My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
My name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.
I think as soon as you start seeing that pancreatic duct light up, that is a signal to slow down on your flush, be careful because you can cause pancreatitis.
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 36 · 1:25
clinicalMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes↗
▶Ep 36 · 1:37
clinicalMMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 36 · 1:43
clinicalHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 36 · 1:56
epidemiologicalOut of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 36 · 2:36
clinicalLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin↗
▶Ep 36 · 3:02
clinicalGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain↗
▶Ep 36 · 3:12
clinicalGGT blood test levels are used to detect diseases of the liver and bile ducts↗
▶Ep 36 · 3:27
clinicalBiliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion↗
▶Ep 36 · 4:09
clinicalLower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes↗
▶Ep 36 · 4:41
clinicalThe reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown↗
▶Ep 36 · 7:02
epidemiologicalThe gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants↗
▶Ep 36 · 7:43
epidemiological78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula↗
▶Ep 36 · 8:27
clinicalThere were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay↗
▶Ep 36 · 12:55
epidemiologicalThe transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 36 · 13:16
clinicalThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)↗
▶Ep 36 · 13:30
clinicalThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 37 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 37 · 3:20
epidemiological85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 37 · 3:45
clinicalKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 37 · 3:57
clinicalChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 37 · 4:26
epidemiologicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 37 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 37 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 37 · 5:13
clinicalHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 37 · 5:24
clinicalThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 37 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 37 · 8:09
clinicalThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 37 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 37 · 10:37
clinicalSkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 37 · 10:44
epidemiologicalGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 37 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods↗
▶Ep 37 · 10:50
clinicalSutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 37 · 10:57
guidelineRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 37 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 37 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 37 · 17:04
epidemiological43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 37 · 17:16
epidemiologicalAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 39 · 0:34
clinicalThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly↗
▶Ep 39 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 39 · 0:50
clinicalDelayed umbilical cord separation can be a manifestation of immune deficiency↗
▶Ep 39 · 0:50
clinicalUmbilical cords usually fall off at 2 to 3 weeks↗
▶Ep 39 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 39 · 1:16
clinicalOmphalitis is most commonly due to staph and strep from skin flora↗
▶Ep 39 · 1:20
clinicalMild omphalitis cases may be treated with alcohol, drying, ampicillin, or amoxicillin with follow-up every 24 hours↗
▶Ep 39 · 1:40
epidemiological16% of patients admitted with omphalitis develop necrotizing fasciitis↗
▶Ep 39 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 39 · 2:27
clinicalUmbilical hernias can be associated with trisomy 13, 18, and 21↗
▶Ep 39 · 2:38
clinicalMost umbilical hernias heal by the time the child is 3 to 5 years old↗
▶Ep 39 · 2:47
clinicalIf the fascial opening is larger than 1.5 centimeters, the hernia may not close by itself↗
▶Ep 39 · 2:55
epidemiologicalIn Walker's study, 96% of umbilical hernias less than 0.5 centimeters closed by six years, but no hernia greater than 1.5 centimeters closed by six years↗
▶Ep 39 · 4:20
guidelineFor asymptomatic umbilical hernias in children around 4 years old, that is when surgery should be considered↗
▶Ep 39 · 4:54
epidemiologicalUnplanned emergency department returns within 30 days occurred at 2.5% and were twice as high for patients younger than 4 years old↗
▶Ep 39 · 5:10
guidelineAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age↗
▶Ep 39 · 5:18
epidemiologicalIn Rangel's study of 167,000 patients, 4,486 had umbilical hernia diagnosis at median age of 1.6 months↗
▶Ep 39 · 5:53
epidemiologicalClosure rates for smaller hernias (less than 1 cm) were nearly 90%, while for larger hernias they were around 80%↗
▶Ep 39 · 5:53
epidemiologicalSpontaneous closure of umbilical hernias occurred in 89% by age 5↗
▶Ep 39 · 6:12
guidelineUmbilical hernia repair should be delayed until age 5 years based on high spontaneous closure rates↗
▶Ep 39 · 7:00
guidelineProboscoid hernia should be corrected before school age to avoid psychological issues↗
▶Ep 39 · 7:22
clinicalUmbilical hernia repair involves interrupted closure using vicryl or absorbable suture↗
▶Ep 39 · 8:55
clinicalUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time↗
▶Ep 39 · 9:00
clinicalUmbilical granulomas often respond to silver nitrate treatment↗
▶Ep 39 · 9:07
clinicalSilver nitrate application can cause burnt skin around the belly button if not properly applied↗
▶Ep 39 · 9:37
clinicalBright red, pedunculated umbilical granulomas that bleed easily are more difficult to manage↗
