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【丁香译站】Keep MD Sharp——《新英格兰医学杂志》临床病例翻译活动（更新至第五期）

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这个帖子发布于8年零71天前，其中的信息可能已发生改变或有所发展。

《新英格兰医学杂志》是全球临床医学领域最权威的期刊，NEJM的栏目设计最有教学意义，编辑非常着重从教学的角度来组织材料，如“Case Report”“Review article”“Image”“Clinical application of basic research”“video”栏目。里面的病例讨论很值得借鉴。我个人比较喜欢里面INTERACTIVE MEDICAL CASE和CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL两个版块，都是对临床病案进行讨论。本帖组织对后一版块的翻译活动，希望各位战友支持，但请勿灌水。

第一期：A 63-year-old man was admitted to this hospital because of paresthesias, difficulty drinking liquids, and anxiety.
第二期：Case 2-2013: A 20-Year-Old Man with Recurrent Ear Pain, Fever, and Headache
第三期：Case 3-2013: A 72-Year-Old Woman with Abdominal Pain and Distention after Peritoneal Dialysis
第四期：Case 5-2013: A 52-Year-Old Woman with a Mass in the Thyroid

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2013-02-04 21:00 浏览 : 9364 回复 : 35

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sjtuwalker 编辑于 2013-03-03 22:53

• 2021内科主治73道全是病例分析题

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认领翻译的战友请跟帖注明“认领本文翻译，48小时内未完成，请其他战友认领！”
欢迎大家认领校对，校对质量优秀者享受加分，投票
请根据自己专业背景选择认领，如使用翻译软件翻译，被发现者扣分1-2分，经常认领而不能及时提供优质稿件者将被列入黑名单，取消认领资格，请大家注意！
新近参与本次活动的会员请查看：http://news.dxy.cn/bbs/topic/21537141
翻译时请把不确定的地方用红色字体标注！
寻找最近的翻译贴请查看：点击进入
翻译时请参照版规 http://news.dxy.cn/bbs/topic/8600034

第一期：
A 63-year-old man was admitted to this hospital because of paresthesias, difficulty drinking liquids, and anxiety.

The patient had been well until 4 days before admission, when aching developed in the left elbow, which improved with ibuprofen. The next day, right-elbow discomfort occurred, and he had decreased appetite. Two days before admission, he noted difficulty forming words, mild light-headedness, and mild recurrent pain in both elbows. An attempt to drink a glass of water precipitated a gagging sensation. He had difficulty breathing and could not swallow the water. The choking sensation resolved when he spat out the water, but it recurred with subsequent attempts. He stopped drinking liquids and became increasingly anxious. One day before admission, he was unable to shower because of increased anxiety and noted intermittent decreased fluency in his speech and pruritus at the nape of his neck. He was concerned that he was having a stroke, and he drove to the emergency department at a local hospital.

On examination, the temperature was 37.8°C, the blood pressure 111/81 mm Hg, the pulse 97 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 96% while the patient was breathing ambient air. He was intermittently very anxious and hyperventilating. When given a cup of water or juice, he gagged as the cup neared his mouth and coughed while attempting to drink, with improvement after he expectorated the liquid. He was able to swallow solids. The remainder of the examination was normal. The blood levels of hemoglobin, electrolytes, total protein, albumin, creatine kinase isoenzymes, and troponin T were normal, as were the hematocrit, platelet count, and red-cell indexes; tests of coagulation and renal and liver function were also normal. Other test results are shown in Table 1. An electrocardiogram (ECG) showed sinus rhythm at a rate of 87 beats per minute, left ventricular hypertrophy, and a QRS-complex duration of 134 msec, without evidence of acute ischemia. A chest radiograph was normal. Lorazepam and intravenous fluids were administered, with some reduction in anxiety.

