RESUMEN
We report a case of a 66-year-old male with T2 American Spinal Injury Association Impairment Scale (AIS) A paraplegia who presented to Urology with worsening autonomic dysreflexia. Work-up identified a bladder mass treated by transurethral resection and pathologically confirmed as melanoma. Additional work-up revealed metastatic melanoma to the back and brain. The patient completely recovered with no evidence of disease more than two years after completing therapy. In this report, we review the presentation of metastatic bladder melanoma presenting with autonomic dysreflexia, which has never been previously described, and discuss the prognosis of metastatic melanoma to the bladder.
RESUMEN
The aim of the study was to determine if the use of an Instructional Video will decrease anxiety during cast removal. We enrolled 60 healthy children undergoing their first cast removal following conservative fracture treatment. Patients were divided into one of three groups (1) No Video (control group), (2) watching a video of a well-tolerated pediatric cast removal (Instructional Video), or (3) watching a nonmedical Children's Video during cast removal. We assessed anxiety to the cast saw by recording heart rate in the waiting room, during the procedure, and 1-2 min after the procedure. There were no significant differences in waiting room, procedure, and post-procedure heart rates between the two interventions and the control group. The mean change in heart rate from baseline to the procedure room for the Instructional Video cohort exhibited a similar increase (25.8 beats/min) in heart rate during cast removal as the No Video group (26.3 beats/min), while the Children's Video had the smallest change in heart rate (17.7 beats/min) with a trend towards significance (P = 0.12). The results were not statistically significant for the full linear mixed-effect model on the three measurements. When we use age to control for variability in the data, we have a moderate effect size between Children's Video and control (η2P = 0.0592), revealing that certain ages likely benefited from the Children's Video intervention. Distraction using a Children's Video may help reduce anxiety during cast removal whereas the Instructional Video did not reduce anxiety as hypothesized.