Текст книги "Английский язык для медиков"

Автор книги: Елена Беликова

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17. Thoracic wall

There are 12 thoracic vertebrae. Each rib articulates with the body of the numerically corresponding vertebra and the one below it. Sternum: the manubrium articulates with the clavicle and the first rib. It meets the body of the sternum at the sternal angel an important clinical landmark.

The body articulates directly with ribs 2–7; it articulates interiorly with the xiphoid process.

Ribs and costal cartilages: there are 12 pairs of ribs, which are attached posteriorly to thoracic vertebrae.

Ribs 1–7 attach directly to the sternum by costal cartilages.

Ribs 8—10 attach to the costal cartilage of the rib above. Ribs 11 and 12 have no anterior attachments. The costal groove is located along the inferior border of each rib and provides protection for the intercostal nerve artery, and vein.

There are 11 pairs of external intercostal muscles.

These muscles fill the intercostal spaces from the tubercles of ribs posteriorly to the costochondral junctions anteriorly. There are 11 pairs of internal intercostal muscles.

These muscles fill the intercostal spaces anteriorly from the sternum to the angles of the ribs posteriorly.

Innermost intercostal muscles: the deep layers of the internal intercostal muscles are the innermost intercostal muscles.

Subcostalis portion: Fibers extend from the inner surface of the angle of one rib to the rib that is inferior to it.

Internal thoracic vessels, branches of the subclavian arteries, run anterior to these fibers. Intercostal structures

Intercostal nerves: there are 12 pairs of thoracic nerves, 11 intercostal pairs, and 1 subcostal pair.

Intercostal nerves are the ventral primary rami of thoracic spinal nerves. These nerves supply the skin and musculature of the thoracic and abdominal walls.

Intercostal arteries: there are 12 pairs of posterior and anterior arteries, 11 intercostal pairs, and 1 subcostal pair. Anterior intercostal arteries.

Pairs 1–6 are derived from the internal thoracic arteries.

Pairs 7–9 are derived from the musculophrenic arteries.

Posterior intercostal arteries: the first two pairs arise from the superior intercostal artery, a branch of the costo—cervical trunk of the subcla vian artery.

Nine pairs of intercostal and one pair of subcostal arter ies arise from the thoracic aorta.

Intercostal veins: Anterior branches of the intercostal veins drain to the internal thoracic and musculophrenic veins.

Posterior branches drain to the azygos system of veins.

Lymphatic drainage of intercostal spaces: anterior drainage is to the internal thoracic (parasternal) nodes.

Posterior drainage is to the paraaortic nodes of the po—ste rior mediastinum.

New words

thoracic – грудной

wall – стенка

clavicle – ключица

xiphisternal – грудинный

groove – углубление

intercostal – межреберный

subcostal – подкостный

transversus – поперечный

musculophrenic – мышечный грудобрюшной

paraaortic – парааортальный

mediastinum – средостение

18. Blood. Formed elements of the blood. Erythrocytes and platelets

Blood is considered a modified type of connective tissue. Mesodermal is composed of cells and cell frag ments (erythrocytes, leukocytes, platelets), fibrous proteins (fi—brinogen), and an extracellular fluid and proteins (plasma). It also contains cellular elements of the immune system as well as humoral factors.

The formed elements of the blood include erythrocytes, leukocytes, and platelets.

Erythrocytes, or red blood cells, are important in trans porting oxygen from the lungs to tissues and in returning carbon dioxide to the lungs. Oxygen and carbon dioxide carried in the RBC combine with hemoglobin to form ox—yhemoglobin and carbaminohemoglobin, respectively.

Mature erythrocytes are denucleated, biconcave disks with a diameter of 7–8 mm. The biconcave shape results in a 20–30 % increase in sur face area compared to a sphere.

Erythrocytes have a very large surface area: volume ratio that allows for efficient gas transfer. Erythrocyte membranes are remarkably pliable, enabling the cells to squeeze through the narrowest capillaries. In sickle cell anemia, this plasticity is lost, and the subsequent clogging of capillaries leads to sickle crisis. The normal concentration of erythrocytes in blood is 3,5–5,5 million/mm ³ in women and 4,3–5,9 million/mm ³ in men. The packed volume of blood cells per total volume of known as the he—matocrit. Normal hematocrit values are 46 % for women and 41–53 % for men.

When aging RBCs develop subtle changes, macropha—ges in the bone marrow, spleen, and liver engulf and digest them. The iron is carried by transferring in the blood to certain tissues, where it combines with apoferritin to form ferritin. The heme is catabolized into biliver—din, which is converted to bilirubin. The latter is secreted with bile salts.

Platelets (thromboplastids) are 2–3 mm in diameter.

They are a nuclear, membrane—bound cellular fragments derived by cytoplasmic fragmentation of giant cells, called megakaryocytes, in the bone marrow.

