Sjögren's syndrome in children with recurrent parotitis.

OBJECTIVE: Optimize the diagnosis of pediatric Sjögren's syndrome in children who present with parotitis. METHODS: Twenty children presented to a pediatric otolaryngology or rheumatology clinic with recurrent parotitis. Presenting symptoms, serologies, sialendoscopy findings, and minor salivary gland biopsy pathology results were reviewed. RESULTS: Twenty patients aged 3-17 years presented with recurrent parotitis. Ten percent of this cohort met the American-European Consensus Group adult diagnostic criteria for Sjögren's syndrome. Forty percent of this cohort met diagnosis of Sjögren's syndrome when utilizing Bartunkova's proposed pediatric criteria for diagnosis of Sjögren's syndrome. CONCLUSION: Sjögren's syndrome is surprisingly common in pediatric patients who present with recurrent parotitis. Otolaryngologists who treat pediatric parotitis should have a high index of suspicion for Sjögren's syndrome. LEVEL OF EVIDENCE: 4.

Changes in Timing of Swallow Events in Parkinson's Disease.

OBJECTIVES:: The prevalence of Parkinson's disease (PD) increases as the population ages. Dysphagia and subsequent aspiration pneumonia are common causes of morbidity and mortality in those with PD. To maximize the benefit of swallowing therapy, protocol design should be based on an understanding of the physiologic swallowing deficits present in the PD population. The aim of this study was to compare the timing of swallow events in a cohort of patients with PD with that in normal age-matched control subjects to characterize variations in the coordination of structural displacement and bolus movement that may contribute to dysphagia. METHODS:: This retrospective study included 68 adults with diagnoses of PD. Liquid bolus swallows during modified barium swallow studies were analyzed and compared with those from an age- and sex-matched cohort of 48 adults without PD. RESULTS:: Patients with PD were significantly slower in initiating and completing airway closure. Hyoid elevation was prolonged in this patient population. CONCLUSIONS:: Patients with PD demonstrate slower initiation of airway closure and a delay in relaxation of hyoid elevation during swallow. Delays increased with larger boluses. These findings may be related to impaired pharyngeal sensation and increased muscular rigidity. The results of this study will be helpful in guiding swallow therapy for patients with PD.

External validation and evaluation of an intermediate proficiency-based knot-tying and suturing curriculum.

PURPOSE: The purpose of this study was to perform external validation, examine educational effectiveness, and confirm construct validity of a previously developed "intermediate-level, proficiency-based knot-tying and suturing curriculum" in preparing residents to achieve proficiency in more advanced open surgical techniques. METHODS: A total of 47 postgraduate year-1 (PGY-1) surgery residents completed 6 intermediate-level knot-tying and suturing exercises. Baseline trainee performance was compared with intermediate and senior (PGY-3 and PGY-4) residents (n = 12) and expert faculty (n = 4). RESULTS: PGY-1 overall proficiency increased from 21.1% at baseline to 92.1% during posttest for all 6 exercises combined (p < 0.001). When compared with the PGY-3 and PGY-4 residents, at baseline intermediate and senior residents scored higher on half of the exercises. However, during posttesting PGY-1 residents not only matched, but also surpassed PGY-3 and PGY-4 residents' performance in 3 of 6 exercises. Significant differences on all 6 exercises were also found during pretesting when comparing interns against faculty, demonstrating construct validity. However, upon completion of the curriculum, PGY-1 residents' posttest scores were equivalent, if not significantly better than expert faculty performance. CONCLUSION: We obtained similar results as those previously reported, showing external validation. Additionally, we demonstrated that first-year surgical residents could achieve performance levels that match or exceed those of senior residents and experienced surgeons on these exercises with 4 weeks of training.