[Accidental silver nitrate inhalation]

INTRODUCTION

Silver nitrate pencil is often used to treat local granuloma caused by tracheotomy and tracheostomy cannula orifice.

CASE REPORT

We report the case of a 69-year-old patient who accidentally inhaled silver nitrate lead from the tip of a pencil during treatment of local granuloma. Inhalation of this product, which is known to cause burns and a risk of perforation of the mucous membranes, could suggest locoregional complications. Clinical monitoring and radiological and endoscopic examinations were carried out. Antibiotics and corticosteroids were administered because of inflammatory lesions. After 6 months, the patient had recovered with restitutio ad integrum of anatomical structures.

CONCLUSION

Silver nitrate pencil should be used with caution. Given the high risk of perforation, painstaking and repeated monitoring are necessary in case of accidental inhalation. Bronchial endoscopy is of central importance as a means of localizing the foreign substance, following which bronchial cleaning is performed, using physiological serum. Corticosteroid appears to be effective to limit the risk of inflammatory bronchial stenosis.

[Bronchial thermoplasty in the treatment of severe adult asthma]

Bronchial thermoplasty is a recent endoscopic technique for the treatment of severe asthma. It is an innovative treatment whose clinical efficacy and safety are beginning to be better understood. Since this is a device-based treatment, the evaluation procedure of risks and benefits is different that for pharmaceutical products; safety aspects, regulatory requirements, study design and the assessment of the magnitude of effects may all be different. The mechanism of action and optimal patient selection need to be assessed further in rigorous clinical and scientific studies. This technique is in harmony with the development of personalised medicine in the 21st century. It should be developed further in response to the numerous challenges and needs not yet met in the management of severe asthma.

Bacterial pericarditis as a fatal complication after endobronchial ultrasound-guided transbronchial needle aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and effective diagnostic tool for mediastinal evaluation. The guidelines for mediastinal evaluation of lung cancer were recently revised for both endoscopic procedures and surgical medical staging, and EBUS-TBNA is expected to be used more often in lung cancer diagnosis and staging. The major complication rate reported in previous meta-analyses is very low at 0.07-.15%; however, the mortality rate has not been reported. We present 2 cases of acute bacterial pericarditis after EBUS-TBNA, with 1 case resulting in mortality, and we discuss the appropriate management.