ミュラー徴候
WordNet
- place signs, as along a road; "sign an intersection"; "This road has been signed"
- (medicine) any objective evidence of the presence of a disorder or disease; "there were no signs of asphyxiation"
- 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
- a character indicating a relation between quantities; "dont forget the minus sign"
- a fundamental linguistic unit linking a signifier to that which is signified; "The bond between the signifier and the signified is arbitrary"--de Saussure
- a gesture that is part of a sign language
- a public display of a message; "he posted signs in all the shop windows"
- engage by written agreement; "They signed two new pitchers for the next season" (同)contract, sign on, sign_up
- approve and express assent, responsibility, or obligation; "All parties ratified the peace treaty"; "Have you signed your contract yet?" (同)ratify
- 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
- mark with ones signature; write ones name (on); "She signed the letter and sent it off"; "Please sign here" (同)subscribe
- be engaged by a written agreement; "He signed to play the casino on Dec. 18"; "The soprano signed to sing the new opera"
- communicate in sign language; "I dont know how to sign, so I could not communicate with my deaf cousin"
- United States geneticist who studied the effects of X-rays on genes (1890-1967) (同)Hermann Joseph Muller
- German mathematician and astronomer (1436-1476) (同)Johann Muller, Regiomontanus
- German physiologist and anatomist (1801-1858) (同)Johannes Peter Muller
- Swiss physicist who studied superconductivity (born in 1927) (同)Karl Alex Muller
- British philologist (born in Germany) who specialized in Sanskrit (1823-1900) (同)Max Muller, Friedrich Max Muller
- Swiss chemist who synthesized DDT and discovered its use as an insecticide (1899-1965) (同)Paul Hermann Muller
- an island in western Scotland in the Inner Hebrides
- having a handwritten signature; "a signed letter"
- a vessel in which wine is mulled
PrepTutorEJDIC
- (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
UpToDate Contents
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English Journal
- Investigation of the unidirectional spin heat conveyer effect in a 200 nm thin Yttrium Iron Garnet film.
- Wid O1, Bauer J2, Müller A1, Breitenstein O2, Parkin SS2, Schmidt G1,3.
- Scientific reports.Sci Rep.2016 Jun 17;6:28233. doi: 10.1038/srep28233.
- We have investigated the unidirectional spin wave heat conveyer effect in sub-micron thick yttrium iron garnet (YIG) films using lock-in thermography (LIT). Although the effect is small in thin layers this technique allows us to observe asymmetric heat transport by magnons which leads to asymmetric
- PMID 27311931
- Can dental panoramic radiographic findings serve as indicators for the development of medication-related osteonecrosis of the jaw?
- Klingelhöffer C1, Klingelhöffer M1, Müller S1, Ettl T1, Wahlmann U1.
- Dento maxillo facial radiology.Dentomaxillofac Radiol.2016;45(5):20160065. doi: 10.1259/dmfr.20160065. Epub 2016 May 23.
- OBJECTIVES: The purpose of this case-control study was to find a correlation between certain imaging findings in dental panoramic radiographs and the risk for developing a medication-related osteonecrosis of the jaw (MRONJ) in patients taking antiresorptive therapy (AT).METHODS: Randomized and blind
- PMID 27213837
- Testicular prostheses in children: Is earlier better?
- Peycelon M1, Rossignol G1, Muller CO1, Carricaburu E1, Philippe-Chomette P1, Paye-Jaouen A1, El Ghoneimi A2.
- Journal of pediatric urology.J Pediatr Urol.2016 May 20. pii: S1477-5131(16)30050-X. doi: 10.1016/j.jpurol.2016.04.022. [Epub ahead of print]
- INTRODUCTION: The absence of a testis occurs for various reasons in children, but testicular prosthesis implantation in children is uncommon. The optimal time for prosthesis placement is still unclear, and its complication rate has been poorly studied in children.OBJECTIVE: The aim of this study was
- PMID 27264050
Japanese Journal
- NOVEL LEAD STRUCTURES AND FEED-THROUGH COMPUTATION OF MULTIPLE MR/SINGLE-POLE HEADS FOR PERPENDICULAR RECORDING
- CHEN Horng-Shiong,INDECK R. S.,MULLER M. W.
- 日本応用磁気学会誌 18(S_1_PMRC_94_1), S1_209-212, 1994
- … The sign as well as the magnitude of the mutual inductance between lead pairs depends on their relative displacement. …
- NAID 130004924516
Related Links
- Müller's sign is the pulsation or bobbing of the uvula that occurs during systole. It can be seen in patients with severe aortic insufficiency. Müller's sign is caused by an increased stroke volume. Müller's sign is named for Friedrich von Müller, ...
