In SCD survivors, sustained monomorphic ventricular tachycardia is inducible by electrophysiologic testing in 40 to 50% and polymorphic VT in 10 to 20%; in 30 to 50%,no sustained arryhthmia is induced. （sustaine 持續(xù)、相同、維持 monomorphic 單一的、單形的)
在心源性猝死生還者中， 40~50%電生理試驗?zāi)苷T導(dǎo)持續(xù)單一型室性心動過速，10~20%能誘導(dǎo)多型的，30~50%不能誘導(dǎo)持續(xù)的節(jié)律異常。
In patients with ischemic heart disease and left ventricular dysfunction, inducibility of sustained VT carries a poor prognosis.
在缺血性心臟病和左室功能不全病人中，能誘導(dǎo)持續(xù)室性心動過速預(yù)后不良。
A low ejection fraction is associated with a poor prognosis, however, regardless of whether sustained VT is inducible; patients with an ejection fraction of 30% or less and who are noninducible have a 25% arrythmia recurrence rate at 1 year, whereas noninducible patients with an ejection fraction greater than 30 have a 10 to 15% recurrence rate.
（ejection fraction 射血分?jǐn)?shù) normotensive 血壓正常)
但是，不良預(yù)后與低射血分?jǐn)?shù)有關(guān)，不管持續(xù)室性心動過速是否能誘導(dǎo)，射血分?jǐn)?shù)30%以下和不能誘導(dǎo)者1年有25%心律失常復(fù)發(fā)率，而射血分?jǐn)?shù)大于30%的不能誘導(dǎo)者只有10~15%復(fù)發(fā)率。
In patients with SCD and idiopathic dilated cardiomyopathy, sustained monomorphic VT is rarely induced. （idiopathic 先天的、初發(fā)的、突發(fā)的)
心源性猝死和先天性擴張性心肌病病人中，持續(xù)單一型室性心動過速極少能誘導(dǎo)。
Neither the inability to induce VT nor the ability of drugs to suppress inducible polymorphic VT or VF is a predictor of a favorable outcome. （administer 執(zhí)行，實施 normotensive 血壓正常)
不能誘導(dǎo)室性心動過速不是，用藥物能控制的可誘導(dǎo)多型的VT和VF也不是良好結(jié)果的信號。
Chapter 22 Shortness of Breath
“shortness of breath”, “a feeling of not being able to get enough air”, and “l(fā)abored breathing” are all terms used by patients to describe the symptom of dyspnea. （Dyspnea 呼吸困難)
“氣促”“不能呼吸足夠空氣”和“用力呼吸”是病人描述呼吸困難癥狀時常用的詞。
The cause of dyspnea may be pulmonary disease, circulatory disease, or both.
呼吸困難的原因可能是肺部疾病，循環(huán)系統(tǒng)疾病或者兩者并存。 Pulmonary肺的 Circulatory循環(huán)
It is the physician’s responsibility to define the causative mechanisms of shortness of breath so that diagnostic techniques and therapies can be directed appropriately.
醫(yī)生應(yīng)該明確氣促的病因以便采用合適的診斷方法和治療。
The most consistent correlate of the symptom of dyspnea is increased mechanical work of breathing, usually brought on by increased airway resistance as occurs in asthma, chronic bronchitis, and emphysema, or decreased distensibility of the lungs as occurs in interstitial fibrotic reactions.
導(dǎo)致呼吸困難癥狀最大可能是呼吸機械阻力增加，通�？梢姷氖窍�慢性支氣管炎和肺氣腫導(dǎo)致的氣道阻力增加或者由于間質(zhì)纖維化反應(yīng)導(dǎo)致的肺膨脹性降低。
Consistent連貫的，一致的 Distensibility膨脹性 interstitial fibrotic reactions間質(zhì)纖維化反應(yīng)
In the latter disease, increased effort is required to produce a higher negative pressure in the pleural space to inflate the lungs. 間質(zhì)纖維化反應(yīng)病人需要更大的努力使胸腔負(fù)壓增加才能保證肺部充氣。（pleural space胸膜腔 Inflate充氣)
The increased mechanical work done on the lungs to overcome obstruction to airflow or decreased distensibility is perceived as an increased effort to breathe and produces the symptom of dyspnea.
