# Neuroblastoma — GCMD Library living collection Also covered as: high-risk neuroblastoma · Wilms tumor · congenital diaphragmatic hernia · hepatoblastoma · stage 4 neuroblastoma · metastatic neuroblastoma · metastatic disease · hepatocellular carcinoma Experts: Dr. Todd Ponsky, Dr. Daniel von Allmen, Dr. Sophia Schermerhorn, Dr. Cecilia Gigena Updated: n/a · 26 episodes · 549 cited statements ## Episodes ### Fundamentals - [Neuroblastoma](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534) — video · [machine version](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534.md) - [Topics in 10: Neuroblastoma](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659) — podcast · 10:25 · [machine version](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659.md) ### Diagnosis & Workup - [Update Course Rewind: Staging and Management of Neuroblastoma 2022](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710) — video · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710.md) - [The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727) — video · 0:59 · [machine version](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727.md) ### Medical Management - [Coagulopathy and Analgesia](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793) — podcast · 45:33 · [machine version](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793.md) ### Surgical Management - [Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109) — video · 10:20 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109.md) ### Evidence & Research - [Neuroblastoma: Update Course 2016](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434) — video · 25:42 · [machine version](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434.md) - [Neuroblastoma: Update Course 2014](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651) — video · 25:59 · [machine version](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651.md) - [Update Course 2021: TOP PUBLICATIONS IN NON - PED SURG JOURNALS](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404) — video · 22:13 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404.md) - [Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820) — video · 64:30 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820.md) - [Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988) — video · 0:54 · [machine version](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988.md) - [Biopsia quirúrgica o con aguja guiada por imágenes para el diagnóstico de neuroblastoma en niños](https://qa.library.globalcastmd.com/watch/biopsia-quir-rgica-o-con-aguja-guiada-por-im-genes-para-el-diagn-stico-de-neuroblastoma-en-ni-os-7990) — video · 0:53 · [machine version](https://qa.library.globalcastmd.com/watch/biopsia-quir-rgica-o-con-aguja-guiada-por-im-genes-para-el-diagn-stico-de-neuroblastoma-en-ni-os-7990.md) - [Heat 2 Winner: Matthew Urichuk, PhD - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013) — video · 1:52 · [machine version](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013.md) - [Dr. Yujie Ma - Best of the Best in Pediatric Surgery 2025](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036) — video · 8:08 · [machine version](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036.md) - [Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044) — video · 6:52 · [machine version](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044.md) - [Quick Literature Updates Ep 19](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465) — video · 4:27 · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465.md) - [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371) — video · 1:06 · [machine version](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371.md) - [Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522) — video · 1:02 · [machine version](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522.md) ### Case-Based Learning - [Neuroblastoma](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620.md) ### In-Depth Reviews - [Hepatoblastoma](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291) — podcast · 54:16 · [machine version](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291.md) - [Wilms Tumor: Audio Chapter](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 64:03 · [machine version](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md) - [Hepatoblastoma with Dr. Greg Tiao](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256) — video · [machine version](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256.md) - [Neuroblastoma with Dr. Meera Kotagal](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212) — video · 14:02 · [machine version](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212.md) ### Emerging & Future Directions - [Dominique Simons, MSc - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009) — video · 7:55 · [machine version](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009.md) ### Long-Term Care - [Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581) — video · 1:04 · [machine version](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581.md) - [Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866) — video · 1:10 · [machine version](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866.md) ## Chapters - [0:00](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=0) ERAS Protocol for Neuroblastoma Resection (Ep 23) - [0:00](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=0) Long-Term Surgical Outcomes in Wilms Tumor and Neuroblastoma Survivors (Ep 24) - [0:00](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=0) Image-Defined Risk Factors in Neuroblastoma (Ep 25) - [0:00](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0) Introduction and Study Context (Ep 26) - [0:13](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13) Study Design and Pancreatic Findings (Ep 26) - [0:43](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43) Body Composition Changes and Clinical Implications (Ep 26) - [0:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=0) Case presentation and initial surgical approach discussion (Ep 2) - [3:46](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=226) Surgical technique and timing of resection (Ep 2) - [6:47](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=407) Discordance between surgical assessment and radiographic findings (Ep 2) - [8:25](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=505) Approach to metastatic disease and surgical morbidity (Ep 2) - [13:25](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=805) German study results: no survival benefit from aggressive resection (Ep 2) - [18:11](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1091) European study results: survival benefit demonstrated (Ep 2) - [20:34](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1234) COG 3973 study results and interpretation (Ep 2) - [22:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1341) Technical expertise requirements and organ preservation (Ep 2) - [0:00](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=0) Social Determinants and Pediatric Oncology Survival (Ep 22) - [0:00](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=0) IPSO Meta-Analysis: Image-Guided vs Surgical Biopsy for Neuroblastoma (Ep 13) - [0:00](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=0) Introduction of Heat 2 Presentations (Ep 16) - [0:54](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=54) Live Voting (Ep 16) - [1:27](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=87) Winner Announcement (Ep 16) - [0:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=0) Prenatal Diagnosis and Observation (Ep 3) - [10:39](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=639) Surveillance Protocol and Indications for Surgery (Ep 3) - [15:08](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=908) Stage MS Disease with Liver Involvement (Ep 3) - [21:05](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) Workup of Large Abdominal Mass in Older Child (Ep 3) - [27:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) Tissue Acquisition Strategies (Ep 3) - [0:00](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0) Introduction and Differential Diagnosis (Ep 9) - [2:20](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140) Clinical Presentation and Diagnostic Workup (Ep 9) - [4:25](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265) Liver Anatomy and Pre-text Staging (Ep 9) - [8:01](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481) Treatment Algorithms and Outcomes (Ep 9) - [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=0) Case Presentation (Ep 12) - [0:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24) Updated COG Risk Stratification (Ep 12) - [1:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=72) Closing Remarks (Ep 12) - [0:05](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=5) Introduction to Non-Core Journal Review by Dr. Jose Campos (Ep 10) - [1:53](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=113) Malrotation Diagnosis: Ultrasound versus Upper GI (Ep 10) - [9:19](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=559) Non-Operative Management of Appendicitis (Ep 10) - [13:01](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=781) Complete Resection in High-Risk Neuroblastoma (Ep 10) - [15:04](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=904) Fetal Tracheal Occlusion for Severe CDH (Ep 10) - [17:10](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1030) Whole Blood Transfusion in Pediatric Trauma (Ep 10) - [0:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=0) Case presentation and initial surgical approach (Ep 1) - [3:29](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=209) Surgical technique and timing of resection (Ep 1) - [8:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=497) Evidence for aggressive resection in stage 3 versus stage 4 disease (Ep 1) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "A multi-center prospective study evaluated a structured ERAS pathway for children undergoing abdominal neuroblastoma resection" — Sophia Schermerhorn (clinical) [Ep 23 · 0:03](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=3) - "The ERAS protocol included 20 evidence-based elements spanning the entire perioperative process" — Sophia Schermerhorn (clinical) [Ep 23 · 0:13](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=13) - "ERAS protocol elements included preoperative counseling, hydrate loading, standardized multimodal analgesia, early feeding, and early mobilization" — Sophia Schermerhorn (clinical) [Ep 23 · 0:13](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=13) - "Length of stay decreased from about 7 days to 3.7 days" — Sophia Schermerhorn (clinical) [Ep 23 · 0:28](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=28) - "Post-operative opioid use dropped by over half" — Sophia Schermerhorn (clinical) [Ep 23 · 0:32](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=32) - "Patients resumed regular diets and ambulated about 3 days earlier" — Sophia Schermerhorn (clinical) [Ep 23 · 0:32](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=32) - "The proportion of patients experiencing any postoperative complication decreased by over 50%" — Sophia Schermerhorn (clinical) [Ep 23 · 0:39](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=39) - "Patients were cleared to resume adjuvant chemotherapy earlier at around 8 days as opposed to 10 days" — Sophia Schermerhorn (clinical) [Ep 23 · 0:46](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=46) - "A structured ERAS pathway meaningfully improves recovery even after complex neuroblastoma resections" — Sophia Schermerhorn (opinion) [Ep 23 · 0:51](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=51) - "ERAS represents a tangible opportunity to standardize perioperative care for neuroblastoma resection" — Sophia Schermerhorn (opinion) [Ep 23 · 0:51](https://qa.library.globalcastmd.com/watch/enhanced-recovery-after-surgery-improves-length-of-stay-and-decreases-complications-after-resection-of-abdominal-neuroblastoma-11522?t=51) - "This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:11](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=11) - "14% of patients required a repeat laparotomy" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:20](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=20) - "The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence" — Sophia Schermerhorn (clinical) [Ep 24 · 0:21](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=21) - "In Wilms tumor, obstruction typically occurred within the first year" — Sophia Schermerhorn (clinical) [Ep 24 · 0:26](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=26) - "In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up" — Sophia Schermerhorn (clinical) [Ep 24 · 0:29](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=29) - "Radiation dose was not associated with re-operation risk" — Sophia Schermerhorn (clinical) [Ep 24 · 0:34](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=34) - "Secondary malignancy was uncommon in this cohort" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:37](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=37) - "Hypertension after nephrectomy was not increased compared to population norms" — Sophia Schermerhorn (clinical) [Ep 24 · 0:37](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=37) - "Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:45](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=45) - "Scoliosis has multi-factorial contributors including surgery and possibly radiation" — Sophia Schermerhorn (clinical) [Ep 24 · 0:45](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=45) - "Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up" — Sophia Schermerhorn (guideline) [Ep 24 · 0:58](https://qa.library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=58) - "IDRFs are necessary knowledge for clinicians treating neuroblastoma to determine safety of surgical intervention" — Sophia Schermerhorn (clinical) [Ep 25 · 0:00](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=0) - "IDRFs are imaging findings on CT or MRI that predict when neuroblastoma may be difficult or dangerous to remove surgically" — Sophia Schermerhorn (clinical) [Ep 25 · 0:14](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=14) - "The IDRF concept was first introduced in 2009 by the International Neuroblastoma Risk Group" — Sophia Schermerhorn (guideline) [Ep 25 · 0:21](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=21) - "The International Neuroblastoma Risk Group defined 20 specific imaging risk factors" — Sophia Schermerhorn (guideline) [Ep 25 · 0:21](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=21) - "Most IDRFs relate to how the tumor interacts with critical anatomy" — Sophia Schermerhorn (clinical) [Ep 25 · 0:29](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=29) - "In the abdomen, a tumor that infiltrates the portahepati or hepatoduodenal ligament is considered to contain an IDRF" — Sophia Schermerhorn (clinical) [Ep 25 · 0:34](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=34) - "The presence of an IDRF does not mean a tumor cannot be resected" — Sophia Schermerhorn (clinical) [Ep 25 · 0:41](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=41) - "IDRF presence signals that surgery may be technically more complex" — Sophia Schermerhorn (clinical) [Ep 25 · 0:41](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=41) - "Patients with IDRFs often receive neoadjuvant therapy first to try to shrink the tumor" — Sophia Schermerhorn (clinical) [Ep 25 · 0:41](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=41) - "Surgeons use IDRFs to predict surgical risk and guide the safest treatment approach using imaging" — Sophia Schermerhorn (clinical) [Ep 25 · 0:52](https://qa.library.globalcastmd.com/watch/the-international-neuroblastoma-risk-group-staging-system-an-inrg-task-force-report-11727?t=52) - "Radiation improves survival in high-risk neuroblastoma" — Sophia Schermerhorn (clinical) [Ep 26 · 0:00](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=0) - "This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy" — Sophia Schermerhorn (clinical) [Ep 26 · 0:13](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=13) - "The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment" — Sophia Schermerhorn (clinical) [Ep 26 · 0:19](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=19) - "There was a significant decrease in pancreatic volume after radiation" — Sophia Schermerhorn (clinical) [Ep 26 · 0:27](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=27) - "Very few patients developed clinically apparent pancreatic insufficiency" — Sophia Schermerhorn (clinical) [Ep 26 · 0:31](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31) - "Pancreatic insufficiency wasn't systematically screened for in this study" — Sophia Schermerhorn (clinical) [Ep 26 · 0:31](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31) - "Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients" — Sophia Schermerhorn (opinion) [Ep 26 · 0:31](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=31) - "Pancreatic dysfunction could be an under-recognized late effect" — Sophia Schermerhorn (opinion) [Ep 26 · 0:43](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=43) - "Patients had a significant drop in weight percentile with smaller decreases in fat and muscle" — Sophia Schermerhorn (clinical) [Ep 26 · 0:48](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48) - "Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone" — Sophia Schermerhorn (opinion) [Ep 26 · 0:48](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48) - "These findings highlight the importance of nutritional screening during cancer treatments" — Sophia Schermerhorn (opinion) [Ep 26 · 0:48](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=48) - "As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself" — Sophia Schermerhorn (opinion) [Ep 26 · 1:03](https://qa.library.globalcastmd.com/watch/pancreas-muscle-and-subcutaneous-fat-atrophy-in-patients-undergoing-radiation-for-neuroblastoma-11866?t=63) - "Survival rate for high-risk neuroblastoma patients is in the 38 to 40% range" — Daniel von Allmen (epidemiological) [Ep 2 · 0:42](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=42) - "Surgeon-reported degree of resection showed only 66% concordance with radiologist assessment of postoperative imaging in tandem transplant pilot study" — Daniel von Allmen (clinical) [Ep 2 · 6:52](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=412) - "Repeat study in recent COG high-risk trial showed same 66% concordance rate between surgeon op notes and postoperative imaging, with surgeons underestimating and radiologists overcalling resection completeness" — Daniel von Allmen (clinical) [Ep 2 · 7:33](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=453) - "Memorial Sloan Kettering data suggests biggest volume response of neuroblastoma tumor occurs with first two cycles of chemotherapy, with very little response after that" — Daniel von Allmen (host_summary) [Ep 2 · 10:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=600) - "More chemotherapy or other agents like MIBG may make tumor more fibrotic and make subadventitial dissection more difficult" — Daniel von Allmen (opinion) [Ep 2 · 10:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=617) - "Complication rate for aggressive neuroblastoma resection is approximately 30% morbidity with mortality less than 1%" — Daniel von Allmen (epidemiological) [Ep 2 · 13:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=787) - "Riley Hospital study showed only survivors with stage 4 neuroblastoma were those who had primary tumor resection" (clinical) [Ep 2 · 14:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=847) - "Sloan Kettering study suggests stage 4 neuroblastoma patients do better with primary tumor resection" (host_summary) [Ep 2 · 14:27](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=867) - "Kylie's study showed no difference in survival based on completeness of neuroblastoma resection" (host_summary) [Ep 2 · 14:33](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=873) - "European studies show no difference in survival based on completeness of neuroblastoma resection" (host_summary) [Ep 2 · 14:35](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=875) - "Most recent COG study shows probably no difference in survival based on completeness of neuroblastoma resection" (host_summary) [Ep 2 · 14:35](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=875) - "High-risk neuroblastoma patients receive 9 different drugs, bone marrow transplantation, and some receive total body radiation" (clinical) [Ep 2 · 14:55](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=895) - "High-risk neuroblastoma treatment includes tandem peripheral blood stem cell transplants, with second transplant given as soon as patient recovers from first, followed by immunotherapy and Retin-A" — Daniel von Allmen (clinical) [Ep 2 · 15:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=910) - "High-risk neuroblastoma survival increased from 10% to 30-40% with treatment intensification" (epidemiological) [Ep 2 · 16:01](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=961) - "Georgia study showed 46% survival in high-risk neuroblastoma with transplantation plus immunotherapy plus differentiating agents" (host_summary) [Ep 2 · 16:22](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=982) - "Many deaths in intensified high-risk neuroblastoma treatment were due to the treatment itself rather than cancer" (host_summary) [Ep 2 · 16:22](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=982) - "German study of 278 stage 4 high-risk neuroblastoma patients achieved complete resection in almost half and >90% resection in another quarter (75% total with >90% resection)" — Daniel von Allmen (host_summary) [Ep 2 · 16:48](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1008) - "German study showed overall survival 45%, event-free survival 33%, and local progression-free survival 58% in stage 4 neuroblastoma" — Daniel von Allmen (host_summary) [Ep 2 · 17:13](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1033) - "German study showed no difference in overall survival, event-free survival, or local progression-free survival based on completeness of resection in stage 4 neuroblastoma" — Daniel von Allmen (host_summary) [Ep 2 · 17:32](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1052) - "German study concluded aggressive surgery is not justified in stage 4 neuroblastoma, that limited operations decrease complications, and there is limited impact on patient outcome" — Daniel von Allmen (host_summary) [Ep 2 · 17:51](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1071) - "European study included 1,324 high-risk neuroblastoma patients (stages 2, 3, and 4) and achieved 76% with >95% resection" — Daniel von Allmen (host_summary) [Ep 2 · 18:14](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1094) - "European neuroblastoma study showed 0.5% mortality and 10% morbidity (30% including lesser complications)" — Daniel von Allmen (host_summary) [Ep 2 · 19:02](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1142) - "European study showed significant improvement in event-free survival and overall survival with aggressive resection in high-risk neuroblastoma - first study to show overall survival benefit" — Daniel von Allmen (host_summary) [Ep 2 · 19:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1157) - "European study concluded >95% resection results in improvement in event-free survival in high-risk neuroblastoma" — Daniel von Allmen (host_summary) [Ep 2 · 20:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1217) - "COG 3973 study of approximately 230 high-risk neuroblastoma patients showed significant improvement in local relapse-free survival and event-free survival but not overall survival" — Daniel von Allmen (host_summary) [Ep 2 · 21:24](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1284) - "COG 3973 study's inability to demonstrate overall survival benefit may be type 2 error due to smaller sample size (230 vs 1,300 patients in European study)" — Daniel von Allmen (opinion) [Ep 2 · 21:56](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1316) - "Aggressive neuroblastoma resections using subadventitial dissection should not be performed by occasional pediatric oncological surgeons doing one case per year or every other year" (opinion) [Ep 2 · 22:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1341) - "European neuroblastoma procedures are performed in more than 200 hospitals yet still demonstrated survival improvements" — Daniel von Allmen (host_summary) [Ep 2 · 23:33](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1413) - "Older data shows worse survival in neuroblastoma when kidney is removed, likely because single kidney limits chemotherapy dosing" — Daniel von Allmen (host_summary) [Ep 2 · 24:03](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1443) - "Immunotherapy is effective in neuroblastoma in the setting of minimal residual disease" — Daniel von Allmen (clinical) [Ep 2 · 25:38](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2014-651?t=1538) - "Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database" — Sophia Schermerhorn (epidemiological) [Ep 22 · 0:12](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=12) - "Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities" — Sophia Schermerhorn (epidemiological) [Ep 22 · 0:20](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=20) - "The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma" — Sophia Schermerhorn (epidemiological) [Ep 22 · 0:31](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=31) - "After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present" — Sophia Schermerhorn (epidemiological) [Ep 22 · 0:37](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=37) - "Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor" — Sophia Schermerhorn (epidemiological) [Ep 22 · 0:44](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44) - "Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma" — Sophia Schermerhorn (epidemiological) [Ep 22 · 0:44](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44) - "Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health" — Sophia Schermerhorn (opinion) [Ep 22 · 0:51](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=51) - "Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors" — Sophia Schermerhorn (opinion) [Ep 22 · 1:00](https://qa.library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=60) - "The systematic review and meta-analysis was conducted by IPSO" — Cecilia Gigena (clinical) [Ep 13 · 0:09](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=9) - "The review analyzed the accuracy and safety of image-guided core needle biopsy for neuroblastoma" — Cecilia Gigena (clinical) [Ep 13 · 0:09](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=9) - "The review included 8 retrospective studies with 490 patients" — Cecilia Gigena (epidemiological) [Ep 13 · 0:23](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23) - "Tissue adequacy was not significantly different between image-guided core needle biopsy and surgical biopsy groups" — Cecilia Gigena (clinical) [Ep 13 · 0:23](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23) - "Biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups" — Cecilia Gigena (clinical) [Ep 13 · 0:23](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23) - "Intraoperative transfusions were higher in the surgical biopsy group compared to image-guided core needle biopsy" — Cecilia Gigena (clinical) [Ep 13 · 0:23](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23) - "Complications were higher in the surgical biopsy group compared to image-guided core needle biopsy" — Cecilia Gigena (clinical) [Ep 13 · 0:23](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=23) - "Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma" — Cecilia Gigena (opinion) [Ep 13 · 0:43](https://qa.library.globalcastmd.com/watch/image-guided-core-needle-or-surgical-biopsy-for-neuroblastoma-diagnosis-in-children-7988?t=43) - "Dr. Bailey Roberts from IPSO presented on extracellular vesicles for metastatic osteosarcoma contributing to the creation of pre-metastatic niche" — Cecilia (clinical) [Ep 16 · 0:08](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=8) - "Dr. Dominic Simons from IPSO presented on multimodal 3D visualization of pediatric neuroblastoma aiding surgical planning beyond anatomical information" — Cecilia (clinical) [Ep 16 · 0:19](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=19) - "Dr. Miyake from CAPS presented on using microinjection for drug delivery with nanoparticles in lung explants to study prenatal treatment of CDH" — Cecilia (clinical) [Ep 16 · 0:31](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=31) - "Dr. Urichuk from CAPS presented that individuals with thoracoabdominal congenital surgical anomalies are at increased risk of adverse mental health outcomes" — Cecilia (clinical) [Ep 16 · 0:47](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=47) - "Dr. Matthew Urichuk won Heat 2 of the Best of the Best in Pediatric Surgery 2024 competition" — Cecilia (clinical) [Ep 16 · 1:27](https://qa.library.globalcastmd.com/watch/heat-2-winner-matthew-urichuk-phd-best-of-the-best-in-pediatric-surgery-2024-8013?t=87) - "Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress" — Daniel von Allmen (clinical) [Ep 3 · 2:11](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=131) - "Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly" — Daniel von Allmen (clinical) [Ep 3 · 2:11](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=131) - "Familial neuroblastoma occurs in about 1% of patients" — Tony Sandler (epidemiological) [Ep 3 · 4:39](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=279) - "For prenatal suprarenal mass, first postnatal study should be ultrasound of the abdomen" — Todd Ponsky (guideline) [Ep 3 · 5:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=307) - "CT scan or MRI not needed for 3 cm lesion unless urine catecholamines are elevated" — Tony Sandler (guideline) [Ep 3 · 5:34](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=334) - "MIBG scan is the next step if catecholamines are elevated" — Daniel von Allmen (guideline) [Ep 3 · 6:02](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=362) - "Radiologists are quite good at identifying adrenal hemorrhage on ultrasound" — Daniel von Allmen (opinion) [Ep 3 · 6:02](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=362) - "In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes" — Daniel von Allmen (clinical) [Ep 3 · 8:14](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=494) - "Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance" — Daniel von Allmen (guideline) [Ep 3 · 8:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=524) - "Of 84 observed patients in Nocktern study, 16 (approximately 20%) underwent resection for growth or family preference" — Tony Sandler (epidemiological) [Ep 3 · 10:39](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=639) - "Nocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma" — Erika Newman (epidemiological) [Ep 3 · 11:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=667) - "First-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year" — Erika Newman (guideline) [Ep 3 · 11:37](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=697) - "After one year, surveillance becomes every six months, then yearly" — Erika Newman (guideline) [Ep 3 · 11:37](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=697) - "Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma" — Daniel von Allmen (clinical) [Ep 3 · 12:27](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=747) - "5 centimeters is used as size cutoff for surgical intervention in observed prenatal masses" — Tony Sandler (guideline) [Ep 3 · 14:36](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=876) - "Volume increase of more than 50% is criterion for considering surgery" — Todd Ponsky (guideline) [Ep 3 · 15:08](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=908) - "50% increase in VMA or HVA prompts consideration of surgery" — Todd Ponsky (guideline) [Ep 3 · 15:08](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=908) - "Laparoscopic approach is reasonable for masses less than 6 centimeters" — Erika Newman (guideline) [Ep 3 · 16:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=967) - "Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor" — Daniel von Allmen (clinical) [Ep 3 · 16:36](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=996) - "Biology of neuroblastoma is more important than lymph node status for treatment decisions" — Erika Newman (clinical) [Ep 3 · 17:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1020) - "Stage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology" — Erika Newman (clinical) [Ep 3 · 17:30](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1050) - "Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise" — Daniel von Allmen (clinical) [Ep 3 · 17:58](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1078) - "Stage MS without distress can be treated with aggressive observation" — Erika Newman (guideline) [Ep 3 · 17:58](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1078) - "Once respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy" — Erika Newman (guideline) [Ep 3 · 17:58](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1078) - "Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy" — Daniel von Allmen (opinion) [Ep 3 · 19:06](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1146) - "Liver biopsy in newborns is difficult because bleeding is hard to control" — Erika Newman (clinical) [Ep 3 · 19:52](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1192) - "If NMYC is amplified in stage MS, staging changes from MS to M" — Todd Ponsky (clinical) [Ep 3 · 20:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1240) - "VIP secretion can cause severe diarrhea in neuroblastoma" — Erika Newman (clinical) [Ep 3 · 21:05](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) - "Initial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid" — Erika Newman (guideline) [Ep 3 · 21:05](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) - "Ultrasound is important for Wilms tumor to assess venous extension" — Tony Sandler (clinical) [Ep 3 · 22:56](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1376) - "Large mass encasing aorta and celiac axis with microcalcifications represents L2 INRG classification" — Tony Sandler (clinical) [Ep 3 · 23:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1430) - "Complete staging workup includes bone marrow biopsy, MIBG scan, chest CT to rule out metastasis, and head CT if clinical symptoms present" — Tony Sandler (guideline) [Ep 3 · 23:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1430) - "10% of neuroblastomas are not MIBG avid" — Daniel von Allmen (epidemiological) [Ep 3 · 25:06](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1506) - "PET scan may detect metastases in MIBG-negative neuroblastomas" — Daniel von Allmen (clinical) [Ep 3 · 25:06](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1506) - "PET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar" — Erika Newman (guideline) [Ep 3 · 26:03](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1563) - "Open retroperitoneal biopsy provides adequate tissue size for pathology and biology studies" — Tony Sandler (opinion) [Ep 3 · 27:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "Transperitoneal laparoscopic biopsy may not allow adequate bleeding control for large tumors" — Tony Sandler (opinion) [Ep 3 · 27:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "Multiple percutaneous biopsies may not provide adequate tissue for biology studies" — Tony Sandler (opinion) [Ep 3 · 27:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "NMYC amplification can be obtained from bone marrow, but additional biology studies require tumor tissue" — Tony Sandler (clinical) [Ep 3 · 27:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "Biology studies beyond NMYC include ALK mutation and ploidy status" — Tony Sandler (clinical) [Ep 3 · 28:28](https://qa.library.globalcastmd.com/watch/neuroblastoma-2534?t=1708) - "Hepatoblastoma is the most common malignant liver tumor in the pediatric population" (epidemiological) [Ep 9 · 0:00](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0) - "There are around 250 new cases of hepatoblastoma per year" (epidemiological) [Ep 9 · 0:20](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=20) - "Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years" (clinical) [Ep 9 · 0:10](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=10) - "Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children" — Greg Tiao (epidemiological) [Ep 9 · 0:46](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=46) - "Neuroblastoma is the most common solid malignancy in the pediatric population" (epidemiological) [Ep 9 · 1:14](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=74) - "Hemangioma is the most common liver lesion in children" (epidemiological) [Ep 9 · 1:40](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=100) - "Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size" — Greg Tiao (clinical) [Ep 9 · 2:20](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140) - "Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty" (clinical) [Ep 9 · 2:46](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166) - "An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response" (clinical) [Ep 9 · 2:46](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166) - "Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma" — Greg Tiao (clinical) [Ep 9 · 3:13](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193) - "Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging" — Greg Tiao (clinical) [Ep 9 · 3:13](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193) - "To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy" (clinical) [Ep 9 · 