Английский язык для медиков

English for MEdical studEnts

Учебник и практикУм для вУзов

под редакцией Н. П. Глинской

2-е издание, переработанное и дополненное

Рекомендовано Учебно-методическим отделом высшего образования в качестве учебника и практикума для студентов высших учебных заведений,

обучающихся по медицинским направлениям

Москва Юрайт 2020

Книга доступна на образовательной платформе «Юрайт» urait.ru, а также в мобильном приложении «Юрайт.Библиотека»

ISBN 978-5-534-13022-5

© Коллектив авторов, 2017© Коллектив авторов, 2020, с изменениями© ООО «Издательство Юрайт», 2020

УДК 811.111(075.8)ББК 81.2Англ-923 А64

Автор:Глинская Нэлли Петровна — кандидат филологических наук, доцент

кафедры английского языка для естественных факультетов факультета ино-странных языков и регионоведения Московского государственного универ-ситета имени М. В. Ломоносова.

Рецензенты:Городецкая Л. А. — доктор культурологии, кандидат филологических

наук, профессор кафедры теории преподавания иностранных языков факуль-тета иностранных языков и регионоведения Московского государственного университета имени М. В. Ломоносова;

Новодранова В. Ф. — профессор, доктор филологических наук, заведую-щая кафедрой латинского языка и основ терминологии Московского государ-ственного медико-стоматологического университета.

А64

Английский язык для медиков. English for Medical Students : учебник

и практикум для вузов / под редакцией Н. П. Глинской. — 2-е изд., перераб. и доп. — Москва : Издательство Юрайт, 2020. — 271 с. — (Высшее образова-ние). — Текст : непосредственный.

ISBN 978-5-534-13022-5

Основная цель учебника — обеспечить студентам получение навыков изучающего и ознакомительного чтения, говорения, письма, перевода и ре-ферирования текстов широкой медицинской тематики. Содержание учеб-ника позволит расширить словарный запас студентов в таких тематических областях, как хирургия, медицинская генетика, акушерство и гинекология, инфекционные и неинфекционные заболевания, неврология и психиатрия, фармакология.

Учебник включает: современные оригинальные тексты научного, учеб-ного и научно-популярного характера; грамматические комментарии и зада-ния; практические упражнения на говорение и письмо; лексический мини-мум; ключи к некоторым типам упражнений.

Соответствует актуальным требованиям Федерального государственного образовательного стандарта высшего образования.

Для студентов высших медицинских учебных заведений.

УДК 811.111(075.8)ББК 81.2Англ-923

Все права защищены. Никакая часть данной книги не может быть воспроизведена в какой бы то ни было форме без письменного разрешения владельцев авторских прав.

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Содержание

Авторский коллектив .....................................................................9Предисловие ................................................................................. 10

Unit 1. Trauma and Surgery ............................................................14Words with Special Medical Meanings....................................................... 14Text 1. ...................................................................................................... 14

Introduction to Operative Surgery ...................................................... 15Text 2. ...................................................................................................... 16

Management of Traumatic Wounds ..................................................... 16Text 3. ...................................................................................................... 18

Look, no Forceps! Kidney Surgeons Use Their Fingers for Transplants ... 18Texts for Retelling in English ..................................................................... 20

Лапароскопия ................................................................................... 20Bariatric Surgery ................................................................................ 20

Additional Reading ................................................................................... 21Pediatric Surgery ................................................................................ 22

Revision .................................................................................................... 24Cholecystectomy ................................................................................. 26Spare Parts ......................................................................................... 30

Grammar .................................................................................................. 30Passive Voice ....................................................................................... 30

Medical Humour ....................................................................................... 35Surgery Course ................................................................................... 35

Unit 2. Medical Genetics ................................................................. 37Text 1. ...................................................................................................... 37

The Medical Genetics Milestones ........................................................ 37Text 2. ...................................................................................................... 39

Genetic Variations and Mutations ....................................................... 39Text 3. ...................................................................................................... 41

Genetic Abnormalities (a conversation between a patient and a doctor) ............................................................................................. 42

Texts for Retelling in English ..................................................................... 44Для чего нужен белок болезни Гентингтона? .................................. 44Telomeres: The Key to Immortality? .................................................... 45Stem Cell Therapy .............................................................................. 46

Additional Reading ................................................................................... 47Cancer Is a Genetic Disease at the Level of Somatic Cells ..................... 47

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Grammar .................................................................................................. 50Conditional Sentences ........................................................................ 50

Revision .................................................................................................... 52Could Genetics Data about Intelligence Be Useful? .............................. 54Cystic Fibrosis ..................................................................................... 58Phenylketonuria ................................................................................. 59

Medical Humour ....................................................................................... 61Darwin Award (abstract) .................................................................... 61

Unit 3. Gynecology And Obstetrics .................................................65Words with Special Medical Meanings....................................................... 65Text 1. ...................................................................................................... 65

Endometriosis ..................................................................................... 66Some Common Cancers of the Women Reproductive System .............. 68

Text 2. ...................................................................................................... 69Pregnancy ........................................................................................... 70Prenatal Care ...................................................................................... 70Prenatal Development ........................................................................ 73

Text 3. ...................................................................................................... 75Uterine Fibroid Embolization .............................................................. 76

Texts for Retelling in English ..................................................................... 80Роды без боли. Возможно ли? ........................................................... 80In Vitro Fertilization ........................................................................... 80

Additional Reading ................................................................................... 81Gentle Persuasion ............................................................................... 82

Grammar .................................................................................................. 84The Gerund ........................................................................................ 84

Revision .................................................................................................... 90Stress during Pregnancy Changes Infants’ Gut Microbiota ................... 95

