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
Книга доступна на образовательной платформе «Юрайт» urait.ru,
а также в мобильном приложении «Юрайт.Библиотека»
Москва  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 иностранных языков и регионоведения Московского государственного университета имени М. В. Ломоносова.
Рецензенты:
Городецкая Л. А. — доктор культурологии, кандидат филологических
наук, профессор кафедры теории преподавания иностранных языков факультета иностранных языков и регионоведения Московского государственного
университета имени М. В. Ломоносова;
Новодранова В. Ф. — профессор, доктор филологических наук, заведующая кафедрой латинского языка и основ терминологии Московского государственного 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 образование). — Текст : непосредственный.
ISBN 978-5-534-13022-5
Основная цель учебника — обеспечить студентам получение навыков
изучающего и ознакомительного чтения, говорения, письма, перевода и реферирования текстов широкой медицинской тематики. Содержание учебника 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, учебного и научно-популярного характера; грамматические комментарии и задания; практические упражнения на говорение и письмо; лексический минимум; 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.
ISBN 978-5-534-13022-5
© Коллектив авторов, 2017
© Коллектив авторов, 2020, с изменениями
© ООО «Издательство Юрайт», 2020
Содержание
Авторский коллектив...................................................................... 9
Предисловие.................................................................................. 10
Unit 1. Trauma and Surgery.............................................................14
Words with Special Medical Meanings....................................................... 14
Text 1. ....................................................................................................... 14
Introduction to Operative Surgery....................................................... 15
Text 2. ....................................................................................................... 16
Management of Traumatic Wounds...................................................... 16
Text 3. ....................................................................................................... 18
Look, no Forceps! Kidney Surgeons Use Their Fingers for Transplants.... 18
Texts for Retelling in English...................................................................... 20
Лапароскопия.................................................................................... 20
Bariatric Surgery................................................................................. 20
Additional Reading.................................................................................... 21
Pediatric Surgery................................................................................. 22
Revision..................................................................................................... 24
Cholecystectomy.................................................................................. 26
Spare Parts.......................................................................................... 30
Grammar................................................................................................... 30
Passive Voice........................................................................................ 30
Medical Humour........................................................................................ 35
Surgery Course.................................................................................... 35
Unit 2. Medical Genetics.................................................................. 37
Text 1. ....................................................................................................... 37
The Medical Genetics Milestones......................................................... 37
Text 2. ....................................................................................................... 39
Genetic Variations and Mutations........................................................ 39
Text 3. ....................................................................................................... 41
Genetic Abnormalities (a conversation between a patient and
a doctor).............................................................................................. 42
Texts for Retelling in English...................................................................... 44
Для чего нужен белок болезни Гентингтона?................................... 44
Telomeres: The Key to Immortality?..................................................... 45
Stem Cell Therapy............................................................................... 46
Additional Reading.................................................................................... 47
Cancer Is a Genetic Disease at the Level of Somatic Cells...................... 47
3
Grammar................................................................................................... 50
Conditional Sentences......................................................................... 50
Revision..................................................................................................... 52
Could Genetics Data about Intelligence Be Useful?............................... 54
Cystic Fibrosis...................................................................................... 58
Phenylketonuria.................................................................................. 59
Medical Humour........................................................................................ 61
Darwin Award (abstract)..................................................................... 61
Unit 3. Gynecology And Obstetrics..................................................65
Words with Special Medical Meanings....................................................... 65
Text 1. ....................................................................................................... 65
Endometriosis...................................................................................... 66
Some Common Cancers of the Women Reproductive System............... 68
Text 2. ....................................................................................................... 69
Pregnancy............................................................................................ 70
Prenatal Care....................................................................................... 70
Prenatal Development......................................................................... 73
Text 3. ....................................................................................................... 75
Uterine Fibroid Embolization............................................................... 76
Texts for Retelling in English...................................................................... 80
Роды без боли. Возможно ли?............................................................ 80
In Vitro Fertilization............................................................................ 80
Additional Reading.................................................................................... 81
Gentle Persuasion................................................................................ 82
Grammar................................................................................................... 84
The Gerund......................................................................................... 84
Revision..................................................................................................... 90
Stress during Pregnancy Changes Infants’ Gut Microbiota.................... 95
Medical Humour........................................................................................ 97
Right for the Boy, Left for the Girl........................................................ 97
Unit 4. Infectious Diseases............................................................. 100
