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1、临床医学英语Chapter 1 Patient-Physician Interaction Page 1第一章 医患沟通 第页The patient-physician interaction proceeds through many phases of clinical reasoning and decision making.proceed 进行、开展 reasoning 推论、推理 clinical reasoning 诊断clinical decision 确定治疗方案 making decision 做出决定医患沟通在临床诊断和治疗决策的许多时期进行着。The interacti
2、on begins with an elucidation of complaints or concerns, followed by inquiries or evaluation toaddress these concerns in increasingly precise ways.elucidation 说明、阐明 inquire 询问、调查 evaluation 评估、评价这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、评估不断精确地确定这些问题。The process commonly requires a careful history or physical exa
3、mination, ordering of diagnostic tests,integration of clinical findings with the test results, understanding of the risks and benefits of the possiblecourses of action, and careful consultation with the patient and family to develop future plans.integration 综合 consultation 磋商、会诊这个过程通常需要细致的询问病史和体格检查，
4、 开具诊断性化验医嘱，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，然后与病人及家属反复磋商以完善治疗方案Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process sothat benefit is maximized,while respecting individual variations among different patientsrespecting 注意到、关系、说到 evidence-based medicine
5、 循证医学尽管考虑到不同病人中个体差异是存在的，但医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化。The increasing availability of randomized trials to guide the approach to diagnosis and therapy should not beequated with cookbook medicineavailability可利用性， 可得到 randomize 随机的cookbook 食谱，烹调书 approach 接近但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作烹调书使用。
6、Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specificcharacteristics.Evidence 证据，迹象 guideline指导方针 emphasize 强调那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人而来的。Substantial clinical judgment is required to determine whether the evidence and guidelines apply to
7、individualpatients and to recognize the occasional.substantial clinical 真实的，实在的 individual 个体 occasional 偶尔的，特殊的实际的临床判断需要确定这些临床表现和诊断依据标准是否能应用于普通病人的个体，并能找出例外。Even more judgment is required in the many situations in which evidence is absent or inconclusive.inconclusive 不确定性，非决定性在许多情况下，临床表现缺乏或不典型，甚至需要考
8、虑得更多。Evidence also must be tempered by patients preferences, although it is a physicians responsibility toemphasize when presenting alternative options to the patient.1临床医学英语temper 脾气，调音 preference 偏爱 presenting 提出 alternative 可选择的，二选一虽然医生喜欢提出选择性问题让病人回答，但病人肯定会根据自己的倾向调节临床症状。The adherence of a patient
9、 to a specific regimen is likely to be enhanced if the patient also understands therationale and evidence behind the recommended option.adherence 坚持、固执 regimen 养生法、食物疗法enhance 提高、加强 rationale 基本原理假如还懂得所提供问题的基本原理和表现，有特殊生活方法病人的固执容易强化这种倾向To care for a patient as an individual, the physician must unders
10、tand the patient as a person.care for 喜欢、照料为了把病人作为一个个体进行治疗，医生必须理解病人是一个人（不是一群人）。This fundamental precept of doctoring includes an understanding of the patients social situation, family issues,financial concerns, and preferences for different types of care and outcomes, ranging from maximumprolongatio
11、n of life to the relief of pain and suffering.precept 训戒 doctoring 行医 prolongation 延长这个最基本的行医原则包括了解病人的社会地位， 家庭问题，资金状况以及正确理解病人对不同治疗方法、 不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和症状。Even as physicians become increasingly aware of new discoveries, patients can obtain their own informationfrom a variety of sources, so
12、me of which are of questionable reliability.questionable 可疑的、成问题的、不可靠的 reliability 可靠、可信赖的甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种途径得到他们的信息，某些信息是不可靠的。The increasing use of alternative and complementary therapies is an example of patients frequentdissatisfaction with prescribed medical therapy.alternative 选择，替代
13、 complementary 补充的、相配的 prescribe 规定、指定、开处方不断增加的替代疗法和辅助疗法的应用就是病人对常规疗法经常不满意的一个例子。Physicians should keep an open mind regarding unproven options but must advise their patients carefully ifsuch options may carry any degree of potential risks, including the risk that they may relied on to substitute forp
14、roven approachessubstitute 代替、代用 rely on 依赖、信任医生对新疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。It is crucial for the physician to have an open dialogue with the patient and family regarding the full range ofoptions that either may considercrucial 严酷的、决定性的 either 两者任一对医生来说，对病人及家属
15、开诚布公地介绍所有可考虑的治疗选择，是非常重要的。The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medicalcare and pubic health.vacuum 真空 extensive 广阔的、大量的医生不是生存在真空中，而是作为一个复杂而庞大的医疗和公共健康体系中的一部分。In premodern times and even today in some developing countries, basic hygiene, c
16、lean water, and adequatenutrition have been the most important ways to promote health and reduce disease.2临床医学英语adequate 足够的、恰当的在未发达时代，甚至当今在一些发展中国家， 基本卫生条件、清洁饮用水和最低营养保障是促进健康的最重要方法。In developed countries, the adoption of healthy lifestyles, including better diet and appropriate exercise, arecornorsto
17、nes to reducing the epidemics of obesity, coronary disease, and diabetes.adoption 采纳、采用 epidemic 流行、传染在发达国家中，健康的生活方式包括良好饮食和适当锻炼，是减少肥胖、冠心病和糖尿病的基础。Public health interventions to provide immunizations and to reduce injuries and the use of tobacco, illicit drugs,and excess alcohol collectively can produ
18、ce more health benefit than nearly any other imaginable healthintervention.illicit 非法的、违禁的 collectively 全体地、共同地 produce 生产、创造公共健康干预如进行疫苗接种、减少损伤、减少吸烟、减少吸毒、减少酗酒等措施共同产生的健康效果比几乎可想象的任何其它健康干预措施都要好得多。Chapter Vital signs Page 15第六章 生命体征 第页A nurse or assistant often obtains the vital signs.护士或护士助手经常可得到生命体征Tr
19、aditionally the vital signs include pulse rate, blood pressure, respiratory rate, and body temperature.传统的生命体征包括脉搏（率）、血压、呼吸（频率）和体温。More recently, advocates of various causes have advocated for a fifth vital sign.advocate 提倡、主张最近，人们以多种理由提出 第五生命体征的建议。The most cogent of these new vital signs is the pat
20、ients quantitative assessment of pain.cogent 今人信服的，切实的，有力的这些新的生命体征中，最今人信服的是病人疼痛的定量评判。The pulse should be recorded as not just the rate but also the rhythm.脉搏不仅要记录频率，而且要记录节律。Physicians may prefer to initiate the examination by holding the patients hand while palpating the pulse.initiate 开始，创始医生喜欢握住病人
21、的手，触摸脉搏，开始检查。This nonthreatening initial contact with the patient allows the physician to determine whether the patient has aregular or irregular rhythm.这个对病人无威胁性的最初接触让医生确定了脉搏是否具有节律性。When the blood pressure is abnormal, many physicians repeat the measurement.当测得的血压不正常，许多医生重复这个测量。The instrument error
22、 that contributes to the greatest variability is the cuff size of the sphygmomanometer.variability 变化，易变性 sphygmomanometer 血压计变异性中占比例最大的设备误差是血压计袖套的大小。Many adults require a large-size adult cuff; using a narrow cuff can alter systolic/diastolic blood pressure by -8to +10/+2 to +8mmHg.3临床医学英语mmHg: mil
23、limeter of mercury许多成人需用大号的成人袖套，如果使用窄袖套能够影响收缩压-810mmHg ，舒张压 28mmHg。The appearance of repetitive sounds (Korotkoff sounds, phase 1) constitutes the systolic pressure.constitute 构成，设立，指定重复脉搏音（Korotkoff 音，第相）的出现定为收缩压。After the cuff is inflated about the palpated pressure, the Korotkoff sounds muffle an
24、d disappear as pressure isreleased (phase 5).inflate 充气、膨胀 muffle 含糊不清当袖套充气压力约在可触摸脉搏压力的2030mmHg 上方，Korotkoff 音变钝，当压力释放， Korotkoff 音消失（第相）。The level at which the sounds disappear is the diastolic pressure.声音消失的水平就是舒张压The American Heart Association recommends that each measure should be rounded upward
25、 to the nearest2mmHgbe round up to the nearest whole number取最近的整数美国心脏病协会建议每次测量取最近的mmHg 整数。The respiratory rate should be assessed at the same time the patient is observed to determine whether there isany respiratory discomfort (dyspnea).dyspnea 呼吸困难测量呼吸频率的同时要观察病人以确定是否存在呼吸困难。The subjective sensation
26、of dyspnea is caused by an increased work of breathing.subjective 主观的呼吸困难的主观感觉是由于呼吸功增加起的。The examiner should decide whether patients have tachypnea (a rapid rate of breathing) or hypopnea (a slowor shallow rate of breathing).tachypnea 呼吸急促 hypopnea 呼吸减弱检查者要确定病人是否存在呼吸急促（呼吸频率快）或呼吸减弱（呼吸频率慢或浅）Tachpnea i
27、s not always associated with hyperventilation, which is defined by increased alvealar ventilationresulting in a lower arterial carbon dioxide level.hyperventilation 换气过度 resulting in 导致、引起呼吸急促不是都伴有过度换气，过度换气的定义是肺泡通气量增高引起动脉血二氧化碳水平降低。In the evaluation of patients suspected of having pneumonia, examiner
28、s agree on the presence of tachypneaonly 63% of the time.agree on 对取得一致意见对一组疑为肺炎患者的评估中，检查者认为当时呼吸急促的出现率仅为63%。The body temperature of adults usually is measured with an oral electric thermometer.成人体温通常用口腔电子体温计测定。These thermometers correlate well with the traditional mercury thermometer and are safer t
29、o use.mercury 汞这种体温计与传统的汞体温计高度相关，使用安全。4临床医学英语Rectal thermometers reliably record temperatures 0.4 higher than oral thermometers.直肠体温计可靠地记录了高于口表0.4的温度。By comparison, newer tympanic thermometers may vary too much compared with oral thermometers (-1.2 to +1.6 versus the oral temperature) to be reliable
30、 among hospitalized patients.tympanic 鼓膜的、鼓室的 too much to be 太以致于不相比较，新型的鼓式体温计相对口表可能误差太大（与口表相差-1.21.6 度），不宜用于住院病人。Chapter 8 Why Geriatric Patients Are Different Page 20第八章 老年病人的特殊性 第 20 页Older patients differ from young or middle-aged adults with the same disease in many ways, one of which isthe fre
