Surgery Godfather

Chapter 308: Chapter 0292: Triple Play

Just now, when Doctor Yang and Director Zhu were outside, they had a heated discussion.

Several international medical bigwigs unanimously believed that the blood supply to the spinal cord was damaged. If it really was, it would be impossible to restore the blood supply through surgery. The only option would be conservative treatment, using some drugs to improve blood circulation and let nature take its course. Paralysis was inevitable eventually.

Dural arteriovenous fistula leading to increased venous pressure, insufficient arterial supply, and subsequent spinal edema, all of these symptoms mirror spinal cord blood supply damage.

Moreover, judging from the MRI and CT that the spinal cord’s blood supply was damaged is not something an ordinary orthopedic surgeon or radiologist can do. Only top-notch orthopedic specialists possess this judgment capability.

Therefore, this case within a case, poses as an advanced stage. Ordinary doctors have ordinary entries, advanced doctors have advanced entries. This is the reason why many experts can not break free. Disease, sometimes, is so peculiar.

Several bigwigs cracked the case using their abundant knowledge, but they never realized that cracking the case was entering a new one. They thought the case was broken, yet they stepped into another more complicated new one. Since they were oblivious to this, it was impossible to break free.

“We can try performing DSA (Digital Subtraction Angiography) on the main feeding blood vessels of the spinal cord, look for damaged blood vessels, such as those caused by excessive ligation of the intercostal arteries during surgery, we can attempt to repair. At present, the spinal cord has not undergone necrotic degeneration, there’s still a chance.” Auguste Bimilton was more proactive.

“This is a massive and complex project, the magnitude and complexity of which exceed your imagination. If it is a research topic, we can give it a try, but there are many obstacles in implementing immature ideas for clinical cases.” Milton remained conservative.

“If the patient is transferred to our Santen Hospital, we have more advanced equipment than DSA to examine and evaluate the location and extent of vascular damage, and whether it is suitable for surgical repair. If surgery is required, our orthopedics department has experience in this field.” Kobayashi Takeshi was confident.

They do possess a more advanced set of equipment than DSA. It was jointly developed by Tokyo University and its affiliated hospitals and Toshiba Corporation. Santen had the opportunity to obtain a prototype.

“If it’s about examination, our hospital also has better vascular examination technology than DSA. It’s the computer X-ray dynamic simulation angiography technology, which can perfectly reconstruct the entire human vascular image.” Auguste Bimilton stood his ground.

Auguste Bimilton came from Harald Orthopedics Hospital in Munich, Germany. The spine surgery of that hospital is top-notch worldwide. When the Japanese touted their advancements, he was slightly displeased.

Among the invited bigwigs for this consultation, there was also a professor from the Twin Cities Spine Center in Minnesota, United States. The center was hosting an academic conference on spinal surgery and declined the consultation invitation.

Source: Webnovel.com, updated on ɴονǤο.с0

The pride of the Britons was shattered by the Germans and the Japanese, as they each claimed to have a more advanced set of examination equipment. These pieces of equipment must be in the experimental research phase and have not been widely deployed yet.

But Milton couldn’t come up with such equipment. Cutting-edge equipment has mostly been monopolized by these guys. Now, in Milton’s hospital, most of the advanced medical equipment is from these two countries.

To identify the location and condition of the damaged blood vessels, it’s not something ordinary equipment can do. It requires even more advanced imaging equipment and technology.

The several doctors from other countries hardly said a word and simply complemented the bigwigs, making the scene appear grand.

“Doctor Yang from China hasn’t expressed his opinion yet. Let’s hear what Doctor Yang thinks.” Doctor Lin took the opportunity to push Yang Ping forward.

Everyone turned their eyes to him. He was just a young doctor. He might be a doctor hired by an insurance company just to fill the quota.

Moreover, during the discussion just now, they didn’t notice this doctor and didn’t know when he entered the conference hall.

“I’m sorry, gentlemen, I can only stay here for another half an hour at most.” Milton, the gentleman, reminded them to either conclude the meeting within half an hour or he would leave early.

Doctor Yang looked around the room calmly and said, “Actually, this patient is quite simple, not very complicated. It’s just that it’s less common, leaving you all a bit bewildered.”

The entire conference was conducted in English, and Doctor Yang was no exception.

As soon as these words came out, everyone in the room was stunned by the confidence and calmness that characterized Doctor Yang’s “man from Earth” demeanor, stating simplicity when gazing across time and space.

Simple? Such a complex case was simplified into two mild words in his mouth – simple!

Milton, Auguste, and Kobayashi Takeshi were all authorities in orthopedic surgery. Someone just said this in front of them. Professor Milton shrugged, considering it a boring joke; Auguste propped his elbow on the table, holding his chin in one hand, listening attentively; Kobayashi Takeshi was contemptuous, considering it to be pure show-off, forcibly seeking attention.

“Can someone help me call up the patient’s imaging pictures? I need both CT and MRI!” Doctor Yang asked.

Doctor Lin immediately ordered the doctor in charge of computer operations to bring up the patient’s imaging pictures.

Yang Ping walked towards the screen opposite the oval table and pointed at the images on the screen, “Slow down, just these few, and the MRI ones, yes, keep these ones.”

After selecting the images, he used a stylus to point at the screen, “This is a typical case within a case, a white trap enclosing a black one. You are all deeply stuck in the white case, unable to extricate yourselves, and the patient is trapped in the black case, unable to be saved.”

A case within a case, incomprehensible. Nobody had heard of this kind of medical condition before. Everyone shrugged, looking helpless.

