We were happy that our first procedure was successful. When we did another one, it was much easier. Of course, at the beginning, the first procedure took us almost 4 hours. Right now it's a 1 hour procedure, but of course it's very difficult, but we are very happy to have no conversion.
recognizing that we all have biases and not being defensive when someone says there's bias in that because we all have bias. We know that we all have bias. And so the question is, what are your biases and how do they affect what you do?
The first, you need experience in endoscopic surgery. And then just you need time, and you must be very experienced in endoscopic suturing. You must be very slow. If you do it slowly, you will do it fast.
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 24 · 7:22
clinicalA child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues↗
▶Ep 24 · 9:29
clinicalPostnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis↗
Quick Literature Updates Episode 6
▶Ep 30 · 0:20
clinicalGunshot wound victims were more likely to require immediate surgery and had increased mortality compared to MVC victims↗
▶Ep 30 · 0:20
clinicalGunshot wound victims were 7.8 times more likely to die than MVC victims↗
▶Ep 30 · 0:20
epidemiologicalIn California statewide data from 2006 to 2015, the case fatality rate for gunshot wound victims was higher than for motor vehicle collisions↗
▶Ep 30 · 0:20
clinicalThe Teodoro study examined pediatric trauma patients with gunshot wounds or MVCs presenting to a level one trauma center between 2009 and 2019↗
▶Ep 30 · 1:29
epidemiologicalThe case fatality rate for pediatric gunshot wounds increased from 2006 to 2015 in California↗
▶Ep 30 · 1:29
quoteThe authors concluded, as others have, that firearm injuries are more lethal in children than MVCs and we need to do something about it.↗
Quick Literature Updates Episode 11
▶Ep 32 · 0:46
epidemiologicalThe Gifford's Law Center annual gun law scorecard between 2014 and 2020 was used to assess state gun law scores.↗
▶Ep 32 · 0:46
epidemiologicalStronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws.↗
▶Ep 32 · 0:46
epidemiologicalIn recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children.↗
▶Ep 32 · 0:46
epidemiologicalThe CDC Wonder database was used to examine data between 1999 and 2020 for pediatric firearm and automobile fatalities.↗
clinicalTreatment options for giant omphalocele include painting the sac, removing sac and placing silo with passive or active reduction, keeping sac with active reduction, or definitive immediate closure↗
▶Ep 49 · 3:54
clinicalHydrocolloid dressing technique for giant omphalocele achieved closure in 97% of 40 patients within 30 days and 92% within 15 days↗
▶Ep 49 · 6:42
quoteThat's Dr. Salim Islam, who's the chief of pediatric surgery at the University of Florida College of Medicine.↗
▶Ep 49 · 10:26
clinicalComponent separation technique involves separating tissue at external oblique about one centimeter beyond rectus sheath on both sides, creating space by dissecting between external and internal oblique↗
▶Ep 49 · 10:26
clinicalTexas report of component separation in nine children aged 7 days to 10 years achieved fascial closure in vast majority, mostly for omphaloceles and giant defects↗
▶Ep 49 · 10:26
clinicalIncision on anterior rectus sheath can provide additional centimeter of space for closure↗
clinicalThe Pediatric Surgical Oncology Research Collaborative study reviewed practices at 15 hospitals for localizing small pulmonary nodules in children↗
▶Ep 14 · 0:24
clinicalDifferent institutions use various localization methods including wires, methylene blue dye, indocyanine green, micro coils, and technetium 99 in different combinations↗
▶Ep 14 · 0:24
clinicalThere was no significant difference in the success of localization between all of the different techniques for pulmonary nodules↗
▶Ep 14 · 0:24
clinicalThe only significant differences in pulmonary nodule localization were in which institution performed each technique, and in IR, OR, and anesthesia times↗
▶Ep 14 · 0:24
