Daniel von Allmen

333 timestamped statements across 12 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Adrenal Tumors · guest expert Aerodigestive / ENT · guest expert Biliary Atresia · guest expert Colorectal / ARM & Hirschsprung · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Fetal Surgery · guest expert Intestinal Failure · guest expert Intestinal Rehab · guest expert Intestinal Transplant · guest expert Neuroblastoma · guest expert Soft Tissue Sarcoma (lymph nodes) · guest expert Wilms Tumor · guest expert

Featured diaries

▶ Ep 18 · 9:56
I don't think we know we should do the studies to understand that. But I would say that this gets back to David van der Zee's comment about, go have a cup of coffee and come back and it'll be fine. Clearly, that's not growth, that's stretch. And yet there's very good physiologic data that tension is a growth promoter, not necessarily in the esophagus, but in other organs. So I think that it's an area ripe for a little more basic science.
quote · Fetal Surgery
▶ Ep 18 · 9:03
You can get extraordinary length on this. And Mike and I have done a few cases for kids who had disasters, multiple operations elsewhere, who had caustic injuries that were involved all the way up to the pharynx, where we had to do a lot of work just on the pharynx to get that open, and then literally sew the colon interposition to the pharynx and then down to the stomach, which is obviously tough to do with a gastric pull-up.
quote · Fetal Surgery
▶ Ep 20 · 1:02
This session. It is really about combining the expertise of surgeons with the expertise of our interventional radiologists and ultimately impacting the patient, so you keep the focus on what's right for the patient and put the egos aside, and you can do really great things.
quote · Neuroblastoma
▶ Ep 12 · 1:02
This session. It is really about combining the expertise of surgeons with the expertise of our interventional radiologists and ultimately impacting the patient, so you keep the focus on what's right for the patient and put the egos aside, and you can do really great things.
quote · Soft Tissue Sarcoma (lymph nodes)
▶ Ep 1 · 3:36
So this was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. The prior staging system required tissue diagnosis before assigning a stage.
quote · Adrenal Tumors
▶ Ep 5 · 3:36
So this was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. The prior staging system required tissue diagnosis before assigning a stage.
quote · Neuroblastoma

