Biomedical subjects
M S Morris
Publications and source records attributed to M S Morris.
Emergency medicine in South Africa.
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Perilymphatic fistulas: state of the art.
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Magnetic resonance imaging of perilymphatic fistula.
Perilymphatic fistula (PLF) is considered to be a most challenging otologic issue. There are no currently agreed upon objective tests for the diagnosis of PLF. In an effort to improve diagnostic accuracy in patients with suspected PLF, a novel diagnostic test involving magnetic resonance (MR) contrast imaging was designed. An experimental PLF was created in the cochlear round window membrane of healthy adult cats. Since cochlear perilymph is thought to be an ultrafiltrate of cerebral spinal fluid, gadodiamide (gadolinium-diethylenetriamine penta-acetic acid [DTPA] bismethylamide), a nonionic paramagnetic contrast agent, was injected intrathecally in an attempt to enhance imaging of the created fistula. Post-contrast images of the fistualized cochlea demonstrate a significant increase in the signal intensity of the cochlear perilymph with pooling of enhanced perilymph observed in the ipsilateral mastoid bulla. Magnetic resonance contrast imaging may prove to be a valuable technique in human studies involving perilymphatic fistula.
Contemporary skin grafting in otologic surgery.
In the post-operative healing phase following external auditory canalplasty or open cavity mastoidectomy, problematic epithelialization of surfaces may ensue. Exposed surfaces or surface epithelialized with tissues other than skin may predispose to secondary infection and result in recurrent otorrhea. Split-thickness skin grafts can be useful in promoting healing of exposed canal and mastoid cavity surfaces. Our experience and methodology for harvesting and placing these grafts are reviewed. The indications, management, and complications of split-thickness otologic skin grafting will be presented.
The perforated tympanic membrane.
Tympanic membrane perforations typically result from trauma or acute otitis media. Most perforations do not cause more than a mild conductive hearing loss, aural fullness and mild tinnitus. Blood, purulent secretions and other debris should be carefully suctioned out of the canal and the perforation size and location described. Irrigation and pneumatic otoscopy should be avoided. A history of vertigo, nausea and vomiting and an audiogram showing a conductive hearing loss of more than 30 dB suggest disruption of the ossicular chain. Profound sensorineural loss may signify inner ear nerve damage. Mastoid radiographs and computed tomographic scans may be useful in cases of significant trauma and infection. Most small perforations resolve spontaneously. The affected ear should be kept dry. Oral and topical antibiotics may be prescribed for perforations related to acute otitis media. Otolaryngologic referral may be necessary to evaluate traumatic perforations associated with vertigo or significant hearing loss, perforations from chronic otitis media or perforations from acute otitis media that do not heal within one month.
Perilymphatic fistula: surgical experience in the United States.
One survey sent to 6953 individual otolaryngologic practices and 106 departments of otolaryngology at teaching hospitals in the United States, and a more limited survey of 75 patients operated on for perilymphatic fistula (PLF) at the House Ear Institute, addressed aspects of managing PLF: surgical incidence, reliability of diagnostic test, preoperative observations, and disability after surgery. Of surgeons sampled, 93% estimated incidence of PLF surgery to be less than or equal to 1 per 1000 otolaryngologic outpatient visits. The most reliable diagnostic indicators were history, symptomatology, and tympanometric and electronystagmographic fistula tests. About 72% of surgeons reported less than 4 weeks' average delay before surgery. Most surgeons and patients (greater than or equal to 70%) rated length of disability before return to work, exposure to noise, travel by airplane, swimming, and heavy lifting, at several weeks to several months. Diving was the most restricted activity. Results suggest that incidence of surgery and disability with PFL in the United States is very limited.
Otologic disease in the acquired immunodeficiency syndrome.
It appears that true otologic manifestations of AIDS are rare and that incidental otologic disease associated with AIDS is more common. A review of the literature revealed that otitis externa, acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media with cholesteatoma, and herpes zoster oticus may all represent incidental otologic disease occurring in patients with AIDS. Chronic otitis media without cholesteatoma (P carinii-infected aural polyps), sensorineural hearing loss, acceleration of otosyphilis from the latent stage, and development of Kaposi's sarcoma of the external auricle or nasopharynx may represent true otologic manifestations of AIDS.
Lymphadenopathy in the HIV-seropositive patient.
The problem of lymphadenopathy in HIV-seropositive patients is reviewed, and indications for further study are presented. Implications for patients who later develop AIDS are discussed.
