『The illness is very rare. Though they have tried, doctors at the best hospitals in Beijing cannot cure her; may do not even know what illness it is.』
沒有做出正確診斷並不代表不知道朱令的病是什麼。從協和神經科的角度出發。當時醫生們的診斷是確定的。作為第一診斷的急性播散性腦脊髓炎是自身免疫性疾病。作為第二診斷紅斑狼瘡,還有被放棄的入院診斷「格林巴利綜合征」都是指向自身免疫性疾病。貝志城所謂『do not even know what illness it is』,『不能診斷她是什麼疾病』,都是一個意思:協和醫院給朱令的診斷是錯誤的。
急性播散性腦脊髓炎(ADEM)是協和醫院在在明確鉈中毒診斷前,經過大會診討論確定的臨床診斷。在求救信中貝志城提到了這個診斷『acute disseminated encephalomyelitis(ADEM)』。但是後面有一句話:『but the data from the tests do not support this conclusion. 』。
全科大討論是必須在病歷記錄在案的,無論是作為醫生的個人意見還是作為權威上級醫師的總結性發言,都必然要說明診斷的支持點和不支持點。在實驗室檢查結果不支持的情況下,依然作出急性播散性腦脊髓炎(ADEM)的診斷。專業表述應該是「檢查結果不排除診斷」(the data from the tests do not rule out this diagnosis),而建立診斷的依據是根據患者的總體臨床表現。只有當主流意見否認某種診斷時,才會使用「檢查結果不支持診斷」。『but the data from the tests do not support this conclusion. 』這句話可以基本肯定不是照抄病歷,而是貝志城自己天才的判斷。以此證明他認為協和醫院診斷錯誤是有實驗室依據的。
This is Peking University in China, a place those dreams of
freedom and democracy. However, a young, 21-year old student has
become very sick and is dying. The illness is very rare. Though they
have tried, doctors at the best hospitals in Beijing cannot cure her;
may do not even know what illness it is. So now we are asking the
world -- can somebody help us?
Here is a description of the illness:
The young woman -- her name is Zhu Ling -- is a student in the
chemistry department. On DEC. 5, 1994, Zhu Ling felt sick to her
stomach. Three days later, her hair began to fall out and within two
days she was completely bald. She entered the hospital, but doctors
could not discover the season for her illness. However, after she was
in the hospital for a month, she began to fell better and her hair
grew back. Zhu Ling went back to school in February, but in March her
legs began to ache severely, and she felt dizzy. She entered XieHe
Hospital - Chinese most famous hospital. In early March and on March 15,
her symptoms worsened. She Began to facial paralysis, central muscle
of eye's paralysis, self-controlled respiration disappeared. So she
was put on a respirator.
The doctors did many tests for many diseases(include anti-H2V,
spinal cord puncture, NMR, immune system, chemical drug intoxication
ANA,ENA,DSONA,ZG and Lyme), but all were negative, except for Lyme
disease(ZGM(+)).
The doctors now think that it might be acute disseminated
encephalomyelitis(ADEM) or lupus erythematosus(LE), but the data from
the tests do not support this conclusion.
The doctors are now treating Zhu Ling with broad-spectrum
antibiotic of cephalosporin, anti-virus drug, hormone, immun-oadjuvent,
gamma globulin intravenous injection and have given her plasma
exchange(PE) of 10,000 CCs. But Zhu Ling has not responded -- she
reamers in a vegetative state, sustained by life support.
If anyone has heard of patients with similar symptoms -- or
have any ideas as to what this illness could be, please contact us. We
are Zhu Ling's friends and we are disparate to help her.
This is the first time that Chinese try to find help from
Internet, please send back E-mail to us. We will send more crystal
description of her illness to you.
Thank you very much
Peking University
April 10th, 1995
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Please foreword this message to your freinds if you think they can
helpus ,Thanks advanced!