{"created":"2023-06-20T15:50:33.244083+00:00","id":3367,"links":{},"metadata":{"_buckets":{"deposit":"6e34cb18-8453-4cb1-975d-c555fa3c0596"},"_deposit":{"created_by":18,"id":"3367","owners":[18],"pid":{"revision_id":0,"type":"depid","value":"3367"},"status":"published"},"_oai":{"id":"oai:redcross.repo.nii.ac.jp:00003367","sets":["99:64:117"]},"author_link":["6842","256","380","8084","48","8085","129","8112","8109","7396"],"item_5_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2006-03-01","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"71","bibliographicPageStart":"66","bibliographicVolumeNumber":"11","bibliographic_titles":[{"bibliographic_title":"徳島赤十字病院医学雑誌"},{"bibliographic_title":"Tokushima Red Cross Hospital Medical Journal","bibliographic_titleLang":"en"}]}]},"item_5_description_5":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"症例は73歳，男性．2004年3月より食欲低下，全身倦怠感が出現．3月30日早朝に意識消失して転倒しているところを発見され，当院に救急搬送された．頭部CT には明らかな異常はなく，入院時検査にて，肝障害（GOT325U/l，GPT108U／l）と高カルシウム・低リン血症（補正Ca14.7mg/dl，P2.2mg/dl）が認められた．腹部CT では肝右葉全体にびまん性に浸潤する巨大肝腫瘍が認められ，門脈塞栓と腹水を伴い，腫瘍マーカーはAFP61,395ng/ml，PIVKA-Ⅱ75,000mAU/lと著明に高値を示した．内分泌検査にて血清intact PTHrP5.5pmol/l，PTHrP-C855pmol/lと高値で，intact PTHは測定感度以下であることから，肝細胞癌からのPTHrP 産生によるhumoral hypercalcemia of malignancy（HHM）が意識障害の原因と考えられた．全身状態などから肝細胞癌は肝動脈塞栓術・化学療法など積極的治療の適応外と考えられたため，pamidronate，elcatonin およびステロイドによる高Ca 血症に対する治療のみ行い，血清Ca 値は低下し，意識障害も改善した．肝細胞癌患者はしばしば肝性脳症による意識障害をきたすばかりでなく，低アルブミン血症のため血清Ca 値が見かけ上低値となり，意識障害の原因として高Ca 血症の存在を見落とす可能性がある．PTHrP 産生によるHHM をきたす肝細胞癌はまれではあるが，肝細胞癌患者の意識障害の原因の1つとして留意する必要がある．","subitem_description_type":"Abstract"}]},"item_5_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifierScheme":"WEKO"}],"names":[{"name":"MIKI, Hirokazu"}]}]},"item_5_heading_23":{"attribute_name":"見出し","attribute_value_mlt":[{"subitem_heading_banner_headline":"症例","subitem_heading_language":"ja"}]},"item_5_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"徳島赤十字病院"}]},"item_5_relation_17":{"attribute_name":"関連サイト","attribute_value_mlt":[{"subitem_relation_name":[{"subitem_relation_name_text":"徳島赤十字病院"}],"subitem_relation_type_id":{"subitem_relation_type_id_text":"http://www.tokushima-med.jrc.or.jp/hospital/medical/2006pdf/014.pdf","subitem_relation_type_select":"URI"}}]},"item_5_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"1346-9878 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淳一"}],"nameIdentifiers":[{},{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2013-05-04"}],"displaytype":"simple","filename":"trchmj1101_66-71.pdf","filesize":[{"value":"873.6 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"pdf002147","url":"https://redcross.repo.nii.ac.jp/record/3367/files/trchmj1101_66-71.pdf"},"version_id":"da7a63ec-a462-44bc-8331-8b7ab76a5596"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"HHM","subitem_subject_scheme":"Other"},{"subitem_subject":"意識障害","subitem_subject_scheme":"Other"},{"subitem_subject":"PTHrP 産生肝細胞癌","subitem_subject_scheme":"Other"},{"subitem_subject":"consciousness disturbance","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"HHM","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"PTHrP","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"HCC","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":"technical report"}]},"item_title":"高Ca 血症による意識障害を契機に発見された副甲状腺ホルモン関連蛋白（PTHrP）産生肝細胞癌の１例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"高Ca 血症による意識障害を契機に発見された副甲状腺ホルモン関連蛋白（PTHrP）産生肝細胞癌の１例"},{"subitem_title":"A Case of PTHrP-Producing Hepatocellular Carcinoma Detected during Management of Consciousness Disturbance due to Hypercalcemia","subitem_title_language":"en"}]},"item_type_id":"5","owner":"18","path":["117"],"pubdate":{"attribute_name":"公開日","attribute_value":"2013-05-04"},"publish_date":"2013-05-04","publish_status":"0","recid":"3367","relation_version_is_last":true,"title":["高Ca 血症による意識障害を契機に発見された副甲状腺ホルモン関連蛋白（PTHrP）産生肝細胞癌の１例"],"weko_creator_id":"18","weko_shared_id":18},"updated":"2023-06-20T22:02:49.195764+00:00"}