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博主胡德良:邢台学院外语系英语教授,中国译协专家会员,河北省译协常务理事,邢台市译协副会长。爱好翻译,内容涉及宇宙探秘、医疗卫生、家庭保健、生命科学、能源科学、地球科学、环境科学、散文小说和纪实文学等领域。所译文章曾见于《光明日报》、《科技日报》、《健康时报》、《健康报》、《英语世界》、《英语知识》、《科技英语学习》、《科学之友》、《科学与文化》、《世界科学》、《生命世界》等全国各大报刊。博客特色:英汉对照、图文并茂,融趣味性、科学性、知识性为一体。

婴儿居室里的苦恼(图)  

2008-02-05 09:49:12|  分类: 医疗保健 |  标签: |举报 |字号 订阅

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婴儿居室里的苦恼 - 月亮飞船 - 欢迎光临月亮飞船的博客

 

Trouble in the Nursery

The dog provides a clue to a family's puzzling seizures.

一家人患癫痫令人困惑,家犬为病因提供线索——

By Pamela Grim  胡德良  

 Chief complaint: "My dog had a seizure."  主要病症:“我的狗癫痫发作。”
 I scratched my head and looked around. Was somebody pulling my leg? I scanned the chart: "Thirty-two-year-old female with history of seizures." What? Was she worried that epilepsy was contagious, like the avian flu, and that the dog had caught it?  我挠了挠头,朝四下看了看。有人跟我开玩笑吗?我浏览了一下病历表:“女性,三十二岁,有癫痫发作史。”什么?她担心癫痫象禽流感那样会传染,这条狗感染了癫痫?
 Three generations sat in the room—grandmother, daughter, and granddaughter. The granddaughter was a year old, maybe a little older. Usually a baby in a good mood can lift my spirits like nothing else. But the baby in this room was not happy. She sat in her mother's lap, head dangling, looking at nothing. Mom was stick thin, worn looking and with disheveled hair.  诊室里坐着三代人:外祖母、女儿和外孙女。外孙女有一周岁,或许稍大一点。通常,精神状态好的婴儿最能调动我的情绪。可是,房间里的这个婴儿并不快乐。她坐在妈妈的大腿上,垂悬的脑袋摆动着,视线没有任何目标。妈妈瘦骨如柴,披头散发,显示出一副疲惫的样子。
 "Something is just not right," were the first words she said to me.  她首先开口对我说:“事情就是不对头。”
 I had to agree. "Well then, tell me your story."  这一点我不得不承认。“噢,那么请讲讲你的情况。”
 She began at an odd place. "When I got pregnant, I decided I didn't want to stay with the guy. I wanted to live with my mom, and my place was this dinky studio..."  她从一个不同寻常时期开始讲述:“我怀孕后,决定不跟那个男人在一起了,我想跟妈妈一起住,我想住的地方就是那间整洁的工作室……
 The grandmother picked up seamlessly: "I was so excited, but she couldn't live with me in that studio, so I bought a ramshackle old house."  外祖母不失时机地接过话题:“我感到非常激动,可是她跟我一起在那间工作室里是住不下的,因此我买了一所摇摇欲坠的旧房子。”
 Her daughter broke in. "But it's big, big enough for a room for me and a room for the baby..."  她女儿插话了:“然而,这所房子足够大,有我的房间和孩子的房间……”
 "And the dog," the grandmother added.  “还有这条狗的房间,”外祖母补充道。
 "The only problem was the view," the daughter continued. "We overlooked a smelter, and there was an asphalt factory down the road. Things went OK through the pregnancy, except I kept having morning sickness the whole time. I was even having morning sickness after I delivered. The baby was born three weeks premature. She was OK, though. Then about two months later, I had a seizure. Two seizures—two in one day."  “唯一的问题就是那里的景观,”女儿继续讲述。“远远望去,可见一座熔炉,道路旁边还有一家沥青厂。整个怀孕期间,情况还可以,只不过一直在早上有呕吐现象,甚至在我生产之后,仍有早上呕吐现象出现。孩子早产三周,不过她还好。后来,大约两个月后,我癫痫发作,发作两次一天之内两次。”
 "There is no history of seizures in the family," the grandmother said.  “我们这个家族没有癫痫发作史,”外祖母说道。
 I thought of preeclampsia, a poorly understood hypertensive condition that can cause seizures in the late stages of pregnancy. But the timing was wrong. A patient can experience symptoms as late as a few days after the delivery, but not two months later.  