Medical Humour ....................................................................................... 97Right for the Boy, Left for the Girl ....................................................... 97

Unit 4. Infectious Diseases ............................................................ 100Words with Special Medical Meanings..................................................... 100Text 1. .................................................................................................... 100

The Body’s Response to Infection ...................................................... 101Types of Immunity ............................................................................ 103

Text 2. .................................................................................................... 104A Modern Menace: Emerging Infectious Diseases .............................. 105

Text 3. .................................................................................................... 107Sexually Transmissible Diseases ........................................................ 107

Texts for Retelling in English ................................................................... 112Смертельное угощение ................................................................... 112Tuberculosis: A Modern and Ancient Infectious Disease .................... 113

Additional Reading ................................................................................. 114

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People Problems ............................................................................... 114Grammar ................................................................................................ 117

Infinitive Constructions ..................................................................... 117Revision .................................................................................................. 120

Виды инфекционных болезней ...................................................... 122Influenza .......................................................................................... 124The Common Cold ............................................................................ 124Viral Hepatitis ................................................................................... 126

Medical Humour ..................................................................................... 131

Unit 5. Non-infectious diseases ..................................................... 132Words with Special Medical Meanings..................................................... 132Text 1. .................................................................................................... 132

Health Problems in Developed Countries .......................................... 132Text 2. .................................................................................................... 135

Why Illnesses Get Worse at Night ...................................................... 135Text 3. .................................................................................................... 137

Digestive Disorders ........................................................................... 137Texts for Retelling in English ................................................................... 140

Роль невербальной информации ................................................... 140Taking Advice to Heart ...................................................................... 141

Additional Reading ................................................................................. 142Angina Pectoris ................................................................................. 142

Grammar ................................................................................................ 143Многофункциональные слова ........................................................ 143

Revision .................................................................................................. 149Medical Humor ....................................................................................... 154

Louis XIV’s Doctors ........................................................................... 154

Unit 6. Neurology.......................................................................... 156Words with Special Medical Meanings..................................................... 156Text 1. .................................................................................................... 156

Stroke ............................................................................................... 156Text 2. .................................................................................................... 163

Honest Liars:How the Brain Leads Us to Believe False Truths ............ 163Text 3. .................................................................................................... 168

The Neglect Syndrome ...................................................................... 169Texts for Retelling in English ................................................................... 172

Инсульт ............................................................................................ 172Left in the Past .................................................................................. 173The Stuttering Brain ......................................................................... 174

Additional Reading ................................................................................. 175Neuroscience and Criminal Defenses ................................................ 175

Grammar ................................................................................................ 177Multi-component Terms .................................................................... 177

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Revision .................................................................................................. 182Medical Humour ..................................................................................... 186

Unit 7. Psychiatry ..........................................................................188Words with Special Medical Meanings..................................................... 188Text 1. .................................................................................................... 188

Schizophrenia ................................................................................... 188Text 2. .................................................................................................... 192

Depression and Depressive Disorders ................................................ 192Text 3. .................................................................................................... 195

Anxiety and Bipolar Disorder ............................................................ 195Texts for Retelling in English ................................................................... 199

Навязчивые состояния: симптомы, ритуалы, виды ....................... 199Taming Compulsion .......................................................................... 201New View on Autism ......................................................................... 202

Additional Reading ................................................................................. 203Facts about Social Phobia .................................................................. 203

Grammar ................................................................................................ 205Types of Questions ............................................................................ 205Mental Status Examination ............................................................... 208

Revision .................................................................................................. 210An Introduction to Bipolar Disorder .................................................. 210Panic Attack Sufferers Are Unaware of Symptoms ............................. 215

Medical Humour ..................................................................................... 216

Unit 8. Medication ........................................................................218Words with Special Medical Meanings..................................................... 218Text 1. .................................................................................................... 218

Classes of Antibiotics ........................................................................ 218Text 2. .................................................................................................... 220

Routes of Administration .................................................................. 220Text 3. .................................................................................................... 223

Anesthesia ........................................................................................ 223Texts for Retelling in English ................................................................... 227

О лекарствах анестезиолога ........................................................... 227Compliance....................................................................................... 228

Additional Reading ................................................................................. 229Echinacea (Echinacea Purpurea) ...................................................... 229Ginkgo (Ginkgo Biloba) .................................................................... 229

Grammar ................................................................................................ 230Независимый причастный оборот, или абсолютная причастная конструкция (Independent Participle Construction) .... 230

Revision .................................................................................................. 232Painkiller Risks ................................................................................. 233Pharmacologic Agents for Procedure-related Pain ............................. 235

Ampicillin ......................................................................................... 238Benzylpenicillin (Penicillin G) .......................................................... 238Erythromycin .................................................................................... 238Gentamicin ....................................................................................... 238Tetracycline ...................................................................................... 239Adverse Reactions to Drugs ............................................................... 240

Medical Humour ..................................................................................... 243How to... Take Medicine.................................................................... 243

Answer Keys .................................................................................245Unit 1 ...................................................................................................... 245Unit 2 ...................................................................................................... 245Unit 3 ...................................................................................................... 246Unit 4 ...................................................................................................... 249Unit 5 ...................................................................................................... 251Unit 6 ...................................................................................................... 251Unit 7 ...................................................................................................... 253Unit 8 ...................................................................................................... 254

Lexical Minimum ..........................................................................256References ....................................................................................264

Список использованной литературы .................................................... 264Список рекомендуемой литературы ..................................................... 266

Новые издания по дисциплине «Английский язык» и смежным дисциплинам ..........................................................267

Авторский коллектив

Глинская Нэлли Петровна — кандидат филологических наук, доцент кафедры английского языка для естественных факультетов факультета иностранных языков и регионоведения Московского го-сударственного университета имени М. В. Ломоносова;

Афанасова Вера Васильевна — кандидат культурологии, препо-даватель кафедры английского языка для естественных факультетов факультета иностранных языков и регионоведения Московского го-сударственного университета имени М. В. Ломоносова;

Долтмурзиев Дмитрий Олегович — старший преподаватель ка-федры английского языка для естественных факультетов факультета иностранных языков и регионоведения Московского государствен-ного университета имени М. В. Ломоносова;

Черезова Татьяна Львовна — кандидат филологических наук, доцент кафедры английского языка для естественных факультетов факультета иностранных языков и регионоведения Московского го-сударственного университета имени М. В. Ломоносова.

