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PubMed2000

Currarino triad--diagnostic dilemma and a combined surgical approach.

PURPOSE: The authors present 2 families with 3 cases of Currarino triad, diagnostic difficulties, their familial occurrence, and genetic mapping, with emphasis on a combined pediatric surgical and pediatric neurosurgical approach in managing these children. RESULTS: The main presentation was intractable constipation. In the first family there was a 4-generation pedigree with recurrence of Currarino triad. The mother and the child have the condition. Family 2 screening showed a 3-generation pedigree with presence of Currarino triad in 3 members. Patients 2 and 3 are cousins whose fathers are affected by spina bifida occulta and Currarino triad, respectively. In patient 1, the diagnosis was made after inadvertent rupture of an anterior meningocele during posterior myectomy. In patient 2, the presacral mass was found on examination under anesthesia, and the planned anorectal myectomy for intractable constipation was abandoned. Patient 3 was a cousin of patient 2, and the diagnosis was considered when she presented with intractable constipation at the age of 7 months. Magnetic resonance scan was useful in showing the presence of presacral mass, spinal abnormalities, and tethered cord. A combined pediatric and neurosurgical approach optimized the extirpation of the presacral mass with minimal complications. Surgical treatment was individualized according to the estimation of the operative risk factors. All patients have a normal bladder function. Patient 1 has required laxatives and enemas for intermittent constipation. She has associated learning difficulties but is otherwise well. Patient 2 and 3, aged 10 and 2 years, respectively, are awaiting closure of colostomy. They are thriving and well. CONCLUSIONS: The authors recommend a combined pediatric and neurosurgical assessment and management for all cases of Currarino triad. Family screening is obligatory. The authors suggest the use of a magnetic resonance scan or computerized axial tomography myelogram to define the presence of anosacral and spinal cord anomalies in patients with intractable constipation.

Anal Canal↗

PubMed1990

Examination of the near triad in VDU operators.

It has recently been demonstrated that the tonic level of accommodation is related to the loading of accommodative work. The aim of the present study was to investigate the effect of a sustained accommodative stimulus on the tonic level of accommodation, pupil, and convergence, i.e., the near triad, in three different groups of young (20-39 years) subjects, viz., 1. 19 professional visual display unit (VDU) workers; 2. 12 ordinary hard copy (non-VDU) workers; and 3. 19 control subjects doing different jobs from the two former groups. All had worked 25-30 h per week for over two years. Only Groups 1 and 2 had eyestrain after office work. Except for mild myopia, subjects had no eye or systemic disease upon routine examination. Accommodation was measured with an objective infrared optometer, the pupil was measured by an infrared video pupillography, and convergence was measured from the contralateral eye by photoelectronic oculography. In order to elicit tonic responses, the velocity of the target stimulus was 0.2 D (diopters) per second. Based on the data obtained from the controls, the near triad was analysed. Asymmetric response of the near triad in the right and the left eye and the existence of a hysteresis curve, especially in the pupil and in convergence, were the major findings. No abnormality was found in the control group. In the VDU group, 34.6% showed an abnormal near triad, but this also occurred in 18.5% of the non-VDU group. Even with the same complaint of eyestrain, it was concluded that VDU work produced abnormalities 1.8 times higher in the near triad produced by tonic stimulus.

Accommodation, Ocular↗

PubMedDate not supplied

Effects of S-glutathionylation and S-nitrosylation on calmodulin binding to triads and FKBP12 binding to type 1 calcium release channels.

This study shows that the combination of glutathione (GSH) plus hydrogen peroxide (H2O2) promotes the S-glutathionylation of ryanodine receptor type 1 (RyR1) Ca2+ release channels, and confirms their joint S-glutathionylation and S-nitrosylation by S-nitrosoglutathione (GSNO). In addition, we show that 35S-labeled 12-kDa FK506-binding protein ([35S]FKBP12) bound with a Kd of 13.1 nM to RyR1 present in triads or heavy sarcoplasmic reticulum vesicles; RyR1 S-nitrosylation by NOR-3 or GSNO, but not S-glutathionylation, specifically increased by four- to fivefold this Kd value. RyR1 redox modifications also increased the Kd of [35S]calmodulin binding to triads without affecting Bmax. RyR1 S-glutathionylation (induced by GSH plus H2O2) or RyR1 S-nitrosylation (produced by NOR-3) increased by approximately six- or twofold, respectively, the Kd of apocalmodulin (apoCaM) or Ca2+-calmodulin (CaCaM) binding to triads. Likewise, the combined S-glutathionylation and S-nitrosylation of RyR1 induced by GSNO increased by fourfold the Kd of CaCaM binding to triads and abolished apoCaM binding. As both FKBP12 and CaCaM inhibit RyR1, decreased FKBP12 binding to RyR1 and/or decreased CaCaM binding to either RyR1 or dihydropyridine receptor in triad preparations may cause the reported enhanced activation of Ca2+-induced Ca2+ release kinetics mediated by S-glutathionylation/S-nitrosylation. We discuss possible consequences of these redox modifications on RyR1-mediated Ca2+ release in physiological or pathological conditions.

