Back in 2002 as a doctor

In the health care team, unlike 912, Huang Lao will be found immediately when there are difficult cases.

But this patient's situation is very special, the diagnosis is clear but there is no way to perform surgical treatment, and the conservative effect is not satisfactory, so the general office called Huang Lao to see if there is any good way.

When Mr. Huang was sent to the ward, he insisted on doing a physical examination himself, but the middle-aged man stopped the doctor.

"Director Zhao, Mr. Huang's condition doesn't look good." The middle-aged man said in a deep voice.

"I heard that Mr. Huang is okay, and I haven't seen him for a while, why is the old man so old?" Director Zhao rubbed his hands and said doubtfully, "The last time I saw Mr. Huang was in the consultation with the health care team two months ago, the old man is very energetic. "

"No wonder I'm late for something." The middle-aged man said, "Is Mr. Huang dying?"

He said, frowning more tightly.

"..." Director Zhao sighed.

The middle-aged man was sullen, his serious expression concealing his anxiety.

"Are there any experts in this field?" The middle-aged man asked.

"The members of the health care team are all here." Director Zhao said, "I found a problem, but the operation has to bear a huge risk... Let's see what Huang Lao said."

When the middle-aged man thought of Huang Lao's old-fashioned appearance, he felt a sense of distrust in his heart.

Director Zhao was also puzzled. Elder Huang's health has always been good. At the beginning of this year, he and his closed disciples completed an epoch-making operation.

Everyone said that Mr. Huang was a veteran, but... Suddenly, Director Zhao thought of a possibility.

Mr. Huang doesn't want to wade into the muddy water!

The patient's illness has nothing to do with cardiothoracic surgery, plus his special status, high age, and poor basic condition, so he should keep silent.

Five minutes later, Mr. Huang came from the ward with his hands bent and his back, accompanied by experts from the health care team with serious expressions.

"Let's have a consultation, I'll listen to everyone's opinions." Huang Lao said.

"Old Huang, what do you think?"

Huang Lao didn't speak, and walked slowly ahead with his hands bent and his waist bent like a bad old man who had just been tired from the fields for a day.

Several experts from the health care team looked at each other helplessly.

Mr. Huang is either really old, or he doesn't want to get involved in diseases that have nothing to do with cardiothoracic surgery, so he doesn't say a word.

That's right, it has nothing to do with cardiothoracic surgery.

When he came to the doctor's office, Mr. Huang sat in a corner with his eyes slightly closed, as if he was dozing off.

The experts in the health care team looked at each other again.

Ugh.

But the discussion that needs to be done still needs to be done. The health care team makes collective decisions. It is his right to not want to talk, but the process still has to go.

"Let me say a few words first." A doctor coughed twice and cleared his throat.

He is the top endocrinology expert in the imperial capital.

"The patient had the typical symptoms of Whipple's triad, manifested as recurrent hypoglycemia, blood glucose lower than 2.8mmol/L at the time of attack, and symptoms were relieved after eating or supplementing glucose.

During the episode of hypoglycemia, INS > 3 μIU/mL and C-peptide > 0.6 ng/mL were detected multiple times synchronously, which supports hypoglycemia caused by endogenous hyperinsulinemia. "

"In terms of localization diagnosis, 68Ga-exendin-4 PET/CT imaging and EUS-FNA pathology confirmed the existence of pancreatic neuroendocrine tumors.

Insulinoma may be one of the components of multiple endocrine neoplasia type 1, but the patient has no family history of MEN-1, and the age of onset is older. He has been screened for related hormone indicators and imaging examinations many times, and currently has no MEN-1 sufficient evidence. "

These words are very technical, but also very... meaningless.

But with this patient, the most meaningless words are somehow the most meaningful.

In order not to come to the consultation, Mr. Huang said he had something to do, so he pushed for two hours. After he came, he sat there without saying a word and dozed off.

But Huang Lao Jianghu has a high status, he can pretend to be confused, but he can't.

Then let's talk a little bit, the endocrinologist thought helplessly after finishing speaking.

Chapter 1542 Useless and Correct Nonsense

Next, an expert in nuclear medicine explained his views.

"Insulinomas are mainly composed of pancreatic β cells, which have the characteristics of high expression of GLP-1R. Based on this principle, GLP-1R imaging technology targeting pancreatic β cells is used for the localization diagnosis of insulinomas."