QUAD #2 Thoracoscopic Tracheopexy with Dr. Aaron Garrison
▶Ep 17 · 0:43
guidelineIn the last 4 to 5 years, it has become standard practice to determine which patients will respond best to tracheopexy versus aortopexy↗
▶Ep 17 · 1:45
clinicalPreoperative workup must confirm there is space to anteriorly suspend the aorta to make the trachea diameter larger↗
▶Ep 17 · 2:02
clinicalPreoperative bronchoscopy assists in classifying the degree of tracheomalacia prior to surgical intervention↗
▶Ep 17 · 3:23
clinicalCorrect positioning is key to success in thoracoscopic approach, using gravity to aid in retracting lungs↗
▶Ep 17 · 4:01
clinicalFinding the pericardial-adventitial junction to suspend is the key point in aortopexy↗
▶Ep 17 · 4:16
clinicalPassing suture transternally is preferred in aortopexy though it can be technically difficult↗
▶Ep 17 · 4:23
clinicalFor tracheopexy, a posterior approach via semiprone position is preferred↗
▶Ep 17 · 4:28
clinicalCreating a pneumothorax by placing the Veress off the tip of the scapula helps collapse the lung for trocar placement↗
▶Ep 17 · 4:38
clinicalTriangulating hands gives the best visualization and working space during posterior tracheopexy↗
▶Ep 17 · 4:56
clinicalMultidisciplinary team with pulmonologist allows internal visualization via bronchoscopy, primarily used in non-esophageal atresia patients↗
▶Ep 17 · 6:07
clinicalFor patients without esophageal atresia or with esophagus in continuity, the first step is to dissect around the esophagus using a vessel loop for retraction↗
▶Ep 17 · 6:32
clinicalPre and post-operative bronchoscopy allows visualization of improvement in posterior tracheal intrusion prior to case completion↗
QUAD #4: Surgical Management of Button Battery & Caustic Ingestion with Dr. Aaron Garrison
▶Ep 18 · 0:41
epidemiologicalA 1992 study of over 2000 button battery ingestions found no deaths↗
▶Ep 18 · 0:52
epidemiologicalRecent studies show a sevenfold increase in fatalities following button battery ingestions↗
▶Ep 18 · 0:59
clinicalThe increase in fatalities is due to change to 20-volt lithium cells which cause coagulative necrosis↗
▶Ep 18 · 1:14
clinicalButton batteries cause transmural injury and create fistulas to adjacent structures including trachea and blood vessels↗
▶Ep 18 · 1:39
clinicalBatteries 20 millimeters or greater in size are riskier↗
▶Ep 18 · 1:49
clinicalBattery location behind the aortic arch is more concerning↗
▶Ep 18 · 2:05
epidemiologicalIn a Colorado study of 13 high-severity injury patients, 30% had esophageal perforation↗
▶Ep 18 · 2:14
epidemiological23% of high-severity injury patients developed strictures↗
▶Ep 18 · 2:16
epidemiologicalHigh-severity injury patients stayed in hospital for nearly 2 weeks↗
▶Ep 18 · 2:32
clinicalSentinel bleeds can be the first sign of aortoenteric fistulas↗
▶Ep 18 · 2:50
clinicalSome aortoesophageal fistulas appeared over 2 weeks after battery removal↗
▶Ep 18 · 3:39
clinicalCTA imaging before endoscopy can assess inflammation and proximity to aorta↗
▶Ep 18 · 6:10
epidemiologicalButton batteries are ingested more than 3500 times per year in the United States↗
▶Ep 18 · 6:20
epidemiologicalCaustic ingestion is most common in children between 1 and 3 years of age↗
▶Ep 18 · 6:25
epidemiologicalMost caustic ingestions by children are accidental and amounts tend to be small↗
▶Ep 18 · 6:43
clinicalSevere epiglottic injury can occur from caustic substances that are spit back up rather than swallowed↗
▶Ep 18 · 7:25
clinicalInjuries from button batteries can progress even after removal↗
▶Ep 18 · 7:39
clinicalSmall perforations from caustic ingestion can heal and be managed conservatively↗
▶Ep 18 · 7:43
clinicalStrictures from caustic ingestion may require dilation or surgery↗
QUAD #7 Anesthesia for Thoracoscopic Techniques with Dr. Nathaniel Tighe
▶Ep 20 · 1:05
epidemiologicalEsophageal atresia has an association with cardiac abnormalities↗
▶Ep 20 · 1:24
clinicalThere are four anesthetic goals in the operating room: amnesia, akinesis, analgesia, and autonomic/hemodynamic stability↗
▶Ep 20 · 1:42
clinicalShort-acting opioid infusions are the most common technique for maintaining stillness and result in relatively little hemodynamic instability↗
▶Ep 20 · 1:53
clinicalVolatile anesthetics are especially useful when preservation of spontaneous ventilation is desired↗
▶Ep 20 · 2:48
clinicalInsufflation is useful for small kids with good lung compliance but not effective in kids with severe bronchopulmonary dysplasia or other compliance abnormalities↗
▶Ep 20 · 4:39
clinicalIn kids with pig bronchus, bronchial blocker placement becomes very difficult and may require selective lobar blockade↗
▶Ep 20 · 4:48
clinicalA tracheal bronchus (pig bronchus) is an anatomical variant where an accessory bronchus originates directly from the supracarinal trachea↗
▶Ep 20 · 5:17
clinicalDouble-lumen tubes can be used in larger kids (usually 8 years old or above) with recurrent fistulas and are the easiest device for lung isolation↗
▶Ep 20 · 5:38
opinionEarly conversations between anesthesiologists and surgeons about patient specifics are part of deciding the best modality for each individual patient↗
▶Ep 20 · 6:07
clinicalSingle ventricle patients may be candidates for open surgery or ECMO support to ensure good outcomes↗
QUAD #5 Pharyngeal Scar Management with Dr. Doug von Allmen
▶Ep 21 · 0:42
clinicalEtiologies of pharyngeal stenosis include caustic ingestion, iatrogenic injury, or multi-level upper airway surgery↗
▶Ep 21 · 1:05
clinicalTreatment goals are tiered: adequate voice, breathing without tracheostomy, prevention of aspiration, and swallowing without G-tube↗
▶Ep 21 · 2:59
clinicalProlonged stenting of 4 to 6 weeks is typical for pharyngeal stenosis management↗
▶Ep 21 · 3:28
clinicalAt 4-6 weeks post-stent placement, well-healed mucosa and improved glottic inlet access were observed↗
