1、CLINICAL MED ENGLISH英语基本都在里面了，我们那年多了个单词“体温表”中翻英I. WORDS LIST替代与补充治疗 alternative and complementary therapies营养 nutrition健康的生活方式 healthy lifestyles免疫接种 immunizations收缩压/舒张压 systolic/diastolic blood pressure呼吸困难 dyspnea呼吸急促 tachypnea呼吸减弱 hypopnea并存病 comorbidities亚临床疾病 subclinical disease不良后果 adverse ou
2、tcomes消化性溃疡（病） peptic ulcer（disease）关节炎 arthritis（静默型）心肌梗死 （silent）myocardial infarction疾病谱 spectrum of diseases体重减轻 weight loss动脉粥样硬化 atherosclerosis慢性疾病终末期 end-stage chronic disease心力衰竭 heart failure理疗 physical therapy生物人工肝装置 bioartificial liver devices自体细胞 autologous cells生长因子 growth factors胃肠道出血
3、 gastrointestinal bleeding上消化道和下消化道 upper and lower gastrointestinal tracts绝经前的 premenopausal活检 biopsy炎性肠病 inflammatory bowel disease血管造影术 angiography胶囊小肠镜 capsule enteroscopy哮喘 asthma慢性支气管炎 chronic bronchitis肺气肿 emphysema低氧，缺氧 hypoxia肺栓子（塞） pulmonary emboli（sm）肺顺应性 lung compliance糖尿病性肾病 diabetic ne
4、phropathy预期寿命（预期生存时间） life expectancy自然病程 natural history高血糖 hyperglycemia微量白蛋白尿 microalbuminuria原发肿瘤 primary tumor病因学 etiology晚期癌症 advanced cancer未足月产 preterm labor流行性感冒 epidemic influenza影像学检查 imaging tests急性胆囊炎 acute cholecystitis胆石 gallstones内镜超声检查 endoscopic ultrasonography胰腺肿瘤 pancreatic tumor
5、s术前分期 preoperative staging慢性胰腺炎 chronic pancreatitis心律失常 cardiac arrhythmia冠状动脉疾病 coronary artery disease肥厚型心肌病 hypertrophic cardiomyopathy心肌炎 myocarditis（持续性单一型）室性心动过速 （sustained monomorphic） ventricular tachycardia特发性扩张型心肌病 idiopathic dilated cardiomyopathy胃肠穿孔 gastrointestinal perforation剖腹术 celi
6、otomy免疫抑制 immunosuppression肠吻合术 intestinal anastomoses择期胃肠手术 elective gastrointestinal surgery腹腔脓肿 intra-abdominal abscess切口（创口）感染 wound infections院内感染 nosocomial infection误吸 aspirationII. PARAGRAPH TRASLATIONi. The patient-physician interaction proceeds through many phases of clinical reasoning and
7、 decision making. The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways. The process commonly requires a careful history or physical examination, ordering of diagnostic tests, integration of cl
8、inical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans. Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so
9、that benefit is maximized, while respecting individual variations among different patients.医患沟通需要通过多阶段的临床循证和决策来进行。这种沟通始于对担忧或关注的事物的阐述，接着进行咨询或评价，从而以更精确的方式处理这些所关注的事物。这个过程通常要求了解详细的病史或体格检查，需要进行诊断性试验，结合临床发现和试验结果，了解各种行为过程可能的益处与风险，并与患者和家属仔细商议从而制定今后的计划。医生越来越依靠不断增加的循证医学文献来指导这一过程，为的是使患者获益最大化，并能注重不同患者间个体的差异。ii.
