# Sarcoma (Ewing/Rhabdo) — GCMD Library living collection

Also covered as: osteosarcoma · synovial sarcoma · ovarian torsion · rhabdomyosarcoma · alveolar rhabdomyosarcoma · soft tissue sarcoma · alveolar soft part sarcoma · undifferentiated sarcoma

Experts: Dr. Todd Ponsky, Dr. Rod Gerardo, Dr. Ellen Encisco, Dr. Jose Campos

Updated: n/a · 26 episodes · 465 cited statements

## Episodes
### Diagnosis & Workup
- [Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care?](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545) — video · 1:05 · [machine version](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545.md)

### Evidence & Research
- [Nonmetastatic Nonrhabdomyosarcoma Soft Tissue Sarcoma](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326) — video · 3:50 · [machine version](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326.md)
- [Case-Based Journal Review- Intussusception in 2022](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092) — podcast · 20:19 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092.md)
- [Case Based Journal Review - CPAM in 2022](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319) — podcast · 12:23 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319.md)
- [Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417) — video · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417.md)
- [Case Based Journal Review: Esophageal Atresia in 2022](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631) — podcast · 17:55 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631.md)
- [Update Course Rewind: Thoracotomy vs VATS for Lung Metastases](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632) — video · 9:40 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632.md)
- [Bailey Roberts, MD - Best of the Best in Pediatric Surgery 2024](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011) — video · 8:39 · [machine version](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011.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)
- [Case-Based Journal Review: Inguinal Hernia 2025](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168) — podcast · 19:13 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168.md)
- [Same-Day Discharge for Elective Pediatric Laparoscopic Gastrostomy Tube Insertion is Safe and Increasing in Frequency; A NSQIP Pediatric Retrospective Review 2017 to 2021](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299) — video · 0:58 · [machine version](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299.md)
- [Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335) — video · 1:14 · [machine version](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335.md)
- [Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354) — video · 0:51 · [machine version](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354.md)

### Case-Based Learning
- [Difficult Cases of Lung Lesions: Pediatric Thoracic Surgery Part 1-Lung...](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085) — video · 21:56 · [machine version](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085.md)
- [Update Course Rewind: Chest Wall Reconstruction 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839) — video · 5:32 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839.md)

### In-Depth Reviews
- [Rapid Fire and Conclusion: Pediatric Obesity 2017](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373) — video · 23:37 · [machine version](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373.md)
- [Ovarian Teratoma - Ovarian Torsion - Soft Tissue Sarcoma: Update Course 2015](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672) — video · 34:37 · [machine version](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672.md)
- [Soft Tissue Sarcoma Rapid Fire: Update Course 2015](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980) — video · 8:27 · [machine version](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980.md)
- [Compiled Hayes Jordan Rapid Fire Sessions: Update Course 2015](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995) — video · 33:36 · [machine version](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995.md)
- [Lymphatic Anomalies](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290) — podcast · 43:16 · [machine version](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290.md)
- [Urology Part I](https://qa.library.globalcastmd.com/watch/urology-part-i-1980) — podcast · 69:50 · [machine version](https://qa.library.globalcastmd.com/watch/urology-part-i-1980.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)
- [Update Course Rewind: 2021 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578) — video · 16:02 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578.md)
- [Update Course Rewind: 2022 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766) — video · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766.md)
- [Update Course Rewind: 2023 Top Ten Key Takeaways](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758) — video · 16:22 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758.md)
- [Choledocholithiasis with Drs. David Vitale & Lucas Neff](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884) — podcast · 15:27 · [machine version](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=0) Image-Guided Percutaneous Biopsy for Pediatric Bone Tumors (Ep 26)
- [0:00](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=0) Study Background and Design (Ep 24)
- [0:32](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32) Key Findings on Relapse Patterns and Survival (Ep 24)
- [0:55](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=55) Clinical Implications (Ep 24)
- [0:00](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=0) Early Postoperative Fever in Pediatric Oncology: Study Findings and Clinical Implications (Ep 25)
- [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 18)
- [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 18)
- [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 18)
- [0:00](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=0) Same-Day Discharge Safety for Pediatric Laparoscopic Gastrostomy (Ep 22)
- [0:00](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=0) Introduction and Series Overview (Ep 8)
- [1:53](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=113) Circumcision: Evidence and Indications (Ep 8)
- [8:50](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=530) Circumcision Technique and Pearls (Ep 8)
- [20:25](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1225) Circumcision Complications and Management (Ep 8)
- [25:30](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1530) Post-Circumcision Issues: Adhesions and Bridges (Ep 8)
- [31:42](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1902) Meatal Stenosis: Diagnosis and Treatment (Ep 8)
- [34:58](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2098) When to Refer: Contraindications to Routine Circumcision (Ep 8)
- [38:14](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2294) Phimosis: Physiologic vs Pathologic (Ep 8)
- [42:58](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2578) Paraphimosis Management (Ep 8)
- [45:20](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2720) Penile Trauma: Zipper Injuries and Crush Injuries (Ep 8)
- [48:58](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2938) Hypospadias: Presentation and Evaluation (Ep 8)
- [53:31](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3211) Hypospadias Repair Principles (Ep 8)
- [57:13](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3433) Other Penile Conditions: Epispadias, Micropenis, Torsion (Ep 8)
- [59:37](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3577) Labial Adhesions in Females (Ep 8)
- [63:48](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3828) Hydrometrocolpos and Midline Genital Bulges (Ep 8)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=0) Introduction and ICG for Cholecystectomy (Ep 13)
- [3:34](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214) ICG Cholecystectomy Technique and Timing (Ep 13)
- [9:34](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574) ICG for Partial Nephrectomy and Varicocele Repair (Ep 13)
- [21:24](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284) Pulmonary Metastasectomy Case Discussion (Ep 13)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=0) Introduction and Gastroschisis Feeding Protocols (Ep 16)
- [3:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=180) Congenital Esophageal Stenosis Management (Ep 16)
- [5:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=300) Outpatient Management of Intussusception (Ep 16)
- [7:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=420) Mechanical Bowel Preparation and Surgical Site Infections (Ep 16)
- [9:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=540) Preventing Pediatric Gunshot Injuries (Ep 16)
- [11:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=660) CT Evaluation of Suspected Airway Foreign Body (Ep 16)
- [13:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=780) Laparotomy versus Peritoneal Drainage for NEC (Ep 16)
- [15:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=900) Implicit and Explicit Bias in Medicine (Ep 16)
- [17:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1020) Isolated Skull Fractures: Safe ED Discharge (Ep 16)
- [19:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1140) Antibiotic Treatment for Complicated Appendicitis (Ep 16)
- [0:00](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=0) Introduction and Clinical Scenario: Timing of Hernia Repair in Preterm Infants (Ep 21)
- [2:48](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=168) First Article: Early vs Late Repair in Preterm Infants - JAMA RCT (Ep 21)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The study evaluated 169 biopsies in 141 patients over a 10-year period at a single institution." — Sophia Schermerhorn (clinical) [Ep 26 · 0:13](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=13)
- "Nearly 90% of the biopsies were core-needle biopsies." — Sophia Schermerhorn (clinical) [Ep 26 · 0:19](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=19)
- "All biopsies were performed with image guidance, most commonly CT, sometimes combined with fluoroscopy and ultrasound." — Sophia Schermerhorn (clinical) [Ep 26 · 0:22](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=22)
- "All biopsies were performed by interventional radiologists." — Sophia Schermerhorn (clinical) [Ep 26 · 0:28](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=28)
- "97.9% of biopsies were diagnostic." — Sophia Schermerhorn (clinical) [Ep 26 · 0:33](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=33)
- "Only 3 patients required repeat biopsy." — Sophia Schermerhorn (clinical) [Ep 26 · 0:33](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=33)
- "There was one patient with transient sciatic nerve paresis, which resolved." — Sophia Schermerhorn (clinical) [Ep 26 · 0:40](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=40)
- "The complication rate was 0.7%." — Sophia Schermerhorn (clinical) [Ep 26 · 0:43](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=43)
- "The approach provided sufficient tissue for histology, immunostains, and molecular studies." — Sophia Schermerhorn (clinical) [Ep 26 · 0:46](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=46)
- "Immunostains and molecular studies are increasingly essential for modern risk stratification and targeted therapy." — Sophia Schermerhorn (clinical) [Ep 26 · 0:46](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=46)
- "Image-guided percutaneous biopsy should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors." — Sophia Schermerhorn (opinion) [Ep 26 · 0:56](https://qa.library.globalcastmd.com/watch/pediatric-and-young-adult-image-guided-percutaneous-bone-biopsy-a-new-standard-of-care-11545?t=56)
- "Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024" — Sophia Schermerhorn (clinical) [Ep 24 · 0:05](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=5)
- "PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology" — Sophia Schermerhorn (clinical) [Ep 24 · 0:07](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=7)
- "The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers" — Sophia Schermerhorn (clinical) [Ep 24 · 0:20](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=20)
- "Among 33 patients studied, about 2/3 had relapse limited to the lungs" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:32](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32)
- "Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:32](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=32)
- "Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation" — Sophia Schermerhorn (clinical) [Ep 24 · 0:39](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39)
- "Patients with solitary pulmonary nodule had the highest overall three-year survival at 73%" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:39](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=39)
- "Three-year survival for patients with multiple nodules was 40%" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:50](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50)
- "Three-year survival for patients with extrapulmonary disease was 23%" — Sophia Schermerhorn (epidemiological) [Ep 24 · 0:50](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=50)
- "Solitary pulmonary relapse may represent a biologically more favorable type of recurrence" — Sophia Schermerhorn (opinion) [Ep 24 · 0:57](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- "Solitary pulmonary relapse is more amenable to achieving meaningful local control" — Sophia Schermerhorn (opinion) [Ep 24 · 0:57](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- "Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma" — Sophia Schermerhorn (opinion) [Ep 24 · 0:57](https://qa.library.globalcastmd.com/watch/current-management-of-pulmonary-relapse-in-ewing-sarcoma-a-report-from-the-pediatric-surgical-oncology-research-collaborative-11335?t=57)
- "42% of 220 oncology patients had a fever in the 48 hours following tumor resection" — Sophia Schermerhorn (epidemiological) [Ep 25 · 0:12](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=12)
- "Only 2 of the febrile patients (2.8%) had an actual infection" — Sophia Schermerhorn (epidemiological) [Ep 25 · 0:19](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=19)
- "The two patients with actual infection were hemodynamically unstable with positive blood cultures" — Sophia Schermerhorn (clinical) [Ep 25 · 0:19](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=19)
- "Most fevers triggered a workup that costs on average about $500 per patient" — Sophia Schermerhorn (epidemiological) [Ep 25 · 0:30](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=30)
- "About a third of patients received empiric antibiotics that they did not need" — Sophia Schermerhorn (epidemiological) [Ep 25 · 0:30](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=30)
- "In the 48 hours following tumor resection, fever alone may not be a reason to panic" — Sophia Schermerhorn (opinion) [Ep 25 · 0:40](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=40)
- "Extensive workup should be reserved for patients who are hemodynamically unstable or have more overt signs of infection" — Sophia Schermerhorn (guideline) [Ep 25 · 0:45](https://qa.library.globalcastmd.com/watch/early-postoperative-fever-in-pediatric-oncology-patients-undergoing-solid-tumor-resection-11354?t=45)
- "Dr. Bailey Roberts from IPSO presented on extracellular vesicles for metastatic osteosarcoma contributing to the creation of pre-metastatic niche" — Cecilia (clinical) [Ep 18 · 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 18 · 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 18 · 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 18 · 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 18 · 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)
- "The study analyzed the ACS NSQIP Pediatric database from 2017 to 2021" — Alex Halpern (clinical) [Ep 22 · 0:13](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=13)
- "5,947 pediatric patients underwent elective laparoscopic gastrostomy tube placement in the study period" — Alex Halpern (epidemiological) [Ep 22 · 0:21](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=21)
- "4.7% of patients were discharged the same day after laparoscopic gastrostomy tube placement" — Alex Halpern (epidemiological) [Ep 22 · 0:29](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=29)
- "There were no significant differences in 30-day unplanned readmissions between same-day discharge and 1-2 day discharge patients" — Alex Halpern (clinical) [Ep 22 · 0:33](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=33)
- "There were no significant differences in reoperations between same-day discharge and 1-2 day discharge patients" — Alex Halpern (clinical) [Ep 22 · 0:33](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=33)
- "There were no significant differences in any other complications between same-day discharge and 1-2 day discharge patients" — Alex Halpern (clinical) [Ep 22 · 0:33](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=33)
- "Same-day discharge for pediatric patients after elective laparoscopic gastrostomy appears to be safe" — Alex Halpern (opinion) [Ep 22 · 0:46](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=46)
- "Same-day discharge after pediatric laparoscopic gastrostomy is not commonly done" — Alex Halpern (epidemiological) [Ep 22 · 0:46](https://qa.library.globalcastmd.com/watch/same-day-discharge-for-elective-pediatric-laparoscopic-gastrostomy-tube-insertion-is-safe-and-increasing-in-frequency-a-nsqip-pediatric-retrospective-review-2017-to-2021-10299?t=46)
- "UTI risk in the first year of life is 3-4% overall, with uncircumcised boys having 1/100 risk versus circumcised boys 1/1000 risk" — Patricio Gargollo (epidemiological) [Ep 8 · 2:40](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=160)
- "Circumcision provides 53% protection against HIV transmission in randomized trials from Kenya and Uganda, with both trials stopped early due to significant benefit" — Patricio Gargollo (clinical) [Ep 8 · 4:16](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=256)
- "Circumcision decreases risk of HIV, syphilis, gonococcus, HPV, and HSV-2, but does not change chlamydia risk" — Patricio Gargollo (clinical) [Ep 8 · 3:16](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=196)
- "The AAP states that data are not sufficient to recommend routine neonatal circumcision, and parents should be given accurate, unbiased information" — Patricio Gargollo (host_summary) [Ep 8 · 5:19](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=319)
- "Office circumcision should be limited to infants 3 months or younger or weighing less than 13 pounds to minimize restraint difficulty and bleeding risk" — Patricio Gargollo (opinion) [Ep 8 · 6:56](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=416)
