Perception of medical students for choice about their career

Background: Career counseling to medical students is vital for future needs of health care system

Objective: To assess the perception of students in choosing the medical profession and their future career planning

Methodology: This cross-sectional study was conducted at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan Pakistan, comprising 152 medical students. The questionnaire included questions on demographic information like age, sex, and year of study, reasons for choosing medical profession, future plans for specialization and choice of career in Pakistan or abroad, and their plans after graduation. SPSS 16 was used for data entry and statistical analysis

Results: Total number of study subjects was 152. Female participants were 62%. Mean age of participants was 22 +/- 2 year.77 [51%] students said they chose the medical profession because their parents wanted them to be doctors; while 50 [33%] chose the career to serve ailing humanity. Regarding specialization, in this study, 13.2% wanted to specialize in Surgery, 14.5% in Medicine, 3% in Public Health, while 24.3% did not want to pursue the medical profession and applied for positions in civil service by appearing in the Central Superior Services [CSS]. While 68%[103] students wanted to pursue the medical profession in Pakistan, the rest preferred to go to the United Kingdom 18.4%, 10% in America and 4% in Australia

Conclusion: Our study showed that most of the medical students selected medical profession due to parental and peer pressure. It was found that one third wanted to leave the country after graduation and one third wanted to leave the profession after graduation. It shows the lack of career counseling at undergraduate level in country

Medicinal plants and management of diabetes mellitus: a review

Diabetes is a metabolic disorder characterized by chronic hyperglycemia and associated with dysfunction and failure of various body organs. Alarming increase in prevalence rate has made this disorder a major health problem globally. The available treatment modalities are not sufficient to combat diabetes and associated complications. A number of medicinal plants have a significant antidiabetic potential against diabetes mellitus. We have listed the use of important medicinal herbs for the treatment and management of diabetes in this review

Comparative study of antioxidant, metal chelating and antiglycation activities oiMomordica charantia flesh and pulp fractions

Momordica charantia is commonly used as a vegetable and folk medicine in most parts of South Asia. This study aims to determine and compare the antioxidant, metal chelating and antiglycation activities of aqueous extracts of M. charantia fruit flesh [MCF] and fruit pulp [MCP] fractions. Our results show that MCP has pronounced DPPH and ABTS radical scavenging potential compared to MCF. In the antiglycation assay both fractions illustrated considerable inhibitory activities against the formation of AGEs induced by glucose with an efficacy of 75 and 67% with 150 microl of MCP and MCF extracts respectively, almost equal to 0.3mM amino guanidine. Results for metal catalysed protein fragmentation and autoxidative and glycoxidation assays demonstrate that MCF and MCP inhibited metal catalysed protein fragmentation. The percentage of relative standard deviation for three replicate measurements of 150 microl of MCF and MCP was

Zuckerkandl tubercle: an important landmark in thyroid surgery

To find out the frequency of Zuckerkandl Tubercle [ZT] and the position of recurrent laryngeal nerve with reference to ZK. Cross-sectional observational study. Surgical Ward-3, Jinnah Postgraduate Medical Centre [JPMC], Karachi, from June 2010 to August 2011. Patients having goiter, aged between 12 - 60 years were admitted through OPD and operated after informed written consent. After admission, they underwent surgery. ZT and recurrent laryngeal nerve position i.e. whether medial, lateral or posterior to ZT was identified during surgery. Data was collected on pre-designed proforma and analysed on SPSS version 15 for descriptive statistics. Out of the 84 patients ZT was found in 52 [61.90%] patients. Nineteen patients had grade-I [less than 0.5 cm], 22 [42.3%] had grade-II [0.5 - 1 cm] and 11 [21.1%] had grade-III [more than 1 cm] ZT. During surgery, 33 [63.4%] patients had recurrent laryngeal nerve medial to ZT, 15 [28.8%] patients had lateral and in 4 [7.6%] patients recurrent laryngeal nerve was engraved posteriorly. Zuckerkandl tubercle was found in about 62% cases; recurrent laryngeal nerve was located pre-dominantly medial to ZT

Quantitative and imlorphometric study of adipose tissue from abdomen in adult women of Hyderabad

