Cognitive impairment in patients with bipolar disorder alone versus those with bipolar disorder comorbid with borderline personality disorder

BACKGROUND Bipolar disorder(BD)is a severe mental illness.BD often coexists with borderline personality disorders,making the condition more complex.AIM To explore the differences in cognitive impairment between patients with BD and those with BD comorbid with borderline personality disorder.METHODS Eighty patients with BD and comorbid borderline personality disorder and 80 patients with BD alone were included in groups A and B,respectively,and 80 healthy volunteers were included as controls.Cognitive function in each group was evaluated using the Chinese version of the repeatable battery for the assess-ment of neuropsychological status(RBANS),the Stroop color-word test,and the Wechsler intelligence scale-revised(WAIS-RC).RESULTS The indices of the RBANS,Stroop color-word test,and WAIS-RC in groups A and B were significantly lower than those of the control group(P<0.05).Group A had significantly longer Stroop color-word test times for single-character,single-color,double-character,and double-color,lower scores of immediate memory,visual breadth,verbal function dimensions and total score of the RBANS,as well as lower scores of verbal IQ,performance IQ,and overall IQ of the WAIS-RC compared with group B(P<0.05).Compared to group B,group A exhibited significantly longer single-character time,single-color time,double-character time,and double-color time in the Stroop color-word test(P<0.05).CONCLUSION The cognitive function of patients with BD complicated with borderline personality disorder is lower than that of patients with BD.

Comprehensive multimodal management of borderline resectable pancreatic cancer:Current status and progress

Borderline resectable pancreatic cancer(BRPC)is a complex clinical entity with specific biological features.Criteria for resectability need to be assessed in combination with tumor anatomy and oncology.Neoadjuvant therapy(NAT)for BRPC patients is associated with additional survival benefits.Research is currently focused on exploring the optimal NAT regimen and more reliable ways of assessing response to NAT.More attention to management standards during NAT,including biliary drainage and nutritional support,is needed.Surgery remains the cornerstone of BRPC treatment and multidisciplinary teams can help to evaluate whether patients are suitable for surgery and provide individualized management during the perioperative period,including NAT responsiveness and the selection of surgical timing.

Is There Re-staging Surgery Necessity for Borderline Ovarian Tumors

Objective:This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors(BOTs)and evaluated the impact of complete surgical staging,lymphadenectomy,and omentectomy on disease recurrence and survival.Methods:We retrospectively reviewed the medical records of patients with BOTs.A total of 901 patients were eligible for inclusion in the study,and we evaluated some of the variables and clinical/surgical characteristics of the cases.The effects of the type of surgical procedure,surgical staging,and complete or incomplete staging on recurrence were calculated.The rates of disease-free survival,overall survival,and recurrence were compared according to complete surgical staging.A Cox regression analysis was performed to identify potential prognostic factors,and survival curves were constructed using the Kaplan-Meier method.Results:The overall recurrence rate was 13.9%,and recurrence was comparable between the complete surgical staging group and the incomplete groups(P>0.05).The performance of complete surgical staging did not show an effect on long-term survival,and complete surgical staging,omentectomy,and lymphadenectomy had no effect on recurrence.In multivariate analyses,only radical surgery and adjuvant chemotherapy were risk factors for the recurrence of BOTs.Furthermore,we found that omentectomy led to a relatively low recurrence rate in patients with International Federation of Gynecology and Obstetrics(FIGO)stage>Ⅰ(P=0.022).Conclusion:Our results suggest that complete surgical staging should be considered a standard treatment for patients with advanced stage BOTs but not for those at FIGO stageⅠ.It might be safe to reduce the scope of surgical procedures in patients with early-stage BOTs.However,it is not necessary to perform re-staging operations for BOTs with a macroscopically normal extra-ovarian appearance.

Borderline resectable pancreatic cancer: Definitions and management

Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving longterm survival and cure. There is now emerging consensus that a subgroup of patients, previously considered poor candidates for resection because of the relationship of their primary tumor to surrounding vasculature, may benefit from resection, particularly when preceded by neoadjuvant therapy. This stage of disease, termed borderline resectable pancreatic cancer, has become of increasing interest and is now the focus of a multiinstitutional clinical trial. Here we outline the history, progress, current treatment recommendations, and future directions for research in borderline resectable pancreatic cancer.