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Предисловие

Учебник «Английский язык для медиков» предназначен для сту-дентов младших курсов медицинских вузов. Основная цель учеб-ника — обеспечить учащимся освоение навыков чтения, перевода и реферирования английских текстов широкой медицинской тема-тики, создать возможности для расширения пассивного и активно-го словарного запаса в области медицинской терминологии. Кроме того, с помощью данного учебника можно развить навыки письмен-ной речи и участия в дискуссиях на профессиональные медицин-ские темы.

Книга написана на базе материалов, использовавшихся при пре-подавании английского языка студентам младших курсов факуль-тета фундаментальной медицины МГУ имени М. В. Ломоносова. К этому моменту обучения уровень студентов оценивается как B1—B2 (Intermediate). Основу книги составляют оригинальные тексты учебного, научного и научно-популярного характера, заимствован-ные из современных специальных медицинских учебников и науч-ных изданий, научно-популярных журналов, Интернета. В некото-рых случаях тексты подвергали небольшой адаптации и сокращали. Поскольку в текстах сохраняется оригинальная орфография, студен-ты закрепляют навыки работы как с британскими, так и с амери-канскими вариантами написания, что также является важным эле-ментом владения языком.

Учебник рассчитан на используемый на факультете метод «мак-симального погружения» в специальные тексты. Авторы глубоко убеждены в том, что обучение английскому языку для медицинских специальностей следует проводить на широком и разнообразном текстовом материале. Структура книги отражает предлагаемый авторами метод обучения. Книга состоит из тематических разде-лов: Trauma & Surgery, Medical Genetics, Gynecology and Obstetrics, Infectious Diseases, Non-infectious Diseases, Neurology, Psychiatry, Medication. Тематически и лексически тексты различных разделов перекликаются между собой: в частности, раздел, посвященный акушерству, углубляет знания, полученные в разделе генетики, а Medication обобщает все разделы, подавая их содержание с точки зрения лекарственной терапии. Тем не менее сравнительно незави-симая и однотипная структура каждого раздела учебника в прин-ципе позволяет вести работу вне предлагаемого порядка, при этом

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содержание всего учебника рассчитано на 120 часов аудиторных занятий.

Каждый раздел пособия включает три основных текста на ан-глийском языке — научного, учебного и научно-популярного ха-рактера. Помимо чтения и перевода основного текста, можно использовать такие виды заданий, как реферирование, краткий пересказ (компрессия), обратный перевод. Все тексты основного курса снабжены предтекстовыми и послетекстовыми упражнения-ми. Упражнения нацелены на развитие основных навыков профес-сионально ориентированной речи. Некоторые виды упражнений предназначены для того, чтобы дать преподавателю возможность заострить внимание студентов на особенностях английского языка медицины: на множестве терминологических дублетов и синони-мов, многозначных терминах, эпонимах и т. д. Особое внимание в учебнике уделяется медицинским терминам, имеющим омонимы в общеупотребительной лексике. Для того чтобы студенты сразу ус-ваивали лексику с терминологическим значением, каждый раздел предваряется небольшим глоссарием с консубстанциональными терминами и их переводом на русский язык (Words with Special Medical Meanings).

Далее предлагаются образцы научно-популярных текстов на рус-ском и английском языках, предназначенные для реферирования (Texts for Retelling in English). Эти тексты позволяют закрепить навыки пересказа: студентов следует научить активно манипули-ровать собственным словарным запасом, находить альтернативные способы выражения одной и той же мысли и тем самым избегать «языковых тупиков», которые возникают в том случае, когда пере-сказ тесно привязан к исходному тексту.

Следующая часть раздела (Additional Reading) предназначена для дополнительного чтения и может использоваться полностью или частично в зависимости от уровня группы. Некоторые допол-нительные тексты содержат в себе задания в виде заключенных в скобки слов. Открывая скобки, студенты должны либо вставить слово в текст в нужной грамматической форме, либо выбрать нуж-ное слово из нескольких.

Каждый тематический раздел содержит грамматический мате-риал (Grammar), объясняющий ряд языковых явлений, системати-зирующее повторение которых было сочтено целесообразным (пас-сивный залог, условные предложения, причастные и герундиальные обороты, многофункциональные слова и т. д.). Активизирующие упражнения составлены на основе медицинской лексики соответ-ствующей тематики.

Все разделы завершаются материалами, предназначенными для проверки усвоения лексики (Revision). Это комплекс заданий, которые способствуют развитию навыков всех видов речевой дея-

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тельности, включая письмо. В учебнике также представлен предна-значенный для студентов младших курсов лексический минимум (Lexical Minimum), обращение к которому предусмотрено при вы-полнении ряда заданий в ходе освоения всего курса. В книгу вклю-чены шутки и юмористические рассказы (Medical Humour), кото-рые можно использовать и в качестве дополнительного чтения.

Учебник также содержит ключи к ряду упражнений (Answer Keys). Это позволяет использовать его и для самостоятельной под-готовки к экзамену.

