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11.
Charnchai Panthongviriyakul Julie E Bines 《Journal of paediatrics and child health》2008,44(12):716-721
Aim: To develop an evidence‐based algorithm for the therapeutic approach to the management of post‐operative chylothorax. Methods: Review and analysis of published literature sourced from Medline from 1964–2007. Results: Understanding the pathophysiology of chylothorax and the anatomical structure of the thoracic duct assisted clinical decision making in the management of a patient with chylothorax. Treatment options for post‐operative chlothorax include conservative management with medium chain triglyceride‐enriched diet or total parenteral nutrition in combination with adequate drainage of pleural fluid, somatostatin or octreotide therapy or surgical intervention. Based on analysis of the available evidence an algorithm for therapeutic approach to the management of post‐operative chylothorax has been developed. Conclusion: Post‐operative chylothorax is associated with significant morbidity and prolonged hospitalization. An evidence based algorithm to guide the therapeutic approach to management of post‐operative chylolthorax is proposed. 相似文献
12.
TOSHIYUKI YAMAMOTO TATSUYA KOEDA AKIKO TAMURA HIROSHI SAWADA IKUO NAGATA NAOKI NAGATA TAKASHI ITO YASUYUKI MIO 《Pediatrics international》1996,38(6):689-691
A female infant with 21 trisomy syndrome associated with congenital chylothorax was reported. She was born at a gestational age of 34 weeks by Cesarean section because of fetal hydrothorax and hydrops fetus, confirmed by ultrasonography at 32 weeks. Emergent resuscitation and immediate thoracentesis were performed soon after birth. After beginning breast feeding, the serous pleural fluid became opalescent and a diagnosis of congenital chylothorax was made. Feeding was changed to medium-chain triglyceride (MCT) feeding and the production of pleural effusion disappeared after thoracentesis was performed several times. Accumulating evidence suggested that MCT feeding and intermittent thoracentesis under echo guide were effective. Some reports on patients, including this one, suggest that there may be more patients with 21 trisomy associated with congenital hydrothorax. Therefore, congenital hydrothorax might be listed as a complication of 21 trisomy. 相似文献
13.
Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative
management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the pediatric
and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action
on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial
of the somatostatin analogue, octreotide. A 33 week gestation female infant, born with the presence of large bilateral pleural
effusion, was unresponsive to conservative management. Octreotide was commenced on day 15, with 10 days of an octreotide infusion,
initially 0.5 μg/kg per hour and increased daily by 1 ug/kg per hour to 10 μg/kg per hour. Treatment was associated with prompt
respiratory improvement prior to cessation of pleural drainage over the 10 day. She remains well at 6 months of age. Further
studies are required to ascertain its true value in congenital chylothorax. 相似文献
14.
Disorders of the lymph circulation: their relevance to anaesthesia and intensive care 总被引:7,自引:0,他引:7
The lymphatic system is known to perform three major functionsin the body: drainage of excess interstitial fluid and proteinsback to the systemic circulation; regulation of immune responsesby both cellular and humoral mechanisms; and absorption of lipidsfrom the intestine. Lymphatic disorders are seen following malignancy,congenital malformations, thoracic and abdominal surgery, trauma,and infectious diseases. They can occasionally cause mortality,and frequently morbidity and cosmetic disfiguration. Many lymphaticdisorders are encountered in the operating theatre and criticalcare settings. Disorders of the lymphatic circulation relevantto anaesthesia and intensive care medicine are discussed inthis review. Br J Anaesth 2003; 91: 26572 相似文献
15.
Chylothorax is an uncommon condition rarely seen outside the clinical scenario of trauma or malignancy, and management may be difficult. We report the case of a 52-year-old man with a right chylothorax occurring 23 years after mantle irradiation for Hodgkin's disease. In addition, a Medline literature search was performed. Chylothorax occurring post-irradiation is rare and the aetiology is uncertain. Recurrent malignancy must be excluded. There are a number of management options and our patient was successfully treated with a combination of thoracocentesis, medium chain triglyceride diet and thoracoscopy with talc pleurodesis. There was no evidence of recurrent chylothorax at 2 years follow up. Prompt assessment and treatment is required. Surgical measures need to be considered early if medical treatment is unsuccessful. 相似文献
16.
