Content We investigated 76 cases during the 6-year period from 1999 to 2005 in which a patient who developed a consciousness disorder while bathing was brought to the Emergency and Critical Care Center of Tokyo Women's Medical University Medical Center East. In. 86% of the cases the patient was in cardiopulmonary arrest, and they had a group of diseases with a poor prognosis in which the outcome was death, even the 6% of the patients who were resuscitated.
The most common age group was the 70-to 79-year group, which contained 46% of the patients, and those 70 years of age and older accounted for 70% of the total.
  Examination was possible in 16 cases, and the most common category, in 10 of them, was “drowning/suspicion of transient ischemic attack”. Adequate examinations were not performed on the patients who died in the outpatient department. Moreover, because the autopsy rate was low, it was impossible to make a definitive etiological diagnosis. However, the fact that “many were elderly persons whose autonomic nervous system's regulatory function is reduced” and that “the incidence was highest during the winter (53% during the 3 months from December to February)” suggests involvement of cardiovascular and cerebrovascular diseases secondary to changes in blood pressure. Many preventive measures have been described in the literature, and improvement in the resuscitation rate is expected as a result of becoming familiar with. and thoroughly implementing them. All 10 cases that occurred in public baths, where the time before discovery should have been short, were cases of cardiopulmonary arrest, and it is impossible to clearly explain why resuseitation attempts failed in all 10 of them. In order to identify the causative diseases we think it would be worthwhile to consider 1) performing a whole-body CT examination after confirming death, and 2) perforrning open-chest cardiac massage (only in patients brought to the hospital within a short time).

The difference in cardiopulmonary response between supine exercise and sitting exercise was assessed by the following protocols.
1) Cardiopulmonary exercise testing utilizing the ramp protocol with a bicycle ergometer (20 W/min) was performed by nine healthy Japanese men (mean age, 19.9 yr) in a sitting and a supine position. Oxygen uptake, heart rate and blood pressure were measured during the test. Blood was sampled in order to measure noradrenaline (NA) and angiotensin II (ANG II) in the resting control state and immediately after exercise.
2) Single-level exercise testing at 100 W was performed on another day. The cardiac index (CI) was computed from the cardiac output, which was measured using the dye-dilution method in the resting control state and during exercise.
The results were as follows:
1) Heart rate and blood pressure during exercise had a tendency to be lower in the supine position compared to the sitting position, although not significantly.
2) Anaerobic threshold (AT) was lower in the supine position than in the sitting position exercise, (18.3±2.6 ml/kg/min and 21.7±1.9 ml/kg/min, respectively) .
3) NA and ANG II in the supine position were slightly lower than in the sitting position.
4) At rest, the CI in the sitting position was significantly less than in the supine position; however, the CI during the 100 W exercises was the same in both the supine and sitting positions.
It is concluded that blood flow to active muscle during 100W exercise is lower in the supine than in the sitting position. This is thought to be due to changes in blood redistribution and lowered blood flow to active muscle in the supine position, creating a lower AT.

Retrospective cohort study.

Retrospective cohort study.