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Biomedical subjects

L Couraud

Publications and source records attributed to L Couraud.

At least 37 records · Page 2Linked to original sources
PubMed1992

Foreign body perforation of the normal oesophagus.

Over an 11-year period, 12 patients with foreign body perforation of a previously normal oesophagus were treated in our institution. The foreign bodies were most commonly bones (10 cases), 5 of which were chicken bones; other species were pigeon, rabbit, veal, pork and fish (one each); 2 perforations were due to swallowed dentures. The mean age was 60 years (range 42-73) and 6 patients were female. A degree of psychosocial dysfunction was present in 3 patients. Seven patients presented late (> 48 h after ingestion). The commonest presenting symptoms were fever and pain (8 patients). Other symptoms included dysphagia (7), respiratory distress (3), and late cervical abscess formation (3). The diagnosis was established by contrast oesophagography or rigid oesophagoscopy. A third of the perforations were cervical, the remainder intrathoracic. All patients were treated by surgical drainage with or without primary closure of the perforation. There were no operative deaths. Five patients developed postoperative oesophageal leaks which required reoperation in 1 patient. All patients were well and swallowing normally on discharge from hospital. Follow-up endoscopy or oesophagography was carried out in all patients and confirmed the absence of oesophageal disorders. Foreign body perforation of the oesophagus is a rare but important subentity of oesophageal perforation which responds well to surgical treatment.

Adult↗
PubMed1992

Lung transplantation with bronchial revascularisation. Surgical anatomy, operative technique and early results.

Ischaemic anastomotic complications are an important cause of mortality and morbidity after lung transplantation. Anatomical studies have demonstrated that the pattern of bronchial arterial supply is relatively constant and therefore amenable to attempts at revascularisation. From May 1990, 10 patients who had a double lung transplantation (tracheal anastomosis) and 1 patient who had a right lung transplantation underwent concomitant bronchial revascularisation. There were two early and one late deaths. There were no anastomotic complications. Regular endoscopic examination showed satisfactory healing in all patients. Early angiography showed patent grafts in 7 of 9 patients. At a mean follow-up of 11 months (range 6-17 months) 8 patients are well and leading a normal life. This report describes the anatomical basis, technical aspects and early results of a promising operative procedure in the field of lung transplantation.

Adult↗
PubMed1992

Classification of airway anastomotic healing.

Airway complications remain a major problem after lung transplantation. There is no standardised method of assessment of airway healing. We propose a classification of airway healing based on the anastomotic appearances at endoscopy 15 days postoperatively. The system appears to correlate well with the subsequent development of anastomotic sequelae and can be used to assess the effectiveness of therapeutic modalities designed to reduce airway complications.

Anastomosis, Surgical↗
PubMed1992

[Anatomical bases for bronchial arterial revascularization in double lung transplantation].

A study of the bronchial arterial blood supply was conducted to facilitate in surgical attempts of bronchial revascularization in double lung transplantation. This study consisted of 20 cadaveric anatomical dissections of the bronchial arterial blood supply as well as a retrospective review of 50 bronchial arteriograms. The right bronchial tree was supplied by an artery originating from the right intercostal bronchial arterial trunk in 76 to 95% of the cases. This artery also supplied the distal trachea and the carina in over 80% of cases as well as the proximal left bronchial tree via a network of small collaterals found in the subcarinal compartment and adventitial tissues located on the anterior surface of the descending aorta. A common arterial trunk for both the right and left bronchial trees was found in 12 of the 20 dissections (60%). Left bronchial arteries were much smaller and less consistent. Proximity of the bronchial arteries orifices was frequently observed: in 10 of the 20 dissections it allowed simultaneous reperfusion of more than one vessel. To maintain the vascular anastomotic network in between the right and left trees, extensive vascular dissection and carinal resections are prohibited. This will allow revascularization of the whole tracheal bronchial tree via the supply of the origin of the RICBA.

Anastomosis, Surgical↗
PubMed1991

Post traumatic tracheobronchial lesions. A follow-up study of 47 cases.

