The document discusses various types of biopsies used in oral pathology. It describes biopsy indications such as persistent lesions and those with suspected malignancy. Types discussed include incisional, excisional, punch, aspiration and brush biopsies. Information to include with biopsies like patient data and lesion description is outlined. Complications are bleeding and infection. Proper planning and including representative tissue are emphasized for diagnostic value.
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.
Paralleling and bisecting radiographic techniquesDr. Ritu Gupta
this is the seminar for Undergraduate students consisting of initial paralellelig and bisecting radiographic techniques, history, types, size, extraoral films, technical errors, radiographic examination in special children
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.
Paralleling and bisecting radiographic techniquesDr. Ritu Gupta
this is the seminar for Undergraduate students consisting of initial paralellelig and bisecting radiographic techniques, history, types, size, extraoral films, technical errors, radiographic examination in special children
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
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
- 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
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
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!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. CONTENTS
• Introduction
• Indications & contraindications
• Types of biopsy
• Point to consider prior to biopsy
• Information to accompany oral biopsy
• Interpretation of biopsy report
• Guidelines for appropriate biopsy
• Conclusion
3. INTRODUCTION
Biopsy: Bios – Life, Opsis – Vision
- Biopsy is the removal of small piece of living
tissue for microscopic examination or
analysis & diagnosis.
- The use of biopsy not confined to the
diagnosis , but valuable in determining the
nature of any unusual lesion.
5. INDICATIONS
- Any lesion that persists for more than 2 weeks
with no apparent etiologic basis.
- Any inflammatory lesion that does not respond to
local treatment after 10-14days .
(i.e. after removing local irritant)
- Persistent hyperkeratotic changes in surface
tissues.
- Bone lesions not specifically identified by clinical
or radiographic findings.
6. - Inflammatory changes of unknown cause, that
persists for long periods.
- Any lesion that has the clinical characteristics of
malignancy.
- To determine the nature of lesion which is
unknown.
- To determine the nature of all abnormal tissue
excised from the oral cavity.
10. Compromised General
health of the patient or a
History Of Bleeding
Disorders, including
patient on Anticoagulant
therapy.
-Proximity of
lesions to Vital
Anatomic Structure
& lesions in areas of
difficult surgical
access.
11. Pulsative lesions or lesions that
suggestive of a vascular nature.
ABSOLUTE
CONTRAINDICATIONS
12. • Intrabony radiolucent lesions should not
be biopsed or removed without prior
investigational aspiration.
Pigmented lesions should not be biopsed
incisionally.
17. Lesion in which the diagnosis will determine whether the
treatment should be conservative or radical.
Whenever there is suspicion of malignancy
18. PRINCIPLES
Biopsy site should be
selected in an area that
shows complete tissue
changes.
Necrotic tissue should be
avoided.
The material should be taken
from the EDGE of the lesion
to include adequate normal
tissue.
19. Take a Deep, Narrow biopsy rather than a broad, shallow
one.
20. TECHNIQUE
Selection of the area to biopsy-
• incisional biopsy performed in the most representative area.
• If there is any doubt about the malignant character of the lesion,
vital staining with toluidine blue can be use.
• •
21. 2. Preparation of the surgical
field
• The surgical area is disinfected - 0.12-
0.20 % chlorhexidine solution is preferred.
Iodine-containing surface antiseptics
should not be used, as they may stain the
tissues.
22. . Local anaesthesia
• Local anaesthetic with vasoconstrictor
[Adrenaline] should be used and infiltrated
away from the lesion to avoid introducing
artefacts in the sample.
23. A clean and defined incision is performed to obtain a slice of tissue.
Soft tissues incisions should be elliptical in shape producing a “V”
wedge that includes both the lesion and healthy margins.
25. TISSUE HANDLING
The specimen is handled gently to avoid crush artefacts and introduced in
the fixing solution.
The role of the fixing agent is to preserve the cellular architecture of the
tissues.
The best fixing agent is a 10% formalin solution, as it induces less
ultrastructural alterations in the samples.
70% ethanol can also be used.
26. - Suture
The suture should achieve good haemostasis, facilitate healing and
should be removed after 6-8 days.
If there is no Non Resorbable Suture than Resorbable Suture can be
used and reviewed 6-8 days after closure.
27. EXCISIONAL BIOPSY
It implies removal of the
entire lesion at the time of
the surgical diagnostic
procedure.
