Levetiracetam-induced rhabdomyolysis: A case report and literature review

Levetiracetam (LEV), a relatively new antiepileptic drug, is now frequently used for treating partial or generalized seizures. Among the adverse effects of LEV, rhabdomyolysis is rare. We describe here a case of LEV-induced rhabdomyolysis in a 26-year-old woman. The patient’s seizures had been controlled with carbamazepine and phenobarbital for the previous 7 years. However, LEV was initiated at the age of 26 years because her seizures control deteriorated with seizures occurring monthly. She experienced lower limb weakness with a high level of creatine kinase 15 days after starting LEV. When LEV was discontinued, her creatine kinase levels decreased and her symptoms gradually improved. This case provide another example of rhabdomyolysis during the early phase of LEV treatment.

Clinical Effects of Steam Rock Bathing in Saiboku Hot Spring for Allergic Rhinitis / 日本温泉気候物理医学会雑誌

<p><b>Background:</b> Hot spring inhalation and rock bathing are widely practiced in Europe, and immersion in water up to the shoulders is popular in Japanese balneotherapy. We designed a combination therapy of steam rock bathing and immersion in an open-air hot spring pool for allergic rhinitis.</p><p><b>Methods:</b> Data were obtained by anonymous questionnaires from 19 participants with perennial allergic rhinitis who underwent the combination therapy for several days during the spring-pollen season. The participants immersed themselves in a sitting position in Saiboku hot spring water (sodium salt hot spring) at 41°C up to the shoulder level for 10 min in the open-air and then lay on a floor paved with small rocks in a supine position for 20 min in a room filled with the steam from hot springs, then immersed themselves again in the hot spring water for 10 min, and finally rested and sat on a chair for 20 min in a comfortable room. The hot spring water circulated through tubes with small holes that were embedded under the floor, which was paved with small rocks consisting of tourmaline and lime stones. Steam from the hot spring water penetrated through the floor and vaporized in the room. The rock bathing room was 40°C in temperature and 75% in humidity.</p><p><b>Results:</b> Clinical symptoms were alleviated in 17 of 19 participants. Watery rhinorrhea, eye itching, sneeze, and sore throat were improved in 100%, 75%, 40%, and 100% of the participants, respectively, compared with symptoms during the previous several years. No adverse effects were observed in any participants. </p><p><b>Conclusion:</b> Steam rock bathing, combined with immersion in an open-air hot spring pool, is useful in ameliorating the focal and systemic symptoms of allergic rhinitis.</p>

Clinical Effects of Steam Rock Bathing in Saiboku Hot Spring for Allergic Rhinitis / 日本温泉気候物理医学会雑誌

Background: Hot spring inhalation and rock bathing are widely practiced in Europe, and immersion in water up to the shoulders is popular in Japanese balneotherapy. We designed a combination therapy of steam rock bathing and immersion in an open-air hot spring pool for allergic rhinitis.Methods: Data were obtained by anonymous questionnaires from 19 participants with perennial allergic rhinitis who underwent the combination therapy for several days during the spring-pollen season. The participants immersed themselves in a sitting position in Saiboku hot spring water (sodium salt hot spring) at 41°C up to the shoulder level for 10 min in the open-air and then lay on a floor paved with small rocks in a supine position for 20 min in a room filled with the steam from hot springs, then immersed themselves again in the hot spring water for 10 min, and finally rested and sat on a chair for 20 min in a comfortable room. The hot spring water circulated through tubes with small holes that were embedded under the floor, which was paved with small rocks consisting of tourmaline and lime stones. Steam from the hot spring water penetrated through the floor and vaporized in the room. The rock bathing room was 40°C in temperature and 75% in humidity.Results: Clinical symptoms were alleviated in 17 of 19 participants. Watery rhinorrhea, eye itching, sneeze, and sore throat were improved in 100%, 75%, 40%, and 100% of the participants, respectively, compared with symptoms during the previous several years. No adverse effects were observed in any participants. Conclusion: Steam rock bathing, combined with immersion in an open-air hot spring pool, is useful in ameliorating the focal and systemic symptoms of allergic rhinitis.

Usefulness of Choline-PET for the detection of residual hemangiopericytoma in the skull base: comparison with FDG-PET.