Words with Special Medical Meanings..................................................... 100
Text 1. ..................................................................................................... 100
The Body’s Response to Infection....................................................... 101
Types of Immunity............................................................................. 103
Text 2. ..................................................................................................... 104
A Modern Menace: Emerging Infectious Diseases............................... 105
Text 3. ..................................................................................................... 107
Sexually Transmissible Diseases......................................................... 107
Texts for Retelling in English.................................................................... 112
Смертельное угощение.................................................................... 112
Tuberculosis: A Modern and Ancient Infectious Disease..................... 113
Additional Reading.................................................................................. 114
4
People Problems................................................................................ 114
Grammar................................................................................................. 117
Infinitive Constructions...................................................................... 117
Revision................................................................................................... 120
Виды инфекционных болезней....................................................... 122
Influenza........................................................................................... 124
The Common Cold............................................................................. 124
Viral Hepatitis.................................................................................... 126
Medical Humour...................................................................................... 131
Unit 5. Non-infectious diseases...................................................... 132
Words with Special Medical Meanings..................................................... 132
Text 1. ..................................................................................................... 132
Health Problems in Developed Countries........................................... 132
Text 2. ..................................................................................................... 135
Why Illnesses Get Worse at Night....................................................... 135
Text 3. ..................................................................................................... 137
Digestive Disorders............................................................................ 137
Texts for Retelling in English.................................................................... 140
Роль невербальной информации.................................................... 140
Taking Advice to Heart....................................................................... 141
Additional Reading.................................................................................. 142
Angina Pectoris.................................................................................. 142
Grammar................................................................................................. 143
Многофункциональные слова......................................................... 143
Revision................................................................................................... 149
Medical Humor........................................................................................ 154
Louis XIV’s Doctors............................................................................ 154
Unit 6. Neurology.......................................................................... 156
Words with Special Medical Meanings..................................................... 156
Text 1. ..................................................................................................... 156
Stroke................................................................................................ 156
Text 2. ..................................................................................................... 163
Honest Liars:How the Brain Leads Us to Believe False Truths............. 163
Text 3. ..................................................................................................... 168
The Neglect Syndrome....................................................................... 169
Texts for Retelling in English.................................................................... 172
Инсульт............................................................................................. 172
Left in the Past................................................................................... 173
The Stuttering Brain.......................................................................... 174
Additional Reading.................................................................................. 175
Neuroscience and Criminal Defenses................................................. 175
Grammar................................................................................................. 177
Multi-component Terms..................................................................... 177
5
Revision................................................................................................... 182
Medical Humour...................................................................................... 186
Unit 7. Psychiatry........................................................................... 188
Words with Special Medical Meanings..................................................... 188
Text 1. ..................................................................................................... 188
Schizophrenia.................................................................................... 188
Text 2. ..................................................................................................... 192
Depression and Depressive Disorders................................................. 192
Text 3. ..................................................................................................... 195
Anxiety and Bipolar Disorder............................................................. 195
Texts for Retelling in English.................................................................... 199
Навязчивые состояния: симптомы, ритуалы, виды........................ 199
Taming Compulsion........................................................................... 201
New View on Autism.......................................................................... 202
Additional Reading.................................................................................. 203
Facts about Social Phobia................................................................... 203
Grammar................................................................................................. 205
Types of Questions............................................................................. 205
Mental Status Examination................................................................ 208
Revision................................................................................................... 210
An Introduction to Bipolar Disorder................................................... 210
Panic Attack Sufferers Are Unaware of Symptoms.............................. 215
Medical Humour...................................................................................... 216
Unit 8. Medication......................................................................... 218
Words with Special Medical Meanings..................................................... 218
Text 1. ..................................................................................................... 218
