Background: Lymphedema, which is classified into primary and secondary origin, affects more than 100.000 patients in Japan. The cause for primary lymphedema—including that of congenital origin—is yet unknown. Secondary lymphedema mostly results due to an obstruction of lymph flow caused by surgery or radiotherapy for cancer. Complex Physical Therapy (CPT) has been determined as the standard therapy for lymphedema treatment by the International Society of Lymphology (ISL). CPT comprises skin care, manual lymphatic drainage (MLD), compression and exercises, which only administered in combination results in a maximum treatment effect. At present only prophylactic instructions for cancer patients and reimbursement of fees for compression garments or bandages are part of the health care insurance in Japan. MLD is not covered by insurance. This study was conducted with the aim to prove the effect of MLD as a single-modality therapy and to contribute to the process of getting MLD covered as health care insurance treatment. Methods: In 72 patients (mean age 60.46±13.00 years) with lymphedema of the extremities only, MLD was administered for 45 minutes in upper extremities and 60 minutes in lower extremities. Treatment effect was examined through measurement of volume change of the affected side before and after treatment. Data was processed statistically by normal distribution and Wilcoxon signed rank test. Result: Edema volume reduction in all patients (n=72) was 69.20ml±93.00ml (p<0.000), for upper extremities (n=16) 26.20ml±45.99ml (p<0.039) and lower extremities (n=56) 81.40ml±99.50ml (p<0.000). In the intensive treatment phase (Phase 1) volume was reduced in twelve patients (n=12) by 112.50ml±118.78ml (p=0.005) and in the maintenance phase (Phase 2) in sixty patients (n=60) by 60.50ml±85.56ml (p<0.000). Phase 2 patients were further separated into stages. Volume in Stage I (n=9) patients was reduced by 75.00ml±98.14ml (p=0.038) and in Stage II (n=46) patients by 56.90ml±88.17ml (p<0.000). Numbers for Stage 0 and III patients were less than five and therefore excluded from analysis. Conclusion: This study showed that edema volume of the affected extremity was statistically significantly reduced after MLD treatment. Based on this result, MLD including Complex Physical Therapy should be recommended to become part of the health insurance plan.
We previously reported that in patients with Alzheimer’s disease (AD), the number of baths that patients report taking at their first evaluation at a memory clinic was significantly decreased in comparison to before the onset of dementia. Based on this research, we thought further longitudinal evaluation was needed regarding the relationship between the number of baths, cognitive impairment and depression state after AD progression. In the present study, we reevaluate the number of baths; cognitive function tests (Hasegawa’s Dementia Scale-Revised [HDS-R], Mini Mental State Examination [MMSE] and Wechsler Adult Intelligence Scale-Revised [WAIS-R]); and the depression assessment (Zung Self-rating Depression Scale [SDS]) 1 year after first evaluation. At the first evaluation, the average number of baths taken by 65 AD patients (16 male, 49 female; range: 64-90 years, average: 79.5±5.6 years), was 5.6±1.6 bathsweek. At the reevaluation, this number had decreased to 4.9±1.9 bathsweek. In the WAIS-R, a significant positive correlation was found between the score change in number of baths and the change in performance intelligence quotient (PIQ) and total intelligence quotient (TIQ). However, no significant correlation was found between the score change in number of baths and the change in HDS-R, MMSE, or verbal intelligence quotient in WAIS-R or SDS. We further evaluated the present series by dividing the study population into two subtypes: a group of patients in which the number of baths decreased 1 year after the first evaluation, and a group in which there was no change. There were no significant differences in background factors (e.g. average age at first evaluation) between the groups. Although, no significant difference was observed between the groups in number of baths before dementia onset (both were 6.7 timesweek), a significant difference was found at the first evaluation (5.3 bathsweek vs 5.9 bathsweek, respectively). No significant differences were observed between the groups in cognitive function test or depression assessment at the first evaluation. However, on reevaluation the group with the decreased number of baths showed significantly lower PIQ and TIQ scores in WAIS-R and a significantly higher SDS score. The results of the present study suggested that number of baths decreased along with the progression of AD and the greatest participating factor was the practical dysfunction reflected by the PIQ score in WAIS-R. Furthermore, we considered the existence of two subtypes: patients in whom the number of baths decreases with AD progression and those in whom there is no change.
