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.
当前美国的外科术后并发症浪费了无数的金钱，同时导致劳动能力的丧失，正常家庭生活的破坏，而且为雇主和社会带来了无法预料的压力。
Frequently, the functional results of the operation are compromised by complication; in some cases, the patient never recovers to the preoperative level of function.
通常术后并发症影响了手术的效果，某些病人无法恢复到术前的功能状态。
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.最严重和难对付的并发症就是看到那些本以为进行安全性很高的手术，结果却导致了术后的痛苦和并发症。Complications can occur for a variety of reasons. 外科并发症的发生有多种原因。
A surgeon can perform a technically perfect operation in a patient who is severely compromised by the disease process and still have a complication.
有时，外科医生手术技术上非常成功，但病人的病情严重可导致并发症的发生。
Similarly, a surgeon who is sloppy, is careless, or hurries through an operation can make technical errors that account for the operative complications.
同样，手术中医生的马虎、粗心或仓促都可以导致技术上的错误从而导致手术并发症
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，病人营养状况良好、手术非常细心，疾病本身也可以导致并发症的发生。
The possibility of postoperative complications is a part of every surgeon’s thought processes-something with which all surgeons will be required to deal.
手术后并发症的可能性是每一个外科医生考虑治疗计划的一个组成部分，因为所有外科医生都将面临这些并发症中的一部分。 Surgeons can do much to avoid complications by the careful preoperative screening process. 外科医生可以在术前进行精心筛选以避免术后并发症。
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许许多多，一大堆) 当外科医生第一次见到即将手术的病人时，需要考虑很多问题，如这个病人的营养状况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.外科医生需要为病人作出正确的手术方式选择。Similarly, the timing of the operation is often an important issue同样的，手术时机也是一个重要的因素。
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)一些手术可以择期进行，而有些可能需要进行急诊手术。Occasionally, the surgeon will demand that the patient lost weight before the operation so that the likelihood of a successful outcome is improved. 有时候，外科医生会要求病人术前减轻体重以提高手术的成功率。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. 有时，明智的外科医生会请心脏或呼吸系统专家进行术前会诊以确定病人是否能耐受特定手术。
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.
流行性感冒是指一个地理区域中的感冒的爆发。
In a given community, epidemics of influenza A virus infection often have a characteristic pattern.
在某些特定的社区，流感病毒A型的传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.
通常爆发性流行，在2至3周内直线到达峰值，并持续6至10周。
Increased numbers of schoolchildren with febrile respiratory illness are often the first indication of influenza in community.
社区中流感发生的第一个迹象就是学生发热呼吸道疾病。
This indication is soon followed by illnesses among adults and about a week later by increased hospital admissions of patients with influenza-related complications.
随后的表现有成人的发病，一周以后感冒相关的并发症引起的入院病人增加。
Hospitalization rates in high-risk persons increase two- to five fold during major epidemics.
在感冒大流行期间，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.
缺学和旷工的情况增加，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.
后一项发现是流感活动高度特异性指标。
Epidemics occur almost exclusively during the winter months in temperate areas, but influenza activity may continue year-round in the tropics.
在温带地区流感基本发生在冬季，但热带区域流感在全年均有发生。
Outbreaks may occur in tour groups (land or ship) and in facilities during summer months, particularly after the appearance of a drift variant.
流感爆发可出现在夏季旅游团队（陆地和船舶)及建筑物内，尤其是在不同地点迁徙后。
Regional differences in the time and magnitude of occurrence of influenza outbreaks are common
流感发生的时间和强度区域差异基本类似。
During epidemics, the overall attack rates typically average 5 to 20% in adults.
成人的流感发生率平均在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.
封闭人群中，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.
一个亚群中的两个不同菌株，两种不同的流感A病毒亚群，或者流感A和B病毒均能发生互相传播。
In addition, simultaneous outbreaks of influenza A and respiratory syncytial viruses have been found.
而且，也有报道发现A型流感病毒和呼吸道合胞病毒同时感染。
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).