Animals↗

PubMed1987

Gastric autonomic nerve (GAN) tumor and extra-adrenal paraganglioma in Carney's triad. A common origin.

Carney's Triad comprises a triad of neoplasms: gastric stromal tumor, extra-adrenal paraganglioma (usually functional), and pulmonary chondroma. At least two of these are needed for the presumptive diagnosis of the Triad. This report presents a patient who had resected a gastric tumor and nonfunctional extra-adrenal paraganglioma. The gastric tumor resembled a gastric leiomyosarcoma by light microscopy, but electron microscopy revealed it to be a gastric autonomic nerve (GAN) tumor. Based on this evidence it appears that both the gastric lesions and the paragangliomata of Carney's Triad are tumors of the autonomic nervous system. Thus, the Triad may be a disorder of the autonomic nervous system rather than a multiple endocrine neoplasia syndrome or multiple hamartoma syndrome.

Adolescent↗

PubMed1994

Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad.

OBJECTIVES: To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. DESIGN: Retrospective review of medical records. SETTING: Two multidisciplinary pediatric ICUs. PATIENTS: Medical records of pediatric patients declared brain dead and admitted to two multidisciplinary pediatric ICUs. MEASUREMENTS AND MAIN RESULTS: Patient records were reviewed for demographic data, primary diagnosis, severity of illness (Pediatric Risk of Mortality score and calculated risk of mortality), methods by which brain-death diagnosis was determined, presence of central diabetes insipidus, low glucose demand, low CO2 production in the final 24 hrs before the diagnosis was made, and whether organ donation was accomplished. The incidence of brain death among all patients admitted to the pediatric ICUs was 0.9%, accounting for 11% of patients who died during the same period. The most common presentation leading to brain-death diagnoses was trauma, followed by drowning/near drowning, and meningitis. The majority of brain-death diagnoses were made using both clinical criteria and confirmatory tests (66%). The incidence of clinical signs of Turner's triad was 41% for central diabetes insipidus, 49% for low glucose demand, and 53% for low CO2 production. Two of the three features were present in 38% of patients, and 12% of the patients had all three features. CONCLUSIONS: Our series of brain-dead patients in the pediatric ICU showed a 0.9% incidence of brain death. The most common primary diagnosis was trauma, a finding that is similar to other series. We also demonstrated that the clinical triad (Turner's triad) is present in this patient population, although only 12% of study patients demonstrated all three features.

Adolescent↗

PubMed1997

American College of Sports Medicine position stand. The Female Athlete Triad.

The Female Athlete Triad is a syndrome occurring in physically active girls and women. Its interrelated components are disordered eating, amenorrhea, and osteoporosis. Pressure placed on young women to achieve or maintain unrealistically low body weight underlies development of the Triad. Adolescents and women training in sports in which low body weight is emphasized for athletic activity or appearance are at greatest risk. Girls and women with one component of the Triad should be screened for the others. Alone or in combination, Female Athlete Triad disorders can decrease physical performance and cause morbidity and mortality. More research is needed on its causes, prevalence, treatment, and consequences. All individuals working with physically active girls and women should be educated about the Female Athlete Triad and develop plans to prevent, recognize, treat, and reduce its risks.

Adolescent↗

PubMed2001

Typical and atypical Carney's triad presenting with malignant hypertension and papilledema.

