Autoimmune sclerosing cholangitis might be triggered by SARS-CoV-2 infection in a child - a case report.

The spectrum of liver involvement during coronavirus disease 2019 (COVID-19) is broad and mainly includes elevated liver enzymes and cholestasis. Severe acute respiratory syndrome corona- virus-2 (SARS-CoV-2) infection most often leads to a transient moderate increase in liver enzymes that is not accompanied by disturbances in the synthetic function of the liver. However, there is increasing evidence that SARS-CoV-2 infection is associated with the development of autoimmune disorders. The pathogenesis of autoimmune hepatobiliary diseases is not fully understood, taking into account genetic and environmental factors such as viral infections. We present a pediatric case of autoimmune sclerosing cholangitis (ASC), which was diagnosed 2 months after SARS-CoV-2 infection. To the best of our knowledge, ASC potentially triggered by COVID-19 has not been reported in pediatric patients. Further studies are needed to describe the clinical impact of the development of autoimmune liver diseases potentially associated with SARS-CoV-2 infection in pediatric patients. Our observations indicate that children with liver injury potentially caused by COVID-19 require long-term monitoring of liver function parameters.

The imbalance of peripheral interleukin-18 and transforming growth factor-ß1 levels in patients with cirrhosis and esophageal varices.

INTRODUCTION: The presence of esophageal varices in liver cirrhosis indicates clinically significant portal hypertension (PH), that results from structural and dynamic changes in the liver and systemic circulation including the activation of several fibrotic and inflammatory pathways. We assessed if interleukin-18 (IL-18) and transforming growth factor-ß1 (TGF-ß1) serum levels can be used as PH markers and reflect its severity. MATERIAL AND METHODS: IL-18 and TGF-ß1 peripheral blood levels were analyzed in 83 cirrhotic patients with esophageal varices compared to healthy individuals, in relation to MELD and Child-Pugh scores, laboratory and Doppler ultrasound parameters, and non-selective beta-blocker therapy (NSBB). RESULTS: IL-18 concentration was significantly higher in cirrhotic patients, while TGF-ß1 concentration was lower than in controls. MELD score correlated positively with IL-18 levels and negatively with TGF-ß1 levels. IL-18 levels correlated positively with bilirubin, INR, ALT and AST levels, and negatively with albumin levels and erythrocyte count. TGF-ß1 levels correlated positively with platelet count, leukocyte, and erythrocyte count, and negatively with bilirubin levels and prothrombin time. Moreover, significant correlations were found: between IL and 18 levels and portal, mesenteric superior, and splenic vein velocity, and between TGF-ß1 levels and splenic vein diameter and spleen size. In a subgroup of patients, IL-18 levels significantly decreased after NSBB. CONCLUSION: The observed imbalance of peripheral IL-18 and TGF-ß1 levels indicates clinically significant PH associated with the presence of esophageal varices in cirrhosis. The correlation of IL-18 levels with liver failure indicators and decrease with NSBB suggest an important role of IL-18 in disease progression and its potential use as noninvasive test for PH assessment.

Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

Endothelin 1 and transforming growth factor-ß1 correlate with liver function and portal pressure in cirrhotic patients.

OBJECTIVE: The invasive measurement of hepatic venous pressure gradient is the recommended method for the assessment of portal hypertension. We assessed if the mediators that regulate portal hypertension may be used as noninvasive markers of portal hypertension and liver insufficiency. MATERIALS AND METHODS: We explored in prospective, observational study the concentration of endothelin-1, nitric oxide, and transforming growth factor-ß1/2 in peripheral and hepatic venous blood; their relationship with the values of portal hypertension and liver insufficiency; and their level changes 4-6 months after non-selective beta-blocker therapy in cirrhotic patients with non-bleeding esophageal varices. RESULTS: (1) Cirrhotics have significantly increased peripheral endothelin 1 and decreased transforming growth factor-ß1 levels; (2) peripheral levels of all factors correlated significantly with their hepatic levels; (3) after therapy, peripheral endothelin-1 levels significantly increased, but transforming growth factor-ß2 levels decreased and were lower in patients with pressure gradient value normalization; (4) before and after therapy, peripheral and hepatic endothelin-1, transforming growth factor-ß1/2 levels correlated significantly with liver failure indicators (laboratory parameters, Child-Pough and MELD scores) and pressure gradient values. CONCLUSIONS: Peripheral endothelin-1 and transforming growth factor-ß1 levels, which strongly correlate with their hepatic levels, reflect the stage of portal hypertension and liver insufficiency in cirrhosis.

