Greg Tiao

530 timestamped statements across 9 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Biliary Atresia · guest expert Liver Tumors (Hepatoblastoma/HCC) · guest expert Neuroblastoma · guest expert Wilms Tumor · guest expert

Featured diaries

▶ Ep 5 · 9:35
You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection.
quote · Hepatoblastoma
▶ Ep 5 · 9:35
You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection.
quote · Liver Tumors (Hepatoblastoma/HCC)
▶ Ep 9 · 9:35
You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection.
quote · Neuroblastoma
▶ Ep 11 · 9:35
You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection.
quote · Wilms Tumor
▶ Ep 13 · 13:46
The NASPGHAN guidelines, which is what most of the North American pediatric GI people are going to, in theory, follow, actually recommends not to get a HIDA scan because there's always a concern, especially in a 50-day-old, that if you tried to load the patient with phenobarb, you delay treatment by potentially five, six days.
quote · Biliary Atresia
▶ Ep 13 · 13:46
The NASPGHAN guidelines, which is what most of the North American pediatric GI people are going to, in theory, follow, actually recommends not to get a HIDA scan because there's always a concern, especially in a 50-day-old, that if you tried to load the patient with phenobarb, you delay treatment by potentially five, six days.
quote · Biliary Atresia

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Biliary Atresia 254 entries

Biliary Atresia

▶ Ep 2 · 1:42
epidemiological Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to recognition of inborn errors of bile acid metabolism and genotyping of progressive familial intrahepatic cholestasis (PFIC). ↗
▶ Ep 2 · 1:43
quote If you actually looked at studies from the 70s and 1980s, idiopathic neonatal hepatitis would be about 70% of the patients. Now it's probably down to 10% ↗
▶ Ep 2 · 3:25
clinical The jaundice chip is a microarray gene chip that tests for PFIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin, and JAG-1 mutation, but takes 4-6 weeks to return results. ↗
▶ Ep 2 · 4:51
clinical The absence of a gallbladder on ultrasound does not conclusively show biliary atresia, and the presence of a gallbladder does not exclude biliary atresia due to sophisticated ultrasound probe sensitivity. ↗
▶ Ep 2 · 4:51
quote The absence of A gallbladder on ultrasound does not conclusively show biliary atresia. The corollary to that, of course, is the presence of a gallbladder doesn't exclude biliary atresia ↗
▶ Ep 2 · 5:14
clinical The triangular cord sign is a radiographic finding representing the fibrous plate above the portal vein where bile ducts were supposed to be, now showing inflammatory fibrous scar. ↗
▶ Ep 2 · 5:41
opinion At Cincinnati Children's Hospital, HIDA scans are not routinely used because the 3-5 day phenobarbital loading period can delay intervention into a time period potentially detrimental to Kasai outcome. ↗
▶ Ep 2 · 5:41
quote At our hospital we actually don't use HIDA scans and in fact if we order a HIDA scan, Dr. Ballesterri, our senior most hepatologists, looks upon it quite poorly. ↗
▶ Ep 2 · 8:23
clinical Pathognomonic findings on liver biopsy for biliary atresia include significant bile duct proliferation in portal triads and bile plugs within bile ducts, with likelihood of biliary atresia exceeding 90% when these are present. ↗
▶ Ep 2 · 8:34
quote If you see that, the confirmatory, I mean the likelihood of it being biliotresia is well over 90+%. It's very rare that you will have a misdiagnosis at this stage. ↗
▶ Ep 2 · 8:50
clinical At Cincinnati, liver biopsies are reviewed with pathologists before taking patients to the operating room, making intraoperative decision-making easier and sometimes reducing the necessity of intraoperative cholangiogram. ↗
▶ Ep 2 · 10:28
clinical Alagille syndrome patients do not have the same bile duct proliferation as biliary atresia patients and will not have the pathognomonic finding of a bile duct plug. ↗
▶ Ep 2 · 11:27
clinical At Cincinnati, the workup for biliary atresia is limited to liver biopsy, labs, and ultrasound before posting the patient for surgery. ↗
▶ Ep 2 · 12:07
clinical The extended hilar dissection technique, going to the first bifurcation of vessels beyond the portal vein, is the proper way Kasai originally described the procedure. ↗
▶ Ep 2 · 12:26
quote This is what the Japanese will call an extended dissection, where they'll go to the first bifurcation of the vessels. This is actually the proper way or the way Kasai. Described it ↗
▶ Ep 2 · 12:35
opinion Japanese centers uniformly perform extended dissections, which may explain why their Kasai outcomes are better than those in the United States. ↗
▶ Ep 2 · 13:26
clinical Polysplenia syndrome patients with biliary atresia are the most difficult cases because they often have pre-duodenal portal veins and frequently have no bile duct remnant, making Kasai nearly impossible in this population. ↗
▶ Ep 2 · 14:57
clinical Data from England by Mark Davenport showed that cystic variants of biliary atresia have better outcomes if intervention occurs before 30 days of age. ↗
▶ Ep 2 · 15:14
clinical Choledochal cyst patients will have pigmented stool, while cystic variant biliary atresia patients will become acholic, providing a simple clinical differentiation. ↗
▶ Ep 2 · 15:42
clinical A Roux limb length of 20 cm is inadequate because 5-8 cm of length is almost always lost during hilar dissection at the time of transplant. ↗
▶ Ep 2 · 15:47
quote 20 is not good for a transplant team because almost always you'll lose 5 to 78 centimeters of length on your root at the time of the hilar dissection. ↗
▶ Ep 2 · 16:09
clinical The target Roux limb length should be 30-40 cm to preserve adequate length for transplant teams, as one advantage of transplanting biliary atresia patients is having a pre-existing Roux limb. ↗
▶ Ep 2 · 16:32
clinical Anti-refluxing valves for the Roux limb have not been proven effective. ↗
▶ Ep 2 · 17:11
quote It's pretty clear cut that when they localized or focused on the group just 3 centers doing their biliatresis, that the 3 centers that did more than 5 cases a year had. Much better outcomes than those who had less. ↗
▶ Ep 2 · 17:11
epidemiological UK data from approximately 15 years ago showed that centers performing more than 5 biliary atresia cases per year had statistically significantly better outcomes (approximately 20% difference) than those performing fewer cases. ↗
▶ Ep 2 · 17:38
guideline The British health service focused all Kasai procedures at three high-volume centers, which are the only centers that can be reimbursed for the procedure. ↗
▶ Ep 2 · 18:03
clinical Two European studies (King's Group using 2 mg/kg steroids and Klaus Peterson's German group using 10 mg/kg for 5 days) showed no benefit from postoperative corticosteroids in biliary atresia. ↗
▶ Ep 2 · 18:22
quote The Children's Network, which is the national biliotreia Research Consortium, did a multi. Center trial in which they had about 70 patients enrolled in two different arms and they showed clearly that there was no improvement of drainage in terms of corticosteroid use between those who got it and those who didn't. ↗
▶ Ep 2 · 18:22
clinical The Children's Network biliary atresia Research Consortium multi-center trial with approximately 70 patients in two arms showed no improvement in bile drainage with corticosteroid use and a slight increase in adverse events (primarily medical rather than surgical complications). ↗
▶ Ep 2 · 18:57
opinion Despite negative trial results, there is a subset of biliary atresia patients with an inflammatory gene profile in which steroids might prove beneficial. ↗
▶ Ep 2 · 19:39
clinical Cincinnati does not use MRCP for biliary atresia diagnosis due to having a high-capacity pathology team. ↗
▶ Ep 2 · 20:12
quote If you cassa and Alis patients, you will shorten their natural. History of that liver staying with them and they will be transplanted sooner. That's actually fairly clear cut. ↗
▶ Ep 2 · 20:12
clinical Performing Kasai on Alagille syndrome patients will shorten the natural history of their native liver and result in earlier transplantation. ↗
▶ Ep 2 · 20:21
clinical For patients with cholestasis where biliary atresia diagnosis is uncertain, workup includes echocardiogram to rule out pulmonic stenosis, spine X-rays to rule out butterfly vertebrae, and eye exams, all to evaluate for Alagille syndrome. ↗

