PubMed Health⌕ Search

Biomedical subjects

L Couraud

Publications and source records attributed to L Couraud.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Treatment of esophagotracheal fistula following intensive care. An experience of 17 cases].

Oesophago-tracheal fistulae secondary to respiratory intensive care have become the commonest type of non-tumoural fistula in adults: 17/26 cases. They complicated a long period of difficult and septic intensive care, after a mean interval of 30 days. The diagnosis was confirmed by bronchoscopy which also provided good assessment of the site and extent of the fistula and the associated tracheal lesions. The severity of this complication is stressed by 5 deaths in the present series (1 toxi-infectious syndrome after 24 hours, 2 abandonments due to a hopeless resuscitation prognosis, 2 cases of oesophago-tracheal reflux which could have been prevented). One should not wait for spontaneous cure (although this did take place in 2 cases). Ideal direct suture (9 cases: 9 cures) requires local conditions favourable for healing and rapid respiratory autonomy. These conditions can be achieved by an active approach to protection against oesophago-tracheal reflux: at least lower oesophageal exclusion (4 cases) by ligation or anti-reflux operation. Oesophageal exclusion followed by oesophago-coloplasty is sometimes the only solution in cases of severe destruction of cervico-mediastinal tissues (2 cases: 1 cure). Five tracheal strictures required an associated resection-anastomosis (5 cures).

Adult↗
PubMed1989

[Value and current role of anterior mediastinotomy in the diagnosis of mediastinal diseases. Apropos of a series of 100 cases].

One hundred anterior mediastinotomies performed between 1981 and 1987 resulted in the diagnosis of 90 malignant mediastino-hilar or anterior mediastinal tumours, 4 benign lymph node diseases and 6 non-specific lesions. This easy to perform biopsy technique was followed by low morbidity (7%) and one death after 48 hours due to major mediastinal compression. Its sensitivity and specificity make it a valuable alternative and, according to the authors, preferable to mediastinoscopy in the diagnosis of tumours of lymph node diseases in the anterior, pulmonary hila, especially on the left side, and anterior mediastinal lymph node chains.

Adolescent↗
PubMed1988

The surgical treatment of inflammatory and fibrous laryngotracheal stenosis.

Seventy-two patients with laryngeal or laryngo-tracheal stenotic lesions resulting from tracheal intubation or laryngo-tracheal injuries are reported. Prior to 1978, the method of surgical treatment consisted mainly of laryngoplasty supported by laryngeal stenting. Twenty-six patients were treated by this method with 2 mortalities. Twenty-one long term results were good and 3 were fair. After 1978, laryngo-tracheal resection was performed in 46 patients. Twenty-seven had a Pearson-type operation, 13 underwent total or subtotal cricoid plate resection and modelling, and the remaining 6 had modelling alone. Perfect results after resection depend on the treatment of infection and inflammation of the airway before surgery. Our preferred method is resection and end-to-end anastomosis whenever possible. In addition to the anatomical site of the lesion, the glottic opening has to be considered in planning the surgical operation since impairment necessitates enlargement of the glottis as part of the procedure.

Adolescent↗
PubMed1988

Bronchogenic carcinoma staging: CT versus MR imaging. Assessment with surgery.

One hundred and twenty patients with bronchogenic carcinoma were prospectively studied by both computed tomography (CT) and magnetic resonance imaging (MRI) during the 2 weeks preceding thoracotomy or mediastinoscopy. MRI scans included contiguous axial and coronal slices. Results of CT and MRI studies were compared with the surgical and pathological findings on the basis of the TNM classification. Although no significant difference was found between the two imaging methods for the evaluation of tumour extent, MRI appears to be a valuable imaging technique for left upper lobe and apical neoplasms. Comparison between the two techniques for mediastinal node evaluation showed that sensitivity of MRI is superior to CT in the left paratracheal, aortopulmonary and subcarinal node areas.

Adult↗
PubMed1987

Diffusion of ofloxacin into human lung tissue.

Ofloxacin 200mg twice daily was administered to 17 patients with pulmonary disorders, which necessitated surgery, during the preceding 48 hours and 200mg was administered 1 hour before the operation. During surgery, blood samples and specimens of healthy and diseased lung tissues were taken simultaneously. Ofloxacin levels were determined by HPLC. The mean values of the tissue concentration/plasma concentration ratio were 3.5 +/- 0.4 for the healthy tissue and 3.9 +/- 0.4 for the diseased tissue. These values reflected good penetration of ofloxacin into both healthy and atelectasic pulmonary parenchyma.

Aged↗
PubMed1986

[Diffusion of ofloxacin in human lung tissue].

Ofloxacin was administered to 17 patients suffering from a pulmonary disorder necessitating surgery. The daily dosage employed was 200 mg b.i.d. during the 48 hours preceding the operation and 200 mg one hour before the operation. During surgery, blood samples and specimens of healthy and diseased lung tissue were taken simultaneously. The ofloxacin levels were determined by HPLC. The mean values of the tissue concentration/plasma concentration ratio were as follows: 3.5 +/- 0.4 for the healthy tissue and 3.9 +/- 0.4 for the diseased tissue. These values reflected good penetration of ofloxacin into both the healthy and atelectatic pulmonary parenchyma.

