Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος -...

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TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜ 2005 TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜ 2005 ¶·È‰È·ÙÚÈ΋ ñ TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜ 2005 www.paediatriki.edu.gr www.paediatriki.edu.gr ISSN 0377-2551 ISSN 0377-2551 Volume 68 ñ Number 1 ñ January 2005 Volume 68 ñ Number 1 ñ January 2005

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Page 1: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜ 2005TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜ 2005

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www.paediatriki.edu.grwww.paediatriki.edu.gr

ISSN 0377-2551ISSN 0377-2551

Volume 68 ñ Number 1 ñ January 2005Volume 68 ñ Number 1 ñ January 2005

Exofyllo Paed 05 14-02-05 16:27 ™ÂÏ›‰·1

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∫ˆ‰ÈÎfi ̃¢È‡ı˘ÓÛË ̃∂ÔÙ›· ̃ªª∂: 3889

ISSN 0377-2551

¶·È‰È·ÙÚÈ΋∆fiÌÔ˜ 68 ñ ∆‡¯Ô˜ 1 ñ π·ÓÔ˘¿ÚÈÔ˜ 2005

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·1

Page 3: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

Bimonthly Publication of

the Greek Paediatric Society

PPrreessiiddeenntt

A. Constantopoulos

Editorial Board

EEddiittoorr

S. Haidas

AAssssiissttaanntt EEddiittoorr

C. Stefanidis

MMeemmbbeerrss

H. Antonopoulou

A. Vazeou-Gerasimidi

G. Varlamis

∂. Katsarou-Pectasides

A. Kattamis

Ch. Costalos

N. Papadopoulos

∞. Papadopoulou

M. Tsolia-Pasparaki

Manuscript Editing

GGrreeeekk EEddiittiinngg

I. Karavranou

EEnngglliisshh EEddiittiinngg

S. Nakou

Publisher

K. Griveas

Publishing Coordinator

SCIENTIFIC PUBLICATIONS Ltd

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All foreign countries: US $ 50

Contents

REVIEW ARTICLES

7 Nutrition of the preterm and growth

retarded baby on discharge from the

hospital

C. Costalos, A. Gounaris

17 IgA nephropathy in children

A. Mitsioni

28 Diagnostic approach and treatment of

parapneumonic effusions in children

D. Mermiri, K. Priftis

36 Pediatric telephone medicine

P. Velentzas

ORIGINAL ARTICLES

44 Parental behavior and childhood injury

prevention

D. Laggas, E. Petridou, N. Dessypris, T. Thomaidis

52 Childhood obesity and its relationship

with parental attitudes and nutritional

habits

E. Kakouros, K. Maniadaki, E. Kapnisi

61 Genetic and clinical-laboratory

investigation of patients with

DiGeorge/velo-cardio-facial syndromes

S. Kitsiou-Tzeli, A. Kolialexi, H. Fryssira, A. Gala-Voumvouraki, C. Salavoura, ª. Kanariou, E. Kanavakis, A. Mavrou

CASE REPORTS

68 Deep vein thrombosis in multiple sites

in an adolescent. Case report

M. Vranou, G. Anastasiadis, G. Panagiotakopoulos, H. Pergantou, H. Platokouki, N. Besias, M. Vakaki, K. Prountzou-Kassiou

73 Isolation of adenovirus B1 in the CNS in

a 6.5 year-old boy with acute

disseminated encephalomyelitis

P. Poulopoulos, A. Messaritaki, K. Kotsonis, K. Prountzou-Kassiou

79 Aspergillosis of the central nervous

system in three children with acute

lymphoblastic leukemia

F. Athanassiadou, A. Tragiannidis, T. Papageorgiou, M. Stamou, A. Drevelegas,A. Velegraki

80 CLINICAL QUIZ

81 BOOK REVIEW

82 NEWS FROM THE INTERNET

PaediatrikiVolume 68 ñ Number 1 ñ January 2005

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·3

Page 4: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

vii∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏

∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ,

∆o ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ Î·È Ë ™˘ÓÙ·ÎÙÈ΋∂ÈÙÚÔ‹ Ù˘ “¶·È‰È·ÙÚÈ΋˜” Û¿˜ ‡¯ÔÓÙ·È Â˘Ù˘¯ÈṲ̂ÓÔ Î·È ‰ËÌÈÔ˘ÚÁÈÎfi ÙÔÓ Î·ÈÓÔ‡ÚÁÈÔ¯ÚfiÓÔ.

Ÿˆ˜ ‰È·ÈÛÙÒÓÂÙ ÙÔ ÂÚÈÔ‰ÈÎfi ΢ÎÏÔÊÔÚ› Û Ӥ· ÌÔÚÊ‹. ∞˘Ùfi Â›Ó·È ·ÔÙ¤ÏÂÛÌ·Ù˘ ÚÔÛ¿ıÂÈ·˜ ·ÊÂÓfi˜ ÌÂÓ ·Ó·‚¿ıÌÈÛ˘ Ù˘ ÌÔÚÊ‹˜, ·ÊÂÙ¤ÚÔ˘ ‰Â ‚ÂÏÙ›ˆÛ˘ ÙÔ˘ Â-ÚȯÔ̤ÓÔ˘. ∂ÈÚfiÛıÂÙ·, ηχÊıËÎ·Ó Ù· ¯ÚÔÓÈο ÂÏÏ›ÌÌ·Ù· Î·È ÙÔ ÂÚÈÔ‰ÈÎfi ΢ÎÏÔ-ÊÔÚ› ¤ÁηÈÚ·. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ı· Û˘Ì‚¿ÏÂÈ ÛÙËÓ Â›Ù¢ÍË ÙÔ˘ ÛÙfi¯Ô˘ Ó· ÂÓÙ·¯ı› Ë“¶·È‰È·ÙÚÈ΋” ÛÙÔ Medline. ªÂ ÙËÓ Â˘Î·ÈÚ›· ·˘Ù‹ Û·˜ ÚÔÛηÏԇ̠ӷ Û˘ÌÌÂÙ¿Û¯ÂÙ ÌÂÙËÓ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ, ÛÙËÚ›˙ÔÓÙ·˜ ·˘Ù‹ ÙËÓ ÚÔÛ¿ıÂÈ· ·Ó·‚¿ıÌÈÛ˘. ™·˜ ˘ÂÓı˘Ì›-˙Ô˘Ì fiÙÈ Ë ˘Ô‚ÔÏ‹ ÙˆÓ ÂÚÁ·ÛÈÒÓ ÌÔÚ› Ó· Á›ÓÂÙ·È Î·È ÛÙ· ·ÁÁÏÈο, ÂÏ›˙ÔÓÙ·˜ fiÙÈ ·˘-Ùfi ı· ·ÔÙÂϤÛÂÈ Î›ÓËÙÚÔ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ Î·È ∂ÏÏ‹ÓˆÓ Û˘Ó·‰¤ÏÊˆÓ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡.

ªÂ ıÂṲ́˜ ¢¯¤˜

ÁÈ· ÙË ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹

OO ¢¢ÈÈ¢̆ıı˘̆ÓÓÙÙ‹‹˜̃ ™™‡‡ÓÓÙÙ··ÍÍˢ̃ OO ∞∞ÓÓ··ÏÏËËÚÚˆ̂ÙÙ‹‹˜̃ ¢¢ÈÈ¢̆ıı˘̆ÓÓÙÙ‹‹˜̃ ™™‡‡ÓÓÙÙ··ÍÍˢ̃

™Ù·‡ÚÔ˜ ÷˚‰¿˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·7

Page 5: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

xi√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™

A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î‰Ô-

ÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜,Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙËÛ˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤-¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ:

1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ-΋˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂȘ.3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.5. ∫ÏÈÓÈο ∫Ô˘›˙6. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.7. ∂›Î·ÈÚ· ı¤Ì·Ù·.8. £¤Ì·Ù· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜.9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ.

10. ™‡ÓÙÔÌ· Ó¤·.11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.14. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ

ÂΉËÏÒÛˆÓ15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È

ͤӈÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔ-ÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô-‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚ-Á·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘-Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›-ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛËÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂ-Ù·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡-ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰Ë-ÌÔÛ›Â˘Û˘.

ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔ-ÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰È-Îfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÙ¿ ·fi ÏËÚÔÊÔ-ÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒ-ˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙËÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂ-ϤÙ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ ηȢÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔ-ÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚÈÛˉȷÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·-ÙÚÈ΋ EÙ·ÈÚ›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙËÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›·ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·Ó·‰Ë-ÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘Áη-Ù¿ıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒӟϘ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚÔ-

‰È·Áڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο

¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts

Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıË-

Î·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ:

http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ

ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È Ù˘ˆ-

̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (21x29,7 cm),

Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘-

Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜.

TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›-

‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·Á-

ÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ η-

ıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜

˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfi-

ÓˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ

Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο

·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·:

ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ.

ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈ-

ÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ.

ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ.

ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘

¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ:ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5

ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ.

ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·-

ÛÙÈ΋.

ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ)

·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤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˘/ÙÔ˘˜.

ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail 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˘.

ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ,

fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ.

ñ ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË

ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤ-

ÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È

ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·-

Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈ-

ÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ ÛÂ: ÂÈÛ·ÁˆÁ‹

(background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results)

Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο

‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ

¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë.

K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛË-

ÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ÏϤ¤ÍÍÂÂÈȘ̃ ÎÎÏÏÂÂÈȉ‰ÈÈ¿¿ Ô˘ ı· ¯ÚËÛÈÌÔ-

ÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

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

ıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÂÈÈÛÛ··ÁÁˆ̂ÁÁ‹‹ ÂÚÈÏ·Ì-‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Î·È ÙÔÓÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó·Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤-ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ··ÔÔÙÙÂÂ--ÏϤ¤ÛÛÌÌ··ÙÙ·· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘-Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H ÛÛ˘̆--˙̇‹‹ÙÙËËÛÛËË Ú¤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˘ÓÎ·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏψÓÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔ-ÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘-˙‹ÙËÛË, Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË.

T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜.

∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·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· ÂÎ-

ÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) ηÈÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û·ڤÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‰È-¢ı‡ÓÛÂȘ:http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

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

‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈÎ·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁÚ·-ʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘÂÚÈÏ‹„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¤ÚÔ-ÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô-̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË.OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›-ÓÔ˘Ó:

ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 12 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ Â-

ÚÈÙÒÛÂȘ. ñ ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·ÈÛ‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜Ù˘ International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted toBiomedical Journals, (http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus[List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶∂ƒπO¢π∫∞

AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈÎ·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡:∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: ›‰Ú·ÛË

ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È-‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279.

Proesmans W. Bartter syndrome and its neonatal variant.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 the renal compli-cations of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

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

Conference. Neurofibromatosis conference statement. ArchNeurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:Schreiner GF, Lange L. Ethanol modulation of

macrophage influx in glomerulonephritis [Abstract]. J AmSoc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of in-haled corticosteroids in asthma? [Editorial]. Am J Respir CritCare Med 1998;158:1697-1701.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vas-culitis associated with levamisole and circulating autoantibod-ies [Letter]. Arch Dis Child 1996;75:355-356.

II. µπµ§π∞

∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syn-

drome. In: Barratt TM, Arner ED, Harmon WE, editors. Pedi-atric Nephrology. 4th ed. Baltimore: Lippincott WilliamWilkins; 1999. p. 742.

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

and neck. 3rd ed. New York: Oxford University Press; 1990.

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

Smith AJ, Rogers CA, eds. Proceedings of the Third Interna-tional Congress of Chemotherapy; 1962 May 29-31; New York:International Society of Chemotherapy; 1963. p. 484-500.

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹:¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·-

ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: the elderly’s ac-cess and utilization [dissertation]. St. Louis (Mo): Washing-ton Univ.; 1995.

πππ. CD-ROM

Anderson SC, Poulsen KB. Anderson’s electronic atlas ofhematology [CD-ROM]. Philadelphia: Lippincott Williams &Wilkins; 2002.

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xiii

IV. ™∆O ¢π∞¢π∫∆ÀOÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi:

Abood S. Quality improvement initiative in nursinghomes: the ANA acts in an advisory role. Am J Nurs[Internet]. 2002 Jun: Webpage:http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

ªÔÓÔÁÚ·Ê›·:Foley KM, Gelband H, editors. Improving palliative care

for cancer [Monograph, Internet]. Washington: NationalAcademy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html

πÛÙÔÛÂÏ›‰Â˜:Cancer-Pain.org [Webpage, Internet]. New York:

Association of Cancer Online Resources, Inc.; 2002:http://www.cancer-pain.org/

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

ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜(15,5 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓÚ¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙËÛÂÈÚ¿ 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¿Ùˆ ̤ÚÔ˜.™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·,ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜ Î·È ı· Ú¤-ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfi-ÓˆÓ Ú¤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·˜. ™ÙȘ ʈÙÔ-Áڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒӟϘ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó

Î·È ÓÓ·· ÛÛ˘̆ÓÓÔÔ‰‰Â‡‡ÔÔÓÓÙÙ··ÈÈ ··fifi ‰‰ÈÈÛÛÎΤ¤ÙÙ·· ‹‹ CCDD, ηıÒ˜ Î·È ·fi ÂÈ-ÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·-Ê›˜, ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ 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 ÙË ‰ËÌÔÛ›-Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤-ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ì-ʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔ-ÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋EÈÙÚÔ‹, Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈ-Ï·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word, ηıÒ˜ Î·È ÂÈ-ÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË-̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤·˘Ô‚ÔÏ‹.

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

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·-ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈʈÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›-¢ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈ-ÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË:

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

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈÂÚÈÏ·Ì‚¿ÓÂÈ:

1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó·Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜.

2. ¢ÈÛΤٷ ‹ CD Ì fiÏÔ ÙÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ (ΛÌÂÓÔ, ›Ó·Î˜, ÂÈÎfiÓ˜).

3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.

4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·.Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚.fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰.fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·Ï-

ÏËÏÔÁÚ·Ê›·. 5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·-

Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘-ÌÂÚ¿ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙË-Ì· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈ-ÛÙ‹ ÛÂÏ›‰·).

7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹-

ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢).9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ

ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆ-

ÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·13

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xiv ™À¡∆√ª√°ƒ∞ºπ∂™ ABBREVIATIONS

Ao

angstrom angstromcal ıÂÚÌ›‰· caloriecm ÂηÙÔÛÙfi centimetercm2 ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi square centimetercm3 ΢‚ÈÎfi ÂηÙÔÛÙfi cubic centimeteroC ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ degree Celsiusg ÁÚ·ÌÌ¿ÚÈÔ gramh ÒÚ· hourIU ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· international unitkg ¯ÈÏÈfiÁÚ·ÌÌÔ kilograml Ï›ÙÚÔ literm ̤ÙÚÔ metermg ¯ÈÏÈfiÁÚ·ÌÌÔ milligrammin ÏÂÙfi minutemm ¯ÈÏÈÔÛÙfiÌÂÙÚÔ millimetermol ÁÚ·ÌÌÔÌfiÚÈÔ molen ·ÚÈıÌfi˜ numberNS ‹ ª™ ÌË ÛËÌ·ÓÙÈÎfi not significantosm ÔÛÌÒÏÈÔ osmole

p Èı·ÓfiÙËÙ· probabilitySD ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË standard deviationSE ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· standard errorsec ‰Â˘ÙÂÚfiÏÂÙÔ secondU ÌÔÓ¿‰· unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· Combining prefixes

tera- (1012) Tgiga- (109) Gmega- (106) Mkilo- (103) khector- (102) hdeca- (101) dadeci- (10-1) dcenti- (10-2) cmilli- (10-3) mmicro- (10-6) Ìnano- (10-9) npico- (10-12) pfemto- (10-15) fatto- (10-18) a

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·14

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xviiINSTRUCTIONS TO AUTHORS

A. General InformationThe Greek Paediatric Society is the owner of “Paediatriki”,

its official scientific journal, which is distributed to its mem-

bers. Its objectives are the publication of paediatric scientific

work and the continuing education of paediatricians. For this

purpose, it publishes a variety of articles, and in particular:

1. Editorials (upon invitation by the Editorial Board).

2. Review articles.

3. Award-winning articles.

4. Original articles.

5. Clinical Quiz

6. Round tables.

7. Current issues.

8. Issues of healthcare management and education.

9. Case reports.

10. News.

11. Brief reports.

12. Letters to the editor.

13. Abstracts.

14. Future congresses and events.

15. Book reviews.

The Editorial Board reserves the right to publish articles of

special scientific interest and articles on current issues without

observing submission order. In addition it publishes upon de-

cision original papers presented at the Annual Paediatric Con-

ference, presentations of special interest - in whole or in part,

and letters - in whole or in part - referring to scientific articles

published in the journal.

Regarding papers on current issues, the author’s request

for immediate publication should be quoted on the first page.

The Editorial Board reserves the right to accept such papers for

immediate publication.

All manuscripts should not have been published previous-

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search should have been conducted following informed con-

sent of participants or of their legal representatives according

to the Declarations of Helsinki and Tokyo. In addition, the US

National Institute of Health guide for the care and use of labo-

ratory animals (DHEW Publication, NIH, 80-23) should have

been observed. Clinical trials should have been approved by

the Ethics Committee of the Hospital.

Authors’ opinions and conclusions expressed in the pub-

lished papers do not necessarily reflect those of the journal.

The Greek Paediatric Society, the Editorial Board and the Pub-

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the advertisements appearing in the journal.

The copyright of all published papers is held by “Paediatri-

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ly following written consent of the journal.

B. Manuscript Preparation“Paediatriki” suggests compliance with the “Uniform Re-

quirements for Manuscripts Submitted to Biomedical Jour-

nals”, recently modified and published on the websites:

http://www.icmje.org and http://www.icmje.org/icmje.pdf

The entire paper (including figure legends and tables)

should be typed on one side of blank paper format A4

(21x29.7 cm), double line spacing and minimum indent 2.5

cm on both sides.

The paper should have the following structure: title page,short title, abstract in Greek and English, list of abbreviations,text, acknowledgements and quoting of grants, sponsorships orother financial support sources, references, tables, figures, fig-ure legends. Each of these sections should be started on a newpage. Pages should be numbered consecutively, beginning withthe title page. Text length shall be:

ñ review articles 2000-3000 words;ñ original articles and case reports 1500-2500 words; ñ brief reports1000-1500 words; ñ letters 250-500 words.

The title page should include:ñ the title (<14 words) and the short title (<5 words) of the

article. No abbreviations are permitted in the title;ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of the

paper. If there is no affiliation with a specific centre, thestatus of the author(s) should be cited (e.g., private paedi-atrician) and home address;

ñ the complete address, e-mail and telephone number of theauthor to whom correspondence should be addressed.

Abstracts

The abstract should summarize the objectives, methodolo-gy, main results and conclusions of the study.

ñ It should contain at least 200 words, and not exceed 250words.

ñ It should consist of the following paragraphs: background,methods, results and conclusions.

The English abstract should cite at the beginning the title ofthe paper and the authors’ names in English. The content of thetext should consist of the following paragraphs: background,methods, results and conclusions. The abstract in English shouldnot differ in content from the corresponding Greek abstract.

Editorials and case reports have an English abstract only. Beneath the Greek and English abstracts, three to five key

words in the respective language should be supplied, to be usedin the thematic index.

Text

Original articles include: introduction, methods, resultsand discussion. The introduction includes the latest researchdata on the subject and the main references and the objectivesof the paper. The description of the methods should be preciseand detailed so as to enable reproduction by other researchers.In addition, the statistical methods of analysis and evaluationof the results should be described. Results should be presentedclearly, together with the appropriate statistical analysis. Dis-

cussion should cover the results ensuing from the research,their significance and possible associations with the observa-tions of other researchers.

Case reports comprise a short introduction, case descriptionand brief discussion, with emphasis on differential diagnosis.

The structure of all other articles is free, according to thejudgment of the authors.

Thanks or acknowledgements (reference to grants, spon-sorships or other sources of financial support) should be quot-ed at the end of the text, before references.

Units of measures of laboratory analyses

Laboratory analyses should be expressed in the Système In-ternational (SI) units and in the metric (Conventional) systemin parentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf

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xviii

AbbreviationsAll issues of the journal contain internationally estab-

lished abbreviations. Complex or long terms often repeated inthe text may be replaced by abbreviations explained by the au-thors in a list submitted with the paper. Abbreviations are re-ported in parentheses only in abstracts.

ReferencesThe reference section contains all references numbered in

the order in which they appear in the text. In the text, refer-ences are to be indicated by Arabic numerals in parentheses.References should be no more than:

ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.

In listing references follow the recently modified standardsof the International Committee of Medical JournalEditors/Uniform Requirements for Manuscripts Submitted toBiomedical Journals, (http://www.icmje.org and http://www.icmje.org/icmje.pdf). Abbreviated names of journalsshould conform to the Cumulated Index Medicus [List of Jour-nals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style

I. JOURNALSAll authors are cited if they are six or less; if they are 7 or

more, the first six are cited, followed by “et al”.

Regular edition:Proesmans W. Bartter syndrome and its neonatal variant.

Eur J Pediatr 1997;156:669-679.

Supplement issue:Flyvbjerg A. Role of growth hormone, insulin-like growth

factors (IGFs) and IGF-binding proteins in the renal compli-cations of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

No author:National Institutes of Health Consensus Development

Conference. Neurofibromatosis conference statement. ArchNeurol 1988;45:575-578.

Article type specification:Schreiner GF, Lange L. Ethanol modulation of

macrophage influx in glomerulonephritis [Abstract]. J AmSoc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of in-haled corticosteroids in asthma? [Editorial]. Am J Respir CritCare Med 1998;158:1697-1701.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vas-culitis associated with levamisole and circulating autoantibod-ies [Letter]. Arch Dis Child 1996;75:355-356.

II. BOOKSChapter in book:

Clark AG, Barratt TM. Steroid-responsive nephrotic syn-drome. In: Barratt TM, Arner ED, Harmon WE, editors. Pedi-atric Nephrology. 4th ed. Baltimore: Lippincott WilliamWilkins; 1999. p. 742.

Book or monograph:Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head

and neck. 3rd ed. New York: Oxford University Press; 1990.

Publication in a volume of proceedings:Bauer AW. The two definitions of bacterial resistance. In:

Smith AJ, Rogers CA, eds. Proceedings of the Third Interna-tional Congress of Chemotherapy; 1962 May 29-31; NewYork: International Society of Chemotherapy; 1963. p. 484-500.

Doctoral dissertation:Kaplan SJ. Post hospital home health care: the elderly’s ac-

cess and utilization [dissertation]. St. Louis (Mo): Washing-ton Univ.; 1995.

πππ. CD-ROMAnderson SC, Poulsen KB. Anderson’s electronic atlas of

hematology [CD-ROM]. Philadelphia: Lippincott Williams &Wilkins; 2002.

IV. ON THE INTERNETArticle in journal

Abood S. Quality improvement initiative in nursinghomes: the ANA acts in an advisory role. Am J Nurs [Inter-net]. 2002 Jun: Webpage:http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

MonographFoley KM, Gelband H, editors. Improving palliative care

for cancer [Monograph, Internet]. Washington: NationalAcademy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html

WebsitesCancer-Pain.org [Webpage, Internet]. New York: Associ-

ation of Cancer Online Resources, Inc.; 2002: http://www.can-cer-pain.org/

Tables and FiguresThree copies should be submitted (original plus 2 copies).

Their width should either be equal to the width of one column(7.5 cm) or to the width of the page (15.5 cm). Their maxi-mum length, titles included, should not exceed 22 cm.

Tables are numbered with Arabic numerals in the order inwhich they appear in the text. They should have a short titleand abbreviations should be listed at the bottom. Vertical linesin tables should be avoided.

All illustration material is considered as figures (graphs,pictures, etc.). They should be of excellent quality. Also, at theback of every picture, the number of the picture and the nameof the first author should be noted in pencil, with an arrowshowing the top of the picture. The identity of patients shouldnot be recognizable from their pictures nor should theirnames be stated.

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xix

C. Manuscript Submission and PublicationAll manuscripts should be accompanied by a floppy disk

or CD, as well as by a letter, signed by all the authors, in whichit is stated that the paper has not been published in part or inwhole, or is not under consideration by another journal andthat the authors accept its publication in “Paediatriki”. Anyfunding, sponsorship or other financial support should be ac-knowledged.

Once the manuscript has been accepted, the correctedversion, rewritten according to the reviewers’ recommenda-tions should be submitted to the Editorial Board accompaniedby a floppy disk or CD, containing the paper in Word format,along with a covering letter specifying in detail the modifica-tions or objections to the reviewers’ suggestions.

Delay in submission of the modified paper exceeding 30days entails new submission.

Authors will be charged film and reprint expenses, paidupon dispatch of the first proof directly to the printer.

Manuscripts of papers which have not been approved forpublication are not returned to the author. The accompanyingfigures and photographs can be returned upon request withinsix months.

Manuscripts submitted for review and publication in“Paediatriki” should be sent in three copies to the followingaddress:

Editorial BoardGreek Paediatric Society92, Michalakopoulou Street115 28 Athens, Greece

Before submitting your paper, make sure it contains:1. 3 copies of the text of the paper, printed according to in-

structions.2. A floppy disk or CD with the entire material of the paper

(text, tables, pictures).3. A covering letter and a statement that the paper has not

been previously published.4. The title page (on a separate page), which includes:

a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and tele-

phone number; 5. English and Greek abstracts, with the following structure:

background, methods, results and conclusions (doublespace, separate page) and keywords.

6. List of abbreviations (double space, separate page).7. Text (double space, separate page).8. Acknowledgements and reference to funding, sponsor-

ships or other financial sources.9. References (double space, separate page).

10. Tables (one per page) in three copies.11. Figures with an arrow at the back showing the top, num-

bered, in two copies.12. Figure titles (double space - on separate pages) in three

copies.

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1∞¡∞™∫O¶∏™∏

¢È·ÙÚÔÊ‹ ÙÔ˘ ÚfiˆÚÔ˘ Î·È ÙÔ˘ ‰˘ÛÙÚÔÊÈÎÔ‡

ÓÂÔÁÓÔ‡ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô

Ã. ∫ÒÛÙ·ÏÔ˜1, ∞. °Ô‡Ó·Ú˘2

¶ÂÚ›ÏË„Ë

∆· ‚Ú¤ÊË Ô˘ Â›Ó·È ÂÏÏÈÔ‚·Ú‹ ηٿ ÙË Á¤ÓÓËÛË ‰È·ÙÚ¤¯Ô˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÌÂȈ̤Ó˘ ۈ̷ÙÈ΋˜ Î·È „˘-¯ÔÎÈÓËÙÈ΋˜ ÂͤÏÈ͢ Î·È ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ηډȷÁÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹.OÚÈṲ̂ӷ, ›Û˘, ÚfiˆÚ· ÓÂÔÁÓ¿, ÂÓÒ Î·Ù¿ ÙË Á¤ÓÓËÛË ¤¯Ô˘Ó ηÓÔÓÈÎfi ‚¿ÚÔ˜, ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fiÙË ª∂¡ ÂÌÊ·Ó›˙Ô˘Ó ‰˘ÛÙÚÔÊ›·. ∞˘Ùfi ÙÔ ¿ÚıÚÔ ·Ó·ÛÎfiËÛ˘ ÂÍÂÙ¿˙ÂÈ ÙȘ ·ÒÙÂÚ˜ Û˘Ó¤ÂȘ Ù˘ η΋˜ıÚ¤„˘ Î·È ÙȘ ‰È·ÙÚÔÊÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Ô˘ ı· Ú¤ÂÈ Ó· Á›ÓÔ˘Ó Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ·ÙË ‰ÈfiÚıˆÛË Ù˘ ‰˘ÛÙÚÔÊ›·˜. ∆fiÛÔ ÙÔ ÌËÙÚÈÎfi Á¿Ï· fiÛÔ Î·È ÙÔ Á¿Ï· Ô˘ ÚÔÔÚ›˙ÂÙ·È ÁÈ· ÙÂÏÂÈfiÌËÓ· ÓÂ-ÔÁÓ¿ ‰ÂÓ Â·ÚÎÔ‡Ó ¿ÓÙ· ÁÈ· ÙËÓ Î¿Ï˘„Ë ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ·Ó·ÁÎÒÓ ÂÓfi˜ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡. ∏ ¯ÚËÛÈÌÔ-Ô›ËÛË ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜, Á¿Ï·ÙÔ˜ ÂȉÈÎÔ‡ ÁÈ· ÚfiˆÚ· ‹ ÂÓÈÛ¯˘Ì¤ÓÔ˘ “Á¿Ï·ÙÔ˜ ÂÍfi‰Ô˘”,‚ÂÏÙÈÒÓÂÈ ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÔÛÙÈ΋ ÌÂÙ¿ÏψÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ˘˜ ÚÒÙÔ˘˜ 18 Ì‹Ó˜ ˙ˆ‹˜. ∆ÔÂÌÏÔ˘ÙÈṲ̂ÓÔ ÌËÙÚÈÎfi Á¿Ï· ·ÔÙÂÏ› ÙËÓ È‰·ÓÈ΋ χÛË. ∆· ˘fiÏÔÈ· ÂÌÏÔ˘ÙÈṲ̂ӷ Á¿Ï·Ù· ‰›ÓÔÓÙ·ÈÛ˘ÌÏËڈ̷ÙÈο Ì ÙÔ ÌËÙÚÈÎfi ÌfiÓÔ Û ÚfiˆÚ· ÓÂÔÁÓ¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ·˘Ù¿ Ì ‚¿-ÚÔ˜ Á¤ÓÓËÛ˘ <1200 g, Û ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ ÙÔ ‚¿ÚÔ˜ ÂÍfi‰Ô˘ Â›Ó·È <5Ë ÂηÙÔÛÙÈ·›· ı¤ÛË, Û fiÛ· ¿Û¯Ô˘Ó·fi ¯ÚfiÓÈ· ¿ıËÛË, Ô˘ ηٷӷÏÒÓÔ˘Ó ÏÈÁfiÙÂÚÔ ·fi 180 ml/kg ËÌÂÚËÛ›ˆ˜ Á¿Ï· Î·È Û ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ˘ÔÏ›ÂÙ·È. ™Â οı ÂÚ›ÙˆÛË, ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ı›ٷÈÛÙÂÓ¿ Ë ÛˆÌ·ÙÈ΋ ·‡ÍËÛË Î·È ÔÈ ‚ÈÔ¯ËÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ Î¿ı ÚfiˆÚÔ˘ ‹ ‰˘ÛÙÚÔÊÈÎÔ‡ ÓÂÔÁÓÔ‡ ÌÂÙ¿ ÙËÓ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ∞·ÈÙÔ‡ÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷ‰Âȯı› ηٿ fiÛÔ Ì›·ÂÓÈÛ¯˘Ì¤ÓË ‰›·ÈÙ· ‚ÔËı¿ÂÈ Ì·ÎÚÔÚfiıÂÛÌ· ‹ fi¯È ÛÙËÓ Î·Ï‡ÙÂÚË ÛˆÌ·ÙÈ΋ Î·È ÓÔËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ Úfi-ˆÚÔ˘ ÓÂÔÁÓÔ‡ Î·È ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ηډȷÁÁÂÈ·ÎÒÓ ·ı‹ÛˆÓ.

§¤ÍÂȘ ÎÏÂȉȿ

¶ÚfiˆÚÔ ÓÂÔÁÓfi, ÂÏÏÈÔ‚·Ú¤˜, ‰È·ÙÚÔÊ‹.

1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·,°ÂÓÈÎfi ¡ÔÛÔÎÔÌ›ԓ∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·Ï›·˜

AÏÏËÏÔÁÚ·Ê›·:

ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜ ∞ÚÙ¤ÌȉԘ 130, ∆.∫. 175 62, ¶. º¿ÏËÚÔ

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 23-04-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-07-2004

¶·È‰È·ÙÚÈ΋ 2005;68:1-6

∂ÈÛ·ÁˆÁ‹

∏ ÛËÌ·Û›· Ù˘ ÛˆÛÙ‹˜ ‰È·ÙÚÔÊ‹˜ ηٿ ÙËÓ

ÚÒÈÌË ÂÚ›Ô‰Ô Ù˘ ˙ˆ‹˜ Â›Ó·È ÌÂÁ¿ÏË. ∏ ÛÙ¤ÚËÛË

Ù˘ ÙÚÔÊ‹˜ ηٿ ÙËÓ Â˘·›ÛıËÙË ÂÚÈÁÂÓÓËÙÈ΋ Â-

Ú›Ô‰Ô fi¯È ÌfiÓÔ ÂËÚ¿˙ÂÈ ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË

ÙÔ˘ ÓÂÔÁÓÔ‡, ·ÏÏ¿ ÌÔÚ› Ó· ηıÔÚ›ÛÂÈ ÙÔ ÙÂÏÈÎfi

̤ÁÂıÔ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1,2). À¿Ú¯Ô˘Ó, ÂÈϤÔÓ,

ÛÙÔȯ›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÚÒÈÌË ‰˘ÛÙÚÔÊ›· ‰È·Ù·-

Ú¿ÛÛÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ‚·ÛÈÎÒÓ ÔÚÌÔÓÒÓ (·˘ÍËÙÈ-

΋, ÈÓÛÔ˘Ï›ÓË, IGF) Î·È Úԉȷı¤ÙÂÈ ÛÙË ÌÂÏÏÔÓÙÈ΋

ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ı‹ÛÂˆÓ Î·È Û·Î¯·ÚÒ-

‰Ô˘˜ ‰È·‚‹ÙË (3-5). ¶Ú¿ÁÌ·ÙÈ, ÓÂÔÁ¤ÓÓËÙ· Ì ¯·ÌË-

Ïfi ‚¿ÚÔ˜ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ Û˘¯Ó¿ ÂΉËÏÒÓÔ˘Ó

ÌÂÙ¤ÂÈÙ· „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ‰È·Ù·Ú·-

¯¤˜ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (2).

∂ÎÙfi˜ ·fi Ù· ÂÏÏÈÔ‚·Ú‹ ÓÂÔÁÓ¿, Ì›· ¿ÏÏË Î·-

ÙËÁÔÚ›· Ì ÚÔ‚Ï‹Ì·Ù· ıÚ¤„˘ Â›Ó·È Ù· ÚfiˆÚ·

ÓÂÔÁÓ¿. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ë ÂÌ‚Ú˘˚΋ ·Ó¿Ù˘ÍË Â›-

Ó·È Ì¤ÁÈÛÙË Î·Ù¿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘,

ÂÚ›Ô‰Ô˜ fiÔ˘ ÙÔ ÚfiˆÚÔ ÓÂÔÁÓfi ‰ÂÓ ‚Ú›ÛÎÂÙ·È

ϤÔÓ ÛÙË Ì‹ÙÚ· (6). ∆Ô ·ÓÒÚÈÌÔ ÓÂÔÁÓfi, Û˘ÓÂÒ˜,

Ô˘ ‰ÂÓ ÙÚ¤ÊÂÙ·È Â·ÚÎÒ˜ ÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜

˙ˆ‹˜, ‚Ú›ÛÎÂÙ·È Û ÂÍ›ÛÔ˘ ‰ÂÈÓ‹ ı¤ÛË Ì ·˘Ù‹ ÙˆÓ

ÂÏÏÈÔ‚·ÚÒÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ. ∏ ‰˘ÛÙÚÔÊ›·

Û ·˘Ù¿ Ù· ÓÂÔÁÓ¿ Â›Ó·È Â͈̋ÙÚÈ· Î·È fi¯È ÂÓ‰ÔÌ‹-

ÙÚÈ· (7-9). ¶Ú¿ÁÌ·ÙÈ, ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈ-

Í·Ó fiÙÈ ÂÓÒ ÙÔ ‚¿ÚÔ˜ ÛÂ ÔÏÏ¿ ·fi ·˘Ù¿ Ù· Úfiˆ-

Ú· ηٿ ÙË Á¤ÓÓËÛË ‚ÚÈÛÎfiÙ·Ó ÛÙËÓ 50‹ ÂηÙÔÛÙÈ-

·›· ı¤ÛË Ù˘ η̇Ï˘ ·‡ÍËÛ˘, ηٿ ÙËÓ ¤ÍÔ‰Ô

·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Ë ÛˆÌ·ÙÈ΋ ÙÔ˘˜ ·Ó¿Ù˘ÍË

˘ÔÏÂÈfiÙ·Ó Î·Ù¿ 35-41% ÙÔ˘ ηÓÔÓÈÎÔ‡ (6). ŸÛÔ

ÈÔ ¯·ÌËÏfi ‹Ù·Ó ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÙfiÛÔ ÈÔ Ô-

χ ˘ÔÏÂÈfiÙ·Ó Ë ÛˆÌ·ÙÈ΋ ÙÔ˘˜ ·Ó¿Ù˘ÍË Î·Ù¿

ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∂¡. ŒÙÛÈ, 36% ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ

‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÈÎÚfiÙÂÚÔ ·fi 1500 g ›¯Â Ì‹ÎÔ˜

ÛÒÌ·ÙÔ˜ οو ·fi ÙË 10Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (10).

∆Ô ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÁÈ· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓË-

Û˘ ÌÈÎÚfiÙÂÚÔ ·fi 1000 g ‹Ù·Ó 80-98% (11). ∞Ó¿-

ÏÔÁË ˘ÛÙ¤ÚËÛË ÂÌÊ·Ó›˙ÂÈ Î·È Ë ÔÛÙÈ΋ ÌÂÙ¿ÏψÛË

ÛÂ ÔÛÔÛÙfi Ô˘ Êı¿ÓÂÈ ÙÔ 50% ÛÂ ÓÂÔÁÓ¿ ÌÂ ‚¿ÚÔ˜

Á¤ÓÓËÛ˘ ÌÈÎÚfiÙÂÚÔ ·fi 1000 g (10).

π‰È·›ÙÂÚË ·ÓËÛ˘¯›· ÚÔηÏÔ‡Ó ÔÈ Ì·ÎÚfi¯ÚÔÓ˜

Û˘Ó¤ÂȘ Û ·˘Ù¿ Ù· ÚfiˆÚ· ÓÂÔÁÓ¿. OÈ Hack ηÈ

Û˘Ó ·Ú·ÎÔÏÔ‡ıËÛ·Ó 249 ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ ‚¿ÚÔ˜

Á¤ÓÓËÛ˘ ÌÈÎÚfiÙÂÚÔ ·fi 1500 g ÁÈ· 8 ¤ÙË. ∞fi ·˘Ù¿

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·1

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¶·È‰È·ÙÚÈ΋ 2005;68:1-6

Ô˘ ‹Ù·Ó ηÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘,

ÌfiÓÔ ÙÔ 5% ›¯Â ‚¿ÚÔ˜ Î·È Ì‹ÎÔ˜ <3Ë ÂηÙÔÛÙÈ·›·

ı¤ÛË. ∞ÓÙ›ıÂÙ·, ·fi Ù· ÓÂÔÁÓ¿ Ô˘ ÂÎÙfi˜ ·fi ·Óˆ-

ÚÈÌfiÙËÙ· ›¯·Ó Î·È ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ÛÙËÓ

·Ó¿Ù˘ÍË, ÂÚ›Ô˘ 29% ›¯Â ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË

οو ·fi ÙËÓ 3Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (12). OÈ Ford ηÈ

Û˘Ó (13) ÌÂϤÙËÛ·Ó, ›Û˘, ‰‡Ô ÔÌ¿‰Â˜ ÚfiˆÚˆÓ

ÓÂÔÁÓÒÓ Ì ÂÍ·ÈÚÂÙÈο ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘

(∂õ°) (<1000 g) Î·È Ì Ôχ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓË-

Û˘ (¶Ãµ°) (<1500 g). ™Â Û‡ÁÎÚÈÛË Ì ̿ÚÙ˘Ú˜ ηÈ

ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ˘ÔÏ›ÔÓÙ·Ó Û ‡„Ô˜ Î·È Û ÂÚ›ÌÂ-

ÙÚÔ ÎÂÊ·Ï‹˜ ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 8 ÂÙÒÓ. ªÂٷ͇

ÙˆÓ ËÏÈÎÈÒÓ 8-14 ÂÙÒÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋

·ÓÙÈÛÙ·ıÌÈÛÙÈ΋ ·‡ÍËÛË ÛÙ· ·È‰È¿ Ì ¶Ãµ°, fi¯È

fï˜ ÛÙ· ÓÂÔÁÓ¿ Ì ∂õ°. OÈ Peralta-Carcelen ηÈ

Û˘Ó (14) ÌÂϤÙËÛ·Ó ÙËÓ ÂͤÏÈÍË ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ

Î·È ‚Ú‹Î·Ó fiÙÈ ÛÙËÓ ËÏÈΛ· ÙˆÓ 15 ÂÙÒÓ ÔÛÔÛÙfi

5,7% ÙˆÓ ÓÂÔÁÓÒÓ Â›¯Â ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË <3Ë

ÂηÙÔÛÙÈ·›· ı¤ÛË Î·È 21% <10Ë ı¤ÛË. ∏ ·fiÎÏÈÛË

‹Ù·Ó Ôχ ÌÂÁ·Ï‡ÙÂÚË Û fiÛ· ÚfiˆÚ· ‹Ù·Ó Ù·˘Ùfi-

¯ÚÔÓ· ÂÏÏÈÔ‚·Ú‹ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ηٿ ÙË

Á¤ÓÓËÛË. ∆¤ÏÔ˜, Ì›· ¿ÏÏË ÌÂϤÙË 166 ÚÔÒÚˆÓ ÌÂ

¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ¤‰ÂÈ-

Í fiÙÈ ÛÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ ÙÔ 35% ›¯Â ۈ̷ÙÈÎfi

‚¿ÚÔ˜, ‡„Ô˜ Î·È ¶∫ <5Ë ÂηÙÔÛÙÈ·›· ı¤ÛË (15).

O ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ‰ÂÓ ·ÊÔÚ¿ ÙfiÛÔ Ôχ ÛÙË

ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË, ·ÏÏ¿ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·˘Ù‹

Û˘Ó‰˘¿˙ÂÙ·È Ì ÌÈÎÚfiÙÂÚË ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜

ηÈ, ÂÔ̤ӈ˜, Ì ¯·ÌËÏfiÙÂÚÔ fiÁÎÔ ÙÔ˘ ÂÁÎÂÊ¿-

ÏÔ˘, Ô˘ ›Ûˆ˜ ·ÔÙÂÏ› ÙÔÓ ÏfiÁÔ ÁÈ· ÙÔÓ ÔÔ›Ô Ë

‰˘ÛÙÚÔÊ›· ηٿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô Û˘¯Ó¿

Û˘Óԉ‡ÂÙ·È ·fi ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ÚÔ‚Ï‹-

Ì·Ù· Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (1). OÈ ÏfiÁÔÈ Ô˘

Ô‰ËÁÔ‡Ó Û ‰˘ÛÙÚÔÊ›· ÙˆÓ ÚÔÒÚˆÓ Î·Ù¿ ÙËÓ

¤ÍÔ‰Ô Â›Ó·È ÔÏÏÔ›, fiˆ˜ ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ·

Î·È ·ÔÚÚÔÊËÙÈÎfiÙËÙ· ÂÙÈÎÔ‡, Á·ÛÙÚÔÔÈÛÔÊ·-

ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·,

ηډȷ΋ ·Ó¿ÚÎÂÈ·, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·,

ÛË„·ÈÌ›· Î·È Ï‹„Ë ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Î·È ‰ÈÔ˘-

ÚËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (16-18). ∂ÊfiÛÔÓ, ÏÔÈfiÓ, Ë Ûˆ-

ÛÙ‹ ‰È·ÙÚÔÊ‹ ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹ ηٿ ÙËÓ ·Ú·ÌÔÓ‹

ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜

¡ÂÔÁÓÒÓ (ª∂¡¡), ȉȷ›ÙÂÚË ÛËÌ·Û›· ‰›ÓÂÙ·È

˘Ô¯ÚˆÙÈο ÛÙË ÛˆÛÙ‹ Û›ÙÈÛË ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô

·fi ÙÔ ÓÔÛÔÎÔÌ›Ô, ÚÔÎÂÈ̤ÓÔ˘ fi¯È ÌfiÓÔ Ó· ‰È·-

ÙËÚ‹ÛÂÈ ¤Ó·Ó Ê˘ÛÈÔÏÔÁÈÎfi Ú˘ıÌfi ·Ó¿Ù˘Í˘, ·ÏÏ¿

Î·È Ó· ·Ó·ÏËÚÒÛÂÈ ÙÔ “¯·Ì¤ÓÔ ¤‰·ÊÔ˜”. ™ÙË Û˘-

Ó¤¯ÂÈ·, ı· Á›ÓÂÈ ·Ó·ÊÔÚ¿ ÛÙȘ ÂÈÎÚ·ÙÔ‡Û˜ ÌÂıfi-

‰Ô˘˜ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÛÙȘ ÌÂıfi‰Ô˘˜

ÂÓ›Û¯˘Û‹˜ Ù˘.

∞Ï¿ Á¿Ï·Ù·

ªËÙÚÈÎfi Á¿Ï·

∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ˘ÂÚ¤¯ÂÈ ÔÈ-

ÔÙÈο οı ¿ÏÏÔ˘ ÙÚfiÔ˘ ‰È·ÙÚÔÊ‹˜, ·ÊÔ‡ - ÂÎÙfi˜

·fi ÙËÓ È‰·ÓÈ΋ ÙÔ˘ Û‡ÓıÂÛË - ¤¯ÂÈ Î·È ¿ÏϘ ÛË-

Ì·ÓÙÈΤ˜ ȉÈfiÙËÙ˜, fiˆ˜ ·ÓÔÛÔÏÔÁÈΤ˜ Î·È ·ÓÙÈ·Ï-

ÏÂÚÁÈΤ˜ (19), ηχÙÂÚË ·Ó¿Ù˘ÍË ÙÔ˘ ‰ÂÛÌÔ‡ ÌË-

Ù¤Ú·˜-ÓÂÔÁÓÔ‡ Î·È Î·Ï‡ÙÂÚË Ó¢ÚÔ·Ó¿Ù˘ÍË (20).

∆ÂÏÂ˘Ù·›·, fï˜, ¤¯ÂÈ ÂÎÊÚ·ÛÙ› ÚÔ‚ÏËÌ·ÙÈÛÌfi˜

ηٿ fiÛÔ ·˘Ùfi ·ÚΛ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·Ó¿-

ÁΘ ÂÓfi˜ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡. ∂›Ó·È, ‚¤‚·È·, ÁÓˆÛÙfi

fiÙÈ ÙÔ Á¿Ï· ÌËÙ¤Ú·˜ Ô˘ Á¤ÓÓËÛ ÚfiˆÚ· ÂÚȤ¯ÂÈ

ÂÚÈÛÛfiÙÂÚÔ Ï‡Έ̷, Ó¿ÙÚÈÔ Î·È Û›‰ËÚÔ ÙÔÓ ÚÒ-

ÙÔ Ì‹Ó· ˙ˆ‹˜. ¶ÚÔԉ¢ÙÈο, fï˜, Ù· ›‰· ÌÂÈ-

ÒÓÔÓÙ·È, ÌÂ Û˘Ó¤ÂÈ· ˘ÛÙ¤ÚËÛË (¶›Ó·Î·˜ 1)

(21,22). ∆· ÔÛÔÛÙ¿ ·Û‚ÂÛÙ›Ô˘ Î·È ÊˆÛÊfiÚÔ˘ ›-

Ó·È ÂÍ·Ú¯‹˜ ·Ó·Ú΋ (23). ŒÙÛÈ, Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi˜

¤ÏÂÁ¯Ô˜ ÙˆÓ ÔÛÙÒÓ ‰Â›¯ÓÂÈ ·Ê·Ï¿ÙˆÛË, ηٿÁÌ·-

Ù·, Ú·¯›Ùȉ·, ˘„ËÏ¿ ›‰· ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿-

Û˘, ¯·ÌËÏ¿ ›‰· ʈÛÊfiÚÔ˘ Î·È ÌÂȈ̤ÓË

ÔÛÙÈ΋ Ì¿˙· Î·È Ë ÌÂÏÏÔÓÙÈ΋ ÂȘ Ì‹ÎÔ˜ ·Ó¿Ù˘ÍË

˘ÔÏ›ÂÙ·È ÛËÌ·ÓÙÈο ÛÙ· ÓÂÔÁÓ¿ Ô˘ ›¯·Ó ÙËÓ

˘„ËÏfiÙÂÚË ÙÈÌ‹ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (24). ∞Ó

Î·È ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÔÛÙÈ΋

Ì¿˙· ·ÔηٷÛÙ¿ıËΠÛÙËÓ ËÏÈΛ· ÙˆÓ 12 ÌËÓÒÓ

Î·È fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ Á¿Ï·ÙÔ˜

(ÂÚ›Ô˘ 180 ml/kg) ÌÔÚ› Ó· ·ÓÙÈÚÚÔ‹ÛÂÈ ÙË

¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ıÚÂÙÈο Û˘ÛÙ·ÙÈο

(25), Ë ÁÓÒÌË ÙˆÓ ÂȉÈÎÒÓ Û˘ÁÎÏ›ÓÂÈ ÛÙÔ fiÙÈ ÁÈ·

ÔÚÈṲ̂ӷ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÚfiˆÚ· ÓÂÔÁÓ¿ ÙÔ ÌËÙÚÈÎfi

Á¿Ï· ‰ÂÓ Â·ÚΛ.

°¿Ï· ÁÈ· ÙÂÏÂÈfiÌËÓ·

∆Ô Á¿Ï· ÁÈ· ÙÂÏÂÈfiÌËÓ· Â›Ó·È ·Ó·ÚΤ˜ ÙfiÛÔ

ÔÛÔÙÈο fiÛÔ Î·È ÔÈÔÙÈο, ÚÔÎÂÈ̤ÓÔ˘ Ó· ηχ-

„ÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ÚfiˆÚÔ˘ ‹ ÙÔ˘ ‰˘ÛÙÚÔÊÈÎÔ‡

ÓÂÔÁÓÔ‡ (26,27).

¶¶››ÓÓ··Îη·˜̃ 11.. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ Û ıÚÂÙÈο Û˘ÛÙ·ÙÈο

™™˘̆ÛÛÙÙ··ÙÙÈÈÎο¿ °°¿¿ÏÏ·· ÚÚÔÔÒÒÚÚÔÔ˘̆ ((‚‚‰‰ÔÔÌÌ¿¿‰‰··)) flflÚÚÈÈÌÌÔÔ ÁÁ¿¿ÏÏ·· ∂∂ÎÎÙÙÈÈÌÌÔÔ‡‡ÌÌÂÂÓÓ˜̃ ··ÓÓ¿¿ÁÁÎΘ̃((ÌÌÔÔÓÓ¿¿‰‰··//kkgg//ËËÌ̤¤ÚÚ··)) 11 22 44

∂Ó¤ÚÁÂÈ· (KJ) 504 504 504 504 504ÀÁÚ¿ (ml) 180 180 180 190 150§Â‡ÎˆÌ· (g) 3,9 3,4 2,8 2,4 3,5¡¿ÙÚÈÔ (mEq) 4,0 2,7 1,8 2,0 3,5∞Û‚¤ÛÙÈÔ (mg) 53 46 42 47 160-200ºÒÛÊÔÚÔ˜ (mg) 25 27 23 26 80-100

2 Ã. ∫ÒÛÙ·ÏÔ˜ Î·È Û˘Ó.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·2

Page 14: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

¶·È‰È·ÙÚÈ΋ 2005;68:1-6

∂ÌÏÔ˘ÙÈṲ̂ӷ Á¿Ï·Ù·

∂ÓÈÛ¯˘Ù¤˜ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜

∆Ô 1980, Ô Lucas ÂÈÛ‹Á·ÁÂ ÙÔÓ fiÚÔ “Á·Ï·ÎÙÔÌË-

¯·ÓÈ΋”, ‰ËÏ·‰‹ ÙËÓ È‰¤· ÂÓ›Û¯˘Û˘ ÙÔ˘ ÌËÙÚÈÎÔ‡

Á¿Ï·ÙÔ˜ Ì ÂÈϤÔÓ Û˘ÛÙ·ÙÈο (28). ™‹ÌÂÚ·,

˘¿Ú¯Ô˘Ó ÔÏÏÒÓ ÂȉÒÓ ÂÓÈÛ¯˘Ù¤˜. ¢È·Ê¤ÚÔ˘Ó ˆ˜

ÚÔ˜ ÙËÓ ÚԤϢÛË (·ÓıÚÒÈÓË ‹ ‚fiÂÈÔ˜), ÙË

Û‡ÓıÂÛË (ÌÔÓÔÂÓÈÛ¯˘Ù‹˜ - Ì ¤Ó· ÌfiÓÔ Û˘ÛÙ·ÙÈÎfi,

.¯. χΈ̷ ‹ ·Û‚¤ÛÙÈÔ Î·È ÊÒÛÊÔÚÔ - ‹ ÔÏ˘Â-

ÓÈÛ¯˘Ù‹˜ - Ô˘ ÂÚȤ¯ÂÈ ÔÏÏ¿ Û˘ÛÙ·ÙÈο), ÙÔ Â›-

‰Ô˜ ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ (·Î¤Ú·ÈÔ ÔÚÔχΈ̷ ‹ η-

˙½ÓË, ˘‰ÚÔÏ˘Ì¤ÓÔ Ï‡Έ̷), ÙÔ Â›‰Ô˜ ÙÔ˘ ˘‰·Ù¿Ó-

ıڷη (Ï·ÎÙfi˙Ë, Ì·ÏÙÔ‰ÂÍÙÚ›Ó˜) ‹ ÙȘ Ê˘ÛÈΤ˜

ȉÈfiÙËÙ˜ (˘ÁÚfi ‹ ÛÎfiÓË) (29,30). O ÂÌÏÔ˘ÙÈÛÌfi˜

ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ Ì ·Û‚¤ÛÙÈÔ Î·È ÊÒÛÊÔÚÔ

Ô‰ËÁ› Û ηχÙÂÚË ÂȘ Ì‹ÎÔ˜ ·Ó¿Ù˘ÍË Î·È ÌÂÙ¿Ï-

ψÛË ÙˆÓ ÔÛÙÒÓ (31,32). ∏ ÚÔÛı‹ÎË Ó·ÙÚ›Ô˘

Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰ÈfiÚıˆÛË ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ Ó·ÙÚ›-

Ô˘ ÛÙÔ ·›Ì· Î·È ÛÙËÓ Î·Ï‡ÙÂÚË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘-

ÍË (33). ∆¤ÏÔ˜, Ë ÚÔÛı‹ÎË ÚˆÙ½Ó˘ Î·È ıÂÚÌ›-

‰ˆÓ ÂÈÙ·¯‡ÓÂÈ ÙÔÓ Ú˘ıÌfi ·Ó¿Ù˘Í˘ ÙÔ˘ ÓÂÔÁÓÔ‡

Î·È ·ÔηıÈÛÙ¿ Ù· ›‰· ÚˆÙÂ˚ÓÒÓ ÛÙÔ ·›Ì·

ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi (34). ∆Ô 1990, Ô Polberger (35)

·Ó¤ÊÂÚ fiÙÈ ¶Ãµ° ÓÂÔÁÓ¿ Ô˘ ¤Ï·‚·Ó Á¿Ï·

ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì Ï‡Έ̷ (3 g/kg) Î·È ÂÈϤÔÓ

ϛԘ Î·È ˘‰·Ù¿ÓıڷΘ (120 kcal/kg ËÌÂÚËÛ›ˆ˜)

›¯·Ó ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË fiÌÔÈ· Ì ÂΛÓË ÂÌ-

‚Ú‡ˆÓ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ ·ËÛ˘. ∆Ô ·ÌÈÓfiÁÚ·ÌÌ·

‹Ù·Ó ·ÚfiÌÔÈÔ ÌÂ ·˘Ùfi ÙˆÓ ıËÏ·˙fiÓÙˆÓ ÓÂÔÁÓÒÓ.

™Â Û‡ÁÎÚÈÛË Ì ÙÔ ·Ïfi Á¿Ï·, ›¯·Ó ηχÙÂÚË ÔÛÙÈ-

΋ ÌÂÙ¿ÏψÛË, ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ (·ÏηÏÈ΋ ʈ-

ÛÊ·Ù¿ÛË, ·Û‚¤ÛÙÈÔ, ÊÒÛÊÔÚÔ˜, Ó¿ÙÚÈÔ, Ô˘Ú›·, Ï¢-

Έ̷ٛÓË, ÚÔ·Ï‚Ô˘Ì›ÓË) Î·È ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË.

∏ ÂÈÎÚ·ÙÔ‡Û· ¿Ô„Ë, Û‹ÌÂÚ·, Â›Ó·È Ó· ¯ÚËÛÈ-

ÌÔÔÈÂ›Ù·È ÔÏ˘ÂÓÈÛ¯˘Ù‹˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜

(¶›Ó·Î·˜ 2), ·ÏÏ¿ ˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· ˆ˜ ÚÔ˜ ÙË

Û‡ÛÙ·ÛË ÙˆÓ ÂÓÈÛ¯˘ÙÒÓ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜. ∞˘-

Ùfi ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ‰ÂÓ

¤¯ÂÈ ÛÙ·ıÂÚ‹ Û‡ÓıÂÛË, ·ÏÏ¿ ÂÌÊ·Ó›˙ÂÈ ÛËÌ·ÓÙÈΤ˜

·˘ÍÔÌÔÈÒÛÂȘ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ

ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ·ÏÏ¿ Î·È ÙȘ ‰È·ÊÔÚÂÙÈΤ˜

·Ó¿ÁΘ ÙÔ˘ οı ÓÂÔÁÓÔ‡ Û ıÚÂÙÈΤ˜ Ô˘Û›Â˜.

ŒÙÛÈ, ‰ËÌÈÔ˘ÚÁ‹ıËÎÂ Ë È‰¤· Ù˘ “ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó˘

ÂÓ›Û¯˘Û˘”, ηٿ ÙËÓ ÔÔ›· ÙÔ ÌËÙÚÈÎfi Á¿Ï· ·Ó·-

χÂÙ·È Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÂÓÈÛ¯‡ÂÙ·È ·Ó¿ÏÔÁ· (36).

°¿Ï· ÁÈ· ÚfiˆÚ· ÓÂÔÁÓ¿

OÈ Cooke Î·È Û˘Ó (37) Û›ÙÈÛ·Ó ÚfiˆÚ· ÓÂÔÁÓ¿

Ì ∏∫ ≤34 ‚‰ÔÌ¿‰Â˜ Î·È µ° <1750 g, ̤¯ÚÈ ÙË

‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ Ì Á¿Ï· ÂȉÈÎfi ÁÈ·

ÚfiˆÚ·, Ô˘ ˆ˜ ÁÓˆÛÙfiÓ Â›Ó·È È‰È·›ÙÂÚ· ÂÓÈÛ¯˘Ì¤-

ÓÔ Û Ï‡Έ̷, ıÂÚÌ›‰Â˜, Ó¿ÙÚÈÔ, ·Û‚¤ÛÙÈÔ Î·È ÊÒ-

ÛÊÔÚÔ (¶›Ó·Î·˜ 2). ™ÙËÓ ËÏÈΛ· ÙˆÓ 12 ÌËÓÒÓ, Ù·

·ÁfiÚÈ· Ù˘ ÌÂϤÙ˘ ›¯·Ó ηχÙÂÚË ÛˆÌ·ÙÈ΋ ·Ó¿-

Ù˘ÍË, ÔÛÙÈ΋ Ì¿˙· Î·È ÌÂÙ¿ÏψÛË Û ۯ¤ÛË ÌÂ

ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ô˘ ¤Ï·‚·Ó ·Ïfi Á¿Ï·. ∏ ˘ÂÚÔ¯‹

·˘Ù‹ Û˘Ó¯›ÛÙËΠ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ.

∆Ô ÛËÌ·ÓÙÈÎfi Â›Ó·È fiÙÈ Ë ·Ó¿Ù˘ÍË Û ۈ̷ÙÈÎfi

‚¿ÚÔ˜ ·ÊÔÚÔ‡Û ΢ڛˆ˜ Û ·‡ÍËÛË Ù˘ Ì˘˚΋˜ Ì¿-

˙·˜ Î·È fi¯È ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜. OÈ Agosti ηÈ

Û˘Ó (38) ¯ÔÚ‹ÁËÛ·Ó ÁÈ· 15 ‚‰ÔÌ¿‰Â˜ Á¿Ï· ÁÈ·

ÚfiˆÚ· ÛÂ ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ µ° <1500 g. ™ÙËÓ

ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ, Ù· ·ÁfiÚÈ· Ù˘ ÌÂϤÙ˘ ›¯·Ó

ηχÙÂÚË ·Ó¿Ù˘ÍË fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ‚¿ÚÔ˜. ∞ÎfiÌ·

ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Û ÂΛ-

Ó· Ù· ÚfiˆÚ· Ô˘ ‹Ù·Ó ÂÈϤÔÓ ÂÏÏÈÔ‚·Ú‹. ™Â

·˘Ù¿ ·Ú·ÙËÚ‹ıËÎ·Ó Î·Ï‡ÙÂÚ˜ ÂȉfiÛÂȘ ÛÙËÓ

Îϛ̷η Griffith, Ë ÔÔ›· ÂÎÙÈÌ¿ ÙË Ó¢ÚÔ·Ó·Ù˘-

Íȷ΋ ÂͤÏÈÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜.

°¿Ï· ÂÍfi‰Ô˘

OÈ Lucas Î·È Û˘Ó (39) ÂÈÛ‹Á·Á·Ó ÙËÓ ¤ÓÓÔÈ· ÙÔ˘

Á¿Ï·ÙÔ˜ ÂÍfi‰Ô˘ ÙÔ 1992, ¯ÔÚËÁÒÓÙ·˜ ÛÂ 16 ÓÂÔÁÓ¿

Ì µ° <1850 g ÂȉÈο ÂÌÏÔ˘ÙÈṲ̂ÓÔ Á¿Ï·, Ì ۇ-

ÛÙ·ÛË ÌÂٷ͇ Á¿Ï·ÙÔ˜ ÁÈ· ÙÂÏÂÈfiÌËÓ· Î·È ·˘ÙÔ‡

ÁÈ· ÚfiˆÚ·, ÁÈ· 9 Ì‹Ó˜. ∏ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË Î·È

Ë ÔÛÙÈ΋ Ì¿˙· ‹Ù·Ó ·ÓÒÙÂÚ˜ Û ۇÁÎÚÈÛË Ì ̿Ú-

Ù˘Ú˜ Ô˘ ¤Ï·‚·Ó Û‡ÓËı˜ Á¿Ï·. ¢‡Ô ÌÂÁ·Ï‡ÙÂÚ˜

ÌÂϤÙ˜, ÛÙË Û˘Ó¤¯ÂÈ·, ¤‰ÂÈÍ·Ó Â›Û˘ ¢ÓÔ˚ο

·ÔÙÂϤÛÌ·Ù·. ™Â Ì›· ·fi ·˘Ù¤˜, ÙˆÓ Lucas ηÈ

Û˘Ó (40), ¯ÔÚËÁ‹ıËÎÂ ÛÂ 229 ÚfiˆÚ· ÓÂÔÁÓ¿ Á¿Ï·

ÂÍfi‰Ô˘ ÁÈ· 9 Ì‹Ó˜ Î·È ‰È·ÈÛÙÒıËΠηχÙÂÚË ÂȘ

Ì‹ÎÔ˜ ·Ó¿Ù˘ÍË ÛÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ. ∂Ӊȷ-

ʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÂÚÈÛÛfiÙÂÚÔ

ˆÊÂÏ‹ıËÎ·Ó Ù· ·ÁfiÚÈ· Ù˘ ÌÂϤÙ˘ Û ۯ¤ÛË Ì ٷ

ÎÔÚ›ÙÛÈ·. OÈ Carver Î·È Û˘Ó (41) ÌÂϤÙËÛ·Ó 123

ÚfiˆÚ·, ¯ÔÚËÁÒÓÙ·˜ Á¿Ï· ÂÍfi‰Ô˘ ÁÈ· 12 Ì‹Ó˜.

¶¶››ÓÓ··Îη·˜̃ 22.. ™‡ÁÎÚÈÛË Á·Ï¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô (·Ó¿ 100 ml)

™™˘̆ÛÛÙÙ··ÙÙÈÈÎο¿ °°ÈÈ·· ÚÚfifiˆ̂ÚÚ·· ∂∂ÍÍfifi‰‰ÔÔ˘̆ °°ÈÈ·· ÙÙÂÂÏÏÂÂÈÈfifiÌÌËËÓÓ·· ªªËËÙÙÚÚÈÈÎÎfifi ªªËËÙÙÚÚÈÈÎÎfifi++**

∂Ó¤ÚÁÂÈ· (Kcal) 81 72-73 67 67 74-79¶ÚˆÙ½ÓË (g) 2,2-2,4 1,9-2,1 1,4 1,0 1,8-2§›Ô˜ (g) 4,1-4,4 3,9-4,1 3,6 3,5 3,9-4,2À‰·Ù¿ÓıڷΘ (g) 8,6-9,0 7,7-8,0 7,3 7,0 9,4-10,6∞Û‚¤ÛÙÈÔ (mg) 133-145 78-90 53 26 59-112ºÒÛÊÔÚÔ˜ (mg) 67-81 46-50 28-36 14 36-56¡¿ÙÚÈÔ (mEq) 1,4-1,5 1,1-1,7 0,7-0,8 0,9 1-1,9

* ªËÙÚÈÎfi+: ÂÓÈÛ¯˘Ì¤ÓÔ ÌËÙÚÈÎfi Á¿Ï·

3¢È·ÙÚÔÊ‹ ÙÔ˘ ÂÏÏÈÔ‚·ÚÔ‡˜ ÓÂÔÁÓÔ‡

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·3

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4 Ã. ∫ÒÛÙ·ÏÔ˜ Î·È Û˘Ó.

™ÙÔ Ù¤ÏÔ˜ Ù˘ ÌÂϤÙ˘, ÙÔ ‚¿ÚÔ˜ Î·È Ë ¶∫ ‹Ù·Ó·ÓÒÙÂÚ· ÛÙ· ÓÂÔÁÓ¿ Ô˘ ¤Ï·‚·Ó ÙÔ Á¿Ï· ÂÍfi‰Ô˘.¶ÂÚÈÛÛfiÙÂÚÔ Â˘ÓÔ‹ıËÎ·Ó Ù· ÈÔ ·ÓÒÚÈÌ· ‚Ú¤ÊËÙ˘ ÌÂϤÙ˘ Î·È Ù· ·ÁfiÚÈ·. ∆· ¢ÓÔ˚ο ·ÔÙÂϤ-ÛÌ·Ù· ‹Ù·Ó ÂÌÊ·Ó‹ ̤۷ ÛÙÔ˘˜ ÚÒÙÔ˘˜ 1-3 Ì‹Ó˜ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘. ∏ Û˘Ó¤¯ÈÛË Ù˘ ¯Ô-Ú‹ÁËÛ˘ ÙÔ˘ ÂȉÈÎÔ‡ Á¿Ï·ÙÔ˜ ‰ÂÓ Â›¯Â ÂÈϤÔÓfiÊÂÏÔ˜. ∆¤ÏÔ˜, ÔÈ Brunton Î·È Û˘Ó (42) ¯ÔÚ‹ÁËÛ·ÓÁ¿Ï· ÂÍfi‰Ô˘ ÁÈ· 3 Ì‹Ó˜ Û 60 ÓÂÔÁÓ¿ Ì ¶Ãµ° Ô˘¤·Û¯·Ó ·fi ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ. ™ÙÔ Ù¤ÏÔ˜Ù˘ ÌÂϤÙ˘, Ù· ·ÁfiÚÈ·, ΢ڛˆ˜, ›¯·Ó ηχÙÂÚË·Ó¿Ù˘ÍË Û ̋ÎÔ˜.

∞fi Ù· ·Ú·¿Óˆ ÚÔ·ÙÂÈ fiÙÈ Ë ¯ÔÚ‹ÁËÛËÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Á¿Ï·ÙÔ˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi Ù˪∂¡ ˆÊÂÏ› ÂÚÈÛÛfiÙÂÚÔ Ù· Ôχ ·ÓÒÚÈÌ· ÓÂÔÁÓ¿Î·È ÂȉÈο ·˘Ù¿ Ô˘ Â›Ó·È Ù·˘Ùfi¯ÚÔÓ· ÂÏÏÈÔ‚·Ú‹.∆· ·ÁfiÚÈ· Û·ÊÒ˜ ˆÊÂÏÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ·’ fi,ÙÈÙ· ÎÔÚ›ÙÛÈ·. ∆· ÂÚˆÙ‹Ì·Ù· Ô˘ ÚÔ·ÙÔ˘Ó Â›Ó·È:·) ÔÈ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·Ó¿ÁÎË ÂÓÈÛ¯˘Ì¤Ó˘ ‰›·ÈÙ·˜Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô, ‚) ÔÈÔ˜ Â›Ó·È Ô Î·Ï‡ÙÂÚÔ˜ ÙÚfiÔ˜ÂÓ›Û¯˘Û˘ ÙÔ˘ Á¿Ï·ÙÔ˜ Î·È Á) ÁÈ· fiÛÔ ‰È¿ÛÙËÌ· ı·Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Ë ÂȉÈ΋ ‰›·ÈÙ·. ∞Ó Î·È ÔÏϤ˜ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó Â˘ÓÔ˚ο ·ÔÙÂϤÛÌ·Ù· ·fi ÙÔÓÂÌÏÔ˘ÙÈÛÌfi ÙÔ˘ Á¿Ï·ÙÔ˜, ˘¿Ú¯Ô˘Ó Î·È ÌÂϤÙÂ˜Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ˘ÂÚ‚ÔÏÈ΋ ¯ÔÚ‹ÁËÛË ıÂÚÌ›‰ˆÓÎ·È Ï¢ÎÒÌ·ÙÔ˜ fi¯È ÌfiÓÔ ‰ÂÓ ˆÊÂÏ›, ·ÏÏ¿ ÌÔÚÂ›Î·È Ó· ‚Ï¿„ÂÈ, ·ÊÔ‡ ÌÔÚ› Ì·ÎÚÔÚfiıÂÛÌ· Ó·Ô‰ËÁ‹ÛÂÈ Û ·¯˘Û·ÚΛ·, ·Ó¿Ù˘ÍË Û·Î¯·ÚÒ‰Ô˘˜‰È·‚‹ÙË Î·È Î·Ú‰È·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ (43,44).∂Í¿ÏÏÔ˘, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÏÏ¿ ÚfiˆÚ· Ú˘ıÌ›-˙Ô˘Ó ·˘ÙfiÌ·Ù· ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Á¿Ï·ÙÔ˜ Ô˘Ï·Ì‚¿ÓÔ˘Ó, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÈηÓÔÔÈ‹ÛÔ˘Ó ÙȘ ‰È·-ÙÚÔÊÈΤ˜ ÙÔ˘˜ ·Ó¿ÁΘ (25). ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Î·Ù¿ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜·ÚÈıÌfi˜ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ¤¯ÂÈ Î·Ï‹ ıÚ¤„Ë. ∞ÏÏ¿Î·È ·fi ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ Ë ·Ó¿Ù˘ÍË ˘ÔÏ›ÂÙ·È,¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ¤¯ÂÈ ·˘ÙfiÌ·ÙË ·ÓÙÈÛÙ·ı-ÌÈÛÙÈ΋ ·‡ÍËÛË Ì¤Û· ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜. ŒÙÛÈ,·Ô̤ÓÂÈ Ì›· ÌÈÎÚ‹ Û¯ÂÙÈο ÌÂÚ›‰· ÓÂÔÁÓÒÓ Ô˘¯ÚÂÈ¿˙ÔÓÙ·È ÂÓ›Û¯˘ÛË Ù˘ ÙÚÔÊ‹˜ ÙÔ˘˜ ÌÂÙ¿ ÙËÓ¤ÍÔ‰Ô ·fi ÙË ª∂¡ (16).

∂ÈÏÔÁ‹ ÓÂÔÁÓÒÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÌÏÔ˘-

ÙÈṲ̂ÓÔ Á¿Ï·

ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ, Ô Shanler (45) ÚÔÙ›ÓÂÈÓ· ‰›ÓÂÙ·È ÂÌÏÔ˘ÙÈṲ̂ÓË ‰›·ÈÙ· ÌfiÓÔ ÛÙȘ ·ÎfiÏÔ˘-ı˜ ÂÚÈÙÒÛÂȘ: ·) Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì µ° <1250g, ȉ›ˆ˜ ·Ó Â›Ó·È Ù·˘Ùfi¯ÚÔÓ· Î·È ÂÏÏÈÔ‚·Ú‹, ‚) ÛÂÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ ηٿ ÙËÓ ¤ÍÔ‰Ô <3Ë ÂηÙÔÛÙÈ·›·ı¤ÛË, Á) Û ÓÂÔÁÓ¿ Ô˘ ηٷӷÏÒÓÔ˘Ó <180ml/kg/24ˆÚÔ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜, ‰) Û ÓÂÔÁÓ¿ ˘„Ë-ÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ‰ËÏ·‰‹ Û fiÛ· ¿Û¯Ô˘Ó ·fi ¯ÚfiÓÈ·Ó¢ÌÔÓÔ¿ıÂÈ·, Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· ‹ ¤¯Ô˘Ó¯ÂÈÚÔ˘ÚÁËı› ÚfiÛÊ·Ù· ÁÈ· ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›-

Ùȉ·, Â) Û ÓÂÔÁÓ¿ Ì ·ıÔÏÔÁÈÎÔ‡˜ ‚ÈÔ¯ËÌÈÎÔ‡˜‰Â›ÎÙ˜, fiˆ˜ ·˘ÍË̤ÓË ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË, ¯·-ÌËÏfi ÊÒÛÊÔÚÔ Î·È ÏÂ˘ÎˆÌ·Ù›ÓË ·›Ì·ÙÔ˜, Ôχ ¯·-ÌËÏ‹ ÙÈÌ‹ Ô˘Ú›·˜ ·›Ì·ÙÔ˜ ‹ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ·ÔÛÙÂÔÂÓ›·˜ Î·È ÛÙ) Û ÓÂÔÁÓ¿ ÙˆÓ ÔÔ›ˆÓ Ô Ú˘ı-Ìfi˜ ·Ó¿Ù˘Í˘ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌ›ԉÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈÎfi˜.

™Â οı ÂÚ›ÙˆÛË, Û˘ÓÈÛÙ¿Ù·È ÛÙÂÓ‹ ·Ú·ÎÔ-ÏÔ‡ıËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ÙˆÓ ‚ÈÔ¯Ë-ÌÈÎÒÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô Î·È¿ÌÂÛË Â¤Ì‚·ÛË Û ÂÚ›ÙˆÛË ·fiÎÏÈÛ˘ ·fiÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ú˘ıÌÔ‡˜ ·‡ÍËÛ˘.

∂ÈÏÔÁ‹ ÙÔ˘ ϤÔÓ Î·Ù¿ÏÏËÏÔ˘ Á¿Ï·ÙÔ˜

O ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ·ÔÙÂÏ› ÙËÓ È‰·ÓÈ΋ÙÚÔÊ‹ Î·È ı· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Û οı Â-Ú›ÙˆÛË. ∂ÊfiÛÔÓ ÎÚ›ÓÂÙ·È fiÙÈ ÙÔ ÓÂÔÁÓfi ¯ÚÂÈ¿˙ÂÙ·ÈÂÈϤÔÓ ÂÓ›Û¯˘ÛË, ÚÔÙ›ÓÔÓÙ·È ÔÈ ÂÍ‹˜ ÂÓ·ÏÏ·-ÎÙÈΤ˜ χÛÂȘ: ∏ ÌËÙ¤Ú·: ·) ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ıËÏ·-ÛÌÔ‡ ‚Á¿˙ÂÈ ÙÔ Á¿Ï· Ô˘ ·Ú¤ÌÂÈÓ ÛÙÔ ÛÙ‹ıÔ˜ ηȷÊÔ‡ ÚÔÛı¤ÛÂÈ Û ·˘Ùfi ÂÓÈÛ¯˘Ù‹ Á¿Ï·ÎÙÔ˜, ÙÔ ‰›-ÓÂÈ ÛÙÔ ÓÂÔÁÓfi ̤ۈ ıËÏ¿ÛÙÚÔ˘, ‚) ÌÂÙ¿ ÙÔÓ ıËÏ·-ÛÌfi ‰›ÓÂÈ Û˘Ìϋڈ̷ ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Á¿Ï·ÙÔ˜(Á¿Ï· ÁÈ· ÚfiˆÚ· ‹ Á¿Ï· ÂÍfi‰Ô˘) Î·È Á) ‰›ÓÂÈ ÂÓ·Ï-Ï¿Í ¤Ó· Á‡̷ ·fi ÙÔ ÛÙ‹ıÔ˜ Î·È ¤Ó· ·fi ͤÓÔÂÌÏÔ˘ÙÈṲ̂ÓÔ Á¿Ï· (46).

™Â ÂÚ›ÙˆÛË Ô˘ Ë ÌËÙ¤Ú· ·‰˘Ó·Ù› ‹ ‰ÂÓ ı¤-ÏÂÈ Ó· ıËÏ¿ÛÂÈ, ÚÔÛʤÚÂÙ·È ÛÙÔ ÓÂÔÁÓfi ÂÓÈÛ¯˘Ì¤-ÓÔ Á¿Ï· (30). ∏ ÂÈÏÔÁ‹, Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË,Â›Ó·È ÌÂٷ͇ Á¿Ï·ÙÔ˜ ÁÈ· ÚfiˆÚ· Î·È Á¿Ï·ÙÔ˜ ÂÍfi-‰Ô˘. ÿÛˆ˜ ı· Ú¤ÂÈ Ó· ÚÔÙÈÌ¿Ù·È ÙÔ Á¿Ï· ÂÍfi-‰Ô˘, ·ÊÔ‡ ÙÔ Á¿Ï· ÁÈ· ÚfiˆÚ·, Â¿Ó ‰Ôı› ÁÈ· ÌÂÁ¿-ÏÔ ‰È¿ÛÙËÌ·, Ô‰ËÁ› Û ·¯˘Û·ÚΛ·.

¢È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ Ù˘ ÂȉÈ΋˜ ‰›·ÈÙ·˜

∏ ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ Ù˘ ÂȉÈ΋˜ ‰›·ÈÙ·˜ ‰ÂÓÂ›Ó·È Î·ıÔÚÈṲ̂ÓË. ¢È¿ÊÔÚ˜ ÌÂϤÙ˜ ÚÔÙ›ÓÔ˘Ó‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ÂȉÈÎÔ‡ Á¿Ï·ÙÔ˜ ·fi 3 ¤ˆ˜ 9 Ì‹Ó˜. Ÿˆ˜ ÚԷӷʤÚıËÎÂ, Ù· ÈÔ ı·-Ì·ÙÈο ·ÔÙÂϤÛÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Ì¤Û· ÛÙÔ˘˜ÚÒÙÔ˘˜ 2-3 Ì‹Ó˜ ·fi ÙËÓ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ‹˜Ù˘. øÛÙfiÛÔ, ›Ûˆ˜ Â›Ó·È ··Ú·›ÙËÙË Ë Û˘Ó¤¯ÈÛËÙ˘ ¯ÔÚ‹ÁËÛ‹˜ Ù˘ ̤¯ÚÈ ÙÔÓ 6Ô Ì‹Ó· ˙ˆ‹˜, ÒÛÙÂÓ· ÛÙ·ıÂÚÔÔÈËı› Ô Ú˘ıÌfi˜ ·Ó¿Ù˘Í˘, ÙÔ˘Ï¿¯È-ÛÙÔÓ Ì¤¯ÚÈ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÂÚ¿˜ ÙÚÔÊ‹˜ (47).¶¿ÓÙˆ˜, ı· Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È Û οı ÂÚ›ÙˆÛË.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ ÔÚÈṲ̂ӷ ÙÔ˘-Ï¿¯ÈÛÙÔÓ ÚfiˆÚ· ÓÂÔÁÓ¿ ¢ÓÔÔ‡ÓÙ·È ·fi ÙË ¯Ô-Ú‹ÁËÛË Ì›·˜ ÂȉÈ΋˜ ‰›·ÈÙ·˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ¶·Ú¿ Ù·‡Ù·, ÛÙȘ ÂÚÈÛÛfiÙÂ-Ú˜ ÌÂϤÙ˜ fiÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÂȉÈΤ˜

¶·È‰È·ÙÚÈ΋ 2005;68:1-6

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5¢È·ÙÚÔÊ‹ ÙÔ˘ ÂÏÏÈÔ‚·ÚÔ‡˜ ÓÂÔÁÓÔ‡

·˘Ù¤˜ ‰›·ÈÙ˜, Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ‹Ù·Ó ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜. ¶ÚÔÎÂÈ̤ÓÔ˘, ÏÔÈfiÓ, Ó·ÂÍ·¯ıÔ‡Ó ÔÚÈÛÙÈο Û˘ÌÂÚ¿ÛÌ·Ù· ÁÈ· ÙËÓ ·Ó·-ÁηÈfiÙËÙ· ‹ fi¯È Ì›·˜ ÂÌÏÔ˘ÙÈṲ̂Ó˘ ‰›·ÈÙ·˜, ı·Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÈÔ Ì·ÎÚÔ¯ÚfiÓȘ ÌÂϤÙ˜, ÒÛÙÂÓ· Ê·Ó› Â¿Ó Ë ÂÓÈÛ¯˘Ì¤ÓË ‰›·ÈÙ· ÌÔÚ› Ó· ¤¯ÂÈıÂÙÈ΋ ›‰Ú·ÛË ÛÙËÓ ÙÂÏÈ΋ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍËÎ·È ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È Â¿Ó ÌÂÈÒÓÂÈ ‹·˘Í¿ÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ηډȷÁÁÂÈ·ÎÒÓ ·ı‹ÛˆÓÎ·È Û·Î¯·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ÙÔ˘·È‰ÈÔ‡.

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dual energy X-ray absorptiometry in preterm and term

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11. Lucas A. Nutrition, growth and development of post discharge

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tal nutrition in the preterm infant. Report of the 106th Ross

Conference on Pediatric Research. Columbus, Ohio: Ross

Products Division, Abbott Laboratories; 1996. p. 81-89.

12. Hack M, Weissman B, Borawski-Clark E. Catch-up growth

during childhood among very low-birth-weight children.

Arch Pediatr Adolesc Med 1996;150:1122-1129.

13. Ford GW, Doyle LW, Davis NM, Callanan C. Very low birth

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14. Peralta-Carcelen M, Jackson DS, Goran MI, Royal SA, Mayo

MS, Nelson KG. Growth of adolescents who were born at ex-

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2000;136:633-640.

15. Monset-Couchard M, de Bethmann O. Catch-up growth in

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26. Raiha NC, Heinonen K, Rassin DK, Gaull GE. Milk proteinquantity and quality in low-birthweight infants: I. Metabolicresponses and effects on growth. Pediatrics 1976;57:659-684.

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31. Abrams SA, Schanler RJ, Garza C. Bone mineralization informer very low birth weight infants fed either human milkor commercial formula. J Pediatr 1988;112:956-960.

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33. Schanler RJ, Garza C. Improved mineral balance in very lowbirth weight infants fed fortified human milk. J Pediatr1988;112:452-456.

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discharge: effect of dietary manipulation on nutrient intakeand growth. Pediatr Res 1998;43:355-360.

38. Agosti M, Vegni C, Calciolari G, Marini A, GAMMA StudyGroup. Post-discharge nutrition of the very low-birthweightinfant: interim results of the multicentric GAMMA study.Acta Paediatr Suppl 2003;91:39-43.

39. Lucas A, King F, Bishop NB. Post discharge formula con-sumption in infants born preterm. Arch Dis Child1992;67:691-692.

40. Lucas A, Fewtrell MS, Morley R, Singhal A, Abbott RA, IsaacsE et al. Randomized trial of nutrient-enriched formula versusstandard formula for postdischarge preterm infants. Pedi-atrics 2001;108:703-711.

41. Carver JD, Wu PY, Hall RT, Ziegler EE, Sosa R, Jacobs J et al.Growth of preterm infants fed nutrient-enriched or term for-mula after hospital discharge. Pediatrics 2001;107:683-689.

42. Brunton JA, Saigal S, Atkinson SA. Growth and body com-position in infants with bronchopulmonary dysplasia up to 3months corrected age: a randomized trial of high-energy nu-trient-enriched formula fed after hospital discharge. J Pedia-tr 1998;133:340-345.

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45. Shanler RJ. Post-discharge nutrition for the NICU graduate.IPOKRaTES, Clinical Seminar on Nutrition, Metabolism andGastro-Intestinal Tract. Lecco: Italy; 3-6 June 2003.

46. Ernst JA, Brine E. Practical use of human milk fortifiers: con-siderations for infants very low and extremely low in birthweight. In: Human milk for very low birth weight infants. Re-port of the 108th Ross Conference on Pediatric Research.Columbus, Ohio: Ross Products Division, Abbott Laborato-ries; 1999. p. 129-143.

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7REVIEW ARTICLE

Nutrition of the preterm and growth retarded

baby on discharge from the hospital

C. Costalos1, A. Gounaris2

Abstract

Infants who are small for gestational age are known to be at risk of continued growth failure as well as ofhaving poor neurodevelopmental and health outcomes. Many preterm babies of appropriate birth weight alsosuffer growth failure during their hospitalization. This review article examines the consequences of this poorgrowth and the use of nutritional interventions after hospital discharge to correct these deficits. Unfortifiedhuman milk may not supply sufficient quantities of nutrients to meet the needs of premature infants. Thesame applies to ordinary formula intended for term infants. The use of enriched formulas in the form offortified human milk, preterm formula or post-discharge formula improves the early growth and bonemineralization at least for the first 18 months of life. Fortified human milk is the preferred form of feeding ofa growth retarded premature infant. An enriched formula is not always necessary, and should be restrictedonly to high risk babies, those with a birth weight <1250 g, those whose weight at the time of discharge is lessthan the 5th centile, those who suffer chronic disease, those who can not consume >180 ml of milk per kg/dayand those who fail to grow after discharge. In any case, growth and biochemical indices should be closelymonitored in every preterm infant after discharge. Further research is needed to assess whether this improvedgrowth following milk fortification improves developmental outcome and leads to decreased long termmorbidity from cardiovascular disease.

Key words

Preterm infant, light for dates, nutrition.

1 Department ofNeonatology, “Alexandra” GeneralHospital, Athens

2 Paediatric Clinic of theUniversity of Thessaly

Correspondence:

Christos Costalos130 Artemidos str., 175 62, P. Faliro, Athens

Date of submission: 23-04-2004Date of approval: 14-07-2004

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8 ∞¡∞™∫O¶∏™∏

¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

∞Ó‰ÚÔÌ¿¯Ë ªËÙÛÈÒÓË ∆›Ú˘ÓıÔ˜ 11, ∆.∫. 175 64, ¶. º¿ÏËÚÔ

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-02-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-09-2004

¶·È‰È·ÙÚÈ΋ 2005;68:8-16

IgA ÓÂÊÚÔ¿ıÂÈ· ÛÙ· ·È‰È¿

∞. ªËÙÛÈÒÓË

¶ÂÚ›ÏË„Ë

∏ IgA ÓÂÊÚÔ¿ıÂÈ·, Ô˘ ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1969 ·fi ÙÔ˘˜ Berger Î·È Hinglais, Â›Ó·È Ë Û˘-¯ÓfiÙÂÚË ÚˆÙÔ·ı‹˜ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ÛÙÔÓ ÎfiÛÌÔ. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÓ·fiıÂÛË ·ÓÔÛÔÛ˘-ÌÏÂÁÌ¿ÙˆÓ IgA ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ÛÙÔ ÌÂÛ¿ÁÁÂÈÔ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÛÂÈÚ¿Ì·ÙÔ˜. ∞Ú¯Èο, ıˆÚÔ‡ÓÙ·Ó Î·ÏÔ‹-ı˘ ÓfiÛÔ˜, ·Ó Î·È ÔÛÔÛÙfi ÂÚ›Ô˘ 20-25% ÙˆÓ ÂÓ‹ÏÈÎˆÓ ·ÛıÂÓÒÓ Ì IgA ÓÂÊÚÔ¿ıÂÈ· ·Ó·Ù‡ÛÛÂÈ ÂÍÂ-

ÏÈÎÙÈ΋ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·ÎfiÌ· ¿ÁÓˆÛÙË Î·È Ë ıÂڷ¢ÙÈ΋ ·ÓÙÈ-ÌÂÙÒÈÛË ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı›. ∏ ÚfiÁÓˆÛË Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È Î·Ï‡-ÙÂÚË ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Ì ̷ÎÚfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛË, ÂÓÒ Ù·ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ·Ó·ÙÚ¤Ô˘Ó ÙË Ì¤¯ÚÈ ÙÒÚ· ÂÈÎÚ·ÙÔ‡Û· ÁÓÒÛË fiÙÈ Ë IgA ÓÂÊÚÔ¿ıÂÈ·ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Î·ÏÔ‹ı˘ ÓfiÛÔ˜.

§¤ÍÂȘ ÎÏÂȉȿ

IgA ÓÂÊÚÔ¿ıÂÈ·, ÓfiÛÔ˜ Berger, ·È‰È¿.

∂ÈÛ·ÁˆÁ‹

∏ IgA ÓÂÊÚÔ¿ıÂÈ·, ÌÂÙ¿ ÙËÓ ÚÒÙË Ù˘ ÂÚÈ-ÁÚ·Ê‹ ·fi ÙÔ˘˜ Berger Î·È Hinglais ÙÔ 1968 (1,2),·Ó·ÁÓˆÚ›˙ÂÙ·È Û·Ó ¤Ó·˜ ͯˆÚÈÛÙfi˜ Ù‡Ô˜ ÛÂÈÚ·-Ì·ÙÔÓÂÊÚ›Ùȉ·˜.

∆· Ù˘Èο Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡, Ô˘ı¤ÙÔ˘Ó Î·È ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘, Û˘Ó›ÛÙ·ÓÙ·È ÛÂÂÓ·fiıÂÛË IgA ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ÛÙË ÌÂÛ·ÁÁÂÈ·Î‹Î·È ·Ú·ÌÂÛ·ÁÁÂȷ΋ ÂÚÈÔ¯‹ ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓÎ·È Û˘Óԉ‡ÔÓÙ·È ·fi ¤Ó· ¢ڇ Ê¿ÛÌ· ÛÂÈÚ·Ì·-ÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ ‰ÈηÈÔÏÔÁÔ‡Ó ÙËÓ ÔÈÎÈÏÔÌÔÚ-Ê›· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ù˘ ÓfiÛÔ˘.

∏ Û˘¯ÓfiÙËÙ· Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ ÔÈΛÏÏÂÈ¢ڤˆ˜ ÛÙȘ ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜, ÁÂÁÔ-Ófi˜ Ô˘ ·ÓÙ·Ó·ÎÏ¿ fi¯È ÌfiÓÔ ÛÙË ‰È·ÊÔÚÂÙÈ΋ ›-ÙˆÛË Ù˘ ÓfiÛÔ˘, ·ÏÏ¿ Î·È ÛÙȘ ‰È·ÊÔÚ¤˜ ÛÙË ‰È·-ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Î·È ÛÙȘ ÂӉ›ÍÂȘ ÁÈ· ÂÎÙ¤ÏÂ-ÛË ÓÂÊÚÈ΋˜ ‚ÈÔ„›·˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙȘ ‰È¿-ÊÔÚ˜ ¯ÒÚ˜ (3,4).

™ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë IgA ÓÂÊÚÔ¿ıÂÈ· ¤¯ÂÈ ÌÂÏÂ-ÙËı› ·ÚÎÂÙ¿ ηϿ Î·È Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÚfiÁÓˆÛËÙ˘ ÓfiÛÔ˘ Ê·›ÓÂÙ·È ¯ÂÈÚfiÙÂÚË ·’ fi,ÙÈ ·Ú¯Èο, ‰Â-‰Ô̤ÓÔ˘ fiÙÈ Û ̷ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÌÂ-Á¿ÏÔ˜ ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ (20-30%) ›¯Â ÂÍÂÏÈÎÙÈ΋ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· 20 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ú¯È΋‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ (5,6). ∏ ÚfiÁÓˆÛË Ù˘ IgA ÓÂ-ÊÚÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ıˆÚÂ›Ù·È Î·Ï‡ÙÂÚË ·’fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (7-9). ¶Ú¤ÂÈ, fï˜, Ó· ÛËÌÂÈ-ˆı› fiÙÈ ÛÙ· ·È‰È¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚΛ˜ Ì·ÎÚÔ-¯ÚfiÓȘ ÌÂϤÙ˜ Î·È Ù· ÚÔÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ·-ڷ̤ÓÔ˘Ó ·Û·Ê‹.

