{"created":"2023-05-15T09:06:18.501805+00:00","id":12947,"links":{},"metadata":{"_buckets":{"deposit":"e1c35405-c3ff-4399-8148-9773305d10e6"},"_deposit":{"created_by":14,"id":"12947","owners":[14],"pid":{"revision_id":0,"type":"depid","value":"12947"},"status":"published"},"_oai":{"id":"oai:sapmed.repo.nii.ac.jp:00012947","sets":["1875:1978:1986"]},"author_link":["19193","19194","19195"],"item_2_alternative_title_18":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Hyperammonemia accompanied with severe sepsis : An autopsy case report"}]},"item_2_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2012-10-31","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"94","bibliographicPageStart":"87","bibliographicVolumeNumber":"72","bibliographic_titles":[{"bibliographic_title":"市立札幌病院医誌 = Acta medica nosocomi Sapporo = The Journal of Sapporo City General Hospital"}]}]},"item_2_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"高アンモニア血症を伴った重症敗血症の剖検例を報告する。症例は72才女性。当院搬入4日前から悪寒と微熱、2日前から膝の痛みが出現した。搬入当日は呼吸窮迫、意識消失で当院に救急搬送された。搬入時JCS 100RI、血圧110/68mmHg、左共同偏視を認めた。DICの状態で、アンモニア、エンドトキシンも著明高値であった。血液培養からH.influenzaeが検出された。搬入後、脳腫脹が進行し搬入3日目に死亡確認され、死亡6時間後に剖検が行われた。両側膝関節からH.influenzaeが検出され、組織学的には肺膿瘍、壊死性筋膜炎が認められた。気道感染から菌血症となり両膝関節炎、壊死性筋膜炎を来たし、敗血症性ショックから循環不全、肝壊死を来したと考えられた。著しい高アンモニア血症の原因は、肝機能障害による尿素回路を介したアンモニア分解能障害、ショックによる肝グルタミンシンテターゼ活性低下、腎前性腎不全よるアンモニア排出能低下の3点からなるアンモニア除去能の低下に加え、壊死性筋膜炎による筋壊死とH.influenzaeが産生するウレアーゼによりアンモニア合成が亢進したためと考えられた。通常敗血症の病態ではアンモニアは採血されないことが多いが、本症例のように異常高値を示すこともあり病態把握ならびに予後予測に有用である可能性がある。","subitem_description_type":"Abstract"}]},"item_2_publisher_32":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"市立札幌病院"}]},"item_2_source_id_7":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0288-6073","subitem_source_identifier_type":"ISSN"}]},"item_2_version_type_15":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"柴山, 惟"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"柳内, 充"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"原田, 太以佑"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2018-07-21"}],"displaytype":"detail","filename":"l425672187.pdf","filesize":[{"value":"1.7 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"l425672187.pdf","url":"https://sapmed.repo.nii.ac.jp/record/12947/files/l425672187.pdf"},"version_id":"e455de0a-02e6-4107-9581-5cf399f657f5"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"高アンモニア血症","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"敗血症性ショック","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"H.influenzae","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"高アンモニア血症を伴った敗血症剖検症例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"高アンモニア血症を伴った敗血症剖検症例","subitem_title_language":"ja"}]},"item_type_id":"2","owner":"14","path":["1986"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2014-05-15"},"publish_date":"2014-05-15","publish_status":"0","recid":"12947","relation_version_is_last":true,"title":["高アンモニア血症を伴った敗血症剖検症例"],"weko_creator_id":"14","weko_shared_id":-1},"updated":"2023-12-13T04:30:18.922761+00:00"}