clinical sign

• 臨床徴候、臨床症候、臨床症状

関

clinical manifestation、clinical observation、clinical presentation、clinical symptom

WordNet

1. place signs, as along a road; "sign an intersection"; "This road has been signed"
2. (medicine) any objective evidence of the presence of a disorder or disease; "there were no signs of asphyxiation"
3. a perceptible indication of something not immediately apparent (as a visible clue that something has happened); "he showed signs of strain"; "they welcomed the signs of spring" (同)mark
4. a character indicating a relation between quantities; "dont forget the minus sign"
5. a fundamental linguistic unit linking a signifier to that which is signified; "The bond between the signifier and the signified is arbitrary"--de Saussure
6. a gesture that is part of a sign language
7. a public display of a message; "he posted signs in all the shop windows"
8. engage by written agreement; "They signed two new pitchers for the next season" (同)contract, sign on, sign_up
9. approve and express assent, responsibility, or obligation; "All parties ratified the peace treaty"; "Have you signed your contract yet?" (同)ratify
10. communicate silently and non-verbally by signals or signs; "He signed his disapproval with a dismissive hand gesture"; "The diner signaled the waiters to bring the menu" (同)signal, signalize, signalise
11. mark with ones signature; write ones name (on); "She signed the letter and sent it off"; "Please sign here" (同)subscribe
12. be engaged by a written agreement; "He signed to play the casino on Dec. 18"; "The soprano signed to sing the new opera"
13. communicate in sign language; "I dont know how to sign, so I could not communicate with my deaf cousin"
14. a healthcare facility for outpatient care
15. a medical establishment run by a group of medical specialists
16. meeting for diagnosis of problems and instruction or remedial work in a particular activity
17. scientifically detached; unemotional; "he spoke in the clipped clinical monotones typical of police testimony"
18. relating to a clinic or conducted in or as if in a clinic and depending on direct observation of patients; "clinical observation"; "clinical case study"
19. having a handwritten signature; "a signed letter"

PrepTutorEJDIC

1. (ある事実・状態・感情などの)『表れ』,印,気配,徴侯(indication);(…の)こん跡,計跡《+『of』+『名』》・『身ぶり』,手まね,合図 / 『標識』,看板 / (数学・音楽などの)記号 / (…の)『象徴』,シンボル(symbol)《+『of』+『名』》・《文》(…の)『前兆』,きざし《+『of』+『名』》・宮(きゅう)(黄道12区分の一つ) ・〈手紙・書類・作品など〉‘に'『署名する』・(…に)〈名前など〉‘を'書く《+『名』+『on』(『to』)+『名』》 / …‘を'雇う契約に署名する・…‘を'合図する,知らせる;…に合図する・署名する・契約書に署名して雇われる
2. 〈U〉(医学の)臨床講義 / 〈C〉《集合的に》臨床講義のクラス / 〈C〉臨床講義室 / 〈C〉(病院・医科大学・社会事業団などに付属した)診療所;《形容詞を判って》医療施設,病院 / 〈C〉(警察・学校・社会事業団などに付属した)相談所
3. 臨床の,臨床講義の / 病床の / 臨床的な,客観的な態度の
4. =ti

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/28 19:43:45」(JST)

wiki en

[Wiki en表示]

A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient. For example, whereas paresthesia is a symptom (only the person experiencing it can directly observe their own tingling feeling), erythema is a sign (anyone can confirm that the skin is redder than usual). Symptoms and signs are often nonspecific, but often combinations of them are at least suggestive of certain diagnoses, helping to narrow down what may be wrong. In other cases they are specific even to the point of being pathognomonic.

Some signs may have no meaning to the patient, and may even go unnoticed, but may be meaningful and significant to the healthcare provider in assisting diagnosis.

Examples of signs include elevated blood pressure, a clubbing of the fingers (which may be a sign of lung disease, or many other things), and arcus senilis.

The term sign is not to be confused with the term indication, which denotes a valid reason for using some treatment.

