The Godfather of Surgery

Zhang Zhe’s child is actually chronic osteomyelitis. Chronic osteomyelitis does not require pathological examination to be diagnosed. The diagnosis can be made based on medical history, physical examination and imaging examination.

It's just that any organs and tissues that are cut out during the operation are subject to pathological examination, which is a medical routine.

Song Zimo just took this opportunity to study the pathological manifestations of this rare focal chronic osteomyelitis, and to see if the surgery really completely removed the lesions.

To this end, Song Zimo asked the pathology department to help, and made dozens of pathological sections of the entire bone plug taken out, so that the entire length of the bone plug could be carefully observed.

The pathological section is cut under a microscope and a low-power microscope into a sandwich of concentric circles. The center is necrotic bone, the surrounding necrotic bone is infected bone tissue, and the outermost circle is normal bone tissue.

Under a high-power microscope, the field of view is like an abstract picture. In the necrotic and infected bone tissue, a small amount of infiltrated lymphocytes can be seen, while normal bone tissue has no lymphocytes.

Judging from these dozens of pathological slices, each of them is similar to a sandwich structure, that is, Yang Ping made an accurate judgment from the patient's image pictures, planned the diameter of the trephine used in the operation, and made it in place at one time during the operation. Remove the entire problem bone tissue.

Even if it is done with a surgical robot, it cannot be so accurate, because the surgical robot cannot replace the clinical judgment of the preoperative surgeon, it is only a passive tool.

Song Zimo, Xu Zhiliang, and Takahashi, all three of them gathered around the multi-head microscope at the same time and continued to watch.

This kind of pathological section, Yang Ping's auxiliary inspection training in the system space, has received devil-like training, not to mention the pathological section, the production of the entire pathological section, he has personally done every process, very skilled.

Now he just wants to pass on some experience to Song Zimo and Xu Zhiliang, so that they can also master how to read pathology slices. He hopes that one day, they can be more powerful than pathology experts.

Xu Zhiliang did not have as much exposure to pathological slices as Song Zimo. When he was a doctoral student, he did experiments and read some, but he had almost no contact after clinical practice.

Takahashi has received systematic and standardized professional training in pathology, but after engaging in trauma surgery, he has little contact.

Song Zimo received a call from Tang Fei. She brought Fujiwara Miyuki to the door of the pathology department, and they also wanted to come in and have a look.

During this time, Fujiwara Miyuki got along very well with Tang Fei, and she also wanted to follow Yang Ping to be able to get in touch with more cutting-edge technologies.

Song Zimo went out to bring the two in, they sat quietly beside them, Fujiwara Miyuki greeted Yang Ping, and Yang Ping responded with a smile.

The microscopic examination room was quiet, and the doctors at the workstations were carefully looking at the pathological slices. Occasionally someone went out to the bathroom, almost trotting out, trotting in, and did not rest after coming in, and continued to sit at the workstation to look at the pathological slices.

If the daily tasks cannot be completed, they will accumulate until the next day, and the next day will receive a lot of specimens. This accumulation will only increase, and pathologists are more difficult to recruit, and most medical students like it. In clinical practice, few are willing to study pathology.

Therefore, the pathology department of a large hospital is not as competitive as the clinical department. To the extent that non-doctors are not allowed to knock on the door, even master students in the pathology department have the opportunity to enter.

A young doctor suddenly got up: Have you seen Director Guan and Director Shi?

Should be looking at the frozen section next door. Several specimens have just been sent to be frozen. Another doctor replied.

This child, please help me to see, there should be no problem. The young doctor asked another doctor with more seniority to help.

The senior doctor went over and looked at it for a while: This seems to be nothing, and I can't see it. Let's wait for the two directors to come over and talk about it.

Yang Ping rested beside him, heard the doctor's confusion, and gave purely technical help: May I help you take a look?

The senior doctor looked up, looked at Yang Ping, and was suspicious: Why don't you help?

Just curious, does this orthopaedic doctor really see pathology slides? It's still a pathological section of the gastrointestinal tract. I don't have any hope of whether he will really see it.

The senior doctor gave up his seat, Yang Ping sat down and watched for a while: Lymphocyte infiltration can be seen in the esophageal squamous epithelium, which is likely to be Crohn's disease. Are there any other sections? If the gastroscope and colonoscopy biopsy also have similar change, and Crohn's disease can be diagnosed.

The pathologists who were concentrating on their work all raised their heads, Song Zimo, Xu Zhiliang, Takahashi, Tang Fei and Fujiwara Miyuki also looked at Yang Ping.

Look at what I'm doing, it's just like this, the esophageal squamous intraepithelial lymphocyte infiltration is a mild manifestation of Crohn's disease in the esophageal mucosa, and there are other parts of the digestive tract? ? Yang Ping didn't expect to open his mouth and attract so many eyes.

A doctor of orthopedics, sitting in the pathology department's microscope room, instructing other pathologists to see the slices. The senior doctor just now should have ten years of experience.

The senior doctor was stunned for a while, then picked out two slides from a large slide box and handed them to Yang Ping.

Yang Ping put the slides one by one under the microscope. After reading it, he said: Focally enhanced gastritis of gastric mucosa and focal active inflammation of the mucosa of the terminal ileum. There is no doubt that the diagnosis is Crohn's disease.

At this time, Director Guan and Director Shi came in, and the young doctor told the two directors in confusion that Director Shi was experienced after all.

