ステロイド依存性重症難治性喘息46例において, 温泉療法 (温泉プールでの水泳訓練, 鉱泥湿布, ヨードゾル吸入) の前後での血清コルチゾール値の変化を年齢, 発症年齢, 臨床病型および喘息症状に対する温泉療法の効果に基づいて検討した。
1. 血清コルチゾール平均値は温泉療法前後で2.8±1.5μg/dlから7.5±7.3μg/dlに有意な増加を示した。
2. 温泉療法前後における血清コルチゾール値は70歳以上の群を除く, 20-29歳, 30-39歳, 40-49歳, 50-59歳, 60-69歳の群で有意な増加を示した。特に20-29歳の群と40-49歳の群での増加率が顕著であった。
3. 発症年齢による検討では発症年齢が60歳以上の群を除く群で有意な増加を示した。
4. 臨床病型では, Ia-2: 気管支攣縮型 (喀痰分泌量50-99ml/day) を除くIa-1: 気管支攣縮型 (喀痰分泌量0-49ml/day), Ib: 過分泌型, II: 細気管支閉塞型を呈する群で温泉療法後に血清コルチゾールの有意な増加を示した。特にIa-1型の群においてコルチゾールの増加が高値であった。
5. 温泉療法によって臨床症状の改善が認められた症例においては, 有意なコルチゾールの増加が認められた。
以上の結果より49歳以下の症例, 気管支攣縮型を呈する症例, 温泉療法による臨床症状の軽減が認められる症例において, 温症状の軽減が認められる症例において, 温泉療法による血清コルチゾール値の改善が大きいと考えられた。

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1995年1月から8月までの8カ月間に当院へ入院し, 温泉療法を受けた呼吸器疾患患者90例について, その地域分布を中心に最近の動向を検討した。1.90例中鳥取県内から来院した患者は28症例 (31.1%) であった。一方, 遠隔地 (鳥取県外) からの患者は62例 (68.9%) であり, 遠隔地から入院してくる患者が多くみられた。2. 遠隔地からの入院患者では, 兵庫県からの14例 (15.6%) が最も多く, ついで大阪府10例 (11.1%), 岡山県9例 (10.0%), 山口県6例 (6.7%) の順であった。3. 呼吸器疾患のうちわけは, 気管支喘息が最も多く, 遠隔地からの患者では62例中51例で82.3%を占め, 鳥取県内からの患者では28例中17例で60.7%を占めた。4. 入院患者の年齢分布では, 鳥取県内の患者では, 70歳以上が最も多く, 次いで60-69歳の年齢層の順であったが, 遠隔地からの患者では, 60-69歳が最も多く, 次いで50-59歳の順であり, 鳥取県内に比べ年齢層が低い傾向が見られた。
5. 遠隔地からの患者では, ステロイド依存重症難治性喘息 (SDIA) 患者は喘息患者51例中32例 (62.7%) であり, 鳥取県内の患者では17例中8例 (47.1%) であった。このように, 遠隔地からの患者のSDIAの頻度が鳥取県内に比べて高値であった。更に, 遠隔地からの患者ではIb. 過分泌型とII. 細気管支閉塞型の気管支喘息の患者の頻度が鳥取県内に比べて高値であった。

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糖尿病性合併症の成因の一つに, アルドース還元酵素 (AR) 活性の亢進に伴う細胞内ソルビトール濃度上昇に代表される, ポリオール代謝異常が挙げられている。温熱療法は種々の疾患のリハビリテーションに応用されているので, 今回温熱ストレスの赤血球ポリオール代謝に与える影響を検討した。9名の健常男子大学生を日を変えて, 3種類の水温で10分間水浸させ, 末梢静脈血を採血した。赤血球のAR活性は42℃で1.09±0.19から1.50±0.25U/gHbへと増加し (p<0.01), 39℃と25℃とではそれ, ぞれ0.92±0.08から0.44±0.08U/gHb (p<0.01), 1.08±0.14から0.54±0.09U/gHb (p<0.05) へと減少した。赤血球ソルビトール濃度は42℃にて32.7±5.8から43.7±8.8nmol/gHbへと上昇した (p<0.05)。赤血球を in vitro で温度を変えてインキュベーションすると, 42℃では明らかにAR活性が上昇したが, 39℃では変化がなく25℃で軽度上昇した。また赤血球を39℃でアドレナリンの存在下でインキュベーションすると, アドレナリンの濃度依存性にAR活性とソルビトール濃度が増加した。これらのことから, (1) 熱ストレスは糖尿病性合併症を悪化させる可能性が考えられた。(2) AR活性の調節にアドレナリンが関与している可能性が考えられた。

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The Ministry of Health and Welfare inaugurated an official recognition system for spa-based health promotion facilities in 1988 as part of its health promotion program. As a result, those facilities gradually increased across the country until the number of the recognized facilities reached 17 by February 1995.
The Japan Health & Research Institute has performed factfinding surveys on the use of these recognized spa-based health promotion facilities every year from the beginning of the recognition system. This paper reports the survey results obtained during these 5 years.
During the past 5 years, 275 males and 138 females used these spa-based health promotion facilities (with tax deductions applied to madical expenses). The number of male patients was about twice as large as that of female patients. Most males used the facilities because of diseases in the field of internal medicine, and most females, because of diseases in the field of orthopedic surgery.
We are planning to prepare a manual for evaluating the effects of spa therapy and assess the efficacy of spa therapy by including a new survey item of “clinical effects of spa therapy” in a questionnaire for a nationwide survey.