Postpartum subcutaneous emphysema with pneumomediastinum.
We have presented a case of pneumomediastinum and subcutaneous emphysema in a 30 year old woman immediately post-partum. The underlying pulmonary pathophysiology and management are discussed.
The flexible/intact-bridge tympanomastoidectomy technique.
A combination of otologic techniques has been presented in the step-wise surgical rationale that we call the flexible approach. The sequence of steps involved in the flexible approach allows the surgeon to adjust his or her surgery to the individual patient's needs. Very often, in patients with chronic otitis media, a middle ear reconstructive procedure (ossiculoplasty including lateralization of the malleus, removal of pathological tissue, insertion of an implant of silicone rubber sheets, and use of ventilation tubes with or without tympanic grafts) will obviate mastoidectomy. When a mastoidectomy is indicated, the IBM is a suitable procedure that encompasses the advantages of both closed and open mastoidectomy techniques.
Treatment failure: the importance of context in treating head and neck cancer.
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SLIPS. A data base system for computer storage and analysis of phonological errors.
The analysis of phonological errors made by normal individuals (slips of the tongue) and brain-damaged patients (paraphasias) is a challenging problem. SLIPS is an experimental data base system for computer storage and analysis of such errors. This paper introduces SLIPS and describes its main features. Some of the problems that arise in analyzing phonological error data are explained, and examples of their solution are presented.
New device for foreign body removal.
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Carcinogen metabolism in rat liver cell culture.
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The comparative ultrastructure of fibrin induced by thrombin and by staphylocoagulase.
Fibrin induced by the action of thrombin and by staphylocoagulase was studied by transmission electron microscopy. Periodic striations were consistently observed in the negatively stained preparations of both fibrins. When 4200 major periods in the thrombin fibrin system were measured the mean length was 228 A. For 3666 major periods in the coagulase fibrin system the mean length was 223 A. While the T test analysis of these values gave a value of 10, it is noteworthy that the differences are well within the scatter of periodicity reported in the literature for thrombin-induced fibrin. Gross inspection of the preparations indicated that the coagulase-induced fibrin had a knottier appearance and was accompanied by a greater amount of background debris than the thrombin-induced fibrin.
Lived experiences, values, and behavior of effective nurse faculty.
This study explored the lived experiences of effective female nurse faculty. The study was guided by a feminist framework. A field study was the specific qualitative approach employed. The research addressed the question: What are the lived experiences of effective female nurse faculty? In addition, four subquestions related to the conceptual framework were explored. The sample was composed of 11 women from National League for Nursing-accredited baccalaureate and higher-degree nursing programs in Virginia who were identified by their peers as being effective in the nurse faculty role. Data were collected through use of unstructured interviews, passive participant observations, and document review. The study yielded themes related to values and effective teaching behaviors. Conclusions of the study were: (1) the feminist framework developed for the study was generally helpful for understanding the women studied; (2) effective female nurse faculty are a work in progress; (3) because they value hard work, caring, interaction, a sense of humor, the worth of others, and learning, subjects were able to develop into effective female nurse faculty; and (4) these women maintain their effectiveness by constantly growing and changing as well as by finding a sense of fit between organizational values and personal values.
Subglottic stenosis: retrospective analysis and proposal for standard reporting system.
A retrospective analysis was undertaken reviewing management of 67 patients treated for subglottic stenosis (SGS) at the Children's Hospital National Medical Center (CHNMC) between 1980 and 1985. Forty-seven (90%) of the patients were followed for at least 18 months from the time diagnosis was made. Twenty-three (66%) of the patients followed for at least 18 months were successfully decannulated or had an adequate airway without tracheotomy. To compare efficacy of management of SGS at the CHNMC with management outcomes previously reported, a review of medical literature was undertaken and data from the most significant reports on management of SGS were collated and tabulated. Since analysis of published reports did not yield a consensus regarding optimal methods for management, and statistics in many published reports were absent or unclear, authors of the previously published reports were contacted personally by means of a letter and survey questionnaire. Results of the survey show that many authors have not performed a statistical review of their case data to determine relative efficacy of different surgical procedures. Thus, retrospective review of cases managed at the CHNMC as well as information obtained from leading experts in management of SGS indicate that there is no single optimal procedure or technique for management of all cases of SGS. Further, the way in which surgical procedures for management of SGS are being reported makes difficult the process of meaningfully comparing results reported by different surgeons. A reporting system is proposed that uses specific terms and objective parameters.