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C Couinaud

Publications and source records attributed to C Couinaud.

At least 19 recordsLinked to original sources
PubMed1992

[Bisection of the liver for transplantation. Simplification of the method].

Blind bipartition of a whole liver to obtain two transplants is problematic, because of frequent vasculo-biliary duplications, especially arterial (mainly on the left) and biliary (mainly on the right) duplications. Arteriography and cholangiography on the back table are necessary to obtain a map of the arterial and biliary distributions without injuring the vessels of the biliary ducts enclosed in the vasculo-biliary sheaths. The surgeon may use three special maneuvers: resection of segment IV when the arterio-biliary duplication involves segment IV; attribution of the common hepatic artery on the side of the arterial duplication (frequent on the left); attribution of a short segment of the common hepatic duct on the side of a biliary duplication (frequent on the right). In an anatomical study of 93 vasculo-biliary casts, the following results were obtained: in 4 cases: bipartition not possible; in 22 cases: "ideal" bipartition (no duplication); in 57 cases: partition right-left livers: in 37 cases 1 maneuver, in 19 cases 2 maneuvers, in 1 case 3 maneuvers; in 10 cases: partition right liver-left lobe: in 2 cases 1 maneuver, in 8 cases 2 maneuvers. We report 8 bipartitions and 16 transplantations (10 children and 6 adults). The duplications we noted do not differ statistically from those reported in our former anatomical study. Survival of the patients (100% in usual cases, 66% in case of extreme emergency or terminal hepatic insufficiency) and survival of the transplants (68,75%) do not differ either from those noted in other transplantation methods. Complications, especially arterial thrombosis, were within the same statistical ranges.(ABSTRACT TRUNCATED AT 250 WORDS)

Dissection↗
PubMed1989

[An unknown syndrome: acute zinc deficiency in the elderly in a surgical milieu].

Old people often present a chronic depletion in zinc. Any stress increases zinc consumption and zinc loss through the kidneys; acute depletion then appears. Anorexia is usual, psycho-neurological troubles induce to a wrong diagnostic of sudden senility or psychiatric disorder. Altered taste and a low blood level of zinc confirms the diagnostic. Zinc administration, usually per os, leads to a prompt recovery. 18 patients have been recorded; acute depletion occurred after infection or any ordinary surgical intervention.

Acute Disease↗
PubMed1989

Exposure of the left hepatic duct through the hilum or in the umbilical of the liver: anatomic limitations.

Anastomosis to the left hepatic duct approached by dissecting the hilar plate is the most reliable method of drainage of the left side of the liver in that longitudinal incision of the left hepatic duct allows a long cholangiojejunostomy. However, the anatomy is not satisfactory in 30% of cases for adequate drainage of the left side of the liver. To further clarify this surgically important area, 107 vasculobiliary casts were reviewed with regard to the anatomy and relationship between the left biliary ductal and left portal venous systems. In cases in which anatomy is unfavorable for adequate drainage by anastomosis to the left hepatic duct in the hilum, several options are available. The anterior portion of the main portal fissure may be opened to gain wide access to the superior aspect of the biliary plate and reach a posterior duct that is more suitable for anastomosis. An anastomosis to an anterior duct may also be possible with this approach. If left portal ducts are inaccessible by division of the main portal fissure because of a retroportal location, then an anastomosis in the anterior portion of the umbilical fissure may give adequate drainage. Therefore a cholangiogram is imperative before any anastomosis in the hilum or the anterior portion of the umbilical fissure.

Anastomosis, Surgical↗
PubMed1988

The parabiliary venous system.

The parabiliary venous system originates from the pancreatico-duodenal and pyloro-duodenal veins, runs along the common bile-duct and the hepatic artery, and divides in the liver hilum into a venous network within the hilar plate. Embryologically, this system, apparently independent of the portal vein, develops together with the bile-ducts and the hepatic artery: these three structures are within the substance of the vasculo-biliary sheaths, and the whole complex invades the liver well after the distribution of the portal vein has been established. It should be pointed out that segments I and IV also appear rather late. Seventy-four specimens with injection of the system have been studied. The hilar plexus sends branches to the veins of the segments adjacent to the hilum. Some vessels directly supply the inferior surface of the quadrate lobe or the caudate lobe, or the left lobe. In 46.50% of specimens, part of the cystic veins are anastomosed with the parabiliary system.

Biliary Tract↗
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↗