novel for you Chapter 994: Patients with similar symptoms to Wilson
Chapter 994: Patients with similar symptoms to Wilson
"Director Chen, are you busy?"
Chen Yang had just hung up the phone when someone knocked on the office door and Zhong Dongyang pushed it open and walked in.
Chen Yang was just talking to Tian Wen. Tian Wen told Chen Yang on the phone that they were not planning to hold a full-month celebration for the child, but a hundred-day banquet instead, and informed Chen Yang that he must attend.
"Director Zhong."
Chen Yang stood up and greeted him with a smile, while making tea for Zhong Dongyang.
"These days our center is relatively quiet, and I don't have anything to do." Chen Yang said with a smile.
Kyoto International Medical Center has been open for ten days, but there are not many patients.
In addition to David, Zhong Dongyang and others from the surgery department treated several patients, and the post-operative care was taken by Xun Jiahong, Lin Yi and others.
At present, the center has more than 20 doctors in the Department of Surgery and the Department of Traditional Chinese Medicine, and they are all very qualified doctors, comparable to the scale of a second-level hospital.
But the number of patients is far from enough.
After all, the medical center is not aimed at treating patients with common diseases, but targets different groups.
Even though there are few patients now, once the center becomes famous, beds will be hard to come by.
Even now, if there is no threshold, it is still difficult to get a bed.
After all, whether it is Zhong Dongyang and others, or Chen Yang, they are experts that many patients want to see.
"Haha, that's true." Zhong Dongyang smiled.
"Director Zhong, do you have something to talk to me about?" Chen Yang asked.
"It's something."
Zhong Dongyang said: "I just sent you an email, have you read it?"
"Not yet."
As Chen Yang spoke, he turned on the computer, and sure enough, there was a new email from Zhong Dongyang.
"It was sent from Shancheng Hospital. You can take a look at the patient's condition first." Zhong Dongyang said at the same time.
Although Kyoto International Medical Center is the window for several hospitals such as Peking Union Medical College Hospital and Kyoto Hospital to connect with the international community, it is not only for foreign patients, but also for domestic patients.
It's just that the threshold is a little higher.
This threshold is not the patient's identity, but the disease.
What I mean is, if it's not a difficult disease, don't bother the International Medical Center. If you have a cold or fever and so on, come here, we are too busy to handle it.
Chen Yang clicked on the email attachment sent by Zhong Dongyang, and a detailed medical record and imaging data from the First Affiliated Hospital of Shancheng Medical University immediately appeared on the screen.
Chen Yang's eyes quickly scanned the summary:
Patient's name: Ye Guoliang, male, 68 years old.
Chief complaint: recurrent right upper abdominal pain, yellowing of the skin and sclera, and progressive weight loss for more than 2 months.
Present medical history: Two months prior, the patient developed persistent, paroxysmal, right upper abdominal pain without apparent cause, accompanied by progressive jaundice of the skin and sclera, dark urine like strong tea, and grayish-white stools the color of clay. This was accompanied by significant loss of appetite, nausea and vomiting (with vomitus containing gastric contents), fatigue, and a weight loss of approximately 2 kg.
The patient had no fever or chills. He had been seen at a local hospital and initially diagnosed with obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) failed (due to unclear papillary structure and difficulty in cannulation). He subsequently underwent external drainage with PTCD (percutaneous transhepatic biliary drainage), which produced dark green bile and slightly relieved his jaundice, but his abdominal pain and systemic symptoms did not improve significantly.
For further diagnosis and treatment, he was transferred to the First Affiliated Hospital of Shancheng Medical University.
Past medical history: history of hepatitis B for more than 30 years (no regular antiviral treatment), history of hypertension for 10 years (well controlled by medication).
Physical examination upon admission: clear consciousness, mental depression, severe malnutrition (BMI 17.5 kg/m), severe jaundice of the skin and sclera.
