Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002

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ISSN 0377-2551 ∞¡∞™∫O¶∏™∏ ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∞. °ÎÈfiη˜ Bƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·ÛıÂÓÒÓ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ˆ˜ ÚÒÈÌÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ›· ª.π. ∏ÏÈÔÔ‡ÏÔ˘, °. ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ÛÙ· ·È‰È¿ Ù˘ ∫Ú‹Ù˘ ™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË, ∂. °·Ï·Ó¿Î˘, £. ∆ÛÂÎÔ˘Ú¿, °. ∑·ÌÂÙ¿Î˘, ∂. ∫fiÎÔÚË ¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙ ¯ÚfiÓÈ· ∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔڷοÎË, ∂. ¶·Ú·Ûο΢, µ. µ·Ï¿ÚË, ª. ∫ÔÚÔÔ‡ÏË, ∂. °·Ï·Ó¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ™˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Î·È ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ Î·È ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ¢. ÷Ù˙ËÁˆÚÁ›Ô˘, ∂. ∫·Ó·‚¿Î˘, Ã. ∆Û¿ÓÙ·ÏË, J. Traeger-™˘ÓÔ‰ÈÓÔ‡, Ã. ¡Ù·ÓÙ¿Ì˘, ∂. ∫·ÓÙÂÚ¤-ªÂÎÈÒÙË, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ REVIEW ARTICLE Spondylodiscitis in childhood A. Giokas AWARD-WINNING ARTICLE The cerebrospinal fluid ‚-glucuronidase activity in patients with bacterial meningitis as an early and sensitive predictor of response to treatment M. Eliopoulou, G.A. Syrogiannopoulos ORIGINAL ARTICLES ∞septic meningitis in children from Crete S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori Perinatal mortality in Crete over the last five years E. Hatzidaki, A. Manoura, E. Korakaki, E. Paraskakis, B. Balari, M. Koropouli, H. Galanakis, Ch. Giannakopoulou Frequency of heterozygotes and detection of mutations for sickle-cell disease and b-thalassemia among high-school students of the prefecture of Karditsa D. Chatzigeorgiou, E. Kanavakis, C. Tsantali, J. Traeger-Synodinos, C. Dadamis, E. Kantere-Bekioti, M. Athanasiou-Metaxa 89 97 108 113 118 March - April 2002 Volume 65 No 2 . . ¶AI¢IATPIKH TOMO™ 65 TEYXO™ 2 ETO™ 2002 ª¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2002 ∆fiÌÔ˜ 65 ∆‡¯Ô˜ 2 . . Continuation of table of contents inside title page ∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

description

Τριμηνιαία έκδοση της Ελληνικής Παιδιατρικής Εταιρείας

Transcript of Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002

Page 1: Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002

ISSN 0377-2551

∞¡∞™∫O¶∏™∏∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∞. °ÎÈfiη˜

Bƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·ÛıÂÓÒÓ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ˆ˜ ÚÒÈÌÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ›· ª.π. ∏ÏÈÔÔ‡ÏÔ˘, °. ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ÛÙ· ·È‰È¿ Ù˘ ∫Ú‹Ù˘ ™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË, ∂. °·Ï·Ó¿Î˘, £. ∆ÛÂÎÔ˘Ú¿, °. ∑·ÌÂÙ¿Î˘, ∂. ∫fiÎÔÚË

¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙ ¯ÚfiÓÈ· ∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔڷοÎË, ∂. ¶·Ú·Ûο΢, µ. µ·Ï¿ÚË, ª. ∫ÔÚÔÔ‡ÏË, ∂. °·Ï·Ó¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

™˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Î·È ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ Î·È ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ¢. ÷Ù˙ËÁˆÚÁ›Ô˘, ∂. ∫·Ó·‚¿Î˘, Ã. ∆Û¿ÓÙ·ÏË, J. Traeger-™˘ÓÔ‰ÈÓÔ‡, Ã. ¡Ù·ÓÙ¿Ì˘, ∂. ∫·ÓÙÂÚ¤-ªÂÎÈÒÙË, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿

REVIEW ARTICLE Spondylodiscitis in childhood A. Giokas

AWARD-WINNING ARTICLE The cerebrospinal fluid ‚-glucuronidase activity in patients withbacterial meningitis as an early and sensitive predictor of response to treatment M. Eliopoulou, G.A. Syrogiannopoulos

ORIGINAL ARTICLES∞septic meningitis in children from Crete S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori

Perinatal mortality in Crete over the last five years E. Hatzidaki, A. Manoura, E. Korakaki, E. Paraskakis, B. Balari, M. Koropouli, H. Galanakis, Ch. Giannakopoulou

Frequency of heterozygotes and detection of mutations for sickle-cell disease and b-thalassemia among high-school students of the prefecture of Karditsa D. Chatzigeorgiou, E. Kanavakis, C. Tsantali, J. Traeger-Synodinos, C. Dadamis, E. Kantere-Bekioti, M. Athanasiou-Metaxa

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Continuation of table of contents inside title page

∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙËÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

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¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜Ù˘ ÂÚÈÔ¯‹˜ µ¿Ú˘ ∞ÙÙÈ΋˜ ∂. ª·Ú·ÁοÎË, °. °·Ï¿ÓË, ª. °ÂÌÂÏÈ¿ÚË, Ã. ∫ÒÛÙ·ÏÔ˜, ¢. ¶··‰ÔÔ‡ÏÔ˘, ¡. º·Ú¿ÎÏ·˜

∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿ ∞. ª‹ÙÛÈη-∫·Ú·Ó¿ÛÔ˘, Ã. ∆˙ÈÔ˘‚¿Ú·, ∞. ∫ÔÓ‰‡Ï˘,°. ∆˙ˆÚÙ˙¿ÙÔ˘, ∑. ∫·Ú·Î·ÙÛ¿ÓË

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ·fi Ó·ÚΈÙÈΤ˜ Î·È ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ π. ∫·ÂÙ·Ó¿Î˘, π. ∫·Ï¤ÁÈ·˜, ª. ª·ÚÎÔ‡ÚË, °. ∞Ï‚È˙fiÔ˘ÏÔ˜, °. ∫Ô˘Ú¿Î˘, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜

ÃÚfiÓÈ· Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ ÏfiÁˆ ·ÓˆÌ·Ï›·˜ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘: ¶ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜ ∞. M›¯Ô˜, ∂. OÚÊ·ÓÔ‡, ∂. ¶··Ó‰Ú¤Ô˘, ¡. ª·ÏÙÔÁÈ¿ÓÓ˘, ∂. ƒÒÌ·-°È·ÓÓ›ÎÔ˘, ¢. ∫ÂÚ·Ì›‰·˜

¡fiÛÔ˜ Kikuchi - Fujimoto: ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ °. ∆Ú›Ì˘, ∫. ∞ı·Ó·Û¿ÎË, ∞. °È·ÓÓÔ‡ÏÈ·-∫·Ú·ÓÙ·Ó¿, •. ∫Ú›ÎÔ˜

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

Body fat indices of school-aged childrenof the Vari region in Attica E. Marangaki, G. Galani, M. Yemeliari, C. Costalos, D. Papadopoulou, N. Faraklas

Cholelithiasis in children A. Mitsika-Karanasou, H. Tziouvara, A. Kondylis, G. Tzortzatou, Z. Karakatsani

CASE REPORTS Neonatal withdrawal syndrome from narcotic and non-narcotic drugs. Report of two cases I. Kapetanakis, J. Kaleyias, M. Markouri, G. Alevizopoulos, G. Kourakis, ∂. Dellagrammaticas

Chronic midgut volvulus due to malrotation: Case report ∞. Michos, E. Orfanou, E. Papandreou, N. Baltogiannis, E. Roma-Giannikou, D. Keramidas

Kikuchi - Fujimoto disease: Case report G. Trimis, K. Athanasaki, A. Giannoulia-Karantana, X. Krikos

PEDIATRIC NEWS

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™˘Ó¤¯ÂÈ· ÂÚȯÔÌ¤ÓˆÓ Continuation of table of contents

™˘Ó¯›˙ÔÓÙ·È Continued

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¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏¡ µπµ§πO°ƒ∞ºπ∞¢È·ÊÔÚÂÙÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Û ÌÔÓÔ‡ÚËÓ· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë ÛÙÚÂÙfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ µ Ô˘ ÚÔηÏÔ‡Ó ÛË„·ÈÌ›· ‹ ÌfiÓÔ ·ÔÈÎÈÛÌfiBerner R, Csorba J, Brandis M∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™. ºˆÙfiÔ˘ÏÔ˜

∏ ·ÈÙÈÔÏÔÁ›· Î·È Ë ¤Î‚·ÛË Ù˘ Ó¢ÌÔÓ›·˜ Û ·È‰È¿ Ì ۇӉÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜ (AIDS) Ô˘ ÂÈÛ‹¯ıËÛ·Ó Û ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ (ª∂£) ·Ó·Ù˘ÛÛfiÌÂÓ˘ ¯ÒÚ·˜Zar H, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et al∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: A. ÷Ù˙‹˜

¢È¿ÁÓˆÛË, ıÂڷ›· Î·È ÓÔÛËÚfiÙËÙ· Û ·È‰È¿ Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (º¡∂)Spray C, Debelle G, Murphy M∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: °. ∫·ÊÚ›ÙÛ·

£Âڷ›· ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ Û ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁËWewer V, Andersen LP, Paerregaard A, Gernow A,Hansen JP, Matzen P et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: °. ∫·ÊÚ›ÙÛ·

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

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LITERATURE ABSTRACTSDifferent cytokine expression in cord blood mononuclear cells after stimulation with neonatal sepsis or colonizing strainsof Streptococcus agalactiaeBerner R, Csorba J, Brandis MGreek translation: S. Fotopoulos

The etiology and outcome of pneumonia in human immunodeficiency virus-infected children admitted to intensive care in a developing countryZar H, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et alGreek translation: A. Chatzis

Current diagnosis, management and morbidity in paediatric inflammatory bowel diseaseSpray C, Debelle G, Murphy MGreek translation: G. Kafritsa

Treatment of Helicobacter pylori in children with recurrent abdominal pain Wewer V, Andersen LP, Paerregaard A, Gernow A,Hansen JP, Matzen P et al Greek translation: G. Kafritsa

Scheduled Medical Meetings

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¢ÈÌËÓÈ·›· ¤Î‰ÔÛËE›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

EΉfiÙ˘K. °ÚÈ‚¤·˜

I‰ÈÔÎÙ‹Ù˘©EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92Aı‹Ó·È 115 28TËÏ.: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹¶Úfi‰ÚÔ˜ : ∫. ª·Ï·Î¿¢È¢ı˘ÓÙ‹˜ : ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË

: º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘: ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜: °. µ·ÚÏ¿Ì˘: ¶. ∫·ÊÚ›ÙÛ·: ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜: £. ∆ÛÈÏÈÁÈ¿ÓÓ˘: ∫. ∆ÛÔ˘Ì¿Î·˜: ™. ºˆÙfiÔ˘ÏÔ˜: A. ÷Ù˙‹˜

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ·∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈ̤ӈÓI. K·Ú·‚Ú¿ÓÔ˘

∂È̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈ̤ӈÓ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∞ÏÏËÏÔÁÚ·Ê›·∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92∞ı‹Ó·È 115 28∆ËÏ: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Bimonthly PublicationThe Official Journal of the Hellenic Paediatric Society

PublisherK. Griveas

Owner©Hellenic Paediatric SocietyMichalakopoulou 92Athens 115 28Tel.: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Scientific Editorial BoardPresident : K. MalakaEditor : Z. Papadopoulou-CouloumbisMembers : E. Agelaki-Georgaki

: F. Athanassiadou-Piperopoulou: M. Anthrakopoulos: G. Varlamis: P. Kafritsa: A. Konstadopoulos: Th. Tsiligiannis: K. Tsoumakas: S. Fotopoulos: ∞. Hatzis

Manuscript Editing

Greek EditingI. Karavranou

English EditingZ. Papadopoulou-Couloumbis

Correspondence Hellenic Paediatric Society Michalakopoulou 92Athens 115 28Tel: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜E¶I™THMONIKE™ EK¢O™EI™ E.¶.E.¶. ∆۷ω¿ÚË 3, 151 22 M·ÚÔ‡ÛÈTËÏ.: 010-61 41 360-5 Fax: 010-61 41 366

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 29,35EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 14,67

Publishing CoordinatorSCIENTIFIC PUBLICATIONS LtdP. Tsaldari 3, Marousi 151 22Tel.: 010-61 41 360-5 Fax: 010-61 41 366

Annual SubscriptionAll foreign countries: US $ 30

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πSSN 0377-2551i

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Page 5: Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002

A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜∆Ô ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊” Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙË-

ÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ-΋˜ EÙ·ÈÚ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡-ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘ÓÂ-¯‹ È·ÙÚÈ΋ ÂÓË̤ڈÛË Î·È ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛËÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂ-Ù¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈ-ÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, ›ηÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓπ·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘Â˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ì·ȉȷÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚȯfiÌÂÓÔ, ÁÂÓÈο ı¤Ì·-Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛËÙ˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘ Î·È ˘Á›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚ-Á·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ,ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ,‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔ-ÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘ÓÂ-‰Ú›ˆÓ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ·Ó·ÊÔ-Ú¤˜ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ÂӉȷʤÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈ-Îfi ÂӉȷʤÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ ηÈÓ· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó‚Ú·‚¢ı› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘ÓÂ-‰Ú›Ô˘, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·-Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈ¢-̤ӷ ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓOÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰Ë-

ÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊” ·ÔÛÙ¤ÏÏÔÓÙ·ÈÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË:

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92115 28 Aı‹Ó·

ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘Á-ÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›-ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙˉËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊”. ∂ÈϤÔÓ,ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤-ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤ-ˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡ÌʈӷÌ ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ.

ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔ-ÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫◊” Î·È Ë ÔÏÈ΋ ‹ ÌÂ-

ÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ“∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿Ï-ÏÔÓÙ·È Û µÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (UniformRequirements for Manuscripts Submitted to BiomedicalJournals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934, http://jama.ama-assn.org/info/auinst_req.html.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤ-ˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰È-ÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔ̤ӈÓÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈ-ÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÛ‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·-ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓEÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·Ì-Ì· Word.doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘-Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó··Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹-ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË ÙË˜Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·ÓÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

°È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·-Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔÙ˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û‰‡Ô (2) Ë̤Ú˜.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏ̘ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘ÓÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘Ô-ÁÚ¿ÊÔ.

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰Â-ÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈ-ÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔ-Áڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

°. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓTÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ӈÓ

ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· ›-Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂÙ·Í‡ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡ÔÏ¢ڤ˜.

TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË:ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈÎ¿Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·-ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹-ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ,ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿ÓˆÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂ-Ï›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›-‰· Ù›ÙÏÔ˘.

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜

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Page 6: Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ ÛÂ15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 ÛÂÏ›‰Â˜,ÁÈ· Ù· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ·ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:- ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ

(<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ

ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·-

ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›Ùˆ-ÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·,Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤ-ˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ÙÔ˘/ÙˆÓ,

- ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘Á-Áڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂȘH ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi-

¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ··ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓÚ¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ ηÈÙ· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfi-ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi.

T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒ-ÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„ËÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

K›ÌÂÓÔOÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·Áˆ-

Á‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·Áˆ-Á‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈ-Τ˜ ·Ú·Ô̤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈ-ÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂ-Ù¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T· ∞ÔÙÂϤÛÌ·Ù· Ú¤ÂÈÓ· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛËÚ¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·-ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó·¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘ÓÛ‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ ηȂڷ¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ Â-ÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ ηÈ

‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆ-ÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹-ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈÓ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓOÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó·

ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units)Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤-Û· Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339.

™˘ÓÙÔÌÔÁڷʛ˜OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜

‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂ-ÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘-¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘-ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂ-ÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ

ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤-ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·-Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·-Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó·˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢-ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂÓ-‰È·Ê¤ÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈ-‡ÛÂȘ.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂ-Ù·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ InternationalCommittee of Medical Journal Editors / UniformRequirements for Manuscripts Submitted to BiomedicalJournals (JAMA 1997;277:927-934), http://jama.ama-assn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙψÓÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated IndexMedicus (List of Journals Indexed in Index Medicus,http://www.nlm.nih.gov).

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶ÂÚÈÔ‰ÈοAÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ,

·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔȤÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:∞ÏÂ͛Ԣ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·,

·ÚfiÓ Î·È Ì¤ÏÏÔÓ: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È-‰È·ÙÚÈ΋ 1996;59:272-279.

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Proesmans W. Bartter syndrome and its neonatalvariant. Eur J Pediatr 1997;156:669-679.

™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:Flyvbjerg A. Role of growth hormone, insulin-like

growth factors (IGFs) and IGF-binding proteins in therenal complications of diabetes. Kidney Int 1997;52 (60Suppl):S12-S19.

Èڛ˜ Û˘ÁÁڷʤ·:National Institutes of Health Consensus

Development Conference. Neurofibromatosisconference statement. Arch Neurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:∫Ô˘Ú›‰Ë˜ Ã, ∫Ô˘Ú›‰Ë˜ °. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈ-

ȉ·ÈÌ›· Û ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈ΋˜ ∫‡ÚÔ˘ [¶ÂÚ›ÏË„Ë].36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›-Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜;1998. ÛÂÏ. 172.

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II. µÈ‚Ï›·

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™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the

head and neck. 3rd ed. New York: Oxford UniversityPress; 1990.

¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ:Bauer AW. The two definitions of bacterial

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¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹:¡ÙÔ˘ÓÙÔ˘Ï¿Î˘ π. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂڷ›· ÙÔ˘

Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ·È‰È¿ οوÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈ-ÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

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¶›Ó·Î˜ Î·È EÈÎfiÓ˜AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô

ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿-ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂ-Ï›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÌÂÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿ÙˆÌ¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂ-Ù˜ ÁÚ·Ì̤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·-Ù·, ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £·Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·-ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓÚ¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤-ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È ËÙ·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·ÈÔÓÔÌ·ÛÙÈο.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ Â-ÚÈÏ·Ì‚¿ÓÂÈ:- ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜- ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜- 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜- ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ

- Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜- fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜),

ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·Ï-

ÏËÏÔÁÚ·Ê›·- ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi

‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹

ÛÂÏ›‰·)- ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ¢¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-

¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢)- ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)- ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó- ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù·

¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó- Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹

ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

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¶·È‰È·ÙÚÈ΋ 2002;65:89-96 Paediatriki 2002;65:89-96

89

∂ÈÛ·ÁˆÁ‹∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ›ӷÈ

Ì›· ÛËÙÈ΋ ‹ ¿ÛËÙË ÊÏÂÁÌÔÓ҉˘ ·ÏÏÔ›ˆÛË ÙÔ˘ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fiÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰˘Ï›Ô˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÌÂÂÏ¿¯ÈÛÙË ‹ ηıfiÏÔ˘ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ∏ÁÓÒÛË Ù˘ Ê˘ÛÈ΋˜ ÔÚ›·˜ Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙÈ-‰·˜ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË, ÂÂȉ‹ Ë ÔÏ˘ÌÔÚÊ›·

ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÓfiÛÔ˘ ÚÔ-ηÏ› ‰È·ÁÓˆÛÙÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈ-Λ·.

Œ¯ÂÈ ‰Â ·Ó·ÁÓˆÚÈÛÙ› ˆ˜ ¿ıËÛË ÛÙËÓ ·È‰È΋ËÏÈΛ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÚÈÓ ÙÔ 1950 Î·È Èı·ÓfiÓ ÔMayer Â›Ó·È Ô ÚÒÙÔ˜ Ô˘ ÂÚȤÁÚ·„Â Î·È ‰ËÌÔÛ›-¢Û ÙËÓ ¿ıËÛË ·˘Ù‹ ÙÔ 1925 ÛÙÔ ÂÚÈÔ‰ÈÎfiJournal of Bone and Joint Surgery.

∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∞. °ÎÈfiη˜

Spondylodiscitis in childhood A. Giokas

∞¡∞™∫O¶∏™∏ REVIEW ARTICLE

µ’ OÚıԷȉÈ΋ ∫ÏÈÓÈ΋¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

B’ Orthopaedic DepartmentChildren’s Hospital “P. & A. Kyriakou”, Athens

�¶ÂÚ›ÏË„Ë: ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙ· ·È‰È¿ ›ӷÈÌ›· ·Û˘Ó‹ı˘ ÓfiÛÔ˜ Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û·Ó ÊÏÂÁ-ÌÔÓ҉˘ ·ÏÏÔ›ˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘.÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘‰È·ÛÙ‹Ì·ÙÔ˜ Ì ÂÏ¿¯ÈÛÙË ‹ ηıfiÏÔ˘ ÚÔÛ‚ÔÏ‹ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ∂ΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ì ÂÒ‰˘Óˉ˘Ûη̄›· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ·ÏÏ¿ Û˘Ó‹-ıˆ˜ Û˘Óԉ‡ÂÙ·È Î·È ·fi ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Ù·ÔÔ›· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ϷÓı·Ṳ̂ÓË ‹ η-ı˘ÛÙÂÚË̤ÓË ‰È¿ÁÓˆÛË Î·È ıÂڷ›·. ∞fi ÙÔÓ ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÌfiÓÔ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·Î·È È‰È·›ÙÂÚ· Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Â›Ó·È ·ÎÚÈ-‚›˜ Î·È Ù·¯Â›Â˜ ̤ıÔ‰ÔÈ Ô˘ ‰›‰Ô˘Ó ¯Ú‹ÛÈ̘ ηÈηıÔÚÈÛÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÚÒÈÌË ‰È¿ÁÓˆÛËÎ·È Èı·Ó‹ ÂÍ‹ÁËÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ù˘ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜. ∏ ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ ÂÚÈ-Ï·Ì‚¿ÓÂÈ ÎÏÈÓÔÛÙ·ÙÈÛÌfi, ·ÓÙÈ‚›ˆÛË (IV Î·È per os)ÁÈ· 3-4 ‚‰ÔÌ¿‰Â˜ Î·È ·ÎÈÓËÙÔÔ›ËÛË Ù˘ ÛÔÓ‰˘-ÏÈ΋˜ ÛÙ‹Ï˘ ÁÈ· 2-3 Ì‹Ó˜. ∏ Ê˘ÛÈ΋ ÂͤÏÈÍË Ù˘ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Â›Ó·È Î·ÏÔ‹ı˘ Î·È Ë ·Ú¯È΋ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙËÓ ËÏÈΛ· ÙÔ˘·È‰ÈÔ‡ Î·È ÙÔ Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ Ù˘ ÛÔÓ‰˘ÏÈ-΋˜ ÛÙ‹Ï˘.

§¤ÍÂȘ ÎÏÂȉȿ: ‰ÈÛΛÙȘ, ÛÔÓ‰˘Ï›ÙȘ, ÊÏÂÁÌÔÓ‹ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘.

�Abstract: Intervertebral discitis is an uncommondisease in children and has been described as aninflammation of the disk-space. It is characterisedby stenosis of the affected disk space with little orno evidence of adjacent vertebral involvement. Themain clinical feature of discitis is painful stiffness ofthe spine, but it may be accompanied by othersymptoms leading to misdiagnosis or delayeddiagnosis and therapy. From the diagnosticprocedures, only the bone scanning and especiallythe M.R.I. are accurate for the early establishmentof the diagnosis, and give useful informationconcerning the clinical syndrome of discitis.Treatment requires bed rest and administration ofantibiotics (IV and per os) for about 3-4 weeks, andstabilisation of the spine with back brace for 2-3months. The natural course of discitis is benign,and the initial clinical picture correlates directly withthe age of the child and the level of spineinvolvement.

Key words: discitis, spondylitis, spine infection.

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∏ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ÔÊÂÈÏÔ̤ÓË Û ÛËÙÈ΋ ‹ ¿ÛËÙË ÊÏÂÁÌÔÓ‹ ¤¯ÂÈÂÚÈÁÚ·Ê› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì ‰È·ÊÔÚÂ-ÙÈο ÔÓfiÌ·Ù·, fiˆ˜: 1) ηÏÔ‹ı˘ Ù‡Ô˜ ÔÛÙÂÔ-Ì˘ÂÏ›Ùȉ·˜ Ù˘ ™.™. (Smith 1933) (55), 2) ÔÍ›·ÊÏÂÁÌÔÓ҉˘ ·ÏÏÔ›ˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›-ÛÎÔ˘ (Ghormley 1940) (23), 3) ÔÍ›· ÔÛÙ½ÙȘ Ù˘™.™. (Bremner Î·È Neligan 1953) (5), 4) ÛÔÓ‰˘ÏÔ-·ÚıÚ›ÙȘ (Saenger 1952) (52), 5) ηٷÛÙÚÔÊÈ΋·ÏÏÔ›ˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ (Mathews1957) (39), 6) ÌË ÂȉÈ΋ ÛÔÓ‰˘Ï›ÙȘ (Dupont ηÈAnderson 1956) (14) Î·È 7) ‰ÈÛΛÙȘ (Menelaus1964) (40).

™ÙËÓ ·È‰È΋ ËÏÈΛ·, Ë Û˘¯ÓfiÙËÙ· ÌÈ·˜ ÊÏÂÁ-ÌÔÓ‹˜ Ù˘ ™.™. Â›Ó·È ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙȘÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÔÛÙÒÓ Î·È ·ÚıÚÒÛÂˆÓ Î·È Û˘Ó‹-ıˆ˜ fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·È Â›Ó·È ·›ÙÈÔ ·È‰È΋˜ÔÛÊ˘·ÏÁ›·˜. ∂›Û˘, Ë ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙ· ·È-‰È¿ Û·Ó›ˆ˜ Û˘Ó˘¿Ú¯ÂÈ Ì ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ¿Ï-ÏˆÓ ÔÛÙÒÓ ÙÔ˘ ÛÎÂÏÂÙÔ‡. H ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ›-Ó·È ÂÚÈÛÛfiÙÂÚÔ Û˘¯Ó‹ Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfi-ÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ, ·ÏÏ¿ ÌÔÚ› Ó· Û˘Ì‚Â› Û fiϘÙȘ ËÏÈ˘. ∏ ÚÔÛ‚ÔÏ‹ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·Â›Ó·È ÂÚ›Ô˘ ›ÛË.

O Eismont Î·È Û˘Ó (1982) Î·È Ô Nade (1983)˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÓÂÔÁÓÈ΋ ËÏÈΛ· ‰È·ÙÚ¤¯ÂÈ ÙÔÓÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÚÔÛ‚ÔÏ‹˜Ù˘ ™.™. (16,41). ∏ ÛË„·ÈÌ›· Â›Ó·È Û˘Ó‹ıˆ˜ ËÚÒÙË ‰È¿ÁÓˆÛË Ô˘ Á›ÓÂÙ·È, ÂÓÒ Ë ‰È¿ÁÓˆÛË Ù˘ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Â›Ó·È ·ÚÎÂÙ¿ ‰‡ÛÎÔÏË Î·È Î·-ı˘ÛÙÂÚ› Ó· Á›ÓÂÈ ·ÚÎÂÙ¤˜ ‚‰ÔÌ¿‰Â˜. ∆Ô Â›Â‰ÔÚÔÛ‚ÔÏ‹˜ Ù˘ ™.™. ·fi ‰ÈÛΛÙȉ· ηٿ ÛÂÈÚ¿ Û˘-¯ÓfiÙËÙ·˜ Â›Ó·È ÚÒÙ· Ë ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ-‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÌÂÙ¿ Ë ıˆÚ·ÎÈ΋ Î·È ÈÔ Û¿ÓÈ·Ë ·˘¯ÂÓÈ΋. ∆Ô Û˘¯ÓfiÙÂÚÔ ‰Â, Â›Â‰Ô ÚÔÛ‚Ô-Ï‹˜ Â›Ó·È ÙÔ ÌÂÛÔÛÔÓ‰‡ÏÈÔ ‰È¿ÛÙËÌ· O2-O3.

∏ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi Ì›· ηÏÔ‹ıË, ·˘ÙÔ˚Ò-ÌÂÓË ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·-ÙÔ˜, ·fi ÙËÓ ÔÔ›· ηӤӷ˜ ·ıÔÁfiÓÔ˜ ÌÈÎÚÔÔÚ-Á·ÓÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ ·ÔÌÔÓˆı›, ̤¯ÚÈ ÙËÓ ·ÚÔ˘-Û›· ˘Ò‰Ô˘˜ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ÊÏÂÁÌÔÓ‹˜ ÌÂÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓÎ·È ÙË ‰ËÌÈÔ˘ÚÁ›· „ÔÈÙÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ (33).

∞ÈÌ¿ÙˆÛË ÛÔÓ‰‡ÏÔ˘ - ‰›ÛÎÔ˘O ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜ ¤¯ÂÈ ‰‡Ô ËÁ¤˜ ·È-

Ì¿ÙˆÛ˘: ·) Ù· ÂÚÈÔÛÙÈο ·ÁÁ›·, ‚) Ù· ·ÁÁ›·Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÎÂÓÙÚÈ΋ ÌÔ›Ú· ÙÔ˘ÛÔÓ‰‡ÏÔ˘. ∞˘Ù¿ ·Ú¯›˙Ô˘Ó Ó· ·ÙÚÔÊÔ‡Ó ·fi ÙÔÚÒÙÔ ¤ÙÔ˜ Î·È ÂÍ·Ê·Ó›˙ÔÓÙ·È Ï‹Úˆ˜ ÛÙËÓ ËÏÈ-Λ· ÙˆÓ 10 ¯ÚfiÓˆÓ. ŒÙÛÈ ·Ú·Ì¤ÓÂÈ ÌfiÓÔ ÙÔ ÙÚÈ-¯ÔÂȉ¤˜ ‰›ÎÙ˘Ô ÛÙÔÓ ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ ÙÔ˘ ÌÂÛÔ-ÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙÔ ÔÔ›Ô ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ

ÙÂÏÈΤ˜ ‰È·ÎÏ·‰ÒÛÂȘ ÙˆÓ ÂÚÈÔÛÙÈÎÒÓ ·ÁÁ›ˆÓ(17,69,71). ∂¿Ó Û˘Ì‚Â› Í·ÊÓÈο ·fiÙÔÌË ‰È·ÎÔ‹Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙfiÙÂÔ ‰›ÛÎÔ˜ Ô‰ËÁÂ›Ù·È ÛÙËÓ È‰ÈÔ·ı‹ Ó¤ÎÚˆÛ‹ ÙÔ˘Ô˘ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˆ˜ ·Û‚¤ÛÙˆÛË (57).™ËÌÂÈÒÓÂÙ·È Â›Û˘ fiÙÈ Ô ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜¯¿ÓÂÈ Ï‹Úˆ˜ ÙËÓ ·ÈÌ¿ÙˆÛ‹ ÙÔ˘ ÂÚ›Ô˘ ÛÙËÓËÏÈΛ· ÙˆÓ 30 ¯ÚfiÓˆÓ (10).

¶·ıÔÁ¤ÓÂÈ· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ ∞. ∞ÈÌ·ÙÔÁÂÓ‹˜. ∏ ˘¿Ú¯Ô˘Û· ·ÈÌ¿ÙˆÛË ÙÔ˘

ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ ·Ú¤¯ÂÈ ÙËÓ Èı·ÓfiÙËÙ·ÚÔÛ‚ÔÏ‹˜ ·˘ÙÔ‡ ·fi ÛËÙÈÎfi ¤Ì‚ÔÏÔ. O Schmorl(1959) ̆ ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ‰ÈÛΛÙȘ Â›Ó·È ÚˆÙÔ·ı‹˜ÊÏÂÁÌÔÓ‹ ÙÔ˘ ‰›ÛÎÔ˘ Î·È fi¯È ‰Â˘ÙÂÚÔ·ı‹˜ ·fiÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ÙÔ˘ ÛÔÓ‰‡ÏÔ˘. ∞˘Ùfi ÂÍËÁ›ٷȷʒ ÂÓfi˜ ÌÂÓ ·fi ÙËÓ ÚÔηÏÔ‡ÌÂÓË ÛÙ¤ÓˆÛË ÙÔ˘ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜, ·Ê’ ÂÙ¤ÚÔ˘ ‰Â ·fiÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ Î·È ÙˆÓ‰‡Ô ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ (53).

Ÿˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔ˘˜ Wiley ηÈTrueta (1959), ¤Ó·˜ ¿ÏÏÔ˜ Ì˯·ÓÈÛÌfi˜ ÚÔÛ‚Ô-Ï‹˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ Â›Ó·È Ë ‰ËÌÈÔ˘Ú-Á›· ÌÈÎÚÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ÛÙË ÌÂÙ¿Ê˘ÛË ÙÔ˘ÛÔÓ‰‡ÏÔ˘ ÏËÛ›ÔÓ Ù˘ ÂÈÊ˘Ûȷ΋˜ Ͽη˜, ÙÔÔÔ›Ô ·ÓÙ› Ó· ηٷÛÙÚ¤„ÂÈ ÙÔÓ ÛfiÓ‰˘ÏÔ, Ú‹ÁÓ˘-Ù·È ÛÙÔÓ ·Ú·Î›ÌÂÓÔ ‰›ÛÎÔ (69). O ·ıÔÁÂÓÂÙÈ-Îfi˜ ·˘Ùfi˜ Ì˯·ÓÈÛÌfi˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔÓRing Î·È Û˘Ó (1994, 1995), ηıÒ˜ Î·È ·fi ÙÔÓKwang Soon Song Î·È Û˘Ó (1997) ÌÂÙ¿ ·fi ÙË ÏÂ-ÙÔÌÂÚ‹ ÌÂϤÙË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ù˘ Ì·ÁÓËÙÈ΋˜ÙÔÌÔÁÚ·Ê›·˜ (47,48,61). ∞fi ÙÔÓ Whalen Î·È Û˘Ó(1985) ÂÚÈÁÚ¿ÊÂÙ·È fiÙÈ Ë ‡·ÚÍË ·ÚÙËÚÈÔÊÏÂ-‚ˆ‰ÒÓ ÎfiÏˆÓ ÛÙË ÌÂÙ¿Ê˘ÛË ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Ì‚ڷ‰Â›· ·ÈÌ·ÙÈ΋ ÚÔ‹ ÌÂÈÒÓÂÈ ÙËÓ Î·Ù·ÛÙÚÔÊ‹ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ·fi Ù· Ï¢ÎÔ·ÙÙ·Ú·, Ì ·ÔÙ¤-ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÚÔ-·ÔÛÙËÌ¿ÙˆÓ (71).∂›Û˘, Ô Coventry Î·È Û˘Ó (1945) Î·È Ô WhalenÎ·È Û˘Ó (1985) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ‰ÈÛΛÙȘ ›ӷÈÈÔ Û˘¯Ó‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ Ë ÛÔÓ‰˘Ï›ÙÈ˜Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ‰ÈfiÙÈ Ô ÌÂÛÔ-ÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚË ·ÈÌ¿ÙˆÛËÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô˘ Û˘Ó‹ıˆ˜ ÌÂÈÒÓÂÙ·È Î·ÈÂÍ·Ê·Ó›˙ÂÙ·È fiÙ·Ó Û˘Ì‚Â› ÔÛÙÂÔÔ›ËÛË ÙÔ˘ Û˘-˙¢ÎÙÈÎÔ‡ ¯fiÓ‰ÚÔ˘ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ (10,71).

O Kwang Soon Song Î·È Û˘Ó (1997) ·Ó·Ê¤ÚÂÈfiÙÈ Ë ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰ÈÛΛÙȘ ÚÔÛ‚¿ÏÏÂÈ ·Ú¯È-ο ÙÔ ÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Î·È ÙÔ˘ ‰›-ÛÎÔ˘ Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÚÔÛ‚ÔÏ‹ÙÔ˘ Ô›ÛıÈÔ˘ ÙÌ‹Ì·ÙÔ˜. O ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›-ÛÎÔ˜ ηٷÛÙÚ¤ÊÂÙ·È ÂÂȉ‹ Ë ÊÏÂÁÌÔÓ҉˘ ‰È·-‰Èηۛ· ¤¯ÂÈ ¯ÔÓ‰ÚÔÏ˘ÙÈ΋ ȉÈfiÙËÙ·, fiˆ˜ ·ÎÚÈ-‚Ò˜ Î·È ÛÙËÓ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· Î·È ÛËÙÈ΋ ·ÚıÚ›ÙÈ-‰· ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ (61).

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B. ∂ÓÔÊı·ÏÌÈÛÌfi˜. ∂›Ó·È ¤Ó·˜ ¿ÏÏÔ˜ ÙÚfiÔ˜ÚfiÎÏËÛ˘ ‰ÈÛΛÙȉ·˜ Ô˘ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È ÌÂÙ¿·fi ·Ú·Î¤ÓÙËÛË, ‰ÈÛÎÔÁÚ¿ÊËÌ·, ‰ÈÛÎÂÎÙÔÌ‹ ηÈÌ˘ÂÏÔÁÚ·Ê›·. ∆Ô ‰ÈÛÎÔÁÚ¿ÊËÌ· Î·È Ë ‰ÈÛÎÂÎÙÔÌ‹Â›Ó·È ÂÂÌ‚¿ÛÂȘ Ô˘ Û˘Ó‹ıˆ˜ Á›ÓÔÓÙ·È Û ·È‰È¿ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜. µ·ÛÈο, Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ÌÂ-ÛÔÛÔÓ‰˘Ï›Ô˘ ‰ÈÛΛÙȉ·˜ ‰ÂÓ Â›Ó·È ÍÂοı·ÚË.Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÙÚ·˘Ì·ÙÈο ·›ÙÈ·, ÈÔ› Î·È ÌÈ-ÎÚfi‚È·.

∏ ηÏÔ‹ı˘ ÔÚ›· ˆ˜ › ÙÔ Ï›ÛÙÔÓ Ù˘ Ófi-ÛÔ˘, Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi ÎÏÈÓÔÛÙ·ÙÈÛÌfi ÌfiÓÔ, Û˘-ÓËÁÔÚ› ÁÈ· Ì›· ¯·ÌËÏ‹˜ ÙÔÍÈÎfiÙËÙ·˜ ÊÏÂÁÌÔÓ‹ ‹ÁÈ· ¿ÛËÙË ÊÏÂÁÌÔÓ‹.

∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ·Ó¿ÏÔ-

Á· Ì ÙËÓ ËÏÈΛ· Î·È ÙË ‰È·ÊÔÚÂÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ·,‰È·ÎÚ›ÓÂÙ·È Û 3 ÔÌ¿‰Â˜, ‰ËÏ·‰‹ ÙË ‚ÚÂÊÈ΋, ÙËÓËȷ΋ Î·È ÙËÓ ·È‰È΋. ∏ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘ÛÎÔ-ÏfiÙÂÚË ÛÙË ‚ÚÂÊÈ΋ Î·È ÓËȷ΋ ËÏÈΛ·, ÂÂȉ‹ÛÙËÓ ËÏÈΛ· ·˘Ù‹ Ù· ·È‰È¿ ‰ÂÓ Â›Ó·È Û˘ÓÂÚÁ¿ÛÈÌ·Î·È ‰ÂÓ ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ÏËÚÔÊÔڛ˜ ηٿ ÙËÏ‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡.

∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÂÌÊ·Ó›˙ÂÙ·È Ì ÔÈΛϷ Û˘-ÌÙÒÌ·Ù· ηÈ, ·Ó¿ÏÔÁ· Ì ÙÔ Î˘Ú›·Ú¯Ô Û‡ÌÙˆÌ·Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, Ù·ÍÈÓÔÌÂ›Ù·È ÛÙ· ·Îfi-ÏÔ˘ı· Û‡Ó‰ÚÔÌ·:

∞. ™‡Ó‰ÚÔÌÔ ÂÒ‰˘ÓÔ˘ ÈÛ¯›Ô˘: ÷ڷÎÙËÚ›˙ÂÙ·È·fi ÌË ÂȉÈÎfi fiÓÔ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÈÛ¯›Ô˘ ‹ ÛÂÔÏfiÎÏËÚÔ ÙÔ ÛΤÏÔ˜, ¯ˆÚ›˜ Ó· Â›Ó·È ÂÓÙÔÈṲ̂ÓÔ˜fiˆ˜ ÛÙË ‰ÈÛÎÔ΋ÏË. ∏ ÔÛÊ˘·ÏÁ›· ‰ÂÓ Â›Ó·È ¤ÓÙÔ-ÓË Î·È Û˘Ó‹ıˆ˜ ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜.

µ. ™‡Ó‰ÚÔÌÔ ÔÍ›·˜ ÎÔÈÏÈ¿˜: ÷ڷÎÙËÚ›˙ÂÙ·È·fi ·ÓÔÚÂÍ›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ¤ÌÂÙÔ Ì¤¯ÚÈ Û˘-Ìو̷ÙÔÏÔÁ›· ÂÈÏÂÔ‡, Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ Ô ·ÛıÂ-Ó‹˜ ¤¯ÂÈ Ô‰ËÁËı› ̤¯ÚÈ ÙË Ï··ÚÔÙÔÌ›·. ™˘Ó‹-ıˆ˜, ÙË Û˘Ìو̷ÙÔÏÔÁ›· ·˘Ù‹ ‰›‰ÂÈ Ë ÛÔÓ‰˘ÏÔ-‰ÈÛΛÙȘ Ô˘ Û˘Ì‚·›ÓÂÈ ·fi ÙË £8 ¤ˆ˜ ÙËÓ O1 Ú›˙·.∂›Û˘, Ë ËÏÈΛ· Ô˘ Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÔÓÙ·È Ù·Û˘ÌÙÒÌ·Ù· ·˘Ù¿ Û ̛· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ· ΢-Ì·›ÓÂÙ·È ·fi Ù· 3 ¤ˆ˜ Ù· 8 ¤ÙË.

°. ™‡Ó‰ÚÔÌÔ ÌËÓÈÁÁÈÙȉÈÎfi: ÷ڷÎÙËÚ›˙ÂÙ·È ·fiÂÚÂıÈÛÌfi ÙˆÓ ÌËÓ›ÁÁˆÓ, fiˆ˜ ‰Â›¯ÓÂÈ Ë ·ÚÔ˘Û›·ÙˆÓ ÛËÌ›ˆÓ Kerning Î·È Brudzinski. ÀÂÚ˘ÚÂÍ›·Î·È ÎÏfiÓÔ˜ ›Ûˆ˜ Â›Ó·È ·ÚfiÓÙ· Û˘ÌÙÒÌ·Ù·, η-ıÒ˜ Î·È Ë ÔÛÊ˘·ÏÁ›·, ·ÏÏ¿ fi¯È ¤ÓÙÔÓË.

¢. ™‡Ó‰ÚÔÌÔ Ú·¯È·ÏÁ›·˜: ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Û·Ê‹ fiÓÔ ÛÙË Oª™™ ‹ ÙËÚ¿¯Ë ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ¯ˆÏfiÙËÙ· Ì ÚÔԉ¢-ÙÈ΋ ¿ÚÓËÛË ÁÈ· ‚¿‰ÈÛË Î·È ÛÙ¿ÛË Î·È ‰˘Ûη̄›·Ù˘ ™.™. ™˘Ó‹ıˆ˜, Ë Â˘ÂÚÂıÈÛÙfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì ٷ ˘¿Ú¯ÔÓÙ· ÁÂÓÈ-ο Û˘ÌÙÒÌ·Ù·.

∫¿ı ΛÓËÛË Ù˘ ÏÂοÓ˘, ÙÔ˘ ÈÛ¯›Ô˘ Î·È ÙÔ˘

ÌËÚÔ‡ ÚÔηÏ› ‰˘ÛÊÔÚ›·. À¿Ú¯ÂÈ ‰˘Ûη̄›·,Ì˘˚Îfi˜ Û·ÛÌfi˜, ÙÔÈ΋ ¢·ÈÛıËÛ›· Î·È Â˘ıÂÈ·-ÛÌfi˜ Ù˘ ™.™. ™˘Ó‹ıˆ˜ ÚÔηÏÂ›Ù·È fiÓÔ˜ ÌÂÙ¿·fi ›ÂÛË ÛÙËÓ ÚÔۂ‚ÏË̤ÓË ÂÚÈÔ¯‹ Ù˘ ™.™.∂›Û˘, ¤Ó· ·ÚÎÂÙ¿ Û˘¯Ófi ÎÏÈÓÈÎfi ‡ÚËÌ· Â›Ó·È Î·ÈË ˘ÂÚ‚ÔÏÈ΋ ÏfiÚ‰ˆÛË ‹ ÛÎÔÏ›ˆÛË Ô˘ ÚÔηÏ›·ÓÒÌ·ÏË ÛÙ¿ÛË Î·È ı¤ÛË ÙÔ˘ ÎÔÚÌÔ‡, fiˆ˜ ›-Û˘ Î·È ÙÔ ıÂÙÈÎfi ÛËÌÂ›Ô laseque.

∂. ™‡Ó‰ÚÔÌÔ Â˘ÂÚ¤ıÈÛÙÔ˘ ·È‰ÈÔ‡: ÷ڷÎÙËÚ›-˙ÂÙ·È ·fi ¢ÂÚÂıÈÛÙfiÙËÙ· Î·È ·Û˘Ó‹ıË Û˘ÌÂÚÈ-ÊÔÚ¿ Ì ¯·ÌËÏfi ˘ÚÂÙfi Î·È Î·ÎÔ˘¯›·.

¶ÚÔÛÂÎÙÈÎfiÙÂÚË ÂͤٷÛË ı· ·Ôηχ„ÂÈ ÙÔÈ-΋ ¢·ÈÛıËÛ›· ÛÙË Oª™™ Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙ¿-ÛË ÙÔ˘ ·È‰ÈÔ‡. ∏ Û˘ÓËı¤ÛÙÂÚË ‰Â, ËÏÈΛ· ÂΉ‹Ïˆ-Û˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·˘ÙÒÓ Â›Ó·È Ì¤¯ÚÈ Ù· 3 ¯Úfi-ÓÈ·.

™·Ó›ˆ˜ Ù· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Ô‰ËÁÔ‡Ó ÛÙˉȿÁÓˆÛË ÊÏÂÁÌÔÓ‹˜ Ù˘ ™.™., ·ÏÏ¿ Ú¤ÂÈ Ó· Á›-ÓÂÈ ¤ÏÂÁ¯Ô˜ ÁÈ’ ·˘Ù‹. ™˘Ó‹ıˆ˜ Ù· ·È‰È¿ Ì ÛÔÓ-‰˘ÏÔ‰ÈÛΛÙȉ· ÂÌÊ·Ó›˙Ô˘Ó Ó·˘Ù›· Î·È ¤ÌÂÙÔ, ¯ˆÚ›˜Ó· ˘¿Ú¯ÂÈ ˘„ËÏfi˜ ˘ÚÂÙfi˜.

¢È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜∞) ∞Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·. H ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·

Û˘Ó‹ıˆ˜ Â›Ó·È ·ÚÓËÙÈ΋ ÁÈ· Â˘Ú‹Ì·Ù· ÛÔÓ‰˘ÏÔ-‰ÈÛΛÙȉ·˜, fiˆ˜ Â›Ó·È Ë ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ-‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È ÔÈ ‹È˜ ·ÏÏÔÈÒÛÂȘ Ù˘ÂÈÊ˘Ûȷ΋˜ Ͽη˜ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘. ∏ ¯·Ú·ÎÙË-ÚÈÛÙÈ΋ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·-ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ô˘Á›ÓÂÙ·È ÌÂÙ¿ ·fi ¤Ó· Ì‹Ó· (∂ÈÎfiÓ· 1 Î·È 5).

µ) ∞ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ÁÂ-ÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, CRP, WIDAL, WRIGHT. ∂¿Ó ‰Â,˘¿Ú¯Ô˘Ó Î·È ÛËÌ›· ÛË„·ÈÌ›·˜, ÙfiÙ ÂӉ›ÎÓ˘Ù·ÈÓ· Á›ÓÂÙ·È Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, ηÏÏȤÚÁÂÈ· Ê¿-Ú˘ÁÁÔ˜ Î·È Ô˘ÚÔηÏÏȤÚÁÂÈ·. ∂›Û˘, ÁÈ· ÙËÓ·Ó‡ÚÂÛË ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔ-ÓÙ· ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ Ó· Á›ÓÔÓÙ·È Î·ÏÏȤÚÁÂȘ˘·Ú¯fiÓÙˆÓ ÙÚ·˘Ì¿ÙˆÓ. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ-¯Ô˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙËÓ ÂͤٷÛË ÁÈ· ÙÔ·ÓÙÈÁfiÓÔ HLA-B27, Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛÙ› Ë·Á΢ÏÔÔÈËÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ·.

°) ¢ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux.¢) ™ÈÓıËÚÔÁÚ¿ÊËÌ·. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ·

ÔÛÙÒÓ Ì 99mTc Â›Ó·È Ì›· ·ÎÚÈ‚‹˜ Î·È Ù·¯Â›· ̤ıÔ-‰Ô˜ ÂÓÙÔÈÛÌÔ‡ ÌÈ·˜ ÊÏÂÁÌÔÓ‹˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ÛÙ‹Ï˘. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Ê·›ÓÂÙ·È Ó·Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙ· ÌÈÎÚ¿ ·È‰È¿, ‰ÈfiÙÈ Ë ÂÓÙfiÈÛËÙ˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÂÂÍÂÚÁ·Û›·˜ ÛÙËÓ ËÏÈΛ· ·˘-Ù‹ Â›Ó·È ·‰‡Ó·ÙË Ì ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË.

ªÂÙ¿ ÙÔ ıÂÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ‰ËÏ·‰‹ ÌÂÙËÓ ·ÚÔ˘Û›· “£ÂÚÌÔ‡ ÛËÌ›Ԣ” (Hot Spot), Û˘ÓÈ-ÛÙ¿Ù·È Ë ÙÔÈ΋ ·ÂÈÎfiÓÈÛË Ì ̷ÁÓËÙÈ΋ ‹ ·ÍÔÓÈ΋ÙÔÌÔÁÚ·Ê›· (∂ÈÎfiÓ· 2).

¶·È‰È·ÙÚÈ΋ 2002;65:89-96 Paediatriki 2002;65:89-96

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∂) ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·Â›Ó·È Ì›· ¯Ú‹ÛÈÌË ‰È·ÁÓˆÛÙÈ΋ ·ÂÈÎÔÓÈÛÙÈ΋ ̤-ıÔ‰Ô˜ ÁÈ· ÙËÓ ¤Ú¢ӷ ÛÔÓ‰˘ÏÈÎÒÓ ·ıÔÏÔÁÈÎÒÓ·ÏÏÔÈÒÛˆÓ. ∂›Ó·È ΢ڛˆ˜ ÔχÙÈÌË ÛÙË ‰È¢ÎÚ›ÓÈ-ÛË Î·È ‰È¿ÁÓˆÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛˆÓÔ˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ˘˜ ÛÔÓ‰‡ÏÔ˘˜ ÌÂÙ¿ ·fiÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·˘ÙÒÓ ·ÏÏÔÈÒÛÂ-ˆÓ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ÙÔ ÛÈÓıËÚÔÁÚ¿-ÊËÌ· ÔÛÙÒÓ. ∂›Û˘, Ô Û˘Ó‰˘·ÛÌfi˜ ·ÍÔÓÈ΋˜ ÙÔ-ÌÔÁÚ·Ê›·˜ Î·È Ì˘ÂÏÔÁÚ·Ê›·˜ ·Ú¤¯ÂÈ ÂÈÚfiÛıÂ-Ù˜ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È·ÁÓˆÛÙÈ΋ÂÎÙ›ÌËÛË Ù˘ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›-ÛÎÔ˘.

™∆) ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. ∂›Ó·È Ì›· Ó¤· ·ÂÈ-ÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ Î·È È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ. ¢ÂÓ ÂΤ-ÌÂÈ ·ÎÙÈÓÔ‚ÔÏ›· Î·È ·ÂÈÎÔÓ›˙ÂÈ Ù· ÚÒÈÌ· ÊÏÂÁ-ÌÔÓÒ‰Ë ÛÙÔȯ›· ÙÔ˘ ‰›ÛÎÔ˘ Î·È ·Ú·ÛÔÓ‰˘ÏÈ-ÎÒÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ. ¢Â›¯ÓÂÈ ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿-‚˘ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙËÓ ·Ú·Î›ÌÂ-ÓË ÂÈÊ˘Ûȷ΋ Ͽη Î·È ÙȘ ·ÏÏÔÈÒÛÂȘ ÙˆÓÛÔÓ‰‡ÏˆÓ. ∂›Û˘, ηٷÁÚ¿ÊÂÈ Î¿ı ‰È·ÊÔÚ¿ÛÙÔ ÓˆÙÈ·›Ô ۈϋӷ Î·È ·Ú¤¯ÂÈ fi¯È ÌfiÓÔÓ ·Ó·ÙÔ-ÌÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ™.™., ·ÏÏ¿ Â›Ó·È ·ÔÙÂÏÂÛÌ·-ÙÈ΋ Î·È ÛÙË ¯ËÌÈ΋ Û‡ÛÙ·ÛË ÙˆÓ ÚÔۂ‚ÏË̤-ÓˆÓ ÈÛÙÒÓ (∂ÈÎfiÓ· 3 Î·È 4).

∑) ¶·Ú·Î¤ÓÙËÛË. ™˘Ó‹ıˆ˜ ‰ÂÓ ÂӉ›ÎÓ˘Ù·È Ó·Á›ÓÂÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÂÂȉ‹ Ô Î›Ó‰˘-ÓÔ˜ ·fi ÙËÓ ·Ú·Î¤ÓÙËÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÂÛ¯¤ÛË Ì ÙËÓ Î·ÏÔ‹ıË ÔÚ›· Ù˘ ÓfiÛÔ˘. ∂›Û˘,fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔÓ Spiegel Î·È Û˘Ó(1972) Î·È Wenger Î·È Û˘Ó (1978), Ì ÙËÓ ·Ú·Î¤-ÓÙËÛË ‹ ÙËÓ ·ÓÔÈÎÙ‹ ‚ÈÔ„›· ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘‰›ÛÎÔ˘ ÌfiÓÔ ÛÙÔ 50% ÂÚ›Ô˘ ·Ó¢ڛÛÎÂÙ·È Ô ·-ıÔÁfiÓÔ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ (58,68).

∏) µÈÔ„›·. ∏ ·ÓÔÈÎÙ‹ ‹ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ‰È¿ ‚Â-

ÏfiÓ˘ Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘ÓÈÛٿٷÈ, ‰ÈfiÙÈ ¤¯ÂÈ ÎÈÓ‰‡-ÓÔ˘˜, ¤¯ÂÈ ·Ô‰Âȯı› ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ·ÓÂÈÙ˘¯‹˜ÁÈ· ÙËÓ ·Ó·Î¿Ï˘„Ë ÙÔ˘ ·ıÔÁÂÓÂÙÈÎÔ‡ ·ÈÙ›Ô˘ ηȉÂÓ ÙËÓ ·Ô‰¤¯ÔÓÙ·È Â‡ÎÔÏ· ÔÈ ÁÔÓ›˜ Î·È ÔÈ ÌÈ-ÎÚÔ› ·ÛıÂÓ›˜. ∏ ‚ÈÔ„›· ‰È¿ ‚ÂÏfiÓ˘ ÙÔ˘ ÚÔÛ‚Â-‚ÏË̤ÓÔ˘ ‰›ÛÎÔ˘ Û˘ÓÈÛÙ¿Ù·È ·fi ÙÔÓ Taylor(1985) Ó· Á›ÓÂÙ·È ÛÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ Ô˘·Ú·ÙËÚÂ›Ù·È ÂÎÙÂٷ̤ÓË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ‰›ÛÎÔ˘Î·È ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ÛÒÌ·ÙÔ˜ ÛÙËÓ ˘Ô„›· Ê˘Ì·-ÙÈÒ‰Ô˘˜ ÛÔÓ‰˘Ï›Ùȉ·˜ ‹ Û ÂΛӘ ÙȘ ÂÚÈÙÒ-ÛÂȘ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏËÛ˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹. ∂›Û˘, ÌÔÚ› Ó· ÎÚÈı›··Ú·›ÙËÙË Ë ·ÓÔÈÎÙ‹ ‹ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ÌfiÓÔÓ ÂÊ’fiÛÔÓ Ù›ıÂÙ·È ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· (63).

¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË1) OÍ›· ÔÛÙÂÔÌ˘ÂÏ›ÙȘ ÛÔÓ‰‡ÏÔ˘. ÷ڷ-

ÎÙËÚ›˙ÂÙ·È ·fi Ôͤ· ÁÂÓÈο Û˘ÌÙÒÌ·Ù· Ì ˘„Ë-Ïfi ˘ÚÂÙfi, Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, ·˘ÍË̤ÓË ∆∫∂ ηÈÙ·¯Â›· ÚÔԉ¢ÙÈ΋ ÔÛÙÈ΋ ηٷÛÙÚÔÊ‹. ∂›Û˘,ÙÔ Ôχ ıÂÚÌfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, Ë ·ÍÔÓÈ΋ Î·È ËÌ·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ·ÚÎÂ-Ù¿ ‰È·ÊˆÙÈÛÙÈο ÛÙÔȯ›· Ù˘ ÚÔۂ‚ÏË̤Ó˘ÂÚÈÔ¯‹˜.

O Correa Î·È Û˘Ó (1993) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ËÔÛÙÂÔÌ˘ÂÏ›ÙȘ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Û˘Ó‹ıˆ˜ ÂΉËÏÒ-ÓÂÙ·È Ì fiÓÔ ·Ó¿ÏÔÁ· Ù˘ ı¤Û˘ ÚÔÛ‚ÔÏ‹˜ÛÙËÓ ·˘¯ÂÓÈ΋, ÙË ıˆÚ·ÎÈ΋ Î·È ÙËÓ ÔÛÊ˘˚΋ ÌÔ›-Ú· Ù˘ ™™ (9).

2) º˘Ì·ÙÈ҉˘ ÛÔÓ‰˘ÏÈ΋ ÔÛÙÂÔÌ˘ÂÏ›ÙȘ.™˘Ó‹ıˆ˜ Ë TBC Â›Ó·È ıˆÚ·ÎÈ΋, ÂÓÒ Ë ‰ÈÛΛÙȘÂÓÙÔ›˙ÂÙ·È ÛÙËÓ Oª™™. ∏ ·ÚÓËÙÈ΋ Mantoux Î·È ËÊ˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·ÔÎÏ›ԢÓÙËÓ ‡·ÚÍ‹ Ù˘.

™ÙËÓ TBC ÛÔÓ‰˘Ï›Ùȉ·, Ë ÔÚ›· Ù˘ ÓfiÛÔ˘¤¯ÂÈ ÚÔԉ¢ÙÈο ·ÚÁfi Ú˘ıÌfi Ì ÌÂÁ¿ÏË ÔÛÙÈ΋

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∂ÈÎfiÓ· 5. ¶ÚÔÛıÔ›ÛıÈ· Î·È Ï·Á›· ·ÎÙÈÓÔÁÚ·Ê›· ÔÛÊ˘˚-΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Ì ÛÙ¤ÓˆÛË ÙÔ˘ O3-O4

ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ıÂڷ¢-ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜.

∂ÈÎfiÓ· 1. ¶ÚÔÛıÔ›ÛıÈ· Î·È Ï·Á›· ·ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘-ÏÈ΋˜ ÛÙ‹Ï˘ Ì ÛÙ¤ÓˆÛË ÙÔ˘ £12-O1 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·-ÛÙ‹Ì·ÙÔ˜. ∞Ó‹ÎÂÈ Û ÎÔÚ›ÙÛÈ 5 ÂÙÒÓ Ô˘ ·ÚÔ˘Û›·Û ·Ú¯È-ο Û˘ÌÙÒÌ·Ù· ÔÍ›·˜ ÎÔÈÏ›·˜.

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ηٷÛÙÚÔÊ‹ Î·È ÂÏ¿¯ÈÛÙË ·ÔηٿÛÙ·ÛË. ∂›Û˘,Û ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È ·Ú·ÛÔÓ‰˘-ÏÈÎfi ·fiÛÙËÌ· Ô˘ ‡ÎÔÏ· ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. 3) ∆˘ÊÈ΋ Î·È ÌÂÏÈÙÔÎÔÎÎÈ΋ ÛÔÓ‰˘Ï›ÙȘ 4) ∞ÔÙÈÙ¿ÓˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ 5) £ˆÚ·ÎÈ΋ Î·È ÔÛÊ˘˚΋ ÓfiÛÔ˜ ÙÔ˘

Scheuermann 6) TÚ·˘Ì·ÙÈ΋ ÛÔÓ‰˘Ï›ÙȘ 7) ŸÁÎÔÈ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ 8) ªËÓÈÁÁ›ÙȘ 9) ¡Â˘ÚÔÏÔÁÈ΋ ÓfiÛÔ˜

10) ™ÎˆÏËÎÔÂȉ›ÙȘ 11) ¶˘ÂÏÔÓÂÊÚ›ÙȘ

£Âڷ¢ÙÈ΋ ·ÁˆÁ‹ 1) ∫ÏÈÓÔÛÙ·ÙÈÛÌfi˜. ∂Ê’ fiÛÔÓ ‰È·ÁÓˆÛı› ‰ÈÛΛ-

ÙȘ, Û˘ÓÈÛÙ¿Ù·È ¿ÌÂÛË Î·Ù¿ÎÏÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ̤-¯ÚÈ Ó· ˘Ô¯ˆÚ‹ÛÂÈ Ô fiÓÔ˜, Ô Ì˘˚Îfi˜ Û·ÛÌfi˜ ηÈË ÙÔÈ΋ ¢·ÈÛıËÛ›·, Î·È ¤ˆ˜ fiÙÔ˘ Ë ∆∫∂, Ë Ï¢-ÎÔ΢ÙÙ¿ÚˆÛË Î·È Ô ˘ÚÂÙfi˜ ·Ú¯›ÛÔ˘Ó Ó· ˘Ô¯ˆ-ÚÔ‡Ó Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ‰Â›ÍÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÂȉÂÈ-Óˆı› Ë ÔÛÙÈ΋ ‰È¿‚ÚˆÛË. ∂ԇψÛË ‹ ›·ÛË ·fiÙË ÓfiÛÔ ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ‡·ÚÍË ÌÂÚÈ΋˜ÛÎÏ‹Ú˘ÓÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ÂÈ-Ê·ÓÂÈÒÓ.

2) ∞ÓÙÈ‚›ˆÛË. ∞Ú¯Èο, Â›Ó·È Û˘Ó‹ıˆ˜ ÂÌÂÈÚÈ΋(ÎÂÊ·ÏÔÛÔÚ›ÓË + ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈο Ê¿ÚÌ·-η) ÁÈ· 10 Ë̤Ú˜ (∂º) Î·È per os ̤¯ÚÈ Ó· ˘Ô¯ˆ-Ú‹ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· Î·È Ë ∆∫∂ ÂÈÛÙÚ¤„ÂÈ ÛÙ·Ê˘ÛÈÔÏÔÁÈο ›‰· (Û˘Ó‹ıˆ˜ ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ·Î˘Ì·›ÓÂÙ·È ·fi 4 ¤ˆ˜ 6 ‚‰ÔÌ¿‰Â˜). ∂¿Ó fï˜·Ó·Î·Ï˘Êı› ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ÛÙËÓ ·ÈÌÔηÏÏȤÚ-ÁÂÈ· Î·È ÛÙËÓ ·Ú·Î¤ÓÙËÛË, ÙfiÙ ¯ÔÚËÁÂ›Ù·È ÙÔ Î·-

Ù¿ÏÏËÏÔ ·ÓÙÈ‚ÈÔÙÈÎfi Û‡Ìʈӷ Ì ÙÔ ÙÂÛÙ Â˘·ÈÛıË-Û›·˜. ™ÙË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·, ·Ú’ fiÙÈ ¤¯ÂÈ ÊÏÂÁ-ÌÔÓÒ‰Ë ÚԤϢÛË, Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ıÂ-ˆÚÂ›Ù·È ·ÌÊÈÛ‚ËÙ‹ÛÈÌË Î·È Û˘Ó‹ıˆ˜ Ë ÓfiÛÔ˜ ›ӷȷ˘ÙÔ˚ÒÌÂÓË Î·È ¤¯ÂÈ Î·Ï‹ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÎÈ-ÓËÙÔÔ›ËÛË Ù˘ ™.™. Î·È ÙÔÓ ÎÏÈÓÔÛÙ·ÙÈÛÌfi.

