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PubMed1975

Management of the borderline patient on a medical or surgical ward: the psychiatric consultant's role.

The patient with borderline personality hospitalized on a medical or surgical ward has a disorganizing effect on the house staff, who may regress in response to the patient's impulsivity, dependency, entitlement, and rage. The psychiatric consultant's role in the management of such a patient should consist of a specialized type of consultee-oriented approach in which countertransference hatred and fear, typically generated in the staff by the borderline, are drawn away from the patient and strategically metabolized within the staff-consultant relationship. The consultant should actively promote a behavioral management practicum, placed in the medical chart for reference and as a symbol of the psychiatrist's helping presence, which discusses: a) clear communication with the patient and among staff, b) understanding the patient's need for constant personnel, c) dealing with the patient's entitlement without confronting the patient's needed defenses, and d) setting firm limits on the patient's dependency, manipulativeness, rage, and self-destructive behaviors. The consultant should work to counteract feelings of helplessness in the staff, to neutralize punitive superego in the staff, and to diminish fearfulness toward the patient.

Adult↗
PubMed1993

Response of early-stage hepatocellular carcinoma and borderline lesions to therapeutic arterial embolization.

OBJECTIVE: In Japan, borderline lesions and early-stage hepatocellular carcinoma (HCC) are now histopathologically divided into two subgroups; one includes adenomatous hyperplasia and atypical adenomatous hyperplasia, and the other includes early HCC and early advanced HCC. In order to evaluate the efficacy of transcatheter arterial embolization for treating such lesions, histopathologic studies were done after embolization and resection in 27 patients. MATERIALS AND METHODS: The lesions consisted of two adenomatous hyperplasias, one atypical adenomatous hyperplasia, 22 early HCCs, and 13 early advanced HCCs. All patients had chronic liver diseases in nontumorous parenchyma in addition to HCC. For transcatheter arterial embolization, one of the following embolizing materials was used: iodized oil (Lipiodol) alone (n = 4), an emulsion of doxorubicin in Lipiodol (n = 8), and the same emulsion followed by gelatin sponge particles (n = 15). RESULTS: The frequencies of tumor stain on the angiogram and retention of Lipiodol within the tumor were 84% and 94% in overt HCC, 23% and 69% in early advanced HCC, and 9% and 9% in early HCC, respectively. The average size of overt HCC was significantly (p < .01) larger than that of early advanced HCC and early HCC. The amount of necrosis induced by embolization relative to the size of the mass was 56% on average in overt HCCs, 14% in early advanced HCCs, and 0% in early HCCs, atypical adenomatous hyperplasias, and adenomatous hyperplasias. Significant differences (p < .01) in mean necrosis rate were seen between overt HCCs and early advanced HCCs, between early advanced HCCs and early HCCs, and between overt HCCs and early HCCs. The frequency of Lipiodol retention correlated with mean necrosis rate for tumor. With reference to therapeutic techniques, only for the overt HCCs was a significant difference (p < .01) in the mean necrosis rate found between the group that received the emulsion of doxorubicin in Lipiodol and the group that received the emulsion and then particles of gelatin. CONCLUSION: This study suggests that transcatheter arterial embolization has limited efficacy for treating early-stage HCC and borderline lesions compared with its efficacy for treating overt HCC.

Aged↗
PubMed2000

Cardiovascular risk profile in individuals with borderline glycemia: the effect of the 1997 American Diabetes Association diagnostic criteria and the 1998 World Health Organization Provisional Report.