31、quent occurrence of comorbidities and of subclinical orbidities 并存病 subclinical 亚临床的同样的疾病，年龄大的病人在许多方面与青中年病人是有区别的，其中之一是并存病多和亚临床疾病多。As a function of the high prevalence of disease, comorbidity (or the co-occurrence of two or more diseases inthe same individual) is also common.prevalence 流行、普遍 co-occur
32、rence 同时发生作为高发疾病的结果，并存病（两个或更多的疾病在同一个体同时发生）也是多见的。Of people age 65 and older, 50% have two or more chronic disease, and these diseases can confer additiverisk of adverse outcomes, such as mortality.confer 授予、给予 additive 附加的、附属物65 岁以上的老年中，50%患有两种以上的慢性疾病，这些疾病能够增加不利预后的风险，如死亡率。In some patients, cognitive
33、impairment may mask the symptoms of important conditions.cognitive 认知的、认识的 impairment 损害 mask 口罩、假面具、掩饰在一些病人中，认知损害可以掩盖重要病情的症状。Treatment for one disease may affect another adversely, as in the use of aspirin to prevent stroke in individualswith a history of peptic ulcer disease.stroke 中风 peptic ulcer
34、 消化性溃疡对一种疾病的治疗可能加重另一种疾病，例如，对有消化性溃疡病史的病人使用阿斯匹林预防中风。The risk for becoming disabled or dependent also increases with the number of diseases present.disabled 残废的、有缺陷的 dependent 依靠的、依赖的病残或生活不能自理发生的风险也随着并存的疾病数而增高。Specific pairs of diseases can increase synergistically the risk of disability.synergistic 协同
35、的特殊的成对疾病可以协同增加病残的风险。Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability areincreased by three-fold to four-fold with either disease alone, the risk of disability increases 14-fold if both arepresent.arthritis 关节炎有 18%的老年人同时患有关节炎和心脏病，虽然每个疾病可以增加34 倍的病
36、残率，但两个疾病同时存在，可使病残率提高 14 倍。5临床医学英语A second way in which older adults differ from younger adults is the greater likelihood that their diseasespresent with nonspecific symptoms and signs.likelihood 可能性老年与青中年的第二个差异是更容易出现非典型的症状和体症。Pneumonia and stroke may present with nonspecific changes in mentation as
37、the primary symptom.pneumonia 肺炎 mentation 精神作用、心理活动 primary 初始的、首要的、主要的肺炎和中风时可出现非典型意识变化作为主要的症状。Similarly, the frequency of silent myocardial infarction increases with increasing age, as does the proportion ofpatients who present with a change in mental status, dizziness, or weakness rather than typ
38、ical chest pain.silent 沉默的、静止的 proportion 成比例的、相称的同样地，隐匿性心肌梗塞发生频度随着年龄的增大而增加，这些病人相应地频发精神状态改变、眩晕、虚弱而不是典型的胸痛症状。As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases thangenerally would be considered in middle-aged adults.spectrum 谱、光谱因此，老年病人的诊断应考虑更广泛的疾病
39、谱，要超过通常对中年病人所考虑的范围。A third condition that is found primarily in older adults is frailty, frailty is thought to be a wasting syndrome thatpresents with multiple symptoms and signs, including reduced muscle mass, weight loss, weakness, poorexercise tolerance, slowed motor performance, and low physical
40、 activity.primarily 起初、首先、原来 frailty 脆弱、虚弱、意志薄弱tolerance 宽容、忍耐、耐受主要出现在老年人的第三个情况是衰弱，衰弱被认为属于衰竭综合症，它有许多症状和体征中，包括肌肉萎缩、体重下降、虚弱、运动耐受差、动作慢、身体活动少。Some estimates indicate that the full syndrome is found in 7% of community-dwelling people age 65 and older,and in 25%of community-dwelling people age 85 and olde
41、r.estimate 估计、评价、看法 indicate 指出、表时、象征、适应征一些人估计 7%的 65 岁以上社区老人和 25%的 85 岁以上社区老人上述症状全部出现。Many institutionalized older adults also are frail.institutionalized 使成公共团体、将收容在公共设施里frail 身体虚弱的、易损坏的、意志薄弱的许多老人院里的老人也是衰弱的。Frailty is a state of decreased reserve and increased vulnerability to all kinds of stress,
42、 from acute infection orinjury to hospitalization, and may identify individuals who cannot tolerate invasive therapies.reserve 保存、克制 vulnerability 易受伤、易受责难衰弱是对各种压力耐受下降、损害增加的一种状态，从急性感染、损伤到住院治疗，都可以发现一些人不能忍受侵入性诊疗措施。The syndrome of frailty is associated with high risk of falls, needs for hospitalization
43、, disability, and mortality.fall 跌倒、下降 frail 身体虚弱的、易损坏的、意志薄弱的衰弱的症状与易于病倒、需要住院治疗、病残、死亡的高风险是相关的。6临床医学英语There is early evidence that a core component of frailty is sarcopenia, or loss of muscle mass associated withaging, which occurs in 13 to 24% of persons age 65 to 70 and in 60% of persons age 80 and
44、ponent 成分、构成要素 sarcopenia 肌减少（症）、与年龄相关的骨骼肌质量下降衰弱一个主要成分的早期表现是肌肉减少，或说随年龄增长的肌肉减少，它发生在1324%的 6570 岁的老人，60%的 80 岁以上的老人。It is likely that dysregulation of multiple physiologic systems, including inflammation, hormonal status, andglucose metabolism, underlies the syndrome, with resulting decreased ability
45、to maintain homeostasis in theface of stress.dysregulation 失调 homeostasis 内环境稳定多种生理系统易于失调 ，包括炎症、激素状态、糖的代谢，结果是在压力面前保持内环境的稳定的能力下降。Subclinical disease (e.g., atherosclerosis), end-stage chronic disease (e.g., heart failure), or a combination ofcomorbid diseases may precipitate the syndrome.atherosclero
46、sis 动脉粥样硬化亚临床疾病(如动脉粥样硬化), 晚期慢性疾病(如心力衰竭），或多种疾病并存可共同形成症状。Evidence from randomized, controlled trials shows that resistance exercise, with or without nutritionalsupplements, and home-based physical therapy can increase lean body mass and strength in even the frailestolder adults.随机对照试验的迹象显示无论有无营养支持和家庭身
47、体疗法， 即使是最虚弱的老年人， 对抗运动能够增加瘦弱躯体的质量和力量。This evidence suggests that earlier stages of frailty may be remediable, although end-stage frailty likelypresages death.remediable 可挽回的 presage 预兆、预示这个结果提示早期衰弱是可挽回的，尽管末期衰弱常提示死亡。Fourth, cognitive impairment increases in prominence as people age.prominence 突出、显著第四，
48、人们变老时认知损害显著增加。Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization,dependency, institutionalization, and mortality.immobilization 活动能力减少 institutionalization 制度化、专门照料认知损害是大量不利结果的风险因子，包括摔倒、活动能力下降、不能自理、需住老人院护理、死亡。Cognitive impairment complicates d
49、iagnosis and requires additional care giving to ensure safety.认知损害使诊断复杂，为保证安全需要更多的照料。Finally, a serious and common outcome of chronic diseases of aging is physical disability, defined as havingdifficulty or being dependent on others for the conduct of essential or personally meaningful activities of
50、 life,from basic self-care (e.g., bathing or toileting) to tasks required to live independently (e.g., shopping, preparingmeals, or paying bills) to a full range of activities considered to be productive and/or personally meaningful.最后， 老年人慢性病严重又常见的结果是身体能力不足， 描述为个人最基本的或有意义的日常活动有困难或不得不依靠别人帮助指导，从基本的自理
51、（如洗澡或如厕）到独立生活需要的各种任务（如购物、做饭、支付各种账单），到具有集体和或个人意义的所有活动。7临床医学英语Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the futuredevelopment of difficulty in instrumental activities of daily living (IADL; household management tasks) andactivities of d
52、aily living (ADL; basic self-care tasks).在老年人中， 40%对需要运动的任务有困难，运动困难提示将来开展日常工具锻炼（IADL；家庭护理项目）和目常锻炼（ADL；基本自理项目）的困难。In persons age 65 and other, difficulty with IADL is reported by 20%, and difficulty with ADL is reported by 11%;for both, the prevalence increases with age.prevalence 流行大于 65 岁的老人或其它人，IA
53、DL 困难报导为 20%，ADL 困难报导为 11%；随年龄增加两个都困难成为普遍现象。People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent.IADL 和 ADL 困难的人处于不能自理演变的高风险中。Of persons older than age 65, 5% reside in nursing homes, largely as a result of dependency in IADL and/orADL secondary to severe dise
54、ase.reside 居住 nursing home 疗养院小于 65 岁的老人中，5%住在疗养院里，大多数是严重疾病后依赖IADL 和 ADL 的结果。Generally, woman live more years with disability, whereas men who become similarly disabled are more likelyto die at a younger age.一般来说，同样的能力不足，男性常死得更年轻，女性比男性能多活几年。Although physical disability is primarily a result of chron
55、ic diseases and geriatric conditions, its onset andseverity are modified by other factors, including treatments that control the underlying diseases, physicalactivity, nutrition, and smoking.Primarily 首先、起初、主要、根本 onset 进攻、有力的开始、发作虽然身体能力不足是慢性疾病和年老状态的一个主要结果， 它的发生和严重程度被其它因素影响着， 包括基础疾病的治疗和控制、身体锻炼、营养和吸烟。
56、Many intervention trials indicate that disability can be prevented or its severity decreased; one trial showedimprovements in functioning with resistance and aerobic exercise in older adults with osteoarthritis of the knee.aerobic exercise 有氧运动 osteoarthritis 骨关节炎许多干预试验揭示能力不足可预防或减轻；一个试验显示膝骨关节炎老年人用对抗
57、运动和有氧运动改善功能。Chapter 13 Tissue Engineering Page 36第十三章 组织工程 第 36 页The loss or failure of an organ or tissue is devastating.devastating 毁灭性的器官、组织的丧失或衰竭是毁灭性的。Current treatment methods include transplantation of organs, surgical reconstruction, use of mechanicaldevices, or supplementation of metabolic p
58、roducts.device 装置现有的治疗方法有器官移植、外科重建、机械装置的应用以及代谢性产品的补充治疗。8临床医学英语However, the ultimate goal of transplantation should reside in the ability to restore living cells to maintain oreven enhance existing tissue function.reside 居住、属于、存在于移植的最终目的应该基于重建活细胞群以维持甚至增进现有组织的功能。By developing replacement tissues that
59、remain intact with bioactive properties after implantation, retainingphysiologic functions as well as structure to the tissue or organ damaged by disease or trauma, tissueengineering could provide an alternative to transplantation and other forms of reconstruction.remain 剩下、留下、保持、属于 retain 保留、保持inta
60、ct 完整无缺的、未受损伤的 property 特征、特性通过植入后仍有生物活性的替换组织发展， 保持因病变或创伤而损害器官的生理功能和组织结构， 组织工程能提供移植和其它重建方式的一种替代选择。Skin replacement products are the most advanced, with several tissue-engineering wound care materialscurrently on the market worldwide.皮肤替代产品最为成熟，最近有好几个组织工程（产商）将在全球市场经营这些材料。The potential impact of this
61、field is endless, offering unique solutions to the medical field for tissue and organreplacement.impact 撞击、冲击 frail unique 唯一的、独特的这个领域的冲力是无限的，它提供了组织、器官替代领域独特的解决方法。Tissue engineering may eventually be applied to the regeneration of diverse tissues such as the liver, smallintestine, cardiovascular str
