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PubMed1975

Altered cardiac responsiveness and regulation in the normal cardiac output type of borderline hypertension.

Of 145 patients with borderline hypertension, 30% had increased resting cardiac index (QI), whereas the remainder had normal values. The specific aim of this study was to investigate cardiac regulation in patients who had normal resting QI. Eighty-five control subjects were used for comparison. At rest, patients with normal QI showed evidence of decreased parasympathetic inhibition; the QI after injection of atropine increased less than in control subjects. After complete cardiac autonomic blockade with propranolol and atropine, QI and stroke volume were significantly lower in patients than in control subjects. The mechanism of this low QI was further analyzed. Central blood volume, which strongly correlates with stroke volume, was used as an estimate of the cardiac venous filling. After blockade, stroke volume was decreased in patients, but central blood volume was normal. Patients also showed a decreased heart rate and QI response to infusion of isoproterenol. It is therefore postulated that two components may be responsible for the low QI in the "denervated" heart: patients exhibit a decreased responsiveness to sympathetic stimulation, and they may also be less responsive to venous filling. Behind the facade of cardiac normality in these borderline hypertensive patients with normal cardiac output, there is evidence of altered autonomic control of the heart (decreased vagal inhibition) and of changed cardiac response to sympathetic stimulation and possibly to venous filling.

Adult↗
PubMed1975

Defining borderline patients: an overview.

This review of the descriptive literature on borderline patients indicates that accounts of such patients vary depending upon who is describing them, in what context, how the samples are selected, and what data are collected. The authors identify six features that provide a rational means for diagnosing borderline patients during an initial interview: the presence of intense affect, usually depressive or hostile; a history of impulsive behavior; a certain social adaptiveness; brief psychotic experiences; loose thinking in unstructured situations; and relationships that vacillate between transient superficiality and intense dependency. Reliable identification of these patients will permit better treatment planning and clinical research.

Affect↗
PubMed1977

Borderline rage and the therapist's reponse.

Borderline patients often engender feelings ranging from apathy to rage in therapists. The author views the borderline patient's rage as defensive against fear of total negation resulting from projective identification with hostile part objects. The therapist's withdrawal or anger parallels the patient's projection of affect. Countertransference offers the potential for understanding a patient's terror, but therapists may become fixed in identifications that distort their understanding. Clarity often comes slowly as the therapist directs attention to his/her own affective state in order to understand the patient's vulnerability.

Affect↗
PubMed1978

Borderline diagnoses.

The author describes the development of the borderline concept and the apparent inaccuracy of the original hypothetical framework. The signs and symptoms used to describe a "borderline syndrome" are often shared with other psychiatric illnesses. The author recommends that clinicians consider patients with only those features as "undiagnosed" until further research determines whether a distinct syndrome exists.

Humans↗
PubMed1977

The borderline syndrome: evolution of the term, genetic aspects, and prognosis.

"Borderline" has been used to designate conditions intermediate between psychosis and neurosis, analyzability and nonanalyzability; also, for dilute or questionable schizophrenia. Contemporary usage inclines toward patients with manic-depressive heredity, although borderlines are still etiologically heterogeneous. Various subtypes are outlined, each responsive to a particular method of psychotherapy or pharmacotherapy. If drug-abuse or antisocial tendencies are absent, prognosis is ofter favorable.

Adaptation, Psychological↗
PubMed1977

Therapeutic technique: treatment of a borderline adolescent girl.

This paper is a case presentation of an acting-out borderline adolescent girl, who had been exposed to three previous attempts at treatment. The clinical material gives evidence of diagnostic and dynamic understanding of the borderline syndrome. The treatment technique--confrontation--is elucidated with examples of its use.

Acting Out↗
PubMed1979

A practical approach to the psychotherapy of the borderline patient.

Guidelines for the ordinary psychotherapist in the day-to-day office treatment of so-called borderline patients are presented. Practical pointers for handling problems of diagnosis, working alliance, transferences, middle phase, and termination are given, followed by a brief discussion of the future of the concept of borderline patient.