BACKGROUND: Choline is a new PET tracer that is useful for the detection of malignant tumor. Choline is a precursor of the biosynthesis of phosphatidylcholine, a major phospholipid in the cell membrane of eukaryotic cells. Malignant tumors have an elevated level of phosphatidylcholine in cell membrane. Thus, choline is a marker of tumor malignancy. METHOD: The patient was a 51-year-old man with repeated recurrent hemangiopericytoma in the skull base. We performed Choline-PET in this patient after various treatments and compared findings with those of FDG-PET. RESULTS: Choline accumulated in this tumor, but FDG did not accumulate. We diagnosed this tumor as residual hemangiopericytoma and performed the resection of the residual tumor. FDG-PET is not appropriate for skull base tumor detection because uptake in the brain is very strong. CONCLUSION: We emphasize the usefulness of Choline-PET for the detection of residual hemangiopericytoma in the skull base after various treatments, compared with FDG-PET.

Effect of Weather on Chief Complaints and Disorders of Outpatients / 日本温泉気候物理医学会雑誌

We investigated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, by way of clarification of relationship between weather and health. This study covered the new outpatients of our division, and carried out on February '03 and June '03 (February: 72 males, 106 females, aged 49.9±18.5, June: 98 males, 109 females, aged 47.6±19.5). We categorized their clinical data into chief complaints (pain, headache, discomforts, fever, cough, vertigo/stagger, palsy) and disorders (gastrointestinal, mental, inflammatory, orthopedic, infection, respiratory, circulatory, tumorous, urinary, autoimmune/allergic, dental/oral, gynecological), then, compared the clinical data of February with June, in terms of seasonal disease. Additionally, we investigated the relationship between weather data and clinical data of February and June, from a perspective of meteoropathy. The average of meteorological phenomena (air pressure, air temperature, relative humidity, velocity of wind, day length, rainfall level) of a week before first visit, were used as weather data. The main results of analysis about seasonal disease, showed that the complaint of discomfort were more frequent in June than February (p=0.005). The orthopedic disorder was more frequent in June than February (p=0.012). Infection was more frequent in February than June (p=0.011). The analyses in terms of meteoropathy, showed that the complaint of cough were more frequent after cold temperature in February (p=0.014). The gastrointestinal disorders were more frequent after humid (p=0.018) and pluvious days (p=0.016) in February. The complaint of headache was liable to be frequent after pluvious weather in June.<br>The relationship between weather and health is known in the prior an, and our study anew demonstrated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, as statistical evidence.

Clinical Analysis of Platelet Shape Change and Coagulation-Fibrinolytic Markers in Patients with Cerebral Infarction in a Spa Resort / 日本温泉気候物理医学会雑誌

This study investigated the existence of platelet activation before the onset of cerebral infarction, and analyzed the association between the platelet activation and the degree of atherosclerosis. Furthermore, prediction of the risk of cerebral infarction by assessing platelet activation was attempted. Thirteen patients with cerebral infarction, 7 patients with atherosclerosis and 8 healthy subjects were enrolled in this study. Ultrastructural shape change, peroxidase reaction, and fibrinogen content in the platelets were observed and plasma levels of thrombin antithrombin complex, α₂-plasmin inhibitor plasmin complex, β-thromboglobulin and platelet factor-4 were measured in patients with atherosclerosis and cerebral infarction at the acute, subacute and chronic phases. The ultrastructural shape change, peroxidase reaction, and fibrinogen content did not differ among acute, subacute and chronic phases of cerebral infarction. The frequency of platelet shape changes were also increased in patients with atherosclerosis, compared with healthy subjects. Plasma levels of β-thromboglobulin, platelet factor-4, and thrombin antithrombin complex increased only during the acute phase of cerebral infarction. It is suggested that platelet activation occurs before the onset of cerebral infarction and that platelet shape change is associated with the degree of atherosclerosis, or plaque stability. Platelet activation would be derived not from thrombotic event itself but from endothelial damage or pre-existing atherosclerosis. Platelet shape change, therefore, could predict the risk of cerebral infarction. Taken together with our previous reports demonstrating increased blood viscosity, noctural hypotension, increased human atrial natriuretic peptide, decreased fibrinolytic activity, and platelet shape change were observed after very hot hot-spring bathing, cerebral infarction in spa-resort could be caused partly by very hot hot-spring bathing after traveling on a tight schedule and alcohol drinking by elderly patients with atherosclerosis.

