DSpace コレクション: 1994-12
http://hdl.handle.net/2433/115116
1994-122024-03-28T22:04:01Z99mTc-DMSA腎摂取率による体外衝撃波結石破砕術(ESWL)の腎機能におよぼす影響の検討 : 経皮的腎結石破砕術(PNL)との比較
http://hdl.handle.net/2433/115420
タイトル: 99mTc-DMSA腎摂取率による体外衝撃波結石破砕術(ESWL)の腎機能におよぼす影響の検討 : 経皮的腎結石破砕術(PNL)との比較
著者: 松浦, 浩; 日置, 琢一; 桜井, 正樹; 有馬, 公伸; 柳川, 眞; 杉村, 芳樹; 栃木, 宏水; 川村, 壽一; 木下, 修隆; 加藤, 廣海
抄録: 99mTc-DMSA腎摂取率の再現性を健常成人で評価し, 1側の腎結石に対し, ESWLまたはPNLを施行した48症例で, 治療前後にDMSA腎シンチグラフィを施行し, 治療法の腎機能への影響を検討した。健常成人では99mTc-DMSA腎摂取率は再現性は保たれているが, 数%の変動がみられた。ESWL群, PNL群または両者併用群において治療前後で治療側腎摂取率には有意な変化はみられなかった。各群間を比較すると, PNL群および両者併用群とESWL群との間に有意な差が認められた(p<0.01); 99mTc-DMSA renal scintigraphy was utilized to investigate the influence of ESWL on renal function in comparison with that of PNL. In the beginning, the reproducibility of renal uptake rate by the scintigraphy was examined in eleven healthy volunteers under both non-diuretic and diuretic states. The renal uptake rate was shown to be sufficiently reproducible in the same person in the two different trials. However, the differences and the standard deviations were shown to be a few percentages, which were not statistically significant. Changes in the repeated renal uptake rate seem to indicate not only changes of renal function with the treatment but also some technical errors. Herein, to investigate changes in renal function of the therapeutic side, the uptake ratio rate (rate of uptake rate in the therapeutic side/uptake rate in the contral lateral side) was utilized instead of uptake rate. Renal scintigraphy was carried out in 48 patients with unilateral renal stones before and after ESWL or PNL monotherapy or the combined ESWL and PNL therapies. Within one week of treatment, the uptake ratio rate significantly decreased in patients with PNL or the combined ESWL and PNL, although DMSA uptake rate in the therapeutic side did not significantly changes. Neither renal uptake rate nor uptake ratio rate significantly changed after ESWL treatment. There was no significant difference in changes of uptake ratio rate between Siemens Lithostars Plus and the improved Dornier HM-3 lithotriptors. This study indicated that ESWL monotherapy did not affect the uptake ratio rate, although PNL monotherapy and the combined ESWL and PNL therapies may affect the uptake ratio rate to some extent.1994-12-01T00:00:00ZDornier MFL5000を用いた上部尿路結石に対する体外衝撃波結石破砕術単独療法
http://hdl.handle.net/2433/115419
タイトル: Dornier MFL5000を用いた上部尿路結石に対する体外衝撃波結石破砕術単独療法
著者: 藤本, 宜正; 京, 昌弘; 市川, 靖二; 永野, 俊介
抄録: 上部尿路結石345例(腎結石188例, 尿管結石157例)にESWL単独療法を施行した。治療終了から3ヵ月後の完全排石率は腎結石60.5%, 尿管結石89.4%で, 完全排石と4mm以下の残石を合わせた有効率は腎結石86.4%, 尿管結石93.6%であった。全体では, 完全排石率74.7%, 有効率89.9%となった。サンゴ状結石では, 治療回数, 総衝撃波数ともに多くなり, 全治療期間は長くなるが, ESWL単独療法で良好な成績がえられた。尿管嵌頓結石もESWL単独で満足できる砕石効果がえられるが, 破砕片が尿管粘膜に包埋されている症例ではTULや尿管切石術が必要であった; A total of 345 cases of upper urinary tract stones (188 renal and 157 ureteral stones) were treated by extracorporeal shock wave lithotripsy (ESWL) monotherapy using the Dornier lithotriptor MFL5000. Of these cases 294 (85.2%) had stones less than 20 mm in length. A double-J ureteral stent was placed in 40 cases of renal stones and 8 ureteral stones due to large stone burden or failure of in situ ESWL for impacted stones. Epidural or spinal anesthesia was necessary in 32 cases to maximize the generator voltage or to prevent intractable pain. The number of ESWL sessions and shock waves increased in accordance with the stone size, with an average of 1.6 and 4442, respectively. Multiple sessions were required in 68 cases of renal stones (36.2%) and 59 of ureteral stones (37.6%). With a 3-month follow-up, the stone-free rate was 60.5% for renal stones and 89.4% for ureteral stones, with the overall stone-free rate of 74.7%. Including the cases with residual fragments