3) ∫ˉÂÌfiÓ·˜. ∂Ê·ÚÌfi˙ÂÙ·È ÎˉÂÌfiÓ·˜ ·Ó¿ÏÔ-Á· Ì ÙËÓ ÂÚÈÔ¯‹ Ù˘ ÚÔۂ‚ÏË̤Ó˘ ™.™ ÁÈ· 2-3 Ì‹Ó˜. OÈ Scoles Î·È Quinn (1982) ˘ÔÛÙËÚ›˙Ô˘ÓfiÙÈ Ë ÙÔÔı¤ÙËÛË Á‡„ÈÓÔ˘ ÎˉÂÌfiÓ· ÂÈÙ·¯‡ÓÂÈÙËÓ ›·ÛË Ù˘ ÓfiÛÔ˘ (54), ÂÓÒ Ô Taylor (1985) È-ÛÙ‡ÂÈ fiÙÈ Ë ¯Ú‹ÛË ÙÔ˘ Á‡„ÈÓÔ˘ ÎˉÂÌfiÓ· ÎÚ›ÓÂÙ·È··Ú·›ÙËÙË fiÙ·Ó Ô ·ÛıÂÓ‹˜ ‰ÂÓ ·Ú·Ì¤ÓÂÈ ÎÏÈÓ‹-Ú˘ ‹, ÂÓÒ ‚Ú›ÛÎÂÙ·È ÎÏÈÓ‹Ú˘, Ë ÛÔÓ‰˘ÏÔ‰ÈÛΛ-ÙȘ Â›Ó·È ¿Ú· Ôχ ÂÒ‰˘ÓË (63). ™˘Ó‹ıˆ˜ Û˘ÓÈ-ÛÙ¿Ù·È ¤Ó·˜ Ô›ÛıÈÔ˜ ÎˉÂÌfiÓ·˜ Ù‡Ô˘ Taylor-Knight Û ÌÂÁ¿Ï· ·È‰È¿, ¤ˆ˜ fiÙÔ˘ ·˘Ù¿ Á›ÓÔ˘Ó·Û˘Ìو̷ÙÈο Ì ÙȘ Û˘Ó‹ıÂȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜.

O ÎÏÈÓÔÛÙ·ÙÈÛÌfi˜ Î·È Ë ·ÎÈÓËÙÔÔ›ËÛË Ì ÎË-‰ÂÌfiÓ·, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÈ Ô Richards Î·È Û˘Ó(1999), ¢ÓÔÔ‡Ó ÙËÓ ÂÔ˘ÏˆÙÈ΋ ‰È·‰Èηۛ· Ù˘ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ‰›ÛÎÔ˘ (49). º˘ÛÈο, Ë ¯ÚÔÓÈfiÙËÙ·ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·ıÔÚ›˙ÂÈ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÓÙÈ-‚›ˆÛ˘ Î·È Ù˘ ·ÎÈÓËÙÔÔ›ËÛ˘.

™Â ÂÚ›ÙˆÛË ‰ËÌÈÔ˘ÚÁ›·˜ ·Ú·ÛÔÓ‰˘ÏÈÎÔ‡·ÔÛÙ‹Ì·ÙÔ˜, Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ ÎÚ›ÓÂ-Ù·È ··Ú·›ÙËÙÔ˜ ÌfiÓÔ ÂÊ’ fiÛÔÓ Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË ÌÈÎÚԂȷ΋ıÂڷ›·. ∂›Û˘, Â¿Ó Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Â›-Ó·È ·Ó·Áη›·, ÌfiÓÔ Ë ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ·ÔÛÙ‹Ì·-ÙÔ˜ Â›Ó·È ·ÚÎÂÙ‹ (Joughin Î·È Û˘Ó, 1991). ∂¿Ófï˜ Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ Â›Ó·È ÂÎÙÂٷ̤-ÓÔ˜, ÙfiÙÂ Â›Ó·È ··Ú·›ÙËÙË Î·È Ë ÂÚÈÔÚÈṲ̂ÓË

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∂ÈÎfiÓ· 2. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ÛÙÔ ÔÔ›Ô ·Ú·ÙËÚÂ›Ù·È Û˘-ÁΤÓÙÚˆÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÛÙÔ £12-O1 ÌÂÛÔÛÔÓ‰‡-ÏÈÔ ‰È¿ÛÙËÌ· Û ÎÔÚ›ÙÛÈ 5 ÂÙÒÓ Ô˘ ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒ-Ì·Ù· ÔÍ›·˜ ÎÔÈÏ›·˜, ·ÏÏ¿ Ë ÙÂÏÈ΋ ‰È¿ÁÓˆÛË ‹Ù·Ó ÛÔÓ‰˘-ÏÔ‰ÈÛΛÙȉ·.

∂ÈÎfiÓ· 3. O‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ù˘ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ¶·Ú·ÙËÚ›ٷÈÚÔÛ‚ÔÏ‹ ÙÔ˘ O3-O4 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘O3 ÔÛÊ˘˚ÎÔ‡ ÛÔÓ‰‡ÏÔ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ 2,5 ÂÙÒÓ ÌÂÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ· Ô˘ ÂÌÊ¿ÓÈÛ ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ·‰˘-Ó·Ì›·˜ Î·È ¿ÚÓËÛ˘ ‚¿‰ÈÛ˘.

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ÚfiÛıÈ· ÛÔÓ‰˘ÏÔ‰ÂÛ›· (28). Ÿˆ˜ ˘ÔÛÙËÚ›˙Ô˘Ó Ô Spiegel Î·È Û˘Ó (1972)

Î·È Ô Wenger Î·È Û˘Ó (1978), ·ÓÂÓÂÚÁÔÔ›ËÛËÙ˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Ì ˘ÔÙÚÔ‹ ÙˆÓ Û˘-ÌÙˆÌ¿ÙˆÓ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Û ·ÛıÂÓ›˜ Ô˘‰ÂÓ Â›¯Â Á›ÓÂÈ ·ÎÈÓËÙÔÔ›ËÛË Ù˘ ™.™. (58,68).

∂·ÎfiÏÔ˘ı· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ 1) ™Ù¤ÓˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜. ∏

ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Û˘-Ó‹ıˆ˜ ·Ú·Ì¤ÓÂÈ, ·ÏÏ¿ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ¤¯ÂÈ ·-Ú·ÙËÚËı› ÌÂÚÈ΋ ·ÔηٿÛÙ·ÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘‰›ÛÎÔ˘. OÈ Kwang Soon Song Î·È Û˘Ó (1997) ‚Ú‹-Î·Ó ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜Û ÚfiÛÊ·ÙË ·Ú·ÎÔÏÔ‡ıËÛË, ÂÓÒ Û ·ÛıÂÓ›˜Ì ·Ú·ÎÔÏÔ‡ıËÛË ¤Ú·Ó Ù˘ ËÏÈΛ·˜ ÔÛÙÈ΋˜ˆÚ›Ì·ÓÛ˘ ·Ú·ÙËÚ‹ıËÎÂ Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ·-ڷΛÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ (61). OÈ Ring Î·È Û˘Ó(1994, 1995) Î·È Wenger Î·È Û˘Ó (1978) ·Ú·Ù‹-

ÚËÛ·Ó ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ-‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ fi¯È Ï‹ÚË ·Ôηٿ-ÛÙ·ÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·-ÙÔ˜ (47,48,58).

∏ ÛÙ¤ÓˆÛË Î·È, ÙÂÏÈο, Ë ·ÒÏÂÈ· ÙÔ˘ ‡„Ô˘˜ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÔÊ›ÏÂÙ·È ÛÙ˯ÔÓ‰ÚÔÏ˘ÙÈ΋ ȉÈfiÙËÙ· ÙˆÓ ÊÏÂÁÌÔÓÒÓ ÛÙȘ ·ÓÒ-ÚÈ̘ ÛÎÂÏÂÙÈο ·ÚıÚÒÛÂȘ, Úԉȷı¤ÙÔÓÙ·˜ ÛÂÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔ›ËÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘‰È·ÛÙ‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ηÙÂÛÙÚ·Ì̤ÓÔ˘ ‰›-ÛÎÔ˘.

2) ªÂÚÈ΋ ‹ Ï‹Ú˘ Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ÛÔÓ‰‡-ψÓ. ªÂÚÈ΋ ‹ Ï‹Ú˘ Û˘ÓÔÛÙ¤ˆÛË ÌÂٷ͇ ‰‡Ô·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ ÌÔÚ› Ó· Û˘Ì‚Â› ηÈÂ›Ó·È ¿ÌÂÛ· ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ÊÏÂÁÌÔÓ‹˜.

3) °ˆÓÈ҉˘ ·Ú·ÌfiÚʈÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘‰È·ÛÙ‹Ì·ÙÔ˜. ∆Ô‡ÙÔ Û˘Ì‚·›ÓÂÈ ÂÂȉ‹ Ë ÌÂÛÔ-ÛÔÓ‰‡ÏÈÔ˜ ‰ÈÛΛÙȘ ÚÔÛ‚¿ÏÏÂÈ ÙÔ ÚfiÛıÈÔ ÙÌ‹-Ì· ÙÔ˘ ‰›ÛÎÔ˘ Î·È ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ.

4) ™ÎÔÏ›ˆÛË Î·È Î‡ÊˆÛË. ∂›Ó·È ·ÔÙ¤ÏÂÛÌ·Ù˘ ÁˆÓÈÒ‰Ô˘˜ ·Ú·ÌfiÚʈÛ˘ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡-ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È Ù˘ ÌÂÚÈ΋˜ ‹ Ï‹ÚÔ˘˜ Û˘-ÓÔÛÙ¤ˆÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ.

5) ªÂÁ¤Óı˘ÛË ÛÔÓ‰‡ÏÔ˘ (Vertebra Magna).¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û˘ÌÌÂÙÚÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÔÓ-‰˘ÏÈÎÔ‡ ÛÒÌ·ÙÔ˜, Ô˘ Ê·›ÓÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÚÔ-ÛıÔ›ÛıÈ· ÚÔ‚ÔÏ‹. OÈ Smith Î·È Taylor (1967)˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ˘ÂÚ·Ó¿Ù˘ÍË ·˘Ù‹ ÔÊ›ÏÂ-Ù·È ÛÙËÓ ˘ÂÚ·ÈÌ›· Ù˘ ÂÚÈÔ¯‹˜, Û˘Ó›· Ù˘ÊÏÂÁÌÔÓ‹˜ (56).

∆· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ Ù· ·ÎÙÈÓÔÁÚ·ÊÈÎ¿Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ‚ÚÂı› Ó· Â›Ó·È ·Û˘Ìو̷ÙÈοÌÂÙ¿ ·fi ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡-ıËÛ˘ Î·È ‰ÂÓ ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ıÂڷ›·.

™˘ÌÂÚ¿ÛÌ·Ù· ™˘ÌÂÚ·ÛÌ·ÙÈο ÌÔÚ› Ó· ϯı› fiÙÈ Ë Ê˘ÛÈ-

΋ ÂͤÏÈÍË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Â›Ó·È Î·ÏÔ‹-ı˘ Î·È Ë ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ··fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ Â›Â‰Ô ÚÔ-Û‚ÔÏ‹˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. O ˘„ËÏfi˜ ‚·ı-Ìfi˜ ˘Ô„›·˜ Î·È Ë ÁÓÒÛË Ù˘ ÓfiÛÔ˘ ıˆÚÔ‡ÓÙ·È··Ú·›ÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌË-ÛË Î·È ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙÈ-‰·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∂›Û˘, Ê·›ÓÂÙ·È fiÙÈ ·fifiϘ ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, Ë ¯Ú‹ÛË Ù˘̷ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Û˘Ì‚¿ÏÏÂÈ Î·ıÔÚÈÛÙÈοÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. An AS, Vaccaro AR, Dolinskas CA, Cotler JM, Balderston

RA, Bauerle WB. Differentiation between spinal tumorsand infections with magnetic resonance imaging. Spine

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∂ÈÎfiÓ· 4. O‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ÔÛÊ˘˚-΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÛÙËÓ ÔÔ›· Ê·›ÓÂÙ·ÈÚÔÛ‚ÔÏ‹ ÙÔ˘ O3-O4 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Ì ‰Ë-ÌÈÔ˘ÚÁ›· ÚÔÛÔÓ‰˘ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜. ¶ÚfiÎÂÈÙ·È ÁÈ··ÁfiÚÈ 6 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¤ÓÙÔÓ˘ ÔÛÊ˘·ÏÁ›·˜.

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¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. °ÎÈfiη˜ ÷ÏÎˉfiÓÔ˜ 57-59, ∞ÌÂÏfiÎËÔÈ, ∆.∫. 115 27, ∞ı‹Ó·

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�¶ÂÚ›ÏË„Ë: ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ-‰¿Û˘ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) ·˘Í¿ÓÂ-Ù·È ÛÙË ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·, ·ÏÏ¿ Ë ÔÚ›· Ù˘ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ Â›Ó·È ¿ÁÓˆÛÙË.™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙË-ÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ ıÂڷ›·˜ Î·È Ë Û‡ÁÎÚÈÛ‹ Ù˘ Ì ¿ÏÏÂ˜Î˘ÙÙ·ÚÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ∂¡À.H ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ô ·ÚÈı-Ìfi˜ ΢ÙÙ¿ÚˆÓ, Ë Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ Î·È ÔÏfiÁÔ˜ ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó Î·Ù¿ ÙˉȿÚÎÂÈ· Ù˘ ıÂڷ›·˜ Û 34 ·ÛıÂÓ›˜ Ì ‚·ÎÙË-Úȷ΋ ÌËÓÈÁÁ›Ùȉ· (ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘), ÛÂ4 ÓÂÔÁÓÈΤ˜ ÌËÓÈÁÁ›Ùȉ˜, Û 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁ-ÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· Î·È Û 97 Ì¿ÚÙ˘Ú˜. OÈ·ÛıÂÓ›˜ ›¯·Ó 1 ‹ 2 ·ӷÏËÙÈΤ˜ ÔÛÊ˘ÔÓˆÙÈ·›-˜ ·Ú·ÎÂÓÙ‹ÛÂȘ. ∂›Û˘, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÙÚ‹ıËΠ۠8 ·ÛıÂÓ›˜ Ì¢ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À. ¶ÚÈÓ ÙËıÂڷ›·, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘-ÎÔ˘ÚÔÓȉ¿Û˘ Û ·ÛıÂÓ›˜ ‚ÚÂÊÈ΋˜ ̤¯ÚÈ ÂÊË‚È-΋˜ ËÏÈΛ·˜ ‹Ù·Ó 136 nmoles 4-methylumbelliferone/ml/ÒÚ· (Ì ‰È·Î‡Ì·ÓÛË 44¤ˆ˜ 826), ÂÓÒ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ‹Ù·Ó 14nmoles/ml/ÒÚ· (Ì ‰È·Î‡Ì·ÓÛË 7 ¤ˆ˜ 23)(p<0,000001). ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÎÏÈÓÈ΋‚ÂÏÙ›ˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿-Û˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË Û ‰Â›ÁÌ·Ù· ∂¡À, Ù· ÔÔ›·ÂÏ‹ÊıËÛ·Ó ÌÂÙ¿ ¿ÚÔ‰Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ˆÚÒÓ ·fiÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜. ŒÍÈ Ì¤¯ÚÈ 12 ÒÚ˜ ÌÂ-Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙË-ÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ›¯Â ‹‰Ë ÌÂȈı›

�Abstract: ‚-Glucuronidase activity is increasedin the cerebrospinal fluid (CSF) in patients withbacterial meningitis, but its course during treatmentis unknown. Our objective was to investigate the ‚-glucuronidase activity during treatment andcompare it to other CSF parameters. The ‚-glucuronidase activity, cell number, proteinconcentration and CSF/blood glucose ratio weremeasured during treatment in 34 consecutivebacterial meningitis patients beyond the neonatalperiod, 4 neonatal meningitis patients, 2 patientswith meningococcal sepsis and 97 controls.Patients had 1 or 2 follow-up lumbar punctures.Also, the activity was measured in 8 patients withpyelonephritis and CSF pleocytosis. Beforetreatment, the median ‚-glucuronidase activity inthe patients with bacterial meningitis beyond theneonatal period was 136 nmoles 4 methy-lumbelliferone/ml/hour (range 44-826), while theCSF of the controls was 14 (7-23) (p<0.000001). Inall patients with clinical improvement the activitywas lower in the follow-up CSF samples. Six to 12hours after initiation of treatment, the medianactivity was already reduced by 59%. The otherCSF parameters showed a variability during thefirst 24 hours of treatment independently of thecourse of the disease. In a patient with pneumo-coccal meningitis, who showed aggravation ofsymptoms, the ‚-glucuronidase activity wasincreased by 89% 22 hours after starting therapy.Also, in neonatal meningitis the ‚-glucuronidaseactivity before treatment was increased, however

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·ÛıÂÓÒÓÌ ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ˆ˜ ÚÒÈÌÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙËıÂڷ›·*ª. π. ∏ÏÈÔÔ‡ÏÔ˘, °. ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜

The cerebrospinal fluid ‚-glucuronidase activity in patients with bacterial meningitis as an early and sensitive predictor of response to treatment*M. Eliopoulou, G. A. Syrogiannopoulos

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ AWARD-WINNING ARTICLE

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·ÙÚÒÓ

*∞’ ÈڤÌÂÈÔ Œ·ıÏÔ39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2001

Department of Pediatrics, University of Patras School of Medicine, General University Hospital, Patra

*1st “Choremio” Award39th Panhellenic Pediatric Meeting, 2001

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™˘ÓÙÔÌÔÁڷʛ˜ ∂¡À ∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi

∂ÈÛ·ÁˆÁ‹∏ ·Ó¿Ù˘ÍË ·ÓÙ›ÛÙ·Û˘ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙȘ ‚-

Ï·Îٿ̘ Î·È ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·-Ú¿ÁÔÓÙ˜ Û˘Ó¯Ҙ ·˘Í¿ÓÂÈ (1-6), ·Ó Î·È Û˘Ó¯ҘηÈÓÔ‡ÚÈ· ·ÓÙÈ‚ÈÔÙÈο Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÙË ıÂÚ·-›· ÌÈÎÚÔ‚È·ÎÒÓ ÏÔÈÌÒ͈Ó. ∞fi ÙËÓ Î·Ù·ÁÂ-ÁÚ·Ì̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÙˆÓ ÙÚÈÒÓÈÔ Û˘ÓËıÈÛÌ¤ÓˆÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÌÈ-ÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÊ‹-‚Ô˘˜, Neisseria meningitidis, Haemophilusinfluenzae Ù‡Ô˘ b Î·È Streptococcuspneumoniae, Ë ·ÓÙ›ÛÙ·ÛË ÛÙÔÓ Ó¢ÌÔÓÈfiÎÔÎÎÔÂ›Ó·È Ë ÈÔ ÛËÌ·ÓÙÈ΋ ÛÙ· ÂÚÈÛÛfiÙÂÚ· ̤ÚË ÙÔ˘ÎfiÛÌÔ˘ (7-12). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ηӤӷ˜ ·ÓÙÈÌÈ-ÎÚÔ‚È·Îfi˜ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ıˆÚË-ı› Ì ‚‚·ÈfiÙËÙ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜, ÚÈÓ ·fi Ù··ÔÙÂϤÛÌ·Ù· Ù˘ ¢·ÈÛıËÛ›·˜ in vitro Î·È Ù˘¤Î‚·Û˘ Ù˘ ÓfiÛÔ˘.

¶ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ ·˘ÍË̤ÓË ‰Ú·ÛÙË-ÚÈfiÙËÙ· ÙÂÛÛ¿ÚˆÓ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÂ Ê˘ÁÔ-ÎÂÓÙÚË̤ÓÔ, ÂχıÂÚÔ Î˘ÙÙ¿ÚˆÓ ∂¡À, ·ÛıÂÓÒÓÌ ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· (13). ∂ȉÈο ‚Ú¤ıËÎÂfiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÂÍ·-ÛÊ·Ï›˙ÂÈ ·ÍÈfiÈÛÙÔ ‰È·¯ˆÚÈÛÌfi ÌÂٷ͇ ·ÛıÂÓÒÓÌ ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· Î·È Ì·ÚÙ‡ÚˆÓ (13).

∂Âȉ‹ Ë ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ·Ú·Ì¤ÓÂÈÌ›· ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ Ïԛ̈ÍË, ÌÂÏÂÙ‹Û·Ì ÙˉڷÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À

·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ ıÂڷ›·˜, ÙË Û˘ÁÎÚ›Ó·Ì Ì ¿ÏϘ ÂÚ-Á·ÛÙËÚȷΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ∂¡À Î·È ÙË Û˘-Û¯ÂÙ›Û·Ì Ì ÙËÓ ÎÏÈÓÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘. ∏ ÂÚ-Á·Û›· ÛÎÔ‡ÂÈ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ·Ó Ë ‰Ú·ÛÙËÚÈfi-ÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÙÔ ∂¡À ·Ú·Ì¤ÓÂÈ ‹ fi¯È ‰Â›-ÎÙ˘ Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜ Î·È Ù˘ ·ÓÙ·fi-ÎÚÈÛ˘ ÛÙË ıÂڷ›·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹Û·Ì 38 ÂÚÈÙÒÛÂȘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜

Î·È 97 Ì¿ÚÙ˘Ú˜ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ·È‰È·ÙÚÈÎfi ÙÌ‹Ì· Ù˘∫ÏÈÓÈ΋˜ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1995 ¤ˆ˜ ÙÔÓ πÔ‡ÓÈÔ 2000. ∞fiÙÔ˘˜ 38 ·ÛıÂÓ›˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, 34 ‹Ù·Ó ‚Ú¤ÊË,·È‰È¿ Î·È ¤ÊË‚ÔÈ, Ì ‰È¿ÌÂÛË ËÏÈΛ· 3,6 ¤ÙË Î·È ‰È·Î‡Ì·ÓÛË3,5 Ì‹Ó˜ ̤¯ÚÈ 14 ¤ÙË. ∏ ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ‰È·ÁÓÒÛÙË-Π̠ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ∂¡À Û 29 ÂÚÈÙÒÛÂȘ, Ì PCR ∂¡ÀÛ 2 ÂÚÈÙÒÛÂȘ Î·È ÌÂ Û˘ÁÎÔÏÏËÙÈÓÔ·ÓÙ›‰Ú·ÛË Latex ∂¡ÀÛ 3 ÂÚÈÙÒÛÂȘ. ¢¤Î· ÂÓÓ¤· ÂÚÈÛÙ·ÙÈο ÔÊ›ÏÔÓÙ·Ó Û N.meningitidis, 7 Û S. pneumoniae, 7 Û H. influenzae Î·È 1 ÛÂStreptococcus ÔÌ¿‰·˜ D. E›ÎÔÛÈ ÔÎÙÒ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ıÂ-ڷ‡ÙËÎ·Ó Ì Ceftriaxone Î·È 6 ÌÂ Û˘Ó‰˘·ÛÌfi Ampicillin-Chloramphenicol. ™Â ¤Ó·Ó ·ÛıÂÓ‹, Ô˘ ·Ú¯Èο ıÂڷ‡ÙËÎÂÌ Ceftriaxone, ÚÔÛÙ¤ıËΠÛÙȘ 24 ÒÚ˜ Ù˘ ıÂڷ›·˜Vancomycin. ∂ÈÚfiÛıÂÙ·, ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ‰ÂÍ·ÌÂı·˙fi-ÓË ÁÈ· 2 Ë̤Ú˜ (14).

OÈ ˘fiÏÔÈÔÈ 4 ·ÛıÂÓ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ 7, 12, 17 Î·È 29 ËÌÂ-ÚÒÓ, Ì ÂÈÏÂÁ̤ÓË ÔÚ›· ÓfiÛÔ˘, ȉȷ›ÙÂÚ· ÙˆÓ ÓÂÔÁÓÒÓÙˆÓ 12 Î·È 29 ËÌÂÚÒÓ. OÈ Î·ÏÏȤÚÁÂȘ ∂¡À ¤‰ÂÈÍ·Ó ∂. coli ÛÙ·ÓÂÔÁÓ¿ ÙˆÓ 7 ËÌÂÚÒÓ (ÂÚ›ÙˆÛË 1) Î·È ÙˆÓ 12 ËÌÂÚÒÓ (Â-Ú›ÙˆÛË 2) Î·È Streptococcus agalactiae, ÔÚfiÙ˘Ô˜ III, ÛÙÔ

ηٿ 59%. ∞ÓÙÈı¤Ùˆ˜, ÔÈ ˘fiÏÔÈÔÈ ·Ú¿ÌÂÙÚÔÈÙÔ˘ ∂¡À ¤‰ÂÈ¯Ó·Ó ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÙÈÌÒÓÙÔ˘˜Î·Ù¿ ÙȘ ÚÒÙ˜ 24 ÒÚ˜ Ù˘ ıÂڷ›·˜ Ô˘‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ™Â¤Ó·Ó ·ÛıÂÓ‹ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· ηÈÂȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ 22 ÒÚ˜ ÌÂÙ¿ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ·˘Í‹ıËΠηٿ 89%. ™ÙË ÓÂÔ-ÁÓÈ΋ ÌËÓÈÁÁ›Ùȉ·, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘-ÚÔÓȉ¿Û˘ ÚÈÓ ÙË ıÂڷ›· ‹Ù·Ó ·˘ÍË̤ÓË, ·ÏÏ¿Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ ··ÈÙ›·Ú·ÙÂٷ̤ÓË ÂÚ›Ô‰Ô ÂÓ˙˘ÌÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÁÈ·¤ÁηÈÚË Ú‡ıÌÈÛË Ù˘ ıÂڷ›·˜. ∏ ‰Ú·ÛÙËÚÈfiÙË-Ù· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ∂¡À Â›Ó·È ·ÍÈfiÈ-ÛÙÔ˜ ‰Â›ÎÙ˘ ‚·ÎÙËÚȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ô˘ ÌÔ-Ú› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ, ÓˆÚ›˜ ÛÙËÓ ÔÚ›· Ù˘ Ófi-ÛÔ˘, ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›·.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÂÍ·ÈÚÂÙÈο¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ·Ú¿ÁÔÓÙ˜ÎÈÓ‰‡ÓÔ˘, ÚÔÁÂÓÓËÙÈÎÔ›, ÓÂÔÁÓÈÎÔ›.

monitoring of the course of illness required aprotracted period of enzyme measurements. Inconclusion, ‚-Glucuronidase activity in the CSF isa reliable indicator of bacterial meningitis, whichcan identify the response to treatment early in thecourse of illness.

Key words: bacterial meningitis, follow-up, ‚-glucuronidase, lysosomal enzymes, menin-gococcal sepsis, neonatal meningitis.

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ÓÂÔÁÓfi ÙˆÓ 17 ËÌÂÚÒÓ (ÂÚ›ÙˆÛË 3). ™ÙÔ 29 ËÌÂÚÒÓ ÓÂÔÁÓfi(ÂÚ›ÙˆÛË 4), Ë Î·ÏÏȤÚÁÂÈ· Î·È ÙÔ Latex ∂¡À ‹Ù·Ó ·ÚÓËÙÈÎ¿Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ‰È¿ÁÓˆÛË ‚·Û›ÛÙËΠÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘∂¡À, ȉȷ›ÙÂÚ· ‰Â ÛÙËÓ Ôχ ˘„ËÏ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ë ÔÔ›· Â›Ó·È ‰È·ÁÓˆÛÙÈ΋ ÌÈÎÚԂȷ΋˜ÌËÓÈÁÁ›Ùȉ·˜ (13).

∂ÈÚfiÛıÂÙ·, ÌÂÏÂÙ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ∂¡À ·fi 2 ·ÛıÂÓ›˜Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›·, ¯ˆÚ›˜ ·Ú¯È΋ ÏÂÈÔ΢ÙÙ¿Úˆ-ÛË ∂¡À.

ø˜ Ì¿ÚÙ˘Ú˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ· ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ËÏÈΛ·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ∂¡À Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó·fi 43 Â̇ÚÂÙÔ˘˜ ·ÛıÂÓ›˜, ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ÛÙÔ∂¡À. ∏ ‰È¿ÌÂÛË ËÏÈΛ· ÙˆÓ Ì·ÚÙ‡ÚˆÓ ‹Ù·Ó 2 ¤ÙË, Ì ‰È·Î‡-Ì·ÓÛË 1,1 Ì‹Ó˜ ¤ˆ˜ 15 ¯ÚfiÓÈ·. ∂ÈÚfiÛıÂÙ·, ¯ÚËÛÈÌÔÔÈ‹-ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘Ú˜, ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›ÙÈ-‰·˜, 54 ÓÂÔÁÓ¿ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ∂¡À. ∏ ̤ÛË ËÏÈ-Λ· ÙˆÓ Ì·ÚÙ‡ÚˆÓ-ÓÂÔÁÓÒÓ ‹Ù·Ó 16 Ë̤Ú˜, Ì ‰È·Î‡Ì·ÓÛË 1¤ˆ˜ 30 Ë̤Ú˜.

∞fi ÙȘ 34 ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁ›Ùȉ·˜ Û ·ÛıÂÓ›˜ ÌÂÁ·Ï‡-ÙÂÚÔ˘˜ ÙˆÓ 3,5 ÌËÓÒÓ, 18 ›¯·Ó Ì›· ·ӷÏËÙÈ΋ ÔÛÊ˘ÔÓˆÙÈ-·›· ·Ú·Î¤ÓÙËÛË Î·È ÔÈ ˘fiÏÔȘ 16 ›¯·Ó ‰‡Ô ·ӷÏËÙÈ-Τ˜ ·Ú·ÎÂÓÙ‹ÛÂȘ. ŒÓ· ̤ÚÔ˜ ÙÔ˘ ∂¡À ˘Ô‚¿ÏÏÔÓÙ·Ó ÛÂ Ê˘-ÁÔΤÓÙÚËÛË Ì¤Û· Û 20 min Î·È ÙÔ ˘ÂÚΛÌÂÓÔ - ÂχıÂÚÔ΢ÙÙ¿ÚˆÓ - ˘ÁÚfi ·Ó·Ï˘fiÙ·Ó ¿ÌÂÛ· ‹ ·ÔıË΢fiÙ·Ó ÛÙÔ˘˜ -70ÔC ̤¯ÚÈ Ó· ·Ó·Ï˘ı›. ªÂÙÚ‹ÛÂȘ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙ· ·ÔıËÎÂ˘Ì¤Ó· ‰Â›ÁÌ·Ù· ∂¡À ¤‰ÂÈÍ·ÓfiÙÈ Ë ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ú¤ÌÂÓ ÛÙ·ıÂÚ‹ ÁÈ· ÂÚÈÛ-ÛfiÙÂÚÔ˘˜ ·fi 6 Ì‹Ó˜.

∂›Û˘, ÌÂÏÂÙ‹ıËÎ·Ó 8 ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· ηÈÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À. ∞fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜, Û 6 Ô ·È-ÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó ÙÔ ∂. coli, Û 1 Staphylococcusepidermidis Î·È Û 1 Klebsiella pneumoniae. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ·ÛıÂÓÒÓ ‹Ù·Ó 42 Ë̤Ú˜, Ì ‰È·Î‡Ì·ÓÛË ·fi 11 Ë̤Ú˜ ¤ˆ˜3,5 Ì‹Ó˜. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›¯ıËΠÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙȘıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ Ô‡ÚˆÓ Î·È ÛÙÔ ÓÂÊÚÈÎfi ÛÈÓıËÚÔÁÚ¿ÊË-Ì· DMSA. OÈ Î·ÏÏȤÚÁÂȘ ∂¡À ‹Ù·Ó ·ÚÓËÙÈΤ˜.

∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘¡ÔÛÔÎÔÌ›Ԣ Î·È ÂÏ‹ÊıË Û˘ÁηٿıÂÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ·ÛıÂÓÒÓ.

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÙÚ‹ıËΠÂȘ‰ÈÏÔ‡Ó, fiˆ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› (14). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ-

˙‡ÌÔ˘ ÂÎÊÚ¿ÛÙËΠ۠nmoles 4-methylumbelliferone/ml∂¡À/ÒÚ·. ∆· ‰Â‰Ô̤ӷ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ‰È¿ÌÂÛË ÙÈÌ‹ ηȉȷ·̷ÓÛË ÙˆÓ ÙÈÌÒÓ. °È· ÙȘ Û˘ÁÎÚ›ÛÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËηÓÙÔ Wilcoxon test Î·È ÙÔ Mann-Whitney U test, fiˆ˜ ÂӉ›ÎÓ˘Ù·È.™ÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ηÈÙ˘ Ë̤ڷ˜ ˙ˆ‹˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Spearman rankcorrelation. ∏ ÛËÌ·ÓÙÈÎfiÙËÙ· ÂÙ¤ıË ÛÙÔ 0,05.

∞ÔÙÂϤÛÌ·Ù· ªËÓÈÁÁ›Ùȉ· ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ˆ˜ ÙËÓ

ÂÊ˂›·∏ ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘-

ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙȘ 34 ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁ›Ùȉ·˜,ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, ‹Ù·Ó 139, ̉ȷ·̷ÓÛË ÙÈÌÒÓ ·fi 44 ¤ˆ˜ 826. ™ÙÔ˘˜ Ì¿ÚÙ˘-Ú˜, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ‹Ù·Ó 14, Ì ‰È·Î‡Ì·ÓÛË ·fi 7̤¯ÚÈ 23, u=22 (p<0,000001).

™ÙÔÓ ¶›Ó·Î· 1 ηٷÁÚ¿ÊÂÙ·È Ë ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ,Ë Û¯¤ÛË ÁÏ˘Îfi˙˘ ∂¡À ÚÔ˜ ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ ηÈË Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À 10 ·ÛıÂÓÒÓ,ÚÈÓ Î·È 6 ¤ˆ˜ 12 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂ-ڷ›·˜. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿-Û˘ ÌÂÈÒıËΠ۠fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∏ ‰È¿ÌÂÛËÙÈÌ‹ Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂÈÒıËΠη-Ù¿ 59%, Ì ‰È·Î‡Ì·ÓÛË ·fi 4% ¤ˆ˜ 96%. ∏ ÌÈ-ÎÚfiÙÂÚË Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰È·Î‡Ì·ÓÛË Ù˘ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ ·Ú·ÙËÚ‹ıËΠ۠‰Â›ÁÌ·Ù· 2 ·ÛıÂ-ÓÒÓ Ô˘ ÂÏ‹ÊıËÛ·Ó Î·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ 9ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜. O ·ÈÙÈÔÏÔ-ÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·ÔÌÔÓÒıËΠÛÙÔ˘˜ ·ÛıÂ-Ó›˜ ·˘ÙÔ‡˜ ‹Ù·Ó H. influenzae Î·È ¡. meningitidis.™Ù· ÚˆÈÌfiÙÂÚ· ‰Â›ÁÌ·Ù· ∂¡À Ù˘ ÌÂϤÙ˘, Ô˘ÂÏ‹ÊıËÛ·Ó ·fi 2 ·ÛıÂÓ›˜ Ì H. influenzae Î·È ¡.meningitidis ÙËÓ 6Ë Î·È 7Ë ÒÚ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ıÂڷ›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿-Û˘ ›¯Â ‹‰Ë ÌÂȈı› ηٿ 46% Î·È 41% ·ÓÙ›ÛÙÔÈ-¯·. ™Â 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁ›Ùȉ· ·fi S.pneumoniae, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙËÓ 8Ë Î·È 12Ë ÒÚ·ıÂڷ›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ›¯Â ÌÂÈ-ˆı› ηٿ 49% Î·È 57% ·ÓÙ›ÛÙÔȯ·. ∞ÓÙ›ıÂÙ· Ì ÙË

¶›Ó·Î·˜ 1. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi-˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 10 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 6 ¤ˆ˜ 12 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜

¶·Ú¿ÌÂÙÚÔ˜ ¶ÚÈÓ ªÂÙ¿ ™ËÌ·ÓÙÈÎfiÙËÙ· ∞ÚÈıÌfi˜∂¡À ¢È¿ÌÂÛË ¢È¿ÌÂÛË p ·ÛıÂÓÒÓ

(‰È·Î‡Ì·ÓÛË) (‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ 216 (71-826) 87 (36-319) 0,005 ↓ 10∫‡ÙÙ·Ú·/mm3 6027 (100-18000) 9750 (120-3000) 0,169 ↑ 8, ↓ 2°Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ 0,32 (0,00-0,65) 0,35 (0,11-0,83) 0,114 ↑ 7, ↓ 3¶ÚˆÙ½ÓË (mg/dl) 141 (40-450) 165 (40-360) 0,508 ↓ 6, ↑ 4

* 5 N. meningitidis, 3 H. influenzae Ù‡Ô˜ b, 2 S. pneumoniae † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

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‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ë ‰È¿ÌÂ-ÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÙˆÓ10 ·ÛıÂÓÒÓ ·˘Í‹ıËΠÛÙÔ 161% ÙÔ˘ ·Ú¯ÈÎÔ‡·ÚÈıÌÔ‡ (̤ÁÈÛÙË ·‡ÍËÛË 373%). ∂›Û˘, Ô ·ÚÈıÌfi˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÎÔÏÔ‡ıËÛ·ڿÏÏËÏË ÔÚ›· (‰È¿ÌÂÛË ·‡ÍËÛË 166%, ̤ÁÈ-ÛÙË ·‡ÍËÛË 376%).

™ÙÔÓ ¶›Ó·Î· 2 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ›‰È˜ ·Ú¿-ÌÂÙÚÔÈ ÙÔ˘ ∂¡À ·fi 13 ·ÛıÂÓ›˜ Ô˘ ·¿ÓÙËÛ·ÓÛÙË ıÂڷ›·, 13 ¤ˆ˜ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍËÙ˘ ·ÁˆÁ‹˜. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, Ë ‰Ú·ÛÙË-ÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÈÒıËÎÂ. ∏ ‰È¿-ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ·˘ÙÒÓ ‹Ù·Ó ÛÙÔ 47% Ù˘ ·Ú¯È΋˜ ÙÈÌ‹˜, Ì ‰È·Î‡-Ì·ÓÛË ·fi 28% ¤ˆ˜ 82%. ∏ ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË·Ú·ÙËÚ‹ıËΠ۠·ÛıÂÓ‹ Ì Ïԛ̈ÍË ·fiStreptococcus oÌ¿‰·˜ D Î·È Ë ÌÈÎÚfiÙÂÚË Û·ÛıÂÓ‹ Ì S. pneumoniae, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙËÓ16Ë Î·È 24Ë ÒÚ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜,·ÓÙ›ÛÙÔȯ·. ∫·È ¿ÏÈ, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ∂¡À ‹Ù·Ó ·˘ÍË̤ÓË ÛÙÔ 188%ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÚÔ Ù˘ ıÂڷ›·˜, Ì ·ÚÈÔ ¯·Ú·-ÎÙËÚÈÛÙÈÎfi ÙË ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ÌÂÙ·Í‡ÙˆÓ ·ÛıÂÓÒÓ (̤ÁÈÛÙË ·‡ÍËÛË 1405%). O ·ÚÈı-Ìfi˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÎÔÏÔ‡ıËÛÂ Î·È ¿-ÏÈ ·Ú¿ÏÏËÏË ÔÚ›· Ì ·˘Ù‹ ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ÙˆÓ Î˘ÙÙ¿ÚˆÓ (‰È¿ÌÂÛË ·‡ÍËÛË 180%, ̤ÁÈÛÙË

·‡ÍËÛË 1874%). ™ÙÔÓ ¶›Ó·Î· 3 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ·Ú¿ÌÂÙÚÔÈ

ÙÔ˘ ∂¡À 10 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÙ¿ ·fi36 ¤ˆ˜ 50 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜. ∏‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÈÒıËÎÂÛ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙÔ 6% ¤ˆ˜ 34% Ù˘ ·Ú-¯È΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∫·Ù¿ ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ, ·ÓÎ·È Ô ‰È¿ÌÂÛÔ˜ ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ ÙÔ˘ ∂¡À ÌÂÈÒ-ıËΠÛÙÔ 28%, ·ÚÔ˘ÛÈ¿ÛÙËΠÌÂÁ¿ÏË ‰È·Î‡Ì·Ó-ÛË ÙˆÓ ÙÈÌÒÓ Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ·fi ÙÔ 5% ¤ˆ˜ ÙÔ7017% Ù˘ ·Ú¯È΋˜ ÙÈÌ‹˜.

∆· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À ·fi 16 ·ÛıÂÓ›˜ Ô˘ÌÂÏÂÙ‹ıËÎ·Ó 3 ¤ˆ˜ 8 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂڷ›·˜ ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›-ӷη 4. OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ¤‰ÂÈÍ·Ó‚ÂÏÙ›ˆÛË Û¯Â‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜.

∆Ô ™¯‹Ì· 1 ‰Â›¯ÓÂÈ ÙËÓ ÔÚ›· Ù˘ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û 34 ·ÛıÂÓ›˜ Ì ÌÈÎÚԂȷ΋ ÌË-ÓÈÁÁ›Ùȉ·, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 8 ËÌÂÚÒÓıÂڷ›·˜.

ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· ™Â 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›·,

¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À, Ë ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ıÂڷ›·˜, ‹Ù·Ó ·˘ÍË̤ÓË ÛÙ· 97 Î·È 62 ·ÓÙ›-ÛÙÔȯ·, ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó 2/mm3

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¶›Ó·Î·˜ 2. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È ·Ó·ÏÔÁ›·ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 13 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 13 ¤ˆ˜ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·-›·˜

¶·Ú¿ÌÂÙÚÔ˜ ¶ÚÈÓ ªÂÙ¿ ™ËÌ·ÓÙÈÎfiÙËÙ· ∞ÚÈıÌfi˜ ∂¡À ¢È¿ÌÂÛË ¢È¿ÌÂÛË p ·ÛıÂÓÒÓ

(‰È·Î‡Ì·ÓÛË) (‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ 112 (57-750) 53 (25-303) 0,001 ↓ 13∫‡ÙÙ·Ú·/mm3 3620 (29-1700) 6800 (290-20500) 0,173 ↑ 8, ↓ 5°Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ 0,40 (0,00-0,62) 0,49 (0,29-1,09) 0,055 ↑ 8, ↓ 5¶ÚˆÙ½ÓË (mg/dl) 120 (25-752) 70 (8-160) 0,017 ↓ 10, ↑ 3

* 8 N. meningitidis, 3 H. influenzae Ù‡Ô˜ b, 1 S. pneumoniae, 1 Streptococcus ÔÌ¿‰· D † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

¶›Ó·Î·˜ 3. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘-Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 10 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 36 ¤ˆ˜ 50 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜

¶·Ú¿ÌÂÙÚÔ˜ ¶ÚÈÓ ªÂÙ¿ ™ËÌ·ÓÙÈÎfiÙËÙ· ∞ÚÈıÌfi˜ ∂¡À ¢È¿ÌÂÛË ¢È¿ÌÂÛË p ·ÛıÂÓÒÓ

(‰È·Î‡Ì·ÓÛË) (‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ 138 (89-750) 31 (20-153) 0,005 ↓ 10∫‡ÙÙ·Ú·/mm3 2620 (56-10975) 725 (142-4930) 0,093 ↓ 7, ↑ 3°Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ 0,22 (0,00-0,65) 0,60 (0,32-0,70) 0,005 ↑ 10¶ÚˆÙ½ÓË (mg/dl) 197 (25-560) 55 (35-180) 0,013 ↓ 9, ↑ 1

*5 N. meningitidis, 4 H. influenzae Ù‡Ô˘ b, 1 S. pneumoniae † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

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Î·È 0, ·ÓÙ›ÛÙÔȯ·. ∂›Û˘, Ë Û˘ÁΤÓÙÚˆÛË Ù˘ڈÙ½Ó˘ ‹Ù·Ó 10 mg/dl Î·È 22 mg/dl Î·È Ë Û¯¤ÛËÁÏ˘Îfi˙Ë ∂¡À/ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ ‹Ù·Ó 0,57 Î·È 0,44·ÓÙ›ÛÙÔȯ·. ™ÙÔÓ ÚÒÙÔ ·ÛıÂÓ‹, ÛÙÔÓ ÔÔ›Ô ¤ÁÈÓ·Ó‰‡Ô ·ӷÏËÙÈΤ˜ ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ24 Î·È 72 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, ËÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ›¯Â ÂÏ·ÙÙˆı› ÛÙ· 77 ηÈ34, ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Â›¯Â ·˘ÍËı› ÛÙ·156/mm3 Î·È 40/mm3 ·ÓÙ›ÛÙÔȯ·.

ªËÓÈÁÁ›Ùȉ· ·fi Ó¢ÌÔÓÈfiÎÔÎÎÔ Ì ·Ó·Ú-΋ ·¿ÓÙËÛË ÛÙËÓ ·Ú¯È΋ ıÂڷ›·

∞ÁfiÚÈ 2 ÂÙÒÓ, 12 ÒÚ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘,·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi Ì ڛÁÔ˜, ÂÌÂÙfi, ˘ÓË-Ï›·, Ù·¯‡ÓÔÈ· Î·È ÙÂÏÈ΋ ·˘¯ÂÓÈ΋ ‰˘Ûη̄›·, ¯ˆ-Ú›˜ ¿ÏÏ· ÂÈÚfiÛıÂÙ· ÌËÓÈÁÁÈο ÛËÌ›·. ¢È·ÁÓÒ-ÛÙËΠÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· Î·È Ô ·ÛıÂÓ‹˜ ¿Ú¯È-

Û ·ÁˆÁ‹ Ì Ceftriaxone Î·È ‰ÂÍ·ÌÂı·˙fiÓË. OÈηÏÏȤÚÁÂȘ ∂¡À Î·È ·›Ì·ÙÔ˜ ·Ó¤‰ÂÈÍ·Ó S.pneumoniae, ÔÚÔÙ‡Ô˘ 14, Ì ÂÏ¿¯ÈÛÙË ·Ó·ÛÙ·Ï-ÙÈ΋ Û˘ÁΤÓÙÚˆÛË Ceftriaxone 0,032 Ìg/ml. ªÂÙ¿·fi 22 ÒÚ˜ ıÂڷ›·˜, Ô ·ÛıÂÓ‹˜ Û˘Ó¤¯ÈÛ ӷ¤¯ÂÈ ˘„ËÏfi ˘ÚÂÙfi, ÂÓÒ ÂÈÚfiÛıÂÙ· ·ÚÔ˘Û›·Û·˘Í·ÓfiÌÂÓË ˘ÓËÏ›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ·˘¯ÂÓÈ΋‰˘Ûη̄›·, ηÙÒÙÂÚÔ ÛËÌÂ›Ô Brudzinski Î·È ÛË-ÌÂ›Ô ÙÚ›Ô‰Ô˜. ∫·Ù¿ ÙÔ ¯ÚfiÓÔ ·˘Ùfi, ¤ÁÈÓ ‰Â‡ÙÂÚËÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË, Ô˘ ·Ó¤‰ÂÈÍ ÛËÌ·-ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·‡ÍËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘. §fiÁˆ Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÚÁ·ÛÙË-Úȷ΋˜ Âȉ›ӈÛ˘ ÚÔÛÙ¤ıËΠVancomycin ÛÙÔıÂڷ¢ÙÈÎfi Û¯‹Ì·. ∂›ÎÔÛÈ Ù¤ÛÛÂÚȘ ÒÚ˜ ·ÚÁfi-ÙÂÚ·, ÙfiÛÔ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· fiÛÔ Î·È Ë ‰Ú·ÛÙËÚÈfi-ÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Û ÙÚ›ÙÔ ‰Â›ÁÌ·

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¶›Ó·Î·˜ 4. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi-˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 16 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 3 ¤ˆ˜ 8 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜

¶·Ú¿ÌÂÙÚÔ˜ ¶ÚÈÓ ªÂÙ¿ ™ËÌ·ÓÙÈÎfiÙËÙ· ∞ÚÈıÌfi˜ ∂¡À ¢È¿ÌÂÛË ¢È¿ÌÂÛË p ·ÛıÂÓÒÓ

(‰È·Î‡Ì·ÓÛË) (‰È·Î‡Ì·ÓÛË)

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™¯‹Ì· 1. ¶ÔÛÔÛÙfi Ù˘ ÚÔ ıÂڷ›·˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û 34 ·ÛıÂ-Ó›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·, ηٿ ÙȘ ÚÒÙ˜ 8 Ë̤Ú˜ Ù˘ ıÂڷ›·˜. ∂ÓÙfi˜ ·ÚÂÓı¤Ûˆ˜, Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ÌÂÏÂÙ‹ıËÎ·Ó Î¿ı ÊÔÚ¿.

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∂¡À, ¤‰ÂÈÍ·Ó ÌÂÁ¿ÏË ‚ÂÏÙ›ˆÛË (™¯‹Ì· 2). ∏ Û˘-ÁΤÓÙÚˆÛË Ù˘ Ceftriaxone ÛÙÔ ‰Â‡ÙÂÚÔ Î·È ÙÚ›Ùԉ›ÁÌ· ∂¡À ‹Ù·Ó 12,5 Ìg/ml Î·È 30 Ìg/ml ·ÓÙ›-ÛÙÔȯ·.

¡ÂÔÁÓÈ΋ ÌËÓÈÁÁ›Ùȉ·™Ù· 54 ÓÂÔÁÓ¿-Ì¿ÚÙ˘Ú˜, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙË-

ÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó 15, Ì ‰È·-·̷ÓÛË 5 ¤ˆ˜ 27. ™Ù· 4 ÓÂÔÁÓ¿ Ì ÌÈÎÚԂȷ΋ÌËÓÈÁÁ›Ùȉ·, Ë ‰È¿ÌÂÛË ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·‹Ù·Ó 1105 Ì ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ·fi 369 ¤ˆ˜3988. ™Ù· ÓÂÔÁÓ¿ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ‰ÂÓ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À Î·È Ù˘ Ë̤ڷ˜˙ˆ‹˜.

™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›ÙÈ-‰·˜ ·Ú·ÙËÚ‹ıËΠ·Ú¯Èο Ù·¯Â›· Ì›ˆÛË Ù˘‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ∂¡À, Ë ÔÔ›· ·ÎÔÏÔ˘ıÔ‡Û ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·-›·˜. ŸÌˆ˜, Ë ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÔÚ›· ‰È¤ÊÂÚÂÔ˘ÛÈ·ÛÙÈο ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ Î·È Û ÔÚÈṲ̂Ó˜ÂÚÈÙÒÛÂȘ ‹Ù·Ó ··Ú·›ÙËÙ˜ Û˘¯Ó¤˜ ·ÏÏ·Á¤˜Ù˘ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜ Ì ·ÓÙÈ‚ÈÔÙÈο, ÒÛÙ ӷ

·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ ‹ ·ӷ-ÌÔχÓÛÂȘ.

™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙËÓ 5Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘,fiÙ·Ó Ô ·ÛıÂÓ‹˜ ‰ÈÂÎÔÌ›ÛıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜,‹Ù·Ó 1152 Î·È 529 ÛÙÔ ÎÔÈÏÈ·Îfi Î·È Ú·¯È·›Ô ∂¡À·ÓÙ›ÛÙÔȯ· (Û¯¤ÛË ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÂÓ˙‡ÌÔ˘ ÛÙÔÎÔÈÏÈ·Îfi/Ú·¯È·›Ô ∂¡À 2,18). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ÂÓ˙‡ÌÔ˘ ·ÎÔÏÔ‡ıËÛ ηıÔ‰È΋ ÔÚ›· Î·È ÙËÓ23Ë Ì¤Ú· ıÂڷ›·˜ ÛÙÔ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ ‹Ù·ÓÛÙÔ 86. ∆ËÓ Ë̤ڷ ·˘Ù‹ ·ÓÙÈηٷÛÙ¿ıËÎÂ Ë ‰ÂÍ·-ÌÂÓ‹ Omaya, ·ÔÙ¤ÏÂÛÌ· Ù˘ ÔÔ›·˜ ‹Ù·Ó Ë Â·-Ó·ÌfiÏ˘ÓÛË, Ë ÔÔ›· ÈÛÙÔÔÈ‹ıËΠ·fi ÙËÓ ·‡ÍË-ÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘Û 154. ∆Ô ıÂڷ¢ÙÈÎfi Û¯‹Ì· ¿ÏÏ·ÍÂ Î·È Ô ·ÛıÂ-Ó‹˜ ·Ó¿ÚÚˆÛ ϋڈ˜ (™¯‹Ì· 3∞).

™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ô ·ÛıÂÓ‹˜ ‰ÈÂÎÔÌ›-ÛıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ·fi ¿ÏÏÔ ÓÔÛÔÎÔÌ›ÔÙËÓ 4Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘. ∏ ·Ú¯Èο Ù·¯Â›· ÙÒÛËÙ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘·ÎÔÏÔ˘ı‹ıËΠ·fi ˘ÔÙÚÔ¤˜ Ô˘ ÛËÌÂÈÒıËηÓÙËÓ 23Ë Î·È ÙËÓ 58Ë Ë̤ڷ. ∏ ÌËÓÈÁÁÈ΋ ÊÏÂÁÌÔÓ‹Ô˘ ÂÌÊ·Ó›ÛÙËΠÙËÓ 58Ë Ë̤ڷ ıÂڷ›·˜, Èı·-ÓfiÓ Ó· ‹Ù·Ó ·ӷÌfiÏ˘ÓÛË Ì¤Ûˆ Ù˘ ‰ÂÍ·ÌÂÓ‹˜Omaya, Ë ÔÔ›· ›¯Â ÙÔÔıÂÙËı›. OÈ Û˘Ó‰˘·ÛÌÔ›·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ¯ÔÚËÁ‹ıËηÓ, Ú˘ıÌ›ÛÙËÎ·Ó ‚¿-ÛÂÈ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿ÛË˜Ô˘ ÌÂÙÚÈfiÙ·Ó ÛÙÔ Ú·¯È·›Ô Î·È ÎÔÈÏÈ·Îfi ∂¡À (™¯‹-Ì· 3µ). ∏ Û¯¤ÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘-ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ Î·È ÙÔ˘ ÔÛÊ˘-˚ÎÔ‡ ˘·Ú·¯ÓÔÂȉԇ˜ ¯ÒÚÔ˘ ÙË 10Ë, 13Ë, 15Ë,17Ë, 20Ë, 23Ë, 41Ë, 59Ë, 64Ë Î·È 72Ë Ë̤ڷ ‹Ù·Ó3,59, 4,00, 2,48, 1,36, 1,00, 1,55, 1,08, 1,10, 0,62Î·È 0,96 ·ÓÙ›ÛÙÔȯ·.

™ÙËÓ ÙÚ›ÙË ÂÚ›ÙˆÛË, Ë Ù·¯Â›· ÙÒÛË Ù˘‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙȘ ÚÒ-Ù˜ 24 ÒÚ˜ ·ÎÔÏÔ˘ı‹ıËΠ·fi ¤Ó·Ó ·ÚÁfi Ú˘ıÌfiÌ›ˆÛ˘ ÙÔ˘ ÂÓ˙‡ÌÔ˘, ÙȘ ÂfiÌÂÓ˜ 4 Ë̤Ú˜ ıÂ-ڷ›·˜. ∆ËÓ 5Ë Ë̤ڷ ÚÔÛÙ¤ıËΠCefotaximeÛÙËÓ ·Ú¯È΋ ·ÁˆÁ‹. ∆ËÓ 9Ë Ë̤ڷ, Ë ‰Ú·ÛÙËÚÈfi-ÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË Ì¤ÙÚËÛË Î·È ÙÔ Û¯‹Ì· ·ÓÙÈ-‚ÈÔÙÈÎÒÓ ¿ÏÏ·ÍÂ Î·È ¿ÏÈ. µ·ıÌÈ·›·, Ë ‰Ú·ÛÙËÚÈfi-ÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ¤ÛÙÚ„ ÛÙ· Ê˘ÛÈÔÏÔÁÈοfiÚÈ· Î·È Ë ıÂÚÌÔÎÚ·Û›· ¤ÂÛ οو ·fi ÙÔ˘˜37ÔC (™¯‹Ì· 3°).

™ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË, ÌÂÙ¿ ·fi Ì›· ·Ú¯Èοٷ¯Â›· ÙÒÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜,˘‹ÚÍ·Ó 2 ÚÔÊ·Ó›˜ ˘ÔÙÚÔ¤˜ Ù˘ ÌËÓÈÁÁÈ΋˜ÊÏÂÁÌÔÓ‹˜, ÙËÓ 5Ë Î·È 10Ë Ë̤ڷ ıÂڷ›·˜, Ô˘·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÚÒÈ̘ ·ÏÏ·Á¤˜ ÙˆÓ ·ÓÙÈ-‚ÈÔÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ. ∏ ·‡ÍËÛË Ù˘ ıÂÚÌÔÎÚ·Û›·˜ÙËÓ 36Ë Ë̤ڷ Û˘Ó¤ÂÛ ¯ÚÔÓÈο Ì ‰È·Ê˘Á‹ ∂¡À·fi ÙË ‰ÂÍ·ÌÂÓ‹ Omaya Î·È ÙËÓ ·ÓÙÈηٿÛÙ·Û‹

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™¯‹Ì· 2. £ÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ-‰¿Û˘ (nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·), ·ÚÈıÌfi˜ÙˆÓ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È ÏfiÁÔ˜ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û ·ÛıÂÓ‹ Ì ÌËÓÈÁÁ›Ùȉ· ·fiS.pneumoniae Î·È ·Ó·Ú΋ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·Ú¯È΋ ıÂ-ڷ›·. [Ctr: ceftriaxone, Vnm: vancomycin]

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™¯‹Ì· 3. £ÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ (nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·), ·ÚÈıÌfi˜ ÙˆÓ Î˘Ù-Ù¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È ÏfiÁÔ˜ ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 3 ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (A, ° ηȢ), ηıÒ˜ Î·È ıÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û ڷ¯È·›Ô Î·È ÎÔÈÏÈ·Îfi ∂¡À ÛÂÓÂÔÁÓfi Ì ÌËÓÈÁÁ›Ùȉ· (B). [Amk: amikacin, Amp: ampicillin, Azc: azactam, Cfp: cefepime, Ctr: ceftriaxone, Ctx: cefotaxime, Cfz: ceftazidime, Cpf:ciprofloxacin, Ntm: netromycin, Mrp: meropenem, Ppr: piperacilin, Rfm: rifampicin, Vnm: vancomycin]

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Ù˘. ¢ÂÓ ‰È·ÈÛÙÒıËΠÌËÓÈÁÁÈ΋ ÊÏÂÁÌÔÓ‹ ηٿÙË ‰È¿ÚÎÂÈ· ·˘ÙÔ‡ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ (™¯‹Ì· 3¢). ∏‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡ÀÙˆÓ ÎÔÈÏÈÒÓ Î·Ù¿ ÙȘ Ë̤Ú˜ 13, 20, 33, 36, 39, 44Î·È 49, fiÙ·Ó ¤ÁÈÓ·Ó ÌÂÙÚ‹ÛÂȘ Î·È Û ڷ¯È·›Ô ∂¡À·fi ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ, ‹Ù·Ó 98, 43,40, 37, 36, 32 Î·È 28 ·ÓÙ›ÛÙÔȯ·. ∏ Û¯¤ÛË Ù˘ ÂÓ-˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡/Ú·¯È·›Ô˘∂¡À ‹Ù·Ó 0,66, 0,29, 0,95, 0,93, 0,90, 0,71 ηÈ0,97 ·ÓÙ›ÛÙÔȯ·.

ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤˙ËÛ·Ó. ∫ÔÈÏÈÔÂÚÈÙÔÓ·˚΋·ÚÔ¯¤Ù¢ÛË ÙÔÔıÂÙ‹ıËΠÛÙË ‰Â‡ÙÂÚË Î·È ÙËÓ٤ٷÚÙË ÂÚ›ÙˆÛË. OÈ ÂÚÈÙÒÛÂȘ 1, 3 Î·È 4 ›-¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË, ¯ˆÚ›˜ η-Ó¤Ó· Ó¢ÚÔÏÔÁÈÎfi ˘fiÏÂÈÌÌ·. ™ÙË ‰Â‡ÙÂÚË ÂÚ›-ÙˆÛË, ÛÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ, fiÙ·Ó ÂÍÂÙ¿ÛÙË-ΠÁÈ· ÙÂÏÂ˘Ù·›· ÊÔÚ¿, Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË‹Ù·Ó ÌÂٷ͇ 12 ¤ˆ˜ 14 ÌËÓÒÓ.

¶ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À ÔÊÂÈÏfiÌÂÓË Û ԢÚÔ-Ïԛ̈ÍË

™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ-΢ÙÙ¿ÚˆÛË ∂¡À, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó 43, Ì ‰È·Î‡Ì·ÓÛË ·fi32 ¤ˆ˜ 53. ∞˘Ù‹ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Â›Ó·È ÛËÌ·ÓÙÈ-ο ˘„ËÏfiÙÂÚË ·’ fiÙÈ ÛÙ· ÓÂÔÁÓ¿-Ì¿ÚÙ˘Ú˜ ¯ˆ-Ú›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À (u=344, p=0,000008),ηıÒ˜ ›Û˘ Î·È ·’ fiÙÈ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ì ËÏÈ-Λ· ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÓÂÔÁÓÈ΋˜ (u=432,p=0,000005). ŸÌˆ˜, Ë ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·Û ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Â›Ó·È ÛËÌ·ÓÙÈο¯·ÌËÏfiÙÂÚË Î·È ·fi ÂΛÓË ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›ÙÈ-‰· (u=269, p=0,00002).

™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ·, Ë ‰È¿ÌÂÛËÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó70/mm3, Ì ‰È·Î‡Ì·ÓÛË ·fi 13 ¤ˆ˜ 300/mm3, ˉȿÌÂÛË ÙÈÌ‹ Ù˘ Û¯¤Û˘ Ù˘ ÁÏ˘Îfi˙˘ ∂¡À/ÁÏ˘-Îfi˙Ë ·›Ì·ÙÔ˜ ‹Ù·Ó 0,54, Ì ‰È·Î‡Ì·ÓÛË 0,41 ¤ˆ˜0,70 Î·È Ë ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ڈÙ½Ó˘ ‹Ù·Ó 43, Ì ‰È·Î‡Ì·ÓÛË ·fi 35 mg/dl¤ˆ˜ 70 mg/dl.

™˘˙‹ÙËÛË ∆· ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ ÂȂ‚·ÈÒÓÔ˘Ó

ÚÔËÁÔ‡ÌÂÓË ‰ËÌÔÛ›Â˘ÛË, Ë ÔÔ›· ¤‰ÂȯÓ fiÙÈ Ë‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Â›Ó·È ·˘-ÍË̤ÓË ÛÙÔ ∂¡À ·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›-Ùȉ·, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ÂÊ›Â˘ÛË ÙÈÌÒÓ ÌÂٷ͇·ÛıÂÓÒÓ Î·È Ì·ÚÙ‡ÚˆÓ (13). ∂ÈϤÔÓ, Ù· ¢ڋ-Ì·Ù· ÂÂÎÙ›ÓÔ˘Ó ÙË ‰È·ÁÓˆÛÙÈ΋ ‰‡Ó·ÌË Ù˘ ÌÂ-ıfi‰Ô˘ Î·È ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. º·›ÓÂÙ·È fiÙÈ Ë‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Û ·ÛıÂÓ‹ ÓÂÔÁÓ¿ÌÔÚ› Ó· Â›Ó·È ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚË ·fi fi,ÙÈ Û Â-ÚÈÙÒÛÂȘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Û ·È‰È¿ ÌÂËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÓÂÔÁÓÈ΋˜. ∂›Û˘, ‚Ú¤ıË-

ΠfiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ÌÔÚ› Ó· Â›Ó·È ·˘ÍË̤ÓË ÛÙÔ ∂¡À ·ÎfiÌË Î·È ÚÈÓÁ›ÓÔ˘Ó ÂÌÊ·Ó›˜ ÔÈ ¿ÏϘ ÎÏ·ÛÈΤ˜ ÂÚÁ·ÛÙËÚÈ·-Τ˜ ·Ú¿ÌÂÙÚÔÈ Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜.∞ÍÈÔÛËÌ›ˆÙË Â›Ó·È Ë ·Ú·Ù‹ÚËÛË fiÙÈ ˘¿Ú¯ÂÈηı˘ÛÙ¤ÚËÛË ÛÙËÓ ÂÌÊ¿ÓÈÛË ÏÂÈÔ΢ÙÙ¿ÚˆÛ˘∂¡À, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ·ÚÎÂÙ¤˜ ÒÚ˜ ·ÚÁfiÙÂ-Ú·, Û ¯ÚfiÓÔ Î·Ù¿ ÙÔÓ ÔÔ›Ô, ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍËÙ˘ ıÂڷ›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘¤¯ÂÈ ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÌÂÈÒÓÂÙ·È.

∏ ÛËÌ·ÓÙÈÎfiÙÂÚË ·Ú·Ù‹ÚËÛË Ù˘ ÌÂϤÙ˘ ›-Ó·È fiÙÈ Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘-ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂ-ڷ›·˜ Â›Ó·È ÚÒÈÌÔ˜ Î·È Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘Úfi‚Ï„˘ Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙËıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. º·›ÓÂÙ·È fiÙÈ Ì ÙË Ì¤ıÔ‰Ô·˘Ù‹ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ì ·ÍÈÔÈÛÙ›· ÔÈ ·ÛıÂÓ›˜Ô˘ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË ıÂڷ›·, 13 ÒÚ˜ ÌÂ-Ù¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ì ·ÓÙÈ‚ÈÔÙÈο Î·È È-ı·ÓfiÓ ·ÎfiÌ· ÓˆÚ›ÙÂÚ·. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ-˙‡ÌÔ˘ ÌÂÈÒıËÎÂ Î·È ÛÙÔ˘˜ 10 ·ÛıÂÓ›˜ Ô˘ ·-ÓÂÎÙÈÌ‹ıËÎ·Ó 6 ¤ˆ˜ 12 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ıÂڷ›·˜, ·ÏÏ¿ Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÌÂ-ÏÂÙ‹ıËÎ·Ó Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ı· Ú¤ÂÈ Ó· ·˘-ÍËı›, ÁÈ· Ó· ÛÙ·ıÌÈÛÙ› Ë ·ÍÈÔÈÛÙ›· ÙˆÓ ÌÂÙÚ‹-ÛˆÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÚԂϤÂÙ·È Ë ÎÏÈÓÈ΋¤Î‚·ÛË Ù˘ ÓfiÛÔ˘ Û ÙfiÛÔ ÚÒÈÌÔ ¯ÚfiÓÔ. ∂›Ó·ÈÈı·Ófi fiÙÈ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ÂÚÈÛÙ·ÙÈο·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ı· ‰Â›ÍÔ˘Ó Ì›ˆÛË Ù˘ ‰Ú·ÛÙË-ÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÙ¿ ·fi 6 ¤ˆ˜12 ÒÚ˜ ıÂڷ›·˜. ™Â ¤Ó·Ó ·ÛıÂÓ‹ Ì ÌËÓÈÁÁ›ÙÈ-‰· ·fi ∏. Influenzae Ù‡Ô˘ b, Ô˘ ÌÂÏÂÙ‹ıËΠ9ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, Ë ‰Ú·ÛÙË-ÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó ÌÂȈ̤ÓËÌfiÓÔ Î·Ù¿ 4% ·fi ÙËÓ ·Ú¯È΋ ÙÈÌ‹. øÛÙfiÛÔ,ÛÙÔ˘˜ ÂÓ·ÔÌ›ӷÓÙ˜ 9 ·ÛıÂÓ›˜, Ë ÔÚ›· Ù˘ÓfiÛÔ˘ ÌÔÚÔ‡Û ӷ ÚÔ‚ÏÂÊı› Ì ·ÍÈÔÈÛÙ›·.

∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ‰Â›¯ÓÂÈ fiÙÈ Û·ÛıÂÓ›˜ ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜, ÌÂÙ¿ ÙËÓ ¿-ÚÔ‰Ô 12ÒÚÔ˘ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ì·ÓÙÈ‚ÈÔÙÈο, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ-‰¿Û˘ ÛÙÔ ∂¡À Â›Ó·È ·ÍÈfiÈÛÙÔ˜ ÚÔÁÓˆÛÙÈÎfi˜‰Â›ÎÙ˘ Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙÔ ıÂڷ¢ÙÈÎfi Û¯‹-Ì·. ∞˘Ùfi Ê¿ÓËΠÔχ ηϿ ÛÙÔÓ ·ÛıÂÓ‹ Ì ÌË-ÓÈÁÁ›Ùȉ· ·fi S. pneumoniae, Ô ÔÔ›Ô˜ ÂÌÊ¿ÓÈÛÂÎÏÈÓÈ΋ Âȉ›ӈÛË Î·Ù¿ ÙȘ ÚÒÙ˜ 22 ÒÚ˜ ıÂ-ڷ›·˜, ÂÓÒ ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ, Ë ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‰ÈÏ·ÛÈ¿ÛÙËÎÂ. ∂›ÎÔÛÈÙ¤ÛÛÂÚȘ ÒÚ˜ ÌÂÙ¿ ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ Û¯‹Ì·ÙÔ˜ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ô ·ÛıÂÓ‹˜ ÎÏÈÓÈο ‚ÂÏÙÈÒıËÎÂÎ·È Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒıËΠηٿ24% ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÙÈÌ‹. ŸÌˆ˜, ‰ÂÓ Â›Ó·È۷ʤ˜ ÁÈ·Ù› ÙfiÛÔ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ·, fiÛÔ Î·È Ë ÙÈÌ‹‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔÓ

¶·È‰È·ÙÚÈ΋ 2002;65:97-107 Paediatriki 2002;65:97-107

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·ÛıÂÓ‹ ¯ÂÈÚÔÙ¤Ú„·Ó ̤۷ ÛÙȘ ÚÒÙ˜ 22 ÒÚ˜ıÂڷ›·˜, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Û٤ϯԘ ÙÔ˘Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ ‹Ù·Ó ¢·›ÛıËÙÔ ÛÙËÓCeftriaxone Î·È Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ÛÙÔ ∂¡À ‹Ù·Ó ˘„ËÏ‹.

∞ÓÙ›ıÂÙ·, ÔÈ 3 ÎÏ·ÛÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ∂¡ÀÁÈ· ‰È¿ÁÓˆÛË Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜ Ô˘ ÌÂ-ÏÂÙ‹ıËηÓ, ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ÁÏ˘Îfi˙Ë Î·ÈÚˆÙ½ÓË, ¤‰ÂÈÍ·Ó Ì›· ·ÍÈÔÛËÌ›ˆÙË Â˘ÌÂÙ·‚ÏËÙfi-ÙËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 24 ˆÚÒÓ ıÂ-ڷ›·˜, Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ˆ˜ ÙȘ 49 ÒÚ˜ ÁÈ· ÙÔÓ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÔÚ›·Ù˘ ÓfiÛÔ˘. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘Ù-Ù¿ÚˆÓ ·˘Í‹ıËΠÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 48 ˆÚÒÓ ıÂڷ›·˜,·ÎfiÌË Î·È ·Ó ÔÈ ·ÛıÂÓ›˜ ıÂڷ‡ÙËÎ·Ó ÂÈÙ˘¯Ò˜.∏ ‚ÂÏÙ›ˆÛË fiÏˆÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÙÔ˘ ∂¡À Ô˘ÌÂÏÂÙ‹ıËηÓ, ·Ú·ÙËÚ‹ıËΠ·fi ÙËÓ ÙÚ›ÙË Ë̤ڷıÂڷ›·˜.

∂ÓÒ ÔÈ ÚÒÈ̘ ÌÂÙÚ‹ÛÂȘ Ù˘ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Â›Ó·È ¯Ú‹ÛÈ̘ ÁÈ· ÙËÓ·Ó·ÁÓÒÚÈÛË Ù˘ ·Ú¯È΋˜ ÌËÓÈÁÁÈ΋˜ ·¿ÓÙËÛ˘ÛÙË ıÂڷ›·, ÔÈ fi„È̘ ÌÂÙÚ‹ÛÂȘ ÌÔÚÔ‡Ó Ó·¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ˘ÚÂÙÔ‡ ‹¿ÏÏˆÓ Û˘Ìو̿وÓ, Ù· ÔÔ›· Â›Ó·È ‰˘Ó·ÙfiÓ Ó·ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÚÁfiÙÂÚ· ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘.∆· ÛÙÔȯ›· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¯·ÌËÏ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ·ÔÎÏ›ÂÈ ÙËÓ ·ÚÔ˘Û›·ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜, ÂÓÒ Ó¤· ·‡ÍËÛË Ù˘ ÂÓ˙˘-ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ı· Ú¤ÂÈ Ó· ·Ô‰Ôı› Û¢ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘.

∏ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÁÈ· ÚÒÈÌË ÂÎÙ›ÌËÛËÙ˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂڷ›·, Â›Ó·È È‰È·›ÙÂÚ·¯Ú‹ÛÈÌË ÛÙȘ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜.∏ Ì·ÎÚÔ¯ÚfiÓÈ· ıÂڷ›· Ô˘ ··ÈÙ›ٷÈ, ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ÙËÓ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙË ÌÂȈ̤ÓË ‰ÈÂÈÛ‰˘-ÙÈÎfiÙËÙ· ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙÔ ∂¡À, Úԉȷı¤ÙÔ˘ÓÛ ıÂڷ¢ÙÈΤ˜ ·ÔÙ˘¯›Â˜ Î·È ÛÙËÓ ·Ó¿Ù˘ÍË ÌÈ-ÎÚԂȷ΋˜ ·ÓÙ›ÛÙ·Û˘. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙȘ Â-ÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿„·ÌÂ, ÌÂÙÚ‹ÛÂȘ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÔÚÔ‡Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó˘ÔÙÚÔ¤˜ ‹ ·ӷÏÔÈÌÒÍÂȘ ÓˆÚ›˜ ÛÙËÓ ÔÚ›·Ù˘ ÓfiÛÔ˘ Î·È ¤ÙÛÈ ‰›ÓÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó·ÚÔ-Û·ÚÌÔÁ‹˜ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÚÈÓ·ÎfiÌ· ÂÌÊ·ÓÈÛÙ› Ë ÎÏÈÓÈ΋ Âȉ›ӈÛË. ∏ ¯ÚËÛÈ-ÌfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ÓÂÔÁÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·,ÛÙ· ÔÔ›· Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·Ú·Ì¤ÓÂÈ¿ÁÓˆÛÙÔ˜, fiˆ˜ ÛÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË Ô˘ Â-ÚÈÁÚ¿„·ÌÂ.

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË

‰È¿ÁÓˆÛË Ù˘ ÎÔÈÏÈ›Ùȉ·˜. ™¯¤ÛË Ù˘ ‰Ú·ÛÙËÚÈfi-ÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ∂¡ÀÚÔ˜ ÙÔ Ú·¯È·›Ô ∂¡À ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1, ‰Â›¯ÓÂÈ˘ÂÚÔ¯‹ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ÎÔÈÏÈÒÓ (ÂÚÈÙÒÛÂȘ1 Î·È 2), ÂÓÒ Û¯¤ÛË ÌÈÎÚfiÙÂÚË ÙÔ˘ 1 ‰Â›¯ÓÂÈ ÂÈ-ÎÚ¿ÙËÛË ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜ (ÂÚ›ÙˆÛË 4).

∏ ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ-‰¿Û˘ ÛÙÔ ∂¡À ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ· ÌÔÚ› Ó·Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ‰È·Ù·Ú·¯‹˜ Ù˘ ‰È·Î›ÓËÛ˘ ÙˆÓÏ˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ (15-17), ·˘ÙfiÏ˘Û˘ ‹ ΢ÙÙ·-ÚÈÎÔ‡ ı·Ó¿ÙÔ˘, Ô˘ ÚÔÎÏ‹ıËÎ·Ó ·fi ÙË ÊÏÂÁÌÔ-Ó‹. ŸÏ· ·˘Ù¿ Ù· ÁÂÁÔÓfiÙ· ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰Ë-Á‹ÛÔ˘Ó Û ̛· ‰È·ÚÚÔ‹ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ‰È·-̤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘, Ì ·ÔÙ¤ÏÂÛÌ··˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÂÓ˙‡ÌˆÓ ·˘ÙÒÓ ÛÙÔÂÍˆÎ˘ÙÙ¿ÚÈÔ ˘ÁÚfi. ∂Ó·ÏÏ·ÎÙÈο, Ë ˘„ËÏ‹ ‰Ú·ÛÙË-ÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÌÔÚ›ӷ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤Ó˘ ‰È¿¯˘Û˘ ÙÔ˘ ÂÓ-˙‡ÌÔ˘, ÏfiÁˆ ·˘ÍË̤Ó˘ ‰È·‚·ÙfiÙËÙ·˜ ÙÔ˘ ·ÈÌ·ÙÔ-ÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡. O Û˘Ó‰˘·ÛÌfi˜ ÂÓ˙˘ÌÈ΋˜‰È·ÚÚÔ‹˜ ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿ÓË˜Î·È ·˘ÍË̤Ó˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙˆÓ ÌËÓÈÁÁÈÎÒÓÌÂÌ‚Ú·ÓÒÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÊÏÂÁÌÔÓ‹˜, Ê·›-ÓÂÙ·È fiÙÈ Â›Ó·È Ë Èı·ÓfiÙÂÚË ÂÍ‹ÁËÛË Ù˘ ˘„ËÏ‹˜‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡ÀÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜.

∆· ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ‰È·-‰Èηۛ·˜ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÚÔηÏ› Ù·¯Â›· Ì›ˆÛËÙ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÙÔ ∂¡À, ËÔÔ›· Â›Ó·È ‹‰Ë ÂÌÊ·Ó‹˜ 6 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍËÙ˘ ıÂڷ›·˜. ∞˘Ùfi ÙÔ Â‡ÚËÌ· ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë·˘ÍË̤ÓË ÂÓ˙˘ÌÈ΋ ‰È·ÚÚÔ‹ ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·-ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È Ë ·˘ÍË̤ÓË ÂÓ˙˘ÌÈ΋ ‰È·‚·-ÙfiÙËÙ· ÙÔ˘ ·ÈÌÔÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·Ú¯›˙Ô˘ÓÓ· ‚ÂÏÙÈÒÓÔÓÙ·È ÁÚ‹ÁÔÚ· ÌÂÙ¿ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ηٷÛÙÔÏ‹˜ Ù˘ ‰È·‰Èηۛ·˜ Ù˘ ÊÏÂÁÌÔÓ‹˜.ŸÌˆ˜, Ë ÂÈÛÙÚÔÊ‹ Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙË-Ù·˜ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ··ÈÙ› ·ÚÎÂÙ¤˜ Ë̤Ú˜ıÂڷ›·˜. ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ı· ÌÔÚÔ‡Û ӷÂÊ·ÚÌÔÛÙ› ÁÈ· ÙË ‰È¿ÁÓˆÛË ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤-ÓˆÓ ÂÚÈÙÒÛÂˆÓ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ÛÙȘÔԛ˜ Ë Èı·ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ıÂÙÈ΋˜ ηÏÏȤÚ-ÁÂÈ·˜ ∂¡À Â›Ó·È ¯·ÌËÏ‹ Î·È Ë Ù˘È΋ ÂÈÎfiÓ· ÙÔ˘∂¡À Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ.ŒÙÛÈ, Ӥ˜ ÚÔÔÙÈΤ˜ ÁÂÓÓÈÔ‡ÓÙ·È ·fi ·˘Ù‹ ÙËÌÂϤÙË, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ Èı·ÓfiÙË-Ù· fiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ÛÙÔ ∂¡À ÌÔÚ› Ó· Â›Ó·È Â›Û˘ ¯Ú‹ÛÈÌË ÛÙË ‰È·-ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓˆÓ ÂÚÈ-ÙÒÛÂˆÓ ÌËÓÈÁÁ›Ùȉ·˜, ηıÒ˜ ›Û˘ ·Ú·ÌËÓÈÁ-ÁÈÎÒÓ ‰È·˘ËÌ¤ÓˆÓ ÂÛÙÈÒÓ, fiˆ˜ ÂÈÛÎÏËÚ›‰ÈÔ˘,˘ÔÛÎÏËÚ›‰ÈÔ˘ ‹ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜, ·-Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜, Ì·ÛÙÔÂȉ›Ùȉ·˜, ıÚÔÌ‚ÔÊÏÂ-‚›Ùȉ·˜ Î·È ÎÚ·Óȷ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜. ∞˘Ù¤˜ ÔÈ

¶·È‰È·ÙÚÈ΋ 2002;65:97-107 Paediatriki 2002;65:97-107

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·fi„ÂȘ ‰ÈηÈÔÏÔÁÔ‡Ó ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ù˘‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ∂¡À Ù¤ÙÔÈˆÓ ·ÛıÂÓÒÓ. ŒÓ· ¿ÏÏÔ ÂÚÒÙËÌ· Ô˘·Ó·Ê‡ÂÙ·È ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜,ÙÔ ÔÔ›Ô ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ˜, Â›Ó·È Ë Èı·-ÓfiÙËÙ· Û˘ÌÌÂÙÔ¯‹˜ Ù˘ ·˘ÍË̤Ó˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜Û˘ÁΤÓÙÚˆÛ˘ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙË ‰È·‰Èη-Û›· Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜. ∞Ó Î·È ÙÔ Î·Ù¿Ï-ÏËÏÔ pH ÙˆÓ ÂÓ˙‡ÌˆÓ ·˘ÙÒÓ Â›Ó·È ÎÔÓÙ¿ ÛÙÔ 4,0,‰Ú·ÛÙËÚÈfiÙËÙ· ÂÎÊÚ¿˙ÂÙ·È Î·È Û Ԣ‰¤ÙÂÚÔ pH.

∏ ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ-‰¿Û˘ Û ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË Ì ÏÂÈÔ΢ÙÙ¿ÚˆÛË∂¡À, Ë ÔÔ›· ÔÊÂÈÏfiÙ·Ó Û Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂ-ÚÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÌÂٷ͇ ·˘-Ù‹˜ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À ηÈÂΛӢ ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·.∞Ó Î·È Î·Ì›· ÂÊ›Â˘ÛË ÙÈÌÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂÌÂٷ͇ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÏÔ-ÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À, Ë ‰Ú·ÛÙË-ÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û ¤Ó·Ó ·fiÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ‹Ù·ÓÂÓÙfi˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÔÚ›Ô˘ Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·-ÛÙËÚÈfiÙËÙ·˜ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜Ì ˘ÂÏÔÓÂÊÚ›Ùȉ·. ∏ ̤ÙÚÈ· ·‡ÍËÛË Ù˘ ‰Ú·ÛÙË-ÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û ·ÛıÂÓ›˜ Ì¢ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À ‰ÂÓÌÔÚ› Ó· ıˆÚËı› ˆ˜ ÌË ·Ó·ÌÂÓfiÌÂÓÔ Â‡ÚËÌ·,ÁÈ·Ù› Ê·›ÓÂÙ·È Ó· ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ‹ÈÔ˘ ‚·ıÌÔ‡ÌËÓÈÁÁÈ΋ ÊÏÂÁÌÔÓ‹, Ô˘ ˘¿Ú¯ÂÈ Û ·˘Ù¤˜ ÙȘ Â-ÚÈÙÒÛÂȘ.

∏ ·ÚÔ‡Û· ÌÂϤÙË ¤¯ÂÈ ÔÚÈṲ̂ÓÔ˘˜ ÂÚÈÔÚÈ-ÛÌÔ‡˜. ¶ÚÒÙÔÓ, Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂÔ-ÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Â›Ó·È ÌÈÎÚfi˜Î·È Û˘ÓÂÒ˜, Ù· Û¯ÂÙÈο ÛÙÔȯ›· ı· Ú¤ÂÈ Ó· ıÂ-ˆÚËıÔ‡Ó ˆ˜ ÚÔηٷÚÎÙÈο. ŸÌˆ˜, ÔÈ ÂÚÈÙÒ-ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ‰Â›¯ÓÔ˘Ó fiÙÈ ˘¿Ú¯ÂÈ ÌÂ-Á¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ ÛÙ·ÓÂÔÁÓ¿ Ô˘ ··ÈÙ› ÂÌÂÈÚ›·, ÒÛÙ ӷ Á›ÓÔ˘Ó¤ÁηÈÚ· ÔÈ Î·Ù¿ÏÏËϘ ·Ó·ÚÔÛ·ÚÌÔÁ¤˜ ÛÙË ıÂ-ڷ›·. ¢Â‡ÙÂÚÔÓ, Ë ·ÔÙ˘¯›· ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘Ó· ·ÔÌÔÓÒÓÂÈ ÌÈÎÚfi‚È· ÛÙ· ‰Â›ÁÌ·Ù· ∂¡À Ô˘ÂÏ‹ÊıËÛ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ ÙˆÓÓÂÔÁÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ·, ‰ÂÓ Â¤ÙÚ„ ÙË Û˘Û¯¤-ÙÈÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ì ÙËÓ ÔÚ›·Ù˘ ·ÔÛÙ›ڈÛ˘ ÙÔ˘ ∂¡À. ∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜, Û ¤Ó· ¢ڇ Ê¿ÛÌ· ÂÚÈ-ÙÒÛÂˆÓ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ı· Ú¤ÂÈ Ó·Ú·ÁÌ·ÙÔÔÈËıÔ‡Ó. ∆Ú›ÙÔÓ, ÂÂȉ‹ Ù· ‰Â‰Ô̤ӷÛ ·ÛıÂÓ›˜ ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜ Ô˘ ‰ÂÓ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙËÓ ·Ú¯È΋ ıÂڷ›· ÂÚÈÔÚ›˙Ô-ÓÙ·È Û ¤Ó· ÌfiÓÔ ÂÚÈÛÙ·ÙÈÎfi, ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛ-ÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ ·fi ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓÌ ·ÔÙ˘¯›· ÛÙË ıÂڷ›·. ∏ ÚÔÛ‰ÔΛ· Â›Ó·È fiÙÈÌ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘

‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Î·È ÙËÓ ¤ÁηÈÚË ÂÊ·ÚÌÔÁ‹Ù˘ ηٿÏÏËÏ˘ ·ÁˆÁ‹˜, ı· ¤ÏıÂÈ Ì›ˆÛË ÙË˜Û˘¯ÓfiÙËÙ·˜ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ ÛÙÔ˘˜·ÛıÂÓ›˜ ·˘ÙÔ‡˜.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘-ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À Ì·˜ ÚÔÛʤÚÂÈ ¤Ó· ̤ÛÔ,fi¯È ÌfiÓÔ ÁÈ· ‰È¿ÁÓˆÛË Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›ÙÈ-‰·˜, ·ÏÏ¿, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ÁÈ· ÚÒÈÌË Î·È·ÍÈfiÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ Ô˘ ı· ıÂڷ¢ÙÔ‡Ó ·fi Ù· ¯ÔÚËÁÔ‡ÌÂÓ··ÓÙÈ‚ÈÔÙÈο Î·È ÂÎÂ›ÓˆÓ ÙˆÓ ÔÔ›ˆÓ Ë ·¿ÓÙËÛËÛÙË ıÂڷ›· Â›Ó·È ÌË ÈηÓÔÔÈËÙÈ΋ Î·È ˆ˜ ÂÎÙÔ‡ÙÔ˘ ÂӉ›ÎÓ˘Ù·È ¿ÌÂÛË ·ÏÏ·Á‹ ÙÔ˘ ıÂڷ¢ÙÈ-ÎÔ‡ Û¯‹Ì·ÙÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Bryan CS, John JF Jr, Pai MS, Austin TL. Gentamicin vs

cefotaxime for therapy of neonatal sepsis. Relationship todrug resistance. Am J Dis Child 1985;139:1086-1089.

2. Sirot DL, Goldstein FW, Soussy CJ, Courtieu AL, HussonMO, Lemozy J et al. Resistance to cefotaxime and sevenother ‚-lactams in members of the familyEnterobacteriaceae: a 3-year survey in France. AntimicrobAgents Chemother 1992;36:1677-1681.

3. Kunin CM. Resistance to antimicrobial drugs - a worldwidecalamity. Ann Intern Med 1993;118:557-561.

4. Legakis NJ, Tzouvelekis LS, Tsakris A, Legakis JN,Vatopoulos AC. On the incidence of antibiotic resistanceamong aerobic Gram-negative rods isolated in Greekhospitals. J Hosp Infect 1993;24:233-237.

5. Chen DK, McGeer A, de Azavedo JC, Low DE.Decreased susceptibility of Streptococcus pneumoniaeto fluoroquinolones in Canada. N Engl J Med1999;341:233-239.

6. Barnett ED, Klein JO. The problem of resistant bacteria forthe management of acute otitis media. In: Schreiber JR,Goldmann DA, eds. Antimicrobial resistance in pediatrics.The Pediatric Clinics of North America. Philadelphia: W.B.Saunders Co; 1995;42:509-517.

7. Fenoll A, Martin Bourgon C, Munoz R, Vicioso D, CasalJ. Serotype distribution and antimicrobial resistance ofStreptococcus pneumoniae isolates causing systemicinfections in Spain, 1979-1989. Rev Infect Dis1991;13:56-60.

8. Friedland IR, Klugman KP. Antibiotic-resistantpneumococcal disease in South African children. Am J DisChild 1992;146:920-923.

9. Appelbaum PC. Antimicrobial resistance in Streptococcuspneumoniae: an overview. Clin Infect Dis 1992;15:77-83.

10. Geslin P, Buu-Hoi A, Fremaux A, Acar JF. Antimicrobialresistance in Streptococcus pneumoniae: anepidemiological survey in France, 1970-1990. Clin InfectDis 1992;15:95-98.

11. Syrogiannopoulos GA, Grivea IN, Beratis NG,Spiliopoulou AE, Fasola EL, Bajaksouzian S et al.Resistance patterns of Streptococcus pneumoniae fromcarriers attending day-care centers in Southwestern

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Greece. Clin Infect Dis 1997;25:188-194. 12. Syrogiannopoulos GA, Grivea IN, Katopodis GD, Geslin P,

Jacobs MR, Beratis NG. Carriage of antibiotic-resistantStreptococcus pneumoniae in Greek infants and toddlers.Eur J Clin Microbiol Infect Dis 2000;19:288-293.

13. Beratis NG, Mavrommatis T, Hatiris I, Kavaliotis J,Tsagaropoulou-Stiga H, Syrogiannopoulos GA. Increasedactivity of lysosomal acid hydrolases in the cell-freecerebrospinal fluid of bacterial meningitis. Pediatr Res1997;128:806-812.

14. Syrogiannopoulos GA, Lourida AN, Theodoridou MC,Pappas IG, Babilis GC, Economidis JJ et al.Dexamethasone therapy for bacterial meningitis inchildren: 2- versus 4-day regimen. J Infect Dis1994;169:853-858.

15. Erickson AH, Blobel G. Early events in the biosynthesis ofthe lysosomal enzyme cathepsin D. J Biol Chem

1979;254:11771-11774. 16. Rosenfeld MG, Kreibich G, Popov D, Kato K, Sabatini DD.

Biosynthesis of lysosomal hydrolyses: their synthesis inbound polysomes and the role of co- and post-translationalprocessing in determining their subcellular distribution. JCell Biol 1982;93:135-143.

17. Proia RL, Neufeld EF. Synthesis of ‚-hexosaminidase incell-free translation and in intact fibroblasts: an insolubleprecursor alpha chain in a rare form of Tay-Sachs disease.Proc Natl Acad Sci USA 1982;79:6360-6364.

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¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· π. ∏ÏÈÔÔ‡ÏÔ˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ∆.∫. 265 00, ƒ›Ô, ¶¿ÙÚ· E-mail: [email protected]

™ÎÔfi˜: O ÛÙÚÂÙfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ µ (GBS) ·ÔÙÂÏ›¤Ó·Ó ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ù˘ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜. ™Â ÌÂÚÈο ÓÂÔÁÓ¿, Ë ÛË„·ÈÌ›· ·fi ÙÔÓGBS ÌÔÚ› Ó· ¤¯ÂÈ ‚·ÚÈ¿ ÔÚ›·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÙÔ˘ÛË„·ÈÌÈÎÔ‡ shock, Ì ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜, ÂÓÒ ¿ÏÏ·ÓÂÔÁÓ¿ ·ÔÈΛ˙ÔÓÙ·È Ì ÙÔÓ GBS ¯ˆÚ›˜ Ó· ÂÌÊ·Ó›˙Ô˘Ó ÎÏÈÓÈοÛËÌ›· ‚·ÎÙËÚȷ΋˜ Ïԛ̈͢. O ÏfiÁÔ˜ ÁÈ· ÙËÓ ·ÓٛʷÛË ·˘-Ù‹ ‰ÂÓ Â›Ó·È ÍÂοı·ÚÔ˜. ÀÏÈÎfi Î·È ÌÂıÔ‰ÔÏÔÁ›·: ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ó·˙ËÙ‹Û·ÌÂÓ· Û˘ÁÎÚ›ÓÔ˘Ì ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙ· ÌÔÓÔ‡-ÚËÓ· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛ‹ ÙÔ˘˜, Ì ÛÙÂ-Ϥ¯Ë ÙÔ˘ GBS Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·,ηıÒ˜ ›Û˘ ·fi ÓÂÔÁÓ¿ Ô˘ ‹Ù·Ó ÌfiÓÔ ·ÔÈÎÈṲ̂ӷ ¯ˆÚ›˜Û˘ÌÙÒÌ·Ù· Ïԛ̈͢. ∆· ÌÔÓÔ‡ÚËÓ· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘Âˆ¿ÛıËηÓ, ›Ù Ì ‚·ÎÙËÚ›‰È· ‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂϯÒÓ Ô˘·‰Ú·ÓÔÔÈ‹ıËÎ·Ó Ì ıÂÚÌfiÙËÙ·, ›Ù Ì ÏÈÔÔÏ˘Û·Î¯·Ú›-‰Â˜, ·ÓÙ›ÛÙÔȯ·. ªÂÙ¿ ·fi 6 Î·È 24 ÒÚ˜, Û˘ÓÂϤÁËÛ·Ó Ù·Î‡ÙÙ·Ú· Î·È ¤ÁÈÓ ·Ó¿Ï˘ÛË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ mRNA ÙˆÓ Î˘Ù-Ù·ÚÔÎÈÓÒÓ Ì PCR. ∂›Û˘, Ù· ˘ÂÚΛÌÂÓ· ·ÙÙ·Ú· ÂϤÁ-¯ıËÎ·Ó Ì ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô, ÁÈ· ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ-‰ÈÔÚÈÛÌfi ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ IL-6 Î·È ÙÔ˘ TNF-·. ∞ÔÙÂϤÛÌ·Ù·: ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ IL-6 ηÈÙÔ˘ TNF-· ‰È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ›‰· IL-6 ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi Ù·ÛË„·ÈÌÈο ÓÂÔÁÓ¿, ·’ fiÙÈ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë Ô˘·ÔÌÔÓÒıËÎ·Ó ·fi ·ÔÈÎÈṲ̂ӷ ÓÂÔÁÓ¿ ¯ˆÚ›˜ Ïԛ̈ÍË. ∂›-Û˘, Ë ¤ÎÊÚ·ÛË ÙÔ˘ mRNA, ÙˆÓ IL-6, IL-1b Î·È IL-12p40, ‹Ù·ÓÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë Ô˘·ÔÌÔÓÒıËÎ·Ó ·fi ÛË„·ÈÌÈο ÓÂÔÁÓ¿. ∆· ›‰È· ·ÔÙÂϤÛÌ·-

Ù·, ›Û˘, ‰È·ÈÛÙÒıËÎ·Ó ÛÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ‰È·ÊÔÚÂ-ÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ÚÔηÏÔ‡Ó Ù· ÛÙÂϤ¯Ë ÙÔ˘ GBS, ›Ù¢fi ÙË ÌÔÚÊ‹ ÛË„·ÈÌ›·˜ ›Ù ˘fi ÙË ÌÔÚÊ‹ ÌfiÓÔ ÙÔ˘ ·ÔÈÎÈ-ÛÌÔ‡, ›Ûˆ˜ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙȘ ÂȉÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÂοÛÙÔÙÂÛÙÂϯÒÓ. ∂¿Ó ηٷÛÙ› ‰˘Ó·Ùfi˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ È‰È·›-ÙÂÚˆÓ ·˘ÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÌÔÚ› ̤ۈ ÌÔÚÈ·ÎÒÓ ÌÂıfi-‰ˆÓ Ó· ‰È·ÎÚÈıÔ‡Ó Ù· ÂÈΛӉ˘Ó· ·fi Ù· ·Î›Ó‰˘Ó· ÛÙÂϤ¯Ë.∂ÈϤÔÓ, Ù· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙÔ ÛËÌ·-ÓÙÈÎfi ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ÛË„·ÈÌ›·˜ ·fi GBS.

¢È·ÊÔÚÂÙÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Û ÌÔÓÔ‡ÚËÓ· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛËÌ ÛÙÂϤ¯Ë ÛÙÚÂÙfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ µ Ô˘ ÚÔηÏÔ‡Ó ÛË„·ÈÌ›· ‹ ÌfiÓÔ ·ÔÈÎÈÛÌfi1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Berner R, Csorba J, Brandis M Different cytokine expression in cord bloodmononuclear cells after stimulation withneonatal sepsis or colonizing strains ofStreptococcus agalactiaePed Res 2001;49:691-697

™‡ÚÔ˜ ºˆÙfiÔ˘ÏÔ˜¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”

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¶·È‰È·ÙÚÈ΋ 2002;65:108-112 Paediatriki 2002;65:108-112

108

∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ÛÙ· ·È‰È¿ Ù˘ ∫Ú‹Ù˘ ™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË, ∂. °·Ï·Ó¿Î˘, £. ∆ÛÂÎÔ˘Ú¿, °. ∑·ÌÂÙ¿Î˘, ∂. ∫fiÎÔÚË

∞septic meningitis in children from Crete S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

∞’ & µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

1st & 2nd Pediatric Clinic Venizelion General Hospital of Heraklion, Crete

�¶ÂÚ›ÏË„Ë: ∏ ‰È¿ÎÚÈÛË Ù˘ ¿ÛËÙ˘ ·fi ÙË ‚·-ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ· Â›Ó·È ‰‡ÛÎÔÏË Ì ‚¿ÛË Ìfi-ÓÔ Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ™ÙËÓ ∫Ú‹ÙË ‰ÂÓ¤¯ÂÈ Á›ÓÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÎÚÈ‚‹˜ ηٷÁÚ·Ê‹ ÙˆÓ·ÈÙ›ˆÓ Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ·˘-ÙÒÓ. ªÂÏÂÙ‹ıËÎ·Ó Ù· ÂȉËÌÈÔÏÔÁÈο, Ù· ÎÏÈÓÈÎ¿Î·È Ù· ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο 81 ·È‰ÈÒÓÌ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ µÂ-ÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ηٿ ÙˉÈÂÙ›· 1999-2000. ¢È·ÈÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚË Â›-ÙˆÛË Ù˘ ÓfiÛÔ˘ ÙÔ Î·ÏÔη›ÚÈ Î·È ÙÔ ÊıÈÓfiˆÚÔ.∆Ô 78% ÙˆÓ ·È‰ÈÒÓ ÓÔÛËχÙËΠηٿ ÙË ‰È¿Ú-ÎÂÈ· 2 Î˘Ì¿ÙˆÓ. ™Â 57 ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ηÏÏȤÚ-ÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ·‹Ù·Ó ıÂÙÈÎfi ÛÙÔ 33% ÙˆÓ ÂÚÈÙÒÛˆÓ. OÚÔÏÔÁÈ-΋ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜·Ô‰Â›¯ÙËΠÛÙÔ 31% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ. ªÂ ‚¿ÛË Ù··ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÎÔÚ¿ÓˆÓ Î·ÈÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, ÙÔ 41% ÙˆÓ ÂÚÈÙÒÛÂ-ˆÓ ÔÊÂÈÏfiÙ·Ó Û ÂÓÙÂÚÔ˚Ô‡˜. ∏ ¤Î‚·ÛË ‹Ù·Ó ηϋÛ fiÏ· Ù· ·È‰È¿. ∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· Â›Ó·È Û˘-¯Ó‹ ÛÙËÓ ∫Ú‹ÙË Î·È ÂÌÊ·Ó›˙ÂÈ Âԯȷ΋ ηٷÓÔÌ‹.¶Ôχ Û˘¯Ó¿ ÔÊ›ÏÂÙ·È Û ÂÓÙÂÚÔ˚Ô‡˜. ∏ ηÏÏȤÚ-ÁÂÈ· ÎÔÚ¿ÓˆÓ Â›Ó·È ¯Ú‹ÛÈÌË, ·ÏÏ¿ ‰ÂÓ ˆÊÂÏ›ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘.

§¤ÍÂȘ ÎÏÂȉȿ: ÈÔÁÂÓ‹˜ ÌËÓÈÁÁ›Ùȉ·, ÂÓÙÂÚÔ˚Ô›,∫Ú‹ÙË.

�Abstract: The differential diagnosis betweenbacterial and aseptic meningitis is often difficult onclinical grounds alone. The exact epidemiologicpatterns of aseptic meningitis in Crete has notbeen investigated yet. The present study included81 children aged 30 days to 14 years, who werehospitalized from 1/1/1999 to 31/12/2000 in theVenizelio General Hospital of Heraklion for asepticmeningitis. We studied the epidemiological,clinical and laboratory characteristics of thechildren. A greater incidence of the disease wasobserved during the summer and fall months.Sixty-three children (78%) were hospitalizedduring 2 clusterings. Stool specimens werecollected from 57 children and enteroviruses (∂Vs)were isolated from 19 (33%). Acute phaseserology was positive for EVs in 31% of theinvestigated patients. Results from positivecultures and/or serology showed that 41% of thecases were due to EVs. The outcome wasexcellent in all patients. Enteroviral meningitis isfrequent in Crete, it has a seasonal distribution andconstitutes a major part of the total cases ofaseptic meningitis. Culture of the virus is useful,but it is not diagnostically helpful during the acutephase of the disease.

Key words: viral meningitis, enteroviruses, Crete.

∂ÈÛ·ÁˆÁ‹O fiÚÔ˜ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ

ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ÌËÓ›ÁÁˆÓ,ÛÙÔ ÔÔ›Ô ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È ‚·ÎÙËÚȉȷÎÔ› ·Ú¿-ÁÔÓÙ˜ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) (1). ∏̤ÛË ÂÙ‹ÛÈ· ›وÛË ÛÙȘ ∏¶∞ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ

4,4 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌfi. ™Â ÂÚÈfi-‰Ô˘˜ Ì ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘, fï˜, Ë ÂÙ‹ÛÈ· ›-ÙˆÛË ÌÔÚ› Ó· ‰ÂηϷÛÈ·ÛÙ› (2). ™‡Ìʈӷ ÌÂÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ, ÔÈ ÂÓÙÂÚÔ˚Ô›, Ì ÂÍ·›ÚÂÛËÙÔ˘˜ ÈÔ‡˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, Â›Ó·È ˘Â‡ı˘ÓÔÈÁÈ· ÙÔ 80%-92% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙ˘

MARCH-APRIL 2002 14-05-03 12:25 ™ÂÏ›‰·108

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ÌËÓÈÁÁ›Ùȉ·˜, ÛÙȘ Ôԛ˜ ·ÔÌÔÓÒÓÂÙ·È ·ÈÙÈÔÏÔÁÈ-Îfi˜ ·Ú¿ÁÔÓÙ·˜ (1-8). ∞ÓÙÈÛÙÚfiʈ˜, Ë ¿ÛËÙËÌËÓÈÁÁ›Ùȉ· ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·fi ÙȘ ÛÔ‚·-Ú¤˜ ÏÔÈÌÒÍÂȘ Ô˘ ÚÔηÏÔ‡Ó ÔÈ ÂÓÙÂÚÔ˚Ô› (1,8,9).™Ù· ‡ÎÚ·Ù· Îϛ̷ٷ, Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·˘ÍË-̤ÓË Û˘¯ÓfiÙËÙ· ηٿ ÙÔ˘˜ ηÏÔηÈÚÈÓÔ‡˜ ηÈÙÔ˘˜ ÊıÈÓÔˆÚÈÓÔ‡˜ Ì‹Ó˜ (1,4,8-11). ∏ ÌÂÙ¿‰ÔÛËÙˆÓ ÂÓÙÂÚÔ˚ÒÓ Á›ÓÂÙ·È Î˘Ú›ˆ˜ Ì ÙËÓ ÎÔÚ·ÓÔ-ÛÙÔ-Ì·ÙÈ΋ Ô‰fi Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Ì ÛÙ·ÁÔÓ›‰È· ·fiÙÔ ·Ó·Ó¢ÛÙÈÎfi, Ì ¯ÚfiÓÔ ÂÒ·Û˘ ·fi 1 Ë̤ڷ¤ˆ˜ 3 ‚‰ÔÌ¿‰Â˜ (Û˘Ó‹ıˆ˜ 4-6 Ë̤Ú˜). ªÂÙ¿‰Ô-ÛË Ù˘ Ïԛ̈͢ ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ÌÂÙ¿ ·fi¤ÎıÂÛË Û ÓÂÚfi Ô˘ ¤¯ÂÈ ÌÔÏ˘Óı›, fiˆ˜ ÌÔÚ›ӷ Û˘Ì‚·›ÓÂÈ Û ÈÛ›Ó˜ (1,4,7-9).

∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· Â›Ó·È Û˘Ó‹ıˆ˜ ·˘ÙÔ˚ÒÌÂ-ÓË ÓfiÛÔ˜ Ì ηϋ ÚfiÁÓˆÛË (1,4,8). ªÂÁ·Ï‡ÙÂÚÔΛӉ˘ÓÔ ÁÈ· ÂÈÏÔΤ˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ηٿÏÔÈ·ÌÂÙ¿ ·fi Ïԛ̈ÍË ÙÔ˘ ∫¡™ ·fi ÂÓÙÂÚÔ˚Ô‡˜ ÂÌÊ·-Ó›˙Ô˘Ó Ù· ÓÂÔÁÓ¿ Î·È Ù· ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ·È-‰È¿ (1,4,5,9). ∏ ‰È¿ÎÚÈÛË Ù˘ Ïԛ̈͢ ÙÔ˘ ∫¡™·fi ÂÓÙÂÚÔ˚Ô‡˜, ·fi ÙË Ïԛ̈ÍË Ô˘ ÚÔηÏ›ٷȷfi Û˘Ó‹ıË ‚·ÎÙËÚ›‰È· Î·È ¿ÏÏÔ˘˜ ÈÔ‡˜, Â›Ó·È Û˘-¯Ó¿ ‰‡ÛÎÔÏË Ì ‚¿ÛË ÌfiÓÔ Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈ-ÛÙÈο Ù˘ ÓfiÛÔ˘ ‹ Ù· ·Ú¯Èο Â˘Ú‹Ì·Ù· ·fi ÙÔ∂¡À (1,3,12,13). °È· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘¿ÛËÙ˘ ·fi ÙË ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ·, Ë ·-Ú·ÌÔÓ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Ë ÂÌÂÈÚÈ΋ ¯ÔÚ‹ÁËÛË·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÂȉÈÎÒÓ ‰È·ÁÓˆÛÙÈ-ÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Â›Ó·È Û˘¯Ó¿ ··Ú·›ÙËÙË (5,8).

™ÙËÓ ·Ó·‰ÚÔÌÈ΋ ·˘Ù‹ ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÔÓÙ·ÈÙ· ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›·, Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈ-ÛÙÈο, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È Ë ‰È·ÁÓˆ-ÛÙÈ΋ ÚÔۤϷÛË fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ¿ÛËÙËÌËÓÈÁÁ›Ùȉ·, Ô˘ ÓÔÛËχÙËÎ·Ó Û ¤Ó· °ÂÓÈÎfi ¡Ô-ÛÔÎÔÌÂ›Ô ÛÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ‰ÈÂÙ›·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË Û˘ÌÂÚȤϷ‚ 81 ·È‰È¿ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·,

Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙȘ ‰‡Ô ¶·È‰È·ÙÚÈΤ˜ ∫ÏÈÓÈΤ˜ ÙÔ˘ µÂÓÈ˙¤-ÏÂÈÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ·fi 1-1-1999 ¤ˆ˜ Î·È 31-12-2000.∆ËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ÓÔÛËχÙËÎ·Ó 8 ·È‰È¿ Ì ‚·ÎÙËÚÈ-‰È·Î‹ ÌËÓÈÁÁ›Ùȉ·. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·-ΤÓÙËÛË (O¡¶) Î·È ÂÏ‹ÊıËÛ·Ó Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜. ø˜ ÎÚÈ-Ù‹ÚÈ· ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ıˆڋıËÎ·Ó Ë ·ÚÔ˘Û›· ÙÔ˘Ï¿¯È-ÛÙÔÓ 15 Ï¢ÎÔ΢ÙÙ¿ÚˆÓ/mm3 ÛÙÔ ∂¡À, ÙÔ ·ÚÓËÙÈÎfi ¿ÌÂÛÔ ·-Ú·Û··ÛÌ·, Ë ·ÚÓËÙÈ΋ ‰ÔÎÈÌ·Û›· ·Ó·˙‹ÙËÛ˘ ·ÓÙÈÁfiÓˆÓ ÁÈ·‚·ÎÙËÚ›‰È· Î·È ÔÈ ÛÙ›Ú˜ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È ∂¡À (4,14).

∏ ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË Ù˘ ¿ÛËÙ˘ ÌË-ÓÈÁÁ›Ùȉ·˜ ÂÚȤϷ‚ Û 57 ÂÚÈÙÒÛÂȘ ηÏÏȤÚÁÂÈ· Î·È ·Ó·-ηÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ ÛÙÔ ∂ÏÏËÓÈÎfi πÓÛÙÈÙÔ‡-ÙÔ Pasteur, ÂÓÒ ÙÔ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÂȂ‚·ÈÒıËΠ۠fiϘÙȘ ÂÚÈÙÒÛÂȘ Ì ÙËÓ ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘(polymerase chain reaction, PCR). ™Â 64 ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ÌËÓÈÁÁ›Ùȉ·˜ ˙ËÙ‹ıËΠ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ ÂÓÙÂ-ÚÔ˚ÒÓ ÛÙÔÓ ÔÚfi, ÙfiÛÔ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, fiÛÔ Î·È

ηٿ ÙË Ê¿ÛË ·Ó¿ÚÚˆÛ˘ Ì ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (ELISA)ÛÙÔ ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ∞ÔÙÂϤ-ÛÌ·Ù· ÂÓ‰ÂÈÎÙÈο ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚fi ıˆڋ-ıËÎ·Ó Â›Ù ٷ ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù· ›ÙÂ Ô ÙÂÙÚ·Ï·ÛÈ·ÛÌfi˜ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ IgG ÛÙ· ‰‡Ô ‰Â›ÁÌ·Ù· ÔÚÔ‡ Ô˘ÂÏ‹ÊıËÛ·Ó Ì ‰È·ÊÔÚ¿ 14-21 ËÌÂÚÒÓ ÌÂٷ͇ ÙÔ˘˜. ™Â 54 Â-ÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ÂÊ·ÚÌfiÛÙËÎ·Ó Î·È ÔÈ ‰‡Ô ‰È·ÁÓˆÛÙÈΤ˜‰ÔÎÈ̷ۛ˜, Û 3 ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ÌfiÓÔ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿-ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜, ÂÓÒ Û 10 ÂÚÈÙÒÛÂȘ ÌfiÓÔ ÔÚÔÏÔÁÈÎfi˜¤ÏÂÁ¯Ô˜. ™˘ÓÂÒ˜, ÂȉÈ΋ ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ (ηÏÏȤÚÁÂÈ·ÎÔÚ¿ÓˆÓ Î·È/‹ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜) ÂÊ·ÚÌfi-ÛÙËΠ۠67 ·fi ÙÔ˘˜ 81 ·ÛıÂÓ›˜ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·.

™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, ÌÂÏÂÙ‹ıË-Î·Ó ·Ó·‰ÚÔÌÈο Ù· ÂȉËÌÈÔÏÔÁÈο, Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚÈ·-ο Â˘Ú‹Ì·Ù· Î·È Ë ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘.

∞ÔÙÂϤÛÌ·Ù· ∞fi Ù· 81 ·È‰È¿ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, Ù· 41

‹Ù·Ó ·ÁfiÚÈ· (51%). ∆· ·È‰È¿ ›¯·Ó ËÏÈΛ· ·fi 30Ë̤Ú˜ ¤ˆ˜ Î·È 14 ¤ÙË (ÂӉȿÌÂÛË ÙÈÌ‹ Ù· 5,4 ¤ÙËÎ·È Ì¤ÛÔ˜ fiÚÔ˜ Ù· 5,8 ¤ÙË). 32 ·È‰È¿ ›¯·Ó ËÏÈΛ·0-4 ÂÙÒÓ, 34 ËÏÈΛ· 5-9 ÂÙÒÓ Î·È 15 ËÏÈΛ· 10-14ÂÙÒÓ (39%, 42% Î·È 19% ·ÓÙÈÛÙÔ›¯ˆ˜).

¶·Ú·ÙËÚ‹ıËΠ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ πÔ‡-ÏÈÔ ¤ˆ˜ Î·È ÙÔ ¢ÂΤ̂ÚÈÔ (™¯‹Ì· 1). To 78% ÙˆÓÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›ÛÙËΠ۠‰‡Ô ¢‰È¿ÎÚÈÙ· ·-Ì·Ù· ·˘ÍË̤Ó˘ ›وÛ˘, Ì οı ·̷ Ó· ·ÓÙÈ-ÛÙÔȯ› ÛÙÔ˘˜ ηÏÔηÈÚÈÓÔ‡˜ Î·È ÊıÈÓÔˆÚÈÓÔ‡˜Ì‹Ó˜ οı ¤ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ Î·Ï-ÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Î·È ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈۈ̿-ÙˆÓ ÛÙÔÓ ÔÚfi ‹Ù·Ó ÂÓ‰ÂÈÎÙÈο ÚfiÛÊ·Ù˘ Ïԛ̈-͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜, ·ÎÚÈ‚Ò˜ ηٿ ÙË ‰È¿ÚÎÂÈ·ÙˆÓ ¯ÚÔÓÈÎÒÓ ·˘ÙÒÓ ÂÚÈfi‰ˆÓ (™¯‹Ì· 1). ™Â ‰‡ÔÔÈÎÔÁ¤ÓÂȘ, ÚÔÛ‚Ï‹ıËÎ·Ó Û˘Á¯ÚfiÓˆ˜ 3 ·È‰È¿·fi οı ÔÈÎÔÁ¤ÓÂÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ·Ú·-¿Óˆ Î˘Ì¿ÙˆÓ Î·È ·ÔÌÔÓÒıËΠ۠fiÏ· ÂÓÙÂÚÔ˚fi˜ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ. ™ÙÔ 85% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ Ì ÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ ÏÔ›-̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜, ÙÔ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ıÂÙÈ-Îfi ÁÈ· ÙÔ˘˜ ÈÔ‡˜ Echo. ∏ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ÔÚÔÙ‡-Ô˘ ÙÔ˘ ÂÓÙÂÚÔ˚Ô‡ ·fi Ù· ÎfiÚ·Ó· ‰ÂÓ ‹Ù·Ó ÙÂÏÈ-ο ÂÊÈÎÙ‹.

™Â 57 ·È‰È¿ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ¤ÁÈÓ ηÏ-ÏȤÚÁÂÈ· Î·È ·Ó·Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂ-ÚÔ˚Ô‡˜ Î·È ·ÔÌÔÓÒıËΠÂÓÙÂÚÔ˚fi˜ Û 19 ÂÚÈ-ÙÒÛÂȘ (33%). ∆Ô ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÂȂ‚·ÈÒ-ıËΠ۠fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ì PCR. ™Â 64 ·È-‰È¿ ¤ÁÈÓ ÔÚÔÏÔÁÈ΋ ·Ó›¯Ó¢ÛË ÂÓÙÂÚÔ˚ÒÓ Û ‰‡Ô‰Â›ÁÌ·Ù· ÔÚÔ‡, ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘Î·È Î·Ù¿ ÙËÓ ·Ó¿ÚÚˆÛË. O Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ‹Ù·Ó ÂÓ‰ÂÈÎÙÈÎfi˜ ÚfiÛÊ·Ù˘ Ïԛ̈͢ Û 20 ÂÚÈ-ÙÒÛÂȘ (31%). ∞fi ÙȘ 54 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓÔ˘ ÂÊ·ÚÌfiÛÙËÎ·Ó Î·È Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Î·ÈÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Û 6 ÂÚÈÙÒÛÂȘ ÙÔ ·ÔÙ¤-ÏÂÛÌ· ‹Ù·Ó ıÂÙÈÎfi Î·È Û 21 ‹Ù·Ó ·ÚÓËÙÈÎfi ηÈ

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ÛÙȘ ‰‡Ô ·˘Ù¤˜ ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜. ™Â 13ÂÚÈÙÒÛÂȘ Ì ·ÚÓËÙÈÎfi ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÁÈ·ÂÓÙÂÚÔ˚Ô‡˜, ·ÔÌÔÓÒıËΠ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ·ÎÔÚ¿ÓˆÓ ÂÓÙÂÚÔ˚fi˜. ™Â 14 ÂÚÈÙÒÛÂȘ Ô˘ ËηÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈ΋, ˘‹ÚÍÂÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fiÂÓÙÂÚÔ˚Ô‡˜. ™˘ÓÂÒ˜, Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù·ÙˆÓ ÎÔÚ·ÓÔηÏÏÈÂÚÁÂÈÒÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ÂϤÁ¯Ô˘, ·fi ÙȘ 81 Û˘ÓÔÏÈο ÂÚÈÙÒÛÂȘ ¿ÛË-Ù˘ ÌËÓÈÁÁ›Ùȉ·˜, Û 33 (41%) ·ÔÌÔÓÒıËÎÂÂÓÙÂÚÔ˚fi˜. ∞fi ÙȘ 67 ÂÚÈÙÒÛÂȘ Ô˘ ÂÊ·ÚÌfi-ÛÙËΠÂȉÈ΋ ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ (ÎÔÚ·ÓÔηÏ-ÏȤÚÁÂÈ· ηÈ/‹ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜), Û 33 (49%)ÙÂÎÌËÚÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›ÙÈ-‰·˜ ·fi ÂÓÙÂÚÔ˚Ô‡˜. ∆Ô ·ÔÙ¤ÏÂÛÌ· ·fi ÙËÓ Î·Ï-ÏȤÚÁÂÈ· ÙˆÓ ÎÔÚ¿ÓˆÓ ‰ÂÓ ‹Ù·Ó ‰È·ı¤ÛÈÌÔ ÚÈÓÙÔ 8Ô 24ˆÚÔ ÓÔÛËÏ›·˜, ÂÓÒ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈ-ÛÌfi ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi ¯ÚÂÈ¿-˙ÔÓÙ·Ó Û˘Ó‹ıˆ˜ 3-8 Ë̤Ú˜.

∆· ·ÚÈ· ÎÏÈÓÈο ÛËÌ›· ηٿ ÙËÓ ÚÔۤϢÛËÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÙÌ‹Ì· ∂ÂÈÁfiÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ›¯·Ó ·Ú¯›ÛÂÈ 28,8 ±11,8 ÒÚ˜ ÚÈÓ ÙËÓ ÚÔۤϢÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÔÓÔÛÔÎÔÌ›Ô. ∆Ô ÂÍ¿ÓıËÌ· ‹Ù·Ó ·ÈÌÔÚÚ·ÁÈÎfi Û 5ÂÚÈÙÒÛÂȘ Î·È ÎËÏȉԂϷÙȉ҉˜ Û ̛·. ™Â ¤Ó··È‰› ‰È·ÈÛÙÒıËΠÂÍ¿ÓıËÌ· ·ÓÂÌÔ‚ÏÔÁÈ¿˜ Û·ԉÚÔÌ‹. ∫·Ó¤Ó· ·È‰› ‰ÂÓ ‹Ù·Ó Û Έ̷ÙÒ‰ËηٿÛÙ·ÛË Î·È Î·Ó¤Ó· ‰ÂÓ ¤Î·Ó ۷ÛÌÔ‡˜.

∆· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙÔ˘ ∂¡À وӷȉÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜Î·È ÂÎÂ›ÓˆÓ Ì ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ· Ô˘ ÓÔ-ÛËχÙËÎ·Ó Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· Ù˘ ÌÂϤÙ˘, ÂÌ-Ê·Ó›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙÔ 48% ÙˆÓ ÂÚÈÙÒ-

ÛÂˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿-ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜ (ÔÏ˘-ÌÔÚÊÔ‡ÚËÓ· >50%). ∂ÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚ-ÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·Ú·ÙËÚ‹ıËΠ۠36 ·fiÙȘ 63 ÂÚÈÙÒÛÂȘ (57%) Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÛÂÏÈÁfiÙÂÚÔ ·fi 24 ÒÚ˜ ·fi ÙÔ ¯ÚfiÓÔ Ô˘ Ú·Á-Ì·ÙÔÔÈ‹ıËÎÂ Ë O¡¶, ·ÏÏ¿ ÌfiÓÔ Û 3 ·fi ÙȘ 18ÂÚÈÙÒÛÂȘ (17%) Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û Â-ÚÈÛÛfiÙÂÚÔ ·fi 24 ÒÚ˜. ∞fi ÙȘ 81 ÂÚÈÙÒÛÂȘ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, Û 42 Ô Ù‡Ô˜ ÙˆÓ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi˜. ∂Ô-̤ӈ˜, Ë Â˘·ÈÛıËÛ›· Ù˘ ÂÈÎÚ¿ÙËÛ˘ ÙˆÓ ÏÂÌ-ÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ¿ÛË-Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ ‹Ù·Ó 52%. ∞fi ÙȘ 8 ÂÚÈÙÒ-ÛÂȘ ·È‰ÈÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·,·ÏÏ¿ ›¯·Ó ‚·ÎÙËÚȉȷ΋, Û 7 Ô Ù‡Ô˜ ÙˆÓ Î˘Ù-Ù¿ÚˆÓ ÛÙÔ ∂¡À ‰ÂÓ ‹Ù·Ó ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi˜, ÂȉÈ-ÎfiÙËÙ· 88%. ∂›Û˘, ·fi Ù· 43 ·È‰È¿ Ì ÏÂÌÊÔ-΢ÙÙ·ÚÈÎfi Ù‡Ô ÛÙÔ ∂¡À, Ù· 42 ›¯·Ó ¿ÛËÙË ÌË-ÓÈÁÁ›Ùȉ·, ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· 98%. ∞fi Ù·46 ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi Ù‡Ô ÛÙÔ∂¡À, Ù· 7 ‰ÂÓ Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, ·ÏÏ¿ ›-¯·Ó ‚·ÎÙËÚȉȷ΋, ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›·15%. ∆· Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛË-Ì·ÓÙÈο ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ÙÂÎÌËÚȈ̤ÓËÏԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜, ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ÔÔ›Ô˘˜ ‰ÂÓ ÙÂÎÌËÚÈÒıËΠÏԛ̈ÍË ·fi ÂÓÙÂÚÔ˚-Ô‡˜ Î·È ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Ï‹ÊıËÎÂÂȉÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 3).

§Â˘ÎÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· (Ï¢ÎÔ-·ÙÙ·Ú· >15.000/mm3) ‰È·ÈÛÙÒıËΠÛÙÔ 28%ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ Ì ̤ÛËÙÈÌ‹ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ 11.850 ± 3.708/mm3 Î·È ÂӉȿÌÂÛË ÙÈÌ‹ 11.400/mm3. ∂ÈÎÚ¿ÙËÛË ÙˆÓ

¶·È‰È·ÙÚÈ΋ 2002;65:108-112 Paediatriki 2002;65:108-112

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ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ‰È·ÈÛÙÒıËΠÛÙÔ 81% ÙˆÓÂÚÈÙÒÛˆÓ. ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ Ô-Ï˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‹Ù·Ó 64%± 22%. ∏ ∆∫∂ ‹Ù·Ó >20 Û 47 ÂÚÈÙÒÛÂȘ (58%).∞fi Ù· 47 ·˘Ù¿ ·È‰È¿, 31 ›¯·Ó ∆∫∂ 20-39 mm/hÎ·È 16 ·È‰È¿ >40 mm/h. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜‹Ù·Ó ÛÙ›Ú˜ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÌË-ÓÈÁÁ›Ùȉ·˜.

™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¯ÚÂÈ¿ÛÙËΠӷ ‰Ôı›·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹, Ë ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜‹Ù·Ó 3-8 Ë̤Ú˜, ¤ˆ˜ fiÙÔ˘ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓηÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·. ∏ ¤Î‚·ÛË Ù˘ Ófi-ÛÔ˘ ‹Ù·Ó ηϋ Û fiÏ· Ù· ·È‰È¿ Î·È Î·Ù¿ ÙËÓ ·-Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓÂÈÏÔΤ˜ ‹ Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ·.

™˘˙‹ÙËÛË ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ˘Ô„›· ÈÔÁÂ-

ÓÔ‡˜ ÌËÓÈÁÁ›Ùȉ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‹ıˆ˜ ÙË ¯ÔÚ‹-ÁËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ Ê·Ú̿ΈÓ, ¤ˆ˜ fiÙÔ˘ Ù··ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈ-Ì·. ∂ÎÙfi˜ ·fi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ‚·ÎÙËÚȉȷÎÒÓ·ÈÙ›ˆÓ, Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË Ù˘ ¿ÛËÙ˘ÌËÓÈÁÁ›Ùȉ·˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È ÂÎÙÂٷ̤ÓË. ∏·Ó‡ÚÂÛË ÙÔ˘ ·ÈÙ›Ô˘ ÊÙ¿ÓÂÈ ÌfiÓÔ ÛÙÔ 55%-70%ÙˆÓ ÂÚÈÙÒÛˆÓ, fiÔ˘ ÂÊ·ÚÌfi˙ÂÙ·È Ì›· ÛÙ·ıÂÚ‹‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ (1,4). ∏ ·ÔÌfiÓˆÛË ÙˆÓÂÓÙÂÚÔ˚ÒÓ ·fi ηÏÏȤÚÁÂÈ· ΢ÙÙ¿ÚˆÓ ¤¯ÂÈ Û¯ÂÙÈο¯·ÌËÏ‹ ¢·ÈÛıËÛ›· (65%-75%) Î·È ··ÈÙÔ‡ÓÙ·È Î·-Ù¿ ̤ÛÔ fiÚÔ 3-8 Ë̤Ú˜ ÁÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ·(5,6,8). ∏ Ù¯ÓÈ΋ Ù˘ ·Ó›¯Ó¢Û˘ ÙÔ˘ RNA ÙÔ˘ÂÓÙÂÚÔ˚Ô‡ Ì PCR ıˆÚÂ›Ù·È Î·È ÈÔ ·ÛÊ·Ï‹˜ ηÈÙ·¯Â›· ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜, ‰›ÓÔÓÙ·˜ ·ÔÙ¤ÏÂ-ÛÌ· ̤۷ Û ϛÁ˜ ÒÚ˜ (5,6,8,15).

∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ‰ÂÓ¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ÌÂÏÂÙËı› ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∫Ú‹-Ù˘. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ÚÔ·ÙÂÈ fiÙÈ Ù· ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ ›ӷȷÚfiÌÔÈ· ·˘ÙÒÓ ÙˆÓ Â‡ÎÚ·ÙˆÓ ÎÏÈÌ¿ÙˆÓ, fiÔ˘·Ú·ÙËÚÂ›Ù·È ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ ÙÔ Î·ÏÔη›ÚÈ Î·ÈÙÔ ÊıÈÓfiˆÚÔ. ™ËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ ÌÂϤÙ˘·ÔÙ¤ÏÂÛ·Ó Ô ·Ó·‰ÚÔÌÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ Î·È Ë¤ÏÏÂÈ„Ë Ù·˘ÙÔÔ›ËÛ˘ ÙÔ˘ ÔÚÔÙ‡Ô˘ ÙÔ˘ ÂÓÙÂÚÔ˚-Ô‡ ·fi Ù· ÎfiÚ·Ó·. ∫·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ·ÂÓÙÂÚÔ˚Ô‡˜ ¤ÁÈÓ ÛÙÔ 70% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛË-Ù˘ ÌËÓÈÁÁ›Ùȉ·˜, ΢ڛˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓÌËÓÒÓ ÙÔ˘ ηÏÔηÈÚÈÔ‡ Î·È ÙÔ˘ ÊıÈÓÔÒÚÔ˘, fiÙ·Ó‹Ù·Ó ÂÌÊ·Ó›˜ ÔÈ Û˘ÛÛˆÚ‡ÛÂȘ ÎÚÔ˘ÛÌ¿ÙˆÓ. ∆ÔıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ηÏÏȤÚÁÂÈ·˜ ‰ÂÓ Â›¯Â ›-‰Ú·ÛË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ, ·ÊÔ‡ ‰ÂÓ‹Ù·Ó Û˘Ó‹ıˆ˜ ‰È·ı¤ÛÈÌÔ ÚÈÓ ÙÔ 8Ô 24ˆÚÔ ÓÔÛË-Ï›·˜. ªÂ ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓÎÔÚ·ÓÔηÏÏÈÂÚÁÂÈÒÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ-¯Ô˘, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 41% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÎÚÔ˘-ÛÌ¿ÙˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙËÓ ∫Ú‹ÙË ÔÊ›ÏÂ-Ù·È Û ÂÓÙÂÚÔ˚Ô‡˜. ∞fi ·˘Ù‹ ÙË ÌÂϤÙË ÚÔ·ÙÂÈ›Û˘ ÂÙ‹ÛÈ· ›وÛË ÁÈ· ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·ÛÙËÓ ∫Ú‹ÙË ÙÔ˘Ï¿¯ÈÛÙÔÓ 20 ÂÚÈÙÒÛÂȘ ·Ó¿100.000 ÏËı˘ÛÌfi. ∏ ›وÛË ·˘Ù‹ Â›Ó·È ·˘ÍË-̤ÓË Ì ‚¿ÛË Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Î·È ¯ÚÂÈ-¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË (2).

