sound

• n.

• 音

• v.

• 響く

• adj.

• 健全な

Use of the amblyopic eye is encouraged by discouraging use of the sound eye with an occluding patch or using drugs or glasses to blur vision in the sound eye.

関

salutary、tone

　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

WordNet

1. thorough; "a sound thrashing"
2. mechanical vibrations transmitted by an elastic medium; "falling trees make a sound in the forest even when no one is there to hear them"
3. the particular auditory effect produced by a given cause; "the sound of rain on the roof"; "the beautiful sound of music"
4. the subjective sensation of hearing something; "he strained to hear the faint sounds" (同)auditory sensation
5. a large ocean inlet or deep bay; "the main body of the sound ran parallel to the coast"
6. the sudden occurrence of an audible event; "the sound awakened them"
7. make a certain noise or sound; "She went `Mmmmm"; "The gun went `bang" (同)go
8. announce by means of a sound; "sound the alarm"
9. appear in a certain way; "This sounds interesting"
10. cause to sound; "sound the bell"; "sound a certain note"
11. financially secure and safe; "sound investments"; "a sound economy"
12. free from moral defect; "a man of sound character"
13. give off a certain sound or sounds; "This record sounds scratchy"
14. in good condition; free from defect or damage or decay; "a sound timber"; "the wall is sound"; "a sound foundation"
15. vary the pitch of ones speech (同)inflect, modulate
16. give a healthy elasticity to; "Lets tone our muscles" (同)tone up, strengthen
17. change the color or tone of; "tone a negative"
18. change to a color image; "tone a photographic image"
19. (linguistics) a pitch or change in pitch of the voice that serves to distinguish words in tonal languages; "the Beijing dialect uses four tones"
20. a steady sound without overtones; "they tested his hearing with pure tones of different frequencies" (同)pure tone
21. the quality of a persons voice; "he began in a conversational tone"; "he spoke in a nervous tone of voice" (同)tone of voice
22. a musical interval of two semitones (同)whole tone, step, whole step
23. the quality of something (an act or a piece of writing) that reveals the attitudes and presuppositions of the author; "the general tone of articles appearing in the newspapers is that the government should withdraw"; "from the tone of her behavior I gathe
24. utter monotonously and repetitively and rhythmically; "The students chanted the same slogan over and over again" (同)chant, intone
25. an attribute of sound
26. making or having a sound as specified; used as a combining form; "harsh-sounding"
27. a measure of the depth of water taken with a sounding line
28. the act of measuring depth of water (usually with a sounding line)
29. having volume or deepness; "sounding brass and a tinkling cymbal"; "the sounding cataract haunted me like a passion"- Wordsworth
30. a former French coin of low denomination; often used of any small amount of money; "he hasnt a sou to his name"

PrepTutorEJDIC

1. 〈C〉〈U〉『音』,『音響』,響き・〈U〉音の聞こえる範囲・〈C〉(音声としての)音 / 《単数形で》(聞いたり,読んだりしたときに受ける)感じ,響き,調子・〈U〉(無意味な)音(声);騒音,ざわめき・『音を出す』,鳴る,響く・『聞こえる,思える』(進行形にできない) ・〈楽器・ベルなど〉‘を'鳴らす・(音で)…‘を'知らせる・…‘を'発音する・〈考えなど〉‘を'打診する
2. (物が)『傷んでいない』,腐っていない,完全な / (心身が)『健全な』,健康な / (財政的に)『安定した』,堅実な / (論理・判断などが)『的確な』,もっともな,分別ある / 合法的な / (道徳的に)高潔な,誠実な / (睡眠が)深い / 徹底した,思う存分の / ぐっすりと
3. (重りのついた糸で)〈海・川など〉‘の'水深を測る / (…について)〈意見・態度など〉‘を'さぐる,調べる《+『名』+『out』(+『out』+『名』)+『about』+『名』》 / 水深を測る / 〈鯨・魚などが〉深く潜る
4. 海峡,瀬戸(strait) / 入り江
5. 〈C〉(高さ・音色・長さ・音量の点から見た)『音』 / 〈C〉〈U〉音質 / 〈C〉楽音;全音程 / 〈C〉《しばしば複数形で》『言い方,書き方』,口調,語調 / 〈C〉支配的な(一般的な)風潮(傾向) / 〈U〉(筋肉などの緊張の)『正常な状態』 / 〈C〉『色調』,色合い,濃淡,明暗 / (音・色などで)…‘に'『ある調子(口調,色合い)をつける』 / …‘の'色を変える,色を補正する
6. (心・精神の)ためになる,有益な / 健康によい
7. 音を出す,鳴り響く
8. 〈U〉水深測量 / 《複数形で》(測量した)水深 / 《複数形で》水深測量できる水域
9. スー(フランスの5サンチームまたは10サンチーム銅貨) / つまらないもの

