Cold Technique in Adult Tonsillectomy Reduces Waste and Cost.

OBJECTIVES: To quantify differences in waste and cost of disposable equipment between different tonsillectomy techniques. METHODS: Prospective study of waste attributable to disposable waste produced by tonsillectomy surgery. Disposable equipment required for tonsillectomy using cold, monopolar electrocautery (ME), and coblation techniques was measured; and differences in mass, volume, and cost of equipment between the 3 techniques were quantified. RESULTS: Cold technique was found to produce the least waste and have the lowest cost attributable to disposable surgical equipment. Projected single-case savings in mass and volume of waste resulting from using cold technique compared to ME were 1.272 kg and 1.013 L, respectively, and 1.043 kg and 1.723 L compared to coblation. Projected single-case savings in cost of disposable equipment for cold technique compared to ME were US$9.35 and US$185.05 compared to coblation. DISCUSSION: Using cold technique for adult tonsillectomy reduces waste and cost of disposable equipment compared to ME and coblation. Implications for Practice: Surgeons desiring to reduce cost and waste associated with tonsillectomy surgery may consider transitioning to cold technique.

Cost benefit of coblation versus electrocautery adenotonsillectomy for pediatric patients.

INTRODUCTION: Coblation and electrocautery are two common techniques used for adenotonsillectomy (T&A). Numerous studies have assessed surgical outcomes of coblation versus electrocautery and overall, postoperative complications are similar with the exception of a decrease in patient reported postoperative pain for coblation. Instrumentation required for coblation is significantly more expensive than that required for electrocautery. With minimal outcome differences, justification for the additional instrumentation costs is difficult. We performed this study to assess if there is a difference between operative & postoperative costs of electrocautery and coblation. METHODS: 300 patient medical records were reviewed from 2015 to 2017 with equal numbers of electrocautery and coblation surgeries. Outcome measures included finance information, duration and cost of OR and Phase I and Phase II post-anesthesia care unit (PACU), in-hospital pharmacy costs, and postoperative complications. Logistic regression was used for analysis. RESULTS: The median patient age for each surgical technique was 6 years old. Electrocautery resulted in more time in the OR compared to coblation, (OR:1.11,95%CI:1.07-1.15, p < .001), with greater associated costs, p < .001. Electrocautery patients were under anesthesia longer and had a longer surgical duration, p < .001. These same patients had longer duration in Phase II PACU, p = .028, and were given pain medications an increased number of times, p < .001. Total costs including operative expense, physician charges, OR and anesthesia times, pharmacy, and instrument were significantly higher for electrocautery patients, p = .003. There were no differences in ED visits, post-tonsillectomy bleed, or additional surgery between techniques, p > .05. CONCLUSION: T&A electrocautery technique was found to have increased overall indirect costs. Costs of instrumentation in addition to increased operative time, use of analgesics and post-operative care contribute to costs associated with electrocautery and coblation should be used when assessing surgical costs.

Electrosurgical and Laser Therapy Tools for the Treatment of Malignant Central Airway Obstructions.

Central airway obstruction (CAO) is associated with significant morbidity and increased mortality. Bronchoscopic electrosurgical and laser ablative tools have proven to be safe and effective instruments for the treatment of malignant CAO. Although therapeutic modalities such as electrocautery, argon plasma coagulation, and laser have been used for decades, additional tools including radiofrequency ablation catheters continue to be developed for the treatment of CAO. These modalities are considered safe in the hands of experienced operators, although serious complications can occur. This review describes various electrosurgical and laser therapy tools used for the treatment of malignant CAO along with the specific advantages and disadvantages of each device.

Dissection of Incomplete Fissure Using Electrocautery Is a Safe and Acceptable Method for Thoracoscopic Right Upper Lobectomy.