我想到了子痫前期一种人们不甚了解的高血压病症,可能会在怀孕后期引起癫痫发作。可是发作时间不对啊!患者经历这些病症,最迟可能在分娩后几天,但决不会在两个月之后。

 The daughter said that a workup had found no cause for the seizures. "They told me it runs in families. I probably inherited it from somebody." 女儿说全面检测并没有发现病因。“他们告诉我这种病在家族中蔓延,很可能是某个祖先遗传给我的。”
 "Seizures do not run in our family," Grandmother repeated.  “我们的家族没有癫痫发病情况,”外祖母重复道。
 Two months after her first seizures, the daughter had a third. Her doctor started her on an anticonvulsant, phenytoin, and then switched her to a newer, more expensive drug. She was fine for more than six months, and then another disaster struck: The baby, who had just started to crawl, had a seizure. 最初的两次癫痫发作后两个月,女儿又发作了第三次。她的医生开始给她服用一种抗痉挛药物苯妥英,后来给她换用了一种更新、更昂贵的药物。在六个多月的时间里,她情况良好。而后,又一场灾难向她袭来:刚刚会爬行孩子癫痫发作了。
 "Did she have a fever?" I asked. High fevers are a common cause of seizures in children.  我问:“她发烧吗?”发高烧是引起儿童癫痫发作的常见原因。
 "No," the daughter said. "They did all sorts of tests—brain scans and heart scans and lung scans and what-all scans. And after everything, the doctor told me that there must be a family history of seizures and that I just didn't know about it. But I know everybody back to my great-granddad, and I can tell you that there's a few horse thieves out there, but nobody with seizures.  “不,”女儿说。“他们进行了各种检测大脑扫描、心脏扫描、肺部扫描,还有什么……所有的扫描。在这一切检测之后,医生告诉我说,一定是有家族癫痫病史,我只是不知道罢了。但是,我了解任何人,上至我的曾祖父。我可以这么跟您说,连他们那里有盗马贼我都知道,可就是没人患癫痫。
 "Today, just one month later, our dog got the fits," she tacked on. "Flossie was just stiff-legged and shaking, and he looked just like my daughter when she had her seizure. So in a little over a year, me, my daughter, and my dog got seizures. That ain't right."  “今天,才刚刚一个月,我们的狗弗洛西突然发病,”她又加上一句。“他腿一挺,就开始颤抖,看起来跟我女儿癫痫发作时一模一样。这样,在一年多一点的时间里,我、我女儿和我的狗相继癫痫发作,这不对头啊。”
 I didn't know where to begin.  我搞不清诊断该从何处着手。
 Mom, however, offered a possible cause. "Could it be the smelter down the road?" she asked. "We've got the smelter smell most of the time."  然而,妈妈提供了一种可能存在的原因。“会不会是路边的熔炉引起的?”她问道。“我们常常闻到来自熔炉的味道。”
 I didn't know, so I ordered a standard set of laboratory tests.  我也说不清,于是我就安排了一套常规的化验检测。
 Diagnosing a disease begins with making a list of the disorders that can cause the patient's symptoms. The causes of seizures range from epilepsy to brain injury to electrolyte imbalance. The next step is to look for clues in the patient's medical history, the physical exam, and results from laboratory tests to narrow the list. Our laboratory had a couple of gifted employees, and I had picked up their habit of searching the complete blood count for clues. The test results for this patient showed a problem in her red blood cells.  诊断疾病通常开始于列出可能导致患者病症的各种不适。这些病情发作的原因不尽相同,可能是癫痫,或者是脑损伤,也许是电解质失衡。下一步是从患者的病历、体检和化验结果中寻找线索,将列单上的范围缩小。我们的化验室有几位天才的化验员,我也养成了象他们那样的习惯:查血常规寻找线索。化验结果显示这位患者的红细胞有问题。
 Normal red blood cells have a uniform red blush. But my patient's red blood cells contained bluish-purple staining granules, which are a form of nucleic acid protein. Their presence suggested a toxic insult to the bone marrow where the red blood cells are formed. Only a few conditions are known to cause this feature, which is called basophilic stippling. The causes are severe bacterial infection, exposure to certain drugs, end-stage alcoholism, bad hereditary anemia, and lead poisoning.  正常的红细胞呈现一致的红色,而我这位患者的红细胞中包含蓝紫色颗粒状污斑,它们是一类核酸蛋白质。这种物质的出现表明制造红细胞的骨髓遭受了毒性刺激。据了解,只有少数情况会导致这种特征的斑点,被称为嗜碱性点彩。致病原因是:严重的细菌感染,接触某些种类的药物,末期酒精中毒,严重的遗传性贫血和铅中毒。
 The patient had been on the right track. Somehow this family—the dog included—had been exposed to lead. But do dogs even get lead poisoning? I went online to Google and tapped out "dogs" and "lead poisoning." There were 3,150,000 hits.  患者想对路了。不知何故,这家人包括狗在内遭受过铅暴露。难道狗也会得铅中毒?我上网到“谷歌”搜寻,打出“狗”和“铅中毒”字样,结果显示有3,150,000个点击选项。
 I ordered a lead level on Mom and made arrangements for her daughter to see a pediatrician. I explained that lead poisoning was a possibility.  我指示对这位妈妈进行血铅浓度化验,并安排她的女儿去看儿科医生。我解释说可能得了铅中毒。
 About a week later the patient dropped by with the test results. Her lead level could have stopped a bull elephant dead in its tracks. She had figured out the source of the lead—and it wasn't the smelter. Although paints containing lead were banned for use in American homes in 1978, older structures are still a worrisome source of exposure. Their home's interior had been painted with lead-based paint at some point, but it had been meticulously stripped away from every room except one. That room had been wallpapered, and it had become the baby's room. The patient and her mother had stripped the wallpaper away and tried to sand down the leftover paint, but they probably hadn't done the job well enough.  大约一周后,那位患者拿着化验结果过来。她的血铅浓度之高,可以将一头公象当场置于死地。她已经弄清了铅的来源并非来自熔炉。虽然早在1978年含铅油漆就被禁止用于美国家庭,但较为陈旧的建筑物仍然是令人忧虑的暴露源。她们家室内有些地方是用含铅油漆涂刷过的,但是除了一个房间之外,其他房间的油漆已全被仔细地刮掉。那个房间贴着墙纸,成为孩子的房间。患者及其母亲揭掉了墙纸,企图用砂布将剩余的油漆磨掉,然而很可能这个活儿干得不够漂亮。
 Mom probably got her initial dose of lead when she stripped off the wallpaper while she was pregnant. The baby had been relatively protected until she started to crawl on the floor and came across leftover paint chips and lead dust. As for the dog, the veterinarian confirmed that he, too, had lead poisoning.  妈妈很可能是在怀孕期间揭掉墙纸的时候摄入了初始剂量的铅。婴儿开始在地板上爬行之前,相对来说是受到保护的;而会爬行之后,她就开始接触残余的漆片和铅粉。至于那条狗,兽医证实也是铅中毒。
 The only treatment for high levels of lead poisoning—and it is far from a perfect cure—is chelation therapy. The word chelation derives from the Greek word for claw. Imagine a giant molecular claw reaching out and grabbing a lead molecule and then spiriting it away for excretion. That's how a chelating agent works. The treatment, which can be given orally or intravenously, may require a weeklong hospital stay.  