- "Exposing young children to elective general anesthesia such as for circumcision is not recommended from an anesthetic safety standpoint" — Patricio Gargollo (clinical) [Ep 8 · 7:53](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=473)
- "The best analgesia for circumcision is a dorsal penile nerve block combined with a ring block using 0.25% bupivacaine without epinephrine" — Patricio Gargollo (clinical) [Ep 8 · 9:28](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=568)
- "The Gomco clamp is preferred over Plastibell (subjectively more complications) and Mogen clamp (risk of glans amputation)" — Patricio Gargollo (opinion) [Ep 8 · 10:22](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=622)
- "Glans amputation during circumcision has been seen 2-3 times with Mogen clamp when small glans is pulled through the slit" — Patricio Gargollo (clinical) [Ep 8 · 11:07](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=667)
- "Complete preputial adhesion takedown is essential—you must see the ridge under the corona all the way around to avoid asymmetric skin removal" — Patricio Gargollo (clinical) [Ep 8 · 15:55](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=955)
- "When using Gomco, leave the bell on for at least 5 minutes for older infants (closer to 3 months/13 pounds) and 1-2 minutes for newborns" — Patricio Gargollo (clinical) [Ep 8 · 16:56](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1016)
- "When removing the Gomco bell, force the skin off the bell rather than pulling the bell off the skin to avoid separating crushed edges" — Patricio Gargollo (clinical) [Ep 8 · 17:01](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1021)
- "A safety pin through both edges of the dorsal slit helps pull foreskin through the Gomco base hole more easily" — Patricio Gargollo (clinical) [Ep 8 · 17:51](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1071)
- "Before clamping, check underneath the bell to ensure shaft skin (not scrotal skin) is visible and the median raphe is centered to avoid twisting" — Patricio Gargollo (clinical) [Ep 8 · 19:35](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1175)
- "Vaseline dissolves Dermabond, so parents must be instructed not to apply Vaseline after Dermabond circumcision" — Patricio Gargollo (clinical) [Ep 8 · 20:47](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1247)
- "Office circumcision tray should include 6-0 chromic or fast-absorbing plain suture for bleeding and 1:1000 epinephrine for topical hemostasis" — Patricio Gargollo (clinical) [Ep 8 · 21:27](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1287)
- "For OR circumcision, 6-0 or 5-0 fast-absorbing plain gut (used by plastic surgeons on face) heals nicely; Vicryl causes pie-crusting unless subcuticular" — Patricio Gargollo (clinical) [Ep 8 · 22:17](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1337)
- "Physiologic post-circumcision adhesions (distinct line visible, common in chubby babies) do not need treatment and will lyse spontaneously as the child grows" — Patricio Gargollo (clinical) [Ep 8 · 25:38](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1538)
- "Lysing physiologic adhesions in the office can turn a non-problem into a problem by creating a raw surface that forms a true skin bridge" — Patricio Gargollo (clinical) [Ep 8 · 26:21](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1581)
- "True skin bridges (no line, two holes on each side) require treatment because they tether the penis and do not resolve spontaneously" — Patricio Gargollo (clinical) [Ep 8 · 27:15](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1635)
- "Most skin bridges can be lysed in office with EMLA cream for 30-40 minutes, hemostat placement, and fine scissor division" — Patricio Gargollo (clinical) [Ep 8 · 27:47](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1667)
- "Redundant foreskin appearance after circumcision is usually due to suprapubic fat pad displacing skin distally; if penis looks circumcised when fat pad is pushed down, no revision is needed" — Patricio Gargollo (clinical) [Ep 8 · 29:25](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1765)
- "Dr. Gargollo has never seen an adolescent complain of too much foreskin after circumcision, suggesting most cases resolve with puberty" — Patricio Gargollo (clinical) [Ep 8 · 29:57](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1797)
- "Dr. Gargollo performs only 1-2 redo circumcisions per year despite high volume, indicating most redundant skin resolves spontaneously" — Patricio Gargollo (clinical) [Ep 8 · 30:53](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1853)
- "Meatal stenosis is a condition exclusively seen in circumcised boys, caused by meatal inflammation from rubbing against diaper/underwear creating a 6 o'clock web" — Patricio Gargollo (clinical) [Ep 8 · 32:11](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1931)
- "Meatal stenosis requires intervention only when urine stream deviates straight upward or child must sit to void, not for subjectively narrow meatus alone" — Patricio Gargollo (clinical) [Ep 8 · 32:45](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=1965)
- "Office meatotomy can be performed with EMLA cream, straight hemostat crush of 6 o'clock web, and fine scissors; sutures at 3 and 6 o'clock have no proven benefit for reducing recurrence" — Patricio Gargollo (clinical) [Ep 8 · 33:44](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2024)
- "Dr. Gargollo has never seen an adolescent with meatal stenosis, suggesting many subjectively narrow meatuses normalize with growth" — Patricio Gargollo (clinical) [Ep 8 · 33:29](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2009)
- "Hypospadias, buried penis, penile-scrotal webbing, penile torsion, and congenital megaprepuce are contraindications to routine circumcision and should be referred to pediatric urology" — Patricio Gargollo (clinical) [Ep 8 · 36:58](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2218)
- "For distal hypospadias discovered during circumcision, the circumcision can be completed because foreskin is not used in modern distal hypospadias repairs" — Patricio Gargollo (clinical) [Ep 8 · 51:14](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3074)
- "A buried penis appears as a short squat pyramid rather than a protruding structure; attempting circumcision can result in complete shaft skin loss requiring skin grafting" — Patricio Gargollo (clinical) [Ep 8 · 37:22](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2242)
- "Micropenis is defined as stretched penile length greater than 2.5 standard deviations below the mean for age; mean is 4 cm at 6-12 months" — Patricio Gargollo (clinical) [Ep 8 · 35:37](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2137)
- "Physiologic phimosis (soft, supple foreskin without symptoms) requires no treatment regardless of age, even in 5-8 year olds" — Patricio Gargollo (clinical) [Ep 8 · 38:47](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2327)
- "First-line treatment for symptomatic phimosis is betamethasone 0.1% three times daily for 2-3 months, with >50% success rate" — Patricio Gargollo (clinical) [Ep 8 · 40:15](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2415)
- "Balanitis xerotica obliterans (BXO) presents with white paper-like, scaly, hard skin at prepuce tip and does not respond to steroids; requires circumcision to prevent urethral stricture" — Patricio Gargollo (clinical) [Ep 8 · 42:20](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2540)
- "Secondary phimosis (post-circumcision cicatrix causing stenotic ring) responds to betamethasone 0.1% TID for 2-3 months in >50% of cases" — Patricio Gargollo (clinical) [Ep 8 · 41:13](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2473)
- "Paraphimosis management includes pain control, D50-soaked bandage wrap to reduce edema, and manual reduction with thumbs on glans pushing back through foreskin" — Patricio Gargollo (clinical) [Ep 8 · 44:02](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2642)
- "Dr. Gargollo has never had to perform a dorsal slit for paraphimosis, as manual reduction with proper pain control and D50 wrap is successful" — Patricio Gargollo (clinical) [Ep 8 · 45:02](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2702)
- "The main cause of penile trauma is zipper injuries; treatment is cutting the zipper bridge with bolt cutters rather than manipulating the zipper" — Patricio Gargollo (clinical) [Ep 8 · 45:55](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2755)
- "Toilet seat crush injuries to penis can be managed conservatively if child is voiding without gross hematuria; glands hematoma may look necrotic but resolves" — Patricio Gargollo (clinical) [Ep 8 · 46:32](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2792)
- "Buck's fascia violation in penile trauma requires OR repair to prevent long-term scarring and potency issues" — Patricio Gargollo (clinical) [Ep 8 · 47:36](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2856)
- "Gross blood at urethral meatus or gross hematuria after trauma mandates full urinary tract evaluation and retrograde urethrogram before catheterization" — Patricio Gargollo (clinical) [Ep 8 · 48:11](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2891)
- "Hypospadias incidence is approximately 1 in 150 live births, likely multifactorial etiology including in vitro fertilization exposure" — Patricio Gargollo (epidemiological) [Ep 8 · 49:34](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=2974)
- "Hypospadias assessment requires evaluation of meatus location and degree of ventral curvature (chordee); more proximal meatus and greater curvature indicate more complex repair" — Patricio Gargollo (clinical) [Ep 8 · 50:34](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3034)
- "Non-palpable gonad with hypospadias requires full disorder of sexual differentiation (DSD) workup; bilateral non-palpable gonads suggests congenital adrenal hyperplasia" — Patricio Gargollo (clinical) [Ep 8 · 52:46](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3166)
- "Hypospadias repair involves urethroplasty (tubularizing urethra with second-layer coverage) and phalloplasty (straightening chordee, often resolved by degloving alone)" — Patricio Gargollo (clinical) [Ep 8 · 56:12](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3372)
- "Very mild hypospadias variants (megameatus, distal) raise controversy about timing of repair given anesthesia exposure concerns in young children" — Patricio Gargollo (opinion) [Ep 8 · 54:40](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3280)
- "Epispadias (dorsal urethral defect) is extremely rare (<1/50,000) and represents the bladder exstrophy-epispadias spectrum with associated incontinence, pubic diastasis, and vesicoureteral reflux" — Patricio Gargollo (clinical) [Ep 8 · 57:22](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3442)
- "Penile torsion (twisted median raphe) requires surgical correction only if rotation is ≥90 degrees" — Patricio Gargollo (clinical) [Ep 8 · 59:58](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3598)
- "Labial adhesions occur in approximately 2% of girls in the first 2 years of life, not in newborns due to protective maternal estrogen" — Patricio Gargollo (epidemiological) [Ep 8 · 61:48](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3708)
- "Labial adhesions require treatment only for symptoms: post-void dribbling, skin breakdown, or recurrent UTIs; asymptomatic adhesions should not be treated" — Patricio Gargollo (clinical) [Ep 8 · 62:29](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3749)
- "First-line treatment for symptomatic labial adhesions is betamethasone ointment BID for 6 weeks, preferred over estrogen cream to avoid pubic hair development in prepubertal girls" — Patricio Gargollo (clinical) [Ep 8 · 62:53](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3773)
- "Surgical lysis of labial adhesions is rarely needed; Dr. Gargollo has performed it only once in his career" — Patricio Gargollo (clinical) [Ep 8 · 63:31](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3811)
- "Differential diagnosis for midline genital bulge includes imperforate hymen, prolapsed urethrocele, paraurethral/perivaginal cysts, and vaginal rhabdomyosarcoma" — Patricio Gargollo (clinical) [Ep 8 · 64:52](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3892)
- "Prolapsed urethrocele is distinct from vagina on exam, associated with prenatal hydronephrosis, and requires renal bladder ultrasound and VCUG" — Patricio Gargollo (clinical) [Ep 8 · 66:30](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=3990)
- "Paraurethral and perivaginal cysts (Gardner's duct, Skene's gland) present at birth, spontaneously regress with loss of maternal estrogen, and show patent urethra and vagina on exam" — Patricio Gargollo (clinical) [Ep 8 · 67:34](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=4054)
- "Vaginal rhabdomyosarcoma appears as a 'bunch of grapes' mass rather than a single bulge and requires oncology involvement" — Patricio Gargollo (clinical) [Ep 8 · 68:03](https://qa.library.globalcastmd.com/watch/urology-part-i-1980?t=4083)
- "In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers" — Chiro Esposito (epidemiological) [Ep 13 · 3:34](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)
- "ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice" — Chiro Esposito (clinical) [Ep 13 · 0:23](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=23)
- "For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization" — Chiro Esposito (clinical) [Ep 13 · 7:15](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=435)
- "If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult" — Chiro Esposito (clinical) [Ep 13 · 7:51](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- "For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively" — Chiro Esposito (clinical) [Ep 13 · 7:51](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- "ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy" — Chiro Esposito (clinical) [Ep 13 · 4:40](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=280)
- "For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line" — Chiro Esposito (clinical) [Ep 13 · 9:34](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- "In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG" — Chiro Esposito (clinical) [Ep 13 · 9:34](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- "For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels" — Chiro Esposito (clinical) [Ep 13 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases" — Chiro Esposito (clinical) [Ep 13 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles" — Chiro Esposito (clinical) [Ep 13 · 19:10](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1150)
- "The spermatic bundle contains three to four lymphatic vessels" — Chiro Esposito (clinical) [Ep 13 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "There is no maximum dose limit for ICG based on adult surgery studies" — Chiro Esposito (clinical) [Ep 13 · 21:53](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1313)
- "ICG vial remains usable for six hours after preparation" — Chiro Esposito (clinical) [Ep 13 · 21:24](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- "No adverse effects of ICG were observed in the presenter's experience" — Chiro Esposito (clinical) [Ep 13 · 21:24](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- "ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system" — Chiro Esposito (clinical) [Ep 13 · 1:20](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=80)
- "The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images" — Chiro Esposito (clinical) [Ep 13 · 5:40](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=340)
- "For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning" — Chiro Esposito (clinical) [Ep 13 · 8:42](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=522)
- "ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes" — Chiro Esposito (opinion) [Ep 13 · 3:34](https://qa.library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)
- "Infants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds." — Em Tombash (host_summary) [Ep 16 · 1:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=60)
- "Based on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated." — Em Tombash (host_summary) [Ep 16 · 2:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=120)
- "Immediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds." — Em Tombash (host_summary) [Ep 16 · 2:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=150)
- "For babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis." — Em Tombash (host_summary) [Ep 16 · 2:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=165)
- "High resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis." — Em Tombash (host_summary) [Ep 16 · 4:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=240)
- "Serial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area." — Em Tombash (host_summary) [Ep 16 · 4:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=255)
- "Surgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component." — Em Tombash (host_summary) [Ep 16 · 4:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=270)
- "Initial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected." — Em Tombash (host_summary) [Ep 16 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=285)
- "Management of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines." — Em Tombash (host_summary) [Ep 16 · 5:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=345)
- "A systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction." — Em Tombash (host_summary) [Ep 16 · 6:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=360)
- "There was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention." — Em Tombash (host_summary) [Ep 16 · 6:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=390)
- "Outpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality." — Em Tombash (host_summary) [Ep 16 · 6:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=405)
- "There is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery." — Em Tombash (host_summary) [Ep 16 · 7:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=450)
- "Recent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections." — Em Tombash (host_summary) [Ep 16 · 7:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=465)
- "Adult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery." — Em Tombash (host_summary) [Ep 16 · 8:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=480)
- "Recent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations." — Em Tombash (host_summary) [Ep 16 · 8:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=495)
- "Case-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery." — Em Tombash (host_summary) [Ep 16 · 8:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=525)
- "Firearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019." — Em Tombash (host_summary) [Ep 16 · 9:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=585)