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/26 09:12:33」(JST)

wiki ja

[Wiki ja表示]

サウンド (sound)

• 音
• 音楽。
• パーソナルコンピュータにおいて、スピーカから音を出力するためのデータ（サウンドファイル）、およびその音。
• コンピュータゲームで使用されるBGMおよび効果音の総称。
• 海峡
• エーレスンド海峡 (The Sound、サウンド海峡)
• サウンドロゴ
• 健全性 (soundness) - 数理論理学の用語

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 audible acoustic waves. For other uses, see Sound (disambiguation).

A drum produces sound via a vibrating membrane.

Sound is a vibration that propagates as a mechanical wave of pressure and displacement, through some medium (such as air or water). Sometimes sound refers to only those vibrations with frequencies that are within the range of hearing for humans or for a particular animal.

Acoustics

Main articles: Acoustics and Acoustical engineering

Audio engineers in R&D design audio equipment

Acoustics is the interdisciplinary science that deals with the study of all mechanical waves in gases, liquids, and solids including vibration, sound, ultrasound and infrasound. A scientist who works in the field of acoustics is an acoustician while someone working in the field of acoustical engineering may be called an acoustic engineer. (Not to be confused with an audio engineer.) The application of acoustics can be seen in almost all aspects of modern society, subdisciplines include: aeroacoustics, audio signal processing, architectural acoustics, bioacoustics, electroacoustics, environmental noise, musical acoustics, noise control, psychoacoustics, speech, ultrasound, underwater acoustics and vibration.

Physics of sound

Propagation of sound

Sound propagates through compressible media such as air, water and solids as longitudinal waves and also as a transverse waves in solids (see Longitudinal and transverse waves, below). The sound waves are generated by a sound source, such as the vibrating diaphragm of a stereo speaker. The sound source creates vibrations in the surrounding medium. As the source continues to vibrate the medium, the vibrations propagate away from the source at the speed of sound, thus forming the sound wave. At a fixed distance from the source, the pressure, velocity, and displacement of the medium vary in time. At an instant in time, the pressure, velocity, and displacement vary in space. Note that the particles of the medium do not travel with the sound wave. This is intuitively obvious for a solid, and the same is true for liquids and gases (that is, the vibrations of particles in the gas or liquid transport the vibrations, while the average position of the particles over time does not change). During propagation, waves can be reflected, refracted, or attenuated by the medium.

The behavior of sound propagation is generally affected by three things:

• A relationship between density and pressure. This relationship, affected by temperature, determines the speed of sound within the medium.
• The propagation is also affected by the motion of the medium itself. For example, sound moving through wind. Independent of the motion of sound through the medium, if the medium is moving, the sound is further transported.
• The viscosity of the medium also affects the motion of sound waves. It determines the rate at which sound is attenuated. For many media, such as air or water, attenuation due to viscosity is negligible.

When sound is moving through a medium that does not have constant physical properties, it may be refracted (either dispersed or focused).

