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M Fisch

Publications and source records attributed to M Fisch.

17 recordsLinked to original sources
PubMed1992

Pediatric urinary diversion: review and own experience.

New insights into the diseases of childhood, profound improvements and new developments in surgical techniques as well as the knowledge gained from long-term follow-up have altered the strategies and indications for urinary diversion in childhood. Continent urinary diversion is generally the method of choice. We are able to construct high capacity, low pressure reservoirs to protect the upper urinary tract and achieve continence. Nowadays, there is hardly any indication for permanent cutaneous urinary diversion. Temporary and intermediate cutaneous diversion are used only when serious conditions such as renal function deterioration occur. The possibility to convert any incontinent form of urinary diversion into a continent form changed the status of intermediate diversion. The indications for urinary diversion, the procedures available, the operative technique, a literature review, our own experience, contemporary strategies and controversies are described and discussed.

Child↗
PubMed1992

The appendix as a continence mechanism.

Although we have progressed very well in creating large capacity, low pressure reservoirs, the construction of a simple and reliable continent outlet still remains a problem. The appendix vermiformis serves well as a continence mechanism for either the bladder or intestinal reservoirs for urine. The different surgical techniques described in the literature are reviewed and discussed in this context. Moreover, we report on our clinical and experimental results of using the appendix during the Mainz pouch procedure for continent urinary diversion.

Adolescent↗
PubMed1992

[The "Mainz pouch" technique (bladder augmentation with ileum and cecum) for bladder augmentation, bladder substitution, and continent urinary diversion].

Back in 1983 we created a continent urinary reservoir, called the MAINZ pouch, using 10 to 15 cm. of cecum as well as two terminal ileal segments of equal length. Following detubularization, the posterior wall of the pouch is established by anastomosis of the ascending colon with the terminal ileal loop starting at the inferior aspect. The latter is then anastomosed with the next proximal ileal segment. The ureters are implanted in an antirefluxive manner in the open end technique through a submucosal tunnel of 4 to 5 cm length. For bladder augmentation the pouch is anastomosed to the bladder remnant. For bladder substitution a buttonhole incision at the most inferior aspect of the cecal pole is placed or the appendix is used for end-to-end anastomosis to the membranous urethra. For continent diversion an additional 7 to 12 cm of ileum are isolated in order to create an ileal intussuscepted valve. Alternatively the appendix can be used. Continence is achieved by submucosal embedding of the appendix into the cecal pole. A total of 346 patients underwent the MAINZ pouch procedure in Mainz and Wuppertal; 56 for bladder augmentation, 49 for bladder substitution and 241 for continent urinary diversion. We encountered early complications in 29 of the 346 patients (8.38%). Late complications were observed in 72 patients (20.8%). The major complications we encountered were stone formation inside the pouch in 19 patients and stomal stenosis in 21. 54 of the 56 patients with a bladder augmentation are completely continent (mean follow-up: 50 months, range: 10 to 83 months). All of the 49 patients who received a bladder substitution after radical cystectomy are continent during daytime. Three of these patients who do not empty their bladder at regular four hour intervals have leakage during the night (follow-up: 23 to 69 months). The revision rate due to nipple gliding and subsequent incontinence could be greatly reduced by the use of staples for fixation of the ileal nipple and the use of the appendix. For correction of the most frequently occurring complications standardized techniques have been developed.

Cecum↗
PubMed1992

Seven years experience with the Mainz pouch procedure.

In 1983 we created a form of continent urinary diversion termed the Mainz pouch procedure utilizing cecum and ileum. For creation of the reservoir 10 to 15 cm of cecum and ascending colon as well as two terminal ileal segments of equal length are isolated and detubularized. The posterior wall of the pouch is completed by anastomosis of the ascending colon with the terminal ileal loop starting at the inferior aspect. The latter is then anastomosed with the next proximal ileal segment. The ureters are implanted in an antirefluxive manner in the open end technique through a submucosal tunnel of 4 to 5 cm of length. For bladder augmentation the pouch is anastomosed to the bladder remnant. For bladder substitution a buttonhole incision at the most inferior aspect of the cecal pole or the appendix is used for end-end anastomosis to the membrancus urethra. For continent diversion and additional 8 to 12 of ileum are isolated in order to create an ileal intussuscepted valve. Alternatively the appendix can be used. Continence is achieved by submucosal embedding of the appendix into the cecal pole. A total of 281 patients underwent the Mainz pouch procedure, 54 for bladder augmentation, 7 for bladder replacement and 200 for continent urinary diversion. We encountered early complications in 15 of the 281 patients (5.3%). Late complications were observed in 63 patients (22.4%). The major complications we encountered were stone formation inside the pouch in 17 patients and stomal stenosis in 19. Fifty-two of the 54 patients with a bladder augmentation are completely continent (mean follow-up: 50 months, range: 10 to 83 months). All of the 27 patients who received a bladder substitution after radical cystectomy are continent during daytime. Three of these patients who do not empty their bladder at regular four hour intervals have leakage during the night (follow-up: 23 to 69 months). The revision rate due to nipple gliding and subsequent incontinence could be greatly reduced by the use of staples for fixation of the ileal nipple and the use of the appendix. For correction of the most frequently occurring complications standardized techniques have been developed.

Cecum↗
PubMed1991

Pyelotransverse pyelocolostomy: an alternative method for high urinary diversion in patients with extended bilateral ureter damage.