OBJECTIVE: In 1997, the American Diabetes Association (ADA) recommended a new diagnostic category, impaired fasting glucose (IFG), to describe individuals with borderline glucose tolerance. On the other hand, the World Health Organization (WHO) suggested retaining the category of impaired glucose tolerance (IGT). We studied the prevalence of IFG and IGT in a multiethnic society and compared the cardiovascular risk profiles of subjects with IFG, IGT, or both IFG and IGT. RESEARCH DESIGN AND METHODS: A total of 3,568 subjects were examined from the 1992 National Health Survey of Singapore, which involved a combination of disproportionately stratified sampling and systematic sampling. Anthropometric, blood pressure, insulin, lipid profile, and uric acid measurements were taken, and a standard 75-g oral glucose tolerance test was performed after a 10-h overnight fast. RESULTS: The prevalence rates of IFG only, IGT only, and both IFT and IGT were 3.45, 10.2, and 3.4%, respectively. The degree of agreement (kappa) between the two diagnostic criteria (the ADA IFG and the WHO IGT) was only 0.25. A fasting glucose level of 5.5 mmol/l was the optimal cutoff for predicting a 2-h postload glucose level of > or =7.8 mmol/l. The following cardiovascular risk factors were higher in subjects with both IFG and IGT compared with those with either IFG or IGT alone: systolic blood pressure (131 +/- 20 vs. 125 +/- 21 and 125 +/- 19 mmHg, respectively; P < 0.05 and P < 0.001, respectively); diastolic blood pressure (77 +/- 12 vs. 73 +/- 12 and 74 +/- 12 mmHg, respectively; P < 0.05); BMI (26.2 +/- 4.2 vs. 24.4 +/- 4.0 and 24.6 +/- 4.4 kg/m2, respectively; P < 0.01 and P < 0.001, respectively); waist circumference (84.1 +/- 10.3 vs. 79.3 +/- 10.7 and 79.3 +/- 10.6 cm, respectively; P < 0.001); waist-to-hip ratio (0.84 +/- 0.08 vs. 0.82 +/- 0.09 and 0.81 +/- 0.08, respectively; P < 0.05 and P < 0.001, respectively); fasting insulin (12.1 +/- 9.7 vs. 9.2 +/- 5.3 and 9.9 +/- 7.7 mU/l; P < 0.01); insulin resistance (by homeostasis model assessment [HOMA]) (3.41 +/- 2.77 vs. 2.58 +/- 1.50 and 2.43 +/- 1.83, respectively; P < 0.01 and P < 0.001, respectively); total cholesterol (5.81 +/- 1.1 vs. 5.51 +/- 1.1 and 5.53 +/- 1.1 mmol/l, respectively; P < 0.05) and apolipoprotein(B) [apo(B)] (1.5 +/- 0.38 vs. 1.40 +/- 0.34 and 1.39 +/- 0.35 mmol/l, respectively; P < 0.01). The pattern of difference remained significant only for fasting insulin, insulin resistance (HOMA), and apo(B) (borderline) after adjustment for age, sex, and ethnic differences. CONCLUSIONS: Obvious discordance was evident in the classification of glycemic status when applying the criteria proposed by the ADA (IFG) or WHO (IGT) in a multiethnic society like Singapore. However, subjects with either IFG or IGT had similar cardiovascular risk profiles. Therefore, both criteria identified individuals at high risk for cardiovascular disease. Individuals with both IFG and IGT had a greater incidence of the cardiovascular dysmetabolic syndrome.

Adolescent↗
PubMedDate not supplied

A 5-month-old boy with recurrent respiratory infections, failure to thrive, and borderline elevated sweat chloride levels.

Both severe combined immunodeficiency (SCID) and cystic fibrosis (CF) may present in infancy with a history of respiratory infections and failure to thrive. Elevated sweat chloride levels on multiple sweat tests is diagnostic of CF; transient elevation of sweat chloride has been reported in patients with hypogammaglobulinemia and antibody deficiency without CF. This article presents a case report of a 5-month-old boy with recurrent respiratory infections, failure to thrive, and two borderline elevated sweat test levels. Laboratory evaluation including testing for CF as well as immune deficiency was performed in this patient. Two borderline abnormal sweat chloride tests together with isolation of Pseudomonas from the airway caused clinicians initially to suspect CF; however, mutation in gene coding for the gamma-chain of the IL-2 receptor and a negative CF genetic mutation analysis ultimately led to the final diagnosis of SCID. It is essential to make the diagnosis of SCID as early as possible because infants with SCID who do not undergo reconstitution of their immune system universally die in infancy because of infection. Early diagnosis and intervention can lead to an excellent prognosis in a previously fatal disease.

