cherry

サクランボ

関

almond、apricot、peach、plum、Prunus、Prunus persica

　 　 　 　

WordNet

1. any of numerous trees and shrubs producing a small fleshy round fruit with a single hard stone; many also produce a valuable hardwood (同)cherry_tree
2. wood of any of various cherry trees especially the black cherry
3. a red fruit with a single hard stone
4. any of several trees producing edible oval fruit having a smooth skin and a single hard stone (同)plum tree
5. a highly desirable position or assignment; "a political plum"
6. any of numerous varieties of small to medium-sized round or oval fruit having a smooth skin and a single pit
7. cultivated in temperate regions (同)peach tree, Prunus_persica
8. downy juicy fruit with sweet yellowish or whitish flesh
9. small bushy deciduous tree native to Asia and North Africa having pretty pink blossoms and highly prized edible nuts enclosed in a hard green hull; cultivated in southern Australia and California (同)sweet almond, Prunus dulcis, Prunus_amygdalus, Amygdalus communis
10. oval-shaped edible seed of the almond tree
11. Asian tree having clusters of usually white blossoms and edible fruit resembling the peach (同)apricot tree
12. downy yellow to rosy-colored fruit resembling a small peach
13. small flowering evergreen tree of southern United States (同)laurel cherry, mock_orange, wild orange, Prunus caroliniana
14. dark red or blackish sweet cherry

PrepTutorEJDIC

1. 〈C〉『サクランボ』 / 〈C〉『サクラの木』 / 〈U〉サクラ材 / 〈U〉サクラ色 / サクラ色の
2. 〈C〉『西洋スモモ』;西洋スモモの木 / 〈C〉(プティング・パイなどに入れる)干しぶどう / 〈U〉(西洋スモモに似た)濃紫色 / 〈C〉《話》(人が)手に入れたがるもの(もうけ仕事など) / 濃紫色の,スモモ色した
3. 〈C〉『モモ』(『桃』) / 〈C〉桃の木 / 〈U〉黄色がかった桃色 / 〈C〉《a ~》《話》すてきなもの;かわいい娘 / 黄色がかった桃色の
4. (共犯者・仲間などを)密告する,裏切る《+『against』(『on, upon』)+『名』》 / …‘を'裏切る
5. アーモンドの木(実)(その果実の核の中に仁(じん)は食用される)
6. 〈C〉アンズ;アンズの木 / 〈U〉アンズ色 / アンズ色の,黄赤色の
7. サクラの木

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/30 16:05:40」(JST)

wiki ja

[Wiki ja表示]

チェリー、Cherry

• 植物のサクランボのこと。また、サクラの木そのものも指す。
• 英語の俗語ではバージンまたは肛門性交経験のない同性愛者の意味。そういう系統では、日本においては主に童貞の意味で使用され、処女はバージンなど。男がバージン、女がチェリーの場合も言葉としてはありうる。
• チェリー (パチスロ) - パチスロにおいて1リールで払い出しが確定する小役の総称。サクランボが絵柄に用いられることが多いことから。

企業

• （Chery）中国の自動車メーカー、奇瑞汽車の英語名。
• ドイツのキーボード会社の2008年までの名。現在の社名はZF Electronics

商品名

• チェリー (たばこ) - 日本たばこ産業（JT）から発売されていた紙巻きたばこの銘柄の一つ（以前にも同名異種のたばこが存在）。
• 日産・チェリー - かつて、日産自動車から生産・販売されていた乗用車の商品名の一つ。

人物

• （Cherry）男性ボーカルグループBaby Booのリードボーカルの名前。
• チェリー (プロレスラー) - ユニオンプロレス所属の女子プロレスラー。
• チェリー (歌手) - NICE GIRL プロジェクト!所属メンバー。
• Cherry (モデル) - 女性ファッション誌「GLITTER」専属モデル。
• ドン・チェリー - アメリカのジャズトランペット奏者。ネナ・チェリーは養子。
• ネナ・チェリー - スウェーデンの歌手。
• ロッキー・チェリー - メジャーリーグの投手。
• 荒井チェリー - 日本の漫画家。代表作『未確認で進行形』など。

