Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of epithelial origin. It is an unusual type of tumor and varies in its aggressiveness from a low grade to a high grade rapidly growing tumor. Low-grade mucoepidermoid carcinoma at times misleads the clinician because of its atypical location and innocent appearance. Immunohistochemical studies prove indispensable in identifying such a tumor as routine histopathology may be inconclusive.

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Background : Anencephaly is a lethal neural tube defect which is due to the defective closure of rostral pore of neural tube. In more than 50% of cases it is associated with other systemic anomalies. Hence this study was undertaken to assess pathological parameters associated with anencephaly in particular attention to associated systemic anomalies. Materials and Methods: It is a study on 41 anencephaly fetuses conducted in the Department of Pathology. The period of study is from January 2001 to December 2011. Results: Out of 41 cases, 30 (73%) cases showed presence of systemic anomalies, 48.5% of the cases were observed in primigravida. Most common associated anomaly was spina bifida followed by gastrointestinal anomalies. Conclusion: Pathological examination of the abortus is essential to document the associated anomalies.

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Giant cell tumor (osteoclastoma) of pelvis is rare entity. Most of these have average size of 9.5cm. We here present a massive osteoclastoma involving pubis and periacetabular region to such an extent that surgical excision could not be done. Our surgical intervention was aimed to correct the associated deformity and improve function by debulking the part of tumor responsible for mechanical symptoms and deformity.

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The primary role of fine needle aspiration (FNA) of the breast is the distinction between benign and malignant lesions; but in many cases, additional information may be obtained. The major breast lesions that yield papillary fragments on FNA are papillary carcinoma, papilloma, fibroadenoma, and invasive ductal carcinoma that have a papillary component. We present cytomorphological features of nipple discharge and FNA of breast lump in a 32-year female.

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Introduction and Objectives: The brachial plexus is highly variable, in its formation and branching pattern thus, knowledge of its anatomical patterns, may be insufficient for the surgeon operating on or around these nerves or for the regional anesthesiologist working in this area. Therefore, the present study was an attempt to study further about variations of brachial plexus encountered during routine dissection classes. Materials and Methods: The present descriptive study was carried out by dissection of 60 upper limbs of 30 cadavers, in the age group of 18 to 85 years, obtained during a study period of 2 years from the Department of Anatomy. The plexus was studied in its entire course commencing from the formation in cervical region, course through root of the neck and axilla, up to the main terminal branches of the upper extremity. During the dissection, variations of brachial plexus pertaining to its formation from the roots, trunks, divisions and cords and the branching pattern were observed and data was collected. Results: Out of the 60 cadaveric upper limbs studied for the anatomical variations of the brachial plexus, 2 limbs (3.33%) were pre-fixed plexuses. Fusion of adjacent trunks was detected in 2 limbs (3.33%). Variations in branches of lateral cord were detected in 8 limbs (13.33%). Among Posterior cord variations 2-thoracodorsal nerves were detected in 2 limbs (3.33%). All the other branches from brachial plexus had been found to have no anatomical variations. Conclusion: In the present study, an attempt has been made to know the possible variations of the brachial plexus. Though the variations mentioned may not alter the normal functioning of the limb of the individual, but knowledge of the variations is of prime importance to be kept in mind, during anaesthetic and surgical procedures.

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Aims and Objectives: To determine the frequency of complications and pain scores post-operatively following TAPP (Transabdominal Pre-peritoneal)repair for inguinal hernia, comparing lightweight polypropylene versus the composite polypropylene mesh. Materials and Methods: This study was conducted at Lady Reading Hospital, Peshawar, from December 1, 2007, to November 30, 2011. Group A included all those patients with inguinal hernia that were operated using the TAPP method and extraperitoneal placement of the lightweight polypropylene mesh, whereas group B comprised of those patients that were placed a composite polypropylene mesh (VYPRO II ^R ). A pro forma was prepared to record all the relevant data such as the NYHUS classification of the type of hernia, the post-operative pain scale score, and the complications that included seroma formation, testicular pain and atrophy, preoperative injuries, surgical emphysema, adhesion obstruction, mesh infection, wound infection, and perioperative mortality. The planned sequence of follow-up after discharge of the patient was at 1 week, 1month, 3 months, 6 months, and one year. Data were analyzed using SPSS ^R for Windows version 13.0. Results: A total of 192 patients were operated, equally divided between both groups. The VYPRO II ^R group had a higher number of direct hernias and the operative time was also much less but this was not statistically significant (P=0.91). The mean hospital stay was slightly higher in the polypropylene group but that was also not significant (P=0.89). The frequency of seroma formation was higher in the polypropylene group (6.25%) and majority of these patients from both groups had larger scrotal hernias (P=0.34). The most significant finding in this study was the frequency of chronic pain with a visual analogue score of >3(1-10) after the six-month period was significantly higher in the polypropylene group (P=0.02). The recurrence rate was comparable in both groups with 3 patients in group B(P=0.62). Conclusions: No difference in the frequency of recurrence was observed over a one-year follow-up period but significant pain scores were observed in the polypropylene group. Studies with longer follow-up to rule the rate of recurrence in composite meshes will determine its benefit over the lightweight polypropylene meshes.

