医学英语案列

1、Case Study 9-1: PTCA （经皮冠状动脉内成形术）and Echocardiogram（超声心动图）A.L., a 68-year-old woman, was admitted to the CCU with chest pain, dyspnea（呼吸困难）, diaphoresis（发汗）, syncope（昏厥）,and nausea（恶心）. She had taken three sublingual（舌下的） doses of nitroglycerine（硝化甘油） tablets（片剂） within a 10-minute time span（跨距） wit

2、hout relief before dialing 911. A previous stress test and thallium（铊） uptake（摄取） scan suggested cardiac disease. Her family history was significant for cardiovascular disease（心血管疾病）. Her father died at the age of 62 of an acute myocardial infarction（急性心肌梗塞）. Her mother had bilateral carotid endarte

3、rectomies（双侧颈动脉内膜切除术）and a femoral-popliteal bypass（股腘动脉旁路术）procedure and died at the age of 72 of congestive heart failure（充血性心力衰竭）. A.L.s older sister died from a ruptured aortic aneurysm（主动脉动脉瘤破裂） at the age of 65. Her ECG（超声心动图） on admission（入院时） presented tachycardia（心跳过速） with a rate of 126 bp

4、m（每分钟心跳次数） with inverted T waves. A murmur（心脏杂音） was heard at S1（第一心音）. Her skin color was dusky to cyanotic（发紫的） on her lips and fingertips. Her admitting diagnosis（入院诊断） was possible coronary artery disease（冠心病）, acute myocardial infarction（急性心肌梗塞）, and valvular disease（心瓣膜病）. Cardiac catheterizat

5、ion（心导管术） with balloon angioplasty (PTCA) （经皮冠状动脉腔内成形术）was performed the next day. Significant（显著的） stenosis（狭窄） of the left anterior descending coronary artery （冠状动脉前降支）was shown and was treated with angioplasty（血管成形术） and stent placement（支架放置）. Left ventricular function（左心室功能） was normal. Echocard

6、iogram（超声心动图）, 2 days later, showed normal-sized left and enlarged right ventricular cavity. The mitral valve（二尖瓣） had normal amplitude of motion（正常运动幅度）. The anterior and posterior leaflets（小叶） moved in opposite directions during diastole（舒张期）. There was a late systolic（收缩期的） prolapse（脱出） of the mi

7、tral leaflet（二尖瓣瓣叶） at rest（静止）. The left atrium（左心房） was enlarged. The impression of the study was mitral prolapse（二尖瓣脱垂） with regurgitation（回流，反流）. Surgery was recommended.翻译：AL，一个68岁的女子，被送往胸痛，呼吸困难，出汗，晕厥，恶心的CCU。她需要三个舌下服用硝酸甘油片不到10分钟的时间跨度无缓解拨打911之前。先前压力测试和铊的吸收扫描表明心脏疾病。她的家族史对心血管疾病有重要意义。她的父亲死于急性心肌梗死的6

8、2岁。她母亲双侧颈动脉内膜切除术和动脉旁路手术的股骨、享年72岁的充血性心力衰竭。这是姐姐死于主动脉瘤破裂65岁。她入院时的心电图出现心动过速126次/分的频率倒置T波。听到杂音在S1。她的皮肤的颜色在她的嘴唇和指尖青紫暗。她承认诊断为冠心病、急性心肌梗死、心脏瓣膜病是可能的。 球囊血管成形术（PTCA）心导管检查是下一天进行。左前降支冠状动脉的显着狭窄的显示，并与血管成形术和支架置入术。左室功能正常。超声心动图，2天后，显示正常大小的左、右心室腔扩大。二尖瓣有正常的运动幅度。前部和后部的传单在相反的方向移动，在舒张期。在休息时，有一个晚期收缩期脱垂的二尖瓣单张。左心房扩大。这项研究的印象是二

9、尖瓣脱垂伴反流。手术推荐。Case Study 9-2: Mitral Valve Replacement Operative ReportA.L. was transferred（转移到） to the operating room（手术室）, placed in a supine position（仰卧位）, and given general endotracheal anesthesia（气管内麻醉）. Her pericardium（心包） was entered longitudinally（纵向） through a median sternotomy（正中胸骨切开术）. The

10、 surgeon（外科医生） found that her heart was enlarged with a dilated（扩大的） right ventricle（右心室）. The left atrium（左心房） was dilated. Preoperative（手术前的） transesophageal （经食道的）echocardiogram（超声心动图） revealed severe mitral regurgitation （二尖瓣回流）with severe posterior and anterior prolapse（脱垂）. Extracorporeal circ