OBJECTIVE: The incidence of prolonged air leak may be highest after right upper lobectomy due to incomplete minor fissure. The objective of this study was to compare the efficacy of direct electrocautery division and suture with that of a fissureless technique during thoracoscopic right upper lobectomy with incomplete fissure. METHODS: One hundred and two patients underwent right upper lobectomy between January 2016 and December 2016. Of these, 60 patients underwent a right upper lobectomy conducted using the fissureless technique (group A), and 42 consecutive patients underwent a right upper lobectomy via electrocautery division of the fissure and suture (group B). The preoperative, operative, and postoperative parameters were compared between the two groups. RESULTS: The electrocautery and suture group had a higher incidence of prolonged air leak (> 5 days) (30% [12/40] vs 11% [7/62], p = 0.00), a higher incidence of air leakage (20 [32%] vs 38 [95%], p = 0.00), a longer air leak duration (days) (4.93 ± 0.86 vs 3.00 ± 1.60 days, p = 0.00), a longer duration of chest tube (mean 5.30 ± 1.20 vs 3.13 ± 1.88 days, p = 0.00), and a lower hospitalization cost (6463.28 ± 958.30 vs 7459.07 ± 1185.00 €, p = 0.00) than did the fissureless technique group. No differences were observed with respect to patient characteristics, operative characteristics, perioperative mortality, or duration of hospital stay after surgery. CONCLUSIONS: The number of patients with prolonged air leak was higher in the electrocautery group. However, electrocautery does not prolong overall length of stay and decreases hospitalization costs. Dissection of incomplete fissure using electrocautery is a safe and acceptable method for thoracoscopic right upper lobectomy.

Comparison of Energy-Based Tissue Dissection Techniques in Abdominoplasty: A Randomized, Open-Label Study Including Economic Aspects.

BACKGROUND: Abdominoplasty is one of the most common procedures in plastic surgery, and energy-based tissue dissection techniques have become the gold standard. Despite its frequency, abdominoplasty is still associated with high complication rates. OBJECTIVES: The authors compared clinical and economic data of 4 methods of energy-based tissue dissection in a randomized, open-label study. METHODS: A total of 57 patients were preoperatively randomized into 4 groups: electrocautery, Ultracision Harmonic Scalpel, argon plasma coagulation, and PEAK-Plasmablade. Demographic and operational data as well as information on the postoperative course and complications were collected. For economic analysis, quotes were obtained from the device companies or official suppliers. RESULTS: Duration of surgery, drainage quantity, and wound healing complications did not differ significantly between groups. The Ultracision method caused significantly greater blood loss compared with all other techniques (P < 0.01). PEAK and Ultracision devices entailed greater surgical costs compared with APC and electrocautery. CONCLUSIONS: All methods evaluated can be applied safely and effectively in abdominoplasty procedures. However, these data demonstrate a significantly higher blood loss for the Ultracision Harmonic Scalpel. Considering the clinical data, the higher costs of PEAK and Ultracision methods appear unjustified.

Cost-Effectiveness of a Radio Frequency Hemostatic Sealer (RFHS) in Adult Spinal Deformity Surgery.

BACKGROUND: Patients undergoing posterior spinal fusion surgery can lose a substantial amount of blood. This can prolong operative time and require transfusion of allogeneic blood components, which increases the risk of infection and can be the harbinger of serious complications. Does a saline-irrigated bipolar radiofrequency hemostatic sealer (RFHS) help reduce transfusion requirements? METHODS: In an observational cohort study, we compared transfusion requirements in 30 patients undergoing surgery for adult spinal deformity using the RFHS with that of a historical control group of 30 patients in which traditional hemostasis was obtained with bipolar electrocautery and matched them for blood loss-related variables. Total expense to the hospital for the RFHS, laboratory expenses, and blood transfusions was used for cost calculations. The incremental cost-effectiveness ratio was calculated using the number of blood transfusions avoided as the effectiveness payoff. RESULTS: Using a multivariable linear regression model, we found that only estimated blood loss (EBL) was an independent significant predictor of transfusion requirement in both groups. We evaluated the variables of age, EBL, time duration of surgery, preoperative hemoglobin, hemoglobin nadir during surgery, body mass index, length of stay, and number of levels operated on. Mean EBL was greater in the control group (2201 vs. 1416 mL, P = 0.0099). The number of transfusions also was greater in the control group (14.5 vs. 6.5, P = 0.0008). In the cost-effectiveness analysis, we found that the RFHS cost $108 more (compared with not using the RFHS) to avoid 1 unit of blood transfusion. CONCLUSIONS: The cost-effectiveness analysis revealed that if we are willing to pay $108 to avoid 1 unit of blood transfusion, the use of the RFHS is a reasonable choice to use in open surgery for adult spinal deformity.

