"Boss, you violate the aseptic principle!"


    "Bellac, recite the aseptic principle of the operating room to me." Wu Mian squatted on the ground and said in a muffled voice.


    "First, the operator''s back below the waist, above the shoulder and below the operating table should be regarded as a bacterial zone and should not be touched."


    "Second..."


    "Third..."


    "Eighteenth, if the operator needs to change the position, he should first step back, and then turn back-to-back to another position. If he needs to change to the opposite side, he needs to move from the left side of the instrument table to the opposite side."


    "Tell me, which aseptic principle did I violate? Did you imagine it out of thin air? Or did you feel uncomfortable without knocking you with hemostatic forceps for a few days." Wu Mian put down the aseptic list of the patient''s feet, stood up and asked, "what disease do you think?"


    "Er... Intestinal perforation, acute peritonitis," replied professor beilac.


    "How did you get here?"


    "Ulcer."


    "How did the ulcer come from?" Wu Mian asked, looking at professor beilac''s operation. He didn''t want to brush his hands on the stage.


    "According to the brain gut axis theory, it is generally believed that after the cerebral cortex receives adverse external stimulation, it leads to the spasm of intestinal wall blood vessels and muscles, the dystrophy of intestinal wall cells and the reduction of the resistance of intestinal mucosa, resulting in the formation of ulcer due to the easy digestion of intestinal mucosa by digestive juice."


    Professor beilac has solid basic skills. Wu Mian answers whatever he asks without hesitation.


    "What you''re talking about is mainly duodenal ulcer, not colonic ulcer." Wu Mian squinted at professor beilac''s operation, just said his condition and didn''t raise any objection to the operation process.


    "Boss, you must have a definite diagnosis. What is it?" Professor beilac asked when he was familiar with Wu Mian.


    "Tell me why you called me." Wu Mian did not answer, but continued to ask Professor beilac.


    "When I checked the patient, I thought it was wrong. He had too many red spots and papules! Boss, when I first saw it, I felt that the patient was inhabited by aliens, which would lead to body surface symptoms."


    "Don''t be ridiculous. It''s Chinese. You can''t joke about it." Wu Mian said faintly. "Your first intuition is very sharp. The source of the patient''s intestinal disease is really related to the red spots and papules on the skin surface."


    "Praise the great beilac!" Professor beilac looked intently at the opposite screen and skillfully operated endoscopic equipment to remove the intestines. But his tone of voice was extremely excited, and his language and action were separated, as if he were two very different people.


    "I guessed!"


    "No, I guessed it. At that time, you just said that the patient was inhabited by aliens, but what I thought was wrong, so I called the boss."


    "How could it be that you were..."


    The two belacs quarreled.


    "Shut up, this is the third time I''ve said it." Wu Mian said, "has the scope of resection been determined?"


    "Boss, I personally went to the endoscopy room to see the whole enteroscopy record. Only 34cm of intestine can be removed."


    "It''s still too long. Just sew the point of intestinal rupture."


    "My God! Are you crazy, boss!" Professor bellac said in surprise. "Didn''t you see the colonoscopy? The patient''s colonic ulcer is so heavy that I doubt whether there will be cancer. No, it''s not whether there will be cancer, but there is cancerous tissue."


    "Bellac, do you doubt the boss''s judgment? Is it true that wearing protective clothing for emergency surgery every day makes you suffer from cerebral ischemia and hypoxia, leading you to forget the words of the boss in the medical group?"


    "No, I insist that part of the intestine needs to be removed. 34cm is the shortest way I can think of. If it is less, the patient will continue to relapse after operation."


    "Bellac, no need," said Wu Mian. "The patient''s diagnosis is malignant atrophic papulosis. Of course, it''s a preliminary diagnosis. To determine the diagnosis, you should remove a piece of epidermal tissue after the operation. I can''t get a conclusion until I see it under the microscope."


    "Malignant atrophic papulosis? Is it skin cancer?"


    "Bellac, that''s it? You deserve to call yourself a top expert in the world? I think you need to go back to Massachusetts Medical School to study again for another five years. It''s hard to imagine that your basic knowledge is weak to this extent." Wu Mian said coldly.


    Zheng Kaixuan was sweating when Wu Mian said so.


    He and Professor beilac believe that malignant atrophic papulosis is a skin disease, which has nothing to do with intestinal ulcer.


    It seems that Mr. Wu is too polite to himself... Zheng Kaixuan has no choice but to think of it.


    "Boss, do you believe that no one in Massachusetts except dermatologists will know the existence of malignant atrophic papulosis?!" Professor bellac argued.


    "You don''t know. Do you want to make a bet? I''ll call now. If anyone knows, you..."


    "Oh, no! Only those blue pools in Cleveland will bet with you!"


    "Sew it, rinse it, and the operation is over. By the way, don''t forget to cut a pathological specimen, and I''ll freeze it during the operation."


    "What about the patient?"


    "Go back to the ward and I''ll talk to the doctor about the next treatment plan," Wu Mian said.


    "It''s amazing, boss. What is malignant atrophic papulosis? Why does maculopapular rash lead to intestinal problems?"


    "This is a kind of skin intestinal or other organ small artery intima inflammation followed by thrombosis. There is no definite evidence of pathology and gene, but the diagnosis is no problem, and there are relevant clinical treatment standards."


    "Boss, you are so knowledgeable!"


    "You know too little. I remember three years ago, specifically on October 22, 2017, Tom''s medical team treated a patient with a typical malignant atrophic papulosis. I told Tom at that time, but he insisted on cutting off an 80cm intestinal tract."


    "I remember that the patient died later! Poor little fellow, he was only 22 years old."


    "The cause is still unknown. Some people think it is related to autosomal dominant inheritance, abnormal autoimmunity, decreased fibrinolytic activity and lentivirus infection. Tom doesn''t think what I said is right, so he rejected my opinion, that hateful guy!" Wu Mian said flatly, "but he can be misdiagnosed. You can''t. you are a member of my medical team."


    "Boss, are you sure?"


    "It is confirmed that this disease can be divided into cutaneous malignant atrophic papulosis and systemic malignant atrophic papulosis.


    The skin type accounts for about 13. It only shows skin lesions without systemic lesions and can survive for more than 14 years. Systemic malignant atrophic papulosis often involves multiple system organs within weeks to years after the rash, with a high mortality rate. "


    "Therefore, try to make patients less hit by surgery, which is very good for future recovery."