Pseudo-Bartter's Syndrome and Pseudohypoparathyroidism Due to Long-term and Long-time Bathing in a Patient with Atopic Dermatitis / 日本温泉気候物理医学会雑誌

A patient with atopic dermatitis who presented muscular weakness of lower extrimities and tetany due to severe hypokalemia, hypocalcemia and hypomagnemia was described. The hypokalemia and hypomagnemia were caused by pseudo-Bartter's syndrome due to persistent dehydration, and the hypocalcemia was caused by pseudohypoparathyroidism due to hypomagnemia. The persistent dehydration was considered to be resulted from long-term and long-time bathing. Thus, adequate supply of water and electrolytes may be necessary in long-term balneotherapy.

Effect of Short Staying Spa Therapy on QOL / 日本温泉気候物理医学会雑誌

Effect of balneotherapy is said to be obtained by continuous bathing in hot spring for 2-4 weeks. However, a short staying at spa for bathing therapy is quite usual in Japan nowadays. So we conducted an investigation on the effect of bathing therapy at spa for 3-7 days (short group), comparing with the effect of the therapy for 14 days or more (long group), through the collaboration of balneologists in all over Japan. The total of 215 cases, having rheumatic, cardiovascular, metabolic, psycho-neurological, postoperative, skin or digestive diseases, of whom 135 were in the short group and 80, in the long group, were analysed for the influence of spa therapy on the patient's quality of life (QOL). Both the severity of disease by doctor's evaluation through visual analogue scale method and the patient's QOL state assessed by patient through the Face Scale method were improved significantly in both groups after the spa therapy. The disease severity and the patient's QOL state at the end of spa therapy were not changed significantly thereafter through 1 month in both groups. Patient's activities of daily living (ADL), appetite, sleep, pain, itch and fatigue, which will make up the patient's QOL, were also improved significantly after the spa therapy, if they had been disturbed or present, in both groups. All these states at the end of spa therapy were not changed significantly at 1 month after the end of spa therapy in both groups. These results may substantiate the rightfulness of patient's assessment of QOL. The tendency to normalization was found in the body weight, blood pressure and passage too after the spa therapy in both groups. A skin rash, itching or slight thermal crisis was observed in 13 cases as the side effects of spa therapy. None of them was serious. From the above results it is concluded that a short staying spa therapy for 3-7 days is effective as well as the standard long therapy on patient's QOL, and the effects last about 1 month long at least.

Balneotherapy for psoriasis at Kusatsu. Value of balneotherapy as alternative and complementary medicine / 日本温泉気候物理医学会雑誌

From March 1990 to September 2001, 24 patients with psoriasis (16 males and 8 females, 54±18 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The psoriasis had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by application of vitamine D3 ointment 1-2 times daily for 37±19 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 20 of 24 cases (83%) were improved through the balneotherapy, while those of the remaining 4 cases were not changed. No side effects were observed. The serum levels of uric acid, GOT and GPT which are reported to be increased slightly did not correlate with the skin symptoms. The serum LDH level which is associated with the skin manifestastions in patients with atopic dermatitis also gave no useful information in the treatment of psoriasis. Although the mechanism of the improvement of skin manifestations is not clarified, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of psoriasis as alternative and complementary medicine

Analysis of the Circumferences of Chest, Abdomen, Thigh and Calf during Head-out Water Immersion / 日本温泉気候物理医学会雑誌

The circumferences of chest, abdomen, thigh and calf during head-out water immersion up to chin level were measured in 8 healthy male subjects (age 35.4±1.6years old, body mass index 23.7±1.6kg/m²) in standing and sitting positions. The circumferences of chest, abdomen, thigh and calf decreased significantly during immersion in standing position. The circumferences of chest, abdmen and thigh decreased significantly in sitting position. The circumference of chest decreased from 90.6±3.4 to 90.1±3.1cm, that of abdomen decreased from 81.4±2.8 to 80.6±2.5cm, that of thigh decreased from 47.1±1.6 to 46.6±1.8cm, and that of calf decreased from 37.7±1.8 to 37.2±1.8cm during immersion in standing position. As the body surface area is about 1.6m², the decrease in the volume of human body is considered to be 730cm³ or less when the body shape change during immersion is not taken into considerarion.

