著者

星 宣次 折笠 精一 吉川 和行 鈴木 謙一 石戸谷 滋人 伊藤 明宏 近藤 丘 今井 克忠 木崎 徳 鈴木 康義 加藤 正和

出版者

一般社団法人 日本泌尿器科学会

雑誌

日本泌尿器科学会雑誌 (ISSN:00215287)

巻号頁・発行日

vol.88, no.1, pp.46-52, 1997-01-20 (Released:2010-07-23)

参考文献数

20

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(背景と目的) 腎癌肺転移切除例を検討し, その有用性と手術適応を明らかにする.(対象と方法) 1981年より1994年末までに腎癌肺転移の切除術を行った17例 (男性14例, 女性3例) を対象とした. 肺転移手術時の年齢は, 45歳から73歳で平均年齢61歳. 原発巣術後に肺転移が出現したのが11例, 6例は腎癌診断時肺転移があり, 3例は肺手術を, 3例は腎摘を先行した. 他臓器転移が4例に見られ, 脳転移摘出, 対側腎転移に対する腎部分切除, 胸壁と肋骨転移部切除, 対側副腎転移の切除がそれぞれ行われた. 肺の片側手術例14例, 両側手術例が3例であり, 12例に肺部分切除が行われ, 5例に肺葉切除術が行われた.(結果) 肺手術後生存期間は10ヵ月から10年9ヵ月で, 肺手術による合併症は認められなかった. 疾患特異的生存率, 無病生存率はそれぞれ5年で55, 48%, 10年で27, 14%であった. 癌なし生存例はすべて10個未満の肺転移例であった.(結論) 腎癌の肺転移切除により長期生存例が得られ, 症例によっては大変有用であった. 肺転移数が10個未満の症例に予後良好例が認められた.

著者

木村 行雄 安達 国昭 木崎 徳 伊勢 和久

出版者

社団法人 日本泌尿器科学会

雑誌

日本泌尿器科學會雑誌 (ISSN:00215287)

巻号頁・発行日

vol.65, no.4, pp.218-228, 1974 (Released:2010-07-23)

参考文献数

22

被引用文献数

1

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For the past 4 years and half 39 cases with ejaculatory disturbance were experienced in our clinic.1) Age and Incidence. The incidence of ejaculatory disturbance was 0.5% of the whole outpatients of our clinic. The age of the patients ranged between 17 to 40 years with the highest incidence in the thirties.2) Classification of ejaculatory disturbance. In this report ejaculatory disturbance was classified into 4 groups: Group A; the patients who complained of abscence of both ejaculation and orgasm; Group B, the patients who complained of absence of ejaculation but maintained orgasm; Group C, the patients who maintained both ejaculation and orgasm; Group D, the patients who maintained ejaculation but complained of loss of orgasm. The incidence of these 4 groups were as follows: Group A, 15 cases (38%); Group B, 8 cases (21%); Group C, 13 cases (33%); and Group D, 3 cases (8%).3) Past history. In Group A, 6 cases had past history of mental diseases; 1 case, polyomyelitis; and 1 case, stomach ulcer. In these cases ejaculatory disturbance occurred during the medication for the diseases. Therefore, these diseases or the medication for them were suspected to be the causative factors of ejaculatory disturbance. No specific history which was suspected of relation to ejaculatory disturbance was found in Group B, C, and D.4) Physical examinations. No remarkable findings were obtained in the physical examinations throughout the groups.5) X-ray examinations. Plain films of lumbo-pelvic region. Spina bifida occulta was seen in 4 cases of 39 cases with ejaculatory disturbance; abnormal enlargement of the intravertebral space, in 1 case; and deformity in the lumbar vertebra, in 1 case. The relation between these anomalies and ejaculatory disturbance could not be clarified.Cystography. No remarkable finding was seen in Group A, C, and D. In Group B patency of the internal urethral orifice was seen in 7 cases. In 6 of these 7 cases the internal urethral orifice opened slightly by abdominal straining and in 1 case the orifice was seen patent without the straining. In one case irregularity of the internal urethral orifice was seen. Retrograde ejaculation occurred by masturbation in these cases. Therefore, cystography was found to be effective in diagnosis of retrograde ejaculation.Urethro-vesicography. In 1 case of Group B patency of the internal urethral orifice was seen and in 1 case irregularity of the posterior urethra was seen. In Groups A, C, and D no remarkable finding was seen.6) Reflexes and sensory and motor disturbances. Some cases of ejaculatory disturbance showed abnormality in reflexes, sensory and/or motor disturbances. However, the relation between these disturbances and ejaculatory disturbance was not clarified.7) Cystometrogram. In 13 of 15 cases of Group A some abnormalities were suspected in the higher center of the urinary bladder. The cystometrogram in these cases was hypotonic without micturition contraction. Both the effect of nitrazepam administration and respiratory effect on the cystometrogram were clearly seen. Two of 15 cases showed disturbance of the peripheral nerves in addition to them. In Group B there was no case which showed abnormal cystometrogram except for a case in which the lesion was suspected in the lower region of the spinal cord. In Group C and D there was no case which showed abnormal cystometrogram.8) Treatment. In Group A vitamin B1, vitamin E, androgen, tranquilizers and imipramine hydrochloride were administered, but no remarkable effect was obtained by them. However, trihydroxpropiophenone, a COMT inhibitor, showed marked effect on 2 cases of Group A. In Group B the internal urethral orifice was narrowed by plastic operation. After the operation ejaculation became normal with normal orgasm. In the cases of Group C and D, the same drugs as in the Group A were used. But no remarkable effect was obtained by these drugs except for a case of Group C