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PubMedDate not supplied

Endoscopic findings potentially predictive of gastric cancer in borderline lesions diagnosed by forceps biopsy.

BACKGROUND/AIMS: When a benign-malignant borderline lesion is diagnosed by the usual small gastric biopsy, there is sometimes difficulty in making a clinical decision. To clarify potentially useful findings to predict the existence of gastric cancer in borderline lesions diagnosed by forceps biopsy, we retrospectively analyzed endoscopic features. METHODOLOGY: We diagnosed 68 consecutive gastric benign-malignant borderline lesions (57 cases) by forceps biopsy and endoscopically resected them. The final diagnosis for 24 lesions (35.3%) was adenocarcinoma (adenocarcinoma group), and for 40 lesions (58.8%) was adenoma (adenoma group). Comparison with endoscopic findings for the groups was carried out using digitally filed endoscopic photos. RESULTS: We found six endoscopic findings (distal location, reddish surface color, lack of smoothness, lack of glossiness, focal roughness, and focal redness) having statistically significant relationships with adenocarcinoma at the final pathological diagnosis. In multivariate analysis, focal redness (p<0.01) and lack of glossiness (p<0.05) were found to have a significant relationship to gastric cancer. CONCLUSIONS: Endoscopic findings such as focal redness and lack of glossiness were potentially predictive of gastric cancer in borderline lesions diagnosed by forceps biopsy.

Adenocarcinoma↗
PubMed1992

[Confirmed and borderline hypertension found in 44% of men (aged 40-59 years) working at the H. Cegielski plant in Poznań].

Blood pressure was measured in 3317 men, aged 40-59, working in H. Cegielski Metal Works in Poznań. The average systolic pressure for the whole population was 130.9 mmHg (SE = 17.90). The average diastolic pressure was 83.7 mmHg (SE = 10.03). The systolic, diastolic and mixed systolic-diastolic hypertension was found in 539 men which makes 16.3% of the study group. The borderline systolic hypertension was found in 327 men i.e. 9.9%, borderline diastolic hypertension in 267 men i.e. 8.0%. Both systolic and diastolic borderline hypertension displayed 339 men i.e. 10.2% of the study group. So, borderline hypertension (systolic, diastolic and systolic-diastolic) was found in 933 men which makes 28.1% of the population under the study.

Adult↗
PubMed1990

[Electrocardiographic and echocardiographic studies in borderline hypertensive patients].

31 male patients (average age 44.0 +/- 8.5 years) suffering from borderline hypertension for many years were examined in comparison with 55 male patients (average age 44.2 +/- 10.1 years) having normotension. We used a conventional electrocardiogram and a two-dimensionally controlled M-mode echocardiogram to diagnose left ventricular hypertrophy of the heart (LVH). Electrocardiographic examinations did not clearly reveal LVH. Septal and posterior wall thicknesses measured by echocardiography as well as the calculated left ventricular muscular mass showed significantly higher mean values in patients suffering from borderline hypertension. An end-diastolic septum thickness equal to or larger than 11 mm and/or a left ventricular muscular mass larger than 155 g showed an LVH prevalence of 26 to 32 per cent in patients with borderline hypertension compared with 13 to 15 per cent in patients having normal blood pressure values. After the relativation of the values measured by the echocardiogram with respect to the body surface, there was no more evidence of significant values. Positive correlations were particularly found between the body weight and the echocardiogram parameters and not so much between the body weight and the blood pressure or the blood pressure and the measured echocardiogram values. No correlation was found concerning the duration of the borderline hypertension of our subjects.

Adult↗
PubMed1987

Medium-term reproducibility of stress tests in borderline arterial hypertension.

Stress tests are commonly used for an evaluation of blood pressure reactivity, but few data exist in the literature about interindividual variability and intraindividual medium-term reproducibility of blood pressure responses to these tests in borderline hypertension. To this aim we have studied 20 borderline hypertensive patients (age range, 33-59, mean 45). Our data suggest that borderline hypertensive patients cannot be considered a homogeneous group with regard to blood pressure reactivity because they tend to have widely different blood pressure responses to various stress tests. For each test (except for orthostatic stimulation), a fairly good intraindividual reproducibility was found. Considering the poor correlations existing between blood pressure responses to tests for each patient, one test may not be sufficient to characterize blood pressure reactivity to stress in borderline hypertension.

