Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
we collected all possible literature from the year 1972 ( when kfd was first described ) to the present day conducting a medical search on kikuchi fujimoto disease ( kfd ) in english language .
we included publications in authorized medical journals including original and review articles / theses , editorials , case reports and brief communications .
kfd is an extremely uncommon disease but cosmopolitan with higher japanese and asiatic prevalence.1,2 however , sporadic cases have also been reported from europe . in asian woman
kikuchi s disease is rare and benign cause of cervical lymphadenopathy.3 the disease , most often , happens to occur in young adults below 40 and seldom in children.4 at first , little female predominance was considered , but the recent literature regards it as male to female ratio 1:1.1,5 a current study on the patients with kfd conducted in taiwan reports the average age of 21.5 cardiac , hepatic and pulmonary involvement raises the morbidity .
however , role of viruses ( epstein - barr virus and others ) in the pathogenesis of kikuchi s disease is controversial and unremarked.1 on the other hand , unger and coworkers are in favor of viral etiology as kfd manifests certain viral features ie , atypical lymphocytosis , certain histologic features , flulike respiratory prodrome and no response to antibiotic therapy.7 also , kikuchi s disease has been reported in patients with aids.8 like systemic lupus erythematosus ( sle ) , lymphocytes and histiocytes in the patients with kikuchi s disease show tubular reticular structures in their cytoplasm on electron microscopy.9 it has been opinioned that in genetically susceptible individuals , kfd may belong to exuberant t - cell mediated immune response provoked by variety of stimuli.1 even though course of cell death in kfd needs to be studied and emphasized , ohshima and his associates remarked apoptotic cell death might be involved in the pathogenesis of kfd.10 regarding to this study , proliferating cd8 t - cells may kill or be killed in the apoptotic process of this disease using fas and perforine pathways .
kikuchi s disease begins as an acute or sub - acute condition , developing over two to three week period .
tender cervical lymphadenopathy is the characteristic feature ( 56%98% ) of kfd , predominantly involving the posterior cervical triangle .
size of the enlarged lymph nodes ranges from 0.5 cm to 4 cm ( occasionally 6 cm ) .
59% patients represent painful lymphadenopathy and 1%22% patients undergo generalized lymphadenopathy.4,7,9,11 kfd , more or less , rarely involves mediastinal , peritoneal or retroperitoneal regions of the body.2 fever ( 30%50% ) associated with upper respiratory symptoms , sore throat , night sweats , weight loss , headache , rash , nausea , vomiting , and leukopenia ( about 50% ) are the other manifestations of the disease .
12,13 atypical lymphocytes have been reported in the peripheral blood film of patients with kfd .
extranodal involvement is rare ; however , skin , eye and bone marrow affection has been reported.1 nevertheless , kfd is linked to sle and autoimmune conditions as lymphocytes and histiocytes in the patients with kikuchi s disease show tubular reticular structures in their cytoplasm on electron microscopy.1,14 additionally , extranodal involvement in kfd is associated with frequent systemic symptoms .
anecdotal reports bring to light the unusual features of kfd like haemophagocytic syndrome and carcinoma15 along with fatal multicentric disease .
nervous system involvement ( septic meningitis , acute cerebellar ataxia , and encephalitis ) rarely happens to occur.16 regarding joint involvement , a case of 14 year old boy with kfd is in the record.17
in patients with kikuchi fujimoto disease , an excisional biopsy of the involved lymph nodes is the investigation of choice .
coagulative necrosis with ample karyorrhetic debris in paracortical areas of the involved lymph nodes is the characteristic histologic feature of kfd .
other baseline investigations are reported unaffected . nevertheless , laboratory results of some kfd cases have reported anemia , little rise in esr and even leukopenia .
one third individuals with kfd have shown atypical lymphocytes in their peripheral blood films.5 predominantly , t - cells ( cd8 + t - cells ) are found in kfd .
however , neutrophils are found absent and scarce plasma cells may or may not be present . according to kuo
, histopathologic features can be classified in three stages : proliferative , necrotizing , and xanthomatous.18 proliferative stage expresses various histiocytes , plasmacytoid monocytes and lymphoid cells containing karyorrhetic nuclear fragments , and eosinophilic apoptotic debris .
necrotizing stage shows a degree of coagulative necrosis while xanthomatous stage is predominantly stuffed with foamy histiocytes .
it must be born in mind that in the individuals with kfd , atypical reactive immunoblastic component is common and can be mistaken for lymphoma.4 histiocyte - associated antigens ( lysozyme , myeloperoxidase and cd68 ) are also expressed by histiocytes in kfd .
kfd is an extremely rare disease and the differential diagnosis can be established on the basis of enlarged lymph nodes which are associated with many other disorders .
it is necessary to born in mind the differential diagnosis of kfd as its treatment dramatically differs from other disorders .
lymphoma ( non - hodgkin s lymphoma ) , tuberculosis , sle , plasmacytoid t - cell leukemia , kawasaki s disease , and myeloid tumor are included in the differential diagnosis of kfd.1 sometimes , because of similar clinical and histological features , it becomes problematic to differentiate kikuchi fujimoto disease from lymphadenitis associated with systemic lupus erythematosus ( sle ) .
however , it has been reported that kfd is associated with sle . in order to exclude sle ,
all the necessary investigations of sle ( c3 , c4 , anf , anti - sm , and le cells ) are required .
early recognition of kikuchi fujimoto disease is of prime importance to save the patient from undergoing extensive investigations related to malignant lymphoma and other related disorders.8 histopathologic features like presence of abundant reactive histiocytes and absence of reed - sternberg cells favor kfd .
sometimes , kfd may express histiocytes resembling with signet - ring cells and can be confused with signet - ring carcinoma .
however , metastaic adenocarcinoma contains cells with atypical nuclei and mucin debris instead of cellular debris .
kikuchi fujimoto disease ( histiocytic necrotizing lymhadenitis ) is a self - limiting condition that resolves spontaneously within 1 to 4 months of period .
however , studies reveal recurrence of the disease in 3%4% of the patients.9 additionally , sle may happen to occur some years later .
no hereditary risk has been documented in kfd.8 most of the time symptomatic relief is offered for the local and systemic complains of the disease .
lymph node tenderness and fever is treated with analgesics , antipyretics , and nsaids . sometimes , but rarely , steroids can be used temporarily , especially in severe extranodal involvement or generalized clinical course.19 in order to run an excisional biopsy of the enlarged lymph nodes , surgical consultation may be prerequisite .
individuals with kikuchi fujimoto disease should be examined systemically and they must be under regular follow - up in order to monitor the manifestations of sle . the course of cervical lymphadenopathy is benign and resolves spontaneously .
very few cases have been reported as fatal . however , no standard or specific treatment of kfd has been recommended .
kikuchi fujimoto disease is an idiopathic , extremely rare , more or less worldwide , and often under - diagnosed condition ; predominantly involving the posterior cervical lymph nodes .
early recognition of kikuchi s disease is of prime importance to avoid extensive and expensive investigations related to malignant lymphoma other related disorders . in order to avoid misdiagnosis , awareness of this disease

Answer:
in order to determine the clinical significance of kikuchi fujimoto disease ( histiocytic necrotizing lymhadenitis ) and to review the literature available on this condition , we selected the medicine research papers in english language published between the years 1972 to 2011.kikuchi fujimoto disease ( kfd ) is an uncommon , cosmopolitan , benign and self - limiting condition with higher japanese and asian prevalence .
 most of the sufferers of kfd are young people who seek treatment because of having acute tender cervical lymphadenopathy , low grade fever and night sweats .
 coagulative necrosis with ample karyorrhetic debris in paracortical areas of the involved lymph nodes is the characteristic histologic feature of kfd .
 diagnosing kfd is crucial as it can be mistaken for malignant lymphoma and sle.kfd was put forth first time in 1972 by dr .
 masahiro kikuchi and by funimoto as lymphadenitis with reticular proliferation , histiocytes and abundant nuclear debris .
 it is a rare benign condition of lymph nodes and most of the clinicians and pathologists are unfamiliar with it .
 kfd is self - limiting disease ( within 1 to 4 months ) , however , patients should be followed up regularly as it may crop up again or progress to sle .
 analgesics and antipyretics help to ameliorate the symptoms .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
a 41-year - old woman prompted a visit to an optometrist due to blurred vision in june 2013 , and was diagnosed to have retinal hemorrhage .
complete blood count revealed marked leukocytosis ( 326  k/l ) , neutrophilia ( 25% , 64.6  k/l ) with a prominent myelocyte peak ( 27.5% myelocytes ) , basophilia ( 4.0% , 12.9  k/l ) , and mild normocytic anemia ( hemoglobin 10.4  g / dl ) .
bone marrow study revealed hyperplastic myeloid series ( myeloid / erythroid ratio of 8.1/1 ) with only 1.2% blasts .
further both karyotype and fish analysis revealed presence of philadelphia chromosome in nearly all cells ( fig .
1a and b ) based on these findings patient was diagnosed with chronic myeloid leukemia ( cml ) , chronic phase .
she was started on imatinib 400  mg daily and hydroxyurea . despite achieving hematological remission three months after diagnosis ,
patient continued to have persistent cytogenetic disease as detected on follow up fish assays with 32% cells showing t ( 9 ; 22 ) . in june 2014 , patient was switched to nilotinib , as she appeared to have imatinib resistant disease , although molecular testing for abl kinase mutational analysis was negative . in july 2015
cbc done at that time revealed a normal white cell count of 9.1  k/l with 17.5% circulating blasts , ( fig .
