Alan Flake

130 timestamped statements across 5 collections — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Congenital Lung Lesions (CPAM) · guest expert Fetal Surgery · guest expert

Featured diaries

Ep 4 · 40:24
At the time of birth, the lungs that had grown the most perhaps functioned the worst. Those kids were born relatively premature, but they didn't respond to surfactant. They had poor compliance of their lungs. It was not a biologically functioning gas exchanging lung.
Ep 10 · 40:24
At the time of birth, the lungs that had grown the most perhaps functioned the worst. Those kids were born relatively premature, but they didn't respond to surfactant. They had poor compliance of their lungs. It was not a biologically functioning gas exchanging lung.
quote · Fetal Surgery
Ep 4 · 40:24
At the time of birth, the lungs that had grown the most perhaps functioned the worst. Those kids were born relatively premature, but they didn't respond to surfactant. They had poor compliance of their lungs. It was not a biologically functioning gas exchanging lung.
Ep 10 · 1:08
most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 10 · 1:08
most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 8 · 1:08
most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.

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Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...

Ep 4 · 24:01
quote One major difference between Your trial and any trial on uh tracheal occlusion versus the myelomeningocele trial is that you have popularized this over the past 10 years.
Ep 4 · 24:30
quote So, has this impacted your effort to do a trial? Have you been able to recruit the numbers of patients that you anticipated?
Ep 4 · 40:05
quote I mean, I would argue, you know, when we did our tracheal occlusion trial, we got tremendous lung growth in some of the kids. We got no lung growth in other kids, and this is with complete tracheal occlusion.
Ep 4 · 40:24
quote At the time of birth, the lungs that had grown the most perhaps functioned the worst. Those kids were born relatively premature, but they didn't respond to surfactant. They had poor compliance of their lungs. It was not a biologically functioning gas exchanging lung.
Ep 4 · 40:46
quote I don't think as a rule at this point there's overwhelming data that we improve lung function with tracheal occlusion.

Open Fetal Surgery Overview: Fetal Surgery 2012

Ep 10 · 0:46
quote you got to give Mike credit for having, uh, real cojones to, uh, start this field.
Ep 10 · 0:46
quote you got to give Mike credit for having, uh, real cojones to, uh, start this field.
Ep 10 · 1:08
quote most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 10 · 1:08
quote most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 10 · 3:45
clinical Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis.
Ep 10 · 3:45
clinical Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis.
Ep 10 · 6:11
clinical CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions.
Ep 10 · 6:11
clinical CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions.
Ep 10 · 6:23
clinical Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age.
Ep 10 · 6:23
clinical Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age.
Ep 10 · 6:31
clinical Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists.
Ep 10 · 6:31
clinical Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists.
Ep 10 · 9:08
quote The key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur.
Ep 10 · 9:08
quote The key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur.
Ep 10 · 9:40
clinical Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery.
Ep 10 · 9:40
clinical Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery.
Ep 10 · 10:34
epidemiological CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival.
Ep 10 · 10:34
epidemiological CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival.
Ep 10 · 10:49
clinical Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases.
Ep 10 · 10:49
clinical Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases.
Ep 10 · 12:18
clinical Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal.
Ep 10 · 12:18
clinical Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal.
Ep 10 · 16:03
clinical Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die.
Ep 10 · 16:03
clinical Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die.
Ep 10 · 16:33
clinical CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases.
Ep 10 · 16:33
clinical CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases.
Ep 10 · 17:33
clinical RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present.
Ep 10 · 17:33
clinical RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present.
Ep 10 · 18:25
clinical The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH.
Ep 10 · 18:25
clinical The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH.
Ep 10 · 18:41
clinical The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance.
Ep 10 · 18:41
clinical The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance.
Ep 10 · 19:10
clinical The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability.
Ep 10 · 19:10
clinical The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability.
Ep 10 · 20:04
clinical A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea.
Ep 10 · 20:04
clinical A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea.
Ep 10 · 21:05
clinical CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT.
Ep 10 · 21:05
clinical CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT.
Ep 10 · 21:33
opinion CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics.
Ep 10 · 21:33
opinion CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics.
Ep 10 · 23:57
opinion Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete.
Ep 10 · 23:57
opinion Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete.
Ep 10 · 26:38
clinical The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age.
Ep 10 · 26:38
clinical The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age.
Ep 10 · 29:19
clinical Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM.
Ep 10 · 29:19
clinical Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM.

Open Fetal Surgery Overview: Fetal Surgery 2012

Ep 8 · 0:46
quote you got to give Mike credit for having, uh, real cojones to, uh, start this field.
Ep 8 · 1:08
quote most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 8 · 3:45
clinical Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis.
Ep 8 · 6:11
clinical CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions.
Ep 8 · 6:23
clinical Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age.
Ep 8 · 6:31
clinical Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists.
Ep 8 · 9:08
quote The key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur.
Ep 8 · 9:40
clinical Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery.
Ep 8 · 10:34
epidemiological CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival.
Ep 8 · 10:49
clinical Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases.
Ep 8 · 12:18
clinical Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal.
Ep 8 · 16:03
clinical Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die.
Ep 8 · 16:33
clinical CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases.
Ep 8 · 17:33
clinical RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present.
Ep 8 · 18:25
clinical The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH.
Ep 8 · 18:41
clinical The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance.
Ep 8 · 19:10
clinical The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability.
Ep 8 · 20:04
clinical A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea.
Ep 8 · 21:05
clinical CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT.
Ep 8 · 21:33
opinion CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics.
Ep 8 · 23:57
opinion Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete.
Ep 8 · 26:38
clinical The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age.
Ep 8 · 29:19
clinical Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM.
Fetal Surgery 51 entries

Open Fetal Surgery Overview: Fetal Surgery 2012

Ep 9 · 0:46
quote you got to give Mike credit for having, uh, real cojones to, uh, start this field.
Ep 9 · 0:46
quote you got to give Mike credit for having, uh, real cojones to, uh, start this field.
Ep 9 · 1:08
quote most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 9 · 1:08
quote most of the time what we do is to wait and treat the neonate still, but we do have a whole armamentarium of options for timing and mode of delivery, and still in a very few cases to with appropriate selection treat patients in utero.
Ep 9 · 3:45
clinical Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis.
Ep 9 · 3:45
clinical Bronchial atresia can be differentiated from microcystic CPAM by the presence of a dilated central bronchus or mucocele and documentation of a contralateral lung to rule out lung agenesis.
Ep 9 · 6:11
clinical CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions.
Ep 9 · 6:11
clinical CVR >1.6 predicts high risk for CPAM evolving into hydrops, particularly for microcystic lesions.
Ep 9 · 6:23
clinical Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age.
Ep 9 · 6:23
clinical Maternal steroids are first-line therapy for high-risk CPAM (CVR >1.6); the majority respond, but open fetal surgery is considered if hydrops persists despite steroids at an early gestational age.
Ep 9 · 6:31
clinical Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists.
Ep 9 · 6:31
clinical Open fetal surgery for CPAM is indicated when hydrops persists despite steroids at an early gestational time point, if the capability exists.
Ep 9 · 9:08
quote The key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur.
Ep 9 · 9:08
quote The key to fetal surgery is putting the kid back in the uterus and keeping them there for an adequate length of time for lung growth to occur.
Ep 9 · 9:40
clinical Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery.
Ep 9 · 9:40
clinical Macrocystic CPAM can be treated by thoracoamniotic shunt rather than open fetal surgery.
Ep 9 · 10:34
epidemiological CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival.
Ep 9 · 10:34
epidemiological CHOP's open fetal surgery for CPAM has approximately 60% survival; thoracoamniotic shunts have 70-75% survival.
Ep 9 · 10:49
clinical Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases.
Ep 9 · 10:49
clinical Bronchial atresia is more difficult to treat by fetal intervention than CPAM; CHOP has had one intraoperative fetal death, one postnatal hepatic necrosis death, and one likely survivor out of three cases.
Ep 9 · 12:18
clinical Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal.
Ep 9 · 12:18
clinical Sacrococcygeal teratoma fetal intervention targets tumor vascular steal leading to high-output cardiac failure; surgical debulking interrupts the arteriovenous steal.
Ep 9 · 16:03
clinical Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die.
Ep 9 · 16:03
clinical Watchful waiting for SCT between 27-32 weeks can be hazardous; the majority of patients who go into preterm labor or evolve significant high-output failure will die.
Ep 9 · 16:33
clinical CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases.
Ep 9 · 16:33
clinical CHOP's recent SCT algorithm emphasizes preemptive early delivery (≥27 weeks) at the first sign of maternal or fetal decompensation, with improved outcomes in 5 recent cases.
Ep 9 · 17:33
clinical RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present.
Ep 9 · 17:33
clinical RFA (radiofrequency ablation) technology for SCT has not identified a safe ablative technology that avoids collateral injury and bad outcomes; it is not recommended at present.
Ep 9 · 18:25
clinical The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH.
Ep 9 · 18:25
clinical The EXIT procedure was initially developed to remove tracheal clips after tracheal occlusion for CDH.
Ep 9 · 18:41
clinical The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance.
Ep 9 · 18:41
clinical The EXIT procedure maintains uteroplacental blood flow using complete uterine relaxation with deep maternal gaseous anesthetic and intrauterine volume maintenance.
Ep 9 · 19:10
clinical The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability.
Ep 9 · 19:10
clinical The EXIT procedure requires a multidisciplinary team with specific roles, and may require a second operating room team for definitive postnatal procedures and ECMO capability.
Ep 9 · 20:04
clinical A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea.
Ep 9 · 20:04
clinical A massive cervical teratoma case required 11.5 hours on placental support during EXIT, with retrograde and antegrade cannulation attempts, ultimately requiring tumor dissection to reach the trachea.
Ep 9 · 21:05
clinical CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT.
Ep 9 · 21:05
clinical CHAOS (congenital high airway obstruction syndrome) can result in marked diaphragm inversion, ascites, and thoracic abnormalities; the first survivor was delivered by EXIT.
Ep 9 · 21:33
opinion CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics.
Ep 9 · 21:33
opinion CHAOS has a strong rationale for prenatal treatment due to morbidity associated with treating at birth and the need for patients to grow into their ventilatory mechanics.
Ep 9 · 23:57
opinion Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete.
Ep 9 · 23:57
opinion Future directions in fetal surgery include clinical trials, reduction of maternal and fetal risk, better imaging for physiologic information, and tissue engineering approaches to make open fetal surgery obsolete.
Ep 9 · 26:38
clinical The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age.
Ep 9 · 26:38
clinical The CPAM volume ratio (CVR) is calculated by measuring the CPAM in 3 dimensions, applying an ellipse formula, and dividing by head circumference to standardize for gestational age.
Ep 9 · 29:19
clinical Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM.
Ep 9 · 29:19
clinical Macrocystic CPAM and bronchial atresia do not respond as well to steroids as microcystic CPAM.

Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...

Ep 10 · 24:01
quote One major difference between Your trial and any trial on uh tracheal occlusion versus the myelomeningocele trial is that you have popularized this over the past 10 years.
Ep 10 · 24:30
quote So, has this impacted your effort to do a trial? Have you been able to recruit the numbers of patients that you anticipated?
Ep 10 · 40:05
quote I mean, I would argue, you know, when we did our tracheal occlusion trial, we got tremendous lung growth in some of the kids. We got no lung growth in other kids, and this is with complete tracheal occlusion.
Ep 10 · 40:24
quote At the time of birth, the lungs that had grown the most perhaps functioned the worst. Those kids were born relatively premature, but they didn't respond to surfactant. They had poor compliance of their lungs. It was not a biologically functioning gas exchanging lung.
Ep 10 · 40:46
quote I don't think as a rule at this point there's overwhelming data that we improve lung function with tracheal occlusion.

Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...

Ep 4 · 24:01
quote One major difference between Your trial and any trial on uh tracheal occlusion versus the myelomeningocele trial is that you have popularized this over the past 10 years.
Ep 4 · 24:30
quote So, has this impacted your effort to do a trial? Have you been able to recruit the numbers of patients that you anticipated?
Ep 4 · 40:05
quote I mean, I would argue, you know, when we did our tracheal occlusion trial, we got tremendous lung growth in some of the kids. We got no lung growth in other kids, and this is with complete tracheal occlusion.
Ep 4 · 40:24
quote At the time of birth, the lungs that had grown the most perhaps functioned the worst. Those kids were born relatively premature, but they didn't respond to surfactant. They had poor compliance of their lungs. It was not a biologically functioning gas exchanging lung.
Ep 4 · 40:46
quote I don't think as a rule at this point there's overwhelming data that we improve lung function with tracheal occlusion.