- Müller's sign is the pulsation, or bob- bing, of the uvula during systole, infrequently seen with severe or sudden-onset aortic regurgitation. In this patient, the pulsation extended to the soft palate and poste- rior oropharynx. Like many of the other ...
★リンクテーブル★
[★]
- 日本では、英語表記ではaortic regurgitation AR、日本語表記では「大動脈弁閉鎖不全症」とするのが一般的?
- 同
- 大動脈弁閉鎖不全症 大動脈弁閉鎖不全 aortic valve insufficiency, AI
- 同
- 大動脈弁逆流症 大動脈弁逆流 aortic regurgitation AR, aortic valve regurgitation
- 関
- 弁膜症
[show details]
概念
- 大動脈弁の閉鎖不全により、拡張期に大動脈の血液が左心室に逆流する病態。
- 左室の容量負荷が特徴
身体所見
聴診
- 参考6
- S1:soft
- S2:variable
- A2:soft~absent
- P2:normal
- S3:左心機能が落ちれば聴取される
- 拡張期逆流性雑音 = 拡張期灌水様雑音 = blowing murmur in early diastole along the left sternal border
- 最強点:3LSB。
- 持続時間:軽症・急性型では持続時間は短い。
- 音量は一定かだんだん小さくなる(decrescendo)
- 重症度と音量は相関しないが、雑音の持続時間は参考になる。軽症では拡張期の初期にのみ吹くような(blowing)音が聴取される。重症になるにつれだんだん伸びていき、しまいには拡張期全体に聴取されるようになり、音は粗な音である(rougher)。
(参考6)
:::持続時間は重症度を反映しないが、軽度ARでは持続時間は短い(なぜ?)。また急性ARでも短いが、これは拡張期にすぐに大動脈と左心室の圧が均衡するからである(圧較差が小さいということか?)。(up2date)
- Austin Flint murmur:拡張期中期に低音を心尖で聴取。拡張期に大動脈弁から逆流してくる血液の乱流により、僧帽弁前尖が下方に押し下げられMS様の雑音を生じる。Austin Flint雑音はMSと違ってopening snapがなく、収縮期前期の雑音の増強がない。(PHD.214)
特徴的な身体所見 PHD.215
- 末梢の症状にトラウベ徴候、デュロジェ雑音、コリガン脈(water hammer pulse)があるが、これらは慢性ARでは特徴的だが、急性ARではほとんど見られない。急性ARではstroke volume and diastolic filling volumeが増えないためである(uptodate)
検査
心エコー
治療
外科治療
- 重症ARでありかつ症状がある場合 → 手術推奨
- 重症ARでありかつ症状が無い場合
- 左室機能低下(LVEF<50%)している場合 → 手術推奨
- 左室機能正常の場合
- 収縮終期左室径 LVESd>45mm の場合 → 手術推奨
- 収縮終期左室径 LVESd≦45mm の場合
- 拡張終期左室径 LVEDd>65mm の場合 → 手術推奨
- 拡張終期左室径 LVEDd≦65mm の場合
- 収縮終期左室径指数 >25mm/m^2 の場合 → 手術推奨
内科治療
-
- 目標:降圧(sBP<140mmHg)
- CCB, ACE-I/ARB
- β blockerは一回拍出量の増加に繋がり、sBPを上昇させうるのて好ましくない。
-
参考
http://www.mayoclinic.com/health/aortic-valve-regurgitation/ds00419
http://www.virtualmedicalcentre.com/diseases.asp?did=7
http://www.heart-valve-surgery.com/aortic-valve-regurgitation-symptoms.php
http://www.americanheart.org/presenter.jhtml?identifier=4448
http://www.patient.co.uk/health/Aortic-Regurgitation.htm
- 6. [charged] Pathophysiology and clinical features of chronic aortic regurgitation in adults - uptodate [1]
ガイドライン
- 1. 弁膜疾患の非薬物治療に関するガイドライン(2007年改訂版)
- http://www.j-circ.or.jp/guideline/pdf/JCS2007_matsuda_h.pdf
- https://www.j-circ.or.jp/old/guideline/pdf/JCS2020_Izumi_Eishi.pdf
国試
[★]
- 英
- Müller's sign, Müller sign, Muller's sign, Muller sign
- 関
- 大動脈弁閉鎖不全症
参考
[★]
- 関
- indication、manifestation、signature、stigma、stigmata、symptom、symptomatic
[★]
ミュラー、ミューラー
- 関
- Mueller