Sialadenosis ultrasound

Ultrasound In acute sialadenitis, the affected gland appears enlarged, hypoechoic and hyperemic on ultrasound 8,10. In chronic infective forms, the affected gland appears atrophic and diffusely hypoechoic with irregular margins - the ultrasound appearances have been likened to that of a cirrhotic liver 8 Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years

Sonography allows detection of obstructive salivary gland diseases such as stenosis or sialolithiasis, as well as sialadenosis such as Sjögren syndrome. Ultrasound examination alone is sufficient to diagnose benign tumors Sialadenosis echocardiography and ultrasound On the Web Most recent articles. Most cited articles. Review articles. CME Programs. Powerpoint slides. Images. American Roentgen Ray Society Images of Sialadenosis echocardiography and ultrasound All Images X-rays Echo & Ultrasound CT Images MRI; Ongoing Trials at Clinical Trials.gov. US National. Ultrasound demonstrates multiple minute (1 mm-3 mm) hypoechoic or anechoic focal lesions corresponding to punctate sialectasis on sialography Sialadenosis. Sialadenosis is defined as a bilateral, persistent, painless, non-inflammatory swelling of the salivary glands, particularly the parotids..

Sialosis (Sialadenosis) Sialogram see also: Sialosis - Rads Sialosis (sialadenosis) is a chronic, bilateral, diffuse, non-inflammatory, non-neoplastic swelling of the major salivary glands that primarily affects the parotid glands, but occasionally involves the submandibular glands and rarely the minor salivary glands (Scully 2008) Sialosis / Sialadenosis What is it? ' Sialadenosis ' is a non-specific term used to describe an uncommon, benign, non-inflammatory, non-neoplastic enlargement of a salivary gland, usually the parotid gland but occasionally affects the submandibular glands and rarely, the minor salivary glands. This enlargement is bilateral, symmetrical and painless (it is often painless but not invariably so) Ultrasound Med Biol. 2016 Jan. 42 (1):167-75. . Larson AR, Aubin-Pouliot A, Delagnes E, Zheng M, Chang JL, Ryan WR. Surgeon-Performed Ultrasound for Chronic Obstructive Sialadenitis Helps Predict Sialendoscopic Findings and Outcomes. Otolaryngol Head Neck Surg. 2017 Dec. 157 (6):973-80. Sialadenitis is an inflammation of a salivary gland. Salivary glands are the glands that make saliva, which helps with swallowing and digestion and protects your teeth from bacteria. There are three main salivary glands: Sialadenitis mostly affects the parotid and submandibular glands. It can be an acute (sudden), chronic (long term), or.

Sialadenitis Radiology Reference Article Radiopaedia

  1. Sialadenitis most commonly affects the elderly and chronically ill especially those with dry mouth or who are dehydrated, but can also affected people of any age including newborn babies. Diagnosis is usually made by clinical exam but a CT scan, MRI scan or ultrasound may be done i
  2. A study by Omotehara et al indicated that ultrasonography is effective in the diagnosis of immunoglobulin G4-related sclerosing sialadenitis (IgG4-SS), with ultrasonography showing the..
  3. Salivary ultrasound standardized diagnostic approach and report. click on image above to enlarge, advance with cursor over lateral border. Procedure: Diagnostic ultrasound of the salivary glands and upper neck. Preop Diagnosis: Status post I-131 therapy with left parotid swelling

Sialadenosis is a benign,non-inflammatory swelling of salivary glands usually associated with metabolic conditions. This activity reviews the epidemiology, pathophysiology, histopathology, clinical features, treatment, and management of submandibular sialadenitis and sialadenosis Surgeon-Performed Ultrasound for Chronic Obstructive Sialadenitis Helps Predict Sialendoscopic Findings and Outcomes. Otolaryngol Head Neck Surg . 2017 Dec. 157 (6):973-80. [Medline] Sialadenosis was identified in 4 (2.6%) cases. Abnormality of the superficial soft tissues was also seen in 25 cases. 12 cases had a lymphatic malformation of the neck, involving the parotid, while 11 cases had a vascular lesion of the cheek, but not involving the parotids directly. Conclusion: High resolution ultrasound remains the first-line. Salivary infection, also called sialadenitis, most commonly affects the parotid salivary glands on the side of the face, near the ears or the submandibular salivary glands under the jaw. A salivary gland infection is also called sialadenitis and is caused by bacteria or viruses. A salivary stone or. Larson AR, Aubin-Pouliot A, Delagnes E, et al. Surgeon-Performed Ultrasound for Chronic Obstructive Sialadenitis Helps Predict Sialendoscopic Findings and Outcomes. Otolaryngol Head Neck Surg 2017; 157:973. Bozzato A, Hertel V, Bumm K, et al. Salivary simulation with ascorbic acid enhances sonographic diagnosis of obstructive sialadenitis