Pancreaticoduodenectomy for borderline resectable pancreatic head cancer with a modified artery-first approach technique

BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach（MAFA）, with conventional techniques for the surgical treatment of BRPHC.METHODS： A total of 117 patients with BRPHC undergone pancreaticoduodenectomy（PD） from January 2013 to June 2015 were included. They were divided into an MAFA group（n=78） and a conventional-technique group（n=39）. Background characteristics, operative data and complications were compared between the two groups.RESULTS： Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group（313 vs 384 min; P=0.014）; mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group（534 vs 756 m L; P=0.043）; and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group（61.5% vs 35.9%; P=0.014）. Pathologic data, early mortality and morbidity were not different significantly between the two groups.CONCLUSIONS： MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.

Isolated subcutaneous implantation of a borderline ovarian tumor:A case report and review of the literature

Laparoscopy-related tumor implantations of gynecological malignancies into the subcutaneous tissue are rarely diagnosed.We report an interesting case of a 46-year-old female who presented with an abdominal subcutaneous metastasis of a borderline ovarian tumor.The patient received a laparoscopic unilateral adnexectomy for a solid-cystic tumor of the right ovary.Histopathological workup showed a papillary borderline tumor of mucinous type.Nine days later she underwent a hysterectomy,left adnexectomy,appendectomy and omentectomy.Exploration of the peritoneum revealed no intraperitoneal implants.Further exploration showed a non-invasive implant of a borderline tumor in the subcutaneous tissue above the fascia that had no contact to the peritoneum.It is hypothesized that tumor cells may have been implanted during a previous laparoscopy,the most recent of which had been fourteen years prior to her current presentation.Various risk factors for port-site malignancies have been identified.Tumor manipulation and extraction of tumor tissue without a protective bag may contribute to development of trocarsite metastasis.

Pathologic tumor response to neoadjuvant therapy in borderline resectable pancreatic cancer

Background:Previous 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.Methods:Patients 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.Results:Seventy-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.Conclusions:A 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.

Borderline resectable pancreatic cancer and vascular resections in the era of neoadjuvant therapy

While pancreatic cancer is still characterized by early systemic spread and poor outcomes,the treatment of this disease has changed significantly in recent years due to major advancements in systemic therapy and advanced surgical techniques.Broader use of effective neoadjuvant approaches combined with aggressive surgical operations within a multidisciplinary setting has improved outcomes.Borderline resectable pancreatic cancer is characterized by tumor vascular invasion,and is a setting where the combination of potent neoadjuvant chemotherapy and aggressive surgical methods,including vascular resections and reconstructions,shows its full potential.Hopefully,this will lead to improved local control and curative treatment in a number of patients with this aggressive malignancy.

Borderline resectable pancreatic cancer:Certainties and controversies

Borderline resectable(BR)pancreatic ductal adenocarcinoma(PDAC)is currently a well-recognized entity,characterized by some specific anatomic,biological and conditional features:It includes patients with a stage of disease intermediate between the resectable and the locally advanced ones.The term BR identifies a tumour with an aggressive biological behaviour,on which a neoadjuvant approach instead of an upfront surgery one should be preferred,in order to obtain a radical resection(R0)and to avoid an early recurrence after surgery.Even if during the last decades several studies on this topic have been published,some aspects of BR-PDAC still represent a matter of debate.The aim of this review is to critically analyse the available literature on this topic,particularly focusing on:The problem of the heterogeneity of definition of BR-PDAC adopted,leading to a misinterpretation of published data;its current management(neoadjuvant vs upfront surgery);which neoadjuvant regimen should be preferably adopted;the problem of radiological restaging and the determination of resectability after neoadjuvant therapy;the post-operative outcomes after surgery;and the role and efficacy of adjuvant treatment for resected patients that already underwent neoadjuvant therapy.

Clinical characteristics and treatment of ovarian serous borderline tumors

Ovarian serous borderline tumors (SBTs) are characterized by good prognosis and occasional late recurrence. The 5-year and 10-year survival rates are all more than 90%. But traditionally patients with SBTs used to be treated with bilateral oophorectomy, hysterectomy and postoperative chemotherapy. A high proportion of SBTs occurred in young patients. The traditional treatment with complete excision of reproductive organs seemed to be too aggressive for young patients. It is imperative that conservative surgical procedures with fertility sparing should be employed to them. In this paper the literatures in regard to the final outcome of the conservative surgical therapy for SBTs were reviewed and the appropriate extent of conservative surgical procedures was discussed in detail.