Anti-Infective Agents↗
PubMed1986

[Diffusion of amikacin in the lungs].

The authors report their findings on amikacin concentrations in serum and in the lungs, its diffusion in the parenchyma of the lungs--evaluated from the ratio tissue/serum concentrations, and they also compare their results with those registered during a study on dibekacin, tobramycin and netilmicin, designed according to the same protocol. Ten patients with bronchial carcinoma who had to undergo chirurgical excision, received 5 IM injections at 12-hourly intervals. The dose administrated at each injection was 7.5 mg/kg. The assay of amikacin was realized by HPLC. Serum concentrations at the presumed peak (17 micrograms/ml) and 12 hours after that were somewhat lower than those reported by other authors. The mean tissue concentrations 2 h 20 min. after the last injection were 14,95 +/- 4,52 micrograms/g in the normal parenchyma, and 16,18 +/- 3,67 micrograms/g in the pathological parenchyma. The ratio concentrations in the tissues and in serum were comparable for both the normal and pathological parenchyma. Compared to dibekacin, tobramycin and netilmicin, this study confirms the large distribution of the aminoglycosides in the lung parenchyma. The behaviour of dibekacin and tobramycin with regard to the pathological parenchyma is rather comparable; netilmicin better penetrates into the normal parenchyma, and the diffusion of amikacin is parallel for both the normal and pathological tissues.

Amikacin↗
PubMed1985

Current reconstructive management of subglottic stenosis of the larynx with reference to sixty consecutively treated cases.

Sixty patients with subglottic stenosis of acquired and nonneoplastic origin were surgically managed by multiple open procedures. Follow-up ranged from 1 to 10 years. Fifty-seven patients had stable and excellent or good results, 2 of them after further surgery, 1 patient had to live with a retained tracheostomy indefinitely and the remaining 2 patients died. While the whole spectrum of surgical modalities employed in this series may not be recommended with total conviction, the authors express their satisfaction with single resection and end-to-end anastomosis which yields invariably good and rapidly obtainable results (22 cases with complete success). Nevertheless, laryngeal enlargement seems to be essential in the case of upper glottic lesions (19 operations provided 19 successes) while primary resection with moulding plasties may be applicable to complex and extended stenoses (19 operations: 16 successful results and 3 failures). With regard to the choice of operation, the authors emphasize the importance of careful preoperative assessment of the lesions which should assure adequate selection of therapeutic methods according to the degree of associated involvement of the trachea, glottis or supraglottic area. Conservative measures including dilatation, electro-coagulation and laser-beam surgery are considered as palliative only, however, they may be useful either in the course of the patient's preparation or in order to achieve more successful postoperative results.

Adolescent↗
PubMed1984

[Endotracheal hemorrhage caused by fissuration of the innominate artery during prolonged intubation. Surgical treatment].

We present our surgical procedure for the control of tracheal haemorrhages due to fissuration of the innominate artery in patients with prolonged tracheal intubation or tracheostomy. Temporary haemostasis and protection of the airways against flooding are ensured by downward advancement of the tube, overinflation of the cuffs and digital pressure if required. The fistula is then located and surgical haemostasis is obtained by resection of the innominate artery away from the infected area. The arterial stumps are covered up for protection against secondary infection. Re-establishment of blood flow is not systematic. Cervicosternotomy is regarded as the incision of choice. No complication was encountered in patients treated by this method.

Brachiocephalic Trunk↗
PubMed1984

Late cataclysmic hemorrhage from the innominate artery after tracheostomy.

We report on 12 patients sustaining late cataclysmic hemorrhage as a complication of tracheostomy or endotracheal intubation, resulting from erosion of the innominate artery. Four long-term survivors are reported. A number of surgical techniques was used and up-to-date management is briefly described. Our technique mainly consists of transecting and suturing the innominate artery without prior debridement. Innominate artery blood flow was not reestablished in all patients, thereby avoiding local wound infection and recurrence of hemorrhage. Initial temporary control of bleeding was achieved either by hyperinflation of the cuff of the tracheostomy tube, or finger compression of the innominate artery against the sternal notch. Definite surgical repair of this lesion and reestablishment of innominate artery flow is carried out through complete sternotomy in combination with right cervical extension which is considered the incision of choice by the authors. To prevent this unusual and lethal complication, tracheostomy should not be used without proper indication and technical errors of its performance, such as placing it lower than the level of third tracheal ring, must be avoided.

Adolescent↗
PubMed1982

[Congenital esophagotracheal fistulas in adults. Apropos of 2 cases].

Repeated bronchopneumopathies are the principal manifestation of congenital esophagotracheal fistulae detected at a late stage. Diagnosis is suggested by air distention of the esophagus on the thoracic image. Esophageal barium swallow examination in the standing position is usually negative: esophageal transit is too rapid, the diameter of the fistula is too small, and its ascending pathway does not allow filling by the contrast medium. Examinations should be conducted in precubitus, after the passage of an esophageal sound, employing barium sulphate as the contrast medium, and with a horizontal beam and profile projection. Kinetic exploration, employing ampliphotography is necessary. The fistula pathway is seen as a thin opaque line, oblique from above forwards, and pushing from the anterior surface of the esophagus to the posterior surface of the trachea. There is associated filling of the tracheobronchial tract.

Adult↗