Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Английский язык для педиатров.pdf
171
8. Read and translate text I. Make the plan of the text (part A) using keywords and write the abstract (part B).
Text I. RESUSCITATION OF THE NEWBORN
A. The concern of medicine is life – helping to create it, preserving it whenev-
er possible, easing its pains, making its ending as painless as possible. The first
concern is birth, and since the beginning of history, lawmaker s have placed it at the
top of their agender because no society can survive wit hout healthy generation.
Nowadays of seriously ill newborn babies has significantly improved by advances in medical technology. Infants who would have died had they been born in
the 1950s or early 1960s can nowoften survive for long periods with the help of the
sophisticated, though costly, medical treatment available in the neonatal intensive
care units (NICUs) found in some 600 hospitals across the USA. As of 1989, these
units had treated 200,0 00 newborn babies each year at an estimated annual cost of
$ 1.5 billio n.
As for Russia, neonatal intensive care units help to survive thousands of infants. The part played by the pediatrician in the marternity service has become very
important, as it is clear now that beneficial results of adequate neonatal care or its
lack extend through entire life span. During the immediate neonatal period the pediatrician must concern himself with three ma jor aspects. Firstly, some babies require special care because of prematurity, low birth weight, congenital malformations, birth trauma, or other disabilities. Secondly, all normal full-term babies
should be under pediatric management and receive specialized evaluation and supervision. Thirdly, it is important for all newborn infants to be thoroughly examined shortly after birth and before discharge, to exclude developmental defects
and deviations from normal. Many neonatal problems may arise after the second
day of life in apparently well babies: the adjustment of correct breast feeding, detection of some congenital malformations and such conditions as hyperbilirubinemia, post-natal infection and tetany.
172
B. Some babies may require emergency procedures which are helpful in their
resuscitation. Cardirespiratory depression (heart rate less than 100 beats per
minute, hytension, hypoventilation, or apnea) may occur to some degree in 10% to
15% of newborn infants. Prompt therapy may be lifesaving and is necessary to minimize permanent CNS disability. Resuscitation techniques may be the following:
thermal protection. Pharengeal suctioning, airway suctioning, external cardiac
massage.
One frequently considered cause of cardiorespiratory depression is asphyxia
(decreased PO
2 and pH and increased PCO2 ). A wide range of maternal, fetal, and
placental conditions can lead to asphyxia in newborn. A common factor seems to
be marginal exchange of O
2 and CO2 across the placenta which becomes further
comprom ised dur in g lab or.
The hallmark of the newborn intensive care unit is the ability to manage longterm assisted ventilation of sick infants. Styles of ventilation (rapid vs. slow, long
vs. short inspiratory times, etc.) may differ among institutions. Various styles have
proven effective. A uniform team approach (physician, nurse, respiratory therapist,
radiologist, and clinical laboratory) is essencial. The brand of equipment used is
not critical. Success is determoned by how well you use the equipment you have
and by your patient evaluation. Respiratory failure may occur in infants with a
wide range of disorders, including lung disease, heart disease, intrathorasic anomalies, CNS depression by drugs or disease, and in premature infants with severe apneic spells. When respiratory failure is severe and other methods for treating pulmonary insuf ficiency have failed, mechanical ventilation is indicated.
Ventilation by bag and mask is easily learned and is usually an effective
means of establishing lung expansion. Its s uccess rate is usually only limited by the
availability of an appropriate size mask and the experience of the operator and less
often by the severity of lung disease. Ventilation assistance is indicated in resuscitation and for managing infants for short periods of time while preparing for intubation.
173
Supplemental oxygen is an important form of therapy for many infants with
cardiopulmonary disorders. It should be recognized that its use may be associated
with the occurrence of retrolental fibroplasia and chronic lung disease and that criteria have not been established that insure minimal hazard to the patient. Therefore,
it is presently recommended oxygen administration to be regulated to maintain the
arterial PO
2 within the range for normal newborns, 50 to 100 torr. Oxygen therapy
is indicated in hy po xemia, resuscitation, cyanosi s.