▶Ep 21 · 3:50
clinicalAt one-year follow-up, the patient remained tracheostomy and G-tube dependent despite colon interposition↗
▶Ep 21 · 4:24
clinicalAdjuvant injectables such as steroids, mitomycin C, and 5-fluorouracil can delay recalcitrant scar formation↗
▶Ep 21 · 5:48
clinicalTracheostomy can be helpful for managing aspiration risk in pharyngeal stenosis patients↗
▶Ep 21 · 5:48
clinicalPharyngeal stenosis patients are at high risk for ongoing aspiration↗
▶Ep 21 · 5:55
clinicalSwallowing outcomes can be difficult and poor in the long term for pharyngeal stenosis patients↗
QUAD #20: Endoscopic Repair of Minor Laryngeal Clefts with Dr. Catherine Hart
▶Ep 22 · 1:45
clinicalThe goal of endoscopic cleft repair is to remove the interarytenoid mucosa to create two raw surfaces that are then sewn together↗
▶Ep 22 · 2:05
clinicalTaking suture bites too deeply results in inverted edges and continued clinical problems↗
▶Ep 22 · 2:23
clinicalInterarytenoid mucosa can be resected using either laser or cold steel↗
▶Ep 22 · 2:42
clinicalComplete demucosalization of the apex is critical; incomplete demucosalization results in a persistent hole at the apex and continued aspiration↗
▶Ep 22 · 2:47
quoteIf it's not, you're going to have a little hole at the apex, and that child is going to continue to aspirate.↗
▶Ep 22 · 3:01
clinicalEpiglottic folds are released after suturing to create additional space↗
▶Ep 22 · 4:31
epidemiologicalSurgical cleft closure achieves symptom improvement in almost 80% of children and resolution in 70%↗
▶Ep 22 · 4:36
clinicalSurgical closure carries a slightly higher risk of complications compared to conservative management↗
QUAD #25: Medical Management of Minor Laryngeal Clefts with Dr. Greg Burg
▶Ep 24 · 0:54
clinicalFlexible bronchoscopy is quite limited in evaluating a cleft unless it's a major cleft↗
▶Ep 24 · 1:44
clinicalRespiratory culture showed predominantly upper airway flora and two candidal species in the mucopurulent bronchitis↗
▶Ep 24 · 4:49
opinionPulmonary therapies for aspiration are mostly considered reactive band-aid therapies↗
▶Ep 24 · 4:57
clinicalSaline is used to thin out secretions in aspiration patients↗
▶Ep 24 · 4:57
clinicalChronic macrolide therapy can be used as an anti-neutrophilic agent, derived from cystic fibrosis literature↗
▶Ep 24 · 5:14
clinicalFor patients with significant tracheomalacia, ipratropium may be used over albuterol↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2025
▶Ep 27 · 2:28
clinicalMost patients in the tracheobronchopexy series had type C esophageal atresia↗
▶Ep 27 · 6:57
epidemiologicalA significant number of outreach services are located within 50 kilometers of a children's hospital↗
▶Ep 27 · 12:38
epidemiologicalThe study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 27 · 13:04
clinicalUpper GI studies were obtained in 45% of first-time G-tube cases with interhospital variability from 0 to 99%↗
▶Ep 27 · 13:45
clinical14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 27 · 13:45
clinical5.2% of G-tube cases involved dislodgement within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 23 · 1:25
clinicalMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes↗
▶Ep 23 · 1:37
clinicalMMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 23 · 1:43
clinicalHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 23 · 1:56
epidemiologicalOut of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 23 · 2:36
clinicalLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin↗
▶Ep 23 · 3:02
clinicalGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain↗
▶Ep 23 · 3:12
clinicalGGT blood test levels are used to detect diseases of the liver and bile ducts↗
▶Ep 23 · 3:27
clinicalBiliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion↗
▶Ep 23 · 4:09
clinicalLower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes↗
▶Ep 23 · 4:41
clinicalThe reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown↗
▶Ep 23 · 7:02
epidemiologicalThe gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants↗
▶Ep 23 · 7:43
epidemiological78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula↗
▶Ep 23 · 8:27
clinicalThere were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay↗
▶Ep 23 · 12:55
epidemiologicalThe transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 23 · 13:16
clinicalThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)↗
▶Ep 23 · 13:30
clinicalThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
clinicalThe key to treating biliary atresia is making an early diagnosis↗
▶Ep 24 · 1:16
clinicalMMP-7 was identified about 10 years ago as a diagnostic biomarker for biliary atresia by Georgia Bezarra's lab↗
▶Ep 24 · 1:37
clinicalThe sooner the Kasai is done, the more likely native liver will be saved↗
▶Ep 24 · 1:37
quoteThe sooner and sooner you get it done, the more likely you'll save the native liver.↗
▶Ep 24 · 2:55
epidemiologicalData from a Midwest study shows that for every 10 day delay in treatment, outcomes worsen by 20%↗
▶Ep 24 · 3:44
epidemiologicalWithin the Children's Network, biliary atresia disease frequency is low, with only 200 to 300 cases per year↗
▶Ep 24 · 4:01
clinicalDr. Bezarra validated MMP-7 findings in just 2 years through a study in mainland China where biliary atresia frequency is much higher↗
▶Ep 24 · 4:22
clinicalMMP-7 is now a validated biomarker for biliary atresia↗
▶Ep 24 · 4:52
epidemiologicalChildren's Network data showed that the average age of a biliary atresia patient going through Kasai in North America was around 75 days↗
Update Course Rewind: Perineal Body Sparing PSARP 2023
▶Ep 154 · 1:17
epidemiologicalOne study has 6 patients and the other has 4 patients.↗
▶Ep 154 · 1:20
clinicalThe techniques are similar but slightly different.↗
▶Ep 154 · 2:29