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Adrenal Tumors 51 entries

Topics in 10: Neuroblastoma

▶ Ep 1 · 0:41
clinical Patients with metastatic disease may present with bony pain or neurologic symptoms from cord compression ↗
▶ Ep 1 · 0:41
quote So in the younger patients, they're oftentimes picked up either prenatally on ultrasound, or in younger kids, say two-year-old or three-year-old, it might be picked up as a solid abdominal mass. ↗
▶ Ep 1 · 0:41
clinical Younger patients are often picked up prenatally on ultrasound or as a solid abdominal mass in two- or three-year-olds ↗
▶ Ep 1 · 1:07
clinical Catecholamines (urine or serum) are one of the most diagnostic laboratory tests for neuroblastoma ↗
▶ Ep 1 · 1:39
clinical Cross-sectional imaging (CT or MRI) is obtained after initial ultrasound and laboratory workup ↗
▶ Ep 1 · 1:39
clinical MIBG study is helpful for confirming neuroblastoma diagnosis and demonstrating metastatic disease ↗
▶ Ep 1 · 2:20
quote The scan, an MIBG is not 100% accurate. About 10% of neuroblastomas are MIBG negative. ↗
▶ Ep 1 · 2:20
clinical About 10% of neuroblastomas are MIBG negative ↗
▶ Ep 1 · 2:20
clinical Some centers obtain a PET scan for MIBG-negative cases to look for tumor uptake and metastatic disease ↗
▶ Ep 1 · 2:45
guideline Tumors with metastatic disease are categorized as M ↗
▶ Ep 1 · 2:45
guideline MS category is for children less than 18 months with metastases to bone marrow or skin ↗
▶ Ep 1 · 2:45
guideline Localized tumors with image-defined risk factors (encasing nerves or vessels) are L2 ↗
▶ Ep 1 · 2:45
guideline Localized tumors without image-defined risk factors are categorized as L1 ↗
▶ Ep 1 · 2:45
guideline The INRGSS staging system allows stage assignment before any invasive procedure ↗
▶ Ep 1 · 3:36
quote So this was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. The prior staging system required tissue diagnosis before assigning a stage. ↗
▶ Ep 1 · 3:36
guideline The INRGSS was created to allow studies from different centers and countries to be compared based on pre-surgical staging ↗
▶ Ep 1 · 3:36
guideline The prior staging system required tissue diagnosis before assigning a stage ↗
▶ Ep 1 · 4:06
clinical A patient with a resectable adrenal mass and positive MIBG without metastases can be treated with primary resection via laparotomy or laparoscopy ↗
▶ Ep 1 · 4:44
clinical For large central abdominal tumors that encase major vasculature, only tissue for diagnosis is needed via open biopsy, laparoscopic biopsy, or core needle biopsy ↗
▶ Ep 1 · 5:14
clinical 1P and 11Q deletions should be assessed in biopsy tissue along with Shimada histology ↗
▶ Ep 1 · 5:14
clinical NMIC status is the most important biologic risk determinant from biopsy tissue ↗
▶ Ep 1 · 5:14
quote So it's important what you're looking for in the biopsy results are to get the biologic risk determinants out of the tissue. The most important of those is the NMIC status. ↗
▶ Ep 1 · 5:45
epidemiological Risk distribution is approximately 50-50 between low risk categories and high risk, with a smaller percentage intermediate risk ↗
▶ Ep 1 · 5:45
guideline Neuroblastoma risk categories are very low risk, low risk, intermediate risk, or high risk ↗
▶ Ep 1 · 6:06
guideline High-risk patients receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with >90% resection goal, radiation, immunotherapy, and potentially retinoic acid therapy ↗
▶ Ep 1 · 6:06
quote Essentially. Not 100%, but that's NMIC and age greater than 18 months are the most important prognostic determinants for neuroblastoma. ↗
▶ Ep 1 · 6:06
clinical NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma ↗
▶ Ep 1 · 6:51
guideline For intermediate risk tumors, the surgical goal is at least 50% response from initial primary tumor volume combining neoadjuvant chemotherapy and surgical resection ↗
▶ Ep 1 · 6:51
guideline Intermediate risk tumors receive varying cycles of chemotherapy based on biologic risk factors ↗
▶ Ep 1 · 7:22
guideline A Children's Oncology Group study led by Jed Nocturne showed patients less than six months with prenatally or early postnatally diagnosed localized mass can be observed with expectation that most will avoid surgery ↗
▶ Ep 1 · 7:22
guideline Low risk patients, depending on age and diagnosis timing, could be followed with observation alone ↗
▶ Ep 1 · 7:55
guideline Patients with metastatic disease typically receive four or five cycles of neoadjuvant chemotherapy and are then reassessed ↗
▶ Ep 1 · 7:55
guideline MS disease is for patients less than 18 months with primary site and metastases to liver, skin, or bone marrow (specifically not cortical bone) ↗
▶ Ep 1 · 7:55
guideline If metastatic disease is progressing on chemotherapy, surgery is not indicated ↗
▶ Ep 1 · 7:55
guideline MS disease patients can be managed with simple observation; treatment is only elected if they progress or develop complications like respiratory issues from enlarging liver mass ↗
▶ Ep 1 · 7:55
guideline If metastatic disease is responding to chemotherapy, the primary tumor site should be resected with attempted >90% resection ↗
▶ Ep 1 · 8:55
clinical Skin lesions in MS disease can be biopsied to provide diagnosis ↗

Neuroblastoma

▶ Ep 2 · 2:00
clinical Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress ↗
▶ Ep 2 · 7:24
clinical The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery ↗
▶ Ep 2 · 10:23
quote We had a case of a child who presented with exactly the scenario was observed. The adrenal mass went away. At age three, she presented with widely metastatic, high-risk neuroblastoma. ↗
▶ Ep 2 · 10:23
clinical A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma ↗
▶ Ep 2 · 14:21
clinical Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor ↗
▶ Ep 2 · 22:12
clinical Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan ↗
▶ Ep 2 · 43:17
clinical Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy ↗
▶ Ep 2 · 44:04
clinical Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival ↗
▶ Ep 2 · 45:28
epidemiological About 70% of patients can achieve greater than 90% resection ↗
▶ Ep 2 · 45:28
clinical European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival ↗
▶ Ep 2 · 47:40
clinical Good local control is achieved with combination of radiation and aggressive surgery ↗
▶ Ep 2 · 52:19
quote There is zero correlation between the findings on post-op imaging and the findings that are reported in the op note. ↗
▶ Ep 2 · 52:19
clinical There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings ↗
▶ Ep 2 · 52:19
opinion Surgeons frequently overestimate the amount of tumor resection achieved ↗
Aerodigestive / ENT 2 entries

Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula

▶ Ep 2 · 9:58
clinical If anti-reflux procedure is performed when patient is aspirating from above, it does not help and makes them worse ↗
▶ Ep 2 · 14:02
clinical Cincinnati routinely performs bronchoscopy on all esophageal atresia cases ↗
Biliary Atresia 20 entries

