泌尿器科領域における日本人胎児の研究第3篇(成人との比較) : 胎児の測定線を基調とする成人ピ***グテムの測定とその異同に就て

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In the easly stage of embryonic life the Kidney lies behind and below the allantois and cloaca, but begins to ascend and assume the normal position at about 7-9 weeks of gestation. During this period of ascension the organ shows a certain degree of the weakness of its sustaining ligament as well as of surrounding tissue the position of the organ presents a considerable variation from case to case. The Kidney as well as the renal pelvis occupies the foremost place among all organs of the body in exhibiting abnormalities, variations and deformities. Determinations of the Kidney and pelvis are usually made anatomically and in recent years mostly by pyelography. The efforts of previous investigators appear to leave little to be added, such as the studies by Hyrtl, Braasch, Legueu, Papin, Eisendraht, Joseph, Lichtenberg, Lauber, Behrenroth,Hauch, Marion and others in foreign countries, while in Japan those of Takahashi, Ichikawa, Namiki, Yamanouchi, Tsuchiya, Shiga, Hirose, Cho, Nozaki, Hasebe, Tomikawa, Mitani,Kobayashi and Hori. Upon examination of the works by these observers, however it is difficult to find results that are in absolute agreement with each other. These studies were done mostly by using adult materials. In our department, Takashima and Nagamine made observations on these problems in detail anatomically as well as by the use of pyelography in 100 normal fetuses. The determination of the positions of the Kidneys, pelves and calyces was made by utilizing newly established measurement curve and base line. The procedures of measurement are as follows: 1) The longitudinal line passing through the middle of vertebral bodies, used by Yamanouchi, was utilized as the first base line while the second base line is the conjugate of the iliac crests on both sides perpendicularly crossing the first base line. 2) The measurement of the long axis of the pelvis was made by the following methods: l) The long axis of pelvis I is determined by first drawing a line along the pelvis starting from the intersection of the first and second base lines, then by finding a line connecting this line with the intersection of lines from the upper and lower poles of the pelvis perpendicular to the first base line. 2) The long axis of pelvis 11 is the diagonal line of a parallel rectangle bound by the four lines along the pelvis paralleling the first and second base lines. 3) The long axis of pelvis III is the Yamanouchi line connecting the upper and lower poles of pelvis. 3) The angle of inclination of the long axis of pelvis is that which is formed by the long axes of pelves I, II and III with the first base line. 4) The theoretical center of pelvis is assumed to correspond with the center of each of the three pelvic axes, and the positional relation of the Kidney is expressed by the rectangular coordinate of these centers. 5) For estimating the area of each pelvis, the use of calculated values of pyelograms reproduced on lmm coordinated papers in combination with planimetric measurements was utilized. The investigations on the Kidney position, major and minor calyces of the fetus are important in themslves, but the comparison of these findings with those of the adult is even more significant. Direct comparison of the results of study, however is difficult because of the difference in the methods of measurement. The author undertook to measure the adult Kidney by using the base line for the fetla Kidney established by Takashima. For this purpose 338 diagnostic pyelograms collected in our department suitable for demonstrating the normal position of the Kidney have been chosen. Various points investigated by Takashima have been checked and the position and shape of the Kidney and pelvis as reported in the literature have been consulted. The findings thus obtained have been compared with the results of measurement in the fetus obtained by Takashima and Nagamine. By so doing the author has been able to correlate the facts in regard to the position and form of the Kidney accrrding to various age groups, namely, the easly and later fetal stases, the newborn, the infantile, the juvenile, the adolescent and the senile periods of life. The main findings thus obtained may be summarized as follows: a) Position of Pelvis. During the period from fetus to 10-20 years of post-natal life the Kidney develops generally in upward and fore ward directions. Up to 10-20 years the, value of Y as obtained during the 4th fetal month doubles its value (the ratio of right.angle coordinate X:Y). In the adult the left side is higher in both males and females, and IP is higher than RP. In the fetus the right side is higher than the lelt dueing the 4th and 9th fetal months, while they become Identical during the 10th month. b) Length of pelvic long axis. The axis grows normally during the fetal period according to the process of growth but there is little age difference in the adult and the axis is longer on the left than on the right side. In the male the valu is greater by the average of 0.18 cm while in the female by 0.11 cm. c)Angle subtended by pelvic long axis with vertebral bisecting line. This angle is greater by 3-5 times in the adult us compured with that in the fetus, and the fetal angle is more vertical than the adult abgle. Thus in the fetal angle measurse 3.17° on the right and 2.63° on the left. In the adult the average values for RP and IP in the male are 13.16° on the right and 11.62° on the left, while in the female the right measures 7.86° and the left 8.79°. These values are somewhat lower than those reported by previous investigators, and IP is slightly greater than RP. d) Area of pelvic shadow. In the adult the area is greater by 18 times on the right and about 36 times on the left as compared with those during the 4th fetal month, while the right side is about 9 times and the left 10 times greater than those of the 10th fetal month. Furthennore, the fetus shows generally corresponding growth according to the month of gestation while no stepwise gain is secognized as indicating age variation in the adult. Paralleling the length of the longitudinal axis of the pelvis, there is a corresponding variation in the pelvic area. e) Pelvic volume. The adult pelvis has vrlumes varyin from 7 to 10 cc while that of fetal pelvis is only 0.1-0.6 cc; the area in the adult is about 70 times that of the 4th month fetus and about 11 times that of the 10th month fetus. f) From of Pelvis. Despite numerous proposals as to the classification of pelvic shape by earlier investigators, the most fearible classification divides the shape into 6 clases, namely, the common form, greater calyx form, ampule from, lesser calyx form, bifid form and branched form. The fetal pelvis may be divided into 5 forms, namely, the ampule form, cauliflower form, semi-adult form, greater calyx form and many branched form. In regard to the differences inform between the two sides, the fetus shows them to be identical in 58 percent, While the adult in 33.6 percent. The results in the former approach those reported by Cho, while the latter agrees with that obtained by Yamanouchi, the cauliflower form seems to be transformed into either the lesser calyx form of the adult or any other form, since this form represents the form during the stage of incomplete development of the renal cortex and medulla in the earlier fetal period. Again, the semi-adult form, greater calyx form and Ampule form predominate in the fetus, whereas in the adult the common form as well as greater calyx form are found in the majority. Finally, it must be stated that the present report is made public, in spite of the fact that the vast amount of problem is by no means all solved with complete satisfaction, leaving many other insolved points.
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泌尿器科領域における日本人胎児の研究第3篇(成人との比較) : 胎児の測定線を基調とする成人ピ***グテムの測定とその異同に就て

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泌尿器科領域における日本人胎児の研究 第3篇(成人との比較) : 胎児の測定線を基調とする成人ピ***グテムの測定とその異同に就て

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泌尿器科領域における日本人胎児の研究第3篇(成人との比較) : 胎児の測定線を基調とする成人ピ***グテムの測定とその異同に就て