Perinephric Extramedullary Disease in Multiple Myeloma.

Extramedullary disease represents an aggressive form of multiple myeloma occurring outside the skeleton and is a poor prognostic indicator. Extramedullary disease most commonly involves the skin, muscle, pleura, lymph nodes, liver, and central nervous system. Infrequently, extramedullary disease can involve the kidneys or perirenal space.

Systemic and Neurosarcoidosis With Rare Involvement of the Extremities' Peripheral Nerves.

We present a case of sarcoidosis with a rare presentation of involvement of peripheral nerves of the lower limbs and subcutaneous nodules detected on 18 F-FDG PET/CT. The patient also had involvement of the spinal nerves and dura, histologically proven to be sarcoidosis. There were other manifestations of systemic sarcoidosis like metabolically active cervical and mediastinal lymphadenopathy.

Design and Impact of a Novel Rural Hospital Alliance.

Without rural hospitals, many patients may not have access to essential services, or even any health care. Rural hospitals provide a community hub for local access to primary care and emergency services, as well as a bridge to specialized care outside the community. The goal of this review was to demonstrate how the University of Arkansas for Medical Sciences supports and empowers rural hospitals through an alliance that provides cost savings through clinical networks, collaborative purchasing, and leveraged services; workforce recruitment and education; telemedicine and distance learning; community outreach; and access to best practices, resources, and tools for hospital transformation.

Exploring Knowledge, Beliefs, and Attitudes about Teen Pregnancy among Latino Parents in Arkansas.

Objectives: Arkansas has the highest incidence of teen pregnancy in 15- to 19-year-olds in the United States, and Latinas remain one of the cultural groups that are most at risk of becoming adolescent mothers. Teen mothers and their children are more likely to face poor socioeconomic conditions and negative health sequelae that perpetuate the cycle of poverty. Tailored interventions meant for families, communities, and/or churches should address both abstinence and other types of contraception to educate young people how to stay healthy, prevent unwanted pregnancy, and empower them to make informed decisions.

Bleeding to death in a big city: An analysis of all trauma deaths from hemorrhage in a metropolitan area during 1 year.

Background: Hemorrhage is the most common cause of potentially preventable trauma deaths, but no studies have focused on all civilian traumatic deaths from hemorrhage, so we describe a year of these deaths from a large county to identify opportunities for preventing hemorrhagic deaths.

Methods: All trauma-related deaths in Harris County, Texas, in 2014 underwent examination by the medical examiner; patients were excluded if hemorrhage was not their primary reason for death. Deaths were then categorized as preventable/potentially preventable hemorrhage (PPH) or nonpreventable hemorrhage.

Seizures, Meds, and Vtach: A Journey to a Brugada Diagnosis.

Sudden cardiac arrest of cardiac etiology is rare in children and adolescents and most often occurs with exertion. Conversely, syncope is a common pediatric emergency department complaint but rarely is associated with a serious underlying cardiac disorder. This report describes a case of the channelopathy Brugada syndrome (BrS) as a cause of sudden cardiac arrest in a febrile preadolescent child taking medications known to affect cardiac conduction.

Combined Superficial and Deep Serratus Plane Block With Bupivacaine, Dexamethasone, and Clonidine in the Treatment of a Patient With Postmastectomy Pain Syndrome: A Case Report.

Postmastectomy pain syndrome poses a significant treatment challenge. We present the case of a 42-year-old woman who presented to our pain clinic with a 16-month history of postmastectomy pain. We performed a combined superficial and deep serratus plane block using bupivacaine, dexamethasone, and clonidine.

Management of Croup in the Emergency Department: The Role of Multidose Nebulized Epinephrine.

Objectives: Croup occasionally requires medical intervention for respiratory distress. Mainstays of treatment are corticosteroids and nebulized epinephrine. Diagnosis and assessment of severity remain clinical.

Maternal folate-related gene environment interactions and congenital heart defects.

Objective: To investigate whether women with congenital heart defect (CHD)-affected pregnancies were more likely to have functional single-nucleotide polymorphisms in genes encoding enzymes in folate-dependent pathways.

Methods: A population-based case-control study of 572 women with CHD-affected pregnancies and 363 women in the control group was conducted. DNA samples were genotyped for single-nucleotide polymorphisms in three genes encoding for folate pathway enzymes.