The effects of the gravitational potential energy change (GPEC) and the thermal stress on finger microvascular responses were studied by laser Doppler and ultrasonic Doppler flowmetry. Seven healthy male subjects, aged 21 to 31 yrs, participated in the experiment after giving their informed consent. The hand was moved upward (about 60 cm) or downward (about 55 cm) from the heart level to change the vascular transmural pressure of the finger (GPEC) . Sensors of laser Doppler and ultrasonic Doppler flowmeters were attached to the lateral side of the first finger and the skin surface over the radial artery, respectively. Experimental room temperature was maintained at 24°C. Laser Doppler flow (LDF) was decreased at an elevated and lowered arm position. The pulsatile component of LDF, evaluated by the difference between systolic and diastolic LDF, increased when the arm was elevated, but it showed no significant changes when the arm was lowered. Mean blood velocity (MBV) and diastolic blood velocity (DBV) of radial artery decreased when the arm was elevated, whereas the pulsatile blood velocity (PBV), evaluated by the difference between systolic blood velocity (SBV) and DBV, were increased. At the lowered arm position, SBV and PBV decreased significantly, but DBV showed no significant changes. The thermal stress (43°C, 10 min) increased the PBV when the arm was elevated, but the PBV diminished the decreasing rate when the arm was lowered.
These results suggest that the measurements used may be useful for the analysis of arteriolar compliance and microvascular response to the change of transmural pressure pro-duced by the gravitational potential energy change.

In patients with type I CD 36 deficiency, immunization with CD 36 antigen (Nak^a) through pregnancy or transfusion, could produce anti-CD 36 antibody (anti-Nak^a), and potentially lead to platelet transfusion refractoriness or posttransfusion purpura. We report a 72-year-old woman who had no history of pregnancy or previous blood transfusions. She had been treated medically for hypertension and heart failure since the age of 65 years. Type I CD 36 deficiency was also diagnosed based on the findings of ¹²³I-β-methyl-iodophenyl pentadecanoic acid cardiac scintigraphy. At 72 years of age, she suffered acute thromboembolism in the left external iliac artery. The thrombus was removed and a left external iliac artery to left superficial femoral artery bypass was performed without any blood transfusion. Echocardiography, left ventriculography and coronary angiography showed left ventricular aneurysm and coronary artery disease. Resection of the left ventricular aneurysm and coronary artery bypass grafting were performed without donor blood transfusion. Autotransfusion by autologous blood donation and intraoperative autologous blood transfusion was used to avoid sensitization by the CD 36 antigen through donor blood transfusion. Autotransfusion should be performed to avoid complications associated with donor blood transfusion particularly in patients with type I CD 36 deficiency.

The patient was a 75-year-old woman, who had been treated for tuberculosis by artificial right pneumothorax at the age of 25. Although a cardiac murmur had been pointed out in her infancy, no treatment had been recommended because she had no symptoms. Effort dyspnea augmented along with her aging by degrees. She began to need oxygen therapy at the age of 75. She had her calcified ductus arteriosus. The systemic to pulmonary blood flow ratio (Qp/Qs) was 1.89. We diagnosed that pulmonary dysfunction after artificial right pneumothorax and pulmonary hypertension caused by persistent ductus arteriosus were the cause of her symptoms. After median sternotomy we closed the persistent ductus arteriosus using a patch through the pulmonary artery under cardiopulmonary bypass. Although she needed respiratory management with a ventilator for 2 days and oxygen therapy for 4 weeks, she has been doing well afterwards. We think that we should close persistent ductus arteriosus even in the elderly.

