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PubMed1982

The autonomic nervous tone abnormalities in the genesis of the impaired baroreflex responsiveness in borderline hypertensive subjects.

1. The effects of intravenous administration of neostigmine and propranolol, individually or in combination, on baroreflex responsiveness have been evaluated in 18 borderline hypertensive subjects and in 14 age-matched control subjects. 2. Baroreceptor sensitivity was tested by evaluating both heart rate response to phenylephrine-induced increase in arterial pressure, and heart rate and blood pressure changes induced by increasing neck-tissue pressure by means of a neck-chamber. 3. In borderline hypertensive subjects a reduced baroreflex responsiveness was demonstrated with both stimuli as compared with normal subjects. Neostigmine administration improved consistently both reflex responses. Similarly, after propranolol treatment, borderline hypertensive subjects showed a significant enhancement of the baroreflex sensitivity. Finally, the combined administration of neostigmine and propranolol restored the baroreflex responses. In fact, both the mean slopes of the regression lines between blood pressure and R-R interval after phenylephrine and the increase in mean arterial pressure and heart rate induced by the reduction in carotid transmural pressure in borderline hypertensive subjects were similar to those observed in normals. 4. These findings indicate that in borderline hypertensive subjects the impairment of baroreflex responsiveness is mainly due to abnormalities of autonomic regulation.

Adult↗
PubMed1984

Studies of salivary flow in borderline hypertension: effects of drugs acting on structures innervated by the autonomic nervous system.

Salivary flow and the influence of drugs on this were studied in subjects with borderline hypertension and in normotensive subjects. Saliva production at rest was lower in borderline hypertensive subjects than in normotensive subjects. Plasma catecholamine levels were similar in both groups of subjects studied. Intravenous injections of propranolol and phentolamine did not enhance saliva secretion in the borderline hypertensive group, whereas atropine caused the secretion to decrease in both groups. Intravenous infusions of neostigmine led to a dose-dependent increase of salivary flow. The dose-response curve for the stimulating effect of neostigmine on saliva production was shifted to the right in borderline hypertensive as compared with normotensive subjects. The results of the study support the assumption that in subjects with borderline hypertension parasympathetic influence on the salivary glands is reduced.

Adult↗
PubMed2001

Increased microvessel density in malignant and borderline mammary phyllodes tumours.

AIMS: Tumour vascularity is considered a prognostic indicator in breast carcinoma, but its utility in mammary phyllodes tumour has not been explored. The authors report the correlation between intratumoral microvessel density and the histological grade of phyllodes tumour. METHODS AND RESULTS: Forty cases of phyllodes tumour were reviewed for stromal cellularity, overgrowth, cytological pleomorphism, mitotic count and margin pattern. Using established criteria, these were diagnosed as benign (n=28), borderline (n=10) and malignant (n=2). Microvessel density was counted on CD31-stained slides as the number of vessels per high power field. For benign phyllodes tumour, the range was 7-26.2 (mean 13.1); for borderline phyllodes tumour the range was 17.2-32.5 (mean 22.4); for malignant phyllodes tumour the range was 25.9-33.3 (mean 29.6). The difference between the benign and borderline groups was significant (P < 0.0001) but that between the borderline and malignant groups was not, due to the small number of malignant cases. CONCLUSIONS: There is a significant difference in stromal microvessel density between benign and borderline phyllodes tumour. Although the small number of cases of malignant phyllodes tumour limits further interpretation, we believe that microvessel density can be used as an additional objective histological parameter in the evaluation of phyllodes tumour.

Adolescent↗
PubMed1995

Basement membrane patterns in borderline tumors of the ovary. An immunohistochemical study with antibodies to laminin and type IV collagen.