Sialadenosis is symptomatic enlargement of the salivary glands, which has been described typically as non-inflammatory, non-neoplastic, and usually the parotid glands are enlarged bilaterally. It is commonly associated with endocrine diseases. Ultrasound reveals enlarged glands with hyperechogenicity and no focal lesions Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid.

Sialadenosis is a non-inflammatory bilateral enlargement of salivary gland sometimes confused with Sjogren's syndrome. In our observation the ultrasonographic observations are isoechoic with homogenous internal echoes and there was no variation in size. Thus sialadenosis can be differentiated from Sjogren's syndrome with ultrasonography Imaging with ultrasound or a CT scan may be helpful. Also during a doctor's exam if the affected gland is massaged it will usually not produce any saliva. Once the underlying cause of chronic sialadentitis is diagnosed treatment should focus on reversing the underling cause of the condition Ultrasound: rarely, a bilateral space-occupying lesion such as a salivary neoplasm, cyst or lymphoid neoplasm may present difficulties in differentiation from sialadenosis, and then ultrasound may help. . Sialography: reveals enlarged but otherwise normal glands, although salivary secretion is not impaired Clinical examination and ultrasound play the biggest role in diagnosis. For all parotid tumors, the preferred treatment is parotidectomy with retention of the facial nerve. A resection of the facial nerve is indicated only if it is infiltrated by the tumor. Postoperative radiation therapy may benefit patients with malignant tumors. Sialadenosis

This review will cover clinical presentations for sialadenosis, radiation-related sialadenitis, and medication-induced salivary disorders. Presentation of metabolic disorder-related sialadenosis or gland enlargement is gradual and progressive without obstructive salivary symptoms. In contrast, radioactive iodine therapy can induce acute and chronic sialadenitis due to salivary gland. Sialadenosis is a rare disease entity showing diffuse, non-inflammatory, non-neoplastic enlargement of the major salivary glands. Although elucidation of the detailed etiology and pathogenesis of sialadenosis is dependent on further research, it is thought that a loss and thinning of the myofilament component of the myoepithelial cells leads to. The salivary glands are located superficially and are therefore easily accessible to ultrasound (US) examination, particularly if a high-frequency probe designed for small parts is used. Hence, US examination of these organs is widely applied particularly in non-neoplastic pathologies. In this way, it is possible to obtain adequate images without the use of ionizing radiation or complex. Sialadenosis MRI On the Web Most recent articles. Most cited articles. Review articles. CME Programs. Powerpoint slides. Images. American Roentgen Ray Society Images of Sialadenosis MRI All Images X-rays Echo & Ultrasound CT Images MRI; Ongoing Trials at Clinical Trials.gov. US National Guidelines Clearinghouse. NICE Guidance. FDA on.

