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Biomedical subjects

H L Morris

Publications and source records attributed to H L Morris.

At least 19 recordsLinked to original sources
PubMed2002

Science, medicine and the future: healing chronic wounds.

Greater interest in wound healing is needed to ensure higher standards of basic care. Precise identification of the systemic, local, and molecular factors underlying the wound healing problem in individual patients should allow better tailored treatment. Allogeneic skin grafting and bioengineered skin equivalents are being used successfully in patients with venous leg ulcers and diabetic patients with foot ulcers.

Administration, Topical↗
PubMed1998

Co-existing abdominal aortic aneurysm and intra-abdominal malignancy: reflections on the order of treatment.

BACKGROUND: The management of simultaneously occurring abdominal aortic aneurysm and intra-abdominal malignancy is controversial. It is unclear whether to treat the aneurysm first or the malignancy, or both simultaneously. If the malignancy is resected first there is a risk of postoperative rupture of the aneurysm. If simultaneous surgery is performed there is a risk of prosthetic graft infection from contamination by gastrointestinal or urinary tract contents. METHODS: Relevant papers from 1960 to 1996, identified from Medline and manual searching, were reviewed. RESULTS AND CONCLUSION: The literature supports the conclusion that the lesion of greater priority is that posing the greater threat to the patient; this is usually the aneurysm, especially if it is over 6 cm in diameter. For renal malignancies simultaneous surgery is the treatment of choice, but for bladder cancer the best management is unclear. Large aneurysms should usually be resected in preference to colorectal cancer unless the cancer is locally advanced, perforated or likely to result in early intestinal obstruction. If both lesions are complicated there may be a case for simultaneous treatment.

Aortic Aneurysm, Abdominal↗
PubMed1995

Clinical results of pharyngeal flap surgery: the Iowa experience.

Sixty-five patients with cleft palate, with or without cleft lip, who received previous pharyngeal flap surgery for chronic velopharyngeal dysfunction in our department, were examined for velopharyngeal status, speech production patterns, and evidence of nasal airway obstruction. Of the 65 subjects, 54 (83.1 percent) showed velopharyngeal function within normal limits, 43 (66.1 percent) showed normal or near-normal speech production, and 58 (89.2 percent) reported snoring sometimes or often. Of the 58 reporting snoring, electrocardiogram (ECG) data for 33 were examined for evidence of right ventricular hypertrophy. Only one (3 percent) of the 33 showed such possible indication. We conclude that by our methods, pharyngeal flap surgery is an effective treatment for velopharyngeal dysfunction. After surgery, patients may report symptoms of nasal airway obstruction during sleep but are not expected to show ECG changes in cardiac function resulting from oxygen deprivation.

Adolescent↗
PubMed1994

Complication outcomes based on preoperative admission and length of stay for primary palatoplasty and cleft lip/palate revision in children aged 1 to 6 years.

With increasing focus on outcome studies, there is continued need for data about whether same-day admission and reduced hospital stay have adverse effects on surgical treatment, including that for cleft lip and palate. In this study, medical records were inspected for all cleft lip and palate patients, aged 1 to 6 years, who had primary palatoplasty or cleft lip/palate revision in this treatment center between 1978 and 1992 (N = 329). Length of stay for 251 (96.5%) of the 260 subjects admitted the day before surgery was from 4 to 7 days; 9 remained in the hospital longer than 8 days. Length of stay for 67 (97.1%) of 69 patients admitted the day of surgery was from 2 to 3 days; 2 were in the hospital for 7 days, and none for 8 or more days. Thirty-seven instances of surgical complications were reported for the 260 patients admitted the day before surgery (14.2%). Twelve complications (17.4%) were recorded for the 69 patients admitted the day of surgery. There was no significant difference in the number of complications between the two groups of patients (Fisher's exact test, p = 0.5682). There was no significant difference in the types of complications observed between the two groups (Fisher's exact test). Surgery was performed at age 1 year for 61 of the 69 patients admitted on the day of surgery (88.4%). The mean age of this group was significantly younger than that of patients operated on earlier than 1989 and admitted on the day before surgery (Wilcoxon's test, p = .0001, Z = 4.48).(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1993

Long-term speech results of cleft palate patients with primary palatoplasty.

