He had an "oral ulcer" and didn't expect to have chest surgery.

Small oral ulcer, the "culprit" is actually a tumor A lot of people have the experience of oral ulcer, most of the time tolerance is over, but the 33 year old Mr. Cheng (pseudonym) was once in critical condition.a few days ago, the "ulcer" disease that had plagued him for nearly a year was finally diagnosed and treated in Shanghai Ruijin Hospital. It turned out to be a rare and fatal disease, paraneoplastic pemphigus associated with Castleman's disease.01 the fatal "oral ulcer" Mr. Cheng recalled that a year ago, he began to feel strange in his mouth - as long as he ate spicy food, both sides of the root of his tongue would be in pain, thinking it was a fire.after half a year, irregular white blisters began to appear on the tip of tongue and other oral mucosa, even in private parts.so he began to seek medical advice.in Wuxi, Nanjing, Shanghai, Mr. Cheng and his family visited seven hospitals and got different diagnoses. They went to see a doctor, take medicine and see a doctor again. However, the symptoms gradually worsened and began to have intermittent cough.after several twists and turns, they came to Shanghai Ruijin Hospital, the eighth hospital they visited in four months.at this time, he had chest tightness, shortness of breath, and could not lie on his back.the director of Dermatology, pan Meng, received a detailed physical examination and consultation for Mr. Cheng.learned that when he was 10 years old, he had detected "chest shadow". At that time, he thought it was dysplasia, so he did not pay attention to it. This shadow has been in the body for more than 20 years.combined with various "clues", director Pan Meng, who has rich clinical experience, immediately determined that the patient might be paraneoplastic pemphigus (PNP).according to pan Meng, PNP is a fatal autoimmune bullous skin disease associated with tumor.the most common damage is stubborn erosion of the lip and oral mucosa. It is easy to be mistaken for oral ulcer or other immune system diseases, thus delaying the treatment time. Eventually, obstructive bronchitis and myasthenia gravis and other complications may occur, leading to death.Mr. Cheng was admitted to hospital soon, and the related tumor screening was carried out quickly.Chief dermatologists Zheng Jie, pan Meng, and attending doctor Zhao Xiaoqing worked out a diagnosis and treatment plan for him.02 "the culprit" appeared, and the multidisciplinary team quickly assembled as expected. The examination results showed that Mr. Cheng had a 6cm "mediastinal tumor" hidden in his chest, and had begun to oppress the trachea, so that he appeared "breathless" symptoms."at that time, director Pan firmly said," as long as we follow the PNP line, we will find out. " I was in awe, and felt hopeful this time! " Mr. Cheng's father sighed. "culprit" found! But how to treat it? At this time, Mr. Cheng in the hospital bed suddenly had difficulty breathing, sweating profusely and could not lie flat The patient's condition is critical, the treatment plan must be determined in the shortest time! In the afternoon of the same day, the multidisciplinary team of Ruijin Hospital gathered, and experts from thoracic surgery, anesthesiology, critical care medicine, respiration and intervention departments gathered in the dermatology ward to analyze the possible diagnosis of the disease, the main contradictions at present, the advantages and disadvantages of the operation, the risks during and after the operation and the corresponding countermeasures. after the multidisciplinary consultation, the experts came to the ward again to visit the patients. The experts believed that if the operation was carried out, the tumor blood vessels should be blocked in advance to reduce the release of pathogenic antibody caused by squeezing the tumor, and glucocorticoids should be used to prevent adrenal gland crisis; large dose of intravenous gamma globulin should be infused before and during the operation to prevent the acute aggravation of the disease after operation. for patients with severe pulmonary dysfunction, anesthesia department and intensive care department should be prepared to use extracorporeal membrane oxygenation (ECMO). "open as soon as possible! Let's open the platform! " Li Hecheng, director of thoracic surgery, said, "never give up a glimmer of hope!" Li Hecheng said: "the lung function of the patient is very poor, which indicates the extremely severe obstructive ventilation dysfunction. Although the operation is very difficult, the urgent