1) Al-Zahrawi, an 11th century Arab physician, is considered the first to perform a needle biopsy of the thyroid gland using hollow needles.
2) In the late 19th century, the terms "biopsy" and "bioscopy" were introduced into medical terminology to describe the microscopic examination of living tissue samples.
3) Over the past century, the use of biopsy has evolved from an occasional procedure performed on living organs to a widely adopted diagnostic tool used across many clinical specialties to characterize lesions and diseases.
Management of soft tissue injuries in facial traumaAhmed Adawy
Management of soft tissue injuries in facial trauma
Dr. Ahmed M. Adawy.
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine, Al-Azhar University.
Soft-tissue injuries are the most common presentation following maxillofacial trauma. In general, injuries can initially be classified as open or closed wounds. A closed wound is one that damages underlying tissue and/or structures without breaking the skin. Examples of closed wounds include hematomas, contusions, and crush injuries. In contrast, open wounds involve a break in the skin, which exposes the underlying structures to the external environment. Open wounds include simple and complex lacerations, avulsions, punctures, abrasions, accidental tattooing, and retained foreign body. Detailed description of management is presented. The principles of repair is discussed.
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
Surgical Management of Jaw Tumors and Other Oral Cavity TumorsHermie Culeen Flores
Powerpoint presentation by Ma. Hermie Culeen F. Barapon
Download the following fonts to view original format:
- Daddy Longlegs
- Angelina
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Management of soft tissue injuries in facial traumaAhmed Adawy
Management of soft tissue injuries in facial trauma
Dr. Ahmed M. Adawy.
Professor Emeritus, Dept. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine, Al-Azhar University.
Soft-tissue injuries are the most common presentation following maxillofacial trauma. In general, injuries can initially be classified as open or closed wounds. A closed wound is one that damages underlying tissue and/or structures without breaking the skin. Examples of closed wounds include hematomas, contusions, and crush injuries. In contrast, open wounds involve a break in the skin, which exposes the underlying structures to the external environment. Open wounds include simple and complex lacerations, avulsions, punctures, abrasions, accidental tattooing, and retained foreign body. Detailed description of management is presented. The principles of repair is discussed.
CARNOY’S SOLUTION AS A SURGICAL MEDICAMENT IN THETREATMENT OF KERATOCYSTIC O...DrKamini Dadsena
The term keratocyst was coined by Philipsen in 1956.
Unlike the other cystic lesion KOT, has got strong tendency for recurrence.
Treatment of these lesions remains controversial and has a number of dilemmas about the choice of treatment whether to use carnoys solution as an adjunct therapy after removal of the lesion.
Surgical Management of Jaw Tumors and Other Oral Cavity TumorsHermie Culeen Flores
Powerpoint presentation by Ma. Hermie Culeen F. Barapon
Download the following fonts to view original format:
- Daddy Longlegs
- Angelina
You can download fonts for free from: www.1001fonts.com
After download, right click zip file then choose 'Extract Here'. Then right click the font file and choose 'Install'
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine
Al-Azhar University. Oral biopsy; why, when, and how? Biopsy is the removal of the tissue from the living organism for the purpose of microscopic examination and diagnosis. Looking for a definitive diagnosis is the aim of biopsy. Types of Biopsy include incisional, excisional, drill, fine needle and frozen section biopsy.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. “The best surgeon is a
clinical pathologist who
performs operations”
2
3. 3
Al-Zahrawi, an Arab physician, surgeon and
pharmacist - perform a needle biopsy (of the thyroid).
He used hollow needles to investigate abnormal
growths of the thyroid gland.
Around the year 1000 AD, he wrote his famous book
'Al Tasreef Liman 'Ajaz 'Aan Al-Taleef (or 'al-Tasreef')
(''An Aid for Those Who Lack the Capacity to Read Big
Books').
History
4. 4
In the early 16th century, Sir Marcello Malphigi
termed it as,
Bios- LIFE, Opsis- A sight
In the modern era, a Russian, M.M. Rudnev –
used diagnostic biopsy in 1875.
5. 5
Expert committee of WHO (1996) – “
Biopsy is examination of tissue removed
from a lesion & by extension the term is also
used to convey the removal of the lesion”
The term 'biopsy' was introduced into medical
terminology in 1879 by Ernest Besnier.
6. 6
• 100 years of biopsy can be easily divided into 3 major
steps:
1. An occasional use of procedure - until the late 19th
century - involving living organs and tissues for
observation and study.
