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  Most popular articles (Since September 05, 2017)

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An uncommon knee pain: Ganglion cyst in the gastrocnemius medialis
Sandesh Madi, Vivek Pandey, Naufal Nahas, Kiran Acharya
January-March 2018, 15(1):26-28
A large symptomatic ganglion cyst occurring in the gastrocnemius has been infrequently described in the literature. Clinical presentation and management of such a symptomatic ganglion are briefly outlined here. This is perhaps the first case that describes the surgical management of symptomatic ganglion and associated internal derangement of the knee with favorable outcomes.
  3,670 145 -
Recurrent aphthous ulcers — Still a challenging clinical entity
Santosh Kumar Swain, Sanjeev Gupta, Mahesh Chandra Sahu
October-December 2017, 14(4):202-206
Recurrent aphthous ulcer (RAU) is a clinical condition characterized by painful ulcer with different size affecting the mucosa of the oral cavity. Its etiology and pathogenesis are not clearly known and the diagnosis is based on the clinical picture. These lesions may be classified into minor, major, and herpetiformis. The aphthous ulcers in the oral cavity affect speech and feeding, leading to poor quality of life. Relevant literature was searched from PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and Scopus last 20 years using the keywords “RAU.” The RAU is a common clinical entity. The diagnosis of RAU is mainly based on clinical ground and must be differentiated from other causes of oral ulceration. The treatment is often unsatisfactory as topical application of corticosteroids and other treatment modalities minimizes the severity of the ulceration but not stop chance of recurrence.
  2,491 202 -
Stroke chameleons: Uncommon presentations of a common disease
Pushpendra Nath Renjen, Dinesh Chaudhari
July-September 2017, 14(3):148-149
Stroke is one of the major causes of death and morbidity worldwide and carries an important economic impact. The diagnosis is still a clinical one, supported by brain imaging. However, up to 30% of suspected stroke presentations have a different diagnosis. In these cases, two scenarios must be considered: a false positive diagnosis, or “stroke mimic”, and a false negative or “stroke chameleon”. The diagnosis of acute ischemic stroke is often straightforward. The sudden onset of a focal neurologic deficit in a recognizable vascular distribution with a common presentation - such as hemiparesis, facial weakness and aphasia - identifies a common syndrome of acute stroke. But differential diagnostic problems remain because there are several subtypes of stroke and also because some non-vascular disorders may have clinical pictures that appear identical to strokes. Acute ischemic stroke (AIS) with neurological deficit is a very debilitating condition, especially in younger patients and the rate of false positive diagnosis of ischemic stroke labeled ''stroke mimics'' ranges from 1.3% to 25%.
  2,144 237 -
Factors influencing outcome in head injury patients with glasgow coma scale <8
Kodeeswaran Marappan, M Prabhu, Balasubramani K, Sherina Paul Raj
October-December 2017, 14(4):207-211
Background: Over the years in the emergency department, it has been generally observed that the overall outcome in severe head injury patients is very poor. Hence, a study was conducted in traumatic brain injury patients with a Glasgow Coma Scale (GCS) <8, in which various factors that affect outcome in severe head injury patients were analyzed. Objective: The objective of the study was to understand the various factors influencing outcome in patients with severe head injury (GCS ≤8). Subjects and Methods: This was a prospective study, conducted on 350 consecutive acute severe head injury patients with a GCS ≤8. Thirteen independent factors expected to affect prognosis of severe head injury patients were analyzed and studied. Multivariate analysis was used to include adjustment for prognostic variables. Positive predictive value and strong association of the data were analyzed using cumulative percentage, Chi-square test, and cross-tabulation. Results: From the study, it was observed that male population, older age group patients, low GCS on arrival, train accidents, increased time interval, poor motor response, sluggish or absent pupillary reaction to light, absence of dolls eye movement, presence of comorbidities and other severe traumatic injury of major organs, poor glycemic status, and altered coagulation profile were associated with poor outcome in patients. Conclusions: A keen evaluation of patient profile before taking definitive management decisions is recommended, so as to improve the outcome in severe head injury patients. This is because, there are certain factors such as glycemic statuses of the patient, hemoglobin level, and coagulation profile that are modifiable, and if identified and corrected early, could improve the prognosis of the patients to a large extent.