"Our PET/CT has a diagnostic sensitivity of more than 95% and a specificity of 100%, which greatly improves the detection rate of occult insulinomas. The lesion was detected for the first time, showing high expression of GLP-1R in the body and tail of the pancreas, thus clearly The location of the tumor can be determined, providing accurate positioning diagnosis for treatment."

What he said was another long piece of nonsense, correct nonsense, without any meaning.

This kind of words can only prove his existence, and there is no more meaning.But what can a nuclear medicine expert do?

The experts in the health care group turned their attention to the experts in gastroenterology and general surgery.

What other people say doesn't make sense, and the diagnosis has been made, what is needed now is not a diagnosis but a treatment.

The specialist in gastroenterology took a look at Huang Lao, seeing that Huang Lao seemed to be falling asleep in a drowsy state, he was about to die, and he had no intention of speaking, so he sighed helplessly.

"Let me tell you my opinion.

Examination of the patient revealed a lesion at the body-tail junction of the pancreas that was consistent with nuclear medicine studies. "

"The patient has many underlying diseases, and treatment methods such as endoscopic surgery, drugs, and nuclides are not suitable."

What he said was more straightforward than the two experts who had just spoken, directly denying the possibility of gastroenterology treatment.

Advanced age and various serious complications, this kind of patients are not willing to take over, even if there is 1% failure, it is unacceptable.

The specialist in general surgery held the medical records in his hand expressionlessly. Seeing that everyone was silent, he knew that everyone was waiting for his "final decision", so he frowned and spoke in a low voice.

"The patient had a single lesion with a diameter of about 2 cm. It was located at the junction of the body and tail of the pancreas. However, the positional relationship between the tumor and the main pancreatic duct and the blood supply to the spleen could not be known. Intraoperative exploration was required."

"Insulinomas can choose tumor enucleation, distal pancreatectomy, duodenum-preserving pancreatic head resection, pylorus-preserving pancreaticoduodenectomy, or pancreaticoduodenectomy."

"Compared with open surgery, laparoscopic pNENs resection has the advantages of less trauma and faster recovery; however, it has higher requirements for preoperative and intraoperative lesion localization, and the incidence of postoperative pancreatic fistula and other complications has not been significantly reduced .”

What he said was complicated, but in fact there was only one meaning - no matter it was the traditional open surgery or the newly popular laparoscopic surgery, they were not suitable.

"Although surgery can achieve the goal of radical cure, it is necessary to choose the appropriate treatment method based on the specific situation of the patient. With the development of minimally invasive diagnosis and treatment technology, the treatment is developing towards precision and individualization, and multidisciplinary cooperation is required to comprehensively grasp the surgical guidelines. sign."

The experts in general surgery talked a lot of "nonsense", but the important thing is that if you don't do surgery, you will hand over the problem again at the end.

More interdisciplinary collaboration and comprehensive grasp of surgical indications are meaningful.

It is also expected that the only department and professional expert who can solve the problem refuses to operate.

You have done similar consultations three times, you have said everything you need to say, and you have done everything you need to do.

Otherwise, Huang Lao would not have been invited from 912 to sit in charge.

If the patient is from a rural area, the specialist in general surgery may explain the condition and difficulty of the operation to the patient's family.

Basically it is the sentence - with surgery, 99% will die; without surgery, 100% will die.

As for whether to do it or not, the choice is left to the patient's family.

But this is the Shuai Mansion, and such words must not be said in the collective decision-making of the health care team.

Leave it blank and make the rest collectively.

If the plan that came out after the final collective decision agreed with the operation, it would not be too late for me to do it myself.

But it is a big taboo to say that the operation can be done and that you are full of confidence.Once... there is a high probability that the operation will fail, so what happens after the failure?I will definitely bear the scapegoat beyond medical worries.

The experts in the expert group present are all old fritters that have been in the oil pan for a lifetime, and they picked themselves out lightly and skillfully.

If there is no rule of collective decision-making, I am afraid that any treatment with any risk cannot be carried out.

The experts in general surgery made it very clear. Everyone looked at each other, and finally their eyes fell on Huang Lao.

The old man seemed to be sleeping, and everyone had a hallucination. It seemed that the old man's head would drop in the next second and he would start to doze off.

Several experts spoke. Although their speeches were meaningless, they still had to say what they had to say, even if it was nonsense.

Half an hour passed, and the air in the doctor's office was stagnant.

