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Biomedical subjects

B J Hunt

Publications and source records attributed to B J Hunt.

133 records · Page 8Linked to original sources
PubMedDate not supplied

Normal expression of cell adhesion molecules in placentae from women with systemic lupus erythematosus and the antiphospholipid syndrome.

Pregnant women with active systemic lupus erythematosus (SLE) and/or the antiphospholipid syndrome (APS) are prone to recurrent miscarriage, pre-eclampsia, intrauterine growth restriction and premature delivery. Placental dysfunction may account for these complications yet the mechanisms remain uncertain. Amongst these, an inflammatory response in the placental vasculature could play a role, involving recruitment of neutrophils and platelets and the increased endothelial expression of cell adhesion molecules (CAM), central to the recruitment process. The aim of this study was primarily to investigate CAM expression in the fetoplacental vasculature in women with SLE/APS. Circulating maternal concentrations of soluble CAM were also elucidated. There were no differences in CAM immunostaining in placentae from patients with SLE and/or APS compared with controls. In both patients and controls moderate immunostaining for the intercellular adhesion molecule-1 (ICAM-1) was observed in placental vascular endothelium and mild immunostaining was present in the placental villous stroma. Strong immunostaining for platelet endothelial CAM (PECAM) occured in the placental vascular endothelium whereas P-selectin was mildly expressed in the stem vessel endothelium only. Vascular CAM-1 (VCAM-1) and E-selectin were undetectable in either study or control placentae. In contrast, ICAM-1 and VCAM-1 but not E-selectin, as assessed by immunoassay (ELISA), were elevated in maternal serum from SLE/APS patients compared with controls. This study suggests that upregulation of CAM expression and subsequent activation of neutrophil and/or platelet activity within the placental villous tree is unlikely to be a mechanism by which the adverse pregnancy outcome arises in SLE/APS pregnancies. However, maternal endothelial cell activation (ECA) may play a more important role.

Adult↗
PubMedDate not supplied

The antiphospholipid or Hughes' syndrome: an underdiagnosed cause of thrombosis.

The antiphospholipid or Hughes' syndrome is the association between antiphospholipid antibodies, recurrent venous and arterial thromboses and recurrent fetal loss. There are many clinical manifestations arising from this acquired thrombophilia and these are described in the article. The pathogenic mechanism by which the antibodies cause thrombosis is the subject of much debate, and current theories are described. The diagnosis and management of patients with the syndrome are also discussed.

Antibodies, Anticardiolipin↗
PubMedDate not supplied

Thromboprophylaxis.

Thromboembolic disease causes significant morbidity and mortality. This article evaluates those patients at risk and the thromboprophylactic strategies that may be employed.

Anticoagulants↗
PubMedDate not supplied

A study of sixty pregnancies in patients with the antiphospholipid syndrome.

OBJECTIVE: To study the maternal and fetal outcome in treated antiphospholipid syndrome (APS) pregnancies. METHODS: Sixty pregnancies in 47 APS patients (11 primary and 36 secondary) were followed in a multidisciplinary clinic. Patients testing antiphospholipid antibody positive and having a history of recurrent miscarriages were treated with low-dose aspirin (75 mg) daily. Patients with APS and a previous history of thrombotic events were treated with subcutaneous unfractionated or low molecular weight heparin and low-dose aspirin (75 mg) daily. RESULTS: The live birth rate increased from 19% of their previous non-treated pregnancies to 70% despite a high incidence of obstetric and fetal complications: pre-eclampsia (18%), prematurity (43%), fetal distress (50%) and intrauterine growth retardation (31%). Two predictors of fetal outcome were observed: the previous obstetric history and the presence of thrombocytopenia. Seven pregnancies (12%) were complicated by thrombotic events during pregnancy or during the puerperium. There were no thrombotic events in those receiving a low molecular weight heparin regimen. CONCLUSION: Close obstetric monitoring by a multidisciplinary team and the use of antithrombotic therapy was effective in reducing the fetal wastage in APS pregnancies despite a high incidence of obstetric and fetal complications.

Abortion, Habitual↗