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Rheumatoid arthritis (RA) is a systemic inflammatory disease with a main symptom of chronic polyarthritis. Migration of T lymphocytes to synovium, which is mediated by the adhesion molecules expressed in both lymphocytes and vascular endothelial cells, play a key role in the synovial imflammation.
To investigate the mechanism of therapeutic effect of low powar laser irradiation to RA Joint, adhesion molecules in synovial tissue were studied.
Nine knee joints of 8 RA cases were irradiated with a Ga-Al-As laser (790nm in wave length and 20mW of output power) at 6 points on the lateral aspect of joint prior to the replacement surgery. Several pieces of synovial tissue from the lateral irradiated area and from the medial nonirradiated area as a control were resected for study at surgical operation. Frozen sections were immunohistochemically studied using monoclonal antibodies to the adhesion molecules. In 5 of 9 knee joints, immunohistochemical studies for adhesion molecules of cultured synovial tissue and ELISA for soluble adhesion molecules in culture fluid were performed. Moreover, in 5 of 9 knees, electron microscopic observation of synovial tissue irradiated with low power laser were carried out.
Expression of ICAM-1, VCAM-1 and fibronectin in the synovial tissue was suppressed in the irradiated area comparing with that in the nonirradiated area. ELAM-1 staining of the endothelial cells was also decreased, although the staining was weak even in nonirradiated area. LFA-1 staining of lymphocytes was markedly decreased in the perivascular area, on the other hand it was almost unchanged in the sublining area of irradiated synovium. Staining of ICAM-1, VCAM-1 and ELAM-1 also decreased in the cultured synovial cells irradiated with low power laser, but soluble adhesion molecules in the culture fluid of synovial cells showed no significant change with low power laser irradiation.
Electron microscopically, markedly dilated rough endoplasmic reticulum of fibroblast like cells and flattening of vascular endothelial cells were observed in the irradiated synovial tissue.
These morphological changes of cells in the synovial tissue irradiated with low power laser would be related to the decreased cytokine production, resulting suppression of adhesion molecule expression and improvement of synovial inflammation.

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This study was conducted to assess the effects of bathing in still water and in flowing water on the heart rate variability. Eight healthy young males (age 20 to 28) bathed in still water at temperatures of 34°C, 38°C, and 41°C for 20 minutes each. The other eight healthy young males (age 22 to 28) bathed in flowing water at a temperature of 36°C for 30 minutes. Electrocardiograms were recorded before, during, and after the bathing. Subjects sat still for 20 minutes before bathing, and then bathed in water to the axilla in a sitting position. Subjects breathed freely during the experiment. Heart rate variability was estimated with the power spectral analysis using FFT. The power densities in the high frequency (0.15 to 0.50Hz) and low frequency (0.04 to 0.15Hz) areas as obtained from this frequency analysis (HF and LF) as well as the ratio of LF/HF were calculated, and HF was used as index of cardiac parasympathetic activity, LF as index of sympathetic activity with parasympathetic modulation, and LF/HF as index of sympathetic activity.
During bathing in still water at 34°C and 36°C, no significant change from the value before the bathing was found in heart rate, HF, LF, or LF/HF. HF and LF significantly decreased during the bathing in still water at 38°C and 41°C, LF/HF significantly increased during the bathing in still water at 38°C, During the bathing in still water at 41°C, we could not calculate LF/HF for many subjects because HF disappeared. During the bathing in water flowing at a moderate speed (1.0m/sec), LF/HF increased significantly. During the bathing in water flowing at a high speed (2.0m/sec), heart rate and LF/HF increased significantly while LF decreased significantly.
These results suggest that parasympathetic nervous activities are suppressed and sympathetic nervous activities are enhanced during bathing in still water at temperatures higher than the neutral temperature (34°C), and sympathetic nervous activity is enhanced during the bathing in flowing water at 36°C, However, the effects of respiration rate and tidal-volume on HF, and the validity of the HR variabilities as an index of autonomic nervous activities should be examined in further detail.

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We studied the effects of transcutaneous electrical nerve stimulation (TENS) of Baxie on local cold tolerance as an index of cold induced vasodilatation (CIVD). The subjects consisted of 22 healthy adult volunteers.
The skin temperature and skin blood flow in the middle finger were measured simultaneously before, during, and after immersing the finger in cold water. TENS at 1Hz with 100-V intensity was applied for 5 minutes before immersion of the finger.
Experiments were conducted with no stimulation and with TENS on the same subjects on different days.
The results revealed the following:
1. The minimum skin temperature and minimum skin blood flow during immersion of the finger in cold water were higher in the TENS group than in the control (no stimulation) group.
2. The maximum skin temperature, mean skin temperature, and increase and decrease of skin blood flow rate during immersion of the finger in cold water and in the rising phase of skin temperature were higher in the TENS group than in the control group.
3. The index of resistance to frostbite was higher in the TENS group than in the control group.
4. The number of fluctuations in skin temperature during immersion of the finger in cold water was significantly higher in the TENS group than in the control group.
5. The incidence of abnormal perception during immersion of the finger in cold water was lower in the TENS group than in the control group.
These results suggest that TENS enhances the local cold tolerance of fingers by suppressing SSA in the initial falling phase on skin temperature and increasing the motion of skin blood vessels in the rising phase of skin temperature.

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