quoteThey found that there was no significant difference in the success of localization between all of the different techniques.↗
Outcomes of laparoscopic versus open resection of pediatric choledochal cyst
▶Ep 3 · 0:13
epidemiologicalThe study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018.↗
▶Ep 3 · 0:24
clinicalPatients who underwent laparoscopic resection were more likely to have a hepaticoduodenostomy.↗
▶Ep 3 · 0:24
clinicalPatients who underwent open resection were more likely to have a Roux-en-Y hepaticojejunostomy.↗
▶Ep 3 · 0:24
epidemiologicalThe majority of patients underwent open resection.↗
▶Ep 3 · 0:39
clinicalPatients who underwent open resection were more likely to have a longer length of hospital stay.↗
▶Ep 3 · 0:39
clinicalPatients who underwent open resection were more likely to have more complications.↗
▶Ep 3 · 0:39
clinicalPatients who underwent open resection had higher total costs.↗
▶Ep 3 · 0:47
quoteHow do you resect colodocal cysts in pediatric patients?↗
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 4 · 5:36
clinicalSevere outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, and development of esophageal stricture↗
▶Ep 4 · 6:05
epidemiologicalThe Boston study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes↗
▶Ep 4 · 6:20
clinicalThree predictive factors for severe button battery outcomes were: presence in esophagus at presentation, two centimeter or larger battery size, and presence of any symptoms↗
Quick Literature Updates Episode 15
▶Ep 5 · 2:11
epidemiologicalThe choledochal cyst study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018↗
▶Ep 5 · 2:21
clinicalPatients who underwent laparoscopic choledochal cyst resection were more likely to have a hepaticoduodenostomy↗
▶Ep 5 · 2:21
clinicalPatients who underwent open choledochal cyst resection were more likely to have a Roux-en-Y hepaticojejunostomy↗
▶Ep 5 · 2:21
epidemiologicalThe majority of choledochal cyst patients underwent open resection↗
▶Ep 5 · 2:36
clinicalPatients who underwent open choledochal cyst resection had higher total costs compared to laparoscopic resection↗
▶Ep 5 · 2:36
clinicalPatients who underwent open choledochal cyst resection had more complications compared to laparoscopic resection↗
▶Ep 5 · 2:36
clinicalPatients who underwent open choledochal cyst resection had longer length of hospital stay compared to laparoscopic resection↗
clinicalThere is literature suggesting a component of psychosocial, psychologic dissociation in children on later testing related to dilations↗
▶Ep 122 · 2:55
clinicalThe number of strictures, number who needed anoplasties, and number of redo operations was the same between the dilation and no-dilation groups↗
▶Ep 122 · 3:04
clinicalThe number of patients who had rectal prolapse is consistent with the literature↗
▶Ep 122 · 5:20
clinicalA study looked at 30-day outcomes for patients with ARM with perineal or rectovestibular fistulas who underwent repair, divided between early (before 6 days old) and late repair (6-8 weeks)↗
▶Ep 122 · 5:31
clinicalThere were 291 patients in the early vs late repair study: 66 underwent early repair and 231 underwent late repair↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 135 · 1:38
clinicalDr. Patkowski's center in Poland has been performing thoracoscopic esophageal atresia repair exclusively since 2005↗
▶Ep 135 · 1:47
quoteWe were happy that our first procedure was successful. When we did another one, it was much easier. Of course, at the beginning, the first procedure took us almost 4 hours. Right now it's a 1 hour procedure, but of course it's very difficult, but we are very happy to have no conversion.↗
▶Ep 135 · 1:54
clinicalThe first thoracoscopic EA procedure took almost 4 hours, but the procedure now takes 1 hour↗
▶Ep 135 · 1:59
clinicalThe Polish center has had no conversions from thoracoscopic to open approach since beginning the technique↗
▶Ep 135 · 2:06
clinicalAll thoracoscopic EA cases at the Polish center have been managed by one team using only the thoracoscopic approach↗
▶Ep 135 · 2:25
clinicalExperience in endoscopic surgery and endoscopic suturing is required for thoracoscopic EA repair↗
