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PubMed1984

Flow cytometric analysis of cellular DNA content as an adjunct to the diagnosis of ovarian tumours of borderline malignancy.

Flow cytometric analysis of cellular DNA content was performed on tissue from 44 borderline ovarian tumours (tumours of low malignant potential). Forty-two tumours (95%) were diploid and associated with both an indolent biological behaviour and good prognosis. Aneuploidy was identified in only 2 tumours (5%), and one of the associated patients died of progressive disease within months of the initial diagnosis. Careful review of the histopathology of these 2 aneuploid tumours revealed areas of invasion in the omental and peritoneal "implants" of each. This study has reinforced the currently advocated separation of so-called borderline tumours from invasive ovarian carcinomas and the interpretation of the pathological criteria used to categorize such neoplasms. Our results indicate that flow cytometric analysis of cellular DNA content may complement conventional histopathological diagnosis by providing an objective parameter which correlates with biological behaviour and may identify the few genuine borderline ovarian epithelial neoplasms which show clinical progression.

Adult↗
PubMed1999

Contemporary treatment of borderline ovarian tumors.

In conclusion, the prognosis for women with stage I borderline tumors is excellent. Surgery alone is the recommended treatment. For young patients, fertility-sparing surgery is optimal, with a small percentage eventually developing tumor in the contralateral ovary. For patients with advanced stage borderline tumors, 10-30% will relapse and approximately 10% will die of tumor. This risk is clearly higher for those with invasive peritoneal implants. Several controversies exist, including the classification of advanced stage serous borderline tumors and the issue of postoperative treatment. Future studies involving larger series and molecular biomarkers will hopefully elucidate the biologic behavior and optimal therapy for this interesting group of tumors.

Diagnosis, Differential↗
PubMed1981

Alteration of the volume-renin component in borderline essential hypertension.

Interrelations between blood pressure, circulatory volumes and the renin-angiotensin system were studied in 15 normal subjects and in 25 young patients with borderline hypertension after equilibration on controlled sodium intake. Total blood and plasma volumes were consistently lower and plasma renin activity higher in borderline hypertensive as compared to normotensive controls. The decreased volumes were inversely correlated with blood pressure and plasma renin activity, but no correlation was found between blood pressure and plasma renin activity or the product of circulating renin and volumes. The fact that blood pressure and plasma renin activity were independently correlated to circulating volumes but did not correlate between themselves would suggest a common causal factor for the three observed phenomena: elevated renin, decreased volume and borderline hypertension; these anomalies of the volume-renin axis might be mediated through the well documented hyperresponsiveness of the sympathetic nervous system in these patients.

Adolescent↗
PubMed1991

Atrial natriuretic factor and ambulatory blood pressure in young male subjects with normal or borderline office blood pressure.

Plasma levels of immuno-reactive atrial natriuretic factor (ANF) and ambulatory blood pressure were studied in 42 male subjects, aged 18 to 31 y, including 24 subjects with normal BP and 18 with borderline essential hypertension. ANF was measured in the morning (9 a.m.-12 a.m.), with the subjects in the supine and in the upright positions. Ambulatory BP was determined in all subjects every 15 minutes, for a whole 24 hour period. A scatter plot of office SBP or DBP versus upright or supine ANF suggested negative relationships (not significant). In contrast, the plasma ANF level was significantly correlated to ambulatory BP, especially to daytime BP (r = -0.52, p less than 0.001, between daytime SBP and upright ANF; r = -0.50, p less than 0.001, between daytime DBP and upright ANF). The data suggested that ANF is decreased in borderline hypertension, but the decrease can be evidenced only when BP is repeatedly determined to afford reliable data. An inhibition of the atrial release of ANF might be one possible mechanism contributing to the genesis of borderline essential hypertension.

Adult↗
PubMed1993

Atrial natriuretic factor response to acute volume expansion in borderline hypertension. Role of ACE-inhibition and changes in peripheral venous tone.

