The debate continues: a prospective, randomised, single-blind study comparing Coblation and bipolar tonsillectomy techniques.

OBJECTIVES: Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients. METHODS: A total of 137 patients, aged 2-50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected. RESULTS: Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001). CONCLUSION: Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.

Linking near- and far-field hydrodynamic models for simulation of desalination plant brine discharges.

A desalination plant is proposed to be the major water supply to the Olympic Dam Expansion Mining project. Located in the Upper Spencer Gulf, South Australia, the site was chosen due to the existence of strong currents and their likely advantages in terms of mixing and dilution of discharged return water. A high-resolution hydrodynamic model (Estuary, Lake and Coastal Ocean Model, ELCOM) was constructed and, through a rigorous review process, was shown to reproduce the intricate details of the Spencer Gulf dynamics, including those characterising the discharge site. Notwithstanding this, it was found that deploying typically adopted 'direct insertion' techniques to simulate the brine discharge within the hydrodynamic model was problematic. Specifically, it was found that in this study the direct insertion technique delivered highly conservative brine dilution predictions in and around the proposed site, and that these were grid and time-step dependent. To improve the predictive capability, a strategy to link validated computational fluid dynamics (CFD) predictions to hydrodynamic simulations was devised. In this strategy, environmental conditions from ELCOM were used to produce boundary conditions for execution of a suite of CFD simulations. In turn, the CFD simulations provided the brine dilutions and flow rates to be applied in ELCOM. In order to conserve mass in a system-wide sense, artificial salt sinks were introduced to the ELCOM model such that salt quantities were conserved. As a result of this process, ELCOM predictions were naturally very similar to CFD predictions near the diffuser, whilst at the same time they produced an area of influence (further afield) comparable to direct insertion methods. It was concluded that the linkage of the models, in comparison to direct insertion methods, constituted a more realistic and defensible alternative to predict the far-field dispersion of outfall discharges, particularly with regards to the estimation of brine dilution in the immediate vicinity of an outfall location.

Restoration of flexor pollicis longus function by flexor digitorum superficialis transfer.

Fourteen patients were treated by flexor digitorum superficialis transfer for irreparable flexor pollicis longus lesions. Results measured by return of interphalangeal joint motion were good in 12 patients, with one patient achieving a fair result and one failure. This is a reliable procedure in thumbs with a grade I or II (Boyes) tendon bed and should be considered as an alternative to free tendon grafting for reconstruction in patients in whom return of interphalangeal motion is desirable.