Medical comorbidities for paradoxical vocal fold motion (vocal cord dysfunction) in the military population.

OBJECTIVES/HYPOTHESES: This study aimed to describe the demographic characteristics of patients diagnosed with paradoxical vocal fold motion (PVFM) at Walter Reed Army Medical Center (WRAMC), and to document common medical comorbidities. The military population was expected to differ from the general population because of a presumed association between high physical demands and PVFM. STUDY DESIGN: Retrospective chart review of active-duty (AD) military personnel compared with a natural control group of non-AD patients. METHODS: Reports of asthma, allergy, gastroesophageal reflux disease (GERD), and postnasal drip (consequent to chronic sinusitis) were recorded for patients referred to the Speech Pathology Clinic at WRAMC with a diagnosis of PVFM from 1996 to 2001. RESULTS: The cohort consisted of 265 patients, 127 of whom were on AD status. The AD group was significantly younger and represented a narrower age range (17-53 years) than the non-AD patients (8-80 years), and had a more balanced sex ratio (1.2:1 vs 2.9:1). Eighty percent of all patients had at least one of the medical comorbidities surveyed, and 51% had two or more factors. GERD and allergies were reported most commonly by both groups; only asthma occurred significantly more in non-AD than AD patients. CONCLUSIONS: PVFM referrals of AD personnel of the US military are characterized by younger patients and a smaller female:male ratio as compared with non-AD patients. Based on the preponderance of men in the military, the number of females in the AD group remained disproportionately large. Multiple medical comorbidities were commonly documented by both groups; the only significant difference was a greater prevalence of asthma in the non-AD group. These data reinforce the need for appropriate differential diagnosis in all patients.

Intralobular bronchopulmonary sequestrations associated with bronchogenic cysts.

We present three cases of intralobar bronchopulmonary sequestrations with associated congenital bronchogenic cysts. As congenital abnormalities tend to be found together, these cases question the notion that intralobar sequestrations only occur secondary to chronic inflammation or infection, and suggest they can be congenital lesions.

Bilateral external laryngoceles following radioiodine ablation for Graves disease.

A 28-year-old trumpet player underwent multiple treatments with radioactive iodine for Graves disease associated with an unusually large goiter. Following his second treatment, the patient developed acute neck pain and swelling. Radiographic studies and a laryngoscopy demonstrated bilateral symptomatic external laryngoceles, a very rare entity, not previously known to be associated with radioiodine treatment or Graves disease. The patient's profession placed him at risk for the development of a laryngocele, but the temporal relationship to goiter regression following radioiodine therapy suggests that this occurred as a result of this treatment. The patient's disease was managed nonsurgically, and he has subsequently done well. This represents the first known association of symptomatic laryngocele with radioiodine treatment for Graves disease.

D-dimer correlates with proinflammatory cytokine levels and outcomes in critically ill patients.

STUDY OBJECTIVES: To determine the relationship between d-dimer (DD) and both proinflammatory and anti-inflammatory cytokine levels, and to confirm the association between DD status and outcomes in critically ill patients. DESIGN: Prospective observational study. SETTING: Medical ICU (MICU) of a tertiary care, academic medical center. PATIENTS: Individuals admitted to the MICU. INTERVENTIONS: Within 24 h of MICU admission, patients had DD status determined and interleukin (IL) levels (IL-6, IL-8, and IL-10) and tumor necrosis factor (TNF)-alpha measured. The strength of the DD level was also noted. Subjects were then monitored prospectively to determine mortality rate and the incidence of organ failure. MEASUREMENT AND RESULTS: The study cohort included 79 patients (mean age, 65.2 years; 54.5% male patients). DD was present in 53.2% of subjects. The DD reaction was weak (1+) in 15 patients and strong (2+) in 27 patients. The TNF-alpha, IL-6, and IL-8 levels all increased in parallel with the increasing strength of the DD level. IL-10 levels did not differ based on DD status. Similarly, the severity of illness as measured by the APACHE (acute physiology and chronic health evaluation) II score was highest among those with higher DD levels: 24.7 +/- 6.2 for those with 2+ DD vs 17.2 +/- 3.1 and 11.5 +/- 2.7 for those with 1+ DD and no circulating DD, respectively (p < 0.001). For patients lacking DD, the mortality rate was 8.1%, compared to 13.3% and 55.6% for those with 1+ and 2+ DD levels, respectively (p < 0.001). No patient without DD had multisystem organ failure (MSOF) develop, while the incidence of MSOF also increased with increasing DD levels. As a screening test for mortality, the DD performed as well as the APACHE II system. CONCLUSIONS: The coagulation system is active in critically ill patients, and DD levels correlate with activation of the proinflammatory cytokine cascade. The absence of a relationship between DD and anti-inflammatory cytokines (IL-10) suggests that the presence of DD may reflect the imbalance between proinflammatory and anti-inflammatory cytokines. DD identifies patients at increased risk for both MSOF and death.