When we separated out the CMV positive and compared it with the CMV negative as a control, there was a dramatic difference, not only in their clinical characteristics, because the CMV positive were older by the time of their Kisai operation, but also the histology was different. And their outcomes were very different.
When we separated out the CMV positive and compared it with the CMV negative as a control, there was a dramatic difference, not only in their clinical characteristics, because the CMV positive were older by the time of their Kisai operation, but also the histology was different. And their outcomes were very different.
Nevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps.
Nevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps.
Nevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps.
quoteThe key point about the biopsy is really to not go to theater to not have a general anesthetic and to not undergo an invasive investigation and to exclude all those I'll put it medical conditions that that sort of mimic biliary atresia.↗
▶Ep 8 · 22:18
clinicalInfants coming to surgery for other matters who later turned out to have biliary atresia in the first week of life all had normal livers, so you can't diagnose early biliary atresia on liver biopsy↗
▶Ep 8 · 22:18
quoteWe published quite a few years ago on infants that were coming to surgery for other matters who later turned out to have biliary atresia in the first week of life. They all had normal livers. So you can't really diagnose those early ones on liver biopsy, that's certainly true.↗
▶Ep 8 · 23:08
clinicalLiver histology looking at inflammation and fibrosis has not shown great discrimination for prognosis in babies coming to surgery before 100 days↗
▶Ep 8 · 24:57
clinicalThe key differential for a prenatally detected cyst is between cystic biliary atresia and a choledochal cyst↗
▶Ep 8 · 25:51
clinicalIf the baby is not jaundiced and not raising conjugated bilirubin, then it's not cystic biliary atresia and you can wait to do the laparotomy↗
Biliary Atresia Part I
▶Ep 13 · 6:56
quoteThe key thing is to show that you've got a conjugated hyperbilirubinemia. And if you've done that, then all else flows.↗
▶Ep 13 · 6:56
clinicalThe key diagnostic finding is conjugated hyperbilirubinemia.↗
▶Ep 13 · 6:56
clinicalThe key diagnostic finding is conjugated hyperbilirubinemia.↗
▶Ep 13 · 6:56
quoteThe key thing is to show that you've got a conjugated hyperbilirubinemia. And if you've done that, then all else flows.↗
▶Ep 13 · 8:39
clinicalUltrasound separates out other surgical issues including inspissated bile syndrome and spontaneous perforation of bile ducts, which should have ultrasound-positive features.↗
▶Ep 13 · 8:39
opinionThe triangular cord sign on ultrasound is not particularly discriminatory for biliary atresia.↗
▶Ep 13 · 8:39
clinicalUltrasound separates out other surgical issues including inspissated bile syndrome and spontaneous perforation of bile ducts, which should have ultrasound-positive features.↗
▶Ep 13 · 8:39
opinionThe triangular cord sign on ultrasound is not particularly discriminatory for biliary atresia.↗
▶Ep 13 · 10:41
clinicalExperienced pathologists can diagnose biliary atresia from percutaneous liver biopsy in almost 90% of cases.↗
▶Ep 13 · 10:41
clinicalExperienced pathologists can diagnose biliary atresia from percutaneous liver biopsy in almost 90% of cases.↗
▶Ep 13 · 15:17
clinicalKing's College Hospital uses ERCP for approximately 10% of biliary atresia cases when biopsy findings are equivocal.↗
▶Ep 13 · 15:17
clinicalKing's College Hospital uses ERCP for approximately 10% of biliary atresia cases when biopsy findings are equivocal.↗
▶Ep 13 · 15:29
quoteThey're not made in America. Don't worry about that. It's a Japanese scope.↗
▶Ep 13 · 15:29
quoteThey're not made in America. Don't worry about that. It's a Japanese scope.↗
▶Ep 13 · 15:47
clinicalHistologic findings diagnostic of biliary atresia include ductular proliferation, small cell infiltrate, and bile duct plugs in proliferating bile ducts.↗
▶Ep 13 · 15:47
clinicalBy 50 days of age, all histologic features of biliary atresia should be established on biopsy, whereas earlier biopsies (10-20 days) may not show consistent diagnostic findings.↗
▶Ep 13 · 15:47
quoteThe other pathognomonic finding for biliary atresia, as opposed to some of the other obstructive processes, is you'll see bile duct plugs in those bile ducts that are proliferating.↗
▶Ep 13 · 15:47
clinicalBy 50 days of age, all histologic features of biliary atresia should be established on biopsy, whereas earlier biopsies (10-20 days) may not show consistent diagnostic findings.↗
