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There are certain risks with this technique, in that anunsealedaccessopeningenablesbacteriaandstainstopenetrateinto Thermocatalytic Technique dentin. Even with a good root filling, the passage of bacteria through the this technique (Fig. It has been observed that heat application studies are summarized in Tables 1 and 2. Most reports present optimal causes a reaction that increases bleaching properties of the hydrogen initial results after bleaching, with complete color matching of the peroxide (2). It is worth noting that the opinion of the patient regarding the success of the therapy is often more positive than the opinion of the dentist (84, 104). One study reported an 80% rate of success after 1 year and 45% after 6 years of 20 cases that were chemically bleached by using the thermocatalytic tech nique (145). Some authors have suggested that teeth that have been discolored for several years do not respond as well to bleaching as teeth that are stained for a short period of time (2, 46). Furthermore, it is uncertain whether darkening after bleach ing is more likely when the tooth is heavily or mildly discolored (2, 46, 131). Certain metallic ions (mercury, silver, copper, iodine) are extremely difficult to remove or alter by bleaching. Brown (46) re ported that trauma or necrosis-induced discoloration can be success fully bleached in about 95% of the cases, compared with lower percent ages for teeth discolored as a result of medicaments or restorations (36). There is a difference in opinion as to whether teeth that respond rapidly to bleaching have a better long-term color stability prognosis (102, 131, 143). Some studies have reported that stained teeth in young patients are easier to bleach than discoloration in older patients (8, 22, 79, 143), presumably because the wide open dentinal tubules in young teeth enable a better diffusion of the bleaching agent. However, not all studies are in agreement with age-related success of bleaching (46, 131). Teeth with internal discoloration caused by root canal medica ments, root-filling materials, or metallic restorations such as amalgam have a poor prognosis, because this type of discoloration is difficult to bleach and tends to reappear over time because of the tenacity of the oxidizing products to dental tissues (40, 46). Anterior teeth with inter proximal restorations occasionally show less optimum results than teeth with a palatal access cavity only (103). This might be attributed to the fact that resin composites cannot be bleached (146).

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It is a wave of gastric peristalsis seen progressing from the left hypochondrium and epigastric region towards the right lumbar region. It is seen as a step ladder form of peristaltic waves, produced by the hypermotile small intestine, in the umbilical region. Idiopathic retroperitoneal fibrosis umbilicus (caput medusae) signifies portal hyper 4. Obstruction caudal to renal vein: Patient presents with thoracic veins above conveying blood from long oedema of both lower limbs and there is dilatation saphenous vein to axillary vein. Obstruction at the level of renal vein: Patient has lumbar is in the cephalic direction. Always select a long segment of vein without Gradual obstruction may lead to collateral formation. Obstruction above the renal vein: Patient has associated should be detected in the standing posture only obstruction of hepatic veins presenting as acute and (Fig. The clinical features depend on the level, Interpretation completeness and the rapidity of obstruction. Linea nigra is a pigmentation below umbilicus seen downward direction, it denotes portal hypertension. Periodic measurement is done to assess Liver prognosis in acute abdomen, peritonitis, paralytic ileus and obstruction of bowel. Umbilicus is displaced downwards in In men, it corresponds to a line joining a point about cirrhosis with ascites and upwards in ovarian or 1 cm below the right nipple to a point about 2 cm below pelvic tumours. Aorta and para-aortic glands and common iliac Spleen vessels It is situated behind 9th, 10th and 11th ribs with its long 7. Palpation by Dipping Kidneys this method is used in tense ascites to detect the the surface marking of kidneys is indicated by Morris presence of hepatic or splenic enlargement. The quadrilateral on either side; Two parallel horizontal technique may help to detect and map the outlines of lines are drawn on the back at the levels of 11th dorsal enlarged organs or of tumours. They are intercepted by 2 of liquid gives a tapping sensation over the surface of vertical lines drawn 3. Gallbladder Structures normally palpable are: It is situated at the junction of 9th costal cartilage and 1. Surface (smooth or nodular) Start in left iliac fossa palpating lightly and working c. Abdomen 277 Palpation of Gallbladder It is felt as a firm, smooth, rough or globular swelling with distinct borders, just lateral to the edge of the rectus abdominis near the tip of ninth costal cartilage. Mucocele or impacted gallstone in the neck of a collapsed empty and uninfected gallbladder. Mucus is secreted into the lumen and in later stages gallbladder becomes palpable. Carcinoma of gallbladder: Gallbladder is felt as a stony hard, irregular swelling.