1c ) and hemoglobin of 7.5  g / dl . bone marrow aspiration and biopsy was performed and the specimen was also submitted for flow cytometry and cytogenetic analysis .
prominent erythroid hyperplasia was noted on the bone marrow aspirate smears with 69.5% erythroid precursors , several of which showed dysplastic features ( fig .
although only 9% blasts were counted on the bone marrow differential count , flow cytometry revealed 14% cells in the blast gate ( fig .
1 g ) mostly expressing myeloid markers cd117 , cd33 , stem cell marker cd34 and with partial aberrant expression of lymphoid marker cd7 .
although no solid sheets of blasts were seen , cd34 highlighted scattered blasts throughout the biopsy section with a variable distribution estimated at approximately 1015% ( fig .
based on the presence of marked erythroid hyperplasia ( 69.5% ) and 9% bone marrow blasts the diagnostic criteria for acute erythroid / myeloid leukemia were met and a diagnosis of blast transformation of underlying cml to acute erythroid / myeloid leukemia was made .
patient received 7 + 3 induction chemotherapy with idarubicin and cytoxan . despite lowering of her
she further developed subarachnoid hemorrhage , and septicemia and subsequently died six weeks after her hospitalization .
chronic myelogenous leukemia ( cml ) is a clonal disorder involving the pluripotent stem cell and is consistently associated with the bcr - abl1 fusion gene located on the philadelphia chromosome .
the disease typically evolves in 3 distinct clinical stages : chronic and accelerated phases and blast crisis . in approximately 70% of cases ,
the blast lineage is myeloid , of which granulocytic and monocytic blasts are more common .
erythroid blast phase of cml is relatively rare and a literature review suggests that the incidence ranges from 0% to 10% .
acute erythroid leukemia is a rare subtype ( < 5% ) of acute myeloid leukemia that may arise de novo or from transformation of an underlying myelodysplastic syndrome .
it is further subdivided into two subtypes namely : acute erythroleukemia and pure erythroid leukemia .
unlike pure erythroid leukemia in which the erythroid series is mostly comprised of proerythroblasts and basophilic erythroblasts , in acute erythroleukemia ( erythroid / myeloid ) all maturation stages of the erythroid precursors are present ( comprise > 50% of the entire nucleated cell population ) , may frequently show a shift to immaturity , are dyspoietic and myeloblasts comprise greater than 20% of non - erythroid cells .
chronic myelogenous leukemia with erythroid crisis is a rare entity with variable reported incidence rates .
based on our review of literature we came across very few reported cases of transformation of underlying cml to acute erythroid leukemia , , , , , .
we also searched our institutional database for all cases of cml that transformed to acute leukemia over the course of last twenty years and did not find any other cml patient with erythroid blast crisis . whether the criteria listed for diagnosis of erythroleukemia should be applied in cml erythroid blast phase is poorly defined .
some studies have considered the percentage of normoblasts below 50% as criteria for erythroblast phase but not erythroleukemia .
although acute erythroid leukemia is far less common than cml erythroblast crisis , a few cases of philadelphia - positive acute erythroid leukemia have been reported .
studies have also suggested that erythroid blast phase is not independent of cml chronic phase .
bcr - abl fusion product in the normoblasts of cml , which provides concrete evidence confirming erythroid leukemia rather than a hyperplastic process . in our case at the time of disease progression in 2015 we were able to demonstrate presence of both bcr - abl fusion and monosomy 7 in majority of the bone marrow cells that on morphology were mostly erythroid precursors by fish assays . although the 9 ; 22 translocation was seen at the time of diagnosis , the anomalies of chromosome 7 and 3 were newly acquired in 2015 , indicating karyotype evolution and disease progression . in the blastic phase of cml ,
several additional chromosome aberrations in addition to the philadelphia chromosome have been reported in 7580% of patients , , .
complex rearrangements are widely dominant in acute erythroleukemia with clonal abnormalities mostly involving chromosomes 5 and 7 followed by 8 , 16 and 21 .
ph - positive acute erythroid leukemia represents an even less common occurrence than erythroid blast phase cml .
it is difficult to distinguish the erythroblast phase of cml from a ph - positive acute leukemia .
although complex karyotype and presence of multiple chromosomal abnormalities is fairly common in all cases of acute erythroleukemia , very few cases of ph - positive erythroleukemia have been reported .
blast phase of cml is often associated with a complex karyotype , including trisomy 8 and 19 , double ph chromosomes , and isochromosome i ( 17q ) , . the who classification
does not specifically address the issue of erythroid hyperplasia in patients with cml or erythroid blast phase of cml .
we feel due to presence of more than 50% erythroid precursors and increased myeloblasts ( greater than 20% of the non - erythroid cells ) our case meets the who diagnostic criteria for acute erythroleukemia ( erythroid / myeloid ) .
the criteria for diagnosing acute erythroleukemia arising from an underlying cml have not been firmly established , partly due to the rare occurrence of this phenomenon .
chronic myelogenous leukemia blast crisis is highly refractory to standard induction chemotherapy , with a response rate of less than 2030% , . in
patient 's with imatinib resistant disease dastanib and nilotinib can help achieve hematological response however neither drug has been reported to be entirely effective in achieving complete cytogenetic remission or for treatment of blast crisis .
further acute erythroid leukemia has an aggressive clinical course mostly with an adverse clinical outcome .

Answer:
chronic myelogenous leukemia ( cml ) is a myeloproliferative disorder where over a period of time 1520% of patients show blastic transformation with majority transforming into acute myeloid leukemia , most of which are of granulocytic lineage .
 erythroid blast phase of cml is relatively rare with the incidence ranging from 010% .
 further the incidence of acute erythroid leukemia by itself is fairly low amongst all acute leukemias .
 we report a case of 41-year - old patient with cml who failed to achieve cytogenetic remission , transformed to acute erythroid leukemia and eventually succumbed to the disease over a short period of time .
 related literature is also reviewed


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
amyotrophic lateral sclerosis / parkinsonism - dementia complex ( als / pdc ) is a rare disorder endemic to guam island and the kii peninsula of japan .
it shows a unique combination of parkinsonism , amyotrophy , and dementia , and the form of dementia , which shows a phenotype similar to alzheimer 's disease ( ad ) , is becoming predominant in the kii peninsula .
although kii als / pdc shows several unique clinical features , including severe atrophy of the frontal and temporal lobes on magnetic resonance imaging ( mri ) , decreased cerebral blood flow in the frontal and temporal lobes on single - photon emission computed tomography ( spect ) , pigmentary retinopathy , and decreased cardiac i - meta - iodobenzylguanidine uptake , a postmortem examination is required for a definitive diagnosis . since biomarkers for als
/ pdc have not yet been identified , we analyzed cerebrospinal fluid ( csf ) biomarkers for kii als / pdc to discriminate it from other neurodegenerative disorders .
we collected csf samples from 12 patients with kii als / pdc ( 6 men , 6 women , mean age 67.9  3.7 years , mean illness duration 5.63 years ) , nine patients with ad ( 2 men , 7 women , mean age 61.1  8.7 years , mean illness duration 1.92 years ) , 11 patients with als ( 8 men , 3 women , mean age 60.6  12.6 years , mean illness duration 1.1 years ) , nine patients with parkinson 's disease ( pd ; 7 men , 2 women , mean age 71.3  2.2 years , mean illness duration 4.42 years ) , and five disease control patients ( c ; 4 men , 1 woman , mean age 36.2  20.3 years ) .
all of the patients with kii als / pdc were natives of hohara village , which is an area of high als / pdc prevalence on the kii peninsula .
we collected csf samples over 10 years ; therefore , the period between csf collection and analysis was not standardized .
the diagnosis of kii als was made according to the airlie house criteria , since the clinical symptoms of kii als are essentially the same as those of classical als .
the diagnosis of kii pdc was made by a unique combination of levodopa - unresponsive parkinsonism and dementia , which are frequently accompanied by amyotrophy of the extremities and/or pyramidal tract signs .
mini - mental state examination ( mmse ) was used for the evaluation of dementia and cut - off point was 23 ( data not shown ) .
the frontal lobes and/or temporal lobes of als / pdc patients showed atrophy on mri and/or a decrease of cerebral blood flow on spect .
csf samples were immediately centrifuged at 1000  g for 15  min and stored at 80c with polypropylene tube .
the total tau ( t - tau ) , phosphorylated tau ( p - tau ) , and amyloid beta ( a ) concentrations were measured with an enzyme - linked immunosorbent assay ( elisa ) kit using a monoclonal antibody specific for t - tau , p - tau , and a142 ( innotest htau ag , phosphor tau(181p ) , and -amyloid ( 142 ) , innogenetics , ghent , belgium ) .
elisa assays were carried out using several samples from each group on the same plate in a randomized manner and were repeated using randomized samples in the same manner in plural times .
a factorial anova was performed with csf - t - tau , csf - p - tau , and csf - a42 , as dependent variables , with the diagnostic category ( ad , als , c , kii als / pdc , and pd ) using jmp 9.0 .
the ethics committee of mie university graduate school of medicine approved this study and the  declaration of helsinki  was followed .
csf - a42 , csf - t - tau , and csf - p - tau were compared between ad , als , c , kii als / pdc , and pd .
the concentrations of csf - t - tau and csf - p - tau were significantly higher in ad ( t - tau ; 378.0  41.76  pg / ml ; p < 0.001 , p - tau ; 42.4  6.78  pg / ml ; p < 0.028 ) than in the other groups .