62、uctures, nerve, and cartilage.regeneration 再生、重建 diverse 不同的、变化多的组织工程可能最终能应用于各种组织的重建，如肝、小肠、心血管结构、神经和软骨。Work on bioartificial liver devices has been under way for several years.bioartificial liver 生物人工肝 under way 进行中生物人工肝装置的研究工作已经进行了好几年。The sources of cells required for tissue engineering are summari
63、zed by three categories, autologous cells(from the patient), allogeneic cells (from donor, but not immunologically identical), and xenogeneic cells (donorform a different species).autologous 自体 allogeneic 同种异体 xenogeneic 异基因的、异种组织工程所需的细胞源被总结为三大类，自体细胞（来源于病人）、同种异体细胞（来源于供者，但不是免疫同源的）和异种细胞（不同物种的供者）。each
64、category may be further delineated in terms of stem cells (adult or embryonic) or differentiated cellsobtained from tissue, where the cell population obtained from tissue dissociation comprises a mixture of cellsat different maturation stages and includes rare stem and progenitor cells.delineate 描绘
65、differentiated 区别、区分 dissociation 分裂、分离maturation 成熟 rare 稀奇的 progenitor 祖先、起源每一类可以用术语干细胞进一步描述（成人的或胚胎的），或从组织获得的 不同细胞进一步描述，组织分离获得的细胞群包含着不同成熟时期的细胞混合体，包括半成熟细胞和原始细胞。Recent discoveries have indicated that stem cells of one type can transdifferentiate to repair damaged tissueof another type (i.e., hematop
66、oietic stem cells home to infarcted myocardium and repair the tissue).9临床医学英语transdifferentiate 转分化 hematopoietic 造血的最近的发现提示一种类型的干细胞能够转分化以修补另一类型的损伤组织 （这就是说， 造血干细胞可植入梗死的心肌进行修复）。Tissue engineering will remain an area of intense research.intense 强烈的、热切的、激烈的组织工程学将保持一个富有希望的研究热园。Advances in the areas of g
67、rowth factors, stromal matrices, gene encapsulation, and gene delivery will all play arole.stromal 间质的 matrix 基质 encapsulation 封闭、包装 delivery 传递在这个热园中，已有进展的生长因子、间质其质、基因封闭、基因传递都将扮演一份角色Chapter 20 Nonsurgical Infections in Surgical Patients Page 57第二十章 外科病人的非外科感染 第 57 页Postoperative patients are at inc
68、reased risk for a variety of nonsurgical postoperative nosocomial infections.nosocomial 医院的术后病人发生各种各样术后非外科医院内感染的风险不断增加。The most common of these is urinary tract infection (UTI).最常见的院内感染是泌尿道感染(UTI)。Any patient who has had an indwelling urinary catheter is at increased risk for a UTI.indwell 存在之中、居住任何
69、留置尿路导管的病人都是UTI 的高风险者。Despite the benign course of most UTIs, the occurrence of one in a surgical patient is associated with athreefold increase in death occurring during hospitalization.threefold 三倍的、三重的尽管大多数的尿路感染过程是良性的，但外科病人发生这样一个感染，住院死亡率提高了三倍。The best prevention is to use urinary catheters sparing
70、ly and for specific indications and short durations and toemploy strict closed drainage techniques for those that are used.sparingly 节俭的、保守的 employ 使用、利用最好的预防方法是少用导尿管、针对特殊指征、短时间使用，并应用严格的闭合引流技术。Lower respiratory tract infections are the third most common cause of nosocomial infection in surgical pati
71、ents(after SSIs and UTIs) and are the leading cause of death due to nosocomial infection.SSIs 手术部位感染、局部感染下呼吸道感染是外科病人院内感染是第三常见原因 （排在局部感染和泌尿系感染之后） ，并且是院内感染首要的死亡因素。Diagnosis is usually relatively straightforward in a patient who is breathing spontaneously.straightforward 一直向前、简单的、明确的 spontaneously 自然的、
72、自发的、不由自主的对一个呼吸自然的病人，诊断通常相对容易。However, a patient who is intubated and being ventilated because of adult respiratory distress syndromepresents an extremely difficult diagnostic problem.intubate 以管插入腔道但是，对一个正在插管通气的成人呼吸窘迫症病人，诊断是非常困难的。10临床医学英语Patients with this syndrome commonly have abnormal chest radio
73、graphic findings, abnormal blood gas values,and elevated temperatures and white blood cell counts even in the absence of infection.radiographic X 线照相术的这种患者甚至未存在感染，却常有阳性胸部X 线发现、血气值异常、体温升高、白细胞计数升高。Both false-positive and false-negative diagnosis of pneumonia is common.假阳性和假阴性的肺炎诊断都很常见。New chest radiog
74、raphic infiltrates with signs of infection constitute a good indication for bronchoalveolar lavage,a method being used to diagnose and identify bacteria causing ventilator-associated pneumonia, which hasproven to minimize the indiscriminate use of antibiotics and possesses a higher specificity than
75、previousmethods.infiltrate 透入、渗透 constitute 构成、指定 indiscriminate 不加区别的、任意的possess 拥有、撑握、具有 specificity 明确性、具体性胸部 X 线新渗出（阴影）伴有感染征象是支气管肺泡灌洗的良好指征，这种方法用于诊断和鉴别通气相关肺炎的病原菌，它被证明最小化了抗生素使用的任意性，比先前的方法更有针对性。As part of the work-up for fever in a surgical patient, central lines used for monitoring or treatment sh
76、ouldalways be considered.work-up 诊断检查 central 中央的、主要的、近的、便利的 line 线路、方法作为外科病人发热诊断检查的一部分，用于监测或治疗的深部导管始终应用考虑。Catheter-related sepsis is diagnosed when an organism is isolated from blood cultures and from a segment ofthe catheter in question, without any other source if septicemia and with clinical fin
77、dings consistent with sepsis.organism 生物、有机体、有机组织 in question 在考虑中、讨论中当血培养中和有怀疑的导管节段中分离到病原菌， 未发现其它部位的感染源，而败血症临床表现持续存在， 导管脓毒败血症诊断就成立。Infection of the catheter site is defined as presence of erythema, warmth, tenderness, and/or pus at the site ofthe catheter insertion.erythema 红斑导管插入处有红、（肿）、热、痛和或有脓液是导
78、管局部感染的特点。Both require removal of the catheter, and if a new central line is needed, a new puncture is warranted.puncture 穿刺 warrant 保证、批准、证明两种情况都要拔除导管，假如需要新的深部导管，要保证从新的部位刺入。Furth treatment usually depends on the organism isolated.通常根据分离到的病菌进行进一步治疗。Placement of lines should be done following standard
79、 aseptic and antiseptic technique including wide drapesand full gown and glove for the inserting physician.drape 窗帘、幔 gown 长礼服、手术衣放置导管前应先进行标准的无菌和抗菌技术，包括大范围铺巾，医生穿隔离衣、戴手套。Still the best way to minimize these infections is to avoid placement of unnecessary lines and to remove themonce the indication is
80、 not present anymore.Still 然而、尽管如此然而，减少这些感染的最好办法是避免放置不必要的导管，一旦引流指征消失立即拔管。11临床医学英语Routine change of central lines has not proven to reduce infection rates.常规更换导管还未证明能降低感染率。Occult and Obscure Gastrointestinal Bleeding Page 60occult 神秘的、秘密的、隐蔽的 obscure 黑暗的、模糊的、隐匿的隐匿性和来源不明性胃肠道出血 第 60 页Occult bleeding is
81、 defined as the detection of asymptomatic blood loss from the gastrointestinal tract, generallyby routine fecal occult blood testing (FOBT) or the presence of iron deficiency anemia.fecal 排泄物、残渣隐匿性出血指的是发现无症状性胃肠道出血，一般通过常规的大便隐血试验（ FOBT）或存在着缺铁性贫血。Obscure gastrointestinal bleeding is defined as bleeding
82、 of unknown origin that persists or recurs after anegative initial endoscopic evaluation of both the upper and lower gastrointestinal tracts.initial 开始的、最初的 evaluation 评价来源不明性胃肠出血是指首次上、下消化管内窥镜检查都阴性、原发部位不明的持续或反复性出血。Both of these entities may be presentations of recurrent or chronic bleeding.entity 实体
83、、存在、本质 presentation 提出、表现、存在两者都可能表现为反复的或慢性的出血。The initial approach to evidence of occult gastrointestinal blood loss should be endoscopic evaluation.对隐匿性胃肠道出血，应该使用内窥镜进行早期检查。In the setting of an isolated positive FOBT, colonoscopy is indicated as the first test.colonoscopy 结肠镜只有单独的大便隐血试验阳性情况下，结肠镜作为首选
84、的检查方法是有适应征的。The yield of colonoscopy in these patients is approximately 2% for cancer and 30% for one of more colonicpolyps.yield 产出、结出、产生这些病人结肠镜的结果大约2%是癌症，30%是单发或多发的结肠息肉。The initial approach to a patient with iron deficiency anemia depends on the presence of symptoms referableto either the upper or
85、 lower gastrointestinal tract.referable 可认为与.有关的、可参考的缺铁性贫血病人的首选检查方法要根据存在的症状跟上消化道还是下消化道相关。Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have bothupper and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if
86、thefirst one was plementary 补充的、互补的 positive 确定的、绝对的、真实的无论首次上、 下消化道内窥镜检查会有何发现， 所有病人两个检查都应该做， 因为互补的内窥镜检查 6%有发现，甚至第一次检查是阳性的。For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency anemia.premenopausal 绝经前的对绝经前妇女，大便隐血试验阳性需要全面分析，缺铁性贫血也一样。Barium radiographs of the upper
87、 and lower gastrointestinal tract have limited utility in the setting of occultbleeding because of their inability to biopsy or treat lesions that are identified.12临床医学英语utility 实用、效用、通用隐匿性出血时，上、下消化道的钡剂造影应用有限，因为它们不能活检或治疗发现的病损。The evaluation of obscure gastrointestinal bleeding is often frustratingfr
88、ustrating 令人泄气的、令人沮丧的隐匿性胃肠道出血的诊断常常令人沮丧。Angiodysplasia is the most common cause in most recent series.Angiodysplasia 血管发育畸形血管发育畸形是最近病例报导中最常见的病因。Initial endoscopic examination should focus on any symptoms reported by the patient.focus 聚焦、集中、明确初始内窥镜检查要盯住病人诉说的任何症状。Potential causative agents, such as NSA
89、IDs and aspirin, should be discontinued.causative 成为原因的NSAIDs 非甾体类抗炎镇痛药 non-steroidal antiinflammatory drugs能成为潜在病因的药物，如非甾体类抗炎镇痛药和阿斯匹林，应该停用。Disorders associated with bleeding, such as hereditary hemorrhagic telangiectasia (Osler-Weber-Rendusyndrome), inflammatory bowel disease, or a bleeding diathes
90、is should be considered.telangiectasia 毛细血管扩张 diathesis 素质胃肠紊乱伴出血，像遗传性出血性毛细血管扩张症（Osler-Weber-Rendu 综合症）、炎症性肠疾病、或出血性体质应该加以考虑。A repeat endoscopic evaluation may be appropriate, because approximately one third of cases reveal a causeof bleeding overlooked during the initial endoscopy.内窥镜重复检查可能是恰当的，因为接近
91、三分之一病例查出了首次内窥镜漏掉的出血原因。When upper endoscopy and colonoscopy are both unrevealing, evaluation of the small bowel is indicated.当上消化道内窥镜和结肠镜均无发现，小肠检查具有指征Radiographic evaluation of the small bowel is noninvasive but relatively insensitive, with a less than 6% yieldfrom small bowel follow-through and a 10
92、 to 21% yield from enteroclysis.insensitive 感觉迟钝的 follow-through 持久的贯彻，持续 enteroclysis 小肠造影小肠 X 线检查是非侵入性的，但相对不灵敏，小肠全片6%不到有发现，小肠造影1021有结果。By comparison, the diagnostic yield of endoscopic enteroscopy of the small bowel in obscure gastrointestinalbleeding is 38 to 75%.enteroscopy 肠镜检查相比较，对来源不明性胃肠道出血小肠
