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PubMed2003

CFTR genotypes in patients with normal or borderline sweat chloride levels.

In recent years, some patients bearing "atypical" forms of cystic fibrosis (CF) with normal sweat chloride concentrations have been described. To identify the spectrum of mutant combinations causing such atypical CF, we collected the results of CFTR (ABCC7) mutation analysis from 15 laboratories. Thirty patients with one or more typical symptoms of the disease associated with normal or borderline sweat chloride levels and bearing two CFTR mutations were selected. Phenotypes and genotypes of these 30 patients are described. A total of 18 different CFTR mutations were observed in the 60 chromosomes analysed. F508del was present in 31.6 % of the mutated chromosomes and 3849+10kbC>T in 13.3 %. R117H, D1152H, L206W, 3272-26A>G, S1235R, G149R, R1070W, S945L, and the poly-T tract variation commonly called IVS8-5T were also observed. The relative frequency of CFTR mutations clearly differed from that observed in typical CF patients or in CBAVD patients with the same ethnic origin. A mild genotype with one or two mild or variable mutations was observed in all the patients. These findings improve our understanding of the distribution of CFTR alleles in CF with normal or borderline sweat chloride concentrations and will facilitate the development of more sensitive CFTR mutation screening.

Adolescent↗

PubMed1993

Prognostic significance of DNA content and nuclear morphology in borderline ovarian tumors.

We used the technique of image analysis to simultaneously measure DNA content and nuclear morphology of 21 borderline ovarian tumors. Aneuploidy was identified in 9 of 21 tumors and was unrelated to tumor stage or nuclear grade. Morphometric nuclear features that were measured included size, shape, texture, and average density. Nuclear size and shape were positively correlated (r = 0.507), and nuclear size and average density were negatively correlated (r = -0.772). Six tumors recurred and recurrence was significantly associated with tumor aneuploidy (P = 0.046), stage III tumors (P = 0.03), and increased nuclear texture (P = 0.07). These results suggest that measurement of DNA ploidy and nuclear morphology using image analysis can provide important prognostic information in patients with borderline ovarian tumors.

Aneuploidy↗

PubMed1993

Epithelial ovarian tumors of borderline malignancy: long-term follow-up.

Thirty-nine patients underwent primary surgery for epithelial ovarian tumors of low malignant potential at the Massachusetts General Hospital between 1970 and 1980. Eighty-five percent of patients were found to have Stage I disease and 15% were found to have Stage III disease. Fifty-four percent of patients had a tumor with serous histology, 39% had a tumor with mucinous histology, and the remainder of patients had tumors with an endometrioid or mixed-cell type. Second malignancies and benign ovarian tumors were frequently found concomitantly with the borderline tumors or in follow-up. Gastrointestinal and endometrial adenocarcinomas were the most common second malignancies and were frequently found associated with a borderline tumor of serous histology. Follow-up was available in all 39 patients (100%). Mean time of follow-up was 11.8 years. Sixty-nine percent of patients are clinically without evidence of disease with a mean follow-up of 14.7 years, 23% died of other causes, 5% died of disease, and 3% died with disease and sepsis. All patients dying with disease did so within 7.3 years of their primary surgery. Seven patients underwent conservative surgery, defined as preservation of some ovarian tissue. Six of 7 patients are clinically free of disease with a mean follow-up of 14.6 years; 1 patient died of other causes. No patients treated conservatively had a recurrence of their disease.

Adenocarcinoma↗

PubMed1996

Clinical value of CA125, CA19-9, CEA, CA72-4, and TPA in borderline ovarian tumor.

