The purpose of this study was to examine the bone stiffness of healthy girls during their growth period and factors affecting on such stiffness. The subjects were 302 secondary school girls in Tokyo. Parameters examined included the body characteristics (standing height, body weight, bone stiffness measured by ultrasound, muscle thickness measured with the ultrasound B-mode system), extension power of the lower limb (containing the knee and hip joints), and a questionnaire about the daily intake of milk, kinds of meals and number of years from menophania. These examinations were carried out in June 1997.
Results were summarized as follows : 1) From the observation of bone stiffness in secondary school girls, it appears that bone stiffness increases during the junior high school period. In other words, the bone stiffness of the subjects had almost reached on adult level by high school. 2) A significant positive correlation was recognized between chronological age and bone stiffness (r=0.365, p<0.05) . A positive correlation also existed between the years from menophania and bone stiffness (r=0.477, p<0.05) . These coefficients showed that the years from menophania correlate with bone stiffness more closely in comparison with chronological age. 3) In the period when short comparatively years from menophania, body characteristics, which were the index of maturity, correlated to bone stiffness. However, muscle thickness/power, which was related to exercise habit, became the major parameter correlating with bone stiffness. These results suggest that factors affecting bone stiffness should differ according to the growth period. 4) Comparison of different athletic clubs showed that the bone stiffness of volleyball players was higher than that of control. These data suggest that physical education class, which was given 3 times a week, is not enough for total body development in both quality and quantity. In other words, physical education should be better matched with total physical development, including the growth of healthy bones.

The changes of hemodynamics during bathing in patients with heart diseases were studied by invasive methods using a Swan-Ganz catheter and UCG. As a population, we have used 37 peatients with heart disease, ages 20 to 76 (average age 52.9). There were 26 cases of myocardial infarction, 5 cases of valvular disease, 5 cases of cardiomyo pathy, and 1 case of VSD. Bathing was done with tap water in a Hubbard tank, for 10 minutes at 40°C and for 5 minutes at 43°C in a supine position. Arterial pressure, heart rate, pulmonary arterial pressure, pulmonary wedge pressure, right atrial pressure, cardiac output, stroke volume and stroke work index were increased during bathing and decreased after bathing. Systemic vascular resistance and pulmonary arteriolar resistance were decreased during bathing. Their changes were marked with a bath of 40 to 43°C. These findings suggest that preload may be increased during bathing, and preload and afterload reduced after bathing. Hydrostatic pressure, autonomic nervous reflexes or endocrine system were thought of as possible reasons for the increase in pulmonary arterial pressure. Because pulmonary arterial pressure, pulmonary wedge pressure and right atrial pressure increased during bathing even though systemic vascular resistance and pulmonary arteriolar resistance decreased, increase in venous return was thought of as the biggest possibility. And because the patients with low cardiac function could not control the extent of increase in venous return, pulmonary arterial pressure increased markedly in patients with low cardiac function. The patients with myocardial infarction were classifed into a group showing elevation of pulmonary arterial pressure (PAP) and a group showing no elevation of PAP. The group showing elevation of PAP, compared with that without PAP elevation, included many cases of severe myocardial infarction deter-mined by Forrester's classification, Killip's classification and Peel's prognostic index at admission to hospital. Among these patients showing PAP elevation, there were more cases having low physical work capacity and low ejection fraction at discharge from hospital than among the patients without PAP elevation.

Little is known about how isosorbide dinitrate (ISDN) contribute to bathing effects on patients with myocardial infarction. A study using an invasive method was made on 29 patients with myocardial infarction to clarify the hemodynamic changes occurring during bathing with and without sublingual ISDN, and to evaluate the overall effects of the ISDN. In bathing after discontinuing dosing of vasodilators (PRE-ISDN), patients were divided into the following two groups depending on the difference between the peak pulmonary capillary wedge pressure (PCWP) during bathing and PCWP before bathing: Increased PCWP group [(Group A): Δ PCWP≥10mmHg] and Unincreased PCWP group [(Group B): Δ PCWP <10mmHg].
Bathing was taken for 5 minutes at 42°C in a Hubbard tank, hemodynamics were observed during bathing and for 10 minutes after bathing, and after 30 minutes of sublingual administration of 5mg ISDN, bathing was taken in a similar manner. Group A patients showed a greater increase in heart rate, blood pressure, pulmonary arterial pressure (PAP), and right artial pressure than of Group B patients during bathing before being dosed with ISDN, and it seemed to be a considerable load on the heart. Although the remarkable increase of PAP and PCWP observed during the early stage of bathing before dosing with ISDN significantly decreased after sublingual dosing of ISDN (POST-ISDN) among Group A patients, these effects were not found in Group B patients. Group A showed more frequent reinfarction from a clinical viewpoint and triple vessel disease upon coronary arteriography, a lower ejection fraction upon left ventriculography, a higher left ventricular end-diastolic pressure, and lower left ventricular performance in most cases as compared to Group B. Although ISDN was found to be effective for severe cases in which the marked pre-load was observed by bathing, no beneficial effect on mild cases with well-maintained left ventricular performance was obtained.

