Background and study aims Despite use of various endoscopic therapies in patients with tumor-related bleeding, various rates of successful immediate hemostasis and short-term rebleeding have been reported. We aimed to evaluate preliminary results of use of the EndoClot polysaccharide hemostatic system (PHS) in patients with acute upper gastrointestinal bleeding (UGIB) from a gastric malignancy. Patients and methods We retrospectively analyzed data from a prospectively collected database of 12 patients with acute UGIB from a gastric malignancy who had been treated with EndoClot PHS. The EndoClot air compressor was used to propel 2 g of absorbable modified polymer particles onto the bleeding site. We checked successful immediate hemostasis, rebleeding events and mortality within 30 days. Results Twelve patients were enrolled in the study. The median patient age was 72.5 years (range, 57 – 89). The initial median hemoglobin level was 6.75 g/dL (range, 5.4 – 8.9). The median systolic blood pressure was 114 mmHg (range, 86 – 153). Eleven patients had advanced gastric cancer and one patient had a gastrointestinal stromal tumor. The lower body of the stomach was the most common tumor location (58.3 %), and the median tumor size was 40 mm (range, 15 – 100). Immediate hemostasis was achieved in all patients, and rebleeding developed in 2 of 12 patients (16 %), 3 and 5 days after treatment. There were no significant Endoclot PHS-related adverse events, and there was no all-cause mortality at 30 days after the intervention. Conclusions Endoclot PHS represents a new alternative, complementary, and promising therapy for patients with an acute UGIB from a gastric malignancy.

Huh U, et al. Korean J Thorac Cardiovasc Surg. 2012 Oct;45(5):316-319. http://dx.doi.org/10.5090/kjtcs.2012.45.5.316

Choi GE, et al. J Korean Med Sci. 2010 Dec;25(12):1716-1721. http://dx.doi.org/10.3346/jkms.2010.25.12.1716

Chylothorax is a disease that has various causes such as neoplasm, infection, post-surgery trauma, congenital, and venous thrombosis. In approximately 15% of cases of chylothorax, the exact cause is unknown. We report a case of delayed occurrence of right chylothorax in a patient who had multiple segmental ribs fracture on his left side. A 70-year-old Asian man had a “rollover” accident in which the cultivator he was driving overturned. He presented to our hospital with the main complaint of severe dyspnea. On chest computed tomography, multiple ribs fracture from the first to the eighth rib of the left side of his chest and left-sided hemopneumothorax were presented, but there was no evidence of fracture in the right side of his chest. After closed thoracostomy, an emergency operation for open reduction of fractured ribs was performed. On the fifth postoperative day, tubal feeding was performed. On the next day, a plain chest X-ray image showed pleural effusion of the right side of his chest. After insertion of a small-bore chest tube, 3390 ml of fluid for 24 hours was drained. The body fluid analysis revealed triglycerides levels of 1000 mg/dL, which led to a diagnosis of chylothorax. Although non-oral feeding and total parenteral nutrition were sustained, drain amount was increased on the fifth day. Surgical treatment (thoracoscopic thoracic duct ligation and pleurectomy) was performed in the early phase. The right chest tube was removed on the 14th postoperative day after the effusion completely resolved and he was uneventfully discharged. In this case, as our patient was in old age and had multiple traumas, surgical treatment for chylothorax needed to be performed in the early phase.

Soojin Lee, M.D., Jeong Su Cho, M.D., Eunsoo Kim, M.D., Yeongdae Kim, M.D., Jonggeun Lee, M.D.. J Chest Surg 2022;55:30-6. https://doi.org/10.5090/jcs.21.119

Surgical intervention might be required in secondary spontaneous pneumothorax (SSP) with prolonged air leak; however, operation under general anesthesia (GA) could be critical in compromised patients. In this study, we performed video-assisted thoracic surgery (VATS) under epidural anesthesia (EA) in compromised patients with SSP and evaluated its feasibility. Of 212 patients who underwent VATS for SSP, 179 patients had surgery under GA and 33 under EA from 2006 to 2014. All medical records were retrospectively reviewed for operative time, pre- and postoperative chest tube drainage, postoperative complications, and hospital death. To evaluate the efficacy of VATS under EA, these factors were compared between EA and GA groups. The mean operative time and the mean duration of postoperative drainage, respectively was 106.2±45.3 minutes and 6.15±10.51 days in GA, and 102.6±43.1 minutes and 6.10±7.20 days in EA. Of 18 cases with recurrence and 13 cases with complications, only one recurrence and one complication developed in EA. In case with patients having intractable SSP with compromised pulmonary function, VATS under EA could be an effective and safe option to approach the appropriate goals of air leak control and less recurrence of pneumothorax.