  1,617 153 -
Neurological benefits of mindfulness meditation
Pushpendra Nath Renjen, Dinesh Mohan Chaudhari
October-December 2017, 14(4):198-201
Meditation can be defined as a form of mental training that aims to improve an individual's core psychological capacities, such as attentional and emotional self-regulation. Research on the biological concomitants of meditation practice is sparse and has mostly focused on changes that occur during meditation compared with a resting control condition in a single experimental session. Over 2000 scientific publications on the term “meditation” have been published till date, mainly in the scientific fields such of psychology and neuroscience. If supported by rigorous research studies, the practice of mindfulness meditation might be promising for the treatment of clinical disorders and might facilitate the cultivation of a healthy mind and increased well-being.
  1,521 207 -
Steroid therapy in swine flu: Beneficial or harmful
Krittibus Samui
January-March 2018, 15(1):2-5
H1N1 influenza virus is responsible for respiratory illness that may range from mild symptoms of common cold to severe disease on presentation that needs hospitalization and management in intensive care. Corticosteroids are used to treat disease of immunity, inflammation or salt, and water balance. Here, the role of corticosteroid in swine flu is reviewed in various literatures. It is found that result of corticosteroid use in the management of swine flu patients is unsatisfactory. Instead of benefit, it is potentially harmful. It causes to develop higher duration of hospital stay, prolonged mechanical ventilation and ultimately increased mortality.
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Pediatric humeral fracture fixed by a single retrograde titanium elastic nail
Kapil Mani K C, Parimal Acharya, Bandhu Ram Pangeni, Suman Babu Marahatta
October-December 2017, 14(4):212-217
Introduction: Almost all pediatric humerus fractures are well managed with conservative treatment with higher percentage of union rate. However there are certain conditions where surgical intervention will be inevitable like humerus fracture associated with polytrauma compound fractures, those with head and unacceptable alignment. It is not only the stable fixation but also the alignment which is important and can be maintained even by a single pre-bent elastic or flexible intramedullary nailing. Methods: This was a retrospective study of 28 pediatric humeral fractures fixed with a single retrograde titanium elastic nail from 2012 to 2016. Time to unite the fracture along with other complications was noted. The functional outcomes were assessed according to Broberg and Morrey for elbow function and Disabilities of the Arm, Shoulder and Hand (DASH) score for shoulder function. Results: Average age of patients was 8.85 1.84 (range 6 to 12 years). Time to unite the fracture was 8.28 2.43 weeks (range 6 to 12 weeks). There were 1 case of malunion around 10 degrees, 1 case of nail migration, one case of superficial infection at the site of nail entry, one case of transient radial nerve palsy and one case of nail protrusion in our study. There were 24 (85.71%) cases of excellent and 4 (14.29%) cases of good results according to Broberg and Morrey functional scores. Conclusion: Fixation of pediatric humerus fractures with a single flexible nail reduces operative time, radiation exposure, cost of treatment, chances of iatrogenic supracondylar fracture and ulnar nerve injury without compromising the final outcomes.
  1,411 119 -
Effect of risk factors on grades of gastroesophageal reflux disease
Batool Mutar Mahdi, Riyadh Mohamad Hasan, Wafaa Hazim
July-September 2017, 14(3):154-159
Background: There are many risk factors associated with degree of development erosive esophagitis and its complications. Aim of the Study: To evaluate the effect of risk factors on severity of esophagitis and identify the most important risk factors among patients presenting to gastroscopy unit. Patients and Methods: Patients with upper gastrointestinal tract (GIT) symptoms were enrolled in gastroscope examination. For each participant, the body mass index (BMI), waist circumference, and immunoglobulin G Helicobacter pylori were done. Results: A total of 195 patients with upper GIT symptoms were examined by gastroscope. One hundred and twenty patients had erosive esophagitis (Grade II and III) (Group A): 75 of them were men (62.5%) and 45 (37.5%) were women. The rest 75 had gastroesophageal reflux disease Grade I (Group B), 52% of them were males, and the rest were females. Group A patients were more likely to be non-steroidal anti-inflammatory (NSAID) users (42.5%) than Group B (P = 0.0002). Group A was more likely to be obese (body mass index >30) (37.5%) (P = 0.015). Men have waist circumference >102 cm and women have a waist circumference >88 cm constitute 92.5% (P = 0.0001) of Group A. Patient with Group A who had hiatus hernia (HH) were (20%) (P = 0.0001) and those with H. pylori (35%) (P = 0.001). Conclusions: Obesity, abdominal obesity, NSAID, HH, and H. pylori infection are strong risk factors for gastroesophageal reflux grades.