A CT scan or ultrasound may be done if the doctor suspects an abscess. Treatment 1. In some cases, no treatment is necessary. 2. If there is pus or a fever, or if the infection is known or thought to be bacterial, antibiotics may be prescribed. Antibiotics are not effective against viral infections The etiology of sialadenosis is unknown; how-ever, the reports have described this condition in association with systemic diseases such as diabetes mellitus, alcoholism, chronic malnutri-tion, antihypertensive therapy, bulimia, and HIV infection.1-6 Diagnosis is based mainly on the clinical find-ings.2 Ultrasound and computed tomography ar ultrasound, can be used to assess the possibility of focal autonomy in a thyroid nodule (Endocrine Society, 2017). (Sjogrens syndrome) and sialosis (aka sialadenosis) can affect the salivary glands. Some conditions, such as mumps, do not require imaging evaluation. Sialosis is non-inflammatory enlargement of predominantly th A case of acute postoperative transitory sialadenosis of the submandibular glands in a healthy dog. Cattai A(1), Levorato S, Franci P. Author information: (1)Department of Animal Medicine, Production and Health, University of Padua. A 1-year-old healthy female cross-breed dog, weighing 4.5 kg, was scheduled for elective neutering Ultrasound can be used in facial swelling to evaluate for infectious/inflammatory diseases, sialolithiasis, sialosis/sialadenosis, Sjogren syndrome, neoplasms, cysts, and trauma. Even if one is able to clinically correlate facial swelling to a glandular structure, there are numerous disease states that require imaging to differentiate

Sialadenosis - Browse free ultrasound cases Ultrasound Case

Ultrasound. Considered 1st line option by many. Can help evaluate the gland and abscess formation. May illustrate a stone, but may still miss smaller stones. [Francis, 2014] CT. Likely needed if surgical options need to be considered. Surgical options: Stone retrieval and ballon dilation; Lithotripsy; Gland excision - has become less commo Sialadenosis can be seen in people with bulimia, anorexia nervosa, malnutrition, liver diseases, diabetes mellitus, and neoplasia.1,7 Sialadenosis is commonly recognized in laboratory mammals and has been reported secondary to some drugs, hormonal changes, salivary gland resection, or amputation of incisor teeth.2 There are several reports. Sialadenosis is an asymptomatic, bilateral enlargement of salivary glands which most commonly affects the parotid glands. Dental practitioners must be able to differentiate gland enlargement to inflammatory, autoimmune and neoplastic processes to prevent unnecessary management and allow for correct referrals to specialists Lately, I encountered two patients with thyroid nodule being subjected to CT scans after an ultrasound. In these two patients, there is a discrepancy in the reports which led me to ask which one is more accurate in diagnosing thyroid nodule: ultrasound or CT scan? First patient: On CT scan, the right thyroid gland is normal 1:45 - 2:00 pm Ultrasonography in Other Forms of Sialadenitis and Lymphoma (IgG4 RD, Eosinophilic Sialodochitis, Sialadenosis, Lymphoma) Alan Baer (Baltimore, USA) 2:00 - 2:15 pm . Ultrasound-Guided Core Needle Biopsy in the Differential Diagnosis of Parotid Gland Enlargement and Nodules . Joel Fradin (Baltimore, USA) 2:15 - 2:30 p

Sialadenosis is a typically bilateral noninflammatory hypertrophy of the submandibular glands, having its origin in metabolic disorders like anorexia nervosa, bulimia, and diabetes. Other clinical conditions associated with a high sialadenosis incidence are alcoholism and non-alcoholic cirrhosis Sialadenosis Sialadenosis refers to nonneoplastic noninflammatory swelling in association with acinar hypertrophy and ductal atrophy. as a contrast agent can aid in the ultrasound assessment of obstructive sialadenitis of the parotid and submandibular glands.[3, 4] Computed tomography scanning is an excellen Sialadenosis caused by medications or underlying metabolic, nutritional, or endocrine pathology may also mimic chronic parotitis. Patients with Sjögren Ultrasound evaluation may locate a stone or abscess. CT scans may identify a parotid mass or sialolith and will also demonstrate th