10、 Fourth, cognitive impairment increases in prominence as people age. Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization, dependency, institutionalization, and mortality. Cognitive impairment complicates diagnosis and requires additional care g
11、iving to ensure safety.第四方面，认知损害会随着年龄的增长而逐渐凸显。认知损害是一系列不良后果的危险因素之一，包括摔跤，运动不能，依赖他人，居住于社会慈善机构以及死亡。认知损害使得诊断变得复杂，并需要额外的看护以确保病人安全。iii. In the face of continued blood loss and no identified etiology, intraoperative endoscopy may provide simultaneous diagnosis and therapy. During the procedure, the surgeon
12、plicates the bowel over the endoscope. As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. The yield of this procedure exceeds 70%. In some clinical situations, the site of bleeding cannot be identified, and the patient requires long-term transfusion
13、 therapy.当出血继续而无法确定病因时，术中内窥镜检查可以同时提供诊断和治疗。在这一过程中，外科医生需将内窥镜穿过小肠。当内窥镜退出时，内镜下的发现可以为外科切除或明确治疗手段提供依据。这个检查过程的获益率超过 70%。在某些临床情况下，出血部位仍然不能确定，而病人就需要长期的灌注治疗。iv. An increased drive to ventilate may also cause dyspnea. Such stimuli include hypoxia, usually when arterial oxygen tensions are less than 60mmHg, and
14、 stimuli from inflamed lung parenchyma, as occur in bacterial pneumonia or alveolitis and that drive the respiratory centers of the brain. These stimuli often lower the resting carbon dioxide pressure (Pco2) to less than the normal level of 40mmHg and cause dyspnea, especially on mild exertion.刺激通气增
15、加的因素也可产生气促。这类因素包括低氧和肺实质炎症，低氧常发生于动脉血氧分压低于 60mmHg 时，肺实质炎症则可源于细菌性肺炎或肺泡炎，并能刺激大脑的呼吸中枢。这些刺激因素常常会使二氧化碳分压降低到正常水平下 40mmHg 并引起气促，尤其是。v. After several years, most diabetic patients exhibit diffuse glomerulosclerosis, although a minority have pathognomonic Kimmelsteil-Wilson nodular lesions. Although pathologic
16、 changes continue to mount throughout the disease, glomerulosclerosis extensive enough to cause ESRD develops in a minority of patients; in these cases, overt albuminuria (3000mg/day) begins approximately 15 years after diagnosis. Soon after, following a variable period on the order of 3 to 5 years,
17、 the GFR begins a relentless decline (10ml/min/year), which is eventually reflected by an increase in serum creatinine. The appearance of massive proteinuria and the nephritic syndrome is common in this context and often heralds progression to ESRD. Once the serum creatinine rises (reflecting an app
18、roximately 50% decline in GFR), ESRD develops in most patients within 10 years. This course is highly variable, however, particularly in type 2 diabetics, who may exhibit moderate proteinuria for several years without a substantial deterioration of renal function. A simple but useful method of monit
19、oring progression to renal failure is to plot the reciprocal of the serum creatinine as a function of time. This technique allows better assessment of both therapeutic interventions and the time when renal replacement therapy will become necessary. 若干年后，尽管只有少数人出现特异病征性的 Kimmelsteil-Wilson 结节病灶，但大多数糖尿
20、病人都开始出现肾小球硬化症。虽然病理学改变在疾病过程中是持续积累的，但少数病人肾小球硬化病变已足够广泛而发展为终末期肾病；这些病例中，确诊大约 15 年后开始出现大量蛋白尿（大于300mg/day） 。很快，约 3 到 5 年后，肾小球滤过率开始快速下降（10ml/min/year ） ，最终表现为血清肌酐水平升高。大量蛋白尿和肾病综合征在这一过程中很常见，而通常也预示着发展为终末期肾病。一旦血清肌酐水平升高（反映了肾小球滤过率降低大约 50%） ，大多数病人将在 10 年内发展为终末期肾病。尽管如此，这个过程是多变的，尤其对于 2 型糖尿病人来说，他们可以出现中度蛋白尿若干年而没有发生实质上
21、的肾功能损害。为监测进展为肾衰的过程，有一种简单而有用的方法就是绘制血清肌酐水平的倒数随时间变化的曲线。这种方法能够更好地确定何时进行治疗干预并且何时应进行肾功能替代治疗。vi. Clinical and pathologic evaluationSince all patients with cancer of unknown primary site have advanced disease, therapeutic nihilism has been common. However, it is now evident that this heterogeneous group con
22、tains subsets of patients with widely diverse prognoses; some cancers are highly responsive to treatment, and some patients may have a substantial chance of achieving long-term survival with appropriate treatment. The initial clinical and pathologic evaluation should therefore focus on identifying a
23、 primary site when possible and on identifying patients for whom specific treatment is indicated.临床和病理评估由于原发灶不明的转移性肿瘤病人都属于晚期癌症病人，所以治疗常常是徒劳无功的。尽管如此，现在有证据显示病人之间存在个体差异而表现出许多不同的疾病预后；有些癌症病人对治疗表现出高度反应，并且有些病人在进行恰当的治疗后可以获得确实的长期生存的机会。因此，最初的临床和病理检查应注意尽可能确定原发灶并且确定病人可否行特异性治疗。vii. In the management of the pregna
