The relationships among serum lipid levels, adiposity, and depressive symptomatology in persons aging with spinal cord injury

BACKGROUND: Cardiovascular disease (CVD) appears to occur prematurely in persons with spinal cord injury (SCI). Stress may play a significant role in the development of CVD. Depression is the most common form of stress complicating the care of persons with SCI. METHODS: In 188 persons with SCI, 46% with tetraplegia and 54% with paraplegia, the relationship between depression and the serum lipid profile was studied. Depression was measured by the Older Adult Health and Mood Questionnaire (OAHMQ) for persons with disability. Total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol and triglycerides were measured; body mass index (BMI) was computed and percent body fat was determined by dual-energy x-ray absorptiometry (DXA). RESULTS: Depression and level of SCI were found to have significant interactive effects on serum lipid levels. Serum total and LDL cholesterol, as well as triglycerides, were all higher among persons with paraplegia who were depressed compared to those who were not depressed. This was not found in persons with tetraplegia. Inverse relationships were evident between serum triglycerides and HDL cholesterol levels. Persons with paraplegia who were depressed had significantly more adiposity than those not depressed. BMI correlated directly with serum triglycerides and indirectly with serum HDL cholesterol. CONCLUSION: Depression appears to be a strong determinant of adverse lipid profiles in patients with paraplegia. association between depression and adiposity in these patients compounds the risk for cardiovascular disease.     

Long-term evolution of blood lipid profiles and glycemic levels in patients after spinal cord injury

OBJECTIVE: To analyze the lipid and glycemic profiles in relation to age, time elapsed post injury and the level of injury in a group of patients with SCI. SUBJECTS: 2135 subjects with SCI were recruited during the annual routine health check-up carried out at the Institut Guttmann of Badalona, in Spain. The patients were classified according to the level of SCI and their age. METHODS: Serum lipid profiles and glycemic (glucose) levels were determined. Data was collected between 1996 and 2001, all biochemical analysis being performed by the same laboratory. RESULTS: Serum cholesterol levels show a statistically significant correlation with patient's age(P<0.001) and with time elapsed after injury (P<0.05). Differences can be observed between the values obtained from the different injury level groups (F=22.14; P<0.001). LDL-c shows a statistically significant difference between the four different age groups (F=3.51, P<0.05). There is an increase in plasma triglycerides related to the increase in age of the patients without observable differences between the injury level groups. The concentration of serum glucose increases with age (P<0.001) and also with the time elapsed after injury (P<0.05). CONCLUSION: There is a direct relationship between various biochemical parameters (total cholesterol, LDL-c and glucose) and the age of the patients, but not with the severity or time of evolution of the spinal cord injury.     

急性脊髓损伤患者血清蛋白质组学研究

目的观察急性脊髓损伤(SCI)患者和健康人群血清差异表达蛋白,寻找急性SCI相关特异性代谢通路或蛋白标志物。方法 2013年7月—2014年12月,采集9例急性颈部SCI患者(病例组)和9例年龄、性别与病例组相匹配的健康受试者(对照组)的血液样本。记录病例组损伤时间、颈椎日本骨科学会(JOA)评分等基本信息。应用非标记相对定量蛋白质组学技术比较病例组与对照组血清蛋白质谱,采用Spearman相关分析寻找差异表达蛋白与患者年龄、损伤时间以及JOA评分的相关性。应用基因本体论(GO)分析、BiNGO富集分析和京都基因与基因组百科全书(KEGG)对差异表达蛋白进行生物信息学分析。结果共发现22个差异表达蛋白。与对照组相比,病例组11个蛋白表达上调(包括果糖-二磷酸醛缩酶、碳酸酐酶等),且与损伤时间和颈椎JOA评分呈正相关;11个蛋白表达下调(包括免疫球蛋白等),且与损伤时间和颈椎JOA评分呈负相关。生物信息学分析发现这些差异表达蛋白主要富集在果糖和甘露糖代谢通路、血小板激活代谢通路、黏附连接代谢通路和氮代谢通路。结论急性SCI患者和健康人群血清蛋白质谱存在差异,果糖-二磷酸醛缩酶、碳酸酐酶等有望成为急性SCI潜在的分子标志物。     

