医学英语文献阅读技巧

TetanusA man who was struck from behind by a sharp dart a little below the neck had a wound which did not look serious because it did not go deep. But sometime later when the point had been extracted the patient was seized with backward-bending convulsions like those of opisthotonus. His jaws were locked, and any liquid that he attempted to swallow was returned through his nostrils. He died on the second day.As of 2010 it caused about 61,000 deaths down from 272,000 in 1990. Tetanus –in particular, the neonatal form –remains a significant public health problem in non-industrialized countries with 59,000 newborns worldwide dying in 2008 as a result of neonatal tetanus.[19] In the United States, from 2000 through 2007 an average of 31 cases were reported per year.[3] Nearly all of the cases in the United States occur in unimmunized individuals or individuals who have allowedtheir inoculations to lapse. Tetanus is the only vaccine-preventable disease that is infectious but is not contagious.[ Lancet(柳叶刀)380 (9859): 2095–128]Tetanus is a common disease, with the progress of medicine, death caused by it has become less and less, but it does not go away. Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced bythe Gram-positive,rod-shaped,obligate anaerobic bacterium Clostridium tetanus.Infection generally occurs through wound contamination and often involves a cut or deep puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus the name lockjaw) and elsewhere in the body. Infection can be prevented by proper immunization or post-exposure prophylaxis.Tetanus is caused by the tetanus bacterium Clostridium tetani. Tetanus is often associated with rust, especially rusty nails. Objects that accumulate rust are often found outdoors, or in places that harbor anaerobic bacteria, but the rust itself does not cause tetanus nor does it contain more C. titanic bacteria. The rough surface of rusty metal merely provides a prime habitat for C. tetani endosperms to reside in, and the nail affords a means to puncture skin and deliver endosperms deep within the body at the site of the wound.[医学微生物学]Tetanus Ab le tt classification:Mild: mild - moderate lockjaw; General spasticity; without difficulty breathing; without convulsions; no or mild dysphagia.Moderate: Moderate lockjaw; obvious spasm; mild - moderate but short convulsions; moderate difficulty breathing and respiratory rate> 30 beats / min; mild dysphagia. Severe: severe lockjaw; generalized spasticity; reflecting sustained convulsions; respiratory rate> 40 beats / min; severe difficulty breathing; severe dysphagia; tachycardia> 120 beats / min.Very serious: three self-discipline and a strong cardiovascular system instability; severe hypertension and tachycardia and hypotension and bradycardia alternately; any form persistent.[医学微生物学]The clinical manifestations are usually classified into three forms:1. Localized tetanus presents with spasm near the site of the injury, usually in an extremity. The fatality rate is 1 percent or less.2. Generalized tetanus, the more common form, is marked by the classic truisms (lockjaw), fixed grin(risus sardonicus), and backward arching of the trunk (opisthotonos). Tonic seizures of the muscle groups occur in spasms, lead to rigidity, and are very painful. They may be precipitated by any stimulus. Pneumonia may follow respiratory muscle involvement or laryngeal spasm with aspiration. Cardiovascular disturbances are common,especially vasoconstriction and a labile blood pressure. Severe spasms may cause vertebral fractures.The course of this form, in survivors, is from1 to 2 weeks.[ The Cambridge World History of Human Disease]3. Cephalic tetanus, an uncommon form of the disease,follows facial wounds, involves the facialnerves, and may be followed by generalized tetanus.4. Neonatal tetanus following infection of the umbilical cord (discussed in the next chapter) usually begins by the third to tenth day after birth, and then progresses to generalized tetanus.It is report ed that mortality of severe tetanus is 15% ~40% . In recent years; along with foreign in severe injury Wind the progress on the treatment, the mortality rate is at the moment gradually declining. Should be carried out to the patients with severe tetanus into the intensive care unit and therefore shall require the surgeon must have good SICU basis and relevant theory. Its treatment is various, in addition to the well-known wound treatment, antibiotics, prevent tetanic convulsion toxin absorption. Besides, it still need to correct the self-discipline which is not stable, trachea cut open, no depolarizing agent application, mechanical ventilation, enterable nutrition support. Hold, maintain water and electrolyte acid-base balance, control of lung Dye and prevention of thromboembolism, and also need to strengthen the sputum suction And the skin and oral care, prevent bedsore and regurgitation Critical onset of the severe tetanus, easy out early Respiratory complications, such as choking, atelectasis and pulmonary feeling Dye, has a high mortality rate if not handled in time, so the comprehensive protection Richard also plays a key role in the treatment.[ 临床外科杂志 2008年 7月第 16卷第 7期JClinSurg, July 2008,Vo.l 16, No. 7]Unlike many infectious diseases, recovery from naturally acquired tetanus does not usually result in immunity to tetanus. This is due to the extreme potency of the tetanospasmin toxin; even a lethal dose of tetanospasmin is insufficient to provoke an immune response.Tetanus can be prevented by vaccination with tetanustoxoid.The CDC recommends that adults receive a booster vaccine every ten years,[ "CDC Features - Tetanus: Make Sure You and Your Child Are Fully Immunized". Retrieved 2010-08-30]and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than three lifetime doses of the vaccine. The booster may not prevent a potentially fatal case of tetanus from the current wound, however, as it can take up to two weeks for tetanus antibodies to form.In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, DPT/DTaP vaccine, which also includes vaccines againstdiphtheria and pertussis. For adults and children over seven, the Td vaccine (tetanus and diphtheria) or Tdap (tetanus, diphtheria, and acellular pertussis) is commonly used.[ Uganda: Nation Free of Maternal And Neonatal Tetanus, Unicef Reports". Retrieved 2011-07-14.]The World Health Organisation certifies countries as having eliminated maternal or neonatal tetanus. Certification requires at least two years of rates of less than 1 case per 1000 live births. In 1998 in Uganda, 3,433 tetanus cases were recorded in newborn babies; of these, 2,403 died. After a major public health effort, Uganda in 2011 was certified as having eliminated tetanus.徐老师您辛苦了，非常谢谢您！《医学基础英语文献阅读技巧》对于医学生来说是大有裨益的，上完本课之后相信大部分同学都受益良多，它不仅仅是一门英语课程，更是一门对医学生而言非常重要也有必要了解的文献阅读课程。