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 持续、相同、维持 monomorphic 单一的、单形的)
在心源性猝死生还者中， 40~50%电生理试验能诱导持续单一型室性心动过速，10~20%能诱导多型的，30~50%不能诱导持续的节律异常。
In patients with ischemic heart disease and left ventricular dysfunction, inducibility of sustained VT carries a poor prognosis.
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 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25%心律失常复发率，而射血分数大于30%的不能诱导者只有10~15%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 VF is a predictor 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 Breath
“shortness of breath”, “a feeling of not being able to get enough air”, and “labored breathing” are all terms used by patients to describe the symptom of dyspnea. （Dyspnea 呼吸困难)
“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。
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 physician’s responsibility to define the causative mechanisms of shortness of breath so that diagnostic techniques 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, 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.
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 negative pressure in the pleural space to 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 decreased distensibility is perceived as an increased effort to breathe and produces the symptom of dyspnea.
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 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 40 mmHg and cause dyspnea, especially 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, characterized 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 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 patients with dyspnea have cardiac abnormalities.
由于心脏疾病和心衰的高发，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 atrial pressures and high pulmonary capillary and pulmonary arterial pressures, which in turn increase the pulmonary blood volume and reduce lung compliance.
呼吸困难的基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 the pulmonary 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，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 performed in 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 origin
DefinitionThe first signs or symptoms of cancer are frequently due to metastases to visceral or nodal sites （Visceral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 evaluation of specific symptoms or signs 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 having cancer 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。
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 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 computed tomography and magnetic resonance imaging, however, autopsy series have identified primary sites in only 50-70% 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50－70％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 it increases 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 advanced disease, therapeutic nihilism has been common.
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 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 when possible and on identifying patients for whom specific treatment 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 strongly suspected 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, including complete blood cell counts, chemistry profile, and computed tomography 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 endoscopic studies.
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 primary 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 for optimal histologic examination and special 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 and procedures 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 complications
Postoperative surgical complications represent one of the most frustrating and difficult occurrences experienced 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 complications 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。