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 6 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 6 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 6 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 6 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 6 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 6 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 6 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 6 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 6 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 6 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 10 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 10 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 10 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 10 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 10 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 10 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 10 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 10 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 10 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 10 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗
Colorectal / ARM & Hirschsprung 24 entries

Neuroblastoma

▶ Ep 74 · 2:00
clinical Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress ↗
▶ Ep 74 · 7:24
clinical The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery ↗
▶ Ep 74 · 10:23
quote We had a case of a child who presented with exactly the scenario was observed. The adrenal mass went away. At age three, she presented with widely metastatic, high-risk neuroblastoma. ↗
▶ Ep 74 · 10:23
clinical A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma ↗
▶ Ep 74 · 14:21
clinical Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor ↗
▶ Ep 74 · 22:12
clinical Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan ↗
▶ Ep 74 · 43:17
clinical Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy ↗
▶ Ep 74 · 44:04
clinical Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival ↗
▶ Ep 74 · 45:28
clinical European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival ↗
▶ Ep 74 · 45:28
epidemiological About 70% of patients can achieve greater than 90% resection ↗
▶ Ep 74 · 47:40
clinical Good local control is achieved with combination of radiation and aggressive surgery ↗
▶ Ep 74 · 52:19
opinion Surgeons frequently overestimate the amount of tumor resection achieved ↗
▶ Ep 74 · 52:19
quote There is zero correlation between the findings on post-op imaging and the findings that are reported in the op note. ↗
▶ Ep 74 · 52:19
clinical There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings ↗

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 76 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 76 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 76 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 76 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 76 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 76 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 76 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 76 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 76 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 76 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗
Etiologies (Gastroschisis/NEC/Atresia/Volvulus) 10 entries

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 26 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 26 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 26 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 26 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 26 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 26 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 26 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 26 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 26 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 26 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗
Fetal Surgery 27 entries

Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement

▶ Ep 18 · 0:46
clinical Cincinnati Children's uses a standardized interventional radiology protocol for measuring the esophageal gap, performed a couple of weeks after initial G-tube placement ↗
▶ Ep 18 · 0:46
clinical Long gap esophageal atresia is defined by absence of gas in the abdomen on initial imaging ↗
▶ Ep 18 · 0:46
quote Our method here is that if we have a child with no gas in the abdomen and we take them to the OR and put a G-tube in, many times we'll do, we'll put something up the distal esophagus at that point and just get a fluoro shot. But then we'd wait a couple of weeks and we have our patients go down to interventional radiology where we have a protocol for measuring the gap. ↗
▶ Ep 18 · 2:10
quote The physiology, which I believe in intensely, is that stretch is a very strong promoter of growth. And then if you put things on tension, they will actually grow over time. That's how the cardiovascular system develops in utero. ↗
▶ Ep 18 · 2:10
clinical Stretch is a very strong promoter of growth, and structures placed under tension will grow over time ↗
▶ Ep 18 · 2:10
clinical The cardiovascular system develops in utero using tension-based growth mechanisms ↗
▶ Ep 18 · 3:15
epidemiological Primary Foker cases had median ICU stay of 70 days with median two weeks of paralysis ↗
▶ Ep 18 · 3:15
epidemiological In secondary Foker cases (patients with previous operations), success rate was approximately two-thirds ↗
▶ Ep 18 · 3:15
epidemiological A 2015 Boston series reported 96% success rate achieving intact esophagus in primary Foker cases ↗
▶ Ep 18 · 3:15
epidemiological About 10% of secondary Foker repair patients achieved full oral nutrition ↗
▶ Ep 18 · 3:15
epidemiological About two-thirds of primary Foker repair patients achieved full oral nutrition ↗
▶ Ep 18 · 3:15
epidemiological Secondary Foker cases had median ICU stay of 110 days with median one month of paralysis ↗
▶ Ep 18 · 4:36
clinical Colon can be used as an interposition conduit for esophageal replacement ↗
▶ Ep 18 · 4:36
clinical In gastric transposition, the esophageal stump is divided at the esophageal hiatus, the fundus is mobilized and pulled up through either anterior or posterior mediastinum ↗
▶ Ep 18 · 4:36
guideline The INOEA surgical group recommends gastric pull-up as the first option for esophageal replacement ↗
▶ Ep 18 · 4:36
quote The surgical group from the INOEA, their recommendation, the recommendation for the first option is a gastric pull up. ↗
▶ Ep 18 · 8:00
clinical Common problems with colonic interposition include dilation and tortuosity, with sigmoid redundancy often developing just above the diaphragm ↗
▶ Ep 18 · 8:17
quote I was taught initially that you can't fix that and that it's too dangerous and that you'll risk the blood supply to the colon interposition. But I found that actually that's not really true. ↗
▶ Ep 18 · 8:17
clinical Sigmoid redundancy in colonic interposition can be revised transhiatally by dividing the gastroduodenal anastomosis, mobilizing the redundant segment, and re-anastomosing to the stomach ↗
▶ Ep 18 · 8:17
clinical Passing the colonic interposition posterior to the stomach leaves the vascular pedicle along the spine, allowing safe mobilization and revision ↗
▶ Ep 18 · 8:17
opinion Traditional teaching held that colonic interposition redundancy cannot be fixed safely due to risk to blood supply ↗
▶ Ep 18 · 9:01
clinical Colonic interposition can achieve extraordinary length, sufficient to reach from pharynx to stomach in cases of extensive caustic injury ↗
▶ Ep 18 · 9:01
clinical Gastric pull-up is difficult to perform when anastomosis to the pharynx is required ↗
▶ Ep 18 · 9:03
quote You can get extraordinary length on this. And Mike and I have done a few cases for kids who had disasters, multiple operations elsewhere, who had caustic injuries that were involved all the way up to the pharynx, where we had to do a lot of work just on the pharynx to get that open, and then literally sew the colon interposition to the pharynx and then down to the stomach, which is obviously tough to do with a gastric pull-up. ↗
▶ Ep 18 · 9:56
quote I don't think we know we should do the studies to understand that. But I would say that this gets back to David van der Zee's comment about, go have a cup of coffee and come back and it'll be fine. Clearly, that's not growth, that's stretch. And yet there's very good physiologic data that tension is a growth promoter, not necessarily in the esophagus, but in other organs. So I think that it's an area ripe for a little more basic science. ↗
▶ Ep 18 · 9:56
opinion The mechanism of esophageal elongation (growth versus stretch) is not definitively known and requires further basic science research ↗
▶ Ep 18 · 9:56
clinical There is good physiologic data that tension is a growth promoter in organs other than the esophagus ↗
Intestinal Failure 20 entries

