Watermans

The incidence of vascular occlusion injuries has risen substantially along with the increasing popularity of cosmetic injectables. Among these occurrences, instances of soft-tissue ischemic events following the injection of nonparticulate solutions, such as botulinum, represent an enigmatic etiology that has yet to be fully understood. One hypothesized mechanism of injury underlying these events relates to the accidental capture and intravascular ejection of needle microcores, defined as submillimeter tissue fragments trapped by the beveled lumen of a needle during conventional injections. To test this hypothesis, the authors conducted a cytologic evaluation of dermal remnants incidentally captured by 31-G tuberculin needles following repeated injections into postrhytidectomy skin fragments. Their findings revealed the presence of dermal tissue microcores ranging from 100 to 275 μm in diameter with an overall microcoring incidence of 0.7%. These findings confirm the ability of ultrafine needles, commonly used in botulinum injections, to produce tissue microcores that may serve as causative agents of vascular occlusion with nonparticulate solutions. Awareness of this mechanism of injury may be of benefit in the early recognition and management of these rare occurrences. Therapeutic, V.

Buildings forms are often complex and a result of end user needs, local surroundings and aesthetic aspirations. The individuality of buildings has therefore posed challenges with respect to harnessing the desired mass production and standardisation linked with off-site manufacture. However, through design for manufacture and assembly (DfMA), construction can be linked with industrial processes and deliver projects that are safer, cleaner and more efficient. Furthermore, successful DfMA projects minimise disruption within the local environment while delivering not only improved quality, cost and programme certainty, but also a more sustainable form of construction. The Two Fifty One project is a 40-storey mixed-use development in central London, UK, that has successfully embraced the principles of DfMA across all engineering disciplines. As a result, the delivery team has developed effective off-site construction solutions for superstructure, facades, bathrooms and mechanical and electrical services. All have been designed, coordinated and facilitated through advanced digital engineering and building information modelling techniques. Overall, the project has been delivered with reduced programme and cost, while simultaneously improving safety, quality and reliability in a more sustainable way through reduced vehicle movements and greater efficiency in site logistics. This case study describes this exemplary project and the design delivery model.

EDITOR, - John Kemm claims that advice about drinking to individual members of the public has been fairly consistent over the past decade.1 This is surprising. In 1979 a special committee of the Royal College of Psychiatrists stated that the absolute upper weekly limit was about 56 units of alcohol.2 In 1981, however, the Department of Health and Social Security stated that these weekly limits were in fact quite high but declined to give precise …

Although a great portion of the county is forested today, there are few areas that are relatively undisturbed and that might be termed samples of the primeval forest.