Winterbottom’s Sign: From 1 Different Sources
A posterior cervical lymphadenopathy indicative of early West African (Gambian) Sleeping Sickness due to Trypanosoma brucei gambiense.
An indication of the existence of something; any objective evidence of a disease.... sign
An indication that an individual is still alive. Chest movements (resulting from respiration), the existence of a pulse (showing that the heart is still beating) and constriction of the pupil of the eye in response to bright light are all vital signs. Other tests such as assessment of brain activity may also be needed in some circumstances: for example, when a patient is on a life-support machine. (See also GLASGOW COMA SCALE.)... vital sign
The pulse, respiration, temperature and blood pressure.... vital signs
A conclusion that an intervention has an effect that is of practical meaning to older persons and health care providers. Even though an intervention is found to have a statistically significant effect, this effect may not be clinically significant. In a trial with a large number of participants, a small difference between treatment and control groups may be statistically significant, but clinically unimportant. In a trial with few participants, an important clinical difference may be observed that does not achieve statistical significance. (A larger trial may be needed to confirm that this is a statistically significant difference).... clinical significance
The physical manifestations of an illness elicited by a doctor when examining a patient – for example, a rash, lump, swelling, fever or altered physical function such as re?exes.... clinical signs
There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.
The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.
In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)
Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of
This is found in MENINGITIS. A healthy person’s thigh can be bent to a right-angle with the body when the knee is straight; in cases of meningitis the knee cannot be straightened when the thigh is bent this way – not without causing the patient intense pain.... kernig’s sign
Oedema of the eyelid in early Chagas’ Disease (South American trypanosomiasis) due to the infected faeces of the vector assassin (triatomid) bug causing swelling of the mucosa of the eye.... romana’s sign
(Latin) A distinguishing sign Signiya, Signea, Signeia, Signeya, Signa... signia
See “probability”.... statistical significance
A reflex movement in which the big toe bends upwards when the outer edge of the sole of the foot is scratched. In adults, Babinski’s sign indicates damage or disease of the brain or the spinal cord. In babies, Babinski’s sign is a normal reflex.... babinski’s sign
ultrasound features of the *Arnold–Chiari malformation in fetuses with spina bifida. The banana sign refers to the shape of the cerebellum owing to caudal displacement; the lemon sign refers to the lemon-shaped head resulting from scalloping of the frontal bones. See illustration.... banana and lemon signs
increased or altered sensitivity in the region of the wing of the right scapula, associated with acute *cholecystitis. [I. I. Boas (1858–1938), German gastroenterologist]... boas’s sign
(BSL) see sign language.... british sign language
a sign present when there is irritation of the meninges (the membranes covering the brain); it is present in meningitis. As the neck is pulled forward, the hips and knees bend involuntarily. [J. von Brudzinski (1874–1917), Polish physician]... brudzinski sign
twitching of the facial muscles elicited by stimulation of the facial nerve by tapping. This indicates muscular irritability, usually due to calcium depletion (see tetany). [F. Chvosteck (1835–84), Austrian surgeon]... chvosteck’s sign
(CROS hearing aid) a form of hearing aid used to help people with severe or profound unilateral hearing loss. Sound information is collected by a microphone worn on the affected side and then transmitted by a thin wire or Bluetooth wireless technology to a device worn on the opposite side. If the hearing in the better ear is normal, no amplification is applied to the signal. If the better ear has a hearing loss the device also acts as a conventional hearing aid and amplifies the signal from both sides: this is known as a BICROS hearing aid.... contralateral-routing-of-signal hearing aid
powerful pulsation of the carotid arteries causing ear movement and/or head nodding. It is a sign of *aortic regurgitation. [Sir D. J. Corrigan]... corrigan’s sign