clinicalPerineal body-sparing techniques can reduce postoperative infection risks in patients undergoing dilations.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 159 · 5:17
clinicalSurvival was not statistically different between early and delayed CDH repair groups on ECMO↗
▶Ep 159 · 5:17
clinicalDuration of ECMO support was shorter in the early CDH repair group↗
▶Ep 159 · 9:32
epidemiologicalPhysician suicide is characterized by tragically high rates of suicide among doctors compared to the general population↗
▶Ep 159 · 10:17
clinicalHigh levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide↗
▶Ep 159 · 10:33
clinicalStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 164 · 1:25
clinicalMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes↗
▶Ep 164 · 1:37
clinicalMMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 164 · 1:43
clinicalHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 164 · 1:56
epidemiologicalOut of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 164 · 2:36
clinicalLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin↗
▶Ep 164 · 3:02
clinicalGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain↗
▶Ep 164 · 3:12
clinicalGGT blood test levels are used to detect diseases of the liver and bile ducts↗
▶Ep 164 · 3:27
clinicalBiliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion↗
▶Ep 164 · 4:09
clinicalLower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes↗
▶Ep 164 · 4:41
clinicalThe reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown↗
▶Ep 164 · 7:02
epidemiologicalThe gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants↗
▶Ep 164 · 7:43
epidemiological78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula↗
▶Ep 164 · 8:27
clinicalThere were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay↗
▶Ep 164 · 12:55
epidemiologicalThe transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 164 · 13:16
clinicalThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)↗
▶Ep 164 · 13:30
clinicalThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 167 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 167 · 3:20
epidemiological85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 167 · 3:45
clinicalKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 167 · 3:57
clinicalChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 167 · 4:26
epidemiologicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 167 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 167 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 167 · 5:13
clinicalHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 167 · 5:24
clinicalThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 167 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 167 · 8:09
clinicalThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 167 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 167 · 10:37
clinicalSkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 167 · 10:44
epidemiologicalGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 167 · 10:50
clinicalSutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 167 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods↗
▶Ep 167 · 10:57
guidelineRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 167 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 167 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 167 · 17:04
epidemiological43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 167 · 17:16
epidemiologicalAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Colorectal Quiz: Episode 49 – Collaborating for Kids: Colorectal & Pelvic Solutions (with a Little Help from AI)
▶Ep 177 · 5:56
quoteWhen you upload anything to the Notebook LM, you kind of create your own expert just from the provided document.↗
▶Ep 177 · 5:56
clinicalWhen content is uploaded to Notebook LM, it creates an expert based only on the provided documents, not external sources↗
Journal of Pediatric Surgery Article Review: October 2023
▶Ep 31 · 3:14
clinicalNo significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not↗
▶Ep 31 · 3:51
clinicalPotential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants↗
▶Ep 31 · 9:20
clinicalFactors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters↗
▶Ep 31 · 9:50
epidemiologicalThe CPAM study did not enroll patients who accepted conservative treatment↗
▶Ep 31 · 10:00
epidemiologicalThe CPAM study had insufficient sample size and was from a single center↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 56 · 1:25
clinicalMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes↗
▶Ep 56 · 1:37
clinicalMMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 56 · 1:43
clinicalHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 56 · 1:56
epidemiologicalOut of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 56 · 2:36
clinicalLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin↗
▶Ep 56 · 3:02
clinicalGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain↗
▶Ep 56 · 3:12
clinicalGGT blood test levels are used to detect diseases of the liver and bile ducts↗
▶Ep 56 · 3:27
clinicalBiliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion↗
▶Ep 56 · 4:09
clinicalLower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes↗
▶Ep 56 · 4:41
clinicalThe reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown↗
▶Ep 56 · 7:02
epidemiologicalThe gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants↗
▶Ep 56 · 7:43
epidemiological78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula↗
▶Ep 56 · 8:27
clinicalThere were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay↗
▶Ep 56 · 12:55
epidemiologicalThe transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 56 · 13:16
clinicalThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)↗
▶Ep 56 · 13:30
clinicalThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 57 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 57 · 3:20
