N-A-A Chapter 667
Chapter 667
Busy until noon,
A group of emergency doctors and nurses, piled up in the duty room to eat.
At this time,
Director Wang Zhengchao, who had a dark face for a morning, walked in.
"What are you doing? This is the duty room, not the canteen! "
"Eat, don't eat here!"
With Director Wang Zhengchao's reprimand, many doctors scattered birds and beasts.
Run outside the emergency room to eat.
A group of people piled together,
While eating, he complained that Wang Zhengchao was not human.
At this time,
Doctor Li Xing suddenly looked at Lin Feng:
"By the way, while everyone is free, help me see a patient, this patient is a little strange..."
"Yes..."
"Come, the exam is coming..."
The doctors enthusiastized.
The diseases that are taken out for consultation must not be simple diseases.
Li Xing said: "I picked up a patient today, it is like this, female, 66 years old, retired, she recently underwent a staff physical examination. Then there was an accident in the physical examination, and unlike the basically normal examination results in previous years, the alpha-fetoprotein (AFP) in Grandma Huang's tumor marker test this year was significantly increased!! "
Alpha-fetoprotein (AFP) is a glycoprotein that belongs to the albumin family and is mainly synthesized by fetal liver cells and yolk sac.
In adults, alpha-fetoprotein is replaced by albumin, so blood levels are extremely low.
But there is a special case: tumors!
When tumors occur, the blood content of alpha-fetoprotein will increase significantly.
Therefore, it can generally be used as a positive detection indicator for a variety of tumors.
That is, "tumor markers"!
Everyone eats and listens at the same time.
Li Xing said: "Then, after I received this patient, I prescribed her tumor-related examinations, what tumor markers, blood biochemistry... All done. As a result, to my surprise, no traces of tumor cancer were found. "
"Then, I gave her a more thorough examination, and even went to MRI, but I still couldn't find it..."
"This grandmother said that she would come back tomorrow, but I just can't think of the reason, why is alpha-fetoprotein abnormally high?"
That's right
It has been determined that it is not a tumor cancer.
Why is it elevated?
Many doctors put down their chopsticks and began to ponder.
suddenly
A doctor looked up.
Voiced a possibility.
"Is it possible that this grandmother is pregnant?"
Pregnant?
The doctors were stunned for a moment.
"Pregnant? 66 years old, is it possible? "
"Elevated alpha-fetoprotein is indeed one of the manifestations of pregnancy, but this is 66 years old..."
This angle is very strange.
Because people's habitual thinking will not think about the pregnancy of a 66-year-old grandmother.
There will be no thoughts.
Because women begin menopause and stop egg shedding at the age of 51. It stands to reason that pregnancy cannot be achieved at the age of 66.
The current world record is a 59-year-old woman who is pregnant, but it's already outrageous.
Li Xing shook his head: "This possibility, although I haven't thought about it, it should be impossible..."
The doctor smiled and said: "When the grandmother comes, you can buy a pregnancy test stick and try it for her, maybe it may or may not be..."
Everyone laughed.
"If you really get pregnant at 66, you will really break the world record."
"I can write a high-quality paper..."
Li Xing thought about it, and it seemed to be right.
Tomorrow you can use a pregnancy test stick to see, if there are two bars, then do a B ultrasound to see if you are pregnant.
Then
Lin Feng, who had been silent for a while, said another possibility.
"I don't think it's pregnancy... It is a certain interfering substance in the blood that causes a false increase in both, commonly known as false positive. "
"What comes to mind is - "rheumatoid factor"!"
"Rheumatoid factor"?
The doctors were stunned for a moment.
Pondered for a long time,
"It's like... It's possible..."
"It seems to interfere with antigen-antibody responses..."
"The test principle of alpha-fetoprotein is the antigen-antibody reaction..."
"So, it seems that it is really possible that it is caused by "rheumatoid factor"..."
The more doctors think about it, the more they feel that it is very likely.
Li Xing's eyes also lit up: "Okay, tomorrow I will try to give this grandmother and ask her if she has symptoms of rheumatoid arthritis, if there is, then it is really possible that this is the reason..."
Solved one thing,
The knowledge that feels strange has increased again.
The appetite of the crowd has improved a lot.
......
The next day,
Sure enough, the grandmother came to the emergency room again.
Li Xing directly asked the grandmother if she had any symptoms of sore hands and feet recently,
Really.
There really is!
The grandmother recalled: "In recent months, the body is indeed a little unhappy, I always feel stiff when I get up in the morning, and the wrist joints and metacarpophalangeal joints of both hands are indeed a little painful, I thought it was because of a lot of travel and overwork recently, so I didn't care about it..."
Li Xing clapped: "That really may be rheumatoid arthritis!" "
And then
Li Xing billed the grandmother and did a full set of rheumatism examinations.
On the third day,
The results of the examination are out.
Confirmed: Rheumatoid arthritis!
At this time,
Li Xing is full of excitement!
In order to write the thesis, he wanted to directly exempt the grandmother from all the examination and treatment fees, and only needed the grandmother to provide a few more tubes of blood.
At the same time, a grandmother is also required to take a pregnancy test (pregnancy test).
If a pregnancy test also detects pregnancy, hCG (human chorionic gonadotropin) also shows a false positive.
Rheumatoid factor can be tested for blood supplementally, AFP (alpha-fetoprotein) and HCG can be tested again after the rheumatoid factor is blocked, and the result should be obtained: normal level, not abnormally elevated.
Proper quality papers.
pity
Grandma is a decent person and does not want to spoil herself.
Rejected his offer.
Li Xing: "..........................."
Tears!!
A quality thesis, flying!
However, it is still recommended that the elderly, if the economic conditions allow, should do a comprehensive examination.
Because rheumatoid arthritis is an autoimmune disease, it accumulates internal organs in severe cases.
As for the treatment of rheumatoid arthritis, the main measures are the application of anti-inflammatory, pain-relieving drugs, such as methylprednisolone, prednisone acetate in hormonal drugs, loxoprofen sodium in nonsteroidal drugs, celecoxib, diclofenac sodium, etc...
Long-term treatment is sufficient.
......
......
At this point,
The endocrinology department produced a special patient.
Difficult!!
The tube bed doctor of Group 3, Chen Li, is a refresher doctor.
The group was led by Professor Chen from 3 groups.
Today, Group 3 received a patient who was brought up from a lower level hospital.
Patient, male, 61 years old.
The medical record system showed that Addison disease, hypothyroidism, diabetes, and the treatment effect was not good.
Discharge report from lower level hospitals: Skin hyperpigmentation appeared a year ago, accompanied by symptoms such as loss of appetite, bloating, constipation, dry skin, less sweating and insomnia...
..