Данный учебник составлен в соответствии с современными требованиями Федерального государственного образовательного стандарта высшего образования. Сочетание тематического и систе-матизирующего подходов к обучению английскому языку как языку медицины составляет спе цифику данного учебника.

Изучив материал учебного пособия, студент будет:знать• специальнуюмедицинскуюлексикуврамкахизучаемыхтем

на английском языке;• переводнарусскийязыкосновныхтерминоввсферемеди­

цины;• языковыеединицынаанглийскомязыке,позволяющиерас-

крывать содержание научных понятий в ситуациях указания, опи-сания, сравнения, пояснения, рассуждения;

• английскиеязыковыесредства,обеспечивающиесвязностьслов, фраз и текста;

• основныелексико­грамматическиеструктурыснеличнымиформами глагола;

уметь• передавать предметное содержание английского медицин-

ского текста на русском языке;• использоватьязыковыесредствавразличныхкоммуникатив-

ных ситуациях;• разъяснятьзначениятерминовнаанглийскомязыке,выделяя

существенные и несущественные свойства медицинских понятий;• перестраиватьвысказывания,используясинонимичныеиан-

тонимичные языковые средства;владеть• навыками ознакомительного и изучающего видов чтения

на английском языке;• навыками создания речевых произведений на английском

языке в жанрах аннотации, тезисов и реферата.

Авторы учебника выражают глубокую признательность заведу-ющей кафедрой английского языка для естественных факультетов факультета иностранных языков и регионоведения Московского го-

сударственного университета имени М.В. Ломоносова профессору Лидии Валериановне Полубиченко, под чьим руководством рабо-тает авторский коллектив и чьи рекомендации позволили внести улучшения в учебник. Теплые слова благодарности авторы адресуют рецензентам, которые сделали ряд ценных пожеланий — профес-сору Валентине Федоровне Новодрановой и профессору Людмиле Александровне Городецкой.

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Unit 1.

TraUma and SUrgery

Words with Special medical meanings

to administer — вводить, давать (лекарство)approach — доступbooster — ревакцинацияcast — гипсto drape — обкладыватьdressing — повязка, перевязкаexposure — выделение (хирург.)gown — стерильный халатto nurse — выхаживатьprocedure — манипуляция, операция, процедураto scrub — отмыватьscrubs — костюм хирургаsponge — тампонto tolerate — переноситьtowel — салфетка

Text 1.

Pre-reading tasks

Exercise 1. Check the pronunciation of the following words:

endeavour, procedure, rehabilitate, major, colostomy, appraisal, haz-ardous, facial, embolus, thyroid, trauma

Exercise 2. Translate the following constructions:

admitted to a ward, procedure in question

Exercise 3. Explain the difference between the words:

a) recovered and rehabilitatedb) anxious, frightened, terrified.

NB: The spelling of certain words (e.g., endeavour, paralyse, anaesthetist) shows that the author of the text is from the UK.

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Introduction to Operative SurgeryIf a surgeon is threatened with an operation on himself, his initial

reaction is “let’s try conservative treatment and endeavour to avoid sur-gery”. This is because surgeons are acutely aware of the dangers of any operative procedure; even the simplest operation can result in disaster. For example, disconnection of the oxygen supply in a paralysed patient, air entry into the venous system, or an operation that was not indicated.

Preoperative AssessmentA patient admitted to a surgical ward is almost always anxious and

may be frightened or even terrified. For some major procedures it can be comforting for him to meet a patient who has recovered from a similar operation, for example, a patient fully rehabilitated after an abdominop-erineal resection of the rectum.

It is important to explain to the patient the exact nature of the opera-tion, what it will involve in terms of the incisions, the pain, and the stay in hospital. If it is likely that the patient will be in an intensive care unit (ICU) after operation, it is helpful if an ICU nurse meets the patient and explains the pattern of care and the various cannulae likely to be insert-ed into him. The fullness of the preoperative explanation will depend, to some extent, on the patient’s own inclinations and intelligence. In all cases, he and his close relatives should be given the surgeon’s appraisal of the prognosis and seriousness of the proposed operation. If a dissec-tion is particularly hazardous, for instance in parotidectomy, where dam-age to the facial nerve may result, it must be explained to the patients and the relatives beforehand, although this does not absolve the surgeon from paying due care and attention to avoid this peril.

The anaesthetist’s assessment will be extremely important and the surgeon also needs to examine the patient to assess the actual surgical exposure and any technical difficulties. For instance, previous operations or peritonitis may have resulted in adhesions which add to the risks. The outcome following surgery may also be influenced by the physical condition of the patient. Obesity, malnutrition, chronic pulmonary, car-diac, renal or hepatic dysfunction and diabetes are all adverse factors that need to be carefully assessed. In all cases the patient should be as relaxed as possible, clean, with an empty stomach and preferably empty bowels and bladder.

Positioning of the Unconscious PatientThe anaesthetized patient is vulnerable, being deprived of his pro-

tective reflexes. One of the most tragic postoperative complications is a pulmonary embolus, following deep vein thrombosis; therefore great care should be exercised in avoiding undue pressure on the calves and if the patient has a poor peripheral blood supply, pressure points must be specially protected.

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The choice of position and incision will depend on the access re-quired for the procedure in question. Most intra-abdominal procedures are performed with the patient lying supine, at a lateral inclination, or in a head-down or head-up position. A patient will lie on his side for an extraperitoneal approach to the kidney, and a pillow placed under the shoulders to extend the neck facilitates approach to the thyroid. In plan-ning the incision the main consideration is to obtain the best view of the operative field with a minimum trauma to the patient.

