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Biomedical subjects

C Couinaud

Publications and source records attributed to C Couinaud.

105 records · Page 6Linked to original sources
PubMedDate not supplied

[Sub-phrenic abscess: 28 cases, one death (author's transl)].

28 patients were operated on for subphrenic abscess, one patient died. The author emphasises the disadvantages of excessive antibiotics. The diagnosis should be made early in order to avoid severe infective complications. The diagnosis is not difficult. It is nowadays facilitated by echotomography and scannography, which permit one to localise precisely the collection of pus and to detect multiple abscesses. The incision should carefully avoid crossing the peritoneal or pleural cavities. The quality and the permanence of the drainage are the key to success. One should therefore leave in position numerous aspiration drains. One should generally abstain from any suture or digestive anastomosis. It is sufficient to direct the digestive fistula, when present, towards the skin surface. But the best policy is to avoid this operative complication the origin of which is almost always a mistake in the design or installation of the drain at the end of various operations on the abdomen.

Adult↗
PubMedDate not supplied

[Preventive treatment of thrombo-embolism in general surgery. A report of 5 242 observations (author's transl)].

5 242 patients in a ward of general surgery have been submitted to prevention by subcutaneous injection of calcium heparinate. In all coagulolytic balance has been measured by thromboelastogram on whole blood. The aim was to reduce any hypercoagulability and maintain orthocoagulability. Three fourths of the patients had preoperative hypercoagulability, which may be responsible of precocious migrations. Except emergency, this hypercoagulability was first treated. The heparin dosis was scheduled according to age, weight and degree of hypercoagulability, and the treatment maintained at least 15 days. These are the results: thromboembolism 2,48 % (lethal 0,76 %). All registered accidents were the consequence of gross error. Heparinotherapy has been stopped in only 3 patients; there was no special hemorrhage during operation.

Blood Coagulation↗
PubMedDate not supplied

[Introduction to the study of hemostasis in cirrhotic patients (author's transl)].

Any diffuse lesion of the liver induces permanent hypercoagulation with subsequent permanent lysis and possible consumption or DIVC/Hemostasis depends on two distinct mechanisms: the platelets, whose functional activity is more important than numbers, and the coagulolytic equilibrium of the plasma. Apart from the activating and inhibiting enzymes of coagulation and lysis, the lungs and liver play an important role. The lungs filter and then determine lysis of the corpuscular agglomerates. The liver produces epuration of the activated factors and prothrombinase, as well as the plasminogen activator. Except in extremely severe cases, however, these functions are rarely involved. Investigations must be complete and include a test of platelet aggregation, a TEG on total blood to analyze whole coagulation, and tests for consumption and lysis. Coagulation and bleeding time tests are of great value during severe hemorrhagic attacks. Pathological examination should evaluate the condition of the vascular state and, more particularly, the presence of fibrin thrombi with the appropriate methods.

Blood Coagulation↗
PubMedDate not supplied

[Hemorrhage in liver cirrhosis : new suggestions (author's transl)].

Current management of hemorrhage in cirrhotic patients is disappointing, probably because it deals only with the portal hypertension, while the coagulation disorders are neglected. Some new suggestions can be made : 1) Hemorrhage originates in coagulation disorders. The mechanical lesion of the mucosa is only the opportunity for these disorders to become apparent. The lesion may be : infrequently, a ruptured esophageal varix or a gastroduodenal peptic ulcer ; a lesion of the cardia (hiatal hernia, reflux, esophagitis, minimal traumatic tears) ; a gastric anomaly (hemorrhagic gastritis, superficial ulcerations, petechiae) ; in some cases no mucosal lesion is apparent. 2) Any widespread liver disease results in lasting hypercoagulability which is responsible for : permanent lysis, consumption, DIC. The spleen is responsible for the functional alteration of the platelets. Splenectomy is followed by permanent recovery. 3) Changes involving the platelets are responsible for most hemorrhages. Thrombopenia and severe anomalies of platelet aggregation are common findings in liver cirrhosis. Further deterioration can be induced by acetylsalicylic acid, especially if it is absorbed after an immoderate ingestion of alcohol. Emergency treatment consists in platelet transfusions. 4) Stasis in the portal system may, however, result in permanent activation of coagulation. 5) Cirrhosis results in chronic hypercoagulability and severe platelet deterioration. Any stress involving coagulation mechanisms may therefore induce hemorrhage : infection, acetyl salicylic acid, respiratory distress, estrogens, massive transfusion. It is always dangerous to "feed" consumption or to restrain lysis. 6) Coagulation tests should be performed rapidly, in order to evaluate hypercoagulability, consumption, lysis, and evidence of DIC ; FDP can probably be responsible for inflammatory changes in the liver and spleen. 8) Coagulation disorders are permanent since the hepatic alterations are irreversible.

Blood Coagulation↗
PubMedDate not supplied

[Surgical approach to the dorsal section of the liver].

The dorsal sector of the liver is a deep and posterior territory which lies behind the hilum, close to the inferior vena cava, beneath a plane passing by the terminal portion of the main hepatic veins. Two segments may be distinguished. A left one, segment I, the prominent part of which is the caudate lobe, is united anteriorly with segment IV and lies to the left of the vena cava. A right one, segment IX, is posterior to the right portal pedicle, anterior to the vena cava (at times also to the right), beneath the terminal portion of the right superior and the middle hepatic veins. This dorsal sector is supplied by numerous small ascending portal branches of 1st, IInd and IIIrd order, and efferent veins enter directly the caval stem. The sector lies in the posterior surface of the liver, covered by the mass of the organ and the lesser omentum, fixed posteriorly by the coronary ligament and the entrance of the hepatic veins into the vena cava. However there is always a loose connective tissue between the liver and the vein. Three manoeuvres give access to this dorsal territory: 1. Posterior detachment of the liver by division of the lesser omentum, the falciform and coronary ligaments; the vena cava is then well exposed.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

[Variations of the right bile ducts. The futility of complete anatomical classifications].

Combination calculus shows that there is a considerable number of theoretical variations of the right ducts: [table: see text] Complete classification is therefore impossible, and the different frequencies of these variations in different series are easy to understand. Probably some of these theoretical distributions do not actually exist. A classification should be limited to a description of the mechanisms of variation (duplication and sliding on other ducts), to a list of the most frequent variations; dangerous distributions from the surgical point of view, even if they are exceptional, must be pointed out. Interesting conclusions can be reached when there is a significant difference between a theoretical and a practical frequencies. For the surgeon, an excellent cholangiography (in three dimensions if possible) is the key of his strategy. Direct approach of the vasculo-biliary sheaths is the key of a speedy and safe surgery: in a sheath the surgeon finds only the branches supplying the parenchyma entered by this sheath.

Bile Ducts↗