by Henry Marsh douban

Henry Thomas Marsh CBE FRCS (born 5 March 1950) is an English neurosurgeon, and a pioneer of neurosurgical advances in Ukraine. His widely acclaimed memoir Do No Harm: Stories of Life, Death and Brain Surgery was published in 2014. According to The Economist, this memoir is "so elegantly written it is little wonder some say that in Mr Marsh neurosurgery has found its Boswell ([詹姆斯·博斯韦尔](<https://zh.wikipedia.org/wiki/%E8%A9%B9%E5%A7%86%E6%96%AF%C2%B7%E5%8D%9A%E6%96%AF%E9%9F%A6%E5%B0%94>))." A further memoir Admissions: A life in brain surgery was published in 2017.

以本书作者为主角在乌克兰医院经历为题材的纪录片 [The English Surgeon](<https://en.wikipedia.org/wiki/The_English_Surgeon>)

本书续作:Admissions: Life as a brain surgeon ([一个医生的自白](<https://book.douban.com/subject/30242326/>): 走在生命与死亡的十字路口)
感想
作者对 NHS (National Health Service,二战后建立的英国公立医疗体系) 的态度基本上是蔑视和讽刺。

Preface

‘First, do no harm…’ (另一个版本: Avobe All, Do No Harm)
Commonly attributed to Hippokrates of Kos, c. 460 BC. (希臘)科斯島的[希波克拉底](<https://zh.wikipedia.org/wiki/%E5%B8%8C%E6%B3%A2%E5%85%8B%E6%8B%89%E5%BA%95>)
希波克拉底誓词

Chapter 1. Pineocytoma

Pineocytoma : n. an uncommon, slow-growing tumour of the pineal gland

hydrocephalus: 脑水肿,脑积水。脑脊液(cerebro-spinal fluid)堆积使颅内压增大,导致头痛。
  * 脑肿瘤可以阻碍脑脊液循环而导致此症状。未治疗患者会在几周内死亡。
  * 脑血栓(clot)引起出血也可能导致此症状。

germinoma. n. 生殖细胞瘤;胚组织瘤;胚细胞瘤
craniectomy 頭蓋骨切除術
meninx 髄膜◆【複】meninges 脑膜;髓膜;脑脊膜
  * the membrane beneath the skull that covers the brain and spinal cord

Chapter 2. ANEURYSM

n. a morbid dilatation of the wall of a blood vessel, usu. an artery. 动脉瘤

动脉瘤是动脉血管的局限性扩张,是由于动脉血管管壁较薄,中层肌纤维较少,外层也少弹力纤维,其薄弱部位在血流冲击下膨大扩张,形成动脉瘤。

手术夹钳是一种封闭动脉瘤的方法。神经外科医生去除颅骨的一部分以进入动脉瘤,并找到为动脉瘤供血的血管。然后,在动脉瘤上放一个小金属夹(spring-loaded tianium clip),以阻止血液流向它。

Brain

arachnoid [蛛网膜](<https://zh.wikipedia.org/zh-cn/%E8%9B%9B%E7%B6%B2%E8%86%9C>)。[くも膜](<https://bsd.neuroinf.jp/wiki/%E3%81%8F%E3%82%82%E8%86%9C>)。named after the Greek word for a spider, as it looks as though it was made from the strands of the finest spider’s web.

Chapter 3. HAEMANGIOBLASTOMA

Haemangioblastoma: n. a tumour of the brain or spinal cord arising from the blood vessels. 成血管细胞瘤

Haemangioblastomas are rare benign brain tumours that start in the cells that line the blood vessels in the brain, spinal cord and brain stem. They usually grow slowly over some years. Most haemangioblastomas start in the back of the brain (cerebellum).

polycythemic adj. 血液里红细胞增多。导致脸红。一种体质。某些肿瘤等疾病可以刺激骨髓增生红细胞导致这种症状。

GCS. [Glasgow Coma Scale](<https://en.wikipedia.org/wiki/Glasgow_Coma_Scale>). [格拉斯哥昏迷指數](<https://zh.wikipedia.org/wiki/%E6%98%8F%E8%BF%B7%E6%8C%87%E6%95%B8>)

