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Chapter 197 Gamma Knife (Part [-])
As an emergency doctor, Yuan Ping'an did have very serious flaws.At the resident level, this deficit is resolved with the supervision and attention of the superior physician.But when he was gradually promoted to chief resident and needed to undertake the work of diagnosis and treatment alone, his flaws began to be gradually exposed.

This defect, in Zhu Minhua's words, is "excessive concentration".In Zhou Jun's view, Yuan Ping'an's problem lies in "not having the capability of multi-tasking parallel processing".

He is so much like a specialist doctor.

How many patients come to the emergency department every day?How many of these patients may be intractable diseases?In the eyes of the director of the emergency department, an excellent emergency doctor must not be the same as a specialist doctor, leaving all the work on his hands for a patient, and then focusing on a single symptom.

This is irresponsible to other colleagues and patients.

Although Yuan Ping'an is still working with the department, it is not realistic to immediately make him a fighting force.But Zhou Jun has already understood the main reason why Zhu Minhua threw Yuan Ping'an to Ningyuan - it is also a rare patient diagnosis, look at Sun Li'en!

So, if you compare people, you will die, and if you compare goods, you will throw them away.Mingming is an excellent emergency doctor, as long as he can clearly distinguish the focus and tendency of his usual work, he can have earth-shaking changes.In the end, compared with Sun Li'en, a guy with cheats, he immediately became a role that needs to be retrained in grassroots hospitals.

On the other hand, Yuan Ping'an was quite satisfied with his performance.After all, it is not easy to figure out the type of Yang Jianqiang's disease, the sequence of onset, and the reason for the rapid progression of the disease.If he hadn't consulted nearly a hundred case reports at home and abroad, and made a bold guess by linking the adjustment of the immunization plan with the disease, he would never have guessed the correct answer out of thin air.In such a short period of time, Yuan Ping'an's ability to string together the above-mentioned series of key points and put forward his own diagnosis plan and treatment suggestion is definitely not weak—at least he is worthy of the Tongxie brand.

But man... To put it bluntly, he is a paralyzed animal.Just like a table tennis cutter, in other countries, a player with the ability of the provincial teams in China will definitely attract the attention of many people.But if you put this player in China, probably not many people will notice his skills-does the national team know?We are all tired of seeing it crookedly.You are a foreign chipper, no matter how good you are, can you beat the national team?nonexistent.

Yuan Pingan is such a chipper.He was extremely cruelly thrown by his coach into a place where "even a fat man who doesn't know how to play is a world champion".Then accept the contempt from all walks of life in the national team.

I really don't blame him, it's just that compared with Sun Lien, Yuan Ping'an is a bit...too ordinary.

"What's the treatment plan?" Zhou Jun frowned, but didn't say anything else.Looking at Yuan Ping'an's face, he knew that since Yang Jianqiang was sent to the hospital, Yuan Ping'an had probably been looking for information.With this work attitude, he really can't say anything critical.

"Sulfadiazine can't be used, the speed is too slow." Yuan Pingan didn't notice the strange atmosphere in the conference room, he was still immersed in his achievement of discovering the problem. "I suggest, do radiotherapy."

Yuan Ping'an had considered this treatment plan for a long time.He also knows how controversial this treatment plan itself will be.However, after comprehensive information and literature, Yuan Ping'an determined that radiotherapy is the only treatment method with the fastest onset and sufficient specificity—according to the data, gamma radiation with a total dose of 0.46 kGy at 0.55 kGy/min Finally, at least it can effectively curb the reproduction of Toxoplasma gondii, and it can also prevent Toxoplasma gondii from forming cysts in the human brain.

However, there is still a big problem with this treatment plan - no one has ever used radiotherapy to treat Toxoplasma gondii infection before, and the information that gamma rays have an inhibitory effect on Toxoplasma gondii is limited to animal experiments. Whether the radiation dose of 0.55kGy is sufficient to inhibit the reproduction of Toxoplasma gondii in the human body, whether the irradiated parasites will die quickly and trigger a more serious immune response, and whether such a large dose will cause strong discomfort to the patients, all of this remains to be seen. unknown.

The most troublesome problem is that, as a treatment method that has never been used before, gamma ray radiation therapy to kill Toxoplasma gondii belongs to the "first domestic" treatment method.According to the relevant regulations, before this treatment method is performed, it needs to be approved by the family members first, and reported to the director of the department for signature, convened for review by the ethics committee, and reported to the Provincial Health and Health Commission for approval.

If he had so much time, Zhou Jun wouldn't have to worry about this kind of problem—just take sulfadiazine.It is an extraordinary state now, and extraordinary means must be used.

"Go talk to the family members first." Zhou Jun listened carefully to Yuan Ping'an's explanation on the radiation dose. The radiation dose of 0.55kGy is not small. The radiation dose of 550Gy is almost ten times the prescribed radiation dose for small tumors.It even exceeded the generally recommended cumulative radiation upper limit of 300Gy.Although considering the radiation sources in these Toxoplasma gondii animal experiments, most of them use gamma knives that are not highly directional, so the dose will be much higher.But it's still a very dangerous treatment.

