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A coronary arteriographic investigation has been made of 492 patients, most of whom had different cardiac diseases. Eighty patients died during an observation period from 1 1/2 up to about 7 years. In 45 patients a postmortem investigation was made. Comparison between arteriographic and post mortem findings in the arteries and the myocardium, as well as the study of other clinical facts at or before the time of investigation, led to the following conclusions. 1 A coronary arteriogram of good quality gives a reliable picture of the intraluminal condition in the big predominantly epicardial coronary arteries. 2 An occlusion or critical obstruction of the coronary arterial stems are in the majority of hearts combined with myocardial disease in the form of old infarction scar or local, patchy fibrosis. 3 Coronary arteriography is of good help to demarcate a group of patients with diffuse non-atherosclerotic, myocardial disease. 4 Early changes of atherosclerotic coronary artery disease seem to be rather evenly distributed among the big coronary arteries. In the living patients the majority of severe obstructions are present in the right and the left descending artery. This distribution is probably due at least partly to the selection of patients in the study. 5 Roughly half of all myocardial infarctions can be clinically traced. 6 The results emphasize that angina pectoris, clinical picture of myocardial infarction and abnormal Q waves in the ECG are not synonymous with coronary heart disease. This may be particularly true in hospitalized patients, who may overrepresent non-atherosclerotic heart diseases, leading to symptoms and signs shared by the atherosclerotic, coronary heart disease.

Ten boys 9-12 years of age with severe perennial asthma participated in a physical exercise programme lasting 8 months. Pulmonary function and psychological tests were performed before training, immediately after, and one year after the end of the exercise programme. Static lung volumes, flow-volume variables and histamine tolerance were used as indicators of pulmonary function. Ego structure, body image, social development and concentration capacity were used as indicators of personality development. Before the study, the group had high FRC (p less than 0.05) and RV (p less than 0.001), low FEV1, MEF50 and MEF25 (all p less than 0.001) and low histamine tolerance. They showed marked disturbances in their personality development with low scores in psychological variables. During the training period, MEF50 and MEF25 increased slightly (p less than 0.01). Marked improvement was observed in all psychological variables (p less than 0.001). The positive effects remained during the following year. The marked and lasting improvement in personality development was regarded as an essential factor behind the more modest positive clinical and pulmonary function changes. The results emphasize the importance of including exercise programmes in the treatment of children with asthma.

The laryngeal chemoreflex involves bradycardia, apnea, swallowing and peripheral vasoconstriction. This reflex was studied in twelve infants, aged 5 days-28 weeks, who had sustained an apparent life-threatening event or were siblings of infants who had died of the sudden infant death syndrome. The bradycardic and apneic components of the reflex were found to be significantly, and sometimes powerfully, reinforced when elicited by pharyngeal water instillation during acute, mild hypoxia (transcutaneous PO2 4.6-8.3 kPa). Apnea duration during normoxia was 0.7-15 sec, and during hypoxia 2-30 sec. Heart rate change ranged from +26% to -21% during normoxia, as compared with -4% to -63% during hypoxia. The percentage change in heart rate was found to inversely correlate with the transcutaneous PO2-level prevailing when the reflex was elicited. The conclusion is that there is a significant reinforcement of the cardiorespiratory adjustments when the laryngeal reflex is activated during simultaneous excitation of the peripheral arterial chemoreceptors. One infant, showing a particularly strong increase of the cardiorespiratory response to laryngeal receptor stimulation during hypoxia, later died of sudden infant death syndrome.

Summary The carboxyhaemoglobin (COHb) concentration in blood, which is assumed to reflect the degree of haemoglobin catabolism, was determined in 62 newborn infants selected because of significant jaundice associated with ABO incompatibility, and in 46 infants with ABO incompatibility, selected without regard to the degree of bilirubinaemia. Furthermore, the COHb level was determined in 46 icteric infants without haemolytic disease, and in 61 infants of ABO homospecific pregnancies, selected without regard to their bilirubin level. In infants with ABO incompatibility increased COHb concentrations were found not only in infants with unequivocal signs of haemolytic disease but also in infants with a clinical picture indistinguishable from physiological jaundice. During the first days the relation between COHb and bilirubin in infants with ABO incompatibility was the same, whether the infants were selected because of significant jaundice or irrespective of the degree of bilirubinaemia. This indicates a common pathogenesis of the bilirubinaemia in the two groups. The COHb and bilirubin levels in infants of ABO heterospecific pregnancies and in infants of ABO homospecific pregnancies, selected without regard to the degree of bilirubinaemia, were compared. It is concluded that the COHb level probably is a more sensitive indicator of haemolysis than the bilirubin concentration. Increased COHb concentrations were also found in icteric infants without blood group incompatibility, but the relation between COHb and bilirubin indicates that in ABO incompatibility increased haemolysis is of greater importance in the pathogenesis of the jaundice.

Summary One hundred and thirteen full-term infants with bilirubin values of 18 mg% or more during the neonatal period, have been followed-up at the age of 2–3 years, and compared with 51 full-term, non-icteric infants, born during the same period. Exchange transfusion was carried out in 30 of the children with jaundice. No cases of kernicterus could be demonstrated. Play audiometry was carried out in 125 children (86 with jaundice, 39 controls). No deafness of central type was revealed. At the paediatric follow-up examination no relevant abnormalities were found. Merrill-Palmer testing produced evidence of a similar I.Q. distribution among the icteric as among the non-icteric children. A cerebral lesion was diagnosed in 3 cases, but in all these another aetiology (disturbance at the time of birth) occurred in addition to hyper-bilirubinaemia. Hyperbilirubinaemia alone did not give rise to any cerebral lesion.

SUMMARY The COHb concentration has been determined in 35 normal non-icteric newborn infants and in 29 infants with icterus of unknown origin. It is stated that the COHb concentration in blood well reflects the degree of red cell destruction. The results indicate that there is an increased haemoglobin catabolism during the newborn period and that increased degradation of haemoglobin contributes to the neonatal hyperbilirubinaemia in cases without known haemolytic disease.