This report concerns 47 ruptures of the tracheo-bronchial tree from the tracheal origin to the division of the lobar bronchi (trachea in 30 patients, main bronchus in 11, intermediate or lobar bronchus in 6). The disruption was circumferential in 24 cases and non-circumferential in 23. Injuries resulted from crush or blunt trauma in 35 cases, from seat belt or rope strangulation in 8 cases and in 4 cases, lesions were discovered following the tracheal intubation. The main symptoms were cervico-mediastinal emphysema (39), pneumothorax (31), acute dyspnea (28) and hemoptysis (11). The diagnosis was always confirmed endoscopically. In 8 patients, management of the lesions was delayed for more than 1 week due to misdiagnosis or severe associated injuries. Thirty-eight patients underwent tracheal or bronchial surgical repair associated in 13 cases with a temporary stenting, 4 patients underwent partial or total lung resection, 2 were managed by laser therapy and the 5 others received only medical care and endoscopic survey. Four patients died (8.5%), 2 from bleeding in the bronchial tree from a pulmonary artery tear, 1 from hypertensive pneumothorax under respiratory support and the last from mediastinitis due to delayed diagnosis of an associated oesophageal wound. All 43 other survived in spite of some very critical situations. This experience confirms that technical problems of surgical repair are nowadays overcome and that prognosis of tracheobronchial ruptures mainly depends on the initial control of respiratory failure and complications. Avoiding lethal anoxia or endobronchial damage in the emergency period before referring the patient to the surgeon is essential.

Bronchi↗
PubMed1991

[Tracheobronchial healing in lung or heart-lung transplantation. An anatomical study of forty anastomoses in men].

The post operative evaluation and endoscopic follow-up of 34 tracheal or bronchial anastomoses after lung or heart-lung transplantation show some aspects of the tracheobronchial healing and difficulties in the healing process: primary type I mucomucosal healing in only 6 cases, secondary type II mucosal healing in 15, delayed type III healing after mucosal or deep parietal necrosis in 13, type IV distant ulcerations of mucosa and spur lesions in 12. Type III difficulties of healing mainly occur after double-lung transplantations which always suffer from ischemia. Autologous tracheal or bronchial sutures in 3 transplanted patients submitted to standard immunosuppressive therapy including corticosteroids were uneventful and type I. This experience suggests that among all factors having an influence on bronchial healing, ischemia of the donor tracheobronchial tree is predominant, justifying all attempts of bronchial revascularization after double-lung transplantation. The efficacy of the arterial revascularization is verified in 3 cases of tracheal anastomosis after double-lung transplantation with type I or II tracheal healing.

Anastomosis, Surgical↗
PubMed1991

[Simultaneous tracheal resection-anastomosis and heart transplantation].

Advanced myocardial disease associated with a post-intubation tracheal stenosis due to acute cardio-pulmonary failure in a 52 year-old patient led to a difficult choice of priorities between tracheal resection-anastomosis and heart transplantation. A simultaneous surgical operation with both heart transplantation and tracheal resection-anastomosis was considered to be a safe solution and was performed successfully. No adverse effect of corticosteroid and immunosuppressive therapy was observed on tracheal healing despite the tension resulting from segmental resection of the trachea.

Anastomosis, Surgical↗
PubMed1990

The growth of circumferential scars of the major airways from infancy to adulthood.

The factors affecting the development and prognosis of scarred airways in children are presented from a long-term follow-up study of 14 cases of tracheobronchial lesions following either injury or operation. Four children managed by endoluminal treatment developed severe stenosis and required treatment, later as adults, by laser resection in 2 cases and by laryngotracheal plastic enlargement and resection with anastomosis in 1 case each. The follow-up of 7 children managed by plastic procedures showed inconsistent results: they were good or excellent in 3 cases but with a decrease in the laryngotracheal diameter of 36%, 28% and 7% respectively. The laryngotracheal calibre decreased in 2 patients to 45% due to partial fibrous stenosis. Resection and anastomosis was required in the remaining 2 patients after 11 and 12 years for severe re-stenosis. The 3 patients who underwent immediate surgical resection all had an excellent clinical and morphological result, with a decrease in the laryngotracheal diameter of only 7%, 13% and 19% after a follow-up of 18, 20 and 15 years, respectively. These results show that the growth capacity of scars in children's airways is closely related to residual sclerosis following the initial treatment. It is thus suggested that primary resection and anastomosis should be performed in as many cases as possible. In the performance of plastic procedures, special attention should be paid to complete resection of the fibrotic tissues. Finally, a very long postoperative follow-up is always required in children in order to assess the development of the airway.

