WordNet

having the surface decorated with a network of fine cracks, as in crackleware; "a crackle glaze"
to become, or to cause to become, covered with a network of small cracks; "The blazing sun crackled the desert sand"
glazed china with a network of fine cracks on the surface (同)crackleware, crackle china
the sharp sound of snapping noises (同)crackling, crepitation
breathe with difficulty
breathing with a husky or whistling sound
(Briticism) a clever or amusing scheme or trick; "a clever wheeze probably succeeded in neutralizing the German espionage threat"

PrepTutorEJDIC

パチパチと音をたてる / 《the ~》パチパチいう音 / 〈U〉(陶磁器の表面の)細かいひび模様;ひび焼き
〈ぜんそくの人などが〉ゼーゼー(ヒーヒー)と息をする / 〈車などが〉ゼーゼー(ヒーヒー)という音を立てる / …‘を'ゼーゼー息を切らして言う《+out+『名』,+『名』+out》 / ゼーゼーすること;その音 / 《俗》冗談;いたずら

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/14 20:30:24」(JST)

wiki en

	Wheezing The sound of wheezing as heard with a stethoscope.
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A wheeze (formally called "sibilant rhonchi" in medical terminology) is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed, or airflow velocity within the respiratory tree must be heightened. Wheezing is commonly experienced by persons with a lung disease; the most common cause of recurrent wheezing is asthma attacks, though it can also be a symptom of lung cancer.

The differential diagnosis of wheezing is wide, and the reason for wheezing in a given patient is determined by considering the characteristics of the wheezes and the historical and clinical findings made by the examining physician.

Characteristics

Wheezes occupy different portions of the respiratory cycle depending on the site of airway obstruction and its nature. The fraction of the respiratory cycle during which a wheeze is produced roughly corresponds to the degree of airway obstruction.^[1]^[2] Bronchiolar disease usually causes wheezing that occurs in the expiratory phase of respiration. The presence of expiratory phase wheezing signifies that the patient's peak expiratory flow rate is less than 50% of normal.^[3] Wheezing heard in the inspiratory phase on the other hand is often a sign of a stiff stenosis, usually caused by tumors, foreign bodies or scarring. This is especially true if the wheeze is monotonal, occurs throughout the inspiratory phase (i.e. is "holoinspiratory"), and is heard more proximally, in the trachea. Inspiratory wheezing also occurs in hypersensitivity pneumonitis.^[4] Wheezes heard at the end of both expiratory and inspiratory phases usually signify the periodic opening of deflated alveoli, as occurs in some diseases that lead to collapse of parts of the lungs.

The location of the wheeze can also be an important clue to the diagnosis. Diffuse processes that affect most parts of the lungs are more likely to produce wheezing that may be heard throughout the chest via a stethoscope. Localized processes, such as the occlusion of a portion of the respiratory tree, are more likely to produce wheezing at that location, hence the sound will be loudest and radiate outwardly. The pitch of a wheeze does not reliably predict the degree of narrowing in the affected airway.^[5]

A special type of wheeze is stridor. Stridor — the word is from the Latin, strīdor^[6] — is a harsh, high-pitched, vibrating sound that is heard in respiratory tract obstruction. Stridor heard solely in the expiratory phase of respiration usually indicates an upper respiratory tract obstruction, "as with aspiration of a foreign body (such as the fabled pediatric peanut)."^[7] Stridor in the inspiratory phase is usually heard with obstruction in the upper airways, such as the trachea, epiglottis, or larynx; because a block here means that no air may reach either lung, this condition is a medical emergency. Biphasic stridor (occurring during both the inspiratory and expiratory phases) indicates narrowing at the level of the glottis or subglottis, the point between the upper and lower airways.

Diagnosis

1 out of 3 preschool children and 2 out of 3 school children with recurrent wheezing/coughing are allergic.^{[citation needed]} The reaction creates an inflammation that, in turn, can lead to a variety of symptoms such as wheezing.

Over the last decade allergy has increased by 18% in the United States.^[8] Today one child in four is allergic.^{[citation needed]} Early diagnosis of allergy is important for the development of the child later in life.^{[citation needed]} There are many patients with symptoms suggesting eczema, rhinitis, hay fever, asthma or wheezing.

References

^ Baughman RP, Loudon RG (Nov 1984). "Quantitation of wheezing in acute asthma" (– ^{Scholar search}). Chest 86 (5): 718–22. doi:10.1378/chest.86.5.718. PMID 6488909. ^{[dead link]}
^ Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V (Jul 1985). "The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry". Am Rev Respir Dis. 132 (1): 16–21. PMID 3160273.
^ Shim CS, Williams MH (May 1983). "Relationship of wheezing to the severity of obstruction in asthma". Arch Intern Med. 143 (5): 890–2. doi:10.1001/archinte.143.5.890. PMID 6679232.
^ Earis JE, Marsh K, Pearson MG, Ogilvie CM (Dec 1982). "The inspiratory "squawk" in extrinsic allergic alveolitis and other pulmonary fibroses". Thorax 37 (12): 923–6. doi:10.1136/thx.37.12.923. PMC 459459. PMID 7170682.
^ Meslier N, Charbonneau G, Racineux JL (Nov 1995). "Wheezes". Eur Respir J. 8 (11): 1942–8. doi:10.1183/09031936.95.08111942. PMID 8620967.
^ Simpson JA, Weiner ESC (eds). "stridor, n. 2." Oxford English Dictionary 2nd ed. Oxford: Clarendon Press, 1989. OED Online Oxford University Press. Accessed September 10, 2005. http://dictionary.oed.com.
^ Sapira JD, Orient JM (2000). Sapira's art & science of bedside diagnosis (2nd ed.). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-683-30714-2.
^ Park, Alice (2009-02-26). "Why We're Going Nuts Over Nut Allergies - TIME". Time. Retrieved 2 March 2009.

