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.

The Effect of Carbon Dioxide on Cardiovascular Functions and Peripheral Circulation Using a New System of Carbon Dioxide Bath / 日本温泉気候物理医学会雑誌

Effect of carbon dioxide bath on cardiovascular functions and peripheral circulation were studied using a new system of carbon dioxide bath. The subjects consisted of 13 males and 17 females, ranging from 50 to 84 years old, 67.4±8.3 in average, having the complaints resulting mainly from arteriosclerosis such as coldness on extremities or exertional pains of lower extremities. Each subject took a bath in plain water (PW) on the first experimental day and then a bath in carbon dioxide (CO₂) at the same time on the second experimental day. Both baths were done for 10min. at 39°C of water temperature. The results obtained were as follows.<br>1) Mean blood pressure (MBP) was elevating during bath and lowered below prebath level immediately after bath in both PW and CO₂ groups. However, MBP in CO₂ group was lower significantly (p<0.05) than in PW group 20 and 30min after bath.<br>2) Both body and skin temperatures were similarly elevated at all points to be measured directly after bath, and then lowerd gradually thereafter. There was no significance in changes between both groups.<br>4) An increase in cutaneous blood flow was observed at the same grade in both groups during and after bath, though no showing significant difference between both groups.<br>5) PO₂ in venous blood increased after bath, while PCO₂ decreased. However, no significant difference in these changes was observed between both groups.<br>6) Tendency to increase in CV R-R was observed during and after bath, though no significant difference was showed between both groups.<br>7) Relating to the feeling to bath, all subjects had the feeling of “warmness” at the beginning of bath and also of comfortableness during and after bath in both PW and CO₂ groups. However, there was no difference in the intensity of these feelings between both groups.<br>8) No side reaction due to an inhalation of carbon dioxide during bath was observed in all subjects.<br>From these results, it is expected that a new carbon dioxide bath results in benefit for patients with disturbance of peripheral circulation.

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.

Antihypertensive Effect of Artificial Mineral Bathing / 日本温泉気候物理医学会雑誌

We investigated the effects of artificial mineral bathing in water containing sodium sulfate and sodium bicarbonate on venous blood gas, blood pressure, heart rate, and deep body temperature in 10 patients with hypertension or history of hypertension. After a 10-minute bathing at 40°C, the parameters described above were carefully checked. The pH and P_O₂ levels in venous blood increased and the P_CO₂ level decreased after the artificial mineral bathing in comparison with plain water bathing. However, these changes were not statistically significant. The systolic blood pressure tended to decrease up to 10 hours after the artificial mineral bathing. The heart rate markedly reduced after the artificial mineral bathing and remained at a low level for 10 hours. The deep body temperature began to decrease 40 minutes after the artificial mineral bathing. However, it increased over the base-line level 6 hours later. From the above result, it is considered that artificial mineral bathing is useful for patients with hypertension.

Study on incidence of cerebral and acute myocardial infarction in tourists visited hot spring / 日本温泉気候物理医学会雑誌

During the past four years authors encountered a total of 25 tourists suffered from cerebral (CI: 14 cases) and acute myocardial infarction (AMI: 11 cases) while staying in Kusatsu Hot Spring. The subjects consisted of 13 males and 12 females, ranging from 49 to 85 years old (mean 68±9.5). Analytical study relating to the time of onset of diseases, bathing, drinking and others was performed in these patients. The results obtained were as follows.<br>1) Higher incidence was observed from May to October in CI, while from March to April and in September in AMI. A majority of the subjects suffered from CI or AMI within two days after arrival in Kusatsu. Attack occurred during bathing in one subject, within six hours after bathing in one, and from six to 24 hours after bathing in the others, respectively. Furthermore, a hourly distribution of the onset of disease showed the high incidence of CI between 3:00 and 9:00, and of AMI between 21:00 and 0:00.<br>2) Bathing was done one to four times within 24 hours before onset in all subjects. Meanwhile, drinking was in 56% of the subjects.<br>3) Out of 21 subjects investigated six cases were under medication with hypotensive drugs.<br>From the results above described, a role of bathing playing in pathogenetic mechanism in thrombotic diseases such as CI and AMI was briefly discussed.