Effect of Hot-spring Bathing on the Control Factors of Coagulation / 日本温泉気候物理医学会雑誌

We have investigated change in platelets and the blood coagulation and fibrinolytic systems as a mechanism of the onset of thrombotic diseases during and after hot-spring bathing. In this study, We examined effect of 10min 42°C and 37°C hot-spring bathing on protein C, protein S and antithrombin III in seven healthy male subjects. The mean values of protein C antigen, protein C activity, total and fee protein S antigens, protein S activity and antithrombin III activity were slightly increased by both methods, while these changes were not statistically significant. Taken together with our previous reports, 10min 42°C hot-spring bathing gives no effect on the blood coagulation system.

Treatment of 100 Cases of Adult-type Atopic Dermatitis with Kusatu Balneotherapy / 日本温泉気候物理医学会雑誌

From June 1990 to October 1998, 100 patients with adult-type atopic dermatitis (59 males and 41 females, 25±8 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The atopic dermatitis in all but 9 cases occurred while the patients were still under 20 and had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by immediate application of white petrolatum 1-2 times daily for 75±46 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 79 of 100 cases (79%) were improved through the balneotherapy and furthermore pruritus was improved in 55 of the 79 cases (70%). The improvement of skin manifestations was supported by a significant decrease in serum LDH levels. In contrast, pruritus was not improved in the remaining 21 cases who showed no changes in skin symptoms and serum LDH levels. Moreover, changes in the number of <i>Staphylococcus aureus</i> on the skin surface were examined before and after balneotherapy. In the 69 cases examined whose skin symptoms were improved, many <i>Staphylococci aureus</i> were detected in 52 of the cases but not in the other 17 cases before starting balneotherapy. They disappeared in 24 cases and decreased in 18 cases of the 52 cases, but were not changed in the remaining 10 cases through the balneotherapy. On the other hand, the number of <i>Staphylococcus aureus</i> on the skin surface was not changed in 11 of the 14 cases examined whose skin symptoms were not improved. Our previous study reported that bactericidal activity against <i>Staphylococcus aureus</i> is expressed by the co-existence of manganese and iodide ions contained in the hot-spring water under an acidic (pH 2.0-3.0) condition. Thus, the mechanisms of the improvement of skin manifestations through the balneotherapy may be explained by considering bactericidal activity of Kusatsu hot-spring water against <i>Staphylococcus aureus</i> inducing acute flares of skin manifestations. Therefore, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of adult-type atopic dermatitis as a suitable method of skin care.

Medical Significance of Pouring 47.DEG.C. Hot-spring Water Over the Head before Taking a 3-min 47.DEG.C. Hot-spring Bath / 日本温泉気候物理医学会雑誌

A 3-min bath in 47°C hot-spring water called ‘jikan-yu’ has been recommended for over 130 years at Kusatsu-spa. There is a traditional custom of pouring hot-spring water of the same temperature over the head before entering the bath to avert an afflux of blood to the brain. The medical significance of this custom was investigated in 8 healthy male volunteers (age 31±6 years and body mass index 22.4±1.6kg/m²). There were no significant differences in plasma levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, and β-endorphin on a comparison of findings before and after the action of pouring 20 pails of 47°C hot-spring water over the parietal and occipital areas of the head. However, the direct effect of heat stress on the internal thermosensor in the anterior hypothalamus regulating heat loss and thermogenesis was not examined in this study. Thus, it is considered that the action does not provide a direct hyperthermal stimulus to the brain stem to release stress hormones but may dilate blood vessels of the head to prepare for the abrupt afflux into the cerebral circulation of blood heated by subsequent very hot hot-spring bathing.

