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PubMed1984

Borderline or malignant ovarian tumour? A case report of decision making with morphometry.

A young woman presented with bilateral ovarian tumours. Multiple sections of each tumour were shown to many pathologists for consultation; some considered the tumours to be borderline, whereas others thought that one or both of them was malignant. Morphometry showed that the numerical classification probabilities for borderline tumour were 0.78 for the left ovarian tumour and 0.85 in the right. The lesions were therefore regarded as borderline tumours and no additional chemotherapy was given. Three years after the second operation the patient is alive and well without clinical or biochemical evidence of recurrence. Most patients with borderline tumours who die from the disease do so in the first two years after the operation. This young patient was prevented from severe overtreatment by the application of morphometry, illustrating its use in this area of diagnostic gynaecopathology.

Adult↗
PubMed1982

Renal function in borderline hypertensive first-degree relatives of essential hypertensives. Effects of sodium load.

Renal function in the basal state and after sodium load has been investigated in 21 borderline, hypertensive, first-degree relatives of established hypertensives and in 21 age- and sex-matched, normal subjects with no family history of hypertension. During intravenous infusion of inulin and p-aminohippurate in saline, both groups showed a decrease in plasma aldosterone levels (p less than 0.05) but renal plasma flow (595 +/- 48 vs. 750 +/- 59 ml/min, p less than 0.05), diuresis (1.4 +/- 0.2 vs. 2.2 +/- 0.5 ml/min, p less than 0.05), natriuresis (0.21 +/- 0.02 vs. 0.3 +/- 0.02 mEq/min, p less than 0.05) and sodium clearance (1.05 +/- 0.1 vs. 2.4 +/- 0.4 ml/min, p less than 0.05) in borderline hypertensives were higher than in the control group. After the salt load (NaCl, 1.35% i.v., 5 ml/min for 2 h) there was an increase in blood pressure and a decrease in plasma aldosterone and potassium levels in both groups. However, borderline hypertensives showed higher diuresis, natriuresis, sodium clearance and also kaliuresis compared to normotensives. These results suggest that borderline hypertensives already present the changes in renal function which are characteristics of established hypertensives.

Adolescent↗
PubMed1991

Left ventricular diastolic function in athletes and borderline hypertensives with mild cardiac hypertrophy.

The aim of this study was to evaluate the diastolic function in athletes and in young borderline hypertensives with mild left ventricular hypertrophy. Left ventricular filling was assessed by echo Doppler measurement of transmitral flow velocity in 18 soccer players (age 22 +/- 4 years, left ventricular mass index, LVMI 136 +/- 12 g/m2), in 15 borderline hypertensives (age 21 +/- 3 years, LVMI 137 +/- 9 g/m2), and 20 normotensive subjects (age 22 +/- 4 years, LVMI 93 +/- 10 g/m2) as reference group. We found that left ventricular filling profile was similar in borderline hypertensives, in athletes and in normotensive subjects. These findings suggest that, at least in the early stage, mild cardiac hypertrophy secondary to borderline blood pressure elevation is characterized by indexes of diastolic function not different from those found in athletes with physiological hypertrophy.

Adult↗
PubMed1997

Psychophysiological reactivity of borderline hypertensives and their recovery after mental stress.

UNLABELLED: The question of psychophysiological reactivity of borderline hypertensives is still controversial. METHODS: Young males with borderline blood pressure levels and normotensive controls were recruited during a routine examination. Samples of study I comprised 19 subjects, samples of study II 18 subjects. Two stressors were presented (distressing movie, mental arithmetic), each followed by a recovery phase. Systolic and diastolic blood pressure, heart rate, and electrodermal parameters were assessed repeatedly. RESULTS: Borderline hypertensives showed greater reactions to stressors in systolic blood pressure only. Changes in percentage of baseline levels were essentially the same. Recovery after stress did not differ between groups. CONCLUSION: Only moderate support is given to the hypothesis that borderline hypertensives show increased and slowly recovering psychophysiological responses.

Adaptation, Physiological↗
PubMed1975

Reduced baroreceptor sensitivity in borderline hypertension.