Biliary Atresia with Dr. Greg Tiao

▶ Ep 12 · 0:40
quote Biliaryresia is an uncommon disease, results in an obstructive cholangiopathy of the biliary system. ↗
▶ Ep 12 · 0:40
clinical Biliary atresia is an uncommon disease that results in an obstructive cholangiopathy of the biliary system ↗
▶ Ep 12 · 0:40
clinical Biliary atresia is unique to infancy ↗
▶ Ep 12 · 0:40
epidemiological Biliary atresia is the most common cause for end-stage liver disease in children ↗
▶ Ep 12 · 0:40
clinical Biliary atresia is unique to infancy ↗
▶ Ep 12 · 0:40
quote Biliaryresia is an uncommon disease, results in an obstructive cholangiopathy of the biliary system. ↗
▶ Ep 12 · 0:40
clinical Biliary atresia is an uncommon disease that results in an obstructive cholangiopathy of the biliary system ↗
▶ Ep 12 · 0:40
epidemiological Biliary atresia is the most common cause for end-stage liver disease in children ↗
▶ Ep 12 · 0:54
clinical The etiology of biliary atresia is uncertain ↗
▶ Ep 12 · 0:54
clinical The etiology of biliary atresia is uncertain ↗
▶ Ep 12 · 0:56
clinical Biliary atresia causes a biliary epithelial injury process that causes biliary obstruction ↗
▶ Ep 12 · 0:56
clinical Biliary atresia causes a biliary epithelial injury process that causes biliary obstruction ↗
▶ Ep 12 · 1:10
clinical Untreated biliary atresia causes progressive cholestasis, portal fibrosis, eventually cirrhosis, portal hypertension, and can cause death by the age of 2 years ↗
▶ Ep 12 · 1:10
quote The infant develops progressive cholestasis, portal fibrosis, eventually cirrhosis, and then the manifestations of that, which include portal hypertension, and if untreated, can cause death by the age of 2 years of age. ↗
▶ Ep 12 · 1:10
quote The infant develops progressive cholestasis, portal fibrosis, eventually cirrhosis, and then the manifestations of that, which include portal hypertension, and if untreated, can cause death by the age of 2 years of age. ↗
▶ Ep 12 · 1:10
clinical Untreated biliary atresia causes progressive cholestasis, portal fibrosis, eventually cirrhosis, portal hypertension, and can cause death by the age of 2 years ↗
▶ Ep 12 · 1:31
epidemiological In the Far East, biliary atresia incidence is estimated at 1 in 8000 live births ↗
▶ Ep 12 · 1:31
quote In the Far East, it's been estimated that 1 in 8000 live births will result in a patient with biliatresia. ↗
▶ Ep 12 · 1:31
epidemiological In the Far East, biliary atresia incidence is estimated at 1 in 8000 live births ↗
▶ Ep 12 · 1:31
quote In the Far East, it's been estimated that 1 in 8000 live births will result in a patient with biliatresia. ↗
▶ Ep 12 · 1:43
epidemiological In the United States, biliary atresia incidence is 1 in 15,000 live births ↗
▶ Ep 12 · 1:43
quote In the West, or especially in the United States, it's less common where the incidence is 1 in 15,000 live births. ↗
▶ Ep 12 · 1:43
quote In the West, or especially in the United States, it's less common where the incidence is 1 in 15,000 live births. ↗
▶ Ep 12 · 1:43
epidemiological In the United States, biliary atresia incidence is 1 in 15,000 live births ↗
▶ Ep 12 · 2:02
quote The child or the infant is typically jaundiced. That's the first clinical manifestation. ↗
▶ Ep 12 · 2:02
clinical Infants with biliary atresia typically present with jaundice as the first clinical manifestation ↗
▶ Ep 12 · 2:02
quote The child or the infant is typically jaundiced. That's the first clinical manifestation. ↗
▶ Ep 12 · 2:02
clinical Infants with biliary atresia typically present with jaundice as the first clinical manifestation ↗
▶ Ep 12 · 2:08
clinical Patients with biliary atresia have acholic or very pale gray stools ↗
▶ Ep 12 · 2:08
clinical Patients with biliary atresia have acholic or very pale gray stools ↗
▶ Ep 12 · 2:13
clinical Patients with biliary atresia have dark urine ↗
▶ Ep 12 · 2:13
clinical Patients with biliary atresia have dark urine ↗
▶ Ep 12 · 2:14
clinical The liver in biliary atresia becomes quite firm and is usually palpable in the right costochondral margin ↗
▶ Ep 12 · 2:14
clinical The liver in biliary atresia becomes quite firm and is usually palpable in the right costochondral margin ↗
▶ Ep 12 · 2:21
clinical Biliary atresia typically presents between 1 to 2 months of age ↗
▶ Ep 12 · 2:21
clinical Biliary atresia typically presents between 1 to 2 months of age ↗
▶ Ep 12 · 2:26
clinical Screening can pick up biliary atresia at an earlier stage and has been demonstrated to improve outcomes ↗
▶ Ep 12 · 2:26
clinical Screening can pick up biliary atresia at an earlier stage and has been demonstrated to improve outcomes ↗
▶ Ep 12 · 2:26
quote And that screening has, has been demonstrated to improve the outcome of patients who are detected at an earlier age. ↗
▶ Ep 12 · 2:26
quote And that screening has, has been demonstrated to improve the outcome of patients who are detected at an earlier age. ↗
▶ Ep 12 · 2:46
clinical The most common reason an infant has jaundice is physiologic jaundice of the newborn ↗
▶ Ep 12 · 2:46
clinical The most common reason an infant has jaundice is physiologic jaundice of the newborn ↗
▶ Ep 12 · 2:53
clinical Indirect hyperbilirubinemia indicates physiologic jaundice ↗
▶ Ep 12 · 2:53
clinical Indirect hyperbilirubinemia indicates physiologic jaundice ↗
▶ Ep 12 · 2:58
clinical Direct hyperbilirubinemia indicates a more pathologic process ↗
▶ Ep 12 · 2:58
quote If it's a direct hyperbilirubinemia, then you actually have to be worried that there's a more pathologic process underway. ↗
▶ Ep 12 · 2:58
quote If it's a direct hyperbilirubinemia, then you actually have to be worried that there's a more pathologic process underway. ↗
▶ Ep 12 · 2:58
clinical Direct hyperbilirubinemia indicates a more pathologic process ↗
▶ Ep 12 · 3:18
clinical Anatomic causes of direct hyperbilirubinemia include biliary atresia, choledochal cysts, and inspissated bile syndrome ↗
▶ Ep 12 · 3:18
clinical Anatomic causes of direct hyperbilirubinemia include biliary atresia, choledochal cysts, and inspissated bile syndrome ↗
▶ Ep 12 · 3:39
clinical Hepatocellular causes of direct hyperbilirubinemia include viral hepatitis, sepsis, PFIC syndromes, alpha-1 antitrypsin deficiency, tyrosinemia, and transport abnormalities ↗
▶ Ep 12 · 3:39
clinical Hepatocellular causes of direct hyperbilirubinemia include viral hepatitis, sepsis, PFIC syndromes, alpha-1 antitrypsin deficiency, tyrosinemia, and transport abnormalities ↗
▶ Ep 12 · 4:23
clinical Workup for biliary atresia includes liver profile with GGT, alpha-1 antitrypsin genotype, and TORCH workup ↗
▶ Ep 12 · 4:23
clinical Workup for biliary atresia includes liver profile with GGT, alpha-1 antitrypsin genotype, and TORCH workup ↗
▶ Ep 12 · 5:00
clinical Patients are screened for cystic fibrosis, hypothyroidism, and galactosemia as part of perinatal screening ↗
▶ Ep 12 · 5:00
clinical Patients are screened for cystic fibrosis, hypothyroidism, and galactosemia as part of perinatal screening ↗
▶ Ep 12 · 5:13
clinical Matrix metalloproteinase 7 (MMP-7) is a new biochemical marker with very high diagnostic sensitivity and specificity for biliary atresia ↗
▶ Ep 12 · 5:13
quote More recently, from a laboratory standpoint, there's been some New studies showing that the protein MMP 7, matrix metallorotinase 7, is a new biochemical marker that has very high diagnostic sensitivity and specificity for biliary. ↗
▶ Ep 12 · 5:13
quote More recently, from a laboratory standpoint, there's been some New studies showing that the protein MMP 7, matrix metallorotinase 7, is a new biochemical marker that has very high diagnostic sensitivity and specificity for biliary. ↗
▶ Ep 12 · 5:13
clinical Matrix metalloproteinase 7 (MMP-7) is a new biochemical marker with very high diagnostic sensitivity and specificity for biliary atresia ↗
▶ Ep 12 · 5:32
clinical Ultrasound is the first imaging test typically obtained for biliary atresia workup ↗
▶ Ep 12 · 5:32
clinical Ultrasound is the first imaging test typically obtained for biliary atresia workup ↗
▶ Ep 12 · 5:42
clinical HIDA scan is fairly sensitive but has quite low specificity for biliary atresia and can delay workup and diagnosis ↗
▶ Ep 12 · 5:42
quote The HIDA scan was used for many years, but that test is fairly sensitive, but its specificity is quite low. ↗
▶ Ep 12 · 5:42
quote The HIDA scan was used for many years, but that test is fairly sensitive, but its specificity is quite low. ↗
▶ Ep 12 · 5:42
clinical HIDA scan is fairly sensitive but has quite low specificity for biliary atresia and can delay workup and diagnosis ↗
▶ Ep 12 · 5:50
quote And so it's usually not utilized because it can actually delay the workup. And diagnosis of bilioresia. ↗
▶ Ep 12 · 5:50
quote And so it's usually not utilized because it can actually delay the workup. And diagnosis of bilioresia. ↗
▶ Ep 12 · 6:09
clinical Liver biopsy is the gold standard for diagnosing biliary atresia ↗
▶ Ep 12 · 6:09
clinical Liver biopsy is the gold standard for diagnosing biliary atresia ↗
▶ Ep 12 · 6:09
quote And then of course the gold standard for biliaryresia is a liver biopsy. ↗
▶ Ep 12 · 6:09
quote And then of course the gold standard for biliaryresia is a liver biopsy. ↗
▶ Ep 12 · 6:18
quote The classic findings of biliotresia on that biopsy is expansion of the perioral space with mononuclear cells. ↗
▶ Ep 12 · 6:18
clinical Bile duct plugs are the pathognomonic finding of biliary atresia on biopsy ↗
▶ Ep 12 · 6:18
quote The classic findings of biliotresia on that biopsy is expansion of the perioral space with mononuclear cells. ↗
▶ Ep 12 · 6:18
clinical Classic biopsy findings of biliary atresia include expansion of the periportal space with mononuclear cells, bile duct proliferation, and bile duct plugs within proliferating periportal biliary ducts ↗
▶ Ep 12 · 6:18
clinical Classic biopsy findings of biliary atresia include expansion of the periportal space with mononuclear cells, bile duct proliferation, and bile duct plugs within proliferating periportal biliary ducts ↗
▶ Ep 12 · 6:18
clinical Bile duct plugs are the pathognomonic finding of biliary atresia on biopsy ↗
▶ Ep 12 · 6:27
quote You'll see bile duct proliferation and then the pathomnemonic finding of bilioresia is bile duct plugs within those proliferating perioral biliary ducts. ↗
▶ Ep 12 · 6:27
quote You'll see bile duct proliferation and then the pathomnemonic finding of bilioresia is bile duct plugs within those proliferating perioral biliary ducts. ↗
▶ Ep 12 · 6:45
clinical Treatment options for biliary atresia are surgical and include Kasai portoenterostomy or liver transplantation ↗
▶ Ep 12 · 6:45
clinical Treatment options for biliary atresia are surgical and include Kasai portoenterostomy or liver transplantation ↗
▶ Ep 12 · 7:00
clinical As long as the patient reaches the OR before 70-75 days, the success rate of Kasai procedure justifies the small morbidity risks ↗
▶ Ep 12 · 7:00
quote Most teams will find that as long as they get the patient to the OR before 70, 75 days, the success rate of the procedure justifies the small morbidity risks of the procedure. ↗
▶ Ep 12 · 7:00
quote Most teams will find that as long as they get the patient to the OR before 70, 75 days, the success rate of the procedure justifies the small morbidity risks of the procedure. ↗
▶ Ep 12 · 7:00
clinical As long as the patient reaches the OR before 70-75 days, the success rate of Kasai procedure justifies the small morbidity risks ↗
▶ Ep 12 · 7:12
clinical In older patients with manifestations of cirrhosis including ascites and coagulopathy, consideration for primary transplant is warranted ↗
▶ Ep 12 · 7:12
clinical In older patients with manifestations of cirrhosis including ascites and coagulopathy, consideration for primary transplant is warranted ↗
▶ Ep 12 · 7:34
clinical Both Kasai and transplant procedures require an intraoperative cholangiogram to establish anatomy and visualize patency of the common hepatic duct and intrahepatic components ↗
▶ Ep 12 · 7:34
clinical Both Kasai and transplant procedures require an intraoperative cholangiogram to establish anatomy and visualize patency of the common hepatic duct and intrahepatic components ↗
▶ Ep 12 · 7:55
clinical In Kasai procedure, the gallbladder is mobilized to identify the common bile duct and common hepatic duct, with dissection carried laterally to where arteries branch ↗
▶ Ep 12 · 7:55
clinical In Kasai procedure, the gallbladder is mobilized to identify the common bile duct and common hepatic duct, with dissection carried laterally to where arteries branch ↗
▶ Ep 12 · 8:08
clinical The hilar plate in biliary atresia has a triangle-like appearance extending from the common hepatic duct to a broader base ↗
▶ Ep 12 · 8:08
clinical The hilar plate in biliary atresia has a triangle-like appearance extending from the common hepatic duct to a broader base ↗
▶ Ep 12 · 8:25
clinical The hilar plate is divided in one sharp transection right proximal to Glisson's capsule ↗
▶ Ep 12 · 8:25
clinical The hilar plate is divided in one sharp transection right proximal to Glisson's capsule ↗
▶ Ep 12 · 8:34
clinical A 30 to 35 centimeter Roux-en-Y limb is created and brought up in a retrocolic fashion for hilar plate reconstruction ↗
▶ Ep 12 · 8:34
clinical A 30 to 35 centimeter Roux-en-Y limb is created and brought up in a retrocolic fashion for hilar plate reconstruction ↗
▶ Ep 12 · 9:04
clinical The most worrisome complication of Kasai is vascular injury to the portal vein or hepatic artery ↗
▶ Ep 12 · 9:04
clinical The most worrisome complication of Kasai is vascular injury to the portal vein or hepatic artery ↗
▶ Ep 12 · 9:11
opinion During Kasai, anything that is easily demonstrable should not be divided; if you think it's a vessel, don't divide it because it may be a segmental artery of importance ↗
▶ Ep 12 · 9:11
quote We really try not to divide anything that is easily demonstrable. What I mean by that is if you think it's a vessel, don't divide it because you'd be surprised how oftentimes you think it's nothing and it turns out to be a segmental artery of importance. ↗
▶ Ep 12 · 9:11
quote We really try not to divide anything that is easily demonstrable. What I mean by that is if you think it's a vessel, don't divide it because you'd be surprised how oftentimes you think it's nothing and it turns out to be a segmental artery of importance. ↗
▶ Ep 12 · 9:11
opinion During Kasai, anything that is easily demonstrable should not be divided; if you think it's a vessel, don't divide it because it may be a segmental artery of importance ↗
▶ Ep 12 · 9:27
clinical Other complications of Kasai include bowel obstruction and wound issues ↗
▶ Ep 12 · 9:27
clinical Other complications of Kasai include bowel obstruction and wound issues ↗
▶ Ep 12 · 9:34
clinical Cholangitis is a longer-term concern after Kasai, but requires adequate bile flow to occur ↗
▶ Ep 12 · 9:34
clinical Cholangitis is a longer-term concern after Kasai, but requires adequate bile flow to occur ↗
▶ Ep 12 · 9:34
quote One of the concerns we have longer term is cholangitis. But of course, for cholangitis, you actually have to have adequate bile flow to even begin to have that. ↗
▶ Ep 12 · 9:34
quote One of the concerns we have longer term is cholangitis. But of course, for cholangitis, you actually have to have adequate bile flow to even begin to have that. ↗
▶ Ep 12 · 9:42
clinical Cholangitis after Kasai is presumed to be an ascending process and can be suppressed with antibiotics ↗
▶ Ep 12 · 9:42
clinical Cholangitis after Kasai is presumed to be an ascending process and can be suppressed with antibiotics ↗
▶ Ep 12 · 9:57
clinical In the United States, most Kasai patients are discharged home within 5 to 7 days after the procedure ↗
▶ Ep 12 · 9:57
clinical In the United States, most Kasai patients are discharged home within 5 to 7 days after the procedure ↗
▶ Ep 12 · 10:06
clinical Post-Kasai patients require multidisciplinary care with both surgeon and gastroenterologist follow-up ↗
▶ Ep 12 · 10:06
clinical Post-Kasai patients require multidisciplinary care with both surgeon and gastroenterologist follow-up ↗
▶ Ep 12 · 10:14
clinical Post-Kasai patients are on prophylactic antibiotics, Actigall, and require nutritional support including fat-soluble vitamins and elemental diets ↗
▶ Ep 12 · 10:14
clinical Post-Kasai patients are on prophylactic antibiotics, Actigall, and require nutritional support including fat-soluble vitamins and elemental diets ↗
▶ Ep 12 · 10:28
clinical A successful Kasai is defined as direct bilirubin under 2 at 3 months of age ↗
▶ Ep 12 · 10:28
quote The definition of a successful cassai is a direct bilirubin under 2 at 3 months of age. ↗
▶ Ep 12 · 10:28
quote The definition of a successful cassai is a direct bilirubin under 2 at 3 months of age. ↗
▶ Ep 12 · 10:28
clinical A successful Kasai is defined as direct bilirubin under 2 at 3 months of age ↗
▶ Ep 12 · 10:35
clinical Immediate post-operative success indicator is a pigmented stool, which indicates the patient is draining ↗
▶ Ep 12 · 10:35
quote What we're looking for immediately post-op is a pigmented stool. If we see that, we know the patient is draining ↗
▶ Ep 12 · 10:35
quote What we're looking for immediately post-op is a pigmented stool. If we see that, we know the patient is draining ↗
▶ Ep 12 · 10:35
clinical Immediate post-operative success indicator is a pigmented stool, which indicates the patient is draining ↗

