[Mechanical ileus caused by a Provox voice prosthesis -- an "iatrogenic" enteral complication in voice prosthesis rehabilitation of laryngectomees]

BACKGROUND

During the exchange of a defect Provox-I voice prosthesis followed by an insertion of a Provox-II voice prosthesis the esophageal part of the prosthesis often is pushed into the esophagus, as the enteral passage of the prosthesis was thought to be less traumatic for the voice shunt in comparison to a complete extraction of the stiff esophageal flange through the tracheostoma. This procedure is also recommended in the users video of the ATOS company.

CASE

A laryngectomized patient, in whom the change of the voice prosthesis was carried out pushing the esophageal flange of the prosthesis into the esophagus, developed a mechanical ileus, as the voice prosthesis got stuck in Bauhin's valve. This resulted in the necessity of a laparatomy for removal of the voice prosthesis.

CONCLUSION

During the replacement of the Provox voice prosthesis it is necessary in all cases that the esophageal remnant of the voice prosthesis either is pulled out of the tracheoesophageal shunt via the tracheostoma or removed with a guide-wire transorally.

Stimulation of wound healing, using brain extract with fibroblast growth factor (FGF) activity

A bovine brain fraction with FGF activity (fibroblast growth factor) increased the formation of granulation tissue of rats in an experimental wound healing model. It was characterised by intensified formation of new capillaries, stimulation of the synthesis function of fibroblasts and myofibroblasts, and proliferation of freshly developed granulation tissue. The results obtained from light microscopy and autoradiographic electron microscopy with 3H-thymidine suggested significant increase in the labelling of activated, undifferentiated endothelial cells in vascular sprouts and of differentiated endothelial cells in developed capillaries. FGF S3 appeared to speed up the differentiation of freshly formed endothelial cells. Also labelled were pericytes and other fibroblastoid cells, undifferentiated mesenchymal cells, juvenile undifferentiated fibroblasts, mature fibroblasts, myofibroblasts, and macrophages. Pericytes are presumed to be preferential precursors of myofibroblasts, on account of their occurrence in time and similar ultrastructural parameters. Close neighbourhood of lymphocytes and labelled fibroblasts gave rise to the assumption of specific effects, such as stimulation by lymphokines.