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PubMed2000

Benign, borderline, and malignant endometrioid neoplasia arising in endometriosis in association with tamoxifen therapy.

Tamoxifen therapy may result in a variety of endometrial proliferative lesions, including adenocarcinoma, and as recently suggested, proliferative changes within endometriosis. This report describes an endometrioid adenocarcinoma arising in ovarian endometriosis in a patient taking tamoxifen. There were also foci of benign and borderline endometrioid adenofibroma in the same ovary and a synchronous endometrioid endometrial adenocarcinoma in the uterus. The spectrum of benign, borderline, and malignant endometrioid neoplasia arising within endometriosis suggests that tamoxifen, as a result of its estrogenic effects, may cause proliferative and, in rare instances, malignant changes in endometriosis.

Adenocarcinoma↗
PubMed2001

Pathologic findings in eight cases of ovarian serous borderline tumors, three with foci of serous carcinoma, that preceded death or morbidity from invasive carcinoma.

We sought to assess the frequency of previously reported adverse histopathologic findings in ovarian serous borderline tumors (SBTs) in cases that preceded a patient's death or caused serious morbidity due to invasive carcinoma. SBTs with foci of invasive carcinoma that occupied a minority of the tumor and were associated with similar outcomes were also studied for potential additional insights. Eight cases were found over a 22-year period. Ten tumors in 5 patients were purely SBT; at initial staging, 1 patient had invasive peritoneal implants; 3 had noninvasive peritoneal implants; 1 was stage I. At last follow-up 3 of the 5 patients had died of carcinoma, 1 was alive with carcinoma, and 1 had no clinical evidence of disease 4 years after a sigmoid colectomy for invasive serous carcinoma of the bowel wall. Four tumors in 3 patients had foci of invasion that were more than microinvasive; at initial staging, all 3 patients had invasive peritoneal implants, and all died of carcinoma. All 14 of the ovarian tumors in the 8 cases had surface involvement by tumor cells, and in 8 tumors in 5 cases they were confined primarily to the ovarian surface. Foci of "micropapillary serous carcinoma" accompanied more obvious areas of infiltrative carcinoma in 2 of the 4 ovarian tumors, the peritoneal implants in 1 of the cases with purely SBTs, and a recurrence in this case and 1 other case. No morphologic finding in the 10 purely SBTs was predictive of subsequent malignant behavior. We conclude that extraovarian invasive serous carcinomas, either following or concurrent with an ovarian SBT, develop from borderline foci that may originate in the ovary, but frequently are likely to have arisen independently in the peritoneum. The carcinomas may be preceded or accompanied by noninvasive-appearing micropapillary foci in the peritoneum in some cases, but micropapillary foci in the ovarian tumors are infrequent and not a necessary antecedent.

Adult↗
PubMed1986

Is sodium restriction effective treatment of borderline and mild essential hypertension? A long-term haemodynamic study at rest and during exercise.

Blood pressure (BP) may fall during moderate sodium restriction in patients with essential hypertension (EH). Few data are available on the haemodynamic changes associated with sodium restriction and exercise data are lacking. We studied the long-term haemodynamic effect of reduced sodium intake in 19 men aged 16-51 years with mild and borderline EH. Cardiac output (CO; by Cardiogreen) and intra-arterial BP were measured at rest and during exercise before and after 9 months therapy. Sodium excretion was reduced by 75 mmol/24 h (36%) from a mean of 209 mmol/24 h and the sodium:potassium (Na:K) ratio fell by 0.75 from 2.17. Intra-arterial pressures fell by 3-5% (P less than 0.05) at rest, both supine and sitting, and during 50, 100 and 150 W bicycle exercise. Body weight and body fluid volumes (isotope dilution) remained unchanged. Haemodynamically, the fall in BP was due to reduction in CO ranging from 7-12% at rest and during exercise, while total peripheral resistance (TPR) rose by 4-10%. Stroke volume and heart rate fell by 2-9%. We conclude that moderate sodium restriction was not an efficient treatment in our patients with borderline and mild EH. The slight reduction in BP was associated with a fall in CO but without reduction of TPR. Thus, the main haemodynamic disturbance of established EH, that is an increase in TPR, was not normalized by 9 months sodium restriction.