To determine adipocytes count per unit area in the superficial subcutaneous layer of the abdomen of an adult woman. Cross sectional study. This study was conducted at Department of Anatomy, Isra University Hospital Hyderabad from July 2011 to December 2011. 80 adult women including 40 obese and 40 non obese for different abdominal surgeries visited in the Isra university hospital Hyderabad. Superficial subcutaneous layer of the abdominal adipose tissue were obtained during surgery. Tissues were processed for routine HandE staining. After processing, the number of adipocytes was counted through ocular grid microscopy method. In obese, the mean number of adipocytes was 119.02 +/- 5.81 with range of 100-140 and in non-obese, the mean number of adipocytes was 79.02 +/- 6.02 with range of 50-98. The result showed a significant [p<0.05] increase number of adipocytes in obese women as compare to non obese women. From this study it was conclude that in obese women there is increased number of adipocytes as compare to non obese women. As increased number of adipocytes enhance the cardiovascular as well as metabolic diseases and producing fatal health risks. Therefore there is need to elaborate the cause of disorder and its proper diagnosis through counting or assessment of adipocytes which helpful for management of diseases

Frequency of chemotherapy induced neutropenia in patients of non hodgkin's lymphoma

The aim of the study is to see the frequency and severity of neutropenia after first or subsequent cycles of chemotherapy in patients of Non Hodgkin's lymphoma [NHL]. Descriptive cross sectional study. This study was carried in the Radiotherpay and Oncology Department, Bolan Medical Complex Hospital, Quetta, from March 2010 to February 2012, Forty two patients of different types of NHL diagnosed on lymph node biopsy presenting for the first time at Radiotherapy and Oncology Department in collaboration with Haematology Section [Pathology Deptt:], Bolan Medical Complex Hospital. Quetta, were included. They were admitted in the ward and evaluated with history, physical examination and for staging investigations. Patients were then planned for chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon [CHOP] and with rituximab [R CHOP]. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data were entered on a designed data sheet. Forty two patients of NHL were included in this study, of which 34 patients received CHOP, and 08 patients R-CHOP, from March, 2010 to February, 2012. According to WHO classification, 24[57.1%] patients were of Diffuse large B-cell lymphoma [DLBCL], 08[19.0%] were follicular lymphoma [FL] and 04[9.5%] patients were Mantle cell lymphoma [MCL] and remaining 06[1430] are other types of NHL's. 2[4.7%] of patients suffered from grage IV neutropenia [absolute neutrophil count of <0.5 x 10[9]7L], 3[7.1%] had grade III Neutropenia [absolute: Neutrophil count of 0.5 x 10[9]L-0.9 x 10[9]/L], 3[71%] had Grade II neutropenia [absolute netrophil count 1.5 x 10[9] /L-1.4 x 10[9]/L] and 5[11.9%] had Grad I neutropenia [absolute netrophil count 1.5 x 10[9]/L-1.900/L]. Other risk factors noted, i.e., cardiac, Liver and Renal comorbidities in 3[7.1%], 5[11.9%] and 4[9.5%] of patients respectively. Overall 30.8% of patients of NHL's suffered from neutropenia of all grades post first cycle of chemotherapy comprising CHOP and R-CHOP

Salt toxicity [sodium intake]: a serious threat to infants and children of Pakistan

Excess sodium intake can lead to hypertension, the primary risk factor for cardiovascular disease. The aim of this study was to investigate the sodium and potassium contents of foodstuff used by infants and children of Pakistan. We analyzed the sodium and potassium contents of infant milk formula [<6 months], follow up milk formula [>6 months], baby food [cereals], biscuits, fruit juices, potato chips [crisps], cheese puffs, roasted cereals [salty], ice cream cones [kulfi] all of which are the processed food extensively used by the children. The amount of sodium and potassium contents in drinking water of few cities of Pakistan were also considered to assess the additional sodium/potassium in the preparation of milk using infant milk formula. Na to K ratio [Na:K] was determined 0.3-1.23, 0.3-1.16, 0.33-0.82, 0.54-2.68, 0.51-0.85, 2.86 and 1.02 for infant milk formula [<6 months], follow up milk formula [>6 months], baby food [cereals], biscuits, fruit juices, potato chips [crisps, cheese puffs, roasted cereals], ice cream cones [kulfi], respectively. The higher sodium content is present than most of the quoted values; whereas lower potassium is present than the recommended values. The higher Na:K ratio indicates the severity of the situation where it is commonly stated that "higher an individual's salt intake, the higher an individual's blood pressure". Present study indicates that nearly all Pakistani children consume substantially more salt than they need which will affect health status in later life