Signs and semiotics

The art of interpreting clinical signs was originally called semiotics (a term now used for the study of sign communication in general) in English. This term, then written semeiotics (derived from the Greek adjective σημειωτικός: semeiotikos, "to do with signs"), was first used in English in 1670 by Henry Stubbes (1631–1676), to denote the branch of medical science relating to the interpretation of signs:

…nor is there any thing to be relied upon in Physick, but an exact knowledge of medicinal phisiology (founded on observation, not principles), semeiotics, method of curing, and tried (not excogitated, not commanding) medicines….

Eponymous signs

Main article: List of eponymous medical signs

Historically, medical signs were named after the physicians who first described them.

Signs versus symptoms

Signs are different from symptoms, the subjective experiences, such as fatigue, that patients might report to their examining physician.

For convenience, signs are commonly distinguished from symptoms as follows: Both are something abnormal, relevant to a potential medical condition, but a symptom is experienced and reported by the patient, while a sign is discovered by the physician during examination or by a clinical scientist by means of an in vitro examination of the patient.

A slightly different definition views signs as any indication of a medical condition that can be objectively observed (i.e., by someone other than the patient), whereas a symptom is merely any manifestation of a condition that is apparent to the patient (i.e., something consciously affecting the patient). From this definition, it can be said that an asymptomatic patient is uninhibited by disease. However, a doctor may discover the sign hypertension in an asymptomatic patient, who does not experience "dis-ease", and the sign indicates a disease state that poses a hazard to the patient. With this set of definitions, there is some overlap – certain things may qualify as both a sign and a symptom (e.g., a bloody nose).

Lester S. King, author of Medical Thinking, argues that an "essential feature" of a sign is that there is both a sign [or "signifier"] and a "thing signified". And, because "the essence of a sign is to convey information", it can only be a sign, properly speaking, if it has meaning. Therefore, "a sign ceases to be a sign when you cannot read it". A person, who has and exercises the knowledge required to understand the significance or indication or meaning of the sign, is necessary for something to be a complete sign. A physical phenomenon that is not actually interpreted as a sign pointing to something else is, in medicine, merely a symptom. Thus, King rejects "these present-day views [distinguishing signs from symptoms based on patient-subjective versus clinician-objective], however widely accepted, as quite faulty, at variance not only with ordinary usage but with the entire history of medicine."

Types of signs

Medical signs may be classified by the type of inference that may be made from their presence, for example:

• Prognostic signs (from progignṓskein, προγιγνώσκειν, "to know beforehand"): signs that indicate the outcome of the current bodily state of the patient (i.e., rather than indicating the name of the disease). Prognostic signs always point to the future. Perhaps the most famous prognostic sign is the facies Hippocratica:

"[If the patient's facial] appearance may be described thus: the nose sharp, the eyes sunken, the temples fallen in, the ears cold and drawn in and their lobes distorted, the skin of the face hard, stretched and dry, and the colour of the face pale or dusky.… and if there is no improvement within [a prescribed period of time], it must be realized that this sign portends death."

• Anamnestic signs (from anamnēstikós, ἀναμνηστικός, "able to recall to mind"): signs that (taking into account the current state of a patient's body), indicate the past existence of a certain disease or condition. Anamnestic signs always point to the past. (Whenever we see a man walking with a particular gait, with one arm paralysed in a particular way, we say "This man has had a stroke"; and, if we see a woman in her late 50s with one arm distorted in a particular way, we say "She had polio as a child".)

• Diagnostic signs (from diagnōstikós, διαγνωστικός, "able to distinguish"): signs that lead to the recognition and identification of a disease (i.e., they indicate the name of the disease).

• Pathognomonic signs (from pathognomonikós, παθογνωμονικός, "skilled in diagnosis", derived from páthos, πάθος, "suffering, disease", and gnṓmon, γνώμον, "judge, indicator"): the particular signs whose presence means, beyond any doubt, that a particular disease is present. They represent a marked intensification of a diagnostic sign. (An example would be the palmar xanthomata seen on the hands of people suffering from hyperlipoproteinaemia.) Singular pathognomonic signs are relatively uncommon.

"[Thus] a symptom is a phenomenon, caused by an illness and observable directly in experience. We may speak of it as a manifestation of illness. When the observer reflects on that phenomenon and uses it as a base for further inferences, then that symptom is transformed into a sign. As a sign it points beyond itself — perhaps to the present illness, or to the past or to the future. That to which a sign points is part of its meaning, which may be rich and complex, or scanty, or any gradation in between. In medicine, then, a sign is thus a phenomenon from which we may get a message, a message that tells us something about the patient or the disease. A phenomenon or observation that does not convey a message is not a sign. The distinction between signs and symptom rests on the meaning, and this is not perceived but inferred."