π‰È·›ÙÂÚÔ ‰È·ÁÓˆÛÙÈÎfi ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙÔ 48% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛË-Ù˘ ÌËÓÈÁÁ›Ùȉ·˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜. ∂ÈÎÚ¿ÙËÛË ÙˆÓ Ô-Ï˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·Ú·ÙËÚ‹ıËΠÛÙÔ57% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û ÏÈ-ÁfiÙÂÚÔ ·fi 24 ÒÚ˜ ·fi ÙÔ ¯ÚfiÓÔ Ô˘ Ú·ÁÌ·-ÙÔÔÈ‹ıËÎÂ Ë O¡¶, fiˆ˜ Î·È ÛÙÔ 17% ÙˆÓ ÂÚÈ-ÙÒÛÂˆÓ Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û ÂÚÈÛÛfiÙÂÚÔ·fi 24 ÒÚ˜. ∏ ¢·ÈÛıËÛ›· Î·È Ë ·ÚÓËÙÈ΋ ÚÔ-ÁÓˆÛÙÈ΋ ·Í›· Ù˘ ÂÈÎÚ¿ÙËÛ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿-ÚˆÓ ÛÙÔ ∂¡À ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁ-Á›Ùȉ·˜ ‹Ù·Ó ¯·ÌËÏ‹. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·-Û›·˜ Û˘ÌʈÓÔ‡Ó Ì ·ÚÎÂÙ¤˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂ-ϤÙ˜, Û‡Ìʈӷ Ì ÙȘ Ôԛ˜, ÛÙË ÌËÓÈÁÁ›Ùȉ··fi ÂÓÙÂÚÔ˚Ô‡˜ Ë ÂÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡-ÚËÓˆÓ ÛÙÔ ∂¡À ·ÔÙÂÏ› ÂÚÈÛÛfiÙÂÚÔ ÙÔÓ Î·ÓfiÓ··fi fiÙÈ ÙËÓ ÂÍ·›ÚÂÛË Î·È Ì¿ÏÈÛÙ· ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È

¶·È‰È·ÙÚÈ΋ 2002;65:108-112 Paediatriki 2002;65:108-112

111

¶›Ó·Î·˜ 1. ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›-Ùȉ· ηٿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ %

¶˘ÚÂÙfi˜ >38,5Ô 88 ∫ÂÊ·Ï·ÏÁ›· Û ·È‰È¿ >2 ÂÙÒÓ 87 ªËÓÈÁÁÈÙȉÈο ÛËÌ›· 87 ŒÌÂÙÔÈ 74 ∂Í¿ÓıËÌ· 11 ¢È¿ÚÚÔÈ· 5 ∂Ï·ÊÚÒ˜ ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË 48

¶›Ó·Î·˜ 2. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À Û ·È‰È¿ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ Î·È Û ·È‰È¿ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·

ÕÛËÙË ÌËÓÈÁ›Ùȉ· µ·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ (n=33) (n=8)

∂ӉȿÌÂÛË ÙÈÌ‹ ∂‡ÚÔ˜ ∂ӉȿÌÂÛË ÙÈÌ‹ ∂‡ÚÔ˜

§Â˘ÎÔ·ÙÙ·Ú·/mm3 75 20-750 53 20-4.600¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (%) 60 10-90 65 49-93°Ï˘Îfi˙Ë (mg/dl) 63 39-105 74 50-128¶ÚˆÙ½ÓË (mg/dl) 30 6-100 40 18-230

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ÛÙȘ ÚÒÙ˜ 24 ÒÚ˜ Ù˘ ÓfiÛÔ˘ (13,14). ™˘ÓÂÒ˜,Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‰ÂÓ ÌÔÚ› Ó·¯ÚËÛÈÌÔÔÈËı› ˆ˜ ·ÛʷϤ˜ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙË ‰È·-ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ·fi ÙË ‚·ÎÙËÚÈ-‰È·Î‹ ÌËÓÈÁÁ›Ùȉ·. ∂Ô̤ӈ˜, ηٿ ÙËÓ ÂÔ¯‹ Ô˘ÂÌÊ·Ó›˙ÂÈ ¤Í·ÚÛË Ë ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜,¤Ó·˜ ·ÛıÂÓ‹˜ Ì ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË ÛÙÔ ∂¡À‰ÂÓ Â›Ó·È ·›ı·ÓÔ Ó· ¤¯ÂÈ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· (14).

∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È Ë ‰È·›ÛÙˆÛË fiÙÈ·ÚÎÂÙ¿ ·È‰È¿ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË ·fiÂÓÙÂÚÔ˚Ô‡˜ ·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË Ù˘ ÚˆÙ½ÓË˜Î·È Ì›ˆÛË Ù˘ ÁÏ˘Îfi˙˘ ÛÙÔ ∂¡À, Â˘Ú‹Ì·Ù· ‰Ë-Ï·‰‹ Ô˘ ıˆÚÔ‡ÓÙ·È ˆ˜ ÂÓ‰ÂÈÎÙÈο ‚·ÎÙËÚȉȷ-΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∏ ÙÂÏÈ΋, ÏÔÈfiÓ, ‰È¿ÎÚÈÛË Ù˘‚·ÎÙËÚȉȷ΋˜ ·fi ÙËÓ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ‰ÂÓÌÔÚ› Ó· ÛÙËÚ›˙ÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙ· Â˘Ú‹Ì·Ù·ÙÔ˘ ∂¡À, ·ÏÏ¿ ÂȉÈΤ˜ ‰È·ÁÓˆÛÙÈΤ˜ ̤ıÔ‰ÔÈ Ú¤-ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È. ∂›Û˘, Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ∂¡À ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ·ÛıÂ-ÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ ÙÂÎÌËÚȈ̤ÓË ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ-‰· ·fi ÂÓÙÂÚÔ˚Ô‡˜.

∏ ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ ·ÔÙÂÏ› ¤Ó· ‚Ú·-¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂ Ù˘È΋ ·ÈÊÓ›-‰È· ¤Ó·ÚÍË ÛÙ· ·È‰È¿. ∏ ·Ú·ÌÔÓ‹ ÙÔ˘ ·È‰ÈÔ‡ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù· ÚÒÙ· 24ˆÚ· Ù˘ÓfiÛÔ˘, ¤ˆ˜ fiÙÔ˘ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈ-ÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·, Â›Ó·È ··Ú·›ÙËÙË. ∏ ÂÊ·ÚÌÔ-Á‹ Ì›·˜ ÌÂıfi‰Ô˘ Ô˘ ÂÈÙÚ¤ÂÈ Ù·¯Â›· ‰È¿ÁÓˆÛË,ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ¿ÛÎÔË ·Ú·ÌÔÓ‹ ÙÔ˘ ·È‰ÈÔ‡ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È ı·‚ÂÏÙÈÒÛÂÈ ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Rotbart HA. Enteroviral infections of the central nervous

system. Clin Infect Dis 1995;20:971-981. 2. Rice SK, Heinl RE, Thornton LL, Opal SM. Clinical

characteristics, management strategies, and costimplications of a statewide outbreak of enterovirusmeningitis. Clin Infect Dis 1995;20:931-937.

3. Norris CM, Danis PG, Gardner TD. Aseptic meningitis inthe newborn and young infant. Am Fam Physician1999;59:2761-2770.

4. Lipton JD, Schafermeyer RW. Central nervous systeminfections. The usual and the unusual. Emerg Med Clin

North Am 1995;13:417-440. 5. Ramers C, Billman G, Hartin M, Ho S, Sawyer MH. Impact

of a diagnostic cerebrospinal fluid enterovirus polymerasechain reaction test on patient management. JAMA2000;283:2680-2685.

6. Ahmed A, Brito F, Goto C, Hickey SM, Olsen KD, Trujillo Met al. Clinical utility of the polymerase chain reaction fordiagnosis of enteroviral meningitis in infancy. J Pediatr1997;131:393-397.

7. Rotbart HA. Viral meningitis. Sem Neurol 2000;20:277-292. 8. Sawyer MH. Enterovirus infections: diagnosis and

treatment. Pediatr Infect Dis J 1999;18:1033-1040. 9. ∆ÛÔÏÈ¿ ª. §ÔÈÌÒÍÂȘ ·fi ÂÓÙÂÚÔ˚Ô‡˜. ™ÙÔ: ¢È·ÁÓˆÛÙÈο

Î·È ıÂڷ¢ÙÈο ÚÔ‚Ï‹Ì·Ù·. ªÂÙÂÎ·È‰Â˘ÙÈÎfi ™ÂÌÈÓ¿-ÚÈÔ ¶·È‰È·ÙÚÈ΋˜ 2000; ∞ı‹Ó·: µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·-ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; 2000. ÛÂÏ. 50-58.

10. Rotbart HA, McCracken GH Jr, Whitley RJ, Modlin JF,Cascino M, Shah S et al. Clinical significance ofenteroviruses in serious summer febrile illnesses ofchildren. Pediatr Infect Dis J 1999;18:869-874.

11. ÷ڛÛË ª, ªÔ˘ÁÈÔ˘ÎÏ‹˜ ¶, °·Ï·Ó¿Î˘ ∂, ª·˘Ú›‰Ë˜ ∞,¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑. ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ·fi ÂÓÙÂÚÔ˚Ô‡˜ [¶ÂÚ›ÏË„Ë]. 38Ô¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘;∫ˆ˜; 2000. ÛÂÏ. 72.

12. Michelow IC, Nicol M, Tiemessen C, Chezzi C, Pettifor JM.Value of cerebrospinal fluid leukocyte aggregation indistinguishing the causes of meningitis in children. PediatrInfect Dis J 2000;19:66-72.

13. ¡›ÙÛ· ∞, §˘ÎÔÔ‡ÏÔ˘ §, µ¤ÚÌ˘ π, º·ÚÌ¿ÎË ∂, ¶··-ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, •·˚‰¿Ú· ∞. ∂˘Ú‹Ì·Ù· ∂¡À ÛÙËÓ¿ÛËÙË Û ۯ¤ÛË Ì ÙË ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· [¶ÂÚ›ÏË-„Ë]. 39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2001 1-3 πÔ˘-Ó›Ô˘; ∫Ú‹ÙË; 2001. ÛÂÏ. 298.

14. Negrini B, Kelleher KJ, Wald ER. Cerebrospinal fluidfindings in aseptic versus bacterial meningitis. Pediatrics2000;105:316-319.

15. Hosoya M, Honzumi K, Sato M, Katayose M, Kato K,Suzuki H. Application of PCR for various neurotropicviruses on the diagnosis of viral meningitis. J Clin Virol1998;11:117-124.

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¶›Ó·Î·˜ 3. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À (ÂӉȿÌÂÛË ÙÈÌ‹, ‡ÚÔ˜) ÛÙ· ·È‰È¿ ÌÂ Î·È ¯ˆÚ›˜ ÙÂÎÌËÚȈ̤ÓË ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·fiÂÓÙÂÚÔ˚Ô‡˜

ŒÏÂÁ¯Ô˜ ÁÈ· n §Â˘ÎÔ·ÙÙ·Ú·/mm3 ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ¶ÚˆÙ½ÓË °Ï˘Îfi˙ËÚfiÛÊ·ÙË Ïԛ̈ÍË (%) (mg/dl) (mg/dl)·fi ÂÓÙÂÚÔ˚Ô‡˜∞ÔÙ¤ÏÂÛÌ· ∂.∆. (‡ÚÔ˜) ∂.∆. (‡ÚÔ˜) ∂.∆. (‡ÚÔ˜) ∂.∆. (‡ÚÔ˜)

£ÂÙÈÎfi 33 75 (20-750) 60 (10-90) 30 (6-100) 63 (39-105)∞ÚÓËÙÈÎfi 34 75 (15-1.000) 60 (0-90) 30 (6-170) 63 (47-87)¢ÂÓ ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ 14 85 (15-510) 55 (0-96) 34 (10-130) 61 (38-81)™‡ÓÔÏÔ 81 84 (15-1.000) 60 (0-96) 30 (6-170) 63 (38-105)

∂.∆.: ÂӉȿÌÂÛË ÙÈÌ‹

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-09-2001HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-01-2002

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ì·Ï›· ∆ÛÈÏÈÌÈÁοÎË ∏ÚÔ‰fiÙÔ˘ 214, ¡¤· ∞ÏÈηÚÓ·ÛÛfi˜ ∆.∫. 716 01, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

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¶·È‰È·ÙÚÈ΋ 2002;65:113-117 Paediatriki 2002;65:113-117

113

™˘ÓÙÔÌÔÁڷʛ˜¶ÂÚÈÁ. ·ÛÊ˘Í›· ¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ™˘Á. ·Ó/ϛ˜ ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ∂ÈÛÚ. ÌËÎ. ∂ÈÛÚfiÊËÛË ÌËÎˆÓ›Ô˘

∂ÈÛ·ÁˆÁ‹∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ·ÔÙÂÏ› ¤Ó·Ó

·fi ÙÔ˘˜ ϤÔÓ ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙ˜ ÂÎÙ›ÌËÛ˘ÙÔ˘ ÂȤ‰Ô˘ Ì·È¢ÙÈ΋˜ Î·È ÓÂÔÁÓÈ΋˜ ÊÚÔÓÙ›‰·˜

Î·È ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Ì›·˜ ¯ÒÚ·˜(1,2). OÈ ‰È·Î˘Ì¿ÓÛÂȘ Ù˘ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ¯ˆÚÒÓ Â›Ó·È ÌÂÁ¿Ï˜, Ì ٿÛÂȘ Û˘Ó¯ԇ˜ Ì›ˆÛ˘ٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÈÂıÓÒ˜ (3-7). ∏ ‚ÂÏÙ›ˆÛËÔ˘ Û˘ÓÙÂϤÛÙËΠٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙ· ÔÛÔ-ÛÙ¿ ÂÈ‚›ˆÛ˘ ÓÂÔÁÓÒÓ Ì Ôχ ¯·ÌËÏfi ‚¿ÚÔ˜Á¤ÓÓËÛ˘ ˘‹ÚÍ ı·̷ÙÈ΋ Î·È ·ÔÙÂÏ› ¤Ó· ·fiÙ· ϤÔÓ ÛËÌ·ÓÙÈο ÂÈÙ‡ÁÌ·Ù· Ù˘ È·ÙÚÈ΋˜ ÙÔ˘ÂÈÎÔÛÙÔ‡ ·ÈÒÓ· (8). ∏ ÚfiÔ‰Ô˜ ·˘Ù‹ ÔÊ›ÏÂÙ·È

¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙ ¯ÚfiÓÈ· ∂. ÷Ù˙ˉ¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ∂. ∫ÔڷοÎË1, ∂. ¶·Ú·Ûο΢1, µ. µ·Ï¿ÚË1, ª. ∫ÔÚÔÔ‡ÏË1, ∂. °·Ï·Ó¿Î˘2, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘1

Perinatal mortality in Crete over the last five years E. Hatzidaki1, A. Manoura1, E. Korakaki1, E. Paraskakis1, B. Balari1, M. Koropouli1, H. Galanakis2, Ch. Giannakopoulou1

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

1 Department of Neonatology of the University of Crete 2 Department of General Pediatrics of the University of Crete

�¶ÂÚ›ÏË„Ë: ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ·Ô-ÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ϤÔÓ ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙ˜ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÂȤ‰Ô˘ Ì·È¢ÙÈ΋˜ Î·È ÓÂÔÁÓÈ΋˜ÊÚÔÓÙ›‰·˜ Î·È ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜Ì›·˜ ¯ÒÚ·˜. OÈ ‰È·Î˘Ì¿ÓÛÂȘ Ù˘ ÌÂٷ͇ ÙˆÓ ‰È·-ÊfiÚˆÓ ¯ˆÚÒÓ Â›Ó·È ÌÂÁ¿Ï˜, Ì ٿÛÂȘ Û˘Ó¯ԇ˜Ì›ˆÛ˘ ‰ÈÂıÓÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™ÎÔfi˜Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Ù˘ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ ¤ÙÔ˜ 2000 Î·È ËÛ‡ÁÎÚÈÛ‹ Ù˘ Ì ٷ ÛÙÔȯ›· ÙÔ˘ 1995 ÛÙÔ ÓËÛ›Ù˘ ∫Ú‹Ù˘. ∫·Ù·ÁÚ¿ÊËΠÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹-ÛˆÓ, ÙˆÓ ıÓËÛÈÁÂÓÒÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ Ù˘ ÚÒ-Ù˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞fi Ù· ·ÔÙÂ-ϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ, ÛÙÔ ÓËÛ› Ì·˜,Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ·fi 9,58òÛ 7,2ò. ∏ ÂÌÊ¿ÓÈÛË ÂÓfi˜ Û˘ÁÎÚ›ÛÈÌÔ˘, Ì ÙȘÂÚÈÛÛfiÙÂÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÔÛÔÛÙÔ‡ Â-ÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ηٷ‰ÂÈÎÓ‡ÂÈ ÙË ‚ÂÏ-Ù›ˆÛË Ô˘ ¤¯ÂÈ Â¤ÏıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· ÛÙÔ ÓËÛ› Ì·˜.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·, ÂÚÈ-ÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰·.

�Abstract: Perinatal mortality rate is considered tobe one of the most reliable indicators regarding thequality of antenatal and perinatal care, and, ingeneral, the delivery of health services of anycountry. Although there are significant differences inperinatal mortality between countries, nevertheless,the tendency during the last years has been towardsa decrease in its rate. The purpose of the presentstudy was to examine the perinatal mortality rate inthe year 2000 in the island of Crete and compare itwith that of the year 1995. The total births, stillbirthsand early neonatal deaths during the first post-natalweek were recorded. The perinatal mortality rateover the last five years in our island has declinedsignificantly; for the year 1995 it was 9.58ò, whilefor the year 2000 was 7.2ò. According to ourfindings, the perinatal mortality rate in Cretecompares favorably with that of the majority of otherEuropean countries. This is indicative of theimprovement that has occurred in the antenatal andperinatal care in our island over the last few years.

Key words: perinatal mortality, perinatal care.

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ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ıÔÏÔÁ›·˜ ÙÔ˘ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡, ÛÙȘ ÂÍÂÏ›ÍÂȘ Ù˘ Ì·È¢ÙÈ΋˜,ÛÙË ¯Ú‹ÛË ÚÔËÁ̤Ó˘ Ù¯ÓÔÏÔÁ›·˜ Î·È ÛÙË ‰ËÌÈ-Ô˘ÚÁ›· Û‡Á¯ÚÔÓˆÓ ÓÂÔÁÓÔÏÔÁÈÎÒÓ ÌÔÓ¿‰ˆÓ ηÈÂÚÈÁÂÓÓËÙÈÎÒÓ Î¤ÓÙÚˆÓ, ÛÙÂϯˆÌ¤ÓˆÓ Ì ÂÍÂȉÈ-ÎÂ˘Ì¤ÓÔ˘˜ Ì·ÈÂ˘Ù‹Ú˜ Î·È ÓÂÔÁÓÔÏfiÁÔ˘˜, Èη-ÓÔ‡˜ Ó· ÊÚÔÓÙ›ÛÔ˘Ó ÙfiÛÔ ÙËÓ ¤ÁÎ˘Ô fiÛÔ Î·È ÙÔÓÂÔÁÓfi Ù˘ (6,9).

O fiÚÔ˜ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ·Ó·Ê¤ÚÂÙ·ÈÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ı·Ó¿ÙˆÓ ·fi ÙËÓ 28Ë Â‚‰ÔÌ¿‰·Ù˘ ·ËÛ˘ ̤¯ÚÈ ÙËÓ 7Ë Ë̤ڷ ÌÂÙ¿ ÙË Á¤ÓÓËÛË,·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ (1). ∏ ÂÈ‚›ˆÛË, fï˜, ÓÂÔÁÓÒÓÔ˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂÙ¿ ·fi ·ËÛË 25 ‚‰ÔÌ¿‰ˆÓ‰ÂÓ Â›Ó·È Ï¤ÔÓ Û¿ÓÈÔ ÁÂÁÔÓfi˜, ÂÓÒ ¤¯ÂÈ ·Ó·ÊÂÚ-ı› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÈ‚›ˆÛË ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹-ıËÎ·Ó ÌÂÙ¿ ·fi ·ËÛË 24 ‹ Î·È 23 ‚‰ÔÌ¿‰ˆÓ (8).∫¿ı ¯ÒÚ·, Ì ‚¿ÛË ÙÔ Û‡ÓÙ·ÁÌ· Î·È ÙÔ˘˜ ÓfiÌÔ˘˜Ù˘, ı¤ÙÂÈ Ù· ‰Èο Ù˘ fiÚÈ· ‚ȈÛÈÌfiÙËÙ·˜ Î·È ıÂ-ÛÌÔıÂÙ› Ù· ‰Èο Ù˘ fiÚÈ· ηٷÁÚ·Ê‹˜ ÙˆÓ ÂÌ-‚Ú‡ˆÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÓÂÎÚ¿ ÛÙË ‰È΋ Ù˘ ÂÈÎÚ¿-ÙÂÈ·. ∏ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË YÁ›·˜ ÚÔÙ›ÓÂÈ ÙËÓηٷÁÚ·Ê‹ οı ÂÌ‚Ú‡Ô˘ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂ-Á·Ï‡ÙÂÚÔ˘ ÙˆÓ 500 ÁÚ·ÌÌ·Ú›ˆÓ. ™Â ÔÏϤ˜ ·fi ÙȘ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ ∞ÌÂÚÈ΋˜ οı ÓÂÔÁÓfi Ô˘ÁÂÓÓÈ¤Ù·È ÓÂÎÚfi ÌÂÙ¿ ·fi ·ËÛË ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ20 ‚‰ÔÌ¿‰ˆÓ ηٷÁÚ¿ÊÂÙ·È Û·Ó ıÓËÛÈÁÂÓ¤˜, ÂÓÒÂ›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙË °·ÏÏ›· οı ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·-ÙÔ˜ Ô˘ ÂÈÛ˘Ì‚·›ÓÂÈ ÚÈÓ ÙËÓ 28Ë Â‚‰ÔÌ¿‰· Ù˘·ËÛ˘ ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È (10). ™‡Ìʈӷ Ì ÙËÓÈÛ¯‡Ô˘Û· ·fi ÙÔ 1976 ÓÔÌÔıÂÛ›· ÛÙË ¯ÒÚ· Ì·˜,ηٷÁÚ¿ÊÂÙ·È Û·Ó ÓÂÎÚfi οı ¤Ì‚Ú˘Ô Ô˘ ÁÂÓÓȤ-Ù·È ÌÂÙ¿ ·fi ·ËÛË 180 ËÌÂÚÒÓ ‹ 25 ‚‰ÔÌ¿‰ˆÓÎ·È 5 ËÌÂÚÒÓ (11).

∞fi ·ÓÂÏÏ‹ÓÈ· ÌÂϤÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠÛÙ˯ÒÚ· Ì·˜ ÙÔ 1983 ‚Ú¤ıËΠfiÙÈ Ë ÂÚÈÁÂÓÓËÙÈ΋ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 23,8ò, ‰ÈÏ¿ÛÈ· ‹ ·ÎfiÌ· ηÈÙÚÈÏ¿ÛÈ· ·fi ‚ÔÚÂÈÔÂ˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÂÓÒ·fi ·Ó¿ÏÔÁË ÌÂϤÙË ÙÔ 1998 ÚԤ΢„ fiÙÈ Â›¯ÂÌÂȈı› ÛËÌ·ÓÙÈο ÛÙÔ Â›Â‰Ô ÙÔ˘ 10,5ò(12,13).

™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·-ÁÚ·Ê‹ Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ ¤ÙÔ˜2000 Î·È Ë Û‡ÁÎÚÈÛ‹ Ù˘ Ì ٷ ÛÙÔȯ›· ÙÔ˘ ¤ÙÔ˘˜1995 ÛÙÔ ÓËÛ› Ù˘ ∫Ú‹Ù˘.

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜∏ ∫Ú‹ÙË Â›Ó·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÓËÛ› Ù˘ ÂÏÏËÓÈ΋˜ ÂÈÎÚ¿-

ÙÂÈ·˜. ∂›Ó·È Ì›· ÎÏÂÈÛÙ‹ ÎÔÈÓfiÙËÙ· Ù˘ ÂÏÏËÓÈ΋˜ ÂÚÈʤÚÂÈ-·˜, Ô˘ ÏfiÁˆ Ù˘ ÁˆÁÚ·ÊÈ΋˜ Ù˘ ı¤Û˘ Â›Ó·È ‰‡ÛÎÔÏË Ë·Ó·˙‹ÙËÛË ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ÛÙÔ Î¤ÓÙÚÔ. ∆· ÓÂÔÁÓ¿ ÓÔÛË-χÔÓÙ·È Û ‰‡Ô ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ NÂÔÁÓÒÓ,Ì›· ÛÙÔ ÎÚ·ÙÈÎfi Î·È Ì›· ÛÙÔ ·ÓÂÈÛÙËÌÈ·Îfi ÓÔÛÔÎÔÌ›Ô∏Ú·ÎÏ›Ԣ, Ô˘ ¿Ú¯ÈÛ·Ó Ó· ÏÂÈÙÔ˘ÚÁÔ‡Ó ·fi ÙÔ 1987 Ë ÚÒ-ÙË Î·È ·fi ÙÔ 1991 Ë ‰Â‡ÙÂÚË Î·È ¤¯Ô˘Ó ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈ-

ο ÙËÓ ÔÈfiÙËÙ· ·ÚÔ¯‹˜ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜. ™ÙËÓ¢ڇÙÂÚË ÂÚÈÔ¯‹ ÙÔ˘ ÓËÛÈÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡Ó ¤ÍÈ È‰ÈˆÙÈΤ˜ Ì·È-¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ Î·È ÂÙ¿ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘-ÛÙ‹Ì·ÙÔ˜ ÀÁ›·˜, ÂÓÒ Ë Ì·È¢ÙÈ΋ ÎÏÈÓÈ΋ Ô˘ ÏÂÈÙÔ˘ÚÁ› Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔ ·ÓÂÈÛÙËÌÈ·Îfi ÓÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›-Ô˘ ·Ó·Ï·Ì‚¿ÓÂÈ ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ÙÔÎÂÙÒÓ Î·È ÙËÓ ÏÂÈ-Ô„ËÊ›· ÙˆÓ ÙÔÎÂÙÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·,¤Ó· ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ ÙˆÓ ÙÔÎÂÙÒÓ ÛÙÔ ÓËÛ› ηχÙÂÙ·È ·fiÂȉÈÎÂ˘Ì¤ÓÔ ÓÂÔÁÓÔÏfiÁÔ.

∫·Ù·ÁÚ¿„·Ì ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛˆÓ, Ù· ıÓËÛÈÁÂÓ‹Î·È Ù· ÓÂÔÁÓ¿ Ô˘ ¤ı·Ó·Ó ÙȘ ÚÒÙ˜ 7 Ë̤Ú˜ ÌÂÙ¿ ÙË Á¤Ó-ÓËÛË ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∫Ú‹Ù˘. ™ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ÂÚÈ-ÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Û˘ÌÂÚÈÏ¿‚·Ì ÓÂÔÁÓ¿ Ô˘ ¤ı·-Ó·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Î·È Ù· ¤Ì‚Ú˘·Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÓÂÎÚ¿ Ì ËÏÈΛ· ·ËÛ˘ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 28‚‰ÔÌ¿‰ˆÓ ‹ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂÁ·Ï‡ÙÂÚÔ ‹ ›ÛÔ ÙˆÓ 500ÁÚ·ÌÌ·Ú›ˆÓ. ∆· ÛÙÔȯ›· Ì·˜ ·ÓÙÏ‹ıËÎ·Ó ·fi Ù· ‚È‚Ï›· Ô˘ÙËÚÔ‡ÓÙ·È ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ· Î·È ÛÙȘ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛË-Ï›·˜ ¡ÂÔÁÓÒÓ.

∞ÔÙÂϤÛÌ·Ù· ∆Ô ¤ÙÔ˜ 2000 ÁÂÓÓ‹ıËÎ·Ó 6513 ÓÂÔÁÓ¿. ¢Âη-

¤ÓÙ ÓÂÔÁÓ¿ ¤ı·Ó·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ÙË Á¤ÓÓËÛË (2,3ò), ÂÓÒ 32 ‹Ù·Ó ıÓËÛÈÁÂÓ‹(4,9ò). ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ‚Ú¤ıËÎÂ7,2ò. ∫·Ù¿ ÙÔ ¤ÙÔ˜ 1995 ÁÂÓÓ‹ıËÎ·Ó 6114 ÓÂÔ-ÁÓ¿. O ·ÚÈıÌfi˜ ÙˆÓ ı·Ó¿ÙˆÓ Ù˘ ÚÒÙ˘ ‚‰Ô-Ì¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó 20 ÓÂÔÁÓ¿ (3,27ò),ÂÓÒ Ù· ıÓËÛÈÁÂÓ‹ ‹Ù·Ó 39 (6,38ò). ∏ ÂÚÈÁÂÓÓË-ÙÈ΋ ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 9,58ò (™¯‹Ì· 1). ∆· ÓÂÔ-ÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó ·Ó¿ÏÔÁ· Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘,·ÊÔ‡ ¯ˆÚ›ÛÙËÎ·Ó ÛÙȘ ·Ú·Î¿Ùˆ ÔÌ¿‰Â˜: 500-1000 g, 1001-1500 g, 1501-2000 g, 2001-2500 gÎ·È >2500 g. ™¯ÂÙÈο Ì ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ıÓËÛÈ-ÁÂÓÒÓ ·Ó¿ÏÔÁ· Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜, ˆ˜ ÔÛÔÛÙfiÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓËı¤ÓÙˆÓ Û ·˘Ù‹ ÙËÓ ÔÌ¿‰·ÓÂÔÁÓÒÓ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Û fiϘ ÙȘ ÔÌ¿‰Â˜ (™¯‹Ì· 2). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÙ›· ÙˆÓı·Ó¿ÙˆÓ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË

¶·È‰È·ÙÚÈ΋ 2002;65:113-117 Paediatriki 2002;65:113-117

114

™¯‹Ì· 1. £¿Ó·ÙÔÈ 1˘ ‚‰ÔÌ¿‰·˜ ˙ˆ‹˜, ıÓËÛÈÁÂÓ‹ Î·È ÂÚÈ-ÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ηٿ Ù· ¤ÙË 1995 Î·È 2000.

141210

86420

£¿Ó·ÙÔÈ 1˘‚‰ÔÌ¿‰·˜

£ÓËÛÈÁÂÓ‹ ¶ÂÚÈÁÂÓÓËÙÈ΋ıÓËÛÈÌfiÙËÙ·

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000

3,272,3

6,384,9

9,58

7,2

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¶·È‰È·ÙÚÈ΋ 2002;65:113-117 Paediatriki 2002;65:113-117

115

ηٿ ÙÔ 2000, ÛËÌÂÈÒıËΠÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ÛË-„·ÈÌ›·˜, ÂÓÒ Ë ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· Î·È ÔÈ Û˘Á-ÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÌÂÈÒıËÎ·Ó (™¯‹Ì· 3). ∞fi Ù·6513 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÙÔ 2000, 695 ÚÔ‹Ï-ı·Ó ·fi ·ÏÏÔ‰·¤˜ ÔÈÎÔÁ¤ÓÂȘ, ÂÓÒ ÙÔ 1995 Ô·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ ‹Ù·Ó 58 ÓÂÔÁÓ¿.

™˘˙‹ÙËÛË∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·, Ù· ÙÂÏÂ˘Ù·›·

¯ÚfiÓÈ· ÛÙÔ ÓËÛ› Ì·˜, ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋Ì›ˆÛË ·fi 9,58ò ÙÔ 1995 Û 7,2ò ÙÔ 2000. ∂›-Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙÔ 1983ÛÙËÓ ∂ÏÏ¿‰· ‹Ù·Ó 23,8ò, ÙÔ 1991 ÌÂÈÒıËΠÛÂ11,06ò ÁÈ· Ó· ÊÙ¿ÛÂÈ ÛÙÔ 9,1ò ÙÔ 1998 (12-14).∞ÓÙ›ÛÙÔȯ·, Û ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜ ÙÔ 1983 ‹Ù·Ó:ÛÙË ™ÎˆÙ›· 11,3ò, ÛÙËÓ ∞ÁÁÏ›· 10,8ò, ÛÙË °ÂÚ-Ì·Ó›· 9,6ò, ÛÙË ¡ÔÚ‚ËÁ›· 9,4ò Î·È ÛÙË ™Ô˘Ë‰›·7,5ò. ∆Ô 1998 ‹Ù·Ó: ÛÙËÓ πÛ·Ó›· 7,3ò, ÛÙË ¢·-Ó›· 7,1ò, ÛÙË ™ÎˆÙ›· Î·È ÙÔ µ¤ÏÁÈÔ 7ò, ÛÙËÓOÏÏ·Ó‰›· 6ò, ÛÙË ¡ÔÚ‚ËÁ›· 5,7ò, ÛÙË ºÈÓÏ·Ó-‰›· 4,7ò Î·È ÛÙË ™Ô˘Ë‰›· 4,1ò (13). ¶·Ú¿ ÙȘ‰˘ÛÎÔϛ˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙË ‰È·ÎÚ·ÙÈ΋ Û‡ÁÎÚÈ-ÛË, Ë ÂÌÊ¿ÓÈÛË ÂÓfi˜ Û˘ÁÎÚ›ÛÈÌÔ˘ Ì ÙȘ ÂÚÈÛÛfi-ÙÂÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ ÔÛÔÛÙÔ‡ ÂÚÈÁÂÓÓËÙÈ-΋˜ ıÓËÛÈÌfiÙËÙ·˜ ηٷ‰ÂÈÎÓ‡ÂÈ ÙË ‚ÂÏÙ›ˆÛË Ô˘¤¯ÂÈ Â¤ÏıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂÚÈÁÂÓÓË-ÙÈ΋ ÊÚÔÓÙ›‰· ÛÙÔ ÓËÛ› Ì·˜.

∏ Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ıÓËÛÈÁÂÓÒÓ ÓÂÔ-ÁÓÒÓ ·fi 6,38ò ÙÔ 1995 Û 4,9ò ÙÔ 2000 ·ÓÙ·-Ó·ÎÏ¿ ÙËÓ Î·Ï‡ÙÂÚË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÁ·ˆÓÎ·È È‰È·›ÙÂÚ· ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∏Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ı·Ó¿ÙˆÓ ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·fi3,27ò Û 2,3ò ·Ô‰›‰ÂÙ·È ÛÙË ÏÂÈÙÔ˘ÚÁ›· Û‡Á-¯ÚÔÓˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓÔ˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙÔ ÓËÛ›, ·ÏÏ¿ Î·È ÛÙË ÛˆÛÙfiÙÂ-ÚË Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË Û˘ÓÂÚÁ·Û›·Ì·ÈÂ˘Ù‹ÚˆÓ-ÓÂÔÁÓÔÏfiÁˆÓ. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘-Í›·, Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘, ÌÂÈÒıËΠÛËÌ·ÓÙÈο, fiˆ˜Î·È Ë ÂÈÛÚfiÊËÛË ÌËÎˆÓ›Ô˘, ÁÂÁÔÓfi˜ Ô˘ ı· ÌÔ-ÚÔ‡Û ӷ ·Ô‰Ôı› ÛÙËÓ Î·Ï‡ÙÂÚË Ì·È¢ÙÈ΋ ·-

Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÈÙfiÎÔ˘ Î·È ÛÙËÓ ·ÚÔ˘Û›·ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ·ÙfiÌÔ˘, ÈηÓÔ‡ Ó· οÓÂÈ ·Ó¿ÓË„ËÛÙÔ ÓÂÔÁÓfi Û ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÙÔÎÂÙÒÓ. ¶·-Ú¿ÏÏËÏ·, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜Ù˘ ÚÔˆÚfiÙËÙ·˜ Î·È Ù˘ ÛË„·ÈÌ›·˜ Û·Ó ·ÈÙ›·˜ı·Ó¿ÙÔ˘. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ‰ÈÂÓÂÚÁ‹ıËΠȷÙÚÔ‰ÈηÛÙÈ΋ Ú·ÁÌ·ÙÔÁÓˆÌÔÛ‡-ÓË, ÔfiÙÂ Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ·ÈÙ›·˜ ı·Ó¿ÙÔ˘‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÎÏÈÓÈ΋ ¿Ô„Ë ÙÔ˘ ıÂÚ¿Ô-ÓÙ· Î·È ÌÔÚ› ÂӉ¯Ô̤ӈ˜ Ó· ÌËÓ Â›Ó·È ·ÎÚÈ‚‹˜.∂‰Ò Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ·Ú·ÙËÚ‹ıËΠο-ÔÈ· ·Ú¤ÎÎÏÈÛË Û ۯ¤ÛË Ì ¿ÏϘ ÚÔËÁ̤Ó˜¯ÒÚ˜, fiÔ˘ Û·Ó Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ηٿ ÙËÓ Â-ÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Û˘ÁÁÂÓ›˜·ÓˆÌ·Ï›Â˜ (1,15,16).

°È· Ó· ÂÈÙ¢¯ı› Ë ÛˆÛÙ‹ Û˘Û¯¤ÙÈÛË ·˘ÙÒÓÙˆÓ ı·Ó¿ÙˆÓ Ì ÙËÓ ÔÈfiÙËÙ· ·ÚÔ¯‹˜ ˘Á›·˜ ηÈÛÙË Û˘Ó¤¯ÂÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó Î·Ù¢ı˘ÓÙ‹ÚȘÁÚ·Ì̤˜ ·Ú¤Ì‚·Û˘, ı· Ú¤ÂÈ, ÂÎÙfi˜ ·fi ÙÈ˜Û˘Óı‹Î˜ ÓÔÛËÏ›·˜ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ªÔÓ¿‰·∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜, Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„Ë ÔÈÛ˘Óı‹Î˜ Ì ÙȘ Ôԛ˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ô ÙÔÎÂÙfi˜,ÔÈ Û˘Óı‹Î˜ ·Ó¿Ó˄˘ Î·È ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘ ÚÔÒ-ÚÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ,·ÏÏ¿ Î·È Ë Â·Ú΋˜ ‹ fi¯È ·Ú·ÎÔÏÔ‡ıËÛË Î·ÈÚÔÂÙÔÈÌ·Û›· Ù˘ ÂÈÙfiÎÔ˘, Ë ¯ÔÚ‹ÁËÛË ‹ fi¯ÈÎÔÚÙÈÎÔÂȉÒÓ ÛÙËÓ ¤ÁÎ˘Ô Ì ÛÙfi¯Ô ÙËÓ ÂÈÙ¿¯˘ÓÛËÙ˘ ˆÚ›Ì·ÓÛ˘ ÙˆÓ Ó¢ÌfiÓˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ηÈÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ·Ï-Ï¿ Î·È Ë ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂӉ¯fiÌÂÓ˘ÚfiˆÚ˘ ڋ͢ ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ Ô˘ ÂÎÙfi˜ ·fiÙËÓ ÚfiÎÏËÛË ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, Úԉȷı¤ÙÂÈÛÙËÓ ·Ó¿Ù˘ÍË ÚÒÈÌˆÓ ÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒ͈Ó,ÂÈ‚·Ú‡ÓÔÓÙ·˜ ÛËÌ·ÓÙÈο ÙÔ ÌÈÎÚfi ÚfiˆÚÔ Î·È·ÓÒÚÈÌÔ ÓÂÔÁÓfi (17-20). ∫‡ÚÈÔ˜ ÛÙfi¯Ô˜ fiÏˆÓ ÙˆÓÂÈÛÙËÌfiÓˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ ÂÚÈÁÂÓÓË-ÙÈ΋ È·ÙÚÈ΋ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô Â›Ó·È Ë ·Ó·-ÛÙÔÏ‹ ‹ ¤ÛÙˆ Î·È Ë Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÚfiˆÚÔ˘ÙÔÎÂÙÔ‡. £ÂˆÚÂ›Ù·È ˆ˜ ÂÈÙ·ÎÙÈ΋ ·Ó¿ÁÎË Ë Ûˆ-ÛÙ‹ ÂÓË̤ڈÛË Î·È ·È‰Â›· ÙfiÛÔ ÙˆÓ ÂÁ·ˆÓ fiÛÔÎ·È ÙˆÓ ÊÔÚ¤ˆÓ ÚˆÙÔ‚¿ıÌÈ·˜ ˘Á›·˜ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ÂÈ‚·Ú˘ÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ·

™¯‹Ì· 2. ∫·Ù·ÓÔÌ‹ (%) ÙˆÓ ıÓËÛÈÁÂÓÒÓ ·Ó¿ÏÔÁ· ÙÔ˘ ‚¿ÚÔ˘˜ÙÔ˘˜ ˆ˜ ÔÛÔÛÙfi ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓËı¤ÓÙˆÓ Û ·˘Ù‹ ÙËÓÔÌ¿‰· ÓÂÔÁÓÒÓ Î·Ù¿ Ù· ¤ÙË 1995 Î·È 2000.

100%

80%

60%

40%

20%

0%500-1000 g 1001-1500 g 1501-2000 g 2001-2500 g >2500 g

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000

69,2%

24,3%

9,1%7%

4,9%2,3%

0,7%0,2%

0,1%

56%

™¯‹Ì· 3. ∞›ÙÈ· ı·Ó¿ÙÔ˘ (%) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 1˘ ‚‰Ô-Ì¿‰·˜ ˙ˆ‹˜ ηٿ Ù· ¤ÙË 1995 Î·È 2000.

60%

50%

40%

30%

20%

10%

0%¶ÚÔˆ-ÚfiÙ˘

¶ÂÚÈÁ.·ÛÊ˘Í›·

™Ë„·È-Ì›·

™˘Á.·Ó/ϛ˜

∂ÈÛÚ.ÌËÎ.

ÕÁÓˆ-ÛÙË

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000 35%

47%

10% 7%10%

26%

35%

20%

5% 5%0% 0%

MARCH-APRIL 2002 14-05-03 12:25 ™ÂÏ›‰·115

Page 35: Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002

ÚfiˆÚÔ ÙÔÎÂÙfi, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Î˘‹ÛÂˆÓ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ·Ó·˙‹ÙËÛË ÊÚÔÓÙ›‰·˜Û ÂÚÈÁÂÓÓËÙÈο ΤÓÙÚ· Èηӿ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘ÓÙfiÛÔ ÙËÓ ¤ÁÎ˘Ô fiÛÔ Î·È ÙÔ ÚfiˆÚÔ ÓÂÔÁÓfi Ù˘(4,9). ™ËÌ·ÓÙÈ΋ ›Û˘ ıˆÚÂ›Ù·È Ë ÛÙÂϤ¯ˆÛËÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ ÌÂÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi Î·È Û‡Á¯ÚÔÓÔ Ù¯ÓÔÏÔ-ÁÈÎfi ÂÍÔÏÈÛÌfi, ηıÒ˜ Î·È Ë ÔÚÁ¿ÓˆÛË ‰ÈÎÙ‡Ô˘ÌÂÙ·ÊÔÚ¿˜ ÓÂÔÁÓÒÓ ÛÙÂϯˆÌ¤ÓÔ˘ Ì ¤ÌÂÈÚÔ˘˜ÓÂÔÁÓÔÏfiÁÔ˘˜ Î·È Ì ۇÁ¯ÚÔÓÔ Ù¯ÓÔÏÔÁÈÎfi ÂÍÔ-ÏÈÛÌfi, ÛÙÔÈ¯Â›Ô Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ·ÛÙÔ ÓËÛ› Ì·˜. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ı· ÂÚÈÔÚÈÛÙ›ηٿ ÙÔ ‰˘Ó·ÙfiÓ Ë ÂÈ‚¿Ú˘ÓÛË Ô˘ ˘Ê›ÛÙ·Ù·È ÙÔÓÂÔÁÓfi, Î·È È‰È·›ÙÂÚ· ÙÔ ÌÈÎÚfi ÚfiˆÚÔ, ηٿ ÙËÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜¡ÂÔÁÓÒÓ, Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ¤¯ÂÈ Û¯ÂÙÈÛ̠ٛ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· (17).

™ËÌ·ÓÙÈ΋ ·Ú·Ù‹ÚËÛË ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜fiÙÈ ·fi Ù· 6513 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙËÓ∫Ú‹ÙË, Ù· 695 (ÔÛÔÛÙfi 10,67%) ÚÔ¤Ú¯ÔÓÙ·È·fi ·ÏÏÔ‰·¤˜ ÔÈÎÔÁ¤ÓÂȘ, ΢ڛˆ˜ ÔÈÎÔÓÔÌÈÎÔ‡˜ÚfiÛÊ˘Á˜ Ô˘ ¤¯Ô˘Ó ¤ÚıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· ·Ó·˙‹ÙËÛË ÂÚÁ·Û›·˜ ΢ڛˆ˜·fi ÙËÓ ∞Ï‚·Ó›·, ÙË µÔ˘ÏÁ·Ú›· Î·È ·fi ¯ÒÚ˜Ù˘ ÚÒËÓ ™Ô‚ÈÂÙÈ΋˜ ŒÓˆÛ˘. ªÂ ‚¿ÛË ÙÔ ÁÂÁÔ-Ófi˜ fiÙÈ ÙÔ 1995 Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ‹Ù·Ó ηٿ ÔχÌÈÎÚfiÙÂÚÔ˜, ÛËÌÂÈÒÓÂÙ·È Ì›· Û¯ÂÙÈ΋ Ì›ˆÛË ÛÙÔÓ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ·fi ÂÏÏËÓÈ-Τ˜ ÔÈÎÔÁ¤ÓÂȘ. ∞fi ·˘Ù‹ ÙËÓ ·Ú·Ù‹ÚËÛË ˘Ô-ÛËÌ·›ÓÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ ÙÔ Úfi‚ÏËÌ· Ù˘Ì›ˆÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÛÙËÓ ÂÏÏËÓÈ-΋ ÔÈÎÔÁ¤ÓÂÈ·. ∞˘ÙÔ› ÔÈ ¿ÓıÚˆÔÈ, Û ·ÚÎÂÙ¤˜ Â-ÚÈÙÒÛÂȘ, ˙Ô˘Ó ÛÂ Û˘Óı‹Î˜ οو ·fi Ù· fiÚÈ·Ù˘ ·ÓıÚÒÈÓ˘ ·ÍÈÔÚ¤ÂÈ·˜ Î·È ‰ÂÓ ¤¯Ô˘Ó ηÓÂ-Ófi˜ ›‰Ô˘˜ ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· ·fi ÙȘ ˘Ë-ÚÂۛ˜ ˘Á›·˜. ∏ ÚÔÛ¤ÁÁÈÛ‹ ÙÔ˘˜ ·fi ÙËÓ ÎÔÈÓˆ-ÓÈ΋ ÚfiÓÔÈ· Î·È Ë Î·ıÔ‰‹ÁËÛ‹ ÙÔ˘˜ ÁÈ· ·Ó·˙‹ÙË-ÛË ·ÚÔ¯‹˜ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ·fi ÙȘ˘ËÚÂۛ˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁ›·˜ ı·ÌÔÚÔ‡Û ‰˘ÓËÙÈο Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ Â›Ù¢ÍËÙÔ˘ ÛÙfi¯Ô˘ Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Ù˘ ÂÚÈ-ÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙË-Ù· ÛÙË ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÌÂȈı›ÛËÌ·ÓÙÈο. ∏ Ì›ˆÛ‹ Ù˘ ·Ô‰›‰ÂÙ·È ÛÙË ‚ÂÏÙ›ˆ-ÛË ÙˆÓ ·Ú¯fiÌÂÓˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ÛÙËÓ¤ÁÎ˘Ô ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔÁÓfi Ù˘. À¿Ú¯Ô˘Ófï˜ ·ÎfiÌ· ÂÚÈıÒÚÈ· ‚ÂÏÙ›ˆÛ˘. ™Ùfi¯Ô˜ Ì·˜ ›-Ó·È Ë ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú¯fiÌÂÓˆÓ ˘Ë-ÚÂÛÈÒÓ ˘Á›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ·ÏÏ¿ Î·È ÛÂ Â›Â‰Ô ‚ÂÏÙ›ˆ-Û˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡Ô-ÛËÏ›·˜ ¡ÂÔÁÓÒÓ. ∂ÎÙfi˜ ·fi ÙȘ ÚÔÛ¿ıÂȘÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡, Ô˘

Û ÌÂÚÈΤ˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ıˆÚÂ›Ù·È fiÙÈ ÍÂÂÚ-ÓÔ‡Ó ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Î·È ÙȘ ·ÓÙÔ¯¤˜ Ù˘ ·ÓıÚÒ-ÈÓ˘ ʇÛ˘ ÙÔ˘˜, Â›Ó·È ¯Ú‹ÛÈÌË Î·È ÂÈÙ·ÎÙÈ΋ Ë‚Ô‹ıÂÈ· Ù˘ ¶ÔÏÈÙ›·˜.

µÈ‚ÏÈÔÁÚ·Ê›·1. Guyer B, Hoyert DL, Martin JA, Ventura SJ, MacDorman

MF, Strobino DM. Annual summary of vital statistics-1998.Pediatrics 1999;104:1229-1246.

2. Richardus JH, Graafmans WC, Verloove-Vanhorick SP,Mackenbach JP. The perinatal mortality rate as anindicator of quality of care in international comparisons.Med Care 1998;36:54-66.

3. Forssas E, Gissler M, Hemminki E. Declining perinatalmortality in Finland between 1987 and 1994: Contributionof different subgroups. Eur J Obstet Gynecol Reprod Biol1998;80:177-181.

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8. Lorenz JM. Survival of the extremely preterm infant in NorthAmerica in the 1990s. Clin Perinatol 2000;27:255-262.

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13. ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ Ã, §ÂΤ· µ, ∫·‚‚·‰›· °, ª·ÎÚ‹ ∞,KÔ˘ÙÛÔ‚›ÙË ¶, ª·ÙÛ·ÓÈÒÙË ¡. ¶Ú·ÎÙÈο Ù˘ ∞η‰ËÌ›·˜∞ıËÓÒÓ- 20Ë ∞ÚÈÏ›Ô˘ 2000; 101-112.

14. Mantagos S. Neonatal-perinatal care in Greece. J Perinatol1997;17:156-160.

15. Sowards KA. What is the leading cause of infant mortality?A note on the interpretation of official statistics. Am J PublicHealth 1999;89:1752-1754.

16. Linhart Y, Bashiri A, Maymon E, Shoham-Vardi I, FurmanB, Vardi H et al. Congenital anomalies are an independentrisk factor for neonatal morbidity and perinatal mortality inpreterm birth. Eur J Obstet Gynecol Reprod Biol2000;90:43-49.

17. Phibbs CS, Bronstein JM, Buxton E, Phibbs RH. Theeffects of patient volume and level of care at the hospital ofbirth on neonatal mortality. JAMA 1996;276:1054-1059.

18. National Institutes of Health Consensus Development

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Panel on the effect of corticosteroids for fetal maturationon perinatal outcomes. Effect of corticosteroids for fetalmaturation on perinatal outcomes. JAMA 1995;273:413-418.

19. Schaap AH, Wolf H, Bruinse HW, Smolders-De Haas H,Van Ertbruggen I, Treffers PE. Effects of antenatalcorticosteroid administration on mortality and long-termmorbidity in early preterm, growth-restricted infants. ObstetGynecol 2001;97:954-960.

20. Ernest JM. Neonatal consequences of preterm PROM. ClinObstet Gynecol 1998;41:827-831.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-09-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-02-2002

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: [email protected]

™ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, ÔÏÏ¿ ·È‰È¿ Ì Ïԛ̈ÍË ·fiÙÔÓ Èfi Ù˘ ›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜ (HIV) ¯ÚÂÈ¿˙ÔÓÙ·È ÓÔ-ÛËÏ›· ÛÙË ª∂£, fï˜ Ï›Á· Â›Ó·È ÁÓˆÛÙ¿ ·Ó·ÊÔÚÈο Ì ÙËÓ·ÈÙÈÔÏÔÁ›· Ù˘ Ó¢ÌÔÓ›·˜ Î·È ÙËÓ Â›‰Ú·ÛË Ù˘ ÓÔÛËÏ›·˜ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙË ª∂£. ™ÎÔfi˜: ∏ Û‡ÁÎÚÈÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù˘ ¤Î‚·Û˘ Ù˘Ó¢ÌÔÓ›·˜ Û HIV-ÔÚÚÔıÂÙÈÎÔ‡˜ [HIV(+)] Î·È HIV-ÔÚÚÔ·Ú-ÓËÙÈÎÔ‡˜ [HIV(-)] ·ÛıÂÓ›˜. ™¯Â‰È·ÛÌfi˜: ¶ÚÔÔÙÈ΋ ÌÂϤÙË. ÃÒÚÔ˜: ¢‡Ô ª∂£ ·È‰ÈÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ ∫·ÈËÙ¿-Ô˘Ó ÛÙË ÓfiÙÈ· ∞ÊÚÈ΋. ∞ÛıÂÓ›˜: ŸÏ· Ù· ·È‰È¿ Ô˘ ÂÈÛ‹¯ıËÛ·Ó Ì Ó¢ÌÔÓ›· ηٿÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 1998. ªÂÙÚ‹ÛÂȘ Î·È Î˘ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù·: °È· ÙË ÌÂϤÙË ¤ÁÈ-ÓÂ Û˘ÏÏÔÁ‹ ÎÏÈÓÈÎÒÓ, ‰ËÌÔÁÚ·ÊÈÎÒÓ, ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È·Ó·Ó¢ÛÙÈÎÒÓ ‰Â‰Ô̤ӈÓ, ηıÒ˜ Î·È Ï‹„Ë ·›Ì·ÙÔ˜ ÁÈ· ÂÚ-Á·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ. ¶Ù‡ÂÏ· ‹ ‚ÚÔÁ¯Ô΢„ÂÏȉÈÎfi ¤ÎÏ˘-Ì· (BAL) ÂϤÁ¯ÔÓÙ·Ó ÁÈ· Ó¢ÌÔÓÔ·ÛÙË carinii (PC) Î·È Á·-ÛÙÚÈÎfi ˘ÁÚfi ÁÈ· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (ª∫). 76 ·È‰È¿, ·fi Ù·ÔÔ›· Ù· 21 (27,6%) HIV(+), Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË.∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, 15/21 (71,4%) HIV(+) ·È‰È¿ ›¯·Ó AIDS.§Ô›ÌˆÍË ·fi PC ‰È·ÈÛÙÒıËΠ۠8 HIV(+) ·È‰È¿ [8/15(38%) ÙˆÓ ·È‰ÈÒÓ Ì AIDS] Î·È Û 1 HIV(-). ™Â 7/15 (47%)HIV(+) ·ÛıÂÓ›˜, ‹Ù·Ó ÙÔ ›‰ÈÔ ÙÔ AIDS Ô˘ ηıfiÚÈ˙ ÙË ÛÔ-‚·ÚfiÙËÙ· Ù˘ ÓfiÛËÛ˘. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÌÈÎÚÔ‚È·ÈÌ›·˜(15,3%) ‹Ù·Ó ›‰È· ÛÙ· HIV(+) Î·È HIV(-) ·È‰È¿ (15,8% ¤Ó·ÓÙÈ15,1%, p=0,94). O Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ Î·È Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘-ÏfiÎÔÎÎÔ˜ ‹Ù·Ó Ù· Û˘¯ÓfiÙÂÚ· ÛÙÂϤ¯Ë Ô˘ ·Ó·Ù‡¯ıËηÓÛÙÔ ·›Ì·. ∞fi Ù· Ù‡ÂÏ· Î·È ÙÔ BAL ·ÔÌÔÓÒıËÎ·Ó Ù· ›‰È· ÌÈ-ÎÚԂȷο ÛÙÂϤ¯Ë Î·È ÈÔ›, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ Î·È ÙÔ˘ ªµ

Û 6 (8%) ÂÚÈÙÒÛÂȘ, ·ÓÂÍ¿ÚÙËÙ· Ù˘ HIV(+) ‹ (-) ηٿ-ÛÙ·Û˘. ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ (ª∞) ÂÊ·ÚÌfiÛÙËΠ۠8/21·ÛıÂÓ›˜ (38%) HIV(+) Î·È Û 28/55 (51%) HIV(-), (p=0,32). ∏̤ÛË ‰È¿ÚÎÂÈ· Û Ë̤Ú˜ ÙÔ˘ ª∞ (3), Ù˘ ÓÔÛËÏ›·˜ ÛÙË ª∂£(5) Î·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (11) ‰ÂÓ ‰È¤ÊÂÚ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∏ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ· ‹Ù·Ó ‰ÈÏ¿ÛÈ· ÛÙÔ˘˜ HIV(+)·ÛıÂÓ›˜ [6/21 (28,6%)] ·fi ÙÔ˘˜ HIV(-) ·ÛıÂÓ›˜ [8/55(14,5%)], [Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (RR) 1,96, (p=0,16). ™˘ÌÂÚ¿ÛÌ·Ù·: ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 1/4 ÙˆÓ ·È‰ÈÒÓ Ù˘ ÁÂ-ˆÁÚ·ÊÈ΋˜ ÂÚÈÔ¯‹˜ Ù˘ ÌÂϤÙ˘ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ÁÈ· Ó¢ÌÔÓ›·, Â›Ó·È HIV(+), Ì ٷ ÈÔ ÔÏÏ¿ Ó· ‰È·ÁÈÁÓÒÛÎÔ-ÓÙ·È Ì ÙËÓ Â›ÛÔ‰Ô ÛÙË ª∂£. ∏ Ïԛ̈ÍË ·fi PC Â›Ó·È ÂÓ‰ÂÈ-ÎÙÈ΋ ÁÈ· AIDS. ∆· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› ·fi ÙÔÓ Èfi[HIV(+)] Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÙË ª∂£ ÁÈ· Ó¢ÌÔÓ›·, ›¯·Ó ¯ÂÈÚfi-ÙÂÚË ¤Î‚·ÛË ·fi fiÙÈ Ù· HIV(-) ·È‰È¿, Ë ‰È·ÊÔÚ¿ fï˜ ·˘Ù‹‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ وӷȉÈÒÓ.

∏ ·ÈÙÈÔÏÔÁ›· Î·È Ë ¤Î‚·ÛË Ù˘ Ó¢ÌÔÓ›·˜ Û ·È‰È¿ Ì ۇӉÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ-·˜ (AIDS) Ô˘ ÂÈÛ‹¯ıËÛ·Ó Û ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ (ª∂£) ·Ó·Ù˘ÛÛfiÌÂÓ˘ ¯ÒÚ·˜1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Zar H, Apolles P, Argent A, Klein M, Burgess J,Hanslo D et al The etiology and outcome of pneumonia in humanimmunodeficiency virus-infected children admittedto intensive care in a developing country Pediatr Crit Care Med 2001;2:108-112

÷Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜

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�¶ÂÚ›ÏË„Ë: ∂ÍÂÙ¿ÛÙËÎ·Ó 1048 Ì·ıËÙ¤˜ ËÏÈΛ·˜14-16 ÂÙÒÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÊÔÚ¤ˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜·Ó·ÈÌ›·˜ Î·È Ù˘ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜.µÚ¤ıËÎ·Ó 99 Ì·ıËÙ¤˜ ÊÔÚ›˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜·Ó·ÈÌ›·˜ (ÔÛÔÛÙfi 9,45%) Î·È 24 Ì·ıËÙ¤˜ ÊÔÚ›˜Ù˘ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ (ÔÛÔÛÙfi2,29%). ∏ ·Ó›¯Ó¢ÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÔÓȉȷÎÒÓÌÂÙ·ÏÏ¿ÍÂˆÓ Û 86 ·fi ÙÔ˘˜ 99 ÊÔÚ›˜ Ù˘ ‚-ÌÂ-ÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤‰ÂÈÍ fiÙÈ Ë Û˘¯ÓfiÙËÙ· Î·È ÔÙ‡Ô˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù¿ÛÙÔ ÁÂÓÈÎfi ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi Ì ÌÈÎÚ¤˜ ‰È·ÊÔ-ÚÔÔÈ‹ÛÂȘ. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤‰ÂÈÍ fiÙÈ ÙÔ80% ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÙȘÙÚÂȘ ·ÎfiÏÔ˘ı˜: IVSI 110(G-�A) (41,86%),cd39(C-�T) (26,74%), IVSI 1(G-�A) (11,63%). ∆··Ú·¿Óˆ Â˘Ú‹Ì·Ù· ı· ‚ÔËı‹ÛÔ˘Ó Û ÚÔÁÚ¿Ì-Ì·Ù· ·Ó›¯Ó¢Û˘ ÙˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏϿ͈ÓÙ˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋‰È¿ÁÓˆÛË Î·È ÁÂÓÈο ÛÙo ۯ‰ȷÛÌfi ÚfiÏ˄˘ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

§¤ÍÂȘ ÎÏÂȉȿ: ‚-ı·Ï·ÛÛ·ÈÌ›·, ‰Ú·ÓÔ΢ÙÙ·ÚÈ-΋ ·Ó·ÈÌ›·, ÌÂÙ·ÏÏ¿ÍÂȘ.

�Abstract: A total of 1048 high-school students ofthe prefecture of Karditsa were investigated for thedetection of heterozygotes for b-thalassemia andsickle-cell anemia. Ninety-nine students werefound to be heterozygotes for b-thalassemia(9.45%), and 24 to be heterozygotes for sickle-cellanemia (2.29%). The investigation for theresponsible genetic mutations in 86 of the 99heterozygotes of b-thalassemia showed that thefrequency and the type of the mutations are similarto those reported in the general Greek populationwith only minor differentiations. DNA analysisrevealed that eighty per cent of the mutationsconcerned mainly the three following: IVSI 110 (G-�A) (41.86%), cd39(C-�T) (26.74%), IVSI 1(G-�A)(11.63%). These findings will be usefull for thescreening programs to detect genetic mutations ofb-thalassemia, the prenatal diagnosis andgenerally for the prevention policy of this disease.

Key words: b-thalassemia, sickle-cell disease,mutations.

∏ ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Ë ‰Ú·ÓÔ΢ÙÙ·ÚÈ-΋ ·Ó·ÈÌ›· ·ÔÙÂÏÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ÎÏËÚÔÓÔÌÈοÓÔÛ‹Ì·Ù· ÁÈ· ÙÔÓ ÏËı˘ÛÌfi Ù˘ ∂ÏÏ¿‰·˜. ™Â ÔÚÈ-Ṳ̂Ó˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ fiˆ˜ Ë Ã·ÏÎȉÈ΋,Ë ª˘ÙÈÏ‹ÓË Î·È Ë ∫·Ú‰›ÙÛ·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÓÔ-ÛËÌ¿ÙˆÓ ·˘ÙÒÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì ÙÔ

ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∏ ·Ó·˙‹ÙËÛË ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÁÈ· Û˘ÁÁÂÓ›˜

·ÈÌÔÏ˘ÙÈΤ˜ ·Ó·È̛˜ Î·È Ë ÂÓË̤ڈۋ ÙÔ˘˜ Û¯ÂÙÈ-ο Ì ÙËÓ Èı·ÓfiÙËÙ· ·fiÎÙËÛ˘ ·È‰ÈÔ‡ Ì ¤Ó··fi Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿ ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜,Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÚfiÏË„‹ ÙÔ˘˜.

™˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Î·È ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ Î·È ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ¢. ÷Ù˙ËÁˆÚÁ›Ô˘1, ∂. ∫·Ó·‚¿Î˘2, Ã. ∆Û¿ÓÙ·ÏË3, J. Traeger-™˘ÓÔ‰ÈÓÔ‡2, Ã. ¡Ù·ÓÙ¿Ì˘1, ∂. ∫·ÓÙÂÚ¤-ªÂÎÈÒÙË1, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿3

Frequency of heterozygotes and detection of mutations for sickle-cell disease and b-thalassemia among high-school students of the prefecture of Karditsa D. Chatzigeorgiou1, E. Kanavakis2, C. Tsantali3, J. Traeger-Synodinos2, C. Dadamis1, E. Kantere-Bekioti1, M. Athanasiou-Metaxa3

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡Ô̷گȷÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∫·Ú‰›ÙÛ·˜

2 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 3 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋

πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢

1 Pediatric Clinic,General Hospital of Karditsa

2 Laboratory of Medical Genetics, University of Athens3 1st Pediatric Clinic,

Ippokration Hospital of Thessaloniki

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∏ ÂÚÁ·Û›· ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÛÎÔfiÙËÓ ÂÓË̤ڈÛË ÙˆÓ Ì·ıËÙÒÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ÁÈ· Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿, ÙËÓ ·Ó‡-ÚÂÛË ÙˆÓ Ì·ıËÙÒÓ ÔÈ ÔÔ›ÔÈ Â›Ó·È ÊÔÚ›˜ ÙˆÓ Û˘Á-ÁÂÓÒÓ ·˘ÙÒÓ ·ÈÌÔÏ˘ÙÈÎÒÓ ·Ó·ÈÌÈÒÓ, ÙËÓ Ù·˘ÙÔÔ›-ËÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Î·ÈÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ Û¯ÂÙÈο Ì ÙËÓ Èı·ÓfiÙË-Ù· ·fiÎÙËÛ˘ ·È‰ÈÔ‡ Ì ¤Ó· ·fi ·˘Ù¿ Ù· ÓÔÛ‹-Ì·Ù·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∂ϤÁ¯ıËÎ·Ó 1048 Ì·ıËÙ¤˜ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡

∫·Ú‰›ÙÛ·˜, ËÏÈΛ·˜ 14-16 ÂÙÒÓ. ™Â οı Á˘ÌÓ¿ÛÈÔ ¤Ó·˜ ÁÈ·-ÙÚfi˜ Ù˘ ÂÚ¢ÓËÙÈ΋˜ ÔÌ¿‰·˜ ¤‰ÈÓ ̛· ÔÌÈÏ›· Û fiÏÔ˘˜ÙÔ˘˜ Ì·ıËÙ¤˜ Û¯ÂÙÈο Ì ÙË ÌÂÛÔÁÂȷ΋ Î·È ÙË ‰Ú·ÓÔ΢Ù-Ù·ÚÈ΋ ·Ó·ÈÌ›·, ÙÔÓ ÙÚfiÔ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ¿˜ ÙÔ˘˜ ηÈÙȘ ÌÂıfi‰Ô˘˜ ÚfiÏ˄˘ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ. ™ÙÔ˘˜ Ì·-ıËÙ¤˜ Ù˘ ‰Â‡ÙÂÚ˘ Ù¿Í˘ ÙÔ˘ °˘ÌÓ·Û›Ô˘ (µ’), ÔÈ ÔÔ›ÔȤÊÂÚ·Ó ÂÓ˘fiÁÚ·ÊË ÙË Û˘ÁηٿıÂÛË ÙÔ˘ ÁÔÓ¤·-ÎˉÂÌfiÓ·ÙÔ˘˜, ÁÈÓfiÙ·Ó ·ÈÌÔÏË„›· ·fi ÓÔÛËχÙÚȘ ÙÔ˘ ¡ÔÛÔÎÔÌ›-Ô˘ ∫·Ú‰›ÙÛ·˜.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ̤ÙÚËÛË ÙÔ˘·ÚÈıÌÔ‡ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ,ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÒÓ ·Ú·-̤ÙÚˆÓ MCV, MCH, MCHC, RDW Ì ·ÈÌ·ÙÔÏÔÁÈÎfi ·Ó·Ï˘Ù‹,ÌÂϤÙË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, ̤ÙÚËÛË Ù˘ ÊÂÚÚÈÙ›Ó˘ÙÔ˘ ÔÚÔ‡, ËÏÂÎÙÚÔÊfiÚËÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û ٷÈӛ˜ ÔÍÂ˚-΋˜ ΢ÙÙ·Ú›Ó˘ Î·È Ì¤ÙÚËÛË ÙˆÓ ·ÈÌÔÛÊ·ÈÚÈÓÈÎÒÓ ÎÏ·ÛÌ¿-ÙˆÓ (HbA, HbA2, HbF, HbS).

∫ÚÈÙ‹ÚÈÔ ÁÈ· ÙÔ ¯·Ú·ÎÙËÚÈÛÌfi ÂÓfi˜ Ì·ıËÙ‹ ˆ˜ ÂÙÂÚÔ-˙˘ÁÒÙË Ù˘ ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ ‹Ù·Ó Ë ·Ó‡ÚÂÛËHbS Û ÔÛÔÛÙfi 35-40% Î·È Ë ıÂÙÈ΋ ‰ÔÎÈÌ·Û›· ‰Ú¿ӈ-Û˘. ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙÔ ¯·Ú·ÎÙËÚÈÛÌfi ÂÓfi˜ Ì·ıËÙ‹ ˆ˜ ÂÙÂÚÔ-˙˘ÁÒÙË Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‹Ù·Ó ÔÈ ¯·ÌËÏÔ› ÂÚ˘-ıÚÔ΢ÙÙ·ÚÈÎÔ› ‰Â›ÎÙ˜ MCV Î·È MCH, Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ÌÔÚÊÔÏÔÁ›· ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (·ÓÈÛÔ΢ÙÙ¿ÚˆÛË, ÔÈ-ÎÈÏÔ΢ÙÙ¿ÚˆÛË, ˘Ô¯ÚˆÌ›·, ÌÈÎÚÔ΢ÙÙ¿ÚˆÛË) ÛÙÔ Â›¯ÚÈ-ÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÔÛÔÛÙfi HbA2 >3,5%.

°È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·Ï-Ï¿ÍÂˆÓ ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜¤ÁÈÓ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ·fi Ï¢ÎÔ·ÙÙ·Ú· ÂÚÈÊÂÚÈÎÔ‡·›Ì·ÙÔ˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ÂÍ·ÁˆÁ‹˜ Ì ¿Ï·˜. ∞ÎÔÏÔ‡ıËÛÂËÏÂÎÙÚÔÊfiÚËÛË Û Á¤ÏË Ì ÎÏ‹ÛË ·Ô‰È·Ù·ÎÙÈÎÒÓ Ô˘ÛÈÒÓ(DCGE Denaturing Gradient Gel Electroforesis) Î·È ÁÈ· οıÂÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË ¤ÁÈÓ ÂȂ‚·›ˆÛË Ì ÙË Ì¤ıÔ‰Ô ARMS(Amplification Refractory Mutation System) (1).

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ˘˜ 1048 Ì·ıËÙ¤˜ Ô˘ ÂϤÁ¯ıËηÓ, ‚Ú¤-

ıËÎ·Ó ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜99 (9,45%) Î·È ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‰Ú·ÓÔ΢ÙÙ·ÚÈ-΋˜ ·Ó·ÈÌ›·˜ 24 Ì·ıËÙ¤˜ (2,29%). ™È‰ËÚÔÂÓ›·(ÊÂÚÚÈÙ›ÓË <10 ng/ml) ›¯·Ó 136 Ì·ıËÙ¤˜ (ÔÛÔ-

ÛÙfi 12,98%), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 41 (30,15%) ‹Ù·Ó·ÁfiÚÈ· Î·È 95 (69,85%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. ™Â 55 Ì·-ıËÙ¤˜ (5,25%) Û˘ÛÙ‹ıËΠ·ÓÂͤٷÛË ÁÈ·Ù› ÂÌ-Ê¿ÓÈ˙·Ó ÂËÚ·Ṳ̂ÓÔ˘˜ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ‡˜ ‰Â›-ÎÙ˜ MCV, MCH, MCHC ‹ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔ-ÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ‹ ÔÚȷΤ˜ ÙÈ̤˜ HbA2.

O ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ¤ÁÈÓÂÛ 86 ·fi ÙÔ˘˜ 99 Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ ÁÈ· ÙË‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· (¶›Ó·Î·˜ 1).

™˘˙‹ÙËÛË ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ Ù˘ ‚-

ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÛÙÔ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi Ù˘∂ÏÏ¿‰·˜ Â›Ó·È ÂÚ›Ô˘ 7,5% (2). ™ÙË ÌÂϤÙË Ì·˜, ËÛ˘¯ÓfiÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Ì·ıËÙÒÓ Ì ‚-ÌÂ-ÛÔÁÂȷ΋ ·Ó·ÈÌ›· ‹Ù·Ó 9,45%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓÂ›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ (p=0,06).

™Â ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, Ë Û˘¯ÓfiÙËÙ· ÙˆÓÂÙÂÚÔ˙˘ÁˆÙÒÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÛÙËÓÂÚÈÔ¯‹ Ù˘ ∫·Ú‰›ÙÛ·˜ ›¯Â ‚ÚÂı› 18,15% (3),14,2% (4) Î·È 9,8% (5). ªÂϤÙË Û ·È‰È¿ Ù˘ µÔ-Ú›Ԣ ∂ÏÏ¿‰Ô˜ ¤‰ÂÈÍÂ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ ÙÔ˘ ·-ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ÛÙÔ ÓÔÌfi Ù˘ £ÂÛÛ·ÏÔӛ΢ 2,69%, ÛÙÔ ÓÔÌfi Ù˘¶ÈÂÚ›·˜ 5,97% Î·È ÛÙÔ ÓÔÌfi Ù˘ ÷ÏÎȉÈ΋˜ 8,4%(6). ª›· ¿ÏÏË ¤Ú¢ӷ Û ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ÛÙÚ·ÙÈÒ-Ù˜ ›¯Â ‰Â›ÍÂÈ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Ù˘ ‚-ÌÂÛÔÁÂÈ·-΋˜ ·Ó·ÈÌ›·˜ 7,9% (7).

∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ Ù˘ ‰Ú·ÓÔ΢ÙÙ·ÚÈ-΋˜ ·Ó·ÈÌ›·˜ ÛÙË ÌÂϤÙË Ì·˜ ‚Ú¤ıËΠ2,29%. ™ÂÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ÛÙÔÓ ›‰ÈÔ ÓÔÌfi, Ë Û˘¯ÓfiÙË-Ù· ‹Ù·Ó 2,04% (3), 1,4% (4) Î·È 2% (5).

OÈ ‰È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· Ô˘ ·Ú·ÙËÚÔ‡-ÓÙ·È ÛÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜ ·ÊÂÓfi˜ ·ÊÔÚÔ‡ÓÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ ÛÙȘÔԛ˜ ¤ÁÈÓ·Ó ÔÈ ·Ú·¿Óˆ ÌÂϤÙ˜, ·ÊÂÙ¤ÚÔ˘ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈıÌfi ÂÍÂÙ·˙fiÌÂÓˆÓ Û οıÂÂÚ›ÙˆÛË.

¢È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ

¶›Ó·Î·˜ 1. ∆‡Ô˜ Î·È Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ˘˜Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜

ªÂÙ¿ÏÏ·ÍË ∞ÚÈıÌfi˜ Ì·ıËÙÒÓ ™˘¯ÓfiÙËÙ· (%)

IVS-110 (G-�A) 36 41,86cd39 (C-�T) 23 26,74IVS 1 (G-�A) 10 11,630IVSII - 745 (C-�G) 6 6,98cd5/A 2 2,33cd6/A 2 2,33‰‚Mac/A 2 2,33‰‚Lepore/A 2 2,33IVSI 5/A 1 1,16IVSI 6 (T-�C) 1 1,16IVSII 1 (G-�A) 1 1,16

MARCH-APRIL 2002 14-05-03 12:25 ™ÂÏ›‰·119

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Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‚Ú¤ıËÎ·Ó Î·È Û Â-ÚÈÔ¯¤˜ ÙÔ˘ ›‰ÈÔ˘ ÓÔÌÔ‡. ™ÙÔ ÓÔÌfi Ù˘ ∫·Ú‰›ÙÛ·˜,Û Á˘ÌÓ¿ÛÈ· ÔÚÂÈÓÒÓ ÂÚÈÔ¯ÒÓ fiˆ˜ ÙÔ˘ ªÔ˘˙·-ΛԢ Î·È ÙÔ˘ §ÂÔÓÙ·Ú›Ô˘, Ë Û˘¯ÓfiÙËÙ· ‹Ù·Ó 4,11%Î·È 0% ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Û Á˘ÌÓ¿ÛÈ· ‰ÈÓÒÓ Â-ÚÈÔ¯ÒÓ, fiˆ˜ ÙÔ˘ ¶·Ï·Ì¿ Î·È Ù˘ fiÏ˘ Ù˘ ∫·Ú-‰›ÙÛ·˜, ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· 14,28% Î·È 11,39%. ∏ ‰È·-ÊÔÚ¿ ·˘Ù‹ ›Ûˆ˜ Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë·Ú·ÌÔÓ‹ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁfiÓÔ˘ Ù˘ ‚-ÌÂÛÔÁÂÈ-·Î‹˜ ·Ó·ÈÌ›·˜ ·ÔÙÂÏ› ÂÍÂÏÈÎÙÈ΋ ÚÔÛ·ÚÌÔÁ‹Ì ÛÎÔfi ÙËÓ ·˘ÍË̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÂÏÔÓÔÛ›·Ô˘ ÂÓ‰ËÌÔ‡Û ÛÙȘ ‰ÈÓ¤˜ ÂÚÈÔ¯¤˜ (5).

™È‰ËÚÔÂÓ›· ‚Ú¤ıËΠ۠136 Ì·ıËÙ¤˜ (ÔÛÔ-ÛÙfi 12,98%), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 41 ‹Ù·Ó ·ÁfiÚÈ·(30,15%) Î·È 95 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (69,85%). ∏ Û˘¯Ófi-ÙËÙ· Ù˘ ÛȉËÚÔÂÓ›·˜ ÛÙËÓ fiÏË Ù˘ ∫·Ú‰›ÙÛ·˜‹Ù·Ó 14,38% (·ÛÙÈÎfi˜ ÏËı˘ÛÌfi˜), ÂÓÒ Û ·ÁÚÔÙÈ-Τ˜ Î·È ËÌÈ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó 12,019%. ∆· ¢-Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ Û˘ÌʈÓÔ‡Ó Ì ÌÂϤÙË ÛÙË µfi-ÚÂÈ· ∂ÏÏ¿‰·, fiÔ˘ ‚Ú¤ıËΠÛȉËÚÔÂÓ›· Û ̷-ıËÙ¤˜ ËÌÈ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÂÔÛÔÛÙfi 20,8% Î·È Û ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Û ÔÛÔ-ÛÙfi 8,4% (7). OÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ Â›Ó·È Èı·Ófi Ó·Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜Ô˘ ·ÊÔÚÔ‡Ó ÔÈ ‰‡Ô ÌÂϤÙ˜. ™ÙÔ˘˜ Ì·ıËÙ¤˜ ·˘-ÙÔ‡˜ Û˘ÛÙ‹ıËÎÂ Ë Ï‹„Ë Ûȉ‹ÚÔ˘ ÁÈ· 3 Ì‹Ó˜ Î·È Ë·ÓÂͤٷۋ ÙÔ˘˜. ∂·ÓÂͤٷÛË Û˘ÛÙ‹ıËΠηÈÛ 55 Ì·ıËÙ¤˜ (5,25%) ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÂËÚ·Ṳ̂-ÓÔ˘˜ ÙÔ˘˜ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ‡˜ ‰Â›ÎÙ˜ MCV,MCH, MCHC ‹ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‹ ÔÚȷΤ˜ ÙÈ̤˜ Ù˘ HbA2ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÊÔÚ¤ˆÓ Ù˘ ·-ÌÂÛÔÁÂȷ΋˜·Ó·ÈÌ›·˜ ‹ ÊÔÚ¤ˆÓ ÙÔ˘ ÛȈËÚÔ‡ ÁfiÓÔ˘ Ù˘ ‚-ÌÂ-ÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘HbA2 (8).

∏ ·Ó¿Ï˘ÛË ÙÔ˘ DNA Û 86 ·fi ÙÔ˘˜ 99 Ì·ıË-Ù¤˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜¤‰ÂÈÍ fiÙÈ ÙÔ 80,23% ·ÊÔÚ¿ Û ÙÚÂȘ ΢ڛˆ˜ ÌÂ-Ù·ÏÏ¿ÍÂȘ: IVSI 110(G-�A), cd39(C-�T) Î·È IVSI1(G-�A). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Â›Ó·È ·ÚfiÌÔÈ·Ì ÂΛӷ ÌÂϤÙ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Ù˘ ∂ÏÏ¿-‰·˜ (10), ÂÓÒ ‰È·Ê¤ÚÔ˘Ó ·fi Ù· ·ÔÙÂϤÛÌ·Ù··ÚfiÌÔÈ·˜ ÌÂϤÙ˘ ÛÙÔ ÓÔÌfi Ù˘ ª·ÁÓËÛ›·˜fiÔ˘ ÙÔ 67,8% ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ‚-ÌÂÛÔÁÂȷ΋˜·Ó·ÈÌ›·˜ ›¯·Ó ÙȘ ·ÎfiÏÔ˘ı˜ ÌÂÙ·ÏÏ¿ÍÂȘ: IVSI110(G-�A), IVSI 6(T-�C), cd39(C-�T), IVSI 1(G-�A) (11).

H Û˘¯ÓfiÙËÙ· Ù˘ ÌÂÙ¿ÏÏ·Í˘ IVSI 110(G-�A)ÛÙÔÓ ÏËı˘ÛÌfi ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ‚-ÌÂÛÔÁÂȷ΋˜·Ó·ÈÌ›·˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó 41,86%, ·ÚfiÌÔÈ·Ì ÙË Û˘¯ÓfiÙËÙ· ÛÙÔ ÁÂÓÈÎfi ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi(42,55%) (10), ÂÓÒ ‰È¤ÊÂÚ ·fi ÂΛÓË ÛÙË ÌÂϤÙËÙÔ˘ ÓÔÌÔ‡ ª·ÁÓËÛ›·˜, fiÔ˘ ‹Ù·Ó 20,8% (11).

∏ ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ÏÏ·ÍË ÛÙÔÓ ÏË-

ı˘ÛÌfi Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë cd39(C-�T), fiˆ˜Î·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ì ÙË ‰È·ÊÔÚ¿ fiÙÈ ÛÙԉ›ÁÌ· Ì·˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Ì ÙËÌÂÙ¿ÏÏ·ÍË cd39(C-�T) ‹Ù·Ó 26,74%, ÂÓÒ ÛÙÔ ÁÂ-ÓÈÎfi ÏËı˘ÛÌfi ‹Ù·Ó 16,95%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓÂ›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ (p=0,09).

∏ ÌÂÙ¿ÏÏ·ÍË IVSI 1(G-�A) ‹Ù·Ó ÙÚ›ÙË ÛÂ Û˘-¯ÓfiÙËÙ· Ì ÔÛÔÛÙfi 11,63%, Ô˘ Ï›ÁÔ ‰È·Ê¤ÚÂÈ·fi ÙÔ ÔÛÔÛÙfi ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (13,22%).

∆¤Ù·ÚÙË, ÛÂ Û˘¯ÓfiÙËÙ·, ÌÂÙ¿ÏÏ·ÍË ÛÙË ÌÂϤÙËÌ·˜ ‹Ù·Ó Ë IVSII 745(C-�G) Ì ÔÛÔÛÙfi 6,98%,·Ó¿ÏÔÁÔ Ì ·˘Ùfi ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (6,9%).

∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ·Ù˘ ÌÂÙ¿ÏÏ·Í˘ IVSI 6(T-�C) ÛÙË ÌÂϤÙË Ì·˜(1,16%), ÂÓÒ ÙfiÛÔ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÛÔ Î·ÈÛÙË ÌÂϤÙË Ù˘ ª·ÁÓËÛ›·˜ ‹Ù·Ó ˘„ËÏfiÙÂÚË,7,18% (p=0,05) Î·È 18,7% (p=0,003) ·ÓÙ›ÛÙÔȯ·.OÈ ‰È·ÊÔÚ¤˜ Ì ÙË ÌÂϤÙË ÛÙÔ ÓÔÌfi Ù˘ ª·ÁÓË-Û›·˜ ›Ûˆ˜ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈı-Ìfi ÙˆÓ ÂÍÂÙ·˙fiÌÂÓˆÓ Û οı ÌÂϤÙË, ηıÒ˜ ηÈÌ ÙË ‰È·ÊÔÚÂÙÈ΋ ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹, ·Ó ηÈÚfiÎÂÈÙ·È ÁÈ· fiÌÔÚÔ˘˜ ÓfiÌÔ˘˜ Ù˘ £ÂÛÛ·Ï›·˜.

§ÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ô˘ ·ÓȯÓ‡ıË-Î·Ó ÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: cd 5(-CT)2,33%, cd6(-A) 2,33%, ‰‚Mac/A 2,33%, ‰‚Lepore/A 2,33%, IVSI 5(G-�A) 1,16% Î·È IVSII 1(G-�A) 1,16%.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓÙ˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Î·È Ù˘ ‰Ú·ÓÔ΢Ù-Ù·ÚÈ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙˆÓ °˘ÌÓ·Û›ˆÓ ÙÔ˘ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ‚Ú¤ıËΠӷ Â›Ó·È 9,45% ηÈ2,29% ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ˘Â‡ı˘-ÓˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È ·ÚfiÌÔÈ· Ì·˘Ù‹ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Ì ÌÈÎÚ¤˜ ÌfiÓÔ ‰È·ÊÔ-ÚÔÔÈ‹ÛÂȘ. ¶ÈÛÙ‡ԢÌ fiÙÈ Ù· Â˘Ú‹Ì·Ù¿ Ì·˜ ·˘-Ù¿ ı· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ˘Â‡ı˘ÓˆÓÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·È-Ì›·˜, ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Î·È ÁÂÓÈÎfiÙÂÚ·ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ·˘ÙÔ‡.

∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙȘ ÓÔÛËχÙÚȘ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ∫·Ú‰›-

ÙÛ·˜ Î. ∞ıËÓ¿ ª·Ó·Û‹ Î·È ∂˘·ÁÁÂÏ›· ¶·¿, ÙȘ ·Ú·Û΢¿-ÛÙÚȘ ÙÔ˘ ∞ÈÌ·ÙÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜∫ÏÈÓÈ΋˜ ÙÔ˘ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢ Î. µ·-ÛÈÏÈ΋ ∞ÏÂÙÚ¿ Î·È ª¿Á‰· ∫ˆÙԇϷ, ηıÒ˜ Î·È ÙËÓ ·Ú·Û΢-¿ÛÙÚÈ· ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›-Ô˘ ∞ıËÓÒÓ ÁÈ· ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘˜ ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÚÁ·-Û›·˜ ·˘Ù‹˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kanavakis E, Traeger-Synodinos J, Vrettou C,

Maragoudaki E, Tzetis M, Kattamis C. Prenatal diagnosis ofthe thalassemia syndromes by rapid DNA analyticalmethods. Mol Hum Reprod 1997;3:523-528.

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2. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. µ-MÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. ∞ÈÎ. ª·Ï·-ο-∑·ÊÂÈÚ›Ô˘, ÂÈÌÂÏËÙ‹˜. ¶Ú·ÎÙÈ΋ ¶·È‰È·ÙÚÈ΋. £ÂÛÛ·-ÏÔÓ›ÎË: University Studio Press; 1999. ÛÂÏ. 611-612.

3. ™¯›˙·˜ ¡, ∆¤ÁÔ˜ ∫, µÔ˘ÙÛ·‰¿Î˘ ∞, ∞Ú·Ì·Ù˙‹˜ °, ∞ÁÁÂ-ÏÔÔ‡ÏÔ˘ ¶, ÃÚ˘Û·ÓıfiÔ˘ÏÔ˜ ∫ Î·È Û˘Ó. ™˘¯ÓfiÙ˘ ηÈηٷÓÔÌ‹ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Î·È ·ıÔÏÔÁÈÎÒÓ ·ÈÌÔ-ÛÊ·ÈÚÈÓÒÓ ÂȘ ÙÔÓ ∂ÏÏËÓÈÎfiÓ ¯ÒÚÔÓ. ŒÚ¢ӷ › 15550 ÓÂ-ÔÛ˘ÏϤÎÙˆÓ. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛË ∂ÏÏËÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘-Ó¿ÌÂˆÓ 1977;11:197-209.

4. Stamatoyannopoylos G, Fessas Ph. ∆halassemia, glucose-6-phosphate dehydrogenase deficiency, sickling andmalaria endemicity in Greece. Brit Med J 1964;1:875-880.

5. Barnicot NA, Allison AC, Blumberg BS, Deliyannis G,Krimbas C, Ballas A. Haemoglobin types in Greekpopulations. Ann Hum Genet 1963;26:229-237.

6. ∫·ÙÚÈÔ‡-¡ÈÎÔϷοÎË ¢, ™ÎÏ·‚Ô‡ÓÔ˘-∆ÛÔ˘ÚÔ˘ÎÙÛfiÁÏÔ˘™, ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º, ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª,∫·Û›ÌÔ˜ Ã. ¶ÏËı˘ÛÌÈ΋ ¤Ú¢ӷ ÙˆÓ ·ÈÌÔÛÊ·ÈÚÈÓÔ·ıÂÈÒÓÂȘ ·È‰È¿ Ù˘ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛË∂ÏÏËÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:237-246.

7. ∫·ÙÙ¿Ì˘ Ã, ªÂٷ͈ÙÔ‡-ª·˘ÚÔÌÌ¿ÙË ∞, ∫ÔÓȉ¿Ú˘ ∫,∆Ô˘ÏÈ¿ÙÔ˜ ¡, ∫ˆÛÙ¿ÓÙ˙·˜ ¡, ª·ÙÛ·ÓÈÒÙ˘ ¡. ™˘¯ÓfiÙ˘ÛȉËÚÔÂÓÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ÛÙ›ÁÌ·ÙÔ˜ ÌÂÛÔÁÂȷ΋˜ ·Ó·È-Ì›·˜ ÂȘ ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ÛÙÚ·ÙÈÒÙ·˜. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛË∂ÏÏËÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:229-235.

8. ∫ÂÚ·Ìȉ¿-∫·˚Ó·‰¿ ª. ∏ ›‰Ú·ÛË ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓË-ıÂÈÒÓ Î·È ÙÔ˘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘ ÛÙËÓ ÂÌÊ¿-

ÓÈÛË ÛȉËÚÔÂÓ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· [¢È‰·ÎÙÔÚÈ΋ ‰È·-ÙÚÈ‚‹]. £ÂÛÛ·ÏÔÓ›ÎË: ∞¶£ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋: 1996.

9. Tzetis M, Traeger-Synodinos J, Kanavakis E, Metaxotou-Mavromati A, Kattamis C. The molecular basis of normalHbA2 (type 2) ‚-Thalassemia in Greece. Hematol Pathol1994;8:25-34.

10. Kattamis C, Hu H, Cheng G, Reese AL, Gonzalez-RedondoM, Kutlar A et al. Molecular characterization of ‚-thalassaemia in 174 Greek patients with thalassaemiamajor. Brit J Haematol 1990;74:342-346.

11. Nissiotou J, Vrettou C, Taeger-Synodinos J, Tzetis M,Kanavakis E, Zeikos G et al. Distribution of ‚-thalassemiamutations in a district of central Greece (Magnesia).Hellenic Association of medical genetics, 1st Balkanmeeting on human genetics; 1994 August 31-September3; Thessaloniki, Greece. 1994. p. 111.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-05-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-12-2001

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ËÌ‹ÙÚÈÔ˜ ÷Ù˙ËÁˆÚÁ›Ô˘ ª¿ÚÎÔ˘ ªfiÙÛ·ÚË 41, ∆.∫. 601 00, ∫·ÙÂÚ›ÓË E-mail: [email protected]

∂ÈÛ·ÁˆÁ‹: ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÛÙÔ ·ÚÂÏıfiÓ ÙfiÓÈ˙·Ó ÙË ÌÂÁ¿-ÏË Î·ı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË ·È‰ÈÒÓ Ì º¡∂. ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ηٿfiÛÔ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÁÈ· ÙË º¡∂ ÛÙËÓ ·È‰È΋ ËÏÈΛ·Ô‰‹ÁËÛ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, ‚ÂÏÙ›ˆÛË Ù˘ ıÂڷ›·˜Î·È ÂÏ¿ÙÙˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 112 ·È‰È¿ Ì º¡∂ (64 Ì ÓfiÛÔ Crohn, 41Ì ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ·, 7 Ì ·ÚÔÛ‰ÈfiÚÈÛÙË ÎÔÏ›Ùȉ·), Ô˘ ·-Ú·¤ÌÊıËÎ·Ó Û °·ÛÙÚÂÓÙÂÚÔÏÔÁÈÎfi ∆Ì‹Ì· ·fi ÙÔ 1994¤ˆ˜ ÙÔ 1998, ÌÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο. ™Ù· ·È‰È¿ Ì ÓfiÛÔCrohn, Ô ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ̤¯ÚÈ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 47 ‚‰Ô-Ì¿‰Â˜ (maximum 7 ¤ÙË). ™Ù· ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ‰È¿ÚÚÔÈ·,Ë ‰È¿ÁÓˆÛË Î·ı˘ÛÙ¤ÚËÛ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ (66 ¤Ó·ÓÙÈ 28‚‰ÔÌ¿‰ˆÓ, p=0,005). O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ‰È¿ÁÓˆÛ˘ ÁÈ· Ù··È‰È¿ Ì ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ· ‹Ù·Ó 20 ‚‰ÔÌ¿‰Â˜ (maximum 3¤ÙË). ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Û ·È‰È¿ Ì ‚·ÚÈ¿ ÎÔÏ›Ùȉ· Ë ‰È¿-ÁÓˆÛË ¤ÁÈÓ ÌÂÙ¿ ·fi 5,5 ‚‰ÔÌ¿‰Â˜ Î·È 4 ·fi ·˘Ù¿ ¯ÚÂÈ¿-ÛÙËÎ·Ó ¿ÌÂÛË ÎÔÏÂÎÙÔÌ‹. ∞ÚÎÂÙ¿ ·È‰È¿ Ì ÓfiÛÔ Crohn ›-¯·Ó ˘Ô‚ÏËı› Û ÌË ·Ô‰ÂÎÙ¤˜ ıÂڷ›˜, fiˆ˜ ¯ÔÚ‹ÁËÛË·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ‹ „˘¯ÔÊ·Ú̿ΈÓ. ¢¤Î· ÂÓÓ¤· (17%) ›-¯·Ó ˘Ô‚ÏËı› Û ÂÓ‰ÔÛÎfiËÛË Û ÓÔÛÔÎÔÌ›· ÂÓËϛΈÓ. ∏˘ÔıÚ„›· ‹Ù·Ó ÙÔ ›‰ÈÔ Û˘¯Ó‹ Û ·È‰È¿ Ì Crohn Î·È Ì ÂÏ-

ÎÒ‰Ë ÎÔÏ›Ùȉ· (11%). ∫ÔÓÙfi ·Ó¿ÛÙËÌ· ›¯Â ÙÔ 19% ÙˆÓ ·È-‰ÈÒÓ Ì Crohn Î·È ÙÔ 5% ·˘ÙÒÓ Ì ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ·. µÚ¤ıË-ΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘ÌÙˆ-Ì¿ÙˆÓ Î·È ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ‰˘ÛÙÚÔÊ›·˜ (p=0,004). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ηı˘ÛÙ¤ÚËÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È Ë ÌË Ûˆ-ÛÙ‹ ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ·ÎfiÌË ÛËÌ·ÓÙÈο ÚÔ-‚Ï‹Ì·Ù· ÁÈ· ÙË º¡∂ ÛÙËÓ ·È‰È΋ ËÏÈΛ·.

¢È¿ÁÓˆÛË, ıÂڷ›· Î·È ÓÔÛËÚfiÙËÙ· Û ·È‰È¿ Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (º¡∂)1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Spray C, Debelle G, Murphy M Current diagnosis, management andmorbidity in paediatric inflammatory boweldisease Acta Paediatr 2001;90:400-405

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ· ¶·È‰›·ÙÚÔ˜-°·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

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¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ÂÚÈÔ¯‹˜ µ¿Ú˘ ∞ÙÙÈ΋˜ ∂. ª·Ú·ÁοÎË1, °. °·Ï¿ÓË1, ª. °ÂÌÂÏÈ¿ÚË1, Ã. ∫ÒÛÙ·ÏÔ˜2, ¢. ¶··‰ÔÔ‡ÏÔ˘1, ¡. º·Ú¿ÎÏ·˜1

Body fat indices of school-aged children of the Vari region in Attica∂. ªarangaki1, G. Galani1, ª. Yemeliari1, C. Costalos2, D. Papadopoulou1, ¡. Faraklas1

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

�¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Ì·˜ ‹Ù·Ó ËÂÎÙ›ÌËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ Û¯Ô-ÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ÂÚÈÔ¯‹˜ µ¿Ú˘ ∞ÙÙÈ΋˜. °È· ÙËÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰Â›ÁÌ· 635 ˘ÁÈÒÓ ·È-‰ÈÒÓ ËÏÈΛ·˜ 5-16 ÂÙÒÓ. ø˜ ‰Â›ÎÙ˜ ·Ó¿Ù˘Í˘¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î·È ÙÔ‡„Ô˜, ·fi Ù· ÔÔ›· ˘ÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙ˘ Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™). ™Â fiÛ· ·È‰È¿ ‹Ù·Ó ¿Óˆ ÙˆÓ8 ÂÙÒÓ ˘ÔÏÔÁ›ÛÙËÎÂ Î·È Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ÛÒÌ·ÙÔ˜ Û ϛԘ (%) Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÈ-΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘. OÈ ÛˆÌ·ÙÔÌÂÙÚÈΤ˜ ÙÈ̤˜ Ù˘ÌÂϤÙ˘ Ì·˜, ÙfiÛÔ ÁÈ· ÙÔ ¢ª™ fiÛÔ Î·È ÁÈ· ÙÔ Ï›-Ô˜, Â›Ó·È ˘„ËÏfiÙÂÚ˜ Û ۇÁÎÚÈÛË Ì ٷ ‰ÈÂıÓ‹ÚfiÙ˘·. ª¤ÁÈÛÙ˜ ÙÈ̤˜ Ï›Ô˘˜ ·Ú·ÙËÚ‹ıËηÓÛÙËÓ ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ ÁÈ· Ù· ·ÁfiÚÈ· Î·È ÙˆÓ 15ÂÙÒÓ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ™‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô ʇψӤ‰ÂÈÍ fiÙÈ Ù· ·ÁfiÚÈ· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ Ï›Ô˜ ̤-¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ, ÂÓÒ ÌÂÙ¿ Ù· 10 ¤ÙË, ËÛ¯¤ÛË ·˘Ù‹ ·ÓÙÈÛÙÚ¤ÊÂÙ·È ˘¤Ú ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∏̤ÙÚËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ËÏÂÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ Â›Ó·È Â‡¯ÚËÛÙË, ÁÚ‹ÁÔ-ÚË Î·È ÔÈÎÔÓÔÌÈ΋.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡ÓıÂÛË ÛÒÌ·ÙÔ˜, ۈ̷ÙÈÎfi Ï›-Ô˜, ‚ÈÔËÏÂÎÙÚÈ΋ ·ÓÙ›ÛÙ·ÛË, ·È‰›.

�Abstract: Assessment of body compositionprovides important data on nutritional status andquality of growth in children. Limited data areavailable, however, on the body composition ofhuman infants due to limitation of existing methodsof measurement. The aim of the present study wasto assess the growth of 635 healthy Greek childrenaged 5 to 16 years, from the Vari area of AtticaGreece. Body mass index (BMI) was estimated inall children while body fat content was assessedby bioelectric impedance analysis in thosechildren who were 8 to 16 years of age. From thepresent survey it is concluded that the mean BMIand the fat content in both sexes exceed USgrowth standards. Maximum fat accretion wasnoted at the age of 13 for boys and 15 for girls.Comparison of both sexes revealed that boys havemore body fat up to the age of 10 years after whichbody fat content in girls exceeds that of boys.Bioelectric impedance analysis constitutes auseful, quick and economic method for estimatingbody fat content in children.

Key words: body composition, body fat content,bioelectric impedance.

∏ ÂÎÙ›ÌËÛË Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ·Ú¤-¯ÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È·ÈÙËÙÈ΋ η-Ù¿ÛÙ·ÛË Î·È ÙËÓ ÔÈfiÙËÙ· ·Ó¿Ù˘Í˘ ÂÓfi˜ ·È‰È-Ô‡. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Û‹ÌÂÚ· Ë ·¯˘Û·ÚΛ· ·ÔÙÂ-Ï› ÛËÌ·ÓÙÈÎfi ÎÔÈÓˆÓÈÎfi ·ÏÏ¿ Î·È ˘ÁÂÈÔÓÔÌÈÎfiÚfi‚ÏËÌ· ÁÈ· Ù· ·È‰È¿ Ù˘ ¯ÒÚ·˜ Ì·˜, ˘¿Ú¯ÂÈÌÂÁ¿ÏË ·Ó¿ÁÎË ÁÈ· ÙË ¯ÚËÛÈÌÔÔ›ËÛË ·ÍÈfiÈÛÙˆÓÌÂıfi‰ˆÓ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ÔÚıÔÏÔÁÈο Ë ·-¯˘Û·ÚΛ·. OÈ ÏËÚÔÊÔڛ˜ Ô˘ ¤¯Ô˘Ì ÁÈ· ÙË Û‡-

ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜ Î·È ·˘ÙfiÁÈ·Ù› ‰ÂÓ ˘‹Ú¯·Ó ̤¯ÚÈ ÚfiÛÊ·Ù· ·Ï¤˜ ηȷÍÈfiÈÛÙ˜ ̤ıÔ‰ÔÈ ÂÎÙ›ÌËÛ˘. ∏ ÈÔ ·Ï‹ ̤ıÔ-‰Ô˜ ˘ÔÏÔÁÈÛÌÔ‡ ÙÔ˘ ÔÏÈÎÔ‡ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜Á›ÓÂÙ·È Ì ̤ÙÚËÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ (1),Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙÔ˘ ‚Ú·¯›ÔÓ· (2) ‹ ÙÔ˘ ‰Â›ÎÙË Ì¿-˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) (3,4). OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜, ·ÓÎ·È ·Ï¤˜, ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ·ÍÈfiÈÛÙ˜. ∏ ̤-ÙÚËÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ¿Ô„Ë fiÙÈ Ë ÔÛfiÙËÙ· ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜

1 ∫¤ÓÙÚÔ ÀÁ›·˜ µ¿Ú˘ 2 ¶° ¡ÔÛÔÎÔÌÂ›Ô ∞ÏÂÍ¿Ó‰Ú· ∞ıËÓÒÓ

1 Vari Health Center, Athens2 Alexandra General Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2002;65:122-127 Paediatriki 2002;65:122-127

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·ÔÙÂÏ› ‰Â›ÎÙË Ù˘ ÔÏÈ΋˜ ÔÛfiÙËÙ·˜ ÙÔ˘ Ï›Ô˘˜ÙÔ˘ ÛÒÌ·ÙÔ˜, ηıÒ˜ Î·È ÛÙÔ Âȯ›ÚËÌ· fiÙÈ ÔÈ ı¤-ÛÂȘ ·’ fiÔ˘ Á›ÓÂÙ·È Ë Ì¤ÙÚËÛË Â›Ó·È ·ÓÙÈÚÔÛˆ-¢ÙÈΤ˜ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ fiÏÔ˘ ÙÔ˘ ÛÒÌ·-ÙÔ˜. •¤ÚÔ˘ÌÂ, fï˜, Û‹ÌÂÚ· fiÙÈ Ù· ‰‡Ô ·˘Ù¿ ÂÈ-¯ÂÈÚ‹Ì·Ù· ‰ÂÓ Â˘ÛÙ·ıÔ‡Ó (5,6). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹,›Û˘, ‰ÂÓ Â›Ó·È Ôχ ·ÓÙÈÎÂÈÌÂÓÈ΋, ·ÊÔ‡ ÂÍ·Ú-Ù¿Ù·È ·fi ÙËÓ ÂÌÂÈÚ›· - ‹ fi¯È - ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∏ÂÎÙ›ÌËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ ¿ÏÈ Ì¤Ûˆ Ù˘ ̤-ÙÚËÛ˘ Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙÔ˘ ‚Ú·¯›ÔÓ· Î·È ÙÔ˘¢ª™ ·ÔÙÂÏ› ÌfiÓÔ ¤ÌÌÂÛË Ì¤ıfi‰Ô Î·È ÛÙËÚ›˙ÂÙ·ÈÛÙËÓ ¿Ô„Ë fiÙÈ Ë Û¯¤ÛË Ï›Ô˘˜/¿ÏÈˆÓ ÈÛÙÒÓ ÙÔ˘·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ÛÙ·ıÂÚ‹, ÁÂÁÔÓfi˜ Ô˘‰ÂÓ Â˘ÛÙ·ı› (7).

∞fi ÙȘ ÌÂıfi‰Ô˘˜ ¿ÌÂÛ˘ ̤ÙÚËÛ˘ ÙÔ˘ Ûˆ-Ì·ÙÈÎÔ‡ Ï›Ô˘˜, Ë ·Ï·ÈfiÙÂÚË Â›Ó·È ·˘Ù‹ Ô˘ ÛÙË-Ú›˙ÂÙ·È Û ÂÎÙ›ÌËÛË Ù˘ ˘ÎÓfiÙËÙ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ÌÂÙ¿ ·fi ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÙÔ˘ ۈ̷ÙÈÎÔ‡‚¿ÚÔ˘˜ Û ·¤Ú· Î·È ÓÂÚfi (8). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ›-Ó·È Ù¯ÓÈο ‰‡ÛÎÔÏË Î·È fi¯È ÙfiÛÔ ·ÎÚÈ‚‹˜, ÂȉÈοÁÈ· ·È‰È¿. ¶ÈÔ ·ÎÚȂ›˜ ̤ıÔ‰ÔÈ ÂÎÙ›ÌËÛ˘ Ù˘ۇÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ·˘Ù¤˜ Ô˘ ¯ÚËÛÈÌÔ-ÔÈÔ‡Ó Ú·‰ÈÔ˚ÛfiÙÔ· (Ú·‰ÈÂÓÂÚÁfi ‡‰ˆÚ ‹ οÏÈÔ)(9-11), ηıÒ˜ Î·È ·˘Ù¤˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·È Û ÂÓÂÚ-ÁÔÔ›ËÛË ÓÂÙÚÔÓ›ˆÓ (7). ∆Ô ˘„ËÏfi ÙÔ˘˜ ÎfiÛÙÔ˜Î·È Ë ¤ÎıÂÛË Û ڷ‰ÈÂÓ¤ÚÁÂÈ· ηıÈÛÙÔ‡Ó ÙȘ ÌÂıfi-‰Ô˘˜ ·˘Ù¤˜ ·Î·Ù¿ÏÏËϘ ÁÈ· ¢Ú›· ¯Ú‹ÛË Û·ȉȿ. ¶ÈÔ ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛ ̛· ¿ÏÏË Ì¤-ıÔ‰Ô˜ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ̤-Ûˆ ̤ÙÚËÛ˘ Ù˘ ËÏÂÎÙÚÈ΋˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÙÔ˘ÛÒÌ·ÙÔ˜ ÌÂÙ¿ ·fi ÙÔÔı¤ÙËÛË ÙÔ˘ ÂÍÂÙ·˙fiÌÂÓÔ˘Û ËÏÂÎÙÚÔÌ·ÁÓËÙÈο ‰›· (TABEC) (12). ∆· ÏÂ-ÔÓÂÎÙ‹Ì·Ù· Ù˘ ÌÂıfi‰Ô˘ ·˘Ù‹˜ Â›Ó·È Ë ÌÂÁ¿ÏË·ÎÚ›‚ÂÈ· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ·Ú¤¯ÂÈ Î·È Ë·Ô˘Û›· ÔÔÈÔ˘‰‹ÔÙ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ ·È‰›. ªÂÈ-ÔÓ¤ÎÙËÌ· ·ÔÙÂÏ› ÙÔ ˘„ËÏfi ÎfiÛÙÔ˜ Î·È Ô ÌÂÁ¿-ÏÔ˜ ¯ÚfiÓÔ˜ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· οı ÂͤٷÛË.

ª›· Ó¤· ̤ıÔ‰Ô˜ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ÛÒÌ·ÙÔ˜ Â›Ó·È Ì¤Ûˆ ̤ÙÚËÛ˘ Ù˘ ËÏÂÎÙÚÈ΋˜·ÓÙ›ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ÛÙËÚ›-˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂχıÂÚÔÈ Ï›Ô˘˜ ÈÛÙÔ›¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ËÏÂÎÙÚÔχ-Ù˜ Î·È ‡‰ˆÚ, ¿Ú· Î·È ÌÂÁ·Ï‡ÙÂÚË ·ÁˆÁÈÌfiÙËÙ··’ fiÙÈ Ô ÏÈ҉˘ ÈÛÙfi˜ Î·È Ù· ÔÛÙ¿. ∞˘Ù‹ Ë ‰È·-ÊÔÚ¿ ÛÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ËÏÂÎÙÚÔχÙ˜ ηÈÛÙËÓ ·ÁˆÁÈÌfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÈÛÙÒÓÂÈÙÚ¤ÂÈ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ÏÈÒ-‰Ô˘˜ ÈÛÙÔ‡ ÙÔ˘ ÛÒÌ·ÙÔ˜ Ì ‚¿ÛË ÙËÓ ËÏÂÎÙÚÈ΋ÙÔ˘ ·ÁˆÁÈÌfiÙËÙ· (13). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ·Ô‰Â›-¯ıËΠڷÎÙÈ΋, ¯Ú‹ÛÈÌË Î·È ·ÍÈfiÈÛÙË ÙfiÛÔ ÛÂÂÓ‹ÏÈΘ (14,15), fiÛÔ Î·È Û ·È‰È¿ (16-18). ∞˘Ù‹ÙË Ì¤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ Î·È ÂÌ›˜ ÛÙËÓ ·-ÚÔ‡Û· ÌÂϤÙË, Ë ÔÔ›· ›¯Â ÛÎÔfi Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘

ÂÚÈÔ¯‹˜ µ¿Ú˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÂÈ Û‡ÁÎÚÈÛËÌ ٷ ˘¿Ú¯ÔÓÙ· ‰ÈÂıÓ‹ ÚfiÙ˘· Î·È Ó· ÂÓÙÔÈ-ÛÙ› ÙÔ ÔÛÔÛÙfi ·¯˘Û·ÚΛ·˜ Û ·˘ÙfiÓ ÙÔÓ ÏË-ı˘ÛÌfi.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó Û˘ÓÔÏÈο 635 ˘ÁÈ‹ ·È‰È¿ - 307 ·ÁfiÚÈ·

Î·È 328 ÎÔÚ›ÙÛÈ· - ËÏÈΛ·˜ 5-16 ÂÙÒÓ. ŸÏ· Ù· ·È‰È¿ ‹Ù·ÓÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜. OÈ ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ÛÙÔ ∫¤ÓÙÚÔÀÁ›·˜ µ¿Ú˘ ÛÙËÓ ÂÚ›Ô‰Ô 1995-2000, ηٿ ÙË ‰È¿ÚÎÂȷ›Û΄˘ ÙˆÓ ·È‰ÈÒÓ ÛÙÔ ·È‰È·ÙÚÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚ›ÔÛÙ· Ï·›ÛÈ· ÁÂÓÈ΋˜ ÂͤٷÛ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔ˘˜ ¯Ô-ÚËÁËı› ÈÛÙÔÔÈËÙÈÎfi ˘Á›·˜ ‹ Ó· ÙÔ˘˜ Á›ÓÂÈ ÂÌ‚ÔÏÈ·-ÛÌfi˜. ŸÏ˜ ÔÈ ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ·fi Ù· ›‰È· ¿ÙÔÌ· (∂ª, °°Î·È ª°). ∏ ‰È·‰Èηۛ· Ô˘ ·ÎÔÏÔ˘ı‹ıËΠ‹Ù·Ó Ë ÂÍ‹˜:∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, ÂÈϤ¯ıË-Î·Ó fiÛ· ·ÚÔ˘Û›·˙·Ó ·fiÎÏÈÛË Ì¤¯ÚÈ 3 ÙÔ Ôχ Ì‹Ó˜·fi ÙȘ ·Ú·¿Óˆ ËÏÈ˘. ∏ ÂͤٷÛË ÁÈÓfiÙ·Ó 2-3 ÒÚ˜ÌÂÙ¿ ÙÔ ÙÂÏÂ˘Ù·›Ô Á‡̷, ÂÊ’ fiÛÔÓ ‰ÂÓ Â›¯Â ÚÔËÁËı› Ûˆ-Ì·ÙÈ΋ ¿ÛÎËÛË ÁÈ· 12 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÒÚ˜, Ô‡Ù ϋ„Ë Î·Ê¤‹ ‰ÈÔ˘ÚËÙÈÎÒÓ Î·È Ë ÂÓ˘‰¿ÙˆÛ‹ ÙÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋.

¶ÚÈÓ ·fi ÙËÓ ÂͤٷÛË ÚÔËÁ‹ıËΠ̤ÙÚËÛË ÙÔ˘ Ûˆ-Ì·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Ì ˙˘Á·ÚÈ¿ ‰¿ÊÔ˘˜ Ù‡Ô˘ Secca ·ÎÚ›-‚ÂÈ·˜ ±100 gr, ÌÂÙ¿ ·fi ·Ê·›ÚÂÛË ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ Î·È ÙˆÓ˘Ô‰ËÌ¿ÙˆÓ. ∆Ô ‡„Ô˜ ÂÎÙÈÌ‹ıËΠ̠·Ó·ÛÙËÌfiÌÂÙÚÔ ÙÔ›-¯Ô˘. ™Â οı ·È‰› Á›ÓÔÓÙ·Ó ÙÚÂȘ ·ÏÏ¿ÏÏËϘ ÌÂÙÚ‹-ÛÂȘ Î·È ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜. O ‰Â›ÎÙ˘ ۈ̷ÙÈ΋˜ Ì¿-˙·˜ (¢™ª) ÂÎÙÈÌ‹ıËΠ̠‚¿ÛË ÙÔÓ Ù‡Ô ¢™ª=µ(kg)/⁄„Ô˜ (m)2. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘ÛÒÌ·ÙÔ˜ Û ϛԘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ·Ó·Ï˘Ù‹˜ Ï›Ô˘˜Ù˘ Maltron (Maltron Ltd Essex, England) Ô˘ ÛÙËÚ›˙ÂÙ·ÈÛÙË Ì¤ıÔ‰Ô Ù˘ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. ø˜ ÁÓˆÛÙfi,Ë ¿·¯Ë Ì¿˙· ÙÔ˘ ÛÒÌ·ÙÔ˜ ¤¯ÂÈ Ôχ ÌÂÁ·Ï‡ÙÂÚË ·ÁˆÁÈ-ÌfiÙËÙ· ·fi ÙÔ Ï›Ô˜ ÏfiÁˆ ÌÂÁ·Ï‡ÙÂÚ˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜Û ËÏÂÎÙÚÔχÙ˜. O ·Ó·Ï˘Ù‹˜ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ ÌÂÙÚ¿ÂÈÙË ÚÔ‹ ËÏÂÎÙÚÈÛÌÔ‡ fiˆ˜ ·˘Ùfi˜ ÂÚÓ¿ÂÈ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ï›-Ô˘˜, ÙˆÓ ¿·¯ˆÓ ÈÛÙÒÓ Î·È ÙÔ˘ ‡‰·ÙÔ˜. ŒÙÛÈ, ÙÔ Ì˯¿-ÓËÌ· ‰ÈÔ¯ÂÙ‡ÂÈ ËÏÂÎÙÚÈÎfi Ú‡̷ ¯·ÌËÏ‹˜ Ù¿Û˘ (6v) ̤-Ûˆ 4 ·ÈÛıËÙ‹ÚˆÓ Î·È Î·Ù·ÁÚ¿ÊÂÈ ÙȘ ËÏÂÎÙÚÈΤ˜ ‚ÈÔ·ÓÙÈ-ÛÙ¿ÛÂȘ, ‰ËÏ·‰‹ ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Ó· ÂÈ‚Ú·‰‡-ÓÂÈ ÙÔÓ ËÏÂÎÙÚÈÛÌfi, ηıÒ˜ ·˘Ùfi˜ ‰È¤Ú¯ÂÙ·È Ì¤Ûˆ ‰È·Êfi-ÚˆÓ ÈÛÙÒÓ Ì ‰È·ÊÔÚÂÙÈ΋ ·ÁˆÁÈÌfiÙËÙ· (ϛԘ, ¿·¯ÔÈÈÛÙÔ›, ‡‰ˆÚ). ªÂÙ¿ ·fi ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÛÙÔȯ›ˆÓ ʇÏÔ˘,ËÏÈΛ·˜, ‚¿ÚÔ˘˜ Î·È ‡„Ô˘˜, ÙÔ ·È‰› ÙÔÔıÂÙÂ›Ù·È Û η-Ù·ÎÂÎÏÈ̤ÓË ‡ÙÈ· ı¤ÛË. ∆ÔÔıÂÙÔ‡ÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ· 2 ·È-ÛıËÙ‹Ú˜ ÛÙÔ ‰ÂÍ› ¯¤ÚÈ Î·È 2 ÛÙÔ ‰ÂÍ› fi‰È ÙÔ˘ ·È‰ÈÔ‡ ηȉÈÔ¯ÂÙ‡ÂÙ·È ËÏÂÎÙÚÈÎfi Ú‡̷ 1 mA Û˘¯ÓfiÙËÙ·˜ 50 KHz̤ۈ 2 ËÏÂÎÙÚÈÎÒÓ ÛÙËÏÒÓ. ªÂÙ¿ ·fi ‰È¿ÛÙËÌ· ÌÈÎÚfiÙÂ-ÚÔ ÙˆÓ 10 sec, Ë Û˘Û΢‹ Ì¿˜ ‰Â›¯ÓÂÈ ÛÙËÓ ÔıfiÓË ÙËÓ Â-ÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛԘ (%). ∏ ÂÎÙ›ÌËÛË ÙÔ˘ÛˆÌ·ÙÈÎÔ‡ Ï›Ô˘˜ ¤ÁÈÓ ÌfiÓÔ ÛÙ· ·È‰È¿ ÂΛӷ Ô˘ ›¯·ÓËÏÈΛ· ¿Óˆ ÙˆÓ 8 ÂÙÒÓ, ·ÊÔ‡ ÙÔ Ì˯¿ÓËÌ· ·˘Ùfi ·‰˘Ó·Ù›ӷ ÌÂÙÚ‹ÛÂÈ ÙË Û‡ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ·È‰È¿ ÌÈÎÚfiÙÂ-Ú˘ ËÏÈΛ·˜.

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∞ÔÙÂϤÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙÔ ÛˆÌ·ÙÈÎfi ϛԘ (%)

Î·È ÙÔ ¢ª™ ÎÔÚÈÙÛÈÒÓ Î·È ·ÁÔÚÈÒÓ Ù˘ ÌÂϤÙ˘ η-Ù·ÁÚ¿ÊÔÓÙ·È ÙfiÛÔ ÛÙÔ˘˜ ¶›Ó·Î˜ 1 Î·È 2 (̤ÛË ÙÈ-Ì‹ Î·È 1 ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË), fiÛÔ Î·È ÛÙ· ™¯‹Ì·Ù·1, 2, 3, 4 (̤ÛË ÙÈÌ‹, 1 Î·È 2 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ).

™˘˙‹ÙËÛË ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› Î·È Â-

ÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿-Ù˘ÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡. ŒÙÛÈ, fi¯È ÌfiÓÔοı ¯ÒÚ·, ·ÏÏ¿ ·ÎfiÌË Î·È ‰È·ÊÔÚÂÙÈΤ˜ Áˆ-ÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ ̤۷ ÛÙËÓ ›‰È· ¯ÒÚ· ¤¯Ô˘Ó‰È·ÌÔÚÊÒÛÂÈ Ù· ‰Èο ÙÔ˘˜ ÚfiÙ˘· ·Ó¿Ù˘ÍË˜Î·È ‰È·ÙËÚÔ‡Ó Î¿ÔȘ ȉȷÈÙÂÚfiÙËÙ˜ Û fi,ÙÈ ·ÊÔ-Ú¿ ÙÔ˘˜ Ú˘ıÌÔ‡˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ (19). ∞˘-Ùfi˜ Â›Ó·È Ô ÏfiÁÔ˜ Ô˘ Ì·˜ ÒıËÛ ӷ ÌÂÏÂÙ‹ÛÔ˘ÌÂÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ì›·˜ Û˘-ÁÎÂÎÚÈ̤Ó˘ ÂÚÈÔ¯‹˜ Ù˘ ∞ÙÙÈ΋˜ Ô˘ ·ÔÙÂÏ›-Ù·È ÙfiÛÔ ·fi ·ÛÙÈÎfi, fiÛÔ Î·È ·fi ·ÁÚÔÙÈÎfi ÏË-ı˘ÛÌfi.

∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ‰È·ÛÙڈ̷ÙÈ΋˜ Ì·˜ ÌÂ-ϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô ¢™ª ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡-Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ˜ Û fiϘ ÙȘ ÂηÙÔ-ÛÙÈ·›Â˜ ı¤ÛÂȘ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›-ÙÛÈ·, Û ۯ¤ÛË Ì ͤÓ˜ ÌÂϤÙ˜ (20-22), ÂÓÒ Â›Ó·ÈÛ˘ÁÎÚ›ÛÈÌ· Ì ÂΛӷ ÌÂϤÙ˘ Ô˘ ¤ÁÈÓ Û ·È‰È¿Ù˘ ™ËÙ›·˜ ∫Ú‹Ù˘ (23), ηıÒ˜ Î·È ·˘Ù‹˜ ·È‰ÈÒÓÙ˘ ∫‡ÚÔ˘ (24) Ô˘ ¤ÁÈÓ ÚfiÛÊ·Ù·.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ ÛˆÌ·ÙÈÎfi ϛԘ, ·˘Ùfi ·ÔÙÂ-Ï› ÙÔ ÈÔ Â˘ÌÂÙ¿‚ÏËÙÔ Û˘ÛÙ·ÙÈÎfi ÙÔ˘ ÛÒÌ·ÙÔ˜,·ÊÔ‡ fi¯È ÌfiÓÔ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈο - ·‡ÍËÛË‹ Ì›ˆÛË - ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ (25),·ÏÏ¿ Î·È ÁÈ· Ì›· Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈΛ· ·Ú·ÙËÚ›ٷȉȷÊÔÚ¿ ̤¯ÚÈ Î·È 5 ÊÔÚ¤˜ ·fi ·È‰› Û ·È‰› (26).

OÈ Ì¤Û˜ ÙÈ̤˜ Ï›Ô˘˜ Ù˘ ÌÂϤÙ˘ Ì·˜ Û ·È-‰È¿ ËÏÈΛ·˜ 13-16 ÂÙÒÓ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·ÈÛÙ· ÎÔÚ›ÙÛÈ·, ‹Ù·Ó ˘„ËÏfiÙÂÚ˜ ·fi ·˘Ù¤˜ Ô˘

·Ó·Ê¤ÚÔÓÙ·È ÙfiÛÔ ·fi ÙËÓ Widowson ÛÙËÓ ∂˘ÚÒ-Ë (26), fiÛÔ Î·È ·fi ‰‡Ô ∞ÌÂÚÈηÓÈΤ˜ ÌÂϤÙ˜(20,21). ª¤ÁÈÛÙ˜ ̤Û˜ ÙÈ̤˜ Ï›Ô˘˜ ·Ú·ÙËÚ‹-ıËÎ·Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ ÁÈ· Ù· ·ÁfiÚÈ· ηÈ15 ÂÙÒÓ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ∞ÓÙ›ıÂÙ·, ÛÙË ÌÂϤÙË Ù˘Widowson (26) ̤ÁÈÛÙË ÙÈÌ‹ ·Ú·ÙËÚ‹ıËΠÛÙ·ÌÂÓ ·ÁfiÚÈ· ÛÙ· 10 Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÙ· 16 ¤ÙË.∫·Ù¿ ÙÔ˘˜ ∏asche et al (27) ̤ÁÈÛÙË ÙÈÌ‹ ·Ú·ÙË-Ú‹ıËΠÁÈ· Ù· ·ÁfiÚÈ· ÛÙ· 11,5 Î·È ÁÈ· Ù· ÎÔÚ›ÙÛÈ·ÛÙ· 15,5 ¤ÙË. ∏ Û‡ÁÎÚÈÛË ·ÁÔÚÈÒÓ-ÎÔÚÈÙÛÈÒÓ ÛÙË

¶·È‰È·ÙÚÈ΋ 2002;65:122-127 Paediatriki 2002;65:122-127

124

¶›Ó·Î·˜ 1. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛԘ (%)

ª¤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË)∏ÏÈΛ· (¤ÙË) ∫ÔÚ›ÙÛÈ· ∞ÁfiÚÈ·

8 12 (5) 10 (8) 9 13 (9) 15 (12)

10 13 (9) 19 (12) 11 18 (10) 18 (12) 12 17 (10) 15 (10) 13 23 (13) 22 (13) 14 26 (12) 18 (10) 15 28 (8) 19 (10) 16 28 (8) 20 (12)

¶›Ó·Î·˜ 2. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™)

ª¤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ∏ÏÈΛ· (¤ÙË) ∫ÔÚ›ÙÛÈ· ∞ÁfiÚÈ·

5 16 (1,5) 17,5 (2) 6 17,5 (2,5) 17,0 (2) 7 17,0 (3) 18,0 (3) 8 17,5 (1,5) 18,0 (3) 9 18,0 (3) 19,0 (3)

10 17,5 (4) 21,0 (5) 11 19,0 (5) 21,0 (4) 12 19,0 (5) 20,0 (2,5) 13 22,5 (2,5) 22,5 (3) 14 22,5 (3) 22,5 (4) 15 22,5 (3) 24,0 (3,5) 16 22,0 (2) 24,5 (4)

™¯‹Ì· 1. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛԘ (%) ÛÙ· ÎÔÚ›ÙÛÈ·.

MT (M¤ÛË TÈÌ‹)

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË)

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ)

8 9 10 11 12 13 14 15 16HÏÈΛ· (¤ÙË)

§›

Ô˜

%

0

-10

10

20

30

40

50

60

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¶·È‰È·ÙÚÈ΋ 2002;65:122-127 Paediatriki 2002;65:122-127

125

ÌÂϤÙË Ì·˜ ¤‰ÂÈÍ fiÙÈ ÂÓÒ ÁÈ· ÙȘ ËÏÈ˘ 9 Î·È 10Ù· ·ÁfiÚÈ· ˘ÂÚÙÂÚÔ‡Ó ˆ˜ ÚÔ˜ ÙËÓ ÂÚÈÂÎÙÈÎfiÙË-Ù· Û ϛԘ, ·fi Ù· 11 ¤ˆ˜ Ù· 16 ˘¿Ú¯ÂÈ Û·Ê‹˜˘ÂÚ›Û¯˘ÛË ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∞Ó¿ÏÔÁ· Â›Ó·È Î·È Ù·

·ÔÙÂϤÛÌ·Ù· Ù˘ Widowson (26). ∞ÓÙ›ıÂÙ·, ÔÈFomon Î·È Û˘Ó (21) ‚Ú‹Î·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ÛÙ· ÎÔÚ›ÙÛÈ· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ·fi ·˘Ùfi ÙˆÓ ·ÁÔ-ÚÈÒÓ ·fi Ù· 5 ¯ÚfiÓÈ· Î·È ¿Óˆ.

40

35

30

25

20

15

10

5

50

6 7 8 9 10 11 12 13 14 15 16

¢M

MT (M¤ÛË TÈÌ‹)

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË)

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ)

HÏÈΛ· (¤ÙË)

™¯‹Ì· 4. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙ· ·ÁfiÚÈ·.

8 9 10 11 12 13 14 15 16

§›

Ô˜ %

-20

-10

0

10

20

30

40

50

60

MT (M¤ÛË TÈÌ‹)

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË)

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ)

HÏÈΛ· (¤ÙË)

™¯‹Ì· 2. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛԘ (%) ÛÙ· ·ÁfiÚÈ·.