11、ulation（体外循环） was established. The aorta（主动脉） was cross-clamped（交叉夹紧）, and cardioplegic solution （交叉夹紧）(to stop the heartbeat) was given into the aortic root （主动脉根）intermittently（间歇地） for myocardial protection（心肌保护）. The left atrium was entered via the interatrial groove（房间沟） on the right, exposing

12、the mitral valve. The middle scallop（扇贝） of the posterior leaflet was resected. The remaining leaflets were removed to the areas of the commissures（连合） and preserved for the sliding（滑动的） plasty（成形术）. The elongated（展长） chordae （腱索）were shortened（缩短）. The surgeon slid the posterior leaflet across the

13、midline and sutured it in place. A no.30 annuloplasty（瓣膜成形术） ring（环） was sutured in place with interrupted（间断的，阻断的） no.2-0（编号） Dacron suture（涤纶缝线）. The valve was tested by inflating（使充气） the ventricle with NSS and proved to be competent（有活性的）. The left atrium was closed with continuous no.4-0 Prolen

14、e suture（聚丙烯缝线）. Air was removed from the heart. The cross-clamp （横跨钳闭）was removed. Cardiac action resumed with normal sinus rhythm（正常窦性心律）. After a period of cardiac recovery and attainment （达到）of normothermia（正常体温）, cardiopulmonary bypass（心肺分流术） was discontinued（不连续的）. Protamine（鱼精蛋白） was given to

15、 counteract（抵抗,解(毒),中和） the heparin（肝素钠,肝素）. Pacer（起搏器）wires were placed in the right atrium and ventricle. Silicone catheters were placed in the pleural and substernal spaces. The sternum（胸骨） and soft tissue wound was closed. A.L. recovered from her surgery and was discharged（出院） 6 days later.翻译：这是

16、转移到营业厅，放置于仰卧位，并给予气管插管全麻。她的包进入纵向通过胸骨正中切口。外科医生发现她的心脏扩大了扩张的右心室。左心房扩张。术前经食管超声心动图显示严重的前、后脱垂二尖瓣重度关闭不全。建立体外循环。主动脉交叉夹紧，和心脏停搏液（停止心跳）进行主动脉根部间断心肌保护。左心房是通过右边的房间沟进入，显露二尖瓣。经手术切除后小叶中孔扇贝。剩下的传单被拆除的连合的区域和保存滑动成形术。细长的腱索缩短。外科医生地滑过中线后叶缝合到位。30瓣环缝合的地方，打断了no.2-0涤纶缝线。该阀是由NSS充气室测试并证明是主管。左心房是连续no.4-0聚丙烯缝线关闭。空气被从心脏取出。取十字钳。正常窦性心

17、律恢复正常。一段时间的心脏复苏和实现常温体外循环停止后。鱼精蛋白中和肝素的了。起搏器导线放置在右心房和右心室。硅胶导管放置在胸腔和胸骨后间隙。胸骨和软组织创面封闭。这从她的手术6天后出院。Case Study 11-1: Preoperative（手术前） Testing（测验） in a Patient With Asthma（哮喘）A.D., 15 years old, was seen in the preadmission testing（入院前检查，预进（气）试验;） unit （单位，基因，设备）in preparation for her elective spinal （脊髓的

18、）surgery（外科手术）. She has a history of mild asthma since age 4, with at least one attack per week. In an acute attack, she will have mild （轻微的）dyspnea（呼吸困难）, diffuse wheezing（喘鸣）, yet an adequate air exchange that responds to bronchodilators（支气管扩张剂）. She was sent to pulmonary health services for a con

19、sult（顾问医生） with a specialist and pulmonary function studies to clear her for surgery. The anesthesiologist（麻醉科医师） reviewed the pulmonologists report. Her prebronchodilator（支气管收缩） spirometry （肺量测定法）showed a mild reduction in vital capacity but with a moderate to severe decrease in FEV1（一秒钟用力呼气量） and

20、FEV1/FVC（快速肺活量） ratio（比例）. After bronchodilator（支气管扩张药） administration（给药）, there was a mild but insignificant improvement in FEV1. The postbronchodilator（支气管的） FEV1 was 55% of predicted and was considered moderately（适度的） abnormal. The flow volume loops （流量循环）and spirographic curves （呼吸描记曲线）were con

