{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390001204371530880.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.3893/jjaam.22.284"}},{"identifier":{"@type":"NAID","@value":"130004542318"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2011313303"}}],"dc:title":[{"@language":"en","@value":"A rapid multidisciplinary cooperation is a key for the treatment of severe Fournier's gangrene: a case report"},{"@language":"ja","@value":"多くの診療科の迅速な連携により救命しえたフルニエ壊疽の一重症例"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"en","@value":"Rapid multidisciplinary cooperation is a key factor for the successful treatment of severe Fournier's gangrene: a case report. We report a case of life-threatening Fournier's gangrene. A 79-year-old man was urgently brought in upon collapsing on the floor at home. In the emergency room, he had a high fever and quickly developed hypotension with metabolic acidosis. His scrotum, upper thighs, and abdomen were swollen and necrotic. He was diagnosed with septic shock due to Fournier's gangrene with an Acute Physiologic and Chronic Health Evaluation (APACHE) II score of 33 and Fournier's gangrene severity index score of 15. The patient was urgently transferred to the ICU and immediately treated according to the Surviving Sepsis Campaign Guidelines 2008. After an emergent conference with multidisciplinary surgeons, he was taken for urgent debridement. Postoperatively, direct hemoperfusion with a polymyxin-B immobilized column and low-dose steroids were introduced, as well as mechanical ventilation. Additional irrigation and debridements were performed as needed. He was weaned from mechanical ventilation on hospital day (HD) 9. After discharge from the ICU on HD12, he underwent colostomy for fecal diversion. On HD 62 he was transferred to a long term rehabilitative health care facility. We conclude that early treatment involving the cooperation of multiple specialists is important for the successful treatment of severe Fournier's gangrene."},{"@language":"ja","@value":"フルニエ壊疽は，会陰部を中心とした壊死性筋膜炎の一種であり，医学の進歩した現代においても依然として予後は不良である。我々は，急激に敗血症性ショックに陥った重症のフルニエ壊疽に対し，多くの診療科の迅速な連携による集学的治療を行って救命し得た一例を経験した。症例は79歳の男性。糖尿病と高血圧の既往があった。自宅で倒れているところを家人により発見され当院へ救急搬送された。来院時，発熱および重度の代謝性アシドーシスを伴い，初療中からショック状態が進行した。陰嚢から両側大腿，下腹部～右季肋部にかけて黒色壊死と発赤腫脹が観察され，フルニエ壊疽による敗血症性ショックと診断し，直ちにICUに収容した。入室時のacute physiologic and chronic health evaluation（APACHE）II scoreは33点，Fournier’s gangrene severity index scoreは15点であった。直ちにSurviving Sepsis Campaign guidelines 2008に基づき輸液負荷と抗菌薬治療を行うとともに，外科，泌尿器科，整形外科，救急科で協議し，合同で陰嚢から大腿にかけての広範囲のデブリードメントならびにドレナージ術を施行した。術後も人工呼吸管理，カテコラミンによる循環維持，エンドトキシン吸着療法やステロイドの持続投与を行った。術後，外科系各科により連日の創洗浄やデブリードメントの追加が行われ，感染は徐々にコントロールされ，ショック状態を離脱した。第9病日には人工呼吸器から離脱。第12病日に一般病棟へ転棟し，その後高圧酸素療法併用による感染コントロールと人工肛門，膀胱瘻造設による排泄路変更を施行，第62病日にリハビリテーション目的に近医へ転院となった。本症例の経験より，フルニエ壊疽に対しては，適確な重症度評価から迅速な対応を心がけることと，多くの診療科の協力が不可欠であることを再認識した。"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410853647403380481","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258210379"}],"foaf:name":[{"@language":"en","@value":"Muto Yoshikazu"},{"@language":"ja","@value":"武藤 義和"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Respiratory Medicine, Ogaki Municipal Hospital"},{"@language":"ja","@value":"大垣市民病院呼吸器科"}]},{"@id":"https://cir.nii.ac.jp/crid/1410853647403380484","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258210380"}],"foaf:name":[{"@language":"en","@value":"Niwa Takehiro"},{"@language":"ja","@value":"丹羽 雄大"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Emergency and Intensive Care Medicine, Tosei General