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Biomedical subjects

H J Englert

Publications and source records attributed to H J Englert.

8 recordsLinked to original sources
PubMed1994

Scleroderma and silicone breast implants.

A 43-yr-old caucasian female presented in July 1992 with an explosive onset of diffuse scleroderma following general anaesthesia for orthopaedic surgery. Her environmental exposures included silicone breast prosthetic surgery and silica exposure, both preceding development of scleroderma. She was DR5-negative, DRw52 positive. All currently available literature relating to breast implants and scleroderma is reviewed and the conclusion drawn that, for currently documented US data, there is no evidence to suggest that patients having had breast augmentation have rates of scleroderma higher than expected to chance alone. However the cause-effect relationship between silicone and scleroderma/other connective tissue disease requires, not just anecdotal reports, but a rigorously designed study.

Adult↗
PubMed1994

Scleroderma and augmentation mammoplasty--a causal relationship?

BACKGROUND: The studies implicating a causal relationship between silicone and scleroderma, other autoimmune disease, and fibromyalgia-like symptoms have been largely descriptive with absence of appropriate controls and no consideration of potential confounders. This case control study of augmentation mammoplasty and scleroderma represents an attempt to answer these deficiencies. AIMS: To compare the frequency and temporal relationship of augmentation mammoplasty in interviewed and deceased cases and interviewed controls. To determine the frequencies of exposure to non-augmentation mammoplasty silicone, and to determine the frequencies of mastectomy and breast lumpectomy in interviewed cases and controls. METHODS: Scleroderma cases and age-stratified general practice controls were interviewed using a prepilotted telephone questionnaire. Self-reported date/s of augmentation mammoplasty were ascertained, as were dates of onset of first and second scleroderma symptom/s and scleroderma diagnosis, where relevant. Comparison of socioeconomically adjusted rates was expressed in terms of rate ratios. RESULTS: Augmentation mammoplasty rates were comparable between interviewed cases and controls. No augmentation mammoplasty procedures were documented in deceased scleroderma patients' medical records. Rates of exposure to non-mammoplasty silicone, mastectomy and breast lumpectomy were comparable in interviewed cases and controls. CONCLUSIONS: This study failed to demonstrate an association between silicone breast implantation and the subsequent development of scleroderma, to a relative risk level as low as 4.5 with 90% power.

Adult↗
PubMed1989

Clinical and immunologic features of livedo reticularis in lupus: a case-control study.

PURPOSE: We recently noticed the occurrence of both livedo and elevated anticardiolipin antibody levels in a small number of patients with lupus. The purpose of our study was two-fold: (1) to investigate whether anticardiolipin antibodies were more common in lupus patients with livedo than in those without; and (2) to determine if the features of Sneddon's syndrome (livedo and cerebrovascular disease) also were found in patients with lupus. PATIENTS AND METHODS: In this case-control study of lupus patients without significant renal impairment, 29 patients with livedo reticularis (cases) were compared clinically and immunologically with 29 patients without livedo (controls). RESULTS: Both groups shared many disease characteristics and were similar in age and sex. However, they differed markedly in other respects. Elevated anticardiolipin antibody levels were significantly more common in the cases. Indeed, 81% of all cases from our study sample had elevated anticardiolipin levels. A history of thrombosis and thrombocytopenia--clinical associates of the anticardiolipin antibody--was also significantly more common in cases than in controls. The relative odds of livedo reticularis were 23-fold greater in those with elevated anticardiolipin levels than in those without these antibodies. The estimated proportion of livedo-positive patients with elevated anticardiolipin antibodies in a general lupus population without significant renal impairment was 0.77. CONCLUSION: The association between livedo reticularis and cerebrovascular disease, originally described by Sneddon in otherwise healthy individuals, also applies to lupus patients. The presence of elevated anticardiolipin antibody levels in 10 of 11 such patients suggests that the anticardiolipin antibody may be of pathogenetic importance in the manifestations of Sneddon's syndrome in lupus and also possibly in the idiopathic form of this disease.

Adult↗
PubMed1988

Pregnancy and lupus: prognostic indicators and response to treatment.

A cohort study was undertaken of 18 consecutive pregnancies in 16 patients with systemic lupus erythematosus without significant renal impairment. Of these, eight each had at least two previously unexplained pregnancy failures, 10 had elevated anticardiolipin antibodies, nine had the lupus anticoagulant and five had antibodies to Ro. Twelve live births resulted but a Downs syndrome baby died in the perinatal period. Fetal morbidity was confined to four cases of fetal growth retardation, all in mothers positive for anticardiolipin antibodies, and fetal distress in another two. There were no cases of the neonatal lupus syndrome. There was one maternal death. An obstetric history of at least two previously unexplained pregnancy failures and the presence of maternal anticardiolipin or anti-Ro antibodies accurately predicted fetal loss in six of seven cases. No other serological risk factors for fetal loss were identified. We were unable to show that suppression of antibodies in those mothers with at least two previously unexplained pregnancy failures improved fetal outcome.

Adult↗
PubMed1988

Association of quantitative anticardiolipin antibody levels with fetal loss and time of loss in systemic lupus erythematosus.

The presence of anticardiolipin antibodies has been associated with the occurrence of spontaneous abortions in patients with systemic lupus erythematosus. Retrospective analysis of the relationship between the levels of IgG and IgM anticardiolipin antibodies in 84 patients with SLE and the prevalence of spontaneous abortions was performed. The time at which abortion occurred amongst these patients was compared with that in 26 subjects with a poor obstetric history, but without SLE. Forty-six of 84 patients had anticardiolipin antibodies and had 143 pregnancies, of which 84 (58.7 per cent) resulted in fetal loss. In contrast, amongst the 38 patients without anticardiolipin antibodies only 23 of 93 pregnancies (24.7 per cent) resulted in fetal loss. The prevalence of spontaneous abortions in the SLE patients was related to the levels of IgG anticardiolipin antibodies; IgM anticardiolipin antibodies were not associated with increased fetal loss. In SLE patients without anticardiolipin antibodies, and in the group of patients without SLE, fetal loss occurred at 14.1 +/- 7.5 (mean +/- SD) and 12.5 +/- 5.5 weeks respectively. When anticardiolipin antibodies were present fetal loss tended to occur at a later stage of pregnancy (17.4 +/- 7.1 weeks) and amongst this group 30 per cent of the pregnancy losses were in the third trimester of pregnancy. These findings demonstrate further that anticardiolipin antibodies are strongly linked to late pregnancy failure in patients with SLE.

Autoantibodies↗
PubMed1987

Sulphasalazine and regression of rheumatoid nodules.

The regression of small rheumatoid nodules was noted in four patients after starting sulphasalazine therapy. This coincided with an improvement in synovitis and also falls in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP). The relation between the nodule regression and the sulphasalazine therapy is discussed.

Aged↗
PubMed1984

Degos' disease: association with anticardiolipin antibodies and the lupus anticoagulant.

A woman presented with multiple cerebral thromboses and skin lesions characteristic of Degos' disease. Her serum contained high titres of anticardiolipin antibodies and showed lupus anticoagulant activity, both known to be strong markers of a thrombotic tendency in systemic lupus erythematosus. This finding may have therapeutic implications for this usually fatal disease.

Adult↗