Chapter 766: 754 Picking at Faults

Zheng Ren smiled, stood up, bowed slightly, let Director Luo sit down, and he himself stood in front of Director Luo.

Young, capable, yet not arrogant or overbearing, Director Luo was still very satisfied with Zheng Ren's performance.

Zheng Ren then spoke at length: "In the hospitals below, diagnosing intestinal obstruction usually involves upright fluoroscopy or going by clinical symptoms. According to the patients' families' accounts, there have been several times when intestinal obstruction was diagnosed, but upon admission to the inpatient department the diagnosis was overturned. I guess this means that once admitted, the intestinal obstruction resolves on its own, without medication."

Director Luo listened quietly, without interrupting Zheng Ren.

"So I guess the patient's intestinal obstruction is merely short-term and temporary. Moreover, the family said the patient easily gets fatigued, leading me to wonder whether both skeletal and smooth muscles are affected. If so, the likelihood of mitochondrial encephalomyopathy is greater."

Dr. Shen was bewildered...

He had seen Zheng Ren's surgery and knew that this Boss Zheng's interventional surgery skills were quite high. Half a year earlier, that ophthalmic artery recanalization procedure opened Dr. Shen's eyes.

At the time he almost wanted to lick the screen, and was scolded by Director Kong.

With that level of skill, Boss Zheng could very well be nominated for a Nobel Prize; Dr. Shen thought that quite reasonable.

However, is he also that skilled at diagnosing rare diseases?

Mitochondrial encephalomyopathy? What the heck is that? Dr. Shen was instantly at a loss.

As a medical doctor, he completely failed to understand the conversation between Zheng Ren and Director Luo, and his face flushed a little.

"So you just looked at the electromyogram?" Director Luo asked.

"At local hospitals, they basically treat headaches for headaches and foot pain for feet. But electromyography... to be frank, it's rarely done at local hospitals; usually only the neurology department performs it."

"Oh? And then?"

"Since I haven't heard the family mention any neurology visits, I guessed it was during a major episode of muscle weakness when the emergency doctor ordered an electromyogram." Zheng Ren said candidly: "This test is rather blind, but we just got lucky and hit the key point."

Luck...

Director Luo found Zheng Ren's bluntness both infuriating and amusing; this little guy really speaks his mind.

As a doctor, who would admit to relying on luck?

Yet limited by scientific and diagnostic standards, even in the capital many disease diagnoses contain an element of luck, let alone in local hospitals.

Especially diseases like mitochondrial encephalomyopathy, which are exceedingly rare.

This disease has little to do with gastroenterology, so Director Luo hasn't studied it. He's curious about this young doctor before him—just how did he make the diagnosis?

A Nobel Prize nominee—can he really pull off such a cross-disciplinary diagnosis?

The situation is looking more and more interesting.

"The electromyogram shows abnormalities, but the abnormal waves are not obvious."

"The electromyogram performed is the most ordinary narrow-type version used at local hospitals; the multiphase wave percentage is usually under 20%, but there are a few stages where it slightly exceeds. Different muscles have different normal ranges, yet during the brief time of the electromyogram, the later phases have gradually returned to normal."

At this point, not only Dr. Shen but even Director Luo felt a bit dazed.

What on earth is Boss Zheng saying?

"The report writes the conclusion with just one hand—for example, interference pattern, mixed pattern, pure pattern, pathological interference pattern, etc. —but if you look at the waveform, you'll see that at the very start, a few seconds of the waveform are off." Zheng Ren said.

Silence fell when Zheng Ren stopped speaking; the director's office was utterly silent.

Soon, Zheng Ren's voice broke the silence again.

"My judgment is that the electromyogram is abnormal, not due to neuronal issues but to a change in the muscle itself. This inference matches the families' description of generalized weakness, electromyogram alterations, and occasional smooth muscle changes—only mitochondrial encephalomyopathy fits."

Zheng Ren spoke with such certainty that, without realizing it, Director Luo already believed him.

Because of his tight logic, and also because of the aura of a Nobel Prize nominee.

Mitochondrial encephalomyopathy is a group of rare diseases caused by abnormalities in mitochondrial structure or function, primarily affecting the brain and muscles as a multisystem disorder.

It is usually maternally inherited, more common in females, and the onset time is uncertain—it can occur from infancy to old age.

Because muscle and brain tissue highly depend on oxidative phosphorylation and similar metabolism, whether nDNA or mtDNA is defective alone or both are affected together, clinical symptoms tend to be systemic.

However, due to varying degrees of involvement of different enzyme systems, clinical presentations differ; hence mitochondrial diseases are artificially divided into two major categories: mitochondrial myopathy and mitochondrial encephalopathy.

The patient before us likely presents as mitochondrial myopathy.

This is the milder form; the one that easily leads to patient death is mitochondrial encephalopathy.

"All just speculation and inference?" Director Luo said softly.

It sounded like he was asking Zheng Ren, yet also like he was talking to himself.

Zheng Ren's remarks sounded like mystifying fog to those who didn't understand, but Director Luo caught a hint of meaning.

Out of professional habit, Director Luo's first thought was to "pick at flaws"!

Lacking solid evidence, that is the biggest flaw.

But the tests brought by the patient's family cannot provide a definitive diagnosis. If one truly suspects mitochondrial encephalomyopathy, one can go for genetic testing to confirm.

Yet this is only a possibility; Zheng Ren's tone was too certain.

"No, Director Luo." Zheng Ren pointed at the patient's data and said: "Just now, when you were reading this image, you frowned—did you also see an abnormality?"

"It can't be called an abnormality; it might be an artifact, but the images of certain spots in the patient's intestinal smooth muscle group do indeed look problematic." Director Luo said.

"Yes, it's the abdominal CT, which actually provides fairly reliable evidence." Zheng Ren said: "Mitochondrial myopathy, in imaging..."

Speaking of the CT images, Zheng Ren's attitude was different from when he talked about the electromyogram.

Dr. Shen knew that Young Zheng Lao Ban's 64-slice three-dimensional CT technique was top-notch.

Half a year ago, after he left, Director Kong immediately organized everyone to study the reconstruction of liver 64-slice three-dimensional CT, and quickly rolled it out clinically.

This examination had already been used clinically. But before, no practitioner performed it; it was all done by the CT room based on software.

At first everyone had some reservations, but Director Kong suppressed all dissent with an iron fist.

After truly delving into the research, everyone... at the very least Dr. Shen recognized the benefits of the three-dimensional reconstruction of 64-slice three-dimensional CT.

Many tumor-released factors, the newly formed abnormal proliferative blood vessels, can be directly shown with 64-slice three-dimensional CT reconstruction, increasing the precision of surgery.