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"
a prosthesis used to close an opening (as to close an opening of the hard palate in cases of cleft palate)
having a handwritten signature; "a signed letter"

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
=ti

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/08 21:57:22」(JST)

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The obturator internus and nearby muscles

A coronal section of the pelvis illustrating the proximity of the obturator internus to the abdominopelvic viscera.

The obturator sign is an indicator of irritation to the obturator internus muscle.^[1]

The technique for detecting the obturator sign, called the obturator test, is carried out on each leg in succession. The patient lies on her/his back with the hip and knee both flexed at ninety degrees. The examiner holds the patient's ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward. This is flexion and internal rotation of the hip.

In the clinical context, it is performed when acute appendicitis is suspected. In this condition, the appendix becomes inflamed and enlarged. The appendix may come into physical contact with the obturator internus muscle, which will be stretched when this maneuver is performed on the right leg. This causes pain and is an evidence in support of an inflamed appendix.

The principles of the obturator sign in the diagnosis of appendicitis are similar to that of the psoas sign. The appendix is commonly located in the retrocecal or pelvic region. The oburator sign indicates the presence of an inflamed pelvic appendix.

Evidence shows that the obturator test does not adequately diagnose appendicitis.^[2]

References

^ Allan B Wolfson (1 September 2009). Harwood-Nuss' Clinical Practice of Emergency Medicine. Lippincott Williams & Wilkins. pp. 1222–. ISBN 978-0-7817-8943-1. Retrieved 30 May 2011.
^ Reference: McGee, S. (2007). Evidence based physical diagnosis (2nd ed.). Philadelphia: Saunders.

External links

Acute appendicitis review in American Family Physician

This medical sign article is a stub. You can help Wikipedia by expanding it.

UpToDate Contents

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1. 成人における急性虫垂炎：臨床症状と鑑別診断 acute appendicitis in adults clinical manifestations and differential diagnosis
2. 小児における急性虫垂炎：臨床症状および診断 acute appendicitis in children clinical manifestations and diagnosis
3. 救急外来における成人の腹痛の評価 evaluation of the adult with abdominal pain in the emergency department
4. 成人における急性虫垂炎：診断のための評価 acute appendicitis in adults diagnostic evaluation
5. 小児における急性虫垂炎：管理 acute appendicitis in children management

English Journal

Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014.

Kramer MW1, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, Merseburger AS, Herrmann TR.
World journal of urology.World J Urol.2015 Apr;33(4):571-9. doi: 10.1007/s00345-014-1337-y. Epub 2014 Jun 17.
INTRODUCTION: Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu
PMID 24935098

Single-incision laparoscopic totally extraperitoneal obturator hernia repair in a patient on antiplatelet therapy: a case report.

Wakasugi M1, Masuzawa T, Tei M, Omori T, Ueshima S, Tori M, Akamatsu H.
Asian journal of endoscopic surgery.Asian J Endosc Surg.2015 Feb;8(1):83-6. doi: 10.1111/ases.12132.
An 83-year-old woman who complained of right lower limb discomfort was diagnosed with a right obturator hernia by CT scan. On examination, she had a soft and flat abdomen without signs of peritoneal irritation. The Howship-Romberg sign was present. She had a history of vasospastic angina and paroxys
PMID 25598062

Internal obturator muscle transposition for treatment of perineal hernia in dogs: 34 cases (1998-2012).

Shaughnessy M1, Monnet E.
Journal of the American Veterinary Medical Association.J Am Vet Med Assoc.2015 Feb 1;246(3):321-6. doi: 10.2460/javma.246.3.321.
OBJECTIVE: To evaluate the outcome of dogs with perineal hernia treated with transposition of the internal obturator muscle.DESIGN: Retrospective case series.ANIMALS: 34 dogs.PROCEDURES: Medical records of dogs with perineal hernia surgically treated from 1998 to 2012 were reviewed. Diagnostic metho
PMID 25587732

Japanese Journal

下肢痛と股関節痛で発症した閉鎖孔ヘルニアの一例

中村幸之,齊藤太一,犀川勲,入江努,田中哲也,山口亮介
整形外科と災害外科 60(2), 283-286, 2011-03-25
NAID 10027974285

症例報告 Howship-Romberg徴候を坐骨神経痛として見過されていた閉鎖孔ヘルニアの1例

加藤丈陽,川本龍一,楠木智
日本老年医学会雑誌 48(2), 176-179, 2011-03
NAID 40018827655

「急性虫垂炎」

　　[★]

英: acute appendicitis
ラ: appendicitis acuta
関: 虫垂炎、腹痛

身体所見

圧痛点：

ローゼンシュタイン徴候 Rosenstein徴候：左側臥位でMcBurney点を圧迫すると仰臥位よりも疼痛が増強する。
ロブシング徴候 Rovsing徴候：仰臥位で下行結腸を下部より上方に押し上げるように手掌で圧迫し回盲部を充満させると回盲部に痛みが誘発される。
ブルンベルグ徴候 Blumberg徴候：反跳痛。腹膜炎
obturator sign：骨盤内炎症。右股関節を内転時に疼痛誘発。
psoas sign：腸腰筋の炎症。右大腿の伸展で右下腹部痛誘発。
Dunphy's sign：咳き込んで右下腹部痛誘発。
tapping pain：腹膜刺激症状
heel drop sign：腹膜刺激症状

虫垂炎、身体診察のの感度、特異度

　　　　　　　　　SEN、SPE　

psoas sign　　：16％、95％

ブルンベルグ徴候：63％、69％　　(*1)

heel drop sign：93％

症状

先駆症状：腹痛、悪心・嘔吐

腹痛：心窩部・臍部の鈍い間欠的疼痛(内臓痛) → 右下腹部に限局する持続的疼痛(体性痛)
発熱
嘔吐

合併症

腹腔内膿瘍
汎発性腹膜炎：麻痺性イレウス、筋性防御

検査

血液検査
腹部単純X線検査
腹部超音波検査
腹部CT検査

鑑別疾患

消化器系：憩室炎、クローン病、大腸癌、stump appendicitis、結腸垂捻転・結腸垂炎
泌尿器系：尿路結石(膀胱尿管移行部の右尿管結石)、精巣捻転
婦人科系：骨盤内炎症疾患、卵巣出血、子宮外妊娠、付属器炎、子宮内膜症、(妊婦)切迫流産、絨毛膜羊膜炎、常位胎盤早期剥離

診断

Alvaradoスコア「MANTRELS」：7点以上で虫垂炎疑い

M	migration of pain	心窩部・臍傍部から右下腹部への痛みの移動	1
A	anorexia	食欲不振	1
N	nausea	嘔気嘔吐	1
T	tenderness in RLQ	右下腹部圧痛	1
R	rebound tenderness	反跳痛	2
E	elevated temperature	37.3℃以上の発熱	1
L	leukocytosis	WBC>1万/μl, 白血球増多	2
S	shift of WBC	白血球の左方移動	1