Classes of Antibiotics......................................................................... 218
Text 2. ..................................................................................................... 220
Routes of Administration................................................................... 220
Text 3. ..................................................................................................... 223
Anesthesia......................................................................................... 223
Texts for Retelling in English.................................................................... 227
О лекарствах анестезиолога............................................................ 227
Compliance....................................................................................... 228
Additional Reading.................................................................................. 229
Echinacea (Echinacea Purpurea)....................................................... 229
Ginkgo (Ginkgo Biloba)..................................................................... 229
Grammar................................................................................................. 230
Независимый причастный оборот, или абсолютная
причастная конструкция (Independent Participle Construction)..... 230
Revision................................................................................................... 232
Painkiller Risks.................................................................................. 233
Pharmacologic Agents for Procedure-related Pain.............................. 235
6
Ampicillin.......................................................................................... 238
Benzylpenicillin (Penicillin G)........................................................... 238
Erythromycin..................................................................................... 238
Gentamicin........................................................................................ 238
Tetracycline....................................................................................... 239
Adverse Reactions to Drugs................................................................ 240
Medical Humour...................................................................................... 243
How to... Take Medicine.................................................................... 243
Answer Keys..................................................................................245
Unit 1....................................................................................................... 245
Unit 2....................................................................................................... 245
Unit 3....................................................................................................... 246
Unit 4....................................................................................................... 249
Unit 5....................................................................................................... 251
Unit 6....................................................................................................... 251
Unit 7....................................................................................................... 253
Unit 8....................................................................................................... 254
Lexical Minimum...........................................................................256
References.....................................................................................264
Список использованной литературы..................................................... 264
Список 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 государственного университета имени М. В. Ломоносова;
Афанасова Вера Васильевна — кандидат культурологии, преподаватель кафедры английского языка для естественных факультетов
факультета иностранных языков и регионоведения Московского государственного университета имени М. В. Ломоносова;
Долтмурзиев Дмитрий Олегович — старший преподаватель кафедры английского языка для естественных факультетов факультета
иностранных языков и регионоведения Московского государственного университета имени М. В. Ломоносова;
Черезова Татьяна Львовна — кандидат филологических наук,
доцент кафедры английского языка для естественных факультетов
факультета иностранных языков и регионоведения Московского государственного университета имени М. В. Ломоносова.
Предисловие
Учебник «Английский язык для медиков» предназначен для студентов младших курсов медицинских вузов. Основная цель учебника — обеспечить учащимся освоение навыков чтения, перевода
и реферирования английских текстов широкой медицинской тематики, создать возможности для расширения пассивного и активного словарного запаса в области медицинской терминологии. Кроме
того, с помощью данного учебника можно развить навыки письменной речи и участия в дискуссиях на профессиональные медицинские темы.
Книга написана на базе материалов, использовавшихся при преподавании английского языка студентам младших курсов факультета 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, заимствованные из современных специальных медицинских учебников и научных изданий, научно-популярных журналов, Интернета. В некоторых случаях тексты подвергали небольшой адаптации и сокращали.
Поскольку в текстах сохраняется оригинальная орфография, студенты закрепляют навыки работы как с британскими, так и с американскими вариантами написания, что также является важным элементом владения языком.
Учебник рассчитан на используемый на факультете метод «максимального 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 разделов: 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 независимая и однотипная структура каждого раздела учебника в принципе позволяет вести работу вне предлагаемого порядка, при этом
10
содержание всего учебника рассчитано на 120 часов аудиторных
занятий.
Каждый раздел пособия включает три основных текста на английском языке — научного, учебного и научно-популярного характера. 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 упражнениями. Упражнения нацелены на развитие основных навыков профессионально 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 синонимов, многозначных терминах, эпонимах и т. д. Особое внимание
в учебнике уделяется медицинским терминам, имеющим омонимы
в общеупотребительной лексике. Для того чтобы студенты сразу усваивали 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 русском и английском языках, предназначенные для реферирования
(Texts for Retelling in English). Эти тексты позволяют закрепить
навыки пересказа: студентов следует научить активно манипулировать собственным словарным запасом, находить альтернативные
способы выражения одной и той же мысли и тем самым избегать
«языковых тупиков», которые возникают в том случае, когда пересказ 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 дополнительные 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 нужное слово из нескольких.
Каждый тематический раздел содержит грамматический материал (Grammar), объясняющий ряд языковых явлений, систематизирующее повторение которых было сочтено целесообразным (пассивный залог, условные предложения, причастные и герундиальные
обороты, многофункциональные слова и т. д.). Активизирующие
упражнения составлены на основе медицинской лексики соответствующей тематики.
Все разделы завершаются материалами, предназначенными
для проверки усвоения лексики (Revision). Это комплекс заданий,
которые способствуют развитию навыков всех видов речевой дея11
тельности, включая письмо. В учебнике также представлен предназначенный для студентов младших курсов лексический минимум
(Lexical Minimum), обращение к которому предусмотрено при выполнении ряда заданий в ходе освоения всего курса. В книгу включены шутки и юмористические рассказы (Medical Humour), которые можно использовать и в качестве дополнительного чтения.
Учебник также содержит ключи к ряду упражнений (Answer
Keys). Это позволяет использовать его и для самостоятельной подготовки к экзамену.