External links

Audio Breath Sounds - Multiple case studies with audio files of lung sounds.
R.A.L.E. Repository - sound files of breath sounds

UpToDate Contents

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1. 小児の喘鳴へのアプローチ approach to wheezing in children
2. 成人における喘息以外の喘鳴をきたす疾患の評価 evaluation of wheezing illnesses other than asthma in adults
3. ウイルス誘発性の喘鳴および喘息：概要 virus induced wheezing and asthma an overview
4. 小児における喘息以外の喘鳴疾患 wheezing illnesses other than asthma in children
5. 幼児における再発するウイルス誘発性喘鳴の治療 treatment of recurrent virus induced wheezing in young children

English Journal

Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial.

Watson DI1, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG.
Annals of surgery.Ann Surg.2015 Feb;261(2):282-9. doi: 10.1097/SLA.0000000000000842.
OBJECTIVE: Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair.BACKGROUND: Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has
PMID 25119120

Life-course of cardio-respiratory associations.

Eising JB1, van der Ent CK2, van der Gugten AC2, Grobbee DE3, Evelein AM3, Numans ME3, Uiterwaal CS3.
European journal of preventive cardiology.Eur J Prev Cardiol.2015 Feb;22(2):140-9. doi: 10.1177/2047487313510410. Epub 2013 Oct 30.
BACKGROUND: Several studies have shown that raised cardiovascular risk factors are associated with an impaired lung function in adulthood. Whether this association also exists in the young is unknown. Our aim was to study the relation between blood pressure and lung function from neonatal to elderly
PMID 24174402

Pre- and postnatal exposure to tobacco smoke and respiratory outcomes during the first year.

Fuentes-Leonarte V1, Estarlich M, Ballester F, Murcia M, Esplugues A, Aurrekoetxea JJ, Basterrechea M, Fernández-Somoano A, Morales E, Gascón M, Tardón A, Rebagliato M.
Indoor air.Indoor Air.2015 Feb;25(1):4-12. doi: 10.1111/ina.12128. Epub 2014 Jun 21.
The different role of prenatal and postnatal exposure to tobacco smoke in respiratory outcomes in infants has not yet been clearly established. Our objective is to assess the effects of these exposures on the risk of respiratory outcomes during the first year of life of infants from a Spanish multic
PMID 24810295

Japanese Journal

小児科領域における研究と治療の進歩(13)小児下気道ウイルス感染症

濱田洋通/寺井勝
東京女子医科大学雑誌 81(6), 391-396, 2011-12-25
小児下気道感染症は,小児診療でもっとも頻度の高い疾患群である.その中で呼吸器ウイルスによる下気道感染症は,起因ウイルスの同定に時間がかるために知見がなかなか蓄積されなかった.しかしここ10年でPCR法による検出が進歩し,ヒトメタニューモウイルス,SARSウイルス,ボカウイルス,A/H1N12009インフルエンザウイルスが次々と発見され,それらの病態理解が進展をみせている.特にヒトメタニューモウイル …
NAID 110008754016

<Originals>An empirical trial of one-week treatment with inhaled orticosteroids for distinguishing asthmatic syndrome from asthma mimics

Haraguchi Ryuta,Tomita Katsuyuki,Sano Hiroyuki,Santo Hiroshi,Ichihashi Hideo,Higashimoto Yuji,Iwanaga Takashi,Kume Hiroaki,Toda Yuji
Acta Medica Kinki University 36(1), 15-22, 2011-6
… This study included 126 subjects who had episodes of wheezing at night and/or in the early morning. …
NAID 120003291652

レーザー療法,アルゴンプラズマ凝固療法で治療後,不幸な転帰をたどった気管気管支アミロイドーシスの1例

吉田健也,山本雅史,島浩一郎,後藤康洋,竹山佳宏,楠瀬公章,各務智彦,水野秀和,田中太郎,小沢直也
気管支学 : 日本気管支研究会雑誌 33(2), 93-98, 2011-03-25
背景.アミロイドは様々な臓器に沈着するが,まれに呼吸器系に沈着する.症例.50歳,男性.2004年7月から呼吸困難,喘鳴が出現.同月,当院を受診.胸部単純X線写真,胸部CTにて気管内に突出する腫瘤性病変を認めた.気管支鏡下生検でアミロイドーシスと診断した.同年7月,レーザー療法,8月にアルゴンプラズマ凝固療法(argon plasma coagulation(APC))を施行し,自覚症状,呼吸機能 …
NAID 110008609499