Adolescent↗
PubMed1987

Haemodynamic basis of early modifications of the large arteries in borderline hypertension.

Quantitative evaluation of brachial artery diameter, blood velocity and flow (pulsed Doppler velocimetry) and of forearm arterial compliance (FAC)--mathematical analysis of the simultaneous diastolic pressure and flow according to a first-order arterial model--was carried out in 10 normotensive controls, and in 23 borderline hypertensive patients, of the same age. Using a value of 2 standard deviations above the average cardiac index of 20 normotensive subjects, enabled us to classify 12 patients as having a normal cardiac output and 11 patients as having a high cardiac output. Each group was of similar age and pressure. FAC was lower in patients with a normal cardiac output than in normal controls (P less than 0.01) and also lower than in patients with high output (P less than 0.01). Brachial artery diameter and flow were higher in patients with high output than in normal controls (P less than 0.01, P less than 0.001) and also higher than in patients with a normal output (P less than 0.001). A positive correlation (r = 0.55; P less than 0.01) was found between heart rate and brachial artery diameter in the 23 patients. These results demonstrate a non-homogenous pattern of brachial artery characteristics of patients with borderline hypertension. Patients with normal cardiac output exhibited a clear reduction of the distensibility of the forearm arteries while patients with high cardiac output had strong dilation of the brachial artery.

Adult↗
PubMed1988

Non-invasive ultrasonic study of maximal aortic blood acceleration in patients with borderline and sustained essential hypertension.

Using a pulsed Doppler method to evaluate the aortic velocity curve transcutaneously, the maximal aortic blood acceleration was evaluated in normal subjects and in age-matched patients with borderline and sustained essential hypertension. Maximal aortic blood acceleration was significantly elevated in patients with borderline hypertension and remained within the normal range in patients with sustained hypertension. Since maximal aortic blood acceleration is relatively insensitive to preload and afterload, these findings might give indirect information on the contractile state of the myocardium in patients with hypertension.

Adult↗
PubMed1990

Adrenaline facilitates neurogenic vasoconstriction in borderline hypertensive subjects.

Adrenaline facilitates the neural release of endogenous noradrenaline by stimulating prejunctional beta-receptors on adrenergic nerve endings. Recently, we demonstrated the functional significance of this action in the control of vascular resistance in young subjects with normal blood pressure. In the present study, we tested the hypothesis that the effects of adrenaline on neurogenic vasoconstriction are exaggerated in humans with borderline hypertension. Forearm blood flow was measured simultaneously in the experimental and contralateral arms of seven young men with borderline hypertension. We compared forearm vasoconstrictor responses to a reflex stimulus to noradrenaline release (lower-body negative pressure, LBNP) and to intra-arterial infusion of noradrenaline before and 30 min after brachial artery infusion of adrenaline (50 ng/min). These doses had no systemic effects. In the experimental arm, the vasoconstrictor response to LBNP was 65% greater 30 min after the adrenaline infusion (P = 0.075), whereas the response to intra-arterial noradrenaline decreased by 36% (P greater than 0.1). Forearm vascular responses to LBNP in the contralateral control arm that did not receive adrenaline were similar before and after the adrenaline infusion. The ratio of forearm vasoconstrictor responses (i.e. the increase in forearm vascular resistance) with LBNP to the forearm vasoconstrictor response to noradrenaline in the experimental arm was used as an index of neural release of the neurotransmitter noradrenaline. This ratio increased from 0.8 to 2.1 (P less than 0.05) after the adrenaline infusion. These facilitatory neural after-effects of adrenaline were similar in magnitude to our previous observation in young normotensive subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Inverse relationship between upright plasma renin activity and twenty-four hour blood pressure variability in borderline hypertension.