3:39](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219) - "The most important intervention for survival is to achieve complete resection" (clinical) [Ep 9 · 3:39](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219) - "Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation" — Greg Tiao (clinical) [Ep 9 · 4:25](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265) - "Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled" (clinical) [Ep 9 · 4:50](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=290) - "The right hepatic vein differentiates anterior and posterior sections of the right liver" — Greg Tiao (clinical) [Ep 9 · 5:41](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=341) - "The right portal vein separates superior and inferior segments of the right liver" — Greg Tiao (clinical) [Ep 9 · 6:02](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=362) - "The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage)" — Greg Tiao (clinical) [Ep 9 · 6:51](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411) - "Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor" — Greg Tiao (clinical) [Ep 9 · 6:51](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411) - "Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis" (clinical) [Ep 9 · 8:01](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481) - "Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today" — Greg Tiao (clinical) [Ep 9 · 8:15](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495) - "Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections" — Greg Tiao (clinical) [Ep 9 · 8:15](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495) - "Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant" (clinical) [Ep 9 · 9:12](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=552) - "It is important to consult a transplant center early for pre-text 3 and 4 tumors" — Greg Tiao (clinical) [Ep 9 · 9:35](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=575) - "The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage" — Greg Tiao (clinical) [Ep 9 · 10:27](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627) - "The PHITT study has been ongoing for three years" — Greg Tiao (clinical) [Ep 9 · 10:27](https://qa.library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627) - "The presented case is a 16-month-old with a right adrenal mass measuring 8 centimeters" (clinical) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=0) - "Biopsy showed favorable cell neuroblastoma biology with no MYCN amplification but with segmental chromosomal abnormalities" (clinical) [Ep 12 · 0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=0) - "The Children's Oncology Group neuroblastoma classification tree is constantly changing as new information is added" — Paul Yasurjak (guideline) [Ep 12 · 0:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24) - "Based on the 2021 COG classification, the presented tumor would be classified as higher risk" — Paul Yasurjak (guideline) [Ep 12 · 0:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24) - "COG reviewed patients enrolled in trials between 2007 and 2017" — Paul Yasurjak (epidemiological) [Ep 12 · 0:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24) - "The presence of segmental chromosomal aberrations such as loss or gain of a portion of the chromosomal arm can have a negative impact on patient outcomes" — Paul Yasurjak (clinical) [Ep 12 · 0:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24) - "The updated schema classifies tumors as high risk when there is no MYCN amplification but segmental chromosomal abnormalities are present" — Paul Yasurjak (guideline) [Ep 12 · 0:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-staging-and-management-of-neuroblastoma-2022-6710?t=24) - "The curation process filters approximately 1200 articles per month from 33 pediatric and general surgical journals plus 3 top clinical journals (NEJM, Lancet, JAMA) down to 25-50 relevant pediatric surgery articles, then further narrows to 10-15 through specialty filtering, quality ranking, methodology assessment, and popularity polling among general surgeons." — Todd Ponsky (host_summary) [Ep 10 · 1:53](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=113) - "Upper GI contrast study is operator-dependent and requires direct communication with radiologist, readily available at high-volume centers but requires more coordination at community hospitals." — Todd Ponsky (clinical) [Ep 10 · 5:30](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=330) - "Ultrasound for malrotation diagnosis is very dependent on the person who performs the ultrasound, making it less reliable than upper GI contrast study." (opinion) [Ep 10 · 8:08](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=488) - "Reversal of vessels at the root of the mesentery on ultrasound is not a very reliable way to make the diagnosis of malrotation." (clinical) [Ep 10 · 8:35](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=515) - "In the Annals of Surgery 5-year follow-up study of non-operative appendicitis management, 46% of patients randomized to non-surgical management required appendectomy during follow-up, while the surgical group had no complications or readmissions." — Todd Ponsky (host_summary) [Ep 10 · 11:52](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=712) - "Half of the non-surgical appendicitis management group presented to the emergency room during 5-year follow-up." — Todd Ponsky (host_summary) [Ep 10 · 12:08](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=728) - "The presence of an appendicolith in appendicitis has about a 50% failure rate with non-operative management, making it a contraindication for non-surgical treatment." — Todd Ponsky (clinical) [Ep 10 · 10:22](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=622) - "In the Journal of Clinical Oncology study of 1,531 patients with stage 4 high-risk neuroblastoma, 5-year event-free survival and overall survival were significantly higher with complete resection compared to incomplete microscopic resection." (host_summary) [Ep 10 · 14:20](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=860) - "Local progression in stage 4 neuroblastoma was lower with complete resection when compared with incomplete resection." (host_summary) [Ep 10 · 14:36](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=876) - "In the New England Journal of Medicine randomized controlled trial of 80 women carrying fetuses with severe isolated left-sided congenital diaphragmatic hernia, fetal endoscopic tracheal occlusion (FETO) at 27-29 weeks resulted in 40% survival to discharge versus 15% with expectant care." (host_summary) [Ep 10 · 16:30](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=990) - "At 6 months of age, survival was the same between FETO and expectant care groups in severe CDH." (host_summary) [Ep 10 · 16:44](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1004) - "FETO was associated with an increased risk of pre-labor rupture of membranes and preterm labor." (host_summary) [Ep 10 · 16:47](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1007) - "In the Journal of Trauma study of 135 children aged 1-17 years who received whole blood as adjunct to component therapy, matched to 270 children receiving only component therapy, the whole blood group had decreased transfusion volume at 24 hours and required fewer ventilation days, though mortality, length of stay, and major complications were the same." — Todd Ponsky (host_summary) [Ep 10 · 18:16](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1096) - "Current ATLS protocols recommend initial bolus with normal saline or crystalloid solution before moving to blood products in pediatric trauma." — Todd Ponsky (guideline) [Ep 10 · 19:40](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180) - "Nationwide in adults, ambulance rigs are starting to travel with whole blood capabilities and people are using whole blood even earlier in trauma resuscitation." — Todd Ponsky (clinical) [Ep 10 · 19:40](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1180) - "The challenge for whole blood in pediatrics is availability, and thankfully for children, we don't use a lot of massive transfusion protocols compared to adults." — Todd Ponsky (clinical) [Ep 10 · 20:28](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1228) - "Some centers are limiting whole blood use to males and some to children older than 15, depending on institutional protocols and blood bank partnerships." — Todd Ponsky (clinical) [Ep 10 · 21:13](https://qa.library.globalcastmd.com/watch/update-course-2021-top-publications-in-non-ped-surg-journals-5404?t=1273) - "High-risk neuroblastoma patients continue to have survival rates in the 38-40% range despite aggressive therapy" — Dan (epidemiological) [Ep 1 · 0:25](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=25) - "Surgeons overestimated their degree of resection compared to postoperative imaging in 2/3 of cases (66% concordance rate) in the tandem transplant pilot study" — Dan (clinical) [Ep 1 · 6:35](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=395) - "In a repeat study with COG high-risk patients, surgeons underestimated resection extent while radiologists overcalled it, again showing only 66% concordance, suggesting no correlation between surgeon assessment and imaging" — Dan (clinical) [Ep 1 · 7:22](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=442) - "The biggest volume response of neuroblastoma tumor occurs with the first two cycles of chemotherapy, with very little response after that (Memorial Sloan Kettering data)" — Dan (clinical) [Ep 1 · 9:43](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=583) - "More chemotherapy or other treatments like MIBG make the tumor more fibrotic and make subadventitial dissection more difficult" — Dan (opinion) [Ep 1 · 10:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=600) - "There is good evidence that aggressive resection improves survival in stage 3 neuroblastoma patients, supported by pre-COG merger studies" (clinical) [Ep 1 · 11:53](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=713) - "Surgical complication rate for aggressive neuroblastoma resection is approximately 30% morbidity with mortality less than 1%" — Dan (epidemiological) [Ep 1 · 12:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=770) - "The Riley study showed the only survivors with stage 4 neuroblastoma were those who had primary tumor resection" (clinical) [Ep 1 · 13:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=830) - "The Sloan Kettering study suggests stage 4 patients do better with primary tumor resection" (clinical) [Ep 1 · 14:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=850) - "Kiely's study showed no difference in survival based on extent of resection" (clinical) [Ep 1 · 14:16](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=856) - "European studies show no difference in survival based on extent of resection in stage 4 disease" (clinical) [Ep 1 · 14:19](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=859) - "High-risk neuroblastoma patients receive 9 different drugs, bone marrow transplantation, and some receive total body radiation, with outrageous morbidity from medical treatment" (clinical) [Ep 1 · 14:31](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=871) - "High-risk neuroblastoma treatment includes tandem peripheral blood stem cell transplants (two sequential transplants), followed by immunotherapy and Retin-A" — Dan (clinical) [Ep 1 · 14:53](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=893) - "High-risk neuroblastoma survival improved from 10% to 30-40% with treatment intensification" (epidemiological) [Ep 1 · 15:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=944) - "The Georgia study showed 46% survival with transplantation plus immunotherapy plus differentiating agents, but many deaths were due to intensified treatment rather than cancer" (epidemiological) [Ep 1 · 16:05](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=965) - "German study of 278 stage 4 high-risk neuroblastoma patients achieved complete resection in almost half and >90% resection in another quarter (75% total achieving >90% resection)" — Dan (epidemiological) [Ep 1 · 16:30](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=990) - "German study outcomes: overall survival 45%, event-free survival 33%, local progression-free survival 58%" — Dan (epidemiological) [Ep 1 · 16:57](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1017) - "German study showed no difference in overall survival, event-free survival, or local progression-free survival based on completeness of resection" — Dan (clinical) [Ep 1 · 17:15](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1035) - "German study concluded aggressive surgery is not justified in stage 4 disease, limited operations decrease complications, and there is limited impact on patient outcome" — Dan (host_summary) [Ep 1 · 17:34](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1054) - "European SIOPEN study included 1,324 high-risk neuroblastoma patients (stages 3 and 4) and achieved >95% resection in 76% of patients" — Dan (epidemiological) [Ep 1 · 17:57](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1077) - "SIOPEN study surgical mortality was 0.5% with 10% morbidity (30% if including lesser complications)" — Dan (epidemiological) [Ep 1 · 18:45](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1125) - "SIOPEN study showed significant improvement in event-free survival and overall survival with >95% resection - the first study to show overall survival benefit" — Dan (clinical) [Ep 1 · 19:01](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1141) - "SIOPEN study concluded >95% resection results in improvement in event-free survival in high-risk neuroblastoma" — Dan (clinical) [Ep 1 · 19:55](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1195) - "COG 3973 study (230 patients) showed statistically significant improvement in local relapse-free survival and event-free survival with aggressive resection" — Dan (clinical) [Ep 1 · 21:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1267) - "COG 3973 study was not able to demonstrate improvement in overall survival, possibly due to type 2 error from smaller sample size (230 vs 1,300 in European study)" — Dan (clinical) [Ep 1 · 21:35](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1295) - "Aggressive neuroblastoma resections using the Kiely subadventitial approach should not be performed by occasional pediatric oncological surgeons doing one case per year or every other year" (opinion) [Ep 1 · 22:05](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1325) - "European neuroblastoma procedures are performed in more than 200 hospitals, yet still demonstrated survival improvements despite this distribution" — Dan (epidemiological) [Ep 1 · 23:16](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1396) - "Older data shows that if the kidney is removed during neuroblastoma resection, survival is worse; renal preservation leads to better outcomes" — Dan (clinical) [Ep 1 · 23:53](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1433) - "Renal preservation is important because patients with only one kidney cannot receive as much chemotherapy, which impacts overall survival" — Dan (clinical) [Ep 1 · 24:12](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1452) - "Aggressive surgical approach to local neuroblastoma recurrence is justified as long as it is not progressive metastatic disease, though prognosis is worse" — Dan (opinion) [Ep 1 · 24:36](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1476) - "New therapies like targeted MIBG therapy may justify surgical removal of bulk disease in recurrent neuroblastoma" — Dan (opinion) [Ep 1 · 25:05](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1505) - "Immunotherapy is effective in the setting of minimal residual disease, so achieving 95% resection may improve the impact of medical therapy on metastatic disease" — Dan (opinion) [Ep 1 · 25:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-update-course-2016-434?t=1521) - "Liver tumors are rare in children, and sorting out the diagnosis is crucial for good outcomes." — Max Langham (clinical) [Ep 7 · 1:37](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=97) - "A one-year-old with a liver mass is likely to be hepatoblastoma, although rhabdoid tumor can occur at that age and is a bad actor." — Max Langham (clinical) [Ep 7 · 1:53](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=113) - "If alpha-fetoprotein is quite high and very elevated, the presumptive diagnosis in a 1-year-old would be hepatoblastoma." — Max Langham (clinical) [Ep 7 · 2:06](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=126) - "Hepatoblastoma presents from the first year of life through perhaps 10 years of age, although there are a few that have been diagnosed older than that." — Max Langham (epidemiological) [Ep 7 · 2:19](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=139) - "If this is a rhabdoid tumor, chemotherapy is not important and the lesion needs to be resected." — Max Langham (clinical) [Ep 7 · 2:43](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=163) - "If it's a very low risk hepatoblastoma, it probably doesn't need a biopsy and needs an upfront resection." — Max Langham (clinical) [Ep 7 · 2:55](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=175) - "Most people favor needle biopsy of the liver rather than an open biopsy or a laparoscopic biopsy." — Max Langham (clinical) [Ep 7 · 3:40](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=220) - "The biopsy should go through the normal part of the liver that will be resected with the specimen, approaching from the side of the tumor to avoid seeding the contralateral lobe." — Max Langham (clinical) [Ep 7 · 3:51](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=231) - "Hepatoblastoma will seed and can create big issues for future resection and cure if the biopsy crosses the uninvolved lobe." — Max Langham (clinical) [Ep 7 · 4:06](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=246) - "There have been prenatal diagnoses of hepatoblastoma, not super rare but not very common." — Max Langham (epidemiological) [Ep 7 · 4:46](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=286) - "Rhabdoid tumor is more common in very young children compared to hepatoblastoma." — Max Langham (epidemiological) [Ep 7 · 4:57](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=297) - "Hepatocellular carcinoma can occur in young children, usually in association with an inborn error of metabolism, with tyrosinemia as the prototype." — Max Langham (clinical) [Ep 7 · 5:29](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=329) - "A baby with tyrosinemia will develop hepatocellular carcinoma if they are not transplanted, usually in the first couple of years of life." — Max Langham (clinical) [Ep 7 · 5:40](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=340) - "There is a mixed tumor with features of hepatoblastoma and hepatocellular carcinoma that tends to occur in children over 6 years of age." — Max Langham (clinical) [Ep 7 · 