They have a short life span of approximately 10 days.

There are normally 150 000–400 000 platelets per mm3 of blood. Ultrastructurally, platelets contain two portions: a peripheral, light—staining hyalomere that sends out fine cytoplasmic processes, and a central, dark—staining granulomere that con tains mitochondria, vacuoles, glycogen granules, and granules. Platelets seal minute breaks in blood vessels and maintain endothelial integrity by adhering to the damaged vessel in a process known as platelet aggregation. Platelets are able to form a plug at the rupture site of a vessel because their mem brane permits them to agglutinate and adhere to surfaces.

Platelets aggregate to set up the cascade of enzymatic reac tions that convert fibrinogen into the fibrin fibers that make up the clot.

New words

mesodermal – мезодермальный

erythrocytes – эритроциты

platelets – тромбоциты

carbon – углерод

dioxid – диоксид

span – промежуток

light—staining – легкое окрашивание

to aggregate – соединяться

19. Blood. Formed elements of the blood. Leukocytes

Leukocytes, or white blood cells, are primarily with the cellular and humoral defense of the organism foreign materials. Leukocytes are classified as granulocytes (neutrophils, eos—inophils, basophils) and agranulocytes (lympmonocytes).

Granulocytes are named according to the staining properties of their specific granules. Neutrophils sare 10–16 mm in diameter.

They have 3–5 nuclear lobes and contain azurophilic granules (lysosomes), which contain hydrolytic enzymes for bacterial destruction, in their cytoplasm. Neutrophils are phagocytes that are drawn (chemotaxis) to bacterial che—moattractants. They are the primary cells involved in the acute inflammatory response and represent 54–62 % of leukocytes.

Eosinophils: they have a bilobed nucleus and possess acid granulations in their cytoplasm. These granules contain hydrolytic enzymes and peroxidase, which a discharged into phagocytic vacuoles.

Eosinophils are more numerous in the blood during allergic diseases; they norma asent only – 3 % of leukocytes.

Basophils: they possess large spheroid granules, which are basophilic and metachromatic.

Basophils degranulate in certain immune reaction, releasing heparin and histamine into their surroundings. They also release additional vasoactive amines and slow reacting substance of anaphylaxis (SRS—A) consisting of leu—kotrienes LTC4, LTD4, and LTE4. They represent less than 1 % – of leukocytes.

Agranulocytes are named according to their lack of specific granules. Lymphocytes are generally small cells measuring 7—10 mm in diameter and constitute 25–33 % of leukocytes. They con tain circular dark—stained nuclei and scanty clear blue cyto plasm. Circulating lymphocytes enter the blood from the lymphatic tissues. Two principal types of immunocompetent lymphocytes can be identified T lymphocytes and В lymphocytes.

T cells differentiate in the thymus and then circulate in the peripheral blood, where they are the principal effec tors of cell—mediated immunity. They also function as helper and suppressor cells, by modulating the immune response through their effect on В cells, plasma cells, mac—rophages, and other T Cells.

В cells differentiate in bone marrow. Once activated by contact with an antigen, they differentiate into plasma cells, which synthesize antibodies that are secreted into the blood, intercellular fluid, and lymph. В lymphocytes also give rise to memory cells, which differentiate into plas ma cells only after the second exposure to the antigen. Monocytes vary in diameter from 15–18 mm and are the largest of the peripheral blood cells. They constitute 3–7 % of leukocytes.

Monocytes possess an eccentric nucleus. The cytoplasm has a ground—glass appearance and fine azurophilic granules.

Monocytes are the precursors for members of the mo—nonuclear phagocyte system, including tissue macropha—ges (histiocytes), osteoclasts, alveolar macrophages, and Kupffer cells of the liver.

New words

mesodermal – мезодермальный

erythrocytes – эритроциты

leukocytes – лейкоциты

fibrous proteins – волокнистые белки

immune – иммунный

humoral – гуморальный

to contain – содержать

nuclei – ядра

20. Plasma

Plasma is the extracellular component of blood. It is an aqueous solution containing proteins, inorganic salts, and organic com pounds. Albumin is the major plasma protein that maintains the osmotic pressure of blood. Other plasma proteins include the globulins (alpha, beta, gamma) and fibrino—gen, which is necessary for the formation of fibrin in the final step of blood coagulation. Plasma is in equilibrium with tissue interstitial fluid through capil lary walls; therefore, the composition of plasma may be used to judge the mean composition of the extracellular fluids. Large blood proteins remain in the intravascular compartment and do not equilibrate with the interstitial fluid. Serum is a clear yellow fluid that is separated from the coagulum during the process of blood clot formation. It has the same com position as plasma, but lacks the clotting factors (especially fib rinogen).