93、内窥镜的诊断结果是3875%。Traditional videoendoscopes can evaluate only the proximal small bowel (150cm), whereas longer scopes,which are passed though the entire small bowel and then withdrawn while visualizing the mucosa (sondeenteroscopy), are limited in their ability to visualize the entire mucosa and cann
94、ot be used to performdiagnostic or therapeutic maneuvers.proximal 最接近的、近侧的 visualize 使看得见，想像 sonde 探空火箭传统的电视内窥镜能检查近端小肠 (150cm),然而能通过整个小肠边退边看肠粘膜的更长内镜， 也不能看到整个肠粘膜，都不能作为常规的诊断或治疗手段。13临床医学英语When endoscopic evaluation does not detect the cause of blood loss, radiographic procedures such asscintigraphy and
95、 angiography should be considered.scintigraphy 闪烁显像当内窥镜检查不能发现出血病因，像闪烁造影和血管造影X 线手段应该考虑。Provocative angiography using heparin or thrombolytic agents has been suggested by some authorities, butthis approach has the potential risk of precipitating major bleeding.Provocative 刺激的、挑拔的、气人的 precipitating 使突然
96、发生、促使虽然使用肝素或溶栓药的刺激性血管造影被某些专家推荐，但这种方法有促发大出血的潜在风险。In the face of continued blood loss and no identified etiology, intraoperative endoscopy may providesimultaneous diagnosis and therapy.simultaneous 同时发生的、同时存在的碰到进行性出血查不到病因，术中肠镜可能同时解决诊断和治疗。During the procedure, the surgeon plicates the bowel over the en
97、doscope.plicate 有褶的;有皱襞的在操作中，外科医生把小肠套迭到内窥镜上。As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment.当内镜后退时，内镜发现可以决定是外科切除或（保守）治疗。The yield of this procedure exceeds 70%.这个措施的结果超过 70%。In some clinical situations, the site of bleelding cannot be identified,
98、and the patient requires long-termtransfusion therapy.long-term 长期的 transfusion 输血某些临床情况下，出血部位无法发现，病人而要长期的输血治疗。A new device for visualizing the entire gastrointestinal mucosa consists of a small camera in an ingestablecapsule that transmits images to receivers attached to the patients abdomen and ma
99、pped to identify thelocation of the image.ingestable 能咽下、能吸收 camera 照相机、电视摄像机一种新的装置能显示全部胃肠粘膜，这种装置由一颗装有小型摄像机能咽下的胶囊组成，它将（数字）影像信号传到附着在病人腹部的接收器，并绘制出图像来识别影像的位置。The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualizesegments of the small bowel that were pr
100、eviously inaccessible.potentially 潜在的、可能的 inaccessible 达不到的、难接近的胶囊小肠镜的诊断效率现在还不清楚，但是，这种方法可能可以显示以前难以接近的小肠段肠管。No therapeutic maneuvers are possible with the device.这个装置不可能有任何治疗性操作。Chapter 23 Diabetic Nephropathy Page 67第二十三章 糖尿病肾病 第 67 页End-stage renal disease (ESRD) from diabetic nephropathy is a majo
101、r cause of morbidity and mortality,particularly in patients with type 1 diabetes, affecting 30 to 35% of patients in the United States.nephropathy 肾病14临床医学英语由糖尿病性肾病所发展的晚期肾病（EARD）是患病和死亡的一个主要原因，特别在1 型糖尿病病人中，在美国涉及 3035%的病人。Although nephropathy is about one half as frequent in type 2 diabetics (partiall
102、y due to a shortened lifeexpectancy), type 2 diabetes still makes up the vast majority of diabetic patients seeking therapy for ESRD.expectancy 期望、预期 make up 补足、编造、组成尽管在 2 型糖尿病（特别是影响寿命的）的肾病发生率大约是（ 1 型的）一半，但2 型糖尿病仍然是需要晚期肾病治疗的糖尿病病人的绝大多数。Overall, diabetes is the leading cause of ESRD in the United stat
103、es, accounting for more than one third ofcases.overall 总体来说 accounting for 说明、证明、对负责总的来说，糖尿病是美国晚期肾病的首要病因，占三分之一以上。Details are less clear in patients with type 2 diabetes, but the natural history of diabetic nephropathy in type 1diabetes is well described.2 型糖尿病病人（肾病）的细节不是很清楚，但1 型糖尿病肾病的自然病程已有充分的描述。The
104、 period immediately following diagnosis is best characterized by glomerular hyperfiltration.glomerular 肾小球的 hyperfiltration 超过滤紧接诊断后的一段时期以肾小球超过滤最具有特征。During this time, there is renal hypertrophy, increased renal blood flow, increased glomerular volume, and anincreased transglomerular pressure gradie
105、nt, all contributing to a rise in GFR.hypertrophy 肥大 gradient 坡度、梯度 GFR glomerular filtration rate 肾小球滤过率在这段时间中，有肾脏肥大、肾血流增加、肾小球容积增大和经肾小球的压力梯度增加，这些都与肾小球滤过率增加有关。Importantly, these changes depend at least in part on hyperglycemia, as they are diminished by intensivediabetes treatment.hyperglycemia 高血糖
106、intensive 加强的，密集的重要的是，这些变化至少是部分依靠高血糖，因为通过有力的糖尿病治疗它们会消失。Three to 5 years after diagnosis, early glomerular lesions appear, characterized by thickening of glomerularbasement membranes, mesangial matrix expansion, and arteriolosclerosis.mesangial 肾小球系膜的 matrix 母体、基础诊断后的 35 年，早期的肾小球损害出现，以肾小球基底膜增厚、系膜基底扩张
107、和小动脉硬化为特征。Albumin excretion remains low during early glomerular changes; however, as pathologic changes mount, theglomeruli lise their functional integrity, resulting in glomerlar filtration defects and increased glomerularpermeability.Albumin 白蛋白 mount 骑上、进行攻击 integrity 完整、完善defect 缺点、缺陷 permeabili
108、ty 渗透性Albumin excretion remains low during early glomerular changes; however, as pathologic changes mount, theglomeruli lose their functional integrity, resulting in glomerlar filtration defects and increased glomerularpermeability.在肾小球变化早期白蛋白排泄仍然较低，但是，病理变化进行着，肾小球失去完善的功能，引起肾小球滤过的缺陷，肾小球渗透性增加。15临床医学英语
109、Although results of routine tests of renal function (creatinine and urinalysis) still remain normal,microalbuminuria (30 to 300 mg/day) appears.尽管肾功能的常规化验（肌酐和尿检）结果还是正常，但微白蛋白尿（30300 毫克天）已经出现。Systemic hypertension is also present at this time in more than 50% of cases.在这个时期，50%以上的病例还出现全身高血压。After seve
110、ral years, most diabetic patients exhibit diffuse glomerulosclerosis, although a minority havepathognomonic Kimmelsteil-wilson nodular throughout lesions .exhibit 展示、陈列 diffuse 扩散、传播 glomerulosclerosis 肾小球硬化症pathognomonic 特异病征性的数年以后，大多数糖尿病病人显示不断扩展的肾小球硬化，尽管只有少数病人有特异性的Kimmelsteil-wilson 小结。Although pa
111、thologic changes continue to mount throughout the disease, glomerulosclerosis extensive enoughto cause ESRD develops in a minority of patients; in these cases, overt albuminuria (300 mg/day) beginsapproximatedly 15 years after diagnosis.overt 明显的、公然的尽管病理变化在整个病程中是持续发展的， 只有少数病人的肾小球硬化范围大到足以引起晚期肾病， 这些病例
112、中，明显的白蛋白尿（300mg/天）大约在诊断后 15 年开始。Soon after, following a variable period on the order of 3 to 5 years, the GFR begins a relentless decline (10ml/min/year), which is eventually reflected by an increase in serum creatinine.on the order of 属于一类的、与相似的 relentless 残忍的、不留情面的之后，接着一个易变的时期，约需35 年，肾小球滤过率开始极度下降（
113、10 毫升/天/年），最终以血清肌酐浓度增高表现出来。The appearance of massive proteinuria and the nephrotic syndrome is common in this context and oftenheralds progression to ESRD.nephrotic syndrome 肾病综合症 context 环境、背境、上下文herald 传令、预示、预报 progression 进行、前进、进展在这样的情况下，大量蛋白尿和肾病综合症的出现是常见的，常预示晚期肾病的进展。Once the serum creatinine ris
114、es (reflecting an approximately 50% decline in GFR), ESRD develops in mostpatients within 10 years.potentially 潜在的、可能的 inaccessible 达不到的、难接近的一旦血清肌酐浓度增高（反映肾小球滤过率约下降50%），多数病人 10 年内发展成晚期肾病。This course is highly variable, houever, particularly in type 2 diabetics, who may exhibit moderate proteinuriafor
115、 several years without a substantial deterioration of renal function.deterioration 变化、退化、恶化但是， 这个过程是非常易变的， 特别是 2 型糖尿病， 可以出现许多年的中等蛋白尿而不发生实质性的肾功能恶化。A simple but useful method of monitoring progression to renal failure is to plot the reciprocal of the seumcreatinine as a function of time.plot 小块地皮、地基、用
116、图标出、阴谋 reciprocal 相互的、倒数、互补一个简单而实用的肾功能衰竭进展的监测方法是用图表记录血清肌酐的倒数作为当时的肾功能。16临床医学英语This technique allows better assesssment of both therapeutic interventions and the time when renalreplacement therapy will become necessary.potentially 潜在的、可能的 inaccessible 达不到的、难接近的这个技术使治疗性干预和肾移植时间的评价更为完善。Chapter 26 Trauma
117、 in Pregnancy Page 78第二十六章 孕期创伤 第 78 页Trauma is the leading nonobstetric cause of maternal mortality and occurs in as many as 7% of pregnancies.maternal 母亲的、母性的 mortality 死亡数、死亡率创伤是产妇死亡首要的非产科因素，在孕妇中多达7%。The most common mechanisms of injury are from falls or from motor vehicle crashes.mechanism 机械、结构
118、、机制vehicle 运载工具、车辆最常见的损伤机制是跌倒或机动车碰撞。When compared to age-matched pregnant controls, pregnant women who sustained trauma had a higherincidence of spontaneous abortion, preterm labor , fetomaternal hemorrhage, abruptio placentae, and uterinerupture.match 与相配、使成对 ssustain 遭受、承受同孕龄配对的对照试验中，遭受创伤的孕妇更易发生自然
119、流产、早产、母婴出血，胎盘早剥和子宫破裂。As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment.agree on 对取得一致意见 sphygmomanometer 血压计因为内镜是后退的，内镜发现可以为外科决定切除或（保守）治疗。The yield of this procedure exceeds 70%.这个措施的结果超过 70%。In some clinical situations, the site of bleelding cannot
120、 be identified, and the patient requires long-termtransfusion therapy.long-term 长期的 transfusion 输血某些临床情况下，出血部位无法发现，病人而要长期的输血治疗。Multiple studies have attempted to identify risk factors that predict morbidity and mortality in the pregnanttrauma patient.multiple 多种因素组成的、复合的、多样的 predict 预计，预测许多组合研究试图确定能
121、预示创伤孕妇发病和死亡的风险因素。The maternal Injury Severity Score, mechanism of injury, and physical findings are unable to adequatelypredict adverse outcomes such as abruptio placentae and fetal loss.adverse 相反的、不利的母亲的创伤指数、损伤机制、体检发现都不能恰当地预示如子宫破裂、妊娠中止等不利结局。Early involvement of an available obstetrician is importa
122、nt to evaluate both maternal and fetal well-being.involvement 连累、缠绕 available 可用的、可联系的 well-being 康乐、安康、福利联系紧密的产科医生早期介入，检查评估母婴双方健康状况是非常重要的。In the management of the pregnant trauma patient, the critical point is that resuscitation of the fetus isaccomplished by resuscitation of the mother.17临床医学英语cri
123、tical 紧要的、关键的处理孕妇创伤病人时，最关键的是抢救胎儿是通过抢救母亲完成的。Therefore, the initial evaluation and treatment of the pregnant injured patient is identical to that of thenonpregnant injured patient.identical 同一的、完全相同的所以，对创伤孕妇的诊断和治疗和非受伤孕妇是相同的。Rapid assessment of the maternal airway , breathing, and circulation and ensur