Adult↗
PubMed1986

Borderline malignant serous tumors of the ovary maintained on extracellular matrix: evidence for clonal evolution and invasive potential.

Four cases of advanced stage (II or III) and one case of early stage (IC) borderline malignant serous cystadenocarcinomas of the ovary were maintained on culture dishes coated with an extracellular matrix (ECM) produced by bovine corneal endothelial cells. Cells harvested for chromosomal analysis after 2-3 days showed diploid or near-diploid modalities in all cases. Banded chromosome studies in two cases revealed nonrandom clonal abnormalities with trisomy 2, 7, and 12 in seven of 13 metaphases. No structural abnormalities were noted. These cytogenetic findings differ from those found in malignant serous tumors of the ovary. In addition, borderline tumor cells digested the ECM in all cases and formed a cribiform pattern within a few days of primary culture. This study suggests clonal progression from early to advanced stages of borderline malignant serous tumors; readily distinguishable from overtly malignant serous tumors of the ovary. Ability of tumor cells derived from both primary tumors and metastatic implants to digest the ECM implies the possibility that borderline serous tumors have invasive potential.

Adult↗
PubMed1979

The significance of changes in the nasal mucosa in indeterminate, tuberculoid and borderline leprosy.

A study of nasal biopsies from 137 leprosy patients classified on the basis of clinical, microbiological and skin biopsy as Indeterminate, Tuberculoid, Borderline-tuberculoid and Borderline-leproma was undertaken. Changes suggestive of leprosy viz., nerve and smooth muscle inflammation with a few acid fast bacilli in a proportion of the biopsies were seen in all groups of patients examined. This suggests, that even in Indeterminate and Tuberculoid leprosy the disease becomes generalised by the time clinical manifestations appear in skin. Tuberculoid granuloma was seen in two nasal biopsies from Borderline-tuberculoid leprosy patients, one of which was located in the wall of a vein, suggesting the possibility of intravascular dissemination of the disease even in non-lepromatous leprosy. 33 of the patients were children 15 years and below and they also showed changes such as nerve and smooth muscle inflammation but bacilli were seen only in the Borderline group. These findings suggest involvement of the nasal mucosa early in the course of the disease as 70% of the children had the skin lesion for less than one year. The nasal mucosa offers favourable conditions for the growth of the organisms and is readily accessible to infection by droplets, and therefore, it could be one of the primary sites of involvement in leprosy.

Adolescent↗
PubMed1979

Glycohemoglobin and glucose tolerance tests compared as indicators of borderline diabetes.

We concurrently measured glycohemoglobin and performed 3-h oral (100 g) glucose tolerance tests on 69 ambulatory patients suspected of having abnormal carbohydrate metabolism. The patients were divided into two groups: (a) The 37 patients for whom the results were normal had plasma glucose concentrations of 0.70--1.15 milligram during fasting and 0.70--1.23 g/L 2 h after glucose ingestion. (b) Borderline diabetics exceeded one or both of these limits. The range of glycohemoglobin in the normal group was 3.0--4.7% of total hemoglobin. Of the 21 borderline diabetics, 11 had increased glycohemoglobin (4.8--8.0%). The difference in tolerance test results between borderline diabetics with and without increased glycohemoglobin was insufficient to predict the status of glycohemoglobin. We suggest a tentative definition for latent diabetes: increased glycohemoglobin in the presence of normal or borderline-abnormal glucose concentration in plasma collected during fasting.

Adolescent↗
PubMed1979

Fluorescein angiography in borderline diabetics.

Fluorescein angiography was performed in twenty three men with impaired oral glucose tolerance (borderline diabetics) and sixteen matched, normoglycaemic controls. Retinal abnormalities (microaneurysms and leakage of dye) were observed in 18.7% of the controls, 41.6% of sustained borderline diabetics and 54.4% of initially borderline diabetics who subsequently "worsened to diabetes". Qualitatively the abnormalities were similar in each group. Although the difference in frequency between the sustained borderline diabetics and the controls does not achieve conventional statistical significance, other studies quoted support the conclusion that moderate impairment of glucose tolerance is associated with a raised frequency of minor retinal abnormalities. The significance of these remains to be determined.

Blood Pressure↗
PubMed1981

[The cardiovascular risk-profile of persons with normal, borderline disturbed and certain pathological glucose tolerance in dependence on the body-weight (author's transl)].

