La myélopathie cervicale est une maladie chronique dégénérative de la moelle épinière dont la fréquence augmente avec l’âge. Elle est caractérisée par une compression mécanique menant à un endommagement de la structure médullaire et peut être source de handicaps sévères dégradant la qualité de vie. Néanmoins, la prise en charge clinique reste délicate.C’est pourquoi les travaux conduits dans le cadre de cette thèse se sont focalisés sur la compréhension des phénomènes biomécaniques à l’origine de cet endommagement (via des méthodes de simulation par éléments finis) et les conséquences microstructurelles pouvant être observées par IRM multi-paramétrique. Plus précisément, le but était d’établir un lien entre la cause mécanique et les conséquences structurelles menant aux déficits cliniques afin de mieux comprendre et prédire l’évolution de ces pathologies.Pour atteindre cela, une caractérisation de la morphologie et microstructure de la moelle épinière saine a été conduite par IRM, procurant à la fois une source de données normatives pour évaluer les atteintes chez patients mais aussi des données d’entrée pour raffiner les modèles numériques utilisés. D’un point de vue biomécanique, les phénomènes mécaniques observés lors d’une compression médullaire telle que pouvant être rencontrée dans une myélopathie cervicale ont été étudiés. Bien qu’à confirmer, les résultats obtenus au cours de ces travaux sont encourageants et posent une première pierre vers l’établissement de nouvelles méthodes permettant de mieux comprendre l’origine des déficits observés chez des patients souffrant de lésions médullaires en étudiant le lien entre mécanique, microstructure et fonction. / Cervical myelopathy is a chronic degenerative spinal cord pathology whose incidence increases with age. It is characterized by a mechanical compression leading to structural spinal cord damage. It can be at the origin of severe handicap hampering the quality of life. However, the clinical management remains challenging.This is why the work conducted in this thesis was focused on the comprehension of the biomechanics of the spinal cord damage (through numerical simulation finite element methods) and microstructural consequences that can be observed with multi-parametric MR imaging. More specifically, the final goal was to link the mechanical cause to the structural consequences at the origin of the clinical deficits in order to better understand and predict the pathology’s evolution.To reach that end, a characterization of the morphology and microstructure of the spinal cord was achieved using MRI, procuring on one side a normative database useful to study the alterations encountered in patients, and on another side to refine the numerical models employed. From a biomechanical perspective, the mechanisms of spinal cord compression as encountered in cervical myelopathy were studied using finite element analysis. The results obtained, which should be confirmed, are encouraging and represent a first stone towards the establishment of new methods in order to help in the clinical management of patients with spinal cord lesions by linking the mechanics, microstructure and function of the spinal cord.

O tratamento cirúrgico das neoplasias espinais intradurais primárias está indicado para conseguir ressecação completa, diminuir morbidade e aumentar a sobrevida livre de doença, em busca da cura. Há dúvidas sobre as consequências do tratamento cirúrgico influenciando a qualidade de vida. Entretanto, até o momento, não foram encontrados dados disponíveis na literatura especializada sobre a qualidade de vida dos pacientes que foram submetidos à cirurgia. Os objetivos foram avaliar a qualidade de vida e testar as propriedades psicométricas dos instrumentos utilizados, verificando a consistência interna e a confiabilidade. O estudo foi realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 2009 a 2011, com aplicação do questionário genérico The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), e das escalas específicas de McCormick e de Aminoff-Logue para a avaliação da qualidade de vida sob o ponto de vista funcional. Todos os pacientes incluídos foram avaliados uma única vez e encontravam-se no período de, no mínimo, seis meses após a data da cirurgia. O banco de dados resultante foi analisado no Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo. A série de casos constou de 148 pacientes, dos quais 48 foram excluídos por não completarem o protocolo. Dentre os 100 casos estudados, 55 eram do sexo feminino, com média de idade de 42,3 anos e tempo de acompanhamento pós-operatório de 20 meses. A pontuação global da qualidade de vida pelo SF-36 foi de 50,5, com resultado geral do componente físico de 46,8. A consistência interna foi demonstrada segundo a validade de construto e de critério, confirmando a hipótese da relação existente entre as pontuações do SF-36 e a escala de McCormick (p = 0,003), as escalas de Aminoff-Logue componente de marcha (p = 0,025), vesical (p = 0,013) e intestinal (p = 0,004). A confiabilidade foi demonstrada em todos os oito domínios do SF-36, alcançando em cada um o alpha Cronbach, satisfazendo o critério de Nunnally > 0,85. Estes