symptoms of dyspnea can be relieved only by removing the tumor as soon as possible, and the cause of paraneoplastic pemphigus may be clearly diagnosed and found. with the strong multidisciplinary team of Ruijin Hospital, we are confident! " 03 behind trust is the demonstration of comprehensive strength. "It's impossible to open such a big sword without worrying. Br / > since the director of the hospital, we have a great trust in him! After that, director Li's daring attitude and serious consultation with experts from various disciplines strengthened our choice! " Mr. Cheng's father said, "I also took the initiative at that time. We knew that the operation was risky, but we fully trusted the doctors and we were willing to fight!" The operation was scheduled for the next morning. Thoracic surgery director Li Hecheng, Dr. Han dingpei and Dr. Zhang Yajie performed anterior mediastinal tumor resection, and anesthesia director Luo Yan, Dr. Li Qiang and Dr. Hu Tianran performed anesthesia. more than 2 hours later, the operation was declared successful! Everyone was relieved. director Li Hecheng said in the operation, "the tumor of the patient is large, and it is located in the right upper mediastinum, surrounded by thick nutrient vessels, and seriously adhered to the superior vena cava, innominate vein and trachea. If it is not careful, it will cause intraoperative hemorrhage and damage to important organs such as trachea. "Li Hecheng said:" in the operation, we can only carefully separate the tumor, ligate the blood vessels, separate the boundary between the tumor and the surrounding vascular organs, and finally completely remove the tumor. ". the Department of anesthesiology is always ready. "we have made a careful anesthesia scheme to overcome the difficulty of opening mouth caused by oral diseases, and successfully completed the tracheal intubation smoothly and smoothly with skillful and light operation, and created better operation conditions under the condition of sufficient oxygenation by using one lung ventilation strategy, so that the surgeons can operate more leisurely. "said Hu. the mediastinal diameter of the tumor was 6cm, which was close to and compressed the superior vena cava, trachea and other important tissues. After the operation, the critical care medical team seamlessly connected to ensure Mr. Cheng to pass the postoperative risk period safely. After successful extubation, Mr. Cheng was transferred to the dermatology ward for follow-up treatment. finally, the pathology department of Ruijin hospital confirmed that the mediastinal tumor was a rare paraneoplastic pemphigus associated with Castleman's disease according to the pathological tissue cut during the operation and through complex differential diagnosis. Pan Meng explained: "Castleman's disease is a lymphoproliferative disease with unknown causes. Clinically, Castleman's disease can be divided into focal and multicentric diseases. The former is a single enlarged lymphoid tissue, which is more likely to occur in young people; the latter is multiple site lymphadenopathy with systemic symptoms and multiple system damage, which is mostly in the middle-aged and elderly. at present, it is the most common tumor associated with PNP in China, while most foreign patients are accompanied by non Hodgkin's lymphoma. this tumor is often located in the abdominal cavity or mediastinum. Mr. Cheng is a giant Castleman disease in the mediastinum. early diagnosis and early tumor resection are the key to the successful treatment of the disease. of course, regular follow-up should be carried out after operation to prevent recurrence of tumor! " Director Pan Meng was visiting the specialist clinic. "Since I got sick, I have been very strong in order not to let my parents worry. But at the moment when I woke up after the operation, I cried People who have not experienced this feeling can't understand it. I am very glad that my family and I have found the right place and found this group of medical staff who are fighting with me in the most difficult time! " After the condition is stable, Mr. Cheng said with emotion. behind the trust is the responsibility of doctors' benevolence and the demonstration of Ruijin Hospital's multidisciplinary comprehensive strength. this article is from Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College, editor in charge: Sharon copyright notice. Welcome to forward friends circle - end - click to read the original text, participate in the activities of rice dumpling dismantling, and more and more awards are waiting for you!