a bluish bruiselike appearance around the umbilicus due to bleeding into the peritoneum. Causes include a ruptured ectopic pregnancy and acute *pancreatitis. [T. S. Cullen (1868–1953), US gynaecologist]... cullen sign
see sign of Dance.... dance’s sign
a bluish bruiselike appearance around the flanks, which is seen in acute *pancreatitis. [G. Grey Turner (1877–1951), British surgeon]... grey turner sign
a crunching sound synchronous with the heartbeat heard with a stethoscope in 45–50% of patients with *pneumomediastinum. [L. V. Hamman (1877–1946), US physician]... hamman’s sign
an indication of pregnancy detectable between the 6th and 12th weeks: used before modern urine tests for pregnancy were available. If the fingers of one hand are inserted into the vagina and those of the other are placed over the pelvic cavity, the lower part of the uterus feels very soft compared with the body of the uterus above and the cervix below. [A. Hegar (1830–1914), German gynaecologist]... hegar’s sign
(finger-flexion reflex) an abnormal reflex elicited by flicking the distal phalanx of the patient’s middle finger sharply downwards. Hoffmann’s sign is positive when there is a brisk flexion response in the index finger and thumb. It indicates an upper *motor neuron response due to a disorder at or above the cervical (neck) level of the spinal cord. [J. Hoffmann (1857–1919), German neurologist]... hoffmann’s sign
a test for deep vein thrombosis of the calf. With the patient lying supine, the examiner squeezes the calf firmly and dorsiflexes the foot; the test is positive if deep-seated pain is felt in the calf. [J. Homans (1877–1954), US physician]... homans’ sign
(ISL) see sign language.... irish sign language
a bluish or purplish coloration of the vagina: a possible indication of pregnancy. [J. M. Jacquemier (1806–79), French obstetrician]... jacquemier’s sign
pain in the left shoulder caused by irritation of the undersurface of the diaphragm by blood leaking from a ruptured spleen. The pain impulses are referred along the *phrenic nerve. [H. Kehr (1862–1913), German surgeon]... kehr’s sign
a symptom of *meningitis in which the hamstring muscles in the legs are so stiff that the patient is unable to extend his legs at the knee when the thighs are held at a right angle to the body. [V. Kernig (1840–1917), Russian physician]... kernig’s sign
(twin-peak sign) an ultrasound diagnosis of dichorionicity at 10–14 weeks gestation: a peak of placental tissue protrudes into the base of the intertwin membrane. See chorionicity.... lambda sign
see banana and lemon signs.... lemon sign
a tingling shocklike sensation passing down the arms or trunk when the neck is flexed. It is a nonspecific indication of disease in the cervical (neck) region of the spinal cord. Causes include multiple sclerosis, cervical *spondylosis, and deficiency of vitamin B12. [J. Lhermitte (1877–1959), French neurologist]... lhermitte’s sign
a sign of inflammation of the gall bladder (see cholecystitis): continuous pressure over the gall bladder while the patient is taking a deep breath will cause pain at the point of maximum inhalation. [J. B. Murphy (1857–1916), US surgeon]... murphy’s sign
(NISL) see sign language.... northern irish sign language
a sign of bilateral periorbital *haematoma associated with injury to the anterior cranial fossa, the front of the skull cavity that supports the frontal lobes of the brain. The name derives from its similarity in appearance to the black eye patches of a panda.... panda sign
a diagnostic sign for *carpal tunnel syndrome. The patient is asked to hold his or her wrists in full flexion with the dorsal surfaces of both hands pushing against each other with fingers pointing downwards for 30–60 seconds. This manoeuvre increases pressure on the median nerve: tingling and numbness or pain in the thumb, index, middle, and ring fingers suggests carpal tunnel syndrome. See also Tinel’s sign. [G. S. Phalen (1911–98), US orthopaedist]... phalen’s sign
an indicator of acute *appendicitis. The appendix lies close to the *iliopsoas muscle: if it is inflamed, any movement that involves the right psoas muscle (such as extension of the right thigh) will be painful in the right lower quadrant.... psoas sign
an early clinical sign of *Chagas’ disease, appearing some three weeks after infection. There is considerable swelling of the eyelids of one or both eyes. This may be due to the presence of the parasites causing the disease but it may also be an allergic reaction to the repeated bites of their insect carriers. [C. Romaña (20th century), Brazilian physician]... romaña’s sign