Sonography: the leading diagnostic tool for diseases of

Sialolithiasis is the main indication for interventional sialendoscopy, especially for the submandibular glands. The decision-making algorithms ( Figs. 15.1 and 15.2) show the steps involved in treatment and management. The indications for sialolith removal are still changing thanks to the continuing development of the available techniques Gynaecology. 3.1 Uterus 3.2 Adnexa 3.3 Vagina. Head and Neck. 4.1 Thyroid gland 4.2 Parathyroid glands 4.3 Salivary glands 4.4 Lymph nodes 4.5 Miscellaneous. Breast and Axilla. 5.1 Benign lesions 5.2 Malignant breast lesions 5.3 Pitfalls 5.4 Elastography 5.5 3D imaging 5.6 Axilla 5.7 Prosthesis 5.8 Male breast. Musculoskeletal Joints and Tendons Ultrasound. If you have bladder signs and symptoms, your doctor might do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract. More Information. Tilt table test; Ultrasound; Treatment. Treatment of autonomic neuropathy includes Home < Medical Services < ENT < Parotid Gland < Sialadenitis - Chronic and Acute Inflammatory Conditions Sialadenitis - Chronic and Acute Inflammatory Conditions. Inflammation of the salivary glands is known as Sialadenitis. This condition can be caused by several factors including obstructions or infections Sialadenosis was identified in 4 (2.6%) cases. Abnormality of the superficial soft tissues was also seen in 25 cases. 12 cases had a lymphatic malformation of the neck, involving the parotid, while 11 cases had a vascular lesion of the cheek, but not involving the parotids directly

Sialadenosis echocardiography and ultrasound - wikido

Sialadenitis is an umbrella term for inflammation of one of the salivary glands, most commonly the parotid or submandibular. The history, symptoms, signs, and investigations required depend on the nature of the presentation, the gland affected, and any underlying contributing conditions, such as an autoimmune disease or ductal stones Sialadenosis . Sialadenosis is a generalised gland swelling caused by hypertrophy of the acinar component of the gland. It is associated with a number of systemic diseases. Treatment for sialadenosis is aimed at the underlying cause. The most common degenerative disease affecting the salivary glands is Sjögren's syndrome, an autoimmune condition Sialadenosis It is a non neoplastic,noninflammatory enlargment of parotid gland. Sialography - enlargement /normal appearance. CT & MRI - straightforward depiction but are nonspecific. 66. Cystic lesions Ultrasound - cyst are sharply marginated and echo free areas. Well circumscribed ,high signal areas on T 2 weighted MRI. 67

FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6963 interlinked topic pages divided into a tree of 31 specialty books and 737 chapters Parotitis; Parotid gland (center left) Specialty: Infectious disease : Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation Sialadenosis Sialadenosis (generalised gland swelling caused by hyper­ ultrasound assessment is frequently combined with fine needle cytology to identify malignancy (see below). Ultrasonography is also valuable in the investigation of non­neoplastic disease of the salivary glands. Diffus

Bilateral parotid swelling: a radiological revie

Sialadenitis is the inflammation and enlargement of one or several major salivary glands. It most commonly affects parotid and submandibular glands. Bacterial infection can supervene if salivary flow is diminished by illness or medication, or is obstructed by a sialolith (salivary stone). Most co.. #### Summary points The investigation and management of salivary swellings have advanced considerably in the past decade, with an emphasis on less invasive techniques and increased preservation of the salivary glands and adjacent structures. Salivary gland swellings usually present on the side of the face, below and in front of the ear (parotid gland), or in the upper part of the neck (tail of. A licence package is needed for accessing this content. Register for trial Choose your licence package for full free access during a 14-day test period

Ultrasound. This uses high-frequency sound waves to make images of your bladder so your doctor can get a better look at what's happening. X-rays. Gastric emptying test Page Contents1 Sialadenitis1.1 Salivary Gland Infection1.2 Chronic Sialadenitis1.3 Submandibular Sialadenitis1.4 Parotid Gland Infection2 Sialadenitis Symptoms3 Sialadenitis Treatment Sialadenitis The salivary glands are exocrine glands (with ducts) responsible for the production of saliva and amylase (enzymes responsible for breaking down of starch to maltose) Sialadenitis. Sialadenitis is bacterial infection of a salivary gland, usually due to an obstructing stone or gland hyposecretion. Symptoms are swelling, pain, redness, and tenderness. Diagnosis is clinical. CT, ultrasonography, and MRI may help identify the cause. Treatment is with antibiotics