epidemiological85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 57 · 3:45
clinicalKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 57 · 3:57
clinicalChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 57 · 4:26
epidemiologicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 57 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 57 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 57 · 5:13
clinicalHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 57 · 5:24
clinicalThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 57 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 57 · 8:09
clinicalThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 57 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 57 · 10:37
clinicalSkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 57 · 10:44
epidemiologicalGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 57 · 10:50
clinicalSutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 57 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods↗
▶Ep 57 · 10:57
guidelineRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 57 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 57 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 57 · 17:04
epidemiological43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 57 · 17:16
epidemiologicalAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 59 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 59 · 0:34
clinicalThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly↗
▶Ep 59 · 0:50
clinicalUmbilical cords usually fall off at 2 to 3 weeks↗
▶Ep 59 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 59 · 0:50
clinicalDelayed umbilical cord separation can be a manifestation of immune deficiency↗
▶Ep 59 · 1:16
clinicalOmphalitis is most commonly due to staph and strep from skin flora↗
▶Ep 59 · 1:20
clinicalMild omphalitis cases may be treated with alcohol, drying, ampicillin, or amoxicillin with follow-up every 24 hours↗
▶Ep 59 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 59 · 1:40
epidemiological16% of patients admitted with omphalitis develop necrotizing fasciitis↗
▶Ep 59 · 2:27
clinicalUmbilical hernias can be associated with trisomy 13, 18, and 21↗
▶Ep 59 · 2:38
clinicalMost umbilical hernias heal by the time the child is 3 to 5 years old↗
▶Ep 59 · 2:47
clinicalIf the fascial opening is larger than 1.5 centimeters, the hernia may not close by itself↗
▶Ep 59 · 2:55
epidemiologicalIn Walker's study, 96% of umbilical hernias less than 0.5 centimeters closed by six years, but no hernia greater than 1.5 centimeters closed by six years↗
▶Ep 59 · 4:20
guidelineFor asymptomatic umbilical hernias in children around 4 years old, that is when surgery should be considered↗
▶Ep 59 · 4:54
epidemiologicalUnplanned emergency department returns within 30 days occurred at 2.5% and were twice as high for patients younger than 4 years old↗
▶Ep 59 · 5:10
guidelineAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age↗
▶Ep 59 · 5:18
epidemiologicalIn Rangel's study of 167,000 patients, 4,486 had umbilical hernia diagnosis at median age of 1.6 months↗
▶Ep 59 · 5:53
epidemiologicalSpontaneous closure of umbilical hernias occurred in 89% by age 5↗
▶Ep 59 · 5:53
epidemiologicalClosure rates for smaller hernias (less than 1 cm) were nearly 90%, while for larger hernias they were around 80%↗
▶Ep 59 · 6:12
guidelineUmbilical hernia repair should be delayed until age 5 years based on high spontaneous closure rates↗
▶Ep 59 · 7:00
guidelineProboscoid hernia should be corrected before school age to avoid psychological issues↗
▶Ep 59 · 7:22
clinicalUmbilical hernia repair involves interrupted closure using vicryl or absorbable suture↗
▶Ep 59 · 8:55
clinicalUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time↗
▶Ep 59 · 9:00
clinicalUmbilical granulomas often respond to silver nitrate treatment↗
▶Ep 59 · 9:07
clinicalSilver nitrate application can cause burnt skin around the belly button if not properly applied↗
▶Ep 59 · 9:37
clinicalBright red, pedunculated umbilical granulomas that bleed easily are more difficult to manage↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 67 · 6:57
epidemiologicalA significant number of outreach services are located within 50 kilometers of a children's hospital↗
▶Ep 67 · 12:42
epidemiologicalThe study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 67 · 13:04
clinicalInterhospital variability in upper GI use ranged from 0 to 99%↗
▶Ep 67 · 13:04
clinicalUpper GI studies were obtained in 45% of first-time G-tube cases↗
▶Ep 67 · 13:45
clinical14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 67 · 13:45
clinical5.2% of G-tubes were dislodged within 0 to 30 days↗
Journal of Pediatric Surgery Article Review: 2nd Quarter (Apr-Jun) 2024
▶Ep 85 · 1:25
clinicalMMP-7 (matrix metalloproteinase 7) are proteolytic peptidases that break down peptide bonds for amino acids and are part of tissue remodeling processes↗
▶Ep 85 · 1:37
clinicalMMP-7 plays an important role in tissue repair, arthritis, metastasis, and cirrhosis↗
▶Ep 85 · 1:43
clinicalHigher levels of MMP-7 are associated with the diagnosis of biliary atresia↗
▶Ep 85 · 1:56
epidemiologicalOut of 329 biliary atresia cases from July 2020 to December 2022, 40 were classified as low MMP-7↗
▶Ep 85 · 2:36
clinicalLow levels of MMP-7 in biliary atresia patients are associated with low levels of preoperative GGT and direct bilirubin↗
▶Ep 85 · 3:02
clinicalGGT (gamma glutamyl transpeptidase) is an enzyme found in high levels in liver, kidney, pancreas, heart, and brain↗
▶Ep 85 · 3:12
clinicalGGT blood test levels are used to detect diseases of the liver and bile ducts↗
▶Ep 85 · 3:27
clinicalBiliary atresia patients can have dramatically different outcomes even when they anatomically look like they should behave in a similar fashion↗