Office, i.e. measured by the physician at rest, and 24 h ambulatory systolic (SBP) and diastolic (DBP) blood pressures, heart rate, supine and upright plasma renin activities, supine and upright aldosterone concentrations and plasma and urine sodium and potassium were measured in 61 young male subjects aged 19-25 years, including 40 normotensive subjects (office DBP less than or equal to 90 mmHg and office SBP less than or equal to 140 mmHg) and 21 borderline hypertensive subjects (non-normal blood pressures with office DBP less than or equal to 95 mmHg and office SBP less than or equal to 160 mmHg). No significant differences were found in the plasma or urine K+ or Na+, upright or supine plasma renin activity or aldosterone concentration between normotensives and borderline hypertensive subjects. No correlation was detected between plasma and urine K+ or Na+, upright and supine aldosterone concentration or supine plasma renin activity and blood pressure. In contrast, significant inverse correlations were observed between upright plasma renin activity and blood pressure. The correlations were approaching statistical significance when upright plasma renin activity was related to office SBP and office DBP (r = -0.22, P = 0.097 and r = -0.25, P = 0.049, respectively), and were more significant when plasma renin activity was related to 24 h mean DBP (r = -0.32, P = 0.013) and to SBP and DBP standard deviations (r = -0.37, P = 0.004 and r = -0.26, P = 0.04, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Hyperkinetic borderline hypertension in Tecumseh, Michigan.

Of 691 healthy (untreated) villagers of Tecumseh, Michigan (average age 32.6 years), 99 had a clinical blood pressure exceeding 140/90 mmHg. Thirty-seven per cent of these borderline hypertensives had increased heart rate, cardiac index, forearm blood flow and plasma norepinephrine. These subjects had elevated self-determined home blood pressure (average of 14 measurements). The present hyperkinetic borderlines had elevated blood pressure at 5, 8, 21 and 23 years of age and their parents also had higher blood pressure. The prevalence of high blood pressure in Tecumseh, its long history, elevated blood pressure readings outside the physician's office and family background of hypertension, suggests that the hyperkinetic state is a significant clinical condition. Previous studies on hospital-based populations proved that the hyperkinetic state is caused by an excessive autonomic drive. The association of the hyperkinetic state with elevated norepinephrine in this study suggests that a sympathetic hyperactivity is present in a large proportion of unselected subjects with mild blood pressure elevation.

Adult↗
PubMed1993

Faster ageing of the carotid artery bifurcation in borderline hypertensive subjects.

OBJECTIVES: It has been suggested that arteries age more quickly in borderline hypertensives (BHT) than in normotensives. If this hypothesis is correct, the decrease in distensibility and compliance in the carotid artery bifurcation should be most pronounced in the carotid artery bulb, because this site is known to be the most affected by age. DESIGN: Arterial distensibility was measured non-invasively by means of an ultrasound vessel wall moving-detector system at various sites along the carotid artery bifurcation in BHT and normotensive controls. METHODS: Sixteen bifurcations of male BHT (mean age 38 years) and 15 bifurcations of normotensive age-matched controls (NTO) were studied in subjects from a population study on borderline hypertension. To evaluate age-related changes, 18 bifurcations of normotensive young male subjects (NTY; mean age 24 years) were included in the study. RESULTS: In NTY subjects no significant variations in distensibility were found along the carotid artery bifurcation, but in NTO subjects the proximal and distal parts of the carotid artery bulb were significantly less distensible than the common carotid artery. In BHT the distensibility was significantly lower at all levels in the bulb than in the common carotid artery, and its proximal part was significantly stiffer than the rest of the bulb. CONCLUSIONS: The findings in this study indicate faster ageing of the carotid artery bifurcation in male BHT than in normotensives of comparable age. In particular, the proximal part of the carotid artery bulb, where the baroreceptors are predominantly located, is most affected by the disease.

Adult↗
PubMed1996

Differential effects of exercise training intensity on blood pressure and cardiovascular responses to stress in borderline hypertensive humans.