Five tumor markers were analyzed clinically in 101 patients with borderline ovarian tumors who were treated by the Tokai Ovarian Tumor Study Group, an association comprising Nagoya University and its affiliated hospital, between January 1986 and December 1994. The positive rate of CA125 was 68.2% in serous tumor and 51.9% in mucinous tumor. The positive rate of CA19-9 was 51.5% in serous tumor and 44.7% in mucinous tumor. The positive rates and mean serum levels of CA125 in serous and mucinous tumor by stage had rising tendencies with an increase in each stage. The mean serum levels of CA19-9 in serous and mucinous tumor by stage had rising tendencies with an increase in each stage. CA125 and CA19-9 were useful for screening of borderline ovarian tumors. The positive rates of CEA and TPA in mucinous tumor were 32.5 and 27.3%, respectively, although none of the patients with serous tumor were positive in CEA and TPA. The positive rates and mean serum levels of CEA in mucinous tumor by stage had rising tendencies with an increase in each stage. The positive rate of CA72-4 was significantly lower than that of CA125 (P < 0.05).

Adenocarcinoma, Mucinous↗

PubMed1998

Treatment for fertility and risk of ovarian tumors of borderline malignancy.

The relationship between fertility drug use and risk of borderline ovarian cancer has been analyzed using data from a case-control study. Cases were 93 women aged 23 to 64 years with histologically confirmed diagnosis of borderline ovarian tumor (according to the World Health Organization criteria) who were admitted to the Obstetrics and Gynecology Clinics of the University of Milan. Control subjects were 273 women (ages 24-64 years) admitted for acute nongynecological, nonhormonal, and nonneoplastic conditions. Four cases (4.3%) and no control reported fertility drugs use: this difference was statistically significant (Fisher's exact test P = 0.004).

Adult↗

PubMed1999

In vitro fertilization following conservative management of stage 3 serous borderline tumor of the ovary.

Among patients with advanced stage serous borderline tumors of the ovary, those with micropapillary architecture or invasive implants have the greatest risk of malignant transformation. In the absence of these patterns, consideration can be given to preservation of reproductive function. A 28-year-old, nulliparous patient presented with symptoms mimicking advanced ovarian cancer. Histology showed a serous borderline tumor with a hierarchical branching pattern. Surgery was able to remove all visible disease but still preserve the uterus and a portion of one ovary. She subsequently underwent in vitro fertilization and delivered a full-term infant.

Adult↗

PubMed2001

K-ras mutations in Müllerian inclusion cysts associated with serous borderline tumors of the ovary.

OBJECTIVE: Müllerian inclusion cysts (MIC) are small benign appearing glands that are occasionally noted in lymph nodes and peritoneal biopsies. They occur most frequently in women with serous ovarian tumors, with borderline tumors (SBOT) having a higher incidence than invasive cancers. The aim of this study was to examine whether MIC and SBOT have identical K-ras mutations, which would suggest that they are related. Methods. Six patients in whom adequate tissue was available from SBOT, MIC, and normal tissue were identified from a consecutive series of patients with SBOT who underwent lymph node sampling from 1992 to 1997 at Duke University Medical Center. DNA extraction was performed using laser capture microdissection. Exon 1 of the K-ras gene was amplified using PCR and subjected to single-strand conformation analysis to screen for mutations. Shifted bands were sequenced to confirm the presence of mutations. RESULTS: Mutations in codon 12 of K-ras were found in three of six (50%) SBOT. In two of these three cases, the identical mutation was found in the SBOT and the MIC (gly to val in both cases), but not in the corresponding normal DNA. In one case, a mutation was seen in the ovarian tumor (gly to asp), but not in the corresponding MIC. CONCLUSIONS: Mutations in codon 12 of the K-ras gene are a hallmark of serous borderline tumors. The presence of identical K-ras mutations in some SBOT and their associated MIC suggests that they are related processes. Both may arise due to a field effect, or alternatively some MIC may represent metastases from the primary ovarian tumor.

Adult↗

PubMed1983

On the ultrastructure of the gastric "borderline lesion".