  1,354 126 -
Vanishing bone disease of the face: A rare case of massive osteolysis
Santosh Kumar Swain, Manash Ranjan Baisakh, Chaubarg Nayak, Mahesh Chandra Sahu
October-December 2017, 14(4):218-220
Vanishing bone disease (VBD) is an uncommon clinical entity with unknown etiology. This disease affects individual irrespective of age or sex. It can affect any bone of the body including the mandibular region of the face. The osseous tissue is progressively replaced by angiomatic tissue and finally by fibrous tissue. It is usually seen in the second and third decades of the life. It is often difficult to diagnose and the treatment is controversial. Here, we report a case of aggressive VBD in the mandibular region which was treated with radiotherapy and zoledronic acid. Because of its rarity, we described this clinical scenario affecting cosmesis of the patient with pain in face-and-neck area.
  1,382 88 -
Nasal myiasis in clinical practice
Santosh Kumar Swain, Mahesh Chandra Sahu, Manash Ranjan Baisakh,
July-September 2018, 15(3):128-131
Nasal myiasis is an opportunistic parasitic infestation of human as well as animals. Infestation of the nasal cavity by dipterous larvae is called nasal myiasis which is commonly seen in developing countries where health and sanitation are poor. Different predisposing factors associated with nasal myiasis are atrophic rhinitis, diabetes with purulent nasal discharge, midline granulomatous lesions or malignancy, and poorly nourished patients with poor hygiene. Other possible predisposing factors causing nasal myiasis include neglected children, mental retardation, and elderly age. Nasal endoscopy is a better method for removal of maggots under direct vision. Nasal endoscopic method is a better technique for the removal of maggots than conventional manual method. The maggots which are often located in deep and inaccessible areas are easily identified and removed.
  1,158 106 -
Frequency of alopecia areata in patients with autoimmune thyroid diseases
Aynure Oztekin, Ahmet Metin, Saliha Can Kirbas, Coskun Öztekin
July-September 2017, 14(3):165-170
Background: Alopecia areata (AA) is higher in patients with thyroid dysfunctions such as Hashimoto's thyroiditis and Graves' disease than in general population. Our aim was to assess AA frequency in patients with thyroid diseases. Materials and Methods: This prospective study included 550 patients with autoimmune thyroid disease (AITD), 126 patients with non-AITD (NAITD), and 100 healthy subjects. Results: Twenty-eight (4.1%) patients were diagnosed with AA based on either medical history or physical examination (P = 0.039). AA was not determined in healthy subjects. The rate of AA was higher among the patients with NAITD than those with AITD (5.6% vs. 3.8%; P = 0.075). Among the AITD patients, 5 (23.8%) patients were diagnosed with AA after being diagnosed with thyroid disease, whereas 15 (71.4%) patients were diagnosed with AA before being diagnosed with thyroid disease. The mean ages at the diagnosis of AITD and at the onset of AA were 36.6 ± 10.8 years and 30.3 ± 13.0 years, respectively. Among the NAITD patients, the mean ages at the onset of thyroid disease and at the onset of AA were 45.3 ± 9.3 years and 37.3 ± 13.3 years, respectively. Other autoimmune-based diseases such as vitiligo, chronic urticaria, and type 1 diabetes were also detected. The patchy pattern of AA was the most common type (n = 27). Conclusions: The frequency of AA was higher in patients with NAITD and AITD compared to the healthy population. Clinicians should be aware of these findings, and accordingly, it would be suitable for them to screen AA patients for thyroid diseases.
  1,156 103 -
Mitral valve prolapse
Nekkanti Venkat Rayudu
January-March 2018, 15(1):11-14
Mitral valve prolapse, Click murmurs syndrome, Barlow's syndrome is one of the common cause of mitral valve disease with or without mitral regurgitation. Barlow gave full clinical description of the disorder in 1963. It has large clinical spectrum from asymptomatic auscultatory or Echodopler finding to frank mitral regurgitation needing valve surgery.