For a group of 218 persons with normal, borderline disturbed and certain pathological glucose tolerance (age and sex matched controls) the following risk factors were determined: - overweight (Broca-index greater than 1.1) - hypertension (WHO-criterions) - hypertriglyceridaemia (from 200 mg/dl) - hypercholesterolaemia (from 260 mg/dl) and - hyperuricaemia (from 6,5 mg/dl (male) respectively 6,0 mg/dl (female). These risk factors were compared in dependence on the bodyweight in each case. There were average values of 1.68 associated risk factors for normal persons, 2.55 for borderline diabetics and 2.72 for newly discovered but not yet treated diabetics. With growing bodyweight the part of hypertensions increases, with borderline diabetics stronger than with normal persons but weaker than with diabetics. The behaviour of the hypertriglyceridaemia frequency is the same. The frequency of hyperuricaemias surpasses with borderline diabetics those for normal persons and diabetics. The frequency of hyperuricaemia does not show the strong proportionality to the bodyweight with disturbed glucose tolerance as with normal persons. The average value of cardiovascular risk factors increases greater with low degree of glucose intolerance than with clearly disturbed glucose tolerance.

Body Weight↗
PubMed1978

Outpatient management of the borderline adolescent.

In summary an attempt is made in this paper to describe the psychopathology of the borderline patient. Descriptive features of the syndrome in children, adults and adolescents are given based on the respective work of Pine, Masterson and Kernberg. The psychic structures of the borderline patient are discussed with their resulting treatment implications. Genetic considerations with their effects on the psychotherapy of the borderline are reviewed. Finally the outpatient treatment strategies of the borderline adolescent are presented in detail including countertransference issues frequently encountered in the course of their treatment.

Acting Out↗
PubMed1994

Increased basal concentrations of plasma endothelin in borderline hypertension.

BACKGROUND: There is evidence for an altered endothelial function in established hypertension but little is known about endothelial function in borderline hypertension. It has also been suggested that the early stages of hypertension are characterized by an increased sympathetic drive. OBJECTIVE: To investigate whether alterations in endothelin, neuropeptide Y (NPY) and calcitonin gene-related peptide (CGRP) are already present in the borderline hypertensive stage. DESIGN: A case-control study of age-matched men recruited from a population screening programme. METHODS: Seventy-five men with stable borderline hypertension [diastolic blood pressure (DBP), 85-94 mmHg] and 75 age- and sex-matched normotensive controls (DBP < or = 80 mmHg) were investigated. Plasma samples were drawn in a standardized fashion, and extracted and analysed using competitive radio immunoassays. RESULTS: Basal concentrations of NPY and CGRP were similar in the two groups (28.4 versus 26.7 pmol/l and 24.2 versus 21.7 pmol/l, respectively). Basal concentrations of endothelin were significantly higher in the borderline hypertensive group (2.0 versus 1.5 pmol/l, P < 0.0001). CONCLUSIONS: These results suggest that a disturbed endothelial function, represented by endothelin, could be involved in the early hypertensive processes. They also suggest that these changes could be present before the basal sympathetic/parasympathetic drive alters, warranting further research into this area.

Adult↗
PubMed1994

[Histological diagnosis and clinical features in borderline smooth muscle tumors of the uterus].

Between leiomyoma and leiomyosarcoma there exists a series of borderline smooth muscle tumors of the uterus, including cellular, bizarre, mitotically active, atypical and uncertain malignant potential leiomyomas. A histological criterion was presented in this study for diagnosis of smooth muscle tumors of the uterus. Forty-two cases originally diagnosed as uterine cellular leiomyomas were re-examined histologically, analyzed clinically and followed up. The results showed that among the 42 cases, there were 5 cases of cellular leiomyoma, 1 case of bizarre leiomyoma, 7 cases of atypical leiomyoma, 2 cases of tumors of uncertain malignant potential, 1 case of leiomyosarcoma and 26 cases of usual leiomyoma. The histological criteria of dense cellularity, cell atypia and nuclear mitosis showed a close correlation, but did not vary at different phases of menstrual cycle. Clinical features of borderline tumors were similar to those of usual leiomyomas, and their prognosis was also good. It is suggested that diagnosis of borderline smooth muscle tumors of the uterus should be made on the basis of three histological characteristics, including cellular density, cell atypia and nuclear mitotic figures. Management of the borderline cases seems to be the same as that of usual leiomyoma, but a further study may be necessary.