Technological development creating signs detectable only by physicians

Prior to the nineteenth century there was little difference in the powers of observation between physician and patient. Most medical practice was conducted as a joint co-operative interaction between the physician and his aristocratic patient as equals; this was gradually replaced by a "monolithic consensus of opinion imposed from within the community of medical investigators". Whilst each noticed much the same things, the physician had a more informed interpretation of those things: "the physicians knew what the findings meant and the layman did not".

Advances in the 19th century

However, the patient was gradually removed from the medical interaction due to significant technological advances such as:

• The 1808 introduction of the percussion technique:

“ "The process through which "the physician can assess the state of the underlying lung by sensing the character of vibrations by gentle taps on the chest wall [something which] greatly facilitated the diagnosis of pneumonia and other respiratory diseases" ”

The techniques, which had been first described by the Viennese physician Leopold Auenbrugger (1722–1809) in 1761, became far more widely known following the publication of Jean-Nicolas Corvisart's translation of Auenbrugger's work in 1808.

• The 1819 introduction by René Laennec (1781–1826) of the technique of auscultation (using a stethoscope to listen to the circulatory and respiratory functions of the body). Laennec's publication was translated into English, 1821–1834, by John Forbes.

• The 1846 introduction by surgeon John Hutchinson (1811–1861) of the spirometer, an apparatus for assessing the mechanical properties of the lungs via measurements of forced exhalation and forced inhalation. (The recorded lung volumes and air flow rates are used to distinguish between restrictive disease (in which the lung volumes are decreased: e.g., cystic fibrosis) and obstructive diseases (in which the lung volume is normal but the air flow rate is impeded; e.g., emphysema).)

• The 1851 invention by Hermann von Helmholtz (1821–1894) of the ophthalmoscope, which allowed physicians to examine the inside of the human eye.

• The (c.1870) immediate widespread clinical use of Sir Thomas Clifford Allbutt's (1836-1925) six inch (rather than twelve inch) pocket clinical thermometer, which he had devised in 1867.

• The 1895 clinical use of X-rays which began almost immediately after they had been discovered that year by Wilhelm Conrad Röntgen (1845–1923).

• The 1896 introduction of the sphygmomanometer, designed by Scipione Riva-Rocci (1863–1937), to measure blood pressure.

Alteration of the relationship between physician and patient

The introduction of the techniques of percussion and auscultation into medical practice altered the relationship between physician and patient in a very significant way, specifically because these techniques relied almost entirely upon the physician listening to the sounds of the patients body.

Not only did this development greatly reduce the patient's capacity to observe and contribute to the process of diagnosis, it also meant that the patient was often instructed to stop talking, and remain silent.

As these sorts of evolutionary changes continued to take place in medical practice, it was increasingly necessary to uniquely identify data that was accessible only to the physician, and to be able to differentiate those observations from others that were also available to the patient, and it just seemed natural to use "signs" for the class of physician-specific data, and "symptoms" for the class of observations available to the patient.

King proposes a more advanced notion; namely, that a sign is something that has meaning, regardless of whether it is observed by the physician or reported by the patient:

The belief that a symptom is a subjective report of the patient, while a sign is something that the physician elicits, is a 20th-century product that contravenes the usage of two thousand years of medicine. In practice, now as always, the physician makes his judgments from the information that he gathers. The modern usage of signs and symptoms emphasizes merely the source of the information, which is not really too important. Far more important is the use that the information serves. If the data, however derived, lead to some inferences and go beyond themselves, those data are signs. If, however, the data remain as mere observations without interpretation, they are symptoms, regardless of their source. Symptoms become signs when they lead to an interpretation. The distinction between information and inference underlies all medical thinking and should be preserved.

Signs as tests

In some senses, the process of diagnosis is always a matter of assessing the likelihood that a given condition is present in the patient. In a patient who presents with haemoptysis (coughing up blood), the haemoptysis is very much more likely to be caused by respiratory disease than by the patient having broken their toe. Each question in the history taking allows the medical practitioner to narrow down their view of the cause of the symptom, testing and building up their hypotheses as they go along.

