This document provides an outline for a presentation on principles of differential diagnosis and biopsy. It begins with an overview of examination and diagnosis methods including health history, history of the specific lesion, and clinical and radiographic examination. It then reviews general principles of biopsy including incisional, excisional, and aspiration biopsy techniques. Soft tissue biopsy techniques such as anesthesia, tissue stabilization, hemostasis, incisions, and wound closure are discussed. Finally, intraosseous (hard tissue) biopsy techniques including precautionary aspiration, mucoperiosteal flaps, and bone windows are covered. The document aims to provide guidance on evaluating lesions, determining appropriate biopsy methods, and surgical principles.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
An oroantral communication is an unnatural perforation between oral cavity and maxillary sinus.
Oroantral fistula is an epithelized, pathological, communication between these two cavities. A fistulous tract present more than 14 days should be considered as chronic fistula.
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.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
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.
4. Health History
• Close interrelationship exists between the medical and dental
health of patients and that oral lesions can be a reflection of, or
contributers to, systemic health problems
1) A preexisting medical problem may affect or be affected by
the dentist’s treatment of the patient
2) The lesion may be the oral manifestation of a significant
systemic disease
5. History of the Specific Lesion
1. How long has the lesion been present?
2. Has the lesion changed in size?
3. Has the lesion changed in character or features?
4. What symptoms are associated with the lesion?
5. What anatomic locations are involved?
6. Are there any associated systemic symptoms?
7. Is there any historical event associated with the onset of the lesions?
6. Clinical Examination
• Anatomic location
• Physical characteristics
• Single versus multiple lesion
• Size, shape and growth presentation
• Surface appearance
• Lesion coloration
• Sharpness of border,mobility
• Consistency of the lesion to palpation
• Presence of pulsation
8. Radiographic Examination
• Useful diagnostic adjuncts after completion of the history and clinical
examination, especially for lesions occurring within or adjacent to bone
• Most pathologic conditions can be adequately viewed on routine plain
views (e.g., periapical, occlusal, or panoramic), but occasionally
specialized imaging techniques are needed—including computed
tomography (CT; with the newer cone-beam CT) or magnetic resonance
imaging (MRI) views
13. Incisional Biopsy
• If the lesion is
• large (>1 cm in diameter),
• located in a risky or hazardous location
• whenever a definitive histopathologic diagnosis (e.g., for
suspected malignancy) is desired before planning a complex
removal or other treatment
14.
15. Excisional Biopsy
• Removal of a lesion in its entirety,
to include a 2- to 3-mm perimeter
of normal tissue around the lesion
• For smaller lesions (<1 cm in
diameter)
16. Aspiration Biopsy
1) Biopsy to explore whether a lesion contains a fluid
2) Biopsy to aspirate cells for pathologic diagnosis
• This latter is termed fine-needle aspiration (FNA) (16- to 18-gauge needle)
-ex:Neck masses
3) Routine aspiration of intraosseous R/L lesions
18. Accurate surgical incisions
can be placed with greater
ease when the involved
tissues are first stabilized
19.
20. Hemostasis
• The assistant can often use gauze sponges to blot the site
• Suctioning can increase not only bleeding but also the risk of
the biopsy tissue sample being accidentally aspirated into the
suction
• If suction is needed, it is helpful to place a gauze pad over the
end of the suction tip to serve as a filter
21. Incisions
• A sharp scalpel, usually with a No. 15 blade
Football-shaped incision:
- yield an optimal specimen
- easy to close
• The use of laser devices and electrosurgical
equipment for making incisions for biopsies is
not desirable
22. Wound Closure
• Primary closure of the wound is desirable
and usually possible
• Attached mucosal surfaces (e.g., gingiva
and hard palate) are generally not closed
but are allowed to heal by secondary
intention
• Undermining permits tension-free
approximation of tissue margins
23. Intraosseous (Hard Tissue) Biopsy
Techniques and Principles
• The most common intraosseous lesions encountered by the
dentist are periapical granulomas and odontogenic cysts
• Treatment generally involves surgical removal of the lesion by
way of excisional biopsy
24. Intraosseous (Hard Tissue) Biopsy
Techniques and Principles
• When such a lesion is large, perforating into soft tissue overlying
the bone, or where a suspicion of malignancy based on history
and radiographic characteristics exists, incisional biopsy is
indicated
25. Precautionary Aspiration
• Aspiration of all intraosseous lesions should be performed routinely before
opening into the osseous defect to determine whether it contains fluid
• If the cortical plate cannot be penetrated by pressing the needle firmly through
the mucoperiosteum, a flap is reflected and a large round burr is used cautiously
to penetrate
26. Aspiration of intraosseous lesions
straw-
colored
cyst
pus inflammatory or infectious process
air traumatic bone cavity
blood vascular lesion (hemangioma or
arteriovenous malformation)
aneurysmal bone cysts and central
giant cell lesions
27. Mucoperiosteal Flaps
• Most biopsies require an approach through a mucoperiosteal flap
• The choice of flap depends mostly on the size and location of the lesion to be
removed
• Flap should extend 4 to 5 mm beyond the surgical margins of any bony defects
• All mucoperiosteal flaps for biopsies in or on the jaws should be full thickness