{"created":"2021-03-01T06:14:55.577967+00:00","id":10767,"links":{},"metadata":{"_buckets":{"deposit":"49257e01-9a86-4a97-a5f0-e334f5776cce"},"_deposit":{"id":"10767","owners":[],"pid":{"revision_id":0,"type":"depid","value":"10767"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:00010767","sets":["453:456","471:537:538:980"]},"item_7_alternative_title_1":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"A case of Toxic Shock Syndrome (TSS) induced by MRSA in Post Operation Period of Gastric Cancer"}]},"item_7_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2009-04","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"4","bibliographicPageEnd":"187","bibliographicPageStart":"181","bibliographicVolumeNumber":"123","bibliographic_titles":[{"bibliographic_title":"新潟医学会雑誌"},{"bibliographic_title":"新潟医学会雑誌","bibliographic_titleLang":"en"}]}]},"item_7_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"Toxic Shock Syndrome (TSS) はMRSAを含む黄色ブドウ球菌が産生する毒素性ショック症候群毒素 (TSST-1) やエンテロトキシンなどの外毒素によって惹起される症候群である. 発熱・血圧低下・全身紅斑・下痢が突然出現し, 敗血症性ショック・DICへと進行し, 重篤な多臓器不全をきたし, 死に至ることも多いが, 消化器手術後のTSS例の報告は少ない. 今回, 胃癌術後にMRSA腸炎となり, さらにTSSを併発し重篤化したが, 早期の集中治療の開始により, 救命し得た1例を経験したので報告する. 59歳男性. 進行胃癌にて胃全摘術後, 第3病日に激しい下痢・発熱があり, 翌日に敗血症性ショックから急性腎不全を併発し, ICU管理となった. 同日に採取した便培養からはMRSAが検出された. 直ちに, VCM・TEICの投与, エンドトキシン吸着・血液透析を含めた集学的治療を開始した. 皮膚所見は3日目から紅斑が出現し全身に広がり, 7日冒頃から落屑が認められ, その後は消退していった. 便培養から検出されたMRSAは, 後日TSST-1およびエンテロトキシンC産生株であることが判明した. TSSにみられる臨床症状は多彩で, 臨床経過としてきわめて突然に発熱・血圧低下・全身紅斑・下痢が出現するのが特徴であり, また皮膚所見も非常に特徴的であるが, 臨床上数日経過してから認められるため, 発症時の診断の決め手になりにくい. TSSを発症したときには, 既に敗血症性ショック・DICに陥っていることが多く, 過去の報告例からも早期の集学的治療導入が救命対策として重要であると考えられた.","subitem_description_type":"Abstract"}]},"item_7_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"73527","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Shimizu, Takao"}]}]},"item_7_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟医学会"}]},"item_7_select_19":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_select_item":"publisher"}]},"item_7_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00182415","subitem_source_identifier_type":"NCID"}]},"item_7_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"00290440","subitem_source_identifier_type":"ISSN"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"清水, 孝王"}],"nameIdentifiers":[{"nameIdentifier":"73526","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-06"}],"displaytype":"detail","filename":"123(4)_181-187.pdf","filesize":[{"value":"1.6 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"123(4)_181-187.pdf","url":"https://niigata-u.repo.nii.ac.jp/record/10767/files/123(4)_181-187.pdf"},"version_id":"4808b909-c65c-4fc7-ab70-b3cc38749f25"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"toxic shock syndrome (TSS)","subitem_subject_scheme":"Other"},{"subitem_subject":"胃癌術後","subitem_subject_scheme":"Other"},{"subitem_subject":"MRSA感染症","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":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"胃癌術後にToxic Shock Syndrome (TSS) を併発し重篤化した1例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"胃癌術後にToxic Shock Syndrome (TSS) を併発し重篤化した1例"},{"subitem_title":"胃癌術後にToxic Shock Syndrome (TSS) を併発し重篤化した1例","subitem_title_language":"en"}]},"item_type_id":"7","owner":"1","path":["456","980"],"pubdate":{"attribute_name":"公開日","attribute_value":"2014-07-22"},"publish_date":"2014-07-22","publish_status":"0","recid":"10767","relation_version_is_last":true,"title":["胃癌術後にToxic Shock Syndrome (TSS) を併発し重篤化した1例"],"weko_creator_id":"1","weko_shared_id":null},"updated":"2022-12-15T03:44:20.464045+00:00"}