Still the best way to minimize these infections is to avoid placement of unnecessary lines and to remove them once the indication is not present anymore.
Still 然而、盡管如此
然而，減少這些感染的最好辦法是避免放置不必要的導(dǎo)管，一旦引流指征消失立即拔管。
Routine change of central lines has not proven to reduce infection rates.
常規(guī)更換導(dǎo)管還未證明能降低感染率。
Chapter 21 Occult and Obscure Gastrointestinal Bleeding Page 60
occult 神秘的、秘密的、隱蔽的 obscure 黑暗的、模糊的、隱匿的
隱匿性和來源不明性胃腸道出血 第60頁
Occult bleeding is defined as the detection of asymptomatic blood loss from the gastrointestinal tract, generally by routine fecal occult blood testing (FOBT) or the presence of iron deficiency anemia. (fecal 排泄物、殘?jiān)?
隱匿性出血指的是發(fā)現(xiàn)無癥狀性胃腸道出血，一般通過常規(guī)的大便隱血試驗(yàn)（FOBT)或存在著缺鐵性貧血。
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial endoscopic evaluation of both the upper and lower gastrointestinal tracts.
(initial 開始的、最初的 evaluation 評(píng)價(jià))
來源不明性胃腸出血是指首次上、下消化管內(nèi)窺鏡檢查都陰性、原發(fā)部位不明的持續(xù)或反復(fù)性出血。
Both of these entities may be presentations of recurrent or chronic bleeding.
entity 實(shí)體、存在、本質(zhì) presentation 提出、表現(xiàn)、存在
兩者都可能表現(xiàn)為反復(fù)的或慢性的出血。
The initial approach to evidence of occult gastrointestinal blood loss should be endoscopic evaluation. 對(duì)隱匿性胃腸道出血，應(yīng)該使用內(nèi)窺鏡進(jìn)行早期檢查。
In the setting of an isolated positive FOBT, colonoscopy is indicated as the first test.
(colonoscopy 結(jié)腸鏡)
只有單獨(dú)的大便隱血試驗(yàn)陽性情況下，結(jié)腸鏡作為首選的檢查方法是有適應(yīng)征的。
The yield of colonoscopy in these patients is approximately 2% for cancer and 30% for one of more colonic polyps.(yield 產(chǎn)出、結(jié)出、產(chǎn)生)
這些病人結(jié)腸鏡的結(jié)果大約2%是癌癥，30%是單發(fā)或多發(fā)的結(jié)腸息肉。
The initial approach to a patient with iron deficiency anemia depends on the presence of symptoms referable to either the upper or lower gastrointestinal tract.
(referable 可認(rèn)為與...有關(guān)的、可參考的)
缺鐵性貧血病人的首選檢查方法要根據(jù)存在的癥狀跟上消化道還是下消化道相關(guān)。
Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have both upper and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if the first one was positive.
complementary 補(bǔ)充的、互補(bǔ)的 positive 確定的、絕對(duì)的、真實(shí)的
無論首次上、下消化道內(nèi)窺鏡檢查會(huì)有何發(fā)現(xiàn)，所有病人兩個(gè)檢查都應(yīng)該做，因?yàn)榛パa(bǔ)的內(nèi)窺鏡檢查6%有發(fā)現(xiàn)，甚至第一次檢查是陽性的。
For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency anemia. (premenopausal 絕經(jīng)前的)
對(duì)絕經(jīng)前婦女，大便隱血試驗(yàn)陽性需要全面分析，缺鐵性貧血也一樣。
Barium radiographs of the upper and lower gastrointestinal tract have limited utility in the setting of occult bleeding because of their inability to biopsy or treat lesions that are identified.
utility 實(shí)用、效用、通用
隱匿性出血時(shí)，上、下消化道的鋇劑造影應(yīng)用有限，因?yàn)樗鼈儾荒芑顧z或治療發(fā)現(xiàn)的病損。
The evaluation of obscure gastrointestinal bleeding is often frustrating
(frustrating 令人泄氣的、令人沮喪的) 隱匿性胃腸道出血的診斷常常令人沮喪。
Angiodysplasia is the most common cause in most recent series.
(Angiodysplasia 血管發(fā)育畸形) 血管發(fā)育畸形是最近病例報(bào)導(dǎo)中最常見的病因。
Initial endoscopic examination should focus on any symptoms reported by the patient.
( focus 聚焦、集中、明確) 初始內(nèi)窺鏡檢查要盯住病人訴說的任何癥狀。
Potential causative agents, such as NSAIDs and aspirin, should be discontinued.
(causative 成為原因的 NSAIDs 非甾體類抗炎鎮(zhèn)痛藥non-steroidal antiinflammatory drugs)
能成為潛在病因的藥物，如非甾體類抗炎鎮(zhèn)痛藥和阿斯匹林，應(yīng)該停用。
Disorders associated with bleeding, such as hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), inflammatory bowel disease, or a bleeding diathesis should be considered. (telangiectasia 毛細(xì)血管擴(kuò)張 diathesis 素質(zhì))
胃腸紊亂伴出血，像遺傳性出血性毛細(xì)血管擴(kuò)張癥（Osler-Weber-Rendu綜合癥)、炎癥性腸疾病、或出血性體質(zhì)應(yīng)該加以考慮。
A repeat endoscopic evaluation may be appropriate, because approximately one third of cases reveal a cause of bleeding overlooked during the initial endoscopy.