Open lichtenstein repair versus laparoscopic transabdominal preperitoneal repair for inguinal hernia

To compare open Lichtenstein with laparoscopic transabdominal preperitoneal [TAPP] inguinal hernia repair. Randomized controlled trial. Surgical Ward Jinnah Postgraduate Medical Center Karachi, from October 2012 to March 2013. This study was carried out on eighty patients, divided into 2 equal groups of 40 patients each. Group I, was offered Lichtenstein hernia repair and in group II, laparoscopic transabdominal preperitoneal approach was performed. Mean operative time, duration of hospital stay, pain score and infection rate were compared between two groups. All the patients included in this study were males. The mean age of the patients was 44.9 +/- 18.02 year in group I and 38.9 +/- 18.21 year in group II. Operative time and hospital stay were statistically insignificant but pain and wound infection had significant differences. The mean VAS score was found higher in group I than group II [p value 0.0048]. It was 6 +/- 1.89 in group I and 3.6 +/- 1.35 in group II. There were three cases [7.5%] of wound infection in group I whereas in group II there were no case of wound infection [p=0.0405]. The laparoscopic hernia repair is a preferable procedure. It has less postoperative pain and less wound infection

Incidence of malignant lymphomas in balochistan

Traditionally lymphomas are classified into Hodgkin's disease [HD] and Non Hodgkin's lymphoma [NHL] depending upon histo-pathological evidence on biopsy taken from an enlarged lymph node. Delayed diagnosis in lymphoma deteriorates the health eminence resulting in poor outcome. The aim of the study is to estimate the incidence and clinical presentation of malignant lymphomas in Balochistan. Prospective Study. This study was carried in the Department of Radiotherapy and Oncology, Bolan Medical Complex Hospital, Quetta from June, 2006 to May, 2012. A total of 263 newly diagnosed patients of both types of lymphoma from different parts of Balochistan were registered in Bolan Medical Complex Hospital in Department of Radiotherapy and Oncology. Followed by histopathology, WHO classification and Ann Arbor staging was done to assign subtype and extent of disease. It was found that the incidence of Non Hodgkin's lymphoma a [64.7%] was greater than Hodgkin's disease [35.2%] and both present bimodal distribution in age. Male patients dominate female patients in both cases [2.5:1]. Lymph-adenopathy of cervical region was primary site in 44 % of cases while 27.6 % were extra nodal. Histopathology shows 57.4 % mixed cellularity variant in Hodgkin's lymphoma and 25.5% diffuse B cell pattern in Non Hodgkin's lymphoma. Ann Arbor staging reveals that 3.4% cases present with stage I and 64.5% show stage IV. To conclude Non Hodgkin's lymphoma is two times more frequent than Hodgkin's lymphoma with greater male contribution. Due to delayed diagnosis resulted in late stage presentation ,health awareness is needed for physicians and general population for availability of patients at a due time for management

Informed consent from uninformed patients: a dilemma

To assess the amount of information provided pre-operatively by the doctors/nurses to the patients undergoing surgery and to relate understanding of this information with the educational status of the patient and their anxiety levels. Descriptive study. Surgical Units of Jinnah Postgraduate Medical Centre, Karachi, From November 2012 to April 2013. A set of standardized questions were asked relating to patient's knowledge about the informed consent process, their education level and its impact on the understanding of informed consent as well as the impact of language of the consent form on the patient's interpretation of the information provided. Out of 291 patients, 168[58.1%] patients signed the consent form themselves. Two hundred eight two [96.9%] patients were aware of the type of surgery they had to undergo. Two hundred and nine [71%] patients knew that it was their legal right to have their consent taken by the doctor before any surgery. Fifty six patients understood the consent form completely. Out of 56 patients who understood the consent form, 39 individuals had an education level of at or above matriculation. Thirty three consents were taken by operating surgeon or residents that significantly decreased the anxiety level. Most of the patients were aware of the importance of consent process as their legal right. High education level improved the understanding of the process

Ibuprofen versus acetaminophen premedication on success of inferior alveolar nerve block in irreversible pulpitis