Данный учебник составлен в соответствии с современными
требованиями Федерального государственного образовательного
стандарта высшего образования. Сочетание тематического и систематизирующего подходов к обучению английскому языку как языку
медицины составляет спе­цифику данного учебника.
Изучив материал учебного пособия, студент будет:
знать
• специальную медицинскую лексику в рамках изучаемых тем
на английском языке;
• перевод на русский язык основных терминов в сфере меди­
цины;
• языковые единицы на английском языке, позволяющие раскрывать содержание научных понятий в ситуациях указания, описания, сравнения, пояснения, рассуждения;
• английские языковые средства, обеспечивающие связность
слов, фраз и текста;
• основные лексико-грамматические структуры с неличными
формами глагола;
уметь
• передавать предметное содержание английского медицинского текста на русском языке;
• использовать языковые средства в различных коммуникативных ситуациях;
• разъяснять значения терминов на английском языке, выделяя
существенные и несущественные свойства медицинских понятий;
• перестраивать высказывания, используя синонимичные и антонимичные 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 заведующей кафедрой английского языка для естественных факультетов
факультета иностранных языков и регионоведения Московского го12
сударственного университета имени М.В. Ломоносова профессору
Лидии Валериановне Полубиченко, под чьим руководством работает авторский коллектив и чьи рекомендации позволили внести
улучшения в учебник. Теплые слова благодарности авторы адресуют
рецензентам, которые сделали ряд ценных пожеланий — профессору Валентине Федоровне Новодрановой и профессору Людмиле
Александровне Городецкой.
Unit 1
Trauma and Surgery
.
Words with Special Medical Meanings
to administer — вводить, давать (лекарство)
approach — доступ
booster — ревакцинация
cast — гипс
to drape — обкладывать
dressing — повязка, перевязка
exposure — выделение (хирург.)
gown — стерильный халат
to nurse — выхаживать
procedure — манипуляция, операция, процедура
to scrub — отмывать
scrubs — костюм хирурга
sponge — тампон
to tolerate — переносить
towel — салфетка
Text 1
.
Pre-reading tasks
Exercise 1.
Check the pronunciation of the following words:
endeavour, procedure, rehabilitate, major, colostomy, appraisal, hazardous, 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 rehabilitated
b) 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.
14
Introduction to Operative Surgery
If a surgeon is threatened with an operation on himself, his initial
reaction is “let’s try conservative treatment and endeavour to avoid surgery”. 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 Assessment
A 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 abdominoperineal resection of the rectum.
It is important to explain to the patient the exact nature of the operation, 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 inserted 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 dissection is particularly hazardous, for instance in parotidectomy, where damage 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, cardiac, 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 Patient
The anaesthetized patient is vulnerable, being deprived of his protective 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.
15
The choice of position and incision will depend on the access required 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 planning 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, hepatic
Exercise 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 undergone a successful surgery.
3. Patients will have the procedure explained to them.
4. The patient should never be told about the hazards of the procedure.
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 Tasks
Exercise 1.
Check the pronunciation of the following words:
wound, precedence, debris, penicillin, immunoglobulin, debridement, saline
Exercise 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 Wounds
In the treatment of wounds, operative or traumatic, the aim is
achievement of primary healing without complications and with minimal 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
16
without tension, necessitating either plastic surgery or open treatment.
The management of wounds that penetrate body cavities will not be discussed here.
Assessment of Wounds
Whether or not a traumatic wound can be closed primarily (after certain 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 infection 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 received 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.
Debridement
In 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 emergency 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, discolored tissue has to be excised with the scalpel, and the wound edges
have to be “freshened up”. The extent of excision depends on the location. Where the skin is loose and movable, the excision can be more
17
generous. In areas where the skin is tight, e.g., on the lower leg, debridement has to be sparse so that primary closure will be possible without
tension, which should be avoided. Wound debridement has to be thorough. 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 Closures
After 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 application 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 Tasks
Exercise 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
18
be hidden in the belly button, was carried out 1,068 times in 2012 — almost 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 transplant recipients.
The technique, known as finger-assisted nephrectomy, has been pioneered 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 instruments 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 instruments 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. Obviously 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 nephrectomy — are safe. I use a variation called hand-assisted nephrectomy 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)
19
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
Лапароскопия
Лапароскопия — вид лечебного или диагностического хирургического вмешательства, при котором необходимые манипуляции
производятся через небольшие проколы. С помощью специального
прибора — троакара — в область брюшной полости вводятся лапароскоп и соответствующие инструменты. Для обеспечения визуального контроля лапароскоп оборудован источником света и системой линз, сигнал от которых через оптический кабель передается
на монитор в виде изображения. Для возможности проведения манипуляций в брюшную полость закачивают углекислый газ, поднимающий брюшную стенку, словно купол.
