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PubMed2003

[Mechanical borderline indications in the treatment of unreamed tibial nailing].

The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goal was to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, and to identify borderline indications due to biomechanical factors. In finite element analyses of a human tibia, horizontal defects were modeled using unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures with unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

Biomechanical Phenomena↗
PubMed2005

Expression and clinical significance of vascular endothelial growth factor, cyclooxygenase-2, and Bcl-2 in borderline ovarian tumors.

OBJECTIVE: The objectives were to study the expression of vascular endothelial growth factor (VEGF), cyclooxygenase-2 (Cox-2), and Bcl-2 in borderline ovarian tumors (BOTs) and the relationship within them, and to investigate the correlation between expression of VEGF, Cox-2, and Bcl-2, and the clinicopathologic features of BOTs. METHODS: An immunohistochemical technique was used to investigate the expression of VEGF ,Cox-2, and Bcl-2 in 69 borderline, 18 benign, and 27 malignant human ovarian tumor tissues. RESULTS: Expression rate of VEGF protein (59.4%) in BOTs was higher than in benign tumors (27.8%) and was lower than in ovarian carcinomas (92.6%), and there was a significant difference between BOTs and benign ovarian tumors (p < 0.05), and carcinoma (p < 0.01). Significant correlation was observed between the positive expression rate for VEGF and clinical stage of BOTs (p < 0.05). The statistical analysis did not show a close correlation between the expression of VEGF and tissue type, and peritoneal implants in BOTs (p > 0.05). The expression rate of Cox-2 was significantly higher in ovarian carcinomas (81.5%) than in BOTs (57.9%) and in benign ovarian tumors (38.9%) (p < 0.05). Significant correlation was observed between the positive expression rate for Cox-2 and the clinical stage of BOTs (p < 0.05). The statistical analysis showed no close correlation between the expression of Cox-2 and tissue type, and peritoneal implants in BOTs (p > 0.05). There was a significant difference between the expression of Bcl-2 in ovarian carcinomas and BOTs than that in benign ovarian tumors (p < 0.05). The positive expression rate of Bcl-2 was not related to clinical stages and peritoneal implants (p > 0.05). Statistical analysis showed a positive correlation between the expression of Cox-2 and VEGF, and Bcl-2 in BOTs. CONCLUSIONS: Overexpression of VEGF, Cox-2, and Bcl-2 in BOTs may play an important role in the oncogenesis and progression of BOTs. It is feasible to detect VEGF, Cox-2, and Bcl-2 in the diagnosis and to predict the prognosis of BOTs.

Cyclooxygenase 2↗
PubMed2003

Investigation of c-myc and p53 gene alterations in the tumor and surgical borderline tissues of NSCLC and effects on clinicopathologic behavior: by the FISH technique.

Genetic alterations on the primary tumoral tissues and surgical borderline tissues of 51 patients with NSCLC on which radiotherapy and chemotherapy had not been performed were analyzed by using the FISH method with locus-specific probes for p53 tumor suppressor gene and c-myc oncogene and centromere-specific probes for chromosome 17 and chromosome 8 on which these genes are located. P53 deletions were detected in 7 patients (13.7%), c-myc amplification in 4 patients (7.8%), monosomy 17 in 2 patients (3.9%) and trisomy 8 in 3 patients (5.8%), and a high level of polyploidy in tumoral tissues of 6 patients (11.7%). P53 deletion and c-myc amplification were found at surgical borderlines of 2 patients and 1 patient, respectively. Although both p53 deletion and c-myc amplification have low frequency at surgical border tissues, not only their detection is important for the follow-up of recurrency and metastasis, but it is also important for genetical and pathological staging. The results of this study show that c-myc amplification in NSCLC is related to the shortening of survival (p < 0.01). C-myc amplification and p53 deletion are also effective for the occurrence of metastasis (p < 0.05) and the effect of c-myc amplification in this matter is much higher than p53 deletion. The gain or loss of copy number of chromosome 8 and monosomy 17 show parallel effects with c-myc amplification and p53 deletion, respectively, on the clinicopathological behavior of tumors.

Adult↗
PubMed2000

Duodenum-preserving pancreatic head resection in patients with benign and borderline tumors of the pancreatic head.