The "borderline lesion" of the stomach (severe dysplasia of the protruded type) is nowadays considered to be a true precancerous lesion. Histologically, this lesion is characterized by a proliferation in the area of the glandular neck, combined with severe cellular atypia. Investigation by means of transmission electron microscopy reveals the structure of these cells to be very similar to the structure of cells of an intestinal-cell-type carcinoma of the stomach. In addition to signs for a loss of differentiation of the cells, such as the absence of rough-surfaced endoplasmatic reticulum, mucin granules, and of the polarity of the cells, remarkably frequently luminal bulges and "blebs" developed to various extents can be detected. Morphometric analysis is delineating the tendency of structural features of the borderline lesion to develop toward the gastric cancer cell. These irregularities might be expressions of the beginning of expansive growth and signs pointing to differentiation into malignant neoplasia.

Carcinoma↗

PubMed1985

Learned control of heart rate during exercise in patients with borderline hypertension.

Twelve patients with borderline hypertension [less than or equal to 21 X 33/12.6, greater than or equal to 18 X 6/12.0 kPa (less than or equal to 160/95; greater than or equal to 140/90 mm Hg)] participated in an experiment aimed at testing whether they could learn to attenuate heart rate while exercising on a cycle ergometer. Six experimental (E) subjects received beat-to-beat heart-rate feedback and were asked to slow heart rate while exercising; six control (C) subjects received no feedback. Averaged over 5 days (25 training trials) the exercise heart-rate of the E group was 97.8 bt min-1, whereas the C group averaged 107 bt min-1 (P = 0.03). Systolic blood pressure was unaffected by feedback training. Generally, changes in rate-pressure product reflected changes in heart-rate. Oxygen consumption was lower in the E than in the C group late in training. We conclude that neurally mediated changes associated with exercise in patients with borderline hypertension can be brought under behavioral control through feedback training.

Adult↗

PubMed1982

Studies on the autonomic nervous system in borderline hypertension.

Parameters of the autonomic nervous system were studied in normotensive subjects (NT; standing blood pressure (BP) less than or equal to 125/85 mmHg) and in subjects with borderline hypertension (BHT; 140/90 less than or equal to standing BP less than 160/100 mmHg). No differences in plasma noradrenaline and adrenaline levels were found between NT and BHT subjects, neither at rest nor during exercise at 75% of maximum work capacity. The dose of noradrenaline required to increase systolic BP by 10 mmHg was significantly higher in NT than in BHT subjects (5.13 +/- 0.42 vs 3.50 +/- 0.57 microgram . min -1). No difference between NT and BHT subjects was found in the dose of isoprenaline required to increase heart rate by 20 beats . min -1 (1.21 +/- 0.12 vs 1.09 +/- 0.11 microgram . min -1), suggesting decreased parasympathetic activity in the former group. The enhanced pressor effect of noradrenaline, together with the decreased parasympathetic activity, could explain the elevated blood pressure and heart rate in subjects with borderline hypertension.

Adolescent↗

PubMed1979

The hospital and the borderline patient: management guidelines for the community mental health center.

Controversy over the treatment of borderline patients in regression has frequently left underfined the practical approaches to hospital management of these patients. The nature and context of the regressive episode, and the implications of potential interventions for specific types of patients are basic considerations in formulating such an approach. Subgroups of borderline patients can be usefully distinguished on the basis of the major management problem to which each is particularly prone.

Acting Out↗

PubMedDate not supplied

Diagnosis of tick-borne encephalitis: evaluation of sera with borderline titers with the TBE-ELISA.

Tick-borne encephalitis (TBE) is a member of the Flaviviridae family. Strong cross-reactions can occur between members of this family, so that it may be difficult to diagnose specific flavivirus infections, especially when tests with frequent cross-reactions e.g. ELISA tests are used. We tested 238 sera with borderline titers for TBE using the indirect immunofluorescence or neutralization test for other flaviviruses (yellow fever, dengue, West Nile) to detect cross-reactions due to other flavivirus infections or flavivirus vaccination. Only one serum reacted against all the flaviviruses tested, indicating cross-reactivity due to infection with any of the flaviviruses. Two other sera exhibited low antibody titers against yellow fever, which could be confirmed by the neutralization test, indicating recent yellow fever vaccination. None of the other sera reacted at all against any of the flaviviruses tested in the tests used, which indicates false positive reactions with the TBE-ELISA. Sera with borderline titers in the TBE-ELISA in particular should be retested using other test systems (preferably neutralization) and for other flaviviruses (yellow fever, dengue, West Nile) to detect cross-reactions and to confirm positive results.