BACKGROUND: Psychologic stress has been associated with the development of hypertension. Aerobic exercise training appears to decrease cardiovascular responses to psychologic stress. OBJECTIVE: To determine the efficacy of low-intensity and moderate-intensity exercise training in reducing blood pressure and cardiovascular responses to stress. DESIGN: We sought to compare the cardiovascular responses to a psychologic stressor, the Stroop Color Word Task (Stroop), before and after 12 weeks of low-intensity (about 45% maximal oxygen uptake) and moderate-intensity (about 75% maximal oxygen uptake) aerobic exercise training. METHODS: Eighteen borderline hypertensive subjects (resting blood pressure 139 +/- 9/92 +/- 9 mmHg) were divided randomly into three groups: control (no exercise), low-intensity exercise (40-50% maximal oxygen uptake), and moderate-intensity exercise (70-80% maximal oxygen uptake). Training groups exercised three times per week at the prescribed exercise intensity. Heart rate and blood pressure were recorded during the Stroop before, and after 4 and 8 weeks of exercise training. RESULTS: In the low-intensity exercise group, exercise training attenuated mean blood pressure, systolic blood pressure, and diastolic blood pressure responses to the Stroop and decreased resting blood pressure. The moderate-intensity exercise group demonstrated a reduced diastolic blood pressure response to the Stroop. CONCLUSIONS: These results suggest that, in borderline hypertensive humans, 12 weeks of aerobic exercise training attenuates the cardiovascular responses to the Stroop. Furthermore, low-intensity exercise training appears to be a more effective stimulus than moderate-intensity exercise training in reducing resting blood pressure and blood pressure responses to stress.

Adult↗
PubMed1984

High salt intake blunts plasma catecholamine and renin responses to exercise: less suppressive epinephrine in borderline essential hypertension.

Graded physical exercise was associated with a parallel increase in plasma epinephrine and norepinephrine concentrations, and increments in the latter correlated directly with concurrent increases in plasma renin activity, heart rate, and blood pressure as studied in four normal subjects. With a high salt intake, plasma catecholamine levels were lower at each grade of exercise; the norepinephrine-renin response curve was shifted to the right and the norepinephrine-heart rate response curve to the left. In five patients with borderline essential hypertension, after salt loading epinephrine concentrations were higher and their responses during exercise greater than in normal subjects. A high salt intake suppresses the activity of the sympathetic nervous system as well as the renin system but increases cardiovascular responsiveness to pressor hormones. A high dietary salt intake may contribute to elevated concentrations of plasma epinephrine and to its cardiovascular effects in borderline essential hypertension.

Adult↗
PubMed1986

Borderline hypertension and sodium sensitivity.

The relationship between sodium sensitivity and borderline hypertension was explored in 63 subjects. Thirty percent of those with borderline hypertension and 15% of normal subjects increased mean arterial pressure by more than 5% when daily sodium intake was increased from 10 to 200 mEq. While most displayed an increase in cardiac dimension, stroke volume, and cardiac index, the sodium-sensitive individuals either failed to reduce vascular resistance to the same degree as normal subjects or actually vasoconstricted.

Aldosterone↗
PubMed1986

Evidence of early changes of the brachial artery circulation in borderline hypertension.

Quantitative evaluation of brachial artery diameter and blood flow (pulsed Doppler velocimetry) was carried out in nine normal subjects and 24 borderline hypertensive patients of the same age. The analysis of patients according to their value of cardiac index compared with the normal mean value plus 2 SD (standard deviation) enabled us to subdivide the patients into those with normal cardiac output and those with high cardiac output of similar age and pressure. Brachial artery diameter and flow were not different in patients with normal output and in normal controls, but were higher in patients with high output than in normal controls (p less than 0.05; p less than 0.01) and lower in patients with normal output than those with high output (p less than 0.01). These results demonstrate a nonhomogeneous pattern of the brachial artery of patients with borderline hypertension. Patients with normal cardiac output exhibited a trend to vasoconstriction, while patients with high cardiac output had a strong dilatation of the brachial artery.

Adult↗
PubMed1986

Specificity of personality traits in borderline hypertension.

