The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Page 806, March 2010

Reply to the Editor

  • G. Stratakos, MD

      Affiliations

    • Critical Care and Respiratory Division, University of Athens, Greece
    • ,
  • Ch. Zisis, MD, FETCS

      Affiliations

    • Thoracic Surgery Department, “Evaggelismos” Hospital, Athens, Greece
    • ,
  • St. Gasparini, MD

      Affiliations

    • Pulmonary Diseases Unit, Department of Internal Medicine, Immunoallergic and Respiratory Diseases, “Ospedali Riuniti”, Ancona, Italy

Article Outline

CTSNet classification: 11, 15

 

We appreciate the interest expressed by Kubisa, Grodzki, and Wójcik in our recently published study concerning silver nitrate technique for the management of small bronchopleural fistulas.1 We are glad to learn that other colleagues as well have experience with this method.

As we noted twice in our study, although this technique was described once, 25 years ago,2 nothing has been reported since on the subject, and it is certain that younger generations of pulmonologists and thoracic surgeons alike are not acquainted with it. In an extensive review on the endoscopic management of bronchopleural fistulas published recently as well, nothing more than the above was reported.3

The references mentioned by Kubisa, Grodzki, and Wójcik were all published during the 1950s and 1960s, before the advent of the flexible bronchoscope, and referred mainly to complications of endobronchial tuberculosis, which is a completely different situation (and topic), ideally rare nowadays.

To our knowledge, based on a systematic research of the literature, our report is the first in the modern era to present this safe and effective technique for endoscopic management of such a serious and difficult-to-treat complication.

With regard to complications and safety, we have already described possible casualties in our report,1 and we are currently working on developing a new bronchoscopic silver nitrate applicator for safer and simpler use with modern flexible bronchoscopes.

We totally agree that much work has to be done in the domains of prevention and new techniques. However, we also believe that revisiting old ideas and techniques (if they are forgotten and continue to be valid) is important and can be of considerable help for clinicians in their daily practice.

Back to Article Outline

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
  2. Høier-Madsen K, Schulze S, Møller Pedersen V, Halkier E. Management of bronchopleural fistula following pneumonectomy. Scand J Thorac Cardiovasc Surg. 1984;18:263–266
  3. Lois M, Noppen M. Bronchopleural fistulae. An overview of the problem with special focus on endoscopic management. Chest. 2005;128:3955–3965

PII: S0022-5223(09)01548-7

doi:10.1016/j.jtcvs.2009.11.050

Refers to article:

  • Silver nitrate: To discover already discovered…

    Bartosz Kubisa, Tomasz Grodzki, Janusz Wójcik
    The Journal of Thoracic and Cardiovascular Surgery March 2010 (Vol. 139, Issue 3, Pages 805-806)

The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 3 , Page 806, March 2010

Article Tools