Surgery Godfather-Chapter 354 - 0337: The Omnipotent

Chapter 354: Chapter 0337: The Omnipotent

Zhang Zhe, the child, actually suffers from chronic osteomyelitis. Chronic osteomyelitis doesn’t require a pathological examination for diagnosis. A clear diagnosis can be made based on the patient’s medical history, physical examination, and radiological examination.

However, any organs and tissues removed during surgery need to undergo a pathological examination – this is standard medical practice.

Song Zimo took this opportunity to study the pathological manifestations of this rare focal chronic osteomyelitis and to determine whether the surgery truly completely removed the diseased tissues.

To this end, Song Zimo asked the Pathology Department for assistance, and they made dozens of pathological slides from the entire bone fragment that was removed. This allowed for a detailed observation of the entire bone fragment.

Under the microscope, the pathological slides displayed a sandwich-style appearance resembling concentric circles. The necrotic bone was in the center, surrounded by the infected bone tissue, and the outermost ring was normal bone tissue.

Under a high magnification microscope, the visual field looked like an abstract painting. In the necrotic and infected bone tissues, a small number of infiltrated lymphocytes were observable, which was not the case in the normal bone tissue.

From viewing these dozens of pathological slides, each slide had the same sandwich-like structure. Which means that Yang Ping’s precise judgment based on the patient’s radiographic images and the planning for the diameter of the ream drill used during the surgery, allowed for a successful one-time surgery that completely removed the problematic bone tissue.

Even robotic surgery couldn’t achieve such precision, because no robotic tool can replace the clinical judgment of the chief surgeon before surgery. The robot is merely a passive tool.

After examining the slides, Song Zimo admitted that his eyes became uncomfortable after a while. He asked Xu Zhiliang to take over and recommended Takahashi to get ready.

Throughout the system-assisted examination training in the system space, Yang Ping had undergone rigorous training in looking at pathological slides. Not only examining the pathological slides, but he was also proficient in creating them as he had personally performed every step of the process.

Given his experience, he now wanted to pass on his knowledge to Song Zimo and Xu Zhiliang, hoping they too could understand how to interpret pathological slides. He hoped that one day, they would surpass the expertise of specialists in the Pathology Department.

Xu Zhiliang had significantly less experience with pathological slides than Song Zimo. It was limited to some he had seen during his PhD studies when conducting experiments and rarely encountered after his clinical training.

Xu Zhiliang settled at his workstation to examine the pathological slides while Takahashi sat beside him, waiting for his turn.

Song Zimo received a call from Tang Fei. She, along with Fujiwara Miyuki, were already at the entrance to the Pathology Department and requested to come in to watch.

During this period, Fujiwara Miyuki became quite close with Tang Fei. She was eager for the chance to learn from Yang Ping and gain exposure to more advanced technology.

Song Zimo went out to bring them in. They sat quietly on the side and Fujiwara Miyuki greeted Yang Ping, who responded with a smile.

The examination room was quiet except for the occasional sound of someone getting up to use the restroom. They quickly returned to their workstations and continued examining the pathological slides without rest.

Tasks that were not finished in a day would accumulate, causing even more work the following day. The Pathology Department was difficult to staff. It proved challenging to find people who preferred Pathology over clinical practice as their medical speciality.

Thus, the competition in the Pathology Department of big hospitals was not as intense as it was in clinical departments, where those without a doctorate degree would hardly get a chance to apply. Even Master’s degree graduates could find opportunities in the Pathology Department.

A young doctor suddenly stood up, “Have you seen Director Guan or Director Shi?”

“They should be checking the frozen sections next door. A few more samples just came in for freezing.” Another doctor responded.

“Can you help me take a look at this kid’s case? There shouldn’t be any problems, right?” The young doctor asked another senior doctor for help.

The senior doctor went over and helped him for a while and then said, “It doesn’t seem to be a problem, but I’m not sure. Let’s wait for the two directors to come over and discuss.”

Yang Ping was resting on the side, he heard the doctor’s dilemma and offered purely technical help: “Can I help you take a look?”

The senior doctor looked up at Yang Ping, somewhat skeptical: “Could you take a look?”

He was just curious. Could this orthopedic doctor actually interpret pathological slides? Especially those concerning gastric pathologies? He did not raise his hopes.

The senior doctor gave up his seat, Yang Ping sat down, looked for a while, and said, “Esophageal squamous epithelium infiltrated with lymphocytes, it is likely Crohn’s disease. Are there slides of other parts? If the biopsy of the gastroscopy and enteroscopy shows similar changes, it can be diagnosed as Crohn’s disease.”

Those pathologists who were focused on their work all lifted their heads, as did Song Zimo, Xu Zhiliang, Takahashi, Tang Fei, and Fujiwara Miyuki, looking at Yang Ping.

“Why are all of you looking at me? It’s just the way it is. The infiltration of lymphocytes in the squamous epithelium of the esophagus is a mild manifestation of Crohn’s disease in the esophageal mucosa. Are there slides of other parts of the digestive tract? Shall I help you take a look?” Yang Ping was surprised to have attracted so many eyes.

An orthopedic doctor sitting in the examination room of the Pathology Department, directing other pathologists on reading the slides – it was pretty normal that the senior doctor with ten years of experience was surprised.

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

Yang Ping put the slides under the microscope, one by one, and then said, “Focal amplified gastritis in the gastric mucosa, with focal active inflammation in the terminal ileum mucosa. There is no doubt, it can be diagnosed as Crohn’s disease.”