▶Ep 85 · 4:09
clinicalLower MMP-7 levels within the cohort of biliary atresia patients are associated with worse outcomes↗
▶Ep 85 · 4:41
clinicalThe reason why low MMP-7 levels equal the worst prognosis in biliary atresia is unknown↗
▶Ep 85 · 7:02
epidemiologicalThe gastroschisis study included 411 infants treated at CAPSNET centers from 2014 to 2022, with 144 excluded, leaving 267 participants↗
▶Ep 85 · 7:43
epidemiological78% of gastroschisis patients received exclusive breast milk in the first 28 days of life, and 22% received supplemental or exclusive formula↗
▶Ep 85 · 8:27
clinicalThere were no significant differences between breast milk and formula groups in time to reach full enteral feeds, duration of parenteral nutrition, or length of stay↗
▶Ep 85 · 12:55
epidemiologicalThe transition research included patients between ages 10 to 30 years with anorectal malformation or Hirschsprung disease↗
▶Ep 85 · 13:16
clinicalThere is a group of colorectal patients discharged from care in late childhood around age 10 years, and another group that remains in pediatric care way beyond the normal age of transfer (around 25 years)↗
▶Ep 85 · 13:30
clinicalThe life course progression of anorectal malformation and Hirschsprung disease is not well understood↗
Journal of Pediatric Surgery Article Review: 3rd Quarter (Jul-Sep) 2024
▶Ep 86 · 1:38
quoteMy name's Jason F Fisher. I'm a pediatric surgeon and director of the Colorectal Center at Cincinnati Children's, and I also happen to be. The lead of the subcommittee for Hirschprung's disease for the PCPLC or Pediatric Colorectal and Pelvic Learning Consortium.↗
▶Ep 86 · 3:20
epidemiological85% of Hirschsprung disease patients in the study were diagnosed at less than 1 year of age↗
▶Ep 86 · 3:45
clinicalKids with shorter segment Hirschsprung disease (rectosigmoid or small portion of aganglionic bowel) were more likely to be diagnosed at a later age↗
▶Ep 86 · 3:57
clinicalChildren with long segment Hirschsprung disease typically presented at birth with classic symptoms such as failure to pass meconium↗
▶Ep 86 · 4:26
epidemiologicalApproximately one-third of neonates and 50% of infants, toddlers, and children had diverting ostomies performed prior to pull-through↗
▶Ep 86 · 5:01
clinicalThere was no difference in overall rates of redo pull-throughs across age groups↗
▶Ep 86 · 5:07
clinicalOlder children were more likely to need a redo pull-through due to an anastomotic leak↗
▶Ep 86 · 5:13
clinicalHigher rates of diverting ostomy post pull-through were likely a treatment for a post pull-through leak or anastomotic leak↗
▶Ep 86 · 5:24
clinicalThe only functional outcome that was different was nighttime soiling or incontinence in the older patient population↗
▶Ep 86 · 7:44
quoteI am a pediatric surgeon. Uh, in the division of pediatric Surgery with Presbyterian Healthcare Services in Albuquerque, New Mexico↗
▶Ep 86 · 8:09
clinicalThe gastroschisis systematic review included 28 high quality manuscripts↗
▶Ep 86 · 8:15
clinicalTwo randomized controlled trials on gastroschisis had been started but both ended prematurely and were underpowered↗
▶Ep 86 · 10:37
clinicalSkin organisms are most commonly identified in infections among infants with gastroschisis↗
▶Ep 86 · 10:44
epidemiologicalGastroschisis infants have a fairly high rate of wound infection↗
▶Ep 86 · 10:50
clinicalSilo closures have a higher rate of infection than other closure methods↗
▶Ep 86 · 10:50
clinicalSutureless closure has the lowest rate of infection in gastroschisis↗
▶Ep 86 · 10:57
guidelineRecommendation is to provide antibiotic coverage for skin flora until the gastroschisis defect is closed and potentially for an additional 24 hours thereafter↗
▶Ep 86 · 12:22
clinicalStable gastroschisis infants with sufficient abdominal capacity for sutureless closure tend to have the best outcomes↗
▶Ep 86 · 12:29
clinicalMinimizing fluids and paralytics in gastroschisis infants improves their results↗
▶Ep 86 · 17:04
epidemiological43% of pediatric surgeons preferred the Clavien-Madadi classification compared to 12% for the Clavien-Dindo classification↗
▶Ep 86 · 17:16
epidemiologicalAdvantages of the Clavien-Madadi classification were affirmed by nearly 82% of the surgeons↗
Umbilical Disorders with Dr. Rebeccah Brown
▶Ep 89 · 0:34
quoteTwo umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Worthin's jelly.↗
▶Ep 89 · 0:34
clinicalThe umbilical cord contains two umbilical arteries and one umbilical vein surrounded by Wharton's jelly↗
▶Ep 89 · 0:50
quoteThey usually fall off 2 to 3 weeks, and the delay can be a manifestation of an immune deficiency.↗
▶Ep 89 · 0:50
clinicalUmbilical cords usually fall off at 2 to 3 weeks↗
▶Ep 89 · 0:50
clinicalDelayed umbilical cord separation can be a manifestation of immune deficiency↗
▶Ep 89 · 1:16
clinicalOmphalitis is most commonly due to staph and strep from skin flora↗
▶Ep 89 · 1:20
clinicalMild omphalitis cases may be treated with alcohol, drying, ampicillin, or amoxicillin with follow-up every 24 hours↗
▶Ep 89 · 1:40
quote16% of the patients admitted with onalittis develop necrotizing fasciitis.↗
▶Ep 89 · 1:40
epidemiological16% of patients admitted with omphalitis develop necrotizing fasciitis↗
▶Ep 89 · 2:27
clinicalUmbilical hernias can be associated with trisomy 13, 18, and 21↗
▶Ep 89 · 2:38
clinicalMost umbilical hernias heal by the time the child is 3 to 5 years old↗
▶Ep 89 · 2:47
clinicalIf the fascial opening is larger than 1.5 centimeters, the hernia may not close by itself↗
▶Ep 89 · 2:55
epidemiologicalIn Walker's study, 96% of umbilical hernias less than 0.5 centimeters closed by six years, but no hernia greater than 1.5 centimeters closed by six years↗
▶Ep 89 · 4:20
guidelineFor asymptomatic umbilical hernias in children around 4 years old, that is when surgery should be considered↗