∞Ó Î·È ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚÔÈ ·ıÔÁÂÓÂÙÈÎÔ›Ì˯·ÓÈÛÌÔ›, Ë ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ

·‰È¢ÎÚ›ÓÈÛÙË Î·È ÂȉÈ΋ ıÂڷ›· ÁÈ· ÙËÓ IgA ÓÂ-ÊÚÔ¿ıÂÈ· ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı›. ∆ËÓ ÙÂÏÂ˘Ù·›·‰ÂηÂÙ›· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÔÏϤ˜ ÌÂϤÙ˜ Ô˘·ÊÔÚÔ‡Ó ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›·, ÙËÓ ÚfiÁÓˆÛË Î·ÈÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·Î·È ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ë IgA ÓÂÊÚÔ¿-ıÂÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‰ÂÓ Â›Ó·È ·Ôχو˜ η-ÏÔ‹ı˘ ÓfiÛÔ˜ (10-12).

∂ȉËÌÈÔÏÔÁ›·

∏ Û˘¯ÓfiÙËÙ· Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ ÔÈΛÏÏÂÈ¢ڤˆ˜ ÛÙȘ ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜. ™ÙËÓπ·ˆÓ›·, ÙË °·ÏÏ›·, ÙËÓ πÙ·Ï›· Î·È ÙËÓ ∞˘ÛÙÚ·Ï›···ÓÙ¿Ù·È Û ÔÛÔÛÙfi 18-40% ÌÂٷ͇ ÙˆÓ ÚˆÙÔ-·ıÒÓ ÛÂÈÚ·Ì·ÙÔ·ıÂÈÒÓ, ÂÓÒ ÛÙȘ ∏ӈ̤Ó˜¶ÔÏÈÙ›˜, ÙËÓ ∞ÁÁÏ›· Î·È ÙÔÓ ∫·Ó·‰¿ ··ÓٿٷÈÏÈÁfiÙÂÚÔ Û˘¯Ó¿, Û ÔÛÔÛÙfi ÌfiÓÔ 2-10% (13-16).∞˘Ù¤˜ ÔÈ ‰È·ÊÔÚ¤˜ ÌÔÚÔ‡Ó Ó· ÂÚÌËÓ¢ıÔ‡Ó Û ÌÂ-Á¿ÏÔ ‚·ıÌfi ·fi ÙË ‰È·ÊÔÚÂÙÈ΋ Ù·ÎÙÈ΋ Ô˘ ÙËÚ›-Ù·È ÛÙȘ ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÂÎÙ¤-ÏÂÛË ·Ó¿Ï˘Û˘ Ô‡ÚˆÓ Û ·È‰È¿ Î·È Ó¤Ô˘˜ ÂÓ‹ÏÈ-Θ, ηıÒ˜ Î·È ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÂӉ›ÍÂȘ ÁÈ·ÂÎÙ¤ÏÂÛË ÓÂÊÚÈ΋˜ ‚ÈÔ„›·˜, ·Ú¿ Û ڷÁÌ·ÙÈ΋‰È·ÊÔÚ¿ ÛÙË ÁˆÁÚ·ÊÈ΋ Û˘¯ÓfiÙËÙ·. ™ÙËÓ ∞˘ÛÙÚ·-Ï›·, fiÔ˘ Ô ÏËı˘ÛÌfi˜ Ù˘ ¯ÒÚ·˜ Â›Ó·È ÂÙÂÚÔÁÂÓ‹˜,Ê·›ÓÂÙ·È fiÙÈ Ë ÓfiÛÔ˜ ÚÔÛ‚¿ÏÏÂÈ ÂÍ›ÛÔ˘ fiϘ ÙÈ˜Ê˘Ï¤˜. ™ÙËÓ π·ˆÓ›·, fiÏ· Ù· ·È‰È¿ ËÏÈΛ·˜ 6-18ÂÙÒÓ ˘Ô‚¿ÏÏÔÓÙ·È Î¿ı ¯ÚfiÓÔ Û ·Ó¿Ï˘ÛË Ô‡ÚˆÓÎ·È fiÛ· ¤¯Ô˘Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·Ú·¤ÌÔ-ÓÙ·È ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô. ™ÙËÓ ¶·ÓÂÈÛÙËÌȷ΋∫ÏÈÓÈ΋ ÙÔ˘ Kobe, Ë IgA ÓÂÊÚÔ¿ıÂÈ· ·ÔÙÂÏ› ÙËÓϤÔÓ Û˘¯Ó‹ ÚˆÙÔ·ı‹ ÛÂÈÚ·Ì·ÙÈ΋ ÓfiÛÔ Î·È

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9IgA ÓÂÊÚÔ¿ıÂÈ·

··ÓÙ¿ Û ÔÛÔÛÙfi 30% ÙˆÓ ÓÂÊÚÈÎÒÓ ‚ÈÔ„ÈÒÓ(17). ™ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ÌÈ-ÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ÛÙË Ì·‡ÚË Ê˘Ï‹ ·’ fi,ÙÈ ÛÙËÏ¢΋ Ê˘Ï‹ (18).

∞fi ÙËÓ Italian Registry of Pediatric RenalBiopsies, ·fi ÈÛÙÔÏÔÁÈο ‰Â‰Ô̤ӷ 432 ·ÛıÂÓÒÓËÏÈΛ·˜ <15 ÂÙÒÓ, ·Ó·Ê¤ÚÂÙ·È Ë ‰È¿ÁÓˆÛË Ù˘ IgAÓÂÊÚÔ¿ıÂÈ·˜ Û ÔÛÔÛÙfi 18,8% ÙˆÓ ·ÛıÂÓÒÓ,ÔÛÔÛÙfi ·ÚfiÌÔÈÔ Ì ÂΛÓÔ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÂÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ (20%). ∂›Û˘, ÛÙËÓ ›‰È· ÌÂϤ-ÙË, IgA ÓÂÊÚÔ¿ıÂÈ· ‰È·ÁÓÒÛÙËΠ۠34,9% ·È-‰ÈÒÓ Ì ÌÂÌÔӈ̤ÓË ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· ηÈÛ 30,4% ·È‰ÈÒÓ Ì ·ÈÌ·ÙÔ˘Ú›· Î·È ÌË ÓÂÊÚˆÛÈ-ÎÔ‡ Ù‡Ô˘ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· (19).

¶·ıÔÁ¤ÓÂÈ·

∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈ-ÛÙË. ∏ ÂÓ·fiıÂÛË ÙˆÓ IgA ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓÛÙÔ ÌÂÛ¿ÁÁÂÈÔ ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ ·ÔÙÂÏ› ÙÔÓ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ Ù˘ ·ıÔÁ¤ÓÂÛ˘ Ù˘ IgA ÓÂÊÚÔ-¿ıÂÈ·˜.

IgA ÓÂÊÚÔ¿ıÂÈ· Î·È ·ÓÔÛÔÏÔÁÈÎfi˜ Ì˯·ÓÈ-

ÛÌfi˜

∞Ú¯Èο, Ë ·ıÔÁ¤ÓÂÛË Ù˘ ÓfiÛÔ˘ ·Ô‰fiıËηÔÎÏÂÈÛÙÈο ÛÙËÓ ÂÓ·fiıÂÛË ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡-ÓÙˆÓ IgA ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ (IgA immunecomplexes - IgA IC). ∞˘Ù‹ Ë ˘fiıÂÛË ÚÔÛʤÚÂÈÈηÓÔÔÈËÙÈ΋ ÂÍ‹ÁËÛË ÛÙË Û˘Û¯¤ÙÈÛË Ô˘ ·Ú·-ÙËÚÂ›Ù·È ÌÂٷ͇ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·ÓÒÙÂÚÔ˘·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Ù˘ ¤Í·ÚÛ˘ Ù˘ ÓfiÛÔ˘ Ì ÂÌ-Ê¿ÓÈÛË ·ÈÌ·ÙÔ˘Ú›·˜ Î·È ÔÈ Ôԛ˜ Û˘Óԉ‡ÔÓÙ·È·fi ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ IgA ·ÓÙÈÛˆÌ¿ÙˆÓ ·fiÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ Ô˘ ÂÎÙ›ıÂÓÙ·È Û ·ÓÙÈÁÔÓÈÎfiÂÚÂıÈÛÌfi. ŸÌˆ˜, ˘„ËÏfi˜ Ù›ÙÏÔ˜ ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓIgA IC ·ÓȯÓ‡ÂÙ·È ÌfiÓÔ Û ÔÛÔÛÙfi 30-70% ÙˆÓ·ÛıÂÓÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÍ¿ÚÛÂˆÓ Ù˘ Ófi-ÛÔ˘ (20,21).

∏ IgA ÚÔ¤Ú¯ÂÙ·È ·fi Â͈ÎÚÈÓ›˜ ÂÎÎÚ›ÛÂÈ˜ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ, ΢ڛˆ˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ηÈÁ·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿ ·fi ·ÓÙÈÁÔÓÈÎfiÂÚÂıÈÛÌfi. À¿Ú¯ÂÈ Û ÌÔÓÔÌÂÚ‹ Î·È ÔÏ˘ÌÂÚ‹ÌÔÚÊ‹. ∏ ÌÔÓÔÌÂÚ‹˜ ·ÓÙÈÚÔۈ‡ÂÈ ÙÔ 90%Ù˘ IgA ÙÔ˘ ÔÚÔ‡ Î·È ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi Ù·Î˘ÎÏÔÊÔÚÔ‡ÓÙ· ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ï·ÛÌ·ÙÔ-·ÙÙ·Ú·, ÛÙÔÓ ÛÏ‹Ó· Î·È ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ.∏ ÔÏ˘ÌÂÚ‹˜ IgA ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi ÏÂÌÊÔ-·ÙÙ·Ú· Î·È Ï·ÛÌ·ÙÔ·ÙÙ·Ú· ÙÔ˘ ·Ó·Ó¢ÛÙÈ-ÎÔ‡ Î·È Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™˘ÓÙ›ıÂÙ·È·fi ÌÔÓÔÌÂÚ‹ ÌfiÚÈ· Ô˘ ÂÓÒÓÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜Ì ÙË Û˘Ó‰ÂÙÈ΋ ¿Ï˘ÛÔ J, Ù· ÔÔ›· ηıÒ˜ ‰È¤Ú¯Ô-ÓÙ·È ·fi Ù· ÂÈıËÏȷο ·ÙÙ·Ú·, Û˘Ó‰¤ÔÓÙ·È ÌÂÙÔ ÂÎÎÚÈÙÈÎfi ÙÌ‹Ì· Ù˘ IgA (S componement). ∏IgA ‰È·ÎÚ›ÓÂÙ·È Û ‰‡Ô ˘ÔÙ‡Ô˘˜: IgA1 Î·È IgA2.

OÈ ÂÓ·Ôı¤ÛÂȘ ÙˆÓ IgA ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ ÛÙÔÌÂÛ¿ÁÁÂÈÔ ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ ·ÔÙÂÏÂ›Ù·È - ¿ÁÓˆ-ÛÙÔ ÁÈ·Ù› - ·fi ÙÔÓ ˘ÔÙ‡Ô IgA1 Û ÔÏ˘ÌÂÚ‹ÌÔÚÊ‹. ∂›Ó·È Èı·Ófi fiÙÈ ÔÈ ÌÔÓÔÌÂÚ›˜ IgA1 Ô˘·Ú¿ÁÔÓÙ·È ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ ÌÂÙ¿ ·fi ·ÓÙÈ-ÁÔÓÈÎfi ÂÚÂıÈÛÌfi, ÂÓÒÓÔÓÙ·È Î·È ÔÏ˘ÌÂÚ›˙ÔÓÙ·ÈÛÙÔ ÌÂÛ¿ÁÁÂÈÔ, ˘fiıÂÛË Ô˘ ÂÓÈÛ¯‡ÂÙ·È ·fi ÙËÓ·Ó›¯Ó¢ÛË Ù˘ Û˘Ó‰ÂÙÈ΋˜ ·Ï‡ÛÔ˘ J ›Û˘ ÛÙÔÌÂÛ¿ÁÁÂÈÔ, fi¯È fï˜ Î·È ÙÔ˘ ÂÎÎÚÈÙÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜(22,23).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ÂȉÈÎÒÓ·ÓÙÈÁfiÓˆÓ Ô˘ ÚÔηÏÔ‡Ó ÙÔÓ ·ÓÔÛÔÏÔÁÈÎfi ÂÚÂıÈ-ÛÌfi ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ IgA ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿-ÙˆÓ, ÔÈ ¤Ú¢Ó˜ ‰ÂÓ ¤¯Ô˘Ó ηٷϋÍÂÈ Û ÈηÓÔÔÈË-ÙÈο ·ÔÙÂϤÛÌ·Ù·. ∞Ó Î·È ¤¯ÂÈ ·Ú·ÙËÚËı› Û˘-Û¯¤ÙÈÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ ·˘ÙÒÓ Ì ÙȘ ÂÍ¿ÚÛÂȘ Ù˘ÓfiÛÔ˘, ÂÓÙÔ‡ÙÔȘ, ‰ÂÓ ·ÓȯÓ‡ıËÎ·Ó ÛÙȘ IgA ÂÓ·-Ôı¤ÛÂȘ ÛÙ· ÛÂÈÚ¿Ì·Ù· ÙˆÓ ·ÛıÂÓÒÓ.

Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ‰È¿ÊÔÚ· ·ÓÙÈÁfiÓ·, fiˆ˜ Ô·ÈÌfiÊÈÏÔ˜ parainfluenza (24), ÈÔ› ÙÔ˘ ·ÓÒÙÂÚÔ˘·Ó·Ó¢ÛÙÈÎÔ‡, ÔÈ ÈÔ› EBV, CMV, HSV (25,26) ηȉȿÊÔÚ· ÙÚÔÊÈο ·ÓÙÈÁfiÓ· (27,28), ÁÈ· ·Ú¿‰ÂÈÁÌ·ÎfiÎÎÔÈ ÛfiÁÈ·˜, ÚˆÙ½Ó˜ Á¿Ï·ÎÙÔ˜ Î.Ï. À¤Ú ÙÔ˘·ÓÔÛÔÏÔÁÈÎÔ‡ ·ıÔÁÂÓÂÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Û˘Ì-‚¿ÏÏÂÈ, ›Û˘, Ë Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ Ig∞ ÂÓ·Ôı¤-ÛÂˆÓ ÛÙ· ÓÂÊÚÈο ÌÔۯ‡̷ٷ ·ÛıÂÓÒÓ Ô˘ ¤·-Û¯·Ó ·fi Ig∞ ÓÂÊÚÔ¿ıÂÈ·, ÂÓÒ ·ÓÙ›ıÂÙ· ·Ú·ÙË-ÚÂ›Ù·È Ì¤¯ÚÈ Î·È ÂÍ·Ê¿ÓÈÛË ÙˆÓ Ig∞ ÂÓ·Ôı¤ÛˆÓÛÙ· ÓÂÊÚÈο ÌÔۯ‡̷ٷ ·ÛıÂÓÒÓ Ì Ig∞ ÓÂÊÚÔ-¿ıÂÈ· fiÙ·Ó ÌÂÙ·ÌÔۯ‡ıËÎ·Ó Û ·ÛıÂÓ‹ Ì ¿ÏÏËÚˆÙÔ·ı‹ ÓfiÛÔ (29,30).

¢È·Ù·Ú·¯¤˜ Ù˘ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ Ù˘ Ig∞

π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ÓfiÛÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÚfiÛÊ·ÙË ıˆڛ· Ù˘ Û‡ÓıÂ-Û˘ ‰ÔÌÈο ·ÓÒÌ·Ï˘ Ig∞ ·fi ÙÔ˘˜ ¿Û¯ÔÓÙ˜.

∏ ·ÓıÚÒÈÓË Ig∞1, Ô˘ Â›Ó·È Ë Î‡ÚÈ· ˘ÔÔÌ¿‰·Ô˘ ··ÓÙ¿Ù·È ÛÙȘ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÂÓ·Ôı¤ÛÂȘÙ˘ ÓfiÛÔ˘, Â›Ó·È Ì›· ÁÏ˘ÎÔÚˆÙ½ÓË Ô˘ ÂÚȤ¯ÂÈ8% ˘‰·Ù¿ÓıڷΘ. ∏ ÂÚÈÔ¯‹ Ô˘ Û˘Ó‰¤ÔÓÙ·È ÔÈ˘‰·Ù¿ÓıڷΘ (hinge region) ¤¯ÂÈ Ì›· ¯·Ú·ÎÙËÚÈ-ÛÙÈ΋ ·ÎÔÏÔ˘ı›· 17 ·ÌÈÓÔͤˆÓ Î·È ÔÏϤ˜ ÁÈ· O-ÁÏ˘ÎÔ˙˘Ï›ˆÛË ÂÚÈÔ¯¤˜ (∂ÈÎfiÓ· 1). OÈ ÂÚÈÔ¯¤˜·˘Ù¤˜ Û˘ÓÈÛÙÒÓÙ·È ·fi ¡-·ÎÂÙ˘ÏÁ·Ï·ÎÙÔ˙·Ì›ÓË,O-Û˘Ó‰Â‰Â̤ÓË Ì ٷ ·ÌÈÓÔͤ· ÛÂÚ›ÓË Î·È ıÚÂÔÓ›-ÓË (31,32).

¢È·Ù·Ú·¯¤˜ Ù˘ O-ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ Ù˘ Ig∞1

¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ¯ËÌÈ΋˜Ù˘ Û˘ÁÁ¤ÓÂÈ·˜ Ì ÙË ÊÈÌÚÈÓÔÓÂÎÙ›ÓË, ÙË Ï·ÌÈÓ›ÓËÎ·È ÙÔ ÎÔÏÏ·ÁfiÓÔ, Ô˘ Ô‰ËÁ› ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfiÂÓ·Ôı¤ÛÂˆÓ ÛÙÔ ÌÂÛ¿ÁÁÂÈÔ (33,34). ¢È·Ù·Ú·¯¤˜ÛÙËÓ ·ÎÔÏÔ˘ı›· ÙˆÓ ·ÌÈÓÔͤˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÙˆÓ˘‰·Ù·ÓıÚ¿ÎˆÓ ı· ÌÔÚÔ‡Û·Ó Ó· Â›Ó·È ¤Ó·˜ Èı·-Ófi˜ Ì˯·ÓÈÛÌfi˜ Ô˘ ı· ÚÔηÏÔ‡Û ‰È·Ù·Ú·¯¤˜Ù˘ O-ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ Ù˘ Ig∞1, ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ¤¯ÂÈ ‰È·ÈÛÙˆı› (35).

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10 ∞. ªËÙÛÈÒÓË

Œ¯ÂÈ, ›Û˘, ·Ó·ÊÂÚı› fiÙÈ ‰È·Ù·Ú·¯‹ Ù˘ O-ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÌÂȈ̤ÓË ‰Ú·ÛÙÈ-ÎfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‚ 1,3 Á·Ï·ÎÙÔ˙˘ÏÙÚ·ÓÊÂÚ¿-Û˘, ¤Ó˙˘ÌÔ Ô˘ ·Ú¿ÁÂÙ·È ÛÙÔ ‹·Ú Î·È Â›Ó·È˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ÙÂÏÈ΋ Á·Ï·ÎÙÔ˙˘Ï›ˆÛË Ù˘ ¡-·ÎÂÙ˘ÏÔÁ·Ï·ÎÙÔ˙·Ì›Ó˘. ∏ ‰ÔÌÈ΋ ‹ ÏÂÈÙÔ˘ÚÁÈ΋·Ó¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Èı·ÓfiÓ Ó· ÚÔÛ‰ÈÔÚ›˙Â-Ù·È ÁÂÓÂÙÈο (36,37).

∏ ·ıÔÏÔÁÈ΋ Ig∞1, ÏfiÁˆ ÌÂȈ̤Ó˘ ÂÚÈÂÎÙÈ-ÎfiÙËÙ·˜ Û Á·Ï·ÎÙfi˙Ë, Û¯ËÌ·Ù›˙ÂÈ ·ÓÔÛÔÛ˘-ÌϤÁÌ·Ù· Ô˘ ‰ÂÓ Û˘Ó‰¤ÔÓÙ·È Â‡ÎÔÏ· Ì ÙÔ˘˜Ë·ÙÈÎÔ‡˜ ˘Ô‰Ô¯Â›˜ Î·È ‰ÂÓ ·ÔÌ·ÎÚ‡ÓÔÓÙ·È·fi ÙËÓ Î˘ÎÏÔÊÔÚ›·. ∂›Û˘, ÏÂÈÙÔ˘ÚÁ› Û·Ó ·ÓÙÈ-ÁfiÓÔ Ô˘ ·Ó·ÁÓˆÚ›˙ÂÙ·È ·fi Ù· Ig∞1 ·ÓÙÈÛÒÌ·Ù·,Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ‰È·ÊfiÚˆÓ Î˘Ù-Ù·ÚÔÎÈÓÒÓ (ÈÓÙÂÚÏ¢ΛÓË 6, ÈÓÙÂÚÏ¢ΛÓË 1, ·Ú¿-ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ ÙˆÓ ÈÛÙÒÓ Î.Ï.), ·ÁÁÂÈÔ‰Ú·ÛÙÈ-ÎÒÓ Ô˘ÛÈÒÓ (ÚÔÛÙ·ÁÏ·Ó‰›Ó˜, ıÚÔÌ‚ÔÍ¿ÓËÎ.Ï.), ηıÒ˜ Î·È Ù˘ ÂÓ·ÏÏ·ÎÙÈ΋˜ Ô‰Ô‡ ÙÔ˘ Û˘-ÌÏËÚÒÌ·ÙÔ˜ (38-40).

ºÏÂÁÌÔÓÒ‰ÂȘ ‰ÈÂÚÁ·Û›Â˜ ÛÙÔ ÌÂÛ¿ÁÁÂÈÔ

∏ ÂÓ·fiıÂÛË Ù˘ ÔÏ˘ÌÂÚÔ‡˜ Ig∞ ÛÙÔ ÌÂÛ¿Á-ÁÂÈÔ ‰‡Ó·Ù·È Ó· ÂÓÂÚÁÔÔÈ‹ÛÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›·ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·˜. À¿Ú¯Ô˘Ó Ï›Á· ÛÙÔȯ›·Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ˘fiıÂÛË fiÙÈ ÔÈ Ì˯·ÓÈÛÌÔ›Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÊÏÂÁÌÔÓÒ-‰Ô˘˜ ·ÓÙ›‰Ú·Û˘ Â›Ó·È ÂȉÈÎÔ› ÛÙËÓ Ig∞ ÓÂÊÚÔ¿-ıÂÈ·. ªÂϤÙ˜ in vitro Î·È Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈ-Í·Ó ÙÔÓ È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ô˘ ¤¯Ô˘Ó ÔÈ΢ÙÔΛÓ˜ Î·È Ô ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ·ÈÌÔ-ÂÙ·Ï›ˆÓ (platelet derived growth factor - PDGF)Ô˘ ·Ú¿ÁÂÙ·È ·fi Ù· ÌÂÛ·ÁÁÂȷο ·ÙÙ·Ú·(41,42). ∏ ¤Á¯˘ÛË ·˘ÙÔ‡ ÙÔ˘ ·Ú¿ÁÔÓÙ· Û ÂÈÚ·-Ì·Ùfi˙ˆ· ÚÔηÏ› ÌÂÛ·ÁÁÂȷ΋ ˘ÂÚÏ·Û›·.ŒÓ·˜ ¿ÏÏÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı›,

Â›Ó·È Ô ÌÂÙ·ÙÚÂÙÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‚(transforming growth factor ‚) Ô˘ Î·È ·˘Ùfi˜ ·-Ú¿ÁÂÙ·È ÌÂÙ¿ ÙËÓ Â·ÁˆÁ‹ ÙÔ˘ ·fi ÙËÓ ·ÁÁÂÈÔÙ·-Û›ÓË ππ Î·È ÚÔηÏ› ›Û˘ ÌÂÛ·ÁÁÂȷ΋ ˘ÂÚ-Ï·Û›· Î·È ÚÔ˚Ô‡Û· ›ÓˆÛË (41,43). ∏ ÌÂÛ·ÁÁÂÈ·-΋ ˘ÂÚÏ·Û›· ‰‡Ó·Ù·È Ó· ·ÔηٷÛÙ·ı› ÌÂÚÈ-ÎÒ˜, Ì Ì˯·ÓÈÛÌÔ‡˜ ΢ÙÙ·ÚÈ΋˜ ·fiÙˆÛ˘, Ë‚Ï¿‚Ë fï˜ ÙˆÓ Ô‰Ô΢ÙÙ¿ÚˆÓ ‰ÂÓ Â›Ó·È ·Ó·-ÛÙÚ¤„ÈÌË, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÛÂÈÚ·Ì·ÙÈ΋ ÛÎÏ‹-Ú˘ÓÛË (44).

∆Ô Û‡ÛÙËÌ· ÚÂÓ›Ó˘-·ÁÁÂÈÔÙ·Û›Ó˘

∏ ·ÁÁÂÈÔÙ·Û›ÓË ππ η٤¯ÂÈ ÚˆÙ·ÁˆÓÈÛÙÈÎfiÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘. ∏ Û˘ÛÙÔÏ‹ ÙˆÓÌÂÛ·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ··Ú¯Èο ÛÙ¿‰È· Ù˘ Ig∞ ÓÂÊÚÔ¿ıÂÈ·˜, ÚÔηÏ›‚Ï¿‚˜ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ ÙÔ˘ÛÂÈÚ¿Ì·ÙÔ˜ Î·È ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ÚÂÓ›Ó˘-·ÁÁÂÈÔÙ·Û›Ó˘. ∏ ·ÁÁÂÈÔÙ·Û›ÓË ·ÊÂÓfi˜¤¯ÂÈ ·ÈÌÔ‰˘Ó·ÌÈ΋ ‰Ú¿ÛË ÚÔηÏÒÓÙ·˜ ÛÂÈÚ·-Ì·ÙÈ΋ ˘¤ÚÙ·ÛË Î·È ˘ÂډȋıËÛË, ·ÊÂÙ¤ÚÔ˘ÂÓÂÚÁÔÔÈ› ÙË ‰Ú¿ÛË ‰È·ÊfiÚˆÓ ·˘ÍËÙÈÎÒÓ ·-Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó ÛÙ· ÌÂÛ·ÁÁÂȷο ·ÙÙ·Ú·Î·È ÚÔηÏÔ‡Ó ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ıÂÌÂÏ›Ô˘ Ô˘-Û›·˜ (45).

∂ÈϤÔÓ, Û ‚ÈÔ„›Â˜ ÓÂÊÚÒÓ ·ÛıÂÓÒÓ Ì Ig∞ÓÂÊÚÔ¿ıÂÈ·, ¤¯ÂÈ ·Ô‰Âȯı› ·˘ÍË̤ÓË ¤ÎÊÚ·ÛËÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ ·ÁÁÂÈÔÙ·Û›Ó˘ ππ Î·È ·˘ÍË̤ÓˉڷÛÙËÚÈfiÙËÙ· Ù˘ ·ÁÁÂÈÔÙ·Û›Ó˘ ̤۷ ÛÙ· ÛÂÈ-Ú¿Ì·Ù·, ÁÂÁÔÓfi˜ Ô˘ ηıÈÛÙ¿ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ig∞ϤÔÓ Â˘·ı›˜ ÛÙËÓ Î·Ù·ÛÙÚÔÊÈ΋ ‰Ú¿ÛË Ù˘ ·Á-ÁÂÈÔÙ·Û›Ó˘ ππ, Û˘ÁÎÚÈÙÈο Ì ¿ÏϘ ÛÂÈÚ·Ì·ÙÔ-¿ıÂȘ (46,47).

°ÂÓÂÙÈÎÔ› ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜

∞Ó Î·È Ë Ig∞ ÓÂÊÚÔ¿ıÂÈ· ÂÌÊ·Ó›˙ÂÙ·È ÛÔÚ·-‰Èο, Ê·›ÓÂÙ·È fiÙÈ ÁÂÓÂÙÈÎÔ› ÚԉȷıÂÛÈÎÔ› ·Ú¿-ÁÔÓÙ˜ ÂËÚ¿˙Ô˘Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘. OÈRambausek Î·È Û˘Ó (48) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÛÔÛÙfi9,6% ÙˆÓ ·ÛıÂÓÒÓ ÛÙË °ÂÚÌ·Ó›· ¤¯ÂÈ ¤Ó·Ó ‹ ÂÚÈÛ-ÛfiÙÂÚÔ˘˜ Û˘ÁÁÂÓ›˜ Ì Ig∞ ÓÂÊÚÔ¿ıÂÈ·, ÂÓÒ ÛÙËÓπÙ·Ï›· (49) ‰È·ÈÛÙÒıËΠfiÙÈ 26 ·fi ÙÔ˘˜ 185·ÛıÂÓ›˜ (ÔÛÔÛÙfi 14%) ›¯·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·ÓÛ˘ÁÁÂÓ‹ Ì ÙËÓ ›‰È· ÓfiÛÔ.

™Â ÌÂϤÙ˜ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó·Ó ÌÈÎÚfi ·ÚÈıÌfi·ÛıÂÓÒÓ ·Ó·Ê¤ÚÂÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤-ÙÈÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ Ì ÔÚÈṲ̂ӷ HLA·ÓÙÈÁfiÓ·, fiˆ˜ BW35, B12, B27, DR1 Î·È DR4(50,51), ÂÓÒ Û ¿ÏϘ ‰ÂÓ ÂȂ‚·ÈÒıËÎ·Ó ·˘Ù¿ Ù·Â˘Ú‹Ì·Ù· (52).

∂›Û˘, Ë ÓfiÛÔ˜ Û˘Ó˘¿Ú¯ÂÈ Ì ÔÚÈṲ̂ÓÔ˘˜Ê·ÈÓÔÙ‡Ô˘˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ Û˘ÌÏËÚÒÌ·-ÙÔ˜. OÈ McLean Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ÓfiÛÔ˜ ›-Ó·È Û˘¯ÓfiÙÂÚË Ì ÙÔÓ ÔÌÔ˙˘ÁÒÙË null C4 (53), ÂÓÒÔÈ Rambausek Î·È Û˘Ó Ì ÙÔÓ ÔÌÔ˙˘ÁÒÙË C3FF Ê·È-ÓfiÙ˘Ô (48).

¶·È‰È·ÙÚÈ΋ 2005;68:8-16

∂∂ÈÈÎÎfifiÓÓ·· 11.. ªÔÚȷ΋ ‰ÔÌ‹ Ù˘ IgA1.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·10

Page 22: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

¶·È‰È·ÙÚÈ΋ 2005;68:8-16

¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈο Â˘Ú‹Ì·Ù·

∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Ù›ıÂÙ·È ·ÔÎÏÂÈÛÙÈο ÌÂ

ÙË ‚ÈÔ„›· ÓÂÊÚÔ‡ ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, ÙËÓ ÂͤٷÛË

ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÈÛÙÔ‡ Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ·ÓÔÛÔÊıÔÚÈ-

ÛÌÔ‡, fiÔ˘ ‰È·ÈÛÙÒÓÔÓÙ·È ÂÓ·Ôı¤ÛÂȘ IgA ·ÓÔ-

ÛÔÛÊ·ÈÚÈÓÒÓ ÛÙÔ ÌÂÛ¿ÁÁÂÈÔ ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ Î·È

ÛÙ· ÙÔȯÒÌ·Ù· ÙˆÓ ÙÚȯÔÂȉÒÓ, ÏËÛ›ÔÓ Ù˘ ÊÏÔÈ-

ÔÌ˘ÂÏÒ‰Ô˘˜ Û˘Ì‚ÔÏ‹˜. ∂Ó·Ôı¤ÛÂȘ IgG Î·È IgM

·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ Â›Ó·È, ›Û˘, ‰˘Ó·ÙfiÓ Ó· ·Ú·-

ÙËÚËıÔ‡Ó, ·ÏÏ¿ Â›Ó·È ÌÈÎÚfiÙÂÚ˘ ¤ÓÙ·Û˘. ™Â 60%

ÙˆÓ ·ÚÚÒÛÙˆÓ ˘¿Ú¯Ô˘Ó Î·È ÎÔÎÎÈÒ‰ÂȘ ÂÓ·Ôı¤-

ÛÂȘ ÙÔ˘ C3, ˘Ô‰ËÏÒÓÔÓÙ·˜ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘

ÂÓ·ÏÏ·ÎÙÈ΋˜ Ô‰Ô‡ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜. ∂Ó·Ô-

ı¤ÛÂȘ C4 Î·È C1q ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È.

™ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ, ÙÔ Ï¤ÔÓ ¯·Ú·ÎÙËÚÈ-

ÛÙÈÎfi ‡ÚËÌ· Â›Ó·È Ë ÂÛÙȷ΋ ‹ ‰È¿¯˘ÙË ÌÂÛ·ÁÁÂÈ·-

΋ ˘ÂÚÏ·Û›·, ·ÔÙ¤ÏÂÛÌ· Ù˘ ·‡ÍËÛ˘ ÙfiÛÔ ÙÔ˘

·ÚÈıÌÔ‡ ÙˆÓ ÌÂÛ·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È Ù˘

ıÂÌÂÏ›Ô˘ Ô˘Û›·˜. ∏ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂ-

Û·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Û˘Ó‹ıˆ˜ ˘ÂÚÙÂÚ› Ù˘ ·‡-

ÍËÛ˘ Ù˘ ıÂÌÂÏ›Ô˘ Ô˘Û›·˜ ÛÙȘ ‚ÈÔ„›Â˜ ·ÛıÂÓÒÓ

Ì ‚Ú·¯‡ ‰È¿ÛÙËÌ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘.

¶ÚÔ˚fiÓÙÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘, Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ

ÌÂÛ·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂÈÒÓÂÙ·È Î·È ·˘Í¿ÓÂÙ·È Ë

ıÂ̤ÏÈÔ˜ Ô˘Û›· Î·È Ë ÛÎÏ‹Ú˘ÓÛË.

OÈ ÈÛÙÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ô˘ ‰‡Ó·ÓÙ·È Ó·

··ÓÙËıÔ‡Ó, ηχÙÔ˘Ó fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ Â˘ÚË-

Ì¿ÙˆÓ, fiˆ˜ ÂÏ¿¯ÈÛÙ˜ ·ÏÏÔÈÒÛÂȘ, ‰È¿¯˘ÙË ÂÓ‰Ô-

ÙÚȯÔÂȉÈ΋ ˘ÂÚÏ·Û›·, Â͈ÙÚȯÔÂȉÈ΋ ˘ÂÚ-

Ï·Û›· Ì ÌËÓÔÂȉ›˜ Û¯ËÌ·ÙÈÛÌÔ‡˜, ˘·Ï›ÓˆÛË

Î·È ÛÎÏ‹Ú˘ÓÛË. ªÂ ‚¿ÛË Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·

ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ Î·È Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ

ÙfiÛÔ ÙËÓ Î·Ù¿Ù·ÍË Ù˘ ¶·ÁÎfiÛÌÈ·˜ OÚÁ¿ÓˆÛ˘

ÀÁ›·˜ fiÛÔ Î·È ÛÙÔȯ›· Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ Úfi-

ÁÓˆÛË Î·È ÙË ıÂڷ›·, fiˆ˜ ¤¯ÂÈ Á›ÓÂÈ Î·È ÛÙÔ

™∂§, Ë ÓfiÛÔ˜ ‰È·ÎÚ›ÓÂÙ·È Û 5 ÛÙ¿‰È· (54): ÛÙ¿‰ÈÔ

π (ÂÏ¿¯ÈÛÙ˜ ·ÏÏÔÈÒÛÂȘ), ÛÙ¿‰ÈÔ ππ (ÂÛÙȷ΋ ÙÌË-

Ì·ÙÈ΋ ˘ÂÚÏ·Û›· ‹ ÛÎÏ‹Ú˘ÓÛË), ÛÙ¿‰ÈÔ πππ

(ÂÛÙȷ΋ ˘ÂÚÏ·Û›· Û <50% ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ

± ÌËÓÔÂȉ›˜ Û¯ËÌ·ÙÈÛÌÔ›), ÛÙ¿‰ÈÔ IV (‰È¿¯˘ÙË

˘ÂÚÏ·Û›· Û >50% ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ ± ÌËÓÔÂÈ-

‰Â›˜ Û¯ËÌ·ÙÈÛÌÔ›) Î·È ÛÙ¿‰ÈÔ V (>40% ÔÏÈ΋

ÛÎÏ‹Ú˘ÓÛË ÛÂÈÚ·Ì¿ÙˆÓ Î·È >40% ·ÙÚÔÊ›· Ûˆ-

ÏËÓ·Ú›ˆÓ).

∞˘Ù‹ Ë ÈÛÙÔÏÔÁÈ΋ ηٿٷÍË - ·Ó Î·È ‰ÂÓ Â›Ó·È

Ï‹Úˆ˜ ·Ô‰ÂÎÙ‹ - ¤¯ÂÈ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›·, ‰Â-

‰Ô̤ÓÔ˘ fiÙÈ 90% ÙˆÓ ·ÛıÂÓÒÓ Ì ÓÂÊÚÔ¿ıÂÈ· ÛÙ·-

‰›Ô˘ π ‹ ππ ‰È·ÙËÚ› ÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· 10 ¯ÚfiÓÈ·

ÌÂÙ¿, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ÓfiÛÔ ÛÙ·‰›-

Ô˘ πππ Î·È ÙˆÓ ·ÛıÂÓÒÓ Ì ÓfiÛÔ ÛÙ·‰›Ô˘ πV ‹ V ›ӷÈ

ÌfiÓÔ 50% Î·È 20%, ·ÓÙ›ÛÙÔȯ· (55). ∏ ¤ÎÙ·ÛË ÙˆÓ

·ÏÏÔÈÒÛÂˆÓ ÙˆÓ Ô˘ÚÔÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ ·ÓÙ·Ó·-

ÎÏ¿ ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ·ÏÏÔÈÒÛÂˆÓ ÙˆÓ ÛÂÈÚ·Ì¿-

ÙˆÓ, ÂÓÒ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ·ÁÁ›ˆÓ Ô˘ Â›Ó·È Û˘¯Ó¤˜

ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Û¿ÓÈ· ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ· ·È‰È¿.

™ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ·ÏÒ˜ ÂȂ‚·È-

ÒÓÔÓÙ·È ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÂÓ·Ôı¤ÛÂȘ IgA ÛÙÔ

ÌÂÛ¿ÁÁÂÈÔ Î·È ÏÈÁfiÙÂÚÔ ˘ÔÂÓ‰ÔıËÏȷο Î·È ˘ÔÂ-

ÈıËÏȷο.

∫ÏÈÓÈ΋ ÂÈÎfiÓ·

∏ ÓfiÛÔ˜ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Û ÔÔÈ·‰‹ÔÙÂ

ËÏÈΛ·, Ì ÌÂÁ·Ï‡ÙÂÚË fï˜ Û˘¯ÓfiÙËÙ· ÛÙË 2Ë ‹

3Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. ™¿ÓÈ· ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿

ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ Î·È ·ÎfiÌ· Û·ÓÈfi-

ÙÂÚ· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 3 ÂÙÒÓ, Èı·-

Ófiٷٷ ÁÈ·Ù› Ë ·Ú·ÁˆÁ‹ ÙˆÓ IgA ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙ·

ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. ¶ÚÔÛ‚¿Ï-

ÏÂÈ Û˘¯ÓfiÙÂÚ· ÙÔ˘˜ ¿Ó‰Ú˜ ·fi ÙȘ Á˘Ó·›Î˜ Î·È Ë

Û¯¤ÛË ¿ÚÚÂÓ/ı‹Ï˘ Î˘Ì·›ÓÂÙ·È ·fi 6:1 ¤ˆ˜ 2:1, Û‡Ì-

ʈӷ Ì ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (9,17,20).

∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ηχÙÂÈ fiÏÔ ÙÔ Â‡ÚÔ˜ ÙˆÓ

Û˘Ìو̿وÓ, ·fi ·Û˘Ìو̷ÙÈ΋ ÌÈÎÚÔÛÎÔÈ-

΋ ·ÈÌ·ÙÔ˘Ú›· ̤¯ÚÈ ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·.

øÛÙfiÛÔ, ·Ú’ fiÏË ÙËÓ ÏËıÒÚ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÎ-

‰ËÏÒÛˆÓ, Ë ÓfiÛÔ˜ ÛÙËÓ ¤Ó·ÚÍ‹ Ù˘ ÂÌÊ·Ó›˙ÂÙ·È

Ì ¤Ó· ·fi Ù· ·ÎfiÏÔ˘ı· ÎÏÈÓÈο Û‡Ó‰ÚÔÌ· (17):

·) Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·, ‚) ÌÈÎÚÔÛÎÔÈ΋

·ÈÌ·ÙÔ˘Ú›· ·Û˘Ìو̷ÙÈ΋ ± ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, Á)

Ô͇ ÓÂÊÚÈÙȉÈÎfi Û‡Ó‰ÚÔÌÔ (·ÈÌ·ÙÔ˘Ú›·, ˘¤ÚÙ·ÛË

± ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·), ‰) ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ

Î·È Â) ÓÂÊÚ›Ùȉ· Î·È ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ (¶›Ó·-

η˜ 1).

∏ Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›-

˙ÂÙ·È Ù·˘Ùfi¯ÚÔÓ· ‹ 1-2 Ë̤Ú˜ ÌÂÙ¿ ·fi Ïԛ̈ÍË

ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ÏÈÁfi-

ÙÂÚÔ Û˘¯Ó¿ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂›Ó·È

‰˘Ó·ÙfiÓ ÔÈ ·ÛıÂÓ›˜ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÙÚÔÈ¿-

˙Ô˘Û· Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· ÌÂÙ¿ ·fi ÙËÓ

›‰È· Ïԛ̈ÍË. O ·ÚÈıÌfi˜ ÙˆÓ ˘ÔÙÚÔÒÓ Î·È ÙÔ ÌÂ-

ÛԉȿÛÙËÌ· ÌÂٷ͇ ÙÔ˘˜ ‰È·Ê¤ÚÔ˘Ó ·fi ·ÛıÂÓ‹ ÛÂ

¶¶››ÓÓ··Îη·˜̃ 11.. ∫ÏÈÓÈο Â˘Ú‹Ì·Ù· ÛÙËÓ ¤Ó·ÚÍË Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ Û ·È‰È¿ (%)

∏∏¶¶∞∞ (56) ππ··ˆ̂ÓÓ››·· (57) °°··ÏÏÏÏ››·· (58)

∞∞ÚÚÈÈııÌÌfifi˜̃ ··ÛÛııÂÂÓÓÒÒÓÓ 6622 225588 115577

ÀÔÙÚÔÈ¿˙Ô˘Û· Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· 55 26 76ªÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· ± ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· 30 62 24¡ÂÊÚ›Ùȉ· ± ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ 25 12 10

11IgA ÓÂÊÚÔ¿ıÂÈ·

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·11

Page 23: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

12 ∞. ªËÙÛÈÒÓË

·ÛıÂÓ‹. ∆· ÂÂÈÛfi‰È· Ù˘ Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·-ÙÔ˘Ú›·˜, Û˘Ó‹ıˆ˜, Û˘Óԉ‡ÔÓÙ·È ·fi ‹ÈÔ ¿ÏÁÔ˜ÛÙËÓ ÔÛÊ˘˚΋ ¯ÒÚ·. ∏ Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·Î·È, Û˘ÁÎÂÎÚÈ̤ӷ, Ë ˘ÔÙÚÔÈ¿˙Ô˘Û· Ì·ÎÚÔÛÎÔ-È΋ ·ÈÌ·ÙÔ˘Ú›· Â›Ó·È ÙÔ Ï¤ÔÓ Û˘¯Ófi ‡ÚËÌ· Ù˘ÓfiÛÔ˘. ™Â Â˘Úˆ·˚Τ˜ ÌÂϤÙ˜ Î·È ÌÂϤÙ˜ ·fi ÙȘ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ ·Ó·Ê¤ÚÂÙ·È Ì·ÎÚÔÛÎÔÈ΋·ÈÌ·ÙÔ˘Ú›· Û ÔÛÔÛÙfi ¤ˆ˜ 80% ÙˆÓ ·ÛıÂÓÒÓ, ÂÓÒÛ ÌÂϤÙ˜ ·fi ÙËÓ π·ˆÓ›· ·Ó·Ê¤ÚÂÙ·È Û ÔÛÔ-ÛÙfi 26% ÙˆÓ ·ÛıÂÓÒÓ (56-58). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ È-ı·Ófiٷٷ ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ËÈfiÙÂÚ˜ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÓˆÚ›ÙÂÚ·, ÏfiÁˆÙÔ˘ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÂϤÁ¯Ô˘ Ô˘ ˘Ô‚¿ÏÏÂÙ·È ÔÏËı˘ÛÌfi˜ ÛÙËÓ π·ˆÓ›·. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘Ù˘ Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·ÙÔ˘Ú›·˜ ·Ó·Ê¤ÚÂÙ·È ÌÂÁ·-χÙÂÚË ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ Ó·ÚÔ‡˜ ÂÊ‹‚Ô˘˜ ·’fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Úfi-ÁÓˆÛË Ù˘ ÓfiÛÔ˘ (59).

∏ ·Û˘Ìو̷ÙÈ΋ ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›·Û˘Ó‹ıˆ˜ Â›Ó·È ÌfiÓÈÌË Î·È Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘ÓÔ-‰Â‡ÂÙ·È ·fi ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·, fi¯È fï˜ ÓÂÊÚˆÛÈÎÔ‡Ù‡Ô˘. ∏ ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ë ÓÂÊÚÈ΋ ÏÂÈÙÔ˘Ú-Á›· Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÛÙËÓ ¤Ó·ÚÍË Ù˘ÓfiÛÔ˘. §Â˘ÎˆÌ·ÙÔ˘Ú›· ÓÂÊÚˆÛÈÎÔ‡ Ù‡Ô˘ ··-ÓÙ¿Ù·È ÂÚ›Ô˘ Û ÔÛÔÛÙfi 10% ÙˆÓ ·ÛıÂÓÒÓ.

OÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¿-ÓÈ·, ηٿ ηÓfiÓ· Û˘Ó˘¿Ú¯ÂÈ Ì ·ÈÌ·ÙÔ˘Ú›· Î·È Â›-Ó·È Û˘Ó‹ıˆ˜ ·Ó·Ù¿ÍÈÌË. ∂›Û˘, Ê·›ÓÂÙ·È fiÙÈ Ë Ù·-¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓË IgA ÓÂÊÚÔ¿ıÂÈ· Ì ‡·ÚÍËÌËÓÔÂȉÒÓ Û¯ËÌ·ÙÈÛÌÒÓ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·È-‰È¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ 41% ÙˆÓ ·ÛıÂÓÒÓ Ì ·˘Ù‹ ÙËÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Â›Ó·È ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 16ÂÙÒÓ (60).

∞Í›˙ÂÈ, Ù¤ÏÔ˜, Ó· ÛËÌÂȈı› fiÙÈ Ù· ›‰· Ù˘IgA ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ÛÙÔÓ ÔÚfi Â›Ó·È ˘„ËÏ¿ Û 30-50% ÙˆÓ ÂÓ‹ÏÈÎˆÓ ·ÛıÂÓÒÓ Ì IgA ÓÂÊÚÔ¿ıÂÈ·,·ÏÏ¿ ÌfiÓÔ Û 8-16% ÙˆÓ ·È‰ÈÒÓ, Ô‡Ùˆ˜ ÒÛÙ ÔÈ˘„ËϤ˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ IgA ÙÔ˘ ÔÚÔ‡ Ó· ÌËÓ·ÔÙÂÏÔ‡Ó ‰Â›ÎÙË ‰È·ÁÓˆÛÙÈ΋˜ ÛËÌ·Û›·˜ ÛÙ··È‰È¿ (17).

¶ÚfiÁÓˆÛË

∏ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ Â›Ó·È Ì·ÎÚÔ¯ÚfiÓÈ·, ÁÂÁÔ-Ófi˜ Ô˘ ‰˘ÛÎÔχÂÈ ÙËÓ ·ÎÚÈ‚‹ ÚfiÁÓˆÛË. ™˘ÁÎÂ-ÎÚÈ̤ӷ, ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ·ÒÙÂÚ˘ ÚfiÁÓˆ-Û˘ ·ÛıÂÓÒÓ Ì IgA ÓÂÊÚÔ¿ıÂÈ·, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ËÓfiÛÔ˜ ‰È·ÁÓÒÛÙËΠÛÙËÓ ·È‰È΋ ËÏÈΛ·, ··ÈÙ›ٷÈË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜ Î·È ÛÙËÓ ÂÓ‹-ÏÈÎË ˙ˆ‹, ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ÂÊÈÎÙfi.

∏ Ê˘ÛÈ΋ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ‰È·Ê¤ÚÂÈ Û οı ·ÛıÂÓ‹. ¶Ï‹Ú˘ ‡ÊÂÛË Ù˘ Ófi-ÛÔ˘ ·Ó·Ê¤ÚÂÙ·È Û 30% ÙˆÓ ·ÛıÂÓÒÓ (61). ∞fi‰Â‰Ô̤ӷ Ù˘ European Dialysis and TransplantAssociation Registry Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·È‰È¿ ηÈ

ÂÓ‹ÏÈΘ, Ë IgA ÓÂÊÚÔ¿ıÂÈ· ·ÔÙÂÏ› ÙÔ 1,5%ÙˆÓ ÓfiÛˆÓ Ô˘ ηٷϋÁÔ˘Ó Û ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ∫¿ÔÈÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ‚Ú·‰Â›· Âȉ›ӈÛË Ù˘ ÓÂÊÚÈ΋˜ ÙÔ˘˜ ÏÂÈ-ÙÔ˘ÚÁ›·˜ (ÙÒÛË ÙÔ˘ GFR 1-3 ml/min/¤ÙÔ˜), ÂÓÒÔÈ ·ÛıÂÓ›˜ Ì ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· ÓÂÊÚˆÛÈÎÔ‡ Ù‡Ô˘·ÚÔ˘ÛÈ¿˙Ô˘Ó Ï¤ÔÓ Ù·¯Â›· Âȉ›ӈÛË (ÙÒÛËÙÔ˘ GFR ¤ˆ˜ 9 ml/min/¤ÙÔ˜). ∏ ÚÔ‚ÏÂfiÌÂÓË›وÛË (estimated incidence) ÓÂÊÚÈ΋˜ ·Ó¿Ú-ÎÂÈ·˜ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ·fi IgA ÓÂÊÚÔ¿ıÂÈ· ΢-Ì·›ÓÂÙ·È ·fi 0,77/1.000.000 ηÙÔ›ÎÔ˘˜ ÛÙËÓ∞ÁÁÏ›· Î·È 1,8/1.000.000 ηÙÔ›ÎÔ˘˜ ÛÙËÓ πÙ·Ï›·¤ˆ˜ 2,9/1.000.000 ηÙÔ›ÎÔ˘˜ ÛÙË °·ÏÏ›·, Ì ÙËÓ ÙÂ-ÏÂ˘Ù·›· ¯ÒÚ· Ó· ıˆÚÂ›Ù·È Ë “ÂÛÙ›·” Ù˘ ÓfiÛÔ˘ÛÙÔÓ ‰˘ÙÈÎfi ÎfiÛÌÔ. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ·ÛıÂÓ›˜(67%) Ô˘ ηٷϋÁÔ˘Ó Û ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ·Ú¯›˙Ô˘ÓÂ͈ÓÂÊÚÈ΋ οı·ÚÛË Û ËÏÈΛ· 24-54 ÂÙÒÓ (62).

O ηıÔÚÈÛÌfi˜ Ù˘ ÚfiÁÓˆÛ˘ Ù˘ ÓfiÛÔ˘ ›ӷÈȉȷ›ÙÂÚ· ‰‡ÛÎÔÏÔ˜ Î·È Û·Ê¤Ûٷٷ ÂËÚ¿˙ÂÙ·È·fi ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È Û οı ÌÂϤÙË, ·fi ÙȘ Ô‰ËÁ›Â˜ Ô˘ ·ÎÔÏÔ˘-ıÔ‡ÓÙ·È ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÓÂÊÚÈ΋˜ ‚ÈÔ„›·˜ ηÈ,‚¤‚·È·, ·fi ÙË ‰È·ÊÔÚ¿ ›وÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙȘ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜.

∏ ÚfiÁÓˆÛË Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ ıˆÚ›ٷÈfiÙÈ Â›Ó·È Î·Ï‡ÙÂÚË ÛÙ· ·È‰È¿ ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈ-Θ, ·ÏÏ¿ Ú¤ÂÈ Ó· ÏËÊı› ˘’ fi„ÈÓ fiÙÈ ‰ÂÓ ˘¿Ú-¯Ô˘Ó ÌÂϤÙ˜ Ì ·Ú΋, Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔ-ÏÔ‡ıËÛË. ∆· ϤÔÓ Â·Ú΋ ‰Â‰Ô̤ӷ ÓÂÊÚÈ΋˜ÂÈ‚›ˆÛ˘ ·ÛıÂÓÒÓ Ì IgA ÓÂÊÚÔ¿ıÂÈ· Ô˘ ‰È·-ÁÓÒÛÙËΠÛÙËÓ ·È‰È΋ ËÏÈΛ· ÚÔ¤Ú¯ÔÓÙ·È Î˘Ú›ˆ˜·fi ÙËÓ π·ˆÓ›· Î·È ÙȘ ∏¶∞. ™ÙËÓ π·ˆÓÈ΋ ÌÂ-ϤÙË (57) Û˘ÁÎÚ›ıËÎ·Ó Ù· ÎÏÈÓÈο Î·È ÈÛÙÔÏÔÁÈο‰Â‰Ô̤ӷ 98 ·È‰ÈÒÓ Î·È 86 ÂÓËÏ›ÎˆÓ Ì IgA ÓÂ-ÊÚÔ¿ıÂÈ·, Ì ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘ Ù·12±4 ¤ÙË ÁÈ· Ù· ·È‰È¿ Î·È Ù· 27±8 ¤ÙË ÁÈ· ÙÔ˘˜ÂÓ‹ÏÈΘ. ∏ ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó11,6±6,3 ¤ÙË ÁÈ· Ù· ·È‰È¿ Î·È 9,5±5,2 ÁÈ· ÙÔ˘˜ ÂÓ‹-ÏÈΘ. ∆ÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ÓÂÊÚÈ΋ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿-ÛÙËΠ۠9,2% ÙˆÓ ·È‰ÈÒÓ Î·È 23,3% ÙˆÓ ÂÓËÏ›-ÎˆÓ (p<0,01). O ÚÔ‚ÏÂfiÌÂÓÔ˜ Ú˘ıÌfi˜ ÓÂÊÚÈ΋˜ÂÈ‚›ˆÛ˘ 10 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘‹Ù·Ó 95% ÁÈ· Ù· ·È‰È¿ Î·È 80% ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ,ÂÓÒ 20 ¯ÚfiÓÈ· ÌÂÙ¿ ‹Ù·Ó 82% Î·È 50%, ·ÓÙ›ÛÙÔȯ·.∏ ηχÙÂÚË ÚfiÁÓˆÛË ÛÙ· ·È‰È¿ ·Ô‰fiıËΠÛÙÔfiÙÈ: ·) Ù· ·È‰È¿ ›¯·Ó ÏÈÁfiÙÂÚÔ ÂÎÙÂٷ̤Ó˜ ÛÂÈ-Ú·Ì·ÙÈΤ˜ ‚Ï¿‚˜ ÛÙË ÓÂÊÚÈ΋ ‚ÈÔ„›· Î·È ‚) Ë Û˘-¯ÓfiÙËÙ· Ù˘ ˘¤ÚÙ·Û˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ·È-‰È¿ (27,6%) ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (41,3%). ™ÙËÌÂϤÙË ·fi ÙȘ ∏¶∞ (11), Û 108 ·È‰È¿ Ì IgA ÓÂ-ÊÚÔ¿ıÂÈ· Ì ̤ÛË ËÏÈΛ· ‰È¿ÁÓˆÛ˘ 10,3 ¤ÙË Î·È̤ÛÔ ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ 8,5 ¤ÙË ·fi ÙÔÓ ¯Úfi-ÓÔ ‚ÈÔ„›·˜, Ë ÚÔ‚ÏÂfiÌÂÓË ÓÂÊÚÈ΋ ÂÈ‚›ˆÛË·fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ‹Ù·Ó 94% Û 5 ¯Úfi-ÓÈ·, 87% Û 10 ¯ÚfiÓÈ·, 82% Û 15 ¯ÚfiÓÈ· Î·È 70% ÛÂ20 ¯ÚfiÓÈ·. ¶·ÚfiÌÔÈ· ÔÛÔÛÙ¿ ·Ó·Ê¤ÚÔÓÙ·È Î·È ÛÂ

¶·È‰È·ÙÚÈ΋ 2005;68:8-16

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·12

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13IgA ÓÂÊÚÔ¿ıÂÈ·

¿ÏÏË Â˘Úˆ·˚΋ ÌÂϤÙË (63). H ηχÙÂÚË ÚfiÁÓˆ-ÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ È·ˆÓÈ΋ ÌÂϤÙË Â›Ó·È Èı·-Ófi Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ·ÛıÂÓÒÓ Ì ËÈfi-ÙÂÚ˜ ÌÔÚʤ˜ ÓfiÛÔ˘ ÏfiÁˆ ¤ÁηÈÚ˘ ‰È¿ÁÓˆÛ˘, ‚¿-ÛÂÈ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Û˘ÛÙËÌ·ÙÈ΋˜ ÂÎÙ¤ÏÂÛ˘·Ó¿Ï˘Û˘ Ô‡ÚˆÓ ÛÙË Û¯ÔÏÈ΋ ÂÚ›Ô‰Ô.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ËÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÂȉÂÈÓÒÓÂÙ·È Ù·¯‡ÙÂÚ· ÛÙÔ˘˜ÌÂÁ·Ï‡ÙÂÚÔ˘˜ Û ËÏÈΛ· ·ÛıÂÓ›˜, ÂÓÒ ÔÈ ·ÛıÂÓ›˜Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÂÈÛfi‰È· ˘ÔÙÚÔÈ¿˙Ô˘Û·˜Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·ÙÔ˘Ú›·˜ ¤¯Ô˘Ó ηχÙÂÚË Úfi-ÁÓˆÛË ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ·ÚfiÌÔÈ·ÂÂÈÛfi‰È· (7,20,64). ∂›Û˘, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó‰Â›ÍÂÈ fiÙÈ ÛÙ· ·È‰È¿ Ô ‚·ıÌfi˜ Ù˘ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜Û˘Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙË ‚·Ú‡ÙËÙ· ÙˆÓ ÛÂÈÚ·Ì·-ÙÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ (9,56,59) Î·È Â›Ó·È ·fi ÙÔ˘˜ Ϥ-ÔÓ ÛËÌ·ÓÙÈÎÔ‡˜ ‰Â›ÎÙ˜ η΋˜ ÚfiÁÓˆÛ˘.

OÈ ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙË ‰˘-ÛÌÂÓ‹ ÚfiÁÓˆÛË Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ ÛÙËÓ ·È‰È-΋ ËÏÈΛ·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ·Ó·Ï˘ı› ÈηÓÔÔÈ-ËÙÈο ÙfiÛÔ ·fi ÙÔ South West Pediatric NephrologyStudy Group fiÛÔ Î·È ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È ·Ó·-ʤÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2, ·Ú¿ÏÏËÏ· Ì ÙË ÛÙ·ÙÈÛÙÈ-΋ ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙËÙ· (56,65). O ÚfiÏÔ˜ Ù˘ ˘¤Ú-Ù·Û˘ ‰ÂÓ Â›Ó·È ·Ôχو˜ ÂÍ·ÎÚÈ‚ˆÌ¤ÓÔ˜. µÂ‚·›ˆ˜,˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·ÛË˜Î·È ÂÍÂÏÈÎÙÈ΋˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘, ·ÏÏ¿ Â›Ó·È Èı·Ófi ˢ„ËÏ‹ ·ÚÙËÚȷ΋ ›ÂÛË Ó· Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ηÈfi¯È Ë ·ÈÙ›· Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘.

£Âڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË

∂ȉÈ΋ ıÂڷ›· ÁÈ· ÙËÓ IgA ÓÂÊÚÔ¿ıÂÈ· ‰ÂÓ˘¿Ú¯ÂÈ. ∏ ȉÂ҉˘ ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË, Ì‚¿ÛË ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ı· ¤Ú ӷ ¤¯ÂÈ

‰‡Ô ÛÙfi¯Ô˘˜: ·) Ó· ÂÚÈÔÚ›˙ÂÈ ÙÔÓ Û¯ËÌ·ÙÈÛÌfi Ì·-ÎÚÔÌÔÚ›ˆÓ ·ıÔÏÔÁÈ΋˜ IgA, ÒÛÙ ӷ ÂÚÈÔÚ›˙ÂÙ·ÈÔ ·ÚÈıÌfi˜ ÙˆÓ ÂÓ·Ôı¤ÛÂˆÓ ÛÙÔ ÌÂÛ¿ÁÁÂÈÔ ÙˆÓÛÂÈÚ·Ì¿ÙˆÓ Î·È ‚) Ó· ÂÚÈÔÚ›˙ÂÈ ÙËÓ ˘ÂÚ·Ú·Áˆ-Á‹ ÙˆÓ IgA ·ÓÙÈÛˆÌ¿ÙˆÓ Û·Ó ·ÓÙÈۈ̷ÙÈ΋ ·ÓÙ·fi-ÎÚÈÛË Û Â͈ÁÂÓ‹ ‹ ÂÓ‰ÔÁÂÓ‹ ·ÓÙÈÁfiÓ·. OÈ ıˆÚËÙÈ-ÎÔ› ·˘ÙÔ› ÛÙfi¯ÔÈ ·¤¯Ô˘Ó Ôχ ·fi ÙËÓ Ú·ÁÌ·ÙÈ-ÎfiÙËÙ· Î·È Ë ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ IgA ÓÂ-ÊÚÔ¿ıÂÈ·˜ ‹Ù·Ó Î·È ·Ú·Ì¤ÓÂÈ Ì›· ÚfiÎÏËÛË.

¶Ú¤ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Î·Ó¤Ó· ıÂڷ¢ÙÈÎfiÚˆÙfiÎÔÏÏÔ ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ȉÂ҉˜ Î·È ÂȉÈÎfiÁÈ· ÙË ÓfiÛÔ, ȉ›ˆ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (66). ∂Ô̤-Óˆ˜, ÚÈÓ ÂÊ·ÚÌÔÛÙ› ÔÔÈÔ‰‹ÔÙ ıÂڷ¢ÙÈÎfiÚˆÙfiÎÔÏÏÔ, ÂÈ‚¿ÏÏÂÙ·È Ë ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·ÛıÂ-ÓÒÓ Ì ÂÍÂÏÈÎÙÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘. O ηıÔÚÈÛÌfi˜·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ÂÈÙ˘Á¯¿ÓÂÙ·È ÙfiÛÔ Ì ÙËÓ·ÍÈÔÏfiÁËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ fiÛÔ Î·È ·fiÙ· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÂÎÙ¤ÏÂÛË Ù˘ ÓÂÊÚÈ΋˜‚ÈÔ„›·˜ fi¯È ÌfiÓÔ ÂȂ‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË, ·ÏÏ¿Û˘Ì‚¿ÏÏÂÈ Î·È ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ϤÔÓ Î·Ù¿ÏÏË-Ï˘ ıÂڷ¢ÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ οı ·ÛıÂÓ‹, ËÔÔ›· Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È. ™Ùfi¯Ô˜ Ù˘ ·Áˆ-Á‹˜ Â›Ó·È Ë ‰È·Ù‹ÚËÛË ÈηÓÔÔÈËÙÈ΋˜ ÓÂÊÚÈ΋˜ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÓÔ‰ÒÓ ÚÔ-‚ÏËÌ¿ÙˆÓ Ù˘ ÓfiÛÔ˘, fiˆ˜ Ë ˘¤ÚÙ·ÛË. ™Â ·ÛıÂ-Ó›˜ Ì ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ÈÛÙÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ηȯˆÚ›˜ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ıÂڷ›·,ÂÓÒ Û ·ÛıÂÓ›˜ Ì ÛÔ‚·Ú¤˜ Î·È ÌË ·Ó·ÛÙÚ¤„È̘ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÏË-Êı› Ë ÂͤÏÈÍË Û ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·.

∫·Ù¿ ηÈÚÔ‡˜ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ‰È¿ÊÔÚ· Ê¿Ú-̷η Î·È Ù·ÎÙÈΤ˜ ¯ˆÚ›˜ ÛÙ·ıÂÚ¿ ·ÔÙÂϤÛÌ·Ù·. ∏ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ë ·Ì˘-Á‰·ÏÂÎÙÔÌ‹ ÂÏ¿ÙÙˆÛ·Ó ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÛÙÚÂÙÔ-ÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Ô˘ Èı·ÓfiÓ ˘ÚÔ‰ÔÙÔ‡Û·ÓÙËÓ ÂÌÊ¿ÓÈÛË ÂÂÈÛÔ‰›ˆÓ Ì·ÎÚÔÛÎÔÈ΋˜ ·ÈÌ·-ÙÔ˘Ú›·˜, ·ÏÏ¿ ‰ÂÓ ‰È·ÈÛÙÒıËΠ‚ÂÏÙ›ˆÛË ÛÙËÓÂͤÏÈÍË Ù˘ ÓfiÛÔ˘. ∏ ¯ÔÚ‹ÁËÛË ‰·Ó·˙fiÏ˘ Î·È ‰È-ÊÂÓ˘Ï˘‰·ÓÙÔ˝Ó˘ Èı·ÓfiÓ Ô‰‹ÁËÛ Û Ì›ˆÛË ÙˆÓÂȤ‰ˆÓ Ù˘ IgA, ·ÏÏ¿ ·ÚÔÌÔ›ˆ˜ ‰ÂÓ ÂËÚ¤·ÛÂÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (67).

∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ù· ·ÓÔÛÔηٷÛÙ·ÏÙÈ-ο Ê¿Ú̷η Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Û ·ÛıÂÓ›˜ ÌÂÈÛÙÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ ÂÍÂÏÈÎÙÈ΋˜ ÓÂÊÚÔ¿ıÂÈ·˜Î·È ÛÔ‚·Ú‹ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· (>1 g/m2/24ˆÚÔ), ÂÓÒÔÈ Û˘Ó‰ڛ˜ Ï·ÛÌ·Ê·›ÚÂÛ˘ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ΢ÎÏÔʈÛÊ·Ì›‰Ë Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ù·¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓ˘ IgA ÓÂ-ÊÚÔ¿ıÂÈ·˜ (68). ∂ȉÈÎfiÙÂÚ·, ÔÈ Niaudet Î·È Û˘Ó(58) ¤¯Ô˘Ó ‰ËÌÔÛȇÛÂÈ ıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏԷȉÈÒÓ Ì IgA ÓÂÊÚÔ¿ıÂÈ· Î·È ÓÂÊÚˆÛÈÎfi Û‡Ó-‰ÚÔÌÔ Ô˘ ›¯·Ó ÛÙË ÓÂÊÚÈ΋ ‚ÈÔ„›· ÌËÓÔÂȉ›˜Û¯ËÌ·ÙÈÛÌÔ‡˜ Û >50% ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ Î·È ·ÓÙÈ-ÌÂÙˆ›ÛÙËÎ·Ó Ì ÒÛÂȘ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ 1g/1,73 m2/48ˆÚÔ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì ÎÔÚÙÈÎÔÛÙÂ-ÚÔÂȉ‹ per os. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂڷ›·˜

¶·È‰È·ÙÚÈ΋ 2005;68:8-16

¶¶››ÓÓ··Îη·˜̃ 22.. ∫ÏÈÓÈÎÔ› Î·È ÈÛÙÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔ-Ú›˙Ô˘Ó ÙËÓ ÚfiÁÓˆÛË Ù˘ IgA ÓÂÊÚÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ηÈË ÛÙ·ÙÈÛÙÈ΋ ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙËÙ·

¶¶··ÚÚ¿¿ÁÁÔÔÓÓÙÙ˜̃ pp--vvaalluuee

∏ÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÓfiÛÔ˘ <9 ¤ÙË 1º‡ÏÔ (¿ÚÚÂÓ) 0,49º˘Ï‹ (Ì·‡ÚË) 0,005ª·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· ÚÔ ¡µ 1↓GFR ηٿ ÙË ¡µ 0,68§Â˘ÎˆÌ·ÙÔ˘Ú›· ηٿ ÙË ¡µ >2+ <0,0001À¤ÚÙ·ÛË Î·Ù¿ ÙË ¡µ 0,003∂ÛÙȷ΋ ‹ ‰È¿¯˘ÙË ˘ÂÚÏ·Û›· ± ÌÂÛ·ÁÁÂȷ΋ ÛÎÏ‹Ú˘ÓÛË <0,001™ÎÏ‹Ú˘ÓÛË ± ˘ÂÚÏ·Û›· >20% ÛÂÈÚ·Ì¿ÙˆÓ 0,001∂ÛÙȷ΋ ÔÏÈ΋ ÛÎÏ‹Ú˘ÓÛË 0,01ªËÓÔÂȉ›˜ Û¯ËÌ·ÙÈÛÌÔ› 0,03¢È·ÌÂÛÔÛˆÏËÓ·ÚȷΤ˜ ·ÏÏÔÈÒÛÂȘ 0,03∂Ó·Ôı¤ÛÂȘ IgA ÛÙ· ÙÚȯÔÂȉ‹ ·ÁÁ›· 0,72

¡µ: ¡ÂÊÚÈ΋ ‚ÈÔ„›· GFR: ƒ˘ıÌfi˜ ÛÂÈÚ·Ì·ÙÈ΋˜ ‰È‹ıËÛ˘

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·13

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14 ∞. ªËÙÛÈÒÓË

fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÛıÂÓÒÓ,Û ۇÁÎÚÈÛË Ì ÈÛÙÔÚÈÎÔ‡˜ Ì¿ÚÙ˘Ú˜ Ô˘ ‰ÂÓ Â›¯·Ó˘Ô‚ÏËı› Û ·˘Ù‹ ÙË ıÂڷ›· ‹ ›¯·Ó Ï¿‚ÂÈ ‰È·-ÊÔÚÂÙÈ΋, ‹Ù·Ó ÛËÌ·ÓÙÈο ηχÙÂÚ·.

∂Óı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù·, ›Û˘, ·Ó·Ê¤ÚÂÈÈ·ˆÓÈ΋ ÌÂϤÙË (17,69) ‚·ÚÈ¿˜ IgA ÓÂÊÚÔ¿ıÂÈ·˜Û ·È‰È¿ ηÙfiÈÓ ıÂڷ›·˜ Ì ‰È˘Úȉ·ÌfiÏË,Ú‰ÓÈ˙fiÓË, ·˙·ıÂÈÔÚ›ÓË Î·È warfarin ‰È¿ÚÎÂÈ·˜ 2ÂÙÒÓ, ÂÓÒ ÔÈ Andreoli Î·È Bergstein (70) Ì ‰È·‰Ô¯È-Τ˜ ‚ÈÔ„›Â˜ ·ÛıÂÓÒÓ ¤‰ÂÈÍ·Ó ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfiÛÎÏËÚ˘Ì¤ÓˆÓ ÛÂÈÚ·Ì¿ÙˆÓ Î·ÙfiÈÓ ¯ÔÚ‹ÁËÛË˜Û˘Ó‰˘·ÛÌÔ‡ ·˙·ıÂÈÔÚ›Ó˘-Ú‰ÓÈ˙fiÓ˘. ¶·È‰È·-ÙÚÈÎÔ› ·ÛıÂÓ›˜ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·,ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· Î·È Ì¤ÙÚÈ·˜ ‚·Ú‡-ÙËÙ·˜ ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ıÂڷ¢ÙÈ-Îfi ‰›ÏËÌÌ· (71). ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÌÈÎÚ‹˜‰fiÛ˘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Û ·Ú‹ÌÂÚÔ Û¯‹Ì· ‰ÂÓÊ·›ÓÂÙ·È - Û‡Ìʈӷ Ì ÙË ‚È‚ÏÈÔÁÚ·Ê›· - Ó· ¤¯ÂÈ ıÂ-ڷ¢ÙÈο ·ÔÙÂϤÛÌ·Ù· (72).

¶ÚfiÛÊ·Ù·, ÂÊ·ÚÌfiÛÙËÎÂ Ë ¯ÔÚ‹ÁËÛË È¯ı˘ÂÏ·›-Ô˘ Û ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓ›˜ Ì ‹È·˜ ‚·Ú‡ÙËÙ·˜ Ófi-ÛÔ, Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ÂÚÈÛÛfi-ÙÂÚ˜ ÂÚÈÙÒÛÂȘ (73,74). O Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓÔÔ›Ô ·ÛÎÂ›Ù·È Ë ÚÔÛٷ٢ÙÈ΋ ·˘Ù‹ ‰Ú¿ÛË ÛÙÔÓ¿Û¯ÔÓÙ· ÓÂÊÚfi ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ› ηȉÂÓ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ ÂÊ·ÚÌÔÁ‹˜ Û ·È‰È¿. ∆Ôȯı˘¤Ï·ÈÔ Â›Ó·È ÏÔ‡ÛÈÔ Û ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ-·Ú¿ Ôͤ·, Ô˘ Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ·ÓÙ·ÁˆÓ›˙ÔÓÙ·ÈÙËÓ ÂÈ‚Ï·‚‹ ‰Ú¿ÛË ÙˆÓ ˆ-6 ÏÈ·ÚÒÓ ÔͤˆÓ Ô˘ÚÔηÏÔ‡Ó ·ÁÁÂÈÔÛ‡Û·ÛË, Û˘ÚÚ›ÎÓˆÛË ÙˆÓ ÌÂ-Û·ÁÁÂÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ¯ËÌÂÈÔÙ·ÎÙÈÛÌfi ÙˆÓÏ¢ÎÔ΢ÙÙ¿ÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ù·ÛÙÔÏ‹Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰ÈÂÚÁ·Û›·˜.

π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘IgA ÓÂÊÚÔ¿ıÂÈ·˜ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÔÈ ·Ó·ÛÙÔÏ›˜ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙ·Û›Ó˘ I(·-ª∂∞) (75-77). ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ ·-ª∂∞ ÂӉ›-ÎÓ˘Ù·È fi¯È ÌfiÓÔ ÛÙÔ˘˜ ˘ÂÚÙ·ÛÈÎÔ‡˜ ·ÛıÂÓ›˜, ·Ï-Ï¿ Î·È Û ·˘ÙÔ‡˜ Ì ÏÂ˘ÎˆÌ·ÙÔ˘Ú›· ¯ˆÚ›˜ ˘¤ÚÙ·-ÛË. ∏ ¢ÓÔ˚΋ ‰Ú¿ÛË ÙˆÓ ·-ª∂∞ ÔÊ›ÏÂÙ·È ÛÙËÓ·ÁÁÂÈԉȷÛÙÔÏ‹ Ô˘ ÚÔηÏÔ‡Ó ÛÙ· ÙÚȯÔÂȉ‹ ηÈÛÙË Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ fiÚˆÓ ÙÔ˘˜, Ì ÙÂÏÈ-Îfi ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜. ∏‚ÂÏÙ›ˆÛË Ù˘ ˘¤ÚÙ·Û˘ Î·È Ù˘ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜Ô˘ ·ÔÙÂÏÔ‡Ó ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ÓfiÛÔ˘ Î·È Ë ‰¤ÛÌ¢ÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ·Ú·ÁˆÁ‹˜Ù˘ ·ÁÁÂÈÔÙ·Û›Ó˘ ππ Ô˘ ˘ÂÈÛ¤Ú¯ÂÙ·È ÛÙËÓ ·ıÔ-Á¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔ-ÛÙ·Û›· Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÂӉ¯Ô̤ӈ˜ÙËÓ ÙÚÔÔÔ›ËÛË Ù˘ Ê˘ÛÈ΋˜ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘.

∂›Û˘, ÛÙËÓ Ï¤ÔÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›·(78) ·Ó·Ê¤ÚÂÙ·È ‚ÂÏÙ›ˆÛË Ù˘ ÏÂ˘ÎˆÌ·ÙÔ˘Ú›·˜·ÏÏ¿ Î·È Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÌÂÙ¿ ·fi ¯ÔÚ‹-ÁËÛË ÊÏÔ˘‚·ÛÙ·Ù›Ó˘ 20 mg ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰È-˘Úȉ·ÌfiÏË (5 mg) Û ·È‰È¿ Ì ‹È· ÌÔÚÊ‹ IgAÓÂÊÚÔ¿ıÂÈ·˜.

µÈ‚ÏÈÔÁÚ·Ê›·

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¶·È‰È·ÙÚÈ΋ 2005;68:8-16

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16 ∞. ªËÙÛÈÒÓË

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17REVIEW ARTICLE

IgA nephropathy in children

A. Mitsioni

Abstract

IgA nephropathy, first described in 1969 by Berger and Hinglais, is the most common variety of primaryglomerulonephritis in the world. It is characterized by mesangial deposits of IgA. Initially, it was considered abenign disease, however long-term follow-up studies indicated a progression of the disease to renal failure in20-25% of the adult patients. The pathogenesis is still unknown and appropriate treatment has not yet beenestablished. However, the favorable prognosis initially attributed in children with IgA nephropathy must bequestioned and reviewed in the light of recent studies.

Key words

IgA nephropathy, Berger’s disease, children.

Department of Nephrology,“P. & A. Kyriakou” Children’sHospital, Athens

Correspondence:

Andromahi Mitsioni 11 Tirynthos str., 175 64, P. Faliro, Athens

Date of submission: 20-02-2004Date of approval: 28-09-2004

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·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ÂÊ·ÙfiÌÂÓ· ¤Ù·Ï·, ÙÔ ÂÚ›-

ÙÔÓÔ Î·È ÙÔ ÂÚÈÛÏ¿Á¯ÓÈÔ. ∫·Ï‡ÙÂÈ ÙÔÓ Ó‡ÌÔÓ·

Î·È ÙȘ ÌÂÛÔÏfi‚Ș Û¯ÈṲ̂˜, ÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ, ÙÔ ‰È¿-

ÊÚ·ÁÌ· Î·È ÙÔ Ï¢ÚÈÎfi ÙÔ›¯ˆÌ·. ™Â οı ¤Ù·ÏÔ

ÂÈÔÏ‹˜ ‚Ú›ÛÎÂÙ·È Ì›· ÛÙÈ‚¿‰· ÌÂÛÔıËÏÈ·ÎÒÓ ÌÔ-

ÓÔ΢ÙÙ¿ÚˆÓ Ô˘ ÛÙËÚ›˙ÂÙ·È ÛÙË ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË

Ì ÈÓÔÂÏ·ÛÙÈο ÛÙÔȯ›· ÛÙȘ ˘ÔΛÌÂÓ˜ ÛÙÈ‚¿‰Â˜

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·18

Page 30: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

¶·Ú·Ó¢ÌÔÓÈΤ˜ Û˘ÏÏÔÁ¤˜

Î·È Ù· ·ÓÙ›ÛÙÔȯ· ·ÁÁ›· Î·È ÏÂÌÊ·ÁÁ›·. O ÚfiÏÔ˜ÙˆÓ ÌÂÛÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ‰ÂÓ ·ÊÔÚ¿ ÌfiÓÔ ÛÙËÓÎ·Ï˘ÙÈ΋, ·ÏÏ¿ Î·È Û ¢Ú›· ÌÂÙ·‚ÔÏÈ΋ ÏÂÈ-ÙÔ˘ÚÁ›·. ∆· ·ÙÙ·Ú· ·˘Ù¿ ·Ú¿ÁÔ˘Ó ÚˆÙ½Ó˜, ÔÈ΢ÚÈfiÙÂÚ˜ ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÙÔ ÎÔÏÏ·ÁfiÓÔ Î·È ËÂÏ·ÛÙ›ÓË (6).

∏ ·ÈÌ¿ÙˆÛË ÙˆÓ ‰‡Ô ÂÙ¿ÏˆÓ ÚÔ¤Ú¯ÂÙ·È ·fiÙË Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·. ∆Ô ·Ú·ÁfiÌÂÓÔ ˘ÁÚfi·ÔÚÚÔÊ¿Ù·È ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ̤ۈ Ù˘ ÏÂÌ-ÊÈ΋˜ ΢ÎÏÔÊÔÚ›·˜, Ô˘ ‚Ú›ÛÎÂÙ·È ÂȉÈο ·ÓÂÙ˘Á-̤ÓË ÛÙÔ Î·ÙÒÙÂÚÔ ËÌÈÌfiÚÈÔ ÙÔ˘ ÂÚÈÙfiÓÔ˘ ÂÙ¿-ÏÔ˘. ™ÙËÓ ›‰È· ˙ÒÓË ·ÔÚÚÔÊÒÓÙ·È Ù· ÚÔ˚fiÓÙ··Ô‰fiÌËÛ˘ Ô˘ ÊÙ¿ÓÔ˘Ó ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈ-ÏfiÙËÙ· (7).

ø˜ ÚÔ˜ ÙË Ó‡ڈÛË, ·ÈÛıËÙÈΤ˜ Ó¢ÚÈΤ˜ ›Ó˜¤¯Ô˘Ó ÌfiÓÔ ÔÈ Ï¢ÚÈΤ˜ Î·È ‰È·ÊÚ·ÁÌ·ÙÈΤ˜ Â-ÚÈÔ¯¤˜ ÙÔ˘ ÂÚÈÙfiÓÔ˘ ÂÙ¿ÏÔ˘ ηÈ, Û˘ÓÂÒ˜, ›ӷÈÔÈ ÌfiÓ˜ ÈηӤ˜ Ó· ÚÔηϤÛÔ˘Ó fiÓÔ fiÙ·Ó ‰¤¯Ô-ÓÙ·È Î¿ÔÈÔ ÂÚ¤ıÈÛÌ·. O fiÓÔ˜ Ô˘ ÚÔ¤Ú¯ÂÙ·È·fi ÙËÓ ÂÚÈÊÂÚÈÎfiÙÂÚË ÏÂ˘Ú¿ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·-ÙÔ˜ ·ÓÙ·Ó·ÎÏ¿Ù·È Î·Ù¿ Ì‹ÎÔ˜ ÙˆÓ Ï¢ÚÒÓ, ÂÓÒ·˘Ùfi˜ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÂÛˆÙÂÚÈ΋ ÏÂ˘Ú¿·ÓÙ·Ó·ÎÏ¿Ù·È ÚÔ˜ ÙÔÓ ÒÌÔ Ì¤Ûˆ ÙÔ˘ ÊÚÂÓÈÎÔ‡Ó‡ÚÔ˘.

™Â Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ÛÙË Ê¿ÛË Ù˘ ‹ÚÂ-Ì˘ ÂÎÓÔ‹˜, Ë (ÂÓ‰Ô)˘Â˙ˆÎÔÙÈ΋ ›ÂÛË Â›Ó·È Â-Ú›Ô˘ 5 cm H2O ¯·ÌËÏfiÙÂÚË Ù˘ ·ÙÌÔÛÊ·ÈÚÈ΋˜. ∏·ÚÓËÙÈ΋ ·˘Ù‹ ›ÂÛË ÔÊ›ÏÂÙ·È ÛÙȘ ‰˘Ó¿ÌÂȘ ÂÏ·-ÛÙÈ΋˜ ·ӷÊÔÚ¿˜ ÙˆÓ Ó¢ÌfiÓˆÓ Ô˘ ¤ÏÎÔ˘ÓÚÔ˜ Ù· ¤Ûˆ, ¤Ó·ÓÙÈ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ (8).

∆· ‰‡Ô ¤Ù·Ï· ÏÂÈÙÔ˘ÚÁÔ‡Ó ˆ˜ ÌÂÌ‚Ú¿Ó˜ ‰È·-ÂÚ·Ù¤˜ ·fi Ù· ÌfiÚÈ· ÌÈÎÚÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜,fiˆ˜ Â›Ó·È Ë ÁÏ˘Îfi˙Ë, ·ÏÏ¿ ËÌȉȷÂÚ·Ù¤˜ ·fi Ì·-ÎÚÔÌfiÚÈ·, fiˆ˜ Â›Ó·È ÙÔ Ï‡Έ̷. ø˜ Û˘Ó¤ÂÈ· ·˘-ÙÔ‡, ÙÔ ˘Â˙ˆÎÔÙÈÎfi ˘ÁÚfi ·ÔÙÂÏ› ˘ÂډȋıËÌ·ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Ì ÙËÓ ˘ÎÓfiÙËÙ· Ù˘ ÁÏ˘Îfi˙˘ÛÙ· ›‰· ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ Î·È Ì ÂΛÓË ÙˆÓÚˆÙÂ˚ÓÒÓ Û ¯·ÌËÏfiÙÂÚ·. O fiÁÎÔ˜ ÙÔ˘ ‰ÂÓ ˘ÂÚ-‚·›ÓÂÈ Ù· 5-15 ml (0,1-0,2 ml/kg ˘ÁÚÔ‡), Ë ÎÔÏÏÔÂÈ-‰ÔÛ̈ÙÈ΋ ›ÂÛË Â›Ó·È ›‰È· Ì ÂΛÓË ÙÔ˘ Ï¿ÛÌ·-ÙÔ˜ (‰ÂÓ ˘ÂÚ‚·›ÓÂÈ Ù· 5 cm H2O), Ì ÌÈÎÚ‹ Úˆ-ÙÂ˚ÓÈ΋ Û˘ÁΤÓÙÚˆÛË (<1,5 g/dL), ÙÔ pH Â›Ó·È ·Ï-ηÏÈÎfi ÏËÛÈ¿˙ÔÓÙ·˜ ÙÔ 7,6 Î·È ÂÚȤ¯ÂÈ ÂÚ›Ô˘1500 ·ÙÙ·Ú· ·Ó¿ ml, Ì ÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô Ù· ÌÔ-ÓÔ·ÙÙ·Ú· (1,2).

™ÙÔȯ›· ·ıÔÏÔÁÈ΋˜ Ê˘ÛÈÔÏÔÁ›·˜

∏ Û˘ÛÛÒÚ¢ÛË ˘ÁÚÔ‡ ‹ ·¤Ú· ÛÙËÓ ˘Â˙ˆÎÔÙÈ-΋ ÎÔÈÏfiÙËÙ· Û˘Óԉ‡ÂÙ·È ·fi ÂÚÈÔÚÈÛÌfi Ù˘ ¤Î-Ù˘Í˘ ÙÔ˘ Ó‡ÌÔÓ· ÛÙÔ Û‡ÛÙÔÈ¯Ô ËÌÈıˆÚ¿ÎÈÔ,ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÚfiÎÏËÛË ‚Ï¿‚˘ ÂÚÈÔÚÈÛÙÈÎÔ‡Ù‡Ô˘. ∏ ˙ˆÙÈ΋ ¯ˆÚËÙÈÎfiÙËÙ·, Ô ÏÂÈÙÔ˘ÚÁÈÎfi˜˘ÔÏÂÈfiÌÂÓÔ˜ fiÁÎÔ˜ Î·È Ë ÔÏÈ΋ ¯ˆÚËÙÈÎfiÙËÙ·ÙˆÓ Ó¢ÌfiÓˆÓ ÌÂÈÒÓÔÓÙ·È.

ÀÂ˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹ ‰ËÌÈÔ˘ÚÁÂ›Ù·È fiÙ·Ó ‰È·-Ù·Ú¿ÛÛÂÙ·È ÙÔ ÈÛÔ˙‡ÁÈÔ ÙÔ˘ Ú˘ıÌÔ‡ ·Ú·ÁˆÁ‹˜ ηÈ

·ÔÚÚfiÊËÛ˘ ÙÔ˘ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡. ™‡ÌʈӷÌ ÙÔÓ Sahn (6) ·˘Ù‹ Ë ‰È·Ù·Ú·¯‹ ÌÔÚ› Ó· Û˘Ì-‚› Ì ÙÔ˘˜ ÂÍ‹˜ Ì˯·ÓÈÛÌÔ‡˜:

·) ∞‡ÍËÛË Ù˘ ˘‰ÚÔÛÙ·ÙÈ΋˜ ›ÂÛ˘, fiˆ˜ÛÙËÓ Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ· (·‡ÍËÛË ÙˆÓ ÙÚȯÔÂȉÈ-ÎÒÓ È¤ÛÂˆÓ Ù˘ Ó¢ÌÔÓÈ΋˜ ΢ÎÏÔÊÔÚ›·˜).

‚) ªÂ›ˆÛË Ù˘ ÎÔÏÏÔÂȉÔÛ̈ÙÈ΋˜ ›ÂÛ˘,fiˆ˜ ÛÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ Î·È ÛÙ· Û‡Ó‰ÚÔÌ·˘ÔÛÈÙÈÛÌÔ‡.

Á) ∞‡ÍËÛË Ù˘ ·ÚÓËÙÈ΋˜ ›ÂÛ˘ ÛÙÔÓ ˘Â˙ˆ-ÎÔÙÈÎfi ¯ÒÚÔ, fiˆ˜ ÛÙË Ì·˙È΋ ·ÙÂÏÂÎÙ·Û›· ÌÂÁ¿-ÏÔ˘ ̤ÚÔ˘˜ ÙÔ˘ Ó‡ÌÔÓ·.

‰) ∞‡ÍËÛË Ù˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ Ù˘ ˘Â˙ˆÎÔÙÈ-΋˜ ÌÈÎÚÔ΢ÎÏÔÊÔÚ›·˜, fiˆ˜ ÛÙȘ ÊÏÂÁÌÔÓÒ‰ÂȘ,ÏÔÈÌÒ‰ÂȘ Î·È ÓÂÔÏ·ÛÌ·ÙÈΤ˜ ·ı‹ÛÂȘ ÙÔ˘ ˘Â-˙ˆÎfiÙ·.

Â) ¢È·Ù·Ú·¯‹ ÛÙË ÏÂÌÊÈ΋ ·ÚÔ¯¤Ù¢ÛË, fiˆ˜Û ڋÍË ‹ ·fiÊÚ·ÍË ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ fiÚÔ˘ (¯˘ÏÔ-ıÒڷη˜).

ÛÙ) ªÂÙ·ÊÔÚ¿ ˘ÁÚÔ‡ ̤ۈ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘, ÙÔÔÔ›Ô Ì¤Ûˆ ÙˆÓ ÏÂÌÊ·ÁÁ›ˆÓ ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜Î·È ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ ÙÚËÌ¿ÙˆÓÊı¿ÓÂÈ ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ·.

º˘ÛÈ΋ ÂͤÏÈÍË ÙˆÓ ·Ú·Ó¢ÌÔÓÈÎÒÓ Û˘Ï-

ÏÔÁÒÓ

∏ Ê˘ÛÈ΋ ÂͤÏÈÍË ÙˆÓ ¶¶™ ·ÎÔÏÔ˘ı› Û˘Ó‹ıˆ˜ÙȘ ÂÍ‹˜ Ê¿ÛÂȘ (3,5,9):

·) ºº¿¿ÛÛËË ÙÙˢ̃ ÍÍËËÚÚ¿¿˜̃ ÏÏ¢̆ÚÚ››ÙÙÈȉ‰··˜̃.. ∏ ÊÏÂÁÌÔÓÒ-‰Ë˜ ‰ÈÂÚÁ·Û›· Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ÛÙÔ Ó¢ÌÔÓÈÎfi ·-Ú¤Á¯˘Ì· Î·È ÂÂÎÙ›ÓÂÙ·È ÛÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô ̆ Â˙ˆÎfi-Ù·, fiÔ˘ ÚÔηÏ› ÙÔÈ΋ ·ÓÙ›‰Ú·ÛË ¯ˆÚ›˜ ÙËÓ ·-Ú·ÁˆÁ‹ ˘ÁÚÔ‡. ∫ÏÈÓÈο, ·ÓÙÈÛÙÔȯ› ÛÙËÓ ÂÌÊ¿ÓÈÛËÏ¢ÚÈÙÈÎÔ‡ ¿ÏÁÔ˘˜ Î·È ÛÙËÓ ·ÎÚfi·ÛË ‹¯Ô˘ ÙÚÈ‚‹˜.

‚) ºº¿¿ÛÛËË ÂÂÍÍÈȉ‰ÚÚÒÒÌÌ··ÙÙÔÔ˜̃.. ™˘ÛÛˆÚ‡ÂÙ·È ÛÙ›ÚÔ˘ÁÚfi ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ· Ô˘ ÚÔ¤Ú¯ÂÙ·È·fi ÙÔÓ ‰È¿ÌÂÛÔ Ó¢ÌÔÓÈÎfi ÈÛÙfi Î·È ·fi ÙÔÛÏ·Á¯ÓÈÎfi ˘Â˙ˆÎfiÙ· ÂÍ·ÈÙ›·˜ Ù˘ ·‡ÍËÛ˘ Ù˘‰È·ÂÚ·ÙfiÙËÙ·˜ ÙˆÓ ÙÚȯÔÂȉÒÓ ÙÔ˘. ∆Ô Ï¢ÚÈÙÈÎfi˘ÁÚfi Â›Ó·È ‰È·˘Á¤˜, Ì ¯·ÌËÏfi ·ÚÈıÌfi Ï¢ÎÔ΢ÙÙ¿-ÚˆÓ (<10.000/mm3), ¯·ÌËÏ‹ LDH (<1000 IU), Ê˘-ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ ÁÏ˘Îfi˙˘ (>60 mg/dl) Î·È pH >7,3.

Á) ππÓÓÔÔ˘̆ÒÒ‰‰Ë˘̃ ÊÊ¿¿ÛÛËË.. OÊ›ÏÂÙ·È ÛÙË ÌÂÙ·ÊÔÚ¿ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ·fi ÙÔÓ Û‡ÛÙÔÈ¯Ô Ó‡ÌÔÓ· Ô˘ÊÏÂÁÌ·›ÓÂÈ ÛÙÔ ˘Â˙ˆÎÔÙÈÎfi ˘ÁÚfi. ∞˘Ùfi ÌÔÚ› Ó·Û˘Ì‚Â› Ôχ Û‡ÓÙÔÌ·, ·ÎfiÌ· Î·È Û ϛÁ˜ ÒÚ˜,ÂÊfiÛÔÓ ‰ÂÓ ¯ÔÚËÁËı› ¤ÁηÈÚ· ÙÔ Î·Ù¿ÏÏËÏÔ ·ÓÙÈ-‚ÈÔÙÈÎfi ‹ Â¿Ó ·˘Ùfi Ô˘ ¯ÔÚËÁÂ›Ù·È Â›Ó·È ·Ó·ÔÙÂ-ÏÂÛÌ·ÙÈÎfi. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÙË Û˘ÛÛÒÚ¢ÛËÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ Ì ¿ÊıÔ-Ó· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, ÌÈÎÚfi‚È· Î·È ÓÂÎÚ¿ ·ÙÙ·-Ú·. ¶·Ú¿ÁÔÓÙ·È ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ ÈÓÈ΋˜, Ë ÔÔ›·Î·Ï‡ÙÂÈ Ù· ‰‡Ô ¤Ù·Ï· ÙÔ˘ ˘Â˙ˆÎfiÙ·, ÂÓÒ ·Ó¿-ÌÂÛ· ÛÙ· ¤Ù·Ï· Û¯ËÌ·Ù›˙ÔÓÙ·È ÎÔÈÏfiÙËÙ˜ ÌÂ

¶·È‰È·ÙÚÈ΋ 2005;68:000-000¶·È‰È·ÙÚÈ΋ 2005;68:18-27

19

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·19

Page 31: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

¢. ªÂÚÌ›ÚË Î·È Û˘Ó.

‰È·ÊÚ·ÁÌ¿ÙÈ·. ∏ ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ ÌÈÎÚÒÓ ÂÈ̤-ÚÔ˘˜ ÎÔÈÏÔÙ‹ÙˆÓ ·ÔÙÚ¤ÂÈ ÙËÓ ÂͤÏÈÍË Û Â̇Ë-Ì·, Ù·˘Ùfi¯ÚÔÓ· fï˜, ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ ·ÚÔ¯¤-Ù¢ÛË ÙÔ˘ ˘Ò‰Ô˘˜ ˘ÁÚÔ‡. ™Â ·˘Ù‹ ÙË Ê¿ÛË, ËÁÏ˘Îfi˙Ë Î·È ÙÔ pH ÌÂÈÒÓÔÓÙ·È ÛÙ·‰È·Î¿ (<50mg/dl Î·È <7,2, ·ÓÙ›ÛÙÔȯ·), ÂÓÒ Ë LDH ·˘Í¿ÓÂÈ(>1000 IU).

‰) ºº¿¿ÛÛËË ÔÔÚÚÁÁ¿¿ÓÓˆ̂ÛÛˢ̃.. OÈ ÈÓÔ‚Ï¿ÛÙ˜ ÛÙÔ ÂÍ›-‰ÚˆÌ· ·Ó·Ù‡ÛÛÔÓÙ·È ·fi ÙȘ ‰‡Ô ÂÈÊ¿ÓÂȘ ÙˆÓ˘Â˙ˆÎÔÙÈÎÒÓ ÂٿψÓ, ÒÛÙÂ Ë ÈÓÈ΋ Ó· ÌÂÙ·ÙÚ¤-ÂÙ·È Û ·¯È¿, ÌË ÂÏ·ÛÙÈ΋ ÛÙÈ‚¿‰·, Ô˘ ÂÌÔ‰›-˙ÂÈ ÙËÓ Ï‹ÚË ¤ÎÙ˘ÍË ÙÔ˘ Ó‡ÌÔÓ·.

∞ÈÙÈÔÏÔÁ›· ÙˆÓ ·Ú·Ó¢ÌÔÓÈÎÒÓ Û˘ÏÏÔÁÒÓ

∏ ·ÔÌfiÓˆÛË ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·fiÙȘ ηÏÏȤÚÁÂȘ ÙÔ˘ ·›Ì·ÙÔ˜ ‹ ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡˘ÁÚÔ‡ ÛÙ· ·È‰È¿ ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÙÔ 40-75% ÙˆÓÂÚÈÙÒÛÂˆÓ (3,9-14).

∆· ÌÈÎÚfi‚È· Ô˘ ·ÔÌÔÓÒÓÔÓÙ·È ÈÔ Û˘¯Ó¿ ÛÙÔÂ̇ËÌ· Â›Ó·È Ô S. pneumoniae, Ô S. Aureus Î·È Ô S.pyogenes. ÕÏÏ· ÏÔÈÌÒ‰Ë ·›ÙÈ· Ô˘ ÚÔηÏÔ‡Ó ¶¶™Â›Ó·È ÔÈ ÈÔ› (·‰ÂÓÔ˚Ô›, Áڛ˘, ·Ú·Áڛ˘), ÙÔÌ˘ÎfiÏ·ÛÌ· Î·È ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆ-Û˘. OÈ ÔÏ˘ÌÈÎÚԂȷΤ˜ ÏÔÈÌÒÍÂȘ, ·fi ·ÚÓËÙÈοηٿ Gram Î·È ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È·, Â›Ó·È ÏÈÁfiÙÂÚÔÛ˘¯Ó¤˜ ÛÙ· ·È‰È¿ ·fi fi,ÙÈ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜.

™Â ·È‰È·ÙÚÈ΋ ÛÂÈÚ¿ Ó¢ÌÔÓÈÔÎÔÎÎÈÎÒÓÓ¢ÌÔÓÈÒÓ (13), ÙÔ 29% Û˘Óԉ¢fiÙ·Ó ·fi ¶¶™,ÙÔ 13,8% ÙˆÓ ÔÔ›ˆÓ ·ÓÙÈÛÙÔȯԇÛ Û Â̇ËÌ·,ÁÂÁÔÓfi˜ ·ÓÙ›ıÂÙÔ Ì fi,ÙÈ Û˘Ì‚·›ÓÂÈ ÛÙÔ˘˜ ÂÓËÏ›-ÎÔ˘˜ (14-16). ™ÙËÓ ›‰È· ÛÂÈÚ¿ ·ÔÌÔÓÒıËΠӢ-ÌÔÓÈfiÎÔÎÎÔ˜ Û ÔÛÔÛÙfi 67% ·˘ÙÒÓ Ô˘ Ú·ÁÌ·-ÙÔÔÈ‹ıËΠıˆÚ·ÎÔΤÓÙËÛË (15). ™˘ÁÎÂÎÚÈ̤ÓÔÈÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›, fiˆ˜ Ô S. aureus, Ô S. pyogenesÎ·È Ù· ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È·, “‰È¢ÎÔχÓÔ˘Ó” ÙËÓ·Ó¿Ù˘ÍË ÂÌ˘ËÌ¿ÙˆÓ. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓηÏÏÈÂÚÁÂÈÒÓ ÛÙ· ÂÌ˘‹Ì·Ù· ·Ó¤Ú¯ÂÙ·È Û 70-90% (17-19).

™ÙȘ Ó¢ÌÔӛ˜ ·fi Ì˘ÎfiÏ·ÛÌ· ÌÔÚ› Ó· ·-Ú·ÙËÚËı› Û˘ÏÏÔÁ‹ ÛÙÔ 5-20%. OÈ Û˘ÏÏÔÁ¤˜ ›ӷÈÁÂÓÈο ÌÈÎÚ¤˜, ·ÏÏ¿ ÂÚÈÛÙ·Ûȷο ÌÔÚ› Ó· ·ÔÌÔ-Óˆı› ÙÔ Ì˘ÎfiÏ·ÛÌ· ÛÙÔ ˘Â˙ˆÎÔÙÈÎfi ˘ÁÚfi (20).

∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ‰È·ÊfiÚˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓÛ ÛÂÈÚ¿ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ Ì fiÏÔ ÙÔ Â‡ÚÔ˜ ÙˆÓËÏÈÎÈÒÓ Â›Ó·È Ë ÂÍ‹˜: S. aureus 35%, S. pneumoniae35%, Streptococcus species 15%, H. influenzae 5%,Pseudomonas 5% Î·È ·Ó·ÂÚfi‚È· 5% (9). øÛÙfiÛÔ, Ù·ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ·‚ÔÏ‹ ÙË˜Û˘¯ÓfiÙËÙ·˜ ·ÔÌfiÓˆÛ˘ ÙˆÓ ‰È·ÊfiÚˆÓ ·ÈÙÈÔÏÔÁÈ-ÎÒÓ ·Ú·ÁfiÓÙˆÓ, Ì ÂÓ›Û¯˘ÛË ÂΛӢ ÙÔ˘ Ó¢ÌÔ-ÓÈfiÎÔÎÎÔ˘. ∂Ó‰ÂÈÎÙÈ΋ Â›Ó·È Ë ÌÂϤÙË 64 ÂÚÈÙÒ-ÛÂˆÓ ÂÈÏÂÁÌ¤ÓˆÓ ¶¶™, fiÔ˘ ·fi ÙȘ 26 ÂÚÈ-ÙÒÛÂȘ Ô˘ ·ÔÌÔÓÒıËΠÌÈÎÚÔ‚È·Îfi˜ ·Ú¿ÁÔ-ÓÙ·˜, ÛÙȘ 23 ·ÔÌÔÓÒıËΠӢÌÔÓÈfiÎÔÎÎÔ˜ (12).

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ·ÛıÂÓÒÓ Ì ¶¶™ ·fi ·Â-Úfi‚ÈÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi Â›Ó·È ›‰È· Ì ÂΛÓË Ù˘ ÌÈ-ÎÚԂȷ΋˜ Ó¢ÌÔÓ›·˜ ¯ˆÚ›˜ Û˘ÏÏÔÁ‹: ˘ÚÂÙfi˜,Ù·¯‡ÓÔÈ·, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜, ·fi¯ÚÂÌ„Ë Î·È ‚‹¯·˜.™Â ÛÂÈÚ¿ 113 ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ Ì Ó¢ÌÔÓ›·¯ˆÚ›˜ Û˘ÏÏÔÁ‹, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜ ·ÚÔ˘Û›·˙ ÙÔ59%, ÂÓÒ ·fi 90 ·ÛıÂÓ›˜ ÌÂ Û˘ÏÏÔÁ‹, ÙÔ 64% (14).

ÀÔ„›· ¶¶™ Ù›ıÂÙ·È Â¿Ó Ô ˘ÚÂÙfi˜ ·Ú·Ì¤ÓÂÈÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 48 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜, ·ÏÏ¿ Ë Èı·ÓfiÙËÙ· ‡·Ú͢¶¶™ Ú¤ÂÈ Ó· ‰È¢ÎÚÈÓ›˙ÂÙ·È ·fi ÙË ÛÙÈÁÌ‹ Ù˘·Ú¯È΋˜ ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜. ŸÛÔ ÌÂÁ·Ï‡-ÙÂÚË Â›Ó·È Ë ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ì¤¯ÚÈ ÙËÓ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜, ÙfiÛÔ ÂÚÈÛÛfiÙÂÚÔ Èı·ÓÔ-ÏÔÁÂ›Ù·È Ë ·ÚÔ˘Û›· ¶¶™.

∂¿Ó Ë ÔÛfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ Â›Ó·È ÌÂÁ¿ÏË, Ô·ÛıÂÓ‹˜ ÂÌÊ·Ó›˙ÂÈ ‰‡ÛÓÔÈ·, ÚÒÙ· ÛÙËÓ ÚÔÛ¿-ıÂÈ· Î·È ÛÙË Û˘Ó¤¯ÂÈ· Î·È ÛÙËÓ ËÚÂÌ›·.

OÈ ÏÔÈÌÒÍÂȘ ·fi ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È· ¤¯Ô˘Ó ÂÈ-‰Èο ¯·Ú·ÎÙËÚÈÛÙÈο. ™˘Ì‚·›ÓÔ˘Ó Û˘Ó‹ıˆ˜ Û ·È-‰È¿ Ì ÂÚÈÔ‰ÔÓÙÈΤ˜ ÏÔÈÌÒÍÂȘ, Ó¢ÚÔÏÔÁÈο ÚÔ-‚Ï‹Ì·Ù· Î·È ‰˘ÛÊ·Á›·, ¤¯Ô˘Ó ˘ÔÍ›· ÎÏÈÓÈ΋ÚÔ‚ÔÏ‹ Ì ̤ÙÚÈÔ ˘ÚÂÙfi, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ï¢-ÎÔ΢ÙÙ¿ÚˆÛË Î·È ÂÏ·ÊÚ¿ ·Ó·ÈÌ›· Ô˘ ÂÍÂÏ›ÛÛÂÙ·ÈÛÙ·‰È·Î¿ Û ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ Ù˘ ‚‰ÔÌ¿‰·˜.

¢È¿ÁÓˆÛË

∏ ÌÂϤÙË ÙˆÓ ·ÛıÂÓÒÓ Ì ˘Ô„›· ¶¶™ Ú¤ÂÈÓ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, CRP, ‚ÈÔ¯Ë-ÌÈÎfi ¤ÏÂÁ¯Ô (Î·È Ï¢ÎÒÌ·Ù·), LDH, ·ÈÌÔηÏÏȤÚ-ÁÂȘ, ‰ÔÎÈ̷ۛ˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ÙÔ˘ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘, ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ,ıˆÚ·ÎÔΤÓÙËÛË Î·È ‰ÔÎÈÌ·Û›· Mantoux.

∞Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη

∏ ÚÔÛıÈÔ›ÛıÈ· ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Û fiÚ-ıÈ· ı¤ÛË ‰ÂÓ Â›Ó·È Ôχ ¢·›ÛıËÙË ÛÙËÓ ·Ó›¯Ó¢-ÛË ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ ˘ÁÚÔ‡. ¶Ôχ ÚÒÈÌÔ ÛË-ÌÂ›Ô ·Ó›¯Ó¢Û˘ ¶¶™ ·ÔÙÂÏ› Ë ÂÍ¿ÏÂÈ„Ë Ù˘Ï¢ÚԉȷÊÚ·ÁÌ·ÙÈ΋˜ (¶¢) ÁˆÓ›·˜. ∞Ó Ë ÔÛfi-ÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ̤ÙÚÈ·, ·Ú·-ÙËÚÂ›Ù·È ıÔÏÂÚfiÙËÙ· Ù˘ Ó¢ÌÔÓÈ΋˜ ‚¿Û˘ Ô˘Î·Ù·Ï·Ì‚¿ÓÂÈ ÙËÓ ¶¢ Î·È ÂÈÎfiÓ· ·ÓÂÛÙÚ·Ì̤ÓÔ˘ÎÔ›ÏÔ˘ ¿ÓˆıÂÓ ÙÔ˘ ËÌȉȷÊÚ¿ÁÌ·ÙÔ˜, ‰›ÎËÓ ÌËÓ›-ÛÎÔ˘, Ì ÙÔ ˘„ËÏfiÙÂÚÔ ÛËÌÂ›Ô ÛÙÔ Ï¿ÁÈÔ ıˆÚ·-ÎÈÎfi ÙÔ›¯ˆÌ·. ∞Ó Ë Û˘ÏÏÔÁ‹ Â›Ó·È ÌÂÁ¿ÏË, ÛËÌÂÈ-ÒÓÂÙ·È ‰È·Ï¿Ù˘ÓÛË ÙˆÓ ÌÂÛÔχÚÈˆÓ ‰È·ÛÙË-Ì¿ÙˆÓ Î·È ·ÒıËÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘. ∂¿Ó Ô·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ηٷÎÂÎÏÈ̤ÓË ı¤ÛË, fiˆ˜Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ·È‰È¿, ·-Ú·ÙËÚÂ›Ù·È ÂÍ¿ÏÂÈ„Ë Ù˘ ¶¢ ÁˆÓ›·˜, ÔÌfiÙÈÌËÛΛ·ÛË ÛÙÔ ËÌÈıˆÚ¿ÎÈÔ, ÌÂȈ̤ÓË ·ÁÁ›ˆÛË Î·È

¶·È‰È·ÙÚÈ΋ 2005;68:000-000¶·È‰È·ÙÚÈ΋ 2005;68:18-27

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21¶·Ú·Ó¢ÌÔÓÈΤ˜ Û˘ÏÏÔÁ¤˜

ÂÌÊ¿ÓÈÛË ˘Â˙ˆÎÔÙÈ΋˜ ÁÚ·ÌÌ‹˜ ÛÙÔ ¤Íˆ Ï¿ÁÈÔÙÌ‹Ì· ÙÔ˘ ËÌÈıˆÚ·Î›Ô˘.

ŸÙ·Ó Ù· ËÌȉȷÊÚ¿ÁÌ·Ù· Â›Ó·È ÔÚ·Ù¿ Û fiÏÔÙÔ˘˜ ÙÔ Ì‹ÎÔ˜ Î·È ‰È·ÙËÚÂ›Ù·È Ë ¶¢ ÁˆÓ›·, ÌÔÚ›ӷ ıˆÚËı› fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ÔÛfiÙËÙ·˘ÁÚÔ‡. ∂¿Ó ··Ï›ÊÂÙ·È Î¿ÔÈÔ ·fi Ù· ËÌȉȷ-ÊÚ¿ÁÌ·Ù· ‹ Ë ¶¢ ÁˆÓ›· Â›Ó·È Î·ÙÂÈÏËÌ̤ÓË, ›Ûˆ˜¯ÚÂÈ¿˙ÂÙ·È Î·È Ï¿ÁÈ· ·ÎÙÈÓÔÁÚ·Ê›·.

ÀÂÚ˯ÔÁÚ¿ÊËÌ· ıÒڷη

™˘¯Ó¿ ·ÔÙÂÏ› ÙËÓ ÔÏ˘ÙÈÌfiÙÂÚË ÂͤٷÛË ÁÈ·ÙËÓ ÂÎÙ›ÌËÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¶¶™.ªÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙȘ ·ÎfiÏÔ˘ı˜ ÂÚÈÙÒÛÂȘ(21): ·) ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ηٷÏÏËÏfiÙÂÚ˘ı¤Û˘ ÁÈ· ÙË ıˆÚ·ÎÔΤÓÙËÛË ‹ ÙËÓ ÙÔÔı¤ÙËÛËıˆÚ·ÎÈ΋˜ ·ÚÔ¯¤Ù¢Û˘, ‚) ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfiÙˆÓ ÂÁ΢ÛÙÒÛÂˆÓ ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ Î·È Á)ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi ÌÂٷ͇ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ ηȿ¯˘ÓÛ˘ ÙÔ˘ ˘Â˙ˆÎfiÙ·.

™ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÌÔÚ› Ó· ·Ú·ÙËÚËı›ÂχıÂÚÔ ˘ÁÚfi Ì ÌÂȈ̤ÓË Ë¯ÔÁ¤ÓÂÈ· (˘fiË¯Ô˘ÁÚfi), ÂχıÂÚ˜ Ù·Èӛ˜ Ó· “Ï¤Ô˘Ó” ̤۷ ÛÙÔÏ¢ÚÈÙÈÎfi ˘ÁÚfi, ·Ï¿ ‰È·ÊÚ·ÁÌ¿ÙÈ· ÂχıÂÚ· ‹ÂÁ΢Ûو̤ӷ Û ÎÔÈÏfiÙËÙ˜. ∏ ·ÚÔ˘Û›· ˯ÔÁÂÓÒÓÙ·ÈÓÈÒÓ ‹ ÂÁ΢ÛÙÒÛÂˆÓ Û¯ÂÙ›˙ÂÙ·È Ì ÂÍ›‰ÚˆÌ·. ∏·Ó‡ÚÂÛË ˘fiË¯Ô˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ÌÔÚ› Ó·Û¯ÂÙ›˙ÂÙ·È Ì ÂÍ›‰ÚˆÌ· ‹ ‰È›‰ÚˆÌ·.

∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙÔ˘ Ï¢ÚÈÙÈ-ÎÔ‡ ˘ÁÚÔ‡ ıˆÚÂ›Ù·È ˆ˜ ¤Ó·˜ ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfi-ÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ηıÔÚ›ÛÔ˘ÓÙËÓ ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂڷ¢ÙÈ΋ ·-ڤ̂·ÛË. ∂¿Ó Ë ·fiÛÙ·ÛË ·fi ÙËÓ ÂÛˆÙÂÚÈ΋ÏÂ˘Ú¿ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÙË ‚¿ÛËÙÔ˘ Ó‡ÌÔÓ· Â›Ó·È <10 mm, Ë Û˘ÏÏÔÁ‹ ‰ÂÓ ıˆ-ÚÂ›Ù·È ÎÏÈÓÈο ÛËÌ·ÓÙÈ΋ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍˉȷÁÓˆÛÙÈ΋˜ ıˆÚ·ÎÈ΋˜ ·Ú·Î¤ÓÙËÛ˘ (22,23).

∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη

™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÏÂÔÓÂ-ÎÙ‹Ì·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜. ™ÙËÓ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÙÔ Ï¢ÚÈÙÈÎfi ˘ÁÚfi ·ÂÈÎÔÓ›-˙ÂÙ·È Ì ۯ‹Ì· ‰Ú¤·ÓÔ˘ ÛÙȘ Ô›ÛıȘ ÂÚÈÔ¯¤˜ÙÔ˘ ıÒڷη Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ÎÏ›ÛË. OÈ ÂÁ΢ÛÙˆ-̤Ó˜ Û˘ÏÏÔÁ¤˜ ˘ÁÚÔ‡ ·Ú·ÙËÚÔ‡ÓÙ·È Û·Ó Ê·ÎÔÂÈ-‰Â›˜ ÛÎÈ¿ÛÂȘ (∂ÈÎfiÓ· 1). ∏ ·ÂÈÎÔÓÈ˙fiÌÂÓË ˘ÎÓfi-ÙËÙ· ‰ÂÓ ‚ÔËı¿ÂÈ ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ‰ÈȉÚÒÌ·-ÙÔ˜ ·fi ÙÔ ÂÍ›‰ÚˆÌ·, Ô‡ÙÂ Â›Ó·È Ôχ Û·Ê‹˜ ÛÙËÓÚÔÛ¿ıÂÈ· ·Ó·˙‹ÙËÛ˘ ÂÁ΢ÛÙÒÛÂˆÓ (24).

∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È Û˘ÛÙË-Ì·ÙÈο Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘Ô„›· ˘Â˙ˆ-ÎÔÙÈ΋˜ Û˘ÏÏÔÁ‹˜. ∂›Ó·È ηٿÏÏËÏË ÁÈ· ÙËÓ ·ÂÈ-ÎfiÓÈÛË ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·-ÙÔ˜, ÔÈ Ôԛ˜ ÂÈηχÙÔÓÙ·È ·fi ÙËÓ ¶¶™ ÛÙËÓ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. ∂›Ó·È ȉȷ›ÙÂÚ· ¯Ú‹-ÛÈÌË ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÂÌ˘‹Ì·ÙÔ˜ Ì ˘‰Ú·-ÂÚÈο ›‰· ·fi ÙÔ Ó¢ÌÔÓÈÎfi ·fiÛÙËÌ·, ÂÓÒ

·Ú¿ÏÏËÏ· ·Ú¤¯ÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ÂÈÙÒ-ÛÂȘ Ù˘ Û˘ÏÏÔÁ‹˜ ÛÙÔ ˘ÔΛÌÂÓÔ Ó¢ÌÔÓÈÎfi ·-Ú¤Á¯˘Ì·, fiˆ˜ Â›Ó·È Ë ÂÎÙÂٷ̤ÓË ·ÙÂÏÂÎÙ·Û›· ÛÂÔÏfiÎÏËÚÔ ÙÔÓ Î¿Ùˆ ÏÔ‚fi (∂ÈÎfiÓ· 2) (25,26).

£ˆÚ·ÎÔΤÓÙËÛË

∏ ‰È·ÁÓˆÛÙÈ΋ ·Ú·Î¤ÓÙËÛË ÂӉ›ÎÓ˘Ù·È ÛÙȘ¶¶™, Ì ÛÎÔfi ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡·Ú¿ÁÔÓÙ·, ·ÏÏ¿ Î·È ÙË ‰È·ÊÔÚԉȿÁÓˆÛË Ù˘ ÂÈ-ÏÂÁ̤Ó˘ ·fi ÙË ÌË ÂÈÏÂÁ̤ÓË Û˘ÏÏÔÁ‹. ∏¤ÁηÈÚË ıˆÚ·ÎÔΤÓÙËÛË Û˘ÓÈÛÙ¿Ù·È Ó· Ú·ÁÌ·ÙÔ-ÔÈÂ›Ù·È ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜·ÁˆÁ‹˜, ÂÊfiÛÔÓ ·˘Ùfi Â›Ó·È ‰˘Ó·Ùfi, ÁÈ· ÙËÓ ·‡ÍËÛËÙˆÓ Èı·ÓÔÙ‹ÙˆÓ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡·Ú¿ÁÔÓÙ·, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ‚ÈÔ¯ËÌÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ, Ô‡Ùˆ˜ ÒÛÙ ӷ ÂÓÙÔÈ-ÛÙ› ÚÒÈÌ· Ë Î·Ù¿ÏÏËÏË ÛÙÈÁÌ‹ ÙÔÔı¤ÙËÛ˘ Ûˆ-Ï‹Ó· ·ÚÔ¯¤Ù¢Û˘, ÚÈÓ ÙÔÓ Û¯ËÌ·ÙÈÛÌfi ‰È·-ÊÚ·ÁÌ·Ù›ˆÓ Î·È ÂÁ΢ÛÙÒÛˆÓ.

OÈ ·ÓÙÂӉ›ÍÂȘ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜. ø˜ Ù¤ÙÔȘıˆÚÔ‡ÓÙ·È Ë ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË (ÚÒÙ· ‰ÈÔÚıÒ-ÓÔÓÙ·È ÔÈ ·ÓˆÌ·Ï›Â˜ ‹Í˘), Ë ‰ÂÚÌ·ÙÈ΋ ‚Ï¿‚Ë ÛÙÔÛËÌÂ›Ô Ù˘ ·Ú·Î¤ÓÙËÛ˘ ‹ Ë ¯ÔÚ‹ÁËÛË Ì˯·ÓÈÎÔ‡

¶·È‰È·ÙÚÈ΋ 2005;68:000-000¶·È‰È·ÙÚÈ΋ 2005;68:18-27

∂∂ÈÈÎÎfifiÓÓ·· 11.. ÀÁÚfi Î·È ÓÂÎÚˆÙÈ΋ Ó¢ÌÔÓ›· ‰ÂÍÈ¿. ∞ÒıËÛËÌÂÛÔıˆÚ·Î›Ô˘ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿.

∂∂ÈÈÎÎfifiÓÓ·· 22.. ÀÁÚfi Î·È ·ÙÂÏÂÎÙ·Û›·. ŒÏÍË ÌÂÛÔıˆÚ·Î›Ô˘ ÚÔ˜Ù· ·ÚÈÛÙÂÚ¿ - ‚ÚÔÁ¯fiÁÚ·ÌÌ·.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·21

Page 33: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

22 ¢. ªÂÚÌ›ÚË Î·È Û˘Ó.

·ÂÚÈÛÌÔ‡ Ì ˘„ËϤ˜ ȤÛÂȘ. ¶ÚfiÛÊ·Ù·, ÂÎÊÚ¿-

ÛÙËÎÂ Ë ¿Ô„Ë fiÙÈ Ë ·Ó¿ÁÎË ıˆÚ·ÎÔΤÓÙËÛ˘

ÂÎÙÈÌ¿Ù·È ·fi ÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ fi„Ë ÙÔ˘ ˘ÁÚÔ‡

(23), ·Ó Î·È Û‡Ìʈӷ Ì ÙËÓ ÎÏ·ÛÈ΋ ÁÓÒÛË Û˘ÓÈ-

ÛÙ¿Ù·È Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Û οı ¶¶™ Ì ÙÔ˘-

Ï¿¯ÈÛÙÔÓ Ì¤ÙÚÈ· ÔÛfiÙËÙ· ˘ÁÚÔ‡ (27).

™ÙÔÓ ¶›Ó·Î· 1 ÂÚÈÁÚ¿ÊÂÙ·È Ë Ù¯ÓÈ΋ Ù˘ ·-

ڷΤÓÙËÛ˘ (28). ¢ÂÓ ˘¿Ú¯ÂÈ Û·Ê‹˜ ¿Ô„Ë ÁÈ· ÙËÓ

ÔÛfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ Ô˘ ÌÔÚ› Ó· ·Ê·ÈÚÂı› ÌÂ

·ÛÊ¿ÏÂÈ·. ªÂÚÈÎÔ› Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ÙË ÁÓÒÌË fiÙÈ

ÁÈ· ÙË ıÂڷ¢ÙÈ΋ ·Ú·Î¤ÓÙËÛË Â›Ó·È ÛÎfiÈÌÔ Ó·

·Ê·ÈÚÂ›Ù·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÔÛfiÙËÙ· ˘ÁÚÔ‡

(29). øÛÙfiÛÔ, Û ·ÛıÂÓ›˜ Ì ̷˙ÈΤ˜ Û˘ÏÏÔÁ¤˜

Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ Î·È - ¿Óˆ ·’ fiÏ· - ÛÂ Û˘ÏÏÔÁ‹

Ì ٷ¯Â›· ÂͤÏÈÍË, Ë ·Ê·›ÚÂÛË ÌÂÁ¿ÏˆÓ fiÁΈÓ

˘ÁÚÔ‡ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÙÂÚfiÏ¢ÚÔ Ó¢ÌÔ-

ÓÈÎfi Ô›‰ËÌ· Î·È ˘fiÙ·ÛË, ÏfiÁˆ ·ӷϋڈÛ˘ ÌÂ

·›Ì· Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ Ô˘ ‹Ù·Ó ÚÒÙ· Û˘ÌÈÂ-

Ṳ̂ӷ. °ÂÓÈο, Û˘ÓÈÛÙ¿Ù·È Ë ·Ê·›ÚÂÛË Ù˘ ÔÛfiÙË-

Ù·˜ ÙÔ˘ ˘ÁÚÔ‡ Ô˘ Â›Ó·È ·Ó·Áη›· ÒÛÙ ӷ ·Ó·ÎÔ˘-

ÊÈÛÙ› Ô ·ÛıÂÓ‹˜ ·fi ÙË ‰‡ÛÓÔÈ·, ¯ˆÚ›˜ Ó· ÂȉÈÒ-

ÎÂÙ·È Ë Ï‹Ú˘ ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ˘ÁÚÔ‡ (30).

™Â ÂÚ›ÙˆÛË ÂÌ˘‹Ì·ÙÔ˜, Ú¤ÂÈ Ó· ·ÔÌ·-

ÎÚ‡ÓÂÙ·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÔÛfiÙËÙ·, Ì ٷ˘-

Ùfi¯ÚÔÓË ÙÔÔı¤ÙËÛË ÛˆÏ‹Ó· ·ÚÔ¯¤Ù¢Û˘. ∂Í·›-

ÚÂÛË ·ÔÙÂÏ› Ë Ê˘Ì·ÙÈ҉˘ Û˘ÏÏÔÁ‹, ÛÙËÓ ÔÔ›·

ÚÔÙÈÌ¿Ù·È Ë ·ÔÊ˘Á‹ Ù˘ ·ÚÔ¯¤Ù¢Û˘, ‰ÈfiÙÈ

·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌÈÎÚԂȷ΋˜ ÂÈÌfiÏ˘ÓÛ˘,

Ô˘ ‰˘Û¯ÂÚ·›ÓÂÈ Î·È ÂÈϤÎÂÈ ÙË ıÂڷ›· Ù˘.

¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË

°È· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ¶¶™ Â›Ó·È ··-

Ú·›ÙËÙ˜ ÔÈ ·ÎfiÏÔ˘ı˜ ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÛÙÔ

Ï¢ÚÈÙÈÎfi ˘ÁÚfi: pH, LDH, ÁÏ˘Îfi˙Ë, ÚˆÙ½Ó˜,

ÏÂ˘Î¿ Î·È Ù‡Ô˜. ∫·Ù¿ ÂÚ›ÙˆÛË, ˙ËÙÂ›Ù·È ·‰ÂÓÔ-

Û›ÓË ‰È·ÌÈÓ¿ÛË (ADA), ·Ì˘Ï¿ÛË, ¯ÔÏËÛÙÂÚfiÏË Î·È

ÙÚÈÁÏ˘ÎÂÚ›‰È·. ∂›Û˘, Â›Ó·È ··Ú·›ÙËÙ˜ ÔÈ ÂÍ‹˜

ÌÈÎÚÔ‚ÈÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ: ¯ÚÒÛË Î·Ù¿ Gram,

Ziehl Neelsen, ·ÂÚfi‚Ș Î·È ·Ó·ÂÚfi‚Ș ηÏÏȤÚÁÂÈ-

˜ Lowenstein Î·È Hongos.

∆Ô ˘ÁÚfi Ô˘ ·ıÚÔ›˙ÂÙ·È ÛÙÔÓ ˘Â˙ˆÎÔÙÈÎfi ¯Ò-

ÚÔ ÌÔÚ› Ó· Â›Ó·È ‰È›‰ÚˆÌ· ‹ ÂÍ›‰ÚˆÌ·.

∆Ô ‰È›‰ÚˆÌ· ÚÔηÏÂ›Ù·È ·fi Â͈˘Â˙ˆÎÔÙÈ-

Τ˜ ‰È·Ù·Ú·¯¤˜, Ô˘ ¢ÓÔÔ‡Ó ÙË Û˘ÛÛÒÚ¢ÛË

˘ÁÚÔ‡ ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ·. ∫·Ù¿ ÛÂÈÚ¿

Û˘¯ÓfiÙËÙ·˜, ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ·ÚÈÛÙÂÚ‹ ηÚ-

‰È·Î‹ ·Ó¿ÚÎÂÈ·, ‰ÂÍÈ¿ ηډȷ΋ ·Ó¿ÚÎÂÈ·,

·ÙÂÏÂÎÙ·Û›· ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ.

∆Ô ÂÍ›‰ÚˆÌ· ÔÊ›ÏÂÙ·È ÛÙËÓ ·‡ÍËÛË Ù˘ ‰È·Â-

Ú·ÙfiÙËÙ·˜ ÙˆÓ ÙÚȯÔÂȉÒÓ ·ÁÁ›ˆÓ. ∞˘Ùfi Û˘Ì‚·›-

ÓÂÈ Û ÏÔÈÌÒÍÂȘ, ÓÂÔϷۛ˜, ÎÔÏÏ·ÁÔÓÒÛÂȘ, Â-

ÚÈÙÒÛÂȘ Ì ÂÓ‰ÔÎÔÈÏȷ΋ ·ıÔÏÔÁ›·, Ê¿Ú̷η,

ÙÚ·‡Ì· Î·È ‚Ï¿‚˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ‹ ÙÔ˘ ıˆÚ·ÎÈ-

ÎÔ‡ fiÚÔ˘. ™Â fiϘ ÙȘ ¶¶™, ÙÔ ˘ÁÚfi ¤¯ÂÈ Ù· ¯·Ú·-

ÎÙËÚÈÛÙÈο ÂÍȉÚÒÌ·ÙÔ˜.

O ¶›Ó·Î·˜ 2 ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ·Ú·-

̤ÙÚÔ˘˜ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó Ù· ‰ÈȉÚÒÌ·Ù· Î·È Ù·

ÂÍȉÚÒÌ·Ù·. ∆· ÂÚÈÛÛfiÙÂÚÔ ÌÂÏÂÙË̤ӷ ÎÚÈÙ‹ÚÈ·

Ô˘ ‰È·ÊÔÚԉȷÁÈÁÓÒÛÎÔ˘Ó ÙÔ ‰È›‰ÚˆÌ· ·fi ÙÔ ÂÍ›-

‰ÚˆÌ· Â›Ó·È ·˘Ù¿ ÙÔ˘ Light, Ô˘ ÂÈÙÚ¤Ô˘Ó ÙÔÓ ¯·-

Ú·ÎÙËÚÈÛÌfi ÂÓfi˜ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ ˆ˜ ÂÍȉÚÒÌ·-

ÙÔ˜ ÛÙÔ 95% ÙˆÓ ÂÚÈÙÒÛˆÓ, Â¿Ó ÏËÚÔ‡Ù·È ÙÔ˘-

Ï¿¯ÈÛÙÔÓ 1 ·fi Ù· ·ÎfiÏÔ˘ı· 3 ÎÚÈÙ‹ÚÈ· (31): i) χ-

Έ̷ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ / χΈ̷ ·›Ì·ÙÔ˜ >0,5,

ii) LDH ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ / LDH ·›Ì·ÙÔ˜ >0,6,

iii) ÙÈÌ‹ LDH ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ ÌÂÁ·Ï‡ÙÂÚË ·fi

Ù· 2/3 ÙˆÓ ÙÈÌÒÓ Ô˘ ıˆÚÔ‡ÓÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈΤ˜.

∆ÈÌ‹ LDH >1000 ı· Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È ıÂÙÈ΋.

¶·È‰È·ÙÚÈ΋ 2005;68:18-27

¶¶››ÓÓ··Îη·˜̃ 11.. ∆¯ÓÈ΋ ıˆÚ·ÎÔΤÓÙËÛ˘ Î·È ÙÔÔı¤ÙËÛ˘ ۈϋӷ ·ÚÔ¯¤Ù¢Û˘ (26,32)

∞∞··ÚÚ··››ÙÙËËÙÙÔÔ ˘̆ÏÏÈÈÎÎfifi 1. ºÏ‚ÔηıÂÙ‹Ú˜ 16-22 G ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÛÙÚfiÊÈÁÁ· ÙÚÈÏ‹˜ ÂÍfi‰Ô˘ Î·È Û‡ÚÈÁÁ· 5 ml. 2. ∏·ÚÈÓÈṲ̂ÓË Û‡ÚÈÁÁ· ÈÓÛÔ˘Ï›Ó˘ Î·È 2 Û‡ÚÈÁÁ˜ ÙˆÓ 20 ml. 3. ∆ÔÈÎfi ·Ó·ÈÛıËÙÈÎfi (.¯. ÏȉÔη˝ÓË 1% Î·È ·‰ÚÂÓ·Ï›ÓË), ‚ÂÏfiÓ˜ 22 Î·È 25 G ÁÈ· ÙÔÈ΋ ¤Á¯˘ÛË. 4. ∞ÔÛÙÂÈڈ̤ӷ Á¿ÓÙÈ·, Ì¿Ûη Î·È ÌÏÔ‡˙· ·ÔÛÙÂÈڈ̤ÓË.

∆∆¯̄ÓÓÈÈÎ΋‹ 1. ∂›Ó·È ÂÈı˘ÌËÙfi Ë ·Ú·Î¤ÓÙËÛË Ó· Á›ÓÂÙ·È ·ÊÔ‡ ¤¯ÂÈ ÚÔËÁËı› ÙÔÈ΋ ·Ó·ÈÛıËÛ›·, ˘fi Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡

Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘. ™Ù· ÌÈÎÚ¿ ·È‰È¿, ¤¯ÂÈ ÂÎÊÚ·ÛÙ› Ë ¿Ô„Ë Ó· ¯ÔÚËÁÂ›Ù·È Î·Ù·ÛÙÔÏ‹ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË Û˘ÓÂÚÁ·Û›·. 2. ∏ ÂÚÈÔ¯‹ Ù˘ ·Ú·Î¤ÓÙËÛ˘ ÂÈϤÁÂÙ·È ¿ÓÙÔÙ ÛÙËÓ ÈÔ ¯·ÌËÏ‹ ı¤ÛË Ù˘ Û˘ÏÏÔÁ‹˜ ÁÈ· ÙË ‰È¢ÎfiÏ˘ÓÛË Ù˘ ÚÔ‹˜ ̤ۈ

Ù˘ ‚·Ú‡ÙËÙ·˜. °ÂÓÈο, Ë Î·Ï‡ÙÂÚË ı¤ÛË ÁÈ· ·Ú·Î¤ÓÙËÛË Â›Ó·È ·ÎÚÈ‚Ò˜ οو ·fi ÙËÓ ÎÔÚ˘Ê‹ Ù˘ ˆÌÔÏ¿Ù˘. 3. O ·ÛıÂÓ‹˜ οıÂÙ·È Ì ٷ fi‰È· Ó· ÎÚ¤ÌÔÓÙ·È ·fi ÙÔ ÂÍÂÙ·ÛÙÈÎfi ÎÚ‚¿ÙÈ Î·È ÙÔ ¯¤ÚÈ Ù˘ ¿Û¯Ô˘Û·˜ ÏÂ˘Ú¿˜ ¿Óˆ ·fi ÙÔÓ

·ÓÙ›ıÂÙÔ ÒÌÔ, ÂÚÓÒÓÙ·˜ ÙÔ ¿Óˆ ·fi ÙÔ ÎÂÊ¿ÏÈ ÁÈ· Ó· ‰È¢ڢÓıÔ‡Ó ÛÙÔ Ì¤ÁÈÛÙÔ ‰˘Ó·Ùfi Ù· ÌÂÛÔχÚÈ· ‰È·ÛÙ‹Ì·Ù·. 4. °›ÓÂÙ·È Î·ı·ÚÈÛÌfi˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙÔÈ΋ ·Ó·ÈÛıËÛ›· ·fi ÙÔ ‰¤ÚÌ· ¤ˆ˜ ÙÔÓ ˘Â˙ˆÎfiÙ·. 5. ∂ÈÛ¿ÁÂÙ·È Ô ÊÏ‚ÔηıÂÙ‹Ú·˜ οıÂÙ· ÛÙÔ ıˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ·, Ì ÙÔ ¿ÓÔÈÁÌ· Ù˘ Û‡ÚÈÁÁ·˜ ÚÔ˜ ÙËÓ ¿Óˆ ÏÂ˘Ú¿. ∫·Ù¿ ÙËÓ

›ÛÔ‰Ô, Á›ÓÂÙ·È ÂÏ·ÊÚ¿ ÂÚÈÛÙÚÔÊ‹ ÁÈ· Ó· ÌËÓ Â›Ó·È fiϘ ÔÈ Â›ÛÔ‰ÔÈ ÛÙËÓ ›‰È· ¢ı›·. 6. ∞ÔÛ‡ÚÂÙ·È Ë ‚ÂÏfiÓ· Î·È ÂÈÛ¿ÁÂÙ·È Â‡Î·ÌÙÔ˜ Â͈ÙÂÚÈÎfi˜ ηıÂÙ‹Ú·˜ ¤ˆ˜ ÙËÓ Ï¢ÚԉȷÊÚ·ÁÌ·ÙÈ΋ ÁˆÓ›·. ™˘Ó‰¤ÂÙ·È ·Ì¤-

Ûˆ˜ Ì ÙË ÛÙÚfiÊÈÁÁ· ÙÚÈÏ‹˜ ÂÍfi‰Ô˘ (ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂÈÛfi‰Ô˘ ·¤Ú· ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ·). 7. ∏ ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ˘ÁÚÔ‡ Á›ÓÂÙ·È ·ÚÁ¿. ™Â ÂÚ›ÙˆÛË ‰È·ÁÓˆÛÙÈ΋˜ ·Ú·Î¤ÓÙËÛ˘, ·Ê·ÈÚÂ›Ù·È ÌfiÓÔ fiÛË ÔÛfiÙËÙ· ¯ÚÂÈ¿-

˙ÂÙ·È ÁÈ· Ó· Á›ÓÔ˘Ó ÔÈ ÂÍÂÙ¿ÛÂȘ. ™ÙË ıÂڷ¢ÙÈ΋ ·Ú·Î¤ÓÙËÛË, ·ÔÌ·ÎÚ‡ÓÂÙ·È fiÛÔ ˘ÁÚfi ¯ÚÂÈ¿˙ÂÙ·È ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛËÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙË ‰‡ÛÓÔÈ·.

8. ∆¤ÏÔ˜, Á›ÓÂÙ·È ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ۈϋӷ ·ÚÔ¯¤Ù¢Û˘.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·22

Page 34: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

23¶·Ú·Ó¢ÌÔÓÈΤ˜ Û˘ÏÏÔÁ¤˜

∂¿Ó ÔÈ ÙÈ̤˜ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ Â›Ó·È

·ÌÊ›‚ÔϘ, ·ÍÈÔÏÔÁÂ›Ù·È ÂΛÓË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘

ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, Ì fiÚÈÔ ÙËÓ ÙÈÌ‹ ÙˆÓ 60

mg/dl (1,55 mmol/L). ∞Ó ‰ÂÓ ÏËÚÔ‡Ù·È Î·Ó¤Ó·

·fi Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·, ÙÔ ˘ÁÚfi Ù˘ ˘Â˙ˆÎÔ-

ÙÈ΋˜ Û˘ÏÏÔÁ‹˜ ıˆÚÂ›Ù·È ‰È›‰ÚˆÌ·.

∆Ô ‰Â›ÁÌ· ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ Ú¤ÂÈ Ó·

Ï·Ì‚¿ÓÂÙ·È ˘fi ·Ó·ÂÚfi‚Ș Û˘Óı‹Î˜ Î·È Ë ·Ó¿Ï˘-

ÛË ÙÔ˘ pH Ó· Á›ÓÂÙ·È Û ·Ó·Ï˘Ù‹ ·ÂÚ›ˆÓ Ì ÙÔ

‰Â›ÁÌ· Û ˷ÚÈÓÈṲ̂ÓË Û‡ÚÈÁÁ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË

Ï‹„Ë ‹, ·ÏÏÈÒ˜, Ó· Ê˘Ï¿ÛÛÂÙ·È Û ¿ÁÔ.

™ÙÔÓ ¶›Ó·Î· 3 Û˘ÓÔ„›˙ÔÓÙ·È Ù· ‚ÈÔ¯ËÌÈο ¯·-

Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ ÛÙÔ˘˜ ‰È¿-

ÊÔÚÔ˘˜ Ù‡Ô˘˜ ¶¶™. OÈ ·ÛıÂÓ›˜ Ì ÂÈÏÂÁ̤ÓË

¶¶™ ¤¯Ô˘Ó Ôχ ¯·ÌËÏ‹ ÙÈÌ‹ pH Î·È ÁÏ˘Îfi˙˘ ηÈ

Ôχ ·˘ÍË̤ÓË ÙÈÌ‹ LDH. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙËÓ

ÙÔÈ΋ ÌÂÙ·‚ÔÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ÊÏÂÁÌÔÓˆ-

‰ÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ (32).

∆Ô pH ·ÔÙÂÏ› ÙËÓ ·Ú¿ÌÂÙÚÔ Ì ÙË ÌÂÁ·Ï‡-

ÙÂÚË ‰È·ÁÓˆÛÙÈ΋ ·Í›·. ªÂÚÈÎÔ› Û˘ÁÁÚ·Ê›˜ ÙÔ

¯ÚËÛÈÌÔÔÈÔ‡Ó ˆ˜ ÌÔÓ·‰ÈÎfi ·Ú¿ÁÔÓÙ·, ˘fi ÙËÓ

ÚÔ¸fiıÂÛË fiÙÈ ÙÔ ‰Â›ÁÌ· ÂÏ‹ÊıË ˘fi ȉ·ÓÈΤ˜

Û˘Óı‹Î˜ (33,34).

™Â ·ÛıÂÓ›˜ Ì ÔͤˆÛË, ÙÈÌ‹ ÙÔ˘ pH ηÙÒÙÂÚË

ÂΛӢ ÙÔ˘ ·›Ì·ÙÔ˜ ηٿ 0,15 ÌÔÓ¿‰Â˜ Â›Ó·È ÂÓ‰ÂÈ-

ÎÙÈ΋ ÂÌ˘‹Ì·ÙÔ˜. ™Â ·Û˘Ó‹ıÂȘ ÂÚÈÙÒÛÂȘ

ÂÌ˘‹Ì·ÙÔ˜, ÙÔ pH ÌÔÚ› Ó· Â›Ó·È ·ÚÔ‰Èο ·Ï-

ηÏÈÎfi. ¶Ï¢ÚÈÙÈÎfi ˘ÁÚfi Ì pH Ù˘ Ù¿Í˘ ÙÔ˘ 8

ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·Ú·ÁˆÁ‹ ·Ì̈ӛ·˜ ·fi

ÛÙÂϤ¯Ë ÙÔ˘ ÚˆÙ¤· Ô˘ ¯ÚËÛÈÌÔÔÈ› ÚˆÙ¿Û˜

ÁÈ· ÙË ‰È¿Û·ÛË Ù˘ Ô˘Ú›·˜. ∂Í·ÈÚÂÙÈο ¯·ÌËÏfi

pH, Ù˘ Ù¿Í˘ ÙÔ˘ 6, Û˘Ó·ÓÙ¿Ù·È ÌfiÓÔ Û ÂÌ˘‹Ì·-

Ù· Î·È Û ڋÍË ÔÈÛÔÊ¿ÁÔ˘. ∏ ̤ÙÚËÛË Ù˘ ·Ì˘Ï¿-

Û˘ ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ ÌÔÚ› Ó· ÂÓÙÔ›ÛÂÈ

ÛȈËÚ‹ ·ÁÎÚ·ٛÙȉ·.

∞ÓÙÈÌÂÙÒÈÛË

∫‡ÚÈÔÈ ÛÙfi¯ÔÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¶¶™ ›-

Ó·È Ë ·ÔηٿÛÙ·ÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ë

·ÔÊ˘Á‹ ÙˆÓ ÂÈÏÔÎÒÓ. ∞ÛÊ·ÏÒ˜, ˆ˜ ÚÔ¸fiıÂ-

ÛË ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ıÂڷ¢ÙÈ-

΋˜ ·ÁˆÁ‹˜ ıˆÚÂ›Ù·È Ë ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛ‹ ÙÔ˘˜.

™ÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú·ÎÙÈ΋ ·ÎÔÏÔ˘ıÔ‡-

ÓÙ·È ‰È¿ÊÔÚ· ıÂڷ¢ÙÈο Û¯‹Ì·Ù·. ¢˘ÛÙ˘¯Ò˜,

‰ÂÓ ˘¿Ú¯Ô˘Ó ‰È·ı¤ÛÈ̘ Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜ ·fi

ÙȘ Ôԛ˜ Ó· ÚÔ·ÙÔ˘Ó ¿ÌÂÛ· Ù· ÏÂÔÓÂÎÙ‹Ì·-

Ù· οÔÈˆÓ ¤Ó·ÓÙÈ ÙˆÓ ˘ÔÏÔ›ˆÓ.

ªÂÚÈÎÔ› Û˘ÁÁÚ·Ê›˜ ÚÔÙ›ÓÔ˘Ó ·ÔÎÏÂÈÛÙÈο

·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Û fiϘ ÙȘ ¶¶™, Ì ÙÔ Âȯ›-

ÚËÌ· fiÙÈ ·ÎfiÌ· Î·È ÔÈ ˘Ò‰ÂȘ Û˘ÏÏÔÁ¤˜ Ì ÂÁ΢-

ÛÙÒÛÂȘ ˘Ô¯ˆÚÔ‡Ó ¯ˆÚ›˜ ·ÚÔ¯¤Ù¢ÛË, ·ÏÏ¿ ·˘-

Ùfi Û˘Ó¿ÁÂÙ·È ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜

Î·È ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÂÈÏÔÎÒÓ.

∏ ÚfiÙ·ÛË ÙÔ˘ Light ·Ó·ÊÔÚÈο Ì ÙȘ ¶¶™

·ÔÙÂÏ› Ì›· ·fi ÙȘ ηχÙÂÚ˜ ÚÔÛÂÁÁ›ÛÂȘ, fi¯È

ÌfiÓÔ ÁÈ· ÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜, ·ÏÏ¿ Î·È ÁÈ· ÙÔÓ ·Ï-

ÁfiÚÈıÌÔ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜. ∆Ô Û¯‹Ì· ¤¯ÂÈ ·Ó·-

Ù˘¯ı› ÁÈ· ÂÓ‹ÏÈÎÔ˘˜ ·ÛıÂÓ›˜, ηıÒ˜ ‰ÂÓ ¤¯Ô˘Ó

Á›ÓÂÈ ·ÚfiÌÔȘ ÌÂϤÙ˜ Û ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi,

·ÎÔÏÔ˘ıÂ›Ù·È ˆÛÙfiÛÔ ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜

·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˘˜ (5).

™ÙËÓ ∂ÈÎfiÓ· 3 Û˘ÓÔ„›˙ÂÙ·È ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ

ıÂڷ¢ÙÈÎfi Û¯‹Ì· Ô˘ ‚·Û›˙ÂÙ·È Û ·˘Ùfi ÙÔ˘

Light, Ì οÔȘ ·Ú·ÏÏ·Á¤˜ (4,17). ∞Ó¿ÏÔÁÔ ·Ï-

ÁfiÚÈıÌÔ ‰ËÌÔÛ›Â˘Û·Ó ÚfiÛÊ·Ù· ÔÈ Grewall Î·È Û˘Ó

(23), Ì ‚¿ÛË ÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ fi„Ë ÙÔ˘ ˘ÁÚÔ‡

Î·È ÙËÓ ÚÒÈÌË ıˆÚ·ÎÔÛÎfiËÛË. ∞Ó Î·È Ê·›ÓÂÙ·È

fiÙÈ Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈÎfi, ¤¯ÂÈ ıˆÚËı›

˘ÂÚ‚ÔÏÈο ÂÈıÂÙÈÎfi, ·ÊÔ‡ ¤ÙÛÈ ˘Ô‚¿ÏÏÔÓÙ·È

οÔÈÔÈ ·ÛıÂÓ›˜ Û ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ¯ˆÚ›˜

ÂӉ¯Ô̤ӈ˜ Ó· Â›Ó·È ··Ú·›ÙËÙÔ.

∞ÓÙÈ‚ÈÔÙÈο

∏ ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›· ·ÔÙÂÏ› ÙÔÓ

·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË fiÏˆÓ ÙˆÓ

¶¶™, ÂÈÏÂÁÌ¤ÓˆÓ ‹ ÌË. ∏ ÂÈÏÔÁ‹ Á›ÓÂÙ·È Û‡Ì-

ʈӷ Ì ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·, ·Ó Î·È Ë Û˘¯ÓfiÙËÙ·

·ÔÌfiÓˆÛ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· Â›Ó·È ÌÈÎÚ‹.

¶·È‰È·ÙÚÈ΋ 2005;68:18-27

¶¶››ÓÓ··Îη·˜̃ 33.. µÈÔ¯ËÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ¶¶™ (6)

∞∞ÏÏ‹‹ ∂∂ÈÈÏÏÂÂÁÁÌ̤¤ÓÓËË ∂∂Ì̇‡ËËÌÌ··

pH <7,3 <7,2 <7,0§Â˘ÎÔ·ÙÙ·Ú· <10.000/mm3 >10.000/mm3 >15.000/mm3

°Ï˘Îfi˙Ë <60 mg/dl <40 mg/dl <40 mg/dl∫·ÏÏȤÚÁÂÈ· ∞ÚÓËÙÈ΋ £ÂÙÈ΋ £ÂÙÈ΋LDH <1000 IU/L >1000 IU/L >1000 IU/L

¶¶››ÓÓ··Îη·˜̃ 22.. µÈÔ¯ËÌÈΤ˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó Ù·‰ÈȉÚÒÌ·Ù· Î·È Ù· ÂÍȉÚÒÌ·Ù· (6)

∂∂ÍÍ››‰‰ÚÚˆ̂ÌÌ·· ¢¢ÈÈ››‰‰ÚÚˆ̂ÌÌ··

¶ÚˆÙ½Ó˜ ≥3 g/dl <3 g/dl§Â˘ÎÒÌ·Ù· Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡/ÔÚÔ‡ >0,5 ≤0,5LDH >200 IU/L <200 IU/LLDH Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡/ÔÚÔ‡ ≥0,6 <0,6pH <7,3 ≥7,3°Ï˘Îfi˙Ë <60 mg/dl >60 mg/dlÃÔÏËÛÙÂÚfiÏË >60 mg/dl <60 mg/dl§Â˘ÎÔ·ÙÙ·Ú· >1000/mm3 <1000/mm3

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·23

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¶·È‰È·ÙÚÈ΋ 2005;68:18-27

∏ ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂ-

ÓÔ‡˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ·ÏÏ¿ Î·È Ë ‰ÈÛÙ·ÎÙÈÎfiÙËÙ·

ÔÏÏÒÓ ÁÈ·ÙÚÒÓ Ó· ÚÔ‚Ô‡Ó ¤ÁηÈÚ· Û ‰È·ÁÓˆÛÙÈ-

΋ ıˆÚ·ÎÔΤÓÙËÛË, ‰ÂÓ ‰È¢ÎÔχÓÔ˘Ó ÙËÓ ÚÔÛ¿-

ıÂÈ· ·ÔÌfiÓˆÛ˘ ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·.

∏ ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›· Ú¤ÂÈ Ó· ¯ÔÚËÁ›-

Ù·È Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÓ‰ÔÊϤ‚È· › 7-10

Ë̤Ú˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ. ∂ÈϤÔÓ, Û˘ÓÈÛÙ¿Ù·È per os

¯ÔÚ‹ÁËÛË ÁÈ· 1-2 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛË

ÙÔ˘ ˘ÚÂÙÔ‡.

∏ ÂÌÂÈÚÈ΋ ·ÁˆÁ‹ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ

·ÓÙÈ‚ÈÔÙÈο Ô˘ ¤¯Ô˘Ó ‰Ú¿ÛË ¤Ó·ÓÙÈ ÙÔ˘ S.

pneumoniae Î·È ÙÔ˘ S. aureus. ™ÙÔ˘˜ Ï‹Úˆ˜ ÂÌ‚Ô-

ÏÈ·Ṳ̂ÓÔ˘˜ ·ÛıÂÓ›˜ ηٿ ÙÔ˘ H. influenzae Î·È ÛÂ

·˘ÙÔ‡˜ Ô˘ Ë ¯ÚÒÛË Î·Ù¿ Gram Â›Ó·È ·ÚÓËÙÈ΋,

‰ÂÓ Â›Ó·È ··Ú·›ÙËÙË Ë Î¿Ï˘„Ë ¤Ó·ÓÙÈ ·˘ÙÔ‡ ÙÔ˘

ÌÈÎÚÔ‚›Ô˘.

ŒÓ· ·Ú¯Èο ηٿÏÏËÏÔ ÂÌÂÈÚÈÎfi Û¯‹Ì· ÁÈ· ÙȘ

Ó¢ÌÔӛ˜ Ù˘ ÎÔÈÓfiÙËÙ·˜ Ì ¶¶™ Û ˘ÁÈ‹ ·È‰È¿

Â›Ó·È Ë ÎÂÊÔ˘ÚÔÍ›ÌË ‹ Ë ÎÂÊÔÙ·Í›ÌË (200

mg/kg/Ë̤ڷ) ‹ Ë ÎÂÊÙÚÈ·ÍfiÓË (100 mg/kg/Ë̤ڷ)

Ì ÎÏÈÓ‰·Ì˘Î›ÓË (40 mg/kg/Ë̤ڷ). ∂Ó·ÏÏ·ÎÙÈο,

ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Ë ·ÌÔ͢ÎÈÏ›ÓË Ì ÎÏ·-

‚Ô˘Ï·ÓÈÎfi (100 mg/kg/Ë̤ڷ Ë ·ÌÔ͢ÎÈÏ›ÓË) (35).

™Â ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿, Ì ¯ÚfiÓÈÔ ÓfiÛË-

Ì· ‹ Ïԛ̈ÍË ·fi ÓÔÛÔÎÔÌÂÈ·Îfi Û٤ϯԘ, ›ӷÈ

··Ú·›ÙËÙË Ë ¯ÔÚ‹ÁËÛË ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë˜ (Ë ·ÌÈ-

ηۛÓË ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯ÂÈ Î·Ï‡ÙÂÚË ‰ÈÂÈÛ‰˘ÙÈÎfi-

ÙËÙ· ÛÙÔ Ô͈ÙÈÎfi Ï¢ÚÈÙÈÎfi ˘ÁÚfi) Î·È ·ÓÙÈÛÙ·-

Ê˘ÏÔÎÔÎÎÈÎÔ‡ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ (‚·ÓÎÔÌ˘Î›ÓË ‹ Ó·Ê-

ÛÈÏ›ÓË) (8).

™Â Û˘ÏÏÔÁ¤˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó Ó¢ÌÔÓ›· ·fi

ÂÈÛÚfiÊËÛË, fiˆ˜ Û ·ÛıÂÓ›˜ Ì Ó¢ÚÔÏÔÁÈΤ˜ ‰È·-

Ù·Ú·¯¤˜, Ú¤ÂÈ Ó· ηχÙÂÙ·È Î·È Ë Èı·ÓfiÙËÙ·

ÙˆÓ ·Ó·ÂÚfi‚ÈˆÓ ÌÈÎÚÔ‚›ˆÓ Ì ÎÏÈÓ‰·Ì˘Î›ÓË ‹ ÙÈ-

ηÚÛÈÏ›ÓË Ì ÎÏ·‚Ô˘Ï·ÓÈÎfi (36).

™Â ·ÛıÂÓ›˜ Ì Ó¢ÌÔÓ›· ·fi Ó¢ÌÔÓÈfiÎÔÎ-

ÎÔ, Ë ÂÈÏÔÁ‹ ÙÔ˘ ηٿÏÏËÏÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ı·

ÂÍ·ÚÙËı› ·fi ÙËÓ ÙÈÌ‹ Ù˘ ÂÏ¿¯ÈÛÙ˘ ·Ó·ÛÙ·ÏÙÈ-

΋˜ ˘ÎÓfiÙËÙ·˜ (MIC) Ù˘ ÂÓÈÎÈÏ›Ó˘. °È· MIC

<0,06 mg/L Û˘ÓÈÛÙ¿Ù·È ¯ÔÚ‹ÁËÛË ÂÓÈÎÈÏ›Ó˘ ‹

·ÌÔ͢ÎÈÏ›Ó˘ ÛÂ Û˘Ì‚·ÙÈΤ˜ ‰fiÛÂȘ. °È· MIC ÌÂÙ·-

͇ 0,12 mg/L Î·È 1 mg/L Û˘ÓÈÛÙÒÓÙ·È ·˘ÍË̤Ó˜

‰fiÛÂȘ ÂÓÈÎÈÏ›Ó˘, ·ÌÔ͢ÎÈÏ›Ó˘ ‹ ·ÌÈÎÈÏ›Ó˘.

24 ¢. ªÂÚÌ›ÚË Î·È Û˘Ó.

∫ÏÈÓÈ΋ ˘Ô„›· ·Ú·Ó¢ÌÔÓÈ΋˜ Û˘ÏÏÔÁ‹˜

¶Ôχ ÌÈÎÚ‹ (<10 mm) ¶ÚÔÛıÈÔ›ÛıÈ· ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Ï¿ÁÈ· (;) ηٷÎÂÎÏÈ̤ÓË (;)

∞ÓÙÈ‚ÈÔÙÈο, ÓÔÛËÏ›·,·Ú·ÎÔÏÔ‡ıËÛË ªÂÁ¿ÏË (>10 mm)

¢˘ÛÌÂÓ‹˜ ÂͤÏÈÍË ¡ÔÛËÏ›·, ˘ÂÚ˯ÔÁÚ¿ÊËÌ·,ıˆÚ·ÎÔΤÓÙËÛË, ·ÓÙÈ‚ÈÔÙÈο

ÀÁÚfi ‰È·˘Á¤˜ ÀÁÚfi ˘Ò‰Â˜ ‹ ıÔÏÂÚfi ÃÚÒÛË Î·Ù¿ Gram(-) ‹/Î·È ¯ÚÒÛË Î·Ù¿ Gram(+)

ÀfiË¯Ô ˘ÁÚfi ‹/Î·È ÁÏ˘Îfi˙Ë <50 mg/dl‹/Î·È pH <7,0

pH >7,2 pH >7,0 Èڛ˜ ∂χıÂÚ˜ ¶ÔÏϷϤ˜°Ï˘Îfi˙Ë >50 mg/dl ‹ pH <7,2 Î·È ‰È·ÊÚ·ÁÌ¿ÙÈ· Ù·Èӛ˜ ÂÚ›ÏÔΘ

ÁÏ˘Îfi˙Ë >50 mg/dl ÂÁ΢ÛÙÒÛÂȘ

¶·Ú·ÎÔÏÔ‡ıËÛË ¶ÔÏϷϤ˜ £ˆÚ·ÎÈ΋ £ˆÚ·ÎÈ΋ ·Ú·ÎÂÓÙ‹ÛÂȘ ·ÚÔ¯¤Ù¢ÛË ·ÚÔ¯¤Ù¢ÛË

πÓˆ‰ÔÏ˘ÙÈο

Èڛ˜ ‚ÂÏÙ›ˆÛË ÃˆÚ›˜ ‚ÂÏÙ›ˆÛË

∂·Ó¿ÏË„Ë ·ÚÔ¯¤Ù¢Û˘, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·ıÒÚ·ÎÔ˜, ıˆÚ·ÎÔÛÎfiËÛË ‹ ıˆÚ·ÎÔÙÔÌ‹

∂∂ÈÈÎÎfifiÓÓ·· 33.. ¶ÚÔÙÂÈÓfiÌÂÓÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì· ÛÙȘ ·Ú·Ó¢ÌÔÓÈΤ˜ Û˘ÏÏÔÁ¤˜.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·24

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25¶·Ú·Ó¢ÌÔÓÈΤ˜ Û˘ÏÏÔÁ¤˜

∆¤ÏÔ˜, ÁÈ· MIC 2-4 mg/L ‹ >4 mg/L ÈηÓÔÔÈËÙÈ΋

·ÓÙ·fiÎÚÈÛË ·Ú·ÙËÚÂ›Ù·È Û˘Ó‹ıˆ˜ ÛÙËÓ ÎÂÊÔÙ·-

Í›ÌË ‹ ÎÂÊÙÚÈ·ÍfiÓË, fiˆ˜ ›Û˘ ÛÙË ‚·ÓÎÔÌ˘Î›-

ÓË, ÂÓÒ ˆ˜ ÙÂÏÂ˘Ù·›· ÂÈÏÔÁ‹ ·Ú·Ì¤ÓÔ˘Ó ÔÈ Î·Ú-

Ì·ÂӤ̘ (35).

¶·ÚÔ¯¤Ù¢ÛË Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡ Ì ۈϋӷ

∏ ÙÔÔı¤ÙËÛË ÛˆÏ‹Ó· ·ÚÔ¯¤Ù¢Û˘ ÂӉ›-

ÎÓ˘Ù·È Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÂÈÏÂÁ̤ӈÓ

¶¶™. ∞ÓÙÈÎÂÈÌÂÓÈÎfi˜ ÛÎÔfi˜ Â›Ó·È Ë ÚÒÈÌË ÙÔÔ-

ı¤ÙËÛË ÙÔ˘ ۈϋӷ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË Ù˘

ÂÈÏÂÁ̤Ó˘ ¶¶™, ‰ÈfiÙÈ ÙÔ ÂχıÂÚÔ Ï¢ÚÈÙÈÎfi

˘ÁÚfi ÌÔÚ› Ó· ÌÂÙ·Ùڷ› Û ˘ÁÚfi Ì ‰È·ÊÚ·ÁÌ¿-

ÙÈ· ·ÎfiÌ· Î·È Û ‰È¿ÛÙËÌ· ̂ ÚÒÓ, Ì ·ÎfiÏÔ˘ıÔ ÙË

‰˘ÛÎÔÏ›· ‹ ›Ûˆ˜ ÙËÓ ·‰˘Ó·Ì›· ·ÚÔ¯¤ÙÂ˘Û‹˜ ÙÔ˘.

OÈ ÂӉ›ÍÂȘ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ۈϋӷ ·ÚÔ¯¤-

Ù¢Û˘ ÛÙȘ ¶¶™ ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. OÈ

·ÛıÂÓ›˜ Ì pH <7 ‰È·ÙÚ¤¯Ô˘Ó ÌÂÁ¿ÏÔ Î›Ó‰˘ÓÔ

·Ó¿Ù˘Í˘ ÂÌ˘‹Ì·ÙÔ˜ Î·È ÂÁ΢ÛÙÒÛˆÓ, ÁÈ’ ·˘Ùfi

ÂÈ‚¿ÏÏÂÙ·È Ë ¤ÁηÈÚË ¤Ó·ÚÍË ·ÚÔ¯¤Ù¢Û˘.

ŸÙ·Ó ÙÔ pH Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 7,0 Î·È 7,2, Û˘ÓÈ-

ÛÙ¿Ù·È Â·Ó¿ÏË„Ë Ù˘ ıˆÚ·ÎÔΤÓÙËÛ˘ ·Ó¿ 12-24

ÒÚ˜, ‰ÈfiÙÈ ˘¿Ú¯Ô˘Ó ·˘ÍË̤Ó˜ Èı·ÓfiÙËÙ˜ Ó·

ÌÂÙ·‚ÏËıÔ‡Ó ÔÈ ÙÈ̤˜ ηÈ, ÙÂÏÈο, Ó· ¯ÚÂÈ¿˙ÂÙ·È

·ÚÔ¯¤Ù¢ÛË (34).

O ۈϋӷ˜ Ú¤ÂÈ Ó· ÙÔÔıÂÙÂ›Ù·È ÛÙÔ ¯·ÌË-

ÏfiÙÂÚÔ ÛËÌÂ›Ô Ù˘ ˘Â˙ˆÎÔÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ηÈ

Ó· Û˘Ó‰¤ÂÙ·È ·Ú¯Èο Ì ·Ó·ÚÚfiÊËÛË ·ÚÓËÙÈ΋˜

›ÂÛ˘ (-20 cm H2O). ∏ ÂÊ·ÚÌÔÁ‹ ·ÚÓËÙÈ΋˜ ›Â-

Û˘ ‰È¢ÎÔχÓÂÈ ÙËÓ ¤ÎÙ˘ÍË ÙÔ˘ Ó‡ÌÔÓ·, Ô

ÔÔ›Ô˜ ÛÙË Û˘Ó¤¯ÂÈ· ÂÚÈÔÚ›˙ÂÈ ÙËÓ ÎÔÈÏfiÙËÙ· ÙÔ˘

ÂÌ˘‹Ì·ÙÔ˜. ™Â Û˘ÏÏÔÁ¤˜ Ì ÂÁ΢ÛÙÒÛÂȘ, ÌÔÚ›

Ó· Â›Ó·È ··Ú·›ÙËÙË Ë ÙÔÔı¤ÙËÛË ÂÚÈÛÛfiÙÂÚˆÓ

·fi ¤Ó·Ó ۈϋӈÓ.

∂¿Ó Û 24-48 ÒÚ˜ ·fi ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ Ûˆ-

Ï‹Ó· ·ÚÔ¯¤Ù¢Û˘ ‰ÂÓ ·Ú·ÙËÚËı› ‡ÊÂÛË ÙÔ˘

˘ÚÂÙÔ‡, Ë ‚ÂÏÙ›ˆÛË ‰ÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈ΋ ‹ Ë

ÔÛfiÙËÙ· ÙÔ˘ ˘ÁÚÔ‡ ‰ÂÓ ¤¯ÂÈ ÌÂȈı› ·ÎÙÈÓÔÏÔÁÈ-

ο, Ú¤ÂÈ Ó· Á›ÓÂÈ Â·Ó¤ÏÂÁ¯Ô˜ ÌÂ Ó¤Ô ˘ÂÚ˯Ô-

ÁÚ¿ÊËÌ· ‹ ›Ûˆ˜ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÚÔÎÂÈ̤ÓÔ˘

Ó· ‰È¢ÎÚÈÓÈÛÙ› ·Ó ÚfiÎÂÈÙ·È ÁÈ·: ·) ·Ú·ÌÔÓ‹

ÂÁ΢Ûو̤ÓÔ˘ ˘ÁÚÔ‡, ‚) ·fiÊÚ·ÍË ÙÔ˘ ۈϋӷ

·fi ·¯‡ÚÚ¢ÛÙÔ ‡ÔÓ, ÁˆÓ›·ÛË ‹ η΋ ÙÔÔı¤-

ÙËÛË ÙÔ˘ ۈϋӷ ‹ Á) ·ÚÔ˘Û›· ÂÎÙÂٷ̤Ó˘ ‹ ÓÂ-

ÎÚˆÙÈ΋˜ ˘ÔΛÌÂÓ˘ Ó¢ÌÔÓ›·˜.

∂¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË Ì˯·ÓÈÎÔ‡ Έχ̷ÙÔ˜

Ô˘ ÌÔÚ› Ó· ÂÈÏ˘ı› Ì ÙË ÌÂٷΛÓËÛË ÙÔ˘ Ûˆ-

Ï‹Ó·, ÙfiÙÂ Û˘˙ËÙÂ›Ù·È Ë ¯Ú‹ÛË ÈÓˆ‰ÔÏ˘ÙÈÎÒÓ ‹ Ë

¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË. O ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·-

ÚÈÛÌfi˜ ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙ› Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ

Ô˘ Ô ·ÛıÂÓ‹˜ ‚ÂÏÙÈÒÓÂÙ·È ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÏÔÁÈ-

ο, ·ÏÏ¿ ÙÔ ˘ÁÚfi Ô˘ ·ÚÔ¯ÂÙ‡ÂÙ·È Û˘Ó¯›˙ÂÈ Ó·

Â›Ó·È ˘Ò‰Â˜. °ÂÓÈο, Ë ÚÒÈÌË ·ÚÔ¯¤Ù¢ÛË ÂÈ-

ÏÂÁ̤Ó˘ ¶¶™ ‹ ÂÌ˘‹Ì·ÙÔ˜ Û ·È‰È¿ ›ӷÈ

·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (36).

O ۈϋӷ˜ ·ÚÔ¯¤Ù¢Û˘ Û˘ÓÈÛÙ¿Ù·È Ó· ·Ú·-

̤ÓÂÈ ¤ˆ˜ fiÙÔ˘ Ë ÔÛfiÙËÙ· ÙÔ˘ ÔÚÒ‰Ô˘˜ ˘ÁÚÔ‡

Ô˘ ·ÚÔ¯ÂÙ‡ÂÙ·È Ó· Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 25-50

ml ·Ó¿ Ë̤ڷ ‹ 1-1,5 ml/kg ·Ó¿ Ë̤ڷ (34).

∏ Û‡Á¯ÚÔÓË Ù¿ÛË Â˘ÓÔ› ÙË ¯Ú‹ÛË ÛˆÏ‹ÓˆÓ ÌÂ-

Á¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·fiÊڷ͢ ·fi

·¯‡ÚÚ¢ÛÙÔ ˘ÁÚfi. øÛÙfiÛÔ, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ηϿ

·ÔÙÂϤÛÌ·Ù· Î·È Ì ÙË ¯Ú‹ÛË ÛˆÏ‹ÓˆÓ ÌÈÎÚ‹˜

‰È·Ì¤ÙÚÔ˘ (8-16 F) ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË ·ÍÔÓÈÎÔ‡

ÙÔÌÔÁÚ¿ÊÔ˘ ‹ ˘ÂÚ˯ÔÙÔÌÔÁÚ¿ÊÔ˘.

∏ ¯ÚËÛÈÌfiÙËÙ· Ù˘ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ

ÂÓ‰Ô¸Â˙ˆÎÔÙÈο ‰ÂÓ ¤¯ÂÈ ÂȂ‚·Èˆı› (37).

πÓˆ‰ÔÏ˘ÙÈο

™¯ÂÙÈο ÚfiÛÊ·Ù· Ù¤ıËΠÙÔ ı¤Ì· Ù˘ ÙÔÈ΋˜

¤Á¯˘Û˘ ÈÓˆ‰ÔÏ˘ÙÈÎÒÓ ÁÈ· ÙË ıÂڷ›· ÙˆÓ ÂÈ-

ÏÂÁÌ¤ÓˆÓ ¶¶™ Î·È ÙˆÓ ÂÌ˘ËÌ¿ÙˆÓ, ÚÔÎÂÈ̤-

ÓÔ˘ Ó· ÂÚÈÔÚÈÛÙÔ‡Ó ÔÈ ÂÚÈÙÒÛÂȘ fiÔ˘ ›ӷÈ

·Ó·Áη›· Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË, ÌÂÙ¿ ·fi ÙË

ıÂÙÈ΋ ÂÌÂÈÚ›· Ô˘ ·ÔÎÔÌ›ÛÙËΠ·fi ÙÔ˘˜ ÂÓË-

Ï›ÎÔ˘˜. ∆Ô ÔÛÔÛÙfi ÙˆÓ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ

ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Î˘Ì·›ÓÂÙ·È ·fi 38% ¤ˆ˜

100%, ·Ó¿ÏÔÁ· Ì ÙÔ ÛÙ¿‰ÈÔ Ù˘ Û˘ÏÏÔÁ‹˜ ÛÙÔ

ÔÔ›Ô ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó (37-40).

¢È·ÈÛÙÒıËÎ·Ó ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ÙfiÛÔ

Ì ÙË ¯Ú‹ÛË Ù˘ ÛÙÚÂÙÔÎÈÓ¿Û˘, fiÛÔ Î·È Ù˘ Ô˘-

ÚÔÎÈÓ¿Û˘. OÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙ›-

ÓÔ˘Ó ÙË ¯Ú‹ÛË Ù˘ Ô˘ÚÔÎÈÓ¿Û˘, ηıÒ˜ ·ÚÔ˘ÛÈ¿-

˙ÂÈ ÏÈÁfiÙÂÚ˜ ·ÏÏÂÚÁÈΤ˜ Î·È ˘ÚÂÙÔÁfiÓ˜ ·ÓÂÈı‡-

ÌËÙ˜ ÂÓ¤ÚÁÂȘ (43,44). ™Â η̛· ÌÂϤÙË ‰ÂÓ ·Ó·-

ʤÚıËΠ‰È·Ù·Ú·¯‹ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ (39).

∏ ‰fiÛË Ù˘ ÛÙÚÂÙÔÎÈÓ¿Û˘ Â›Ó·È 250.000 ÌÔ-

Ó¿‰Â˜ ·Ó¿ Ë̤ڷ, ÂÓÒ Ù˘ Ô˘ÚÔÎÈÓ¿Û˘ Î˘Ì·›ÓÂÙ·È

·fi 50.000 ̤¯ÚÈ 250.000 ÌÔÓ¿‰Â˜ ·Ó¿ Ë̤ڷ.

OÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ (40) Û˘ÓÈÛÙÔ‡Ó ıÂ-

ڷ›· Ì ÈÓˆ‰ÔÏ˘ÙÈο ÁÈ· 3 Ë̤Ú˜ Î·È Â¿Ó ‰ÂÓ

ÛËÌÂȈı› ‚ÂÏÙ›ˆÛË, ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÚÔ¯¤Ù¢ÛË.

ÕÏÏÔÈ ÚÔÙ›ÓÔ˘Ó Î·È ‰Â‡ÙÂÚË ÚÔÛ¿ıÂÈ· ÈÓˆ‰Ô-

Ï˘ÙÈ΋˜ ·ÁˆÁ‹˜ (41-43).

∫·È Ù· ‰‡Ô ÈÓˆ‰ÔÏ˘ÙÈο ¯ÔÚËÁÔ‡ÓÙ·È Ì¤Ûˆ

ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ۈϋӷ, ‰È·Ï˘Ì¤Ó· Û 50-100 ml

¶·È‰È·ÙÚÈ΋ 2005;68:18-27

¶¶››ÓÓ··Îη·˜̃ 44.. ∂Ӊ›ÍÂȘ ÙÔÔı¤ÙËÛ˘ ۈϋӷ ·ÚÔ¯¤Ù¢Û˘ ÛÙȘ ¶¶™ (6)

1. ¶·ÚÔ˘Û›· ‡Ô˘ ÛÙËÓ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ· 2. £ÂÙÈ΋ ¯ÚÒÛË Î·Ù¿ Gram ÙÔ˘ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ 3. °Ï˘Îfi˙Ë <50 mg/dl ÛÙÔ Ï¢ÚÈÙÈÎfi ˘ÁÚfi 4. pH <7 ÙÔ˘ ˘Â˙ˆÎÔÙÈÎÔ‡ ˘ÁÚÔ‡ 5. ¶·ÚÔ˘Û›· ‰È·ÊÚ·ÁÌ·Ù›ˆÓ Î·È Ù·ÈÓÈÒÓ ÛÙÔ Ï¢ÚÈÙÈÎfi ˘ÁÚfi ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·

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26 ¢. ªÂÚÌ›ÚË Î·È Û˘Ó.

Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡. ™ÙË Û˘Ó¤¯ÂÈ·, ‰È·ÎfiÙÂÙ·È Ë·ÚÔ¯‹ ÁÈ· 2, 4, 6 ‹ 12 ÒÚ˜, Ì ٷ˘Ùfi¯ÚÔÓ˜ ·ÏÏ·-Á¤˜ Ù˘ ÛÙ¿Û˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ Û ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ·.∆ÂÏÈο, ÂÏ¢ıÂÚÒÓÂÙ·È Ô ÛˆÏ‹Ó·˜ Î·È Û˘Ó‰¤ÂÙ·ÈÌ ÙËÓ ·Ó·ÚÚfiÊËÛË. ∞Ó ·Ú·ÙËÚÂ›Ù·È ¿ÏÁÔ˜ ηٿÙËÓ ÂÓÛÙ¿Ï·ÍË Ù˘ Ô˘ÚÔÎÈÓ¿Û˘, ÌÔÚ› Ó· ¯ÔÚË-ÁËı› ·Ó·ÏÁËÙÈÎfi ·fi ÙÔ ÛÙfiÌ· ‹ Ó· ÙÔÔıÂÙËı›ÙÔÈÎfi ·Ó·ÈÛıËÙÈÎfi ‰È·Ì¤ÛÔ˘ ÙÔ˘ ۈϋӷ.

∞ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÈÓˆ‰ÔÏ˘ÙÈÎÒÓ·ÔÙÂÏÔ‡Ó Ë ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË Û ·˘Ù¤˜ ÙȘ Ô˘-ۛ˜ Û ÚÔËÁÔ‡ÌÂÓË ¯ÔÚ‹ÁËÛË, ÙÔ ÚfiÛÊ·ÙÔÙÚ·‡Ì· ‹ ¯ÂÈÚÔ˘ÚÁ›Ô, ÙÔ ÂÁÎÂÊ·ÏÈÎfi ·ÈÌÔÚÚ·ÁÈÎfi¤ÌÊÚ·ÎÙÔ, ÔÈ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜, Ë ıÚÔÌ‚ÔÂÓ›·,Ë Ë·ÙÈ΋ ·Ó¿ÚÎÂÈ·, Ë ÂÁ΢ÌÔÛ‡ÓË Î·È ÙÔ ‚ÚÔÁ-¯ÔÓ¢ÌÔÓÈÎfi Û˘Ú›ÁÁÈÔ.

ÃÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ ̤ۈ ıˆÚ·ÎÔÙÔ-

Ì‹˜ ‹ ̤ۈ ıˆÚ·ÎÔÛÎfiËÛ˘

O ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ ̤ۈ ÌÈÎÚ‹˜ ıˆÚ·-ÎÔÙÔÌ‹˜ ·ÔÙÂÏ› ÙÔÓ ÎÏ·ÛÈÎfi ÙÚfiÔ ·ÚÔ¯¤Ù¢-Û˘ ÙÔ˘ ÂÌ˘‹Ì·ÙÔ˜ fiÙ·Ó ÂÈ̤ÓÂÈ Ô ˘ÚÂÙfi˜ ηÈÂ›Ó·È ¯Ú‹ÛÈÌÔ˜ ÛÙËÓ ÈÓÔ˘Ò‰Ë Ê¿ÛË Ì ÂÁ΢ÛÙÒ-ÛÂȘ Î·È Û˘ÌʇÛÂȘ. ∂Ó·ÏÏ·ÎÙÈ΋ χÛË ·ÔÙÂÏ› Ôηı·ÚÈÛÌfi˜ ̤ۈ ıˆÚ·ÎÔÛÎfiËÛ˘. ¶ÏÂÔÓÂÎÙ›¤Ó·ÓÙÈ Ù˘ ıˆÚ·ÎÔÙÔÌ‹˜, ‰ÈfiÙÈ Â›Ó·È ÏÈÁfiÙÂÚÔÙÚ·˘Ì·ÙÈÎfi˜ Î·È ÚÔηÏ› ÏÈÁfiÙÂÚÔ ÌÂÙÂÁ¯ÂÈÚËÙÈ-Îfi ¿ÏÁÔ˜. ∞ÓÙÈı¤Ùˆ˜, ‰ÂÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ÛÙË Ê¿ÛË Ù˘ ÔÚÁ¿ÓˆÛ˘ Î·È Â›Ó·È ÂÊÈÎÙfi˜ ÌfiÓÔ Û·ÛıÂÓ›˜ Ô˘ ·ÓÙ¤¯Ô˘Ó ÙËÓ ÂÎÏÂÎÙÈ΋ ·Ó·Ó¢ÛÙÈ-΋ ˘ÔÛÙ‹ÚÈÍË. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ ÛÙȘ‰È¿ÊÔÚ˜ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ÔÈΛÏÏÂÈ, ·Ó¿ÏÔÁ·Ì ÙÔ fiÛÔ ÚÒÈÌ· ÂÎÙÂÏ›ٷÈ, Î˘Ì·ÈÓfiÌÂÓË ·fi30% ¤ˆ˜ 100% (43-48). ∂¿Ó ·ÔÙ‡¯ÂÈ, Ú¤ÂÈ Ó··ÎÔÏÔ˘ı‹ÛÂÈ ıˆÚ·ÎÔÙÔÌ‹.

∞ÔÊÏÔ›ˆÛË Ì¤Ûˆ ıˆÚ·ÎÔÙÔÌ‹˜

ªÂ ·˘Ù‹ ÙË ‰È·‰Èηۛ· ·Ê·ÈÚÂ›Ù·È fiÏÔ˜ Ô ÈÓÒ-‰Ë˜ ÈÛÙfi˜ ÙÔ˘ ÛÏ·Á¯ÓÈÎÔ‡ ÂÙ¿ÏÔ˘ ÙÔ˘ ˘Â˙ˆÎfi-Ù· Î·È ·ÚÔ¯ÂÙ‡ÂÙ·È fiÏÔ ÙÔ ‡ÔÓ ·fi ÙËÓ ˘Â˙ˆ-ÎÔÙÈ΋ ÎÔÈÏfiÙËÙ·. ∂›Ó·È ··Ú·›ÙËÙË Ï‹Ú˘ ıˆÚ·-ÎÔÙÔÌ‹.

™ÙËÓ ÔÍ›· Ê¿ÛË ÂӉ›ÎÓ˘Ù·È ÌfiÓÔ ÁÈ· ÙÔÓ¤ÏÂÁ¯Ô Ù˘ Ïԛ̈͢ ÙÔ˘ ˘Â˙ˆÎfiÙ·, ·Ó ·˘Ùfi ‰ÂÓÂÈÙ˘Á¯¿ÓÂÙ·È Ì ¿ÏϘ Û˘ÓÙËÚËÙÈÎfiÙÂÚ˜ ÌÂıfi-‰Ô˘˜. ™ÙË ¯ÚfiÓÈ· Ê¿ÛË Á›ÓÂÙ·È ·Ê·›ÚÂÛË ÙÔ˘ ÈÓÒ-‰Ô˘˜ ÙÔȯÒÌ·ÙÔ˜ Ô˘ ÚÔηÏ› ÏÂÈÙÔ˘ÚÁÈÎfi ÂÚÈÔ-ÚÈÛÌfi. ∂›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙË Ï‡ÛË ÙÔ˘ÂÌ˘‹Ì·ÙÔ˜ ÛÙÔ 90-95% (48-50).

¢ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È fiÙ·Ó ˘¿Ú¯ÂÈ ÌfiÓÔ ¿-¯˘ÓÛË ÙÔ˘ ˘Â˙ˆÎfiÙ·, ‰ÈfiÙÈ ·˘Ù‹ ˘Ô¯ˆÚ› ·˘Ùfi-Ì·Ù· Û ‰È¿ÛÙËÌ· ÌÂÚÈÎÒÓ ÌËÓÒÓ.

∏ ıÓËÙfiÙËÙ· Î·È Ë ÓÔÛËÚfiÙËÙ· ·Ú·Ì¤ÓÔ˘Ó˘„ËϤ˜ ·ÎfiÌ· Î·È Û‹ÌÂÚ·. ∏ ıÓËÙfiÙËÙ· Î˘Ì·›ÓÂ-Ù·È Û ÔÛÔÛÙfi 2-15%, ÂÓÒ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ıˆÚÔ‡ÓÙ·È Ë ‰È¿ÚÎÂÈ·, Ë ‚·Ú‡ÙËÙ· Ù˘ Ïԛ̈ÍË˜Î·È Ë ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓ‹ (4).

™˘ÌÂÚ¿ÛÌ·Ù·

OÈ ¶¶™ Û˘ÓÔ‰Â‡Ô˘Ó Û˘¯Ó¿ ÙȘ Ó¢ÌÔӛ˜ Ô˘¯ÚÂÈ¿˙ÔÓÙ·È ÓÔÛËÏ›· ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ÚÔ‚¿Ï-ÏÔ˘Ó ÎÏÈÓÈο Ì ÔÈΛÏË ‚·Ú‡ÙËÙ·.

°È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ ¯ÚËÛÈÌÔÔÈÔ‡-ÓÙ·È ÙfiÛÔ ÎÏÈÓÈο fiÛÔ Î·È ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ·.ÃÚ‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ·Ú¤¯ÂÈ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊË-Ì·. ∏ ıˆÚ·ÎÔΤÓÙËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÁηÈÚ·.OÈ ÏËÚÔÊÔڛ˜ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È ·fi ÙËÓ ·Ó¿Ï˘-ÛË ÙÔ˘ ˘ÁÚÔ‡ Â›Ó·È Î·ıÔÚÈÛÙÈΤ˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛËÙˆÓ ÂÚ·ÈÙ¤Úˆ ıÂڷ¢ÙÈÎÒÓ ¯ÂÈÚÈÛÌÒÓ.

∏ ÂÈÏÔÁ‹ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·ÈÌ ÂÚ›Û΄Ë. ∏ ÙÔÔı¤ÙËÛË ÙÔ˘ ۈϋӷ ·ÚÔ¯¤-Ù¢Û˘, ÂÊfiÛÔÓ ÎÚÈı› ··Ú·›ÙËÙË, Ú¤ÂÈ Ó· Á›ÓÂ-Ù·È ÓˆÚ›˜, ÙÔ ›‰ÈÔ Î·È Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜fiÙ·Ó ¯ÚÂÈ¿˙ÂÙ·È.

∏ ‚È‚ÏÈÔÁÚ·Ê›· ·Ú·Ì¤ÓÂÈ ÂÈÊ˘Ï·ÎÙÈ΋ ˆ˜ÚÔ˜ ÙË ¯Ú‹ÛË ÙˆÓ ÈÓˆ‰ÔÏ˘ÙÈÎÒÓ ÛÙ· ·È‰È¿.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Mocelin HT, Fischer GB. Epidemiology, presentation andtreatment of pleural effusion. Paediatr Respir Rev2002;3:292-297.

2. Tan TQ, Mason EO Jr, Wald ER, Barson WJ, Schutze GE,Bradley JS et al. Clinical characteristics of children with com-plicated pneumonia caused by Streptococcus pneumoniae.Pediatrics 2002;110:1-6.

3. De Luca A, Kurland G. Empyema in children: epidemiology,diagnosis and management. Semin Pediatr Infect Dis1998;9:205-211.

4. Hamm H, Light RW. Parapneumonic effusion and empye-ma. Eur Respir J 1997;10:1150-1156.

5. Light RW. A new classification of parapneumonic effusionsand empyema. Chest 1995;108:299-301.

6. Sahn SA. State of the art. The pleura. Am Rev Respir Dis1988;138:184-234.

7. Structure and function of the respiratory system. πn: BerneRM, Levy MN, editors. Physiology. 4th ed. Saint Louis, MO,U.S.A.: Mosby, Inc; 1998. p. 517-533.

8. Efrati O, Barak A. Pleural effusions in the pediatric popula-tion. Pediatr Rev 2002;23:417-426.

9. Freij BJ, Kusmiesz H, Nelson JD, McCracken GH Jr. Parap-neumonic effusions and empyema in hospitalized children: aretrospective review of 227 cases. Pediatr Infect Dis1984;3:578-591.

10. Bremont F, Baunin C, Juchet A, Rance F, Puget C, Juricic Met al. Evolution clinique et traitement de l’empyeme pleuralchez l’enfant. Arch Pediatr 1996;3:335-341.

11. Sarihan H, Cay A, Aynaci M, Akyazici R, Baki A. Empyemain children. J Cardiovasc Surg 1998;39:113-116.

12. Hardie WD, Roberts NE, Reising SF, Christie CD. Compli-cated parapneumonic effusions in children caused by peni-cillin-nonsusceptible Streptococcus pneumoniae. Pediatrics1998;101:388-392.

13. Tan TQ, Mason EO Jr, Barson WJ, Wald ER, Schutze GE,Bradley JS et al. Clinical characteristics and outcome of chil-dren with pneumonia attributable to penicillin-susceptibleand penicillin-nonsusceptible Streptococcus pneumoniae.Pediatrics 1998;102:1369-1375.

14. Bryant RE, Salmon CJ. Pleural empyema. Clin Infect Dis1996;22:747-762.

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¶·È‰È·ÙÚÈ΋ 2005;68:18-27

27¶·Ú·Ó¢ÌÔÓÈΤ˜ Û˘ÏÏÔÁ¤˜

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19. Ginsburg CM, Howard JB, Nelson JD. Report of 65 cases ofHaemophilus influenzae b pneumonia. Pediatrics1979;64:283-286.

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21. Yang PC, Luh KT, Chang DB, Wu HD, Yu CJ, Kuo SH. Valueof sonography in determining the nature of pleural effusion:analysis of 320 cases. AJR Am J Roentgenol 1992;159:29-33.

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28. Leonard SR, Nikaidoh H, Thompson WR. Thoracocentesisand chest tube insertion. In: Levin DL, Morriss FC, editors.Essentials of pediatric intensive care. 2nd ed. New York:Churchill Livingstone Inc; 1997. p. 1519-1526.

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38. Krishnan S, Amin N, Dozor AJ, Stringel G. Urokinase in themanagement of complicated parapneumonic effusions inchildren. Chest 1997;112:1579-1583.

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40. Bouros D, Schiza S, Patsourakis G, Chalkiadakis G, PanagouP, Siafakas NM. Intrapleural streptokinase versus urokinasein the treatment of complicated parapneumonic effusions: aprospective, double-blind study. Am J Respir Crit Care Med1997;155:291-295.

41. Thomson AH, Hull J, Kumar MR, Wallis C, Balfour LynnIM. Randomised trial of intrapleural urokinase in the treat-ment of childhood empyema. Thorax 2002;57:343-347.

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28 REVIEW ARTICLE

Department of Allergiology,Penteli Children’s Hospital,Athens

Correspondence:

Despina Mermiri Department of Allergiology,Penteli Children’s Hospital152 36, P. Penteli, Athens

Date of submission: 25-02-2004 Date of approval: 27-09-2004

Paediatriki 2005;68:28

Diagnostic approach and treatment of

parapneumonic effusions in children

D. Mermiri, K. Priftis

Abstract

Parapneumonic effusions constitute a rather common coexisting presentation of microbial pneumonias thatneed hospitalization, whereas empyemas are considered as complications of the disease per se. Despite thedecrease in morbidity from microbial infections of the respiratory tract, the frequency of empyemas isincreasing and that is considered to be the result of the widespread use of antibiotics and vaccine that favorthe emergence of resistant microbial strains. In regard to the recommended diagnostic practice, specialemphasis is given to the thoracic ultrasound because of the valuable information that could be drawn for theestimation of the effusion. The value of the in time thoracic paracentesis before the start of antibiotic therapy,in order to determine the type of effusion, is highlighted. The appropriate treatment is chosen according tothe results of the paracentesis fluid and the imaging findings. In case of a complicated parapneumoniceffusion, the positioning of a drainage tube and/or surgical management is recommended, aiming atdecreasing hospitalization time and avoiding adverse consequences. In the present review of the literature, therecent diagnostic and therapeutic approaches are discussed.

Key words

Parapneumonic effusion, empyema, pneumonia, drainage.

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29∞¡∞™∫O¶∏™∏

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¶. µÂϤÓÙ˙·˜

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∏ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ ·ÔÙÂÏ› Ôχ ‰È·‰Â‰Ô̤ÓË Ú·ÎÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ˘ Û˘ÓËıÈÛÌ¤ÓˆÓ ÎÏÈ-ÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ. ∆Ô ÙËϤʈÓÔ Â›Ó·È ¤Ó·˜ ‡ÎÔÏÔ˜, ¿ÌÂÛÔ˜, ÊıËÓfi˜ Î·È - οو ·fi Û˘-ÁÎÂÎÚÈ̤Ó˜ ÚÔ¸Ôı¤ÛÂȘ - ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜ ÂÈÎÔÈÓˆÓ›·˜ ÙˆÓ ÁÔÓ¤ˆÓ Ì ÙÔÓ ·È‰›·ÙÚÔ. °È· ÙÔÓÏfiÁÔ ·˘Ùfi, Ô ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ‰È·ı¤ÙÂÈ ·ÚÎÂÙfi ¯ÚfiÓÔ Î·ıËÌÂÚÈÓ¿ - Î·È ÂȉÈο ÙȘ ÌË ÂÚÁ¿ÛÈ-̘ ÒÚ˜ - ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰›ÓÂÈ Û˘Ì‚Ô˘Ï¤˜ Î·È Ô‰ËÁ›Â˜ ·fi ÙÔ ÙËϤʈÓÔ. ™ÙÔ ¿ÚıÚÔ ·˘Ùfi Á›ÓÂÙ·È Ì›· Û˘-ÓÔÙÈ΋ ·Ó·ÊÔÚ¿ ÛÙËÓ ÈÛÙÔÚ›· Ù˘ ·È‰È·ÙÚÈ΋˜ ·fi ÙÔ ÙËϤʈÓÔ Î·È ÛÙË Û¯¤ÛË ·È‰È¿ÙÚˆÓ-ÙËÏÂʈÓÈ-΋˜ È·ÙÚÈ΋˜, ÛÙÔ˘˜ Ù‡Ô˘˜ Î·È ÙȘ ‰˘ÛÎÔϛ˜ Ù˘ ÎÏÈÓÈ΋˜ ÊÚÔÓÙ›‰·˜ ̤ۈ ÙËÏÂÊÒÓÔ˘, ÛÙȘ ·Ó¿ÚÎÂÈÂ˜Î·È ÂÏÏ›„ÂȘ ÙÔ˘ ˘ÁÂÈÔÓÔÌÈÎÔ‡ ÚÔÛˆÈÎÔ‡ Ô˘ ‰›ÓÂÈ Û˘Ì‚Ô˘Ï¤˜ ·fi ÙÔ ÙËϤʈÓÔ Î·È ÛÙȘ Ô‰ËÁ›Â˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÎÏÈÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙËÏÂʈÓÈο. ∂›Û˘, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‰Â‰Ô̤ӷ ÁÈ· ÙËÓ ·ÔÙÂ-ÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ·˘Ù‹˜ Ù˘ ÌÂıfi‰Ô˘, ÙȘ ›ÁÔ˘Û˜ ÎÏ‹ÛÂȘ ÛÙËÓ ·È‰È·ÙÚÈ΋, ηıÒ˜ ηȂȂÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ̤ÛÔ˘ ·˘ÙÔ‡ ˆ˜ ÙÚfiÔ˘ ‰È·ÏÔÁ‹˜ (triage) Î·È ·ÚÔ¯‹˜Û˘Ì‚Ô˘ÏÒÓ Û ÎÏÈÓÈο ÂÚÈÛÙ·ÙÈο Ì ÙË ¯Ú‹ÛË ·È‰È·ÙÚÈÎÒÓ ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ Î·È Ì¤Ûˆ ÔÚÁ·Óˆ-Ì¤ÓˆÓ ÙËÏÂʈÓÈÎÒÓ Î¤ÓÙÚˆÓ.

§¤ÍÂȘ ÎÏÂȉȿ

TËÏÂʈÓÈ΋ È·ÙÚÈ΋, ·È‰È·ÙÚÈ΋, ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰·, ›ÁÔ˘Û· È·ÙÚÈ΋, ÙËÏÂʈÓÈο ΤÓÙÚ·.

∫¤ÓÙÚÔ ÀÁ›·˜ ª·ÚÎfiÔ˘ÏÔ˘ªÂÛÔÁ·›·˜

AÏÏËÏÔÁÚ·Ê›·:

¶ÔÏ˘˙Ò˘ µÂϤÓÙ˙·˜ ∂˘ÊÚ¿ÓÔÚÔ˜ 25, ∆.∫. 116 35, ∞ı‹Ó· E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 23-04-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 01-10-2004

¶·È‰È·ÙÚÈ΋ 2005;68:29-35

∂ÈÛ·ÁˆÁ‹

∏ ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›· ·ÔÙÂÏ› ··Ú·›ÙË-ÙÔ Î·È ·Ó·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ Ù˘ Û‡Á¯ÚÔÓ˘ ·È-‰È·ÙÚÈ΋˜ Ú·ÎÙÈ΋˜. OÈ ÁÔÓ›˜ ÚÔÛ‰ÔÎÔ‡Ó Ì¤ÛˆÙÔ˘ ÙËÏÂÊÒÓÔ˘ Ó· ¤¯Ô˘Ó Ì›· ¿ÌÂÛË, ·ÔÙÂÏÂÛÌ·-ÙÈ΋ Î·È Ì ÂÏ¿¯ÈÛÙÔ ÎfiÛÙÔ˜ ÂÈÎÔÈÓˆÓ›· Ì ÙÔӷȉ›·ÙÚfi ÙÔ˘˜, Ì ÛÎÔfi ÔÏϤ˜ ÊÔÚ¤˜ ÙËÓ ·ÓÙÈ-ÌÂÙÒÈÛË ÎÏÈÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓÙÔ˘˜. ∏ Î¿Ï˘„Ë Ô˘ ·Ú¤¯ÂÙ·È Û ٤ÙÔȘ ÂÚÈ-ÙÒÛÂȘ ̤ۈ ÙÔ˘ ÙËÏÂÊÒÓÔ˘ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfiÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ·È‰È¿ÙÚÔ˘ Î·È ÁÈ· ÙËÓ ÔÈ-ÎÔ‰fiÌËÛË Î·ÏÒÓ Û¯¤ÛÂˆÓ Ì ÙÔ˘˜ ÁÔÓ›˜.

ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ·Ú¤-¯ÔÓÙ·È ·Ó·ÚΛ˜ ÙËÏÂʈÓÈΤ˜ Û˘Ì‚Ô˘Ï¤˜ ·fi˘Â‡ı˘ÓÔ˘˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ·È‰ÈÒÓ. ŒÙÛÈ, Ë ·Ó¿-Ù˘ÍË ÂÎ·È‰Â˘ÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ - Ô˘ ̤¯ÚÈÛ‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙË ¯ÒÚ· Ì·˜ - ÁÈ· ·˘Ùfi ÙÔÛËÌ·ÓÙÈÎfi fiÛÔ Î·È ·ÌÊÈÏÂÁfiÌÂÓÔ ÎÔÌÌ¿ÙÈ Ù˘ ·È-‰È·ÙÚÈ΋˜ Ú·ÎÙÈ΋˜, ·ÔÙÂÏ› Ì›· Û‡Á¯ÚÔÓË ·Ó·-ÁηÈfiÙËÙ·. ™ÙËÓ Î·Ù‡ı˘ÓÛË ·˘Ù‹ ¤¯Ô˘Ó ·Ó·Ù˘-¯ı›, ΢ڛˆ˜ ÛÙȘ ∏¶∞, ÙËÏÂʈÓÈΤ˜ ·È‰È·ÙÚÈΤ˜Û˘ÛÙ¿ÛÂȘ, Ì ÙȘ Ôԛ˜ ·Ú¤¯ÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ·‰È·ÏÔÁ‹˜ ÙˆÓ ·È‰ÈÒÓ Î·È ·ÚÔ¯‹˜ Ô‰ËÁÈÒÓ Î·ÈÛ˘Ì‚Ô˘ÏÒÓ ·fi ÙÔ ÙËϤʈÓÔ.

™ÎÔfi˜ ÙÔ˘ ¿ÚıÚÔ˘ Â›Ó·È Ó· ‰ÒÛÂÈ ÛÙÔÓ ÎÏÈÓÈÎfi·È‰›·ÙÚÔ Ì›· ÁÂÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÚÔ-‚ÏËÌ·ÙÈÛÌÔ‡ - fiˆ˜ ·˘Ùfi˜ ÚÔ·ÙÂÈ ·fi ‚È‚ÏÈÔ-ÁÚ·ÊÈο ‰Â‰Ô̤ӷ - Î·È Ó· ı›ÍÂÈ, ›Ûˆ˜ ÁÈ· ÚÒÙË ÊÔ-Ú¿, ÔÚÈṲ̂Ó˜ ÂӉȷʤÚÔ˘Û˜ Ù˘¯¤˜ ÙÔ˘ ı¤Ì·ÙÔ˜.

∏ ÙËÏÂʈÓÈ΋ È·ÙÚÈ΋ ÛÙËÓ ·È‰È·ÙÚÈ΋:

ÈÛÙÔÚÈ΋ ·Ó·‰ÚÔÌ‹

1876: £ÂˆÚÂ›Ù·È Ë ¯ÚÔÓÈ¿ ·Ó·Î¿Ï˘„˘ ÙÔ˘ ÙË-ÏÂÊÒÓÔ˘ ·fi ÙÔÓ Alexander G. Bell, ∞ÌÂÚÈηÓfi-™ÎˆÙÛ¤˙Ô ∫·ıËÁËÙ‹ Ù˘ º˘ÛÈÔÏÔÁ›·˜ ÙÔ˘ ÏfiÁÔ˘ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ µÔÛÙfiÓ˘, Ô ÔÔ›Ô˜ ÂӉȷ-ʤÚıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÁÈ· ÙË ÌÂÙ¿‰ÔÛË Ù˘ ·Ó-ıÚÒÈÓ˘ ʈӋ˜.

1879: ∏ ÚÒÙË ·Ó·ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·ÓÙÈ-ÌÂÙÒÈÛ˘ ÎÏÈÓÈÎÔ‡ ÂÚÈÛÙ·ÙÈÎÔ‡ ÙËÏÂʈÓÈο (1).ª›· ·Ó‹Û˘¯Ë ÌËÙ¤Ú· ηÏ› ÙÔÓ ·È‰›·ÙÚÔ ÌÂÙ·ÌÂ-ÛÔÓ‡¯ÙÈ· ÒÚ· ÁÈ·Ù› ÓÔÌ›˙ÂÈ fiÙÈ ÙÔ ÌÈÎÚfi ·È‰› Ù˘¤¯ÂÈ croup. O ÁÈ·ÙÚfi˜ ϤÂÈ ÛÙË ÌËÙ¤Ú· Ó· ÙÔÔıÂ-Ù‹ÛÂÈ ÙÔ ·È‰› ‰›Ï· ÛÙÔ ·ÎÔ˘ÛÙÈÎfi ÁÈ· Ó· ·ÎÔ‡ÛÂÈÒ˜ ‚‹¯ÂÈ Î·È ‰È·ÈÛÙÒÓÔÓÙ·˜ fiÙÈ ‰ÂÓ ¤¯ÂÈ croup,ηıËÛ‡¯·Û ÙË ÌËÙ¤Ú·.

1930-1950: ªÂ ÙËÓ Â˘Ú›· ‰È¿‰ÔÛË ÙÔ˘ ÙËÏÂÊÒ-ÓÔ˘ ÛÙÔÓ ‰˘ÙÈÎfi ÎfiÛÌÔ, ·Ó·Ù‡ÛÛÂÙ·È Î·È Ë ÚÔÛ-‰ÔΛ· ÁÈ· ·ÚÔ¯‹ 24ˆÚ˘ ÙËÏÂʈÓÈ΋˜ Î¿Ï˘„˘·fi ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜.

1960-1970: ™Â ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ÛÙȘ ∏¶∞, ‰È·-ÈÛÙÒıËΠfiÙÈ Ô ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜ ÂÚÓ¿ ÙÔ 12,5%Ù˘ ÂÚÁ¿ÛÈÌ˘ Ë̤ڷ˜ ÛÙÔ ÙËϤʈÓÔ ‹ ··Û¯ÔÏ›ٷÈ11,9±2,8 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰· ‰›ÓÔÓÙ·˜ ÙËÏÂʈÓÈΤ˜Û˘Ì‚Ô˘Ï¤˜ (2,3). OÈ ·È‰›·ÙÚÔÈ Â›Ó·È ÔÈ ÁÈ·ÙÚÔ› Ì ÙÔÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ¯Ú‹Û˘ Ù˘ ÙËÏÂʈÓÈ΋˜ ÂÈ-ÎÔÈÓˆÓ›·˜ ÁÈ· ÎÏÈÓÈ΋ ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘˜.

1972: ∏ ∞ÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∞η‰ËÌ›·(∞∞P) ÂΉ›‰ÂÈ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·fi

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·29

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30 ¶. µÂϤÓÙ˙·˜

ÙÔ ÙËϤʈÓÔ ÎÔÈÓÒÓ ·È‰È·ÙÚÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ(4). ∞Ú¯›˙ÂÈ Ë ‰ËÌÔÛ›Â˘ÛË ÙˆÓ ÚÒÙˆÓ ·È‰È·ÙÚÈ-ÎÒÓ ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛˆÓ.

1985: ∆· ÌÈÛ¿ (51%) ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›·ÛÙȘ ∏¶∞ ·Ú¤¯Ô˘Ó ÛÙÔ˘˜ ÂȉÈ΢fiÌÂÓÔ‡˜ ÙÔ˘˜Î¿ÔÈ·˜ ÌÔÚÊ‹˜ Âη›‰Â˘ÛË ÛÙËÓ ÙËÏÂʈÓÈ΋ È·-ÙÚÈ΋, fiˆ˜ ‰È·Ï¤ÍÂȘ, ·Ó·ÛÎfiËÛË ÙËÏÂʈÓÈÎÒÓÛ˘Ó‰È·Ï¤ÍˆÓ, ‰È‰·Ûηϛ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÎÏ‹Û˘ Î·È ¯ÚËÛÈÌÔÔ›ËÛË ˘ÔıÂÙÈÎÒÓ ·ÛıÂÓÒÓ(5). ∆ÂÏÂ˘Ù·›·, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂȉÈο CD-ROMÁÈ· Âη›‰Â˘ÛË Ì¤Ûˆ ˘ÔÏÔÁÈÛÙ‹ (6).

1988: OÚÁ·ÓÒÓÂÙ·È ÙÔ ÚÒÙÔ ·È‰È·ÙÚÈÎfi ÙËÏÂ-ʈÓÈÎfi ΤÓÙÚÔ (after-hours pediatric call center)ÛÙÔ Denver, Ì ÙËÓ ÂıÂÏÔÓÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ȉȈÙÒӷȉȿÙÚˆÓ Î·È ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ηıÔ‰‹ÁËÛË Î·ÈÔÚÁ¿ÓˆÛË ÙÔ˘ ·ÓÂÈÛÙËÌÈ·ÎÔ‡ ·È‰È·ÙÚÈÎÔ‡ ÓÔ-ÛÔÎÔÌ›Ԣ Ù˘ fiÏ˘ (7). ∆Ô 1998, Ë AAP Âͤ‰ˆÛÂÔ‰ËÁ›Â˜ ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ·È‰È·ÙÚÈÎÒÓ ÙËÏÂʈÓÈ-ÎÒÓ Î¤ÓÙÚˆÓ (8). ™‹ÌÂÚ·, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ˘Ï¿-¯ÈÛÙÔÓ ÙÔ 25% ÙˆÓ ÁÂÓÈÎÒÓ ·È‰È¿ÙÚˆÓ ÛÙȘ ∏¶∞ηχÙÂÈ ÙȘ ÙËÏÂʈÓÈΤ˜ ·Ó¿ÁΘ ÙˆÓ ·ÛıÂÓÒÓÙÔ˘ ÛÙȘ ÌË ÂÚÁ¿ÛÈ̘ ÒÚ˜ Î·È Ë̤Ú˜ ̤ۈ Ù¤ÙÔÈ-ˆÓ ÔÚÁ·ÓˆÌ¤ÓˆÓ ΤÓÙÚˆÓ (8). ™ÙËÓ ›‰È· ¯ÒÚ·, ›-Û˘, ÂÓı·ÚÚ‡ÓÂÙ·È Ë ÂÚÁ·Û›· ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÂÌÈÎÚ¤˜ ÔÌ¿‰Â˜ (3-8 ÁÈ·ÙÚÔ›) Î·È Ë ÔÚÁ¿ÓˆÛË ÌÈÎÚfi-ÙÂÚˆÓ ÙËÏÂʈÓÈÎÒÓ Î¤ÓÙÚˆÓ Ô˘ Ó· ηχÙÔ˘Ó Ù·Ì¤ÏË Ù˘ ÔÌ¿‰·˜.

1990: ∆Ô American College of EmergencyPhysicians ıˆÚ› fiÙÈ Ù· ∆Ì‹Ì·Ù· ∂ÂÈÁfiÓÙˆÓ ¶Â-ÚÈÛÙ·ÙÈÎÒÓ (∆∂¶) ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ‰ÂÓ Ú¤ÂÈ Ó·ı¤ÙÔ˘Ó ‰È¿ÁÓˆÛË Ô‡Ù ӷ ‰›ÓÔ˘Ó Î¿ÔÈ· ıÂڷ›··fi ÙÔ ÙËϤʈÓÔ, ÂÎÙfi˜ Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ·ÛıÂÓ›˜Ô˘ ¤¯Ô˘Ó ‹‰Ë ÂÍÂÙ·ÛÙ› ÛÙ· ›ÁÔÓÙ· Î·È ¯ÚÂÈ¿-˙ÔÓÙ·È ‰È¢ÎÚÈÓ›ÛÂȘ ÁÈ· ÙË ıÂڷ›· ÙÔ˘˜, Â¿Ó Úfi-ÎÂÈÙ·È ÁÈ· ·ÚÔ¯‹ ÚÒÙˆÓ ‚ÔËıÂÈÒÓ ‹ ÁÈ· ÙËÓ ˘fi-‰ÂÈÍË ÙÚfiÔ˘ ÚfiÛ‚·Û˘ ÁÈ· È·ÙÚÈ΋ ÊÚÔÓÙ›‰· (9).

2000: ∏ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ ·ÊÔÚ¿ÛÙÔ 30% Ù˘ ηıËÌÂÚÈÓ‹˜ ÎÏÈÓÈ΋˜ Ú·ÎÙÈ΋˜ ÙÔ˘ÁÂÓÈÎÔ‡ ·È‰È¿ÙÚÔ˘ Î·È Êı¿ÓÂÈ ÛÙÔ 80% ÛÙȘ ÌË ÂÚ-Á¿ÛÈ̘ ÒÚ˜ Î·È Ë̤Ú˜ (10). ¶·Ú·ÙËÚ›ٷÈ, ‰Ë-Ï·‰‹, ·‡ÍËÛË Ù˘ ÙËÏÂʈÓÈ΋˜ È·ÙÚÈ΋˜ Ù· ÙÂÏ¢-Ù·›· ¯ÚfiÓÈ·, ÏfiÁˆ Ù˘ ·Ó¿Ù˘Í˘ Ù˘ Ù¯ÓÔÏÔÁ›·˜(ÎÈÓËÙ‹ ÙËÏÂʈӛ·) Î·È Î˘Ú›ˆ˜ ÏfiÁˆ ÙÔ˘ Û‡Á¯ÚÔ-ÓÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ (ÂÚÁ·˙fiÌÂÓÔÈ Î·È ÔÈ ‰‡Ô ÁÔÓ›˜,·È‰ÈÎÔ› ÛÙ·ıÌÔ› Î.¿.).

2002: ∫˘ÎÏÔÊÔÚ› Ë ÙÂÏÂ˘Ù·›· ¤Î‰ÔÛË ÙˆÓ ·È-‰È·ÙÚÈÎÒÓ ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ ·fi ÙËÓ AAP,ÙËÓ ÔÔ›· ÌÔÚ› Ó· ÚÔÌËı¢Ù› οı ÂӉȷÊÂÚfi-ÌÂÓÔ˜ ̤ۈ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ Ù˘ ∞η‰ËÌ›·˜(www.aap.org/bst).

™¯¤ÛË ·È‰È¿ÙÚˆÓ-ÙËÏÂÊÒÓÔ˘

¶ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÔ˘Ó Î·Ï‡ÙÂÚ· ηٷÓÔËÙ¤˜ÔÈ ·fi„ÂȘ ÙˆÓ ·È‰È¿ÙÚˆÓ ÁÈ· ·˘Ù‹ ÙË Û¯¤ÛË, ·˜

˘ÔÙÂı› fiÙÈ ¤Ó·˜ ·È‰›·ÙÚÔ˜ ·Ú·ÎÔÏÔ˘ı› ÛÙÔÈ·ÙÚÂ›Ô ÙÔ˘ 500 ÔÈÎÔÁ¤ÓÂȘ (1000 ·È‰È¿) Î·È fiÙÈοı ÔÈÎÔÁ¤ÓÂÈ· ı· ÙÔ˘ ÙËÏÂʈӋÛÂÈ Ó˘ÎÙÂÚÈÓ‹ÒÚ· 2 ÊÔÚ¤˜ ÙÔÓ ¯ÚfiÓÔ. ∂¿Ó Ë ÓÔÛËÚfiÙËÙ· ÛÙËÓÎÔÈÓfiÙËÙ· Â›Ó·È 2%, Ô ·È‰›·ÙÚÔ˜ ı· ‰¤¯ÂÙ·È Î·-ıËÌÂÚÈÓ¿ 3 Ó˘ÎÙÂÚÈÓ¤˜ ÎÏ‹ÛÂȘ Î·È 20 ËÌÂÚ‹ÛȘÁÈ· ·ÓÙÈÌÂÙÒÈÛË ÎÏÈÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ∂¿Ó Û·˘Ù¤˜ ÚÔÛÙÂıÔ‡Ó Î·È ÔÈ ÎÏ‹ÛÂȘ ÁÈ· ÂÓË̤ڈÛËÛ ˙ËÙ‹Ì·Ù· ·Ó¿Ù˘Í˘, ‰È·ÙÚÔÊ‹˜ ‹ ÂÌ‚ÔÏÈ·-ÛÌÒÓ, ÙfiÙ ÚfiÎÂÈÙ·È ÁÈ· Ú·ÁÌ·ÙÈ΋ “¯ÈÔÓÔÛÙÈ-‚¿‰·” ÙËÏÂʈÓËÌ¿ÙˆÓ, ÛÙ· ÔÔ›· Ô ÁÂÓÈÎfi˜ ·È-‰›·ÙÚÔ˜ ηÏÂ›Ù·È Ó· ·ÓÙ·ÔÎÚÈı› ηıËÌÂÚÈÓ¿.¢ÂÓ ı· ‹Ù·Ó ˘ÂÚ‚ÔÏ‹, ÂÔ̤ӈ˜, Ó· ¯·Ú·ÎÙËÚÈ-ÛÙ› ˆ˜ Û¯¤ÛË “·Á¿Ë˜/Ì›ÛÔ˘˜”. “∞Á¿Ë˜” ÁÈ·Ù› ËÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›· Â›Ó·È ¿ÌÂÛË Î·È Â‡ÎÔÏË,ÂÓÒ Ë ÛˆÛÙ‹ Î·È ÏÔÁÈ΋ ¯Ú‹ÛË Ù˘ ‚ÔËı¿ÂÈ ÛÙˉËÌÈÔ˘ÚÁ›· ηÏÒÓ Û¯¤ÛÂˆÓ Ì ÙÔ˘˜ ÁÔÓ›˜. ∂›-Û˘, Â›Ó·È ¯Ú‹ÛÈÌË fiÙ·Ó ÌÂÈÒÓÂÈ ÙÔÓ ÊfiÚÙÔ ÂÚÁ·-Û›·˜ ÛÙÔ È·ÙÚ›Ô, ¯ˆÚ›˜ Ó· ‰ËÌÈÔ˘ÚÁ› ·›ÛıËÌ··Ó·ÛÊ¿ÏÂÈ·˜ ÛÙÔ˘˜ ÁÔÓ›˜. “ª›ÛÔ˘˜” ÁÈ·Ù› ÔÈ ÎÏ‹-ÛÂȘ Á›ÓÔÓÙ·È ·ÈÙ›· ÁÈ· Û˘Ó¯›˜ ‰È·ÎÔ¤˜ Ù˘ Âͤ-Ù·Û˘ ÛÙÔ È·ÙÚ›Ô, ·ÏÏ¿ ΢ڛˆ˜ ÁÈ·Ù› ÙÔ ÙËϤʈ-ÓÔ “ÂÈÛ¿ÁÂÈ” ÙËÓ ÂÚÁ·Û›· ÛÙËÓ ÚÔÛˆÈ΋ Î·È ÔÈ-ÎÔÁÂÓÂȷ΋ ˙ˆ‹ ÙÔ˘ ÁÈ·ÙÚÔ‡, ÂÓÒ ·Ú¿ÏÏËÏ··ÔÙÂÏ› Ì›· Ú·ÎÙÈ΋ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· È·-ÙÚÈÎfi Ï¿ıÔ˜.

¢ÂÓ ·ÔÙÂÏÔ‡Ó ¤ÎÏËÍË Â˘Ú‹Ì·Ù· ÌÂÏÂÙÒÓÛ‡Ìʈӷ Ì ٷ ÔÔ›· 50,5% ÙˆÓ ·È‰È¿ÙÚˆÓ ÈÛÙ‡ÂÈ fiÙÈ ÙÔ ÙËϤʈÓÔ Â›Ó·È Ë “ÈÔ ·ÔÁÔËÙ¢-ÙÈ΋” ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÂÚÁ·Û›·˜ ÙÔ˘˜ (11) ηÈ54% fiÙÈ ÔÈ Ó˘ÎÙÂÚÈÓ¤˜ ÎÏ‹ÛÂȘ Â›Ó·È “Ôχ ÂÓÔ-¯ÏËÙÈΤ˜” Ì ÔÛÔÛÙfi 35% ·˘ÙÒÓ ÙˆÓ ÎÏ‹ÛˆÓÓ· Â›Ó·È “ÌË ··Ú·›ÙËÙ˜” (12). ∆Ô 31% ÙˆÓ ·È‰È¿ÙÚˆÓ ı· ‹ıÂÏ ÏfiÁˆ ÙˆÓ ÂÓÔ¯ÏËÙÈÎÒÓ ÎÏ‹-ÛÂˆÓ Ó· ÛÙ·Ì·Ù‹ÛÂÈ ÙËÓ ÂÚÁ·Û›· ÙÔ˘, ÂÓÒ ÙÔ 60%ıˆÚ› fiÙÈ Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ·Ì›‚ÂÙ·È ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ÊÚÔÓÙ›‰· Ô˘ ·Ú¤¯ÂÈ Ì¤Ûˆ ÙÔ˘ ÙË-ÏÂÊÒÓÔ˘ (13).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ ı¤Ì· Ù˘ ·Ô˙ËÌ›ˆÛ˘ ÁÈ·ÙȘ Û˘Ì‚Ô˘Ï¤˜ Î·È ÙȘ Ô‰ËÁ›Â˜ Ô˘ ·Ú¤¯ÔÓÙ·È·fi ÙÔ ÙËϤʈÓÔ, ˘¿Ú¯ÂÈ ¤ÓÙÔÓÔ˜ ÚÔ‚ÏËÌ·ÙÈ-ÛÌfi˜. ∞˘ÙÔ› Ô˘ Û˘ÌʈÓÔ‡Ó Ì ÙËÓ ‡·ÚÍË ·ÌÔÈ-‚‹˜, ıˆÚÔ‡Ó fiÙÈ Ô ÁÈ·ÙÚfi˜ ·ÓÙÈÌÂÙˆ›˙ÂÈ ÔÏÏ¿ÎÔÈÓ¿ ·È‰È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ ÙËϤʈÓÔ,¯¿ÓÂÈ ÛËÌ·ÓÙÈÎfi ÂÚÁ¿ÛÈÌÔ ¯ÚfiÓÔ Î·È ¤¯ÂÈ ·˘ÍË̤-ÓÔ Î›Ó‰˘ÓÔ Ó· ˘Ô¤ÛÂÈ Û ȷÙÚÈÎfi ÛÊ¿ÏÌ·. ŸÛÔȉȷʈÓÔ‡Ó, ıˆÚÔ‡Ó ÙËÓ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙË-ϤʈÓÔ ·Ó·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ Ù˘ Û˘ÓÔÏÈ΋˜ ·-Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Î·È ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈÂ¿Ó ˘¿Ú¯ÂÈ ·ÌÔÈ‚‹, ›Ûˆ˜ ·Ôı·ÚÚ‡ÓÔÓÙ·È ÔÈ ÁÔ-Ó›˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ Î·ÏÔ‡Ó ÁÈ· Èı·Ó¤˜ÛÔ‚·Ú¤˜ ηٷÛÙ¿ÛÂȘ. ∂ÈϤÔÓ, Â›Ó·È Èı·Ófi Ó·‰ËÌÈÔ˘ÚÁËı› ·ÚÓËÙÈ΋ ÂÈÎfiÓ· ÁÈ· ÙÔ È·ÙÚÈÎfi ÏÂÈ-ÙÔ‡ÚÁËÌ·, Ó· ˘¿ÚÍÔ˘Ó ˘ÂÚ‚ÔÏÈΤ˜ ÔÈÎÔÓÔÌÈΤ˜··ÈÙ‹ÛÂȘ ‹, Ù¤ÏÔ˜, Ó· ·˘ÍËıÔ‡Ó ÔÈ ·‰ÈηÈÔÏfiÁË-Ù˜ ÂÈÛΤ„ÂȘ ÛÙÔ È·ÙÚ›Ô.

¶·È‰È·ÙÚÈ΋ 2005;68:29-35

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·30

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31¶·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ

∆‡ÔÈ ÎÏÈÓÈ΋˜ ÊÚÔÓÙ›‰·˜ ·fi ÙÔ ÙËϤʈÓÔ

ÛÙËÓ ·È‰È·ÙÚÈ΋

∏ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ ÂÚÈÏ·Ì‚¿ÓÂÈÙ¤ÛÛÂÚȘ Ù‡Ô˘˜ ÎÏÈÓÈ΋˜ ÊÚÔÓÙ›‰·˜ (14):

·) ¢È·ÏÔÁ‹ (triage) Î·È ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ(advice) Û ·È‰È¿ Ì Ô͇ ÎÏÈÓÈÎfi Úfi‚ÏËÌ·. ∏ Ϥ-ÍË “triage” (Á·ÏÏÈ΋˜ ÚÔ¤Ï¢Û˘) ÛËÌ·›ÓÂÈ “οӈ‰È·ÏÔÁ‹” Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÂÔÏÂÌÈΤ˜ Ì¿¯Â˜ (15). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ÙËÏÂ-ʈÓÈ΋˜ È·ÙÚÈ΋˜, ‰È·ÏÔÁ‹ ÛËÌ·›ÓÂÈ fiÙÈ Ô ÁÈ·ÙÚfi˜ -Ì ٷ ÛÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Ô˘ Û˘ÁÎÂÓÙÚÒÓÂÈÙËÏÂʈÓÈο - ηıÔÚ›˙ÂÈ ÙÔÓ ‚·ıÌfi ÛÔ‚·ÚfiÙËÙ·˜Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÂÈϤÁÂÈ ÙÔÓ Î·-Ù¿ÏÏËÏÔ - ÁÈ· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË - ¯ÚfiÓÔ,ÙfiÔ Î·È ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ‹˜ Ù˘.

‚) ¶·ÚÔ¯‹ ÏËÚÔÊÔÚÈÒÓ ÁÈ· ı¤Ì·Ù· ˘Á›·˜,ÚfiÏ˄˘, ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ Î·È Âη›‰Â˘-Û˘ ÙˆÓ ÁÔÓ¤ˆÓ. ∂›Ó·È ¤Ó· Ôχ ‚·ÛÈÎfi ÎÔÌÌ¿ÙÈ Ù˘·È‰È·ÙÚÈ΋˜ ·fi ÙÔ ÙËϤʈÓÔ, Ô˘ ·ÊÔÚ¿ ΢ڛˆ˜ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘.

Á) ¶·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ‹‰ËÂÍÂÙ·ÛÙ› ÛÙÔ È·ÙÚ›Ô.

‰) ¶·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ Ì ¯ÚfiÓÈÔ ÓfiÛËÌ·.∞˘Ùfi˜ Ô Ù‡Ô˜ ÎÏÈÓÈ΋˜ ÊÚÔÓÙ›‰·˜ ·fi ÙÔ ÙËϤʈ-ÓÔ ·ÊÔÚ¿ ΢ڛˆ˜ Û ·È‰È¿ÙÚÔ˘˜ Ì ÂÍÂȉ›Î¢ÛË.

∆ÔÓ ÁÂÓÈÎfi ·È‰›·ÙÚÔ ··Û¯ÔÏ› Î·È ÚÔ‚ÏË-Ì·Ù›˙ÂÈ Î˘Ú›ˆ˜ Ô ÚÒÙÔ˜ Ù‡Ô˜ ÎÏÈÓÈ΋˜ ÊÚÔÓÙ›‰·˜·fi ÙÔ ÙËϤʈÓÔ, ηıÒ˜ ·˘Ùfi Â›Ó·È ÙÔ ÂÚȯfiÌÂ-ÓÔ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÎÏ‹ÛÂˆÓ Ô˘ ‰¤¯ÂÙ·È - ȉȷ›-ÙÂÚ· Û ÌË ÂÚÁ¿ÛÈ̘ ÒÚ˜ - Î·È Û ·˘ÙfiÓ ı· ·Â˘-ı˘ÓıÔ‡Ó ÔÈ ÁÔÓ›˜ ÌfiÏȘ ÙÔ ·È‰› ÙÔ˘˜ ·ÚÔ˘ÛÈ¿ÛÂÈÔÔÈÔ‰‹ÔÙ ÎÏÈÓÈÎfi Úfi‚ÏËÌ·.

¢˘ÛÎÔϛ˜ Ù˘ ·È‰È·ÙÚÈ΋˜ ·fi ÙÔ ÙËϤ-

ʈÓÔ (14)

∏ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ ÌÔÚ› Ó· ·-ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰˘ÛÎÔϛ˜ ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ:

·) ∏ ÂÈÎÔÈÓˆÓ›· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È ·Ô˘-ÛÈ¿˙Ô˘Ó ÔÈ ÏËÚÔÊÔڛ˜ ·fi ÙËÓ ÚfiÛˆÔ Ì Úfi-ÛˆÔ Â·Ê‹ Ì ÙÔ ·È‰›. ŒÙÛÈ, ÌÔÚ› Ó· ÌËÓ ÂÎÙÈ-ÌËı› ÛˆÛÙ¿ Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡,ÏËÚÔÊÔÚ›· ÎÚ›ÛÈÌ˘ ÔÏϤ˜ ÊÔÚ¤˜ ÛËÌ·Û›·˜, ÂÈ-‰Èο Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ‚Ú¤ÊÔ˜.

‚) O ÁÈ·ÙÚfi˜ ¤¯ÂÈ Û˘Ó‹ıˆ˜ ÏÈÁfiÙÂÚÔ ¯ÚfiÓÔ - ÛÂÛ¯¤ÛË Ì ÙËÓ ÂͤٷÛË ÛÙÔ È·ÙÚÂ›Ô - ÁÈ· Ó· ·ÔÊ·-Û›ÛÂÈ. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ ÔÈ ÎÏ‹ÛÂȘ Ô˘ ·ÊÔÚÔ‡ÓÛ ·ÓÙÈÌÂÙÒÈÛË ÎÏÈÓÈÎÔ‡ ÂÚÈÛÙ·ÙÈÎÔ‡ ¤¯Ô˘Ó ̤-ÛË ‰È¿ÚÎÂÈ· 3-5 ÏÂÙ¿ Î·È ·˘Ùfi˜ Â›Ó·È Ô ¯ÚfiÓÔ˜ Ô˘Ô ÁÈ·ÙÚfi˜ ı· Ú¤ÂÈ Ó· ¿ÚÂÈ ÙȘ ·ÔÊ¿ÛÂȘ ÙÔ˘.

Á) O ÁÈ·ÙÚfi˜ ‰ÂÓ ÌÔÚ› Ó· ÂÍÂÙ¿ÛÂÈ ÙÔ ·È‰›Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ÌÈÏ¿ Ì·˙› ÙÔ˘. ∞ÎfiÌ· Î·È ÁÈ· ÌÂ-Á¿Ï· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜, ÙÔ ÈÛÙÔÚÈÎfi Û˘Ó‹ıˆ˜ ‰›-ÓÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜.

‰) O ÁÈ·ÙÚfi˜ ÌÔÚ› Ó· ÌËÓ ÁÓˆÚ›˙ÂÈ ÙÔ ·È‰›Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘. O ÔÈÎÔÁÂÓÂÈ·Îfi˜ ·È‰›·-ÙÚÔ˜ Ô˘ ÁÓˆÚ›˙ÂÈ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÌÔÚ› Ó· ¿ÚÂÈÂÚÈÛÛfiÙÂÚ˜ Î·È ÈÔ ·ÍÈfiÈÛÙ˜ ÏËÚÔÊÔڛ˜ ·fiÙÔ ÙËϤʈÓÔ Î·È ¤ÙÛÈ Ó· ¯ÂÈÚÈÛÙ› ÙËÓ ÂÚ›ÙˆÛËÌ ÌÂÁ·Ï‡ÙÂÚË ·ÛÊ¿ÏÂÈ·, Û ·ÓÙ›ıÂÛË Ì ÙÔÓ ÂÊË-ÌÂÚ‡ÔÓÙ· ÓÔÛÔÎÔÌÂÈ·Îfi ÁÈ·ÙÚfi, fiÔ˘ Ë ·Ô˘Û›·ÁÓˆÚÈÌ›·˜ Ì ÙÔÓ Û˘ÓÔÌÈÏËÙ‹ ÙÔ˘ Î·È Ô ÊfiÚÙÔ˜ ÂÚ-Á·Û›·˜ Ú¤ÂÈ Ó· ÙÔÓ Î¿ÓÔ˘Ó Ôχ ÂÈÊ˘Ï·ÎÙÈÎfi.

Â) ∆· ·È‰È¿ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÚ›ÏÔÎÔÈ Î·È ‰‡-ÛÎÔÏÔÈ ·ÛıÂÓ›˜.

ÛÙ) ∏ ··›ÙËÛË ÁÈ· ÙËÏÂʈÓÈ΋ È·ÙÚÈ΋ ·ÚÔ˘-ÛÈ¿˙ÂÈ ·‡ÍËÛË. ∏ ·‡ÍËÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È ÌfiÓÔ ÔÛÔ-ÙÈ΋, ·ÏÏ¿ Î·È ÔÈÔÙÈ΋. OÈ ÁÔÓ›˜ ›Ù ÁÈ· ÔÈÎÔÓÔÌÈ-ÎÔ‡˜ ÏfiÁÔ˘˜ ›Ù ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ ٷϷȈڛ·˜ÌÂÙ¿‚·Û˘ ÛÙÔ È·ÙÚÂ›Ô ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Û˘¯Ó¿“Ȥ˙Ô˘Ó” ÙÔÓ ·È‰›·ÙÚÔ Ó· ı¤ÛÂÈ ·fi ÙÔ ÙËϤʈÓÔÙË ‰È¿ÁÓˆÛË ‹/Î·È Ó· ‰ÒÛÂÈ ıÂڷ›· ÛÙÔ ·È‰›. ∂›-Ó·È Î·ı‹ÎÔÓ ÙÔ˘ ·È‰È¿ÙÚÔ˘ Ó· ÌËÓ “˘Ô·ÙÂÈ” ÛÂÙ¤ÙÔȘ “‡ÎÔϘ” χÛÂȘ, ÔÈ Ôԛ˜ ÌÂÏÏÔÓÙÈοÌÔÚ› Ó· ÙÔÓ ÂÎı¤ÛÔ˘Ó, ηıÒ˜ Î·È Ó· ı¤ÙÂÈ ÛÙÔ˘˜ÁÔÓ›˜ Ù· ÛˆÛÙ¿ fiÚÈ· ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ Ô˘ ¤¯ÂÈÂÍ·ÛÎÒÓÙ·˜ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ.

Œ¯ÂÈ ÂӉȷʤÚÔÓ Ì›· Á·ÏÏÈ΋ ÌÂϤÙË, Ô˘ ›¯ÂÛÎÔfi ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ Ï‹„˘ ÈÛÙÔÚÈÎÔ‡ ηÈÙ˘ Û˘Ì‚Ô˘Ï‹˜ Ô˘ ·Ú¤¯ÂÙ·È Û ̛· ÌËÙ¤Ú·, ËÔÔ›· ˙ËÙ¿ ·fi ÙÔ ÙËϤʈÓÔ È·ÙÚÈ΋ ÁÓÒÌË ÁÈ· ÙԷȉ› Ù˘ (16). ∆Ô ÂÚÈÛÙ·ÙÈÎfi ‹Ù·Ó ˘ÔıÂÙÈÎfi ηÈÌ›· ·fi Ù˘ ÂÚ¢ӋÙÚȘ - ÚÔÛÔÈÔ‡ÌÂÓË ÙË ÌË-Ù¤Ú· - ¤ÏÂÁÂ: “£¤Ïˆ Ì›· Û˘Ì‚Ô˘Ï‹. ∆Ô ·È‰› ÌÔ˘¤¯ÂÈ ˘ÚÂÙfi Î·È ‰ÂÓ Í¤Úˆ ÙÈ Ó· οӈ”. OÈ ˘fiÏÔÈ-˜ ÏËÚÔÊÔڛ˜ ‰ÂÓ ‰›ÓÔÓÙ·Ó, ·Ú¿ ÌfiÓÔ Â¿Ó ÙȘ˙ËÙÔ‡ÛÂ Ô Û˘ÓÔÌÈÏËÙ‹˜. ŒÙÛÈ, ı· ·ÔÎ·Ï˘ÙfiÙ·ÓfiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ¤Ó· ı‹Ï˘ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 4 ÌË-ÓÒÓ Ì ˘ÚÂÙfi 38,5-39,5ÔC, ÙÔ ÔÔ›Ô Â›¯Â Ï¿‚ÂÈ ‰‡Ô‰fiÛÂȘ ·ÓÙÈ˘ÚÂÙÈÎÔ‡, ‹Ù·Ó ¢ÂÚ¤ıÈÛÙÔ, ‰ÂÓ Â›¯ÂÊ¿ÂÈ Î·Ï¿, ›¯Â οÓÂÈ ¤Ó·Ó ¤ÌÂÙÔ, ·Ó¤Ó ÈÔ ÁÚ‹-ÁÔÚ· Î·È ‹Ù·Ó ÂÚÈÛÛfiÙÂÚÔ ¯ÏˆÌfi ·fi ¿ÏÏË ÊÔÚ¿.¢ÂÓ Â›¯Â ÚÈÓ›Ùȉ·, ‚‹¯·, ÂÍ¿ÓıËÌ· ‹ ‰È¿ÚÚÔÈ·. ∞fiÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ÎÚ›ıËÎ·Ó ··Ú·›ÙËÙ˜ 13 ÂÚˆÙ‹-ÛÂȘ ÁÈ· ÙËÓ ÔÏÔÎÏËڈ̤ÓË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡,ÂÓÒ Ë ÛˆÛÙ‹ Ô‰ËÁ›· ı· ¤Ú ӷ ‹Ù·Ó Ë ¿ÌÂÛËÂͤٷÛË ·fi ÙÔÓ ÂÊËÌÂÚ‡ÔÓÙ· ÁÈ·ÙÚfi, Ì Èı·Ó‹‰È¿ÁÓˆÛË ÙË ÛË„·ÈÌ›·.

∏ ¤Ú¢ӷ ·ÊÔÚÔ‡Û Û 100 ÓÔÛÔÎÔÌ›· (50 Ì·ȉȷÙÚÈÎfi ÙÌ‹Ì· Î·È 50 ¯ˆÚ›˜ ·˘Ùfi), ÂÓÒ Ô‰ËÁ›Â˜¤‰ˆÛ·Ó Ù· 94. ¶ÔÛÔÛÙfi 65% ·˘ÙÒÓ Ô˘ ¤‰ˆÛ·Ó ÙȘԉËÁ›Â˜ ‹Ù·Ó ÁÈ·ÙÚÔ›, 34% ‹Ù·Ó ÓÔÛËÏÂ˘Ù¤˜ Î·È 1%ÁÚ·ÌÌ·Ù›˜. O ̤ÛÔ˜ fiÚÔ˜ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ ‹Ù·Ó 3,1(3,2 ÁÈ· ÁÈ·ÙÚÔ‡˜, 3,1 ÁÈ· ÓÔÛËÏÂ˘Ù¤˜). ¶ÔÛÔÛÙfi36,1% ‰ÂÓ ÚÒÙËÛ ηıfiÏÔ˘ ÁÈ· ÙËÓ ËÏÈΛ· ‹/Î·È ÙËıÂÚÌÔÎÚ·Û›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, 85% ÁÈ· ÙËÓ fiÚÂÍË‹/Î·È ·Ó ¤Î·Ó ¤ÌÂÙÔ, 75% ÁÈ· ÙËÓ ·Ó·ÓÔ‹, ÂÓÒηӤӷ˜ ‰ÂÓ ÚÒÙËÛ ÁÈ· ÙËÓ fi„Ë Î·È ÙÔ ¯ÚÒÌ· ÙÔ˘.∞fi ÙȘ Ô‰ËÁ›Â˜ Ô˘ ‰fiıËηÓ, ÙÔ 18,1% ‰ÂÓ Û˘Ó¤-ÛÙËÛ ¿ÌÂÛË È·ÙÚÈ΋ ÂͤٷÛË (21% ÁÈ·ÙÚÔ›, 8,6%

¶·È‰È·ÙÚÈ΋ 2005;68:29-35

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32 ¶. µÂϤÓÙ˙·˜

ÓÔÛËÏÂ˘Ù¤˜ Î·È 27,7% ÓÔÛÔÎÔÌ›· Ì ·È‰È·ÙÚÈÎfiÙÌ‹Ì·, 8,5% ÓÔÛÔÎÔÌ›· ¯ˆÚ›˜ ·˘Ùfi), ÂÓÒ ÙÔ 7,5%·˘ÙÒÓ Û˘Ó¤ÛÙËÛ ·Ú·ÌÔÓ‹ ÛÙÔ Û›ÙÈ.

¶·Ú¿ ÙȘ fiÔȘ ·‰˘Ó·Ì›Â˜ ›¯Â ÙÔ ˘ÔıÂÙÈÎfi·˘Ùfi ÛÂÓ¿ÚÈÔ, ÔÈ ÂÚ¢ÓËÙ¤˜ ıˆÚÔ‡Ó Ù· ·ÔÙÂϤ-ÛÌ·Ù· ·ÔÁÔËÙ¢ÙÈο (1 ÛÙ· 5 ÓÔÛÔÎÔÌ›· ÛÙË °·Ï-Ï›· ¤‰ˆÛ ϿıÔ˜ ÙËÏÂʈÓÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ¤Ó· ‚Ú¤-ÊÔ˜ Ì Èı·Ó¿ ÛÔ‚·Ú‹ ‚·ÎÙËÚȷ΋ Ïԛ̈ÍË). °È·ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÚÔÙ›ÓÔ˘Ó fiÙÈ Ù· ÓÔÛÔÎÔÌ›· Ô˘ı¤ÏÔ˘Ó Ó· ‰›ÓÔ˘Ó Ô‰ËÁ›Â˜ ·fi ÙÔ ÙËϤʈÓÔ ı· Ú¤-ÂÈ Ó· ‰È·ı¤ÙÔ˘Ó Î·Ù·ÚÙÈṲ̂ÓÔ ÚÔÛˆÈÎfi, ÂȉÈΤ˜Û˘ÛÙ¿ÛÂȘ, Ó· Á›ÓÂÙ·È Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÎÏ‹ÛÂˆÓ Î·ÈÓ· ˘¿Ú¯ÂÈ Û˘Ó¯‹˜ Âη›‰Â˘ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡.

™Â Ì›· ·ÚfiÌÔÈ· ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙȘ ∏¶∞,28,3% ·fi 61 ∆∂¶ Û˘Ó¤ÛÙËÛ ·Ú·ÌÔÓ‹ ÛÙÔ Û›ÙÈÁÈ· ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 5 ‚‰ÔÌ¿‰ˆÓ Ì ˘ÚÂÙfi 38,8ÔC(17). ∞ÎfiÌË Î·È ÁÈ·ÙÚÔ› Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›-ı·Ï„˘, ˆÛÙfiÛÔ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ›¯·Ó ηχÙÂÚ··ÔÙÂϤÛÌ·Ù· ÛÙȘ ÙËÏÂʈÓÈΤ˜ Ô‰ËÁ›Â˜, ηıÒ˜25% ÙˆÓ È‰ÈˆÙÒÓ ·È‰È¿ÙÚˆÓ ÛÙȘ ∏¶∞ ‰ÂÓ ¤Ï·‚ÂÙȘ ··Ú·›ÙËÙ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ‚Ú¤ÊÔ˜ Ì Èı·-Ó‹ ˘ÏˆÚÈ΋ ÛÙ¤ÓˆÛË (18), ÂÓÒ Û ¿ÏÏË ÌÂϤÙË,40% ÙˆÓ ·È‰È¿ÙÚˆÓ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘ÂÎÙ›ÌËÛ ϿıÔ˜ ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ·Ê˘‰¿ÙˆÛ˘ÂÓfi˜ ‚Ú¤ÊÔ˘˜ (19).

O‰ËÁ›Â˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÎÏÈÓÈÎÒÓ

ÚÔ‚ÏËÌ¿ÙˆÓ ·fi ÙÔ ÙËϤʈÓÔ

OÈ ·ÎfiÏÔ˘ı˜ ÁÂÓÈΤ˜ Ô‰ËÁ›Â˜ ·ÊÔÚÔ‡Ó ÛÙËÓ·ÓÙÈÌÂÙÒÈÛË ÎÏÈÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ·fi ÙÔ ÙËϤ-ʈÓÔ Î·È ÚÔÙ›ÓÔÓÙ·È ·fi ·ÚÎÂÙÔ‡˜ Û˘ÁÁÚ·Ê›˜(4,20). O ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ÙȘ ÙÚÔÔÔÈ› ‹ Ó·ÙȘ ‚ÂÏÙÈÒÓÂÈ, ·Ó¿ÏÔÁ· Ì ÙȘ ÂÚÈÛÙ¿ÛÂȘ. ŒÙÛÈ, Էȉ›·ÙÚÔ˜ Ú¤ÂÈ:

·) Ó· Û˘ÛÙ‹ÓÂÙ·È Ì ÙÔ ÔÓÔÌ·ÙÂÒÓ˘ÌÔ Î·È ÙËÓȉÈfiÙËÙ¿ ÙÔ˘.

‚) Ó· ÚˆÙ¿ ¿ÓÙ· ÙÔ fiÓÔÌ·, ÙÔ Ê‡ÏÔ Î·È ÙËÓËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, ηıÒ˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ Û˘ÓÔ-ÌÈÏËÙ‹ ÙÔ˘ Î·È ÙË Û¯¤ÛË ÙÔ˘ Ì ÙÔ ·È‰›. ∏ ËÏÈΛ·Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋ ÏËÚÔÊÔÚ›· ÁÈ· ÙË ÛˆÛÙ‹‰È·ÊÔÚԉȿÁÓˆÛË.

Á) Ó· ÚˆÙ¿ ÁÈ· ÙËÓ ¤Ó·ÚÍË, ÙË ‰È¿ÚÎÂÈ· Î·È ÙËÓÂͤÏÈÍË ÙˆÓ Û˘Ìو̿وÓ, ηıÒ˜ Î·È ÙÔ Ò˜ ·˘Ù¿ÂËÚ¿˙Ô˘Ó ÙÔÓ ‡ÓÔ, ÙËÓ fiÚÂÍË ÁÈ· Ê·ÁËÙfi Î·È ÙˉȿıÂÛË ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ·È¯Ó›‰È.

‰) Ó· ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙȘ ÂÓ¤ÚÁÂȘ Ô˘ ¤¯Ô˘Ó ‹‰ËοÓÂÈ ÔÈ ÁÔÓ›˜ (Â¿Ó ¤‚·Ï·Ó ıÂÚÌfiÌÂÙÚÔ, Â¿Ó ¤‰ˆ-Û·Ó ·ÓÙÈ˘ÚÂÙÈÎfi, fiÛÔ Î·È fiÙ ‹ Â¿Ó ¤‰ˆÛ·Ó ¿Ï-Ï· Ê¿Ú̷η).

Â) Ó· ¯ÚËÛÈÌÔÔÈ› fiÚÔ˘˜ Ô˘ Â›Ó·È Â‡ÎÔÏ··ÓÙÈÏËÙÔ› Î·È Ó· ·ÔʇÁÂÈ ÙȘ ·Û¿ÊÂȘ.

ÛÙ) Ó· ÚÔÛ‰ÈÔÚ›˙ÂÈ ÙÔ Î‡ÚÈÔ Û‡Ìو̷ ÙÔ˘·È‰ÈÔ‡, ·ÏÏ¿ Î·È ·˘Ù¿ Ô˘ ÚÔηÏÔ‡Ó ÌÂÁ¿ÏÔ ¿Á-¯Ô˜ ÛÙÔ˘˜ ÁÔÓ›˜. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ·ÚÈÔ˘ Û˘-

ÌÙÒÌ·ÙÔ˜ Â›Ó·È ÛËÌ›Ô-ÎÏÂȉ›, ÁÈ·Ù› ¿Óˆ Û ·˘-Ùfi ÔÈÎÔ‰ÔÌÂ›Ù·È Ë Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ‰È·ÏÔ-Á‹ ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡. ªÔÚ› Ó· ÌË Û˘Ì›ÙÂÈ Ì·˘Ùfi Ô˘ ÔÈ ÁÔÓ›˜ ıˆÚÔ‡Ó ÈÔ ÛËÌ·ÓÙÈÎfi Úfi-‚ÏËÌ· ÁÈ· ÙÔ ·È‰› ÙÔ˘˜.

˙) Ó· ·ÔÊ·Û›˙ÂÈ ÙËÓ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡, ¿ÓË Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÂÚ›ÏÔÎË ‹/Î·È ÔÈÁÔÓ›˜ ȉȷ›ÙÂÚ· ·Ó‹Û˘¯ÔÈ.

Ë) Ó· ÏËÚÔÊÔÚ› ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ Èı·Ó‹ÔÚ›· Î·È ‰È¿ÚÎÂÈ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ó· ÙÔ˘˜ÂÈÛËÌ·›ÓÂÈ Ì ۷ʋÓÂÈ· fiÙ ڤÂÈ Ó· ·ÓËÛ˘¯‹-ÛÔ˘Ó Î·È Ó· ÙÔÓ Í·Ó·Î·Ï¤ÛÔ˘Ó. ¶Ú¤ÂÈ Ó· ·Ôʇ-ÁÂÈ Ó· ı¤ÙÂÈ ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË ·fi ÙÔ ÙËϤʈÓÔ.¶Èı·Ó‹ ‹ ÚÔÛˆÚÈÓ‹ ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ÁÓˆÛÙÔ-ÔÈÂ›Ù·È ÛÙÔ˘˜ ÁÔÓ›˜ ÂÊfiÛÔÓ Ù· Û˘ÌÙÒÌ·Ù· ›ӷÈÙ˘Èο (.¯. ÎÔÈÓfi ÎÚ˘ÔÏfiÁËÌ·, ·ÓÂÌ¢ÏÔÁÈ¿ ÌÂÙ¿·fi ÁÓˆÛÙ‹ ¤ÎıÂÛË ÛÙÔÓ Èfi Î.¿.).

ı) Ó· ‚‚·Èˆı› fiÙÈ ÔÈ ÁÔÓ›˜ ¤¯Ô˘Ó ÙË ‰˘Ó·Ùfi-ÙËÙ· Î·È ÙÔÓ ÂÍÔÏÈÛÌfi ÁÈ· Ó· ÂÊ·ÚÌfiÛÔ˘Ó ÙȘԉËÁ›Â˜ Ô˘ ÙÔ˘˜ ‰fiıËηÓ.

È) Ó· ÚˆÙ¿ ÙÔ˘˜ ÁÔÓ›˜, ÚÈÓ ÙÂÏÂÈÒÛÂÈ Ë Û˘ÓÔ-ÌÈÏ›·, Â¿Ó ¤¯Ô˘Ó ·Ôڛ˜ Î·È Ó· ·ӷϷ̂¿ÓÂÈ ÙȘԉËÁ›Â˜ Ô˘ ıˆÚÔ‡ÓÙ·È Ôχ ÛËÌ·ÓÙÈΤ˜.

∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi Ó· ηٷÁÚ¿ÊÔÓÙ·È Ù·Î‡ÚÈ· ÛÙÔȯ›· Ù˘ Û˘ÓÔÌÈÏ›·˜, ÂȉÈο Â¿Ó ‰ÂÓ Â›-Ó·È ÁÓˆÛÙÔ› ÔÈ ÁÔÓ›˜ Î·È Â¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ Ë Úfi-ıÂÛË Ó· ÂÍÂÙ·ÛÙ› ¿ÌÂÛ· ÙÔ ·È‰› Î·È ¤¯ÂÈ ¯ÔÚË-ÁËı› ıÂڷ›·. ∏ ηٷÁÚ·Ê‹ ÙˆÓ ÎÏ‹ÛÂˆÓ ıˆ-ÚÂ›Ù·È ··Ú·›ÙËÙË ÛÙȘ ∏¶∞, fiÔ˘ Û˘ÓÈÛٿٷȷfi ÙËÓ AAP ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÓÔÌÈÎÒÓ ÚÔ‚ÏË-Ì¿ÙˆÓ, Ô˘ - ·Ó Î·È Û¿ÓÈ· - Â›Ó·È ˘·ÚÎÙ¿ ÛÙ˯ÒÚ· ·˘Ù‹ (21,22).

¢Â‰Ô̤ӷ ÁÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ηÈ

·ÛÊ¿ÏÂÈ·

™ÙË Û˘Ó¤¯ÂÈ·, ·Ó·Ê¤ÚÔÓÙ·È ÂÓ Û˘ÓÙÔÌ›· ÌÂÚÈ-Τ˜ Ô‰ËÁ›Â˜ Ô˘ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı› Ô ·È‰›·-ÙÚÔ˜, ÒÛÙ ӷ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· ÂÍ·ÛÎÒÓÙ·˜ ·È‰È·ÙÚÈ΋ ·fi ÙÔÙËϤʈÓÔ (14,23).

°È· ÙË ÛˆÛÙ‹ ‰È·ÏÔÁ‹, Ú¤ÂÈ: ·) Ó· Á›ÓÔÓÙ·ÈÚÒÙ· ÔÈ ÈÔ ÛËÌ·ÓÙÈΤ˜ ÂÚˆÙ‹ÛÂȘ, ‚) Ó· ÂÈÎÂ-ÓÙÚÒÓÔÓÙ·È ÛÙÔ Î‡ÚÈÔ Û‡Ìو̷ ÙÔ˘ ·È‰ÈÔ‡, Á)Ó· Á›ÓÔÓÙ·È Î·Ù¿ Û‡ÛÙËÌ·, ‰) Ó· ˘¿Ú¯ÂÈ Â›ÁÓˆ-ÛË Ù˘ ÎÏÈÓÈ΋˜ (˘ÔÛ˘Ó›‰ËÙ˘) ÚÔηٿÏ˄˘(wellness bias/illness bias) ÙˆÓ ·È‰È¿ÙÚˆÓ. OÈ ·È-‰›·ÙÚÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÂÚ›-ı·Ï„Ë ‰¤¯ÔÓÙ·È ˆ˜ › ÙÔ Ï›ÛÙÔÓ ÎÏ‹ÛÂȘ ÁÈ·ÎÔÈÓ¿ Î·È ‹È· ÎÏÈÓÈο ÚÔ‚Ï‹Ì·Ù·. OÈ ÓÔÛÔÎÔ-ÌÂÈ·ÎÔ› ·È‰›·ÙÚÔÈ Î·È ÔÈ ÂȉÈ΢fiÌÂÓÔÈ ·Û¯ÔÏÔ‡-ÓÙ·È Î˘Ú›ˆ˜ Ì ·È‰È¿ Ì ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·˘Á›·˜ Î·È ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Û˘¯Ó¿ ÙȘ ÂÈÏÔΤ˜ÙˆÓ ÎÔÈÓÒÓ ·È‰È·ÙÚÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∏ ·ÓÙÈÎÂÈ-ÌÂÓÈÎfiÙËÙ· Â›Ó·È ‰‡ÛÎÔÏË, ·ÏÏ¿ ··Ú·›ÙËÙË, Â) Ó·

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33¶·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ

ÂÓËÌÂÚÒÓÔ˘Ó ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ fiÙ·Ó Ù·Û˘ÌÙÒÌ·Ù· ÂÈ̤ÓÔ˘Ó, ·ÏÏ¿˙Ô˘Ó, ÂȉÂÈÓÒÓÔ-ÓÙ·È, ÚÔηÏÔ‡Ó È‰È·›ÙÂÚÔ ¿Á¯Ô˜ ‹ Â›Ó·È ÂȉÈο ο-ÔÈÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

°È· ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÂÈÎÔÈÓˆÓÈ·ÎÒÓ ÈηÓÔÙ‹-ÙˆÓ (¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· fi¯È ÌfiÓÔ ·˘Ùfi Ô˘ ϤÁÂ-Ù·È, ·ÏÏ¿ Î·È Ô ÙÚfiÔ˜ Ô˘ ϤÁÂÙ·È), Ô ·È‰›·ÙÚÔ˜Ú¤ÂÈ: ·) Ó· ÚÔÛʈÓ› ÙÔÓ Û˘ÓÔÌÈÏËÙ‹ Ì ÙÔ›ıÂÙfi ÙÔ˘, ‚) Ó· Â›Ó·È Â˘ÁÂÓ‹˜ Î·È Úfiı˘ÌÔ˜ Ó·ÚÔÛʤÚÂÈ ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘ (smile over phone), Á) Ó·ÌË ‰Â›¯ÓÂÈ ÂÓfi¯ÏËÛË Î·È Ó· ÌË ‚È¿˙ÂÙ·È, ‰) Ó· ›ӷÈηÏfi˜ ·ÎÚÔ·Ù‹˜ Î·È Î·Ïfi˜ “·Ó·ÎÚÈÙ‹˜”, Â) Ó· ›ӷȤÙÔÈÌÔ˜ Ó· ¯ÂÈÚÈÛÙ› ÙÔ˘˜ ‰‡ÛÎÔÏÔ˘˜ Û˘ÓÔÌÈÏËÙ¤˜,fiˆ˜ Â›Ó·È ÔÈ ı˘ÌˆÌ¤ÓÔÈ, ·Á¯ˆÌ¤ÓÔÈ, ٷϷȈÚË-̤ÓÔÈ Î·È Û ‰‡ÛÎÔÏË ÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË ÁÔ-Ó›˜, ηıÒ˜ Î·È ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Â›Ó·È ÓfiÌÈÌÔÈ ÂÎ-ÚfiÛˆÔÈ ÙÔ˘ ·È‰ÈÔ‡.

¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ıÔ‡Ó È·ÙÚÈο-ÓÔÌÈοÚÔ‚Ï‹Ì·Ù·, Ú¤ÂÈ: ·) Ó· ÂÍ·ÛÎÂ›Ù·È ÛˆÛÙ‹ È·-ÙÚÈ΋, ‚) Ó· ÔÚÁ·ÓÒÓÂÙ·È Û‡ÛÙËÌ· ηٷÁÚ·Ê‹˜(documentation) ÙˆÓ ÎÏ‹ÛˆÓ, ÙfiÛÔ ÛÙÔ È·ÙÚ›ÔfiÛÔ Î·È ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Á) Ó· ·ÔʇÁÂÙ·È Ë ‰Ë-ÌÈÔ˘ÚÁ›· ·ÈÛıËÌ¿ÙˆÓ ÂÓÔ¯‹˜ ÛÙÔ˘˜ ÁÔÓ›˜, ‰) Ó·‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Ú·ÏÈÛÙÈΤ˜ ÚÔÛ‰Ô˘ ÛÙÔ˘˜ÁÔÓ›˜, Â) Ó· ÂÌÈÛÙ‡ÔÓÙ·È ÔÈ ÁÈ·ÙÚÔ› ÙÔ ¤ÓÛÙÈÎÙÔÎ·È ÙȘ ÂÌÂÈڛ˜ ÙÔ˘˜. ∏ ‰È·›ÛıËÛË Û ̛· ÙËÏÂ-ʈÓÈ΋ Û˘ÓÔÌÈÏ›· Û˘Ó‰˘¿˙ÂÈ ÙËÓ ÎÏÈÓÈ΋ ÂÌÂÈÚ›·ÙÔ˘ ÁÈ·ÙÚÔ‡, ÙË ÁÓÒÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Ù˘ ÎÔÈ-ÓfiÙËÙ·˜, ÙËÓ ·ÍÈÔÈÛÙ›· ÙˆÓ ÁÔÓ¤ˆÓ, ÙËÓ È‰ÈÔÛ˘-ÁÎÚ·Û›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ÚfiÛ‚·-Û˘ Û ȷÙÚÈ΋ ˘ËÚÂÛ›·. ¢ÂÓ Â›Ó·È ·Û˘Ó‹ıÈÛÙÔ,ÂÔ̤ӈ˜, Ë ‰È·›ÛıËÛË Ó· Â›Ó·È ÈÔ ·ÍÈfiÈÛÙË·fi ÔÔÈÔ‰‹ÔÙ ۇÌو̷ ÙÔ˘ ·È‰ÈÔ‡, ÛÙ) ¿-ÓÙ· Ó· ˙ËÙÂ›Ù·È - › ·ÌÊÈ‚ÔÏÈÒÓ - Ë ÂͤٷÛË ÙÔ˘·È‰ÈÔ‡.

¶·È‰È·ÙÚÈΤ˜ ÙËÏÂʈÓÈΤ˜ Û˘ÛÙ¿ÛÂȘ

OÈ ·È‰È·ÙÚÈΤ˜ ÙËÏÂʈÓÈΤ˜ Û˘ÛÙ¿ÛÂȘ Ԣ΢ÎÏÔÊÔÚÔ‡Ó ÛÙȘ ∏¶∞ Â›Ó·È ÁÚ·Ù¤˜ Ô‰ËÁ›Â˜ ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÎÏÈÓÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ ÚÔ‚ÏË-Ì¿ÙˆÓ ·fi ÙÔ ÙËϤʈÓÔ, Ì ‚¿ÛË ÙÔ Î‡ÚÈÔ Û‡-Ìو̷ ÙÔ˘ ·È‰ÈÔ‡ (23,24). ¢ÂÓ Â›Ó·È ‰ÂÛÌ¢ÙÈΤ˜Î·È Ô Î¿ı ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÙȘ‰ÈΤ˜ ÙÔ˘ Ì ‚¿ÛË ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ Î·È ÙËÓ Ú·-ÎÙÈ΋ ÙÔ˘. ¢ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈÎÔ› ·ÏÁfiÚÈıÌÔÈ Î·È‰ÂÓ ·ÓÙÈηıÈÛÙÔ‡Ó ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË.

OÈ Û˘ÛÙ¿ÛÂȘ ·˘Ù¤˜ Â›Ó·È ¯Ú‹ÛÈ̘ ÛÙËÓ ÂÓÈ·›··ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ, ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡-ÓÔ˘ ÁÈ· È·ÙÚÈÎfi Ï¿ıÔ˜, ÛÙËÓ Î·Ï‡ÙÂÚË ÔÚÁ¿ÓˆÛËÙÔ˘ È·ÙÚ›Ԣ Î·È ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÎÏ‹ÛˆÓ,ηıÒ˜ Î·È ÛÙËÓ Âη›‰Â˘ÛË ÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÌË È·-ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡ (14,22,25).

∏ ‰ÔÌ‹ ÙˆÓ ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ Ú¤ÂÈÓ· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ·ÎfiÏÔ˘ı· (14,23,24): ·) ÔÚÈÛÌfi

ÙÔ˘ ·ÚÈÔ˘ Û˘ÌÙÒÌ·ÙÔ˜, ‚) Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ Ì‚¿ÛË ÙÔ Î‡ÚÈÔ Û‡Ìو̷, Á) ‰È·ÏÔÁ‹, Ì ¤ÓÙ·ÍËÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ Û ̛· ·fi ÙȘ ηÙËÁÔڛ˜: i)¿ÌÂÛË ÌÂÙ·ÊÔÚ¿ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (ÂÍ·ÈÚÂÙÈο ›-ÁÔÓÙ·), ii) ¿ÌÂÛË ÂͤٷÛË ÛÙÔ È·ÙÚÂ›Ô ‹ ÛÙÔ ÓÔÛÔ-ÎÔÌÂ›Ô (›ÁÔÓÙ·), iii) ÂͤٷÛË ÙËÓ ›‰È· Ë̤ڷ ÛÂ12-24 ÒÚ˜ ‹ ÙËÓ ÂfiÌÂÓË >24 ÒÚ˜ (Ôͤ· ÌË Â›-ÁÔÓÙ·), iv) ÂͤٷÛË Ì¤Û· Û 2 ‚‰ÔÌ¿‰Â˜ (¯ÚfiÓÈ· ‹˘ÔÙÚÔÈ¿˙ÔÓÙ·), v) ·Ú·ÌÔÓ‹ ÛÙÔ Û›ÙÈ (‹È·,·˘ÙÔ˚ÒÌÂÓ·), ‰) Ô‰ËÁ›Â˜-Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ·ÓÙÈÌÂÙÒ-ÈÛË ÛÙÔ Û›ÙÈ, Â) Ô‰ËÁ›Â˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ÂÈÎÔÈÓˆ-Ó›· Ì ÙÔÓ ·È‰›·ÙÚÔ.

∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÙËÏÂʈÓÈÎÒÓ Û˘-

ÛÙ¿ÛÂˆÓ ÛÙËÓ ·È‰È·ÙÚÈ΋

™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÔÛÔÛÙ¿‰È·ÏÔÁ‹˜ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ì ÙË ¯Ú‹ÛË ÙËÏÂʈÓÈ-ÎÒÓ Û˘ÛÙ¿ÛÂˆÓ ·fi ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (7,26-28).OÈ ‰È·ÊÔÚ¤˜ ÛÙ· ÔÛÔÛÙ¿ ÔÊ›ÏÔÓÙ·È ÙfiÛÔ ÛÙÔ ˘ÏÈ-Îfi ÙˆÓ ÌÂÏÂÙÒÓ (∆∂¶ ÓÔÛÔÎÔÌ›ˆÓ, È·ÙÚ›· Úˆ-ÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘) fiÛÔ Î·È ÛÙÔ ¿ÙÔÌÔ Ô˘‹Ù·Ó Ô ·Ô‰¤ÎÙ˘ ÙˆÓ ÎÏ‹ÛÂˆÓ (ÁÈ·ÙÚÔ›, ÓÔÛËÏ¢-ÙÈÎfi ÚÔÛˆÈÎfi). ™Â ÌÂϤÙ˜ ÛÙȘ ∏¶∞, fiÔ˘ ›ӷÈÛ‡ÓËı˜ ÛÙ· ÙËÏÂʈÓÈο ΤÓÙÚ· Ó· ··ÓÙÔ‡Ó ÓÔ-ÛËÏÂ˘Ù¤˜ ÂȉÈο ÂÎ·È‰Â˘Ì¤ÓÔÈ ÛÙËÓ ·È‰È·ÙÚÈ΋·fi ÙÔ ÙËϤʈÓÔ, ¤¯ÂÈ ‚ÚÂı› fiÙÈ Ù· ·ÔÙÂϤÛÌ·-Ù· Â›Ó·È ÂÍ›ÛÔ˘ ÈηÓÔÔÈËÙÈο, Û˘ÁÎÚÈÓfiÌÂÓ· ÌÂÂΛӷ ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì·(7,14,18). ∏ ÌfiÓË ‰È·ÊÔÚ¿ Ô˘ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› ›-Ó·È fiÙÈ ÔÈ ÁÈ·ÙÚÔ› Û˘ÓÈÛÙÔ‡Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÙËÓ¿ÌÂÛË ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÁÈ’ ·˘Ùfi, Ë ·fiÊ·-ÛË ÁÈ· ·Ú·ÔÌ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÓÔÛÔÎÔÌ›ÔÏ·Ì‚¿ÓÂÙ·È ·fi ÙÔÓ ˘Â‡ı˘ÓÔ ÁÈ·ÙÚfi (second-levelphysician triage) (29).

ŒÓ· ·ÎfiÌ· ˙‹ÙËÌ· Â›Ó·È Û ÔÈÔ ÔÛÔÛÙfi ›ӷÈÔÚı‹ Ë ¿ÌÂÛË ·Ú·ÔÌ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÂÓfi˜·È‰ÈÔ‡ ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛˆÓ(ηٿ οÔÈÔ ÙÚfiÔ Ë ÂȉÈÎfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ ·-Ú·ÔÌ‹˜). ª›· ÂӉȷʤÚÔ˘Û· ÌÂϤÙË Ô˘ ¤ÁÈÓÂÛ ÌÂÁ¿ÏÔ ·È‰È·ÙÚÈÎfi ÓÔÛÔÎÔÌÂ›Ô ÙˆÓ ∏¶∞, ¤‰ÂÈ-Í fiÙÈ ÙÔ 80,5% ÙˆÓ ·Ú·ÔÌÒÓ Ô˘ ¤ÁÈÓ·Ó Ì¤ÛˆÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛÂˆÓ ‹Ù·Ó ÔÚı¤˜, ÂÓÒ ÛÙËÓÔÌ¿‰· ÂϤÁ¯Ô˘ ÌfiÓÔ 60,8% (30). ∂Ô̤ӈ˜, Ê·›ÓÂ-Ù·È fiÙÈ Ë ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ - Ì ÙËÓ Î·-Ù¿ÏÏËÏË ÔÚÁ¿ÓˆÛË Î·È Âη›‰Â˘ÛË - ÌÔÚ› Ó·ÌÂÈÒÛÂÈ ÙȘ ÌË ·Ó·Áη›Â˜ ÂÈÛΤ„ÂȘ ÛÙ· ∆∂¶ ÙˆÓÓÔÛÔÎÔÌ›ˆÓ Î·È Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ÔÈÎÔÓÔÌ›· ÙÔ˘Û˘ÛÙ‹Ì·ÙÔ˜ ˘Á›·˜.

¶·È‰È·ÙÚÈ΋ 2005;68:29-35

¶¶››ÓÓ··Îη·˜̃ 11.. ∞ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛˆÓÛÙËÓ ·È‰È·ÙÚÈ΋

¢¢ÈÈ··ÏÏÔÔÁÁ‹‹

∆ËÏÂʈÓÈΤ˜ Ô‰ËÁ›Â˜ ÌfiÓÔ 40-60%∂ͤٷÛË ÙËÓ ÂfiÌÂÓË Ë̤ڷ 25-40%ÕÌÂÛË ÂͤٷÛË 10-25%

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·33

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34 ¶. µÂϤÓÙ˙·˜

∏ ·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ Î·ı˘ÛÙÂ-

Ú› ÙË ‰È¿ÁÓˆÛË ‹/Î·È ÙË ıÂڷ›· ÛÔ‚·-

ÚÒÓ ÂÚÈÙÒÛˆÓ;

∏ ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ ·ÔÙÂÏ› Î·È ÙÔ ÛË-Ì·ÓÙÈÎfiÙÂÚÔ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ·Ô‰Ô¯‹ Ù˘ ˆ˜ Ì›·˜ÌÂıfi‰Ô˘ ‰È·ÏÔÁ‹˜ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ.™ÙÔ Denver, ÛÙ· 4 ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÙËÏÂʈÓÈÎÔ‡ ΤÓÙÚÔ˘ ‰ÈÂÎÂÚ·È-ÒıËÎ·Ó Ì ÂÈÙ˘¯›· 107.938 ÂÚÈÙÒÛÂȘ. ªÈÎÚ¿Ï¿ıË ÛÙË ¯Ú‹ÛË ÙˆÓ Û˘ÛÙ¿ÛÂˆÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÂ1/1450 ÎÏ‹ÛÂȘ (0,07%) (7). ™Â Ì›· ÚfiÛÊ·ÙË ÔÏ˘-ÎÂÓÙÚÈ΋ ÌÂϤÙË (Denver-Philadelphia-Cleveland-Petesbourg) 1561 ÂÚÈÙÒÛˆÓ, Ë ÛÔ‚·ÚfiÙËÙ· Ù˘ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡ ˘ÔÙÈÌ‹ıËΠ۠5 ÂÚÈ-ÙÒÛÂȘ (1/500 ÎÏ‹ÛÂȘ, 0,3%), ÂÓÒ ÛÙȘ 3 ·fi ·˘-Ù¤˜ ¤ÁÈÓ η΋ ¯Ú‹ÛË ÙˆÓ ÙËÏÂʈÓÈÎÒÓ Û˘ÛÙ¿ÛˆÓ(31). ™Â ¿ÏÏË, Ôχ ÚfiÛÊ·ÙË ÌÂϤÙË, ÛÙËÓ ÔÔ›·¤ÁÈÓ ۇÁÎÚÈÛË ÌÂٷ͇ È·ÙÚÈÎÔ‡ Î·È ÂȉÈο ÂηÈ-‰Â˘Ì¤ÓÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡ fiÔ˘ ‰ÂÓ ‰È·-ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡ÔÔÌ¿‰ˆÓ ˆ˜ ÚÔ˜ ÙË ‰È·ÏÔÁ‹ Î·È ÙȘ Ô‰ËÁ›Â˜, Û 48(4,2%) ·fi ÙȘ 1182 ÂÚÈÙÒÛÂȘ ηı˘ÛÙ¤ÚËÛ ˯ÔÚ‹ÁËÛË “ÛËÌ·ÓÙÈ΋˜” ıÂڷ›·˜ (ÔÛÔÛÙfi 2%,ˆÛÙfiÛÔ, ·ÊÔÚÔ‡Û Û ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚›ˆÛ˘ ÁÈ·ÎÔÈÓ¤˜ ·È‰È·ÙÚÈΤ˜ ÏÔÈÌÒÍÂȘ, Ô˘ ˆ˜ ÁÓˆÛÙfiÓ ‰ÂÓÎÚ›ÓÂÙ·È ¿ÓÙ· ·fi fiÏÔ˘˜ ··Ú·›ÙËÙË) (32).

∆· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ¤ˆ˜ Û‹ÌÂÚ· ·ÓÙÈ-ÌÂÙˆ›˙Ô˘Ó Ôχ ıÂÙÈο ÙÔÓ ÚfiÏÔ Ù˘ ÙËÏÂʈÓÈ-΋˜ È·ÙÚÈ΋˜ ÛÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË, ÂÊfiÛÔÓ ·˘-Ù‹ Á›ÓÂÙ·È ÔÚÁ·ÓˆÌ¤Ó·. ™ÙȘ ∏¶∞ ıˆÚÂ›Ù·È fiÙÈ Ù··È‰È·ÙÚÈο ÙËÏÂʈÓÈο ΤÓÙÚ· Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡ÓÌ ‚¿ÛË ÂȉÈΤ˜ Û˘ÛÙ¿ÛÂȘ Î·È ˘fi ÙËÓ Â›‚ÏÂ„Ë -ÂȉÈÎÒÓ Ì ÙÔ ı¤Ì· - ·È‰È¿ÙÚˆÓ Î·È ÂÍÂȉÈÎÂ˘Ì¤-ÓÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡, ÚÔÛʤÚÔ˘Ó ˘„Ë-Ï¿ ÔÛÔÛÙ¿ ÈηÓÔÔ›ËÛ˘ Û ÁÔÓ›˜ Î·È ÁÈ·ÙÚÔ‡˜,ÂÓÒ ÌÂÈÒÓÔ˘Ó ÙȘ ÂÈÛΤ„ÂȘ ÛÙ· ∆∂¶ ÙˆÓ ÓÔÛÔÎÔ-Ì›ˆÓ ¯ˆÚ›˜, ·Ú¿ÏÏËÏ·, Ó· ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔÁÈ· È·ÙÚÈο Ï¿ıË. ªÂ ‚¿ÛË ·˘Ùfi, ı· ÌÔÚÔ‡Û·Ó Ó·ÔÚÁ·ÓˆıÔ‡Ó ·ÚfiÌÔÈ· ÙËÏÂʈÓÈο ΤÓÙÚ· ÛÙ··È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›·, ÂÓÒ Î·È ÔÈ ·È‰›·ÙÚÔÈ Ù˘ڈÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘ Ô˘ οÓÔ˘Ó Ú·ÎÙÈ΋ÌfiÓÔÈ ÙÔ˘˜, ı· ÌÔÚÔ‡Û·Ó Ó· ‰·ÓÂÈÛÙÔ‡Ó ¯Ú‹ÛÈ̘ȉ¤Â˜ Î·È ÂÌÂÈڛ˜ ÁÈ· ÙËÓ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋‰È·¯Â›ÚÈÛË ÙˆÓ ÙËÏÂʈÓÈÎÒÓ ÎÏ‹ÛÂˆÓ Ô˘ ‰¤¯Ô-ÓÙ·È (7,14,28,33,34). ∂›Û˘, Â›Ó·È ¯Ú‹ÛÈÌÔ Ó· ÌÂÏÂ-ÙËı› Î·È Ë ÂÌÂÈÚ›· ·fi ¿ÏϘ ¯ÒÚ˜ Ô˘ ÂÊ·Ú-Ìfi˙Ô˘Ó Û˘ÛÙ‹Ì·Ù· ÙËÏÂʈÓÈ΋˜ È·ÙÚÈ΋˜ (35-38).

∂›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ ÛÙËÓ ·È‰È·ÙÚÈ΋

™ÙÔÓ ¶›Ó·Î· 2 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Î·Ù·ÛÙ¿ÛÂȘ Ô˘Ô ·È‰›·ÙÚÔ˜ Ú¤ÂÈ ¿ÓÙ· Ó· ·Ó·ÁÓˆÚ›˙ÂÈ ·fi ÙÔÙËϤʈÓÔ Î·È ÁÈ· ÙȘ Ôԛ˜ Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿ ÙËÓ¿ÌÂÛË ÂͤٷÛË ÛÙÔ È·ÙÚÂ›Ô ‹ ÙËÓ ¿ÌÂÛË ÌÂÙ·ÊÔÚ¿

ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (14). ™Â ÌÂÚÈΤ˜, Ì¿ÏÈ-

ÛÙ·, ·fi ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ı· Ú¤ÂÈ Ó· ‰ÒÛÂÈ

Ô‰ËÁ›Â˜ ÛÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ·ÚÔ¯‹ ÚÒÙˆÓ ‚ÔËıÂÈ-

ÒÓ ÛÙÔ ·È‰› (ÁÈ· ·Ú¿‰ÂÈÁÌ· ¯ÔÚ‹ÁËÛË ÈÂηÎÔ˘-

¿Ó·˜ Û ʷÚ̷΢ÙÈ΋ ‰ËÏËÙËÚ›·ÛË). ∂˘Ù˘¯Ò˜,

·˘Ù¤˜ ÔÈ ÂÍ·ÈÚÂÙÈο ›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ ›ӷÈ

Û¿ÓȘ Î·È ·ÔÙÂÏÔ‡Ó ÔÛÔÛÙfi <1% ÙˆÓ ÎÏ‹ÛˆÓ

Ô˘ ‰¤¯ÂÙ·È Ô ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜.

¶·È‰È·ÙÚÈ΋ 2005;68:29-35

¶¶››ÓÓ··Îη·˜̃ 22.. ∂›ÁÔ˘Û˜ ÙËÏÂʈÓÈΤ˜ ÎÏ‹ÛÂȘ ÛÙËÓ ·È‰È·-ÙÚÈ΋

ñ ¢‡ÛÎÔÏË ·Ó·ÓÔ‹ (¿ÓÔÈ·, ·‰‡Ó·ÌË ·Ó·ÓÔ‹, ÛÈÁÌfi˜,΢¿ÓˆÛË)

ñ ¶Èı·Ó‹ ·Ó·Ê˘Ï·Í›· (‰‡ÛÎÔÏË ·Ó·ÓÔ‹ ÌÂÙ¿ ·fi Ï‹„ËÊ·ÚÌ¿ÎÔ˘, ‰‹ÁÌ· ÂÓÙfiÌÔ˘, Ê·ÁËÙfi)

ñ ¡Â˘ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· (Û·ÛÌÔ›, ·ÒÏÂÈ· Û˘Ó›‰ËÛ˘,Û‡Á¯˘ÛË, Ï‹ı·ÚÁÔ˜)

ñ ¢ËÏËÙËÚ›·ÛË, Ï‹„Ë Ê·ÚÌ¿ÎˆÓ ñ ∆Ú·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ·˘¯¤Ó· ‹ ÙˆÓ ÔÊı·ÏÌÒÓ ñ ∞ÓÂͤÏÂÁÎÙË ·ÈÌÔÚÚ·Á›· ñ ∞fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜ ‹ ηÎÔÔ›ËÛË ñ ¶˘ÚÂÙfi˜ Û ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ <3 ÌËÓÒÓ ‹ >40,5oC

Û ÔÔÈÔ‰‹ÔÙ ·È‰› ñ ∞·ÚËÁfiÚËÙÔ ÎÏ¿Ì·, ÛÔ‚·Úfi˜ fiÓÔ˜ ñ ¶·Ú’ ÔÏ›ÁÔÓ ÓÈÁÌfi˜ ñ ¢È·ÌÂÚ‹ ÙÚ·‡Ì·Ù· ñ ¶Ôχ ·Ó‹Û˘¯ÔÈ ÁÔÓ›˜ ñ ∫¿ÎˆÛË ÎÂÊ·Ï‹˜ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ·ÏÏ·Á‹

Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ·ӷϷ̂·ÓfiÌÂÓÔ˘˜ Â̤ÙÔ˘˜ ñ ∞ÈÌÔÚÚ·ÁÈÎfi ÂÍ¿ÓıËÌ·

¶¶››ÓÓ··Îη·˜̃ 33.. ÃÚ‹ÛÈ̘ ÂÚˆÙ‹ÛÂȘ ÁÈ· Ó· ·Ó·ÁÓˆÚÈÛÙÔ‡Ó Â›-ÁÔ˘Û˜ ÎÏ‹ÛÂȘ ÛÙËÓ ·È‰È·ÙÚÈ΋ (ªÓËÌÔÓ‡ÔÓÙ·È ˆ˜ A, B,C, D, S)

ñ A - Airway: “∆Ô ·È‰› Û·˜ ‰˘ÛÎÔχÂÙ·È Ó· ·Ó·Ó‡ÛÂÈ ‹Î¿ÓÂÈ ıfiÚ˘‚Ô Î·ıÒ˜ ·Ó·Ó¤ÂÈ;”

ñ B - Breathing: “ª‹ˆ˜ ÙÔ ·È‰› Û·˜ ·Ó·Ó¤ÂÈ ÁÚ‹ÁÔÚ·;” ñ C - Circulation: ∂ÎÙ›ÌËÛË Ù˘ ÂÓ˘‰¿ÙˆÛ˘

“¶fiÛ· ˘ÁÚ¿ ‹È ÙÔ ·È‰› Û·˜;”“¶fiÙ ԇÚËÛ ÁÈ· ÙÂÏÂ˘Ù·›· ÊÔÚ¿;”“¶fiÛÔ˘˜ Â̤ÙÔ˘˜ Î·È ‰È¿ÚÚÔȘ ¤¯ÂÈ Î¿ÓÂÈ;”

ñ D - Deficits: ∂ÎÙÈÌԇ̠ÙÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘ Î·È ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· “Œ¯ÂÈ ÙÔ ·È‰› Û·˜ ÙË Û˘ÓËıÈṲ̂ÓË ‰Ú·ÛÙËÚÈfiÙËÙ·;” “∂ӉȷʤÚÂÙ·È ÁÈ· Ù· ·È¯Ó›‰È· ÙÔ˘ Î·È Ù· ÚfiÛˆ·Á‡Úˆ ÙÔ˘;”

ñ S - Skin: “Œ¯ÂÈ ÌÂÏ·Ó¤˜ ÎËÏ›‰Â˜ ‹/Î·È ÎfiÎÎÈÓ· ÛÙ›ÁÌ·Ù·ÛÙÔ ‰¤ÚÌ· ÙÔ˘;”

¶¶››ÓÓ··Îη·˜̃ 44.. ™˘¯ÓfiÙÂÚ· ·›ÙÈ· ÎÏ‹Û˘ ·È‰È¿ÙÚˆÓ

1. ¶˘ÚÂÙfi˜ 11. ∫fiÎÎÈÓÔ Ì¿ÙÈ 2. ŒÌÂÙÔ˜ 12. ∫Ï¿Ì· ‚ÚÂÊÒÓ 3. øÙ·ÏÁ›· 13. ∆Ú·˘Ì·ÙÈÛÌÔ› ‰¤ÚÌ·ÙÔ˜ 4. ¶ÔÓfiÏ·ÈÌÔ˜ 14. Croup 5. ∫Ú˘ÔÏÔÁ‹Ì·Ù· 15. ∂Í·Óı‹Ì·Ù· 6. µ‹¯·˜ 16. ∫Ó›‰ˆÛË 7. ¢È¿ÚÚÔÈ· 17. ¶·ÚÂÓ¤ÚÁÂȘ ÂÌ‚ÔÏ›ˆÓ 8. ∫¿ÎˆÛË ÎÂÊ·Ï‹˜ 18. ¢˘ÛÎÔÈÏÈfiÙËÙ· 9. ∫ÔÈÏÈ·Îfi ¿ÏÁÔ˜ 19. ∫ÂÊ·Ï·ÏÁ›·

10. ∆Ú·˘Ì·ÙÈÛÌÔ› ¿ÎÚˆÓ 20. ∫Ú›ÛÂȘ ¿ÛıÌ·ÙÔ˜

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¶·È‰È·ÙÚÈ΋ 2005;68:29-35

35¶·È‰È·ÙÚÈ΋ ·fi ÙÔ ÙËϤʈÓÔ

™ÙÔÓ ¶›Ó·Î· 3 ·Ó·Ê¤ÚÔÓÙ·È ÂÚˆÙ‹ÛÂȘ Ô˘Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ó·ÁÓˆÚ›˙Ô-ÓÙ·È ÔÈ Â›ÁÔ˘Û˜ ηٷÛÙ¿ÛÂȘ.

OÈ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ Ô˘ ÔÈ ÁÔÓ›˜ ηÏÔ‡Ó

ÙÔÓ ·È‰›·ÙÚÔ

™ÙÔÓ ¶›Ó·Î· 4 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ 20 Û˘¯ÓfiÙÂÚ˜·Èٛ˜ ÁÈ· ÙȘ Ôԛ˜ ÔÈ ÁÔÓ›˜ ÙËÏÂʈÓÔ‡Ó ÛÙÔӷȉ›·ÙÚfi ÙÔ˘˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡ÓÎÏÈÓÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∞ÔÙÂÏÔ‡Ó>70% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÎÏ‹ÛÂˆÓ Ô˘ ‰¤¯ÂÙ·È Ô ÁÂ-ÓÈÎfi˜ ·È‰›·ÙÚÔ˜ (7,14). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, οı·ȉ›·ÙÚÔ˜ Ô˘ ı¤ÏÂÈ Ó· ÂÍ·ÛΛ ·È‰È·ÙÚÈ΋ ·fiÙÔ ÙËϤʈÓÔ Ì ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿-ÏÂÈ·, ı· Ú¤ÂÈ Ó· Ì¿ıÂÈ Ó· ¯ÂÈÚ›˙ÂÙ·È Ì ¢¯¤ÚÂÈ·ÙȘ ÎÏ‹ÛÂȘ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙȘ ·Ú·¿Óˆ ·Èٛ˜›Ù ÌÂÏÂÙÒÓÙ·˜ ÙȘ Û˘ÛÙ¿ÛÂȘ Ô˘ ΢ÎÏÔÊÔÚÔ‡ÓÎ·È ÚÔÛ·ÚÌfi˙ÔÓÙ·˜ ·˘Ù¤˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘Ú·ÎÙÈ΋, ›Ù - ·ÎfiÌ· ηχÙÂÚ· - Ì ÙËÓ Âη›-‰Â˘Û‹ ÙÔ˘ ˆ˜ ÂȉÈ΢fiÌÂÓÔ˜ Û ·˘Ù¿ Ù· ˙Ë̷ًٷηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÏÈÓÈ΋˜ ÙÔ˘ Ú·ÎÙÈ΋˜.

µÈ‚ÏÈÔÁÚ·Ê›·

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36 REVIEW ARTICLE

Health Center ofMarkopoulo, Mesogaia

Correspondence:

Polizois Velentzas 25 Efranoros str., 116 35, Athens E-mail: [email protected]

Date of submission: 23-04-2004 Date of approval: 01-10-2004

Paediatriki 2005;68:36

Pediatric telephone medicine

P. Velentzas

Abstract

Management of several clinical problems in children by telephone is a common practice in pediatrics.Telephone communication between parents and pediatrician is easy, direct, inexpensive and effective,provided some basic terms are fulfilled. General pediatricians may spend considerable time daily, especiallyafter-hours, to provide advice by telephone. The present article reviews the historical background of pediatrictelephone medicine and the relations between pediatricians and telephone, types and difficulties of clinicalcare by telephone, and the inadequacies and deficiencies of the personnel providing information by telephone.Furthermore, some key-points are presented on the effectiveness and safety of the procedure, emergency callsin pediatrics and data to support the role of pediatric call centers using pediatric telephone guidelines for triageand advice.

Key words

Telephone medicine, pediatrics, primary care, emergency medicine, call centers.

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1 ∂ıÓÈ΋ ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ÀÁ›·˜

2 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ ηÈ∂ȉËÌÈÔÏÔÁ›·˜, π·ÙÚÈ΋™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ

AÏÏËÏÔÁÚ·Ê›·:

¢ËÌ‹ÙÚ˘ §¿ÁÁ·˜ ∫·ÏÏȉÚÔÌ›Ô˘ 6, ∆.∫. 114 72, ∞ı‹Ó· E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-03-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-09-2004

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

°ÔÓÂ˚΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È ÚfiÏË„Ë ·È‰ÈÎÒÓ

·Ù˘¯ËÌ¿ÙˆÓ

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¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ·Ú·Ì¤ÙÚˆÓ Ô˘ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙËÓ È-ı·Ó‹ ÂÌÏÔ΋ Ù˘ ÁÔÓÂ˚΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙËÓ ÚfiÎÏËÛË ÔÈÎÈ·ÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ-΋˜ ËÏÈΛ·˜.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙË Û˘ÌÏ‹ÚˆÛË 400 ·ÓÒÓ˘ÌˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓÌ ÚÔÛˆÈΤ˜ Û˘ÓÂÓÙ‡ÍÂȘ ·fi ÁÔÓ›˜ ·È‰ÈÒÓ ËÏÈΛ·˜ 2-4 ÂÙÒÓ, 200 ·fi Ù· ÔÔ›· ηÙÔÈÎÔ‡Û·Ó ÛÙËÓ Â-ÚÈÔ¯‹ ∞ÌÂÏÔ΋ˆÓ ÙÔ˘ ¢‹ÌÔ˘ ∞ıËÓ·›ˆÓ (ÂÚÈÔ¯‹ Ì ̤ÛÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ›‰Ô) Î·È 200 ÛÙÔÓ¢‹ÌÔ ÕÓˆ §ÈÔÛ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ∞ÙÙÈ΋˜ (ÂÚÈÔ¯‹ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο ˘Ô‚·ıÌÈṲ̂ÓË). OÈ ÂÚˆÙ‹ÛÂȘ·ÊÔÚÔ‡Û·Ó Û ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÛÙË Û˘¯ÓfiÙËÙ· Î·È ÙÔÓ Ù‡Ô ÂӉ¯fiÌÂÓˆÓ ·Ù˘¯Ë-Ì¿ÙˆÓ Î·È Û ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È·ÌfiÚʈÛË: ·) ÂÓfi˜ ¢Â›ÎÙË °ÔÓÂ˚΋˜ ™˘ÌÂÚÈÊÔÚ¿˜ (¢°™) Û¯ÂÙÈο ÌÂÙȘ ÔÚı¤˜ ÁÓÒÛÂȘ Î·È ÛÙ¿ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙÔ ·ÛʷϤ˜ ·È‰ÈÎfi ÂÚÈ‚¿ÏÏÔÓ Î·È ‚) ÂÓfi˜ ¢Â›ÎÙË °ÔÓÂ˚΋˜∂›‚Ï„˘ (¢°∂) Û¯ÂÙÈο Ì ÙËÓ ÔÈÔÙÈ΋ ÁÔÓÂ˚΋ ›‚Ï„Ë. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓÂÌ ÔÏÏ·Ï‹ ÁÚ·ÌÌÈ΋ Î·È ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË.

∞ÔÙÂϤÛÌ·Ù·: µÚ¤ıËΠfiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ¢°™ ηٿ 1 ÌÔÓ¿‰· Û¯ÂÙ›˙ÂÙ·È Ì Ì›ˆÛË Ù˘ ÙÈÌ‹˜ ÙÔ˘ ‰Â›ÎÙË·Ù˘¯‹Ì·ÙÔ˜ ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ ηٿ 0,09 Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÚfiÎÏËÛ˘ ·Ù˘¯ËÌ¿ÙˆÓ ¤Íˆ·fi ÙÔ Û›ÙÈ Î·Ù¿ 15%, ÂÓÒ Ë Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ¢°∂ ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∂›Û˘, ‰È·È-ÛÙÒıËÎ·Ó ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÙÔ˘ ‰Â›ÎÙË ·Ù˘¯‹Ì·ÙÔ˜ ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ Û ·È‰È¿ Ô˘‰È·Ì¤ÓÔ˘Ó ÛÙËÓ ˘Ô‚·ıÌÈṲ̂ÓË ÂÚÈÔ¯‹ Î·È Û ÂΛӷ ÌËÙ¤ÚˆÓ Ì ¯·ÌËÏfi Â›Â‰Ô ÌfiÚʈÛ˘. ∞ÓÙ›ıÂÙ·,Ù· ·Ù˘¯‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ηٷӷψÙÈο ·Á·ı¿, ·ÏÏ¿ Î·È fiÛ· Û˘Ì‚·›ÓÔ˘Ó ¤Íˆ ·fi ÙÔ Û›ÙÈ ‹Ù·ÓÛ˘¯ÓfiÙÂÚ· Û ·È‰È¿ ÂÚÁ·˙fiÌÂÓˆÓ ÌËÙ¤ÚˆÓ ˘„ËÏ‹˜ ÌfiÚʈÛ˘.

™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÚÈṲ̂Ó˜ ·Ú¿ÌÂÙÚÔÈ Ô˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ÔÚı¤˜ ÁÓÒÛÂȘ Î·È ÛÙ¿ÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙË ‰È·ÌfiÚʈÛË ·ÛÊ·ÏÔ‡˜ ÂÚÈ‚¿ÏÏÔÓÙÔ˜‰È·‚›ˆÛ˘ ÙÔ˘ ·È‰ÈÔ‡, ÂËÚ¿˙Ô˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÔÈÎÈ·ÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙËÓÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·.

§¤ÍÂȘ ÎÏÂȉȿ

AÙ‡¯ËÌ·, ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜, ÁÔÓÂ˚΋ Û˘ÌÂÚÈÊÔÚ¿.

∂ÈÛ·ÁˆÁ‹

∆· ·Ù˘¯‹Ì·Ù· Â›Ó·È Û‹ÌÂÚ· Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿-ÙÔ˘ Î·È ·Ó·ËÚ›·˜ ÛÙ· ·È‰È¿ ÌÂÙ¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜Ù˘ ˙ˆ‹˜ Û fiϘ ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ¤¯ÔÓÙ·˜Ï¿‚ÂÈ Ï¤ÔÓ - ηٿ ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ - ‰È·ÛÙ¿-ÛÂȘ ÂȉËÌ›·˜ (1-3). √È ÎÔÈÓˆÓÈΤ˜ ÂÈÙÒÛÂȘ,·ÓÂÍ¿ÚÙËÙ· ·fi ÙË Ì¤ıÔ‰Ô ÂÎÙ›ÌËÛ‹˜ ÙÔ˘˜ (·Ò-ÏÂÈ· ·ÓıÚÒÈÓÔ˘ ‰˘Ó·ÌÈÎÔ‡, ÎfiÛÙÔ˜ ıÂڷ›·˜,·ÔηٿÛÙ·Û˘ Î·È Â·Ó¤ÓÙ·Í˘), ·Ú·Ì¤ÓÔ˘Ó Û·Ó›ÙÚÂÙ· ˘„ËÏ¿ ›‰· (4).

™ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, Ù· ÂÚÈÛÛfiÙÂÚ· ·Ù˘-¯‹Ì·Ù· Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡,fiÔ˘ Ù· ·È‰È¿ ÂÚÓÔ‡Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘¯ÚfiÓÔ˘ ÙÔ˘˜ (5-8). OÈ Û˘¯ÓfiÙÂÚÔÈ Ù‡ÔÈ ·Ù˘¯‹Ì·-

ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙȘ ÙÒÛÂȘ, Ù· ÂÁη‡Ì·Ù· ηÈ

ÙȘ ‰ËÏËÙËÚÈ¿ÛÂȘ (9-10). ∆Ô Ê‡ÏÔ, ÙÔ ÛÙ¿‰ÈÔ Ù˘

„˘¯ÔÎÈÓËÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡, ÙÔ ÎÔÈÓˆ-

ÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, Ë

ËÏÈΛ· Î·È ÙÔ Â›Â‰Ô ÌfiÚʈÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘

Â›Ó·È ÌÂÚÈÎÔ› ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚ› Ó·

¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿-

ÙˆÓ (11-14). ∂ȉÈο ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·,

fiÔ˘ ÔÈ ÁÔÓ›˜ ¤¯Ô˘Ó ۯ‰fiÓ ·ÔÎÏÂÈÛÙÈο ÙËÓ

¢ı‡ÓË Ù˘ ÊÚÔÓÙ›‰·˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ¤¯ÂÈ ÂÓÔ-

¯ÔÔÈËı› Î·È Ë ÁÔÓÂ˚΋ Û˘ÌÂÚÈÊÔÚ¿, ˘fi ÙËÓ

¤ÓÓÔÈ· ÙˆÓ ÔÚıÒÓ ÁÓÒÛˆÓ, ÛÙ¿ÛÂˆÓ Î·È Ú·ÎÙÈ-

ÎÒÓ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ·È‰ÈÎÒÓ

·Ù˘¯ËÌ¿ÙˆÓ Î·È Ù˘ ‰È·ÌfiÚʈÛ˘ ·ÛÊ·ÏÔ‡˜ Â-

ÚÈ‚¿ÏÏÔÓÙÔ˜ ‰È·‚›ˆÛ˘ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ (15-17).

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·37

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38 ¢. §¿ÁÁ·˜ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

∞ÓÙ›ıÂÙ·, Ë ÔÈÔÙÈ΋ ÁÔÓÂ˚΋ ›‚ÏÂ„Ë ÙÔ˘ ·È-‰ÈÔ‡ ηٿ ÙËÓ ÒÚ· ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÙÔ˘ ¤¯ÂÈ·ÌÊÈÛ‚ËÙËı› ·fi ÌÂÚÈÎÔ‡˜ ÂÚ¢ÓËÙ¤˜ ˆ˜ ·Ú¿-ÁˆÓ ÚfiÏ˄˘ ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ (18).

™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡-ÓËÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙËÓ Èı·-Ó‹ ›‰Ú·ÛË Ù˘ ÁÔÓÂ˚΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙfiÛÔÛÙËÓ ÚfiÎÏËÛË fiÛÔ Î·È ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ·Ù˘¯Ë-Ì¿ÙˆÓ Û ·È‰È¿ ËÏÈΛ·˜ 2-4 ÂÙÒÓ, Ô˘ Û˘Ó¤‚ËÛ·ÓÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡, ·ÏÏ¿ Î·È ÛÙÔ˘˜ ¯Ò-ÚÔ˘˜ ¤Íˆ ·fi ·˘Ùfi. OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÚ¢ӋıË-Î·Ó Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ‹ ¤ÌÌÂÛ· Ì ÙËÓ ÔÈÔÙÈ΋ÁÔÓÂ˚΋ ›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙȘ ‰Ú·ÛÙËÚÈfi-ÙËÙ¤˜ ÙÔ˘ ÛÙÔ ÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È ÛÙÔ˘˜ ¯Ò-ÚÔ˘˜ ·Ó·„˘¯‹˜ Î·È ÙË ‰È·ÌfiÚʈÛË ·ÛÊ·ÏÔ‡˜ Â-ÚÈ‚¿ÏÏÔÓÙÔ˜ ‰È·‚›ˆÛ‹˜ ÙÔ˘, ÒÛÙ ӷ Â›Ó·È ‰˘Ó·Ù‹Ë ·ÛÊ·Ï‹˜ ÂÎÙ›ÌËÛË ÙÔ˘ ‚·ıÌÔ‡ ›‰Ú·Û˘ Ù˘ÁÔÓÂ˚΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ÂÈ-‰ËÌÈÔÏÔÁÈÎÔ‡ ÚÔÙ‡Ô˘ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙËÓÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ¤Ú¢ӷ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÙËÓ ÂÚ›Ô‰Ô ¢ÂΤ̂ÚÈÔ˜1996 - OÎÙÒ‚ÚÈÔ˜ 1998, Û ‰‡Ô ÂÚÈÔ¯¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∞ÙÙÈ-΋˜ Ì ‰È·ÊÔÚÂÙÈÎfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ›‰Ô: ÛÙËÓÂÚÈÔ¯‹ ÙˆÓ ∞ÌÂÏÔ΋ˆÓ Î·È ÛÙÔÓ ¢‹ÌÔ ÕÓˆ §ÈÔÛ›ˆÓ(̤ÛÔ Î·È ˘Ô‚·ıÌÈṲ̂ÓÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ›‰Ô,·ÓÙ›ÛÙÔȯ·).

∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙË Û˘ÌÏ‹ÚˆÛË ÂÈ-‰Èο ‰È·ÌÔÚʈ̤ÓÔ˘ ·ÓÒÓ˘ÌÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ “ÎÏÂÈ-ÛÙÔ‡ Ù‡Ô˘” - Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ ÚÔÛˆÈÎÒÓ Û˘ÓÂÓÙ‡ÍÂ-ˆÓ - ·fi 200 ÔÈÎÔÁ¤ÓÂȘ οı ÂÚÈÔ¯‹˜. ∆Ô ÂÚˆÙËÌ·ÙÔÏfi-ÁÈÔ Î¿Ï˘Ù ٷ ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ (¶›Ó·Î·˜ 1), η٤ÁÚ·Ê ÏÂ-ÙÔÌÂÚÒ˜ ÙÔÓ Ù‡Ô Î·È ÙË Û˘¯ÓfiÙËÙ· fiÏˆÓ ÙˆÓ ·È‰ÈÎÒÓ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û˘Ó¤‚ËÛ·Ó ÛÙÔ ÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·ÈÛÙÔ˘˜ ¯ÒÚÔ˘˜ ¤Íˆ ·fi ÙÔ Û›ÙÈ, ̤¯ÚÈ ÙË ÛÙÈÁÌ‹ Ù˘ Û˘Ó¤-ÓÙ¢Í˘, ÂÓÒ Û˘ÁΤÓÙÚˆÓÂ Î·È ¤Ó· ¢ڇ Ê¿ÛÌ· ·Ú·Ì¤ÙÚˆÓÂϤÁ¯Ô˘ ÙˆÓ ÁÓÒÛˆÓ, ÛÙ¿ÛÂˆÓ Î·È Ú·ÎÙÈÎÒÓ ÙˆÓ ÁÔÓ¤ˆÓÛÙËÓ ÚfiÏË„Ë ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ. ™ÙËÓ ¤ÚÂ˘Ó·Û˘ÌÌÂÙ›¯·Ó fiÏÔÈ ÔÈ ÁÔÓ›˜ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ¶ÚfiÙ˘·∂Î·È‰Â˘ÙÈο ∫¤ÓÙÚ· ÙÔ˘ ∂ÏÏËÓÈÎÔ‡ ∂Ú˘ıÚÔ‡ ™Ù·˘ÚÔ‡ ο-ı ÂÚÈÔ¯‹˜ ÁÈ· ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ÚfiÏ˄˘ ÛÙ· ·È‰È¿ÙÔ˘˜ (΢ڛˆ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜). OÈ ÂÚˆÙËı¤ÓÙ˜ ‹Ù·Ó ÛÙË Û˘-ÓÙÚÈÙÈ΋ ÏÂÈÔÓfiÙËÙ· (95,5%) ÌËÙ¤Ú˜. ŸÏÔÈ ÔÈ ÁÔÓ›˜‹Ù·Ó ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È ˘ËÎÔfiÙËÙ·˜, Û˘ÌÌÂÙ›¯·ÓÂıÂÏÔÓÙÈο Î·È ‰ÂÓ ˘‹ÚÍ·Ó ·ÚÓ‹ÛÂȘ. ∞ÏÏÔ‰·Ô›, ÔÈÎÔÓÔ-ÌÈÎÔ› ÌÂÙ·Ó¿ÛÙ˜ Î·È ŒÏÏËÓ˜ ÌË ÌfiÓÈÌÔÈ Î¿ÙÔÈÎÔÈ ÙˆÓ Â-ÚÈÔ¯ÒÓ Ù˘ ¤Ú¢ӷ˜ ·ÔÎÏ›ÛÙËηÓ.

ø˜ ·Ù‡¯ËÌ· ÔÚ›ÛÙËΠοı ·ÎÔ‡ÛÈ· ۈ̷ÙÈ΋ ‚Ï¿‚ËÔ˘ ÔÊ›ÏÂÙ·È ÛÙËÓ ÂÓÂÚÁÂȷ΋ ›‰Ú·ÛË (Ì˯·ÓÈ΋, ¯ËÌÈ-΋, ıÂÚÌÈ΋, ËÏÂÎÙÚÈ΋) Ì›·˜ Â͈ÙÂÚÈ΋˜ ‰‡Ó·Ì˘, Ë ÈÛ¯‡˜Ù˘ ÔÔ›·˜ ˘ÂÚ‚·›ÓÂÈ Ù· ÁÂÓÈο ‹ ÙÔÈο fiÚÈ· ·ÓÙÔ¯‹˜ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·ÈηٷÛÙ¿ÛÂˆÓ ÛÙ¤ÚËÛ˘ ‚·ÛÈÎÒÓ ˙ˆÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ,fiˆ˜ ÙÔ Ô͢ÁfiÓÔ Î·È Ë ıÂÚÌfiÙËÙ· (4), ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË‚·Ú‡ÙËÙ¿ ÙÔ˘.

∆· ·Ù˘¯‹Ì·Ù· ηÙËÁÔÚÈÔÔÈ‹ıËηÓ, ·Ó¿ÏÔÁ· Ì ÙÔÓÌ˯·ÓÈÛÌfi ÚfiÎÏËÛ˘, Û ٤ÛÛÂÚȘ ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 2). °È·ÙËÓ ÚÒÙË ÔÌ¿‰· (·Ù˘¯‹Ì·Ù· ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜

ÂÓ¤ÚÁÂÈ·˜) ÔÚ›ÛÙËΠ¤Ó·˜ ‰Â›ÎÙ˘ ·Ù˘¯‹Ì·ÙÔ˜ Ô˘ ‚·ıÌÔ-ÏÔÁÔ‡ÓÙ·Ó ·fi 0 (ηӤӷ ·Ù‡¯ËÌ·) ¤ˆ˜ 10 (fiÏ· Ù· ·Ù˘¯‹-Ì·Ù·). °È· οı ̛· ·fi ÙȘ ˘fiÏÔȘ ÙÚÂȘ ÔÌ¿‰Â˜ ·Ù˘¯Ë-Ì¿ÙˆÓ (Ï‹„Ë Î·Ù·Ó·ÏˆÙÈÎÒÓ ·Á·ıÒÓ, ·ʋ Ì ıÂÚÌÈ΋-ËÏÂÎÙÚÈ΋ ÂÓ¤ÚÁÂÈ· Î·È ·Ù˘¯‹Ì·Ù· ¤Íˆ ·fi ÙÔ Û›ÙÈ), ‰ËÌÈ-Ô˘ÚÁ‹ıËΠ·ÓÙ›ÛÙÔȯԘ ‰Â›ÎÙ˘ Ì ÙÈ̤˜ 0 (ηӤӷ ·Ù‡¯Ë-Ì·) Î·È 1 (¤ÛÙˆ Î·È ¤Ó· ·Ù‡¯ËÌ· Ù˘ ›‰È·˜ ÔÌ¿‰·˜).

°È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÁÔÓÂ˚΋˜ ¢ı‡Ó˘ ÛÙÔ ·Ù‡¯ËÌ·‰È·ÌÔÚÊÒıËÎ·Ó Ô ¢Â›ÎÙ˘ °ÔÓÂ˚΋˜ ∂›‚Ï„˘ (¢°∂) Î·È Ô¢Â›ÎÙ˘ °ÔÓÂ˚΋˜ ™˘ÌÂÚÈÊÔÚ¿˜ (¢°™). ™ÙÔÓ ÚÒÙÔ Û˘ÌÂ-ÚÈÏ‹ÊıËÛ·Ó 5 ÚÔÏËÙÈο ̤ÙÚ· ·ÓÙÈÚÔÛˆÂ˘ÙÈο Ù˘ÔÈÔÙÈ΋˜ ÁÔÓÂ˚΋˜ ›‚Ï„˘ Î·È ÛÙÔÓ ‰Â‡ÙÂÚÔ 10 ̤ÙÚ·Ô˘ ·ÔÙ˘ÒÓÔ˘Ó ÙȘ ÁÓÒÛÂȘ, ÛÙ¿ÛÂȘ Î·È Ú·ÎÙÈΤ˜ ÙˆÓÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÔÈÎÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ (¶›-ӷη˜ 3), Û‡Ìʈӷ Ì ÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ Ù˘ Û‡Á¯ÚÔ-Ó˘ ÂÏÏËÓÈ΋˜ ÎÔÈÓˆÓ›·˜ (19). OÈ ÙÈ̤˜ ÙˆÓ ‰ÂÈÎÙÒÓ ‹Ù·Ó·fi 0 (ηӤӷ ̤ÙÚÔ) ¤ˆ˜ 5 ÁÈ· ÙÔÓ ¢°∂ Î·È ¤ˆ˜ 10 ÁÈ· ÙÔÓ¢°™ (Ï‹„Ë fiÏˆÓ ÙˆÓ Ì¤ÙÚˆÓ).

∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ù˘ ¤Ú¢ӷ˜ ¤ÁÈ-Ó Ì ÔÏÏ·Ï‹ ÁÚ·ÌÌÈ΋ ÂÍ¿ÚÙËÛË, fiÔ˘ ˘ÔÏÔÁ›ÛÙËÎÂÁÈ· οı ·ÓÂÍ¿ÚÙËÙË ÌÂÙ·‚ÏËÙ‹ Ô Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÚÈ΋˜ÂÍ¿ÚÙËÛ˘ (b), Ô˘ ÂÎÊÚ¿˙ÂÈ ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ÌÂÙ·‚ÔÏ‹Ù˘ ÂÍ·ÚÙË̤Ó˘ ÌÂÙ·‚ÏËÙ‹˜ (‰Â›ÎÙ˘ ·Ù˘¯‹Ì·ÙÔ˜ ÏfiÁˆ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜), fiÙ·Ó Ë ·ÓÙ›ÛÙÔÈ¯Ë ·ÓÂÍ¿Ú-ÙËÙË ÌÂÙ·‚ÏËÙ‹ ÌÂÙ·‚ÏËı› ηٿ Ì›· ÌÔÓ¿‰· ‹ ηٿ Ì›· η-ÙËÁÔÚ›·, ÂÓÒ ÔÈ ˘fiÏÔȘ ·ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ ·Ú·-̤ÓÔ˘Ó ÛÙ·ıÂÚ¤˜ (20). ∂›Û˘, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ÔÏ-Ï·Ï‹ ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË, ˘ÔÏÔÁ›ÛÙËÎÂ Ô Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜ ÁÈ· ·Ù‡¯ËÌ·, Ô˘ ηٷٿÛÛÂÙ·È Û οÔÈ· ·fi ÙȘÙÚÂȘ ÔÌ¿‰Â˜ ·Ù˘¯ËÌ¿ÙˆÓ, ·Ó¿ÏÔÁ· Ì ÙȘ ‰ËÌÔÁÚ·ÊÈΤ˜,ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜, ·ÏÏ¿ Î·È ÙÔ˘˜ ‰Â›ÎÙ˜Ù˘ ÁÔÓÂ˚΋˜ ›‚Ï„˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (20).

∞ÔÙÂϤÛÌ·Ù·

O ¶›Ó·Î·˜ 1 ‰Â›¯ÓÂÈ ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ‰ËÌÔ-ÁÚ·ÊÈÎÒÓ Î·È ÎÔÈÓˆÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ∏ ηٷÓÔÌ‹ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ ·Ó¿ ÂÍ¿ÌËÓÔ Â›-Ó·È ·ÚfiÌÔÈ· Î·È Ù· ·ÁfiÚÈ· ˘ÂÚ¤¯Ô˘Ó ÂÏ·ÊÚÒ˜ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∆Ô Â›Â‰Ô ÌfiÚʈÛ˘ ÙˆÓ ÌËÙ¤-ÚˆÓ Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙË ÌÂÛÔ·ÛÙÈ΋ ÂÚÈÔ¯‹ Ù˘¤Ú¢ӷ˜ Â›Ó·È Û·ÊÒ˜ ˘„ËÏfiÙÂÚÔ ÂÎÂ›ÓˆÓ Ô˘ ‰È·-̤ÓÔ˘Ó ÛÙËÓ ˘Ô‚·ıÌÈṲ̂ÓË ÂÚÈÔ¯‹. ™ÙËÓ ›‰È·ÂÚÈÔ¯‹ ·Ú·ÙËÚ‹ıËΠ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ÂÚÁ·-˙fiÌÂÓˆÓ ÌËÙ¤ÚˆÓ, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÔÈÎÔÁÂÓÂÈ-ÒÓ Ì ÙÚ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·È‰È¿ ˘ÂÚ¤¯ÂÈ ÛÙËÓ ˘Ô-‚·ıÌÈṲ̂ÓË ÂÚÈÔ¯‹ Û˘ÁÎÚÈÙÈο Ì ÙË ÌÂÛÔ·ÛÙÈ΋.

™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ·ÔÙÂϤ-ÛÌ·Ù· Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È ÙÔ˘ ›‰Ô˘˜ ÙˆÓ ·Ù˘¯Ë-Ì¿ÙˆÓ Ô˘ Û˘Ó¤‚ËÛ·Ó ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘. ∆· Û˘¯ÓfiÙÂÚ· ·Ù˘¯‹Ì·Ù· Ô˘ ηٷÁÚ¿ÊËηÓÔÊ›ÏÔÓÙ·È ÛÙËÓ ¤ÎÏ˘ÛË Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜(ÎÙ˘‹Ì·Ù· Û ÔÍ›˜ ÁˆÓ›Â˜ Â›ÏˆÓ 73,3%,ÙÒÛÂȘ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‚¿‰ÈÛ˘ 50,3%, ÔÏÈ-Ûı‹ÛÂȘ Û ÏÂ›Ô ‰¿Â‰Ô 46,5%) Î·È ·ÎÔÏÔ˘ıÔ‡ÓÙ· ÂÁη‡Ì·Ù· ÏfiÁˆ ·ʋ˜ Ì ıÂÚÌ‹ Û˘Û΢‹(45,0%). ∏ ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ· Ô˘ ·Ú·ÙËÚ‹ıË-ΠÁÈ· Ù· ·Ù˘¯‹Ì·Ù· ¤Íˆ ·fi ÙÔ Û›ÙÈ (13,3%) ‰ÈηÈÔÏÔÁ›ٷÈ, ηıÒ˜ Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·38

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39¶ÚfiÏË„Ë ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

ËÏÈΛ·˜ ÂÚÓÔ‡Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘ÙÔ˘˜ ̤۷ ÛÙÔ Û›ÙÈ.

∞fi ÙÔÓ ¶›Ó·Î· 3 ÚÔ·ÙÂÈ fiÙÈ Ë Û˘ÌÌfiÚʈÛˤÛÙˆ Î·È ÂÓfi˜ ÂÎ ÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó Ôχ ÈηÓÔÔÈË-ÙÈ΋ ÛÙË Ï‹„Ë ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ Ì¤ÙÚˆÓ ÚfiÏË-„˘, Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÔÈÔÙÈ΋ ÁÔÓÂ˚΋ ›-‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÙˆÓ ‰Ú·ÛÙËÚÈÔ-Ù‹ÙˆÓ ÙÔ˘ (ÂÓÂÚÁËÙÈ΋ ÚfiÏË„Ë), ÂÓÒ ‹Ù·Ó ȉȷ›-ÙÂÚ· ·Ó·Ú΋˜ Û ÔÚÈṲ̂ӷ ̤ÙÚ· Ô˘ ·ÓÙ·Ó·-ÎÏÔ‡Ó ÙË ÁÔÓÂ˚΋ Ú·ÎÙÈ΋ ÁÈ· ‰È·ÌfiÚʈÛË ·ÛÊ·-ÏÔ‡˜ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ‰È·‚›ˆÛ˘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜(·ıËÙÈ΋ ÚfiÏË„Ë). ªÂÏÂÙÒÓÙ·˜ ·ıÚÔÈÛÙÈο ÙÔÓ¢°∂ ÚԤ΢„ fiÙÈ 268 ÔÈÎÔÁ¤ÓÂȘ (67,0%) ›¯·ÓÏ¿‚ÂÈ fiÏ· Ù· ÚÔÏËÙÈο ̤ÙÚ· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ-ÓÙ·È ÛÙÔÓ ‰Â›ÎÙË. ∞ÓÙ›ıÂÙ·, fiÛÔÓ ·ÊÔÚ¿ Û ·˘Ù¿Ô˘ Û˘ÌÂÚÈÏ‹ÊıËÛ·Ó ÛÙÔÓ ¢°™, ÌfiÓÔ 38 ÔÈÎÔÁ¤-ÓÂȘ (9,5%) ›¯·Ó Ï¿‚ÂÈ Û¯Â‰fiÓ fiÏ· Ù· ̤ÙÚ· (8-10), ÂÓÒ 82 (20,5%) ›¯·Ó Ï¿‚ÂÈ Ì¤¯ÚÈ Î·È 3 ̤ÙÚ·.

™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ·ÔÙÂϤ-ÛÌ·Ù· Ù˘ ÔÏÏ·Ï‹˜ ÁÚ·ÌÌÈ΋˜ ÂÍ¿ÚÙËÛ˘ ÙÔ˘‰Â›ÎÙË ·Ù˘¯‹Ì·ÙÔ˜ ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜ÂÓ¤ÚÁÂÈ·˜ Û ۯ¤ÛË Ì ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ÌÂÏÂ-Ù‹ıËηÓ. ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ ‰Â›ÎÙË ÛÙ· ·ÁfiÚÈ· ‹Ù·Ó˘„ËÏfiÙÂÚË ÂΛӢ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Î·Ù¿ 0,37 ·Ù˘-¯‹Ì·Ù· (Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÚÈ΋˜ ÂÍ¿ÚÙËÛ˘ b ÙÔ˘Ê‡ÏÔ˘). ™Ù· ·È‰È¿ Ô˘ ‰È¤ÌÂÓ·Ó ÛÙËÓ ÂÚÈÔ¯‹ ÌÂ̤ÛÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ›‰Ô, Ë ÙÈÌ‹ ÙÔ˘

›‰ÈÔ˘ ‰Â›ÎÙË ‚Ú¤ıËΠÌÈÎÚfiÙÂÚË Î·Ù¿ 0,61 ·Ù˘¯‹-Ì·Ù·, Û˘ÁÎÚÈÙÈο Ì ÂΛӷ Ù˘ ˘Ô‚·ıÌÈṲ̂Ó˘ÂÚÈÔ¯‹˜. ∂›Û˘, ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÙÔ˘ ‰Â›ÎÙË·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙ· ·È‰È¿ ÔÈÎÔ΢ÚÒÓ Î·È ÂÚ-Á·˙fiÌÂÓˆÓ ÌËÙ¤ÚˆÓ Ì ¯·ÌËÏfi Â›Â‰Ô ÌfiÚʈ-Û˘ (0,86 Î·È 0,74 ÂÚÈÛÛfiÙÂÚ· ·Ù˘¯‹Ì·Ù·, ·ÓÙ›-ÛÙÔȯ·), Û ۯ¤ÛË Ì ٷ ·È‰È¿ ÔÈÎÔ΢ÚÒÓ ÌËÙ¤-ÚˆÓ Ì¤Û˘ ÌfiÚʈÛ˘, ÂÓÒ Ë ·‡ÍËÛË ÙÔ˘ ¢°™ η-Ù¿ 1 ÌÔÓ¿‰· ÌÂÈÒÓÂÈ ÙËÓ ÙÈÌ‹ ÙÔ˘ ‰Â›ÎÙË Î·Ù¿ 0,09·Ù˘¯‹Ì·Ù·.

O ¶›Ó·Î·˜ 5 ‰Â›¯ÓÂÈ Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓÂÊ·ÚÌÔÁ‹ Ù˘ ÔÏÏ·Ï‹˜ ÏÔÁ·ÚÈıÌÈÛÙÈ΋˜ ÂÍ¿Ú-ÙËÛ˘ Û οı ̛· ·fi ÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ·Ù˘¯ËÌ¿-ÙˆÓ Ì ·ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙȘ ›‰È˜ Ô˘ ¯ÚË-ÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙÔÓ ¶›Ó·Î· 4. O Û¯ÂÙÈÎfi˜ ΛӉ˘-ÓÔ˜ ÚfiÎÏËÛ˘ ·Ù˘¯‹Ì·ÙÔ˜ ÏfiÁˆ Ï‹„˘ ηٷӷ-ψÙÈÎÒÓ ·Á·ıÒÓ Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ηٿ 58% ÛÙ··È‰È¿ Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙËÓ ÂÚÈÔ¯‹ Ì ̤ÛÔ ÎÔÈ-ÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ¤Ó·ÓÙÈ ÙˆÓ ·È‰ÈÒÓ Ô˘‰È·Ì¤ÓÔ˘Ó ÛÙËÓ ˘Ô‚·ıÌÈṲ̂ÓË ÂÚÈÔ¯‹, ÂÓÒ ÌÂÈ-ÒÓÂÙ·È Î·Ù¿ 39% ÁÈ· οı ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ Ù˘ÌËÙ¤Ú·˜ ηٿ 10 ¤ÙË. ∂›Û˘, Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ÚfiÎÏËÛ˘ ·Ù˘¯‹Ì·ÙÔ˜ Ù˘ ›‰È·˜ ÔÌ¿‰·˜ ‚Ú¤ıËÎÂÂÚ›Ô˘ ÙÂÙÚ·Ï¿ÛÈÔ˜ ÛÙ· ·È‰È¿ ÂÚÁ·˙fiÌÂÓˆÓÌËÙ¤ÚˆÓ ˘„ËÏ‹˜ ÌfiÚʈÛ˘ Û ۯ¤ÛË Ì ÂÎÂ›Ó·ÙˆÓ ÔÈÎÔ΢ÚÒÓ ÌËÙ¤ÚˆÓ Ì¤Û˘ ÌfiÚʈÛ˘. ∆· ·È‰È¿ ÂÚÁ·˙fiÌÂÓˆÓ ÌËÙ¤ÚˆÓ ¯·ÌËÏ‹˜ ÌfiÚʈÛ˘

¶¶››ÓÓ··Îη·˜̃ 11.. ∫·Ù·ÓÔÌ‹ ÙˆÓ 400 ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ·Ó¿ÏÔÁ· Ì ٷ ‰ËÌÔÁÚ·ÊÈο Î·È ÎÔÈÓˆÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ηıÒ˜ Î·È ÙÔÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ù˘ ÂÚÈÔ¯‹˜ ‰È·ÌÔÓ‹˜ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜

Ã÷·ÚÚ··ÎÎÙÙËËÚÚÈÈÛÛÙÙÈÈÎο¿ ªªÂÂÛÛÔÔ··ÛÛÙÙÈÈÎ΋‹ ÂÂÚÚÈÈÔÔ¯̄‹‹ ÀÀÔÔ‚‚··ııÌÌÈÈÛÛÌ̤¤ÓÓËË ÂÂÚÚÈÈÔÔ¯̄‹‹ ™™‡‡ÓÓÔÔÏÏÔÔ ‰‰Â››ÁÁÌÌ··ÙÙÔÔ˜̃NN ((%%)) ¡¡ ((%%)) ¡¡ ((%%))

∏∏ÏÏÈÈÎΛ›·· ··Èȉ‰ÈÈÔÔ‡‡ ((ÌÌ‹‹ÓÓ˜̃))

25-30 50 25,0 51 25,5 101 25,231-36 59 29,5 53 26,5 112 28,037-42 30 15,0 55 27,5 85 21,343-48 61 30,5 41 20,5 102 25,5º‡ÏÔ∞ÁfiÚÈ 102 51,0 108 54,0 210 52,5∫ÔÚ›ÙÛÈ 98 49,0 92 46,0 190 47,5™™ÂÂÈÈÚÚ¿¿ ÁÁ¤¤ÓÓÓÓËËÛÛˢ̃

1 92 46,0 94 47,0 186 46,52 85 42,5 67 33,5 152 38,03+ 23 11,5 39 19,5 62 15,5∞∞ÚÚÈÈııÌÌfifi˜̃ ··Èȉ‰ÈÈÒÒÓÓ ÛÛÙÙËËÓÓ ÔÔÈÈÎÎÔÔÁÁ¤¤ÓÓÂÂÈÈ··

1 65 32,5 65 32,5 130 32,52 111 55,5 89 44,5 200 50,03+ 24 12,0 46 23,0 70 17,5∏∏ÏÏÈÈÎΛ›·· ÌÌËËÙÙ¤¤ÚÚ··˜̃ ((¤¤ÙÙËË))

≤26 29 14,5 80 40,0 109 27,327-36 146 73,0 106 53,0 252 63,037+ 25 12,5 14 7,0 39 9,7∂∂Îη·››‰‰Â¢̆ÛÛËË ÌÌËËÙÙ¤¤ÚÚ··˜̃ ((¤¤ÙÙËË))

≤6 30 15,0 80 40,0 110 40,07-12 128 64,0 106 53,0 234 58,513+ 42 21,0 14 7,0 56 14,0∞∞··ÛÛ¯̄fifiÏÏËËÛÛËË ÌÌËËÙÙ¤¤ÚÚ··˜̃

OÈÎȷο 92 46,0 146 73,0 238 59,5∂ÚÁ·˙fiÌÂÓË 108 54,0 54 27,0 162 40,5

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40 ¢. §¿ÁÁ·˜ Î·È Û˘Ó.

‰È·ÙÚ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÚfiÎÏËÛ˘ ·Ù˘¯‹-Ì·ÙÔ˜ ÏfiÁˆ ¤ÎÏ˘Û˘ ıÂÚÌÈ΋˜ ‹ ËÏÂÎÙÚÈ΋˜ ÂÓ¤Ú-ÁÂÈ·˜ ηٿ 70%, Û ۯ¤ÛË Ì ÂΛӷ ÔÈÎÔ΢ÚÒÓ ÌË-Ù¤ÚˆÓ Ì¤Û˘ ÌfiÚʈÛ˘. ∆¤ÏÔ˜, Ô Î›Ó‰˘ÓÔ˜ Úfi-ÎÏËÛ˘ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ¤Íˆ ·fi ÙÔÛ›ÙÈ Â›Ó·È ‰ÈÏ¿ÛÈÔ˜ ÛÙ· ·È‰È¿ ÂÚÁ·˙fiÌÂÓˆÓ ÌË-Ù¤ÚˆÓ ˘„ËÏ‹˜ ÌfiÚʈÛ˘ Û ۯ¤ÛË Ì ÂΛӷ ÙˆÓÔÈÎÔ΢ÚÒÓ ÌËÙ¤ÚˆÓ Ì¤Û˘ ÌfiÚʈÛ˘, ÂÓÒ ÂÏ·Ù-ÙÒÓÂÙ·È Î·Ù¿ 15% ÁÈ· οı ·‡ÍËÛË ÙÔ˘ ¢°™ ηٿ 1ÌÔÓ¿‰·.

™˘˙‹ÙËÛË

°È· ÙËÓ ÏËÚ¤ÛÙÂÚË ·ÔÙ‡ˆÛË Ù˘ Û˘¯ÓfiÙË-Ù·˜ Î·È ÙÔ˘ Ù‡Ô˘ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ, Ë Î·Ù·ÁÚ·Ê‹ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ·Â˘-ı›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ· Î·È fi¯È Û ·È‰È¿ Ô˘ ÓÔÛË-χÙËÎ·Ó ‹ ÚÔÛÎÔÌ›ÛÙËÎ·Ó Û ˘ËÚÂۛ˜ ˘Á›·˜ÏfiÁˆ ·Ù˘¯‹Ì·ÙÔ˜ (6,21). ∂ÎÙfi˜ ·˘ÙÔ‡, Ë Û˘ÁΤ-ÓÙÚˆÛË ÂÓfi˜ ÌÂÁ¿ÏÔ˘ Ê¿ÛÌ·ÙÔ˜ ÎÔÈÓˆÓÈÎÔ‰ËÌÔ-ÁÚ·ÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ Î·È ·Ú·Ì¤ÙÚˆÓ ÂϤÁ¯Ô˘ÙˆÓ ÁÓÒÛˆÓ, ÛÙ¿ÛÂˆÓ Î·È Ú·ÎÙÈÎÒÓ ÙˆÓ ÁÔÓ¤ˆÓÛ ı¤Ì·Ù· ÚfiÏ˄˘ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·Ú¤¯ÂÈ ÙË

‰˘Ó·ÙfiÙËÙ· ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË Ù˘ ÁÔÓÂ˚΋˜ Û˘ÌÂ-

ÚÈÊÔÚ¿˜ ˆ˜ ¤Ó· Ì›˙ÔÓ· ·Ú¿ÁÔÓÙ· ÚfiÎÏËÛ˘

·Ù˘¯ËÌ¿ÙˆÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·. ∞fi ÙËÓ ¿Ï-

ÏË ÏÂ˘Ú¿, Ì ÙËÓ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ Ù˘ Û˘-

¯ÓfiÙËÙ·˜ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ÙÔ˘ ‚·ıÌÔ‡ Ï‹„˘

ÙˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÙȘ

Û˘Á¯ÚÔÓÈΤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (cross-

sectional studies) (22), ‰ÂÓ ÌÔÚ› Ó· ·Ô‰Âȯı› ÌÂ

·ÎÚ›‚ÂÈ· Â¿Ó Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ì¤ÙÚˆÓ ¤ÁÈÓ ÚÈÓ ‹

ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜. ŒÓ· ¿ÏÏÔ ÌÂÈ-

ÔÓ¤ÎÙËÌ· Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰Ô-

Ì¤ÓˆÓ Ì ÚÔÛˆÈΤ˜ Û˘ÓÂÓÙ‡ÍÂȘ, fiÔ˘ Ô ˘Ô-

ÎÂÈÌÂÓÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂËÚ¿-

˙ÂÈ ÙËÓ ·ÍÈÔÈÛÙ›· ÙˆÓ ··ÓÙ‹ÛˆÓ.

Ÿˆ˜ ¤¯ÂÈ ˘ÔÛÙËÚȯı› Î·È ·fi ¿ÏϘ ÌÂϤÙ˜

(1,2,6,21,23), Ù· Û˘¯ÓfiÙÂÚ· ·Ù˘¯‹Ì·Ù· ÛÙËÓ ÚÔ-

Û¯ÔÏÈ΋ ËÏÈΛ· ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ¤ÎÏ˘ÛË ÌË-

¯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, ÂÂȉ‹ - ηٿ ÙË ÛÙ·‰È·Î‹ „˘-

¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË - Ë ¤Ó·ÚÍË ÙˆÓ ÎÈÓËÙÈÎÒÓ ÏÂÈ-

ÙÔ˘ÚÁÈÒÓ ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ Û˘Óԉ‡ÂÙ·È Î·È Ì ·ÓÙ›-

ÛÙÔÈ¯Ë ÂͤÏÈÍË Ù˘ ÓÔËÙÈ΋˜ ÙÔ˘ ÈηÓfiÙËÙ·˜ (9,24).

∂Âȉ‹ Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ¤ÁÈÓÂ

·Â˘ı›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ

·Ù˘¯ËÌ¿ÙˆÓ ÌÈÎÚ‹˜ ‚·Ú‡ÙËÙ·˜ Ô˘ ÌÔÚÔ‡Ó Ó·

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

¶¶››ÓÓ··Îη·˜̃ 22.. ∫·Ù·ÓÔÌ‹ ÙˆÓ 400 ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ·Ó¿ÏÔÁ· Ì ÙÔ ·Ù‡¯ËÌ· Ô˘ ˘¤ÛÙËÛ·Ó

∂∂››‰‰ÔÔ˜̃ ··ÙÙ˘̆¯̄‹‹ÌÌ··ÙÙÔÔ˜̃ ¶¶··Èȉ‰ÈÈ¿¿ ÌÌ ··ÙÙ‡‡¯̄ËËÌÌ··∞∞ÚÚÈÈııÌÌfifi˜̃ ((%%))

ŒŒÎÎÏÏ˘̆ÛÛËË ÌÌË˯̄··ÓÓÈÈÎ΋‹˜̃ ÂÂÓÓ¤¤ÚÚÁÁÂÂÈÈ··˜̃

¶ÙÒÛË ÚÈÓ ‹ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‚¿‰ÈÛ˘ 201 50,3¶ÙÒÛË ·fi ÙÔ ÎÚ‚¿ÙÈ 161 40,3¶ÙÒÛË ·fi ÛοϷ 107 26,8∫Ù‡ËÌ· Û ÔÍ›˜ ÁˆÓ›Â˜ Â›ÏˆÓ 293 73,3¶ÙÒÛË ·fi ¤ÈÏ· 162 40,5∆Ú·˘Ì·ÙÈÛÌfi˜ ÌÂÏÒÓ ·fi Í·ÊÓÈÎfi Î·È ‚›·ÈÔ ÎÏ›ÛÈÌÔ fiÚÙ·˜-·Ú¿ı˘ÚÔ˘ 162 40,5¶ÂÚ›ÛÊÈÍË Ì¤ÏÔ˘˜ ÛÙ· ÌÂÛԉȷÛÙ‹Ì·Ù· ÎÈÁÎÏȉˆÌ¿ÙˆÓ (ÎÚ‚·ÙÈÔ‡, ÂÍÒÛÙË) 62 15,5∞Ù‡¯ËÌ· Ì ԉ‹Ï·ÙÔ Ì¤Û· ÛÙÔ Û›ÙÈ 118 29,5OÏ›ÛıËÛË Û ÏÂ›Ô ‰¿Â‰Ô 186 46,5∞Ù‡¯ËÌ· ÏfiÁˆ ¯Ú‹Û˘ ‚ÚÂÊÔ‚·‰ÈÛÙ‹* 42 17,0§§‹‹„„ËË Îη·ÙÙ··ÓÓ··Ïψ̂ÙÙÈÈÎÎÒÒÓÓ ··ÁÁ··ııÒÒÓÓ

¢ËÏËÙËÚ›·ÛË ·fi Ê¿ÚÌ·ÎÔ, ηÏÏ˘ÓÙÈÎfi Î.Ï. 31 7,8ª¿ÛËÛË ÙÛÈÁ¿ÚÔ˘ 80 20,0∂ÂÈÛfi‰ÈÔ ÂÈÛÚfiÊËÛ˘ ÙÚÔÊ‹˜ ‹ ͤÓÔ˘ ÛÒÌ·ÙÔ˜** 96 24,0∞˘ÙÔ„ÂηÛÌfi˜ Ì ¯ËÌÈ΋ Ô˘Û›· 37 9,3∂∂··ÊÊ‹‹ ÌÌ ııÂÂÚÚÌÌÈÈÎ΋‹--ËËÏÏÂÂÎÎÙÙÚÚÈÈÎ΋‹ ÂÂÓÓ¤¤ÚÚÁÁÂÂÈÈ··

ŒÁη˘Ì· ·fi ·Ó·Ù‹Ú· ‹ Û›ÚÙ· 16 4,0ŒÁη˘Ì· ÏfiÁˆ ·ʋ˜ Ì ıÂÚÌ‹ Û˘Û΢‹ 180 45,0ŒÁη˘Ì· ÏfiÁˆ ·ʋ˜ Ì ˙ÂÛÙfi ˘ÁÚfi 28 7,0∂ÂÈÛfi‰ÈÔ ËÏÂÎÙÚÔÏËÍ›·˜ 34 8,5∞∞ÙÙ‡‡¯̄ËËÌÌ·· ÛÛ ¯̄ÒÒÚÚÔÔ˘̆˜̃ ¤¤Í͈̂ ··fifi ÙÙÔÔ ÛÛ››ÙÙÈÈ

∞Ù‡¯ËÌ· Û ·È‰È΋ ¯·Ú¿ 53 13,3∞Ù‡¯ËÌ· ̤۷ Û ·˘ÙÔΛÓËÙÔ 43 10,8¢‹ÁÌ· ˙ÒÔ˘ 19 4,8∫›Ó‰˘ÓÔ˜ ÓÈÁÌÔ‡ ÛÙË ı¿Ï·ÛÛ· 38 9,5

* ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·˘ÙÒÓ ·Ó·Ê¤ÚÂÙ·È ÌfiÓÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ‚ÚÂÊÔ‚·‰ÈÛÙ‹(61,3%)

** ™˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ ·È‰› ¤‚·Ï ÛÙÔ ÛÙfiÌ· ÙÔ˘ οÔÈ· ·Î·Ù¿ÏÏËÏË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ÙÚÔÊ‹(.¯. ÍËÚfi ηÚfi) ‹ ¿ÏÏÔ Í¤ÓÔ ÛÒÌ·, ·ÏÏ¿ - ÂÂȉ‹ ¤ÁÈÓ ¿ÌÂÛ· ·ÓÙÈÏËÙfi ·fi ÙÔ˘˜ ÁÔÓ›˜ - ·Ê·ÈÚ¤ıËÎÂ Î·È ‰ÂÓ ÚÔο-ÏÂÛ ÓÈÁÌÔÓ‹ (58 ·È‰È¿, ÔÛÔÛÙfi 14,5% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜)

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·40

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41¶ÚfiÏË„Ë ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ÛÙÔ Û›ÙÈ (.¯. ÂÁη‡Ì·Ù· ÏfiÁˆ

·ʋ˜ Ì ıÂÚÌ‹ Û˘Û΢‹) ‚Ú¤ıËΠ˘„ËÏfiÙÂÚË

Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÂÚ¢ÓÒÓ Ô˘ ¤ÁÈÓ·Ó Û ·È‰È¿ Ô˘

ÓÔÛËχÙËÎ·Ó ‹ ÚÔÛÎÔÌ›ÛÙËÎ·Ó Û ˘ËÚÂۛ˜

˘Á›·˜ ÏfiÁˆ ·Ù˘¯‹Ì·ÙÔ˜ (10,21), ÂÓÒ ‹Ù·Ó ·Úfi-

ÌÔÈ· ÁÈ· Ù· ·Ù˘¯‹Ì·Ù· Ô˘ - ÏfiÁˆ Ù˘ ‚·Ú‡ÙËÙ¿˜

ÙÔ˘˜ - Â›Ó·È ·Ó·Áη›· Ë ÚÔÛ·ÁˆÁ‹ ‹ Î·È ÓÔÛËÏ›·

Û ˘ËÚÂۛ˜ ˘Á›·˜, fiˆ˜ ÔÈ ‰ËÏËÙËÚÈ¿ÛÂȘ Î·È Ë

Ì¿ÛËÛË ÙÛÈÁ¿ÚÔ˘ (6,25).

∏ ÔÈÔÙÈ΋ ÁÔÓÂ˚΋ ›‚ÏÂ„Ë ‰ÂÓ ·Ô‰ÂÈÎÓ‡Â-

Ù·È ÛÙ·ÙÈÛÙÈο fiÙÈ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ·

ÚfiÏ˄˘ ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ (18,26), ·-

Ú¿ Ù· ‰È·ÊÔÚÂÙÈο Â˘Ú‹Ì·Ù· ¿ÏÏ˘ ¤Ú¢ӷ˜ (27).

∞ÓÙ›ıÂÙ·, Ë Ï‹„Ë ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ, Û¯ÂÙÈÎÒÓ

Ì ÙȘ ÔÚı¤˜ ÛÙ¿ÛÂȘ Î·È ÁÓÒÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙË

‰È·ÌfiÚʈÛË ·ÛÊ·ÏÔ‡˜ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ‰È·‚›ˆÛ˘

ÙÔ˘ ·È‰ÈÔ‡, Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Úfi-

ÎÏËÛ˘ ·Ù˘¯ËÌ¿ÙˆÓ ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜

ÂÓ¤ÚÁÂÈ·˜ ÛÙÔ ÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È ÛÙÔ˘˜ ¯Ò-

ÚÔ˘˜ ·Ó·„˘¯‹˜, ‡ÚËÌ· Ô˘ ‰Â›¯ÓÂÈ ÙË Û·Ê‹ ˘Â-

ÚÔ¯‹ ÙˆÓ Ì¤ÙÚˆÓ Ù˘ ·ıËÙÈ΋˜ ÚfiÏ˄˘ ¤Ó·ÓÙÈ

ÂÎÂ›ÓˆÓ Ù˘ ÂÓÂÚÁËÙÈ΋˜ (28,29).

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÎÔÈÓˆÓÈ-

ÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ¤ÁÈÓ ¤Ì-

ÌÂÛ·, Ì ÎÚÈÙ‹ÚÈÔ ÙËÓ ÂÚÈÔ¯‹ ‰È·ÌÔÓ‹˜ (30,31).

∆Ô ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ù˘ ÔÈÎÔ-

Á¤ÓÂÈ·˜ ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÚfiÎÏËÛ˘ ·È‰ÈÎÒÓ ·Ù˘-

¯ËÌ¿ÙˆÓ ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi ¿ÏϘ ÌÂϤÙ˜

¶¶››ÓÓ··Îη·˜̃ 44.. ¶ÔÏÏ·Ï‹ ÁÚ·ÌÌÈ΋ ÂÍ¿ÚÙËÛË. ™˘ÓÙÂÏÂÛÙ‹˜ ÌÂÚÈ΋˜ ÂÍ¿ÚÙËÛ˘ (b) Î·È 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (95% O∞) ÙÔ˘ ‰Â›-ÎÙË ·Ù˘¯‹Ì·ÙÔ˜ ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ ·Ó¿ÏÔÁ· Ì ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ

ªªÂÂÙÙ··‚‚ÏÏËËÙÙ‹‹ bb 9955%% OO∞∞ pp

ºº‡‡ÏÏÔÔ

∫ÔÚ›ÙÛÈ ∫·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜∞ÁfiÚÈ 0,37 (0,06)-(0,67) 0,02∏∏ÏÏÈÈÎΛ›·· ··Èȉ‰ÈÈÔÔ‡‡ (·Ó¿ ÂÍ¿ÌËÓË ·‡ÍËÛË) 0,05 (-0,16)-(0,05) 0,31∫∫ÔÔÈÈÓÓˆ̂ÓÓÈÈÎÎÔÔÔÔÈÈÎÎÔÔÓÓÔÔÌÌÈÈÎÎfifi ››Â‰‰ÔÔ ÙÙˢ̃ ÂÂÚÚÈÈÔÔ¯̄‹‹˜̃ ‰‰ÈÈ··ÌÌÔÔÓÓ‹‹˜̃

ÀÔ‚·ıÌÈṲ̂ÓÔ ∫·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜ª¤ÛÔ -0,61 (-0,96)-(-0,27) 10-4

∏∏ÏÏÈÈÎΛ›·· ÌÌËËÙÙ¤¤ÚÚ··˜̃ (·Ó¿ ‰ÂηÂÙ‹ ·‡ÍËÛË) 0,01 (-0,29)-(0,31) 0,94∂∂Îη·››‰‰Â¢̆ÛÛËË Îη·ÈÈ ÂÂÚÚÁÁ··ÛÛ››·· ÙÙˢ̃ ÌÌËËÙÙ¤¤ÚÚ··˜̃

√ÈÎÔÎ˘Ú¿ Ì ≤6 ¤ÙË ÛÔ˘‰ÒÓ 0,86 (0,43)-(1,30) 10-4

∂ÚÁ·˙fiÌÂÓË Ì ≤6 ¤ÙË ÛÔ˘‰ÒÓ 0,74 (-0,09)-(1,58) 0,08√ÈÎÔÎ˘Ú¿ Ì 7-12 ¤ÙË ÛÔ˘‰ÒÓ ∫·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜∂ÚÁ·˙fiÌÂÓË Ì 7-12 ¤ÙË ÛÔ˘‰ÒÓ -0,15 (-0,55)-(0,25) 0,47√ÈÎÔÎ˘Ú¿ Ì >12 ¤ÙË ÛÔ˘‰ÒÓ 0,72 (-0,20)-(1,64) 0,12∂ÚÁ·˙fiÌÂÓË Ì >12 ¤ÙË ÛÔ˘‰ÒÓ 0,41 (-0,12)-(0,96) 0,13¢¢Â››ÎÎÙÙˢ̃ ÁÁÔÔÓÓÂÂ˚̊Î΋‹˜̃ ››‚‚ÏÏ„„ˢ̃ (·Ó¿ 1 ÌÔÓ¿‰· ·‡ÍËÛË) -0,11 (-0,34)-(0,14) 0,39¢¢Â››ÎÎÙÙˢ̃ ÁÁÔÔÓÓÂÂ˚̊Î΋‹˜̃ ÛÛ˘̆ÌÌÂÂÚÚÈÈÊÊÔÔÚÚ¿¿˜̃ (·Ó¿ 1 ÌÔÓ¿‰· ·‡ÍËÛË) -0,09 (-0,19)-(0,01) 0,05

¶¶››ÓÓ··Îη·˜̃ 33.. ∫·Ù·ÓÔÌ‹ ÙˆÓ 400 ÔÈÎÔÁÂÓÂÈÒÓ Ù˘ ÌÂϤÙ˘ ·Ó¿ÏÔÁ· Ì ÙË Û˘ÌÌfiÚʈÛË, ¤ÛÙˆ Î·È ÂÓfi˜ ÁÔÓ¤·, ÛÙ· ÚÔÏËÙÈο̤ÙÚ· ÁÔÓÂ˚΋˜ ›‚Ï„˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜

¶¶ÚÚÔÔÏÏËËÙÙÈÈÎÎfifi Ì̤¤ÙÙÚÚÔÔ ∞∞ÚÚÈÈııÌÌfifi˜̃ ((%%))

°°ÔÔÓÓÂÂ˚̊Î΋‹ ››‚‚ÏÏ„„ËË

∂›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÛÙ· ÚÒÙ· ÙÔ˘ ‚‹Ì·Ù· 314 78,5∂›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ fiÙ·Ó ·›˙ÂÈ Ì ԉ‹Ï·ÙÔ ÛÙÔ Û›ÙÈ 355 88,8∂›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÙËÓ ÒÚ· Ô˘ Ì·ÁÂÈÚ‡ÂÈ Ë ÌËÙ¤Ú· 394 98,5∂›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÙËÓ ÒÚ· Ô˘ ÛȉÂÚÒÓÂÈ Ë ÌËÙ¤Ú· 395 98,8∂›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ ·È‰È΋ ¯·Ú¿ 381 95,3°°ÔÔÓÓÂÂ˚̊Î΋‹ ÛÛ˘̆ÌÌÂÂÚÚÈÈÊÊÔÔÚÚ¿¿

∆ÔÔı¤ÙËÛË ÙˆÓ ·È¯ÓȉÈÒÓ Û ηϷı¿ÎÈ fiÙ·Ó ÙÔ ·È‰› ·Ú¯›˙ÂÈ Ó· ÌÂٷʤÚÂÈ ·ÓÙÈΛÌÂÓ· ÛÙÔ ÛÙfiÌ· 310 77,5∞Ê·›ÚÂÛË ÌÈÎÚÔ·ÓÙÈÎÂÈÌ¤ÓˆÓ ·fi ¤ÈÏ· ¯·ÌËÏÔ‡ ‡„Ô˘˜ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ‚¿‰ÈÛ˘ 167 41,8⁄·ÚÍË ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi Ê·ÚÌ·ÎÂ›Ô ÙÔ˘ Û΢¿ÛÌ·ÙÔ˜ ÈÂηÎÔ˘¿Ó·˜ ÁÈ· ÚfiÎÏËÛË Â̤ÙÔ˘ 8 2,0OÚı‹ ÁÓÒÛË ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ∫¤ÓÙÚÔ˘ ¢ËÏËÙËÚÈ¿ÛÂˆÓ 233 58,3∫Ï›‰ˆÌ· ÂÍÒÔÚÙ·˜ 286 71,5∆ÔÔı¤ÙËÛË ÚÔÛٷ٢ÙÈÎÔ‡ ‰ÈÎÙ‡Ô˘ ÛÙÔ˘˜ ÂÍÒÛÙ˜ ÙÔ˘ ÛÈÙÈÔ‡* 186 57,6∫Ï›‰ˆÌ· ÂÈΛӉ˘ÓˆÓ Ô˘ÛÈÒÓ Û ·ÛÊ·Ï‹ ÛËÌ›· 42 10,5∆ÔÔı¤ÙËÛË ÙÛÈÁ¿ÚˆÓ Î·È Û›ÚÙˆÓ Û ·ÛÊ·Ï‹ ÛËÌ›· 310 77,5∞ÛÊ¿ÏÈÛË ËÏÂÎÙÚÈÎÒÓ ‰È·ÎÔÙÒÓ 288 72,0⁄·ÚÍË Â›ÏˆÓ Ì ÛÙÚÔÁÁ˘ÏÂ̤Ó˜ ¿ÎÚ˜ ÛÙÔ Û›ÙÈ 217 54,3

* ∞ӷʤÚÂÙ·È ÌfiÓÔ ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ fiÔ˘ ˘‹Ú¯Â ·Ó·ÁηÈfiÙËÙ· Ï‹„˘ ÙÔ˘ ̤ÙÚÔ˘. ∂‚‰ÔÌ‹ÓÙ· ÂÙ¿ (77) ÔÈÎÔÁ¤ÓÂȘ (19,2%)‰È¤ÌÂÓ·Ó Û ÈÛfiÁÂȘ ηÙÔÈ˘

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·41

Page 53: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

42 ¢. §¿ÁÁ·˜ Î·È Û˘Ó.

(13,32,33), ·Ó Î·È ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËı› fiÙ·Ó ÚfiÎÂÈ-

Ù·È ÁÈ· ·Ù‡¯ËÌ· ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (34). OÈ

ÈÔ Èı·Ó¤˜ ÂÚÌËÓ›˜ Â›Ó·È Ë Î·Ï‡ÙÂÚË ÂÓË̤ڈ-

ÛË ÙˆÓ ÁÔÓ¤ˆÓ Ì ˘„ËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ›-

Â‰Ô ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÚfiÎÏËÛ˘ ·Ù˘¯‹Ì·ÙÔ˜

Ô˘ ‰È·ÙÚ¤¯Ô˘Ó Ù· ·È‰È¿ ÙÔ˘˜ ÛÙ· ‰È¿ÊÔÚ· ÛÙ¿‰È·

Ù˘ ·Ó¿Ù˘Í‹˜ ÙÔ˘˜ Î·È Ë ‰˘Ó·ÙfiÙËÙ· Ï‹„˘ ÔÚÈ-

ÛÌ¤ÓˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ, Ô˘ ÂÍ·ÚÙÒÓÙ·È ·fi

ÙÔ ‡„Ô˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÈÛÔ‰‹Ì·ÙÔ˜, fiˆ˜ ÙÔ

ÂȉÈÎfi οıÈÛÌ· ÁÈ· ÙÔ ·È‰› ÛÙÔ ·˘ÙÔΛÓËÙÔ ‹ Ë

·ÛÊ¿ÏÈÛË ÙˆÓ ËÏÂÎÙÚÈÎÒÓ ‰È·ÎÔÙÒÓ (35).

°È· ÙÔ˘˜ ›‰ÈÔ˘˜ ÏfiÁÔ˘˜, ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ

·Ù˘¯ËÌ¿ÙˆÓ - ΢ڛˆ˜ ÏfiÁˆ ¤ÎÏ˘Û˘ Ì˯·ÓÈ΋˜

ÂÓ¤ÚÁÂÈ·˜ - Ê·›ÓÂÙ·È fiÙÈ ‰È·ÙÚ¤¯Ô˘Ó Î·È Ù· ·È‰È¿

ÌËÙ¤ÚˆÓ ¯·ÌËÏ‹˜ ÌfiÚʈÛ˘, ÂÚÁ·˙fiÌÂÓˆÓ Î·È ÔÈ-

ÎÔ΢ÚÒÓ (36). ™Â ·˘ÍË̤ÓÔ, fï˜, ΛӉ˘ÓÔ ÁÈ· ·Ù˘-

¯‹Ì·Ù· ÏfiÁˆ Ï‹„˘ ηٷӷψÙÈÎÒÓ ·Á·ıÒÓ Î·È ÁÈ·

·Ù˘¯‹Ì·Ù· ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ¤Íˆ ·fi ÙÔ Û›ÙÈ ‚Ú›ÛÎÔ-

ÓÙ·È Î·È Ù· ·È‰È¿ ÂÚÁ·˙fiÌÂÓˆÓ ÌËÙ¤ÚˆÓ ˘„ËÏ‹˜

ÌfiÚʈÛ˘ (12). OÈ Á˘Ó·›Î˜ ·˘Ù¤˜, ÏfiÁˆ ·˘ÍË̤-

ÓˆÓ Â·ÁÁÂÏÌ·ÙÈÎÒÓ ˘Ô¯ÚÂÒÛˆÓ, ‰È·ı¤ÙÔ˘Ó Â-

ÚÈÔÚÈṲ̂ÓÔ ¯ÚfiÓÔ ÁÈ· ÙË ÊÚÔÓÙ›‰· Î·È ÙËÓ Âη›-

‰Â˘ÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ ÛÙË ‰È·ÌfiÚʈÛË ÚÔÙ‡-

Ô˘ ·ÛÊ·ÏÔ‡˜ Û˘ÌÂÚÈÊÔÚ¿˜. °È· ÙÔÓ ›‰ÈÔ ÏfiÁÔ, Ù·

·È‰È¿ ÙÔ˘˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ̤ÓÔ˘Ó ·ÚÎÂÙfi ¯ÚfiÓÔ

ÂÎÙfi˜ ÛÈÙÈÔ‡ (.¯. ·È‰È΋ ¯·Ú¿) Î·È Û˘¯Ó¿ Ó· ÌËÓ

Û˘Óԉ‡ÔÓÙ·È ·fi ÙȘ ›‰È˜, ·ÏÏ¿ ·fi οÔÈÔ ¿ÏÏÔ

ÚfiÛˆÔ (ÁÈ·ÁÈ¿, ÔÈÎȷ΋ ‚ÔËıfi˜) Ô˘ Èı·ÓfiÓ Ó·

ÌËÓ ÂȂϤÂÈ Â·ÚÎÒ˜ ÙÔ ·È‰›. ∞ÓÙ›ıÂÙ·, ·Ú·-

ÙËÚ‹ıËΠÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· ÁÈ· ·Ù‡¯ËÌ· ÏfiÁˆ

ıÂÚÌÈ΋˜-ËÏÂÎÙÚÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ ÛÙ· ·È‰È¿ ÙˆÓ ÂÚ-

Á·˙fiÌÂÓˆÓ ÌËÙ¤ÚˆÓ ¯·ÌËÏ‹˜ ÌfiÚʈÛ˘, ÂÂȉ‹

·˘Ù¿ Û˘Ì‚·›ÓÔ˘Ó ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ÛÙÔÓ ¯Ò-

ÚÔ Ù˘ ÎÔ˘˙›Ó·˜ (37), fiÔ˘ ÔÈ ÂÚÁ·˙fiÌÂÓ˜ ÌËÙ¤Ú˜

··Û¯ÔÏÔ‡ÓÙ·È Ôχ ÏÈÁfiÙÂÚÔ ·fi ÙȘ ÔÈÎÔ΢ڤ˜.

Ÿˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È Û ¿ÏϘ ÌÂϤÙ˜

(14,24,38,39), ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÚfiÎÏËÛ˘ ·Ù˘-

¯ËÌ¿ÙˆÓ ‰È·ÙÚ¤¯Ô˘Ó Î·È Ù· ·È‰È¿ ÙˆÓ ÌËÙ¤ÚˆÓ

Ó·ڋ˜ ËÏÈΛ·˜. ∏ ¤ÏÏÂÈ„Ë ÂÌÂÈÚÈÒÓ ÏfiÁˆ ÙÔ˘ ÓÂ-

·ÚÔ‡ Ù˘ ËÏÈΛ·˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, Ë ·Ó·Ú΋˜

›‚ÏÂ„Ë ÙÔ˘ ·È‰ÈÔ‡ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ¿ÁÓÔÈ·

ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ·˘Ùfi ‰È·ÙÚ¤¯ÂÈ ÛÙ· ‰È¿ÊÔ-

Ú· ÛÙ¿‰È· Ù˘ ·Ó¿Ù˘Í‹˜ ÙÔ˘, ÂȉÈο ηٿ Ù· ÚÒ-

Ù· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘, Â›Ó·È Ë Ï¤ÔÓ ·Ô‰ÂÎÙ‹

ÂÍ‹ÁËÛË (38).

H ÚfiÏË„Ë fiÏˆÓ ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ Â›-

Ó·È ¤Ó·˜ ·Ó¤ÊÈÎÙÔ˜ ÛÙfi¯Ô˜. øÛÙfiÛÔ, Ë ¤ÁηÈÚË

·Ó·ÁÓÒÚÈÛË ‰˘ÓËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ·

ÚfiÎÏËÛË ·Ù˘¯ËÌ¿ÙˆÓ ÛÙÔ Ê˘ÛÈÎfi Î·È ÙÔ ÎÔÈÓˆÓÈ-

Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋

ÁÈ· ÙÔ˘˜ ÁÔÓ›˜, ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ·ÏÏ¿

Î·È fiÛÔ˘˜ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·È-

‰ÈÒÓ. ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂ-

ϤÙ˘, ·Ú¿ÌÂÙÚÔÈ Ô˘ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙȘ ÔÚı¤˜

ÁÓÒÛÂȘ, ÛÙ¿ÛÂȘ Î·È Ú·ÎÙÈΤ˜ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙË

‰È·ÌfiÚʈÛË ·ÛÊ·ÏÔ‡˜ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙÔ˘ ·È‰È-

Ô‡, ηıÒ˜ Î·È ÔÚÈṲ̂ӷ ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο

¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, fiˆ˜ ÙÔ ÎÔÈÓˆÓÈ-

ÎÔÔÈÎÔÓÔÌÈÎfi ›‰Ô, ÙÔ Â›Â‰Ô Âη›‰Â˘Û˘,

Ë ··Û¯fiÏËÛË Î·È Ë ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜, ÂËÚ¿-

˙Ô˘Ó Û ÈηÓfi ‚·ıÌfi ÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ·Ù˘-

¯ËÌ¿ÙˆÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·. ∏ ÂÈÛ‹Ì·ÓÛË

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

¶¶››ÓÓ··Îη·˜̃ 55.. ¶ÔÏÏ·Ï‹ ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË. ™¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ (™∫) Î·È 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (95% O∞) ÁÈ· ·Ù‡¯ËÌ· ο-ı ÔÌ¿‰·˜ ·Ó¿ÏÔÁ· Ì ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ

ªªÂÂÙÙ··‚‚ÏÏËËÙÙ‹‹ OOÌÌ¿¿‰‰·· ··ÙÙ˘̆¯̄ËËÌÌ¿¿ÙÙˆ̂ÓÓ OOÌÌ¿¿‰‰·· ··ÙÙ˘̆¯̄ËËÌÌ¿¿ÙÙˆ̂ÓÓ OOÌÌ¿¿‰‰·· ··ÙÙ˘̆¯̄ËËÌÌ¿¿ÙÙˆ̂ÓÓ ÏÏfifiÁÁˆ̂ ÏÏ‹‹„„ˢ̃ ÏÏfifiÁÁˆ̂ ¤¤ÎÎÏÏ˘̆ÛÛˢ̃ ÛÛ ¯̄ÒÒÚÚÔÔ˘̆˜̃

Îη·ÙÙ··ÓÓ··Ïψ̂ÙÙÈÈÎÎÒÒÓÓ ııÂÂÚÚÌÌÈÈÎ΋‹˜̃--ËËÏÏÂÂÎÎÙÙÚÚÈÈÎ΋‹˜̃ ··ÓÓ··„„˘̆¯̄‹‹˜̃··ÁÁ··ııÒÒÓÓ ÂÂÓÓ¤¤ÚÚÁÁÂÂÈÈ··˜̃

™™∫∫ 9955%% OO∞∞ pp ™™∫∫ 9955%% OO∞∞ pp ™™∫∫ 9955%% OO∞∞ pp

ºº‡‡ÏÏÔÔ

∫ÔÚ›ÙÛÈ ∫·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜∞ÁfiÚÈ 0,72 0,47-1,10 0,13 1,18 0,78-1,78 0,41 0,86 0,55-1,35 0,53∏∏ÏÏÈÈÎΛ›·· ··Èȉ‰ÈÈÔÔ‡‡ (·Ó¿ ÂÍ¿ÌËÓË ·‡ÍËÛË) 0,99 0,85-1,15 0,94 0,93 0,80-1,07 0,33 1,28 1,09-1,50 10-4

∫∫ÔÔÈÈÓÓˆ̂ÓÓÈÈÎÎÔÔÔÔÈÈÎÎÔÔÓÓÔÔÌÌÈÈÎÎfifi ››Â‰‰ÔÔ ÙÙˢ̃ ÂÂÚÚÈÈÔÔ¯̄‹‹˜̃ ‰‰ÈÈ··ÌÌÔÔÓÓ‹‹˜̃

ÀÔ‚·ıÌÈṲ̂ÓÔ ∫·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜ª¤ÛÔ 0,42 0,26-0,68 10-4 0,95 0,59-1,50 0,82 0,81 0,49-1,36 0,44∏∏ÏÏÈÈÎΛ›·· ÌÌËËÙÙ¤¤ÚÚ··˜̃ (·Ó¿ ‰ÂηÂÙ‹ ·‡ÍËÛË) 0,61 0,40-0,94 0,03 1,08 0,72-1,63 0,68 0,85 0,55-1,33 0,49∂∂Îη·››‰‰Â¢̆ÛÛËË Îη·ÈÈ ÂÂÚÚÁÁ··ÛÛ››·· ÙÙˢ̃ ÌÌËËÙÙ¤¤ÚÚ··˜̃

√ÈÎÔÎ˘Ú¿ Ì ≤6 ¤ÙË ÛÔ˘‰ÒÓ 1,13 0,78-2,63 0,24 0,86 0,47-1,56 0,63 1,33 0,71-2,49 0,36∂ÚÁ·˙fiÌÂÓË Ì ≤6 ¤ÙË ÛÔ˘‰ÒÓ 1,20 0,39-3,72 0,74 0,30 0,09-0,95 0,04 1,57 0,49-4,96 0,44√ÈÎÔÎ˘Ú¿ Ì 7-12 ¤ÙË ÛÔ˘‰ÒÓ ∫·ÙËÁÔÚ›· ·Ó·ÊÔÚ¿˜∂ÚÁ·˙fiÌÂÓË Ì 7-12 ¤ÙË ÛÔ˘‰ÒÓ 0,88 0,49-1,56 0,66 0,63 0,39-1,08 0,09 0,99 0,52-1,85 0,97√ÈÎÔÎ˘Ú¿ Ì >12 ¤ÙË ÛÔ˘‰ÒÓ 1,03 0,27-3,88 0,95 0,89 0,26-3,08 0,86 0,49 0,09-2,55 0,40∂ÚÁ·˙fiÌÂÓË Ì >12 ¤ÙË ÛÔ˘‰ÒÓ 3,90 1,79-8,47 10-3 0,55 0,27-1,14 0,11 2,22 1,01-4,89 0,05¢¢Â››ÎÎÙÙˢ̃ ÁÁÔÔÓÓÂÂ˚̊Î΋‹˜̃ ››‚‚ÏÏ„„ˢ̃

(·Ó¿ 1 ÌÔÓ¿‰· ·‡ÍËÛË) 1,13 0,80-1,59 0,48 0,78 0,56-1,09 0,14 1,07 0,74-1,53 0,70¢¢Â››ÎÎÙÙˢ̃ ÁÁÔÔÓÓÂÂ˚̊Î΋‹˜̃ ÛÛ˘̆ÌÌÂÂÚÚÈÈÊÊÔÔÚÚ¿¿˜̃

(·Ó¿ 1 ÌÔÓ¿‰· ·‡ÍËÛË) 0,88 0,77-1,01 0,07 0,95 0,83-1,07 0,42 0,85 0,74-0,98 0,03

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·42

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43¶ÚfiÏË„Ë ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ

¶·È‰È·ÙÚÈ΋ 2005;68:37-43

·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÚÔ-ÏËÙÈÎÒÓ Ì¤ÙÚˆÓ Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ÙÚÔÔÔ›Ë-ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÙËÓ ·ÏÏ·Á‹ Ù˘ Û˘ÌÂ-ÚÈÊÔÚ¿˜ - ÂÂȉ‹ ÔÈ ÎÔÈÓˆÓÈÎÔ› Î·È ‰ËÌÔÁÚ·ÊÈÎÔ›·Ú¿ÁÔÓÙ˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ·ÏÏ¿ÍÔ˘Ó - Â›Ó·È ‰‡Ô‚·ÛÈΤ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙË ‰È·Ù‹ÚËÛË Ù˘ ›-ÙˆÛ˘ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ¯·ÌË-ÏfiÙÂÚ· ›‰· (40).

µÈ‚ÏÈÔÁÚ·Ê›·

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Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·43

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44 ORIGINAL ARTICLE

1 National School of PublicHealth

2 Department of Hygieneand Epidemiology,University of AthensMedical School

Correspondence:

Dimitris Laggas 6 Kallidromiou str., 114 72, ∞thensE-mail: [email protected]

Date of submission: 22-03-2004Date of approval: 28-09-2004

Paediatriki 2005;68:44

Parental behavior and childhood injury

prevention

D. Laggas1, E. Petridou2, N. Dessypris2, T. Thomaidis1

Abstract

Background: The aim of this study was to investigate parameters assessing a possible contribution of parentalbehavior in the causation of injuries among preschool children.

Methods: Data were collected through 400 interpersonal structured interviews based on anonymousquestionnaires from parents residing in two areas of the Greater Athens, namely an urban, relativelyprosperous area and a socially deprived one. The questionnaire covered sociodemographic characteristics, thetype of injuries that had been sustained by the study subjects and information concerning two indices: theParental Behavior Index (PBI) related to parental knowledge and attitudes towards a safe child environmentand the Parental Supervision Index (PSI) related to appropriate parental supervision. Statistical analysis wasdone through multiple linear and logistic regression analysis.

Results: The increase of the PBI by one unit was associated with a reduction of the mean number of injuriesdue to release of mechanical energy by 0.09 and the risk for injuries outside home by 15%, whereas nostatistical association of PSI was noted. Increased number of injuries due to release of mechanical energy wasfound among children from the deprived area and in those with mothers of lower educational level. Bycontrast, children of higher education working mothers sustained a higher number of injuries due toconsumer goods and they were at a higher risk for injuries outside home.

Conclusions: Findings of the present study show that certain variables related to higher parental knowledgeand attitudes towards a safe child living environment affect the epidemiological profile of injuries in earlychildhood.

Key words

Injury, preschoolers, parental behavior.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·44

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¶·È‰È·ÙÚÈ΋ 2005;68:45-51

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¶·È‰È΋ ·¯˘Û·ÚΛ·, ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ, ·È‰È΋ ‰È·ÙÚÔÊ‹.

∂ÈÛ·ÁˆÁ‹

™‡Ìʈӷ Ì ‰ÈÂıÓ‹ ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ, Ë·¯˘Û·ÚΛ· ·ÔÙÂÏ› ¤Ó· ·fi Ù· Û˘ÓËı¤ÛÙÂÚ·ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ·È‰È¿(1). ∏ ·¯˘Û·ÚΛ· ¤¯ÂÈ ÔÏϤ˜ ·ÚÓËÙÈΤ˜ Âȉڿ-ÛÂȘ ÛÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ, fiˆ˜ ÂΉ‹ÏˆÛˢ¤ÚÙ·Û˘, ·˘ÍË̤Ó˘ ¯ÔÏËÛÙÂÚfiÏ˘, ηډȷÁÁÂÈ-·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Î.¿. (2,3). ∞Ó Î·È Ë ·¯˘Û·ÚΛ·‰ÂÓ ·ÔÙÂÏ› „˘¯È΋ ‰È·Ù·Ú·¯‹, Â›Ó·È ˆÛÙfiÛÔ ¤Ó·ÔχÏÔÎÔ Úfi‚ÏËÌ·, ÙÔ ÔÔ›Ô ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ÂÈÙÒÛÂȘ, fi¯È ÌfiÓÔ ÔÚÁ·ÓÈΤ˜ ·ÏÏ¿ Î·È „˘¯ÔÏÔ-ÁÈΤ˜, ÔÈ Ôԛ˜ Ê·›ÓÂÙ·È ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ Ó· ›ӷÈÈÔ ÛÔ‚·Ú¤˜ ·fi ÙȘ ÔÚÁ·ÓÈΤ˜ (4,5). øÛÙfiÛÔ, ·-Ú¿ ÙË ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ·¯˘Û·Ú-Λ·˜ ÛÙ· ·È‰È¿ Î·È ÙËÓ ÏËıÒÚ· ÙˆÓ ÔÚÁ·ÓÈÎÒÓÎ·È „˘¯ÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙ· ÔÔ›· Û˘¯Ó¿Ô‰ËÁ›, ÙÔ ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ ÙˆÓ ÂȉÈÎÒÓ ‰ÂÓ˘‹ÚÍ ̤¯ÚÈ Û‹ÌÂÚ· ·Ó¿ÏÔÁÔ Ì ÙË ÛÔ‚·ÚfiÙËÙ·ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ (6).

™ÙȘ ∏¶∞, Û‡Ìʈӷ Ì ÛÙÔȯ›· ÚfiÛÊ·ÙˆÓ

ÂÚ¢ÓÒÓ, ÙÔ 22% ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ›-Ó·È ˘¤Ú‚·ÚÔ Î·È ÙÔ 11% ·¯‡Û·ÚÎÔ (1). ™ÙȘ·Ú·‚ÈΤ˜ ¯ÒÚ˜, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë ·¯˘Û·ÚΛ··ÊÔÚ¿ ÛÙÔ 16-25% ÙÔ˘ ·Ó‰ÚÈÎÔ‡ Î·È ÛÙÔ 17-43%ÙÔ˘ Á˘Ó·ÈΛԢ ÏËı˘ÛÌÔ‡ (7). ™Â ¤Ú¢Ó˜ Ô˘¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ Î·È ÙËÓ ∫‡-ÚÔ, Ù· ÔÛÔÛÙ¿ ÙˆÓ ·¯‡Û·ÚÎˆÓ Î·È ˘¤Ú‚·ÚˆÓ·È‰ÈÒÓ Î˘Ì·›ÓÔÓÙ·È ·fi 10,3% ¤ˆ˜ 14,4% ηȷfi 16,9% ¤ˆ˜ 22,7%, ·ÓÙ›ÛÙÔȯ· (8,9), ÂÓÒ Ê·›ÓÂ-Ù·È fiÙÈ Ù· ›‰· Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ Â›Ó·È˘„ËÏfiÙÂÚ· ÛÙȘ ·ÁÚÔÙÈΤ˜ Û ۯ¤ÛË Ì ÙȘ ·ÛÙÈΤ˜ÂÚÈÔ¯¤˜ (10).

∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜, Ùfi-ÛÔ ÛÙ· ·È‰È¿ fiÛÔ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Ù›ÓÂÈ Ó··˘Í¿ÓÂÙ·È Ú·Á‰·›·. ™Â ÚfiÛÊ·ÙË ¤Ú¢ӷ ÛÙË ªÂ-Á¿ÏË µÚÂÙ·Ó›· Û ·È‰È¿ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜, ‰È·È-ÛÙÒıËΠfiÙÈ ·fi ÙÔ 1988 ¤ˆ˜ ÙÔ 1998, ÙÔ ÔÛÔÛÙfiÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ·˘Í‹ıËΠ·fi 14,7% ÛÂ23,6% Î·È ÙˆÓ ·¯‡Û·ÚÎˆÓ ·fi 5,4% Û 9,2%(11). ™ÙȘ ∏¶∞, ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1971-1974,ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ ÎÔÚÈÙÛÈÒÓ ËÏÈΛ·˜

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·45

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46 ∂. ∫¿ÎÔ˘ÚÔ˜ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2005;68:45-51

4-5 ÂÙÒÓ ·ÓÂÚ¯fiÙ·Ó ÛÙÔ 5,8%, ÂÓÒ ÛÙÔ ‰È¿ÛÙËÌ·1988-1994 ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ¤ÊÙ·Û ÙÔ10,8% (12). ¶·ÚfiÌÔȘ Â›Ó·È ÔÈ ‰È·ÈÛÙÒÛÂȘ Ô˘·ÊÔÚÔ‡Ó ÛÙËÓ ·‡ÍËÛË ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓÎ·È ÛÙËÓ ∂˘ÚÒË, ȉȷ›ÙÂÚ· ÛÙËÓ ∞Ó·ÙÔÏÈ΋ ηÈÙË ¡fiÙÈ· (13).

™ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, Û ¤Ú¢ӷ Ô˘ ¤ÁÈÓ ÛÙËÓ∫Ú‹ÙË Ì ‰Â›ÁÌ· 6000 Ì·ıËÙ¤˜ ‰ËÌÔÙÈÎÔ‡ Û¯ÔÏ›-Ô˘, ‰È·ÈÛÙÒıËΠfiÙÈ ÔÈ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·˘-Í‹ıËÎ·Ó ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1990 ηÈ, Û˘ÁÎÚÈÓfi-ÌÂÓÔÈ Ì ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ‰Â›ÎÙ˜ ÛÙËÓ ∞ÌÂÚÈ΋, ‹Ù·ÓÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ÈÔ ·˘ÍË̤ÓÔÈ ÛÙËÓ ∫Ú‹-ÙË (14).

∆· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ Ô˘ Â›Ó·È ‰È·ı¤ÛÈÌ·Û¯ÂÙÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ·¯˘Û·ÚΛ·˜ ›ӷÈÂÚÈÔÚÈṲ̂ӷ. OÚÈṲ̂Ó˜ ÊÔÚ¤˜, Ë ÂÌÊ¿ÓÈÛË Ù˘·¯˘Û·ÚΛ·˜ ÌÔÚ› Ó· ·Ô‰Ôı› Û οÔÈ· ÔÚÁ·-ÓÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·, ˆÛÙfiÛÔ Ë ·ÈÙÈÔÏÔÁ›· ·˘Ù‹ ‰ÂÓηχÙÂÈ ·Ú¿ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÂÚÈÙÒÛˆӷ¯˘Û·ÚΛ·˜. ∂ÈϤÔÓ, ÂÎÙÈÌ¿Ù·È fiÙÈ Ë ÎÏËÚÔÓÔ-ÌÈÎfiÙËÙ· ¢ı‡ÓÂÙ·È ÌfiÓÔ ÁÈ· ÙÔ 10% ÂÚ›Ô˘ Ù˘‰È·Î‡Ì·ÓÛ˘ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (15).

™Â ÔÏϤ˜ ¤Ú¢Ó˜ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·Ú¿ÁÔÓÙ˜fiˆ˜ Ë ÂÚÈÔÚÈṲ̂ÓË ÛˆÌ·ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, Ô·˘ÍË̤ÓÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂÔÙÈÎÒÓÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È ÔÈ Î·Î¤˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂÈ-˜, Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜(16,17). °È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, ÔÈ ÚÔÛ¿ıÂÈÂ˜Ô˘ Á›ÓÔÓÙ·È ÁÈ· ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ·¯˘Û·ÚΛ·˜Û˘Ó‹ıˆ˜ ÂÛÙÈ¿˙ÔÓÙ·È ÛÙËÓ ·ÚfiÙÚ˘ÓÛË ÙˆÓ ·È-‰ÈÒÓ Ó· ·ıÏÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ, Ó· ‚Ï¤Ô˘Ó ÏÈÁfi-ÙÂÚÔ ÙËÏÂfiÚ·ÛË Î·È Ó· ÚÔÛ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔÙÔ ‰È·ÈÙÔÏfiÁÈfi ÙÔ˘˜ ηٷӷÏÒÓÔÓÙ·˜ ˘ÁÈÂÈÓ¤˜ÙÚÔʤ˜ (18).

™Â ÌÈ· ÛÂÈÚ¿ ÂÚ¢ÓÒÓ ÛÙÔ Ï·›ÛÈÔ Ù˘ ıˆڛ·˜Ù˘ ÎÔÈÓˆÓÈ΋˜ Ì¿ıËÛ˘, ÙÔÓ›˙ÂÙ·È Ô ÛËÌ·ÓÙÈÎfi˜ÚfiÏÔ˜ Ô˘ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ·¯‡Û·ÚÎÔÈ ÁÔÓ›˜ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿. OÈÁÔÓ›˜ ·˘ÙÔ› ·ÔÙÂÏÔ‡Ó ÚfiÙ˘· Î·È ÂÓı·ÚÚ‡ÓÔ˘ÓÙËÓ ·Ó¿ÏÔÁË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ ÛÂÛ¯¤ÛË Ì ÙÔ Ê·ÁËÙfi. OÈ Klesges Î·È Û˘Ó (19), Û¤ÚÂ˘Ó¿ ÙÔ˘˜ Ô˘ ÛÙËÚÈ˙fiÙ·Ó ÛÙËÓ ·Ú·Ù‹ÚËÛ˷ȉÈÒÓ ËÏÈΛ·˜ 30 ÌËÓÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘Ê·ÁËÙÔ‡, ‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÈ Ô‰ËÁ›Â˜ ÙˆÓ ÁÔÓ¤ˆÓÛ¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈο ÙfiÛÔ Ì ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯Úfi-ÓÔ˘ Ô˘ ·ÊÈÂÚˆÓfiÙ·Ó ÛÙÔ Ê·ÁËÙfi fiÛÔ Î·È Ì ÙÔ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡. ™Â ¤Ú¢ӷ ÙˆÓ Baughcum ηÈÛ˘Ó (20) ‚Ú¤ıËΠfiÙÈ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ÁÔ-Ó›˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ Ê·ÁËÙfi ÚÔÎÂÈ̤ÓÔ˘ Ó·ÈηÓÔÔÈ‹ÛÔ˘Ó Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·Ó¿ÁΘ ÙˆÓ ·È-‰ÈÒÓ ÙÔ˘˜ ‹ fiÙ·Ó Ë Î·Ù·Ó¿ÏˆÛË Ê·ÁËÙÔ‡ ·ÍÈÔÏÔ-ÁÂ›Ù·È ·fi ÙÔ˘˜ ÁÔÓ›˜ ˆ˜ ¤Ó‰ÂÈÍË Ù˘ ηϋ˜ Û˘-ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ·È‰ÈÔ‡, ÙfiÙ ÔÈ ÁÔÓ›˜ Ì ÙÔÓ ÙÚfi-Ô ÙÔ˘˜ ÂÓı·ÚÚ‡ÓÔ˘Ó ÙÔ ·È‰› Ó· ÙÚÒÂÈ ÂÚÈÛÛfiÙÂ-ÚÔ Î·È ÙÔ Ô‰ËÁÔ‡Ó Ì ¢ÎÔÏ›· ÛÙËÓ ·¯˘Û·ÚΛ·.∞Ó¿ÏÔÁ˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó Ú·ÁÌ·ÙÔÔÈËı› ηÈ

ÛÙËÓ ∂ÏÏ¿‰·, fiÔ˘ ÔÚÈṲ̂ÓÔÈ ÂȉÈÎÔ› ÂÎÙÈÌÔ‡Ó fiÙÈ

Ë ·È‰È΋ ·¯˘Û·ÚΛ· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ˘ÂÚÚÔ-

Ûٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÁÔÓ¤ˆÓ, ηıÒ˜ ηÈ

Ì ÙËÓ Ù¿ÛË ÙÔ˘˜ Ó· Ù·˝˙Ô˘Ó Ù· ·È‰È¿ ·ÎfiÌË Î·È

fiÙ·Ó ·˘Ù¿ ‰ÂÓ ÂÈÓÔ‡Ó (21).

∂Ô̤ӈ˜, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÙÔ̤·˜ ¤Ú¢ӷ˜

ÁÈ· Ù· ·›ÙÈ· Ù˘ ·¯˘Û·ÚΛ·˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË

ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ηÈ

ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ·fi ÙȘ

Ôԛ˜ ËÁ¿˙Ô˘Ó ·˘Ù¤˜ ÔÈ Û˘Ó‹ıÂȘ. ∏ ‰ÈÂÚ‡ÓË-

ÛË ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÌÔÚ› Ó· ‰È¢ڇÓÂÈ ÙË

ÁÓÒÛË Ì·˜ ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ÔÈ ÁÔ-

Ó›˜ ÂÓ‰¤¯ÂÙ·È Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘

·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿. ∆¤ÙÔÈÔ˘ ›‰Ô˘˜ Û˘ÌÂÚ¿-

ÛÌ·Ù· ÌÔÚÔ‡Ó Ó· ·ÍÈÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ÂÓË̤ڈ-

ÛË ÙˆÓ ÂÓËÏ›ÎˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ·›ÙÈ· Î·È ÙȘ Û˘-

Ó¤ÂȘ Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ Ì ÛÙfi¯Ô ÙËÓ

ÚfiÏË„‹ Ù˘.

ªÂ ‚¿ÛË ·˘Ù‹ ÙË Û˘ÏÏÔÁÈÛÙÈ΋, ˘ÈÔıÂÙÂ›Ù·È Ë

¿Ô„Ë fiÙÈ Ë ·¯˘Û·ÚΛ·, ÙfiÛÔ ÛÙ· ·È‰È¿ fiÛÔ Î·È

ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Û ·ÚÎÂÙ¤˜

ÂÚÈÙÒÛÂȘ Ì ÙȘ ·ÓÙÈÏ‹„ÂȘ Û¯ÂÙÈο Ì ÙË ‰È·-

ÙÚÔÊ‹, ηıÒ˜ Î·È Ì ÔÚÈṲ̂ӷ ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘

ÚÔÛˆÈÎfiÙËÙ·˜ ÙÔ˘ ·ÙfiÌÔ˘, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁ-

Ì· ÙËÓ ·˘ÙÔ΢ÚÈ·Ú¯›·. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜

¤Ú¢ӷ˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓ

ÌËÙ¤ÚˆÓ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹, ÙˆÓ ÂÎÙÈÌ‹ÛÂÒÓ

ÙÔ˘˜ Û¯ÂÙÈο Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙˆÓ

‰È·ÙÚÔÊÈÎÒÓ Ú·ÎÙÈÎÒÓ Ô˘ ˘ÈÔıÂÙÔ‡Ó ÛÙËÓ ÔÈÎÔ-

Á¤ÓÂÈ·, ηıÒ˜ Î·È Ô Èı·Ófi˜ Û˘Û¯ÂÙÈÛÌfi˜ ÙˆÓ ·-

Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ Ì ÙËÓ ÂΉ‹ÏˆÛË ·¯˘Û·ÚΛ·˜

ÛÙ· ·È‰È¿.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ·ÚÔ‡Û· ¤Ú¢ӷ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙËÓ ∫‡ÚÔ

ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ¡Ô¤Ì‚ÚÈÔ˜ 2001 ¤ˆ˜ ºÂ‚ÚÔ˘¿-

ÚÈÔ˜ 2002. ∆Ô ‰Â›ÁÌ· ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 498 ·È‰È¿ ËÏÈΛ·˜

3-7 ÂÙÒÓ Î·È ÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜. ∆· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡-

Û·Ó ·È‰ÈÎfi ÛÙ·ıÌfi Î·È ÓËÈ·ÁˆÁÂ›Ô ‹ ‹Ù·Ó Ì·ıËÙ¤˜ Ù˘

∞’ ‰ËÌÔÙÈÎÔ‡. ∆· 302 ·È‰È¿ ‰È¤ÌÂÓ·Ó ÛÙË §Â˘ÎˆÛ›· Î·È Ù·

196 ÛÙËÓ ¶¿ÊÔ. ∞fi ·˘Ù¿, ÙÔ 52,6% ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù·

˘fiÏÔÈ· ÎÔÚ›ÙÛÈ·. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›Á-

Ì·ÙÔ˜ ‹Ù·Ó 63,41 Ì‹Ó˜ (SD=10,72).

§fiÁˆ ¤ÏÏÂȄ˘ ÛÙ·ıÌÈṲ̂ÓÔ˘ ÂÚÁ·Ï›Ԣ Ô˘ Ó· ‰ÈÂÚ¢-

Ó¿ ÙȘ ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È-

‰ÈÒÓ, ÔÈ ÌËÙ¤Ú˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ Û˘ÌÏ‹Úˆ-

Û·Ó ¤Ó· Έ‰ÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Î·Ù·Û΢·Ṳ̂ÓÔ

ÁÈ· ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ ÔÔ›Ô ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 22

ÂÚˆÙ‹ÛÂȘ, ÔÌ·‰ÔÔÈË̤Ó˜ Û ٤ÛÛÂÚȘ ηÙËÁÔڛ˜:

·) ¶¤ÓÙ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙË Û˘ÁΤÓÙÚˆÛË ‰ËÌÔÁÚ·ÊÈÎÒÓ

ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈο Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (ËÏÈΛ· ÁÔÓ¤ˆÓ,

ÌÔÚʈÙÈÎfi ›‰Ô, ÙfiÔ˜ ‰È·ÌÔÓ‹˜).

‚) ¶¤ÓÙ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ

Û˘ÓËıÂÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ì ‚¿ÛË Ì›· Îϛ̷η ¤ÓÙ ‚·ı-

Ì›‰ˆÓ (1=¿ÓÙ·, 2=Ôχ Û˘¯Ó¿, 3=ÌÂÚÈΤ˜ ÊÔÚ¤˜, 4=Û¿ÓÈ·,

5=ÔÙ¤). OÈ ÂÚˆÙ‹ÛÂȘ ·˘Ù¤˜ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙÔÓ ‚·ıÌfi

˘Ô¯ˆÚËÙÈÎfiÙËÙ·˜ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙȘ Èı·Ó¤˜ ··ÈÙ‹ÛÂȘ ÙÔ˘

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·46

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47¶·È‰È΋ ·¯˘Û·ÚΛ· Î·È ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ

¶·È‰È·ÙÚÈ΋ 2005;68:45-51

·È‰ÈÔ‡ Û¯ÂÙÈο Ì ÙÔ Ê·ÁËÙfi, ÛÙ· ÚfiÛˆ· Ô˘ ·Û¯ÔÏÔ‡-ÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÛÙËÓ Èı·Ó‹ ›‰Ú·ÛËÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ‰È·ÙÚÔÊÈÎÔ‡ ÚÔ-ÁÚ¿ÌÌ·ÙÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜.

Á) ŒÍÈ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓÌËÙ¤ÚˆÓ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ ÁÂÓÈÎfiÙÂÚ·, ÔÈ Ôԛ˜ ·ÊÔ-ÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙË ‰˘Ó·ÙfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ó· Ú˘ıÌ›˙Ô˘ÓÌfiÓ· ÙÔ˘˜ ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· ηٷ-Ó·ÏÒÛÔ˘Ó Î·È ÛÙËÓ Èı·ÓfiÙËÙ· ¯Ú‹Û˘ ÙÔ˘ Ê·ÁËÙÔ‡ ·fi Ù··È‰È¿ ˆ˜ ̤ÛÔ ÁÈ· Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ‹ Ó· ‰˘Û·ÚÂÛÙ‹ÛÔ˘ÓÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜. OÈ ·ÓÙÈÏ‹„ÂȘ ·˘Ù¤˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì‚¿ÛË ÙËÓ ›‰È· Îϛ̷η ¤ÓÙ ‚·ıÌ›‰ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıË-ΠÛÙËÓ ÚÔËÁÔ‡ÌÂÓË ÂÓfiÙËÙ·.

‰) ŒÍÈ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂˆÓ ÙˆÓÌËÙ¤ÚˆÓ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, ÔÈ ÔÔ›-˜ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ Û ۯ¤-ÛË Ì ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi, ηıÒ˜ Î·È ÛÙÔÓ ‚·ıÌfi ÈηÓÔÔ›ËÛ‹˜ÙÔ˘˜ ·fi ·˘Ùfi. ∏ Îϛ̷η ·ÍÈÔÏfiÁËÛ˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıË-Π۠·˘Ù‹ ÙËÓ ÂÓfiÙËÙ· ÔÈΛÏ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚÒÙËÛË.

∏ Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÛÙÔȯ›ˆÓ ¤ÁÈÓ Û ‰‡Ô Ê¿ÛÂȘ: π. ™ÙËÓ ÚÒÙË Ê¿ÛË, ˙ËÙ‹ıËΠ·fi ÙȘ ÌËÙ¤Ú˜ 700 ·È-

‰ÈÒÓ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ Îˆ‰ÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfi-ÁÈÔ Ô˘ ÙÔ˘˜ ‰È·ÓÂÌ‹ıËÎÂ. ™Â ·˘Ù‹ ÙË Ê¿ÛË, ÂÈÛÙÚ¿ÊËηÓÛ˘ÌÏËڈ̤ӷ 498 ÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ∂Í·ÈÙ›·˜, fï˜, Ú·-ÎÙÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ ‰ÂÓ ÛÙ¿ıËΠ‰˘Ó·Ù‹ Ë Û˘ÁΤÓÙÚˆÛËÛÙÔȯ›ˆÓ Û¯ÂÙÈο Ì ٷ ·È‰È¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ‰ÂÓ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘,Ô‡ÙÂ Ë Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÂӉ¯fiÌÂÓ˘ ·¯˘Û·ÚΛ·˜ÛÙÔ˘˜ ÁÔÓ›˜.

ππ. ™ÙË ‰Â‡ÙÂÚË Ê¿ÛË, ÌÂÙÚ‹ıËΠÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ‡„Ô˜fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ÚÔËÁÔ˘-̤ӈ˜ Û˘ÌÏËÚÒÛÂÈ Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ·. ™ÙË Û˘Ó¤¯ÂÈ·,Û‡Ìʈӷ Ì ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ‡„Ô˜ ÙˆÓ ·È‰ÈÒÓ ˘ÔÏÔÁ›-ÛÙËÎÂ Ô ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Î·È Ì ‚¿ÛË Ù·fiÚÈ· (cut-off points) Ô˘ ÚÔÙ›ÓÔÓÙ·È ÁÈ· ÙÔÓ ÔÚÈÛÌfi ÙˆÓ·¯‡Û·ÚÎˆÓ Î·È ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ÛÙÔ˘˜ ›Ó·Î˜ ÙÔ˘Cole Î·È Û˘Ó (22), Ù· ·È‰È¿ ηٷٿ¯ÙËÎ·Ó Û ÙÚÂȘ ÔÌ¿-‰Â˜. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ, Ë Î·Ù·ÓÔÌ‹¤ÁÈÓ ˆ˜ ÂÍ‹˜:

·) ∆· ·ÁfiÚÈ· Ì ¢ª™ <17,42 Î·È Ù· ÎÔÚ›ÙÛÈ· Ì ¢ª™<17,15 ηٷٿ¯ÙËÎ·Ó ÛÙËÓ ÔÌ¿‰· ·È‰ÈÒÓ Ì ηÓÔÓÈÎfi ‚¿ÚÔ˜.

‚) ∆· ·ÁfiÚÈ· Ì ¢ª™ 17,42-19,29 Î·È Ù· ÎÔÚ›ÙÛÈ· Ì¢ª™ 17,15-19,16 ηٷٿ¯ÙËÎ·Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ ˘¤Ú‚·-ÚˆÓ ·È‰ÈÒÓ.

Á) ∆· ·ÁfiÚÈ· Ì ¢ª™ >19,30 Î·È Ù· ÎÔÚ›ÙÛÈ· Ì ¢ª™>19,17 ηٷٿ¯ÙËÎ·Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ.

°È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¯ÚËÛÈ-ÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ Ù˘ ÔÛÔÛÙÈ·›·˜ ηٷÓÔÌ‹˜ ÙÔ˘‰Â›ÁÌ·ÙÔ˜ ·Ó¿ÏÔÁ· Ì ÙȘ ÂÍÂÙ·˙fiÌÂÓ˜ ÌÂÙ·‚ÏËÙ¤˜ Î·È˘ÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙ˘ ¯2 ÌÂٷ͇ ηÙËÁÔÚÈÎÒÓ ÌÂÙ·‚ÏË-ÙÒÓ. ∂›Û˘, ˘ÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙ˘ ÛÙ·ÙÈÛÙÈ΋˜ Û˘Û¯¤ÙÈ-

Û˘ Pearson r ÌÂٷ͇ ·ÚÈıÌËÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ.

∞ÔÙÂϤÛÌ·Ù·

™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜, ËηٷÓÔÌ‹ ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ Â›Ó·È Â-Ú›Ô˘ Ë ›‰È·. ™Â fi,ÙÈ ·ÊÔÚ¿, fï˜, ÛÙËÓ Î·Ù·ÓÔÌ‹ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÙÔ 40%ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·ÔÙÂÏÂ›Ù·È ·fi ·È‰È¿ ËÏÈΛ·˜ 61-72 ÌËÓÒÓ (¶›Ó·Î·˜ 1).

∏ Û˘¯ÓfiÙËÙ· Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ ËÏÈ-Λ·˜ 3-7 ÂÙÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ ·Ó¤Ú-¯ÂÙ·È Û ÔÛÔÛÙfi 6,4%. ™˘Ó˘ÔÏÔÁ›˙ÔÓÙ·˜, fï˜,ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ (15,9%), ÙfiÙ‰ȷÈÛÙÒÓÂÙ·È fiÙÈ ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· ÛÙ· ¤ÓÙ·ȉȿ ¤¯ÂÈ ‚¿ÚÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi(¶›Ó·Î·˜ 2).

™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ·¯‡Û·ÚΈӷȉÈÒÓ ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ ÙÔ˘˜, ‰È·ÈÛÙÒÓÂÙ·ÈfiÙÈ Ù· ÔÛÔÛÙ¿ ÂÌÊ¿ÓÈÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ Û·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Â›Ó·È ·ÚfiÌÔÈ· (¶›Ó·Î·˜ 3).

∏ ÌÂϤÙË Ù˘ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙˆÓ ˘ÔÎÂÈ-ÌÂÓÈÎÒÓ ÂÎÙÈÌ‹ÛÂˆÓ ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÙÔ˘ Ú·ÁÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙÔ˘ ·È-‰ÈÔ‡ ‰Â›¯ÓÂÈ fiÙÈ ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ıÂ-ÙÈ΋ Û˘Û¯¤ÙÈÛË (r=0,44, p<0,01). º·›ÓÂÙ·È, ÏÔÈfiÓ,fiÙÈ ÔÈ ÌËÙ¤Ú˜ Â›Ó·È Û ı¤ÛË Ó· ÂÎÙÈÌ‹ÛÔ˘Ó Û·‰Ú¤˜ ÁÚ·Ì̤˜ ηٿ fiÛÔ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ÙÔ˘˜ Î˘Ì·›ÓÂÙ·È ÛÙ· Ï·›ÛÈ· ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡.

øÛÙfiÛÔ, ÔÈ ˘ÔÎÂÈÌÂÓÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÌËÙ¤-ÚˆÓ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Ê·›ÓÔÓÙ·È ·-Ú¿‰Ô͘ Û ۯ¤ÛË Ì ÙÔÓ ‚·ıÌfi ÈηÓÔÔ›ËÛ‹˜ ÙÔ˘˜·fi ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ·˘Ùfi ηٷӷÏÒ-ÓÂÈ. ¢È·ÈÛÙÒÓÂÙ·È fiÙÈ ÛÙÔ 53,1% ÙˆÓ ÂÚÈÙÒÛˆÓfiÔ˘ ÙÔ ·È‰› - Û‡Ìʈӷ ¿ÓÙ· Ì ÙËÓ ÂÎÙ›ÌËÛËÙ˘ ÌËÙ¤Ú·˜ ÙÔ˘ - ¤¯ÂÈ ‚¿ÚÔ˜ ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ

¶¶››ÓÓ··Îη·˜̃ 22.. ¶ÔÛÔÛÙÈ·›· ηٷÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Û‡Ìʈӷ Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ ·Ó¿ÏÔÁ· Ì ÙÔÓ ¢ª™ ·Ó¿ ËÏÈÎȷ΋ÔÌ¿‰·

∏∏ÏÏÈÈÎΛ›·· ∫∫··ÙÙ··ÓÓÔÔÌÌ‹‹ ÙÙˆ̂ÓÓ ··Èȉ‰ÈÈÒÒÓÓ ÛÛ‡‡ÌÌÊʈ̂ÓÓ·· ÌÌ ÙÙÔÔ ‚‚¿¿ÚÚÔÔ˜̃ ÙÙÔÔ˘̆˜̃ ((%%))ºº˘̆ÛÛÈÈÔÔÏÏÔÔÁÁÈÈÎÎfifi ÀÀ¤¤ÚÚ‚‚··ÚÚÔÔ ¶¶··¯̄‡‡ÛÛ··ÚÚÎÎÔÔ ÀÀ¤¤ÚÚ‚‚··ÚÚ·· Îη·ÈÈ ··¯̄‡‡ÛÛ··ÚÚÎη·

3,1-4 ÂÙÒÓ (n=45) 80 15,6 4,4 204,1-5 ÂÙÒÓ (n=144) 81,9 13,9 4,2 18,15,1-6 ÂÙÒÓ (n=199) 76,4 16,6 7 23,66,1-6,9 ÂÙÒÓ (n=110) 73,6 17,3 9,1 26,4™‡ÓÔÏÔ (n=498) 77,7 15,9 6,4 22,3

x2=3,95, p=0,683

¶¶››ÓÓ··Îη·˜̃ 11.. ∫·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Û‡ÌʈӷÌ ÙËÓ ËÏÈΛ· ÙÔ˘˜

∏∏ÏÏÈÈÎΛ›·· NN %%

3,1-4 ÂÙÒÓ 45 94,1-5 ÂÙÒÓ 144 28,95,1-6 ÂÙÒÓ 199 406,1-6,9 ÂÙÒÓ 110 22,1™‡ÓÔÏÔ 498 100

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48 ∂. ∫¿ÎÔ˘ÚÔ˜ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2005;68:45-51

ηÓÔÓÈÎfi, Ë ÌËÙ¤Ú· ‰ËÏÒÓÂÈ Â˘¯·ÚÈÛÙË̤ÓË Ì ÙËÓ

ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ ηٷӷÏÒÓÂÈ ÙÔ ·È‰› Ù˘.

∂›Û˘, ÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ÔÈ ÌËÙ¤Ú˜ ÂÎÙÈ-

ÌÔ‡Ó fiÙÈ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi,

ÙÔ 28,3% ·˘ÙÒÓ ‰ËÏÒÓÂÈ fiÙÈ ı· ÂÈı˘ÌÔ‡Û ӷ

ÙÚÒÂÈ ÙÔ ·È‰› ÂÚÈÛÛfiÙÂÚÔ (¶›Ó·Î·˜ 4).

º·›ÓÂÙ·È, ›Û˘, fiÙÈ ÔÈ ÌËÙ¤Ú˜ ÙˆÓ ·È‰ÈÒÓ

Ô˘ Â›Ó·È Ú·ÁÌ·ÙÈο ˘¤Ú‚·Ú· (Û‡Ìʈӷ Ì ÙÔÓ

¢ª™) - Û ÔÛÔÛÙfi 19,2% - ı· ‹ıÂÏ·Ó Ó· ‚Ϥ-

Ô˘Ó ÙÔ ·È‰› ÙÔ˘˜ Ó· ÙÚÒÂÈ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ,

ÂÓÒ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÌËÙ¤ÚˆÓ ·˘ÙÒÓ ÙˆÓ ·È-

‰ÈÒÓ Â›Ó·È ÈηÓÔÔÈË̤Ó˜ ·fi ÙËÓ ÔÛfiÙËÙ· Ê·-

ÁËÙÔ‡ Ô˘ ηٷӷÏÒÓÔ˘Ó Ù· ·È‰È¿ ÙÔ˘˜. ∞fi ÙÔ

Û‡ÓÔÏÔ ÙˆÓ ÌËÙ¤ÚˆÓ ÙˆÓ ÔÔ›ˆÓ ÙÔ ·È‰› ›ӷÈ

·¯‡Û·ÚÎÔ, ÌfiÓÔ ÙÔ ¤Ó· ÙÚ›ÙÔ ı· ‹ıÂÏ ӷ ηٷ-

Ó·ÏÒÓÂÈ ÙÔ ·È‰› ÙÔ˘˜ ÌÈÎÚfiÙÂÚË ÔÛfiÙËÙ· Ê·ÁË-

ÙÔ‡ (¶›Ó·Î·˜ 5).

∂ÈϤÔÓ, ÙÔ 19,4% ÙˆÓ ÌËÙ¤ÚˆÓ ÙˆÓ ·¯‡Û·Ú-

ÎˆÓ ·È‰ÈÒÓ ÈÛÙ‡ÂÈ fiÙÈ Ù· ·È‰È¿ ÙÔ˘˜ ı· ¤ÙÚˆ-

Á·Ó Ôχ Ï›ÁÔ Â¿Ó ·Ê‹ÓÔÓÙ·Ó Ó· ηıÔÚ›ÛÔ˘Ó ÌfiÓ·

ÙÔ˘˜ ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ı¤ÏÔ˘Ó Ó·

ηٷӷÏÒÛÔ˘Ó (¶›Ó·Î·˜ 6). ¢È·ÈÛÙÒÓÂÙ·È, ›-

Û˘, fiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ Â›Ó·È ·˘Ù¿ Ô˘ ·ÍÈÔ-

ÏÔÁÔ‡ÓÙ·È Û˘ÓËı¤ÛÙÂÚ· ·fi ÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜ (ÛÂ

ÔÛÔÛÙfi 59%) ˆ˜ ·È‰È¿ Ô˘, Â¿Ó ·Ê‹ÓÔÓÙ·Ó Ó·

Ê¿Ó fiÛÔ ı¤ÏÔ˘Ó, ı· ¤ÙÚˆÁ·Ó ηÓÔÓÈ΋ ÔÛfiÙËÙ·

Ê·ÁËÙÔ‡. ∞ÓÙ›ıÂÙ·, ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì η-

ÓÔÓÈÎfi ‚¿ÚÔ˜, ÔÛÔÛÙfi ÌfiÓÔ 46,5% ÙˆÓ ÌËÙ¤ÚˆÓ

ÙÔ˘˜ ıˆÚ› fiÙÈ Ù· ·È‰È¿ ·˘Ù¿ ı· ¤ÙÚˆÁ·Ó ηÓÔÓÈ-

ο Â¿Ó ·Ê‹ÓÔÓÙ·Ó ÂχıÂÚ· (¶›Ó·Î·˜ 6).

∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ (59,9%) Ê·›ÓÂÙ·È fiÙÈ

ÁÂ˘Ì·Ù›˙Ô˘Ó Ì ÙËÓ ˘fiÏÔÈË ÔÈÎÔÁ¤ÓÂÈ· ·fi ·Ú-

ÎÂÙ¿ ÓˆÚ›˜ (¶›Ó·Î·˜ 7). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‰È¢ÎÔ-

χÓÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ Â›‰Ú·ÛË ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈ-

Ï‹„ÂˆÓ Î·È Ú·ÎÙÈÎÒÓ ÛÙ· ·È‰È¿. ∂ÈϤÔÓ, ÙÔ

50,3% ÙˆÓ ÁÔÓ¤ˆÓ ÚÔÛʤÚÂÈ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÛÙÔ

·È‰› Î·È ¿ÏϘ ÂÓ·ÏÏ·ÎÙÈΤ˜ χÛÂȘ ÛÙËÓ ÂÚ›-

ÙˆÛË Ô˘ ‰ÂÓ ı¤ÏÂÈ Ó· Ê¿ÂÈ ÙÔ ›‰ÈÔ Ê·ÁËÙfi Ì ÙËÓ

˘fiÏÔÈË ÔÈÎÔÁ¤ÓÂÈ·. ª¿ÏÈÛÙ·, ÛÙÔ 15,5% ÙˆÓ Â-

ÚÈÙÒÛˆÓ, ÙÔ ·›ÙËÌ· ·˘Ùfi Á›ÓÂÙ·È ¿ÓÙ· ·Ô‰Â-

ÎÙfi ·fi ÙÔ˘˜ ÁÔÓ›˜ (¶›Ó·Î·˜ 7). ™ÙȘ ÂÚÈÙÒÛÂȘ

‰Â Ô˘ ÙÔ ·È‰› ·ÚÓÂ›Ù·È Ó· Ê¿ÂÈ, ·ÚÎÂÙÔ› ÁÔÓ›˜

(17,4%) ·ÛÎÔ‡Ó ›ÂÛË Û ·˘Ùfi, ÂÓÒ ·ÚÎÂÙÔ› ¿ÏÏÔÈ

(23%) ÙÔ˘ ‰›ÓÔ˘Ó ‰È¿ÊÔÚ˜ ˘ÔÛ¯¤ÛÂȘ.

¶ÔÛÔÛÙfi 25,1% ÙˆÓ ÌËÙ¤ÚˆÓ ÂÎÙÈÌ¿ fiÙÈ Ú¤ÂÈ

¿ÓÙ· Ó· ηıÔÚ›˙Ô˘Ó ÔÈ ›‰È˜ ÙËÓ ÔÛfiÙËÙ· Î·È ÙÔ

›‰Ô˜ ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ÙÚÒÂÈ ÙÔ ·È‰› ÙÔ˘˜, ÂÓÒ Ìfi-

ÓÔ ÙÔ 6,3% ÂÎÙÈÌ¿ fiÙÈ ÙÔ ·È‰› Ú¤ÂÈ Ó· ·Ê‹ÓÂÙ·È

¶¶››ÓÓ··Îη·˜̃ 33.. ¶ÔÛÔÛÙÈ·›· ηٷÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ Û‡Ìʈӷ Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ ·Ó¿ÏÔÁ· Ì ÙÔÓ ¢ª™ ·Ó¿ ʇÏÔ

ºº‡‡ÏÏÔÔ ∫∫··ÙÙ··ÓÓÔÔÌÌ‹‹ ÙÙˆ̂ÓÓ ··Èȉ‰ÈÈÒÒÓÓ ÛÛ‡‡ÌÌÊʈ̂ÓÓ·· ÌÌ ÙÙÔÔ ‚‚¿¿ÚÚÔÔ˜̃ ÙÙÔÔ˘̆˜̃ ((%%))ºº˘̆ÛÛÈÈÔÔÏÏÔÔÁÁÈÈÎÎfifi ÀÀ¤¤ÚÚ‚‚··ÚÚÔÔ ¶¶··¯̄‡‡ÛÛ··ÚÚÎÎÔÔ

∞ÁfiÚÈ (n=262) 77,9 14,5 7,6∫ÔÚ›ÙÛÈ (n=236) 77,5 17,4 5,1

x2=1,90, p=0,387

¶¶››ÓÓ··Îη·˜̃ 44.. ∏ Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È ÛÙÔÓ ‚·ıÌfi ÈηÓÔÔ›ËÛ‹˜ Ù˘ ·fi ÙËÓÔÛfiÙËÙ· ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ·˘Ùfi ηٷӷÏÒÓÂÈ

∂∂ÎÎÙÙ››ÌÌËËÛÛËË ‚‚¿¿ÚÚÔÔ˘̆˜̃ ··Èȉ‰ÈÈÔÔ‡‡ µµ··ııÌÌfifi˜̃ ÈÈÎη·ÓÓÔÔÔÔ››ËËÛÛˢ̃ ÙÙˢ̃ ÌÌËËÙÙ¤¤ÚÚ··˜̃ ··fifi ÙÙËËÓÓ ÔÔÛÛfifiÙÙËËÙÙ·· ÊÊ··ÁÁËËÙÙÔÔ‡‡ ÔÔ˘̆ Îη·ÙÙ··ÓÓ··ÏÏÒÒÓÓÂÂÈÈ ÙÙÔÔ ··Èȉ‰›› ÙÙˢ̃ ((%%))

∂∂˘̆¯̄··ÚÚÈÈÛÛÙÙËËÌ̤¤ÓÓËË ££·· ‹‹ııÂÂÏÏ ÂÂÚÚÈÈÛÛÛÛfifiÙÙÂÂÚÚÔÔ ££·· ‹‹ııÂÂÏÏ ÏÏÈÈÁÁfifiÙÙÂÂÚÚÔÔ

ªÈÎÚfiÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡ (n=76) 7,9 90,8 1,3∫·ÓÔÓÈÎfi (n=390) 69,9 28,3 1,8ªÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ηÓÔÓÈÎÔ‡ (n=32) 53,1 0 46,9™‡ÓÔÏÔ (n=498) 59,4 36 4,6

x2=254,67, p<0,0005

¶¶››ÓÓ··Îη·˜̃ 55.. ∏ Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ (Û‡Ìʈӷ Ì ÙÔÓ ¢ª™) Î·È ÛÙÔÓ ‚·ıÌfi ÈηÓÔÔ›ËÛ˘ Ù˘ ÌËÙ¤Ú·˜ ·fiÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ·˘Ùfi ηٷӷÏÒÓÂÈ

µµ¿¿ÚÚÔÔ˜̃ ÛÛ‡‡ÌÌÊʈ̂ÓÓ·· ÌÌ ÙÙÔÔÓÓ ¢¢ªª™™ µµ··ııÌÌfifi˜̃ ÈÈÎη·ÓÓÔÔÔÔ››ËËÛÛˢ̃ ÙÙˢ̃ ÌÌËËÙÙ¤¤ÚÚ··˜̃ ··fifi ÙÙËËÓÓ ÔÔÛÛfifiÙÙËËÙÙ·· ÊÊ··ÁÁËËÙÙÔÔ‡‡ ÔÔ˘̆ Îη·ÙÙ··ÓÓ··ÏÏÒÒÓÓÂÂÈÈ ÙÙÔÔ ··Èȉ‰›› ((%%))

∂∂˘̆¯̄··ÚÚÈÈÛÛÙÙËËÌ̤¤ÓÓËË ££·· ‹‹ııÂÂÏÏ ÂÂÚÚÈÈÛÛÛÛfifiÙÙÂÂÚÚÔÔ ££·· ‹‹ııÂÂÏÏ ÏÏÈÈÁÁfifiÙÙÂÂÚÚÔÔ

º˘ÛÈÔÏÔÁÈÎfi (n=387) 57,1 42,1 0,8À¤Ú‚·ÚÔ (n=79) 69,3 19,2 11,5¶·¯‡Û·ÚÎÔ (n=32) 62,5 3,1 34,4™‡ÓÔÏÔ (n=498) 59,4 36 4,6

x2=254,67, p<0,0005

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¶·È‰È·ÙÚÈ΋ 2005;68:45-51

49¶·È‰È΋ ·¯˘Û·ÚΛ· Î·È ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ

Ó· ηıÔÚ›˙ÂÈ ÌfiÓÔ ÙÔ˘ ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Ê·ÁËÙÔ‡

Ô˘ ı¤ÏÂÈ Ó· ηٷӷÏÒÛÂÈ (¶›Ó·Î·˜ 8).

™˘˙‹ÙËÛË

∏ Û˘¯ÓfiÙËÙ· Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙÔÓ ÏËı˘ÛÌfi

ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 3-7 ÂÙÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó

ÛÙËÓ ¤Ú¢ӷ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 6,4%. ∏ Û˘¯ÓfiÙËÙ· ·˘-

Ù‹, Û˘ÁÎÚÈÓfiÌÂÓË Ì ÛÙÔȯ›· ·fi ·Ó¿ÏÔÁ˜ ¤Ú¢-

Ó˜ Ô˘ ¤ÁÈÓ·Ó Û ¿ÏϘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜

(1,11,12), ‰ÂÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË. ∂¿Ó,

fï˜, ÛÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Û˘-

Ó˘ÔÏÔÁÈÛÙ› Î·È ·˘Ùfi ÙˆÓ ˘¤Ú‚·ÚˆÓ (15,9%),

ÙfiÙ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· ÛÙ·

¤ÓÙ ·È‰È¿ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜ ¤¯ÂÈ ‚¿ÚÔ˜ ÌÂÁ·Ï‡-

ÙÂÚÔ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi.

¢È·ÈÛÙÒÓÂÙ·È, ›Û˘, fiÙÈ ÔÈ ÁÔÓ›˜ - ·Ú’ fiÏÔ

Ô˘ Â›Ó·È Û ı¤ÛË Ó· ÂÎÙÈÌ‹ÛÔ˘Ó Â¿Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘

·È‰ÈÔ‡ ÙÔ˘˜ Î˘Ì·›ÓÂÙ·È ‹ fi¯È ÛÂ Ê˘ÛÈÔÏÔÁÈο

Ï·›ÛÈ· - Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÓËÛ˘¯Ô‡Ó fiÙ·Ó ÙÔ ·È‰›

ÙÔ˘˜ Â›Ó·È ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ Î·Ù¿ ÙËÓ ÚÔ-

Û¯ÔÏÈ΋ ËÏÈΛ·. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ ‚¿ÚÔ˜

ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ÔÈ ÌÈÛ¤˜ ÂÚ›Ô˘

ÌËÙ¤Ú˜ ı· ‹ıÂÏ·Ó ÙÔ ·È‰› ÙÔ˘˜ Ó· ÙÚÒÂÈ ÂÚÈÛ-

ÛfiÙÂÚÔ. ¶·ÚfiÌÔÈ· ÂÈı˘Ì›· ¤¯Ô˘Ó, Û ·ÚÎÂÙ¤˜ Â-

ÚÈÙÒÛÂȘ, ·ÎfiÌË Î·È ÔÈ ÌËÙ¤Ú˜ ÙˆÓ ·¯‡Û·ÚΈÓ

·È‰ÈÒÓ. º·›ÓÂÙ·È fiÙÈ Ë ·ÓËÛ˘¯›· ÙÔ˘˜ ÂÌÊ·Ó›˙Â-

Ù·È ÌfiÓÔ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È-

‰ÈÔ‡ ηٿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Â›Ó·È ¯·ÌËÏfiÙÂ-

ÚÔ ·fi ÂΛÓÔ Ô˘ ÔÈ ›‰È˜ ÂÎÙÈÌÔ‡Ó ˆ˜ ηÓÔÓÈÎfi

Î·È fi¯È ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰È-

Ô‡ Â›Ó·È ·˘ÍË̤ÓÔ. ª›· Èı·Ó‹ ÂÚÌËÓ›· Â›Ó·È Ë

ÂӉ¯fiÌÂÓË ·ÓÙ›ÏË„Ë ÙˆÓ ÌËÙ¤ÚˆÓ fiÙÈ Ë ·¯˘-

Û·ÚΛ· ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ Â›Ó·È Ì›· ·ÚÔ‰È΋ η-

Ù¿ÛÙ·ÛË. øÛÙfiÛÔ, Ë ·ÓÙ›ÏË„Ë ·˘Ù‹ Ê·›ÓÂÙ·È Ó·

Û˘ÓÙÂÏ› ÛÙËÓ Â‰Ú·›ˆÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ù˘ ·-

¯˘Û·ÚΛ·˜, Û‡Ìʈӷ Ì ÚÔËÁÔ‡ÌÂÓË ÚÔÊÔÚÈ΋

·Ó·ÎÔ›ÓˆÛ‹ Ì·˜ ÛÙÔ 20th International Human

Science Research Conference ÛÙÔ ∆fiÎÈÔ ÙÔ 2001.

∂ÈϤÔÓ, ÔÈ ÌËÙ¤Ú˜ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜

ÂÎÙÈÌÔ‡Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ‰ÂÓ ¤¯ÂÈ ÙËÓ ÈηÓfiÙËÙ·

Ó· Ú˘ıÌ›˙ÂÈ ÌfiÓÔ ÙÔ˘ ÙËÓ ÔÛfiÙËÙ· Î·È ÙÔ Â›‰Ô˜

ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ηٷӷÏÒÓÂÈ. ∂Ô̤ӈ˜, ÈÛÙ‡-

Ô˘Ó fiÙÈ Ë ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ı· Ú¤ÂÈ Ó·

Ú˘ıÌ›˙ÂÙ·È ¿ÓÙ· - ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÚÈΤ˜ ÊÔÚ¤˜ -

·fi ÙȘ ›‰È˜. ¶·ÚfiÌÔȘ ‹Ù·Ó Î·È ÔÈ ‰È·ÈÛÙÒÛÂȘ

Û ̛· ¿ÏÏË ¤Ú¢ӷ Ì ÏËı˘ÛÌfi ∂ÏÏËÓ›‰ˆÓ ÌËÙ¤-

ÚˆÓ ·fi ÙȘ ÂÚÈÔ¯¤˜ Ù˘ ∞ı‹Ó·˜ Î·È Ù˘ ∞ÏÂÍ·Ó-

‰ÚÔ‡ÔÏ˘ (23).

º·›ÓÂÙ·È fiÙÈ ÔÈ ÌËÙ¤Ú˜ Û˘¯Ó¿ Ȥ˙Ô˘Ó ÙÔ ·È‰›

ÙÔ˘˜ Ì ‰È¿ÊÔÚÔ˘˜ ÙÚfiÔ˘˜ Ó· ÙÚÒÂÈ fiÛÔ ÂÎÙÈÌÔ‡Ó

ÂΛӘ fiÙÈ Ú¤ÂÈ Ó· Ê¿ÂÈ. ∏ ›ÂÛË ÛÙÔ Ê·ÁËÙfi, ÛÂ

Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈ-

ÊÔÚ¿ (21), Â›Ó·È Èı·Ófi Ó· ·ÔÙÂÏÔ‡Ó ‚·ÛÈÎÔ‡˜ ·È-

ÙÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ ·¯˘Û·ÚΛ·˜. Œ¯ÂÈ

¶¶››ÓÓ··Îη·˜̃ 66.. H Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·È‰ÈÔ‡ (·Ó¿ÏÔÁ· Ì ÙÔÓ ¢ª™) Î·È ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÙËÓ ÔÛfiÙË-Ù· Ê·ÁËÙÔ‡ Ô˘ ı· ηٷӿψÓ ÙÔ ·È‰› Ù˘ Â¿Ó ÙÔ˘ ÚÔÛÊÂÚfiÙ·Ó Ë ‰˘Ó·ÙfiÙËÙ· Ó· ÙÚÒÂÈ fiÛÔ ÙÔ ›‰ÈÔ ı· ‹ıÂÏÂ

µµ¿¿ÚÚÔÔ˜̃ ÛÛ‡‡ÌÌÊʈ̂ÓÓ·· ÌÌ ÙÙÔÔÓÓ ¢¢ªª™™ ∂∂ÎÎÙÙ››ÌÌËËÛÛËË ÙÙˢ̃ ÌÌËËÙÙ¤¤ÚÚ··˜̃ ÁÁÈÈ·· ÙÙËËÓÓ ÔÔÛÛfifiÙÙËËÙÙ·· ÊÊ··ÁÁËËÙÙÔÔ‡‡ ÔÔ˘̆ ıı·· Îη·ÙÙ··ÓÓ¿¿Ïψ̂ÓÓ ÙÙÔÔ ··Èȉ‰›› ÙÙˢ̃ ¿¿ÓÓ ÙÙÔÔ˘̆ ÚÚÔÔÛÛÊÊÂÂÚÚfifiÙÙ··ÓÓ ËË ‰‰˘̆ÓÓ··ÙÙfifiÙÙËËÙÙ·· ÓÓ·· ÙÙÚÚÒÒÂÂÈÈ fifiÛÛÔÔ ÙÙÔÔ ››‰‰ÈÈÔÔ ıı·· ‹‹ııÂÂÏÏ ((%%))

££·· ¤¤ÙÙÚÚˆ̂ÁÁ ¿¿ÚÚ·· ÔÔÏχ‡ ££·· ¤¤ÙÙÚÚˆ̂ÁÁ ÔÔÏχ‡ ÏÏ››ÁÁÔÔ ££·· ¤¤ÙÙÚÚˆ̂ÁÁ Îη·ÓÓÔÔÓÓÈÈÎο¿

º˘ÛÈÔÏÔÁÈÎfi (n=387) 1,8 51,7 46,5À¤Ú‚·ÚÔ (n=79) 10,3 30,8 59¶·¯‡Û·ÚÎÔ (n=32) 29 19,4 51,6™‡ÓÔÏÔ (n=498) 4,9 46,4 48,8

x2=62,74, p<0,0005

¶¶››ÓÓ··Îη·˜̃ 77.. ¢È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜

¢¢ÈÈ··ÙÙÚÚÔÔÊÊÈÈÎΤ¤˜̃ ÛÛ˘̆ÓÓ‹‹ııÂÂÈȘ̃ %%¶¶¿¿ÓÓÙÙ·· ªªÂÂÚÚÈÈÎΤ¤˜̃ ÊÊÔÔÚÚ¤¤˜̃ ™™¿¿ÓÓÈÈ··

°Â˘Ì·Ù›˙ÂÈ Ì ÙËÓ ˘fiÏÔÈË ÔÈÎÔÁ¤ÓÂÈ· 59,9 37 3,1À¿Ú¯Ô˘Ó ÂÓ·ÏÏ·ÎÙÈΤ˜ χÛÂȘ Â¿Ó ‰ÂÓ ÙÔ˘ ·Ú¤ÛÂÈ Î¿ÔÈÔ Ê·ÁËÙfi 15,5 50,3 34,2°›ÓÔÓÙ·È ‰ÂÎÙ¤˜ ÔÈ ÂÈı˘Ì›Â˜ ÙÔ˘ fiÙ·Ó ˙ËÙ¿ Û˘ÁÎÂÎÚÈ̤ÓÔ Ê·ÁËÙfi 11,9 73,8 14,3

¶¶››ÓÓ··Îη·˜̃ 88.. ∞fi ÔÈÔÓ Ú¤ÂÈ Ó· Ú˘ıÌ›˙ÂÙ·È Ë ÔÛfiÙËÙ· ÙÔ˘ Ê·ÁËÙÔ‡ Ô˘ ηٷӷÏÒÓÂÈ ÙÔ ·È‰› Û‡Ìʈӷ Ì ÙȘ ·fi„ÂȘ ÙˆÓÌËÙ¤ÚˆÓ

∏∏ ÔÔÛÛfifiÙÙËËÙÙ·· ÙÙÔÔ˘̆ ÊÊ··ÁÁËËÙÙÔÔ‡‡ ÚÚ¤¤ÂÂÈÈ %%ÓÓ·· ÚÚ˘̆ııÌÌ››˙̇ÂÂÙÙ··ÈÈ ··fifi:: ¶¶¿¿ÓÓÙÙ·· ªªÂÂÚÚÈÈÎΤ¤˜̃ ÊÊÔÔÚÚ¤¤˜̃ ™™¿¿ÓÓÈÈ··

ÙË ÌËÙ¤Ú· 25,1 59,5 15,4ÙÔ ·È‰› 38 55,8 6,3

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·49

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50 ∂. ∫¿ÎÔ˘ÚÔ˜ Î·È Û˘Ó.

‰È·ÈÛÙˆı› fiÙÈ Ë ÈηÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ó· Ú˘ıÌ›-

˙Ô˘Ó ÌfiÓ· ÙÔ˘˜ ÙËÓ ÔÛfiÙËÙ· Ê·ÁËÙÔ‡ Ô˘ Ú¤ÂÈ

Ó· ηٷӷÏÒÓÔ˘Ó, Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ‚¿ÚÔ˜ ÙˆÓ ÌË-

Ù¤ÚˆÓ ÙÔ˘˜, ηıÒ˜ Î·È Ì ÙÔÓ ÙÚfiÔ Ô˘ ÔÈ ›‰È˜

·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È fiÙÈ Ú¤ÂÈ Ó· ·ÛÎÂ›Ù·È ·˘Ùfi˜ Ô

¤ÏÂÁ¯Ô˜. ™˘ÁÎÂÎÚÈ̤ӷ, ‚Ú¤ıËΠfiÙÈ Ù· ·È‰È¿ ÌÂ

ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‚¿ÚÔ˜ Î·È Ù· ·È‰È¿ ÙˆÓ ÌËÙ¤ÚˆÓ

Ô˘ ‰‹ÏˆÓ·Ó ·‰˘Ó·Ì›· Ó· ÂÚÈÔÚ›ÛÔ˘Ó ÙÔ Ê·ÁËÙfi

Ô˘ ηٷӷÏÒÓÔ˘Ó, ›¯·Ó ÂÚÈÔÚÈṲ̂Ó˜ ÈηÓfiÙË-

Ù˜ Ú‡ıÌÈÛ˘ Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ (24). ∂›Û˘, ÔÈ

Birch Î·È Fisher (25), Û ÚfiÛÊ·ÙË ¤ÚÂ˘Ó¿ ÙÔ˘˜,

‰È·›ÛÙˆÛ·Ó fiÙÈ ÔÈ Ú·ÎÙÈΤ˜ Ô˘ ˘ÈÔıÂÙÔ‡Ó ÔÈ

ÌËÙ¤Ú˜ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Û¯ÂÙ›-

˙ÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹-

ıÂȘ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘. ™Â ¤Ú¢ӷ ÙˆÓ Cutting ηÈ

Û˘Ó (26) ‚Ú¤ıËΠfiÙÈ ÔÈ ÔÈÎÔÁÂÓÂȷΤ˜ ÂȉڿÛÂȘ

ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ‰È·ÊÔÚÔÔÈÔ‡-

ÓÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ ÙÔ˘ ÁÔÓ¤· Î·È ÙÔ˘ ·È‰È-

Ô‡ ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, ‰È·ÈÛÙÒıËΠfiÙÈ ÌÂÁ·Ï‡ÙÂ-

ÚË Â›Ó·È Ë Â›‰Ú·ÛË ÙˆÓ ÌËÙ¤ÚˆÓ ÛÙȘ ÎfiÚ˜ ÙÔ˘˜.

∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ·È‰È¿ ÌÔÚÔ‡Ó Â‡ÎÔÏ· Ó·

˘ÈÔıÂÙ‹ÛÔ˘Ó ÙȘ ·fi„ÂȘ, ÙȘ ÛÙ¿ÛÂȘ Î·È ÙȘ ·ÓÙÈ-

Ï‹„ÂȘ ÙˆÓ ·ÓıÚÒˆÓ Ô˘ ·Á·Ô‡Ó, ÚÔÎÂÈ̤ÓÔ˘

Ó· Á›ÓÔÓÙ·È fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ ·Ô‰Â-

ÎÙ¿ ·fi ·˘ÙÔ‡˜ (27). °È· Ó· ÌÔÚ›, fï˜, ¤Ó·

·È‰› Ó· ·ÔÎÙ‹ÛÂÈ ÙËÓ ÈηÓfiÙËÙ· ·˘ÙÔÚÚ‡ıÌÈÛ˘

Ù˘ ÔÛfiÙËÙ·˜ Ù˘ ÙÚÔÊ‹˜ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· η-

Ù·Ó·ÏÒÛÂÈ, ı· Ú¤ÂÈ Ó· ÂÈÛÚ¿ÍÂÈ ·fi ÙÔ ÂÚÈ-

‚¿ÏÏÔÓ ÙÔ˘ Ù· ·Ó¿ÏÔÁ· ÌËӇ̷ٷ Î·È Ó· ÂηÈ-

‰Â˘Ù› Û ·˘Ùfi, ·Ó¿ÏÔÁ· ‚¤‚·È· Ì ÙËÓ ËÏÈΛ· ÙÔ˘

Î·È Ì ÙÔ Ú·ÁÌ·ÙÈÎfi ÙÔ˘ ‚¿ÚÔ˜. ŸÙ·Ó ÔÈ ÁÔÓ›˜

·ÛÎÔ‡Ó ›ÂÛË ÛÙÔ ·È‰› ÙÔ˘˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· Ê¿-

ÂÈ ‹ fiÙ·Ó ÙÔ ÙÈ̈ÚÔ‡Ó ÂÂȉ‹ ·˘Ùfi ‰ÂÓ ÙÚÒÂÈ Û‡Ì-

ʈӷ Ì ÙȘ ‰ÈΤ˜ ÙÔ˘˜ ÂÈı˘Ì›Â˜, ÙfiÙ ÙÔ ·È‰›

‰ÂÓ ÌÔÚ› Ó· ·Ó·Ù‡ÍÂÈ ÙËÓ ·˘ÙÔÓÔÌ›· Î·È ÙÔÓ

·˘ÙÔ¤ÏÂÁ¯Ô ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘. °ÂÓÈο, ̤۷ ·fi

ÙË ÛÙ¿ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ·¤Ó·ÓÙÈ ÛÙÔ Ê·ÁËÙfi,

fiˆ˜ ÂÎÊÚ¿˙ÂÙ·È Ì¤Û· ·fi ÙȘ ηıËÌÂÚÈÓ¤˜ ‰È·-

ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ, ÌÂÙ·‰›‰ÔÓÙ·È ÛÙÔ ·È‰› ·ÓÙÈ-

Ï‹„ÂȘ Î·È Û˘Ó‹ıÂȘ, ÙȘ Ôԛ˜ ·ÚÁfiÙÂÚ· Û˘Ó‹-

ıˆ˜ ˘ÈÔıÂÙ› Î·È ÙÔ ›‰ÈÔ.

∂Ô̤ӈ˜, Ë ÌÂÙ¿‰ÔÛË ·Ó¿ÏÔÁˆÓ ·ÓÙÈÏ‹„ˆÓ

Ì ·˘Ù¤˜ Ô˘ ˘ÈÔıÂÙ› ˘„ËÏfi ÔÛÔÛÙfi ÌËÙ¤ÚˆÓ

ÛÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ Î·È Ë ˘ÈÔı¤ÙËÛË ÙˆÓ Û¯ÂÙÈ-

ÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ ·fi Ù· ·È‰È¿, ÂÓ‰¤-

¯ÂÙ·È Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ Û˘-

¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ ÙȘ

‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ (28). ∂ȉÈÎfiÙÂÚ·, Ë ˘ÂÚ-

ÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÁÔÓ¤ˆÓ, Ë ÔÔ›·

ÙÔ˘˜ Ô‰ËÁ› ÛÙÔÓ ˘ÂÚ‚ÔÏÈÎfi ¤ÏÂÁ¯Ô Ù˘ ‰È·ÙÚÔ-

Ê‹˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜, ÌÔÚ› Û˘¯Ó¿ Ó· ÛÙÂÚ› ·fi

Ù· ›‰È· Ù· ·È‰È¿ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó·Ù‡ÍÔ˘Ó

ÙËÓ ÈηÓfiÙËÙ· ·˘ÙÔÚÚ‡ıÌÈÛ˘ Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜.

¶ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÔ˘Ó Î·Ù·ÓÔËÙ¤˜ ÔÈ ·ÓÙÈÏ‹-

„ÂȘ ÙˆÓ ·È‰ÈÒÓ, ÔÈ Ôԛ˜ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙÂÏÈο

Û Ôχ ÌÂÁ¿ÏÔ ‚·ıÌfi Î·È ÙȘ ‰È·ÙÚÔÊÈΤ˜ ÙÔ˘˜

Û˘Ó‹ıÂȘ, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Ó· Á›ÓÔ˘ÓÚÒÙ· ηٷÓÔËÙ¤˜ ÔÈ ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ›‰ÈˆÓ ÙˆÓ ÁÔ-Ó¤ˆÓ ÁÈ· ÙÔ Ê·ÁËÙfi Î·È ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙȘ Ôԛ˜ÂÈÙÂÏ› ÁÈ’ ·˘ÙÔ‡˜ Ë Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ‹˜. ∫·Ù¿Û˘Ó¤ÂÈ·, Ë ·ÚÔ‡Û· ¤Ú¢ӷ ·Ú¤¯ÂÈ ·ÚÎÂÙ¤˜ ÂÓ-‰Â›ÍÂȘ ÁÈ· ÙË ÛËÌ·Û›· Ù˘ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË˜ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈÏ‹„ÂˆÓ Î·È ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘-ÓËıÂÈÒÓ, ÔÈ Ôԛ˜ ÂÓ‰¤¯ÂÙ·È Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓÂÌÊ¿ÓÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜. ™˘ÌÂÚ·-ÛÌ·ÙÈο, Ë ‰ÈÂÍ·ÁˆÁ‹ ·Ó¿ÏÔÁˆÓ ÂÚ¢ÓÒÓ ÛÙÔ Ï·›-ÛÈÔ ·˘Ù‹˜ Ù˘ Û˘ÏÏÔÁÈÛÙÈ΋˜ Ê·›ÓÂÙ·È Î·ıÔÚÈÛÙÈ-΋˜ ÛËÌ·Û›·˜, ÙfiÛÔ ÁÈ· ÙËÓ ÚfiÏË„Ë fiÛÔ Î·È ÁÈ·ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿.

µÈ‚ÏÈÔÁÚ·Ê›·

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2. ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›Ù˘ ª, ∫ˆÓÛÙ·ÓÙ›ÓÔ˘ ∂, ÷Ù˙Ë-

˚ˆ¿ÓÓÔ˘ ª, °È·ÓÎÔ˘Ï‹ ∞, µÚ·¯›Ì˘ ƒ. ŒÏÂÁ¯Ô˜ ÂȤ‰Ô˘

ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·¯˘Û·ÚΛ·˜ Û 1132 ·È‰È¿ Ù˘ ™Ù’ Ù¿-

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·¯˘Û·ÚΛ· Î·È Î·Ú‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù·. π·ÙÚÈ΋ ∫‡ÚÔ˜

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η ∂, ƒÔ‰ÔÔ‡ÏÔ˘ ª, ¡ÈÎÔÏÔÔ‡ÏÔ˘ π Î·È Û˘Ó. ¶·¯˘Û·Ú-

Λ· Î·È ·È‰›. ¶Ú·ÎÙÈο 38Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡

™˘Ó‰ڛԢ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜. Abstract No 283.

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‰¿Î˘ ª, ∫˘Úȷο΢ ª Î·È Û˘Ó. ¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ηÈ

·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ·ÁÚÔÙÈ΋˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ-

¯‹˜ Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 2003;66:264-277.

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51¶·È‰È΋ ·¯˘Û·ÚΛ· Î·È ÁÔÓÈΤ˜ ·ÓÙÈÏ‹„ÂȘ

¶·È‰È·ÙÚÈ΋ 2005;68:45-51

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20. Baughcum AE, Burklow KA, Deeks CM, Powers SW, Whi-taker RC. Maternal feeding practices and childhood obesity:a focus group study of low-income mothers. Arch PediatrAdolesc Med 1998;152:1010-1014.

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23. ∫¿ÎÔ˘ÚÔ˜ ∂, ª·ÓÈ·‰¿ÎË ∫. ∏ ›‰Ú·ÛË ÙˆÓ ÁÔÓÈÎÒÓ ·ÓÙÈ-Ï‹„ÂˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜. ¶·È‰È·-ÙÚÈ΋ 2000;63:507-518.

24. Johnson SL. Improving preschoolers’ self-regulation of ener-gy intake. Pediatrics 2000;106:1429-1435.

25. Birch L, Fisher J. Mothers’ child-feeding practices influencedaughters’ eating and weighting. Am J Clin Nutr2001;71:1054-1061.

26. Cutting TM, Fisher JO, Grimm-Thomas K, Birch LL. Likemother, like daughter: familial patterns of overweight aremediated by mothers’ dietary disinhibition. Am J Clin Nutr1999;69:608-613.

27. Bandura A. Social learning theory. Englewood Cliffs, NewJersey: Prentice-Hall; 1977.

28. ∫¿ÎÔ˘ÚÔ˜ ∂, ª·ÓÈ·‰¿ÎË ∫. æ˘¯Ô·ıÔÏÔÁ›· ·È‰ÈÒÓ Î·ÈÂÊ‹‚ˆÓ. ∞Ó·Ù˘Íȷ΋ ÚÔÛ¤ÁÁÈÛË. ∞ı‹Ó·: ∂ΉfiÛÂȘ∆˘ˆı‹Ùˆ; 2002.

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52 ORIGINAL ARTICLE

1 Center of Early ChildhoodEducation, TechnologicalEducational Institute ofAthens

2 Psychological Center ofDevelopmental Disabilities“ARSI”, Athens

Correspondence:

Katerina Maniadaki 52 Karatasou str., Thrakomacedones, 136 76, ∞thens E-mail: [email protected]

Date of submission: 07-11-2003Date of approval: 22-10-2004

Paediatriki 2005;68:52

Childhood obesity and its relationship with

parental attitudes and nutritional habits

E. Kakouros1, K. Maniadaki2, E. Kapnisi2

Abstract

Background: The aim of this study was to investigate maternal attitudes regarding nutrition, nutritionalhabits adopted in the family and the possible relationship of these factors with the development of childhoodobesity.

Methods: The sample consisted of 498 children aged 3-7 years, residents of Nicosia and Paphos in Cyprus,and their mothers.

Results: According to the results, 6.4% of the children of the sample were obese and 15.9% overweight.However, it was found that a high percentage of the mothers with overweight or obese children were satisfiedwith the amount of food consumed by their children, whereas in the cases of children with normal weight,almost half of the mothers would like their child to eat more. In addition, a high percentage of mothers didnot consider children capable of regulating on their own the amount of food they need to consume.

Conclusions: It seems, therefore, that mothers’ attitudes about the amount of food children need to consumeare often mistaken. It is possible that these attitudes usually lead to the adoption of analogous nutritionalhabits that may be related, to a certain degree, to the development of childhood obesity. On the basis of theabove results, possible etiological mechanisms for the development of obesity in children are discussed withinthe framework of social learning theory.

Key words

Childhood obesity, parental attitudes, nutritional habits.

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53∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

°ÂÓÂÙÈ΋ Î·È ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË

·ÛıÂÓÒÓ Ì ۇӉÚÔÌ· DiGeorge/˘ÂÚˆÈÔ-

ηډÈÔ-ÚÔÛˆÈÎfi (velo-cardio-facial syndrome)

™. ∫›ÙÛÈÔ˘ - ∆˙¤ÏË1, ∞. ∫ÔÏȷϤÍË1, ∂. ºÚ˘Û›Ú·1, ∞. °·ÏÏ¿ - µÔ˘Ì‚Ô˘Ú¿ÎË2, ∞. ™·Ï·‚Ô‡Ú·3, ª. ∫·Ó·Ú›Ô˘3,

∂. ∫·Ó·‚¿Î˘1, ∞. ª·‡ÚÔ˘1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ·Ó›¯Ó¢ÛË ÂÏÏ›ÌÌ·ÙÔ˜ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙË ı¤ÛË q11.2ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 22 Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÁÂÓÂÙÈÎÒ˜ ÔÌÔÂȉ‹ Û‡Ó‰ÚÔÌ· DiGeorge/velo-cardio-facialsyndrome (VCFS) Î·È Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘˜.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ŒÁÈÓ ÌÂϤÙË ÙÔ˘ ηڢÔÙ‡Ô˘ Ì ٷÈӛ˜ G Î·È ·Ó›¯Ó¢ÛË ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ 22q11.2Ì ÙËÓ Ù¯ÓÈ΋ ÙÔ˘ ÊıÔÚ›˙ÔÓÙÔ˜ in situ ˘‚ÚȉÈÛÌÔ‡ (FISH).

∞ÔÙÂϤÛÌ·Ù·: ŒÏÏÂÈÌÌ· 22q11.2 ‰È·ÈÛÙÒıËΠ۠17/139 ·ÛıÂÓ›˜ Ô˘ ÂÚ¢ӋıËÎ·Ó (14 ·ÁfiÚÈ· Î·È 3 ÎÔ-Ú›ÙÛÈ·), ËÏÈΛ·˜ 10 ËÌÂÚÒÓ ¤ˆ˜ 17 ÂÙÒÓ. ™Â ÙÚÂȘ ·ÛıÂÓ›˜, ÙÔ ¤ÏÏÂÈÌÌ· ‹Ù·Ó ÎÏËÚÔÓÔÌÈÎfi (2 ÌËÙÚÈ΋˜ ηÈ1 ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘). ∂›Û˘, ‰È·ÈÛÙÒıËÎ·Ó ‰‡Ô ·ıÔÏÔÁÈÎÔ› ηڢfiÙ˘ÔÈ Û ‰‡Ô ·È‰È¿ (Û‡Ó‰ÚÔÌÔKlinefelter Ì ηڢfiÙ˘Ô 47,ÃÃÀ Î·È 46,ÃÃ,2p+), ÔÈ ÔÔ›ÔÈ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ʷÈÓfiÙ˘Ô DGS/VCFS. OÈ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈÌÌ· ÂÌÊ¿ÓÈ˙·Ó ‰˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ (82%), Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·(70%), ·ÓÔÛÔ·Ó¿ÚÎÂÈ· (47%), ÔÏϷϤ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (64%), ˘·Û‚ÂÛÙÈ·ÈÌ›· (47%), „˘¯ÔÎÈ-ÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË/Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜/‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (35%), ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜(23%), ˘ÂÚˆÈÔÛ¯ÈÛÙ›·/˘ÂÚˆÈÔÊ·Ú˘ÁÁÈ΋ ·Ó¿ÚÎÂÈ· (23%), Û·ÛÌÔ‡˜/˘ÔÙÔÓ›· (23%) Î·È ÛˆÌ·ÙÈ΋ηı˘ÛÙ¤ÚËÛË (12%). ∏ ÎÏÈÓÈ΋ ÁÂÓÂÙÈ΋ ·ÓÂÎÙ›ÌËÛË Û 39/139 ·ÛıÂÓ›˜ ¯ˆÚ›˜ ¤ÏÏÂÈÌÌ· 22q11.2 Û˘Ó¤-‚·Ï ÛÙËÓ Î·Ù¿Ù·ÍË ÙˆÓ 14 (37%) ·fi ·˘ÙÔ‡˜ Û ‰È·ÊÔÚÂÙÈο ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ·.

™˘ÌÂÚ¿ÛÌ·Ù·: ∞fi ÙË ÌÂϤÙË ÚÔ·ÙÂÈ Ë ¯ÚËÛÈÌfiÙËÙ· Ù˘ Ù¯ÓÈ΋˜ FISH ÛÙËÓ ·Ó›¯Ó¢ÛË ÂÏÏ›ÌÌ·-ÙÔ˜ 22q11.2 Î·È Ë ·Ó¿ÁÎË ÔÏÔÎÏ‹ÚˆÛ˘ ÙÔ˘ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ ·ÛıÂÓÒÓ Ì DGS/VCFS ÛÂÛ˘ÓÂÚÁ·Û›· Ì ÙÔÓ ÁÂÓÂÙÈÛÙ‹.

§¤ÍÂȘ ÎÏÂȉȿ

DGS/VCFS, FISH, ¤ÏÏÂÈÌÌ· 22q11.2, ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο.

1 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜°ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ, ÈڤÌÂÈÔ∂Ú¢ÓËÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2 ∂ÚÁ·ÛÙ‹ÚÈÔ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

3 ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜Î·È πÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜°ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ ÃˆÚ¤ÌÂÈÔ ∂Ú¢ÓËÙÈÎfi∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ “∞Á›· ™ÔÊ›·”∆.∫. 115 27, ∞ı‹Ó· E-mail: [email protected]

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-04-2004∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 28-09-2004

¶·È‰È·ÙÚÈ΋ 2005;68:53-60

™˘ÓÙÔÌÔÁڷʛ˜

FISH ºıÔÚ›˙ˆÓ in situ ˘‚ÚȉÈÛÌfi˜ (fluorescent in situ hybridization)

DGS ™‡Ó‰ÚÔÌÔ DiGeorge VCFS ™‡Ó‰ÚÔÌÔ ˘ÂÚˆÈÔ-ηډÈÔ-ÚÔÛˆÈÎfi ª™ ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ µ™ µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ∂∫ ∂ηÙÔÛÙÈ·›· ı¤ÛË Mb ª¤Á· ‚¿ÛÂȘ (mega bases)

∂ÈÛ·ÁˆÁ‹

∆· Û‡Ó‰ÚÔÌ· DiGeorge (DGS) Î·È ˘ÂÚˆÈÔ-ηډÈÔ-ÚÔÛˆÈÎfi (VCFS) Û ÔÛÔÛÙfi ≥90% ÙˆÓÂÚÈÙÒÛÂˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘ÔÌÈÎÚÔÛÎÔÈ-ÎÒÓ ÂÏÏÂÈÌÌ¿ÙˆÓ ‹ ¿ÏÏˆÓ ‰È·Ù·Ú·¯ÒÓ ÛÙÔ ¯ÚˆÌfi-ۈ̷ 22q11.2 (1,2). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ DGS/VCFS

Â›Ó·È 1:4000, ·ÏÏ¿ ·fi ÔÏÏÔ‡˜ ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È˘ÂÚ‰ÈÏ¿ÛÈ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÏÏ¿ ÓÂÔÁ¤ÓÓËٷηٷϋÁÔ˘Ó ÏfiÁˆ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ (3,4).

∆Ô ÎÏÈÓÈÎfi Ê¿ÛÌ· Â›Ó·È Â˘Ú‡ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈÂÚÈÛÛfiÙÂÚ˜ ·fi 80 ‰È·ÊÔÚÂÙÈΤ˜ Û˘ÁÁÂÓ›˜ ·Óˆ-̷ϛ˜ Û ‰È¿ÊÔÚÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ (2). ∆· ΢ÚÈfi-ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ DGS Î·È VCFS ÂÚÈÏ·Ì-‚¿ÓÔ˘Ó ‰È·Ù·Ú·¯¤˜ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜ ÏfiÁˆ˘ÔÏ·Û›·˜ ‹ ·Ï·Û›·˜ ÙÔ˘ ı‡ÌÔ˘ ·‰¤Ó·, ˘·Û‚Â-ÛÙÈ·ÈÌ›· ÏfiÁˆ ·Ô˘Û›·˜ ÙˆÓ ·Ú·ı˘ÚÂÔÂȉÒÓ ·‰¤-ÓˆÓ, Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Ì ÌÂÁ¿ÏË ÓÔÛËÚfiÙËÙ·Î·È ıÓËÛÈÌfiÙËÙ·, ηıÒ˜ Î·È ·ÚÎÂÙ¿ Ù˘ÈÎfi ÚÔÛˆ-Â›Ô (5,6), ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ ‰È·ÈÛÙÒ-ÓÂÙ·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· „˘¯È·ÙÚÈÎÒÓ ÓÔÛËÌ¿-ÙˆÓ (Û¯È˙ÔÊÚ¤ÓÂÈ· ‹ ‰ÈÔÏÈ΋ ‰È·Ù·Ú·¯‹) (7). ∆¤-ÏÔ˜, ¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› ÙfiÛÔ ‚·Ú‡Ù·Ù˜ ÂÚÈÙÒ-ÛÂȘ Ì ı¿Ó·ÙÔ Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· fiÛÔ Î·È

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·53

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54 ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË Î·È Û˘Ó.

ÂÏ·ÊÚ¤˜ ÌÔÚʤ˜ Ì ˘Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi ‹ ¤ÓÚÈ-ÓË ÔÌÈÏ›· (8-12). OÈ Ê·ÈÓfiÙ˘ÔÈ ÙˆÓ DGS/VCFSÂÌ‚Ú˘ÔÁÂÓÂÙÈο ·ÔÙÂÏÔ‡Ó ÙËÓ ¤ÎÊÚ·ÛË ·Ó·Ù˘-ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ Ó¢ÚÈ΋˜ ·ÎÚÔÏÔÊ›·˜ ÙÔ˘ÙÚ›ÙÔ˘ Î·È Ù¤Ù·ÚÙÔ˘ Ê·Ú˘ÁÁÈÎÔ‡ ı˘Ï¿ÎÔ˘ (13,14).∞ÈÙÈÔÏÔÁÈο Â›Ó·È Èı·Ófi fiÙÈ ÔÈ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜ÔÊ›ÏÔÓÙ·È ÛÙËÓ ‡·ÚÍË ÂÓfi˜ ·ÓÙÈÁÚ¿ÊÔ˘ ·ÓÙ› ‰‡ÔÛÙË ı¤ÛË ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÁÔÓȉ›ˆÓ ÛÙË ¯Úˆ-ÌÔÛˆÌÈ΋ ÂÚÈÔ¯‹ 22q11.2 (·ÏÔ·Ó¿ÚÎÂÈ·), ·Ï-Ï¿ Ê·›ÓÂÙ·È fiÙÈ ÙÔ ÌÔÚÈ·Îfi ÁÂÓÂÙÈÎfi ˘fiÛÙÚˆÌ·ÙˆÓ DGS/VCFS Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÔχÏÔÎÔ (15-18). ™Â ·ÚÎÂÙ¤˜ ÔÈÎÔÁ¤ÓÂȘ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÔÊ·ÈÓfiÙ˘Ô˜ ‰È·Ê¤ÚÂÈ ÌÂٷ͇ ÙˆÓ ÌÂÏÒÓ Ì ÙÔ ›‰ÈÔÌÈÎÚÔ¤ÏÏÂÈÌÌ· 22q11.2 (19). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‚·-Ú‡ÙËÙ· Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜, ÛËÌ·Û›· ¤¯ÂÈ Ë ·Ô˘-Û›· ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÁÔÓȉ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜,·Û¯¤Ùˆ˜ Ù˘ ¤ÎÙ·Û˘ ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ (20,21). ∆¤-ÏÔ˜, ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ÛÙȘÔԛ˜ ‰ÂÓ ˘‹Ú¯Â ÂÌÊ·Ó¤˜ ÌÈÎÚÔ¤ÏÏÂÈÌÌ·22q11.2, Ô‡Ù ·ÓȯÓ‡ÙËÎ·Ó ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿-ÍÂȘ. ∞˘Ùfi Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Â›ÙÂÚfiÎÂÈÙ·È ÁÈ· ·ÈÙÈÔÏÔÁÈÎÒ˜ ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰·, ›ÙÂÁÈ· ÔχÏÔÎË ·ÏÔ·Ó¿ÚÎÂÈ· ÂÚÈÛÛfiÙÂÚˆÓÙÔ˘ ÂÓfi˜ ÁÔÓȉ›ˆÓ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙËÓ ÂÚÈÔ¯‹ÂÚȤ¯ÔÓÙ·È ÂÚ›Ô˘ 100 ÁÔÓ›‰È· (2).

∆Ô ¤ÏÏÂÈÌÌ· 22q11.2, ‡ÚÔ˘˜ ≈3 ̤Á· ‚¿ÛˆÓ(Mb), ¤¯ÂÈ Èı·ÓfiÙËÙ· ÎÏËÚÔÓÔÌÈ΋˜ ÌÂÙ·‚›‚·Û˘5-10% (2,20), Â›Ó·È ÙÔ Û˘¯ÓfiÙÂÚÔ ÌÂٷ͇ ÙˆÓ ÂӉȿ-ÌÂÛˆÓ ÌÈÎÚÔÂÏÏÂÈÌÌ¿ÙˆÓ Î·È ·ÓȯÓ‡ÂÙ·È Ì ÙËÓÙ¯ÓÈ΋ ÙÔ˘ ÊıÔÚ›˙ÔÓÙ· in situ ˘‚ÚȉÈÛÌÔ‡ (FISH).

ªÂ ÛÎÔfi ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·-ÛÙËÚÈ·ÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ DGS/VCFS ¤ÁÈÓÂ

¶·È‰È·ÙÚÈ΋ 2005;68:53-60

∂∂ÈÈÎÎfifiÓÓ·· 11.. ªÂÙ¿Ê·ÛË ·fi ηÏÏȤÚÁÂÈ· ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÂÚÈ-ÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ·ÛıÂÓÔ‡˜ Ì ¤ÏÏÂÈÌÌ· 22q11.2 Ì in situ˘‚ÚȉÈÛÌfi Î·È ·ÓȯÓÂ˘Ù‹ Ù˘ ¯ÚˆÌÔÛˆÌÈ΋˜ ı¤Û˘ 22q11.2(ÎfiÎÎÈÓÔ Û‹Ì·). ™ÙË ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÂÏÔÌÂÚȉȷ-Îfi˜ ‰Â›ÎÙ˘ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 2 (Ú¿ÛÈÓ· Û‹Ì·Ù·).¶¶

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Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·54

Page 66: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

¶·È‰È·ÙÚÈ΋ 2005;68:53-60

55™‡Ó‰ÚÔÌ· DiGeorge/˘ÂÚˆÈÔ-ηډÈÔ-ÚÔÛˆÈÎfi

ÛÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·Ó·‰ÚÔÌÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ

ÈÛÙÔÚÈÎÒÓ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ú·¤ÌÊıËÎ·Ó ·fi

·È‰È¿ÙÚÔ˘˜ Î·È ÁÈ·ÙÚÔ‡˜ ¿ÏÏˆÓ ÂȉÈÎÔÙ‹ÙˆÓ ÛÙÔ

∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›-

Ô˘ ∞ıËÓÒÓ, Ì ¤Ó‰ÂÈÍË ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Ù·ÈÓ›·˜

22q11.2 ÌÂ FISH.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

™ÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi

¤ÏÂÁ¯Ô 139 ·ÛıÂÓ›˜ (82 ·ÁfiÚÈ· Î·È 57 ÎÔÚ›ÙÛÈ·), ËÏÈΛ·˜ 10

ËÌÂÚÒÓ ¤ˆ˜ 15 ÂÙÒÓ, Ì Èı·Ó‹ ‰È¿ÁÓˆÛË DGS/VCFS. OÈ

ÎÏÈÓÈΤ˜ ÏËÚÔÊÔڛ˜ Û ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜

(83/139) ÂÚÈÔÚ›˙ÔÓÙ·Ó Û fi,ÙÈ ‹Ù·Ó ηٷÁÂÁÚ·Ì̤ÓÔ ÛÙ·

·Ú·ÂÌÙÈο ÛËÌÂÈÒÌ·Ù·, ΢ڛˆ˜ fiÛˆÓ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi

ÙËÓ Â·Ú¯›· Î·È ÙÔ ‰Â›ÁÌ· ›¯Â ÛÙ·Ï› Ù·¯˘‰ÚÔÌÈο ‹ ‰ÂÓ

›¯Â ÔÏÔÎÏËÚˆı› Ô ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ∫ÏÈÓÈ-

Îfi˜ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ Û 56/139 ·ÛıÂÓ›˜, ÁÈ· ÙÔ˘˜

ÔÔ›Ô˘˜ Û˘ÁÎÂÓÙÚÒıËÎ·Ó Â·Ú΋ ÛÙÔȯ›· ·fi ÙÔ ·ÙÔÌÈÎfi

Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙÔÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi

¤ÏÂÁ¯Ô.

∏ ÌÂϤÙË ÙÔ˘ ηڢÔÙ‡Ô˘ ¤ÁÈÓ ·fi ηÏÏȤÚÁÂÈ· ÏÂÌ-

ÊÔ΢ÙÙ¿ÚˆÓ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È Ë Û‹Ì·ÓÛË ÙˆÓ ¯Úˆ-

ÌÔÛˆÌ¿ÙˆÓ Ì ٷÈӛ˜ -G. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ë ·Ó›-

¯Ó¢ÛË ÙÔ˘ ÌÈÎÚÔÂÏÏ›ÌÌ·ÙÔ˜ 22q11.2 ¤ÁÈÓ Ì ÙËÓ Ù¯ÓÈ΋

FISH, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔÓ ÂȉÈÎfi DNA ·ÓȯÓÂ˘Ù‹ TUPLE

DiGeorge (Oncor) Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·-

ÛÙ‹. O ›‰ÈÔ˜ ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ˘˜

ÔÔ›Ô˘˜ ‰È·ÈÛÙÒıËΠÙÔ ÌÈÎÚÔ¤ÏÏÂÈÌÌ·. OÈ ·ÛıÂÓ›˜ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÈÛÙÒıËΠ¤ÏÏÂÈÌÌ· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·ÈÙ·ÎÙÈο ÛÙÔ π·ÙÚÂ›Ô ∫ÏÈÓÈ΋˜ °ÂÓÂÙÈ΋˜.

∞ÔÙÂϤÛÌ·Ù·

∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋ ÌÂϤÙË

O ¤ÏÂÁ¯Ô˜ ÙˆÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ 137 ·ÛıÂÓÒÓ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ (98,56%), ÂÓÒ ‰È·ÈÛÙÒıËηӉ‡Ô ·ıÔÏÔÁÈÎÔ› ηڢfiÙ˘ÔÈ: 47,ÃÃÀ (·ÁfiÚÈ 5ÂÙÒÓ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·/„˘¯ÔÎÈÓËÙÈ΋ η-ı˘ÛÙ¤ÚËÛË) Î·È 46,ÃÃ,2p+, de novo (ÎÔÚ›ÙÛÈ 14 ÌË-ÓÒÓ Ì ˘ÔÙÔÓ›·, ΢·ÓˆÙÈο ÂÂÈÛfi‰È· Î·È „˘¯ÔÎÈ-ÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË).

ºıÔÚ›˙ˆÓ in situ ˘‚ÚȉÈÛÌfi˜ (FISH)

ŒÏÏÂÈÌÌ· 22q11.2 ·ÓȯÓ‡ıËΠ۠17/139 ·ÛıÂ-Ó›˜ (12%) (∂ÈÎfiÓ· 1). ∆Ô ¤ÏÏÂÈÌÌ· ‹Ù·Ó ÎÏËÚÔÓÔ-ÌÈÎfi Û ÙÚÂȘ ÔÈÎÔÁ¤ÓÂȘ (17,6%), ‰‡Ô ÌËÙÚÈ΋˜Î·È Ì›· ·ÙÚÈ΋˜ ÚÔ¤Ï¢Û˘, ÂÓÒ ÔÈ ˘fiÏÔȘÂÚÈÙÒÛÂȘ ‹Ù·Ó ÛÔÚ·‰ÈΤ˜.

∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÛıÂÓÒÓ Ì ¤ÏÏÂÈÌ-

Ì· 22q11.2

™ÙÔÓ ¶›Ó·Î· 1 ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔȯ›· ÙÔ˘·ÙÔÌÈÎÔ‡ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ηıÒ˜ ηÈ

14

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

121086420

ª¿ÁÔ˘Ï· ÁÂÌ¿Ù·

ª¿ÙÈ· ÌÈÎÚ¿

∂ÓÙ‡ˆÌ· Û·ÁÔÓÈÔ‡

µÏÂÊ·ÚÈΤ˜ Û¯ÈṲ̂˜ ÛÙÂÓ¤˜

µÏÂÊ·ÚÈΤ˜ Û¯ÈṲ̂˜ ·ÓÙÈÌÔÁÁÔÏÔÂȉ›˜

µÚ·¯˘Ï·ÈÌ›·

ÀÂÚÒ· ıÔψً

ªÈÎÚfi ÛÙfiÌ·

ÀÂÚÙÂÏÔÚÈÛÌfi˜

∂›Î·ÓıÔ˜

ªÈÎÚÔÁÓ·ı›·

√ÈÛıÔÁÓ·ı›·

ª‡ÙË Ì ¢Ú›· ‚¿ÛË/ÚÔ¤¯Ô˘Û·

∞˘ÙÈ¿ ¯·ÌËÏ¿/ÚÔ¤¯ÔÓÙ·

∂∂ÈÈÎÎfifiÓÓ·· 22.. ¢˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ Û 14/17 ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈÌÌ· 22q11.2 (¿ÍÔÓ·˜ ¯: ·ÚÈıÌfi˜ ·ÛıÂÓÒÓ Ì ÙÔ ‰˘-ÛÌÔÚÊÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi, ¿ÍÔÓ·˜ „: ‰˘ÛÌÔÚÊÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi).

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·55

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56 ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË Î·È Û˘Ó.

Ù˘ ÂͤÏÈ͢ ÙˆÓ 17 ·ÛıÂÓÒÓ Ì ¤ÏÏÂÈÌÌ· 22q11.2.

∞fi ÙÔ˘˜ 17 ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈÌÌ·, 14 ‹Ù·Ó ·ÁfiÚÈ·

Î·È 3 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 10 ËÌÂÚÒÓ ¤ˆ˜ 5 ÂÙÒÓ

(n=11), 6-10 ÂÙÒÓ (n=2) Î·È 11-15 ÂÙÒÓ (n=4). ∏

̤ÛË ËÏÈΛ· ÙˆÓ ÁÔÓ¤ˆÓ ηٿ ÙË Á¤ÓÓËÛË ‹Ù·Ó 35

(·Ù¤Ú·˜) Î·È 26,5 (ÌËÙ¤Ú·). TÔ Ì¤ÛÔ ‚¿ÚÔ˜ Á¤ÓÓË-

Û˘ ‹Ù·Ó 2864 g ÛÙȘ 38 ‚‰ÔÌ¿‰Â˜ (3018 g Ù· ·Áfi-

ÚÈ· Î·È 2480 g Ù· ÎÔÚ›ÙÛÈ·), ÂÓÒ 4 ÁÂÓÓ‹ıËÎ·Ó ÚÈÓ

ÙËÓ 37Ë Â‚‰ÔÌ¿‰· (23,5%). ™ÙÔ ÈÛÙÔÚÈÎfi Ù˘ ÂÚÈ-

ÁÂÓÓËÙÈ΋˜/ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘, Û 4 (23%) ÂÚÈ-

ÙÒÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È Û·ÛÌÔ›/˘ÔÙÔÓ›·, Û 4(23%) ÚÔ‚Ï‹Ì·Ù· Û›ÙÈÛ˘ Û˘Óԉ¢fiÌÂÓ· Û˘¯Ó¿·fi ·ÓˆÌ·Ï›Â˜ Ù˘ ˘ÂÚÒ·˜, Û 8 (47%) ˘·Û‚Â-ÛÙÈ·ÈÌ›· Î·È Û 11 (65%) ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ ·fiÛ˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·. ™ˆÌ·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË(M™ Î·È B™ <3Ë E£) ‰È·ÈÛÙÒıËΠ۠2 ·È‰È¿ ÌÂÛÔ‚·Ú‹ ηډÈÔ¿ıÂÈ·. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍËÂÎÙÈÌ‹ıËΠ۠11/17 ·ÛıÂÓ›˜, ‰ÈfiÙÈ ÔÈ ˘fiÏÔÈÔÈ 6‹Ù·Ó ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜, ÂÂÈ-‰‹ ‰ÂÓ ÌÔÚ› Ó· ·ÔÎÏÂÈÛÙ› ÂÏ·ÊÚÈ¿ ÎÈÓËÙÈ΋ ηÈÁψÛÛÈ΋ ηı˘ÛÙ¤ÚËÛË. OÈ 6/17 ·ÚÔ˘Û›·˙·Ó „˘-¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË/Ì·ıËÛȷΤ˜ ‰˘ÛÎÔÏ›Â˜Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (35%).

¢˘ÛÌÔÚÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ ÂÌÊ¿-ÓÈ˙·Ó 14/17 ·ÛıÂÓ›˜ (82%) Î·È Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2. ¢‡Ô ·ÛıÂÓ›˜ Ì ¤Ï-ÏÂÈÌÌ· 22q11.2 Ê·›ÓÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 3, Û ËÏÈΛ·10 ËÌÂÚÒÓ (·ÛıÂÓ‹˜ ¡Ô 1, ¶›Ó·Î·˜ 1 Î·È 2) Î·È 2ÂÙÒÓ (·ÛıÂÓ‹˜ ¡Ô 12, ¶›Ó·Î·˜ 1 Î·È 2).

∆Ô Ê¿ÛÌ· ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙˆÓ 17 ·È-‰ÈÒÓ Ì DGS/VCFS ·Ú·Ù›ıÂÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ¶›Ó·Î· 2. ª›· ‹ ÂÚÈÛÛfiÙÂÚ˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿-ıÂȘ ›¯·Ó Ù· 12/17 ·È‰È¿ ÛÙ· ÔÔ›· ‰È·ÁÓÒÛÙËÎÂDGS/VCFS (70%), ÌÂ Û˘¯ÓfiÙÂÚ˜ ÙË ÌÂÛÔÎÔÈÏȷ΋ÂÈÎÔÈÓˆÓ›· (35%) Î·È ÙËÓ ÙÂÙÚ·ÏÔÁ›· Fallot (17%).ÕÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ·ÊÔÚÔ‡Û·Ó ÛÙÔ Ô˘ÚÔ-ÔÈÔÁÂÓÓËÙÈÎfi (35%), ÛÙ· ¿ÎÚ· (53%), ÛÙËÓ ˘Â-ÚÒ·/Ï¿Ú˘ÁÁ· (41%) Î·È ÛÙÔÓ ÂÁΤʷÏÔ (17%).

¢È·Ù·Ú·¯‹ ÙˆÓ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒӉȷÈÛÙÒıËΠ۠6 ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1¤ÙÔ˘˜ ηٿ ÙË ‰È¿ÁÓˆÛË, Ì ÂÏ·Ùو̤ÓÔ ÔÛÔÛÙfi ∆ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (CD4+) Î·È ·ÓÙÈÛÙ·ıÌÈÛÙÈ΋ ·‡ÍË-ÛË ÙˆÓ µ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÂÓÒ Â›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi·ÚÈıÌfi Ê˘ÛÈÎÒÓ Î˘ÙÙ·ÚÔÎÙfiÓˆÓ, Ê˘ÛÈÔÏÔÁÈΤ˜·ÓÔÛÔÛÊ·ÈÚ›Ó˜ Î·È ‹È· ÎÏÈÓÈ΋ ·ÓÔÛÔÏÔÁÈ΋ ÂÈ-ÎfiÓ·. ∂Ï·Ùو̤ÓË ÂȉÈ΋ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛˉȷÈÛÙÒıËΠÌfiÓÔ Û 2/6 ·È‰È¿ (·ÛıÂÓ›˜ ¡Ô 8Î·È 12, ¶›Ó·Î·˜ 3). ™Â 5 ·ÛıÂÓ›˜, Ë ÂÚÁ·ÛÙËÚȷ΋ÂÈÎfiÓ· ·ÔηٷÛÙ¿ıËΠ¤Ó·Ó ¯ÚfiÓÔ ÌÂÙ¿, ÂÓÒ ÛÙÔÓ·ÛıÂÓ‹ ¡Ô 12 ̄ ÚÂÈ¿ÛÙËΠ·Ú·ÙÂٷ̤ÓË ÂÓ‰ÔÓÔÛÔ-ÎÔÌÂȷ΋ ÓÔÛËÏ›· ÏfiÁˆ ÛÔ‚·ÚÒÓ ÏÔÈÌÒ͈Ó.

™˘˙‹ÙËÛË

∞fi ÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ 139 ÂÚÈÙÒÛˆÓÔ˘ ·Ú·¤ÌÊıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ·fi ÁÈ·-ÙÚÔ‡˜ ‰È·ÊfiÚˆÓ ÂȉÈÎÔÙ‹ÙˆÓ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛËÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ 22q11.2, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ‰È¿-ÁÓˆÛË ÙˆÓ DGS/VCFS ÂȂ‚·ÈÒıËΠÛÙÔ 12% ÙÔ˘Û˘ÓfiÏÔ˘. ªÂٷ͇ ÙˆÓ 56 ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜‹Ù·Ó ‰È·ı¤ÛÈÌÔ ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi Î·È ·Ó·Ï‡ıË-Î·Ó Ù· ÂÈ̤ÚÔ˘˜ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ÛÙÔȯ›·,‰È·ÈÛÙÒıËΠfiÙÈ Ë ÂÚÁ·ÛÙËÚȷ΋ ÂȂ‚·›ˆÛËÙ˘ ÎÏÈÓÈ΋˜ ‰È¿ÁÓˆÛ˘ ‰È·Ê¤ÚÂÈ Â¿Ó Á›ÓÂÈ Î·Ù¿Ù·-Í‹ ÙÔ˘˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·: DGS/VCFS

¶·È‰È·ÙÚÈ΋ 2005;68:53-60

∂∂ÈÈÎÎfifiÓÓ·· 33.. ¢‡Ô ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈÌÌ· 22q11.2. ¢È·ÎÚ›ÓÔÓÙ·È ÙÔÌÈÎÚfi ÛÙfiÌ·, Ë ÌÈÎÚÔ-ÔÈÛıÔÁÓ·ı›· Ì ÂÓÙ‡ˆÌ· Û·ÁÔÓÈÔ‡,Ù· ¯·ÌËÏ¿ Î·È ÚÔ¤¯ÔÓÙ· ·˘ÙÈ¿, Ë ‚Ú·¯˘Ï·ÈÌ›·, Ù· Ì¿ÁÔ˘Ï·ÁÂÌ¿Ù· Î·È Ë ÎÔÓÙ‹ ̇ÙË.

Paediatriki Jan-Feb 05 teliko 10-02-05 13:36 ™ÂÏ›‰·56

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57™‡Ó‰ÚÔÌ· DiGeorge/˘ÂÚˆÈÔ-ηډÈÔ-ÚÔÛˆÈÎfi

ÂȂ‚·ÈÒıËÎ·Ó Û 8/8 Ì ˘·Û‚ÂÛÙÈ·ÈÌ›· (100%),

Û 6/10 Ì ·ÓÔÛÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (60%), Û 4/7

Ì ˘ÔÙÔÓ›·/Û·ÛÌÔ‡˜ (57%), Û 2/4 Ì ˘ÂÚˆÈÔ-

Û¯ÈÛÙ›· (50%), Û 11/15 Ì ÔÏϷϤ˜ Û˘ÁÁÂÓ›˜

·ÓˆÌ·Ï›Â˜ (70%), Û 14/37 Ì ‰˘ÛÌÔÚÊÈο ¯·Ú·-

ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ (38%), Û 2/5 Ì ˘ÂÚˆÈÔ-

Ê·Ú˘ÁÁÈ΋ ·Ó¿ÚÎÂÈ· (30%), Û 6/23 Ì „˘¯ÔÎÈ-

ÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË/Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜/‰È·-

Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (26%), Û 12/47 ÌÂ Û˘ÁÁÂÓ‹

ηډÈÔ¿ıÂÈ· (25%) Î·È Û 2/8 Ì ۈ̷ÙÈ΋ ηı˘-

ÛÙ¤ÚËÛË (25%) (∂ÈÎfiÓ· 4).

∏ Û˘¯ÓfiÙËÙ· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ

·ÓˆÌ·ÏÈÒÓ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙ· DGS/VCFS ÛÂ

Û‡ÁÎÚÈÛË Ì ٷ ÛÙÔȯ›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ê·›-

ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 4 (5,12,22). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ

ηډÈÔ¿ıÂȘ (¶›Ó·Î·˜ 2), Ô ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈı-

Ìfi˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ˘ÏÈÎÔ‡ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘

Ì ¤ÏÏÂÈÌÌ· 22q11.2, ‰ÂÓ Â¤ÙÚ„ ÙËÓ ·Ó¿‰ÂÈÍË

¿ÏÏˆÓ Û·ÓÈfiÙÂÚˆÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·-

Ê›, fiˆ˜ ÌÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ÎÔÈÓfi˜ ·ÚÙË-

ÚÈ·Îfi˜ ÎÔÚÌfi˜ Î·È ‰È·ÎÂÎÔÌ̤ÓÔ ·ÔÚÙÈÎfi ÙfiÍÔ

(5,12,23). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÌfiÓÔ Û 5/17 (30%)

ÂÚÈÙÒÛÂȘ Ì ¤ÏÏÂÈÌÌ· 22q11.2 ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ

ηډÈÔ¿ıÂÈ·, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ÙË ‰ÈÂıÓ‹ ‚È-

‚ÏÈÔÁÚ·Ê›· (¶›Ó·Î·˜ 4). ÀÂÚÙÔÓ›˙ÂÙ·È Ë ÛËÌ·Û›·

Ù˘ ÚÔÛÂÎÙÈ΋˜ ηډÈÔÏÔÁÈ΋˜ ÂÎÙ›ÌËÛ˘ οı ÓÂ-

ÔÁÓÔ‡, ·ÎfiÌ· ÎÈ ·Ó ‰ÂÓ ÂÌÊ·Ó›˙ÂÈ ÙȘ ˘fiÏÔȘ

Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ DGS/VCFS.

∂›Û˘, Ë ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘

Ô˘ÚÔÁÂÓÓËÙÈÎÔ‡ (35%) ÛÙË ÌÂϤÙË (¶›Ó·Î·˜ 2)

·ÔÙÂÏ› ÈÛ¯˘Ú‹ ¤Ó‰ÂÈÍË ÒÛÙ ӷ ηıÈÂÚˆı› Ë ˘Â-

Ú˯ÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÓÂÊÚÒÓ-Ô˘ÚËÙ‹ÚˆÓ-·-

ÛÙˆ˜ Û οı ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ Ì ¤ÏÏÂÈÌÌ·

22q11.2, ÂÊfiÛÔÓ Ì¿ÏÈÛÙ· ÔÏϤ˜ ·fi ·˘Ù¤˜ ÙȘ ·Óˆ-

̷ϛ˜ ¤¯Ô˘Ó ¤Ó‰ÂÈÍË ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘.

¢È·Ù·Ú·¯¤˜ Ù˘ ˘ÂÚÒ·˜ (Û¯ÈÛÙ›·/˘ÂÚˆÈÔÊ·-

Ú˘ÁÁÈ΋ ·Ó¿ÚÎÂÈ·) ·Ú·ÙËÚ‹ıËÎ·Ó Û ÔÛÔÛÙfi

23% (¶›Ó·Î·˜ 2), ·Ó Î·È ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜

(5,12,22) ·Ó·Ê¤ÚÔ˘Ó ˘„ËÏfiÙÂÚ˜ Û˘¯ÓfiÙËÙ˜ (¶›-

ӷη˜ 4). ªÂ ‚¿ÛË ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô-

̤ӷ, Ë Û˘¯ÓfiÙËÙ· ·Ó›¯Ó¢Û˘ ÂÏÏ›ÌÌ·ÙÔ˜

22q11.2 ÌÂٷ͇ ·È‰ÈÒÓ Ì ˘ÂÚˆÈÔÛ¯ÈÛÙ›·, ¯ˆÚ›˜

fï˜ ¿ÏÏ· Û˘ÌÙÒÌ·Ù· ÙÔ˘ VCFS, ÂÎÙÈÌ¿Ù·È fiÙÈ

Â›Ó·È 1:99, ·ÚÎÂÙ¿ ¯·ÌËÏ‹ ÒÛÙ ӷ ıˆÚËı› fiÙÈ ı·

Ú¤ÂÈ Ó· ÂÊ·ÚÌÔÛÙ› Ô ¤ÏÂÁ¯Ô˜ ·˘Ùfi˜ Û fiÏ· Ù·

ÓÂÔÁ¤ÓÓËÙ· Ì ۯÈÛٛ˜ (24). ∞Ó·ÌÊ›‚ÔÏ· fï˜,

ÂÈ‚¿ÏÏÂÙ·È Ë ÎÏÈÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È-

‰ÈÒÓ ·˘ÙÒÓ Î·È Ë Âͤٷۋ ÙÔ˘˜ ·fi ÁÂÓÂÙÈÛÙ‹,

ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÎÏÂÈÛÙ› ÙÔ VCFS.

∆¤ÏÔ˜, ÔÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙÔ˘˜ Â-

ÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ ‹Ù·Ó ‹È˜, ‰ÂÓ ¯ÚÂÈ¿ÛÙËηÓ

ȉȷ›ÙÂÚË ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È ·ÚÔ˘-

Û›·Û·Ó ÛÙ·‰È·Î‹ ‚ÂÏÙ›ˆÛË ÌÂÙ¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜.

ªfiÓÔ Û ̛· ·ÛıÂÓ‹ (·ÛıÂÓ‹˜ ¡Ô 12, ¶›Ó·Î·˜ 3)

··ÈÙ‹ıËΠ·Ú·ÙÂٷ̤ÓË ıÂڷ›· Ì ÂÓ‰ÔÊϤ-

‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ Î·È ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ì¤¯ÚÈ

ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ. ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ¤Ó·˜

·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘, Ì ÌÂÛÔÎÔÈÏȷ΋

¶·È‰È·ÙÚÈ΋ 2005;68:53-60

¶¶››ÓÓ··Îη·˜̃ 22.. º¿ÛÌ· Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ˘˜ 17 ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈÌÌ· 22q11.2

11 22 33 44 55 66 77 88 99 1100 1111 1122 1133 1144 1155 1166 1177

∫·Ú‰È·ÁÁÂÈ·ÎfiªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· + + + + + +∆ÂÙÚ·ÏÔÁ›· Fallot + + +ÀÔ‚·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ + +™‡ÌÏÔÎË Î·Ú‰ÈÔ¿ıÂÈ· + +¢ÂÍÈfi ·ÔÚÙÈÎfi ÙfiÍÔ +ÀÔÏ·Û›· Ó¢ÌÔÓÈ΋˜ +∞ÓÔÈÎÙfi˜ ‚ÔÙ¿ÏÂÈÔ˜ fiÚÔ˜ +O˘ÚÔÔÈÔÁÂÓÓËÙÈÎfi¢È¿Ù·ÛË ˘ÂÏÔÎ·Ï˘ÎÈÎÔ‡ + +ªÔÓ‹Ú˘ ÓÂÊÚfi˜ +∫Ú˘„ÔÚ¯›· +ÀÔÛ·‰›·˜ +º›ÌˆÛË +ÕÎÚ·ª·ÎÚÈ¿ ‰¿ÎÙ˘Ï· + + + + +∂Ê›Â˘ÛË ‰·ÎÙ‡ÏˆÓ + +™˘Ó‰·ÎÙ˘Ï›·/·ÓÒÌ·Ï· Ó‡¯È· + +∂ÁΤʷÏÔ˜°ÏÔ›ˆÌ· ÂÁÎÂÊ¿ÏÔ˘ +ÀÔÂÂÓ‰˘Ì·ÙÈ΋ ·ÛÙË +¢È¿Ù·ÛË ÎÔÈÏÈÒÓ ÂÁÎÂÊ¿ÏÔ˘ +ÀÂÚÒ·/Ï¿Ú˘ÁÁ·˜§·Ú˘ÁÁÔ̷ϷΛ· + + +ÀÂÚˆÈÔÛ¯ÈÛÙ›· + +ÀÂÚˆÈÔÊ·Ú˘ÁÁÈ΋ ·Ó¿ÚÎÂÈ· + +

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¶·È‰È·ÙÚÈ΋ 2005;68:53-60

58 ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË Î·È Û˘Ó.

¶¶››ÓÓ··Îη·˜̃ 33.. ∞ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û 6/17 ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈÌÌ· 22q11.2 ηٿ ÙË ‰È¿ÁÓˆÛË Î·È ¤Ó·Ó ¯ÚfiÓÔ ÌÂÙ¿

∞∞ÛÛııÂÂÓÓ››˜̃ ((··//··)) ∫∫··ÙÙ¿¿ ÙÙËË ‰‰ÈÈ¿¿ÁÁÓÓˆ̂ÛÛËË** ŒŒÓÓ··ÓÓ ¯̄ÚÚfifiÓÓÔÔ ÌÌÂÂÙÙ¿¿****

11 CD3=27% IgG=837 CD3=77% IgG=343CD4=20% IgA<7 CD4=43% IgA=41CD8=15% IgM=23 CD8=28% IgM=30

CD19=34% CD19=15%CD16=17% CD16=10%

88 CD3=55% IgG=389 CD3=55% IgG=647CD4=35% IgA=19 CD4=40% IgA=23CD8=16% IgM=93 CD8=15% IgM=86

CD19=32% CD19=25%CD16=12% CD16=9%

99 CD3=34% IgG=1135 CD3=46% IgG=1057CD4=18% IgA=47 CD4=23% IgA=28CD8=16% IgM=67 CD8=18% IgM=180

CD19=50% CD19=39%CD16=11% CD16=17%

1100 CD3=32% IgG=705 CD3=55% IgG=952CD4=23% IgA=33 CD4=35% IgA=70CD8=8% IgM=59 CD8=19% IgM=68

CD19=57% CD19=31%CD16=6% CD16=18%

1122 CD3=36% IgG=503 CD3=36% IgG=882CD4=27% IgA=10 CD4=23% IgA=16CD8=12% IgM=76 CD8=12% IgM=46

CD19=44% CD19=40%CD16=17% CD16=24%

1133 CD3=23% IgG=710 CD3=70% IgG=757CD4=14% IgA=29 CD4=54% IgA=73CD8=9% IgM=52 CD8=12% IgM=41

CD19=60% CD19=26%CD16=14% CD16=4%

* ™‡Ìʈӷ Ì ÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ ∞ÓÔÛÔÏÔÁ›·˜, ·ıÔÏÔÁÈΤ˜ ıˆڋıËÎ·Ó ÔÈ ÙÈ̤˜ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ ÙÈÌÒÓ ·Ó·ÊÔÚ¿˜ ÁÈ· ÙËÓ ËÏÈ-Λ· ÙÔ˘ ·ÛıÂÓÔ‡˜

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∂∂ÈÈÎÎfifiÓÓ·· 44.. ∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ÛÙÔȯ›· ÙˆÓ 56 ·ÛıÂÓÒÓ Ì ·ÚΤ˜ ÈÛÙÔÚÈÎfi Ô˘ ·Ú·¤ÌÊıËÎ·Ó ÁÈ· ¤ÏÂÁ¯Ô ÂÏÏ›ÌÌ·ÙÔ˜22q11.2 (Ì·‡Ú˜ ÛًϘ) Î·È ÙˆÓ 17 ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂȂ‚·ÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË DGS/VCFS (¿ÛÚ˜ ÛًϘ).

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59™‡Ó‰ÚÔÌ· DiGeorge/˘ÂÚˆÈÔ-ηډÈÔ-ÚÔÛˆÈÎfi

ÂÈÎÔÈÓˆÓ›· Î·È ‰È¿ÁÓˆÛË ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ 22q11.2Û ËÏÈΛ· 11 ÂÙÒÓ (·ÛıÂÓ‹˜ ¡Ô 5, ¶›Ó·Î˜ 1 Î·È 2),‰ÂÓ ÂÌÊ¿ÓÈ˙ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙË ‚ÚÂÊÈ-΋ ËÏÈΛ·, ·ÏÏ¿ ·Ó¤Ù˘Í ϤÌʈ̷ Û ËÏÈΛ· 15ÂÙÒÓ Î·È Î·Ù¤ÏËÍ ÌÂÙ¿ ‰ÈÂÙ›· ·fi ÓfiÛÔ ÌÔۯ‡-Ì·ÙÔ˜ ηٿ ÍÂÓÈÛÙ‹. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ¤¯ÂÈ ÂÚÈÁÚ·Ê› ·Ó¿ÏÔÁË ÂÚ›ÙˆÛË DGS Ì ·ÈÌ·-ÙÔÏÔÁÈ΋ ηÎÔ‹ıÂÈ·.

∆· ΢ÚÈfiÙÂÚ· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈ-ÛÙÈο Ô˘ ÎÈÓËÙÔÔÈÔ‡Ó ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi Ó· ·-Ú·¤Ì„ÂÈ ·ÛıÂÓ›˜ Ì Èı·Ó‹ ‰È¿ÁÓˆÛËDGS/VCFS ÁÈ· ÁÂÓÂÙÈ΋ ‰ÈÂÚ‡ÓËÛË Ì ¤ÏÂÁ¯Ô ÙÔ˘ÂÏÏ›ÌÌ·ÙÔ˜ 22q11.2, Â›Ó·È - ηٿ ÛÂÈÚ¿ Û˘¯ÓfiÙË-Ù·˜ - ÔÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Ù· ‰˘ÛÌÔÚÊÈο¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘, ÔÈ ‰È·Ù·Ú·¯¤˜ Ì¿ıË-Û˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜, ÔÈ ÔÏϷϤ˜ Û˘ÁÁÂÓ›˜·ÓˆÌ·Ï›Â˜, ÔÈ ·ÓÔÛÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ˘·Û‚Â-ÛÙÈ·ÈÌ›·, Ë ÛˆÌ·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË, Ë ˘ÔÙÔÓ›·/Û·ÛÌÔ›, Ë ˘ÂÚˆÈÔÊ·Ú˘ÁÁÈ΋ ·Ó¿ÚÎÂÈ· Î·È Ë˘ÂÚˆÈÔÛ¯ÈÛÙ›· (∂ÈÎfiÓ· 4). ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈfiÙ·Ó Â·ÓÂÎÙÈÌ‹ıËÎ·Ó ·fi ÎÏÈÓÈÎfi ÁÂÓÂÙÈÛÙ‹ 39·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·ÔÎÏ›ÛÙËÎÂ Ë ‰È¿ÁÓˆÛËDGS/VCFS, ÔÈ 14 ηٷٿ¯ıËÎ·Ó Û ‰È·ÊÔÚÂÙÈοÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ·.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËÎ·Ó ÙÚÂȘ ÔÈÎÔÁ¤-ÓÂȘ Ì ÎÏËÚÔÓÔÌÈÎfi DGS/VCFS. ∏ Ì›· ÌËÙ¤Ú·-ÊÔÚ¤·˜ ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜ ·ÚÔ˘Û›·˙ ÂÏ·ÊÚ¿ ÓÔË-ÙÈ΋ ˘ÛÙ¤ÚËÛË, ÂÓÒ ÛÙȘ ‰‡Ô ¿ÏϘ ÔÈÎÔÁ¤ÓÂȘ,fiÔ˘ ÊÔÚ¤·˜ ‹Ù·Ó Ô ·Ù¤Ú·˜, ‰È·ÈÛÙÒıËηÓȉÈfiÌÔÚÊ· ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛÒÔ˘ ·ÚfiÌÔÈ·Ì ÙÔ˘ ·È‰ÈÔ‡. ∂›Ó·È Èı·Ófi fiÙÈ Ô ÁÔÓ¤·˜ Ì ÙÔ ¤Ï-ÏÂÈÌÌ· ·ÚÈÛÙ¿ ÙÔ ÂÏ·ÊÚÈ¿˜ ‚·Ú‡ÙËÙ·˜ ¿ÎÚÔ ÙÔ˘Â˘Ú¤Ô˜ ÎÏÈÓÈÎÔ‡ Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÁÈ’ ·˘-Ùfi ¿ÏψÛÙ ÙÂÎÓÔÔÈ›. ™ÙÔ˘˜ 2/3 ·ÛıÂÓ›˜, ÙÔ ¤Ï-ÏÂÈÌÌ· ‹Ù·Ó ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘, ‡ÚËÌ· Û˘Ì-‚·Ùfi Ì ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (5). ¶Ú¤ÂÈ Ó· ÛË-ÌÂȈı› fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ÂÏ-ÏÂÈÌÌ¿ÙˆÓ 22q11.2 ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó18%, ÂÓÒ Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ‰ÂÓ ˘ÂÚ‚·›-ÓÂÈ ÙÔ 10% (23,24). ™Â Ì›· ÌÂÁ¿ÏË Â˘Úˆ·˚΋ Û˘-ÓÂÚÁ·ÙÈ΋ ÌÂϤÙË, fiÔ˘ ‰È·ÈÛÙÒıËÎ·Ó ÎÏËÚÔÓÔ-ÌÈο ÌÈÎÚÔÂÏÏ›ÌÌ·Ù· Û ·ÚÎÂÙ¿ ˘„ËÏfiÙÂÚÔ Ô-ÛÔÛÙfi (28%) (3), Èı·ÓÒ˜ ¤ÁÈÓ ÂÈÏÂÎÙÈÎfiÙÂÚˉȷÏÔÁ‹ ÁÈ· ¤ÏÂÁ¯Ô, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÁÔÓ›˜, ÌÂ

‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ÂÈÎfiÓ·. ∂ÓÙÔ‡ÙÔȘ, ıˆÚ›-Ù·È ÂȂ‚ÏË̤ÓÔ Û οı ÂÚ›ÙˆÛË ‰È¿ÁÓˆÛ˘·È‰ÈÔ‡ Ì DGS/VCFS Ó· ÂϤÁ¯ÔÓÙ·È Î·È ÔÈ ‰‡ÔÁÔÓ›˜, ·ÎfiÌË Î·È Â¿Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó Û ·˘ÙÔ‡˜ ‹Û ·‰¤ÏÊÈ· ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÂÌÊ·Ó›˜ Ê·ÈÓÔÙ˘ÈΤ˜ÂΉËÏÒÛÂȘ ‹ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔ-ÚÈÎfi ηډÈÔ·ıÂÈÒÓ. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ·‰ÂÏÊÒÓ ÂÓ-‰Â›ÎÓ˘Ù·È ÌfiÓÔ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·fi ÙÔÓ¤ÏÂÁ¯Ô ÙˆÓ ÁÔÓ¤ˆÓ ‰È·ÈÛÙˆı› fiÙÈ ÚfiÎÂÈÙ·È ÁÈ·ÎÏËÚÔÓÔÌÈÎfi ¤ÏÏÂÈÌÌ·.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ô Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ Ì ηڢfi-Ù˘Ô Î·È FISH ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ú·Ï›ÂÙ·È ÛÂη̛· ÔÈÎÔÁ¤ÓÂÈ·, ÚÔÎÂÈ̤ÓÔ˘ fi¯È ÌfiÓÔ Ó· ÂÓÙÔ›-˙ÂÙ·È Ô ÁÔÓ¤·˜ ‹ Ù· ·‰¤ÏÊÈ· Ì ÙÔ ¤ÏÏÂÈÌÌ· 22q11.2,ÒÛÙ ӷ ·Ú·¤ÌÂÙ·È ÁÈ· ηډÈÔÏÔÁÈ΋ ÂͤٷÛË,·ÏÏ¿ Î·È Ó· ·Ú¤¯ÂÙ·È ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋ÚÈÓ ÙËÓ ÂfiÌÂÓË Î‡ËÛË. ™ÙȘ ÔÈÎÔÁ¤ÓÂȘ Ì ÎÏË-ÚÔÓÔÌÈÎfi ¤ÏÏÂÈÌÌ· Û˘ÓÈÛÙ¿Ù·È ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ-¯Ô˜, ·ÓÂÍ·Úًو˜ Ù˘ ‚·Ú‡ÙËÙ·˜ ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ÛÙÔÓ ÁÔÓ¤· ‹ ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ ¿Û¯ÔÓ ·È‰›.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Wilson DI, Burn J, Scambler P, Goodship J. DiGeorge syn-drome: part of CATCH 22. J Med Genet 1993;30:852-856.

2. Scambler PJ. The 22q11 deletion syndromes. Hum MolGenet 2000;9:2421-2426.

3. Shpritzen RJ. Velo-cardio-facial syndrome. In: Cassidy SB,Allanson JE, editors. Management of genetic syndromes.New York: Wiley-Liss; 2001. p. 495-516.

4. McKusick VA. Mendelian inheritance in man. A catalogue ofhuman genes and genetic disorders, OMIM, # 188400: DiGe-orge syndrome, # 192430, Velocardiofacial syndrome. 12thed. Baltimore: The Johns Hopkins University Press; 1998(http://www.nlm.nih.gov/omim/).

5. Ryan AK, Goodship JA, Wilson DI, Philip N, Levy A, SeidelH et al. Spectrum of clinical features associated with intersti-tial chromosome 22q11 deletions: a European collaborativestudy. J Med Genet 1997;34:798-804.

6. Vantrappen G, Devriendt K, Swillen A, Rommel N, Vogels A,Eyskens B et al. Presenting symptoms and clinical features in130 patients with the velo-cardio-facial syndrome. The Leuvenexperience. Genet Couns 1999;10:3-9.

7. Berend SA, Spikes AS, Kashork CD, Wu JM, Daw SC, Scam-bler PJ et al. Dual-probe fluorescence in situ hybridizationassay for detecting deletions associated with VCFS/DiGeorgesyndrome I and DiGeorge syndrome II loci. Am J Med Genet2000;91:313-317.

¶·È‰È·ÙÚÈ΋ 2005;68:53-60

¶¶››ÓÓ··Îη·˜̃ 44.. ™˘¯ÓfiÙËÙ· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙ· DGS/VCFS

ºº··ÈÈÓÓÔÔÙÙ˘̆ÈÈÎΤ¤˜̃ GGoollddbbeerrgg eett aall,, 11999933 ((1122)) LLeeaannaa--CCooxx eett aall,, 11999966 ((2222)) RRyyaann eett aall,, 11999977 ((55)) ¶¶··ÚÚÔÔ‡‡ÛÛ·· ÌÌÂÂÏϤ¤ÙÙËË ··ÓÓˆ̂ÌÌ··ÏÏ››Â˜̃ ((nn==99)) ((nn==1122)) ((nn==228855)) ((nn==1177))

π‰ÈfiÌÔÚÊÔ ÚÔÛˆÂ›Ô 93% 82%∫·Ú‰ÈÔ¿ıÂÈ· 77% 68% 75% 70%∞Ï·Û›· ı‡ÌÔ˘/·ÓÔÛÔ·Ó¿ÚÎÂÈ· 64% 47%¢È·Ù·Ú·¯¤˜ ·Ú·ı˘ÚÂÔÂȉÒÓ,˘·Û‚ÂÛÙÈ·ÈÌ›· 12%, 20% 63% 60% 47%™¯ÈÛÙ›·, ˘ÂÚˆÈÔÊ·Ú˘ÁÁÈ΋ ·Ó¿ÚÎÂÈ· 100% 48% 9%, 32% 23,5%∞ӈ̷ϛ˜ Ô˘ÚÔÁÂÓÓËÙÈÎÔ‡ 36% 35%

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¶·È‰È·ÙÚÈ΋ 2005;68:53-60

8. Lipson A, Emanuel B, Colley P, Fagan K, Driscoll DA.“CATCH 22” sans cardiac anomaly, thymic hypoplasia, cleftpalate, and hypocalcaemia: cAtch 22. A common result of22q11 deficiency? J Med Genet 1994;31:741.

9. Scire G, Dallapiccola B, Iannetti P, Bonaiuto F, Galasso C,Mingarelli R et al. Hypoparathyroidism as the major mani-festation in two patients with 22q11 deletions. Am J MedGenet 1994;52:478-482.

10. Greig F, Paul E, DiMartino-Nardi J, Saenger P. Transientcongenital hypoparathyroidism: resolution and recurrence inchromosome 22q11 deletion. J Pediatr 1996;128:563-567.

11. Clouthier DE, Williams SC, Yanagisawa H, Wieduwilt M,Richardson JA, Yanagisawa M. Signaling pathways crucial forcraniofacial development revealed by endothelin-A receptor-deficient mice. Dev Biol 2000;217:10-24.

12. Goldberg R, Motzkin B, Marion R, Scambler PJ, ShprintzenRJ. Velo-cardio-facial syndrome: a review of 120 patients.Am J Med Genet 1993;45:313-319.

13. Lammer EJ, Opitz JM. The DiGeorge anomaly as a develop-mental field defect. Am J Med Genet 1986;2 (Suppl):S113-S127.

14. Van Mierop LH, Kutsche LM. Cardiovascular anomalies inDiGeorge syndrome and importance of neural crest as a pos-sible pathogenetic factor. Am J Cardiol 1986;58:133-137.

15. Lindsay EA, Halford S, Wadey R, Scambler PJ, Baldini A.Molecular cytogenetic characterization of the DiGeorge syn-drome region using fluorescence in situ hybridization. Ge-nomics 1993;17:403-407.

16. Levy A, Demczuk S, Aurias A, Depetris D, Mattei MG, PhilipN. Interstitial 22q11 microdeletion excluding the ADUbreakpoint in a patient with DiGeorge syndrome. Hum MolGenet 1995;4:2417-2419.

17. Rizzu P, Lindsay EA, Taylor C, O’Donnell H, Levy A, Scam-bler P et al. Cloning and comparative mapping of a genefrom the commonly deleted region of DiGeorge and Velo-cardiofacial syndromes conserved in C. elegans. MammGenome 1996;7:639-643.

18. Gottlieb S, Emanuel BS, Driscoll DA, Sellinger B, Wang Z,Roe B et al. The DiGeorge syndrome minimal critical regioncontains a goosecoid-like (GSCL) homeobox gene that is ex-pressed early in human development. Am J Hum Genet1997;60:1194-1201.

19. Kasprzak L, Der Kaloustian VM, Elliott AM, Shevell M, Le-jtenyi C, Eydoux P. Deletion of 22q11 in two brothers with dif-ferent phenotype. Am J Med Genet 1998;75:288-291.

20. Carlson C, Papolos D, Pandita RK, Faedda GL, Veit S, Gold-berg R et al. Molecular analysis of velo-cardio-facial syn-drome patients with psychiatric disorders. Am J Hum Genet1997;60:851-859.

21. Kimber WL, Hsieh P, Hirotsune S, Yuva-Paylor L, Suther-land HF, Chen A et al. Deletion of 150 kb in the minimalDiGeorge/velocardiofacial syndrome critical region inmouse. Hum Mol Genet 1999;8:2229-2237.

22. Leana-Cox J, Pangkanon S, Eanet KR, Curtin MS, Wulfs-berg EA. Familial DiGeorge/ velocardiofacial syndromewith deletions of chromosome 22q11.2: report of five fami-lies with a review of the literature. Am J Med Genet1996;65:309-316.

23. Sullivan KE. DiGeorge syndrome/chromosome 22q11.2 dele-tion syndrome. Curr Allergy Asthma Rep 2001;1:438-444.

24. Swillen A, Vogels A, Devriendt K, Fryns JP. Chromosome22q11 deletion syndrome: update and review of the clinicalfeatures, cognitive-behavioral spectrum, and psychiatriccomplications. Am J Med Genet 2000;97:128-135.

60 ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË Î·È Û˘Ó.

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61ORIGINAL ARTICLE

Genetic and clinical-laboratory investigation

of patients with DiGeorge/velo-cardio-facial

syndromes

S. Kitsiou - Tzeli1, A. Kolialexi1, H. Fryssira1, A. Gala - Voumvouraki2, C. Salavoura3, ª. Kanariou3,

E. Kanavakis1, A. Mavrou1

Abstract

Background/Methods: The aim of the present study was the detection of genetic deletion within q11.2region of chromosome 22 which is pathognomonic of DiGeorge/velo-cardio-facial syndromes (VCFS), usingkaryotypic and fluorescent in situ hybridization (FISH) analysis, and the analysis of clinical-laboratoryspectrum of the patients studied.

Results: A deletion was found in 17/139 patients (14 males/3 females), aged 10 days-17 years. In 3 cases thedeletion was inherited (2 maternal and 1 paternal origin). Cytogenetic analysis revealed an abnormalkaryotype in 2/139 cases (Klinefelter syndrome 47,XXY and 46,XX,2p+), which most likely did not contributeto the DGS/VCFS phenotype. Patients with 22q11.2 deletion exhibited facial dysmorphic features (82%),congenital heart defects (70%), immunological problems (47%), multiple congenital anomalies (64%),hypocalcemia (47%), mental retardation/behavioral problems/learning difficulties (35%), skeletalabnormalities (23%), cleft palate/velopharyngeal insufficiency (23%), seizures/hypotonia (23%) and growthretardation (12%). The clinical genetic reevaluation of 39/139 patients without 22q11.2 deletion contributedto the classification of 14 (37%) under different genetic syndromes.

Conclusions: The present study emphasizes the importance of FISH technique to detect 22q11.2 deletion andthe need of thorough clinical and laboratory investigation in patients referred for DG/VCFS.

Key words

DGS/VCFS, FISH, 22q11.2 deletion, clinical spectrum.

1 Medical GeneticsLaboratory, University ofAthens, ChoremioResearch Laboratory,“Aghia Sophia” Children’sHospital, Athens

2 Cytogenetics Laboratory,2nd Paediatric Clinic of theUniversity of Athens, “P. & A. Kyriakou”Children’s Hospital, Athens

3 Immunology andHistocompatibilityLaboratory, “AghiaSophia” Children’sHospital, Athens

Correspondence:

Sophia Kitsiou-Tzeli Medical Genetics Laboratory,University of Athens,Choremio ResearchLaboratory, “Aghia Sophia”Children’s Hospital115 27, ∞thensE-mail: [email protected]

Date of submission: 30-04-2004 Date of approval: 28-09-2004

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62 ∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2 ªÔÓ¿‰· ∞ÈÌÔÚÚ·ÁÈÎÒӢȷı¤ÛˆÓ, ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ “∞Á›· ™ÔÊ›·”,∞ı‹Ó·

3 ∞ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋,¡ÔÛÔÎÔÌÂ›Ô “∂Ú˘ıÚfi˜ ™Ù·˘Úfi˜” ∞ı‹Ó·

4 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

ª·Ú›· µÚ¿ÓÔ˘ ∫ÏÂÈÛfi‚˘ 20, ∆.∫. 185 39, ¶ÂÈÚ·È¿˜

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-01-2004∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 19-04-2004

¶·È‰È·ÙÚÈ΋ 2005;68:62-67

∂Ó Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË Ì ÔÏÏ·Ï‹

ÂÓÙfiÈÛË Û ¤ÊË‚Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

ª. µÚ¿ÓÔ˘1, °. ∞Ó·ÛÙ·ÛÈ¿‰Ë˜1, °. ¶·Ó·ÁȈٷÎfiÔ˘ÏÔ˜1, ∂. ¶ÂÚÁ¿ÓÙÔ˘2, ∂. ¶Ï·ÙÔÎÔ‡ÎË2, ¡. ª¤ÛÈ·˜3,

ª. µ·Î¿ÎË4, ∫. ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡1

¶ÂÚ›ÏË„Ë

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¤Ê˂˘, ËÏÈΛ·˜ 12,5 ÂÙÒÓ, Ì ÂÓ Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË Û ÔÏϷϤ˜ı¤ÛÂȘ. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÂÓÙfiÈÛË ·ÊÔÚÔ‡Û ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË Î·È ÛÙȘ ÌËÚÈ·›Â˜ ÊϤ‚˜. H ·ÛıÂÓ‹˜ ·-ÚÔ˘Û›·Û ¯ˆÏfiÙËÙ·, ¿ÏÁÔ˜ Î·È Ô›‰ËÌ· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ηْ ÈÛ¯›ÔÓ ¿ÚıÚˆÛË˜Î·È ÈÁÓ˘·Î‹˜ ¯ÒÚ·˜, Ï›Á˜ Ë̤Ú˜ ÌÂÙ¿ ·fi ·Ó·ÊÂÚfiÌÂÓÔ ÙÚ·˘Ì·ÙÈÛÌfi ηٿ ÙË ‰È¿ÚÎÂÈ· ۈ̷ÙÈ΋˜ ¿ÛÎË-Û˘. ∏ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË ÂȂ‚·ÈÒıËΠ·Ú¯Èο Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (U/S Doppler) ÊÏ‚ÒÓ Î¿Ùˆ ¿ÎÚˆÓ

Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (C/T) ÎÔÈÏ›·˜. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÁÈ· ÚÔıÚÔÌ‚ˆÙÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ÂÙÂÚÔ˙˘ÁÒÙ˘ Ù˘ ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ ÁÔÓȉ›Ô˘ FVLeiden, ηıÒ˜ Î·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ˆ˜ ÚÔ˜ ÙË ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ MTHFR. ∏ ıÚÔÌ‚ÔÏ˘ÙÈ΋ Î·È ·ÓÙÈ-ËÎÙÈ΋ ·ÁˆÁ‹ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÚÈ΋ χÛË ÙÔ˘ ıÚfiÌ‚Ô˘ Î·È ÙËÓ Â·Ó·ÛËÚ·ÁÁÔÔ›ËÛË ÙˆÓ ·Ô-ÊÚ·ÁÌ¤ÓˆÓ ÌËÚÈ·›ˆÓ ÊÏ‚ÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ

ºÏ‚È΋ ıÚfiÌ‚ˆÛË, ·È‰È΋ ËÏÈΛ·, ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜.

™˘ÓÙÔÌÔÁڷʛ˜

º£ ºÏ‚È΋ ıÚfiÌ‚ˆÛË INR International normalizing ratio MTHFR Methylenetetrahydrofolate reductase PS ¶ÚˆÙ½ÓË S PC ¶ÚˆÙ½ÓË C FV Leiden ¶·Ú¿ÁˆÓ V Leiden ™∂§ ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ C/T ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· U/S ÀÂÚ˯ÔÁÚ¿ÊËÌ· ¶∂ ¶Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ LMWH ÷ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË

∂ÈÛ·ÁˆÁ‹

∏ ÂÓ Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË (º£) ›ӷÈÛ¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ȉȷ›ÙÂÚ· fiÙ·Ó ËÂÓÙfiÈÛ‹ Ù˘ Â›Ó·È ÔÏÏ·Ï‹. ¶·Ú·Ì¤ÓÂÈ, fï˜,˘·ÚÎÙfi˜ o ΛӉ˘ÓÔ˜, ÙÔÓ ÔÔ›Ô Ô È·ÙÚfi˜ ‰ÂÓ ı·Ú¤ÂÈ Ó· ·ÁÓÔ‹ÛÂÈ. ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ıÚfiÌ-‚ˆÛ˘ Â›Ó·È ¿ÁÓˆÛÙË ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹-‚Ô˘˜. º·›ÓÂÙ·È, ¿ÓÙˆ˜, fiÙÈ ·ÔÙÂÏ› ÔÏ˘·Ú·-ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 12,5 ÂÙÒÓ, ·¯‡Û·ÚÎÔ Ì ‰Â›-ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (µMI) 34, Ì ÂχıÂÚÔ ·ÙÔÌÈÎfiÈÛÙÔÚÈÎfi, ÚÔÛ‹Ïı ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ ¡Ô-ÛÔÎÔÌ›Ԣ Ì ¯ˆÏfiÙËÙ·, ¿ÏÁÔ˜ Î·È Ô›‰ËÌ· Ì·Ï·-

ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ηْ

ÈÛ¯›ÔÓ ¿ÚıÚˆÛ˘ Î·È ÈÁÓ˘·Î‹˜ ¯ÒÚ·˜. ∆· Û˘ÌÙÒ-

Ì·Ù· ÂÌÊ·Ó›ÛÙËÎ·Ó 10 Ë̤Ú˜ ÌÂÙ¿ ·fi ÙÚ·˘Ì·ÙÈ-

ÛÌfi ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÚÔÛ·ÁˆÁÔ‡

Ì˘fi˜, ηٿ ÙË ‰È¿ÚÎÂÈ· ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘.

∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎÂ

˘ÚÂÙfi˜, ÂÓÒ Ë ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÔÈ ÛʇÍÂȘ

‹Ù·Ó ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·. À‹Ú¯Â ÛÙ·ıÂÚ‹

‰È·ÊÔÚ¿ 2 cm ÌÂٷ͇ Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙˆÓ ÌËÚÒÓ,

ÂÓÒ ·Ú¿ÏÏËÏ· ÙÔ ¿ÎÚÔ ÂÌÊ¿ÓÈ˙Â ıÂÚÌfiÙËÙ·, ¿Ï-

ÁÔ˜ Î·È ‰ÈfiÁΈÛË Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÈÛ¯›-

Ô˘. ∞Ú¯Èο, ·ÓÙÈÌÂÙˆ›ÛÙËΠÛÙËÓ OÚıԷȉÈ΋

∫ÏÈÓÈ΋ ˆ˜ ˘ÌÂÓ›Ùȉ·, ·Ú·Ì¤ÓÔÓÙ·˜ ÎÏÈÓ‹Ú˘ ηÈ

Û ·ÎÈÓËÙÔÔ›ËÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ÁÈ· 4 Ë̤Ú˜.

ªÂÙ¿ ·fi ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô, ‰È·ÈÛÙÒıËÎÂ

Ë ·ÚÔ˘Û›· ıÚfiÌ‚Ô˘ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÌËÚÈ·›· ÊϤ-

‚·, ÂÓÒ Ù· D-‰ÈÌÂÚ‹ (D-dimers) ‹Ù·Ó 8 Ìg/dl (º.∆.

<0,5 Ìg/dl), ÁÂÁÔÓfi˜ Û˘Ì‚·Ùfi Ì ÙË ıÚfiÌ‚ˆÛË. ∫·-

ÙfiÈÓ ÙÔ‡ÙÔ˘, ÍÂΛÓËÛ ˷ÚÈÓÔıÂڷ›· Ì ¯·ÌË-

ÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË (LMWH).

§›Á˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜, Ë ·ÛıÂ-

Ó‹˜ ÂÌÊ¿ÓÈÛ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ‡ÔÙË ÁÈ·

Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ (¶∂) (·ÈÊÓ›‰ÈÔ ÔÈÛıÔÛÙÂÚÓÈÎfi

¿ÏÁÔ˜, ‰‡ÛÓÔÈ·, Ù¿ÛË ÁÈ· ÏÈÔı˘Ì›·, ¤ÓÙÔÓË ÂÊ›-

‰ÚˆÛË). O ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓ ·Ì¤Ûˆ˜ ÚÔ˜ ÂÈ‚Â-

‚·›ˆÛË Èı·Ó‹˜ ¶∂, ÂÚÈÂÏ¿Ì‚·Ó ËÏÂÎÙÚÔηډÈÔ-

ÁÚ¿ÊËÌ· (∏∫°) (SI QII TIII), ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·-

ÎÔ˜ (ηٿ ʇÛË), ·¤ÚÈ· ·›Ì·ÙÔ˜ (·Ó·Ó¢ÛÙÈ΋ ·Ï-

οψÛË). ∂ÈÛ‹¯ıË ÛÙË ª∂£, fiÔ˘ ¤ÁÈÓ ıÚÔÌ‚fiÏ˘-

ÛË (r-tPA Û ·Ú¯È΋ ‰fiÛË 0,5 mg/kg iv Î·È ÌÂÙ¿ 0,1

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63∂Ó Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË

¶·È‰È·ÙÚÈ΋ 2005;68:62-67

mg/kg/h) ÁÈ· ‰‡Ô ÒÚ˜ (D-dimers: 32 Ìg/ml) ηÈ, ÛÙËÛ˘Ó¤¯ÂÈ·, Ë·ÚÈÓÔıÂڷ›· (sodium heparin Û ‰fi-ÛË 100 U/kg/4 h) Û ÛÙ¿Á‰ËÓ ¤Á¯˘ÛË.

∂ÓÓÈ¿ Ë̤Ú˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘ÌÙˆ-Ì¿ÙˆÓ Ù˘ Èı·Ó‹˜ ¶∂ Î·È ÂÓÒ Ë ·ÛıÂÓ‹˜ ›¯Â ‹‰ËÌÂÙ·ÊÂÚı› Û ·È‰È·ÙÚÈÎfi ÙÌ‹Ì· Î·È ‚ÚÈÛÎfiÙ·Ó˘fi ÎÏÈÓÔÛÙ·ÙÈÛÌfi Î·È ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ (‚·Ú-Ê·Ú›ÓË), ¤ÁÈÓ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÈÌ¿ÙˆÛ˘ Ó¢-ÌfiÓˆÓ Ì ∆c99m MAA, ÛÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËÎÂÂÏ·ÊÚÒ˜ ÌÂȈ̤ÓË ‰È¿¯˘ÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ÛÙË ‚¿ÛË ÙÔ˘ ‰ÂÍÈÔ‡ Ó‡ÌÔÓ·. ™ÈÓıËÚÔÁÚ¿ÊËÌ··¤ÚˆÛ˘ Ó¢ÌfiÓˆÓ ‰ÂÓ ¤ÁÈÓÂ, ÏfiÁˆ Ù˘ ÂÈÎÈÓ‰˘-ÓfiÙËÙ·˜ Ù˘ ÂͤٷÛ˘ (·˘ÍË̤ÓË ÎÈÓËÙÔÔ›ËÛË).

¢‡Ô ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi, Ë ·ÛıÂ-Ó‹˜ ·ÚÔ˘Û›·Û ¿ÏÁÔ˜ Î·È ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‰ÂÍÈÔ‡ÚÔÛ·ÁˆÁÔ‡. ™ÙÔ U/S Doppler Ô˘ ·ÎÔÏÔ‡ıËÛÂ,‰ÂÓ ·ÂÈÎÔÓÈ˙fiÙ·Ó ÚÔ‹ ÙfiÛÔ ÛÙËÓ ·ÚÈÛÙÂÚ‹ fiÛÔ Î·ÈÛÙË ‰ÂÍÈ¿ ¤Íˆ Ï·ÁfiÓÈÔ ÊϤ‚·, ÛÙȘ ÎÔÈÓ¤˜ ÌËÚÈ·›Â˜ÊϤ‚˜ ¿Ìʈ, ηıÒ˜ Î·È ÛÙÔ Î·ÙÒÙÂÚÔ ÙÌ‹Ì· Ù˘οو ÎÔ›Ï˘ ÊϤ‚·˜ Î·È Û ‡„Ô˜ 6,5 cm ÂÚ›Ô˘¿Óˆ ·fi ÙÔÓ ‰È¯·ÛÌfi Ù˘. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·(C/T) ÎÔÈÏ›·˜ ·ÔÎ¿Ï˘„ ıÚfiÌ‚ˆÛË Î¿Ùˆ ÎÔ›Ï˘ÊϤ‚·˜ (∂ÈÎfiÓ· 1). ∏ ¤ÎÙ·ÛË ÙÔ˘ ıÚfiÌ‚Ô˘, ·Ú¿ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÛıÂÓ‹˜ ‚ÚÈÛÎfiÙ·Ó ˘fi ·ÓÙÈËÎÙÈ-΋ ·ÁˆÁ‹, ‹Ù·Ó Ë ·ÊÔÚÌ‹ ÁÈ· ‰Â‡ÙÂÚË ÂÈÛ·ÁˆÁ‹ÛÙË ª∂£, fiÔ˘ - ·Ú¿ÏÏËÏ· Ì ÙËÓ Ë·ÚÈÓÔıÂÚ·-›· - ¤ÁÈÓ ÂÎ Ó¤Ô˘ ıÚÔÌ‚fiÏ˘ÛË ÁÈ· 6 ÒÚ˜, ¯ˆÚ›˜Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÈÏÔ΋ (·ÈÌÔÚÚ·Á›·).

∂›ÎÔÛÈ Ë̤Ú˜ ÌÂÙ¿ ÙÔ Û˘Ì‚¿Ó Î·È ÂÓÒ Ë ·ÛıÂ-Ó‹˜ ÓÔÛËÏ¢fiÙ·Ó Û ·È‰È·ÙÚÈÎfi ÙÌ‹Ì· ˘fi ·ÓÙÈ-ËÎÙÈ΋ ·ÁˆÁ‹ Î·È ·ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›· ÏfiÁˆ·Ú·ÙÂÈÓfiÌÂÓÔ˘ Â̇ÚÂÙÔ˘ (ÏfiÁˆ Ù˘ ıÚfiÌ‚ˆ-Û˘), ÙÔ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ U/S Doppler ¤‰ÂÈÍÂıÚfiÌ‚ˆÛË Î¿Ùˆ ÎÔ›Ï˘, Ï·ÁÔÓ›ˆÓ Î·È ÎÔÈÓÒÓ ÌËÚÈ-·›ˆÓ Ì ÌÂÚÈ΋ ·ӷÛËÚ·ÁÁÔÔ›ËÛË Ù˘ ·ÚÈÛÙÂ-Ú‹˜ Ì›˙ÔÓÔ˜ Û·ÊËÓÔ‡˜ Î·È ÌÈÎÚ‹ ·ӷÛËÚ·ÁÁÔ-Ô›ËÛË Ù˘ ‰ÂÍÈ¿˜ Ì›˙ÔÓÔ˜ Û·ÊËÓÔ‡˜ ÊϤ‚·˜. ∆·›‰È· Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒıËÎ·Ó Û ‰Â‡ÙÂÚË C/TÎÔÈÏ›·˜ (∂ÈÎfiÓ˜ 2 Î·È 3), fiÔ˘ ‹Ù·Ó ÂÌÊ·Ó‹˜ Ë ‰È-‡ڢÓÛË ÙˆÓ ÎÔÈÓÒÓ Ï·ÁfiÓÈˆÓ ÊÏ‚ÒÓ (ȉ›ˆ˜ ‰Â-

ÍÈ¿), ηıÒ˜ Î·È ÙˆÓ ÌËÚÈ·›ˆÓ ÊÏ‚ÒÓ Û fiÏÔ ÙÔÌ‹ÎÔ˜ ÙÔ˘˜ (∂ÈÎfiÓ˜ 4 Î·È 5).

∂Ó¿ÌÈÛË Ì‹Ó· ÌÂÙ¿ ÙÔ Û˘Ì‚¿Ó, Ë C/T ÎÔÈÏ›·˜ -Ì ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ - ¤‰ÂÈÍ ÂÏ¿ÙÙˆÛË ÙԢ‡ÚÔ˘˜ Ù˘ οو ÎÔ›Ï˘ Î·È ÙˆÓ ÂÈÔÏ‹˜ Ï·ÁÔ-Ó›ˆÓ ÊÏ‚ÒÓ, ÌÂ Â˘Ú‹Ì·Ù· ÌÂÚÈ΋˜ ·ӷÛËÚ·Á-ÁÔÔ›ËÛ˘ Î·È ·Ó¿Ù˘ÍË ·Ú¿Ï¢Ú˘ ΢ÎÏÔÊÔ-Ú›·˜ ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ‰È¯·ÛÌÔ‡ Ù˘ οو ÎÔ›Ï˘¤ˆ˜ οوıÂÓ ÙˆÓ ÓÂÊÚÈÎÒÓ ÊÏ‚ÒÓ (∂ÈÎfiÓ˜ 6 ηÈ7). O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË ‰È¿-ÁÓˆÛË Ù˘ º£ Î·È ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜·Ó·ÁÚ¿ÊÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

ªÂÙ¿ ·fi ÁÔÓȉȷÎfi ¤ÏÂÁ¯Ô ÙˆÓ ˘fiÏÔÈˆÓ ÌÂ-ÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÚԤ΢„ fiÙÈ ËÌËÙ¤Ú· ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˘ MTHFR Î·È ÂÙÂÚÔ˙˘ÁÒ-Ù˘ FV Leiden, ÂÓÒ ÔÈ ‰‡Ô ·‰ÂÏʤ˜ Ù˘ ‹Ù·Ó, ›-Û˘, ÂÙÂÚÔ˙˘ÁÒÙ˜ MTHFR Î·È FV Leiden.

∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠˷ÚÈÓÔıÂÚ·-›· - Ù¤ÛÛÂÚȘ Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘-Ìو̿وÓ, Ì ıÚÔÌ‚ÔÏ˘ÙÈ΋ (rtpA) Î·È ·ÓÙÈËÎÙÈ-΋ ·ÁˆÁ‹ ÏfiÁˆ Ù˘ Èı·Ó‹˜ ¶∂ Î·È Ù˘ ¤ÎÙ·Û˘

∂∂ÈÈÎÎfifiÓÓ·· 11.. (C/T ÎÔÈÏ›·˜) £ÚfiÌ‚ˆÛË Î¿Ùˆ ÎÔ›Ï˘, ÎÔÈÓÒÓ ÌË-ÚÈ·›ˆÓ Î·È ¤Íˆ Ï·ÁfiÓÈˆÓ ÊÏ‚ÒÓ ¿Ìʈ.

∂∂ÈÈÎÎfifiÓÓ·· 22.. (C/T ÎÔÈÏ›·˜) £ÚfiÌ‚ˆÛË Î¿Ùˆ ÎÔ›Ï˘, Ï·ÁfiÓȈÓÎ·È ÎÔÈÓÒÓ ÌËÚÈ·›ˆÓ ÊÏ‚ÒÓ ¿Ìʈ Ì ÌÂÚÈ΋ ·ӷÛËÚ·ÁÁÔ-Ô›ËÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ Ì›˙ÔÓÔ˜ Û·ÊËÓÔ‡˜ Î·È ÌÈÎÚ‹ ·ӷ-ÛËÚ·ÁÁÔÔ›ËÛË Ù˘ ‰ÂÍÈ¿˜ Ì›˙ÔÓÔ˜ Û·ÊËÓÔ‡˜ ÊϤ‚·˜.

∂∂ÈÈÎÎfifiÓÓ·· 33.. (U/S Doppler ÎÔÈÏ›·˜) £ÚfiÌ‚ˆÛË Î¿Ùˆ ÎÔ›Ï˘, Ï·-ÁfiÓÈˆÓ Î·È ÎÔÈÓÒÓ ÌËÚÈ·›ˆÓ ÊÏ‚ÒÓ ¿Ìʈ Ì ÌÂÚÈ΋ ·ӷ-ÛËÚ·ÁÁÔÔ›ËÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ Ì›˙ÔÓÔ˜ Û·ÊËÓÔ‡˜ Î·È ÌÈÎڋ·ӷÛËÚ·ÁÁÔÔ›ËÛË Ù˘ ‰ÂÍÈ¿˜ Ì›˙ÔÓÔ˜ Û·ÊËÓÔ‡˜ ÊϤ‚·˜.

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64 ª. µÚ¿ÓÔ˘ Î·È Û˘Ó.

ÙÔ˘ ıÚfiÌ‚Ô˘ Î·È Ì ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ·fi ÙÔ˘ÛÙfiÌ·ÙÔ˜.

∞Ú¯Èο, ¯ÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· Ó·ÙÚÈÔ‡¯Ô˜Ë·Ú›ÓË, ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ‚·ÚÊ·Ú›ÓË, ÙËÓÔÔ›· Ï·Ì‚¿ÓÂÈ ¤ˆ˜ Û‹ÌÂÚ· (19 Ì‹Ó˜ ÌÂÙ¿ ÙÔÛ˘Ì‚¿Ó), ¯ˆÚ›˜ Ó· ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÂÈÏÔΤ˜ (·È-ÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË). ∆Ô π¡R (internationalnormalizing ratio) ‰È·ÙËÚÂ›Ù·È ÌÂٷ͇ 2-3. ™Â η̛·Ê¿ÛË ‰ÂÓ ÎÚ›ıËΠ·Ó·Áη›· Ë ·ÁÁÂÈÔ¯ÂÈÚÔ˘ÚÁÈ΋·Ê·›ÚÂÛË ÙÔ˘ ıÚfiÌ‚Ô˘.

∏ ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÌÂÙ¿ ·fi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·‰‡Ô ÌËÓÒÓ, Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÂÚÈ·ÙË-ÙÈ΋, ·‡ÚÂÙË, Ì ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÛʇÍÂȘÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ÂÏ¿ÙÙˆÛË ÙÔ˘ ‚¿-ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ηٿ 10 ÎÈÏ¿ ÌÂÙ¿ ·fi ˘ÔıÂÚÌȉÈ-΋ ‰›·ÈÙ· Î·È ‚ÂÏÙ›ˆÛË ÙˆÓ ÙÔÈÎÒÓ Û˘Ìو̿وÓ(·ÔηٿÛÙ·ÛË Ù˘ ıÂÚÌfiÙËÙ·˜ ÙÔ˘ ÛΤÏÔ˘˜, Ù˘‰ÈfiÁΈÛ˘ Î·È ÙÔ˘ ¿ÏÁÔ˘˜). ™˘ÓÂÛÙ‹ıË Ë Û˘Ó¤¯ÈÛËÙ˘ ·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÂÙÒÓ Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÂȉÈ-ÎÒÓ ÂÏ·ÛÙÈÎÒÓ Î·ÏÙÛÒÓ Î·ıËÌÂÚÈÓ¿. O ·ӤÏÂÁ-¯Ô˜ - ·ÂÈÎÔÓÈÛÙÈÎfi˜ Î·È ·ÈÌ·ÙÔÏÔÁÈÎfi˜ - Á›ÓÂÙ·È ÛÂÙ·ÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·.

∆ÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÙÈËÎÙÈ΋˜·ÁˆÁ‹˜, Û ¤Á¯ÚˆÌÔ Doppler ÊÏ‚ÒÓ Î¿Ùˆ ¿ÎÚˆÓÛ fiÚıÈ· Î·È ‡ÙÈ· ı¤ÛË Î·ıÒ˜ Î·È ÎÔÈÏ›·˜ ‰È·È-ÛÙÒıËΠÈηÓÔÔÈËÙÈÎÔ‡ ‚·ıÌÔ‡ ·ӷÛËÚ·ÁÁÔ-Ô›ËÛË Î¿Ùˆ ÎÔ›Ï˘, Ï·ÁÔÓ›ˆÓ Î·È ÌËÚÈ·›ˆÓ ÊÏÂ-‚ÒÓ, ¯ˆÚ›˜ ·Ó¿ÚÎÂÈ· ÙˆÓ ‚·Ï‚›‰ˆÓ ÛÙÔ ÂÈÔ-Ï‹˜ ÊÏ‚ÈÎfi Û‡ÛÙËÌ· Ù˘ Ì›˙ÔÓÔ˜ Î·È ÂÏ¿ÛÛÔÓÔ˜Û·ÊËÓÔ‡˜ ÊϤ‚·˜.

™˘˙‹ÙËÛË

∏ º£ ·ÔÙÂÏ› ÛÔ‚·Ú‹, ·ÏÏ¿ Û¿ÓÈ· ·ÈÙ›· ÓÔ-ÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·.∂ÎÙfi˜ ·fi ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, Û˘¯ÓfiÙÂÚ· ·Ú·-ÙËÚÂ›Ù·È Î·Ù¿ ÙËÓ ÂÊ˂›· (1). ∆Ô ÔÛÔÛÙfi ÂÌÊ¿ÓÈ-Û˘ Ù˘ Û˘Ìو̷ÙÈ΋˜ º£ ÛÙ· ·È‰È¿ Â›Ó·È Û·-ÊÒ˜ ÌÈÎÚfiÙÂÚÔ ·’ fi,ÙÈ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, Ì ·Ó·ÏÔÁ›·

¶·È‰È·ÙÚÈ΋ 2005;68:62-67

∂∂ÈÈÎÎfifiÓÓ·· 77.. ∂Ï¿ÙÙˆÛË ÙÔ˘ ‡ÚÔ˘˜ ÙˆÓ ÂÈÔÏ‹˜ Ï·ÁfiÓÈˆÓ ÊÏÂ-‚ÒÓ Î·È Ù˘ οو ÎÔ›Ï˘ ÊϤ‚·˜, ÌÂ Â˘Ú‹Ì·Ù· ÌÂÚÈ΋˜ ·-Ó·ÛËÚ·ÁÁÔÔ›ËÛ˘ Î·È ·Ó¿Ù˘ÍË ·Ú¿Ï¢Ú˘ ΢ÎÏÔÊÔÚ›·˜·fi ÙÔ ‡„Ô˜ ÙÔ˘ ‰È¯·ÛÌÔ‡ Ù˘ οو ÎÔ›Ï˘ ¤ˆ˜ οوıÂÓ ÙˆÓÓÂÊÚÈÎÒÓ ÊÏ‚ÒÓ.

∂∂ÈÈÎÎfifiÓÓ·· 44.. (C/T ÎÔÈÏ›·˜) ¢È‡ڢÓÛË ÎÔÈÓÒÓ ÌËÚÈ·›ˆÓ ÊÏ‚ÒÓÛ fiÏÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘˜.

∂∂ÈÈÎÎfifiÓÓ·· 55.. ¢È‡ڢÓÛË ÎÔÈÓÒÓ ÌËÚÈ·›ˆÓ ÊÏ‚ÒÓ Û fiÏÔ ÙÔ Ì‹-ÎÔ˜ ÙÔ˘˜.

∂∂ÈÈÎÎfifiÓÓ·· 66.. (C/T ÎÔÈÏ›·˜) ∂Ï¿ÙÙˆÛË ÙÔ˘ ‡ÚÔ˘˜ ÙˆÓ ÂÈÔÏ‹˜Ï·ÁfiÓÈˆÓ ÊÏ‚ÒÓ Î·È Ù˘ οو ÎÔ›Ï˘ ÊϤ‚·˜, ÌÂ Â˘Ú‹Ì·Ù·ÌÂÚÈ΋˜ ·ӷÛËÚ·ÁÁÔÔ›ËÛ˘ Î·È ·Ó¿Ù˘ÍË ·Ú¿Ï¢ÚË˜Î˘ÎÏÔÊÔÚ›·˜ ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ‰È¯·ÛÌÔ‡ Ù˘ οو ÎÔ›Ï˘ ¤ˆ˜Î¿ÙˆıÂÓ ÙˆÓ ÓÂÊÚÈÎÒÓ ÊÏ‚ÒÓ.

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65∂Ó Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË

¶·È‰È·ÙÚÈ΋ 2005;68:62-67

5,3/10000 ÂÈÛ·ÁˆÁ¤˜ (1). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ‰ÈηÈÔ-

ÏÔÁÂ›Ù·È ÂÓ Ì¤ÚÂÈ ·fi ÙȘ ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù˘ ·2

Ì·ÎÚÔÛÊ·ÈÚ›Ó˘ Î·È ÙÔ˘ ¿ıÈÎÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ηٿ

ÙËÓ ·È‰È΋ ËÏÈΛ·, Ë ÔÔ›· ·Ó·ÛÙ¤ÏÏÂÈ ÙË ‰ËÌÈ-

Ô˘ÚÁ›· ıÚÔÌ‚›Ó˘ ηÈ, ÂӉ¯Ô̤ӈ˜, ÙËÓ ·fiÊÚ·-

ÍË ÙˆÓ ·ÁÁ›ˆÓ.

∏ ıÚfiÌ‚ˆÛË ÛÙ· ·È‰È¿ ÌÔÚ› Ó· ÂΉËψı›

ˆ˜ ÂÓ Ùˆ ‚¿ıÂÈ º£ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, ÙˆÓ ÓÂÊÚÈÎÒÓ,

ÙˆÓ Ë·ÙÈÎÒÓ ÊÏ‚ÒÓ, Ù˘ ˘Ï·›·˜ ÊϤ‚·˜ Î·È ÙÔ˘

∫¡™. ªÂÙ¿ ÙȘ ıÚÔÌ‚ÒÛÂȘ ÙÔ˘ ∫¡™, Û˘¯ÓfiÙÂÚË

ÂÓÙfiÈÛË ÁÈ· º£ ·ÔÙÂÏ› ÙÔ Î·ÙÒÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘

ÛÒÌ·ÙÔ˜ (1). OÈ ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜ ·ÔÙÂÏÔ‡Ó

ÙÔÓ Û˘¯ÓfiÙÂÚÔ Â›ÎÙËÙÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ·

ıÚfiÌ‚ˆÛË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ

50% ÙˆÓ ·ÛıÂÓÒÓ Ì º£ ÛÙÔ ·ÓÒÙÂÚÔ ÊÏ‚ÈÎfi Û‡-

ÛÙËÌ· ¤¯ÂÈ ÎÂÓÙÚÈÎfi ηıÂÙ‹Ú·.

™˘Ó‰˘·ÛÌfi˜ ÎÏËÚÔÓÔÌÈÎÒÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ

Î·È Â›ÎÙËÙˆÓ ·Ú·ÁfiÓÙˆÓ ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙËÓ

ÚfiÎÏËÛË º£. ∏ ·ÚÔ˘Û›· ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ

ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Û ·È‰È¿ Ì ‰Â˘ÙÂ-

ÚÔ·ı‹ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË Êı¿ÓÂÈ Û ÔÛÔÛÙfi 13-

78% (1).

∞Ó¿ÚÎÂÈ· PC, PS, ·ÚÔ˘Û›· Ù˘ ÌÂÙ¿ÏÏ·Í˘

FII20210A (2), FV Leiden G1691A, MTHFRTT677,

›‰· ÏÈÔÚˆÙ½Ó˘ Lp(a) >30 mg/dl (7) ηÈ

ıÂÙÈο ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· (2,4,5)

·ÔÙÂÏÔ‡Ó ÙÔ˘˜ Èo ÛËÌ·ÓÙÈÎÔ‡˜ ÚÔıÚÔÌ‚ˆÙÈ-

ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ˘Â‡ı˘ÓÔ˘˜ ÁÈ· ÙË ıÚfiÌ‚ˆÛË

Ù˘ ˘Ï·›·˜ Î·È ÙˆÓ Ë·ÙÈÎÒÓ Î·È ÓÂÊÚÈÎÒÓ ÊÏÂ-

‚ÒÓ (6,7). °È· ÙÔ 95% ÙˆÓ º£ ÛÙ· ·È‰È¿ ÂÓÔ¯Ô-

ÔÈÔ‡ÓÙ·È ÛÔ‚·Ú¤˜ ÓfiÛÔÈ/ηٷÛÙ¿ÛÂȘ, fiˆ˜ η-

ÎÔ‹ıÂȘ, ·ÁÁÂÈ›Ùȉ˜, ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜, ÓÂ-

ÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ™E§, ·ÓÙÈʈÛÊÔÏÈȉÈÎfi Û‡Ó-

‰ÚÔÌÔ, Û˘ÁÁÂÓ¤˜ ηډȷÎfi ÓfiÛËÌ·, ÂÚÈÁÂÓÓËÙÈ΋

·ÛÊ˘Í›·, ÛË„·ÈÌ›·, ÂÌ‚Ú˘˚Îfi˜ ‰È·‚‹Ù˘, ‰Ú·ÓÔ-

΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· Î·È ÔÌÔ΢ÛÙÈÓ·ÈÌ›· (1,6,8).

∂ÎÏ˘ÙÈο ·›ÙÈ· ·ÔÙÂÏÔ‡Ó ÙÔ ÙÚ·‡Ì·, Ë ·¯˘Û·Ú-

Λ·, Ë ·Ê˘‰¿ÙˆÛË, ÔÈ ÌÂÁ¿Ï˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ-

‚¿ÛÂȘ (ÎÚ·ÓÈÔÙÔÌ›·, Ï··ÚÔÛÎfiËÛË, ÂÂÌ‚¿ÛÂȘ

ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË), Ë ıÂڷ›· Ì L-

asparginase (·Ó¿ÚÎÂÈ· ∞∆) Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹

Î·È ÔÈ ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜ (8). O ÙÚ·˘Ì·ÙÈÛÌfi˜

ÛÙÔÓ ıÒڷη, ÙÔ ÎÚ·Ó›Ô, ÙËÓ ÎÔÈÏȷ΋ ¯ÒÚ· Î·È ÙË

ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË ¤¯ÂÈ ÂÓÔ¯ÔÔÈËı› ÁÈ· ÂÌÊ¿ÓÈÛË

º£ (9). ∂Ô̤ӈ˜, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿-

ÊÂÙ·È, Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ÚÔÛ·ÁˆÁÔ‡ Ì˘fi˜ ÏÂÈ-

ÙÔ‡ÚÁËÛ ˆ˜ ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ·Ó¿-

Ù˘ÍË º£.

O ÚfiÏÔ˜ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·-

Ú·ÁfiÓÙˆÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË º£ ÛÙ· ·È‰È¿ ÔÈΛÏÏÂÈ

·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·. ∏ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘

ÙÔ˘ ·Ú¿ÁÔÓÙ· V (FV Leiden) Â›Ó·È Ô ÈÔ Û˘¯Ófi˜

ÂÓÔ¯ÔÔÈËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·ÈÊÓ›‰È·˜ ıÚfiÌ‚ˆÛ˘

ÛÙË ‚ÚÂÊÈ΋ Î·È ÚÒÙË ·È‰È΋ ËÏÈΛ· (̤ÛË ËÏÈ-

Λ· 2 ÂÙÒÓ) Î·È ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ıÚfiÌ‚ˆÛË ˘Ï·›·˜,

ÓÂÊÚÈ΋˜ Î·È ÂÁÎÂÊ·ÏÈÎÒÓ ÊÏ‚ÒÓ (7,10). ∏ ·ÛıÂ-

Ó‹˜ ·Â‰Â›¯ıË fiÙÈ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ Ù˘ ÌÂÙ¿Ï-

Ï·Í˘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÁÔÓȉ›Ô˘.

∏ ÌÂÙ¿ÏÏ·ÍË FV Leiden ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÈÔ Û˘-

¯Ó¿ ÛÙË Ï¢΋ Ê˘Ï‹, Û ÔÛÔÛÙfi 5,27% (ÛÙËÓ

¶¶››ÓÓ··Îη·˜̃ 11.. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÛıÂÓÔ‡˜ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ·ÁˆÁ‹˜

∞ÈÌÔÂÙ¿ÏÈ· 260 x 109 (º.∆.: 150-400 x 109/L)™˘ÛÙÔÏ‹ ıÚfiÌ‚Ô˘ º˘ÛÈÔÏÔÁÈ΋ÃÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘ 11’’2 (º.∆.: 11’’0-13’’0)ÃÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ 27’’4 (º.∆.: 20’’0-40’’0)ÃÚfiÓÔ˜ ıÚÔÌ‚›Ó˘ 11’’3 (º.∆.: 10’’0-14’’0)πÓˆ‰ÔÁfiÓÔ 516 mg% (º.∆.: 200-400%)¶·Ú¿ÁÔÓÙ·˜ ππ 125% (º.∆.: 60-120%)¶·Ú¿ÁÔÓÙ·˜ VII 92% (º.∆.: 60-120%)¶·Ú¿ÁÔÓÙ·˜ VIII >200 u/dl (º.∆.: 50-150 u/dl)¶·Ú¿ÁÔÓÙ·˜ Ãππ 92% (º.∆.: 50-150%)∞ÓÙÈıÚÔÌ‚›ÓË ∞∆ 107% (º.∆.: 60-120%)¶ÚˆÙ½ÓË C (PC) 104% (º.∆.: 65-140%)¶ÚˆÙ½ÓË S (PS) 78% (º.∆.: 65-140%)¶Ï·ÛÌÈÓÔÁfiÓÔ 132% (º.∆.: 80-120%)D-dimers 8 Ìg/ml(º.∆.: <0,5 Ìg/ml)APCR 1,83 (º.∆.: >2,20)OÌÔ΢ÛÙ½ÓË 13,3 mmol/l (º.∆.: <10,8 mmol/l)º˘ÏÏÈÎfi Ô͇ 4,8 ng/ml (º.∆.: 3,1-12,4 ng/ml)µÈÙ·Ì›ÓË µ12 775 pg/mL (º.∆.: 223-1132 pg/mL)∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ‚2GP1 (-)∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Î·Ú‰ÈÔÏÈ›Ó˘ (-)∞ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∞ÚÓËÙÈÎfi˜¶ÚˆÙ½Ó˜ Ï¿ÛÌ·ÙÔ˜ º˘ÛÈÔÏÔÁÈΤ˜£˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· ∫·Ù¿ ʇÛË∂ÙÂÚÔ˙˘ÁÒÙ˘ ˆ˜ ÚÔ˜ ÙË ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ G1691A ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· V (FV Leiden) ∂ÙÂÚÔ˙˘ÁÒÙ˘ MTHFR∞ÚÓËÙÈ΋ ÁÈ· ÌÂÙ·ÏÏ·Á̤ÓË ÚÔıÚÔÌ‚›ÓË FII20210A

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66 ª. µÚ¿ÓÔ˘ Î·È Û˘Ó.

∂ÏÏ¿‰· 8%). ∆Ô ÔÛÔÛÙfi ÛÙÔ˘˜ ∞ÊÚÔ·ÌÂÚÈηÓÔ‡˜Â›Ó·È 1,23%, ÛÙÔ˘˜ ∞ÛÈ¿Ù˜ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ∞ÌÂÚÈ΋ 0,45%, ÂÓÒ ÛÙÔ˘˜ ∞ÌÂÚÈηÓÔ‡˜ 1,25%(p<0,001) (11). OÈ ÔÌÔ˙˘ÁÒÙ˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ FVLeiden ¤¯Ô˘Ó 50-100 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙË-Ù· ÂÌÊ¿ÓÈÛ˘ º£, ÂÓÒ ÔÈ ÂÙÂÚÔ˙˘ÁÒÙ˜ 3-7 ÊÔÚ¤˜.Œ¯ÂÈ ·Ó·ÊÂÚı› Û˘Û¯¤ÙÈÛË ÙÔ˘ FV Leiden Ì ÂÂÈ-Ûfi‰ÈÔ ÔÍ›·˜ ·fiÚÚȄ˘ ÓÂÊÚÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓÎ·È ¯ÚfiÓÈ·˜ ÏÂÈÙÔ˘ÚÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ ÌÔۯ‡̷ÙÔ˜ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË ÓÂÊÚÔ‡ (12).

∏ ÌÂÙ¿ÏÏ·ÍË 20210∞ ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ·Ú¿ÁÔ-ÓÙ· ππ (FII20210A) ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· º£ ÛÙËÓ ÂÊË-‚›· (̤ÛË ËÏÈΛ· 16 ÂÙÒÓ).

∏ ÔÌÔ΢ÛÙÈÓ·ÈÌ›· Û˘Ó·ÓÙ¿Ù·È Û ÔÛÔÛÙfi 1%ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Î·È ÔÈ ÔÌÔ˙˘ÁÒÙ˜ Ù˘ ‰È·-Ù·Ú·¯‹˜ ¤¯Ô˘Ó 2-3 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÂÌ-Ê¿ÓÈÛ˘ º£. O ΛӉ˘ÓÔ˜ ·˘Ùfi˜ ·˘Í¿ÓÂÈ Î·Ù¿ 10-20ÊÔÚ¤˜, fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Ì FV Leiden (11). ∏·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ Â›Ó·È ÂÙÂÚÔ˙˘-ÁÒÙ˘ FV Leiden, ÂÙÂÚÔ˙˘ÁÒÙ˘ MTHFR Ì ˘Â-ÚÔÌÔ΢ÛÙÈÓ·ÈÌ›· (ÎÏËÚÔÓÔÌÈÎÔ› ÚÔıÚÔÌ‚ˆÙÈÎÔ›·Ú¿ÁÔÓÙ˜), ›¯Â ·˘ÍË̤ÓÔ˘˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜‹Í˘ π Î·È VIII (›ÎÙËÙÔÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿-ÁÔÓÙ˜ ) Î·È ÂÈϤÔÓ, ‹Ù·Ó ·¯‡Û·ÚÎË.

∂ÓÙ˘ˆÛÈ·Îfi, ¿ÓÙˆ˜, Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙ··È‰È¿ ÔÈ ÂÈÏÔΤ˜ ÙÔ˘ ÌÂÙ·ıÚÔÌ‚ˆÙÈÎÔ‡ Û˘Ó-‰ÚfiÌÔ˘ (PTS) (¿ÏÁÔ˜, ÊÏ‚È΋ ·Ó¿ÚÎÂÈ·, ˘¤Ú-¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜) ÂÌÊ·Ó›˙ÔÓÙ·È ÎÏÈÓÈο ÌÂ Û˘¯Ófi-ÙËÙ· ÌfiÓÔ 10-20%, ÂÓÒ ÔÈ ˘ÔÎÏÈÓÈΤ˜ ÂÚÈÙÒ-ÛÂȘ ˘ÔÏÔÁ›˙ÔÓÙ·È Û ÔÛÔÛÙfi 65% (1). ∏ ·ÛıÂ-Ó‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ÂÌÊ¿ÓÈÛ fiϘ ÙȘÂÈÏÔΤ˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È.

∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ º£ ÌÔÚ›ӷ ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ (rtpA)ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ıÚfiÌ‚ˆÛ˘ Î·È ‚) ·ÓÙÈËÎÙÈ-΋ ·ÁˆÁ‹ (Ë·Ú›ÓË ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ·ÓÙÈ‚ÈÙ·-̛Ә ∫). ∏ ÛÙÚÂÙÔÎÈÓ¿ÛË ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÛÙË º£Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (1).

™ÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, Ô˘·ÚÔ˘Û›·Û ıÚfiÌ‚ˆÛË Û ÌÂÁ¿ÏË ¤ÎÙ·ÛË ÙÔ˘ ÊÏÂ-‚ÈÎÔ‡ ‰ÈÎÙ‡Ô˘ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ‹‰Ë ·fi ÙÔ ÚÒÙÔÂÂÈÛfi‰ÈÔ, ÎÚ›ıËΠ·Ó·Áη›· Ë ÂÊ·ÚÌÔÁ‹ ıÚÔÌ‚Ô-Ï˘ÙÈ΋˜ ·ÁˆÁ‹˜, Ì ÛÎÔfi ÙËÓ ¿ÌÂÛË Ï‡ÛË ÙÔ˘ıÚfiÌ‚Ô˘. ™‡Ìʈӷ Ì ٷ ‰ÈÂıÓ‹ ÚˆÙfiÎÔÏÏ·, Ë·ÁˆÁ‹ Û˘Ó¯›ÛÙËΠ̠·ÓÙÈËÎÙÈο (S. Heparin,LMWHsc Î·È Warfarin p.o.), ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÚÈÔ-ÚÈÛÙ› Ë Â¤ÎÙ·ÛË ÙÔ˘ ıÚfiÌ‚Ô˘ Î·È Ó· ÚÔÏËÊı› ËÂӉ¯fiÌÂÓË ¶∂, Ë ÔÔ›· ·Ú’ fiÏ· ·˘Ù¿ Û˘Ó¤‚Ë. ∏·ÈÙ›· Ù˘ ˘ÔÙÚÔ‹˜ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË.

∆· ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù˘ ˘Ô‰fiÚÈ·˜ ¤Á¯˘Û˘LMWH (ÂÒ‰˘ÓË ‰È·‰Èηۛ·, Âί˘ÌÒÛÂȘ ÛÙ· ÛË-Ì›· ¤Á¯˘Û˘ Ì ·Ó¿ÏÔÁÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·),Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ¯·ÌËÏ‹ Û˘ÌÌfiÚʈÛË ÙˆÓ Ó·ÚÒÓ·ÛıÂÓÒÓ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, fiˆ˜Î·È ÛÙËÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘, ‰fiıË-Π·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÁˆÁ‹ Ì Warfarin, Ë ÔÔ›·

‰ÂÓ ¤¯ÂÈ Ù· ·Ú·¿Óˆ ÌÂÈÔÓÂÎÙ‹Ì·Ù·, ÂËÚ¿˙Â-Ù·È fï˜ ·fi ÙË ‰È·ÙÚÔÊ‹ (ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓÙÚÔÊÒÓ Û ‚ÈÙ·Ì›ÓË ∫), ÏÔÈÌÒÍÂȘ ‹ Ê¿Ú̷η, ÂÓÒË ‰ÔÛÔÏÔÁ›· Ú˘ıÌ›˙ÂÙ·È Û‡Ìʈӷ Ì ÙËÓ ÙÈÌ‹ ÙÔ˘π¡R (international normalizing ratio). ∏ Û˘ÌÌfiÚ-ʈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, fï˜, Â›Ó·È ÈÔ ˘„ËÏ‹, ÁÂÁÔ-Ófi˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi, ·ÊÔ‡ Ë ‰È¿ÚÎÂÈ· Ù˘ ıÂ-ڷ›·˜ Â›Ó·È ÌÂÁ¿ÏË (1).

∏ ıÂڷ›· ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ÂÓ Ùˆ ‚¿ıÂȺ£ Û˘Ó‹ıˆ˜ ‰È·ÚΛ 3-6 Ì‹Ó˜, fï˜ fiÙ·Ó Ë ıÚfiÌ-‚ˆÛË Â›Ó·È ÂÎÙÂٷ̤ÓË Î·È Û˘Ó˘¿Ú¯Ô˘Ó ÚÔıÚÔÌ-‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ¯ÔÚËÁÂ›Ù·È Â› Ì·ÎÚfiÙÂÚÔ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ·Ó¿ÏÔÁ· Ì ÙËÓ ÔÚ›· ÙÔ˘·ÛıÂÓÔ‡˜. ™ÎÔfi˜ Ù˘ Â›Ó·È Ë ·ÔÊ˘Á‹ ÙˆÓ ÂÈ-ÏÔÎÒÓ Ù˘ º£. ÕÌÂÛË ÂÈÏÔ΋ Ù˘ º£ ·ÔÙÂ-Ï› Ë Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹. ∞ÒÙÂÚË ·ÔÙÂÏ› ÙÔÌÂÙ·ÊÏ‚ÈÙȉÈÎfi Û‡Ó‰ÚÔÌÔ. ™Â ÂÚ›ÙˆÛË ˘Ô-ÙÚÔ‹˜ ‹ ‰Â‡ÙÂÚÔ˘ ÂÂÈÛÔ‰›Ô˘ º£, ¯ÔÚËÁ›ٷȷÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ‰È¿ ‚›Ô˘.

∏ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ÂÚÈÁÚ¿ÊÂÙ·È ÁÈ·Ù› ÚÔ-‚ÏËÌ¿ÙÈÛ ÙÔ˘˜ ıÂÚ¿ÔÓÙ˜ È·ÙÚÔ‡˜. ∂ÚfiÎÂÈÙÔÁÈ· ¤Ó· ·¯‡Û·ÚÎÔ ÎÔÚ›ÙÛÈ Ô˘ ÂÈÛ‹¯ıË, ·Ú¯Èο,ÁÈ· ‰ÈÂÚ‡ÓËÛË Ì›·˜ ·Ï‹˜ οΈÛ˘ ÛÙËÓ OÚıÔ-·È‰È΋ ∫ÏÈÓÈ΋, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ‰È·ÈÛÙÒıËÎÂfiÙÈ Â›¯Â ˘ÔÛÙ› ÂÎÙÂٷ̤ÓË ÂÓ Ùˆ ‚¿ıÂÈ º£ (‰˘-Û·Ó¿ÏÔÁ· ‚·ÚÈ¿ Û ۯ¤ÛË Ì ÙËÓ ·‚Ï˯ڋ ÎÏÈÓÈÎ‹Û˘Ìو̷ÙÔÏÔÁ›·), Ë ÔÔ›· ˘ÔÙÚÔ›·ÛÂ Î·È Â›¯ÂÂͤÏÈÍË È‰È·›ÙÂÚ· ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·È‰È-Ô‡. ∂›Ó·È ۷ʤ˜ fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ·È‰È·-ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ Á‡Úˆ ·fi ÙÔ ÎÂÊ¿Ï·ÈÔ Ù˘ ıÚfiÌ‚ˆ-Û˘ Â›Ó·È ÂӉ¯Ô̤ӈ˜ ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ‚‹Ì· ÁÈ·ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ÙˆÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈ-ÛÔ‰›ˆÓ Î·È ÙËÓ ÚfiÏË„Ë ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ ·fi·˘Ù¿. ∂ÊfiÛÔÓ ‰È·ÈÛÙÒÓÔÓÙ·È Û˘ÁÁÂÓ›˜ ÚÔıÚÔÌ-‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ô ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· ·ÊÔ-Ú¿ Û fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ó· η-Ù¢ı‡ÓÂÙ·È ·Ó¿ÏÔÁ·.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Chan AK, Deveber G, Monagle P, Brooker LA, MassicottePM. Venous thrombosis in children. J Thromb Haemost2003;1:1443-1455.

2. Simioni P, Sanson BJ, Prandoni P, Tormene D, FriederichPW, Girolami B et al. Incidence of venous thromboembolismin families with inherited thrombophilia. Thromb Haemost1999;81:198-202.

3. Nowak-Gottl U, Schobess R, Kurnik K, Schwabe D, Fleis-chhack G, Junker R. Elevated lipÔprotein(a) concentration isan independent risk factor of venous thromboembolism.Blood 2002;99:3476-3477.

4. Arnout J. Antiphospholipid syndrome: diagnostic aspects oflupus anticoagulants. Thromb Haemost 2001;86:83-91.

5. Bertina RM. Genetic approach to thrombophilia. ThrombHaemost 2001;86:92-103.

6. Munchow N, Kosch A, Schobess R, Junker R, Auberger K,Nowak-Gottl U. Role of genetic prothrombotic risk factors inchildhood caval vein thrombosis. Eur J Pediatr 1999;158(Suppl 3):S109-S112.

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67∂Ó Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË

¶·È‰È·ÙÚÈ΋ 2005;68:62-67

7. Heller C, Schobess R, Kurnik K, Junker R, Gunther G, KreuzW et al. Abdominal venous thrombosis in neonates and in-fants: role of prothrombotic risk factors - a multicentre case-control study. For the Childhood Thrombophilia StudyGroup. Br J Haematol 2000;111:534-539.

8. ∞ÚÒÓË-µÔ˘ÚÓ¿ ™. £ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ÎÂÓÙÚÈ-ÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) ‰È¿ÊÔÚ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙ··È‰È¿. ª›· ÚfiÎÏËÛË ÁÈ· ÙÔ ÁÈ·ÙÚfi. ¶·È‰È·ÙÚÈ΋2002;65:4-8.

9. Vavilala MS, Nathens AB, Jurkovich GJ, Mackenzie E, RivaraFP. Risk factors for venous thromboembolism in pediatrictrauma. J Trauma 2002;52:922-927.

10. Schobess R, Junker R, Auberger K, Munchow N, Burdach S,

Nowak-Gottl U. Factor V G1691A and prothrombinG20210A in childhood spontaneous venous thrombosis - ev-idence of an age-dependent thrombotic onset in carriers offactor V G1691A and prothrombin G20210A mutation. EurJ Pediatr 1999;158 (Suppl 3):S105-S108.

11. Price DT, Ridker PM. Factor V Leiden mutation and the risksfor thromboembolic disease: a clinical perspective. Ann In-tern Med 1997;127:895-903.

12. Hocher B, Slowinski T, Hauser I, Vetter B, Fritsche L, BachertD et al. Association of factor V Leiden mutation with delayedgraft function, acute rejection episodes and long-term graftdysfunction in kidney transplant recipients. Thromb Hae-most 2002;87:194-198.

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68 CASE REPORT

1 1st Paediatric Clinic,“Aghia Sophia” Children’sHospital, Athens

2 Hemophilia andHemostasis Unit, “Aghia Sophia” Children’sHospital, Athens

3 Vascular Surgery Clinic,“Erythros Stavros”Hospital, Athens

4 Department of Radiology,“Aghia Sophia” Children’sHospital, Athens

Correspondence:

ªaria Vranou 20 Klisovis str., 185 39, Piraeus

Date of submission: 09-01-2004Date of approval: 19-04-2004

Paediatriki 2005;68:68

Deep vein thrombosis in multiple sites in an

adolescent. Case report

M. Vranou1, G. Anastasiadis1, G. Panagiotakopoulos1, H. Pergantou2, H. Platokouki2, N. Besias3,

M. Vakaki4, K. Prountzou - Kassiou1

Abstract

The case of a girl 12.5 years old with deep vein thrombosis (DVT) in multiple sites (inferior vena cava, right

and left femoral veins) is described. The patient presented with limping, pain and oedema of soft tissues in theleft hip and the left poplideal region, a few days after experiencing trauma during physical exercise.Thrombosis was confirmed by triplex of veins in the lower limbs and computed tomography scan (C/T) of the

abdomen. Laboratory investigation for the presence of prothrombotic factors predisposing to thrombosisrevealed that the patient was heterozygote for FV Leiden and MTHFR. Thrombolytic and anticoagulanttherapy resulted in partial resolution of the thrombus and recanalization of the obstructed femoral veins.

Key words

Vein thrombosis, childhood, prothrombotic factors.

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AÏÏËÏÔÁÚ·Ê›·:

∫ÔÛÌ¿˜ ∫ÔÙÛÒÓ˘ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-01-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-11-2004

¶·È‰È·ÙÚÈ΋ 2005;68:69-72

¶ÂÚ›ÙˆÛË ·ÔÌfiÓˆÛ˘ ·‰ÂÓÔ˚Ô‡ µ1 ÛÙÔ ÎÂÓÙÚÈÎfi

Ó¢ÚÈÎfi Û‡ÛÙËÌ· Û ·È‰› ËÏÈΛ·˜ 6,5 ÂÙÒÓ

Ì ÔÍ›· ‰È¿¯˘ÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·

¶. ¶Ô˘ÏfiÔ˘ÏÔ˜, Õ. ªÂÛÛ·ÚÈÙ¿ÎË, ∫. ∫ÔÙÛÒÓ˘, ∫. ¶ÚÔ‡ÓÙ˙Ô˘ - ∫·ÛÛÈÔ‡

¶ÂÚ›ÏË„Ë

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 6,5 ÂÙÒÓ Ì ÔÍ›· ‰È¿¯˘ÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·. ∏ ‰È¿ÁÓˆÛË‚·Û›ÛÙËΠηٿ ·ÚÈÔ ÏfiÁÔ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ì ÙËÓ ÔÏÏ·ÏfiÙËÙ· ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂΉËÏÒÛˆÓ,ÛÙ· Â˘Ú‹Ì·Ù· ·fi ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi Î·È ÛÙ· ȉȷ›ÙÂÚ· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔ-

ÌÔÁÚ·Ê›·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∏ ·ÔÌfiÓˆÛË ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ·‰ÂÓÔ˚Ô‡ µ1, Ì ÙË̤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ Ù˘ ÔÏ˘ÌÂÚ¿Û˘, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘, ÌÔ-Ú› Ó· ÛËÌ·›ÓÂÈ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ·‰ÂÓÔ˚Ô‡ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ÛÙÔÓ ¿ÓıÚˆÔ.

§¤ÍÂȘ ÎÏÂȉȿ

OÍ›· ‰È¿¯˘ÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·, O¢∂ª, ·‰ÂÓÔ˚fi˜, ·È‰È¿.

™˘ÓÙÔÌÔÁڷʛ˜

O¢∂ª OÍ›· ‰È¿¯˘ÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·

∂¡À ∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi

™¶ ™ÎÏ‹Ú˘ÓÛË Î·Ù¿ Ͽη˜

∫¡™ ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·

MRI Magnetic resonance imagining

PCR Polymerase chain reaction

ADEM Acute disseminated encephalomyelitis

EBV Epstein-Barr virus

CMV Cytomegalovirus

ECHO Enteric cytopathogenic human orphan viruses

HSV1 Herpes simplex virus-1

HSV2 Herpes simplex virus-2

CT Computed tomography

HIV Human immunodeficiency

BCG Bacillus Calmette-Guerin

∂ÈÛ·ÁˆÁ‹

∏ ÔÍ›· ‰È¿¯˘ÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ· (O¢∂ª),

Â›Ó·È ÊÏÂÁÌÔÓ҉˘ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ‰È·Ù·Ú·¯‹, Ë

ÔÔ›· ÚÔÛ‚¿ÏÏÂÈ Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÙËÓ ˘ÔÊÏÔÈÒ-

‰Ë Ï¢΋ Ô˘Û›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

H ÓfiÛÔ˜ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜

ÂÊ‹‚Ô˘˜. ∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ Â›Ó·È ¿ÁÓˆÛÙË Î·È Ë

›وۋ Ù˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Â›Ó·È ÂÚ›Ô˘ 4,5 Â-

ÚÈÙÒÛÂȘ ·Ó¿ 10.000 ÂÈÛ·ÁˆÁ¤˜ Û ·È‰È·ÙÚÈο ÓÔ-

ÛÔÎÔÌ›· (1,2).

∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI)

Û˘Ì‚¿ÏÏÂÈ ·ÔÊ·ÛÈÛÙÈο ÛÙË ‰È¿ÁÓˆÛ‹ Ù˘, Ì ÙËÓ

·ÂÈÎfiÓÈÛË ÙˆÓ ‰È¿¯˘ÙˆÓ ·ÌÊÔÙÂÚfiÏÂ˘ÚˆÓ ·Ô-

Ì˘ÂÏÈÓˆÙÈÎÒÓ ‚Ï·‚ÒÓ Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÙÔ˘ ÂÁÎÂ-

Ê¿ÏÔ˘ Î·È Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜, ÔÈ Ôԛ˜ Â›Ó·È È‰È-

·›ÙÂÚ· ÂÌÊ·Ó›˜ ÛÙȘ ∆2 ·ÎÔÏÔ˘ı›Â˜ (1,3).

∏ ·ÈÙÈÔÏÔÁ›· Ù˘ Â›Ó·È ¿ÁÓˆÛÙË, ·Ó Î·È Èı·ÓÔ-

ÏÔÁÂ›Ù·È fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·Ú·ÏÔÈÌÒ‰Ë ‹ ÌÂÙ·ÏÔÈ-

ÌÒ‰Ë ‰È·Ù·Ú·¯‹. ™˘¯Ó¿ ÚÔËÁÂ›Ù·È (1-2 ‚‰ÔÌ¿-

‰Â˜) Ù˘ ÂÈÛ‚ÔÏ‹˜ Ù˘ ÓfiÛÔ˘, ÈÔÁÂÓ‹˜ ‹ ‚·ÎÙËÚÈ·-

΋ Ïԛ̈ÍË ‹ ÂÌ‚ÔÏÈ·ÛÌfi˜. ¶ÔÏϤ˜ ·Ó·ÊÔÚ¤˜ ÛÙË

‚È‚ÏÈÔÁÚ·Ê›· Û˘Ó‰¤Ô˘Ó ‰È¿ÊÔÚÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜

·Ú¿ÁÔÓÙ˜ Ì ÙËÓ O¢∂ª, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ›ӷÈ

·Ôχو˜ ηٷÓÔËÙfi˜ Ô Ì˯·ÓÈÛÌfi˜ ¤Ó·Ú͢ Ù˘

·ÔÌ˘ÂϛӈÛ˘.

¶Ôχ Û¿ÓÈ· ·Ó·Ê¤ÚÂÙ·È ·Ó›¯Ó¢ÛË ÏÔÈÌÔÁfi-

ÓÔ˘ ·Ú¿ÁÔÓÙ· ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À)

(4). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ô˘ ¤·-

ۯ ·fi O¢∂ª, ÛÙÔ ∂¡À ÙÔ˘ ÔÔ›Ô˘ ·ÓȯÓ‡ıËÎÂ

- Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ Ù˘ Ô-

Ï˘ÌÂÚ¿Û˘ (PCR) - ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ·‰ÂÓÔ˚Ô‡ µ1,

ÂÓÒ Ô ÏÔÈfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ¿ÏϘ

ÏÔÈÌÒÍÂȘ ‹Ù·Ó ·ÚÓËÙÈÎfi˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 6,5 ÂÙÒÓ Ô˘ ÂÈÛ‹-

¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ˘ÚÂÙÔ‡ ¤ˆ˜ 40ÔC ·fi ÙÚÈË-

̤ÚÔ˘, Ô ÔÔ›Ô˜ Û˘Óԉ¢fiÙ·Ó ·fi Ú›ÁÔ˜, ·‰˘Ó·Ì›·

‚¿‰ÈÛ˘ Î·È Î·Ù·‚ÔÏ‹. ¢Âη¤ÓÙ Ë̤Ú˜ ÚÈÓ ÙËÓ

ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ ‹È· Â̇ÚÂÙË ÈÔ-

ÁÂÓ‹ Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘-

ÛÙ‹Ì·ÙÔ˜, Ë ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠·ÓÙÈ˘ÚÂ-

ÙÈο. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó

ÂχıÂÚ·.

∫·Ù¿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÙÔ ·È‰›

‹Ù·Ó Û ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ì ¤ÓÙÔ-

ÓË ˘ÓËÏ›·, ˆ¯ÚfiÙËÙ· Î·È ·˘¯ÂÓÈ΋ ‰˘Ûη̄›·. ∏

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Page 81: Παιδιατρική | Τόμος 68 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2005

70 ¶. ¶Ô˘ÏfiÔ˘ÏÔ˜ Î·È Û˘Ó.

¶·È‰È·ÙÚÈ΋ 2005;68:69-72

ÏÔÈ‹ ηٿ Û˘ÛÙ‹Ì·Ù· ÎÏÈÓÈ΋ ÂͤٷÛË Î·È Ë ‚˘-ıÔÛÎfiËÛË ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·.

O ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: °ÂÓÈ-΋ ·›Ì·ÙÔ˜: §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 32400/mm3 (¶:89%, §: 6%, ª: 2%, ƒ: 3%), ∆∫∂: ·/50 mmHg, CRP:27 mg/L, ∂¡À: §Â˘Î¿: 480/mm3 (¶: 75%, §: 25%),χΈ̷ ∂¡À: 36,5 mg/dl, ÁÏ˘Îfi˙Ë ∂¡À: 55 mg/dl,ÁÏ˘Îfi˙Ë ÔÚÔ‡: 85 mg/dl, Á·Ï·ÎÙÈÎfi Ô͇: 10,89mg/dl, NH3: 21 Ìg/dl, ηÏÏȤÚÁÂÈ· ∂¡À: ÛÙ›ڷ,ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ: ÛÙ›ڷ, Ô ‰Â ˘fiÏÔÈÔ˜ ‚ÈÔ¯Ë-ÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·.

ªÂ ÙËÓ Èı·ÓfiÙËÙ· Ù˘ ‚·ÎÙËÚȷ΋˜ Ïԛ̈͢ÙÔ˘ ∫¡™, ¯ÔÚËÁ‹ıËΠ·Ú¯Èο ÎÂÊÙÚÈ·ÍfiÓË, ‚·ÓÎÔ-Ì˘Î›ÓË Î·È ‰ÂÍ·ÌÂı·˙fiÓË. ™ÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ Ù˘·ÁˆÁ‹˜, ÙÔ ·È‰› ·ÚÔ˘Û›·Û ‰È·Ù·Ú·¯‹ ÛÙËÓ ÂÎ-ÊÔÚ¿ ÙÔ˘ ÏfiÁÔ˘, ·‰˘Ó·Ì›· ÈÛÔÚÚÔ›·˜ Î·È ·Ù·ÍÈÎfi‚¿‰ÈÛÌ·. ∏ Ì˘˚΋ ÈÛ¯‡˜ ‹Ù·Ó ÌÂȈ̤ÓË, Ù· ÙÂÓfi-ÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ÙÔ˘ Ê˘ÛÈÔÏÔÁÈο, ÂÓÒ Ù· ÎÔÈ-Ïȷο Î·È ÙÔ˘ ÎÚÂÌ·ÛÙ‹Ú· ηٷÚÁË̤ӷ. §fiÁˆ ÙˆÓ·ÓˆÙ¤Úˆ ¤ÁÈÓ Ӥ· ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË, ËÔÔ›· ¤‰ÂÈÍÂ: ÏÂ˘Î¿: 172/mm3 (¶: 52%, §: 48%),χΈ̷: <20 mg/dl, ÁÏ˘Îfi˙Ë: 78 mg/dl (ÁÏ˘Îfi˙ËÔÚÔ‡: 102 mg/dl). ™ÙËÓ PCR ∂¡À ·ÓȯÓ‡ıËΠÁÂ-ÓÂÙÈÎfi ˘ÏÈÎfi ·‰ÂÓÔ˚Ô‡ ÔÌ¿‰·˜ B1, ÂÓÒ ÁÈ· EBV,CMV, HSV-1, HSV-2, ÂÓÙÂÚÔ˚Ô‡˜ Ë PCR ‹Ù·Ó ·Ú-ÓËÙÈ΋, ÔÏÈÁÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ∂¡À ·ÚÓËÙÈο.OÈ ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ∂¡À Î·È ÔÚÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ-Τ˜, ÙÔ C3 ÔÚÔ‡ ·˘ÍË̤ÓÔ Î·È ÙÔ C4 Ê˘ÛÈÔÏÔÁÈÎfi.OÈ ÔÚÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ÁÈ· Ì˘ÎfiÏ·ÛÌ·,Coxsackie, ECHO, Coxiella burnetti, HSV1, HSV2,CMV, EBV, Helicobacter pylori Î·È ÁÈ· ÚÈΤÙÛȘ‹Ù·Ó ·ÚÓËÙÈΤ˜. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ·-ÚÔ˘Û›·˙ ‰È¿ÁÚ·ÌÌ· ÂÁÚ‹ÁÔÚÛ˘ ÂÏ·ÊÚ¿ ‚Ú·‰˘Ú-Ú˘ıÌÈÎfi ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡. ªÂ ÙËÓ ˘Ô-„›· Ù˘ ÂÁÎÂÊ·Ï›Ùȉ·˜, ÚÔÛÙ¤ıËΠÛÙË ıÂڷ›··Î˘ÎÏÔ‚›ÚË ÂÓ‰ÔÊÏ‚›ˆ˜. ¢‡Ô 24ˆÚ· ·ÚÁfiÙÂÚ·,ÂÂȉ‹ Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ‰ÂÓ ÂÌÊ¿ÓÈ˙ ‚ÂÏÙ›ˆÛËÙ˘ ÎÏÈÓÈ΋˜ ÙÔ˘ ÂÈÎfiÓ·˜, ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·-Ê›· (CT), Ë ÔÔ›· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ì·ÁÓËÙÈ΋ÙÔÌÔÁÚ·Ê›· (MRI) ÂÁΤʷÏÔ˘, Ë ÔÔ›· ¤‰ÂÈÍ ·-ıÔÏÔÁÈ΋˜ ¤ÓÙ·Û˘ Û‹Ì· (∂ÈÎfiÓ· 1) Û ¤ÏÈΘ ÙÔ˘ÊÏÔÈÔ‡ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÌÂوȷ›Ô˘ Î·È ÙÔ˘ ‰ÂÍÈÔ‡‚ÚÂÁÌ·ÙÈÎÔ‡ ÏÔ‚Ô‡, ÔÈ Ôԛ˜ ÂÚÈ‚¿ÏÏÔÓÙ·Ó ·fiÌÈÎÚÔ‡ ‚·ıÌÔ‡ ÂÚÈÂÛÙÈ·Îfi Ô›‰ËÌ·, ÌÂÙ¿ ‰Â ÙË ¯Ô-Ú‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈ΋˜ Ô˘Û›·˜ ·ÚÔ˘Û›·˙·Ó ÏÂÙÔ-ÌËÓÈÁÁÈ΋ ÚfiÛÏË„Ë. ∂Ûٛ˜ ·ıÔÏÔÁÈÎÔ‡ Ì·ÁÓË-ÙÈÎÔ‡ Û‹Ì·ÙÔ˜ ˘‹Ú¯·Ó ›Û˘, ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈ-ÛÊ·›ÚÈÔ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜. ∞˘Ù¿ Ù· ·ÂÈÎÔÓÈÛÙÈ-ο Â˘Ú‹Ì·Ù· ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ·ÏÏÔÈÒÛÂȘ ÊÏÂÁ-ÌÔÓÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜. ∏ MRI ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡, Ô‰‹ÁËÛ·Ó ÛÙË ‰È·-ÁÓˆÛÙÈ΋ ÛΤ„Ë Ù˘ O¢∂ª. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ¯Ô-ÚËÁ‹ıËΠÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË 20 mg/kg ÁÈ· 4 Ë̤-Ú˜. ∏ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂڷ›· ‹Ù·Ó ¿ÌÂÛË, ÌÂÙ·¯Â›· Î·È Ï‹ÚË ·ÔηٿÛÙ·ÛË ÙˆÓ Ó¢ÚÔÏÔÁÈ-ÎÒÓ Û˘Ìو̿وÓ. ∆¤ÛÛÂÚȘ Ì‹Ó˜ ÌÂÙ¿, ¤ÁÈÓÂ

·ӿÏË„Ë Ù˘ MRI ÂÁΤʷÏÔ˘, Ë ÔÔ›· ‹Ù·Ó Ê˘-ÛÈÔÏÔÁÈ΋ (∂ÈÎfiÓ· 2). ¢¤Î· ÔÎÙÒ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, ÙÔ ·È‰› ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ›-Ó·È ··ÏÏ·Á̤ÓÔ ·fi Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù·.

™˘˙‹ÙËÛË

ªÔÏÔÓfiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÎÏÈÓÈο ‹ ¿ÏÏ· ÎÚÈÙ‹-ÚÈ· Ô˘ Ó· ‰È·ÛÊ·Ï›˙Ô˘Ó ·Ôχو˜ ÙË ‰È¿ÁÓˆÛËÙ˘ O¢∂ª, Ô ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ - Ì‚¿ÛË ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÓfiÛËÛ‹ ÙÔ˘ ·fi ÈÔÁÂÓ‹Ïԛ̈ÍË, ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ÂÚÁ·ÛÙË-Úȷο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· - ıˆڋıËΠfiÙȤ·Û¯Â ·fi O¢∂ª. ∏ ·Ó›¯Ó¢ÛË ÙÔ˘ ·‰ÂÓÔ˚Ô‡ µ1

ÛÙÔ ∂¡À Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ Ófi-ÛÔ˘, ·Ó Î·È ·˘Ùfi˜ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ˘˜ ·ÈÙÈÔÏÔÁÈ-ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.

O ˘ÚÂÙfi˜, Ë ˆ¯ÚfiÙËÙ·, Ë ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ηٿÛÙ·ÛË Î·È Ë ÔÏÏ·ÏfiÙËÙ· ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓÂΉËÏÒÛˆÓ, fiˆ˜ Ë ·˘¯ÂÓÈ΋ ‰˘Ûη̄›·, Ë ·Ê·-Û›· Î·È Ë ·Ù·Í›· Ô˘ ·ÚÔ˘Û›·˙ ÙÔ ·È‰›, Â›Ó·È Ù·Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ· Û˘ÌÙÒÌ·Ù· Ù˘ O¢∂ªÛ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜. ∏ ÌÈÎÚ‹ ËÏÈΛ· Î·È Ë Ï‹Ú˘ÎÏÈÓÈ΋ ·ÔηٿÛÙ·ÛË ÌÂÙ¿ ‰‡Ô ¯ÚfiÓÈ· ·Ú·ÎÔ-ÏÔ‡ıËÛ˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÌÔÓÔÊ·ÛÈ΋˜ÌÔÚÊ‹˜ Ù˘ ÓfiÛÔ˘, ·fi ÙËÓ ÔÔ›· ¤·Û¯Â ÙÔ ·È‰›(3,5,6).

∏ ·‡ÍËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÙÔ˘·È‰ÈÔ‡ (480/mm3) Î·È Ë ·Ô˘Û›· ÔÏÈÁÔÎψÓÈÎÒÓ·ÓÙÈÛˆÌ¿ÙˆÓ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ‰È¿ÁÓˆÛË Ù˘O¢∂ª, ·ÊÔ‡ Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·Ó¢ڛÛÎÂÙ·ÈÏÂÈÔ·ÙÙˆÛË ÛÙÔ ∂¡À Û ÔÛÔÛÙfi 71-75% ηÈÔÏÈÁÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· Û ÔÛÔÛÙfi ÌfiÓÔ 6%.∂›Û˘, ÙÔ ÂÏ·ÊÚ¿ ‚Ú·‰˘ÚÚ˘ıÌÈÎfi ÂÁÎÂÊ·ÏÔÁÚ¿-ÊËÌ· Â›Ó·È Û˘Ì‚·Ùfi Ì ÙË ‰È¿ÁÓˆÛË Ù˘ O¢∂ª(3,5,6).

∏ Ê˘ÛÈÔÏÔÁÈ΋ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ‰È¿-ÁÓˆÛË Ù˘ O¢∂ª. ™ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ÂÁÎÂÊ¿ÏÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙȘ ∆2 ·ÎÔÏÔ˘ı›Â˜ ‰È¿-¯˘Ù˜, ÔÏϷϤ˜, ·Û‡ÌÌÂÙÚ˜, ·ÌÊÔÙÂÚfiÏ¢Ú˜,·ÔÌ˘ÂÏÈÓˆÙÈΤ˜ ‚Ï¿‚˜, ÂÓÙÔ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÏ¢΋ Î·È ÏÈÁfiÙÂÚÔ ÛÙË Ê·È¿ Ô˘Û›·, ÂÓÒ Ôχ Û˘-¯Ó¿ Û˘ÌÌÂÙ¤¯ÂÈ Ë ·ÚÂÁÎÂÊ·Ï›‰·. ∏ ·Ô˘Û›· ·-ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·Ù¤ÛÛÂÚȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· Î·È Ë ÌË ‡·ÚÍË ÎÏÈÓÈÎÒÓÂΉËÏÒÛÂˆÓ ÌÂÙ¿ 1,5 ¯ÚfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÂÓÈ-Û¯‡Ô˘Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ (3,5-7).

∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ·Ú¯Èο, ÂÚÈÂÏ¿Ì‚·ÓÂÙËÓ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË, ÙË Ï‹„Ë Ê·Ú̿ΈÓ,ÙË ‚·ÎÙËÚȉȷ΋ ‹ ÈÔÁÂÓ‹ ÌËÓÈÁÁ›Ùȉ·, ÙËÓ ÈÔÁÂÓ‹ÂÁÎÂÊ·Ï›Ùȉ·, ÙËÓ ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·, ÌÂÙ·‚ÔÏÈÎ¿Î·È ·ÁÁÂȷο ÓÔÛ‹Ì·Ù·, ÙÔ Û‡Ó‰ÚÔÌÔ Guillain-BarreÎ·È Î˘Ú›ˆ˜ ÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ͽη˜ (™¶). ∏ ÙÂ-ÏÂ˘Ù·›· ÚÔÛ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿,

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71∞ÔÌfiÓˆÛË ·‰ÂÓÔ˚Ô‡ µ1 ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·

¶·È‰È·ÙÚÈ΋ 2005;68:69-72

Ù· ÔÔ›· ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÚÂÙfi, ·˘¯ÂÓÈ΋ ‰˘-

Ûη̄›·, ÎÂÊ·Ï·ÏÁ›· ‹ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂȤ‰Ô˘

Û˘Ó›‰ËÛ˘ ÛÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘. ™˘Ó‹ıˆ˜ ·ÚÔ˘-

ÛÈ¿˙ÂÙ·È ˆ˜ ÌÔÓÔÛ˘Ìو̷ÙÈ΋ Û˘Ó‰ÚÔÌ‹, .¯.

ÔÙÈ΋ Ó¢ڛÙȘ Î·È Î˘Ú›ˆ˜ Ì ˘ÔÙÚÔ¤˜. ™Â ÂÚÈ-

ÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙ› ˆ˜ O¢∂ª fiÙ·Ó

˘ÔÙÚÔÈ¿ÛÔ˘Ó ¤ÍÈ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ÂÈÛ‚ÔÏ‹ Ù˘ Ófi-

ÛÔ˘, Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ÛÔ‚·Ú¿ ÙÔ ÂӉ¯fiÌÂÓÔ

Ù˘ ™¶. ∞ÓÙ›ıÂÙ·, ˘ÔÙÚÔ¤˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Óˆ-

Ú›ÙÂÚ· ÙˆÓ ¤ÍÈ ÌËÓÒÓ ‹ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂÚ·-

›·˜ Ì ÎÔÚÙÈÎÔÂȉ‹ ·ÔÙÂÏÔ‡Ó ¤Ó‰ÂÈÍË ÔÏ˘Ê·-

ÛÈ΋˜ O¢∂ª. OÈ ·ÔÌ˘ÂÏÈÓˆÙÈΤ˜ ‚Ï¿‚˜ Ù˘ ™¶

ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Â›Ó·È ÌÈÎÚfiÙÂÚ˜, ÂÚÈÛ-

ÛfiÙÂÚÔ Û˘ÌÌÂÙÚÈΤ˜ Î·È ‰È·ÊÔÚÂÙÈ΋˜ ËÏÈΛ·˜, ÂÓÒ

Ê·›ÓÔÓÙ·È Î·Ï‡ÙÂÚ· ÛÙȘ ∆1 ·ÎÔÏÔ˘ı›Â˜.

∏ O¢∂ª ıˆÚÂ›Ù·È ÌÂÙ·ÏÔÈÌ҉˘ ‹ ·Ú·ÏÔÈ-

Ì҉˘ ‰ÈÂÚÁ·Û›·, Ë ÔÔ›· Èı·Ófiٷٷ ‰ÈÂÁ›ÚÂÈ

·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, Ô‰ËÁÒÓÙ·˜ ¤ÙÛÈ ÛÂ

·ÔÌ˘ÂϛӈÛË Î‡ÙÙ·Ú· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡

Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ¿Ô„Ë ·˘Ù‹ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi

ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ Ë Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ›ӷÈ

ÌÂÁ·Ï‡ÙÂÚË ÙÔÓ ¯ÂÈÌÒÓ· Î·È ÙËÓ ¿ÓÔÈÍË, ÂÔ¯¤˜

¤Í·ÚÛ˘ ÙˆÓ ÈÒÛÂˆÓ Î·È fiÙÈ Û ÔÛÔÛÙfi 75% Ù˘

ÓfiÛÔ˘ Û˘¯Ó¿ ÚÔËÁÂ›Ù·È ÈÔÁÂÓ‹˜ ‹ ‚·ÎÙËÚȷ΋ ÏÔ›-

̈ÍË ‹ ÂÌ‚ÔÏÈ·ÛÌfi˜. ™‡Ìʈӷ Ì ÙË ıˆڛ· ·˘Ù‹,

ÚˆÙ½Ó˜ ÙˆÓ ÔÏÈÁÔ‰ÂÓ‰ÚÔ΢ÙÙ¿ÚˆÓ, .¯. Ë Ì˘Â-

Ï›ÓË, ¤¯Ô˘Ó ·ÚfiÌÔÈÔ˘˜ ·ÓÙÈÁÔÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜

Ì ‚·ÎÙ‹ÚÈ· ‹ ÂÌ‚fiÏÈ·. ŒÙÛÈ, Ë ·¿ÓÙËÛË ÙÔ˘ ÔÚ-

Á·ÓÈÛÌÔ‡ Ì ·Ú·ÁˆÁ‹ ·ÓÙÈ-ÈÈÎÒÓ ‹ ·ÓÙÈ‚·ÎÙËÚÈ·-

ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Â›Ó·È ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË Î·È ÛÙÚ¤-

ÊÂÙ·È Ù·˘Ùfi¯ÚÔÓ· ¤Ó·ÓÙÈ ÙÔ˘ ÂÚÈ‚Ï‹Ì·ÙÔ˜ ÙˆÓ

Ó¢ÚÈÎÒÓ ÈÓÒÓ, ‰ËÏ·‰‹ Ù˘ Ì˘ÂÏ›Ó˘, Ô‰ËÁÒÓÙ·˜

Û ·ÔÌ˘ÂϛӈÛË ÙˆÓ Ó¢ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (8).

∂Ì‚fiÏÈ· Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Â›Ó·È ÙÔ BCG, Ù˘

∂∂ÈÈÎÎfifiÓÓ·· 11.. MRI ÂÁÎÂÊ¿ÏÔ˘, ÔÈ Ôԛ˜ ‰Â›¯ÓÔ˘Ó ÂÛٛ˜ ·ıÔÏÔÁÈÎÔ‡ Û‹Ì·ÙÔ˜ (‚¤ÏË) ÛÙÔÓ ÊÏÔÈfi Î·È ÙËÓ ·ÚÂÁÎÂÊ·Ï›‰·.

∂∂ÈÈÎÎfifiÓÓ·· 22.. ªRI ÂÁÎÂÊ¿ÏÔ˘ 4 Ì‹Ó˜ ÌÂÙ¿ ÙË ıÂڷ›·. ∞Ô˘Û›· ·ıÔÏÔÁÈÎÔ‡ Û‹Ì·ÙÔ˜.

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72 ¶. ¶Ô˘ÏfiÔ˘ÏÔ˜ Î·È Û˘Ó.

ÈÏ·Ú¿˜, Ù˘ ÂÚ˘ıÚ¿˜, Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ ∞ Î·È C, Ù˘ȷˆÓÈ΋˜ ÂÁÎÂÊ·Ï›Ùȉ·˜, Ù˘ ¢ÏÔÁÈ¿˜ Î·È Ù˘χÛÛ·˜. ∞fi ÈÔ‡˜, ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ·˘ÙÔ› Ù˘·ÓÂÌ¢ÏÔÁÈ¿˜, Ù˘ ÈÏ·Ú¿˜, Ù˘ Ë·Ù›Ùȉ·˜ ∞ Î·È µ,ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡, ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ·, ÙÔ˘HIV, Ù˘ Áڛ˘, Ù˘ ·Ú·Áڛ˘, Coxsackie, ÎÔ-ÚˆÓ·˚fi˜, Ebstein-Barr. µ·ÎÙËÚ›‰È· Ô˘ ÂÓÔ¯ÔÔÈ-Ô‡ÓÙ·È Â›Ó·È ÙÔ Î·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ, Ë Û·ÏÌÔӤϷ,Ù· ¯Ï·Ì‡‰È·, ÙÔ Ì˘ÎfiÏ·ÛÌ·, ÔÈ ÚÈΤÙÛȘ, Ë ÏÂÁÈÔ-ӤϷ, Ë ÏÂÙÔÛ›ڈÛË, Ë Borrelia burgdorferi Î.¿.(4,9,10).

°ÂÓÈÎÒ˜, Ë ·ÔÌfiÓˆÛË ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÔÍ›·˜ Ê¿Û˘ Ù˘ O¢∂ª Û¿ÓÈ· ·Ó·Ê¤ÚÂÙ·È (4). OÈ·‰ÂÓÔ˚Ô› ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ˆ˜ ·È-ÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙËÓ O¢∂ª. ™Ù· ·È‰È¿ Û˘-Ó‹ıˆ˜ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È Á·ÛÙÚÂ-ÓÙÂÚÈÎfi Û‡ÛÙËÌ·, ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ ÚÔηÏÒÓÙ·˜ÂÈÂÊ˘Î›Ùȉ· Î·È ÙÔ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎfi Û‡ÛÙËÌ·ÚÔηÏÒÓÙ·˜ ΢ÛÙ›Ùȉ· Î·È ¤ÏÎË ÛÙËÓ Ô˘ÚÔÁÂÓÓË-ÙÈ΋ ÂÚÈÔ¯‹ (11). ™Ô‚·Ú¿ Ó¢ÚÔÏÔÁÈο Û‡Ó‰ÚÔÌ·¤¯Ô˘Ó ·Ô‰Ôı› Û ·‰ÂÓÔ˚Ô‡˜, fiˆ˜ ¿ÛËÙË ÌËÓÈÁ-Á›Ùȉ·, Ì˘ÂÏ›Ùȉ·, ˘ÔÍ›· ÂÛÙȷ΋ ÂÁÎÂÊ·Ï›Ùȉ·,Reye-like Û‡Ó‰ÚÔÌÔ Î·È ·ÚÔ‰È΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·.∂›Û˘, ÚÔÛ‚¿ÏÏÂÈ ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·ÛÙÔ Ï·›ÛÈÔ ÁÂÓÈÎfiÙÂÚ˘ ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘,ȉȷÈÙ¤Úˆ˜ Û ¿ÙÔÌ· Ì ·ÓÔÛÔ·Ó¿ÚÎÂÈ·. ∏ ·Ô-ÌfiÓˆÛË ·‰ÂÓÔ˚Ô‡ ÔÌ¿‰·˜ µ1 Ì ÔÔÈÔÓ‰‹ÔÙ ÙÚfi-Ô Û ·È‰È¿ Ì O¢∂ª, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ÂÚÈÁÚ¿ÊËÎÂ, ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·.∂›Û˘, ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ·ıÔÊ˘ÛÈÔÏÔÁÈÎÔ› Ì˯·-ÓÈÛÌÔ› Ô˘ Ó· ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›··‰ÂÓÔ˚ÒÓ Î·È ÔÈ ÔÔ›ÔÈ Ó· ÚÔηÏÔ‡Ó ·ÔÌ˘Âϛӈ-ÛË Û Ó¢ÚÈο ·ÙÙ·Ú· in vitro ‹ Û ÂÈÚ·Ì·Ùfi˙ˆ·.øÛÙfiÛÔ, ıˆÚÂ›Ù·È fiÙÈ ÔÈ ·‰ÂÓÔ˚Ô›, fiˆ˜ Î·È ÔÈ ¿Ï-ÏÔÈ ÈÔ›, ÌÔÚ› Ó· Â›Ó·È ÂÎÏ˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ·ÓÔ-ÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Ì ÙÂÏÈ΋ ηٿÏËÍË ÙËÓ·ÔÌ˘ÂϛӈÛË Ó¢ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ∫¡™ ηÈÙËÓ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ O¢∂ª. OˆÛ‰‹ÔÙÂ,··ÈÙÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ ÂÈ‚Â-‚·›ˆÛË ·˘Ù‹˜ Ù˘ ·Ú·Ù‹ÚËÛ˘.

™ÙË ıÂڷ›· Ù˘ O¢∂ª ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı›ÂÌÂÈÚÈο Ù· ÎÔÚÙÈÎÔÂȉ‹ Ì ηϿ ·ÔÙÂϤÛÌ·Ù·.™˘ÓÈÛÙ¿Ù·È Ë IV ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘,Û ‰fiÛË 20-30 mg/kg/Ë̤ڷ ÁÈ· ÙÚÂȘ ¤ˆ˜ ¤ÓÙÂË̤Ú˜, Ë ÔÔ›· ÌÔÚ› Ó· Û˘Ó¯ÈÛÙ› Ì ÙË ¯ÔÚ‹-ÁËÛË Ú‰ÓÈ˙ÔÏfiÓ˘, Û ‰fiÛË 2 mg/kg/Ë̤ڷ ηÈÛÙ·‰È·Î‹ Ì›ˆÛ‹ Ù˘ Û 4 ¤ˆ˜ 6 ‚‰ÔÌ¿‰Â˜, ·Ó¿-ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡. ™ÙËÓ ·-ÚÔ‡Û· ÂÚ›ÙˆÛË ÚÔÙÈÌ‹ıËΠӷ ÌË Û˘Ó¯ÈÛÙ› ËıÂڷ›· ÌÂÙ¿ ÙËÓ IV ·ÁˆÁ‹ ‰È¿ÚÎÂÈ·˜ 5 ËÌÂÚÒÓÌ Ú‰ÓÈ˙ÔÏfiÓË, ÏfiÁˆ Ù˘ ÂÍ·ÈÚÂÙÈ΋˜ ‚ÂÏÙ›ˆÛ˘Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡. ∂Ó·ÏÏ·ÎÙÈΤ˜ ıÂÚ·-›˜, fiˆ˜ Ë ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓ˘ Î·È ·ÓÔ-ÛÔÛÊ·ÈÚÈÓÒÓ ‹ Ë Ï·ÛÌ·Ê·›ÚÂÛË, ¯Ú‹˙Ô˘Ó ÂÚ·È-Ù¤Úˆ ·ÍÈÔÏfiÁËÛ˘ (3,12).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë O¢∂ª Â›Ó·È Û¯ÂÙÈο Û¿-ÓÈ· ÓfiÛÔ˜, ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÔÔ›·˜ Û˘Ì‚¿ÏÏÔ˘ÓÙÔ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓ˘ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢, ËÎÏÈÓÈ΋ ÂÈÎfiÓ· Ì ÙËÓ ÔÏÏ·ÏfiÙËÙ· ÙˆÓ Ó¢ÚÔÏÔ-ÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Î˘Ú›ˆ˜, Ë Ì·ÁÓËÙÈ΋ ÙÔ-ÌÔÁÚ·Ê›· Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù· ÛÙȘ ∆2

·ÎÔÏÔ˘ı›Â˜. ∏ Ï‹Ú˘ ·Ô‰ÚÔÌ‹ ÙˆÓ ·ıÔÏÔÁÈ-ÎÒÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ë ·Ô˘Û›· ˘ÔÙÚÔÒÓÎ·È Ë ÂÍ·Ê¿ÓÈÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙËÌ·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ‰È·ÊÔÚÔÔÈÔ‡Ó ÙËÓ O¢∂ª·fi ÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ͽη˜. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ÓfiÛÔ˘ › ÙÔ˘ ·ÚfiÓÙÔ˜ ıˆÚÂ›Ù·È fiÙÈ Â›Ó·È ÔÏ˘-·Ú·ÁÔÓÙÈ΋, Ì ÙÔ˘˜ ÁÂÓÂÙÈÎÔ‡˜ Î·È ÂÚÈ‚·ÏÏÔ-ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∏·Ó›¯Ó¢ÛË ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È ÌÂÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘. O ·‰ÂÓÔ˚fi˜ µ1, Ô ÔÔ›Ô˜ ·ÓÈ-¯Ó‡ıËΠÛÙÔ ∂¡À ÙÔ˘ ·ÛıÂÓÔ‡˜ Ù˘ ·ÚÔ‡Û·˜ÂÚ›ÙˆÛ˘, ·Ó Î·È ·ÔÙÂÏ› ÙËÓ ÚÒÙË ·Ó·ÊÔÚ¿ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ıˆÚÂ›Ù·È fiÙÈ Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Murthy SN, Faden HS, Cohen ME, Bakshi R. Acute dissemi-nated encephalomyelitis in children. Pediatrics 2002;110:e21.

2. Davis LE, Booss J. Acute disseminated encephalomyelitis inchildren: a changing picture. Pediatr Infect Dis J2003;22:829-831.

3. Stonehouse M, Gupte G, Wassmer E, Whitehouse WP. Acutedisseminated encephalomyelitis: recognition in the hands ofgeneral paediatricians. Arch Dis Child 2003;88:122-124.

4. Yeh EA, Collins A, Cohen ME, Duffner PK, Faden H. Detec-tion of coronavirus in the central nervous system of a childwith acute disseminated encephalomyelitis. Pediatrics2004;113:e73-76.

5. Dale RC, de Sousa C, Chong WK, Cox TC, Harding B,Neville BG. Acute disseminated encephalomyelitis, multi-phasic disseminated encephalomyelitis and multiple sclerosisin children. Brain 2000:123:2407-2422.

6. Hynson JL, Kornberg AJ, Coleman LT, Shield L, Harvey AS,Kean MJ. Clinical and neuroradiologic features of acute dis-seminated encephalomyelitis in children. Neurology2001;56:1308-1312.

7. Andreula CF, Recchia Luciana NMA, Milella D. Magneticresonance imaging in the diagnosis of acute disseminated en-cephalomyelitis (ADEM). Int J Neuroradiol 1997;3:21-35.

8. Pohl-Koppe A, Burchett SK, Thiele EA, Hafler DA. Myelinbasic protein reactive Th2 T cells are found in acute dissem-inated encephalomyelitis. J Neuroimmunol 1998;91:19-27.

9. Voudris KA, Vagiakou EA, Skardoutsou A. Acute dissemi-nated encephalomyelitis associated with parainfluenza virusinfection of childhood. Brain Dev 2002;24:112-114.

10. Yamamoto K, Takayanagi M, Yoshihara Y, Murata Y, Kato S,Otake M et al. Acute disseminated encephalomyelitis associ-ated with Mycoplasma pneumoniae infection. Acta PaediatrJpn 1996;38:46-51.

11. Straussberg R, Harel L, Levy Y, Amir J. A syndrome of tran-sient encephalopathy associated with adenovirus infection.Pediatrics 2001;107:E69.

12. Straub J, Chofflon M, Delavelle J. Early high-dose intravenousmethylprednisolone in acute disseminated encephalomyelitis:a successful recovery. Neurology 1997;49:1145-1147.

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73CASE REPORT

Isolation of adenovirus B1 in the CNS in

a 6.5 year-old boy with acute disseminated

encephalomyelitis

P. Poulopoulos, A. Messaritaki, K. Kotsonis, K. Prountzou - Kassiou

Abstract

The case of a 6.5 year-old boy with acute disseminated encephalomyelitis is reported. Diagnosis was mainlybased on the clinical presentation, the CSF findings and the specific findings of the brain MRI. The isolationof adenovirus B1 from the CSF through the PCR technique during the acute phase of the disease, may implythe involvement of adenovirus B1 in the pathogenesis of the disease in humans.

Key words

Acute disseminated encephalomyelitis, ADEM, adenovirus, children.

1st Paediatric Clinic, “Aghia Sophia” Children’sHospital, Athens

Correspondence:

Kosmas Kotsonis1st Paediatric Clinic, “Aghia Sophia” Children’sHospital, Athens

Date of submission: 20-01-2004 Date of approval: 15-11-2004

Paediatriki 2005;68:73

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74 ∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

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OÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Û ·ÛıÂÓ›˜ Ì η-ÎÔ‹ıË ÓÔÛ‹Ì·Ù·. OÈ ·Û¤ÚÁÈÏÏÔÈ ·ÔÙÂÏÔ‡Ó ÙË ‰Â‡ÙÂÚË ·ÈÙ›· Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Û ·ÓÔÛÔηÙÂ-ÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜, fiˆ˜ Ù· ·È‰È¿ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ. ∏ ·ÛÂÚÁ›ÏψÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢-ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) ·ÔÙÂÏ› ÙËÓ ÙÚ›ÙË Û˘¯ÓfiÙÂÚË ı¤ÛË ÂÓÙfiÈÛ˘ Ù˘ Ïԛ̈͢, ÌÂÙ¿ ÙËÓ Ó¢-ÌÔÓÈ΋ Ïԛ̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ Î·È ÙËÓ ·ÛÂÚÁ›ÏψÛË ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiψÓ, ÂÓÒ Û¯ÂÙ›˙ÂÙ·È Î·È Ì¢„ËÏ‹ ıÓËÙfiÙËÙ·. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÂÚÈÙÒÛÂȘ ÙÚÈÒÓ ·È‰ÈÒÓ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· Ô˘ÂÌÊ¿ÓÈÛ·Ó ·ÛÂÚÁ›ÏψÛË ÙÔ˘ ∫¡™, ËÏÈΛ·˜ 14, 3 Î·È 2 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·. ∫·È Ù· ÙÚ›· ·È‰È¿ ‚Ú›ÛÎÔÓÙ·ÓÛ ıÂڷ›· ÂÊfi‰Ô˘ Ì ÙÔ ¯ËÌÂÈÔıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ALL-BFM ’95. ∏ ˘Ô„›· Ì˘ÎËÙÈ·ÛÈ΋˜ ÏÔ›-̈͢ ‚·Û›ÛÙËΠÛÙ· ÎÏÈÓÈο ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· (·Ú·ÙÂÈÓfiÌÂÓÔ˜ ˘ÚÂÙfi˜ >10 Ë̤Ú˜, ‰‡ÛÓÔÈ·,ÎÂÊ·Ï·ÏÁ›·, Ó¢ÚÔÏÔÁÈο ÛËÌ›·). ∏ ‰È¿ÁÓˆÛË ‚·Û›ÛÙËΠÛÙËÓ PCR ÛÙÔÓ ÔÚfi Ô˘ ·ÔÎ¿Ï˘„ ÙËÓ ·-ÚÔ˘Û›· ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ ÛÙÔ ·›Ì· fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÂÓfi˜·fi ·˘ÙÔ‡˜. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì MRI ÙÔ˘ ∫¡™ ·ÔÎ¿Ï˘„ ÔÏϷϤ˜ ÂÛٛ˜ ÛÙÔÓ ÌÂوȷ›ÔÏÔ‚fi Û ‰‡Ô ·È‰È¿ Î·È ÙËÓ ·ÚÔ˘Û›· ‚Ï¿‚˘ ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÏÔ‚Ô‡ Ì ÎÂÓÙÚÈ΋ Ó¤ÎÚˆÛË Î·È Â·Îfi-ÏÔ˘ıÔ Ô›‰ËÌ· ÛÙÔ ÙÚ›ÙÔ. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹ Ì ÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË µÁÈ· 4, 12 Î·È 8 Ì‹Ó˜, ·ÓÙ›ÛÙÔȯ·. ™Â Ù·ÎÙÈÎfi ·ӤÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠ‚ÂÏÙ›ˆÛË ÙfiÛÔ ÙˆÓ ·ÎÙÈÓÔÏÔÁÈ-ÎÒÓ fiÛÔ Î·È ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û 2 ·È‰È¿ Î·È ¤ÁÈÓ ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÌ˘ÎËÙÈ·-ÛÈ΋˜ ·ÁˆÁ‹˜. ∆Ô ÙÚ›ÙÔ ·È‰› η٤ÏËÍ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û‡Ìʈӷ ÌÂÙ· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ë ·ÛÂÚÁ›ÏψÛË ÙÔ˘ ∫¡™ ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜Î·È ıÓËÙfiÙËÙ·˜ Û ·È‰È¿ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ. ∏ ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋˜ ıÂÚ·-›·˜ Î·È Ë ¯ÔÚ‹ÁËÛ‹ Ù˘ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÌÔÚÔ‡Ó Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË Ì›ˆÛË Ù˘ ıÓËÙfi-ÙËÙ·˜ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜.

§¤ÍÂȘ ÎÏÂȉȿ

AÛÂÚÁ›ÏψÛË ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·, ·È‰È΋ ËÏÈΛ·.

∂ÈÛ·ÁˆÁ‹

OÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÛËÌ·-ÓÙÈÎfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Û ·ÛıÂ-Ó›˜ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù·. OÈ Î˘ÚÈfiÙÂÚÔÈ ·Ú¿-ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ÏÔÈÌÒÍÂȘ ÛÙÔ˘˜·ÛıÂÓ›˜ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ ›ӷÈ: ·) Ô ‚·ıÌfi˜ Î·È Ë ‰È¿ÚÎÂÈ· Ù˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜, Ô˘ÚÔηÏÂ›Ù·È ·fi ÙË ¯ËÌÂÈÔıÂڷ›·, ‚) Ë ‰È·Ù·-Ú·¯‹ Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜, Á) Ë ‰È·Ù·Ú·¯‹ Ù˘¯˘ÌÈ΋˜ ·ÓÔÛ›·˜, ‰) ÔÈ ‚Ï¿‚˜ ÙˆÓ ·Ó·ÙÔÌÈÎÒÓÊÚ·ÁÌÒÓ Î·È Â) ÔÈ ıÂڷ¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ(ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ΢ÙÙ·ÚÔÛÙ·ÙÈο, ·ÎÙÈÓÔ‚Ô-Ï›·) (1). O Aspergillus spp. ·ÔÙÂÏ› ÙÔ ‰Â‡ÙÂÚÔ·›ÙÈÔ Ì˘ÎËÙÈ¿Ûˆ˜, ÌÂÙ¿ ÙËÓ Candida, Û ·ÓÔÛÔ-ηÙÂÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜, fiˆ˜ Ù· ·È‰È¿ Ô˘¿Û¯Ô˘Ó ·fi ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ (2). O Aspergillus fumigatus Â›Ó·È ˘Â‡ı˘ÓÔ˜ ÁÈ· ÙÔ

80% ÙˆÓ ÂÓ Ùˆ ‚¿ıÂÈ ˘ÊÔÌ˘ÎËÙÈ¿ÛˆÓ, ÂÓÒ Ô

Aspergillus flavus ÚÔηÏ› Û˘¯ÓfiÙÂÚ· ÏÔÈÌÒÍÂȘ

Ù˘ ÚÈÓfi˜ Î·È ÙˆÓ ·Ú·ÚÚ›ÓÈˆÓ ÎfiψÓ. ¶ÚfiÛÊ·-

Ù˜ ÌÂϤÙ˜ ·¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÛÂÚÁ›ÏψÛË

·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ıÓËÙfiÙËÙ·˜ Û˘ÁÎÚÈ-

ÙÈο Ì ÙËÓ Î·ÓÙÈÓÙ›·ÛË (2,3). ∏ Ó¢ÌÔÓÈ΋ ÏÔ›-

̈ÍË ·fi ·Û¤ÚÁÈÏÏÔ ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË

ÂÓÙfiÈÛË, Ì ‰Â‡ÙÂÚË ÙËÓ ·ÛÂÚÁ›ÏψÛË ÙˆÓ ·-

Ú·ÚÚ›ÓÈˆÓ ÎfiψÓ. ∏ ·ÛÂÚÁ›ÏψÛË ÙÔ˘ ∫¡™

·ÔÙÂÏ› ÙËÓ ÙÚ›ÙË Û˘¯ÓfiÙÂÚË ı¤ÛË ÂÓÙfiÈÛ˘

Î·È Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏ‹ ıÓËÙfiÙËÙ·, Ô˘ ÏËÛÈ¿-

˙ÂÈ ÙÔ 85-90% (3,4). ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÙÚÂȘ ÂÚÈ-

ÙÒÛÂȘ ·È‰ÈÒÓ Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋

Ï¢¯·ÈÌ›· (O§§), ËÏÈΛ·˜ 14, 3 Î·È 2 ÂÙÒÓ ·ÓÙ›-

ÛÙÔȯ·, Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·ÛÂÚÁ›ÏψÛË ÙÔ˘ ∫¡™.

∫·È Ù· ÙÚ›· ·È‰È¿ ‚Ú›ÛÎÔÓÙ·Ó Û ıÂڷ›· ÂÊfi-

‰Ô˘ Ì ÙÔ ¯ËÌÂÈÔıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ALL-

BFM ’95.

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75∞ÛÂÚÁ›ÏψÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛˆÓ

¶ÂÚ›ÙˆÛË ÚÒÙË

∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 14 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋

ÏfiÁˆ ·Á΢ÙÙ·ÚÔÂÓ›·˜. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο ¢-

Ú‹Ì·Ù· Î·È ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ-

¯Ô Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ O§§ Î·È ¿Ú¯ÈÛ ıÂÚ·-

›· Ì ÙÔ ¯ËÌÂÈÔıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ALL-

BFM ’95. ¢‡Ô Ì‹Ó˜ ·ÚÁfiÙÂÚ·, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘-

Û›·Û ÂÂÈÛfi‰ÈÔ Â̇ÚÂÙ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜

(·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ <500/mm3)

‰È¿ÚÎÂÈ·˜ >10 ËÌÂÚÒÓ. ∏ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔ-

Á›· ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi ˘„ËÏ‹ ˘ÚÂÙÈ΋ ΛÓËÛË

(ıÂÚÌÔÎÚ·Û›· >39ÔC), ‰‡ÛÓÔÈ·, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜,

¤ÓÙÔÓË ÎÂÊ·Ï·ÏÁ›· Î·È Â̤ÙÔ˘˜. O ·ÂÈÎÔÓÈÛÙÈ-

Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠ̠MRI ÙÔ˘ ∫¡™

·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· ÂÛÙȷ΋˜ ‚Ï¿‚˘ ÛÙË

‰ÂÍÈ¿ ÌÂوȷ›· ¯ÒÚ·, Ô˘ ·ÚÔ˘Û›·˙ ÛÙÈÎÙfi

ÂÌÏÔ˘ÙÈÛÌfi (∂ÈÎfiÓ· 1), ÂÓÒ Ë PCR ·ÔÎ¿Ï˘„Â

ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘

ÛÙÔ ·›Ì·. ∆Ô ·È‰› ¤Ï·‚ ·ÁˆÁ‹ Ì ÏÈÔÛˆÌÈ΋

·ÌÊÔÙÂÚÈΛÓË µ. ∆ÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘

·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜, ÙÔ ÎÔÚ›ÙÛÈ ‹Ù·Ó Û η-

Ï‹ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ™Â Ù·ÎÙÈÎfi ·ӤÏÂÁ¯Ô ÌÂ

MRI ÂÁÎÂÊ¿ÏÔ˘, ‰È·ÈÛÙÒıËΠ·Ô˘Û›· ÙˆÓ ·-

ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ŒÁÈÓ ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÌ˘-

ÎËÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜, ·ÏÏ¿ 10 Ë̤Ú˜ ·ÚÁfiÙÂÚ· Ë

·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÙËÓ ·Ú¯È΋ Û˘Ìو̷ÙÔÏÔ-

Á›· (˘ÚÂÙfi˜, ‰‡ÛÓÔÈ·, ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜). ∆¤ıËÎÂ

ÂÎ Ó¤Ô˘ Û ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹, fï˜ ÛÙË Û˘-

Ó¤¯ÂÈ·, ÏfiÁˆ Âȉ›ӈÛ˘ Ù˘ ÎÏÈÓÈ΋˜ ηٿÛÙ·-

Û˘, ‰È·ÎÔÌ›ÛÙËΠÛÙË ª∂¡ ¶·›‰ˆÓ, fiÔ˘ η٤-

ÏËÍ 10 Ë̤Ú˜ ·ÚÁfiÙÂÚ·.

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË

∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 2 ÂÙÒÓ, Ì ۇӉÚÔÌÔ Down,ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÏfiÁˆ ·Ó·ÈÌ›·˜, ıÚÔÌ‚ÔÂ-Ó›·˜ Î·È ˘ÚÂÙÔ‡. ∞fi ÙÔÓ ¤ÏÂÁ¯Ô Ô˘ ‰ÈÂÓÂÚÁ‹-ıËÎÂ, Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË O§§ Î·È ¿Ú¯ÈÛ ıÂÚ·-›· Ì ÙÔ ÚˆÙfiÎÔÏÏÔ ALL-BFM ’95. ∫·Ù¿ ÙˉȿÚÎÂÈ· Ù˘ Ê¿Û˘ ÂÊfi‰Ô˘, ·ÚÔ˘Û›·Û ÂÂÈÛfi-‰ÈÔ Â̇ÚÂÙ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ ‰È¿ÚÎÂÈ·˜ >10ËÌÂÚÒÓ, Â̤ÙÔ˘˜ Î·È ÎÂÊ·Ï·ÏÁ›·. ∞fi ÙÔÓ ¤ÏÂÁ¯ÔÔ˘ ‰ÈÂÓÂÚÁ‹ıËΠ٤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ·ÛÂÚ-Á›ÏψÛ˘ (‡ÚÂÛË ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ ·Û¤ÚÁÈÏ-ÏÔ˘ Ì PCR ÛÙÔ ·›Ì· Î·È ÛÙÔ ∂¡À). O ·ÂÈÎÔÓÈ-ÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì MRI ÙÔ˘ ∫¡™ ·ÔÎ¿Ï˘„ ‰È·-Ù·Ú·¯‹ ÙˆÓ ‚·ÛÈÎÒÓ ÁÚ·ÌÌÒÓ Ù˘ ‚¿Û˘ ÙÔ˘ ÎÚ·-Ó›Ô˘, ·ÚÔ˘Û›· ÁÏÔȈÙÈ΋˜ ÂÛÙ›·˜ ÛÙË Á¤Ê˘Ú· ÎÂ-ÓÙÚÈο Î·È ÛÙÔÓ ÚÔÌ‹ÎË Ì˘ÂÏfi Î·È ·ÚÔ˘Û›·ÔÏÏ·ÏÒÓ ·ÔÛÙËÌ·Ù›ˆÓ ¢ηÈÚȷ΋˜ Ïԛ̈͢ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· ¿Ìʈ (∂ÈÎfiÓ˜ 2, 3,4). ∆Ô ·È‰› Ù¤ıËΠ۠·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹ ÌÂÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË µ, Ë ÔÔ›· Û˘Ó¯›ÛÙËÎÂÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 8 ÌËÓÒÓ, ̤¯ÚÈ ÙË ‚ÂÏÙ›ˆÛËÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿-ÙˆÓ Î·È ÙËÓ Ï‹ÚË ‡ÊÂÛË Ù˘ ÎÏÈÓÈ΋˜ Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›·˜. ™‹ÌÂÚ·, ÙÔ ÎÔÚ›ÙÛÈ ‚Ú›ÛÎÂÙ·È Û ηϋÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ·ÎÔÏÔ˘ı› ÙË Ê¿ÛË Û˘ÓÙ‹-ÚËÛ˘ ÙÔ˘ ÚˆÙÔÎfiÏÏÔ˘.

¶ÂÚ›ÙˆÛË ÙÚ›ÙË

∞ÁfiÚÈ ËÏÈΛ·˜ 3 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ïfi-Áˆ ˘ÚÂÙÔ‡ Î·È ·Á΢ÙÙ·ÚÔÂÓ›·˜. ªÂ ‚¿ÛË ÙËÓÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ô˘‰ÈÂÓÂÚÁ‹ıËÎÂ, Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ O§§ Î·È ¿Ú-¯ÈÛ ıÂڷ›· Ì ÙÔ ÚˆÙfiÎÔÏÏÔ ALL-BFM ’95.ŒÓ·Ó Ì‹Ó· ·ÚÁfiÙÂÚ·, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ÂÂÈ-Ûfi‰ÈÔ Â̇ÚÂÙ˘ Ô˘‰ÂÙÂÚÔÂÓ›·˜ Î·È Û˘Ìو̷-ÙÔÏÔÁ›· ·fiÊڷ͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡.§fiÁˆ Ù˘ ·Ú¿Ù·Û˘ Ù˘ Â̇ÚÂÙ˘ Ô˘‰ÂÙÂÚÔÂ-Ó›·˜, ¤Ï·‚ ÂÌÂÈÚÈ΋ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ¯ËÌÂÈÔÚÔ-Ê˘Ï·ÎÙÈ΋ ·ÁˆÁ‹ Ì ÏÈÔÛˆÌÈ΋ ·ÌÊÔÙÂÚÈΛÓË µ.∏ ‰È¿ÁÓˆÛË Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ Ù¤-ıËΠ̠‚¿ÛË Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Ù˘ CTıÒÚ·ÎÔ˜ Î·È Ù˘ MRI ÂÁÎÂÊ¿ÏÔ˘, ηıÒ˜ ›ÛË˜Î·È Ù˘ PCR, Ë ÔÔ›· ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›·ÙÔ˘ ÁÂÓÒÌ·ÙÔ˜ ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ ÛÙÔ ·›Ì·. ∏ MRIÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„ ÙËÓ ·ÚÔ˘Û›· ÂÛÙ›·˜ Ì ‰·-ÎÙ˘ÏÈÔÂȉ‹ ÂÌÏÔ˘ÙÈÛÌfi ÛÙÔÓ ıfiÏÔ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡‚ÚÂÁÌ·ÙÈÎÔ‡ ÏÔ‚Ô‡ (ÂÓÙfiÈÛË ·ÛÂÚÁÈÏÏÒÌ·ÙÔ˜ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ·Ú¤Á¯˘Ì·) (∂ÈÎfiÓ· 5). ™Â Ù·ÎÙÈ-ÎÔ‡˜ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ˘˜ ·ӤÏÂÁ¯Ô˘˜ Ô˘ ‰ÈÂ-ÓÂÚÁ‹ıËÎ·Ó Î¿ı 2 Ì‹Ó˜, ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ-΋ ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ô˘ -ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ‡ÊÂÛË Ù˘ ÎÏÈÓÈ΋˜ Û˘ÌÙˆ-Ì·ÙÔÏÔÁ›·˜ - Ô‰‹ÁËÛ ÛÙË ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÌ˘ÎË-ÙÈ·ÛÈ΋˜ ·ÁˆÁ‹˜ 12 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍ‹ Ù˘. ∆Էȉ›, Û‹ÌÂÚ·, ¤¯ÂÈ ÔÏÔÎÏËÚÒÛÂÈ ÙË ¯ËÌÂÈÔıÂÚ·-›· ÂÊfi‰Ô˘ Î·È ‚Ú›ÛÎÂÙ·È ÛÙË Ê¿ÛË Û˘ÓÙ‹ÚËÛ˘.

¶·È‰È·ÙÚÈ΋ 2005;68:74-78

∂∂ÈÈÎÎfifiÓÓ·· 11.. ¶·ÚÔ˘Û›· ÂÛÙȷ΋˜ ÌÔÓ‹ÚÔ˘˜ ‚Ï¿‚˘ ÌÂوȷ›· ‰Â-ÍÈ¿ Ì ÛÙÈÎÙfi ÂÌÏÔ˘ÙÈÛÌfi.

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76 º. ∞ı·Ó·ÛÈ¿‰Ô˘ Î·È Û˘Ó.

™˘˙‹ÙËÛË

OÈ Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈ-

Îfi ·›ÙÈÔ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÙfiÙËÙ·˜ Û ·ÛıÂÓ›˜

Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ, ȉȷ›ÙÂÚ· ÌÂÙ¿ ÙËÓ

¢Ú›· ·Ô‰Ô¯‹ Î·È ̄ Ú‹ÛË Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÓÙÈ-

ÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜, Ô˘ ‚ÂÏÙ›ˆÛ ÛËÌ·ÓÙÈο ÙËÓÂÈ‚›ˆÛË ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ. ∞Ú¯Èο, Ë Candida·ÔÙÂÏÔ‡Û ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈ-ÌÒ͈Ó. ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, fï˜, ¿ÏÏÔÈ ÌÈ-ÎÚÔÔÚÁ·ÓÈÛÌÔ› ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙË Û˘Ó¯‹·‡ÍËÛË ·˘ÙÒÓ ÙˆÓ ÏÔÈÌÒ͈Ó, Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜·fi ÙÔ˘˜ ÔÔ›Ô˘˜ Â›Ó·È Ô ·Û¤ÚÁÈÏÏÔ˜, ÏfiÁˆ Ù˘ ·˘-ÍË̤Ó˘ Û˘¯ÓfiÙËÙ·˜ Ì ÙËÓ ÔÔ›· ηٷÁÚ¿ÊÂÙ·È(2,3). ∏ ÚÒÙË ÂÚ›ÙˆÛË Û˘ÛÙËÌ·ÙÈ΋˜ ·ÛÂÚÁ›Ï-ψÛ˘ Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ ÛÙË ‰ÈÂ-ıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÙÔ 1953, Û˘Á¯ÚfiÓˆ˜Ì ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Î·È Ù˘ ¯Ë-ÌÂÈÔıÂڷ›·˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË (5). ¶·Ú¿ ÙËÓÚfiÔ‰Ô Ô˘ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·ÙfiÛÔ ÛÙË ‰È¿ÁÓˆÛË fiÛÔ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘,Ë Û˘ÛÙËÌ·ÙÈ΋ ·ÛÂÚÁ›ÏψÛË Û˘Ó¯›˙ÂÈ Ì¤¯ÚÈ Û‹ÌÂ-Ú· Ó· ·ÔÙÂÏ› Ïԛ̈ÍË ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ Û·ÓÔÛÔηÙÂÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ (3,6).

∏ ·ÛÂÚÁ›ÏψÛË ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi Úfi‚ÏË-Ì· ÛÙÔ˘˜ Ô˘‰ÂÙÂÚÔÂÓÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È È‰È·›ÙÂÚ·Û ÂΛÓÔ˘˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÁÈ·ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, fiˆ˜ Ù· ·È‰È¿ Ù˘ ·-ÚÔ‡Û·˜ ÌÂϤÙ˘ (5,7). ™Â ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, Ë Û˘-¯ÓfiÙËÙ· Ù˘ ·ÛÂÚÁ›ÏψÛ˘ Û ·ÛıÂÓ›˜ Ì ÔÍ›·Ï¢¯·ÈÌ›· ÛÙË Ê¿ÛË ÂÊfi‰Ô˘ Ù˘ ıÂڷ›·˜, fiˆ˜ ÔÈ·ÛıÂÓ›˜ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË,·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 20-40% (3,7). ∆Ô Û˘¯ÓfiÙÂÚÔ·ıÔÁfiÓÔ Ô˘ ·ÔÌÔÓÒÓÂÙ·È Â›Ó·È Ô Aspergillusfumigatus. ÕÏÏ· ·ıÔÁfiÓ· ›‰Ë ÁÈ· ÙÔÓ ¿ÓıÚˆÔ Â›-Ó·È Ô A. terreus, Ô A. flavus, Ô A. niger Î·È Ô ∞.nidulans. ∏ Ïԛ̈ÍË ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÈÛÓÔ‹ÛfiÚˆÓ Ô˘ ·ÔÈΛ˙Ô˘Ó ÙÔ˘˜ ·Ú·ÚÚ›ÓÈÔ˘˜ ÎfiÏ-Ô˘˜ Î·È ÙÔ˘˜ Ó‡ÌÔÓ˜. O ¯ÒÚÔ˜ ÙÔ˘ ÓÔÛÔÎÔÌ›-Ô˘ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ËÁ‹ ÌÈÎÚÔÂȉËÌÈÒÓ·ÛÂÚÁ›ÏψÛ˘, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ Ôԛ˜ۯÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÎÙ¤ÏÂÛË ÔÈÎÔ‰ÔÌÈÎÒÓ ¤ÚÁˆÓ̤۷ ‹ ÎÔÓÙ¿ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∞fi ÌÂϤÙ˜ ÚÔ·-ÙÂÈ fiÙÈ Ë Û˘ÁΤÓÙÚˆÛË ÛfiÚˆÓ ·Û¤ÚÁÈÏÏÔ˘ ·˘Í¿-ÓÂÙ·È, fiÛÔ ÈÔ ÎÔÓÙ¿ ÂÎÙÂÏÔ‡ÓÙ·È ÔÈÎÔ‰ÔÌÈΤ˜ ÂÚ-Á·Û›Â˜ ÛÙ· ÙÌ‹Ì·Ù· ÓÔÛËÏ›·˜ ·ÓÔÛÔηÙÂÛÙ·Ï̤-ÓˆÓ ·ÛıÂÓÒÓ (8). ∂ÈϤÔÓ, ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ÂΉ‹ÏˆÛ˘ Ù˘ ·ÛÂÚÁ›Ï-ψÛ˘ ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÂÎÙÂÏÔ‡-ÓÙ·Ó ÔÈÎÔ‰ÔÌÈΤ˜ ÂÚÁ·Û›Â˜ ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ ¶·ÓÂÈ-ÛÙËÌ›Ô˘, ÏËÛ›ÔÓ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ∞Ã∂¶∞.

O Ó‡ÌÔÓ·˜ ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛËÙ˘ Ïԛ̈͢, Û ÔÛÔÛÙfi Ô˘ ÏËÛÈ¿˙ÂÈ ÙÔ 70%,·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ÙÔ˘˜ ·Ú·ÚÚ›ÓÈÔ˘˜ ÎfiÏÔ˘˜(15%) Î·È ÙÔ ∫¡™ (10-15%) (3). ∞fi ‰Â‰Ô̤ӷ ÌÂ-ϤÙ˘ Û 66 ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ‰ÈËıËÙÈ΋·ÛÂÚÁ›ÏψÛË Ê·›ÓÂÙ·È fiÙÈ Ë ıÓËÙfiÙËÙ· ·ÁÁ›˙ÂÈ ÙÔ90% ÛÙȘ ÂÚÈÙÒÛÂȘ ÂÓÙfiÈÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙÔ∫¡™, ÂÓÒ Ù· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ Â›Ó·È Î·Ï‡ÙÂÚ·fiÙ·Ó Ë Ïԛ̈ÍË ÂÓÙÔ›˙ÂÙ·È ÛÙÔ˘˜ Ó‡ÌÔÓ˜ ‹ÛÙÔ˘˜ ·Ú·ÚÚ›ÓÈÔ˘˜ ÎfiÏÔ˘˜ (70% Î·È 60%, ·ÓÙ›-ÛÙÔȯ·) (3,7). ∆· Û˘ÌÙÒÌ·Ù· Î·È Ù· ÛËÌ›· Ô˘

¶·È‰È·ÙÚÈ΋ 2005;68:74-78

∂∂ÈÈÎÎfifiÓÓ˜̃ 22,, 33,, 44.. ¶·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ·ÔÛÙËÌ·Ù›ˆÓ ¢ηÈ-Úȷ΋˜ Ïԛ̈͢ ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· ¿Ìʈ.

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77∞ÛÂÚÁ›ÏψÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜

Û˘¯ÓfiÙÂÚ· ·Ó·Ê¤ÚÔÓÙ·È Û ÂÚÈÙÒÛÂȘ ÂÓÙfiÈÛ˘

Ù˘ ‰ÈËıËÙÈ΋˜ ·ÛÂÚÁ›ÏψÛ˘ ÛÙÔ ∫¡™ Â›Ó·È Ë

ÎÂÊ·Ï·ÏÁ›·, Ù· ÂÛÙȷο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ô

Ï‹ı·ÚÁÔ˜, ÔÈ ¤ÌÂÙÔÈ Î·È Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂȤ‰Ô˘

Û˘Ó›‰ËÛ˘, Ù· ÔÔ›· ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ·-

ÚÔ˘Û›·˙·Ó Î·È ÔÈ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘,

ÂÎÙfi˜ ÙÔ˘ Ï‹ı·ÚÁÔ˘, Ô˘ fiˆ˜ ·Ó·Ê¤ÚÂÙ·È ·Ú·-

ÙËÚÂ›Ù·È Û ÂÚÈÙÒÛÂȘ ÔÏÏ·ÏÒÓ Î·È ÌÂÁ¿ÏˆÓ

ÂÓÙÔ›ÛÂˆÓ (3).

∏ ‰È¿ÁÓˆÛË Ù˘ ·ÛÂÚÁ›ÏψÛ˘ ÙÔ˘ ∫¡™ ‚·Û›-

˙ÂÙ·È ÛÙ· Â˘Ú‹Ì·Ù· ÙfiÛÔ ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ fiÛÔ

Î·È ÙÔ˘ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘. ∏ ˘Ô„›·

Ù˘ Ïԛ̈͢ Ù›ıÂÙ·È ·fi ÙË Ó¢ÚÔÏÔÁÈ΋ ÛËÌÂÈÔ-

ÏÔÁ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·Ú·ÙÂ-

ٷ̤ÓË Â̇ÚÂÙË Ô˘‰ÂÙÂÚÔÂÓ›·. ™ÙËÓ ÂÚ›ÙˆÛË

Ù˘ Ïԛ̈͢ ·fi ·Û¤ÚÁÈÏÏÔ, Ë ·Ô˘Û›· Ì›·˜

“ȉ·ÓÈ΋˜” ÂÚÁ·ÛÙËÚȷ΋˜ ÂͤٷÛ˘ ÁÈ· ÙËÓ ÙÂÎÌË-

Ú›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Ô‰ËÁ› ÛÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÂÈ-

ÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Ì MRI ÂÁÎÂÊ¿ÏÔ˘, Ì ÛÙfi¯Ô

fi¯È ÌfiÓÔ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ¤ÎÙ·Û˘ Î·È Ù˘ ı¤Û˘

Ù˘ ‚Ï¿‚˘, ·ÏÏ¿ Î·È Ù˘ ÙÂÎÌËÚ›ˆÛ˘ Ù˘ ‰È¿ÁÓˆ-

Û˘ (3). ªÂ ÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘ ·ÔηχÙÂÙ·È

Û˘¯ÓfiÙÂÚ· Ë ·ÚÔ˘Û›· ÌÔÓ‹ÚˆÓ ‹ ÔÏÏ·ÏÒÓ

ÂÛÙÈÒÓ Ì ÛÙÈÎÙfi ÂÌÏÔ˘ÙÈÛÌfi (3). ™·ÓÈfiÙÂÚ· ¢-

Ú‹Ì·Ù· ·fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Û ·È‰È¿ ÌÂ

·ÛÂÚÁ›ÏψÛË ∫¡™ ·ÔÙÂÏÔ‡Ó Ë ·ÚÔ˘Û›· ıÚÔÌ-

‚ˆÙÈÎÒÓ ÂÛÙÈÒÓ, ÂÌÊÚ¿ÎÙˆÓ Î·È Ô Û¯ËÌ·ÙÈÛÌfi˜

·ÔÛÙËÌ¿ÙˆÓ (3,4). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜

ÌÂϤÙ˘, Ë MRI ·ÔÎ¿Ï˘„ ÙËÓ ‡·ÚÍË ÔÏÏ·-

ÏÒÓ ÂÛÙÈÒÓ Û ‰‡Ô ·fi ·˘ÙÔ‡˜ Î·È ÙËÓ ·ÚÔ˘Û›·

ÌÔÓ‹ÚÔ˘˜ ·ÔÛÙËÌ·ÙÈ΋˜ ‚Ï¿‚˘ ÛÙÔÓ ÙÚ›ÙÔ, fiϘ

ÂÓ‰ÂÈÎÙÈΤ˜ Ïԛ̈͢ ·fi ·Û¤ÚÁÈÏÏÔ.

∞fi Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ÚÔ·ÙÂÈ

fiÙÈ Ë ·Ó‡ÚÂÛË ÙÔ˘ ̇ÎËÙ· Û ηÏÏȤÚÁÂÈ· ·›Ì·-

ÙÔ˜ ·ÔÙÂÏ› ÙÔ ‚¤‚·ÈÔ ÂÚÁ·ÛÙËÚÈ·Îfi ÎÚÈÙ‹ÚÈÔ

ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ Ïԛ̈͢. øÛÙfiÛÔ, Ë

·ÔÌfiÓˆÛ‹ ÙÔ˘ ·fi ˘ÏÈÎfi ·ÈÌÔηÏÏȤÚÁÂÈ·˜ ›ӷȉ‡ÛÎÔÏË Î·È Û˘Ó‹ıˆ˜ ·Ô‚·›ÓÂÈ ·ÚÓËÙÈ΋, Ì·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË - Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· -Ó¤ˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· ÙËÓ ·ÔÌfiÓˆÛËÙˆÓ ·Û¤ÚÁÈÏÏˆÓ Û ‚ÈÔÏÔÁÈο ˘ÁÚ¿ ÙÔ˘ ÛÒÌ·ÙÔ˜.∂ÈϤÔÓ, Û˘¯Ó¿ ÔÈ ·ÛıÂÓ›˜ Ì ˘Ô„›· Ì˘ÎËÙÈ·-ÛÈ΋˜ Ïԛ̈͢ ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÂÌ‚·ÙÈΤ˜‰È·ÁÓˆÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ Ì ÛÎÔfi ÙËÓ ·ÔÌfiÓˆÛËÙÔ˘ ̇ÎËÙ· ·fi ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ˘ÏÈÎfi, ÙÂ-¯ÓÈ΋ Ô˘ ·ÔʇÁÂÙ·È ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜·ÛıÂÓ›˜. ∞ÓÙ›ıÂÙ·, ÛÙ· ·È‰È¿ Û˘Ó‹ıˆ˜ ÂÈϤÁÂ-Ù·È Ë ÙÂÎÌËÚ›ˆÛË Ù˘ Ïԛ̈͢ Ì Ù¯ÓÈΤ˜ ÌÔ-Úȷ΋˜ ‚ÈÔÏÔÁ›·˜ (·Ó‡ÚÂÛË ÙÔ˘ Ì˘ÎËÙÈ·ÛÈÎÔ‡DNA Ì ̤ıÔ‰Ô PCR), ·Ó·˙‹ÙËÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ Ì ̤ıÔ‰Ô ELISA ‹, Ù¤ÏÔ˜, ÌÂÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȤ‰ˆÓ ÙÔ˘ galactomannan,Ì›· ÚfiÛÊ·ÙË Î·È ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË Ì¤ıÔ‰Ô˜ (9-12). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ë ÙÂÎ-ÌËÚ›ˆÛË Ù˘ ·ÛÂÚÁ›ÏψÛ˘ ¤ÁÈÓ Ì ÙËÓ ·Ó‡ÚÂ-ÛË ÙÔ˘ DNA ÙÔ˘ ·Û¤ÚÁÈÏÏÔ˘ Ì Ù¯ÓÈ΋ PCR, ËÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ¢·ÈÛıËÛ›·(100%) Î·È ÈηÓÔÔÈËÙÈ΋ ÂȉÈÎfiÙËÙ· (60-80%)(9,11-14). ∏ ÂͤٷÛË ·˘Ù‹ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÛ˘Ó¤¯ÂÈ· Î·È ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·ÓÙ·fi-ÎÚÈÛ˘ ÛÙË ¯ÔÚËÁÔ‡ÌÂÓË ıÂڷ›· ηٿ ÙËÓ ÂÍÂ-ÏÈÎÙÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·ÈÎ·È ·fi Ù· ‰Â‰Ô̤ӷ ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (11-13).

∂Ô̤ӈ˜, Ë ·Ô˘Û›· Ì›·˜ “ȉ·ÓÈ΋˜” ÂÚÁ·ÛÙË-Úȷ΋˜ ÂͤٷÛ˘ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆ-Û˘ Ù˘ Ïԛ̈͢ ·fi ·Û¤ÚÁÈÏÏÔ, ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈÛÙË ı¤ÛÈÛË ‰ÈÂıÓÒÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÎÚÈÙË-Ú›ˆÓ, ‚¿ÛÂÈ ÙˆÓ ÔÔ›ˆÓ Ë ‰È¿ÁÓˆÛË Ù˘ ·ÛÂÚÁ›Ï-ψÛ˘ ÂȂ‚·ÈÒÓÂÙ·È (·Ó‡ÚÂÛË ÙÔ˘ ̇ÎËÙ· ÌÂηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜), Èı·ÓÔÏÔÁÂ›Ù·È (Û˘Ó‡·ÚÍËÂÓfi˜ ÎÏÈÓÈÎÔ‡/·ÂÈÎÔÓÈÛÙÈÎÔ‡ Î·È ÂÓfi˜ ÂÚÁ·ÛÙË-ÚÈ·ÎÔ‡ Â˘Ú‹Ì·ÙÔ˜) Î·È Â›Ó·È ÂӉ¯fiÌÂÓË (‡·ÚÍË‹ ÂÓfi˜ ÎÏÈÓÈÎÔ‡/·ÂÈÎÔÓÈÛÙÈÎÔ‡ ‹ ÂÓfi˜ ÂÚÁ·ÛÙË-ÚÈ·ÎÔ‡ Â˘Ú‹Ì·ÙÔ˜) (2,3).

™˘ÌÂÚ·ÛÌ·ÙÈο, ÚÔ·ÙÂÈ fiÙÈ Ë ‰ÈËıËÙÈ΋·ÛÂÚÁ›ÏψÛË ·ÔÙÂÏ› ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ÏÔ›-̈ÍË Û ·È‰È¿ Ì ·ÈÌ·ÙÔÏÔÁÈ΋ ηÎÔ‹ıÂÈ· Î·È ¯·-Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËÏ‹ ıÓËÙfiÙËÙ· Î·È ÓÔÛËÚfiÙË-Ù·, ȉȷ›ÙÂÚ· fiÙ·Ó ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ∫¡™. ∏ ÂÌÂÈÚÈ-΋ ·ÓÙÈÌ˘ÎËÙÈ·ÛÈ΋ ·ÁˆÁ‹ › ˘Ô„›·˜ Ù˘ Ïԛ̈-͢ (15,16), ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ¯ÔÚ‹ÁËÛË Ó¤ˆÓ·ÓÙÈÌ˘ÎËÙÈ·ÛÈÎÒÓ Û ˘„ËϤ˜ ‰fiÛÂȘ ‹ ÛÂ Û˘Ó‰˘·-ÛÌÔ‡˜ ÙÔ˘˜ (16,17), ηıÒ˜ Î·È Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛËÌ ÙË ¯Ú‹ÛË Ó¤ˆÓ ÌÂıfi‰ˆÓ, ÌÔÚÔ‡Ó ÛÙÔ Ì¤ÏÏÔÓ Ó·Û˘Ì‚¿ÏÔ˘Ó Ô˘ÛÈ·ÛÙÈο ÛÙË Ì›ˆÛË Ù˘ ıÓËÙfiÙËÙ·˜Î·È ÛÙËÓ Ï‹ÚË ›·ÛË ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Klont RR, Meis JF, Verweij PE. Critical assessment of issuesin the diagnosis of invasive aspergillosis. Clin Microbiol In-fect 2001;7 (Suppl 2):S32-S37.

¶·È‰È·ÙÚÈ΋ 2005;68:74-78

∂∂ÈÈÎÎfifiÓÓ·· 55.. ¶·ÚÔ˘Û›· ÂÛÙ›·˜ Ì ‰·ÎÙ˘ÏÈÔÂȉ‹ ÂÌÏÔ˘ÙÈÛÌfiÛÙÔÓ ıfiÏÔ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ‚ÚÂÁÌ·ÙÈÎÔ‡ ÏÔ‚Ô‡.

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¶·È‰È·ÙÚÈ΋ 2005;68:74-78

2. Groll A, Shal P, Mentzel C, Schneider M. Changing patternof invasive mycoses at autopsy [abstract]. In: Program andabstracts of the 34th Interscience Conference on Antimicro-bial Agents and Chemotherapy (Orlando, Florida). Washing-ton, DC: Americal Society for Microbiology; 1994. AbstractNo J 109.

3. Lin SJ, Schranz J, Teutsch SM. Aspergillosis case-fatality rate:systematic review of the literature. Clin Infect Dis2001;32:358-366.

4. Ng A, Gadong N, Kelsey A, Denning DW, Leggate J, EdenOB. Successful treatment of aspergillus brain abscess in achild with acute lymphoblastic leukemia. Pediatr HematolOncol 2000;17:497-504.

5. Rankin NE. Disseminated aspergillosis and moniliasis associ-ated with agranulocytosis and antibiotic therapy. Br Med J1953;1:918-919.

6. Stevens DA. Diagnosis of fungal infections: current status. JAntimicrob Chemother 2002;49 (Suppl 1):S11-S19.

7. Gozdasoglu S, Ertem M, Buyukkececi Z, Yavuzdemir S,Bengisun S, Ozenci H et al. Fungal colonization and infectionin children with acute leukemia and lymphoma during in-duction therapy. Med Pediatr Oncol 1999;32:344-348.

8. Anderson K, Morris G, Kennedy H, Croall J, Michie J,Richardson MD et al. Aspergillosis in immunocompromisedpaediatric patients: associations with building hygiene, de-sign, and indoor air. Thorax 1996;51:256-261.

9. Lass-Florl C, Aigner J, Gunsilius E, Petzer A, Nachbaur D, GastlG et al. Screening for Aspergillus spp. using polymerase chainreaction of whole blood samples from patients with haemato-logical malignancies. Br J Haematol 2001;113:180-184.

10. Kawamura S, Maesaki S, Noda T, Hirakata Y, Tomono K,Tashiro T et al. Comparison between PCR and detection ofantigen in sera for diagnosis of pulmonary aspergillosis. JClin Microbiol 1999;37:218-220.

11. Buchheidt D, Hummel M, Schleiermacher D, Spiess B, Sch-werdtfeger R, Cornely OA et al. Prospective clinical evalua-tion of a LightCycler-mediated polymerase chain reaction as-say, a nested-PCR assay and a galactomannan enzyme-linkedimmunosorbent assay for detection of invasive aspergillosisin neutropenic cancer patients and haematological stem celltransplant recipients. Br J Haematol 2004;125:196-202.

12. Wheat LJ. Rapid diagnosis of invasive aspergillosis by antigendetection. Transpl Infect Dis 2003;5:158-166.

13. Challier S, Boyer S, Abachin E, Berche P. Development of aserum-based Taqman real-time PCR assay for diagnosis ofinvasive aspergillosis. J Clin Microbiol 2004;42:844-846.

14. Kwak EJ, Husain S, Obman A, Meinke L, Stout J, Kusne S etal. Efficacy of galactomannan antigen in the PlateliaAspergillus enzyme immunoassay for diagnosis of invasiveaspergillosis in liver transplant recipients. J Clin Microbiol2004;42:435-438.

15. Hope WW, Denning DW. Invasive aspergillosis: current andfuture challenges in diagnosis and therapy. Clin MicrobiolInfect 2004;10:2-4.

16. Baden LR, Katz JT, Fishman JA, Koziol C, DelVecchio A, Do-ran M et al. Salvage therapy with voriconazole for invasivefungal infections in patients failing or intolerant to standardantifungal therapy. Transplantation 2003;76:1632-1637.

17. Wingard JR, Leather H. A new era of antifungal therapy. Bi-ol Blood Marrow Transplant 2004;10:73-90.

78 º. ∞ı·Ó·ÛÈ¿‰Ô˘ Î·È Û˘Ó.

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79CASE REPORT

Aspergillosis of the central nervous system

in three children with acute lymphoblastic

leukemia

F. Athanassiadou1, A. Tragiannidis1, T. Papageorgiou1, M. Stamou1, A. Drevelegas2, A. Velegraki3

Abstract

Fungal infections represent a serious cause of morbidity and mortality in patients with malignancies. Aspergilliare the second cause of fungal infection in immunocompromised patients such as children with hematologicalmalignancies. Aspergillosis of the central nervous system (CNS) represents the third most frequent site of

infection, after lung and sinonasal cavity and carries a high mortality. The cases of three children aged 14, 3and 2 years old respectively with acute lymphoblastic leukemia, which presented CNS aspergillosis arereported. All of them were under remission induction therapy with ALL-BFM ’95 protocol. Suspicion offungal infection was based on the clinical signs and symptoms (prolonged fever >10 days, dyspnea, headache,neurological signs). Diagnosis was based on plasma PCR that detected aspergillus DNA in all patients and inCSF in one of them. Radiological findings on MRI of CNS showed multiple foci on frontal lobe in two childrenand the presence of a temporal lobe lesion with central necrosis and concomitant edema in the third one. Allpatients received antifungal therapy with liposome amphotericin B for 4, 12 and 8 months respectively. Oncontrols made periodically an improvement of radiological as well as clinical/laboratory findings was found intwo children and antifungal therapy was discontinued. The third one died while on therapy. In conclusion, thefindings suggest that CNS aspergillosis represents a serious cause of morbidity and mortality in children withhematological malignancies. The early initiation and the long-term administration of antifungal therapy maydecrease mortality in these patients.

Key words

Aspergillosis of the central nervous system, acute lymphoblastic leukemia, childhood.

1 2nd Paediatric Clinic ofAristotelion University,AHEPA Hospital,Thessaloniki

2 Laboratory of Radiology ofAristotelion University,AHEPA Hospital,Thessaloniki

3 Mycology ReferenceLaboratory, MedicalSchool, Athens

Correspondence:

Fani Athanassiadou-Piperopoulou AHEPA Hospital,1 St. Kyriakidi str., 546 36, ThessalonikiE-mail: [email protected]

Date of submission: 28-04-2004Date of approval: 28-09-2004

Paediatriki 2005;68:79

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80 ∫§π¡π∫√ ∫√Àπ∑

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

AÏÏËÏÔÁÚ·Ê›·:

∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ E-mail: [email protected]

¶·È‰È·ÙÚÈ΋ 2005;68:80,84

∞. BÈÏÏÈÒÙ˘, °. ƒÔ˘Ì¿Ó˘, Ã. ∫ÔÙÛÒÓ˘, ∞. ¶··‰ÔÔ‡ÏÔ˘

∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 24 ÌËÓÒÓ ÚÔÛÎÔÌ›ÛÙËΠÛÙÔÓÔÛÔÎÔÌÂ›Ô ÁÈ·Ù› ·ÚÔ˘Û›·˙ ·fi ¤ÙÔ˘˜ ÂÏÏÈ‹ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ Î·È ‰È¿Ù·ÛË ÎÔÈÏ›·˜ ÛÂ Û˘Ó-‰˘·ÛÌfi Ì ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÔÏÙÒ‰ÂȘ, ·ÓÔÈÎÙfi-¯ÚˆÌ˜ ÎÂÓÒÛÂȘ. ∞fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÚÔ¤-΢„ ˘ÔıÚ„›· (‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ 8,8 kg <3Ë ÂηÙ.ı¤ÛË, ‡„Ô˜ 84 cm ~10Ë ÂηÙ. ı¤ÛË) Î·È ÌÂÙˆÚÈ-ÛÌfi˜ ÎÔÈÏ›·˜, ¯ˆÚ›˜ ¿ÏÏ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·.∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÚԤ΢„ ·Ó·ÈÌ›·(Ht 30,6 g/L), ÂÏ·Ùو̤ÓË ¯ÔÏËÛÙÂÚ›ÓË ÔÚÔ‡ (68mg/dL, º.∆. >130), ÂÏ·Ùو̤ÓË HDL (20 mg/dL,º.∆. >40), ÂÓÒ Ë Û˘ÁΤÓÙÚˆÛË ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓÛÙÔÓ ÔÚfi ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ (53 mg/dL), fiˆ˜ ηÈÙ· ÔÏÈο Ï¢ÎÒÌ·Ù· Î·È Ë ÏÂ˘ÎˆÌ·Ù›ÓË ÔÚÔ‡, Ù·Ë·ÙÈο ¤Ó˙˘Ì· Î·È Ô ¤ÏÂÁ¯Ô˜ ÓÂÊÚÒÓ. H ¯˘ÌÔ-ıÚ˘„›ÓË ÎÔÚ¿ÓˆÓ Î·È Ë ·1-·ÓÙÈıÚ˘„›ÓË ÎÔÚ¿-ÓˆÓ ‹Ù·Ó ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ, ÂÓÒ ÔÈÌÈÎÚÔÛÎÔÈΤ˜ ÎÔÚ¿ÓˆÓ ¤‰ÂÈÍ·Ó ÔÏÏ¿ ÏÈÔ-ÛÊ·›ÚÈ·. OÈ Î·ÏÏȤÚÁÂȘ Î·È ÔÈ ·Ú·ÛÈÙÔÏÔÁÈΤ˜ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈΤ˜. ∆Ô test ȉÚÒÙ·, ηıÒ˜Î·È Ù· ·ÓÙÈÛÒÌ·Ù· ηٿ Ù˘ ÁÏÈ·‰›Ó˘, ÚÂÙÈÎÔ˘Ï›-Ó˘ Î·È ÂÓ‰ÔÌ˘›Ô˘ ‹Ù·Ó fiÏ· ·ÚÓËÙÈο. ∆· ›Â-

‰· ÙˆÓ ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈÓÒÓ (∞ Î·È ∂) ‹Ù·ÓÂÓÙfi˜ ÙˆÓ Î·ÙÒÙÂÚˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. ∏ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË Ì ۯÈÛÌÔÂȉ‹ Ï˘¯Ó›·‰ÂÓ ·Ó¤‰ÂÈÍ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. O ·ÓÂÈ-ÏËÌ̤ÓÔ˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÁÈ··Î·ÓıÔ·ÙÙ·Ú· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∏ ÌÈÎÚÔÛÎÔÈ΋ÂͤٷÛË ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ˘ÏÈÎÔ‡ ˘ÁÚÔ‡ ÁÈ· Ï¿Ì-‚ÏȘ ‹Ù·Ó ·ÚÓËÙÈ΋. ∏ ËÏÂÎÙÚÔÊfiÚËÛË ÏÈÔ-ÚˆÙÂ˚ÓÒÓ ÌÂÙ¿ ·fi ÊfiÚÙÈÛË Ì ϛԘ (50 g Ï›-Ô˘˜ ·Ó¿ 1,73 m2 ÂÈÊ¿ÓÂÈ·˜ ÛÒÌ·ÙÔ˜) ¤‰ÂÈÍ ÌË·‡ÍËÛË Ù˘ ¯ÔÏËÛÙÂÚ›Ó˘, Ù˘ HDL, ÙˆÓ ApoAÎ·È B ÛÙȘ 2 Î·È ÛÙȘ 6 ÒÚ˜ ÌÂÙ¿ ÙË ÊfiÚÙÈÛË Î·È,·Ú¿ÏÏËÏ·, ·ÓÙÂÏ‹ ·Ô˘Û›· ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ·fi ÙÔÓ ÔÚfi. ∏ ‚ÈÔ„›· ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÛÙÔ ·ÏfiÌÈÎÚÔÛÎfiÈÔ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈ΋ ·Ú¯ÈÙÂÎÙÔÓÈÎ‹ÙˆÓ Ï·¯ÓÒÓ Ì ‡·ÚÍË ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÎÂÓÔÙÔ-›ˆÓ. ∏ ÌÔÚÊÔÌÂÙÚÈ΋ ÌÂϤÙË ÙÔ˘ ÈÛÙÔÙÂÌ·¯›Ô˘ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ¤‰ÂÈÍ ÙËÓ ‡·ÚÍËÔÏ˘¿ÚÈı̈Ó, ¢ÌÂÁ¤ıˆÓ ÏÈÔÛÙ·ÁÔÓȉ›ˆÓ ‰È·Ì¤-ÙÚÔ˘ 0,5-0,1 Ìm ÂÓÙfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÂÓÙÂÚÈ-ÎÔ‡ ÂÈıËÏ›Ô˘, Ì ·‰˘Ó·Ì›· ÂÍÔ·ÙÙˆÛ˘ ÙÔ˘ Ï›-Ô˘˜ ÛÙÔ˘˜ ÌÂÛÔ΢ÙÙ¿ÚÈÔ˘˜ ¯ÒÚÔ˘˜ (∂ÈÎfiÓ·).

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. ∫ÔÈÏÈÔοÎË 2. ∞‚ËÙ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· 3. OÈÎÔÁÂÓ‹˜ ˘Ô‚ËÙ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›· 4. ¡fiÛÔ˜ ηٷÎÚ¿ÙËÛ˘ ¯˘ÏÔÌÈÎÚÒÓ 5. ∂ÓÙÂÚÈ΋ ÏÂÌÊ·ÁÁÂÈÂÎÙ·Û›·

∏∏ ··¿¿ÓÓÙÙËËÛÛËË ··ÎÎÔÔÏÏÔÔ˘̆ıı›› ÛÛÙÙËË ÛÛÂÂÏÏ››‰‰·· 8844

∂∂ÈÈÎÎfifiÓÓ··.. µÈÔ„›· ÂÓÙ¤ÚÔ˘ ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ.

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81µπµ§πO¶∞ƒOÀ™π∞™∏ BOOK REVIEW

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”

AÏÏËÏÔÁÚ·Ê›·:

ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜ E-mail: [email protected]

¶·È‰È·ÙÚÈ΋ 2005;68:81

∂ÓÙ·ÙÈ΋ ÓÔÛËÏ›· ÓÂÔÁÓÒÓ

Àfi ¡. ¡ÈÎÔÏ·˝‰Ë

£ÂÛÛ·ÏÔÓ›ÎË, 2004

ªÂ ¯·Ú¿ ‰¤¯ÙËη Ó· Û¯ÔÏÈ¿Ûˆ ÙÔ ‚È‚Ï›Ô ·˘Ùfi ÙÔ˘ ∫·ıËÁËÙ‹ Ù˘¡ÂÔÁÓÔÏÔÁ›·˜ Î·È ¢È¢ı˘ÓÙ‹ Ù˘ µ’ ¡ÂÔÁÓÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞ÚÈ-ÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ ÛÙÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›ԓ¶··ÁˆÚÁ›Ô˘”. Ÿˆ˜ ·Ó·Ê¤ÚÂÈ Ô Î·ıËÁËÙ‹˜ ÛÙÔÓ ÚfiÏÔÁÔ ÙÔ˘ ‚È-‚Ï›Ô˘, ‰ÂÓ ÚfiÎÂÈÙ·È ÁÈ· Û‡ÁÁÚ·ÌÌ· ¡ÂÔÁÓÔÏÔÁ›·˜, ·ÏÏ¿ ÁÈ· Û˘ÁΤ-ÓÙÚˆÛË ÙˆÓ Ú·ÎÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ› Ë ∫ÏÈÓÈ΋ÙÔ˘ Û˘ÁÁڷʤ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·ıËÌÂÚÈÓÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙ˪∂¡¡.

•ÂÊ˘ÏÏ›˙ÔÓÙ¿˜ ÙÔ, ‰È·›ÛÙˆÛ· fiÙÈ ÙfiÛÔ ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘ (ÌfiÓÔ 280ÛÂÏ›‰Â˜) fiÛÔ Î·È ÙÔ ‰¤ÛÈÌfi ÙÔ˘ ˘fi ÌÔÚÊ‹ ÛÈÚ¿Ï, ‚ÔËıÔ‡Ó ÔχÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ÛÙfi¯Ô˘ ÙÔ˘, ‰ËÏ·‰‹ ÛÙËÓ Â‡ÎÔÏË ÌÂÙ·ÊÔÚ¿ ÙÔ˘·fi ÙÔÓ ÓÂÔÁÓÔÏfiÁÔ Î·È ÛÙË ÁÚ‹ÁÔÚË ÚfiÛ‚·ÛË Û ÔÔÈÔ‰‹ÔÙ›ÁÔÓ ÓÂÔÁÓÔÏÔÁÈÎfi Úfi‚ÏËÌ· Î·È fi¯È ÌfiÓÔ.

ŒÓ· ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi ÛËÌÂ›Ô Ô˘ ‚ÔËı¿ÂÈ ÛÙÔ Ó· ·Á·Ëı› ·fi ο-ı ÁÈ·ÙÚfi Ô˘ ·Û¯ÔÏÂ›Ù·È Ì ÙÔ ÚÔ‚ÏËÌ·ÙÈÎfi ÓÂÔÁ¤ÓÓËÙÔ, Â›Ó·È Î·È ÔÙÚfiÔ˜ Û˘ÁÁÚ·Ê‹˜ ÙÔ˘. ∆Ô Î›ÌÂÓÔ Â›Ó·È ÁÚ·Ì̤ÓÔ Ì ÌÂÁ¿Ï· ÁÚ¿Ì-

Ì·Ù·, ˘¿Ú¯Ô˘Ó ·ÓÙÔ‡ ›Ó·Î˜, ÂÓÒ Ù· ÛËÌ·ÓÙÈο ÛËÌ›· ÙÔÓ›˙ÔÓÙ·È Ì ÎfiÎÎÈÓÔ ÌÂÏ¿ÓÈ. ∫¿ı ı¤Ì· Â-ÚÈÁÚ¿ÊÂÙ·È ÌÂ Û˘ÓÔÙÈÎfi, ·ÏÏ¿ Û·Ê‹ ÙÚfiÔ Î·È ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Û‡Á¯ÚÔÓË ‚È‚ÏÈÔÁÚ·Ê›·. ™Ù· ıÂÙÈο ÙÔ˘‚È‚Ï›Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÙ·È, ›Û˘, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ·ÏÒ˜ ÛÙËÓ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÔÍÂÈÒÓ Î·-Ù·ÛÙ¿ÛˆÓ, ·ÏÏ¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ÎÂÊ¿Ï·È· Ô˘ ‰È·Ú·ÁÌ·Ù‡ÔÓÙ·È ÙËÓ „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÁÔÓ¤-ˆÓ ·È‰ÈÒÓ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙË ª∂¡¡, ηıÒ˜ Î·È ÙËÓ Â͈ÓÔÛÔÎÔÌÂȷ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓÔ˘ ÓÔÛËχıËÎ·Ó ÛÙË ª∂¡¡.

™Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù¿ ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ·Ó·Ï‡ÂÈ Ì ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ Ó¤-˜ Ù¯ÓÈΤ˜ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, .¯. Û˘Á¯ÚÔÓÈṲ̂ÓÔ˜ Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, ¢·ÈÛıËÛ›· ›ÎÏËÛ˘ (triggersensitivity), ·ÂÓÂÚÁÔÔ›ËÛË Î‡ÎÏÔ˘ ÂÈÛÓÔ‹˜ (termination sensitivity), ˘ÔÛÙ‹ÚÈÍË ›ÂÛ˘ (pressuresupport), Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ fiÁÎÔ˘, ηıÒ˜ Î·È Ò˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·˘Ù¤˜ ÛÙËÓ Ú¿ÍË. ∂›Û˘, ·Ó·Ê¤-ÚÂÙ·È ·ÔÎÏÂÈÛÙÈο Û ¤Ó·Ó ÌfiÓÔ Ù‡Ô ·Ó·Ó¢ÛÙ‹Ú· Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ÎÏÈÓÈ΋ ÙˆÓ Û˘ÁÁڷʤˆÓ.™ÙÔ ÎÂÊ¿Ï·ÈÔ Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘, ‰ÂÓ ·Ó·Ï‡ÂÙ·È Ô ÙÚfiÔ˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ NO. £· ‹Ù·Ó ¯Ú‹ÛÈÌÔ,›Ûˆ˜, Ó· ÚÔÛÙÂıÔ‡Ó ÔÚÈṲ̂ӷ ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙËÓ Ô͢ÌÂÙÚ›·, Ù· ·›ÙÈ· Ì›·˜ ˘ÔÍ›·˜, ÙË ‰‰ ÙÔ˘ ΢·-ÓˆÙÈÎÔ‡ ÓÂÔÁÓÔ‡, ÙȘ ‰È·Ù·Ú·¯¤˜ Ù˘ Oµπ Î·È ÙËÓ ¤ÓÓÔÈ· Ù˘ ̤Û˘ ›ÂÛ˘ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ô‰ÒÓ(ª∞P). ™ÙȘ ÌÈÎÚÔÂÂÌ‚¿ÛÂȘ ı· ‚ÔËıÔ‡ÛÂ Ë ÚÔÛı‹ÎË ÌÂÚÈÎÒÓ ÂÈÎfiÓˆÓ.

¶·Ú¿ ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜, ıˆÚÒ fiÙÈ ÙÔ ‚È‚Ï›Ô ·˘Ùfi ¤Ú¯ÂÙ·È Ó· ηχ„ÂÈ ¤Ó· ÎÂÓfi Ô˘ ˘¿Ú¯ÂÈ ÛÙËÓ ