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PubMed1993

Active ambulatory blood pressures and urinary electrolytes in young male subjects with normal blood pressure or borderline hypertension.

OBJECTIVES: To examine the relationship between ambulatory blood pressure (ABP) and 24-h urinary electrolytes in young subjects with normal blood pressure or borderline hypertension. DESIGN: ABP shows a circadian profile. We question whether high- and low-level pressure spans might have a relationship with urinary salt output. METHODS: ABP was monitored by the SpaceLabs 5200 system in 182 young male subjects (aged 17-25 years) with normal or borderline office blood pressure. In all subjects, 24-h urinary sodium, potassium and chloride were measured. The mean values and SD of ABP during 24 h, or during the daytime (0900-2100 h) and night-time (2115-0845 h), were estimated. In addition, using a 'cumulative sum' method, 'active' (high-level) and 'passive' (low-level) spans of APB were identified in each subject. RESULTS: No relationship was found between 24-h urinary sodium, potassium or chloride and office systolic blood pressure. Also, no relationship was found between the electrolytes and mean value or SD of ABP during 24 h, daytime or night-time. In contrast, significant positive correlations were found between 24-h urinary sodium and active systolic and diastolic blood pressure. The present study suggests that the active blood pressure span is associated with salt intake in normal and borderline blood pressure groups.

Adult↗
PubMed1996

Feelings of exhaustion, emotional distress, and pituitary and adrenocortical hormones in borderline hypertension.

OBJECTIVE: To examine whether feelings of exhaustion and emotional distress reflecting chronic perceived stress contribute to a pattern of pituitary and adrenocortical responses that would in turn be able to distinguish borderline hypertensives from normotensive controls. DESIGN: A cross-sectional study. SETTING: Helsinki University Central Hospital. PARTICIPANTS: Twenty-one middle-aged, male borderline hypertensives (140/90 mmHg < or = blood pressure < 160/95 mmHg) and 69 healthy normotensive controls (blood pressure < 140/90 mmHg). Main outcome measures Basal pituitary-adrenocortical activity was assessed by measurements of plasma cortisol and adrenocorticotrophin concentrations during the oral glucose tolerance test. Cortisol responses to dexamethasone suppression and adrenocorticotrophin stimulation tests were measured to determine the functional pituitary-adrenocortical activity. Feelings of exhaustion, namely, feelings of excess fatigue, loss of energy, increased irritability, demoralization and emotional distress were measured using a questionnaire. RESULTS: As has previously been shown, feelings of exhaustion and emotional distress are associated with a hormonal pattern consisting primarily of an elevation in cortisol response to adrenocorticotrophin stimulation and secondarily of dominance of cortisol in the ratio of mean basal cortisol level to mean basal adrenocorticotrophin level. This particular neuroendocrine pattern, denoting a defeat type of reaction to stress, was in turn able to distinguish borderline hypertensives from normotensive controls significantly. Adjustment for age and health-related lifestyle factors including smoking, alcohol consumption and physical activity did not alter the difference found between the groups. CONCLUSIONS: The results suggest that the variance shared by feelings of exhaustion, emotional distress and pituitary-adrenocortical hormones could elucidate the mechanisms by which stress exerts its influence towards an increased risk for hypertension.

Adrenal Cortex Hormones↗
PubMed1998

Increased blood pressure reactivity in children of borderline hypertensive fathers.

OBJECTIVE: To evaluate the influence of heredity on blood pressure levels and reactivity in the offspring of borderline hypertensive and normotensive fathers. PARTICIPANTS AND OUTCOME MEASURES: Borderline hypertensive and normotensive men having normotensive wives (n = 25 and 26) were identified in a population screening program. Their children aged above 12 years were invited to participate. Seventeen having a borderline hypertensive father (BHT+) and 19 with a normotensive father (NT+) were investigated. Clinical and 24 h ambulatory blood pressure was measured, as well as blood pressure reactivity to an arithmetic mental stress test. RESULTS: The BHT+ group had a significantly higher clinical systolic blood pressure than the NT+ group (126 +/- 13 versus 115 +/- 7 mmHg, P< 0.01) but similar 24 h blood pressure levels. Systolic blood pressure variability (standard deviation of systolic blood pressure measurements each hour over 24 h) was significantly higher in the BHT+ group (18 +/- 4 versus 16 +/- 4 mmHg, P< 0.05). During mental stress test the BHT+ group had significantly higher increases in systolic and diastolic blood pressures at 4 min (NT+ 8% and 13% versus BHT+ 16% and 23% above baseline, P< 0.05) and significantly elevated DBP during the period after the stress test (NT+ 1% versus BHT+ 13% above baseline, P < 0.01). CONCLUSION: Even a mild level of hypertensive heredity affects important markers of blood pressure regulation, such as blood pressure variability and reactivity to mental stress. This might have prognostic implications; it also points to the possible importance of these variables as early signs of a familial predisposition to hypertension.