Abnormalities in the response of atrial natriuretic factor (ANF) to volume expansion have been reported in hypertensive-prone animals and men as well as in hypertensive patients undergoing ACE-inhibition. To investigate some of the mechanisms affecting ANF release in borderline hypertensive patients (BHT) we have studied 16 subjects by assessing their neuro-humoral and hemodynamic response to a two-hour isotonic i.v. NaCl infusion carried out during short-term administration of either placebo or captopril. ACE-inhibition increased baseline venous distensibility (VV30:1.4 vs 1.6 ml/100 ml; p < .05) and reduced the prompt (45') ANF response to saline loading (10.3 +/- 13 vs 42.7 +/- 15%; p < .05)) without affecting the overall ANF release (120':92 +/- 25 vs 65.8 +/- 20%; NS)). A significant pressor increase in response to NaCl loading was observed exclusively after ACE-inhibition (SBP: 5.2 +/- 2 vs 2.4 +/- 1%; p < .05--DBP: 7.1 +/- 3 vs 2 +/- 3%; p < .025) and occurred along with a peripheral arterial and venous constriction and with an increase in plasma levels of an endogeneous Na+/K+ATPase inhibitor (8.8 +/- 4 vs -2 +/- 4%; p < .05). We conclude that the ANF response to saline infusion is delayed by ACE-inhibition in borderline hypertensives. The abnormalities observed in ANF response could follow the changes in peripheral venous distensibility and contribute to the pressor and neuro-humoral derangements described in borderline hypertensives during volume expansion.

Adolescent↗
PubMed2026

Characterization of a Novel BTD Hypomorphic Variant in a Patient with Complex Neurodevelopmental Delay: Resolving Actionable Metabolic Vulnerabilities Beyond Borderline Plasma Biochemistry.

Plasma biochemistry often presents significant limitations in diagnosing borderline metabolic disorders, particularly within complex neurodevelopmental phenotypes. Here, we present the clinical genomic evaluation of a six-year patient presenting with early-onset hypotonia and severe gastrointestinal complications whose newborn screening panel did not evaluate biotinidase (BTD) activity. While initial baseline plasma biochemistry yielded borderline residual BTD function (46% of the population mean), targeted sequencing identified a novel, compound heterozygous hypomorphic variant (p.Thr459Met) in trans with the common p.Asp424His allele. In vitro functional validation confirmed that p.Thr459Met induces severe protein misfolding and intracellular retention, impairing enzyme secretion. Biotin supplementation triggered a documented and favorable therapeutic improvement, establishing this borderline enzymatic background as an actionable metabolic vulnerability unmasked by chronic gastrointestinal stressors. This study underscores the critical value of functional genomic characterization over static enzymatic biomarkers to identify highly treatable metabolic components within heterogeneous clinical landscapes.

Humans↗
PubMed1983

Cardiac status in juvenile borderline hypertension.

A prospective M-mode echocardiographic study was done to look for early cardiovascular changes in children prone to hypertension with blood pressures between the 75th and 95th percentiles for age. Average systolic/diastolic pressures in 27 children with borderline hypertension were 137/89 mm Hg compared to 110/68 mm Hg for the 26 controls. Echocardiographic measurements were normalized for comparison using two methods. The borderline hypertensive group mean values were significantly greater than controls for left ventricular wall thickness (p less than 0.05 for method 1; p less than 0.001 for method 2), left ventricular mass (p less than 0.001; p less than 0.005) and left ventricular wall thickness to radius ratio (p less than 0.001, both methods). Echocardiographic estimates of left ventricular function were lower in the hypertensive group. This study suggests that cardiac hypertrophy can be shown by noninvasive means in some children before arterial pressure becomes elevated. To assess the incidence and possible consequences of early target organ changes, more extensive clinical evaluation of borderline hypertension in children is recommended.

Adolescent↗
PubMed1999

Borderline ovarian tumors complicating pregnancy: a case report.