The sensitivity of the baroreceptor reflex in nine patients with borderline hypertension (mean age 19.1 plus or minus 0.2 years) was compared to that in six normal subjects of comparable age (mean 18.8 plus or minus 0.3 years) and that in 14 patients with established hypertension (mean age 48.3 plus or minus 3.1 years). The sensitivity of the baroreceptor reflex was assessed by determining the slope of the regression line relating the rise of systolic pressure to the prolongation of the R-R Interval during the transient rise of arterial pressure induced by an intravenous injection of phenylephrine. The average baroreceptor slope in nine patients with borderline hypertension was 9.1 plus or minus 0.8 msec/mm Hg, which was significantly less than that in six normal subjects (16.0 plus or minus 2.0; P smaller than 0.01), but was greater than that in 14 patients with established hypertension (4.9 plus or minus 0.7; P smaller than 0.01). The significant negative correlation was found as the baroreceptor slope was related to the mean arterial pressure in patients with borderline hypertension and normal subjects, all of whom were 20 years old or less. Attenuation of the baroreceptor sensitivity may influence the maintenance of raised arterial pressure in borderline hypertension.

Adult↗
PubMed1981

Borderline hypertension: relationship between age, hemodynamics and circulating catecholamines.

The relationships between age, systemic and renal hemodynamics, circulating catecholamines (norepinephrine, epinephrine and dopamine) and intravascular volumes were studied in 38 normotensive subjects and in 77 patients with borderline essential hypertension. Borderline hypertensive patients had a higher cardiac index (p less than 0.02) and renal blood flow (p less than 0.05) than normotensive subjects if they were younger than 30 years of age, whereas in older patients no difference was observed. In contrast, total peripheral resistance was normal in young borderline hypertensive patients, but significantly increased (p less than 0.02) in patients older than age 40 years. Cardiac output (r = -0.28, p less than 0.01) and renal blood flow (r = -0.47, p less than 0.001) correlated inversely with age in the entire population and in both subgroups. Cardiac output also correlated closely with renal blood flow in all subjects (r = 0.45, p less than 0.001). Circulating norepinephrine levels increased with age (r = 0.25, p less than 0.05), whereas epinephrine concentration tended to decrease. Plasma and total blood volume correlated directly with cardiac output (r = 0.39, p less than 0.001) and inversely with peripheral resistance (r = -0.34, p less than 0.001). These data indicate that the hyperdynamic circulation (high cardiac output and renal blood flow) of borderline hypertension is found predominantly in patients younger than age 30 years. Older patients are characterized by an elevated total peripheral resistance and normal cardiac output. The age-dependent increase in circulating norepinephrine and decrease in epinephrine levels may participate in the shift of the hemodynamic profile from high-cardiac-output hypertension in the young to a high-arteriolar-resistance hypertension in the older patient.

Adolescent↗
PubMed1988

Potentiation of sympathetic nerve responses to hypoxia in borderline hypertensive subjects.

We tested the hypothesis that sympathetic nerve responses to stimulation of chemoreceptors by hypoxia are exaggerated in borderline hypertensive humans. We compared responses to isocapnic hypoxia in eight borderline hypertensive subjects and eight normotensive control subjects matched for age, sex, weight, and height without a family history of hypertension. Measurements of heart rate, mean blood pressure, minute ventilation, and sympathetic nerve activity to muscle were made before and during hypoxia. We also measured responses to a period of voluntary apnea during hypoxia. There were no significant differences between the increases in heart rate, blood pressure, and ventilation in response to hypoxia in the two groups. However, during hypoxia sympathetic activity in the hypertensive subjects increased by 40.6 +/- 13.6% (mean +/- SE), greater than the increase of 20.4 +/- 5.0% in the control subjects (p less than 0.05). In six hypertensive and six control subjects, when apnea was performed during hypoxia, sympathetic activity increased by 605.0 +/- 294.3% in the hypertensive subjects and by only 52.8 +/- 17.3% in the control subjects (p less than 0.001). We conclude that the chemoreceptor reflex is enhanced in borderline hypertensive subjects and results in exaggerated increases in sympathetic nerve activity during hypoxia. This enhanced chemoreceptor reflex is especially obvious when the inhibitory influence of breathing and thoracic afferent activity is eliminated by apnea. This exaggerated response may contribute to excess sympathetic activity in borderline hypertensive subjects and to adverse consequences of sleep apnea in hypertensive subjects.

Apnea↗
PubMed1990

Psychosomatic factors in borderline hypertensive subjects and offspring of hypertensive parents.

