Chapter 2151: line with translation of title

As for the uninvited Zheng Lao Ban, Lin Ge still felt hopeful.

Zheng Lao Ban is indeed awesome, but for this clueless consultation, what good ideas could he have? Hopefully there will be.

Lin Ge looked at Zheng Lao Ban with expectant eyes.

"I agree with Professor Gu's view; it's systemic lupus erythematosus, and the diagnosis is fairly clear." Zheng Ren said in a low voice.

"Zheng Lao Ban..." the head of the Obstetrics Department was stunned for a moment.

Obstetrics Department and Obstetrics, the doctors of the two departments in a smaller hospital are the same team. Although in 912 they are different departments, the Obstetrics Department has a deep understanding of Obstetrics.

Zheng Lao Ban's recently completed intracardiac intervention surgery was no less than Arabian Nights for the obstetrics and gynecology doctors.

That wasn't hearsay; Zheng Lao Ban was full of confidence and even dared to perform the Shou Bing live.

He is a true expert; even the head of the Obstetrics Department at 912 feels deep admiration and even awe for Zheng Lao Ban from the bottom of his heart.

The same words, when spoken by Professor Gu, convey one attitude; but when spoken from Zheng Lao Ban's mouth, they become another attitude.

The head of the Obstetrics Department hesitated for a moment, not scolding Zheng Lao Ban from a superior position, but instead assuming a posture of attentive listening.

"I saw in the medical record that after immunotherapy, the patient experienced shortness of breath and palpitations."

Considering acute left heart failure, after diuretic and cardiotonic treatment, the patient's dyspnea improved, but palpitations gradually worsened; follow-up UCG showed LVEF of 36%, pulmonary artery pressure 35mmHg.

Zheng Ren also didn't look at the medical record, smiling as he said: "So far, the diagnosis still considers systemic lupus erythematosus. There is no evidence of involvement of the heart valves, cardiac conduction system, or coronary arteries, so heart failure may be due to systemic lupus erythematosus affecting the myocardium."

"But the patient's condition worsened following systemic lupus erythematosus treatment." the head of the Obstetrics Department asked.

Lin Ge was also puzzled; the doctors in the office were all puzzled.

"In the situation where hormone and immunosuppressant use leads to worsening cardiac dysfunction, I have several considerations."

First, the original treatment plan lacked intensity; I agree with Professor Gu's view and can administer shock therapy to salvage vital organ function.

Second, fluid and sodium retention after hormone use exacerbates heart failure, which may also produce similar symptoms.

Third, ……

Everyone in the room fell silent.

Rheumatology Immunology diseases are indeed difficult to diagnose and treat; even veteran clinical doctors with many years of experience may never have encountered this field.

Related diseases are complex and treatments varied; this is also why Su Yun said that when encountering a baffling disease, one should go directly to Rheumatology Immunology.

As for the doctors of the high-level Rheumatology Immunology Department, most will disdainfully stand atop the peak of medical technology, looking down on other disciplines, and say disparagingly, "Do they even treat patients?"

Zheng Lao Ban, a doctor of the Intervention Department, sat here speaking fluently, firm and confident, truly making people feel dazed.

"The lungs also seem to have a problem." someone asked softly.

"The patient's bilateral lung markings are clearly thickened; this is an imaging manifestation." Zheng Ren, having anticipated the question, spoke confidently.

"At this point we need to determine whether the thickening of lung markings is a hormone-induced pulmonary infection or a manifestation of systemic lupus erythematosus in the lungs."

Of course, I just took a quick look at the patient.

The patient, due to intestinal obstruction with a nasogastric tube in place, still had vomiting and choking cough; plus being bedridden, with hormone use and possible aspiration, therefore inhalational pulmonary infection cannot be ruled out.

This is vague talk, similar to what the respiratory medicine professor said earlier, with a tendency to avoid the important and focus on the trivial.

But Zheng Ren shifted his tone and said: "However, fever, lung symptoms, and worsening cardiac dysfunction occurring together, with no clear infectious foci on high-resolution chest CT and ineffective anti-infection treatment, makes it more likely due to active systemic lupus erythematosus."

The medical record notes the patient possibly has Raynaud's phenomenon; I think this is one of the bases for Professor Gu's judgment.

"If you're worried..." Zheng Ren began to pursue the rationality of the clinical diagnosis.

Generally speaking, the diagnosis of Rheumatology Immunology diseases is rather vague; the patient's situation is best suited for a cystoscopy to obtain a tissue biopsy. However, the urology department also said that the condition of the bladder wall is not suitable for biopsy.

The best method is a kidney tissue needle biopsy.

"I suggest we still persuade the patient's family to undergo a kidney needle biopsy." Zheng Ren said firmly: "After the biopsy, we can pinpoint the problem."

Lin Ge felt as if a huge black pot was being dumped over him.

"The reason for diagnostic therapy is that the patient's family believes nausea, vomiting, diarrhea, and the kidneys are unrelated, so they insist it's an issue of obstetrics department Shou Bing."

"Is a biopsy needed?"

If someone else said a needle biopsy was definitely necessary, Lin Ge would certainly not fully believe it. Such an operation could be a trigger that exacerbates conflict; once no positive findings appear, it's hard to predict how the family's emotions will change.

But if Zheng Lao Ban said it, Lin Ge would start calculating how to explain it to the patient's family.

"If the patient's family agrees to the kidney biopsy, and the result is positive, we can use a more aggressive treatment approach." Zheng Ren thought for a moment and said: "Methylprednisolone 1g, once daily shock therapy + vein immunoglobulin 20g, once daily treatment. Then give cyclophosphamide 1.0g shock therapy, hydrocortisone sodium succinate 300mg daily."

This dosage……

If the judgment is wrong, it could be fatal.

Lin Ge frowned, looking at Zheng Lao Ban, wondering if the dosage really had to be that high.

Cyclophosphamide 0.2g used for one day already caused severe damage to the patient's heart muscle; yet Zheng Lao Ban actually prescribed a dose of 1g—this… this…

This is hard to explain.

Lin Ge's thoughts flashed; thinking about the lethal dose of the drug, this still needs to be handled more carefully.

He glanced at Zheng Lao Ban, whose gentle, steady smile gave Lin Ge almost boundless confidence.

The office fell silent; Professor Gu looked at Zheng Ren with astonishment—this dosage was the utmost limit he could imagine.

Although he had just spoken of administering a large-dose shock therapy, Professor Gu knew he himself could hardly use such an extreme amount on the patient.

Using this amount for shock therapy is normally done only after a needle biopsy confirms systemic lupus erythematosus; beforehand, Zheng Lao Ban confidently stated the drug dosage…

This young Zheng Lao Ban's gall—isn't it too big? Is he really an Intervention Department doctor or a Rheumatology Immunology specialist?

After a moment's thought, Lin Ge closed his notebook, forced a smile, and said: "Alright, let patient's family go to the Medical Department; I'll go discuss with them the matter of undergoing a kidney needle biopsy."

Lin Ge had been forced into this.

It is estimated that on the Medical Department side, there will be an arduous and extraordinary battle.