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Biomedical subjects

C Couinaud

Publications and source records attributed to C Couinaud.

At least 37 records · Page 2Linked to original sources
PubMed1985

The "lead-induced colic" syndrome in lead intoxication.

Lead has a multiplicity of biologic effects. The universal occurrence of lead accounts for the continuous appearance of new instances of human lead poisoning. The most common and one of the earliest manifestations of lead intoxication in the adult is so-called lead-induced colic, which is a syndrome with a multiplicity of clinical patterns and at least three possible different pathogenic mechanisms. It may be caused by changes in the visceral smooth muscle tone secondary to the action of lead on the visceral autonomic nervous system, lead-induced alterations in sodium transport in the small-intestinal mucosa, and lead-induced interstitial pancreatitis. It should be considered in the differential diagnosis of abdominal pain of obscure etiology and whenever a disparity is observed between the symptoms and the abdominal findings in a patient with abdominal pain, especially in the presence of a history of occupational exposure to lead.

Abdominal Muscles↗
PubMed1984

[Zinc].

Zinc is indispensable for life from bacteria to man. As a trace element it is included in numerous enzymes or serves as their activator (more than 80 zinc metallo-enzymes). It is necessary for nucleic acid and protein synthesis, the formation of sulphated molecules (insulin, growth hormone, keratin, immunoglobulins), and the functioning of carbonic anhydrase, aldolases, many dehydrogenases (including alcohol-dehydrogenase, retinal reductase indispensable for retinal rod function), alkaline phosphatase, T cells and superoxide dismutase. Its lack provokes distinctive signs: anorexia, diarrhea, taste, smell and vision disorders, skin lesions, delayed healing, growth retardation, delayed appearance of sexual characteristics, diminished resistance to infection, and it may be the cause of congenital malformations. Assay is now simplified by atomic absorption spectrophotometry in blood or hair. There is a latent lack prior to any disease because of the vices of modern eating habits, and this increases during stress, infections or tissue healing processes. Its lack is accentuated during long-term parenteral feeding or chronic gastrointestinal affections. Correction is as simple as it is innocuous, and zinc supplements should be given more routinely during surgical procedures.

Acrodermatitis↗
PubMed1983

[Coagulation and the general surgeon. Its physiology and laboratory tests].

Mechanisms of coagulation and appropriate laboratory tests necessary for general surgical procedures are outlined. Physiologic features discussed include: platelet coagulation (with a brief analysis of the release and the role of prostaglandins); the equilibrium between plasma coagulation and lysis, each dependent on activators and inhibitors (a total of 4 enzymatic systems); and finally the role of the liver, lungs, and reticuloendothelial system. However, the two types of coagulation are narrowly intricated. Vessel endothelium prevents or assists platelet adhesion, coagulation, and lysis. An important feature is that total blood coagulates more rapidly than plasma. Physiopathological features described are activation of platelets or their inhibition by anti-aggregants, and induction of coagulation by endothelial lesions or eruption of an autologous or heterologous protease, as well as a brief outline of consumption coagulopathy and disseminated intravascular coagulation, and the concept of hypercoagulability. With respect to laboratory tests it is suggested that an overall picture of coagulation of total blood and not of plasma should be obtained before individual examinations for certain coagulation or lysis elements. Minimum data necessary preoperatively are the coagulation and bleeding times, completed by questioning the patient, the costs of these procedures being insignificant. If laboratory tests are necessary, these should involve a thromboelastogram of total blood, sometimes combined with a test of ADP-induced platelet aggregation. Certain plasma tests can provide complementary confirmatory data. These remarks are obviously applicable to general and digestive surgery only, and not to research investigations or the study of rare phenomena.

Blood Coagulation↗
PubMed1983

[Ischemic necrosis of the lesser curvature of the stomach after supraselective vagotomy. Apropos of 2 personal cases and 43 cases published in the literature].

The author presents two personal cases (from a series of 176 operations) of this complication of which 43 cases have already been reported in the literature. Necrosis perforating into the peritoneum is the most dramatic form: fever, pain, abdominal distension and most importantly, the appearance of gastric fluid in the drain (hence the importance of drainage). X-rays show a gas-fluid level in the left hypochondrium. It is important to be aware of this complication, as the prognosis depends on early re-operation (most often an overlapping suture): the mortality is presently 23,5%. One external gastric fistula has been reported. A common form is a necrotic ulcer walled off by neighbouring tissues. It is sometimes quite small, revealed by endoscopy in which case it generally heals with medical treatment. It can be very large requiring operation because of its persistence or because of haemorrhages. In this case, it is most often treated by gastrectomy. The pathogenesis of this condition is uncertain; it seems preferable not to denude the esophagus too much and not to interfere with collateral blood supply: ligature of small vessels, splenectomy, fundoplication has also been implicated. Only one fact is certain: the high incidence in patients with renal failure and hypertension; in no case should these patients be submitted to a highly selective vagotomy.

Adult↗
PubMed1980

[Surgical approach to the posterior surface of the liver (author's transl)].

Anterior incision does not afford a direct approach to lesions located in the posterior part of the liver, or to right subphrenic and retrohepatic abcesses, and may contaminate the peritoneal cavity in suppurative collections. Posterior incision is a more direct approach. It can be extrapleural and extraperitoneal, or transpleural with exclusion of the pleura when resecting a lower rib; a posterior thoraco-phreno-laparotomy gives a wider exposure. When the pleural cavity has been opened it should be drained and excluded before dealing with the subphrenic lesion. Such an incision is advocated in posterior abscesses of the liver, in those located under the diaphragm or posterior to the liver, as well as in posterior hydatic and biliary cysts. Scannography helps to locate exactly the cavity and makes sure that there is no other cyst or collection. Endoscopic cholangiography supplies valuable information concerning the bile ducts in case of hydatic cyst.

Diaphragm↗