however , the concentrations of csf - t - tau and csf - p - tau did not differ significantly between kii als / pdc , als , c , and pd ( figures 1(a ) and 1(b ) ) .
the concentration of csf - a42 was significantly reduced in ad ( 402.2  56.6  pg / ml ; p < 0.03 ) compared to als and c and relatively reduced in kii als / pdc ( 465.4  53.69  pg / ml ; p < 0.018 ) compared to als .
most of the als / pdc patients had csf concentration values that fell below the cutoff based on c ( figure 1(c ) ) .
the ratios of csf - p - tau to csf - a42 were significantly increased in ad ( 0.125  0.02 ) compared with kii als / pdc ( 0.043  0.02 ; p < 0.008 ) , als ( 0.035  0.019 ; p < 0.003 ) , pd ( 0.025  0.02 ; p < 0.002 ) , and c ( 0.027  0.09 ; p
the concentrations of csf - t - tau , csf - p - tau , or csf - a42 were not related to the clinical parameters ( age , sex , illness duration , or dementia ) in the kii als / pdc patients .
the number of c samples was small and the average age of control patients was low .
generally , csf tau level gradually increase according to age and csf a is not affected by age .
csf tau level of c samples was relatively low , but it was not significant .
thus , the csf values of c were not comparable to those of other groups .
nevertheless , the optimal cut - off values that discriminate c from ad were similar to those in previous reports [ 6 , 7 ] in which a larger number of control samples were analyzed .
csf tau level of kii als / pdc samples did not increase , although the average age of kii als / pdc group was older than that of ad group .
the present study showed that csf - t - tau and csf - p - tau concentrations from patients with kii als / pdc were not increased compared to those in the other disease groups , and a42 concentration in the csf was relatively decreased .
the ratio of csf - p - tau to csf - a42 segregates kii als / pdc from ad .
because als / pdc is associated with tau pathology in the absence of amyloid plaques , the expectation was that als / pdc patients would not show the alzheimer 's disease ( ad ) profile of decreased a42 but might show increased t - tau and/or p - tau in the csf .
in general , decreased csf - a42 indicates plaque pathology , and increased csf - t - tau and csf - p - tau indicate axonal degeneration and tangle pathology , respectively .
recently , the average age of onset of kii als / pdc is increasing and a deposition is conspicuous in autopsied patients . therefore , decreased csf - a42 may reflect a pathology in the most recent patients .
we analyzed the precise tau isoform of over 10 patients with autopsy - proven als / pdc recently and identified a 3r  +  4r type , 4r > 3r type , and a 4r predominant type .
the glial tau pathology is particularly related to the 4r isoform , and we consider kii als / pdc to be a 4r - dominant tauopathy ( unpublished data ) .
noguchi et al . examined the concentrations of csf - t - tau , csf - p - tau , and csf - a42 in patients with progressive supranuclear palsy ( psp ) and corticobasal degeneration ( cbd ) ; the concentrations of csf - t - tau and csf - p - tau did not significantly differ between psp , cbd , and controls , and the concentration of csf - a42 was significantly lower in psp and cbd than in controls .
the authors speculated that the absence of an increase of csf - t - tau and csf - p - tau concentrations might reflect 4r tau predominance and a reduction of csf - a42 might suggest deposition or mismetabolism of a . taken together , csf biomarkers of kii als / pdc might have similar properties to those of 4r tauopathy , psp , and cbd ; however the relationship between tau isoform and csf tau level remains to be resolved .
finally , the present findings , in which csf - t - tau and csf - p - tau concentrations were not increased and csf - a42 concentration was relatively decreased , suggest that csf analysis may be useful to differentiate als / pdc from ad , als , and pd . nevertheless there is a major limitation of the interpretation of the data .
the size of each group is small , the age of the control group is much younger , and there were two populations in the ad group regarding the levels tau , p - tau , and a/p - tau .
further study using groups with larger size of subjects is needed to confirm the proposed utility of the csf biomarkers .

Answer:
objective .
 amyotrophic lateral sclerosis / parkinsonism - dementia complex is classified as one of the tauopathies . methods .
 the total tau , phosphorylated tau , and amyloid 42 levels were assayed in cerebrospinal fluid from patients with kii amyotrophic lateral sclerosis / parkinsonism - dementia complex ( n = 12 ) , alzheimer 's disease ( n = 9 ) , parkinson 's disease ( n = 9 ) , amyotrophic lateral sclerosis ( n = 11 ) , and controls ( n = 5 ) using specific enzyme - linked immunosorbent assay methods . results .
 total tau and phosphorylated tau did not increase and amyloid 42 was relatively reduced in kii amyotrophic lateral sclerosis / parkinsonism - dementia complex .
 relatively reduced amyloid 42 might discriminate kii amyotrophic lateral sclerosis / parkinsonism - dementia complex from amyotrophic lateral sclerosis and parkinson 's disease , and the ratios of phosphorylated - tau to amyloid 42 could discriminate kii amyotrophic lateral sclerosis / parkinsonism - dementia complex from alzheimer 's disease
 . conclusions .
 cerebrospinal fluid analysis may be useful to differentiate amyotrophic lateral sclerosis / parkinsonism - dementia complex from alzheimer 's disease , amyotrophic lateral sclerosis , and parkinson 's disease .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
although decades have passed since most cellular organelles were initially characterized by microscopy and subcellular fractionation , a complete catalogue of the proteins in each organelle has yet to be obtained .
whereas genomics provides a list of potential proteins encoded by an organism 's genome , data from proteomic analysis can provide the ' rosetta stone ' that allows assignment of specific proteins to different subcellular structures .
the most informative proteomic analysis requires highly purified organelle ( sub)fractions , yet subcellular fractionation is notorious for cross - contamination .
comparative analysis of organellar subfractions can potentially circumvent this problem by providing a rational basis for distinguishing bona fide organelle components from contaminants . here , we scrutinize the use of such an approach to survey the integral membrane proteins of the nuclear envelope .
the nuclear envelope is a double - membrane system , continuous with the endoplasmic reticulum ( er ) , that encloses the nuclear contents ( figure 1 ) .
it is perforated by nuclear pore complexes ( npcs ) , large supramolecular assemblies that mediate nucleo - cytoplasmic traffic . in higher eukaryotes ,
the nuclear envelope is lined by a protein meshwork , the nuclear lamina , which is an attachment site for npcs   and chromatin .
in contrast , the inner nuclear membrane ( inm ) contains a set of unique integral membrane proteins , many of which bind to lamins ( the predominant proteins of the nuclear lamina ) and/or to chromatin .
a quarter of a century of biochemical , cell biological , and genetic approaches has identified several integral inm proteins in higher eukaryotes , including lamin - b receptor ( lbr ) , lamina - associated polypeptides ( laps ) 1 and 2 , man1 , nurim , and emerin .
most of these proteins and several novel components have now been detected in a single proteomics study of nuclear envelopes .
many methods have been developed to isolate nuclear and nuclear - envelope fractions from eukaryotic cells .
these fractions are invariably contaminated by other cytoplasmic organelles and filaments , however . moreover ,
the close interactions between the npcs , nuclear lamina , inm and chromatin make it impossible to cleanly separate these components .
proteomics , which couples mass - spectrometric analysis of proteins with mining of the protein databases derived from genomics , can potentially identify most proteins in a nuclear envelope fraction , but it can not distinguish nuclear envelope components from contaminants .
dreger and colleagues   used comparative proteomics of different nuclear envelope subfractions isolated from cultured neuroblastoma cells to identify integral proteins of the inm .
they took advantage of previous findings that the nuclear lamina is insoluble in both nonionic detergent and salt , and that many integral proteins of the inm remain associated with the lamina after detergent or salt extraction .
they therefore separated proteins from three different nuclear envelope subfractions on two - dimensional gels , excised protein spots from the gels , cleaved the proteins within each spot with protease , and analyzed the resulting peptides by maldi - tof ( matrix - assisted laser - desorption / ionization time - of - flight ) mass spectrometry . in one extraction ,
nuclear envelopes were treated with the detergent triton x-100 to solubilize proteins of the outer nuclear membrane and er .
the triton x-100 pellet ( ' detergent - resistant ' in table 1 ) , which contains the nuclear lamina , is enriched in lamin - binding inm proteins .
a second pellet was obtained by salt extraction of nuclear envelopes ( ' salt - resistant ' ; table 1 ) and is expected to be similarly enriched in the lamina , but with different contaminants removed .
a third extraction involved treatment of nuclear envelopes with a urea / carbonate solution and yields a pellet ( ' chaotrope - resistant ' ; table 1 ) containing integral membrane proteins of the inm , outer nuclear membrane and er ( plus contaminating organelles ) . on the basis of the logic discussed above , integral membrane proteins ( chaotrope pellet ) that were also found in the detergent and salt pellets were good candidates for novel inm proteins .
this analysis   identified most previously characterized inm proteins , as well as four novel integral proteins .
two of the novel four were splice variants of the lamina - associated protein lap2 , previously observed only as mrnas .
the identification of unique peptides , including some that overlap predicted splice junctions between exons , confirmed the presence of three previously observed (  ,  ,  ) and two novel (  ,  ) lap2 isoforms .
the remaining two lap2 isoforms that had been identified as mrnas (  ,  ' ) were not observed ( although all lap2 isoforms contain chromatin and/or lamin - binding domains that predict their targeting to the nuclear envelope ) .
lap2 , a splice variant lacking a transmembrane domain , was absent from the chaotrope - resistant fraction , supporting the logic of the comparative approach .
the third novel inm protein to be identified was a homolog of unc84a , a caenorhabditis elegans protein previously localized to the nuclear envelope .
