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In Reply.—
We agree with Chuang and Ilstrup that a prospective controlled study is necessary to determine if there is a statistically significant association between SIN and internal malignant neoplasms. We have reported a seemingly high rate of secondary neoplasms in our group of 130 patients. As seen in our Table 3, the rate of concurrent or subsequent internal neoplasms is approximately 14% in all combined groups. Although we cannot compare this with population data, this percentage seems amazingly high. In other words, a patient with SIN has about a one in six chance of having an internal malignant neoplasm or in having one develop.It is unfortunate that in the multiple revisions of this article, two typographic errors were not recognized and thus the 13th case in Table 2 was left out and "22" appears in Table 4. The text is correct. The patient left out of Table 2 was a