昏迷程度以E、V、M三者分数加总来评估,正常人的昏迷指数是满分15分,昏迷程度越重者的昏迷指数越低分,最低为3分。

格拉斯哥昏迷指数的评估分为三个方面(EVM),三个分数之和即为昏迷指数:
睁眼反应(E, Eye opening)
4分:主动地睁开眼睛(spontaneous)。
3分:听到呼唤后会睁眼(to speech)。
2分:有刺激或痛楚会睁眼(to pain)。
1分:对于刺激无反应。
C:有外力阻止眼睛睁开(closed),例如眼皮水肿。
说话反应(V, Verbal response)
5分:说话有条理,会与人交谈(oriented)。
4分:可应答,但说话没有逻辑(confused)。
3分:可说出单字或胡言乱语(inappropriate words)。
2分:可发出声音(unintelligible sounds)。
1分:无任何反应(none)。
T:气管切开无法正常发声(tracheostomy)。
E:气管插管无法正常发声(endotracheal tube)。
A:失语症(aphasia)
运动反应(M, Motor response)
6分:可依指令做出各种动作(obey commands)。
5分:施以刺激时,可定位出疼痛位置(localize)并有目的地的去除疼痛刺激行为。
4分:对疼痛刺激呈现正常屈曲回缩反应(normal flexion),病人只呈现无目的性的肢体移动,屈曲回缩反应。
3分:不正常屈曲:对痛刺激呈现痉挛式手臂屈曲姿势。
2分:对疼痛刺激呈现手臂伸直僵硬的姿势反应(decerebrate extension)。
1分:无任何反应(no response)。

轻度昏迷:13分到15分。
中度昏迷:9分到12分。
重度昏迷:3分到8分。
其他状况:因插管或气切无法发声的重度昏迷者会有 VE或VT

hemostatic 止血的

Level 3 critical care:
ICU: intensive care unit (ICU) / ITU: intensive therapy unit
UK 多使用 ITU。US和其他地方多使用 ICU。

Level 2 critical care
HDU: high dependency units

CCU: critical care unit 介于 Level 2 / 3 之间。

Chapter 4. Melodrama

meningioma 复数 meningiomas或meningiomata. [肿瘤] 脑膜瘤;脊膜瘤。最常见的原发性颅内肿瘤。大多数脑膜瘤是良性的,但它们可以表现有从I级到III级(间变性/恶性)的不同程度的去分化(dedifferentiation),并与不同的结果相关。放射影像监测是低级别无症状脑膜瘤的有效选择。在其他情况下,治疗通常采取外科手术,目的是实现完全切除。

suprasellar 鞍上区

chias 左、右视神经(left / right optic nerves)交叉点
pituitary stalk 垂体柄。连接脑垂体和大脑的结构。位于称作 sella (鞍) 的空腔(cavity)里

glioma 胶质瘤;[肿瘤] 神经胶质瘤 复数gliomas或gliomata
intracerebral 大脳内の adj
intracerebral haemorrhage 脑部肿瘤切除手术罕见(致命)并发症

Chapter 5.

trigeminal neuralgia [三叉神经痛](<https://zh.wikipedia.org/wiki/%E4%B8%89%E5%8F%89%E7%A5%9E%E7%B6%93%E7%97%9B>) (latin. tic douloureux))
脑血管压迫三叉神经导致
手术治疗: 神经损毁;血管减压 (microvascular decompression)

The operation involves exposing one side of the brain through a very small opening in the skull behind the ear and gently displacing a small artery off the sensory nerve – the trigeminal nerve – for the face. The pressure of the artery on the nerve is responsible for the pain though the exact mechanism is not understood.

Spassky tower [斯巴斯克塔](<https://zh.wikipedia.org/zh-cn/%E6%96%AF%E5%B7%B4%E6%96%AF%E5%85%8B%E5%A1%94>)(俄语:Спасская башня,罗马化:Spasskaya Bashnya),意为救世主塔,又称救世主塔楼,是俄罗斯克里姆林宫在东侧城墙的主要塔楼,也是克里姆林宫的主要入口,可以俯瞰红场。

Upper Volta ([上伏塔](<https://zh.wikipedia.org/wiki/%E4%B8%8A%E4%BC%8F%E5%A1%94>), 当时是非洲最贫困的国家。1984年改名为布吉納法索) with rockets: The Soviet Union

Chapter 6. ANGOR ANIMI

n. the sense of being in the act of dying, differing from the fear of death or the desie for death. - the anguish of the soul – the feeling that some people have, when they are having a heart attack, that they are about to die.

Ventricular tachycardia (VT or V-tach) is a type of abnormal heart rhythm, or arrhythma. It occurs when the lower chamber of the heart beats too fast to pump well and the body oesn't receive enough oxygenated blood.

Chapter 7. Meningioma