(Calne, Pollard. Operative Surgery, p. ix)Exercise 1. Substitute the following words by their synonyms:

endeavour, pulmonary, cardiac, renal, hepaticExercise 2. Find passages describing various surgery risks.

Exercise 3. Say whether the following statements are true or false:

1. Surgeons are eager to be operated on.2. It is helpful for the patient to meet with a person who has under-

gone a successful surgery.3. Patients will have the procedure explained to them.4. The patient should never be told about the hazards of the proce-

dure.5. The outcome of the operation may be influenced by the physical

condition of the patient.6. A blood clot in a deep vein can cause serious complications.7. The incision does not depend on the surgery.

Text 2.

Pre-reading TasksExercise 1. Check the pronunciation of the following words:

wound, precedence, debris, penicillin, immunoglobulin, debride-ment, salineExercise 2. Find an adequate translation for the terms:

primary healing, elective operation, primary closure, body cavity, scar formation, laceration, tetanus toxiod, debridement, saline, to excise, compound fracture, interrupted suture

Management of Traumatic WoundsIn the treatment of wounds, operative or traumatic, the aim is

achievement of primary healing without complications and with mini-mal scar formation. Infection is the main adversary to primary wound healing. Whereas elective operations are done under optimal conditions, this is not the case with traumatic wounds. In the latter, there can also be loss of tissue, which does not permit primary closure or at least not

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without tension, necessitating either plastic surgery or open treatment. The management of wounds that penetrate body cavities will not be dis-cussed here.

Assessment of WoundsWhether or not a traumatic wound can be closed primarily (after cer-

tain measures, to be discussed) depends on the time that has elapsed since injury, the appearance of the wound, the mode of injury, and the general condition of the patient. Within 8 hours of the injury, primary closure is generally accepted. Beyond that “golden period” it becomes a question of judgment in each case, balancing the risk of a possible in-fection if the wound is sutured against ugly scar formation if the wound is not sutured. For wounds in the head and neck area, particularly in the face with its excellent blood supply, the 8-hour period can safely be extended. A clean-cut wound is less likely to become infected than one that has crushed tissue or dirt ground into it. Bite wounds should almost always be left open. If the patient is in precarious condition from severe internal injuries, the latter take precedence over superficial skin wounds. In all cases of laceration, tetanus prophylaxis is mandatory. Since most people in the United States have been immunized, a booster dose of 0.5ml of tetanus toxoid should be given unless the patient has re-ceived a booster within the past 10 years. For a deep wound, particularly when it is contaminated with dirt, a booster should be given anyway. If the wound is deep and dirty, penicillin and immunoglobulin should be added as prophylaxis.

DebridementIn preparation for debridement the traumatic wound and surrounding

skin are cleansed and disinfected. Local anesthesia is introduced around (not into) the wound. When the procedure is performed in the emer-gency room instead of the operating room, simple draping around the wound with four towels or a towel with a hole in the center suffices. The surgeon does not scrub for the usual period and is not gowned, but he should at least wash his hands and don a cap, mask, and sterile gloves. The wound is first thoroughly irrigated with saline to wash away loose debris. A wound with clean-cut edges can be sutured after irrigation. The skin is closed loosely. A small drain can be inserted for 24 hours. The placement of subcutaneous or other deep sutures should be avoided. Burying sutures in a potentially contaminated wound is only justified when vital structures such as arteries or tendons have to be secured. Wounds that rupture from blunt force usually have irregular, crushed edges and contain traumatized, devitalized tissue. These wounds have to be carefully debrided before they can be closed. All traumatized, dis-colored tissue has to be excised with the scalpel, and the wound edges have to be “freshened up”. The extent of excision depends on the lo-cation. Where the skin is loose and movable, the excision can be more

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generous. In areas where the skin is tight, e.g., on the lower leg, debride-ment has to be sparse so that primary closure will be possible without tension, which should be avoided. Wound debridement has to be thor-ough. Antibiotics are no substitute and are no excuse for sloppy surgical debridement. Again, burying sutures should be avoided. Dead space can be avoided by including deeper tissues in the skin sutures. A drain can be left in place to prevent accumulation of secretions.

Wound ClosuresAfter debridement, the skin can be closed with simple interrupted

sutures. When the wound cannot be sutured, usually because too much time has elapsed, it should be covered with an antibiotic ointment and a sterile dressing. The ointment minimizes adherence of the dressing to the wound and facilitates dressing changes. When the wound is already infected, the choice lies between ointment and moist dressings with ap-plication of heat.

(Crew’s Manual of Basic Surgical Skills. 77, 80—81)Exercise 1. Answer the following questions:

1. What is meant by “the golden period”? Why is this expression used in the context?

2. What kinds of wounds are rarely complicated by infections?3. Can antibiotics be used instead of saline solution?4. When a wound should not be sutured?5. When is the use of ointment indicated?

Exercise 2. Find antonyms for the following words:

latter; ugly; severe; superficial; dirty; sloppy; moist

Text 3.

Pre-reading TasksExercise 1. Look the article through and find out how many different

surgery techniques are mentioned there.

Exercise 2. Note the manner of introducing direct speech and compare it to the one used in Russian.

Exercise 3. What is the inch equal in the metric system? Try to remember or look it up and convert the figures that are given in inches.

Look, no Forceps! Kidney Surgeons Use Their Fingers for Transplants

It is no coincidence that advances in keyhole surgery ten years ago led to a steady rise in the number of people deciding to donate a kidney. The operation, which can be performed via an incision so tiny that it can

19

be hidden in the belly button, was carried out 1,068 times in 2012 — al-most three times the number of a decade ago.

