Chapter 662: Chapter 595: Surface Warrior Chapter 662: Chapter 595: Surface Warrior In a manner similar to a movie playing on a large screen, the cases discussed by each department were briefly reviewed, getting everyone on the same page.

Then, the cases were discussed in detail one by one, in order.

The experts sitting in the front row were a bunch of die-hards, known for their strictness in academics, which put the young doctors behind under considerable pressure.

A weekly hospital-wide discussion was proposed by them. For some complicated cases, they were put forward for discussion. In principle, all departments should send representatives to participate. Departments related to the case could make remarks, whereas unrelated ones could listen and broaden their horizons.

These discussions were particularly favored by internal medicine doctors compared to surgeons.

The competence of a surgeon is mainly determined during surgery. They are not particularly interested in discussions.

However, internal medicine doctors are different. They tend to enjoy reasoning through complex diseases, treating the greater difficulties as a measure of their capability.

A surgeon, after seeing the diagnosis, will simply say: Surgery!

Internal medicine doctors face diseases with elaborate arguments, from basics to clinical, from textbooks to cutting-edge papers.

Although internal medicine and surgery are two sides of the same coin, they somehow began to look down on each other.

Internists think that surgeons only know how to operate and can’t even read an ECG.

Surgeons think that internists can’t cure any diseases and are not as straightforward as surgeons who operate decisively.

Therefore, these case discussions involving both internal medicine and surgery are quite interesting.

Especially when it comes to areas of overlap between internal medicine and surgery, such as tumors.

A surgeon would say: Stop your chatter, just remove the tumor with a broad lymphadenectomy. How can it be cured without surgery?

Internal medicine doctors would retort: All you know is to cut! Cut out all the organs of the body? No rush, let’s treat it slowly, with chemotherapy, radiation, see which one the tumor is sensitive to, first try one, then targeted therapy, and finally biological therapy, immunotherapy to assist.

The experts organized these mixed discussions to avoid the inflexibility of thinking. The communication between internal medicine and surgery broadened the thinking on many complicated diseases.

A female patient, 64 years old, suffering from an Ear, Nose, and Throat (ENT) disorder, with a foreign body in the left sinus. The diagnosis was clear, and they weren’t concerned with how the screw from the dental implant “smuggled” itself over there. The proposed treatment plan is to cooperate with the Department of Neurosurgery to remove the screw.

A patient from the Department of Urological Surgery, a 36-year-old male, with continuous erection. This occurred after a fever a week ago, and various drugs were ineffective. Only through epidural anesthesia could the erection be eliminated. As soon as the anesthesia wore off, the erection tendency returned. In order to avoid causing corporal necrosis, the Anesthesia Department was asked to install an epidural anesthesia pump to keep it anesthetized.

This case was purely an attempt by the Department of Urological Surgery to establish their presence. They had already diagnosed it themselves. Discussing it here was merely to share their diagnostic and treatment process with everyone else.

There are relatively fewer complicated cases in surgery compared to internal medicine, so such cases are presented to bolster the profile of the surgical team.

“Director Zha, tell us your opinion.”

Director Lu of the Urological Surgery singled out Director Zha of the Nephrology Department.

Even though both were specialized in “plumbing”, urological surgery was more proficient when it came to male functions.

The Nephrology Department mainly focused on the medical treatment of renal diseases, such as uremia and the like.

Playing to their own strengths to compensate for their deficiencies was a tactic favored by both internal medicine and surgery.

Director Zha pondered for a moment: “Has he taken any medication recently?”

“No!”

“Have you checked the androgen levels?”

“They’re normal!”

“What about his blood count? Have you considered sickle cell disease?”

“We’ve looked into that and ruled it out!”

“Are there any blood clots on the penis?”

“No!”

Director Zha was a bit puzzled, then thought and said, “Do you have an MRI of the spine? Can we consider spinal cord injury, such as tumor invasion?”

Director Lu, who had been confident all along, suddenly lost his energy: his case had been cracked! It was indeed a spinal cord tumor that caused excessive excitation in the central nervous system.

There is a famous saying in diagnosis: Common diseases presenting unusual symptoms are far more common than rare diseases.

Actually, making a diagnosis is like solving a case. It’s a process of logical inference: weed out the false and retain the true, peel back the layers, and gradually uncover the truth, step by step.

The Nephrology Department also brought out their case: a 48-year-old male, suspecting renal osteodystrophy. Fifteen years ago, he had bilateral kidney stones, had undergone stone removal eight times, and the stones continued to grow after removal. Seven years ago, due to kidney stones causing kidney failure, he underwent dialysis. Later, he felt pain all over his bones, gradually developing symptoms like joint deformation, blurred vision, tooth loss, and subcutaneous nodules.

There were also several similar cases of kidney stones in the family, one of whom died of uremia at the age of ten due to renal calculi.

Physical examination suggested that the patient’s vision had decreased, multiple teeth had fallen out, there were multiple hard nodules under the skin of the limbs, fingernails and toenails were deformed, the interdigital joints of both hands and feet, both ankle joints, knee joints, elbow joints, and shoulder joints were all swollen and deformed. Slit lamp examination revealed peripheral corneal calcification in the left eye. Abdominal CT showed bilateral renal calcinosis. X-rays revealed extensive destruction of the phalanges, high density at the ends of the epiphysis, finger soft tissue calcification, and deformed toenails.

Both Director Lu and Director Zha were doctors, academics, and were enthusiastic about such technical competitions.

Behind closed doors, they could pound the table. But outside the door, they were all good brothers.

“Does anyone have any opinions, Director Lu? What are the thoughts of your department?” One of the old internists in the expert group deliberately stirred things up.