Adolescent↗
PubMed1990

Lung and heart-lung transplantation for end-stage lung disease. The Bordeaux Lung and Heart-Lung Transplant Group.

Between February 1988 and December 1989, 15 combined heart-lung, 2 double lung and 5 single lung transplants were performed at our institution for end stage lung disease. The indication for heart-lung transplantation was primary lung disease with associated secondary heart failure in 11 cases, diffuse pulmonary disease with extensive adenopathy of the hilum in 2 cases and profuse and antibiotic-resistant tracheobronchial infection due to Pseudomonas in 2 cases. A double lung transplant was performed in 2 patients with hypertensive emphysema. The indication for a single lung transplantation was emphysema in 2 cases and pulmonary fibrosis in 3 cases; in this last indication, transplantation should be performed on the right side with a slight lengthening of the main bronchus to avoid the side-effects of mediastinal shift. There were 2 early deaths, 7 secondary deaths (from the 2nd to the 5th month) due to viral or bacterial infectious complications, and 1 late death in the 7th month (infection due to a syncitial virus). All 12 surviving patients have an excellent functional result; the size of the tracheal or bronchial anastomosis ranges from 85% to 100% of normal. From this experience, we conclude that specificity and severity of lung hazards are mainly related to bronchial infection, dependence on steroids and pleural adhesions. Moreover, posttransplant pulmonary oedema, mucociliary dysfunction and the differential diagnosis between rejection and infection require careful endobronchial suction and periodical sampling.

Adult↗
PubMed1990

Concentrations of cefpodoxime in plasma and lung tissue after a single oral dose of cefpodoxime proxetil.

Eighteen patients undergoing thoracotomy for suspected pulmonary neoplasia were given 200 mg cefpodoxime equivalent by mouth, before operation. Plasma samples were obtained before dose administration, and plasma and lung tissue samples were obtained at the time of operation which was 3, 6 or 12 h after the dose. All samples were assayed for cefpodoxime. The mean ratios for lung tissue/plasma concentrations were similar between 3 and 12 h after dose, suggesting that equilibrium between plasma and lung tissue concentrations was reached within 3 h of medication. The mean concentrations of cefpodoxime in lung tissue were 0.63 +/- 0.16, 0.52 +/- 0.09 and 0.19 +/- 0.02 mg/kg at 3, 6 and 12 h after administration, respectively. These observations indicate good, rapid and sustained penetration into lung tissue in concentrations greater than or equal to the MIC90 for most common micro-organisms found in community-acquired pneumonia.

Administration, Oral↗
PubMed1990

[Perforation and rupture of the esophagus. Apropos of 35 cases].