Chlorides↗
PubMed1996

Treatment strategies of the borderline ovarian tumors.

The present study was undertaken to establish the role of surgical procedures, histologic type, and stage of the tumor on the survival rate of patients with borderline ovarian tumors in a 5 to 15 years of follow-up. Data reported in the literature have shown the low malignancy of this cancer and that only the stage, but not the pathological diagnosis, is significantly influencing the survival rate of the patients. After 5 years, the survival rate of patients with tumors of stage I to stage II is 98.2% (n=567) and 81.4% (n=46), respectively, with no statistical difference. After 5 years, survival rate between tumors of stage I to stage III is 98.2% (n=567) and 79.1% (n=96), respectively (p< 0.05). The data shows that for borderline ovarian tumors, a minimally invasive surgery is warranted.

Female↗
PubMed1989

Broad ligament mucinous and serous cystadenomas of borderline malignancy.

The clinical and pathological findings including light microscopic and ultrastructural features of two cases of borderline mucinous and serous cystadenomas that originated in the broad ligament are reported. The tumors did not involve the oviduct or ovary. They probably arose in pre-existing cysts of mesothelial and paramesonephric (primary Müllerian) origin. These rare tumors bear a close resemblance to the borderline epithelial tumors of the ovary and the same prognostic criteria may be applicable to the lesions presented here.

Adnexa Uteri↗
PubMed1995

Plasma adrenaline modulates alpha 1-adrenoceptor mediated pressor responses and the baroreflex control in patients with borderline hypertension.

Plasma level of adrenaline has been reported to be elevated in borderline hypertension. However, its role in developing and maintaining hypertension is still not completely understood. This study aimed to estimate the role of plasma adrenaline in developing hypertension. Ten patients with borderline hypertension (BHT) and 10 age-matched normotensive subjects were included. We infused at least three graded doses of phenylephrine, an alpha-adrenoceptor agonist, into the antecubital vein of subjects lying quietly in a supine position. Mean blood pressure was measured continuously through the right radial artery. Cardiac output was measured by the thermodilution method before and after the administration of each dose of phenylephrine infusion. We obtained dose-response curves for mean blood pressure and total peripheral resistance to phenylephrine. Baroreflex sensitivity was calculated by plotting the longest R-R intervals against the elevated peak mean blood pressure after the infusion of each dose of phenylephrine. Plasma noradrenaline and adrenaline concentrations at rest were measured by high performance liquid chromatography coupled with trihydroxyindole fluorimetric detection. The plasma adrenaline level at rest was higher in patients with BHT than in normotensive subjects. With graded infusion of phenylephrine, both the pressor responses and the changes in total peripheral resistance were greater in patients with BHT than in normotensive subjects. The plasma adrenaline level was positively correlated with the slope of dose response curves for the increments of mean blood pressure to phenylephrine (r = 0.60, p < 0.01). Baroreflex sensitivity was reduced in patients with BHT as compared with normotensive subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1996

Low dose of ACE-inhibitor enhances sodium excretion in volume expanded patients with borderline hypertension.

The purpose of the present study was to separately investigate the effects of two different dosages of captopril on pressor, vascular and humoral response to acute extracellular volume expansion in patients with borderline hypertension (BHT). Thirty-five patients were randomly allocated in two groups undergoing acute saline infusion (0.40 ml/min/kg for 45 min and 0.15 ml/min/kg for 75 min)before and after a 7-day period of treatment with either placebo or captopril at the dose of 12.5 (LD-CAP) or 50 mg (HD-CAP) twice a day. At baseline the effects of LD-CAP were limited to an increase in PRA and to a decrease in plasma aldosterone whereas HD-CAP decreased systolic and diastolic blood pressure (SBP, DBP), forearm vascular resistance (FVR) and increased venous distensibility (VV(30)) as well. After saline loading patients treated with HD-CAP showed an increase in SBP, DBP not observed in patients allocated to LD-CAP. Urinary sodium excretion in response to NaCl loading was selectively enhanced by LD-CAP (+25%) whereas HD-CAP did not (+6.3%). The present data suggest that low-doses of ACE-inhibitors acting through a selective blockade of RAA not associated with hemodynamic changes can enhance the natriuretic response to acute volume expansion in borderline hypertensives.