Spherical compression (longitudinal) waves

The mechanical vibrations that can be interpreted as sound are able to travel through all forms of matter: gases, liquids, solids, and plasmas. The matter that supports the sound is called the medium. Sound cannot travel through a vacuum.

Longitudinal and transverse waves

Sound is transmitted through gases, plasma, and liquids as longitudinal waves, also called compression waves. Through solids, however, it can be transmitted as both longitudinal waves and transverse waves. Longitudinal sound waves are waves of alternating pressure deviations from the equilibrium pressure, causing local regions of compression and rarefaction, while transverse waves (in solids) are waves of alternating shear stress at right angle to the direction of propagation.

The energy carried by an oscillating sound wave converts back and forth between the potential energy of the extra compression (in case of longitudinal waves) or lateral displacement strain (in case of transverse waves) of the matter, and the kinetic energy of the displacement velocity of particles of the medium.

Sound wave properties and characteristics

Sinusoidal waves of various frequencies; the bottom waves have higher frequencies than those above. The horizontal axis represents time.

Sound waves are often simplified to a description in terms of sinusoidal plane waves, which are characterized by these generic properties:

• Frequency, or its inverse, the period
• Wavelength
• Wavenumber
• Amplitude
• Sound pressure
• Sound intensity
• Speed of sound
• Direction

Sound that is perceptible by humans has frequencies from about 20 Hz to 20,000 Hz. In air at standard temperature and pressure, the corresponding wavelengths of sound waves range from 17 m to 17 mm. Sometimes speed and direction are combined as a velocity vector; wavenumber and direction are combined as a wave vector.

Transverse waves, also known as shear waves, have the additional property, polarization, and are not a characteristic of sound waves.

Speed of sound

U.S. Navy F/A-18 approaching the sound barrier. The white halo is formed by condensed water droplets thought to result from a drop in air pressure around the aircraft (see Prandtl-Glauert Singularity).

Main article: Speed of sound

The speed of sound depends on the medium the waves pass through and is a fundamental property of the material. The first significant effort towards developing a formula to measure the speed of sound was made by Newton. He believed that the speed of sound in a particular substance was equal to the square root of the pressure acting on it (STP) divided by its density.

$c = \sqrt{ {p \over \rho}}\,$

This was later proved wrong when found to incorrectly derive the speed. French mathematician Laplace corrected the formula by deducing that the phenomenon of sound travelling is not isothermal, as believed by Newton, but adiabatic. He added another factor to the equation-gamma-and multiplied $\sqrt{\gamma}\,$ to , thus coming up with the equation $c = \sqrt{\gamma \cdot {p \over \rho}}\,$ . Since $K = \gamma \cdot p\,$ the final equation came up to be $c = \sqrt{\frac{K}{\rho}}\,$ which is also known as the Newton-Laplace equation. In this equation, K = elastic modulus, c = velocity of sound, and = density. Thus, the speed of sound is proportional to the square root of the ratio of the elastic modulus (stiffness) of the medium to its density.

Those physical properties and the speed of sound change with ambient conditions. For example, the speed of sound in gases depends on temperature. In 20 °C (68 °F) air at sea level, the speed of sound is approximately 343 m/s (1,230 km/h; 767 mph) using the formula "v = (331 + 0.6 T) m/s". In fresh water, also at 20 °C, the speed of sound is approximately 1,482 m/s (5,335 km/h; 3,315 mph). In steel, the speed of sound is about 5,960 m/s (21,460 km/h; 13,330 mph). The speed of sound is also slightly sensitive (a second-order anharmonic effect) to the sound amplitude, which means that there are nonlinear propagation effects, such as the production of harmonics and mixed tones not present in the original sound (see parametric array).