BACKGROUND: Benign tumors of the pancreas are rare, accounting for only 1-2% of primary pancreatic lesions. Up to now, partial duodenopancreatectomy is still one of the established forms of treatment of benign tumors of the pancreas. We applied duodenum-preserving pancreatic head resection in 12 patients with benign pancreatic tumors to evaluate the feasibility, morbidity and recurrence rates after this less aggressive method. METHODS: Between April 1984 and December 1999, 12 patients with benign and borderline tumors of the pancreatic head were operated on by duodenum-preserving pancreatic head resection. RESULTS: All five patients with serous cystadenoma are free of recurrence 4.4 years after primary resection. One of two patients with mucinous cystadenoma and one of three patients with intraductal papillary mucinous tumor developed recurrent tumor within the former pancreatic head 5 years and 6 years, respectively, after the primary operation. Both patients were resected a second time. One of two patients with gastrinoma still has elevated serum gastrin levels. There was no hospital or long-term mortality. CONCLUSION: For a symptomatic serous cystadenoma, duodenum-preserving pancreatic head resection is a good alternative to partial duodenopancreatectomy. In borderline tumors with malignant potential, we would rather suggest a more radical duodenum-preserving segmental resection. A video clip (3 min) is attached demonstrating the basic steps of duodenum-preserving pancreatic head resection.

Adult↗
PubMed2006

[Pain processing in patients with borderline personality disorder, fibromyalgia, and post-traumatic stress disorder].

The authors review relevant experimental studies on pain perception and processing in psychiatric disorders with traumatic stress as an etiological factor. In borderline personality disorder, post-traumatic stress disorder, and fibromyalgia neurophysiological and neuropsychological patterns of pain processing appear to be different. Experimental studies in borderline patients show a desensitization of pain thresholds whereas patients with fibromyalgia show an opposite pattern, which could be explained by a central augmentation of pain processing. Furthermore, the authors outline methods to assess pain perception (peripheral and central) and describe the neurobiological mechanisms of pain processing, particularly the distinction between the sensory-discriminative lateral system and the affective-motivational medial system. Finally, suggestions for further research and implications for therapy are proposed.

Central Nervous System↗
PubMed2006

Evaluation of mucin expression patterns in gastric borderline (group III) lesions.

BACKGROUND: Recommendations for diagnosis and treatment of gastric borderline (group III) lesions remain controversial. We examined mucin expression patterns in endoscopically resected and forceps biopsy samples. METHODS: Sixty-three gastric lesions were histopathologically identified as belonging to group III on the basis of an endoscopic forceps biopsy. All of the patients underwent endoscopic resection, and the lesions were classified into group A (final diagnosis, adenocarcinoma) or group B (final diagnosis, adenoma). Immunostaining for MUC2, MUC5AC, MUC6, and CD10 was performed and the mucin phenotype determined. An additional 26 forceps biopsy samples from the above 63 patients were similarly evaluated. RESULTS: The proportion of complete gastric (positive for MUC5AC and MUC6) plus gastric-predominant phenotypes was significantly higher in group A (58.0%) than in group B (18.7%) lesions (P < 0.05). The proportion of the complete intestinal (positive for MUC2 and CD10) phenotype was significantly higher in group B (68.8%) than in group A (19.4%) (P < 0.05). Similar results were also observed in the 26 forceps biopsy samples histopathologically diagnosed as group III lesions. The proportion of samples with a diffuse Ki-67 immunostaining pattern was significantly higher in group A than in group B (P < 0.05). p53 expression was significantly higher in group A (29.2%) than in group B (4.3%) (P < 0.05). CONCLUSIONS: Immunostaining of forceps biopsy samples for the mucin phenotype may be helpful for diagnosing gastric borderline (group III) lesions.

Aged↗
PubMed1982

Prospective study of predictive factors determining borderline hypertensive individuals who develop sustained hypertension: prognostic value of increased diastolic orthostatic blood pressure tilt-test response and subsequent weight gain.

