2013 Vol. 4, No. 2

Display Method:
Original Contributions
Abstract:
  Objective  To assess the clinical features and to identify genetic mutations in Chinese patients with X-linked retinoschisis (XLRS).  Methods  Patients were recruited from ophthalmic clinics in Peking Union Medical College Hospital. A cohort of five unrelated XLRS families (including 12 XLRS patients), 10 sporadic XLRS patients, 16 female carriers and 100 normal subjects were enrolled in this study. Clinical evaluation was performed on all probands from 5 unrelated families and 10 sporadic cases involved in this study (15 patients in total). Genomic DNA was extracted from the peripheral leukocytes of 22 patients and 16 carriers. All exons and the flanking introns of the RS 1 gene were amplified by polymerase chain reaction and screened for mutations by direct DNA sequencing.  Results  A total of 11 mutations including p. E72K, p. W92C, p. R102Q, p. W112X, p. S134P, p. R156G, p. P193S, p. R200H, p. R209C, p. R213W and p. R213Q were identified, among which p. W112X and p. S134P were two novel mutations. We did not find any mutation in one sporadic case. Clinical evaluation on patients with RS1 mutation (14 patients in total) showed that reduced visual acuity was the common initial symptom in all 14 patients. The best corrected visual acuity ranged from 0.04 to 0.8. Typical foveal schisis was found in all 14 patients, among whom 6 were found to be with peripheral schisis. Electroretinogram was carried out on 10 patients with RS1 gene mutations and 9 of them displayed electronegative in the standard combined response. Patients with same RS1 mutation exhibited remarkable phenotypic differences.  Conclusions  Chinese patients with XLRS displayed variability in clinical phenotypes. No association was found between the genotypes and phenotypes.
Abstract:
  Objective  To investigate the feasibility of multiplex ligation-dependent probe amplification (MLPA) for the molecular diagnosis of mitochondriopathy.  Methods  Totally 281 patients with suspected mitochondriopathy in Peking Union Medical College Hospital from May 2010 to August 2012 were enrolled in this study. Among them 233 with nervous system damage were from the department of neurology and 48 with suspected Leber hereditary optic neuropathy (LHON) were from the department of ophthalmology. The common mutation sites for mitochondrial disease were detected with MLPA, and the results were verified by mitochondrial DNA (mtDNA) sequencing.  Results  We found 38 cases carried mtDNA mutations from all 281 cases, and the total detection rate was 13.5%. Among 48 cases suspected of LHON, 19 cases (39.6%) were found containing 3460G > A, 11778G > A or 14484T > C. Among 233 cases suspected of mitochondria related neuropathies, 19 cases (8.2%) were found containing 3243A > G, 8344A > G, 8993T > G or a large deletion. Except that the large deletion could not be sequenced, the other mutations detected by MLPA were all verified as consistent with gene sequencing results.  Conclusions  MLPA is a rapid, accurate, and simple method for detecting mtDNA mutation for common mitochondriopathy. It is feasible to be used in clinical diagnostic laboratory.
Abstract:
  Objective  To evaluate the clinical efficacy of surgical removal of subretinal fibrosis in patients with Vogt-Koyanagi-Harada disease (VKH).  Methods  The clinical data of VKH patients who underwent trans pars plana vitrectomy and subretinal fibrosis removal in our hospital from January 2008 to December 2011 were retrospectively analyzed.  Results  Two male and one female VKH patients (4 eyes), with an average age of 40.7 years (31 to 48 years), were included in this case series. Before surgery, of the 4 eyes, all had subretinal fibrosis in the macula, 1 had mild cataract, and 1 had severe cataract. All the 4 eyes underwent conventional 20-gauge trans pars plana vitrectomy, retinotomy and subretinal fibrosis removal, of which 1 eye was tamponed with C3F8 and the rest 3 were tamponed with silicon oil. An additional lensectomy preserving the anterior capsule with intraocular lens (IOL) implantation was performed in the eye with severe cataract during vitrectomy. No severe perioperative complication was observed. All the 3 silicon oil tamponed eyes underwent successful surgical removal of silicon oil without retinal detachment during follow-up. The 2 eyes without preoperative cataract developed cataract during the follow-up after subretinal fibrosis removal and were successfully treated with phacoemulsification and IOL implantation. Exacerbation of cataract was observed in the eye with mild preoperative cataract and was treated with trans pars plana lensectomy preserving the anterior capsule with IOL implantation during silicon oil removal surgery. The patients were followed up for 1 to 6 months after the last surgical intervention (3.8 months on average) and no active ocular inflammation was observed. When compared to preoperative conditions, improvement in visual acuity was observed in all the 4 eyes in the last follow up visit.  Conclusions  Surgical removal may be a potentially effective treatment for subretinal fibrosis in the macula in VKH patients. Cataract is a common complication after this surgery and requires further surgical intervention.