Adolescent↗
PubMed1986

Cardiovascular characteristics of the young with borderline hypertension.

Borderline hypertension generally describes blood pressure levels at the margins of an established disease state. Prior to adulthood, this definition becomes less clear. Juveniles with blood pressure levels at the extremes of the normal distribution may be borderline hypertensive, hypertensive, or normal. Aberrant mechanisms that progress to essential hypertension have their onset in the young. Evidence is emerging that demonstrates variation in neurogenic function in young people. Other functional and structural variations have also been described prior to adulthood. These observations are beginning to characterize young people having borderline hypertension and also those with a greater risk for progressing to essential hypertension.

Adolescent↗
PubMed1986

Clinical assessment of the patient with borderline hypertension.

Borderline hypertension occurs in approximately 15% of adults. While these individuals are at increased risk for developing sustained hypertension, roughly three-fourths do not progress to that level. In order to facilitate the clinical assessment, we have reviewed the known pathophysiology of the borderline hypertensive state. The recommended clinical evaluation including history, physical and laboratory examinations is directed at identifying those borderline hypertensives at highest risk for future hypertension and cardiovascular complications. Therapeutic interventions are directed at the high risk subgroup.

Electrocardiography↗
PubMed1986

Management of the patient with borderline hypertension.

A clinical definition of borderline hypertension is offered that includes increased risk of complications but no proof that interventions will be effective in reducing those complications. Defining an average blood pressure level permits improved prediction of individual risk. Simple clinical assessment permits definition of overall risk for hypertension and atherosclerosis. The vigor of intervention should be matched to the level of overall absolute risk. Pharmacologic treatment is appropriate for patients with borderline pressure elevation who have hypertensive target organ changes or a history of hypertensive complications. Patients with borderline hypertension deemed to be at intermediate to high risk but without target organ injury should receive nonpharmacologic (NP) instruction to reduce overall cardiovascular risk. The average blood pressure level, other atherosclerosis risk factors, and the effects of NP measures on these variables should be reevaluated at 6-12-month intervals in this group. Those at low risk should be cautioned about excessive weight gain and should have annual blood pressure measurements.

Aerobiosis↗
PubMed1986

Circulating levels of catecholamines and cyclic AMP during the handgrip test in borderline hypertension.

Systolic and diastolic blood pressure, heart rate, and circulating levels of catecholamines and cyclic AMP were measured during the handgrip test in 18 borderline hypertensive patients, 22 stable hypertensive patients, and 20 normotensive control subjects. No difference was observed, at rest, for plasma levels of noradrenaline, adrenaline, dopamine, and cyclic AMP among the three groups. During the handgrip test in borderline hypertensive patients, the percentage of increase of plasma levels of noradrenaline, adrenaline, dopamine, and cyclic AMP were significantly more elevated with respect to the levels of control subjects but not when compared with those of stable hypertensive patients. These results are in agreement with the hypothesis that in both borderline and stable hypertension there is an exaggerated sympathetic response to the handgrip test.

Adult↗
PubMed1986

Effects of one year of physical training on borderline hypertension: an evaluation by bicycle ergometer exercise testing.

Previous observations have suggested the possibility of separating the borderline hypertensive population into two groups on the basis of blood pressure responses to maximal exercise testing. In order to evaluate the effects of 1 year of physical training on hypertensive subjects, 14 men with resting borderline hypertension and with a normal pressure response to exercise (group I) and 12 with resting borderline hypertension but with an abnormal pressure response to exercise (group II) underwent a maximal bicycle ergometer stress test in a sitting position before and after the training period. In group I, systolic and diastolic blood pressure levels both at rest and during submaximal exercise were significantly reduced after the training period. In group II, resting systolic blood pressure was unchanged, whereas resting diastolic pressure was significantly increased. During submaximal exercise, systolic and diastolic blood pressure showed only mild, nonsignificant differences when compared before and after training. No differences were found during maximal exercise. Blood pressure response to stress testing is useful to identify early stages of the disease and to plan preventive measures consisting of regular physical training either alone or associated with dietary and/or pharmacological treatment.

