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PubMed1976

Plasma factors in delayed-type hypersensitivity. Augmentation of lymphocyte responses in borderline leprosy reactions.

The phytohaemagglutinin-induced responses of lymphocytes were found to be inhibited by plasma from patients with leprosy when compared with their responses in pooled serum from healthy donors. When patients developed reversal reactions, the initial inhibitory effect of their plasma was replaced by an augmentary effect on the responses to phytohaemagglutinin. The period of augmentation coincided with that of the reversal reaction in patients with borderline tuberculoid leprosy, but was delayed in patients with borderline lepromatous leprosy. The plasma from each leprosy patient was also observed to have the same effect on lymphocytes from unrelated individuals, showing that the inhibition and augmentation were due to factors in the plasma and not to a change in lymphocyte receptors. It is possible that the normal stable state of leprosy results from the presence of factors in plasma which act as a control mechanism, and that delayed hypersensitivity reactions may be caused by a breakdown of this control.

Adolescent↗
PubMed2000

Quantitative detection of oncogenic HPV DNA using hybrid capture to triage borderline and mildly dyskaryotic Papanicolaou smears.

OBJECTIVE: To investigate the use of hybrid capture to triage borderline and mildly abnormal PAP smears to either colposcopy or continued cytological surveillance. METHOD: A prospective cross-sectional study of 207 women with either mild or borderline dyskaryosis referred to the colposcopy clinic at the Whittington Hospital, London was done. Quantitative detection of oncogenic human papillomavirus deoxyribose nucleic acid was performed using the solution hybridization technique Hybrid Capture I (Digene Diagnostics). Positive or negative hybrid capture results were compared to colposcopically directed punch biopsy or loop excision of the transformation zone. RESULTS: Hybrid capture correctly predicted 1/1 micro-invasive cancers, 23/24 CIN 3 and 20/24 CIN 2, giving a sensitivity to detect significant disease of CIN 2 or above of 90%. For CIN 1, 37/66 were HPV positive making the sensitivity to detect all grades of CIN 70%. Of women with a normal cervix, 39/92 were HPV positive and in total 58% of the women were HPV positive and would have been referred to colposcopy. CONCLUSIONS: Hybrid capture was a simple solution hybridization method which provided a sensitive method of detecting CIN 2 and above lesions in women with minor PAP smear abnormalities. However, the sensitivity for CIN 1 and the specificity were low, meaning that further improvements in the technique are needed before it can be used as a triage strategy.

Adolescent↗
PubMed2000

Cervicography to triage women with borderline or mild dyskaryotic cervical PAP smears.

OBJECTIVE: To evaluate six years experience using cervicography to triage women with borderline or mildly dyskaryotic PAP smears to either immediate colposcopy or cytological surveillance. METHOD: Retrospective study of 1,436 women referred to the cervicography clinic of the Whittington Hospital, London. Women with suspicious cervigrams were examined colposcopically and biopsied. Women with normal appearances at cervicography were followed-up with cytology over a period of a least two years. RESULTS: Cervicography detected 281 out of 307 women with CIN 2/3 and 215 out of 264 women with CIN 1. The sensitivity of cervicography to detect CIN 1, 2 or 3 in women with minor PAP smear abnormalities was 92%. The specificity was 39% and 847 (59%) of the women were referred for colposcopy; 215 (15%) were lost to follow-up. CONCLUSIONS: Cervicography was a sensitive method to detect CIN in women with mild or borderline dyskaryosis on their PAP smears. However, the low specificity meant that a high proportion of the women were referred for colposcopy, and a significant proportion of women were lost to follow-up. Thus cervicography is not an efficient strategy for managing women with minor PAP smears abnormalities.

Adult↗
PubMed2001

Treatment with simvastatin and low-dose aspirin depresses thrombin generation in patients with coronary heart disease and borderline-high cholesterol levels.