A perimeter of normal
tissue surrounding the
lesion is also excised to
ensure total removal.
33. PUNCH BIOPSY
- Involves a special instrument (PUNCH) for the
removal of a portion of the lesion.
- The punches are composed of a circular blade
or trephine attached to a pencil-like handle.
35. The edge of the blade of the biopsy punch is placed on the
site and rotated back and forth using moderate pressure to
an appropriate depth until the external bevel is not visible
36. It creates a clearly defined surgical
margin or incision
SPECIMEN REMOVED WITH SCISSORS
38. - Punch biopsies can remove the entire depth of
lesion, but they are difficult to use in certain
locations, such as where bone is close to the
skin.
- In this method the surgical instrument fills out
small segment of tissue from inaccessible lesion
or from large lesion where excision is
contraindicated.
40. INDICATIONS
• In all lesions thought to contain
fluid or any intraosseous lesion
before surgical exploration.
• A fluctuant mass in the soft
tissues to determine its contents.
41. • Any radiolucency in the bone of the jaw
should be aspirated to rule out a vascular
lesion.
42. - A sample of tissue is obtained by passing a
needle into the suspected mass.
-
- Suction is then produced in the syringe &
the needle is moved back & forth rapidly
in the tissue.
- Small shavings of tissue are obtained in the
barrel of the syringe that are later fixed on a
slide & examined under microscope.
TECHNIQUE
45. ORAL EXFOLIATIVE CYTOLOGY
- Exfoliative cytology is the
microscopic examination of shed
cells from an epithelial surface.
- Rapid, Non Invasive Procedure,
which is valuable in screening
patients with oral lesions.
46. INDICATIONS
- Periodic review of Oral Premalignant Lesions &
Oral Cancer Patients.
- Population screening of oral lesions.
- When biopsy is contraindicated on medical grounds.
- In the diagnosis of lesions e.g Herpes simplex
infection, Herpes Zoster, Pemphigus vulgaris,
White sponge nevus.
- In patient who refuse biopsy
47. ARMAMENTARIUM
- Glass slides
- Cytobrush (if there is more than one lesion, then
1 Cytobrush per lesion) or wooden/ steel
spatula.
- Cotton, gauze,mouthmirror &probe
48. - With a gauze gently remove any excess
saliva in the area that will be smeared.
- Vigorously scrape & rotate the Cytobrush
over the entire lesion.
- Scraping should not be painful to the patient
but it should be vigorous enough so that it is
noticeable & may generate a small amount
of bleeding.
- Take the Cytobrush & spread the harvested
cells onto the glass slide.
TECHNIQUE
49.
50. ADVANTAGES
- Non invasive & easy to perform.
- Requires no specialized instruments .
- Can be used to note the progress of treatment &
regression of lesion.
- Repeated smears can be taken.
- Early diagnosis of cancer.
- No problem of wound healing.
51. DISADVANTAGES
- Acts only as a supportive diagnostic aid & acts
as an adjuvant to biopsy.
- Definitive diagnosis is not possible
- Does not help in diagnosing the depth of the
lesion.
- Inflammatory lesions may be misdiagnosed as
malignancy.
52. ORAL BRUSH BIOPSY
Components of kits
– Oral brush biopsy
instrument
– Precoded glass slide &
matching coded test
requisition form
– Alcohol / carbowax fixative
pouch
– Preaddressed container for
submitting the contents
53. BRUSH BIOPSY INSTRUMENT
• The brush is sterile.
• One OralCDx test kit
• Brush is designed to penetrate to the basement
membrane & thus achieve a complete
transepithelial specimen.
54. Unlike cytology instruments which collect only superficial cells,
the biopsy brush obtains cells from all three epithelial layers of
the oral mucosa: Superficial, Intermediate & Basal.
55. INDICATIONS
Epithelial abnormalities
– Leukoplakia, Erythroplakia, Chronic Ulcerations,
Mucosa That Is Atrophic, Thickened, Traumatized
CONTRAINDICATIONS
Lesions with Intact Normal Epithelium
– Fibromas, Mucoceles, Hemangiomas, Submucosal
Masses, Pigmented Lesions, Amalgam Tattoos
– Highly suspicious lesions
60. ORALCDX RESULTS
“INADEQUATE”: Re-test
“NEGATIVE”: No Cellular Abnormalities
“POSITIVE”: Definitive Cellular Evidence of
Epithelial Dysplasia Or Carcinoma
“ATYPICAL”: Abnormal Epithelial changes
warranting Further Investigation
61. SHAVE BIOPSY
• Best for raised lesions
mostly confined to the
epidermis
– benign nevi
– small nodular basal cell
carcinomas
• Not for suspected
melanoma
62. SHAVE BIOPSY STEPS
The most commonly performed shave biopsy technique employs a No. 15 scalpel
blade.
