Previously one of our colleagues reported that the serial bathing (twice a day for 3 weeks) in a cold spring, Kan-no-Jigoku (simple hydrogen sulfide spring of 14°C) resulted in clinical improvements for patients with rheumatoid arthritis (RA). In that study, the effect on immune functions was also investigated, since RA is characterized by immune abnormalities. The following results were obtained.
1. No change was observed in serum gamma globulin levels and hemolytic complement activities.
2. Rheumatoid factor titers after the latex fixation test were improved in 2 out of 8 cases, by 1-2 steps after 2 weeks of bathing.
3. Circulating immune complex levels, which were significantly higher initially, fell gradually during 3 weeks of bathing, but insignificantly.
4. OKT4T cells decreased significantly after 3 weeks of bathing, while OKT3 and OKT8T cells decreased insignificantly. The OKT4/OKT8 ratio was elevated slightly after serial bathing of 3 weeks.
5. Plasma prostaglandin E levels were elevated significantly after 2 weeks, but returned to the initial levels after 3 weeks of bathing, although all the levels were within normal range. No such changes of them were observed by a hot spring bathing.
6. Plasma cyclic AMP levels, which were a little higher than the normal range in 3 out of 9 cases initially, were also elevated significantly after 1 week of bathing and returned to the initial levels thereafter gradually, while no significant changes of them were observed by a hot spring bathing.
7. Urinary hydroxyproline excretion was not changed by the serial bathing.
From the above results it was suggested that a cold spring bathing may give an immunosuppressive effect to a living body, resulting in benefit for RA patients.

The patient was a 61-year-old woman. In April 2005, she suffered a cerebral infarction and became paralyzed on the right side. In June 2005, a stent graft was placed to treat significant stenosis of the right coronary artery. Computed tomography (CT) in October 2006 revealed widespread patent aortic dissection in both the true and false lumens, extending from the origin of the ascending aorta to the three arch branches and both femoral arteries. Preoperative coronary angiography also showed occlusion of the left anterior descending branch. As a result of these findings, widespread Stanford type A chronic aortic dissection with coronary artery disease was diagnosed, and surgery was performed in February 2007. Brachiocephalic artery dissection and severe stenosis of the right subclavian artery were present, and the left common carotid artery and left subclavian artery were also dissected distally. In addition, both the true and false lumens were patent distal to the aortic arch, with the major abdominal branch bifurcating from both lumens and the dissection extending to the femoral artery, requiring cannulation of both lumens. During surgery, extracorporeal circulation was established by means of blood removal from the right atrium, transapical aortic cannulation, and cannulation of both luminens of the left femoral artery, in an effort to prevent malperfusion due to hypothermia. For revascularization, a Y-shaped artificial blood vessel was used to reconstruct the three arch branches first (the arch-first technique), after which an I-shaped artificial blood vessel was used to form anastomoses distally with both lumens, ensuring perfusion to the false lumen. The proximal anastomosis was then formed, and finally, a single coronary artery bypass graft (CABG) branch was performed using a great saphenous vein graft. No postoperative complications were encountered, and CT showed good blood flow through both luminens below the graft and aortic arch. The patient was discharged from hospital and returned home in an anbulatory condition independently 18 days postoperatively. In this case of widespread type A chronic aortic dissection, the cannulation site was selected and the order of reconstruction and methods of anastomosis were carefully chosen to avoid cardiac malperfusion during arch replacement, resulting in a good outcome.