外傷性脊髄損傷患者の泌尿器科学的研究 第3報: 上部尿路のレ線学的研究並びに腎機能について
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In about 40 patients with traumatic spinal cord injury, re n al function tests and excretory pyelography were performed with specific effects toward classification of shape of the renal pelvis and measurement of various parts on the intravenous pyelogram. The morphological changes of the upper urinary tracts we r e studied with their relation to renal functions. Clinical symptoms and findings of the renal pelvis were followed thereafter for years. 1) Renal fun ctions : Impairments of renal functions were found in 53.2 % of the cases on PSP test, 10.4 % on NPN determination, 52.5 % on urine concentration test, and 34.2 % on excretory function at IVP. These abnormalities were more frequently observed in cases of upper motor neuron lesions and complete lesions. 2) Morphological pictures of the renal p elvis : The shape was classified into 7 types. Bilateral N-type was found in 14.3 %. In 56.4 % of the patients, severer changes than Attype was found in either one of the kidneys which was thought to have dilatation of the upper urinary tracts. Severer changes were more frequently recognized in the right kidney, in the group of upper motor neuron lesions and in the patients having elapsed more than 2 years after injury. 3) Measurem ent of various parts of the renal pelvis : The results of mean values were compared to the means of normal subjects reported by Fujisawa. In our series of patients, the length of long axis of the renal pelvis was shorter in the right kidney and approximately same in the left. The angle of long axis of the renal pelvis showed tendency to be acute in the right and to be obtuse in the left. The location of the pelvis was about 1 cm lower than normal and seemed to be slightly approached to the spinal column. The area of the renal pelvis was almost identical to normal in the right and slightly narrow in the left. It was found that the area of the renal pelvis is not necessary to concurrently changed with the length of long axis. The angle of the pelvisureteral transition was 30.9° in the right and 32.08° in the left as the means of our series . The group of lower moter neuron lesion showed obtuser angles than the group of upper motor neuron lesion in both sides. 4) Relations between renal functions and morphological changes and area of the renal pelvis : In patients with spinal cord injury, the severer impairment of renal functions was not always accompanied with severer morphological changes and wider area of the renal pelvis. 5) Follow-up observations of IVP and clinical symptoms : Some cases showed improvement of morphological changes, regardless drug therapy and despite marked initial changes on IVP, as far as the patients showed sufficiently good renal functions and improvements of clinical symptoms such as turbid urine and others.
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