Biomedical subjects
Publications and source records attributed to R L Tomczak.
Without question, injury to the Achilles' tendon is one of the commonest running injuries involving the lower extremity. Repair of acute and delayed ruptures is discussed. Tendonitis is by far commoner than ruptures. The pathology and conservative and surgical treatments are discussed.
Evaluation and treatment recommendations for a painful knee in a runner can be accomplished with a good knowledge of knee pathology, careful physical exam, and appropriate use of imaging tests. Most knee problems in a runner fall into one of the entities listed above. Fortunately, almost all can expect significant improvement with appropriate treatment.
Philosophy offers us the ability to think logically and critically about any field of knowledge, podiatric medical education included. By proceeding in an orderly manner, the growth of the profession will be ensured as long as the thinkers are willing to be truthful. Ironically, conformity is not a necessity and a diversity of philosophies is actually encouraged.
The College of Podiatric Medicine and Surgery was established in 1981 as a fully integrated college of the University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa, becoming the only school in the profession to be part of an academic health science center. Thus, this college provides a unique opportunity for the students and the podiatric medical profession to receive a multidisciplinary education, preparing them for podiatric medical practice as an integral part of total health care.
The authors present a study of the treatment of Morton's neuroma. Sixty patients, involving 65 feet treated, were studied. Conservative treatments were compared to surgical excision of the neuroma. As a result of the findings in this study, the authors recommend surgical excision as the initial treatment of choice.
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Podiatric surgeons no longer care only for patients who are systemically well. The foot surgeon must also become intimately familiar with the diseases and conditions which may affect his patients.
This paper, along with a review of osteoporosis, examines 21 patients (15 women and 6 men) who presented to the senior author between May 1997 and January 1999 with unexplained metatarsal fractures. All 21 patients agreed to bone density testing. Twenty of the 21 had bone densities significantly below the mean for corresponding age, gender, and race. The average bone density for the 21 patients was 2.1 standard deviations below the expected mean for the corresponding 30-year-old reference population and 1.7 standard deviations below the mean for an age, gender, weight, and ethnicity matched population. Distribution and location of the fractures were also investigated. The Body Mass Indices were calculated for all 21 patients, but did not seem to play a role in the fractures. Pertinent medical histories and possible factors for comorbidity are also presented. In all cases successful treatment consisted of guarded weightbearing in a padded boot. The authors conclude that there is a previously unreported correlation between metatarsal insufficiency fractures and low bone mass in both genders, confirmed by the abnormal bone mineral density testing. They also point out that men should be made aware that they can suffer from this disease.
The authors review the etiologies and treatments of plantar fasciitis or heel spur syndrome. They offer results of a retrospective study. Comparison of the return to work time after surgery for this condition, examinations of the effects of patient age at the time of surgery, gender, duration of pain prior to surgery, and type of surgical procedure, either endoscopic plantar fasciotomy or open plantar fasciotomy with heel spur resection, is provided.
An extremely rare case of systemic podophyllin toxicity from local injection is presented with a review of the literature. There is only one other known similar case reported in the medical literature world wide. Clinical and pathologic findings will be discussed.
Many authors have published their results of first metatarsal osteotomies to reduce the intermetatarsal angle. Each study has shown some degree of success. The meta-analysis or research synthesis that follows is a method of providing a quantitative review of these studies. It is a procedure for aggregating numerous studies and comparing the evidence derived from each.
Antibiotic-impregnated polymethyl methacrylate beads have been used in other countries to treat osteomyelitis. The drug of choice for this has historically been gentamicin. The authors have chosen ceftazidime to treat iatrogenic Pseudomonas aeruginosa osteomyelitis in rabbit femurs. After implanting the beads, the rabbits were killed at various times in the treatment period. Rabbits were killed at 15 days and later showed no signs of current osteomyelitis, including cultures and histologic examination. Blood antibiotic levels were measured at euthanasia and were minimal for all animals. It appears that ceftazidime may be an effective alternative to gentamicin, especially in treating gentamicin-resistant P. aeruginosa.
The efficacy of the preoperative surgical scrub has been studied extensively throughout the years. However, to the best of the authors' knowledge, this is the first comparative study between surgeons, residents, operating room personnel, and medical students. This paper demonstrates the efficacy of the surgical scrub and the differences between these groups, as well as presents a simple method of monitoring the effectiveness of the surgical scrub in vivo.
The actual process for selecting surgical residents is plagued with inadequacies. Two of those problems, namely the evaluation of the application and the interview itself, are addressed in this paper. An attempt has been made to standardize both in hopes of making the experience more objective.
Historically, patients suffering from fibrous dysplasia of the metatarsals faced amputation or resection as the treatments of choice. Although the lesion itself is not malignant, pain, swelling, and disability dictated the treatment. With recent refinements in microvascular surgery, vascularized bone grafting has offered a viable alternative for this and similar conditions that offers the potential for a functional, pain-free foot.