Adult↗
PubMed1988

Borderline epithelial tumors of the ovary: ovarian intraepithelial neoplasia.

Although the concept of low malignant potential and/or borderline malignancy of some epithelial ovarian tumors was endorsed by the World Health Organization in 1973, uncertainty exists regarding the biologic behavior aspects of these lesions and this may account for the discrepancy in the 5-year survival figures reported for patients afflicted with these malignancies (76-95 per cent). We have reviewed the clinicopathologic aspects of 26 cases of borderline epithelial ovarian tumors and searched the literature. Based on our analysis, we have concluded that: 1) rupture of the cyst at surgery did not affect the patient's outcome but positive peritoneal fluid cytology did. 2) The term borderline should be replaced by ovarian intraepithelial neoplasia or preinvasive carcinoma and should solely be used in patients with stage I disease. 3) There is no justification for adjuvant therapy in adequately staged and surgically treated stage Ia and Ib disease. 4) Patients with stage II or more disease and those with positive peritoneal fluid cytology should be treated as aggressively as all other invasive, well-differentiated, epithelial ovarian tumors. 5) Our observation in cases of epithelial ovarian tumor cells grown on an extracellular matrix tends to indicate that parameters other than morphology may aid in assessing the invasive potential of these malignancies.

Adult↗
PubMedDate not supplied

Effects of aerobic exercise training on hemodynamic responses during psychosocial stress in normotensive and borderline hypertensive type A men: a preliminary report.

This study assessed the effects of aerobic exercise training on cardiovascular responses to a 5-min reaction time competition task. Twenty-seven Type A men (aged 30-56) participated in this randomized study in which 14 underwent supervised aerobic training and 13 strength training, with sessions scheduled three times per week for 12 consecutive weeks. Aerobic exercise training was associated with a 13.6% increase in VO2max compared to 2.9% for the strength group. The effects of aerobic exercise training were most evident in subjects whose initial casual blood pressure readings fell in the borderline hypertensive range (N = 5). These individuals exhibited a general reduction in diastolic blood pressure (i.e., during rest, competition, and recovery) which was associated with a fall in both heart rate and total peripheral vascular resistance. Furthermore, diastolic pressure reactivity to the competition task was attenuated in borderline hypertensive subjects who underwent aerobic conditioning. These data are interpreted as preliminary findings suggesting that borderline hypertensives may be particularly responsive to the cardiovascular benefits of aerobic conditioning. For patients who have progressed to this stage of hypertensive disease, aerobic exercise may be of ameliorative value.

Adult↗
PubMed1999

Effects of nandrolone decanoate therapy in borderline hypogonadal men with HIV-associated weight loss.

Serum testosterone concentrations are frequently in the low-normal range (lowest quartile, <500 ng/dl) in men with AIDS-wasting syndrome (AWS) and in other chronic wasting disorders. The response of patients in this group to androgen treatment has not been determined, however. Eighteen men with AWS (mean +/- standard error [SE]: 87% +/- 1% usual body weight; CD4 count 90 +/- 24) and borderline low serum testosterone concentrations (382 +/- 33 ng/dl) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular (i.m.) placebo (n = 7) with low-dose (65 mg/week; n = 4) and high-dose (200 mg/week; n = 7) nandrolone decanoate, a testosterone analogue. Nitrogen balance, stable isotope-mass spectrometric measurement of de novo lipogenesis (DNL), resting energy expenditure, and gonadal hormone levels were measured. Both low-dose and high-dose nandrolone resulted in significant nitrogen retention (33-52 g nitrogen/14 days, representing gains of 0.5 to 0.9 kg lean tissue/week) compared with placebo (loss of 11 g nitrogen/week). This was reflected biochemically in a borderline significant reduction of high DNL (p < .06). Serum testosterone and gonadotropins were suppressed whereas resting energy expenditure was unchanged by nandrolone treatment. In 10 study subjects completing a 12-week open-label follow-up phase, body weight increased by 4.9 +/- 1.2 kg, including 3.1 +/- 0.5 kg lean body mass, and treadmill exercise performance also improved. In summary, nandrolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial nitrogen retention compared with placebo, similar in extent to the nitrogen retention previously achieved with recombinant growth hormone. It is reasonable to expand the criteria for androgen treatment in AWS to include at least patients in the lowest quartile of serum testosterone.

Adult↗
PubMed2004

Port-site implantation after laparoscopic treatment of borderline ovarian tumors.