Aspirin and statins are beneficial in coronary heart disease across a broad range of cholesterol levels. We assessed the effects of low-dose aspirin (75 mg daily) on thrombin generation in patients with coronary heart disease and average blood cholesterol levels. We also investigated whether in patients with borderline-high cholesterol level who have been already taking aspirin, additional treatment with simvastatin would affect thrombin generation. Seven-day treatment with low-dose aspirin decreased thrombin generation ex vivo only in patients with total cholesterol < or = 5.2 mmol/L. In patients with higher cholesterol levels aspirin had no effect. In these patients, already taking low-dose aspirin, additional three-month simvastatin treatment resulted in a reduction of thrombin generation. This demonstrates that low-dose aspirin depresses thrombin generation only in subjects with desirable blood cholesterol levels, while in others, with borderline-high cholesterol, thrombin formation is being reduced following the addition of simvastatin.

Adult↗
PubMed2001

[Borderline tumors of the ovary: a multicenter study in 137 patients].

OBJECTIVES: Evaluate management of patients with a borderline ovarian tumor. MATERIALS AND METHODS: A multicentric retrospective survey was conducted in 137 patients with borderline ovarian tumor diagnosed between January 1, 19975 and December 31, 1995. RESULTS: Mean follow-up was 6.5 years, mean age was 50 years. Initial surgery was cystectomy, unilateral salpingo-oophorectomy and total hysterectomy with bilateral salpingo-oophorectomy in 22, 40 and 75 cases respectively. Eleven patients had residual disease. Serous, mucinous and Brenner tumors were observed in 67, 69 and 1 cases respectively. Staging was I, II, III in 117, 3, and 17 cases respectively with two pseudomyxomas. Adjuvant therapy was given in 15 patients. There was a recurrence in 15 patients and 14 died. The 5-year survival rate was 89.3%. Prognosis factors with an impact on survival rate were age, recurrence and type of surgery. Factors with a negative impact on recurrence were adjuvant therapy and residual disease after surgery. CONCLUSION: Careful staging followed by complete and radical surgery is essential. Unilateral salpingo-oophorectomy with omentectomy and multiple peritoneal biopsies may be indicated in younger patients undergoing radical surgery after pregnancy. Aduvant therapy is necessary for invasive implants.

Biopsy↗
PubMedDate not supplied

[Central segmental pancreatectomy in benign and borderline neoplasms of the pancreatic isthmus and body].

We report our experience with middle segment pancreatectomy for benign, cystic and borderline tumours of the neck and body of the pancreas. The guidelines for management of these tumours are unclear. Formerly they were usually resected with a pancreatico-duodenectomy or distal pancreatectomy including the spleen. However, such operations may cause high morbidity, a notable wastage of normal tissue and an unnecessary risk of diabetes mellitus and splenic loss. Four patients (age range: 34-72 years) with tumours of the neck or body of the pancreas underwent a middle segmental pancreatectomy. The cephalic stump was sutured with duct ligation. The distal stump was anastomosed with a Roux-en-Y jejunal loop. Neither pancreatic fistulas nor operative death occurred in any of the patients. In 3 patients with serous cystadenoma and in one with mucinous cystadenoma, the tumours measured 3.5 to 7 cm in size. These were located in the neck and body of the pancreas and could not be safely enucleated without compromising the pancreatic duct. All tumours were resected with clear margins. The mean operative time was 230 minutes and the median postoperative hospital stay 14 days (range: 10-23 days). The patients have been followed up for five years after surgery and all are disease-free. None of the patients became diabetic or presented exocrine insufficiency. Middle segment pancreatectomy may be an appropriate technique for selected benign or borderline pancreatic tumours in the neck and body of the pancreas. This procedure has an acceptable surgical risk when compared to that of major pancreatic resections and preserves pancreatic function and the spleen.

Adult↗
PubMedDate not supplied

u-PA expression in benign, borderline and malignant ovarian tumors.