內(nèi)窺鏡重復(fù)檢查可能是恰當(dāng)?shù)�，因�(yàn)榻咏种徊±槌隽耸状蝺?nèi)窺鏡漏掉的出血原因。
When upper endoscopy and colonoscopy are both unrevealing, evaluation of the small bowel is indicated. 當(dāng)上消化道內(nèi)窺鏡和結(jié)腸鏡均無發(fā)現(xiàn)，小腸檢查具有指征。
Radiographic evaluation of the small bowel is noninvasive but relatively insensitive, with a less than 6% yield from small bowel follow-through and a 10 to 21% yield from enteroclysis.
insensitive 感覺遲鈍的 follow-through 持久的貫徹，持續(xù) enteroclysis 小腸造影
小腸X線檢查是非侵入性的，但相對(duì)不靈敏，小腸全片6%不到有發(fā)現(xiàn)，小腸造影10～21％有結(jié)果。
By comparison, the diagnostic yield of endoscopic enteroscopy of the small bowel in obscure gastrointestinal bleeding is 38 to 75%. (enteroscopy 腸鏡檢查)
相比較，對(duì)來源不明性胃腸道出血小腸內(nèi)窺鏡的診斷結(jié)果是38～75%。
Traditional videoendoscopes can evaluate only the proximal small bowel (≤150cm), whereas longer scopes, which are passed though the entire small bowel and then withdrawn while visualizing the mucosa (sonde enteroscopy), are limited in their ability to visualize the entire mucosa and cannot be used to perform diagnostic or therapeutic maneuvers.
proximal 最接近的、近側(cè)的 visualize 使看得見，想像 sonde 探空火箭
傳統(tǒng)的電視內(nèi)窺鏡能檢查近端小腸 (≤150cm),然而能通過整個(gè)小腸邊退邊看腸粘膜的更長內(nèi)鏡，也不能看到整個(gè)腸粘膜，都不能作為常規(guī)的診斷或治療手段。
When endoscopic evaluation does not detect the cause of blood loss, radiographic procedures such as scintigraphy and angiography should be considered. (scintigraphy 閃爍顯像)
當(dāng)內(nèi)窺鏡檢查不能發(fā)現(xiàn)出血病因，像閃爍造影和血管造影X線手段應(yīng)該考慮。
Provocative angiography using heparin or thrombolytic agents has been suggested by some authorities, but this approach has the potential risk of precipitating major bleeding.
Provocative 刺激的、挑拔的、氣人的 precipitating 使突然發(fā)生、促使
雖然使用肝素或溶栓藥的刺激性血管造影被某些專家推薦，但這種方法有促發(fā)大出血的潛在風(fēng)險(xiǎn)。
In the face of continued blood loss and no identified etiology, intraoperative endoscopy may provide simultaneous diagnosis and therapy. (simultaneous 同時(shí)發(fā)生的、同時(shí)存在的)
碰到進(jìn)行性出血查不到病因，術(shù)中腸鏡可能同時(shí)解決診斷和治療。
During the procedure, the surgeon plicates the bowel over the endoscope.
(plicate 有褶的;有皺襞的) 在操作中，外科醫(yī)生把小腸套迭到內(nèi)窺鏡上。
As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment. 當(dāng)內(nèi)鏡后退時(shí)，內(nèi)鏡發(fā)現(xiàn)可以決定是外科切除或（保守)治療。
The yield of this procedure exceeds 70%. 這個(gè)措施的結(jié)果超過70%。
In some clinical situations, the site of bleelding cannot be identified, and the patient requires long-term transfusion therapy. (long-term 長期的 transfusion 輸血)
某些臨床情況下，出血部位無法發(fā)現(xiàn)，病人而要長期的輸血治療。
A new device for visualizing the entire gastrointestinal mucosa consists of a small camera in an ingestable capsule that transmits images to receivers attached to the patient’s abdomen and mapped to identify the location of the image.
ingestable 能咽下、能吸收 camera 照相機(jī)、電視攝像機(jī)
一種新的裝置能顯示全部胃腸粘膜，這種裝置由一顆裝有小型攝像機(jī)能咽下的膠囊組成，它將（數(shù)字)影像信號(hào)傳到附著在病人腹部的接收器，并繪制出圖像來識(shí)別影像的位置。
The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualize segments of the small bowel that were previously inaccessible.
potentially 潛在的、可能的 inaccessible 達(dá)不到的、難接近的
膠囊小腸鏡的診斷效率現(xiàn)在還不清楚，但是，這種方法可能可以顯示以前難以接近的小腸段腸管。
No therapeutic maneuvers are possible with the device. 這個(gè)裝置不可能有任何治療性操作。
Chapter 23 Diabetic Nephropathy Page 67 第二十三章 糖尿病腎病 第67頁
End-stage renal disease (ESRD) from diabetic nephropathy is a major cause of morbidity and mortality, particularly in patients with type 1 diabetes, affecting 30 to 35% of patients in the United States. (nephropathy 腎病)
由糖尿病性腎病所發(fā)展的晚期腎病（EARD)是患病和死亡的一個(gè)主要原因，特別在1型糖尿病病人中，在美國涉及30~35%的病人。
Although nephropathy is about one half as frequent in type 2 diabetics (partially due to a shortened life expectancy), type 2 diabetes still makes up the vast majority of diabetic patients seeking therapy for ESRD. (expectancy 期望、預(yù)期 make up 補(bǔ)足、編造、組成)
盡管在2型糖尿�。ㄌ貏e是影響壽命的)的腎病發(fā)生率大約是（1型的)一半，但2型糖尿病仍然是需要晚期腎病治療的糖尿病病人的絕大多數(shù)。
Overall, diabetes is the leading cause of ESRD in the United states, accounting for more than one third of cases. (overall 總體來說 accounting for 說明、證明、對(duì)…負(fù)責(zé))
總的來說，糖尿病是美國晚期腎病的首要病因，占三分之一以上。