Как правило, лапароскопические исследования и несложные
хирургические операции проводятся под местным наркозом, время выполнения операции резко сокращается. В отличие от полостных операций с разрезами брюшной стенки, лапароскопические
вмешательства менее травматичны, позволяют существенно снизить срок реабилитации, риск повторного инфицирования и возникновения спаечных процессов. Для пациентов, особенно женщин, важно знать, что о проведенной операции будут напоминать
лишь небольшие шрамы от проколов, незаметные невооруженному глазу.
Для хирургов современные технологии дают более широкий
диапазон действий: многократное увеличение, возможность изменения угла обзора и работа с высокоточным оборудованием позволяют более эффективно произвести необходимые манипуляции, поставить диагноз. Значительно снижаются риск инфицирования ран
и последующие сложности с обработкой швов.
(http://propagandahistory.ru/1441/CHto-takoe-laparоskopiya/)
Bariatric Surgery
Currently, bariatric surgery may be an option for people with severe 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,
20
or severe sleep apnea (when breathing stops for short periods during
sleep).
Bariatric surgery restricts food intake, which leads to weight loss. Patients 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 providers 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 laparoscopy. 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 requires 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 diversion 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 patient’s BMI, eating habits, health conditions related to obesity, and previous stomach surgeries.
(http://www.niddk.nih.gov/health-information/health-topics/
weight-control/bariatric-surgery-severe-obesity/Pages/bariatricsurgery-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 disease, hernia, lethargy, incubator, viscera, vomitus, morbidity
Exercise 3.
Explain the difference between the pairs:
examination — observation
life expectancy — life span
21
Pediatric Surgery
Today in industrialized countries more than a half of hospitalized
children have disease with surgical overtones and one fourth of all surgical 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 special 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 operations.
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 gastrointestinal 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 obstruction is generally caused by webs, bands, membranes, faulty innervation, 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.
22
The newborn infant is much more sensitive to environmental temperature and humidity than the adult, so body temperature must be monitored continuously. Body heat of the infant is conserved when the operating 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 surgical principles are never more important than in the neonate: precision (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 obviates the use of restricting conventional dressings that prevent observation 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 generally gratifyingly rapid. The infant should be checked frequently visually, 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 anomaly is completely corrected, no other anomalies are present, and no
complications appear. Multiple anomalies, incomplete surgical correction, 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, surgically 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…
23
Exercise 2.
Arrange according to the increased age:
adolescent, adult, child, infant, neonate
Exercise 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 descriptions:
a) cystectomy, b) arthroplasty, c) ceasarean section, d) partial mastectomy, 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 abdominal 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 abdominal 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 horizontal movement of the eyeball.
9. Removal of a lump from the female breast that is known or suspected 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 normal position.
Exercise 2.
Explain the difference between the following pairs of words:
access
abscess
die
dye
too
toe
blood
bleed
24
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.
a)
b)
c)
d)
e)
Find the odd word in each group:
scalpel, scissors, stethoscope, forceps, retractor
tattoo, mole, wart, sore, furuncle, bruise
pain, ache, itch, tenderness, scratch
interrupted, continuous, absorbable, scarring
aspiration, laparotomy, surgery, resection, respiration, puncture
Exercise 4.
Match the words of everyday English and appropriate medical 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
25
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.
Cholecystectomy
Cholecystectomy is usually __________ (curative, operative, suppurative) 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
26
of the gallbladder difficult if it is allowed to __________ (assist, consist,
persist) for longer.
If the patient has diabetes mellitus, which carries __________ (associated, 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 emphysematous 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 __________ (absolution, dissolution, resolution) of sepsis with less morbidity and mortality.
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 cholecystectomy should __________ (perceive, conceive, receive) routine postoperative 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; compound fracture; compression (crush) fracture; displaced fracture; greenstick fracture; simple fracture; to reduce (to set) a fracture
b) absorbable suture; apposition suture; approximation suture; buried suture; continuous suture; interrupted suture; purse-string suture;
tension suture
Exercise 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 mentioned?
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 hospital alive. If they had a compound fracture, an operation was their only
chance of survival. For that they would have to endure the horrific torture 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.
27