Using antibodies directed against the basement membrane (BM) components laminin and type IV collagen, basement membrane patterns were studied in borderline epithelial tumors of the ovary. To determine the potential use of BM immunohistochemistry in the histopathologic diagnosis of tumors of borderline category, BM patterns were compared with those in cystadenomas and cystadenocarcinomas. In cystadenomas, regular and intact BM were found at the interface between the epithelial cells of the cysts and the adjacent stroma. Cystadenocarcinomas displayed an irregular pattern, with areas of intact BM between tumor cells and stroma, as well as areas with irregular discontinuities. Tumors of borderline malignancy shared a continuous BM pattern with cystadenomas, However, 30% of the borderline malignant tumors contained small areas with BM interruptions resembling those of invasive carcinoma. From the results of this study we conclude that BM patterns in ovarian tumors of borderline malignancy are mostly similar to those of benign epithelial tumors. Focal defects possibly indicating early invasive growth, however, occur in 30% of the cases.

Journal Article↗
PubMed1999

Clinical relevance of retroperitoneal involvement from epithelial ovarian tumors of borderline malignancy.

Rota SM, Zanetta G, Ieda N, Rossi R, Chiari S, Perego P, Mangioni C. Clinical relevance of retroperitoneal involvement from epithelial ovarian tumors of borderline malignancy. Ovarian tumors of borderline malignancy have an outstanding prognosis. The need for aggressive surgical staging is questionable and the need for retroperitoneal node sampling is debated. From 1982 to 1996, 81 women underwent surgical staging including retroperitoneal sampling. Three patients (3.7%) with serous tumor had microscopic nodal involvement. Retroperitoneal metastases were found in two intraperitoneal stage I tumors and in one stage IIIA tumor. Positive nodes were found in 1/31 (3.2%) women undergoing sampling of para-aortic nodes and in 2/69 (2.8%) women undergoing sampling of pelvic nodes. With a median follow-up of 79 months we observed five recurrences, but none involved the retroperitoneum. The three patients with positive nodes remain alive without disease. Among 236 patients with diagnosis of borderline tumor but without sampling of the nodes, we observed one retroperitoneal recurrence (0.4%) in a serous tumor. There are no indications for retroperitoneal sampling of mucinous borderline tumors. For serous tumors this procedure should only be performed as a part of prospective trials. The clinical relevance of retroperitoneal involvement in borderline tumors appears minimal and does not justify routine aggressive surgery.

Journal Article↗
PubMed1996

Diagnosis of borderline adenomas of the stomach by endoscopic mucosal resection.

BACKGROUND AND STUDY AIMS: The correct histological diagnosis of gastric borderline adenomas is often difficult, especially in excluding malignancy, since the usual diagnostic methods, such as radiography and histological examination of forceps biopsy specimens, are of limited accuracy. The aim of this study was to retrospectively analyze the value of endoscopic mucosal resection in establishing the correct diagnosis of borderline adenomas. RESULTS: Fourteen borderline adenomas were finally diagnosed as containing early gastric cancer type IIa (well-differentiated tubular adenocarcinoma) after endoscopic mucosal resection, of the remaining 36 tubular adenomas, six represented mild dysplasia, 24 moderate dysplasia, and six severe dysplasia. Most parts of the 14 adenomas containing early gastric cancers had regions of structural atypia, and cellular atypia was moderate in all. Seven of 14 cancers were completely resected, all patients being tumor-free after a follow-up of 33-61 months. CONCLUSIONS: These results suggest that diagnosing borderline adenoma on the basis of radiographic and endoscopic-bioptic findings is generally unreliable, because biopsy specimens may not be representative of the entire lesion. Borderline adenomas of the stomach should be completely resected by endoscopic mucosal resection to obtain a final diagnosis and - depending on the size and type of the lesion - possibly also definitive treatment.

Adenoma↗
PubMed1987

[Morphologic criteria of prognosis and clinical course in ovarian tumors of the borderline type].