Abstract:
  Objective  To determine the choroidal thickness in the eyes with idiopathic macular hole (IMH) and the unaffected fellow eyes.  Methods  Twenty IMH patients and 20 ageand sex-matched healthy controls were recruited. Enhanced depth images were obtained using spectal-domain optical coherence tomography. The choroidal thickness was measured in the subfoveal area and 1 mm and 2 mm away from the fovea in the nasal, temporal, superior and inferior regions.  Results  The mean subfoveal area choroidal thickness was (161.53±50.50) μm in the eyes with IMH, (204.95±59.58) μm in the fellow eyes, and (248.00±63.40) μm in the control group (P=0.000). The choroidal thickness at all measured regions showed significant differences among three groups (P < 0.05). Compared with the control group, the choroidal thickness was significantly thinner in eyes with IMH (P < 0.01) and unaffected fellow eyes except for the superior choroidal thickness at 2 mm and inferior choroidal thickness at 2 mm (P < 0.05).  Conclusion  Choroidal thickness decreases in eyes with IMH and may also reduce in the unaffected fellow eyes, suggesting that the development of IMH may be associated with the choroid perfusion.
Abstract:
  Objective  To summarize the clinical characteristics of septo-optic dysplasia (SOD).  Methods  The clinical data of 4 SOD patients who were admitted to our department from April 2009 to December 2012 were retrospectively analyzed. The diagnosis was based on comprehensive clinical evaluations including ophthalmological examination, brain magnetic resonance imaging (MRI) and laboratory tests. All 4 patients were followed up.  Results  All 4 patients had bilateral optic nerve dysplasia, severe visual impairment and nystagmus. One patient had short stature, seizures, mental retardation, nystagmus and insulin-like growth factor 1 (IGF-1) deficiency. The other 3 patients had development retardation. On the brain MRI, one patient showed blurred pituitary structure, thin optic nerves and optic chiasm. Midline brain defects, including absence of corpus callosum brain dysplasia, agenesis of corpus callosum and dilation of ventricular system were observed in the other patients.  Conclusions  Severe visual impairment, optic nerve dysplasia, midline brain defects, pituitary endocrine dysfunction and development retardation are the main clinical characteristics of SOD.
Abstract:
  Objective  To compare the effect of laser in situ keratomileusis (LASIK) surgery after flap creation with a femtosecond laser and a mechanical microkeratome.  Methods  Totally 300 eyes of 150 cases after FEMTO LDV femtosecond laser LASIK surgery (F-LASIK group) and 300 eyes of 150 cases after mechanical microkeratome LASIK surgery (M-LASIK group) were included from our department from July 2011 to July 2012. Uncorrcted visual acuity, dry-eye syndromes including tear film break-up time (BUT), Schirmer Ⅰ test, and corneal fluorescein staining, corneal topography data, and subjective symptoms evaluated with questionnaire were recorded and compared between these two groups.  Results  Primary healing was achieved in both groups. In F-LASIK group, 1 eye had a little fold of flap on the fist postoperative day, which was improved after washing. The expected uncorrected visual acuity was achieved within 1 month after surgery in both groups. The values of steep keratometric power (K1) and flat keratometric power (K2) were significantly decreased 1 month after operation in both groups (P < 0.05), whereas no significant difference was found between these two groups (P>0.05). BUT and Schirmer Ⅰ test results were significantly declined 1 month after surgery, and the FS score significantly increased (P < 0.05). One month after the operation, the average BUT was significantly longer in F-LASIK group than in M-LASIK group (P=0.045). Schirmer Ⅰ test results and the FS score were not significantly different between these two groups (P>0.05). The total score of 9 symptoms in F-LASIK group was significantly lower than that in M-LASIK group (Z=-0.989, P=0.043). The score of satisfaction in F-LASIK group was significantly higher than that in M-LASIK group (Z=-2.316, P=0.021).  Conclusions  Both traditional LASIK and FEMTO LDV LASIK can achieve good visual acuity and improve quality of life. However, the incidence and severity of dry eye is lower in FEMTO LDV LASIK than in traditional LASIK.