The purpose of percussion, vibration, and suctioning (PVS) therapy is to improve the clearance of mucous and debris from the airways. These techniques are
often fatiguing to the infant and time consuming for nursery personnel and therefore need to be used judiciously. The use of PVS is indicated in patients with
excess or thickened pulmonary secretions and prophylactically in patients with
chronic lung disease and impaired respiratory movement (e.g., paralyzed infants).
Frequency depends on productivity of secretions, therapeutic goals, and tolerance.
PVS orders must be individualized, not ritualized, and frequently reassessed. Personell providing PVS therapy are often the best judges of effectiveness and patient
tolerance. If an infant fights PVS, blood gases may deteriorate for the subsequent
30 minutes or even longer. Tolerance of PVS therapy should be evaluated initially
and periodically using a transcutaneous CO
2 monitor and pulse oximetry. Infants
who have cardiorespiratory instability are the most likely to deteriorate during
PVS.
Safety of babies with severe labor complications and inhereted diseases depends on highly qualified medical personnel and well-equipped neonatal intensive
care units. Thanks to the achievements of medical science it has become possible
to treat and to prevent many fatal neonatal disirders and to recognize at early stage
defects which may cause chronic diseases. Acute observation and intensive care
have impro ved surviv al statistics for newborns with developmenta l anomalies.
9. Answer the questions using the text:
1.What is the concern of medcine?
174
2. Why can no society survive without healthy new generation?
3. Are advances in medical technology helpful in treatment of seriously ill in-
fants or not?
4. Why may some b abies require special care during the immediate neonatal
period?
5. What is asphyxia?
6. What can lead to asphyxia?
7. What may detect those infants who cannot tolerate labor?
8. When is mechanical ventilation indicate d?
9. What infants may respiratory failure occur e in?
10. In what cases is oxygen therapy indicated ?
11. When may prompt the rapy be lifesaving?
12. What is the purpose of P VS therapy?
13. When is PVS therapy indicated?
14. Thanks to what has it become possible to prevent and to treat many fatal
neonatal disorders?
10. Give the English equivalents to the word combinations in brackets.
Translate the sentences:
1. The concern of medicine is (сохранить жизнь) whenever possible. 2.
Treatment of seriously ill infants becomes possible due to (достижениям в меди-
цинских технологиях). 3. A wide range of maternal, fetal and placental condotions (могут привести к асфиксии) in the newborn. 4. (Многие неонатальные
проблемы) may arise after the second day of life in apparently well babies. 5.
When (остановка дыхания) is severe mechanical ventilation (показана). 6. (Зна-
чительная гипоксия у новорожденного) is usually defined as P
aO2 le ss than 50
torr. 7. Some practitioners (рекомендуют ограничение) of FiO
2 to 0.80 (для
оживления новорожденного) in the delivery room. 8. It is common practice (назначать кислород) in a concentration just sufficient (чтобы облегчить цианоз),
while awaiting the results of blood gas maesurements. 9. The goal of therapy is to
175
maintain PaO2 in the range of 50 to 100 torr and preferably 60 to 80 torr in small
prematures (чтобы избежать гипоксии или гипероксии). 10. Thanks to the constantly improving (родовспомогательная служба) and child care there has been a
large decrease in inf a nt (смертность) in our country.
11. Choose the definiti ons corresponding to the following terms:
asphyxia, hydrocephaly, premature, amniotic, rubella, perinatal, trimester, mi-
crocephaly, hyperbilirubinemia
one third Ithree month) of the period of pregnancy; excess of the bilirubin in
the blood; pathological smallness of the head due to defective development of the
brain; congenital dropsy of the brain due to its defective development; an acute exanthematous contagious febrile disease caused by virus; occurring at the time of
birth; pertainingto the amnion, fetal membrane forming bag of waters; born or interrupted b efore the stage of maturity; decreased PO
2 and pH2 and increa se d PCO 2.
12. Give the summary of text I accord ing to your plan.
13. Read text II and say wh at the main idea of it is:
Infant Patient s wit h A du lt Pai n
While doctors and nurses accept that newborn babies suffer pain as much as
older children and adults, they do little to help infants who have to undergo distressing procedures. Dr Jane Tohill and Dr Olive McMorrow of the National Maternity Hospital, Dublin, sent out a detailed questionnaire to the staf f of 21 neonatal
intensive care units in the British Isles about their pain relief policy. Of the 17 that
replied, just less than three-quarters agreed that doctors tend to under-prescribe
painkillers and a third that nurses do the same.