Borderline tumors of the ovary are morphologically characterized by histologic and cellular criteria and by lack of evidence of invasion. During an observation period of 12 years at Heidelberg University Gynecological Clinic, 49 patients with borderline tumors underwent surgery and the clinical course was followed up. In 15 cases the tumor was at an advanced stage (FIGO III/IV); chemotherapy was instituted after surgery in 12 of these women. None of the patients with early-stage tumors (FIGO I/II) were lost due to the tumor during the period of observation; the death rate among patients with stage III/IV tumors (FIGO) was 40%. However, the death of three of these women was also due to their advanced age and high internal risks. As in the case of ovarian carcinomas, the survival rates improve if the postoperative residual tumor mass is smaller than 2 cm. Subsequent histologic work-up of archived, formalin-fixed tumor tissue and metastases thereof showed that two forms of the metastasizing borderline tumor exist: one with a favorable prognosis, a "pure" form with borderline changes in the ovary and metastases, and one with a less favorable prognosis, with borderline changes in the ovary and destructive-invasive portions of tumor in the metastazation areas. Impulse cytophotometric studies (ICP) showed that all primary tumors had the same degree of ploidy i.e., diploid. However, detection of an aneuploid distribution pattern in a metastasis correlated with subsequent histological confirmation of tumor invasion and rapid tumor death. The S-phase fraction was low, at 2.02% +/- 1.3.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed2004

Life events, motives, and precipitating factors in parasuicide among borderline patients.

The high prevalence of borderline personality disorder in parasuicide raises the question whether there are differences in motives, precipitating factors, and life events as compared to other clinical groups. Consecutive hospital admitted parasuicide patients were therefore investigated for personality disorders by a structured clinical interview (SCID-II), a structured interview concerning precipitating factors and a self-report questionnaire on motives and life events. Out of a total of 64 patients, 55% met the criteria for a borderline personality disorder. While the parasuicidal motives and precipitating factors did not differ between the borderline group and the others, the borderline group reported significantly more adverse life events. Our findings suggest that the overrepresentation of borderline personality disorder in parasuicide might be related to accumulated adverse life events rather than to manipulative motives.

Journal Article↗
PubMed1992

Prevalence of left ventricular hypertrophy and cardiac arrhythmias in borderline hypertension.

Seventy-eight men with borderline hypertension according to the World Health Organization criteria underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings for 24 h. The prevalence of echocardiographic left ventricular hypertrophy was 16.6% (13/78). Borderline hypertensives with left ventricular hypertrophy had more supraventricular (P less than .001) and ventricular ectopic beats (P less than .001) than normotensive controls and borderline hypertensives without cardiac involvement. Furthermore, ventricular ectopic activity was significantly related to left ventricular mass (r = 0.58, P less than .05) in borderline hypertensives showing echocardiographic evidence of left ventricular hypertrophy. Our findings suggest that noninvasive assessment of target organ status, including echocardiography, should be employed to optimize risk stratification in borderline hypertension.

Adult↗
PubMed1979

The treatment of female borderlines.

Failure to complete needed operations in the separation-individuation process during early childhood development is increasingly suspected of being a major source of borderline pathology. Building on Mahler's descriptions of this process as an interpersonal operation between child and mother, we have directly intervened in the patient-mother relationship in a small group of adult female borderlines. All patients displayed rapid and apparently complete clearing of borderline symptoms following limited conjoint therapy. Although neuroses remained, the criteria for a borderline diagnosis were no longer met. Treatment results with six women who had pretreatment and posttreatment psychological testing are reported. Testing confirmed clinical impressions of significant shifts in psychological defenses as well as perceptions of self and others. Fundamentals of this approach are discussed briefly, and observations regarding possible borderline pathology, mother-daughter interactions, family dynamics, and therapeutic philosophy are made. This approach appears not only to be effective but offers promise of simplifying both the role of the therapist and the therapy itself.

Adult↗
PubMed2001

Serous borderline tumor of the paratestis: a report of seven cases.

We report the clinical, morphologic, immunophenotypic, and ploidy findings of seven cases of serous borderline tumor of the paratestis. Mean patient age was 56 years (range, 14-77 years), and the clinical presentation was that of a testicular mass. Tumors ranged in size from 1 to 6 cm (mean, 3.5 cm). Six tumors arose from the tunica albuginea, and two of these tumors were intratesticular. One tumor arose from the tunica vaginalis. Serous borderline tumor of the paratestis is histologically identical to its ovarian counterpart. The tumors were cystic with numerous intracystic blunt papillae lined by stratified epithelial cells with minimal to mild cytologic atypia. Psammoma bodies were present in two cases. In all cases, the neoplastic cells stained strongly and diffusely for cytokeratin 7, estrogen receptor, and CD15, and six of seven cases were positive for progesterone receptor and MOC-31. The cells did not stain for cytokeratin 20, carcinoembryonic antigen, calretinin, and HER2/neu. Proliferative activity, as assessed by MIB-1 staining, ranged from 1.3% to 10% (mean, 5.5%). Five of six tumors were diploid, and one was tetraploid. Patients were treated by radical orchiectomy and followed up from 4 months to 18 years (mean, 48 months; median, 8.5 months). No recurrences or metastases occurred. Serous borderline tumor of the paratestis is morphologically and immunophenotypically identical to ovarian serous borderline tumor. To date, no serous borderline tumor of the paratestis reported in the literature or in our series has recurred or metastasized after resection.

