In recent years, plain X-ray CT has often been the first choice for imaging examination of acute abdomen in emergency medical settings. Ultrasound examination depends on the skill of the operator and the findings are subjective. However, we often experience cases in which more information can be obtained by abdominal ultrasonography than by plain CT. In this report, we describe two cases in which ultrasonography and plain CT imaging were performed in patients with right lower abdominal pain due to suspected abscess formation around the cecum. In the future, policies to reduce medical costs such as community healthcare initiatives may progress, and the number of facilities with high-priced medical equipment such as X-ray CT may decrease. Ultrasonography provides more information than simple CT examination, so we believe that ultrasonography should be the first choice for diagnostic imaging of acute abdomen. Therefore, it is important for those involved in ultrasonography to continuously acquire knowledge and scanning techniques.

Objectives: To assess the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy and balneotherapy checklist (SPAC), and to show the relationship between SPAC score and the characteristics of publication. Methods: We searched the following databases from 1990 up to September 30, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, Global Health Library, the Western Pacific Region Index Medicus, Psyc INFO, and the Cochrane Database of Systematic Reviews. We used the SPAC to assess the quality of reports on spa therapy and balneotherapy trials (SPAC) that was developed using the Delphi consensus method. Results: Fifty-one studies met all inclusion criteria. Forty studies (78%) were about “Diseases of the musculoskeletal system and connective”. The total SPAC score (full-mark; 19pts) was 10.8±2.3pts (mean±SD). The items for which a description was lacking (very poor; ＜50%) in many studies were as follows: “locations of spa facility where the data were collected”; “pH”; “scale of bathtub”; “presence of other facility and exposure than bathing (sauna, steam bath, etc.)”; “qualification and experience of care provider”; “Instructions about daily life” and “adherence”. We clarified that there was no relationship between the publish period, languages, and the impact factor (IF) for the SPAC score. Conclusion: In order to prevent flawed description, SPAC could provide indispensable information for researchers who are going to design a research protocol according to each disease.

  Less than 0.5% of hot springs in Japan is natural carbonated hot springs.   Therefore, the spread of artificial bicarbonate (CO2) water in Japan starts by developing the gas-permeable membrane.   There are two methods to produce artificial CO2 water. The first is gas-permeable membrane method and the second is pressurizing stir method. Both are widespread. Because the gas-permeable membrane method is provided by stable concentration in medical treatment, generally the stirring methods spread because a price is cheap.   There is a custom of whole body bathing in Japan from old days, and the CO2 warm water bathing has spread all over Japan in about ten years recently.   The vasodilation effect can be caused by the CO2 in warm water of 41 degrees Celsius (approximately 1,000ppm: max saturation under conditions of atmospheric pressure), which is the temperature favored by Japanese people. This differs from the vasodilation caused by the nitric oxide (NO) by thermal, and the reason is thought to be the participation of hormone from a blood vessel endothelium such as prostaglandin E2.   When CO2 penetrates from the epidermis and it reaches the dermis, it enhances the entering blood vessel to the capillary of the dermis.   The blood vessel is enhanced according to the concentration of CO2.   A wide capillary increases volume flow of blood, sends the tissue oxygen and nourishment, and accentuates the renewal of the skin.   By the use of this mechanism, arteriosclerosis obliterans using the footbath and the pressure sore treatment in the medical, and cosmetics with CO2 water are widespread in the beauty industry in Japan.   Moreover, a vasodilated vessel carries the febris easily from the warm water to the inside of the body, and raises the body temperature high early.   Body temperature increases CO2 water 1.5 degrees Celsius, tap water 1.0 degrees Celsius by the warm water hole body bathing of 41 degrees Celsius 15 minutes from before bathing.   　This phenomenon of CO2 warm water raises the body temperature easier than the tap water, and works as a heat stress for the human body.   It provides to increasing of the immunity (natural killer cell activities) and the heat shock protein (HSP) caused by this stress, and it consequentially enhances health promotion.   In addition, using the bulla from unstable CO2 to clean the hair and the hair root and to improve the blood circulation of the scalp is becoming popular in Japanese hair salon. Though custom of the drinking CO2 water has been performed in Europe from long ago, it became popular in Japan several years ago, for the appetite increase with small and for the diet with large amount. These spread as one of the dieting methods of a woman from last 2 years.   Japan is a country that can use the favor of high concentrate artificial CO2 warm water anywhere, for the development and the widespread of the high concentrated artificial CO2 producting apparatus.

 Hot sprigs elements and balneological effects of Tokyo 23 wards, which is not recognized as hot spring region were considered. The density of the hot spring’s source in this region is high compared to other parts of the country. Moreover, a useful element and temperature for the balneological treatment was confirmed by the hot springs with deep digging in a lot of places.  The hot springs in Tokyo can be classified into the NaCl strong salt hot springs, NaHCO3, and the sodium metasilicates. The strong Na-Cl (salt) springs are recognized in hot springs found by deep digging, and exists everywhere in Tokyo. The hot springs of the NaHCO3 are localized in Ohta ward by moderate depth digging. The hot springs including with the rich sodium metasilicates in Ohta ward by shallow digging. If the hot springs in Tokyo are to be used the balneologically, the following effects are expected.  Thermal and warm keeping effects can be expected from the strong Na-Cl (salt) springs. Cleanness and smoothing effects of the skin can be expected of NaHCO3. Hyperkeratosis of the skin can be expected from rich sodium metasilicates.