Abstract:
  Objective  To investigate the advantage and feasibility of three-dimensional computed tomography (CT) reconstruction technique for optic canal fracture evaluation.  Methods  After the removal of soft tissues, 16 anatomical markers were selected from the optic canals of one Jackal dog for measurement. One ophthalmologist and one radiologist carried out the measurement independently. The 16-planar spiral CT (Sensation 16, Siemens) was adopted for CT reconstruction, using the interval of 0.1 mm. Reconstructive threshold series was built up based on anatomical results of one optic canal. The threshold series included width, level, brightness, opacity, and thickness et al, during multi-planar reconstruction (MPR), surface rendering technique (SRT), volume rendering technique (VRT), and InSpace technique. According to the threshold series from above, CT spatial measurement was made for all the measuring points agreed between two observers. Rotational projection method was used for measuring. According to common types, fracture models were made from 18 optic canals (9 Jackal dogs), including tear fracture, greenstick fracture, rupture fracture, sink fracture, and comminuted fracture. Surface shaded display (SSD), maximum intensity projection (MIP), VRT and InSpace techniques were applied in CT reconstruction. Comparison was made between the CT reconstruction result and the anatomy of the fracture models. CT virtual endoscopy (VE) technique was applied to reconstruct and fly through the optic canal dynamically, so as to evaluate the recurrence of three-dimensional anatomy.  Results  InSpace technique combined with the rotating planar projection was a reliable method to measure the length of diameter line in space quantitatively. The measurement results using this method showed no significant difference with the anatomical measurement results (P=1.00). The whole spatial morphology of optic canal could be exhibited by SSD, VR, and InSpace technique. The sensitivity and accuracy of each technique were different depending on the fracture type. InSpace technique showed good result for most fracture types, except the sink fracture. SSD was excellent in displaying the sink fracture, although it presented worse for the sharp fracture compared with InSpace and VRT. MIP was not satisfactory in displaying most fracture types. VRT generally appeared to be the medium between InSpace and SSD in displaying optic canal fracture. Three-dimensional reconstruction combined with MPR remarkably improved the sensitivity for detection of fracture. VE technique presented the inner structure of optic canal clearly. Moreover, it could differentiate between fracture and variation. The effect of VE reconstruction was excellent in terms of spatial appearance and topography.  Conclusion  Volume CT scanning and three-dimensional reconstruction technique is a reliable diagnostic method. The combination of different reconstructive methods can effectively evaluate the optic canal fracture.
Abstract:
  Objective  To explore the effectiveness and complications of retinal detachment surgery.  Methods  A total of 68 patients (70 eyes) received different retinal reattachment surgeries based on the retinal detachment type and severity. Best corrected visual acuity (BCVA), retinal attachment condition, and complications were observed before and after the surgery.  Results  Among these 70 eyes, 62 eyes (19 eyes with silicone tamponade) were reattached completely to the first surgery. The reattachment rate was 88.6%. Six eyes received a second and/or third surgery, and the final retinal reattachement rate was 97.1%. The preoperative BVCA was less than finger count in 46 eyes (65.7%). After (5.3±2.2) months of follow-up, the postoperative BVCA was more than 0.05 in 58 eyes (82.9%). Comparison of the visual acuity showed significant difference before and after surgery (χ2=58.26, P=0.000). The postoperative complications included sore eye (n=1), focal preretinal proliferation (n=3), cataract (n=5), and secondary glaucoma (n=8).  Conclusion  Timely and reasonable reattachment surgeries can effectively treat retinal detachment and improve vision.