Adenocarcinoma↗
PubMed1984

Plasma prolactin, renin and catecholamines in young normotensive and borderline hypertensive subjects.

It has been reported that patients with essential hypertension have high plasma prolactin levels and suggested that reduced central dopaminergic activity may be a factor in the pathogenesis of essential hypertension. This study examines the influence of posture on plasma prolactin, plasma catecholamines, plasma renin activity, blood pressure and heart rate in 24 patients with borderline hypertension (age 19 +/- 1 years) and 20 normotensive subjects matched for age and body mass index. Supine plasma prolactin levels were similar in both groups [borderline hypertension, 11.3 +/- 0.7 ng/ml; normotensive, 10.7 +/- 0.8 ng/ml (mean +/- s.e.m.)] and no increase in plasma prolactin was observed after 10 min standing in both groups. Normotensive and borderline hypertensive subjects had similar values for supine and upright plasma renin activity and plasma norepinephrine. There were no significant correlations between supine plasma prolactin and supine blood pressure, supine plasma renin activity or plasma norepinephrine when data from both normotensive and borderline hypertensive subjects were combined. These results may provide indirect evidence against the occurrence of reduced central dopaminergic activity in borderline hypertension.

Adult↗
PubMed1989

The k-complex vasoconstrictor response: evidence for central vasomotor downregulation in borderline hypertension.

Central sympathetic outflow and the baroreflex were measured as an integrated cardiopressor response to a noise stimulus during normal sleep, in 13 normotensives and 14 borderline hypertensives. The pressor response latency was prolonged in the borderline hypertensives, and the stimulus-induced increase in systolic and diastolic intra-arterial pressure was greater in the borderline hypertensives (23.0 +/- 7.3-16.2 +/- 5.6 mmHg) compared with the normotensives (16.7 +/- 5.9-13.6 +/- 4.6 mmHg; P less than 0.001), but the heart rate was not increased. Despite the increased pressor response, the baroreflex-mediated fall in the heart rate following the pressor response was reduced in the borderline hypertensives, indicating secondary adaptation to hypertension and a resetting, or downregulation, of central vasomotor control mechanisms in the borderline hypertensives relative to normotensives.

Acoustic Stimulation↗
PubMed1989

Linear cardiac output in borderline and sustained hypertension.

We assessed the relative contributions of raised cardiac output and increased peripheral resistance to elevation and lability of blood pressure in patients with borderline and sustained hypertension. Ninety-five untreated patients were admitted to hospital for assessment. Using Doppler ultrasound, linear cardiac output was measured as minute distance on the day of admission and 24 h later; blood pressure was measured at the same times, enabling calculation of linear resistance (analogous to peripheral vascular resistance). In sustained, but not borderline, hypertension linear resistance was increased at the first measurement (+ 36%, P less than 0.001), but mean minute distance did not differ significantly from normal in either group. Between the first and second measurements in borderline and sustained hypertension there were significant falls of mean blood pressure (-9%, P less than 0.001 and -4%, P less than 0.01). In borderline, but not sustained, hypertension there was an associated fall of linear resistance (-11%, P less than 0.05); in neither group was there a significant change of minute distance. Both elevation and lability of blood pressure in borderline and sustained hypertension are due more to changes of peripheral resistance than to changes of cardiac output.

Adolescent↗
PubMed1997

Clinical significance of renal allograft biopsies with "borderline changes," as defined in the Banff Schema.