the fourth protein , luma , was completely novel and includes no known domains and so has no predicted functions .
dreger and colleagues   did not detect lap1 , although it has been observed in a variety of mammalian cell types .
this could result from its loss during fractionation , its absence from the neuroblastoma line examined , or other technical problems ( for example , only about 75% of the protein spots seen on the two - dimensional gel yielded assignments by mass spectrometry ) .
low abundance is also a potential problem . whereas lamins are present at millions of copies per cell , previously characterized inm proteins are far less abundant . notwithstanding
the high sensitivity of mass spectrometry , minor proteins may go undetected . just as local dialect modifications can limit some translations using the rosetta stone , atypical protein behaviors can limit comparative proteomic approaches . each comparative approach is tailored by knowledge of the fractionation behavior of previously characterized components of an organelle .
thus , in comparing the proteins appearing in the three nuclear envelope fractions , dreger and colleagues   found that all well characterized intranuclear proteins were absent from the chaotrope - resistant fraction , and most known inm proteins were in all three fractions .
emerin , which is known to bind lamins , was absent from the detergent - resistant fraction , and lbr , the sequence of which includes seven transmembrane segments , was detected only in the detergent - resistant fraction and not in the chaotrope- or salt - resistant fractions ( table 1 ) .
three of the novel proteins identified by the study were in all three fractions , but luma was absent from the salt - resistant fraction .
thus , luma would have been missed if a requirement that novel inm proteins appear in all three fractions had been enforced .
atypical behavior of contaminants can also limit the effectiveness of comparative approaches . in the dreger study
, some known proteins with clearly cytoplasmic localizations and functions also appeared in all three pellets , including mitochondrial proteins ( f1-atp - synthase  ) and cytoskeletal ones ( actin and tubulin ) .
this underscores the need to complement the proteomic identification of new organellar components with other approaches , including direct localization .
thus , to ensure that luma and the unc84a homolog were not contaminants , their cdnas were isolated , epitope - tagged , and transfected into cos7 cells , to confirm nuclear - envelope targeting .
rout and colleagues , when analyzing the yeast npc by proteomics , used the additional criterion of enrichment with the npc to distinguish contaminants .
candidate proteins from an npc - enriched fraction were epitope - tagged at their genomic loci .
only when the majority of tagged protein was found to reside at the npc ( by immunogold electron microscopy , immunofluorescence microscopy , and co - fractionation with known npc proteins ) was it considered a true npc component .
some proteins have multiple cellular localizations , however , and this criterion eliminated , for example , the sec13 protein , which is involved in protein translocation across the er membrane yet has a second function at the npc .
even with the four novel inm proteins demonstrated by the dreger study , we predict that many inm proteins remain to be discovered ; some of these could be amongst the 25% of protein spots that eluded analysis .
for example , unc84a appears in all c. elegans tissues , but unc83 , an inm protein that interacts with unc84a , appears in only a subset .
nuclear envelope proteome analyses of different tissues may uncover a mammalian unc83 homolog and other tissue - specific inm proteins .
indeed , a novel tissue - specific inm protein was just discovered . this protein , named myne-1 , binds lamins and appears specifically in myocytes .
applying proteomics directly to complex protein mixtures , rather than restricting analysis to the proteins recovered from gels , should increase the number of proteins detected .
moreover , this method could estimate the relative amounts of different proteins in a subcellular compartment by determining the relative peptide quantities after protease cleavage .
post - translationally modified peptides could be identified by comparing peptide profiles with or without treatments that remove the modifications ( for example , chemical removal of sugars ) ; and a combination of this type of approach with relative quantitation could provide information on the proportion of a protein in an organelle that is modified . by analysis of complex mixtures ,
the protein profiles of organelles in different functional states or extracted with different ionic strengths can be compared more comprehensively and rapidly than with classical approaches . in the past two years , organellar proteomics
has also profiled mitochondrial , chloroplast , and nucleolar   proteomes , uncovered minor golgi proteins , and compared functional states of the golgi .
the speed of proteomics can produce petabytes of data far faster than we can analyze them .
it thereby allows a wider range of comparative analyses than has so far been possible .
the roads opened by comparative proteomics will one day provide a complete map of all the cellular proteins in each organelle in each tissue at each stage of development . through comparison of this map with datasets generated from people with particular diseases , proteomics
the opening of the nuclear envelope by proteomics has already identified new inm proteins and produced a catalogue of yeast npc proteins .
schematic of the nuclear envelope . the outer nuclear membrane ( onm ) and inner nuclear membrane ( inm )

Answer:
proteomic studies have the potential to comprehensively define the composition of organelles but are limited by the organellar cross - contamination that arises during subcellular fractionation .
 comparative proteomics of organellar subfractions can mitigate these problems , as demonstrated by a recent study involving the nuclear envelope .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
cryptosporidiosis is a parasitic disease that causes diarrhea lasting for about 1 - 2 weeks among the immunocompetent and becoming a more severe life - threatening illness among immunocompromised individuals .
it constitutes 24% of human immunodeficiency virus ( hiv ) positive patients with diarrhea compared with 6.1% in the immunocompetent individuals .
association of cryptosporidiosis with malignancies is not as robust as acquired immunodeficiency syndrome ( aids ) . here
, we report a case of cryptosporidiosis causing severe persistent diarrhea in a patient with multiple myeloma .
the case we present here is the patient was a 64-year - old female who had been diagnosed to have multiple myeloma , stage iii b , type igg kappa 17 years ago in 1993 .
she was being treated with oral lenalidomide ( 25 mg for 21 days ) and dexamethasone ( 40 mg on days 1 , 8 and 15 ) of 28 days cycle for the current progression of myeloma .
the baseline serum m band prior to the start of this regimen was 3.4 g / dl .
she presented on day 17 of the 2 cycle with the complaints of profuse watery diarrhea , 10 - 12 times / day for the previous 15 days .
the diarrheal product was non - bloody , without any mucus and not foul smelling .
this was associated with nausea , mild crampy abdominal pain and a sense of fecal urgency without any fever .
there was anemia ( hemoglobin of 9.7 g / dl ) and leucopenia ( white blood cells count 2800/mm ) but the absolute neutrophil count ( 1700/mm ) and platelets were normal .
the liver and renal function tests were within normal limits but serum potassium was low ( 2.2 meq / l ) .
the routine blood culture was sterile and the polymerase chain reaction test in peripheral blood for cytomegalovirus deoxyribonucleic acid was negative .
stool examination showed 2 - 3 polymorphonuclear leucocytes per high power field with mucus but no visible or occult blood .
colonoscopy was performed , which suggested colonic mucosal inflammation likely to be infective in origin [ figure 1 ] . at this point ,
a diagnosis of cryptosporidial infection was suspected and the stool was submitted for examination with the modified kinyoun acid - fast stain .
the patient was then started on oral nitazoxanide 500 mg 12 hourly for 10 days .
the diarrheal frequency decreased after 5 days and it resolved completely by the 10 day of this drug .
the patient was able to resume treatment with lenalidomide and dexamethasone later without any complications .
colonic mucosal inflammation on colonoscopy of the patient oocysts of cryptosporidium parvum in modified kinyoun acid - fast stain
cryptosporidiosis is a protozoal intestinal infection caused by many species of the genus cryptosporidium that are either obligate human or human and bovine parasites .
the first association with human diarrheal disease was reported in 1976 , one case in an otherwise healthy child and one in an immunosuppressed adult . the infection is acquired by ingesting parasites in water or food contaminated by human or animal feces or by having contact with soil , a person , or an item that has been contaminated with the parasite . the diagnosis is established by demonstration of oocysts in the stool by the modified acid - fast kinyoun stain . since the initial reports
four clinical syndromes of cryptosporidial infection have been described in hiv positive patients : chronic diarrhea ( affecting 36% of patients ) , cholera - like disease ( 33% ) , transient diarrhea ( 15% ) and relapsing illness ( 15% ) .
the severity of illness is related to the cd4 count in these patients . in immunocompetent patients , usually children < 5 years of age
the clinical presentation in our patient with severe diarrhea of 2 weeks duration that resulted in dehydration and dyselectrolytemia was more consistent with an underlying immunodeficiency which is expected in a patient with long standing multiply treated myeloma .
although uncommon , cryptosporidial diarrhea has been described in patients with malignancy . in one study ,
the incidence of cryptosporidiosis was 1.3% in the 560 cancer patients presenting with symptoms of diarrhea out of which 71% had hematolymphoid malignancy .
in other studies it was found that the risk of severe disease is largely limited to children with acute leukemia and lymphoma .
interestingly , bone marrow transplantation does not seem to confer any additional risk over that of the underlying disease .
cryptosporidial diarrhea should be included in the differential diagnosis of any patient with persistent severe diarrhea , especially in patients with hematological malignancies .
diagnosis can be established by stool examination and administration of nitazoxanide is effective in controlling the infection .