  1,137 121 -
Early detection of hearing loss with connexin 26 gene assessment
Santosh Kumar Swain, Mahesh Chandra Sahu, Manash Ranjan Baisakh
July-September 2017, 14(3):150-153
Hearing loss is the most prevalent type of sensory impairment in human beings. Hearing loss is a global problem. Genetic alteration accounts for 50% of the congenital deafness. The connexin 26 (Cx26) mutations are the most common cause behind the nonsyndromic hearing loss and it is easily identified by polymerase chain reaction. Genes responsible for hearing loss are being mapped and cloned progressively. Mutations in the gene (gap junction beta 2) encoding Cx26 have been associated with congenital hearing loss either alone or as part of a syndrome. Cx26 is a part of a large family of gap junction membrane proteins that help electrical and metabolic coupling between adjacent cells. This review article focuses on genetic analysis of nonsyndromic hearing loss, as genetic alteration in this type of deafness recently begun to be identified, epidemiology, diagnosis criteria, and emphasis in early detection.
  1,125 122 -
Three-dimensional printing for complex orthopedic cases and trauma: A blessing
Raju Vaishya, Vipul Vijay, Abhishek Vaish, Amit Kumar Agarwal
April-June 2018, 15(2):51-54
Three-dimensional (3D) printing technology is penetrating the health-care field at an astonishing rate. In the clinical settings, 3D printing, as a novel additive manufacturing technique, is mainly applied in orthopedics. A group of 3D printing-based patient-specific osteotomy instruments, orthopedic implants, and dental implants have been available for clinical use. The uses of 3D printing have been explored in the field of arthroplasty, sports medicine, spine, pediatric orthopedics, and trauma. The 3D printing technology may provide a chance for the Indian orthopedists and technicians to independently develop innovative medical devices to catch up with their Western counterparts. Its role in patient as well as medical education is also worth exploring. With these myriad applications, 3D printing holds great promise to improve patient as well as surgeon satisfaction in the near future. We discuss the process, applications, and advantages of 3D printing in this review article.
  1,005 141 -
Management of aneurysmal bone cyst using nonvascularized fibula graft: A series of four cases
Malkesh D Shah, Chirag S Kapoor, Rishit J Soni, Jagdish J Patwa, Paresh P Golwala
July-September 2017, 14(3):171-175
Aneurysmal bone cyst (ABC) is an uncommon pathological condition, which leads to weakening and fracture of the affected part of the bone. Radiologically, ABC is an eccentric, metaphyseal, expansile, lytic and non-neoplastic lesion of the bone, giving blown-out/ballooned/soap-bubble appearance. Though benign, malignant transformation is reported. It accounts for 1–6% of all primary bone tumours with incidence rate of 0.14% annually. Usually occurs during second decade of life and most common sites for the lesions are the tibia, femur, vertebra, pelvis, humerus and fibula. The various treatment modalities include selective arterial embolisation, en-bloc/wide marginal resection and curettage with phenol, liquid nitrogen, etc., use of sclerosing agents and use of autogenic/allogenic bone graft or polymethylmethacrylate, with or without osteosynthesis. There exists controversy regarding optimum treatment of ABC as recurrence rate ranges from 5–40% depending upon the treatment method used. Use of non-vascularised fibular strut graft yields good results as per many studies especially in large lesions. Hereby, we present four cases of ABC, treated by extended curettage or En bloc excision of lesions and reconstruction using fibular strut graft.
  1,036 74 -
A case of Salmonella typhi sepsis with acute encephalopathy and disseminated intravascular coagulopathy
Sharmili Sinha, Antaryami Nanda, Indraprava Mandal
July-September 2017, 14(3):179-181
Typhoid is a serious systemic illness commonly presenting with fever and abdominal symptoms. However, it very rarely can manifest without any gastrointestinal symptoms and with acute indolent neurological features only which can pose a diagnostic challenge. We had a such a case which took a fatal course later on with sepsis, disseminated intravascular coagulation (DIC) and multi-organ failure. We did a literature survey on the unusual and extra-intestinal features of the disease. We found when associated with serious neurological findings, the disease has a worse prognosis. Vaccines along with public awareness should be promoted in endemic zones as the disease can often otherwise take a complicated course with high morbidity and mortality.
