Efficacy and Safety Profile of Montgomery T-Tube Implantation in Patients with Tracheal Stenosis.

Background: Tracheal stenosis is able to lead to airway obstruction. Objective: To evaluate the efficacy and safety profile of Montgomery T-tube implantation in patients with tracheal stenosis. Methods: Fifty-two patients with tracheal stenosis diagnosed between 2016 and 2019 were included in this retrospective cohort study. The patients were divided into observation group (n = 25 cases) and control group (n = 27). The therapeutic effect, arterial blood gas analysis, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2), shortness of breath score, airway diameter change, dyspnea score, quality of life, and safety were compared between the two groups before and after treatment. Results: The therapeutic effect of the observation group gained better results than that of the control group (84.00% vs. 62.96%). One week after operation, the pH value, SaO2, PaCO2, shortness of breath score, airway diameter change, dyspnea score, life quality, and incidence of postoperative complications in the observation group exerted better results as compared to the control group. Conclusion: The implantation of Montgomery T-tube has effective function in terms of improving the symptoms of dyspnea and the life quality of patients with safety profile in patients harboring tracheal stenosis.

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.

Effects of Growth Factors on Mobilization of Mesenchymal Stem Cells.

We studied mobilization of bone marrow stem cells the under conditions of boost-therapy with granulocytic CSF and erythropoietin. Immunophenotyping of the peripheral blood was carried out in patients after transplantation of tissue-engineered trachea during the perioperative period. We observed an increase in hemopoietic stem cell pool and appearance of multipotent mesenchymal stromal cells in systemic circulation, their maximum concentration being recorded on days 10-14 after surgery. These data indicated a positive effect of growth factors on mobilization of stem cells.

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.

Intraoperative Extracorporeal Carbon Dioxide Removal During Apneic Oxygenation with an EZ-Blocker in Tracheal Surgery.

Tracheal surgery requires continued innovation to manage the anesthetic during an open airway phase. A common approach is apneic oxygenation with continuous oxygen flow, but the lack of effective ventilation causes hypercapnia, with respiratory acidosis. We used extracorporeal carbon dioxide removal for intraoperative decapneization during apneic oxygenation in a 64-year-old woman who was scheduled for tracheal surgery because of tracheal stenosis caused by long-term intubation. Our findings demonstrate that even after 40 minutes of total apnea, using an EZ-blocker for oxygenation and external decapneization, hemodynamic and gas exchange variables never demonstrated any dangerous alterations.

[Serum proteomic analysis of cicatricial airway stenosis].

OBJECTIVE: To establish serum protein fingerprint profile in patients with cicatricial airway stenosis and compared with healthy control. METHODS: Serum samples of 17 cicatricial airway stenosis patients and 17 healthy persons were analyzed by SELDI-TOF-MS to select the differently expressed proteins through Biomarker Wizard software. RESULTS: Compared with healthy control, 49 protein biomarkers were identified. Among them, 25 proteins were up-regulated, 24 proteins were down-regulated. These proteins were confirmed by searching database. CONCLUSIONS: There are obvious differentially expressed proteins in patients with cicatricial airway stenosis and controls, which may related with the development of airway scar.

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.

[Tracheal stent implantation for the treatment of tumor-induced acute airway stenosis].

BACKGROUND & OBJECTIVE: Tumor-induced acute airway stenosis is a medical emergency. Metal airway stent implantation can relieve dyspnea of patients suffering from this symptom and provide time for their further treatment. This study was to investigate the clinical application, efficacy, and complication management of tracheal stent implantation for the treatment of tumor-induced acute airway stenosis. METHODS: Nickel-titanium (Ni-Ti) alloy stent implantation was performed under the guidance of fiber-optic bronchoscopy in 52 patients with tumor-induced acute airway stenosis. RESULTS: Stent implantation was successful in all 52 patients. Dyspnea in all patients was significantly relieved. Values of arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and Karnofsky performance status (KPS) changed from (7.74+/-0.99) kPa, (5.37+/-0.39) kPa, and (68.85+/-8.08) preoperatively to (11.12+/-0.61) kPa, (4.58+/-0.30) kPa, and (84.62+/-5.03) postoperatively (P<0.01). The three-year survival rate was higher in lymphoma group than in lung cancer or esophageal cancer group. Postoperative complications were properly managed in all cases after symptomatic treatments. CONCLUSIONS: Tracheal stent implantation is an effective palliative treatment for acute dyspnea caused by local tumor compression or tumor invasion of large airways. It can rescue patients at risk for airway obstruction, improve the quality of life in terminal cancer patients, and provide further treatment opportunities for them.