Psychosomatic factors, sympathoneural and sympathoadrenal as well as cardiovascular mechanisms, were studied in 24 patients 18-24 years of age with borderline hypertension, 50 age-matched normotensive offspring of hypertensive parents, and 49 controls with no family history of hypertension. They were compared by projective and questionnaire-based psychological tests and their circulatory and neurohormonal reactivity to mental (Stroop color-word conflict test and arithmetic test) and physical stressors (orthostasis and bicycle ergometry test) were measured. Borderline hypertensive subjects externalized aggression less (p less than 0.05) but internalized it more (p less than 0.05) and were more submissive (p less than 0.05) when compared with controls. Offspring of hypertensive parents showed a similar but weaker pattern. Both risk groups reported more positive interactions with their parents (genetic risk subjects versus controls, p less than 0.05; borderline hypertensive patients versus controls, p = 0.08) and had higher state-anxiety levels (p less than 0.05). There were more subjective symptoms of beta-adrenergic receptor-mediated functions (e.g., tachycardia, tremor) in borderline hypertensive subjects and offspring of hypertensive parents, elevated heart rates (analysis of repeated measures, p less than 0.001), and enhanced plasma norepinephrine concentrations (p less than 0.05) when compared with controls. These findings in subjects at risk for the development of hypertension suggest that psychosomatic factors and sympathetic overactivity are involved in the early phase of hypertension.

Adult↗
PubMed1993

Developmental sensitivity to high dietary sodium chloride in borderline hypertensive rats.

The present study compared the postweaning blood pressures and body weights of borderline hypertensive rats exposed to a high (8%) sodium chloride maternal diet either from conception to weaning or only during the weaning period with borderline hypertensive rats consistently exposed to a normal (1%) sodium chloride maternal diet. Because the effects of early sodium chloride exposure may be most evident during a subsequent challenge, rats from each group were assigned to receive either an 8% sodium chloride or a 1% sodium chloride diet from 8 to 17 weeks of age. Exposure to an 8% sodium chloride diet from conception through weaning increased the adult blood pressure of borderline hypertensive rats compared with that of controls exposed to a 1% sodium chloride diet; exposure to an 8% sodium chloride diet only during weaning did not increase blood pressure. An 8% sodium chloride diet beginning at 8 weeks of age increased systolic blood pressure. The effects of perinatal and adult exposure to high dietary sodium chloride were additive. Behavioral observations and urinary electrolyte measures confirmed that pups exposed to an 8% sodium chloride diet during weaning ingested the high-sodium chloride diet. The blood pressure and heart rate response to autonomic nervous system ganglionic blockade were assessed at 17 weeks of age. Borderline hypertensive rats exposed to an 8% sodium chloride diet from conception through weaning showed an increased bradycardic response, but no difference in depressor response, to ganglionic blockade. These data suggest that the window of developmental sensitivity for modulation of blood pressure regulation by high dietary sodium chloride occurs during prenatal and early postnatal development.

Animals↗
PubMed1994

Dyslipoproteinemic changes in borderline hypertension.

The present study examined plasma lipoprotein, lipoprotein lipase, hepatic lipase, and insulin levels in men with borderline hypertension (diastolic blood pressure 85 to 94 mm Hg) compared with age-matched normotensive control subjects (diastolic blood pressure less than or equal to 80 mm Hg, n = 75 + 75). High-density lipoprotein (HDL) subclasses were determined in a subset (n = 45 + 45). While total and low-density lipoprotein cholesterol levels were similar, levels of very-low-density lipoprotein (VLDL) cholesterol and triglycerides (0.46 versus 0.41 mmol/L, P = .027, and 1.0 versus 0.85 mmol/L, P = .031) and total triglycerides (1.53 versus 1.33 mmol/L, P = .009) were elevated and HDL cholesterol was reduced in the borderline group compared with the normotensive group (1.17 versus 1.26 mmol/L, P = .043). The HDL subclass HDL2b concentration was lower (0.16 versus 0.24 mmol/L, P = .006), while HDL3b and HDL3c concentrations were higher in the borderline group (0.38 versus 0.32 mmol/L, P = .016, and 0.19 versus 0.16 mmol/L, P = .042). Significantly higher activities of hepatic lipase in the borderline group (282 versus 232 mU/mL, P = .024) and significant correlations between lipoprotein lipase activity and VLDL and HDL concentrations suggest an involvement of these enzymes in the development of these differences. When adjusted for body mass index or insulin level, all differences disappeared, except for HDL3b and HDL3c concentrations, which remained significantly elevated. These results indicate that dyslipoproteinemic changes are present in early hypertension. Although most of these changes are related to obesity, alterations in HDL profile were not explained by influences of body mass index and insulin.

Adult↗
PubMedDate not supplied

Pressor factors and cardiovascular pressor responsiveness in borderline hypertension.