  985 99 -
Functional outcomes of type c distal humerus fractures in adults fixed by orthogonal double plating
Kapil Mani KC, Parimal Acharya, Dirgha Raj RC, Arun Sigdel
January-March 2018, 15(1):15-20
Background: Surgical reconstruction of intra-articular distal humerus fractures imposes a challenge to even experienced surgeons as it is complicated by anatomy of elbow, small area of fixation, associated comminution, and osteopenia of articular surfaces. Single-column plating does not provide stable construct for comminuted distal humerus fractures as compared to the double-column plating methods. The purpose of this study is to evaluate the functional outcomes, technical difficulties, complications, and patients' satisfactions after orthogonal double plating. Materials and Methods: This was a retrospective analytical study of 54 patients with Type C distal humerus fractures fixed with orthogonal plating from 2012 to 2016. Time to unite the fractures and functional outcomes along with other major and minor complications were noted. Results: Seven (13%) fractures were C1, 12 (22.2%) were C2, and 35 (64.8%) were C3 types according to the AO classification. Major complications were noted in 5 patients and minor complications in 19 patients. Eleven (20.4%) patients were rated as excellent, 33 (61.1%) rated as good, 7 (12.9%) rated as fair, and 3 (5.6%) rated as poor. Mayo Elbow Performance Score in overall patients (n = 54) was 81.62 ± 10.28, C1/C2 subgroup (n = 19) was 89.05 ± 60, and C3 subgroup was 77.60 ± 9.91 (P = 0.627). Similarly, the Disabilities of the Arm Shoulder and Hand Score in overall patients was 17.96 ± 15.67, C1/C2 subgroup was 8.78 ± 7.07, and C3 subgroup was 22.82 ± 16.78 (P = 0.285). Conclusion: Orthogonal dual-plate configurations can provide anatomical reconstruction and stable fixation of Type C intra-articular distal humeral fractures and allow early mobilization of the elbow after surgery; however, a significant number of patients do not satisfy after surgery.
  969 113 -
Gynaecomastia in AIDS patient: An association with zidovudine treatment
Himanshu Bhusan Sahoo, Prasanna Kar, Bandana Rath
July-September 2017, 14(3):182-184
Adverse drug reactions (ADRs) occupy a significant role in the etiology of gynecomastia. Gynecomastia is an ADR, rarely formed due to some antiretroviral drugs. Zidovudine is a first-line drug of choice in AIDS patients, but consumption of this drug has not been reported yet for gynecomastia as an adverse effect. Here, we present the case of a 36-year-old male, who developed bilateral gynecomastia following zidovudine use and was completely regressed after discontinuation. Discontinuation of the zidovudine is quite efficient approach without any pharmacological or surgical treatment.
  979 70 -
Mucormycosis of the head and neck
Santosh Kumar Swain, Mahesh Chandra Sahu, Manash Ranjan Baisakh
January-March 2018, 15(1):6-10
Mucormycosis is a rare clinical entity, often affecting immunocompromised patients. It is often an emergency situation and has poor prognosis. In head-and-neck region, mucormycosis spread by angioinvasion and may present with sinonasal, rhino-orbito-cerebral, palatal, cutaneous, or disseminated involvement. Prompt diagnosis with tissue biopsy, local control of the disease by aggressive surgical debridement, and appropriate systemic antifungal treatment improve the prognosis and survival of the patients. Treatment of mucormycosis needs antifungal agents such as amphotericin B and wide surgical debridement. Early diagnosis and treatment is often needed for survival of the patients. This paper will review the etiopathogenesis, epidemiology, clinical presentations, investigations, and treatment of the dreaded fungal infections called mucormycosis in the head-and-neck region.
  918 131 -
A rare case report of solid pseudopapillary tumor of the pancreas
Vandana Gite, Maruti Dhakane
October-December 2017, 14(4):221-223
A solid pseudopapillary tumor is a low-grade malignant cystic exocrine neoplasm of the pancreas of papillary architecture that typically afflicts young women with excellent postsurgical curative rates and rare metastasis. It may be locally aggressive. Pathological evaluation remains the gold standard in reaching a definitive diagnosis. We report a case of solid pseudopapillary neoplasm of the pancreas that was suspected on radiology and diagnosed preoperatively on biopsy guiding definitive surgery.
