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Purpose: Various forms of local haemostats are increasingly used routinely in surgical procedures. Our work is the first comparison of the efficacy and safety of non-regenerated and regenerated oxidized cellulose based fibrous haemostats. Methods: The haemostatic efficacy and safety of fibrous haemostats based on ONRC and ORC were compared in a randomized multicenter study. The primary endpoint was successful haemostasis within 3 minutes of application and no need for surgical revision within 12 hours after the procedure for recurrent bleeding. Results: There was a significant difference in the rate of successful haemostasis in 3 minutes that was achieved in 82% and 55% in the ONRC and ORC groups, respectively (confidence interval 99%; p = 0.009). Mean time to haemostasis was 133.9 ± 53.95 seconds and 178.0 ± 82.33 seconds, in the ONRC, and ORC group, respectively (p = 0.002). Revision surgery for re-bleeding was necessary in 0 (0%), and 1 (2%) of patients in the ONRC, and ORC group, respectively. No adverse events were reported. Conclusion: Fibrous haemostat based on ONRC was non-inferior compared to fibrous haemostat based on ORC when used in accordance with its intended purpose, and was safe and efficient.

Introduction. Chylothorax is the result of traumatic as well as nontraumatic events. The conservative approach is usually applied in the management of chylothorax. Surgical treatment is not commonly used and is considered only in specific patients. Case presentation. We describe a complicated algorithm that was used in treating a 70-year-old woman with Bechterew's disease. Admitted for healthcare after a fall, she suffered from a blunt chest injury with subsequent right-sided serial rib fracture with hemothorax and thoracic vertebral body fracture. The hyperextension of the ossified thoracic spine associated with Bechterew's disease caused the injury of the thoracic lymphatic duct. Simultaneous thoracic spine stabilization and surgical revision of the thoracic lymphatic duct from an anterior approach were indicated. Despite the urgency of thoracic spine stabilization, the procedure was postponed due to acute coronary syndrome, which was treated with drug-eluting stent insertion with a subsequent need for dual antiplatelet therapy. Thus, the procedure was performed 16 days after stent insertion. Conclusion. The diagnosis of chylothorax must be considered in case of thoracic injury with continuing waste to the chest tube and detection of well-expanded pulmonary parenchyma. Biochemical investigation of the effusion is the cornerstone in establishing the diagnosis of chylothorax.