Daily physical activities for 12 severely physically and mentally handicapped persons were investigated using heart rates during a 24-hr period. The recorded heart rates were processed statistically and analyzed. The standard deviation and skewness for the severely handicapped persons with low ambulatory ability were significantly greater than those for the most severely handicapped persons without ambulatory ability. These properties confirmed that physical activities of daily living were extremely different for the two groups. The severely handicapped persons with low ambulatory ability had higher heart rates of about 10% relating to active physical activities. It was suggested that the active physical activities of daily living could contribute to the improvement of physical work capacity if these activities were more prolonged in duration. On the other hand, such higher heart rates were not observed in the case of most severely handicapped persons and extremely low function in their cardiorespiratory system was suspected. It became impor. tant to apply physical training to the most severely handicapped persons even though light work was performed passively.

Eighteen persons with both severe mental retardation and severe physical disabilities and ten normal persons participated to investigate cardiovascular response to hydrostatic pressure stress using supine and sitting positions. All of the handicapped subjects lay down on the bed during the entire day. They were classified into three groups. That is, the first group (LD) had not opportunity of sitting passively in daily living at all. Another two groups were given opportunity of sitting. In addition, the second group (ST 1) was unable to sit and stand independently in the past but the third group (ST 2) was able. The LD showed unchanged heart rate and decreased blood pressure with reduced peripheral blood flow in the sitting position. This suggested that serious lower function or dysfunction in both central and peripheral circulatory system. The cardiovascular function of the ST 1 was characterized by elevated heart rate and lowered blood pressure. This seemed to indicate lower baroreflex control to the peripheral vascular system. The ST 2 demonstrated similar function to the normal persons. The cardiovascular regulation in the severely handicapped persons may depend on opportu-unity of taking orthostatic posture in daily living in addition to motor adility in the past.

A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.