女子尿道細網肉腫の1例

83歳の女子で排尿困難を主訴として当科受診，外尿道口部に直径約3cmの腫瘤を認め，生検にて細網肉腫と判明。胸部X線写真およびリンパ管造影にて転移所見なし。入院後全身状態が悪化し， 14日目にたまたま右下腹部の激痛と腹部膨満を訴え，発熱と白血球増多を認めたため虫垂穿孔による汎発性腹膜炎の疑いにて開腹符を施行した。虫垂および上部消化管に異常なく子宮底中央部より膿汁が腹膜腔内に流出するのが認められた。子宮膿瘍穿孔による腹膜炎の診断のもとに，同部を切除縫合し腹膜腔内にドレーンを設置し手術を終えた。術中，傍大動脈および腸間膜リンパ節を観察する機会が与えられたが， とくに異常を認めなかった。術後経過は悪く嚥下性肺炎のため死亡した。剖検はおこなわれなかった。女子尿道の悪性リンパ題症例の報告は原発性にしろ転移性にしろ非常に少ない。われわれの症例は剖検できなかったので，厳密にいうと臨床検査や手術時観察の到達しうる以外の部位に原発巣が絶無であるとはいえないが，臨床所見からすると，あきらかに原発性細網肉腫症例と考えられる。本文の要旨は第87回日本泌尿器科学会関西地方会にて発表した。Primary reticulum cell sarcoma of the urethra seen in an 83-year-old woman is described

加計呂麻諸島における地域住民の生活と福祉ニーズ : 経年比較にみる一般成人調査より (1)

鹿児島県の離島である奄美大島の南部に位置している瀬戸内町は、大島本島から更に海を隔てて3つの離島を行政区に持っている。2004年の調査時において、加計呂麻島：芝地区60.91%・花富地区75.0%、請島：請阿室58.0%・池地55.7%、与路島：52.9%は超高齢社会となっており、集落の存続自体が危うい状況にあった。 8年後の2012年にこれらの地域がどのような状況になっているのか、平成26年３月に作成した調査報告書と比較検討することでみえてきた問題点・課題点、有効な対策について論述する。Setouchi Town which lies to the south of Amami Oshima is an island in Kagoshima prefecture. Setouchi Town consists of three remote islands which have administrative districts. According to the research in 2004, in Kakeroma Island, 60.91% of Shiba district and 75.0% of Kedomi district were super-aging society; in Uke Island, so were 58.0% of Ukeamuro district and 55.7% of Ikeji district; and 52.9% of Yoro Island, too. And these districts were in difficult condition to continue as villages in 2004.Comparing the above with the conditions in these districts eight years later based on the research in March, 2014, we will discuss the problems and possible measures

奄美諸島と八重山諸島における高齢者の生活と福祉ニーズ : 調査対象者の健康状態、家族の状況、社会とのかかわり状況（１）

本研究の目的は、琉球弧の北に位歴する鹿児島県の奄美諸島と南に位歴する沖縄県の八重山諸島における島嘆地域の高齢者の生活の現状と福祉ニーズを把握することである。調査対象地は、奄美諸島の中心である奄美市(島嘆都市部)および瀬戸内町の加計呂麻島、請島、与路島(島嘆集落部)、八重山諸島の中心である石垣市(島填都市部)、および竹富町西表島西部および鳩間島(島喚集落部)であった。鹿児島県の場合、特に島填集落は過疎高齢化が進行し、集落機能の低下を余儀なくされている。沖縄県の場合、鹿児島県ほどの過疎高齢化は進んでいない状況であるが、島填地域のもつ生活上の課題を共有している。いずれも、相互扶助の伝統等の地域文化あるいはその精神が残っているという共通点を持つ地域である。本稿では、調査対象者の属性、健康状態、家族の状況、社会参加状況および社会関連性指標についての分析結果を示す。居住地域と年齢の両方に回答した対象者は714人(男性284人、女性430人)であった。健康状態では、すべての調査対象地で健康な人の割合が高かった。家族の状況では、対象地ごとに特徴がみられた。集落行事への参加は島嘆集落部の方が高かったが、社会とのかかわり状況全般では島喚集落部の方が低かった。The purpose of the study was to investigate the life styles and the social welfare needs of the elderly who live on the Amami islands and the Yaeyama islands through a questionnaire survey. The regions surveyed were the urban area of the Amami Ohshima (Amami City) and the rural area of the Kakeroma islands (Setouchi Town) in Kagoshima prefecture, and the urban area of Ishigaki island (Ishigaki City) and the rural area of Iriomote island and Hatoma island (Taketomi Town) in Okinawa Prefecture. The people who dwell on these remote islands are usually under unfavorable conditions geographically and economically and the communities there are under dysfunctional state by depopulation and aging. On the other hand, these islands keep the spirit of mutual helping and the traditional cultures. From the data of 714 respondents (284 males and 430 females) , we analyzed the health states, the family situations and the social involvements. Almost 90 percent of the elderly reported that they were healthy. There was no difference in the self-rated health condition among these islands. The number of the single elderly people was higher in Setouchi Town and the number of the multigenerational households was higher in Ishigaki City. Although the percentage of the elderly who participate in community events was higher in the rural area of Setouchi Town and Taketomi Town than in the urban area of Amami City and Ishigaki City, the index of social interaction was lower in the rural area than in the urban area