To compare impact of ibuprofen and acetaminophen premedication on the efficacy of inferior alveolar nerve block in irreversible pulpitis. Randomized controlled trial. Operative Department, AFID Rawalpindi from 18 September 2007 to 17 September 2008. Three hundred and sixty patients with irreversible pulpitis were divided into two groups. At base line patients pain was recorded. Ibuprofen was given to patients in group A and acetaminophen to group B patients. Patients were given drugs in tablet form. After 30 minutes cold test with ethyl chloride was done and patient pain was recorded on visual analogue scale. Inferior alveolar nerve block was administered. Forty five minutes from base line cold test was performed and pain was recorded. Access to the endodontic cavity with round bur in high speed handpiece was made and patient response was noted. Inferior alveolar nerve block was successful if patient had no pain to cold test at 45 minutes and on access to cavity preparation. Data was analyzed by SPSS version 12. There was no statistically significant difference between ibuprofen and acetaminophen on success rate of inferior alveolar nerve block in patient with irreversible pulpitis. Ibuprofen and acetaminophen premedication has similar efficacy on success of inferior alveolar nerve block in patients with irreversible pulpitis.

Influence of size of tympanic membrane perforation on outcome of myringoplasty

The objective of this study was to determine the influence of size of central tympanic membrane perforation on outcome ofmyringoplasty. Descriptive-Interventional Study. ENT Department PNS SHIFA Karachi. The study was completed in seventeen months from 22nd August 2009 to 22nd Jan 2010. The study consists of 60 cases. Non-Probability Convenience Sampling. After obtaining informed consent sixty patients undergoing myringoplasty at PNS SHIFA Karachi during the study period fitting the inclusion criteria were selected. Patients were examined and the size of tympanic membrane perforation was recorded. Perforation up to two quadrents was labeled as small perforation, three quadrents as large perforation and four quadrents labeled as subtotal perforation. The patients were managed by myringoplasty using Endaural incision with underlay technique to place the graft harvested from Temporalis fascia under General Anesthesia. All surgeries were performed by second author [senior consultant surgeon]. After undergoing myringoplasty patients were followed in ENT OPD on 2nd week to check the status of ear after removal of BIPP and eight weekly interval to check complete healing of graft for final result.:After 8wks 100% [n=20] patients with small perforation, 85% [n=17] with large perforation and 60% [n=12] with subtotal perforation had perfect healing and graft was intact. Smaller perforations have a greater chance of healing after surgery

Efficacy of gluma desensitizer[TM] and duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions

The objective of this study was to compare the efficacy of Gluma Desensitizer[TM] and Duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions by a randomized control trial. 196 patients having hypersensitive non-carious cervical lesions were divided into two groups. Gluma Desensitizer[TM] was applied to patients in Group A and Duraphat[TM] to patients ingroup B. Patient's pain response to compressed air was recorded on the visual analogue scale at baseline, 5 minutes, 7 days and 30 days after treatment. Data were analyzed using SPSS version 12. Comparison of sensitivity between the two treatment groups on application of compressed air showed a statistically significant difference. The results of this study showed that Gluma Desensitizer[TM] showed better results in relieving dentinal hypersensitivity than Duraphat[TM] in non-carious cervical lesions

Single incision laparoscopic cholecystectomy [SILS]

Single incision laparoscopic surgery is a rapidly emerging technique worldwide. The primary goal of the surgery is invisible scar. The objective of this study was to share our initial experience with the rest of world. From October 2009 to April 2010, single port surgery was offered to 30 patients of symptomatic gallstones. The data collected prospectively included age, sex, operative time, complications, pain and reason for conversion. Thirty SILS cholecystectomies were attempted and 27 were completed successfully. The mean operative time was 80 minutes [ranges 50-180min].Three patients needed further ports to complete the operation. All patients were discharged on 2[nd] postoperative day except one who had severe abdominal pain. This patient was discharged on 6[th] postoperative day. Two patients had mild umbilical wound infection, one patient was readmitted for pain management. SILS Cholecystectomy is a safe, feasible and without visible scar surgery in the hands of trained laparoscopic surgeons but needs more studies before it is recommended