Why don't you take a rest, Mr. Shi. Director Guan couldn't bear it. Director Shi just looked at several frozen sections and his eyes were red.

It's okay, I'll take a look. Director Shi was very persistent.

The old director sat down and read the three slides carefully before speaking: Lymphocyte infiltration can be seen in the squamous epithelium of the esophagus, focal enhanced gastritis in the gastric mucosa, focal active inflammation in the mucosa of the terminal ileum, Crohn's disease!

The old director raised his head, took out his sunglasses, and put it on: The pathological changes in this case are very slight, and most people can't see it. This is what the teacher taught me when I was a visiting scholar in the United States. Write down this set of slides and arrange a small class, I'll tell you a lesson.

The pathologist immediately turned his attention to Yang Ping again, this time with adoring eyes. He only looked at one slide, and inferred the pathological manifestations of the other two slides, and gave the most probable diagnosis. The other two slides were directly placed to confirm the diagnosis, and it took less than two minutes.

As a pathologist, I am dissatisfied with the ability to capture images under the microscope.

An orthopaedic doctor sees a pathological section, and he is even more powerful than a pathologist, and he sees a biopsy from a gastroenterology department, and he still doesn't let people live.

Song Zimo was also amazed. If he hadn't dragged him down to see the pathological slices together today, who would have known that this guy had such a high level of pathological slices, he was so versatile!

Dr. Yang from the Department of Orthopedics just saw it and said it was Crohn's disease. I still don't believe it, said the senior doctor.

Oh?

Director Shi was greatly surprised. He stood up, picked two more slides from the box, and put one under the microscope: Dr. Yang, help me take a look?

Look? Still not watching?

Yang Ping is also not polite, no matter if he really wants to ask himself for help or test himself, it is not easy to refuse, and he glances a little: Serrated adenoma of the intestine (SSP)!

Director Shi immediately showed Yang Ping another one, and Yang Ping quickly said the diagnosis: Pan's cell metaplasia.

The quality of the slides is not good. Only one cross section can be seen. It would be great if the flattened mucosal full-thickness structure can be seen. Yang Ping added.

Director Shi took off his sunglasses: Young man, it's a waste not to do pathology. From a cross section, we can see that intestinal serrated adenoma (SSP) and Paneth cell metaplasia, the national pathologist's wrench index, indeed, this slide's The quality is not good. If a high-quality endoscopic biopsy specimen is used, the entire mucosal layer can be seen flat, but we often cannot. Intestinal serrated adenoma and Paneth cell metaplasia are determined by observing the base of the crypt. Only The crypt base can only be displayed with a full-thickness tiling mucosa, and the changes in the crypt base cannot be observed, and the general doctor cannot make a diagnosis.

Director Shi turned his head to all pathologists and said: The quality of pathological slides has a very important impact on pathological diagnosis. To make a satisfactory slide, every step of sampling, embedding, sectioning, staining, and mounting is required. There are very high demands.”

When I was a visiting scholar at the MIT Department of Pathology, their endoscopic biopsy specimens could see the flattened full-thickness mucosal structure. In comparison, our domestic endoscopic biopsy slices often only see a transverse section.

It suddenly made me understand why we rarely diagnose colonic serrated adenoma (SSP) and rarely see Paneth cell metaplasia, which is important in the diagnosis of inflammatory bowel disease, not a disease spectrum issue, but a slide quality issues.

Of course, there are issues with machinery and equipment, but it's more about professionalism and competence.

A perfect slice is very important. It is not only pleasing to the eye, but also the pathological changes can be seen at a glance, so as to ensure the quality of pathological diagnosis to the greatest extent.

Young man, what do you think is the problem with these slides, and what needs to be improved? Director Shi asked Yang Ping, he wanted to see how well this young man understood.

Yang Ping can only point out objectively: During the production process of this specimen, the tissue was curled during dehydration, the tissue was not erected during embedding, the color matching of HE staining was not very harmonious, and the coverslips had holes and glue overflow. If these steps are improved It should be better.

Director Shi almost applauded: It's very well said, for example, the color matching of HE staining is perfectly coordinated, and the infiltration of intraepithelial lymphocytes can be accurately detected under a low-power microscope, and it will not be invisible under a high-power microscope; When burying, the tissue is erected, and all the tissues are neatly arranged like soldiers in a queue, which can ensure that the full-thickness structure of the mucosa is cut out when slicing.”

Young man, have you done pathology before? Director Shi wondered how he knew so much.

Yang Ping didn't mean to show off, but just wanted to share the knowledge he mastered with everyone, so that everyone can improve and do better next time. The most troublesome thing is to explain: When I was studying, I was more interested in pathology. So study hard.

Not only can he read pathological slides, but he is so familiar with the production process of pathological slides. Where is the deficiency of a slide, and where is the problem, at a glance, it is not as simple as interest.

If the IQ is calculated based on the full score of 200, Takahashihara estimates that Dr. Yang's IQ starts at 160. Now I think that Dr. Yang's IQ is going to break through the rhythm of 200%. He has received professional and systematic pathology training, which cannot match Yang Ping's occasional interest.

Seeing Yang Ping sitting there, quietly and calmly, Fujiwara Miyuki suddenly had an inexplicable intuition, and Yang Ping was hiding loneliness.

Perhaps, that is the height of genius.