Abstract:
  Objective  To observe the application and effectiveness of corticosteroid therapy for the initial cases of Vogt-Koyanagi-Harada disease (VKH).  Methods  Totally 21 VKH cases (42 eyes) from January 2008 to January 2012 in our hospital with initial onset and duration within a week were administered with prednisone of 120-140 mg/d at early morning. The dosage was reduced 20 mg every 3 to 5 days based on the condition improved and reduced 10 mg every 5 days when the dosage reached 80 mg/d, then reduced 5 mg every week from 60 mg/d. When the dose reduced to 15 mg/d, it was maintained for 1-2 months. After that the dose should be gradually reduced by 5 mg per week until zero.  Results  One day after treatment, headache disappeared and visual acuity improved in all patients. On the third day, the visual acuity improved significantly and retinal detachment improved remarkably. On the seventh day, there were 36 eyes (85.7%) with visual acuity ≥ 0.5 and retinal detachments disappeared in all eyes. One month later, the visual acuity returned the optimal levels before the onset in all patients. No serious corticosteroid complications occurred during the treatment. During the 12to 36month follow-up, no recurrence was noted.  Conclusion  Initial treatment with high-dose corticosteroids followed by prolonged corticosteroid therapy can effectively control the VKH.
Abstract:
  Objective  To evaluate macular morphological changes by spectral domain optical coherence tomography (3D OCT) in patients with persistent subclinical subretinal fluid after successful scleral buckle surgeries.  Methods  Totally 19 cases (21 eyes) with incomplete visual acuity recovery or metamorphosis were reviewed. 3D OCT was performed in the macula (size:6 mm×6 mm×1.7 mm; resolution:512×128). The morphological changes of macula including thickness of foveal neuroepithelium, neuroepithelial detachment, inner segment/outer segment (IS/OS) junction were recorded.  Results  3D OCT showed persistent subclinical subretinal fluid in 15 eyes, and all of them occurred in patients with preoperative macular detachment. Also, 14 of 15 eyes showed disruption of the photoreceptor IS/OS junction, 2 showed irregularity of retinal pigment epithelium reflection signal, and 2 showed thin epiretinal membrane. Seven of these 15 eyes showed discontinuous retinal detachment. During the 3to 12month continuous follow-up for 7 eyes, the neuroepithelial detachment finally disappeared, and the best corrected visual acuity returned to 0.7-1.2.  Conclusions  3D OCT can demonstrate areas of persistent subclinical subretinal fluid after successful scleral buckle surgeries. Most patients have neural epithelium shallow detachment as well as complete and enhanced IS/OS junction signal.
Abstract:
  Objective  To evaluate the effectiveness of vitrectomy in treating polypoidal choroidal vasculopathy (PCV) associated with vitreous hemorrhage.  Methods  We retrospectively analyzed the clinical data of 29 patients (18 males and 11 females, 29 eyes) who were first diagnosised as vitreous hemorrhage and ultimately confirmed to be with PCV after the standard pars plana vitrectomy (PPV) between July 2007 and August 2012 in our hospital. These patients aged 40 to 84 years (mean:61.5±11.5 years). The best corrected visual acuity (BCVA) was light perception in 5 eyes, hand moving in 17 eyes, counting finger in 3 eyes, < 0.1 in 3 eyes, and ≥ 0.1 in 1 eye. PPV were performed in all 29 eyes, among which 13 were given gas tamponade and 14 were given oil tamponade. Cataract extraction was performed for 14 eyes. The follow-up lasted 1 to 84 weeks (mean:33 weeks).  Results  The BCVA was improved in 23 eyes (79.3%), and remained stable in 6 eyes (20.7%). At the end of the follow-up, the BCVA was ≥ 0.3 in 4 eyes, ≥ 0.1 in 6 eyes, ≥ 0.01 in 9 eyes, counting finger in 5 eyes, and hand moving in 5 eyes. The BCVA showed significant difference before and after the operation(t=6.032, P < 0.05). Retina remained attached in 28 eyes, including 8 eyes with silicone oil tamponade. Nevertheless, retina detachment was observed in one patient. All these 29 eyes had massive subretinal hemorrhage during the surgery, which was somehow absorbed after the surgery. In 7 patients, the blood was completely absorbed, leaving exudative membrane or pigment disorder.  Conclusions  PPV is effective for the treatment of vitreous hemorrhage in PCV patient. When in combination with silicone oil or gas resules, it can achieve retinal reattachment and improve the vision in most patients.