Patients with borderline hypertension tend to suppress expression of anger and hostility. However, if anything, they are psychologically hyperresponsive. The blood pressure elevation is maintained neurogenically in many with borderline hypertension. Consequently, it is tempting to postulate that suppressed anger causes neurogenic increases in blood pressure. Available data are inadequate to substantiate this hypothesis. It is equally plausible that neurogenic factors affect emotions, behavior and blood pressure. The terms specificity and directionality are introduced and defined to facilitate a better understanding of this important area of research.

Anxiety↗
PubMed1986

Behavioral treatment of borderline hypertension: an overview of results.

The evidence for blood pressure reduction by behavioral interventions based on relaxation, biofeedback, and related approaches is reviewed. The majority of controlled investigations indicate that behavioral treatments results in greater reductions in blood pressure than no-treatment control conditions, particularly for higher levels of blood pressure. Behavioral interventions are also effective as an adjunct to pharmacotherapy when blood pressure remains elevated despite antihypertensive medication. Results with borderline and mild hypertensives are mixed. Nonspecific factors, such as positive expectancy and habituation to repeated blood pressure monitoring, play a significant role in blood pressure change and have important clinical implications. A stepped approach for the treatment of borderline hypertensives is advanced, entailing systematic monitoring with positive expectancy followed by behavioral treatments for individuals whose blood pressure remains elevated. Next comes combined behavioral and pharmacological interventions in those still not showing adequate blood pressure decreases. Recommendations for future research on behavioral interventions are presented.

Behavior Therapy↗
PubMed1986

Borderline hypertension: a psychophysiologic approach.

Stress is a condition capable of causing complex psychobehavioral and psychobiological responses, during which blood pressure can reach pathological values. The study reported here investigated the correlation among physiological responses to stress, psychobehavioral assessments, and borderline hypertension. We developed a psychobehavioral questionnaire and submitted patients to a battery of four stressors (mental arithmetic, Sacks's test, white noise, and electric stimulus). We measured levels of muscular contractions, skin conductance, digital temperature, heart rate, and systolic, mean, and diastolic blood pressures. Abnormal psychobehavioral traits and abnormal profiles of physiological responses are more common among borderline hypertensive patients and among patients with a family history of hypertension. The data obtained seem to suggest an interaction of the central nervous system, psyche, and the autonomic nervous system in the origin of hypertension.

Body Temperature↗
PubMed1986

Perception of emotions in borderline hypertensive patients and normal subjects.

The ability to recognize the facial expressions of emotions was investigated in 30 borderline hypertensive patients, 16 with high intralymphocytic sodium content (ILSC) and 14 with normal ILSC, and in 34 normotensive matched controls. To this aim, 48 slides with the facial expressions of emotions and with neutral expressions were shown to the subjects by means of a tachistoscope. Two brief questionnaires, the Affective Communication Test and the Dimensions Rating Scale, were used to assess the ability to express emotions and the intensity of emotional experience in the subjects. Results show in borderline hypertensives a difficulty in recognizing emotions, with differences between the two subgroups of patients.

Adult↗
PubMed1986

Predictors of stable hypertension in young borderline subjects: a five-year follow-up study.

Forty-four young subjects with borderline hypertension underwent a 5-year follow-up. At the first examination their intralymphocytic Na+ (Nai) was measured before and after 1 month of a low-salt diet. Blood pressure and heart rate were recorded at rest (baseline), during mental arithmetic, and after the test (recovery). After 5 years, no subject with normal Nai developed hypertension, and, furthermore, subjects with normal Nai had no increase in blood pressure values. Thirty-one percent of subjects with high Nai developed hypertension. Subjects developing hypertension were characterized by a high pressor response to mental stress and by an increase in recovery diastolic blood pressure in comparison with baseline diastolic blood pressure. Sixty percent of the subjects whose recovery diastolic blood pressure was at least 6% higher than baseline developed hypertension. Eighty percent of subjects whose Nai was not reduced after the diet became hypertensive. Nai and diastolic blood pressure were unrelated at the first examination; however, a significant correlation was found between Nai recorded at first examination and diastolic blood pressure recorded after 5 years. It is concluded that Nai is a good predictor of future blood pressure in borderline subjects and that subjects with normal Nai have a very low risk of developing high blood pressure.

Adult↗