Abstract. Since 1990, Polish municipalities have exercised planning power in terms of deciding on the ways of their economic and spatial development. Results of dynamic and sometimes uncontrolled, spontaneous development processes cross the borders of municipalities bringing problems, that can not be addressed, and solved by one municipality. Polish legislation provides legal basis for cooperation of municipalities: they may establish common goals' unions and associations in order to deal with problems that are important for more than one municipality. However, experience of the last several years proves that cooperation among municipalities is not an easy task. It creates problems especially within functional urban areas, including metropolitan ones. In this paper, the issue of cooperation among municipalities from the Warsaw Metropolitan Area (WMA) is addressed using the perspective of networking and formulation of common development policy.

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Objective: The clinical outcome of a total knee arthroplasty.(TKA) is maidy determined by the accuracy of the surgical procedure itself. T o improve the final result, one must take into account (a) the alignment of the prosthesis with respect to the mechanical axis, and (b) the balance of the soft tissues. Therefore, morphologic data (such as the shape of the epiphysis) and geometric data are essential. We present a new method for performing TKA based on morphologic and geometric data without preoperative images. Materials and Methods: The global method is based on the digitization of points with an optical 3D localizer. For the morphologic acquisitions, we use a method based on the registration of sparse point data with a 3D statistical deformable model. T o build the mechanical axis, we use a kinematics method for the hip center and digitization of anatomical landmarks for the ankle centers. The knee center is not determined by digitization or kinematics of the knee, as this would not be accurate. The surgical planning relies totally on the soft-tissue balance, which is the key issue for a good kinematics result. Results: We have used this system for 6 months in a randomized clinical mal involving 35 patients to date. For the first 11 patients that could be measured in the navigation group, the postoperative frontal alignment was within the range of 180 & 3". Fluoroscopic assessment of the soft-tissue balancing will be performed at the conclusion of an extended 2-year study to evaluate the results from a functional point of view. Conclusion: Bone Morphing is an accurate, fast, and user-friendly method that can provide morphologic as well as geometric data. We have introduced the important notion of soft-tissue balancing into the intraoperative planning step to optimize the kinematics as well as the anatomy. Therefore, this method should be considered as an alternative to the CT-based method. Comp Aid Surg 7:156-168 (2002). 02002 WiIey-Liss, Inc.

Emergency physicians missed a substantial proportion of acute ACL ruptures. Efforts are needed to improve their skills in diagnosing ACL rupture.