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A model was developed to provide a tool to forecast demographic trends in populations of people with traumatic spinal cord injury at the national and state level. This information is critical to planning for the allocation and distribution of resources to care for people with spinal cord injury. The literature on incidence, mortality, and prevalence of spinal cord injury in the United States was reviewed and reported values were evaluated for incorporation into the model. A linear relationship between age specific survival rates of the spinal cord injury population, and expected survival rates in the absence of spinal cord injury was established and this provided the basis for projections using age cohort survival methodology. The model's projections indicate a need for future expansion of capacity to treat traumatic spinal cord injury in the private sector, and a need to prepare for an aging disabled population. The annual number of traumatic spinal cord injury cases admitted to hospitals is projected to increase from approximately 11 500 in 1994 to almost 13 400 in 2010. Age adjusted post-hospitalization incidence rate in 1994 is estimated at approximately 38 per million (23 per million for females and 55 per million for males). A 20% increase in the US spinal cord injury prevalence can be expected over the next 10 years, going from approximately 207000 estimated in 1994, to 247 000. During this time, the veteran segment, which currently comprises 22% of the spinal cord injury population, is projected to decline. Increases in the number of people aged 65 or more with spinal cord injury, currently estimated to be around 11% of the total spinal cord injury population, can be expected to grow more than 24% by 2025 to almost 73 000.

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Eleven cases of wandering spleen are described of which 8 were in children. Six patients presented with a chronic abdominal mass and 5 with acute torsion. In the chronic case the diagnosis may be cIariJied by the use of radioactive W?, and the plain abdominal X-ray is of value in chronic and acute presentations. Splenectomy is required for all acute cases but a technique for preservation of the spleen is feasible in the chronic case. The condition may arise from association of splenomegaly and maldevelopment of the dorsal rnesogastrium.

Groups of patients with lepromatous and tuberculoid leprosy and hospital staff from six leprosaria in East Africa and 'non-contact' groups of villagers or staff from general hospitals have been skin tested with 10 reagents. These were prepared by ultrasonic disintegration from M. tuberculosis, M. duvalii, M. chelonei and 7 other species identified in the Ugandan environment. Comparisons were made of the percentages of positive reactors in each study group for each reagent. The 'specific' defect of lepromatous patients was found to apply to a variable extent to six of the species tested, but not to M. tuberculosis, M. avium or M. 'A'. The defect applied most noticeably to M. nonchromogenicum and M. vaccae, suggesting that they are more closely related to M. leprae than are the other species tested. The reagent Chelonin produced unexpected and anomalous results in the lepromatous group. It is suggested that this was due to an unusually slow clearing of Arthus' reaction.

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The specificities of antibodies reacting with peptides encoded by V3 loop apical epitopes were determined for sera from 230 seropositive Ugandans, including asymptomatic persons and AIDS patients, sampled between 1986 and 1992. Most (71%) of the sera reacted with the peptide encoded by HIV-MN, 59% reacted with a peptide containing a consensus sequence for Ugandan variants of the HIV-1 global subtype A (referred to as the Uganda A consensus), 59% reacted with a peptide containing a consensus sequence for Ugandan variants of the global subtype D (the Uganda D consensus); 19% of the sera also reacted with peptides encoded by the divergent Ugandan variant U31. There was no obvious correlation between the specificities of antibody binding and the V3 loop sequence of the corresponding virus isolate or provirus. Competitive inhibition and antibody adsorption experiments indicated that the MN peptide, the Uganda A consensus peptide, the Uganda D consensus peptide, and the U31 peptide were recognized by different sets of antibodies. Eighteen percent of the sera from AIDS patients and 26% of the sera from asymptomatic persons were monospecific for one of the MN, Uganda A, or Uganda D peptides. Whereas all except one of the singly reactive AIDS sera were specific for MN, 39% of the singly reactive asymptomatic sera were specific for MN, 39% for the Uganda A peptide, and 21% for the Uganda D peptides. We conclude that analysis of the specificities of antibodies against the V3 loop epitopes in sera from asymptomatic persons could provide useful epidemiological data about the prevalence of viral subtypes within a population.

No abstract