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化疗会给别人带来危害吗?

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WASHINGTON — Doctors told Ann B. Maddox that she had thyroid cancer and that the cure was to swallow radioactive iodine, to kill the malignant cells. She traveled 500 miles from her home in Fayetteville, N.C., for treatment at Johns Hopkins Hospital in Baltimore.
华盛顿报道——Ann B. Maddox 的医生告诉她,她得了甲状腺癌,需要通过吞服放射性元素碘来杀死那些恶性的癌细胞,从而达到治疗的效果。于是,为了治病,她穿越500英里从她在北卡罗来纳州费耶特维尔的家来到了位于巴尔的摩的Johns Hopkins 医院。

Then began a problem: what do you do when you cannot go home and you are radioactive?
于是,一个问题显现出来,即,当你体内含有放射性元素,而你又无家可归的时候,你该怎么办。

There are about 40,000 new cases of thyroid cancer a year, and most patients are treated with radiation, which makes them potentially dangerous to people around them for up to a week.
每年都会产生四万个甲状腺癌新病例,其中大多数患者都被施以放射疗法,而这将使他们在一周的时间内对他们周围的人造成潜在的威胁。

The question of where they should spend that time is drawing new concern from doctors, public health officials and regulators.
因而,医生、卫生部官员和监测者们已经开始着眼于这部分患者的合理安置问题。

In 1997, the Nuclear Regulatory Commission dropped a requirement that such patients be quarantined in the hospital. Instead, patients can be released right after their treatment, when they are at their most radioactive.
其实早在1997年,核管制委员会就已规定这类患者必须在医院进行隔离。然而现在,患者们却在治疗刚结束,即他们身上的辐射最强烈的时候就被放出了医院。

And while most people go right home, one patient in New York boarded a bus for Atlantic City, N.J., and set off a radiation alarm in the Lincoln Tunnel. And about 5 percent of patients do what Ms. Maddox did: check into a hotel.
大多数患者都会选择直接回家,而一位在纽约治疗的患者坐上了一辆开往亚特兰大的大巴,毋庸置疑,他引发了林肯隧道中的放射性警报。而大约百分之五的患者做了与Maddox太太一样的决定:去宾馆住。

“There weren’t many choices, really,” said Ms. Maddox, who is 72. The night before her treatment, in 2003, she stayed with her daughter in Delaware, but her daughter was pregnant, and fetuses and children are especially vulnerable to radiation. Johns Hopkins had no place for her to spend the night, she said. Getting on an airplane was out of the question because of the dose of radiation she would give other passengers. And there was concern about what would have happened if, as many patients do, she vomited the radioactive contents of her stomach.
“选择实在是不多啊,”现年72岁的Maddox太太说。2003年时,在她接受治疗的前一天晚上,她住在了位于特拉华的女儿家,但是治疗后她显然不能再住在那里了,因为他的女儿有孕在身,而胎儿和小孩子是最易受辐射侵害的。她告诉记者,Johns Hopkins 医院那天晚上没有足够的床位供她住了,她又不可能乘坐飞机,因为她可能会将一部分辐射传递给其他旅客,而且她还担心她会像许多患者一样,把胃里的放射性元素呕吐出来。

Instead, her husband, Bryce, booked a room at a hotel in Newark, Del. “I pretty much went in the back door,” Ms. Maddox said. When they hit the road the next day, heading home, she sat as far as possible from her husband, in the third row of seats in their Honda Odyssey minivan. “I’m sure we looked like we’d had some kind of spat,” she said.
于是,她的丈夫布赖斯帮她在特拉华州的纽华克市订了酒店房间。“我当然是从酒店后门进去的,”Maddox太太如是说。当他们第二天开着本田奥德赛微型面包车走在返乡路上的时候,她坐在了第三排座位上,以求离她丈夫越远越好。她说:“我们俩在外人看来一定像是一对闹别扭的小夫妻。”

Fortunately, like most thyroid cancer patients, she needed only a single dose of radiation to get rid of the cancer.
幸运的是,和大多数罹患甲状腺癌的患者一样,她只需要单剂放疗即可摆脱癌症的困扰。

Scientists have estimated that, depending on the amount of radioactive drug given to a thyroid patient, a secondhand dose could exceed an average American’s annual level from all natural sources, and three or four times the safe level recommended for a pregnant woman.
科学家估计,因甲状腺癌诊患者所吞食的放射性药品剂量而异,其“二手辐射”量会超过美国年均天然辐射源造成的辐射量,并且是孕妇所能承受的辐射量的三至四倍。