124、ing an adequate airway avoidsmaternal and fetal hypoxia.快速评估母亲呼吸道、呼吸和循环，保证呼吸道通畅避免母亲和胎儿缺氧。In the later stages of pregnancy, as already described, uterine compression of the vena cava may result inhypotension from diminished venous return, so the pregnant trauma patient should be placed in left latera
125、ldecubitus pression 压缩、挤压 decubitus 卧姿、褥疮在妊娠后期， 如已描述的那样， 子宫压迫腔静脉可引起静脉回流减少的低血压， 所以创伤孕妇应摆放为左侧卧位。If spinal cord injury is suspected, the patient may be secured to a backboard and then tilted to the left.secure 安全的、有把握的 backboard 靠背板、后部挡板 tilt 使倾斜、使偏斜假如怀疑脊柱损伤，病人可先仰卧在硬板然后转向左侧。The increased blood volume a
126、ssociated with pregnancy has important implications in the trauma patient.implication 涉及、牵连因妊娠所增加的血容量与外伤关系密切。Signs of blood loss such as tachycardia and hypotension may be delayed until the patient loses nearly 30% ofher blood volume.失血体征如心动过速、低血压可能延迟到病人失血达到近30%的血容量。As a result, the fetus may be exp
127、eriencing hypoperfusion long before the mother manifests any signs.perfusion 灌注结果，在母亲出现表现前，胎儿可能存在长时间的血流灌注不足。Early and rapid fluid resuscitation should be administered even in the pregnant patient who is normotensive.administer 执行，实施 normotensive 血压正常要早期快速输液，甚至对血压正常的孕妇也是如此。Chapter 41 Diagnosis of Sud
128、den Cardic Death(SCD) Page 118第四十一章 心源性猝死的诊断 第 118 页SCD is death due to instantaneous, unanticipated circulatory collapse within 1 hour of initial symptoms and isoften, but not always, due to a cardiac arrhythmia.instantaneous 瞬间的、即刻的、即时的 unanticipated 不曾预料到的心源性猝死是指出现初始症状1 小时内的未能预料的循环衰竭死亡，并不少见，但不全是心
129、律失常。More than 70% of all sudden natural deaths have a cardiac cause, and 80% of these are attributable tocoronary artery disease.attributable 可归于的70%以上的自然猝死有心脏的原因，心脏原因中80%跟冠状动脉疾病有关。18临床医学英语In assessing prognosis and planning a treatment strategy, it is useful to classify SCD as either primary (witho
130、uta clear trigger) or secondary.strategy 策略、战略 trigger 触发、引起在评估预后和制定治疗方案时，将心源性猝死分为原发性（无明确的诱发因素）和继发性是实用的。A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associatedwith recurrence rates of less than 2%.episode 一段情节、插曲、有趣的事 associated with 联合原发性的在 1 年内有 103
131、0 的复发率，而大多数继发性的合在一起复发率小于2%。Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include transient ischemia possiblyrelated to vasospasm;identifiable 可确认的 reversible 可逆的 precipitant 仓促的、突然的transient 短暂的、瞬时的可确认的可逆性继发性心室颤动（VF）的发作包括可能因血管痉挛的短暂缺血；hypokalemia resulting from diure
132、tics; hyperkalimia secondary to renal failure, angiotensin-converting enzymeinhibitors, prostaglandin inhibitors,or potassium-sparing diuretics;hypokalemia 低钾血症 angiotensin-converting enzyme血管紧张素转化酶prostaglandin 前列腺素 sparing 节俭的、保守的利尿剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾利尿剂所致的高钾血症；proarrhythmia s
133、econdary to antiarrhythmics, tricyclics, and antihistamines;proarrhythmia 致心律失常作用 tricyclic 三环的、三环分子antihistamine 抗组织胺类继发抗心律失常药、三环类药和抗组胺类药的心律失常；or substance abuse with drugs such as cocaine and amphetamines.administer abuse 滥用、陋习 amphetamine 安非他明、苯异丙胺或可卡因或安非他明类药物的滥用。可确认的可逆性继发性心室颤动（VF）的发作包括可能是血管痉挛的短暂
134、缺血；利尿剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾利尿剂所致的高钾血症；抗心律失常药、三环类药和抗组胺类药引起的心律失常；或可卡因或安非他明类药物的滥用。Therapy is directed toward removing or treating the acute precipitant.removing 消除治疗是直接消除或处理急性发作。SCD related to acute ischemia in the absence of prior MI often is associated with severe proximal occlusive
135、disease, normal left ventricular function, normal signal-averaged ECG, and noninducibility absence ofventricular tachycardia (VT) during electrophysiologic study.MI myocardial infarction 心肌梗死 average 平均 inducibility 可诱导的缺乏心肌梗死前兆的急性缺血性心源性猝死常与严重的近端梗阻疾病有关， 电生理研究时心室功能正常， 心电图正常信号普通，无法诱异缺乏室性心动过速（VT）19临床医学
136、英语Most patients should undergo comprehensive evaluation of myocardial function and coronary anatomy.undergo 经历、忍受 comprehensive 全面的、广泛的，能充分理解的大多数病人应该进行全面的心肌功能评价和冠状动脉解剖。Echocardiography is useful for excluding hypertrophic cardiomyopathy and valvular heart disease;echocardiography 超声心动图 hypertrophic
137、cardiomyopathy 肥厚性心肌病超声心动图对肥厚性心肌病和瓣膜性心脏病在内的疾病很有用；magnetic resonance imaging, for diagnosing arrhythmogenic right ventricular dysplasia;magnetic resonance imaging 磁共振 dysplasia 发育异常、结构异常磁共振对有心律失常性右室发育不良症的诊断很有用；and myocardial biopsy, for identifying infiltrative diseases such as myocarditis, amyloidos
138、is, hemochromatosis,and sarcoidosis.infiltrative 渗透性的、浸润性的 amyloidosis 淀粉样变hemochromatosis 血色素沉着 sarcoidosis 结节病心肌活检对浸润性疾病如心肌炎、淀粉样变、结节病很有用。Coronary angiography shoule be performed to assess for the presence of coronary occlusive disease and toexclude coronary artery anomalies.应该进行冠状动脉血管造影评估冠脉阻塞性疾病的存
139、在和排除冠脉的结构异常。Myocardial perfusion scintigraphy provides complementary data for assessing ischemic burden.myocardial perfusion scintigraphy 心肌灌注闪烁照相术心肌灌注闪烁照相术对缺血程度估计提供辅助资料。Left ventricular function can be assessed by contrast ventriculography, radionuclide ventriculography, orechocardiography.ventricu
140、lography 心室造影术 radionuclide ventriculography 放射性核素心室显像术通过对比心室造影、同位素心室造影或超声心动图可以评价左心室。Evaluation of SCD survivors also includes Holter monitoring and/or electrophysiologic testing.Holter monitoring 动态心电图监护仪心源性猝死生还者的评价也包括动态心电图监护仪和/或电生理测试。The Electrophysiological Study Versus Electrocardiographic Monit
141、oring (ESVEM) trial showed, however, a50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom antiarrhythnmic drugs successfullysuppressed PVCs.ventricular tachyarrhythmias 室性快速型心律失常PVCs premature ventricular contraction 室性早搏The Electrophysiological Study Versus Electrocardiographi
142、c Monitoring (ESVEM) trial showed, however, a50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom antiarrhythnmic drugs successfullysuppressed PVCs.但是，电生理研究加心电图监测的试验显示，用药物成功控制的室性早搏病人2 年内 50%复发These data suggest a dissociation between PVC suppression and recurrence of VT; PVCs ma
143、y represent amarker of left ventricular dysfunction rather than a trigger of SCD, or the arrhythmogenic substrate may changeover time.dissociation 分裂、分离 substrate 底层、底物、基础20临床医学英语这些资料提示室性早搏的控制和室性心动过速的复发是不相关的； 室早可能是代表左室功能紊乱的一个信号， 而不是心源性猝死的触发者，或心律不齐的基础可能因时间而变化。In SCD survivors, sustained monomorphic v
144、entricular tachycardia is inducible by electrophysiologic testing in40 to 50% and polymorphic VT in 10 to 20%; in 30 to 50%,no sustained arryhthmia is induced.sustaine 持继不变、相同、维持 monomorphic 单一同态的、单形的在心源性猝死生还者中，4050%电生理试验能诱导持续单一型室性心动过速， 1020%能诱导多型的， 3050%不能诱导持续的节律异常。In patients with ischemic heart d
145、isease and left ventricular dysfunction, inducibility of sustained VT carries apoor prognosis.administer 执行，实施 normotensive 血压正常在缺血性心脏病和左室功能不全病人中，能诱导持续室性心动过速预后不良。A low ejection fraction is associated with a poor prognosis, however, regardless of whether sustained VT isinducible; patients with an eje
146、ction fraction of 30% or less and who are noninducible have a 25% arrythmiarecurrence rate at 1 year, whereas noninducible patients with an ejection fraction greater than 30 have a 10 to15% recurrence rate.ejection fraction 射血分数 normotensive 血压正常但是，不良预后与低射血分数有关，不管持续室性心动过速是否能诱导，射血分数30%以下和不能诱导者 1 年有 2
147、5%心律失常复发率，而射血分数大于30%的不能诱导者只有 1015%复发率。In patients with SCD and idiopathic dilated cardiomyopathy, sustained monomorphic VT is rarely induced.idiopathic 先天的、初发的、突发的心源性猝死和先天性扩张性心肌病病人中，持续单一型室性心动过速极少能诱导。Neither the inability to induce VT nor the ability of drugs to suppress inducible polymorphic VT or V
148、F is apredictor of a favorable outcome.administer 执行，实施 normotensive 血压正常不能诱导室性心动过速不是，用药物能控制的可诱导多型的VT 和 VF 也不是良好结果的信号。Chapter 22 Shortness of Breathshortness of breath, a feeling of not being able to get enough air, and labored breathing are all termsused by patients to describe the symptom of dyspn
149、ea. 气促 不能呼吸足够空气和 用力呼吸是病人描述呼吸困难症状时常用的词。Dyspnea 呼吸困难The cause of dyspnea may be pulmonary disease, circulatory disease, or both. 呼吸困难的原因可能是肺部疾病，循环系统疾病或者两者并存。Pulmonary 肺的Circulatory 循环It is the physicians responsibility to define the causative mechanisms of shortness of breath so thatdiagnostic techniq
150、ues and therapies can be directed appropriately.医生应该明确气促的病因以便采用合适的诊断方法和治疗。The most consistent correlate of the symptom of dyspnea is increased mechanical work of breathing, usuallybrought on by increased airway resistance as occurs in asthma, chronic bronchitis, and emphysema, ordecreased distensibi
151、lity of the lungs as occurs in interstitial fibrotic reactions.21临床医学英语 导致呼吸困难症状最大可能是呼吸机械阻力增加， 通常可见的是哮喘、 慢性支气管炎和肺气肿导致的气道阻力增加或者由于间质纤维化反应导致的肺膨胀性降低。 Consistent 连贯的，一致的Distensibility 膨胀性interstitial fibrotic reactions 间质纤维化反应In the latter disease, increased effort is required to produce a higher negativ
152、e pressure in the pleural spaceto inflate the lungs.间质纤维化反应病人需要更大的努力使胸腔负压增加才能保证肺部充气。pleural space 胸膜腔 Inflate 充气The increased mechanical work done on the lungs to overcome obstruction to airflow or decreaseddistensibility is perceived as an increased effort to breathe and produces the symptom of dys
153、pnea. 用来克服气道阻塞和膨胀性降低的机械原理的增加就表现出呼吸费力和困难的症状An increased drive toventilate may also cause dyspnea. Such stimuli include hypoxia, usually when arterial oxygen tensions areless than 60 mmHg, and stimuli from inflamed lung parenchyma, as occur in bacterial pneumonia or alveolitisand that drive the respir
154、atory centers of the brain.Ventilate 通气Hypoxia 缺氧arterial oxygen tensions 动脉血氧张力 通气需求的增加也会导致呼吸困难。这类刺激包括了缺氧，通常动脉血氧张力低于60mmHg,或者见于细菌性肺炎或者肺泡炎导致的肺实质炎症促使脑部呼吸中心增加通气需求。 These stimuli often lower the resting carbon dioxide pressure (Pco2) to less than the normal level of 40mmHg and cause dyspnea, especially