Study on the mechanism of onset of cerebral and myocardial infarction from the viewpoint of circadian change in blood viscosity. I. Effect of alcohol drinking and hot spring bathing on the diurnal variation in blood viscosity in young men / 日本温泉気候物理医学会雑誌

We have pointed out that the incidence of cerebral and myocardial infarction that occur early in the morning is high and estimated its correlation with blood viscosity as a cause. To clarify the mechanism of onset of such diseases early in the morning in further details, we examined the effect of alcohol drinking and hot spring bathing on the circadian changes in blood viscosity on normotensive and nonsmoking young men. It was observed that both drinking a bottle or 633ml of beer containing 4.5% alcohol and taking a hot spring bath at 42°C for 10 minutes at 8p.m. tended to enhance the rate of increase in blood viscosity between 4a.m. and 8a.m. the next morning as compared with the control. In contrast, drinking 500ml of water at 0a.m. after either drinking a bottle of beer or having a hot spring bath mitigated the change in blood viscosity the next morning. These findings may suggest that both drinking alcohol and taking a hot spring bath around dinner time elevate the rate of increase in blood viscosity in the next morning, leading to possible onset of cerebral and myocardial infarction. Drinking two glasses of water at midnight is effective in preventing such change in blood viscosity in the morning.

Effect of artificial carbon dioxide bathing on oxygen-dissociation curve of hemoglobin / 日本温泉気候物理医学会雑誌

Many researchers have pointed out that CO₂ bathing directly effects expanding dermal vessels. The authors have recently reported a decrease in red blood cell after CO₂ bathing. To clarify other effects of CO₂ bathing on RBC, the changes in the hemoglobinoxygen-dissociation curve (P50) were measured after single bathing (for 10 minutes at 40°C) with artificial CO₂ water made of sodium bicarbonate and citric acid dissolved in plain water. P50 was measured with an oxygen-dissociation analyzer (HEMO-O-SCAN^TM made by American Instrument Company) and 2, 3-diphosphoglycerate (2, 3-DPG) in RBC, with enzymatic analysis. The subjects of this study consisted of six male patients and four female patients, ranging from 53 to 80 years old.<br>The results are presented below.<br>1) Nine of ten patients showed an increase in P50 after 15 to 30 minutes of CO₂ bathing. The remainder showed a transient increase in P50.<br>2) No significant increase in 2, 3-DPG concentration in RBC was found in the group subjected to CO₂ bathing as compared to that of the controls who were subjected to plain water bathing. However, seven patients showed an increase in 2, 3-DPG after 15 to 30 minutes of CO₂ bathing, and three patients showed a decrease in 2, 3-DPG.<br>3) Partial pressures of oxygen (PO₂) and carbon dioxide (PCO₂) in the venous blood were measured. Elevation of PO₂, lowering of PCO₂, and increase in pH were observed in almost all patients after a single CO₂ bath.<br>From these results, we can conclude that a single CO₂ bath effectively decreases oxygen affinity of hemoglobin, presumably due to a rise in the blood temperature and partially due to an increase in 2, 3-DPG concentration in RBC.

Effect of artificial carbon dioxide bathing on red blood cell viscosity / 日本温泉気候物理医学会雑誌

Many researchers have pointed out that CO₂ bathing directly effects expanding dermal vessels. To clarify the effect of CO₂ bathing on red blood cell (RBC), the change of RBC viscosity after single bathing(for 10 minutes at 40°C) with artificial CO₂ water made of sodium bicarbonate and citric acid dissolved in plain water was investigated. RBC viscosity was measured at both shear rates of 0.0439 (low) and 94.5 (high) sec^-1 using a viscosimeter (Low Shear 30 made by Contraves). The subjects of this study consisted of three male patients and three female patients with a history of cerebro-vascular disease and ranging from 53 to 80 years old.<br>The results are presented below.<br>1) On the twenty-first day of serial CO₂ bathings, a significant decrease in RBC viscosity was found in these patients as compared with that in controls who were subjected to bathing with plain water. However, it was not found on the first day. RBC viscosity of the blood sample that has an elevated PCO₂ due to the CO₂ gas bubbled into it was measured in relation with the PCO₂. RBC viscosity decreased gradually at both shear rates as the PCO₂ was elevated and the MCV increased.<br>2) MCV increased significantly after single bathing on the twenty-first day of serial CO₂ baths as compared to that of controls who were subjected to bathing with plain water.<br>3) ATP concentration in RBC decreased significantly after single bathing as compared to that before bathing.<br>From these results, we can conclude that serial CO₂ baths effectively decrease RBC viscosity due to the increase in MCV, which is attained by CO₂ through “chloride shift.”