Although the majority of ovarian tumors complicating pregnancy are benign, they still pose a challenge because of the difficulty in differentiating between benign and malignant tumors during pregnancy. To our knowledge, the value of color Doppler ultrasound in the diagnosis of borderline malignant tumors complicating pregnancy remains unclear. We present the case of a 29-year-old pregnant woman with an ovarian tumor of low malignant potential. Preoperative ultrasound revealed a well-encapsulated cystic complex on the left ovary measuring 16 x 18 x 12 cm with an internally smooth surface, multiple septa ranging from 2 to 4 mm in thickness and a small solid component 2 cm in diameter, with a resistance index of 0.42. The differential diagnosis preoperatively was a borderline tumor. The patient underwent a left oophorectomy at 18 weeks of gestation. Frozen pathology indicated a mucinous cystadenocarcinoma of low malignant potential. A thorough surgical staging was completed. The final pathology confirmed mucinous cystadenocarcinoma of low malignant potential, stage IA. Postoperatively, the patient had an uneventful course and did not receive any adjuvant therapy. She delivered a normal male fetus weighing 3,450 g at 38 weeks of gestation. We conclude that color Doppler ultrasound is helpful for the preoperative diagnosis of borderline tumors of the ovaries but its usefulness for making an accurate diagnosis may require further evaluation.

Adult↗
PubMed1998

[Pregnancy, labor and puerperium in patients after surgery for ovarian tumors of borderline malignancy].

OBJECTIVES: The aim of the study was to assess procreation in patients treated surgically for borderline tumours of the ovary. DESIGN: The analysis included 114 patients operated for ovarian tumours of borderline malignancy in the Gynaecological Department, Medical University of Gdańsk between 1978-1997. Evaluated were: the incidence of pregnancy, age of patients, tumour pathology, type of surgery, the course of pregnancy, labour and puerperium. RESULTS: In the group of 37 stage Ia patients, who had undergone conservative surgical procedure, 7 patients conceived and 9 healthy children were born. All patients are free of disease. CONCLUSIONS: Conservative surgery for borderline ovarian tumours allows for retaining procreational potential and normal conception in young women.

Adolescent↗
PubMed1976

Transformation from lepromatous to borderline leprosy under clofazimine therapy.

Patients of lepromatous leprosy who have evolved from the borderline type of disease are known to revert to the borderline state through a reactionary phenomenon under anti-leprosy chemotherapy with Dapsone. We present here the case report of a reversal from a reactional lepromatous disease to the borderline type under Clofazimine.

Adult↗
PubMed1997

Serous borderline tumors of the ovary.

The distinction of borderline tumors from invasive carcinomas is one of the commonest problems in ovarian tumor pathology. The borderline tumors are characterized by absence of destructive stromal invasion although they can implant on peritoneal surfaces. The implants may in turn invade the underlying tissue. Serous borderline tumors (SBTs) account for one-quarter to one-third of malignant serous tumors. Mostly, they are confined to the ovary (Stage 1), whereas in some cases they spread within the pelvis (Stage 2) or upper abdomen (Stage 3). As recently shown, typical SBTs may contain foci of microinvasion, a finding that does not appear to influence the prognosis. SBTs are associated with peritoneal implants in about 30% of cases. Peritoneal implants most often appear similar to the primary ovarian tumor, although they could show more or less atypia than the primary tumor. The peritoneal implants of SBTs have been classified into non-invasive and invasive categories. Recently, some studies showed that in SBTs associated with peritoneal implants, separation of the implants into invasive and non-invasive categories has important prognostic implications. Furthermore, severe nuclear atypia and mitotic activity in the implants are independently related with a poor prognosis. In addition, these studies suggest that chemotherapy is appropriate only for patients with invasive implants without taking into account lymph node status. Finally, it has recently been established that tumors with a morphology identical to that of SBTs may arise as primary tumors of the peritoneum with absent or minimal involvement of ovarian surfaces.

Journal Article↗
PubMed1999

The biophysical/biochemical test. A new marker of fetal lung maturity in borderline cases.

