Takuo Shirakura

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.

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.

The behaviour of red cells in narrow tubes in vitro as a model of the microcirculation

To investigate the behaviour of red cells in the microcirculation, we established a new capillary method using narrow fluorinated ethylenepropylene copolymer tubes with internal diameters of 12.5 and 25.0 μm. Red cell flow in the tubes under a given range of pressure was analysed through a video system connected to a microscope. The experimental condition was adjusted so that the velocity of the control normocytes would be compatible with that in corresponding vessels in vivo, 0.5–1.5 mm/s. In the 12.5 μm tube, normocytes obtained from 12 young normal volunteers ran in an axisymmetric edge‐on orientation with a folded shape at higher pressures, but rolled along freely without deformation at lower pressures. Deformation during the passage of the microcytes obtained from four patients with polycythaemia vera complicated with iron‐deficient microcytosis and 10 patients with iron deficiency anaemia was relatively mild, whereas that of the macrocytes obtained from eight patients with refractory anaemia was marked. Even after the screening effect at the tube entrance was taken into consideration, the velocities of both microcytes and macrocytes were found to be significantly lower than the control normocytes. Therefore this method may be a new way to investigate the flow properties of red cells in the microcirculation.

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.

Hematological study on a case with cerebellar hemangioblastoma associated with erythrocytosis, with special reference to a erythropoiesis-stimulating activity present in the fluid of the cyst of tumor

SummaryA case of cerebellar hemangioblastoma associated with slight but definite erythrocytosis is reported. Operative removal of the tumor resulted in the reversion to a normal blood picture. Erythropoietin-like activity, being non-dialyzable and relatively thermolabile, was detected in the fluid aspirated from tumor. The mother of the reported patient suffered from the same disease which was also associated with a slight degree of erythrocytosis.ZusammenfassungEs wird über den Fall eines cerebellaren Hämangioblastoms begleitet von einer leichten, aber doch eindeutig diagnostizierten Erythrozytose berichtet. Die operative Entfernung des Tumors führte zu einer Renormalisierung des Blutbildes. In der aus dem Tumor aspirierten Flüssigkeit wurde eine erythropoetinähnliche Wirkung entdeckt, die relativ thermolabil und nicht dialysierbar war. Die Mutter des geschilderten Patienten litt an der gleichen Krankheit, die ebenfalls von einer Erythrozytose leichten Grades begleitet war.

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.

An indolent type of Epstein-Barr virus-associated T-cell-rich B-cell lymphoma of the skin: report of a case.

A 74‐year‐old Japanese man presented with systemic lymphadenopathy, hepatosplenomegaly, and erythroderma in December 1991. A characteristic pattern of anti‐EBV antibodies was suggestive of latent EBV infection. A skin tumor biopsied in April 1993 contained biclonal EBV genomes diffusely in the infiltrate of polyclonal T cells and monoclonal B cells. The clinical course was rather mild in contrast to that of classical EBV‐associated disorders. Our case was considered a rare indolent type of EBV‐associated T‐cell‐rich B‐cell lymphoma of the skin.

Electron Microscopic Analysis of Myeloma Cells in Relation to Drug Response and Prognosis

Myeloma cells obtained from 33 patients were analyzed by electron microscopy to determine whether there is any correlation among ultrastructural characteristics of myeloma cells, drug response, and prognosis. The median survival time after diagnosis of responders (18 cases) and nonresponders (15 cases) was more than 423 days and 139 days, respectively. Nuclear immaturity and three cytoplasmic abnormalities--scattered pattern of mitochondria, single-sac looplike structures, and numerous intramitochondrial granules--were found to be associated with poor outcome. Although the cytoplasm of almost all the myeloma cells examined was judged to be mature or intermediate, the degree of nuclear immaturity was considered to correspond closely to the grade of nuclear-cytoplasmic asynchrony. Thus the electron microscopic examination of myeloma cells is of use to assess accurately their immaturity and abnormality and might provide clues for the prediction of drug response and prognosis of individual patients.

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.