Department of Surgery, Lincoln Medical and Mental Health Center, Weill Medical College of Cornell University, 234 East 149th Street, Bronx, NY 10451, USA.

A literature search revealed only five recent articles with specific information on the incidence of performance of pancreaticoduodenectomy when the preoperative diagnosis is uncertain. The collected incidence of benign diagnoses in the five papers was 13.1%. Five other papers describing patients from before 1990 reported rates of benign diagnoses of 9.7%, p<0.007 compared to the more recent series. The introduction of advanced diagnostic tests has not decreased the incidence of benign pathology after pancreaticoduodenectomy for presumed cancer. Pancreaticoduodenectomy should be performed without a definitive diagnosis of cancer if, in the opinion of an experienced surgeon, clinical suspicion is high.

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School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK.

Patients with early stage breast cancer can opt for either mastectomy or breast-conserving surgery (BCS), but BCS requires daily radiotherapy for some weeks. The hypothesis that ease of access to radiotherapy might affect choice of surgery was investigated using records of 6014 breast cancer patients in Northern England. Adjusting for the effects of age, deprivation and hospital type, the choice of BCS was not associated with the estimated car journey time to radiotherapy for most women but there was an association for patients living in places without a regular bus service, so transport problems might influence surgery choice for a minority of women.

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Department of Pathology, New York Eye and Ear Infirmary, New York, New York 10003, USA. dhu@nyee.edu

PURPOSE: To investigate racial and ethnic differences in the incidence of conjunctival melanoma in a large population-based study. DESIGN: Observational cross-sectional study. METHODS: Using data from 1992 through 2003 provided by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, we calculated age-adjusted incidence rates of conjunctival melanoma in various racial and ethnic groups (Black, American Indian, Asian and Pacific Islander, Hispanic, and non-Hispanic White). In addition, we calculated the standard incidence ratios (risk ratios) and 95% confidence intervals to describe the differences within these racial and ethnic groups. RESULTS: From 1992 through 2003, there were a total of 168 conjunctival melanomas diagnosed in 13 SEER registries with known racial and ethnic groups. The annual age-adjusted incidence rates (per million population) of conjunctival melanoma was 0.18 (Blacks), 0.17 (American Indians), 0.15 (Asians), 0.33 (Hispanics), and 0.49 (non-Hispanic Whites). The difference in the incidence of conjunctival melanoma between Whites and Blacks or Asians was statistically significant, but was not significant between Blacks and Asians. CONCLUSIONS: The overall White-to-Black incidence ratio in conjunctival melanoma was 2.6:1, which is much less than that of uveal melanoma (18:1) and cutaneous melanoma (13:1 to 26:1), but is similar to that of mucosal melanoma (2.2:1 to 2.3:1). The cause and significance of this difference of racial and ethnic incidence in various melanomas are discussed.

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Laboratorio de Biología Molecular, Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico; Laboratorio de Biología Molecular, Unidad de Investigación Médica en Genética Humana, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico.

Approximately 30% of the cases of retinoblastoma (RB), the childhood eye cancer, are inherited and are manifested by unilateral or bilateral tumor. In sporadic tumors, accounting for 70% of cases, only one eye is affected. RB has three histological features: undifferentiated anaplastic cells, retinoblast pattern, and differentiated pattern characterized by Flexner Wintersteiner rosettes (FWR). Currently, results concerning phosphoprotein RB (pRB) expression in RB tumors are contradictory. In this study we detected pRB immunohistochemically in 10 tumors from bilateral or unilateral RBs, which did not show gross chromosomal alterations in cytogenetic studies. Interestingly, pRB was undetectable in only one tumor where we found distinct histological features. Our results suggest that pRB immunopositivity may be common in these tumors. However, it does not rule out the possibility that pRB is functionally inactive in some cases. This may be due to the protein being present in phosphorylated form or being altered by point mutations not affecting its expression. Another possibility is that mechanisms other than RB1 gene changes may lead to retinoblastoma because not all cases of retinoblastoma show gene alterations. Together these findings may be useful in understanding the molecular mechanisms associated with this type of pediatric tumor.

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Department of Otorhinolaryngology and Head and Neck Surgery, Turku University Hospital, Turku, Finland.

PURPOSE: Synthetic bioactive glass (BAG) is used in many surgical applications. Special bioactive glasses do not favor microbial growth. This study evaluated the clinical outcome of bioactive glass plates in reconstructive orbital surgery. PATIENTS AND METHODS: In a retrospective series of 49 patients, 35 orbital floors and 6 orbital medial and superior walls were reconstructed after fronto-orbital trauma, and 8 patients were treated with BAG plates after fronto-orbital tumor resection. These patients were evaluated in terms of reconstruction materials, complications, and functional outcomes. RESULTS: During the 2-year follow-up, 3 of the 35 orbital floor trauma reconstructions were reoperated (9%) because of diplopia, and new reconstructions with BAG were performed. In all of the 8 patients with tumors and in 6 of the patients undergoing orbital wall reconstruction, the plates were in the correct position after reconstruction, and none had to be removed. One patient with a benign tumor and 7 of the 8 patients with malignant tumors survived to the 2-year follow-up. CONCLUSIONS: Reconstructive surgery of the orbit is one of the most demanding challenges in head and neck surgery. In orbital defect reconstruction, a BAG plate seems to be a well-tolerated and reliable reconstruction material alternative; however, BAG plates are brittle and rigid, and cannot be molded and shaped by a surgeon. The use of a stainless steel template of equal shape and size to a BAG plate is recommended to ameliorate this deficiency.

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