Biliary Atresia Part I

▶ Ep 13 · 6:06
clinical A high GGT is more consistent with an obstructive process and helps guide toward eliminating PFIC (progressive familial intrahepatic cholestasis) diagnoses. ↗
▶ Ep 13 · 6:06
clinical A high GGT is more consistent with an obstructive process and helps guide toward eliminating PFIC (progressive familial intrahepatic cholestasis) diagnoses. ↗
▶ Ep 13 · 6:37
clinical At 50 days of age, physiologic jaundice from the newborn period would have resolved. ↗
▶ Ep 13 · 6:37
clinical At 50 days of age, physiologic jaundice from the newborn period would have resolved. ↗
▶ Ep 13 · 8:16
quote We're fortunate in Cincinnati that we have an excellent ultrasound team and they will look for a triangle chord sign, but we really don't find that to be too consistent. ↗
▶ Ep 13 · 8:16
quote We're fortunate in Cincinnati that we have an excellent ultrasound team and they will look for a triangle chord sign, but we really don't find that to be too consistent. ↗
▶ Ep 13 · 9:45
clinical Cincinnati Children's Hospital has not used HIDA scans for biliary atresia diagnosis in approximately 25 years. ↗
▶ Ep 13 · 9:45
clinical Cincinnati Children's Hospital has not used HIDA scans for biliary atresia diagnosis in approximately 25 years. ↗
▶ Ep 13 · 13:46
guideline NASPGHAN guidelines recommend not obtaining HIDA scans because phenobarbital loading delays treatment by 5-6 days, pushing closer to the window where Kasai efficacy deteriorates. ↗
▶ Ep 13 · 13:46
quote The NASPGHAN guidelines, which is what most of the North American pediatric GI people are going to, in theory, follow, actually recommends not to get a HIDA scan because there's always a concern, especially in a 50-day-old, that if you tried to load the patient with phenobarb, you delay treatment by potentially five, six days. ↗
▶ Ep 13 · 13:46
host_summary NASPGHAN guidelines recommend not obtaining HIDA scans because phenobarbital loading delays treatment by 5-6 days, pushing closer to the window where Kasai efficacy deteriorates. ↗
▶ Ep 13 · 13:46
quote The NASPGHAN guidelines, which is what most of the North American pediatric GI people are going to, in theory, follow, actually recommends not to get a HIDA scan because there's always a concern, especially in a 50-day-old, that if you tried to load the patient with phenobarb, you delay treatment by potentially five, six days. ↗
▶ Ep 13 · 16:28
clinical Significant fibrosis on liver biopsy reflects disease progression and may guide surgical decision-making. ↗
▶ Ep 13 · 16:28
clinical Significant fibrosis on liver biopsy reflects disease progression and may guide surgical decision-making. ↗
▶ Ep 13 · 20:26
quote I've seen some of the consequences of that, where you just seem to see a little bit more dense adhesions. And again, depending on the stage of the liver disease patients, those things can become quite vascularized. ↗
▶ Ep 13 · 20:26
clinical Liver exteriorization during Kasai portoenterostomy can create denser, more vascularized adhesions that complicate future liver transplantation. ↗
▶ Ep 13 · 20:26
clinical Liver exteriorization during Kasai portoenterostomy can create denser, more vascularized adhesions that complicate future liver transplantation. ↗
▶ Ep 13 · 20:26
quote I've seen some of the consequences of that, where you just seem to see a little bit more dense adhesions. And again, depending on the stage of the liver disease patients, those things can become quite vascularized. ↗
▶ Ep 13 · 24:31
quote The only chance this kid has to avoid transplant early on is a well-done Kasai. And so, that's where I think you really have to be thinking about the patient's best interest when you consider this. ↗
▶ Ep 13 · 24:31
host_summary Peterson ran a prospective randomized trial comparing laparoscopic to open Kasai and stopped the trial early. ↗
▶ Ep 13 · 24:31
opinion The only chance a child with biliary atresia has to avoid early transplant is a well-done Kasai portoenterostomy. ↗
▶ Ep 13 · 24:31
clinical Even in the best hands, long-term drainage rate after Kasai portoenterostomy is only 70-75%. ↗
▶ Ep 13 · 24:31
quote The problem with Kasai is even open, that because the drainage rate is not so ideal, even in the best hands, it's only 70%, 75% long-term. ↗
▶ Ep 13 · 24:31
quote The only chance this kid has to avoid transplant early on is a well-done Kasai. And so, that's where I think you really have to be thinking about the patient's best interest when you consider this. ↗
▶ Ep 13 · 24:31
quote The problem with Kasai is even open, that because the drainage rate is not so ideal, even in the best hands, it's only 70%, 75% long-term. ↗
▶ Ep 13 · 24:31
clinical Even in the best hands, long-term drainage rate after Kasai portoenterostomy is only 70-75%. ↗
▶ Ep 13 · 24:31
opinion The only chance a child with biliary atresia has to avoid early transplant is a well-done Kasai portoenterostomy. ↗
▶ Ep 13 · 24:31
clinical Peterson ran a prospective randomized trial comparing laparoscopic to open Kasai and stopped the trial early. ↗
▶ Ep 13 · 25:50
clinical In the Children's Network surgical committee, approximately one-third of centers cut into the liver during Kasai, while the rest transect at 1-2 mm of fibrous remnant. ↗
▶ Ep 13 · 25:50
quote We do not dig into the liver. I think Dr. Neo wrote a paper just a few years ago where he described the different depth of the hilar plate transection. ↗
▶ Ep 13 · 25:50
clinical Damage to hepatic artery branches during Kasai dissection can exacerbate the underlying liver disease process. ↗
▶ Ep 13 · 25:50
clinical The hilar plate should be transected at the level of Glisson's capsule, leaving it intact, without cutting into the liver parenchyma itself. ↗
▶ Ep 13 · 25:50
clinical Dr. Neo published a paper describing different depths of hilar plate transection in Kasai portoenterostomy. ↗
▶ Ep 13 · 25:50
clinical Damage to hepatic artery branches during Kasai dissection can exacerbate the underlying liver disease process. ↗
▶ Ep 13 · 25:50
clinical In the Children's Network surgical committee, approximately one-third of centers cut into the liver during Kasai, while the rest transect at 1-2 mm of fibrous remnant. ↗
▶ Ep 13 · 25:50
host_summary Dr. Neo published a paper describing different depths of hilar plate transection in Kasai portoenterostomy. ↗
▶ Ep 13 · 25:50
clinical The hilar plate should be transected at the level of Glisson's capsule, leaving it intact, without cutting into the liver parenchyma itself. ↗
▶ Ep 13 · 25:50
quote We do not dig into the liver. I think Dr. Neo wrote a paper just a few years ago where he described the different depth of the hilar plate transection. ↗
▶ Ep 13 · 30:10
clinical For the portoenterostomy anastomosis, 6-0 Maxon suture is used with all knots tied on the outside. ↗
▶ Ep 13 · 30:10
opinion The Roux anastomosis suture choice does not make a difference in outcomes. ↗
▶ Ep 13 · 30:10
clinical For the portoenterostomy anastomosis, 6-0 Maxon suture is used with all knots tied on the outside. ↗
▶ Ep 13 · 30:10
opinion The Roux anastomosis suture choice does not make a difference in outcomes. ↗