At this point, Director Guan and Director Shi entered the room. The young doctor shared his confusion with both of the directors. After all, Director Shi was tremendously experienced, and he was always the one to turn to when encountering difficult cases.

“Maybe you should rest for a bit, Dr. Shi,” Director Guan suggested sympathetically. Director Shi had just looked through several cryostat sections, his eyes red from strain.

“It’s okay. Let me take a look.” Dr. Shi insisted steadfastly.

Yang Ping gave up his seat and the old director sat down. He examined all three slides thoroughly before speaking: “There are infiltrates of lymphocytes seen within the squamous epithelium in the esophagus, chronic gastritis characterized by irritations in gastric mucosa, focal active inflammation in the mucosa at the terminal ileum… it’s Crohn’s disease!”

The old director looked up and put on his sunglasses: “The pathological changes in this case were very subtle and could easily go unnoticed by most people. But I was taught by my mentors during my time as a visiting scholar in the United States. Make a note of this set of slides, it would be good to arrange a session for me to explain them to everyone.”

The pathologists present immediately looked at Yang Ping again, this time with admiration. He had only looked at one slide and had deduced the pathological characteristics of the other two slides, providing the most probable diagnosis. After examining the remaining two slides, he made a definitive diagnosis in just two minutes.

As pathologists, they were in awe of his ability to capture images under the microscope.

A doctor from orthopedics looking at pathology slides was outperforming the actual pathologists, and he was even looking at gastroenterological slides. They felt utterly outdone.

Song Zimo was also amazed. Had he not invited him down to examine the pathology slides today, he would have not known that Yang Ping was so proficient at it. His skills seemed too multifaceted!

“Dr. Yang, the orthopedic doctor, mentioned earlier that it was Crohn’s Disease, but I didn’t believe it,” said the senior doctor.

“Oh?”

Director Shi was astonished. He stood up, picked up two glass slides from the box, and placed one under the microscope: “Could you take a look, Dr. Yang?”

Should he, or shouldn’t he?

Yang Ping didn’t want to seem discourteous. Despite whether it was an honest request for help, or a test, he felt he couldn’t refuse. Sitting at the microscope, he diagnosed: “Serrated polyposis syndrome (SPS)!”

Director Shi immediately switched to another slide for Yang Ping. Yang Ping quickly diagnosed again: “Pan-cell metaplasia.”

“The quality of the slide isn’t good. We can only see a cross-section. If we could see the whole mucous membrane, that would be better,” Yang Ping added.

Director Shi removed his sunglasses: “Young man, it would be a waste if you’re not pursuing pathology. Diagnosing the serrated pattern in the colon adenoma and seeing the Pan-cell metaplasia from a cross-section, these are the things that national pathology experts would be impressed with. Indeed, the quality of the slides are lacking. With high-quality endoscopic biopsy specimens, we can see the whole mucous membrane layer by layer. But we often can’t obtain those. Serrated pattern in the colon adenoma and Pan-cell metaplasia are identified by observing the base of the crypt. In cases where we cannot observe the changes at the base of the crypt, a general doctor would struggle to make a diagnosis.”

Turning to all the pathologists present, Director Shi said, “The quality of a pathology slide has a very important impact on the diagnosis. In order to make a satisfactory tissue section, every step of specimen collection, embedding, slicing, staining, and encapsulation must meet very high standards.”

“When I was a visiting scholar at MIT’s Pathology Department, their endoscopic biopsy specimens allowed us to see the entire mucous membrane structure. Compared with that, the cross-sections we often see in our endoscopic biopsies are of lower quality.”

“This made me realize that the reason we don’t often diagnose serrated polyposis of the colon (SSP) or often see Pan-cell metaplasia, an important diagnosis in inflammatory bowel disease, is not due to a spectrum of diseases, but rather the quality of the slides.”

Of course, it’s partly due to the lack of advanced machines and equipment, but the more important issue is professional spirit and professional attitude.

A perfect tissue section is extremely important. Not only is it pleasant to look at, but the pathological changes are clearly visible, ensuring the quality of the pathological diagnosis to the greatest extent.”

“Young man, what do you think the problem with this slide is? How can it be improved?” Director Shi asked Yang Ping, wanting to know the extent of his understanding.

Yang Ping could only objectively point out: “The specimen curled during dehydration in the manufacturing process. The tissue wasn’t arranged vertically during embedding. The color scheme in the Hematoxylin and Eosin staining was not harmonious. There were air pockets and resin overflow in the encapsulation. If these issues could be improved, it would be better.”

Director Shi almost clapped his hands: “You’ve said it very well. For instance, if the color scheme in the Hematoxylin and Eosin staining is perfectly coordinated, lymphocyte infiltrates in the epithelium could be accurately identified under a low magnification microscope. You wouldn’t even have to struggle over identifying them under high magnification. When you embed the tissue, making sure all of the tissue is arranged upright like soldiers in formation can ensure complete cross-sections.”

“Young man, have you worked in pathology before?” Director Shi was curious about how he had acquired so much knowledge.

The sourc𝗲 of this content is freēwēbηovel.c૦m.

Yang Ping didn’t mean to show off. He just wanted to share what he knew with everyone. That way, everyone could improve and do better next time. The hardest part was explaining: “During my studies, I had a particular interest in pathology, hence, I studied it very diligently.”