The patient was an 86-year-old man, whose medical history included pulmonary tuberculosis, pulmonary emphysema, hypothyroidism, subtotal gastrectomy for gastric cancer and proctectomy for rectal cancer. Since he suffered sick sinus syndrome (bradycardia-tachycardia syndrome), a DDD pacemaker was implanted using the right subclavian vein approach. Three months later, he suffered from a pacemaker infection of Methicillin-resistant Staphylococcus aureus. We performed extraction of the infected pacemaker system and implanted a new pacemaker. Because he had thoracic deformity, colostomy, and was in poor condition in general, we implanted the myocardial electrode through a small thoracotomy at the 6th costal bed under local anesthesia. The postoperative course was uneventful and there was no relapse of infection. Although this method is conventionally performed under general anesthesia, it is also possible to perform it under local anesthesia in selected patients. This method could be an alternative when endocardial electrode insertion is very difficult.

In addition to the histological study of tendon blood circulation, high level of resting blood flows have been functionally observed in the in-vivo tendon tissue preparation. Interest has been directed to investigate the phenomenon from the measurement of tendon tissue Po2 changes which may indicate the activity of capillary blood flow. Simultaneous measurements were done in tendon synovial fluid, tendon and muscle tissues of the 15 rabbit hindlimbs, in conditions of hypoxia and hyperoxia. Continuous measurements of tissue Po₂ were performed by polarographic method using a pair of the wire platinum electrode (80μm in diameter) with polymer membrane to the indifferent silver electrode. Average Po₂ of tendon synovial fluid, tendon fiber and muscle tissues at rest (mean±SD, n) were 37.36±24.32 (10), 30.96±14.72 (10) and 19.54±8.05 (8), respectively. These data increased gradually to the maximal level of 45.46±27.46 (10), 39.23±16.23 (10) and 25.96±9.77 (8) after cutting of sciatic nerve. Reactive hyperemia-like Po₂ increase immediately after release of femoral arterial occlusion was observed neither in tendon synovial fluid nor in tendon tissue. There was no significant difference between each other of tissues in the process of Po₂ increase during oxygen intake and the decrease after cessation of oxygen flushing. During exercise, a marked decrease of Po2 was obtained in muscle, but not in tendon synovial fluid.
These data indicate that high level of Po₂ in tendon and the surrounding tissuse may have some oxygen supply channels including segmental blood supply system with a short length of and/or a large size of capillary.

A study was designed to determine the effect of cooling down and massage on lower leg volume after heel-raising exercise in men. The subjects were six healthy athletes ranging in age from 18 to 23 years. Lower leg volume was measured at rest and after heel-raising exercise using Lundvall's volumetric method with a water-filled“boot”. Ten minutes of rhythmic heel-raising, performed at 45 times per minute, was monitored continuously using a mech-anograph.
Immediately after the end of exercise, each subject lay in a relaxed supine position and the leg was raised to 45 degrees. A cuff was then attached around the thigh, and the cuff pressure was increased to occlude the leg circulation. The leg volume was then determined in a standing position. After the first measurement of the lower leg, three kinds of treatment were applied for each subject (no treatment, one minute walking : total seven minutes, one minute massage : total five minutes) .
The results obtained were as follows ;
1) The slopes of the recovery curve of lower leg volume were more gentle with no treatment than with cooling down and massage.
2) The time constant (min) obtained from the decreasing curve of lower leg volume after heel-raising exercise was 10.2 for no treatment, 9.4 for cooling down and 6.4 for massage.
3) The total fluid accumulation volume in the lower leg (ml/l lower leg) following heel-raising exercise was 450.9 for no treatment, 288.9 for cooling down and 198.6 for massage.
It is suggested that such a disappearance of fluid accumulation in exercising muscles of the lower leg following cooling down and massage is due to a mechanical pump action against the surrouding local skeletal muscle tissues.

