Anticuerpos anti-anexina V y otros marcadores de actividad antifosfolip¿¬dica en mujeres abortadoras recurrentes con enfermedades autoinmunes / Anti-annexi V antibodies and other markers of antiphospholipid activity in women with recurrent miscarriage with autoinmune diseases

Los anticuerpos (Ac) antifosfolip¿¬dicos componen una familia de auto Ac involucrada en eventos tromb¿«ticos que participar¿¬an de la actividad antifosfolip¿¬dica (AAF). La probabilidad de aborto en una paciente con estos Ac es del 91%. Se ha sugerido la existencia de un nuevo cofactor: la anexina V, altamente expresada en el sinciciotrofoblasto placentario, originando Ac que podr¿¬an estar implicados en las p¿ªrdidas fetales recurrentes. Nuestro objetivo fue analizar la asociaci¿«n entre los Ac anti-anexina V y otros indicadores de AAF [anticardiolipina(ACA), anti-ªÂ2 glicoprote¿¬na 1 (a-ªÂ2GP1) o anticoagulante l¿²pico (AL)] en mujeres con enfermedades autoinmunes y repetidas p¿ªrdidas fetales. Se incluyeron 25 mujeres abortadoras recurrentes con lupus eritematoso sist¿ªmico y/o s¿¬ndrome antifosfolip¿¬dico (A) y un grupo control de 33 mujeres con las patolog¿¬as mencionadas anteriormente, no abortadoras (NA). Se determinaron los niveles de anti-anexina V, ACA y de a-ªÂ2GP1 por ELISA. El AL se evidenci¿« con pruebas de screening y confirmatorias. El 96% del grupo A present¿« AAF positiva y el 4% niveles elevados de Ac a-anexina V. El grupo NA mostr¿« AAF en el 70% de los casos y niveles elevados de Ac a-anexina V en un 3%. Se puede concluir que no existe asociaci¿«n entre Ac anti-anexina V y los indicadores de AAF.(AU)

Anticuerpos anti-anexina V y otros marcadores de actividad antifosfolip¨ªdica en mujeres abortadoras recurrentes con enfermedades autoinmunes / Anti-annexi V antibodies and other markers of antiphospholipid activity in women with recurrent miscarriage with autoinmune diseases

Los anticuerpos (Ac) antifosfolip¨ªdicos componen una familia de auto Ac involucrada en eventos tromb¨®ticos que participar¨ªan de la actividad antifosfolip¨ªdica (AAF). La probabilidad de aborto en una paciente con estos Ac es del 91%. Se ha sugerido la existencia de un nuevo cofactor: la anexina V, altamente expresada en el sinciciotrofoblasto placentario, originando Ac que podr¨ªan estar implicados en las p¨¦rdidas fetales recurrentes. Nuestro objetivo fue analizar la asociaci¨®n entre los Ac anti-anexina V y otros indicadores de AAF [anticardiolipina(ACA), anti-¦Â2 glicoprote¨ªna 1 (a-¦Â2GP1) o anticoagulante l¨²pico (AL)] en mujeres con enfermedades autoinmunes y repetidas p¨¦rdidas fetales. Se incluyeron 25 mujeres abortadoras recurrentes con lupus eritematoso sist¨¦mico y/o s¨ªndrome antifosfolip¨ªdico (A) y un grupo control de 33 mujeres con las patolog¨ªas mencionadas anteriormente, no abortadoras (NA). Se determinaron los niveles de anti-anexina V, ACA y de a-¦Â2GP1 por ELISA. El AL se evidenci¨® con pruebas de screening y confirmatorias. El 96% del grupo A present¨® AAF positiva y el 4% niveles elevados de Ac a-anexina V. El grupo NA mostr¨® AAF en el 70% de los casos y niveles elevados de Ac a-anexina V en un 3%. Se puede concluir que no existe asociaci¨®n entre Ac anti-anexina V y los indicadores de AAF.

The Swedish reflux trial in children: I. Study design and study population characteristics.

PURPOSE: We compared the rates of febrile urinary tract infection, kidney damage and reflux resolution in children with vesicoureteral reflux treated in 3 ways, including antibiotic prophylaxis, endoscopic therapy and surveillance with antibiotics only for symptomatic urinary tract infection. MATERIALS AND METHODS: Children 1 to younger than 2 years with grade III-IV reflux were recruited into this prospective, open, randomized, controlled, multicenter study and followed for 2 years after randomization. The main study end points were recurrent febrile urinary tract infection, renal status on dimercapto-succinic acid scintigraphy and reflux status. Outcomes were analyzed by the intent to treat principle. RESULTS: During a 6-year period 128 girls and 75 boys entered the study. In 96% of cases reflux was detected after urinary tract infection. The randomization procedure was successful and resulted in 3 groups matched for relevant factors. Recruitment was slower than anticipated but after patients were entered adherence to the protocol was good. Of the children 93% were followed for the intended 2 years without a treatment arm change. All except 2 patients completed 2-year followup scintigraphy. CONCLUSIONS: Recruitment was difficult but a substantial number of children were entered and randomly assigned to 3 groups with similar basic characteristics. Good adherence to the protocol made it possible to address the central study questions.

The Swedish reflux trial in children: v. Bladder dysfunction.

PURPOSE: We investigated the prevalence and types of lower urinary tract dysfunction in children with vesicoureteral reflux grades III and IV, and related improved dilating reflux, renal damage and recurrent urinary tract infection to dysfunction. MATERIALS AND METHODS: A total of 203 children between ages 1 to less than 2 years with reflux grades III and IV were recruited into this open, randomized, controlled, multicenter study. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done at study entry and 2-year followup. Lower urinary tract function was investigated by noninvasive methods, at study entry with 4-hour voiding observation in 148 patients and at 2 years by structured questionnaire and post-void residual flow measurement in 161. RESULTS: At study entry 20% of patients had lower urinary tract dysfunction, characterized by high bladder capacity and increased post-void residual urine. At 2 years there was dysfunction in 34% of patients. Subdivision into groups characteristic of children after toilet training revealed that 9% had isolated overactive bladder and 24% had voiding phase dysfunction. There was a negative correlation between dysfunction at 2 years and improved dilating reflux (p = 0.002). Renal damage at study entry and followup was associated with lower urinary tract dysfunction at 2 years (p = 0.001). Recurrent urinary tract infections were seen in 33% of children with and in 20% without dysfunction (p = 0.084). CONCLUSIONS: After toilet training a third of these children with dilating reflux had lower urinary tract dysfunction, mainly voiding phase problems. Dysfunction was associated with persistent reflux and renal damage while dysfunction at study entry did not predict the 2-year outcome.