Those present were all the expert directors who came to consult, and talking to family members of course could only be left to the young doctor with the lowest rank in the field.Therefore, Yuan Pingan, who just broke into the conference room, was arrested logically.

"You go to Sun Li'en and take him with you to have a family talk." Before leaving the house, Zhou Jun specially instructed him.Using Gamma Knife to treat Yang Jianqiang is extremely risky, but it is currently the only treatment plan that can keep up with time.The stakes involved must be clearly explained, so that the family members of the patient can make a decision that best suits the interests of the patient.As for Yuan Ping'an... Zhou Jun was not at ease.Although Sun Lien is much younger than Yuan Ping'an, in several conversations with his family members, Sun Lien can make some unexpected gains.Letting Sun Lien talk with him may help doctors and patients communicate better.

Zhou Jun sent Yuan Ping'an away, and began to discuss the issue of radiation dose with experts from the Department of Imaging and Nuclear Medicine Therapy. The radiation dose of 550Gy is almost absolutely unacceptable, but how much the dose is reduced can still guarantee the killing of Toxoplasma gondii, which requires experts to consult a lot of data and make calculations.

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"Do you really want radiotherapy?" Sun Lien was blocked by Yuan Pingan on the way back to the ninth consultation room.After he heard the content and direction of the conversation, Sun Li'en looked extremely shocked.Although he proposed radiotherapy at the beginning, it was just an "immature idea" of his. When he put forward this idea, Sun Lien's main purpose was to remind Zhou Jun that the patient's condition was serious.Precise irradiation with gamma rays is one of the commonly used treatment methods in the field of nuclear medicine, but the content of nuclear medicine is extremely professional, and Sun Lien has little understanding of this method.But even if he didn't know much about it, Sun Li'en knew that using gamma rays to treat toxoplasmic encephalopathy was definitely a slant - this was not a solution that ordinary people could come up with.

"Clinical research in this area is basically zero. Even the radiation dose data are only done in vitro experiments on animals... and it is still the research path of attenuated vaccines." Yuan Pingan, who calmed down, also felt that his suggestion It may be a little too much, "I checked a lot of information, most of which are research results from 20 years ago. Whether it can be applied in clinical practice, and how many side effects there are, no one can say."

"Then we both have to convince the patient's family to create an unprecedented treatment method in her husband's mind. And the radiation dose is still determined by the research direction of making vaccines." Sun Li'en suddenly felt that the future was bleak, and the more he talked, the more discouraged he became. "I think... as long as the patient's family members have no problem with their brains, they should all reject this treatment plan, right?"

"If you refuse the treatment plan, then you have to prepare for her husband's funeral." There was no one around, and Yuan Ping'an spoke a lot more bluntly. "Actually, this plan is a gamble that her husband can survive. Anyway, if you don't gamble, you will definitely die. If you gamble, you may still survive."

Sun Li'en blinked, he really couldn't put himself into the perspective of these patients' families to think about this issue.As a doctor, he certainly knew that this might be Yang Jianqiang's only chance to survive, but it was still unknown whether the family would agree.Originally, radiotherapy was a treatment plan that many patients and their families were reluctant to accept. The saying that radiation causes cancer has been deeply ingrained in the minds of ordinary people for many years.Many people find it unacceptable to take the risk of cancer to treat diseases.

The role of the doctor's conversation is to help these patients and their families turn this corner.Cancer is scary, but only the living can get cancer.

Dead people don't have cancer cells.Cancer is terrible, but in the face of death, it is just an insignificant side effect.What's more, the current gamma knife technology is advanced and the positioning is extremely accurate, and generally there will be no serious side effects.Although some acute radiation damage is unavoidable, it is generally not serious enough to induce cancer.

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"Make a gamma knife? Yes." What Sun Lien didn't expect was that Mrs. Yang agreed to their request without any hesitation. "How many times do I need to do it? What parts are they used for? What is the dosage?" Not only did she readily agree, but Madam Yang also asked questions very expertly.

However, these expert questions, which are supposed to promote doctor-patient communication, directly asked Sun Lien and Yuan Pingan.How to answer this? "Eight regions of the brain will be irradiated. We are calculating the frequency and dose?"

"The problem doesn't lie in how many times..." Sun Lien pondered for a long time, and felt that it would be better to tell the truth. "To be honest, we should only have one chance. If the radiation doesn't achieve the expected effect, it's probably...too late."

Madam Yang suddenly raised her head, her eyes were full of shock, "What?!"

　Thanks to book friend Luo Jiu QAQ for the reward of 120000 book coins... the second leader.

　　As usual, the lord will add five updates... Adding updates will be done within seven days as much as possible.

　　
　
(End of this chapter)