Adult↗
PubMed1988

Neurogenic abnormalities in young borderline hypertensives.

Although neurogenic abnormalities have been postulated to be involved in the pathogenesis of borderline hypertension, no direct evidence has been documented. We continuously recorded muscle sympathetic nerve activity (MSNA) using a microelectrode in the tibial nerve, along with arterial pressure (AP) and heart rate (HR) during the cold pressor or isometric handgrip test in 16 male adolescents with borderline hypertension (BHT) and 10 normotensive adolescents (NT). Baroreflex changes in MSNA were also assessed during the pressor responses to intravenous phenylephrine. During the cold pressor test, both MSNA and AP gradually increased, but the HR responses were inconsistent. The resulting changes in MSNA, AP and HR were all augmented in BHT compared with NT. By contrast during the isometric handgrip test, MSNA, AP, and HR increased in both groups, but none of the differences between the groups was significant. Furthermore, baroreflex inhibition of MSNA were significantly reduced in BHT. Thus, some neurogenic abnormalities exist in BHT, which can be easily detected by recording MSNA.

Adolescent↗
PubMed1989

Increased hematocrit with normal red blood cell mass in early borderline essential hypertension.

Hematocrit, red blood cell mass, plasma volume and plasma renin activity were evaluated in 33 (15 women) young patients with borderline hypertension and in 30 (15 women) age- and sex-matched normotensive control subjects. Mean hematocrit values were slightly but significantly higher (P less than 0.05) at this early stage of hypertension and it correlated with the elevation of arterial hypertension (r = 0.39, P less than 0.05). Red blood cell mass was normal indicating normal bone marrow production. Plasma volume was significantly contracted (p less than 0.05) and it can account in part for the increased hematocrit and plasma renin activity. These results indicate that the alterations in circulating fluid components and in hematocrit described in moderate to severe forms of hypertension are also present in early borderline hypertension.

Adult↗
PubMed1992

Factors associated with acute salt-sensitivity in borderline hypertensive patients.

The acute sensitivity to sodium loading has been investigated in 26 borderline hypertensive patients (BHT) undergoing acute i.v. NaCl infusion. Measurements included blood pressure (BP), forearm vascular resistance (FVR) and venous distensibility (VV30), plasma renin activity (PRA), plasma aldosterone, plasma atrial natriuretic factor (ANF), and plasma levels of endogenous Na+/K+ATPase inhibitor. Sodium loading was associated with a greater than 8% increase in mean BP in 12 patients defined as salt-sensitive (NaCl-SENS) in comparison to salt-insensitive (NaCl-INSENS) subset. NaCl-SENS patients in comparison to NaCl-INSENS exhibited 1) a greater baseline VV30 (2.1 vs 1.4 ml/100 ml; p less than .005), and a response to saline characterized by 2) increased FVR (21.4 vs -6.5%; p less than .005), 3) blunted PRA suppression (-42 vs -67%; p less than .05), 4) delayed ANF response and 5) release of a Na+/K+ATPase inhibitor. Post-loading cumulative urinary sodium excretion was reduced in NaCl-SENS borderline hypertensives compared to NaCl-INSENS (2.6 vs 3.8 mumol/min/Kg; p less than .05). We conclude that acute salt-sensitivity in BHT is characterized by a blunted hormonal response to sodium loading which could be responsible of the activation of hemodynamic as well as humoral mechanisms leading to progressive blood pressure increase.

