Pyoderma gangrenosum is an ulcerative skin disorder usually associated with an underlying systemic disease. Head and neck involvement is rare, but possibly more common than once thought. The etiology of this disease is unclear, but may be related to an abnormal immunologic response. There are no pathognomonic histologic or laboratory findings; the diagnosis is made by the clinical appearance of the lesions and disease course. Treatment consists of immunosuppression and local wound care in addition to a search for and treatment of an underlying primary systemic disorder. A case report and review of the literature is presented with discussion of common head and neck manifestations, the differential diagnosis, and treatment alternatives.

\s=b\An alarmingly high rate of postirradiation sarcomas following treatment for retinoblastoma has been described in the literature. We present four new cases and report 57 others from the English literature. Osteogenic sarcoma was the predominant histologic type (58%), followed by fibrosarcoma (21%) and various other sarcomas (21%). The average latency period between irradiation and development of the second primary (sarcoma) was 12.4 years. Irrespective of irradiation, a genetic linkage between retinoblastoma and osteogenic sarcoma on the 13q14 chromosome is recognized. Through a pleiotropic effect of this same chromosome, a predisposition for other sarcomas may exist as well. Finally, a strong role for radiation induction is proposed for all of these postirradiation sarcomas. This is based on the increased number of sarcomas arising in the field of prior irradiation (sites uncharacteristic of spontaneously occurring primary sarcomas) and the prolonged latency periods.(Arch Otolaryngol Head Neck Surg 1988;114:640-644) A recent review of patients presenting to the Stanford (Ca¬ lif) University Head and Neck Tumor Board with postirradiation sarcomas revealed that most had been irra¬ diated for retinoblastoma and devel¬ oped osteogenic sarcoma as their sec¬ ond primary sarcoma. Another pa¬ tient was brought to our attention who also developed an osteogenic sar¬ coma following irradiation for retino¬ blastoma, but outside the field of irra¬ diation in her lower extremity. This latter case prompted the question of whether these secondary head and neck sarcomas were radiation induced or if long-term survivors were simply expressing a genetic predisposition to develop second malignant neoplasms. To answer this question, four new patients with postirradiation sarco¬ mas developing after treatment for ford, CA 94305 (Dr Fee). retinoblastoma are described herein, with a review of the literature. We describe a possible genetic predisposi¬ tion for development of osteogenic sarcoma as a second primary sarco¬ ma, and propose a role for radiation induction. METHODS AND MATERIALSHead and Neck Tumor Board records at Stanford University Medical Center were reviewed from 1980 to 1985. Patients selected had a history of retinoblastoma and developed second sarcomas fulfilling the criteria of Cahan et al1 for radiationinduced sarcoma, with the modifications of Arien et al2: (1) microscopic or roentgeno¬ graphic evidence of an initial nonmalignant state, or a malignant state devoid of osteoid production; (2) development of sar¬ coma within the field of radiation; (3) long disease-free latency period between irradi¬ ation and onset of second primary symp¬ toms or tumor (eg, three years); and (4) histologie documentation of the sarcoma.One case was excluded because the sec¬ ondary tumor, although undifferentiated on initial histologie sections, proved to be recurrent retinoblastoma.The literature review was based on a MEDLINE search of the English literature for the 20-year period from 1966 to 1985, referencing postradiation (rad...

Intubation of the cervical esophagus with a long-term indwelling prosthesis is described to palliate malignant strictures, and manage benign strictures in high-risk patients. The inner cannula of a Moore design tracheostomy tube was used as the prosthesis. Over a 10-year period, seven cases were managed in this fashion. The tube remained in place in five of seven patients for periods of 1.5 to 11 months, while a pureed or well-masticated soft diet was tolerated. There were no major complications in this small series. Retrograde displacement was the most common minor complication; displacement did not occur in the last two cases after addition of a silicone sponge ring to the distal end of the prosthesis. Pain and discomfort was experienced in two cases, requiring temporary removal in one patient.