Adult↗
PubMed1993

Ambulatory blood pressure monitoring and diastolic left ventricular abnormalities in established and borderline hypertension.

In order to evaluate left ventricular diastolic function by means of Doppler echocardiography in borderline and established hypertension, identified by office and ABPM, compared with normotensives, 54 subjects: 15 normotensives, 11 borderlines and 28 nontreated mild to moderate essential hypertensives were studied. Age and weight were similar among groups. Established hypertensives showed higher left ventricular mass index (p < 0.05), peak velocity of late left ventricular filling (peak A; p < 0.01), ratio peak A/peak velocity of early ventricular filling, peak E (p < 0.01), velocity time integral of systolic atrial volume (p < 0.001), deceleration half time of peak early diastolic inflow velocity (p < 0.05), left ventricular isovolumic relaxation period (IRP; p < 0.01) than normotensives and lower Doppler indexes of early diastolic left ventricular filling (p < 0.01), peak filling rat normalized to mitral stroke volume (PFRn; p < 0.01) than normotensives. Although borderline hypertensives showed intermediate LVM and Doppler indexes between hypertensives and normotensives only IRP (p < 0.05) and PFRn (p < 0.05) were significant different to normotensives. In conclusion, established hypertension leads to abnormalities in left ventricular diastolic function which can be detected by Doppler echocardiography. In borderline hypertension, the left ventricular diastolic abnormalities are predominantly related to the active process of early diastole. Therefore, these indexes may be early markers of left ventricular dysfunction in hypertension.

Adult↗
PubMed1994

Abnormalities of lipid metabolism and arterial rigidity in young subjects with borderline hypertension.

Plasma lipoprotein levels and carotid-femoral pulse wave velocity, used as a marker of aortic rigidity, were evaluated in 53 young subjects with borderline hypertension by comparison with normotensive controls of the same age and body surface area. Subjects with body weight excess, exaggerated alcohol intake, and/or tobacco consumption were excluded from the study. Borderline hypertensive patients were characterized by significantly higher values of pulse wave velocity and plasma levels of glucose, total cholesterol, high density lipoprotein subfraction HDL3, apolipoprotein B, and lipoprotein (a). There were no group/sex interactions. A significant dyslipidemia was observed in 13 males of the 53 borderline hypertensive subjects. Only in this subgroup did subjects exhibit a strong positive relationship between pulse wave velocity and either plasma total cholesterol or apolipoprotein B. The correlation was observed even after adjustment for blood pressure. The study provides evidence that, in young males with borderline hypertension, some abnormalities of plasma lipoproteins requiring treatment may be present and are associated with an increased stiffness of the arterial wall.

Adolescent↗
PubMed1993

[Cardiac and vascular hypertrophy in juvenile borderline hypertension: echocardiographic and ultrasonographic study].

BACKGROUND: High resolution ultrasonography is a noninvasive technique that allows us to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries, with accuracy and reproducibility. METHODS: We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensive (age 24 +/- 4 years) and in 20 normotensive subjects (age 24 +/- 4 years), as a control group. Both carotid axes were scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high resolution steerable linear array of 5 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. RESULTS: In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mmHg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2). The intima-media thickness of both the CCA and BIF was significantly higher in borderlines than in normotensives (CCA 0.6 +/- 0.08 vs 0.4 +/- 0.05 mm, p < 0.001; BIF 0.7 +/- 0.08 vs 0.5 +/- 0.08, p < 0.001). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass. CONCLUSIONS: Our data show that ultrasonography provides direct evidence that in young borderline hypertensives the increased left ventricular mass is associated with vascular hypertrophy.

Adult↗
PubMed1993

[Fluorocytometric DNA analysis of borderline lesions in the large intestine].