Adult↗
PubMed1994

Changes in creatine kinase expression induced by exercise in borderline hypertensive rat hearts.

Hypertrophy in hypertensive hearts is associated with increased risk of cardiac morbidity and mortality that is not characteristic of exercised hearts. This study was done to determine whether exercise training of normotensive and borderline hypertensive rats induces the increased myocardial expression of BB and MB isoforms of creatine kinase (CK) that characterizes hypertensive hypertrophy. Spontaneously hypertensive (SHR), borderline hypertensive (BHR), and normotensive Wistar-Kyoto (WKY) rats were subjected to either an 8% sodium chloride diet or swim training to produce myocardial hypertrophy. Both exercise and a high salt diet induced an increase in the combined expression of CK-MB and CK-BB in SHR after 2 months. However, since swimming also exacerbated hypertension in SHR, exercise induced effects on CK were not distinguishable from those of hypertension. In WKY, neither exercise nor a high salt diet induced significant changes in CK isozyme expression. In BHR fed a high sodium chloride diet, significant increases in mean arterial pressure and left ventricular weight to body weight were not associated with changes in CK expression. In contrast, following 10 months of swim training BHR exhibited mild hypertrophy, decreased resting heart rates, and an increase in the combined expression of CK-MB and CK-BB. Therefore, exercise associated with a cardiac training effect in BHR induced changes in CK isozyme expression similar to those in hypertensive hearts.

Animals↗
PubMed1995

Insulin attenuates alpha-adrenergic aortic contraction in normotensive but not borderline hypertensive rats.

Hyperinsulinemia can alter vasoconstrictor responses in normotensive and hypertensive rats, but the effects of insulin on vascular contraction have not been evaluated in borderline hypertension. This study determined the effects of insulin on alpha-adrenoceptor mediated aortic contraction in male and female borderline hypertensive rats (BHR) and normotensive Wistar Kyoto (WKY) rats. Dose-response curves to norepinephrine (NE) and phenylephrine (PE) were performed in thoracic aorta in the absence or presence of insulin (100 microU/ml) for 2 hrs. Contraction to NE and PE was reduced in aorta from female WKY rats incubated with insulin compared to control. In aorta from 6 of 13 male WKY rats (insulin responders), an attenuated response to NE and PE was observed in the presence of insulin. However, insulin did not alter responses to NE or PE in aorta from male or female BHR. These results indicate that insulin impairs alpha-adrenoceptor mediated contraction in the normotensive female WKY rat and in a group of responder male WKY rats, but not in BHR. This study supports the presence of a resistance to the vascular effects of insulin in BHR.

Animals↗
PubMed1996

Long-term reproducibility and usefulness of daytime recording of noninvasive 24-hour ambulatory blood pressure monitoring in borderline hypertension: a two-year follow-up study.

We investigated the long-term reproducibility of noninvasive 24-hour ambulatory blood pressure monitoring (ABPM) compared with casual blood pressure measurements in 54 individuals (47 +/- 11 years) with borderline hypertension. ABPM and casual blood pressure measurements were obtained 3 times over 2 year period. ABPM data were analyzed to determine the average 24-hour blood pressure (24-BP), the average blood pressure during the waking hours (Day-BP), and the average blood pressure from the time the subject went to bed until he awoke (Night-BP). ABPM measurements were similar for Year 1, 2, and 3 (24-BP: Year 1; 130 +/- 10/79 +/- 6 mmHg; Year 2; 130 +/- 10/79 +/- 7 mmHg; and Year 3; 130 +/- 10/78 +/- 7 mmHg). Bland-Altman analysis and standard deviation of the difference also indicated the reproducibility of 24-BP was better than casual pressure. The 24-BP was significantly correlated with both Day-BP and Night-BP for each year. Day-BP showed the stronger correlation. Our results suggest that Day-BP provides reproducible estimation in subjects with borderline hypertension.

Adult↗
PubMed1997

Effects of alpha 1-blockade on maximal vascular conductance in young borderline hypertensives.

