Abstract. In a study of 145 patients with severe cervical spine injury, it was found that 79 had serious neurological disturbance. A policy of the earliest possible referral to a spinal paralysis service is recommended. Associated injuries and in particular a head injury can make early precise neurological diagnosis difficult, and may affect management of the spinal injury. The use of Gardner Wells Skull Tongs and the Edinburgh Simpson Bed is recommended. Early spinal operation does not influence outcome of neurological function. Anatomical re-alignment of the spine is not essential for neurological recovery. Myelography is very rarely of benefit in assisting diagnosis and treatment. Glucocorti costeroids and Mannitol do not appear to influence neurological recovery.The prognosis in relation to clinical neurological syndromes is discussed.

Acute hypoglycaemia has been achieved in tetraplegic subjects and in healthy controls using insulin. The recovery from hypoglycaemia has been followed by measuring appropriate substrate levels in blood. Abnormal responses of lactate and free fatty acid concentrations were observed; blood glucose recovery proceeded at a normal rate.

The contributions of adrenergic and cholinergic mechanisms to recovery from acute hypoglycaemia induced by insulin (0.15 units/kg i.v.) were examined in eleven normal subjects, six subjects with a pre-ganglionic sympathectomy (adrenergic denervation) and six sympathectomized subjects given atropine (combined adrenergic denervation and cholinergic blockade). Blood glucose recovery was impaired only in the sympathectomized subjects given atropine. The blood lactate response was reduced and the rise in free fatty acids was delayed in both groups of sympathectomized subjects, in whom the normal rises of plasma cyclic AMP and noradrenaline were absent. The plasma pancreatic glucagon response was appropriate to the prevailing blood glucose concentrations in all three groups. The cortisol response was impaired and the pattern of ACTH secretion was abnormal in sympathectomized subjects given atropine. Growth hormone levels were higher in both sympathectomized groups. Blood glucose homeostasis was impaired during combined adrenergic denervation and cholinergic blockade. Glucagon secretion was activated independently of vagal control. In the sympathectomized group given atropine, the rise in plasma cortisol was blunted despite a greater degree of hypoglycaemia. A blockade of central cholinergic receptors producing impaired activation of ACTH secretion at hypothalamic level may explain, at least in part, this delayed restoration of normoglycaemia.

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Abstract. A simple, inexpensive low-pressure air bed has been developed for use in situations where decubitus ulcers may arise. This bed is currently being evaluated in patients with spinal injuries, both in the hospital situation and in the home. Early experience is highly encouraging as regular turning of the patient can be safely omitted. We feel that widespread use of this bed could greatly decrease the incidence of pressure sores.

Abstract. The problem of decubitus ulceration is a common one in para-and tetraplegic patients. It is a problem which involves these patients rpending long periods in hospital.In 1977 almost 50 per cent of the patients re-admitted to our Unit had skin problems.During 1977 the average time spent in our Unit with skin problems of all degrees, was almost 3 months.Over the past few years several new products have become available for cleansing and healing these sores which, it seems, may reduce the time required in preparation for surgery or in achieving healing.We discuss the application of these products and the results of their use in our hands.

A review of the results of a medical and nursing audit of pressure sore care in one hospital.

No abstract