resultados sugerem associação consistente entre a qualidade de vida e as funções medulares nesta série de casos, caracterizando melhor a percepção de saúde dos pacientes submetidos ao tratamento cirúrgico. O avanço do conhecimento aplicado à prática neurocirúrgica focada no paciente aponta para a necessidade de avaliação longitudinal da qualidade de vida para auxílio no planejamento terapêutico destas doenças. A qualidade de vida pode ser avaliada pelo questionário SF36, que se correlaciona bem com as escalas específicas de McCormick e Aminoff-Logue / The surgical treatment of intradural primary spinal tumors is indicated to obtain total ressection, decrease morbidity rate and increase survival rate, aiming at the cure. There are doubts about the consequences of surgical treatment influencing the quality of life. However, until now there have been no available data in specialized literature on the quality of life of patients who have undergone this surgery. The objectives of this study were to evaluate the patient´s quality of life and to test the psychometric properties of the instruments used, verifying consistency and reliability. The study was carried out at the Clinics Hospital of the University of São Paulo Medical School, between 2009 and 2011, by means of The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) generic questionnaire and the McCormick and the Aminoff-Logue specific scales to assess the patient´s quality of life from the functional perspective. All patients included in the study were assessed only once, at least six months postoperatively. The resulting data were analyzed at the Department of Preventive Medicine of the University of São Paulo Medical School. The series of cases comprised 148 patients; 48 patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients. Fifty-five patients were women, the mean age was 42,3 years and the mean postoperative follow-up period was 20 months. The quality of life total score on the SF-36 was 50,5, and the Physical Component Summary (PCS) score was 46,8. Based upon construct validity and criterion, the internal consistency was demonstrated, confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the AminoffLogue defecation subscale (p = 0.004). Reliability was demonstrated for all eight SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0,85. These results suggest a consistent relationship between the quality of life and the spinal cord functions in this series of cases, better characterizing the evaluation of the health of the patients who underwent surgical treatment. The advancement of knowledge applied to neurosurgery practice with a patient-focused approach shows the necessity of a longitudinal evaluation of the quality of life to help tailor a treatment plan for these diseases. The quality of life can be analyzed by the SF-36 questionnaire, which is well correlated with the McCormick and the Aminoff-Logue specific scales

Introdução: Várias são as propostas descritas para tratar farmacologicamente a lesão traumática da medula espinal. A metilprednisolona já foi padronizada para uso clínico. O fator estimulador de colônia de granulócitos (G-CSF) tem sido promissor em estudos experimentais e clínicos. Não há pesquisas quanto ao efeito da associação dos dois fármacos. Objetivo: Avaliar o efeito do tratamento com o fator estimulador de colônia de granulócitos associado a metilprednisolona na lesão medular aguda experimental em ratos. Material e métodos: Foram avaliados 40 ratos Wistar submetidos a lesão medular moderada com o NYU-Impactor. Os animais foram divididos em quatro grupos de 10 ratos. O Grupo Controle não recebeu tratamento; o Grupo G-CSF, foi tratado com G-CSF no momento da lesão e diariamente ao longo dos cinco dias subsequentes; o Grupo Metilprednisolona, com metilprednisolona durante 24 horas; e o Grupo G-CSF/Metilprednisolona, com metilprednisolona durante 24 horas e G-CSF no momento da lesão e ao longo de cinco dias. Os animais foram mantidos vivos durante 42 dias; a avaliação funcional foi realizada com a aplicação da escala funcional de Basso, Beattie e Bresnahan (BBB) nos dias 2, 7, 14, 21, 28, 35 e 42 subsequentes à lesão. A avaliação dos potenciais evocados motores foi realizada no dia 42 e a avaliação histológica da lesão da região da medula espinal lesada, realizada logo após a eutanásia ocorrida no dia 42. Resultados e conclusões: A associação de metilprednisolona e G-CSF no tratamento do traumatismo medular contuso experimental em ratos promoveu melhora neurológica avaliada pela escala BBB superior à melhora promovida pela metilprednisolona e G-CSF quando utilizadas isoladamente. A associação teve também efeito sinérgico que resultou em melhora nos parâmetros histológicos no local da lesão. Não houve diferença entre os grupos quanto à avaliação neurofisiológica / Introduction: There are several proposals to pharmacologically treat traumatic spinal cord injury. Methylprednisolone has already been standardized for clinical use. Granulocyte colony stimulating factor (G-CSF) has been promising in experimental and clinical studies. There is no research on the effect of the association of the two drugs. Objective: to