- "There are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country." — Em Tombash (host_summary) [Ep 16 · 10:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=600)
- "As pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is." — Em Tombash (host_summary) [Ep 16 · 10:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=615)
- "Pediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy." — Em Tombash (host_summary) [Ep 16 · 10:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=645)
- "Unwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray." — Em Tombash (host_summary) [Ep 16 · 11:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=705)
- "The gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise." — Em Tombash (host_summary) [Ep 16 · 12:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=720)
- "CT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress." — Em Tombash (host_summary) [Ep 16 · 12:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=735)
- "Low-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies." — Em Tombash (host_summary) [Ep 16 · 12:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=750)
- "CT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure." — Em Tombash (host_summary) [Ep 16 · 12:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=765)
- "The largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months." — Em Tombash (host_summary) [Ep 16 · 13:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=810)
- "Death or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage." — Em Tombash (host_summary) [Ep 16 · 14:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=840)
- "The prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC." — Em Tombash (host_summary) [Ep 16 · 14:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=855)
- "For infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies." — Em Tombash (host_summary) [Ep 16 · 14:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=885)
- "Racism and sexism that manifest as microaggressions are commonly experienced by members of minority groups." — Em Tombash (host_summary) [Ep 16 · 15:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=945)
- "Individuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments." — Em Tombash (host_summary) [Ep 16 · 16:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=960)
- "Placing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging." — Em Tombash (host_summary) [Ep 16 · 16:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=975)
- "Bystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions." — Em Tombash (host_summary) [Ep 16 · 16:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1005)
- "Blunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures." — Em Tombash (host_summary) [Ep 16 · 17:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1050)
- "A 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission." — Em Tombash (host_summary) [Ep 16 · 18:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1095)
- "Pediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation." — Em Tombash (host_summary) [Ep 16 · 18:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1125)
- "The IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome." — Em Tombash (host_summary) [Ep 16 · 19:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1170)
- "Patients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy." — Em Tombash (host_summary) [Ep 16 · 20:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1200)
- "Piperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy." — Em Tombash (host_summary) [Ep 16 · 20:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1215)
- "Monotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis." — Em Tombash (host_summary) [Ep 16 · 20:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2022-top-ten-key-takeaways-6766?t=1230)
- "Preterm infants with inguinal hernia have a very high rate of incarceration" — Todd Ponsky (clinical) [Ep 21 · 1:17](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=77)
- "The younger the baby, the higher the risk of incarceration in inguinal hernia" — Jose Campos (clinical) [Ep 21 · 1:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=103)
- "In the JAMA trial of 308 preterm infants, 44 patients (28%) in the early repair group had at least one serious adverse event versus 27 patients (18%) in the late repair group" — Em Gootee (host_summary) [Ep 21 · 3:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=216)
- "Recurrence rate after inguinal hernia repair in the trial was less than 1%" — Em Gootee (host_summary) [Ep 21 · 4:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=247)
- "Incarceration rate in the late repair group was around 4%" — Em Gootee (host_summary) [Ep 21 · 4:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=247)
- "In the early repair group, 4% of hernias resolved spontaneously; in the late repair group, 11% resolved spontaneously" — Jose Campos (host_summary) [Ep 21 · 4:20](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=260)
- "One patient in the trial had a bowel injury during hernia repair" — Todd Ponsky (host_summary) [Ep 21 · 4:56](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=296)
- "There was zero incidence of bowel loss in the trial" — Todd Ponsky (host_summary) [Ep 21 · 4:56](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=296)
- "The trial showed more reintubations and more apnea in the early repair group" — Todd Ponsky (host_summary) [Ep 21 · 5:26](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=326)
- "The JAMA trial was terminated early, had low recruitment rate, and ended up with less statistical power than initially calculated" — Em Gootee (host_summary) [Ep 21 · 7:12](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=432)
- "In the Dutch one-stop surgery study of 91 patients (54 one-stop, 37 usual care), all but one of the one-stop surgery patients were discharged home on the day of surgery" — Em Gootee (host_summary) [Ep 21 · 10:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=654)
- "Post-operative complication and recurrence rates did not differ between one-stop surgery and usual care patients in the Dutch study" — Em Gootee (host_summary) [Ep 21 · 10:59](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=659)
- "General satisfaction and inclusion of family were higher after one-stop surgery experience" — Em Gootee (host_summary) [Ep 21 · 11:05](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=665)
- "There was no diagnostic uncertainty in the one-stop surgery program" — Jose Campos (host_summary) [Ep 21 · 11:35](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=695)
- "A recent Surgery journal article found that routine post-operative visits alter management in less than 1% of cases for routine pediatric surgical conditions including circumcision, orchiopexy, and inguinal hernia" — Jose Campos (host_summary) [Ep 21 · 12:26](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=746)
- "When facing medical problems with low risk of complications, family satisfaction becomes a surrogate for quality" — Jose Campos (host_summary) [Ep 21 · 13:28](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=808)
- "In the multi-institutional patent processus vaginalis study, 246 eligible infants under 4 months with PPV found at pyloromyotomy were enrolled at 8 children's hospitals, with 85% responding to at least one annual follow-up" — Em Gootee (host_summary) [Ep 21 · 15:34](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=934)
- "Of the 246 infants with patent processus vaginalis, two had inguinal hernia repair for symptomatic hernia, one had orchiopexy and incidental inguinal hernia repair, for a total of 3 hernia repairs" — Em Gootee (host_summary) [Ep 21 · 15:49](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=949)
- "The presence of patent processus vaginalis at the time of pyloromyotomy was common, but the need for hernia repair was around 1% in the first year of follow-up" — Em Gootee (host_summary) [Ep 21 · 16:13](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=973)
- "A Mayo Clinic study by Ben Zendejas showed contralateral hernia occurrence after a 50-year follow-up period" — Todd Ponsky (host_summary) [Ep 21 · 16:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-inguinal-hernia-2025-10168?t=1003)
- "The ISSVA classification system was updated in 2014 and is based on John Mulligan's original classification from Boston Children's Hospital" — Denise Adams (guideline) [Ep 7 · 2:12](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=132)
- "Lymphatic anomalies are classified into lymphatic tumors and lymphatic malformations, with malformations further divided into macrocystic, microcystic, combined lesions, generalized lymphatic anomaly, Gorham-Stout disease, and central conducting anomalies" — Denise Adams (clinical) [Ep 7 · 2:58](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=178)
- "Using incorrect terminology like cystic hygroma and lymphangioma causes confusion among clinicians, colleagues, and patients" — Steve Fishman (opinion) [Ep 7 · 4:45](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=285)
- "Macrocystic lymphatic malformations can be described to patients as like a bunch of grapes where each grape is visible and can be accessed with a needle for sclerotherapy" — Steve Fishman (clinical) [Ep 7 · 5:43](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=343)
- "Microcystic lesions are like a small porous sponge with cysts too tiny to see individually, making sclerotherapy less practical" — Steve Fishman (clinical) [Ep 7 · 6:14](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=374)
- "Most lymphatic malformations are present at birth and visible at birth, though some may present later with sudden expansion" — Steve Fishman (clinical) [Ep 7 · 9:06](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=546)
- "There are four general treatment options for lymphatic malformations: observation with reassurance, microinterventional therapy with needle or catheter, resective surgery, and pharmacological therapy" — Steve Fishman (clinical) [Ep 7 · 10:05](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=605)
- "For very large truncal lesions extending from axilla to pelvis, surgical resection may be preferred over multiple sclerotherapy sessions to avoid significant radiation exposure and potentially unsatisfactory outcomes from residual tissue" — Steve Fishman (opinion) [Ep 7 · 12:30](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=750)
- "Sirolimus (rapamycin) is an mTOR inhibitor that blocks the PIK3CA pathway, which has been shown to be a somatic mutation in many lymphatic malformations" — Denise Adams (clinical) [Ep 7 · 15:43](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=943)
- "Boston Children's Hospital received FDA funding in 2008 to study sirolimus for complicated vascular anomalies based on the hypothesis that the PIK3CA pathway controls blood vessel growth" — Denise Adams (clinical) [Ep 7 · 16:18](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=978)
- "Sirolimus improved quality of life, decreased pain, and reduced infection frequency in patients with complicated lymphatic anomalies" — Denise Adams (clinical) [Ep 7 · 16:59](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1019)
- "Preoperative sirolimus therapy can soften lymphatic tissue and decrease lesion size, making surgical procedures less extensive" — Denise Adams (clinical) [Ep 7 · 17:41](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1061)
- "Operating on patients while continuing sirolimus makes tissue softer, allows easier elevation of skin flaps, and enables more extensive resection with better closure compared to operating without the medication" — Steve Fishman (clinical) [Ep 7 · 19:31](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1171)
- "Sirolimus is unlikely to be useful for purely macrocystic lesions, and the tissue expansion effect from large cysts can actually make surgery easier" — Steve Fishman (opinion) [Ep 7 · 20:25](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1225)
- "Spontaneous resolution of macrocystic lymphatic malformations occurs in less than a handful of cases out of several thousand patients" — Steve Fishman (epidemiological) [Ep 7 · 22:33](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1353)
- "EXIT procedures are not really necessary for lymphatic lesions because they are soft and compressible, allowing intubation, unlike firm teratomas" — Steve Fishman (clinical) [Ep 7 · 23:27](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1407)
- "Babies with congenital lymphedema of the lower extremities can have regression to the point of non-detection on physical exam, though this is uncommon" — Steve Fishman (clinical) [Ep 7 · 25:11](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1511)
- "For lesions impinging on the airway that could cause emergency if infected or bleeding occurs, observation is not a good option" — Steve Fishman (clinical) [Ep 7 · 25:55](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1555)
- "Early treatment in infancy is now preferred for microcystic lesions on the face, tongue, and floor of mouth, with medical therapy rather than surgery" — Steve Fishman (opinion) [Ep 7 · 26:09](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1569)
- "Burroughs rule states that if diagnosis is not classic on history, physical, and imaging, tissue biopsy is necessary" — Steve Fishman (guideline) [Ep 7 · 29:28](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1768)
- "Doxycycline is used for macrocystic lesions, bleomycin for microcystic lesions (with monitoring for side effects), and sodium tetradecyl sulfate for venous components" — Belinda Dickey (clinical) [Ep 7 · 33:10](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=1990)
- "A small amount of ethanol systemically can cause sudden fatal pulmonary hypertension" — Steve Fishman (clinical) [Ep 7 · 34:25](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2065)
- "Large venous anomalies with direct macroscopic outflow to systemic veins can result in pulmonary embolism from clot induced by sclerotherapy" — Steve Fishman (clinical) [Ep 7 · 34:45](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2085)
- "Venous mapping by MR, ultrasound, or venography is essential before sclerotherapy, and direct venous outflow must be obliterated first using laser, coils, or glue to prevent fatal pulmonary embolism" — Steve Fishman (clinical) [Ep 7 · 34:59](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2099)
- "Most sclerotherapy worldwide is likely performed by surgeons rather than interventional radiologists because many countries lack image-guided fluoroscopy suites" — Steve Fishman (epidemiological) [Ep 7 · 37:12](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2232)
- "When bleomycin was first used for vascular anomalies, there were reported cases of pneumonitis because practitioners didn't understand there is a maximum safe dose" — Denise Adams (clinical) [Ep 7 · 38:09](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2289)
- "Patients with central conducting lymphatic anomalies can present with subcutaneous chyle, eroding bones, chylous ascites, chylothorax, and chyle dripping from urethra, scrotum, vagina, or even from under toenails" — Steve Fishman (clinical) [Ep 7 · 39:38](https://qa.library.globalcastmd.com/watch/lymphatic-anomalies-290?t=2378)
- "The study compared outcomes between patients who had unplanned excision of lesions later found to be non-rhabdomyosarcoma followed by re-excision versus patients who had planned workup and excision." — Todd Ponsky (host_summary) [Ep 1 · 0:16](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=16)
- "40 patients were referred after having an innocuous lesion removed that came back as non-rhabdomyosarcoma." — Todd Ponsky (host_summary) [Ep 1 · 0:49](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=49)
- "5 of the 40 referred patients were deemed impossible to re-excise based on location or other reasons, leaving 35 patients for re-excision." — Todd Ponsky (host_summary) [Ep 1 · 1:00](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=60)
- "44 patients had planned excision at the study institution after workup with MRI or incisional biopsy or core biopsy." — Todd Ponsky (host_summary) [Ep 1 · 1:10](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=70)
- "23 of the 44 planned excision patients received neoadjuvant therapy, leaving 21 for comparison." — Todd Ponsky (host_summary) [Ep 1 · 1:33](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=93)
- "45.7% of patients who underwent re-excision had residual tumor found in the specimen." — Todd Ponsky (host_summary) [Ep 1 · 1:56](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=116)
- "There was no difference in disease relapse between planned and unplanned excision groups." — Todd Ponsky (host_summary) [Ep 1 · 2:13](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=133)
- "There was no difference in 5-year overall survival between planned and unplanned excision groups." — Todd Ponsky (host_summary) [Ep 1 · 2:21](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=141)
- "There was no difference in disease-free survival between planned and unplanned excision groups." — Todd Ponsky (host_summary) [Ep 1 · 2:26](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=146)
- "There was no difference in local control rates or local recurrence between planned and unplanned excision groups." — Todd Ponsky (host_summary) [Ep 1 · 2:26](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=146)
- "The study authors concluded that patients should have a higher index of suspicion and should be worked up more thoroughly." — Todd Ponsky (host_summary) [Ep 1 · 2:56](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=176)
- "Since there is no outcome difference between planned and unplanned excision, it may be acceptable with low index of suspicion to excise the lesion and perform re-excision if it returns as non-rhabdomyosarcoma." — Todd Ponsky (opinion) [Ep 1 · 3:26](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=206)
- "Re-excision can have high morbidity because it may require taking significantly more tissue." — Todd Ponsky (clinical) [Ep 1 · 3:39](https://qa.library.globalcastmd.com/watch/nonmetastatic-nonrhabdomyosarcoma-soft-tissue-sarcoma-326?t=219)
- "BMIs in the 40s will predictably achieve post-surgical BMIs less than 30" (clinical) [Ep 2 · 0:56](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=56)
- "Earlier intervention in bariatric surgery improves quality of life for patients" (clinical) [Ep 2 · 1:49](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=109)
- "Operating at lower degrees of obesity allows moving patients into a much healthier state" (host_summary) [Ep 2 · 2:27](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=147)
- "Patients above BMI 55 have only about 14% probability of achieving BMI below 30 after surgery (data published by Tom in 2009)" (host_summary) [Ep 2 · 3:05](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=185)