Answer:
cryptosporidiosis is a protozoal infection that leads to self - limited diarrheal disease in immunocompetent individuals and a more severe illness in immunocompromised patients especially those infected with the human immunodeficiency virus .
 although patients with hematolymphoid malignancies can develop this infection , it is an uncommon cause of diarrhea in these patients .
 the patient was a 64-year - old woman , a known case of multiple myeloma for 17 years , who had been treated with multiple lines of chemotherapy earlier .
 she was being treated with lenalidomide plus dexamethasone for active myeloma at the time of this episode .
 she presented with profuse watery diarrhea of 15 days duration that was proven to be due to cryptosporidium parvum on stool examination . the diarrheal illness resolved after treatment with nitazoxanide .
 although uncommon , cryptosporidial infection should be suspected in patients with hematological malignancies who have persistent diarrhea .
 stool examination with the modified acid - fast kenyoun stain establishes the diagnosis in the majority of cases .
 antiparasitic treatment is effective in controlling the infection .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
incompetence in locating , cleaning and shaping or obturating the complete root canal system causes primary and post - treatment infections which often lead to endodontic treatment failures . however , the most significant reason for the root canal treatment failure is insufficient knowledge about the root canal morphology and its variations .
this is because such unexplored areas of root canal system remain unaffected by instruments and antimicrobial substances and form the seat for the persistent infection .
thus , it is critical to assess the numerous morphological variations of the root canal system before initiating the endodontic procedure .
however , certain internal and external morphological variations in the mandibular canine like single or bifid roots with two or three canals have been reported in the literature . till date , no case report on management of two rooted three canaled mandibular canine with a fractured instrument has been reported in the literature . in the documented case ,
dental operating microscope is used to bypass the fractured instrument in the middle canal of a three canaled mandibular canine with the patients consent .
a 38-year - old healthy asian woman was referred to the endodontic clinic by a general dentist .
the patient presented to her dentist with a severe pain in left mandibular region ten days ago .
the dentist initiated the root canal treatment in left mandibular canine ( tooth # 22 ) . during the cleaning and shaping procedure , an iso # 10 k - file
the dentist could not bypass the fractured instrument and hence the case was opted for the referral . on clinical examination , tooth # 22 did not appear to have any coronal morphological variations and was identical to its right counterpart except it was mesially rotated .
it was tender to percussion without any evidence of mobility , swelling or sinus tract .
careful pre - operative radiographic examination revealed a two rooted three canaled ( i.e. buccal , middle and lingual canals ) mandibular canine with a fractured instrument in the middle canal [ figure 1 ] .
buccal ( a ) , middle ( b ) and lingual ( c ) with a fractured instrument in the middle canal prior to the initiation of root canal treatment , patient was explained about the aberrant root canal morphology and presence of a separated instrument in the middle canal .
patient was administered local anesthetic solution with adrenalin ( 2% lidocaine with 1 : 100000 epinephrine , lox 2% neon lab , india ) . under rubber dam isolation ( hygienic , coltne whaledent inc .
, usa ) , access opening was re - defined with the help of ultrasonic tips ( pro ultra endo tips no . 2 and 3 , dentsply maillefer , new york , usa ) .
careful clinical explorations of access opening with a dg-16 endodontic explorer ( hu - friedy , chicago , il , usa ) revealed two root canal orifices in bucco - lingual direction and were present more towards the buccal side .
moreover , a bleeding point was noted lingually at the end of a developmental fusion line indicating the location of unexplored third root canal orifice .
troughing the developmental fusion line lingually with ultrasonic tips under a dental operating microscope ( carl zeiss surgical gmbh , oberkochen , germany ) revealed a third root canal orifice [ figure 2 ] .
all three root canal orifices  buccal ( a ) , middle ( b ) and lingual ( c ) present alongside the developmental fusion line ( d ) are located with the help of ultrasonic tips and dental operating microscope all the three root canal orifices were coronally pre - flared using a nickel - titanium ( niti ) protaper sx rotary file ( dentsply maillefer , ballaigues , switzerland ) with a brushing outstroke action to improve the straight - line access .
dental operating microscope was used to visualize the fractured instrument present in the apical third of the middle canal . the maneuver to bypass the instrument was initiated in the presence of glyde ( dentsply maillefer , tulsa , ok ) by wedging an iso # 8 k - file ( dentsply maillefer , tulsa , ok ) between the fractured instrument and the canal walls with frequent radiographic checks .
the file was then advanced and withdrawn repeatedly in an attempt to widen the canal space and loosen the retained fragment from the root canal .
so it was decided to prepare the entire root canal system , and incorporate the fragment into the obturation .
the space created between the fractured instrument and the canal walls was enlarged with the larger sized files sequentially till iso # 25 k - file .
working lengths for all three canals were determined with an apex locator ( root zx ; morita , tokyo , japan ) and were confirmed radiographically [ figure 3 ] .
all three canals were prepared using protaper niti rotary instruments ( dentsply maillefer , ballaigues , switzerland ) according to manufacturer 's recommendations .
protaper s1/s2 rotary files were used with brushing outstroke action . finishing files f1 and f2
irrigation was performed using triple distilled water , 2.5% sodium hypochlorite solution ( cmident , india ) and 15% edta ( largal ultra , septodont , saint maur des fosses , france ) .
2% chlorhexidine digluconate ( r4 , septodont , saint maur des fosses , france ) . were used as the final irrigant .
the canals were dried with sterile paper points ( dentsply maillefer , tulsa , ok ) .
the access cavity was sealed temporarily with intermediate restorative material ( irm , caulk dentsply , milford , de ) .
the root canals were again irrigated with triple distilled water to remove the intracanal dressing of calcium hydroxide .
obturation was done by a single cone technique with the use of gutta - percha cones and epoxy resin - based root canal sealer ( ah plus sealer , dentsply maillefer , tulsa , ok ) . in the middle canal ,
tooth was restored using light cured composite resin ( z100 ; 3 m dental products ) .
subsequent follow - up x - ray was taken at 12 months [ figure 4b ] .
working length radiograph with fractured instrument bypassed in the middle canal ( a ) post - obturation radiograph with inclusion of a fractured instrument in the obturation .
essential pre - requisites for a successful endodontic treatment are careful interpretation of pre - operative radiographs , a thorough knowledge and detailed exploration of internal root canal morphology and its divergence under the magnification and illumination .
straight radiograph provides information about the mesio - distal root canal orientation where as angled radiographs ( radiographs at two different horizontal angulations ) provide information about the facio - lingual canal position . any attempt to reduce
the required number of radiographs runs the risk of missing information of the complex canal morphology .
furthermore , a careful tracing of periodontal ligament space suggested the presence of two separate roots with three canals .
the access cavity was extended buco - lingually with the help of ultrasonic tips in order to conserve the tooth structure while searching for an extra and elusive canal orifice .
the internal and external morphological variations of the mandibular canine were clearly appreciable from the radiographic and clinical examination in the present case .
hence , cone beam computed tomography ( cbct ) scan was not done to reduce any extra radiation dosages . even though the mandibular canine shows a single root and a single root canal with single apical foramen in about 92.2% of cases , clinicians should always search for any possible extra root or canal .
root canal morphological variations reported in the mandibular canine include two canals and one apical foramen in 4.9% of cases , two canals and two apical foramens in 1.2% of cases and two different roots each one with one canal in 1.7% of the cases . also two distinct case reports of mandibular canine with three canals in one root or two roots were reported in the past .
hence , it is always prudent to consider all anatomical variations in the mandibular canine while performing a root canal treatment .
any pre - determined assumption about the root canal morphology leads to failure to locate any morphological variation , if present .
it hinders the effective cleaning and shaping and creates a nidus of infection that directly compromises the long term prognosis of the tooth . in the documented case , the fractured k - file in the middle canal prevented the negotiation and thorough biomechanical preparation of the canal .
however , the chances of uneventful retrieval of the fractured instrument were not predictable considering the impossibility of visibility of instrument under dental operating microscope , strategic importance of tooth , the location of the instrument and the limited thickness of the root .
success in management of fractured instrument is defined as the complete removal or complete bypass of the fragment without creating a perforation .
hence , decision was made to bypass the instrument under dental operating microscope to enhance the visualization of operating field and to conserve the maximum root structure . during the bypassing maneuver ,
higher magnification was used with frequent radiographic checks to avoid intra - operative complications like root perforation , ledge formation , pushing the instrument more apically etc .
so , a clear understanding of pulp anatomy and its variations is essential if effective cleaning , shaping and obturation of the pulp space are to be achieved to assure the successful and predictable outcome of endodontic treatment .
mandibular canine with variations in number of roots and root canals should be treated without any pre - operative assumptions regarding its typical single rooted and single canaled anatomy .
thus the present case report highlights the endodontic management of an unusual case of mandibular canine with two roots and three canals .
it also highlights the need for use of dental operating microscope and ultrasonics in locating the elusive canal orifices .
so it is important to note the internal and external root canal morphological variations so that similar anatomy may be predicted and managed successfully . sometimes retrieval of a fractured instrument is impossible or undesirable . in these cases , bypassing the instrument under magnification is a valid alternative , which can lead to a favorable outcome as presented in the given case .