急性脊髓损伤患者血清中单核趋化蛋白-1的表达

目的:观察急性不完全性脊髓损伤患者血清中单核细胞趋化蛋白-1(MCP-1)的表达,探讨继发性脊髓损伤的可能机制。方法:收集急性不完全性脊髓损伤患者和单纯脊柱压缩骨折患者及正常对照者的血清,ELISA方法检测其中MCP-1的水平。结果:与健康对照组相比,急性不完全性脊髓损伤患者血清中MCP-1的浓度明显增高(P<0.01)。结论:MCP-1可能通过向脊髓损伤部位募集炎症细胞而参与脊髓损伤部位的继发性炎症反应。     

脊髓损伤患者的救治特点及生存状态分析

目的分析脊髓损伤患者的救治特点及生存状态。方法对2006年12月1日至2007年12月31日62例脊髓损伤患者通过病历查询、现场随访及电话随访的方式获取资料,记录患者的基本情况、受伤后救治情况和经济状况。采用美国脊髓损伤协会（American spinal injury association,ASIA）制定的感觉、运动评定标准和功能独立性评定（functional indepen-dence measure,FIM）对患者的恢复情况进行评分,采用抑郁自评量表（self-rating depression scale,SDS）对患者及其家属进行生存状态评估。用SPSS软件进行统计学分析。结果62例脊髓损伤患者中男60例,年龄16～45岁,平均26．9岁;女2例,年龄24和36岁。高处坠落或重物砸伤42例（占67．75％）,交通创伤18例（占29％）,摔伤2例（占3．25％）。根据美国脊髓损伤协会ASIA伤残分级标准划分：A级完全损伤33例,（占53．3％）;B级不完全损伤25例（占40．3％）,C级2例（占3．2％）,D级2例（占3．2％）。受伤后送至救治医院的时间为4～28h,平均11h。颈椎损伤42例（占68．75％）,胸椎损伤20例（占32．25％）。A级损伤的33例患者中,8例行减压内固定手术,6例行减压内固定＋自体髂骨植骨术,6例行单纯减压手术,13例采取保守治疗。B级损伤的25例患者中,5例行减压内固定手术,7例行减压内固定＋自体髂骨植骨术,4例行单纯减压手术,9例采取保守治疗。4例C级和D级损伤的患者全部采用保守治疗。受伤至手术时间8～32h,平均10．4h。手术时间1．5～6h,平均3．2h。术后随访时6例患者生活能够自理（占9．67％）,44例完全需要护理人员（占70．97％）,12例均不同程度地需要护理。62例患者中社会保险覆盖率不足5％。患者受伤后患者的家庭年收入1800—8000元,平均3460元,与受伤前相比家庭总收入平均下降80％以上。结论ASIA伤残分级A级损?     

Evaluation of the effect of spinal cord injury on serum PSA levels

OBJECTIVES: Prostatic structure and secretory activity are thought to be influenced by autonomic innervation of the prostate. Prostatic denervation is especially likely in patients with spinal cord injury (SCI) at the level of the cauda equina or the conus medullaris, where the peripheral nerve supply to the prostate may be specifically damaged. This may result in changes in serum prostate-specific antigen (PSA) levels, either directly or indirectly. Therefore, we measured serum PSA levels and also studied the influence of factors such as age, catheterization, duration of SCI, urinary tract infection, and history of cystitis on serum PSA values in men with SCI. METHODS: Serum PSA levels were determined in 79 men with SCI (age older than 40 years) using banked sera by the Abbott MEIA PSA assay. Variables such as age, catheterization, duration of SCI, urine culture results, and history of cystitis were obtained from a review of patient records. Comparisons were made with a randomly selected, non-SCI control population of 501 men, 40 to 89 years old, who underwent serum PSA determination at our institution. Statistical comparisons were performed using the Mann-Whitney U test (nonparametric), since the populations were not normally distributed. Multivariate logistic regression analysis was used to assess the correlation between the various factors and the serum PSA levels in men with SCI. RESULTS: No statistically significant differences were found in the median serum PSA values between the SCI group and the non-SCI control population. The age-specific PSA values obtained in the SCI group were also comparable to those reported for the general population at large. Age (P <0.03) and the presence of a catheter (P <0.0002) were the only two factors that were correlated with higher serum PSA values in the SCI group by regression analysis. CONCLUSIONS: Men with SCI tended to have serum PSA value distributions that were similar to those of the general population. However, those in the SCI group who had indwelling catheters were more likely to have higher PSA values at baseline, as were older men with SCI.     