BACKGROUND: The Banff Schema suggests the term "borderline changes" for biopsies showing changes insufficient for a diagnosis of mild acute rejection. The appropriate clinical management for patients showing such changes on biopsy is controversial. METHODS: We reviewed the clinical course and response to antirejection therapy of 24 patients with borderline changes, and compared our findings with those obtained from 14 patients with mild acute rejection. Patients were classified as showing complete response, partial response, or no response to antirejection treatment, depending on whether the posttreatment fall in serum creatinine was >70%, 30-70%, or <30% of the pretreatment rise, respectively. Renal allograft biopsies were systematically evaluated in accordance with the Banff schema. RESULTS: Complete response to antirejection therapy was seen in 15/24 (63%), partial response in 3/24 (13%), and nonresponse in 6/24 (25%) patients with borderline change. Compared with patients showing complete response, nonresponse was associated with higher scores of acute tubular necrosis and chronic allograft nephropathy (P<0.05). By comparison, 12/14 (86%) cases of mild acute rejection showed complete response to antirejection therapy (P=0.25 vs. patients with borderline change), and lack of response was associated with a higher score for chronic allograft nephropathy. CONCLUSION: When biopsies are done in the context of renal allograft dysfunction, borderline changes frequently require increased immunosuppression. These findings should not be extrapolated to protocol biopsies performed in the setting of stable graft function.

Adult↗
PubMed1995

Arterial elements and perisinusoidal cells in borderline hepatocellular nodules and small hepatocellular carcinomas.

Borderline hepatocellular nodule in the human cirrhotic liver is considered a preneoplastic lesion of hepatocellular carcinoma (HCC). However, the angiogenetic process and changes in perisinusoidal cells (fat-storing cells or Ito cells) during the borderline nodule-HCC sequence have not been investigated. We have investigated intraparenchymal arterial elements and perisinusoidal cells in normal livers, chronic hepatitis, borderline nodules and small HCC, using an immunohistochemical staining for alpha-smooth muscle actin. In normal livers, chronic hepatitis, cirrhotic nodules and large regenerative nodules, no or few arterial elements were present in the parenchyma, and alpha-smooth muscle actin-positive perisinusoidal cells were increased further. These data suggest that angiogenesis first occurs in borderline hepatocellular nodules and it gradually proceeds during the nodule to HCC sequence along with an increase in perisinusoidal cells. The demonstration of arterial elements and perisinusoidal cells may be useful for the differential diagnosis of large regenerative nodule, borderline hepatocellular nodule and small HCC.

Arteries↗
PubMed2005

Molecular pathogenesis of ovarian borderline tumors: new insights and old challenges.

Ovarian borderline (low malignant potential) tumors are a puzzling group of neoplasms that do not fall neatly into benign or malignant categories. Their behavior is enigmatic, their pathogenesis unclear, and their clinical management controversial, especially for serous borderline tumors (SBT), the most common type of ovarian borderline tumor. Clarifying the nature of borderline tumors and their relationship to invasive carcinoma has puzzled investigators since the category was created over 30 years ago. Much of the confusion and controversy concerning these tumors is due to a lack of understanding of their pathogenesis and an absence of a model for the development of ovarian carcinoma. This review summarizes recent molecular studies of ovarian borderline tumors with special emphasis on the role of SBT in tumor progression and its relationship to ovarian serous carcinoma.

Cystadenoma, Serous↗
PubMed1979

Carotid baroreflex function in young men with borderline blood pressure elevation.

Carotid baroreflex function was assessed in 10 normotensive young men and 20 age-matched subjects with borderline hypertension (successive blood pressures above and below 140/90 mm Hg) by measuring sinus node responses to brief neck suction. Subjects with borderline hypertension were divided into two equal groups according to their average systolic arterial pressures. Baroreflex responses were reset to function at higher pressure levels than normal in subjects with mild borderline hypertension, but reflex sensitivity was normal. Responses were also reset in subjects with more severe borderline hypertension, but reflex was subnormal. The results suggest that a gradation of baroreflex responsiveness exists among patients classified as having borderline hypertension: Subnormal responsiveness was found in those subjects whose resting average systolic arterial pressure was greater than or equal to 140 mm Hg.

Adult↗