Successful complete thoracoscopic resection of costal osteochondroma: A case report.

Osteochondroma rarely occurs in the ribs; therefore, the treatment is not standardized. There are few studies of resection via complete thoracoscopic surgery (CTS), although video-assisted thoracoscopic surgery with mini-thoracotomy has been reported. Herein, we report a case of costal osteochondroma managed with CTS. A 23-year-old woman presented to our hospital due to left chest pain. Chest computed tomography revealed a bone-like structure protruding into the thoracic cavity from the left fourth rib. Thus, surgery was performed to obtain a definitive diagnosis and provide appropriate treatment. The tumor was resected from the base at the border of the normal bone via CTS using three 5.5-mm ports. A pathological diagnosis of costal osteochondroma was made. The patient had an uneventful clinical course and did not present with a recurrence 1 year after surgery. Therefore, CTS can be a good approach for cases with slim and stalked costal osteochondroma.

A Novel Hemostatic Peptide Solution for Common Acute Gastrointestinal Bleeding Diseases: First Case Series Study on the Treatment Results of Endoscopic Hemostasis by Nonexpert Endoscopists.

INTRODUCTION: We investigated the hemostatic effect and safety of a hemostatic peptide solution for the treatment of gastrointestinal bleeding requiring emergency endoscopy. METHODS: We retrospectively examined the patient backgrounds, hemostatic results, and procedural safety in patients who were treated with a hemostatic peptide solution for hemostasis during emergency endoscopies for gastrointestinal bleeding. All hemostatic procedures were performed by nonexpert physicians with less than 10 years of endoscopic experience. All of the cases were treated at a single institution over the months from January 2022 to January 2023. RESULTS: Twenty-six consecutive patients (17 males and 9 females) with a median age of 74 (45-95) years were included. Their conditions requiring emergency endoscopy were melena in 8 patients, hematochezia in 2, hematemesis in 8, anemia in 6, and bleeding during esophagogastroduodenoscopy in 2. The sites of bleeding were the esophagus in 3 patients, the stomach in 17, the duodenum in 3, the small intestine in 2, and the colon in 1. Hemostasis was obtained with another hemostasis device used in conjunction with the hemostatic peptide solution in 13 cases and with the hemostatic peptide solution alone in 13 cases. The hemostasis success rate was 100%, with no complications. Rebleeding occurred within 1 week in 4 cases. CONCLUSION: Hemostasis with the hemostatic peptide solution was safe and provided a temporary high hemostatic effect in emergency gastrointestinal endoscopy.

Comparison of Short-term Visual Acuity Changes After Trabeculotomy ab Interno Using Trabectome and Trabeculectomy ab Externo.

PURPOSE: To compare short-term visual acuity (VA) changes after trabeculotomy ab interno (TAI) using trabectome and trabeculectomy ab externo (TAE) performed on pseudophakic eyes. DESIGN: A single-center retrospective study. PARTICIPANTS: Patients with pseudophakic eyes who had primary open-angle glaucoma or exfoliation glaucoma and underwent TAI or TAE alone. METHODS: Changes in intraocular pressure (IOP), medication score, Snellen VA, and the number of eyes with vision loss (loss of ≥ 2 Snellen lines) were evaluated at baseline, week 1, and months 1, 3, and 6. The risk factors for vision loss at 6 months postoperatively were analyzed in both groups. MAIN OUTCOME MEASURES: Visual acuity changes. RESULTS: A total of 112 eyes of 112 patients were examined: 46 in the TAI group and 66 in the TAE group. Intraocular pressure was significantly lower in both groups at each visit than at baseline. The TAI group had a significantly higher mean postoperative IOP than the TAE group. Medication scores in the TAI group were significantly different after 3 months compared with baseline; however, decreased significantly at all study visits in the TAE group. The mean VA in the TAI group did not decrease significantly at each visit. In the TAE group, it decreased significantly up to 3 months but was not significantly different at 6 months. At all study visits, the number of eyes with vision loss was significantly lower in the TAI group than in the TAE group. Only 2 eyes in the TAI group (4.3%) had vision loss at 6 months, which was caused by macular edema. In the TAE group, 13 eyes (19.7%) experienced vision loss at 6 months. In all cases, the presence of preoperative split fixation [odds ratio = 7.30, P < 0.05] and the occurrence of hypotony-related complications [odds ratio = 6.76, P < 0.05] within 6 months were risk factors for vision loss. CONCLUSIONS: TAI lowered IOP less than TAE; however, there was less vision loss with TAI. For eyes with a target IOP in the mid-teens, TAI can be recommended as initial surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosuremay be found in the Footnotes and Disclosures at the end of this article.

Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity.

PURPOSE: To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery. METHOD: Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated. RESULTS: The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05). CONCLUSION: The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.

[Long-term Relapse-free Survival after Gefitinib Treatment Followed by Salvage Surgery for Postoperative Recurrence of Non-small Cell Lung Cancer:Report of a Case].

We present a case of a 54-year-old woman who had been performed video-assisted thoracic surgery (VATS) right upper lobectomy for stageⅡB adenocarcinoma. The patient had the recurrence of multiple lung metastases at 12 months after the surgery and was administrated gefitinib. The lung metastases disappeared at 3 months after the administration of gefitinib. A single metastasis in the left lower lung appearance again and VATS wedge left lung resection as salvage surgery was performed in postoperative 82 months. After salvage surgery, the patient has been followed up without additional treatment and is alive recurrence-free at 19 months.

[Reoperation for Recurrent Pulmonary Metastases].

From 1990 to 2019, 256 patients underwent surgery for metastatic lung tumors in our hospital, of which 23 (9.0%) had multiple surgeries. There were 15 cases of colorectal cancer, 2 cases of renal cancer, 2 cases of breast cancer, and 4 cases of others according to the primary lesion, and the number of operations was 2 times 18 cases, 3 times 4 cases, and 4 times 1 case. The average disease-free interval( DFI) was 27.2 months, and the average interval between the first and second operations was 25 months. The median observation period from the last surgery was 58.5 months, the 5-year survival rate was 67%, and the 10-year survival rate was 39%. If the surgical indication for metastatic lung tumor is satisfied and the prognostic factors such as long DFI or a small number of recurrences are met, re-surgery should be actively considered, and the significance of lung metastasectomy remains even now that drug therapy has advanced.

Clinical significance of bifocal treatment for synchronous brain metastasis in T1-2 non-small-cell lung cancers: JNETS0301.

OBJECTIVES: The treatment of patients with brain metastases associated with non-small-cell lung cancer (NSCLC) is frequently challenging. Starting in 2003, we conducted a phase II study of surgery for patients with clinical T1-2N0-1 NSCLC with oligometastasis. The aim of this subset study was to assess the clinical significance of bifocal treatment for synchronous brain metastases in T1-2N0-1 NSCLC using prospectively collected data. METHODS: In this phase II study of clinical T1-2N0-1 NSCLC patients with oligometastasis, 47 patients were enrolled from December 2003 to December 2016. Among them, 18 NSCLC patients with synchronous brain metastases were investigated in this subset analysis. RESULTS: Fourteen patients underwent complete resection, and 4 underwent incomplete resection of the primary lung cancer. The number of synchronous brain metastases was one in 14 and multiple in 4 patients. After surgery for the primary lung cancer, 12 of 18 patients underwent treatment for their brain lesions, including stereotactic radiosurgery (SRS) in 10, surgical resection in 1, and SRS followed by surgical resection in 1. In 5 of the 18 patients (28%), the brain lesion was diagnosed as benign on follow-up radiological imaging. The 5-year overall survival rate after enrollment was 31.8% for all 18 patients and 35.2% for the 13 patients with brain metastases. Univariate analysis showed that having multiple brain lesions was a significant factor related to a worse prognosis. CONCLUSION: For patients with suspected brain metastases associated with NSCLC, bifocal local treatment could be an acceptable therapeutic strategy, especially for solitary brain metastasis.

A phase 2 study of adjuvant carboplatin plus S-1 followed by maintenance S-1 therapy for patients with completely resected stage II/IIIA non-small cell lung cancer-Japanese Northern East Area Thoracic Surgery Study Group JNETS1302 study.