島嶼集落における社会的かかわり状況と見守り、防災、医療体制について : 奄美大島大和村における中高年者調査から

本研究の目的は奄美大島大和村における中高年者の社会的かかわり状況、見守り体制、災害への備え、医療体制などの現状と課題をアンケート調査により把握し、地域課題の改善に役立てることである。民生委員の協力を得た留置き調査により、40歳以上の1,240人を調査対象とし、928人から回答を得た（回収率74.8%）。近隣の交流は少し減ってきていた。社会とのかかわりでは女性の方が男性よりも高く、年齢が高くなるにつれ低くなる傾向にあった。自然な形での見守りがなされていたが、高齢になると見守り体制への要求もあった。集落の防災組織がうまく機能しているが、災害弱者や避難などへの対処に課題を残していた。医療体制については診療所への満足がある一方、緊急医療や専門医療への要望が強かった。地域の課題では買い物が不便とかハブの存在など社会的・自然的課題があった。The purpose of the study was to assess the present state of the social interaction, the supporting system, the disaster prevention measures, and the medical system in Yamato Village of Amami Oshima island. A questionnaire was personally delivered to 1240 residents of 40-year-old and above and later picked up by commissioned welfare volunteers. The number of people who responded to the questionnaire was 928 and the rate of collection was 74.8%.Neighborhood interaction decreased a little. Social interaction of women was higher than men. Social interaction of the elderly was lower than the younger. Although there were spontaneous watch activities in a natural way, the elderly hoped to have the local supporting system for them. The voluntary organizations for disaster prevention were well functioned, but there remained challenges of the measures for the vulnerable people and the emergency evacuation. With respect to the medical system, there was satisfaction with the community clinic, but on the other hand, there remained wishes regarding emergency medical system and specialized medical service. There were also social and natural problems that the shopping was inconvenient, and that the poisonous snake harmed people, and so on