After previous radiation due to pelvic malignoma or after multiple operations, the ileal conduit as well as sigmoid conduit are associated with an increased rate of complications. In these patients, the middle and distal ureter often cannot be considered for reimplantation due to fibrosis. High anastomosis to a bowel segment which is undamaged proves favorable. The transverse colon, conveniently situated in the cranial abdomen, is close enough to the kidneys for such a high anastomosis and is mostly spared from irradiation. In cases where severely damaged ureters forbid connection to a normal transverse conduit, we performed a pyelotransverse pyelocolostomy with high anastomosis of the bowel to both renal pelves or ureteropelvic junctions. 7 patients have been treated in this way and the follow-up of these patients ranges between 14 and 24 months. Postoperatively increased renal function was found in 6 renal units, stable function in 6 renal units, and only 1 patient showed a functional ureteropelvic stenosis. 4 months after the operation 1 patient died of sepsis caused by recurrent urinary tract infections due to recurrent stone disease as a consequence of immobilization in myelomeningocele. In patients with nearly total loss of ureters the pyelotransverse conduit is an effective surgical solution and may prove more comfortable to the patient than bilateral percutaneous nephrostomies.

Adult↗
PubMed1991

[The Mainz pouch. Ileocecal reservoir, Mainz pouch].

The surgical technique for creation of the Mainz-pouch uses 12cm of cecum and ascending colon and 2 ileal loops of the same length for construction of an urinary reservoir, which has proven to be applicable for bladder augmentation, bladder substitution as well as for continent urinary diversion. For the creation of a continent nipple in urinary diversion 6cm of ileum in addition are necessary. As a modification we use the non-infected submucosal imbedded appendix as continence mechanism. Since 1986 a total of 247 patients underwent a Mainz-pouch procedure: 54 for bladder augmentation, 27 for bladder substitution and 166 for continent diversion. The appendix as continence mechanism was used in 30. Postoperative mortality rested under 1%, early complications have been observed in 4.4% and late complications in 13.7% (mean follow-up of 35 months). In the bladder augmentation group 52 patients are completely dry, 2 patients have urge and frequency and 5 patients are on intermittent self catheterisation to avoid residual urine. In the bladder substitution group all patients are continent at daytime. At nighttime 3 patients have leakage if they don't empty their bladder all 4 hours. In the urinary diversion group all but 3 are completely dry and are on intermittent catheterization. The main problem of our initial series was prolapse of the continent nipple which has been solved by staple fixation of the nipple to the bowel wall and to the ileocecal valve or by using the submucosal imbedded appendix.

Adult↗
PubMed1990

[The Mainz-pouch. 6 years of clinical experience].

The surgical technique for creation of the Mainz-pouch uses 12 cm of cecum and ascending colon and 2 ileal loops of the same length for construction of an urinary reservoir, which has proven applicable for bladder augmentation, bladder substitution as well as for continent urinary diversion. For the creation of a continent nipple in urinary diversion 6 cm of ileum in addition are necessary. As a modification we use the non-infected submucosal imbedded appendix as continence mechanism. Since 1986 a total of 247 patients underwent a Mainz-pouch procedure: 54 for bladder augmentation, 27 for bladder substitution and 166 for continent diversion. The appendix as continence mechanism was used in 30. Postoperative mortality rested under 1%, early complications have been observed in 4.4% and late complications in 13.7% (mean follow-up of 35 months). In the bladder augmentation group 52 patients are completely dry, 2 patients have urge and frequency and 5 patients are on intermittent self catheterisation to avoid residual urine. In the bladder substitution group all patient are continent at daytime. At nighttime 3 patients have leakage if they don't empty their bladder all 4 hours. In the urinary diversion group all but 3 are completely dry and are on intermittent catheterisation. The main problem of our initial series was prolapse of the continent nipple which has been solved by stable fixation of the nipple to the bowel wall and to the ileocecal valve or by using the submucosal imbedded appendix.

Bioprosthesis↗
PubMed1988

Quasi-elastic light scattering of antigen-antibody complexes.

Many biological properties of immune complexes (IC) depend upon their size. Quasi-elastic light scattering (QLS) was used to measure a mean equivalent hydrodynamic radius (Rh) and variance of the distribution of model IC composed of bovine serum albumin (BSA) as antigen (Ag) and combinations of two or three well-characterized monoclonal antibodies (MAb) which bound noncompetitively to unique epitopes on BSA. With the molar ratio (X) of each MAb to Ag fixed, Rh increased with concn. Rh was maximal at equivalence (X = 0.5) with two MAb and at slight MAb excess (X = 0.67) with three MAb. The largest Rh with two MAb was about 200 A, and Rh was uniformly different amongst the three combinations of two MAb IC. The largest hydrodynamic radius of individual complexes which formed with two MAb was estimated to be about 400 A; even larger individual complexes were formed with three MAb. Size changes following alteration of solution concns were also followed with QLS. Kinetics of two MAb IC association were too fast to observe; dissociation following large dilution (40-fold) required 5-10 min to attain a new steady state, much less at small dilution. With three MAb, Rh dropped sharply in 5 min and became steady after 1-2 hr. These results suggest that conventional chromatographic and ultracentrifugation techniques for studying IC size, involving large dilution and long measurement time, provide misleading results. Association of three MAb produced a rapid initial increase of Rh in several min, followed by diverse behavior which depended upon concn. From high to low concn, these included (1) exponential growth of Rh with time and appearance of visible macroscopic particles; (2) metastable states for several hr followed by slow growth to large size over several days, leading to formation of particles; and (3) rapid growth to steady state conditions with no visible particles. This heretofore unobserved equilibrium and kinetic behavior of model IC in solution may be reflected in the behavior of more complex, naturally occurring IC.

Animals↗