The role of various pressor factors and cardiovascular responsiveness to norepinephrine or angiotensin II in the pathogenesis of borderline hypertension was evaluated. Exchangeable body sodium, blood volume, plasma renin activity, norepinephrine or dopamine levels, and norepinephrine or epinephrine excretion rates were similar between 24 patients with borderline hypertension (mean age 34 +/- 4 (SEM) years and 22 normal subjects matched for age; the patients had a slight increase in supine plasma epinephrine. Pressor doses of norepinephrine or angiotensin II were significantly lower (p less than 0.01 and 0.001, respectively) in the borderline hypertensive group. These findings suggest that borderline hypertension may be maintained by inappropriately increased cardiovascular response to norepinephrine and angiotensin II in the presence of normal sympathetic and renin activity and a normal body sodium-volume state.

Adult↗
PubMed1975

Effects of high and low sodium intake on arterial pressure and forearm vasular resistance in borderline hypertension. A preliminary report.

The purpose of this study was to evaluate effects of high and low sodium intake on arterial pressure and forearm vascular resistance in subjects with borderline hypertension and to compare responses to sodium excess in these subjects with responses in a recent study in normotensive subjects. Six subjects with borderline hypertension were studied after ten days of high (410 mEq/24hr) and low (10mEq/24hr) sodium intake. Potassium intake was constant. In five of six subjects, high sodium intake decreased forearm blood flow and increased forearm vascular resistance and arterial pressure. During low and high sodium intake forearm blood flow averaged 7.8 plus or minus 1.2 (SE) and 5.9 plus or minus 0.8 ml/min x 100 ml, respectively; forearm vascular resistance averaged 13.5 plus or minus 2.2 and 19.1 plus or minus 3.0 units, respectively; and mean arterial pressure averaged 89 plus or minus 3 and 98 plus or minus 2 mm Hg, respectively. High sodium intake augmented forearm vasoconstrictor responses to lower body negative pressure, a stimulus to neurogenic vasoconstriction. The results contrast with our earlier results in normotensive subjects in whom sodium excess produced forearm vasodilatation and failed to increase arterial pressure significantly. Decreases in renin and aldosterone with high sodium intake were similar in the two groups. The results suggest that excessive sodium intake in subjects with borderline hypertension produces abnormal increases in forearm vascular resistance, neurogenic vasoconstriction, and arterial pressure. The reasons for the contrast between the borderline hypertensives and normotensives are unknown, but they do not seem to be related to the renin-angiotensin-aldosterone system.

Adult↗
PubMed2005

Serous borderline tumor of the fallopian tube presented as hematosalpinx: a case report.

BACKGROUND: Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date. CASE PRESENTATION: A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusually presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years. CONCLUSION: The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube.

Adult↗
PubMed2001

Behavior of borderline tumors with particular interest to persistence, recurrence, and progression to invasive carcinoma: a prospective study.

PURPOSE: Borderline tumors account for 10% to 20% of epithelial ovarian tumors, and their prognosis is outstanding; nevertheless, a mortality of up to 20% has been reported, particularly in earlier reports. There is a lack of information about the actual mortality and the rate of progression into invasive carcinoma in large and prospectively accrued populations. PATIENTS AND METHODS: All women with borderline ovarian tumors undergoing primary surgery in our department or referred within 3 months from surgery performed elsewhere from 1982 to 1997 were prospectively accrued and observed. RESULTS: We studied 339 women (83.4% stage I, 7.9% stage II, and 8.5% stage III). The median age at diagnosis was 39 years. A total of 150 women underwent radical surgery, and 189 underwent fertility-sparing surgery. After surgery, 13 women had macroscopic residual disease. With a median follow-up of 70 months, 317 women are alive with no clinical disease (eight with documented subclinical persistence of implants), three are alive with clinical disease, two died of disease, 10 died of other reasons, and seven women have been lost to follow-up. The recurrence of disease was higher after fertility-sparing surgery (35 of 189 cases) than after radical surgery (seven of 150 cases); nevertheless, all but one woman with recurrence of borderline tumor or progression to carcinoma after conservative surgery were salvaged. We observed seven progressions (2.0%) into invasive carcinoma, five in serous tumors (2.4%), and two in mucinous tumors (1.6%). The disease-free survival is 99.6% in stage I patients, 95.8% in stage II, and 89% in stage III. CONCLUSION: The survival of patients with borderline tumors is higher than previously described in some retrospective studies. Conservative surgery is safe and may be proposed to several patients with early and disseminated disease after thorough discussion of all therapeutic options. Progression to carcinoma is approximately 2% and may be observed in both mucinous and serous tumors.

