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University of Massachusetts Medical School Worcester, MA
Correspondence to: Gregory J. Gallivan, MD, FCCP, Assistant Professor of Clinical Surgery, 299 Carew St, Suite 404, Springfield, MA 01104-2361; e-mail: gallivan{at}juno.com
To the Editor:
Vargas and coworkers (September 2000)1 have concluded that intrapleural silver nitrate was more effective than talc in producing a pleurodesis. Bouros and coworkers (September 2000)2 have commented that silver nitrate could become the sclerosant of choice, given its wide availability and inexpensiveness.
Brock,3 in 1948, advocated the production of a chemical pleuritis by injecting into the pleural cavity, through an intercostal tube, 5 to 10 mL of a weak solution (2%) of silver nitrate followed by active suction on the drainage tube to rapidly reexpand the lung. This method was effective but had been condemned by some who maintained that it may have caused a fibrothorax.
Robert R. Shaw, MD, Professor of Thoracic Surgery during my cardiothoracic residency training at the University of Texas Southwestern Medical School at Dallas, TX, gave us his 107-page Surgery for Thoracic Disease: an Outline as a teaching guide, in 1969–1971.4 Under the tutelage of Dr. Shaw and Donald L. Paulson, MD, in Dallas, we had routinely used dry talc poudrage on the ward via 3/4-inch thoracostomy sites, using a combination of latex chest tubes and sterilized rigid bronchoscopes, for bedside talc poudrage. For > 30 years, I have also successfully used a 1% solution of silver nitrate, 5 to 10 mL, via a chest tube, on highly selected cases, not only for pleural effusions but for patients with prolonged air leaks.
When, rarely, dry talc pleurodesis via video-assisted thoracic surgery or talc slurry pleurodesis for bedside use via chest tubes fails, patients have been successfully treated with silver nitrate sclerosis. The two major clinical drawbacks have been the occasional febrile response and an infrequent occurrence of a transient (< 24 h) production of a few hundred milliliters of cloudy, gray pleural fluid before pleural symphysis is achieved.
While there may be "nothing new under the sun," I commend Vargas and coworkers1 and Bouros and coworkers2 in applying modern methods of reevaluation to old methods of effective treatment in thoracic surgical patients.
References
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  B. Marcheix, L. Brouchet, C. Renaud, Y. Lamarche, A. Mugniot, V. Benouaich, J. Berjaud, and M. Dahan Videothoracoscopic silver nitrate pleurodesis for primary spontaneous pneumothorax: an alternative to pleurectomy and pleural abrasion? Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1106 - 1109. [Abstract] [Full Text] [PDF]
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S. Yalonetsky, A. B. Nun, Y. Shwartz, and A. Lorber Transcatheter closure of a patent foramen ovale prior to a pneumonectomy to prevent platypnea syndrome. Eur. J. Cardiothorac. Surg., April 1, 2006; 29(4): 622 - 624. [Abstract] [Full Text] [PDF]
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 I. D. Bella, S. Pasquino, U. D. Col, and T. Ragni Cyanosis in atrial septal defect without pulmonary hypertension: a case of Platypnea-orthodeoxya syndrome Interactive CardioVascular and Thoracic Surgery, February 1, 2005; 4(1): 15 - 17. [Abstract] [Full Text] [PDF]
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