醫(yī)療劇《豪斯醫(yī)生》助醫(yī)生確診疑難病例

醫(yī)療劇《豪斯醫(yī)生》助醫(yī)生確診疑難病例

By a strange coincidence, two leading medical journals on Thursday published case studies of the same arcane medical mystery. In one, doctors solved the riddle only after the patient, a middle-aged woman, got so sick she had to have a heart transplant. But in the other, a physician who teaches at the University of Marburg in Germany found the clues in Season 7, Episode 11, of the Fox television show “House.”

上周四，兩份主要的醫(yī)學(xué)期刊出于某種離奇的巧合，刊發(fā)了兩篇關(guān)注同一種醫(yī)學(xué)謎題的病例研討。在一個病例中，醫(yī)生們是在中年女病人病情嚴重，需要接受心臟移植后，才得以解決迷團。而在另一個病例中，一位在德國馬爾堡大學(xué)(University of Marburg)執(zhí)教的醫(yī)生從?？怂闺娨暸_(Fox)劇集《豪斯醫(yī)生》(House)第7季第11集中得到了線索。

It turned out that Dr. Gregory House, the cantankerous, fictional diagnostician modeled on Sherlock Holmes, had used his powers of deduction to diagnose the very same ailment in a woman played by the actress Candice Bergen on an episode that first aired in 2011.

劇中的格里高利·豪斯(Gregory House)是位以夏洛克·福爾摩斯為原型的診斷專家，為人刁鉆，在2011年首播的這集電視劇中，他通過排除法為一位由坎迪斯·伯根(Candice Bergen)飾演的女病人確診病情，而德國的這位醫(yī)生發(fā)現(xiàn)，他的病人患上的恰恰是同一種疾病。

In this case of life imitating art — or at least television — a paper in The Lancet, a London-based medical publication, described how an ailing man in Germany had gone from doctor to doctor, seeking a diagnosis as his condition worsened.

這篇發(fā)表在《柳葉刀》(The Lancet，總部設(shè)在倫敦的醫(yī)學(xué)期刊)的報告講述了一個現(xiàn)實生活效仿藝術(shù)——或者說是電視——的病例：一位德國男性病人遍尋名醫(yī)，病情不斷惡化，卻遲遲得不到確診。

His problems began about three years ago. He had low thyroid hormone levels, inflammation of his esophagus and fever of unknown origin. His loss of vision was so profound he was almost blind, and his loss of hearing so severe he was almost deaf. Most perilous of all, his heart had weakened so much it could not pump hard enough to supply blood to his body.

他的問題始于三年前。他的甲狀腺激素水平很低，食道發(fā)炎，毫無來由地發(fā)燒。他的視力嚴重下降，到了近乎全盲的程度，同時聽力嚴重受損，幾乎全聾。最危險的情況在于，他的心臟出現(xiàn)了嚴重衰竭，無法把血液泵送到全身。

Heart failure usually follows coronary artery disease, but this man’s arteries were fine. Doctor after doctor was stumped.

心臟衰竭通常是因冠狀動脈疾病而引起的，但這位病人的動脈狀況良好。醫(yī)生們接二連三地敗下陣來。

Finally, in May 2012, the man, then 55, arrived at a University of Marburg clinic run by Dr. Juergen R. Schaefer, who specializes in puzzling cases and happens to be a major fan of “House.” In fact, Dr. Schaefer uses “House” in teaching medicine, and he realized his patient’s symptoms were eerily similar to those of Ms. Bergen’s character on the show. In that episode, she, too, had heart failure. Dr. House’s diagnosis: cobalt poisoning from her artificial metal hip.