用來克服氣道阻塞和膨脹性降低的機械原理的增加就表現(xiàn)出呼吸費力和困難的癥狀A(yù)n increased drive to ventilate may also cause dyspnea. Such stimuli include hypoxia, usually when arterial oxygen tensions are less than 60 mmHg, and stimuli from inflamed lung parenchyma, as occur in bacterial pneumonia or alveolitis and that drive the respiratory centers of the brain.
（Ventilate通氣 Hypoxia缺氧 arterial oxygen tensions動脈血氧張力)
通氣需求的增加也會導(dǎo)致呼吸困難。這類刺激包括了缺氧，通常動脈血氧張力低于60mmHg,或者見于細(xì)菌性肺炎或者肺泡炎導(dǎo)致的肺實質(zhì)炎癥促使腦部呼吸中心增加通氣需求。
These stimuli often lower the resting carbon dioxide pressure (Pco2) to less than the normal level of 40 mmHg and cause dyspnea, especially on mild exertion.
尤其在輕度體力負(fù)荷情況下，這些刺激通常使靜止二氧化碳壓力（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線片)
肺栓塞病人也可能出現(xiàn)氣促，但是胸部X線片表現(xiàn)正常。
However, the inefficiency of the embolized lung for gas exchange, characterized by an enlarged deadspace, requires abnormally high ventilatory rates to maintain a normal arterial Pco2.
但是肺栓塞使死腔擴大，氣體交換不充分，從而需要高頻率的通氣以保證動脈Pco2維持在正常水平。
Unless this particular presentation of pulmonary embolism is appreciated, embolic disease goes unrecognized in many patients until they suddenly die or are extremely incapacitated by pulmonary hypertension and right ventricular failure.
除非有特殊的臨床表現(xiàn)，很多肺栓塞病人很難發(fā)現(xiàn)直至出現(xiàn)突然死亡或者由于肺性高血壓或右心室衰竭而導(dǎo)致的極度功能障礙。
Because of the high prevalence of heart disease and heart failure in the general population, many patients with dyspnea have cardiac abnormalities.
由于心臟疾病和心衰的高發(fā)，很多呼吸困難的病人有心功能的異常。
The basis of the dyspnea is usually a high filling pressure of the left ventricle, which cuases high left atrial pressures and high pulmonary capillary and pulmonary arterial pressures, which in turn increase the pulmonary blood volume and reduce lung compliance.
呼吸困難的基礎(chǔ)通常是左心室充盈壓增高導(dǎo)致肺毛細(xì)血管和肺動脈壓的增加，從而肺血流量提高，肺順應(yīng)性降低。
If the pulmonary capillary wedge pressure is in the range of 25 mmHg, capillary fluid transudates into the pulmonary matrix, thereby reducing lung compliance, increase the work of breathing, and causing dyspnea.
如果肺毛細(xì)血管楔壓在25mmHg左右，毛細(xì)血管液就會漏出至肺基質(zhì)，從而降低了肺順應(yīng)性，導(dǎo)致呼吸用力增加，引起呼吸困難。
Echocardiography is usually diagnostic of abnormal ventricular or valvular function and should be performed in any patient in whom the cause of dyspnea is not readily apparent.
超聲心動圖通常被用來診斷心室和瓣膜異常，對任何呼吸困難病因不明確的病人均 可采用。
Chapter 25 Cancer of unknown primary origin
DefinitionThe first signs or symptoms of cancer are frequently due to metastases to visceral or nodal sites （Visceral內(nèi)臟的) 腫瘤的第一個癥狀或體征往往是由于內(nèi)臟或淋巴結(jié)轉(zhuǎn)移
In most such patients, routine clinical evaluation with a comprehensive history, physical examination, complete blood cell count, screening chemistries, and directed radiologic evaluation of specific symptoms or signs identifies the primary tumor.
大多數(shù)此類病人，需要進行常規(guī)的臨床檢查，如詳細(xì)的病史詢問，體格檢查，全血細(xì)胞計數(shù)，生化篩選及根據(jù)特定的癥狀和體征進行定向的放射學(xué)檢查
Patients who have no primary tumor located after this routine clinical evaluation are defined as having cancer of unknown primary site.
常規(guī)臨床檢查后如果沒有發(fā)現(xiàn)原發(fā)腫瘤，被稱為原發(fā)灶不明的腫瘤。
EtiologyIn patients whose primary site of cancer remains undetectable, the primary site presumably has remained small or, less likely, has regressed spontaneously.