▶Ep 89 · 4:54
epidemiologicalUnplanned emergency department returns within 30 days occurred at 2.5% and were twice as high for patients younger than 4 years old↗
▶Ep 89 · 5:10
guidelineAsymptomatic umbilical hernia repair should be delayed until greater than 4 years of age↗
▶Ep 89 · 5:18
epidemiologicalIn Rangel's study of 167,000 patients, 4,486 had umbilical hernia diagnosis at median age of 1.6 months↗
▶Ep 89 · 5:53
epidemiologicalClosure rates for smaller hernias (less than 1 cm) were nearly 90%, while for larger hernias they were around 80%↗
▶Ep 89 · 5:53
epidemiologicalSpontaneous closure of umbilical hernias occurred in 89% by age 5↗
▶Ep 89 · 6:12
guidelineUmbilical hernia repair should be delayed until age 5 years based on high spontaneous closure rates↗
▶Ep 89 · 7:00
guidelineProboscoid hernia should be corrected before school age to avoid psychological issues↗
▶Ep 89 · 7:22
clinicalUmbilical hernia repair involves interrupted closure using vicryl or absorbable suture↗
▶Ep 89 · 8:55
clinicalUmbilical granulomas are usually moist but commonly dry up and fall off spontaneously over time↗
▶Ep 89 · 9:00
clinicalUmbilical granulomas often respond to silver nitrate treatment↗
▶Ep 89 · 9:07
clinicalSilver nitrate application can cause burnt skin around the belly button if not properly applied↗
▶Ep 89 · 9:37
clinicalBright red, pedunculated umbilical granulomas that bleed easily are more difficult to manage↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 98 · 6:57
epidemiologicalA significant number of outreach services are located within 50 kilometers of a children's hospital↗
▶Ep 98 · 12:42
epidemiologicalThe study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 98 · 13:04
clinicalInterhospital variability in upper GI use ranged from 0 to 99%↗
▶Ep 98 · 13:04
clinicalUpper GI studies were obtained in 45% of first-time G-tube cases↗
▶Ep 98 · 13:45
clinical14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
▶Ep 98 · 13:45
clinical5.2% of G-tubes were dislodged within 0 to 30 days↗
clinicalNeuroblastoma cells often make catecholamines like epinephrine and norepinephrine↗
▶Ep 17 · 3:03
clinicalThe Curie score is specifically used to assess the extent of metastasis in neuroblastoma patients based on MIBG scans, with the body divided into 10 regions each scored 0 to 3, producing a maximum score of 30↗
▶Ep 17 · 4:08
clinicalThe INSS takes into account the results of surgery to remove the tumor and cannot help doctors determine a stage before any treatment has started↗
▶Ep 17 · 4:26
clinicalINRG is a preoperative staging system designed to allow thinking about how difficult patients may be to resect and how to compare patients preoperatively↗
▶Ep 17 · 6:11
clinicalFor many cancer patients, 2/3 of them will have some long term morbidity from their chemo↗
▶Ep 17 · 7:29
clinicalWith neuroblastoma resections, we divide them into tiny, tiny pieces while we're taking them out↗
▶Ep 17 · 7:38
clinicalThe biggest thing to do with neuroblastoma is stay on the vessels - find yourself a normal vessel and work from normal to abnormal↗
▶Ep 17 · 7:38
quoteThe biggest thing to do with neuroblastoma is stay on the vessels.↗
▶Ep 17 · 9:13
clinicalWhen corneal biopsies are performed by experienced practitioners who ensure to obtain multiple cores, the adequacy of these biopsies significantly improves↗
▶Ep 17 · 10:44
clinicalFor neuroblastoma, unlike most tumors that we resect, we would like to get as much of it we can, but we would expect that we're not possibly getting every single ounce of tumor↗
▶Ep 17 · 11:01
clinicalYour goal is to get as much of the tumor as you can without causing harm↗
▶Ep 17 · 11:01
quoteYour goal is to get as much of the tumor as you can without causing harm.↗
▶Ep 17 · 12:21
clinicalIn the COG study of 87 patients less than 6 months of age with a small adrenal mass, the 4 year event free survival for patients with neuroblastoma was 97%↗
Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024
▶Ep 20 · 0:13
clinicalThe 12th annual update course in pediatric surgery was held in August 2024↗
▶Ep 20 · 0:56
guidelineImage-guided surgery session classifies as blue square for promising newer practice↗
▶Ep 20 · 1:15
clinicalImage-guided surgery uses real-time imaging including CT, MRI, ultrasound, or fluoroscopy to provide detailed views of internal structures↗
▶Ep 20 · 1:39
opinionSurgeons may not know what is possible with image guidance so they don't know what to ask for↗
▶Ep 20 · 2:59
clinicalCone beam CT provides excellent visualization of bony structures making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries↗
▶Ep 20 · 3:36
clinicalInterventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access↗
Update Course Rewind: Pediatric Biliary Stones - Surgery First Mindset 2024
▶Ep 23 · 0:52
epidemiologicalStone disease is increasing along with obesity in pediatric patients around the world, not just in the United States↗
▶Ep 23 · 1:25
clinicalThere are two main approaches for CBD stones requiring cholecystectomy: ERCP first followed by laparoscopic cholecystectomy, or surgery-first with IOC to identify and potentially remove stones during the same surgery↗
▶Ep 23 · 2:11
clinicalA surgery-first pathway reduces resource utilization, including MRCP↗
▶Ep 23 · 3:02
clinicalERCP adds potential morbidity, with a pancreatitis rate of 10% even when performed well↗
▶Ep 23 · 3:16
clinicalIf a surgeon cannot perform a cholangiogram, then ERCP is necessary if available↗
▶Ep 23 · 3:44
quoteif you know how to put in a central line and you understand the principles Singer technique, then you can do this.↗
▶Ep 23 · 3:44
opinionIf you know how to put in a central line and understand Seldinger technique, you can perform intraoperative stone removal↗
▶Ep 23 · 3:50
clinicalWith a surgery-first mindset, stone clearance rate reflected by negative IOC was 86%↗