終于，到了2012年5月，這位當時55歲的男性病人來到馬爾堡大學(xué)診所，診所主管是擅長解決疑難雜癥的于爾根·舍費爾(Juergen R. Schaefer)醫(yī)生，而他碰巧是《豪斯醫(yī)生》的忠實粉絲，甚至在平時教授醫(yī)學(xué)課時會拿這部電視劇為教材。他意識到病人的癥狀跟劇集中伯根女士扮演的角色像得出奇。在這一集中，她同樣出現(xiàn)了心臟衰竭。而豪斯醫(yī)生的診斷是：由人造金屬髖關(guān)節(jié)而引發(fā)的鈷中毒。

Dr. Schaefer’s patient had had an artificial ceramic hip that failed, and it was replaced with a metal one in November 2010, shortly before his symptoms began. So Dr. Schaefer tested the man’s cobalt level and discovered it was a thousand times the level considered normal.

舍費爾醫(yī)生的這位男性病人曾移植過陶瓷人造髖關(guān)節(jié)，但手術(shù)未能成功，2010年11月?lián)Q成了金屬髖關(guān)節(jié)，不久后癥狀開始出現(xiàn)。于是舍費爾檢查了這位病人血液中的鈷含量，結(jié)果發(fā)現(xiàn)比正常水平高出了1000倍。

A scan showed the metal in his hip was eroded. The reason, Dr. Schaefer speculated, was that when the man’s doctor removed the broken ceramic hip, he inadvertently left behind tiny particles of ceramic. Those particles, Dr. Schaefer said, acted like sandpaper: “You destroy the metal part with each movement.”

掃描結(jié)果顯示，他髖關(guān)節(jié)中的金屬受到了侵蝕。舍費爾推測認為，當手術(shù)醫(yī)生移除了破裂的陶瓷髖關(guān)節(jié)時，不小心留下了一些陶瓷碎片。舍費爾說，這些小碎片就像是砂紙那樣：“每活動一下，都會磨損金屬部分。”

The man had his metal hip replaced with another ceramic one, after which his cobalt level plunged. His heart function improved, but he still needed a defibrillator implanted. His fever and esophagus problems went away. But his hearing and eyesight barely got any better.

于是這位病人又接受一次手術(shù)，將金屬髖關(guān)節(jié)重新?lián)Q成陶瓷關(guān)節(jié)，此后他體內(nèi)的鈷水平急劇下降。他的心臟功能得以改善，但仍需要植入起搏器。發(fā)熱和食道問題消失了。但聽力和視力幾乎沒有一點好轉(zhuǎn)。

Needless to say, the doctors in the other case, published in The New England Journal of Medicine, had not seen that episode of “House.”

不消說你應(yīng)該也能猜得出，發(fā)表于《新英格蘭醫(yī)學(xué)期刊》(The New England Journal of Medicine)的另一個病例，主管醫(yī)生們沒看過《豪斯醫(yī)生》劇集。

The patient, a woman in Denver who asked not to be named to protect her privacy, said she began feeling ill on a vacation in Hawaii a few years ago.

病人是位住在丹佛的女性，為保護隱私要求不透露她的姓名，她介紹說，自己是在幾年前去夏威夷度假時，開始感覺到身體不舒服的。

“I was tired all the time,” she said. When she returned from her travels, she discovered she had gained 10 pounds on her 4-foot-10, 95-pound frame, for no apparent reason. Her abdomen was swollen, as were her arms and legs.

“我老是覺得累得不行，”她說。結(jié)束旅行回家時，她發(fā)現(xiàn)自己1.47米高、43公斤重的纖細身材毫無來由地一下子重了4.5公斤。她的小腹和四肢都出現(xiàn)浮腫。

Her doctor ordered a CT scan, which showed fluid accumulating around her heart. He drained the fluid, but she still felt ill. Normally, someone with such a condition, cardiomyopathy, has an enlarged heart, but hers was a normal size.

她的醫(yī)生安排了一次CT掃描，發(fā)現(xiàn)心臟周圍出現(xiàn)積水。積水抽除后她還是不舒服。通常出現(xiàn)這種心肌癥的人心臟都會變得肥大，但她的心臟大小很正常。

“It was kind of a puzzle to my first cardiologist,” she said.