Sensitivity and specificity of bi-rads scoring system in carcinoma of breast

To find out the sensitivity and specificity of mammogram according to BI-RADS scoring, in correlation with pathological findings so as to develop protocol for biopsy in patients presenting with clinically palpable breast lump or nipple discharge. Cross sectional study. Jinnah Postgraduate Medical Centre, Surgical unit 1 [Ward 3] Karachi, from July 2007 to June 2008. Female patients who presented with clinically palpable breast lumps or nipple discharge in general surgical OPD were examined and referred for mammography. Ultrasound examination was also done where considered necessary. The final diagnosis regarding the lump or nipple discharge as shown in the mammography was made and patients sent for biopsy [FNAC/ Trucut/ excision biopsy]. The mammographic diagnosis was compared with the histopathological report. Fifty patients were examined of whom 47 clinically suspected patients had confirmation of diagnosis on biopsy while 3 were found negative. Forty one suspected cases on BI-RADS mammogram were true positive that revealed 87.2% sensitivity of BI-RADS mammogram while 6 cases were false negative. All three cases of negative on biopsy were true negative that revealed hundred percent specificity. In this way positive predictive value was also hundred percent with negative predictive value of 33.3%. Overall diagnostic accuracy of mammogram was 88% when compared with histopathological diagnosis. Mammography can be used as an important diagnostic tool for the diagnosis of breast diseases and where there is doubt, diagnosis should be made by means of triple assessment i.e. clinical examination, mammography, and histopathology

Carcinoma thyroid in multi and uninodular goiter

To determine the frequency and profile of carcinoma in multi-nodular goiter and solitary thyroid nodule. Case series. Surgical Unit-I, Ward-3 of Jinnah Postgraduate Medical Center, Karachi, from January 1999 to January 2009. Cases with solitary thyroid nodules and multi-nodular goiter were included. Patients under 12 years of age, cystic benign lesion in solitary thyroid nodules or those multi-nodular goiters, which were not causing pressure symptoms, cosmetic problems or sign of malignancy were excluded. In solitary thyroid nodule, hemithyroidectomy was done and if histopathology examination revealed carcinoma thyroid then completion thyroidectomyw as done. In multi-nodular goiter sub-total thyroidectomy done. Results were described as frequency percentages and mean. Out of 379 patients of multi-nodular goiter only one patient was found to be papillary carcinoma [0.25%]. In 220 patients of solitary thyroid nodules, 93 patients were diagnosed as carcinoma of thyroid [42.27%]. Others diagnosed in solitary thyrid nodule were thyroid adenoma, colloid goiter, thyroiditis and multi-nodular goiter. The frequency of papillary carcinoma in 65.95% occurring females of 12-30 years of age and being multifocal in 6.45% follicular carcinoma in 23.49%, medullary carcinoma in 7.44%, analplastic carcinoma in 2.12% and lymphoma in 1.01%. Female were predominantly involved and papillary carcinoma was common in 12-30 years of age [7.63%] and follicular was common in 30-40 years of age [68.18%. 6.45% of papillary carcinoma was found to be multifocal in nature. Frequency of carcinoma of thyroid is very high in solitary thyroid nodule [42.27%], but markedly low in multi-nodular goiter. Papillary carcinoma is the most common variety, most of in younger female

Diagnostic accuracy of fine needle aspiration of thyroid nodule verses biopsy in thyroid lesions

FNA biopsy of thyroid is a rapid, minimally invasive, and cost effective first line procedure in the evaluation of thyroid nodule. This study was conducted to evaluate the cytological accuracy, sensitivity and specificity of fine needle aspiration [FNA] of solitary thyroid nodules in correlation with post-surgical histological findings. This retrospective study was carried out at Department of Pathology, Abbottabad International Medical College, Abbottabad from January 2009 to December 2010. A total of 81 patients with clinically palpable solitary thyroid nodule were included in the study. Thyroid function tests were initially performed followed by FNA of thyroid nodules later operated and histopathological examination was conducted on the excised nodules. FNA diagnoses were correlated with the histological findings. The accuracy, sensitivity and specificity of the procedure were determined. Out of 81 cases, 5 [6.2%] were unsatisfactory and 76 cases were satisfactory for cytological evaluation. Cytohistopathological correlation was carried out for these cases. The study showed a diagnostic accuracy of 93% with sensitivity and specificity rates of 75% and 96% respectively. Positive predictive value is 81% and negative predictive value is 95%. Fine needle aspiration [FNA] has evolved as an accurate and sensitive diagnostic tool for the initial screening of patients with thyroid nodules, and has reduced the need for unnecessary surgery