Perception of sound

Human ear

The perception of sound in any organism is limited to a certain range of frequencies. For humans, hearing is normally limited to frequencies between about 20 Hz and 20,000 Hz (20 kHz), although these limits are not definite. The upper limit generally decreases with age. Other species have a different range of hearing. For example, dogs can perceive vibrations higher than 20 kHz, but are deaf to anything below 40 Hz. As a signal perceived by one of the major senses, sound is used by many species for detecting danger, navigation, predation, and communication. Earth's atmosphere, water, and virtually any physical phenomenon, such as fire, rain, wind, surf, or earthquake, produces (and is characterized by) its unique sounds. Many species, such as frogs, birds, marine and terrestrial mammals, have also developed special organs to produce sound. In some species, these produce song and speech. Furthermore, humans have developed culture and technology (such as music, telephone and radio) that allows them to generate, record, transmit, and broadcast sound. The scientific study of human sound perception is known as psychoacoustics.

Noise

Main article: Noise

Noise is a term often used to refer to an unwanted sound. In science and engineering, noise is an undesirable component that obscures a wanted signal.

Sound pressure level

Main article: Sound pressure

Sound measurements
Characteristic	Symbol
Sound pressure	p · SPL
Particle velocity	v · SVL
Particle displacement	ξ
Sound intensity	I · SIL
Sound power	Pac
Sound power level	SWL
Sound energy
Sound exposure	E
Sound exposure level	SEL
Sound energy density	E
Sound energy flux	q
Acoustic impedance	Z
Speed of sound
Audio frequency	AF

Sound pressure is the difference, in a given medium, between average local pressure and the pressure in the sound wave. A square of this difference (i.e., a square of the deviation from the equilibrium pressure) is usually averaged over time and/or space, and a square root of this average provides a root mean square (RMS) value. For example, 1 Pa RMS sound pressure (94 dBSPL) in atmospheric air implies that the actual pressure in the sound wave oscillates between (1 atm Pa) and (1 atm Pa), that is between 101323.6 and 101326.4 Pa. As the human ear can detect sounds with a wide range of amplitudes, sound pressure is often measured as a level on a logarithmic decibel scale. The sound pressure level (SPL) or L_p is defined as

$L_\mathrm{p}=10\, \log_{10}\left(\frac{{p}^2}{{p_\mathrm{ref}}^2}\right) =20\, \log_{10}\left(\frac{p}{p_\mathrm{ref}}\right)\mbox{ dB}\,$

where p is the root-mean-square sound pressure and is a reference sound pressure. Commonly used reference sound pressures, defined in the standard ANSI S1.1-1994, are 20 µPa in air and 1 µPa in water. Without a specified reference sound pressure, a value expressed in decibels cannot represent a sound pressure level.

Since the human ear does not have a flat spectral response, sound pressures are often frequency weighted so that the measured level matches perceived levels more closely. The International Electrotechnical Commission (IEC) has defined several weighting schemes. A-weighting attempts to match the response of the human ear to noise and A-weighted sound pressure levels are labeled dBA. C-weighting is used to measure peak levels.

Equipment for dealing with sound

Equipment for outputing or generating : musical instrument, sound box, hearing phones, sonar systems, sound reproduction, and broadcasting equipment. Many of these use electro-acoustic transducers for input : microphones.

Sound measurement

• Decibel, Sone, mel, Phon, Hertz
• Sound pressure level, Sound pressure
• Particle velocity, Acoustic velocity
• Particle displacement, Particle amplitude, Particle acceleration
• Sound power, Acoustic power, Sound power level
• Sound energy flux
• Sound intensity, Acoustic intensity, Sound intensity level
• Acoustic impedance, Sound impedance, Characteristic impedance
• Speed of sound, Amplitude

See also

• Acoustic theory
• Beat
• Doppler effect
• Echo
• Musical tone
• Pitch
• Resonance
• Reverberation
• Sonic weaponry
• Sound localization
• Soundproofing
• Structural acoustics
• Timbre
• Ultrasound
• List of unexplained sounds

References

External links

Library resources about Sound

Resources in your library

• Sounds Amazing; a KS3/4 learning resource for sound and waves
• HyperPhysics: Sound and Hearing
• Introduction to the Physics of Sound
• Hearing curves and on-line hearing test
• Audio for the 21st Century
• Conversion of sound units and levels
• Sound calculations
• Audio Check: a free collection of audio tests and test tones playable on-line
• More Sounds Amazing; a sixth-form learning resource about sound waves

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. 心音の聴診 auscultation of heart sounds
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English Journal

• Sound symbolism in infancy: Evidence for sound-shape cross-modal correspondences in 4-month-olds.