Examination, which is essentially looking for clinical signs, allows the medical practitioner to see if there is evidence in the patient's body to support their hypotheses about the disease that might be present.

A patient who has given a good story to support a diagnosis of tuberculosis might be found, on examination, to show signs that lead the practitioner away from that diagnosis and more towards sarcoidosis, for example. Examination for signs tests the practitioner's hypotheses, and each time a sign is found that supports a given diagnosis, that diagnosis becomes more likely.

Special tests (blood tests, radiology, scans, a biopsy, etc.) also allow a hypothesis to be tested. These special tests are also said to show signs in a clinical sense. Again, a test can be considered pathognonomic for a given disease, but in that case the test is generally said to be "diagnostic" of that disease rather than pathognonomic. An example would be a history of a fall from a height, followed by a lot of pain in the leg. The signs (a swollen, tender, distorted lower leg) are only very strongly suggestive of a fracture; it might not actually be broken, and even if it is, the particular kind of fracture and its degree of dislocation need to be known, so the practitioner orders an x-ray. The x-ray film shows a fractured tibia, so the film is said to be diagnostic of the fracture.

Examples of signs

• Ascites
• Clubbing (deformed nails)
• Cough
• Death rattle (last moments of life in a person/animal)
• Fever

• Gynecomastia (excessive breast tissue in males)
• Hemoptysis (blood-stained sputum)
• Hepatosplenomegaly (enlarged liver and spleen)
• Icterus ("jaundice")
• Lymphadenopathy (swollen lymph nodes)
• Palmar erythema (reddening of hands)
• Splenomegaly (enlarged spleen)

See also

• Symptom
• Stethoscope
• Radiologic sign
• neurological sign

References

External links

• Who Named It?[1]: eponymous signs.

UpToDate Contents

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English Journal

• Upper-Extremity Transplantation Using a Cell-Based Protocol to Minimize Immunosuppression.

• Schneeberger S, Gorantla VS, Brandacher G, Zeevi A, Demetris AJ, Lunz JG, Metes DM, Donnenberg AD, Shores JT, Dimartini AF, Kiss JE, Imbriglia JE, Azari K, Goitz RJ, Manders EK, Nguyen VT, Cooney DS, Wachtman GS, Keith JD, Fletcher DR, Macedo C, Planinsic R, Losee JE, Shapiro R, Starzl TE, Lee WP.Source*Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA †Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD ‡Department of Pathology, University of Pittsburgh, Pittsburgh, PA §Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA ‖Department of Medicine, University of Pittsburgh, Pittsburgh, PA ¶Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA **Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA ††Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA ‡‡Department of Orthopedic Surgery and Division of Plastic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA §§Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA ‖‖Division of Transplant Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA ¶¶These authors contributed equally to the study ***These authors are currently also affiliated with the Department of General, Transplant and Thoracic Surgery, Center for Operative Medicine, Innsbruck Medical University, Innsbruck, Austria.
• Annals of surgery.Ann Surg.2013 Feb;257(2):345-351.
• OBJECTIVE:: To minimize maintenance immunosuppression in upper-extremity transplantation to favor the risk-benefit balance of this procedure. BACKGROUND:: Despite favorable outcomes, broad clinical application of reconstructive transplantation is limited by the risks and side effects of multidrug im
• PMID 23001085

• Radiological evaluation of single implants in maxillary anterior sites with special emphasis on their relation to adjacent teeth - a 3-year follow-up study.

• Vilhjálmsson VH, Klock KS, Størksen K, Bårdsen A.SourceDepartment of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
• Dental traumatology : official publication of International Association for Dental Traumatology.Dent Traumatol.2013 Feb;29(1):66-72. doi: 10.1111/j.1600-9657.2012.01155.x. Epub 2012 Jun 19.
• AIM: The aim of this study was to measure, in adults, changes in crest bone level around single dental implants in the anterior maxilla and continuous eruption of adjacent teeth.MATERIAL AND METHODS: In this prospective study, 50 patients received single-implant-supported crowns in the maxillary ant
• PMID 22712441

• A urinary peptide biomarker set predicts worsening of albuminuria in type 2 diabetes mellitus.