▶Ep 135 · 2:25
quoteThe first, you need experience in endoscopic surgery. And then just you need time, and you must be very experienced in endoscopic suturing. You must be very slow. If you do it slowly, you will do it fast.↗
▶Ep 135 · 2:58
opinionCentralization of EA care is important even if transportation costs are higher, because complication costs are much higher↗
▶Ep 135 · 2:58
quoteEven if this is a higher cost, but probably the costs of complications are much, much more higher than transportation.↗
▶Ep 135 · 3:06
quoteAt my center we have about 15 to 20 cases a year. It depends on the year, and it shows that with such a number of cases you can get a good experience.↗
▶Ep 135 · 3:06
clinicalThe Polish center handles 15 to 20 EA cases per year, which provides sufficient volume for good experience↗
▶Ep 135 · 5:25
epidemiologicalThe Sheffield study included 95 Hirschsprung disease patients from January 2004 to August 2021↗
▶Ep 135 · 5:41
clinicalIn the stoma cohort, 38 patients had ileostomies and the remainder had colostomies↗
▶Ep 135 · 5:46
clinicalThe most common indication for initial stoma was washout failure in nearly 40% of cases↗
clinicalThe Tendon et al. study was a prospective randomized control trial conducted between 2017 and 2018↗
▶Ep 138 · 3:55
clinicalThe study compared three skin closure groups: sutures with tissue adhesive, sutures with adhesive tape, and sutures alone↗
▶Ep 138 · 4:10
clinicalWounds were assessed at two weeks, six weeks, and more than six months after operation by surveying clinicians and parents↗
Quick Literature Updates Episode 14
▶Ep 149 · 1:13
epidemiological384 females with anorectal malformations were studied from the Pediatric Colorectal and Pelvic Learning Consortium database↗
▶Ep 149 · 1:22
epidemiologicalAbout 46% of females with anorectal malformations had VACTERL association (anorectal malformation plus two of: vertebral, cardiac, tracheoesophageal, renal, or limb anomaly)↗
▶Ep 149 · 1:22
epidemiologicalAbout 27% of patients with anorectal malformations had a gynecologic anomaly↗
▶Ep 149 · 1:39
clinicalHaving VACTERL association was associated with more gynecologic anomalies compared to those without VACTERL↗
▶Ep 149 · 1:49
clinicalThe association between VACTERL and gynecologic anomalies was especially true when renal anomalies were found↗
▶Ep 149 · 1:49
clinicalThe association between VACTERL and gynecologic anomalies was especially true when patients had recto vestibular or rectal perineal fistulas↗
▶Ep 149 · 1:57
quoteSo for females with inner rectum malformations and veal association, especially renal anomalies, we should look carefully for gynecologic anomalies.↗
▶Ep 149 · 1:57
guidelineFor females with anorectal malformations and VACTERL association, especially renal anomalies, clinicians should look carefully for gynecologic anomalies↗
Quick Literature Updates Episode 15
▶Ep 156 · 2:11
epidemiologicalThe choledochal cyst study used the nationwide readmissions database and identified 577 children who underwent choledochal cyst resection between 2016 and 2018↗
▶Ep 156 · 2:21
clinicalPatients who underwent open choledochal cyst resection were more likely to have a Roux-en-Y hepaticojejunostomy↗
▶Ep 156 · 2:21
epidemiologicalThe majority of choledochal cyst patients underwent open resection↗
▶Ep 156 · 2:21
clinicalPatients who underwent laparoscopic choledochal cyst resection were more likely to have a hepaticoduodenostomy↗
▶Ep 156 · 2:36
clinicalPatients who underwent open choledochal cyst resection had longer length of hospital stay compared to laparoscopic resection↗
▶Ep 156 · 2:36
clinicalPatients who underwent open choledochal cyst resection had more complications compared to laparoscopic resection↗
▶Ep 156 · 2:36
clinicalPatients who underwent open choledochal cyst resection had higher total costs compared to laparoscopic resection↗
Journal of Pediatric Surgery Article Review: November 2021
▶Ep 26 · 1:09
clinical40% of patients ultimately required a central venous line within 30 days after ECMO decannulation↗
▶Ep 26 · 2:27