Diagnosis, Differential↗
PubMed2005

Differential gene expression in ovarian tumors reveals Dusp 4 and Serpina 5 as key regulators for benign behavior of serous borderline tumors.

PURPOSE: Ovarian serous borderline tumors (SBT) are characterized by arborizing papillae lined by stratified epithelial cells, varying atypia, and absence of stromal invasion. Originally, these tumors have been classified as borderline because they behaved in a remarkably indolent manner, even with widespread tumor deposits called implants and the presence of lymph node involvement. The molecular biology of these lesions has just begun to be explored. High prevalence of B-RAF/K-RAS mutations in SBTs in contrast to serous carcinomas (SCAs) indicates that the mitogenic RAS-RAF-MEK-ERK-MAP kinase pathway is crucial for the pathogenesis of SBTs. The purpose of this study was to further unravel the genetic pathways through which SBTs develop, with a special focus on explaining the generally benign SBT behavior. MATERIALS AND METHODS: We generated RNA expression profiles of 38 ovarian serous neoplasms. Global Test pathway analysis and significance analysis of microarrays (SAM) of the expression profiles was performed. RESULTS: SAM and Global Testing showed that although the mitogenic pathway is activated in SBTs, activation of downstream genes involved in extracellular matrix (ECM) degradation is absent, suggesting an uncoupling of both events. In addition, we show that two genes involved in regulating this uncoupling, ERK-inhibitor Dusp 4 and uPA-inhibitor Serpina 5, are downregulated in SCAs in contrast to SBTs. In SCAs, this was associated with downstream MMP-9 activation at both mRNA and protein level. CONCLUSION: We propose that the putative tumor suppressor genes Dusp 4 and Serpina 5 provide a major clue to the indolent behavior of SBTs.

Dual-Specificity Phosphatases↗
PubMed1975

The stroke volume in juvenile borderline hypertension.

Hemodynamic changes in supine and upright position and during exercise were studied in 144 men including 37 normal subjects and 107 patients with borderline hypertension. Borderline hypertensives were classified in 4 groups, according to the basal level of heart rate and stroke index. In the first two groups, stroke index was normal, but heart rate was either decreased (Group I) or elevated (Group II): supine total peripheral resistance was superior (Group I; p less than 0.02) or equal (Group II) to normal values; plasma volume was normal or slightly decreased; hemodynamic response to tilt test closely approximated the normal; impaired adaptation of cardiac index and stroke index to exercise was observed in Group II (p less than 0.001). In the other two groups, stroke index was significantly elevated (p less than 0.0001) but heart rate was either decreased (Group III) or increased (Group IV); supine total peripheral resistance values were decreased (p less than 0.001); plasma volume was equally reduced (p less than 0.001); abnormal percentile increase in diastolic arterial pressure (p less than 0.02; p less than 0.001) and total peripheral resistance during tilt test were observed; during exercise, only the patients of Group IV had an impaired adaptation of cardiac index (p less than 0.001) and total peripheral resistance (p less than 0.02). The study provide evidence that in boderline hypertension i) a high basal level of stroke volume is associated with a reduced plasma volume and an imparied adaptation of total peripheral resistance during tilt, ii) a high basal level of heart rate is associated with an impaired adapatation of cardiac output during exercise, and iii) only patients having an increase in both heart rate and stroke volume exhibited a specific hemodynamic pattern including: reduction of plasma volume, impaired adaptation of cardiac output during exercise, impaired adaptation of total peripheral resistance during tilt and exercise.

Adult↗
PubMed1984

Plasma noradrenaline concentration and pressor response to infused noradrenaline in patients with borderline hypertension, and mild or moderate essential hypertension.

