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Metastatic tumors to the upper gastrointestinal tract were identified by esophagogastroduodenoscopy in 14 patients. Malignant melanoma, breast cancer, and lung cancer were the most common primary cancers in four, three, and three patients, respectively. Osteogenic sarcoma, renal cell carcinoma, Meckel cell carcinoma of the skin, and germ-cell tumor were the primary cancer in the remaining four. The esophagus was involved in three patients, the stomach in 13, duodenum in four, and papilla of Vater in one. Upper gastrointestinal bleeding and anemia were the most common presenting features. There was correlation between symptoms and endoscopic findings in all patients. Involvement of gastrointestinal tract at endoscopy was the initial and only evidence of metastases in all patients without evidence of metastases elsewhere, as evidenced by other diagnostic tests in any of these patients. Endoscopic biopsies and/or brush cytology provided histologic diagnosis in all 14 patients. The endoscopic and nonendoscopic literature regarding metastases to the upper gastrointestinal tract is reviewed. 相似文献
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Joseph?H.?MarcotteEmail authorView authors OrcID profile Kinjal?Patel Ronak?Desai John?P.?Gaughan Deviney?Rattigan Kevin?W.?Cahill Robin?F.?Irons Justin?Dy Monika?Dobrowolski Helena?McElhenney Michael?Kwiatt Steven?McClane 《International journal of colorectal disease》2018,33(9):1259-1267
Purpose
Fluid management within Enhanced Recovery After Surgery (ERAS) protocols is designed to maintain a euvolemic state avoiding the negative sequelae of hypervolemia or hypovolemia. We sought to determine the effect of a recent ERAS protocol implementation on kidney function and on the incidence of postoperative acute kidney injury (AKI).Methods
A total of 132 elective colorectal resections performed using our ERAS protocol were compared to a propensity-matched group prior to ERAS implementation. Fluid balance, urine output, creatinine, and blood urea nitrogen (BUN) were recorded for all patients, and the incidence of AKI was determined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.Results
Implementation of our ERAS protocol decreased average postoperative length of hospital stay (5.5 vs 7.7 days, p <?0.0001) and time to return of bowel function (2.5 vs 4.1 days, p <?0.0001). The rate of postoperative AKI increased following implementation of the protocol (11.4 vs 2.3%, p <?0.0001). However, by the time of discharge, the average creatinine of ERAS patients who had experienced AKI had returned to their preoperative baseline values (p =?0.9037). Significant univariate predictors of AKI in ERAS patients were longer operative times (p <?0.01) and the diagnosis of diverticulitis (p <?0.01). Within our ERAS patients, AKI was associated with a prolonged postoperative length of hospital stay (p <?0.01).Conclusions
Despite the proven benefits of the Enhanced Recovery After Surgery (ERAS) protocols, care should be taken during protocol implementation to monitor for and to prevent acute kidney injury.24.
Sameep Kadakia David Chan Yadranko Ducic Ricardo Cristobal Moustafa Mourad 《Oral and maxillofacial surgery》2017,21(1):7-11
Objective
We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.Study design
The study design is a case series with chart review.Setting
The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.Subjects and methods
The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.Results
Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).Conclusions
Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.Level of evidence
Level of evidence is a 4 case series.25.
Jigar Kadakia MD Mohit Gupta MD Matthew J. Budoff MD 《Catheterization and cardiovascular interventions》2013,82(6):E765-E768
Congenital coronary anomalies are uncommon but can cause sudden cardiac death or myocardial ischemia. Conventional coronary angiography is an invasive and expensive modality, sometimes unable to delineate the exact origin and course of an anomalous artery. In this case report, we describe an “extremely rare” anomaly of the right coronary artery where a 64‐slice multidetector computed tomography provided valuable information regarding its exact site of the aortocoronary take‐off and its spatial relationship with the great vessels. Knowledge of CT appearances and an understanding of the clinical significance of these anomalies are essential for making the correct diagnosis and planning patient treatment. © 2010 Wiley Periodicals, Inc. 相似文献
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Gary N. McAbee D.O. Sheryl E. Siegel M.D Satish Kadakia M.D. Eric Cantos M.D. 《Headache》1993,33(3):143-144
SYNOPSIS
Twenty four pediatric migraineurs were prospectively evaluated to determine if white matter hyperi ntensities were presenton magnetic resonance imaging (MRI). None had white matter findings or brain abnormalities. Five had mucoperiosteal thickening of the paranasal sinuses, which were unrelated to the patients' clinical course. MRI white matter findings are probably not a common occurrence in pediatric migraineurs. In addition, MRI sinus findings are not necessarily related to a child's headache complaints. 相似文献
Twenty four pediatric migraineurs were prospectively evaluated to determine if white matter hyperi ntensities were presenton magnetic resonance imaging (MRI). None had white matter findings or brain abnormalities. Five had mucoperiosteal thickening of the paranasal sinuses, which were unrelated to the patients' clinical course. MRI white matter findings are probably not a common occurrence in pediatric migraineurs. In addition, MRI sinus findings are not necessarily related to a child's headache complaints. 相似文献
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Arnav Kumar Kimi Sato Kinjal Banerjee Jyoti Narayanswami Jorge Betancor Vivek Menon Divyanshu Mohananey Anil Kumar Anumandla Abhishek C. Sawant Amar Krishnaswamy E. Murat Tuzcu Wael Jaber Stephanie Mick Lars G. Svensson Zoran B. Popovi Eugene H Blackstone Samir R. Kapadia 《Catheterization and cardiovascular interventions》2019,93(4):729-738
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