地名

• チェリー郡 (ネブラスカ州) - アメリカネブラスカ州の郡。

作品

• 『チェリー (曲)』 -　日本のロックバンド、スピッツの曲。
• 『CHE.R.RY』 - YUIの曲。
• 『チェリー (窪之内英策)』 - 窪之内英策の漫画作品。
• 『チェリー (小沢としお)』 - 小沢としおの漫画作品。
• 『CHERRY (漫画)』 - 筒井旭の漫画作品。

関連項目

• さくらんぼ (曖昧さ回避)

このページは曖昧さ回避のためのページです。一つの語句が複数の意味・職能を有する場合の水先案内のために、異なる用法を一覧にしてあります。お探しの用語に一番近い記事を選んで下さい。このページへリンクしているページを見つけたら、リンクを適切な項目に張り替えて下さい。

wiki en

[Wiki en表示]

This article is about the fruit. For other uses, see Cherry (disambiguation).

"Wild cherry" redirects here. For the species called "wild cherry" in the British Isles, see Prunus avium. For other uses, see Wild Cherry.

"Cherry tree" redirects here. For story about George Washington's honesty, see Parson Weems#The cherry-tree anecdote.

Prunus avium, sweet cherry, also called wild cherry

The cherry is the fruit of many plants of the genus Prunus, and is a fleshy drupe (stone fruit). The cherry fruits of commerce are usually obtained from a limited number of species such as cultivars of the sweet cherry, Prunus avium. The name 'cherry' also refers to the cherry tree, and is sometimes applied to almonds and visually similar flowering trees in the genus Prunus, as in "ornamental cherry", "cherry blossom", etc. Wild Cherry may refer to any of the cherry species growing outside of cultivation, although Prunus avium is often referred to specifically by the name "wild cherry" in the British Isles.

Botany

Prunus padus, bird cherry

Many cherries are members of the subgenus Cerasus, which is distinguished by having the flowers in small corymbs of several together (not singly, nor in racemes), and by having smooth fruit with only a weak groove or none along one side. The subgenus is native to the temperate regions of the Northern Hemisphere, with two species in America, three in Europe, and the remainder in Asia. Other cherry fruits are members of subgenus Padus. Cherry trees with low exposure to light tend to have a bigger leaf size so they can intercept all light possible. Cherry trees with high exposure to light tend to have thicker leaves to concentrate light and have a higher photosynthetic capacity.

Most eating cherries are derived from either Prunus avium, the sweet cherry (also called the wild cherry), or from Prunus cerasus, the sour cherry.

History

Etymology and antiquity

The native range of the sweet cherry extends through most of Europe, western Asia and parts of northern Africa, and the fruit has been consumed throughout its range since prehistoric times. A cultivated cherry, as well as the apricot, is recorded as having been brought to Rome by Lucius Licinius Lucullus from northeastern Anatolia, also known as the Pontus region, historic Armenia, in 72 BC.

A form of cherry was introduced into England at Teynham, near Sittingbourne in Kent by order of Henry VIII, who had tasted them in Flanders.

The English word cherry, French cerise and Spanish cereza all come from the classical Greek (κέρασος) through the Latin cerasum, thus the ancient Greek place name Cerasus, today a city in northern Turkey Giresun from which the cherry was first exported to Europe.

Wildlife value

Cherry trees also provide food for the caterpillars of several Lepidoptera.

Cultivation

The cultivated forms are of the species sweet cherry (P. avium) to which most cherry cultivars belong, and the sour cherry (P. cerasus), which is used mainly for cooking. Both species originate in Europe and western Asia; they do not cross-pollinate. Some other species, although having edible fruit, are not grown extensively for consumption, except in northern regions where the two main species will not grow. Irrigation, spraying, labor, and their propensity to damage from rain and hail make cherries relatively expensive. Nonetheless, demand is high for the fruit. In commercial production, cherries are harvested by using a mechanized 'shaker'. Hand picking is also widely used to harvest the fruit to avoid damage to both fruit and trees.

Growing season

Cherries have a very short growing season and can grow in most temperate latitudes. The peak season for cherries is in the summer. In Australia and New Zealand they are usually at their peak in late December, in southern Europe in June, in North America in June, in south British Columbia (Canada) in July to mid-August and in the UK in mid-July. In many parts of North America, they are among the first tree fruits to ripen, while in Australia and New Zealand cherries are widely associated with Christmas.