Spinal cord evoked injury potentials in patients with acute spinal cord injury

Six patients were examined in the acute stage of spinal cord injury, between 11 h and 12 days posttrauma. Quadripolar epidural electrodes were positioned either percutaneously using a Tuohy needle or directly into the epidural space during surgical intervention. These electrodes were combined with a common reference to obtain monopolar recordings of spinal cord evoked potentials resulting from either median nerve stimulation at the wrist or tibial nerve stimulation at the popliteal fossa. Spinal cord evoked injury potentials (SCEIPs), stationary potentials with positive polarity on the distal aspect of the lesion and negative polarity on the proximal aspect, were recorded in all cases. The average amplitude (n = 3) of the SCEIP resulting from tibial nerve stimulation as measured across the lesion was 13.5 microV with an average duration of 12.7 msec. For median nerve stimulation, the average amplitude (n = 3) of the SCEIP was 16.3 microV with an average duration of 6.7 msec. There was a change in polarity in all cases over a distance of less than 6 mm, the distance between the electrode contacts on the epidural electrode. In one case, recordings were performed initially at 11 h and repeated at 21 days posttrauma. In the latter recording, the SCEIP was still present but was five times smaller in amplitude. Coincidentally, the patient also showed clinical signs of improvement in sensory and motor spinal cord function. This study demonstrates the feasibility of recording the SCEIP in patients with acute spinal cord injury, describes the features of these SCEIPs, discusses their origins, and explores the utility of recording the SCEIP as an aid in determining the severity of the injury as well as a means of monitoring changes in spinal cord function.     

The male reproductive function in patients with spinal cord injury

Seminal findings and blood hormone levels were studied for evaluating the male reproductive function in patients with spinal cord injury. The patients were divided into 3 groups, namely, 18 patients with complete injury, 5 patients with incomplete injury and 3 patients with dyspermatism. The number of sperms, the rate of movement and rate of deformation were measured for semen obtained by forced ejaculation. The number of sperms was kept at a relatively high level in the three groups, while the rate of movement fell off in all of the three groups. The rate of deformation was highest in the patients with complete injury and lowest in the patients with dyspermatism. As for blood hormone levels, LH, FSH and Testosterone (hereinafter referred to as TES) were determined by the RIA. The cases were classified into those in the acute stage and those in the chronic stage 3 months after sustaining injury for a comparative study. The subjects consisted of 27 cases in the acute stage and 47 cases in the chronic stage. For 8 patients in the acute stage, the blood hormone levels were determined even in the chronic stage and follow-up observations were made on the changes in the levels. The FSH level was low in both stages, while LH and TES tended to increase in the chronic stage. Particularly, the TES level was elevated in all the cases in the follow-up observations made in 8 patients. From the results mentioned above, transient disturbance of the interstitial function is suggested as the mechanism of male gonadal disturbance due to spinal cord injury.     

Monocyte chemoattractant protein-1 level in serum of patients with acute spinal cord injury

Spinalcordinjury(SCI)withinthefirstfewhours,isfrequentlycomplicatedbyinflammatorymechanisms,includingtheinfluxofmonocyte/macrophagesaswellastheactivationofresidentspinalmicrogliaandastrocytes.Numerousstudieshave suggestedthattheinitialinfiltrationofthe hematogenouscellsmaybeduetothesecretionof cytokinesandchemokinesintheinjuredcentral nervoussystem(CNS),amongwhichmonocyte chemoattractantprotein1(MCP1),amemberofβfamilychemokines,isthemostwellrecognized.Studiesconductedinmanylaboratorieshave…     

Incidence and clinical correlates of increased serum creatine kinase levels in persons with spinal cord injury