Abstract:
  Objective  To analyze the causes of uveitis recurrence with an attempt to improve uveitis management.  Methods  Totally 99 patients with uveitis recurrence from July 2011 to September 2011 in uveitis clinic of Peking Union Medical College Hospital received a questionnaire-based survey on the potential causes of the relapses.  Results  Among these 99 patients with uveitis recurrence, the causes of relapses were found in 92 patients (92.9%), and 70.7% patients had two or more causes. And the relapse was associated with the withdrawal or switching of glucocorticoids or immunosuppressive agents in 53.5% patients, particularly among those with Behcet's disease (71.9%) or Vogt-Koyanagi-Harada syndrome (77.8%). The recurrence was also found to be related with fatigue (37.4%), biological clock disorder (24.2%), systemic diseases (22.2%), and mood swings (22.2%). Other factors included constipation (12.1%), climate and geographical changes (8.1%), improper diets (7.1%), and excessive alcohol and tobacco use (6.1%). The cause was unclear in 7 patients (7.1%).  Conclusions  During the treatment of uveitis, inappropriate medication, fatigue, biological clock disorder, other diseases, and mood swings may trigger its recurrence.
Abstract:
  Objective  To analyze the change of corneal topography after excimer laser photorefractive keratectomy and the influence of surgery types and ablation ratios.  Methods  A total of 52 myopic patients (103 eyes) underwent excimer laser refractive surgery in our hospital from August 2008 to February 2009. The patients were grouped by the type of surgery:laser in situ keratomileusis (LASIK) group (27 patients, 53 eyes) and advanced surface ablation (ASA) group (25 cases, 50 eyes). In both groups, the patients were subgrouped by ablation depth/corneal thickness ratio (AD/CT):subgroup 1 (AD/CT ≤ 0.15) and subgroup 2 (AD/CT > 0.15). Routine ophthalmological examinations and corneal topography were performed before operation and 1 week, 1 month, and 3 months after operation. The main outcome measures included surface asymmetry index (SAI), surface regularity index (SRI), Δsimulated keratoscopy reading (ΔSimK), and simulated keratoscopy reading (SimK).  Results  In subgroups L2 and A2, all the three postoperative SAI values improved significantly compared with preoperative values (P=0.000), but not in subgroups L1 and A1 (P>0.05). In subgroup L2, the SRI value improved significantly 1 week after surgery (P=0.010), but not after 1 month and 3 months (P > 0.05). In subgroup A2, the SRI values improved significantly 1 week and 1 month after surgery (P=0.000, P=0.005), but not after 3 months (P > 0.05). The SRI showed no significant difference among different time points in both subgroup L1 and A1 (P > 0.05). In all patients, both ΔSimK and SimK equivalent value decreased significantly after the operation (P=0.000). The changes of SAI and ΔSimK were influenced by both surgery type and the ablation ratio (P < 0.05), while the changes of SRI and SimK equivalent only by ablation ratio (P < 0.05).  Conclusions  The postoperative corneal topographic parameters change after excimer laser refractive surgery. The changes after LASIK are larger than those after advanced surface ablation, and the changes increase with the ablation ratio.