This investigation examined the influence of cleft type, type of surgery, age at surgery, and gender on speech proficiency of 204 patients with cleft palate who required only primary palatoplasty. Speech measures were obtained for each subject from at least three annual examinations between the ages of 4 and 16 years. Neither age at surgery nor type of surgery were discriminating factors. The less extensive cleft type, i.e., soft palate only, was associated with greater rates of change in the performance variables than were the other three cleft types. Females showed greater rate changes than males.

Adolescent↗
PubMed1993

Multidisciplinary treatment results for patients with isolated cleft palate.

Fifty-eight patients with cleft palate only who had received treatment in the Department of Otolaryngology-Head and Neck Surgery at the University of Iowa were examined for treatment results. Forty-one (70.7 percent) of the 58 patients showed a syndrome or suggestive factors. An unusually high percentage (36 percent) of the 58 patients required secondary surgery for velopharyngeal dysfunction or showed indications for surgery at examination. Some but not all of the relatively low success rate appears related to surgical experience. Speech proficiency, hearing acuity, and dental status were within normal limits or nearly so. The 20 patients with pharyngeal flap surgery were doing well, with minimal indications of functional obstruction.

Adolescent↗
PubMed1992

Communication status following laryngectomy: the Iowa experience 1984-1987.

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively. Thirty-nine (53%) of the 73 had received a surgical tracheoesophageal fistula (TEF) for voice restoration, as either a primary or a secondary procedure. Of the 39, 75% were using the TEF at last examination, with no failures attributed to sphincter spasm. Of the total group, the primary communication modality was reported to be use of a TEF by 44% and use of an electrolarynx by 50%. Limitations of the study and directions for future investigations are discussed.

Aged↗
PubMed1992

Correspondence between nasalance scores and listener judgments of hypernasality and hyponasality.

The relationship between nasalance scores and perceptual judgments of hypernasality and hyponasality was examined for 74 subjects (51 with cleft palate and 23 noncleft controls). Twenty-nine of the 51 subjects with cleft palate had received pharyngeal flap surgery. Predictive analyses were performed to assess the sensitivity, specificity, and efficiency of the Nasometer as a screening instrument. The overall relationship between perceptual judgments of hypernasality and nasalance scores was good for the nonflap subjects when a nasalance cutoff score of 26 was used. A sensitivity coefficient of 0.87 and a specificity coefficient of 0.93 were obtained. Ninety-one percent of the nasometry-based classifications accurately reflected listener judgments of hypernasality. The correspondence between nasalance scores and clinical judgments of hyponasality was also good for the nonflap subjects when a nasalance cutoff score of 50 was used. Ninety-one percent of these classifications were consistent with the listener judgments. Efficiency of nasometry was poorer for the flap subjects.

Adolescent↗
PubMed1992

Results of multidisciplinary management of bilateral cleft lip and palate at the Iowa Cleft Palate Center.

Bilateral cleft of the lip and palate is by many standards the most complex and severe form of the defect. The complexity and severity of the defect require an unusual degree of cooperation among all specialists and especially between the surgeon and the orthodontist. There are no published findings that we know about in which comprehensive data from a number of disciplines are reported for the same group of bilateral cleft patients. Fifty randomly selected patients with bilateral complete clefts were examined by the Iowa team and two orthodontists from other institutions. The evaluations revealed that a large number of patients over the age of 10 have multiple residual problems requiring further treatment. Only 23 percent of the older patients studied were judged to have had treatment completed by the surgeon, speech pathologist, and orthodontist. It is very difficult to state whether the results obtained by our team can be considered satisfactory because there are no comparable studies that have attempted to evaluate the same parameters in multidisciplinary management.

Adolescent↗
PubMed1991

Cleft palate. Diagnosis.

The necessary information for diagnosis of "cleft palate speech" is available from clinical speech pathology tests and observations for the majority of patients. Test findings about error type and stimulability often give direction to our decisions about speech therapy. Other kinds of tests are useful for confirming these findings or for other purposes. Trial speech therapy is a very useful diagnostic procedure. Problem patients (those who fail to make suitable progress) should be referred without hesitation to a cleft palate team, or to a colleague who is an SLP on that team. Referrals to other specialists should be made appropriately, using careful, clear referral language.

Child↗
PubMed1990

Long-term speech results of cleft palate speakers with marginal velopharyngeal competence.

The purposes of this study were to (1) examine the long-term speech status of patients judged to exhibit marginal velopharyngeal competence at 6 years of age and (2) determine whether speech performance data obtained at age 6 could be used to discriminate patients with marginal velopharyngeal competence who eventually demonstrate velopharyngeal incompetence from those who do not. Longitudinal speech performance data were retrieved for 48 subjects and examined descriptively for the total group. Data obtained at the subjects' last evaluation (adolescence) were then used to reassign these subjects into one of three classification groups for estimating velopharyngeal status (competent, marginal, incompetent) on the basis of the clinical ratings of velopharyngeal competence assigned at the time of their last examination in adolescence. Differences in measures of articulation proficiency and hypernasality among the three groups were examined at age 6 using an analysis of variance. A stepwise discriminate analysis was also performed to determine whether the speech data obtained at age 6 could be used to discriminate the three adolescent classification groups. The ANOVA revealed no significant differences among the classification groups in type of articulation errors. Differences in articulation test scores and severity ratings of articulation defectiveness and nasality in connected speech were evident among the groups. The discriminate analysis revealed that the groups could be separated, in part, on the basis of two variables: the severity ratings of articulation defectiveness and nasality.

Adolescent↗
PubMed1990

Speech production time and judgments of disordered nasalization in speakers with cleft palate.

The purpose of this study was to investigate the effect of production time on the perception of disordered nasalization in children with cleft palate. The subjects with cleft palate included 5 who produced acceptable speech consistently, 5 who produced disordered nasalization consistently, and 10 who were inconsistent in the production of disordered nasalization. We examined a range of production times similar to those for the production of single-word and connected speech tasks. Ten judges used direct magnitude estimation to rate severity of disordered nasalization. An accelerometric ratio technique was used to estimate the extent and timing of nasal acoustic activity. The results showed that reducing the production time did not change perceptible nasalization.

Adolescent↗
PubMed1990

Velar-pharyngeal status in cleft palate patients with expected adenoidal involution.

This study was designed to provide information about whether cleft palate patients with hypertrophied adenoids maintain velar-pharyngeal contact during the time of expected adenoidal atrophy. Thirty-nine subjects were selected from a large longitudinal study on the basis of availability of lateral still x-ray films taken in series from 5 to 16 years of age. Ratings of velar-pharyngeal contact and ratings of adenoid size were obtained from the films. The obtained data indicated the expected decrease in adenoid size but also, for the group, maintenance of velar-pharyngeal contact. However, three of the 39 subjects were judged to show loss of such contact during the period of study, and an additional four had surgery for velopharyngeal incompetence after the completion of the study. All seven appeared to show significant deterioration of velopharyngeal status in middle or late adolescence. Implications of these findings are discussed.

Adenoids↗
PubMed1989

Cleft lip and palate and related disorders: issues for future research of high priority.

On October 14 to 17, 1987, a meeting entitled "State of the Art Conference: Multidisciplinary Management of Cleft Lip and Palate" was held in Iowa City. The major purpose of the conference was to review the available knowledge concerning management of unilateral cleft lip and palate from the perspectives of surgery, speech-language pathology, and orthodontics. The closing feature of the conference was the identification of issues for future research. Participants identified issues of high priority that were then discussed by the entire conference faculty. This paper reports the summary of that discussion and the recommendations of the Conference.

Cleft Lip↗