• Ozturk O, Krehm M, Vouloumanos A.SourceDepartment of Psychology, New York University, New York, NY 10003, USA. Electronic address: ozge.ozturk@nyu.edu.
• Journal of experimental child psychology.J Exp Child Psychol.2013 Feb;114(2):173-86. doi: 10.1016/j.jecp.2012.05.004. Epub 2012 Sep 7.
• Perceptual experiences in one modality are often dependent on activity from other sensory modalities. These cross-modal correspondences are also evident in language. Adults and toddlers spontaneously and consistently map particular words (e.g., 'kiki') to particular shapes (e.g., angular shapes). Ho
• PMID 22960203

• An electrodiagnostic approach to the evaluation of peripheral neuropathies.

• Bromberg MB.SourceDepartment of Neurology, University of Utah, 175 North Medical Drive, Salt Lake City, UT 84132, USA. Electronic address: mbromberg@hsc.utah.edu.
• Physical medicine and rehabilitation clinics of North America.Phys Med Rehabil Clin N Am.2013 Feb;24(1):153-68. doi: 10.1016/j.pmr.2012.08.020. Epub 2012 Oct 16.
• Electrodiagnosis, which includes nerve conduction and needle electromyographic studies, is an essential element in the evaluation of peripheral neuropathies. A systematic approach to the electrodiagnostic evaluation aids in clarifying the distribution and extent of involvement, type of nerve damage,
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• Electrodiagnosis of cervical radiculopathy.

• Hakimi K, Spanier D.SourceRehabilitation Care Services, Department of Rehabilitation Medicine, VA Puget Sound, Rehabilitation Care Services (RCS-117), 1660 South Columbian Way, Seattle, WA 98108, USA. Electronic address: khakimi@uw.edu.
• Physical medicine and rehabilitation clinics of North America.Phys Med Rehabil Clin N Am.2013 Feb;24(1):1-12. doi: 10.1016/j.pmr.2012.08.012. Epub 2012 Oct 24.
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• PMID 23177027

• Improved corner detection by ultrasonic testing using phase analysis.

• Broberg P, Runnemalm A, Sjödahl M.SourceUniversity West, SE-461 86 Trollhattan, Sweden. Electronic address: patrik.broberg@hv.se.
• Ultrasonics.Ultrasonics.2013 Feb;53(2):630-4. doi: 10.1016/j.ultras.2012.10.015. Epub 2012 Nov 6.
• In ultrasonic testing, corners are used for sensitivity calibration in the form of notches, for measuring the sound velocity in the material, and as known reference points during testing. A 90° corner will always reflect incoming waves in the opposite direction due to a double reflection and theref
• PMID 23164172

Japanese Journal

• モバイルアプリケーションのための階層キーバリューストア

• 喜田 一成,前田 敦司,山口 喜教
• 情報処理学会論文誌. プログラミング 6(2), 104, 2013-08-29
• 近年,高速な移動通信システムの普及や演算装置の高速化,省電力化にともない,基本ソフトを搭載したスマートフォンと呼ばれる高機能な携帯電話が急速に普及している.スマートフォンにおいては,ベンダが安全性や健全性を審査したソフトウェアだけが利用者に配信される機構を採用しており,開発者はソフトウェアの更新のたびにベンダに再審査を依頼しなければならず,利用者へ瞬時に更新内容を提供することができない.この問題を …
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• A short note on Dynamic Stabilization of Moving Particle Semi-implicit method