Managing Seborrheic Keratosis: Evolving Strategies and Optimal Therapeutic Outcomes.

Seborrheic keratosis (SK) is the most common skin tumor seen by dermatologists in everyday practice. Although the lesions are mostly benign, many patients still elect to have asymptomatic SK removed. The historical standards of treatment are cryosurgery and electrocautery, two surgical options that are effective at lesion removal but have high rates of postoperative adverse events such as treatment-site scarring and pigmentary alterations. The cosmetic outcomes of SK treatment modalities are of keen interest to dermatologists, as the American population becomes increasingly more diverse. In this article, the inclusion of darker Fitzpatrick skin types into clinical studies investigating post-treatment side effects of SK therapy is reviewed. The recent approval of a 40% hydrogen peroxide topical formulation is discussed in light of these issues, and several non-invasive topical treatments that optimize cosmetic outcomes of SK lesion removal are highlighted. Finally, treatment strategies aimed at reducing cost and minimizing the burden of adverse sequelae are provided. J Drugs Dermatol. 2018;17(9):933-940.

Comparison of pediatric adenoidectomy techniques.

OBJECTIVES: Evaluate the effects of electrocautery, microdebrider, and coblation techniques on outpatient pediatric adenoidectomy costs and complications. STUDY DESIGN: Observational retrospective cohort study. METHODS: An observational cohort study was performed in a multihospital network using a standardized accounting system. Children < 18 years of age who underwent outpatient adenoidectomy were included from January 2008 to September 2015. Cases with additional procedures were excluded. The cohorts were divided into children who underwent electrocautery, microdebrider, or coblator adenoidectomy. Data regarding costs, postoperative complications, and revision surgeries were analyzed. RESULTS: A total of 1,065 cases of adenoidectomy were performed with electrocautery (34.9%), microdebrider (26.1%), and coblation (39.0%). There was an increased after direct cost associated with the microdebrider, $833 (standard deviation [SD] $363) and the coblator, $797 (SD $262) compared to the electrocautery, $597 (SD $361) (P < 0.0001). There was a greater overall operating room (OR) time associated with use of the microdebrider (mean 28.7, SD 11.0 minutes) compared with both the electrocautery (mean 24.7, SD 8.1 minutes) and coblator (mean 26.2, SD 9.8 minutes) (P < 0.0001). No significant difference was found with regard to complication rates. The incidence of repeat adenoidectomies was significantly greater for microdebrider (9.7%) compared to electrocautery (2.7%; P = 0.0002) and coblator (5.3%; P = 0.0336) techniques. CONCLUSION: These results suggest that adenoidectomy with electrocautery is significantly less expensive than microdebrider and coblator, with no differences in complication rates or surgical times among the techniques. Microdebrider adenoidectomy was associated with a longer overall OR time and a higher rate of adenoid regrowth, requiring revision surgery. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:745-749, 2018.

Intranasal cautery for the management of adult epistaxis: systematic review.

BACKGROUND: Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment. METHOD: A systematic review of the literature was performed using a standardised methodology and search strategy. RESULTS: Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures. CONCLUSION: Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.

Simultaneous arsenic and fluoride removal from synthetic and real groundwater by electrocoagulation process: Parametric and cost evaluation.

Co-existence of arsenic and fluoride in groundwater has raised severe health issues to living being. Thus, the present research has been conducted for simultaneous removal of arsenic and fluoride from synthetic groundwater by using electrocoagulation process with aluminum electrode. Effects of initial pH, current density, run time, inter electrode distance and NaCl concentration over percentage removal of arsenic and fluoride as well as operating cost have been studied. The optimum experimental conditions are found to be initial pH: 7, current density: 10 A/m2, run time: 95 min, inter electrode distance: 1 cm, NaCl concentration: 0.71 g/l for removal of 98.51% arsenic (initial concentration: 550 µg/l) and 88.33% fluoride (initial concentration: 12 mg/l). The concentration of arsenic and fluoride in treated water are found to be 8.19 µg/l and 1.4 mg/l, respectively, with an operating cost of 0.357 USD/m3 treated water. Pseudo first and second order kinetic model of individual and simultaneous arsenic and fluoride removal in electrocoagulation have also been studied. Produced sludge characterization studies also confirm the presence of arsenic in As(III) form, and fluoride in sludge. The present electrocoagulation process is able to reduce the arsenic and fluoride concentration of synthetic as well as real groundwater to below 10 µg/l and 1.5 mg/l, respectively, which are maximum contaminant level of these elements in drinking water according to WHO guidelines.