Answer:
it is important to assess the root canal morphology and its variations before initiating the endodontic procedure .
 this is because the inability to clean the complete root canal system forms the seat for the persistent infection which ultimately leads to endodontic treatment failure .
 this case reports the use of dental operating microscope for the successful endodontic management of a two rooted and three canaled mandibular canine with the fractured instrument in the middle canal of a 38-year - old healthy asian woman .
 this case report highlights the need to use the dental operating microscope and ultrasonics in locating the elusive canal orifices .
 it is important to note the internal and external root canal morphological variations before starting the endodontic treatment without any pre - operative assumptions about the usual anatomy of the toot .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
acute mesenteric ischemia ( ami ) is an emergency situation that is caused by circulatory disturbances of mesenteric vessels and is frequently associated with atherosclerosis and cardiovascular disorders .
ami is a complex disease entity including acute mesenteric arterial embolism and thrombosis , mesenteric venous thrombosis , and non - occlusive mesenteric ischemia ( nomi ) .
nomi results from low - velocity blood flow states or from mesenteric vasoconstrictions caused by some drugs .
the abdominal pain caused by intestinal ischemia is not proportional to the physical examination findings , especially in elderly persons .
although computed tomography ( ct ) , magnetic resonance imaging and angiography are valuable diagnostic steps , definite diagnosis of intestinal ischemia frequently depends upon the clinical history because the representation would be subtle and obscure . the majority of patients with ischemic colitis can be treated medically , but approximately 20% of the patients clinically deteriorate to develop peritonitis and sepsis , necessitating surgical intervention with an associated 60% mortality rate [ 1 , 2 ] .
a laparotomy is helpful for rapid confirmation of the diagnosis and for optimal treatment , which often consists of revascularization and resection of the affected bowel .
alcohol is well recognized as a systemic toxin that causes serious health problems , including psychosocial problems , myocardial infarction , stroke and atherosclerosis .
we reported a case of sub - acute ileal and colonic ischemia in an elderly patient , not having a history of cardiovascular disorders , after heavy alcohol intake , and we present a review of the literature .
an 80-year - old male patient was admitted due to uncontrolled diarrhea and abdominal pain accompanied by fever . he became unconscious after drinking 1,800 ml of soju ( korean traditional drink
, 25% distilled alcohol ) in one sitting and was then admitted to a local clinic . after conservative management
, he woke up coherent , but he was referred to ewha womans university mokdong hospital because his diarrhea , fever and abdominal pain had not subsided after 10 days .
he had no history of chronic diseases such as diabetes , cardiovascular disease , hypertension , hepatitis or smoking .
he had had a drinking habit of half a bottle of soju ( 90 ml ) daily for forty years .
on admission , his blood pressure was 110/60 mmhg , his pulse rate was 84 beats / min , his respiratory rate was 24 breaths / min , his body temperature was 36 , and his mental status was clear . he had continuously suffered from diarrhea from the onset of the illness , 6 to 7 times daily , including night - time defecation . upon physical examination , there was mild generalized tenderness with abdominal distension on the whole abdomen and hyperactive bowel sound .
laboratory data included the following : leukocyte count , 14,100/l with no leftward shift ( neutrophil count , 61.8% ) ; hemoglobin level , 12.1 g / dl ; platelet count , 263,000/dl ; total protein , 4.8 g / dl ; albumin , 2.2 g / dl ; aspartate transaminase , 78 iu / l ; alanine transaminase , 103 iu / l ; blood urea nitrogen 8 mg / dl ; serum creatinine , 0.7 mg / dl ; amylase , 82 u / l ; creatine kinase , 48
upright and supine roentgenograms of the abdomen showed the paralytic ileus with bowel distension ( fig .
abdominal ct scan showed circumferential wall thickening of the bowel from the distal ileum to the ascending colon ( fig .
frequently the clinician finds no evidence of alcohol - induced hepatitis or pancreatitis that could be the cause of abdominal pain in patients suffering from alcohol abuse . upon the suspicion of ischemic colitis ,
the patient was treated with intravenous hydration , bowel rest , and broad - spectrum antibiotics .
after 5 days of treatment , he still had intermittent fever above 39 and severe cramping abdominal pain . on day 7
diffuse wall thickening of the terminal ileum to the transverse colon and a large amount of ascites in the pelvic cavity were noted in the ct scan ( fig .
mucosal edema and multiple phlegmons were found on the ascending colon with colonoscopy ( fig .
, symptoms such as diffuse abdominal distension , abdominal tenderness and rebound tenderness were aggravated ; hence , a laparotomy was performed .
when the abdomen was opened , a small amount serous colored ascites was noted in the pelvic cavity .
the outer surface of the ileum ( from the ileocecal valve to the proximal 30 cm ) looked dark brown to blackish with severe edema and a weakening of the tissues of the bowel wall was observed .
also , the findings of the cecum and the ascending colon appeared to be similar to those of the affected ileum .
the gross appearances of the transverse and the descending colon and the sigmoid colon were almost normal .
pathologically , a diffuse acute infarction was present in the ileum and cecum , with acute vasoconstrictions of the mesenteric vessels .
a polyp of 0.4 cm was found on the ascending colon , 13 cm distal to the ileocecal valve , and was revealed to be a mucosal adenocarcinoma .
the postoperative course was uncomplicated , and the patient was discharge in good condition on the 15th postoperative day .
nomi , the dominant non - thrombotic cause of acute mesenteric ischemia , results from low - flow states ( cardiogenic shock , sepsis , and hypovolemia ) , vasoconstriction , or occasionally drugs .
nomi is defined as " intestinal infarction without mesenteric vascular occlusion , " and is the most lethal form of ami , with mortality rates of up to 70% [ 3 , 4 ] .
the condition commonly occurs in elderly patients , but a subset of young patients with mesenteric ischemia has been reported in the literature . in this young population , etiologies were reported as hypovolemic shock , vasculitis , and drug use .
medication and addictive drugs , such as digitalis , oral contraceptives , phenobarbital , ergotamine , furosemide and cocaine , have been implicated in the development of ischemic intestinal disease .
for a long time , alcohol has been known to be a precipitating factor of vasodilatation ; thus , after alcohol intake , the face becomes red , the blood pressure falls and the blood flow increases in the splanchnic vasculature . unlike such physiologic changes
, pathological binge drinking is known to act as a vasocontricting situation and to be the cause of cardiovascular events . during the past ten years
, alcohol consumption has come to be known as a risk factor for developing cerebral vascular diseases , such as stroke .
several studies suggest that ethanol produces prolonged constrictions in cerebral blood vessels , and the vasoconstrictive actions of ethanol are involved in the hypoxic , ischemic and hemorrhagic actions on the brain [ 5 , 6 ] .
although several studies have investigated alcohol 's effect on the vascular system , there are no reports that alcohol - caused mesenteric vasoconstriction directly causes intestinal ischemia .
the mechanism of alcohol - induced splanchnic vasoconstriction is unclear and is thought to be multifactorial .
several mechanisms want for consideration to explain how alcohol causes bowel ischemia in spite of the difficulty in proving a direct causal relationship between the abuse of alcohol and intestinal ischemia . at first
, alcohol may have a direct toxic effect on the gut mucosa and increase bacterial overgrowth in the small intestine [ 7 , 8 ] .
this persistent mucosal irritation is also likely to impair the susceptibility to abundant normal bacterial floras inside the bowel .
another indirect effect of alcohol on the mucosal microcirculation is an enhanced trans - capillary fluid filtration , increasing the permeability of the mucosa to macromolecules , such as endotoxin and/or other bacterial toxin that cause sepsis .
in such a state , the intestinal infection has already started and may result in an irreversible clinical course .
alcohol intake induces abnormalities in the plasma proteins that are required for blood clotting , leading to the formation of blood clots and the thrombotic occlusion of arterioles .
alcohol may induce mesenteric vasoconstriction directly by suppressing the endothelium - dependent vasorelaxation , leading to reduced blood flow and ischemia . in our case ,
the patient had no history of any specific infection , had no predisposing factors for systemic vascular problems , and was healthy for his age .
we tried conservative treatment under the clinical diagnosis of acute gastroenteritis because there was no evidence of thrombus or constricted vessels in the first series of ct scans , but , in spite of bowel rest and conservative management , the symptoms continued for 15 days ( including the treatment period at another hospital ) without improvement
. there were some differences between the operation findings and the ct findings . during surgery ,
however , the distal ileum to the mid - transverse colon showed diffuse ischemic change , and there were much ascites .
pathological examination of the mesenteric vessels harvested revealed neither thrombosis or embolus within arteries or veins nor evidence of inflammatory bowel disease , such as systemic vasculitis and chronic granulomatous inflammation .
extensive mucosal necrosis , which was associated with inflammation of the mucosa and vascular congestion , was consistent with nomi .
it is doubtful that the clinical course of this patient would have been positive if prompt surgery had not been performed . recently , with increasing average life span , the elderly population has been increasing rapidly .
many studies on systemic vascular disorders in the elderly have been reported . in the case of emergency situations such as cerebrovascular disease or cardiovascular disease ,
the best procedure has been established relatively well . however , there are frequent occasions where even doctors can not diagnose an intestinal infarction when a patient presents with an acute abdomen .
fortunately , with the improvement of high resolution ct , the accuracy of the diagnosis of an acute abdomen in the elderly is much improved .
ct may be helpful in determining the primary cause of bowel ischemia and in allowing direct evaluation of the bowel wall , the adjacent mesentery , and vascular structures .
ct is fundamental for early diagnosis and management when evaluating elderly patients with an acute abdomen , and we should have intestinal infarction in mind when evaluating patients with a history of binge drinking .
drug abuse , including excessive alcohol consumption in particular , has become a major health problem in korea .
this report established that , for successful treatment , mesenteric ischemia should be considered in the differential diagnosis of an acute abdomen in patients with a history of alcohol abuse .

