We studied four families each with three trisomy 21 conceptions. In two of the families the trisomy 21 conceptions all occurred when the mothers were under 35 years of age and in the other two families they all occurred when the mothers were over 35 years of age. Cytogenetic studies showed low level mosaic trisomy 21 in the two younger mothers, but not in the two older. In the three families tested using molecular techniques the results were consistent with the additional chromosome 21 in the trisomic conceptuses being maternally derived. Novel alleles were detected in the trisomic offspring of one of the younger mothers, demonstrating that the mother had been conceived as a trisomy with three different chromosomes 21. Therefore the multiple trisomy 21 pregnancies in the two younger mothers resulted from maternal trisomy 21 mosaicism, but may have been due to chance in the older mothers.

Down Syndrome↗

PubMedDate not supplied

Earthquake epidemiology: the 1994 Los Angeles Earthquake emergency department experience at a community hospital.

INTRODUCTION: To assess the volume of patients and the composition of their injuries and illnesses that presented to an emergency department (ED) close to the epicenter of an earthquake that occurred in a seismically prepared area. METHODS: A retrospective analysis of data abstracted from charts and ED logs for patient census and types of injuries and illnesses of the patients who presented in the ED of a community hospital before and after the earthquake (6.8 Richter scale) that occurred in 1994 in Los Angeles. Illnesses were classified as trauma- and non-trauma related. Data were compared with epidemiological profiles of earthquakes in seismically prepared and unprepared areas. RESULTS: A statistically significant increase in ED patient census over baseline lasted 11 days. There was a large increase in the number of traumatic injuries such as lacerations and orthopedic injuries during the first 48 hours. Beginning on the third day after the event, primary care conditions predominated. When the effects of the LA quake were compared with those of similar Richter magnitude and disruptive capability, the ED epidemiology profile was similar to those in seismically unprepared areas, except for the total number of casualties. CONCLUSION: The majority of patients with traumatic injuries presented within the first 48 hours. The increase relative to baseline lasted 11 days. Efforts to develop disaster response systems from resources outside the disaster-stricken area should focus on providing mostly primary care assistance. Communities in seismically prepared areas could require external medical assistance for their EDs for up to two weeks following the event.

Disasters↗

PubMedDate not supplied

Paraplegia following spinal anesthesia in a patient with chronic renal failure.

Paraplegia after spinal anesthesia secondary to hematoma formation has been described. Many such reports have involved patients with a variety of coagulation disorders. This article describes a patient with clotting abnormalities, apparently due to chronic renal failure, who developed paraplegia after spinal anesthesia secondary to subarachnoid hematoma formation.

Anesthesia, Spinal↗

PubMedDate not supplied

Computed tomography of the cervical lymph nodes: use of intravenous contrast enhancement.

Intravenous contrast administration increases the sensitivity of computed tomographic scanning for enlarged cervical lymph nodes but requires a detailed knowledge of neck anatomy, especially in order to distinguish certain normal vessels from involved nodal groups. Along the collar chain, relations between the parotid and submandibular salivary glands and the posterior and anterior facial veins and facial artery are analyzed. The digastric muscle is defined as a transitional landmark between collar and deep cervical nodes. Along the deep cervical chain, emphasis is on the internal jugular vein, its variability in size, and its relations to the anterior scalene and omohyoid muscles.

Humans↗