One person alarmed about the situation is Representative Edward J. Markey, Democrat of Massachusetts, whose office has been studying the issue. He accuses the Nuclear Regulatory Commission of turning a blind eye to the problem.
马萨诸塞州的民主党议会代表Edward J. Markey所在的部门正在研究分析这一日趋严峻的问题,他就这一严重状况向市民们敲响了警钟, 并谴责了核管制委员会对这件事熟视无睹的态度。

“My investigation has led me to conclude that the levels of unintentional radiation received by members of the public who have been exposed to patients that have received ‘drive through’ radiation treatments may well exceed international safe levels established for pregnant women and children,” Mr. Markey said in a statement.
Markey先生在陈述中这样说道:“我们从调查中得出了这样的结论,那些接收了‘得来速’放疗的患者对公众无意间造成的辐射量远远超出了孕妇和儿童所能承受的安全标准。”

The Nuclear Regulatory Commission took up the issue at a meeting last Wednesday. James G. Luehman, a staff official who helps monitor the safe handling of radioactive materials used in medicine, said his agency might have made a mistake in dropping the quarantine requirement. The idea was that letting people return home to recuperate would cut costs, benefit the patients and allow doctors with no quarantine facilities to perform the treatment.
星期三的核管制委员会会议上,委员们就这项议题进行了讨论。负责监控药品内放射性原料安全使用的行政官员James G. Luehman提出,他所在的机构在取消“隔离规定”是犯了大错。他们本希望通过让患者回家休养节约开支,使患者受益,并使没有隔离设施的医生们也可以对患者进行这种治疗。

The agency knew that relatives and strangers would get a radiation dose from such patients, Mr. Luehman said, but it assumed that the doses to people like hotel clerks and chambermaids would be random and that no one was likely to be exposed repeatedly. He recommended that the commission study whether such patients tended to stay at certain hotels near major medical centers, but no conclusion about such a study was reached on Wednesday.
Luehman先生还说,机构知道这些患者会给他们的亲人或是身边的陌生人带来辐射,但对类似宾馆服务员和房间服务生这些人的辐射是随机的,同一个人不太可能被重复地暴露在辐射之下。他建议委员会对患者们是否更愿意在主要医疗中心的周边宾馆住宿进行调研,但到星期三为止,还没有类似的结论公布。

New York City has gone a step further. Last June, it advised radiologists and endocrinologists, “Do not advise patients to go to a hotel.” A few states have similar policies.
纽约则更进一步。去年六月纽约政府通知放射科医生和内分泌科医生,让他们不要建议他们的患者去宾馆留宿。一些其他州也有类似的政策。

同时,患者也可以采取一些简单的预防措施来大大降低危险系数,如:尽量离别人远一些,不要让他人接触到患者的唾液,尿液和其他体液。

Radiation from patients decreases both as the iodine dose is flushed out of their bodies and as it loses strength.
患者体内碘元素的放射性会随着放射性元素从患者体内的排出和其自身放射性的衰退而减弱。

Many radiation experts doubt that radioactive thyroid patients represent a public health problem. “We’re talking about really small doses,” said Dr. Henry D. Royal, the associate director of nuclear medicine at the Mallinckrodt Institute of Radiology at Washington University, in St. Louis.
很多放射学专家并不认为接受那种治疗的甲状腺癌的患者会对公众健康造成威胁。Henry D. Royal博士说:“我们所探讨的都是十分小剂量的辐射。”他是圣路易斯华盛顿大学马林克罗制药机构放射学部门旗下核医学部的副董事长。

“Who is it going to harm?” added Dr. Royal, who is on the executive board of the American Nuclear Society. “Show me some measurement that you’ve made, that this really happens.”
“这又会伤害得了谁呢?”现在美国核能协会执行局任职的Royal博士接着说,“如果这些造成的伤害是真的,你得给我举出实际调查得出的证据啊。”