BACKGROUND: The standard adjuvant chemotherapy regimen for completely resected pathological stage II/IIIA non-small cell lung cancer (NSCLC) is four courses of cisplatin plus vinorelbine. However, the continuity and toxicity of cisplatin-based regimens remain problematic. Conversely, carboplatin-based chemotherapy is a less toxic and more tolerable regimen for various stages of NSCLC. In particular, the efficacy and tolerability of carboplatin plus S-1 in advanced NSCLC were confirmed by previous pivotal studies such as the LETS trail. Therefore, this phase II study assessed the feasibility, safety, and usefulness of carboplatin plus S-1 followed by maintenance S-1 as an adjuvant treatment. METHODS: In this single-arm, multicenter phase II study, 40 patients who previously underwent complete resection of NSCLC were enrolled from November 2013 to January 2015. The chemotherapy protocol was four cycles of carboplatin (AUC 5 on day 1) and oral S-1 (80 mg/m2 every other day from days 1 to 21) followed by oral S-1 (80 mg/m2 every other day for 48 weeks). The primary endpoint was the treatment completion rate, and the secondary endpoints were adverse events and 2-year recurrence-free survival. RESULTS: The treatment completion rate of the planned schedule was as low as 30.0% (90% confidence interval: 40.3-63.0%). The reasons for adjuvant chemotherapy discontinuation were adverse events, refusal, tumor recurrence, and other reasons in 13, 6, 10, and 2 patients, respectively. The 2-year progression-free survival rate was 66.7% among patients who completed maintenance chemotherapy. There were no treatment-related deaths, and most adverse events were less than grade 3. CONCLUSIONS: Carboplatin plus S-1 followed by S-1 maintenance for 1 year in the adjuvant treatment of NSCLC was not tolerable, although most adverse events were not severe. However, patients who can fully complete the regimen might experience clinical benefit.

[Iatrogenic Injury of the Bronchus Suspiciously Caused by Sengstaken-Blakemore Tube into the Airway].

BACKGROUND: Tracheobronchial injury is often operated urgently because of the risk of high mortality. However, small injuries can recover by conservative management. CASE: A 65-year-old man was treated for esophageal varix with transcatheter arterial embolization therapy. He vomited blood and endoscopic sclerotherapy was performed because a Sengstaken-Blake-more tube could not be inserted. Thereafter, computed tomography( CT) detected mediastinal emphysema and an injury to his left main bronchus. The patient consulted our department and bronchoscopy detected a laceration of the left main bronchus. Conservative management was chosen because the laceration was limited to the membranous portion, with the improvement of inflammatory reaction. Several weeks later, CT and bronchoscopy confirmed recovery from the injury of the left main bronchus without stricture. CONCLUSION: An operation is indicated for many tracheobronchial injuries. However, some injuries can recover with conservative management. It is important that indication for surgery should be considered based on bronchoscopic findings and the progress of inflammatory reaction.

A case of massive hemothorax associated with an intrathoracic bronchogenic cyst.

A 34-year-old man presented with sudden back pain and dyspnea. Chest X-ray showed left-sided massive pleural effusion. Chest computed tomography revealed an intrathoracic mass sized 9 cm. Hemorrhagic effusion was achieved with thoracic drainage on admission. Diagnostic video-assisted surgery was indicated, and an unexpected cyst with bloody content was observed. The cyst was bluntly dissected from the pleura and removed from the diaphragm. The patient discharged uneventfully and there were no significant postoperative complications including bleeding or pneumothorax. Pathological observation of the cyst revealed pseudostratified ciliated epithelial cells, mucinous glands, and cartilage compatible with the diagnostic criteria for a bronchogenic cyst. Malignant transformation was not observed. Common clinical presentations of bronchogenic cysts include pain, dyspnea, and cough. Although rare, the risk of hemorrhage from bronchogenic cysts and subsequent development of hemothorax should not be underestimated.

[A Pulmonary Mucoepidermoid Carcinoma with Anaplastic Lymphoma Kinase Fusion Responding to Alectinib Hydrochloride].