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∏ ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ËÏÂÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·-Û˘ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ÛÒ-Ì·ÙÔ˜ Û ϛԘ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ô‰Â›¯ıË-Π‡¯ÚËÛÙË, ÁÚ‹ÁÔÚË Î·È ÔÈÎÔÓÔÌÈ΋. ªÔÚ› Ó·ÌËÓ ·Ú¤¯ÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÈÔ ÂÚ›ÏÔÎˆÓ ÌÂıfi-‰ˆÓ, ˘ÂÚ¤¯ÂÈ fï˜ Û·ÊÒ˜ Ù˘ ÌÂıfi‰Ô˘ ̤ÙÚË-Û˘ Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜, ·ÊÔ‡ Ù· ·ÔÙÂϤ-ÛÌ·Ù· Â›Ó·È ·ÓÙÈÎÂÈÌÂÓÈο Î·È ·Ó··Ú·ÁÒÁÈÌ· ηȉÂÓ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ÂÌÂÈÚ›· ‹ fi¯È ÙÔ˘ ¯ÂÈÚÈ-ÛÙ‹ ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜. ªÂÈÔÓ¤ÎÙËÌ· Ù˘ ÌÂıfi‰Ô˘Â›Ó·È Ë ·‰˘Ó·Ì›· ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û ÌÈÎÚ¿ ·È‰È¿,‰ÈfiÙÈ ÌÈÎÚ¤˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ÛÒÌ·ÙÔ˜ Û ‡‰ˆÚ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙË Û¯¤ÛËÏ›Ô˘˜/¿ÏÈË ÛˆÌ·ÙÈ΋ Ì¿˙·. ŒÙÛÈ, ÏÔÈfiÓ, Ë Ù·-¯¤ˆ˜ ÌÂÙ·‚·ÏÏfiÌÂÓË ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·-ÙÔ˜ Û ‡‰ˆÚ Î·È Ù˘ ηٷÓÔÌ‹˜ Ù˘ ¿ÏÈ˘ ۈ̷-ÙÈ΋˜ Ì¿˙·˜ ÌÂٷ͇ ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ ÛÙÔ ÌÈÎÚfi·È‰› ηıÈÛÙ¿ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ÏÈÁfiÙÂÚÔ ·ÍÈfiÈÛÙËÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ (28). ∞˘Ùfi˜ Â›Ó·È Î·È Ô ÏfiÁÔ˜Ô˘ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ÛÒÌ·ÙÔ˜ Û ϛԘ ÌÂÙÚ‹ıËΠÌfiÓÔ Û ·È‰È¿ ËÏÈ-Λ·˜ ¿Óˆ ÙˆÓ 8 ÂÙÒÓ, ·ÊÔ‡ ·fi ·˘Ù‹ ÙËÓ ËÏÈΛ·Î·È ¿Óˆ ÙfiÛÔ Ô fiÁÎÔ˜ fiÛÔ Î·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ˘ÁÚÒÓ ÙÔ˘ ÛÒÌ·ÙÔ˜ ‰È·ÙËÚÔ‡ÓÙ·È ÛÙ·ıÂÚ¿ ηÈÚÔÛÔÌÔÈ¿˙Ô˘Ó Ì ·˘Ù¿ ÙˆÓ ÂÓËÏ›ÎˆÓ (26).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ì ‚¿ÛË Ù· fiÛ· ·Ó·Ù‡Í·ÌÂÌÔÚԇ̠ӷ ԇ̠fiÙÈ: ·) Ù· ÂÏÏËÓfiÔ˘Ï· Ù˘

ÂÚÈÔ¯‹˜ µ¿Ú˘ Â›Ó·È Û·ÊÒ˜ ÈÔ ·¯‡Û·Úη ÛÂÛ¯¤ÛË Ì ͤӷ ÚfiÙ˘· Î·È ‚) Ë Ì¤ÙÚËÛË ÙÔ˘ Ûˆ-Ì·ÙÈÎÔ‡ Ï›Ô˘˜ Û ·È‰È¿ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂ-ÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ Â›Ó·È Â‡¯ÚËÛÙË, ÁÚ‹ÁÔÚËÎ·È ÔÈÎÔÓÔÌÈ΋.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Falkner F. Growth monitoring: Fetus to the first two

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3. Hammer LD, Kraemer HC, Wilson DM. Standarizedpercentile curves of body-mass index for children andadolescents. Am J Dis Child 1991;145:259-265.

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™¯‹Ì· 3. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙ· ÎÔÚ›ÙÛÈ·.

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8. Behnke AR Jr, Feen BG, Welham WC. The specific gravityof healthy men. JAMA 1942;118:495-499.

9. Forbes GB. Methods for determining composition of thehuman body with a note of the effect of diet on bodycomposition. Pediatrics 1962;29:477-494.

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14. Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI.Assessment of fat-free mass using bioelectrical impedancemeasurements of the human body. Am J Clin Nutr1985;41:810-816.

15. Kushner RF, Schoeller DA. Estimation of total body waterby bioelectrical impedance analysis. Am J Clin Nutr1986;44:417-423.

16. Newman SL. Bioelectric impedance analysis in thedetermination of body composition of children. In: KlishWJ, Kretchmer N, editors. Body compositionmeasurements in infants and children. Report of the ninety-eight Ross Conference on Pediatric Research. ColombusOhio: Ross Laboratories; 1989. p. 8-13.

17. Barillas-Mury C, Vettorazzi C, Molina S, Pineda O.Experience with bioelectrical impedance in young children.In: Ellis KJ, Yasumura S, Morgan WD, eds. In vivo bodycomposition studies. London: Institute of PhysicalSciences in Medicine; 1987. p. 87-90.

18. DeLozier M, Gutin B, Wang J. Bioimpedance-derivedestimates of body composition in 4-8 year olds [abstract].Med Sci Sports Exerc 1988;20:S31.

19. Rooth G. Low birthweight revised. Lancet 1980;1:639-641. 20. Ten-State Nutrition Survey, 1968-1970. DHEW Publication

No [HSM] July 1972;72-8132. 21. Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body

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22. Rolland-Cachera MF, Cole TJ, Sempe M, Ticher J,Rossignal C, Charraud A. Body mass index variations.Centiles from birth to 87 years. Eur J Clin Nutr1991;45:13-21.

23. ªÈÙÛÒÚË ª, ¡Â¿Ú¯Ô˘ ∞, ∫·ÏÌ·Ù˙‹ µ, ª·Ï·ıÚ¿ÎË ª, ∫Ô-Ï˘‰¿ÎË-™˘Úȉ¿ÎË ª, ƒÂÌÂÏ¿Î˘ µ Î·È Û˘Ó. AÓ¿Ù˘ÍËÎ·È ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙËÓ·گ›· ™ËÙ›·˜. ¶·È‰È·ÙÚÈ΋ 1995;58:326-335.

24. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›Ù˘ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, ÷Ù˙Ë-ÁˆÚÁ›Ô˘ Ã, ™È·ÌÔ˘Ó¿ÎË ª. ∏ ·¯˘Û·ÚΛ· Û ·È‰È¿ ËÏÈ-Λ·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù· ÙÂÏ¢-Ù·›· 8 ¯ÚfiÓÈ·. ¶·È‰È·ÙÚÈ΋ 2000;63:137-144.

25. Falkner F. Monitoring growth. In: Nutritional needs andassessment of normal growth. Gracey M, Falkner F,editors. Nestle’ Nutrition, Vevey, New York: Raven Press;1985. p. 123-137.

26. Widdowson EM. Growth and body composition inchildhood. In: Clinical nutrition of the young child. BrunserO, Carrazza F, Gracey M, Nichols B, Senterre J, editors.New York: Raven Press; 1985. p. 1-14.

27. Haschke F. Body composition of adolescent males. ActaPaediatr Scand 1983;307[Suppl]:1-13.

28. Malina RM. Application of bioelectric impedance analysisto children and adolescents. In: Klish WJ, Kretchmer N,editors. Body composition measurements in infants andchildren. Report of the ninety-eight Ross conference onPediatric Research. Colombus Ohio: Ross Laboratories;1989. p. 14-19.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-09-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-02-2002

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∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿ ∞. ª‹ÙÛÈη - ∫·Ú·Ó¿ÛÔ˘, Ã. ∆˙ÈÔ˘‚¿Ú·, ∞. ∫ÔÓ‰‡Ï˘, °. ∆˙ˆÚÙ˙¿ÙÔ˘, ∑. ∫·Ú·Î·ÙÛ¿ÓË

Cholelithiasis in children A. Mitsika - Karanasou, H. Tziouvara, A. Kondylis, G. Tzortzatou, Z. Karakatsani

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

�¶ÂÚ›ÏË„Ë: ∏ ¯ÔÏÔÏÈı›·ÛË ·Ú·Ì¤ÓÂÈ Û¿ÓÈÔÎÏÈÓÈÎfi Úfi‚ÏËÌ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ˆÛÙfiÛÔ ËÛ˘¯ÓfiÙËÙ· Î·È ÙÔ Ê¿ÛÌ· ÙˆÓ ÚԉȷıÂÛÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ Ù˘ ÓfiÛÔ˘ Ê·›ÓÂÙ·È Ó· ·ÏÏ¿˙Ô˘Ó Î·Ù¿ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÂÈ-Ú›· Ì·˜ ·fi ÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ú·-ÎÔÏÔ‡ıËÛË 9 ·È‰ÈÒÓ Ì ¯ÔÏÔÏÈı›·ÛË Î·Ù¿ ÙËÓ ÙÂ-ÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ وӷȉÈÒÓ Ô›ÎÈÏ·Ó: 4 ·fi Ù· 9 ·È‰È¿ ·ÚÔ˘Û›·˙·ÓÙ˘Èο Û˘ÌÙÒÌ·Ù· (fiÓÔ ÛÙÔ ‰ÂÍÈfi ¿Óˆ ÙÂÙ·ÚÙË-ÌfiÚÈÔ Ù˘ ÎÔÈÏ›·˜ ‹ ÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, Â̤-ÙÔ˘˜ Î·È ‰˘Û·ÓÂÍ›· ÛÙË Ï‹„Ë ÏÈ·ÚÒÓ ÁÂ˘Ì¿ÙˆÓ),2 ›¯·Ó ¿Ù˘Â˜ ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈÎfi Î·È 3‹Ù·Ó ·Û˘Ìو̷ÙÈο. ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ¤ÁÈ-Ó Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ¶ÚԉȷıÂÛÈÎÔ›·Ú¿ÁÔÓÙ˜ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ·Ó¢ڤ-ıËÛ·Ó Û 7/9 ·È‰È¿. ÃÔÏÔ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ Û 4·È‰È¿, ÂÓÒ Ù· ˘fiÏÔÈ· 5 ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Áȷ̤ÛÔ ‰È¿ÛÙËÌ· 3,2 ¯ÚfiÓˆÓ Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó·Â›Ó·È ·Û˘Ìو̷ÙÈο. ∫·Ó¤Ó· ·fi Ù· ·È‰È¿ ‰ÂÓ·ÚÔ˘Û›·Û ÂÈÏÔΤ˜.

§¤ÍÂȘ ÎÏÂȉȿ: ¯ÔÏÔÏÈı›·ÛË, ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹, Ì˯ÔÏÂÚ˘ıÚÈÓÈÎÔ› ¯ÔÏfiÏÈıÔÈ.

�Abstract: Cholelithiasis remains a rare clinicalproblem in childhood, although the frequency andspectrum of the risk factors concerning this entityseems to be changing during the past decades.We are describing our 5 year experienceconcerning the diagnosis, management andfollow-up of 9 children with gallstones. The clinicalpresentation showed variability: of the 9 children, 4presented with typical symptoms such as rightupper quadrant or epigastric pain, nausea,vomiting and fat intolerance, 2 children hadnonspecific abdominal symptoms and 3 wereasymptomatic. The diagnosis of cholelithiasis wasbased on abdominal ultrasonography. Predi-sposing risk factors for gallstone formation werefound in 7 of 9 children. Cholecystectomy wasperformed in 4 children, while the other 5 are underclose observation for a mean period of 3.2 years,and remain asymptomatic. None of our patientsdeveloped complications.

Key words: cholelithiasis, cholecystectomy,nonpigmented gallstones.

∂ÈÛ·ÁˆÁ‹∏ ¯ÔÏÔÏÈı›·ÛË Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈ-

Λ·. ŒÙÛÈ, Û˘¯Ó¿ ‰È·Ê‡ÁÂÈ ˆ˜ Èı·Ó‹ ·ÈÙ›· ÎÔÈÏÈ·-ÎÔ‡ ¿ÏÁÔ˘˜. πÛÙÔÚÈο, Ë ÓfiÛÔ˜ Â›Ó·È Û˘Ó‰Â‰Â̤ÓËÌ ÙȘ ·ÈÌÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÙËÓ ÂÁ΢ÌÔÛ‡-ÓË ÛÙËÓ ÂÊ˂›· (1-3). ∆Ș ÙÂÏÂ˘Ù·›Â˜ 3 ‰ÂηÂٛ˜,Ì ÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜, ˯ÔÏÔÏÈı›·ÛË ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯Ófi-ÙËÙ·, ·ÎfiÌË Î·È Û ÔÌ¿‰Â˜ ·È‰ÈÒÓ Ô˘ ÚÔËÁÔ‡-ÌÂÓ· ‰ÂÓ ‹Ù·Ó ÁÓˆÛÙfi fiÙÈ ‚Ú›ÛÎÔÓÙ·Ó Û ΛӉ˘ÓÔÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ (¶›Ó·Î·˜ 1). ∂›Û˘,

ÔÏϤ˜ ¯ÔÏÔÏÈıÈ¿ÛÂȘ, ÂÎÙfi˜ ·fi ·˘Ù¤˜ Ô˘ Û¯Â-Ù›˙ÔÓÙ·È Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È È‰ÈÔ-·ı›˜. ∞fi ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ ÙÔ80% ÂÚ›Ô˘ ÙˆÓ ¯ÔÏfiÏÈıˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ ÔÊ›-ÏÂÙ·È Û ·ÈÌÔÏ˘ÙÈ΋ ‰È·Ù·Ú·¯‹ Î·È ÙÔ ˘fiÏÔÈÔ20% Û¯ÂÙ›˙ÂÙ·È Ì ˘ÔÙÚÔÈ¿˙Ô˘Û· ·ÈÌfiÏ˘ÛË (4-6). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¯ÔÏfiÏÈıˆÓ ÛÙ· ·È‰È¿·ÔÙÂÏ› ıÂڷ¢ÙÈÎfi ‰›ÏËÌÌ·. ∂›Ó·È ÁÓˆÛÙfi fiÙÈÙÔ 10% ÙˆÓ ÂÓËÏ›ÎˆÓ ı· ¤¯Ô˘Ó ·Û˘Ìو̷ÙÈÎÔ‡˜¯ÔÏfiÏÈıÔ˘˜ ·Ó ˘Ô‚ÏËıÔ‡Ó Û ÂͤٷÛË ÚÔ˘Ù›Ó·˜Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ∞fi ·˘ÙÔ‡˜, ÌfiÓÔ

∞’ Î·È µ’ ¶·È‰È·ÙÚÈο ∆Ì‹Ì·Ù· °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

1st and 2nd Pediatric Divisions Children’s General Hospital of Penteli, Athens

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10%-25% ı· ·Ó·Ù‡ÍÂÈ Û˘ÌÙÒÌ·Ù· Ô˘ Ó· ¯ÚÂÈ-¿˙ÔÓÙ·È ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹ (7,8). ™Â ·ÓÙ›ıÂÛË, fï˜,Ì ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ù· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌË ÂÈ-‰ÈΤ˜ ÂΉËÏÒÛÂȘ ·fi ÙËÓ ÎÔÈÏÈ¿ Î·È ‰ÂÓ ÌÔÚÔ‡ÓÌ ·ÎÚ›‚ÂÈ· Ó· ÂÚÈÁÚ¿„Ô˘Ó Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜.∂Ì›˜ ÌÂÏÂÙ‹Û·Ì 9 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ¯ÔÏfi-ÏÈıÔ˘˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ÂͤٷÛË Î·È ·Ó·Ï‡Ô˘Ì ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ,ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ÙÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ·fi ÙÔÓ ∞Ú›ÏÈÔ 1995 ¤ˆ˜ ÙÔÓ

∞Ú›ÏÈÔ 2001 ÓÔÛËχÙËÎ·Ó ÛÙȘ ·È‰È·ÙÚÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ÓÔÛÔÎÔÌ›Ԣ Ì·˜ 9 ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË. ¶·Ú·ÎÔÏÔ˘ı‹-Û·Ì ٷ ·È‰È¿ ·˘Ù¿ Ì ÎÏÈÓÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ, ÙËÏÂʈÓÈ΋ ÂÈ-ÎÔÈÓˆÓ›· Ì ÙÔ˘˜ ÁÔÓ›˜ ‹ Ù· ·È‰È¿ Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο.¶ÏËÚÔÊÔڛ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi, ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ıÂڷ›·˜ ηٷÁÚ¿ÊËÎ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∆· Û˘-ÌÙÒÌ·Ù· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ Ù˘Èο, ¿Ù˘· ‹ ·fiÓÙ·. ∆··Û˘Ìو̷ÙÈο ·È‰È¿ ‰ÂÓ Â›¯·Ó ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈ-Îfi. ™Â ·˘Ù¿, ÔÈ ¯ÔÏfiÏÈıÔÈ ‰È·ÁÓÒÛÙËÎ·Ó Ù˘¯·›· Ì ˘ÂÚ˯Ô-ÁÚ¿ÊËÌ· Ô˘ ¤ÁÈÓ ÁÈ· ¿Û¯ÂÙ· ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ηٿ ÙÔÓ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÌÂÙ¿ ·fi Ô˘ÚÔÏԛ̈ÍË. ∆· Û˘-Ìو̷ÙÈο ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ·˘Ù¿ ÌÂ Ù˘Èο Û˘ÌÙÒ-Ì·Ù· ·fi Ù· ¯ÔÏËÊfiÚ·, fiˆ˜ fiÓÔ ÛÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ ‹ÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, Â̤ÙÔ˘˜ Î·È ‰˘Û·ÓÂÍ›· ÛÙ· Ï›Ë Î·ÈÛ ·˘Ù¿ Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi. ÃÔÏÔ΢ÛÙÂ-ÎÙÔÌ‹ ¤ÁÈÓ ÛÙ· ·È‰È¿ ÌÂ Ù˘Èο Û˘ÌÙÒÌ·Ù·, ÂÓÒ Ù· ˘fi-ÏÔÈ· Ù¤ıËÎ·Ó Û ·Ú·ÎÔÏÔ‡ıËÛË. ™Ù· ¯ÂÈÚÔ˘ÚÁËı¤ÓÙ··È‰È¿ ÂÎÙÈÌ‹ıËÎ·Ó Ù· ¯ÂÈÚÔ˘ÚÁÈο Â˘Ú‹Ì·Ù· Î·È Ë ÌÂÙÂÁ-¯ÂÈÚËÙÈ΋ ÔÚ›· Î·È ÛÙËÓ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛËÌÂÈÒ-ıËÎÂ Ë Ù˘¯fiÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ ‹ ÂÈÏÔÎÒÓ.

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ˘˜ 9 ·ÛıÂÓ›˜ Ì ¯ÔÏÔÏÈı›·ÛË, 5 ‹Ù·Ó

·ÁfiÚÈ· Î·È 4 ÎÔÚ›ÙÛÈ·. ∏ ËÏÈΛ· ÙÔ˘˜ Î˘Ì·ÈÓfiÙ·Ó·fi 9 Ì‹Ó˜ ˆ˜ 15 ¯ÚfiÓÈ· (̤ÛË ËÏÈΛ· 11,5 ¯Úfi-

ÓÈ·). ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ¤ÁÈÓ Ì ˘ÂÚ˯ÔÁÚ¿-ÊËÌ· ÎÔÈÏ›·˜.

∫·Ù¿ ÙË ‰È¿ÁÓˆÛË, ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ وӷȉÈÒÓ Ô›ÎÈÏ·Ó Â˘Ú¤ˆ˜. ÿÎÙÂÚÔ Î·È fiÓÔ ÛÙÔ ‰Â-ÍÈfi ˘Ô¯fiÓ‰ÚÈÔ ·ÚÔ˘Û›·˙ 1 ·È‰›, Â̤ÙÔ˘˜ ηÈfiÓÔ ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ 1, ‰˘Û·ÓÂÍ›· ÛÙȘ ÏÈ·Ú¤˜ÙÚÔʤ˜ 1 Î·È ›ÎÙÂÚÔ 1. ∆Ô ÙÂÏÂ˘Ù·›Ô ·˘Ùfi ·È‰› ›-¯Â ÓÔÛËÏ¢Ù› Ì ›ÎÙÂÚÔ Î·È ÚÔ ‰ÈÂÙ›·˜, ÔfiÙ‰ȷÈÛÙÒıËΠϋÚ˘ ¤ÏÏÂÈ„Ë G6PD, ÂÓÒ ÙÔ ˘Â-Ú˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ÕÙ˘·ÎÔÈÏȷο Û˘ÌÙÒÌ·Ù· ›¯·Ó 2 ·È‰È¿ Î·È 3 ‹Ù·Ó·Û˘Ìو̷ÙÈο.

¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯Ô-ÏfiÏÈıˆÓ ·Ó¢ڤıËÛ·Ó Û 7/9 ·È‰È¿: 2 ·È‰È¿ ÌÂÚÔˆÚfiÙËÙ· Î·È ·Ú·ÙÂٷ̤ÓË Ï‹„Ë ·ÚÂÓÙÂÚÈ-΋˜ ‰È·ÙÚÔÊ‹˜ (2 Î·È 2ó Ì‹Ó˜), 1 Ì ÚÔˆÚfiÙË-Ù· Î·È ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË, 1 Ì ۇӉÚÔÌÔGilbert, 1 Ì ϋÚË ¤ÏÏÂÈ„Ë G6PD, 1 Ì ÂÙÂÚfi˙˘ÁÔ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Û˘Ó‡·ÚÍË ÙÚÈÏ·ÛÈ·-Ṳ̂ÓÔ˘ · ÁfiÓÔ˘ Î·È 1 ·È‰› ÌÂ Û˘Ó‰˘·ÛÌfi ÔÏÏÒÓ·Ú·ÁfiÓÙˆÓ (ÚÔˆÚfiÙËÙ·, Ï‹ÚË ¤ÏÏÂÈ„Ë G6PD,Û‡Ó‰ÚÔÌÔ Gilbert). ™Â 2 ·È‰È¿ ‰ÂÓ ·Ó¢ڤıËÛ·ÓÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜. £ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi ¯ÔÏÔÏÈı›·Û˘ ‰È·ÈÛÙÒıËΠ۠4 ·È‰È¿.

∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ·˘ÍË̤Ó˜ÙÚ·ÓÛ·ÌÈÓ¿Û˜ (SGOT: 186 U/L, SGPT: 121 U/L)·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ Û 1 ·È‰›, ÙÔ ÔÔ›Ô Â›¯ÂÔÚȷο ·˘ÍË̤ÓË Î·È ÙËÓ ¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË (ÔÏ.¯ÔÏ.: 1,49 mg%, ·Ì.: 0,53 mg%). ™ÙÔ ·È‰› ·˘Ùfi, Ë·Ê·ÈÚÂı›۷ ¯ÔÏˉfi¯Ô˜ ·ÛÙË Â›¯Â ÂӉ›ÍÂȘ ¯Úfi-ÓÈ·˜ ¯ÔÏÔ΢ÛÙ›Ùȉ·˜. ª¤ÙÚÈ· ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·È-Ì›· ¤ÌÌÂÛÔ˘ Ù‡Ô˘ ›¯·Ó Ù· ·È‰È¿ Ì ·ÈÌÔÏ˘ÙÈ΋‰È·Ù·Ú·¯‹ ‹ Û. Gilbert. ŸÏ· Ù· ·È‰È¿ ›¯·Ó Ê˘-ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ·Ì˘Ï¿Û˘, ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿-Û˘, Á-GT, Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ∆∫∂.

ÃÔÏÔ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ Û 4/9 ·È‰È¿, Û 3 ÌÂÙ˘Èο Û˘ÌÙÒÌ·Ù· Î·È Û 1 ·Ú¯Èο ·Û˘Ìو̷ÙÈ-Îfi. ªÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô Î·È Ù· 4 ·È‰È¿ Â›Ó·È Âχ-ıÂÚ· Û˘Ìو̿وÓ. ∆· ˘fiÏÔÈ· 5 Â›Ó·È ˘fi ·-Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ¤Ó· ̤ÛÔ ‰È¿ÛÙËÌ· 3,2 ¯ÚfiÓˆÓ(6 Ì‹Ó˜ ˆ˜ 5 ¯ÚfiÓÈ·) Î·È ·Ú·Ì¤ÓÔ˘Ó ·Û˘ÌÙˆ-Ì·ÙÈο. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ¤Ó· ·È‰› ËÏÈΛ·˜ 9¯ÚfiÓˆÓ ·ÚÔ˘Û›·Û ·˘ÙfiÌ·ÙË Ï‡ÛË ÙˆÓ ¯ÔÏfiÏÈ-ıˆÓ. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¯ÔÏfiÏÈıÔÈ ÛÙËÓ ˘ÂÚ˯Ô-ÁÚ·ÊÈ΋ ·ÓÂÎÙ›ÌËÛË Ô˘ ¤ÁÈÓ ÛÙÔ˘˜ 6 Ì‹Ó˜·fi ÙË ‰È¿ÁÓˆÛË. ∂›Û˘, ¤Ó· ·È‰›, ·Ú¯Èο ·Û˘-Ìو̷ÙÈÎfi, ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù· ηٿ ÙËÓÂÚ›Ô‰Ô Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¯ÂÈÚÔ˘ÚÁ‹ıË-ÎÂ. ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·ÛÂÂÈÏÔΤ˜.

™˘˙‹ÙËÛË∏ ¯ÔÏÔÏÈı›·ÛË ÂÚÈÁÚ¿ÊËΠÚÒÙË ÊÔÚ¿ ÛÂ

·È‰È·ÙÚÈÎfi ·ÛıÂÓ‹ ÚÈÓ 250 Î·È Ï¤ÔÓ ¯ÚfiÓÈ·,

¶›Ó·Î·˜ 1. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌË ·ÈÌÔÏ˘ÙÈ΋˜ ¯Ô-ÏÔÏÈı›·Û˘

ñ OÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ñ ¶ÚÔˆÚfiÙËÙ·, ʈÙÔıÂڷ›· ñ ¡fiÛÔ˜ ˘·ÏÔÂȉԇ˜ ÌÂÌ‚Ú¿Ó˘, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘-

ÛÏ·Û›· ñ ™˘ÛÙËÌ·ÙÈ΋ Ïԛ̈ÍË ‹ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ñ ∂ÎÙÔÌ‹ ÂÈÏÂÔ‡, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, Ó. Crohn,

ÙÚ·‡Ì· ñ ∞ӈ̷ϛ˜ ¯ÔÏËÊfiÚˆÓ Î·È ¯ÔÏˉfi¯Ô˘ ·ÛÙˆ˜ ñ ∂Á΢ÌÔÛ‡ÓË, ·ÓÙÈÛ˘ÏÏËÙÈο per os ñ ¶·¯˘Û·ÚΛ· ñ ∆Ú·˘Ì·ÙÈÛÌÔ› Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ·Ú·ÙÂٷ̤ÓË

·ÎÈÓËÛ›· ñ ∞Ê˘‰¿ÙˆÛË, ¤ÌÂÙÔÈ, ¯ÔÚ‹ÁËÛË ÊÔ˘ÚÔÛÂÌ›‰Ë˜

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fiÙ·Ó ÔÏÏ·ÏÔ› ¯ÔÏfiÏÈıÔÈ ·Ó¢ڤıËÛ·Ó ÛÙÔÓ ÎÔÈ-Ófi ¯ÔÏˉfi¯Ô fiÚÔ, ηٿ ÙËÓ ·˘ÙÔ„›· ÂÓfi˜ ·ÁÔÚÈ-Ô‡ 13 ¯ÚfiÓˆÓ (9). ∏ ¯ÔÏÔÏÈı›·ÛË ·Ú·Ì¤ÓÂÈ Ì›··Û˘Ó‹ı˘ ηٿÛÙ·ÛË ÛÙ· ·È‰È¿, ·Ó Î·È ÚfiÛÊ·-Ù˜ ÛÂÈÚ¤˜ ÂȂ‚·ÈÒÓÔ˘Ó Ì›· ·˘Í·ÓfiÌÂÓË Â›-ÙˆÛË Ù˘ ÓfiÛÔ˘ (4,10), Ë ÔÔ›· ı· ÌÔÚÔ‡Û ÌÂ-ÚÈÎÒ˜ Ó· ÂÍËÁËı› ·fi ÙË Û˘¯Ó‹ ¯Ú‹ÛË ÙÔ˘ ˘Â-Ú˯ÔÁÚ·Ê‹Ì·ÙÔ˜. ™Â ‰‡Ô ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜,ÛÙȘ Ôԛ˜ Ë ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ Ì ‚¿ÛËÙ· ·Ú¯Èο Û˘ÌÙÒÌ·Ù·, ¯ÔÏfiÏÈıÔÈ ·Ó¢ڤıËÛ·ÓÛ ÔÛÔÛÙfi 0,13%-0,19% (11,12). ™Â ÙÂÏÂ˘Ù·›·ÌÂϤÙË 4.200 ·È‰ÈÒÓ, Ô˘ ¤Î·Ó·Ó ˘ÂÚ˯ÔÁÚ¿-ÊËÌ· ÎÔÈÏ›·˜ ÁÈ· ‰È¿ÊÔÚ· ·›ÙÈ·, ¯ÔÏfiÏÈıÔÈ ·Ôη-χÊıËÎ·Ó Û ÔÛÔÛÙfi 1,9%, ‡ÚËÌ· ÙÔ ÔÔ›Ô·Ô‰fiıËΠ·fi ÙÔ˘˜ ÌÂÏÂÙËÙ¤˜ ÛÙËÓ ÂÓÙfiÈÛË Â-ÚÈÛÛfiÙÂÚˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ¯ÔÏfiÏÈıˆÓ ̤ۈÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ (10).

∏ ¯ÔÏÔÏÈı›·ÛË ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜Â›Ó·È Û˘Ó‰Â‰Â̤ÓË Ì ÎÏËÚÔÓÔÌÈΤ˜ ·ÈÌÔÏ˘ÙÈΤ˜‰È·Ù·Ú·¯¤˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ·È‰È¿ Ì ‰Ú·ÓÔ-΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿Úˆ-ÛË Î·È ·Ó¿ÚÎÂÈ· G6PD ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ‰Â˘ÙÂÚÔ·ıÒ˜ ·fi Ù˯ÚfiÓÈ· ·ÈÌfiÏ˘ÛË, Ë ÔÔ›· ÚÔηÏ› ·˘ÍË̤ÓË ·-Ú·ÁˆÁ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘. ™Â ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜, ·˘-ÙÔ› ÔÈ ·ÛıÂÓ›˜ ·ÔÙÂÏÔ‡Ó ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÚÈÙÒÛÂˆÓ (1,2). øÛÙfiÛÔ, ÙȘÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÙÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Î·È ÂÊ‹-‚ˆÓ Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó ¯ÔÏÔÏÈı›·ÛË ÏfiÁˆ ˘ÔΛ-ÌÂÓ˘ ·ÈÌ·ÙÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ ·ÊÔÚ¿ ÙÔ 20%-25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5,10). ™ÙË ‰È΋ Ì·˜ ÌÂϤ-ÙË, ‰‡Ô ·ÛıÂÓ›˜ (22,2%) ›¯·Ó ˘ÔΛÌÂÓË ·ÈÌÔ-Ï˘ÙÈ΋ ‰È·Ù·Ú·¯‹.

∆Ô Û‡Ó‰ÚÔÌÔ Gilbert, Ì›· ηÏÔ‹ı˘, Û˘¯Ó‹ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘¯ÔÏÂÚ˘ıÚ›Ó˘, Úԉȷı¤ÙÂÈ Û ۯËÌ·ÙÈÛÌfi ¯ÔÏfi-ÏÈıˆÓ. ™˘ÁÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘Gilbert Ì ·Ó¿ÚÎÂÈ· ÙÔ˘ G6PD ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó-‰˘ÓÔ ÁÈ· ¯ÔÏÔÏÈı›·ÛË. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙÔ Û˘Ó-‰˘·ÛÌfi Ù˘ ·˘ÍË̤Ó˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ·fi ÙË ¯Úfi-ÓÈ· ·ÈÌfiÏ˘ÛË Î·È ÙË ÌÂȈ̤ÓË Ë·ÙÈ΋ Ù˘ Û‡Ó‰Â-ÛË (13,14). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ¤Ó· ·È‰› ›¯ÂÛ‡Ó‰ÚÔÌÔ Gilbert Î·È ¤Ó· ¿ÏÏÔ Û˘Ó‡·ÚÍË Û˘Ó-‰ÚfiÌÔ˘ Gilbert Ì ϋÚË ¤ÏÏÂÈ„Ë G6PD. ∫·È Ù·‰‡Ô ·È‰È¿ ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¯Ô-ÏÔÏÈı›·Û˘.

µÚ¤ÊË Î·È ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÚÂÓÙÂÚÈ΋‰È·ÙÚÔÊ‹ Â›Ó·È Û ΛӉ˘ÓÔ ÁÈ· ·Ó¿Ù˘ÍË ¯ÔÏÔÏ›-ıˆÓ (15). O ΛӉ˘ÓÔ˜ ·˘Ùfi˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÌÂ-Á·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ÂÓ‰ÔÊϤ-‚È· ‰È·ÙÚÔÊ‹ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 30 Ë̤Ú˜,¯ˆÚ›˜ Û˘Ìϋڈ̷ ‰È·ÙÚÔÊ‹˜ ·fi ÙÔ ÛÙfiÌ·(5,16). ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, Ë ¯ÔÏÈ΋ ÛÙ¿ÛË Î·ÈË Á·ÛÙÚÂÓÙÂÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Èı·ÓfiÓ Ó· ›ӷÈ

ÔÈ ÚˆÙ·Ú¯ÈÎÔ› ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙËÓ ·-ıÔÁ¤ÓÂÛË Ù˘ ¯ÔÏÔÏÈı›·Û˘. ∏ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛËÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ÌÔÚ› Ó· ÂÌÔ‰›˙ÂÈ ÙÔ Û¯Ë-Ì·ÙÈÛÌfi ÙˆÓ ¯ÔÏfiÏÈıˆÓ (5). ™˘ÓÈÛÙ¿Ù·È ˘ÂÚ˯Ô-ÁÚ·ÊÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÁÈ·Èı·Ófi Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ÁÈ· ‰È¿ÛÙËÌ· ÙÔ˘-Ï¿¯ÈÛÙÔÓ 10 ¯ÚfiÓˆÓ (17). ™Â ÔÚÈṲ̂ӷ ‚Ú¤ÊË ·Ó·-ʤÚÂÙ·È ·˘ÙfiÌ·ÙË Ï‡ÛË ÙˆÓ ¯ÔÏfiÏÈıˆÓ 2 ‚‰ÔÌ¿-‰Â˜ ˆ˜ 6 Ì‹Ó˜ ·fi ÙË ‰È¿ÁÓˆÛË (18). ∞fi ÙÔ˘˜·ÛıÂÓ›˜ Ì·˜, ‰‡Ô ›¯·Ó ÈÛÙÔÚÈÎfi ÚÔˆÚfiÙËÙ·˜Ì ·Ú·ÙÂٷ̤ÓË Ï‹„Ë ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜.∏ ËÏÈΛ· ‰È¿ÁÓˆÛ˘ Ù˘ ¯ÔÏÔÏÈı›·Û˘ ‹Ù·Ó 3 ηÈ14 ¯ÚfiÓÈ· ·ÓÙ›ÛÙÔȯ·. ∫·È ÛÙ· ‰‡Ô ·È‰È¿ ‰ÂÓ Â›¯ÂÁ›ÓÂÈ ÚÔËÁÔ‡ÌÂÓ· ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜.

¡ÔÛ‹Ì·Ù· ÙÔ˘ ÂÈÏÂÔ‡ ‹ ÂÎÙÔÌ‹ ÙÔ˘ Ô˘ ÂÌÔ-‰›˙Ô˘Ó ÙË Ê˘ÛÈÔÏÔÁÈ΋ ΢ÎÏÔÊÔÚ›· ÙˆÓ ¯ÔÏÈÎÒÓ·Ï¿ÙˆÓ, Úԉȷı¤ÙÔ˘Ó Û ۯËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ.∂ÌϤÎÔÓÙ·È ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë ÓÂÎÚˆÙÈ-΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, Ë ÓfiÛÔ˜ Crohn, ÙÔ ÏÂÌÊ·ÁÁ›-ˆÌ· ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È Ë ‚Ï¿‚Ë ÙÔ˘ ÂÈÏÂÔ‡ ·fi·ÎÙÈÓÔ‚ÔÏ›· (18). ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜‰ÂÓ Â›¯Â ÓfiÛËÌ· ÙÔ˘ ÂÈÏÂÔ‡.

™Â ‰‡Ô ·ÛıÂÓ›˜ (22,2%) ‰ÂÓ ·Ó¢ڤıËÛ·Ó ·-Ú¿ÁÔÓÙ˜ Ô˘ Ó· Úԉȷı¤ÙÔ˘Ó ÛÙÔ Û¯ËÌ·ÙÈÛÌfi¯ÔÏfiÏÈıˆÓ. ∆Ô ›‰ÈÔ ÔÛÔÛÙfi ·Ó·Ê¤ÚıËΠ·fiÙÔ˘˜ Reif Î·È Û˘Ó (6), fiˆ˜ Î·È ·fi ÙÔ˘˜ WesdorpÎ·È Û˘Ó (10).

OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ¯ÔÏÔÏÈı›·Û˘ ÛÙ··È‰È¿ ÔÈΛÏÔ˘Ó Â˘Ú¤ˆ˜ Î·È ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓËÏÈΛ· Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÛ¯ËÌ·ÙÈÛÌfi ÙˆÓ ¯ÔÏfiÏÈıˆÓ. ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ÂÓ‹ÏÈΘ, Ù· ·È‰È¿ Û˘¯Ó¿ ¤¯Ô˘Ó ÌË ÂȉÈο ÎÔÈÏÈ·-ο ÂÓԯϋ̷ٷ Î·È ‰ÂÓ ÌÔÚÔ‡Ó Ì ·ÎÚ›‚ÂÈ· Ó·ÂÚÈÁÚ¿„Ô˘Ó Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘˜. ŒÙÛÈ, ÎÏ·ÛÈÎ¿Û˘ÌÙÒÌ·Ù·, fiˆ˜ fiÓÔ˜ ÛÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ ‹ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, ¤ÌÂÙÔÈ Î·È ‰˘Û·ÓÂÍ›· ÛÙËÏ‹„Ë ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÌÂÁ·-χÙÂÚ· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ. ∆· ÌÈÎÚfiÙÂÚ· ·È‰È¿,΢ڛˆ˜ οو ÙˆÓ 5 ¯ÚfiÓˆÓ, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó‹-ıˆ˜ ÌË ÂȉÈο Û˘ÌÙÒÌ·Ù·. ∂˘ÂÚÂıÈÛÙfiÙËÙ·, ΢-Ú›ˆ˜ ÌÂÙ¿ Ù· Á‡̷ٷ, ı· ÌÔÚÔ‡Û ӷ ˘Ô‰ËÏÒ-ÓÂÈ Èı·Ó‹ ¯ÔÏÔÏÈı›·ÛË, ȉȷ›ÙÂÚ· Û ÚfiˆÚ· ‚Ú¤-ÊË ‹ ‚Ú¤ÊË Ì ÈÛÙÔÚÈÎfi ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜‹ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ (6). ∂›Û˘, Û˘¯Ó¿Ë ¯ÔÏÔÏÈı›·ÛË Â›Ó·È ·Û˘Ìو̷ÙÈ΋ Î·È ·Ôηχ-ÙÂÙ·È Ù˘¯·›·, fiˆ˜ Ì ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ-¯Ô Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ·fi Ô˘ÚÔÏԛ̈ÍË. ™ÙË ÌÂϤÙËÌ·˜, 3 ·È‰È¿ (33,3%) ‹Ù·Ó ·Û˘Ìو̷ÙÈο.

O ›ÎÙÂÚÔ˜ ÌÔÚ› Ó· ¤¯ÂÈ Û¯¤ÛË Â›Ù Ì ·fi-ÊÚ·ÍË ÙÔ˘ ÎÔÈÓÔ‡ ¯ÔÏˉfi¯Ô˘ fiÚÔ˘ ‹ Ì ÊÏÂÁ-ÌÔÓ‹ Ù˘ ¯ÔÏˉfi¯Ô˘ ·ÛÙ˘ ·fi ÙÔ˘˜ ¯ÔÏfiÏÈ-ıÔ˘˜. ∏ ¯ÔÏˉԯÔÏÈı›·ÛË ÛÙ· ·È‰È¿ Ê·›ÓÂÙ·È Ó·Â›Ó·È Û¿ÓÈ·. ™ÙË ÛÂÈÚ¿ ÙˆÓ Reif Î·È Û˘Ó, Û ηӤ-Ó· ·fi Ù· 50 ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË ‰ÂÓ ‚Ú¤ıËÎÂ

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¯ÔÏˉԯÔÏÈı›·ÛË (6). ¢‡Ô ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜Â›¯·Ó ›ÎÙÂÚÔ, ·ÏÏ¿ Î·È ÔÈ 2 ›¯·Ó ˘ÔΛÌÂÓË ·ÈÌÔ-Ï˘ÙÈ΋ ‰È·Ù·Ú·¯‹ ‹ ÓfiÛÔ Gilbert.

∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤¯ÂÈ ·˘Í‹ÛÂÈ ÛËÌ·ÓÙÈοÙË ‰È·ÁÓˆÛÙÈ΋ Ì·˜ ·ÎÚ›‚ÂÈ· Î·È Â˘·ÈÛıËÛ›· ÛÙÔÓÂÓÙÔÈÛÌfi ÙˆÓ ¯ÔÏfiÏÈıˆÓ. ÕÏϘ ‰È·ÁÓˆÛÙÈΤ˜ ̤-ıÔ‰ÔÈ, fiˆ˜ Ë ÂÓ‰ÔÛÎÔÈ΋ ·Ï›Ó‰ÚÔÌË ¯ÔÏ·ÁÁÂÈ-Ô·ÁÎÚ·ÙÔÁÚ·Ê›· (ERCP), ı· Ú¤ÂÈ Ó· ÂÊ·Ú-Ìfi˙ÔÓÙ·È fiÙ·Ó Ù· ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ‰ÂÓÂ›Ó·È ÂÈÛÙÈο ‹ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ·Óˆ-̷ϛ˜ ÙˆÓ ¯ÔÏËÊfiÚˆÓ Ô‰ÒÓ ‹ ÂÈÏÔΤ˜ Ù˘ Ófi-ÛÔ˘.

OÈ ÂÈÏÔΤ˜ Ù˘ ¯ÔÏÔÏÈı›·Û˘ fiˆ˜ ¯ÔÏÔ΢-ÛÙ›Ùȉ·, ¯ÔÏˉԯÔÏÈı›·ÛË, ¯ÔÏ·ÁÁÂÈ›Ùȉ·, ‰È¿ÙÚË-ÛË Î·È ·ÁÎÚ·ٛÙȉ·, ‰ÂÓ Â›Ó·È Û˘¯Ó¤˜ ÛÙ· ·È‰È¿.™Â ÚfiÛÊ·ÙË ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË, ÂÈÏÔΤ˜ ·-ÚÔ˘Û›·Û·Ó 6 ·fi Ù· 82 ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË. ∫·-Ì›· fï˜ ·fi ·˘Ù¤˜ ÙȘ ÂÈÏÔΤ˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿-ÛÙËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÌË ÂȉÈο ÎÔÈÏȷο Û˘-ÌÙÒÌ·Ù· (19/82) ‹ ÛÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜·ÛıÂÓ›˜ (14/82) Ù˘ ÌÂϤÙ˘ (10). ™ÙËÓ ·ÚÔ‡Û·ÌÂϤÙË, ÌfiÓÔ ¤Ó·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ¯ÔÏÔ΢-ÛÙ›Ùȉ·.

£Âڷ›· ÂÎÏÔÁ‹˜ ÁÈ· ÙÔ˘˜ ¯ÔÏfiÏÈıÔ˘˜ وӷȉÈÒÓ Ô˘ ¤¯Ô˘Ó ÎÏ·ÛÈο Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë¯ÔÏÂ΢ÛÙÂÎÙÔÌ‹. øÛÙfiÛÔ, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·-›· ‰ÂÓ Ê·›ÓÂÙ·È Ó· ‰›ÓÂÈ ¿ÓÙ· χÛË ÛÙËÓ ˘Ô-¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ. ∫·Ù¿ ÙË ‰ÈÂıÓ‹ ‚È-‚ÏÈÔÁÚ·Ê›·, 10%-45% ÙˆÓ ¯ÂÈÚÔ˘ÚÁËı¤ÓÙˆÓ ·È-‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘ÔÙÚÔ‹ ÙˆÓ ·Ú¯ÈÎÒÓ Û˘ÌÙˆ-Ì¿ÙˆÓ (10,19). ÃÔÏÂ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ Û 4 ·fiÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜, ÔÈ ÔÔ›ÔÈ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛËÂ›Ó·È ÂχıÂÚÔÈ Û˘Ìو̿وÓ.

∆· ·È‰È¿ Ì ¯ÔÏfiÏÈıÔ˘˜ Î·È ÌË ÂȉÈο ÎÔÈÏÈ·Î¿Û˘ÌÙÒÌ·Ù· ·ÔÙÂÏÔ‡Ó ‰È·ÁÓˆÛÙÈÎfi Î·È ıÂÚ·-¢ÙÈÎfi ‰›ÏËÌÌ·. ∆· Û˘ÌÙÒÌ·Ù· ÌÔÚ›, ·ÏÏ¿ÌÔÚ› Î·È Ó· ÌËÓ ÔÊ›ÏÔÓÙ·È ÛÙË ¯ÔÏÔÏÈı›·ÛË. OÈBrush Î·È Û˘Ó ·Ú·ÎÔÏÔ‡ıËÛ·Ó 41 Ù¤ÙÔÈ· ·È‰È¿,·ÊÔ‡ Ù· ¤ıÂÛ·Ó Û ‰›·ÈÙ· ÊÙˆ¯‹ Û ϛԘ ηÈÏÔ‡ÛÈ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜, ÁÈ· Ó· ‰È·ÈÛÙÒÛÔ˘Ó ·ÓÔÈ ·Û˘Ìو̷ÙÈÎÔ› ¯ÔÏfiÏÈıÔÈ ÌÔÚÔ‡Ó Ì ·ÛÊ¿-ÏÂÈ· Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Û˘ÓÙËÚËÙÈο. ªÂÙ¿ ·fi̤ÛÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ 21 ÌËÓÒÓ (3-41Ì‹Ó˜), ÙÔ 82% ÙˆÓ ·È‰ÈÒÓ Â›¯Â Ï‹ÚË ‹ ÌÂÚÈ΋˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ, ÂÓÒ ÔÛÔÛÙfi 18%·Ú¤ÌÂÈÓÂ Û˘Ìو̷ÙÈÎfi Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ̯ÔÏÂ΢ÛÙÂÎÙÔÌ‹ (19). ∂›Û˘, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·fiÙÔ˘˜ ÂÓ‹ÏÈΘ Ì ·Û˘Ìو̷ÙÈ΋ ¯ÔÏÔÏÈı›·ÛË, Ìfi-ÓÔ 10%-25% ·Ó·Ù‡ÛÛÂÈ Û˘ÌÙÒÌ·Ù·, Ù· ÔÔ›·Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÔÓÙ·È ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛËÂÈÏÔÎÒÓ (8). ∞fi Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷʷ›ÓÂÙ·È ˆ˜ Ë Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ·È‰ÈÒÓ Ì ÌË ÂȉÈ΋ ‹ ·Û˘Ìو̷ÙÈ΋ ÚÔ‚ÔÏ‹Ù˘ ¯ÔÏÔÏÈı›·Û˘ Â›Ó·È ·Ô‰ÂÎÙ‹. ™ÙË ‰È΋ Ì·˜

ÌÂϤÙË, ÌfiÓÔ ¤Ó· ·Ú¯Èο ·Û˘Ìو̷ÙÈÎfi ·È‰› ·-ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù·, ¯ˆÚ›˜ ÂÈÏÔΤ˜ ηٿ ÙËÓÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ.

∫·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜, Ë ¯ÔÏÔÏÈ-ı›·ÛË ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Û ·˘ÍË̤ÓÔ ·ÚÈıÌfi ·È-‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ. ∏ ‰È¿ÁÓˆÛË ·˘Ù‹ Ú¤ÂÈ Ó·Ï·Ì‚¿ÓÂÙ·È ˘’ fi„Ë Î·Ù¿ ÙËÓ ÂÎÙ›ÌËÛË ·È‰ÈÒÓ ÌÂÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈÎfi, ȉȷ›ÙÂÚ· ·Ó ˘¿Ú-¯Ô˘Ó ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔ-ÓÙ˜. ∏ ·Ú¯‹ ·˘Ù‹ Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ·ÎfiÌËÎ·È Û ‚Ú¤ÊË, ΢ڛˆ˜ Û ·˘Ù¿ Ì ÈÛÙÔÚÈÎfi ÚÔˆ-ÚfiÙËÙ·˜ Î·È ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. ªÂ ‚¿ÛË Ù·ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù·, Ù· ·È‰È¿ Ì ¯ÔÏfiÏÈıÔ˘˜ÌÔÚÔ‡Ó Ó· ¯ˆÚÈÛÙÔ‡Ó Û 2 ÔÌ¿‰Â˜. ∞˘Ù¿ ÌÂ Ù˘-Èο Û˘ÌÙÒÌ·Ù· ¯ÚÂÈ¿˙ÔÓÙ·È ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹.∞Û˘Ìو̷ÙÈο ·È‰È¿ Î·È ·È‰È¿ Ì ¿Ù˘· Û˘-ÌÙÒÌ·Ù· ÌÔÚÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· Ó· ·ÓÙÈÌÂÙˆÈ-ÛÙÔ‡Ó Û˘ÓÙËÚËÙÈο. ∞˘Ù¿ Ù· ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·ÈÛ˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· Ó· ·Ó·ÁÓˆÚÈÛÙ›¤ÁηÈÚ· ÂӉ¯fiÌÂÓË ÂÌÊ¿ÓÈÛË Û˘Ìو̿وÓ,ÔfiÙÂ Î·È ı· ¯ÚÂÈ·ÛÙÔ‡Ó ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹.

µÈ‚ÏÈÔÁÚ·Ê›·1. Ariyan S, Shessel FS, Pickett LK. Cholecystitis and

cholelithiasis masking as abdominal crisis in sickle celldisease. Pediatrics 1976;58:252-258.

2. Lan GE, Andrassy RJ, Mahour GH. A 30-year review of themanagement of gallbladder disease at a children’shospital. Am J Surg 1983;49:411-413.

3. Andrassy RJ, Treadwell TA, Ratner IA, Buckley CJ.Gallbladder disease in children and adolescents. Am JSurg 1976;132:19-21.

4. Bailey VP, Robert H, Tracy FT, Sotelo-Avila CJ, Lewis E,Weber RT et al. Changing spectrum of cholelithiasis andcholecystitis in infants and children Am J Surg1989;158:585-588.

5. Holcomb WG, Holcomb WG, III. Cholelithiasis in infants,children, and adolescents. Pediatr Rev 1990;11:268-276.

6. Reit C, Daniel G, Lebenthal E. Gallstones in children. AJDC1991;145:105-108.

7. Hopper DK, Landis JR, Meilstrup JW, McCauslin AM,Sechtin GA. The prevalence of asymptomatic gallstones inthe general population. Invest Radiol 1991;26:939-945.

8. McSherry CK, Ferstenberg H, Calhoun WF. The naturalhistory of diagnosed gallstone disease in symptomatic andasymptomatic patients. Ann Surg 1985;202:59-63.

9. Gibson J. An extraordinary large gallbladder and hydropiccystitis. Medical assays and observations. Philosoph SocEdin 1737;2:352.

10. Wesdorp I, Bosman D, Graaff A, Arohson D, Blij VF,Taminiau J. Clinical presentations and predisposingfactors of cholelithiasis and sludge in children. J PediatrGastroenterol Nutr 2000;31:411-417.

11. Palasciano G, Portincasa P, Vinciguerra V. Gallstoneprevalence and gallbladder volume in children andadolescents: an epidemiological ultrasonography surveyand relationship to body mass index. Am J Gastroenterol

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1989;84:1378-1382. 12. Gilger MA. Cholelithiasis and cholecystitis. In: Wyllie R,

Hyams JS, eds. Pediatric Gastrointestinal Disease. W.B.Saunders Co; 1993. p. 931-940.

13. Giudice ME, Perrota S, Nobili B, Specchia C, Urzo G,Iolascon A. Coinheritance of Gilbert syndrome increasesthe risk for developing gallstones in patients withhereditary spherocytosis. Blood 1999;94:2259-2262.

14. Meloni T, Forteleoni G, Noja G, Dettori G, Sale MA, MelaniGF. Increased prevalence of glucose-6 phosphatedehydrogenase deficiency in patients with cholelithiasis.Acta Haematol 1991;85:76-79.

15. King RD, Ginn-Paese EM, Lioyd VT, Hoffman J, ColumbusHK. Parenteral nutrition with associated cholelithiasis:Another iatrogenic disease of infants and children. JPediatr Surg 1987;22:593-596.

16. Pitt HA, King W, Mann LL. Increased risk of cholelithiasiswith prolonged parenteral nutrition. Am J Surg

1983;145:106-112. 17. Schweizer P, Lenz MP, Kirschner HJ. Pathogenesis and

symptomatology of cholelithiasis in childhood. Aprospective study. Dig Surg 2000;17:459-467.

18. Debray D, Pariente D, Gauthier F, Myara A, Bernard O.Cholelithiasis in infancy: A study of 40 cases. J Pediatr1993;122:385-391.

19. Brush WS, Ein HS, Rocchi C, Kim CWP. The managementof nonpigmented gallstones in children. J Pediatr Surg2000;35:729-732.

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132

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-11-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-02-2002

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ÁÁÂÏÈ΋ ª‹ÙÛÈη ¶›Ó‰Ô˘ 9-11, ∆∫. 152 35, µÚÈÏ‹ÛÛÈ·

™ÎÔfi˜: O ÚfiÏÔ˜ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ (H.pylori) ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·Ï-ÁÒÓ ·Ú·Ì¤ÓÂÈ ·Û·Ê‹˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂ-Ú¢ÓËı› ·Ó Û ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË Î·ÈÏԛ̈ÍË ·fi H. pylori Ù· Û˘ÌÙÒÌ·Ù· ÂÍ·Ê·Ó›˙ÔÓÙ·È ÌÂÙ¿ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 37 ·È‰È¿ ËÏÈΛ·˜ 4,9-14,5 ÂÙÒÓ (‰È¿ÌÂÛËËÏÈΛ· 9,8 ¤ÙË) Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË Î·È Ïԛ̈-ÍË ·fi H. pylori ·ÔÙ¤ÏÂÛ·Ó ÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘. ∏ ‰È¿-ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi H. pylori ¤ÁÈÓ Ì ÈÛÙÔÏÔÁÈ΋ Âͤٷ-ÛË Î·È Î·ÏÏȤÚÁÂÈ·. ¢fiıËΠ·ÁˆÁ‹ ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H.pylori Î·È ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ·ÁˆÁ‹˜ ¤ÁÈÓ ·ӿ-ÏË„Ë Ù˘ Á·ÛÙÚÔÛÎfiËÛ˘ Ì ϋ„Ë ‚ÈÔ„ÈÒÓ. ∏ ·ÚÔ˘Û›· ‹fi¯È Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù·ÁÚ¿ÊËΠ3 Î·È 6 Ì‹Ó˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜Ù˘ ıÂڷ›·˜ ÂÎÚ›˙ˆÛ˘ Î·È ·Ú¿ÏÏËÏ· ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ·ÓÙÈ-ÛˆÌ¿ÙˆÓ ÁÈ· H. pylori ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜. ∫·Ù¿ ÙËÓ Â-Ú›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÓ‰ÔÛÎfiË-Û˘ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ ‰ÂÓ ÁÓˆÛÙÔÔÈ‹ıËÎ·Ó ÛÂ23 ·ÛıÂÓ›˜, ÂÓÒ ¤ÁÈÓ·Ó ÁÓˆÛÙ¿ Û 14, Û‡Ìʈӷ Ì ÙËÓ ÂÈ-ı˘Ì›· ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ. ∞ÔÙÂϤÛÌ·Ù·: ∆· ÔÛÔÛÙ¿ ÂÎÚ›˙ˆÛ˘ ‹Ù·Ó 81% (30/37)ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Î·È 74% (17/23) ÛÙËÓ Ù˘ÊÏ‹ ÔÌ¿‰·.∆· IgG ·ÓÙÈÛÒÌ·Ù· ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο ÛÙÔ˘˜ 3 Ì‹Ó˜(p<0,03), ηıÒ˜ ›Û˘ Î·È ÛÙÔ˘˜ 6 Ì‹Ó˜ (p<0,001) ÛÙ·

·È‰È¿ Ì ÂÈÙ˘¯‹ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ ÌÂÈÒıËÎÂ Î·È ˘‹Ú¯Â ‚ÂÏÙ›ˆÛË Ù˘ ÁÂÓÈ΋ηٿÛÙ·Û˘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (95%) 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ·ÁˆÁ‹. ¢ÂÓ ‚Ú¤ıËΠfï˜ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÎÚ›˙ˆÛ˘ ‹fi¯È ÙÔ˘ H. pylori Î·È ÂÍ·Ê¿ÓÈÛ˘ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ, ›ÙÂÛÙÔ˘˜ 3 Î·È 6 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È-‰ÈÒÓ (p=0,94 Î·È p=0,90), ›Ù ÛÙËÓ Ù˘ÊÏ‹ ÔÌ¿‰· (p=0,42Î·È p=0,65). ™˘ÌÂÚ¿ÛÌ·Ù·: ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘‰ÂÓ ·Ô‰ÂÈÎÓ‡ÂÙ·È ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ˘ÔÙÚÔÈ·-˙fiÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ Î·È H. pylori.

£Âڷ›· ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ Û ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË1

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›·

1Wewer V, Andersen LP, Paerregaard A,Gernow A, Hansen JP, Matzen P et al Treatment of Helicobacter pylori in childrenwith recurrent abdominal pain Helicobacter 2001;6:244-248

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ· ¶·È‰›·ÙÚÔ˜-°·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

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¶·È‰È·ÙÚÈ΋ 2002;65:133-137 Paediatriki 2002;65:133-137

133

™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ·fi Ó·ÚΈÙÈΤ˜ Î·È ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ π. ∫·ÂÙ·Ó¿Î˘1, π. ∫·Ï¤ÁÈ·˜1, ª. ª·ÚÎÔ‡ÚË1, °. ∞Ï‚È˙fiÔ˘ÏÔ˜2, °. ∫Ô˘Ú¿Î˘1, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜1

Neonatal withdrawal syndrome from narcotic and non-narcotic drugs. Report of two cases I. Kapetanakis1, J. Kaleyias1, M. Markouri1, G. Alevizopoulos2, G. Kourakis1, ∂. Dellagrammaticas1

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

1 ∆Ì‹Ì· ¡ÂÔÁÂÓÓ‹ÙˆÓ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

2 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÔ‰ÈηÛÙÈ΋˜ Î·È ∆ÔÍÈÎÔÏÔÁ›·˜ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ

1 Neonatal Intensive Care Unit2nd Pediatric Clinic, University of Athens

2 Forensic Medicine and Toxicology Lab, University of Athens

�¶ÂÚ›ÏË„Ë: ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó ÂıÈÛÙ›ÛÙË ¯Ú‹ÛË ‰È·ÊfiÚˆÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘·ËÛ˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚË-Û˘ (™™) ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô ÏfiÁˆ ·ÈÊÓ›‰È·˜ ‰È·-ÎÔ‹˜ Ù˘ ÂıÈÛÙÈ΋˜ Ô˘Û›·˜ Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ÙÔÓÙÔÎÂÙfi. OÈ Ô˘Û›Â˜ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ™™ÛÙÔ ÓÂÔÁÓfi Â›Ó·È ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡Ó ÂÍ¿ÚÙËÛËÛ ÂÓ‹ÏÈΘ, fiˆ˜ Ù· ÔÈÔÂȉ‹ (ËÚˆ›ÓË, ÌÂı·‰fiÓË,ÌÔÚÊ›ÓË), Ù· ‚·Ú‚ÈÙÔ˘ÚÈο, ÙÔ ·ÏÎÔfiÏ Î·È ÔÈ ‚ÂÓ˙Ô-‰È·˙›Ó˜. OÈ ÂΉËÏÒÛÂȘ ÙÔ˘ ™™ Â›Ó·È ÔÈΛϘ ηȷÓÂÍ¿ÚÙËÙ˜ Ù˘ Ô˘Û›·˜ Î·È Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó·‰˘Ó·Ì›· ‡ÓÔ˘, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÙÚfiÌÔ, ˘ÂÚ·ÓÙÈ-‰Ú·ÛÙÈÎfiÙËÙ·, ‰È¿ÚÚÔÈ·, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·,¿ÓÔÈ·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·Ó·Ó¢ÛÙÈ΋ ·ÏοψÛËÎ·È ‰·ÎÚ‡ÚÚÔÈ·. ∏ ÌË ÂȉÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ™™Î·ıÈÛÙ¿ ÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘ ‰˘Û¯ÂÚ‹. º·Ú̷΢ÙÈ΋·Ú¤Ì‚·ÛË ··ÈÙÂ›Ù·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÛÔ‚·ÚÒÓÂΉËÏÒÛˆÓ. ∆· Ê¿Ú̷η Ô˘ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈ-ÌÔÔÈÔ‡ÓÙ·È Â›Ó·È Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÙÔ ·ÚËÁÔÚÈ-Îfi Ï¿‚‰·ÓÔ, Ë ¯ÏˆÚÔÚÔÌ·˙›ÓË Î·È Ë ‰È·˙¿ÌË.¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂȘ ™™ ÛÙË ÓÂÔÁÓÈ΋ËÏÈΛ· ·fi Ó·ÚΈÙÈΤ˜ (ÌÂı·‰fiÓË) Î·È ÌË-Ó·ÚΈÙÈ-Τ˜ (‚ÂÓ˙ԉȷ˙›ÓË) Ô˘Û›Â˜ Ô˘ ›¯·Ó ·ÚfiÌÔÈ·ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ∆Ô Î‡ÚÈÔ Û‡Ìو̷ ‹Ù·Ó Ë ÚÒÈÌˤӷÚÍË Û·ÛÌÒÓ. ∏ ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ· ηٿ-¯ÚËÛ˘ Ê·ÚÌ¿ÎˆÓ ÛÙË ¯ÒÚ· Ì·˜ Ô‰ËÁ› Û ·˘Í·-ÓfiÌÂÓÔ ·ÚÈıÌfi ÓÂÔÁÓÒÓ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› Û ·˘Ù¿ÂÓ‰ÔÌËÙÚ›ˆ˜. ∏ ÚfiÏË„Ë, Ë ıÂڷ›· Î·È Ë ÊÚÔÓÙ›-‰· ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ ÂÈ‚¿ÏÏÂÈ ÙË ÛÙÂÓ‹ Û˘ÓÂÚ-Á·Û›· Ù˘ ÔÏÈÙ›·˜, ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÊÔÚ¤ˆÓ, ÙÔ˘È·ÙÚÈÎÔ‡ Î·È ÙÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡.