島嶼集落高齢者の生きがい感に及ぼす社会関連性の影響

本研究の目的は島嶼集落に居住する高齢者の生きがい感に及ぼす社会関連性の影響を検討することである。鹿児島県の離島にある小規模自治体の高齢者に配票調査を実施し、455人の回答を分析した。生きがい感は「ふつう」レベルであり、年齢が低い方が生きがい感が高い傾向にあった。社会関連性指標の因子分析の結果、安梅（2000）と同じ5因子が見いだされた。社会関連性指標の全体の得点に性差や年齢差は見られなかった。女性の方が男性よりも得点が高いのは｢他者とのかかわり」「生活の安心感」「生活の主体性」であった。前期高齢者の方が後期高齢者よりも得点が高いのは「社会への関心」「身近な社会参加」であり、後期高齢者の方が前期高齢者よりも得点が高いのは「生活の主体性」であった。重回帰分析の結果、男女で共通して生きがい感に影響を及ぼしていた因子は「生活の安心感」「社会への関心」「生活の主体性」であった。性と年齢ともに共通して生きがい感に影響を及ぼしていた因子は「生活の主体性」であった。The purpose of the study was to investigate the effects of the indices of social interaction on the feeling that life is worth living. The questionnaire was personally delivered to the elderly who live in villages of an island in Kagoshima prefecture and picked up by commissioned welfare volunteers. The number of people who responded to the question items was 455. The level of the feeling that life is worth living was moderate, and its average score of the elderly aged 75 or over was lower than those of the young-old. Factor analysis of the social interaction measures resulted in five factors as Anme (2000) found. There was no difference related to gender or age in the total score of social interaction. Females\u27 scores of "Interaction", "Feeling of safety", and "Independence" were higher than those of males. The young-old\u27s scores of "Social curiosity" and "Participation in the society" were higher than those of the elderly aged 75 or over. The old-old\u27s score of "Independence" was higher than that of the young-old. The results of multiple regression analysis showed that for both of men and women, "Feeling of safety", "Social curiosity" and "Independence" were found respectively to affect the degrees of the feeling that life is worth living. For the respondents of both gender and age, "Independence" was relevant to the degrees of feeling that life is worth living

島嶼集落における社会的かかわり状況と見守り、防災、医療体制について : 奄美市住用町における中高年者調査から

本研究の目的は奄美市住用町における中高年者の社会的かかわり状況と、見守り体制、災害への備え、医療体制などの現状と課題をアンケート調査により把握し、地域課題の改善に役立てることである。郵送調査により、５５歳以上74歳以下の476人を調査対象とし、175人から回答を得た（回収率36.8％)。回答者は夫婦世帯が多く、世帯収入は年金が多かった。地域の交流は少し減ってきていたが、地域への愛着は高かった。家族との交流、近所づき合い、相談相手、役割などは女性の方が男性よりも良好であった。見守りは自然な形でなされていたが、見守り体制作りへの要求もあった。集落の防災組織はうまく機能しているが、避難所の確保や水害対策などに課題を残していた。医療体制については診療所への肯定的評価がある一方、緊急医療や専門医療への要望が強かった。地域の課題では買い物が不便とか自然災害に弱いなど社会的・自然的課題があった。The purpose of the study was to assess the present state of the social interaction, the supporting system, the disaster prevention measures, and the medical system in Sumiyo Town of Amami City. A questionnaire was personally mailed to 476 residents of 55 to 74-year-old and later returned. The number of people who responded to the questionnaire was 175 and the rate of collection was 36.8%.The respondents to this survey were mostly couple households and their income was mainly a pension. Neighborhood interaction decreased a little. An attachment to the local community was strong. Social interaction of women (e.g. contact with family member, relations with neighbors, having counsel, and having active role) was stronger than men. Although there were spontaneous watch over activities in a natural way, the respondents hoped to have a supporting system for them. The voluntary organizations for disaster prevention were well functioned, but there were issues of making a safe shelter and establishing flood-control measures. With respect to the medical system, there was a satisfaction with the community clinic, but on the other hand, there remained demands for an emergency medical system and a specialized medical service. There were also social and natural problems that the shopping was inconvenient, the town was prone to natural disasters, and so on

奄美諸島と八重山諸島における地域住民の生活と福祉ニーズ : 奄美諸島と八重山諸島における一般成人調査より紐解く(2)

