Liu Tonghua: Pathology is inseparable from clinical

　[Listen to the doctor]

　Pathology is the process and principle of the occurrence and development of diseases. This discipline has always been regarded as a "bridge discipline" between basic medicine and clinical medicine.

Liu Tonghua is a well-known pathologist. He is good at diagnosis of lymph node pathology, digestive tract disease pathology, endocrine pathology, etc. He has conducted in-depth and systematic research on experimental gene therapy of pancreatic tumors, especially pancreatic cancer, and carried out molecular biology and endocrine tumors. Molecular genetics research.

She works with a microscope and a magnifying glass to diagnose difficult cases with "fire eye and golden eye".

　Academician Liu Tonghua focused her entire life on a small glass slide, challenged each "turbulent sea" with great wisdom and courage, and naturally divided the "good and evil" at the two ends with her eyes and eyes. Her diagnosis opinion was hailed as the national pathological diagnosis. "gold standard".

　　At that time, there was a saying in the pathology circle called "Southern Liangbeihu", with Liang Boqiang in the south and Hu Zhengxiang in the north. Later, when I went to Xiehe, I was directed at Professor Hu Zhengxiang.

In 1957, I went to the Department of Pathology of Union Medical College as a teaching assistant.

Professor Hu told me that you should watch the film carefully, and you should watch it comprehensively from beginning to end.

Scan the entire slide under the microscope, scan it with a low-power lens, see clearly what is wrong, and then use high-power to look at it, then low-power, high-power, back and forth, carefully.

Otherwise, take a film for you, take a microscope and put it on, grab a little, you can only see a little, and you don't see important lesions in other places.

　　At that time, the pathology business of the hospital was managed by the Department of Pathology of the Medical College.

Once I was bold enough and ran to the hospital to find Professor Zhang Xiaoqian and Professor Zeng Xianjiu and said that I would like to do pathology in the hospital. Would you welcome it?

They were very welcome, so I came over with two old technicians.

Later, the two old technicians all left one after another and came to Wang Detian.

At that time, the conditions were difficult, and I became a technician and a doctor.

At that time, there was no money to buy a cover glass, so the cover glass on the old glass slide was melted with an alcohol lamp, and it was melted down, and then the glue on it was soaked with alcohol, washed and used again.

Wang Detian and I started from nothing, and finally built the pathology department.

Although I worked hard during that time, I felt very happy because I was finally with the clinic.

　　I think pathology is inseparable from clinical.

Only doing theoretical research on pathology without combining it with clinical practice is not called clinical pathology. There are many problems that I slowly figured out after I arrived in the clinic.

I remember that in the old building, No. 10, Room 223, there were often seminars, clinical pathology discussions on autopsy, or external pathology discussions. The clinical doctor talked about it before, and the pathologist went in to announce the final results after talking about it.

This is very useful, because many clinical conditions may not be diagnosed before death, and can only be known after an autopsy after death.

Whether the diagnosis before death is consistent with the results of the autopsy after death can explain the level of the doctor.

All departments in the hospital love to participate in this discussion, and clinical doctors want to hear what the patient's final result is.

　　The first thing I did was pancreatic cancer, pancreatic tumor, and insulinoma, because at that time, I worked with Chen Minzhang and Professor Zeng Xianjiu. Professor Zeng’s focus was on the pancreas and insulinoma.

　　In the external examination, I think some cases are still meaningful. For example, I did a study on lymph nodes with Professor Zhang Zhinan of the internal medicine and blood group. Such lymph nodes were previously diagnosed as lymphomas. Many patients received radiotherapy and chemotherapy.

Later, we analyzed together. I watched the film carefully and felt that it was different from lymphoma. The main reason was that many tissue cells were necrotic like debris.

We used to think that necrosis in the lymph nodes is malignant. In fact, some necrosis is just a viral infection or the result of an infection reaction. It is equivalent to a disease. After a while, it will heal by itself. Without treatment, it will slowly recover by itself. Up.

We followed up some patients with a particularly good prognosis, so we concluded that it was reactive hyperplasia.

　　A British professor named Morson said that the Chinese only have tuberculosis, not Crohn's disease.

I don’t believe it, and Professor Pan Guozong of the Department of Gastroenterology took out all the specimens that I had saved before. I looked for it from the specimen file. He looked for it from the clinic and checked more than 60 cases, except for all tuberculosis. More than 40 cases did not have any tuberculosis lesions or lesions, but the lesions were the same as Crohn's disease, and the morphology was completely consistent. It has not been reported in China, so I wrote an article.

Later when Professor Morson visited the hospital, I showed him the specimen.

　　Director Zeng Xianjiu mainly deals with islet cell tumors. Most islet cell tumors are benign and some are malignant.

This islet cell tumor looks like a lymph node, and it is often unclear on the operating table which is the tumor and which is the lymph node.

I came back after studying fine needle aspiration in Sweden and found that after the puncture smear, lymphocytes and islet cells can be clearly seen, so there is no need for biopsy to make a section. It is easy to know which islet cell is after the puncture.

　　Professor Chen Minzhang is under Professor Zhang Xiaoqian. I know him very well because he is about the same age, so we can say that we are alumni.

After the endoscope came, I worked with him to study how to get a piece of real diseased tissue.

While looking at the pathological slices and studying with him under the endoscope, I found that this material was very problematic.

For example, gastric ulcers. If you just take the surface, it may be necrotic, because the surface of the ulcer is necrotic, but you need to take it deeper and dig a little inside. The place may be a granulation or it may be taken out. The cancer is there.

So I feel that being with the clinic is especially helpful.

If pathology is not together with the clinic, you can't dynamically observe a patient, and you can't get accurate judgment results.

　　My motto is perseverance. No matter what difficult case I encounter, I always want to use various methods to finally diagnose it.

When encountering difficult cases, I have to look up textbooks first.

Some students who went abroad asked me what to bring me back, and I said you brought me a book.

I also often go to the library to borrow magazines, such as "Surgical Pathology" and "Modern Pathology".

I used to have some small cards. When I saw good documents, I wrote down the topics and put them in the box, and sorted them briefly. I would check the cards whenever I needed them in the future.

　　Pathology has developed into molecular pathology at this stage. What should be done next is to move forward with clear goals.

I hope young people do the same, look forward and move forward.

In addition, I hope that the clinical departments and auxiliary departments can work closely together to do their own work.

If everyone can cooperate sincerely with each other in this way, they will develop better.

　(Compiled by our reporter Tian Yating)