The patient reported intermittent tremulousness during the previous 2 days, retching when thinking about drinking water, and a transient pruritic rash on his left shoulder 2 weeks before this presentation, without recent fever, chills, vomiting, diarrhea, pharyngitis, or focal motor deficits. He had hypertension, chronic ptosis of the right eyelid, and, 6 months earlier, a tick bite for which doxycycline had been administered. Medications included hydrochlorothiazide and low-dose aspirin daily; he had received influenza and tetanus vaccinations within the past year. He had no allergies. He drank alcohol occasionally, had stopped smoking 25 years earlier, and did not use illicit drugs. He lived with his wife in an oldhouse in a semirural region of New England. He had no history of animal bites; however, bats had been seen in his home and in a barn where he had worked several times during the previous year. He had not traveled internationally
in the past decade. His father had had lung cancer.

On examination, the patient appeared anxious, with dry mucous membranes. The blood pressure was 171/80 mm Hg, the pulse 86 beats per minute, the temperature 36.4°C, the respiratory rate 16 breaths per minute, and the oxygen saturation 98% while he was breathing ambient air. Other findings included ptosis of the right eyelid, mild facial twitching, postural hand tremors, and dysmetria on finger–nose–finger and heelto-shin testing, without truncal ataxia. Deeptendon reflexes were symmetrically hyperactive throughout; plantar reflexes were flexor. There was mild difficulty with tandem walking. The patient’s speech was rushed and fluent, except for occasional slurred words and pauses for word finding; the remainder of the general and neurologic examination was normal. The hematocrit, platelet count, erythrocyte sedimentation rate, and levels of hemoglobin, C-reactive protein, and troponin T were normal, as were tests of renal and liver function; toxicologic screening and testing for antibodies to Ro and La were negative. Other test results are shown in Table 1. Lorazepam was administered.

Magnetic resonance imaging (MRI) of the brain without the administration of contrast material and magnetic resonance angiography (MRA) of the head and neck revealed abnormal signal hyperintensity scattered in the periventricular
and subcortical white matter on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images and was otherwise normal. A chest radiograph was normal. The patient was admitted to the hospital.

During the first day, the patient was conversant and had increasing anxiety and discomfort from ambient noises, including hospital monitor alarms. Evaluation by a speech and language pathologist revealed severe anxiety related to swallowing liquids (characterized by physically aversive behaviors when liquids began to approach his facial area), without evidence of focal dysphagia, dysarthria, or an anatomical contraindication to swallowing.

Overnight, anxiety increased. Lorazepam and haloperidol were administered. Early in the morning of the second day, the temperature rose to 38.2°C. The patient was tremulous, agitated, oriented but confused, and unable to give a clear history. After premedication with additional lorazepam and haloperidol, a lumbar puncture was performed. The opening pressure was 33 cm of water. Results of cerebrospinal fluid (CSF) analysis and other test results are shown in Table 1. Cytologic examination and flow cytometry of the CSF showed no abnormalities.

Immediately after the procedure, cyanosis developed; the systolic blood pressure was 240 mm Hg, the pulse 160 beats per minute, the respiratory rate 40 breaths per minute, and the oxygen saturation 40 to 49%. An ECG showed supraventricular tachycardia at a rate of 150 beats per minute, with regular rhythm and right bundle-branch block, without ischemic changes. The pulse suddenly decreased from 150 beats per minute to 60, then returned to 150 beats per minute before pharmacologic intervention. Oxygen was administered, and the oxygen saturation rose to 95%. Metoprolol and furosemide were administered intravenously, followed by diltiazem. A repeat chest radiograph showed perihilar fullness and loss of definition of the pulmonary vasculature, consistent with pulmonary edema. The trachea was intubated, and the patient was admitted to the cardiac care unit. An electroencephalogram (EEG) showed moderate generalized background slowing without focal features, epileptiform activity, or correlation to episodes of arm tremors and twitching. CT of the brain showed no evidence of acute injury.

Diagnostic procedures were performed