I Can See Health

Everyone returned to the doctor's office, first revised the medical instructions given by Li Yao, and then began to write down the course of the disease.

Lu Chen specifically asked the nurse on duty to pay attention to the blood drawing orders for the 10-bed patient.

Because these correspond to different time periods, it is easier to miss them.

This morning, Lu Chen was quite busy. Apart from going to the toilet, he basically had no time to rest.

Of course, the Department of Cardiology itself is one of the busiest departments in the internal medicine system.

As long as Lu Chen was still in the Department of Cardiology, this busy clinical life would be routine.

In contrast, Zhou Wei lived a life of "raising mice" ahead of schedule.

Although Zhou Wei also has a master's degree, his mentor is on the rise in his career and there is a shortage of people in the laboratory. After many coordinations, he was temporarily transferred to the laboratory.

Therefore, Zhou Wei stayed in the laboratory every day and basically did not go to the clinical department.

However, despite the hard work in clinical practice, the scientific research life in the laboratory is not much better!

"I also want to go to the clinic! Raising rats is not only troublesome, but also really smelly!"

During lunch, Zhou Wei couldn't help but complain to Lu Chen.

"And no matter what, I have a master's degree now. I will still have to take the final exam for regular training in the future. If I fail the exam, I won't be able to get my diploma!"

"Don't worry, the instructor won't let you stay in the laboratory all the time." Lu Chen comforted, "You are equivalent to dual majors. In the future, you can be both clinical and engaged in scientific research. It will be beneficial to find a job or study for a Ph.D. of."

Zhou Wei sighed softly: "That's all I can think about now. But I won't be able to leave the laboratory within half a year."

"Try to get an SCI article. If you can, it will be worth it!" Lu Chen smiled.

"Hey, SCI can't just publish it if you want!" Zhou Wei shook his head and said with a wry smile, "What's more, I'm just a handyman, you can't tell me if you can bring my name!"

Lu Chen smiled helplessly.

This is also an embarrassment for most graduate students.

If you don’t do it, there will be nothing!

If you do it, it may be in vain.

Before you really master the key technologies, whether you can publish articles depends on the instructor's character.

…

In the afternoon, as soon as Lu Chen came to the department, he received unexpected and happy news from Sun Guoguo.

Dong Hao's radiofrequency ablation surgery is scheduled for the day after tomorrow.

At that time, Lu Chen can go to the cath lab on the fourth floor to watch the entire operation process up close.

For a graduate student, this opportunity is extremely rare!

According to Sun Guoguo, Teacher Li Yao fought for this opportunity with him.

This can also be regarded as a reward for him taking first place in the case discussion last weekend!

Compared to the two thousand yuan, Lu Chen would rather choose this opportunity to observe the surgery.

What's more, electrophysiological surgery is almost always free from the effects of radiation.

Lu Chen spent the entire day today busy.

…

the next day.

The test results of 10 patients are out!

The final result confirmed the analysis of Director Li Yao and Lu Chen.

The patient's cortisol (hormone) was 402 μg/L (reference value 55-168 μg/L) at 0 a.m., 450 (reference value 150-552 μg/L) at 8 a.m., and 578 (reference value 55) at 16 p.m. -248μg/L).

It can be clearly seen that cortisol levels at 0 o'clock and in the afternoon are much higher than normal levels.

The adrenocorticotropic hormone (ACTH) measurement is \u003c1.0 (reference value 25-100ng/L).

This is also consistent with Cushing's syndrome!

ACTH is secreted by the pituitary gland and is used to control the secretion of hormones by the adrenal glands.

Theoretically, if ACTH is secreted more, the adrenal glands will secrete more hormones because of the greater pressure from above.

But now the patient's ACTH is obviously less.

This is easy to understand. It means that the patient's increased cortisol secretion has nothing to do with the pituitary gland. It is not the pituitary gland that tells the adrenal glands to secrete more hormones. It is the adrenal glands that secrete so many hormones on their own initiative.

The more hormones the adrenal gland secretes, it will naturally feed back to the pituitary gland. The pituitary gland feels that the adrenal gland has already secreted so many hormones, so it no longer needs to beat it or put pressure on it, so it secretes less ACTH.

This is the classic negative feedback regulation in the human body!

"Junior brother, do you understand?" Lu Chen told Wei Zhongwen all the principles of negative feedback.

Wei Zhongwen shook his head, showing confusion in his eyes.

Lu Chen was not impatient and explained patiently.

Junior Brother Wei is a potential source of gratitude points, so he needs to "take care" of him carefully!

Lu Chen thought for a while and continued:

"Junior brother, think about it, the pituitary gland is the boss, and the adrenal glands are the employees. If he wants his employees to work more (secret cortisol), the boss has to keep urging them (secreting ACTH, in order to urge the adrenal glands to work). "

"Now we see that employees do a lot of work (secret a lot of hormones), but the boss does not urge them (ACTH is very low), but they don't talk much (ACTH is really too low). Why?"

"Because employees are working like crazy now, working hard and secreting a lot of hormones. After seeing this situation, does the boss still have the nerve to urge employees? There is no reason to urge employees anymore, so ACTH secretion That’s the point of negative feedback regulation!”

Wei Zhongwen suddenly realized, "Brother, it seems that this is what you said."

"Congratulations, I received a thank you from Wei Zhongwen!"

Sure enough, hard work pays off!

…

The next step is to improve brain MRI and adrenal gland CT.

A brain MRI is done to confirm that there is no problem with the pituitary gland.

Adrenal CT is done to confirm that the problem is in the adrenal gland. Whether it is an adrenal adenoma or adenocarcinoma, it must be clearly seen.

In the afternoon, the patient's brain MRI was done first, and the results came out.

The pituitary gland is really innocent, fine, without any tumors.

The patient was a little worried and immediately went for kidney and adrenal gland CT.

In the eight districts of the heart, the doctors in Li Yao's group were all gathered around a computer.

Everyone is waiting for the results of kidney CT and adrenal CT.

When the patient completes the CT scan, the images are uploaded to the case system.

Lu Chen immediately clicked on the images and looked at the patient's kidney shape frame by frame.

"There really is something!"

Lu Chen noticed that there was a small mass in the patient's right adrenal gland, about 3cm in size.

Needless to say, this small lump must be the culprit causing abnormal increase in hormone secretion!

About twenty minutes later, the report from the CT room came out.

The diagnosis reported by CT is: right adrenocortical adenoma (high possibility)!

Since then, the truth has finally been revealed!

When Lu Chen informed the patients and their families of the results, they finally breathed a sigh of relief.

Because from the film, it looked more like an adenoma than a cancer.

Adenomas are easier to treat. One cut and that's it.

…

"Ask the urology department for consultation!" Li Yao ordered.

Soon the urologist was called to the cardiology office.

The extracology doctor finally decided to transfer the patient to the other department and perform laparoscopic surgery to remove the small tumor. UU Reading www. uukanshu.net

The patient’s family naturally agreed immediately!

Lu Chen went through the transfer procedures directly for him without any ink, and transferred the patient to the Department of Urology on the same day.

"Congratulations, the system upgrade completion rate has increased!"

The system prompt sounds.

Lu Chen is one step closer to the next upgrade!

…

Heart zone eight, doctor's office.

Although the patient was transferred to another department and left, all the doctors in Li Yao's group, including Sun Guoguo and Fan Zhiping, were all amazed when they recalled the patient's diagnosis process.

From suspected myocardial infarction, aortic dissection, to suspected hypertrophic cardiomyopathy, to finally Cushing's syndrome and adrenocortical adenoma.

Whenever you think you've reached the end of your diagnosis, you're often just getting started!