BACKGROUND: Elevated plasma levels of creatine kinase (CPK) are found in various neuromuscular conditions as a result of muscle damage and necrosis. Elevated CPK has also been described in elite wheelchair athletes and in able-bodied individuals after strenuous exercise. METHODS: The incidence of elevated CPK in individuals with spinal cord injury (SCI) has not been well established. We reviewed laboratory data from 581 individuals with chronic SCI. RESULTS: Most individuals with SCI (73.3%) had CPK values within 95% confidence intervals for able-bodied individuals. The highest levels were seen in African Americans (21% had CPK values > 95 confidence intervals for able-bodied individuals). Significant associations between CPK and the following independent variables were identified: impairment group, gender, duration of injury, body mass index, and ethnic group. Multiple regression analysis revealed significant correlations between CPK and oxygen consumption (beta .37, P < .01) in 32 individuals who performed the exercise test. CONCLUSIONS: These findings are important for clinicians evaluating symptoms of fatigue and myopathy in individuals with SCI.     

Hypothermia in patients with chronic spinal cord injury

DESIGN: Retrospective analysis of medical records. BACKGROUND/OBJECTIVES: To determine frequency and degree of hypothermic episodes in patients with chronic spinal cord injury (SCI). SETTING: Veterans Administration Medical Center. METHODS: Research involved analysis of body temperature records of 50 chronic patients with tetraplegia. All patients were men with a length of injury of 19 +/- 6 years. Mean age was 53 +/- 15 (SD) years. Data were derived from the computerized patient record database system of the Veterans Administration Medical Center. Results were classified into 3 groups: (a) hypothermia (< 95 degrees F), (b) subnormal temperature (< 97.7 degrees F), and normal temperatures (97.7 degrees F to 98.4 degrees F). Body temperature was recorded during hospitalization (minimum duration of 30 days) using an oral probe twice a day. Ambient temperature was controlled by a central air-conditioning system and maintained at 72 degrees F to 74 degrees F. RESULTS: A total of 867 measurements of body temperature were evaluated; normal temperature was recorded 298 times (35%), subnormal temperature was recorded 544 times (63%), and hypothermia was recorded 25 times (3%). There were 15 patients with 30 hypothermic episodes; subnormal temperature was found in all 50 patients from 1 to 47 times. Regression analysis of age and duration of SCI showed a nonsignificant relationship with body temperature. CONCLUSIONS: Our data suggest that patients with tetraplegia after SCI have significant dysfunction of thermoregulation associated with frequent episodes of subnormal body temperature in a normal ambient environment. Further studies are needed to evaluate possible consequences of low temperatures on the general health of patients and to develop preventive interventions.     

Cholecystectomy in patients with previous spinal cord injury

BACKGROUND: The number of people in the United States with spinal cord injury (SCI) is estimated at about 200,000. The prevalence of gallbladder disease in this population is about three times as high as in neurally intact people, but the results of surgical treatment have received little attention. METHODS: A retrospective, population-based study of patients with SCI who later received cholecystectomy for benign gallbladder disease was performed. National computer data sets of all patients receiving medical care in all Department of Veterans Affairs (DVA) medical centers for fiscal years 1994 to 1998 were used. Computer-based data were augmented with chart-based resources. RESULTS: During the period of interest, there were 21,849 patients with ICD-9-CM codes for SCI in the DVA computer system, among whom 367 had codes for cholecystectomy. After retrieval and review of data from individual charts, 118 were deemed evaluable. There were 68 who had successful laparoscopic cholecystectomy and 14 who required conversion to open cholecystectomy after laparoscopic efforts failed (conversion rate 14 of 82=17%). There were 36 who received planned open cholecystectomy. Patients under the age of 60 years were more likely to have a laparoscopic approach (P <0.05). Emergency cholecystectomies were more likely to be performed via the open route (P <0.01). The morbidity rate was 8 of 68 (12%) for successful laparoscopic cholecystectomy, 4 of 14 (29%) for failed laparoscopic surgery completed by conventional open technique, and 11 of 36 (31%) for planned open surgery. The mortality rate in the traditional surgery group was 1 of 36 (3%). There were no deaths in the other groups. CONCLUSIONS: We believe this series is the largest so far reported. The mortality rate of cholecystectomy in SCI patients is comparable to that in neurally intact individuals, but the morbidity rate is high. Contractures, stomas, heterotopic ossification, and other sequelae of SCI do not generally cause technical difficulties with surgery. If complications of cholecystectomy are indeed SCI-related, attention to perioperative SCI care could improve outcomes of cholecystectomy. Future research should continue to explore this important research topic.     

Bladder cancer in patients with spinal cord injury

OBJECTIVE: The incidence of bladder cancer in spinal cord injury (SCI) is 16 to 28 times higher than that in the general population. The objective of this study was to investigate the characteristics of bladder cancer that are unique to the SCI population. DESIGN: Retrospective review. METHODS: The charts of 16 patients diagnosed with bladder cancer from 1982 to 2001 were reviewed for type of cancer, exposure to risk factors, presenting symptoms, and survival time. RESULTS: The presenting manifestations were gross hematuria in 14 patients, papillary urethral growth in 1 patient, and acute obstructive renal failure in 1 patient. The diagnosis was made on initial cystoscopic evaluation in 16 patients; 3 patients required further evaluation. Eight of the 11 screening cytologies were suspicious for a malignancy prior to the diagnosis. Seven patients had transitional cell carcinoma, 6 patients had squamous cell carcinoma (SCCA), and 3 patients had both. The bladder wasmanaged with chronic indwelling catheter in 12 patients. Nine patients died of bladder cancer metastases and the remaining 3 patients died of other causes. Six patients survived 5 years or more; 4 were still alive at the completion of this study. CONCLUSION: Gross hematuria in individuals with SCI warrants aggressive assessment for bladder cancer. Chronic indwelling catheter, smoking, and renal and bladder stones are important risk factors for cancer. The incidence of SCCA in the SCI popullation is much higher than in the general population. Cystoscopic and cytologic evaluation in patients with advanced disease may fail to confirm the diagnosis in a high proportion of patients.     

Appendicitis in patients with previous spinal cord injury

BACKGROUND: Acute abdominal emergencies are particularly dangerous in patients with impaired sensation. METHODS: Thirty patients with spinal cord injury who later developed appendicitis were identified in Department of Veterans Affairs computer files over a 5-year period; 26 were evaluable. RESULTS: The mean age was 55 years (range 27 to 79); all were males. Abdominal distention or discomfort was present in 16 of 26 (62%), while 2 of 26 (8%) presented in shock. A palpable right lower quadrant mass was present in 6 of 26 (23%). The mean initial white blood cell count was 18,000/mm3. Only 9 of 26 (35%) had the diagnosis of appendicitis made on admission. In 12 of 26, computed tomography was done; all correctly diagnosed appendicitis. The mean delay in diagnosis after hospitalization was 2 days (range 0 to 5). Perforated appendicitis was found at surgery in 24 of 26 (92%). Twenty-three of 26 (88%) underwent appendectomy; 3 of 26 (12%) underwent right colectomy. The 30-day mortality rate was 4%. Six of 26 (23%) developed a postoperative complication. The mean length of stay was 16 days. CONCLUSIONS: Acute appendicitis in spinal-cord-injured patients frequently presents late and complications are common. Computed tomography appears to be an excellent diagnostic modality. Some of the adverse outcomes which are related to preexisting spinal cord injury may be preventable with early intervention.     

Urethral cultures in patients with spinal cord injury

STUDY DESIGN: Prospective analysis. OBJECTIVES: To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury (SCI) and to examine the association between bacteriuria and colonization of the distal urethra. SETTING: Selcuk University Meram Faculty of Medicine, Konya, Turkey. METHODS: A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects. RESULTS: Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66). CONCLUSIONS: Our study suggested that urethral flora was a significant source for the development of urinary infection in spinal cord-injured patients.     

Marjolin's ulcer in patients with spinal cord injury

BACKGROUND: The term "Marjolin's ulcer" is now synonymous with malignant transformation, usually ectodermal and rarely mesenchymal, of chronic ulcers, sinus tracts, and burn scars. DESIGN: Literature search and personal experience with 5 patients during a 30-year period in a spinal cord injury center. FINDINGS: Five cases of Marjolin's ulcer diagnosed among approximately 10,000 patients indicate the rarity of the metaplasia. All cases were fatal. CONCLUSIONS: Chronic pressure ulcers of more than 10 years' duration should be biopsied to rule out malignancy, especially with any change in the nature of the ulcer (eg, exuberant granulation and/or bleeding).     

Megacolon in patients with chronic spinal cord injury

PURPOSE: To investigate the clinical and functional correlates of megacolon in individuals with chronic spinal cord injury (SCI). PATIENTS AND METHODS: This is a cross-sectional study of 128 patients consecutively admitted to a SCI in-patient service in a US Veterans Administration Medical Centre (mean age 57+/-15 years, mean years since injury 20+/-13, 97% male) who underwent plain abdominal radiography for study purposes. Participants were characterised by radiological findings. 'Megacolon' was defined as colonic dilatation of >6 cms in one or more colonic segment(s). Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews were conducted with study participants regarding bowel-related symptoms and treatment over the previous 1-month period. RESULTS: Seventy-three per cent of subjects (n=94) had megacolon, and 52% of these individuals had associated radiological constipation. Subjects with megacolon were compared with those without colonic dilatation (n=34). Factors significantly associated with megacolon were older age, longer duration of injury, symptom of abdominal distension, radiological constipation, urinary outlet surgery, laxative use at least once weekly, use of anticholinergic drugs, and use of calcium-containing antacids. These factors were simultaneously included in a multiple logistic regression model. Independent correlates of megacolon were more than 10 years elapsed since acute injury, age over 50 years, and use of >/=4 laxative doses per month. CONCLUSION: Megacolon is a highly prevalent disorder in individuals with chronic spinal cord injury. Our findings suggest that the presence of megacolon may be predicted in older individuals, and in those who are more than 10 years post-SCI. We also found that clinical constipation was frequently present in individuals with megacolon, despite their significantly greater use of laxatives. SPONSORSHIP: This work was supported by a grant from the Claude D Pepper Geriatric Research and Training Center from the National Institute of Ageing-AG08812-05, and a grant from the Education and Training Foundation of the Paralyzed Veterans Association in the USA. Dr Harari is currently recipient of a grant from Action Research (UK). Spinal Cord (2000) 38, 331 - 339.     

Urinary infections in patients with spinal cord injury

STUDY DESIGN: A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients. OBJECTIVES: To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment. SETTING: Ghent University Hospital, East-Flanders, Belgium. METHODS: Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology. RESULTS: An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated. CONCLUSION: Despite different catheterisation techniques in para- and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.     

Fibrinogen metabolism in patients with spinal cord injury

BACKGROUND/OBJECTIVE: Deep venous thrombosis and pulmonary thromboembolism are common within weeks of spinal cord injury (SCI) but clinically uncommon in the chronically paralyzed. Fibrinogen half-life (FHL) and fibrin uptake of the legs (FUT), as indicators of an active thrombotic process, have been used to test this clinical impression. METHODS: Data from the use of autologous preparations of radioiodinated fibrinogen to determine FHL and FUT in 17 men paralyzed at cervical (6), thoracic (10), and lumbar levels (1), at ASIA grades A (15) and C (2) in 1974 to 1976 were reviewed. Group A consisted of 12 subjects 29 +/- 8 years of age and paralyzed 1 week to 5 months (median, 1 month). Group B consisted of 5 subjects 46 +/- 17 years of age and paralyzed 24 to 96 months (median, 36 months). Group B subjects were older and paralyzed longer than Group A. Group C consisted of 4 able-bodied control subjects enrolled at the same time for FHL studies, and these subjects were 34 to 38 years of age. RESULTS: FHL was 61 +/- 14 hours for all SCI subjects and 95 +/- 23 hours for Group C (P = 0.001). Group A FHL was 59 +/- 16 hours, and FUT was positive in 8 of 12 subjects. Group B FHL was 66 +/- 7 hours, and FUT was positive in 3 of 4 subjects (1 FUT not done; P = 0.30 and 1.0, respectively). CONCLUSIONS: Fibrinogen metabolism was abnormal in patients with acute SCI at high risk for pulmonary thromboembolism (PE) but continued to be abnormal beyond the high risk period for PE, possibly because of the greater age of the patients in the long-term paralysis group.