7. 7
2. Restricted application of biopsy- until the
mid-20th century.
3. Present stage - widely adopted, not only in
oncology but practically in all clinical specialties.
8. Histological characteristics
Differentiation
Extent or spread
Evoluative control of disease process
Healing or relapse
Irrefutable legal medical value.
8
The Technique Allows Us To Establish
9. Indications
Primarily – To confirm the clinical
impression of the lesion.
Any persistent lesions >10-14days
With no apparent etiologic basis.
That does not respond to Rx even after
removal of cause / irritant.
9
10. 10
Persistent swelling
Bone lesions - Not specifically identified by
clinical & radiographic findings.
Lesions presenting the characteristics of
malignancy
11. Conditions that are potentially precancerous
Persistent hyperkeratotic change. e.g.:
leukoplakia.
Inflammatory changes of unknown causes.
11
14. Contraindications
Compromised general health, h/o bleeding
diathesis.
Lesion close to vital anatomic, vascular or ductal
structures.
Intrabony lesions should not be biopsied or
removed prior to investigational aspiration.
14
15. 15
Normal anatomic & racial variation – e.g.
Physiologic pigmentation, linea alba,
Fordyce's granules.
Acute / sub acute inflammatory condition –
bacterial, viral infection.
17. Selection Of Specimen
Area representative of whole lesion.
Adequate amount of tissue must be present.
17
18. 18
In large lesions – Specimen is removed
from most easily accessible & representative
area.
Deep sections of lesion along with normal
tissue are needed.
If several lesions - specimen taken from
most representative area.
19. Intra osseous lesions – Cortical plate of
bone should be removed & curetted material
must be evaluated.
Skin / mucosal biopsy – Epithelium +
Connective tissue.
19
20. 20
Ulcer – Normal area + Deep part of ulcer
Multiple ulcers – More than one biopsy & at
the site of maximum clinical activity.
35. 35
Oral cavity – Commonest lesion for incisional
biopsy – white hyperkeratotic lesions.
Bleeding, ulcerated or indurated area must be
taken.
36. EXCISIONAL BIOPSY
Removal of lesion in -
Toto – with adequate
margins
Accomplishes the goal of
the biopsy (entire lesion
is available for H/P
examination)as well as
Rx
36
38. PUNCH BIOPSY
Convenient method for oral
mucosal lesions
Biopsy punch Make
circular incisions (3-4mm in
diameter)
Surgically inaccessible
regions e.g. palatal biopsy of
minor salivary glands, lips.
38
41. Principle
Punch – circular / twisting motion a
circular incision on lesion.
Remove the punch.
Grasp the margin – separate the base with
scissors or scalpel.
41
43. 43
Quick & effective
Produces a clean & sharp incision
Little bleeding
Minimal pain
Advantages
Disadvantages
Tissue distorted
Can’t be used in soft palate, floor of mouth
44. CURETTAGE
Curette – Spoon like tip
Designed for scraping
out cavities for tissue
(diagnostic/therapeutic
purposes)
eg: maxillary antrum,
cystic lesions within the
jaws
44
45. 45
Used primarily for intraosseous lesions
(cystic/fibro-osseous), soft friable soft
tissues (granulation tissue)
Easy to perform
46. 46
Modified Ellis drill, fits into straight
hand piece.
For central fibro -osseous lesions,
osteolytic lesions of bone, lymph
node masses.
Needle is introduced through small
skin incision & rotated at slow
speed until tumor is reached.
Drill biopsy
47. Entered into tumor mass.
Gentle negative pressure is applied to needle
by means of small syringe on withdrawal.
Contained core expelled into fixative.
47
49. Shave biopsy
Easiest biopsy to take when lesion is raised above
surface.
Using scalpel blade or special disposable blade.
Sawing / shaving action is used.
49
52. Electro surgery/ Laser biopsy
• Specimen is taken using electrode.
• Minimum discomfort & bleeding. (cauterization)
52
53. Electro-surgery refers to the cutting and coagulation of
tissue using very high-frequency, low-voltage electrical
currents.
Useful in producing a bloodless operative field.
Thermal coagulation is used.
53
54. Electro-surgical
technique
The lesion is grasped
with forceps through
the loop electrode.
The electrode is
activated going
under the lesion,
removing the growth.