5:50](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=350) - "There is a predisposition of premature infants to getting hepatoblastomas, usually not in the nursery but in the first year or two of life." — Max Langham (epidemiological) [Ep 7 · 7:40](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=460) - "For the biology arm of the Children's Oncology Group, they want 10 core biopsies." — Max Langham (guideline) [Ep 7 · 8:52](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=532) - "The complication rate and some mortality seems higher with open biopsies than with the needle technique." — Max Langham (clinical) [Ep 7 · 9:16](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=556) - "There is no role for frozen section in hepatoblastoma, either for initial biopsy or for later margin assessment." — Max Langham (clinical) [Ep 7 · 9:57](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=597) - "The overarching goal of treatment for hepatoblastoma is to get the kids to a safe resection." — Max Langham (clinical) [Ep 7 · 10:27](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=627) - "The PRETEXT system is a pre-treatment extent of disease radiographic imaging-based system developed in Europe during SIOPEL 1." — Max Langham (clinical) [Ep 7 · 10:46](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=646) - "Couinaud based the numerology of liver segments on the street map of Paris, with the caudate lobe (segment 1) representing the Île de Paris where Notre Dame is located." — Max Langham (clinical) [Ep 7 · 12:13](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=733) - "A PRETEXT 1 lesion has three contiguous sectors of the liver that are free of tumor." — Max Langham (clinical) [Ep 7 · 12:50](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=770) - "A PRETEXT 2 lesion has two adjoining sectors free of tumor." — Max Langham (clinical) [Ep 7 · 13:17](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=797) - "With PRETEXT 3, there is only one sector free of disease." — Max Langham (clinical) [Ep 7 · 13:42](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=822) - "In PRETEXT 4, all of the sectors are involved with no sectors of the liver free of disease." — Max Langham (clinical) [Ep 7 · 14:00](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=840) - "It is more common for people to over-read PRETEXT than under-read it." — Max Langham (clinical) [Ep 7 · 14:17](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=857) - "In AHEP 0731 and the FIT trial, upfront resection is acceptable if it is a conventional hemihepatectomy or less, with clearly 1 centimeter of normal liver between the middle hepatic vein and tumor, and no annotation factors." — Max Langham (guideline) [Ep 7 · 14:43](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=883) - "If a lesion is resected upfront and histology shows well-differentiated pure fetal histology, the baby is done with no need for any chemotherapy at all, and survival is 100%." — Max Langham (clinical) [Ep 7 · 15:37](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=937) - "Along with imaging for suspected hepatoblastoma, a chest CT is needed because pulmonary metastases make up the vast majority of metastases, and even small liver tumors can metastasize." — Max Langham (clinical) [Ep 7 · 16:52](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1012) - "If there is a PRETEXT 1 lesion with metastatic disease in the lungs, that is a high-risk patient." — Max Langham (clinical) [Ep 7 · 17:21](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1041) - "For a PRETEXT 1 lesion with clear lungs, no vena cava, hepatic vein confluence, or portal vein involvement, and judged resectable by the surgeon, it should be resected with an anatomic resection and the child will be in a very low risk group." — Max Langham (clinical) [Ep 7 · 17:31](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1051) - "A PRETEXT 1 lesion with vascular involvement (within 1 cm of cava or hepatic veins) would be considered an intermediate risk patient." — Max Langham (clinical) [Ep 7 · 18:44](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1124) - "If a patient with hepatoblastoma is over 8 years of age, that moves the patient into a higher risk environment." — Max Langham (clinical) [Ep 7 · 18:59](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1139) - "Not all PRETEXT 1 lesions are resectable upfront, and there are some PRETEXT 2 lesions that are resectable upfront." — Max Langham (clinical) [Ep 7 · 19:53](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1193) - "Annotation factors include V for vena cava and hepatic veins; if they are more than 1 centimeter away from the vena cava, there is no annotation factor." — Max Langham (clinical) [Ep 7 · 20:14](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1214) - "V0 means the lesion is within 1 centimeter of the cava or confluence of hepatic veins, making the patient no longer eligible for upfront resection." — Max Langham (clinical) [Ep 7 · 20:35](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1235) - "V1 means the tumor is abutting either the vena cava or the three hepatic veins." — Max Langham (clinical) [Ep 7 · 20:48](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1248) - "V2 means the tumor is large enough that it is distorting or pushing the vessels away." — Max Langham (clinical) [Ep 7 · 20:56](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1256) - "V3 means there is evidence of tumor thrombus extending out of the vein, which is particularly problematic." — Max Langham (clinical) [Ep 7 · 21:00](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1260) - "Hepatoblastoma is like Wilms tumor in that you can get direct extension of large tumor thrombus out of the hepatic veins into the vena cava and even up into the heart." — Max Langham (clinical) [Ep 7 · 21:09](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1269) - "Most hepatoblastomas are a mixture of fetal and embryonal histologies." — Max Langham (clinical) [Ep 7 · 22:34](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1354) - "The most common adverse finding is small cell undifferentiated (SCU) histology, which is a primitive tumor with small blue cell morphology and high nuclear-cytoplasmic ratio, making it a much higher risk lesion." — Max Langham (clinical) [Ep 7 · 22:54](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1374) - "In AHEP 0731, patients with mixed fetal and embryonal histology after upfront resection with negative margins were treated with two courses of cisplatin-based chemotherapy with excellent results." — Max Langham (clinical) [Ep 7 · 24:25](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1465) - "If the diagnosis is hepatoblastoma, the child needs long-term central access and will have two rounds of cisplatin-based chemotherapy in the United States, then be reimaged." — Max Langham (clinical) [Ep 7 · 25:40](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1540) - "Most of the tumor shrinkage that will occur with chemotherapy happens in the first two rounds." — Max Langham (clinical) [Ep 7 · 26:31](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1591) - "After two rounds of chemotherapy and reimaging, the surgeon should make a commitment about resectability; if resectable, do 2 more rounds of chemotherapy, resect after 4, then give 2 consolidation rounds for a total of 6." — Max Langham (clinical) [Ep 7 · 26:41](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1601) - "Multifocal tumors should be referred to transplantation because they have high recurrence risk after resection." — Max Langham (clinical) [Ep 7 · 27:14](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1634) - "Most surgeons will be able to make the call about resectability at the end of two rounds of chemotherapy." — Max Langham (opinion) [Ep 7 · 27:59](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1679) - "A child that is 6 years of age or older with hepatoblastoma is going to be a significantly higher risk patient." — Max Langham (clinical) [Ep 7 · 29:06](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1746) - "Children who are 8 years of age or older with hepatoblastoma are going to be high risk." — Max Langham (clinical) [Ep 7 · 29:53](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1793) - "Children with hepatoblastoma who have normal or near-normal alpha-fetoproteins (less than 100) are going to be high-risk patients." — Max Langham (clinical) [Ep 7 · 30:08](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1808) - "Pulmonary metastases in hepatoblastoma can have superb results, and current AHEP results look similar to Wilms tumor outcomes with pulmonary mets." — Max Langham (clinical) [Ep 7 · 31:01](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1861) - "Rapid responders whose pulmonary mets disappear with chemotherapy probably do not need any specific pulmonary therapy." — Max Langham (clinical) [Ep 7 · 31:35](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1895) - "A child where the pulmonary mets get smaller but persist will need a pulmonary metastectomy, which can be done thoracoscopically or open." — Max Langham (clinical) [Ep 7 · 31:53](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1913) - "The Japanese have published using indocyanine green as a marker for thoracoscopic metastectomy because it is concentrated in the liver and lights up." — Max Langham (clinical) [Ep 7 · 32:17](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1937) - "If pulmonary mets don't disappear, they should be biopsied to confirm metastatic disease and rule out other lesions like histoplasmosis in the Mississippi Valley." — Max Langham (clinical) [Ep 7 · 32:35](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=1955) - "Before doing anything of consequence with the liver, ensure you can vascularly isolate it by dissecting the suprahepatic and infrahepatic vena cava and placing umbilical tapes for potential clamping." — Max Langham (clinical) [Ep 7 · 36:56](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2216) - "Disasters during liver resection happen because of major bleeding or air embolism from holes in the low-pressure vena cava system." — Max Langham (clinical) [Ep 7 · 37:52](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2272) - "Use hypovolemic anesthesia with low CVP during liver resection, preserving transfusions until later in the case, because high CVP causes the liver to swell, become turgid, bleed more, and makes veins harder to dissect." — Max Langham (clinical) [Ep 7 · 38:52](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2332) - "Take inflow before outflow during liver resection to prevent the liver from swelling." — Max Langham (clinical) [Ep 7 · 39:37](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2377) - "Anatomic resections are preferred; non-anatomic resections are generally not favored except for lesions hanging off the edge of segments 3 or 5." — Max Langham (opinion) [Ep 7 · 39:46](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2386) - "The handheld harmonic device used for thyroidectomies is fast with excellent hemostasis for parenchymal transection." — Max Langham (opinion) [Ep 7 · 40:08](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2408) - "The CUSA is good for dissecting around veins and clearing anatomy but provides no hemostasis." — Max Langham (clinical) [Ep 7 · 40:16](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2416) - "Staplers work well in older kids and adults but in babies the stapler width can be wider than the margin, potentially causing false positive margins or getting into vessels." — Max Langham (clinical) [Ep 7 · 41:06](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2466) - "Liver transplant has great 3- and 5-year disease-free survival but requires lifelong immunosuppression with risks of rejection, secondary malignancies, and post-transplant lymphoproliferative disorders." — Max Langham (clinical) [Ep 7 · 42:20](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2540) - "Extreme resections with vena cava reconstruction or hepatic vein reimplantation can provide equivalent oncologic results to transplant without immunosuppression." — Max Langham (opinion) [Ep 7 · 42:44](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2564) - "Several patients have developed portal hypertension or other problems late after extreme resections that required transplant or other therapy." — Max Langham (clinical) [Ep 7 · 43:18](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2598) - "The complication rate of extreme resections is higher than transplantation." — Max Langham (clinical) [Ep 7 · 43:30](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2610) - "Having a grossly positive margin or leaving gross residual disease behind is not acceptable and should not happen if surgical guidelines are followed." — Max Langham (clinical) [Ep 7 · 44:47](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2687) - "Gross residual disease most often happens in older kids with trauma who rupture a liver tumor, such as during peewee football." — Max Langham (clinical) [Ep 7 · 45:00](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2700) - "Kids relapse either locally in the liver or in the lungs." — Max Langham (clinical) [Ep 7 · 45:30](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2730) - "If a patient has a negative margin resection and relapses locally in the liver, refer them for transplantation; salvage transplantation is not optimal but probably better than re-resection." — Max Langham (opinion) [Ep 7 · 45:36](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2736) - "For pulmonary recurrence, treating with chemotherapy is important but you will probably need to re-excise the pulmonary mets." — Max Langham (clinical) [Ep 7 · 46:08](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2768) - "Hepatoblastoma is not thought to be radiation sensitive, and there is almost no anecdotal data of radiation being used in the lungs." — Max Langham (clinical) [Ep 7 · 46:19](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2779) - "After resection following 4 rounds of chemotherapy with clear margins and no residual tumor, patients usually receive 2 courses of consolidation chemotherapy." — Max Langham (clinical) [Ep 7 · 46:53](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2813) - "Most recurrences will happen within the first 3 years of therapy." — Max Langham (clinical) [Ep 7 · 47:02](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2822) - "After a child gets two cycles of chemotherapy and is restaged, whether it is PRETEXT 2, 3, or has annotation factors, the surgeon's job is to resect that patient after 4 courses of chemotherapy." — Max Langham (clinical) [Ep 7 · 48:02](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2882) - "In a recent SIOPEL study, nearly half of PRETEXT 4 lesions were resected with conventional resections and did not need liver transplants." — Max Langham (clinical) [Ep 7 · 48:30](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2910) - "In the US for PRETEXT 4 in AHEP 0731, about 90% of those patients were transplanted." — Max Langham (epidemiological) [Ep 7 · 48:44](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2924) - "A patient being PRETEXT 3 or 4 does not mean they cannot be resected ultimately; it just means they need chemotherapy first." — Max Langham (clinical) [Ep 7 · 48:53](https://qa.library.globalcastmd.com/watch/hepatoblastoma-291?t=2933) - "Neuroblastoma is the most common extracranial solid tumor in children, with the majority occurring in children less than a year old." — Rae Hanke (host_summary) [Ep 5 · 0:00](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0) - "In younger patients, neuroblastoma is often picked up either prenatally on ultrasound, or in younger kids (two-year-old or three-year-old) as a solid abdominal mass." — Daniel von Allmen (clinical) [Ep 5 · 0:41](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41) - "When neuroblastoma patients have metastatic disease, they may present with either bony pain or potentially neurologic symptoms from cord compression." — Daniel von Allmen (clinical) [Ep 5 · 0:41](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41) - "When considering neuroblastoma as part of the differential diagnosis, it is important to get catecholamines (either urine or serum) as one of the most diagnostic laboratory tests for this tumor." — Daniel von Allmen (clinical) [Ep 5 · 1:07](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67) - "Most children with suspected neuroblastoma would get a cross-sectional imaging study, either a CT scan or an MRI." — Daniel von Allmen (clinical) [Ep 5 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99) - "If imaging suggests neuroblastoma (central abdominal mass or adrenal mass rather than kidney mass), the next test would be a nuclear medicine study, typically an MIBG study." — Daniel von Allmen (clinical) [Ep 5 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99) - "The MIBG study is helpful for confirming the diagnosis of neuroblastoma and can also demonstrate metastatic disease." — Daniel von Allmen (clinical) [Ep 5 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99) - "About 10% of neuroblastomas are MIBG negative." — Daniel von Allmen (clinical) [Ep 5 · 2:20](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140) - "Some centers, including Cincinnati Children's Hospital, would get a PET scan looking for tumor uptake as well as potential metastatic disease." — Daniel von Allmen (clinical) [Ep 5 · 2:20](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140) - "Based on the most recent iteration of the neuroblastoma staging system (INRGSS), it is possible to assign a stage before any invasive procedure is performed." — Daniel von Allmen (guideline) [Ep 5 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165) - "In the INRGSS system, tumors that are localized are categorized as L1; if localized but have image-defined risk factors (encasing nerves or vessels), they are L2; if they have metastatic disease, they are M." — Daniel von Allmen (guideline) [Ep 5 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165) - "There is a special category MS for children less than 18 months of age who have metastases to either the bone marrow or the skin." — Daniel von Allmen (guideline) [Ep 5 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165) - "The INRGSS pre-biopsy staging system was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient." — Daniel von Allmen (guideline) [Ep 5 · 3:36](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216) - "The prior neuroblastoma staging system required tissue diagnosis before assigning a stage." — Daniel von Allmen (guideline) [Ep 5 · 3:36](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216) - "A child with an adrenal mass on the right side and a positive MIBG scan but no evidence of metastases could potentially be treated with a primary resection of the mass via laparotomy." — Daniel von Allmen (clinical) [Ep 5 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246) - "Some surgeons would approach resection of a localized