OBJECTIVE: To assess the diagnostic accuracy of the combination of a biophysical (lamellar body count [LB]) with a biochemical test lecithin/sphingomyelin ratio (L/S) for the evaluation of fetal lung maturity (FLM) in cases of intermediate-borderline pulmonary maturity. STUDY DESIGN: We studied 105 cases with one or both intermediate (2.1-2.4:1 for L/S and/or 15,000-19,000/microL for LB) or borderline (2.5:1 for L/S and/or 20,000/microL for LB count) FLM indices and no phosphatidylglycerol who delivered within 72 hours of amniocentesis, excluding multiple gestation and contaminated amniotic fluid samples. The biophysical x biochemical marker (B x B) was calculated by multiplying L/S by the corresponding LB, then dividing by 10(3). By using the ROC curve, a cutoff of 50 was found. RESULTS: B x B values were lower in respiratory distress syndrome (RDS) than in the non-RDS group (30 [23-41] vs. 52 [50-70], P < .001; median, 25-75%). All RDS cases had a B x B value < 50. Diagnostic accuracy for B x B was: sensitivity, 100%; specificity, 83%; positive predictive value, 61%; negative predictive value, 100%. Sensitivity and positive predictive values were higher for B x B than L/S. CONCLUSION: B x B may be a useful tool for cases with borderline FLM.

Amniocentesis↗
PubMed2001

[Conservative treatment of patients with borderline ovarian tumors].

OBJECTIVES: The aim of this study was to characterise group of patients with borderline tumours undergoing surgical treatment. DESIGN: The analysis included 83 patients with ovarian tumours of borderline malignancy at stage Ia, operated in the Gynaecological Department of Medical University of Gdańsk between 1978-1997. The study takes into account comparison of: age of patients, type of surgery, tumour pathology, post surgical treatment. Furthermore, long term follow up was assessed. RESULTS: In the group of 83 patients with stage Ia 37 ware treated with conservative surgery, 46 underwent radical treatment. Postsurgical chemical treatment was not applied. Three patients had to be reoperated because of neoplasm disease recurrence. 8 patients were died from reasons not connected with main disease. CONCLUSIONS: Conservative surgery is proper treatment for young women with borderline ovary tumours in stage Ia. For older, perimenopausal women TAH with BSO without additional chemotherapy is suggested.

Adolescent↗
PubMed1975

Experiences within a borderline syndrome.

This paper provides an experiential view of a borderline syndrome and its psychotherapy. In a letter to her therapist a gifted patient speaks of the symptoms and treatment of her illness. This provides the basis for studying the precipitous transference relationships in borderline patients and the urgent need in these patients for clarity and dependability from their therapists. Common fears of being "set adrift" by psychotherapy are contrasted to the characteristic tenacity of the patient-therapist bond. A review of the patient's life allows the reader to evaluate the clinical applicability of her insights. The letter's multiple communicative functions illustrate some of the qualities of the object relations sought by borderline personalities, and stress is placed upon the sublimatory aspect of such letters and the prognostic importance of the capacities for sublimation.

Acting Out↗
PubMed2002

A 2D Echo color-Doppler study of the extracranial carotid arteries in borderline arterial isolated systolic hypertension.

BACKGROUND: The aim of this study was to evaluate the prevalence of atherosclerotic carotid lesions in isolated systolic borderline arterial hypertension by 2D echo color-Doppler and effect of night-time pressure fall by ambulatory blood pressure monitoring. METHODS: Outpatients from January 1992 to December 1998 were examined. One hundred and twenty normotensive control subjects and 99 isolated systolic borderline untreated hypertensives were studied, based on blood pressure fall were divided into dippers, with nocturnal systolic and/or diastolic blood pressure fall of >10%, and non dippers. Subjects with ischemic heart disease, valvulopathies, heart failure, renal insufficiency, cerebrovasculopathies, hypercholesterolemia (total cholesterol >200 mg/dl) and diabetes. Normotensives and hypertensives were homogenous for cardiovascular risk factors. A thickness of =/> 0.95 mm, calculated as a mean of 5 measurements of the common carotid artery, 2-3 cm from the carotid bifurcation, was considered a sign of myointimal thickening, and the plaque as a focal thickening of =/> 2 mm, based on echogenic characteristics and site. RESULTS: Compared to normotensives, isolated systolic borderline hypertensives, showed carotid arteries with an intima-media thickening (p=0.002) with one or more plaques (p=0.0001) much more frequently, while normal carotid arteries (p=0.0001) were less frequent. In normotensives, like in hypertensives, the prevalence of vasal lesions was not significantly different in dippers compared with non dippers. Plaques were most often localized at level of the common carotid and lesions were hard. CONCLUSIONS: The conclusions is drawn that isolated systolic hypertension is the sign of major vascular atherosclerotic lesions. The night-time pressure fall does not affect the importance of the lesions.