▶Ep 13 · 15:47
quoteThe other pathognomonic finding for biliary atresia, as opposed to some of the other obstructive processes, is you'll see bile duct plugs in those bile ducts that are proliferating.↗
▶Ep 13 · 15:47
clinicalHistologic findings diagnostic of biliary atresia include ductular proliferation, small cell infiltrate, and bile duct plugs in proliferating bile ducts.↗
▶Ep 13 · 19:17
quoteThis is one of the last remaining examples of a maximally invasive operation.↗
▶Ep 13 · 19:17
quoteThis is one of the last remaining examples of a maximally invasive operation.↗
▶Ep 13 · 28:21
quoteIt's a beautiful thing to see, the surgical plane. You can almost strip it off. And the idea is there's nothing left.↗
▶Ep 13 · 28:21
clinicalCoring into the liver creates an unstable interface that has never achieved good results in the literature, as biliary ductules that transgress simply scar over.↗
▶Ep 13 · 28:21
quoteAny kind of biliary ductules that transgress that just simply scar over. I've never seen any kind of coring of the liver that's achieved anything in the literature.↗
▶Ep 13 · 28:21
quoteAny kind of biliary ductules that transgress that just simply scar over. I've never seen any kind of coring of the liver that's achieved anything in the literature.↗
▶Ep 13 · 28:21
clinicalCoring into the liver creates an unstable interface that has never achieved good results in the literature, as biliary ductules that transgress simply scar over.↗
▶Ep 13 · 28:21
quoteIt's a beautiful thing to see, the surgical plane. You can almost strip it off. And the idea is there's nothing left.↗
▶Ep 13 · 29:48
clinicalStandard Roux limb length for Kasai portoenterostomy is 40 centimeters, though Cincinnati uses 35-40 cm and measures with silk suture to 45 cm.↗
▶Ep 13 · 29:48
clinicalStandard Roux limb length for Kasai portoenterostomy is 40 centimeters, though Cincinnati uses 35-40 cm and measures with silk suture to 45 cm.↗
Biliary Atresia Part II
▶Ep 14 · 7:19
epidemiologicalSTART trial subset analysis for patients <70 days old: placebo arm 57% jaundice clearance, steroid arm 72% clearance—difference not statistically significant due to insufficient numbers (type 2 error)↗
▶Ep 14 · 7:19
epidemiologicalSTART trial subset analysis for patients <70 days old: placebo arm 57% jaundice clearance, steroid arm 72% clearance—difference not statistically significant due to insufficient numbers (type 2 error)↗
▶Ep 14 · 9:56
epidemiologicalKing's College initial low-dose steroid trial (2mg/kg/day prednisone): no difference in jaundice clearance between groups, but statistically significant lower bilirubin at one month in steroid group↗
▶Ep 14 · 9:56
epidemiologicalKing's College high-dose steroid protocol (5mg/kg/day): 67% jaundice clearance vs 52% in controls, difference reached statistical significance with larger numbers↗
▶Ep 14 · 9:56
epidemiologicalKing's College high-dose steroid protocol (5mg/kg/day): 67% jaundice clearance vs 52% in controls, difference reached statistical significance with larger numbers↗
▶Ep 14 · 9:56
epidemiologicalKing's College initial low-dose steroid trial (2mg/kg/day prednisone): no difference in jaundice clearance between groups, but statistically significant lower bilirubin at one month in steroid group↗
▶Ep 14 · 12:02
clinicalKing's College current protocol: 5mg/kg/day prednisone starting day 4 post-op when oral feeds begin↗
▶Ep 14 · 12:02
clinicalKing's College current protocol: 5mg/kg/day prednisone starting day 4 post-op when oral feeds begin↗
▶Ep 14 · 17:35
clinicalGI bleeding is a potential steroid complication; King's College always gives ranitidine with steroids, which may not have been standard in START trial↗
▶Ep 14 · 17:35
clinicalGI bleeding is a potential steroid complication; King's College always gives ranitidine with steroids, which may not have been standard in START trial↗
▶Ep 14 · 19:34
clinicalKing's College antibiotic protocol: IV tazocin-gentamicin for 5 days, then oral cephalosporin for 1 month↗
▶Ep 14 · 19:34
clinicalKing's College antibiotic protocol: IV tazocin-gentamicin for 5 days, then oral cephalosporin for 1 month↗
▶Ep 14 · 21:20
clinicalFor patients presenting at 100+ days with cirrhosis on ultrasound (heterogeneous surface, ascites), consider primary transplant rather than Kasai; primary transplant rate in England/Wales is approximately 5%↗
▶Ep 14 · 21:20
clinicalFor patients presenting at 100+ days with cirrhosis on ultrasound (heterogeneous surface, ascites), consider primary transplant rather than Kasai; primary transplant rate in England/Wales is approximately 5%↗
▶Ep 14 · 21:20