高剂量铅中毒的唯一治疗方法是螯合疗法,然而这远非完美的疗法。“chelation”(螯合作用)这个词是来自希腊语的词汇,意思是“爪子”。试想象一下:一个由分子构成的巨型爪子,伸出去抓住铅分子,然后神秘地将其带走并排泄掉。这就是螯合剂的作用原理。治疗可以采用口服或静脉注射的方式,需要一周时间的住院。

 I didn't know how this child and her mother would fare. What I did know is that infants and children are far more vulnerable to high levels of lead exposure than adults. Although lead poisoning affects all organ systems, the nervous system is particularly susceptible. The body mistakes lead for calcium, a mineral that is crucial to cell signaling throughout the body. The metal so disrupts cell communication in the brain that it causes subtle deficits in growing minds. Other environmental factors can heighten the insult. A high-fat diet, for example, increases the body's vulnerability to lead toxicity; a diet rich in green vegetables helps minimize the impact. I hoped that catching the poisoning early would minimize the damage.  我不知道那个孩子和她妈妈的康复情况如何,但我的确知道:比起成年人,婴幼儿和孩子们对高浓度的铅暴露要敏感得多。铅中毒会殃及所有的脏器系统,但是特别容易受影响的是神经系统。身体会错误地把铅当作钙,而钙这种矿物质对于向周身发出信号的细胞是至关重要的。这样以来,这种金属就会扰乱大脑中的细胞通讯,不知不觉地导致智力发育上的不足。其他环境因素会加重这种危害,例如:高脂肪饮食会使身体更易遭受铅中毒的危害。富含绿色蔬菜的饮食却能帮助将危害降到最低。我希望及早发现中毒能将危害最小化。
 Preventing lead poisoning from the outset through public-health measures and education is far easier than trying to undo the poison's damage after the fact. Identifying lead poisoning isn't what busy emergency room doctors do best. But sometimes the most important clues to a case come where they are least expected—in this case, from man's best friend.  从一开始通过公共健康措施和教育来防止铅中毒,比既成事实后再设法解除毒害要容易得多。识别铅中毒并不是忙碌的急诊室医生最拿手的。然而,有时候一个病例最重要的线索竟来自最意想不到之处。在这个病例中,线索来自人类最好的朋友——狗。

译自:Discover

月亮飞船经典日志导读

 适度饮酒有利于心脏  绝经后应该做做心电图
 预防中风的新药——阿哌沙班  有益胆固醇可能会保护记忆(图)
 患有早期卵巢癌的妇女应该做活检  胰岛素水平高会增加乳腺癌的发病几率
 从猴子传播到实验室工作人员身上的新型病毒(图)  白血病人的化疗用药剂量
 美国国家地理2011年最佳新闻图片:僵尸蚂蚁  葡萄籽提取物可以杀死白血病细胞
 美丽的澳洲野生动植物(组图)  为何光线会使偏头痛加剧(图)

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