Iron removal, energy consumption and operating cost of electrocoagulation of drinking water using a new flow column reactor.

The goal of this project was to remove iron from drinking water using a new electrocoagulation (EC) cell. In this research, a flow column has been employed in the designing of a new electrocoagulation reactor (FCER) to achieve the planned target. Where, the water being treated flows through the perforated disc electrodes, thereby effectively mixing and aerating the water being treated. As a result, the stirring and aerating devices that until now have been widely used in the electrocoagulation reactors are unnecessary. The obtained results indicated that FCER reduced the iron concentration from 20 to 0.3 mg/L within 20 min of electrolysis at initial pH of 6, inter-electrode distance (ID) of 5 mm, current density (CD) of 1.5 mA/cm2, and minimum operating cost of 0.22 US $/m3. Additionally, it was found that FCER produces H2 gas enough to generate energy of 10.14 kW/m3. Statistically, it was found that the relationship between iron removal and operating parameters could be modelled with R2 of 0.86, and the influence of operating parameters on iron removal followed the order: C0>t>CD>pH. Finally, the SEM (scanning electron microscopy) images showed a large number of irregularities on the surface of anode due to the generation of aluminium hydroxides.

A comprehensive review of electrocoagulation for water treatment: Potentials and challenges.

Electrocoagulation is an effective electrochemical approach for the treatment of different types of contaminated water and has received considerable attention in recent years due its high efficiency in dealing with numerous stubborn pollutants. It has been successful in dealing with organic and inorganic contaminants with negligible or almost no generation of by-product wastes. During the past decade, vast amount of research has been devoted to utilizing electrocoagulation for the treatment of several types of wastewater, ranging from polluted groundwater to highly contaminated refinery wastewater. This paper offers a comprehensive review of recent literature that has been dedicated to utilizing electrocoagulation for water treatment, focusing on current successes on specific applications in water and wastewater treatment, as well as potentials for future applications. The paper examines such aspects as theory, potential applications, current challenges, recent developments as well as economical concerns associated with the technology. Most of the recent EC research has been focusing on pollutant-specific evaluation without paying attention to cell design, process modeling or industrial applications. This review attempts to highlight the main achievements in the area and outlines the major shortcomings with recommendations for promising research options that can enhance the technology and broaden its range of applications.

Post-treatment of molasses wastewater by electrocoagulation and process optimization through response surface analysis.

Molasses wastewater is a high strength effluent of food industry such as distilleries, sugar and yeast production plants etc. It is characterized by a dark brown color and exhibits a high content in substances of recalcitrant nature such as melanoidins. In this study, electrocoagulation (EC) was studied as a post treatment step for biologically treated molasses wastewater with high nitrogen content obtained from a baker's yeast industry. Iron and copper electrodes were used in various forms; the influence and interaction of current density, molasses wastewater dilution, and reaction time, on COD, color, ammonium and nitrate removal rates and operating cost were studied and optimized through Box Behnken's response surface analysis. Reaction time varied from 0.5 to 4 h, current density varied from 5 to 40 mA/cm(2) and dilution from 0 to 90% (v/v expressed as water concentration). pH, conductivity and temperature measurements were also carried out during each experiment. From preliminary experiments, it was concluded that the application of aeration and sample dilution, considerably influenced the kinetics of the process. The obtained results showed that COD removal varied between 10 and 54%, corresponding to an operation cost ranging from 0.2 to 33 euro/kg COD removed. Significant removal rates were obtained for nitrogen as nitrate and ammonium (i.e. 70% ammonium removal). A linear relation of COD and ammonium to the design parameters was observed, while operation cost and nitrate removal responded in a curvilinear function. A low ratio of electrode surface to treated volume was used, associated to a low investment cost; in addition, iron wastes could be utilized as low cost electrodes i.e. iron fillings from lathes, aiming to a low operation cost due to electrodes replacement. In general, electrocoagulation proved to be an effective and low cost process for biologically treated molasses-wastewater treatment for additional removal of COD and nitrogen content and color reduction. Treated effluent samples with good quality were produced by EC, with COD, NH4-N and NO3-N concentrations of 180, 52 and 2 mg/l respectively. Response surface analysis revealed that optimized conditions could be established under moderate molasses wastewater dilution, (e.g. 45%), at 3.5 h treatment time and 33 mA/cm(2) current density.