A series of 35 oesophageal perforations from the period 1980-1987 is reported. Sixteen perforations followed oesophageal endoscopy, 10 were spontaneous, 8 were due to foreign bodies and one was post-operative. The delay in reaching the right diagnosis was less than 24 hours in 18 cases and more than 24 hours in 17 cases. Oesophageal leak was demonstrated in 86% of our cases by contrast study; in the others by rigid oesophagoscopy. Perforation occurred in the cervical oesophagus in 6 patients, thoracic oesophagus in 28 and abdominal oesophagus in 2 (one had a double perforation). Three patients were managed non operatively and survived. Cervical oesophagostomy and oesophageal diversion were used in 4 patients as primary treatment because of perforation occurring in caustic burn cases (2 cases, both survived) or late severe sepsis (2 cases, both died). Two patients with neoplastic stricture were treated by oesophago-jejunal bypass without resection and partial oesophago-gastrectomy respectively: both survived. Direct suture and closure of the perforation were performed in 26 patients. Two died, one because of oesophageal leak. Post-operative localized leaks developed in 5 other patients without any mortality and 4 healed with conservative management. The overall mortality rate was 11% (4 patients). All had a delayed diagnosis (more than 48 hours). We suggest that even in patients with delayed diagnosis of a non-malignant oesophageal perforation, direct suture and closure should be attempted under protection of functional oesophageal diversion and "contact drainage" to canalize a possible post-operative localized leak. Good oesophageal diversion can be achieved by naso-oesophageal suction and gastric suction through gastrostomy or with oesogastric antireflux procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Contribution of x-ray computed tomography and MRI to the surgical diagnosis of bronchial cancers. Comparative evaluation of x-ray computed tomography, MRI and thoracotomy in 111 cases].

Computed tomography and magnetic resonance imaging have respectively decreased the incidence of exploratory thoracotomy by 11.6% to 5.7% then 5.3% after their successive inclusion in the assessment of the operability of lung cancers. Based on a systematic comparison of CT and MRI with exploratory thoracotomy in 111 patients, the yield, sensitivity and positive predictive value of these examinations was assessed in relation to tumour extension to various sites: to the chest wall, for which the sensitivity was poor (38% for CT, 54% for MRI) with a moderate predictive value (71% for CT, 77% for MRI); to the mediastinum with improved sensitivity (69% and 72%) but an uncertain predictive value (61% and 72%). The sensitivity and predictive value were then measured for lymph node involvement: N1: moderate sensitivity (69% and 76%) but a good predictive value (95% and 92%); N2 and N3: good sensitivity (79% and 93%) but a poor predictive value (70% and 66%). Apart from a few particular indications specific to MRI, especially in the apex, left hilum and in contact with the atrium, the efficacy of these two investigations is very similar. However, their lack of specificity means that certain exploratory thoracotomies are still justified in order to assess the operability of the tumour. A surgical or mediastinoscopic anatomical assessment is still necessary for a good classification of lymph node extension of lung tumours.

Carcinoma, Bronchogenic↗
PubMed1989

[Pulmonary diffusion of cefixime in man].

We measured the concentrations of cefixime in the human lung in vivo in order to evaluate indirectly the effectiveness of this antibiotic in the treatment of pulmonary infections. Twenty-three patients undergoing lung surgery entered the study and received cefixime either 200 mg 12-hourly (4 times) or 400 mg every 24 hours (twice). Blood samples and tissue specimens were collected simultaneously during surgery 4 or 8 hours after the last dose. Cefixime concentrations were measured by HPLC. The penetration of cefixime in both normal and neoplastic lung tissue was significant. Four or 8 hours after a 200 or 400 mg oral dose, lung concentrations were higher than the MIC90 values for sensitive strains and therefore consistent with effective therapeutic activity. The pharmacokinetics of cefixime in blood and in lung tissue suggest that pulmonary infections could be treated with a 400 mg dose once a day.

Cefixime↗
PubMed1989

Post traumatic disruption of the laryngo-tracheal junction.

Of 43 tracheo-bronchial ruptures, 19 patients presented with disruption of the laryngo-tracheal junction which would appear to be a very specific anatomical lesion. The disruptions were secondary to blunt cervical trauma in 11 cases and strangulation in 8 cases. The disruption was complete in 14 cases and incomplete in 5. The lesion is very complex and involved the retraction of the lower part of the trachea into the mediastinum (14 cases), fracture of the cricoid ring (9 cases), bilateral recurrent nerve tears (14 cases), unilateral (4 cases) and retraction of the laryngeal mucosa with exposure of the cricoid cartilage in all cases. According to the complexity of the lesion, the treatment was: laryngo-tracheal resection and end-to-end anastomosis with treatment of the vocal cord palsy in 13 patients; simple end-to-end anastomosis in 4 patients who had an unilateral vocal cord palsy; 2 patients with a partial disruption were treated medically with endoscopic stenting and laser photocoagulation. All had restoration of airway patency and recovery of voice. The results contrast with the failures and reoperations reported in the literature and underline the necessity of complete evaluation and treatment of these complex lesions.