“On the surface, this case is about a cyst compressing the spinal cord, followed by surgery to remove the cyst from within the vertebral canal. The operation accidentally damaged the spinal cord’s blood supply. Postoperatively, the neurologic symptoms were temporarily relieved due to the cyst removal, but later aggravated due to the disruption of the spinal cord’s blood supply. Everything seems perfectly consistent, with the whole diagnostic and therapeutic process being textbook worthy. Even years later, no one would doubt this,” Yang Ping paused.

Doctor Lin took this opportunity to hand him a bottle of mineral water, which Yang Ping took a sip from.

He continued, “But in reality, it is far from this. If we dissect this case, within it hides a rare disease—”

Yang Ping’s rhetoric had also improved, with his case presentation much resembling storytelling.

“The rare disease is— a dural arteriovenous fistula. You solved the white case, but failed to notice the black one. The black case continues to wreak havoc, and grows progressively worse. Thus, the neurological symptoms of the legs aggravated. The white case conceals the black one, with surgery damaging the blood supply of the spinal cord playing the role of a scapegoat. It blinds everyone’s eyes and leads everyone unconsciously into a trap, but they remain completely oblivious,” he concluded.

“This is so thrilling! My God, are you sure you’re being serious?” Auguste exclaimed in surprise. He had never heard such a strange opinion before. It was incredibly refreshing.

“Complete nonsense! A dural arteriovenous fistula must be diagnosed with DSA or more advanced vascular imaging technologies. CTs and MRIs simply cannot diagnose it. This patient did not undergo these examinations, how did you arrive at your diagnosis?” Kobayashi Takeshi sneered. There were no papers or textbooks in the world mentioning using CTs and MRIs to diagnose a dural arteriovenous fistula.

Milton shook his head, “No, no, no, there are fewer than 300 reported cases of a dural arteriovenous fistula worldwide. CTs and MRIs cannot diagnose it at all. It requires DSA, a specialist arteriography procedure of the spinal cord. Even then, there’s still a chance that the diagnosis might be missed. I believe you should at least demonstrate some professional caution when making statements.”

“No matter if he’s right or wrong, we heard a different voice, and that’s very important. Most times, the truth is held by the minority. Please continue, I am very interested,” said the old German man who strongly disliked the arrogance of the British.

“That’s true. From these images, one cannot directly see the fistula, but if you all look at the MRIs and CT scans, a few images make it apparent—these images show vascularization. This is the blood vessel image from the CT scan, this is the MRI image obtained using blood flow effects. Both have one thing in common, which I refer to as the ‘cutoff effect’: from a certain point as the boundary, the diameter of the proximal veins appears discontinuously expanded, while there are no such changes in the arteries. This is a characteristic of arteriovenous fistulas, indicating a fistula connection between an artery and a vein at some point, causing venous congestion. This congestion leads to venous dilatation, and the dilatation lacks the expected smooth transition. The venous congestion consequently causes spinal cord edema, and the combination of these two conditions leads to the diagnosis being trapped in a labyrinth,” Yang Ping said, pointing at several images.

If observed from a standpoint of medical knowledge, everyone lacked information in this regard and was unable to either support or refute Yang Ping’s statements.

“So, if the patient underwent a DSA and a superselective arteriography of the spinal cord vessels, wouldn’t Doctor Yang’s diagnosis be confirmed?” Auguste was always deeply interested in this case.

The Briton maintained his conservative stance, “Superselective arteriography is time-consuming and may be unsuccessful. Can you trust his words?”.

“We have technologies that are even more advanced than DSA and can verify this diagnosis,” Kobayashi Takeshi kept suggesting that the patient should be transferred to Japan.

“In fact, there is no problem with this patient’s diagnosis. It’s just that we want to confirm the diagnosis in a way that everyone is familiar with. We could carry out a DSA again, which imposes very high technical requirements on the physician. There is a more crucial problem—the surgery. The arteriovenous fistula is located in a rather hidden place and handling the blood vessels requires high precision. The surgery must be extremely meticulous. It is best for my team to treat this patient. Others may have difficulty gaining experience in this area.”

What Yang Ping said was the truth. In terms of handling the arteriovenous fistula, the treatment requires neither ligating the blood vessel nor repairing the fistula after separating the blood vessels like a normal fistula. For the patient’s safety, he might indeed have to perform the operation himself.

“Doctor, your words lack basic supportive evidence. Plus, you claim that only you can perform the surgery? May I ask which hospital you are from, what research you are engaged in, and what research achievements you have made?” Kobayashi Takeshi sharply retorted, unimpressed.

“I am Yang Ping from China’s Sanbo Hospital. Soon you will see my research papers. I am not making unfounded assertions. This operation is truly difficult. There might indeed be a real disruption of blood supply to the spinal cord after the operation, which would be disastrous and irreversible. I do not wish to witness that.”

Yang Ping was extremely calm, having said all that was necessary. He stepped down from the podium and drank a mouthful of water.

He always goes the extra mile for each patient, trying his best to achieve the best outcome for them.

This patient was actually a triple-layered case, Yang Ping only explained the first two layers. He would let them accept these two layers first before explaining the third layer. As some people had not yet fully understood the two layers, abruptly explaining the third layer would be too mind-boggling.

The reason why Yang Ping insisted on performing the surgery himself was that, during the surgery to treat the arteriovenous fistula, several arteries in the access route had to be either ligated or electrocoagulated.

However, these arteries are usually considered useless in the surgical access route and can be ligated or electrocoagulated. In fact, these arteries are the main blood supplying vessels for a specific segment of the spinal cord.

It was a bizarre variation, which made this case weird and unpredictable at every turn!

If Yang Ping had not obtained strong abilities in the system space, this triple-layered case, like most perplexing diseases around the world, would probably never be solved, remaining an eternal mystery.

Everyone started whispering and discussing in low voices, unsure of what to do next.