Submandibular lymphadenopathy refers to enlarged lymph nodes located beneath the mandible (lower jaw). LEarn about what could be causing enlarged lymph nodes, symptoms to look out for, and. DOI: 10.1056/NEJM195703142561103. CHRONIC, noninflammatory enlargement of the parotid glands has been noted in populations whose food supplies are inadequate and in this country has been reported. K11.20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2021 edition of ICD-10-CM K11.20 became effective on October 1, 2020. This is the American ICD-10-CM version of K11.20 - other international versions of ICD-10 K11.20 may differ Although post mortems can provide additional proof, a diagnosis can be made while the dog is still living by blood tests, urinalysis, wedge biopsy and ultrasound. A lot of old dogs die of kidney disease - could it be just old age not PLN? Changes in the kidney due to old age cannot be mistaken for those caused by PLN Patients were diagnosed with EDs by our center according to DSM-V. ED related parotidomegaly and sialadenosis was diagnosed after clinical and radiological examination, and exclusion of drinking history, parotid gland infective diseases, sialolithiasis or tumors.. Morphological analysis was performed through ultrasound and MRI scans

Ultrasonographic Evaluation of Salivary Gland Enlargements

Sialosis or Sialadenosis of the Salivary Glands Iowa

Sialosis-Sialadenosis - Exodontia

Submandibular Sialadenitis/Sialadenosis: Practice

Sialadenosis Sialadenosis (generalised gland swelling caused by hyper­ ultrasound assessment is frequently combined with fine needle cytology to identify malignancy (see below). Ultrasonography is also valuable in the investigation of non­neoplastic disease of the salivary glands. Diffus Ultrasound had an accuracy, sensitivity, specificity, PPV, and NPV of 94.77 %, 94.91 %, 94.57 %, 96.14 %, and 92.89 %, respectively, for the diagnosis of sialolithiasis. All false-positive findings were correctly diagnosed, and in all false-negative findings, stones/fragments were visualized by sialendoscopy The clinical findings most classically associated with eating disorders—namely, the extremely low body mass index and lack of subcutaneous fat [ 1, 2 ]—can also be seen radiographically ( Figs. 4A and 4B ). Such findings in an otherwise young healthy patient are suggestive of an eating disorder. Conclusion

Saliva makes food moist, which helps chewing and swallowing and the digestion of food. Saliva also keeps the mouth clean and healthy because it contains antibodies that kill germs. If the salivary glands are damaged or aren't producing enough saliva it can affect taste, make chewing and swallowing more difficult, and increase the risk for. Salivary gland infections usually affect the glands under the ears (parotid glands) and the glands under the chin (submandibular glands). Having salivary stones or other blockages can lead to. Korea University Experts Portal. Korea University was founded in 1905 on a mission to save the nation through education. Korea University led Korea's economic and political development and social democratization during last 40 years of 20th century. Korea University is already competing against globally prestigious universities in numerous.

Sialadenosis causes enlargement of the affected salivary glands (frequently the mandibular gland but occasionally the zygomatic) in addition to ptyalism, retching or gagging, gulping and inappetence. If the zygomatic gland is involved exophthalmos, epiphora and divergent strabismus may be seen Diagnosis of infectious sialadenitis is usually made clinically and thus microscopic evaluation is rare. Cytomegalovirus : Intranuclear owl's eye viral inclusions in ducts and acini. Lacks acute inflammation. Tuberculosis : Usually within an intraparotid or periparotid lymph node. Necrotizing granulomas

D/D •Malnutrition — Sialadenosis, which is a noninflammatory, non-neoplastic enlargement of a salivary gland, typically the parotid. • Associated conditions include anorexia nervosa, bulimia, beriberi, pellagra, diabetes, and alcoholic cirrhosis. • Histologic evaluation reveals acinar hypertrophy without an inflammatory infiltrate It is commonly caused by infections. Non-inflammatory swelling of a salivary glands in known as sialadenosis and is caused by hypertrophy (enlargement) of the acini and ductal atrophy (shrinking). Dryness of the mouth, slurred speech, mouth pain (stomatodynia) and strange tastes in the mouth, usually a bad taste in the mouth (cacogeusia) often.

