Background: We assessed the cases of intraoperative spillage of primary pleomorphic adenomas (PPAs) of the parotid gland in the literature, comparing them with our own cases. We aim to explain how the surgeon should manage a spillage during surgery (i.e., how to avoid spreading the contents that are coming out of the tumor). We also aim to investigate whether or not spillage is linked to a higher rate of PPA recurrence. Methods: We collected surgical and pathological reports, taking data on capsular ruptures and the spillage of tumors. Results: Intraoperative tumor spillage and tumor rupture occurred in 34/202 cases. There were three recurrences after a mean of 3.7 years (mean follow-up duration: 10.3 years). One recurrence happened to a patient who had an intraoperative tumor spillage, and two more recurrences happened to patients who did not have spillage. Conclusion: We believe that the real number of the events of spillage is underestimated and underreported by surgeons. Capsular rupture must always be avoided, and secure resection margins must always be pursued, independent of the type of parotidectomy being performed. Features that increase the risk of recurrence are an intraoperative rupture and the presence of satellite nodules (as recorded in the pathologist’s report). In these cases, patients need a longer follow-up period.

BackgroundThe “cost of illness” of the acute allergic rhinitis (AR) episodes in patients with chronic AR is very high in terms of therapy and quality of life. AR represents a worldwide health problem; despite the fact that many standardized treatments have been proposed and used, the recurrence rate of acute rhinitis episodes in springtime is always higher.Materials and methodsSixty consecutive patients (13 F and 17 M in group A, 15 F and 15 M in group B; p=0.60) with chronic AR were enrolled in this prospective, controlled clinical trial. Thirty patients were treated daily for the same 5 months of the following year (2013) with isotonic seawater nasal spray enriched with manganese (Sterimar Mn; 4 puffs/day), whereas 30 patients received only the standard care and were used as control group.ResultsA 5 months course treatment with the nasal Sterimar Mn was able to decrease, significantly (p<0.001), the number of episodes of acute AR (6.33 episodes in the group of treated patients versus 9.33 episodes in control group). Also, the 5 months quality of life reduced over time (Visual Analogue Scale 5th month 9.90 in treated group versus Visual Analogue Scale 5th month 8.72 in control group: p<0.001) without the typical adverse effects of the AR standard care therapy.ConclusionThis study shows the effectiveness of the use of Sterimar Mn for a 5 months therapy in terms of reduction of the number of episodes of acute AR and effectiveness of intrasubject improvement of Visual Analog Scale (quality of life).

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Renal allograft recipients are at greater risk of developing tuberculosis than the general population. A woman with a kidney transplant was admitted to the emergency department with high temperature, dysphonia, odynophagia, and asthenia. The final diagnosis was laryngeal tuberculosis. Multidisciplinary collaboration enabled accurate diagnosis and successful treatment. Laryngeal tuberculosis should be considered in renal allograft recipients with hoarseness. A more rapid diagnosis of tuberculosis in renal transplant recipients is desirable when the site involved, such as the larynx, exhibits specific manifestations and the patient exhibits specific symptoms. In these cases, prognosis is excellent, and with adequate treatment, a complete recovery is often achieved.

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