Reply to the Editor

Abstract

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.1Stratakos 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: 603-607Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar 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,2Høier-Madsen K. Schulze S. Møller Pedersen V. Halkier E. Management of bronchopleural fistula following pneumonectomy.Scand J Thorac Cardiovasc Surg. 1984; 18: 263-266Crossref PubMed Scopus (44) Google Scholar 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.3Lois M. Noppen M. Bronchopleural fistulae. An overview of the problem with special focus on endoscopic management.Chest. 2005; 128: 3955-3965Crossref PubMed Scopus (280) Google Scholar 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,1Stratakos 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: 603-607Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar 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. Silver nitrate: To discover already discovered…The Journal of Thoracic and Cardiovascular SurgeryVol. 139Issue 3PreviewTo the Editor: Full-Text PDF