54
55. • Currently not advised for
oral biopsies
Disadvantages:
• In electro surgery – Thermal
damage may result in charred
appearance of tissue.
• Laser – less extensive thermal
damage.
55
56. Aspiration biopsy
(FNAC / FNAB)
• To obtain material from body cavity, cystic
space or fluid containing lesion.
• Introduced by Martin, Ellis & Stewart in 1950.
• Obtained material can be smeared on a slide,
fixed & stained.
56
63. The proper lesion may get missed easily.
Tissue relationships not known (as only few cells
are studied)
Most of the times needs a confirmatory biopsy
Disadvantages 63
64. Stab incision
To distinguish between reactive
changes / recurrent malignancies/
cervical metastases.
Symptom less H&N swellings
Disadvantages
•Tumor dissemination / seeding
Core biopsy / True – cut biopsy
64
66. Study of superficial cells which have been either
exfoliated or shed from mucous membrane.
Cells are collected by scraping or pulling off from
tissue surface.
Can also be done with sputum or saliva.
66
Exfoliative cytology
67. Indications:
For suspected malignant and premalignant oral
lesions.
Recurrent oral cancers after treatment.
Mass screening of oral cancer.
67
69. 69
The lesion is repeatedly scraped with a moistened
tongue depressor or spatula or cytobrush type
instrument.
The cells obtained are smeared on a glass slide and
immediately fixed with a fixative spray or solution.
Technique
72. 72
Special instrument called biopsy brush
Trans-epithelial biopsy obtained
Indications
For precancerous / cancerous oral
mucosal lesions
Advantages
Easy to perform; requires less time
Well tolerated by the patient
Oral brush biopsy
78. Specific tissue considerations
Oral biopsies: methods and applications
R. J. Oliver, P. Sloan and M. N. Pemberton BRITISH DENTAL JOURNAL
VOLUME 196 NO. 6 MARCH 27 2004
78
79. For red & white lesions include both red & white
area
79
84. Do not cut into pigmented and vascular lesions
84
85. 85
Oral biopsies: methods and applications
R. J. Oliver, P. Sloan and M. N. Pemberton BRITISH DENTAL JOURNAL
VOLUME 196 NO. 6 MARCH 27 2004
86. 86
Clinical diagnosis Type of biopsy Suitable for general dental
practice
Chronic ulcer or
squamous cell
carcinoma
Incisional biopsy of
margin of ulcer
No, urgent referral
to hospital
Leukoplakia/
erythroplakia
Incisional or punch
biopsy of worst area
consider multiple
biopsies if extensive
lesion
No, referral to
hospital
Mucosal lichen
planus
Incisional biopsy of
the area
Only very
experienced
practitioners
Bullous lesions
(pemphigus
pemphigoid etc.)
Incisional or punch
biopsy of unaffected
mucosa close to bulla
No, referral to
hospital
87. 87
Clinical diagnosis Type of biopsy Suitable for general
dental practice
Granulomatous diseases
(Crohn’s,
Orofacial granulomatosis,
ulcerative colitis, TB)
Deep incisional biopsy
plus fresh sample to
microbiology if
infective agent
suspected
No, referral to
hospital
Mucocele Careful excision biopsy Yes, with care
Fibroepithelial polyp,
pyogenic granuloma, epulis
Excision biopsy Yes
Minor salivary gland
tumour
Palate: deep incisional
biopsy
Upper lip: excisional
biopsy
No, urgent referral
to
hospital
Medium through which the doctor in clinical practice gets an opportunity to learn & relearn the important basic scientific facts is the “Biopsy”.
Since the nineteenth century, medical researchers and practitioners have developed many different kinds of instruments to perform biopsies on different body parts.
Modern instruments such as intestinal biopsy tubes can extract samples from parts of the body which are not easily accessible.
When there is a lesion which is persistent from more than 10-14 days with etiology and does not respond to medicines
Tumescence = swelling due to vascular congestion
Alleviate – making less severe
Prognosis – forecast of the outcome of a medical situation
bleeding diathesis. -unusual susceptibility to bleed
From a pathologist’s point of view– whole lesion is most desirable specimen.
Formalin – disinfectant, germicide and antiseptic in nature
Prevents decay by bacterial growth
Pigmented lesions (melanoma) may be removed with generous margin of normal surrounding tissue.
sinus, fistulae with in soft tissue.
Specimen is forcibly ejected over albumin coated slide & then spread.