Towards the twenty‐first century

It is suggested that the change in thought and technology in France, North America and England in the late 18th century is paralleled in the change in contemporary modes of behaviour and ways of looking at the self. The philosophy articulated at that time was by the philosophers of the Enlightenment and poets of Romanticism. Contemporary psychologies are concerned with the structure of the individual psyche and with social organization.

In this nuclear age we are threatened by nuclear war, over‐population and ecological imbalance, with irreversible destruction of living and technological resources. The contemporary philosophical and technological changes are on a global basis, as is the current conflict reflecting a war of man against himself. This can lead to either complete annihilation of humanity or to a re‐appraisal through a holistic approach to ourselves and our planet, based on internationalism.     

Building world democracy through the UN

The evolution of autonomous units of organized human society from tribes to sovereign nation‐states has been paralleled by a belief in a need for global unification under a religious or secular authority.

A modern alternative to the subordination of nation‐state sovereignty to a higher authority is to restrain the excesses of the established world system by institutionalizing in the United Nations a democratic voice for the world public's opinions. This could be done by means of: (1) a UN Second ('we the peoples') Assembly or related proposal; (2) a UN Parliamentary Assembly to represent national parliaments; (3) an assembly representative of non‐governmental organizations affiliated with the UN or its Agencies and other bodies; (4) a UN‐grassroots system for information‐sharing and dispute‐solving.

The paper summarizes the principles of these approaches, and outlines in more detail the multidisciplinary basis of the concept of a UN Second Assembly, the Penrose method for equitable voting power or distribution of seats in a world assembly, and the work of the International Network for a UN Second Assembly (INFUSA) including the initiative for a series of international Conferences on A More Democratic United Nations (CAMDUN).     

Traditional and complementary medicine (T/CM) in the treatment of erection difficulties – experience from the Asian Men's Attitudes To Life Events and Sexuality (MALES) study

BackgroundLittle is known about the practice, perceptions and experience of using traditional and complementary medicine (T/CM) for erection difficulties among Asian men.MethodsA total of 10,934 Asian men living in China (n = 2,055), Japan (n = 877), Korea (n = 2,000), Malaysia (n = 3,000) or Taiwan (n = 2,002) were recruited via random digit dialing, street interception and face-to-face interview in the Asian Men's Attitudes To Life Events and Sexuality (MALES) Phase I study. The Phase II study was comprised of a total of 1,286 men who experienced erection difficulties and who lived in China (n = 255), Japan (n = 228), Korea (n = 225), Malaysia (n = 380) or Taiwan (n = 228).ResultsUse of T/CM for erection difficulties (9.1%) was relatively low compared to conventional medicine (83.5%). Among those that seek help and treatment from T/CM, the majority were respondents from Malaysia, followed by respondents from China, whereas respondents from Japan and Korea ranked lowest. Use of a combination of alternative and conventional therapy was prevalent. Erection difficulty was amongst the highest in terms of preference of treatment seeking using traditional approaches after back pain, arthritis and gout. Overall outcome was expressed as ‘Partly satisfied’ with T/CM treatment for erection difficulties. The main reason that T/CM outweighs conventional medicine was because it was perceived that T/CM had fewer side effects than conventional medicine (56.1%). Users of T/CM were mostly middle-aged, married, employed, and perceived their health status and the severity of their erection dysfunction as moderate.ConclusionsThe findings help to identify the differences in practices and beliefs about T/CM among Asian countries and provide useful information to conventional practitioners about the alternative help- and treatment-seeking behaviors for erectile difficulties.     

Backside Wear in Modern Total Knee Designs

Although modularity affords various options to the orthopedic surgeon, these benefits come at a price. The unintended bearing surface between the back surface of the tibial insert and the metallic tray results in micromotion leading to polyethylene wear debris. The objective of this study was to examine the backside wear of tibial inserts from three modern total knee designs with very different locking mechanisms: Insall-Burstein II® (IB II®), Optetrak®, and Advance®. A random sample of 71 inserts were obtained from our institution’s retrieval collection and examined to assess the extent of wear, depth of wear, and wear damage modes. Patient records were also obtained to determine patient age, body mass index, length of implantation, and reason for revision. Modes of wear damage (abrasion, burnishing, scratching, delamination, third body debris, surface deformation, and pitting) were then scored in each zone from 0 to 3 (0 = 0%, 1 = 0–10%, 2 = 10–50%, and 3 = >50%). The depth of wear was subjectively identified as removal of manufacturing identification markings stamped onto the inferior surface of the polyethylene. Both Advance® and IB II® polyethylene inserts showed significantly higher scores for backside wear than the Optetrak® inserts. All IB II® and Advance® implants showed evidence of backside wear, whereas 17% (5 out of 30) of the retrieved Optetrak® implants had no observable wear. There were no significant differences when comparing the depth of wear score between designs. The locking mechanism greatly affects the propensity for wear and should be considered when choosing a knee implant system.Key words: polyethylene, wear, knee, backside, back surface, locking mechanism     

Osteochondral Fracture of the Fourth Metatarsal Head Treated by Open Reduction and Internal Fixation

Fracture of the metatarsal head is uncommon, and reports of isolated osteochondral fracture of the metatarsal head are rare. Because of the distal location of the fracture, it is difficult to achieve and maintain reduction, and potential complications include avascular necrosis and subchondral fatigue fracture. The authors present a case of an osteochondral fracture in a 40-year-old man, which was treated by open reduction and internal fixation with a single twist-off screw, with good results 12 months postoperatively.     

Modified Technique of Mesh Hepatorrhaphy for Management of Juxtahepatic Venous Injury in a Case of Blunt Liver Trauma: A Case Report

The liver is the most frequently injured organ in cases of blunt abdominal trauma. Injuries to the caudate lobe are rarely isolated and usually associated with retrohepatic caval injury or hepatic vein injury. The management of the associated vascular injuries is usually difficult owing to the short courses of the hepatic veins and the difficulty in obtaining proximal and distal control of the suprarenal and suprahepatic inferior vena cava – hence the frequency of perihepatic packing in the management of caudate lobe and hepatic venous injuries. We present here a rare case of the failure of perihepatic packing to effectively control hemorrhage from blunt injury to the caudate lobe and retrohepatic vena cava. A case of blunt abdominal trauma with injury to the caudate lobe and retrohepatic venous injury was initially managed with perihepatic packing. The patient developed hemorrhage 48 h after pack removal, which was then successfully managed with mesh hepatorrhaphy of the caudate lobe.