{"created":"2023-05-25T05:25:45.945717+00:00","id":4248,"links":{},"metadata":{"_buckets":{"deposit":"69415ebd-0d5b-4b85-875b-adb436e68ea5"},"_deposit":{"created_by":17,"id":"4248","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4248"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004248","sets":["29:31:124:125"]},"author_link":["13439","13426","13431","13438","13429","13427","13436","13442","13430","13424","13434","13422","13437","13420","13428","13432","13433","13421","13440","13423","13441","13425","13443","13435"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"A case of gangrenous cholecystitis combined with idiopathic thrombocytopenic purpura : including significance of enteral nutrition for bleeding in medulla oblongata"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"エソセイ タンノウエン ト トクハツセイ ケッショウバン ゲンショウセイ シハンビョウ オ ガッペイ シタ 1レイ : エンズイ シュッケツゴ ノ ケイチョウ エイヨウ ノ ユウヨウセイ モ フクメテ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2018-02-15","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"62","bibliographicPageStart":"57","bibliographicVolumeNumber":"36","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"【背景】壊疽性胆嚢炎症例で血小板減少を認めた場合、通常は敗血症、播種性血管内凝固症候群\n（DIC）を原因として考える。しかし今回、壊疽性胆嚢炎に血小板減少性紫斑病（ITP）を合併した症例を経験したので報告する。\n【症例】54歳の女性。急性胆嚢炎に対し経皮経肝胆嚢ドレナージで保存的に治療されていたが、血小板が7.8万/μlと低下したため外科紹介となった。血小板輸血後に緊急胆嚢摘出術を行った。術後、全身状態は良好であったが、血小板が5,000～20,000/μl以下と低く、連日血小板輸血した。骨髄生検し、抗血小板抗体の結果を待っていたところ、延髄出血が生じた。\n　ITPの可能性も考え、大量γグロブリン療法を行ったところ血小板が上昇した。ステロイド、エルトロンボパグを投与した。後に血小板関連IgG陽性でITPと診断した。延髄出血による嚥下障害に対しては経腸栄養を行い栄養状態の指標であるControlling nutritional status（CONUT）値の改善が得られ、転院した。\n【結論】重症感染症症例であっても全身状態が良好で血小板数のみ少ない場合はITPの合併も念頭に入れる必要がある。術後の延髄出血症例にはEDチューブからの経腸栄養で全身状態を良好にすることが救命のために重要と考えられた。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13436","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ヒライ, イチロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13437","nameIdentifierScheme":"WEKO"}],"names":[{"name":"タカハシ, リョウスケ"}]},{"nameIdentifiers":[{"nameIdentifier":"13438","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ワタナベ, トシヒロ"}]},{"nameIdentifiers":[{"nameIdentifier":"13439","nameIdentifierScheme":"WEKO"}],"names":[{"name":"テズカ, コウジ"}]},{"nameIdentifiers":[{"nameIdentifier":"13440","nameIdentifierScheme":"WEKO"}],"names":[{"name":"スガワラ, シュウイチロウ"}]},{"nameIdentifiers":[{"nameIdentifier":"13441","nameIdentifierScheme":"WEKO"}],"names":[{"name":"トダ, マコト"}]},{"nameIdentifiers":[{"nameIdentifier":"13442","nameIdentifierScheme":"WEKO"}],"names":[{"name":"コウノ, ミチヒサ"}]},{"nameIdentifiers":[{"nameIdentifier":"13443","nameIdentifierScheme":"WEKO"}],"names":[{"name":"キムラ, ワタル"}]}]},"item_3_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"13428","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Hirai, Ichiro"}]},{"nameIdentifiers":[{"nameIdentifier":"13429","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Takahashi, Ryosuke"}]},{"nameIdentifiers":[{"nameIdentifier":"13430","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Watanabe, Toshihiro"}]},{"nameIdentifiers":[{"nameIdentifier":"13431","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Tezuka, Koji"}]},{"nameIdentifiers":[{"nameIdentifier":"13432","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Sugawara, Shuichiro"}]},{"nameIdentifiers":[{"nameIdentifier":"13433","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Toda, Makoto"}]},{"nameIdentifiers":[{"nameIdentifier":"13434","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kono, Michihisa"}]},{"nameIdentifiers":[{"nameIdentifier":"13435","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kimura, Wataru"}]}]},"item_3_identifier_registration":{"attribute_name":"ID登録","attribute_value_mlt":[{"subitem_identifier_reg_text":"10.15022/00004226","subitem_identifier_reg_type":"JaLC"}]},"item_3_publisher_32":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"山形大学"}]},"item_3_source_id_7":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0288-030X","subitem_source_identifier_type":"ISSN"}]},"item_3_source_id_9":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00067279","subitem_source_identifier_type":"NCID"}]},"item_3_text_33":{"attribute_name":"出版者（ヨミ）","attribute_value_mlt":[{"subitem_text_value":"ヤマガタ 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秀一郎"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"外田, 慎"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"河野, 通久"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"木村, 理"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2018-02-15"}],"displaytype":"detail","filename":"kiyoum-36-1-57to62.pdf","filesize":[{"value":"1.7 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"kiyoum-36-1-57to62","url":"https://yamagata.repo.nii.ac.jp/record/4248/files/kiyoum-36-1-57to62.pdf"},"version_id":"3172170a-3fd2-4c6a-a7ca-4268899a198c"}]},"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":"departmental bulletin 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