This report encourages clinicians to consider a diagnosis of Carney's triad in patients with multifocal gastric stromal sarcoma, extraadrenal paraganglioma (predominantly mediastinal), or pulmonary chondroma. The authors conducted a retrospective 20-year survey at the Hospital for Sick Children and identified two children with Carney's triad. One child, presenting atypically with papilledema and fundal hemorrhages from malignant hypertension and benign intracranial hypertension from chronic iron-deficiency anemia, is the second patient ever to date be described with the complete Carney's triad of neoplasms at diagnosis. Another child presented more typically with gastric stromal sarcoma and pulmonary chondroma without paraganglioma. Carney's triad is a rare differential diagnosis for "idiopathic" hypertension or iron-deficiency anemia from chronic gastrointestinal bleeding. If missed, patients with Carney's triad may have the debilitating physical and mental consequences of chronic iron deficiency and may die of untreated prolonged hypertension and metastatic leiomyosarcoma.

Adolescent↗

PubMed2005

Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities.

OBJECTIVE: The purpose of this study was to survey universities affiliated with Canadian Interuniversity Sport on existing screening protocols for the female athlete triad, and to identify any potential areas for improvement of this system. DESIGN: Surveys were faxed or e-mailed to Canadian Interuniversity Sport-affiliated universities in Canada, and preparticipation physical examination (PPE)/medical history forms from each institution were analyzed. SETTING: The Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario. PARTICIPANTS: In 2000, of the 48 universities, 35 responded (73.0% response rate). In 2002, 39 of 49 universities responded (79.6%). MAIN OUTCOME MEASUREMENTS: Although the majority of institutions surveyed implement a PPE form (80.0% in 2000, 87.2% in 2002), only 70.6% to 75.0% of these institutions actually conduct a follow-up when deemed necessary. However, the number of forms including a specific female section increased from 46.4% in 2000 to 61.8% in 2002. Also encouraging is the percentage of universities attempting to increase awareness of the triad disorders (33.3% in 2002 vs. 14.3% in 2000). It is interesting to note that in over half of the institutions surveyed both years, the athletic therapist or trainer is responsible for analyzing the completed PPE forms. CONCLUSIONS: This study has shown substantial improvement from 2000 to 2002 in the development of the PPE across Canada, even in a relatively short period of 2 years. However, this study also demonstrates the lack of uniformity within Canada of the PPE forms. There remains a need to improve the PPE form to target a section of the form specifically to female athletes, or else cases may be missed. The triad is also not found solely in sports where leanness is associated with better performance. Better efforts need to made to increase awareness of the triad and its risks among female athletes, as well as provide educational opportunities for athletic therapists, who are the first line of intervention in many cases. CLINICAL RELEVANCE: The key to successful prevention and intervention is education. This study demonstrates the need for education for all people directly involved with the athlete, and the need to work together to promote a healthy and realistic body image and increase awareness of the female athlete triad among athletes.

Amenorrhea↗

PubMed2004

The female athlete triad.

The Female Athlete Triad is a syndrome of the interrelated components of disordered eating, amenorrhea, and osteoporosis. Sometimes inadvertently, but more often by willful dietary restriction, many female athletes do not ingest sufficient calories to adequately fuel their physical or sport activities, which can disrupt menstrual functioning, thereby increasing their risk of bone loss. Although its prevalence is unknown, the Female Athlete Triad is believed to affect many athletes at all ages and all sport competition levels. Even though the Triad affects athletes in all sports, girls and women in sports that emphasize a thin or small body size or shape appear to be most at risk. This article focuses on the risks of the Female Athlete Triad for middle- and high-school-age female athletes as well as the unique issues related to the identification, management, and treatment of the various components of the Triad in this special adolescent subpopulation.

Adolescent↗

PubMed2005

The female athlete triad: are elite athletes at increased risk?

PURPOSE: The aim of this study was to examine the percentage of elite athletes and controls at risk of the female athlete triad. METHODS: A detailed questionnaire, which included questions regarding training and/or physical activity patterns, menstrual history, oral contraceptive use, weight history, eating patterns, dietary history, and the Body Dissatisfaction (BD) and Drive for Thinness (DT) subscales of the Eating Disorder Inventory (EDI), was prepared. The questionnaire was administered to the total population of female elite athletes in Norway representing the national teams at the junior or senior level, 13-39 yr of age (N = 938) and non-athlete controls in the same age group (N = 900). After exclusion, a total of 669 athletes (88%) and 607 controls (70%) completed the questionnaire satisfactorily. RESULTS: A higher percentage of controls (69.2%) than athletes (60.4%) was classified as being at risk of the Triad (P < 0.01). A higher percentage of controls than athletes reported use of pathogenic weight-control methods and had high BD subscale scores (P < 0.001). However, more athletes reported menstrual dysfunction and stress fractures compared with controls (P < 0.05). A higher percentage of both athletes competing in leanness sports (70.1%) and the non-athlete control group (69.2%) was classified as being at risk of the Triad compared with athletes competing in non-leanness sports (55.3%) (P < 0.001). Furthermore, a higher percentage of athletes competing in aesthetic sports (66.4%) than ball game sports (52.6%) was classified as being at risk of the Triad (P < 0.001). CONCLUSIONS: More athletes competing in leanness sports and more non-athlete controls were classified as being at risk of the Triad compared with athletes competing in non-leanness sports.