  965 78 -
Postpartum hypernatremic encephalopathy with “Wine Glass Sign” on magnetic resonance imaging
Vinit Suri, Sanjiv Jasuja, Neelam Suri, Rahul Saini, Mohit Kalangi Venkata Naga, Kunal Suri
July-September 2017, 14(3):188-189
We report a 28-year-old postpartum female with acute delirium, agitation, confusion, visual hallucinations, and limb weakness. Investigations revealed severe hypernatremia, hyperuricemia, rhabdomyolysis, acute kidney injury, normal serum and urine osmolarity, normal urine spot sodium level, and normal serum antidiuretic hormone level. Magnetic resonance imaging of brain revealed hyperintensities in bilateral corticospinal tracts showing the classical “Wine Glass sign” suggesting hypernatremia-related osmotic demyelination. Patient improved with gradual correction of hypernatremia. We would like to highlight the importance of timely recognition and appropriate treatment of this rare condition which is potentially fatal and may also lead to severe permanent neurological deficits.
  956 86 -
An intriguing case of rapidly progressive dementia: Creutzfeldt–Jakob Disease
Dinesh Chaudhari, Pushpendra Nath Renjen, Dhruv Zutshi, Kamal Ahmad, Abhas Kumar
October-December 2017, 14(4):234-237
Although no formal definition exists for what constitutes a rapidly progressive dementia (RPD), generally we use the term when dementia occurs in <1–2 years from illness onset, but more commonly over weeks to months. Prion diseases are the prototypical causes of RPD, but reversible causes of RPD might mimic prion disease and should always be considered in a differential diagnosis. We report the case of a 65-year-old male with progressive dementia and typical neurologic symptoms, myoclonic jerks, and magnetic resonance imaging findings of Creutzfeldt–Jakob disease (CJD). This case highlights the need for a high index of suspicion to diagnose CJD.
  969 69 -
A review of sports-related injuries: Head to toe spectrum
Reddy Ravikanth, Jyotin Kshitiz Singh, Anegh Pavithran, Anoop Pilar, Anush Nagotu, Parthasarathi Sarkar, S Sandeep, Denver Steven Pinto, Mathew David, John Joshy, Manu Jacob Abraham, Ashok Alapati, Robert Patrick Selvam, Sunil Mathew
April-June 2018, 15(2):79-87
All sports come with a risk of injury, and in general, the more contact involved in the sports, the higher the risk of a more significant or traumatic injury. The most frequent types of sports injuries are sprains (ligament injuries), strains (muscle injuries), and stress fractures (bone injuries). In sports medicine, a catastrophic injury is defined as severe trauma to the human head, spine, or brain. Concussions in sports became a major issue in the 2000s as evidence connected repeated concussions and subconcussive hits with chronic traumatic encephalopathy and increased suicide risk. Overuse and repetitive stress injury problems associated with sports include jumper's knee, tennis elbow, and tendinosis. In this review article, we have made an attempt to describe the head to toe spectrum of sports-related injuries including traumatic injuries of the head and face, extremity injuries, soft-tissue injuries, and contact sports-related injuries.
  874 92 -
Management of neglected clubfoot by ilizarov device, without osteotomy: Yemen experience
Sharker Barker
July-September 2018, 15(3):135-137
The medium-term clinical and functional results of treating neglected clubfoot deformities with Ilizarov device are good. In a limited health-care resource country (such as Yemen) and poor financial situation and education of the patients, the results of Ilizarov surgical correction of the neglected and severe deformities of the foot and ankle are promising, and it seems an excellent surgical option for this challenging condition.
  867 97 -
Pulmonary sclerosing pneumocytoma or sclerosing hemangioma mimicking lung cancer
Vandana Gite, Maruti Dhakane
July-September 2017, 14(3):193-195
Pulmonary sclerosing pneumocytoma or sclerosing hemangioma is an uncommon benign neoplasm, often asymptomatic, affects middle-aged women and usually found incidentally as solitary pulmonary nodule on radiologic examination. It is thought to be derived from incompletely differentiated respiratory epithelium. Histologically, it is distinctive neoplasm of the lung and shows two epithelial cell types, surface cells, and round cells with four architectural patterns, papillary, sclerotic, solid, and hemorrhagic. Preoperative diagnosis of this tumor is difficult, and it is now generally accepted that surgical excision alone is curative without the need for additional treatment.
  879 73 -