After successful emergency treatment of a spontaneous pneumothorax, referral or consultation regarding definitive management with pleurodesis with or without VAT or thoracotomy should be done. Some authors recommend VAT for the first spontaneous pneumothorax due to the relative high rate of pneumothorax recurrence, lower overall cost, and success rate of the procedure, but this seems overly aggressive. 17 Recurrence after VAT requires open thoracotomy with pleurectomy or pleural scarification.8

Recurrence of the pneumothorax is the major long-term complication and the reason that all patients with spontaneous pneumothorax require referral for potential definitive therapy. Primary spontaneous pneumothorax recurs in about 30 to 40 percent and is independent of the method chosen to remove the intrapleural air. 6 Two-thirds of such cases occur within the first year.6 Smoking cessation reduces this risk by half.2 Secondary spontaneous pneumothorax recurs in 40 to 50 percent of patients.

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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