More upsetting, the survey revealed that more than a quarter of the units give
babies no pain relief before a chest drain is inserted and only 40 per cent provide
176
relief to babie s suffering from fatal conditions such as spina bifida. The researchers
argue in The Lancet that units should have a written policy on when pain relief
should be given; otherwise it will not be provided. Most important, traumatic procedures sho uld be performed without pain relief only in emergencies.
14. Read and translate the dialogue between the doctor working at the in-
tensive car e units and his assistant :
Assistant: And what does the Apgar Score provide?
Doctor: So, it provides a standard for describing condition of infants at birth.
Assistant: What objective signs does Apgar Scoring system evaluate?
Doctor: It evaluates heart rate, respiratory effort, muscle tone, reflex irritabili-
ty and colour (blue, pink or pale) at 1 and 5 minutes after birth and each is given a
score 0,1 or 2. The sum of the 5 scores i s the Apgar Score.
Assistant: What does a score o f 3 to 6 indicate?
Doctor: Moderate depress ion.
Assistant: And score of 0 to 2?
Doctor: Oh, it indicates severe depression. The one-minute Apgar Score and
the five minutecorrelate best with survival, while the those at 10 and 20 minutes
seem to be better prognosticators of neurological damage at 1 year of age.
15. Make up your own dia logue “At the Neonatal In tensive Care Unit”.
16. Point out ‘the preposition + gerund constructions’ in the following
sentences. Translate them:
1. On examining the child they decided to apply chemotherapy. 2. On paasing
through the diaphragm, the thorasic duct enters the posterior mediastinum. 3. By
following the doctor’s advice carefully parents may help to prevent many infectious diseases. 4. Sometimes the child stops crying after placed on his stomach. 5.
The doctor diagnoses diphtheria by examining the patient’s mouth and throat. 6 .
Bacterial infection maybplay a part in causing neonatal jaundice. 7. The child’s
177
appetite and sleep depend on being out in the open air for some time every day. 8.
The patient’s body reacts to infection by producing substances capable of combating the germs and their toxins. 9. We have had the experience of selecting and intensively studying a single drug suspected on clinical basis of producin g malformations of the heart and have demonstrated that it is highly capable of causing congenital heart defects. 10. On comparing small series of patients, such discrepancies in
results may be observed due not only to differences in the methodology employed
but also to pa tient character.
17. Translat e the sentences containing ‘withou t + gerund construction’:
1. The cardiac muscle has a remarkable “built-in” safety mechanism which
enables the heart to sustain the increased burden without failing. 2. No doctor will
ever risk diagnosing anemia without first doing blood tests. 3. The sick child was
lying quietly without complaining of anything. 4. It is impossible to prevent
spreading of whooping cough without isolating sick children from healthy ones. 5.
The mild form of scarlet fever allowed the child to be treated at home without being hospitalized. 6. It is impossible to protect children against diseases without
creating condotions for strengthening them and building up their resistance. 7. Inoculations with weakened strains of the infection-germs will make a person immune to the given disease without causing any severe form of it. 8. The doctor
cannot take a case-history without describing the patient’s complaints. 9. A physician mustn’t make a diagnosis without examining a patient. 10. It appears, that
HTLV-III (Human T-Lymphotropic Virus, Type III), like other viruses, may ramain latent in the body without ever causing AIDS (Acquired Immune Deficiency
Syndrome) disease.
18. Point out gerundial c onstructi ons in the fol lowing sentences. Translate
the sentences:
178
1. The child’s being infected with antitoxin in time may lead to a favourable
birth rate
рождаемость
death rate
уровень смертности
dose rate
мощность дозы
course of diphtheria. 2. The doctor insited on the chold’s adenoids being removed
as soon as possible. 3. Because of the pregnant woman’s gaining excessive weight
her diet has been changed. 4. Causative agents having penetrated in the body
doesn’t necessarily cause an infectious disease. 5. The onset of rheumatic fever began with the child’s sleeping poorly, loosing his appetite and running a subfebrile
fever in evenings. 6. The necessity of the child’s being isolated from healthy children immediately was emphasized by the doctor. 7. After the child’s having been
discharged from the hospital all steps must be taken at home to prevent a recurrence of the attack. 8. The child became infected with scarlet fever because of the
mother’s having allowed him to come into contact with his sick brother. 9. The
home of the sick child must be thoroughly disinfected after his having been taken
to the hospital. 10. The child’s appetite being impaired made him refuse not only
food, but even drink.