Adolescent↗

PubMed1998

The female athlete. The triad of disordered eating, amenorrhoea and osteoporosis.

Over the last few decades, the number of women participating in organised sports has grown dramatically. Participation in sports has led to significant health benefits for these women; however, several medical disorders have become more prevalent as the number of female athletes has increased. In response to the increase in the number of female athletes and potential medical disorders, the American College of Sports Medicine coined the term 'the female athlete triad' in 1992. The female athlete triad is a serious syndrome comprising 3 interrelated components: (i) disordered eating; (ii) amenorrhoea; and (iii) osteoporosis. The female athlete triad is a syndrome that can be prevented. Medical management of the female athlete triad requires a multidisciplinary approach, with early diagnosis and treatment being key factors. More studies are required to determine its causes, prevalence and consequences and to develop an optimal treatment strategy. All individuals, including coaches and parents, who are working with physically active girls and women should be educated about these disorders, and they should develop strategies to prevent, recognise and treat the female athlete triad.

Adolescent↗

PubMed2000

Outcome analysis of endoscopic sinus surgery for chronic sinusitis in patients having Samter's triad.

A study was conducted to assess outcome analysis in acetylsalicylic acid (ASA) triad patients after endoscopic sinus surgery (ESS). The control group consisted of patients with chronic sinusitis, with or without asthma, who had also undergone ESS. The study group contained 18 patients with the classic triad who were compared with 22 controls. The study was conducted in retrospective fashion highlighting clinical presentation, radiologic evaluation, surgical findings, and recurrence rate of nasal polyps. Although both groups had a relatively similar age of onset of symptoms, the symptomatic picture was different in the two groups. Radiologic evaluation of the nose and paranasal sinuses revealed more extensive involvement of the sinuses in ASA triad patients. Furthermore, ASA triad patients underwent a greater number of repeat operations. This review suggests that ASA triad patients respond less well to surgical intervention and that other treatment modalities should perhaps be explored.

Adult↗

PubMed2005

TRIad: foundation for proarrhythmia (triangulation, reverse use dependence and instability).

There exist both safe and dangerous prolongations of the QT interval. Proarrhythmia can be induced by triangulation of the cardiac action potential, reverse use dependence and instability, a set of three features termed TRIad. TRIad leads to dispersion (spatial, transmural and temporal), stalling of fast repolarization or even early after-depolarization (EAD). EAD can progress to Torsade de Pointes (TdP) especially in the presence of prolonged APD; as the QT interval shortens (e.g. by reverse use-dependence), the cardiac wavelength shortens and TdP can progress to ventricular fibrillation (VF). In the absence of TRIad and QT prolongation, chemicals exhibit on average neither pro- nor anti-arrhythmia. However, QT prolongation in the absence of TRIad becomes antiarrhythmic. Furthermore, this desirable effect increases as TRIad components are replaced by squaring of the action potential, use-dependent prolongation of APD and stabilization of the action potential. It is concluded that proarrhythmic characteristics of drugs can readily be recognized and that hope exists for an effective and safe class III antiarrhythmic agent after all.

Action Potentials↗

PubMed1989

Inositol polyphosphate-mediated repartitioning of aldolase in skeletal muscle triads and myofibrils.