Hospital"},{"@language":"ja","@value":"公立陶生病院救急部"}]},{"@id":"https://cir.nii.ac.jp/crid/1410001204426621440","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000259319357"}],"foaf:name":[{"@language":"en","@value":"Hasegawa Ryuichi"},{"@language":"ja","@value":"長谷川 隆一"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Emergency and Intensive Care Medicine, Tosei General Hospital"},{"@language":"ja","@value":"公立陶生病院救急部"}]},{"@id":"https://cir.nii.ac.jp/crid/1410001204426621441","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000006820676"}],"foaf:name":[{"@language":"en","@value":"Kawase Masaki"},{"@language":"ja","@value":"川瀬 正樹"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"公立陶生病院救急部"},{"@language":"en","@value":"Department of Emergency and Intensive Care Medicine, Tosei General Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410853647403380485","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258210383"}],"foaf:name":[{"@language":"en","@value":"Nakashima Yoshihito"},{"@language":"ja","@value":"中島 義仁"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Emergency and Intensive Care Medicine, Tosei General Hospital"},{"@language":"ja","@value":"公立陶生病院救急部"}]},{"@id":"https://cir.nii.ac.jp/crid/1410853647403380480","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000258210384"}],"foaf:name":[{"@language":"en","@value":"Ichihara Toshihiko"},{"@language":"ja","@value":"市原 利彦"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"公立陶生病院救急部"},{"@language":"en","@value":"Department of Emergency and Intensive Care Medicine, Tosei General Hospital"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"0915924X"},{"@type":"EISSN","@value":"18833772"}],"prism:publicationName":[{"@language":"en","@value":"Nihon Kyukyu Igakukai Zasshi"},{"@language":"ja","@value":"日本救急医学会雑誌"},{"@language":"en","@value":"Nihon Kyukyu Igakukai Zasshi"},{"@language":"ja","@value":"日救急医会誌"},{"@language":"en","@value":"Nihon Kyukyu Igakukai Zasshi"}],"dc:publisher":[{"@language":"en","@value":"Japanese Association for Acute Medicine"},{"@language":"ja","@value":"一般社団法人 日本救急医学会"}],"prism:publicationDate":"2011","prism:volume":"22","prism:number":"6","prism:startingPage":"284","prism:endingPage":"290"},"reviewed":"false","url":[{"@id":"https://search.jamas.or.jp/link/ui/2011313303"}],"availableAt":"2011","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=necrotizing%20fasciitis","dc:title":"necrotizing fasciitis"},{"@id":"https://cir.nii.ac.jp/all?q=septic%20shock","dc:title":"septic shock"},{"@id":"https://cir.nii.ac.jp/all?q=multiple%20organ%20failure","dc:title":"multiple organ failure"},{"@id":"https://cir.nii.ac.jp/all?q=debridement","dc:title":"debridement"},{"@id":"https://cir.nii.ac.jp/all?q=PMX-DHP","dc:title":"PMX-DHP"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A3%8A%E6%AD%BB%E6%80%A7%E7%AD%8B%E8%86%9C%E7%82%8E","dc:title":"壊死性筋膜炎"},{"@id":"https://cir.nii.ac.jp/all?q=%E6%95%97%E8%A1%80%E7%97%87%E6%80%A7%E3%82%B7%E3%83%A7%E3%83%83%E3%82%AF","dc:title":"敗血症性ショック"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A4%9A%E8%87%93%E5%99%A8%E4%B8%8D%E5%85%A8","dc:title":"多臓器不全"},{"@id":"https://cir.nii.ac.jp/all?q=%E3%83%87%E3%83%96%E3%83%AA%E3%83%BC%E3%83%89%E3%83%A1%E3%83%B3%E3%83%88","dc:title":"デブリードメント"},{"@id":"https://cir.nii.ac.jp/all?q=%E3%82%A8%E3%83%B3%E3%83%89%E3%83%88%E3%82%AD%E3%82%B7%E3%83%B3%E5%90%B8%E7%9D%80%E7%99%82%E6%B3%95","dc:title":"エンドトキシン吸着療法"}],"relatedProduct":[{"@id":"https://cir.nii.ac.jp/crid/1360011145645066752","@type":"Article","relationType":["references"],"jpcoar:relatedTitle":[{"@value":"Necrotising 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