Stretch and stabilize the skin with your nondominant hand , hold the scalpel blade
horizontal to the skin, and insert it just outside the periphery of the lesion. Whenever
possible, use a single, smooth cutting stroke..
65. ELECTRO-SURGERY BIOPSY
- Refers to the cutting & coagulation of tissue using
very high-frequency, low-voltage electrical currents.
- A blended current combines cutting & coagulation,
& is useful in producing a bloodless operative field.
- Lesion excisions on the face are usually performed
with only a cutting current to limit scarring at the
wound base, which can be produced by the effects
of thermal coagulation.
66. TECHNIQUE
The lesion is
Grasped with
forceps through the
loop electrode. The
electrode is activated
going under the
lesion, removing the
growth.
67. EXPLORATORY BIOPSY
It is done for the investigations of an
internal lesion.
In this removal of all portion of tissue
expose is done.
This is commonly employed for the intra
osseous lesions of mandible &maxilla.
68. CURETTAGE BIOPSY
- Used primarily for Intra Osseous Lesions & very
friable cellular lesions, where only small
amounts of surface material are necessary for
evaluation.
- Extremely small tissues are centrifuged &
sedimentary segments are placed in Agar media
and then sectioned as tissue blocks.
- Used successfully on lesions like actinic
keratosis, superficial SCC & BCC & Warts.
69. IMPRINT CYTOLOGY
- In this technique , the biopsed tissue is cut into
two halves and the cut surface is touched to
the slide.
- Slide is stained later to see the exfoliated cells.
- Imprint cytology of biopsed tissue could be used
to provide a rapid preliminary diagnosis.
- Imprint cytology of a biopsy can be reported
within an hour.
70. ARMAMENTARIUM FOR BIOPSY
- Mouth mirror, probe, antiseptic
agent.
- Local anaesthetic agent &
syringe,B.P blade no. 15.
- Surgical scissors & tissue forceps
- Bone curette, small hemostat.
- 10%neutral buffered formalin.
- Sterile saline irrigation.
71. INFORMATION TO ACCOMPANY
MUCOSAL BIOPSIES
1. Patient demographic data
2. Description of the clinical appearance of the lesion &
suspected diagnosis
3. Site of the biopsy-An explanatory diagram of the biopsy area
may be useful for this purpose.
4. Relationship of the lesion to restorations, particularly amalgam
5. Detailed Drug history
6. Medical history including blood disorders
7. Smoking & alcohol consumption
72. PRINCIPLES OF SURGERY
• Mucoperiosteal flaps should be designed to
allow adequate access for
incisional/excisional biopsy.
• Incisions should be over sound bone.
• Cortical perforation must be considered
when designing flaps.
• Flaps should be full thickness.
• Major neurovascular structures should be
avoided.
73. INCISION
- Sharp scalpel should be used to incise
tissue for routine conventional biopsy.
- Two incisions forming an ellipse at the
surface & converging a V at the base of
the lesion provide a good specimen &
leave a wound that is easy to close.
- Thin, deep specimens are preferable to
broad, shallow specimens.
- A periphery of the normal appearing
tissue should be included in both
Incisional & excisional biopsy
specimens.
74. IDENTIFICATION OF SURGICAL MARGIN
Margins of the biopsy specimen should be marked
with a silk suture to orient the specimen to the pathologist.
SPECIMEN CARE
After removal, the tissue should be immediately placed
in 10% formalin solution, at least 20 times the volume
of the surgical specimen.
- Specimens should be placed in wide opened bottle.
- Leakage of the formalin should be prevented.
75. COMPLICATIONS OF
ORAL BIOPSY
- Hemorrhage
- Infection
- Poor wound healing
- Spread of Tumour cells
- Injury to adjacent tissues
- Reactions to local anesthetics
84. CONCLUSION
• Biopsies are important diagnostic tool
for diagnosis of lesions ranging from
simple periapical lesions to malignancies.
• Planning prior to performing a biopsy is
essential . It will be beneficial to the receiving
pathologist in reaching a helpful & meaningful
diagnosis.