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 3 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 3 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 3 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 3 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 3 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 3 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 3 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 3 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 3 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 3 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 7 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 7 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 7 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 7 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 7 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 7 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 7 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 7 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 7 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 7 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗
Intestinal Rehab 20 entries

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 14 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 14 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 14 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 14 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 14 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 14 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 14 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 14 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 14 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 14 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 35 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 35 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 35 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 35 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 35 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 35 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 35 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 35 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 35 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 35 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗
Intestinal Transplant 10 entries

Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...

▶ Ep 4 · 2:13
quote This paper is the product of a multi-institutional group called the Childhood Liver Disease Research and Education Network ↗
▶ Ep 4 · 2:56
clinical The START trial randomized 140 infants with biliary atresia to high-dose steroids (13-week course) versus placebo after Kasai portoenterostomy ↗
▶ Ep 4 · 3:46
clinical The study was powered to detect a 25% absolute treatment difference in outcomes ↗
▶ Ep 4 · 4:01
clinical High-dose steroid therapy following Kasai did not result in statistically significant treatment difference in bile drainage at 6 months: 58.6% treatment group versus 48.6% placebo ↗
▶ Ep 4 · 4:39
clinical Survival without liver transplant at 24 months was not statistically different: 58.7% steroid group versus 49.4% placebo group ↗
▶ Ep 4 · 4:55
clinical Adverse events occurred in near 80% of patients in both steroid and placebo groups, attributed largely to severe underlying liver dysfunction ↗
▶ Ep 4 · 5:10
clinical Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia ↗
▶ Ep 4 · 5:31
quote I personally used to use them in my practice, but based on this study have stopped using them ↗
▶ Ep 4 · 8:01
quote The whole point of this is to preserve the native liver ↗
▶ Ep 4 · 8:59
clinical Steroids are proposed to work through two mechanisms: reducing ongoing inflammation to preserve bile ductules, and acting as a choleretic to maintain bile flow ↗
Neuroblastoma 83 entries

