Search PubMed⌕ Search

Biomedical subjects

L L Morris

Publications and source records attributed to L L Morris.

At least 19 recordsLinked to original sources
PubMed2000

Magnetic resonance imaging of growth plate injuries: the efficacy and indications for surgical procedures.

In 23 patients with growth plate injuries, magnetic resonance imaging (MRI) studies were performed a total of 31 times to evaluate the physis which showed plain radiographic evidence of possible damage. Fourteen patients clinically showed growth arrest, and 10 patients required a Langenskiold operation. In 3 patients who underwent this operation, subsequent premature total fusion of the physis adversely affected the postoperative results. We propose that the merging shape of the arrest line with calcification of the provisional zone of the metaphysis shown by MRI indicates poor viability of the physis. MRI provided useful information on the appearance of the growth plate and changes in the metaphysis, both of which affected the prognosis and the results of the surgical procedures.

Adolescent↗
PubMed1999

Distal mucocolpos and proximal hematocolpos secondary to concurrent imperforate hymen and transverse vaginal septum.

A 12-year-old girl had cruciate incision of imperforate hymen draining a large mucocolpos. Her symptoms did not abate thereafter, and 3 months later a transverse vaginal septum was diagnosed. This was perforated and dilated under ultrasound (US) guidance draining a large hematocolpos. Results of examination under anesthesia after 3 months was satisfactory, and she has had normal periods in follow-up for 9 months. Imperforate hymen and transverse vaginal septum are known causes of mucocolpos and hematocolpos. However, the concurrent occurrence of the two abnormalities is unique.

Child, Preschool↗
PubMed1998

Primary care guide to managing a breast mass: a legal perspective on risk management.

Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the US, and it is the most costly claim made against physicians. Common reasons for delay of diagnosis include unimpressive physical findings, failure to follow up with the patient, and a negative mammogram report. Equally important for quality patient care and for defense against malpractice suits is thorough documentation of history, examination, test results, recommendations, and patient interactions. This article provides guidelines with case studies that stress the importance of effective documentation and communication with the patient and offers recommendations for risk management.

Breast Neoplasms↗
PubMed1998

Primary care guide to managing a breast mass: step-by-step workup.

Missed breast cancer is the most common malpractice suit filed in the US. But even without a biopsy of every mass, clinicians can reduce the risk of failed diagnosis to 1% by using a triple-diagnosis method to working up a breast mass, according to these experts, who offer a step-by-step guide. Includes QuickTimeTM video of breast exam. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the US. Unless the potential for false-negative results of physical examination, mammography, ultrasound, and fine-needle aspiration biopsy (FNAB) is recognized, delay in the diagnosis of breast cancer will continue to occur. A systematic, thorough approach to the workup of any breast mass-- including a careful history, clinical breast examination, and documentation--is crucial. Upon detection of a mass, distinguishing the cyst from the solid mass (often by fine-needle aspiration or FNAB) is one of the most important tasks facing the clinician. Although most cysts resolve upon aspiration, solid masses require further workup to rule out cancer. Because of the false-negatives associated with individual methods of diagnosis, the authors recommend the triple-diagnosis method of detection. Simultaneous evaluation of a breast mass using clinical breast examination, radiography, and FNAB can lower the risk of missing cancer to only 1%, effectively reducing the rate of diagnostic failure and increasing the quality of patient care.

Breast↗
PubMed1996

Childhood acute lymphoblastic leukaemia presenting as jaundice.

An unusual presentation of acute lymphoblastic leukaemia (ALL) in a 6-year-old girl is reported. She presented with unilateral cervical lymphadenopathy, a mixed obstructive/cholestatic jaundice and a progressive pancytopenia. Ultrasound examination revealed an obstructed common bile duct with gross thickening of the wall of the duct and intrahepatic bile duct dilatation. The jaundice resolved with high dose intravenous (i.v.) methylprednisolone. It is postulated that this was due to infiltration of the common bile duct, given the failure to demonstrate any other cause for the bile duct pathology.

Child↗
PubMed1995

Distinct skeletal abnormalities in four girls with Shprintzen-Goldberg syndrome.

We describe 4 girls with Shprintzen-Goldberg syndrome. Skeletal abnormalities common to 3 of them include bowing of long bones (with a variable degree of progression over time), flare of the metaphyses, a large anterior fontanel with persistent patency into the second to fourth years of life, 13 pairs of ribs, distinct vertebral abnormalities which were absent neonatally but evolved by the second year of life, and progressive osteopenia. These abnormalities were generalized and, in one case, progressive over the first few years of life. Communicating hydrocephalus was present in all 4 cases. The eldest, an 11-year-old girl, had additional anomalies not reported previously in this syndrome, including intestinal malrotation, an anteriorly placed anus, and mild cerebral atrophy. This is the first detailed report of skeletal manifestations in this rare disorder of unknown cause. These cases, in conjunction with a review of the literature, suggest that skeletal abnormalities are common in Shprintzen-Goldberg syndrome.

