The cost of surgical complications 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.
當(dāng)前美國(guó)的外科術(shù)后并發(fā)癥浪費(fèi)了無數(shù)的金錢，同時(shí)導(dǎo)致勞動(dòng)能力的喪失，正常家庭生活的破壞，而且為雇主和社會(huì)帶來了無法預(yù)料的壓力。
Frequently, the functional results of the operation are compromised by complication; in some cases, the patient never recovers to the preoperative level of function.
通常術(shù)后并發(fā)癥影響了手術(shù)的效果，某些病人無法恢復(fù)到術(shù)前的功能狀態(tài)。
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.最嚴(yán)重和難對(duì)付的并發(fā)癥就是看到那些本以為進(jìn)行安全性很高的手術(shù)，結(jié)果卻導(dǎo)致了術(shù)后的痛苦和并發(fā)癥。Complications can occur for a variety of reasons. 外科并發(fā)癥的發(fā)生有多種原因。
A surgeon can perform a technically perfect operation in a patient who is severely compromised by the disease process and still have a complication.
有時(shí)，外科醫(yī)生手術(shù)技術(shù)上非常成功，但病人的病情嚴(yán)重可導(dǎo)致并發(fā)癥的發(fā)生。
Similarly, a surgeon who is sloppy, is careless, or hurries through an operation can make technical errors that account for the operative complications.
同樣，手術(shù)中醫(yī)生的馬虎、粗心或倉促都可以導(dǎo)致技術(shù)上的錯(cuò)誤從而導(dǎo)致手術(shù)并發(fā)癥
Finally, the patient can be doing well nutritionally, have an operation performed meticulously, and yet suffer a complication because of the nature of the disease.
最后，病人營(yíng)養(yǎng)狀況良好、手術(shù)非常細(xì)心，疾病本身也可以導(dǎo)致并發(fā)癥的發(fā)生。
The possibility of postoperative complications is a part of every surgeon’s thought processes-something with which all surgeons will be required to deal.
手術(shù)后并發(fā)癥的可能性是每一個(gè)外科醫(yī)生考慮治療計(jì)劃的一個(gè)組成部分，因?yàn)樗型饪漆t(yī)生都將面臨這些并發(fā)癥中的一部分。 Surgeons can do much to avoid complications by the careful preoperative screening process. 外科醫(yī)生可以在術(shù)前進(jìn)行精心篩選以避免術(shù)后并發(fā)癥。
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許許多多，一大堆) 當(dāng)外科醫(yī)生第一次見到即將手術(shù)的病人時(shí)，需要考慮很多問題，如這個(gè)病人的營(yíng)養(yǎng)狀況或者心肺功能是否正常。
The surgeon will make a decision regarding performing the correct operation for the appropriate disease.外科醫(yī)生需要為病人作出正確的手術(shù)方式選擇。Similarly, the timing of the operation is often an important issue同樣的，手術(shù)時(shí)機(jī)也是一個(gè)重要的因素。
Some operations can be performed in a purely elective fashion, whereas others have some urgency about an expeditious surgical solution. （Expeditious迅速地，敏捷地)一些手術(shù)可以擇期進(jìn)行，而有些可能需要進(jìn)行急診手術(shù)。Occasionally, the surgeon will demand that the patient lost weight before the operation so that the likelihood of a successful outcome is improved. 有時(shí)候，外科醫(yī)生會(huì)要求病人術(shù)前減輕體重以提高手術(shù)的成功率。Occasionally, the wise surgeon will request preoperative consultation from a cardiologist or pulmonary specialist to make certain that patient will be able to tolerate the stresses of a particular procedure. 有時(shí)，明智的外科醫(yī)生會(huì)請(qǐng)心臟或呼吸系統(tǒng)專家進(jìn)行術(shù)前會(huì)診以確定病人是否能耐受特定手術(shù)。
Chapter 30 Epidemic influenza 第三十篇 流行性感冒
An epidemic is an outbreak of influenza confined to one geographic location.
流行性感冒是指一個(gè)地理區(qū)域中的感冒的爆發(fā)。
In a given community, epidemics of influenza A virus infection often have a characteristic pattern.
在某些特定的社區(qū)，流感病毒A型的傳播通常有特征性的模式。
They usually begin rather abruptly, reach a sharp peak in 2 or 3 weeks, and last 6 to 10 weeks.
通常爆發(fā)性流行，在2至3周內(nèi)直線到達(dá)峰值，并持續(xù)6至10周。
Increased numbers of schoolchildren with febrile respiratory illness are often the first indication of influenza in community.
社區(qū)中流感發(fā)生的第一個(gè)跡象就是學(xué)生發(fā)熱呼吸道疾病。
This indication is soon followed by illnesses among adults and about a week later by increased hospital admissions of patients with influenza-related complications.