Cross Reactions↗

PubMed1988

Erythrocyte sodium content and transport in borderline and mild hypertension.

Sodium content and transport of red blood cells were examined in 98 male blood donors. Regarding their blood pressure they were classified into the following groups: (a) 57 normotensives, (RR less than 140/90 mm Hg); (b) 24 borderline hypertensives (140/90 less than or equal to RR less than 160/95 mm Hg); and (c) 17 hypertensives (RR greater than 160/100 mm Hg). Compared with the normotensives the borderline hypertensives have significantly reduced red cell sodium content. The ouabain-resistant net Na+ uptake and the relative Na+ uptake, as a measure of the Na+/K+ pump, were significantly increased. With rising blood pressures the measured values turn to normal, so that no difference exists between the normotensive and hypertensive groups. It is supposed that in the initial or even prehypertensive state a considerable enhancement of the pump activity occurs, simultaneously accompanied by less marked increases in sodium influx, leading to a reduced intracellular sodium content. In the course of hypertension, possibly caused by the formation of a pump inhibitor, the sodium content of red cells turns to normal or supernormal values.

Adult↗

PubMed1993

Thermoregulatory response to passive body heating in borderline hypertension.

Sweating and vasodilatation in the cutaneous circulation were investigated during passive body heating in eight borderline hypertensive subjects and in eight normotensive controls, matched for age, sex and body mass. Blood flow through the finger and forearm was examined in relation to changes in oral temperature; blood pressure, heart rate and sweating in the forehead and forearm were also measured. Systolic blood pressure decreased in borderline hypertensive subjects during the early stages of heating and then returned to baseline, but increased in normotensives. Increases in skin blood flow and decreases in cutaneous vascular resistance were similar in both groups. Thus, cutaneous vasodilatation during moderate body heating did not differ between normotensive subjects and subjects with mildly elevated blood pressure. These findings do not rule out attenuation of cutaneous vasodilatation in mildly hypertensive subjects during more intense heating.

Adult↗

PubMed1996

Intracytoplasmic sperm injection and conventional in vitro fertilization for sibling oocytes in cases of unexplained infertility and borderline semen.

PURPOSE: In a prospective study, conventional IVF and intracytoplasmic sperm injection (ICSI) were performed on sibling oocytes of 22 patients with unexplained infertility (Group A) and 24 patients with borderline semen (Group B). RESULTS: In Group A, there was no significant difference (P = 0.070) in the fertilization rate per oocyte between ICSI (63%) and conventional IVF (50.7%), however, there was total failure of fertilization in conventional IVF in 5 of the 22 patients with IVF and none in ICSI. In group B, there was a significant difference (P < 0.001) between the fertilization rate per oocyte in ICSI (59%) and conventional IVF (27.1%). There was total failure of fertilization in 11 patients after conventional IVF and none after ICSI. CONCLUSIONS: The study showed that 22.7% of unexplained infertility and 45.8% of patients with borderline semen would have lost their chance of embryo transfer completely because of total failure of fertilization if ICSI was not performed on some oocytes in this cycle.

Adult↗

PubMed1990

Detection of borderline oxacillin-resistant Staphylococcus aureus and differentiation from methicillin-resistant strains.

