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Prolonged artificial ventilation was employed 29 times in cases of severe status asthmaticus at the Medical Department, University of Turku, in co-operation with the Department of Anesthesiology. Three of the 26 patients were twice under respirator treatment. The outcome was fatal in four cases. At the time they were connected up to the respirator all the patients were physically exhausted, pale, cyanosed and had difficulties in coughing up bronchial secretions. Seventeen patients were unconscious. Carbon dioxide retention occurred in all the cases. The mean duration of controlled mechanical ventilation was five days. The indications for controlled respirator therapy are examined with reference to the material. The conclusion reached is that this form of therapy is useful, often a necessary and lifesaving measure in the treatment of patients with most severe status asthmaticus.

High-performance liquid (HPLC) and gas--liquid chromatographic (GLC) methods for the measurement of the antidepressant nomifensine in human serum were developed and compared for precision, accuracy, sensitivity and convenience. No significant difference was found between these two techniques with regard to sensitivity and precision. Both methods can accurately measure serum nomifensine concentrations down to 8 nmol/1. The coefficient of variation (C.V.) for intra-assay variability of nomifensine was 4.8% (HPLC) and 5.5% (GLC) at 150 nmol/1. The HPLC method proved to be both simpler and more selective than the GLC method. The calibration graph was linear over the range 8-1000 nmol/1 in the HPLC method, but only up to 150 nmol/1 in the GLC method. The selectivity and simplicity of the HPLC method make it useful for both pharmacokinetic studies and therapeutic serum level monitoring of nomifensine. The HPLC method was applied to the analysis of serum samples obtained from four healthy individuals receiving therapeutic dosages of nomifensine.

Fifty-four patients who died from asthma in hospital in 1956–1967 were analysed retrogressively, with special reference to the drug therapy immediately before death. Clinically sudden and unexpected death was as common as death which was attributed to asphyxia, but at autopsy (45 patients) mucous bronchial obstruction was established in 37 cases. During the last 24 hours of life, 51 of the patients were given sympathomimetics, 31 of them several sympathomimetics concomitantly and 21 in nebulised form. One of the patients died during an adrenaline injection, and one made liberal use of the orciprenaline aerosol she had brought with her to hospital. The xanthine derivative (glyphylline) was given during the last 24 hours to 50 patients. The glyphylline dose was over 3 g/24 hours in eight cases. The death of seven of them was regarded as clinically sudden and unexpected; at least one patient had manifest symptoms of central nervous system stimulation prior to death. Equally large glyphylline doses, however, were given to the control patients in status asthmaticus who survived. Polypharmacy seems to have been a probable iatrogenic factor influencing the mechanism of death in at least four patients of the total material. Corticosteroids were not administered to four patients who had been managed for the last month prior to hospitalisation with corticosteroids. Other iatrogenic factors influencing the mechanism of death seemed to be technical complications of respirator treatment in two cases and the possibility that respirator therapy was delayed.