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41.
Bedoui R Nouira R Zribi R Guesmi F Ben Achour J Daghfous M Cherif A Zoghlami A Najah N 《La Tunisie médicale》2002,80(10):645-649
The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery. 相似文献
42.
43.
Mounir C Mohamed K Mahmoud BM Mehrez K Zeid F Chekib K Adel K Naoufel BD Abdelhamid H 《La Tunisie médicale》2005,83(10):607-611
We reviewed retrospectively 40 patients treated surgically for rupture of anterior cruciate ligament. The technique used was arthroscopy bone patellar tendon reconstruction. The mean age of patients was 27 years. The operative delay was 27.2 months in average. Functional and anatomic result was evaluated with a mean follow up of 24 months. 80% of patients were classified IKDC A or B. Sports activity was resumed after 6.6 months in average. Results depented meniscus lesions and operative delay. Reconstruction of anterior cruciate ligament with bone patellar tendon bone is a reliable technique. Operative delay should be as short as possible to prevent meniscus lesion and aggravation of laxity. 相似文献
44.
Diagnostic contribution of HBME-1 and anti-cytokeratin-19 antibodies in thyroid pathology: a retrospective study of 163 cases 总被引:3,自引:0,他引:3
The objective of our study was to estimate the expression of 2 antibodies HBME-1 and anti-cytokeratin-19 and their diagnostic importance in thyroid pathology. MATERIAL AND METHODS: 163 thyroid lesions were retrospectively examined by immnohistochemistry. RESULTS: 92% (46/50 cases) of papillary carcinomas expressed HBME-1 as well as 50% (8/16 cases) of follicular carcinomas and 15% (6/40 cases) of follicular adenomas. 8 insular carcinomas, 5 anaplastic carcinomas, 20 cases of Basedow disease and lymphocytic thyroiditis, and the 24 cases of nodular goiters did not express it or very focally. Anti-cytokératine-19 marked 92% of papillary carcinomas, 56.2% of follicular carcinomas, 100% of the medullar carcinomas and 45% of follicular adenomas. Whereas the cases of anaplastic carcinomas, Basedow disease, thyroiditis and the cases of nodular goiters were negative or focally marked. CONCLUSION: HBME-1 is an excellent marker for papillary carcinoma which can be helpful in the diagnosis of its follicular variant; the association with anti-cytokératine-19 increases its specificity. 相似文献
45.
Rachdi R Kaabi M Zayene H Basly M Messaoudi F Messaoudi L Chibani M 《La Tunisie médicale》2005,83(2):67-72
Severe gravidic toxemia gives heavy maternal and foetal morbidity and mortality. The purpose of our study is to loosen the factors of bad maternal and foetal prognostic. It's a retrospective study about 100 cases of severe and complicated gravidic toxemia repertorieted in the maternity of Military Hospital of Tunis. Maternal morbidity is dominated by the complications of hypertension and a blood disorders. We raised 4 cases of eclampsia, 9 cases of retro placental hematome and 5 cases of HELLP syndrome. We don't deplore any maternal death. Perinatal mortality is 28.8%. The rate of delay intra-uterine growth was 43.8% and the prematurity 65.9%. More toxemia appears early during pregnancy more maternal and foetal prognostic is compromised. 相似文献
46.
Ophthalmologic surgery is not a vital one. It mostly concerns patients in extreme ages: children and old people. The risk of anaesthesia mainly depends on the health conditions of the patient. General anaesthesia through use of intravenous drugs alters the balance of the endocrine and sympathetic systems. Tracheal airway intubation constitutes an added constraint and stress especially for the vascular system. Retrobulbar anaesthesia is not devoid of risks: ptosis, diplopic, orbit haematoma, lesion of the optic nerve, eye perforation, vascular occlusion, intra arterial injection, neurologic and cardiovascular toxic effects of local anaesthetics, are all ever present risk Topical anaesthesia with its various variants (single topic or associated with intracameral injection, subconjunctival, circumferential perilimbal, subtenon) represents an interesting alternative for it is simple, less toxic and harless. In our experience, this method is indicated in surgery of eye's anterior segment. We find it safe, efficacisious and economical. Regional anaesthesia is preferred to general anaesthesia especially in the surgery of dacryocystitis and ptosis. General anaesthesia in stell indicated in case of children. 相似文献
47.
Preoperative concurrent chemotherapy and radiation therapy in cervix cancer: preliminary results 总被引:2,自引:0,他引:2
Kochbati L Ben Ammar CN Benna F Hechiche M Boussen H Besbes M Ben Abdallah M Rahal K Ben Ayed F Ben Romdhane K Maalej M 《La Tunisie médicale》2005,83(3):146-149
This is a retrospective study of patients treated for cervix cancer staged IB2, IIA or IIB with bulky tumor (> 4cm). Treatment was concurrent radiotherapy (45Gy with 1,8Gy daily fraction) and chemotherapy (5 cycles of Platinum 40mg/m2/week). All patients underwent Brachytherapy (15Gy on the reference isodose according to Paris system) followed by surgery (radical abdominal hysterectomy and bilateral pelvic lymphadenectomy: Piver 3) Between October 1999 and December 2002, forty five patients were treated in this protocol. Median age was 46 years (21- 68). Histology was squamous cell carcinoma in 93% and glandular carcinoma in 7%. Average external radiation dose was 44Gy (20-50). Ninety three percent of patients had at least 3 cycles of chemotherapy and 46,5% received the planned 5 cycles. On the operative specimens, there was 62,5% complete response and only 7 pelvic node involvement (17,5%). Four postoperative complications were noted (one vascular injury, one urinary fistula, one phlebitis and one lymph collection). Preoperative combined radiotherapy and chemotherapy in the early bulky stages of uterine cervix cancer is well tolerated and "gives" a high rate of sterilisation. There was no increase in surgical morbidity. 相似文献
48.