21、sistent with airflow obstruction.翻译：年，15岁，在她的脊柱手术术准备住院前的测试单元。从4岁开始，她有轻度哮喘史，每周至少有一次发作。在急性发作时，她会有轻度的呼吸困难、弥漫性喘息，但适当的空气交换，对支气管扩张剂。她被派到肺部健康服务，向一位专家咨询，并进行肺功能检查，以清除手术中的她。麻醉师回顾专家的报告。肺功能检查显示她的prebronchodilator肺活量轻微下降，但与中度至重度减少FEV1和FEV1/FVC比值。支气管扩张药后，有一个轻微但显著改善FEV1。55%的postbronchodilator FEV1预测被认为是中度异常。流量循环和呼

22、吸描记曲线与气流阻塞一致。Case Study 11-2: Giant Cell Sarcoma of the LungL.E., a 68-year-old man, was admitted to the pulmonary unit with chest pain on inspiration, dyspnea,and diaphoresis. He had smoked 11.2 packs of cigarettes per day for 52 years and had quit 3 months ago.L.E. was retired from the advertising

23、 industry and admitted to occasional alcohol use. He was treatedfor primary giant cell sarcoma of the left lung 3 years ago with a lobectomy of the left lung followed byradiation and chemotherapy. Physical examination was unremarkable except for a thoracotomy scar in the left hemithorax, decreased b

24、reath sounds, and dullness to percussion of the left base. There was no hemoptysis. Radionucleotide bone scan showed increased activity in the left upper posterior hemithorax. Chest and upper abdomen CT scan showed .ndings compatible with recurrent sarcoma of the left hemithorax. Abnormal mediastina

25、l nodes were evident. Thoracentesis was attempted but did not yield .uid. L.E. was scheduled for a left thoracoscopy, mediastinoscopy, and biopsy.Case Study 11-3: Terminal DyspneaN.A., a 76-year-old woman, was in the ICU in the terminal stage of multisystem organ failure. She hadbeen admitted to the

26、 hospital for bacterial pneumonia, which had not resolved with antibiotic therapy.She had a 20-year history of COPD. She was not conscious and was unable to breathe on her own. HerABGs were abnormal, and she was diagnosed with refractory ARDS. The decision was made to support her breathing with endo

27、tracheal intubation and mechanical ventilation. After 1 week and several unsuccessful attempts to wean her from the ventilator, the pulmonologist suggested a permanent tracheostomy and family consideration of continuing or withdrawing life support. Her physiologic status met the criteria of remote o

28、r no chance for recovery. N.A.s family discussed her condition and decided not to pursue aggressive life-sustaining therapies. N.A. was assigned DNR status. After the written orders were read and signed by the family, the endotracheal tube, feeding tube, pulse oximeter, and ECG electrodes were remov

29、ed and a morphine IV drip was started with prn boluses ordered to promote comfort and relieve pain and other symptoms of dying. The family sat with N.A. for many hours while her breaths became shallow with Cheyne-Stokes respirations.She died surrounded by her family, joined by the hospital chaplain.

30、Case Study 12-1: CholecystectomyG.L., a 42-year-old obese Caucasian woman, entered the hospital with nausea and vomiting, .atulenceand eructation, a fever of 100.5F, and continuous right upper quadrant and subscapular pain. Examination on admission showed rebound tenderness in the RUQ with a positiv

31、e Murphy sign. Her skin, nails, and conjunctivae were yellowish, and she complained of frequent clay-colored stools. Her leukocyte count was 16,000. An ERCP and ultrasound of the abdomen suggested many small stones in her gallbladder and possibly the common bile duct. Her diagnosis was cholecystitis

32、 with cholelithiasis.A laparoscopic cholecystectomy was attempted, with an intraoperative cholangiogram and commonbile duct exploration. Because of G.L.s size and some unexpected bleeding, visualization was dif.cultand the procedure was converted to an open approach. Small stones and granular sludge

33、 were irrigatedfrom her common duct, and the gallbladder was removed. She had a T-tube inserted into the duct forbile drainage; this tube was removed on the second postoperative day. She had an NG tube in place before and during the surgery, which was also removed on day two. She was discharged on t

34、he .fth postoperative day with a prescription for prn pain medication and a low-fat diet.Case Study 12-2: Surgical Pathology ReportGross Description: The specimen is received in formalin labeled “ruptured duodenal diverticula” andconsists of enteric tissue measuring approximately 6.3 2.8 0.7 cm. The