Doppler ultrasound detection of preclinical changes in foot arteries in early stage of type 2 diabetes.

BACKGROUND: There are few reports regarding the changes within the vessels in the initial stage of type 2 diabetes. The aim of this study was to estimate the hemodynamic and morphological parameters in foot arteries in type 2 diabetes subjects and to compare these parameters to those obtained in a control group of healthy volunteers. MATERIAL/METHODS: Ultrasound B-mode, color Doppler and pulse wave Doppler imaging of foot arteries was conducted in 37 diabetic patients and 36 non-diabetic subjects to determine their morphological (total vascular diameter and flow lumen diameter) and functional parameters (spectral analysis). RESULTS: In diabetic patients, the overall vascular diameter and wall thickness were statistically significantly larger when compared to the control group in the right dorsalis pedis artery (P=0.01; P=0.001), left dorsalis pedis artery (P=0.007; P=0.006), right posterior tibial artery (P=0.005; P=0.0005), and left posterior tibial artery (P=0.007; P=0.0002). No significant differences were observed in both groups in flow lumen diameters and blood flow parameters (PSV, EDV, PI, RI). In the diabetic group, the level of HbA1c positively correlated with flow resistance index in the right dorsalis pedis artery (r=0.38; P=0.02), right posterior tibial artery (r=0.38; P=0.02) and left posterior tibial artery (r=0.42; P=0.009). The pulsatility index within the dorsalis pedis artery decreased with increased trophic skin changes (r=-0.431, P=0.009). CONCLUSIONS: In the diabetic group, overall artery diameters larger than and flow lumina comparable to the control group suggest vessel wall thickening occurring in the early stage of diabetes. Doppler flow parameters are comparable in both groups. In the diabetic group, the level of HbA1c positively correlated with flow resistance index and negative correlation was observed between the intensity of trophic skin changes and the pulsatility index.

Activity of N-acetyl-ß-D-hexosaminidase in the saliva of children with type 1 diabetes.

BACKGROUND/AIM: Type 1 diabetes is one of the most common chronic diseases in children. The aim of the study was to evaluate the catabolism of glycoconjugates in saliva of children with type 1 diabetes, by measurement of the activity of N-acetyl-ß-D-hexosaminidase (HEX) in their saliva. MATERIAL/METHODS: The study was performed in 65 children with type 1 diabetes and 39 healthy children. Salivary HEX activity was determined spectrophotometrically by the method of Zwierz et al. in the modification of Marciniak et al. Protein was determined by the bicinchoninic acid method (BCATM Assay Protein Kit). Concentration of the HEX activity was expressed in pKat/mL and HEX specific activity in pKat/µg of protein. RESULTS: A significant increase in the concentration and the specific activity of HEX in the saliva of children with type 1 diabetes, compared to healthy children, was found. CONCLUSIONS: Type 1 diabetes increases salivary catabolism of glycoconjugates reflected by the significant increase in the activity of HEX in the saliva of children with type 1 diabetes compared to healthy children. The salivary HEX activity may be used in the diagnosis of children with type 1 diabetes after confirmation of our results on a larger cohort of children with type 1 diabetes.

Elevated levels of soluble glycoprotein V - The plasma marker of platelet activation by thrombin in patients with early stage primary biliary cholangitis (PBC).