clinicalIn neonates (babies less than 28 days), the primary reason for needing a central line after ECMO decannulation was access, with many being CDH babies↗
▶Ep 26 · 2:41
clinicalIn older children or babies, the primary reason for needing a line after ECMO decannulation was hemodialysis↗
▶Ep 26 · 8:35
clinicalThe partial splenectomy study reviewed cases from 2002 to 2019, spanning 17 years↗
▶Ep 26 · 9:33
clinicalOther indications included splenomegaly or hereditary pyropoikilocytosis in about 3 patients↗
Case Based Journal Review - CPAM in 2022
▶Ep 27 · 2:30
clinicalA prospective study followed prenatally diagnosed congenital cystic lung lesions for a median of 10 years↗
▶Ep 27 · 2:38
clinical57% or 68% of patients in the prospective study were managed conservatively↗
▶Ep 27 · 4:47
clinicalOf 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor↗
▶Ep 27 · 7:18
clinicalPatients without prior infection had fewer postoperative fevers and less need for antibiotics postoperatively↗
▶Ep 27 · 7:18
clinicalPatients without prior pulmonary infection had shorter operative times↗
▶Ep 27 · 7:37
clinicalThere were no significant differences in postoperative complications between groups with and without prior infection↗
▶Ep 27 · 9:32
clinicalOperative time increased with each increase in age group↗
▶Ep 27 · 9:39
clinicalAt younger ages, the tissue planes are easier to dissect↗
▶Ep 27 · 9:50
clinicalBetween 1 and 3 months, operative time was 115 minutes compared to 163 minutes in the 6 to 12 months group↗
clinicalThe Teodoro study examined pediatric trauma patients with gunshot wounds or MVCs presenting to a level one trauma center between 2009 and 2019↗
▶Ep 49 · 0:20
clinicalGunshot wound victims were 7.8 times more likely to die than MVC victims↗
▶Ep 49 · 0:20
epidemiologicalIn California statewide data from 2006 to 2015, the case fatality rate for gunshot wound victims was higher than for motor vehicle collisions↗
▶Ep 49 · 0:20
clinicalGunshot wound victims were more likely to require immediate surgery and had increased mortality compared to MVC victims↗
▶Ep 49 · 1:29
epidemiologicalThe case fatality rate for pediatric gunshot wounds increased from 2006 to 2015 in California↗
▶Ep 49 · 1:29
quoteThe authors concluded, as others have, that firearm injuries are more lethal in children than MVCs and we need to do something about it.↗
Quick Literature Updates Episode 11
▶Ep 52 · 0:46
epidemiologicalThe CDC Wonder database was used to examine data between 1999 and 2020 for pediatric firearm and automobile fatalities.↗
▶Ep 52 · 0:46
epidemiologicalIn recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children.↗
▶Ep 52 · 0:46
epidemiologicalStronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws.↗
▶Ep 52 · 0:46
epidemiologicalThe Gifford's Law Center annual gun law scorecard between 2014 and 2020 was used to assess state gun law scores.↗
clinicalTreatment options for giant omphalocele include painting the sac, removing sac and placing silo with passive or active reduction, keeping sac with active reduction, or definitive immediate closure↗
▶Ep 73 · 3:54
clinicalHydrocolloid dressing technique for giant omphalocele achieved closure in 97% of 40 patients within 30 days and 92% within 15 days↗
▶Ep 73 · 6:42
quoteThat's Dr. Salim Islam, who's the chief of pediatric surgery at the University of Florida College of Medicine.↗
▶Ep 73 · 10:26
clinicalComponent separation technique involves separating tissue at external oblique about one centimeter beyond rectus sheath on both sides, creating space by dissecting between external and internal oblique↗
▶Ep 73 · 10:26
clinicalTexas report of component separation in nine children aged 7 days to 10 years achieved fascial closure in vast majority, mostly for omphaloceles and giant defects↗
▶Ep 73 · 10:26
clinicalIncision on anterior rectus sheath can provide additional centimeter of space for closure↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 9 · 7:22
clinicalA child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues↗
▶Ep 9 · 9:29
clinicalPostnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