In patients with myocardial infarction (MI), anginal attacks, reinfarctions or sudden deaths occur occasionally during or after bathing. Therefore it is important to know well about influence of bathing on cardiac function. In this study we examined hemodynamic indices by means of Swan-Ganz catheter and blood flow pattern with Doppler echocardiographic method in comparison with cardiac events (CE) during and after admission.
Forty-nine patients with MI (mean age 58.9 years) were examined, including 14 patients with extensive anterior MI, 12 with anterior, 17 with inferior and 6 with anterior and inferior MI. Bathing was carried out at supine position in a tap water at 42°C during 5 minutes in the Hubbard tank. The patients was classified into two groups, one with CE (Group A), and the other without CE (Group B). Hemodynamic indices by means of Swan-Ganz catheter, peak velocities of blood flow (PV) at left ventricular outflow tract (LVOT) and blood flow pattern at left ventricular inflow tract (LVIT) with Doppler echocardiographic method were studied in comparisons.
Seven of 49 patients had CE (2 cases with sudden death, 2 cases with reattack of MI and 3 cases with heart failure), and 2 of theses 7 cases had CE during bathing (one with sudden death and the other with reattack of MI). Pulmonary capillary wedge pressure (PCWP) increased from 4.0±2.7mmHg to 12.5±4.6mmHg in Group B, while in Group A marked increases in PCWP on bathing were noted from 3.9±1.2mmHg to 18.1±4.8mmHg (p<0.001) and significant high level was maintained during bathing. Mean pulmonary arterial pressure (mPAP) in Group A also increased during bathing significantly compared with Group B. Six of 13 patients (46.2%) with decreased PV at LVOT and 3 of 8 patients (37.5%) with markedly increased A/R at LVIT on bathing had CE, which was noted at the higher rate compared with those with increased PV and without markedly increased A/R (each, p<0.001, p<0.05). In Group A, severe heart failure on admission into coronary care unit was significantly noted much (p<0.001), physical work capacity was lower in exercise tolerance test by bycyle ergometer and left ventricular ejection fraction was lower (26.9±6.1% vs 56.1±16.6%, p<0.001) with significance in cardiac catheterization, suggesting cardiac dysfunction.
In conclusion, bathing should be carried out carefully in patients with markedly increased PCWP or mPAP, with decreased PV at LVOT and with markedly increased A/R at LVIT.

STUDY DESIGN: Retrospective observational study. PURPOSE: We considered the relationship between spinal alignment and skeletal muscle mass on clinical outcomes following a surgery for lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: There are no reports of preoperative factors predicting residual low back pain following surgery for LSS. METHODS: Our target population included 34 women (mean age, 74.4 years) who underwent surgery for LSS. Prior to and 6 months after the surgery, systemic bone mineral density and lean soft tissue mass were measured using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated as the sum of the arm and leg lean mass in kilograms divided by height in meters squared. The spinal alignment was also measured. Clinical outcomes were evaluated using the Japanese Orthopedic Association scoring system, leg and low back pain Visual Analog Scale, and Roland–Morris Disability Questionnaire (RDQ). Additionally, we examined the bone mineral density, skeletal muscle mass, and spinal alignment before and after the surgery. We used the Spearman correlation coefficient to examine the associations among clinical outcomes, preoperative muscle mass, and spinal alignment. RESULTS: Sarcopenia (SMI <5.46) was observed in nine subjects (26.5%). Compared with normal subjects (SMI >6.12), RDQ was significantly higher in subjects with sarcopenia (p=0.04). RDQ was significantly negatively correlated with SMI (r=−0.42, p<0.05). There was a significant positive correlation between postoperative RDQ and pelvic tilt (PT; r=0.41, p<0.05). SMI and PT were significantly negatively correlated (r=−0.39, r<0.05). CONCLUSIONS: Good postoperative outcomes were negatively correlated with low preoperative appendicular muscle mass, suggesting that postoperative outcomes were inferior in cases of decreased appendicular muscle mass (sarcopenia). Posterior PT due to decreased limb muscle mass may contribute to postoperative back pain, showing that preoperatively reduced limb muscle mass and posterior PT are predictive factors in the persistence of postoperative low back pain.
Absorptiometry, Photon ; Arm ; Asian Continental Ancestry Group ; Back Pain ; Bone Density ; Extremities ; Female ; Health Services Needs and Demand ; Humans ; Leg ; Low Back Pain ; Muscle, Skeletal ; Observational Study ; Orthopedics ; Retrospective Studies ; Sarcopenia ; Spinal Stenosis ; Visual Analog Scale