Abnormalities, Multiple↗
PubMed1994

Jackson-Weiss syndrome: clinical and radiological findings in a large kindred and exclusion of the gene from 7p21 and 5qter.

We describe the clinical and radiological manifestations of the Jackson-Weiss syndrome (JWS) in a large South Australian kindred. Radiological abnormalities not previously described in the hands include coned epiphyses, distal and middle phalangeal hypoplasia, and carpal bone malsegmentation. New radiological findings in the feet include coned epiphyses, hallux valgus, phalangeal, tarso-navicular and calcaneonavicular fusions, and uniform absence of metatarsal fusions. Absence of linkage to eight markers along the short arm of chromosome 7 excluded allelism between JWS and Saethre-Chotzen syndrome at 7p21. No linkage was detected to D5S211, excluding allelism to another recently described cephalosyndactyly syndrome mapping to 5qter.

Alleles↗
PubMed1994

Neurological involvement in Worth type endosteal hyperostosis: report of a family.

We present the first Australian family known with autosomal dominant endosteal hyperostosis affecting a mother and her 2 children. Neurological involvement comprising chronic intracranial hypertension and cranial nerve palsies were found in the mother; computerised tomography and magnetic resonance imaging of the head demonstrated symmetrical sclerosis of the cranial vault, narrow internal auditory meati and canals, inferior herniation of the cerebellar tonsils into the foramen magnum, and encroachment of occipital bone into the foramen magnum posteriorly. This is the fifth report of significant neurologic involvement in this condition and supports the view that severe forms of endosteal hyperostosis are not confined to the autosomal recessive variant, as individuals with the autosomal dominant form may also show progression with neurological involvement in adulthood.

Adult↗
PubMed1994

Polydactyly, campomelia, ambiguous genitalia, cystic dysplastic kidneys, and cerebral malformation in a fetus of consanguineous parents: a new multiple malformation syndrome, or a severe form of oral-facial-digital syndrome type IV?

We describe a 27-week fetus with occipitoschisis, polydactyly, campomelia, cleft palate, laryngeal dysplasia, ocular colobomata, hepatic fibrosis and intrahepatic cyst, ambiguous genitalia, cystic dysplastic kidneys, and brain malformation. This pattern of abnormalities appears unique. The differential diagnosis is discussed. The parents are first cousins, making autosomal recessive inheritance likely.

Abnormalities, Multiple↗
PubMed1994

Congenital urethral obstruction: Cobb's collar or prolapsed congenital obstructive posterior urethral membrane (COPUM).

OBJECTIVE: To determine whether there are two distinct types of congenital obstruction of the proximal urethra. PATIENTS AND METHODS: Three boys with a congenital bulbar urethral narrowing (Cobb's collar) were examined. Recent papers on congenital obstructive posterior urethral membrane (COPUM) were reviewed. RESULTS: The more proximal lesion is a membranous obstruction which is able to prolapse as far as the bulbar urethra, but has paramedian folds that attach along the posterior wall of the urethra to the verumontanum, and is due to persistence of an embryological attachment between the distal verumontanum and the anterior wall of the posterior urethra. The more distal narrowing is not always obstructive and is primarily a bulbar urethral membrane, is independent of the verumontanum and external sphincter, and may represent a persistence of part of the urogenital membrane. CONCLUSIONS: There are two distinct types of congenital obstruction of the proximal urethra, with the association to the verumontanum being the distinguishing feature.

Child↗
PubMed1994

Management of pseudomembranous colitis.

Controversy exists as to the appropriate management of fulminant C. difficile-associated pseudomembranous colitis (PMC). We reviewed our most recent 5-year experience with 191 patients with PMC. Nine patients had an initial presentation of a surgical abdomen with clinical signs of peritonitis, elevated white blood cell count, and eight had received antibiotics prior to presentation. Two patients were placed on no cardiopulmonary resuscitation status at admission to the surgical intensive care unit; both died within 24 hours. The remaining seven patients had exploratory laparotomies. The four who had total abdominal colectomies with ileostomies recovered promptly. Two of the other three had no resection because there was edema of the colon, but no other gross pathological changes. The third had only a segmental colon resection. All three deteriorated postoperatively, and two were dead within 48 hours. The remaining patient was returned to the operating room 48 hours after the first procedure, and an abdominal colectomy and ileostomy was performed. She never recovered, however, and died 12 days later. We conclude that although most patients with PMC can be treated effectively medically, total abdominal colectomy with ileostomy is indicated when signs of peritonitis occur, even if the only finding at laparotomy is edema of the colon.