'Kordia' is an early variety which ripens during the beginning of December, 'Lapins peak' ripens near the end of December, and 'Sweethearts' finish slightly later in the Southern Hemisphere.

Like most temperate-latitude trees, cherry seeds require exposure to cold to germinate (a mechanism the tree evolved to prevent germination during the autumn, which would then result in the seedling being killed by winter temperatures). The pits are planted in the autumn (after first being chilled) and seedlings emerge in the spring. A cherry tree will take three to four years to produce its first crop of fruit, and seven years to attain full maturity. Because of the cold-weather requirement, none of the Prunus family can grow in tropical climates.

Cultivars

The following cultivars have gained the Royal Horticultural Society's Award of Garden Merit:

Name Size Ref. Accolade 64m² Amanogawa 32m² Autumnalis (P. × subhirtella) 64m² Autumnalis Rosea (P. × subhirtella) 32m² Avium Grandiflora see Plena Colorata (P. padus) 96m² Grandiflora see Plena Kanzan 100m²+ Kiku-shidare-zakura 16m²+ Kursar 64m² Morello (P. cerasus) 16m² Okamé (P. × incam) 96m² Pandora 96m² Pendula Rosea 16m²

Name Size Ref. Pendula Rubra 16m² Pink Perfection 64m² Plena (Grandiflora) 100m²+ Praecox (P. incisa) 64m² Prunus avium (sweet cherry) 120m²+ Prunus × cistena 2.5m² Prunus sargentii 100m²+ Prunus serrula (Tibetan cherry) 100m²+ Shirofugen 64m² Shirotai 64m² Shōgetsu 64m² Spire 96m² Stella 16m² Ukon 64m²+

Ornamental trees

See cherry blossom and Prunus.

Commercial production

Worldwide cherry yield

Annual world production (as of 2007) of cultivated cherry fruit is about two million tonnes. Around 40% of world production originates in Europe and around 13% in the United States.

Top Cherry Producing Nations - 2011
(in metric tons)

Rank	Country	Production
1	Turkey	438,550
2	United States	303,376
3	Iran	241,117
4	Italy	112,775
5	Spain	101,945
6	Austria	92,520
7	Uzbekistan	82,000
8	Romania	81,842
9	Russia	76,000
10	Ukraine	72,800
11	Syria	62,195
12	Chile	61,088
13	France	48,054
14	Greece	44,200
15	Poland	37,984
16	Germany	37,035
17	China	32,000
18	Bulgaria	30,063
19	Serbia	28,551
	World	2,196,000
Source: UN Food & Agriculture Organization

Eurasia

Cherries

Major commercial cherry orchards in West Asia and Europe are in Turkey (mainly Anatolia), Lebanon (Bekaa Valley), Syria (Golan Heights) , Israel (Northern Galilee), Italy and Spain, and to a smaller extent in the Baltic States and southern Scandinavia.

North America

In the United States, most sweet cherries are grown in Washington, California, Oregon, Wisconsin, and Michigan. Important sweet cherry cultivars include 'Bing', 'Brooks', 'Tulare', 'King', 'Sweetheart', and 'Rainier'. In addition, the 'Lambert' variety is grown on the eastern side of Flathead Lake in northwestern Montana. Both Oregon and Michigan provide light-colored 'Royal Ann' ('Napoleon'; alternately 'Queen Anne') cherries for the maraschino cherry process. Most sour (also called tart) cherries are grown in Michigan, followed by Utah, New York, and Washington. Sour cherries include 'Nanking' and 'Evans'. Traverse City, Michigan claims to be the "Cherry Capital of the World", hosting a National Cherry Festival and making the world's largest cherry pie. The specific region of northern Michigan known for tart cherry production is referred to as the "Traverse Bay" region.

Native and non-native sweet cherries grow well in Canada's provinces of Ontario and British Columbia where an annual cherry fiesta has been celebrated for 66 consecutive years (including 2014) in the Okanagan Valley town of Osoyoos. In addition to the Okanagan, other British Columbia cherry growing regions are the Similkameen Valley and Kootenay Valley, all three regions together producing 5.5 million kg annually or 60% of total Canadian output. Sweet cherry varieties in British Columbia include Rainier, Van, Chelan, Lapin, Sweetheart, Skeena, Staccato, Christalina and Bing.

