Do Not Harm: Stories of Life, Death, and Brain Surgery Paperback

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)." 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

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。

‘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
希波克拉底誓词

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

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。

arachnoid 蛛网膜。くも膜。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.

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. 格拉斯哥昏迷指數

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。

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

trigeminal neuralgia 三叉神经痛 (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（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, 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

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.

n. a benign tumour arising from the fibrous covering of the brain and spinal cord; usu. slow-growing, produces symptoms by pressure on the underlying nervous tissue.

aortic stenosis 大動脈弁狭窄症◆【略】AS 主动脉狭窄

n. a benign tumour of the choroid plexus, a structure made from tufts of villi within t e ventricular system that produces cerebrospinal fluid.

脉络丛乳头状瘤（choroid plexus papilloma，CPP）是颅内少见的良性神经外胚层肿瘤，约占颅内原发瘤的0.3%~0.6%.

n. the surgical cutting of tracts of white nerve fibres in the brain; orig. spec., prefrontal lobotomy; an instance of this.

脑白质切除术

The operation involved severing the frontal lobes from the rest of the brain with a specially shaped knife and was completely irreversible.

phenothiazine 吩噻嗪

obsessional compulsive disorder (OCD) 强迫症
psychosurgery 手术。缩小版的 LEUCOTOMY。损毁 frontal lobe 里某些部位。已被禁止。

Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. ADEM often follows viral or bacterial infections, or less often, vaccination for measles, mumps, or rubella. 多发于儿童，可自愈，但病程较长（4-6weeks)。可导致大脑肿胀而出现致命的脑水肿，需要开颅减压。

Dance of Death

n. a cerebral tumor derived from the non-nervous cells lining the cavities of the ventricles of the brain. [肿瘤] 室管膜瘤；室管膜细胞瘤。通常见于儿童。通常手术治疗。但复发率高（特别是初次手术未能彻底清除肿瘤情形）。

intracranial pressure 颅内压

Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope. It can be very difficult to find the balance between optimism and realism. There are degrees of malignancy with tumours and you never know what will happen to the individual patient in front of you – there are always a few long-term survivors – not miracles but statistical outliers. So I tell my patients that if they are lucky they might live for many years, and if unlucky it might be much less. I tell them that when the tumour recurs it might be possible to treat them again and, although to some extent it is clutching at straws, you can always hope that some new treatment will be found.

n. the most aggressive type of brain tumour derived from non-nervous tissue.
恶性胶质瘤；成胶质细胞瘤

astrocytoma  星形细胞瘤。
low grade astrocytoma  低分化。最初成长缓慢。逐渐恶性化变成致命的恶性胶质瘤，过程可能持续多年。部分较小的能够手术治愈。

folie à deux 二联性精神病，意思是“二人共享的瘋狂”: 形容一個有精神病症狀的人，將妄想的信念傳送到另一個人。同樣的症狀可傳達至三人，四人，甚至更多

Thinking, Fast and Slow 快思慢想 (2011)

As with all NHS chief executives in my experience (I have now got through eight) they do the rounds of the hospital departments when they are appointed and then one never sees them again, unless one is in trouble, that is. This is called Management, I believe.

n. the complete severance of a peripheral nerve. Complete recovery of function is impossible. 神経断裂症

glioblastoma multiforme (GBM): 多形性成胶质细胞.恶行程度高。

disc prolapse 椎间盘突出。手术中的医疗事故可能导致切断神经

一起注册医生手术引起的医疗事故。作者认为现在的医生培养制度有问题，培养的医生一代不如一代。

n. a malignant brain tumour that occurs during childhood.
成神经管细胞瘤。多见于儿童

PITUITARY ADENOMA
n. a benign tumour of the pituitary gland.

acromegaly 【名】《医》末端肥大症
松果体肿瘤导致生长因子(growth hormone)激素分泌过多

EMPYEMA n. a condition characterized by an accumulation of pus in a body cavity 积脓症

CARCINOMA
n. a cancer, esp. one arising in epithelial(上皮) tissue. 恶性上皮肿瘤

上皮細胞（じょうひさいぼう）とは、体表面を覆う「表皮」、管腔臓器の粘膜を構成する「上皮（狭義）」、外分泌腺を構成する「腺房細胞」や内分泌腺を構成する「腺細胞」などを総称した細胞。これら以外にも肝細胞や尿細管上皮など分泌や吸収機能を担う実質臓器の細胞も上皮に含められる。

The Binding problem

AKINETIC MUTISM n. a syndrome characterized by the inability to speak, loss of voluntary movement and apparent loss of emotional feeling. （常由中风引起的）无动性缄默, 运动不能性缄默

脑积水分流 shunt operation for hydrocephalus
persistent vegetative state (PVS)

PHOTOPSIA n. the sensation of flashes of light caused by mechanical stimulation of the retina of he eye 闪光幻觉

ASTROCYTOMA 星形细胞瘤
n. a brain tumour derived from non-nervous cells. All grades of malignancy occur.

本书里的乌克兰医生：Dr Igor Kurilets
The History of International Neurosurgery Center

TYROSINE KINASE
n. an enzyme that acts as an on/off switch in many cellular functions. Drugs to reduce its activity, known as tyrosine kinase inhibitors or TKIs (酪氨酸激酶抑制劑, 例如治疗慢性骨髓性白血病的格列卫), are used in the treatment of many cancers. 酪氨酸激酶

NICE: National Institute of Clinical Excellence

Quality Adjusted Life Year (QALY, 质量调整寿命年) 衡量药物价值标准（成本效果分析,CEA, cost-effectiveness analysis），特别是评估晚期癌症等绝症的仅能延迟生存期而不能治愈的药物（新药）是否应该包含在医疗保险覆盖范围内。

the Incremental Cost Effectiveness Ratio, which is the cost of one extra quality-adjusted life year which the new treatment achieves when compared to the best current alternative. If this is more than £30,000 NICE will not approve the use of the drug by the NHS, although exceptions will sometimes be made for patients dying from rare cancers.

Whenever NICE refuses to approve a drug there is an inevitable outcry from patient groups and the drug companies. Patients dying from various distressing diseases will appear on the television news accusing the NHS and NICE of abandoning them. NICE will be accused of being a Death Panel.

EOL: end of life。对于延迟绝症末期病人生命的药物。NICE 会放宽 ICER 标准（愿意为同等延长的 QALY 付出更多钱）。根据2016年的一份报告，这个标准是 £50,000 per QALY

OLIGODENDROGLIOMA n. a tumour of the central nervous system [肿瘤] 少突神经胶质瘤；[肿瘤] 间胶质瘤

ANAESTHESIA DOLOROSA n. severe spontaneous pain occurring in an anesthetic area. 痛性感觉缺失

2022-08-11 读完