Actual Situation of Rehabilitation in the Kusatsu Branch Hospital Gunma University Hospital over the Last 10 Years / 日本温泉気候物理医学会雑誌

A total of 422 patients who were hospitalized in the Division of Rehabilitation, Kusatsu Branch Hospital of the Gunma University Hospital from 1986 to 1996 was analysed with respect to the patients' sex, age, place of residence, disease, complications, day from onset to admission to our hospital, days of treatment in the hospital, outcome, reason to receive rehabilitation, persons who took care of the patient, and family members. Of the 422 cases, 262 (62.1%) were 65 or more years old. 193 patients (45.7%) were residents of Kusatsu, and 143 patients (33.9%) were from outside Gunma Prefecture.<br>With respect to diseases, cerebral diseases had the highest percentage (148 cases, 35.1%) and 277 (65.6%) cases had complications. The mean days of treatment in the hospital were 73 days. Hot-spring bathing was used for rehabilitation in 351 (83.2%) cases, resulting in improvement of clinical symptoms and quality of life in almost all cases. As to reason to receive rehabilitation in our hospital, 202 (47.9%) came of own will, 79 (18.7%) were recommended by doctors of other hospitals, and 68 (16.1%) were emergency admissions. Most patients lived alone or had only one family member of an old age and 83.2% of the persons who took care of patients were female family members. Many patients still wanted to receive rehabilitation even long after the onset of their impairment. These findings suggest that hot-spring bathing is effective for rehabilitation of various kinds of diseases. Although it has been found that many patients came to our hospital from various areas in the country expecting to rehabilitation using hot-spring water, it is difficult to follow up on them and to contact their family members for instructions.

Effects of Hot Spring Bathing on Blood Pressure, Heart Rate, Plasma Cortisol and Hematocrit at Kusatsu / 日本温泉気候物理医学会雑誌

To clarify possible involvement of hot spring bathing in the occurrence of acute myocardial infarction and cerebral infarction at Kusatsu, its effects on blood pressure, heart rate, plasma cortisol and hematocrit were examined in 9 healthy young men. Abrupt increase in systolic blood pressure was observed immediately after starting a 3-minute 47°C or a 10-minute 42°C hot-spring bath. Both systolic and diastolic blood pressure were abruptly decreased one minute after completing either 47°C or 42°C bathing. The heart rate was increased gradually after the start of either 47°C or 42°C bathing and was decreased gradually after the completion of either 47°C or 42°C bathing. It was considered that the plasma Cortisol level was increased 15 minutes after starting 47°C bathing and the hematocrit was increased 15 minutes after starting 42°C bathing. We have already reported that fibrinolytic activity was decreased and platelet function was activated by 47°C bathing. Taken together, it is suggested that the mechanism of the occurrence of thrombotic diseases after hot spring bathing may be explained by considering transient changes in blood pressure, heart rate, blood viscosity, fibrinolytic activity and platelet function induced by hyperthermal stress.

Effect of Hot Spring Bathing on Nocturnal Blood Pressure at Kusatsu / 日本温泉気候物理医学会雑誌

The effect of hot spring bathing on nocturnal blood pressure was investigated in 6 normotensive young individuals at Kusatsu. Blood pressure and heart rate were measured at 1-hour intervals from 18:00 one day until 12:00 the following day. The experiments were performed on 2 consecutive days. Three subjects took a 10-minute 42°C hot-spring bath at 20:00 on the first experimental day but did not on the second experimental day. The order of experiments was inverted in the other 3 subjects. While not statistically significant, the nocturnal blood pressure on the “bathing” day tended to be decreased more than that on the control day. However, there was no difference in the heart rate. These findings may suggest possible involvement of hot spring bathing in the initiation of thrombotic diseases occurred in the morning hours at Kusatsu.

Skin Surface Temperature after Bathing in Very Hot Hot-Spring Water at Kusatsu / 日本温泉気候物理医学会雑誌

The change in the skin surface temperature after taking a 3-minute 47°C hot-spring bath was examined in five healthy male volunteers whose mean age was 29.5 years and body mass index was 22.6kg/m², As a control, they took a 10-minute 42°C hot-spring bath after 4 days. Skin surface temperature was measured by a thermotracer in a room where the ambient temperature was maintained at 25°C and relative humidity at 38%. To eliminate any effect of diurnal variation in skin surface temperature, the experiment was started at 1 p.m. of each day. There was no significant difference in the highest value of skin surface temperature of the face, chest, arm, hand, leg and foot between both bathings. However, the abdominal skin surface temperature was slightly higher after the 3-minute 47°C bath than after the 10-minute 42°C bath. The skin surface temperature of the chest was transiently decreased after the 3-minute 47°C bath. The highest value of skin surface temperature of all areas examined after the 3-minute 47°C bath was about 34°C and did not differ from that after the 10-minute 42°C bath. These findings suggest that external heat stress gives no influence on the skin surface temperature and the transient decline of the skin surface temperature of the chest after the 3-minute 47°C bath may be due to some pathophysiological change in the vascular and respiratory systems.