Objective: This study was conducted to analyze the effects of acupuncture regarding prevention of migraine attacks based on the measurements of headache days, and tenderness and muscle tightness in the neck and shoulder muscles and in the masticatory muscles, and to evaluate the relationship between them. Methods: The subjects were 70 patients (22 men and 48 women) who satisfied the diagnostic criteria of migraine according to The International Classification of Headache Disorders, 2nd edition. The mean age was 35.5±14.3 years (mean±S.D.). Thirteen patients had migraine with aura and 57 had migraine without aura. Acupuncture was performed for 2 month; the number of days with a moderate or severe headache as well as tenderness and muscle tightness of the neck, shoulder and masticatory muscles, were assessed before and after acupuncture treatment. In addition, the relationship between the decrease in the number of headache days and improvement in tenderness and muscle tightness was analyzed. Results: Acupuncture reduced the number of days with a moderate or severe headache (p<0.05) and improved tenderness and muscle tightness (p<0.01). Also, a positive correlation was noted between the decrease in the number of headache days and improvement of neck, shoulder and masticatory muscle tenderness; the correlation with the improvement of neck tenderness was the strongest. Discussion and Conclusion: When acupuncture was performed continuously for a certain period, the number of headache days decreased, and tenderness and tightness in the neck, shoulder and masticatory muscles improved, demonstrating the efficacy of acupuncture. The results suggest that acupuncture prevents the attacks by relieving muscle tightness. The mechanism by which acupuncture would prevent migraine attacks can be its effect on higher brain centers via the spinal nucleus of the trigeminal nerve through the upper cervical plexus and trigeminal nerve as the afferent pathways.
Recently, new hot springs are born in Tokyo one after another. Most of these are artificial hot springs by digging deep under the ground on the bowling, and pumping up the deep water warmed by the heat source of geothermal gradient. Maeda et al. have investigated the ingredients in these hot springs of Tokyo 23 wards, and concluded that they are medically effective to promote health. It is unclear, however, how much these hot springs are medically effective compared to the well-known volcanic hot springs. Thus, sodium-chloride type hot springs (Tokyo-A & Atami) and sodium-hydrogen carbonate type hot springs (Tokyo-B & Naruko) were chosen, and their analytical tables of chemical compositions were obtained from each hot spring resort through the Internet. Comparisons of the ingredients shown in the analytical tables were carried out to clarify difference between the artificial hot springs and the volcanic hot springs. Since Tokyo-A and Tokyo-B do not belong to volcanic hot springs, their source temperatures are lower than the source temperatures of Atami and Naruko, and they do not contain various pharmacologically effective chemicals, such as sulfur compounds, free carbonate, etc. Furthermore, the modulation effects by the environmental factors such as hot spring location, climate, landscape etc. cannot be expected for the hot springs in Tokyo. However, the physical effects of hydrostatic pressure and buoyancy are expected in Tokyo-A containing large amounts of seawater components. The most important medical effects of hot springs are considered to be suppressing active oxygen species and their activities, and repairing the cells damaged by the active oxygen species. From these points, although Tokyo hot springs have some healing effects, the medical effects as observed in the volcanic hot springs cannot be expected in Tokyo hot springs. For the establishment of balneology, the evaluations of each hot spring based on scientifically accurate information are required.
We carried out a questionnaire survey among 119 institutions picked on the internet and on the list of our association to investigate the use of hot spring in the hospital, and institution, and got an answer from 88 institutions (73.9%). As a result, hot spring was used in 90.9% of institutions. The form of use was bathing (87.5%), rehabilitation (50.0%), drinking (6.8%), daycare, and warm water swimming pool. In addition, as the special use, a dermatotherapy, carbonated spring treatment and period pack therapies were carried out. There was an eager demand about the authorization by the medical insarnce system.