• Tsuruta Naoki,Khayyer Abbas,Gotoh Hitoshi
• Computers & Fluids 82, 158-164, 2013-08-00
• … The DS scheme is shown to provide physically sound and computationally stable simulations of such flows. …
• NAID 120005296112

• 形態素解析手法と通俗的単語群に基づく類音文変換システム

• 金久保 正明
• 情報処理学会論文誌 54(7), 1937-1950, 2013-07-15
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• NAID 110009586575

• 小中学校の音環境に関する調査研究 : 長野市と名古屋市を例として

• 西川 嘉雄,立石 春貴,倉橋 彩百合
• 長野工業高等専門学校紀要 = Memoirs of Nagano National College of Technology 47, 1-8, 2013-06-30
• … This study aimed to sound environment of elementary and junior high schools in the questionnaire survey and noise measurement. …
• NAID 120005306253

Related Links

• Sound Horizon official website

Sound Horizon（サウンドホライズン）は Revo（レヴォ サウンドクリエーター）を中心とした幻想楽団です。 ... [フィーチャーフォン] http://sound-horizon.jp [スマートフォン] http://sp.sound-horizon.jp

• ＠sound.jp - 大容量1GBの無料ホームページ

スピードと安定性重視の大容量1GB無料ホームページスペースです。先着順のsound.jpアカウントを利用できます。 ... URL http://sound.jp/user/ 料金 無料 UpLoad FTP 容量 1GB 広告 あり（位置指定可） 商用利用 可能（条件あり）

• 楽器 サウンドハウス - PA音響機器、DJ・DTM、照明機器 ...

楽器、PA音響機器、DJ・DTM、照明機器、カラオケ機材をどこよりも【激安特価】でご提供する全国通販サイトです。楽器、音響機器のことならサウンドハウスにお任せください！

Related Pictures

---

★リンクテーブル★

国試過去問	「107H020」
リンク元	「100Cases 10」「音」「ブジー」「tone」「salutary」
拡張検索	「breath sound」「vesicular sound」

「107H020」

　　[★]

• 検査と物理現象の組合せで正しいのはどれか。

• a　electrocardiography － sound
• b　endoscopy － heat
• c　magnetic resonance imaging － light
• d　positron emission tomography － radiation
• e　ultrasonography － gravitation

[正答]

D

※国試ナビ4※　［107H019］←［国試_107］→［107H021］

「100Cases 10」

　　[★]

☆case10　背痛

■症例

27歳　女性

主訴：背中に突き抜ける？痛み(pain across her back)

現病歴：背中に広がる痛みを訴えて、27歳の女性が救急部に運ばれてきた。２日前に熱が出て背部痛が始まり、以降調子が悪い。痛みは増強している。6時間前に2度嘔吐した。

既往歴：3ヶ月前に合併症のない胆嚢炎。

・身体診断

調子が悪そうであり、紅潮している。体温：39.2℃。脈拍：120/分。血圧：104/68 mmHg。心血管系、呼吸器系に異常を認めず。腹部：全体的に圧痛。両側の腰部で著明な圧痛。

・検査

(血液生化学)

白血球↑、血清尿素↑、CRP↑

(尿検査)

タンパク：++、鮮血：+++、亜硝酸塩：++

尿の顕微鏡検査：(おそらく400倍の一視野に)赤血球>50、白血球>50

腹部X線：正常

■glossary

loin n. (pl)腰、腰部(→(adj.)lumbar)。(獣の)腰肉、ロイン。(pl)陰部、生殖器、性器

腸雑音、腸音、intestinal murmur、intestinal sound、bowel sound

urine microscopy 尿の顕微鏡検査

dysuria 排尿障害

urgency n. 切迫、急迫、危急。緊急、火急、焦眉の急。[pl]しつこい要求、懇願。せき立てる力、刺激

hydronephrosis 水腎症

-nephros 腎臓

-stomy 開口術

nephrostomy n. 腎瘻造設術、腎造瘻術、腎瘻術

obstructive urophathy 閉鎖性尿路疾患

intravenous fluid 静脈内輸液

commence vt. 始める、開始する。 vi. ～から始める、始まる(with)

