Coventry Award paper. Backsurface wear and deformation in polyethylene tibial inserts retrieved postmortem

Wear and deformation were characterized at the backsurface of 25 posterior cruciate-retaining total knee arthroplasty polyethylene inserts retrieved postmortem from 20 subjects. The mean implantation time was 64.1 months (range, 4-156 months). The backsurface of the inserts was inspected using a stereomicroscope with a digital optical system. Coronal histologic sections of 13 proximal tibias were inspected for the presence and extent of penetration of granuloma. Damage to the backsurface was limited. Polishing was recorded on 21 (84%) of the inserts and abrasive wear on five (20%) inserts. Pitting was present in 21 (84%) components, but involved less than 1% of the area in all but one of these components. Delamination and cracking were not observed. Extrusions were seen in all 10 of the components that had screw holes in the tibial tray. A correlation was found between the depth of penetration of the granuloma along the posteromedial screw and the height of the corresponding extrusion. The anteroposterior profiles showed a concave deformation of the backsurface in 24 (96 %) of the cases. The concave deformation of tibial inserts may facilitate accumulation and transportation of wear debris to the tibial bone-implant interface through the screw holes in implants designed for cementless fixation.     

Immunoneuroendocrine communication network and homeostasis regulation: the use of hormones and neurohormones as immunotherapy

The complex communication between the immune and neuroendocrine systems is bi-directional, and involves sharing different ligands and receptors in tissues and organs in vertebrate in general, and mammals in particular. It have been demonstrated that many hormones, neurohormones and neurotransmitters have profound effects on the immune system, and in turn, cytokines produced by cells of the immune system cause important changes in the neuroendocrine function. It has been shown in different animal models with induced and spontaneously occurring autoimmune diseases that alterations of the immunoendocrine interactions are involved in the breakdown of self tolerance, and by extend, the homeostasis. This review discusses the role of the neuroimmunoendocrine interactions in maintaining the homeostasis of mammals, and their role in the development of some autoimmune diseases. The finding that could exist a defective immunoneuroendocrine communication may lead to more specific therapy of several autoimmune human diseases.     

International expert workshop on the analysis of the economic and public health impacts of air pollution: workshop summary

Forty-nine experts from 18 industrial and developing countries met on 6 September 2001 in Garmisch-Partenkirchen, Germany, to discuss the economic and public health impacts of air pollution, particularly with respect to assessing the public health benefits from technologies and policies that reduce greenhouse gas (GHG) emissions. Such measures would provide immediate public health benefits, such as reduced premature mortality and chronic morbidity, through improved local air quality. These mitigation strategies also allow long-term goals--for example, reducing the buildup of GHG emissions--to be achieved alongside short-term aims, such as immediate improvements in air quality, and therefore benefits to public health. The workshop aimed to foster research partnerships by improving collaboration and communication among various agencies and researchers; providing a forum for presentations by sponsoring agencies and researchers regarding research efforts and agency activities; identifying key issues, knowledge gaps, methodological shortcomings, and research needs; and recommending activities and initiatives for research, collaboration, and communication. This workshop summary briefly describes presentations made by workshop participants and the conclusions of three separate working groups: economics, benefits transfer, and policy; indoor air quality issues and susceptible populations; and development and transfer of dose-response relationships and exposure models in developing countries. Several common themes emerged from the working group sessions and subsequent discussion. Key recommendations include the need for improved communication and extended collaboration, guidance and support for researchers, advances in methods, and resource support for data collection, assessment, and research.     

Drug and alcohol-related emergency department visits: results of a pilot survey in two hospitals in Israel

There is no system for reporting drug and alcohol-related emergency department (ED) visits in Israel. This pilot survey was aimed at examining the feasibility of establishing an ED surveillance system in a general hospital and a psychiatric hospital. We describe the design and preliminary results of a pilot-survey conducted in the emergency departments of two hospitals in Northern Israel. Active and passive case identification was conducted in Rambam Hospital and Tirat Carmel Psychiatric Hospital, from August, 1999-January, 2000. A total of 160 ED patients were identified, 64% as drug-related, with heroin being the most common drug. The majority of cases were identified through self-reports. Overdose and IVDU complications accounted for 20% of drug cases identified at Rambam Hospital, and injury and motor vehicle accidents accounted for 12% of all visits at this hospital. We did not attempt to estimate the proportion of all ED visits that are associated with drugs and/or alcohol. Under-ascertainment of cases and incomplete data recording remain major concerns for a survey of this nature. Results of this pilot survey indicate that with proper training of ED nurses a national ED surveillance system can be successfully and efficiently established in general hospitals and psychiatric hospitals in Israel.     

Late lower extremity fractures in patients with paraplegia

We report the result of the treatment of 26 lower limb fractures in patients with established paraplegia. We treated one fracture of the femoral neck, one intertrochanteric, two subtrochanteric, two of the femoral shaft, seven of the supracondylar region, six of the proximal tibia, one of the tibial shaft, and six pilon fractures. Nine fractures were treated non-operatively, and the remaining fractures were treated operatively. Union was achieved in all the patients, but we think that open reduction and internal fixation may improve the level of independence and mobility of these patients during fracture healing.