In situ testing of early age energy absorption in sprayed fiber reinforced concrete - HyEA – test

The properties of fibre-reinforced sprayed concrete concerning energy absorption are mainly assessed according the standard of EFNARC, EN14488-5 and ASTM C 1550. Energy absorption will be measured after 28 days up to a deflection of 25 or 40 mm (depending on the applied standard). Fibre-reinforced concrete is often used for rock support and as a first safety layer. When covering the tunnel face with fibre-reinforced sprayed concrete, the concrete will be removed after approx. 6 to 12 hours. Taking into account the situation in modern tunnel headings, the performance of fibre-reinforced sprayed concrete with-in the first hours is essential to provide a sufficient safety level, while accelerating work progress. For those applications the 28-day-properties have no relevance. Even for durable sprayed concrete applications the early support function of rein-forced sprayed concrete will be decisively for the loading bearing behaviour of the rock support system. Currently, there is no test procedure available to assess the properties – specially load bearing - of fibre-reinforced concrete within the first hours. At early age only the early strength is determined, e. g. penetration needle acc. EN 14488-2 (“HILTI”-method). Hagerbach Test Gallery (VSH, Switzerland) has been operating an underground facility for research and development activities for more than 40 years. Based on the above mentioned considerations a test method has been developed to assess the capability of energy absorption of young sprayed concrete. The test method is named HyEA-TestTM. (HyEA-Test = Hagerbach young Early Age-Test) Based on the experience with production, application and testing of shotcrete, VSH did evaluate during research projects with different mix-designs and fibre contents the test method. As a result of the research projects a mobile testing equipment for in-situ use at construction sites faces was developed and designed. The results from these research projects will show, that it is possible to test the ener-gy absorption according to ASTM C1550 in a very early age, meaning during the first hours after the application. Furthermore it is possible to achieve results in such a quality to get information about best dosage of fibres, performance of fibres and mix optimization in general. The presentation is showing, that the test method should be used for quality control during tunnel excavation. The test method is very helpful to increase the safety level during excavation and installing of additional rock support

The Transareolar Incision for Breast Augmentation Revisited

Of the various possible incisions for breast augmentation, the transareolar access has gained only limited popularity. The potential side effects of this incision are said to be altered nipple sensation, impaired lactation, an increased rate of infections with capsular fibrosis, well visible scar formation with hypopigmentation, and the need for an additional access in case a breast ptosis correction should prove necessary at a later date. The purpose of this retrospective study was to judge advantages and limitations of transareolar breast augmentation, and to verify whether the reluctant attitude toward this surgical approach is justified. A sample of 18 patients with a transareolar, retropectoral breast augmentation was selected for a retrospective evaluation. The suitability of the technique in general was examined together with early postoperative complications, sensory changes, and late complications on the basis of an evaluation system for cosmetic surgical results. The study showed that only women with an areolar diameter of 3.5cm or more without pronounced breast ptosis were suitable for the transareolar access. No early infections were noted. The rate of capsular fibrosis was 11%. Two years after breast augmentation, 16 women (89%) judged their breast sensation to be normal, but objective assessment showed that mean pressure and vibration sensation were moderately compromised in all parts of the breast. The scars were of good quality, with very little hypopigmentation. With appropriate patient selection, respecting the advantages and limitations, the transareolar incision has its definite place among the different incisions for breast augmentatio

Der Body Mass Index als Entscheidungsgrundlage für medizinisch indizierte Brustreduktionen