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The objective of this study is to evaluate whether the addition of ultrasound to breast cancer screening resulted in a decrease in the size of high-risk or malignant lesions when initially found on imaging. Methods: Retrospective analysis of both pathology and radiology data was performed on all patients who received either screening or diagnostic mammograms and whether ultrasound was use in adjunct. All biopsy-proven high-risk or malignant lesions were then evaluated for size, and whether they appeared on mammography, ultrasound, or both. These sizes were compared to the imaging modalities for the year 2013 during which the notification law was implemented. Results: Out of 371 total biopsies in 2013, 96 came back positive for high-risk or malignant lesions. In the group that only received mammography, the average size detected on imaging was 2. In the group that received mammography/sonography, the average size detected on imaging was 1. For all patients that underwent previously documented ultrasound surveillance, the average size detected on any imaging was 1. For all patients that did not undergo documented ultrasound surveillance previously, the average size detected on any imaging was 1. Conclusions: With the use of ultrasound as an adjunct to mammography, the detected size of biopsy proven malignant or high-risk lesions were significantly smaller detected on imaging compared to mammography alone. The sizes on pathology and imaging were the similar for biopsy-proven lesions for patients who were under sonographic surveillance compared to no previous ultrasound. Methods: A retrospective review was conducted of all patients diagnosed with breast cancer at our institution between 2015 and 2016. All patients received a standard screening mammographic protocol of 2D and 3D breast tomosynthesis. At the time of screening mammogram, the images were reviewed by the technologist, and the breast density was determined according to a density algorithm. Radiographic findings were correlated with demographic information from the electronic medical record, as well as tumor registry data and pathology. Results: A total of 389 patients were diagnosed with breast cancer during the study period. Conclusions: the effectiveness of multimodality breast cancer screening may be influenced by breast density as well as clinical and demographic factors. Further studies are warranted to determine the value of each modality alone, and in combination in our patient population. Standard cranio-caudal and medio-lateral oblique views of each breast were obtained. Results: We are reporting on 63 patients, 64 at the breast level (1 bilateral case).

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Grossly, no visible tumour dilated ducts containing cheesy necrotic material (in is identified. Clinically, iv) Cribriform pattern is recognised by neat punched out majority of infiltrating duct carcinomas have a hard fenestrations in the intraductal tumour. Cut surface shows a grey white firm tumour extending irregularly into adjacent breast parenchyma. Microscopic features include formation of solid nests, cords, gland-like structures and intraductal growth pattern of anaplastic tumour cells. There is infiltration of densely collagenised stroma by these cells in a haphazard manner. They are found more frequently in the left breast, ii) Infiltration by these patterns of tumour cells into often in the upper outer quadrant. Grossly, the tumour is Infiltrating (Invasive) Lobular Carcinoma irregular, 1-5 cm in diameter, hard cartilage-like mass that cuts with a grating sound. The sectioned surface of the Invasive lobular carcinoma comprises about 5% of all breast tumour is grey-white to yellowish with chalky streaks and cancers. This peculiar morphologic form differs from other often extends irregularly into the surrounding fat invasive cancers in being more frequently bilateral; and (Fig. Grossly, the appearance different from other special types in lacking a regular and varies from a well-defined scirrhous mass to a poorly uniform pattern throughout the lesion. A variety of defined area of induration that may remain undetected histologic features commonly present are as under by inspection as well as palpation. Colloid (Mucinous) Carcinoma 763 Infiltrating cells may be arranged concentrically around this is an uncommon pattern of breast cancer occurring more ducts in a target-like pattern. Some tumours may show signet-ring cells usually a soft and gelatinous mass with well-demarcated distended with cytoplasmic mucin. Histologically, colloid carcinoma contains large amount Medullary Carcinoma of extracellular epithelial mucin and acini filled with Medullary carcinoma is a variant of ductal carcinoma and mucin. Cuboidal to tall columnar tumour cells, some comprises about 1% of all breast cancers. The tumour has a showing mucus vacuolation, are seen floating in large significantly better prognosis than the usual infiltrating duct lakes of mucin (Fig. Tubular carcinoma is an Histologically, medullary carcinoma is characterised by uncommon variant of invasive ductal carcinoma which has 2 distinct features (Fig.

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