Few cases of lung mucoepidermoid carcinomas with anaplastic lymphoma kinase (ALK) fusion have been reported. A 35-year-old woman was found to have an abnormal chest X-ray. A tumor and obstructive pneumonitis in her left upper lobe was detected using computed tomography (CT). She was admitted to our hospital, and was diagnosed with mucoepidermoid carcinoma by transbronchial biopsy. Left pneumonectomy and lymphadenectomy were performed for lung mucoepidermoid carcinoma and a mediastinal lymph node metastasis (pT2aN2M0, stage ⅢA). Postoperative radiotherapy (50 Gy) to the mediastinum and chemotherapy were performed followed by several radiotherapies for cervical and mediastinal lymph node and right ischium metastases. Since then, further radiotherapy was impossible. However, we detected ALK fusion in the resected specimen and the cancer responded to alectinib hydrochloride.

Subacute Sensory Ataxic Neuronopathy With Thymoma Presenting Marked Improvement After Steroid Therapy.

Subacute sensory ataxic neuronopathy is a well-known form of paraneoplastic syndrome. Most sensory neuronopathies are associated with small cell lung cancer and anti-Hu antibodies, and usually show only slight improvement with immunotherapy. To date, there have been few reports of neuropathy associated with thymoma and no treatment strategy has been established for thymoma-related neuropathy. Here, we provide the first report of a case of sensory ataxic neuronopathy with thymoma that showed marked improvement after steroid therapy, even though preceding intravenous immunoglobulin treatments and tumor resection were less effective. A 57-year-old Japanese man was referred to our hospital with a 6-week history of distal paresthesia in his four limbs and an unsteady gait. He presented with left-dominant ataxia in his four limbs due to reduced sensation in his extremities. He also complained of constipation, difficulty urinating, and erectile dysfunction. Upon investigation, including electrodiagnostic studies, the patient was diagnosed as having sensory ataxic neuronopathy with invasive thymoma. A first round of intravenous immunoglobulin therapy, a following thymectomy, and a second round of intravenous immunoglobulin therapy after the surgery were not effective in treating his neurological symptoms. Subsequently, oral steroid therapy was started, which brought about a remarkable improvement; 6 weeks after the beginning of the steroid therapy, his neurological symptoms were resolved, except for slight distal paresthesia in his feet. Although rarely reported, thymoma can underlie sensory neuronopathy, and the response of thymoma-associated sensory neuronopathy to immunotherapy might be better than that of anti-Hu antibody-related neuropathies. Even if the first immunotherapy is not effective in treating neuropathy with thymoma, further immunomodulatory treatment should be tried after treating the tumor.

[Surgery for a Metastatic Tumor in the Right Lung in Case of Congenital Left Pulmonary Artery Defect].

Unilateral absence of a pulmonary artery (UAPA) is a rare congenital cardiovascular malformation and clinical experience of the surgery for this disease are limiting. We report a case of 62-year-old woman of UAPA (absence of left pulmonary artery) underwent a wedge resection of right lung for metastatic lung cancer. The surgery was performed under double lung ventilation because abnormal lung does not contribute to gas exchange. We were able to perform a wedge resection easily by setting the thoracotomy wound right above the tumor in the spine position. In a performing thoracic surgery under double lung ventilation, the position of surgical wound is very important. Therefore, although the diagnosis of this disease is difficult for the rarity and its nonspecific presentation, preoperative diagnosis of UAPA is very important.

Progressive multifocal leukoencephalopathy associated with thymoma with immunodeficiency: a case report and literature review.

