Document Detail


Silver nitrate through flexible bronchoscope in the treatment of bronchopleural fistulae.
MedLine Citation:
PMID:  19698843     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Bronchopleural fistula is a severe complication after pneumonectomy or lobectomy. Local application of silver nitrate to seal bronchopleural fistulae was reported once 25 years ago with considerable success but was never repeated. We aimed to develop and evaluate a concrete technique of applying silver nitrate through a flexible bronchoscope to treat bronchopleural fistulae in central airways. METHODS: Consecutive patients with small (<or=5 mm) bronchopleural fistulae in proximal airways were included in the study. After measurement of bronchopleural fistula size through a flexible videobronchoscopy, a standard bronchoscopic cytology brush covered with silver nitrate was passed through the working channel of the scope and was rubbed against the fistula's orifice producing blanching and edema on the mucosa. This procedure was repeated until closure of the fistula's orifice (treatment success) or absence of any tissue response after 2 bronchoscopic sessions (treatment failure). RESULTS: Of 16 patients referred, 5 were excluded from treatment because of large (>5 mm) fistulae. Among the 11 treated patients (median fistula diameter 3 mm, range 2-5 mm), treatment failure was observed in 2 patients in whom treatment was attempted early (15 days postsurgery). In the remaining 9 patients, treatment success was achieved (81.8% success rate) after a median of 2.5 (range 1-10) applications of silver nitrate. After 11 (0.5-24) months of follow-up, no relapse was observed among successfully treated fistulae. CONCLUSION: The local application of silver nitrate through a flexible bronchoscopic brush produced a burn and healing process on the mucosa of small bronchopleural fistulae of the central airways, leading to effective and lasting treatment in most cases.
Authors:
Grigoris Stratakos; Lina Zuccatosta; Ilias Porfyridis; Michele Sediari; Charalambos Zisis; Vasso Mariatou; Eleftherios Kostopoulos; Argini Psevdi; Spyros Zakynthinos; Stefano Gasparini
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Publication Detail:
Type:  Journal Article     Date:  2009-02-23
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-24     Completed Date:  2009-09-18     Revised Date:  2010-03-04    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  603-7     Citation Subset:  AIM; IM    
Affiliation:
Critical Care and Respiratory Division, University of Athens, Athens, Greece.
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MeSH Terms
Descriptor/Qualifier:
Aged
Bronchial Fistula / drug therapy*,  etiology
Bronchoscopy / methods*
Drug Administration Schedule
Follow-Up Studies
Humans
Male
Middle Aged
Pleural Diseases / drug therapy*,  etiology
Pneumonectomy / adverse effects
Recurrence
Silver Nitrate / administration & dosage*
Treatment Outcome
Chemical
Reg. No./Substance:
7761-88-8/Silver Nitrate
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2010 Mar;139(3):805-6; author reply 806   [PMID:  20176238 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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