PURPOSE: There is a growing body of evidence for a prothrombotic tendency in patients with primary biliary cholangitis (PBC). The aim of the study was to evaluate coagulation disorders in patients with early stage PBC compared to healthy controls and evaluation of their relationship with clinical data, with particular emphasis on minimal hepatic encephalopathy (MHE). PATIENTS AND METHODS: Fifty-one participants (PBC group - 38 patients, all patients but one Child-Pugh A; control group - 13 healthy controls) were included in our prospective, single center study. We assessed the plasma levels of sGPV, plasma procoagulant phospholipids (PPL) and rotational thromboelastometry (ROTEM) profiles in all study participants. Porto-systemic encephalopathy syndrome test was used to assess MHE. RESULTS: The sGPV levels were higher in the PBC group compared to the controls: 36.07 â€‹± â€‹11.32 â€‹ng/mL vs 27.04 â€‹± â€‹11.72 â€‹ng/mL, p â€‹= â€‹0.031. The PPL level was lower in the PBC group compared to controls resulting in increased clotting time in a factor Xa-based coagulation assay: 54.65 (47.83-58.83) sec. vs 45.90 (43.3-50.5) sec., p â€‹= â€‹0.0065. PPL levels were correlated with platelet count (rho â€‹= â€‹-0.46, p â€‹= â€‹0.001). ROTEM parameters did not differ significantly between groups. Coagulation parameters did not differ significantly between patients with and without MHE. CONCLUSIONS: We have showed increased levels of sGPV - a plasma marker of platelet activation by thrombin in patients with early stage PBC compared to healthy controls. We found no relationship between the coagulation disorders and the occurrence of MHE. The PPL level was lower in the PBC group.

The effect of contrast medium SonoVue® on the electric charge density of blood cells.

The effect of contrast medium SonoVue® on the electric charge density of blood cells (erythrocytes and thrombocytes) was measured using a microelectrophoretic method. We examined the effect of adsorbed H⁺ and OH⁻ ions on the surface charge of erythrocytes or thrombocytes. Surface charge density values were determined from electrophoretic mobility measurements of blood cells performed at various pH levels. The interaction between solution ions and the erythrocyte's or thrombocyte's surface was described by a four-component equilibrium model. The agreement between the experimental and theoretical charge variation curves of the erythrocytes and thrombocytes was good at pH 2-9. The deviation observed at a higher pH may be caused by disregarding interactions between the functional groups of blood cells.

Palliative embolization of hemorrhages in extensive head and neck tumors.

BACKGROUND: A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. MATERIAL/METHODS: Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. RESULTS: Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. CONCLUSIONS: We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers.

[Activity of N-acetyl-ß-hexosaminidase and its isoenzymes A and B in cancer]. / Aktywnosc N-acetylo-ß-D-heksozoaminidazy i jej izoenzymów A i B w nowotworach.

There were approximately 93,060 deaths from cancers in Poland in 2008, and about 105,000 are predicted for the year 2025. Early detection of cancer is a major problem throughout the world, which is why many researchers are still looking for specific and sensitive markers of malignant tumors. Our work is a review of recent publications on activity of N-acetyl-ß-D-hexosaminidase (HEX) and its isoenzymes A (HEX A) and B (HEX B) as potential markers of malignant tumors. HEX is the most active of the lysosomal exoglycosidases, taking part in degradation of glycoconjugates (glycoproteins, glycolipids, proteoglycans). HEX cleaves N-acetyl-D-glucosamine and N-acetyl-D-galactosamine from non-reducing ends of oligosaccharide chains of glycoproteins, glycolipids and glycosaminoglycans. The activity of HEX, and its isoenzymes A (HEX A) and B (HEX B), was determined by spectrophotometric and isoelectric focusing methods. There was a statistically significant increase in activity of HEX in tumors of the kidney, pancreas, thyroid, colon, ovary, brain, salivary gland, stomach and larynx, which suggests potential applicability of HEX and its isoenzymes in cancer diagnosis.

