Cross-sectional study on the occurrence of Frey's syndrome following superficial parotidectomy or extracapsular dissection.

BACKGROUND: Most studies that examine postoperative outcomes after parotidectomy in patients with benign parotid gland tumors are based on retrospective chart reviews. Data about long-term results in patients with parotid gland surgery with patient contact are still sparsely published. METHODS: During the period of 1960-2005, a total of 127 patients underwent either extracapsular dissection (ECD) or superficial parotidectomy (SP) and were available for interview. Patients were questioned about their postoperative outcome after parotid gland surgery. RESULTS: The mean follow-up was 21.5 years. A total of 42 and 85 patients underwent ECD and SP, respectively. No significant differences were observed in the rates of permanent facial paralysis (SP 1.2% vs. ECD 7.1%; p = 0.1053) or recurrence (SP 4.7% vs. ECD 11.9%; p = 0.1557), and Frey's syndrome was diagnosed only after SP (10.6% vs. 0% after ECD, p = 0.0293). Frey's syndrome was detected more often compared to retrospective chart analysis. CONCLUSION: We conclude that Frey's syndrome is underdiagnosed after SP without standardized follow-up examinations. Long-term follow-up should be applied to detect and treat gustatory sweating.

Rising incidences of Warthin's tumors may be linked to obesity: a single-institutional experience.

PURPOSE: Recently, there has been an increase in the number of reported Warthin's tumors, but few risk factors have been described for this benign tumor. Yet, smoking is the only evidently identified risk factor. Obesity and the metabolic syndrome are causally linked to or a risk factor for a variety of diseases. Therefore, we analyzed whether metabolic syndrome, including obesity, might influence the incidence of Warthin's tumors. METHODS: In this retrospective study, we evaluated 197 patients with Warthin's tumor. We assessed the tumor size, the body mass index (BMI), comorbidities related to the metabolic syndrome, and cigarette and alcohol consumption. Additionally, we evaluated several blood parameters and their influence. RESULTS: Warthin's tumor patients had a significantly higher BMI in comparison to patients with other benign parotid gland tumors (29.1 versus 26.2, p < 0.0001). The rate of metabolic syndrome-associated comorbidities was higher in Warthin's tumor patients (62.4% versus 35.2%, p < 0.0001). CONCLUSION: Our results might be the first step to recognize obesity and its consequences as a co-driver in the formation of Warthin's tumors. Nevertheless, further studies are requested to validate our results and to answer the question whether obesity or the metabolic syndrome are integrally linked to Warthin's tumors.

Extracapsular dissection versus superficial parotidectomy in benign parotid gland tumors: The Vienna Medical School experience.

BACKGROUND: The purpose of this study was to evaluate the clinical outcome in patients with benign parotid gland tumors after extracapsular dissection or superficial parotidectomy (SP). METHODS: Eight hundred ninety-four patients with primary pleomorphic adenoma or Warthin's tumor were included from this study. Type and length of surgery, tumor size, resection margins, and complication rates were assessed. RESULTS: Three hundred ninety-five (44.2%) extracapsular dissections and 499 SPs (55.8%) were performed. The rate of positive margins was significantly higher in the extracapsular dissection compared to the SP group (29.4% vs 10.2%; p < .0001). Recurrent disease (extracapsular dissection = 7.2% vs SP = 2.2%; p = .0003) and permanent facial palsy were significantly more frequent after extracapsular dissection than SP (2.2% vs 0.6%; p = .0396). Significant prolonged surgery time was observed after SP (146 vs 94 minutes; p < .0001). CONCLUSION: Because extracapsular dissection led to a significantly higher percentage of permanent facial palsy, recurrent disease, and positive resection margins compared to SP, we recommend SP for treating benign parotid gland tumors. © 2016 Wiley Periodicals, Inc. Head Neck 39: 356-360, 2017.

Influence of a revision course and the gender of examiners on the grades of the final ENT exam--a retrospective review of 3961 exams.