Adult↗
PubMed2000

[The establishment of the model for differential diagnosis of borderline cases with anterior crossbite using fuzzy set theory].

OBJECTIVE: To introduce the fuzzy set theory to orthodontics by using the diagnostic information drawn out from the diagnosed cases to solve the problem of borderline- case diagnosis. METHOD: Lateral cephalometric radiographs of 107 anterior crossbite patients in early permanent dentition were traced, measured, and 31 variables calculated. Diagnosis was made by experienced specialists and the cases were divided into three groups: dental anterior crossbite (52 cases), borderline cases (22 cases) and skeletal anterior crossbite (33 cases). Among 85 cases with accurate diagnosis we selected 70 cases to establish 6-factor model using stepwise discriminant analysis. This afforded 100 percent correct respective check and the predictive diagnosis of the other 15 cases showed that its correction rate was 93.3 percent which proved that most useful information was included. Then the contributions of the six variables were calculated and we established two sets: skeletal anterior crossbite set and dental anterior crossbite set with skeletal and dental means to be their thresholds. For each case the individual measurements of the six variables were standardized and afterwards transferred into constituent ratio and at the same time their degrees of membership of these two sets were calculated according to the distance between its location and the two thresholds. Using this fuzzy model we got the individual scores of the two sets. The diagnosis of the patient was coincident with the set of higher scores. This model was testified by 85 cases with accurate diagnosis and its correction was absolute. RESULT: 22 borderline cases were diagnosed by this model. CONCLUSION: The two-set difference were far less than that of the cases with accurate diagnosis which prove the model was reasonable.

Dentition, Permanent↗
PubMed2003

Serum uric acid and hemorheology in borderline hypertensives and in subjects with established hypertension and left ventricular hypertrophy.

Serum uric acid (SUA) but also hemorheological parameters such as hematocrit (Hct) and whole blood viscosity (WBV) are markers of cardiovascular risk. Increased blood cell volume is one of the known causes of hyperuricemia. We therefore aimed to investigate the relationship between SUA and hemorheology in untreated borderline hypertensive young men (n = 67) and in subjects with established hypertension and left ventricular hypertrophy (n = 40) examined when they had been without treatment for 2 weeks. We found positive correlations between SUA and Hct (r = 0.46, p < 0.0001), hemoglobin (Hgb) (r = 0.40, p = 0.001), mean blood pressure (BP) (r = 0.39, p = 0.001) and body weight (r = 0.26, p = 0.036) in the borderline hypertensive young men. No relation between SUA and glucose disposal rate (GDR) assessed with hyperinsulinemic isoglycemic glucose clamp appeared (r = -0.06, p = 0.633). Multiple regression analysis showed that 33% of the variation in SUA could be explained by BP and Hct. We also found positive correlations between SUA and Hgb (r = 0.40, p = 0.011) and body weight (r = 0.42, p = 0.006) and an inverse trend with GDR (r = -0.27, p = 0.087) in the subjects with established hypertension. Multiple regression showed that 32% of the variation in SUA was explained by Hgb and body weight. These data suggest that hemorheology may be involved in the uric acid metabolism in borderline as well as in established hypertensives. Hemorheology may possibly be a link between SUA and cardiovascular risk. There was no relation between SUA and insulin resistance in these hypertensive groups.

Adolescent↗
PubMed2003

Ocular complications in incident relapsed borderline lepromatous and lepromatous leprosy patients in south India.

PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5%) patients had lagophthalmos, 1 (1.6%) patients each had ectropion and trichiasis, 32 (53%) patients had impaired corneal sensation in both eyes, 2 (3.3%) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6%) patients had cataract associated with decreased vision, 1 (1.6%) patient had blocked naso-lacrimal duct and 13 (21.7%) patients had pterygium. Seven (12%) patients had a visual acuity of 6/18 or less, 4 (6.7%) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups. Borderline and lepromatous leprosy patients tend to have had more ocular complications than patients with tuberculoid leprosy.

Adult↗