Everyone knew that the next step would be a collective decision-making process. In fact, the health care team didn't care whether to have surgery or not.

When the plan is handed over, there will naturally be a conclusion on whether to do it or not.

And the experts in the old health care group knew that more than ten years ago, it was time for Mr. Huang to speak up to see if there was any other way for the elderly.

The leader of the expert team sat next to Mr. Huang. He scanned the familiar faces in the doctor's office. He was about to proceed with the collective decision-making process, but he hesitated for a moment, and whispered next to Mr. Huang, "Mr. Huang?"

"Ok?"

"We've finished speaking, see if you have anything to add." The health care team leader asked.

What could Mr. Huang have to add? The same thought came to everyone else's minds.

"Are we going to make a collective decision?" Elder Huang asked.

"Yes." The leader of the health care team said, "After your old man has finished speaking, we are ready to make a collective decision."

"Then let me say a few words." Huang Lao opened his eyes slightly, full of old-fashioned appearance, and even the tone of his speech was trembling.

"You are always welcome." The leader of the health care team said respectfully.

He also knew that Mr. Huang would not have any unique insights, but he came here all the time, and he couldn't do without saying a few words. This was a matter of attitude.

Mr. Huang still looked drowsy. He sat in a chair with a hunched back, and said lightly, "Insulinoma is the most common functional pNENs, accounting for about 70% to 80% of pNENs, and the malignant tumors do not exceed 10%, the incidence rate is about 5.25/10."

"..."

"..."

The doctors in the doctor's office bowed their heads.

Jiang is still old and hot, but Huang Lao was the leader of the health care team in the past. When he talks about everything, he is like an old man doing Tai Chi in the park.

These are useless at all, but the correct "nonsense" Huang Lao said is very slippery.

But does it help with treatment?

Not at all, Huang Laobi moved away from the final ending, randomly found a point as an entry point, and began to talk endlessly.

Some experts began to let go of themselves and cultivate their spirits. It is completely meaningless to listen to such nonsense.

Chapter 1543 It turns out that you also want to cure the disease

"Insulinomas originate from pancreatic β cells, and the mammalian target of rapamycin pathway may be involved in the occurrence and development of the disease.

Due to the secretion of a large amount of INS and is not regulated by the negative feedback of hypoglycemia, 99% of patients present with recurrent hypoglycemia, and Whipple's triad is the most typical manifestation.

In addition to confusion and delirium, hypoglycemia-related nervous system damage may also cause hallucinations, seizures, memory impairment, etc., and severe cases may cause coma.

Patients are often accompanied by symptoms of sympathetic hyperactivity related to increased adrenaline release, such as tremor, palpitations, pale complexion, and profuse sweating.Hypoglycemia caused by insulinoma is a rare disease with a low incidence, and it is easy to miss and misdiagnose. "

"..."

All the health care experts present were dumbfounded.

Mr. Huang is reciting the medical records of the whole hospital consultation?

Does it make sense to say this?

Are the old people too old to think?

It can't be, it is said that not long ago, Mr. Huang also supported his students to win the first place in the world in the world cardiothoracic surgery competition.

What is he doing.

"Studies have reported that the cognitive function of patients after 1 year of radical surgery for insulinoma has improved, and some of them can return to normal.

Therefore, patients with hypoglycemia should be differentiated from other functional and organic diseases.

When a patient presents with typical Whipple's triad, it is necessary to monitor the attack in time, measure fasting blood glucose, INS, C-peptide, etc. simultaneously, and identify and treat it as soon as possible. "

"Insulinoma requires qualitative and localized diagnosis. The difficulty of the former is that the symptoms can be quickly relieved after eating, and the clinical manifestations of hypoglycemia are not typical, so it is easy to be misdiagnosed and missed diagnosis; the difficulty of the latter lies in the current conventional imaging methods, such as abdominal ultrasound, CT, MRI, etc. have low sensitivity and specificity for insulinoma, and are easy to miss diagnosis.”

The experts in the health care group became more confused and helpless the more they heard.

No one expected Huang Lao to spout so much correct and useless nonsense.

Everyone knows that Mr. Huang only needs to say one thing - whether the operation can be performed or not.

But Huang Lao kept talking nonsense.

Everyone was stunned at first, but as Huang Lao continued to explain the basic things, the brilliance in his eyes gradually faded and he gradually became numb.