Two or three notches on the superior border of spleen are not an uncommon presentation. As many as seven notches were observed in a spleen of 32 year old female in Rural Medical College, PIMS, Loni, Maharashtra, India, during autopsy. Along the superior border of spleen six notches were present and one notch was observed on the broad anterior pole. A 2.8 cm long fissure was also seen on the renal visceral surface of the specimen. This unusual anatomical variation may lead to difficulty while distinguishing the spleen from adjoining organs in patients of splenomegaly. The variation is explained on the basis of embryological development. A sound knowledge of such variation is essential for physicians, surgeons, radiologists, and of course the anatomists.

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The evolution of modern neurosurgical techniques in traumatic brain injury has been ongoing for the last two centuries. However, it has always been a challenge to obtain an effective clinical outcome, especially in those following severe traumatic brain injuries. Other than the well-established procedures for acute and/or chronic subdural hematomas and depressed skull fractures, newer avenues for the development of surgical techniques, where indicated, have been minimal. The study proposes to apply the principles of microvascular surgery and skull base surgery in selected cases of severe traumatic brain injuries.

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Objective: Patients of polytrauma due to road traffic accident, fall from height, sports injury with blunt chest trauma, as well as penetrating injury to chest were investigated for pneumomediastinum and pneumopericardium, which may prove life threatening. Material and Methods: This study was retrospective for three years and prospective for three years and was conducted in the department of cardiovascular and thoracic surgery at the Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir for six years. All patients who reported to the hospital as polytrauma were investigated by noncontrast computed tomography (CT) scan of the chest. We did 1,350 CT scans of the chest for blunt and/or penetrating chest trauma in the last six years as a part of emergency investigations. All chest CT scans were investigated for pneumopericardium, simultaneous with other traumatic pathologies. Results: Of the 1,350 chest CT scans, 930 were normal. Twenty-one patients had pneumomediastinum in addition to other primary surgical pathology. Of these 21 patients with simultaneous pneumomediastinum, eight patients had associated pneumopericardium; five patients with pneumopericardium had blunt chest trauma as etiology and three patients had penetrating trauma as etiology for pneumopericardium. Conclusion: To overcome the fatality of pneumopericardium, two important approaches need to be followed. The first is continuous monitoring of blood pressure and the second is the availability of an immediate facility for drainage of pneumopericardium. Pneumomediastinum is obligatory for pneumopericardium to occur.

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Introduction: Oral health is an important aspect of health for all children and is all the more important for children with special needs. Aim: To evaluate the oral health status of special health need children at Vidya Sudha, a day care centre in Chennai. Materials and Method: A modified WHO oral health assessment form was used to assess the caries experience, gingival, and oral hygiene status. Result: Data were analyzed using ANOVA and chi-square test. No statistical significant differences were found between the evaluated groups regarding age or gender, and medical conditions. Conclusion: Majority of the children had poor oral hygiene, showing high caries prevalence as well as moderate gingivitis.

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Rapid resolution of post-traumatic acute subdural hematoma is infrequently reported. We report a case of rapid spontaneous disappearance of post-traumatic acute subdural hematoma in one patient who was discovered to have a contralateral middle cranial fossa arachnoid cyst. The previously reported mechanisms responsible for the rapid spontaneous disappearance of post-traumatic acute subdural hematoma are reviewed and the contribution of the middle cranial fossa arachnoid cyst to the disappearance of the pos-traumatic acute subdural hematoma that has taken place in our case is discussed. To the best of our knowledge the association between spontaneous disappearance of post-traumatic acute subdural hematoma and arachnoid cysts has not been previously reported.

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Amelogenesis imperfecta (AI) is a rare genetic disorder inherited as either autosomal dominant, autosomal recessive, or X- linked modes. AI is characterized by the defect in enamel formation, resulting in defective mineralization or formation of the matrix. Restoration of the dentition poses great challenges, especially when teeth are severely affected. Treatment aims to relieve pain or sensitivity of teeth and to preserve as much tooth structure as possible while preventing further loss of teeth, to maintain masticatory function, and last but not the least, to improve the aesthetic appearance and quality of life as it has a great psychological impact on the self-esteem of the patient. This case report describes the treatment of a young boy who presented with a severe form of AIimperfect (AI) with a minimally invasive, relatively simple, and cost-effective treatment with composite restorations.

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Inflammatory myofibroblastic tumor (IMT) of the liver is a rare tumor like lesion that can mimic malignant liver neoplasm. IMT is a lesion composed of myofibroblastic spindle cells, plasma cells, lymphocytes, and eosinophils. It can occur in soft tissues and viscera. It was previously called plasma cell granuloma, inflammatory myofibrohistiocytic proliferation, and inflammatory pseudo tumor, but IMT is the designation currently used. IMT is more frequently described in the lung and abdomen of young patients, but it can also be found in the central nervous system, salivary glands, larynx, bladder, breast, spleen, skin, and liver. Here, we present a case of IMT of the liver in a 55-year-old female patient which is a rare presentation.

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