evaluate the effect of combined treatment of the granulocyte colony-stimulating factor (G-CSF) associated with methylprednisolone in experimental acute spinal cord injury in rats. Material and methods: Forty male Wistar rats were submitted to a moderate spinal cord injury with the NYU-Impactor. The animals were divided into four groups of ten rats each. The Control Group was not treated; the G-CSF Group was treated with G-CSF at the time of injury and daily over the next five days; the Methylprednisolone Group was treated with methylprednisolone for 24 hours; the G-CSF/methylprednisolone Group, was treated with methylprednisolone for 24 hours and G-CSF at the time of injury and daily over the next five days. The animals were kept alive for 42 days; Functional evaluation was performed using the Basso, Beattie and Bresnahan (BBB) score on days 2, 7, 14, 21, 28, 35 and 42 following the spinal cord injury. Evaluation of motor evoked potentials was held and histological examination of the lesion of the spinal cord was done immediately after euthanasia on day 42. Results and conclusions: The combination of methylprednisolone and G-CSF in the treatment of experimental spinal cord injury in rats promoted neurological improvement as assessed by BBB scale with greater improvement than with methylprednisolone or G-CSF when used alone. The combination of treatment had also a synergistic effect resulting in improvement in histological parameters at the injury site. There was no difference between groups regarding neurophysiological evaluation

A utilização das células progenitoras hematopoéticas (CPH) obtidas do sangue de cordão umbilical e placentário (SCUP) apresenta vários benefícios para o transplante de CPH em comparação às células provenientes de outras fontes. Dentre eles, a maior disponibilidade e a maior imaturidade imunológica das CPH, o que permite certa flexibilidade nos critérios de compatibilidade entre doador e receptor e uma menor taxa de reação do enxerto-versus-hospedeiro. A legislação brasileira e órgãos internacionais exigem a realização de vários testes para garantir a qualidade do produto hemoterápico contendo CPH a ser transplantado. O objetivo deste estudo foi confirmar que o teste para quantificação de CPH com elevada atividade da enzima ALDH1(ALDHbr) pode ser considerado um teste de adequado ou seja, é capaz de predizer quais produtos tem melhor capacidade de repopular a medula óssea do recipiente após o transplante. Para isso, foram utilizadas 40 unidades de SCUP coletadas e processadas pelo Banco de Sangue de Cordão Umbilical e Placentário do Cetebio / Fundação Hemominas. As unidades foram processadas por método automatizado e amostras do creme leucocitário (buffy coat) foram coletadas para a realização da quantificação de células ALDHbr, quantificação de células CD34+, ensaio clonogênico (CFU), hemograma e cálculo do total de células nucleadas (TCN). A citometria de fluxo foi utilizada para a quantificação das CPH ALDHbr e CD34+ e das subpopulações CD45dim e CD38+. Outras informações como idade materna, idade gestacional e sexo do recém-nascido também foram coletadas para descrição das unidades. Para verificar a viabilidade da utilização do teste de ALDH pelos BSCUP foi realizado o levantamento do seu custo. A capacidade funcional das CPH em proliferar e se diferenciar em tecido hematopoético foi avaliada por meio do ensaio clonogênico. Detectou-se correlação entre a quantidade de células ALDHbr e o número de colônias no ensaio clonogênico (p<0,001), entre o número de células ALDHbr e de células CD34+ (p=0,001) e entre o número de colônias no ensaio clonogênico e o número de células CD34+ (p<0,001). A imunofenotipagem mostrou que 46,25% das células ALDHbr eram CD45dimCD38+CD34+. Os dados sugerem que a quantificação de células ALDHbr em unidades de SCUP pode ser considerada teste adequado, de baixo custo, de execução simples, rápida e menos dependente do operador em relação ao ensaio clonogênico. / The use of the umbilical cord blood cells presents numberless benefits when compared to the cells from different sources. Among them, the ease of availability, the bigger immunological immaturity, which allows some flexibility in the compatibility between donor and receptor and less induction of reaction of graft-versus-host. The Brazilian legislation and international organizations demand the practice of various tests to guarantee the quality of the product to be transplanted. The aim of this research was to confirm that the test used to quantify ALDHbr cells can be considered a power test, meaning that it tests the ability to repopulate the bone marrow after transplant. For this study, it has been used 40 units of SCUP collected and processed by the Cetebio Umbilical Cord Blood Bank - Fundação Hemominas. The units were processed by the automatized method and the samples of the final product (buffy coat) were collected for the quantification of ALDHbr cells, quantification of CD34+ cells, clonogenic essay (CFU), hemogram and the total number of nucleated cells (TNC). It was used the flow cytometry to perform ALDH and CD34+ tests. Besides that, it was also performed the association of antibodies