招行运通金卡权益:谁对我们的气味最了解

谁对我们的气味最了解

“Not surprising,” I told her. “Halitosis almost never arises from the esophagus, stomach, or intestine.” Undaunted, she repeated, “Something’s wrong.”

        我告诉她，“这没什么”，“口臭从不会从食道、胃或者肠里来的”，她坚持道：“肯定哪里出问题了。”

I thought for a moment and then said: “Fair enough. You know, sometimes conditions in the lungs can cause the breath to be bad. Let’s do a chest X-ray.” Even though I was certain that the yield on the X-ray would be small, I wanted to be able to tell her we had turned over every stone in search of the cause of Jerry’s nonproblem.

       我考虑了一会告诉她：“一般来说，肺在某些条件下使呼吸变得难闻，做一个胸部X-光看看吧。”尽管我确定X-光的作用不大，而是想告诉她我们已经寻找每一个可能的原因来解决Jerry的本不存在的毛病。

So even though Sandy was the only one who thought her husband’s breath was bad; even though Jerry had no symptoms, findings, or risk factors whatsoever; and even though his lungs had sounded clear when I listened to them at his first visit, I had my medical assistant walk him down the hall for the chest film.

       虽然Sandy 是唯一一个认为她丈夫的气息是难闻的，虽然Jerry 没有任何症状，表现或者任何可能的危险因素；尽管第一次接诊时听他的肺是清晰的，我还是让助手带他去做胸片。

Several minutes later my assistant put the X-ray up on the view box in my office. I took one look and had to suppress an expletive. Sitting in Jerry’s right midlung was a rounded density with a central cavity containing air and fluid. It was the radiographic signature of an abscess.

     几分钟后助手把X片放到办公室阅片框上，我看了一眼，马上掩饰住自己惊讶。Jerry的右中肺有一个圆形的中空密度影，里面有气体和液体，放射诊断写着脓肿。

Amazingly, Jerry had been harboring a chronic infection in his right lung, but it had not been accompanied by any of the typical symptoms of an abscess—fever, cough, sputum production, sweats, and weight loss. He’d had none of them. None, that is, except for an odor on his breath. The smell of purulent sputum incubating deep within a lung may waft its way up the bronchial tree, resulting in serious halitosis. But in Jerry’s case the odor was so subtle that it took the exquisitely sensitive olfactory memory of his wife to pick up the change. The “ghosts” she smelled were real, and antibiotics were exactly what it was going to take to get rid of them.

      让人惊讶的是，虽然Jerry右肺有慢性感染，但并没有其他任何典型的脓肿伴随症状--发热，咳嗽，吐痰，汗多和体重减轻，没有上述任何表现，除了呼出的气味。肺中的浓痰的气味沿着支气管呼出来导致严重的口臭。Jerry这种微小的气味变化被有敏感嗅觉记忆的夫人捕捉到。她所闻到的“灵息”是真的，可用抗生素去除它们。

Adding to my surprise was the fact that Jerry had none of the risk factors associated with a lung abscess. Among patients with intact immune systems (not compromised by HIV or chemotherapy, for example), lung abscesses occur most frequently in those with conditions that impair the swallowing mechanism and allow for the aspiration of food or saliva into the lungs. Disorders such as strokes or neurodegenerative disease and conditions that depress consciousness like alcoholism, seizures, and drug abuse can all predispose to oral contents “going down the wrong pipe.” When coupled with poor dental hygiene, which can lead to the buildup of bacteria, these disorders set people up for aspiration pneumonias, infections that can smolder and destroy normal lung tissue, literally rotting out a “dead zone” in the lung.

       更让我惊讶的是Jerry没有任何导致肺脓肿的危险因素。对免疫系统正常的人（不包括HIV和接受化疗的患者）来说，肺脓肿多是由于吞咽受损食物或唾液的误吸。在中风、神经系统疾病及意识不清的状态下如酗酒、突发疾病、滥用药物等容易使嘴里的东西进错“管道”。如果加上牙齿卫生不佳导致的细菌寄存，这将导致吸入性肺炎。感染逐渐进展致使正常肺组织被破坏，理论上将形成肺的一个坏死区。

But in a small number of cases, lung abscesses may arise in the absence of any identifiable risk factor. It is possible that Jerry had a congenital anomaly in his bronchial tree that led to the pooling of mucus, and eventually to infection, but it is impossible to know for certain.

      但在少数情况下，肺脓肿并没有任何可以明确的诱发因素。Jerry有可能是先天性支气管异常导致粘液的蓄积导致最终感染，但很难验证这种情况。

In the pre-antibiotic era, lung abscesses were fatal one-third of the time and left another third with lifelong debilitating lung disease. The introduction of lobectomy, the surgical removal of part of the lung, improved these numbers, but an extended course of antibiotics long ago replaced surgery as the mainstay of treatment for these infections.

      在没有抗生素的年代，肺脓肿三分之一是致命的，其余的留下慢性肺部消耗性疾病。外科的部分肺叶切除，提高了生存率，但是抗生素广泛使用取代了外科治疗成为治疗感染的主要手段。

In consultation with an infectious-disease expert, I started Jerry on clindamycin, a potent antibiotic effective against the anaerobic (non-oxygen-consuming) bacteria that most frequently populate this type of infected cavity. After six weeks, an X-ray showed the abscess had shrunk down to a stable and probably permanent scar on Jerry’s lung. There was no reason to expect any recurrence. But had Jerry’s abscess gone undiagnosed, it might well have continued to grow and could have eventually necessitated the surgical removal of part of his lung.

       咨询感染病专家后，我给Jerry开了林可霉素，一种针对存在于这种感染灶的厌氧菌的有效抗生素。六周后，X-光显示脓肿减小至稳定有可能在Jerry肺中留下一个永久的疤痕。这并不意味着不会再发做。但是Jerry的脓肿并未最终确诊，有可能会继续生长，最终需要外科切除部分肺叶。

At a visit shortly after finishing the antibiotic course, Jerry told me he had gained new respect for both his wife’s dogged persistence and her uniquely talented nose. Then he said he was considering adding a bit to his stand-up routine about hiring his wife out to the bomb squad at the Los Angeles International Airport. ?“Or,” I suggested, “maybe you could just get her a bouquet of sweet-smelling flowers and take her out to a nice dinner.”

       结束抗生素疗程后不久的随诊中，告诉我他对夫人的固执的坚持和独一无二的鼻子充满敬重，他说按他的想法应该考虑雇佣他妻子来洛杉矶国际机场防爆队。我建议他：“也许应该买束花，带她吃顿大餐。”

H. Lee Kagan is a internist in Los Angeles. The cases described in Vital Signs are real, but names and certain details have been changed.