The incidence of mucinous appendiceal malignancies: a population-based study.

PURPOSE: Mucinous appendiceal tumours were described already 180 years ago, but reliable data on the incidence of these tumours are sparse. The clinical importance of these tumours is increasing since they are now identified as the most common site of origin for pseudomyxoma peritonei (PMP), which is currently recognised as a treatable condition. METHODS: Data on the incidence of mucinous appendiceal tumours were retrieved from the Eindhoven Cancer Registry, which collects data on all patients with newly diagnosed cancer in a large part of the southern Netherlands that comprises about 2.3 million inhabitants. From 1980 to 2010, all cases of primary adenocarcinomas of the appendix were included. RESULTS: From 1980 to 2010, a mucinous adenocarcinoma was diagnosed in 78 patients being 48 % of all cases of appendiceal adenocarcinoma diagnosed during this period (n = 164). The incidence increased during the study period from 0.6 to 1.9 per 1,000,000 person-years for women and from 0.4 to 1.0 per 1,000,000 person-years for men. CONCLUSION: The reported incidence of mucinous adenocarcinomas of the appendix shows an increasing trend. This is probably mainly explained by the increased awareness of this tumour and its relation with PMP, and better registration of this specific diagnosis.

The role of antioxidants in ischaemia-reperfusion in a human DIEP flap model.

BACKGROUND: A better understanding of the pathophysiology of ischaemia-reperfusion injury and a possible treatment for it, is of great importance. The deep inferior epigastric perforator (DIEP) flap is an innovative, clinical model of ischaemia-reperfusion. There has been an ongoing interest in the health benefits and medical applications of antioxidants. We hypothesised that during ischaemia-reperfusion, specific antioxidants are depleted. METHODS: Seventeen DIEP flaps were performed in 15 patients undergoing breast reconstruction. In each free flap, 3-mm skin biopsies were taken from the DIEP flap at four different time points during and after surgery. In those tissue biopsies, concentrations of the antioxidants vitamin E, glutathione (GSH) and uric acid and total antioxidant capacity (TEAC) were measured. RESULTS: Unexpectedly, no immediate change was observed in GSH concentrations during ischaemia-reperfusion. Uric acid concentrations were significantly increased at all time points following reperfusion. Vitamin E concentrations also showed a significant incline 30min and 1h after reperfusion. However, 1h after reperfusion, a significant decrease in total hydrophilic antioxidant capacity (TEAC) was seen. In the next hour, this capacity recovered. CONCLUSIONS: During ischaemia-reperfusion, a deficiency in hydrophilic antioxidant capacity develops. This is a potential cause for the development of ischaemia-reperfusion injury by reactive oxygen species. This clinical trial is registered on Clinical Trials: http://www.clinicaltrials.gov/. Trial registry name: The DIEP-flap as a model of ischaemia-reperfusion. Registration identification number (NCT): 00482469.

The Effect of Statins and Other Cardiovascular Medication on Ischemia-Reperfusion Damage in a Human DIEP Flap Model: Theoretical and Epidemiological Considerations.

Background. Statins and other cardiovascular medication possess antioxidant capacity. It was examined whether chronic use of these medications protects from the development of ischemia-reperfusion (I/R) related complications after DIEP (Deep Inferior Epigastric Perforator Free Flap) surgery. This paper contains a literature study on the antioxidant working mechanisms of these drugs. Methods. Medical information of 134 DIEP patients (173 flaps) was studied from their medical files. Patient and operative characteristics were registered, as well as I/R related complications. Results. Of the group that didnot use statins, 16.3% developed complications versus 30.8% amongst patients that did use these drugs (P = 0.29). Amongst patients that chronically use other cardiovascular medication, 26.8% developed I/R related complications versus 14.4% of the patients without medication (P = 0.10). Conclusions. Chronic use of statins or other cardiovascular medication didnot decrease the occurrence of I/R related complications after DIEP surgery. Therefore, research should be aimed at evaluating short-term pre-treatment with statins.