Neuroblastoma: Update Course 2014

▶ Ep 2 · 0:42
epidemiological High-risk neuroblastoma patients continue to have a survival rate in the 38 to 40% range ↗
▶ Ep 2 · 6:12
quote I think the safest technique is to get on the vessels and stay on the vessels as opposed to getting close to the vessels because then you don't know where you are ↗
▶ Ep 2 · 6:12
opinion The safest surgical technique is to get on the vessels and stay on the vessels rather than getting close to the vessels ↗
▶ Ep 2 · 6:31
quote The difference between what a surgeon says they did in the operating room and what the postoperative imaging says they did in the operating room, and those are not necessarily the same ↗
▶ Ep 2 · 6:52
clinical There is only 66% concordance between surgeon's operative assessment of resection completeness and postoperative imaging assessment ↗
▶ Ep 2 · 10:00
clinical The biggest volume response of neuroblastoma tumor is with the first two cycles of chemotherapy, with very little response after that ↗
▶ Ep 2 · 10:17
opinion More chemotherapy or other agents like MIBG make the tumor more fibrotic and make subadventitial dissection more difficult ↗
▶ Ep 2 · 13:12
clinical The complication rate for aggressive neuroblastoma resection is about 30% morbidity with mortality less than 1% ↗
▶ Ep 2 · 16:48
clinical In the German study of 278 stage 4 patients, 75% achieved greater than 90% resection with overall survival 45% and event-free survival 33% ↗
▶ Ep 2 · 17:32
clinical The German study showed no difference in overall survival, event-free survival, or local progression-free survival based on completeness of resection ↗
▶ Ep 2 · 19:02
clinical The European study had surgical mortality of 0.5% and morbidity of 10%, though lower-grade complications reached 30% ↗
▶ Ep 2 · 19:17
clinical The European study of 1,324 patients showed significant improvement in both event-free survival and overall survival with greater than 95% resection ↗
▶ Ep 2 · 21:32
clinical The COG 3973 study of 230 patients showed significant improvement in local relapse-free survival and event-free survival but not overall survival ↗
▶ Ep 2 · 23:33
epidemiological In European studies, neuroblastoma procedures are done in more than 200 hospitals ↗
▶ Ep 2 · 24:12
clinical If you take out the kidney during neuroblastoma resection, survival is worse, likely because patients cannot receive as much chemotherapy with only one kidney ↗
▶ Ep 2 · 24:56
quote if you can't be informed, be opinionated ↗
▶ Ep 2 · 25:38
clinical Immunotherapy is effective in the setting of minimal residual disease ↗

Neuroblastoma

▶ Ep 3 · 2:11
clinical Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly ↗
▶ Ep 3 · 2:11
clinical Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress ↗
▶ Ep 3 · 6:02
opinion Radiologists are quite good at identifying adrenal hemorrhage on ultrasound ↗
▶ Ep 3 · 6:02
guideline MIBG scan is the next step if catecholamines are elevated ↗
▶ Ep 3 · 8:14
clinical In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes ↗
▶ Ep 3 · 8:44
guideline Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance ↗
▶ Ep 3 · 12:27
quote The only caution I would raise is that we had a case of a child who presented with exactly this scenario, was observed, the adrenal mass went away and age at age three she presented with widely metastatic high risk neuroblastoma. ↗
▶ Ep 3 · 12:27
clinical Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma ↗
▶ Ep 3 · 16:36
clinical Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor ↗
▶ Ep 3 · 17:58
clinical Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise ↗
▶ Ep 3 · 17:58
quote The most common thing that we worry about is is the mass, is the mass effect of the tumor in the liver, which can be really dramatic and causes respiratory compromise. ↗
▶ Ep 3 · 19:06
opinion Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy ↗
▶ Ep 3 · 25:06
clinical PET scan may detect metastases in MIBG-negative neuroblastomas ↗
▶ Ep 3 · 25:06
epidemiological 10% of neuroblastomas are not MIBG avid ↗