- "Once BMI crosses 50 threshold, probability of mitigating risks associated with BMI 35+ becomes challenging" (clinical) [Ep 2 · 3:32](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=212)
- "Conversation about bariatric surgery should begin when BMI reaches mid-30s, especially with comorbidities" (opinion) [Ep 2 · 3:59](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=239)
- "At BMI 49, surgery may fail to get patients out of the severely obese category" (clinical) [Ep 2 · 5:34](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=334)
- "Topiramate and phentermine can be used as bridge therapy to buy time for patient maturity before surgery" (clinical) [Ep 2 · 6:27](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=387)
- "Medications can serve as bridge to surgery, primary therapeutic intervention, or post-surgical adjunct depending on patient needs" (clinical) [Ep 2 · 7:06](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=426)
- "Obesity is a heterogeneous disease requiring continuous treatment escalation based on individual patient response" (clinical) [Ep 2 · 7:56](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=476)
- "Medications should be initiated after 3-6 months in program when healthy living alone is insufficient to control disease" (guideline) [Ep 2 · 8:31](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=511)
- "Dexamphetamine has evidence base for hypothalamic obesity patients and may be needed pre- and post-surgery" (clinical) [Ep 2 · 9:15](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=555)
- "Hypothalamic obesity patients have biological drive to gain weight that defeats surgery, profoundly different from patients without brain injury" (clinical) [Ep 2 · 9:32](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=572)
- "Private insurers are limiting dietitian visits to 3 per year, inadequate for chronic disease management" (clinical) [Ep 2 · 13:36](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=816)
- "Sugar taxation decreases consumption and generates revenue (data shown by Gellibrano)" (host_summary) [Ep 2 · 15:24](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=924)
- "Taxing specific products like sugar will not have desired impact because obesity is not caused by sugar per se" (opinion) [Ep 2 · 15:08](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=908)
- "Most obese patients meet objective criteria for binge eating disorder when assessed with questionnaires, even without formal diagnosis" (epidemiological) [Ep 2 · 19:53](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1193)
- "Bariatric surgery demonstrates good resolution of binge eating disorder symptoms in adult literature (Jim Mitchell's work in LABS consortium)" (host_summary) [Ep 2 · 20:20](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1220)
- "Surgery is effective at extinguishing binge eating behaviors" (clinical) [Ep 2 · 20:49](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1249)
- "Prior binge eating disorder diagnosis may pose higher risk for relapse or weight regain long-term after surgery" (clinical) [Ep 2 · 21:03](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1263)
- "Rate of true diagnosable binge eating disorder in obese pediatric patients is under 5% when screened with diagnostic criteria" (epidemiological) [Ep 2 · 21:33](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1293)
- "Disordered eating (restricting during day, overeating in evening) is present in many obese patients even without formal eating disorder diagnosis" (clinical) [Ep 2 · 21:18](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1278)
- "Patients who develop fear of eating and severe restriction should be referred to eating disorders programs" (guideline) [Ep 2 · 21:51](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1311)
- "Disordered eating applies to nearly every obese patient, involving feelings and emotions around eating, food, and restricting, even without meeting DSM criteria" (clinical) [Ep 2 · 22:20](https://qa.library.globalcastmd.com/watch/rapid-fire-and-conclusion-pediatric-obesity-2017-373?t=1340)
- "80% of ovarian masses are teratomas" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 1:25](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=85)
- "In the year 2000, girls with ovarian germ cell tumors have almost 100% survival" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 1:50](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=110)
- "Stage one ovarian tumors limited to the ovary now receive only oophorectomy without chemotherapy" — Andrea Hayes Jordan (guideline) [Ep 3 · 2:14](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=134)
- "Microscopic residual and lymph node involvement in ovarian tumors require chemotherapy" — Andrea Hayes Jordan (guideline) [Ep 3 · 2:26](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=146)
- "25% of girls with ovarian germ cell tumors will be missed if peritoneal cytology and washings are not performed" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 3:16](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=196)
- "If staging procedures are omitted from the operative report, oncologists will treat ovarian tumors as stage 2" — Andrea Hayes Jordan (clinical) [Ep 3 · 3:54](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=234)
- "Gliomatosis peritonei is a benign disease appearance associated with ovarian teratomas with nearly 100% survival" — Andrea Hayes Jordan (clinical) [Ep 3 · 4:41](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=281)
- "In bilateral ovarian disease, tumors larger than 10 cm should definitely be biopsied" — Andrea Hayes Jordan (guideline) [Ep 3 · 5:37](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=337)
- "If an ovarian tumor is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum" — Dan (clinical) [Ep 3 · 7:11](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=431)
- "15% of ovarian tumors in adolescents are epithelial tumors with different staging criteria than germ cell tumors" — Dan (epidemiological) [Ep 3 · 7:19](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=439)
- "If alpha-fetoprotein and beta-HCG levels are normal preoperatively, there is some comfort about draining a cyst without contamination" — Andrea Hayes Jordan (clinical) [Ep 3 · 8:07](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=487)
- "The salvage rate for recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective" — Dan (clinical) [Ep 3 · 12:15](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=735)
- "Ovarian torsion is an urgent but not emergent situation if the goal is to preserve the ovary" — Andrea Hayes Jordan (guideline) [Ep 3 · 13:40](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=820)
- "Many black-colored ovaries from torsion have viable follicles and ovarian preservation should be the goal" — Andrea Hayes Jordan (clinical) [Ep 3 · 13:40](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=820)
- "76% of ovaries removed for torsion had normal ovarian tissue, only 13% had no ovarian tissue, and only 11% were completely necrotic" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 15:44](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=944)
- "Pain after oophoropexy is usually short-lived and resolves in about a week" — Andrea Hayes Jordan (clinical) [Ep 3 · 16:34](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=994)
- "The ability to preserve ovarian function after torsion is related to age, with pediatric patients having more active follicles than older adults" — Andrea Hayes Jordan (clinical) [Ep 3 · 16:58](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1018)
- "Ultrasound Doppler for ovarian torsion has sensitivity and specificity in the 50-60% range" — Andrea Hayes Jordan (clinical) [Ep 3 · 21:03](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1263)
- "Blood flow on ultrasound does not exclude torsion because the ovary may be twisted but not completely occluded at that moment in time" — Todd Ponsky (host_summary) [Ep 3 · 22:35](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1355)
- "Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdo sarcomas" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 25:58](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1558)
- "Abdominal, pelvic, and retroperitoneal rhabdomyosarcomas have the worst survival while orbital rhabdomyosarcomas have the best survival" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 26:22](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1582)
- "Even small tumors in the extremity or abdomen can only achieve stage 2 at best (not stage 1) in rhabdomyosarcoma staging" — Andrea Hayes Jordan (clinical) [Ep 3 · 27:04](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1624)
- "Surgical extent determines clinical group in rhabdomyosarcoma: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only" — Andrea Hayes Jordan (guideline) [Ep 3 · 27:15](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1635)
- "Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis while group 3 patients do more poorly" — Andrea Hayes Jordan (clinical) [Ep 3 · 27:27](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1647)
- "Inability to resect a large rhabdomyosarcoma is a biologic determination, not a reflection of surgical skill, and aggressive resection with high morbidity will not improve outcome" — Andrea Hayes Jordan (opinion) [Ep 3 · 27:44](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1664)
- "Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas" — Andrea Hayes Jordan (guideline) [Ep 3 · 29:15](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1755)
- "For rhabdomyosarcoma, completion node dissection is not performed for positive sentinel nodes; radiation therapy is given instead" — Andrea Hayes Jordan (guideline) [Ep 3 · 29:31](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1771)
- "Sentinel lymph node mapping for rhabdomyosarcoma should be performed at the time of re-excision if initial excisional biopsy had positive margins" — Andrea Hayes Jordan (guideline) [Ep 3 · 30:10](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1810)
- "40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive" — Andrea Hayes Jordan (epidemiological) [Ep 3 · 30:36](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1836)
- "Histologic grade is now critical in non-rhabdo soft tissue sarcomas, not just the diagnosis" — Andrea Hayes Jordan (guideline) [Ep 3 · 31:00](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1860)
- "Low-grade soft tissue sarcomas require only resection with observation, no chemotherapy or radiation" — Andrea Hayes Jordan (guideline) [Ep 3 · 31:27](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1887)
- "Low-grade soft tissue sarcomas with positive margins receive adjuvant radiation therapy" — Andrea Hayes Jordan (guideline) [Ep 3 · 31:34](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1894)
- "Unresectable soft tissue sarcomas should receive both preoperative radiation and chemotherapy (previously only chemotherapy was recommended)" — Andrea Hayes Jordan (guideline) [Ep 3 · 31:49](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1909)
- "Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma" — Andrea Hayes Jordan (clinical) [Ep 3 · 32:07](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1927)
- "Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, which are primarily treated with surgery and radiation" — Andrea Hayes Jordan (clinical) [Ep 3 · 32:25](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1945)
- "A 5 cm tumor in a child less than 3 years old is equivalent to a 3 cm tumor in a larger patient, so 3 cm should be the cutoff for excision versus biopsy in toddlers" — Andrea Hayes Jordan (clinical) [Ep 3 · 32:51](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=1971)
- "Low-grade non-rhabdo sarcomas with negative margins can be cured with surgery alone without chemotherapy" — Andrea Hayes Jordan (clinical) [Ep 3 · 33:22](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=2002)
- "Core needle biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained" — Andrea Hayes Jordan (guideline) [Ep 3 · 34:07](https://qa.library.globalcastmd.com/watch/ovarian-teratoma-ovarian-torsion-soft-tissue-sarcoma-update-course-2015-672?t=2047)
- "Half of soft tissue sarcomas are rhabdomyosarcomas, and the other half are non-rhabdomyosarcomas." — Andrea (epidemiological) [Ep 4 · 0:00](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=0)
- "Prognosis in rhabdomyosarcoma varies depending on site, with abdominal, pelvic, and retroperitoneal tumors having the worst survival and orbital rhabdomyosarcomas having the best survival." — Andrea (clinical) [Ep 4 · 0:25](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=25)
- "Stage 1 rhabdomyosarcoma includes favorable sites (vaginal and paratesticular), while stages 2, 3, and 4 are unfavorable sites with various amounts of disease." — Andrea (clinical) [Ep 4 · 0:50](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=50)
- "Even a small tumor in the extremity or abdomen can only achieve stage 2 at best." — Andrea (clinical) [Ep 4 · 1:02](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=62)
- "Clinical grouping in rhabdomyosarcoma depends on surgical extent: group 1 is complete removal, group 2 is microscopic residual, and group 3 is biopsy only." — Andrea (clinical) [Ep 4 · 1:14](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=74)
- "Group 1 and 2 rhabdomyosarcoma patients have an excellent prognosis, while group 3 patients do more poorly." — Andrea (clinical) [Ep 4 · 1:30](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=90)
- "A large tumor that a surgeon cannot resect is a biologic determination, and attempting resection with high morbidity will not improve the patient's outcome." — Andrea (opinion) [Ep 4 · 1:45](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=105)
- "Five centimeters is the cutoff for low-risk versus high-risk patients in soft tissue sarcoma." — Andrea (clinical) [Ep 4 · 2:09](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=129)
- "Sentinel lymph node biopsies are now required for all rhabdomyosarcoma patients with trunk or extremity tumors." — Andrea (guideline) [Ep 4 · 3:18](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=198)
- "In rhabdomyosarcoma, completion node dissection is not performed after sentinel lymph node biopsy; patients receive radiation therapy instead." — Andrea (guideline) [Ep 4 · 3:34](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=214)
- "Alveolar rhabdomyosarcoma patients should receive chemotherapy after biopsy, which typically reduces the tumor to approximately 1 centimeter, making resection with negative margins easier." — Andrea (clinical) [Ep 4 · 3:53](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=233)
- "Sentinel lymph node mapping should be performed at the time of re-excision in rhabdomyosarcoma." — Andrea (guideline) [Ep 4 · 4:07](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=247)
- "Forty to fifty percent of biopsied lymph nodes are positive in rhabdomyosarcoma." — Andrea (epidemiological) [Ep 4 · 4:39](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- "Clinically negative lymph nodes may be positive in rhabdomyosarcoma, which is why sentinel node biopsy is performed." — Andrea (clinical) [Ep 4 · 4:39](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- "Positive lymph nodes in rhabdomyosarcoma have a worse prognosis and require radiation therapy." — Andrea (clinical) [Ep 4 · 4:39](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=279)
- "In non-rhabdomyosarcoma soft tissue sarcoma, histological grade is now critical for treatment planning." — Andrea (guideline) [Ep 4 · 4:54](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294)
- "Large soft tissue sarcoma tumors should be biopsied first and treated with chemotherapy before resection." — Andrea (guideline) [Ep 4 · 4:54](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=294)
- "Soft tissue sarcomas have been identified as chemotherapy-sensitive or chemotherapy-insensitive, which changes treatment approach." — Andrea (clinical) [Ep 4 · 5:13](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=313)
- "Low-grade soft tissue sarcoma tumors require only resection and observation, with no need for radiation or chemotherapy." — Andrea (guideline) [Ep 4 · 5:21](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=321)
- "If a low-grade soft tissue sarcoma is resected with positive margins, the patient will receive adjuvant radiation therapy." — Andrea (guideline) [Ep 4 · 5:38](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=338)
- "Unresectable large soft tissue sarcomas should be treated with preoperative radiation therapy and preoperative chemotherapy (previously only chemotherapy was recommended)." — Andrea (guideline) [Ep 4 · 5:52](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=352)
- "Small soft tissue sarcoma tumors less than 5 centimeters should be resected with attempts to achieve negative margins." — Andrea (guideline) [Ep 4 · 6:10](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370)
- "Chemotherapy-sensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma." — Andrea (clinical) [Ep 4 · 6:10](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=370)
- "Chemotherapy-insensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid sarcoma, and clear cell sarcoma, all of which are high-grade tumors." — Andrea (clinical) [Ep 4 · 6:28](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388)
- "For chemotherapy-insensitive soft tissue sarcomas, the surgeon and radiation therapist are the primary treaters." — Andrea (clinical) [Ep 4 · 6:28](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=388)
- "High-risk soft tissue sarcoma patients receive preoperative radiation and chemotherapy." — Andrea (guideline) [Ep 4 · 6:48](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=408)
- "An Italian study showed that a 5 centimeter tumor in a child less than 3 years old is equivalent to a 3 centimeter tumor in larger patients, suggesting 3 centimeters as the cutoff for excision versus biopsy in toddlers." — Andrea (host_summary) [Ep 4 · 6:54](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=414)
- "Sentinel lymph node biopsy should always be performed if lymph nodes are clinically negative by imaging." — Andrea (guideline) [Ep 4 · 7:15](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435)
- "Positive lymph nodes receive radiation to the lymph node basin, and completion node dissection is not required." — Andrea (guideline) [Ep 4 · 7:15](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=435)
- "Non-rhabdomyosarcoma tumors with negative margins after resection do not need chemotherapy if they are low-grade." — Andrea (guideline) [Ep 4 · 7:25](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=445)
- "Chemotherapy-insensitive soft tissue sarcomas require aggressive surgical extirpation as much as possible." — Andrea (guideline) [Ep 4 · 7:37](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=457)
- "Core biopsies are acceptable for soft tissue sarcoma diagnosis if 3 or 4 good cores that are not necrotic are obtained, with the pathologist checking the core before the interventional radiologist finishes." — Andrea (clinical) [Ep 4 · 8:10](https://qa.library.globalcastmd.com/watch/soft-tissue-sarcoma-rapid-fire-update-course-2015-980?t=490)
- "80% of ovarian masses in children are teratomas" — Andrea Hayes-Jordan (epidemiological) [Ep 5 · 0:37](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=37)
- "By the year 2000, girls with ovarian germ cell tumors have almost 100% survival" — Andrea Hayes-Jordan (epidemiological) [Ep 5 · 1:03](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=63)
- "Stage 1 ovarian germ cell tumors (limited to ovary) now receive only oophorectomy without chemotherapy" — Andrea Hayes-Jordan (guideline) [Ep 5 · 1:22](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=82)
- "Peritoneal cytology/washings will miss approximately 25% of girls with disease if not performed" — Andrea Hayes-Jordan (clinical) [Ep 5 · 2:28](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=148)
- "If staging procedures are omitted from the operative report, oncologists will treat the patient as stage 2" — Andrea Hayes-Jordan (clinical) [Ep 5 · 3:06](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=186)
- "Gliomatosis peritonei is a benign disease with 100% survival, typically associated with ovarian teratomas" — Andrea Hayes-Jordan (clinical) [Ep 5 · 3:53](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=233)
- "For bilateral ovarian disease, tumors larger than 10 centimeters should be biopsied, with lower threshold for bilateral oophorectomy on first operation" — Andrea Hayes-Jordan (clinical) [Ep 5 · 4:38](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=278)
- "15% of ovarian tumors in the teenage age range are actually epithelial tumors with different staging criteria than germ cell tumors" — Dan (epidemiological) [Ep 5 · 6:31](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=391)
- "If a presumed teratoma is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum" — Dan (clinical) [Ep 5 · 6:12](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=372)
- "If preoperative AFP and beta-HCG levels are normal, there is increased comfort (though not 100%) about draining a cystic ovarian mass" — Andrea Hayes-Jordan (clinical) [Ep 5 · 7:18](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=438)
- "The salvage rate for patients with recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective" — Dan (clinical) [Ep 5 · 11:28](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=688)
- "Ovarian torsion should be considered an urgent rather than emergent situation if the goal is ovarian preservation" — Andrea Hayes-Jordan (clinical) [Ep 5 · 12:52](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=772)
- "Many black-colored ovaries from torsion actually contain viable follicles and ovarian preservation should be the goal" — Andrea Hayes-Jordan (clinical) [Ep 5 · 13:25](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=805)
- "76% of ovaries removed for torsion (that surgeons judged to be dead) contained normal ovarian tissue on pathology; only 11% were completely necrotic" — Andrea Hayes-Jordan (clinical) [Ep 5 · 14:56](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=896)
- "The ability to preserve ovarian function after torsion is related to patient age, with pediatric patients having more active follicles than older adults" — Andrea Hayes-Jordan (clinical) [Ep 5 · 16:10](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=970)
- "The current recommendation is detorsion without complete oophorectomy for ovarian torsion" — Andrea Hayes-Jordan (guideline) [Ep 5 · 17:17](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1037)
- "Ultrasound Doppler has only 50-60% sensitivity and specificity for diagnosing ovarian torsion" — Andrea Hayes-Jordan (clinical) [Ep 5 · 20:10](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1210)
- "Good blood flow on ultrasound does not rule out torsion because the ovary may be intermittently twisted" — Todd Ponsky (host_summary) [Ep 5 · 21:50](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1310)
- "Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdomyosarcomas" — Andrea Hayes-Jordan (epidemiological) [Ep 5 · 25:10](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1510)
- "In rhabdomyosarcoma, prognosis varies by site, with abdominal/pelvic/retroperitoneal tumors having the worst survival and orbital tumors having the best" — Andrea Hayes-Jordan (clinical) [Ep 5 · 25:27](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1527)
- "The surgeon determines the clinical group in rhabdomyosarcoma based on surgical extent: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only" — Andrea Hayes-Jordan (clinical) [Ep 5 · 26:27](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1587)
- "Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis; group 3 patients do more poorly" — Andrea Hayes-Jordan (clinical) [Ep 5 · 26:39](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1599)
- "Attempting to resect a large unresectable rhabdomyosarcoma with high morbidity will not improve the patient's outcome; this is a biologic determination, not a reflection of surgical skill" — Andrea Hayes-Jordan (opinion) [Ep 5 · 27:01](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1621)
- "A 4-centimeter mass in the forearm of a 5-year-old is relatively huge and should probably be biopsied rather than resected initially" — Andrea Hayes-Jordan (clinical) [Ep 5 · 28:08](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1688)
- "Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas" — Andrea Hayes-Jordan (guideline) [Ep 5 · 28:27](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1707)
- "For rhabdomyosarcoma, completion lymph node dissection is not performed for positive sentinel nodes; patients receive radiation therapy instead" — Andrea Hayes-Jordan (guideline) [Ep 5 · 28:43](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1723)
- "40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive" — Andrea Hayes-Jordan (epidemiological) [Ep 5 · 29:48](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1788)
- "For non-rhabdomyosarcoma soft tissue sarcomas, histologic grade is now critical and determines treatment" — Andrea Hayes-Jordan (guideline) [Ep 5 · 30:03](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1803)
- "Low-grade soft tissue sarcomas require only resection and observation; no chemotherapy or radiation unless margins are positive" — Andrea Hayes-Jordan (guideline) [Ep 5 · 30:39](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1839)
- "For unresectable soft tissue sarcomas, preoperative radiation therapy and chemotherapy are now recommended (previously only chemotherapy)" — Andrea Hayes-Jordan (guideline) [Ep 5 · 31:01](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1861)
- "Chemosensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma" — Andrea Hayes-Jordan (clinical) [Ep 5 · 31:19](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1879)
- "Chemoinsensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid, and clear cell sarcoma; surgery and radiation are the primary treatments" — Andrea Hayes-Jordan (clinical) [Ep 5 · 31:37](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1897)
- "A 5-centimeter tumor in a child less than 3 years old is equivalent to a 3-centimeter tumor in a larger patient, so 3 centimeters should be the cutoff for excision in toddlers" — Andrea Hayes-Jordan (clinical) [Ep 5 · 32:03](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1923)
- "Low-grade non-rhabdomyosarcoma soft tissue sarcomas with negative margins can be cured with surgery alone and do not need chemotherapy" — Andrea Hayes-Jordan (clinical) [Ep 5 · 32:34](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1954)
- "Core biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained, confirmed by pathologist during the procedure" — Andrea Hayes-Jordan (clinical) [Ep 5 · 33:19](https://qa.library.globalcastmd.com/watch/compiled-hayes-jordan-rapid-fire-sessions-update-course-2015-995?t=1999)
- "The patient was an 11-year-old boy from a particular area of Chile with right pulmonary hydatid cyst occupying the entire right thorax." — Marco (clinical) [Ep 6 · 0:00](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=0)
- "Initial thoracoscopic approach was attempted but was impossible due to the size of the cyst." — Marco (clinical) [Ep 6 · 0:26](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=26)
- "After a month, eight bronchial fistulas were treated through mini-thoracotomy." — Marco (clinical) [Ep 6 · 1:10](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=70)
- "A second thoracoscopic procedure was performed to address the residual cavity, using experience from esophageal atresia cases to judge available space." — Marco (clinical) [Ep 6 · 1:39](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=99)
- "Only one port was used during the second thoracoscopic procedure because the tissue was highly inflamed and the surgeon did not want to damage too much parenchyma." — Marco (clinical) [Ep 6 · 3:12](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=192)
- "Intraoperative bleeding occurred during closure of the last fistula due to limited room and instrument depth, controlled by compression with the needle driver." — Marco (clinical) [Ep 6 · 3:51](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=231)
- "A small piece of Surgicel was placed in the fistula and closed with PDS suture." — Marco (clinical) [Ep 6 · 4:03](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=243)
- "Patient was discharged 5 days after surgery with no complications and no pneumothorax after chest drain removal." — Marco (clinical) [Ep 6 · 7:22](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=442)
- "At 3 months postoperative, the patient is doing well." — Marco (clinical) [Ep 6 · 7:53](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=473)
- "Yama believes the entire mucosa should be removed rather than suturing from the inside, and predicts recurrence with the suturing approach." — Marco (opinion) [Ep 6 · 8:12](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=492)
- "Yama would perform bronchoscopy to identify the involved segment, then thoracotomy (not thoracoscopy) in conjunction with intraoperative bronchoscopy for a patient with multiple prior operations." — Marco (opinion) [Ep 6 · 8:36](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=516)
- "Alan suggests the intracavitary approach might be useful for treating pneumatoceles, recalling a case where he inadvertently entered a large pneumatocele with the camera and identified a discrete bronchopleural fistula that could be addressed." — Alan (opinion) [Ep 6 · 9:47](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=587)
- "Hydatid cyst is very common in the southern part of Argentina and is a parasitosis not commonly seen in first-world countries." — Marcello (epidemiological) [Ep 6 · 10:23](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=623)
- "Marcello's group was the first to perform hydatid cyst removal thoracoscopically from the beginning." — Marcello (clinical) [Ep 6 · 12:06](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=726)
- "The key to hydatid cyst surgery is removing the white parasitic membrane inside the lung; there is usually a good plane between the lung and the cyst." — Marcello (clinical) [Ep 6 · 12:06](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=726)
- "After membrane removal, bronchi from the lung will always show some bubbling, and these small holes should be carefully identified and sutured during the first surgery when tissues are not yet friable or bleeding." — Marcello (clinical) [Ep 6 · 12:33](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=753)
- "Marcello believes Marco's patient had a very good result because once the parasitic membrane is removed in the first surgery, the patient is cured; the remaining issue is only closing the fistulas." — Marcello (opinion) [Ep 6 · 13:06](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=786)
- "Marco attempted the first surgery thoracoscopically but all lung tissue was fixed to the thoracic wall, necessitating conversion to mini-thoracotomy for the standard procedure." — Marco (clinical) [Ep 6 · 13:34](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=814)
- "The situation with hydatid cyst bronchial fistulas is very similar to bronchial fistulas after staphylococcal pneumonia and empyema." — Liam (clinical) [Ep 6 · 14:30](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=870)
- "Liam always performs thoracoscopy to remove the membrane and allow lung expansion, which is very important for fistula healing." — Liam (clinical) [Ep 6 · 14:45](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=885)
- "Marco believes the intracavitary suturing technique works because the fistula size was small; he would not try this technique for a huge fistula." — Marco (opinion) [Ep 6 · 15:11](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=911)
- "Yama uses Hem-o-lok clips and finds them more reliable compared to metal clips." — Todd (host_summary) [Ep 6 · 18:28](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1108)
- "Liam uses Hem-o-lok, but if the bronchus diameter is bigger than 5 mm, he performs interrupted suture closure and is pleased with that approach." — Liam (clinical) [Ep 6 · 18:41](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1121)
- "Marcello's group has used Hem-o-lok for at least 10 years for esophageal atresia and all lung lobectomies with no problems." — Marcello (clinical) [Ep 6 · 19:05](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1145)
- "Hem-o-lok clips come in three sizes; the large size with a 10-mm plier can take very wide and large bronchi." — Marcello (clinical) [Ep 6 · 19:21](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1161)
- "Marcello's group uses Hem-o-lok in patients over 7 years old for lobectomy, applying a proximal clip when the ligature alone is not enough for a large vessel, avoiding stapler use for a single vessel." — Marcello (clinical) [Ep 6 · 19:31](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1171)
- "Marcello describes Hem-o-lok as 'a mechanical suture of the third world countries' because it is cheap and not as expensive as staplers, which are very expensive in resource-limited settings." — Marcello (opinion) [Ep 6 · 20:00](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1200)
- "Alan has performed one recurrent lobectomy and found it easier than expected." — Alan (clinical) [Ep 6 · 16:59](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1019)
- "Alan has not experienced persistent air leaks lasting more than a few days maximum in infant lobectomies with incomplete fissures." — Alan (clinical) [Ep 6 · 21:22](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1282)
- "Alan worries about tissue sealant including the chest tube and has not used it in infant lobectomies because he has not needed it." — Alan (opinion) [Ep 6 · 21:38](https://qa.library.globalcastmd.com/watch/difficult-cases-of-lung-lesions-pediatric-thoracic-surgery-part-1-lung-1085?t=1298)
- "In the Petcova et al. study published in Annals of Surgery 2020, children with uncomplicated appendicitis were randomized to medical management with antibiotics or surgery, with 5-year follow-up." — Ellen Encisco (host_summary) [Ep 10 · 0:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=43)
- "In the Petcova et al. appendicitis study, the surgery group had no complications, while 46% of patients in the non-surgical management group required appendectomy during follow-up." (host_summary) [Ep 10 · 1:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=71)
- "Medical management of acute uncomplicated appendicitis may be safe but is associated with a high failure rate, with many children ultimately requiring laparoscopic appendectomy." — Ellen Encisco (host_summary) [Ep 10 · 1:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=82)
- "Metastectomy for osteosarcoma lung metastases improves survival and can make patients long-term survivors." (host_summary) [Ep 10 · 2:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=135)
- "Approximately 10% of 1 millimeter lung nodules in osteosarcoma patients contain malignant disease." (host_summary) [Ep 10 · 2:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=144)
- "The Children's Oncology Group is starting a study to determine whether thoracotomy or thoracoscopy is superior for resection of pulmonary metastases in osteosarcoma, with enrollment expected late 2021 or early 2022." (host_summary) [Ep 10 · 2:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=160)
- "The Flourish device is a catheter-based device that places magnets in proximal and distal esophageal pouches to create a compression anastomosis by causing ischemia of tissue between the magnets, which then sloughs off." (host_summary) [Ep 10 · 3:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=196)
- "Inclusion criteria for the Flourish device are: atretic gap less than 4 centimeters long, fistula repaired or absent, and G-tube able to accommodate an 18 French catheter." (host_summary) [Ep 10 · 3:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=219)
- "The Flourish device is associated with a high stricture rate and known serious life-threatening complications, and should only be used by centers with capabilities to treat the many issues associated with esophageal atresia." (host_summary) [Ep 10 · 3:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=237)
- "Indocyanine green (ICG) has become a topic of interest in the last few years for use in pediatric surgery, especially in minimally invasive procedures to improve visualization of structures." — Ellen Encisco (host_summary) [Ep 10 · 4:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=283)
- "For laparoscopic cholecystectomy, ICG must be administered intravenously 12 to 18 hours prior to surgery to allow time for accumulation in the extrahepatic ducts, or can be injected directly into the gallbladder during surgery." — Ellen Encisco (host_summary) [Ep 10 · 5:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=332)
- "ICG applications in pediatric surgery include laparoscopic cholecystectomies, varicocele repairs, partial nephrectomies, and tumor excisions." — Ellen Encisco (host_summary) [Ep 10 · 5:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=348)
- "For anorectal malformations with rectal-perineal or rectal-vestibular fistula, outcomes including complications are similar whether the procedure is done before or after 14 days of life." (host_summary) [Ep 10 · 6:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=397)
- "A PCPLC consortium study comparing endorectal pull-through for Hirschsprung disease at less than 31 days versus greater than 31 days found that preoperative enterocolitis, postoperative enterocolitis, constipation, and incontinence were the same between both groups." (host_summary) [Ep 10 · 6:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=414)
- "Delayed pull-through with irrigations is a safe alternative to an operation in the neonatal period for Hirschsprung disease." (host_summary) [Ep 10 · 7:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=434)
- "Cryoanalgesia is probably effective at improving post-operative pain and decreasing length of stay for pectus patients, with length of stay reduced from 4 days to 1 day." (host_summary) [Ep 10 · 8:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=491)
- "There are no long-term studies on the effects of cryoanalgesia for pectus repair." (host_summary) [Ep 10 · 8:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=514)
- "The double rim sign or halo sign on X-ray indicates a child has swallowed a button battery rather than a coin." — Ellen Encisco (host_summary) [Ep 10 · 9:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=588)
- "The main goal of button battery ingestion treatment is to remove the battery within 2 hours of ingestion." — Ellen Encisco (host_summary) [Ep 10 · 10:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=613)
- "Sucralfate or honey can help reduce damage from button batteries on the child's esophagus as temporizing measures." — Ellen Encisco (host_summary) [Ep 10 · 10:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=620)
- "Children less than 1 year old should not receive honey due to risk of botulism and should instead receive 10 mL of sucralfate every 10 minutes for up to 3 doses for button battery ingestion." — Ellen Encisco (host_summary) [Ep 10 · 10:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=635)
- "Children over age 1 with button battery ingestion should receive honey 10 mL every 10 minutes for up to 6 doses." — Ellen Encisco (host_summary) [Ep 10 · 10:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=651)
- "New ATLS recommendations for pediatric trauma patients in hemorrhagic shock call for earlier transfusion: after 1 bolus of 20 cc per kilogram of crystalloid fluid, blood should be given." (host_summary) [Ep 10 · 11:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=688)
- "Balanced transfusion protocol for pediatric hemorrhagic shock typically includes 10 to 20 mLs per kilogram of packed red blood cells, plus inclusion of FFP and platelets." (host_summary) [Ep 10 · 11:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=698)
- "Earlier transfusion in pediatric trauma was associated with shorter median time to transfusion and a decrease in total fluid volume administered." (host_summary) [Ep 10 · 11:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=706)
- "Whole blood in trauma patients requires less volume compared to component therapy." (host_summary) [Ep 10 · 11:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=719)
- "Research shows that observation of spontaneous pneumothorax in adults is non-inferior to immediate intervention with tube thoracostomy." (host_summary) [Ep 10 · 12:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=762)
- "The Midwest Pediatric Surgery Consortium study on spontaneous pneumothorax management with simple aspiration showed 48% success rate, but 44% of patients in the simple aspiration group recurred." (host_summary) [Ep 10 · 12:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=773)
- "83% of patients who failed simple aspiration for spontaneous pneumothorax ultimately ended up with VATS or blebectomy." (host_summary) [Ep 10 · 13:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=796)
- "Greenwood et al. showed that mortality amongst black newborns is 3 times that of white newborns." — Ellen Encisco (host_summary) [Ep 10 · 14:10](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=850)
- "When black newborns are treated by black physicians, their mortality is reduced by 58% compared to black newborns treated by white physicians." — Ellen Encisco (host_summary) [Ep 10 · 14:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=859)
- "Bias exists within medicine and can change outcomes; representation matters and can make a difference." — Ellen Encisco (host_summary) [Ep 10 · 14:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-2021-top-ten-key-takeaways-4578?t=870)
- "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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 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 9 · 43:32](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2612)
- "Point-of-care ultrasound for intussusception diagnosis achieved 95% sensitivity and 99% specificity in a 2019 American Journal of Emergency Medicine study." — Rod Gerardo (host_summary) [Ep 11 · 2:12](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=132)
- "High-volume centers where non-radiologists (surgeons or ED physicians) perform frequent ultrasounds can achieve good diagnostic results for intussusception." — Todd Ponsky (opinion) [Ep 11 · 2:52](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=172)
- "It would be irresponsible for institutions to adopt POCUS for intussusception based solely on this study without adequate training and volume." — Todd Ponsky (opinion) [Ep 11 · 3:50](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=230)
- "Ultrasound-guided hydrostatic reduction had 95.8% success rate versus 93.1% for fluoroscopy-guided air reduction in a 2021 World Journal of Emergency Surgery study from China." — Rod Gerardo (host_summary) [Ep 11 · 5:08](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=308)
- "The 2% difference in success rates between hydrostatic and air reduction is not clinically significant enough to justify changing established practice." — Ellen Encisco (opinion) [Ep 11 · 6:04](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=364)
- "The hydrostatic versus air reduction study validates an alternative reduction method showing at least equivalent results." — Todd Ponsky (opinion) [Ep 11 · 6:04](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=364)
- "Obstructive bowel gas pattern on radiograph is associated with decreased air enema success and increased need for surgical bowel resection in a 2020 Pediatric Radiology study." — Rod Gerardo (host_summary) [Ep 11 · 7:20](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=440)
- "A 2018 Journal of Pediatric Surgery prediction model using clinical and sonographic data (free fluid, extension beyond splenic flexure, altered Doppler) identified 80% of failed saline enema reductions before the procedure." — Rod Gerardo (host_summary) [Ep 11 · 8:29](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=509)
- "Sedation for pneumatic reduction showed slightly better success rate but higher recurrence rate (5.1% vs 1.3%, non-significant) and more perforations (3 vs 0, non-significant) in a 2017 Pediatric Anesthesia study." — Ellen Encisco (host_summary) [Ep 11 · 9:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=594)
- "S-ketamine sedation versus morphine analgesia showed non-significant differences in success rate (90% vs 70%) and recurrence (10% vs 15%) with no perforations in either group." — Rod Gerardo (host_summary) [Ep 11 · 10:59](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=659)
- "If sedation shows no increased perforation risk compared to no sedation, then sedating children for comfort during reduction is justified." — Ellen Encisco (opinion) [Ep 11 · 11:47](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=707)
- "A 2019 JPS systematic review and meta-analysis of 10 studies found no significant difference in ED returns, recurrence, need for operation, or mortality between inpatient and outpatient management after successful air enema reduction." — Rod Gerardo (host_summary) [Ep 11 · 12:48](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=768)
- "COVID-era hospital bed and staff scarcity is forcing reconsideration of routine admission practices, and intussusception is an example where evidence supports not admitting by default." — Todd Ponsky (opinion) [Ep 11 · 13:46](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=826)
- "A 2020 Journal of Pediatric Surgery database study of 8,289 patients found 3.7% readmission and recurrence rate after intussusception reduction." — Rod Gerardo (host_summary) [Ep 11 · 14:55](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=895)
- "A 2020 Pediatric Emergency Care study of 200 cases found 13.5% overall recurrence rate with 7.3% recurring within 48 hours, with fever and female sex as risk factors for early recurrence." — Todd Ponsky (host_summary) [Ep 11 · 15:31](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=931)
- "Both recent studies show lower recurrence rates (3.7-13.5%) than the traditionally quoted 15-20% that surgeons have been telling families." — Ellen Encisco (clinical) [Ep 11 · 16:17](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=977)
- "Increasing tolerance for recurrence risk benefits the vast majority of children by avoiding unnecessary admission and its associated complications." — Ellen Encisco (opinion) [Ep 11 · 16:59](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=1019)
- "In resource-limited settings without 24-hour radiology, unnecessary laparotomies are sometimes performed for intussusception diagnosis in the middle of the night." — Ellen Encisco (clinical) [Ep 11 · 3:14](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=194)
- "Standard practice in many US institutions is to admit intussusception patients overnight and discharge the next morning, not keep them for 48 hours." — Todd Ponsky (clinical) [Ep 11 · 16:50](https://qa.library.globalcastmd.com/watch/case-based-journal-review-intussusception-in-2022-5092?t=1010)
- "Most children with prenatally diagnosed CPAM are born asymptomatic" (clinical) [Ep 12 · 1:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=104)
- "A 2017 prospective study in Archives of Disease in Childhood followed 119 prenatally diagnosed congenital cystic lung lesions for a median of 10 years" — Rod Gerardo (host_summary) [Ep 12 · 2:00](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=120)
- "57% (68 patients) of the 119 cases were managed conservatively, and none of those who could be followed up became symptomatic" — Ellen Encisco (host_summary) [Ep 12 · 2:38](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=158)
- "Respiratory compromise at birth in CPAM is very unusual; the speaker has not seen it in 20 years" (clinical) [Ep 12 · 2:49](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=169)
- "The 2017 study is the only completely prospective study on CPAM natural history and the only one dealing with long-term follow-up" — Jose Campos (clinical) [Ep 12 · 3:13](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=193)
- "Retrospective studies show a huge range of 3-85% for risk of becoming symptomatic, but systematic reviews narrow this to 3.2% in one review and 25% in another" — Jose Campos (host_summary) [Ep 12 · 3:32](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=212)
- "A 2021 Pediatrics study by the Midwest Pediatric Surgery Consortium retrospectively examined histology of 521 lung lesions resected across 11 children's hospitals" — Rod Gerardo (host_summary) [Ep 12 · 4:04](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=244)
- "Out of 344 prenatally diagnosed lesions, none had malignant pathology when resected" — Ellen Encisco (host_summary) [Ep 12 · 4:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=276)
- "Of 177 children with postnatal diagnosis of CPAM, 15 (8.7%) were classified as having a malignant tumor" — Rod Gerardo (host_summary) [Ep 12 · 4:47](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=287)
- "The risk of malignancy approached 10% for lung masses diagnosed postnatally" — Ellen Encisco (host_summary) [Ep 12 · 5:03](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=303)
- "For prenatally diagnosed asymptomatic CPAM, Dr. Campos would find it very difficult to recommend operation; for postnatally diagnosed lesions, very difficult not to operate" — Jose Campos (opinion) [Ep 12 · 5:21](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=321)
- "Prenatal CPAM (0% malignancy) and postnatal CPAM (10% malignancy) represent two different populations or diseases" (clinical) [Ep 12 · 5:37](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=337)
- "The International Pleuropulmonary Blastoma Registry has 350 cases reported worldwide and has found only 9 cases of prenatally diagnosed lesions that turned out to be pleuropulmonary blastoma" — Jose Campos (host_summary) [Ep 12 · 5:49](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=349)
- "Common practice in Chile is to resect prenatally diagnosed CPAMs, but after reviewing the literature, the academic discussion at Dr. Campos's hospital now leans toward not operating" — Jose Campos (clinical) [Ep 12 · 6:16](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=376)
- "A 2021 Journal of Pediatric Surgery study examined whether previous infection matters for thoracoscopic surgery outcomes in congenital lung malformations" — Rod Gerardo (host_summary) [Ep 12 · 6:53](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=413)
- "The study was retrospective and looked at about 90 patients undergoing thoracoscopic lung resections" — Ellen Encisco (host_summary) [Ep 12 · 7:08](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=428)
- "Patients without prior pulmonary infection had shorter operative time, fewer postoperative fevers, less need for postoperative antibiotics, but no significant difference in postoperative complications or conversion rates" — Rod Gerardo (host_summary) [Ep 12 · 7:18](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=438)
- "After infection, there is a higher rate of conversion from thoracoscopy to open surgery" — Jose Campos (host_summary) [Ep 12 · 8:17](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=497)
- "The number of patients who will have an infection is so low that the benefit of lesser conversion rate does not justify preemptive surgery in all cases" — Jose Campos (opinion) [Ep 12 · 8:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=505)
- "If you only operate on lesions that get infected, you will miss those that develop pleuropulmonary blastoma without a pre-existing infection" (clinical) [Ep 12 · 8:38](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=518)
- "Screening everyone and removing every lung lesion results in many unnecessary lobectomies in a group with very low rate of problems" (opinion) [Ep 12 · 8:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=524)
- "A 2018 Journal of Pediatric Surgery study examined optimal timing for elective resection of asymptomatic CPAM, dividing patients under 1 year into three groups: 1-3 months, 4-6 months, and 6-12 months" — Rod Gerardo (host_summary) [Ep 12 · 9:12](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=552)
- "Operative time increased with each increase in age; at younger ages the tissue planes are easier to dissect" — Rod Gerardo (host_summary) [Ep 12 · 9:39](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=579)
- "The 1-3 month group had the shortest operative time at 115 minutes compared to 163 minutes in the 6-12 month group" — Rod Gerardo (host_summary) [Ep 12 · 9:50](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=590)
- "There were no differences in major complications, conversion rates, or readmissions between the three age groups" — Ellen Encisco (host_summary) [Ep 12 · 10:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=607)
- "The 1-3 month group had a 40% thoracotomy rate, suggesting the outcome depends on surgeon expertise in performing safe thoracoscopy" — Jose Campos (clinical) [Ep 12 · 10:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=625)
- "Kansas City showed that complication rate of operating on perforated appendix with abscess is the same as interval appendectomy, analogous to the CPAM timing question" (host_summary) [Ep 12 · 10:42](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=642)
- "Even if complication rates are the same, surgeons generally prefer to do cases that are easier and less stressful" (opinion) [Ep 12 · 10:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=654)
- "Elective preventive resection should be easy and have nearly zero complications; prophylactic operations should be close to zero complications" — Jose Campos (opinion) [Ep 12 · 11:06](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cpam-in-2022-5319?t=666)
- "The azygous vein drains the bronchi, trachea, and esophagus, and its division may lead to impaired function postoperatively and impaired clearance of mucus and debris from the tracheobronchial tree" — Jose Campos (host_summary) [Ep 14 · 3:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=205)
- "In a meta-analysis of almost 700 neonates, preserving the azygous vein resulted in significantly lower postoperative pneumonitis compared to division" — Ellen Encisco (host_summary) [Ep 14 · 3:02](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=182)
- "There was no significant difference in anastomotic leak rate or stricture rate between azygous vein preservation and division" — Ellen Encisco (host_summary) [Ep 14 · 3:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=191)
- "The endpoint of chest infection in the azygous vein meta-analysis was not clearly defined across studies—some used 'chest infection,' some 'pneumonitis,' some 'pneumonia'—making it a non-homogeneous endpoint" — Jose Campos (clinical) [Ep 14 · 4:45](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=285)
- "In the Quebec study of 244 patients, the overall anastomotic stricture rate at one year was 30%" — Ellen Encisco (host_summary) [Ep 14 · 6:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=403)
- "36% of patients with transanastomotic tubes developed strictures compared to 19% without tubes, a difference that remained significant after multivariable analysis" — Ellen Encisco (host_summary) [Ep 14 · 6:50](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=410)
- "Patients with transanastomotic tubes had 2.72 times higher odds of developing a stricture compared to those without" — Ellen Encisco (host_summary) [Ep 14 · 7:06](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=426)
- "The Quebec study adjusted for gestational age, leak, length of gap, and tension, and still found almost 3 times higher stricture rates with transanastomotic tubes" — Jose Campos (host_summary) [Ep 14 · 7:32](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=452)
- "Patients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups" — Em Gootee (host_summary) [Ep 14 · 7:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=474)
- "Congenital esophageal stenosis is associated with esophageal atresia in 7% to 10% of cases and most are diagnosed really late, sometimes after the anastomosis fails" — Jose Campos (epidemiological) [Ep 14 · 9:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=584)
- "Passing a tube through the anastomosis to check for resistance can help identify distal esophageal stenosis intraoperatively" — Jose Campos (clinical) [Ep 14 · 9:58](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=598)
- "In a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed" — Em Gootee (host_summary) [Ep 14 · 12:20](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=740)
- "The group that received a chest drain had a significantly higher chance of returning to the operating room" — Em Gootee (host_summary) [Ep 14 · 12:31](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=751)
- "If a leak occurs, it doesn't always drain through the chest tube" — Todd Ponsky (clinical) [Ep 14 · 11:23](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=683)
- "A chest tube may injure, suck on, or increase the chance of disruption of the anastomosis" — Todd Ponsky (opinion) [Ep 14 · 11:30](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=690)
- "Chest tubes are painful for patients" — Todd Ponsky (clinical) [Ep 14 · 11:39](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=699)
- "Giving acid suppression to neonates increases the risk of necrotizing enterocolitis according to neonatologists' concerns" — Todd Ponsky (host_summary) [Ep 14 · 13:41](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=821)
- "Giving PPIs to neonates can increase pneumonia in different populations, but the risk is very minimal" — Jose Campos (clinical) [Ep 14 · 14:24](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=864)
- "In the Midwest Pediatric Surgery Consortium study, antibiotics for more than 24 hours and acid suppression showed no difference in strictures or leaks" — Ellen Encisco (host_summary) [Ep 14 · 14:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=894)
- "Not giving antibiotics postoperatively helps detect complications early rather than having antibiotics cover a complication" — Jose Campos (clinical) [Ep 14 · 14:10](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=850)
- "About 20% of osteosarcoma patients already have lung metastases by the time of diagnosis, usually picked up on staging chest CT." — Rod Gerardo (host_summary) [Ep 15 · 1:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=89)
- "About 40% of patients can achieve a durable cure response after 5 years with complete metastatic site clearance." — Roshni Dasgupta (clinical) [Ep 15 · 2:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=128)
- "Complete surgical resection of all metastatic tumor sites is an independent positive prognostic factor and affects overall survival, not just disease recurrence." — Roshni Dasgupta (clinical) [Ep 15 · 2:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=143)
- "In patients with metastatic osteosarcoma, even 1-millimeter nodules can contain malignant disease in about 60% of cases." — Roshni Dasgupta (clinical) [Ep 15 · 2:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=155)
- "The bigger the nodule is, the more likely it contains malignancy, but all the way down to 1 millimeter, tumor can be found." — Roshni Dasgupta (clinical) [Ep 15 · 2:47](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=167)
- "Thoracotomy has historically been standard of care because surgeons can use fingers and hands to feel tiny nodules." — Roshni Dasgupta (clinical) [Ep 15 · 3:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=193)
- "Manual palpation during thoracotomy finds about 30 to 40% more lung nodules than are detected on CT scan, even with thin-cut CT scans." — Roshni Dasgupta (clinical) [Ep 15 · 3:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=199)
- "ICG can be used with thoracotomy to find deeper nodules, though depth of penetration is a limitation." — Roshni Dasgupta (clinical) [Ep 15 · 3:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=230)
- "It is uncertain whether removing tiny 1-millimeter nodules actually provides a survival advantage." — Roshni Dasgupta (opinion) [Ep 15 · 4:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=255)
- "VATS is minimally invasive with shorter length of stay, and repeat thoracoscopy typically encounters fewer adhesions compared to repeat thoracotomy." — Roshni Dasgupta (clinical) [Ep 15 · 4:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=281)
- "VATS often requires some sort of localization process and good interventional radiology support." — Roshni Dasgupta (clinical) [Ep 15 · 4:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=298)
- "With thoracotomy, surgeons can typically remove 15 to 20 nodules, but with thoracoscopy the number is more limited." — Rod Gerardo (host_summary) [Ep 15 · 5:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=303)
- "A multi-institution study of 200 patients with metastatic osteosarcoma—the largest study ever done—compared outcomes between open resection and thoracoscopy." — Rod Gerardo (host_summary) [Ep 15 · 5:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=323)
- "In oligometastatic disease (patients with fewer than 4 nodules on each side), there was no difference in mortality between open resection and thoracoscopy." — Roshni Dasgupta (clinical) [Ep 15 · 5:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=334)
- "The survival curves for thoracotomy and thoracoscopy in oligometastatic disease are essentially identical, meaning the optimal operation is unknown." — Roshni Dasgupta (clinical) [Ep 15 · 5:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=344)
- "The multi-institution study had significant selection bias and institutional selection bias, with patients unlikely to receive thoracoscopy if they had many nodules." — Roshni Dasgupta (epidemiological) [Ep 15 · 6:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=363)
- "Metastatic disease is typically addressed after 4 cycles of chemotherapy, and residual nodules at that point are unlikely to change with additional chemotherapy." — Roshni Dasgupta (clinical) [Ep 15 · 6:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=394)
- "Practice for bilateral lung metastases is highly varied, with options including median sternotomy, staged thoracotomies, or bilateral thoracoscopies." — Roshni Dasgupta (clinical) [Ep 15 · 7:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=422)
- "Most practitioners perform staged procedures for bilateral disease, particularly with thoracotomy, typically 4 to 6 weeks apart to allow a cycle of chemotherapy in between." — Roshni Dasgupta (clinical) [Ep 15 · 7:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=433)
- "Dr. Rothenberg's institution reported almost 20 years ago that survival didn't change when there were only 3 to 4 nodules per side." — Steven Rothenberg (clinical) [Ep 15 · 7:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=449)
- "Because osteosarcoma is a systemic disease, the argument that manual palpation is necessary would logically require bilateral thoracotomy, not unilateral." — Steven Rothenberg (opinion) [Ep 15 · 7:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=472)
- "Even with the best CTs, only 1 to 2 millimeter nodules can be visualized, and some are still missed." — Steven Rothenberg (clinical) [Ep 15 · 8:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=482)
- "There are nodules that can be felt but not seen, and nodules that cannot be felt at all." — Steven Rothenberg (clinical) [Ep 15 · 8:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=485)
- "Dr. Rothenberg's practice is to use thoracoscopy when there are only 3 to 4 nodules per side that are amenable to thoracoscopic resection, in order to reduce morbidity." — Steven Rothenberg (clinical) [Ep 15 · 8:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=492)
- "For bilateral oligometastatic disease, Dr. Rothenberg performs bilateral thoracoscopy." — Steven Rothenberg (clinical) [Ep 15 · 8:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=503)
- "Non-surgical methods such as CyberKnife using fiducials to localize and ablate lesions may be a future approach for lung metastases." — Todd Ponsky (opinion) [Ep 15 · 8:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=523)
- "The Children's Oncology Group is starting a study to answer the question of thoracotomy versus VATS, with enrollment expected to begin late 2021 or early 2022." — Todd Ponsky (guideline) [Ep 15 · 8:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-thoracotomy-vs-vats-for-lung-metastases-5632?t=536)
- "Osteosarcoma most commonly affects adolescents and young adults" — Bailey Roberts (epidemiological) [Ep 17 · 1:08](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=68)
- "Gross metastasis at the time of diagnosis is present about 20% of the time in osteosarcoma" — Bailey Roberts (epidemiological) [Ep 17 · 1:11](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=71)
- "The most common site of metastasis in osteosarcoma is in the lung" — Bailey Roberts (clinical) [Ep 17 · 1:11](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=71)
- "Overall survival in osteosarcoma worsens from 80% to about 20% for metastatic disease" — Bailey Roberts (epidemiological) [Ep 17 · 1:19](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=79)
- "Recurrence is very common in osteosarcoma, and the most common site of recurrence is in the lungs" — Bailey Roberts (clinical) [Ep 17 · 1:25](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=85)
- "Extracellular vesicles are carriers of amino acids, proteins, mRNA or other forms of cellular communication" — Bailey Roberts (clinical) [Ep 17 · 1:38](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=98)
- "EV content is unique and specific to the cells that released it, and therefore can be traced back to the cell type" — Bailey Roberts (clinical) [Ep 17 · 1:45](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=105)
- "EVs are involved in the metastatic cascade and implicated as potential markers for disease diagnosis and staging" — Bailey Roberts (clinical) [Ep 17 · 1:52](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=112)
- "EVs have been shown to change fibroblasts, inhibit T cell activity, and are involved in establishing a pre-metastatic niche" — Bailey Roberts (clinical) [Ep 17 · 1:59](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=119)
- "K12 is a spontaneous osteosarcoma with low metastatic capability" — Bailey Roberts (clinical) [Ep 17 · 2:31](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=151)
- "K7M2 is a highly metastatic osteosarcoma derived from a spontaneous osteosarcoma that went through two reiterations of harvesting spontaneous lung metastases and reimplanting them into the mouse" — Bailey Roberts (clinical) [Ep 17 · 2:35](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=155)
- "The K7M2 cell line is more aggressive and causes death at a much higher rate than K12" — Bailey Roberts (clinical) [Ep 17 · 2:57](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=177)
- "Pre-education with K7M2 EVs drastically increases the metastatic burden in the lungs of mice with K7M2 tumors" — Bailey Roberts (clinical) [Ep 17 · 3:59](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=239)
- "Pre-education with K7M2 EVs increased the overall mortality during the five-week study period in mice with K7M2 tumors" — Bailey Roberts (clinical) [Ep 17 · 4:18](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=258)
- "K7M2 EV education led to increased metastatic burden in mice with K12 tumors" — Bailey Roberts (clinical) [Ep 17 · 4:44](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=284)
- "Pre-education with highly metastatic cell line EVs increases the metastasis seen in a normally low metastatic tumor" — Bailey Roberts (clinical) [Ep 17 · 5:01](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=301)
- "No mice with K12 tumors died in the study period" — Bailey Roberts (clinical) [Ep 17 · 5:09](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=309)
- "Extracellular vesicles delivered prior to tumor implantation from highly metastatic K7M2 increase the metastatic burden of K7M2 tumors" — Bailey Roberts (clinical) [Ep 17 · 5:14](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=314)
- "Increased metastatic burden from extracellular vesicles decreases overall survival" — Bailey Roberts (clinical) [Ep 17 · 5:24](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=324)
- "Extracellular vesicles from highly metastatic K7M2 increase the metastatic burden of less metastatic K12 tumors" — Bailey Roberts (clinical) [Ep 17 · 5:30](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=330)
- "All cells in the body release EVs, so we can't just generally target EVs and hope to decrease the establishment of a pre-metastatic niche" — Bailey Roberts (clinical) [Ep 17 · 6:27](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=387)
- "IRF5 is a molecule being explored as a potential immunotherapy target in osteosarcoma EVs" — Bailey Roberts (clinical) [Ep 17 · 6:48](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=408)
- "Surgically removing the primary tumor is the current standard of care for osteosarcoma" — Bailey Roberts (guideline) [Ep 17 · 7:10](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=430)
- "There are certain membrane EV markers, but they're shared by all types of EVs" — Bailey Roberts (clinical) [Ep 17 · 7:31](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=451)
- "The differences in EVs by cell type have more to do with the contents inside of them than the targets on them, which makes them difficult to target as far as treatment" — Bailey Roberts (clinical) [Ep 17 · 7:40](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=460)
- "Studies in dogs have shown ability to take serum of dogs with osteosarcoma and determine their likelihood of metastasis based on the EVs" — Bailey Roberts (clinical) [Ep 17 · 7:57](https://qa.library.globalcastmd.com/watch/bailey-roberts-md-best-of-the-best-in-pediatric-surgery-2024-8011?t=477)
- "Choledocholithiasis stones may be made up of bile pigments or calcium and cholesterol salts." — Cecilia Gigena (host_summary) [Ep 20 · 0:43](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=43)
- "Risk factors for choledocholithiasis include metabolic diseases, hemolysis such as sickle cell, and congenital biliary anomalies like choledochal cysts." — David Vitale (clinical) [Ep 20 · 0:55](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=55)
- "Choledocholithiasis is more common in older children, children with higher BMI, and patients of Hispanic ethnicity." — David Vitale (epidemiological) [Ep 20 · 1:03](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=63)
- "According to ASGE guidelines, patients with high probability of common bile duct stones (common bile duct stones seen on ultrasound, ascending cholangitis, or quite high bilirubin) should go straight to ERCP." — David Vitale (host_summary) [Ep 20 · 1:52](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=112)
- "Patients with intermediate risk (abnormal liver biochemical tests or dilated common bile ducts) can undergo endoscopic ultrasound, MRCP, laparoscopic cholangiogram, or intraoperative ultrasound." — Cecilia Gigena (host_summary) [Ep 20 · 2:11](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=131)
- "In pediatric literature, direct (conjugated) bilirubin more than 2 mg/dL was the most predictive factor for common bile duct stones." — David Vitale (host_summary) [Ep 20 · 2:40](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=160)
- "Common bile duct diameter greater than 6 millimeters was most sensitive for predicting common bile duct stones in children, although without statistical significance." — Cecilia Gigena (host_summary) [Ep 20 · 2:50](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=170)
- "The pediatric duct score (published in Journal of American College of Surgeons with 10 centers) identified three most predictive risk factors: ducts greater than 6 mm, common bile duct stones on ultrasound, or total bilirubin greater than 1.8 mg/dL." — David Vitale (host_summary) [Ep 20 · 3:03](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=183)
- "Pediatric literature with small sample size shows that same-anesthesia laparoscopic cholecystectomy with ERCP in stone disease led to less anesthesia time and lower length of stay." — David Vitale (host_summary) [Ep 20 · 3:41](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=221)
- "Retrospective data comparing ERCP versus laparoscopic common bile duct exploration is conflicted and the choice is institution-dependent and provider-dependent based on expertise." — David Vitale (opinion) [Ep 20 · 4:03](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=243)
- "Randomized trials from 2013 show no significant difference in morbidity, mortality, retained stones, or failure rates between ERCP and laparoscopic common bile duct exploration." — Cecilia Gigena (host_summary) [Ep 20 · 4:18](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=258)
- "Stones above the cystic duct pose a problem because they can float up during attempted laparoscopic removal, making a straightforward procedure much more difficult." — David Vitale (clinical) [Ep 20 · 4:39](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=279)
- "Local expertise and availability is the most important factor in the decision tree between ERCP and laparoscopic common bile duct exploration." — David Vitale (opinion) [Ep 20 · 5:00](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=300)
- "Most free-standing children's hospitals do not have ERCP capabilities." — Cecilia Gigena (host_summary) [Ep 20 · 8:59](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=539)
- "Dr. Neff uses a 12-gauge angiocath for access, which may be hard to find in pediatric hospitals but can be ordered." — Luke Neff (clinical) [Ep 20 · 9:37](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=577)
- "The angle of entry into the cystic ductotomy should be as flat as possible, which is why a new incision is made rather than using existing ports." — Luke Neff (clinical) [Ep 20 · 9:42](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=582)
- "Dr. Neff uses a 6 French urethral stent cut down shorter for better flow, with a glide wire inside, using a coaxial technique to navigate the valves of Heister." — Luke Neff (clinical) [Ep 20 · 9:57](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=597)
- "Dr. Neff typically uses either a 6 millimeter or 8 millimeter angioplasty balloon, but definitely not more than that." — Luke Neff (clinical) [Ep 20 · 10:37](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=637)
- "The balloon dilation technique involves inflating the balloon in the duct, pulling back for tactile feedback to locate the sphincter, partially deflating, straddling the ampulla, then going to full profile under fluoroscopy and holding for about 5 minutes." — Luke Neff (clinical) [Ep 20 · 11:02](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=662)
- "Never use a balloon larger than the dilated common bile duct, as adult literature shows higher rates of pancreatitis with ampullary dilation without sphincterotomy." — David Vitale (clinical) [Ep 20 · 11:23](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=683)
- "After balloon dilation, Dr. Neff creates a seal on the distal common duct by partially inflating a balloon straddling the cystic duct-common duct junction so that flushing through the guide wire lumen gets pressurized downstream." — Luke Neff (clinical) [Ep 20 · 11:55](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=715)
- "If laparoscopic common bile duct exploration is not successful, Dr. Neff places an endoloop on the cystic duct and refers to GI for ERCP." — Luke Neff (clinical) [Ep 20 · 12:16](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=736)
- "If the pancreatic duct is visualized during fluoroscopy, the procedure should be stopped due to higher risk for pancreatitis." — Cecilia Gigena (host_summary) [Ep 20 · 12:24](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=744)
- "The prevalence of stone disease is increasing." — Luke Neff (epidemiological) [Ep 20 · 12:34](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=754)
- "The learning curve for laparoscopic common bile duct exploration is around 5 to 10 cases, though this is person-specific." — Luke Neff (clinical) [Ep 20 · 13:38](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=818)
- "The position of the 12-gauge angiocath is critical, and the ability to manipulate the catheter and wire in the duct depends on the initial setup and how flat the angle of entry is into the cystic duct." — Luke Neff (clinical) [Ep 20 · 13:24](https://qa.library.globalcastmd.com/watch/choledocholithiasis-with-drs-david-vitale-lucas-neff-8884?t=804)
- "The gold standard for achalasia treatment is laparoscopic Heller myotomy." (host_summary) [Ep 19 · 0:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=38)
- "POEM (peroral endoscopic myotomy) provides 360 degrees of options to perform myotomy, whereas with Heller myotomy you have maybe 180 degrees and must worry about the vagus nerve." (clinical) [Ep 19 · 1:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=66)
- "POEM can be performed after a failed Heller or previous POEM by choosing a different side for dissection, avoiding burned bridges." (clinical) [Ep 19 · 1:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=82)
- "POEM does not require dissection of the hiatus, reducing concern for reflux." (clinical) [Ep 19 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=92)
- "Blunt cerebrovascular injury (BCVI) occurs in 1.3% of all head trauma in the pediatric population." (host_summary) [Ep 19 · 2:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=122)
- "Nearly one-third of pediatric patients with BCVI will have a stroke, increasing mortality up to 20%." (host_summary) [Ep 19 · 2:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=122)
- "A patient with delayed diagnosis stroke from a missed BCVI prompted the institution to create a routine BCVI screening protocol requiring CTA head and neck for at-risk patients." (clinical) [Ep 19 · 2:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=144)
- "The Memphis score is the most sensitive scoring system for BCVI screening in pediatric head trauma patients." (host_summary) [Ep 19 · 2:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=171)
- "Patients under 37 weeks gestational age require overnight monitoring following anesthesia after pyloromyotomy, even if tolerating feeds shortly after surgery." (host_summary) [Ep 19 · 3:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=225)
- "Full-term babies over 4 weeks old may be eligible for discharge from PACU after pyloromyotomy." (host_summary) [Ep 19 · 3:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=236)
- "NSQIP data shows only 1.5% of pyloromyotomy patients were discharged on day of surgery, with no difference in odds of readmission or complications compared to overnight stay." (host_summary) [Ep 19 · 4:01](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=241)
- "ICG (indocyanine green) has become increasingly integrated into biliary-related surgeries such as cholecystectomies due to its hepatic excretion." (host_summary) [Ep 19 · 4:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=286)
- "Technetium-99 requires a special machine to detect and is difficult to control the injection timing." (host_summary) [Ep 19 · 5:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=308)
- "ICG technique is real-time in the operating room with equipment that is standard or soon to be standard in all laparoscopic towers." (host_summary) [Ep 19 · 5:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=320)
- "With ICG injection into the tumor, you can watch over 45-75 seconds as the ICG travels to the sentinel node with lights off under fluorescence." (host_summary) [Ep 19 · 5:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=352)
- "Recent studies have revealed a lack of firm correlation between anal dilations and stricture development following PSARP." (host_summary) [Ep 19 · 6:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=399)
- "Many PSARP patients have a colostomy and will undergo another procedure for colostomy closure, which is a perfect moment to perform strictureplasty if needed." (host_summary) [Ep 19 · 7:02](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=422)
- "The surgeon sees PSARP patients 2-4 weeks postoperatively, sizes the anoplasty in office, and discusses whether dilations are needed based on the examination, informing families that strictureplasty may be needed later." (host_summary) [Ep 19 · 7:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=433)
- "Every society emphasizes fertility preservation counseling even when surgery is not planned for children facing gonadotoxic therapy." (host_summary) [Ep 19 · 8:20](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=500)
- "When a patient has a new cancer diagnosis or is approaching stem cell transplant, the fertility preservation counseling service is activated through an Epic order set, triggering consultation by advanced practice nurse, physician, or oncology team for risk assessment." (host_summary) [Ep 19 · 8:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=516)
- "In a prepubertal child, the ovary is about 2 centimeters in size, approximately the size of a grape, and laparoscopic oophorectomy is the best recommendation for ovarian tissue preservation." (host_summary) [Ep 19 · 9:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=545)
- "Laparoscopic oophorectomy is recommended to reduce the risk of hemorrhage and ensure remaining ovarian tissue is preserved for future fertility." (host_summary) [Ep 19 · 9:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=557)
- "Massive transfusion protocol (MTP) is a multidisciplinary process for rapidly obtaining blood and blood products for severely bleeding patients." (host_summary) [Ep 19 · 9:49](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=589)
- "If you are giving blood in the trauma bay, you need to activate MTP—giving blood equals MTP activation." (guideline) [Ep 19 · 10:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=615)
- "For bad trauma with unstable or abnormal patients, whole blood would be the best option." (opinion) [Ep 19 · 10:39](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=639)
- "The blood bank has not been able to provide whole blood for pediatric patients because it needs to be irradiated." (clinical) [Ep 19 · 10:48](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=648)
- "The goal is 1:1:1 ratio of blood products (packed red blood cells:FFP:platelets), with FFP given after blood." (guideline) [Ep 19 · 10:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=653)
- "Most hospital trauma coolers do not initially contain platelets, requiring separate call for platelets through MTP or direct request." (clinical) [Ep 19 · 10:58](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=658)
- "Massive transfusion protocol should be activated after administering 20 mL/kg of blood in the trauma bay." (host_summary) [Ep 19 · 11:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=668)
- "Ovarian torsion often presents with a cystic area visible on ultrasound that may be less visible in the operating room due to edema." (host_summary) [Ep 19 · 11:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=711)
- "If the fallopian tube is black and edematous after detorsion and adequate time, consideration should be given to management of that tube." (host_summary) [Ep 19 · 12:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=728)
- "It is best to avoid removing the ovary in torsion because it may regain functionality even if it appears black." (host_summary) [Ep 19 · 12:23](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=743)
- "Doctor Breech advises against oophoropexy (ovarian fixation) and instead recommends detorsion with subsequent monitoring." (host_summary) [Ep 19 · 12:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=751)
- "Chronic pancreatitis causes pancreatic insufficiency and damage to islet cells." (host_summary) [Ep 19 · 13:08](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=788)
- "TPIAT involves complete removal of pancreas and spleen, extraction of islet cells in a specialized lab, then injection of those cells into the portal vein." (host_summary) [Ep 19 · 13:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=797)
- "In the acute postoperative period after TPIAT, glucose must be managed externally; all patients are on insulin in the ICU to avoid stressing the islet cells, allowing them to implant and find new vessels from the liver without doing work." (clinical) [Ep 19 · 13:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=807)
- "Many chronic pancreatitis patients have gene mutations triggering recurrent attacks, causing the gland to replace normal cells with fibrosis." (host_summary) [Ep 19 · 13:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=825)
- "Performing surgical resection for chronic pancreatitis without islet cell extraction may result in continued pancreatitis attacks and increased diabetes risk due to reduced pancreatic parenchyma." (host_summary) [Ep 19 · 13:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=835)
- "The American Pediatric Surgical Association (APSA) released revised guidelines for blunt hepatosplenic trauma management including four categories: admission location, procedures, discharge timing, and post-discharge management." (host_summary) [Ep 19 · 14:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=892)
- "For grades 1 and 2 blunt liver and spleen trauma, hemodynamically stable patients can be monitored and considered for discharge from the emergency department." (host_summary) [Ep 19 · 15:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=913)
- "In one institution's practice, 80% of pediatric trauma patients are transfers who have already had CBC at the referring hospital; hemodynamically normal children go to the floor without repeat hemoglobin." (clinical) [Ep 19 · 15:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=927)
- "Data shows hemodilution occurs in trauma, and patients more likely to fail non-operative management have initial hemoglobin less than 9.25 g/dL." (host_summary) [Ep 19 · 15:43](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=943)
- "For blunt liver and spleen trauma, increasing evidence supports treating the patient based on signs and symptoms rather than solely on injury grade." (host_summary) [Ep 19 · 16:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-2023-top-ten-key-takeaways-8758?t=964)
- "Doctor Margaret Mutch's team has about 10 years of experience with chest wall reconstructions." — Margaret Mutch (clinical) [Ep 23 · 0:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=16)
- "Examination revealed an incomplete cord injury with absent lower limb reflexes and altered motor and sensation below the level of T6." — Margaret Mutch (clinical) [Ep 23 · 0:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=27)
- "The patient underwent an emergency posterior laminectomy and partial tumor debulking initially for cord decompression between the levels of T3 and T7." — Margaret Mutch (clinical) [Ep 23 · 0:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=42)
- "The histopathology report confirmed an aggressive osteosarcoma." — Lizzie Lee (host_summary) [Ep 23 · 0:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=51)
- "PET scan showed a PET avid lesion on the right-hand side just next to the sternum." — Margaret Mutch (clinical) [Ep 23 · 1:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=64)
- "Radio guided occult lesion localization using technetium 99 was performed, followed by anterior thoracotomy to remove the lesion, which confirmed aggressive osteosarcoma replacing a lymph node." — Margaret Mutch (clinical) [Ep 23 · 1:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=72)
- "Most of the reconstruction needs to be tailored to the needs of each individual, location and size of defects, and the particular type of material used." — Margaret Mutch (opinion) [Ep 23 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=92)
- "There is a lack of clear evidence-based guidelines for reconstructive materials, but the priority is long-term durability, aesthetics, function, and accommodating future growth." — Lizzie Lee (host_summary) [Ep 23 · 1:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=105)
- "A lot of the literature on chest wall reconstruction is coming from adults." — Margaret Mutch (epidemiological) [Ep 23 · 1:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=115)
- "The spinal surgeons removed all of the vertebral bodies between T4 and T7 and inserted a cage, and the thoracic team resected ribs 4 to 7." — Margaret Mutch (clinical) [Ep 23 · 2:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=126)
- "During surgery, a tumor thrombus was found in the azygos, which extended into the SVC." — Margaret Mutch (clinical) [Ep 23 · 2:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=148)
- "Doctor Mutch's team tends to use resorbable and biosynthetic materials to do the reconstruction." — Margaret Mutch (clinical) [Ep 23 · 2:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=164)
- "In Australia, two systems are used for chest wall reconstruction: one by Stryker and one by KLS, using resorbable plates that are molded in a water bath to reconstruct the rigid part of the chest wall." — Margaret Mutch (clinical) [Ep 23 · 2:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=171)
- "Instead of using screws that came packaged with the plates, they used a K-wire drill to drill through the remaining ribs and then used Prolene sutures to secure the implant." — Lizzie Lee (host_summary) [Ep 23 · 3:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=185)
- "Following plate placement, Permacol is placed on top of the implant, and subsequently a muscular flap, in this case the latissimus dorsi, is used to cover the Permacol." — Margaret Mutch (clinical) [Ep 23 · 3:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=194)
- "Permacol is a surgical implant made of a porcine dermal collagen matrix that allows device placement." — Lizzie Lee (host_summary) [Ep 23 · 3:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=209)
- "The delta plates or the sonic weld system are polylactide and polyglycolide and polylactide plates with a strength of 78% at 2 months and 50% at 6 months." — Margaret Mutch (clinical) [Ep 23 · 3:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=217)
- "The patient had a relapse 18 months following surgery close to his sternum." — Margaret Mutch (clinical) [Ep 23 · 4:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=245)
- "Doctor Mutch performed a further chest wall reconstruction where they excised the entire sternum, costochondral cartilages, and anterior ribs and replaced it with a cement mesh." — Lizzie Lee (host_summary) [Ep 23 · 4:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=252)
- "The patient is currently having adjuvant chemotherapy." — Margaret Mutch (clinical) [Ep 23 · 4:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=262)
- "In the team's 10-year experience, there was early postoperative wound infection in one patient, which was treated with IV antibiotics." — Margaret Mutch (clinical) [Ep 23 · 4:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=271)
- "There were sterile seromas in two patients in the early stages, one at 2 months and one at 8 months, both treated with IR drainage." — Margaret Mutch (clinical) [Ep 23 · 4:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=276)
- "There was one case of minor scoliosis on follow-up, which is being followed by the spinal team and so far has not needed intervention." — Lizzie Lee (host_summary) [Ep 23 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=285)
- "Bioengineering of tissue replacement and 3D printing may be the way of the future in chest wall reconstructions." — Lizzie Lee (host_summary) [Ep 23 · 5:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=317)

## Common questions
### Who requires surgical intervention for circumcision?
Patients requiring surgical intervention for circumcision include infants over 3 months of age or weighing more than 13 pounds, who cannot safely undergo office circumcision. Additionally, patients with isolated chordee without hypospadias benefit from operative circumcision to release adhesions and straighten the penis. Conversely, elective circumcision in infants under 3 months should not require general anesthesia due to anesthetic safety concerns.
### How is Sarcoma (Ewing/Rhabdo) diagnosed?
Diagnosis of soft tissue sarcomas (rhabdo and non-rhabdo) involves imaging and tissue sampling. The workup includes MRI and either incisional or core biopsy. Histological grade is critical in non-rhabdomyosarcoma soft tissue sarcomas for treatment decisions. For regional disease assessment, sentinel node biopsy is performed because clinically negative nodes may harbor occult disease; 40–50% of biopsied nodes are positive, and positive nodes carry worse prognosis and require radiation therapy.
### What did Todd Ponsky say about Sarcoma (Ewing/Rhabdo)?
Todd Ponsky discussed surgical decision-making for non-rhabdomyosarcoma soft tissue sarcomas. He presented a study comparing outcomes between patients who had unplanned excision of lesions later found to be non-rhabdomyosarcoma followed by re-excision versus those with planned workup and excision. The study involved 40 patients referred after innocuous lesion removal that returned as non-rhabdomyosarcoma. Ponsky concluded that since there is no outcome difference between planned and unplanned excision, it may be acceptable with low index of suspicion to excise the lesion and perform re-excision if it returns as non-rhabdomyosarcoma.

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: 2 promo items hidden (trailer / commercial); unhide from the owner view
- Sep 7: 8 items hidden — never mention Sarcoma (Ewing/Rhabdo); unhide from the owner view
- Aug 31: 38 doctors auto-found from episode dossiers
- Aug 30: 37 doctors auto-found from episode dossiers
- Aug 30: 29 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 32 doctors auto-found from episode dossiers
- Aug 29: 33 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 42 items, 28 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 31 items, 28 dossiers, summaries for 3 audience(s)
- Aug 29: Collection generated from campaign corpus: 31 items, 28 dossiers, summaries for 1 audience(s)

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