Lymphatic vessels

Lymphatic vessels consist of a, fine network of thin—walled vessels that drain into progressively larger and progressively thicker—walled collecting trunks. These ultimately drain, via the thoracic duct and right lymphatic duct, into the left and right subclavian veins at their angles of junction with the internal jugular veins, respectively. The lymphatics serve as a one—way (i. e., toward the heart) drainage sys tem for the return of tissue fluid and other diffusible substances, including plasma proteins, which constantly escape from the blood through capillaries. They are also important in serving as a conduit for channeling lymphocytes and antibodies produced in lymph nodes into the blood circulation.

Lymphatic capillaries consist of vessels lined with en—dothelial cells, which begin as blind—ended tubules or sac—cules in most tis sues of the body. Endothelium is attenuated and usually lacks a continuous basal lamina. Lymphatic vessels of large diameter resemble veins in their struc ture but lack a clear—cut separation between layers. Valves are more numerous in lymphatic vessels. Smooth muscle cells in the media layer engage in rhythmic contraction, pumping lymph toward the venous system. Smooth muscle is well—developed in large lymphatic ducts.

Circulation of lymph is slower than that of blood, but it is nonetheless an essential process. It has been estimated that in a single day, 50 % or more of the total circulating protein leaves the blood circulation at the capillary level and is recaptured by the lymphatics.

Distribution of lymphatics is ubiquitous with some notable excep tions, including epithelium, cartilage, bone, central nervous sys tem, and thymus.

New words

plasma – плазма

extracellular – внеклеточный

aqueous – водный

solution – раствор

proteins – белки

inorganic – неорганический

salts – соли

organic – органический

albumin – альбумин

globulins – глобулины

alpha – альфа

beta – бета

gamma – гамма

fibrinogen – фибриноген

lymphatic – лимфатический

vessel – сосуд

endothelium – эндотелий

circulation – кровообращение

lymph – лимфа

ubiquitous – вездесущий

notable – известный

21. Hematopoietic tissue. Erythropoiesis

Hematopoietic tissue is composed of reticular fibers and cells, blood vessels, and sinusoids (thin—walled blood channels). Myeloid, or blood cell—forming tissue, is found in the bone marrow and provides the stem cells that develop into erythrocytes, granulocytes, agranulocytes, and platelets. Red marrow is characterized by active hemato—poiesis; yellow bone marrow is inactive and contains mostly fat cells. In the human adult, hematopoiesis takes place in the mar row of the flat bones of the skull, ribs and sternum, the vertebral column, the pelvis, and the proximal ends of some long bones. Erythropoiesis is the process of RBC formation. Bone marrow stem cells (colony—forming units, CFUs) differentiate into proerythroblasts under the influence of the glycoprotein erythropoietin, which is produced by the kidney.

Proerythroblast is a large basophilic cell containing a large spherical euchromatic nucleus with prominent nucleoli.

Basophilic erythroblast is a strongly basophilic cell with nucleus that comprises approximately 75 % of its mass. Numerous cytoplasmic polyribosomes, condensed chro—matin, no visible nucleoli, and continued hemoglobin synthesis characteristics of this cell.

Polychromatophilic erythroblast is the last cell in this line undergoes mitotic divisions. Its nucleus comprises approximately 50 % of its mass and contains condensed chroma—tin which appears in a «checkerboard» pattern. The po—lychnsia of the cytoplasm is due to the increased quantity of acidophilic hemoglobin combined with the basophilia of cytoplasmic polyribosomes.

Normoblast (orthochromatophilic erythroblast) is a cell with a small heterochromatic nucleus that comprises ap proximately 25 % of its mass. It contains acidophilic cytoplasm because the large amount of hemoglobin and degenerating organelles. The pyknotic nucleus, which is no longer capable of division, is extruded from the cell.

Reticulocyte (polychromatophilic erythrocyte) is an immature acidophilic denucleated RBC, which still contains some ribosomes and mitochondria involved in the synthesis of a small quantity of hemoglobin. Approximately 1 % of the circulating RBCs are reticulocytes.

Erythrocyte is the mature acidophilic and denucleated RBC. Erythrocytes remain in the circulation approximately 120 days and are then recycled by the spleen, liver, and bone marrow.

New words

reticular – сетчатый

sinusoids – синусоиды

granulocytes – гранулоциты

agranulocytes – агранулоциты

active – активный

yellow – желтый

glycoprotein – гликопротеин

erythropoietin – эритропоэтин

amount – количество

hemoglobin – гемоглобин

degenerating – дегенерирующие

condensed – сжатый

22. Hematopoietic tissue

Granulopoiesis, thrombopoiesis

Granulopoiesis is the process of granulocyte formation. Bone marrow stem cells differentiate into all three types of granulocytes.