A total of 9 surgically resected non-cancerous benign lesions (5 regenerative epithelium, 4 hyperplastic or metaplastic epithelium), 4 normal epithelium, 30 carcinomas and 12 adenomas containing 7 moderate dysplastic epithelium and 5 severe dysplastic epithelium in the large intestine, were used. Then 40 microns thick paraffin sections were made from each specimen, dewaxed, and the target portion was excised under microscopic visualization. Free cells isolated by 0.5% pepsin solution were smeared and followed by DNA staining by DAPI, and fluorocytometric DNA measurement was performed using a fluorocytometer (BH 2.QRFL, Olympus). All specimens of non-cancerous benign epithelium and normal epithelium showed diploidy. The average mean DNA value was 2.03 +/- 0.04 c (1.95-2.10), the percentage of cells above 4.1 c (4.1 c > or = %) averaged 0.26 +/- 0.42% (0-1.25) and the coefficient of variation (CV) averaged 14.30 +/- 3.18% (10.19-19.58). Seven of 30 carcinomas showed diploidy. Among these diploid carcinomas, the mean DNA value averaged 2.30 +/- 1.98 c (2.01-2.71) (p < 0.05), 4.1 c > or = % averaged 4.17 +/- 2.91% (2.0-10.5) (p < 0.05) and CV averaged 32.2 +/- 5.8% (24.43-38.90) (p < 0.01). Based on these results, aneuploid cases were judged to be malignant. In the case of diploidy, if the percentage of cells above 4.1 c was more than 2.0% and CV was more than 24.43%; when the former was less than 1.25% and the latter was less than 19.58%; and when one or both of the two was out of the range described in the above two categories, they were judged to be malignant, benign or borderline, respectively. From these criteria, 7 adenomas showing moderate dysplasia were analyzed as benign in 2, borderline in 4 and malignant in 1, while 5 adenomas evidencing severe dysplasia were analyzed as malignant in 4 and borderline in 1. In conclusion, fluorocytometric evaluation of the malignant or benign tumor of borderline lesions in the large intestine was found to be possible.

Colonic Neoplasms↗
PubMed1995

Attitudes and beliefs of Canadian infection control decision-makers towards 'borderline' methicillin-resistant Staphylococcus aureus.

'Borderline' methicillin-resistant Staphylococcus aureus (MRSA) strains are inhibited by drug concentrations of 2 to 8 micrograms/mL. This type of resistance is usually mediated by 'hyper beta-lactamase' production which is detectable in vitro by susceptibility to combinations of a beta-lactam and a beta-lactamase inhibitor (ie, amoxicillin and clavulanic acid). A survey of Canadian infection control experts was performed to assess the knowledge, attitudes and beliefs regarding the containment requirements for borderline MRSA strains in acute health care facilities. Twenty-three of 38 Canadian infection control experts (61%) (members of the Canadian Hospital Epidemiology Committee [CHEC] or the Society for Healthcare Epidemiology of American [SHEA]) returned a questionnaire about a fictional patient with a postoperative wound infection with such a strain. Eleven respondents (48%) considered the isolate as an MRSA, 11 did not and one was unsure. All who did not believe the strain to be MRSA would not have isolated or cohorted the patient. Four in the latter group would have isolated the patient if he or she were on a neurosurgery or cardiovascular surgery unit, indicating a desire to restrict spread of this isolate on those units. Seven of the 12 individuals who had managed at least one patient with a borderline MRSA did not advocate patient isolation or cohorting, and five did. This survey has supported the belief that there are discrepancies among infection control decision-makers in Canada regarding the approach, precautions and therapy of patients infected with borderline strains of MRSA. Further data on virulence of and effective therapy for these isolates are needed to assess whether the additional cost is warranted in controlling the nosocomial spread of these isolates.

Canada↗
PubMed1995

Plasma endothelin-1 levels in normotensive and borderline hypertensive subjects during a standard cold pressor test.

Endothelin-1 (ET-1) is a potent vasoconstrictor peptide derived from endothelium. The presence of ET-1 in human vascular endothelium and in the plasma suggests that it may play a role in the regulation of vascular tone and blood pressure (BP) in humans. The aim of this study was to evaluate the behaviour of plasma ET-1 in 10 normotensives (average 36.3 +/- 14.8 years) and 10 borderline hypertensives (average 42.0 +/- 11.7 years) before, during and after a standard cold pressor test. We also evaluated the behaviour of heart rate and BP at the same time. Our results demonstrated that the baseline (-10 and 0 min) plasma ET-1 values were identical for the two groups (8.6 +/- 5.8 and 8 +/- 4.7 pg/ml in normotensives; 7.8 +/- 2.7 and 7 +/- 2.4 pg/ml in borderline hypertensives). A statistically significant increment was verified 10 min after exposure to cold in the borderline hypertensive group (12.1 +/- 5.1 pg/ml) compared with the normotensives group (6.8 +/- 4.5 pg/ml; P < 0.05). In conclusion, our study demonstrated that after 10 min of cold pressor stimulus an increase of circulating ET-1 levels was seen in borderline hypertensives.

Adult↗