urgently

eradication n. 根絶、撲滅

mimic vt. ～の物まねをする、まねて馬鹿にする。そっくりに[卑屈に]まねる。～によく似る

renal ultrasound 腎臓超音波検査

obstructive uropathy 閉塞性尿路疾患

polycystic kidney disease 多発性嚢胞腎

medullary sponge kidney 海綿腎

loin-pain hematuria syndrome 腰痛血尿症候群

■解説

(第1パラグラフ)疫学

　急性腎盂腎炎：男性より女性でmore common。尿路からの細菌の上行感染。リスク：妊娠、糖尿病、免疫低下者、尿路奇形(尿の腎臓への逆流。そして多分、狭窄していたりして結石で閉塞されやすいこともあると思う)

(第2パラグラフ)病態

　食欲不振、悪心、嘔吐と共に40℃の発熱が出ることがある。

　腎盂腎炎患者の中には膀胱炎の先行症状(排尿障害、頻尿、尿意切迫、血尿)がある人がいるけど、こういう下部尿路症状がいつも出現するわけではない。

　多くの腎盂腎炎患者は、先行する6ヶ月以内の膀胱炎の既往がある。

　老人の場合、非典型的な症状を示し、そして混乱した状態でやってくる。

　腎盂腎炎は他の病態によく似ている：急性虫垂炎、急性胆嚢炎、急性膵炎、下葉の肺炎

　普通、体表から見て腎臓の直上に前からも後ろからも圧痛を感じる。

　未治療の腎盂腎炎では敗血症になるかもしれない。

(第3パラグラフ)本ケースについて

　・CRP上昇は急性感染症を示唆

　・顕微鏡的血尿・タンパク尿、白血球増多は尿路の炎症を示す。

　・硝酸塩(nitrate, HNO3と何かの塩)から亜硝酸塩(nitrite, HNO2と何かの塩)への還元により細菌の存在が確認される。

　　覚え方：亜硝酸は(Oが一つ)足らないi(愛)

　　でも複雑です。

　　　HNO2　亜硝酸 nitrous acid, nitrite　。亜硝酸塩 nitrite

　　　HNO3　硝酸 nitric acid, nitrate　　 。硝酸塩 nitrate

(第4パラグラフ)管理

　・女性は入院すべき。

　・血液と尿の採取

　・静脈内輸液＋抗生物質で治療開始。微生物が同定されたら、感受性のある抗菌薬を使用する。初期治療ではゲンタマイシン、アンピシリン、シプロフロキサシンを用いる

　・腎臓エコー検査：尿路閉塞を除外するため。閉塞性尿路疾患では、激しい痛み、発熱、敗血症ショック、腎不全を伴う脳腎症を起こしうる。

　・尿路敗血症の経過で水腎症が疑われたら、合併症を防ぐために緊急に腎瘻を造設すべき

(第5パラグラフ)薬物治療

　・(腎結石など合併していない)腎感染症(ucomplicated renal infection)患者は抗生物質2週間のコースで治療すべき。

　・感染の根絶を確実にする治療が終わった後10-14日間は、反復して細菌培養をする。＜

　・尿路結石を有する感染症や腎瘢痕を有する患者では抗生物質6週間のコースが用いられる。

■鑑別診断のポイント

　腎盂腎炎は片側性、あるいは両側性の腰痛を引き起こす。

　腰部痛の鑑別診断：

　　閉塞性尿路疾患

　　腎梗塞：心疾患などで生じた血栓が腎動脈またはその分枝を閉塞し、その血管の支配領域が虚血性壊死に陥った状態。

　　腎細胞癌：腎尿細管上皮細胞より発生する悪性腫瘍

　　腎乳頭壊死：腎乳頭より腎髄質にかけて、その支配動脈の虚血により壊死を来したもの。 主として基礎疾患に糖尿病を有する人にみられ、しばしば急性腎盂腎炎などの尿路感染に伴って発症する。