• Roscioni SS, de Zeeuw D, Hellemons ME, Mischak H, Zürbig P, Bakker SJ, Gansevoort RT, Reinhard H, Persson F, Lajer M, Rossing P, Heerspink HJ.SourceDepartment of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan, 1, 9713 AV, Groningen, the Netherlands, s.s.roscioni@umcg.nl.
• Diabetologia.Diabetologia.2013 Feb;56(2):259-67. doi: 10.1007/s00125-012-2755-2. Epub 2012 Oct 20.
• AIMS/HYPOTHESIS: Microalbuminuria is considered the first clinical sign of kidney dysfunction and is associated with a poor renal and cardiovascular prognosis in type 2 diabetes. Detection of patients who are prone to develop micro- or macroalbuminuria may represent an effective strategy to start or
• PMID 23086559

Japanese Journal

• Difference in fine specificity to polysaccharides of Candida albicans mannoprotein between mouse SIGNR1 and human DC-SIGN.

• Takahara Kazuhiko,Arita Takuya,Tokieda Sumika,Shibata Nobuyuki,Okawa Yoshio,Tateno Hiroaki,Hirabayashi Jun,Inaba Kayo
• Infection and immunity 80(5), 1699-1706, 2012-05
• … C-type lectin SIGNR1 directly recognizes Candida albicans and zymosan and has been considered to share properties of polysaccharide recognition with human DC-SIGN (hDC-SIGN). … However, the precise specificity of SIGNR1 and the difference from that of hDC-SIGN remain to be elucidated. … We prepared soluble forms of SIGNR1 and hDC-SIGN and conducted experiments to examine their respective specificities. …
• NAID 120004161058

• 歯科患者ロボット-安静時呼気機能の開発-

• 大久保 則男,高信 英明,鈴木 健司,三浦 宏文,槇 宏太郎,宮崎 芳和,間所 睦,丹澤 豪,高本 陽一,宮本 賢一,石井 佑典,沖野 明久,高西 淳夫
• 工学院大学研究報告 (112), 7-13, 2012-04-30
• … Therefore the present study aims at developing a patient-robot for use in an actual clinical training. … However, there has been little study done concerning a sign of ill-health. …
• NAID 110009001907

Related Links

• wn.com

wn.com

• A Clinical Sign of Canal Paresis - JAMA Network | JAMA ...

• Unilateral loss of horizontal semicircular canal function, termed canal paresis, is an important finding in dizzy patients. To our knowledge, apart from head-shaking nystagmus, no clinical sign of canal paresis has yet been described ...

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★リンクテーブル★

リンク元	「clinical manifestation」「臨床症状」「clinical observation」「clinical symptom」「clinical presentation」
関連記事	「sign」「clinical」「clinic」

「clinical manifestation」

　　[★]

manifestation

• 臨床症状、臨床所見、臨床像、臨床病態

関

clinical finding、clinical impression、clinical observation、clinical phenotype、clinical presentation、clinical sign、clinical symptom

「臨床症状」

　　[★]

英

clinical manifestation、clinical presentation、clinical sign、clinical symptom、clinical observation

関

臨床像、臨床所見、臨床病態、臨床症候、臨床知見、臨床徴候

「clinical observation」

　　[★]

• 臨床所見、臨床知見、臨床症状

関

clinical finding、clinical impression、clinical manifestation、clinical presentation、clinical sign、clinical symptom

「clinical symptom」

　　[★]

• 臨床症状、臨床像、臨床症候

関

clinical manifestation、clinical observation、clinical phenotype、clinical presentation、clinical sign

「clinical presentation」

　　[★]

• 臨床症状、臨床像

関

clinical manifestation、clinical observation、clinical phenotype、clinical sign、clinical symptom

「sign」

　　[★]

• n.

• 徴候、兆候、サイン、(数学)符号

関

indication、manifestation、signature、stigma、stigmata、symptom、symptomatic

　 　 　 　 　 　 　 　 　 　 　 　 　 　

「clinical」

　　[★]

• adj.

• 臨床の、臨床的な、臨床上の、クリニカル

関

clin、clinically

　 　 　

「clinic」

　　[★]

• n.

• クリニック、臨床講義、診療所