A Dissolution of Borderlines in Toni Morrison＇s God Help the Child

The paper focuses on Toni Morrison＇s latest novel God Help the Child （2015）. By presenting a skillful though somewhat perverse merger of binary oppositions at different levels （racial, social, moral, and psychological）, the writer makes borderlines of all sorts appear artificial and therefore invalidates them. Thus, childhood merges with adulthood through sexual traumas that live on; touch with no touch as the evil touch of a parent equals an abhorrence of touching the child Other; truth with a lie as it proves as destructive as lying in good faith; passing blackness with blue blackness as the former conceives the latter; and appearances with reality in the ironic title of the book, where it is both the mother and the child that in fact need God＇s help. Thus, as Toni Morrison demonstrates, a thoroughly surreptitious, because natural, process of dissolution of all barriers makes them appear to be arbitrary constructs responsible for the equally arbitrary notion of the Other. Taking an utterly holistic view of the nature of things, Morrison seems to suggest that borderlines are a consequence and a manifestation of a lack of balance, which therefore needs to be redressed through love, mutual understanding, and maturation.

Neoadjuvant chemoradiation is associated with decreased lymph node ratio in borderline resectable pancreatic cancer:A propensity score matched analysis

Background:Lymph node ratio(LNR)and margin status have prognostic significance in pancreatic cancer.Herein we examined the pathologic and clinical outcomes in patients with borderline resectable pancreatic cancer(BRPC)following neoadjuvant therapy(NAT)and pancreaticoduodenectomy.Methods:Patients who underwent treatment between January 1,2012 and June 30,2017 were included.Sequential patients in the BRPC group were compared to a propensity score matched cohort of patients with radiographically resectable pancreatic cancer who underwent upfront surgical resection.The BRPC group was also compared to sequential patients with radiographically resectable pancreatic cancer who required vein resection(VR)during upfront surgery.Results:There were 50 patients in the BRPC group,50 patients in the matched control group,and 38 patients in the VR group.Negative margins(R0)were seen in 72%,64%,and 34%of the BRPC,control,and VR groups,respectively(P=0.521 for BRPC vs.control;P=0.002 for BRPC vs.VR),with 24%of the BRPC group requiring a vascular resection.Nodal stage was N0 in 64%,20%,and 18%of the BRPC,control,and VR groups,respectively(P<0.001 for BRPC vs.control or VR).When nodal status was stratified into four groups(N0,or LNR≤0.2,0.2–0.4,≥0.4),the BRPC group had a more favorable distribution(P<0.001).The median overall survival were 28.8,38.6,and 19.0 months for the BRPC,control,and VR groups,respectively(log-rank P=0.096).Conclusions:NAT in BRPC was associated with more R0 and N0 resections and lower LNR compared to patients undergoing upfront resection for resectable disease.

Develop a nomogram to predict overall survival of patients with borderline ovarian tumors

BACKGROUND The prognosis of borderline ovarian tumors(BOTs)has been the concern of clinicians and patients.It is urgent to develop a model to predict the survival of patients with BOTs.AIM To construct a nomogram to predict the likelihood of overall survival(OS)in patients with BOTs.METHODS A total of 192 patients with histologically verified BOTs and 374 patients with epithelial ovarian cancer(EOC)were retrospectively investigated for clinical characteristics and survival outcomes.A 1:1 propensity score matching(PSM)analysis was performed to eliminate selection bias.Survival was analyzed by using the log-rank test and the restricted mean survival time(RMST).Next,univariate and multivariate Cox regression analyses were used to identify meaningful independent prognostic factors.In addition,a nomogram model was developed to predict the 1-,3-,and 5-year overall survival of patients with BOTs.The predictive performance of the model was assessed by using the concordance index(C-index),calibration curves,and decision curve analysis(DCA).RESULTS For clinical data,there was no significant difference in body mass index,preoperative CA199 concentration,or tumor localization between the BOTs group and EOC group.Women with BOTs were significantly younger than those with EOC.There was a significant difference in menopausal status,parity,preoperative serum CA125 concentration,Federation International of gynecology and obstetrics(FIGO)stage,and whether patients accepted postoperative adjuvant therapy between the BOT and EOC group.After PSM,patients with BOTs had better overall survival than patients with EOC(P value=0.0067);more importantly,the 5-year RMST of BOTs was longer than that of EOC(P value=0.0002,95%CI-1.137 to-0.263).Multivariate Cox regression analysis showed that diagnosed age and surgical type were independent risk factors for BOT patient OS(P value<0.05).A nomogram was developed based on diagnosed age,preoperative serum CA125 and CA199 Levels,surgical type,FIGO stage,and tumor size.Moreover,the c-index(0.959,95%confidence interval 0.8708–1.0472),calibration plot of 1-,3-,and 5-year OS,and decision curve analysis indicated the accurate predictive ability of this model.CONCLUSION Patients with BOTs had a better prognosis than patients with EOC.The nomogram we constructed might be helpful for clinicians in personalized treatment planning and patient counseling.