The effects of inositol 1,4,5-trisphosphate (Ins(1,4,5)P3), which has been hypothesized to be a chemical transmitter in excitation-contraction coupling in skeletal muscle, on aldolase bound to isolated triad junctions were investigated. Fructose-1,6-bisphosphate aldolase was identified as the major specific binding protein for the Ins(1,4,5)P3 analogue glycolaldehyde (2)-1-phospho-D-myo-inositol 4,5-bisphosphate which can form covalent bonds with protein amino groups by reduction of the Schiff's base intermediate with [3H]NaCNBH3. This analogue, Ins(1,4,5) P3, and the inositol polyphosphates inositol 1,3,4,5-tetrakisphosphate and inositol 1,4-bisphosphate were nearly equipotent in selectively releasing membrane bound aldolase with a K0.5 of about 3 microM. The rank order of the K0.5 values was identical to the KI values for inhibition of aldolase. Aldolase was also released by its substrate fructose 1,6-bisphosphate and by 2,3-bisphosphoglycerate. Ins(1,4,5)P3-induced aldolase release did not disrupt the triad junction; glyceraldehyde-3-phosphate dehydrogenase, a known junctional constituent, was displaced only at much higher Ins(1,4,5)P3 concentrations. Ins(1,4,5)P3 was as effective as fructose 1,6-bisphosphate in releasing aldolase from myofibrils. A finite number of binding sites for aldolase exist on triads (Bmax = 43-47 pmol of tetrameric aldolase exist on triads (Bmax = 43-47 pmol of tetrameric aldolase/mg of triad protein, KD = 23 nM). The junctional foot protein was implicated as an aldolase binding site by affinity chromatography with the junctional foot protein immobilized on Sepharose 4B. The potential consequences of aldolase being bound in the gap between the terminal cisternae and the transverse tubule to inositol polyphosphate and glycolytic metabolism in that local region are discussed.

Animals↗

PubMed1979

[Fiber-type morphology and function of the triads in frog (Rana esculenta) skeletal muscle)].

1. Owing to differing structural characteristics of the contractile substance, the muscle fibres have been divided into the three types A, B and C in former papers. This distinction seems to be corroborated by our investigations into the different structure regarding the traids. As for the A-fibres, they are structured in terms of the T-system being connected in its entire length with the SR-cisternae and circling the myofibrils at the level of the Z-layer. In the B-fibres, this permanent couping of the two membrane systems is partially interrupted so that the T-tubules are arranged round the myofibrils in such a way that they are isolated or only coupled on one side with the SR-cisternae. Apart from the triads we also find diads. There is a totally different arrangement of the membrane systems in the C-fibres. In this instance the T-tubules are not only arranged transversally but also vertically along the contractile elements. They are surrounded by an "SR-labyrinth" which forms individual minor cisternae which are lateraly coupled with the T-tubules. So the axis of these triads is turned by 90 degrees as compared to the A and B fibres. As a result of this different arrangement, these triads always appear in cross-sections, not however, in longitudinal sections as is the case with the A and B fibres. The tirads have a varying shape in the cross-sections depending on the level of the section and due to the fact that the cisternae are not always coupled congruently with the T-tubules. 2. In our discussion we have tried to related these differing shapes and arrangements of the triads in the fibre types A, B and C to known physiological findings. Therefore we deduced that the excitation transmittance and calcium release can be correlated with the anomal rectification of the triads, which has been localized in the region where the T-tubules and SR-cisternae are coupled. However, we can only reckon with a solution once the morphology and function of the "feet" and the eletronmicroscopically "blank" spaces which fill the gap-junction between the T-tubules and the SR-cisternae have been explained. Whatever function the free surface of the T-tubules has remains open. It is directly adjoining the sarcoplasm and we are tryping to relate it to the delayed rectification which appears on the fibre membrane. 3. Moreover from the arrangement of the SR-cisternae i- the individual fibre types we can deduce th intrafibrillar directions of expansion of the calcium after its release and thus the process of the excitation in the A, B and C fibres. It appears that calcium is being directed homogeneously from the SR-cisternae of the A-fibres to the actinfilaments. here the morphological appearance of the twitch fibre presents itself to us. In principle this pattern of expansion of calcium in the B-fibres remains consistent. Owing to the interruption between the T-system and the SR-cisternae we may assume that the process of contraction is delayed in contrast to the A-fibres...

Animals↗

PubMed2002

Synthesis, optical properties, and aggregation behavior of a triad system based on perylene and oligo(p-phenylene vinylene) units.