Effects of yperthermia on Human Platelets. Flow cytometric analysis on the formation of platelet-derived microparticles and the expression of CD62 antigen on the platelet surface / 日本温泉気候物理医学会雑誌

Effects of hyperthermia on the formation of platelet-derived microparticles (MP) and the expression of surface CD62 antigen were examined in normal human platelets. Venous blood from healthy subjects, anticoagulated with 1 volume of 3.8% sodium citrate, was heated at 37°C (control), 42°C and 47°C for 15 minutes. Then 2μl of each sample was incubated with FITC or PE-conjugated anti-human CD42b or CD62 antibodies, and assayed for MP and CD62 by flow cytometry. The percentage of MP after the incubation was not significantly different from that before the incubation nor that of control (9.9±0.6% before incubation, 10.2±0.6% at 37°C, 10.8±0.4% at 42°C and 10.3±0.3% at 47°C), CD62 positive-platelets slightly increased after the incubation, but no significant differences were observed between the control value and the values at 42°C and 47°C (1.6±0.3% at 37°C, 1.9±0.5% at 42°C and 1.7±0.3% at 47°C). These data suggest that hyperthermia has only a weak stimulatory effect on platelets and is unable to induce MP formation.

Effects of Hot-Spring Bathing on Plasma Concentrations of Human Atrial Natriuretic Polypeptide, Antidiuretic Hormone, Aldosterone and Endothelin / 日本温泉気候物理医学会雑誌

Effects of hot-spring bathing on plasma concentrations of diuresis-related hormones were examined. Four healthy males were asked to bath in either 47°C hot-spring water for 3 minutes (jikan-yu) or 42°C hot-spring water for 10 min. Plasma levels of human atrial natriuretic polypeptide (HANP), anti-diuretic hormone (ADH), aldosterone (ALD), and endothelin (ET) were measured at 0, 5, 15, and 30 minutes after the start of the immersion. A transient rise was found only in plasma HANP at 5 minutes in the 42°C bath, which may have been induced by the hydrostatic pressure. Plasma concentrations of ADH, ALD, and ET hormones showed no remarkable change.<br>These results suggest that a few minutes of hot-spring bathing may have little influence on the amount of these hormones secreted.

Effect of Highly Concentrated Carbon Dioxide-Bathing on Circadian Blood Pressure Variations in Drug-refractory Hypertensive, Specially Non-dipper Patients / 日本温泉気候物理医学会雑誌

Using a highly concentrated CO₂-bathing, authors studied an effect of the bathing (CO₂: 1, 000ppm, for 10min at 40°C) on circadian blood pressure in six cases of antihypertensive drug-refractory hypertension. The patients were females, ranging from 62 to 70 years old (mean age: 65.8±2.6). All of the patients were diagnosed as the III stage of essential hypertension (according to WHO criteria) and have been treated with captopril, nifedipine or α-methyl DOPA since three to ten years ago. Out of six cases five showed non-dipper pattern in circadian blood pressure. All bathings were done at 16:30 and comparative study of circadian blood pressure between plain water and CO₂-bathing was carried out.<br>The results obtained were as follows.<br>1) In five cases of non-dippers CO₂-bathing exerted the therapeutic effect upon the high blood pressure at night and resulted in the significant decrease in hyperbaric indici of systolic, mean and diastolic blood pressure, comparing with plain water-bathing. However, no significant difference of heart rate was observed between plain water and CO₂-bathing.<br>2) In a case of good responder to antihypertensive drug, a relatively low blood pressure continued all day after CO₂-bathing.<br>From these results it is expected that a highly concentrated CO₂-bathing is useful as supportive therapy to essential hypertension, specially to non-dipper.