The effects of the bathing on renal function were studied in 12 healthy men (32.3±7.7y. o.). The subjects took 41°C, 10min bathing and kept warm by a blanket for 30min, and then a mixture of 10% para-aminohippurate (PAH, 0.3ml/kg) and 10% sodium thiosulfate (NTS, 80ml) was infused intravenously. Clearance of PAH and NTS was calculated as the index of renal plasma flow (RPF) and glomerular filtration rate (GFR). PAH and NTS clearance test was also done at rest without bathing in another day. Blood Pressure (BP), Heart rate (HR), cardiac output (CO), sublingual temperature by electric thermista as deep body temperature were measured during the experiment. 30min after bathing, sublingual temperature was significantly increased by 0.9°C, and CO by +40%. After bathing, renal plasma flow (PAH clearance) significantly increased from 388.5±158.9ml/min to 572±170.7ml/min. Glomerular filtration rate (NTS clearance) was, however, unchanged from 115.6±37.3ml/min to 119.3±51.3ml/min. Filtration fraction (GFR/RPF) was significantly decreased. These results indicated that GFR was not improved by bathing although CO and RPF was increased by thermal vasodilation effect. The mechanism of unchanged GFR, despite of increased RPF, is probably that glomerular filtration pressure unchanged by thermal vasodilation of glomerular efferent and afferent arterioles.
Clinical effects of spa therapy for patients with pulmonary emphysema (PE) were evaluated by observing changes in %LAA of the lung on HRCT, %RV, %FVC, %FEV 1.0, and %DLco values after the long-term therapy. The subjects in this study 16 patients with PE. The subjects were divided into two groups according to the extent of %LAA<-950 HU of the lung on HRCT: %LAA<50% (N=6) and 50%≤%LAA (N=8). 1. Spa therapy significantly improved %LAA (42.5% at the initial stage to 36.3% 24 months after spa therapy), %RV (202.1% to 156.1%) and %DLco 71.0% to 85.7%), but not %FVC and %FEV 1.0, in patients with PE of %LAA<50%, however, significant. Improvement of these parameters was not observed in patients without spa therapy. 2. Spa therapy did not improve the values of %LAA, %RV, and %DLco, as well as %FVC and %FEV 1.0, in patients with PE of 50%≤%LAA. These parameters tended to decrease in the patients of 50%≤%LAA. These results suggest that spa therapy improves %LAA and parameters related to pulmonary function when they are at early stage of PE, however, the therapy was not remarkably effective for these parameters when they were at advanced stage of PE.
Spa therapy has been performed at our medical center for last 20 years. The changes in number and frequency of patients with respiratory disease were analyzed every 5 year for last 20 years. The total number of patients with respiratory disease who were admitted at our medical center for last 20 years was 1934, of whom the number of patients with asthma was 1226 (63.4%), and the number of those with COPD was 415 (21.5%). The number of patients with asthma treated with spa therapy showed a tendency to increase form 57 for the first 5 years (first stage) to 465 for the last 5 years (forth stage). The number of patients with COPD also increased from 26 for the first 5 years to 227 for the last 5 years. The frequency of SDIA decreased from 68.4% for the first 5 years to 29.0% for the last 5 years. In contrast, the frequency of pulmonary emphysema increased 19.2% at the first stage to 76.7% at the forth stage. The number and frequency of elderly patients with asthma and COPD over the age of 60 tended to increase for last 20 years.
Recently, many deaths while bathing in the home bath have been reported. During the winter season, hot water at a high temperature is commonly used for bathing. The circulatory system may thus be seriously affected by the hyperthermia load produced by undressing in a cold environment and subsequent bathing in a bathtub at a high temperature followed by a rapid temperature change due to exposure to cold air after bathing. However, death while bathing also occurs in the summer season. From the cases of death while bathing in the summer season, we found commonality in terms of sex, age, water temperature, bathtub size, and causes of death. The average age in all cases was 69.7. There were 47 male and 46 female deaths indicating an almost equal ratio. The average water temperature at the time of deaths while bathing was 40.7°C. The typical bathtub size was small, 750 to 900mm. In a small Japanese style bathtub, one must compress the body and therefore become more vulnerable to water pressure. From these results, warming, drawing in of limbs, and effects of water pressure on the body may contribute to deaths while bathing in the summer season and also are factors produced by bathing throughout the year.
Characteristics of low attenuation area (LAA) of the lungs on HRCT were studied in 132 patients with asthma, and long-term spa therapy on the LAA of the lungs was observed in 5 patients with asthma, whose me an %LAA was more than 30%. 1. The morphology of LAA of the lungs on HRCT observed in asthma was different from that in pulmonary emphysema. 2. The LAA of the lungs in asthma was closely related to residual volume (RV). 3. The mean %LAA value significantly decreased from 33.5% before spa therapy to 24.5% at 24 months after beginning of the therapy. CT number also significantly increased after long-term spa therapy. 4. %FEV1.0 value significantly improved from 52.1% before spa therapy to 72.1% at 24 months after spa therapy. The RV value also decreased by spa therapy, however, the decrease was not significant. These results suggest that LAA of the lungs in asthma is associated with hyperinflation, and the LAA of the lungs decreases after long-term spa therapy.
This research verified changes in composition in various parts of the body caused by conductive heat and the influence of the body composition on the effect of the contra-lateral thermal reaction in order to clarify factors for improving the effect of local bathing. The body composition was investigated by means of Segmental Bioelectrical Impedance Analysis. The percentage of fat was 14.23±2.40% in men and 29.60±7.66% in women, indicating a higher percentage in women than in men (p<0.01). The volume of body fluids in lower limbs was 6.46±0.83l in the right limb and 6.39±0.86l in the left limb of men, and 4.78±0.49l in the right limb and 4.78±0.49l in the left limb of women, indicating a higher value in men than in women (both p<0.01). During each bathing, the volume of body fluids on the surface, in deep part 1 and deep part 2 of men reached a maximum earlier than that of women. Conclusions: 1) In bathing using external conductive heat, sebaceous is a large factor for changes in temperature both on the surface and in deep parts. 2) In bathing part of the body, there is little movement of total body water (TBW) and fluids inside the body eliminating risk factors of bathing such as the oligohidria, suggesting that bathing is a safe treatment for elderly people. 3) In the contra-lateral thermal reaction using conductive heat, the possibility of increasing the effect of raising the temperature on the surface and in deep parts on the non-bathing side was suggested.