New estimates of the direct costs of traumatic spinal cord injuries (SCI) are obtained from a comprehensive survey of the US SCI population. These direct costs, defined as the value (in 1988 dollars) of resources used specifically to treat or to adapt to the SCI condition, represent the average experience of the US SCI population. Responses to a detailed questionnaire administered to a sample of traumatic SCI persons in the United States provide the primary source of data for this study. Analysis of this survey data indicates that more recently injured SCI persons (ie those injured since 1970) spent an average of 171 days in a hospital over the first 2 years post injury. Initial hospital expenses will average $95,203. Home modification costs in excess of $8,000 can also be expected. After recovery and rehabilitation, a SCI person will pay, on average, $2,958 per year in hospital expenses and $4,908 per year for other medical services, supplies and adaptive equipment. Personal assistance costs and costs of institu tional care will average $6,269 per year. These cost estimates represent the incremental costs of SCI, ie they exclude any costs that would have been incurred in the absence of SCI.

New estimates of traumatic spinal cord injury (SCI) prevalence are developed from a survey specifically designed to identify the SCI population in both institutional and non institutional settings. The survey utilised a mixed-mode sampling design based on probability sampling methods. Detailed interviews were conducted with SCI persons identifted in this survey. We estimate that the traumatic SCI prevalence rate in the United States is 721 cases per million, and that there are about 177 000 SCI persons residing in the United States. This approach represents a significant departure from the methodologies used

Summary Seven cases illustrating the syndrome of mucoid impaction of bronchi are described. The syndrome seems to be confined to asthmatics. It may be clinically silent for long periods, or it may lead to bronchiectasis, pulmonary infection and hæmoptysis. Radiologically it may show both peripheral and hilar components. Diagnostically it may be confused with pulmonary tuberculosis, neoplasm or Loeffler's syndrome. Treatment is primarily medical. Adrenal corticoids may aggravate infection and are contraindicated. Surgical resection may be necessary to remove areas of destroyed lung or when a differentiation from bronchial carcinoma is impossible on clinical grounds. Lobectomy was performed in two cases only in this series, and the examination of operation specimens showed bronchi occluded by eosinophilic mucous material. There was inflammation with disorganization of the bronchial walls, and the alveoli showed collapse and lipoid pneumonia. It is considered that the syndrome described represents a more benign and localized variant of the widespread mucus obstruction of small bronchi found in fatal cases of status asthmaticus, and that both have their basis in a quantitative or qualitative disorder of bronchial mucus secretion in asthmatics. This disorder may be present even when clinical asthma is temporarily absent.