目的:探讨乳糜胸的成因、诊断、治疗及再次手术的有关问题。方法:回顾分析1992年2月~1998年11月,我院行食管癌手术1203例,并发乳糜胸11例,采取保守治疗3例、手术治疗8例。结果:10例痊愈、1例同时并发乳糜腹和胸内吻合口瘘,术后第30天死亡。结论:乳糜胸应根据胸腔引流量合理选择保守治疗或手术治疗。 相似文献
17.
C. Han L. Guo K.-J. Wang J.-Q. Zhao 《International journal of oral and maxillofacial surgery》2009,38(10):1119-1122
Bilateral chylothorax is mainly encountered following certain thoracic procedures. It is a rare complication following neck dissection, but can be serious and life threatening. The authors report a case of bilateral chylothorax following left modified radical neck dissection, right modified neck dissection and superior mediastinal dissection for bilateral medullary thyroid cancer. The patient was treated successfully with conservative management. The pathophysiology of this complication is discussed and multidisciplinary approach is advocated. 相似文献
18.
Although the accumulation of gas is the most common cause of an expanding interpleural space, the presence of other structures or substances (hydrothorax, gastrothorax, hemothorax, urohemothorax, pyothorax, and chylothorax) under pressure may be sufficient to cause hemodynamic and respiratory compromise. We present two pediatric patients that developed hemodynamic and respiratory effects secondary to a chylothorax. The first patient presented in respiratory distress and cardiovascular collapse 4 weeks after a Fontan procedure. Placement of a chest tube resulted in the release of chyle under pressure and prompt resolution of hemodynamic and respiratory symptoms. The second patient was a 2100 g neonate who developed a chylothorax during an episode of sepsis following gastroschisis repair. On two separate occasions, the development of the chylothorax was associated with tachycardia, oliguria, and increased requirements during mechanical ventilation. Chest tube placement resulted in the release of chyle under pressure and resolution of the symptoms. These two cases demonstrate that chylothorax like pneumothorax can have deleterious effects on hemodynamic and respiratory function. 相似文献
19.
S Caserío C Gallego P Martin MT Moral CR Pallás A Galindo 《Acta paediatrica (Oslo, Norway : 1992)》2010,99(10):1571-1577
Aim: To analyse the main prenatal and postnatal features of congenital chylothorax (CC), and the outcome including mid‐term follow‐up. Methods: We searched our databases for CC diagnosed between 1990 and 2006. Data of 29 cases were retrieved and analysed. Follow‐up until 3 years of age was available for all patients. Results: Most patients were diagnosed prenatally (94%) and most cases were complicated by foetal hydrops (66.7%). The overall survival rate at 3 years was 56%. A significantly poorer outcome was observed when foetal hydrops, preterm birth < 34 weeks, large effusions and/or early‐onset pneumothorax were present. An important but not significant improvement in the survival rate was observed through the study period; while in 1990–1998, the survival rate was 41.7%, from 1999 to 2006 it was 66.7% (p = 0.19). In the mid‐term follow‐up, we did not observe any recurrence of CC and most infants remain asymptomatic. However, 27% of survivors were diagnosed as having asthma in early infancy. Conclusion: CC still carries a significant risk of perinatal mortality. However, continuous advances in foetal and neonatal medicine are improving the prognosis of these patients, and nowadays most of them are likely to survive. Beyond the neonatal period, most survivors have an uneventful outcome. 相似文献
20.
Nobuaki Hirata Takayoshi Ueno Akira Amemiya Norihisa Shigemura Akinori Akashi Tetsuo Kido 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2003,51(8):378-380
We report that an earlier thoracoscopic clipping of the thoracic duct was advantageous in a case of post-operation chylothorax
that occurred following thoracic aneurysm surgery. A 61-year-old man developed chylothrax on postoperative day 2 following
graft replacement of the descending thoracic aorta using a left-sided thoracotomy. Since a replaced graft infection is lethal,
earlier thoracoscopic clipping of the thoracic duct through the right side chest wall was indicated. The patient underwent
thoracoscopic clipping on postoperative day 7 and was successfully treated. The duration of drainage was 2 days and oral intake
was started on the seventh day. From our results, we recommend a thoracoscopic procedure through the opposite (right) side
chest wall in the early stage of chylothorax development following thoracic aneurysm surgery. 相似文献