155、 on mild exertion.尤其在轻度体力负荷情况下，这些刺激通常使静止二氧化碳压力（Pco2）降低在正常的 40mmHg 以下。Patients with pulmonary emboli may present with shortness of breath and a normal chest roentgenogram.Chest roentgenogram.胸部 X 线片 肺栓塞病人也可能出现气促，但是胸部X 线片表现正常。However, the inefficiency of the embolized lung for gas exchange, characteri
156、zed by an enlarged deadspace,requires abnormally high ventilatory rates to maintain a normal arterial Pco2. 但是肺栓塞使死腔扩大，气体交换不充分，从而需要高频率的通气以保证动脉Pco2 维持在正常水平。Unless this particular presentation of pulmonary embolism is appreciated, embolic disease goesunrecognized in many patients until they suddenly d
157、ie or are extremely incapacitated by pulmonaryhypertension and right ventricular failure. 除非有特殊的临床表现， 很多肺栓塞病人很难发现直至出现突然死亡或者由于肺性高血压或右心室衰竭而导致的极度功能障碍。Because of the high prevalence of heart disease and heart failure in the general population, many patientswith dyspnea have cardiac abnormalities. 由于心脏疾病
158、和心衰的高发，很多呼吸困难的病人有心功能的异常。The basis of the dyspnea is usually a high filling pressure of the left ventricle, which cuases high left atrialpressures and high pulmonary capillary and pulmonary arterial pressures, which in turn increase the22临床医学英语pulmonary blood volume and reduce lung compliance. 呼吸困难的基
159、础通常是左心室充盈压增高导致肺毛细血管和肺动脉压的增加， 从而肺血流量提高， 肺顺应性降低。If the pulmonary capillary wedge pressure is in the range of 25 mmHg, capillary fluid transudates into thepulmonary matrix, thereby reducing lung compliance, increase the work of breathing, and causing dyspnea. 如果肺毛细血管楔压在25mmHg 左右，毛细血管液就会漏出至肺基质，从而降低了肺顺应性
160、，导致呼吸用力增加，引起呼吸困难。 Echocardiography is usually diagnostic of abnormal ventricular or valvular function and should be performedin any patient in whom the cause of dyspnea is not readily apparent.超声心动图通常被用来诊断心室和瓣膜异常，对任何呼吸困难病因不明确的病人均 可采用。 Chapter 25 Cancer of unknown primary originDefinitionThe first si
161、gns or symptoms of cancer are frequently due to metastases to visceral or nodal sitesVisceral 内脏的肿瘤的第一个症状或体征往往是由于内脏或淋巴结转移In most such patients, routine clinical evaluation with a comprehensive history, physical examination,complete blood cell count, screening chemistries, and directed radiologic eva
162、luation of specific symptoms orsigns identifies the primary tumor. 大多数此类病人，需要进行常规的临床检查，如详细的病史询问，体格检查，全血细胞计数，生化筛选及根据特定的症状和体征进行定向的放射学检查Patients who have no primary tumor located after this routine clinical evaluation are defined as havingcancer of unknown primary site. 常规临床检查后如果没有发现原发肿瘤，被称为原发灶不明的肿瘤。Et
163、iologyIn patients whose primary site of cancer remains undetectable, the primary site presumably hasremained small or, less likely, has regressed spontaneously. 如果病人原发肿瘤无法检测到，有可能肿瘤尚小，或者自然退化。Large autopsy series before the routine use of computed tomographic scans or magnetic resonanceimaging identif
164、ied small primary sites of cancer in 85% of patients with previously unidentified primary tumors,在 CT 和核磁共振常规应用之前，大批量的尸体解剖发现85原发灶不明的肿瘤可以发现原发小肿瘤，usually in the pancreas, lung, and various other gastrointestinal sites; with current use of computedtomography and magnetic resonance imaging, however, aut
165、opsy series have identified primary sites in only50-70% of patients. 常见于胰腺，肺部和其他胃肠部位，而CT 和核磁共振应用以后，尸检只能发现5070的原发部位。Incidence About 3% of all patients with cancer have metastatic disease without a known primary site,accounting for about 50000 to 60000 cases per year in the united states 约 3肿瘤转移的病人不能发
166、现原发部位，美国一年大约发生50000 到 60000 例Cancer of unknown primary site occurs with approximately equal frequency in men and women, and itincreases in incidence with advancing age.原发灶不明肿瘤男女发病率相似，随年龄增加发病率也有提高Clinical and pathologic evaluationSince all patients with cancer of unknown primary site have advanceddis
167、ease, therapeutic nihilism has been common.23临床医学英语 Nihilism 虚无幻想，怀疑的因为很多原发灶不明的病人病程久远，通常认为治疗效果不佳。However, it is now evident that this heterogeneous group contains subsets of patients with widely diverseprognoses; some cancers are highly responsive to treatment, and some patients may have a substanti
168、alchance of achieving long-term survival with appropriate treatment.但是现在已经明确，这个特质人群中包括了很多完全不同的预后病人， 有些患者对治疗高度敏感，另外一些病人经过适当治疗可以出现本质上的改善从而延长The initial clinical and pathologic evaluation should therefore focus on identifying a primary site whenpossible and on identifying patients for whom specific tre
169、atment is indicated.最初的临床和病理评估应仅可能寻找原发部位，同时为患者确定特效的治疗。In the majority of patients with cancer of unknown primary site, the diagnosis of advanced cancer is stronglysuspected after the initial history and physical examination.大多数原发灶不明的肿瘤病人，经过初步的病史和体格检查，基本能够确定晚期癌症的诊断。 A brief additional evaluation, inc
170、luding complete blood cell counts, chemistry profile, and computedtomography of the chest and abdomen should be performed. 其他的附加检查，包括全血细胞计数，生化检查和胸部腹部CT。In addition, specific symptoms or signs should be evaluated with appropriate radiologic and endoscopicstudies. 有特殊症状和体征的病人可以使用合适的放射学和内镜检查。If a prima
171、ry site is located, management should follow guidelines for the specific cancer identified. 如果确定了原发部位，应根据特定的肿瘤治疗指南进行治疗。In patients with no obvious primary site, the most accessible site should be biopsied.那些无明显原发病灶的病人，应对最可疑的部位进行活检。 Fine needle aspiration may or may not provide sufficient material fo
172、r optimal histologic examination andspecial pathologic procedures. Optimal 理想的，足够的细针穿刺能否取得足够的组织进行组织学和特殊的病理学检查。If tissue is inadequate, a larger biopsy sample should be obtained so that all necessary stains andprocedures can be performed.如果组织不够，需要进行较大的活检样本以便进行必要的染色和操作。 Chapter 28 Surgical complicatio
173、nsPostoperative surgical complications represent one of the most frustrating and difficult occurrencesexperienced by surgeons who do a significant volume of surgery.Frustrating 无效的，挫折的 外科术后并发症是经验丰富的外科医生最困扰和最难对付的困扰之一。Regardless of how technically gifted,bright, and capable a surgeon is, surgical comp
174、lications are a virtually guaranteed aspect of life.Virtually 事实上不管外科医生有多大的能力，技术高超，聪明智慧，外科并发症 也很难免。The cost of surgical complications in the United States today runs into millions of dollars and is associatedwith lost work productivity, disruption of normal family life, and unanticipated stress to e
175、mployers and society in24临床医学英语general. 当前美国的外科术后并发症浪费了无数的金钱， 同时导致劳动能力的丧失，正常家庭生活的破坏， 而且为雇主和社会带来了无法预料的压力。Frequently, the functional results of the operation are compromised by complication; in some cases, thepatient never recovers to the preoperative level of function. 通常术后并发症影响了手术的效果，某些病人无法恢复到术前的功能状
176、态。The most significant and difficult part of complications is the suffering borne by the patient who enters thehospital anticipating an uneventful operation but is left suffering and compromised by the complication.最严重和难对付的并发症就是看到那些本以为进行安全性很高的手术，结果却导致了术后的痛苦和并发症。 Complications can occur for a variety
177、 of reasons.外科并发症的发生有多种原因。A surgeon can perform a technically perfect operation in a patient who is severely compromised by thedisease process and still have a complication. 有时，外科医生手术技术上非常成功，但病人的病情严重可导致并发症的发生。Similarly, a surgeon who is sloppy, is careless, or hurries through an operation can make t
178、echnical errorsthat account for the operative complications.同样，手术中医生的马虎、粗心或仓促都可以导致技术上的错误从而导致手术并发症Finally, the patient can be doing well nutritionally, have an operation performed meticulously, and yet suffera complication because of the nature of the disease.最后，病人营养状况良好、手术非常细心，疾病本身也可以导致并发症的发生。The po
179、ssibility of postoperative complications is a part of every surgeons thought processes-something withwhich all surgeons will be required to deal. 手术后并发症的可能性是每一个外科医生考虑治疗计划的一个组成部分， 因为所有外科医生都将面临这些并发症中的一部分。Surgeons can do much to avoid complications by the careful preoperative screening process. 外科医生可以在
180、术前进行精心筛选以避免术后并发症。When the surgeon sees the potential surgical candidate the first time, a host of questions come to mind,such as the nutritional status of the patients and questions about the health of the heart and lungs.a host of 许许多多，一大堆当外科医生第一次见到即将手术的病人时， 需要考虑很多问题， 如这个病人的营养状况或者心肺功能是否正常。 The surg
181、eon will make a decision regarding performing the correct operation for the appropriate disease.外科医生需要为病人作出正确的手术方式选择。Similarly, the timing of the operation is often an important issue同样的，手术时机也是一个重要的因素。Some operations can be performed in a purely elective fashion, whereas others have some urgency abo
182、utan expeditious surgical solution.Expeditious 迅速地，敏捷地一些手术可以择期进行，而有些可能需要进行急诊手术。Occasionally, the surgeon will demand that thepatient lost weight before the operation so that the likelihood of a successful outcome is improved.25临床医学英语有时候，外科医生会要求病人术前减轻体重以提高手术的成功率。 Occasionally, the wise surgeon will r
183、equestpreoperative consultation from a cardiologist or pulmonary specialist to make certain that patient will be able totolerate the stresses of a particular procedure.有时，明智的外科医生会请心脏或呼吸系统专家进行术前会诊以确定病人是否能耐受特定手术。 Chapter 30 Epidemic influenza第三十篇 流行性感冒 本篇篇名为流行性感冒， 人类史上几次人流感的世界性爆发都造成了巨大死伤。 近几年的禽流感疫情也给人
184、类带来了恐慌。本篇主要介绍流感的概念、过程和基本特点。 An epidemic is an outbreak of influenza confined to one geographic location.流行性感冒是指一个地理区域中的感冒的爆发。In a given community, epidemics of influenza A virus infection often have a characteristic pattern. 在某些特定的社区，流感病毒A 型的传播通常有特征性的模式。They usually begin rather abruptly, reach a sh