neuroblastoma with laparoscopy depending on the size of the tumor." — Daniel von Allmen (opinion) [Ep 5 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246) - "For very large masses that encase the aorta, cava, or other major vasculature, all you really want is tissue for diagnosis, which can be obtained through open biopsy, laparoscopic biopsy, or core needle biopsies done by an interventional radiologist." — Daniel von Allmen (clinical) [Ep 5 · 4:44](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284) - "The most important biologic risk determinant to obtain from neuroblastoma biopsy tissue is the NMIC status." — Daniel von Allmen (clinical) [Ep 5 · 5:14](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314) - "In addition to NMIC status, you want to look for 1P and 11Q deletions and Shimada histology in neuroblastoma biopsy tissue." — Daniel von Allmen (clinical) [Ep 5 · 5:14](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314) - "Biologic risk determinants from biopsy will tell you what risk category the patient falls into: very low risk, low risk, intermediate risk, or high risk." — Daniel von Allmen (clinical) [Ep 5 · 5:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345) - "Neuroblastoma risk is divided about 50-50 between the low risk categories and the high risk category, with a smaller percentage being intermediate risk." — Daniel von Allmen (epidemiological) [Ep 5 · 5:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345) - "NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma." — Daniel von Allmen (clinical) [Ep 5 · 6:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371) - "Patients with high risk neuroblastoma receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with the goal of greater than 90% resection of the tumor, followed by radiation, immunotherapy after chemotherapy, and potentially retinoic acid therapy." — Daniel von Allmen (clinical) [Ep 5 · 6:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371) - "Intermediate risk neuroblastoma tumors get varying cycles of chemotherapy based on the biologic risk factors they have." — Daniel von Allmen (clinical) [Ep 5 · 6:51](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411) - "For intermediate risk neuroblastoma, the goal at the time of debulking or resecting the primary tumor is to achieve at least a 50% response from the initial volume of the primary tumor through the combination of neoadjuvant chemotherapy and surgical resection." — Daniel von Allmen (clinical) [Ep 5 · 6:51](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411) - "The low risk neuroblastoma group, depending on the actual age of the patient and how it is diagnosed, could potentially be followed simply with observation." — Daniel von Allmen (clinical) [Ep 5 · 7:22](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442) - "Jed Nocturne led a study through the Children's Oncology Group looking at patients less than six months of age with either a prenatally diagnosed or shortly postnatally diagnosed localized mass, showing these patients can be observed with the expectation that the vast majority will avoid any type of surgical procedure." — Daniel von Allmen (clinical) [Ep 5 · 7:22](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442) - "Patients with metastatic neuroblastoma typically receive four or five cycles of neoadjuvant chemotherapy and then are reassessed." — Daniel von Allmen (clinical) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475) - "If the tumor and metastatic disease are responding to neoadjuvant chemotherapy, one would attack the primary tumor site with a resection, with many advocating for attempting a greater than 90% resection." — Daniel von Allmen (clinical) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475) - "If the metastatic disease is progressing on neoadjuvant chemotherapy, then surgery is not indicated." — Daniel von Allmen (clinical) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475) - "MS disease is specifically for patients who have a primary site with metastatic disease to the liver, the skin, or the bone marrow (specifically not bone, not cortical bone) and is less than 18 months of age." — Daniel von Allmen (clinical) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475) - "In patients with MS disease, simple observation can be the treatment path." — Daniel von Allmen (clinical) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475) - "If MS disease patients progress or develop respiratory issues because of an enlarging liver mass, treatment might be elected because of the complication of the size of the tumor, but the tumor itself usually does not have to be treated." — Daniel von Allmen (clinical) [Ep 5 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475) - "You can biopsy the skin lesions in MS disease and that will give you the diagnosis." — Daniel von Allmen (clinical) [Ep 5 · 8:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535) - "Adrenal hemorrhage is the most common cause of prenatal suprarenal mass, especially with history of fetal stress" — Daniel von Allmen (clinical) [Ep 6 · 2:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=120) - "Familial neuroblastoma occurs in approximately 1% of patients" — Tony Sandler (epidemiological) [Ep 6 · 3:27](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=207) - "The GetNucturne study showed that prenatal/neonatal neuroblastomas can be safely observed with careful ultrasound surveillance, with many patients spared surgery" — Daniel von Allmen (clinical) [Ep 6 · 7:24](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=444) - "In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival" — Tony Sandler (clinical) [Ep 6 · 9:09](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=549) - "Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly" — Erika Newman (guideline) [Ep 6 · 9:58](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=598) - "Criteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA" — Erika Newman (guideline) [Ep 6 · 13:20](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=800) - "Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma" — Tony Sandler (opinion) [Ep 6 · 12:43](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=763) - "Lymph node status in neuroblastoma does not change therapy, unlike Wilms tumor" — Daniel von Allmen (clinical) [Ep 6 · 14:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=861) - "Stage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly" — Erika Newman (clinical) [Ep 6 · 14:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=890) - "Treatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy" — Erika Newman (clinical) [Ep 6 · 15:42](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=942) - "Approximately 10% of neuroblastomas are not MIBG-avid, which is when PET scan may be useful" — Daniel von Allmen (clinical) [Ep 6 · 22:12](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1332) - "Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status" — Tony Sandler (clinical) [Ep 6 · 23:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1430) - "Approximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma" — Erika Newman (epidemiological) [Ep 6 · 26:56](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1616) - "Percutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment" — Erika Newman (clinical) [Ep 6 · 28:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1684) - "Optimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor" — Erika Newman (clinical) [Ep 6 · 28:55](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1735) - "Open biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy" — Erika Newman (clinical) [Ep 6 · 29:45](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1785) - "NMEC amplification automatically means high-risk neuroblastoma regardless of other factors" — Tony Sandler (clinical) [Ep 6 · 31:38](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1898) - "Loss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category" — Erika Newman (clinical) [Ep 6 · 33:49](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2029) - "Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months)" — Tony Sandler (guideline) [Ep 6 · 35:25](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2125) - "High-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant" — Erika Newman (clinical) [Ep 6 · 37:20](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2240) - "Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy" — Tony Sandler (clinical) [Ep 6 · 45:31](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2731) - "Tumor shrinkage in neuroblastoma plateaus after cycle 2-3 of chemotherapy per LaQuaglia and Von Allman studies" — Daniel von Allmen (clinical) [Ep 6 · 43:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2597) - "After 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect" — Erika Newman (clinical) [Ep 6 · 42:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2560) - "COG high-risk study showed >90% resection improved event-free survival but not overall survival (approximately 245 patients)" — Daniel von Allmen (clinical) [Ep 6 · 44:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2644) - "European neuroblastoma group study (approximately 1000 cases) showed >90% resection improved both event-free survival and overall survival" — Daniel von Allmen (clinical) [Ep 6 · 45:28](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2728) - "Approximately 70% of high-risk neuroblastoma patients can achieve >90% resection" — Daniel von Allmen (epidemiological) [Ep 6 · 46:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2770) - "Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes" — Tony Sandler (clinical) [Ep 6 · 46:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2810) - "High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence" — Tony Sandler (clinical) [Ep 6 · 47:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2860) - "Neuroblastoma theoretically does not invade vessel adventitia, though invasion has been observed" — Daniel von Allmen (clinical) [Ep 6 · 50:54](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3054) - "There is zero correlation between surgeon operative note description of resection extent and post-operative imaging findings" — Daniel von Allmen (clinical) [Ep 6 · 51:30](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3090) - "Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction" — Tony Sandler (clinical) [Ep 6 · 53:13](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3193) - "Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60%" — Tony Sandler (clinical) [Ep 6 · 53:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3224) - "Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor" — Tony Sandler (clinical) [Ep 6 · 54:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3280) - "Dr. Vogel completed fellowships in both pediatric surgery and surgical critical care, with research interests in viscoelastic monitoring, goal-directed hemostatic resuscitation, massive transfusion, and optimizing anticoagulation/ventilation during ECLS." — Alexander Gibbons (host_summary) [Ep 4 · 0:00](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=0) - "In coagulopathic trauma patients, trending coagulation values over time is more clinically useful than a single point measurement." — Vogel (clinical) [Ep 4 · 1:53](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=113) - "Initial assessment of coagulopathy should include review of crystalloid volume, blood product volumes, and transfusion ratios (red cells to plasma to platelets) received during resuscitation." — Vogel (clinical) [Ep 4 · 1:53](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=113) - "Goal-directed hemostatic therapy requires INR, PTT, hemoglobin, platelet count, and ideally viscoelastic monitoring (TEG or ROTEM) to assess functional coagulation." — Vogel (clinical) [Ep 4 · 1:53](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=113) - "Viscoelastic monitoring (TEG/ROTEM) provides global assessment of the entire coagulation system including hemostasis and fibrinolysis by transducing mechanical changes in clotting blood into electrical signals." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Viscoelastic tests measure four phases: time to clot formation (factor function), amplification rate (fibrinogen function), clot strength (platelet function), and fibrinolysis." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Prolonged clot formation time on viscoelastic monitoring indicates factor deficiency and should be treated with plasma." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Abnormal amplification phase (alpha angle) on viscoelastic monitoring indicates fibrinogen dysfunction and should be treated with cryoprecipitate or fibrinogen concentrate." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Reduced clot strength (maximal amplitude on TEG) indicates platelet dysfunction and can be treated with platelet transfusion or DDAVP in specific populations like end-stage renal disease patients." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Rapid drop-off in clot strength on viscoelastic monitoring indicates hyperfibrinolysis and may warrant antifibrinolytic therapy with tranexamic acid or aminocaproic acid." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Tranexamic acid has been widely used in adults for trauma-associated hyperfibrinolysis and is being used increasingly in children." — Vogel (clinical) [Ep 4 · 7:10](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=430) - "Viscoelastic monitoring results are available within 5-15 minutes, compared to 30-45 minutes for conventional coagulation tests (PT/INR/PTT)." — Vogel (clinical) [Ep 4 · 11:42](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=702) - "Severely injured children exhibit two fibrinolytic phenotypes: hyperfibrinolysis (rapid fibrinolysis contributing to coagulopathy) and fibrinolytic shutdown (smaller percentage)." — Vogel (clinical) [Ep 4 · 14:38](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=878) - "Tranexamic acid may be beneficial in hyperfibrinolytic patients but potentially detrimental in fibrinolytic shutdown patients by increasing hypercoagulability." — Vogel (clinical) [Ep 4 · 14:38](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=878) - "In adults, balanced resuscitation with 1:1:1 ratio of red cells to plasma to platelets improves mortality based on prospective observational studies and randomized trials." — Vogel (clinical) [Ep 4 · 16:16](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=976) - "Balanced resuscitation in adults improves multiple ICU outcomes including kidney injury, ventilator duration, ICU length of stay, and infection rates." — Vogel (clinical) [Ep 4 · 16:16](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=976) - "Balanced resuscitation achieves coagulopathy control more efficiently with less overall blood product volume despite appearing to use more products." — Vogel (clinical) [Ep 4 · 16:16](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=976) - "In pediatric trauma, retrospective studies using National Trauma Databank and TQIP show that 1:1 ratio of red cells to plasma provides improved outcomes." — Vogel (epidemiological) [Ep 4 · 16:16](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=976) - "The ATOMIC Group published a study of over 100 severely injured pediatric trauma patients showing best outcomes and survival with resuscitation closer to 1:1:1 balanced ratio." — Vogel (epidemiological) [Ep 4 · 16:16](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=976) - "Standard of care for hemostatic resuscitation in 2019 is balanced resuscitation with 1:1:1 ratio of red cells, plasma, and platelets." — Vogel (guideline) [Ep 4 · 16:16](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=976) - "Massive transfusion protocols should deliver blood products in 1:1:1 ratio, and this is part of American College of Surgeons Committee on Trauma verification standards for trauma centers." — Vogel (guideline) [Ep 4 · 19:07](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1147) - "Multimodal approach to postoperative analgesia has substantial benefits and should include narcotics, non-narcotics, regional techniques, and non-pharmacologic interventions." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Partnering with anesthesia pain service teams and pharmacists is valuable for managing complex postoperative pain in pediatric patients." — Vogel (opinion) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Non-steroidal anti-inflammatory medications (IV Toradol or oral NSAIDs) help minimize narcotic use and can decrease postoperative complications like ileus." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Regional analgesia techniques including epidural catheters and ultrasound-guided nerve blocks are effective for managing incisional pain and reducing intraoperative and postoperative opioid use." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Indwelling analgesic catheters that deliver slow-release local anesthetics into surgical wounds have been shown to be helpful for large incisions." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Gabapentinoids (pregabalin and gabapentin) are useful components of multimodal pain management." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Non-pharmacologic therapies for pain and distress include creating child-friendly environments, supporting families, pet therapy, and augmented virtual reality devices for procedures like dressing changes in burn patients." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "When children are less stressed, their pain tends to be more manageable." — Vogel (clinical) [Ep 4 · 19:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1196) - "Most intubated postoperative patients receive combination sedative therapy with benzodiazepines (midazolam or lorazepam) plus low-dose narcotic infusions (fentanyl, morphine, or dilaudid)." — Vogel (clinical) [Ep 4 · 25:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1556) - "Dexmedetomidine (Precedex) is used increasingly for sedation, particularly in congenital heart/cardiac populations, and is helpful for decreasing anxiety associated with intubation." — Vogel (clinical) [Ep 4 · 25:56](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1556) - "Validated pain assessment tools exist across all pediatric ages including FLACC (Faces, Legs, Activity, Cry, Consolability) for preverbal children, validated in surgery, trauma, cancer, and other disease processes." — Vogel (clinical) [Ep 4 · 27:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1671) - "Other validated pediatric pain scales include Faces Pain Scale Revised, Visual Analog Scale (VAS), Color Analog Scale (CAS), and Non-Communicating Children's Pain Checklist (with postoperative version)." — Vogel (clinical) [Ep 4 · 27:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1671) - "Visual Analog Scale and Color Analog Scale tend to be better received than Faces Pain Scale in pediatric patients." — Vogel (clinical) [Ep 4 · 27:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1671) - "Richmond Agitation Sedation Score (RASS) is the most commonly employed sedation assessment technique in adults." — Vogel (clinical) [Ep 4 · 27:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1671) - "State Behavioral Score (SBS) is a commonly used sedation assessment score in pediatric ICU patients." — Vogel (clinical) [Ep 4 · 27:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1671) - "Goal-directed sedation aims to keep patients comfortable but not comatose and not overly agitated, allowing them to wake up, interact, and be assessed." — Vogel (clinical) [Ep 4 · 27:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1671) - "The Society of Critical Care Medicine's ABCDEF bundle is an evidence-based approach for ICU management, extensively studied in adults and increasingly used in pediatric ICUs over the past five years." — Vogel (guideline) [Ep 4 · 31:24](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1884) - "The ABCDEF bundle components are: A (assess and manage pain), B (spontaneous awakening and breathing trials), C (choice of analgesia and sedation), D (delirium assessment, prevention, management), E (early mobility and exercise), F (family engagement)." — Vogel (guideline) [Ep 4 · 31:24](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1884) - "Daily spontaneous awakening trials (sedation holidays) and spontaneous breathing trials in appropriate patients decrease duration of sedation, mechanical ventilation, and ICU stay, improving overall outcomes in both adults and children." — Vogel (clinical) [Ep 4 · 31:24](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1884) - "Most ICUs have escalation and de-escalation sedation protocols developed with hospital pharmacists, often unique to the ages and patient populations of that institution." — Vogel (clinical) [Ep 4 · 31:24](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1884) - "Minimizing benzodiazepine use is important because benzodiazepines contribute to development of delirium." — Vogel (clinical) [Ep 4 · 31:24](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1884) - "Benzodiazepine-sparing agents like dexmedetomidine (Precedex) are important for reducing delirium risk." — Vogel (clinical) [Ep 4 · 31:24](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=1884) - "Approximately 40% of pediatric ICU patients will experience delirium at some point during their ICU stay, with incidence increasing the longer children remain in the ICU." — Vogel (epidemiological) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Delirium is a waxing and waning change in mental status." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Risk factors for pediatric delirium include age less than 2 years, mechanical ventilation, benzodiazepine use, narcotic use, and physical restraints." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Validated delirium assessment tools include CAM-ICU (Confusion Assessment Method for ICU), pediatric CAM-ICU, preschool CAM-ICU (developed at Vanderbilt), and CAP-D (Cornell Assessment of Pediatric Delirium)." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Delirium assessment requires first assessing sedation level; comatose patients cannot be reliably assessed for delirium using screening tools." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Delirium screening tools assess components including appropriate eye contact, purposeful actions, awareness of surroundings, ability to interact with family/caregivers, and ability to communicate." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Positive delirium screening does not definitively diagnose delirium; patients may be uncomfortable from uncontrolled pain, worsening illness, sepsis, or ventilator dyssynchrony requiring detailed clinical assessment." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Non-pharmacologic delirium management includes environmental modifications: maintaining sleep-wake cycles with lights-on during day and lights-off at night, family presence, child life services, and pet therapy." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Melatonin can be effective for managing sleep difficulties in ICU patients as part of delirium management." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Atypical antipsychotics, particularly risperidone started at low dose and titrated up, can be helpful in managing delirium." — Vogel (clinical) [Ep 4 · 36:04](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2164) - "Delirium prevention requires addressing underlying medical needs (infection control, early cultures/antibiotics when indicated), family involvement, and maintaining normal sleep-wake cycles and routines as much as possible." — Vogel (clinical) [Ep 4 · 42:51](https://qa.library.globalcastmd.com/watch/coagulopathy-and-analgesia-1793?t=2571) - "In North America, the preferred approach for resectable Wilms tumor is primary nephrectomy (total nephrectomy and ureterectomy with lymph node sampling)." — Peter Ehrlich (guideline) [Ep 8 · 6:23](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383) - "Preoperative chemotherapy is recommended if tumor extends into the IVC beyond the infrahepatic vena cava, if tumor is so large it compromises respiratory status, if major liver or bowel resection would be required, if only one functioning kidney exists, or if bilateral tumors are present." — Peter Ehrlich (guideline) [Ep 8 · 7:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=421) - "The 'claw sign' on CT—normal kidney displaced into a horseshoe pattern around a mass—is a classic feature of Wilms tumor." — Peter Ehrlich (clinical) [Ep 8 · 3:49](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229) - "Wilms tumor tends to push structures out of the way rather than growing into them, whereas neuroblastoma grows around structures like blood vessels." — Peter Ehrlich (clinical) [Ep 8 · 4:16](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256) - "If a tumor requires major liver or bowel resection, biopsy and preoperative chemotherapy are preferred because complication rates are higher when these organs are resected at the same time as the kidney, and most tumors will respond to chemotherapy." — Peter Ehrlich (clinical) [Ep 8 · 10:24](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=624) - "Biopsy with residual gross tumor has always been treated as stage 3 abdominal disease, requiring three-drug chemotherapy plus flank radiation." — Peter Ehrlich (guideline) [Ep 8 · 11:18](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=678) - "Evidence suggests higher risk of tumor rupture when tumors reach 13-15 centimeters or larger, which may warrant consideration of preoperative chemotherapy." — Peter Ehrlich (clinical) [Ep 8 · 14:33](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873) - "For biopsy, open biopsy provides large tissue sections; large-core needle biopsy (10-20 cores) has proven accurate in several series. Fine needle aspiration or single-pass true-cut biopsy cannot diagnose anaplasia and should not be used." — Peter Ehrlich (guideline) [Ep 8 · 17:19](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1039) - "COG stage 1 is tumor limited to kidney, completely resected, no capsular invasion, no rupture or biopsy, vessels of renal sinus not involved, negative margins, and negative regional lymph nodes." — Peter Ehrlich (guideline) [Ep 8 · 20:00](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1200) - "COG stage 2 is complete resection with negative margins but tumor extends beyond kidney through capsular penetration, renal sinus invasion, or blood vessel involvement within the nephrectomy specimen outside the primary kidney." — Peter Ehrlich (guideline) [Ep 8 · 20:28](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228) - "COG stage 3 includes: biopsy with gross residual tumor, positive lymph nodes, peritoneal surface penetration with implants, positive margins, microscopic residual from intraoperative spill, incomplete resection, piecemeal removal, or renal vein division with tumor present." — Peter Ehrlich (guideline) [Ep 8 · 21:00](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1260) - "COG stage 4 is hematogenous metastasis to lung, liver (most common), bone, or brain. Stage 5 is bilateral renal tumor involvement." — Peter Ehrlich (guideline) [Ep 8 · 21:58](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1318) - "Stage 1-2 abdominal disease without lung metastases receives two-drug chemotherapy (vincristine and dactinomycin) for shorter duration without abdominal radiation, significantly reducing late effects including renal failure, second malignancies, and cardiovascular disease." — Peter Ehrlich (guideline) [Ep 8 · 23:08](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1388) - "If a patient has a lung lesion but stage 1-2 abdominal disease after primary nephrectomy with negative lymph nodes, the child avoids abdominal radiation (though still receives chemotherapy for the lung lesion)." — Peter Ehrlich (clinical) [Ep 8 · 24:15](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455) - "Recent COG data shows approximately 40% of patients with pulmonary metastases who have complete response at 6 weeks can avoid pulmonary radiation without affecting event-free or overall survival, with 80-85% not relapsing." — Peter Ehrlich (clinical) [Ep 8 · 26:24](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1584) - "Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer, a significant late effect." — Peter Ehrlich (epidemiological) [Ep 8 · 26:08](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568) - "For a single lung lesion remaining at 6 weeks that did not respond to chemotherapy, thoracoscopic biopsy is reasonable because 50-60% of such lesions may not be cancer (could be scar), and if benign, the patient would not need pulmonary radiation." — Peter Ehrlich (clinical) [Ep 8 · 28:09](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1689) - "SIOP protocols use preoperative chemotherapy for all patients at higher doses than COG, with evaluation at 4 and 8 weeks, then resection followed by post-chemotherapy pathology-based risk stratification (low, intermediate, high risk)." — Peter Ehrlich (guideline) [Ep 8 · 30:16](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1816) - "In SIOP protocols, predominantly blastema component after preoperative chemotherapy is a negative prognostic factor, but blastema percentage does not correlate with outcome in COG primary nephrectomy patients." — Peter Ehrlich (clinical) [Ep 8 · 31:19](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1879) - "Outcomes for stage 1 and stage 2 patients are basically identical between COG and SIOP treatment approaches." — Peter Ehrlich (clinical) [Ep 8 · 33:58](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2038) - "Some Wilms tumor patients present with low hemoglobin because the tumor ruptures internally and bleeds." — Peter Ehrlich (clinical) [Ep 8 · 34:46](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2086) - "Acquired von Willebrand disease occurs in Wilms tumor patients; in most cases it is meaningless, but a few case series report significant intraoperative bleeding until tumor removal." — Peter Ehrlich (clinical) [Ep 8 · 35:11](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111) - "Right-sided tumors can cause complications including adrenal vein injury, duodenal injury (due to proximity), superior mesenteric artery injury, and IVC injury due to anatomic distortion." — Peter Ehrlich (clinical) [Ep 8 · 36:25](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2185) - "Wilms tumors can cause intense inflammatory reaction making them adherent to diaphragm or liver; taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided." — Peter Ehrlich (clinical) [Ep 8 · 42:31](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551) - "The main factor predicting outcome in stage 3 disease is whether lymph nodes are positive, along with genetic changes including loss of heterozygosity and 1Q gain." — Peter Ehrlich (clinical) [Ep 8 · 32:50](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1970) - "Patients with loss of heterozygosity of both 1p and 16q (5-7% of patients) have significantly worse outcomes regardless of stage. Stage 1-2 patients with LOH have about 10% lower overall survival; stage 3-4 patients have 18% lower survival." — Peter Ehrlich (clinical) [Ep 8 · 54:41](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281) - "Patients with both 1p and 16q loss of heterozygosity receive augmented therapy: doxorubicin is added for stage 1-2 disease, and five-drug regimen M is used for stage 3-4 disease." — Peter Ehrlich (guideline) [Ep 8 · 55:07](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3307) - "IVC tumor extension is not a negative prognostic factor if the tumor is completely resected." — Peter Ehrlich (clinical) [Ep 8 · 46:27](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2787) - "Major complication rate for primary surgery with tumor extending beyond infrahepatic IVC is 26-30%, including mortality, increased transfusions, and ICU stay, supporting preoperative chemotherapy for these cases." — Peter Ehrlich (clinical) [Ep 8 · 48:49](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929) - "Favorable histology Wilms tumor has three components: blastema, stroma, and epithelial (triphasic tumor). Tumors with only two components are also considered favorable histology." — Peter Ehrlich (clinical) [Ep 8 · 52:39](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3159) - "Unfavorable histology is classified as focal anaplasia or diffuse anaplasia based on number of high-power fields showing anaplasia, with different treatments for each." — Peter Ehrlich (clinical) [Ep 8 · 55:58](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3358) - "Clear cell sarcoma of the kidney has reasonable treatment outcomes, particularly for low stages. Rhabdoid tumors have poor outcomes except for stage 1; most present at stage 3-4 with terrible outcomes." — Peter Ehrlich (clinical) [Ep 8 · 57:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3421) - "Renal cell carcinoma in children has no good therapy, particularly for metastatic disease." — Peter Ehrlich (clinical) [Ep 8 · 56:51](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411) - "Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor." — Peter Ehrlich (epidemiological) [Ep 8 · 57:46](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3466) - "The strategy for bilateral Wilms tumor is preoperative chemotherapy to shrink tumors enough to allow partial nephrectomy of at least one kidney (ideally both) to avoid dialysis." — Peter Ehrlich (guideline) [Ep 8 · 58:07](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3487) - "Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% compared to 88% for unilateral tumors; overall survival was 80% vs. 95%." — Peter Ehrlich (epidemiological) [Ep 8 · 58:40](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3520) - "Maximum tumor response to chemotherapy in most children with Wilms tumor occurs by 12 weeks, and early response at 6 weeks predicts late response." — Peter Ehrlich (clinical) [Ep 8 · 59:37](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577) - "In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. In a recent COG study of 250 enrolled patients, only one turned out to have rhabdoid tumor." — Peter Ehrlich (epidemiological) [Ep 8 · 60:31](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3631) - "Biopsy is recommended for bilateral tumors in older patients (8-10 years) or those with syndromes like von Hippel-Lindau where renal cell carcinoma is more likely." — Peter Ehrlich (guideline) [Ep 8 · 61:56](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3716) - "If biopsying bilateral tumors, both kidneys should be biopsied because there is discordant pathology in up to 20% of patients." — Peter Ehrlich (clinical) [Ep 8 · 62:16](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3736) - "A small subset of very young patients (<24 months) with stage 1 favorable histology tumors <550g can be treated with surgery alone without chemotherapy, with >95% overall survival. Those who relapse (about 10%) have 100% salvage with chemotherapy." — Peter Ehrlich (clinical) [Ep 8 · 43:32](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2612) - "Microaggressions are verbal, nonverbal, environmental slights, snubs, invalidations, or insults that send hostile, derogatory, or negative messages to individuals based solely on their marginalized group membership" — Craig Lillehei (clinical) [Ep 11 · 3:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=210) - "Microaggressions have a cumulative impact causing isolation and self-doubt despite being termed 'micro'" — Craig Lillehei (clinical) [Ep 11 · 4:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=240) - "Bystanders who do not speak up compound the harm of microaggressions even if they address the issue later" — Craig Lillehei (opinion) [Ep 11 · 4:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=270) - "In the TOTAL trial for severe CDH, FETO significantly improved survival" — Craig Lillehei (host_summary) [Ep 11 · 10:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=600) - "In the TOTAL trial for moderate CDH, FETO showed some improvement in survival but did not approach statistical significance" — Craig Lillehei (host_summary) [Ep 11 · 10:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=630) - "The TOTAL trial was conducted over an 11-year period at multiple centers with variable CDH management protocols" — Craig Lillehei (host_summary) [Ep 11 · 11:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=660) - "Prematurity and premature rupture of membranes are significant complications of FETO" — Craig Lillehei (clinical) [Ep 11 · 11:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=690) - "NPO guidelines for children are based on very poor evidence and vary considerably between institutions" (clinical) [Ep 11 · 15:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=900) - "Pulmonary aspiration is very scary but very rare, usually occurring in emergency surgeries in high-risk children rather than elective procedures" (clinical) [Ep 11 · 15:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=930) - "Studies suggest clear liquids containing carbohydrates empty the stomach very quickly regardless of age" (host_summary) [Ep 11 · 16:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=960) - "British and Irish consensus recommends one hour NPO for clear liquids, four hours for breast milk, six hours for solid foods in children under 17" (host_summary) [Ep 11 · 16:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=990) - "ASA currently recommends two hours for clear liquids, four hours for breast milk, six hours for non-human milk and light meals, eight hours for heavy meals" (host_summary) [Ep 11 · 17:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1020) - "European Society of Anesthesia recommends one hour for clear liquids, three hours for breast milk, four hours for formula, six hours for everything else" (host_summary) [Ep 11 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1050) - "Prolonged NPO periods generate