloids or thermally degenerative red blood cells is the "gold standard" for imaging diagnosis of spleen transplantation, but the problem is that there is no such thing at the General Hospital for the time being, and further examinations cannot be conducted.

After hearing this, Su Yang smiled and said, "I used other methods to confirm the diagnosis."

"There are other ways?" Cao Jia was stunned.

Su Yang nodded and then said, "Call everyone here, I will tell you how to use CT to diagnose spleen transplantation."

"Okay." Cao Jia agreed, turned around and ran out.

Su Yang looked at Cao Jia who was whining, and felt helpless, with a look of laughter and crying. She is now the hospitalization officer in the emergency room. It should be down-to-earth and steady. She has a mountain of mountains and faces that remain unchanged, but she... seems to be getting more and more frigid. I don’t know if this will be better or worse?

The only thing that is thankful is that when she was undergoing surgery and was no longer so reckless.

Su Yang took his eyes back and began to think in his mind about how to talk about spleen transplantation for a while.

His philosophy is that emergency doctors must be general practitioners, so they need to understand all kinds of diseases. Of course, today's teaching focus is not to let everyone understand spleen transplantation or surgery for spleen transplantation, but to look at CT and how to use CT to diagnose spleen transplantation. This is his teaching focus today.

What Su Yang didn't expect was that after a while, a lot of people came around in his office. Interns, trainees, and other directors brought them, and people from Fang Min and other departments also came. Some were even in their forties and fifties, and some were not sure where they were.

Why are there so many people?

Su Yang was startled.

"Director, we want to hear your spleen transplantation. Is it OK?" A trainee doctor asked timidly.

"Yes, I welcome you very much." Su Yang said hurriedly.

Dingling.

The phone rings.

"Hey, I'm Su Yang."

"Director Su, I heard that you are going to talk about CT to diagnose spleen implants. I asked my doctors to come and listen to it?"

Su Yang was stunned. After coming to his senses, he hurriedly agreed with a smile.

He didn't expect that it was just a random teaching, but it turned into an open class.

"Everyone knows that ectopic spleen transplantation refers to autologous implantation caused by spleen trauma or splenectomy. Most patients may have no obvious symptoms in clinical practice and do not require special treatment. Some patients may accidentally discover during physical examinations and are prone to misdiagnosis as tumors and undergo surgical treatment.

It is difficult to confirm the diagnosis. Routine imaging examinations such as x-ray, ultrasound, ct, etc. are of certain value for the diagnosis of spleen implantation, but are not specific.

In the past, clinically confirmed spleen transplantation was mostly obtained through some invasive techniques for histopathological examinations, such as laparoscopy, surgical exploration, and fine needle aspiration cytology examination.

Currently, because of its unique display of spleen physiological functions, the nuclide spleen imaging can be used non-invasively for the diagnosis of ectopic spleen transplantation.

But what should I do if I do not have the conditions for nuclide spleen imaging?

Our general principle is that it is feasible and necessary to use non-invasive examination methods to clearly diagnose it, which can reduce unnecessary surgery.

My method is to use ct for diagnosis.

ct    Scanning uses energy spectrum      ct. The energy spectrum scanning mode is adopted, spiral scanning, ball tube speed      0.6     sec/week, pitch is 0.984:1, detector width is 0.625    mm×64, the tube voltage is high and low energy (140,80    kvp) instantaneously (0.5    ms) switching, tube

The current is about 640   ma. The non-ionic iodine contrast agent iodine is injected into the vein using a double-barrel high-pressure syringe. The injection rate is 3.5   ml/s, and the total amount is 70    ml. After injection of the medicine, 28    s, 60    s, 180    s                                                                                                                                                                                           �

After pausing, Su Yang released a CT picture and explained to everyone: "Esat   is different from normal spleen tissue in histological manifestations. Esat     Usually lacks a trabecular structure, and the membrane is thin and has no elastic fiber tissue. The red pulp of esat   is the same as normal spleen tissue. The white pulp can be the same as normal spleen tissue, or there is no formation of a central artery."

He had just finished speaking, and a doctor in the training asked, "Director, can we use other methods?"

"Yes!" Su Yang nodded: "There is another method, using GE Company's 64-row 128-layer spiral ct, philipsbriliance     ict   256 models and siemens     Definition     As40-row spiral ct to perform a full abdominal scan and enhanced scan. Before the scan, the patient was asked to take 800-1000 ml of clean water to fill the stomach cavity and part of the intestines. The patient held his breath and cooperated with the scan.

The enhanced scan uses a high-pressure syringe, and 80-90ml of contrast agent (iopamol 300gi/mg) is injected into the vein mass, and the injection flow rate is 2.0-3.0ml/s. The automatic threshold tracking and triggering technology is used to select the bilateral renal artery to draw the area of ​​interest in the abdominal aorta above the bifurcation. When the ct value in the area of ​​interest is greater than 100hu, the scanning is immediately triggered to obtain the horizontal axis image of the arterial phase, and then the horizontal axis image of the portal phase and delayed phase is obtained by delaying for 25s and 60s respectively... "

"Look at it, the spleen transplantation occurs in the left abdominal cavity, with no spleen tract and blood is supplied by the implanted organ. The spleen transplantation occurs in the stomach needs to be distinguished from the gastric stromal tumor. Both are extracaval tumors, but the latter strengthens more significantly and is not evenly."

Su Yang explained one by one.

After he finished what he should say, he waved his hand and told everyone to part.

With a rush, the intern doctors and further doctors, or other residents, all dispersed.

But there was a person who stayed in it all the time.

At this time, Su Yang noticed that this guy was in his fifties and didn't know when he got in.

"Comrade, is there anything you have to do?" Su Yang walked up in confusion.

The other party stood up with a smile, stretched out his hand and said, "Hello, I am Zhang Zheng, deputy director of xxx office."

Su Yang was shocked when he heard this. This guy was nothing but the leader of the health care group and the deputy director of the office. He was specifically responsible for the selection and management of the health care group members. Although he was just a deputy director, his status and power were more powerful than the president of the General Hospital.

"Hello, Director Zhang!" Su Yang hurriedly held the other party's hand.

"After the joint recommendation of Professor Fang Min and Dean Zhang Tong, we decided to absorb you into the health care group and become a member of the expert group.

After preliminary review and inspection, your conditions are basically in line with them, but further inspection is still needed.

Li Haiyang is a real patient, but in fact it is also our investigation of you. The lecture just now is an assessment on another aspect. I listened to it from beginning to end, and two other imaging experts also came to listen to it. You spoke very well, very professional, and easy to understand.
Chapter completed!