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Biomedical subjects

Thom E Lobe

Publications and source records attributed to Thom E Lobe.

7 recordsLinked to original sources
PubMed2003

Early experience with needleoscopic inguinal herniorrhaphy in children.

BACKGROUND/PURPOSE: To validate its safety and efficacy, the authors evaluated their early experience with needleoscopic inguinal herniorrhaphy in children. METHODS: Twelve consecutive children, older than 6 months, with unilateral (n = 8) or bilateral (n = 4) inguinal hernias underwent a needleoscopic herniorrhaphy. A 1.7-mm needle laparoscope was introduced through the umbilicus, and a grasper placed laterally was used for traction. A curved stainless steel awl introduced percutaneously anterolateral to the internal ring was used to pass a ligature circumferentially to complete an extraperitoneal high ligation of the sac (without handling the vas deferens and spermatic vessels in males). Four of 12 patients underwent their repair combined with other procedures. Children who underwent herniorrhaphy only were allowed immediate return to unrestricted activity. Data recorded with IRB approval included operating time, postoperative discomfort, recurrence, and complications. RESULTS: For herniorrhaphy only the mean operating time was 23 minutes (unilateral, n = 5) or 46 minutes (bilateral, n = 3). All were able to return to immediate unrestricted activity. None required any analgesics other than acetaminophen. There were no recurrences or complications. CONCLUSIONS: Needleoscopic inguinal herniorrhaphy in children is safe and effective. This technique potentially offers less risk of injury to cord structures with a superior cosmetic result.

Child↗
PubMed2003

Prognostic factors and surgical treatment guidelines for children with rhabdomyosarcoma of the perineum or anus: a report of Intergroup Rhabdomyosarcoma Studies I through IV, 1972 through 1997.

BACKGROUND/PURPOSE: Rhabdomyosarcoma (RMS) of the perineum or anus is a rare sarcoma of childhood with a poor prognosis. This study reviews the Intergroup Rhabdomyosarcoma Study Group (IRSG) studies I through IV to identify determinants of patient outcome and to refine surgical treatment guidelines. METHODS: From 1972 through 1997, 71 eligible patients were treated and studied. The median patient age was 6 years. The majority (64%) were at an advanced stage (clinical group III and IV) at initial presentation and 50% had positive regional lymph node (LN) involvement. RESULTS: The 5-year failure-free survival rate (FFS) for all patients was 45% and the overall survival rate (OS) was 49%. Characteristics that were associated with significantly improved survival rate were primary tumor size less than 5 cm, lower (less advanced) clinical group and stage, negative regional lymph node status, and age less than 10 years. When the extent of disease was controlled for in multivariate analysis, only age less than 10 predicted an improved outcome. The 5-year overall survival rate for patients less than 10 years of age was 71% versus 20% in older patients (P <.001). Histology (alveolar versus embryonal) and primary site (perineal versus anal) did not significantly affect outcome. CONCLUSIONS: Because of the high incidence of regional LN involvement in these patients, a strategy of routine surgical evaluation of ilioinguinal lymph nodes in all patients with perineal or anal RMS is recommended.

Adolescent↗
PubMed2002

Children from ethnic minorities have benefited equally as other children from contemporary therapy for rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Study Group.

PURPOSE: To define the clinical characteristics of rhabdomyosarcoma (RMS) occurring in children from ethnic minorities and determine whether these children have benefited equally from advances in therapy. PATIENTS AND METHODS: This was a retrospective cohort analysis of children treated on the Intergroup Rhabdomyosarcoma Study Group protocols between 1984 and 1997. The clinical features and outcomes of 336 African-American children and 286 children from other ethnic minorities were compared with those of white children (n = 1,721). RESULTS: African-American, other ethnic group, and white children enjoyed similar 5-year failure-free survivals (FFS) of 61%, 61%, and 66%, respectively, P =.15. Compared with white children, nonwhite patients more often had (1) invasive, T2 tumors (P =.03); (2) stage 2 or 3 tumors (P =.003); (3) large tumors (more than 5 cm, P <.006); and/or (4) tumors with positive regional nodes (ie, N1, P =.002). Using Cox proportional hazards analysis, seven patient risk categories were defined with significant differences in outcome. This model was then used to search for other factors associated with FFS after adjusting for these risk categories. Only T stage and age remained associated with FFS (P =.001 and P <.001, respectively). After adjusting for T stage, risk category, and age, we explored the relationship of ethnic group to FFS and found that, compared with whites, the relative risk of failure was 1.14 for African-American patients and 1.2 for other ethnic minority patients, values that are not significantly different. CONCLUSION: Patients from ethnic minority groups more often have larger, invasive tumors with positive lymph nodes. Nevertheless, they have benefited as equally as white children from the dramatic progress in therapy of RMS.

Black or African American↗
PubMed2002

Gastroesophageal reflux disease in neurologically impaired children: the role of the gastrostomy tube.

We review our experience with gastrostomy techniques in neurologically impaired (NI) children, with or without a Nissen fundoplication. The records of 130 NI children who had a gastrostomy tube (GT) placed between January 1999 and October 2001 were reviewed. Data collected included: demographics, neurological status, operative time, time to first feed, postoperative stay, analgesic requirements, follow-up, mortality and complication rates. Open GTs were placed using the standard Stamm gastrostomy technique through a midline incision and were combined with a standard open Nissen fundoplication when indicated. Laparoscopic GTs were placed after institution of carbon dioxide pneumoperitoneum using a 2-port technique, a Mic-key G device of appropriate size and anchored to the anterior abdominal wall with 2 "U" stitches. The laparoscopic Nissen fundoplication (LNF) procedures were performed using a 5-port technique. Patients were divided into 4 groups: group I (n = 12) laparoscopic GT alone, group II (n = 44) open GT alone, Group III (n = 44) laparoscopic GT with LNF and Group IV (n = 30) open GT with Nissen fundoplication. Based on their similar characteristics, Groups I and II and Groups III and IV were compared together. Data were analysed using Student's t test, and internal review board approval was obtained. Patients ranged in age between 10 days and 17.7 years (mean 3.64 years). Their weight was between 1.2 and 63.4 kg (mean 12.8 kg). The compared groups showed similar characteristics with regard to age, weight, cause of mental impairment, and the reason for placement of the GT. The operative time for group III was significantly longer than that of group IV (P < 0.05). Time to first feed was significantly shorter for group I when compared to group II. The postoperative analgesic requirements were not statistically different. The overall short- and long-term complication rates were not statistically different when the related groups were compared, however, site-related complications and feeding problems were significantly less in group I compared to group II. Only 1 operative mortality occurred in group III. Follow-up showed less long-term morbidity and fewer complications with the laparoscopic GT compared to the open one as regard to admissions, surgery, and emergency department visits related to GT problems as well as frequency of GT change. Based on our experience, laparoscopic placement of a low-profile GT in NI children appears to be associated with less morbidity, permits earlier enteral nutrition, and has a cosmetic advantage. We believe that the laparoscopic technique should be the procedure of choice for GT placement in these children even when a Nissen fundoplication is deemed necessary.

Adolescent↗