We evaluated the effects of SCP bathing on the body by compared with those of a-EG, one of major component of SCP, bathing and the control bathing with tap water alone. Healthy adults were used as the subjects. The effects of bathing on blood pressure and pulse rate were not significantly different among the three bathings, indicating that effects of SCP and α-EG bathing on the lung and heart were similar to those of an ordinary bathing. The surface skin temperature at the forehead decreased more slowly in the subjects after taking a SCP bathing than the other two, suggesting that SCP has temperature holding effects. Also, the results of deep body temperature suggested that α-EG might be related to the heat absorbing effects of SCP bathing, which were significantly marked than those of the other two bathings. The present results regarding the changes in blood flow and deep body temperature during bathing suggest that SCP might produce an environment that allows more rapid heat transfer from bath water to the body and less releasing it from the body. Therefore, we concluded that some component other than α-ethylglucoside would be involved in the heat transfer and moisturizing during SCP bathing. Measurement of skin water content indicated that a region directly contacting with hot water was moisturized in a short time, but this condition quickly returned to the pre-bath condition. Whereas, for regions not contacting with bath water, the skin was much more moisturized by taking SCP bath than the other two bathings. Therefore, it was concluded that SCP is effective for enhancement of skin moisturizing.

The effect of changes in vascular transmural pressure upon differential digital plethysmogram (delta DPG) was studied in seven normal subjects. Changes in vascular transmural pressure were produced by the gravitational potential energy change (GPEC method) of an extremity from the heart level. Delta DPG which was characteristic of stability, discrimination and low speed record by modified devices was applied for the experiments including postural, static and dynamic exercises. Room temperature during experiments was kept constant. The Delta DPG-P wave amplitude in maximal elevation of upper and lower extremities (mean±S. D., n) increased to 162.3±33.5% (38) and 176.7±33.4% (12), respectively, and that in maximal lowering of upper and lower extremities decreased to 36.9±10.5% (35) and 37.5±12.6% (15), respectively. These data reveal that the GPEC method may be useful for the determination of arteriolar sensitivity in humans.

In this study, we examined changes in the amplitude of differential digital photoplethysmogram (ΔDPG) and the power spectral changes of EEG at rest during cold water immersion of the contralateral fingers (2°C), and after alcohol intake (0.3 g/kg) in 8 male subjects. This experiment showed that the ΔDPG amplitude decreased at rest and finger blood pressure was increased during the cold water stimulation, but there was no signifincant change in heart rate and EEG power spectrum. On chronological measurements for 30 minutes after alcohol intake, ΔDPG amplitude decreased slightly and finger blood pressure increased. Heart rate also tended to increase, and the alpha 1 power (8.0-9.8 Hz) on EEG gradually increased. The ODPG and finger blood pressure responses to cold water stimulation every 10 minutes was decreased after alcohol intake, whereas heart rate was not affected. However, a decrease in the alphal power after stimulation was revealed. From these results, it may be concluded that during 5-10 s of cold water stimulation, increased skin sympathetic nerve activity was one of the factors that raises blood pressure.

Objectives: The purpose of this study was to examine the beneficial effects of balneotherapy in patients with chronic heart failure (CHF).
Background: Some reports have shown that balneotherapy reduces systemic blood pressure in healthy volunteers. However, it is not clear whether balneotherapy improves the status of CHF. We hypothesized that hyperthermia using hot water would improve cardiac and peripheral endothelial function and clinical symptoms.
Methods: Twenty-six patients with chronic systolic heart failure classified as New York Heart Association (NYHA) functional status II or III were divided into two groups. In the balneotherapy group, patients were immersed in a hot spring at 40°C for 10min daily for two weeks; in the control group, patients took a daily shower. We measured plasma brain natriuretic peptide (BNP) and asymmetric dimethylarginine (ADMA). The left ventricular ejection fraction (LVEF) and cardiothoracic ratio (CTR) were evaluated by echocardiography and chest radiography, respectively. Brachial-ankle pulse-wave velocity (baPWV) was measured non-invasively using an automatic device.
Results: Clinical symptoms were improved after two weeks of hot spring therapy. Although heart rate and CTR did not change, clinical symptom and LVEF improved and mean blood pressure, BNP, ADMA and PWV significantly decreased.
Conclusions: Repeated immersion in a hot spring improves peripheral vascular endothelial function, thus leading to improvement of clinical activity and symptoms in patients with CHF.