In order to evaluate the significance of sympathetic nerve activity in the pathophysiology and pathogenesis of borderline hypertension or mild or moderate essential hypertension, plasma noradrenaline concentration (PNA) at supine rest and pressor response to infused noradrenaline (NA-R) were evaluated in these in-patients. A significantly positive correlation (r = 0.395, p less than 0.001) between PNA and age was found in normotensive subjects (NT), but not in essential hypertensives (EHT). In the young (below 40 years of age) group, the mean value of PNA in EHT was significantly higher (p less than 0.05) than that in NT. However no significant difference in PNA between NT and EHT was observed in the middle-age (40-59 years) and old-age (above 60 years) groups. PNA was highest in borderline hypertensives (BHT), second highest in EHT with WHO stage I (WHO-I), third in EHT with WHO stage II (WHO-II), and lowest in NT. Among these age-matched four groups, significant differences in the mean value of PNA were found between NT and BHT (p less than 0.001) or WHO-I (p less than 0.05), and between BHT and WHO-II (p less than 0.05). In a comparison of the age-matched NT, normal renin EHT (NRH) and low renin EHT (LRH), the mean value of PNA in NRH was significantly higher than that in NT (p less than 0.001) and LRH (p less than 0.001). Similar differences were observed in the peak value of PNA during 20 minutes when the head was tilted up. A close positive correlation between PNA and simultaneously measured mean arterial pressure (MAP) in the young EHT (r = 0.698, p less than 0.001) and WHO-I (r = 0.631, p less than 0.001), and a weak correlation in the middle-age EHT (r = 0.435, p less than 0.05) and NRH (r = 0.311, p less than 0.05) were demonstrated immediately after hospital admission. In the old-age EHT, WHO-II and LRH, however, no significant correlation was found between PNA and MAP. The mean value of NA-R in young (p less than 0.005) and middle-aged EHT (p less than 0.001) was significantly greater than that in respectively age-matched NT.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Insulin and cardiovascular diseases in Japanese work-site population with borderline to mild hypertension.

To clarify whether significant interrelations between hyperinsulinemia and cardiovascular diseases exist in Japanese, we analyzed serum insulin levels, fasting and after oral glucose load, in relation to blood pressure (BP), serum lipids, and incidence of acute myocardial infarction (MI) and stroke in 584 male employees of a railroad company with borderline to mild hypertension (age: 49 +/- 7 years, BP: 139 +/-13/90 +/- 8 mmHg, body mass index: BMI 24.0 +/- 2.8, mean +/- SD). Those who were taking antihypertensive drugs and/or hypoglycemic agents were excluded. The subjects were classified into five groups of comparable size according to sigma IRI (area composed by insulin levels at 0, 1, 2 hours post glucose load). Although averaged age, levels of fasting glucose and HbA1c were not significantly different among quintiles, the hyperinsulinemic groups had higher levels of fasting IRI and sigma glucose. Multiple regression analysis revealed that sigma IRI was associated positively with BMI, sigma glucose, systolic BP, total cholesterol, and negatively with HDL-cholesterol. During 7-year follow-up 7 cases with MI and 15 cases with stroke were registered. The subjects with MI, but not with stroke were involved in higher deciles of insulin levels. These results indicate that the insulin resistance syndrome exists in Japanese middle-aged men with borderline to mild hypertension. The association with cardiovascular morbid events appeared to be evident in coronary heart disease but not in cerebrovascular disease.

Adult↗
PubMed1997

Preferential changes in hepatosplanchnic hemodynamics in patients with borderline hypertension.

