泌尿器科領域に於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エログテムの測定とその異同に就て

抄録

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:
1) 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 II 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 1mm 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