Summary: PURPOSE: Breast reduction is a highly emotional theme and bears conflicting interest groups: (1) women who are suffering from symptomatic macromastia and therefore would wish to have their breast reduction paid by the insurers, irrespective of the amount of resection weight, (2) the insurance companies, who are ready to cover only really medically indicated operations and due to a lack of objective parameters often apply the very strict, arbitrary criterium for a minimum resection weight of 500g per breast, and (3) the surgeons, who try to provide a fair, scientific basis for the differentiation between cosmetic and reconstructive indications for breast reductions for the sake of both the patients and the insurance parties. Concerned about such a generalizing rule, we undertook a retrospective review of our patients' charts with both cosmetic and reconstructive indications to judge the available, more-level minimum resection weight standards and see wether they were appropriate to use, or to provide an objective and measurable guideline for a scaled amount of breast reduction beyond the 500 g-resection-rule, adapted to the individual woman's body proportions. METHODS: 136 women could be included in the study. The resection weight was recorded and correlated to various parameters of the body proportions such as weight, height, the body mass index (BMI) and the body surface. The results were compared to the available minimum resection weight rules. RESULTS: The resection weight ranged from 55 to 1530g (mean, 450g ± 266g; median, 406g). Overweight was present in 36% of all patients, whereas obesity was present in 7.5 % of women. The mean BMI was 25.1 kg/m2. Of the twenty-four patients (18%), who were classified a priori as having a cosmetic indication, 4 (18%) had more than 500g breast tissue resected bilaterally. On the other hand, in 55% of reconstructive patients less than the predicted 500g of breast tissue had been resected. From all examined parameters the BMI had the highest correlation to the resected mean breast tissue (r = 0.64, p ≤ 0.001). DISCUSSION: Our retrospective review thus showed that with an arbitrary 500g breast resection-rule all women beyond the mean values for weight and height were clearly put at a disadvantage. Also not completely solving this problem are the already available, more objective guidelines for graded minimum resection weight recommendations which have relied on the body weight or the body surface area, parameters that both had a much lower correlation to the resected breast tissue in the patient group than the BMI. We therefore suggest using the BMI as the basis for a graded, more-level weight resection standard for reconstructive breast reductions. This algorithm is related solely to objectifying data and thus avoids biases from empirically derived data or hardly quantifiable breast (or obesity) related pain syndromes, and respects all the different body builds of wome

A body mass index related scale for reconstructive breast reduction

Breast reduction is a highly emotional topic, involving three conflicting interests: (a) women suffering from symptomatic macromastia, (b) health insurance companies, and (c) surgeons. Many insurance companies, including those in Austria, cover (if at all) only breast reductions with a minimum resection weight of 500g per breast, irrespective of the physical build of the woman involved. We retrospectively reviewed 136 patients' charts from both cosmetic and reconstructive breast reduction operations and compared the breast resection weight to various parameters of body proportions such as height, weight, body mass index (BMI), and body surface area to determine the parameter best correlated to the weight of breast tissue resected. From this we developed a graded scale for guiding future operations irrespective of a woman's body build. The resection weight ranged from 55 to 1530g (mean 450±266, median 406); mean BMI was 25.1. The arbitrary 500g breast resection rule discriminates against women of nonaverage weight or height: of 24 patients (18%) with a cosmetic indication 4 had more than 500g breast tissue resected bilaterally, while in 62 reconstructive patients (46%) less than the arbitrary 500g breast tissue was resected. The parameter best correlated to the mean weight of breast tissue resected (sum of both breasts) was BMI. We therefore suggest using the BMI as the basis for a graded weight resection guideline for reconstructive breast reductions. The BMI-based scale treats equally women of all types of body build. In women with a BMI greater than 30 (classified as adiposity) we recommend that breast reduction be postponed, and a general body weight reduction program be undertaken for the sake of a higher impact on general well-bein

The Cartilage-Sparing Versus the Cartilage-Cutting Technique: A Retrospective Quality Control Comparison of the Francesconi and Converse Otoplasties

From a total of 281 patients with protruding ears who underwent a bilateral otoplasty between 1990 and 2001, a group of 28 (10%) was selected for a retrospective quality control study. The goal was to compare two methods of otoplasty, the Francesconi, a cartilage-sparing technique, and the Converse, a cartilage-cutting technique, in terms of objectively measurable and subjectively discernable differences in results. Objective parameters included measurement of the three cephaloauricular distances and the conchoscapal angle. An independent plastic surgeon performed the evaluation by means of a systematic evaluation system for rating cosmetic surgical procedures and a 5-point visual analog scale for rating satisfaction. The patients' subjective rate of satisfaction also was investigated using the 5-point scale. The mean medial and inferior cephaloauricular distances were significantly smaller in the Francesconi group. The concoscaphal angle was 90°, or less in all the patients of the Francesconi group, but more than 90° in eight patients (57%) of the Converse group (p = 0.041). Accordingly, the independent surgeon found adequate correction of protrusion in 86% of the Francesconi group and 50% of the Converse group (p = 0.050). His satisfaction rate was significantly in favor of the Francesconi technique (p = 0.006). Not unexpectedly, the patients' satisfaction rate was comparably high in both groups, and there was no statistical difference between them. In conclusion, the quality control led to a clear preference of the Francesconi over the Converse otoplasty. In addition, the assessment of the postoperative results with the systematic evaluation system offered an excellent information base by which to judge the results of otoplasty. Consequent use of this evaluation system will lead to progress in the surgical procedur