BACKGROUND: The aim of this article is to report 3 cases of port-site implantation after laparoscopic treatment of a borderline ovarian tumor. CASES: Three patients underwent a laparoscopic procedure for a serous (2 patients) or mucinous (1 patient) borderline ovarian tumor. In 2 patients, the port-site implantation was discovered during a later surgical procedure, and one was discovered clinically 11 months after the initial laparoscopic oophorectomy. Surgical resection of the port-site was the only treatment in all cases. These women are currently alive and disease-free 11, 23, and 51 months after the treatment of the scar metastasis. CONCLUSIONS: These results suggest that, unlike port-site metastasis in other gynecologic malignancies, the prognosis in patients with a port-site implantation after laparoscopic management of borderline ovarian tumor is excellent. The treatment of this complication is surgical resection.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Prognostic significance of p53, Her-2, and EGFR overexpression in borderline and epithelial ovarian cancer.

The objective of the study was to evaluate the prognostic effect of p53, Her-2, and EGFR in borderline and epithelial ovarian cancer. Tumor tissue from 85 patients with borderline and 783 patients with epithelial ovarian cancer stage I-IV were analyzed immunohistochemically for p53 positivity and over-expression of Her-2 and EGFR. In the ovarian cancer (OC) group 415 patients (53%) had p53-positive tumors, 272 (35%) had tumors with Her-2 over-expression, and 483 (62%) had over-expression of EGFR. In the OC group the classical prognostic factors (older age, higher FIGO stage, and poorer differentiated stage) had significant prognostic value in both uni- and multivariate analyses. Multivariate analyses in the OC group proved p53 positivity to increase mortality significantly depending on the grade of the tumor. Her-2 likewise increased the risk of mortality significantly in this group depending on the grade of the tumor. EGFR on the other hand did not have any additional prognostic effect in the OC group after adjustment for the classical prognostic and molecular factors was made. In the borderline group Her-2 and EGFR over-expression in combination, adjusted for age and p53, significantly improved the prognosis.

Adenocarcinoma, Clear Cell↗
PubMed1995

Platelet function and fibrinolytic activity during rest and exercise in borderline hypertensive patients.

In this study we examined whether the reduced fibrinolysis and increased platelet activity that are known to occur in hypertension are already present in borderline hypertension. Twelve patients with 'borderline' hypertension (diastolic blood pressure 90-95 mmHg) were found to have substantially reduced fibrinolytic activity, both at rest and during exercise, compared with 12 normotensive controls. Euglobulin clot lysis time (ECLT) was significantly higher in hypertensive subjects (218 min vs. 145 min; P < 0.05), and this difference persisted during exercise. Resting tissue plasminogen activator activity (t-PA) did not differ in the two groups, but the brisk increase in t-PA in controls during exercise (0.64 rising to 1.44 IU mL-1; P < 0.01) did not occur to the same extent in the borderline hypertensive subjects. Levels of the fast-acting t-PA inhibitor, normally referred to as PAI-1, were considerably higher in hypertensives (9.22 vs. 4.41 IU mL-1; P < 0.02), and this difference persisted in the upright posture, indicating a decrease in fibrinolytic activity. Platelet aggregability induced by ADP in vitro was not significantly higher in the hypertensive subjects, but indices of platelet activity in vivo (B-TG and PF-4 levels) revealed enhanced platelet function in the hypertensives. These results indicate that the indicators of altered haemostatic function known to occur in hypertension, namely diminished fibrinolytic activity and increased platelet function, are already detectable during the very earliest stage of the disease.

Adenosine Diphosphate↗
PubMed2005

Double-blind placebo-controlled study of testosterone patch therapy on bone turnover in men with borderline hypogonadism.

Clinical studies suggest there may be a threshold concentration of serum testosterone below which replacement will result in skeletal and psychological benefit. We evaluated the response to testosterone in men with borderline hypogonadism. A randomized double-blind placebo-controlled trial in 39 men over age 40 years presenting with sexual dysfunction and a borderline low testosterone level (total testosterone <10 nmol/L or free androgen index <30%). Patients were randomized to Testoderm TTS body patch (5 mg/day, n = 20) or a placebo patch (n = 19) for 6 months, followed by open-label testosterone replacement for a further 6 months in all patients. During the placebo-controlled phase of the study serum testosterone increased significantly on testosterone vs. placebo treatment (p = 0.004); this was associated with a decrease in total body fat mass (p = 0.019) and increase in haemoglobin level (p = 0.036). There were no significant changes in lean body mass, markers of bone turnover, and measures of bone mineral density (BMD). There was evidence of difference in quality of life according to the Male Erectile Dysfunction Quality of Life questionnaire (MEDQoL score, p = 0.017), mainly accounted for by deterioration in the placebo arm. When the active treatment period was combined for placebo and testosterone groups, the within-patient analysis showed a significant effect of testosterone to decrease markers of bone resorption (uNTX/Cr, p = 0.007; iFDPD/Cr, p = 0.0006) and to increase lean body mass (p = 0.001). There was little convincing evidence from this study that testosterone replacement is likely to have major benefit in men over age 40 years with borderline hypogonadism and sexual dysfunction. However, there was evidence of suppression in bone resorption and hence longer and larger studies are needed to examine its effect on BMD.