Eighty-eight Staphylococcus aureus clinical isolates meeting criteria for borderline oxacillin resistance (intermediate susceptibility or resistance to oxacillin but susceptibility to amoxicillin/clavulanic acid upon disk diffusion testing) were studied to determine optimal test techniques and conditions for differentiating borderline oxacillin-resistant Staphylococcus aureus (BORSA) from methicillin-resistant Staphylococcus aureus (MRSA). Further testing revealed three distinct resistance patterns: 61 strains (69%) consistently met BORSA criteria and had average beta-lactamase levels five- to six-fold higher than oxacillin-susceptible controls; 11 strains (13%) were markedly heteroresistant MRSA with delayed appearance of resistant colonies leading to spurious susceptibility to amoxicillin/clavulanic acid; 16 strains (18%) appeared to be oxacillin-susceptible on repetitive testing. Under conditions used to elicit intrinsic methicillin resistance in Staphylococcus aureus, a large percentage of BORSA appeared resistant to amoxicillin/clavulanic acid. This clearly shows that BORSA may be misidentified as MRSA while heteroresistant MRSA may appear to be BORSA. It is concluded that amoxicillin/clavulanic acid zone sizes should be measured after a full 24 hours of incubation, that susceptibility testing of Staphylococcus aureus under certain environmental conditions should be interpreted with caution, and that MIC testing is the most reliable technique for differentiating these two resistance patterns in Staphylococcus aureus.

Amoxicillin↗

PubMed2001

Non-palpable thyroid nodules in a borderline iodine-sufficient area: detection by ultrasonography and follow-up.

Thyroid ultrasonography was performed in 482 subjects, free of known thyroid disease and living in a borderline iodine-sufficient urban area, to assess the prevalence of non-palpable thyroid nodules and evaluation their evolute during a 3-yr follow-up. The mean (+/-SD) thyroid volume in the whole study group was 10.9+/-3.7 ml and was higher in males (12.9+/-3.6 ml) than in females (9.2+/-2.9 ml) (p<0.0001). Thyroid volume was correlated with body surface, height and weight, while no correlation was present with lean and fat body mass. Goiter was found in 5/256 females and in 13/226 males. Thyroid nodules were found in 27/482 subjects (18 females, 9 males). Single nodules were found in 17/464 subjects (3.66%) with a thyroid gland of normal volume and in 4/18 subjects (22.2%) with goiter (chi2=10.21; p=0.001). Multiple nodules were found in 3/464 subjects (0.6%) with a thyroid of normal volume and in 3/18 (16.6%) subjects with goiter (chi2=24.31; p<0.0001). The prevalence of thyroid nodules was significantly higher in females >35 yr than in those <34 yr (chi2=7.47; p=0.0062). A significant increase (>30%) of nodular volume was found in 5 subjects, while an increased number of nodules was found in 8. In conclusion, thyroid ultrasonography reveals the presence of thyroid nodules in a significant proportion of apparently thyroid disease-free subjects living in a borderline iodine-sufficient urban area. Incidentally discovered thyroid nodules are associated with goiter and are likely to progress in volume and number.

Adolescent↗

PubMed1997

[Functional failure of an inspiratory Draeger-circuit system. An example of the fundamental problem of borderline damage to a component part in anesthesia and intensive care].

Unnoticed, minor damage to the unidirectional respiratory valves of the Draeger respiratory circuit may lead to intermittent and unpredictable malfunction, resulting in rebreathing and hypercapnia. The damage may be so minor that normal visual and functional test routines may be insufficient to detect it. We report one case of a potential life-threatening malfunction of the inspiratory valve and also propose economical solutions utilizing altered construction, modified machine-check procedures, or a simple instrument that adds only one step to the machine-check procedure. The general problem of minor but functionally important damage to parts of ventilatory equipment--so-called borderline damage--may not be limited to this particular model or manufacturer. Most users of ventilatory equipment believe that equipment that goes through normal check procedures is either fully functional or nonfunctional. In reality, this is not the case. Intermittent malfunctions due to slightly damaged equipment may be missed with normal machine-check procedures. This problem results in a significant but incalculable increased in risk to patients. Because of unclear reproduceability of intermittent malfunctions caused by borderline damage, there also is an increased forensic risk for the anaesthesiologist. The risk of mechanical malfunction might be displaced by software problems in new-generation ventilators in the market.

Anesthesia, Closed-Circuit↗