To investigate changes in systemic and regional hemodynamics during the development of human hypertension, we simultaneously measured cardiac index (CI) by the indocyanine green (ICG) dye dilution method, hepatosplanchnic blood flow (HBF) by the ICG clearance method using a two-compartment model, and renal blood flow (RBF) by the p-aminohippurate clearance method in patients with borderline and essential hypertension. In patients with borderline hypertension (BH, n = 27), HBF (435 +/- 15 ml/min/m2) and HBF/CI (16 +/- 1%) were significantly (p < 0.05) lower than in age-matched normotensive controls (528 +/- 21 and 19 +/- 1, respectively, n = 21), while CI, RBF and RBF/CI were similar. In patients with essential hypertension (EH, n = 32), HBF, RBF, and RBF/CI were all significantly (p < 0.01) lower than in the control subjects. Hepatosplanchnic vascular resistance (HVR) in patients with BH was preferentially increased, while total peripheral resistance (TPR) and renal vascular resistance (RVR) remained in the normal range. In patients with EH, TPR, HVR, and RVR were all increased. These results indicate that hemodynamic changes in patients with BH do not occur uniformly among the various regional circulations and suggest that hemodynamic changes in the hepatosplanchnic region precede those in other organ circulations during the development of human hypertension.

Adolescent↗
PubMed2005

Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: influences of age and sex.

BACKGROUND: We present a large European population-based study of thyroid function, performed in a population with longstanding borderline sufficient iodine intake. METHODS: The Nijmegen Biomedical Study is a population-based survey conducted in the eastern part of The Netherlands. Randomly selected inhabitants received a postal questionnaire on lifestyle and medical history, which was filled out by 9371 individuals (41.7%). We measured serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and anti-thyroperoxidase antibodies (TPOAbs) in 6434 responders. A reference population of 5167 individuals was selected by excluding those at risk for thyroid disease. RESULTS: Overt thyrotoxicosis was found in 0.4% of the total population and subclinical thyrotoxicosis in 0.8%. Overt hypothyroidism was found in 0.4% and subclinical hypothyroidism in 4.0%. In individuals older than 60 years, mean FT4 concentrations increased with age. Mean TSH decreased with age, from 1.46 mIU/L at 18-24 years to 1.07 mIU/L after 85 years. The mean TSH in the total population did not differ from the mean TSH in the reference population; the exclusion of those at risk for thyroid disease, however, lowered the upper limit of the TSH reference interval considerably. In the total population, 8.6% of males and 18.5% of females had positive TPOAbs. The presence of TPOAbs was associated with abnormally high and low TSH concentrations. CONCLUSION: In inhabitants of the eastern part of The Netherlands, serum TSH gradually decreases with age, whereas after age 60, serum FT4 increases, possibly because of the development of thyroid autonomy after longstanding borderline sufficient iodine intake.

Adolescent↗
PubMed1983

Use of clonidine and propranolol as monotherapy in borderline hypertension.

The effect of clonidine (average 0.24 mg/day) and propranolol (average 105 mg/day) on home blood pressure readings in 16 patients with borderline hypertension was investigated in a randomized, double-blind, placebo crossover design. Patients could detect small but significant decreases of blood pressure with both active compounds (-8/-5 with propranolol and -11/-7 with clonidine). The larger mean blood pressure decrease from clonidine vs propranolol was significant (p less than 0.015). Small doses of sympatholytic agents might control the blood pressure in patients with borderline hypertension, and the home blood pressure technique is a convenient tool to detect and monitor such changes. Biochemical predictors of the responsiveness to clonidine were investigated. There was no difference in placebo norepinephrine and renin values between better and lesser responders to clonidine. Plasma norepinephrine fell with clonidine treatment, but with no relationship to the blood pressure response. Plasma norepinephrine response to clonidine might reflect not only the central withdrawal of sympathetic tone, but also, in part, the effect of clonidine on peripheral presynaptic alpha 2-receptors.

Adult↗
PubMed2003

Reliability and validity of the borderline personality disorder severity index.