Related Pictures

★リンクテーブル★

リンク元	「喘鳴」「有機リン中毒」「連続音」「副雑音」「crackle」

「喘鳴」

Wheezing
ICD-10	R06.2
ICD-9	786.07
MedlinePlus	003070

　　[★]

英: wheezing, wheeze, stridor, harsh, grating sound
同: 狭窄音 stenotic sound
関: ラ音、呼吸音

概念

広義：聴診器なしに聴かれる異常呼吸音
狭義：聴診上、高音(400Hz以上)で連続性(0.25秒以上続く)の副雑音

定義：weezeとstridor

wheeze

a wheeze is a musical and continuous sound that originates from oscillations in narrowed airways (NEL.1773)

wheezing is heard mostly on expiration as a result of critical airway obstruction

stridor (NEL.1773)

when obstruction occurs in the extrathoracic airways during inspiration, the noise is reffered to as stridor (NEL.1773)
吸気時喘鳴、吸気性喘鳴、inspiratory stridorとも記載されうる。

吸気時により著明なで、上気道・中枢気道狭窄による喘鳴

喘鳴を来す疾患

呼気時の喘鳴

気管支喘息

etc.

吸気時の喘鳴

気道感染
先天性

喉頭無力症、気管無力症、喉頭・気管奇形

喉頭・気管嚢腫瘍

甲状舌管嚢胞、乳頭症

神経性

反回神経麻痺、分娩障害

圧迫による気管狭窄

巨舌症、頚部腫瘍、食道癌

喉頭浮腫

血管神経性、機械的刺激、全身浮腫

喉頭痙攣

テタニー、Gaucher病、機械的刺激

喉頭・気管異物

小児の喘鳴

SPE.300

	急性喘鳴	反復性喘鳴
乳児 2歳未満	急性細気管支炎気管支炎・肺炎食物アレルギーによるアナフィラキシークループ食道異物	乳児喘息喉頭軟化症・気管支軟化症慢性肺疾患（新生児期の呼吸器障害後) 先天異常による気道狭窄(血管輪など) 胃食道逆流症閉塞性細気管支炎心不全声帯機能異常
幼児以降 2歳以降	食道胃物食物アレルギーによるアナフィラキシークループ腫瘤による気道圧迫(縦隔腫瘍など)	喘息慢性肺疾患（新生児期の呼吸器障害後) 気管支拡張症胃食道逆流症閉塞性細気管支炎先天性免疫不全症(反復性呼吸器感染) 声帯機能異常

心不全の喘鳴

臥位になってから2時間程度して喘鳴が出現する。間質に分布していた水分が血管内に戻ってきてそして肺で溢れる

参考

喘鳴を来す小児疾患

http://www.med.kurume-u.ac.jp/med/imed1/students/syllabus/kokyuki24.pdf

「有機リン中毒」

　　[★]

英: organophosphorus poisoning
関: パラチオン、サリン、サリン中毒; 研修医当直御法度症例帳 p.24; 研修医当直御法度第5版 p.145

概念

有機リン系農薬(有機リン化合物、有機リン剤)による中毒を指す。

病態

コリンエステラーゼを不可逆的に不活化して阻害し、シナプスにおけるアセチルコリン濃度を上昇させる。

症状

症状はムスカリン受容体を介した作用、ニコチン受容体を介した作用、中枢神経作用が見られる。針先瞳孔を見たらまず有機リン中毒を疑う
軽症例：頭痛、倦怠感、嘔気、嘔吐、流涎、発汗
中等症：縮瞳、筋線維束攣縮、言語障害
重症例：

　[中枢神経症状]意識混濁、昏睡　[ニコチン受容体を介した作用]全身痙攣、呼吸筋麻痺

治療

原因の除去：

1. PAMの静脈投与　→　ただし、有効な時間が限定される
2. 透析療法、血漿交換　→　有機リンは組織への移行性が高く有効性は低い。

対症療法：アトロピン

研修医当直御法度第5版 p.145

PAM 1-2g 静注
アトロピン静注　　←　　減量に注意(recurrentする)

	症状	血中ChE (正常比)	治療
無症状	なし	≧50%	6hr経過観察
軽度	(歩行可能) 全身倦怠感、頭痛、眩暈、四肢痺れ、悪心、嘔吐、発汗、唾液分泌亢進、wheezing、腹痛、下痢	20-50%	アトロピン 1mg IV PAM 1g IV
中等度	(歩行不能) 軽度の症状に加え、全身筋力低下、構語障害、筋攣縮、縮瞳	10-20%	アトロピン 1-2mg IV, 15-30分ごと。atropinazationまで PAM 1g IV
重症	意識障害、四肢麻痺、筋攣縮、針先瞳孔、呼吸促迫、チアノーゼ	≦10%	アトロピン 5mg IV, 15-30分ごと。atropinazationまで PAM 1-2g IV。奏効しない場合 0.5g/hr 点滴静注