如果病人原發(fā)腫瘤無法檢測到，有可能腫瘤尚小，或者自然退化。
Large autopsy series before the routine use of computed tomographic scans or magnetic resonance imaging identified small primary sites of cancer in 85% of patients with previously unidentified primary tumors,
在CT和核磁共振常規(guī)應(yīng)用之前，大批量的尸體解剖發(fā)現(xiàn)85％原發(fā)灶不明的腫瘤可以發(fā)現(xiàn)原發(fā)小腫瘤，
usually in the pancreas, lung, and various other gastrointestinal sites; with current use of computed tomography and magnetic resonance imaging, however, autopsy series have identified primary sites in only 50-70% of patients.
常見于胰腺，肺部和其他胃腸部位，而CT和核磁共振應(yīng)用以后，尸檢只能發(fā)現(xiàn)50－70％的原發(fā)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
約3％腫瘤轉(zhuǎn)移的病人不能發(fā)現(xiàn)原發(fā)部位，美國一年大約發(fā)生50000到60000例
Cancer of unknown primary site occurs with approximately equal frequency in men and women, and it increases in incidence with advancing age.
原發(fā)灶不明腫瘤男女發(fā)病率相似，隨年齡增加發(fā)病率也有提高
Clinical and pathologic evaluationSince all patients with cancer of unknown primary site have advanced disease, therapeutic nihilism has been common.
Nihilism虛無幻想，懷疑的
因為很多原發(fā)灶不明的病人病程久遠(yuǎn)，通常認(rèn)為治療效果不佳。
However, it is now evident that this heterogeneous group contains 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.
但是現(xiàn)在已經(jīng)明確，這個特質(zhì)人群中包括了很多完全不同的預(yù)后病人，有些患者對治療高度敏感，另外一些病人經(jīng)過適當(dāng)治療可以出現(xiàn)本質(zhì)上的改善從而延長
The initial clinical and pathologic evaluation should therefore focus on identifying a primary site when possible and on identifying patients for whom specific treatment is indicated.
最初的臨床和病理評估應(yīng)僅可能尋找原發(fā)部位，同時為患者確定特效的治療。
In the majority of patients with cancer of unknown primary site, the diagnosis of advanced cancer is strongly suspected after the initial history and physical examination.
大多數(shù)原發(fā)灶不明的腫瘤病人，經(jīng)過初步的病史和體格檢查，基本能夠確定晚期癌癥的診斷。
A brief additional evaluation, including complete blood cell counts, chemistry profile, and computed tomography of the chest and abdomen should be performed.
其他的附加檢查，包括全血細(xì)胞計數(shù)，生化檢查和胸部腹部CT。
In addition, specific symptoms or signs should be evaluated with appropriate radiologic and endoscopic studies.
有特殊癥狀和體征的病人可以使用合適的放射學(xué)和內(nèi)鏡檢查。
If a primary site is located, management should follow guidelines for the specific cancer identified.
如果確定了原發(fā)部位，應(yīng)根據(jù)特定的腫瘤治療指南進行治療。
In patients with no obvious primary site, the most accessible site should be biopsied.
那些無明顯原發(fā)病灶的病人，應(yīng)對最可疑的部位進行活檢。
Fine needle aspiration may or may not provide sufficient material for optimal histologic examination and special pathologic procedures. （Optimal理想的，足夠的)。細(xì)針穿刺能否取得足夠的組織進行組織學(xué)和特殊的病理學(xué)檢查。If tissue is inadequate, a larger biopsy sample should be obtained so that all necessary stains and procedures can be performed. 如果組織不夠，需要進行較大的活檢樣本以便進行必要的染色和操作。
Chapter 28 Surgical complications
Postoperative surgical complications represent one of the most frustrating and difficult occurrences experienced by surgeons who do a significant volume of surgery.
Frustrating無效的，挫折的
外科術(shù)后并發(fā)癥是經(jīng)驗豐富的外科醫(yī)生最困擾和最難對付的困擾之一。
Regardless of how technically gifted, bright, and capable a surgeon is, surgical complications are a virtually guaranteed aspect of life. （Virtually事實上)
不管外科醫(yī)生有多大的能力，技術(shù)高超，聰明智慧，外科并發(fā)癥 也很難免。