185、arp peak in 2 or 3 weeks, and last 6 to 10 weeks. 通常爆发性流行，在2 至 3 周内直线到达峰值，并持续6 至 10 周。Increased numbers of schoolchildren with febrile respiratory illness are often the first indication of influenzain community.社区中流感发生的第一个迹象就是学生发热呼吸道疾病。This indication is soon followed by illnesses among adults and a
186、bout a week later by increased hospitaladmissions of patients with influenza-related complications. 随后的表现有成人的发病，一周以后感冒相关的并发症引起的入院病人增加。Hospitalization rates in high-risk persons increase two- to five fold during major epidemics. 在感冒大流行期间，高危住院病人住院率可能增加二到五成。School and employment absenteeism increases,
187、as does mortality from pneumonia and influenza,especially in older persons. 缺学和旷工的情况增加，肺炎流感死亡率提高，尤其是老年人。The latter finding is a highly specific indicator of influenza activity.后一项发现是流感活动高度特异性指标。Epidemics occur almost exclusively during the winter months in temperate areas, but influenza activity may
188、continue year-round in the tropics. 在温带地区流感基本发生在冬季，但热带区域流感在全年均有发生。Outbreaks may occur in tour groups (land or ship) and in facilities during summer months, particularly afterthe appearance of a drift variant.流感爆发可出现在夏季旅游团队（陆地和船舶）及建筑物内，尤其是在不同地点迁徙后。Regional differences in the time and magnitude of occ
189、urrence of influenza outbreaks are common流感发生的时间和强度区域差异基本类似。During epidemics, the overall attack rates typically average 5 to 20% in adults.成人的流感发生率平均在 5至 20。Attack rates of 40 to 50% are not uncommon in closed populations, including those in hospitals and nursinghomes, and in certain highly suscept
190、ible age groups. 封闭人群中，包括住院病人或易感人群的感染率通常在40 至 50。Two different strains within a single26临床医学英语subtype, two different influenza A subtypes(H1N1 and H3N2), or both influenza A and B viruses maycocirculate.一个亚群中的两个不同菌株，两种不同的流感A 病毒亚群，或者流感A 和 B 病毒均能发生互相传播。 In addition, simultaneous outbreaks of influenza
191、 A and respiratory syncytial viruses have been found.而且，也有报道发现 A 型流感病毒和呼吸道合胞病毒同时感染。Strains circulating at the end of one seasons epidemic are sometimes responsible for the next seasonsoutbreak (the so-called herald wave phenomenon). 每个季度末期流行的菌株通常会导致下一轮流感爆发（ the so-called herald wave phenomenon）Furth
192、ermore, other than the association of influenza outbreaks with colder seasons, the factors that allowsan epidemic to develop or those responsible for the tapering off of an epidemic when only some susceptiblepersons have been infected are unknown.而且，除了流感爆发与气候寒冷有关以外，流感爆发或逐渐消失而仅影响易感人群的机制尚不清楚。Pneumonia
193、 and influenza (P+I)- related deaths fluctuate annually, with peaks in the winter months. 肺炎和流感相关死亡一年中有波动，冬季为高峰期。When such P+I deaths exceed the predicted number, it is due to influenza A or occasionally to influenza Bvirus or respiratory syncytial virus activity. 如果肺炎流感死亡超过预期数字，这是A 型流感所造成的，偶尔也有可能为B
194、 型流感病毒或者是呼吸道合胞病毒引起。Although mortality is greatest during pandemics, substantial total mortality occurs with epidemics.Pandemics 大范围流传Over 85% of P+I deaths occur among persons aged 65 and older.超过 85的肺炎流感死亡发生于超过65 岁的老年人群。Other cardiopulmonary and chronic diseases also result in increased mortality a
195、fter influenza epidemics, sothat overall influenza-associated mortality is about two- to fourfold higher than P+I deaths.其他心肺和慢性疾病也可以使流感后死亡率的上升，因此总的流感相关的死亡率比肺炎流感的死亡率高2040。Chapter 35 Principles of ordering imaging tests 本篇篇名为影像检查的选择原则。 影像学检查在临床的诊治中是不可或缺的， 但如何选择则有原则可循。 本篇主要介绍选择影像学检查的基本原则，列举了几种常见影像学检查的
196、比较。 As a general rule, when confronted with two reasonable alternatives, it is advisable to choose the leastexpensive, safest, and least uncomfortable imaging examination first.通常来说，如果有两种检查方法可以选择，首先我们会使用低价位，安全和较舒适的影像检查。 For acute right upper quadrant abdominal pain, ultrasonography is usually the pr
197、ocedure of choice becauseit is less expensive than CT, primarily because the imaging equipment is cheaper. 对急性右上腹痛，超声是常规的检查方法，因为它比CT 更便宜，原因在于影像设备的便宜。Although ultrasound is more subjective and operator dependent than CT, ultrasound can yield exquisitevisualization of the biliary tree, including the g
198、allbladder and the pericholecystic space, in which fluid can be asign of acute cholecystitis. 虽然超声比 CT 更加主观，更加以来于操作人员的经验，但超声对胆道的图像非常精确，包括胆囊和胆囊周围的空间，如急性胆囊炎可表现出液体。27临床医学英语 UItrasonography also confirms or denies the presence of gallstones in the gallbladder with high accuracythat at least equals that
199、of CT, and ultrasonography can detect biliary dilations and masses in the liver andpancreas超声对胆囊中胆石是否存在的精确度超过至少与CT 相似，超声也能确定胆管是否扩张及肝脏或胰腺的占位病变。 Ultrasonography can be difficult and suboptimal in patients who are obese or who have a distendedabdomen.超声检查对肥胖或腹胀病人的诊断比较困难或效果不佳。Ultrasonography is generall
200、y less accurate in surveying the remainder of the abdomen, an important issuewhen the pain is less localized.超声对诊断腹部残留物的诊断不佳，尤其是腹部不局限的情况下。 How should the choice between CT or ultrasonography be made in a patient who presents with acuteabdominal pain?急腹症时如何选择 CT 或者超声诊断呢？More specifically, when is it
201、appropriate to move directly to CT？ 更具体地说，什么时候可以直接进行CT 检查？In general, if the pain is not biliary in character, is not localized to the right upper quadrant, or occurs in anobese patient, CT is preferred because it often reveals previously unsuspected abnormalities. 通常认为，如果疼痛特征不提示胆道疾病，不局限于右上腹部，或者病人肥胖
202、，可以直接进行 CT 检查可以发现先前未明确的疾病。At least three other imaging choices exist: (1) no imaging study; (2) a plain radiographic series of theabdomen(technically and economically similar to the chest radiograph but generally not as useful); (3) MRI ofthe abdomen or pelvis(usually reserved for more complex situa
203、tions or after failure to diagnose with othermethods). 至少还可有其它三种影像学检查的选择：（1）不做影像学检查；（2）腹部平片（技术和价格与胸片相当，当效果通常不好）；（3）腹部或盆腔的核磁共振（在复杂或者其他诊断技术无效的情况下使用） Other than identifying free intraperitoneal air(perforated viscus), gas patterns of bowel obstruction, andradiodense ureteral calculi, the traditional ab
204、dominal series, although the least expensive test, is consideredgenerally inferior to CT and has been largely replaced by CT. 除了鉴别游离的腹腔气体（内脏穿孔），肠梗阻的积气和输尿管不透射线的结石以外，虽然价格低廉，但效果通常比 CT 差，而且大部分已被 CT 替代。A current-generation multislice helical CT scanner can generate 5-mm sections of the entire abdomen and
205、pelvis in about 1 minute. 当代的多层螺旋 CT 可以在 1 分钟内形成腹部和盆腔的5mm 切片。It is helpful to use oral and intravenous contrast material to opacify (and identify) loops of bowel and vascularstructures.Opacify 不透明的 口服或静脉使用造影剂有助于使肠道或者血管突出显影。MRI can be useful for the cooperative patient in renal failure who cannot rec
206、eive intravenous contrastmaterial because it can provide tissue and vascular detail not achievable without contrast-enhanced CT.28临床医学英语对不能使用静脉造影剂的配合的肾衰病人，可以使用核磁共振获得通常只有增强造影CT 可以获得的组织和血管影像。Patient cooperation is required because of the longer imaging times and respiratory motion artifacts.respirator
207、y motion artifacts 呼吸伪影 病人的合作是必须的，因为检查时间长，而且存在呼吸伪影。Chapter 45 Acute Abodomen -Decision to OperateThese difficulties notwithstanding, the surgeon must make a decision to operate or not. Certain indicationsfor surgical treatment exist.Notwithstanding 尽管 虽然 尽管有这些困难，外科医生必须作出是否手术的选择。有一些外科手术的指征。For exampl
208、e, definite signs of peritonitis such as tenderness, guarding, and rebound tenderness support thedecision to operate.Peritonitis 腹膜炎 比如说，特定的腹膜炎体征如腹痛，肌卫，反跳痛都支持手术的决定。Likewise， severe or increasing localized abdominal tenderness should prompt an operation. 同样的，严重的或者逐渐加重的局限性腹痛也应马上手术。Patients with abdomi
209、nal pain and signs of sepsis that cannot be explained by any other finding shouldundergo operation. 无法解释的腹痛伴随脓毒症的病人应该进行手术。Those patients suspected of having acute intestinal ischemia should be operated on after completeevalution. 对怀疑肠缺血的病人需进行充分评估后手术。Certain radiogragphic findings confidently predict
210、 the need for operation.某些诊断学的发现比较确切地提示了手术指证。These finding include pneumoperitoneum and radiologic evidence of gastrointestinal perforation 这些发现包括气腹证或者胃肠穿孔的放射学证据。Patients presenting with abdominal pain and free intra-abodominal gas seen on radiograph warrantoperation with limited exceptions.如果患者有腹痛并
211、且 X 光片上有腹腔内气体，绝大部分病人需要手术。Observation with serial examinations may be appropriate for a patient with free gas after a colonoscopy.结肠镜检查后出现自由气体的病人需要观察并做一系列的检查。Intra-abdominal gas can persist for a day or two following celiotomy.剖腹术后腹腔内气体还可以遗留一至二天。 Imaging tests can reveal signs of vascular occlusion r
212、equiring operation. 放射学检查可以提示需要手术的血管阻塞疾病。After careful examination and evaluation, diagnostic uncertainty can remain. Some patients may haveequivocal physical findings. 详细的检查和评估之后，诊断未明确的可以继续观察。一些病人可能表现出模棱两可的体征。When this occurs and the diagnosis is unclear and the patients wellness is unclear, it may
213、 be advisable todefer operation and to re-examine the patient carefully after several hours.29临床医学英语如果有上述情况，诊断不明确，病人症状无好转，建议延期手术，数小时后再次详细检查。 This is best done ina short-stay unit in the hospital, in a special unit in the emergency department, or if necessary, by regularhospital admission. 最好能在医院短期留观
214、或者在急诊室观察，如果有必要可以入院观察。In a period of hours, vague pain with minimal physical findings may proceed to definite localized pain withtenderness, guarding, and rebound tenderness; if that occurs, operation should follow如果在数小时内，没有明显体征的腹胀转化为明确的局限性腹痛，肌卫和反跳痛，则手术指证明显。 After several hours , the patients symptom
