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临床医学翻译样例

发布者:鑫达医学翻译 发布时间:2013-06-07阅读:

 

Most patients present with locally advanced disease at diagnosis. Since the bulk of the tumor is frequently outside the bladder lumen, the disease may be clinically silent until sufficient growth has occurred to penetrate the ladder, thereby causing local symptoms. More frequently presenting with symptoms of gross hematuria and irritative voiding symptoms, patients have also reported voiding mucous-like material, consistent with the frequent mucinous enteric elements seen on histopathology. Since urachal carcinomas can develop anywhere along the urachal ligament, patients may report a suprapubic or umbilical mass. Some patients have also reported umbilical pain and umbilical discharge. One patient described initially being diagnosed with an umbilical infection; however, after it proved unresponsive to antibiotic therapy, radiographic imaging led to the appropriate diagnosis. Peritoneal carcinomatosis and pseudomyxoma peritonei may also be present on radiographic imaging.

A typical work-up includes cystoscopy with biopsy and radiographic evaluation with contrast-enhanced computed tomography(CT) scans or magnetic resonance imaging (MRI) of the abdomen and pelvis, with a CT of the chest or chest x-ray to exclude metastatic disease. The presence of a cystic or solid midline mass, at times with calcifications present, should be considered pathognomonic for the diagnosis (FIGURES 1 & 2). An exam under anesthesia (EUA) can also be useful to determine clinical staging and resection status in the absence of clinical or radiological evidence of metastasis. In addition to lymph node palpation, physical examination should include an abdominal exam with palpation of the umbilicus and suprapubic area. In situations where the diagnosis is uncertain or where past history or imaging suggest an alternative primary site, a breast exam, prostate and rectal exam and a stool guaiac exam should be considered. Although searching for an occult primary of an another organ is not routinely recommended, colonoscopy, esophagogastroduodenoscopy and breast mammogram should be performed if an alternative diagnosis are suggested by history, imaging or physical examination.

 

多数患者确诊时为局部晚期病症。由于肿块常位于膀胱腔外,初期该肿瘤无临床症状,肿块长大穿透膀胱后,出现局部症状。更频繁地出现血尿和排泄刺激症状时,患者也报告排泄粘液状物质,与组织病理观察中频繁出现肠道黏液一致。由于脐尿管癌可沿脐尿管韧带发生于任何地方,患者可能会出现耻骨上或脐肿块。部分患者还报道脐痛和脐出脓。一例患者最初诊断为脐感染,抗生素治疗无效后,X片检查后才做出了正确诊断。X片也显示存在腹膜扩散和腹膜假粘液瘤可能。

采用以下典型的检查方法排除疾病转移可能:膀胱镜检查伴活组织检查,腹部和盆腔增强CT扫描或磁共振成像(MRI),及胸部CT或X片。膀胱顶或中线附近发现肿块,及膀胱造影出现钙化为主要的诊断依据(图1和图2)。在缺少肿瘤转移的临床或影像学证据时,麻醉下检查(EUA)对于确定临床阶段和切除状态也很有用。体格检查应包括淋巴结触与腹部检查,即对脐部和耻骨上区实施触诊。在诊断不明确,或既往病史或影像学资料提示有其他的原发病灶时,应考虑对乳房、前列腺直肠和粪便检查。通常,并不推荐在另一器官内找寻隐匿原发灶,但如果病史、影像学或体格检查提示有其他的诊断结果,就应当进行结肠镜检查、食管胃十二指肠镜检查和乳房X光造影检查。


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