24、nt trauma patient, the critical point is that resuscitation of the fetus is accomplished by resuscitation of the mother. Therefore, the initial evaluation and treatment of the pregnant injured patient is identical to that of the nonpregnant injured patient. Rapid assessment of the maternal airway, b
25、reathing, and circulation and ensuring an adequate airway avoids maternal and fetal hypoxia. In the later stages of pregnancy, as already described, uterine compression of the vena cava may result in hypotension from diminished venous return, so the pregnant trauma patient should be placed in left l
26、ateral decubitus position. If spinal cord injury is suspected, the patient may be secured to a backboard and then tilted to the left. The increased blood volume associated with pregnancy has important implications in the trauma patient. Signs of blood loss such as tachycardia and hypotension may be
27、delayed until the patient loses nearly 30% of her blood volume. As a result, the fetus may be experiencing hypoperfusion long before the mother manifests any signs. Early and rapid fluid resuscitation should be administered even in the pregnant patient who is normotensive. 治疗孕期创伤的关键在于通过复苏母体来完成对胎儿的复苏
28、。因此，对孕期创伤病人的初步评估及治疗和对非孕期创伤病人是一样的。快速地确定母体气道、呼吸及循环的情况并且确保足够的气道供气能避免母体和胎儿缺氧。如前所述，在怀孕的后期，腔静脉因子宫压迫而回心血量减少导致了低血压产生，因此孕期创伤病人应置于左侧卧位。如怀疑脊髓损伤，应将病人固定于靠板上然后再侧向左方。怀孕后引起的血容量增加对创伤病人来说有很重要的意义。当病人失血近 30%时才会出现诸如心动过速和低血压的失血体征。结果，在母体表现出任何体征前胎儿可能长时间经历血流灌注不足。即使是血压正常的怀孕病人也应尽早进行快速的液体复苏治疗。viii. Postoperative surgical compl
29、ications represent one of the most frustrating and difficult occurrences experienced by surgeons who do a significant volume of surgery. Regardless of how technically gifted, bright, and capable a surgeon is, surgical complications are a virtually guaranteed aspect of life. The cost of surgical comp
30、lications in the United States today runs into millions of dollars and is associated with lost work productivity, disruption of normal family life, and unanticipated stress to employers and society in general. Frequently, the functional results of the operation are compromised by complications; in s
31、ome cases, the patient never recovers to the preoperative level of function. The most significant and difficult part of complications is the suffering borne by the patient who enters the hospital anticipating an uneventful operation but is left suffering and compromised by the complication.术后并发症的发生对
32、于有大量手术经验的外科医生来说是一件令其最受打击和最为难的事情。不论一个外科医生的天赋技能、聪明智慧以及能力才干如何，术后并发症在日常生活中是常发生的事。现在美国外科并发症的处理需耗费数百万美元，总的来说会导致病人失去工作能力、日常生活能力，并对雇主和社会产生无法预期的压力。通常，手术会因为并发症的发生而对机体功能产生影响；在某些病例中，病人再也无法恢复到手术前的功能水平。病人入院后期望手术平安无事，但却受术后并发症的折磨和困扰，病人的这种负担是术后并发症最重要和最困难的部分。ix. Epidemics occur almost exclusively during the winter mo
33、nths in temperate areas, but influenza activity may continue year-round in the tropics. Outbreaks may occur in tour groups (land or ship) and in facilities during summer months, particularly after the appearance of a drift variant. Regional differences in the time and magnitude of occurrence of infl
34、uenza outbreaks are common. During epidemics, the overall attack rates typically average 5 to 20% in adults. Attack rates of 40 to 50% are not uncommon in closed populations, including those in hospitals and nursing homes, and in certain highly susceptible age groups. Two different strains within a
35、single subtype, two different influenza A subtype (H1N1 and H3N2), or both influenza A and B viruses may cocirculate. In addition, simultaneous outbreaks of influenza A and respiratory syncytial viruses have been found. Strains circulating at the end of one seasons epidemic are sometimes responsible
36、 for the next seasons outbreak (the so-called herald wave phenomenon). Furthermore, other than the association of influenza outbreaks with colder seasons, the factors that allow an epidemic to develop or those responsible for the tapering off of an epidemic when only some susceptible persons have be