Myeloblast is a cell that has a large spherical nucleus containing delicate euchromatin and several nucleoli. It has a basophilic cytoplasm and no granules. Myeloblasts divide differentiate to form smaller promyelocytes.

Promyelocyte is a cell that contains a large spherical indented nucleus with coarse condensed chromatin. The cytoplasm is basophilic and contains peripheral azurophi—lic granules.

Myelocyte is the last cell in this series capable of division. The nucleus becomes increasingly heterochromatic with subsequent divisions. Specific granules arise from the Golgi apparatus, resulting in neutrophilic, eosinophilic, and basophilic myelocytes.

Metamyelocyte is a cell whose indented nucleus exhibits lobe formation that is characteristic of the neutrophil, eos—inophil, or basophil. The cytoplasm contains azurophilic granules and increasing numbers of specific granules. This cell does not divide. Granulocytes are the definitive cells that enter the blood. Neutrophilic granulocytes exhibit an intermediate stage called the band neutrophil. This is the first cell of this series to appear in the peripheral blood.

It has a nucleus shaped like a curved rod or band.

Bands normally constitute 0,5–2 % of peripheral WBCs; they subsequently mature into definitive neutrophils.

Agranulopoiesis is the process of lymphocyte and mono—cyte for mation. Lymphocytes develop from bone marrow stem cells (lymphoblasts). Cells develop in bone marrow and seed the secondary lymphoid organs (e. g., tonsils, lymph nodes, spleen). Stem cells for T cells come from bone marrow, develop in the thymus and, subsequently, seed the secondary lym phoid organs.

Promonocytes differentiate from bone marrow stem cells (monoblasts) and multiply to give rise to monocytes.

Monocytes spend only a short period of time in the marrow before being released into the bloodstream.

Monocytes are transported in the blood but are also found in connective tissues, body cavities and organs.

Outside the blood vessel wall, they are transformed into macrophages of the mononuclear phagocyte system.

Thrombopoiesis, or the formation of platelets, occurs in the red bone marrow.

Megakaryoblast is a large basophilic cell that contains a U—shaped or ovoid nucleus with prominent nucleoli. It is the last cell that undergoes mitosis.

Megakaryocytes are the largest of bone marrow cells, with diameters of 50 mm or greater. They undergo 4–5 nuclear divi sions without concomitant cytopla—smic division. As a result, the megakaryocyte is a cell with polylobulated, polyploid nucleus and abundant granules in its cytoplasm. As megakaryocyte maturation proceeds, «curtains» of platelet demarcation vesicles form in the cytoplasm. These vesicles coalesce, become tubular, and eventually form platelet demarcation membranes. These membranes fuse to give rise to the membranes of the platelets.

A single megakaryocyte can shed (i. e., produce) up to 3,500 platelets.

New words

capable – способный

spherical – сферический

indented – зазубренный

chromatin – хроматин

23. Arteries

Arteries are classified according to their size, the appearance of their tunica media, or their major function.

Large elastic conducting arteries include the aorta and its large branches. Unstained, they appear yellow due to their high con tent of elastin.

The tunica intima is composed of endothelium and a thin sub jacent connective tissue layer. An internal elastic membrane marks the boundary between the intima and media.

The tunica media is extremely thick in large arteries and con sists of circularly organized, fenestrated sheets of elastic tissue with interspersed smooth muscle cells. These cells are responsi ble for producing elastin and other extracellular matrix com ponents. The outermost elastin sheet is considered as the external elastic membrane, which marks the boundary between the media and the tunica adventitia.

The tunica adventitia is a longitudinally oriented collection of collagenous bundles and delicate elastic fibers with associated fibroblasts. Large blood vessels have their own blood supply (vasa vasorum), which consists of small vessels that branch profusely in the walls of larger arteries and veins. Muscular distributing arteries are medium—sized vessels that are characterized by their predominance of circularly arranged smooth muscle cells in the media interspersed with a few elastin compo nents. Up to 40 layers of smooth muscle may occur. Both internal and external elastic limiting membranes are clearly demonstrated. The intima is thinner than that of the large arteries.

Arterioles are the smallest components of the arterial tree. Generally, any artery less than 0,5 mm in diameter is considered to be a small artery or arteriole. A suben—dothelial layer and the inter nal elastic membrane may be present in the largest of these vessels but are absent in the smaller ones. The media is composed of sev eral smooth muscle cell layers, and the adventitia is poorly devel oped. An external elastic membrane is absent.

New words

endothelium – эндотелий

media – средняя

arteries – артерии

to be classified – классифицированный

according – соответственно

their – их

size – размер

appearance – вид

tunica – оболочка

major – главный

elastic – эластичный

conducting – проведение

arteries – артерии

to include – включать

aorta – аорта

branches – ветви

up to – до

layers – слои

smooth – гладкий

may – может

infima – внутренняя полость артерии