Fertility after conservative treatment for borderline ovarian tumors: a French multicenter study

OBJECTIVE: To examine fertility outcomes and determinants of fertility after conservative surgery for women with borderline ovarian tumors. DESIGN: Retrospective multicenter study. SETTING: Thirteen specialized gynecologic units and one cancer center. PATIENT(S): In a study of women with borderline ovarian tumors, 162 of 360 women underwent conservative surgery; from these 162, we compared epidemiologic, surgical, and histological parameters between 21 women who conceived and 44 women who failed to conceive. INTERVENTION(S): Conservative surgery for borderline ovarian tumors. MAIN OUTCOME MEASURE(S): Fertility results and outcome. RESULT(S): Women undergoing conservative treatment were significantly younger and more likely to be nulliparous. Tumor size was significantly smaller in the conservative treatment group. Thirty pregnancies occurred in 21 (32.3%) of the 65 women who wished to conceive after conservative treatment. Twenty-seven pregnancies were spontaneous, whereas three occurred after ovarian stimulation and IUI (one case) or IVF (2 cases). Women who conceived did not differ from women who did not conceive in terms of the tumor recurrence rate or the mean time to recurrence (39.6 +/- 28.2 and 22.9 +/- 14.9 months, respectively). Age at initial treatment was the only determinant of fertility. CONCLUSION(S): Despite a high recurrence rate, our results confirm that conservative surgery for women with borderline ovarian tumors is an acceptable option and that fertility is preserved in nearly one third of cases.     

A borderline mucinous ovarian tumour treated by ovarian cystectomy in a 16-year-old patient

We present a case of a mucinous borderline ovarian tumour in a 16-year-old patient. It was removed by ovarian cystectomy before histological confirmation of its borderline nature.     

Identification of borderline personality disorders among substance abuse inpatients

By means of a structured interview procedure, individuals with borderline personality disorders were identified among a sample of 50 patients admitted to an inpatient substance abuse treatment program. When given a series of psychological tests, borderline patients were shown to be more pathological than a nonborderline group of substance abusers in a number of areas including depression, impulse control, antisocial tendencies and reality testing. Time spent in treatment was also shorter for the borderline group. Implications for substance abuse treatment programs and the potential impact of these patients on such programs is discussed.     

Adolescent alcohol use disorders predict adult borderline personality

BACKGROUND: This study investigated adolescent alcohol use disorders (AUDs) and other characteristics as predictors of adult borderline personality disorder (BPD) symptoms. METHODS: Adolescents with AUDs (n = 355) were recruited from clinical treatment sources and adolescents without AUDs (n = 169) were recruited from the community. During an adolescent assessment (age 16+/-1.3), childhood physical and/or sexual abuse history, AUDs and associated psychiatric disorders were measured via semi-structured interviews. Symptoms of BPD were measured in a young adult follow-up assessment (age 22+/-2.4). Latent class analysis was utilized to classify individuals into four categories based upon BPD symptom profiles. RESULTS: Multinomial regression models indicated that adolescent AUDs and other psychiatric disorders mediated the relationship between child physical and/or sexual abuse and adult BPD latent class. CONCLUSIONS: Results were consistent with a developmental conceptualization of BPD, with AUDs and other adolescent psychopathology antecedents representing developmentally relevant forms of dysregulation, and in their more severe forms culminating in borderline symptomatology.     

边缘性人格障碍治疗脱落引发的思考

目的验证心理动力学为背景的辩证行为心理治疗技术(Dialectical behavior therapy,DBT)对边缘性人格障碍患者的疗效。方法药物治疗和门诊心理治疗相结合。结果治理过程中出现移情与反移情,最终导致治疗关系恶化,在第8次治疗后患者攻击治疗师。结论边缘性人格障碍患者将不稳定的人际关系投射到治疗关系中,医生往往会替代现实中的客体被攻击和指责,现阶段的心理治疗还处于艰难状态。     

边缘性人格障碍对抑郁症患者临床疗效的影响

目的 探讨有边缘性人格障碍倾向的抑郁症与单纯抑郁症患者之间短期临床疗效的差异.方法 采用17项汉密尔顿抑郁量表(HAMD17)、14项汉密尔顿焦虑量表(HAMA14)在治疗前、治疗后第2,4周末分别对22例有边缘性人格障碍倾向的抑郁症患者(BPD组)和22例单纯抑郁症患者(对照组)进行评定.结果 第2周末,BPD组HAMD17总分、情绪因子分和认知障碍因子分分别为(15.5 ±4.50)分、(6.32±1.70)分、(1.09 ±0.75)分,高于对照组[分别为(11.7±3.75)分、(4.77±2.18)分、(0.59±0.73)分],均差异有统计学意义(均P＜ 0.05);第4周末,HAMD17总分、情绪因子分、睡眠因子分、精神焦虑因子分、躯体焦虑因子分、认知障碍因子分分别为(11.73±4.26)分,(5.41±2.13)分、(1.68±1.17)分、(1.91±.92)分、(1.95±1.10)分、(0.73±0.63)分,高于单纯抑郁组[分别为(5.91±2.74)分、(3.00±1.54)分、(0.77±.69)分、(1.05±0.38)分、(0.82±0.85)分、(0.18±0.40)分],均差异有统计学意义(均P＜0.05);BPD组与对照组HAMA14总分减分和各因子分减分在第2,4周末差异无统计学意义(均P＞0.05);第4周末,BPD组HAMD17、HAMA14总分减分率[分别为(50±16)％、(58±12)％],低于对照组分别为[(74±11)％、(74±10)％],均差异有统计学意义(均P＜0.05);BPD组与对照组在HAMD17疗效上的差异有统计学意义(P＜0.05).结论 有边缘性人格障碍倾向会影响抑郁症临床症状的缓解.     