Cardiopulmonary auscultation was unremarkable. The abdomen was flat and soft, with marked tenderness in the right upper quadrant and below the xiphoid process, but no rebound tenderness or muscle tension. Murphy's sign was questionably positive. The liver was not palpable below the ribs, while the spleen was palpable 2 cm below the ribs, with a medium texture and blunt margins. A shifting dullness (-) was present. Mild pitting edema was noted in both lower extremities.
Auxiliary inspection:
实验室检查：总胆红素（TBIL）： 385mmol/L（显著升高），直接胆红素（DBIL）： 325mmol/L，间接胆红素（IBIL）： 60mmol/L。谷丙转氨酶（ALT）： 128 U/L，谷草转氨酶（AST）： 156 U/L，碱性磷酸酶（ALP）： 890 U/L，γ-谷氨酰转肽酶（GGT）： 1050 U/L（均显著升高）。白蛋白（ALB）： 28 g/L（显著降低）。凝血酶原时间（PT）： 18.5秒（对照13秒），国际标准化比值（INR）： 1.6。乙肝病毒DNA定量： 4.5 x 10^4 IU/ml。肿瘤标志物：CA19-9： 650 U/ml（显著升高），CEA： 8.2 ng/ml（轻度升高），AFP：正常。
Imaging examinations:
Abdominal enhanced CT: The intrahepatic bile duct was significantly dilated, showing a "soft vine sign", the bile duct was cut off at the portal area, and an irregular soft tissue density shadow of about 3.5cm x 2.8cm was visible locally. The enhanced scan showed mild uneven enhancement.
The gallbladder wall is thickened and roughened, with no clear gallstones visible within the gallbladder. The pancreatic head is plump, and the pancreatic duct is slightly dilated. The portal vein trunk and branches are patent, with no clear filling defects. The spleen is enlarged, with minimal ascites.
Abdominal MRI + MRCP (Magnetic Resonance Cholangiopancreatography): Clearly demonstrated significant dilatation of the intrahepatic and extrahepatic bile ducts, with an abrupt truncation of the bile duct at the hilum. An irregular mass was visible at the truncation site, with low signal intensity on T1-weighted imaging, slightly high signal intensity on T2-weighted imaging, and high signal intensity on DWI, with mild enhancement after contrast enhancement. The pancreatic duct was mildly dilated throughout. Several small lymph nodes, with a short diameter of <1 cm, were observed in the hilar region and retroperitoneum.
Initial diagnosis:
Obstructive jaundice (hilar bile duct space-occupying lesion? Cholangiocarcinoma?)
Chronic hepatitis B (active?)
Cirrhosis (Child-Pugh B?)
Malnutrition
Hypertension stage 2 (intermediate risk)
The Shancheng Hospital consultation favored hilar cholangiocarcinoma (Klatskin tumor), but the tumor was located in a difficult position, close to the portal vein bifurcation and hepatic artery. Furthermore, the patient's liver function was poor (Child-Pugh score estimated at 9-10, grade B), coagulation function was poor (INR 1.6), and nutritional status was extremely poor. The surgical risk was extremely high. The assessment concluded that radical resection, such as a combined hepatectomy for hilar cholangiocarcinoma and lobectomy, was highly unlikely, and the risk of postoperative liver failure was significant.
“Similar to Wilson’s situation!”
After reading it, Chen Yang raised his head and looked at Zhong Dongyang.
"good."
Zhong Dongyang nodded and said, "That's why Shancheng asked us for help, hoping that we could complete this operation."
"Director Zhong, what do you think?" Chen Yang asked Zhong Dongyang.
Although the patient's condition was similar to Wilson's, the surgeon last time was Borg, and experts from the Mayo Clinic medical team also participated. Only Chen Yang and Zhong Dongyang actually participated in the operation from Kyoto.
If they agree to accept Ye Guoliang, then the operation will have to be performed by Chen Yang and others themselves.
"I think it's okay."
Zhong Dongyang pondered for a moment and said, "Although the last surgery attracted a lot of international attention, everyone in the industry knows that the main force is still Borg and Mayo Clinic. If we can complete this surgery independently, the situation will be completely different."
"Since Director Zhong said so, let's give it a try. Let the patient come to Kyoto for preoperative conditioning first." Chen Yang nodded.