The malignant potential of solid tumors is related to their ability to invade adjacent tissue and to metastasize. The plasminogen activation system is one of the critical factors in tumor progression since it is involved in tumor invasion and metastasis. This study was performed to examine the expression of u-PA in benign, borderline and malignant tumors of the ovary by immunohistochemical evaluation on formalin-fixed, paraffin-embedded specimens applying monoclonal antibody 3689 directed to the b-chain of u-PA. Normal epithelial cells of the ovary (n = 5) showed no staining of u-PA but some stromal cells were slightly stained. Invasive carcinomas (n = 16) and borderline tumors (n = 15) showed a moderate to strong diffuse cytoplasmic staining. Benign tumors (n = 20) showed a variety of staining. The observation of randomly positive u-PA stromal cells is noteworthy. The percentage of u-PA-positive tumors was higher in carcinomas than in other tumors. There was no correlation with other known risk factors of malignancy such as differentiation, stage or type of tumor. In conclusion there are noticeable differences in u-PA expression among ovarian tumors and u-PA increase in ovarian tumors can be attributed to an increased diffuse cytoplasmic content in the neoplastic epithelial cells.

Adult↗
PubMed1975

[A contribution to handling counter-transference in borderline patients (author's transl)].

This paper is based on the concept that, instead of neurotic conflicts as studied and treated by Freud, Earlier ego-disturbances e.g. psychotic and borderline reactions have nowadays become prominent and need a very different technique of treatment. These so called archaic ego-illnesses are due to an unresolved symbiosis complex, a disturbance which arises already in very early childhood before the development of speech. On a sample of a female borderline patient the author tries to show that in such cases active use of countertransference often provides the only technique with which the psychotherapist may recognize on an averbal plane the needs of the patient and may be able to make them available to her verbally.

Adult↗
PubMed2002

Reduced tolerance of simulated altitude (4200 m) in young men with borderline hypertension.

BACKGROUND: Primary hypertensives who are acutely exposed to hypoxic hypoxia show an enhanced reactivity of arterial chemoreceptors as well as an exaggerated response of the sympathetic nervous system. Since these phenomena could influence their ability to tolerate sustained hypoxic hypoxia, this study was performed to determine whether persons predisposed to hypertension have a normal tolerance of simulated high altitude. METHODS: Subjects were 18 young men with a family history of hypertension (sons of hypertensives, SOHT) whose BP values were in the upper normal or borderline hypertensive range. Controls were 15 young men without parental hypertension (sons of normotensives, SONT) who had normal BP values. Each subject underwent both a control and an altitude experiment. The latter consisted of an 8-h exposure to hypobaric hypoxia (equivalent to 4200 m) while resting supine in an altitude chamber. Fluids were administered by mouth and by intravenous line to produce sustained diuresis. Variables measured included heart rate, BP, respiratory rate, O2 saturation, urine flow rate, and sodium excretion. RESULTS: All subjects tolerated the control experiment and all SONT also completed altitude exposure. However, 8 of 18 SOHT developed antidiuresis and had to leave the chamber early due to symptoms of mild acute mountain sickness. Compared with SONT, SOHT exhibited more stable cardiorespiratory parameters at altitude. CONCLUSIONS: The data support the hypothesis that borderline hypertensives have stronger cardiorespiratory responses to altitude than controls, a response that is compatible with higher excitability of their arterial chemoreceptors. However, their altitude tolerance is reduced even at rest, probably because of the renal effects of an exaggerated response in the sympathetic nervous system.

Adaptation, Physiological↗
PubMed2001

Borderline personality disorder: Psychosocial considerations and rehabilitation implications.

The article describes the medical and psychosocial aspects of borderline personality disorder, a common and sometimes severe psychiatric condition marked by emotional instability and problems with interpersonal relationships. Medication, psychosocial and other treatment issues are discussed within the context of the rehabilitation counselor's role in providing vocational services for people with borderline personality disorder.

Journal Article↗
PubMed2002

[Bacterial cellulitis. Forms borderline between medical and surgical (3 cases)].