Anterior cingulate volume reduction in adolescents with borderline personality disorder and co-morbid major depression

Borderline Personality Disorder (BPD) is a serious illness characterized by emotional dysregulation, impulsivity, and impaired interpersonal relationships. Prior work shows the anterior cingulate gyrus (ACG)—a region primarily involved in assessing the salience of emotional information and regulating emotional responses--is smaller in adults with BPD. We tested the hypothesis that, similar to adults, adolescents with BPD would have reduced Brodmann area (BA)-24 volume. Thirteen adolescent inpatients with co-morbid BPD and Major Depressive Disorder (MDD) and 13 matched healthy controls received 3T-MRI scans. Using a cytoarchitecturally-derived approach measuring gray and white matter volume, we observed a Group × Cingulate BA (25,24,31,23,29) × Matter (gray, white) type interaction indicating the BPD/MDD adolescents had smaller BA24 volume in gray but not white matter. Greater number of suicide attempts and BPD symptom severity measured by the Diagnostic Interview for BPD-revised (DIB-R) total score but not depressive symptoms measured by the Beck Depression Inventory (BDI) was associated with smaller BA24 volume. Our preliminary findings suggest that BPD-related abnormalities in BA24 volume may occur early in the developmental course of BPD with MDD. Future studies examining samples of MDD patients with and without BPD co-morbidity will be needed to clarify whether BA24 volume reductions are specific to BPD.     

Pathologic tumor response to neoadjuvant therapy in borderline resectable pancreatic cancer

BackgroundPrevious studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy (NAT). The aim of this study was to determine the incidence of significant pathologic response to NAT in borderline resectable pancreatic cancer (BRPC), and association of NAT regimen and other clinico-pathologic characteristics with pathologic response.MethodsPatients with BRPC who underwent NAT and pancreatic resection between January 2012 and June 2017 were included. Pathologic response was assessed on a qualitative scale based on the College of American Pathologists grading system. Demographics and baseline characteristics, oncologic treatment, pathology, and survival outcomes were compared.ResultsSeventy-one patients were included for analysis. Four patients had complete pathologic responses (tumor regression score 0), 12 patients had marked responses (score 1), 42 had moderate responses (score 2), and 13 had minimal responses (score 3). Patients with complete or marked responses were more likely to have received neoadjuvant gemcitabine chemoradiation (62.5%, 38.1%, and 23.1% of the complete/marked, moderate, and minimal response groups, respectively; P = 0.04). Of the complete/marked, moderate, and minimal response groups, margins were negative in 75.0%, 78.6%, and 46.2% (P = 0.16); node negative disease was observed in 87.5%, 54.8%, and 15.4% (P < 0.01); and median overall survival was 50.0 months, 31.7 months, and 23.2 months (P = 0.563). Of the four patients with pathologic complete responses, three were disease-free at 66.1, 41.7 and 31.4 months, and one was deceased with metastatic liver disease at 16.9 months.ConclusionsA more pronounced pathologic tumor response to NAT in BRPC is correlated with node negative disease, but was not associated with a statistically significant survival benefit in this study.     

HPA axis alterations in mental disorders: impact on memory and its relevance for therapeutic interventions

Dysfunctions in hypothalamic-pituitary-adrenal (HPA) axis have been reported for several mental disorders that are also often characterized by memory disturbances. It is now well established that glucocorticoids influence cognitive processes by enhancing memory consolidation and impairing memory retrieval. There is further evidence for an association between HPA axis related disturbances and memory function in mental disorders. The present selective review provides a brief overview of HPA axis dysfunction and its impact on memory function in major depressive disorder, posttraumatic stress disorder, and borderline personality disorder. Furthermore, the relevance of these findings for therapeutic intervention is discussed.     

Neural correlates of impulsive responding in borderline personality disorder: ERP evidence for reduced action monitoring

Patients with borderline personality disorder (BPD) are characterized by marked impulsive behaviour. The impulsive response style of patients with BPD may be associated with diminished action monitoring, which can be investigated by measuring the error-related negativity (ERN). The ERN is an ERP component generated in the anterior cingulate cortex (ACC) following erroneous responses. Behavioural and ERP measurements were obtained during performance on a speeded two-choice reaction task in a group of patients with BPD (N=12) and in a group of age-matched controls (N=12). The ERP results showed that ERN amplitudes were reduced for patients with BPD, as were the P300 amplitudes after late feedback. The behavioural results confirmed a more impulsive response style for the BPD group, reflected in larger RT differences between correct and incorrect responses and in an increase in erroneous responses to the easy congruent stimuli. Additionally, analyses on post-error congruency effects demonstrated that controls adjusted their behaviour following errors, but patients with BPD did not. The attenuated ERNs indicate reduced action monitoring in patients with BPD. This suggests that the ACC, or the action-monitoring network it is part of, is not functioning optimally. Due to this reduced action monitoring, patients with BPD do not learn from their errors as well as controls. Consequently, they do not adjust their behaviour when necessary and thus maintain their impulsive response style.