Association Between Red Blood Cell Distribution Width and Outcomes of Open Airway Reconstruction Surgery in Adults.

Importance: Airway reconstruction for adults with laryngotracheal stenosis (LTS) is directed toward improving airway caliber to mitigate the patient's dyspnea and achieve prosthesis-free breathing (ie, without tracheostomy, intraluminal stent, or T-tube). Despite the importance of preoperative risk stratification to minimize postoperative complications, consensus on an objective predictive algorithm for open airway reconstruction is lacking. Objective: To determine whether the ability to achieve a prosthesis-free airway in adults after open airway reconstruction is associated with red blood cell distribution width (RDW) at the time of surgery. Design, Setting, and Participants: Case series study investigating 92 consecutive patients 18 years and older with laryngotracheal stenosis who underwent open airway reconstruction at a US tertiary care hospital from January 1, 2006, to January 1, 2017. Main Outcomes and Measures: The main outcome was a prosthesis-free airway (absence of tracheostomy, intraluminal stent, or T-tubes) at last follow-up. Multivariate logistic regression modeling was used to identify independent factors associated with this outcome. Results: Of the 92 patients who met inclusion criteria, the median (interquartile range) age was 44 (33.0-60.3) years; 50 (53%) were female, and 82 (89%) were white. In all, 74 patients (80%) were prosthesis free at the last follow-up (mean, 833 days; 95% CI, 10-4229 days). In multivariate analyses, airway decannulation was significantly correlated with reduced RDW (odds ratio [OR], 0.40; 95% CI, 0.19-0.84) and the absence of posterior glottic stenosis (OR, 0.12; 95% CI, 0.04-0.37). Conclusions and Relevance: These data suggest that surgical success in open airway reconstruction is significantly associated with RDW and whether the patient had posterior glottic stenosis. The RDW is a routine laboratory parameter that may provide some insight to the preoperative probability of prosthesis removal, facilitate risk stratification, promote informed patient decision making, and optimize health care resource management.

Evaluating the utility of serological testing in laryngotracheal stenosis.

OBJECTIVES/HYPOTHESIS: Whereas mechanical (traumatic) causes of laryngotracheal stenosis (LTS) are identified based on history, autoimmune laryngotracheal stenosis (aLTS) and idiopathic laryngotracheal stenosis (iLTS) are often more difficult to differentiate. The objective of this study was to evaluate serologic testing in a large cohort of nonmechanical LTS patients to determine which tests, if any, lead clinicians to the etiology of the LTS. STUDY DESIGN: Retrospective chart review. METHODS: This study reviewed nonmechanical LTS patients seen at a tertiary medical center from 2007 to 2014. Data were obtained on patient demographics, associated preexisting autoimmune conditions, comorbidities, intubation history, and serologic testing. RESULTS: Ninety-two records were reviewed. Twenty-three (25%) patients were found to have autoimmune disease; 69 (75%) met criteria for iLTS. A history of cigarette smoking was more significant in the aLTS group than the iLTS group (P < .001). Antineutrophil cytoplasmic antibody (ANCA) was positive only in patients with known granulomatosis with polyangiitis (GPA). All other serological testing was equivocal between the two cohorts. CONCLUSIONS: Differentiating iLTS from aLTS has proven difficult. The lack of information about the two entities has resulted in variability in the diagnostic workup to distinguish them. This study's finding of a more significant smoking history in the aLTS group correlates with the literature, which suggests an inflammatory effect of smoking cigarettes and an association with autoimmune disease. The only significant cohort of patients in this study found to have positive serological testing correlated with a diagnosable condition responsible for LTS was GPA patients with positive ANCA. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1408-1412, 2017.

Effect of pentoxifylline and 5-fluorouracil/triamcinolone on laryngotracheal stenosis developing as a complication of tracheostomy: study in rats.