▶Ep 23 · 4:01
clinicalWith simple adjuncts like advancing the catheter into the CBD or reaming the sphincter, success rate rises to the 90s↗
▶Ep 23 · 4:11
quoteThat's the dirty little secret is like, let's do something that, that I think is accessible to everybody.↗
▶Ep 23 · 4:17
clinicalFor the 15% of unsuccessful cases, the plan is to clip the cystic duct, close, and have ERCP performed within the next day or two, or same-day in the OR if an endoscopist is available↗
▶Ep 23 · 4:56
clinicalAn endo-loop may be used instead of a clip when ERCP is planned, to facilitate subsequent endoscopic access↗
▶Ep 23 · 5:06
opinionThe learning curve for intraoperative stone removal is manageable: the first few times are difficult, but after a few cases it becomes easier and even enjoyable↗
▶Ep 23 · 5:15
clinicalThe biggest key to success is having all necessary equipment in one place, because OR staff will not know what to get on the fly↗
▶Ep 23 · 5:26
clinicalSuccess depends on IOC findings: a CBD chock full of 3-4 impacted stones is typically not amenable to surgery-first approach↗
▶Ep 23 · 6:03
clinicalWhen flushing an impacted stone, there is a risk of inadvertently injecting contrast into the pancreatic duct, which can increase the risk of pancreatitis↗
▶Ep 23 · 6:15
clinicalIf the pancreatic duct lights up during flushing, that is a signal to slow down and be careful to avoid causing pancreatitis↗
▶Ep 23 · 6:15
quoteI think as soon as you start seeing that pancreatic duct light up, that is a signal to slow down on your flush, be careful because you can cause pancreatitis.↗
▶Ep 23 · 6:33
clinicalA study demonstrated 86% success rate for surgery-first, while the ERCP group had a 10% complication rate including cholangitis, bleeding, pancreatitis, and hemophilia↗
clinicalPatient is neutropenic with markedly elevated liver function tests and ultrasound findings consistent with acute cholecystitis and choledocholithiasis↗
▶Ep 24 · 1:20
opinionOver 50% of audience opted to start antibiotics and address elevated liver function tests↗
▶Ep 24 · 1:49
clinicalGallstone pancreatitis is inflammation of the pancreas triggered by a gallstone obstructing the bile duct, which can also impede pancreatic drainage↗
▶Ep 24 · 1:57
clinicalBlockage prevents pancreatic enzymes from reaching the small intestine, leading them to accumulate and damage the pancreas↗
quoteHello pediatric surgery family, I'm E Gdy, a research fellow from Cincinnati Children's Hospital Medical Center.↗
Journal of Pediatric Surgery Article Review: September 2023
▶Ep 42 · 5:17
clinicalSurvival was not statistically different between early and delayed CDH repair groups on ECMO↗
▶Ep 42 · 5:17
clinicalDuration of ECMO support was shorter in the early CDH repair group↗
▶Ep 42 · 9:32
epidemiologicalPhysician suicide is characterized by tragically high rates of suicide among doctors compared to the general population↗
▶Ep 42 · 10:17
clinicalHigh levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide↗
▶Ep 42 · 10:33
clinicalStigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders↗
Journal of Pediatric Surgery Article Review: 1st Quarter (Jan-Mar) 2025
▶Ep 50 · 6:57
epidemiologicalA significant number of outreach services are located within 50 kilometers of a children's hospital↗
▶Ep 50 · 12:42
epidemiologicalThe study analyzed 4,612 G-tube placements from 71 NSQIP-Pediatric hospitals in 2023↗
▶Ep 50 · 13:04
clinicalInterhospital variability in upper GI use ranged from 0 to 99%↗
▶Ep 50 · 13:04
clinicalUpper GI studies were obtained in 45% of first-time G-tube cases↗
▶Ep 50 · 13:45
clinical5.2% of G-tubes were dislodged within 0 to 30 days↗
▶Ep 50 · 13:45
clinical14% of G-tube cases resulted in an ED visit within 0 to 30 days↗
clinicalPyloric stenosis occurs when the pyloric muscle becomes thickened or hypertrophied, creating a narrower passage between stomach and small intestine that blocks food passage.↗
▶Ep 24 · 0:40
clinicalThe classic symptom of pyloric stenosis is projectile vomiting after feeding followed by signs of hunger, which can lead to severe dehydration and weight loss.↗
▶Ep 24 · 2:19
quoteDon't forget the bilious vomiting should be considered as an emergency in an infant.↗
▶Ep 24 · 2:19
guidelineBilious vomiting should be considered an emergency in an infant.↗
▶Ep 24 · 2:56
epidemiologicalPyloric stenosis usually affects babies between 2 and 8 weeks of age but can occur anytime from birth to 6 months.↗
▶Ep 24 · 3:24
epidemiologicalA 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.↗
▶Ep 24 · 4:25
clinicalResearchers have identified specific genetic changes that may indicate risk for pyloric stenosis as a molecular diagnostic marker.↗
▶Ep 24 · 5:22
clinicalLaboratory findings typically include hyperbilirubinemia, hypochloremia, and elevated bicarbonate levels.↗
▶Ep 24 · 5:46
clinicalElevated bicarbonate is excreted in urine, which obligates sodium loss to maintain electroneutrality; water loss follows sodium excretion, making the patient more hemodynamically unstable.↗
▶Ep 24 · 7:04
guidelineRecommended fluid resuscitation is a bolus of isotonic saline followed by maintenance IV fluids of D5 half-normal saline with 20 milliequivalents per liter of potassium chloride added.↗
▶Ep 24 · 7:53
clinicalPyloromyotomy is a 45-minute curative operation that can be done safely and quickly.↗
▶Ep 24 · 8:12
clinicalAccording to a 2023 Journal of Pediatric Surgery study, antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.↗
▶Ep 24 · 12:52
clinicalRisks of pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, and wound infection.↗
▶Ep 24 · 14:30
clinicalA flexible feeding protocol that reduces formula volume if a baby vomits 6 times but continues smaller feeds and increases as tolerated allows greater flexibility and decreases length of hospital stay.↗