215、s and signs may also resolve. 也有可能，数小时后病人的症状和体征消失。When that happens, the patient can be dismissed, although the patient should have a follow-up appointmentscheduled within a day or so to permit re-examination to be certain that an important diagnosis was not missed.如果是这种情况，病人可以出院，虽然仍需短期的随访和重新检查，以免遗漏
216、重要的诊断。Certain patients are difficult to evaluate because of special characteristics. 有些病人由于特殊性很难评估。For example, patients who are neurologically impaired as result of stroke or a spinal cord injury may bedifficult to evaluate. 如由于中风或脊髓损伤导致的神经系统功能不全的病人。Patients who are under the influence of drugs or
217、alcohol may require special or subsequent examination.受药物（毒品）或酒精影响的病人需要进行特殊或者后续进一步检查。Patients who take steroids or are otherwise immunosuppressed deserve special mention because steroidsand immunosuppression mask the intensity of abdominal pain and the physical findings of severe,life-threatening in
218、tra-abdominal disease. 服用类固醇或免疫抑制剂的病人需要特别注意， 因为类固醇和免疫抑制剂能掩盖腹痛的程度及严重致命的腹腔疾病。Patients in this category who have persistent, unequivocal abdominal pain and even minimal findings shouldbe considered for surgical operation. unequivocal 明确的，不模棱两可的此类病人如果有持续性，明确的腹痛，甚至轻微的腹痛也应该手术。Some patients with clear find
219、ings of the acute abdomen may be treated without surgical operation有些病人即使有明确的急腹症也可以不需要手术。For example, patients with perforated duodenal ulcer who seek attention late in the course of their diseaseafter they have been sick for several days may be treated best by careful supportive care including naso
220、gastricsuction, intravenous fluids, and pain relief. 如十二指肠溃疡穿孔病人，病人已有多天，而发作也很迟，最好进行支持性治疗，如胃肠减压，静脉输液和止痛。Certain patients with empyema积脓 of the gallbladder, especially those with other serious concomitant伴随的 illnesses, can be treated by percutaneous drainage of the infected gallbladder and careful sup
221、portive carerather than with cholecystectomy. 对于胆囊积脓患者，尤其是伴有其他严重疾病，宁可选择经皮引流和支持疗法，而不进行胆囊切除术。30临床医学英语 Chapter 36 Endoscopic ultrasonograhy本篇篇名为内镜超声检查（或称超声内镜）。在疾病诊治上，超生内镜作为一种检查和治疗的新技术在临床上逐渐得以应用，与传统的诊治方法比较，它具有一定的优势。本篇主要介绍内镜超声检查的基本情况、与传统方法比较以及它在临床诊治方面的优势所在。The development of endoscopic ultrasonography(EU
222、S), or endosonography, has been a majortechnological achievement in gastroenterology. Gastroenterology胃肠学achievement 成就胃肠内镜的发展是胃肠学上重大的技术成就。The incorporation of an ultrasonic transducer in tip of a flexible endoscope or the use of stand-aloneultrasound probes has now made it possible to obtain images
223、 of gastrointestinal lesions that are not apparenton superficial views, including lesions within the wall of the gut as well those that lie beyond(e.g., pancreatic orlymph node lesions)。Incorporation 并入，掺合 Transducer 超声换能器Superficial 表面的，浅表的Gut 肠道的Flexible 柔软的，易曲的 将超声换能器并入内镜的头部或仅仅使用超声探头就现在就可以获得无法从浅表
224、探测到的胃肠疾病的影像 ,包括肠壁内或这肠表面(如胰腺疾病或淋巴结病变）。A further role of EUS is to guide fine-needle aspiration, which often provides pathologic confirmation ofsuspicious lesions. 超声内镜另外被用作细针穿刺的引导，可以对可疑的病灶进行病理学的确诊。In many cases, this approachappears to be even more accurate than conventional radiologic techniques suc
225、h abdominal ultrasonography orCT.Conventional 常规的，一般的Approach 方法 在许多病例中，这种方法比常规的放射学检查如腹部超声、CT 更精确。Thus, EUS is probably the single best test for diagnosing pancreatic tumors, particularly the small endocrinevarieties, with sensitivities approaching 95%. 因此，EUS 可能是最好的胰腺肿瘤诊断方法，尤其对小的内分泌肿瘤，灵敏度可达95。It is
226、 also the procedure of choice for imaging submucosal and other wall lesions of the gastrointestinal tract(overall accuracy of 65 to 70%) as well as for staging of a variety of gastrointestinal tumors (overall accuracy of90% or more).Submucosa 粘膜下层的EUS 同时是粘膜下层和其他胃肠道壁疾病的常规检查方法（总体准确率为65到 70），也是很多胃肠道肿瘤分
227、期的方法（总体准确率超过90） Preoperative staging is a critical element in the management strategy for tumors such as esophageal andpancreatic cancer, 肿瘤治疗的术前分期是非常关键的因素，尤其对食道癌和胰腺癌。31临床医学英语EUS can complement more conventional radiologic tests to help determine the resectability and curativepotential of surgery in
228、 these cases.Complement 补足，补充Conventional 常规的，惯例的，一般的 EUS 可以弥补常规的放射学检查方法来确定外科切除和治疗的可能性。In addition to its valuable diagnostic role, EUS is rapidly emerging as therapeutic tool.除了其有价值的诊断作用，EUS 正快速地成为治疗工具。One example is EUS-diercted celiac plexus neurolysis, a technique that appears to effective for t
229、hetreatment of pain in patients with pancreatic cancer.celiac plexus 腹腔丛Neurolysis 神经松紧术其中一个例子就是采取 EUS 导向的腹腔丛神经松紧术治疗胰腺癌所导致的疼痛。Unfortunately, this approach does not appear to work as well in patients with chronic pancreatitis. 不幸的是，这个治疗方法好像对慢性胰腺炎疗效不佳。Chapter 54 Benefit of Early enteral feeding versus
230、 parenteral nutrition 本篇篇名为早期肠内与肠外营养的优点比较。 病人的营养供给是必需的， 但选择的途径可以有所不同， 如肠内营养或肠外营养。比较而言，这两种营养均比较安全。本篇主要对一些病人的早期营养与肠外营养进行比较，结果提示，早期场内营养在降低感染和减少住院时间等方面有优势。 It is often said that enteral nutrition is safer and more efficacious than the parenteral route.人们通常认为肠内营养比肠外营养更安全,更有效.但这一观点并没有在早期的动物实验和临床研究中得到承认 Ho
231、wever a preliminary note of caution is raised from observations in experimental animals, which concludedthat outcomes of enteral and parentaeral nutrition were equivalent when animals with catheter sepsis wereeliminated.但是动物实验观察得到的初部结果告诉我们当导管脓毒症消除以后，肠内和肠外营养结果是类似的。 Numerous studies have shown that it
232、 is safe to feed the gut in the immediate postoperative period and thatthis practice does not place the integrity of intestinal anastomoses at risk.为数众多的研究标明术后即刻的肠内营养是安全的，同时对肠吻合口也不会带来风险。Early feeding has been studied primarily in two patient populations: those who have undergonegastrointestinal surg
233、ery and in traumatically injured or critically ill persons.早期进食实验最初是在两组实验病人中进行：一组是为胃肠术后病人，另一组为创伤或危重病人。 A recent meta-analysis reviewed 11 prospective, randomized, controlled trails that compared the practice ofearly enteral feeding to maintaining patients NPO after elective gastrointestinal surgery.
234、 最近的一项 meta 分析对 11 个随机分组前瞻性研究来对照择期胃肠术后早期肠内营养与禁食病人。This analysis of 837 patients concluded that there is no clear advantage to keeping patients NPOpostoperatively and that early feeding may be of benefit in decreasing infections and shortening postoperativelength of stay. 对 837 位病人的研究标明术后禁食病人（比早期肠内营养
235、）没有明显益处，而且早期进食可以降低感染率，缩短住院时间。However, a closer evaluation of this data reveals that the length of stay was reduced only by 0.84 day, andalthough there was an increase in any type of infection in the NPO group, whenconsidered individually, therewas no difference in the incidence of anastomotic dehisc
236、ence, wound infections, pneumonia, intra-abdominal32临床医学英语abscess, or mortality. 但是，另一项相近的研究认为禁食组病人虽然住院时间缩短了0.84 天，但 感染 发生率提高了，个别进行分析的结果表明，吻和口瘘，切口感染，肺炎，腹内脓肿及死亡率（两组间）没有差别。 In 2001 Marik and Zaloga performed a meta-analysis of 15 randomized, controlled trails involving 753subjects that compared early
237、with delayed enteral nutrition in critically ill surgical patients. Early enteralnutrition was associated with a significantly lower incidence of infection (relative risk reduction of 0.45) andreduced length of hospital stay (2.2 days less).2001 年 Marik 和 Zaloga 对 15 组 753 例危重外科病人进行了meta 分析以比较早期和晚期肠
238、内营养的疗效。早期肠内营养组感染发生率明显较低（相对风险降低0.45），住院日也有减少（少2.2 天）。 There were no differences in noninfectious complications or in mortality. The authors concluded that earlyinitiation of enteral feeding was beneficial, but this result must be interpreted with caution because ofsubstantial heterogeneity between st
239、udies. 非感染性并发症和死亡率无明显差别。 作者认为早期肠内营养是有益的， 但是考虑到研究中的差异性， 这个结果需要谨慎对待The studies that compared enteral and parenteral nutrition in the trauma population, as discussed earlier,concluded that enteral was superior because of an attenuated inflammatory response and a decrease in septicmorbidity.Attenuated 衰
240、减，减弱Inflammatory 炎症性septic morbidity 败血症发病率由于感染率和败血症发病率低， 正如先前所进行的创伤病人有关肠内和肠外营养的结果得出， 肠内营养超过肠外营养。When these studies are examined more closely, it is clear that patients who were fed enterally usuallyreceived significantly less calories than those fed parenterally.经过严密的研究发现肠内营养的病人吸收的热量明显少于肠外营养病人。This
241、 discrepancy of relative overfeeding in the TPN groups in many instances led to hyperglycemia,presumably predisposing patients to immune dysfunction and nosocomial infection.Discrepancy 不一致，偏差Hyperglycemia 高血糖症nosocomial infection 院内感染Predispose 成为因素 TPN 组相对营养过度使许多病人产生高血糖症，据推测可以导致免疫功能下降和院内感染。Thus, p
242、oor glucose control alone may account for the observed differences in outcome.account for 说明，解释 因此，血糖控制不佳可以解释说观察到的结果的差异。In more contemporary studies where feeds are carefully advanced in a manner that avoids hyperglycemiaand groups are fed equivalent protein and calories, there appears to be little
243、difference in clinical outcomebetween enteral and parenteral routes of feeding. Contemporary当代的，同代的Equivalent 相当的，相等的33临床医学英语 当代的研究发现，如果肠外营养经过改进避免高血糖的可能， 给予与肠内营养相似的蛋白质和热量， 两组之间的预后差异不大。Enteral nutrition also can endanger patient safety in unique ways.Endanger 使危险，危及 Unique 独特的肠内营养也可以危及病人的安危。Deaths in
244、 persons receiving enteral nutrition are often due to aspiration, for example when gastric motilitysuddenly is impaired with the onset of sepsisAspiration 误吸gastric motility肠内营养病人的死亡常常是由于误吸，如由于败血症的发生说导致的胃能动性的损伤。One death from aspiration is equivalent to the mortality over 2 to 3 years of well-operated parenteral nutritionprogram, despite the danger of catheter sepsis, which in well-operated units is now less than 1% to 3%.equivalent 相当的，相等的 catheter sepsis 导管脓毒症除了导管脓毒症的危险以外，通常在管理良好的单位发病率低于1至 3，误吸的死亡率与实行了23 年良好管理的肠外营养病人相当。34