Adult↗
PubMed1991

Affect in early memories of borderline patients.

Psychoanalytically oriented observers using the framework of object relations theory noted that patients with borderline personality organization manifest serious pathology in their capacity to use internalized imagery to cope with the vicissitudes of separation-individuation. This study examined one source of such imagery, the affect associated with a specific sample of early memories, including the earliest recollections of parents. Patients with borderline personality disorder were compared with paranoid schizophrenics and patients with neurotic character pathology. Forty-five outpatients, 15 in each group, participated in the study. It was found that borderline patients had significantly fewer positively toned early memories than neurotics or paranoid schizophrenics. Only the neurotic group, had a majority of affectively positive memories. The results are generally consistent with object relations theories of borderline psychopathology.

Journal Article↗
PubMed1993

The rorschach search for the borderline Holy Grail: an examination of personality structure, personality style, and situation.

Much of the research on the use of the Rorschach to diagnose borderline disturbance has sought to discover a specific borderline pattern or Rorschach configuration. Given our increased understanding of borderline functioning representing a level of personality organization (or personality structure), this single pattern approach is excessively simplistic. It fails to consider the complex interaction between personality structure, personality style, and situational variables. An approach to the Rorschach assessment of borderline functioning is presented using a clinical example. The patient was tested at the onset of psychotherapy and then some 4 years into treatment. Results from the two testings were compared using Weiner and Exner's (1991) Rorschach variable clusters for assessing change in psychotherapy.

Journal Article↗
PubMed1983

Predictors of future established hypertension and diurnal blood pressure variability in borderline hypertension.

Among 157 patients with borderline hypertension 33.8% developed established hypertension (H), 28.6% became normotensive (N), and 37.6% still had borderline hypertension (BH) during a 3 to 10 year follow-up period (an average of 6.4 years). Significant differences in the clinical data among these 3 groups at the first examination were observed in systolic blood pressure (SBP), diastolic blood pressure (DBP), age, obesity, known duration of hypertension and SV1 + RV5 on an electrocardiogram. Analysis of variance showed that SBP increased with age in both sexes, while DBP of men less than 49 years of age was higher in the H group than in the other groups. Obesity and duration of hypertension appeared to contribute to the later development of hypertension because of a higher blood pressure. Obese men in the H group generally had higher DBP than nonobese patients in the other groups. Men with a longer history of hypertension in the H group also had a higher initial blood pressure. SV1 + RV5 in many of the subgroups of the H group was often higher in similar subgroups of the other groups. These inter-subgroup differences may affect the statistical differences in the above-mentioned parameters among the 3 groups. The mean value and standard deviation of SBP and DBP of diurnal blood pressure measurements were in the order of established hypertensives, borderline hypertensives and normotensive subjects when power-normal distribution was applied. There was no evidence that lability of blood pressure was a characteristic feature of borderline hypertension.

Adult↗
PubMed2006

Clinicopathological study of metallothionein immunohistochemical expression, in benign, borderline and malignant ovarian epithelial tumors.

Metallothioneins (MTs) are a family of cystein-rich metal-binding proteins, which are expressed in normal cells during fetal and postnatal life but also in a variety of human neoplasms. MT expression in human tumors has been linked to resistance to anticancer drugs and differentiation and progression in some types of tumors. This study examined the immunohistochemical expression of MTs in benign, borderline and malignant tumors of ovarian surface epithelium and the possible correlations with clinicopathological parameters and survival. A total of 87 cases with diagnosis of ovarian surface epithelial tumors were included. Specifically, 21 cases of benign cystadenomas (11 serous and 10 mucinous), 14 borderline (low malignant potential tumors, 8 mucinous and 6 serous) and 52 cases of ovarian cancer were analysed. Immunohistochemical expression of MT (cut-off level > 10% of tumor cells) was clearly associated with malignancy. A statistically significant correlation was found between the expression of MT in cancer cases and benign tumors (p < 0.0001) and cancer cases and borderline tumors p = 0.003. In cancer cases a difference was observed between grade I and III (p = 0.002). There was no correlation of MT overexpression with survival in the small number of ovarian carcinoma patients where it was analysed. MT constitutes a marker that characterizes aggressiveness and a high malignant potential in ovarian epithelial tumors. In diagnostic problems MT may help distinguish between benign, borderline and malignant tumors.

Adolescent↗