We aimed to investigate the prophylactic effect of pentoxifylline (PTX) and 5-fluorouracil (5-FU) on laryngotracheal stenosis in tracheotomised rats by evaluating blood glutathione peroxidase (GPx) and superoxide dismutase activities and by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind study. Standard vertical tracheotomy was performed on 24 rats. Then, the animals were randomly divided into three groups. Intraperitoneal PTX administered to group A (study group) for 10 days. 5-FU was injected in paratracheal tissues in group B (study group) for 10 days. In group C (control group), intraperitoneal saline was administered for 10 days. After 10 days, tracheal cannules were removed. For biochemical analysis, two blood samples were obtained. Three weeks later, all animals were euthanized and trachea specimens were harvested. Stenosis index and mean wall thickness in PTX group were lower as compared to other groups but the difference was statistically insignificant. Minimum inflammation and fibrosis plus maximum epithelial regeneration were seen in PTX group. In addition, GPx activity was at highest level in PTX group and a statistically significant difference was found between control and PTX groups (P = 0.024) though the difference between remaining groups was statistically insignificant (P = 0.121). Superoxide dismutase activity was highest in PTX group but no statistically significant difference was found between the three groups (P = 0.305). The administration of PTX increases GPx activity and it may have some effect on tracheal scar formation which develops following tracheostomy.

Prevention of laryngotracheal stenosis with carnitine after tracheotomy: an experimental study on rats.

OBJECTIVE: We investigated the effect of carnitine on wound healing of trachea in tracheotomyzed rats. This study was undertaken to test the hypothesis that treatment with carnitine would protect the wound tissue, which was evaluated by measuring nitrite and nitrate, thus nitric oxide, malondialdehyde and cholinesterase in blood, and examining the histopathological changes. METHODS: Standard vertical tracheotomy was performed on 24 Wistar-Albino type rats. Then the animals were randomly divided into two groups; group A (the study group) was administered intraperitoneal carnitine 100 mg/kg for 10 days; group B (the control group) was administered intraperitoneal saline for 10 days. On the 10th day, all animals were decanulated. Three weeks later, cardiac blood samples were taken for biochemical assays and trachea specimens were harvested for histopathologic examination. RESULTS: In the carnitine-administered group, granulation tissue thickness resulting from the wound healing in the level of tracheotomy incision was lower compared to the control group (P < 0.01). When serum malondialdehyde levels were considered, a lower malondialdehyde level was found in the carnitine-administered group (P < 0.01). However, serum nitric oxide levels were close to each other in both groups (P > 0.05), while serum cholinesterase level was higher in the carnitine-administered group than in the control group (P < 0.01). CONCLUSION: Carnitine treatment partially prevents and significantly reduces the severity of tracheotomy induced laryngotracheal stenosis.

[Enzymatic status of leukocytes and its correction in acute stenosing laryngotracheitis in children]. / Fermentnyi status lekotsitov krovi i ego korrektsiia pri ostrykh stenoziruiushchikh laringotrakheitakh u detei.

Virological and cytochemical parameters of blood leukocytes during acute stenosing laryngotracheitis in 53 children were measured, viz. succinate dehydrogenase, mitochondrial alpha-glycerophosphate dehydrogenase, acid and alkaline phosphatase, myeloperoxidase. The patients were subjected to a combined treatment which included metabolites and their cofactors. The treatment gave good results, shortening the duration and reducing the number of relapses of the disease.

[Serum factors regulating macrophage migration in chronic cicatricial stenosis of larynx and trachea in children]. / Sootnoshenie syvorotochnykh factorov, reguliruiushchikh migratsiiu makrofagov pri khronisheskom rubtsovom stenoze gortani i trakhei u detei.

Many children with chronic cicatricial stenosis of the larynx and trachea showed a high activity of the factor stimulating macrophage migration in vitro (MSF). The high MSF level is typical of patients with large scars in tissues rich in cellular elements. The MSF predominance was to a certain extent correlated with abnormal responses to surgical intervention. This was indicated by poor results of surgical treatment if the MSF was low before and immediately after it. With normal MSF the treatment was effective in at least 50% of cases. The therapeutic effectiveness was correlated with MSF variations at an early postoperative stage.