Abstract:
  Objective  To study the clinical features of spectral domain optical coherence tomography (SD-OCT) scanning in patients with central serous chorioretinopathy (CSC).  Methods  Thirty-four patients (40 eyes) with confirmed CSC underwent SD-OCT scanning and fundus fluorescein angiography (FFA). Clinical findings in both examinations were analyzed and compared.  Results  As shown by SD-OCT, local neuro-retina detachments in macular areas were found in 37 of 40 eyes (92.5%), and retinal pigment epithelium (RPE) detachments without neuro-retina detachments were found in 3 eyes (7.5%). In the eyes with neoro-retina detachments, high and thickened signals of photoreceptor inner segment/outer segment (IS/OS) junction were found in 9 eyes (24.3%), and low or disappeared signals of IS/OS junction were found in 28 eyes (75.7%). Twenty of 37 eyes (54.1%) with neuro-retina detachments had RPE detachments, 12 eyes (32.4%) had small RPE elevations or thickened RPE layer. RPE detachments in both SD-OCT and FFA in 3 eyes kept consistent. In 28 eyes, RPE lesions in SD-OCT were found in the same area of the fluorescein leakage spots in FFA. More RPE detachments and neuro-retina detachments were found in SD-OCT than in FFA.  Conclusions  Small RPE elevations, thickened RPE layer, or RPE detachments can be found in the retinal detachment areas by SD-OCT in most CSC patients. Low or disappeared signals may exist in the IS/OS junction.
Abstract:
  Objective  To summarize our experiences in the diagnosis and treatment of primary abdominal cocoon.  Methods  The clinical data of 12 patients with abdominal cocoon who were treated in the general surgery department of Peking Union Medical College Hospital from January 2002 to January 2012 were retrospectively analyzed.  Results  Of these 12 patients, there were 8 males and 4 females. The main clinical manifestations included abdominal pain, abdominal distention, nausea, vomiting, and abdominal mass. Ultrasonography was the most frequent diagnostic approach. Computed tomography (CT) was performed in 6 cases, among whom only one patient was considered to be with abdominal cocoon. All these 12 patients received surgical treatment and 8 of them underwent partial intestinal excisions. The postoperative exhaust time was (5.8±3.0) days; the time to foodtaking was (14.8±3.6) days; and the mean hospital stay was (28.2±6.5) days. The postoperative complications included delayed gastric emptying (n=6), abdominal infection (n=4), and anastomotic fistula (n=2). Three patients (25%) died after the surgery due to sever infection and the remaining patients were followed up for 16 months (mean). Six patients well recovered, whereas the remaining 3 patients had incomplete intestinal obstruction and were given conservative treatment.  Conclusion  The preoperative diagnosis of abdominal cocoon remains challenging. Abdominal ultrasonography is the most commonly applied examination, and enhanced CT may facilitate the diagnosis. Surgery should be performed for patients with recurrent acute or chronic intestinal obstruction.
Abstract:
  Objective  To investigate the risk factors, labor characteristics, and perinatal outcomes of shoulder dystocia (SD).  Methods  The clinical data of 81 SD cases who were admitted to Peking Union Medical College from January 1993 to December 2012 were retrospectively analyzed. Meanwhile, 6299 cases of term vaginal deliveries of singleton offspring in cephalic presentation during the same period were enrolled as the control group. The risk factors of SD and its influence on the maternal and neonatal outcomes were retrospectively analyzed.  Results  The incidence of SD during this period was 0.47% (81/17 287). The incidence of SD significantly increased in fetuses with gestational age of greater than 40 weeks and in mothers with diabetes mellitus (both P < 0.001). The SD group had significantly higher rates of uterine inertia (54.3%), abnormal fetal heart rate (27.2%), and meconium stained amniotic fluid (22.2%) than in the control group (all P < 0.001). More patients in the SD group received assisted deliveries (24.7%) and episiotomy (93.8%) (both P < 0.001). Newborns delivered after SD had significantly higher rates of asphyxia (19.8%), clavicular fracture (18.5%) and brachial plexus injury (6.2%) (all P < 0.001). Their body weight was also significantly higher (P=0.004). Multivariable analysis showed the independent risk factors for SD included macrosomia (OR=12.7; 95% CI:7.6-21.4), uterine inertia (OR=12.1; 95% CI:7.3-20.1), diabetes mellitus (OR=8.4; 95% CI:5.0-14.8), assisted deliveries (OR=6.6; 95% CI:3.5-12.4) and deliveries after due date (OR=2.6; 95% CI:1.6-4.3) (all P < 0.001).  Conclusions  Macrosomia, deliveries after due date, and diabetes mellitus are risk factors of SD. SD should be suspected when secondary uterine inertia exists or assisted delivery is applied. The maternal and neonatal complications are closely related with fetal weight and assisted deliveries.
Abstract:
  Objective  To evaluate the effectiveness of B-lynch suture in treatment and prevention of postpartum hemorrhage.  Methods  The clinical data of 20 Cesarean section cases who were admitted to our department from January 2006 to January 2012 were retrospectively analyzed. B-lynch suture was placed in 19 patients due to postpartum hemorrhage and in 1 patient for preventing massive hemorrhage with oxytocin and prostaglandins contraindications. The effectiveness, uterine retracting, and other complications were investigated during the follow-up.  Results  The amount of bleeding before and 24 hours after B-lynch suture were 200-4800 ml (median:900 ml) and 50-200 ml (median:100 ml), respectively. Good hemostatic effect was achieved in 17 patients immediately after the suture procedure. In 3 severe cases, the blood loss declined after the procedure, while other interventions including uterine artery ligation and/or embolization were also applied. All patients recovered well after surgery and during the postpartum follow-up. No specific complication was found.  Conclusion  B-lynch suture is a simple and effective surgical technique that can be used to manage postpartum hemorrhage and avoid hysterectomy.
2013, 4(2): 91-94. doi: 10.3969/j.issn.1674-9081.2013.02.001
HTML (68) PDF(22)
Abstract:
2013, 4(2): 95-97. doi: 10.3969/j.issn.1674-9081.2013.02.002
HTML (364) PDF(24)
Abstract:
2013, 4(2): 108-108.
HTML (28) PDF(3)
Abstract:
Abstract:
2013, 4(2): 122-122.
HTML (40) PDF(3)
Abstract:
2013, 4(2): 137-137.
HTML (34) PDF(5)
Abstract:
2013, 4(2): 159-159.
HTML (57) PDF(5)
Abstract:
2013, 4(2): 178-180. doi: 10.3969/j.issn.1674-9081.2013.02.020
HTML (25) PDF(6)
Abstract:
2013, 4(2): 181-184. doi: 10.3969/j.issn.1674-9081.2013.02.021
HTML (25) PDF(21)
Abstract:
2013, 4(2): 184-184.
HTML (56) PDF(0)
Abstract:
2013, 4(2): 185-190. doi: 10.3969/j.issn.1674-9081.2013.02.022
HTML (84) PDF(6)
Abstract:
2013, 4(2): 191-194. doi: 10.3969/j.issn.1674-9081.2013.02.023
HTML (62) PDF(29)
Abstract:
2013, 4(2): 195-200. doi: 10.3969/j.issn.1674-9081.2013.02.024
HTML (118) PDF(3)
Abstract:
2013, 4(2): 201-203. doi: 10.3969/j.issn.1674-9081.2013.02.025
HTML (21) PDF(6)
Abstract:
2013, 4(2): 203-203.
HTML (40) PDF(0)
Abstract:
2013, 4(2): 204-207. doi: 10.3969/j.issn.1674-9081.2013.02.026
HTML (24) PDF(3)
Abstract:
2013, 4(2): 208-210. doi: 10.3969/j.issn.1674-9081.2013.02.027
HTML (25) PDF(1)
Abstract:
2013, 4(2): 210-210.
HTML (65) PDF(5)
Abstract:
2013, 4(2): 211-212. doi: 10.3969/j.issn.1674-9081.2013.02.028
HTML (22) PDF(1)
Abstract:
2013, 4(2): 212-212.
HTML (30) PDF(7)
Abstract:
2013, 4(2): 213-216. doi: 10.3969/j.issn.1674-9081.2013.02.029
HTML (29) PDF(4)
Abstract:
2013, 4(2): 217-220. doi: 10.3969/j.issn.1674-9081.2013.02.030
HTML (34) PDF(12)
Abstract:
2013, 4(2): 220-220.
HTML (38) PDF(6)
Abstract: