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1.
It is widely accepted that patients presenting with acute anterior myocardial infarction and acute onset of right bundle branch block should be prophylactically paced in contrast with those who have a chronic bundle branch block. The admitting physician is faced with the dilemma of how to act if the age of this conduction disturbance is unknown. This problem has further intensified in recent years, with the introduction of thrombolytic treatment, where insertion of a central vascular line is associated with increased morbidity. The objectives of this study were to define clinical or electrocardiographic parameters that may help the admitting physician to decide whether patients presenting with an anterior wall myocardial infarction and a right bundle branch block of unknown age should be prophylactically paced. We examined prospectively the in-hospital clinical course of 39 consecutive patients presenting with an acute myocardial infarction in whom the age of a right bundle branch block upon admission was unknown (group C, n = 39) and compared it with two similar groups of patients who presented with an acute right bundle branch block (group A, n = 38) and with a known chronic right bundle branch block (group B, n = 22). Thirty-three patients (33%) died, with cardiogenic shock being the leading cause of death in the entire population. Prophylactic pacing, which was carried out in 66% and 54% of patients in groups A and C, respectively, did not reduce mortality rates. No clinical or electrocardiographic variables on admission were predictive to support prophylactic pacing in group C. In 10 of 46 (22%) patients who were prophylactically paced with a transvenous electrode, the following complications attributed to the procedure were detected: (1) either rapid sustained ventricular tachycardia (during implantation) that was unresponsive to overdrive pacing, or ventricular fibrillation necessitating electrical defibrillation (4 patients); (2) recurrent episodes of rapid nonsustained ventricular tachycardia, which stopped only after the pacemaker was turned off (1 patient); (3) complete AV block (1 patient); (4) fever appearing on the third or fourth day after implantation (3 patients); and (4) a large hematoma in the groin in 1 patient who was treated with thrombolysis shortly before pacemaker electrode insertion. Thus, the complications of transvenous temporary pacing in the era of thrombolysis may outweigh any theoretical advantage. (PACE 1995; 18:1496-1508)  相似文献   
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Diuretic renography using radioidine sodium hippurate and a frusemide stimulus was used to differentiate between obstructive and nonobstructive dilatation of the urinary tract. Information was recorded by a gamma camera on line to a computer. Sixty-seven uretero-renal units (URU) were studied in 33 patients with an average age of 91/2 years. The diuretic renogram correctly indicated obstructions in 18 URU but gave false positive results in another five. Of these five, four had severely Impaired function. The renogram indicated nonobstruction in 49 URU, and gave false negative results in another two; of these two one patient had a duplex kidney with a poorly functioning ureteric segment and the other patient had gross reflux and megaureters. The diuretic renogram is useful in the investigation of equivocal upper urinary tract obstruction but may be unreliable in situations of inadequate renal function.  相似文献   
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Thirty-nine patients, aged 3 to 22, who have handicapping conditions were examined twice in a range of 1 1/2 years to determine oral hygiene level, periodontal treatment needs, and level of caries. During this period, each patient was given periodontal treatment, including scaling, caries treatment, and oral health education, which also was given to hospital staff members. Findings showed a slight increase in the DMF rate, a minor improvement in oral hygiene, and a significant reduction in periodontal treatment needs. The results showed that without cooperation of the staff members, a dental education program would not succeed in this setting.  相似文献   
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A 71‐year‐old woman with severe nonischemic dilated cardiomyopathy and low ejection fraction with severe mitral regurgitation and tricuspid regurgitation and pulmonary hypertension underwent multiple valve repairs and cardiac resynchronization therapy implantation with epicardial shock leads. (PACE 2013; 36:e56–e58)  相似文献   
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Studies on the Regulation of Hemopoietic Spleen Colonies   总被引:2,自引:0,他引:2  
The in vivo intrasplenic cloning of haemopoietic cells was used as an experimental system for the study of some aspects concerned with the regulationof erythropoiesis. Experiments on the effects of polycythemia on the formationof erythroid clones demonstrated that the "feedback" suppression of such cloneswas inhibited if the polycythemic animals were kept under hypoxic conditions. Overloading with oxygen is, thus, an essential factor in the polycythemia-induced suppression of erythroid clones. Polycythemic animals whichwere transferred to hypoxic conditions for only 48 hours before the terminationof the experiment showed the formation of erythroid clones. Analysis of cloneformation following such short exposures to hypoxia suggests that the endogenous erythropoietin which had been functioning in this situation actednot upon the single clone-forming cell, but rather on small cell populationswhich derived from the clone-forming cells in the absence of erythropoietin.There is, therefore, an early, erythropoietin-independent phase of replicationof the clone-forming cells. The application of erythopoietin only during this"early" phase of replication resulted in the formation of erythroid clones, which,following the discontinuation of erythropoietin, disappeared from the spleen.Similar results were obtained when the action of endogenous erythropoietinwas terminated by subjecting animals to polycythemic conditions a few daysafter the injection of bone marrow. It appears that in both these cases thereduction in the number of spleen colonies following discontinuation of erythropoietin activity is due to the total maturation of the erythroid colonies,ending in the evacuation from the spleen of the mature red blood cells. Thedifferentiation of the cloned cells is, thus, causally related to the cessation ofthe replicating effect of erythropoietin.

Submitted on June 22, 1966 Accepted on November 24, 1966  相似文献   
7.
Insoluble 2-mercaptopyridine and 2-mercapto-nitrobenzene derivatives were prepared by modification of commercially available polystyrene. Applicability of these polymers as reagents for the thiolytic removal of the 2-nitrophenyl-sulphenyl amino-protecting group and as supports for preparation of polymeric active esters was evaluated. Polymeric 2-mercaptopyridine (PMP) was found efficient for both purposes. It was used in the stepwise synthesis of Leu-enkephalin via the polymeric reagent approach, serving as an Nps-cleaver. Polymeric esters derived from PMP and Boc-amino acids proved to be excellent acylators. Their usefulness is exemplified in the preparation of two dipeptides, which were produced rapidly and in high yields and purity.  相似文献   
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The following hypotheses have been tested: (a) sensation seeking, A–State and Trait and Depressive Mood should positively affect the initiation and continuation of adolescent substance use: and (b) Following Zuckerman's conclusion with regard to the relationships between sensation seeking and drug use, and Khantzian's ‘self medication hypothesis’, different patterns of relationships between personality variables and substance use should be found: Whereas sensation seeking will be associated with substance use regardless of the specific psychopharmacological properties of a given substance, anxiety and depressive mood will be primarily associated with the use of depressants. One thousand nine hundred adolescents, 14–19 years old, were tested twice, 12 months apart, for alcohol and drug use. The major findings were as follows: (a) Sensation seeking was found to affect substance use among adolescents more than State and Trait Anxiety, and Depressive Mood; (b) Sensation seeking differentiated among abstainers, beginners, and users of all substances. A different pattern of relationship between State-Trait Anxiety, and Depressive Moods and substance use was found. These personality variables appeared to differentiate only among those subjects who used depressants; (c) It is also evident that previous experimentation with drugs significantly affect current–use. The implications of these findings for interventions among adolescents are discussed.  相似文献   
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