Repeat hemodynamic determinations in supine and tilting positions were performed in 23 young men with borderline hypertension (HBP). The mean duration of follow-up was 48 months. During the study 11 patients had no change in hemodynamic parameters (group II), while 12 patients exhibited significant increase in systolic (p less than 0.001) and mean (p less than 0.01) arterial pressures (BP) and in body weight (p less than 0.05) (group I). In this latter group, the initial hemodynamic pattern included supine elevations in cardiac output (CO) and heart rate (HR) and significant increase in diastolic orthostatic BP. After follow-up, the group I primary supine increases in CO and HR were followed by secondary supine increases in total peripheral resistance (p less than 0.01) and systolic (p less than 0.001) and mean (p less than 0.01) BP with lower CO (p less than 0.05) and HR (p less than 0.001). In addition, it was shown during long-term follow-up in group I patients that : (1) the increase in systolic BP per unit age was negatively correlated with initial age (p less than 0.001), (2) the increase in BP was positively correlated with weight gain (p less than 0.05), and (3) the diastolic orthostatic hypertension disappeared. This study provides evidence that, in patients with borderline HBP having supine elevations of CO and HR, the subsequent development of sustained HBP can be expected, with follow-up observation of lower supine HR and disappearance of diastolic orthostatic hypertension accompanied by rapid weight gain.

Adult↗
PubMed1986

Relative tachycardia in ambulant children with borderline hypertension.

Borderline hypertensives who demonstrate tachycardia have a tendency toward the development of essential hypertension. However, the documentation of tachycardia in previous studies has been generally based on brief periods of observation. In the present study, we measured heart rates through a 24-hour period in 16 ambulatory mildly hypertensive subjects (ages 5 to 23 years). When compared with normal matched controls, significantly (p less than 0.05) higher heart rates were observed during the waking periods (99 +/- 9 vs 90 +/- 11) and sleep periods (72 +/- 12 vs 62 +/- 7). Similar observations were also made for 24 hours (90 +/- 8 vs 79 +/- 8). In addition, hypertensives also demonstrated thickened (during diastole) left ventricular posterior wall (0.96 +/- 0.17 vs 0.85 +/- 0.13 cm; p less than 0.05) and interventricular septum (0.98 +/- 0.17 vs 0.84 +/- 0.19 cm; p less than 0.05). It is suggested that tachycardia may be an early manifestation of borderline hypertension in children.

Adolescent↗
PubMed1988

Borderline ovarian tumors.

Ninety-four patients with borderline ovarian tumors were retrospectively analyzed for clinical features, treatments, and survival characteristics. There were 46 patients with FIGO stage IA cancer, 7 with stage IB, 20 with stage IC, 4 with stage IIB, 5 with stage IIC, 5 with stage IIIA, 3 with stage IIIB, and 4 with stage IIIC tumors. Seventy patients had at least a total abdominal hysterectomy and bilateral salpingo-oophorectomy, 20 patients had conservative surgery including unilateral salpingo-oophorectomy or ovarian cystectomy, and 4 patients had bilateral salpingo-oophorectomy. Fifteen patients with stage I disease received adjuvant melphalan therapy and 2 received external beam radiation for concomitant gynecologic cancers; 7 with stage II tumors received adjuvant melphalan therapy and 1 received external beam radiation; and 5 with stage III tumors received melphalan therapy and 6 patients received cisplatin-based combination chemotherapy. Follow-up ranged from 1 to 117 months, with a median of 33.5 months. Eighty-seven patients were alive. Seven patients died, two of disease. The overall 5-year survival rate was 83.0%; those treated with adjuvant therapy had a 79.5% survival, whereas the others had 84.6% survival. Second-look surgery was performed in 10 patients; six results were negative after melphalan therapy, one was negative after cisplatin combination therapy, and one was negative after no adjuvant treatment. Two patients had positive second-look surgery, one with stage IIIC disease treated with a cisplatin combination and the other with stage IC disease treated with melphalan. This review did not demonstrate that patients with borderline ovarian tumors benefited from adjuvant therapy.

Adolescent↗
PubMed1983

Peripheral resistance and red cell Li-Na countertransport in borderline hypertensives.

We have studied ouabain-resistant, external sodium-stimulated, lithium efflux (Li-Na countertransport) in red blood cells from 21 borderline hypertensives with at least one hypertensive first degree relative (BH-F), 19 borderline hypertensives without family history of essential hypertension (BH-NF), and 35 age-matched normotensive subjects. The data indicate the finding of an increased Li-Na countertransport in all BH (F+NF), but with a significant overlap between BH values and control ones: Li-Na countertransport is significantly higher only in BH-F but it is normal in BH-NF. Moreover, there is a significant correlation of Li-Na countertransport to total peripheral resistance but not to mean blood pressure in all hypertensive patients. It is suggested that in BH the increase of erythrocyte Na flux is mediated by the Na-Na exchange diffusion, and its abnormality may be associated to the hereditary trait of essential hypertension rather than the high blood pressure per se, probably resulting in the development of hypertension, through the increased vascular smooth muscle tone.