Topics in 10: Neuroblastoma

▶ Ep 5 · 0:41
clinical Younger patients are often picked up prenatally on ultrasound or as a solid abdominal mass in two- or three-year-olds ↗
▶ Ep 5 · 0:41
quote So in the younger patients, they're oftentimes picked up either prenatally on ultrasound, or in younger kids, say two-year-old or three-year-old, it might be picked up as a solid abdominal mass. ↗
▶ Ep 5 · 0:41
clinical Patients with metastatic disease may present with bony pain or neurologic symptoms from cord compression ↗
▶ Ep 5 · 1:07
clinical Catecholamines (urine or serum) are one of the most diagnostic laboratory tests for neuroblastoma ↗
▶ Ep 5 · 1:39
clinical Cross-sectional imaging (CT or MRI) is obtained after initial ultrasound and laboratory workup ↗
▶ Ep 5 · 1:39
clinical MIBG study is helpful for confirming neuroblastoma diagnosis and demonstrating metastatic disease ↗
▶ Ep 5 · 2:20
quote The scan, an MIBG is not 100% accurate. About 10% of neuroblastomas are MIBG negative. ↗
▶ Ep 5 · 2:20
clinical About 10% of neuroblastomas are MIBG negative ↗
▶ Ep 5 · 2:20
clinical Some centers obtain a PET scan for MIBG-negative cases to look for tumor uptake and metastatic disease ↗
▶ Ep 5 · 2:45
guideline MS category is for children less than 18 months with metastases to bone marrow or skin ↗
▶ Ep 5 · 2:45
guideline Tumors with metastatic disease are categorized as M ↗
▶ Ep 5 · 2:45
guideline Localized tumors with image-defined risk factors (encasing nerves or vessels) are L2 ↗
▶ Ep 5 · 2:45
guideline Localized tumors without image-defined risk factors are categorized as L1 ↗
▶ Ep 5 · 2:45
guideline The INRGSS staging system allows stage assignment before any invasive procedure ↗
▶ Ep 5 · 3:36
guideline The INRGSS was created to allow studies from different centers and countries to be compared based on pre-surgical staging ↗
▶ Ep 5 · 3:36
guideline The prior staging system required tissue diagnosis before assigning a stage ↗
▶ Ep 5 · 3:36
quote So this was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. The prior staging system required tissue diagnosis before assigning a stage. ↗
▶ Ep 5 · 4:06
clinical A patient with a resectable adrenal mass and positive MIBG without metastases can be treated with primary resection via laparotomy or laparoscopy ↗
▶ Ep 5 · 4:44
clinical For large central abdominal tumors that encase major vasculature, only tissue for diagnosis is needed via open biopsy, laparoscopic biopsy, or core needle biopsy ↗
▶ Ep 5 · 5:14
clinical 1P and 11Q deletions should be assessed in biopsy tissue along with Shimada histology ↗
▶ Ep 5 · 5:14
quote So it's important what you're looking for in the biopsy results are to get the biologic risk determinants out of the tissue. The most important of those is the NMIC status. ↗
▶ Ep 5 · 5:14
clinical NMIC status is the most important biologic risk determinant from biopsy tissue ↗
▶ Ep 5 · 5:45
guideline Neuroblastoma risk categories are very low risk, low risk, intermediate risk, or high risk ↗
▶ Ep 5 · 5:45
epidemiological Risk distribution is approximately 50-50 between low risk categories and high risk, with a smaller percentage intermediate risk ↗
▶ Ep 5 · 6:06
quote Essentially. Not 100%, but that's NMIC and age greater than 18 months are the most important prognostic determinants for neuroblastoma. ↗
▶ Ep 5 · 6:06
guideline High-risk patients receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with >90% resection goal, radiation, immunotherapy, and potentially retinoic acid therapy ↗
▶ Ep 5 · 6:06
clinical NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma ↗
▶ Ep 5 · 6:51
guideline For intermediate risk tumors, the surgical goal is at least 50% response from initial primary tumor volume combining neoadjuvant chemotherapy and surgical resection ↗
▶ Ep 5 · 6:51
guideline Intermediate risk tumors receive varying cycles of chemotherapy based on biologic risk factors ↗
▶ Ep 5 · 7:22
guideline Low risk patients, depending on age and diagnosis timing, could be followed with observation alone ↗
▶ Ep 5 · 7:22
guideline A Children's Oncology Group study led by Jed Nocturne showed patients less than six months with prenatally or early postnatally diagnosed localized mass can be observed with expectation that most will avoid surgery ↗
▶ Ep 5 · 7:55
guideline Patients with metastatic disease typically receive four or five cycles of neoadjuvant chemotherapy and are then reassessed ↗
▶ Ep 5 · 7:55
guideline If metastatic disease is responding to chemotherapy, the primary tumor site should be resected with attempted >90% resection ↗
▶ Ep 5 · 7:55
guideline If metastatic disease is progressing on chemotherapy, surgery is not indicated ↗
▶ Ep 5 · 7:55
guideline MS disease is for patients less than 18 months with primary site and metastases to liver, skin, or bone marrow (specifically not cortical bone) ↗
▶ Ep 5 · 7:55
guideline MS disease patients can be managed with simple observation; treatment is only elected if they progress or develop complications like respiratory issues from enlarging liver mass ↗
▶ Ep 5 · 8:55
clinical Skin lesions in MS disease can be biopsied to provide diagnosis ↗