�Abstract: A group of symptoms referred to asneonatal withdrawal syndrome (NWS) may occurin infants born to mothers addicted to certaindrugs, as a result of sudden discontinuation of thedrug supply. The classes of drugs that cause NWSare those that produce addiction in adults, such asopiates (heroin, methadone, morphine), barbi-turates, alcohol and benzodiazepines. Many of themanifestations of NWS occur regardless of thedrug type and include wakefulness, irritability,tremors, hyperactivity, diarrhea, respiratorydistress, apnoeic attacks, weight loss, respiratoryalkalosis and lacrimation (WITHDRAWAL). The factthat these symptoms are nonspecific makes theidentification of NWS difficult, unless it isspecifically looked for. Pharmacologic interventionmay be required to control severe signs andsymptoms. The most common drugs used tomodify withdrawal symptoms are phenobarbital,paregoric, chloropromazine, and diazepam. Wereport two neonates with NWS from narcotic(methadone) and non-narcotic (benzodiaze-pamine) drugs which had similar clinical presen-tation. Early onset seizures was the presentingsymptom. The increasing incidence of drug abusein Greece leads to a growing number of childrenwith intrauterine drug exposure. The prevention,therapy, and care of these neonates demands theclose cooperation of the state, social welfareservices, midwives, and the medical and nursingpersonnel.

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∂ÈÛ·ÁˆÁ‹ ∏ ÂÓ‰ÔÌ‹ÙÚÈ· ¤ÎıÂÛË Û ӷÚΈÙÈΤ˜ Î·È ÌË-Ó·Ú-

ΈÙÈΤ˜ Ô˘Û›Â˜ Ô‰ËÁ› Û ÙÔÍÈ΋ ¤ÎıÂÛË ÙÔ˘ ÂÌ‚Ú‡-Ô˘ Î·È Û ۇӉÚÔÌÔ ÛÙ¤ÚËÛ˘ (™™) ÛÙË ÓÂÔÁÓÈ΋ ËÏÈ-Λ· (1). ∏ ÂÍ¿ÚÙËÛË ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ¤¯ÂÈ ·-ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙË ¯ÒÚ· Ì·˜ Ù· ÙÂ-ÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∞fi ÚfiÛÊ·ÙË ÌÂϤÙË ‰È·ÈÛÙÒıË-ΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ¯ÚËÛÙÒÓ ËÚˆ›Ó˘ Ô˘ ‰È·-ÎÔÌ›˙ÔÓÙ·È ÛÙ· ¡ÔÛÔÎÔÌ›· ÏfiÁˆ ˘ÂÚ‚ÔÏÈ΋˜ ‰fi-Û˘, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ·Ó·-·Ú·ÁˆÁÈ΋ ËÏÈΛ· (77% ÙˆÓ ¯ÚËÛÙÒÓ ‹Ù·Ó ÌÂٷ͇15-30 ÂÙÒÓ) (2). ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË Ù˘ Û˘-¯ÓfiÙËÙ·˜ ÂÍ¿ÚÙËÛ˘ ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜, ÚÔ-ÁÚ¿ÌÌ·Ù· ·ÂÍ¿ÚÙËÛ˘ Ì ÌÂı·‰fiÓË ‹‰Ë ÏÂÈÙÔ˘Ú-ÁÔ‡Ó ÛÙË ¯ÒÚ· Ì·˜ Î·È ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ Â›Ó·È ÂÓÙ·Á-̤Ó˜ Û ·˘Ù¿ (3). OÈ Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ·ÔÙÂÏÔ‡ÓÙÔ Î‡ÚÈÔ ·›ÙÈÔ ™™, ·ÏÏ¿ ÙÂÏÂ˘Ù·›· ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈÛ˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈ ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜(1). ¡·ÚΈÙÈΤ˜ Ô˘Û›Â˜ Ô˘ ÚÔηÏÔ‡Ó ™™ Â›Ó·È ËÌÔÚÊ›ÓË, Ë ËÚˆ›ÓË Î·È Ë ÌÂı·‰fiÓË, ÂÓÒ ÌË-Ó·ÚΈÙÈ-Τ˜ Â›Ó·È Ù· ‚·Ú‚ÈÙÔ˘ÚÈο, ÔÈ ‚ÂÓ˙ԉȷ˙›Ó˜, Ù· ÙÚÈ-΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο, ÔÈ Ê·ÈÓÔıÂÈ·˙›Ó˜, ÙÔ Ï›-ıÈÔ, ÙÔ ·ÏÎÔfiÏ Î·È ¿ÏϘ. ∆· Û˘ÌÙÒÌ·Ù· ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ ÛÙ¤ÚËÛ˘ Â›Ó·È ·˘Ù¿ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÌÂÙ· ·Ú¯Èο Ù˘ ·ÁÁÏÈ΋˜ Ϥ͢ WITHDRAWAL(wakefulness, irritability, tremors, hyperactivity,diarrhea, respiratory distress, apnoeic attacks, weightloss, respiratory alkalosis, lacrimation) (4). ∆· Û˘-ÌÙÒÌ·Ù· Â›Ó·È ÌË ÂȉÈο Î·È ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Â›-‰Ô˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. OÈ Û·ÛÌÔ› Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿-˙ÔÓÙ·È Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÌÔÚ›fï˜ Ó· ·ÔÙÂÏÔ‡Ó Î·È ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË.

¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÛÙ·ÙÈο ™™ ·fi οıÂηÙËÁÔÚ›· (Ó·ÚΈÙÈο Î·È ÌË-Ó·ÚΈÙÈο) ÚÔÎÂÈ-̤ÓÔ˘ Ó· ÙÔÓÈÛÙ› fiÙÈ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ·Úfi-ÌÔÈ· Î·È fiÙÈ Ë ÎÏÈÓÈ΋ ·ÁÚ‡ÓËÛË Â›Ó·È ÛËÌ·ÓÙÈ-΋ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈ-Û‹ ÙÔ˘. ™‹ÌÂÚ·, ÙÔ ™™ Û ÓÂÔÁ¤ÓÓËÙ· ‰ÂÓ Â›Ó·È ·Ú-ÎÂÙ¿ Û˘¯Ófi, ÌÂÏÏÔÓÙÈο fï˜ Â›Ó·È Èı·Ófi Ó· ·Ô-ÙÂϤÛÂÈ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆ-Ó›·, ÏfiÁˆ Ù˘ ÂͿψÛ˘ ÙˆÓ Ó·ÚΈÙÈÎÒÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÂÚ›ÙˆÛË ÚÒÙË: ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ¶ÚfiˆÚÔ ¿ÚÚÂÓ ÓÂÔÁÓfi, ËÏÈΛ·˜ ·ËÛ˘ (∏∫) 29 ‚‰ÔÌ¿-

‰ˆÓ, ÂÈÛ‹¯ıË ÛÙÔ ∆Ì‹Ì· ÙËÓ 8Ë Ë̤ڷ ˙ˆ‹˜ ÏfiÁˆ Û·ÛÌÒÓ.

∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ (∫∆) ÏfiÁˆ ÚfiˆÚ˘¤Ó·Ú͢ ˆ‰›ÓˆÓ Î·È ÚÔËÁËı›۷˜ ∫∆ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘(µ°) 1350 g (50Ë ∂£), Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (ª™) 40 cm (50Ë ∂£)Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ (¶∫) 27,5 cm (50Ë ∂£). ∏ ÌËÙ¤Ú·‹Ù·Ó 39 ÂÙÒÓ, ·Ó‡·ÓÙÚË, ÙÂÙ·ÚÙ¤ÁÎ˘Ô˜ Î·È ‰Â˘ÙÂÚfiÙÔÎÔ˜Î·È Â›¯Â Û˘ÛÙËÌ·ÙÈ΋ Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ™ÙË ‰È¿Ú-ÎÂÈ· Ù˘ ·ËÛ˘, Ë ÌËÙ¤Ú· ‹Ù·Ó ˘fi ÔÏÏ·Ï‹ Ê·Ú̷΢ÙÈ-΋ ·ÁˆÁ‹, ÏfiÁˆ ηٷıÏÈÙÈ΋˜ „‡¯ˆÛ˘ Ô˘ ›¯Â ‰È·ÁÓˆ-ÛÙ› ÚÈÓ ÙËÓ Î‡ËÛË (ÏÔÚ·˙¿ÌË, Ï‚ÔÚÔÌ·˙›ÓË, ‰È·˙¿-ÌË, ÎÏÔÌÈÚ·Ì›ÓË Î·È ¯ÏˆÚÔÚÔÌ·˙›ÓË). ∆Ô Apgar score ÙÔÚÒÙÔ ÏÂÙfi ‹Ù·Ó 5 Î·È ÙÔ ¤ÌÙÔ 7. ∞̤ۈ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂ-Ùfi, ÙÔ ÓÂÔÁ¤ÓÓËÙÔ ·ÚÔ˘Û›·Û ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ÁÈ·ÙËÓ ÔÔ›· ‰È·ÛˆÏËÓÒıËÎÂ Î·È ¯ÔÚËÁ‹ıËΠ·Ú¿ÏÏËÏ· ÂÈ-Ê·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Î·È ·Ú¤ÌÂÈÓ ‰È·ÛˆÏËӈ̤-ÓÔ ÁÈ· 48 ÒÚ˜. ∆Ô ÓÂÔÁÓfi ·fi ÙËÓ 3Ë Ë̤ڷ ˙ˆ‹˜ ·ÚÔ˘-Û›·Û ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›· Î·È ÙËÓ 8Ë Ë̤ڷ ˙ˆ‹˜ ÁÂÓÈ-ÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÔfiÙÂ Î·È ÌÂٷʤÚ-ıËΠÛÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ (ª∂¡) ÓÂÔÁÓÒÓ.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó Û ̤ÙÚÈ· ÁÂÓÈ΋ η-Ù¿ÛÙ·ÛË, Ì ¤ÓÙÔÓ˜ ·ÁÁÂÈÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ıÂÚÌÔÎÚ·-Û›· 36,7ÔC, ·Ó·ÓÔ¤˜ 40/min, ÛʇÍÂȘ 135/min Î·È Î·ıÔÏÈ΋˘ÂÚÙÔÓ›·. ¶·ÚÔ˘Û›·˙ ›ÌÔÓÔ˘˜, ·ÓıÂÎÙÈÎÔ‡˜ Û·ÛÌÔ‡˜,ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÔÔ›ˆÓ ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ·ÓÙÈ-Û·Û̈‰ÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ê·ÈÓ˘ÓÙÔ˝ÓË Î·È‰È·˙¿ÌË). ∏ ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÈηٷıÏÈÙÈ΋ ·ÁˆÁ‹Ù˘ ÌËÙ¤Ú·˜ ¤ıÂÛ ÈÛ¯˘Ú¿ ÙËÓ ˘Ô„›· ÙÔ˘ ™™, ·Ú¿ÏÏËÏ·fï˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ô ··Ú·›ÙËÙÔ˜ ¤ÏÂÁ¯Ô˜ Î·È ·ÔÎÏ›ÛÙË-Î·Ó ¿ÏÏ· ·›ÙÈ· Û·ÛÌÒÓ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (Ïԛ̈ÍË, ˘Ô-ÁÏ˘Î·ÈÌ›·, ˘·Û‚ÂÛÙÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ÂÁÎÂÊ·ÏÈ΋ ·È-ÌÔÚÚ·Á›· Î·È ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·). ∂›Û˘, ÚÔÛ‰ÈÔÚ›-ÛÙËÎ·Ó Ù· ›‰· ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ¤·ÈÚÓÂ Ë ÌËÙ¤Ú· ÛÙÔÏ¿ÛÌ· ÙÔ˘ ÓÂÔÁÓÔ‡: ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο 40 ng/ml(ıÂڷ¢ÙÈο ›‰· 121-150 ng/ml) Î·È ‰È·˙¿ÌË 482ng/ml (ıÂڷ¢ÙÈο ›‰· 86-595 ng/ml). ∆· ·ÓȯÓ‡ÛÈ̷›‰· ÙˆÓ ÙÚÈ΢ÎÏÈÎÒÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ Î·È Ù· ˘„ËϿ›‰· Ù˘ ‰È·˙¿Ì˘ (Ù· ÔÔ›· fï˜ ÚÔÛ‰ÈÔÚ›ÛÙËηÓÌÂÙ¿ ÙË ıÂڷ¢ÙÈ΋ ¯ÔÚ‹ÁËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓÛ·ÛÌÒÓ) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Û˘ÓËÁÔÚÔ‡-Û·Ó ÁÈ· ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓÎϛ̷η ηٿ Finnegan, ÙÔ ÓÂÔÁÓfi ›¯Â 11 ‚·ıÌÔ‡˜ [ÙÚÔÌÒ-‰ÂȘ ÎÈÓ‹ÛÂȘ (4)+ ˘ÂÚÙÔÓ›· (2)+ Û·ÛÌÔ› (5)] ηÈ, ÂÔ̤-Óˆ˜, ÂÚfiÎÂÈÙÔ ÁÈ· ÛÔ‚·Úfi ™™ Ô˘ ¤¯ÚË˙ ʷÚ̷΢ÙÈ΋˜·ÓÙÈÌÂÙÒÈÛ˘. ÃÔÚËÁ‹ıËΠʷÈÓÔ‚·Ú‚ÈÙ¿ÏË Û ‰fiÛË Û˘-ÓÙ‹ÚËÛ˘ (5 mg/kg/∏, ™Ù.). ∆· ÂÂÈÛfi‰È· Û·ÛÌÒÓ Û˘Ó¯›-ÛÙËÎ·Ó Î·È ÙȘ ÂfiÌÂÓ˜ 48 ÒÚ˜, ·ÏÏ¿ ·Ú·ÈfiÙÂÚ· Î·È ‹Ù·ÓÈÔ Û‡ÓÙÔÌ˘ ‰È¿ÚÎÂÈ·˜, ÂÓÒ ‹Ù·Ó ·ÎfiÌ· ¢ÂÚ¤ıÈÛÙÔ, ÙÚÔÌ҉˜ Î·È ˘ÂÚÙÔÓÈÎfi (‚·ıÌÔÏÔÁ›· ηٿ Finnegan 6). ∆Ë13Ë Ë̤ڷ ˙ˆ‹˜, Ù· ›‰· Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ‹Ù·Ó 44ng/ml, ÂÓÒ Ù· ›‰· ÙˆÓ ÙÚÈ΢ÎÏÈÎÒÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ

¶·È‰È·ÙÚÈ΋ 2002;65:133-137 Paediatriki 2002;65:133-137

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§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ÛÙË ÓÂÔÁÓÈ΋ËÏÈΛ·, ÌÂı·‰fiÓË, ‚ÂÓ˙ԉȷ˙›Ó˜.

Key words: neonatal withdrawal syndrome,methadone, benzodiazepine.

™˘ÓÙÔÌÔÁڷʛ˜™™ ™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘

MARCH-APRIL 2002 14-05-03 12:25 ™ÂÏ›‰·134

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‹Ù·Ó ÛÙ·ıÂÚ¿ (39 ng/ml) Î·È Ù˘ ‰È·˙¿Ì˘ Û وÙÈ΋ Ô-Ú›· (247 ng/ml). ∆ËÓ 24Ë Ë̤ڷ ˙ˆ‹˜, Ù· ›‰· ÙˆÓ ÙÚÈ-΢ÎÏÈÎÒÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ Î·È Ù˘ ‰È·˙¿Ì˘ ›¯·Ó ÌˉÂ-ÓÈÛÙ› Î·È Ù˘ Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ‹Ù·Ó Û وÙÈ΋ ÔÚ›·. ∆ËÓ28Ë Ë̤ڷ ˙ˆ‹˜, ‰È·ÎfiËÎÂ Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ù· ›‰·Ù˘ ÔÔ›·˜ ‹Ù·Ó ˘ÔıÂڷ¢ÙÈο Î·È ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ·Û˘-Ìو̷ÙÈÎfi. ∆Ô ÓÂÔÁÓfi ÂÍ‹Ïı ÙËÓ 60Ë Ë̤ڷ ˙ˆ‹˜ Î·È ÛÂËÏÈΛ· 2 ÂÙÒÓ Â›¯Â Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË.

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË: ™™ ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ (ÌÂı·‰fiÓË) ¡ÂÔÁÓfi ·ÁfiÚÈ, ∏∫ 37 ‚‰ÔÌ¿‰ˆÓ, ÏÈÔ‚·Ú¤˜ [µ° 2180 g

(10Ë ∂£), ¶∫ 29,5 cm (5Ë ∂£)] ÂÈÛ‹¯ıË ÛÙÔ ÙÌ‹Ì· ÏfiÁˆ Û·-ÛÌÒÓ Û ËÏÈΛ· 24 ˆÚÒÓ. ∏ ÌËÙ¤Ú· ‹Ù·Ó 28 ÂÙÒÓ, ‰Â˘ÙÂÚ¤-ÁÎ˘Ô˜, ‰Â˘ÙÂÚfiÙÔÎÔ˜ Î·È ·ÎÔÏÔ˘ıÔ‡Û ÚfiÁÚ·ÌÌ· ·ÂÍ¿Ú-ÙËÛ˘ ·fi ËÚˆ›ÓË Ì ÌÂı·‰fiÓË. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠ̠∫∆ÏfiÁˆ ·ÈÌÔÚÚ·Á›·˜ ÙÔ˘ Ï·ÎÔ‡ÓÙ·. ∆Ô Apgar score ÛÙÔ ÚÒ-ÙÔ ÏÂÙfi ‹Ù·Ó 9. ∏ ÌËÙ¤Ú· ‹Ù·Ó ¯ÚfiÓÈÔ˜ ÊÔÚ¤·˜ Ë·Ù›Ùȉ·˜C Î·È ¯Ú‹ÛÙ˘ ËÚˆ›Ó˘ ̤¯ÚÈ ÙÔÓ 4Ô Ì‹Ó· ·ËÛ˘, Ë ÔÔ›··ÎÔÏÔ‡ıˆ˜ ÂÓÙ¿¯ıËΠ۠ÚfiÁÚ·ÌÌ· ·ÂÍ¿ÚÙËÛ˘ Ì ÌÂ-ı·‰fiÓË. ™ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ÂÏ¿Ì‚·Ó ÂÚÈ-ÛÙ·Ûȷο Î·È ‰È·˙¿ÌË. O ·Ù¤Ú·˜ ‹Ù·Ó ›Û˘ ¯ÚfiÓÈÔ˜ ÊÔ-Ú¤·˜ Ë·Ù›Ùȉ·˜ Î·È ¯Ú‹ÛÙ˘ ËÚˆ›Ó˘. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ·È‰›ËÏÈΛ·˜ 14 ÂÙÒÓ ‹Ù·Ó ˘ÁȤ˜. ∆Ô ÓÂÔÁÓfi ÙËÓ 3Ë ÒÚ· ˙ˆ‹˜ ·-ÚÔ˘Û›·Û ÙÚfiÌÔ Î·È ÙË 12Ë ÒÚ· Û·ÛÌÔ‡˜ (ÎÏÔÓÈΤ˜ Û˘Û¿-ÛÂȘ ¿ÎÚˆÓ, ηٷÔÙÈΤ˜ ÎÈÓ‹ÛÂȘ Î·È Û˘Û¿ÛÂȘ ‚ÏÂÊ¿ÚˆÓ).∆· ÂÂÈÛfi‰È· Û·ÛÌÒÓ ‹Ù·Ó ·Ú¯Èο ·Ú·È¿, ÛÙ·‰È·Î¿ ‡ÎÓˆ-Û·Ó Î·È ÙÂÏÈο ¤ÁÈÓ·Ó Û˘Ó¯‹. ÃÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· ‰È·-˙¿ÌË (0,1 mg/kg, 6 ‰fiÛÂȘ). §fiÁˆ ÂÌÌÔÓ‹˜ ÙˆÓ Û·ÛÌÒÓ,ÙÔ ÓÂÔÁÓfi ‰È·ÎÔÌ›ÛÙËΠÛÙÔ ÙÌ‹Ì· ¡ÂÔÁÂÓÓ‹ÙˆÓ. ∫·Ù¿ ÙËÓÂÈÛ·ÁˆÁ‹ ÙÔ˘, ‹Ù·Ó Û ̤ÙÚÈ· ÎÏÈÓÈ΋ ηٿÛÙ·ÛË, Ì ¯ÚÒÌ·‰¤ÚÌ·ÙÔ˜ ÚÔ‰·Ïfi, ıÂÚÌÔÎÚ·Û›· 36,6ÔC, Ù·¯‡ÓÔÈ· (80 ·Ó·-ÓÔ¤˜/min), ÛʇÍÂȘ 150/min, ˘„›Û˘¯ÓÔ ÎÏ¿Ì· Î·È ‹Ù·Ó ¢Â-Ú¤ıÈÛÙÔ Ì ÙÚfiÌÔ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚˆÓ Î·È ·˘ÍË̤ÓÔ Ì˘˚ÎfiÙÚfiÌÔ. ∆Ô ÈÛÙÔÚÈÎfi Ï‹„˘ ÌÂı·‰fiÓ˘ ·fi ÙË ÌËÙ¤Ú· ¤ıÂÛÂÈÛ¯˘Ú¿ ÙËÓ ˘Ô„›· ™™ ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ (ÌÂı·‰fiÓË). OÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠÁÈ· ·ÔÎÏÂÈÛÌfi¿ÏÏˆÓ ·ÈÙ›ˆÓ Û·ÛÌÒÓ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (Ïԛ̈ÍË, ˘Ô-ÁÏ˘Î·ÈÌ›·, ˘·Û‚ÂÛÙÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ÂÁÎÂÊ·ÏÈ΋ ·È-ÌÔÚÚ·Á›· Î·È ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜.™Ù· Ô‡Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ ·ÓȯÓ‡ıËΠÌÂı·‰fiÓË, fiˆ˜ Î·È ÛÙ·Ô‡Ú· Ù˘ ÌËÙ¤Ú·˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™ Ù¤ıËΠ̠‚¿ÛË ÙËÓÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·ÎfiÈÛÙÔÚÈÎfi. ∏ ÎÏÈÓÈ΋ ‚·ıÌÔÏÔÁ›· ηٿ Finnegan ‹Ù·Ó 15 [Ô͇ÎÏ¿Ì· (2)+ ÂÏ·ÊÚ¤˜ ÙÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ ÛÙËÓ ·Ó¿·˘ÛË(3)+ ˘ÂÚÙÔÓ›· (2)+ Û·ÛÌÔ› (5)+ ‰È¿ÚÚÔȘ (2)+ Ù·¯‡ÓÔÈ·(1)]. ªÂ ‚¿ÛË ÙË ‚·ıÌÔÏÔÁ›· ·˘Ù‹, ÂÚfiÎÂÈÙÔ ÁÈ· ÛÔ‚·Úfi ™™Ô˘ ¤¯ÚË˙ ʷÚ̷΢ÙÈ΋˜ ·Ú¤Ì‚·Û˘. ÃÔÚËÁ‹ıËΠʷÈ-ÓÔ‚·Ú‚ÈÙ¿ÏË Û ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ (5 mg/kg/∏, ™Ù). ∏ ÎÏÈÓÈ΋ÂÈÎfiÓ· ÛÙ·‰È·Î¿ ‚ÂÏÙÈÒıËÎÂ, fiˆ˜ Î·È Ë ‚·ıÌÔÏfiÁËÛË Î·Ù¿Finnegan. ∆Ë 13Ë Ë̤ڷ ˙ˆ‹˜, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó Û ηϋ ÁÂÓÈ-΋ ηٿÛÙ·ÛË, ÛÈÙÈ˙fiÙ·Ó Ì ÌÈÌÂÚfi, ·Ó¤ÎÙËÛ ÙÔ µ°, ÂÓÒÔÈ ·Ú¯Èο ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ ·ÔηٷÛÙ¿ıËηÓ. ¶·Ú¤ÌÂÈ-Ó ‹ÈÔ˜ ÙÚfiÌÔ˜ ¿ÎÚˆÓ Î·È ˘ÂÚÙÔÓ›· (Finnegan 4). ∏ ÂÏ¿Ù-ÙˆÛË Ù˘ ‚·ıÌÔÏfiÁËÛ˘ Ô‰‹ÁËÛ Û ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ʷÈÓÔ‚·Ú‚ÈÙ¿Ï˘, Ë ÔÔ›· ‰È·ÎfiËΠÙËÓ 24Ë Ë̤ڷ. ∆Ô ÓÂ-

ÔÁÓfi ÂÍ‹Ïı Û ËÏÈΛ· 27 ËÌÂÚÒÓ Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ Âͤ-ÏÈÍË ÛÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ Î·È 3 ÌËÓÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋.

™˘˙‹ÙËÛË∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÚÈÁÚ¿-

ÊËÎ·Ó ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙÔÓ ÂÚ-Á·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÙÔ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi Ï‹„Ë˜Ô˘ÛÈÒÓ ·fi ÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ·Ù˘ ·ËÛ˘. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ™™·fi ÌË-Ó·ÚΈÙÈΤ˜ Î·È Ë ‰Â‡ÙÂÚË ·fi Ó·ÚΈÙÈ-Τ˜ Ô˘Û›Â˜.

∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ™™ ÔÈΛÏÏÂÈ Î·È ÂÍ·Úٿٷȷfi ÙËÓ ÒÚ· Î·È ÙË ‰fiÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ ¯ÔÚ‹ÁË-Û˘ Ô˘ ‹ÚÂ Ë ¤ÁÎ˘Ô˜, ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ Ô˘-Û›·˜ ÛÙË ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔÁÓfi, ÙÔ Ú˘ıÌfi ·¤Î-ÎÚÈÛ˘ Ù˘ Ô˘Û›·˜, ·ÏÏ¿ Î·È ·fi ¿ÏÏÔ˘˜ ·‰È¢-ÎÚ›ÓÈÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ (1). °ÂÓÈο, Ù· Û˘ÌÙÒÌ·-Ù· ÙÔ˘ ™™ ·fi ÔÈÔ‡¯· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ¢Â-ÚÂıÈÛÙfiÙËÙ· ÙÔ˘ ∫¡™ Î·È ·fi Û˘ÌÙÒÌ·Ù· ÙÔ˘Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ¢ÂÚÂıÈÛÙfiÙËÙ·ÙÔ˘ ∫¡™ Û˘Óԉ‡ÂÙ·È ·fi Û·ÛÌÔ‡˜ (2% ̤¯ÚÈ11%) (5) Î·È ·ıÔÏÔÁÈÎfi ∏∂° (40%) (6). OÈ Û·-ÛÌÔ› Û˘ÓÔ‰Â‡Ô˘Ó Î·È ÙÔ ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘-ۛ˜, fiˆ˜ Ù· ‚·Ú‚ÈÙÔ˘ÚÈο (7), Ù· ˘ÓˆÙÈο-·Á-¯ÔÏ˘ÙÈο (8) Î·È ÙÔ ·ÏÎÔfiÏ (9). O ¯ÚfiÓÔ˜ ÂÌÊ¿ÓÈ-Û˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ¤ÚËÛ˘ ÂÍ·ÚÙ¿Ù·È ·fiÙÔ ¯ÚfiÓÔ Ï‹„˘ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰fiÛ˘ Ù˘ Ô˘Û›·˜Î·È ·fi ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ ·¤ÎÎÚÈÛË Ù˘ Ô˘-Û›·˜ Î·È ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘. ∞Ó ÌÂٷ͇ Ù˘ ÙÂ-ÏÂ˘Ù·›·˜ ‰fiÛ˘ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡ ÌÂÛÔÏ·‚‹ÛÂÈ ‰È¿-ÛÙËÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ‚‰ÔÌ¿‰·, ÙfiÙÂ Ë È-ı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ™™ ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο.∞Ó fï˜ Ë ÙÂÏÂ˘Ù·›· ‰fiÛË Â›Ó·È 24 ÒÚ˜ ÚÈÓ ÙÔÓÙÔÎÂÙfi, ÙfiÙ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì¤Û· ÛÙ· ÚÒÙ·24ˆÚ· ˙ˆ‹˜. ∏ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™™ ·fi ÔÈÔ‡¯·, Û˘-ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ÌÂı·‰fiÓ˘, Â›Ó·È Û˘-Ó‹ıˆ˜ ÙȘ ÚÒÙ˜ 48-72 ÒÚ˜ ˙ˆ‹˜, ·ÏÏ¿ ÌÔÚ›ӷ ÊÙ¿ÛÂÈ Î·È ÙȘ 4 ‚‰ÔÌ¿‰Â˜ (10). ∏ fi„ÈÌË ÂÌ-Ê¿ÓÈÛË ÙÔ˘ ™™ ·fi ÌÂı·‰fiÓË ¤¯ÂÈ ÎÏÈÓÈ΋ ÂÈÎfiÓ··ÚfiÌÔÈ· Ì ÙËÓ ÚÒÈÌË Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi‚Ô˘ÏÈÌ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ™ÙÔ ÓÂÔÁÓfi Ô˘ Â-ÚÈÁÚ¿ÊÂÙ·È, Ë ÙÂÏÂ˘Ù·›· ‰fiÛË ÌÂı·‰fiÓ˘ ‹Ù·Ó 36ÒÚ˜ ÚÈÓ ÙÔÓ ÙÔÎÂÙfi Î·È ÙÔ ™™ ÂΉËÏÒıËΠÙÔÚÒÙÔ 24ˆÚÔ ˙ˆ‹˜. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ η-Ù·Ï‹ÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ fiÛÔ ÌÂÁ·Ï‡ÙÂÚËÂ›Ó·È Ë ‰fiÛË Ù˘ ÌÂı·‰fiÓ˘ ÛÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌË-ÓÔ Ù˘ ·ËÛ˘, ÙfiÛÔ ˘„ËÏfiÙÂÚ˜ Â›Ó·È ÔÈ Û˘ÁÎÂ-ÓÙÚÒÛÂȘ ÛÙÔ ÓÂÔÁÓfi (1,5,10,11). °È· ·˘Ùfi ÙÔ Ïfi-ÁÔ, Û‹ÌÂÚ· ÚÔÙ›ÓÂÙ·È Ë ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘‰fiÛ˘ Ù˘ ÌÂı·‰fiÓ˘ (<20 mg/Ë̤ڷ) ÛÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ÒÛÙ ӷ ÌÂÈÒÓÂÙ·ÈÔ Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ™™ (1,11). ∏ ‰È¿ÁÓˆÛË ÙÔ˘™™ ·fi ·Á¯ÔÏ˘ÙÈο-˘ÓˆÙÈο Ê¿Ú̷η Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË, ÁÈ·Ù› ÂÌÊ·Ó›˙ÂÙ·È ÙËÓ 4Ë ¤ˆ˜ 7Ë

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Ë̤ڷ (‡ÚÔ˜ ·fi 1Ë ¤ˆ˜ 14Ë Ë̤ڷ ˙ˆ‹˜) (7). ∆ÔÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Ì ™™ ·fi ÌË-Ó·ÚΈÙÈ-Τ˜ Ô˘Û›Â˜ ÂΉ‹ÏˆÛ ÙÔ ™™ ÙËÓ 3Ë Ë̤ڷ ˙ˆ‹˜.ÕÏϘ ˘ÓˆÙÈΤ˜ Ô˘Û›Â˜ ÂΉËÏÒÓÔ˘Ó Û˘ÌÙÒÌ·-Ù· ™™ ·ÎfiÌ· ·ÚÁfiÙÂÚ·, fiˆ˜ Ë ‰È·˙¿ÌË ÙË 12ËË̤ڷ Î·È Ë ¯ÏˆÚ·‰È·˙ÂÔÍ›‰Ë ÙËÓ 21Ë Ë̤ڷ ˙ˆ-‹˜ (12,13).

∆Ô Â˘Ú‡ Ê¿ÛÌ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙÔ˘™™ Ê·›ÓÂÙ·È ·fi ÙËÓ Îϛ̷η ‚·ıÌÔÏfiÁËÛ˘ ηٿFinnegan (14) (¶›Ó·Î·˜ 1). ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓÔ˘ Â›Ó·È Û ÚfiÁÚ·ÌÌ· ·ÂÍ¿ÚÙËÛ˘ Ì ÌÂı·-‰fiÓË ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ µ° Û ۯ¤ÛË Ì ·˘Ù¿ ÙˆÓÌËÙ¤ÚˆÓ Ô˘ Â›Ó·È ¯Ú‹ÛÙ˜ ËÚˆ›Ó˘, ·ÏÏ¿ ¤¯Ô˘ÓÛ˘¯ÓfiÙÂÚ· ÌÈÎÚÔÎÂÊ·Ï›·, fiˆ˜ Î·È ÙÔ ÓÂÔÁÓfi Ô˘ÂÚÈÁÚ¿ÊÂÙ·È (10,14).

∏ Ì·ÎÚÔ¯ÚfiÓÈ· ÓÔÛËÚfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ ‰ÂÓ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› (1). §›Á˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ú·-ÎÔÏÔ˘ı‹ÛÂÈ Ù· ÓÂÔÁÓ¿ ·˘Ù¿ ÌÂÙ¿ Ù· ÚÒÙ· ¤ÙË˙ˆ‹˜. OÈ Ofofsson Î·È Û˘Ó (15) ·Ú·ÎÔÏÔ‡ıËÛ·Ó72 ÓÂÔÁÓ¿ Ì ™™ ·fi ÌÂı·‰fiÓË ÁÈ· ‰È¿ÛÙËÌ· ·fi1 ¤ˆ˜ 10 ¤ÙË Î·È Î·Ù¤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈÙÔ 50% ·ÚÔ˘Û›·˙ ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔ-Ú¿˜ (‰È¿Û·ÛË Ù˘ ÚÔÛÔ¯‹˜, ÂÈıÂÙÈÎfiÙËÙ·), ÙÔ20% ›¯Â ̤ÙÚÈ·/ÛËÌ·ÓÙÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤-ÚËÛË ÏfiÁˆ ÛÙ¤ÚËÛ˘ ÊÚÔÓÙ›‰·˜, Î·È ÙÔ 43% ›¯Â·ÔÌ·ÎÚ˘Óı› ·fi ÙË ÌËÙ¤Ú· ÙÔ˘˜ ÌÂÙ¿ ·fi ‰È-ηÛÙÈ΋ ·fiÊ·ÛË. ∆· ‰‡Ô ÓÂÔÁÓ¿ Ô˘ ÂÚÈÁÚ¿-ÊÔÓÙ·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û ËÏÈΛ· 2 ÂÙÒÓ Î·È ‰ÂÓ

·ÚÔ˘Û›·˙·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ‹ÛÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË.

∏ ·Ú¯È΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÓÂÔÁÓÒÓ Ì ™™ ›-Ó·È ˘ÔÛÙËÚÈÎÙÈ΋. ∏ ·fiÊ·ÛË ÁÈ· ıÂڷ¢ÙÈ΋·Ú¤Ì‚·ÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ Û˘Ó-‰ÚfiÌÔ˘ Î·È Û ·˘Ù‹ ‚ÔËı¿ Ë ¯ÚËÛÈÌÔÔ›ËÛË Ù˘Îϛ̷η˜ Finnegan.

∏ ·fiÊ·ÛË ÁÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÂÍ·ÙÔÌÈ-·ÂÙ·È Î·È ÛÙËÚ›˙ÂÙ·È ÛÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ™™. ∆Ô™™ ÌÔÚ› Ó· Â›Ó·È ı·Ó·ÙËÊfiÚÔ. ¶·Ú’ fiÏ· ·˘Ù¿, ËÛÙ¤ÚËÛË Â›Ó·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ‰È·‰Èηۛ·. ∆ÔfiÊÂÏÔ˜ Ù˘ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë ‚Ú·¯˘-¯ÚfiÓÈ· ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿وÓ. ¢ÂÓ ¤¯ÂÈ,fï˜, ·ÎfiÌ· ‰È¢ÎÚÈÓÈÛÙ› ·Ó Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÓÔ-ÛËÚfiÙËÙ· ·fi ÛÙ¤ÚËÛË ÌÂÈÒÓÂÙ·È Ì ʷÚ̷΢ÙÈ-΋ ·ÁˆÁ‹ (10,15).

¡ÂÔÁÓ¿ Ì ÙÂÎÌËÚȈ̤ÓË ¤ÎıÂÛË ÛÂ Ô˘Û›Â˜ÂÓ‰ÔÌËÙÚ›ˆ˜ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‰ÂÓ ¯Ú‹˙Ô˘ÓÊ·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. OÈ ÂӉ›ÍÂȘ ÁÈ· ·ÁˆÁ‹Â›Ó·È ÔÈ Û·ÛÌÔ›, Ë ·Ó·Ú΋˜ Û›ÙÈÛË, ÔÈ ‰È¿ÚÚÔÈ-˜, ÔÈ ¤ÌÂÙÔÈ Ô˘ Ô‰ËÁÔ‡Ó Û ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È·Ê˘‰¿ÙˆÛË, Ë ·‰˘Ó·Ì›· ‡ÓÔ˘ Î·È Ô ˘ÚÂÙfi˜(1,10,14). ∏ ‚·ıÌÔÏfiÁËÛË Î·Ù¿ Finnegan ÌÂÁ·-χÙÂÚË ·fi 8 ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÛÔ‚·ÚÔ‡ ™™ ηȷӿÁ΢ ÁÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ∞Ó ÙÂÏÈο ÎÚÈ-ı› ÛÎfiÈÌË Ë Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ÙfiÙÂÚÔÙÈÌ¿Ù·È Ê¿ÚÌ·ÎÔ ·fi ÙËÓ ›‰È· ηÙËÁÔÚ›· Ô˘ÚÔοÏÂÛ ÙË ÛÙ¤ÚËÛË. ∂ÁÎÂÎÚÈ̤ӷ Ê¿Ú̷η

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¶›Ó·Î·˜ 1. ∫ÏÈÓÈ΋ ‚·ıÌÔÏfiÁËÛË Î·Ù¿ Finnegan

∂‡ÚËÌ· µ·ıÌfi˜ ¶ÂÚ›ÙˆÛË 1 ¶ÂÚ›ÙˆÛË 2

O͇ ÎÏ¿Ì· 2 +™˘Ó¯¤˜ Ô͇ ÎÏ¿Ì· 3⁄ÓÔ˜ <1 ÒÚ· ÌÂÙ¿ ·fi Û›ÙÈÛË 4⁄ÓÔ˜ <2 ÒÚ˜ ÌÂÙ¿ ·fi Û›ÙÈÛË 3⁄ÓÔ˜ <3 ÒÚ˜ ÌÂÙ¿ ·fi Û›ÙÈÛË 2∞ÓÙ·Ó·ÎÏ·ÛÙÈÎfi Moro ++ 2∞ÓÙ·Ó·ÎÏ·ÛÙÈÎfi Moro +++ 3∂Ï·ÊÚfi˜ ÙÚfiÌÔ˜ ÛÙ· ÂÚÂı›ÛÌ·Ù· 2∂Ï·ÊÚ¤˜ ÙÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ ÛÙËÓ ·Ó¿·˘ÛË 3 +∆ÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ ÛÙËÓ ·Ó¿·˘ÛË 4 +ÀÂÚÙÔÓ›· 2 + +™·ÛÌÔ› 5 + +£ËÏ·ÛÌfi˜ ÁÚÔıÈ¿˜ ¿Ìʈ 1¶Ùˆ¯‹ Û›ÙÈÛË 2∞Ó·ÁˆÁ¤˜ 2ŒÌÂÙÔÈ 3¢È¿ÚÚÔÈ· + 2¢È¿ÚÚÔÈ· ++ 3™˘¯Ó¿ ¯·ÛÌÔ˘ÚËÙ¿ 1¶ÙÂÚÓ›ÛÌ·Ù· 1£ÔÚ˘‚҉˘ ·Ó·ÓÔ‹ 1∂Ê›‰ÚˆÛË 1£ÂÚÌÔÎÚ·Û›· >38ÔC 2∆·¯‡ÓÔÈ· (>60 ·Ó·ÓÔ¤˜/min) 1 +∆·¯‡ÓÔÈ· Î·È ÂÈÛÔÏ΋ 2∂ΉÔÚ¿ ̇Ù˘ / ÁÔÓ¿ÙˆÓ 1

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Â›Ó·È Ë ‚ÂÓ˙ԉȷ˙›ÓË ÁÈ· ÙÔ ·ÏÎÔfiÏ Î·È Ë ÌÂı·-‰fiÓË ÁÈ· Ù· ÔÈÔ‡¯·. ∂›Ó·È ÁÓˆÛÙfi, fï˜, fiÙÈ ¯ÚË-ÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ¿ÏÏ· Ê¿Ú̷η, fiˆ˜ ÙÔ Ï¿‚‰·-ÓÔ, Ë ¿Ó˘‰ÚÔ˜ ÌÔÚÊ›ÓË, Ë ÎÏÔÓȉ›ÓË, Ë Ê·ÈÓÔ‚·Ú-‚ÈÙ¿ÏË, Ë ¯ÏˆÚÔÚÔÌ·˙›ÓË Î·È Ë ‰È·˙¿ÌË. ∏‚ÂÏÙ›ˆÛË Ù˘ ‚·ıÌÔÏfiÁËÛ˘ ηٿ Fineggan ‚ÔË-ı¿ÂÈ ÛÙËÓ ·fiÊ·ÛË ÁÈ· ÙË Ì›ˆÛË Ù˘ ¯ÔÚËÁÔ‡-ÌÂÓ˘ ‰fiÛ˘. ∆· ÎÚÈÙ‹ÚÈ· ·ÚÎÔ‡˜ ·ÁˆÁ‹˜ ›ӷÈË Ê˘ÛÈÔÏÔÁÈ΋ ıÂÚÌÔÎÚ·Û›·, Ë ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ÓÂÔÁÓÔ‡ Ó· ÎÔÈÌ¿Ù·È ÌÂٷ͇ ÙˆÓ ÁÂ˘Ì¿ÙˆÓ, Ë Ì›-ˆÛË ÙÔ˘ ÎÏ¿Ì·ÙÔ˜ Î·È Ë ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜.

™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ ™™ Û ÓÂÔÁ¤ÓÓËÙ· ÙÔÍÈÎÔ-Ì·ÓÒÓ ÌËÙ¤ÚˆÓ, Ô˘ Û‹ÌÂÚ· Â›Ó·È Û¯ÂÙÈο Û¿ÓÈÔÊ·ÈÓfiÌÂÓÔ, ı· ·ÔÙÂϤÛÂÈ ÌÂÏÏÔÓÙÈο ÛÔ‚·ÚfiÚfi‚ÏËÌ· ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆÓ›·, ÏfiÁˆ ÌË ÂÏÂÁ-¯fiÌÂÓ˘ ÂͿψÛ˘ ÙˆÓ Ó·ÚΈÙÈÎÒÓ ÛÙË ÓÂÔÏ·›·Ì·˜. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ ÙÔ ™™ ÂΉËÏÒÓÂÙ·È ·ÎfiÌ·Î·È Û ÓÂÔÁÓ¿ Ô˘ ·›ÚÓÔ˘Ó ÌË-Ó·ÚΈÙÈΤ˜ Ô˘-ۛ˜, fiˆ˜ ·Á¯ÔÏ˘ÙÈο Î·È ·ÓÙÈηٷıÏÈÙÈο Ê¿Ú-̷η. ∏ ÚfiÏË„Ë, Ë ıÂڷ›· Î·È Ë ÓÔÛËÏ›· ÙˆÓÓÂÔÁÓÒÓ Ì ™™ ÂÈ‚¿ÏÏÔ˘Ó ÙË ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›·Ù˘ ¶ÔÏÈÙ›·˜, ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÊÔÚ¤ˆÓ, ηıÒ˜ ηÈÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡.

µÈ‚ÏÈÔÁÚ·Ê›·1. American Academy of Pediatrics. Policy Statement.

Neonatal drug withdrawal. Pediatrics 1998;101:1079-1088. 2. ¢Ú›ÙÛ·˜ ¶, ∆ÛÂÚ¤ ¶, °Î›Î· ª, ™Ù·Ì·ÙfiÔ˘ÏÔ˜ ∏, ª·Ì·-

ÏÔ‡Áη ª, ªÔ‡Ú· ™ Î·È Û˘Ó. ÃÚ‹ÛÙ˜ ËÚˆ›Ó˘ Î·È ÂÊË-ÌÂÚ›·. π·ÙÚÈÎfi µ‹Ì· 2001;74:18-21.

3. ¶··ıˆÌ¿ ∂, ÷Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑, OÈÎÔÓÔÌ›‰Ô˘ O, ÷ڷ-Ï¿ÌÔ˘˜ ∞, ¡ÈÎÔÏfiÔ˘ÏÔ˜ ¢. ¡ÂÔÁ¤ÓÓËÙ· ÌËÙ¤ÚˆÓ ¯ÚË-ÛÙÒÓ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ. ¶Ú·ÎÙÈο 9Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ™˘-Ó‰ڛԢ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÀÁ›·˜1997:30.

4. Rylance G. Neonatal pharmacology. In: Roberton NRC,editor. Textbook of Neonatology. 2nd ed. New York:Churchill Livingstone; 1992. p. 1208-1209.

5. Herzlinger RA, Kandal SR, Vaughan HG. Neonatal seizuresassociated with narcotic withdrawal. J Pediatr1971;91:638-641.

6. Van Baar AI, Fleury P, Soepatmi S, Ultee CA, WesselmanPJ. Neonatal behavior after drug dependent pregnancy.Arch Dis Child 1989;64:235-240.

7. Bleyer WA, Marshall RE. Barbiturate withdrawal syndromein passively addicted infants. JAMA 1972;221:185-186.

8. Prenner BM. Neonatal withdrawal syndrome associatedwith hydroxyzine hydrochloride. Am J Dis Child1977;131:529-530.

9. Pierog S, Chandavasu O, Wexler I. Withdrawal syndromein infants with the fetal alcohol syndrome. J Pediatr1977;90:529-530.

10. Zelson C, Rubio E, Wassermann E. Neonatal narcoticaddiction: 10 year observation. Pediatrics 1971;48:178-179.

11. Doberczak TM, Kandall SR, Friedmann P. Relationsbetween maternal methadone dosage, maternal-neonatalmethadone levels, and neonatal withdrawal. ObstetGynecol 1993;81:936-940.

12. Rementeria JL, Bhatt K. Withdrawal symptoms in neonatesfrom intrauterine exposure to diazepam. J Pediatr1977;90:123-126.

13. Athinarayanan P, Pierog SH, Nigam SK, Glass L.Chlodiazepoxide withdrawal syndrome in the neonate. AmJ Obstet Gynecol 1976;124:212-213.

14. Finnegan LP. Neonatal abstinence. In: Nelson NM, editors.Current therapy in neonatal-perinatal medicine. Toronto,Ontario: BC Decker, Inc; 1985. p. 262-270.

15. Olofsson M, Beckley W, Adersen GE, Friss-Hansen B.Investigation of 89 children born by drug-dependentmothers. II. Follow-up 1-10 years after birth. Acta PediatrScand 1983;72:407-410.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-10-2001HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-01-2002

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆÛ‹Ê ∫·Ï¤ÁÈ·˜ Õıˆ 31 Î·È øÚˆÔ‡, ¶¿ÙÚ· E-mail: [email protected]

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ÃÚfiÓÈ· Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ ÏfiÁˆ ·ÓˆÌ·Ï›·˜ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘: ¶ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜ ∞. M›¯Ô˜1, ∂. OÚÊ·ÓÔ‡1, ∂. ¶··Ó‰Ú¤Ô˘2, ¡. ª·ÏÙÔÁÈ¿ÓÓ˘2, ∂. ƒÒÌ· - °È·ÓÓ›ÎÔ˘1, ¢. ∫ÂÚ·Ì›‰·˜2

Chronic midgut volvulus due to malrotation: Case report ∞. Michos1, E. Orfanou1, E. Papandreou2, N. Baltogiannis2, E. Roma - Giannikou1, D. Keramidas2

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 µ’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋

¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

1 1st Pediatric Clinic, University of Athens 2 2nd Pediatric Surgical Clinic

Children’s Hospital of “St. Sophia”, Athens

�¶ÂÚ›ÏË„Ë: ∏ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹Ïˆ-Û˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ Úԉȷı¤ÙÂÈ ÛÂ Û˘ÛÙÚÔÊ‹ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È Û¿ÓÈ· ÌÂ-Ù¿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛ˷ȉÈÔ‡ 5 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¯ÚfiÓÈ·˜ ‰È¿ÚÚÔÈ-·˜, ÂÚÈÔ‰ÈÎÔ‡ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È Â̤وÓ. ∆Էȉ› ›¯Â ÓÔÛËÏ¢Ù› Û ‰È¿ÊÔÚ· ÓÔÛÔÎÔÌ›· ¯ˆ-Ú›˜ Ó· ÙÂı› Û·Ê‹˜ ‰È¿ÁÓˆÛË. ™Â Ê¿ÛË ˘ÔÙÚÔ-‹˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰È·ÁÓÒÛÙËΠ̠·ÂÈÎÔÓÈ-ÛÙÈ΋ ̤ıÔ‰Ô Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È ·Óˆ-Ì·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤-ÚÔ˘. ∆· Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒıËÎ·Ó Î·È Î·Ù¿ Ù˯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË fiÔ˘ ¤ÁÈÓÂ Î·È ·ÓÙÈÌÂÙÒÈ-ÛË. ™˘˙ËÙÔ‡ÓÙ·È Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Î·È ÔÈ Ì¤ıÔ‰ÔȉȿÁÓˆÛ˘ Ù˘ ¯ÚfiÓÈ·˜ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÌÂÛÂÓÙÂ-Ú›Ô˘, ÂÓÒ ÙÔÓ›˙ÂÙ·È fiÙÈ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙÚÔÊ‹˜ ÙÔ˘Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ı· Ú¤ÂÈ Ó· ·ÔÎÏ›ÔÓÙ·È Û ·È-‰È¿ Ì ¯ÚfiÓÈ· Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ Á·ÛÙÚÂ-ÓÙÂÚÈÎfi Û‡ÛÙËÌ·.

§¤ÍÂȘ ÎÏÂȉȿ: Û˘ÛÙÚÔÊ‹ ÌÂÛÂÓÙÂÚ›Ô˘, ·ÓˆÌ·Ï›·ÛÙÚÔÊ‹˜ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘, ¯ÚfiÓÈ· ¿Ù˘· ÎÔÈÏÈ·Î¿Û˘ÌÙÒÌ·Ù·, ·È‰È΋ ËÏÈΛ·.

�Abstract: Midgut malrotation and abnormalfixation predisposes to midgut volvulus which israrely symptomatic after infancy. This is a casereport of a 5 year old boy, who presented withsymptoms of chronic diarrhea, periodic abdominalpain and vomiting. He had been hospitalized inseveral hospitals without a definitive diagnosis.During · relapsing episode, chronic volvulus withmidgut malrotation was identified usingradiographic and sonographic studies. Thefindings were further confirmed during surgicalexploration at which time the anomaly wascorrected. The clinical presentation as well as thediagnostic approach of chronic volvulus arediscussed. It is emphasized that midgut malro-tation must be included in the differential diagnosisin children with chronic, undiagnosed gastro-intestinal complaints.

Key words: volvulus, midgut malrotation, chronicabdominal symptoms, childhood.

∂ÈÛ·ÁˆÁ‹H ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤-

ÛÔ˘ ÂÓÙ¤ÚÔ˘ (∞™∫ª∂) (malrotation) ÌÔÚ› Ó·ÚÔηϤÛÂÈ Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘. ∏ Û˘-Ìو̷ÙÔÏÔÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ ÔÍ›· ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ Î·È ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜, ÂÓÒ ÛÙȘÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ ÌÔÚ› Ó· Â›Ó·È ‰È·ÏÂ›Ô˘Û·Î·È ·Ì‚Ï˘¯Ú‹, Ì ·ÔÙ¤ÏÂÛÌ· Ë ‰È¿ÁÓˆÛË Û˘¯Ó¿Ó· ‰È·Ï·Óı¿ÓÂÈ (1). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛ˷ȉÈÔ‡ 5 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¯ÚfiÓÈ·˜ ‰È¿ÚÚÔÈ-·˜, ÂÚÈÔ‰ÈÎÔ‡ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È Â̤وÓ, ÌÂ

·ÓÂÈÏËÌ̤Ó˜ ÂÈÛ·ÁˆÁ¤˜ Û ÓÔÛÔÎÔÌ›·. ∫·Ù¿ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ‰È·ÁÓÒÛıËÎÂÛ˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Û ¤‰·ÊÔ˜ ·ÓÒÌ·Ï˘ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜

ÏfiÁˆ Â̤وÓ, ‰È¿ÚÚÔÈ·˜ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜.∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ·Ó·Ê¤-ÚÂÙ·È Î¿ÙÈ ·ıÔÏÔÁÈÎfi ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ,ÂÓÒ ÙÔ ·È‰› ÚÔÛÏ¿Ì‚·ÓÂ Ê˘ÛÈÔÏÔÁÈο ‚¿ÚÔ˜,

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‡„Ô˜ Î·È ·ÚÔ˘Û›·˙Â Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ÂͤÏÈÍË. ªÂÙ¿ ÙÔ 2Ô ¤ÙÔ˜ ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÔ‰ÈοÂÂÈÛfi‰È· ‰È·ÚÚÔ˚ÎÒÓ ÎÂÓÒÛÂˆÓ ÎÈÙÚÈÓˆÒÓ Ì‚ϤÓÓË (ÂÚ›Ô˘ 4-5/24ˆÚÔ) Ô˘ ‰È·ÚÎÔ‡Û·Ó Â-Ú›Ô˘ Ì›· ‚‰ÔÌ¿‰·, ·ӷϷ̂¿ÓÔÓÙ·Ó Î¿ı 2-3Ì‹Ó˜ Î·È Û˘Óԉ‡ÔÓÙ·Ó ·fi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ‚ÔÚ-‚ÔÚ˘ÁÌÔ‡˜ Î·È Â̤ÙÔ˘˜. ∆· ÂÂÈÛfi‰È· ·ÓÙÈÌÂÙˆ›-˙ÔÓÙ·Ó Ì ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜, ‰È·ÎÔ‹ Á·Ï·ÎÙÔ-ÎÔÌÈÎÒÓ, ·ÓÙȉȷÚÚÔ˚ο Ê¿Ú̷η, ·ÓÙÈÌÈÎÚԂȷ΋·ÁˆÁ‹ Î·È ˘Ô¯ˆÚÔ‡Û·Ó. ∆Ô ·È‰› ›¯Â ÂÈÛ·¯ı›ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ 3 ÊÔÚ¤˜ Û ÂÚÈÊÂÚÂȷοÓÔÛÔÎÔÌ›·, fiÔ˘ Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È Ô ·ÂÈÎÔ-ÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜ (3ÊÔÚ¤˜), ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ (3 ÊÔÚ¤˜), ‰È¿-‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ (2 ÊÔÚ¤˜) ‰ÂÓ ¤‰ÂÈ-Í·Ó Î¿ÙÈ ·ıÔÏÔÁÈÎfi.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜, ·fiÙËÓ ÂÈÛÎfiËÛË ¤‰ÈÓ ÙËÓ ÂÓÙ‡ˆÛË ¿Û¯ÔÓÙÔ˜Î·È ‰˘ÛÙÚÔÊÈÎÔ‡ ·È‰ÈÔ‡ (·Ó·ÊÂÚfiÙ·Ó ·ÒÏÂÈ·‚¿ÚÔ˘˜ 2 kg ηٿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ). ∆· Ûˆ-Ì·ÙÔÌÂÙÚÈο ÙÔ˘ ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: B.™.: 17 kg(10-25Ë ∂.£.), ‡„Ô˜: 119 cm (>97Ë ∂.£.), ÂÓÒ ·fiÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ‚Ú¤ıËΠοÙÈ ·ıÔÏÔÁÈÎfi.O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÁÂ-ÓÈ΋ ·›Ì·ÙÔ˜, ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ·ÓÔÛÔÛÊ·ÈÚ›-Ó˜, RAST test ÁÈ· ÙÚÔÊÈο ·ÓÙÈÁfiÓ·, ·ÓÙÈÁÏÔÈ·‰È-ÓÈο ·ÓÙÈÛÒÌ·Ù·, ‰ÔÎÈÌ·Û›· ÊfiÚÙÈÛ˘ Ì ϷÎÙfi˙Ë,‰ÔÎÈÌ·Û›· ͢Ïfi˙˘, ıÚ˘„›ÓË ÎÔÚ¿ÓˆÓ, ‰ÔÎÈÌ·Û›·È‰ÚÒÙ· Î·È pHÌÂÙÚ›·, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∂Âȉ‹ÛÙÔ ·È‰› ›¯Â Á›ÓÂÈ ÚfiÛÊ·Ù· ·ÂÈÎÔÓÈÛÙÈÎfi˜¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÙÈÎÔ‡ ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·-Ù·, ıˆڋıËΠÛÎfiÈÌÔ ÏfiÁˆ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ηÈÙ˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ó· ÚÔËÁËı› ÂÓ‰ÔÛÎÔÈ-Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› Ë È‰ÈÔ·ı‹˜ ÊÏÂÁ-ÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ™ÙË Á·ÛÙÚÔÛÎfiË-ÛË ‰È·ÈÛÙÒıËΠÁ·ÛÙÚ›ÙȘ ·fi H. Pylori, ÂÓÒ ËÎÔÏÔÓÔÛÎfiËÛË ¤‰ÂÈÍ ̤ÙÚÈ· ÊÏÂÁÌÔÓ‹ ÛÙÔ ÔÚ-ıfi Ì Èı·Ó‹ ·ÏÏÂÚÁÈ΋ Û˘ÌÌÂÙÔ¯‹. ÃÔÚËÁ‹ıËηÁˆÁ‹ ÂÎÚ›˙ˆÛ˘ ÁÈ· ÙÔ H. Pylori Î·È Û˘ÛÙ‹ıËηӿÏË„Ë ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ › ˘Ô-ÙÚÔ‹˜. ∆Ô ·È‰› ¤ÌÂÈÓ ÂχıÂÚÔ Û˘Ìو̿وÓÁÈ· 6 Ì‹Ó˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·˘Í‹ıËΠηٿ 3 kg.™ÙË Û˘Ó¤¯ÂÈ·, fï˜, ·ÚÔ˘Û›·Û ¿ÏÈ ‰È·ÚÚÔ˚Τ˜ÎÂÓÒÛÂȘ, ¤ÓÙÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È Â̤ÙÔ˘˜. ™ÙˉȿÚÎÂÈ· Ù¤ÙÔÈÔ˘ ÔͤԘ ÂÂÈÛÔ‰›Ô˘ ¤ÁÈÓ ÂÂÈÁfi-ÓÙˆ˜ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜, ÙÔ ÔÔ›Ô ¤‰ÂÈÍÂÂÈÎfiÓ· Û˘ÛÙÚÔÊ‹˜ ÌÂÛÂÓÙÂÚ›Ô˘ Ì ÂÏÈÎÔÂȉ‹ Ô-Ú›· ÙˆÓ ·ÁÁ›ˆÓ (∂ÈÎfiÓ· 1). ™ÙË ‰È¿‚·ÛË ÙÔ˘ ÏÂ-ÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ ‚Ú¤ıËΠ·fiÊÚ·ÍË ÛÙÔ‡„Ô˜ Ù˘ Ó‹ÛÙȉ·˜ (∂ÈÎfiÓ· 2), Ô ‰Â ‚·ÚÈÔ‡¯Ô˜˘ÔÎÏ˘ÛÌfi˜ ¤‰ÂÈÍ ·ÓÒÌ·ÏË ı¤ÛË ÙÔ˘ Ù˘ÊÏÔ‡, ÂÈ-ÎfiÓ˜ Û˘Ì‚·Ù¤˜ Ì ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Û ʿÛËÛ˘ÛÙÚÔÊ‹˜ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋¤̂·ÛË ¤ÁÈÓ ·Ú¯Èο Ï··ÚÔÛÎÔÈο, fiÔ˘ ÂÈ-

‚‚·ÈÒıËÎÂ Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÙÔÔÔ›Ô ·ÚÔ˘Û›·˙ ٤ÛÛÂÚȘ (4) ÛÙÚÔʤ˜ ηٿ ÙËÊÔÚ¿ ÙˆÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÚÔÏÔÁÈÔ‡. ∞ÎÔÏÔ‡ıËÛ Ϸ-·ÚÔÙÔÌ›·, ·Ó¿Ù·ÍË Ù˘ Û˘ÛÙÚÔÊ‹˜ (∂ÈÎfiÓ· 3),‰È·ÙÔÌ‹ ÙˆÓ ÂÚÈÙÔÓ·˚ÎÒÓ Ù˘¯ÒÓ Ô˘ ÂÚȤ‚·Ï-Ï·Ó ÙÔ Ù˘ÊÏfi Î·È ÙË Ó‹ÛÙȉ· Î·È ·ÂÏ¢ı¤ÚˆÛËÙÔ˘ ÂÓÙ¤ÚÔ˘. ∆Ô ·È‰› ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ η-Ù¿ÛÙ·ÛË Î·È ¤¯ÂÈ ·Ú·Ì›ÓÂÈ ÂχıÂÚÔ Û˘Ìو̿-ÙˆÓ Â› ¤Ó· ÂÚ›Ô˘ ¤ÙÔ˜.

™˘˙‹ÙËÛË ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÛÙÚÔÊ‹ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘

ÛÙËÓ ÂÌ‚Ú˘˚΋ ËÏÈΛ· ÍÂÎÈÓ¿ÂÈ ÙËÓ 3Ë Î·È ÔÏÔÎÏË-ÚÒÓÂÙ·È ÙË 14Ë Â‚‰ÔÌ¿‰·, Á›ÓÂÙ·È ‰Â Ì ÊÔÚ¿·ÓÙ›ÛÙÚÔÊË ·fi ÙÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ ÚÔÏÔÁÈÔ‡ ÛÙȘ270Ô Ì ¿ÍÔÓ· ÛÙÚÔÊ‹˜ ÙËÓ ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ ·ÚÙË-Ú›·. ∏ ·Ó·ÛÙÔÏ‹ Ù˘ ÛÙÚÔÊ‹˜ (non rotation) ‹ ˉȷÎÔ‹ Ù˘ Û οÔÈÔ ·fi Ù· ÂӉȿÌÂÛ· ÛÙ¿‰È·¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ ¤ÓÙÂÚÔ Ó· ÎÚ¤ÌÂÙ·È ·fiÛ¯ÂÙÈο ÛÙÂÓfi Ì›Û¯Ô Î·È Ó· Â›Ó·È ÂÈÚÚ¤˜ ÛÂ Û˘-ÛÙÚÔÊ‹ (volvulus), ÂÓÒ Ù˘¯¤˜ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘

∂ÈÎfiÓ· 1. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜: ∞. º·›ÓÂÙ·È ·Ó·ÛÙÚÔ-Ê‹ Ù˘ ı¤Û˘ ÙˆÓ ÌÂÛÂÓÙ¤ÚÈˆÓ ·ÁÁ›ˆÓ Û˘Ì‚·Ù‹ Ì ·Óˆ-Ì·Ï›· ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. µ. ∆Ô ¤ÓÙÂÚÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÈ-ÎfiÓ· ÛÙÚÔ‚›ÏÔ˘ (whirlpool sign) ÏfiÁˆ Ù˘ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ÌÂÛÂÓÙÂÚ›Ô˘.

∂ÈÎfiÓ· 2. ∞. ¢È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ: ÂÈÎfiÓ· ‰ˆ-‰Âη‰·ÎÙ‡ÏÔ˘ Û ۯ‹Ì· ·ÓÂÛÙÚ·Ì̤ÓÔ˘ ∂ Î·È ·ÙÂÏ‹˜·fiÊÚ·ÍË ÛÙÔ ‡„Ô˜ Ù˘ Ó‹ÛÙȉ·˜. µ. µ·ÚÈÔ‡¯Ô˜ ˘ÔÎÏ˘-ÛÌfi˜: ÎÂÓÙÚÈ΋ ı¤ÛË ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘ Î·È Ù˘ÊÏÔ‡, Û˘Ì‚·Ù‹Ì ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘.

