Surgery Godfather

Chapter 2101: Chapter 1795: Time to Hone My Skills (Part 4)

Zhaxi now deeply understands that an excellent doctor must learn to check English literature in order to learn from the experiences of doctors worldwide. ƒreewebɳovel.com

He closed his notebook, looked at the clock; it was already 6 PM. He stood up, holding those papers, and walked to Professor Yang’s office. Professor Yang hadn’t left work yet.

He was examining an MRI scan; seeing Zhaxi enter, he put down the scan: "Found anything?"

Zhaxi placed the papers on the table and began his report. He detailed all the information he had gathered, his analysis process, and reasons for excluding other diagnoses. Finally, he reached his conclusion: "Professor Yang, I suspect this patient has an autoinflammatory disease, possibly an atypical presentation of adult Still’s disease or an unclassified autoinflammatory syndrome. I suggest a whole-body PET-CT scan to rule out potential tumors and infections. Meanwhile, check serum ferritin and glycosylated ferritin — adult Still’s disease patients usually have significantly elevated serum ferritin and decreased glycosylated ferritin ratio. If the ferritin is markedly elevated, it supports the diagnosis."

Yang Ping listened, without speaking immediately, and then browsed through the literature, page by page. After finishing, he dialed Director Liu’s mobile phone.

"Director Liu, hello, regarding the patient in bed 15, I suggest checking serum ferritin and glycosylated ferritin. Yes, and a whole-body PET-CT. Okay, thank you."

After hanging up, he looked at Zhaxi: "As before, when the results are out, you do the analysis."

Zhaxi nodded.

Three days later, the test results gradually came out. Serum ferritin was 1500 ng/mL, the normal range being 20 to 200. The glycosylated ferritin ratio was 20%, with the normal range above 50%. The ferritin was significantly elevated, and the glycosylated ferritin ratio significantly decreased. This is a typical presentation of adult Still’s disease. The PET-CT also came back, showing no evidence of tumors or infections. There was no abnormal metabolic activity throughout the body, only mild splenomegaly.

Zhaxi took these results to Yang Ping. After reviewing them, Yang Ping nodded: "The diagnosis is clear, adult Still’s disease involving the central nervous system. It seems you’ve learned to check the literature; now that the diagnosis is clear, let’s proceed with the treatment."

Zhaxi revealed his treatment plan: "Glucocorticoids, methylprednisolone pulse therapy, followed by a slow tapering of oral prednisone. If the effect is poor, IL-1 antagonists, like Anakinra, or IL-6 antagonists, like Tocilizumab, can be added."

"Did you notice that glucocorticoids can be used in many scenarios, and in some they are the only option? An excellent doctor must master the use of glucocorticoids," Yang Ping reminded him. freёwebnovel.com

Zhaxi continued to manage this patient, assisting as the primary doctor in the Neurology Department.

Every morning, he did ward rounds, as before, asked about changes in the illness, performed physical exams, and documented the disease progress. He reviewed a vast amount of literature, learning comprehensively about the etiology, pathology, diagnosis, treatment, and prognosis of adult Still’s disease. This time he also learned how to interpret PET-CT scans of this disease, assessing the size and metabolic activity of the spleen.

The treatment was very effective; three days after methylprednisolone pulse therapy, the patient’s temperature returned to normal. A week later, joint pain significantly reduced, and the rash subsided. Two weeks later, consciousness completely returned. As he was discharged, he held Zhaxi’s hand and said, "Doctor Zhaxi, thank you. I finally know what illness I have."

Zhaxi smiled: "You’re welcome, it’s our duty."