Australia

In Australia, cherries are grown in all the states except for the Northern Territory. The major producing regions are located in the temperate areas within New South Wales, Victoria, South Australia and Tasmania. Western Australia has limited production in the elevated parts in southwest of the state. Key production areas include Young, Orange and Bathurst in New South Wales, Wandin, the Goulburn and Murray valley areas in Victoria, the Adelaide Hills region in South Australia, and the Huon and Derwent Valleys in Tasmania.

Key commercial varieties in order of seasonality include 'Empress', 'Merchant', 'Supreme', 'Ron's seedling', 'Chelan', 'Ulster', 'Van', 'Bing', 'Stella', 'Nordwunder', 'Lapins', 'Simone', 'Regina', 'Kordia' and 'Sweetheart'. New varieties are being introduced, including the late season 'Staccato' and early season 'Sequoia'. The Australian Cherry Breeding program is developing a series of new varieties which are under testing evaluation.

The New South Wales town of Young is called the "Cherry Capital of Australia" and hosts the National Cherry Festival.

Nutritional value

Cherries, sour, red, raw Nutritional value per 100 g (3.5 oz) Energy 209 kJ (50 kcal) Carbohydrates 12.2 g Sugars 8.5 g Dietary fiber 1.6 g Fat 0.3 g Protein 1 g Vitamins Vitamin A equiv. beta-carotene lutein zeaxanthin (8%) 64 μg (7%) 770 μg 85 μg Thiamine (B1) (3%) 0.03 mg Riboflavin (B2) (3%) 0.04 mg Niacin (B3) (3%) 0.4 mg Pantothenic acid (B5) (3%) 0.143 mg Vitamin B6 (3%) 0.044 mg Folate (B9) (2%) 8 μg Choline (1%) 6.1 mg Vitamin C (12%) 10 mg Vitamin K (2%) 2.1 μg Trace metals Calcium (2%) 16 mg Iron (2%) 0.32 mg Magnesium (3%) 9 mg Manganese (5%) 0.112 mg Phosphorus (2%) 15 mg Potassium (4%) 173 mg Sodium (0%) 3 mg Zinc (1%) 0.1 mg Link to USDA Database entry Units μg = micrograms • mg = milligrams IU = International units Percentages are roughly approximated using US recommendations for adults. Source: USDA Nutrient Database

Cherries, sweet, red, raw Nutritional value per 100 g (3.5 oz) Energy 263 kJ (63 kcal) Carbohydrates 16 g Sugars 12.8 g Dietary fiber 2.1 g Fat 0.2 g Protein 1.1 g Vitamins Vitamin A equiv. beta-carotene lutein zeaxanthin (0%) 3 μg (0%) 38 μg 85 μg Thiamine (B1) (2%) 0.027 mg Riboflavin (B2) (3%) 0.033 mg Niacin (B3) (1%) 0.154 mg Pantothenic acid (B5) (4%) 0.199 mg Vitamin B6 (4%) 0.049 mg Folate (B9) (1%) 4 μg Choline (1%) 6.1 mg Vitamin C (8%) 7 mg Vitamin K (2%) 2.1 μg Trace metals Calcium (1%) 13 mg Iron (3%) 0.36 mg Magnesium (3%) 11 mg Manganese (3%) 0.07 mg Phosphorus (3%) 21 mg Potassium (5%) 222 mg Sodium (0%) 0 mg Zinc (1%) 0.07 mg Link to USDA Database entry Units μg = micrograms • mg = milligrams IU = International units Percentages are roughly approximated using US recommendations for adults. Source: USDA Nutrient Database

As raw fruit, sweet cherries provide little nutrient content per 100 g serving (nutrient table). Dietary fiber and vitamin C are present in the most significant content while other vitamins and dietary minerals each supply less than 10% of the Daily Value (DV) per serving, respectively.

Compared to sweet cherries, raw sour cherries contain higher content per 100 g of vitamin C (12% DV) and vitamin A (8% DV).