anti-CD34, anti-CD45 and anti-CD38 for the immunophenotyping of the units. Other information such as maternal age, fertilization age and the newborn gender were also collected for description of the units. In order to verify the viability of the use of the ALDH test by BSCUP its costs were calculated, as well as of the clonogenic essay. The results showed a significant correlation between ALDHbr cells and the clonogenic essay (p<0.001), between ALDHbr and CD34+ cells (p=0,001) and between the clonogenic essay and the quantification of CD34+ cells (p<0,001). The immunophenotyping revealed that 46,25% of ALDHbr cells were CD45dimCD38+CD34+. The data indicated that the quantification of ALDHbr cells in the SCUP units can be considered a powerful and low cost procedure, of easier and quicker execution and less operator dependent.

Forty spinal cord injury (SCI) patients were studied in order to determine the effects of an attribution based therapeutic recreation program on their perception of freedom in leisure. Perception of freedom in leisure of SCI patients was measured by a seventy-two item scale. This scale was translated into Spanish, adapted, revised, validated, and tested for reliability. The reliability of the Spanish Version of the scale was very similar to the English Version of the scale.

Background: In Nigeria, there is an escalating incidence of hypertension, its complications and other cardiovascular risks, likely to have their origins in early life. Malaria is still hyperendemic, with pregnant women at increased risk, with associated consequences of maternal anemia and high rates of delivering low birth-weight babies. Aims and Hypothesis: In this study, we have tested the hypothesis that malaria in pregnancy will not only enhance the risk of small birth size and poor infant growth, but will also generate higher blood pressures in infancy and beyond. We also tested the hypothesis that metabolic markers in pregnant mothers affected by malaria would relate to infant birth size. Thus the aims of this project were: 1) to define relationships between the type of malaria exposure and birth size, 2) to characterize the association between maternal and cord metabolic biomarkers and birth size on the background of prenatal malaria exposure and 3) to examine the effect prenatal malaria exposure on first year growth and whether higher blood pressure (BP) is generated. Methods: Healthy pregnant women were recruited and followed at Adeoyo Maternity Hospital, Ibadan. Anthropometric, BP, and biomarkers (lipids, glucose, insulin and TNFα) measurements were obtained in the mothers at booking. Birth size and growth at 3 and 12 months along with biomarkers (as above) and IGF-I measures in cord blood were assessed in the infants. Blood films for malaria parasites were taken throughout pregnancy including delivery and in all babies. Women were grouped to distinguish between the timing of malaria parasitaemia (either during pregnancy only or during pregnancy and at delivery) and the severity of malaria infection (low vs high parasite load). At birth, 436 mother-baby pairs were measured. 467 maternal samples were obtained for metabolic profile and 187 cord blood samples. 318 babies were all followed from birth to 3 and 12 months. Results: Malaria parasitaemia was found in 48% of the women, associated with younger maternal age, being primigravid and a lower haematocrit. Babies of mothers with high parasitaemia through pregnancy had the smallest birth growth parameters compared with those without malaria (weight, length, and head circumference were smaller by 300g, 1.1cm and 0.7cm respectively, all p≤0.005) but their systolic BP (SBP) and diastolic BP (DBP) adjusted for weight were higher than those with low parasitaemia by 1.7 and 1.4 mmHg/kg respectively. SBPs were lowest in babies of mothers with malaria at delivery implying an acute effect on the babies’ circulation. Mothers with malaria had significantly lower lipids (except triglycerides) but higher TNFa, effect not seen in cord blood. Cord IGF-I was significantly lower in babies whose mothers had malaria. Significant determinants of birth size were maternal total cholesterol, LDL- cholesterol, insulin, malarial status and cord insulin and IGF-I. Babies exposed to maternal malaria remained smaller at 1 year, most marked in boys, whose SBP adjusted for weight at 3 and 12 months was higher than those not exposed. Change in SBP over the first year was greater in boys than girls while the change in girls was greater in those exposed to maternal malaria than those not exposed (18.7 vs 12.7 mmHg, 95% CI 1-11, p=0.02). 11% of boys ( > twice expected) had BP >95th percentile (hypertensive, US criteria) of whom 68% had maternal malaria exposure. Gender, maternal malaria exposure and weight change were all independently associated with increased change in BP to 1 year. Conclusion: Intrauterine exposure to malaria appears not only to have an important impact on birth size but also gender-dependent effects on growth and changes in infant BP. These findings have potential implications for cardiovascular health in sub-Saharan Africa and may contribute to the global burden of hypertension.