A donor-acceptor-donor triad molecule with a perylene bisimide derivative as electron acceptor, and an oligo(p-phenylene vinylene) (OPV) derivative as electron donor was synthesized (OPV-PERY-OPV). The structure of the triad was characterized by (1)H and (13)C NMR spectroscopy, size-exclusion chromatography (SEC), and MALDI-TOF spectrometry. Absorbance spectra and CD spectroscopic measurements of the triad molecule indicated the formation of aggregates in solvents such as toluene, chloroform, and tetrachloroethane, whereas it was present in the molecularly dissolved state in THF. The (1)H NMR spectra of the molecule in chloroform had, unexpectedly, four doublet peaks for the perylene protons, instead of the two doublets that is generally seen in N,N'-substituted perylene molecules. To understand the aggregation behavior and the splitting of the signals in the (1)H NMR spectra, a simple model compound was synthesized, in which the OPV units were replaced by phenyl groups (Ph-PERY-Ph). (1)H NMR spectra in CDCl(3) and tetrachloroethane again had four doublet peaks for the perylene protons, whereas in THF the perylene protons gave only a single peak. NOE and COSY spectroscopy were used to assign the peaks to their corresponding perylene protons. UV/Vis and CD spectroscopic measurements indicated that, similar to the OPV-PERY-OPV triad molecule, the model compound Ph-PERY-Ph was also present in the aggregated form in solvents such as toluene, chloroform, and tetrachloroethane, and in the molecularly dissolved state in THF. IR measurements of the model molecule in the first set of solvents indicated carbamate bond (bond;OCObond;NHbond;)-induced intermolecular hydrogen bonding, whereas in THF, the molecule was mostly present in the free form. CPK models with a dimeric structure, in which two perylene molecules are held together by intermolecular hydrogen bonding with the perylene core shifted slightly with respect to one another, could account for the optical properties and the observation of the four different peaks in the (1)H NMR spectra in polar solvent. Temperature-dependent (1)H NMR spectroscopic, UV/Vis, and CD measurements indicated that the transition from the aggregated to the molecularly dissolved state took place at higher temperatures. The electrochemical studies indicated that OPV-PERY-OPV was both p- and n-dopable, whereas Ph-PERY-Ph was only n-dopable. Cyclic voltammetry measurements of Ph-PERY-Ph in THF had two reduction peaks corresponding to the reduction of the perylene core to the monoanion and dianion, respectively. In dichloromethane, however, an additional reduction peak at lower potential was observed. This new reduction peak might arise from the hydrogen-bonded species.

Journal Article↗

PubMed2005

The innovation triad: an EvoDevo agenda.

This article introduces a special issue on evolutionary innovation and morphological novelty, two interrelated themes that have received a remarkable increase of attention over the past few years. We begin with a discussion of the question of whether innovation and novelty represent distinct evolutionary problems that require a distinct conceptualization. We argue that the mechanisms of innovation and their phenotypic results--novelty--can only be properly addressed if they are distinguished from the standard evolutionary themes of variation and adaptation, and we present arguments for making such a distinction. We propose that origination, the first formation of biological structures, is another distinct problem of morphological evolution, and that together with innovation and novelty it constitutes a conceptual complex we call the innovation triad. We define a problem agenda of the triad, which separates the analysis of the initiating conditions from the mechanistic realization of innovation, and we discuss the theoretical problems that arise from treating innovation as distinct from variation. Further, we categorize the empirical approaches that address themes of the innovation triad in recognizing four major strands of research: the morphology and systematics program, the gene regulation program, the epigenetic program, and the theoretical biology program. We provide examples of each program, giving priority to contributions in the present issue. In conclusion, we observe that the innovation triad is one of the defining topics of EvoDevo research and may represent its most pertinent contribution to evolutionary theory. We point out that an inclusion of developmental systems properties into evolutionary theory represents a shift of explanatory emphasis from the external factors of natural selection to the internal dynamics of developmental systems, complementing adaptation with emergence, and contingency with inherency.

Adaptation, Physiological↗

PubMed2005

Use of transportal balloon catheter occlusion of the portal triad in prevention of bleeding during liver resection.

BACKGROUND: Operative blood loss is among the most important factors determining the prognosis of patients undergoing hepatic resection. The best method for preventing bleeding is preliminary selective vascular occlusion of lobar, sectoral, or segmental portal triads, although not always technically feasible. METHOD: Transportal occlusion of the portal triad with a balloon catheter was used in 35 hepatectomies for various tumors. RESULTS: In 27 out of 35 resections, there was absence or minimal bleeding from afferent vessels (portal vein, hepatic artery). In the remaining eight cases, there was significant bleeding from the hepatic artery. In these cases, transportal occlusion of portal triad was combined with a temporary interruption of the hepatic artery after the dissection of the hepatoduodenal ligament. The average intraoperative blood loss was 350-1,500 ml. CONCLUSION: The use of a balloon catheter occlusion of the portal triad during liver resection is often technically feasible. It facilitates temporary occlusion of hardly accessible portal veins in the hepatic hilus without their prior exposure and minimizes bleeding.

Adult↗