Minimal hepatic encephalopathy may be present despite the absence of non-invasive and elastography evidence of cirrhosis in patients with primary biliary cholangitis.

PURPOSE: Minimal hepatic encephalopathy (MHE) is an important complication of chronic liver disease (CLD); however, MHE burden in patients with primary biliary cholangitis (PBC) has not been determined yet. Therefore, our study aimed to assess the prevalence of MHE in a typical cohort of middle-aged, patients with PBC suspicion of liver fibrosis and to investigate the relationship between MHE, basic laboratory tests and the stage of liver fibrosis. PATIENTS AND METHODS: Fifty-one patients (38 with PBC and 13 controls), were prospectively enrolled. Portosystemic Encephalopathy-Syndrome test was used to diagnose MHE. Elastography point qualification (ElastPQ) and non-invasive markers (APRI and FIB-4) were used to assess liver fibrosis. The severity of CLD was assessed using the Model of End-Stage Liver Disease (MELD) and Child-Pugh score. RESULTS: MHE was diagnosed in 9 patients (24.3%) with PBC and none in the control group. As many as 44.4% of the patients with MHE had neither advanced fibrosis nor cirrhosis, as demonstrated using non-invasive markers of liver fibrosis or ElastPQ. The MELD score was the only predictor of MHE with cut-off value 8.5 [AUC â€‹= â€‹0.753, CI95% â€‹= â€‹0.569 to 0.938)] with sensitivity of 56%, specificity of 85% and accuracy of the test of 78%. Non-invasive markers of liver fibrosis and ElastPQ did not predict MHE. CONCLUSIONS: MHE may occur in PBC despite no evidence of advanced liver fibrosis or cirrhosis. The slightly elevated MELD score may indicate a substantially increased risk of MHE in patients with PBC.

Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the determination of cerebral circulatory arrest during brain death/death by neurological criteria diagnosis procedure in paediatric population below 12 years of age.

We would like to invite paediatric intensive care units (PICU) to join our multi-center trial concerning patient population < 12 y/o and aiming at: • validation of computed tomography angiography (CTA)/computed tomography perfusion (CTP) tests for brain death/death by neurological criteria (BD/DNC) diagnosis procedures, • validation of duplex Doppler insonation of extracranial segments of the internal cerebral arteries and the vertebral arteries for choosing an optimal time for CTA/CTP testing.

Contrast-enhanced ultrasonography versus computed tomographic angiography in the monitoring of patients after endovascular repair of abdominal aortic aneurysm -- preliminary experience.

BACKGROUND: Computed tomographic angiography (CTA) is routinely used in the monitoring of patients after endovascular repair of abdominal aortic aneurysm. The aim of the study was to determine if contrast-enhanced ultrasonography (CEUS) provides equivalent results to CTA in detection of endo-leaks in patients after abdominal aortic stentgraft placement. MATERIAL AND METHODS: In a group of 7 patients (6 men and 1 woman; aged 71+/-7 years) after repair procedure, 16 CTA and 16 CEUS follow-up examinations were performed. Second-generation contrast agent (Sonovue) and low-mechanical index technique were used for ultrasonography imaging. RESULTS: Computed tomographic angiography showed seven cases of type I, five cases of type II, and no endo-leaks in four examinations. In 15 out of 16 studies, the results of CEUS were consistent with the results of CTA. In one discrepant study, type II endo-leak was detected with CEUS while CTA was negative. CONCLUSIONS: Contrast-enhanced ultrasonography and CTA examinations in patients after endovascular repair of abdominal aortic aneurysm provide comparable results. CEUS may be considered an alternative technique to CTA.

Genetic identification of a gunshot victim four years posthumously.