每个季度末期流行的菌株通常会导致下一轮流感爆发（ 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，除了流感爆发与气候寒冷有关以外，流感爆发或逐渐消失而仅影响易感人群的机制尚不清楚。
Pneumonia and influenza (P+I)- related deaths fluctuate annually, with peaks in the winter months.
肺炎和流感相关死亡一年中有波动，冬季为高峰期。
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过预期数字，这是A型流感所造成的，偶尔也有可能为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大范围流传 Over 85% of P+I deaths occur among persons aged 65 and older.
超过85％的肺炎流感死亡发生于超过65岁的老年人群。
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，因此总的流感相关的死亡率比肺炎流感的死亡率高20％——40％。
Chapter 35 Principles of ordering imaging tests
本篇篇名为影像检查的选择原则。影像学检查在临床的诊治中是不可或缺的，但如何选择则有原则可循。本篇主要介绍选择影像学检查的基本原则，列举了几种常见影像学检查的比较。
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.
通常来说，如果有两种检查方法可以选择，首先我们会使用低价位，安全和较舒适的影像检查。
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.
对急性右上腹痛，超声是常规的检查方法，因为它比CT更便宜，原因在于影像设备的便宜。
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.
虽然超声比CT更加主观，更加以来于操作人员的经验，但超声对胆道的图像非常精确，包括胆囊和胆囊周围的空间，如急性胆囊炎可表现出液体。
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
超声对胆囊中胆石是否存在的精确度超过至少与CT相似，超声也能确定胆管是否扩张及肝脏或胰腺的占位病变。
Ultrasonography can be difficult and suboptimal in patients who are obese or who have a distended abdomen.
超声检查对肥胖或腹胀病人的诊断比较困难或效果不佳。
Ultrasonography is generally less accurate in surveying the remainder of the abdomen, an important issue when the pain is less localized.
超声对诊断腹部残留物的诊断不佳，尤其是腹部不局限的情况下。
How should the choice between CT or ultrasonography be made in a patient who presents with acute abdominal pain?
急腹症时如何选择CT或者超声诊断呢？
More specifically, when is it appropriate to move directly to CT？
更具体地说，什么时候可以直接进行CT检查？
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.
通常认为，如果疼痛特征不提示胆道疾病，不局限于右上腹部，或者病人肥胖，可以直接进行CT检查可以发现先前未明确的疾病。
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).
至少还可有其它三种影像学检查的选择：（1)不做影像学检查；（2)腹部平片（技术和价格与胸片相当，当效果通常不好)；（3)腹部或盆腔的核磁共振（在复杂或者其他诊断技术无效的情况下使用)
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.
除了鉴别游离的腹腔气体（内脏穿孔)，肠梗阻的积气和输尿管不透射线的结石以外，虽然价格低廉，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.
当代的多层螺旋CT可以在1分钟内形成腹部和盆腔的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
口服或静脉使用造影剂有助于使肠道或者血管突出显影。
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.
对不能使用静脉造影剂的配合的肾衰病人，可以使用核磁共振获得通常只有增强造影CT可以获得的组织和血管影像。
Patient cooperation is required because of the longer imaging times and respiratory motion artifacts.
respiratory motion artifacts呼吸伪影
病人的合作是必须的，因为检查时间长，而且存在呼吸伪影。
Chapter 36 Endoscopic ultrasonograhy
本篇篇名为内镜超声检查（或称超声内镜)。在疾病诊治上，超生内镜作为一种检查和治疗的新技术在临床上逐渐得以应用，与传统的诊治方法比较，它具有一定的优势。本篇主要介绍内镜超声检查的基本情况、与传统方法比较以及它在临床诊治方面的优势所在。
The development of endoscopic ultrasonography(EUS), or endosonography, has been a major technological achievement in gastroenterology.
Gastroenterology胃肠学
achievement成就
胃肠内镜的发展是胃肠学上重大的技术成就。
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，掺合
Transducer超声换能器
Superficial表面的，浅表的
Gut肠道的
Flexible柔软的，易曲的
将超声换能器并入内镜的头部或仅仅使用超声探头就现在就可以获得无法从浅表探测到的胃肠疾病的影像,包括肠壁内或这肠表面(如胰腺疾病或淋巴结病变)。
