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Operative treatment of patients with Raynaud's Syndrome is rarely used, and is recommended by most authors only in the case of disthrophic changes or so advanced symptoms, which disturb normal social and daily life. Recently, thoracoscopic sympathectomy is applied more frequently. The aim of this study was to assess the usefulness of thoracoscopic sympathectomy by the presentation of early and long-term outcome of 43 thoracic and eight lumbar sympathectomies performed in 41 patients with Raynaud's Syndrome. Transpleural posterio-lateral thoracotomy was performed 29 times in 27 patients, whereas thoracoscopic sympatectomy 14 times in 8 patients. Surgical techniques, early and long-term results were discussed. Based on early and long-term outcome, there were no significant differences between applied surgical techniques. Moreover, thoracoscopic sympathectomy was safe in the aspect of a short duration as well as good therapeutic and cosmetic effect of the procedure. It should be applied instead of others, so far used methods, with the exception of patients with massive pleural adhesions, which need thoracotomy.

A group of 235 patients were treated between 1981 and 1993 for primary spontaneous pneumothorax. Immediate recovery was obtained in 150 (75%) out of 8 in whom drainage had been applied, and in a total of 79 who had been operated. Fifty of the remaining 52 patients with the first episode of pneumothorax, had repeated paracentesis with no complete lung expansion prior to operation, and 2 were referred to pleural cavity drainage. Three out of 79 operated patients, required re-thoracotomy (2 on the second day, and 1 on the eighth day following operation) because of hemothorax. In 3 patients an infection developed, thereupon a prolonged drainage of pleural cavity was used with good result.

Out of 235 patients discharged from the Department of Thoracic Surgery, Silesian Medical Academy, after treatment of primary spontaneous pneumothorax between 1981 and 1993, 232 (98.7%) answered our questionnaire and so were included in the study. Mean follow-up time was 10.4 years. No recurrence of the disease was reported by any of 79 patients who had been treated by surgical procedure/thoracotomy plus pleurectomy/, but 21 (14.3%) out of 147 treated by paracentesis reported a recurrence of pneumothorax. In 17 patients the recurrence was the first-time case, in 3 the second-time, in 1 the third-time. Out of 232 patients, 10 (4.3%) had a recurrence of pneumothorax on the opposite side. Achieving expansion of the lung, 80% of the patients reported no problems at all. Only 6 (2.6%) of the whole group stated they could no longer work in their profession because of the pneumothorax they had suffered in the past.

Persistent chylothorax is usually treated by frequent aspirations or intercostal-tube drainage with interpleural installation of chemical or mechanical irritants. In 1986 Denver pleuroperitoneal shunt has been introduced. This is a single-unit silicone rubber conduit consisting of unidirectional valved pumping chamber located between pleural and peritoneal catheters. Manual compression of the shunt is required to achieve active pumping. The described unit is implanted subcutaneously in the lover thoracic and upper abdominal region in the anterior axillary line. We present a 38 year old patient with persistent chylothorax treated successfully by implantation of the described device.

Pleurectomy as a method for treatment of recurrent pneumothorax and its influence on pulmonary ventilation are analyzed. Fifty-one patients were hospitalised twice at the Thoracic Surgery Department in Szczecin. The pneumothorax was treated by a chest tube drainage at the first time, and by pleurectomy in case of recurrent incident. Each time--with both lungs expanded--VC (vital capacity), MVV (maximal voluntary ventilation) and FEV1 (forced expiratory volume) were measured, thus it was possible to compare pre- and postoperative spirometric results. There was no statistically significant deficiency of ventilation after pleurectomy. The risk of different therapeutical methods and effectiveness in the protection against recurrence of pneumothorax were discussed. The results of own observations are compared with other authors' ones.