OBJECTIVES: sedation is central to the management of intensive care patients. The aim of this study was to establish the current sedation practice in Maghrebian intensive care units (ICUs). The use of sedation policies with or without a written protocol, the use of scoring systems, the influence of costs on drug choice, the most common drugs for sedation and the use of neuromuscular blocking agents. METHODS: a self-administered questionnaire composed of 20 items was sent to 138 intensivists in the Maghreb working in 25 teaching hospitals and 16 private clinics. RESULTS: 50 of 138 questionnaires were returned (response rate = 36.2%). Midazolam and Fentanyl were the main sedative agents used (respectively 98% and 87%) less than 14% of the ICUs used the Propofol mainly in the first 48 hours. A sedation policy was adopted in 63.6% with a written protocol in 20% of cases. Sedation scoring systems were noted in 14.3% of cases (RAMSAY scale in 100%). Economic aspect was important for 64.6% of ICUs. DISCUSSION: sedation may seem secondary in the initial management of intensive care patients, only 63% of our respondents had a sedation policy and 20% a written protocol though its use is thought to improve outcome and reduce costs. Economic aspect was important for the choice of the drug to use (64%), this may explain the preferential use of Midazolam 98% in association with an analgesic (Fentanyl: 85%) while Propofol is used only in 14% though pharmacoeconomic studies may be in fact in favor of the latter. Neuromuscular blocking agents are less frequently used (16%) mainly because of the risk of complications. 相似文献
49.
Beyrouti ML Abid M Beyrouti R Ben Amar M Gargouri F Frikha F Affes N Boujelbene S Ghorbel A 《Presse medicale (Paris, France : 1983)》2005,34(5):385-390
Sarcomas of the small intestine are rare, clearly differentiated, malignant, mesenchymatous tumours that can be of smooth muscle, Schwann cell or fibroblastic origin. From a clinical point of view, the pain and abdominal mass are the 2 types of symptoms that frequently reveal the disease. In rare cases, sarcomas of the small intestine are manifested by an acute complication. No imaging method can clearly confirm the diagnosis. Before immunohistochemistry, differential diagnosis was made on undifferentiated mesenchymatous "stromal" tumours, which are also rare. Exeresis must be complete and without perforation of the tumour because of the risk of locoregional relapse. The benefits provided by chemotherapy and radiotherapy are limited because of the low mitotic activity of the tumour cells and its weak vascularisation. Long-term survival is limited by poor prognosis criteria: high grade malignancy, size greater than 5 cm, tumour extension, perforation of the tumour, quality of surgical resection and histological type. 相似文献
50.
Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases 总被引:1,自引:0,他引:1
Bahloul M Chelly H Ben Hmida M Ben Hamida C Ksibi H Kallel H Chaari A Kassis M Rekik N Bouaziz M 《The Journal of trauma》2004,57(2):255-261
BACKGROUND: This study aimed to determine predictive factors of mortality after posttraumatic brain injury. METHODS: A retrospective study conducted over a 3-year period (1997-1999) involved 437 adult patients with head injury admitted to the intensive care unit of a university hospital in Sfax, Tunisia. Basic demographic, clinical, biologic, and radiologic data were recorded at admission and during the intensive care unit stay. RESULTS: This study included 393 men (90%) and 44 women with a mean age of 36 +/- 17 years. Traffic accidents were the main cause of trauma (85.6%). In 58% of the cases, the injury was serious (Glasgow Coma Score, <8). The mean simplified acute physiology score was 39 +/- 15, and the mean Injury Severity Score was 34.5 +/- 17. Of the 437 patients, 127 (29.1%) died. According to multivariate analysis, the factors that correlated with a poor prognosis were age older than 40 years (p < 0.01), simplified acute physiology score exceeding 40 (p < 0.001), Glasgow Coma Score lower than 7 (p = 0.03), intracranial mass lesion (p = 0.02), a cerebral herniation (p < 0.001), diabetes insipidus (p < 0.001), and blood sugar level higher than 10 mmol/L (p < 0. 001). CONCLUSIONS: In Tunisia, head injury is a frequent cause of hospitalization, comprising 14.4% of all adult admissions. It is observed most often among young patients involved in traffic accidents. The short-term prognosis is poor, with a high (29%) mortality rate, and determined by demographic, clinical, radiologic, and biologic factors. Prevention is highly advised. 相似文献