▶Ep 18 · 5:52
clinicalEven if an anastomosis is patent, disparate diameter will result in functional obstruction↗
▶Ep 18 · 9:36
clinicalAt birth, bowel is usually not dilated enough to apply the STEP procedure↗
▶Ep 18 · 13:36
quoteThe last thing you want to do is make it too narrow and then you end up obstructing the patient.↗
▶Ep 18 · 15:57
clinicalIf one part of the bowel becomes dilated, the STEP segments can rotate away from each other and form a functional obstruction↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
▶Ep 19 · 1:50
epidemiologicalIn the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols↗
▶Ep 19 · 9:36
clinicalAt birth, neonatal bowel is usually not dilated enough to apply the STEP procedure↗
▶Ep 19 · 15:52
clinicalDilated segments in STEP can allow the stepped segments to rotate away from each other and twist, forming a functional obstruction↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 2
▶Ep 20 · 2:04
clinicalThe STEP procedure redistributes bowel rather than creating new bowel, helping to reestablish normal caliber which improves motility↗
▶Ep 20 · 3:34
clinicalAbout 50% reduction in parental nutrition support can be expected after STEP↗
▶Ep 20 · 6:32
clinicalThere is a spectrum of bleeding from staple-line ulcers ranging from specks of blood in stool to requiring transfusion every week and a half↗
▶Ep 20 · 7:21
clinicalMedical management attempts for staple-line bleeding have included enteral omega 3 lipid supplements, cycled antibiotics, probiotics, 5ASA, budesonide, and immune modulators like Remicade, but none have been the perfect remedy↗
▶Ep 20 · 8:17
clinicalMesenteric scarring causes enlarged veins, venous hypertension, and large lymph nodes from lymphatic obstruction visible on the bowel↗
▶Ep 20 · 10:25
clinicalDoing things in a staged fashion is typical for the intestinal failure patient population↗
▶Ep 20 · 11:15
clinicalIntestinal failure is a lifelong issue requiring long-term multidisciplinary follow-up↗
Intestinal Rehabilitation, Episode 6: Cholestasis
▶Ep 21 · 10:17
clinicalIt may take several weeks for bilirubin and liver enzyme levels to come back down after refeeding↗
clinicalIf contrast enters the stomach in organoaxial volvulus, the greater curvature appears flipped up↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
▶Ep 66 · 5:52
clinicalEven if an anastomosis is patent, disparate diameter will result in functional obstruction↗
▶Ep 66 · 9:36
clinicalAt birth, bowel is usually not dilated enough to apply the STEP procedure↗
▶Ep 66 · 13:36
quoteThe last thing you want to do is make it too narrow and then you end up obstructing the patient.↗
▶Ep 66 · 15:57
clinicalIf one part of the bowel becomes dilated, the STEP segments can rotate away from each other and form a functional obstruction↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
▶Ep 67 · 1:50
epidemiologicalIn the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols↗
▶Ep 67 · 9:36
clinicalAt birth, neonatal bowel is usually not dilated enough to apply the STEP procedure↗
▶Ep 67 · 15:52
clinicalDilated segments in STEP can allow the stepped segments to rotate away from each other and twist, forming a functional obstruction↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 2
▶Ep 68 · 2:04
clinicalThe STEP procedure redistributes bowel rather than creating new bowel, helping to reestablish normal caliber which improves motility↗
▶Ep 68 · 3:34
clinicalAbout 50% reduction in parental nutrition support can be expected after STEP↗
▶Ep 68 · 6:32
clinicalThere is a spectrum of bleeding from staple-line ulcers ranging from specks of blood in stool to requiring transfusion every week and a half↗
▶Ep 68 · 7:21
clinicalMedical management attempts for staple-line bleeding have included enteral omega 3 lipid supplements, cycled antibiotics, probiotics, 5ASA, budesonide, and immune modulators like Remicade, but none have been the perfect remedy↗
▶Ep 68 · 8:17
clinicalMesenteric scarring causes enlarged veins, venous hypertension, and large lymph nodes from lymphatic obstruction visible on the bowel↗