BACKGROUND: An acute infectious cellulitis may be managed medically (erysipelas or non-necrotizing infectious cellulitis) or surgically (necrotizing infectious cellulitis, necrotizing fasciitis). We report 3 cases of non-necrotizing infectious cellulitis borderline between medical and surgical forms, complicated by compartment syndrome, the surgical decompression of which permitted patients' cure. CASE REPORTS: Three patients, 27, 52 and 84 years old, were admitted for an acute infectious cellulitis of the leg. At admission, the leg area involved was erythematous, painful, indurated, with one or several bullae, purpura, pustules, hypoesthesia or limited skin necrosis, and no immediate need for surgical exploration. The clinical evolution was characterized by the slow appearance or extension of signs of severity, despite the modification in antibiotic treatment. Magnetic resonance imaging findings were indicative of a non-necrotizing infectious cellulitis in 2 patients. In one patient, necrotizing fasciitis could not be excluded. In all patients, surgical exploration showed an important quantity of non-purulent fluid between muscles and hypodermis, with no evidence of abscess or necrosis. A large incision rapidly cured all patients. DISCUSSION: These three observations were characterized by the initial signs of moderate severity and no response to an appropriate medical treatment, which led to surgical exploration. Surgery showed no abscess or necrosis but an important quantity of sterile fluid; it also permitted rapid cure of patients. These cases present a borderline form of infectious cellulitis, with severe local inflammation caused by a compartment syndrome. Surgical decompression was needed for cure. The potential value of magnetic resonance imaging in this situation should also be stressed.

Adolescent↗
PubMed2002

[Conservative management of malignant and borderline ovarian tumor].

Conservative management of at least a part of one ovary and the uterus, in order to preserve fertility-potential, could be propose in most of patients with nonepithelial and borderline ovarian tumor. This conservative management could be performed even in patients with borderline ovarian tumor associated with noninvasive peritoneal implants (if complete resection of peritoneal disease). A removal of the preserved ovary after completion of the pregnancy(ies) is not necessary if patients agree to a careful follow-up procedure. In patient with epithelial ovarian cancer, conservative management could be performed only in case of young patients who desire to preserve fertility function with: unilateral tumor (stage IA), grade 1 (and 2?), who underwent an adequate staging surgery (including peritoneal washings, omentectomy, multiple peritoneal biopsies, uterine curettage and complete pelvic and paraaortic lymphadenectomy) and with a careful follow-up. A conservative management should not be performed in patients with tumor stage > IA and/or grade 3. Removal of preserved ovary should be performed after completion of pregnancy(ies) in order to reduce the risk of ovarian recurrence.

Age Factors↗
PubMed1992

Reduced platelet thromboxane formation after long-term administration of a dihydropyridine calcium channel blocker: a prospective, double-blind, placebo-controlled study with nitrendipine in borderline hypertensive patients with IDDM-type diabetes mellitus.

Twenty-nine IDDM patients with borderline hypertension were randomly allocated to placebo or nitrendipine treatment. Nitrendipine was given orally at a dosage of 20 mg once daily over 4 weeks. Stimulated platelet thromboxane formation at rest and after standardized, non exhausting exercise was measured by standard methods. In addition, plasma levels of platelet factor 4 and aggregation responses to collagen and ADP were determined. In the treatment group thromboxane formation after stimulation with collagen (0.3 and 1.0 micrograms/ml) and 1 mM arachidonic acid (AA) was reduced in the resting state. Exercise induced change of thromboxane synthesis in response to 1.0 micrograms/ml collagen was significantly lower as compared to placebo (p < 0.05). In parallel, PF4 plasma levels were significantly lowered (p < 0.05). Whole blood aggregation after collagen stimulation (1.0 micrograms/ml) was reduced after 4 weeks of nitrendipine treatment, but ADP (5 microM) induced aggregation was not. These effects of nitrendipine were not seen in platelet rich plasma. In conclusion long-term nitrendipine treatment may inhibit collagen dependent platelet activation in the blood of diabetic patients with borderline hypertension.

Adenosine Diphosphate↗
PubMed2003

[Mural nodules of anaplastic carcinoma in bilateral ovarian borderline mucinous cystadenoma: a case report].

The occurrence of mural nodules in serous or mucinous ovarian tumors is not frequent but is currently well established. Mural nodules can developed in benign, borderline or malignant tumors. They can be reactive, benign or malignant. In these situations, the nodule may be carcinomatous, sarcomatous or mixed. Thus, the prognosis of the ovarian tumor can be dramatically modified by the presence of this nodule. About twenty cases of mural nodules of anaplastic carcinoma have been described. We report an additional case of two mural nodules of anaplastic carcinoma associated with bilateral ovarian borderline mucinous tumor. This tumor was synchronous with a renal cell carcinoma. We give details about the classification, the differential diagnoses and prognosis of these nodules.

Carcinoma↗
PubMed2004

Diagnosis of borderline ovarian cancers in pregnancy.

PURPOSE OF INVESTIGATION: Borderline ovarian tumors make up about 10 to 15% of all epithelial ovarian tumors. The aim of this study was to determine the sensitivity and specificity of Doppler ultrasound for adnexal masses in pregnancy by verifying histological lesions after surgery. METHODS: We analysed Doppler flows of ovarian cystic tumors in pregnancy. In cases of cystectomy in pregnancy, cesarean section and puerperium the obtained histopathological findings were analysed. RESULTS: For one year nine women were observed, primiparas, who had adnexal cystic tumefactions with pathological Doppler indexes, i.e. resistent index of the ovaries under 0.50 and ovarian capsules from 0.30 to 0.40. Delivery ended surgically and histopathological results (ex tempore of analysis) revealed borderline adenocarcinoma. CONCLUSION: Even though our series was very small, considering that cysts in pregnancy are not common it is necessary to consider the significance of Doppler flow following the diagnosis so therapeutic measures can be timely determined and morbidity and mortality decreased.

Adenocarcinoma↗
PubMed2004

A borderline form of empty follicle syndrome. Case report.

BACKGROUND: Empty follicle syndrome is known as the failure of oocyte retrieval despite the adequate response to ovarian stimulation. It is a rare phenomenon in in-vitro fertilization and borderline forms of this syndrome have also been described. MATERIALS AND METHODS: Two cycles in the same patient were stimulated with GnRH agonist/hMG and recFSH; the first followed the long and the second followed the short protocol. RESULTS: There was a sudden drop in estradiol levels while the ovaries contained a large number of small and medium sized follicles. hCG was administered and oocyte retrieval was performed 36 hours later. There was no indication of low hCG levels. For the first cycle two oocytes were collected: one degenerated and one of poor quality. The second cycle resulted in total failure of oocyte retrieval. CONCLUSION: The two cycles were classified as borderline forms of empty follicle syndrome. The possible aetiology is discussed.

Adult↗
PubMed2004

Hyperplastic mesothelial cells in pelvic and abdominal lymph node sinuses mimicking metastatic ovarian microinvasive serous borderline tumor.

Hyperplastic mesothelial cells within pelvic and abdominal lymph nodes were encountered in the staging procedure of a 32-year-old woman with a left ovarian microinvasive serous borderline tumor. Mesothelial hyperplasia was noted in the pelvic and abdominal peritoneum. Intranodal mesothelial cells occupied the subcapsular sinus with subadjacent interfollicular sinuses involved less strikingly. These mesothelial cells were originally misdiagnosed as a metastatic serous borderline tumor. Histologic review and immunohistochemistry confirmed mesothelial origin. This case represents the second reported example of mesothelial cells within the lymph nodes of patients with ovarian serous tumors. Similar involvement of the mediastinal, cervical and internal mammary lymph nodes has been described in several patients with pleural effusions without neoplastic cells. Intranodal mesothelial cells should be distinguished from metastasis--an error ending in upper staging of a case.

Adult↗