Adolescent↗
PubMed1991

Pulmonary mucinous cystic tumors of borderline malignancy.

Mucus-filled cystic tumors of low or borderline malignant potential, well recognized in ovary and appendix, have received little attention in the lung. We present data on 11 patients, all of whom had solitary pulmonary nodules resected in which mucus was the major histologic component. Prognosis appears good; no patient had developed local recurrence or metastatic spread of tumor (follow-up, 1 to 9.5 years; mean, 4.7 years). Columnar mucus-producing cells lined the cysts in all cases, with cytologic and architectural atypia varying from minimal to microscopic foci of carcinoma; paucicellular mucus dissection into surrounding lung analogous to pseudomyxoma peritonei was seen in seven cases. The histologic and clinical findings are consistent with a mucinous cystic tumor of low or borderline malignant potential.

Cysts↗
PubMed1992

Serous papillary cystic tumor of borderline malignancy with focal carcinoma arising in testis: case report with immunohistochemical and ultrastructural observations.

A 59-year-old white man presented with painless scrotal swelling, a symptom he stated he had had for "several decades." Pathologic examination (conventional stainings, immunohistochemistry, and electron microscopy) revealed a cystic papillary tumor that was classified as a serous papillary cystadenoma, ovarian type, of borderline malignancy, with focal transition into invasive cancer. This appears to be the ninth reported case of testicular tumors of the serous or mucinous ovarian type and the first reported case with development of a circumscribed carcinoma from serous cystadenoma of borderline malignancy.

Cystadenoma↗
PubMed1992

Preoperative serum CA-125 levels in borderline tumors of the ovary.

Preoperative serum CA-125 levels were evaluated in 38 patients who underwent primary surgery for epithelial ovarian tumors of borderline malignancy at the Brigham and Women's Hospital and Massachusetts General Hospital between 1981 and 1990. Surgical staging was Stage I in 25 (66%) patients, Stage II in 2 (5%) patients, Stage III in 10 (26%) patients, and Stage IV in 1 (3%) patient. The mean sizes of mucinous and serous ovarian tumors were 21.9 and 10.3 cm, respectively (P = 0.0002). All 13 patients (100%) with mucinous tumors had Stage I disease, while 12 (50%) of 24 patients with serous tumors were Stage I. Combining all cell types, 10 (40%) of 25 patients with Stage I disease had an elevated preoperative CA-125 level, while 2 (100%) of 2, 9 (90%) of 10, and 1 (100%) of 1 patient with Stage II, III, and IV disease, respectively, had increased preoperative levels. Among patients with serous tumors, 3 (25%) of 12 Stage I patients had an elevated preoperative CA-125 level, while 11 (92%) of 12 Stage II-IV tumors had elevated levels (P less than 0.001). These data suggest that preoperative CA-125 level correlates with stage of disease in patients with serous borderline ovarian tumors.

Adult↗
PubMed1992

Ovarian borderline mucinous tumor in a premenarchal girl: review on ovarian epithelial cancer in young girls.

Ovarian tumors constitute the most common gynecological neoplasms during childhood. Unlike in adult women, ovarian epithelial tumors are uncommon in young girls and extremely rare prior to menarche. To our knowledge this is the first report of a borderline malignant mucinous tumor of the ovary in a premenarchal girl. It was successfully treated by conservative surgery. In our review of ovarian neoplasms in girls under 20 years of age, epithelial tumors were found in 19.3%, with a malignancy rate of 15.9%. Of these malignant tumors, 39.4% were of the mucinous type and 30.3% were borderline malignant. The occurrence of such a tumor at this age underscores the possibility of malignant transformation of the ovarian epithelium even prior to menarche. Its mucinous nature confirms the predominance of the mucinous subgroup in young girls. Hypotheses on the origin of mucinous tumors are discussed.

Adolescent↗
PubMed1980

Low platelet monoamine oxidase activity: a possible biochemical correlate of borderline schizophrenia.