▶Ep 68 · 10:25
clinicalDoing things in a staged fashion is typical for the intestinal failure patient population↗
▶Ep 68 · 11:15
clinicalIntestinal failure is a lifelong issue requiring long-term multidisciplinary follow-up↗
Quick Literature Updates Episode 6
▶Ep 71 · 0:20
clinicalGunshot wound victims were 7.8 times more likely to die than MVC victims↗
▶Ep 71 · 0:20
clinicalGunshot wound victims were more likely to require immediate surgery and had increased mortality compared to MVC victims↗
▶Ep 71 · 0:20
clinicalThe Teodoro study examined pediatric trauma patients with gunshot wounds or MVCs presenting to a level one trauma center between 2009 and 2019↗
▶Ep 71 · 0:20
epidemiologicalIn California statewide data from 2006 to 2015, the case fatality rate for gunshot wound victims was higher than for motor vehicle collisions↗
▶Ep 71 · 1:29
quoteThe authors concluded, as others have, that firearm injuries are more lethal in children than MVCs and we need to do something about it.↗
▶Ep 71 · 1:29
epidemiologicalThe case fatality rate for pediatric gunshot wounds increased from 2006 to 2015 in California↗
Quick Literature Updates Episode 7
▶Ep 72 · 3:35
clinicalThe Tendon et al. study was a prospective randomized control trial conducted between 2017 and 2018↗
▶Ep 72 · 3:55
clinicalThe study compared three skin closure groups: sutures with tissue adhesive, sutures with adhesive tape, and sutures alone↗
▶Ep 72 · 4:10
clinicalWounds were assessed at two weeks, six weeks, and more than six months after operation by surveying clinicians and parents↗
Intestinal Rehabilitation, Episode 6: Cholestasis
▶Ep 73 · 10:17
clinicalIt may take several weeks for bilirubin and liver enzyme levels to come back down after refeeding↗
Quick Literature Updates Episode 11
▶Ep 76 · 0:46
epidemiologicalThe CDC Wonder database was used to examine data between 1999 and 2020 for pediatric firearm and automobile fatalities.↗
▶Ep 76 · 0:46
epidemiologicalIn recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children.↗
▶Ep 76 · 0:46
epidemiologicalThe Gifford's Law Center annual gun law scorecard between 2014 and 2020 was used to assess state gun law scores.↗
▶Ep 76 · 0:46
epidemiologicalStronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws.↗
clinicalTreatment options for giant omphalocele include painting the sac, removing sac and placing silo with passive or active reduction, keeping sac with active reduction, or definitive immediate closure↗
▶Ep 105 · 3:54
clinicalHydrocolloid dressing technique for giant omphalocele achieved closure in 97% of 40 patients within 30 days and 92% within 15 days↗
▶Ep 105 · 6:42
quoteThat's Dr. Salim Islam, who's the chief of pediatric surgery at the University of Florida College of Medicine.↗
▶Ep 105 · 10:26
clinicalComponent separation technique involves separating tissue at external oblique about one centimeter beyond rectus sheath on both sides, creating space by dissecting between external and internal oblique↗
▶Ep 105 · 10:26
clinicalIncision on anterior rectus sheath can provide additional centimeter of space for closure↗
▶Ep 105 · 10:26
clinicalTexas report of component separation in nine children aged 7 days to 10 years achieved fascial closure in vast majority, mostly for omphaloceles and giant defects↗
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain↗
Update Course Rewind: Pectus Excavatum 2021
▶Ep 26 · 1:57
clinicalCryoanalgesia uses cold temperatures to cause a conduction block that interrupts pain impulses to the brain↗
Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum - JPS article
▶Ep 29 · 0:11
clinicalThe Haller index and correction index are the currently primarily used indices for pectus excavatum and tell us about the severity of the deformity.↗
▶Ep 29 · 0:19
clinicalThe Titanic index takes into account the extent of the pectus excavatum deformity.↗
▶Ep 29 · 0:25
clinicalThe Titanic index is calculated as the percentage of the sternum that lies behind the anterior costal line as seen on CT scans.↗
▶Ep 29 · 0:35