ketone bodies, cause hypoglycemia, and make children irritable preoperatively" (clinical) [Ep 11 · 18:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1080) - "In C-arm fluoroscopy, the x-ray source is conventionally placed below the table with the image intensifier above" (clinical) [Ep 11 · 25:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1500) - "Placing radiation shields on top of the patient does nothing to protect them because radiation comes from below the table" (clinical) [Ep 11 · 25:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1530) - "If a shield is in the fluoroscopy field, automatic brightness control increases x-ray energy to compensate, increasing patient exposure" (clinical) [Ep 11 · 26:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1560) - "Collimation focuses the x-ray beam to a specific area, increasing detail and clarity while decreasing total patient dose and room exposure" (clinical) [Ep 11 · 27:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1620) - "Pulse mode fluoroscopy is feasible for most pediatric surgery applications and does not require the temporal resolution of continuous fluoroscopy" (clinical) [Ep 11 · 28:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1680) - "Using magnification setting on fluoroscopy significantly increases radiation dose to both patient and room" (clinical) [Ep 11 · 28:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=1710) - "In a study of 521 primary lung lesions from 11 children's hospitals, none of the prenatally diagnosed lesions were malignant" (host_summary) [Ep 11 · 40:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2400) - "Approximately 10% of postnatally diagnosed lung lesions were malignant in the Midwest consortium study" (host_summary) [Ep 11 · 40:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2430) - "About half of malignant lung lesions were associated with DICER1 mutation" (host_summary) [Ep 11 · 41:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2460) - "No malignant lung lesion had a systemic feeding vessel in the consortium study" (host_summary) [Ep 11 · 41:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2490) - "CT scan sensitivity and specificity for detecting pleuropulmonary blastoma was poor, with poor inter-rater reliability among nine radiologists" (host_summary) [Ep 11 · 42:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2520) - "In a series of approximately 600 patients with prenatal lung lesion diagnosis, the chance of pleuropulmonary blastoma is close to zero" (host_summary) [Ep 11 · 44:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2640) - "In the IMPACT study, piperacillin-tazobactam had significantly lower postoperative abscess rate, ER visit rate, and postoperative CT scan rate compared to ceftriaxone-metronidazole for perforated appendicitis" (host_summary) [Ep 11 · 48:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2880) - "A NSQIP study by Sean Rangel of 654 patients showed opposite results, suggesting ceftriaxone-metronidazole were preferred over piperacillin-tazobactam" (host_summary) [Ep 11 · 48:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2910) - "The IMPACT study was multi-institutional but 75% of patients were at one institution and 25% at another" (host_summary) [Ep 11 · 49:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=2940) - "Mechanical bowel preparation has no effect on surgical site infection rates" — Paul Yzotrak (host_summary) [Ep 11 · 51:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3060) - "Some data suggests mechanical bowel preparation actually increases surgical site infections" — Paul Yzotrak (host_summary) [Ep 11 · 51:30](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3090) - "The strongest data for preventing surgical site infection is appropriate timing of preoperative intravenous antibiotics" — Paul Yzotrak (clinical) [Ep 11 · 52:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3120) - "The NEST trial showed neurodevelopmental outcomes are improved with laparotomy compared to peritoneal drainage for NEC" — Paul Yzotrak (host_summary) [Ep 11 · 55:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3300) - "The NEST trial used approximately one kilogram as the cutoff weight for laparotomy" — Paul Yzotrak (host_summary) [Ep 11 · 54:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3240) - "For NEC survival in the first 24-48 hours, it is unclear whether there is a survival advantage or disadvantage for drain versus laparotomy" (opinion) [Ep 11 · 58:00](https://qa.library.globalcastmd.com/watch/update-course-2022-apsa-pdc-updates-mary-edwards-paul-jeziorczak-craig-lillehei-and-charles-snyder-5820?t=3480) - "Neuroblastoma is surgically challenging to resect mainly due to adhesion and encasement to important structures, heterogeneity, and therapy-induced changes." — Dominique Simmons (clinical) [Ep 15 · 0:35](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=35) - "The surgical goal for neuroblastoma is to resect more than 95% of the tumor tissue while sparing anatomical structures." — Dominique Simmons (guideline) [Ep 15 · 0:45](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=45) - "3D models of patient-specific anatomy are routinely made to prepare surgeons for neuroblastoma resection." — Dominique Simmons (clinical) [Ep 15 · 0:53](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=53) - "Complete resection of neuroblastoma is often very difficult or even impossible due to tumor location." — Dominique Simmons (clinical) [Ep 15 · 0:57](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=57) - "Surgeons face a dilemma of whether to resect more tumor tissue with possible complications such as bleeding or to leave residual tumor tissue." — Dominique Simmons (clinical) [Ep 15 · 1:07](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=67) - "Biology can be used as a biomarker for tumor vitality in neuroblastoma." — Dominique Simmons (opinion) [Ep 15 · 1:26](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=86) - "In ADC imaging, diffusion restriction is associated with viable tumor tissue and appears as a low signal." — Dominique Simmons (clinical) [Ep 15 · 1:36](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=96) - "In MIBG SPECT-CT imaging, high uptake is associated with viable tumor tissue." — Dominique Simmons (clinical) [Ep 15 · 1:36](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=96) - "MIBG uptake and diffusion restriction in neuroblastoma change over time, suggesting the biology and vitality of the tumor may also change." — Dominique Simmons (clinical) [Ep 15 · 1:52](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=112) - "ADC and MIBG scans have different 3D positions from T1-weighted MRI, requiring image registration." — Dominique Simmons (clinical) [Ep 15 · 2:10](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=130) - "Registration accuracy is evaluated using the Dice coefficient (which measures overlap between two structures) and target registration error (which measures distance between two points)." — Dominique Simmons (clinical) [Ep 15 · 2:18](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=138) - "Risk group delineation uses ADC and MIBG values within the tumor volume with thresholds based on literature." — Dominique Simmons (clinical) [Ep 15 · 2:30](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=150) - "High-risk areas in the 3D model are associated with diffusion restriction and MIBG uptake." — Dominique Simmons (clinical) [Ep 15 · 2:41](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=161) - "Seven patients with abdominal neuroblastoma eligible for surgery were included prospectively." — Dominique Simmons (epidemiological) [Ep 15 · 2:58](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=178) - "Accurate initial registration was achieved for all patients with a median Dice of 0.81 for ADC and 0.77 for MIBG." — Dominique Simmons (clinical) [Ep 15 · 3:10](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=190) - "Median target registration error was 5.3 mm for ADC and 4.3 mm for MIBG." — Dominique Simmons (clinical) [Ep 15 · 3:10](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=190) - "Multimodal 3D models were successfully created for every patient in the study." — Dominique Simmons (clinical) [Ep 15 · 3:10](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=190) - "In some cases, ADC and MIBG risk models showed similar patterns, with the lateral side of the tumor marked as high risk and the medial side as low risk." — Dominique Simmons (clinical) [Ep 15 · 3:37](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=217) - "In other cases, ADC and MIBG identified completely different regions as high risk (e.g., cranial part high-risk on ADC versus a different region on MIBG)." — Dominique Simmons (clinical) [Ep 15 · 3:52](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=232) - "The thresholds used for risk stratification are based on limited literature, which questions the reliability of the ADC and MIBG values used." — Dominique Simmons (opinion) [Ep 15 · 4:53](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=293) - "The image registration is performed using Elastix software in programming environments such as Python or MATLAB." — Dominique Simmons (clinical) [Ep 15 · 5:48](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=348) - "Segmentation of the neuroblastoma is the most time-consuming step; the actual registration takes only a few minutes." — Dominique Simmons (clinical) [Ep 15 · 6:14](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=374) - "Simmons performs the 3D model creation herself with verification from radiologists, especially in early phases." — Dominique Simmons (clinical) [Ep 15 · 7:07](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=427) - "Current practice believes that MIBG-positive areas should be resected, but discordant ADC/MIBG findings suggest this may need re-evaluation." — Dominique Simmons (opinion) [Ep 15 · 7:22](https://qa.library.globalcastmd.com/watch/dominique-simons-msc-best-of-the-best-in-pediatric-surgery-2024-8009?t=442) - "Neuroblastoma makes up about 8 to 10% of all pediatric cancers and about 15% of cancer-related deaths." — Meera Kotagal (epidemiological) [Ep 17 · 0:23](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=23) - "For patients with relapsed high risk neuroblastoma, the survival rate is 0%." — Meera Kotagal (epidemiological) [Ep 17 · 0:48](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=48) - "90% of neuroblastomas have elevated HVA and VMA (catecholamine metabolites)." — Meera Kotagal (clinical) [Ep 17 · 2:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=137) - "Neuroblastomas are not typically thought of as causing elevated blood pressure despite producing catecholamines." — Meera Kotagal (clinical) [Ep 17 · 2:22](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=142) - "The Curie score is used to assess the extent of metastasis in neuroblastoma patients based on MIBG scans, with the body divided into 10 regions each scored 0-3, for a maximum score of 30." — Em Gootee (host_summary) [Ep 17 · 3:03](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=183) - "The International Neuroblastoma Staging System (INSS) takes into account the results of surgery to remove the tumor and cannot help doctors determine a stage before any treatment has started." — Em Gootee (host_summary) [Ep 17 · 4:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=244) - "The International Neuroblastoma Risk Group (INRG) is a preoperative staging system designed to assess how difficult patients may be to resect and allow comparison of patients preoperatively." — Em Gootee (host_summary) [Ep 17 · 4:26](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=266) - "Image-defined risk factors (IDRFs) are best understood as things that touch important structures: vessels, brachial plexus, or trachea." — Meera Kotagal (clinical) [Ep 17 · 5:09](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=309) - "NMYC amplification status, ploidy, and 11Q aberrations are factors considered for neuroblastoma staging." — Em Gootee (host_summary) [Ep 17 · 5:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=344) - "For low stage neuroblastoma with good survival rates, the goal is to reduce therapy and avoid late effects, as 2/3 of cancer patients will have some long-term morbidity from chemotherapy." — Em Gootee (host_summary) [Ep 17 · 6:11](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=371) - "Intermediate risk neuroblastoma patients receive neoadjuvant chemotherapy with 2, 4, 6, or 8 cycles depending on chromosomal factors, followed by surgical resection." — Meera Kotagal (guideline) [Ep 17 · 7:15](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=435) - "Neuroblastoma resections differ from other tumors because the tumor is divided into tiny pieces during removal." — Em Gootee (host_summary) [Ep 17 · 7:29](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=449) - "The key surgical principle for neuroblastoma resection is to stay on the vessels and work from normal to abnormal anatomy." — Meera Kotagal (clinical) [Ep 17 · 7:38](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=458) - "Image-defined risk factors (IDRFs) are associated with increased risk of surgical complications." — Meera Kotagal (clinical) [Ep 17 · 8:22](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=502) - "When percutaneous core biopsies are performed by experienced practitioners who obtain multiple cores, the adequacy of these biopsies significantly improves and they are not inferior to open surgical biopsies." — Meera Kotagal (clinical) [Ep 17 · 9:13](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=553) - "At Cincinnati Children's, radiologists obtain 25 cores from different parts of neuroblastoma tumors during percutaneous biopsy." — Meera Kotagal (clinical) [Ep 17 · 9:33](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=573) - "For neuroblastoma, unlike most tumors, the goal is to get as much tumor as possible but complete resection of every ounce of tumor is not expected." — Meera Kotagal (clinical) [Ep 17 · 10:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=644) - "Tumor extending into neural foramina or other difficult locations should not be aggressively pursued; the goal is maximal safe resection without causing harm." — Meera Kotagal (clinical) [Ep 17 · 10:55](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=655) - "A Children's Oncology Group study of 87 patients less than 6 months of age with small adrenal masses and no metastatic disease showed 97% four-year event-free survival with observation." — Em Gootee (host_summary) [Ep 17 · 12:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=741) - "The observation protocol for infants with neuroblastoma has been expanded from primary adrenal tumors to L1 tumors in children under 6 months." — Meera Kotagal (guideline) [Ep 17 · 12:48](https://qa.library.globalcastmd.com/watch/neuroblastoma-with-dr-meera-kotagal-9212?t=768) - "Neuroblastoma is the most common extracranial solid tumor of childhood arising from aberrant differentiation of sympathoadrenal cells in neural crest." — Yujie Ma (epidemiological) [Ep 18 · 0:45](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=45) - "Retinoic acid is used to induce differentiation in treatment of high risk neuroblastoma." — Yujie Ma (clinical) [Ep 18 · 0:56](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=56) - "Retinoic acid efficacy varies in patients due to the highly heterogeneous nature of neuroblastoma." — Yujie Ma (clinical) [Ep 18 · 1:03](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=63) - "PCP4 was identified as one of the differentiation markers of neuroblastoma tumor cells in a previous Cancer Cell publication." — Yujie Ma (clinical) [Ep 18 · 1:19](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=79) - "PCP4 modulates the rate of calcium binding to calmodulin, which is a critical step in activating calmodulin dependent kinase." — Yujie Ma (clinical) [Ep 18 · 1:38](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=98) - "The binding of PCP4 with calmodulin was verified in neuroblastoma by co-immunoprecipitation." — Yujie Ma (clinical) [Ep 18 · 1:49](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=109) - "CAMK2G was identified as a target kinase of calmodulin using mass spectrometry." — Yujie Ma (clinical) [Ep 18 · 1:49](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=109) - "CAMK2G is a member of the serine/threonine protein kinase family." — Yujie Ma (clinical) [Ep 18 · 2:06](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=126) - "CAMK2G plays an important role in neuronal development and synaptic plasticity." — Yujie Ma (clinical) [Ep 18 · 2:10](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=130) - "When CAMK2G is activated by calmodulin, it gets autophosphorylated at the site of threonine 287." — Yujie Ma (clinical) [Ep 18 · 2:24](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=144) - "PCP4 overexpression upregulated the threonine 287 phosphorylation of CAMK2G in neuroblastoma cells." — Yujie Ma (clinical) [Ep 18 · 2:33](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=153) - "Low CAMK2G mRNA expression was associated with worse overall and event-free survival in neuroblastoma patients." — Yujie Ma (clinical) [Ep 18 · 3:02](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=182) - "Low CAMK2G expression was associated with advanced INSS stages and unfavorable histology in neuroblastoma." — Yujie Ma (clinical) [Ep 18 · 3:02](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=182) - "Low CAMK2G expression was associated with MYCN amplified status, high risk, and tumor progression in neuroblastoma." — Yujie Ma (clinical) [Ep 18 · 3:14](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=194) - "CAMK2G knockdown in SKNSH cells resulted in inhibited neurite outgrowth even under retinoic acid induction." — Yujie Ma (clinical) [Ep 18 · 3:30](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=210) - "Expression of neuronal differentiation markers were downregulated following CAMK2G knockdown." — Yujie Ma (clinical) [Ep 18 · 3:44](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=224) - "Gene enrichment analysis of downregulated genes following CAMK2G knockdown showed enriched terms related to neuronal differentiation including synaptic signaling, plasma membrane, and ion channel activity." — Yujie Ma (clinical) [Ep 18 · 3:58](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=238) - "CAMK2G knockdown promoted migration and invasion of neuroblastoma cells as shown by transwell assays." — Yujie Ma (clinical) [Ep 18 · 4:13](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=253) - "KEGG analysis of upregulated genes following CAMK2G knockdown identified enriched pathways associated with tumor migration and invasion, including extracellular matrix receptor interaction, focal adhesion, and regulation of actin cytoskeleton." — Yujie Ma (clinical) [Ep 18 · 4:21](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=261) - "CAMK2G is expressed at low levels in SKNSH neuroblastoma cell line." — Yujie Ma (clinical) [Ep 18 · 6:20](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=380) - "CAMK2G is highly expressed in BE2 and SKNS neuroblastoma cell lines, which are MYCN amplified cell lines." — Yujie Ma (clinical) [Ep 18 · 6:33](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=393) - "CAMK2G function is not strong enough to overcome the oncogenic function of MYCN in MYCN-amplified neuroblastoma cell lines." — Yujie Ma (clinical) [Ep 18 · 6:33](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=393) - "CAMK2G did not regulate neuronal differentiation in MYCN-amplified neuroblastoma cell lines." — Yujie Ma (clinical) [Ep 18 · 7:11](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=431) - "The CAMK2G differentiation mechanism is not universal for all neuroblastoma cell lines and patients, and can only be explained in MYCN non-amplified cell lines and corresponding patients." — Yujie Ma (opinion) [Ep 18 · 7:33](https://qa.library.globalcastmd.com/watch/dr-yujie-ma-best-of-the-best-in-pediatric-surgery-2025-10036?t=453) - "Patients with high-risk neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured." — Sabine Irtan (clinical) [Ep 19 · 0:40](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=40) - "The role of surgery in high-risk neuroblastoma remains controversial." — Sabine Irtan (opinion) [Ep 19 · 0:48](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=48) - "Kewarm stated in a 2020 GCO paper that complete macroscopic excision of the primary tumor improved both overall and event-free survival in a cohort of 1,531 patients with stage 4 neuroblastoma." — Sabine Irtan (host_summary) [Ep 19 · 0:52](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=52) - "In Kewarm's study, the success of the intervention and judgment on the post-operative residue was based on the operative report with no systematic radiological assessment of residue performed." — Sabine Irtan (host_summary) [Ep 19 · 1:08](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=68) - "The study included 283 patients (108 females, 175 males) who had a diagnosis at a median age of 35 months." — Sabine Irtan (epidemiological) [Ep 19 · 1:48](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=108) - "The primary tumor site was the abdomen in 95% of patients." — Sabine Irtan (epidemiological) [Ep 19 · 1:57](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=117) - "The tumor origin was the adrenal gland in 81% of patients." — Sabine Irtan (epidemiological) [Ep 19 · 2:02](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=122) - "The postoperative imaging was performed at a median of 62 days after surgery and was mainly a CT scan or MRI." — Sabine Irtan (clinical) [Ep 19 · 2:06](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=126) - "Residue was present in half of the patients on post-operative imaging." — Sabine Irtan (epidemiological) [Ep 19 · 2:17](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=137) - "The median volume of the residue was 0.27 mL." — Sabine Irtan (epidemiological) [Ep 19 · 2:20](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=140) - "The residue was a microcalcification in 28 patients." — Sabine Irtan (epidemiological) [Ep 19 · 2:25](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=145) - "Excluding patients with microcalcifications, the median residue volume was 1.04 mL, and only 11% of patients had a residue of more than 5 mL." — Sabine Irtan (epidemiological) [Ep 19 · 2:29](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=149) - "The residue was linked to the presence of IDRF in 71% of patients." — Sabine Irtan (epidemiological) [Ep 19 · 2:40](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=160) - "MIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available." — Sabine Irtan (epidemiological) [Ep 19 · 2:40](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=160) - "There was no impact of the radiological postoperative residue on event-free survival and overall survival." — Sabine Irtan (clinical) [Ep 19 · 2:58](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=178) - "MIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival." — Sabine Irtan (clinical) [Ep 19 · 3:08](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=188) - "Patients who had an MIBG-positive residue had 25% and 27% five-year event-free survival, whereas patients with no residue or no MIBG-positive residue had 51% five-year event-free survival." — Sabine Irtan (clinical) [Ep 19 · 3:20](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=200) - "External validation on the entire high-risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had surgery and post-surgical MIBG evaluation confirmed the results, especially in patients with complete response of the metastasis." — Sabine Irtan (clinical) [Ep 19 · 3:45](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=225) - "The difference between patients with MIBG-positive residue and patients with no residue or no MIBG-positive residue was still present for patients with partial or minimal response with a 10% survival difference." — Sabine Irtan (clinical) [Ep 19 · 4:04](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=244) - "Half of the patients operated on in expert centers have a tumor residue objectively identified on postoperative images of less than 1 mL." — Sabine Irtan (clinical) [Ep 19 · 4:26](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=266) - "The residue was MIBG-positive in around 20% of patients." — Sabine Irtan (epidemiological) [Ep 19 · 4:36](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=276) - "Radiologically detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies." — Sabine Irtan (clinical) [Ep 19 · 4:40](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=280) - "Complete resection should be maintained as a major surgical goal." — Sabine Irtan (guideline) [Ep 19 · 4:54](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=294) - "Metastatic response is an important prognostic cofactor in stage 4 neuroblastoma." — Sabine Irtan (clinical) [Ep 19 · 4:59](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=299) - "In COG data, there was zero correlation between what the surgeon said they resected and what was actually present on post-operative imaging." (clinical) [Ep 19 · 5:19](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=319) - "For patients for whom the surgeon said they left nothing, almost half of the patients had still something on the postoperative images." — Sabine Irtan (clinical) [Ep 19 · 5:43](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=343) - "For patients for whom the surgeon said they left something, residue was found in two-thirds of patients and no residue was found in one-third of patients." — Sabine Irtan (clinical) [Ep 19 · 5:57](https://qa.library.globalcastmd.com/watch/dr-sabine-irtan-best-of-the-best-in-pediatric-surgery-2025-10044?t=357) - "The 12th annual update course in pediatric surgery was held in August 2024 and introduced a new classification system: green circle for established practice, blue square for promising newer practice, and black diamond for early adopter practice only." — Em Gootee (host_summary) [Ep 20 · 0:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=13) - "Information from this session on image-guided surgery collaboration classifies as a blue square for promising newer practice." — Em Gootee (host_summary) [Ep 20 · 0:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=56) - "Image-guided surgery uses real-time imaging (CT, MRI, ultrasound, or fluoroscopy) to help surgeons navigate during procedures with greater precision, improving accuracy and safety." — Em Gootee (host_summary) [Ep 20 · 1:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=75) - "Surgeons and interventional radiologists may speak different languages regarding image guidance, with surgeons not knowing what's possible and radiologists not knowing what surgeons need." — John Ricardo (opinion) [Ep 20 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=92) - "A hybrid operating room integrates advanced imaging technology and traditional surgical setup, eliminating the need to transport patients between radiology and surgical areas, which enhances efficiency, reduces complications, and improves patient outcomes." — Em Gootee (host_summary) [Ep 20 · 1:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=110) - "A hybrid OR is not required for image-guided surgery; collaboration can occur in regular ORs with ultrasound machines or in dual settings where patients go to interventional radiology for localization then to the OR." — Daniel von Allmen (clinical) [Ep 20 · 2:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=132) - "Cone beam CT is a CT scan performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT." — Amanda Bellingford (clinical) [Ep 20 · 2:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=164) - "Cone beam CT provides excellent visualization of bony structures, making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries." — Em Gootee (host_summary) [Ep 20 · 2:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=179) - "Cone beam CT technology is available at many institutions even if they don't have a hybrid OR space, though people may not realize they have it." — Daniel von Allmen (clinical) [Ep 20 · 3:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=195) - "Cincinnati Children's hybrid OR has been open for about 7 years with collaborative work between surgeons and interventional radiologists." — John Ricardo (clinical) [Ep 20 · 3:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=204) - "Interventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access." — Em Gootee (host_summary) [Ep 20 · 3:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=215) - "Having a program manager serve as liaison between surgeons and interventional radiologists is important because nobody will try something new if it's more complicated and takes longer than their normal practice." — Amanda Bellingford (opinion) [Ep 20 · 3:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=234) - "Leadership engagement from both the chief of surgery (Doctor von Alman) and chief of radiology has been crucial support for the collaboration program." — Amanda Bellingford (opinion) [Ep 20 · 4:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=251) - "The hybrid OR at Cincinnati Children's was built so any division can use the room, with collaborative cases being performed with urology, neurosurgery, pulmonary, and gynecology, often doing multiple procedures on patients." — Amanda Bellingford (clinical) [Ep 20 · 4:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=264) - "For supraclavicular lymph nodes that are difficult to palpate, ultrasound-guided localization with a Copan's needle wire allows the surgeon to follow it down and find the lymph node easily, turning what could be a big dissection into a nice and easy one." — John Ricardo (clinical) [Ep 20 · 4:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=284) - "For foreign body localization (such as glass), interventional radiologists can localize it with ultrasound before introduction of air, which makes things virtually invisible." — John Ricardo (clinical) [Ep 20 · 5:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=315) - "During neuroblastoma excisions when dissecting near the aorta, ultrasound can be used every 5 minutes to identify the celiac takeoff and reorient the surgeon." — Daniel von Allmen (clinical) [Ep 20 · 5:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=340) - "Ultrasound can be used at the end of cases to confirm vessel patency, such as looking at flow in kidney transplants, portal flow after Mesorex bypass, or renal flow after challenging neuroblastoma excisions where the renal hilum has been skeletonized." — Daniel von Allmen (clinical) [Ep 20 · 5:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=352) - "Pulmonary nodule localization can be done with wire, coil, or dye depending on institutional preference." — Daniel von Allmen (clinical) [Ep 20 · 6:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=379) - "At one institution (Laurie), pulmonary nodule localization is performed in two locations: first in pre-op CT where interventional radiologists use CT guidance to place a coil next to the nodule, then in the OR using fluoroscopy under two orthogonal planes to ensure accurate nodule identification and removal." — Daniel von Allmen (clinical) [Ep 20 · 6:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=395) - "Using coil localization combined with dye eliminates the risk of wire displacement." — Daniel von Allmen (clinical) [Ep 20 · 6:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=416) - "At Cincinnati Children's, pulmonary nodule localization uses a combination of methylene blue blood patch with cone beam CT performed with the patient in thoracoscopy position, involving one draping and prepping in the hybrid OR, tattooing the visceral pleura with methylene blue blood patch while deploying a Copan's wire." — John Ricardo (clinical) [Ep 20 · 7:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=423) - "Vascular malformations are often managed in multidisciplinary VLC clinics where interventional radiologists offer sclerotherapy and pediatric surgeons offer resection, but sometimes a combination approach is best." — Daniel von Allmen (clinical) [Ep 20 · 7:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=458) - "For vascular malformations not amenable to sclerotherapy alone, interventional radiologists can perform angiography, directly inject contrast, and place glue to ensure complete resection of small outpouchings or legs." — Daniel von Allmen (clinical) [Ep 20 · 7:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=472) - "For transbronchial biopsies, cone beam CT is used to segment out 3D anatomy in about 1 minute, then live fluoroscopy is superimposed over the nodule in AP and lateral views so the pulmonology team always knows where they are performing the biopsy." — John Ricardo (clinical) [Ep 20 · 8:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=493) - "Augmented reality technology uses holographic displays superimposed over patients on the table, taking pre-procedure CT or MRI imaging, segmenting it out, and co-registering it to the patient, with the ability to track instruments." — John Ricardo (clinical) [Ep 20 · 8:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=521) - "In a hydrocephalic sheep model demonstration, MRI imaging was used to create a holographic overlay of anatomy, and by aligning key reference points (fiducials), the hologram matches perfectly with actual anatomy, allowing virtual slicing through the holographic image to view dilated ventricles for precise drain placement." — Em Gootee (host_summary) [Ep 20 · 9:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=543) - "APSA created a peer support program for pediatric surgeons in 2020." — Lizzie Lee (host_summary) [Ep 21 · 1:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=60) - "The goal of the APSA peer support program was to support surgeons after traumatic events." — Lizzie Lee (host_summary) [Ep 21 · 1:12](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=72) - "The most common referral reasons for the peer support program were toxic work environments and adverse events." — Lizzie Lee (host_summary) [Ep 21 · 1:16](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=76) - "50 surgeons total agreed to receive training on how to be a supporter in the APSA program." — Lizzie Lee (host_summary) [Ep 21 · 1:20](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=80) - "Over 80% of trained peer supporters were able to use these peer support skills informally with colleagues, partners, and trainees." — Lizzie Lee (host_summary) [Ep 21 · 1:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=85) - "The peer support program shows that this type of support system can work really well to help surgeons heal from traumatic experiences and toxic work environments." — Lizzie Lee (host_summary) [Ep 21 · 1:31](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=91) - "Tracheomalacia was 5% more common in tracheal occluded infants with CDH, with 4% more cases." — Carlos Colunga (host_summary) [Ep 21 · 2:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145) - "Tracheomalacia symptoms in FETO-treated CDH infants typically receded within 55 months." — Carlos Colunga (host_summary) [Ep 21 · 2:25](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=145) - "FETO-treated CDH infants typically showed a larger trachea, which was around 31% wider." — Carlos Colunga (host_summary) [Ep 21 · 2:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "37% of tracheal occluded CDH cases retained metallic balloon components, although no significant complications were reported." — Carlos Colunga (host_summary) [Ep 21 · 2:34](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=154) - "While tracheal occlusion is effective in promoting lung growth, it is associated with a higher risk of tracheomalacia, although most cases resolve and do not appear to have long-term effects." — Carlos Colunga (host_summary) [Ep 21 · 2:47](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=167) - "The IPSO systematic review and meta-analysis gathered 8 retrospective studies with 490 patients comparing image-guided core needle biopsy to surgical biopsy for neuroblastoma." — Cecilia Gigena (host_summary) [Ep 21 · 3:27](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=207) - "Tissue adequacy and biological characterization of the biopsy was not significantly different between image-guided core needle biopsy and surgical biopsy groups for neuroblastoma." — Cecilia Gigena (host_summary) [Ep 21 · 3:40](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=220) - "Intraoperative transfusions and complications were higher in the surgical biopsy group compared to image-guided core needle biopsy for neuroblastoma." — Cecilia Gigena (host_summary) [Ep 21 · 3:54](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=234) - "Image-guided core needle biopsy is safe and effective for diagnosing neuroblastoma." — Cecilia Gigena (host_summary) [Ep 21 · 4:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-ep-19-10465?t=240) ## Changelog - Sep 9: Summaries and takeaways published for 4 audiences - Sep 7: Audit reverted — short clips unhidden - Aug 31: 36 doctors auto-found from episode dossiers - Aug 30: 29 doctors auto-found from episode dossiers - Aug 30: 21 doctors auto-found from episode dossiers - Aug 30: Members-only episodes removed from this collection - Aug 29: 22 doctors auto-found from episode dossiers - Aug 29: 23 doctors auto-found from episode dossiers - Aug 29: Collection generated from campaign corpus: 29 items, 18 dossiers, summaries for 2 audience(s) - Aug 29: Collection reviewed and published - Aug 29: Collection generated from campaign corpus: 20 items, 18 dossiers, summaries for 1 audience(s) - Aug 29: Collection generated from campaign corpus: 20 items, 18 dossiers, summaries for 3 audience(s) --- Educational content from recorded physician discussions — not medical advice. 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