本研究は、奄美諸島と八重山諸島における、地域住民の生活と福祉ニーズを一般成人調査 より紐解こうとするものである。調査対象地として、島喚都市部からは奄美市と石垣市を、島喚集落 部としては瀬戸内町の加計呂麻島、請島、与路島と、竹富町からは西表島、鳩間島を選出した。両諸島とも相互扶助としての「結い」の精神の色濃く残る集落群であるが､鹿児島県と沖縄県の諸島では、集落の有り様に差異があることが明らかになった。本稿では食生活、保健・医療福祉サービス、地域の課題等についての分析結果を示す。飲酒に関しては、「毎日飲む」と答えた人は、都市部より、集落部において高かった。「生活習慣病に関する催しへの参加」では、「参加したことが無い」と回答した人は､都市部の方が高かった。地域で感じている問題点については、奄美市と瀬戸内町では「ハブ」の問題、集落部である瀬戸内町と竹富町では日常の買い物の不便があがっていた。総じて、集落部における地域問題の指摘が多かった。国や自治体に望む重点施策について、４地区とも「在宅介護のための、自宅を訪問するサービスの充実」を第１位にあげていた。The purpose of this study was to analyze the life styles and the social welfare needs of the adults who live on the Amami islands and the Yaeyama islands. The regions surveyed were the urban areas of Amami City and Ishigaki City, and the rural areas of the Kakeroma island, Uke island, Yoro island (Setouchi Town) and the rural areas of Iriomote island and Hatoma island (Taketomi Town). Both islands have kept the spirit of mutual helping and the traditional cultures. But it is clear that the conditions of the rural areas in Kagoshima Prefecture and Okinawa Prefecture are different. In this paper we report analyses of the eating habits, the evaluation of health-care services, welfare services, and other regional subjects. The number of the respondents who drink every day was larger in the rural areas of the island than in the urban areas. The number of people who participate in the events concerning life-style rerated diseases was larger in the urban areas. Regional issues in the Amami City and in the Setouchi Town were "habu", inconvenience of daily shopping in Setouchi Town and Taketomi Town, which are in the rural areas of the island. In general, there were many regional issues in the rural areas of the island. The four areas want the national and local governments to "improve the visiting service for homecare" in the first place

奄美大島と八重山諸島における集落等の現状と課題 : 集落・町内会・自治会代表者へのアンケート調査から

本研究の目的は、琉球弧の島喚集落の現状と課題を明らかにすることであった。奄美大島と八重山諸島の集落・町内会・自治会の代表者を調査対象にした郵送調査を実施し、177人から回答を得た(回収率61.9%)。調査内容は、集落の団体、集落の行事、集落維持の見通し、郷友会、支え合い活動、災害対策の現状、集落の課題、回答者の個人属性等であった。結果、台風被害、伝統的行事の種類、郷友会の現状、支え合い活動については奄美大島と八重山諸島で共通性が見られた。一方、八重山諸島のように観光産業が盛んでない奄美大島では人口減少が大きいため課題を抱えた集落が多かった。また、伝統的行事の存続や集落の維持の見通しについても奄美大島の方がより深刻であった。The purpose of this study was to clarify the actual conditions and problems of the village communities in the islands of the Ryukyu arc. The questionnaire survey was conducted on 286 chiefs of the village communities and the neighborhood associations in Amami Oshima and the Yaeyama islands. The number of respondents was 177, and the response rate was 61.9%. The contents of the questions were concerning the associations in the village community, the present situations and the prospects for the maintenance of the traditional events, "Goyukai" (immigrant\u27s voluntary association), the situations of the reciprocal help activities, the disaster-related measures, the problems of the community, and the personal attributes of the respondents. Amami Oshima and the Yaeyama islands had many common features as to typhoon damage, traditional events, the present state of "Goyukai", and mutual support activities. On the other hand, since Amami Oshima was less active in the tourism industry than the Yaeyama islands, many village communities in Amami Oshima had some problems due to a decrease in population. They were also pessimistic about prospects for the maintenance of the traditional events and the community itself

奄美諸島と八重山諸島における高齢者の生活と福祉ニーズ : 将来の生活の不安と生きがい感、食生活、保健医療・福祉サービス、地域の問題(2)