Adipose Tissue↗
PubMed2004

Ovarian mucinous borderline tumors of intestinal type without intraepithelial carcinoma: are they still tumors of low malignant potential?

The purpose of this study was to clarify whether ovarian intestinal-type mucinous borderline tumors without intraepithelial carcinoma should still be considered tumors of low malignant potential. Fifty-five intestinal-type mucinous borderline tumors without intraepithelial carcinoma in which a section had been taken for each 2 cm or less of the tumor's greatest diameter were selected. The International Federation of Gynecology and Obstetrics' stage and follow-up data of each case were examined. All 55 patients had stage I disease (including one with pseudomyxoma peritonei of superficial organizing type, according to Lee and Scully's classification). No patient had metastases or died from the tumor, although in one patient who underwent cystectomy, the disease recurred in the remaining ovary 5 years after surgery. However, the patient was alive and well after undergoing salpingo-oophorectomy. The patient with pseudomyxoma peritonei had no recurrence and did not die from the tumor. These findings indicated that intestinal-type mucinous borderline tumors, in which intraepithelial carcinoma has been ruled out with adequate histological sampling, are benign tumors, not tumors of low malignant potential. It is proposed here that these tumors should be designated as high-grade mucinous adenoma. Unilateral salpingo-oophorectomy is the recommended treatment because cystectomy alone may allow local recurrence in the remaining ovary.

Adenocarcinoma, Mucinous↗
PubMed1998

Borderline tumors of the ovary: a clinico-pathologic and immunohistochemical study of 54 cases.

OBJECTIVE: To study EGF-R, HER-2/neu (p185), p53, Mib-1 (Ki-67), Bax, Bcl-2, ras expression and ploidy in borderline tumors of the ovary by assessing their frequency, and relationship to histologic type, tumor recurrence and survival. METHODS: Fifty-four patients with borderline tumors were followed 3-140 months (median: 38 months). Paraffin-embedded sections were stained using monoclonal antibodies against EGF-R, HER-2/neu (p185), p53, Mib-1 (Ki-67), Bax, Bcl-2, and ras. The immunohistochemical findings were correlated to histologic subtype, tumor recurrence, and survival. RESULTS: Positivity for EGF-R was found in 24% (13/54), in 22% (12/54) p185 was positive, 9% (5/54) of tumors were p53-positive, Mib-1 (Ki-67)-positivity was demonstrable in 46% (25/54). Expression of Bax, Bcl-2, and ras was found in 37% (20/54), 28% (15/54) and in 7% (4/54) of the cases, respectively. CONCLUSION: The data demonstrate expression of EGF-R, p185/HER-2/neu, p53, Mib-1 (Ki-67), Bax, Bcl-2, and ras in a subgroup of patients with ovarian borderline tumors. Further studies to evaluate their prognostic value are warranted.

Adult↗
PubMedDate not supplied

Metastasis to sigmoid colon mucosa and submucosa from serous borderline ovarian tumor: response to hormone therapy.

Distant metastasis to sites other than lymph nodes of borderline ovarian tumor is rare. We describe a case metastasized to sigmoid colon mucosa and submucosa. The metastatic lesion was detected incidentally by screening colonoscopy 7 years after the patient was treated for the primary tumor. The metastatic lesion responded well to treatment with oral Arimidex 1 mg/day. A follow-up colonoscopy with biopsy and imaging studies after 3 months of treatment revealed no evidence of disease in the sigmoid colon. This case showed that the sigmoid colon mucosa and submucosa should be considered as one of distant metastatic sites of a serous borderline ovarian tumor and the favorable response to Arimidex provides support the use of hormone therapy in women with serous borderline ovarian tumor.

Adenocarcinoma, Papillary↗