But the issue has, in fact, stirred considerable concern among endocrinologists and others involved in nuclear medicine. Dr. Gregory A. Brent, the president of the American Thyroid Association, said that his group had spent two years trying to develop guidance for doctors on how to advise patients, but that there was no data about the risks of secondhand radiation to work from.
然而,事实上,这件事已经在内分泌科医生和其他从事有关核医学的研究者之间掀起了不小的波澜。美国甲状腺联盟主席Gregory A. Brent医生说他的团队已经花了两年时间尝试着建立一个关于医生如何劝说病人的指导系统,但是由于缺少关于“二手辐射”危害的数据支持,工作进行的很困难。

The risk seems hypothetical, he said. “You can imagine the pregnant woman working in a hotel, cleaning up urine,” he said. “One can generate scenarios. But from what we know and what has been looked at, that hasn’t been the case.”
他还说这种危害看上去仅仅像是一种假说。“你可以想象一个在宾馆工作并清理尿液的孕妇,”他说,“你可以随意假想出各种情形,但是就我们已知的和我们一直所观察到的现象而言,那些情形都没有出现。”

The staff of Mr. Markey, who is chairman of the Energy and Environment subcommittee of the House Committee on Energy and Commerce, has been gathering reports of contamination. In Maryland and Massachusetts, for example, patients have put contaminated items in the trash, and the trucks that collected it set off alarms at dumps.
Markey先生是众议院能源与贸易中能源与环境小组委员会主席,他的职员一直在收集关于放射性污染的研究报告。例如,在马里兰州和马萨诸塞州,有些患者将被放射性污染过的废料投入垃圾堆,从而使运垃圾的卡车倾泻垃圾时响起了警报。

After thyroid treatment, patients are advised not to hug children or pregnant women, or to sleep next to another person, for several days — depending on the size of the dose.
患者们得到这样的建议——在治疗之后的一段时期不要拥抱儿童和孕妇,或是和他人同床而眠,时间长短取决于使用剂量的大小。

They are even advised against eating chicken wings or whole apples, because the bones or the core will be contaminated with radioactive saliva.
他们甚至被告知尽量不要吃鸡翅和整个的苹果,因为他们吃剩下的鸡骨头和苹果核会被含有放射性物质的唾液污染。

Hospital isolation is still the practice in Europe. Patients can be hospitalized in the United States, but only if they try hard.
在欧洲,对这些患者进行医务隔离仍在实行。美国也一样可以强制患者留在医院,但有关部门一定要付出很大努力。

例如,弗吉尼亚州洛亚诺克城的Janis Lewis带着她刚刚确诊为甲状腺癌的16岁女儿在六月份接受了碘元素放疗。

For example, Janis Lewis, of Roanoke, Va., took her 16-year-old daughter for an iodine dose in June, soon after thyroid cancer was diagnosed.

The girl, whose name Ms. Lewis asked not be published, gets motion sickness even in normal circumstances, she said, and she asked at the endocrinologist’s office if her daughter could be admitted overnight. She was told that was not possible, and that her medical insurance would not pay for it.
据Lewis女士讲,她的女儿(Lewis女士未曾透露她的姓名)在正常条件下都会晕车,所以她询问了内分泌科办公室可否让她女儿住院一晚。然而她被告知这不可能,而且医疗保险也不会来为她支付这笔钱。

But Ms. Lewis eventually determined that her insurance would cover the expense if a doctor said hospitalization was medically necessary; but the hospital involved had no isolation rooms for thyroid cancer patients.
但是Lewis女士最终坚决地认为,如果医生认定住院治疗是必须的,那么她的医疗保险就可以报销这笔钱。然而,这所医院却没有单独的病房供甲状腺癌病人入住。

She gave up on that hospital. “I wasn’t comfortable driving her home three and a half hours in the car,” said Ms. Lewis, an occupational therapist.
她对那所医院失望透顶,作为一位专业的医师,她说:“在开车带我女儿回家那三四个小时里,我一直很不舒服。”

她到哥伦比亚的华盛顿医疗中心找了另一个医生,她的女儿在那里住了院,也确实一整晚都在不停地呕吐放射性物质。

Instead, she found another doctor, at Washington Hospital Center, in the District of Columbia, where her daughter stayed overnight, and did, in fact, vomit radioactive material all night.

Outpatient treatment is often appropriate, Ms. Lewis said, but “in some cases, it’s gone too far.”
Lewis女士说道:“对病人进行门诊治疗而不留院观察常常是合理的,但对于某些病例来说,就太出格了。”

标签:化疗
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2010-10-26 23:03 编辑:kuaileyingyu
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