Value of total leucocyte count and C-reactive proteins in the diagnosis of acute appendicitis

To find out the predictive value of total leucocytes count and C-reactive proteins [CRP] in the diagnosis of acute appendicitis. Cross sectional study. Surgical unit 1, Department of Surgery, Jinnah Postgraduate Medical Center Karachi, from November 2006 to April 2007. A total of 50 patients attending emergency department with provisional diagnosis of acute appendicitis were included. All patients were evaluated by clinical features and their total leucocytes count and C-reactive protein levels were checked and compared with histopathological report which is gold standard for the diagnosis of acute appendicitis. Positive predictive value of total leucocyte count was 90.6% and negative predictive value was 44.4% with accuracy of diagnosis of 74%. Positive predictive value of C-reactive protein was 97.1% and negative predictive value was 62.5% with accuracy of diagnosis of 86%. The diagnosis of acute appendicitis can be made confidently with excellent history and proper examination. Total leucocyte count and C-reactive protein levels estimation can be helpful in the diagnosis of doubtful cases of right iliac fossa pain. When measured together it increases their diagnostic value

Frequency of chronic suppurative otitis media in the junior ranks of Pakistan Army

The purpose of this study were to find out the frequency of chronic suppurative otitis media [CSOM] in the junior ranks of army, and to find out the number of such patients serving in low medical category due to CSOM. It was a simple multi-centre descriptive study. This study was conducted in ENT department of Combined Military Hospital Lahore from March 2003 to August 2003. Feedback was also taken from CMH Abbottabad and HIT Hospital Wah during this period. A total of 5000 junior ranks were examined for CSOM. Out of these 56 [1.12%] were suffering from inactive mucosal disease. Seventy nine [1.58%] had active mucosal disease. Attico antral disease was present in 33 [0.66%] subjects and out of these 8 [0.16%] subjects had undergone mastoid exploration in the past. Ninety [1.8%] cases were serving in low medical category due to CSOM. The frequency of CSOM is significantly high in the army [03.36%], considering that all inductions are made after initial medical examination. By observing few precautions the frequency may be reduced, thus decreasing the financial drain on national exchequer

Laterality of pleomorphic adenoma of parotid gland

Although pleomorphic adenoma is the commonest benign tumor of both major and minor salivary glands, yet it bears certain peculiar characters like invariable growth rate, short spells of spurts of growth, long quiescent periods, invasion of surrounding tissues by its capsular projections, recurrence, notorious for implantation and classic origin from the tail of parotid gland. Since the nerve of facial expression [facial nerve] falls within the domain of otolaryngologists but its course along with its variable branches through the parotid gland has always remained an area of common interest between general and ENT surgeons. With the more and more involvement of E.N.T. surgeons in head and neck oncology, the cancer of salivary glands looks to be being taken over by them in recent decades. FNAC inspite of its accuracy is loosing its superiority over modern ultrasonography. This is an observational study. This study was carried out in Combined Military Hospital Lahore from Feb 2005 to Feb 2008. A total of 28 patients with unilateral mass of parotid gland, all with FNAC [Fine needle aspiration cytology] positive for pleomorphic adenoma were included in the study without any discrimination of age, sex or size of tumor. Each patient underwent CT scan and surgical modality of treatment was selected for every patient with post-operative histopathology study to confirm or otherwise of FNAC diagnosis. Female male ratio was 3:4, mean age in males was 44, in females was 37. Histopathology-disproved FNAC in 7.14%. Ratio between involvement of superficial lobe and both lobes was 13:1. Post-operative transient facial nerve paresis was seen in 12 out of 28 patients and there was surprising laterality of right parotid involvement, ratio between right and left parotid being 11:3. Smallest tumor at presentation was 3x3 centimeter and largest was 14x10 centimeter in size. Markedly more incidence of pleomorphic adenoma on right side of face is observed. It has not been reported previously. Zero percent facial nerve severance in 28 parotidectomies reflects vigilance and surgical skill of today's otorhinolaryngologists