The psychometric properties and validity of the Borderline Personality Disorder Severity Index (BPDSI), a semistructured interview assessing the frequency and severity of manifestations of Borderline Personality Disorder (BPD) during a circumscribed period, were investigated in two studies. In study 1, patients with BPD (n = 15), with other personality disorders (PD; n = 18), and without Axis II disorders (but with Axis I disorders; n = 10) assessed with the SCID were interviewed with the BPDSI (1-yr. version). Patients also filled out a number of questionnaires. A second rater judged taped BPDSI interviews. The BPDSI appeared to yield highly reliable (ICC = .93) and internally consistent (Cronbach's alpha = .85) scores. The BPDSI strongly discriminated BPD patients from other patients, and was not related to other Axis II pathology. Concurrent and construct validity was excellent. In study 2, a version of the BPDSI suitable for use in treatment outcome research was investigated (3-month version) in a sample of 64 BPD patients, 23 Cluster C PD patients, and 20 nonpsychiatric controls. Again, reliability coefficients were excellent (ICC = 0.97; Cronbach's alpha = 0.93), and validity indices were good. Clinical norms were also derived. In a sample of 28 BPD patients, the instrument detected improvement during 6 months of psychotherapy.

Adult↗
PubMed1996

Ovarian epithelial borderline tumor and carcinoma in young women.

To clarify the influence of age on clinical and histologic features, young women with ovarian epithelial borderline tumors and carcinomas were analyzed. A retrospective review of 93 patients with ovarian common epithelial borderline tumors and carcinomas was performed. Twenty-one of 93 patients (22.6%) were under age 40. Predominant symptoms in young patients were abdominal pain or abdominal distention, but 4 (19%) patients had no symptom. Eleven (11/21; 52.4%) patients were nulliparous and six patients received conservative surgery to preserve fertility. The rate of histologic type and stage did not significantly differ between the young and older groups. Although overall survival between young and older patients did not significantly differ, the survival of young patients with advanced disease (stage III and IV) was significantly worse than in older patients with advanced disease. (p < 0.05).

Adolescent↗
PubMed1999

Urinary excretion of ceruloplasmin is elevated in the subjects with "borderline glucose tolerance test".

To examine whether or not there are any renal alterations in subjects with borderline glucose tolerance and in patients with non-insulin dependent diabetes mellitus (NIDDM) classified by the criteria of Japan Diabetic Association, urinary excretions of plasma proteins including albumin, ceruloplasmin (Cerulo) and IgG were measured in timed overnight urine samples. Eighty middle-aged, non-obese, normotensive, untreated men with urinary albumin excretion rates below 20 microg/minutes, beta2-microglobulin excretion rates below 140 microg/minutes and creatinine clearance values exceeding 80 ml x min(-1) x (1.73 m2)(-1) were included in this study. Three groups were defined according to the results of 75 g oral glucose tolerance test (OGTT) as follows: D group, 10 subjects with NIDDM; B group, 40 subjects with "borderline glucose tolerance test" and N group, 30 subjects with normal glucose tolerance. The fractional clearance (theta) of Cerulo, but not albumin and IgG, was elevated in 37. 5% of the B group compared with the upper limit of that of the N group. Furthermore, theta-Cerulo and theta-IgG increased in the D group compared with those of the N and the B groups. Recently, we found that theta-Cerulo and theta-IgG increased in healthy volunteers when GFR was elevated by acute protein loading and that increase in theta-Cerulo is remarkable than increase in theta-IgG. The present result, taken together with our recent finding mentioned above, suggests that increases in theta-Cerulo and theta-IgG may not be due to an impairment of charge selectivity in the glomerular basement membrane, but due to an increase of intraglomerular hydraulic pressure.

Adult↗
PubMed1976

Borderline hypertension discovered during screening: effect of twelve months' treatment.

The frequency of borderline hypertension (diastolic BP 95 to 109 mm Hg) is described in 5,877 men and 1,125 women attending a screening clinic. Borderline hypertension is more frequent in each 5-year age group in men than women. The results of the initial 12 months treatment show a greater fall in mean systolic and diastolic pressures in those on active treatment in comparison with placebo. Over the same 12 months the sum of selected ECG precordial lead voltages shows a significant fall in those on active treatment as compared with those on placebo.

Adult↗