Understanding Relational Dysfunction in Borderline, Narcissistic, and Antisocial Personality Disorders: Clinical Considerations, Presentation of Three Case Studies, and Implications for Therapeutic Intervention

Personality disorders are a class of mental disorders involving enduring maladaptive patterns of behaving,thinking,and feeling which profoundly affect functioning,inner experience,and relationships.This work focuses on three Cluster B personality disorders(PDs)(Borderline,Narcissistic,and Antisocial PDs),specifically illustrating how relational dysfunction manifests in each condition.People with Borderline Personality Disorder(BPD)experience pervasive instability in mood,behavior,self-image,and interpersonal patterns.In relationships,they tend to alternate between extremes of over-idealization and devaluation.Intense fear of abandonment,fluctuating affect,inappropriate anger,and black/white thinking deeply influence how they navigate personal relationships,which are often unstable,chaotic,dramatic,and ultimately destructive.They have a fundamental incapacity to self-soothe the explosive emotional states they experience as they oscillate between fears of engulfment and abandonment.This leads to unpredictable,harmful,impulsive behavior and chronic feelings of insecurity,worthlessness,shame,and emptiness.Their relationships are explosive,marked by hostility/contempt for self and partner alternating with bottomless neediness.Manipulation,lying,blaming,raging,and“push-pull”patterns are common features.Individuals with Narcissistic Personality Disorder(NPD)exhibit a long-standing pattern of grandiosity and lack of empathy.They have an exaggerated sense of self-importance,are self-absorbed,feel entitled,and tend to seek attention.Scarcely concerned with others’feelings,they can be both charming and exploitative.Oversensitive to criticism,they are prone to overt or covert rage,gaslighting and self-referential thinking.Antisocial Personality Disorder(APD)is marked by impulsive,callous,and irresponsible behavior with no regard to be manipulative,parasitic,aggressive,cold,cruel,and self-serving.In addition to analyzing relational dysfunction in each disorder,this paper presents three relational case studies(BPD-couple,NPD-parent/child,APD-various relations)and discusses treatment implications.

Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison

BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders(BPD)are still insufficiently understood.Evidence of differences between different types of therapies has been questioned.AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.METHODS Psychoanalysis(PSA)or psychodynamic psychotherapy(PDT)was administered to 10 patients each,the two groups were matched.Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual.Randomization to one of the groups was done after baseline assessment.During classical PSA(n=10)and PDT(n=10),semiannually,recordings(audio or video)of five consecutive therapy sessions were taken over three years for an ex-post analysis.The patients'characteristics,such as affect parameters[Affect regulation and experience Q-sort(AREQ)],quality of object relations(quality of object relations scale)and personality traits[Shedler-Westen Assessment Procedure(SWAP-200)]were analyzed retrospectively by independent raters.Therapeutic action(psychotherapy process Q-sort)and affective(re)actions of the patients(AREQ)were then analyzed in relation to changes found in the patients'characteristics.RESULTS During the first year of therapy(PSA:n=10;PDT:n=9),the therapeutic method PSA was associated with significant improvements in the variable"SWAP Borderline",while in PDT change was not significantly different to baseline(PSA:P=0.04;PDT:P=0.33).Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years;change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline(P=0.545).However,differences between PSA and PDT were significant when analyzing the“mean change”in the SWAP Borderline variable after one year of therapy(P=0.024):PSA led to slightly increased BPD symptoms,while PDT to a decrease;for the long run,variance of observed change was higher in PSA than in PDT(SDPSA±9.29 vs SDPDT±7.94).Our assumption that transference interpretations,closely followed by affective changes in the patient,could be useful modes of interaction was reproducible in our findings,especially when looking at the descriptive findings in the long-term data.The analysis of repetitive interaction structures demonstrated a very specific"time-lag"between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.CONCLUSION Exploring the change processes in the patients'characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.

Borderline resectable for colorectal liver metastases:Present status and future perspective

Surgical resection for colorectal liver metastases(CRLM)may offer the best opportunity to improve prognosis.However,only about 20% of CRLM cases are indicated for resection at the time of diagnosis(initially resectable),and the remaining cases are treated as unresectable(initially unresectable).Thanks to recent remarkable developments in chemotherapy,interventional radiology,and surgical techniques,the resectability of CRLM is expanding.However,some metastases are technically resectable but oncologically questionable for upfront surgery.In pancreatic cancer,such cases are categorized as"borderline resectable",and their definition and treatment strategies are explicit.However,in CRLM,although various poor prognosis factors have been identified in previous reports,no clear definition or treatment strategy for borderline resectable has yet been established.Since the efficacy of hepatectomy for CRLM was reported in the 1970 s,multidisciplinary treatment for unresectable cases has improved resectability and prognosis,and clarifying the definition and treatment strategy of borderline resectable CRLM should yield further improvement in prognosis.This review outlines the present status and the future perspective for borderline resectable CRLM,based on previous studies.