epidemiologicalKing's College data from 2001: 100+ day Kasai patients achieved approximately 40% five-year native liver survival↗
▶Ep 14 · 21:20
epidemiologicalKing's College data from 2001: 100+ day Kasai patients achieved approximately 40% five-year native liver survival↗
▶Ep 14 · 25:41
epidemiologicalKing's College data with high-dose steroids: 100% of patients who underwent Kasai before 30 days of age cleared their jaundice↗
▶Ep 14 · 25:41
epidemiologicalKing's College data with high-dose steroids: 100% of patients who underwent Kasai before 30 days of age cleared their jaundice↗
▶Ep 14 · 28:16
clinicalKing's College does not use steroids for cholangitis treatment and does not perform early revision Kasai↗
▶Ep 14 · 28:16
clinicalKing's College does not use steroids for cholangitis treatment and does not perform early revision Kasai↗
▶Ep 14 · 32:54
epidemiologicalCMV IgM-positive biliary atresia represents approximately 10% of cases in Western Europe and North America; prevalence higher in China and Japan↗
▶Ep 14 · 32:54
epidemiologicalCMV IgM-positive biliary atresia represents approximately 10% of cases in Western Europe and North America; prevalence higher in China and Japan↗
▶Ep 14 · 34:15
quoteIn the last analysis, we cleared jaunice in seven out of nine of them, which is about 70 odd percent. And that was a dramatic difference from what we'd experienced previously.↗
▶Ep 14 · 34:15
clinicalCMV PCR levels in biliary atresia show inverse relationship with age and AST levels; highest viral loads in younger babies, suggesting body clears virus over time↗
▶Ep 14 · 34:15
clinicalKing's College prospective antiviral treatment (valganciclovir): 7 of 9 (approximately 78%) CMV-positive patients cleared jaundice, dramatic improvement from historical <10%↗
▶Ep 14 · 34:15
epidemiologicalKing's College retrospective data (2010-11): CMV IgM-positive patients were older at Kasai, had different histology, and cleared jaundice in less than 10% of cases without antiviral treatment↗
▶Ep 14 · 34:15
epidemiologicalKing's College retrospective data (2010-11): CMV IgM-positive patients were older at Kasai, had different histology, and cleared jaundice in less than 10% of cases without antiviral treatment↗
▶Ep 14 · 34:15
clinicalKing's College prospective antiviral treatment (valganciclovir): 7 of 9 (approximately 78%) CMV-positive patients cleared jaundice, dramatic improvement from historical <10%↗
▶Ep 14 · 34:15
clinicalCMV PCR levels in biliary atresia show inverse relationship with age and AST levels; highest viral loads in younger babies, suggesting body clears virus over time↗
▶Ep 14 · 34:15
quoteWhen we separated out the CMV positive and compared it with the CMV negative as a control, there was a dramatic difference, not only in their clinical characteristics, because the CMV positive were older by the time of their Kisai operation, but also the histology was different. And their outcomes were very different.↗
▶Ep 14 · 34:15
quoteIn the last analysis, we cleared jaunice in seven out of nine of them, which is about 70 odd percent. And that was a dramatic difference from what we'd experienced previously.↗
▶Ep 14 · 34:15
quoteWhen we separated out the CMV positive and compared it with the CMV negative as a control, there was a dramatic difference, not only in their clinical characteristics, because the CMV positive were older by the time of their Kisai operation, but also the histology was different. And their outcomes were very different.↗
▶Ep 14 · 38:22
epidemiologicalKing's College colchicine trial (1970s-80s) for liver fibrosis showed no difference in long-term fibrosis levels or clinical outcomes between treatment and placebo groups↗
▶Ep 14 · 38:22
epidemiologicalKing's College colchicine trial (1970s-80s) for liver fibrosis showed no difference in long-term fibrosis levels or clinical outcomes between treatment and placebo groups↗
▶Ep 14 · 38:22
clinicalIncreasing proportion of biliary atresia patients require transplant despite modest bilirubin elevation due to progressive fibrosis and portal hypertension complications↗
▶Ep 14 · 38:22
clinicalIncreasing proportion of biliary atresia patients require transplant despite modest bilirubin elevation due to progressive fibrosis and portal hypertension complications↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 135 · 3:38
clinicalThe Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland↗
▶Ep 135 · 3:38
clinicalThe Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland↗
▶Ep 135 · 6:35
opinionThe Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK↗
▶Ep 135 · 6:35
opinionThe Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK↗
▶Ep 135 · 9:04