Biliary Atresia Part II

▶ Ep 14 · 8:57
quote I think you've got to be very careful when you make those kind of statements. Because it was a properly designed randomized trial. I mean, Georgians work to do this. It's not a small number. It's 110 patients in each arm. ↗
▶ Ep 14 · 8:57
quote I think you've got to be very careful when you make those kind of statements. Because it was a properly designed randomized trial. I mean, Georgians work to do this. It's not a small number. It's 110 patients in each arm. ↗
▶ Ep 14 · 12:31
clinical Cincinnati molecular profiling identified two biliary atresia phenotypes: inflammatory (potentially steroid-responsive) and fibrotic (less likely to respond) ↗
▶ Ep 14 · 12:31
clinical Cincinnati molecular profiling identified two biliary atresia phenotypes: inflammatory (potentially steroid-responsive) and fibrotic (less likely to respond) ↗
▶ Ep 14 · 19:48
host_summary START trial antibiotic protocol: treatment dose for 2 weeks, then prophylaxis for 6 months ↗
▶ Ep 14 · 19:48
clinical Cincinnati antibiotic protocol: cephalosporin until taking PO, then Bactrim or amoxicillin for minimum 3 months post-op ↗
▶ Ep 14 · 19:48
clinical Cincinnati antibiotic protocol: cephalosporin until taking PO, then Bactrim or amoxicillin for minimum 3 months post-op ↗
▶ Ep 14 · 19:48
clinical START trial antibiotic protocol: treatment dose for 2 weeks, then prophylaxis for 6 months ↗
▶ Ep 14 · 24:14
clinical Cincinnati approach: clinical assessment with consideration of biopsy fibrosis; will explore surgically unless significant cirrhosis on pre-op biopsy; some 120-day patients have done well while some 60-day patients had advanced disease ↗
▶ Ep 14 · 24:14
quote I've done 120 day olds who actually used liver was actually reasonable and the patients are still training. ↗
▶ Ep 14 · 24:14
quote I've done 120 day olds who actually used liver was actually reasonable and the patients are still training. ↗
▶ Ep 14 · 24:14
clinical Cincinnati approach: clinical assessment with consideration of biopsy fibrosis; will explore surgically unless significant cirrhosis on pre-op biopsy; some 120-day patients have done well while some 60-day patients had advanced disease ↗
▶ Ep 14 · 27:21
clinical Cholangitis management: early recognition critical, families instructed to seek immediate medical attention for fever, not wait at home ↗
▶ Ep 14 · 27:21
clinical Cincinnati cholangitis protocol: IV antibiotics, consider short course of steroids if no response after several days ↗
▶ Ep 14 · 27:21
clinical Cincinnati cholangitis protocol: IV antibiotics, consider short course of steroids if no response after several days ↗
▶ Ep 14 · 27:21
clinical Cholangitis management: early recognition critical, families instructed to seek immediate medical attention for fever, not wait at home ↗
▶ Ep 14 · 27:21
quote If they have an episode of cholangitis, which is the biggest complication that can affect the long-term efficacy of a KASAI, we would bring them in early for antibiotics. ↗
▶ Ep 14 · 27:21
quote If they have an episode of cholangitis, which is the biggest complication that can affect the long-term efficacy of a KASAI, we would bring them in early for antibiotics. ↗
▶ Ep 14 · 29:07
clinical Cincinnati performs revision Kasai only in highly selected patients: those who previously cleared jaundice and normalized bilirubin, then became acholic after cholangitis; 25-patient series showed native liver salvage possible, some patients 5-10 years out with native liver ↗
▶ Ep 14 · 29:07
clinical Cincinnati performs revision Kasai only in highly selected patients: those who previously cleared jaundice and normalized bilirubin, then became acholic after cholangitis; 25-patient series showed native liver salvage possible, some patients 5-10 years out with native liver ↗
▶ Ep 14 · 31:22
clinical Transplant referral timing: if bilirubin has not dropped below 2 at 3 months post-Kasai, refer to transplant center for evaluation even if not immediately listing ↗
▶ Ep 14 · 31:22
clinical Transplant referral timing: if bilirubin has not dropped below 2 at 3 months post-Kasai, refer to transplant center for evaluation even if not immediately listing ↗
▶ Ep 14 · 32:54
clinical Cincinnati mouse model identified peptide sequence common to rotavirus, CMV, and EBV that may govern host immune response in biliary atresia ↗
▶ Ep 14 · 32:54
clinical Cincinnati mouse model identified peptide sequence common to rotavirus, CMV, and EBV that may govern host immune response in biliary atresia ↗

Update Course Rewind: MMP-7 & Biliary Atresia Diagnosis 2024

▶ Ep 24 · 0:53
quote What we're gonna try to touch on is a concept which is a timely diagnosis of biliatresia is critical to prolong the native liver survival. ↗
▶ Ep 24 · 0:53
clinical Timely diagnosis of biliary atresia is critical to prolong native liver survival ↗
▶ Ep 24 · 0:53
quote What we're gonna try to touch on is a concept which is a timely diagnosis of biliatresia is critical to prolong the native liver survival. ↗
▶ Ep 24 · 0:53
clinical Timely diagnosis of biliary atresia is critical to prolong native liver survival ↗
▶ Ep 24 · 2:47
clinical Cincinnati Children's stopped doing HIDA scans about 25 years ago ↗
▶ Ep 24 · 2:47
clinical Cincinnati Children's stopped doing HIDA scans about 25 years ago ↗
▶ Ep 24 · 2:50
clinical HIDA scan adds about 5 days to the diagnostic workup ↗
▶ Ep 24 · 2:50
clinical HIDA scan adds about 5 days to the diagnostic workup ↗
▶ Ep 24 · 3:17
clinical Doctor Bezarra screened about 1000 proteins in the Children's Network registry and found 70 or so that were elevated in the biliary atresia population, of which MMP-7 was the most clear ↗
▶ Ep 24 · 3:17
clinical Doctor Bezarra screened about 1000 proteins in the Children's Network registry and found 70 or so that were elevated in the biliary atresia population, of which MMP-7 was the most clear ↗
▶ Ep 24 · 4:22
clinical MMP-7 is now a validated biomarker for biliary atresia but is not perfect ↗
▶ Ep 24 · 4:22
clinical MMP-7 is now a validated biomarker for biliary atresia but is not perfect ↗
▶ Ep 24 · 4:26
quote It's not perfect. ↗
▶ Ep 24 · 4:26
quote It's not perfect. ↗
▶ Ep 24 · 4:27
clinical The sensitivity of MMP-7 is pretty good, but cutoffs vary because the assay is still evolving ↗
▶ Ep 24 · 4:27
clinical The sensitivity of MMP-7 is pretty good, but cutoffs vary because the assay is still evolving ↗
▶ Ep 24 · 4:44
clinical At Cincinnati Children's, the commitment is to perform Kasai within 7 days of a biliary atresia patient showing up ↗
▶ Ep 24 · 4:44
clinical At Cincinnati Children's, the commitment is to perform Kasai within 7 days of a biliary atresia patient showing up ↗
▶ Ep 24 · 4:44
quote Our commitment to the patients who come to our institution is within 7 days of them showing up. If they have it, they're in the OR. ↗
▶ Ep 24 · 4:44
quote Our commitment to the patients who come to our institution is within 7 days of them showing up. If they have it, they're in the OR. ↗
▶ Ep 24 · 5:03
clinical A European study showed that performing Kasai before 45 days reduces the incidence of transplant need ↗
▶ Ep 24 · 5:03
clinical A European study showed that performing Kasai before 45 days reduces the incidence of transplant need ↗
▶ Ep 24 · 5:22
guideline Kasai portoenterostomy done before 45 days is the goal ↗
▶ Ep 24 · 5:22
guideline Kasai portoenterostomy done before 45 days is the goal ↗
▶ Ep 24 · 5:27
clinical Cincinnati Children's will perform Kasai before 30 days if diagnosis can be established ↗
▶ Ep 24 · 5:27
clinical Cincinnati Children's will perform Kasai before 30 days if diagnosis can be established ↗
▶ Ep 24 · 5:37
clinical A direct bilirubin over 1 in the newborn period is very sensitive for biliary atresia ↗
▶ Ep 24 · 5:37
clinical A direct bilirubin over 1 in the newborn period is very sensitive for biliary atresia ↗
Cholestasis 68 entries

