Shrinkage in oral squamous cell carcinoma: An analysis of tumor and margin measurements in vivo, post-resection, and post-formalin fixation.

PURPOSE: To quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma. MATERIALS AND METHODS: Nineteen patients were studied via cohort design. Between May and December 2011, measurements of tumor size and tumor-free margin were made in patients with squamous cell carcinoma of the oral cavity. Mucosal reference points were marked with sutures, representing tumor diameter and two separate resection margins. Measurements were recorded immediately before resection, after resection, and following fixation in formalin. RESULTS: The overall mean shrinkage in tumor size was 10.7% (95% CI 3.4-18.0, p=0.006). When comparing mean tumor measurements, most of the tumor size decrease (6.4%, 95% CI 0.4-12.4, p=0.039) occurred between pre- and post-excision measurements. To a lesser extent, tumor size decreased following formalin fixation. Comparison of tumor-free margin measurements revealed a pre-excision to post-fixation mean decrease of 11.3% (95% CI 2.9-19.6%, p=0.011), with a statistically significant decrease of 14.9% (95% CI 8.5-21.3%, p<0.001) occurring between pre- and post-excision, and no significant decrease from post-excision to post-formalin fixation. CONCLUSION: Mucosal dimensions of both tumor and tumor-free margins in oral cavity squamous cell carcinoma specimens decrease between surgical resection and pathologic analysis. Most of this decrease occurs prior to fixation, especially for margins, and may be due to intrinsic tissue properties rather than formalin effects.

The Feasibility of Clean Intermittent Self-Catheterization Teaching in an Outpatient Setting.

OBJECTIVES: The aim of this study was to evaluate the feasibility of teaching clean intermittent self-catheterization (CISC) in an outpatient setting to women planning surgery for pelvic organ prolapse (POP) and/or urinary incontinence (UI). METHODS: This was a prospective observational study of 55 women who planned surgical correction of POP and/or UI. All women were taught CISC as part of their preoperative education. The ability to learn CISC and the amount of time needed to teach CISC were recorded. Multivariate modeling, χ2 test, Fisher exact test, and Kruskal-Wallis analysis of variance were used for statistical analysis. RESULTS: Of the 55 subjects consecutively enrolled, 51 subjects (93%) were able to learn CISC and demonstrate competency (P < 0.00001). Four subjects (7%) were unable to learn CISC. The median time to teach CISC with demonstrated proficiency was 3.7 minutes (range, 1.8-7.4 minutes). Of the subjects who learned CISC and had surgery, the mean (SD) time in days from preoperative teaching to the postoperative voiding trial was 16 (11) days (range, 2-39 days). Of the 41 subjects who completed the postoperative voiding trial and had data recorded, 33 (80%) were able to self-catheterize without nurse assistance or with minimal verbal coaching, whereas 8 (20%) subjects required hands-on nursing assistance or were unable to perform CISC (P < 0.001). CONCLUSIONS: Clean intermittent self-catheterization can be taught to most patients undergoing POP/UI surgery in a short time (median, 3.7 minutes). The overwhelming majority of patients are able to retain the CISC skill weeks after being taught in the clinic.