The use of energy devices for thyroid surgical procedures. Harmonic Focus versus Biclamp 150.

BACKGROUND: Thyroidectomy is the most frequently performed endocrine surgery, and in recent years, the surgical instruments and techniques used in this surgery have greatly evolved. New devices are created to facilitate dissection, haemostasis increasing the intraoperative cost. MATERIAL AND METHOD: We prospectively examined patients undergoing to traditional thyroidectomy using reusable vs disposable devices (BiClamp 150, ERBE ® - group A vs. Harmonic Focus, ETHICON® - group B). The patients were treated for benign and malignant diseases from two experienced surgeons. The two groups were separated based on age, sex, skin-to-skin operative time, the number of parathyroid glands identified by the surgeon during the operation, preand post-operative serum calcium levels evaluated with PTH until 24 hours after surgery, the mean hospital stay, the evaluation of the content of the drainages at 6 hours and 24 hours, and the thyroid gland volume calculated via ultrasound preoperatively. The patients were asked to complete a form at 24 hours post-op to self-evaluate dysphagia to liquids and pain on a scale from 0 to 10. RESULTS: The patients analysed were 80 pts. Analysis of the data showed no significant differences between the groups with respect to age, (p = 0:48), or gender, 9 males and 31 females in group A and 8 males and 32 females in group B.The thyroid volume (in ml), calculated on the basis of preoperative ultrasonography, was 43.89 ± 37.10 in group A vs. 54.54 ± 51.92 in group B (p = 0.35). The skin-to-skin operative time was equal to 50.16 ± 10.43 min.vs. 52.39 ± 11:54 min.(p = 0.36) in groups A and B, respectively. No statistically significant differences in pre e postoperative calcium levels. The amount of drainage at 6 hours after surgery was 16.63 ± 15.24ml. in group A and 23.72 ± 21.93ml. in group B (p = 0.07). At 24 hours after surgery, the amount was 57.84 ± 32.56ml. in group A and 66.79 ± 39.94ml. in group B (p = 0.28). For group A and group B, we analysed dysphagia for liquids on a scale from 0 to 10 (4.5 ± 2.35 vs. 4.18 ± 2.4, p = 0.48, respectively), alterations in patients' tone of voice (1.97 ± 2.51 vs. 1.43 ± 0:48, p = 0.29, respectively), and postoperative pain at 24 hours after surgery (2.76 ± 1.99 vs. 2.68 ± 2.12, p = 0.87, respectively). The average cost for group A was equal to € 25 × 40 = 1000 vs. € 450 × 40 = 18000 for Group B. The hospital stay in days was equal to 1.70 ± 0.46 (Group A) vs. 1.66 ± 0.53 (Group B) (p = 0.69). CONCLUSIONS: One limitation of the current study is its small sample size. Both devices are effective and safe for total thyroidectomy because they have similar effects on the operative time, postoperative bleeding and patient outcomes in endocrine experienced surgical team. On the other hand, in a time of the spending review and the standardisation of surgical techniques to ensure the highest quality of services offered, the BiClamp is a viable alternative tool with a high security standard and low cost that offers significant savings to the health care system. KEY WORDS: Energy devices, Health care, Thyroidectomy.

Comparison of outcomes and cost in patients undergoing tonsillectomy with electrocautery and thermal welding.