BACKGROUND: The development of progressive multifocal leukoencephalopathy (PML) is associated with severe cellular immunosuppression. Good's syndrome (GS) is a rare immunodeficiency syndrome related to thymoma, with the development of humoral as well as cellular immunosuppression; however, there are few reports of PML due to GS. One report suggested that the neurological symptoms of PML related to thymoma may be improved by a reduction of immunosuppressive therapy for myasthenia gravis (MG). It is therefore necessary to identify the cause of immunodeficiency in patients with PML to enable an appropriate treatment strategy to be adopted. CASE PRESENTATION: A 47-year-old Japanese woman was admitted with aphasia and gait difficulty. She had an invasive thymoma that had been treated with repeated chemotherapy, including cyclophosphamide. She had also previously been diagnosed with MG (Myasthenia Gravis Foundation of America clinical classification IIa), but her ptosis and limb weakness had completely recovered. On admission, neurological examination revealed motor aphasia and central facial weakness on the right side. Laboratory studies showed severe lymphopenia, decreased CD4+ and CD8+ T cell and CD19+ B cell counts, and reduced levels of all subclasses of immunoglobulins, suggesting GS. Serology for human immunodeficiency virus (HIV) infection was negative. Brain magnetic resonance imaging showed asymmetric multifocal white matter lesions without contrast enhancement. Cerebrospinal fluid real-time polymerase chain reaction for JC virus was positive, showing 6,283,000 copies/mL. We made a diagnosis of non-HIV-related PML complicated with GS and probable chemotherapy-induced immunodeficiency. She then received intravenous immunoglobulin therapy, mirtazapine, and mefloquine, but died of sepsis 46 days after admission. CONCLUSIONS: It is necessary to consider the possibility of immunodeficiency due to GS in patients with PML related to thymoma. Neurologists should keep in mind the risk of PML in MG patients with thymoma, even if the MG symptoms are in remission, and should thus evaluate the immunological status of the patient accordingly.

A prospective 5-year follow-up study after limited resection for lung cancer with ground-glass opacity.

OBJECTIVES: The incidence of small-sized pulmonary adenocarcinomas with ground-glass opacity (GGO) has recently increased, with excellent postoperative prognosis. The limited resection of such cancers has been deemed to be acceptable based on retrospective studies. We conducted a prospective multi-institutional study evaluating the validity of limited resection for small-sized pulmonary adenocarcinoma with GGO. METHODS: The inclusion criteria were 25-80 years of age, no prior treatment, a maximum tumour diameter of 8-20 mm, a GGO ratio of ≥ 80%, clinical T1N0M0, lower 18F-fluorodeoxyglucose accumulation than the mediastinum, resectable by sublobar resection, pulmonary lobectomy tolerable and an intraoperative pathological diagnosis of bronchiloalveolar carcinoma. Wedge resection was preferred, but segmentectomy was permitted. Disease-specific survival and overall survival were analysed. RESULTS: From November 2006 to April 2012, 73 patients were enrolled from 13 institutions. One patient was ineligible, and the remaining 72 patients were preregistered. The tumours of 3 and 14 patients were intraoperatively diagnosed as benign lesions and adenocarcinomas with mixed subtype, respectively. Intraoperative cytological/histological examination of surgical margin was not performed in 2 patients, and the remaining 53 patients were ultimately eligible for this study. The mean tumour size was 14.0 mm and the mean GGO ratio was 95.9%. Thirty-nine and 14 patients underwent wedge resection and segmentectomy, respectively. Although all tumours were intraoperatively diagnosed as bronchioloalveolar carcinomas, 6 were ultimately diagnosed as adenocarcinoma with a mixed subtype. No completion lobectomy was performed. As of 1 May 2017, no recurrence of the original lung cancer was observed during 60.0-126.3 months after surgery. Two patients died from other diseases. The 5-year disease-specific and overall survival rates were 100% and 98.1%, respectively. The reduction in the pulmonary function after limited resection was minimal. CONCLUSIONS: With these criteria, limited resection was performed safely without any recurrence, and the postoperative pulmonary function was well preserved. The outcomes of limited resection for small-sized lung cancer with GGOs that met the criteria of this study were satisfactory.

[Slowly progressive Basaloid Squamous Cell Carcinoma of the Lung].