UNLABELLED: Revision courses should repeat already acquired knowledge and skills and mostly provide a basis for passing the following exam. AIM: The aim of the study is to investigate the influence of a previously attended revision course on the grades achieved in a final exam (Ear, Nose and Throat Diseases). Additionally we ask the question whether the gender of the examiners plays a role concerning the marks or not. METHODS: 3961 exams at the Department of Ear, Nose and Throat (ENT) Diseases in Vienna were investigated, 725 with revision course (experimental group) and 3236 without previous revision course (comparison group). The revision courses were performed in a standardized way concerning form and content, interactive and case based. Both groups were examined uniform in regard to topics and time duration. 16 male and 6 female examiners were involved. The grading followed a five-level scale. The examination marks were calculated in the arithmetic mean and median value for the entire sample, gender dependence was calculated according to the Wilcoxon-Mann-Whitney-Test. The inferential statistics included single- and multiple factorial analyses of variance as well as uni- and multivariate regression models. RESULTS: The experimental group achieved a grade average of 2.54 compared with 2.46 for the comparison group. Splitting up into male and female examiners, an average of 2.54 and 2.58 resp. for the experimental group and 2.44 and 2.61 resp. for the comparison group resulted. Female examiner marked significantly lower grades in comparison to their male colleagues (P= 0.001926). CONCLUSIONS: The ENT revision course did not improve the grade averages of the final ENT exam. Female examiners grade stricter than male examiners. There was no difference concerning grades 4 (pass) and 5 (fail) but female examiners grade less with mark 1.

Classification and prediction of HCC tissues by Raman imaging with identification of fatty acids as potential lipid biomarkers.

PURPOSE: Patients with hepatocellular carcinoma (HCC) can only be treated curatively at early stages and then have a favorable prognosis of this often fatal disease. For this reason, an early detection and diagnostic confirmation are crucial. Raman imaging spectroscopy is a promising technology for high-resolution visualization of the spatial distribution of molecular composition in tissue sections. The aim of this study was to investigate molecular information of liver tissue by Raman imaging for classification and diagnostic prediction. METHODS: Unstained cryosections of human hepatic tissues (23 patients) were measured by Raman spectroscope in the regions of HCC (n = 12) and fibrosis (n = 17). The acquired data set was used to generate a random forest classification model with 101 iterations of sevenfold cross-validation. The models obtained during cross-validation were also used to predict regions of tumor margin (n = 8) aside from independent testing. RESULTS: Raman spectra differed between malignant and non-malignant tissue regions. Based on these spectral data, a random forest classification model calculated a prediction accuracy of 86 % (76 % sensitivity and 93 % specificity). The ten most important variables were identified at 2895, 2856, 1439, 1298, 1080, 1063, 1023, 937, 920, and 719 cm(-1). CONCLUSIONS: In this study, Raman imaging spectroscopy was applied successfully for liver tissue to differentiate, classify, and predict with high accuracy malignant and non-malignant tissue regions. Furthermore, the most important differences were identified as the Raman signature of fatty acids. The demonstrated results highlight the enormous potential which vibrational spectroscopy techniques have for the future diagnostics and prognosis estimation of HCC.

Discrimination and classification of liver cancer cells and proliferation states by Raman spectroscopic imaging.

Discrimination of nodular lesions in cirrhotic liver is a challenge in the histopathologic diagnostics. For this reason, there is an urgent need for new detection methods to improve the accuracy of the diagnosis of liver cancer. Raman imaging allows to determine the spatial distribution of a variety of molecules in cells or tissue label-free and to correlate this molecular information with the morphological structures at the same sample location. This study reports investigations of two liver cancer cell lines, - HepG2 and SK-Hep1, - as well as HepG2 cells in different cellular growth phases using Raman micro-spectroscopic imaging. Spectral data of all cells were recorded as a color-coded image and subsequentially analyzed by hierarchical cluster and principal component analysis. A support vector machine-based classification algorithm reliably predicts previously unknown cancer cells and cell cycle phases. By including selectively the Raman spectra of the cytoplasmic lipids in the classifier, the accuracy has been improved. The main spectral differences that were found in the comparative analysis can be attributed to a higher expression of unsaturated fatty acids in the hepatocellular carcinoma cells and during the proliferation phase. This corresponds to the already examined de novo lipogenesis in cells of liver cancer.

