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The role of computed tomography (CT) in the evaluation of abdominal pain is well established. However, concern exists in regard to procedure‐related radiation levels, contrast‐medium toxicity and costs. We sought to determine whether the use of abdominal CT caused major changes in the management of patients who had abdominal pain and diarrhoea. We reviewed all abdominal CT examinations that were performed at our hospital from October through December 2010. We selected 574 scans that had been performed in patients who presented with or without diarrhoea. We examined the selected medical records to determine whether the CT scan changed patients' management. A scan was considered to be management changing if a decisive intervention occurred on the basis of the scan results. Among 124 scans in patients with diarrhoea and 450 scans in patients without diarrhoea, the scan results changed management in 13 of the patients with diarrhoea (11%) and in 233 of those without diarrhoea (52%) (P < 0.001). When management changed, the changes resulted from findings unrelated to diarrhoea. Despite its defined role in the assessment of abdominal pain, CT of patients that also had diarrhoea seldom caused a major change in management. The probability of CT causing such a change does not outweigh the cost, radiation risk or potential for contrast‐induced nephropathy.  相似文献   
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Transcatheter aortic valve replacement (TAVR) can improve the symptoms and prognosis of patients with severe aortic stenosis who, due to a high expected operative risk, would not have otherwise been treated surgically. If these patients develop prosthetic valve endocarditis, their presentations may be atypical causing a delay in the diagnosis and treatment. The management is also complicated by their comorbidities, and surgical treatment may not be feasible leading to a significant morbidity and mortality. We describe a case of an 85‐year‐old man with TAVI prosthetic valve endocarditis successfully treated medically, discuss the challenges in the diagnosis and management of such patients, and review available literature on the incidence and outcome of the condition. © 2012 Wiley Periodicals, Inc.  相似文献   
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Despite drug eluting stents (DES), as compared to bare metal stents, have reduced in‐stent restenosis, complex and long lesions remains a challenge for interventional cardiologist. Their treatment is often associated with an unfavorable outcome, related to in‐stent restenosis, stent thrombosis, and target lesion revascularization. These complications may derive from the contact between metallic structures and coronary artery endothelium, and consequent overexpression of platelet activating factors, growth factors, and inflammatory cytokines. Recently, an additional mechanism has emerged as new cause of these complications: “stent fracture.” Several factors are involved in this phenomenon including material and stent platform, target vessel features, stent implantation technique, and implant duration. We reported a case of 69 years old man with rare early and complex DES fractures on right coronary that caused acute coronary syndrome 36 hr after a previous percutaneous coronary intervention.© 2012 Wiley Periodicals, Inc.  相似文献   
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We recently showed in a euglycaemic glucose clamp study among 18 healthy volunteers that using jet injectors rather than conventional pens significantly improved the time‐action profiles of rapid‐acting insulin analogs. Here, we investigated whether such profiles were modified by body mass index (BMI) and related weight parameters by comparing insulin administration by jet injection to that by conventional pen in subgroups defined by BMI, waist‐to‐hip ratio, waist circumference and insulin dose. After conventional administration, times to peak insulin levels (T‐INSmax) occurred 31.1 [95% confidence interval (CI) 13.7–48.5] min later and time to maximum glucose requirement (T‐GIRmax) 56.9 (95%CI 26.6–87.3) min later in more obese (BMI > 23.6 kg/m2) than in lean subjects (BMI < 23.6 kg/m2). In contrast, T‐INSmax and T‐GIRmax were similar in subjects with high and low BMI, when insulin was administered by jet injection. We conclude that using jet injection for insulin administration may especially benefit subjects with higher body weight.  相似文献   
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Merkel cell polyomavirus (MCPyV), human polyomaviruses 6 (HPyV6) and 7 (HPyV7) are novel human polyomaviruses. This study investigated their detection rates and DNA loads in various skin cancers from Japanese patients. MCPyV, HPyV6 and HPyV7 were detected in 22.2%, 3.2% and 1.6% of squamous cell carcinomas, 18.0%, 2.0% and 4.0% of basal cell carcinomas, and 19.1%, 4.3% and 4.3% of melanomas, respectively. Quantitative real‐time polymerase chain reaction showed that their DNA loads were low. These findings provide the first evidence of the prevalence of HPyV6 and HPyV7 in skin cancers in Asia. Nucleotide differences were found in the large T‐sequenced region between Japanese and North American isolates: a nucleotide substitution of A to G for HPyV6; and a nucleotide substitution of T to C and the insertion of a gap for HPyV7. This suggested that two genotypes of HPyV6 and HPyV7 would be present and associated with geographical origin.  相似文献   
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