19. Mind the meaning of the word “rate”, learn its combinations by
heart:
rate n – 1. скорость, быстрота; темп, ритм; интенсивность
2. степень; процент; коэффициент; индекс; уровень; пропорция, доля
3. мощность, интенсивность
4. частота
5. доза; норма; количество; производительность
6. цена; оценка
rate v – 1. ценить, оценивать, измерять
2. считать, рассматривать, полагать
179
heart rate
частота сердечных сокращений
infant mor tality rate
коэффициент детской смертности
metabolic rate
скорость, уровень метаболизма
morbidity rate
заболеваемость; распространенность болезни
sinoatrial r ate
синусный ритм
20. Translate the following sentences into Russian paying attention to the
word “rate”:
1. The rates of incidence vary by area. 2. The rate of HIV infection among
women in the US varies from 0% to more than 50%. 3. In many populations tested
it is difficult to separate rates for alcohol and for drug use. 4. The procedure is safe
and leads to excellent survival rates. 5. Heart rate was monitored continuously and
blood pressure (systolic and diastolic) was recorded every 5 min. 6. We also observed a high rate of remission. 7. In contrast to Liquid Chromatography the technique of Gas Chromatography developed at an amazing. 8. Advertising rates are
available on request. 9. Burn patients have caloric needs exceeding those of any
other injury, and their metabolic rate is related to burn size. 10. Fig. 16 shows the
results of a trial in which brodicoum pellets (гранулы) achieved effect at only half
the applicat ion ra te.
21. Form the words given below choose the synonyms of the words and
word combinations in b old type:
1. The normal babies born at term require an environmental temperature of
21-24°C. 2. Serologic techniques for demonstra ting the infectio n in the mother and
the fetus were developed. 3. It is obvious from this and other studies that hearing
loss is an important symptom in congenital infection. 4. It has been suggested that
the the shortened period of exis tence of infected cells may lead to the small size of
the virus-infected newborns. 5. Because of pyelonephritis ampicilline sodium was
given during the second three months of pregnancy. 6. There was initial im-
180
provement in the child’s condotion, but recurrent heart failure demanded several
subsequent hospitalizations. 7. The defects resulting from inhibition of growth of
specific tissues occurred only in the presence of fully infective virus. 8. The low
birth weight babies may need an envi ronmental temperature of 35°C.
(span of life, trimester, premature, consequent upon, unborn child, require,
deafness, full-term ba bies)
22. Fill in the blanks with suitable preposition s. Translate the senten ces:
1. The average duration … treatment was about 3 months and antibacterial
agents were commonly given as well. 2. Congenital malformations consequent …
harmful prenatal influences caused a chronic disability … this child. 3. An anesthetist must concern himself deeply … the complicated pediatric anesthesia if he
wants to work … pediatric surgery. 4. The doctors of a women’s consultation centre assume full responsibility … the health of a future mother. 5. Every future
mother must prepare herself for caring … her child both in health and in disease. 6.
Premature infants are especially susceptible to infection … different microorganisms. 7. … examining the child they decided to apply chemotherapy. 8. Being an
introduction to neonatology, the book is suitible … those who are interested … pediatrics.
23. Translat e the following sente nces into Russian:
1. The care of VLBW (very-low-birth-weight) infants remains a unique challenge. 2. Thanks to advances in cardiac surgery, many children born with congenital anomalies of the heart can have these disorders corrected surgically. 3. On
admission to the hospital a full history had been taken, and the child was given a
clinical examination. 4. They didn’t have the course of their disease changed by
this therapy. 5. Cardiologists are known to treat people with diseases of the heart.
6. The neonatal survival rate has dramatically improved in recently years. 7. To
understand the basic signs of every doctor. 8. The book is to be used by every
member of the care unit. 9. It is now possible to examine the electrocardiogram of