Yet one of Britain’s leading transplant surgeons now argues that a back-to-basics approach to open surgery — using fingers as well as surgical instruments — offers the best outcome for donors and trans-plant recipients.

The technique, known as finger-assisted nephrectomy, has been pio-neered by Professor Nadey Hakim. It reduces the operating time from between two and three hours to just 45 minutes, and according to new research, the donor is at lower risk of complications. The reduction in operating time also means the kidney is fresher for transplant and there is less chance of the organ being damaged during retrieval.

Twenty years ago all kidneys were removed using a large incision up to 8in long. Then, following the introduction of keyhole surgery, up to five smaller incisions were required, each measuring about 3in.

During finger-assisted nephrectomy, a 1½in incision is made below the ribcage for removal of the kidney. The surgeon uses his fingers to manoeuvre the kidney into a position where it can be removed, using in-struments to separate in from the connective tissue that holds it in place. Once this is done, the organ is lifted out with the fingers.

“With keyhole surgery you are making four or five holes for the in-struments plus a 3in incision to remove the organ,” explains Prof Hakim. “Complications include accidental injury to the bowel or blood vessel which can damage the kidney itself. Getting the organ out of the patient itself takes longer once you have separated the kidney. And the longer the kidney remains disconnected without cooling, the greater chance of delayed function.”

Prof Hakim adds: “Keyhole surgery is a fine technology, but it is not without risk and there are still merits in old-fashioned open surgery. Ob-viously both are an advance on the very large incision — as big as 8in — that we used to use in the pioneering days of kidney transplantation where everything inside was laid out for the surgeon to see.

“We have had only very minor complications with this approach and the patients are absolutely delighted because we leave them with such a tiny incision and enjoy a very speedy recovery once they have left the hospital.”

Nicos Kessaris, a transplant surgeon at Guy and St Thomas’ Hospital in London, says Prof Hakim technique is widely admired.

“My view is that both techniques — keyhole and finger-assisted ne-phrectomy — are safe. I use a variation called hand-assisted nephrec-tomy where the incision is about 3in and you put your whole hand in to remove the kidney.

“But the vast majority of retrievals are made by keyhole surgery. I think that being able to give the patient choice is a good idea.”

(Martyn Halle. The Mail on Sunday, January 12, 2014, p. 84)

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Exercise 1. Answer one of the following questions in written form (no less than 100 words).

1. What is the meaning and aim of the first part of the article title?2. Do you agree with the last statement of the surgeon (I think that

being able to give the patient choice is a good idea)?3. If you were a donor, which operation technique would you prefer?

Texts for retelling in english

ЛапароскопияЛапароскопия — вид лечебного или диагностического хирурги-

ческого вмешательства, при котором необходимые манипуляции производятся через небольшие проколы. С помощью специального прибора — троакара — в область брюшной полости вводятся лапа-роскоп и соответствующие инструменты. Для обеспечения визуаль-ного контроля лапароскоп оборудован источником света и систе-мой линз, сигнал от которых через оптический кабель передается на монитор в виде изображения. Для возможности проведения ма-нипуляций в брюшную полость закачивают углекислый газ, подни-мающий брюшную стенку, словно купол.

Как правило, лапароскопические исследования и несложные хирургические операции проводятся под местным наркозом, вре-мя выполнения операции резко сокращается. В отличие от полост-ных операций с разрезами брюшной стенки, лапароскопические вмешательства менее травматичны, позволяют существенно сни-зить срок реабилитации, риск повторного инфицирования и воз-никновения спаечных процессов. Для пациентов, особенно жен-щин, важно знать, что о проведенной операции будут напоминать лишь небольшие шрамы от проколов, незаметные невооруженно-му глазу.

Для хирургов современные технологии дают более широкий диапазон действий: многократное увеличение, возможность изме-нения угла обзора и работа с высокоточным оборудованием позво-ляют более эффективно произвести необходимые манипуляции, по-ставить диагноз. Значительно снижаются риск инфицирования ран и последующие сложности с обработкой швов.

(http://propagandahistory.ru/1441/CHto-takoe-laparоskopiya/)

Bariatric SurgeryCurrently, bariatric surgery may be an option for people with se-

vere obesity. Body mass index (BMI), a measure of height in relation to weight, is used to define levels of obesity. Clinically severe obesity is a BMI > 40 or a BMI > 35 with a serious health problem linked to obesity. Such health problems could be type 2 diabetes, heart disease,

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or severe sleep apnea (when breathing stops for short periods during sleep).

Bariatric surgery restricts food intake, which leads to weight loss. Pa-tients who have bariatric surgery must commit to a lifetime of healthy eating and regular exercise. These healthy habits may help patients maintain weight loss after surgery.

The type of surgery that may help an adult or youth depends on a number of factors. Patients should discuss with their health care pro-viders what kind of surgery is suitable for them.

Bariatric surgery may be performed through “open” approaches, which involve cutting the stomach in the standard manner, or by lapa-roscopy. With the latter approach, surgeons insert complex instruments through ½-inch cuts and guide a small camera that sends images to a monitor. Most bariatric surgery today is laparoscopic because it re-quires a smaller cut, creates less tissue damage, leads to earlier hospital discharges, and has fewer problems, especially hernias occurring after surgery.

There are four types of operations that are commonly offered in the United States: adjustable gastric band, gastric bypass, biliopancreatic di-version with a duodenal switch, and vertical sleeve gastrectomy. Each surgery has its own benefits and risks. The patient and provider should work together to select the best option by considering the benefits and risks of each type of surgery. Other factors to consider include the pa-tient’s BMI, eating habits, health conditions related to obesity, and previ-ous stomach surgeries.