clinicalThe study was a retrospective review of patients at an institution in Argentina who had undergone minimally invasive repair of pectus excavatum.↗
▶Ep 29 · 0:46
clinicalThe study found a weak correlation between the Titanic index and the other indices (Haller and correction index).↗
▶Ep 29 · 0:46
clinicalThe Titanic index might be more helpful for helping determine how many bars a patient is going to need for repair.↗
▶Ep 29 · 0:57
clinicalThe threshold established was 66.5%, meaning that patients with a higher Titanic index than that probably needed more than 2 bars.↗
▶Ep 29 · 0:57
quoteThe threshold they established here was 66.5%, meaning that patients with a higher titanic index than that probably needed more than 2 bars.↗
Journal of pediatric surgery Article Review: April 2023, IPEG issue
▶Ep 31 · 5:36
clinicalSevere outcomes in button battery ingestion were defined as deep mucosal erosion, perforation, mediastinitis, vascular or airway injury or fistula, and development of esophageal stricture↗
▶Ep 31 · 6:05
epidemiologicalThe Boston study included 143 patients under 21 years old from 2008 to 2021, with 24 having severe outcomes↗
▶Ep 31 · 6:20
clinicalThree predictive factors for severe button battery outcomes were: presence in esophagus at presentation, two centimeter or larger battery size, and presence of any symptoms↗
Quick Literature Updates Episode 13
▶Ep 37 · 1:12
clinicalThe Haller index and correction index are currently the primary indices used for pectus excavatum and tell us about the severity of the deformity↗
▶Ep 37 · 1:20
quoteThis new index, or the Titanic index as they're calling it, takes into account the extent of the deformity.↗
▶Ep 37 · 1:26
clinicalThe Titanic index is the percentage of the sternum that lies behind the anterior costal line as seen on CT scans↗
▶Ep 37 · 1:44
clinicalThere is a weak correlation between the Titanic index and the other indices (Haller and correction indices)↗
▶Ep 37 · 1:44
clinicalThe Titanic index might be more helpful for determining how many bars a patient will need for pectus excavatum repair↗
▶Ep 37 · 1:55
clinicalA Titanic index threshold of 66.5% was established, with patients above this threshold probably needing more than 2 bars for repair↗
clinicalThe Haller index and correction index are currently the primary indices used for pectus excavatum and tell us about the severity of the deformity↗
▶Ep 7 · 1:20
quoteThis new index, or the Titanic index as they're calling it, takes into account the extent of the deformity.↗
▶Ep 7 · 1:26
clinicalThe Titanic index is the percentage of the sternum that lies behind the anterior costal line as seen on CT scans↗
▶Ep 7 · 1:44
clinicalThe Titanic index might be more helpful for determining how many bars a patient will need for pectus excavatum repair↗
▶Ep 7 · 1:44
clinicalThere is a weak correlation between the Titanic index and the other indices (Haller and correction indices)↗
▶Ep 7 · 1:55
clinicalA Titanic index threshold of 66.5% was established, with patients above this threshold probably needing more than 2 bars for repair↗
clinicalPetcova et al. published in Annals of Surgery in 2020 a study of children with uncomplicated appendicitis randomized to medical management with antibiotics or surgery, with 5-year follow-up↗
▶Ep 13 · 5:20
quoteYou can see very well the biliary anatomy is absolutely. Amazing, as you can see, the main biliary tree, the gallbladder, and then the cystic duct.↗
▶Ep 13 · 5:32
clinicalICG must be administered intravenously 12-18 hours prior to surgery to accumulate in extrahepatic ducts↗
▶Ep 13 · 5:43
clinicalICG can be injected directly into the gallbladder during surgery as an alternative to pre-operative IV administration↗
▶Ep 13 · 9:48
clinicalDouble rim sign or halo sign on X-ray indicates button battery ingestion rather than coin ingestion↗
▶Ep 13 · 10:13
guidelineMain goal of button battery ingestion treatment is removal within 2 hours of ingestion↗
▶Ep 13 · 10:27
quoteWhat you need to do is cut down on the damage, the injury that this is doing. Sucralfate or honey can help.↗
▶Ep 13 · 10:35
