A 34-year-old female patient, who had undergone several operations relating to pulmonary atresia with ventricular septal defect (PA/VAD), was admitted to our hospital for recurrent massive hemoptysis requiring blood transfusion. She had undergone a Potts' shunt (systemic-pulmonary shunt) at age 3, and undergone intraaortic patch closure for paraanastomotic pseudoaneurysm of occluded Potts' shunt at age 28. Chest CT scan revealed an enhancement of this aneurysm surrounding ground glass like appearance of left lung lobe which indicated pulmonary bleeding. In order to avoid skeltonization of severe adhesion of mediastinal and left thoracic space due to several prior operations, endovascular repair of this pseudoaneurysm with debranching of left subclavian artery was performed. Postoperative course was uneventful and hemoptysis was disappeared. She was discharged at 8 postoperative day.

Objectives: The warm-water foot bathing is widely used as a clinical method for hemiplegic limb. Recent research have reported that the artificial high concentration carbon-dioxide (CO2) water foot bathing have a potent vasodilative action. However, the definite effects of the artificial high concentration CO2 water foot bath for hemiplegic limbs remain uncertain. We examined that the effects of the artificial high concentration CO2 water foot bath for patients after stroke. Patients: Three inpatients after stroke were recruited for this study. The age and duration after onset were 58.3 ± 21.4 years and 63.0 ± 38.9 months, respectively. Of the three patients (two males and one female), two were diagnosed with cerebral hemorrhage, one with cerebral infarction. Methods: The artificial high concentration CO2 water foot bath and tap water foot bath were prepared. The concentration of CO2 water foot bath was approximately 1000-1,200 ppm, and both lower limbs (under the knee joint) were immersed in 38 °C water for 20 minutes. Foot bathing in tap water was also carried out under the same conditions in the another day. The following physiological data were measured before foot bathing and after the end of foot bathing. Not only the deep body temperature at axillary, the surface skin temperature at the front of femur, the calf of the leg and the dorsal foot, but also the muscle stiffness at triceps muscle of calf were evaluated. Results: None of the subjects experienced discomfort before and after both the high concentration CO2 water and the tap water foot bath. The physiological examination was completed safely in all subjects. The results were as follows: The deep body temperature and the surface skin temperature had increased, and the muscle stiffness had been relieved in the high concentration CO2 water foot bath compared with the tap water bathing. The deep body temperature of the high concentration CO2 water foot bath have risen from 36.4 °C to 36.9 °C, the surface-skin temperature of the front of femur (from 26.7 °C to 28.1 °C), the calf of the leg (from 29.5 °C to 31.9 °C) and the dorsal foot (from 29.9 °C to 32.3 °C) have risen, respectively. The muscle stiffness have been relieved from 55.3 to 51.8 before and after. There was no change that the tap water had increased in the deep body temperature and the surface-skin temperature, and the muscle stiffness had been relieved before and after. Conclusion: These results suggested that the use of the high concentration CO2 water foot bath was more effective in hyperthermia compared with the tap water. Furthermore, we considered that carbon dioxide had promoted to increase the skin and the muscle blood flow by vasodilative action to the arteriole, and use of the high concentration CO2 water foot bath contribute to improve the circulatory dynamics for the hemiplegic limb. These findings may suggest that the use of the high concentration CO2 water foot bath is an effective physiotherapy for circulatory dynamics treatment that might facilitate stroke rehabilitation

Objectives: To preliminarily assess the effects of a single warm-water bath (WWB) on the quality of sleep, we measured sleep pattern after WWB in healthy volunteers. The primary objective of the present before-after study was to evaluate whether a single 10-minute WWB at 41°C could modulate sleep pattern in a single group of healthy subjects. In this pilot study, we also assessed the difference in general fatigue and subjects’ satisfaction responses to WWB under two conditions: WWB using tap water (WWB with tap water) and WWB using a bath additive that included inorganic salts and artificial carbon-dioxide (CO2) (WWB with ISCO2). Methods: Eleven healthy volunteers aged 20 to 48 years (29.8±8.9 years, mean ± SD) participated in this study. Inclusion criteria were as follows: age 20-50 years; free of cardiovascular disease; not taking medications or supplements. In this within-subject, two-way crossover study, all subjects underwent WWB with tap water or WWB with ISCO2 in random order for two consecutive nights. Objective sleep measures from sleep sensor mat (sleep-scan) and subjective subjects’ reports were collected. This study was approved by the Ethics Committee of Kagoshima University Hospital and written informed consent was obtained from all of the subjects. Results: None of the subjects experienced discomfort before, during or after the study period. The objective sleep measures and subjects’ reports were completed safely in all subjects. WWB with ISCO2 bathing produced significant improvement in objective and subjective sleep latency compared with WWB with tap water bathing (P<0.05). Sleep-scan-determined wake time after sleep onset (WASO), sleep efficiency, and number of awakenings (NA), and patient-reported measures of WASO, NA, sleep quality, sleep depth, and daytime functioning significantly improved following WWB with ISCO2 bathing versus WWB with tap water bathing (P<0.05). WWB with ISCO2 bathing also increased deep sleep time and sleep score (P<0.01 for both comparisons), but did not alter REM or slow-wave sleep. Conclusion: In conclusion, in our group of healthy volunteers, a single warm-water bath was shown to have the potential to modulate the quality of sleep. These findings demonstrate that WWB with ISCO2 bathing might be effective in improving some domains of sleep quality of healthy volunteers, and the subjects showed acceptance towards the intervention. Strengths and limitations of the present study as well as suggestions for further studies were considered. Further evaluations with larger and longer-term randomized double-blind placebo-controlled trials based on the present study are needed.