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Objectives: The present study was undertaken to assess the antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from healthcare associated infections at a tertiary care hospital. Due to significant changes in microbial genetic ecology, as a result of indiscriminate use of anti-microbials, the spread of anti-microbial resistance is now a global problem. Materials and Methods: A total of 290 Pseudomonas aeruginosa isolates from various clinical samples like urinary catheters, tips of endotracheal tube, and central venous catheter were tested for antibiotic sensitivity pattern using disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. Results: The highest number of Pseudomonas infections was found in urinary catheters, followed by endotracheal tips and central venous catheters. Maximum resistance was seen to cefotaxime and gentamycin (40%) followed by ciprofloxacin (39%), amikacin (26%), cefoperazone- sulbactum (22%), piperacillin-tazobactum (16%), and imipenem (14%). Conclusion: Over all we have observed that there is increased antibiotic resistance which may be due to the selective pressure from the use of anti-microbial agents is a major determinant for the emergence of resistance strains. Antimicrobial surveillance should be done periodically to monitor the current susceptibility patterns in local hospitals.

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The term schizophrenia was coined by Eugene Bleuler. Symptoms of schizophrenia are arranged into groups or clusters called as domains. The domains of dysfunctions are positive symptoms, negative symptoms, cognitive impairments, mood and suicidity, and aggression. Cognition is the sum total of mental processes that makes us acquire knowledge and keeps us aware of our surroundings and thus enables us to arrive at appropriate judgments. Cognitive deficits are recognized as enduring and persistent features in schizophrenia and can be neuro-cognitive or relating to social cognition. Neurocognitive deficits are deficits in speed of processing, attention / vigilance, working memory, verbal memory, visual memory, reasoning and problem solving, social cognition. Cognitive function can be assessed by various methods like experimental approach, neuropsychological and psychometric and ecologic approach. Cognitive deficits are present at onset of illness producing substantial impairment. Unlike psychotic symptoms, which remit with treatment, functional impairments remain stable over time. Detail understanding of such symptoms will help in disability limitation. Various cognitive remediation programmes are underway with such intent. Articles till March, 2012 were searched through PubMed and Google Scholar, which were studied in an attempt of understanding the topic. The information was structured and organized.

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Dental traumatic injuries are widespread in the population and are a frequent pathology among children and teenagers. Fiber-reinforced composite (FRC) bonded fixed dental prothesis have been used as an alternative to conventional metal-based or zirconia-based fixed restorations especially among young patients. As well as the bonding system, mechanical adaptation and the retention of the fiber frame and the grooves of the pontic are fundamental for the success of this type of adhesive restoration. The esthetic solution was the building of a biologic restoration using reinforced polyethylene fibers as an interim restoration for this case.

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"Late preterms may be apparently normal but a vulnerable group of preterm infants needing due attention both by the Obstetricians and Pediatricians. Late preterms like any other preterms are vulnerable to complications such as Respiratory Distress Syndrome (RDS) and other complications seen in a preterm infant. The American Congress of Obstetricians and Gynecologists guidelines recommend administration of antenatal corticosteroids in a mother in premature labor only up to the gestational age of 34 weeks. This is a case report of a preterm baby with a gestational age of 35 weeks which presented with RDS. We are hereby reporting this case to draw attention of the Obstetricians and Pediatricians toward this entity of 'Late Preterm' to provide better care to them and obtain better outcomes."

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Acquired Pure Red Cell Aplasia (PRCA) is a rare occurrence in children.This is a case of an eight year old girl child who developed acquired PRCA secondary to long term intake of sodium Valproate. This case is reported to review the causes of PRCA in children and to reconsider the use of drugs of longer duration in children and adults.

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A 12 year old girl child from the department of Ophthalmology posted for right eye limbal dermoid excision. Opthlamic examination and history revealed bilateral restricted eye movements, limbal dermoids, and decreased vision since birth. Fundus examination showed pathological myopia. There were multiple preauricular appendages in front of both ears. The lateral X-ray of cervical spine showed fused second and third cervical vertebra with loss of intervertebral disc space. Chest X-ray showed scoliosis of Cervico-Thorasic vertebra with convexity to right. Clinical examination of the airway revealed restricted head and neck movements with Mallampatti class II which indicates difficult intubation. The history, clinical examination and radiological findings confirmed her to be a case of Goldenhar syndrome. Difficult airway continues to be a major cause of anaesthesia related complications. Therefore fibre optic intubation under regional nerve block and sedation was planned for the surgery. Lack of associated cardiac and neurological anomalies encouraged us to present the advantage of fibre optic intubation. The larynx was adequately relaxed because of regional nerve block which helped us by decreasing the number of attempt of scopy and vocal cords injury. The intraoperative and postoperative period was uneventful.

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