n.

明らかにする/なること。(通例 -s)明示。現れ。(霊の)出現
(政府・政党などの)政策表明。(政治的な)示威運動
病気の徴候/症状

WordNet

a clear appearance; "a manifestation of great emotion"
a manifest indication of the existence or presence or nature of some person or thing; "a manifestation of disease"
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"
without unnecessary stops; "an express train"; "an express shipment"
rapid transport of goods (同)expressage
public transport consisting of a fast train or bus that makes only a few scheduled stops; "he caught the express to New York" (同)limited
mail that is distributed by a rapid and efficient system (同)express mail
give expression to; "She showed her disappointment" (同)show, evince
indicate through a symbol, formula, etc.; "Can you express this distance in kilometers?" (同)state
articulate; either verbally or with a cry, shout, or noise; "She expressed her anger"; "He uttered a curse" (同)verbalize, verbalise, utter, give tongue to
by express; "please send the letter express"
manifest the effects of (a gene or genetic trait); "Many of the laboratory animals express the trait"
not tacit or implied; "her express wish"
send by rapid transport or special messenger service; "She expressed the letter to Florida"
present oneself formally, as before a (judicial) authority; "He had to appear in court last month"; "She appeared on several charges of theft"
come into being or existence, or appear on the scene; "Then the computer came along and changed our lives"; "Homo sapiens appeared millions of years ago" (同)come along
be issued or published; "Did your latest book appear yet?"; "The new Woody Allen film hasnt come out yet" (同)come_out
seem to be true, probable, or apparent; "It seems that he is very gifted"; "It appears that the weather in California is very bad" (同)seem
appear as a character on stage or appear in a play, etc.; "Gielgud appears briefly in this movie"; "She appeared in `Hamlet on the London stage"
come into sight or view; "He suddenly appeared at the wedding"; "A new star appeared on the horizon"
reveal its presence or make an appearance; "the ghost manifests each year on the same day"
a customs document listing the contents put on a ship or plane
record in a ships manifest; "each passenger must be manifested"

PrepTutorEJDIC

〈U〉表明,明示;現れ,表現;〈C〉表明されたこと / 〈C〉(霊魂などの)出現
(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
(言葉で)〈思想・感情など〉‘を'『表現する』,言い表す,述べる / (言葉以外で)…‘を'『示す』,表す(indicate);〈数字・記号・式などが〉…‘を'表す / 《英》〈荷物など〉‘を'至急便で送る / (…から)〈果汁など〉‘を'絞り出す《+『名』+『from』+『名』》 / 特別の,特定の / はっきりした,明白な / 『至急便の』,急行の / 至急便で,急行で / 〈U〉(手紙・荷物などの)『至急便』 / 〈C〉(至急便を扱う)通運会社 / 〈C〉(列車・バスなどの)『急行』
『姿を現す』,出現する / 〈本・記事などが〉公になる,出版される / (劇などに)出演する;(法廷などに)出廷する,出頭する / (…のように)『見える』,『思われる』
『明白な』,はっきりした(clear) / …‘を'『はっきり表す』(『示す』),表明する・(税関に提出するための船・飛行機の)積み荷目録;乗客名簿・宣言・声明書・檄文・特に，共産党宣言・政策綱領（イギリスの選挙で政党から公表されるもので，具体性を欠く選挙スローガンや公約と異なり，政策の数値目標，実施期限，財源などを明示する）

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/28 18:58:22」(JST)

wiki en

[Wiki en表示]

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における歯肉炎および歯周炎：分類と歯科治療 gingivitis and periodontitis in adults classification and dental treatment
2. 馬尾症候群などの腫瘍による硬膜外脊髄圧迫の臨床的特徴および診断 clinical features and diagnosis of neoplastic epidural spinal cord compression including cauda equina syndrome
3. Epidemiology, pathogenesis, and etiology of kidney disease in multiple myeloma and other monoclonal gammopathies
4. 悪性腫瘍関連心膜疾患 pericardial disease associated with malignancy
5. ライム病：小児における臨床症状 lyme disease clinical manifestations in children

English Journal

Human pleural B-cells regulate IFN-γ production by local T-cells and NK cells in a Mycobacterium tuberculosis-induced delayed hypersensitivity reaction.

Schierloh P1, Landoni V1, Balboa L1, Musella RM2, Castagnino J2, Moraña E3, de Casado GC, Palmero D2, Sasiain MC1.
Clinical science (London, England : 1979).Clin Sci (Lond).2014 Sep 1;127(6):391-403. doi: 10.1042/CS20130769.
DTH (delayed type hypersensitivity) reactions are secondary cellular immune responses that appear 24-72 h after antigen exposure. Tuberculous pleurisy is a common manifestation of extrapulmonary TB (tuberculosis) and is considered a human model of Th1-mediated DTH. In order to identify functional
PMID 24689690

How does ASD symptomology correlate with ADHD presentations?

Konst MJ1, Matson JL2, Goldin R2, Rieske R2.
Research in developmental disabilities.Res Dev Disabil.2014 Sep;35(9):2252-9. doi: 10.1016/j.ridd.2014.05.017. Epub 2014 Jun 12.
Elevated rates of attention deficit/hyperactivity disorder (ADHD) symptoms have been documented in the autism spectrum disorder (ASD) population. However, the recent restructuring of the ASD diagnostic category and its respective symptom structure has elicited concern about how these changes may imp
PMID 24929307

The mediating role of non-suicidal self-injury in the relationship between impulsivity and suicidal behavior among inpatients receiving treatment for substance use disorders.