Este trabalho avaliou a incidência de pacientes com lesão traumática da coluna cervical causada por mergulho em águas rasas, que foram atendidos nos Hospitais da cidade de Ribeirão Preto-SP, entre janeiro de 1989 a dezembro de 1996. O estudo epidemiológico foi realizado mediante investigação feita nos prontuários médicos desses pacientes. Complementou-se as informações por meio de uma entrevista realizada com 12 deles. Com base nos números apresentados, elaborou-se um programa de prevenção decorrente desses traumatismos a implantou-se uma Campanha de prevenção das lesões cervicais por mergulho em águas rasas em Ribeirão Preto. Um Programa de Campanha foi encaminhado à Assembléia Legislativa do Estado e transformado em Projeto de Lei. Os resultados mostraram que, dos 355 casos estudados, 69 deles foram por acidentes em águas rasas, a dentre estes, 58% tiveram danos neurológicos. Os locais mais freqüentes dos acidentes foram rios, córregos, lagos, cachoeiras,com a ocorrência de 75,4% dos casos, enquanto que a incidência em piscinas foi de 24,6%. A média de idade variou entre 10 a 30 anos, havendo diferença significativa com outras faixas etárias. Quanto ao sexo, 92,8% ocorreram em homens a 7,2% com mulheres. Em relação ao estado civil, 68,2% eram solteiros e 31,9% eram casados. O período do ano em que houve um número mais elevado dos traumatismos da coluna cervical causado pelo mergulho nas chamadas águas rasas foi nos meses de estações mais quentes na região (primavera, verão a outono). Dos 17,4% dos pacientes entrevistados de um total de 40 que tiveram lesão medular, todos mostraram desconhecimento desse tipo de acidente, bem como suas conseqüências. A Campanha de prevenção teve início em setembro de 1996 e está em fase de desenvolvimento em Ribeirão Preto. O Projeto de Lei estadual nº 183 aguarda aprovação da Assembléia. Conclui-se que, a incidência de acidentes com lesão traumática da coluna cervical por mergulho em águas rasas é elevada, sendo a terceira causa de danos traumáticos. A desinformação da população no que diz respeito ao perigo de um mergulho em águas rasas é elevado. A redução deste tipo de acidente pode acontecera partir de um processo educacional da população a da atuação decisiva do poder público. / This study is an evaluation of the incidence of patients treated in the hospitals in Ribeirão Preto - SP for traumatic injury of the cervical cord caused by diving in shallow waters. The epidemiological study was held by means of an investigation of the medical charts of patients who underwent treatment from January 1989 to December 1996. The information on the charts was complemented through interviews held with 12 of these patients. Based on the results of these investigations, a campaign to prevent cervical injury caused by diving into shallow waters was elaborated and sent to the State Legislature, where it was transformed into a bill. The study revealed that in the 355 cases of cervical injury investigated, 69 were the result of accidents in shallow waters, and of these, 58% suffered neurological dysfunction. Rivers, lakes and waterfalls were most frequently cited as locations for the occurrence of these injuries (75,4% of the cases), with the incidence of accidents in swimming pools at 24,6%. The average age of patients varied between 10 to 30 years of age, with a significant difference in other age groups. In relation to sex, 92,8% of the accidents occurred in men, and only 7,2% in women. As to marital status, 68,2% were single and only 31,9% were married. The greatest number of cases of trauma of the cervical cord caused by diving in shallow waters occurred in the warmer seasons of the year (spring summer and fall). 17,4% of the patients interviewed out of a total of 40 with medullar injury, claimed not to know about this kind of accident and its consequences. The Prevention Campaign began in September 1996 and is presently being carried out in the city of Ribeirão Preto. The Bill of Law no. 183 awaits approval from the State Legislature. One may conclude that the incidence of traumatic injury of the cervical cord due to diving in shallow waters is high (third place as the cause of injury). The lack of information on the part of the population regarding the dangers of this type of accident may be one of the reasons behind these high statistics. The reduction of this type of accident may occur as the result of an educational process involving the population as well as decisive action on the part of the government.