PURPOSE: To assess the morbidity and efficacy of thermal tissue welder instrument for tonsillectomy and compare it with monopolar electrocautery. MATERIALS AND METHODS: IRB approval was obtained at the Wexner Medical Center at Ohio State University for a prospective, randomized, single-blinded, controlled clinical study of 48 healthy adult volunteers undergoing tonsillectomy for chronic tonsillitis and tonsil hypertrophy. Subjects were randomized to the TW or EC group. Post-operative pain, pain medication use, return to normal oral intake, return to normal activity, and bleeding were measured on the post-operative log. We recorded operative time, operating room time, and blood loss. All procedures were performed by one surgeon to eliminate variations in time and experience. Operative and patient data were analyzed using a Student T-test and evaluated by cost analysis. RESULTS: There was a statically significant increase in operative time with the TW taking an average of 4min longer per procedure, p<0.001. However, when total anesthesia time was compared, this did not translate into a statistically significant increase in total operating room time and therefore did not translate into additional cost. The remaining categories were not significantly different between the two groups. In 3/23 TW cases, suction cautery was required for hemostasis. Two patients had 3 occurrences of secondary bleeding in the electrocautery group and none in the tissue welder group. TW cost increase per case was $167 per instrument but averaged $700 per case. CONCLUSIONS: While the tissue welder remains a viable option for the adult tonsillectomy procedure, it has not demonstrated in our study the necessary parameters intraoperatively, postoperatively, or via cost analysis to become the choice instrument at our institution. We cannot ignore the increase in cost that may be seen for short and routine procedures without an added benefit to the patient in terms of outcome or safety. A larger study is needed to determine if secondary bleeding rates are lower with this instrument.

Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study.

BACKGROUND: A relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery. METHODS: In a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods. RESULTS: Patient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (-2.0 ± 2.2 vs. -3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost. CONCLUSIONS: The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.

Reducing electrocoagulation harvesting costs for practical microalgal biodiesel production.

Electrocoagulation has shown potential to be a primary microalgae harvesting technique for biodiesel production. However, methods to reduce energy and electrode costs are still necessary for practical application. Electrocoagulation tests were conducted on Nannochloris sp. and Dunaliella sp. using perforated aluminium and iron electrodes under various charge densities. Aluminium electrodes were shown to be more efficient than iron electrodes when harvesting both algal species. Despite the lower harvesting efficiency, however, the iron electrodes were more energy and cost efficient. Operational costs of less than $0.03/L oil were achieved when harvesting Nannochloris sp. with iron electrodes at 35% harvest efficiency, whereas aluminium electrodes cost $0.75/L oil with 42% harvesting efficiency. Increasing the harvesting efficiencies for both aluminium and iron electrodes also increased the overall cost per litre of oil, therefore lower harvesting efficiencies with lower energy inputs was recommended. Also, increasing the culturing salinity to 2 ppt sodium chloride for freshwater Nannochloris sp. was determined practical to improve the electrocoagulation energy efficiency despite a 25% reduction in cell growth.

[Epistaxis and anticoagulation - a medical and economic challenge?]. / Epistaxis bei Antikoagulation - eine klinische und ökonomische Herausforderung?

BACKGROUND: According to recent statistics more and more elderly patients are hospitalized due to epistaxis and need anticoagulation. Aim of the present study was to investigate if it was more complex to treat anticoagulated patients than non-anticoagulated patients, if these patients needed a longer hospital stay and to characterize the study population in terms of the various applied therapeutic methods. METHODS: Retrospective study, collecting clinical data of all in-patients treated between 1.1.2007 to 1.8.2011 at an ENT-Department of an University Clinic due to epistaxis. RESULTS: Of 656 patients 265 were not anticoagulated, 391 were anticoagulated. The mean patients' age increased statistically significant. Patients without anticoagulation were significantly younger than patients with anticoagulation. The duration of the hospitalization differed significantly between the groups, with the longest for patients treated with warfarin (5.4 days). 71 patients underwent surgical treatment of epistaxis (cautery of the sphenopalatine artery or anterior ethmoid artery). CONCLUSION: During the study period an increasing number of more elderly patients needed hospitalization due to epistaxis. The duration of hospitalization differed significantly between the groups, with longer stays for the anticoagulated patients. Currently, treatment of epistaxis patients however is reimbursed independently of the presence of comorbidities or anticoagulation therapy. For the further development of the German DRG System a new split of the epistaxis DRG should be considered.