guidelineChildren <1 year with button battery ingestion should receive 10mL sucralfate every 10 minutes for up to 3 doses (not honey due to botulism risk)↗
▶Ep 13 · 10:51
guidelineChildren ≥1 year with button battery ingestion should receive 10mL honey every 10 minutes for up to 6 doses↗
▶Ep 13 · 14:13
epidemiologicalMortality among black newborns is 3 times that of white newborns↗
▶Ep 13 · 14:19
epidemiologicalWhen black newborns are treated by black physicians, their mortality is reduced by 58% compared to black newborns treated by white physicians (Greenwood et al.)↗
▶Ep 13 · 14:57
quoterecognizing that we all have biases and not being defensive when someone says there's bias in that because we all have bias. We know that we all have bias. And so the question is, what are your biases and how do they affect what you do?↗
▶Ep 13 · 15:14
quoteSo I would push everyone. To say, as you're thinking about this work, as you, as you live in this space, you know, what are you doing about it?↗
▶Ep 13 · 15:21
quoteSo let's not just settle to talk about it, but let's figure out what the system level changes are that make a difference and change the outcome.↗
Case Based Journal Review - CPAM in 2022
▶Ep 15 · 2:30
clinicalA prospective study followed prenatally diagnosed congenital cystic lung lesions for a median of 10 years↗
▶Ep 15 · 2:38
clinical57% or 68% of patients in the prospective study were managed conservatively↗
▶Ep 15 · 4:47
clinicalOf 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor↗
▶Ep 15 · 7:18
clinicalPatients without prior infection had fewer postoperative fevers and less need for antibiotics postoperatively↗
▶Ep 15 · 7:18
clinicalPatients without prior pulmonary infection had shorter operative times↗
▶Ep 15 · 7:37
clinicalThere were no significant differences in postoperative complications between groups with and without prior infection↗
▶Ep 15 · 9:32
clinicalOperative time increased with each increase in age group↗
▶Ep 15 · 9:39
clinicalAt younger ages, the tissue planes are easier to dissect↗
▶Ep 15 · 9:50
clinicalBetween 1 and 3 months, operative time was 115 minutes compared to 163 minutes in the 6 to 12 months group↗
Update Course Rewind: Thoracotomy vs VATS for Lung Metastases
▶Ep 18 · 1:29
epidemiologicalAbout 20% of osteosarcoma patients already have lung metastases by the time of diagnosis↗
▶Ep 18 · 4:10
clinicalThoracotomy is more invasive than other alternatives and there is longer hospital stay↗
▶Ep 18 · 5:07
clinicalOften with thoracotomy, you can take out 15 to 20 nodules, but with thoracoscopy, it's a little more limited as to how many you can actually find and localize↗
▶Ep 18 · 5:23
epidemiologicalA multi-institution study including 200 patients with metastatic osteosarcoma is the largest study that has ever been done↗
Intestinal Rehabilitation, Episode 1: What is intestinal rehabilitation?
▶Ep 4 · 7:22
clinicalA child with gastroschisis could have short bowel because it was not all viable, inflammation affecting absorption, and motility issues↗
▶Ep 4 · 9:29
clinicalPostnatal acquired problems leading to intestinal rehabilitation include volvulus and necrotizing enterocolitis↗
Intestinal Rehabilitation, Episode 4: Surgical Management, Part 1
▶Ep 5 · 1:50
epidemiologicalIn the 1980s and 1990s, babies with intestinal failure had poor outcomes primarily due to liver progression to inflammation and fibrosis associated with parenteral nutrition, lipids, and phytosterols↗
▶Ep 5 · 9:36
clinicalAt birth, neonatal bowel is usually not dilated enough to apply the STEP procedure↗
▶Ep 5 · 15:52
clinicalDilated segments in STEP can allow the stepped segments to rotate away from each other and twist, forming a functional obstruction↗
Quick Literature Updates Episode 7
▶Ep 6 · 3:35
clinicalThe Tendon et al. study was a prospective randomized control trial conducted between 2017 and 2018↗
▶Ep 6 · 3:55
clinicalThe study compared three skin closure groups: sutures with tissue adhesive, sutures with adhesive tape, and sutures alone↗
▶Ep 6 · 4:10
clinicalWounds were assessed at two weeks, six weeks, and more than six months after operation by surveying clinicians and parents↗