Anestis MD1, Tull MT2, Lavender JM3, Gratz KL2.
Psychiatry research.Psychiatry Res.2014 Aug 15;218(1-2):166-73. doi: 10.1016/j.psychres.2014.03.031. Epub 2014 Apr 3.
Several theories posit a direct role of impulsivity in suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) argues that the relationship between impulsivity and suicidal behavior is explained by the painful and/or provocative experiences (PPEs) often encountered by i
PMID 24768248

Personality organization in borderline patients with a history of suicide attempts.

Baus N1, Fischer-Kern M2, Naderer A2, Klein J2, Doering S2, Pastner B2, Leithner-Dziubas K2, Plener PL3, Kapusta ND2.
Psychiatry research.Psychiatry Res.2014 Aug 15;218(1-2):129-33. doi: 10.1016/j.psychres.2014.03.048. Epub 2014 Apr 5.
Suicide attempts (SA) are common in patients with Borderline Personality Disorder (BPD). Recent studies focus on aspects of personality associated with risk for SA such as deficits in affect regulation including impulse control and aggression. The current study examines associations of dysfunctional
PMID 24746393

Japanese Journal

Being and Aesthetic : Poetic Wisdom as The Manifestation of A Culture's Power to Live

Peng Shuixiang
Asian journal of social sciences & humanities 3(2), 22-29, 2014-05
NAID 40020084862

Longitudinal Study on Respiratory Viral Co-Infections in the Presence or Absence of Clinical Manifestation in Infants Aged 0-2 Years

Kawabuchi-Kurata Takako,Misaki Takako,Suehiro Yutaka [他]
Japanese Journal of Infectious Diseases 67(3), 216-220, 2014-05
NAID 40020072234

顕微鏡的多発血管炎の病態,肺病変の特徴,治療 (特集肺血管炎の基礎と臨床)

穂積宏尚,須田隆文
呼吸器内科 25(4), 294-302, 2014-04
NAID 40020086045

下顎頭への転移を初発症状とした肝細胞癌の1例

加藤晃一郎,森家祥行
日本口腔外科学会雑誌 = Japanese journal of oral and maxillofacial surgery 60(4), 240-244, 2014-04
NAID 40020072233

Related Pictures

★リンクテーブル★

リンク元	「100Cases 33」「manifest」「appear」「finding」「indication」
拡張検索	「clinical manifestation」「neurobehavioral manifestation」「cognitive manifestation」

「100Cases 33」

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)

According to the US CDC definition, one has AIDS if he/she is infected with HIV and present with one of the following:

A CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

or he/she has one of the following defining illnesses:

01. Candidiasis of bronchi, trachea, or lungs
02. Candidiasis esophageal
03. Cervical cancer (invasive)
04. Coccidioidomycosis, disseminated or extrapulmonary
05. Cryptococcosis, extrapulmonary
06. Cryptosporidiosis, chronic intestinal for longer than 1 month
07. Cytomegalovirus disease (other than liver, spleen or lymph nodes)
08. Encephalopathy (HIV-related)
09. Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
10. Histoplasmosis, disseminated or extrapulmonary
11. Isosporiasis, chronic intestinal (for more than 1 month)
12. Kaposi's sarcoma
13. Lymphoma Burkitt's, immunoblastic or primary brain
14. Mycobacterium avium complex
15. Mycobacterium, other species, disseminated or extrapulmonary
16. Pneumocystis carinii pneumonia
17. Pneumonia (recurrent)
18. Progressive multifocal leukoencephalopathy
19. Salmonella septicemia (recurrent)
20. Toxoplasmosis of the brain
21. Tuberculosis
22. Wasting syndrome due to HIV

People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:

undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia

AND

the individual has had Pneumocystis carinii pneumonia
OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

□AIDSのステージング

Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)

http://en.wikipedia.org/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「manifest」

　　[★]

adj.

明白な、はんぜんとした、一目瞭然の。公知の。(精神分析)意識に現れた、顕在的な

vt.

明らかにする、明示する。証明する。(行為などによって)(感情などを)表す

vi.

(幽霊などが)現れる

osteomyelitis classically manifests as an acute systemic illness with malaise, fever, leukocytosis, and throbbing pain over the affected region.

In PAN, renal involvement most commonly manifests as hypertension, renal insufficiency, or hemorrhage due to microaneurysms. (HIM.2125)(結節性多発動脈炎では、一般的に腎病変は高潔悦、腎不全あるいは微小血管瘤による出血として現れる)

n.

関: clarify, conspicuous, disclose, dominant, dramatic, elucidate, express, intense, manifestation, marked, markedly, notable, outstanding, overt, profound, remarkable, reveal, significant, striking, uncover, unmask

「appear」

　　[★]

vi.

見えてくる、現れる。発生/出現する、出る。出頭/出場/出演する(as)。
明白である、はっきりしてくる。見たところ～らしい、～と思われる。

The ovarian hyperstimulation syndrome appears to be due to increased capillary permeability triggered by excessive release of one or more vasoactive substances secreted during maturation and luteinization of multiple follicles.(uptodate)(OHSSは、多数の卵胞が成熟し黄体となる過程で放出されるいくつかの血管作動性物質の過剰な放出が引き金となり、毛細血管の透過性が増加することによると思われる。)

関: advent、appearance、arrival、assume、believe、emerge、emergence、feel、look、manifestation、occurrence、seem、suppose、suspect、think

「finding」

　　[★]

n.

見つけたこと、発見。[～s]発見物。(調べて)明らかになったこと[結論]
[～s](法律)(裁判官の)事実認定、(陪審員の)評決。(学者などの)研究結果、結論。(医学)(検死官・医師の)所見。(委員会の)答申

Findings on the frequency of injuries attributable to abuse versus accidents inthe first 36 months of life should be helpful for clinicians evaluating injuries in yound children.