Acute suppurative sialadenitis. Acute sialadenitis is a bacterial inflammation of the salivary gland. Acute sialadenitis typically affects one major salivary gland, most commonly the parotid 1) and is common in medically debilitated, hospitalized, or postoperative patients. Retrograde bacterial contamination from the oral cavity is thought to be the inciting cause 2) Function of the Esophagus. The function of the esophagus is to transport food and liquid from the pharynx to the stomach. The esophageal stage is the last stage of the swallowing action and although linked to the pharyngeal stage, is under distinct neuronal control. Swallowing is a physiologic phenomenon that occurs many times daily What is albuminuria? Albumin is a type of protein that is normally found in the blood. Your body needs protein. It is an important nutrient that helps build muscle, repair tissue, and fight infection. But it should be in your blood, not your urine. When you have albumin (protein) in your urine, it is called albuminuria or proteinuria Initial imaging using ultrasound guidance (USG) and/or magnetic resonance imaging enables localization of the lesion within the salivary gland and provides information regarding the imaging characteristics, including the contours of the lesion. In addition, imaging assists with surgical planning for larger tumors within the salivary gland 2014 · American College of Veterinary Internal Medicine. The Ann Johnson and Wally Hoffman Resident Teaching Excellence Award. 2008 · College of Veterinary Medicine, University of Illinois at Urbana-Champaign. Dean's List of Excellence Award. 1992 · The Faculty of Agricultural, food and environmental studies, The Hebrew University of.

Sialadenitis - Cleveland Clini

Sialadenitis Genetic and Rare Diseases Information

3: Differential diagnosis by site | Pocket Dentistry

Submandibular Sialadenitis/Sialadenosis Workup: Laboratory

1. Look for swelling of the chin. One of the major signs that a dog might have a salivary mucocele is swelling under the chin. The swelling occurs in the angle of the jaw. In the early stages, the swelling sits to either the left or the right side. The longer the mucocele has been present, the more it spreads and it can be difficult to tell. Technique adjustments routinely utilized by skilled ultrasound practitioners embrace: 1. How to Communicate With the Healthcare Team Patients and caregivers can ease some of their anxieties by establishing open, sincere communication with their healthcare group relating to their prognosis and treatment anxiety 5 4 3-2-1 [url=http. gestational diabetes and what to avoid yeast infection. In The Natural Way to Beat Diabetes, you'll discover how to control your blood sugar naturally with easy lifestyle changes and delicious ways to eat better.You can get the same results but without insulin and without the risk of hypoglycemia and weight gain.. gestational diabetes and what to avoid weight gain ( common. Methods: The Ear Nose and Throat Interest Group at Louisiana State University Health Sciences Center in New Orleans under the supervision of senior author compiled the patient education and instructional video. Summary: Educational video on salivary gland massage is a way to disseminate a resource that can be easily accessed by patients and can.

What is the role of ultrasonography in the diagnosis of

Ultrasound. Sialography. Radionuclide Studies. Diagnostic Sialendoscopy2 Effective for intraductal stones, while. intraglandular, radiolucent or small stones may be missed. Large stones or small CT slices done. Also used for inflammatory disorders. Operator dependent, can detect small stones (>2mm), inexpensive, non-invasive Consists of. Ultrasound can differentiate a benign mixed tumor from a malignant tumor in over 90% of cases. 17 Criteria for malignancy include irregular shape, ill defined and irregular margins, inhomogeneous structure, Sialadenosis or sialosis is a noninflammatory, nonneoplastic, mostly symmetric enlargement of the salivary glands, sometimes associated. Sialadenosis, bilateral noninflammatory enlargement of the parotid gland, is associated with diabetes mellitus. Periodontal bleeding and inflammation, candidiasis, and delayed wound healing also are associated with diabetes mellitus.Tooth erosion can be an oral manifestation of gastroesophageal reflux disease or bulimia

Submandibular calculi and sialadenitis | ImageHead and Neck | 4

Salivary ultrasound standardized diagnostic approach and

Ultrasound of the stomach after water loading revealed an echogenic antral web with an eccentric aperture and distal antral hypertrophy. Subsequent endoscopy The authors investigated the significance of vomiting for hyperamylasemia and sialadenosis in patients with bulimia nervosa. Hyperamylasemia was found in 61% of the bulimics and in 20%. A thorough physical examination is re quired and should include assessment of from MEDICAL 101 at Airlangga Universit

Salivary gland imagingPPT - Chronic Obstructive Sialadenitis & SialendoscopyPPT - Chapter 10 PowerPoint Presentation, free download