Silver nitrate: To discover already discovered…

To the Editor:

We read the article by Stratakos and colleagues1 with great interest inasmuch as the treatment of bronchial fistulas is of utmost importance to both the pulmonary and thoracic surgery divisions. The exact method of silver nitrate (SN) application through the videobronchoscope shown by the authors is very valuable on one hand. However, on the other hand, it is rather evident for us, and we have treated many patients without publishing our experience owing to its obviousness. We appreciate this work as a well-planned scientific trial to prove the application of SN to heal bronchial fistulas, but its use has been known for longer than the 25 years postulated by the authors. Melfi, Schverlich, and Tambornini2 in 1954 used SN for endobronchial treatment of tuberculosis cavities. The same method of treating the opened bronchi was described by Guzeev3 in 1965. Worth mentioning is the toxicity induced by SN, sometimes even demanding lobectomy.4

In conclusion, we thank the authors for reminding us to use SN for smaller bronchial fistulas, but let us focus on finding new ways to heal the fistulas or preventing this complication during the operation, rather than reminding us of the old known methods.