This project was undertaken with the following aims: 1) To generate a data base concerning the management of children with congenital spinal anomalies, who are known to form a significant proportion of the patients being treated in the Department of Paediatric Urology at Red Cross Hospital. 2) To assess the results of the management of these children, with special attention to the goals of therapy, namely preservation of renal function, establishment of urinary continence and protection from urinary tract infection. 3) To compare the treatment methods and results obtained to those reported in the literature. 4) To evaluate critically the treatment methods and results obtained with a view to identifying areas where improvements are possible.

Wheelchair-bound paraplegics are in an unnatural, almost all-day sitting position. This is physiologically disadvantageous as it may cause increased abdominal pressure, renal dysfunction, pressure sores, muscle atrophy and osteoporosis. Thus it would be beneficial, physiologically and psychologically, for a paraplegic to be able to stand for temporary periods of time. As a result of the muscle atrophy and functional degeneration that follows a spinal cord injury, it is essential for paraplegics to undergo a muscle restrengthening program, using Functional Neuromuscular Stimulation (FNS), before standing up under FNS control can be attempted. Six healthy spinal cord injured subjects with spinal lesions between CS and T9 (two tetraplegics and four paraplegics) exercised their quadriceps muscles at home using a portable two-channel FNS muscle stimulator. The muscles were exercised against an increasing load to maximise the training effect. Inclined standing exercise, under FNS control, was performed in the Inclistand. The subjects' general state of health and fitness were assessed, namely their responses during a maximal arm ergometry exercise test, arm muscle function, lung function, blood biochemistry and their dietary habits. Subjects have shown improvement in quadriceps muscle strength, fatigue resistance and muscle bulk to varying degrees - according to their individual circumstances. The tetraplegics responded in a different manner to that of the paraplegics. The muscle strength increased significantly by a mean (+SD) of 97,8 + 59,6% and 171,2 + 118,1% for the four paraplegics, left and right leg respectively. There was a mean improvement of 16% in fatigue resistance in the left leg (p=0,08), while the mean response of the right leg varied. Quadriceps muscle bulk increased by 4,43 + 3,4% (left) and 2,7 + 2,1% (right) (0,05&lt;p&lt;0,l). The amount of subcutaneous fat around the mid-thigh decreased significantly by 4,73 + 1,4% (left) and 3,43 + 1,1% (right leg). The group was in a state of general well-being, with the exception of one subject whose serum cholesterol concentration fell within the high risk category. This study therefore showed that the FNS was sucessful in improving the quadriceps muscle strength, bulk and fatigue response of the SCI people in our research group. The valuable experience gained from this FNS study will be used to improve the present program.

Ten caucasian male quadriplegics were compared with eight sedentary caucasian male controls in regards to left ventricular dimensions and mass obtained from echocardiograrns. The interventricular septum (IVS), left ventricular posterior wall (LVPW) and left ventricular internal diameter (LVII) were within normal limits for both groups. However, the INS in the SCI were significantly thicker than controls (p <0.05). Myocardial thickness was larger in SCI subjects (p <0.05). Absolute left ventricular mass (LVM) and total left ventricular volume was not different ( p > 0.05), but SCI subjects had significantly greater LVM to lean body mass ratios. Echocardiographically, SCI patients demonstrate concentric hypertrophy. This suggests adaptive response to chronic increase in afterload pressure secondary to their daily activities and muscle spasticity.