Silver nitrate: To discover already discovered…

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CTSNet classification: 15.5

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.

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References 

1. Stratakos G, Zuccatosta L, Porfyridis I, Sediari M, Zisis C, Mariatou V, et al. Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae. J Thorac Cardiovasc Surg. 2009;138:603–607
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2. Melfi J, Schverlich M, Tambornini M. Endobronchial treatment of tuberculous cavities. Arch Argent Tisiol. 1954;30:225–237
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3. Guzeev IuM. Present state of the role of cauterization of tuberculous lesions of the bronchi with a 30 per cent solution of silver nitrate. Zh Ushn Nos Gorl Bolezn. 1965;25:72–73
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4. Gignoux M, Termet H, Woehrle R, Loire R. Accidental burn of the bronchial tree with silver nitrate. Emergency lobectomy. Recovery. Lyon Chir. 1971;67:457–459
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