This study was conducted to determine if reducing sympathetic tone with alpha 1-adrenergic receptor blockade affected the maximal forearm vascular conductance (FVCmax, reactive hyperemia) responses in young borderline hypertensives and normotensive controls. The FVC response following ischemia (14 min arterial occlusion with 3 min of hand exercise) was determined after systemic alpha 1-blockade (5 mg prazosin in preceding 24 h) in hypertensives (n = 11, MAP = 110 +/- 1, age = 24.5 +/- 1.1, mean +/- SEM) and normotensives (n = 13, MAP = 82 +/- 1, age = 22.5 +/- 0.3). During the placebo trial, resting FVC was lower in the hypertensives than the normotensives (.0472 +/- .0073 vs .0755 +/- .0095 units; P < .05). During alpha 1-blockade, FVC did not differ between the groups. Within each group, FVCmax did not differ significantly between either trial. During placebo, FVCmax was lower (P < .05) in the hypertensives (.3485 +/- .0335 vs .5641 +/- .0503 units) and remained so during alpha 1-blockade (.4048 +/- .0520 vs .5286 +/- .0275 units; P < .05). These data suggest that alpha 1-blockade does not increase FVCmax in borderline hypertensives and that both functional and structural changes in the peripheral vasculature are involved in the blood pressure elevations seen in this group.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1987

Evaluating borderline students.

While it was difficult for our faculty to face the disparity which arose in deciding whether or not to pass Anne, many important points were raised which strengthened the evaluation process particularly in the case of the borderline student. Newer faculty members related uneasiness in being specific and directive with "borderline" students. Experienced faculty offered suggestions on overcoming this fear and finding support among peers. Open discussion provided a forum for the exchange of ideas and philosophies. Though no definitive solutions were uncovered we judged this workshop to be a valuable learning experience with broad appeal across a very diverse faculty.

Clinical Competence↗
PubMed2007

Primary peritoneal serous borderline tumors.

CONTEXT: Primary peritoneal serous borderline tumor is a rare epithelial proliferation that can present as an incidental finding at laparotomy and raises concern for a primary ovarian tumor with peritoneal implants. OBJECTIVE: To present a brief history of this condition and describe its distinctive histology and clinical presentation, as well as to review the chief differential diagnostic considerations, to include mesothelial proliferations, endosalpingiosis, endometriosis, high-grade primary peritoneal papillary serous carcinoma, and implants from primary ovarian serous neoplasms. DATA SOURCES: Relevant articles indexed in PubMed (National Library of Medicine) between 1966 and 2005, references thereof, and reference surgical pathology texts. CONCLUSIONS: Primary peritoneal serous borderline tumor should be considered in the differential diagnosis of an epithelial proliferation with prominent psammoma bodies on the peritoneal surface of specimens submitted for nongynecologic complaints.

Cystadenocarcinoma, Serous↗
PubMed1999

[Coexistence of ovarian epithelial tumor of borderline malignancy with pregnancy: a case report].

OBJECTIVES: Ovarian tumors during pregnancy are a rare event. In most cases the tumors are detected accidentally during routine examination, ultrasound or a caesarean section at term. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy, it seems however, that there are more lesions of borderline malignancy and of low grade. STUDY DESIGN: The patient age 26 during 16 week of pregnancy was operated in Department of Gynecology & Obstetrics in Hospital of Słupsk. RESULTS: During laparotomy ovarian epithelial tumor of borderline malignancy stage I A has been diagnosed and unilateral cystectomy after meticulous surgical exploration was done. A successful spontaneous delivery occurred subsequently when the patient was in 38 week of pregnancy. The patient is followed for disease status every three month and her health is good. CONCLUSIONS: Serous low malignant potential ovarian tumors during pregnancy have microscopic and clinical features suggesting aggressive behavior, however, these features appear to regress at the termination of pregnancy. Limited resection, after meticulous surgical exploration is adequate therapy for women of reproductive age.

Adult↗