Kousei Tamura

A transient rise in plasma β-endorphin after a traditional 47°C hot-spring bath in Kusatsu-spa, Japan

Abstract To clarify the mechanism of the intoxicating feeling attained after a traditional 47°C hot-spring bath called ‘jikan-yu’ in Kusatsu-spa, Japan, we examined the change in plasma levels of β-endorphin and methionine enkephalin in 7 healthy subjects. The mean sublingual temperature rose from 36.8°C to 38.6°C and the plasma β-endorphin level from 16.2 pg/ml to 49.5 pg/ml 2 minutes after completing a 3-minute bath in 47°C hot-spring water. However, the plasma methionine enkephalin level was not changed. This feeling of intoxication may be explained by the transient rise in plasma β-endorphin level.

Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water.

Kurabayashi H, Tamura K, Machida I, Kubota K: Inhibiting bacteria and skin pH in hemiplegia: effects of washing hands with acidic mineral water. Am J Phys Med Rehabil 2002;81:40–46. ObjectiveTo evaluate bacterial flora in hemiplegic hands as a possible pathogen of endogenous infection in a rehabilitation unit and to examine the effect of cleansing hands with acidic mineral water on the flora. DesignCase-control study in a university affiliated hospital. Seventy-two patients with hemiplegia caused by cerebrovascular diseases were included in this study. Bacterial flora by the swab method, bacterial frequency on the palm by the stamp method, and skin surface pH were examined before and after single cleansing by immersion in plain or acidic mineral water. ResultsThe bacterial frequencies of patients with hemiplegia and diabetes were higher than those of normal healthy subjects. After cleansing with acidic mineral water, skin surface pH was decreased and bacterial frequency was markedly decreased. A prolonged decrease in skin surface pH was observed in patients with hemiplegia in contrast to normal healthy subjects who presented a short-term decrease. ConclusionIncreased bacterial frequencies were associated with a high skin surface pH caused by disordered skin systems in patients with hemiplegia. Acidic mineral water may be useful for inhibiting bacterial growth in patients with hemiplegia.

Effective physical therapy for chronic obstructive pulmonary disease : Pilot study of exercise in hot spring water

Respiratory function and arterial blood gas were examined before and after a two-month exercise program performed in a pool filled with hot spring water in 22 patients (70.9 +/- 9.1 years of age) with stable chronic obstructive pulmonary disease (12 cases of bronchial asthma and 10 cases of pulmonary emphysema) treated at our hospital between 1991 and 1994. The ratio of forced expired volume in one second to forced vital capacity (FEV1%) was significantly increased after the exercise program (P < 0.05), whereas the ratio of forced vital capacity to predicted normal value (%FVC) did not change. In addition, a tendency toward an increase in peak flow without an increase in maximum expiratory flow at 25 and 50% (V25 and V50) was observed. Although PaO2 was not increased, PaCO2 was selectively decreased by the exercise program (P < 0.05). The changes in respiratory function and arterial blood gas were considered attributable to respiratory muscle training and small airway clearance. Exercise in a pool filled with hot spring water may be useful in treating chronic obstructive pulmonary disease.

Effects of hyperthermal stress on the fibrinolytic system

The effects of hyperthermal stress on the coagulation and fibrinolytic systems were examined in five healthy subjects who took a 3-min 47 degrees C hot-spring bath. After a 3-min 47 degrees C bath, the sublingual temperature was transiently increased about 1.8 degrees C, returning to the baseline level within 60 min. The plasma level of plasminogen activator inhibitor-1 antigen (PAI-1) was transiently increased 15 min after the start of bathing and returned to the pre-bathing level 360 min later. The plasma levels of tissue plasminogen activator antigen, alpha 2 plasmin inhibitor activity, plasmin-antiplasmin complex, thrombin-antithrombin III complex, and thrombomodulin antigen were not influenced by the bath. The in vivo result correlated well with the in vitro result that PAI-1 was released from cultured endothelial cells by heating. These findings suggest that the increase in plasma PAI-1 level may be due to the direct hyperthermal action of the very hot hot-spring bath on the endothelial cells and that acute hyperthermal stress may decrease the fibrinolytic capacity, leading to the occurrence of thrombotic events.