(http://www.niddk.nih.gov/health-information/health-topics/weight-control/bariatric-surgery-severe-obesity/Pages/bariatric-

surgery-for-severe-obesity.aspx)

additional reading

Pre-reading Tasks

Exercise 1. Check the pronunciation of the following words:

etiology, adolescence, cerebrospinal, major, hypertrophy, gestation, congenital, degenerative, neoplasm, vital, catheter, convalescence

Exercise 2. Find an adequate translation for the terms:

maintenance, emergency surgery, to obstruct, conduit, neoplastic dis-ease, hernia, lethargy, incubator, viscera, vomitus, morbidity

Exercise 3. Explain the difference between the pairs:

examination — observationlife expectancy — life span

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Pediatric Surgery

Today in industrialized countries more than a half of hospitalized children have disease with surgical overtones and one fourth of all sur-gical patients are children. Ill infants and children cannot be treated as small adults. There are enough differences in the etiology, course, and pathophysiology of disease in the very young to adequately justify spe-cial consideration and training. The obvious problems are imposed by the small size of the patient, the different maintenance requirements, inability to give a history, and the magnitude of certain corrective opera-tions.

The newborn infant epitomizes the profound differences that exist between the adult and the pediatric surgery patient. These differences become less striking and important as the baby grows into childhood and adolescence. About 1 out of 200 of live-born babies require emergency neonatal surgery, generally because of congenital anomalies obstructing flow through one of the vital body conduits (food through the gastro-intestinal tract, cerebrospinal fluid through the central nervous system, blood through the heart or major vessels).

In certain ways newborns tolerate operations surprisingly well. The body systems that have developed correctly function remarkably well, despite measurable anatomic and physiologic evidence of immaturity. The cardiovascular system is perhaps the outstanding example: the heart muscle is hypertrophied at birth because during gestation it pumps 20% to 30% more blood than the postnatal circulatory volume. The heart therefore possesses relatively more functional reserve at birth than it will have later.

Congenital anomalies are the most frequent indication for operations on the newborn, in distinction to infection, trauma, and degenerative and neoplastic diseases in the adult. Thus neonatal intestinal obstruc-tion is generally caused by webs, bands, membranes, faulty innerva-tion, or other abnormalities of development, whereas in the adult it is generally caused by hernias, postoperative adhesions, and neoplasms. Congenital anomalies are simply abnormalities of development that are present at birth. They constitute about 80% of surgical problems in the newborn.

The speed at which surgical disease progresses is often dramatically accelerated in the newborn patient and may result in death in just a few hours. Small actual volumes of body fluids, low energy and nutritional reserves, and poor defenses against infection contribute to this rapid progression. Furthermore, the newborn must communicate his illness by indirect and often subtle signs such as changes in color and rates of pulse and respiration, inability to feed, irritability, and lethargy. Time is truly vital in the newborn surgical patient.

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The newborn infant is much more sensitive to environmental temper-ature and humidity than the adult, so body temperature must be moni-tored continuously. Body heat of the infant is conserved when the op-erating room air is warmed, large volumes of rapidly evaporating fluids to prepare the skin are avoided, and infrared lamps are used to deliver radiant heat to the baby. The neonatal surgical patient must be nursed in an incubator.

Placing a plastic catheter in a vein must precede all major operations as a dependable route for administration of fluids and blood. Good sur-gical principles are never more important than in the neonate: preci-sion (magnification is sometimes helpful), gentleness, protection of the exposed viscera, miniaturized instruments, and fine suture material are essential. Subcuticular closure of the skin incision will avoid the need for later suture removal, and clear plastic sprayed on the wound obvi-ates the use of restricting conventional dressings that prevent observa-tion and easy examination of the area. Above all, the proper operation must be performed correctly. The margin of error in neonatal surgery is narrow.

Postoperative convalescence of the newborn surgical patient is gen-erally gratifyingly rapid. The infant should be checked frequently visu-ally, but manipulations should be held to a minimum (e.g. at regular 2-hour intervals). Postoperative complications are mainly those of the operation itself plus infection and aspiration of vomitus. However, they are poorly tolerated and are best prevented or diagnosed and treated early.

The results of surgical treatment are very gratifying when the anom-aly is completely corrected, no other anomalies are present, and no complications appear. Multiple anomalies, incomplete surgical correc-tion, prematurity, and postoperative complications favor morbidity and mortality. There is no greater satisfaction to the surgeon or nurse than a newborn patient who has been given a normal life expectancy, surgi-cally cured of an otherwise lethal anomaly.

(Liechty R.D., Soper T.R. Fundamentals of Surgery. 1989, pp. 528—530)

Exercise 1. Complete the following sentences using the material in the text:

1. Special training in pediatric surgery is necessary because…2. Babies require surgery mostly because of…3. Intestinal obstructions in the adult can be caused by…4. Surgical disease in infants progresses rapidly due to…5. Good surgical principles are…6. The causes of morbidity and mortality in newborn surgery patients

are…

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Exercise 2. Arrange according to the increased age:

adolescent, adult, child, infant, neonateExercise 3. Use the correct preposition (if necessary, consult the text

again): “for, in, into, of, on, to”.

cure …, deliver …, difference …, evidence …, expose …, grow …, indication …, need …, sensitive …, spray …

revision

Exercise 1. Match the names of the surgical procedures with their de-scriptions:

a) cystectomy, b) arthroplasty, c) ceasarean section, d) partial mas-tectomy, e) nephrolithostomy, f) rhinoplasty, g) strabismus surgery, h) hydrocelectomy, i) laparascopy, j) keratoplasty, k) laminectomy.

