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Introduction and Aim Management of spontaneous pneumothorax is predominantly inpatient based despite availability of devices which facilitate ambulatory management. At our institution most patients meeting predefined criteria have outpatient management. We aimed to assess the effectiveness of ambulatory management of SSP. Methods Data on all secondary spontaneous pneumothorax patients presenting to the emergency department between September 2014 and June 2017 was prospectively recorded. Patients were initially managed by the emergency department practitioners, usually with insertion of a Rocket seldinger (size 12 F) chest drain. They were then referred to the respiratory team at the earliest opportunity. Patients meeting eligibility criteria (age 16–80, WHO performance status 0–1 and no co-existing condition requiring admission) had their underwater seal replaced with a Pneumostat valve (Atrium Medical Corporation) which was connected to their chest drain. They were then discharged from hospital with reviews on alternate days on the ambulatory care unit. Chest drains were removed once air leakage had stopped for 24 hours. Suction was not employed. Patients with a persistent air leak were referred to the thoracic surgeons on day five and were admitted electively from home for surgery with chest drains in-situ. Results Data on all 99 consecutive patients with spontaneous pneumothorax were collected prospectively. Patient characteristics and outcomes are shown in Table 1. 55 episodes qualified for ambulatory management of which 49 SSP had outpatient management. The six patients who were not treated on the ambulatory pathway had resolution of pneumothorax by day 2. Of the 49 SSP who had ambulatory treatment, nine (18.37%) required surgery due to non-resolution whilst 11 achieved resolution between 6 and 19 days. There were a total of six complications during ambulatory management. Three patients experienced drain blockage which necessitated replacement of the tube. Two patients developed empyema; one of these was following prolonged drainage (19 days) as he declined surgery. One patient’s drain fell out but did not require reinsertion as the pneumothorax had already healed. Conclusion This study confirms that the use of chest drains with one-way valves in the ambulatory management of selected secondary spontaneous pneumothoraces is safe with few complications.

Milk of calcium (MOC) is a colloidal suspension of calcium salts occurring in calyceal cysts and diverticula. Although reported to be rare, in fact it seems to be more common than previously thought. It has characteristic appearances on plain x-rays, ultrasound, and CT imaging particularly in the prone and supine positions. Often entirely asymptomatic, its appearance may be mistaken for renal stones on radiography or angiomyolipomas on ultrasonography. In this paper, a series of cases is presented outlining its characteristic features and reviewing the relevant literature.

The main causes of nocturia, or voiding at night, are reduced bladder capacity and nocturnal polyuria. The authors discuss lifestyle changes that may help address this bothersome symptom, and outline the available treatment choices. Copyright © 2011 Wiley Interface Ltd

Alkaline encrusted cystitis is a chronic inflammatory condition. It is rare now because of appropriate antibiotics. It is a challenging situation with regard to its diagnosis and management. We are presenting an interesting case of alkaline cystitis post transurethral resection of prostate. The management includes careful acidification of urine, curettage of calcified material, and appropriate antibiotics.

We are presenting an interesting case of impacted stone and stent in a pregnant patient. We have proved safe use of ureteroscopy and laser in pregnancy with minimal x-ray exposure.