Breathing out into water during subtotal immersion: a therapy for chronic pulmonary emphysema.

OBJECTIVE To determine the importance of a breathing out into water exercise during subtotal immersion for emphysematous patients. DESIGN Results of a respiratory function test and arterial blood gas analysis were examined to compare the programs of breathing exercise with and without the breathing out into water exercise. The breathing exercises in a pool filled with 38 degrees C water were performed 30 min/day, 5 days/wk, for 2 mo in 17 patients with stable chronic emphysema. Patients were randomly assigned to breathing exercise programs including subtotal water immersion with the nose and mouth either immersed (9 patients) or out of the water (8 patients) during exhalation. RESULTS The ratio of %forced expired volume in 1 sec to forced vital capacity and %forced vital capacity at rest were significantly increased in the program with the breathing out into water exercise, but they did not change in the program without the breathing out into water exercise. A significant increase in peak flow was observed in the former program, although it did not change in the latter program. The maximal expiratory flow at 25% did not change in either program. Pao2 was significantly increased and Paco2 was significantly decreased in the former program, although a trend for a decrease in Paco2 was observed in the latter program. CONCLUSIONS These results suggest that the breathing out into water exercise enhances the effects of a breathing exercise during immersion and is useful in rehabilitation for chronic pulmonary emphysema.

Effects of hyperthermal stress on the ultrastructure of platelets with reference to the localization of platelet peroxidase and fibrinogen in vivo.

Ultrastructure of platelets with the localization of platelet peroxidase and fibrinogen through 3‐min 47°C hot‐spring bathing was investigated in eight healthy volunteers. The mean sublingual temperature rose about 1.8°C 5 min after the start of bathing. The frequencies of fold, pseudopods, vacuoles, and centralization were increased after bathing. Platelet peroxidase activity was decreased after bathing. Furthermore, fibrinogen was decreased in α‐granules after bathing. Thus, hyperthermal stress in vivo may activate platelets, resulting in consumption of platelet peroxidase and fibrinogen. Am. J. Hematol. 56:244–247, 1997.

The Effects of hydraulic pressure on atrial natriuretic peptide during rehabilitative head-out water immersion

To study the hydraulic effects of subtotal immersion as a rehabilitative hydrotherapy, we examined the change in serum levels of atrial natriuretic peptide, catecholamine, cortisol and interleukins in 12 healthy volunteers. The subjects soaked in 42 degrees C water of 70 cm depth up to chin level in the upright seated position for 10 min. The serum level of atrial natriuretic peptide increased significantly 15 min after the start of subtotal immersion, though that of brain natriuretic peptide did not change. The serum dopamine level increased significantly 15 min after immersion, though neither the serum epinephrine nor norepinephrine levels did. In addition, 30 min after the start of immersion, the serum levels of atrial natriuretic peptide and dopamine decreased to those before immersion. The serum level of adrenocorticotropic hormone increased 15 min after immersion, though those of cortisol, interleukin-1beta and 6, and tumor necrotic factor-alpha did not change. It is suggested that 10-min head-out water immersion increased atrial natriuretic peptide partly due to increased venous return or right atrial load by hydraulic pressure.

Blood Viscosity and Cerebral Blood Flow.