Biliary Atresia

▶ Ep 2 · 1:42
epidemiological Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to recognition of inborn errors of bile acid metabolism and genotyping of progressive familial intrahepatic cholestasis (PFIC). ↗
▶ Ep 2 · 1:42
epidemiological Idiopathic neonatal hepatitis has decreased from 70% of cholestatic infants in the 1970s-1980s to approximately 10% currently due to recognition of inborn errors of bile acid metabolism and genotyping of progressive familial intrahepatic cholestasis (PFIC). ↗
▶ Ep 2 · 1:43
quote If you actually looked at studies from the 70s and 1980s, idiopathic neonatal hepatitis would be about 70% of the patients. Now it's probably down to 10% ↗
▶ Ep 2 · 1:43
quote If you actually looked at studies from the 70s and 1980s, idiopathic neonatal hepatitis would be about 70% of the patients. Now it's probably down to 10% ↗
▶ Ep 2 · 3:25
clinical The jaundice chip is a microarray gene chip that tests for PFIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin, and JAG-1 mutation, but takes 4-6 weeks to return results. ↗
▶ Ep 2 · 3:25
clinical The jaundice chip is a microarray gene chip that tests for PFIC abnormalities (PFIC 1, 2, 3), alpha-1 antitrypsin, and JAG-1 mutation, but takes 4-6 weeks to return results. ↗
▶ Ep 2 · 4:51
quote The absence of A gallbladder on ultrasound does not conclusively show biliary atresia. The corollary to that, of course, is the presence of a gallbladder doesn't exclude biliary atresia ↗
▶ Ep 2 · 4:51
clinical The absence of a gallbladder on ultrasound does not conclusively show biliary atresia, and the presence of a gallbladder does not exclude biliary atresia due to sophisticated ultrasound probe sensitivity. ↗
▶ Ep 2 · 4:51
quote The absence of A gallbladder on ultrasound does not conclusively show biliary atresia. The corollary to that, of course, is the presence of a gallbladder doesn't exclude biliary atresia ↗
▶ Ep 2 · 4:51
clinical The absence of a gallbladder on ultrasound does not conclusively show biliary atresia, and the presence of a gallbladder does not exclude biliary atresia due to sophisticated ultrasound probe sensitivity. ↗
▶ Ep 2 · 5:14
clinical The triangular cord sign is a radiographic finding representing the fibrous plate above the portal vein where bile ducts were supposed to be, now showing inflammatory fibrous scar. ↗
▶ Ep 2 · 5:14
clinical The triangular cord sign is a radiographic finding representing the fibrous plate above the portal vein where bile ducts were supposed to be, now showing inflammatory fibrous scar. ↗
▶ Ep 2 · 5:41
opinion At Cincinnati Children's Hospital, HIDA scans are not routinely used because the 3-5 day phenobarbital loading period can delay intervention into a time period potentially detrimental to Kasai outcome. ↗
▶ Ep 2 · 5:41
quote At our hospital we actually don't use HIDA scans and in fact if we order a HIDA scan, Dr. Ballesterri, our senior most hepatologists, looks upon it quite poorly. ↗
▶ Ep 2 · 5:41
quote At our hospital we actually don't use HIDA scans and in fact if we order a HIDA scan, Dr. Ballesterri, our senior most hepatologists, looks upon it quite poorly. ↗
▶ Ep 2 · 5:41
opinion At Cincinnati Children's Hospital, HIDA scans are not routinely used because the 3-5 day phenobarbital loading period can delay intervention into a time period potentially detrimental to Kasai outcome. ↗
▶ Ep 2 · 8:23
clinical Pathognomonic findings on liver biopsy for biliary atresia include significant bile duct proliferation in portal triads and bile plugs within bile ducts, with likelihood of biliary atresia exceeding 90% when these are present. ↗
▶ Ep 2 · 8:23
clinical Pathognomonic findings on liver biopsy for biliary atresia include significant bile duct proliferation in portal triads and bile plugs within bile ducts, with likelihood of biliary atresia exceeding 90% when these are present. ↗
▶ Ep 2 · 8:34
quote If you see that, the confirmatory, I mean the likelihood of it being biliotresia is well over 90+%. It's very rare that you will have a misdiagnosis at this stage. ↗
▶ Ep 2 · 8:34
quote If you see that, the confirmatory, I mean the likelihood of it being biliotresia is well over 90+%. It's very rare that you will have a misdiagnosis at this stage. ↗
▶ Ep 2 · 8:50
clinical At Cincinnati, liver biopsies are reviewed with pathologists before taking patients to the operating room, making intraoperative decision-making easier and sometimes reducing the necessity of intraoperative cholangiogram. ↗
▶ Ep 2 · 8:50
clinical At Cincinnati, liver biopsies are reviewed with pathologists before taking patients to the operating room, making intraoperative decision-making easier and sometimes reducing the necessity of intraoperative cholangiogram. ↗
▶ Ep 2 · 10:28
clinical Alagille syndrome patients do not have the same bile duct proliferation as biliary atresia patients and will not have the pathognomonic finding of a bile duct plug. ↗
▶ Ep 2 · 10:28
clinical Alagille syndrome patients do not have the same bile duct proliferation as biliary atresia patients and will not have the pathognomonic finding of a bile duct plug. ↗
▶ Ep 2 · 11:27
clinical At Cincinnati, the workup for biliary atresia is limited to liver biopsy, labs, and ultrasound before posting the patient for surgery. ↗
▶ Ep 2 · 11:27
clinical At Cincinnati, the workup for biliary atresia is limited to liver biopsy, labs, and ultrasound before posting the patient for surgery. ↗
▶ Ep 2 · 12:07
clinical The extended hilar dissection technique, going to the first bifurcation of vessels beyond the portal vein, is the proper way Kasai originally described the procedure. ↗
▶ Ep 2 · 12:07
clinical The extended hilar dissection technique, going to the first bifurcation of vessels beyond the portal vein, is the proper way Kasai originally described the procedure. ↗
▶ Ep 2 · 12:26
quote This is what the Japanese will call an extended dissection, where they'll go to the first bifurcation of the vessels. This is actually the proper way or the way Kasai. Described it ↗
▶ Ep 2 · 12:26
quote This is what the Japanese will call an extended dissection, where they'll go to the first bifurcation of the vessels. This is actually the proper way or the way Kasai. Described it ↗
▶ Ep 2 · 12:35
opinion Japanese centers uniformly perform extended dissections, which may explain why their Kasai outcomes are better than those in the United States. ↗
▶ Ep 2 · 12:35
opinion Japanese centers uniformly perform extended dissections, which may explain why their Kasai outcomes are better than those in the United States. ↗
▶ Ep 2 · 13:26
clinical Polysplenia syndrome patients with biliary atresia are the most difficult cases because they often have pre-duodenal portal veins and frequently have no bile duct remnant, making Kasai nearly impossible in this population. ↗
▶ Ep 2 · 13:26
clinical Polysplenia syndrome patients with biliary atresia are the most difficult cases because they often have pre-duodenal portal veins and frequently have no bile duct remnant, making Kasai nearly impossible in this population. ↗
▶ Ep 2 · 14:57
clinical Data from England by Mark Davenport showed that cystic variants of biliary atresia have better outcomes if intervention occurs before 30 days of age. ↗
▶ Ep 2 · 14:57
host_summary Data from England by Mark Davenport showed that cystic variants of biliary atresia have better outcomes if intervention occurs before 30 days of age. ↗
▶ Ep 2 · 15:14
clinical Choledochal cyst patients will have pigmented stool, while cystic variant biliary atresia patients will become acholic, providing a simple clinical differentiation. ↗
▶ Ep 2 · 15:14
clinical Choledochal cyst patients will have pigmented stool, while cystic variant biliary atresia patients will become acholic, providing a simple clinical differentiation. ↗
▶ Ep 2 · 15:42
clinical A Roux limb length of 20 cm is inadequate because 5-8 cm of length is almost always lost during hilar dissection at the time of transplant. ↗
▶ Ep 2 · 15:42
clinical A Roux limb length of 20 cm is inadequate because 5-8 cm of length is almost always lost during hilar dissection at the time of transplant. ↗
▶ Ep 2 · 15:47
quote 20 is not good for a transplant team because almost always you'll lose 5 to 78 centimeters of length on your root at the time of the hilar dissection. ↗
▶ Ep 2 · 15:47
quote 20 is not good for a transplant team because almost always you'll lose 5 to 78 centimeters of length on your root at the time of the hilar dissection. ↗
▶ Ep 2 · 16:09
clinical The target Roux limb length should be 30-40 cm to preserve adequate length for transplant teams, as one advantage of transplanting biliary atresia patients is having a pre-existing Roux limb. ↗
▶ Ep 2 · 16:09
clinical The target Roux limb length should be 30-40 cm to preserve adequate length for transplant teams, as one advantage of transplanting biliary atresia patients is having a pre-existing Roux limb. ↗
▶ Ep 2 · 16:32
clinical Anti-refluxing valves for the Roux limb have not been proven effective. ↗
▶ Ep 2 · 16:32
clinical Anti-refluxing valves for the Roux limb have not been proven effective. ↗
▶ Ep 2 · 17:11
epidemiological UK data from approximately 15 years ago showed that centers performing more than 5 biliary atresia cases per year had statistically significantly better outcomes (approximately 20% difference) than those performing fewer cases. ↗
▶ Ep 2 · 17:11
host_summary UK data from approximately 15 years ago showed that centers performing more than 5 biliary atresia cases per year had statistically significantly better outcomes (approximately 20% difference) than those performing fewer cases. ↗
▶ Ep 2 · 17:11
quote It's pretty clear cut that when they localized or focused on the group just 3 centers doing their biliatresis, that the 3 centers that did more than 5 cases a year had. Much better outcomes than those who had less. ↗
▶ Ep 2 · 17:11
quote It's pretty clear cut that when they localized or focused on the group just 3 centers doing their biliatresis, that the 3 centers that did more than 5 cases a year had. Much better outcomes than those who had less. ↗
▶ Ep 2 · 17:38
guideline The British health service focused all Kasai procedures at three high-volume centers, which are the only centers that can be reimbursed for the procedure. ↗
▶ Ep 2 · 17:38
guideline The British health service focused all Kasai procedures at three high-volume centers, which are the only centers that can be reimbursed for the procedure. ↗
▶ Ep 2 · 18:03
clinical Two European studies (King's Group using 2 mg/kg steroids and Klaus Peterson's German group using 10 mg/kg for 5 days) showed no benefit from postoperative corticosteroids in biliary atresia. ↗
▶ Ep 2 · 18:03
host_summary Two European studies (King's Group using 2 mg/kg steroids and Klaus Peterson's German group using 10 mg/kg for 5 days) showed no benefit from postoperative corticosteroids in biliary atresia. ↗
▶ Ep 2 · 18:22
clinical The Children's Network biliary atresia Research Consortium multi-center trial with approximately 70 patients in two arms showed no improvement in bile drainage with corticosteroid use and a slight increase in adverse events (primarily medical rather than surgical complications). ↗
▶ Ep 2 · 18:22
quote The Children's Network, which is the national biliotreia Research Consortium, did a multi. Center trial in which they had about 70 patients enrolled in two different arms and they showed clearly that there was no improvement of drainage in terms of corticosteroid use between those who got it and those who didn't. ↗
▶ Ep 2 · 18:22
quote The Children's Network, which is the national biliotreia Research Consortium, did a multi. Center trial in which they had about 70 patients enrolled in two different arms and they showed clearly that there was no improvement of drainage in terms of corticosteroid use between those who got it and those who didn't. ↗
▶ Ep 2 · 18:22
host_summary The Children's Network biliary atresia Research Consortium multi-center trial with approximately 70 patients in two arms showed no improvement in bile drainage with corticosteroid use and a slight increase in adverse events (primarily medical rather than surgical complications). ↗
▶ Ep 2 · 18:57
opinion Despite negative trial results, there is a subset of biliary atresia patients with an inflammatory gene profile in which steroids might prove beneficial. ↗
▶ Ep 2 · 18:57
opinion Despite negative trial results, there is a subset of biliary atresia patients with an inflammatory gene profile in which steroids might prove beneficial. ↗
▶ Ep 2 · 19:39
clinical Cincinnati does not use MRCP for biliary atresia diagnosis due to having a high-capacity pathology team. ↗
▶ Ep 2 · 19:39
clinical Cincinnati does not use MRCP for biliary atresia diagnosis due to having a high-capacity pathology team. ↗
▶ Ep 2 · 20:12
quote If you cassa and Alis patients, you will shorten their natural. History of that liver staying with them and they will be transplanted sooner. That's actually fairly clear cut. ↗
▶ Ep 2 · 20:12
clinical Performing Kasai on Alagille syndrome patients will shorten the natural history of their native liver and result in earlier transplantation. ↗
▶ Ep 2 · 20:12
clinical Performing Kasai on Alagille syndrome patients will shorten the natural history of their native liver and result in earlier transplantation. ↗
▶ Ep 2 · 20:12
quote If you cassa and Alis patients, you will shorten their natural. History of that liver staying with them and they will be transplanted sooner. That's actually fairly clear cut. ↗
▶ Ep 2 · 20:21
clinical For patients with cholestasis where biliary atresia diagnosis is uncertain, workup includes echocardiogram to rule out pulmonic stenosis, spine X-rays to rule out butterfly vertebrae, and eye exams, all to evaluate for Alagille syndrome. ↗
▶ Ep 2 · 20:21
clinical For patients with cholestasis where biliary atresia diagnosis is uncertain, workup includes echocardiogram to rule out pulmonic stenosis, spine X-rays to rule out butterfly vertebrae, and eye exams, all to evaluate for Alagille syndrome. ↗
Fetal Surgery 42 entries

Urologic Fetal Intervention: Cincinnati Fetal Center

▶ Ep 3 · 7:38
clinical When a vesicoamniotic shunt is placed, the bladder often collapses and upper tracts decompress significantly, though residual hydroureteronephrosis may persist. ↗
▶ Ep 3 · 7:38
clinical When a vesicoamniotic shunt is placed, the bladder often collapses and upper tracts decompress significantly, though residual hydroureteronephrosis may persist. ↗
▶ Ep 3 · 11:35
epidemiological Fetoscopic cystoscopy altered the diagnosis in 25–33% of fetuses with suspected LUTO, according to a review by Katie Morris. ↗
▶ Ep 3 · 11:35
host_summary Fetoscopic cystoscopy altered the diagnosis in 25–33% of fetuses with suspected LUTO, according to a review by Katie Morris. ↗
▶ Ep 3 · 11:58
guideline Fetoscopic cystoscopy must be considered experimental for LUTO until properly evaluated in a rigorous trial. ↗
▶ Ep 3 · 11:58
guideline Fetoscopic cystoscopy must be considered experimental for LUTO until properly evaluated in a rigorous trial. ↗
▶ Ep 3 · 12:09
epidemiological A French-Brazilian-Houston study of 111 LUTO fetuses found that only cystoscopy (not shunting) may prevent renal function impairment at 6 months of age. ↗
▶ Ep 3 · 12:09
host_summary A French-Brazilian-Houston study of 111 LUTO fetuses found that only cystoscopy (not shunting) may prevent renal function impairment at 6 months of age. ↗
▶ Ep 3 · 12:55
host_summary In a Barcelona-Leuven series of 20 fetoscopic valve ablations, bladder size and amniotic fluid normalized in 80% of cases; among livebirths, there was no pulmonary hypoplasia and three-quarters had normal renal function. ↗
▶ Ep 3 · 12:55
epidemiological In a Barcelona-Leuven series of 20 fetoscopic valve ablations, bladder size and amniotic fluid normalized in 80% of cases; among livebirths, there was no pulmonary hypoplasia and three-quarters had normal renal function. ↗
▶ Ep 3 · 13:36
clinical Fetoscopic valve ablation carries a 9–10% risk of urethral fistula and a 6% risk of recurrent severe LUTO. ↗
▶ Ep 3 · 13:36
host_summary Fetoscopic valve ablation carries a 9–10% risk of urethral fistula and a 6% risk of recurrent severe LUTO. ↗
▶ Ep 3 · 14:06
clinical Vesicoamniotic shunt complications include migration, blockage, and (rarely) iatrogenic gastroschisis when placed at 17 weeks. ↗
▶ Ep 3 · 14:06
clinical Vesicoamniotic shunt complications include migration, blockage, and (rarely) iatrogenic gastroschisis when placed at 17 weeks. ↗
▶ Ep 3 · 34:57
epidemiological In Mark Johnson's historical studies, the third vesicocentesis provided fresher urine that correlated strongly with histologic renal damage; the first and second taps were not predictive. ↗
▶ Ep 3 · 34:57
epidemiological In Mark Johnson's historical studies, the third vesicocentesis provided fresher urine that correlated strongly with histologic renal damage; the first and second taps were not predictive. ↗
▶ Ep 3 · 35:41
quote The Pluto trial had many, many flaws. ↗
▶ Ep 3 · 35:41
quote The Pluto trial had many, many flaws. ↗
▶ Ep 3 · 37:04
quote The major renal morbidity comes postnatally. ↗
▶ Ep 3 · 37:04
quote The major renal morbidity comes postnatally. ↗
▶ Ep 3 · 43:12
opinion Greg Ryan argues there is no role for open fetal surgery in LUTO, especially in the worst-prognosis group, given the maternal and fetal risks and the experimental nature of the procedure. ↗
▶ Ep 3 · 43:12
opinion Greg Ryan argues there is no role for open fetal surgery in LUTO, especially in the worst-prognosis group, given the maternal and fetal risks and the experimental nature of the procedure. ↗
▶ Ep 3 · 43:18
quote I would argue that there is absolutely no role for open surgery for a fetus, particularly the ones in the group you've identified, and I think your own results are simply supporting that. ↗
▶ Ep 3 · 43:18
quote I would argue that there is absolutely no role for open surgery for a fetus, particularly the ones in the group you've identified, and I think your own results are simply supporting that. ↗
▶ Ep 3 · 49:58
epidemiological In a long-term follow-up series, one-third of shunted LUTO survivors developed end-stage renal disease requiring transplant after age 5 years, despite having acceptable discharge creatinine. ↗
▶ Ep 3 · 49:58
epidemiological In a long-term follow-up series, one-third of shunted LUTO survivors developed end-stage renal disease requiring transplant after age 5 years, despite having acceptable discharge creatinine. ↗
▶ Ep 3 · 51:24
epidemiological Posterior urethral valve patients required transplant at median age 10–12 years; prune belly/urethral hypoplasia at ~4.5 years; urethral atresia earlier. ↗
▶ Ep 3 · 51:24
epidemiological Posterior urethral valve patients required transplant at median age 10–12 years; prune belly/urethral hypoplasia at ~4.5 years; urethral atresia earlier. ↗
▶ Ep 3 · 52:13
clinical Progressive renal injury in shunted LUTO survivors is driven by repeated urinary tract infections, vesicoureteral reflux, and valve bladder dysfunction. ↗
▶ Ep 3 · 52:13
clinical Progressive renal injury in shunted LUTO survivors is driven by repeated urinary tract infections, vesicoureteral reflux, and valve bladder dysfunction. ↗
▶ Ep 3 · 52:49
quote These MFM crazy people are trying to give us survivors of what would have otherwise been a lethal disease. ↗
▶ Ep 3 · 52:49
quote These MFM crazy people are trying to give us survivors of what would have otherwise been a lethal disease. ↗
▶ Ep 3 · 54:16
quote We may be giving you pretty good kids, but we really have to figure out how to protect those kidneys after these kids are born. ↗
▶ Ep 3 · 54:16
quote We may be giving you pretty good kids, but we really have to figure out how to protect those kidneys after these kids are born. ↗
▶ Ep 3 · 58:46
opinion Mark Johnson's closing pearl: patient selection is the most critical factor in fetal intervention for LUTO. ↗
▶ Ep 3 · 58:46
opinion Mark Johnson's closing pearl: patient selection is the most critical factor in fetal intervention for LUTO. ↗
▶ Ep 3 · 58:51
quote Selection, selection, selection. ↗
▶ Ep 3 · 58:51
quote Selection, selection, selection. ↗
▶ Ep 3 · 1:00:04
opinion Greg Ryan's closing pearl: just because a procedure can be done does not mean it should be done; honest counseling about outcomes is essential. ↗
▶ Ep 3 · 1:00:04
opinion Greg Ryan's closing pearl: just because a procedure can be done does not mean it should be done; honest counseling about outcomes is essential. ↗
▶ Ep 3 · 1:00:42
quote Just because we can do them doesn't always mean we should do them. ↗
▶ Ep 3 · 1:00:42
quote Just because we can do them doesn't always mean we should do them. ↗
Hepatoblastoma 36 entries

Hepatoblastoma with Dr. Greg Tiao

▶ Ep 4 · 0:15
epidemiological There are around 250 new cases of hepatoblastoma per year. ↗
▶ Ep 4 · 0:15
quote So, Hepatoblastoma, there's around 250 new cases a year. Huge changes in terms of the treatment algorithm over the last 20 years. ↗
▶ Ep 4 · 0:51
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 4 · 1:41
epidemiological Hemangioma is the most common liver lesion in children. ↗
▶ Ep 4 · 1:41
quote The most common lesion is hemangioma. Even though hepatoblastoma is the most common malignant liver tumor in children, it's still pretty rare with about 250 cases per year. ↗
▶ Ep 4 · 1:41
quote Common things being common, hemangioma should be pretty high on the list. ↗
▶ Ep 4 · 3:00
quote EOVIST is an MRI contrast agent that is taken up by the hepatocytes and then excreted. It can provide the best definition when looking at the liver on imaging. ↗
▶ Ep 4 · 3:00
clinical EOVIST is an MRI contrast agent that is taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging and distinguishing biliary anatomy. ↗
▶ Ep 4 · 4:08
clinical Couinaud labeled the liver segments in a counterclockwise fashion after the districts of Paris, by injecting portal vessels. ↗
▶ Ep 4 · 4:08
quote He injected them into portal vessels. And so that's really how these are labeled. But he labeled them in this counterclockwise fashion after, I can never pronounce this, but the districts of Paris are done in the same fashion. ↗
▶ Ep 4 · 4:45
clinical The right hepatic vein differentiates the anterior sections (segments 5 and 8) from the posterior sections (segments 6 and 7) of the right liver. ↗
▶ Ep 4 · 4:45
clinical The right portal vein separates superior segments (7 and 8) from inferior segments (5 and 6) in the right liver. ↗
▶ Ep 4 · 7:15
quote Pretext 3 and 4 is the big game changer. This change in practice is what improves survival rates for patients with hepatoblastoma from less than 30% in the 70s and 80s to between 80 and 90% today. ↗
▶ Ep 4 · 7:15
epidemiological The change in practice for PRETEXT 3 and 4 tumors improved survival rates for patients with hepatoblastoma from less than 30% in the 1970s and 1980s to between 80 and 90% today. ↗
▶ Ep 4 · 7:31
guideline PRETEXT 3 tumors should generally be biopsied at diagnosis and then started on neoadjuvant chemotherapy, with readiness to send patients to a transplant center or a center with expertise in advanced liver resections depending on response. ↗
▶ Ep 4 · 7:31
guideline For PRETEXT 3 or 4 liver disease, specific indications for transplant include unresectable disease, unsafe resection, or resection that would leave the patient with an inadequate liver remnant. ↗
▶ Ep 4 · 8:19
clinical Teams are now trained to recognize hepatoblastoma tumors and send them to centers that offer transplant or can do aggressive resection, resulting in more patient referrals than 15 years ago. ↗
▶ Ep 4 · 8:19
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program 15 years ago. Because teams are trained to recognize tumors and send them to a center that offers transplant or can do aggressive resection. ↗
▶ Ep 4 · 9:06
clinical The FIT study has been ongoing for three years. ↗
▶ Ep 4 · 9:06
quote The FIT study has been going on now for three years. We've had the privilege of contributing to it in terms of its development. ↗

Hepatoblastoma with Dr. Greg Tiao

▶ Ep 5 · 0:46
epidemiological Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children ↗
▶ Ep 5 · 0:46
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 5 · 2:20
clinical Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size ↗
▶ Ep 5 · 3:13
clinical Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma ↗
▶ Ep 5 · 3:13
clinical Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging ↗
▶ Ep 5 · 4:25
clinical Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation ↗
▶ Ep 5 · 5:41
clinical The right hepatic vein differentiates anterior and posterior sections of the right liver ↗
▶ Ep 5 · 6:02
clinical The right portal vein separates superior and inferior segments of the right liver ↗
▶ Ep 5 · 6:51
clinical The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage) ↗
▶ Ep 5 · 6:51
clinical Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor ↗
▶ Ep 5 · 8:15
clinical Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today ↗
▶ Ep 5 · 8:15
clinical Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections ↗
▶ Ep 5 · 9:35
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection. ↗
▶ Ep 5 · 9:35
clinical It is important to consult a transplant center early for pre-text 3 and 4 tumors ↗
▶ Ep 5 · 10:27
clinical The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage ↗
▶ Ep 5 · 10:27
clinical The PHITT study has been ongoing for three years ↗
Liver Tumors (Hepatoblastoma/HCC) 56 entries

Hepatoblastoma with Dr. Greg Tiao

▶ Ep 4 · 0:15
quote So, Hepatoblastoma, there's around 250 new cases a year. Huge changes in terms of the treatment algorithm over the last 20 years. ↗
▶ Ep 4 · 0:15
epidemiological There are around 250 new cases of hepatoblastoma per year. ↗
▶ Ep 4 · 0:15
quote So, Hepatoblastoma, there's around 250 new cases a year. Huge changes in terms of the treatment algorithm over the last 20 years. ↗
▶ Ep 4 · 0:15
epidemiological There are around 250 new cases of hepatoblastoma per year. ↗
▶ Ep 4 · 0:51
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 4 · 0:51
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 4 · 1:41
quote The most common lesion is hemangioma. Even though hepatoblastoma is the most common malignant liver tumor in children, it's still pretty rare with about 250 cases per year. ↗
▶ Ep 4 · 1:41
quote The most common lesion is hemangioma. Even though hepatoblastoma is the most common malignant liver tumor in children, it's still pretty rare with about 250 cases per year. ↗
▶ Ep 4 · 1:41
epidemiological Hemangioma is the most common liver lesion in children. ↗
▶ Ep 4 · 1:41
quote Common things being common, hemangioma should be pretty high on the list. ↗
▶ Ep 4 · 1:41
epidemiological Hemangioma is the most common liver lesion in children. ↗
▶ Ep 4 · 1:41
quote Common things being common, hemangioma should be pretty high on the list. ↗
▶ Ep 4 · 3:00
clinical EOVIST is an MRI contrast agent that is taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging and distinguishing biliary anatomy. ↗
▶ Ep 4 · 3:00
quote EOVIST is an MRI contrast agent that is taken up by the hepatocytes and then excreted. It can provide the best definition when looking at the liver on imaging. ↗
▶ Ep 4 · 3:00
quote EOVIST is an MRI contrast agent that is taken up by the hepatocytes and then excreted. It can provide the best definition when looking at the liver on imaging. ↗
▶ Ep 4 · 3:00
clinical EOVIST is an MRI contrast agent that is taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging and distinguishing biliary anatomy. ↗
▶ Ep 4 · 4:08
quote He injected them into portal vessels. And so that's really how these are labeled. But he labeled them in this counterclockwise fashion after, I can never pronounce this, but the districts of Paris are done in the same fashion. ↗
▶ Ep 4 · 4:08
clinical Couinaud labeled the liver segments in a counterclockwise fashion after the districts of Paris, by injecting portal vessels. ↗
▶ Ep 4 · 4:08
quote He injected them into portal vessels. And so that's really how these are labeled. But he labeled them in this counterclockwise fashion after, I can never pronounce this, but the districts of Paris are done in the same fashion. ↗
▶ Ep 4 · 4:08
clinical Couinaud labeled the liver segments in a counterclockwise fashion after the districts of Paris, by injecting portal vessels. ↗
▶ Ep 4 · 4:45
clinical The right hepatic vein differentiates the anterior sections (segments 5 and 8) from the posterior sections (segments 6 and 7) of the right liver. ↗
▶ Ep 4 · 4:45
clinical The right portal vein separates superior segments (7 and 8) from inferior segments (5 and 6) in the right liver. ↗
▶ Ep 4 · 4:45
clinical The right portal vein separates superior segments (7 and 8) from inferior segments (5 and 6) in the right liver. ↗
▶ Ep 4 · 4:45
clinical The right hepatic vein differentiates the anterior sections (segments 5 and 8) from the posterior sections (segments 6 and 7) of the right liver. ↗
▶ Ep 4 · 7:15
epidemiological The change in practice for PRETEXT 3 and 4 tumors improved survival rates for patients with hepatoblastoma from less than 30% in the 1970s and 1980s to between 80 and 90% today. ↗
▶ Ep 4 · 7:15
quote Pretext 3 and 4 is the big game changer. This change in practice is what improves survival rates for patients with hepatoblastoma from less than 30% in the 70s and 80s to between 80 and 90% today. ↗
▶ Ep 4 · 7:15
quote Pretext 3 and 4 is the big game changer. This change in practice is what improves survival rates for patients with hepatoblastoma from less than 30% in the 70s and 80s to between 80 and 90% today. ↗
▶ Ep 4 · 7:15
epidemiological The change in practice for PRETEXT 3 and 4 tumors improved survival rates for patients with hepatoblastoma from less than 30% in the 1970s and 1980s to between 80 and 90% today. ↗
▶ Ep 4 · 7:31
guideline For PRETEXT 3 or 4 liver disease, specific indications for transplant include unresectable disease, unsafe resection, or resection that would leave the patient with an inadequate liver remnant. ↗
▶ Ep 4 · 7:31
guideline PRETEXT 3 tumors should generally be biopsied at diagnosis and then started on neoadjuvant chemotherapy, with readiness to send patients to a transplant center or a center with expertise in advanced liver resections depending on response. ↗
▶ Ep 4 · 7:31
guideline For PRETEXT 3 or 4 liver disease, specific indications for transplant include unresectable disease, unsafe resection, or resection that would leave the patient with an inadequate liver remnant. ↗
▶ Ep 4 · 7:31
guideline PRETEXT 3 tumors should generally be biopsied at diagnosis and then started on neoadjuvant chemotherapy, with readiness to send patients to a transplant center or a center with expertise in advanced liver resections depending on response. ↗
▶ Ep 4 · 8:19
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program 15 years ago. Because teams are trained to recognize tumors and send them to a center that offers transplant or can do aggressive resection. ↗
▶ Ep 4 · 8:19
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program 15 years ago. Because teams are trained to recognize tumors and send them to a center that offers transplant or can do aggressive resection. ↗
▶ Ep 4 · 8:19
clinical Teams are now trained to recognize hepatoblastoma tumors and send them to centers that offer transplant or can do aggressive resection, resulting in more patient referrals than 15 years ago. ↗
▶ Ep 4 · 8:19
clinical Teams are now trained to recognize hepatoblastoma tumors and send them to centers that offer transplant or can do aggressive resection, resulting in more patient referrals than 15 years ago. ↗
▶ Ep 4 · 9:06
quote The FIT study has been going on now for three years. We've had the privilege of contributing to it in terms of its development. ↗
▶ Ep 4 · 9:06
clinical The FIT study has been ongoing for three years. ↗
▶ Ep 4 · 9:06
quote The FIT study has been going on now for three years. We've had the privilege of contributing to it in terms of its development. ↗
▶ Ep 4 · 9:06
clinical The FIT study has been ongoing for three years. ↗

Hepatoblastoma with Dr. Greg Tiao

▶ Ep 5 · 0:46
epidemiological Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children ↗
▶ Ep 5 · 0:46
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 5 · 2:20
clinical Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size ↗
▶ Ep 5 · 3:13
clinical Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging ↗
▶ Ep 5 · 3:13
clinical Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma ↗
▶ Ep 5 · 4:25
clinical Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation ↗
▶ Ep 5 · 5:41
clinical The right hepatic vein differentiates anterior and posterior sections of the right liver ↗
▶ Ep 5 · 6:02
clinical The right portal vein separates superior and inferior segments of the right liver ↗
▶ Ep 5 · 6:51
clinical Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor ↗
▶ Ep 5 · 6:51
clinical The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage) ↗
▶ Ep 5 · 8:15
clinical Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today ↗
▶ Ep 5 · 8:15
clinical Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections ↗
▶ Ep 5 · 9:35
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection. ↗
▶ Ep 5 · 9:35
clinical It is important to consult a transplant center early for pre-text 3 and 4 tumors ↗
▶ Ep 5 · 10:27
clinical The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage ↗
▶ Ep 5 · 10:27
clinical The PHITT study has been ongoing for three years ↗
Lower Urinary Tract Obstruction 21 entries

Urologic Fetal Intervention: Cincinnati Fetal Center

▶ Ep 2 · 7:38
clinical When a vesicoamniotic shunt is placed, the bladder often collapses and upper tracts decompress significantly, though residual hydroureteronephrosis may persist. ↗
▶ Ep 2 · 11:35
host_summary Fetoscopic cystoscopy altered the diagnosis in 25–33% of fetuses with suspected LUTO, according to a review by Katie Morris. ↗
▶ Ep 2 · 11:58
guideline Fetoscopic cystoscopy must be considered experimental for LUTO until properly evaluated in a rigorous trial. ↗
▶ Ep 2 · 12:09
host_summary A French-Brazilian-Houston study of 111 LUTO fetuses found that only cystoscopy (not shunting) may prevent renal function impairment at 6 months of age. ↗
▶ Ep 2 · 12:55
host_summary In a Barcelona-Leuven series of 20 fetoscopic valve ablations, bladder size and amniotic fluid normalized in 80% of cases; among livebirths, there was no pulmonary hypoplasia and three-quarters had normal renal function. ↗
▶ Ep 2 · 13:36
host_summary Fetoscopic valve ablation carries a 9–10% risk of urethral fistula and a 6% risk of recurrent severe LUTO. ↗
▶ Ep 2 · 14:06
clinical Vesicoamniotic shunt complications include migration, blockage, and (rarely) iatrogenic gastroschisis when placed at 17 weeks. ↗
▶ Ep 2 · 34:57
epidemiological In Mark Johnson's historical studies, the third vesicocentesis provided fresher urine that correlated strongly with histologic renal damage; the first and second taps were not predictive. ↗
▶ Ep 2 · 35:41
quote The Pluto trial had many, many flaws. ↗
▶ Ep 2 · 37:04
quote The major renal morbidity comes postnatally. ↗
▶ Ep 2 · 43:12
opinion Greg Ryan argues there is no role for open fetal surgery in LUTO, especially in the worst-prognosis group, given the maternal and fetal risks and the experimental nature of the procedure. ↗
▶ Ep 2 · 43:18
quote I would argue that there is absolutely no role for open surgery for a fetus, particularly the ones in the group you've identified, and I think your own results are simply supporting that. ↗
▶ Ep 2 · 49:58
epidemiological In a long-term follow-up series, one-third of shunted LUTO survivors developed end-stage renal disease requiring transplant after age 5 years, despite having acceptable discharge creatinine. ↗
▶ Ep 2 · 51:24
epidemiological Posterior urethral valve patients required transplant at median age 10–12 years; prune belly/urethral hypoplasia at ~4.5 years; urethral atresia earlier. ↗
▶ Ep 2 · 52:13
clinical Progressive renal injury in shunted LUTO survivors is driven by repeated urinary tract infections, vesicoureteral reflux, and valve bladder dysfunction. ↗
▶ Ep 2 · 52:49
quote These MFM crazy people are trying to give us survivors of what would have otherwise been a lethal disease. ↗
▶ Ep 2 · 54:16
quote We may be giving you pretty good kids, but we really have to figure out how to protect those kidneys after these kids are born. ↗
▶ Ep 2 · 58:46
opinion Mark Johnson's closing pearl: patient selection is the most critical factor in fetal intervention for LUTO. ↗
▶ Ep 2 · 58:51
quote Selection, selection, selection. ↗
▶ Ep 2 · 1:00:04
opinion Greg Ryan's closing pearl: just because a procedure can be done does not mean it should be done; honest counseling about outcomes is essential. ↗
▶ Ep 2 · 1:00:42
quote Just because we can do them doesn't always mean we should do them. ↗
Neuroblastoma 16 entries

Hepatoblastoma with Dr. Greg Tiao

▶ Ep 9 · 0:46
epidemiological Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children ↗
▶ Ep 9 · 0:46
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 9 · 2:20
clinical Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size ↗
▶ Ep 9 · 3:13
clinical Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma ↗
▶ Ep 9 · 3:13
clinical Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging ↗
▶ Ep 9 · 4:25
clinical Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation ↗
▶ Ep 9 · 5:41
clinical The right hepatic vein differentiates anterior and posterior sections of the right liver ↗
▶ Ep 9 · 6:02
clinical The right portal vein separates superior and inferior segments of the right liver ↗
▶ Ep 9 · 6:51
clinical Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor ↗
▶ Ep 9 · 6:51
clinical The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage) ↗
▶ Ep 9 · 8:15
clinical Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today ↗
▶ Ep 9 · 8:15
clinical Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections ↗
▶ Ep 9 · 9:35
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection. ↗
▶ Ep 9 · 9:35
clinical It is important to consult a transplant center early for pre-text 3 and 4 tumors ↗
▶ Ep 9 · 10:27
clinical The PHITT study has been ongoing for three years ↗
▶ Ep 9 · 10:27
clinical The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage ↗
Posterior Urethral Valves 21 entries

Urologic Fetal Intervention: Cincinnati Fetal Center

▶ Ep 2 · 7:38
clinical When a vesicoamniotic shunt is placed, the bladder often collapses and upper tracts decompress significantly, though residual hydroureteronephrosis may persist. ↗
▶ Ep 2 · 11:35
host_summary Fetoscopic cystoscopy altered the diagnosis in 25–33% of fetuses with suspected LUTO, according to a review by Katie Morris. ↗
▶ Ep 2 · 11:58
guideline Fetoscopic cystoscopy must be considered experimental for LUTO until properly evaluated in a rigorous trial. ↗
▶ Ep 2 · 12:09
host_summary A French-Brazilian-Houston study of 111 LUTO fetuses found that only cystoscopy (not shunting) may prevent renal function impairment at 6 months of age. ↗
▶ Ep 2 · 12:55
host_summary In a Barcelona-Leuven series of 20 fetoscopic valve ablations, bladder size and amniotic fluid normalized in 80% of cases; among livebirths, there was no pulmonary hypoplasia and three-quarters had normal renal function. ↗
▶ Ep 2 · 13:36
host_summary Fetoscopic valve ablation carries a 9–10% risk of urethral fistula and a 6% risk of recurrent severe LUTO. ↗
▶ Ep 2 · 14:06
clinical Vesicoamniotic shunt complications include migration, blockage, and (rarely) iatrogenic gastroschisis when placed at 17 weeks. ↗
▶ Ep 2 · 34:57
epidemiological In Mark Johnson's historical studies, the third vesicocentesis provided fresher urine that correlated strongly with histologic renal damage; the first and second taps were not predictive. ↗
▶ Ep 2 · 35:41
quote The Pluto trial had many, many flaws. ↗
▶ Ep 2 · 37:04
quote The major renal morbidity comes postnatally. ↗
▶ Ep 2 · 43:12
opinion Greg Ryan argues there is no role for open fetal surgery in LUTO, especially in the worst-prognosis group, given the maternal and fetal risks and the experimental nature of the procedure. ↗
▶ Ep 2 · 43:18
quote I would argue that there is absolutely no role for open surgery for a fetus, particularly the ones in the group you've identified, and I think your own results are simply supporting that. ↗
▶ Ep 2 · 49:58
epidemiological In a long-term follow-up series, one-third of shunted LUTO survivors developed end-stage renal disease requiring transplant after age 5 years, despite having acceptable discharge creatinine. ↗
▶ Ep 2 · 51:24
epidemiological Posterior urethral valve patients required transplant at median age 10–12 years; prune belly/urethral hypoplasia at ~4.5 years; urethral atresia earlier. ↗
▶ Ep 2 · 52:13
clinical Progressive renal injury in shunted LUTO survivors is driven by repeated urinary tract infections, vesicoureteral reflux, and valve bladder dysfunction. ↗
▶ Ep 2 · 52:49
quote These MFM crazy people are trying to give us survivors of what would have otherwise been a lethal disease. ↗
▶ Ep 2 · 54:16
quote We may be giving you pretty good kids, but we really have to figure out how to protect those kidneys after these kids are born. ↗
▶ Ep 2 · 58:46
opinion Mark Johnson's closing pearl: patient selection is the most critical factor in fetal intervention for LUTO. ↗
▶ Ep 2 · 58:51
quote Selection, selection, selection. ↗
▶ Ep 2 · 1:00:04
opinion Greg Ryan's closing pearl: just because a procedure can be done does not mean it should be done; honest counseling about outcomes is essential. ↗
▶ Ep 2 · 1:00:42
quote Just because we can do them doesn't always mean we should do them. ↗
Wilms Tumor 16 entries

Hepatoblastoma with Dr. Greg Tiao

▶ Ep 11 · 0:46
quote Hepatoblastoma is the most common malignant liver tumor in children, but it's nowhere near the most common liver tumor or the most common abdominal tumor. ↗
▶ Ep 11 · 0:46
epidemiological Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children ↗
▶ Ep 11 · 2:20
clinical Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size ↗
▶ Ep 11 · 3:13
clinical Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma ↗
▶ Ep 11 · 3:13
clinical Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging ↗
▶ Ep 11 · 4:25
clinical Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation ↗
▶ Ep 11 · 5:41
clinical The right hepatic vein differentiates anterior and posterior sections of the right liver ↗
▶ Ep 11 · 6:02
clinical The right portal vein separates superior and inferior segments of the right liver ↗
▶ Ep 11 · 6:51
clinical The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage) ↗
▶ Ep 11 · 6:51
clinical Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor ↗
▶ Ep 11 · 8:15
clinical Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today ↗
▶ Ep 11 · 8:15
clinical Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections ↗
▶ Ep 11 · 9:35
quote You refer these patients to liver transplant programs much earlier. And this is why we see so many more patients nowadays than perhaps when Fred and Maria were running the program, uh 15 years ago because teams are are trained to recognize the tumors and send them to a center that offers transplant um um or or can and can do aggressive resection. ↗
▶ Ep 11 · 9:35
clinical It is important to consult a transplant center early for pre-text 3 and 4 tumors ↗
▶ Ep 11 · 10:27
clinical The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage ↗
▶ Ep 11 · 10:27
clinical The PHITT study has been ongoing for three years ↗