隨后的表現(xiàn)有成人的發(fā)病，一周以后感冒相關(guān)的并發(fā)癥引起的入院病人增加。
Hospitalization rates in high-risk persons increase two- to five fold during major epidemics.
在感冒大流行期間，高危住院病人住院率可能增加二到五成。
School and employment absenteeism increases, as does mortality from pneumonia and influenza, especially in older persons.
缺學(xué)和曠工的情況增加，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.
后一項(xiàng)發(fā)現(xiàn)是流感活動(dòng)高度特異性指標(biāo)。
Epidemics occur almost exclusively during the winter months in temperate areas, but influenza activity may continue year-round in the tropics.
在溫帶地區(qū)流感基本發(fā)生在冬季，但熱帶區(qū)域流感在全年均有發(fā)生。
Outbreaks may occur in tour groups (land or ship) and in facilities during summer months, particularly after the appearance of a drift variant.
流感爆發(fā)可出現(xiàn)在夏季旅游團(tuán)隊(duì)（陸地和船舶)及建筑物內(nèi)，尤其是在不同地點(diǎn)遷徙后。
Regional differences in the time and magnitude of occurrence of influenza outbreaks are common
流感發(fā)生的時(shí)間和強(qiáng)度區(qū)域差異基本類似。
During epidemics, the overall attack rates typically average 5 to 20% in adults.
成人的流感發(fā)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 nursing homes, and in certain highly susceptible age groups.
封閉人群中，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 single subtype, two different influenza A subtypes(H1N1 and H3N2), or both influenza A and B viruses may cocirculate.
一個(gè)亞群中的兩個(gè)不同菌株，兩種不同的流感A病毒亞群，或者流感A和B病毒均能發(fā)生互相傳播。
In addition, simultaneous outbreaks of influenza A and respiratory syncytial viruses have been found.
而且，也有報(bào)道發(fā)現(xiàn)A型流感病毒和呼吸道合胞病毒同時(shí)感染。
Strains circulating at the end of one season’s epidemic are sometimes responsible for the next season’s outbreak (the so-called herald wave phenomenon).
每個(gè)季度末期流行的菌株通常會(huì)導(dǎo)致下一輪流感爆發(fā)（ the so-called herald wave phenomenon)
Furthermore, other than the association of influenza outbreaks with colder seasons, the factors that allows an epidemic to develop or those responsible for the tapering off of an epidemic when only some susceptible persons have been infected are unknown.
而且，除了流感爆發(fā)與氣候寒冷有關(guān)以外，流感爆發(fā)或逐漸消失而僅影響易感人群的機(jī)制尚不清楚。
Pneumonia and influenza (P+I)- related deaths fluctuate annually, with peaks in the winter months.
肺炎和流感相關(guān)死亡一年中有波動(dòng)，冬季為高峰期。
When such P+I deaths exceed the predicted number, it is due to influenza A or occasionally to influenza B virus or respiratory syncytial virus activity.
如果肺炎流感死亡超過預(yù)期數(shù)字，這是A型流感所造成的，偶爾也有可能為B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大范圍流傳 Over 85% of P+I deaths occur among persons aged 65 and older.
超過85％的肺炎流感死亡發(fā)生于超過65歲的老年人群。
Other cardiopulmonary and chronic diseases also result in increased mortality after influenza epidemics, so that 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，因此總的流感相關(guān)的死亡率比肺炎流感的死亡率高20％——40％。
Chapter 35 Principles of ordering imaging tests
本篇篇名為影像檢查的選擇原則。影像學(xué)檢查在臨床的診治中是不可或缺的，但如何選擇則有原則可循。本篇主要介紹選擇影像學(xué)檢查的基本原則，列舉了幾種常見影像學(xué)檢查的比較。
As a general rule, when confronted with two reasonable alternatives, it is advisable to choose the least expensive, safest, and least uncomfortable imaging examination first.
通常來說，如果有兩種檢查方法可以選擇，首先我們會(huì)使用低價(jià)位，安全和較舒適的影像檢查。
For acute right upper quadrant abdominal pain, ultrasonography is usually the procedure of choice because it is less expensive than CT, primarily because the imaging equipment is cheaper.
對(duì)急性右上腹痛，超聲是常規(guī)的檢查方法，因?yàn)樗菴T更便宜，原因在于影像設(shè)備的便宜。
Although ultrasound is more subjective and operator dependent than CT, ultrasound can yield exquisite visualization of the biliary tree, including the gallbladder and the pericholecystic space, in which fluid can be a sign of acute cholecystitis.
