Patellar Avulsion Fracture.

We report on the case of a 52-year-old male who sustained a transverse patellar fracture after tripping on uneven pavement. These fractures can be easy to miss on anteroposterior views, highlighting the importance of multiple radiographic views of the knee. Examination of the knee is also important, as initial clinical appearance can be benign. These fractures are most often seen in adolescents, which makes the current case somewhat unusual.

Esophageal Replacement by Colonic Interposition for the Surgical Management of Acute Necrotic Gastric Volvulus: A Case Report.

Acute gastric volvulus, a condition where the stomach rotates around itself, is a rare clinical entity that requires prompt identification and immediate intervention to prevent life-threatening complications. Upon diagnosis, an emergent exploratory laparotomy is the procedure of choice, especially if complications, such as obstruction, ischemia, or perforation, are present. Management techniques and surgical corrections vary depending on the degree of obstruction, the consequent damage to surrounding structures, and the functional reservoir. We present a case of acute gastric volvulus with extensive esophageal and gastric necrosis requiring total gastrectomy and partial esophagectomy. We discuss the patient's operative management requiring colonic interposition with esophagocolonic anastomosis to reconnect this patient's gastrointestinal tract.

Robotic Surgery Techniques to Improve Traditional Laparoscopy.

Introduction: Laparoscopic instruments and techniques are constantly improving, as the ability to perform minimally invasive surgery is crucial in modern medicine. The progression from open surgery to minimally invasive surgery over the years eventually led to the use of robotic devices to either assist or completely replace patient-side surgery with a separate console. Though robotic surgery has been praised for its surgical outcomes, certain situations limit its use, such as cost-effectiveness or physical space constraints. The objectives of this review were to perform a search and discuss the trends in the literature. Methods: A literature search using keywords ((laparoscopic) OR (laparoscopy) OR (minimally invasive)) AND ((instrument) OR (instrumentation) OR (tool) OR (device) OR (apparatus)) AND ((advancement) OR (upgrade)) AND ((hysterectomy) OR (prostatectomy) OR (transoral) OR (cholecystectomy)) AND (robot) in PubMed, looking for trends in advancements or appeals for change. Results: This search provides a framework for these trends to facilitate discussion of ways in which laparoscopic surgery can be improved using the benefits of robotic surgical systems. This allows others to approach the successes of the current robotic systems for laparoscopic surgery with the intention of deriving advancements toward traditional laparoscopic surgery.

The role of liver microenvironment in hepatic metastasis.

Metastasis is still poorly understood and thus further research must be conducted to provide insight into the driving factors. Novel research has revealed the significance of the microenvironment in the delegation of metastasis, expanding the field of cancer metastasis to cells and cell environments surrounding the migrated tumor cells. Research on hepatic metastasis is an ever-growing domain of this field, as several primary tumors can metastasize to the liver. The two features within the liver that promote metastasis-cellular and acellular-are found in the current interpretation of liver microenvironment. Novel findings of both are included in this review. Different hypotheses detailing the methods by which metastasis can occur must be included to understand the significance of the microenvironment, as well as a brief overview of the methods that can be used during research. This review aims to highlight the importance of liver microenvironment on the development or potential regression of hepatic metastasis through discussing both acellular and cellular components of liver microenvironment and their interaction with metastasis.