膀胱腫瘍ノ臨牀的觀察
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概要
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Clinical obserbations on the tumor in the bladder are performed closely by the present author with patients of this department for full four years dating from 1927 to 1930, with the following results. 1) Occurrence. The total number of the cases came under my observation is 34 or roughly 0.1 p.c. out of 21. 888, the aggregate number of patients of the department. The percentage would be higher(0.6 p.c.) when the total number (viz.5. 511) of genital disease is considered, or again it become as high as 4.9p.c. aginst 673 cases of bladder diseases. 2) Type. The types of the tumor can be divided into following four groups: Type: Number of patient: Pecentage: papilloma 17 50 cancer 12 35.2 endothelioma 1 2.9 undecided 4 12.9 It should be noted that the percenage of papilloma and cancer show above cannot be regarded as invariable; the large number of reports available up to the present indicate the variability of these ratios-one differs greathly from the other or even against one another. This sort of circumstance probably from the fact that an extremely malignant papilloma may be atransient form of cancer and correspondingly in some of the cases the condition of the affected region at the moment of making diagnosis is a derterming factor for the decision of the type of tumor. To quote an example. among 17 cases of papilloma under my obselivation, 2 cases are known to alter later into cancer form. We are therefore inclined to believe that the ratio of good-natured and malignant cases of papilloma must be taken account to a greater extent, than discuss the meaning of the percentages mentioned above which is often the object of discussion among the investgators on cancer. 3) Age. The frequency of occurrence of papilloma is fairly invariably distributed between the ages of 20 to 70, without showing any preference. Cancer, on the other hand, seems to occur more frequently in 30 to 70 years of age. 4) Sexual difference. A marked difference exsists between both sexes with regard to the occurrence of the tumor; viz. 12 cases of cancer are distributed in men 8 (66. 4 p. c. ) and in women 4 (33. 4 p. c.) , and 17 cases of papilloma in men 12 (79.9 . p. c.) and 5 (29.1 p. c.) in women. Generally among women the tumor tends to appear more frequently at the age of climateric. 5) profession. Reports were often made that professional difference can be recognised among the cases of tumor in the bladder. We are however unable to confirm these statements. 6) Anamnesis and complications. Nearly all the patients complain of the suffering from some other type of bladder disease. 7) Location of occurrence. The tumor appears in various parts of the bladder. The places of occurrence are as follows: the base, most highly preffered, the lateral side and finally most infrequently the front and upper walls. None we have observed on the posterior wall. 8) Haematuria and pain by exeretion of urine. On the whole, heamaturia and following pains are experienced in case of cancer, but the reverse is true in cases of papilloma. The haematuria due to cancer is generally continuous and that due to papillolma is intermittent. 9) Differential diagnosis. a. For syphilis. Bladder syphilis in tertiary stadium can clearly be recognised by the specific ulcerous condition surrounded by an intensive infiltration, but the precaution must be taken against the cases showing papilloma-like appearance. In the latter case the anamnesis, general status presence and serological reaction would decide the matter. In still more doubtful cases the experimental anti-syphilitic treatment can be employed for differentiation. b. For bladder tuberclosis. This often shows tulnor-like apearance by the transitory intensive granulation.
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