a finding on examination suggesting a sensory disorder affecting those nerves that transmit information to the brain about the position of the limbs and joints and the tension in the muscles. The patient is asked to stand upright. Romberg’s sign is positive if he maintains his posture when his eyes are open but sways and falls when his eyes are closed. [M. Romberg (1795–1873), German neurologist]... romberg’s sign
a test used during the assessment of a patient with a possible diagnosis of appendicitis. Pressure is applied to the left iliac fossa. If the test is positive the patient experiences pain in the right iliac fossa. This can be used in conjunction with the history and other clinical signs to guide the clinician as to the likelihood of a diagnosis of appendicitis. [N. T. Rosving (1862–1927), Danish surgeon]... rosving’s sign
1. a sickle-shaped *scotoma appearing as an upward or downward extension of the blind spot. 2. a test to confirm leakage of the aqueous humour. *Fluorescein sodium dye is instilled and viewed with cobalt blue light; a bright green flow of liquid is seen at the site of the leakage. [E. Seidel (1882–1948), German ophthalmologist]... seidel sign
(signed language) a form of communication that uses movements of the hands and other parts of the body together with facial expressions instead of sound. There are many different forms of sign language throughout the world. British Sign Language (BSL) is the form most commonly used in Great Britain. In Northern Ireland, Northern Irish Sign Language (NISL), BSL, and Irish Sign Language (ISL; the most common form in Ireland) are all used.... sign language
(Dance’s sign, signe de Dance) a feeling of emptiness on palpation of the right lower quadrant of the abdomen, which is thought to be characteristic of *intussusception. [J. B. H. Dance (1797–1832), French physician]... sign of dance
apparent widening of the distance between the upper and lower eyelids (the palpebral fissure) due to retraction of the upper lid and protrusion of the eyeball. It is a sign of exophthalmic *goitre. [C. Stellwag von Carion (1823–1904), Austrian ophthalmologist]... stellwag’s sign
inability to lift and pinch the skin of the base of the second toe, which is characteristic of lymphoedema. [R. Stemmer (1925–2000), French phlebologist]... stemmer’s sign
a method for checking the regeneration of a nerve: usually used in patients with *carpal tunnel syndrome. Direct tapping over the sheath of the nerve elicits a distal tingling sensation (see paraesthesia), which indicates the beginning of regeneration. [J. Tinel (1879–1952), French neurosurgeon]... tinel’s sign
n. (in statistics) the degree to which an observed relationship between two test groups is unlikely to have occurred by chance alone. An initial assumption is made that there is no meaningful difference between the groups or conditions under investigation (the null hypothesis). This can be tested using various statistical procedures, and a calculation that there is a probability of less than 5% (P value <0.05) is usually considered sufficient to reject the null hypothesis: the observed difference is statistically significant. Some tests are parametric, based on the assumption that observations will be distributed in a normal or Gaussian *distribution, where 95% of observations lie within two *standard deviations of the mean (Student’s t test to compare means). Nonparametric tests (Mann–Whitney U tests) make no assumptions about distribution patterns. See also standard error of the mean.... significance
enlargement of the lymph node at the base of the neck on the left side (Troisier’s node), which indicates metastatic spread from an abdominal malignant growth, usually a carcinoma of the stomach. [C. E. Troisier (1844–1919), French physician]... troisier’s sign
spasmodic contractions of muscles, especially the muscles of mastication, in response to nerve stimulation (e.g. by tapping). It is a characteristic sign of hypocalcaemia (see tetany). [A. Trousseau (1801–67), French physician]... trousseau’s sign
an ultrasound diagnosis of monochorionicity at 10–14 weeks gestation: the intertwin membrane inserts directly into the placenta, forming a T-sign. See chorionicity.... t-sign
see lambda sign.... twin-peak sign
see Barlow manoeuvre. [S. Von Rosen, Swedish orthopaedic surgeon]... von rosen’s sign
a test used in the diagnosis of a macular hole in the retina. A thin line of light is projected over the macula with a *slit lamp and the patient is asked to report on its appearance. A line appearing broken may indicate a macular hole.... watzke–allen sign
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