Trachea stoma vent voice prosthesis.

Having been in use for the past couple of years, the "duckbill" valved Silastic tube developed by Blom and Singer is well established as a device for vocal rehabilitation of the laryngectomee. The newer "voice button" prosthesis developed by Panje incorporates a similar vale in Silastic. Neither of these devices can be used with tracheal stomal stenosis or with a deep tracheal stoma behind prominent sternomastoid muscles. The ritual of taping the Blom-Singer prosthesis and the frequent failure of the tape to hold are other distinct disadvantages. Limitations are imposed on patient selection with the Panje prosthesis because of the rigid dimensions and the possibility of aspiration of the device, as well as the necessity for manual dexterity on the part of the patient. A new device has been fashioned utilizing the "duckbill" Silastic tube as a valve attached to a new type of trachea stoma button. This appears to have universal application, is not difficulty to change, requires no taping, and is self-maintaining. There is no possibility of aspiration. The device is simple and appears to overcome many of the disadvantages of the other two. The tracheal esophageal puncture must be made in a cephalad direction so that the tracheal air diverted through the prosthesis will be directed toward the pharynx and not toward the esophagus. Prostheses directed caudad will not function and those patients should be repunctured.

Eosinophilic gastroenteritis with ascites and colon involvement.

The case of a 39-year old white man with eosinophilic gastroenteritis is presented. The major clinical features were gastric outlet obstruction, diarrhea and massive ascites. At surgery, significant involvement of the entire gastrointestinal tract from the gastric antrum to the sigmoid colon was found. Histologic documentation of colon involvement was obtained. The response to corticosteroids was prompt and sustained. At present, he is maintained on an alternating day schedule of steroid administration.