本研究の目的は、琉球弧の北に位世する鹿児島県の奄美諸励と南に位置する沖縄県の八重山諸島における島嘆地域の高齢者の生活の現状と福祉ニーズを把握することである。調査対象地は、奄美諸島の中心である奄美市(島嶼都市部)および瀬戸内町の加計呂麻島、請島、与路島(島嶼集落部)、八重山諸島の中心である石垣市(島嶼都市部)、竹富町西表島西部および鳩間島(島嶼集落部)であった。鹿児島県の場合、特に島嘆集落は過疎高齢化が進行し、集落機能の低下を余儀なくされている。沖細県の場合、鹿児島県ほどの過疎高齢化は進んでいない状況であるが、島嶼地域のもつ生活上の課題を共有している。いずれも、相互扶助の伝統等の地域文化あるいはその精神が残っているという共通点を持つ地域である。本稿では、前稿に引き続き、日常生活の不安と生きがい感､食生活､保健医療･福祉サービス、暮らし向きと地域の問題等についての分析結果とそのまとめを示す。将来の生活不安は島喚集落部の方が島嶼都市部よりも不安を感じる人が多かった。一方、生きがい感は、島嶼都市部の方が高かった。食生活では、栄養面のバランスを欠きやすい環境下にあった。保健医療では、島嶼集落部は医療サービスの地域格差への不満や問題が見られると同時に、健康に対するセルフケア意識の高さが伺えた。福祉サービスでは、島嶼集落部では天候や交通手段によるサービスの中止や困難性などが生じていた。暮らし向きと地域の問題では地域差はなく、共通して台風､交際費､老後の生活の不安があげられ、特に瀬戸内町で地域の問題を感じている人が多かった。The purpose of the study was to investigate the life styles and the social welfare needs of the　elderly who live on the Amami Islands and the Yaeyama Islands through a questionnaire survey. The regions surveyed were the urban area of the Amami Ohshima (Amami City) and the rural area of the Kakeroma Islands (Setouchi Town) in Kagoshima prefecture, and the urban area of Ishigaki Island (Ishigaki City) and the rural area of Iriomote Island and Hatoma Island (Taketomi Town) in Okinawa Prefecture. The people who dwell on these remote islands are usually under unfavorable conditions geographically and economically and the communities there are under functional decline due to depopulation and aging. On the other hand, these islands keep the spirit of mutual helping and the traditional cultures. In this paper we report analyses of the anxiety about future life, the feeling that life is worth living, the eating habits, the evaluation of health-care services and welfare services, the family finances, and other regional issues. The anxiety about future life was higher in the rural areas of the islands than in the urban areas. On the other hand, the feeling that life is worth living was higher in the urban areas of the islands than in the rural areas. Respondents were prone to eat poor-balanced meals. In the rural areas of the islands, while they expressed their dissatisfaction with regional gaps of health-care services, they showed high awareness of self-care about their own health. In the rural areas of the islands, welfare services at home were sometimes cancelled by bad weather or transportation trouble by sea. There was no difference in the family finances and regional issues between areas. Regional issues shared by all islands were the vulnerability to typhoons, high social expenses, and the anxiety about life in the future, and especially the elderly in the Setouchi Town listed more regional issues than those in other areas.area of the Kakeroma Islands (Setouchi Town) in Kagoshima prefecture, and the urban area of Ishigaki Island (Ishigaki City) and the rural area of Iriomote Island and Hatoma Island (Taketomi Town) in Okinawa Prefecture. The people who dwell on these remote islands are usually under unfavorable conditions geographically and economically and the communities there are underfunctional decline due to depopulation and aging. On the other hand, these islands keep the spirit of mutual helping and the traditional cultures.In this paper we report analyses of the anxiety about future life, the feeling that life is worth living, the eating habits, the evaluation of health-care services and welfare services, the family finances, and other regional issues. The anxiety about future life was higher in the rural areas ofthe islands than in the urban areas. On the other hand, the feeling that life is worth living was higher in the urban areas of the islands than in the rural areas. Respondents were prone to eat poor-balanced meals. In the rural areas of the islands, while they expressed their dissatisfaction with regional gaps of health-care services, they showed high awareness of self-care about their own health. In the rural areas of the islands, welfare services at home were sometimes cancelled by bad weather or transportation trouble by sea. There was no difference in the family finances and regional issues between areas. Regional issues shared by all islands were the vulnerability to typhoons, high social expenses, and the anxiety about life in the future, and especially the elderly in the Setouchi Town listed more regional issues than those in other areas

悪性度の高い組織像を示したポリープ様尿管腫瘍の1例

A case of a lobulated polypoid tumor of the ureter showing histologically high grade malignancy is reported. Such a tumor is rare in the bladder, and to date none have been documented in the ureter. This tumor is probably the most malignant urothelial tumor of the inverted type in the urinary tract, including inverted papilloma