The Transareolar Incision for Breast Augmentation Revisited

Of the various possible incisions for breast augmentation, the transareolar access has gained only limited popularity. The potential side effects of this incision are said to be altered nipple sensation, impaired lactation, an increased rate of infections with capsular fibrosis, well visible scar formation with hypopigmentation, and the need for an additional access in case a breast ptosis correction should prove necessary at a later date. The purpose of this retrospective study was to judge advantages and limitations of transareolar breast augmentation, and to verify whether the reluctant attitude toward this surgical approach is justified. A sample of 18 patients with a transareolar, retropectoral breast augmentation was selected for a retrospective evaluation. The suitability of the technique in general was examined together with early postoperative complications, sensory changes, and late complications on the basis of an evaluation system for cosmetic surgical results. The study showed that only women with an areolar diameter of 3.5cm or more without pronounced breast ptosis were suitable for the transareolar access. No early infections were noted. The rate of capsular fibrosis was 11%. Two years after breast augmentation, 16 women (89%) judged their breast sensation to be normal, but objective assessment showed that mean pressure and vibration sensation were moderately compromised in all parts of the breast. The scars were of good quality, with very little hypopigmentation. With appropriate patient selection, respecting the advantages and limitations, the transareolar incision has its definite place among the different incisions for breast augmentatio

A body mass index related sacle for reconstructive breast reduction

Breast reduction is a highly emotional topic, involving three conflicting interests: (a) women suffering from symptomatic macromastia, (b) health insurance companies, and (c) surgeons. Many insurance companies, including those in Austria, cover (if at all) only breast reductions with a minimum resection weight of 500 g per breast, irrespective of the physical build of the woman involved. We retrospectively reviewed 136 patients' charts from both cosmetic and reconstructive breast reduction operations and compared the breast resection weight to various parameters of body proportions such as height, weight, body mass index (BMI), and body surface area to determine the parameter best correlated to the weight of breast tissue resected. From this we developed a graded scale for guiding future operations irrespective of a woman's body build. The resection weight ranged from 55 to 1530 g (mean 450±266, median 406); mean BMI was 25.1. The arbitrary 500 g breast resection rule discriminates against women of nonaverage weight or height: of 24 patients (18%) with a cosmetic indication 4 had more than 500 g breast tissue resected bilaterally, while in 62 reconstructive patients (46%) less than the arbitrary 500 g breast tissue was resected. The parameter best correlated to the mean weight of breast tissue resected (sum of both breasts) was BMI. We therefore suggest using the BMI as the basis for a graded weight resection guideline for reconstructive breast reductions. The BMI-based scale treats equally women of all types of body build. In women with a BMI greater than 30 (classified as adiposity) we recommend that breast reduction be postponed, and a general body weight reduction program be undertaken for the sake of a higher impact on general well-being

Oral premedication for operations on the face under local anesthesia: a placebo-controlled double-blind trial

Modern strategies for preventing or controlling pain and anxiety demand a premedication for operations using local anesthesia and for those using sedation or general anesthesia. For optimal patient care, the premedication should be given orally and, with respect to the outpatient basis of the operations, should have a short recovery period. Midazolam, one of the most favored premedications for general anesthesia, has been recommended as a premedication for operations using local anesthesia as well. However, midazolam has only sedative-anxiolytic effects and does not reduce pain sensation, which should be mandatory for operations using local anesthesia. A further requirement is the maintenance of stable hemodynamics for the prevention of postoperative hematomas, especially in the face. For these reasons, another premedication meeting all requirements (anxiolysis, analgesia, and stable hemodynamics) was researched. A randomized, double-blind prospective study was performed from March of 1997 to June of 1998. Five groups totalling 150 patients were included in the study; each group contained 30 patients who had operations performed solely on the face. In the first four groups, the effect of midazolam (0.15 mg/kg(-1)), morphine (0.3 mg/kg(-1)), and clonidine (1.5 microg/kg(-1)) administered orally was compared with a placebo. The fifth group was the control group and received no premedication. To evaluate the effects of the premedications, a corresponding questionnaire was completed independently by the patient and surgeon. With regard to the anxiolytic or analgesic properties of the premedication, 61 percent of the patients preferred pain reduction to anxiety control, and 24 percent of patients preferred reduction of anxiety. The remainder insisted on a reduction of both properties (8 percent) or had no preference (7 percent). Reduction of anxiety was largest in the midazolam and the clonidine groups, but the difference was not significant. The least pain during the application of local anesthesia was experienced by the morphine group (37 percent) and the clonidine group (33 percent), in contrast to the midazolam group (60 percent) (p = 0.04). Morphine and clonidine met the requirements of pain reduction equally well. Nevertheless, considering the rate and intensity of adverse effects with respect to hemodynamic compromises, nausea, and emesis, clonidine is even better suited as an oral premedication for operations on the face using local anesthesia