Answer:
alcohol is well - recognized systemic toxin that causes numerous adverse effects , including psychosocial problems , fatal myocardial infarction , stroke and atherosclerosis .
 the intra - abdominal complications caused by acute alcohol consumption have not been defined .
 we report an 80-year - old man with sub - acute small bowel and colonic ischemia after heavy alcohol intake in one sitting .
 we performed a resection of gangrenous bowel segments .
 microscopically , there were diffuse infarction , with vasoconstriction of the mesenteric vessels in the ileum and colon without any thrombotic occlusion of the intestinal vessels .
 the clinicians should always be assured by confirmation of a history of recent substance abuse in patients with unexplained abdominal pain , and mesenteric ischemia should be considered in the differential diagnosis of acute or chronic abdominal pain in consumers of alcohol .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
macular edema ( me ) is a complication of branch retinal vein occlusion ( brvo ) with serious adverse effects on vision.1,2 increased intravascular pressure and reduced blood flow in the macular capillaries lead to dysfunction of the endothelial blood
 retinal barrier and to increased vascular permeability , resulting in me.3 although grid laser photocoagulation was previously the only established treatment for me secondary to brvo , visual recovery was slow and limited.1 vascular endothelial growth factor ( vegf ) has been reported to play an important role in the pathogenesis of me secondary to brvo,46 and the introduction of intravitreal anti - vegf treatment has improved the visual prognosis of brvo;710 this treatment has consequently been adopted as the standard treatment . the effect of anti - vegf treatment on the absorption of me is rapid , but most eyes need to be treated repeatedly . in the horizon trial ,
the mean number of injections of ranibizumab was 2.02.4 in the second year after the initiation of the treatment for me associated with brvo.11 previously , some investigators reported the efficacy of pars plana vitrectomy combined with internal limiting membrane peeling for me associated with brvo.1220 it was reported that the reduction in me was not rapid after the surgery but the effect was maintained for years . for eyes with me refractory to repeated intravitreal injections of anti - vegf agents ,
recently , yunoki et al reported the efficacy of pars plana vitrectomy with internal limiting membrane peeling for recurrent me associated with brvo after intravitreal injections of bevacizumab.21 so far , however , limited information is available on this surgical intervention for recurrent or persistent me after anti - vegf treatment . in the study
described herein , we retrospectively investigated the anatomic and functional outcomes of eyes treated with pars plana vitrectomy combined with internal limiting membrane peeling for recurrent me due to brvo , in spite of anti - vegf treatment .
for this retrospective study , we reviewed the medical records of 24 eyes of 24 consecutive patients who underwent pars plana vitrectomy combined with internal limiting membrane peeling for recurrent me due to brvo after anti - vegf treatment at kagawa university hospital from october 2009 through december 2012 .
patients were offered pars plana vitrectomy with internal limiting membrane peeling if they had visual loss caused by recurred me after intravitreal injections of anti - vegf agents .
exclusion criteria were proliferative diabetic retinopathy , vitreous hemorrhage , central retinal vein occlusion , dense cataract , or a short follow - up period of < 6 months after the surgery .
eyes with previous focal scatter photocoagulation were included , but eyes with any previous treatments for me were excluded from the current study ( eg , intravitreal injections of any anti - vegf agent or triamcinolone acetonide , or grid laser photocoagulation ) .
this retrospective study was approved by the institutional review board of the faculty of medicine , kagawa university .
the study adhered to the tenets of the declaration of helsinki . we did not obtain written informed consent from each participant , because according to the guidelines of the institutional review board of the faculty of medicine , kagawa university , it is not necessarily mandatory to obtain informed consent from the patients for a retrospective study in which the researchers reviewed only the patients medical records .
the diagnoses of brvo and me were made by fundus examination and confirmed by fluorescein angiography and optical coherence tomography ( oct ) .
each patient supplied a medical history and then underwent a complete ophthalmologic examination , including best - corrected visual acuity ( va ) measurement with a landolt chart , slit - lamp biomicroscopy , indirect fundus ophthalmoscopy , and oct examination . in each patient
, digital fundus photographs and fluorescein angiography were obtained using a digital fundus camera ( trc-50lx ; topcon , tokyo , japan ) after pupil dilatation .
eyes with brvo were classified as ischemic when the area of nonperfusion was > 5 disk diameters in size.22 macular perfusion status was also determined as complete or incomplete , according to the previous report of finkelstein.23 repeated fluorescein angiography was performed if necessary . to evaluate the condition of me , oct examination was performed ( cirrus ; carl zeiss meditec ag , jena , germany ) at each visit .
central retinal thickness ( crt ) was determined as the average retinal thickness in a 1 mm diameter circular region at the fovea . in the current study , patients who suffered visual disturbances due to me associated with brvo were offered intravitreal injection of bevacizumab ( avastin ; genentech , inc . , south san francisco , ca , usa ) .
the inclusion criterion was eyes with a crt > 300 m . in this study ,
pseudophakic eyes were included , but eyes that had undergone a prior vitrectomy were excluded .
off - label use of bevacizumab was approved by the institutional ethics committee ; the study protocol adhered to the tenets of the declaration of helsinki , and written informed consent was obtained from each patient .
intravitreal injection of ranibizumab ( lucentis ; novartis international ag , basel , switzerland ) was also used for the recurred me after its approval in japan .
for the treatment for recurrent me , all eyes in the current study underwent a standard 25-g three - port pars plana vitrectomy .
after core vitrectomy , posterior vitreous detachment was induced if the cortical vitreous was adherent to the retina .
the internal limiting membrane was peeled ~3.0 disk diameters around the fovea with the use of brilliant blue g. during the surgery , no laser photocoagulation was performed on the nonperfusion area of brvo .
statistical analysis was performed using ibm spss statistics version 21.0 ( ibm corporation , armonk , ny , usa ) .
, va measured with a landolt chart was converted to the logarithm of the minimum angle of resolution ( logmar ) .
repeated measurement of analysis of variance was used to analyze crt and va after the initiation of the treatment .
student s t - test was used for comparisons of the change in va during the treatment between eyes classified by the initial retinal features .
in the current study , 24 eyes of 24 patients with brvo ( ten women and 14 men ) were included ( table 1 ) . at the initial visit ,
no eyes had previously been treated with intravitreal injections of any anti - vegf agent or triamcinolone acetonide , or grid laser photocoagulation .
after the comprehensive ophthalmic examinations , each eye was treated with an intravitreal injection of bevacizumab . immediately after treatment , a reduction in me was achieved .
va was also significantly improved at 1 month after the initial injection ( p=0.0050 ) .
however , all eyes showed recurrence of me , and 14 eyes were received additional injection of anti - vegf agents ( bevacizumab or ranibizumab ) .
mean number of injections of anti - vegf agent was 2.331.46 ( table 2 ) .
one eye was also treated with a subtenon injection of triamcinolone acetonide for recurrent me .
the duration of the initiation of anti - vegf treatment to undergoing pars plana vitrectomy was 232 months ( mean , 10.89.0 months ) . in spite of the treatment for me , all eyes showed recurrent me with subjective visual disturbance .
crt was significantly reduced at 1 month ( p=0.031 ) after the surgery , and the reduction increased with time ( p=0.007 at the final visit ) . with the reduction in crt
mean follow - up after the surgery was 13.810.8 months . at the final visit , however , improvement in va was statistically significant compared with baseline va ( p=0.048 ) , although not significant compared with va before the surgery ( p=0.078 ) .
no serious complications were seen during or after the surgery . in the current study , mean follow - up after the initial treatment was 24.510.8 months .
table 3 shows the comparisons of the change in va and crt during the treatment between eyes classified by the initial retinal features .
the presence of cystoid spaces , serous retinal detachment , or subretinal hemorrhage under the fovea had no significant association with the change in va .
however , the presence of epiretinal membrane showed a significant association with the visual recovery .
although eyes without epiretinal membrane showed visual improvement ( 0.100.32 ) with the treatment , eyes with epiretinal membrane showed greater visual improvement ( 0.380.12 , p=0.012 , figure 2 ) .
since the branch vein occlusion study group reported the efficacy of grid laser photocoagulation for chronic me associated with brvo,1 grid laser photocoagulation has been the only established treatment for me associated with brvo . however , the visual recovery is slow and limited because the average number of lines gained in treated eyes is limited to 1.33 .
now , anti - vegf treatment is generally accepted as the first choice for me associated with brvo.79,24 indeed , the effect of anti - vegf treatment is rapid and remarkable . in the bravo study , the mean improvement in va was 16.6 and 18.3 letters with 6 monthly injections of ranibizumab ( 0.3 mg and 0.5 mg , respectively).10 however , most eyes need to be treated repeatedly . in the horizon trial ,
the mean number of injections of ranibizumab was 2.02.4 in the second year after the initiation of the treatment for me associated with brvo.11 the retain study showed that long - term outcomes in brvo treated with ranibizumab were excellent but that approximately half of the cases still required occasional injections after 4 years.25 although the anti - vegf treatment for me is convenient and has a rapid effect , repeated injections may be a burden for patients . in the current study , an intravitreal injection of bevacizumab achieved rapid reduction in me . in spite of repeated treatment for me , however , all eyes showed recurrent me with subjective visual disturbance .
all our patients treated with pars plana vitrectomy with internal limiting membrane peeling achieved reduction in me . to date , some investigators have reported the efficacy of this surgical intervention for me associated with brvo.1220 however , most reports show efficacy for treatment - naive me , and limited information is available on recurrent me .
recently , yunoki et al showed promising effects of pars plana vitrectomy with internal limiting membrane peeling for recurrent me due to brvo after intravitreal injections of bevacizumab.21 in their report , the improvement in va was achieved as early as 1 month after the surgery while our patients did not as long as 6 months .
this surgical intervention may be a treatment option for me refractory to the anti - vegf treatment .
vitrectomy may have beneficial effects on retinal ischemia by allowing oxygenated fluid to circulate in the vitreous cavity.26 in addition , vitreomacular attachment is suggested to be involved in persistent me in eyes with brvo .
takahashi et al reported that the incidence of me was higher in eyes with no or partial posterior vitreous detachment.27 therefore , induction of posterior vitreous detachment may contribute primarily to the absorption of me associated with brvo .