　　腎結石：

　　糸球体腎炎：

　　多発性嚢胞腎：先天性かつ両側性に腎実質内に大小無数の嚢胞を発生する。 ほとんどが両側性で、貧血、顕微鏡的血尿、蛋白尿、高血圧といった症状を呈しながら腎機能が低下し、最終的には腎不全となる疾患

　　海綿腎：腎錐体における集合管の先天性嚢状拡張症。症状としては拡張した集合管に尿の停滞　→　感染・細かな結石ができる。

　　腰痛血尿症候群：若年女性に好発し、反復して出現する腰部から側腹部の強い疼痛と血尿を主徴とする病因不明の疾患。肉眼的血尿や軽度の蛋白尿がみられることもあるが、特異的な検査所見はなく、診断は他疾患の除外診断による

■KEYPOINT

・急性腎盂腎炎は下部尿路症状があったり無かったりする。

・腎臓超音波検査は尿路閉塞を否定するために、入院24時間後に行うべき。

・抗菌薬は、再発のリスクを最小限にするために、少なくとも2週間継続すべき。

□閉塞性尿路疾患(http://merckmanual.jp/mmpej/sec17/ch229/ch229a.htmlより引用)

• 閉塞性尿路疾患は正常な尿流を構造的または機能的に妨げ，ときに腎機能不全（閉塞性腎症）を起こすことがある。症状は，慢性の閉塞では認められないこともあるが，T11からT12にかけての皮膚分節に放散する疼痛，無尿，夜間頻尿または多尿がある。診断は閉塞のレベルによって，膀胱カテーテル法，超音波検査，CT，膀胱尿道鏡検査，膀胱尿道撮影または腎盂造影に基づく。治療は原因によって異なり，迅速なドレナージ，器具使用，外科手術（例，内視鏡法，砕石術）および/またはホルモン療法を必要とする場合がある。

□KUBの陰影から尿路結石成分の推定

　リン酸カルシウム(22.0)

　シュウ酸カルシウム(10.8)：シュウ酸カルシウム結石は，尿路結石のうちで最も頻度が高く（70～80％），シュウ酸カルシウム結石の約半数はリン酸カルシウムとの混合結石である。

　リン酸マグネシウムアンモニウム(4.1)：ストラバイト結石：尿素分解菌(Proteus　、Klebsiella　、Pseudomonas　)による尿路感染が原因で、尿素が分解されアンモニアとなると尿がアルカリ性となり、リン酸マグネシウムアンモニウム結石が形成される。

　シスチン(3.7)：ホモシスチン尿症

　尿酸(1.4)：痛風

　キサンチン(1.4)：プリン体

□多嚢胞腎

　常染色体劣性多発性嚢胞腎：ARPKD

　　旧名：幼児型嚢胞腎

　常染色体優性多発性嚢胞腎：ADPKD

　　旧名：成人型嚢胞腎

「音」

　　[★]

英

tone、sound

関

緊張、緊張度、トーン、響く、健全

• 音の大きさ loudness：心理的な尺度。単位はsone
• 音の強さ：物理的な尺度
• 音の高さ

「ブジー」

　　[★]

英

bougie

同

消息子 ゾンデ sound、探針 probe、Sonde、proba、probatus、specillum

• 狭窄部を拡張する針金状器具

「tone」

　　[★]

• n.

• 音、緊張、緊張度、トーン

関

sound、strain、stress、tonicity、tonus

　 　 　 　 　 　 　 　 　 　 　

「salutary」

　　[★]

• adj.

• 有益な、健全な

関

beneficial、helpful、informative、of use、sound、useful

　

「breath sound」

　　[★]

• 呼吸音

関

respiratory sound

「vesicular sound」

　　[★] 肺胞呼吸音。肺胞音