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排序方式: 共有283条查询结果,搜索用时 15 毫秒
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Esophageal perforation with subsequent formation of a mediastinal abscess is a well-recognized clinical entity. Causes include perforation due to rigid and fiberoptic endoscopy, bouginage, breakdown of surgical anastomoses, and protracted vomiting. This disorder is associated with a high morbidity and, without intervention, a high mortality. In the past, surgery has been the treatment of choice. Although percutaneous drainage techniques have been used in some cases, they are frequently less attractive due to the location of the esophagus and its proximity to thoracic organs and vascular structures. In this study, eight abscesses caused by esophageal perforations were drained through a transesophageal route with minimal patient morbidity. These cases are presented with a discussion of the techniques and patient follow-up. 相似文献
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Renal and related retroperitoneal abscesses cause significant morbidity and mortality and almost always require drainage. The authors report 18 cases of percutaneous drainage of renal and related retroperitoneal abscesses, all of which were successfully managed. In 11 of these cases (61%), percutaneous drainage constituted the only treatment required. In the remaining seven (39%), the patients' clinical status improved after percutaneous drainage, and they were able to undergo subsequent elective nephrectomy with fewer complications. These results are comparable to those achieved with percutaneous abdominal abscess drainage and justify the use of percutaneous drainage for renal and related retroperitoneal abscesses as the therapeutic procedure of choice. 相似文献
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Efthimiadis GK Meditskou S Vassilikos V Hadjimiltiades S Styliadis IH Parcharidis GE 《Swiss medical weekly》2008,138(21-22):322; author reply 322-322; author reply 323
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Navaneethan U Gutierrez NG Jegadeesan R Venkatesh PGK Sanaka MR Vargo JJ Parsi MA 《World journal of gastrointestinal endoscopy》2014,6(3):74-81
AIM: To identify potential factors that can predict adverse short-term outcomes in patients with acute cholangitis undergoing endoscopic retrograde cholangiopancreatography (ERCP).METHODS: Retrospective analysis of consecutive patients admitted to our center for acute cholangitis and underwent ERCP from 2001 to 2012. Involvement of two or more organ systems was termed as organ failure (OF). Cardiovascular failure was defined based on a systolic blood pressure of < 90 mmHg despite fluid replacement and/or requiring vasopressor treatment; respiratory failure if the Pa02/Fi02 ratio was < 300 mmHg and/or required mechanical ventilation; coagulopathy if the platelet count was < 80; and renal insufficiency if serum creatinine was > 1.9 mg/dL. Variables associated with short term adverse clinical outcomes defined as persistent OF and/or 30-d mortality was determined.RESULTS: A total of 172 patients (median age 62 years, 56.4% female) were included. The median door to ERCP time was 17 h. Bile duct stones were the most common etiology (n = 67, 39.2%). In multivariate analysis, factors that were independently associated with persistent OF and/or 30-d mortality included American Society of Anesthesiology (ASA) physical classification score > 3 (OR = 7.70; 95%CI: 2.73-24.40), presence of systemic inflammatory response syndrome (OR = 3.67; 95%CI: 1.34-10.3) and door to ERCP time greater than 72 h (OR = 3.36; 95%CI: 1.12-10.20). Door to ERCP time greater than 72 h was also associated with 70% increase in the mean length of stay (P < 0.001). Every one point increase in the ASA physical classification and every 1 mg/dL increase in the pre-ERCP bilirubin level was associated with a 34% and 2% increase in the mean length of hospital stay, respectively. Transfer status did not impact clinical outcomes.CONCLUSION: Higher ASA physical classification and delays in ERCP are associated with adverse clinical outcomes and prolonged length of hospital stay in patients with acute cholangitis undergoing ERCP. 相似文献
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Navaneethan U Konjeti R Venkatesh PGK Sanaka MR Parsi MA 《World journal of gastrointestinal endoscopy》2014,6(5):200-208
AIM: To study the cannulation and complication rates of early pre-cut sphincterotomy vs persistent attempts at cannulation by standard approach.METHODS: Systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published up to February 2013. The main outcome measurements were cannulation rates and postendoscopic retrograde cholangiopancreatography(ERCP) complications. A comprehensive systematic search of the Cochrane library, PubMed, Google scholar, Scopus, National Institutes of Health, meta-register of controlled trials and published proceedings from major Gastroenterology journals and meetings until February 2013 was conducted using keywords. All Prospective randomized controlled trials(RCT) studies whichmet our inclusion criteria were included in the analysis. Prospective non-randomized studies and retrospective studies were excluded from our meta-analysis. The main outcomes of interest were post-ERCP pancreatitis, overall complication rates including cholangitis, ERCPrelated bleeding, perforation and cannulation success rates. RESULTS: Seven RCTs with a total of 1039 patients were included in the meta-analysis based on selection criteria. The overall cannulation rate was 90% in the pre-cut sphincterotomy vs 86.3% in the persistent attempts group(OR = 1.98; 95%CI: 0.70-5.65). The risk of post-ERCP pancreatitis(PEP) was not different between the two groups(3.9% in the pre-cut sphincterotomy vs 6.1% in the persistent attempts group, OR = 0.58, 95%CI: 0.32-1.05). Similarly, there was no statistically significant difference between the groups for overall complication rate including PEP, cholangitis, bleeding, and perforation(6.2% vs 6.9%, OR = 0.85, 95%CI: 0.51-1.41). CONCLUSION: This meta-analysis suggests that precut sphincterotomy and persistent attempts at cannulation are comparable in terms of overall complication rates. Early pre-cut implementation does not increase PEP complications. 相似文献