less than 4 mm, ESWL monotherapy was successful for 86.4% of renal stones and 93.6% of ureteral stones, achieving the overall success rate of 89.9%. No serious complications related to ESWL were observed. Four cases of impacted ureteral stones underwent ureteroscopic extraction or open ureterolithotomy for fragment removal. ESWL monotherapy using the Dornier MFL5000 is an effective and noninvasive method of treating upper urinary tract stones. Satisfactory fragmentation and clearance can be achieved with multiple sessions even for large or impacted stones, but alternative procedures may be necessary to salvage fragments of impacted stones.1994-12-01T00:00:00Z尿路上皮癌におけるE-カドヘリンの発現と浸潤・転移の検討
http://hdl.handle.net/2433/115418
タイトル: 尿路上皮癌におけるE-カドヘリンの発現と浸潤・転移の検討
著者: 川喜田, 睦司; 諸井, 誠司; 京谷, 京子; 筧, 善行; 吉田, 修
抄録: 尿路上皮癌30例について検討した。E-カドヘリンの発現が減弱しているものは全例grade 2以上でpT 2以上が75%を占め, high grade, high stageが有意に多く, 今後予後因子のひとつとなる可能性がある; E-cadherin expression was investigated in 30 patients with urothelial cancer (bladder; 27, ureter; 2, urethra; 1) by an immunohistochemical method. Twelve out of 22 patients with strong and homogeneous expression of E-cadherin (preserved) had grade 1 tumors, while all 8 patients with heterogeneous, weak and homogeneous, or lost expression of E-cadherin (reduced) had grade 2 or grade 3 tumors. Only 2 out of 22 patients with preserved expression had invasive tumors (> or = pT2), whereas 6 out of 8 patients with reduced expression had invasive tumors (p = 0.002). Three out of 4 patients with metastasis had reduced expression and 2 of them died. These findings suggest that urothelial tumors with reduced expression of E-cadherin have high grade and high stage, and E-cadherin expression could be one of the prognostic factors.1994-12-01T00:00:00Z前立腺肥大症に対する経尿道的前立腺切除後の生活の質調査
http://hdl.handle.net/2433/115417
タイトル: 前立腺肥大症に対する経尿道的前立腺切除後の生活の質調査
著者: 植田, 健; 江越, 賢一; 鈴木, 規之; 三河, 健治; 森, 偉久夫
抄録: performance status (PS)に対する影響は, 手術前後で認められなかった。尿流測定やAUA symptom indexの結果と同様に夜間頻尿, 頻尿, 排尿困難の改善に対する満足度は高かった。精神的評価として心配事, 精神的ストレスが, また肉体的評価として睡眠の改善がみられた。術前の性交の頻度は年齢とともに減少しており, それに伴い性生活に対する不満が増加した。術前後の性機能は, 手術前後で射精能および性交時の満足度が有意に低下し, 早朝勃起, 接触性欲, 陰茎硬度, 性生活の満足度は変らなかった。経尿道的前立腺切除術(TURP)による社会的支障, 家族的支障や精神的不快感は少ないと思われたが, 肉体的不快感は21例とやや多いと思われた。TURPに対する全般的満足度は86例中67例と高かった; The quality of life (QOL) after transurethral resection of the prostate (TURP) was studied. A total of 113 patients were operated and released, and 86 (76%) cases responded to the TURP follow-up survey. The average age was 69 years and the average time elapsed after the operation was 220 days. Data regarding the patients undergoing TURP was gathered from a questionnaire consisting of 22 questions concerning the preoperative condition and 28 about the post-operative state. Performance status was not changed post-TURP. The patients showed improvements in nocturia, pollakisuria and dysuria. These urological symptoms were in accordance with the findings of uroflowmetry and American Urological Association Symptom Index. Ten questions addressing the patients mental and physical conditions revealed that good quality was generally retained. Sexual activity showed a tendency of gradual decrease in relation to increasing age. Ejaculatory function and actual satisfaction with the sexual act were obviously damaged by the operation. TURP showed no changes in regard to morning erection, sexual desire in an arousing atmosphere, penile hardness at sex and total satisfaction with the sexual life. Social life, family life and mental status were not influenced, but the physical status of 21 (26%) of the patients was decreased by the operation and hospital stay. Over all, 78% of the patients could maintain a good quality of life in post-TURP.1994-12-01T00:00:00Z