Adult↗
PubMed1989

Experience of partial oesophagectomy in surgical treatment of lower and middle thoracic oesophageal cancer. From a follow-up of 366 cases.

Since carcinoma of the oesophagus is considered to be frequently multicentric, total oesophagectomy appears the only radical therapeutical approach. A follow-up of 366 patients who underwent partial oesophagectomy shows that this procedure can be curative as well as palliative and is sometimes the only procedure possible with a reasonable mortality. These patients had an oesophageal carcinoma located between the cardia and the level of the aortic arch (60.5% squamous, 37% adenocarcinoma). Of these, 22% were over 70 years of age. The surgical route was a left thoracotomy in 280 cases (with anastomosis below or above the aortic arch) or a laparotomy and right thoracotomy in 86 cases. The oesophagus was transected as high as possible and replaced by an isoperistaltic tube fashioned from the greater curvature of the stomach. Mediastinal tissues and the lesser curvature with their lymph nodes were removed. The overall operative mortality was 7% (4% in patients less than 70 and 15% over 70). Very few anastomotic fistulae were observed (6 cases) but they were always severe (6 deaths). The middle and long term results show acceptable functional sequelae and a good survival quality. The survival is 57% at 1 year, 30% at 3 years and 23% at 5 years (27% when the excision appeared curative). There was no significant difference in survival for patients whose cancer was in the mid-oesophagus compared to the lower oesophagus. There was no difference in survival in the cell type squamous or adenocarcinoma. Death was mainly due to metastatic lesions and mediastinal lymphatic recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1989

[2 cases of pulmonary excision in patients with acquired immunodeficiency syndrome. What is the role of surgery in AIDS?].

The authors report two cases of lung resection in patients with AIDS: left upper lobectomy for diagnosis and treatment of an active, localized lung lesion which proved to be tuberculosis and atypical resection of the right apex and pleurodesis for an infected pneumohydrothorax. The postoperative course was uneventful despite the fragile clinical context. The place of surgical indications for diagnostic purposes is reduced by the good results obtained with endoscopic investigations and limited to failures of these procedures and to pulmonary sarcomatous lesions. The place of therapeutic surgical indications is essentially reserved for pleural complications (pleurodesis, pleurectomy, pleurotomy). Surgery may be unjustified in tracheostomised patients at the stage of respiratory failure. It may have a small but effective role with reduced risk in active, localized lung lesions. The surgery must be performed according to simple and classical by very rigorous rules of protection for the operators and the environment.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Lung and heart-lung transplantation in respiratory tract diseases. Evaluation and development of the indications based on our first 15 cases].

Since January 1988, the Bordeaux group has performed 15 transplantations for lung disease: 9 heart-lung transplants, 1 heart + left lung, 1 double lung, 2 right lungs and 2 left lungs. The transplantations were performed for pulmonary emphysema (10 cases), pulmonary artery hypertension (2 cases), cystic fibrosis (1 case), pulmonary fibrosis (2 cases). Cardiopulmonary transplantation was not always performed because of associated heart failure but sometimes because of large intrahilar adenopathy or intractable bronchial infection. Pulmonary transplantation is recommended on the right side in cases of pulmonary fibrosis. One patient died postoperatively (ischaemia of the transplant). Four others died during the 2nd and 3rd months from poorly defined but probably infectious pulmonary syndromes. The tracheobronchial patency of the 10 survivors was 80% or 100% of the predicted value. The respiratory functional result was excellent in the short and intermediate term. Specific difficulties essentially consisted of pleural symphyses, hilar adenopathy, bronchial infection, steroid dependence of certain subjects, the difficulty of identifying the cause and treating lung opacities during the 2nd and 3rd months.

Anastomosis, Surgical↗