clinicalThe Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria↗
▶Ep 135 · 9:04
clinicalThe Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria↗
▶Ep 135 · 9:53
host_summaryLength of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group↗
▶Ep 135 · 9:53
epidemiologicalLength of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group↗
▶Ep 135 · 11:04
opinionThe Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem↗
▶Ep 135 · 11:04
opinionThe Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 4 · 3:38
clinicalThe Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland↗
▶Ep 4 · 6:35
opinionThe Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK↗
▶Ep 4 · 9:04
clinicalThe Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria↗
▶Ep 4 · 9:53
host_summaryLength of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group↗
▶Ep 4 · 11:04
opinionThe Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 12 · 4:44
quoteSo this is a 25 year experience. Description of 220 consecutive infants with esophageresia in Newcastle.↗
▶Ep 12 · 4:44
host_summaryThe esophageal atresia study is a 25 year experience describing 220 consecutive infants with esophageal atresia in Newcastle.↗
▶Ep 12 · 7:32
quoteNevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps.↗
▶Ep 12 · 7:32
opinionThe Newcastle series is a pushback series which extols relatively conventional open surgery and begs the question as to what role lengthening procedures have in those with long gaps.↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 55 · 3:38
clinicalThe Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland↗
▶Ep 55 · 3:38
clinicalThe Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland↗
▶Ep 55 · 6:35
opinionThe Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK↗
▶Ep 55 · 6:35
opinionThe Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK↗
▶Ep 55 · 9:04
clinicalThe Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria↗
▶Ep 55 · 9:04
clinicalThe Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria↗
▶Ep 55 · 9:53
host_summaryLength of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group↗
▶Ep 55 · 9:53
epidemiologicalLength of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group↗
▶Ep 55 · 11:04
opinionThe Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem↗
▶Ep 55 · 11:04
opinionThe Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem↗
Journal of Pediatric Surgery Article Review: February 2023, BAPS issue
▶Ep 3 · 3:38
clinicalThe Centre in Rocklaw has become the referral center for esophageal atresia and long gap esophageal atresia cases from the whole of Poland↗
▶Ep 3 · 6:35
opinionThe Sheffield study represents real life surgical reporting and reflects overall management of Hirschsprung's disease within the UK↗
▶Ep 3 · 9:04
clinicalThe Tanzania study used trained carers to direct the method of cleansing, concentrating on areas known to harbor commensal and pathogenic bacteria↗
▶Ep 3 · 9:53
host_summaryLength of stay in the soap bathing intervention group was 12 days compared to 22 days in the non-intervention group↗
▶Ep 3 · 11:04
opinionThe Tanzania soap bathing trial was well designed, analyzed in substantial detail, and has implications for low to middle income countries where surgical site infections are a major problem↗
Journal of Pediatric Surgery Article Review: Q1 (Jan-Mar) 2024
▶Ep 44 · 4:44
quoteSo this is a 25 year experience. Description of 220 consecutive infants with esophageresia in Newcastle.↗
▶Ep 44 · 4:44
clinicalThe esophageal atresia study is a 25 year experience describing 220 consecutive infants with esophageal atresia in Newcastle.↗
▶Ep 44 · 4:44
quoteSo this is a 25 year experience. Description of 220 consecutive infants with esophageresia in Newcastle.↗
▶Ep 44 · 4:44
host_summaryThe esophageal atresia study is a 25 year experience describing 220 consecutive infants with esophageal atresia in Newcastle.↗
▶Ep 44 · 7:32
quoteNevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps.↗
▶Ep 44 · 7:32
opinionThe Newcastle series is a pushback series which extols relatively conventional open surgery and begs the question as to what role lengthening procedures have in those with long gaps.↗
▶Ep 44 · 7:32
opinionThe Newcastle series is a pushback series which extols relatively conventional open surgery and begs the question as to what role lengthening procedures have in those with long gaps.↗
▶Ep 44 · 7:32
quoteNevertheless, this is definitely a pushback series which extols relatively conventional open surgery, of course. It really, it really does beg the question as to what role and they would say, if any, er lengthening procedures have in those with er with long gaps.↗