Expression of apoptosis-related genes after fetal tracheal occlusion in rabbits.

BACKGROUND/PURPOSE: Late-gestation lung remodeling is associated with alveolar type II cell apoptosis early in the saccular stage (day 28 in fetal rabbits). Intrauterine tracheal occlusion (TO), a potent stimulus of fetal lung growth and maturation, significantly increases type II cell apoptosis. The aim of this study was to determine the effect of fetal TO on the spatiotemporal expression of key apoptosis-related signaling molecules. METHODS: Tracheal occlusion of fetal rabbits was performed at gestational day 25 (term, 31 days), and apoptotic gene expression was studied between days 26 and 28. RESULTS: At days 26 and 27, the protein levels of Fas and Fas-ligand (FasL) in lung lysates were similar in TO fetuses and sham-operated controls. At day 28, however, synchronous with the onset of TO-induced pulmonary distension and type II cell apoptosis, the FasL protein content was 8-fold higher in TO lungs compared with controls (P < .01), whereas Fas levels were comparable. In contrast, Bax and Bcl-2 protein levels were similar in TO and control fetuses at all time-points. TO significantly increased the cellular concentration of immunoreactive FasL in type II cells and bronchial epithelial Clara cells. Furthermore, bronchoalveolar lavage fluid (BAL) from TO fetuses at day 28 induced significantly more type II cell apoptosis in vitro compared with control BAL, an effect that was inhibited by neutralizing anti-FasL antibody. CONCLUSIONS: Our findings show that TO results in time-specific increase of both cellular and soluble FasL in fetal lungs and implicate the Fas/FasL pathway as a pivotal autocrine and/or paracrine regulator of TO- induced type II cell apoptosis.

Breathing pattern and arterial blood gases during Nd-YAG laser photoresection of endobronchial lesions under general anesthesia: use of negative pressure ventilation: a preliminary study.

STUDY OBJECTIVE: To evaluate the efficacy of negative pressure ventilation (NPV) in avoiding or reducing apneas and related hypoxemia and respiratory acidosis during laser therapy (LT) of endobronchial lesions. DESIGN: A prospective, controlled, randomized study. SETTING: An operating theater of a respiratory endoscopy and laser therapy unit. POPULATION AND INTERVENTION: Twenty-seven consecutive patients referred to LT were entered into the study. Fourteen patients were randomly assigned to LT under general anesthesia and spontaneous assisted ventilation (control group) whereas in 13 cases, NPV by a poncho-wrap ventilator (NPV group) was added to the procedure. MEASUREMENTS AND RESULTS: The prevalence and the duration of apnea/hypopnea periods assessed by respiratory inductive plethysmography during LT were significantly reduced under NPV, compared to the control group. As compared to baseline, during LT, all control patients developed mild to severe hypercapnia (PaCO2 ranging from 55 to 76 mm Hg) and respiratory acidosis (pH from 7.33 to 7.19), whereas only three patients undergoing NPV (23%) developed hypercapnia (PaCO2 from 52 to 68 mm Hg) and related acidosis (pH from 7.29 to 7.21). Optimal oxygenation was achieved in all of the patients; nevertheless, patients under NPV needed a lower mean oxygen supply; five of them (38%) could be treated at a fraction of inspired oxygen of 0.21 for the whole procedure. CONCLUSION: NPV may be useful in reducing apneas during laser therapy under general anesthesia, thus reducing hypercapnia, related acidosis, and need of oxygen supplementation.

[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.

Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis.

The anaesthetic management of patients undergoing tracheal resection for tracheal stenosis and the advantage of the maintenance of spontaneous respiration without intubation of the distal tracheal segment is discussed. The case reports of two such patients using a continuous intravenous infusion of Althesin with maintenance of spontaneous respiration are presented. The technique expedited the surgical reanastomosis due to lack of instrumentation in the surgical field. While some mild respiratory depression as evidenced by carbon dioxide retention did occur, the technique is worthy of consideration for the procedure.