著者らは血液粘度と脳循環との関連を検討する目的で老年者の各種多血症6例 (男, 平均年齢66.6±4.6歳), および47歳ストレス多血症1例 (女) 計7例についてPET study により局所脳血流量 (CBF) および局所脳酸素代謝率 (CMRO2) を瀉血 (総量800～1,000ml) 前後で測定し, 血液粘度の面より脳循環動態につき検討した. CBFは血液粘度およびCMRO2両者との間に相関性を示し, この際, 高血液粘度 (5.0cp以上, ずり速度: 94.5sec-1) でもCBFと相関が全例でみられた点注目される. なお血液粘度は cerebral oxygen transport とは有意の相関性を示さなかった. 以上の成績から, 老年者多血症に対する瀉血は血液粘度低下と同時に脳循環, 脳酸素代謝の改善をもたらし, 血栓形成の危険を少なくする意味で臨床的に意義あることと考えられた.温泉湯治老年者に脳梗塞発症が稀ならずみられ, 発症が3:00より6:00に集中していた点に注目して発症機転を検討した. 脳血管障害後遺症男性5例を対象として, 温泉浴 (42℃, 10分, 16:00) 後の血液粘度の日内変動を検討したところ, 淡水浴に比し4:00から12:00に至る時間帯で血液粘度は有意に上昇した. 同時に測定した24時間血圧では, 同様に真夜から翌朝8:00にかけて血圧低下傾向が淡水浴に比してより著明に観察された. 温泉浴時の種々の浴温度の凝固・線溶系におよぼす影響について健康男性10例を対象として検討した. 42℃10分浴では開始後15分にtPAは増加し, 47℃3分浴では15分後にPAI-1は著増, tPA増加は消失した. TATには著変はなく, 一次線溶能亢進と推定された. 人臍帯静脈内皮細胞を用いた in vitro 実験では培養温度の上昇につれPAI-1は培養液中に増加し, 高温浴時のPAI-1増加が血管内皮細胞由来によることが推定された.以上の in vivo, in vitro 成績から, 温泉浴客に稀ならずみられる脳梗塞発症に高温浴が血液粘度, 血圧および線溶系を介して病因的役割を演じている可能性が推定された.

Complete cure of urinary and faecal incontinence after intravenous vitamin B12 therapy in a patient with post-gastrectomy megaloblastic anaemia

Abstract. The case of a 59‐year‐old Japanese woman with post‐gastrectomy megaloblastic anaemia having urinary and faecal incontinence and paraesthesia in four extremities is described. While the haematological abnormalities were improved by administration of a total dose of 17 mg of intramuscular mecobalamin, the neurological abnormalities remained unchanged. Five months later, a total dose of 7.5 mg of mecobalamin was injected intravenously over a period of 5 weeks, although the serum level of vitamin B12 was > 1180 pmol l−1. Immediately after initiation of the therapy, the urinary and faecal incontinence were gradually improved, and were completely cured within 2 months. The peripheral neuropathy was also ameliorated. The effectiveness of intravenous vitamin B12 injection for the neurological abnormalities due to vitamin B12 deficiency is emphasized.

Assessment of upper limb function in hemiplegia by measuring transcutaneous oxygen tension

To investigate whether the noninvasive determination of transcutaneous oxygen tension (TcO2) can be used to evaluate the degree of hemiplegia, we measured TcO2 before and after a 2-mo rehabilitation course in 12 patients with hemiplegia caused by cerebrovascular diseases. All patients with no evidence of heart failure (ejection fraction evaluated by echocardiogram: 68.7 +/- 6.4%) began to receive conventional physical therapy a few days after the onset of stroke. The measurement of TcO2 was performed at 9:00 a.m. with an electrode placed on the skin surface of the flexion side of the forearm 5 cm distal to the elbow. Before rehabilitation, the difference in TcO2 between the paralyzed and healthy upper limbs ((delta)TcO2) in patients at Brunnstroms stage V was significantly lower than that in patients at stages II, III, and IV (P < 0.05, P <0.01, and P < 0.01, respectively). After rehabilitation, (delta)TcO2 in patients at Brunnstroms stage V was significantly lower than that in patients at stage III(P < 0.05). The (delta)TcO2 in the patients with severe hemiplegia was larger than that in patients with slight hemiplegia. In addition, TcO2 at the paralyzed upper limb increased significantly after rehabilitation (before 62.7 +/- 10.5 mm Hg; after 71.9 +/- 9.0 mm Hg; P < 0.05), although arterial blood oxygen tension (PaO2) did not. Therefore, the TcO2 determination may be useful in assessing the degree of hemiplegia in upper limbs.