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(Ù·Èӛ˜ ÙÔ˘ Ladd) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Ȥ˙Ô˘Ó ÙÔ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÚÈ΋ ‹ ÔÏÈ-΋ ·fiÊÚ·ÍË (1). ∏ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ÌÔÚ› Ó·Û˘Ó˘¿Ú¯ÂÈ Î·È Ì ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ÙÔ˘ ÂÙÈÎÔ‡ Û ÔÛÔÛÙfi 30%-62%, fiˆ˜ Ë ÔÌ-Ê·ÏÔ΋ÏË, Ë Á·ÛÙÚfiÛ¯ÈÛË, ·ÙÚËۛ˜ ‹ ÛÙÂÓÒÛÂȘÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙÔ ÂÎÎfiψ̷ Meckel, Ë ÓfiÛÔ˜Hirschsprung, Ë ÔÏÈ΋ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á-¯ÓˆÓ, ÔÈ Î‡ÛÙÂȘ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÔÈ ·ÓˆÌ·Ï›Â˜‰È¿Ï·Û˘ Ù˘ ¯ÔÏˉfi¯Ô˘ ·ÛÙ˘ Î·È ÙˆÓ ¯ÔÏË-ÊfiÚˆÓ (1,2). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Û˘-Ìو̷ÙÔÏÔÁ›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ÓÂÔÁÓÈ΋(65%) ‹ ‚ÚÂÊÈ΋ (21%) ËÏÈΛ·, ÂÓÒ Û ÌÈÎÚfiÙÂÚÔÔÛÔÛÙfi Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· (14%) (1,3). ™ÙËÓÂÔÁÓÈ΋ Î·È ‚ÚÂÊÈ΋ ËÏÈΛ· ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜Ì ıÔÚ˘‚Ò‰Ë Û˘Ìو̷ÙÔÏÔÁ›· Î·È ÂÈÎfiÓ· ÔÍ›-·˜ ÎÔÈÏ›·˜ (¯ÔÏÒ‰ÂȘ ¤ÌÂÙÔÈ, ·›Ì· ·fi ÙÔ ÔÚıfi,ÂÈÎfiÓ· shock). ∞ÓÙ›ıÂÙ·, Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Ù·Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· Â›Ó·È ·Ì‚Ï˘¯Ú¿ ‹ ‰È·Ï›-ÔÓÙ· (chronic midgut volvulus), o ·ÂÈÎÔÓÈÛÙÈÎfi˜¤ÏÂÁ¯Ô˜ Ó· ÌËÓ Â›Ó·È ‰È·ÁÓˆÛÙÈÎfi˜ Î·È Ô ¤ÏÂÁ¯Ô˜Ó· ηÙ¢ı‡ÓÂÙ·È Û ¿ÏÏ· ·›ÙÈ·, fiˆ˜ ÊÏÂÁÌÔÓÒ-‰ÂȘ ÓfiÛÔ˘˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·, ÓÔ-Û‹Ì·Ù· Ô˘ ÚÔηÏÔ‡Ó ‰˘Û·ÔÚÚfiÊËÛË ‹ ·Îfi-ÌË Ù· Û˘ÌÙÒÌ·Ù· Ó· ıˆÚÔ‡ÓÙ·È „˘¯ÔÁÂÓ‹(4,5). ªÔÚ› ·ÎfiÌË Ó· ÌËÓ ˘¿Ú¯ÂÈ Î·Ó¤Ó· Û‡-Ìو̷ Î·È Ë ‰È¿ÁÓˆÛË Ó· Â›Ó·È Ù˘¯·›Ô ‡ÚËÌ·.™Â ¯ÚfiÓȘ ÂÚÈÙÒÛÂȘ, Ù· ·ÚÈ· Û˘ÌÙÒÌ·Ù· ›-Ó·È ÙÔ ÂÚÈÔ‰ÈÎfi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, Ë ‰È·ÏÂ›Ô˘Û·‰È¿ÚÚÔÈ·, ÔÈ ¤ÌÂÙÔÈ (¯ÔÏÒ‰ÂȘ ‹ ÌË), Ë ‰˘Û·ÔÚ-ÚfiÊËÛË Ì ·ÒÏÂÈ· ‹ ÌË ÚfiÛÏË„Ë ÈηÓÔÔÈËÙÈ-ÎÔ‡ ‚¿ÚÔ˘˜, ·ÓÔÚÂÍ›·, Ó·˘Ù›· ÌÂÙ¿ Ù· Á‡̷ٷ(1,3,4). ∆Ô ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ·Ô‰›‰ÂÙ·È ÛÙËÓ ÂÚÈÔ-‰È΋ ÈÛ¯·ÈÌ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÂÓÒ Ë ‰È¿ÚÚÔÈ· ÛÙÔ¯ÚfiÓÈÔ Ô›‰ËÌ· ÙˆÓ ÏÂÌÊ·ÁÁ›ˆÓ Î·È ÙÔ˘ ‚ÏÂÓÓÔ-

ÁfiÓÔ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙËÓ ·ÒÏÂÈ· ˆÛ̈ÙÈο‰Ú·ÛÙÈÎÒÓ Ô˘ÛÈÒÓ (1,2).

∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈ-ÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘, Ô˘ ÌÔÚ› fï˜ Ó· ÌËÓ Â›Ó·È¿ÓÙ· ‰È·ÁÓˆÛÙÈο, ÂȉÈο Û ÂÚÈfi‰Ô˘˜ ËÚÂÌ›·˜.™Â Ê¿ÛË Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (volvulus), ÛÙËÓ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜, ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ÂÈ-ÎfiÓ· ‰ÈÏ‹˜ Ê˘Û·Ï›‰·˜ (double-bubble sign) Ì¢‰Ú·ÂÚÈο ›‰·, ÏfiÁˆ Ù˘ ‰È¿Ù·Û˘ ÙÔ˘ ÛÙÔ-Ì¿¯Ô˘ Î·È Ù˘ 1˘ ÌÔ›Ú·˜ ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘,ηıÒ˜ Î·È ·Ô˘Û›· ·¤Ú· ÛÙÔ ÂÚÈÊÂÚÈÎfi ¤ÓÙÂÚÔ,Â˘Ú‹Ì·Ù· Ô˘ ‰ÂÓ ··ÓÙÒÓÙ·È fï˜ Û˘¯Ó¿ (1,6).∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈÛÙË ‰È¿ÁÓˆÛË Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ı¤ÛË˜ÙˆÓ ÌÂÛÂÓÙ¤ÚÈˆÓ ·ÁÁ›ˆÓ. º˘ÛÈÔÏÔÁÈο, Ë ¿Óˆ ÌÂ-ÛÂÓÙ¤ÚÈÔ˜ ÊϤ‚· (∞ªº) ‚Ú›ÛÎÂÙ·È ‰ÂÍÈ¿ Ù˘ ¿ÓˆÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜ (∞ª∞) (6,7). ∞Ó Ë ∞ªº ‚ÚÂ-ı› ·ÚÈÛÙÂÚ¿ ‹ ÌÚÔÛÙ¿ Ù˘ ∞ª∞, ·ÔÙÂÏ› ¤Ó‰ÂÈ-ÍË ÁÈ· ·ÓÒÌ·ÏË ÂÚÈÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (∂ÈÎfiÓ·1), ‡ÚËÌ· Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ·ÎfiÌËÎ·È ÁÈ· ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË (8). ∞ÎfiÌË, Û Â-ÚÈÙÒÛÂȘ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÔÚ› Ó·˘¿Ú¯ÂÈ ÌÔÚÊÔÏÔÁ›· ÛÙÚÔ‚›ÏÔ˘ (whirlpool sign) ‹ÂÏ·ÙËÚ›Ô˘ (corkscrew sign) (1,5,6).

∏ ‰È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ ·ÔÙÂÏ›ÙËÓ ÂͤٷÛË ÂÎÏÔÁ‹˜ Ô˘ ‚ÔËı¿ÂÈ ÙË ‰È¿ÁÓˆÛË ÛÂÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ (42%-94%) (3,9). ∏Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ ÙÔ˘ Treitz ›ӷȷÚÈÛÙÂÚ¿ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÛÙÔ ‡„Ô˜ ÙÔ˘Á·ÛÙÚÈÎÔ‡ ¿ÓÙÚÔ˘, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ∞¶ª∂‚Ú›ÛÎÂÙ·È ‰ÂÍÈ¿ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÌÚÔÛÙ¿·fi ÙÔ ‚ÔÏ‚fi ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘. O ˘ÔÎÏ˘-ÛÌfi˜ Ì ‚¿ÚÈÔ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÈϤÔÓ(23%-34%) Û ·ÌÊ›‚ÔϘ ÂÚÈÙÒÛÂȘ Ì ÙÔÓÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ı¤Û˘ ÙÔ˘ Ù˘ÊÏÔ‡, ÙÔ ÔÔ›Ô

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∂ÈÎfiÓ· 3. ∞. ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÂÈÎfiÓ·: ‰È·ÎÚ›ÓÂÙ·È Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È ‰È¿Ù·ÛË ÙˆÓ ·ÈÌÔÊfiÚˆÓ ·ÁÁ›ˆÓ ÏfiÁˆ ÛÙ¿-Û˘. µ. ªÂÙÂÁ¯ÂÈÚËÙÈ΋ ÂÈÎfiÓ·: ¤¯ÂÈ Á›ÓÂÈ ·Ó¿Ù·ÍË ·fi ÙË Û˘ÛÙÚÔÊ‹.

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Ê˘ÛÈÔÏÔÁÈο ‚Ú›ÛÎÂÙ·È ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ,ÂÓÒ Û ÂÚÈÙÒÛÂȘ ∞¶ª∂ ‚Ú›ÛÎÂÙ·È Û ˘„ËÏfiÙÂ-ÚË ı¤ÛË, ÛÙË ‰ÂÍÈ¿ ¿Óˆ ÎÔÈÏ›· ‹ ÌÔÚ› Ó· Â›Ó·È ÎÈ-ÓËÙfi (3,6,9). O ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·ÎÔÈÏ›·˜ ‰ÂÓ ¤¯ÂÈ ·ÍÈÔÏÔÁËı› ·ÚÎÒ˜ ÁÈ· ÙË ‚Ô‹-ıÂÈ· Ô˘ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÛÙË ‰È¿ÁÓˆÛË (5).™Â ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÁÓˆÛÙÈÎfi·ÔÙ¤ÏÂÛÌ·, ÌÔÚ› Ó· ··ÈÙËı› ·ӿÏË„Ë ÙÔ˘·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Û ʿÛË ÔÍ›·˜ Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›·˜, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜Ì·˜, ‹ ·ÎfiÌË Î·È ‰ÈÂÚ‡ÓËÛË Ì Ϸ·ÚÔÛÎfiËÛËÔ˘ Û ·Ï¤˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Â›Ó·È ‰È·-ÁÓˆÛÙÈ΋ Î·È ıÂڷ¢ÙÈ΋ (10).

∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ· Ó· ÙÔÓÈÛÙ›ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ÏfiÁˆ Û˘ÁÁÂÓÔ‡˜ ·ÓÒÌ·Ï˘ ÛÙÚÔÊ‹˜ ÌÔÚ› Ó·¤¯ÂÈ Î·È ¯ÚfiÓÈ· ‹ Ï·Óı¿ÓÔ˘Û· ÔÚ›· Î·È Û ÂÚÈ-ÙÒÛÂȘ Ì ‰È·Ï›ÔÓÙ· Û˘ÌÙÒÌ·Ù· ¤¯ÂÈ ÛËÌ·-Û›· Ó· ÙÂı› ¤ÁηÈÚ· Ë ‰È¿ÁÓˆÛË ÒÛÙ ӷ Á›ÓÂÈ ¯ÂÈ-ÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË.

µÈ‚ÏÈÔÁÚ·Ê›·1. Warner µW. Malrotation. In: Oldham KT, Colombani PM,

Foglia RP, editors. Surgery of infants and children:Scientific Principles and practice. Philadelphia: Lippincott-Raven Publishers; 1997. p. 1229-1240.

2. Brandt ML, Pokomy WJ, Mc Gill CW, Harberg FJ. Latepresentations of midgut malrotation in children. Am J Surg1985;150:767-771.

3. Powell DM, Othersen HB, Smith CD. Malrotation of theintestines in children: The effect of age on presentation

and therapy. J Pediatr Surg 1989;24:777-780. 4. Kullendorff CM, Mikaelsson C, Ivancev K. Malrotation in

children with symptoms of gastrointestinal allergy andpsychosomatic abdominal pain. Acta Pediatr Scand1985;74:296-299.

5. Walsh DS, Crombleholme TM. Superior mesentericvenous thrombosis in malrotation with chronic volvulus. JPediatr Surg 2000;35:753-755.

6. Berdon WE. The diagnosis of malrotation and volvulus inthe older child and adult: a trap for radiologists. PediatrRadiol 1995;25:101-103.

7. Dufour D, Delaet MH, Dassonville M, Cadranel S,Perlmutter N. Midgut malrotation, the reliability ofsonographic diagnosis. Pediatr Radiol 1992;22:21-23.

8. ÀÔÔ SJ, Park KW, Cho SY, Sim JS, Hhan KS. Definitivediagnosis of intestinal volvulus in utero. Ultrasound ObstetGynecol 1999;13:200-203.

9. Prasil P, Flageole H, Shaw KS, Nguyen LT, Youssef S,Laberge JM. Should malrotation in children be treateddifferently according to age? J Pediatr Surg2000;35:756-758.

10. Gross E, Chen MK, Lobe TE. Laparoscopic evaluation andtreatment of intestinal malrotation in infants. Surg Endosc1996;10:936-937.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2001HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-12-2001

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ı·Ó¿ÛÈÔ˜ °. ª›¯Ô˜ ¶·ÓfiÚÌÔ˘ 26-28, ∞ÌÂÏfiÎËÔÈ ∆.∫. 115 23, ∞ı‹Ó· E-mail: [email protected]

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¡fiÛÔ˜ Kikuchi - Fujimoto: ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ °. ∆Ú›Ì˘, ∫. ∞ı·Ó·Û¿ÎË, ∞. °È·ÓÓÔ‡ÏÈ· - ∫·Ú·ÓÙ·Ó¿, •. ∫Ú›ÎÔ˜

Kikuchi - Fujimoto disease: Case report G. Trimis, K. Athanasaki, A. Giannoulia - Karantana, X. Krikos

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

�¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ËÏÈΛ·˜ 10 ÂÙÒÓ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi Î·È ÂÈ-̤ÓÔ˘Û· ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, Ù· ÔÔ›· ·Ô-Ù¤ÏÂÛ·Ó ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Kicuchi. ∏ ‰È¿ÁÓˆ-ÛË Ù¤ıËΠÌÂÙ¿ ‚ÈÔ„›· ÚÔۂ‚ÏË̤ÓÔ˘ ÏÂÌÊ·-‰¤Ó·, fiÔ˘ ·ÓȯÓ‡ıËÎÂ Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÈÛÙÈÔ-΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· Ì ·ÚÂÌ‚Ô-Ï‹ ÂÚÈÔ¯ÒÓ ˘ÁÈÔ‡˜ ÈÛÙÔ‡. OÈ ÂΉËÏÒÛÂȘ Ù˘ Ófi-ÛÔ˘ ˘Ô¯ÒÚËÛ·Ó ·˘ÙfiÌ·Ù· ÂÓÙfi˜ ÙÚÈÒÓ ÌËÓÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ Kicuchi, ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·-‰ÂÓ›Ùȉ·, ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·.

�Abstract: A case of a 10 year old girl isdescribed who presented with prolonged fever andpersistent cervical lymphadenitis, which werefound to be manifestations of Kikuchi’s disease.The diagnosis was based on a lymph node biopsythat showed the characteristic histiocytic necroticlymphadenitis with interjection of areas withhealthy tissue. The manifestations of the diseaseresolved spontaneously in 3 months.

Key words: Kikuchi’s disease, cervicallymphadenitis, histiocytic necrotic lymphadenitis.

∂ÈÛ·ÁˆÁ‹∏ ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·,

ÁÓˆÛÙ‹ ˆ˜ ÓfiÛÔ˜ Kikuchi - Fujimoto, Â›Ó·È ÏÂÌÊ·-‰ÂÓÔ¿ıÂÈ· Ô˘ ÂÚÈÁÚ¿ÊËΠ·Ú¯Èο ÙÔ 1972ÛÙËÓ π·ˆÓ›· ·fi ÙÔÓ Kikuchi Î·È ÙÔÓ Fujimoto (1).TËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· ·Ó·Ê¤ÚÔÓÙ·È ÛÔÚ·‰ÈΤ˜ÂÚÈÙÒÛÂȘ ·fi fiÏÔ ÙÔÓ ÎfiÛÌÔ, ·Ó Î·È ·Ú·Ì¤ÓÂÈÛ˘¯ÓfiÙÂÚË ÛÙËÓ ∞Û›·. ¶ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ Á˘Ó·›-Θ Ì ̤ÛË ËÏÈΛ· Ù· 30 ¯ÚfiÓÈ·, ÂÓÒ Â›Ó·È È‰È·ÈÙ¤-Úˆ˜ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (2). ¶ÚÔ‚¿ÏÏÂÈÛ˘Ó‹ıˆ˜ Ì ˘ÚÂÙfi Î·È ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·,·ÓÒ‰˘ÓË ‹ ÂÒ‰˘ÓË. Œ¯Ô˘Ó ·Ó·ÊÂÚı›, ›Û˘,¤ÌÂÙÔÈ, ‰È¿ÚÚÔÈ·, Ì˘·ÏÁ›Â˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔ-ÛÏËÓÔÌÂÁ·Ï›· Î·È ÂÍ¿ÓıËÌ· (3). ∆· ÌÔÓ·‰Èο ·-ıÔÏÔÁÈο ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Â›Ó·È ÔÈ ÌÂ-ÙÚ›ˆ˜ ·˘ÍË̤ÓÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ηÈ, ÂÓ›ÔÙÂ, ËÏ¢ÎÔÂÓ›·.

∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂÙ¿ ‚ÈÔ„›· ÚÔۂ‚ÏË̤-ÓÔ˘ ÏÂÌÊ·‰¤Ó· Ì ·Ó›¯Ó¢ÛË ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ, ηٿÙfiÔ˘˜ Ó¤ÎÚˆÛË ¯ˆÚ›˜ ·ÔÛÙËÌ·ÙÔÔ›ËÛË Î·È·ÚÂÌ‚ÔÏ‹ ÂÚÈÔ¯ÒÓ ˘ÁÈÔ‡˜ ÈÛÙÔ‡. ∆· ÈÛÙÔÏÔÁÈÎ¿Â˘Ú‹Ì·Ù· Û˘¯Ó¿ Û˘Á¯¤ÔÓÙ·È Ì ·˘Ù¿ ÙÔ˘ ηÎÔ‹-

ıÔ˘˜ ÏÂÌÊÒÌ·ÙÔ˜. ∏ ÓfiÛÔ˜ ¤¯ÂÈ Î·ÏÔ‹ıË ÔÚ›· Î·È ·˘ÙÔ˚¿Ù·È ÛÂ

4-6 Ì‹Ó˜. ÀÔÙÚÔÈ¿˙ÂÈ Û ÔÛÔÛÙfi 3%, ÂÓÒÛ¿ÓÈ· Â›Ó·È Ë ÚÒÙË ÂΉ‹ÏˆÛË ™˘ÛÙËÌ·ÙÈÎÔ‡∂Ú˘ıËÌ·ÙÒ‰Ô˘˜ §‡ÎÔ˘ (™∂§) (4). ∏ ·ÈÙÈÔÏÔÁ›·Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, ·Ó Î·È Èı·ÓÔÏÔ-ÁÂ›Ù·È ˘ÂÚ¿ÓÔÛË ·ÓÙ›‰Ú·ÛË Û ÏÔÈÌÒ‰Ë ·Ú¿ÁÔ-ÓÙ· fiˆ˜ Ô Èfi˜ Epstein-µarr (5).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜10 ÂÙÒÓ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi Î·È ÂÈ̤ÓÔ˘Û·ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›··ÔÙÂÏÔ‡Ó ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Kikuchi.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 10 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋

Ì·˜ Ì ˘ÚÂÙfi ¤ˆ˜ 40ÔC Î·È ·ÌÊÔÙÂÚfiÏ¢ÚË,·ÓÒ‰˘ÓË ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi 6Ë̤ÚÔ˘.∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤-ÚÔÓÙ·È ÂχıÂÚ·.

∏ ·ÛıÂÓ‹˜ ‹Ù·Ó Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛËÎ·È ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎÂÔÌ¿‰· ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ÌÂÁ¤ıÔ˘˜ 3x3 cm,

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, Aı‹Ó·

1st Pediatric Clinic of University of Athens “St. Sophia” Children’s Hospital, Athens

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ÔÈ ÔÔ›ÔÈ ‹Ù·Ó ˘fiÛÎÏËÚÔÈ, ¢ΛÓËÙÔÈ, ·ÓÒ‰˘ÓÔÈ,ÌË Û˘ÌÊ˘fiÌÂÓÔÈ Ì ÙÔ ˘ÂÚΛÌÂÓÔ ‰¤ÚÌ· Î·È ¯ˆ-Ú›˜ ÛËÌ›· ÊÏÂÁÌÔÓ‹˜. ∏ ÂÓÙfiÈÛ‹ ÙÔ˘˜ ‹Ù·Ó fiÈ-ÛıÂÓ ÙÔ˘ ÛÙÂÚÓÔÎÏÂȉÔÌ·ÛÙÔÂȉԇ˜ Ì˘fi˜ ‰ÂÍÈ¿Î·È ÛÙËÓ ÚfiÛıÈ· ¿Óˆ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· ·ÚÈÛÙÂÚ¿.∆Ô ‹·Ú Î·È Ô ÛÏ‹Ó·˜ ‹Ù·Ó ·„ËÏ¿ÊËÙ·, ÂÓÒ ‰ÂÓ·Ó¢ڤıËÛ·Ó ÏÂÌÊ·‰¤Ó˜. ∞fi Ù· ˘fiÏÔÈ· Û˘-ÛÙ‹Ì·Ù· ‰ÂÓ ÚԤ΢„ οÙÈ ·ıÔÏÔÁÈÎfi.

∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: Ht: 37,3%, Hb: 12,1gr/dl, WBC: 10400/Ìl (¶/ 66% §/26% ª/6%),PLT: 502000/Ìl, TKE: 90 mm, CRP: 113 mg/L,SGOT: 10 IU/L, SGPT: 11 IU/L, ÁGT: 12 IU/L,ALP: 112 IU/L, LDH: 240 IU/L, Cu: 227 Ìg/dl,ÊÂÚÚÈÙ›ÓË: 211 ng/ml, ÏÔÈfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ-¯Ô˜: ÎÊ, ÁÂÓÈ΋ Ô‡ÚˆÓ: ÎÊ, ·ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ-¯Ô˜ (·ÓÔÛÔÛÊ·ÈÚ›Ó˜, C3, C4, ANA, anti-DNA):ÎÊ, ·ÓÙÈÛÒÌ·Ù· ÔÚÔ‡ ¤Ó·ÓÙÈ HSV1, HSV2, HSV6,EBV, CMV, HIV, Coxsackie, Parvo, Yersinia,µartonella, ÙÔÍÔÏ¿ÛÌ·ÙÔ˜, ‚ÚԢΤÏÏ·˜, ÚÈÎÂ-ÙÛÈÒÓ: ·ÚÓËÙÈο, Mantoux: (-), VMA Ô‡ÚˆÓ24ÒÚÔ˘: ÎÊ. ŒÁÈÓÂ, ›Û˘, ·ÎÙÈÓÔÁÚ·Ê›· ıÒ-Ú·ÎÔ˜, U/S ÎÔÈÏ›·˜, ‚˘ıÔÛÎfiËÛË Î·È Û¯ÈÛÌÔÂÈ-‰‹˜ Ï˘¯Ó›·, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆıÔ‡Ó ·ıÔÏÔÁÈÎ¿Â˘Ú‹Ì·Ù·. ∞fi ÙÔ U/S ÙÚ·¯‹ÏÔ˘ ‰È·ÈÛÙÒıËÎÂfiÙÈ ÔÈ ÏÂÌÊ·‰¤Ó˜ ‹Ù·Ó ÛÙÚÔÁÁ˘ÏÔ›, Û˘Ì·Á›˜,¯ˆÚ›˜ ‰È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ Î·È Ù˘ ·È-Ì·ÙÒÛÂÒ˜ ÙÔ˘˜.

∆Ô ·È‰› ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠‰È¿ÊÔÚ· Û¯‹Ì·Ù·ÂÓ‰ÔÊϤ‚È·˜ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â˘Ú¤Ô˜ Ê¿-ÛÌ·ÙÔ˜ › 20‹ÌÂÚÔ, ¯ˆÚ›˜ ‡ÊÂÛË ÙÔ˘ ˘ÚÂÙÔ‡ ‹˘Ô¯ÒÚËÛË Ù˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜. ∏ ÁÂÓÈ΋ η-Ù¿ÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ·Ú¤ÌÂÓ Ôχ ηϋ, ÂÓÒ‰ÂÓ ÂÌÊ¿ÓÈÛ ¿ÏÏ· Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·. EÓ fi„ÂȉȷÁÓˆÛÙÈÎÔ‡ ·‰ÈÂÍfi‰Ô˘, ‰ÈÂÓÂÚÁ‹ıËΠ‚ÈÔ„›·ÏÂÌÊ·‰¤Ó· Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜, ÂÓÒ Ù·˘Ùfi-¯ÚÔÓ· ¤ÁÈÓÂ Ì˘ÂÏfiÁÚ·ÌÌ· Î·È ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ-„›·. O Ì˘ÂÏfi˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÓÒ ·fi ÙË ‚ÈÔ-„›· ÙÔ˘ ÏÂÌÊ·‰¤Ó· ‰È·ÈÛÙÒıËÎ·Ó ·ÏÏÔÈÒÛÂÈ˜Ô˘ ÚÔÛÏ¿Ì‚·Ó·Ó ηٿ ı¤ÛÂȘ ¯·Ú·ÎÙ‹Ú˜ÈÛÙÈÔ΢ÙÙ·ÚÈ΋˜ ÓÂÎÚˆÙÈ΋˜ ÌË ·ÔÛÙËÌ·ÙÈ΋˜ÏÂÌÊ·‰ÂÓ›Ùȉ·˜. ∏ ÂÚÈÁÚ·ÊfiÌÂÓË ÈÛÙÔÏÔÁÈ΋ ÂÈ-ÎfiÓ· ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ÙËÓ ·Ú·ÙËÚÔ‡ÌÂÓË ÛÂÏÂÌÊ·‰ÂÓ›Ùȉ· Ù‡Ô˘ Kikuchi-Fujimoto, ÂÊ’ fiÛÔÓ›¯Â ·ÔÎÏÂÈÛÙ› ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ÙÔ ÂӉ¯fi-ÌÂÓÔ ˘ÔÛÙÚÒÌ·ÙÔ˜ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜(™∂§). ∏ ηÏÏȤÚÁÂÈ· ÙÔ˘ ˘ÏÈÎÔ‡ ÁÈ· ÎÔÈÓ¿, ·Ó·Â-Úfi‚È· ÌÈÎÚfi‚È·, ̇ÎËÙ˜ Î·È Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·¤-‚Ë ·ÚÓËÙÈ΋.

ªÂ ‚¿ÛË ÙË ‚ÈÔ„›·, Ë ÔÔ›· ¤ıÂÛ ÙË ‰È¿ÁÓˆÛËÙ˘ ÓfiÛÔ˘ Kikuchi, ‰È·ÎfiËÎÂ Ë Ê·Ú̷΢ÙÈ΋·ÁˆÁ‹. O ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛ ·˘ÙfiÌ·Ù· 3 Ë̤-Ú˜ ·ÚÁfiÙÂÚ·. ∆Ô ·È‰› ÂÍ‹ÏıÂ Î·È Ù¤ıËΠ۠ٷ-ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ∏ ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË˘Ô¯ÒÚËÛ ÚÔԉ¢ÙÈο ÂÓÙfi˜ 3 ÌËÓÒÓ.

™˘˙‹ÙËÛË ªÔÏÔÓfiÙÈ Ë ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·-

‰ÂÓ›Ùȉ· ‹ ÓfiÛÔ˜ Kikuchi ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙËÊÔÚ¿ ÚÔ 30ÂÙ›·˜, Ï›Á˜ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∏ ̤-ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fiÙË ÓfiÛÔ Â›Ó·È 30 ÂÙÒÓ, Ì ‡ÚÔ˜ ·fi 11 ˆ˜ 75 ¤ÙË.∏ ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ-ıËϤˆÓ Â›Ó·È 1:4 (2). ∏ ›-ÙˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ ¯ÒÚ˜Ù˘ ∞Û›·˜, ·Ó Î·È ÛÔÚ·‰Èο ÎÚÔ‡ÛÌ·Ù· ηٷ-ÁÚ¿ÊÔÓÙ·È Û fiÏÔ ÙÔÓ ÎfiÛÌÔ. ∂›Ó·È Èı·Ófi Ô ·ÚÈı-Ìfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ Î·È Ó·‰È·Ê‡ÁÂÈ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ÏfiÁˆ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜fiÙÈ Ë ÓfiÛÔ˜ Â›Ó·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË Î·È ÚÔηÏ›·ÓËÛ˘¯›· ÛÙÔ ıÂÚ¿ÔÓÙ· È·ÙÚfi ÌfiÓÔ fiÙ·Ó ·˘Ù‹·Ú·Ù›ÓÂÙ·È. OÈ ÈÔ Û˘¯Ó¤˜ ÂΉËÏÒÛÂȘ Â›Ó·È Ô·Ú·ÙÂٷ̤ÓÔ˜ ˘ÚÂÙfi˜ Î·È Ë ·ÓÒ‰˘ÓË ÙÚ·¯ËÏÈ΋ÏÂÌÊ·‰ÂÓ›Ùȉ·. ªÂÚÈΤ˜ ÊÔÚ¤˜, Ë ÏÂÌÊ·‰ÂÓÔ¿-ıÂÈ· ÂÓÙÔ›˙ÂÙ·È ÛÙÔ˘˜ ‚Ô˘‚ˆÓÈÎÔ‡˜, ÙÔ˘˜ ÌÂÛÔ-ıˆÚ·ÎÈÎÔ‡˜ ‹ ÙÔ˘˜ ÌÂÛÂÓÙ¤ÚÈÔ˘˜ ÏÂÌÊ·‰¤Ó˜,ÂÓÒ ÌÔÚ› Ó· Â›Ó·È Î·È ÁÂÓÈÎÂ˘Ì¤ÓË, Û˘Óԉ¢fiÌÂ-ÓË ·fi Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. OÈ ·ÛıÂÓ›˜ ÌÔÚ›·ÎfiÌ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó·˘Ù›·,Â̤ÙÔ˘˜, Ú›ÁÔ˜, ÛÙÔÌ·ÙÈο ¤ÏÎË, Ì˘·ÏÁ›Â˜, ·Ú-ıÚ·ÏÁ›Â˜, Ó˘¯ÙÂÚÈÓ¤˜ ÂÊȉÚÒÛÂȘ Î·È ‰ÂÚÌ·ÙÈΤ˜ÂΉËÏÒÛÂȘ, fiˆ˜ ÂÚ‡ıËÌ· ÚÔÛÒÔ˘, ÎËÏȉÔ-‚Ï·Ùȉ҉˜ ÂÍ¿ÓıËÌ· Î·È ÔÌÊÔ‡˜, fï˜ Ë ÁÂÓÈ-΋ ÙÔ˘˜ ηٿÛÙ·ÛË ·Ú·Ì¤ÓÂÈ Î·Ï‹ (3,6). ∏ Û˘-Ìو̷ÙÔÏÔÁ›· ·˘Ù‹ Ô‰ËÁ› ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ-„Ë Û ¤Ó· Â˘Ú‡Ù·ÙÔ Ê¿ÛÌ· ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ÏÂÌÊ·‰ÂÓ›Ùȉ· ÏÔÈÌÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜, ÓÔÛ‹Ì·Ù·ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ ‹ ηÎfiËı˜ ϤÌʈ̷.

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È ‚ÔËıËÙÈ-Îfi˜, ·ÊÔ‡ Ù· ÌfiÓ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È ÔÈ·˘ÍË̤ÓÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ÛÙÔÓ ÔÚfi (∆∫∂,CRP, LDH, ¯·ÏÎfi˜, ÊÂÚÚÈÙ›ÓË) Î·È ÂÓ›ÔÙ ̛· ‹È·Ï¢ÎÔÂÓ›· (7). ∏ ÂÈÌÔÓ‹ Ù˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜,·Ú¿ ÙË Û˘Ó‹ıˆ˜ ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹ Ì ·ÓÙÈ-‚ÈÔÙÈο, ηıÈÛÙ¿ ·Ó·Áη›· ÙË ‚ÈÔ„›· ÚÔۂ‚ÏË-̤ÓÔ˘ ÏÂÌÊ·‰¤Ó·, Ë ÔÔ›· Î·È ı¤ÙÂÈ ÙË ‰È¿ÁÓˆÛË.O ÚÔۂ‚ÏË̤ÓÔ˜ ÏÂÌÊ·‰¤Ó·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì·-ÎÚÔÛÎÔÈο ÂÎÙÂٷ̤Ó˜ ÓÂÎÚÒÛÂȘ, ÂÓÒ ÂӉȿÌÂ-Û· ·ÚÂÌ‚¿ÏÏÔÓÙ·È ˘ÁÈ›˜ ÂÚÈÔ¯¤˜. ∫·Ù¿ ÙËÓÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒÓÂÙ·È Û˘ÛÛÒÚ¢ÛËηٿ ÙfiÔ˘˜ ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ÚÔηÏ› η-Ú˘ÔÚÚËÍ›· Î·È Ó¤ÎÚˆÛË, ΢ڛˆ˜ ÛÙËÓ ·Ú·ÊÏÔÈÒ-‰Ë ÂÚÈÔ¯‹ ÙÔ˘ ·‰¤Ó·. ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë·Ô˘Û›· ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ÛÙȘ ÂÛٛ˜ Ó¤ÎÚˆÛ˘(8). ∏ ÈÛÙÔÏÔÁÈ΋ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Î˘-Ú›ˆ˜ ·fi ÙÔ Î·ÎfiËı˜ ϤÌʈ̷, ÁÈ· ÙË ‰È¿ÎÚÈÛËÙÔ˘ ÔÔ›Ô˘ ··ÈÙÂ›Ù·È ÌÂÁ¿ÏË ÂÌÂÈÚ›· ·fi ÙÔÓ·ıÔÏÔÁÔ·Ó·ÙfiÌÔ, ÙÔ ™∂§, ÁÈ· ÙÔÓ ÔÔ›Ô Û˘ÓÂÎÙÈ-ÌÒÓÙ·È Ù· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, Î·È ÙËÓfiÛÔ ÂÍ’ ÔÓ‡¯ˆÓ Á·Ï‹˜, fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Ù·

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¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÛÙËÌ¿ÙÈ·. ∏ ‚ÈÔ„›· Ì ÏÂÙ‹‚ÂÏfiÓË ÌÔÚ› Ó· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË ÛÙÔ 50% Â-Ú›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ·˘Ùfi ÂÍ·ÚÙ¿Ù·È ·fiÙË Ï‹„Ë ÙÔ˘ ˘ÏÈÎÔ‡, ÙÔ ÔÔ›Ô Û˘Ìو̷ÙÈο ÌÔ-Ú› Ó· ÚÔ¤Ú¯ÂÙ·È ·fi ·ıÔÏÔÁÈ΋ ÂÚÈÔ¯‹ (3,9).

∏ ÔÚ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ηÏÔ‹ı˘,ηıÒ˜ Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Ô ˘ÚÂÙfi˜ ˘Ô¯ˆ-ÚÔ‡Ó ÙÔ ·ÚÁfiÙÂÚÔ Û 4-6 Ì‹Ó˜. £ÂˆÚÂ›Ù·È ·˘ÙÔ˚-ÒÌÂÓË ÓfiÛÔ˜, ηıÒ˜ Ô˘‰ÂÌ›· Ê·Ú̷΢ÙÈ΋ ·Áˆ-Á‹ Ê·›ÓÂÙ·È Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙËÓ ÔÚ›· Ù˘. ∫·-Ù¿ ηÈÚÔ‡˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Ù· ÎÔÚÙÈÎÔÂȉ‹,¯ˆÚ›˜ Ó· ÂȂ‚·ÈÒÓÂÙ·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ÙÔ˘˜ (10). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÌfiÓÔ Ì›·ı·Ó·ÙËÊfiÚÔ˜ ÂÚ›ÙˆÛË, ÏfiÁˆ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘Ì˘Ôηډ›Ô˘ (11). ÷ڷÎÙËÚÈÛÙÈÎfi Â›Ó·È fiÙÈ ¤¯Ô˘Ó·Ú·ÙËÚËı› ˘ÔÙÚÔ¤˜ Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›-ÓÂÙ·È ·fi 2%-4% (12). ™¿ÓÈ· ¤¯Ô˘Ó ηٷÁÚ·Ê›ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ô˘ ÂΉ‹ÏˆÛ·Ó ™∂§ Û ‡-ÏÔÁÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ê’ fiÙÔ˘ ›¯·Ó ÚÔÛ‚ÏË-ı› ·fi ÓfiÛÔ Kikuchi (4,13).

∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË.º·›ÓÂÙ·È fiÙÈ Î¿ÔÈÔ˜ ·Ú¿ÁÔÓÙ·˜, ›ÙÂ Ê˘ÛÈÎfi˜ ›-Ù ¯ËÌÈÎfi˜ ›Ù ÏÔÈÌ҉˘, Ô˘ Â›Ó·È Î·È ÙÔ Èı·Ófi-ÙÂÚÔ, ‰ÈÂÁ›ÚÂÈ Ù· ∆ ÏÂÌÊÔ·ÙÙ·Ú·, Ì ·ÔÙ¤ÏÂ-ÛÌ· Ó· ÚÔηÏÂ›Ù·È ·Ô‰fiÌËÛË Î˘ÙÙ¿ÚˆÓ Î·È Ó¤-ÎÚˆÛË ÛÙËÓ ·Ú·ÊÏÔÈÒ‰Ë ÂÚÈÔ¯‹ ÙˆÓ ÏÂÌÊ·‰¤-ÓˆÓ Î·È Â·ÎfiÏÔ˘ıË Û˘ÛÛÒÚ¢ÛË ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ.¶Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘Ó‡·ÚÍË ·˘ÙÔ¿ÓÔÛÔ˘ ˘Ô-ÛÙÚÒÌ·ÙÔ˜, Ô˘ ÂÍËÁ› Î·È ÙËÓ ÂͤÏÈÍË ÔÚÈṲ̂ӈÓÂÚÈÙÒÛÂˆÓ Û ™∂§. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì Ófi-ÛÔ Kikuchi ¤¯ÂÈ ‰È·ÈÛÙˆı› ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ ÏÔ›-̈ÍË ·fi Èfi Epstein-Barr (5) ‹ HTLV1 (10).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÛˆÛÙ‹ Î·È ¤ÁηÈÚË ‰È¿ÁÓˆ-ÛË ·˘Ù‹˜ Ù˘ Û¿ÓÈ·˜ ÔÓÙfiÙËÙ·˜ Â›Ó·È È‰È·›ÙÂÚ˘ÛËÌ·Û›·˜, ·ÊÔ‡ ·ÔÙÚ¤ÂÈ ·fi ÙË ‰ÈÂÓ¤ÚÁÂÈ··ÓÒÊÂÏˆÓ ÂÂÌ‚·ÙÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È ÙË ¯ÔÚ‹-ÁËÛË ÙÔÍÈÎÒÓ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ÌÂÙËÓ ˘fiÓÔÈ· ηÎÔ‹ıÔ˘˜ ÏÂÌÊÒÌ·ÙÔ˜ (14). ∏ ¢·È-ÛıËÙÔÔ›ËÛË ÙÔ˘ ·ıÔÏÔÁÔ·Ó·ÙfiÌÔ˘ ·fi ÙÔӷȉ›·ÙÚÔ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ù›ıÂÙ·È ˘fiÓÔÈ·‡·Ú͢ ÓfiÛÔ˘ Kikuchi ‚ÔËı¿ÂÈ ÛÙËÓ Â‰Ú·›ˆÛËÙ˘ ‰È¿ÁÓˆÛ˘.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kikuchi M. Lymphadenitis showing focal reticulum cell

hyperplasia with nuclear debris and phagocytosis: aclinicopathological study. Acta Hematol Jpn 1972;7:261-267.

2. Dorfman RF, Berry G. Kikuchi’s histiocytic necrotizinglymphadenitis: an analysis of 108 cases with emphasison the differential diagnosis. Semin Diagn Pathol1988;5:329-345.

3. Tsang W, Chan J, Ng CS. Kikuchi’s lymphadenitis: Amorphologic analysis of 75 cases with special reference tounusual features. Am J Surg Pathol 1994;18:219-231.

4. Chen YH, Lan JL. Kikuchi’s disease in systemic lupuserythematosus: clinical features and literature review. JMicrobiol Immunol Infect 1998;31:187-192.

5. Hudnall SD. Kikuchi-Fujimoto disease. Is Epstein-Barrvirus the culprit? Am J Clin Pathol 2000;113:761-764.

6. Rakic L, Arrese JE, Thiry A, Pierard GE. Kikuchi-Fujimotolymphadenitis with cutaneous involvement. J Eur AcadDermatol Venereol 1999;13:118-122.

7. Sierra ML, Vegas E, Blanco-Gonzalez JE, Gonzalez A,Martinez P, Calero MA. Kikuchi’s disease withmultisystemic involvement and adverse reaction to drugs.Pediatrics 1999;104:24.

8. Thongsuksai P, Kayasut K. Histiocytic necrotizinglymphadenitis (Kikuchi’s disease): clinicopathologiccharacteristics of 23 cases and literature review. J MedAssoc Thai 1999;82:812-818.

9. Viguer JM, Jimenez-Heffernan JA, Perez P, Lopez-Ferrer P,Gonzalez-Peramato P, Vicandi B. Fine-needle aspirationcytology of Kikuchi’s lymphadenitis: A report of ten cases.Diagn Cytopathol 2001;25:220-224.

10. Bataille V, Harland CC, Behrens J, Cook MG, Holden CA.Kikuchi’s disease (histiocytic necrotizing lymphadenitis) inassociation with HTLV1. Br J Dermatol 1997;136:610-612.

11. Chan JKC, Wong KC, Ng CS. A fatal case of multicentricKikuchi’s histiocytic necrotizing lymphadenitis. Cancer1989;63:1856-1862.

12. Blewitt RW, Kumar SN, Abraham JS. Reccurrence ofKikuchi’s lymphadenitis after 12 years. J Clin Pathol2000;53:157-158.

13. Litwin MD, Kirkham B, Henderson DR, Milazzo SC.Histiocytic necrotizing lymphadenitis in systemic lupuserythematosus. Ann Rheum Dis 1992;51:805-807.

14. Chamulak GA, Brynes RK, Nathwani BN. Kikuchi-Fujimotodisease mimicking malignant lymphoma. Am J SurgPathol 1990;14:514-523.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-10-2001HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-01-2002

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›Ì˘ ∏Ï›· ∑ÂÚ‚Ô‡ 72, ∆.∫. 111 44, ¶·Ù‹ÛÈ·

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∞. ∆Ô ∞ ¶Â™À ¡ÔÙ›Ô˘ ∞ÈÁ·›Ô˘ ˙ËÙ¿ ÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÁÈ·ÙÚÔ‡˜ ÁÈ· Ó· ÂÚÁ·ÛıÔ‡Ó Î˘Ú›ˆ˜ ηٿ ÙÔ˘˜ ıÂÚÈ-ÓÔ‡˜ Ì‹Ó˜, Û‡Ìʈӷ Ì ٷ ÚÔ‚ÏÂfiÌÂÓ· ÛÙÔ ÓfiÌÔ 2889/2001, Ì ۇ̂·ÛË ÂÚÁ·Û›·˜ ȉȈÙÈÎÔ‡ ‰Èη›-Ô˘ ·fi ÙÚÂȘ ̤¯ÚÈ 12 Ì‹Ó˜, Ì ÙË Û¯¤ÛË ÂÚÁ·Û›·˜ ÙÔ˘ “ÂÈÎÔ˘ÚÈÎÔ‡ ÁÈ·ÙÚÔ‡”, ÛÙȘ ·ÎfiÏÔ˘ı˜ ˘ÁÂÈÔ-ÓÔÌÈΤ˜ ÌÔÓ¿‰Â˜ ÙˆÓ ÓËÛÈÒÓ ÙˆÓ ∫˘ÎÏ¿‰ˆÓ:

1. ™ÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ ∆‹ÓÔ˘ ÁÈ·ÙÚÔ‡˜ ÂȉÈÎfiÙËÙ·˜ ·È‰È·ÙÚÈ΋˜, ÌÈÎÚÔ‚ÈÔÏÔÁ›·˜.

2. ™ÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ £‹Ú·˜ ÁÈ·ÙÚÔ‡˜ ÂȉÈÎÔÙ‹ÙˆÓ °ÂÓÈ΋˜ π·ÙÚÈ΋˜ ‹ ¶·ıÔÏÔÁ›·˜, ·È‰È·ÙÚÈ΋˜, ÔÚ-ıÔ‰È΋˜ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋˜

3. ™ÙÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ™‡ÚÔ˘ ÁÈ·ÙÚÔ‡˜ ÂȉÈÎÔÙ‹ÙˆÓ ·È‰È·ÙÚÈ΋˜.

OÈ ÂӉȷÊÂÚfiÌÂÓÔÈ ÌÔÚÔ‡Ó Ó· ÂÁÁÚ·ÊÔ‡Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÂÈÎÔ˘ÚÈÎÒÓ ÁÈ·ÙÚÒÓ Ô˘ ÙËÚÂ›Ù·È ÛÙË ¢È-‡ı˘ÓÛË ¡ÔÌÈÎÒÓ ¶ÚÔÛÒˆÓ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ (∞ÚÈÛÙÔÙ¤ÏÔ˘˜ 17, ∞ı‹Ó· 101 87, ÙËÏ.: 010-5232821/123) Î·È Ó· ˙ËÙ‹ÛÔ˘Ó ÙË ı¤ÛË ÛÙËÓ ÔÔ›· ı¤ÏÔ˘Ó Ó· ÂÚÁ·ÛÙÔ‡Ó Î·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙÔÔÔ›Ô ı¤ÏÔ˘Ó Ó· ··Û¯ÔÏËıÔ‡Ó.

¢ÈηÈÔ‡¯ÔÈ ÂÁÁÚ·Ê‹˜ Â›Ó·È ÂȉÈÎÂ˘Ì¤ÓÔÈ ÁÈ·ÙÚÔ›, ÔÈ ÔÔ›ÔÈ Â›ÙÂ Â›Ó·È ¿ÓÂÚÁÔÈ Â›Ù ··Û¯ÔÏÔ‡ÓÙ·È ÛÙÔÓȉȈÙÈÎfi ÙÔ̤·.

¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÁÁÚ·ÊÔ‡Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÔÈ ÁÈ·ÙÚÔ› ‰ÂÓ Ú¤ÂÈ Ó· η٤¯Ô˘Ó ÙÔÓ Ù›ÙÏÔ ÂȉÈÎfiÙËÙ·˜ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ϤÔÓ ÙˆÓ ¤ÓÙ ÂÙÒÓ Î·È Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ Û ·˘ÙfiÓ ÂÚÈÔÚ›˙ÂÙ·È Û ¤ÓÙ ¯Úfi-ÓÈ·.

ªÂ ÙË ‰‹ÏˆÛË ÂÁÁÚ·Ê‹˜ ηٷٿÛÛÔÓÙ·È Û ηٿÏÔÁÔ ·Ó¿ ÂȉÈÎfiÙËÙ·. OÈ ¿ÓÂÚÁÔÈ ÁÈ·ÙÚÔ› Ô˘ ›ӷÈÂÁÁÂÁÚ·Ì̤ÓÔÈ ÛÙÔÓ O∞∂¢ ÚÔËÁÔ‡ÓÙ·È ¤Ó·ÓÙÈ ·˘ÙÒÓ Ô˘ ··Û¯ÔÏÔ‡ÓÙ·È ÛÙÔÓ È‰ÈˆÙÈÎfi ÙÔ̤·.

∏ ۇ̂·ÛË ÂÚÁ·Û›·˜ Â›Ó·È ÔÚÈṲ̂ÓÔ˘ ¯ÚfiÓÔ˘ Ì ηıÂÛÙÒ˜ Ï‹ÚÔ˘˜ Î·È ·ÔÎÏÂÈÛÙÈ΋˜ ··Û¯fiÏËÛË˜Î·È ·Ô‰Ô¯¤˜ ÂȉÈÎÂ˘Ì¤ÓÔ˘ ÁÈ·ÙÚÔ‡ ∂ÈÌ. µ ∂™À. O ¯ÚfiÓÔ˜ ˘ËÚÂÛ›·˜ Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë ÛÙȘ ÎÚ›ÛÂȘ ÁÈ·ÂÈÏÔÁ‹ ÁÈ·ÙÚÒÓ ÎÏ¿‰Ô˘ ∂™À.

OÈ ÂӉȷÊÂÚfiÌÂÓÔÈ ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ ÌÔÚÔ‡Ó Ó· ÂÈÎÔÈÓˆÓ‹ÛÔ˘Ó Ì ÙËÓ ·ÚÌfi‰È· ¢È-‡ı˘ÓÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ ‹ Ó· ·Â˘ı‡ÓÔ˘Ó ÁÚ·Ù¿ ÂÚˆÙ‹Ì·Ù· ÛÙ· ÁÚ·Ê›· ÙÔ˘ ∞ ¶Â™À ¡. ∞È-Á·›Ô˘

Fax: 02810-96639 & ∆ËÏ.: 02810-96630

E-mail: [email protected]

™Â ÌÂÚÈο ÓËÛÈ¿ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÛʤÚÔÓÙ·È ·fi ÙÔ˘˜ ÙÔÈÎÔ‡˜ ¢ËÌ¿Ú¯Ô˘˜ Â͢ËÚÂÙ‹ÛÂȘ ÁÈ· ÙˉȷÌÔÓ‹ ÙˆÓ ÁÈ·ÙÚÒÓ.

∂ÈϤÔÓ, ·Ó·ÎÔÈÓÒÓÂÙ·È fiÙÈ:

™Ù· ÓËÛÈ¿ ÙˆÓ ∫˘ÎÏ¿‰ˆÓ Î·È Û ı¤ÛÂȘ Î·È ÂȉÈÎfiÙËÙ˜ ·ÓÙ›ÛÙÔȯ˜ ÌÂ ÙˆÓ ÂÈÎÔ˘ÚÈÎÒÓ ÁÈ·ÙÚÒÓ Â›Ó·È‰˘Ó·ÙfiÓ Ó· ·ÔÛ·ÛıÔ‡Ó ÁÈ·ÙÚÔ› ÙÔ˘ ∂™À ÔÔÈ·Û‰‹ÔÙ ‚·ıÌ›‰·˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ¤ÍÈ Ì‹Ó˜̤¯ÚÈ ‰‡Ô ¯ÚfiÓÈ·.

™ÙȘ ·ÔÛ¿ÛÂȘ ·˘Ù¤˜ ÈÛ¯‡Ô˘Ó Ù· ·ÎfiÏÔ˘ı· ΛÓËÙÚ·:

1. ∫·Ù·‚ÔÏ‹ ÚÔÛ·‡ÍËÛ˘ 50% › ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÈÛıÔ‡ (Ó. 2071, ·Ú. 75, ·Ú. 3)

2. ™Â ÎÚ›ÛÂȘ ÂͤÏÈ͢ (Ó. 2920/2001):

- O ¯ÚfiÓÔ˜ ·fiÛ·Û˘ ˘ÔÏÔÁ›˙ÂÙ·È ˆ˜ ‰ÈÏ¿ÛÈÔ˜ ¯ÚfiÓÔ˜ ÚÔ¸ËÚÂÛ›·˜

- ∆· Û˘ÓÔÏÈο ÌfiÚÈ· ÚÔÛ·˘Í¿ÓÔÓÙ·È Î·Ù¿ 15%.

∞¡∞∫Oπ¡ø™∂π™ COMMUNICATIONS

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏ PEDIATRIC NEWS

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µ. ªÂ ÙËÓ ˘’ ·ÚÈıÌ. 1933/27-10-99 Ù. µ’ º∂∫, ·ÚÈıÌ. ∞Ú. ∞π·/9879/99 ·fiÊ·ÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›-·˜ Î·È ¶ÚfiÓÔÈ·˜ ȉڇıËÎÂ Î·È ÏÂÈÙÔ˘ÚÁ› ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ÂȉÈÎfi ΤÓÙÚÔ ·ÓÙÈÌÂÙÒ-ÈÛ˘ Û˘ÁÁÂÓÒÓ ÁÓ·ıÔÚÔÛˆÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ.

°ÓˆÛÙÔÔÈÂ›Ù·È ÛÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÙˆÓ Û¯ÂÙÈÎÒÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È fi¯È ÌfiÓÔ fiÙÈ:

1. ∂›Ó·È ˘Ô¯ÚˆÙÈ΋ Ë ·Ó·ÊÔÚ¿ ÁÂÓÓ‹Ûˆ˜ ·È‰ÈÔ‡ Ì ÁÓ·ıÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜ (΢ڛˆ˜ ˘Â-ÚˆÈÔÛ¯ÈÛٛ˜ Î·È ¯ÂÈÏÂÔÛ¯ÈÛٛ˜) ÛÙÔ ÂȉÈÎfi ΤÓÙÚÔ. ∆ËÏ./Fax: 010-746 7165.

2. À¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ıÂڷ¢ÙÈÎÒÓ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ·fi Ù˘ ÁÂÓÓ‹Ûˆ˜ ÙÔ˘ ·È-‰ÈÔ‡ ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛ‹ ÙÔ˘.

∏ ÔÌ¿‰· Ô˘ ·Ú·ÎÔÏÔ˘ı› Î·È ·ÓÙÈÌÂÙˆ›˙ÂÈ Ù· ·È‰È¿ ·ÔÙÂÏÂ›Ù·È ·fi ¶·È‰›·ÙÚÔ, °ÂÓÂÙÈÛÙ‹, æ˘-¯ÔÏfiÁÔ, ÃÂÈÚÔ˘ÚÁfi øÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ, ∞ÎÔÔÏfiÁÔ, ∂Ó‰ÔÛÎfiÔ, ¶Ï·ÛÙÈÎfi ÃÂÈÚÔ˘ÚÁfi, O‰ÔÓÙ›·ÙÚÔ,OÚıÔ‰ÔÓÙÈÎfi, °Ó·ıÔ¯ÂÈÚÔ˘ÚÁfi, ∫ÔÈÓˆÓÈÎfi §ÂÈÙÔ˘ÚÁfi Î·È ¡ÔÛËχÙÚÈ·.

°È· ÔÔÈ·‰‹ÔÙ ÂÈÛÙËÌÔÓÈ΋ ÂÓË̤ڈۋ Û·˜ ·Ú·Î·Ïԇ̠ӷ ÂÈÎÔÈÓˆÓ›Ù Ì ÙÔ ÂȉÈÎfi ΤÓÙÚÔ ÛÙÔÙËÏ.:/fax: 010-746 7165.

°. ÃÚÈÛÙfiÔ˘ÏÔ˜

¢/ÓÙ‹˜ ø.ƒ.§. ÙÌ‹Ì·ÙÔ˜

°. ∏ ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¤¯ÂÈ Î·Ù·Û΢¿ÛÂÈ ÈÛÙÔÛÂÏ›‰· ÛÙÔ ‰È·‰›ÎÙ˘Ô Ì ÂӉȷ-ʤÚÔ˘Û˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ ŒÏÏËÓ· ¶·È‰›·ÙÚÔ.

∏ ‰È‡ı˘ÓÛË Â›Ó·È: www.gprs.org.gr

¢. π∞∆ƒO∆∂∫

∆· ª¤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫∏”, ·Ú·Î·ÏÔ‡ÓÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙȘ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔ˘Ó ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË Î·È ·ÓÙ›ÛÙÔȯ˜·Ó·ÊÔÚ¤˜ ·fi ÙËÓ ∂ÏÏËÓÈ΋ µÈ‚ÏÈÔÁÚ·Ê›·.

¶ÏËÚÔÊÔڛ˜: π∞∆ƒO∆∂∫

www.mednet.gr/iatrotek

∂Π̤ÚÔ˘˜ Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜

∫·ıËÁ‹ÙÚÈ· ∑ˆ‹ ¶··‰ÔÔ‡ÏÔ˘ - ∫Ô˘ÏÔ˘Ì‹

¶·È‰È·ÙÚÈ΋ 2002;65:145-146 Paediatriki 2002;65:145-146

146

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21-24 ª·ÚÙ›Ô˘ 2002 29Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ πˆ¿ÓÓÈÓ· ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ Î·È ªÂÙ·‚ÔÏÈÛÌÔ‡ •ÂÓÔ‰Ô¯Â›Ô Du Lac ∆ËÏ.: 010-77.74.370

23-24 ª·ÚÙ›Ô˘ 2002 6Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ¶·È‰È¿ÙÚˆÓ ∫ÔÌÔÙËÓ‹ ∞Ó·ÙÔÏÈ΋˜ ª·Î‰ÔÓ›·˜ & £Ú¿Î˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¢ËÌÔÎÚ›ÙÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘¶ÏËÚÔÊÔڛ˜: Minerva Fairs and Congresses ∆ËÏ.: 010-32.17.456, 32.17.474 Fax: 010-32.20.595 E-mail: [email protected]

19-21 ∞ÚÈÏ›Ô˘ 2002 8Ô ∂ÈÛÙËÌÔÓÈÎfi ™˘Ó¤‰ÚÈÔ πˆ¿ÓÓÈÓ·ºÔÈÙËÙÒÓ π·ÙÚÈ΋˜ ∂ÏÏ¿‰Ô˜ ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ ∆ËÏ.: 06510-97.719

20 ∞ÚÈÏ›Ô˘ 2002 3Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ ™˘ÌfiÛÈÔ ∞ı‹Ó·∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¶ÔÏÂÌÈÎfi ªÔ˘Û›԰·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ∏·ÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜“™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· Û˘Ó‹ıË ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·È‰È·ÙÚÈ΋ Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›·”

20-21 ∞ÚÈÏ›Ô˘ 2002 10Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Ù˘ ª‡ÎÔÓÔ˜ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ªÂϤÙ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ OÛÙÒÓ ∆ËÏ.: 010-62.31.541 Fax: 010-80.18.122

21-24 ∞ÚÈÏ›Ô˘ 2002 VIII International Congress on Cannes, France Immunorehabilitation “Allergy, Immunology and Global Network” Congress Secretariat Tel.: (++7-095) 336-5000 Fax: (++7-095) 336-5000 E-mail: [email protected] Web site: http://www.isir.ru

26-28 ∞ÚÈÏ›Ô˘ 2002 1st Mediterranean Congress Limassol, Cyprus of Neurology ¶ÏËÚÔÊÔڛ˜: Demos Antoniou∆ËÏ.: 357-5-749919 Fax: 357-5-749744 E-mail: [email protected]

¶PO™EXH ™YNE¢PIA

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4-7 ª·˝Ô˘ 2002 American Pediatric Society: Baltimore, MD U.S.A. Pediatric Societies Joint Meeting Baltimore Convention Center Fax: 011-281-419-0082 Web site: http://www.pas-meeting.org

5-8 ª·˝Ô˘ 2002 4th European Congress Paris, France of Chemotherapy and Infection Congress Secretariat: Congrex Sweden AB Attn: ECC-4, P.O. Box 5619 SE-114 86 Stockholm, Sweden Tel.: +46 8 459 66 00 Fax: +46 8 661 91 25 Web site: www.congrex.se/ecc-4

21-25 ª·˝Ô˘ 2002 28Ô ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó· °Ú·ÌÌ·Ù›· π·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÓÒÓ ª·È¿Ó‰ÚÔ˘ 23, 115 28 ∞ı‹Ó· ∆ËÏ.: 010 - 72 11 845 Fax: 010 - 72 15 082 E-mail: [email protected]

23-25 ª·˝Ô˘ 2002 14Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈ΋˜ £ÂÛÛ·ÏÔÓ›ÎË ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ¶ÏËÚÔÊÔڛ˜: FORUM International Congress Organizers ∆ËÏ.: 0310 - 257 128 & 0310 - 243 588 Fax: 0310 - 231 849 E-mail: [email protected]

24-27 ª·˝Ô˘ 2002 International Research Society ∞ı‹Ó· of Spinal Deformities Meeting Tel.: 010-5534 256 & 010-7562 256-7 E-mail: [email protected]

25-26 ª·˝Ô˘ 2002 11Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞ı‹Ó· ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ ¶ÏËÚÔÊÔڛ˜: Î. ¶Ú›ÊÙ˘ °. ¡. ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ ∆ËÏ.: 010 - 80 36 484 Fax: 010 - 61 31 173 E-mail: [email protected]

13-15 πÔ˘Ó›Ô˘ 2002 13th Annual Congress of the Ljubljana, Slovenia European Society of Pediatric and Neonatal Intensive Care (ESPNIC)Tel./Fax: ++ 386 (0) 1 430 17 14 E-mail: [email protected]

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™˘ÓÙÔÌÔÁڷʛ˜AIDS

AMP, ADP, ATP

ATPasecalCSF ‹ ENYCNS ‹ ∫¡™cmCoAcmÑcm2

cAMPÆCCRPDNAECG ‹ ∏∫°EEG ‹ ∏∂°ELISA

ESR ‹ ∆∫∂EDTAgHctHbHLA

IgICU ‹ ª∂£IUi.m. ‹ ∂.ª.i.p. ‹ ∂.¶.i.v. ‹ ∂.º.LlogmolªW ‹ MBMCHMCVmRNAmminnNNS ‹ ª™Ôsm%PCRpHPCO2PO2p

EÏÏËÓÈÎÔ› fiÚÔÈÛ‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ıÂÚÌ›‰·ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·ÂηÙÔÛÙfiÛ˘Ó¤Ó˙˘ÌÔ ∞΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi΢ÎÏÈÎfi AMP‚·ıÌfi˜ KÂÏÛ›Ô˘C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓˉÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ÚÔÛ‰ÈÔÚÈÛÌfi˜Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓÂı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ÁÚ·ÌÌ¿ÚÈo·ÈÌ·ÙÔÎÚ›Ù˘·ÈÌÔÛÊ·ÈÚ›ÓË·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓËÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜‰ÈÂıÓ‹˜ ÌÔÓ¿‰·ÂÓ‰ÔÌ˘˚οÂÓ‰ÔÂÚÈÙÔÓ·˚οÂÓ‰ÔÊϤ‚È·Ï›ÙÚÔ(·)ÏÔÁ¿ÚÈıÌÔ˜ÁÚ·ÌÌÔÌfiÚÈÔÌÔÚÈ·Îfi ‚¿ÚԘ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ̤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA̤ÙÚÔÏÂÙfi·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔÌË ÛËÌ·ÓÙÈÎfiÔÛÌÒÏÈÔ› ÙÔȘ ÂηÙfi·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿ÛË˜Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ÌÂÚÈ΋ Ù¿ÛË CO2ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘Èı·ÓfiÙËÙ·

AÁÁÏÈÎÔ› fiÚÔÈacquired immunodeficiencysyndromeadenosine 5mono-, di-,triphosphateadenosine triphosphatasecaloriecerebrospinal fluidcentral nervous systemcentimetercoenzyme Acubic centimetersquare centimetercyclic AMPdegree(s) CelsiusC-reactive proteindeoxyribonucleic acidelectrocardiogramelectroencephalogramenzyme-linked immunoabsorbentassayerythrocyte sedimentation rateethylenediaminetetracetategramhaematocrithaemoglobin(human) histocompatibilityleucocyte antigenimmunoglobulinintensive care unitinternational Unitintramuscularintraperitonealintravenousliterlogarithmmolemolecular weightmean corpuscular haemoglobinmean corpuscular volumemessenger RNAmeterminutenumber newtonnot significantosmolepercent polymerase chain reactionpotentia hydrogeniicarbon dioxide pressureoxygen pressureprobability

™YNTOMO°PAºIE™ ABBREVIATIONS

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EÏÏËÓÈÎÔ› fiÚÔÈ™˘ÓÙÔÌÔÁڷʛ˜

p.o.RIARNARDSsecs.c. ‹ À.¢.SDSEU

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù·

tera- (1012)giga- (109)mega-(106)kilo- (103)hecto(102)deca (101)deci (10-1)centi- (10-2)milli(10-3)micro (10-6)nano (10-9)pico (10-12) femto (10-15)atto (10-18)

·fi ÙÔ ÛÙfiÌ·Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›·ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜‰Â˘ÙÂÚfiÏÂÙÔ˘Ô‰fiÚÈ·ÛÙ·ıÂÚ‹ ·fiÎÏÈÛËÛÙ·ıÂÚfi ÛÊ¿ÏÌ·ÌÔÓ¿‰·

Combining prefixes

TGMkhdadcmÌnpfa

by mouthradioimmunoassayribonucleic acidrespiratory distress syndromesecondsubcutaneousstandard deviationstandard errorunit

AÁÁÏÈÎÔ› fiÚÔÈ

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