Aged↗
PubMed1993

Hunter-McAlpine syndrome: report of a third family.

A 9-year-old girl with craniosynostosis, facial dysmorphism, mental retardation, proportionate short stature and acral abnormalities is described, in whom both clinical and radiological features support a diagnosis of Hunter-McAlpine syndrome. Her mother is mildly affected, confirming previous evidence that this syndrome is dominantly inherited and shows considerable phenotypic variability within families.

Abnormalities, Multiple↗
PubMed1992

Radiological assessment of duodenal calibre in congenital duodenal obstruction.

A review of barium meal studies in 32 cases of congenital intrinsic duodenal obstruction (CDO) from the Adelaide Children's Hospital was performed to assess and measure pre and post operative duodenal dilatation. Comparisons were made with a group of 153 normal barium studies from the same Hospital with a view to quantifying normal and abnormal proximal duodenal calibre. Duodenal size was expressed as a ratio D1/L1, (diameter of 1st part of duodenum/height of first lumbar vertebra). In this study a normal range of duodenal diameter was found to be 0.90 to 1.62 (+/- 2 SD from mean), with a mean of 1.26. The CDO patients recorded a range of postoperative ratios on first follow-up barium studies of between 1.2 and 4.5 with a mean of 2.28. Where serial studies had been performed, duodenal diameter was found to show some decrease in size postoperatively. In patients who underwent surgery for membrane obstruction there was a trend towards normalisation of duodenal diameter over time, compared with the atresia group. However, this difference did not reach statistical significance.

Barium Sulfate↗
PubMed1992

Ectopic ureter with complete ureteric duplication in the female child.

Twenty-two female children with complete ureteric duplication and ectopic ureter (two bilateral) were seen in a 15-year period. The most common clinical presentation was dribbling urinary incontinence with "normal" micturition. Other presentations included urinary infection and vaginal discharge. Four cases were diagnosed after antenatal recognition of ureterohydronephrosis. The clinical diagnosis was supported by various radiological investigations but ultrasonography (US) proved to be particularly reliable in diagnosing ectopic ureter. The most common sites of opening of the ectopic ureter were the urethral margin or the urethrovaginal septum, although in seven cases the site was not identified. Twenty-one kidneys were managed by upper pole heminephrectomy and three by ureteropyelostomy, removing as much of the ectopic ureter as possible via the renal approach. The distal ectopic ureter was removed via a separate suprapubic incision at the initial operation in four cases, and in two cases, delayed excision of the distal ectopic ureter was necessary. All surgical specimens were examined histologically and only two heminephrectomy specimens showed features of renal dysplasia. Dribbling urinary incontinence was cured in all cases, although in one patient the entire kidney was lost after heminephrectomy. Ectopic ureter should be suspected in girls with dribbling urinary incontinence. The diagnosis is best supported by US together with conventional radiology. The majority of cases can be managed by heminephrectomy, but when adequate function is demonstrated in the upper pole, ureteropyelostomy is recommended.

Child↗
PubMed1992

Limb deformity and metaphyseal abnormalities in thalassaemia major.

Regular bone survey radiographs have allowed identification of limb deformity and metaphyseal changes in several patients with thalassaemia major treated at the Adelaide Children's Hospital. Following the progression of limb deformity in five of these patients who were receiving human growth hormone therapy, the records of 25 thalassaemia patients were reviewed. Six patients had evidence of limb deformity, four of whom also had metaphyseal changes. Three additional patients had metaphyseal changes alone. Patients with either type of skeletal change shared similar characteristics, including younger age, earlier commencement of desferrioxamine therapy, better compliance and, in general, lower levels of ferritin. Females predominated in both groups. The frequency of sensorineural hearing loss was similar in affected and nonaffected groups and biochemical parameters, especially plasma calcium, phosphate, alkaline phosphatase, and zinc, which were normal in all patients. The cause of these skeletal changes is not clear; however, several potential factors need to be considered. Among these are focal marrow expansion in the metaphyseal region due to incomplete suppression of erythropoiesis and possible effects of desferrioxamine, including direct interference with bone growth, altered response of bone to inflammation or infection, and altered bone metabolism related to chelation of trace metals. While we can only speculate on aetiological factors, it is clear that human growth hormone therapy has resulted in exaggeration of deformity due to an increased rate of bone growth or decreased rate of mineralization of physeal cartilage. We believe that bone survey radiographs are useful in early identification of skeletal changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