35、 serosal surface is markedlydull in appearance and .brotic. The mucosal surface is hemorrhagic. Representative sections are takenfor microscopic examination. Microscopic Description: Sectioned slide shows segments of duodenal tissues with areas of gangrenous change in the bowel wall, and acute and c

36、hronic in.ammatory in.ltrates. There are chronic and focal acute in.ammatory cell in.ltrates with hemorrhage in the mesenteric fatty tissue. There are areas of acute in.ammatory exudates noted in the fatty tissue. Histopathologic changes are consistent with ruptured duodenal diverticula.Case Study 1

37、2-3: Colonoscopy With BiopsyS.M., a 24-year-old man, had a recent history of lower abdominal pain with frequent loose mucoidstools. He described symptoms of occasional dysphagia, dyspepsia, nausea, and aphthous ulcers of histongue and buccal mucosa. A previous barium enema showed some irregularities

38、 in the sigmoid andrectal segments of his large bowel. Stool samples for culture, ova, and parasites were negative. His tentative diagnosis was irritable bowel syndrome. He followed a lactose-free, low-residue diet and took Imodium to reduce intestinal motility. His gastroenterologist recommended a

39、colonoscopy. After a 2-day regimen of soft to clear liquid diet, laxatives, and an enema the morning of the procedure, he reported to the endoscopy unit. He was transported to the procedure room. ECG electrodes, a pulse oximeter sensor, and a blood pressure cuff were applied for monitoring, and an I

40、V was inserted in S.M.s right arm. An IV bolus of Demerol and a bolus of Versed were given, and S.M. was positioned on his left side. The colonoscope was gently inserted through the anal sphincter and advanced proximally. S.M. was instructed to take a deep breath when the scope approached the spleni

41、c .exure and the hepatic .exure to facilitate comfortable passage. The physician was able to advance past the ileocecal valve, examining the entire length of the colon. Ulcerated granulomatous lesions were seen throughout the colon, with a concentration in the sigmoid segment. Many biopsy specimens

42、were taken. The mucosa of the distal ileum was normal. Pathology examination of the biopsy samples was expected to establish a diagnosis of IBD.Case Study 17-1: Pediatric Brain TumorB.C., a 6-year-old .rst-grade student, was referred to a pediatric neurologist by his primary pediatricianfor a neuro

43、consult. He had presented with an acute onset of headaches, vomiting on waking in themorning, and progressive ataxia. The neurologist conducted a thorough neuro exam and ordered a CTscan, MRI, and lumbar puncture (LP) to look for possible tumor cells. When the LP revealed suspiciouscells and the sca

44、ns showed a tissue density, he was referred to a neurosurgeon for treatment of a suspected infratentorial astrocytoma of the posterior fossa. B.C. had a craniotomy with tumor resection 5 days later. The cerebellar tumor was found to be nonin .ltrating and was enclosed within a cyst, which was totall

45、y removed. B.C. spent 2 days in the neurological intensive care unit (NICU) because he was on seizure precautions and monitoring for increased intracranial pressure (ICP). A regimen of focal radiation followed after recovery from surgery. His spine was also treated because of the potential spread of

46、 tumor cells in the CSF. B.C. did not have chemotherapy because of the danger that he might develop hydrocephalus, which generally requires a ventriculoperitoneal (VP) shunt. B.C. was discharged 6 days after his surgery with a mild hemiparesis, which was expected to resolve within the next few weeks

47、. He was scheduled for 6 weeks of outpatient rehabilitation, and his prognosis was good.Case Study 17-2: Cerebrovascular Accident (CVA)A.R., a 62-year-old man, was admitted to the ER with right hemiplegia and aphasia. He had a historyof hypertension and recent transient ischemic attacks (TIAs), yet

48、was in good health when he experienced a sudden onset of right-sided weakness. He arrived in the ER via ambulance within15 minutes of onset and was received by a member of the hospitals stroke team. He had a rapid generalassessment and neuro exam, including a Glasgow coma scale (GCS) rating, to dete

49、rmine his candidacyfor fibrinolytic therapy. He was sent for a noncontrast CT scan to look for evidence of hemorrhagic or ischemic stroke, postcardiac arrest ischemia, hypertensive encephalopathy, craniocerebral or cervical trauma, meningitis, encephalitis, brain abscess, tumor, and subdural or epidural hematoma. The CT scan, read by the radiologist, did not show intracerebral or subarachnoid hemorrhage. A.R. was diagnosed with probable acute ischemic stroke within 1 hour of onset of symptoms and cleared as a can