2018年 · 第34卷第01期

Compared with conventional non-stop coronary artery bypass grafting with median sternal incision (OPCABG), the lower sternal small incision OPCABG is less invasive and can keep the thoracic part intact. It is one of the main surgical methods for three-vessel coronary artery disease^[1,2]。 CTCA has good specificity and sensitivity in assessing vascular patency in coronary artery bypass grafting (CABG)^[3,4]。 This study followed up the 2-year graft patency rate after OPCABG with two different incisions for coronary three-vessel disease, which is reported below.

Morgagni hernia, also known as retrosternal hernia, accounts for 3% of congenital diaphragmatic hernias^[1]Clinically rare, easily missed or misdiagnosed. From October 2008 to August 2017, we diagnosed and treated 5 cases of adult Morgagni hernia with satisfactory results, which are reported below.

Liposarcoma is the most common malignant tumor of soft tissue, accounting for about 20% of malignant tumors from mesenchymal tissue^[1]。 The primary liposarcoma of the mediastinum is rare. It is reported in the literature that the primary liposarcoma of the mediastinum is one of all malignant tumors of the mediastinum<1%^[2,3,4]。 At present, there have been reports of primary mediastinal liposarcoma in China^{[5,6,7,8,9,10]}The vast majority of the reported patients underwent surgical treatment, and the surgical results were acceptable, but recurrence and metastasis have been reported^[11]。 This paper discusses the surgical treatment of primary mediastinal liposarcoma in adults.

Male, 68 years. Fever (up to 37.8℃), fatigue accompanied by right chest tightness and chest pain for more than 10 days, without cough, expectoration, hemophosis and other accompanying symptoms. The patient had undergone endoscopic nasal surgery for "intranasal melanoma" in 2010, and was reoperated for in situ recurrence in 2013, without continuing treatment after surgery. Smoking for 20 years, with an average of 10 cigarettes/day, and having quit smoking for 4 years; No alcoholism, no history of toxic and harmful work, no history of exposure to radioactive materials, and no history of metallurgical travel. If the family does not suffer from similar diseases, there is no familial genetic history. There was no yellowing stain on the skin and mucosa of the whole body, no rash, subcutaneous hemorrhage, subcutaneous nodules and scars, normal hair distribution, no subcutaneous edema, no liver palms and spider nevus. Superficial lymph nodes throughout the body were unpalpable. No breathing sounds were heard in the right lung, no dry or wet rales, no pleural friction sounds, and the right speech resonance was enhanced.

Female, 42 years old, suffered from distension and pain in the right shoulder and both knees for nearly 7 months, and was treated with arthritis and rheumatoid arthritis in another hospital for 3 months without significant improvement; One month after the diagnosis of right upper lung cancer, chest CT showed right upper lung nodules with mediastinal lymph node enlargement, and right cervical lymph node puncture biopsy smear was prone to metastatic adenocarcinoma.

Male, 2 years 4 months. Intermittent fever for about 2 weeks, left thoracic mass found for 5 days. CT scan of the chest in the local hospital showed a huge mass in the left thoracic cavity, mediastinum shifted to the right, and left pneumonia (Figure 1)。 Admission physical examination: clear consciousness, spirit can. The superficial lymph nodes of the whole body were not swollen. The thorax is symmetrical and the left breathing sound is low. The abdomen was flat and soft, without tenderness and rebound pain, and the liver and spleen were not reached under the costs. The muscle strength of the limbs is normal.

Male, 56 years old. Chest pain with chest tightness and shortness of breath for 6 years. The electrocardiogram showed that Q waves were visible in leads Ⅱ and Ⅲ AVF, and T waves were low and flat in leads Va 4~ Va 6. Echocardiography showed: left ventricular ejection fraction (LVEF) 0.45. Coronary angiography showed 90% proximal stenosis of the left anterior descending artery (LAD), 80% proximal stenosis of the first diagonal artery (D1), 50% proximal stenosis of the circumflex artery (LCX), and proximal occlusion of the right coronary artery.