The paper presents a personal identification case of an unrecognized corpse, presumably belonging to a male missing for four years. The cadaver was buried in a ground ditch and covered with slaked lime and soil. During the investigation the burial place was indicated. The corpse was exhumed and afterwards transferred to the Department of Forensic Medicine, Medical University of Bialystok. External examination and autopsy findings demonstrated adipocere formation and putrefaction, as well as two gunshot wounds in the thorax and the head assumed to be the cause of death. Personal identification procedure included skeletal and dental examination. As a source material for genetic typing, the femur, brain, lung, kidney and spleen samples were collected. DNA templates were extracted by a modified organic procedure and genotyped with the use of AmpFISTR Identifiler Amplification Kit and PowerPlex Y System in an ABI 310 Genetic Analyzer (Applied Biosystems). All the soft tissue samples yielded sufficient quantity and quality of DNA to perform genetic profiling.

Detectability of SGM Plus profiles in heart and lungs tissue samples incubated in different environments.

The aim of the study was assessment of environmental effect on typeability of AmpFlSTR SGM Plus loci: D3S1358, VWA, D16S539, D2S1338, D81179, D21S11, D18S51, D19S433, TH01, FGA and gender marker amelogenin. Heart and lungs specimens collected during autopsies of five persons aged 20-30 years were incubated at 21 degrees C and 4 degrees C in different environmental conditions, fresh different water and soil conditions. DNA was extracted by organic method from tissue samples collected in 7-day intervals and subsequently typed using AmpFlSTR SGM Plus kit and ABI 310. Incubation at 21 degrees C and prevented air access, as well as in peat soil and in sand favoured faster DNA degradation reflected by decrease in typeability rate. In samples with negative genotyping results no DNA was found by fluorometric quantitation. Decomposed soft tissues are potential material for DNA typing.

[Pathologies of the cervical spine anatomy as a possible cause of young patients vertigo]. / Nieprawidlowosci odcinka szyjnego kregoslupa jako mozliwa przyczyna zawrotów glowy u mlodych osób.

Vertigo occurs in many diseases, especially in older people. It is a specific diagnostic problem in young people. In the paper, 86 young patients with incidental vertigo were clinically assessed. Electronystagmography, eye-tracking pattern test, optokinetic test and cervical spine X rays were used in examination. The results were compared with the control group of young and healthy people and also with the older patients group with degenerative changes of the cervical spine. In the examined group the disturbances of physiologic cervical lordosis were found in 33.8% and positional nystagmus in 23%. The vestibular tests and hearing were frequently normal. These results suggest that disturbances of physiologic cervical lordosis may be the cause of balance disturbances.

The role of magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) in the diagnosis and assessment of resectability of pancreatic tumors.

BACKGROUND: Carcinoma of the pancreas is one of the most malignant tumors. Symptoms are usually nonspecific and insidious, such that the cancer is advanced by the time of diagnosis. The aim of the study was to assess the usefulness of MRI and MRCP in the diagnosis of patients suspected of pancreatic carcinoma and to define the role of these methods in the evaluation of resectability of pancreatic cancer in comparison with surgical findings. MATERIAL/METHODS: Forty-seven patients (32 men and 15 women) aged 46-81 had undergone MRI and MRCP examination of the upper abdomen on a 1.5 T system with a standard flexible surface coil. The results of those tests were compared with surgical and histopathological findings. The capacity of MR and MRCP to detect pathological mass, assess the nature of the disease process, and accurately assess the resectability of the malignant lesion were evaluated. In the statistical analysis the chi-squared and Fisher's precise tests were performed. RESULTS: Statistical analysis showed 87% sensitivity, 97% specificity, and 95% accuracy of MRI and MRCP in the evaluation of the nature of tumors within the pancreas and 100% sensitivity, 90% specificity, and 93% accuracy in determining the resectability of the lesion. The positive predictive value came to 83%, while the negative predictive value was 100%. The kappa compatibility index in comparison with surgical findings was 0.85714. CONCLUSIONS: MR and MRCP is an important diagnostic method in assessing pancreatic tumors. It is very useful in differential diagnosis and determination of tumor resectability.

Contrast-enhanced ultrasonography in diagnosing liver metastases.

BACKGROUND: Dual-phase spiral computed tomography (CT) is still the primary imaging technique in the diagnosis of focal liver lesions. Contrast-enhanced ultrasonography (CEUS) is the most sensitive sonographic technique. The purpose of this study was to investigate the efficacy of CEUS in detecting liver metastases compared with CT as the standard of reference. MATERIAL/METHODS: The examined group consisted of 51 patients (24 men and 27 women, age range: 27-84 years, mean: 57.4 years) suspected of liver metastases. The routine diagnostic approach consisted of B-mode US, CEUS, and CT. Final diagnosis was made at cytologic (n=18) or histologic examination (n=14) and in 9 patients by combining information from CT scans, medical history, and clinical and biochemical investigations. RESULTS: Liver cysts and abscesses were detected in 10 patients. They were excluded from the further analyses. In the remaining 41 patients a total of 134 metastases were detected. In 15 patients with metastases, US images of the liver appeared normal. CEUS detected metastases in 36 patients. The sensitivities of the methods per patient were US 63.4% and CEUS 90.2%. Sensitivities of the methods per lesion were US 60.9%, CT 77.6%, and CEUS 90.2%. Application of contrast media (SonoVue) significantly increased diagnosing of liver metastases compared with standard sonography and CT. CONCLUSIONS: CEUS increased diagnostic confidence in the detection and characterization of hepatic metastases compared with standard sonography. Real-time contrast-enhanced sonography is particularly advantageous in detecting small metastases.

Typeability of AmpFlSTR SGM Plus loci in brain and thyroid gland tissue samples incubated in different environments.

Autolysis and putrefaction are crucial factors responsible for degradation of cells, tissues, and organs. Postmortem changes may assume different course depending on extrinsic and intrinsic conditions. The aim of the study was assessment of environmental effect on typeability of AmpFlSTR SGM Plus loci: D3S1358, VWA, D16S539, D2S1338, D81179, D21S11, D18S51, D19S433, TH01, FGA, and gender marker amelogenin. Brain and thyroid gland tissue specimens collected during autopsies of five persons aged 20-30 years were incubated at 21 degrees C and 4 degrees C in different environmental conditions. DNA was extracted by organic method from tissue samples collected in 7-day intervals and subsequently typed using AmpFlSTR SGM Plus kit and ABI 310. A fast decrease in typeability rate was seen in specimens incubated in peat soil and in sand. Brain tissue samples were typeable in all AmpFlSTR SGM Plus loci within 126 days of incubation at 4 degrees C. Faster DNA degradation was recorded in thyroid gland specimens. In samples with negative genotyping results, no DNA was found by fluorometric quantitiation.

[Spinal cord injuries -- opinions represented by neurologists]. / Urazy kregoslupa z uszkodzeniem rdzenia kregowego -- poglady reprezentowane przez neurologów.

Neurologists distinguish two mechanisms of spinal cord injury (SCI): a closed injury and a penetrating injury. A mechanical damage to the spinal cord, particularly to its central segment, results in a secondary injury to the nervous tissue (such as ischemia and spinal cord edema). A neurological examination following SCI is primarily aimed at the injury assessment and evaluation on rating scales. The extent of injury is defined by the American Spinal Injury Association (ASIA) Impairment Scale (modified from the Frankel classification). Neurologists distinguish several characteristic syndromes of partial SCI: the Brown-Sequard syndrome, central cord syndrome, anterior spinal artery syndrome, posterior spinal cord contusion and spinal cord concussion. The incidence of SCI is estimated at 25-35 persons per 1 million population, including 80-85% males. Sixty one percent of the injured parties are between the ages of 16 and 30 years. Nearly one half of SCI cases results from traffic accidents. The most frequently affected segments include the cervical spinal cord (C1-C8) level and the thoracolumbar (ThL) spinal cord.