Research Developments on the Histopathology and Prognostic Predictors of Serous Borderline Tumor of Ovary

Serous borderline tumor of ovary (SBT)includes two subtypes of typical serous borderline tumor andmicropapillary variant, which have different histopathologyfeatures. Although SBTs behave in either way of the benigncounterparts or malignant serous carcinomas, microinvasion,peritoneal implants, and nodal involvement are all very commonin both subtypes of typical SBT and the micropapillary variant.The prognosis of the patients with serous borderline tumorof ovary and the mechanism of the microinvasion, peritonealimplantation and nodal involvement are still being debated, noris there universal agreement about the management of SBT. Toidentify the histopathologic features, prognostic predictors ofthe SBT, and its association with ovarian serous carcinomas, wereviewed the majority of the relevant papers published in recentliterature.

A Systematic Review of Neoadjuvant Therapy Compared to the “Resection First” Approach for Patients with Borderline Resectable Pancreatic Adenocarcinoma

Background: Survival for patients with pancreatic adenocarcinoma continues to be poor. Patients with pancreatic adenocarcinoma that is deemed borderline resectable have imaging that shows disease involvement of the portal vein and/or superior mesenteric vein that is amenable to reconstruction or abutment (≤180 degrees) of the superior mesenteric artery. The best initial treatment for patients with borderline resectable pancreatic adenocarcinoma has yet to be determined. Proponents of neoadjuvant therapy purport its utility for patients with borderline resectable pancreatic adenocarcinoma with the intention of increasing the likelihood of a microscopically negative (R0) margin, but the consequences of this approach are not established. This study was undertaken to systematically review the outcomes for patients with borderline resectable pancreatic adenocarcinoma to compare neoadjuvant therapy to a “resection first” approach. Methods: A MEDLINE/PubMed search was undertaken to find all studies regarding patients who underwent neoadjuvant therapy for patients with borderline resectable pancreatic adenocarcinoma. Results: A total of 112 studies were found regarding borderline resectable pancreatic cancer. Fourteen studies contained cohorts of patients with borderline resectable pancreatic adenocarcinoma who received neoadjuvant therapy (n = 471 patients) or a resection-first approach (n = 76 patients). Resection after neoadjuvant therapy was undertaken for 233 (49%) patients. Neoadjuvant therapy followed by an R0 resection occurred for 42% of patients. For patients who underwent resection first, 71% (54/76) had an R0 margin. Conclusion: Patients with borderline resectable pancreatic adenocarcinoma were more often found to undergo neoadjuvant therapy than a “resection first” approach in the available literature. Although neoadjuvant therapy portends a high rate of R0 resections, less than half of the patients who undergo neoadjuvant therapy for borderline resectable pancreatic adenocarcinoma undergo resection. Patients who undergo “resection first” for borderline resectable pancreatic adenocarcinoma have an increased chance for a resection and an R0 margin compared to patients who undergo neoadjuvant therapy for borderline pancreatic adenocarcinoma.

Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.

Huge mucinous borderline ovarian cystadenoma in a premenarchal girl

Epithelial ovarian tumors are common in adult women, but rare in children. Especially mucinous ovarian cystadenoma is extremely rare, with only 16 cases in premenarchal girls reported to date. We present a case of 12-year-old premenarchal girl with symptoms of lower abdominal distension. CT showed a large multilocular tumor spreading throughout the entire abdominal cavity from the right upper quadrant to the pelvic cavity. The tumor was brought out little by little with aspiration of the fluid contents with a small incision. The tumor was found to originate from the left ovary, and oophorectomy was performed. The tumor measured 26 × 18 cm and weighed 5860 g. Histological diagnosis was mucinous ovarian cystadenoma with borderline malignancy. No evidence of recurrence had been seen as of 2 years postoperatively. In the review of premenarchal mucinous borderline ovarian cystadenoma, all cases were stage I and underwent salpingo-oophorectomy or oophorectomy. Those patients were alive without recurrence. Al-though mucinous borderline ovarian cystadenoma was characterized as malignancy, premenarchal cases showed favorable outcomes and salpingo-oohprectomy or oophorectomy appears appropriate.