Basaloid squamous cell carcinoma (BSC) of the lung is a rare variant of squamous cell carcinoma (SCC) and is reported to show poor prognosis. A 70-year-old man presented to the clinic complaining of a productive cough. Computed tomography( CT) of the chest revealed a nodule in the left lower lobe of the lung. A bronchoscopy and transbronchial lung biopsy(TBB) were performed twice;no evidence of malignancy was found. So we followed up by periodic chest CT. One year and 4 months after the 1st visit, the nodule increased in size from 14 to 19 mm. TBB was performed again and the tumor was diagnosed as SCC. The patient underwent a left lower lobectomy and the tumor was diagnosed as BSC by postoperative pathological examination. Two years and 6 months after surgery, no recurrence has been observed in the patient.

Diminished capacity of opsonization and immune complex solubilization, and detection of anti-C1q antibodies in sera from patients with hereditary angioedema.

BACKGROUND: Hereditary angioedema (HAE) is an autosomal dominant disease caused by deficiency of C1 esterase inhibitor. Symptoms of HAE include edema, which can potentially cause suffocation. Some patients with HAE exhibit immunological abnormalities, which could prevent an accurate diagnosis. Low levels of complement components are characteristic of HAE and in other settings are thought to reduce elimination of apoptotic cells and immune complex (IC). Thus, we aimed to experimentally clarify the mechanism of immunological abnormalities using sera from HAE patients. METHODS: Serum samples from 18 patients with HAE were collected when free from angioedema attack and compared with normal human pooled sera (NHPS) from 20 healthy volunteers. Opsonization was measured as the rate of phagocytosis of apoptotic Jurkat cells by macrophages differentiated from THP-1 cells incubated with serum. IC solubilization in serum was analyzed by quantifying peroxidase released from a synthetic IC composed of peroxidase and anti-peroxidase antibodies. Anti-C1q antibody levels were detected using an enzyme-linked immunosorbent assay. RESULTS: Serological immunological abnormalities were detected in 12 patients. Opsonization in serum samples from each patient with HAE was lower than that in NHPS (∼20% versus 70%, respectively). The rate of IC solubilization was lower in serum from HAE patients than NHPS. Some patients had high serum anti-C1q antibody levels with increased serum IC levels. CONCLUSIONS: Sera from patients with HAE exhibit anti-C1q antibodies, with a lower capacity for opsonization and IC solubilization. This may be associated with immunological abnormalities and should be investigated further to facilitate accurate diagnosis of HAE.

A case of primary pulmonary choriocarcinoma successfully treated by surgery.

Primary pulmonary choriocarcinoma is a very rare tumor and eventually diagnosed by pulmonary resection. A poor prognosis has been reported for this disease, but appropriate treatment has not been established. Here, we report the successful surgical treatment for a primary pulmonary choriocarcinoma. A 70-year-old male presented with cough and a 3.8-cm solid tumor was detected in the right upper lobe of the lung on CT scan. Results of an open lung biopsy indicated carcinoma with indeterminate histological subtype. Right upper lobectomy was performed and the permanent pathological diagnosis was choriocarcinoma. Right after surgery, systemic and genital screening was performed by urologist, but no abnormal findings were observed. Elevation of serum ß-hCG was confirmed at the same time and the value dropped within normal range in 2 months. According to diagnosis criteria, we reached final diagnosis of primary pulmonary choriocarcinoma. The patient has been alive with no recurrence for 2 years after surgery.

[Effectiveness of Portable Thoracic Drainage Kit for Outpatient Treatment of Spontaneous Pneumothorax].

The demand for outpatient management of spontaneous pneumothorax (SP) has been increased, therefore we evaluated the effectiveness of Thoracic Egg(TE), a portable thoracic drainage kit for SP. We studied 43 SP patients who had received TE treatment between May 2008 and October 2010. Ages were ranged 12~73 years (mean:29.1), with 39 males, 4 females, 25 had primary, 18 had recurrent, pneumothorax. Of the 43 patients, 23 were treated outpatient therapy with TE only, 20 were required hospitalization for persistent air leakage, poor expansion or intent to surgery. Surgical intervention was undergone in 18 patients for persistent air leaks or recurrent pneumothorax. The average length of treatment was 8.4 days for outpatient therapy only cases. Of 25 patients who had primary SP, 18( 72%) were not required hospitalization. Outpatient therapy using TE was considered very useful for SP, especially for primary cases.