Phytochemical research

Cherry anthocyanins, a class of phytochemical red pigments, were shown in preliminary research to possibly affect pain and inflammation mechanisms in rats. Anthocyanins may have other effects which remain under basic research for their potential mechanisms. For example, according to one study, genetically obese rats given a diet of tart cherry powder mixed into a high-fat diet did not gain weight or body fat like those on a similar diet without the powder, and their blood levels of inflammation indicators were lower.

Other information

The wood of some cherry species is especially esteemed for the manufacture of fine furniture.

Species

The list below contains many Prunus species that bear the common name cherry, but they are not necessarily members of the subgenus Cerasus, or bear edible fruit. For a complete list of species, see Prunus. Some common names listed here have historically been used for more than one species, e.g. "rock cherry" is used as an alternative common name for both P. prostrata and P. mahaleb and "wild cherry" is used for several species.

• Prunus apetala (Siebold & Zucc.) Franch. & Sav. - clove cherry
• Prunus avium (L.) L. - sweet cherry, wild cherry, mazzard or gean
• Prunus campanulata Maxim. - Taiwan cherry, Formosan cherry or bell-flowered cherry
• Prunus canescens Bois. - grey-leaf cherry
• Prunus caroliniana Aiton - Carolina laurel cherry or laurel cherry
• Prunus cerasoides D. Don. - wild Himalayan cherry
• Prunus cerasus L. - sour cherry
• Prunus cistena Koehne - purple-leaf sand cherry
• Prunus cornuta (Wall. ex Royle) Steud. - Himalayan bird cherry
• Prunus cuthbertii Small - Cuthbert cherry
• Prunus cyclamina Koehne - cyclamen cherry or Chinese flowering cherry
• Prunus dawyckensis Sealy - Dawyck cherry
• Prunus dielsiana C.K. Schneid. - tailed-leaf cherry
• Prunus emarginata (Douglas ex Hook.) Walp. - Oregon cherry or bitter cherry
• Prunus eminens Beck - German: mittlere Weichsel (semisour cherry)
• Prunus fruticosa Pall. - European dwarf cherry, dwarf cherry, Mongolian cherry or steppe cherry
• Prunus gondouinii (Poit. & Turpin) Rehder - duke cherry
• Prunus grayana Maxim. - Japanese bird cherry or Gray's bird cherry
• Prunus humilis Bunge - Chinese plum-cherry or humble bush cherry
• Prunus ilicifolia (Nutt. ex Hook. & Arn.) Walp. - hollyleaf cherry, evergreen cherry, holly-leaved cherry or islay
• Prunus incisa Thunb. - Fuji cherry
• Prunus jamasakura Siebold ex Koidz. - Japanese mountain cherry or Japanese hill cherry
• Prunus japonica Thunb. - Korean cherry
• Prunus laurocerasus L. - cherry laurel
• Prunus lyonii (Eastw.) Sarg. - Catalina Island cherry
• Prunus maackii Rupr. - Manchurian cherry or Amur chokecherry
• Prunus mahaleb L. - Saint Lucie cherry, rock cherry, perfumed cherry or mahaleb cherry
• Prunus maximowiczii Rupr. - Miyama cherry or Korean cherry
• Prunus mume (Siebold & Zucc.) - Chinese plum or Japanese apricot
• Prunus myrtifolia (L.) Urb. - West Indian cherry
• Prunus nepaulensis (Ser.) Steud. - Nepal bird cherry
• Prunus nipponica Matsum. - Takane cherry, peak cherry or Japanese alpine cherry
• Prunus occidentalis Sw. - western cherry laurel
• Prunus padus L. - bird cherry or European bird cherry
• Prunus pensylvanica L.f. - pin cherry, fire cherry, or wild red cherry
• Prunus pleuradenia Griseb. - Antilles cherry
• Prunus prostrata Labill. - mountain cherry, rock cherry, spreading cherry or prostrate cherry
• Prunus pseudocerasus Lindl. - Chinese sour cherry or false cherry
• Prunus pumila L. - sand cherry
• Prunus rufa Wall ex Hook.f. - Himalayan cherry
• Prunus salicifolia Kunth. - capulin, Singapore cherry or tropic cherry
• Prunus sargentii Rehder - Sargent's cherry
• Prunus serotina Ehrh. - black cherry, wild cherry
• Prunus serrula Franch. - paperbark cherry, birch bark cherry or Tibetan cherry
• Prunus serrulata Lindl. - Japanese cherry, hill cherry, Oriental cherry or East Asian cherry
• Prunus speciosa (Koidz.) Ingram - Oshima cherry
• Prunus ssiori Schmidt- Hokkaido bird cherry
• Prunus stipulacea Maxim.
• Prunus subhirtella Miq. - Higan cherry or spring cherry
• Prunus takesimensis Nakai - Takeshima flowering cherry
• Prunus tomentosa Thunb. - Nanking cherry, Manchu cherry, downy cherry, Shanghai cherry, Ando cherry, mountain cherry, Chinese dwarf cherry, Chinese bush cherry
• Prunus verecunda (Koidz.) Koehne - Korean mountain cherry
• Prunus virginiana L. - chokecherry
• Prunus x yedoensis Matsum. - Yoshino cherry or Tokyo cherry

See also

• Cherry blossom
• Cherry pitter
• Dried cherry
• Griotte de Kleparow
• List of AGM flowering cherries
• Marasca cherry

Notes

External links

Media related to Cherry at Wikimedia Commons

•  "Cherry". The American Cyclopædia. 1879. 

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• Food chemistry.Food Chem.2016 Apr 15;197(Pt A):150-60. doi: 10.1016/j.foodchem.2015.10.098. Epub 2015 Oct 20.
• Gallic acid (GA) and pomegranate rind extract (PRE), cherry stem extract (CSE) and green tea extract (GTE) were added to sour cherry juice concentrates (SCJCs) to enhance the colour. Effects of these copigment sources on anthocyanins, colour and turbidity were investigated during storage at -20, 4 a
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• Stability of phenolic compounds, antioxidant activity and colour through natural sweeteners addition during storage of sour cherry puree.

• Nowicka P1, Wojdyło A2.
• Food chemistry.Food Chem.2016 Apr 1;196:925-34. doi: 10.1016/j.foodchem.2015.10.019. Epub 2015 Oct 9.
• The aim of this study was to describe the changes in phenolic compounds, antioxidant activity and colour of sour cherry puree supplemented with different natural sweeteners (sucrose, palm sugar, erythritol, xylitol, steviol glycoside, Luo Han Kuo), and natural prebiotic (inulin). A total of 18 types
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• Anthocyanin composition, antioxidant efficiency, and α-amylase inhibitor activity of different Hungarian sour cherry varieties (Prunus cerasus L.).

• Homoki JR1, Nemes A2, Fazekas E3, Gyémánt G4, Balogh P5, Gál F6, Al-Asri J7, Mortier J8, Wolber G9, Babinszky L10, Remenyik J11.
• Food chemistry.Food Chem.2016 Mar 1;194:222-9. doi: 10.1016/j.foodchem.2015.07.130. Epub 2015 Jul 29.
• Five Hungarian sour cherry cultivars were studied to determine their anthocyanin contents and their possible inhibitory properties. The water and methanol soluble antioxidant capacities were separately assessed by photoluminescence showing values ranged from 3.4μgmg(-1) to 15.4μgmg(-1), respective
• PMID 26471548

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「MIDI関係」カテゴリーの人気ランキング 1位Cherry - MIDIシーケンサ (ユーザー評価： 5) 2位自動作曲システム ACS - ジャンルを選択するだけで、MIDI、着メロを自動生成し、演奏 (ユーザー評価： 1) 3位テキスト音楽「サクラ」 - 「ドレミ ...

• cherry

福岡天神のメンズ セレクトショップ cherry/チェリー 公式サイト。Rick Owens(リック オウエンス)・sacai・HOOD BY AIR.・Marcelo Burlon(マルセロ バーロン)・OFF-WHITE Vir・THOM BROWNE(トム ブラウン)・BUSCEMI(ブシェミ)他多数

• CHERRY FURNITURE-桜屋工業(株)

名古屋市中川区。椅子・応接セットなど家具の製造・輸出入。会社概要・沿革、商品カタログ。

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★リンクテーブル★

リンク元	「100Cases 75」「Prunus」「almond」「plum」「サクランボ」
拡張検索	「cherry-red spot」「cherry-red spotミオクローヌス症候群」

「100Cases 75」

　　[★]

☆case75　自宅での意識消失

■症例

21歳　男性

主訴：意識消失

現病歴：男性のアパートで意識を失っている所を彼女に発見され、午後5時に搬送された。彼女が最後に彼に会ったのは午後8時で、クリスマスの買い物をして帰宅した時であった。翌日午後、彼女が彼に会いに行った所、彼がお風呂の床で意識を失っているのを見つけた。彼女によれば、前日変わった様子(unusal mood)はなかった。彼は心理学の期末試験が1週間に迫っておりこのことを心配していたが、勉強はうまくいっているようだった。また以前の試験に問題はなかった。

喫煙歴：なし。

飲酒歴：機会飲酒 10 units/week(1週間に350mlビール6本弱)

既往歴：なし

家族歴：父と2人の兄弟のうち1人が糖尿病

服薬歴：以前、エクスタシー錠剤を服用していたが、静脈注射の薬はやったことがない。

身体所見 examination

　顔貌　青白。注射痕は認められない。脈拍　92/分、血圧　114/74 mmHg、呼吸数　22/分。心血管系、呼吸器系に異常を認めず。神経系　命令に従わないが、痛みに反応して適切に手を引っ込める(GCS M4)。腱反射(+)・対称性、足底反射(-)。瞳孔散大、対光反射(+)。眼底　視神経円板腫脹

■鑑別診断をあげるためのkeyword(司会者用)

・24時間以内に来した意識消失、糖尿病の家族歴、冬、風呂、精神疾患リスク(試験で悩んでいる。薬物の服用歴)、顔色、脈拍、血圧、呼吸数、腱反射、病的反射、瞳孔、眼底(司会者用)

■keywordからどういう疾患を考えるか？

　真っ先にあげたいもの

　・二次的な脳圧亢進

　・糖尿病

　・薬物中毒、中毒物質の摂取・吸引

　・神経疾患(てんかんなど)の発作

・24時間以内に来した意識消失

　・クモ膜下出血：局所神経症状、硝子体下出血(subhyaloid hemorrhage)。

・糖尿病の家族歴

　・低血糖発作

　　低血糖による昏睡は早いが糖尿病の新規症状として起こらない。まれにインスリノーマによる低血糖による昏睡があり得る。

　・糖尿病性ケトアシドーシス diabetic ketoacidosis DKA

　　極度のインスリン欠乏とコルチゾールやアドレナリンなどインスリン拮抗ホルモンの増加により、(1)高血糖(≧250mg/dl)、(2)高ケトン血症(β-ヒドロキシ酪酸の増加)、アシドーシス(pH7.3未満)をきたした状態。(糖尿病治療ガイド 2008-2009 p.66)

　・高浸透圧性非ケトン性昏睡 nonketotic hyperosmolar coma

　　DM type 2

　　50歳以上に好発し、インスリン非依存性糖尿病＊患者が腎不全や中枢神経障害、悪性腫瘍、消化器疾患、呼吸器感染などを合併するときに多くみられ、ステロイドや利尿薬の投与、輸液や高カロリー補給、人工透析などの際に医原性に起きやすい。

　高血糖性の昏睡は発症が早くない。その前に口渇や多尿があるはず。

　→　否定するための検査　→　血糖測定

・風呂

　・脳出血

　・冬だし、風呂(脱衣所のことか)にガスヒーターがあったら疑わしい。

・精神疾患リスク(試験で悩んでいる。薬物の服用歴)

　(最も多いのが)薬物中毒(鎮静薬、アスピリン、アセトアミノフェン)

　(意識障害で運ばれてきたときに考えるべきなのが)一酸化中毒

　一酸化中毒の場合の顔色は蒼白(cherry-red colorと言われてきたが)。眼底所見：(severe CO中毒で)乳頭浮腫

・顔色

・脈拍、血圧、呼吸数

・腱反射、病的反射

　腱反射が亢進していたら、上位運動ニューロンの障害を考慮する。腱反射亢進と意識障害が共存していれば、障害部位は脊髄の伝導路ではなくむしろ脳幹・大脳皮質に障害があると考えることができる。

・瞳孔

　瞳孔が散大していれば交感神経興奮、副交感神経の麻痺：フェニレフリン・エピネフリン・コカインなど交感神経刺激、動眼神経麻痺、脳死の徴候

　瞳孔が縮瞳していれば副交感神経興奮、オピオイド受容体への刺激：麻薬中毒、有機リン中毒、橋出血、脳幹部梗塞(脳底動脈閉塞症など)

・眼底 (IMD.71)

　視神経円板(=視神経乳頭)の腫脹は乳頭浮腫(papilledema, DIF.342)を反映。乳頭浮腫の発生機序は軸索輸送障害や静脈還流うっ滞である。原因として頭蓋内疾患が最も多い。頭蓋外の疾患(高血圧、視神経炎、偽性脳腫瘍)。

乳頭浮腫 papilledema DIF.243

V 動静脈奇形、高血圧による脳血圧脳症・頭蓋内出血、クモ膜下出血、硬膜下血腫

I 脳膿瘍、慢性経過の髄膜炎(細菌性×)、敗血症による血栓や静脈洞血栓

N 脳腫瘍

D -

C 動静脈奇形、水頭症、頭蓋奇形(尖頭症などによる)、血友病、時にSchilder disease

A ループス脳炎、動脈周囲炎

T 急性期の硬膜外血腫や硬膜下血腫ではない。慢性硬膜下血腫ならありうる。

E 褐色細胞腫による悪性高血圧、偽性脳腫瘍(=特発性頭蓋内圧亢進症)(肥満・無月経・感情障害(emotionally disturbed)をきたした女性に多い)

■問題

　症例だけでは絞れないので、最も疑われる疾患をあげ、鑑別診断を列挙し、検査、治療を考えていくことにします。

■一酸化炭素中毒

■オチ

　血中carboxyhemoglobinを測定したところ32%。高レベルの酸素投与でゆっくりだが、48時間で完全に回復。脳浮腫にたいするマンニトールや高圧酸素療法も考慮する。問題は4年間点検されていないガス温水器の不完全燃焼だったとさ。

■KEY POINTS

・薬物中毒は若い人の意識消失の最も一般的な原因だけど、他の診断もいつも考慮しておく。

・一酸化炭素ヘモグロビンレベルは屋内や車内、あるいはよく分からない煙に暴露した意識消失患者で測るべき

・一酸化中毒による重度の低酸素血症ではチアノーゼを欠く。

■initial plan(救急だからのんびりやってられないだろうけど)

A.

1. 呼吸器系、循環器系の安定を確認

2. 血液ガス検査

　3. 血液生化学(電解質(Na,Ca)、血糖)

□ビール1本 = 350ml アルコール5%： 350 (ml/本) x 0.05 / 10 (ml/unit) =1.75 (unit/本)

■参考文献

　DIF　Differential Diagnosis in Primary Care Fourth Edition版 Lippincott Williams & Wilkins

「Prunus」

　　[★]

サクラ属、プルヌス属、Prunus属

関

almond、apricot、cherry、peach、plum、Prunus persica

　

「almond」

　　[★]

アーモンド

関

apricot、cherry、peach、plum、Prunus、Prunus amygdalus、Prunus persica

　 　 　

「plum」

　　[★]

セイヨウスモモ

関

almond、apricot、cherry、peach、Prunus、Prunus persica

　 　 　 　

「サクランボ」

　　[★]

英

cherry

関

アーモンド、アンズ、モモ、セイヨウスモモ、サクラ属

「cherry-red spot」

　　[★]

• 網膜中心動脈閉塞症
• リピドーシス lipidosis
• ムコ多糖症 mucopolysaccharidosis

• 循環障害の場合：還流障害により虚血に陥りapoptosisへ。
• 代謝異常の場合：異常代謝産物が神経節細胞に蓄積してapoptosisに陥る。

「cherry-red spotミオクローヌス症候群」

　　[★]

英

cherry-red spot myoclonus syndrome

同

サクランボ赤色斑ミオクローヌス症候群