1. Visual examination and some treatments of the pelvic and abdomi-nal organs by a fiber-optic instrument.

2. Removal of fluid that has collected in a small sac usually in the testicle or in the membrane covering the testicle.

3. Reconstruction of the nose.4. Delivery of the baby through incision in the mother’s lower ab-

dominal and uterine walls.5. Cutting into the collecting system inside the kidney where a large

stone has formed.6. Removal of the urinary bladder and adjacent tissues and organs

and diversion of the urinary stream.7. Surgical formulation or reformation of the diseased hip or shoulder

joint to re-establish motion.8. Surgery to strengthen or weaken the muscles that regulate hori-

zontal movement of the eyeball.9. Removal of a lump from the female breast that is known or sus-

pected to be cancerous.10. Removing a diseased or injured cornea and replacing it with

a healthy cornea from a donor.11. Removal of an intervertebral disk that has protruded from its nor-

mal position.Exercise 2. Explain the difference between the following pairs of words:

access abscess

die dye

too toe

blood bleed

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thus this

cast caste

split splint

bite byte

later latter

plaque plague

tip type

vary very

whether weather

taste test

element ailment

stricture structure

extend extent

Exercise 3. Find the odd word in each group:

a) scalpel, scissors, stethoscope, forceps, retractorb) tattoo, mole, wart, sore, furuncle, bruisec) pain, ache, itch, tenderness, scratchd) interrupted, continuous, absorbable, scarringe) aspiration, laparotomy, surgery, resection, respiration, puncture

Exercise 4. Match the words of everyday English and appropriate medi-cal terms:

1. breastbone a. aperture

2. thighbone b. masticate

3. hole c. transplant

4. gristle d. sternum

5. womb e. cicatrix

6. gullet f. femur

7. graft g. excise

8. birthmark h. nevus

9. navel i. clavicle

10. collarbone j. umbilicus

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11. scar k. esophagus

12. cut out l. uterus

13. freckle m. cartilage

14. chew n. lentigo

Exercise 5. Translate from Russian into English:

1. Миссис Браун понадобилась срочная операция.2. Девочке удалили аппендикс.3. В этом случае катетер вводится в бедренную артерию.4. Заячья губа — дефект, который легко устраняется с помощью

операции.5. Родители привезли ребенка в отделение неотложной помощи.6. Перед операцией пациенту определили группу крови.7. Если у пострадавшего перелом руки, ее следует зафиксировать

с помощью шины.8. Кетгут — это рассасывающийся шовный материал.9. Операция по удалению опухоли мозга прошла успешно.10. Перед серьезным хирургическим вмешательством больного

необходимо обследовать.Exercise 6. Translate the following sentences with special attention to

the underlined words which have special meanings in the language of medicine.

1. If patients were to be visited preoperatively by an anaesthetist, they would have to be admitted to hospital earlier.

2. The wound was not dressed properly.3. Broken bones take longer to knit in old people than in children.4. Bone marrow from donors has to be carefully matched with the

recipient or graft-versus-host disease will ensue.5. The hernia should be reduced promptly.6. The wound healed by second intention could leave scars resulting

in disfigurement.7. Mastoid process is a part of temporal bone.

Exercise 7. Read the text and fill in the gaps with appropriate words from the brackets.

CholecystectomyCholecystectomy is usually __________ (curative, operative, suppura-

tive) and patients may live a normal life without a gallbladder. Timing of the cholecystectomy has recently been the __________ (line, point, spot) of much discussion. If early operation is contemplated, it should be performed within the first 48 hours from the onset of attack, since the inflammatory process may make surgical manipulation in the area

27

of the gallbladder difficult if it is allowed to __________ (assist, consist, persist) for longer.

If the patient has diabetes mellitus, which carries __________ (associ-ated, dissociated, officiated) increased morbidity and mortality, surgery should be performed as soon as possible, especially since the signs and symptoms may not be as obvious in these patients. Patients with emphy-sematous cholecystitis or empyema of the gallbladder, and those with perforation of the gallbladder also require early operation.

If the patient is __________ (critically, politically, statistically) ill and definitive surgery cannot be performed, cholecystectomy may need to be done as an emergency. In this procedure, a drainage tube is inserted into the gallbladder, through which any gallstones and pus are drained. This is a simpler and shorter procedure and allows for __________ (ab-solution, dissolution, resolution) of sepsis with less morbidity and mor-tality.

Cholecystectomy might be __________ (deferred, preferred, referred) in elderly patients who are poor surgical risks, since only approximately one-half of them will develop symptoms within a five-year period.

Patients with cholecystitis who undergo an uneventful cholecystec-tomy should __________ (perceive, conceive, receive) routine postopera-tive followup one and two months after surgery.Exercise 8. Work with a medical dictionary and find professional Russian

terms for the following word-combinations with the words “fracture” and “suture”:

a) capillary (hairline, fissure) fracture; complicated fracture; com-pound fracture; compression (crush) fracture; displaced fracture; green-stick fracture; simple fracture; to reduce (to set) a fracture

b) absorbable suture; apposition suture; approximation suture; bur-ied suture; continuous suture; interrupted suture; purse-string suture; tension sutureExercise 9. Listen to the text and find answers to the following questions:

1. In what century did Robert Liston live and work?2. What did a compound fracture mean at that time?3. Did the discovery of aneasthetic improve the survival rate?4. What four main factors of successful surgery have been men-

tioned?

When one of the world’s finest surgeons, Robert Liston, operated on patients in 1842, they had a one in six chance of coming out of hospi-tal alive. If they had a compound fracture, an operation was their only chance of survival. For that they would have to endure the horrific tor-ture of being held on a hard wooden table without anaesthetic, while their leg was sawn off. Ten years later they would have still lost their leg, but at least there was pain relief and, assuming the chloroform did not kill them, a similar chance of survival.