“對于我的第一位心臟病醫(yī)生來說，這真是個謎題，”她說。

By 2011, her heart was failing. She went to the Anschutz Medical Campus of the University of Colorado, Denver, where her doctor, Larry A. Allen, a heart failure and transplant specialist, confessed he was baffled.

到了2011年，她的心臟快不行了。她去了位于丹佛的科羅拉多大學(xué)(University of Colorado)的安舒茨醫(yī)學(xué)院，這次她的醫(yī)生是心臟衰竭和移植權(quán)威拉里·亞倫(Larry A. Allen)，他承認，自己當時完全沒招了。

“We did a work-up looking at possible causes and even rare causes,” he said. “Nothing showed up.”

“我們做了各種檢查，考慮了所有可能的原因，甚至各種罕見病，”他說，“可還是查不出原因。”

On Sept. 10, 2011, she underwent a heart transplant.

2011年9月10日，病人接受了心臟移植手術(shù)。

Sometime later, the orthopedist who had replaced her hips with metal implants took some routine blood tests and found something curious. Her cobalt level was more than 300 times normal. Cobalt poisoning can seriously damage organs, particularly the heart. The cause of her problems was suddenly clear.

過了段時日，曾為她做過金屬髖關(guān)節(jié)置換手術(shù)的骨科大夫要給她進行例行血檢，結(jié)果發(fā)現(xiàn)了些奇怪的問題。她血液中的鈷含量比正常值高了300倍。鈷中毒可嚴重傷害內(nèi)臟器官，尤其是心臟。她身上出現(xiàn)的各種離奇問題一下子有了個清晰的答案。

About a year after her heart transplant, she had both artificial hips replaced with ones that had a polyethylene liner. Her postoperative course was rocky, but her cobalt level declined.

心臟移植一年后，她的兩個人造金屬髖關(guān)節(jié)都換上了聚乙烯墊片。術(shù)后她的恢復(fù)過程起起伏伏，不過鈷水平降了下來。

“I have much of my old energy back,” she said in an interview.

“我覺得自己又漸漸恢復(fù)了活力，”在采訪中她說。

In their article describing the case, Dr. Allen and his colleagues wrote that cobalt poisoning was first described in the 1960s in people who had been drinking beer that had foam stabilizers that contained cobalt.

亞倫醫(yī)生和同事們在這篇病例報告中介紹說，鈷中毒首次被人提出，是在20世紀60年代，當時人們喝的啤酒中有含鈷的泡沫穩(wěn)定劑。

But its link to metal-on-metal hip implants leaves questions, they said. Their patient had nothing obviously wrong with her prosthetic hips. And, Dr. Allen said, “literally tens of thousands of people had these hips without her problems.”

但他們在文中說，鈷中毒跟金屬對金屬(metal-on-metal)髖關(guān)節(jié)假體聯(lián)系在一起，仍然讓人們心存疑問。這位病人的人造髖關(guān)節(jié)看來并沒有明顯的問題，而且亞倫醫(yī)生說，“有上萬人植入了類似的髖關(guān)節(jié)，但沒有出現(xiàn)她這樣的問題。”

But Dr. Allen said the patient’s case was a good reminder. However rare cobalt poisoning might be, it is something to consider when people with metal-on-metal hip implants have symptoms suggestive of it.

不過亞倫醫(yī)生也說，這位病人的病例可以起到很好的提示作用：不管鈷中毒有多么罕見，如果病人在植入金屬對金屬髖關(guān)節(jié)假體后，出現(xiàn)了相關(guān)的癥狀，就有必要考慮這種可能性。

And, yes, he said, maybe if he had just seen Dr. House in action he would have considered it.

同時他也說，如果他看到了豪斯醫(yī)生的診治過程，肯定會早點考慮這個診斷的。

“Unfortunately,” he said, “I have seen about two half-episodes of ‘House.’ ”

“不巧的是，我統(tǒng)共就看過兩集《豪斯醫(yī)生》，而且每集只看了一半，”他說。