37、en infected are unknown.在温带地区流感几乎只在冬季发生，而在热带地区流感可以全年都有。流感暴发可能出现在夏季的旅行团（陆路或水路）和交通工具内，尤其是在气候变化后。流感暴发的时间和程度在地域上的差别是很常见的。在流感期间，成年人患病率通常在 5%到 20%间。在一些封闭群体譬如医院和护理机构以及高度易感的某年龄段人群，流感的患病率可达 40%到 50%也并非罕见。同亚型不同菌株，如 A 亚型不同菌株（ H1N1 和 H3N2） ，或者 A 型和 B 型流感病毒都可能共同传播。并且，人们也发现了 A 型流感病毒和呼吸道合胞病毒同时暴发的例子。在一个季节流感结束的时候菌株的
38、传播可能是引起下一季流感暴发的原因（因而被称为前峰波现象） 。另外，除了流感暴发与寒冷季节相关性明确外，其他影响流感发展的因素或者当只有易感人群感染时能逐渐减少流感发生的因素都尚不清楚。x. How should the choice between CT or ultrasonography be made in a patient who presents with acute abdominal pain? More specifically, when is it appropriate to move directly to CT? In general, if the pain i
39、s not biliary in character, is not localized to the right upper quadrant, or occurs in an obese patient, CT is preferred because it often reveals previously unsuspected abnormalities. At least three other imaging choices exist: (1) no imaging study; (2) a plain radiographic series of the abdomen (te
40、chnically and economically similar to the chest radiograph but generally not as useful); and (3) MRI of the abdomen or pelvis (usually reserved for more complex situations or after failure to diagnose with other methods). Other than identifying free intraperitoneal air (perforated viscus), gas patte
41、rns of bowel obstruction, and radiodense ureteral calculi, the traditional abdominal series, although the least expensive test, is considered generally inferior to CT and has been largely replaced by CT. A current-generation multislice helical CT scanner can generate 5-mm sections of the entire abdo
42、men and pelvis in about 1 minute. It is helpful to use oral and intravenous contrast material to opacify (and identify) loops of bowel and vascular structures. 急性腹痛病人应如何选择 CT 或超声检查？特别是何时应直接行 CT 检查？通常，如考虑非胆道性疼痛，定位于右上腹以外位置或者肥胖病人疼痛，医生应选择 CT 检查，这是因为它常能揭示先前未曾预料的疾病。至少有三种其他的影像学检查的选择：（1）不进行影像学检查；（2）腹部平片检查（技
43、术上和经济上和胸片检查相似但并不像胸片那么有用） ；以及（3）腹部或盆腔核磁共振检查（通常在对更复杂部位检查时或其他检查手段无法诊断时应用） 。除了用于确定腹腔内游离气体（内脏穿孔） ，肠梗阻的气体影和输尿管结石的高密度影之外，在其他检查方面传统的腹部平片检查虽然价格最低，但其效果逊于 CT 检查而被大量取代。现代的多层螺旋 CT 扫描仪可使得全腹影像的每层薄度达到 5mm 而在盆腔可达到 1mm。使用口服和静脉对比剂可有助于让肠襻以及血管结构变透明（从而加以判断） 。xi. In assessing prognosis and planning a treatment strategy, i
44、t is useful to classify SCD as either primary (without a clear trigger) or secondary. A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associated with recurrence rates of less than 2%. Identifiable reversible precipitants of secondary ventricular fibrilla
45、tion (VF) include transient ischemia possibly related to vasospasm; hypokalemia resulting from diuretics; hyperkalemia secondary to renal failure, angiotensin-converting enzyme inhibitors, prostaglandin inhibitors, or potassium-sparing diuretics; proarrhythmia secondary to antiarhythmics, tricyclics
46、, and antihistamines; or substance abuse with drugs such as cocaine and amphetamines. Therapy is directed toward removing or treating the acute precipitant. SCD related to acute ischemia in the absence of prior MI often is associated with severe proximal occlusive disease, normal left ventricular fu
47、nction, normal signal-averaged ECG, and noninducibility absence of ventricular tachycardia (VT) during electrophysiologic study.将心源性猝死归为原发（即找不到触发原因）或继发有助于评估预后并制定治疗策略。主要事件的 1 年复发率约为 10%到 30%，而次要事件的复发率小于 2%。已知可继发心室纤颤的可逆因素包括短暂缺血引起的血管痉挛；利尿剂引起的低钾血症；肾衰、血管紧张素转化酶抑制剂、前列腺素或保钾利尿剂引起的高钾血症；抗心律失常药、三环类药物和抗组胺药的致心律失常
48、作用；或者滥用譬如可卡因和安非他命等药物。治疗的目的在于去除或处理急性的触发因素。无心梗史的急性心肌缺血所引起的心源性猝死往往伴随着严重的近端冠脉闭塞，而左心室功能正常，心电图显示正常范围，电生理检查不可诱导（无室性心动过速） 。xii. Some patients with clear findings of the acute abdomen may be treated without surgical operation. For example, patients with perforated duodenal ulcer who seek attention late in th
49、e course of their disease after they have been sick for several days may be treated best by careful supportive care including nasogastric suction, intravenous fluids, and pain relief. Certain patients with empyema of the gallbladder, especially those with other serious concomitant illnesses, can be treated by percutaneous drainage of the infected gallbladder and careful supportive care rather than with cholecystectomy. 某些急腹症原因明确的病人可以行保守治疗。比如，对发病若干天后才确诊的十二指肠溃疡穿孔的病人，最好的处理方法应是细致的支持治疗，包括鼻胃管鼻饲，静脉输液和缓解疼痛。对于某些胆囊积脓的病人，尤其是伴有其他严重合并症的，可行经皮穿刺胆囊引流并辅以细致的支持治疗，而不是行胆囊切除术。xiii. The studies that compared e