Neuroblastoma

▶ Ep 6 · 2:00
clinical Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress ↗
▶ Ep 6 · 7:24
clinical The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery ↗
▶ Ep 6 · 10:23
quote We had a case of a child who presented with exactly the scenario was observed. The adrenal mass went away. At age three, she presented with widely metastatic, high-risk neuroblastoma. ↗
▶ Ep 6 · 10:23
clinical A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma ↗
▶ Ep 6 · 14:21
clinical Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor ↗
▶ Ep 6 · 22:12
clinical Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan ↗
▶ Ep 6 · 43:17
clinical Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy ↗
▶ Ep 6 · 44:04
clinical Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival ↗
▶ Ep 6 · 45:28
clinical European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival ↗
▶ Ep 6 · 45:28
epidemiological About 70% of patients can achieve greater than 90% resection ↗
▶ Ep 6 · 47:40
clinical Good local control is achieved with combination of radiation and aggressive surgery ↗
▶ Ep 6 · 52:19
opinion Surgeons frequently overestimate the amount of tumor resection achieved ↗
▶ Ep 6 · 52:19
clinical There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings ↗
▶ Ep 6 · 52:19
quote There is zero correlation between the findings on post-op imaging and the findings that are reported in the op note. ↗

Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024

▶ Ep 20 · 1:02
quote This session. It is really about combining the expertise of surgeons with the expertise of our interventional radiologists and ultimately impacting the patient, so you keep the focus on what's right for the patient and put the egos aside, and you can do really great things. ↗
Soft Tissue Sarcoma (lymph nodes) 52 entries

Topics in 10: Neuroblastoma

▶ Ep 3 · 0:41
clinical Younger patients are often picked up prenatally on ultrasound or as a solid abdominal mass in two- or three-year-olds ↗
▶ Ep 3 · 0:41
quote So in the younger patients, they're oftentimes picked up either prenatally on ultrasound, or in younger kids, say two-year-old or three-year-old, it might be picked up as a solid abdominal mass. ↗
▶ Ep 3 · 0:41
clinical Patients with metastatic disease may present with bony pain or neurologic symptoms from cord compression ↗
▶ Ep 3 · 1:07
clinical Catecholamines (urine or serum) are one of the most diagnostic laboratory tests for neuroblastoma ↗
▶ Ep 3 · 1:39
clinical Cross-sectional imaging (CT or MRI) is obtained after initial ultrasound and laboratory workup ↗
▶ Ep 3 · 1:39
clinical MIBG study is helpful for confirming neuroblastoma diagnosis and demonstrating metastatic disease ↗
▶ Ep 3 · 2:20
clinical Some centers obtain a PET scan for MIBG-negative cases to look for tumor uptake and metastatic disease ↗
▶ Ep 3 · 2:20
clinical About 10% of neuroblastomas are MIBG negative ↗
▶ Ep 3 · 2:20
quote The scan, an MIBG is not 100% accurate. About 10% of neuroblastomas are MIBG negative. ↗
▶ Ep 3 · 2:45
guideline Localized tumors without image-defined risk factors are categorized as L1 ↗
▶ Ep 3 · 2:45
guideline The INRGSS staging system allows stage assignment before any invasive procedure ↗
▶ Ep 3 · 2:45
guideline Localized tumors with image-defined risk factors (encasing nerves or vessels) are L2 ↗
▶ Ep 3 · 2:45
guideline Tumors with metastatic disease are categorized as M ↗
▶ Ep 3 · 2:45
guideline MS category is for children less than 18 months with metastases to bone marrow or skin ↗
▶ Ep 3 · 3:36
quote So this was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. The prior staging system required tissue diagnosis before assigning a stage. ↗
▶ Ep 3 · 3:36
guideline The prior staging system required tissue diagnosis before assigning a stage ↗
▶ Ep 3 · 3:36
guideline The INRGSS was created to allow studies from different centers and countries to be compared based on pre-surgical staging ↗
▶ Ep 3 · 4:06
clinical A patient with a resectable adrenal mass and positive MIBG without metastases can be treated with primary resection via laparotomy or laparoscopy ↗
▶ Ep 3 · 4:44
clinical For large central abdominal tumors that encase major vasculature, only tissue for diagnosis is needed via open biopsy, laparoscopic biopsy, or core needle biopsy ↗
▶ Ep 3 · 5:14
clinical 1P and 11Q deletions should be assessed in biopsy tissue along with Shimada histology ↗
▶ Ep 3 · 5:14
quote So it's important what you're looking for in the biopsy results are to get the biologic risk determinants out of the tissue. The most important of those is the NMIC status. ↗
▶ Ep 3 · 5:14
clinical NMIC status is the most important biologic risk determinant from biopsy tissue ↗
▶ Ep 3 · 5:45
epidemiological Risk distribution is approximately 50-50 between low risk categories and high risk, with a smaller percentage intermediate risk ↗
▶ Ep 3 · 5:45
guideline Neuroblastoma risk categories are very low risk, low risk, intermediate risk, or high risk ↗
▶ Ep 3 · 6:06
clinical NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma ↗
▶ Ep 3 · 6:06
guideline High-risk patients receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with >90% resection goal, radiation, immunotherapy, and potentially retinoic acid therapy ↗
▶ Ep 3 · 6:06
quote Essentially. Not 100%, but that's NMIC and age greater than 18 months are the most important prognostic determinants for neuroblastoma. ↗
▶ Ep 3 · 6:51
guideline Intermediate risk tumors receive varying cycles of chemotherapy based on biologic risk factors ↗
▶ Ep 3 · 6:51
guideline For intermediate risk tumors, the surgical goal is at least 50% response from initial primary tumor volume combining neoadjuvant chemotherapy and surgical resection ↗
▶ Ep 3 · 7:22
guideline A Children's Oncology Group study led by Jed Nocturne showed patients less than six months with prenatally or early postnatally diagnosed localized mass can be observed with expectation that most will avoid surgery ↗
▶ Ep 3 · 7:22
guideline Low risk patients, depending on age and diagnosis timing, could be followed with observation alone ↗
▶ Ep 3 · 7:55
guideline Patients with metastatic disease typically receive four or five cycles of neoadjuvant chemotherapy and are then reassessed ↗
▶ Ep 3 · 7:55
guideline If metastatic disease is responding to chemotherapy, the primary tumor site should be resected with attempted >90% resection ↗
▶ Ep 3 · 7:55
guideline If metastatic disease is progressing on chemotherapy, surgery is not indicated ↗
▶ Ep 3 · 7:55
guideline MS disease is for patients less than 18 months with primary site and metastases to liver, skin, or bone marrow (specifically not cortical bone) ↗
▶ Ep 3 · 7:55
guideline MS disease patients can be managed with simple observation; treatment is only elected if they progress or develop complications like respiratory issues from enlarging liver mass ↗
▶ Ep 3 · 8:55
clinical Skin lesions in MS disease can be biopsied to provide diagnosis ↗