Deeper understanding of biological tissue: quantitative correlation of MALDI-TOF and Raman imaging.

In order to achieve a comprehensive description of biological tissue, spectral information about proteins, lipids, nucleic acids, and other biochemical components need to be obtained concurrently. Different analytical techniques may be combined to record complementary information of the same sample. Established techniques, which can be utilized to elucidate the biochemistry of tissue samples are, for instance, MALDI-TOF-MS and Raman microscopic imaging. With this contribution, we combine these two techniques for the first time. The combination of both techniques allows the utilization and interpretation of complementary information (i.e., the information about the protein composition derived from the Raman spectra with data of the lipids analyzed by the MALDI-TOF measurements). Furthermore, we demonstrate how spectral information from MALDI-TOF experiments can be utilized to interpret Raman spectra.

[Vocational rehabilitation after total laryngectomy]. / Berufliche Rehabilitation nach Laryngektomie.

BACKGROUND: Aim of this study was to find out how many patients after a total laryngectomy (TLE) return to work successfully and what factors support vocational rehabilitation. PATIENTS AND METHODS: Laryngectomees (n=231) aged up to 60 years completed questionnaires and structured interviews before TLE (t1), before rehabilitation (t2), at the end of rehabilitation (t3), 1 year after TLE (t4), 2 years after TLE (t5), and 3 years after TLE (t6). RESULTS: Prior to TLE, 38% of all respondents were employed, 34% were unemployed, 23% received disability-related and 3% age-related pension retirement. One year after TLE, 13% were employed, 15% 2 years and 14% 3 years after TLE. Unemployed were 10% (t4), 5% (t5), and 7% (t6) of the patients. For 59% of all respondents it was very important to have a job. Predictors of successful vocational rehabilitation were employment prior to TLE, age <50 years, being self-employed or clerical employee, good physical functioning, good speech intelligibility, high motivation to go back to work, and support from colleagues. CONCLUSION: Only few laryngectomees return to work. However, even before TLE only a third of the patients was employed, another third was unemployed. Most of the patients receive pension retirement after TLE. As return to work is important for many patients, patient consultations should consider possibilities to support vocational rehabilitation before offering to apply for retirement.

A decade of vibrational micro-spectroscopy of human cells and tissue (1994-2004).

Instrumentation used in infrared microspectroscopy (IR-MSP) permits the acquisition of spectra from samples as small as 100 pg (10(-10) g), and as small as 1 pg for Raman microspectroscopy (RA-MSP). This, in turn, allows the acquisition of spectral data from objects as small as fractions of human cells, and of small regions of microtome tissue sections. Since vibrational spectroscopy is exquisitely sensitive to the biochemical composition of the sample, and variations therein, it is possible to monitor metabolic processes in tissue and cells, and to construct spectral maps based on thousands of IR spectra collected from pixels of tissue. These images, in turn, reveal information on tissue structure, distribution of cellular components, metabolic activity and state of health of cells and tissue.

Fragment mode analysis and its application to the vibrational normal modes of boron trichloride-ammonia and boron trichloride-pyridine complexes.

A method for expressing quantitatively the vibrational normal modes of a molecule in a basis set consisting of the normal vibrations (plus translations and rotations) of its constituent fragments is presented. The method is illustrated by describing the vibrational modes of BCl3-NH3 and BCl3-pyridine electron donor-acceptor complexes in terms of motions of BCl3 and either NH3 or pyridine. These complexes show examples of mixing between modes located on different fragments, mixing between modes of one fragment due to symmetry lowering, and the transformation of six fragment translations/rotations into vibrations of the complex. Although perturbation theory has been proposed to explain such examples of mode mixing, calculations imply that interactions between fragments of both complexes are too strong for perturbation theory to be generally applicable. In addition, the transformation of fragment rotations and/or translations into vibrations of the composite molecule will always occur and cannot be understood in detail by using perturbation theory. For the BCl3-pyridine complex, a band observed at 1107 cm(-1) is re-assigned as a combination of C-H in-plane bending and a ring-breathing mode of the pyridine fragment.