Platelet monoamine oxidase (MAO) activity, psychiatric disorders, and family history of psychopathology were studied in 115 nonhospitalized, previously undiagnosed college student volunteers. Subjects were classified into two extreme groups: those with platelet MAO activity two standard deviations below the mean ("low-MAO" probands) and those with platelet MAO activity two standard deviations above the mean ("high"-MAO probands). Low-MAO probands were found to have a significant increase in the incidence of borderline schizophrenia and other psychiatric disorders compared to high-MAO probands. First-degree relatives of low-MAO probands were more often affected with psychiatric disorders and borderline schizophrenia than relatives of high-MAO probands. The data suggest that reduced platelet MAO activity is associated with psychiatric vulnerability and that the spectrum of schizophrenia may be more closely related to this vulnerability than other psychiatric disorders.

Adult↗
PubMed1990

Dissociation of autonomic controls of heart rate in weaning-aged borderline hypertensive rats by perinatal NaCl.

The ontogeny of functional sympathetic neural, adrenal medullary, and extra-adrenal components of adrenergic control of heart rate was investigated in borderline hypertensive rats exposed to either high or low sodium chloride (NaCl) from conception through weaning. Borderline hypertensive rats were produced by mating spontaneously hypertensive females with normotensive Wistar-Kyoto males. Females were maintained on diets containing either low (0.12% NaCl) or high (3% NaCl) dietary NaCl throughout pregnancy and lactation. At 28 days of age, baseline heart rates recorded from awake and unrestrained pups did not differ between low and high NaCl-exposed pups. Overall sympathetic tone, inferred from heart rate change after beta 1-adrenergic blockade with atenolol, did not differ between high and low NaCl-exposed pups. Early NaCl exposure did not alter the neural component of sympathetic control of heart rate as inferred from heart rate decrease after bretylium tosylate. Parasympathetic nervous system control, as reflected by tachycardic response to muscarinic receptor blockade with atropine methyl nitrate was also unchanged by early NaCl exposure. The adrenal catecholamine component of sympathetic control of heart rate was inferred from bradycardia following administration of the ganglion blocking agent, chlorisondamine, to pups pretreated with bretylium and atropine methyl nitrate. Pups exposed to low NaCl showed increased adrenal control of heart rate compared to high NaCl-exposed pups. The influence of residual catecholamines on heart rate was inferred from bradycardia following administration of the beta 1-adrenergic receptor blocking agent, atenolol, in pups pretreated with bretylium, atropine methyl nitrate, and chlorisondamine. Residual catecholamine influence was greater in rats exposed to high NaCl.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic Fibers↗
PubMed1995

Young borderline hypertensives are hyperreactive to mental arithmetic stress: spectral analysis of R-R intervals.

To investigate whether sympathetic tone and its reactivity to stress are increased in borderline hypertension, we compared pressor and autonomic nervous responses to mental arithmetic stress in male borderline hypertensives (BH) and normotensive volunteers (NT). Three age groups, 30, 40 and 50-year-old groups, which included 30 to 39, 40 to 49 and 50 to 59-year-old subjects, were studied. Fractional LF (%LF), fractional HF (%HF) and L/H, obtained from the power spectrum of R-R intervals, were used as indices of autonomic nervous function. Baseline autonomic nervous indices did not differ between NT and BH of any age group. Blood pressure rose higher during mental arithmetic stress in 50 than in 30-year-old NT but not in comparable age groups of BH. Pressor responses were augmented in BH compared to NT only in the 30-year-old group. However, the differences were not significant when pressor responses were expressed as percent increases in blood pressure. Both %L and L/H increased during arithmetic stress. The increase in %L did not differ between NT and BH but that in L/H (% delta L/H) was larger in 50 than in 30-year-old NT. % delta L/H was larger in BH than in NT only in the 30-year-old group. These findings suggest that both pressor and autonomic nervous responses to metal arithmetic stress were altered by aging and augmented in BH compared to NT in the 30-year-old group.

Adult↗
PubMed1992

Supernumerary ring chromosomes in five bone and soft tissue tumors of low or borderline malignancy.

Five tumors (two myxoid malignant fibrous histiocytoma, two dermatofibrosarcoma protuberans, and one parosteal osteosarcoma) with ring chromosomes as the sole cytogenetic anomaly or as the only structural rearrangement were observed in a series of 60 karyotypically abnormal, nonlipogenic bone and soft tissue tumors (BST). All five tumors were of borderline or low malignancy. These findings support the suggestion that supernumerary ring chromosomes as the sole structural chromosomal aberration are not associated with any particular histopathologic diagnosis but may characterize a group of BST of borderline or low malignancy.

Adolescent↗