The Raynaud phenomenon of fingers, a specific physical disturbance, frequently occurs in those who have used pneumatic vibrating tools such as chain saws for many years. Only a few pathological studies of this lesion have been reported although there are many clinical physiological studies. We conducted an autopsy of a 71-year-old man, who was a patient with cholecystocarcinoma and died of pneumonia. He had worked for 17 years using pneumatic vibrating tools and had been an out-patient of the surgical department, where he received physical treatment and spa therapy because he suffered from the Raynaud syndrome in his left fingers. The findings obtained from a microscopic observation of the finger tip skin of the corpse are summarized as follows:
1. Many dilated small arteries, accompanied by local thickening of the intima and torn medial elastic fibers, were noticed between the subpapillary and deep layer of the dermis.
2. Stenotic arterioles due to muscular hyperplasia of the media were relatively few.
3. Dilatation of capillaries was found in the subpapillary layer of the dermis, and dilatation of small veins, in the deep layer.
4. Atrophy was noticed in the peripheral neurofibers, Vater-Pacini corpuscles, and sweat glands.
5. The dermis showed sclerotic changes with marked diffuse fibrosis.

Currently 1.5 million people a year visit the Gero hot spring. A total of 44 patients who suffered from disease while staying there and required treatment were admitted to our hospital during 1987. This paper presents a statistical analysis these 44 cases.
There was no large numerical difference between male and female patients, and about 60% of them were 60 to 70 years old. While some came from Aichi Prefecture, a notable number of patients came from remote places. Most of the patients were admitted to the hospital from the end of summer through winter and often at night. About 50% of patients suffered from heart diseases and cerebrovascular disturbances. The next largest percentage had gastrointestinal diseases. Fifty percent of the patients recovered within a couple of days of hospitalization and all other patients, except two patients who died, left the hospital within 20 days. About 70% of these patients were carried to the hospital by ambulance. About 30% of the patients were considered to have contracted the disease while they were drinking, and the majority of them had heart disease, cerebrovascular disturbance, or acute alcoholism. About 40% of the patients contracted the disease while bathing, and the majority of them had cerebrovascular diseases and respiratory disturbance. Although no correlation with weather was found in 21 cases of heart diseases and cerebrovascular disturbance, onset of the disease in other than optimum temperature and humidity was observed in many cases.
The following five factors were considered to have aggravated the diseases:
1) Advanced age.
2) Overwork.
3) Chronic disease or insufficient health checks.
4) Drinking heavily, bathing after drinking, or bathing for too long.
5) Seasonal factors (summer through winter) and improper temperature or humidity for those patients with circulatory diseases.
Results of the statistical analysis indicated the necessity for guidance in relaxation and at hot springs as well as improvement of spa facilities.

To re-examine the effectiveness of spa bathing for chronic pain. The comparison study was between spa bathing and usual hot baths, with 41 patients, 7 with rheumatoid arthritis, 11 with cerebrovascular hemiplegia, and 23 with vibration syndrome.
The patients bathed once a day for 10min, at 40°C and then once a day for six consecutive days for 10min. at 40°C
There was not much correlation between blood circulation and chronic pain: but spa bathing showed a significant longterm improvement in lessening pain than did hot bathing. The spa bathing in lessening was most efficacious 120min. and 180min. after bathing.

Hybrid revascularization by MIDCAB and stent was performed in a 70-year-old man for reperfusion in the treatment of graft stenosis after CABG. The right SVG, which supplied coronary blood flow, was immediately under the median incision site, and was approached safely by the present method. After intervention, bleeding in the left thoracic cavity occurred, but this was treated conservatively. During intervention after cardiac surgery, transient heparinization of blood was performed for prevention of coagulation. Since strong anticoagulative treatment was continued thereafter, the patient was easily bled. Therefore, it appeared preferable to take time after cardiac operation or insert an indwelling drainage tube into the pleural cavity to monitor hemorrhage. The present method appears useful for patients undergoing re-operation or of high risk.