internal limiting membrane peeling may contribute to the complete removal of traction in the macular area .
previous reports showed that fovea cystoid spaces , fovea serous retinal detachment , and subretinal hemorrhage are signs of poor visual prognosis in brvo.2831 in the current study , these features had no significant association with the change in va .
finkelstein reported incomplete macular perfusion as a sign of good va prognosis in ischemic me.23 in the current study , perfusion status in either the extramacular or the macular area showed no significant association with va improvement .
however , the presence of epiretinal membrane showed a significant association with the visual recovery .
physicians sometimes see eyes with me due to brvo together with a fine epiretinal membrane . in case
the epiretinal membrane is the primary cause of visual disturbance , surgical intervention is indicated . because the treatment effect of anti - vegf agents is limited in vitrectomized eyes because of rapid clearance,32 physicians tend to choose anti - vegf agents as the initial treatment for me even if it is accompanied by a fine epiretinal membrane .
previously , marticorena et al reported that intravitreal bevacizumab may be associated with early development of epiretinal membrane in eyes with retinal vein occlusion.33 when such eyes show persistent me , surgical intervention may help .
this study has several limitations , mainly the small sample size ( especially eyes with epiretinal membrane ) and retrospective study design . in the current study ,
a recent report by yunoki et al showed no favorable va change in eyes with epiretinal membrane or vitreomacular traction after surgery . small sample size in the current study may account for the discrepancy.21 in addition , the noncomparative design of this study prevented determination of whether surgical intervention improved the visual prognosis . in the current study ,
however , as shown in figure 1 , while the reduction in crt was already significant at 1 month , postoperative improvement in va was slow .
in addition , mean va change at 1 month in eyes with combined cataract surgery ( 0.060.33 ) was not different , compared with eyes without ( 0.000.12 , p=0.525 ; data not shown ) .
in the retrospective study reported herein , pars plana vitrectomy combined with internal limiting membrane peeling showed efficacy for recurrent me associated with brvo after anti - vegf treatment .
there is no doubt that anti - vegf treatment is the first choice for me associated with brvo . for recurrent me ,
this is a small case series ; therefore , a prospective study with larger sample populations is necessary to evaluate the efficacy of surgical interventions in such eyes .

Answer:
purposeto evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema ( me ) due to branch retinal vein occlusion ( brvo ) after intravitreal injections of antivascular endothelial growth factor ( anti - vegf ) agents.methodstwenty-four eyes of 24 patients with treatment - naive me from brvo were treated with intravitreal injections of anti - vegf agents
 . recurred me was treated with pars plana vitrectomy combined with internal limiting membrane peeling.resultsafter the surgery , me was significantly reduced at 1 month ( p=0.031 ) and the reduction increased with time ( p=0.007 at the final visit ) . with the reduction in me ,
 treated eyes showed a slow improvement in visual acuity ( va ) . at the final visit ,
 improvement in va was statistically significant compared with baseline ( p=0.048 ) .
 the initial presence of cystoid spaces , serous retinal detachment , or subretinal hemorrhage under the fovea , as well as retinal perfusion status , showed no association with va improvement .
 however , the presence of epiretinal membrane showed a significant association with the visual recovery .
 although eyes without epiretinal membrane showed visual improvement ( 0.100.32 in logarithm of the minimum angle of resolution [ logmar ] ) , eyes with epiretinal membrane showed greater visual improvement ( 0.380.12 in logmar , p=0.012).conclusionfor recurrent me due to brvo after anti - vegf treatment , particularly when accompanied by epiretinal membrane , pars plana vitrectomy combined with internal limiting membrane peeling might be a possible treatment option .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
trauma to the popliteal arteries resulting in pseudoaneurysm formation is rarely encountered outside the setting of wartime surgery [ 1 , 2 ] .
popliteal pseudoaneurysms ( pps ) account for < 4% of all popliteal artery aneurysms , and hence experience of their management in individual centres is limited [ 35 ] .
the diagnosis of pp may also be delayed due to long - time interval between the initial trauma and symptom onset .
we present the case of a large pp causing acute limb ischaemia to a 37-year - old man .
an otherwise healthy 37-year - old man presented with acute limb ischaemia of recent onset .
his past medical history was significant for smoking as well as a previous gunshot wound to the right lower limb 12 years previously that required fasciotomies .
diagnostic work - up included an arterial duplex scan of the right lower limb , which demonstrated a 5.5 cm  5.2 cm aneurysm of the right popliteal artery and the lack of flow in the right anterior tibial and peroneal arteries .
a ct angiogram was subsequently undertaken to establish the morphology of the aneurysm for preoperative planning , which confirmed the diagnosis but also demonstrated a large number of pellets in the soft tissues surrounding the right knee in keeping with the history of previous gunshot injury to the area .
poor opacification of the right anterior tibial and peroneal arteries was also demonstrated , suggestive of thrombosis or embolization secondary to the popliteal aneurysm .
angiography , via an antegrade right femoral approach , showed a false aneurysm of the popliteal artery at the knee joint level .
a 6 mm  25 mm viabahn ( gore ) covered stent was deployed to exclude the pseudoaneurysm , and a thrombolysis catheter was left in situ in the below - knee popliteal artery ( fig .  1 ) .
thrombolysis was started using alteplase at a rate of 1 mg / h , with a concurrent infusion of heparin 400 iu / h via the arterial sheath , as per local protocol .
 figure  1:a digital subtraction angiogram of the right popliteal artery demonstrating the pseudoaneurysm , pre- ( a ) and post- ( b ) stenting .
a digital subtraction angiogram of the right popliteal artery demonstrating the pseudoaneurysm , pre- ( a ) and post- ( b ) stenting .
a repeat angiogram after 24 h of thrombolysis demonstrated improved patency while at 48 h excellent patency of the infragenicular vessels was seen ( fig .
2 ) , and the patient was subsequently discharged on dual - antiplatelet and statin therapy . a follow - up arterial duplex performed at 6 weeks post discharge demonstrated excellent patency of the stent graft and infragenicular arteries .

figure  2:a digital subtraction angiogram at presentation ( a ) and after 48 h of continuous alteplase thrombolysis ( b ) demonstrating the improved patency of the infrapopliteal arteries .
a digital subtraction angiogram at presentation ( a ) and after 48 h of continuous alteplase thrombolysis ( b ) demonstrating the improved patency of the infrapopliteal arteries .
pps are a clinical entity that is rarely encountered in civilian medicine , and account for < 4% of all aneurysms of the popliteal artery [ 1 , 2 ] .
its development is considered to be secondary to the formation of a thick fibrous pseudosac following arterial wall injury and haematoma organization .
this rather slow process may explain the usual delay in diagnosis which may range from days to years , with a median delay of 1.5 months .
in our case , the delay in diagnosis was 12 years after the gunshot wound .
the usual presentation is that of a painful , pulsatile mass that may have given rise to complications that may threaten limb function or viability , including thrombotic and embolic events .
a wide range of options exist for the management of pps , including open surgical repair and endovascular treatment options .
surgical methods include the resection of the pseudoaneurysm with interposition grafting , ligation and bypass and primary arterial repair without grafting . finally ,
aneurysm resection and primary end - to - end anastomosis can be considered for small aneurysms .
the limiting factor , however , is the amount of perianeurysmal fibrosis and chronic inflammatory changes that are frequently encountered and hinder the safe performance of open surgical repair [ 1 , 6 ] . in this case , we elected to proceed with an endovascular repair .
the reasons were 2-fold : on one hand , the previous gunshot injury and the subsequent fasciotomies had led to significant deformity of the patients lower limb , while the amount of scarring would make access to the popliteal artery difficult , thus not favouring an open surgical repair .
on the other hand , the distal anterior tibial and peroneal artery thrombosis would require thrombolytic therapy and thus , the endovascular approach was considered more appropriate .
the false aneurysm was excluded with the covered stent prior to starting thrombolysis in order to eliminate the risk of distal embolization of thrombus from within the false aneurysm into the calf arteries during thrombolysis .
endovascular repair has been shown to be a safe and efficient way of treating pps associated with lower morbidity and shorter hospital stay .
careful patient selection , however , is warranted , as increased risk of early occlusion has been reported , and hence may render this approach less desirable [ 7 , 8 ] .
covered stent placement was considered appropriate in this case in order to enable thrombolysis , which would not have been possible immediately after open surgical bypass .
it is unclear whether stenting in this case will be the definitive treatment , as due to the young age of the patient and the anatomical location of the stenting , stenosis or occlusion of the stent is likely in the future . to this end
, the patient has been put on a surveillance programme and will be followed up closely .
a short covered stent ( 25 mm ) was used to avoid compromising future graft anastomotic sites .
thus , the endovascular treatment offered in this case was efficient in dealing with both the acute ischaemia secondary to thrombosis as well as the aneurysm itself in the short term .
on the other hand , the presence of a stent does not preclude open surgery in the future , preferably in an elective setting , and this is the approach the patient selected having being informed of his options .
this case report demonstrates the efficiency of stenting in the acute management popliteal artery pseudoaneurysms with encouraging early radiological and clinical outcomes .

Answer:
pseudoaneurysms of the popliteal artery are a rare clinical entity , accounting for < 4% of all popliteal aneurysms .
 accurate diagnosis and effective intervention is required to prevent potentially limb - threatening complications .
 we present the case of a 37-year - old man with acute limb ischaemia due to distal calf vessel thrombosis secondary to a popliteal pseudoaneurysm that was managed with covered stent placement and thrombolysis .