雖然超聲比CT更加主觀，更加以來于操作人員的經(jīng)驗(yàn)，但超聲對(duì)膽道的圖像非常精確，包括膽囊和膽囊周圍的空間，如急性膽囊炎可表現(xiàn)出液體。
UItrasonography also confirms or denies the presence of gallstones in the gallbladder with high accuracy that at least equals that of CT, and ultrasonography can detect biliary dilations and masses in the liver and pancreas
超聲對(duì)膽囊中膽石是否存在的精確度超過至少與CT相似，超聲也能確定膽管是否擴(kuò)張及肝臟或胰腺的占位病變。
Ultrasonography can be difficult and suboptimal in patients who are obese or who have a distended abdomen.
超聲檢查對(duì)肥胖或腹脹病人的診斷比較困難或效果不佳。
Ultrasonography is generally less accurate in surveying the remainder of the abdomen, an important issue when the pain is less localized.
超聲對(duì)診斷腹部殘留物的診斷不佳，尤其是腹部不局限的情況下。
How should the choice between CT or ultrasonography be made in a patient who presents with acute abdominal pain?
急腹癥時(shí)如何選擇CT或者超聲診斷呢？
More specifically, when is it appropriate to move directly to CT？
更具體地說，什么時(shí)候可以直接進(jìn)行CT檢查？
In general, if the pain is 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.
通常認(rèn)為，如果疼痛特征不提示膽道疾病，不局限于右上腹部，或者病人肥胖，可以直接進(jìn)行CT檢查可以發(fā)現(xiàn)先前未明確的疾病。
At least three other imaging choices exist: (1) no imaging study; (2) a plain radiographic series of the abdomen(technically and economically similar to the chest radiograph but generally not as useful); (3) MRI of the abdomen or pelvis(usually reserved for more complex situations or after failure to diagnose with other methods).
至少還可有其它三種影像學(xué)檢查的選擇：（1)不做影像學(xué)檢查；（2)腹部平片（技術(shù)和價(jià)格與胸片相當(dāng)，當(dāng)效果通常不好)；（3)腹部或盆腔的核磁共振（在復(fù)雜或者其他診斷技術(shù)無效的情況下使用)
Other than identifying free intraperitoneal air(perforated viscus), gas patterns 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.
除了鑒別游離的腹腔氣體（內(nèi)臟穿孔)，腸梗阻的積氣和輸尿管不透射線的結(jié)石以外，雖然價(jià)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 pelvis in about 1 minute.
當(dāng)代的多層螺旋CT可以在1分鐘內(nèi)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 vascular structures.
Opacify不透明的
口服或靜脈使用造影劑有助于使腸道或者血管突出顯影。
MRI can be useful for the cooperative patient in renal failure who cannot receive intravenous contrast material because it can provide tissue and vascular detail not achievable without contrast-enhanced CT.
對(duì)不能使用靜脈造影劑的配合的腎衰病人，可以使用核磁共振獲得通常只有增強(qiáng)造影CT可以獲得的組織和血管影像。
Patient cooperation is required because of the longer imaging times and respiratory motion artifacts.
respiratory motion artifacts呼吸偽影
病人的合作是必須的，因?yàn)闄z查時(shí)間長(zhǎng)，而且存在呼吸偽影。
Chapter 36 Endoscopic ultrasonograhy
本篇篇名為內(nèi)鏡超聲檢查（或稱超聲內(nèi)鏡)。在疾病診治上，超生內(nèi)鏡作為一種檢查和治療的新技術(shù)在臨床上逐漸得以應(yīng)用，與傳統(tǒng)的診治方法比較，它具有一定的優(yōu)勢(shì)。本篇主要介紹內(nèi)鏡超聲檢查的基本情況、與傳統(tǒng)方法比較以及它在臨床診治方面的優(yōu)勢(shì)所在。
The development of endoscopic ultrasonography(EUS), or endosonography, has been a major technological achievement in gastroenterology.
Gastroenterology胃腸學(xué)
achievement成就
胃腸內(nèi)鏡的發(fā)展是胃腸學(xué)上重大的技術(shù)成就。
The incorporation of an ultrasonic transducer in tip of a flexible endoscope or the use of stand-alone ultrasound probes has now made it possible to obtain images of gastrointestinal lesions that are not apparent on superficial views, including lesions within the wall of the gut as well those that lie beyond(e.g., pancreatic or lymph node lesions)。
Incorporation并入，摻合
Transducer超聲換能器
Superficial表面的，淺表的
Gut腸道的
Flexible柔軟的，易曲的
將超聲換能器并入內(nèi)鏡的頭部或僅僅使用超聲探頭就現(xiàn)在就可以獲得無法從淺表探測(cè)到的胃腸疾病的影像,包括腸壁內(nèi)或這腸表面(如胰腺疾病或淋巴結(jié)病變)。