Neuroblastoma

▶ Ep 5 · 2:00
clinical Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress ↗
▶ Ep 5 · 7:24
clinical The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery ↗
▶ Ep 5 · 10:23
clinical A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma ↗
▶ Ep 5 · 10:23
quote We had a case of a child who presented with exactly the scenario was observed. The adrenal mass went away. At age three, she presented with widely metastatic, high-risk neuroblastoma. ↗
▶ Ep 5 · 14:21
clinical Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor ↗
▶ Ep 5 · 22:12
clinical Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan ↗
▶ Ep 5 · 43:17
clinical Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy ↗
▶ Ep 5 · 44:04
clinical Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival ↗
▶ Ep 5 · 45:28
clinical European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival ↗
▶ Ep 5 · 45:28
epidemiological About 70% of patients can achieve greater than 90% resection ↗
▶ Ep 5 · 47:40
clinical Good local control is achieved with combination of radiation and aggressive surgery ↗
▶ Ep 5 · 52:19
quote There is zero correlation between the findings on post-op imaging and the findings that are reported in the op note. ↗
▶ Ep 5 · 52:19
clinical There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings ↗
▶ Ep 5 · 52:19
opinion Surgeons frequently overestimate the amount of tumor resection achieved ↗

Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024

▶ Ep 12 · 1:02
quote This session. It is really about combining the expertise of surgeons with the expertise of our interventional radiologists and ultimately impacting the patient, so you keep the focus on what's right for the patient and put the egos aside, and you can do really great things. ↗
Wilms Tumor 14 entries

Neuroblastoma

▶ Ep 9 · 2:00
clinical Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress ↗
▶ Ep 9 · 7:24
clinical The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery ↗
▶ Ep 9 · 10:23
clinical A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma ↗
▶ Ep 9 · 10:23
quote We had a case of a child who presented with exactly the scenario was observed. The adrenal mass went away. At age three, she presented with widely metastatic, high-risk neuroblastoma. ↗
▶ Ep 9 · 14:21
clinical Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor ↗
▶ Ep 9 · 22:12
clinical Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan ↗
▶ Ep 9 · 43:17
clinical Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy ↗
▶ Ep 9 · 44:04
clinical Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival ↗
▶ Ep 9 · 45:28
epidemiological About 70% of patients can achieve greater than 90% resection ↗
▶ Ep 9 · 45:28
clinical European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival ↗
▶ Ep 9 · 47:40
clinical Good local control is achieved with combination of radiation and aggressive surgery ↗
▶ Ep 9 · 52:19
opinion Surgeons frequently overestimate the amount of tumor resection achieved ↗
▶ Ep 9 · 52:19
clinical There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings ↗
▶ Ep 9 · 52:19
quote There is zero correlation between the findings on post-op imaging and the findings that are reported in the op note. ↗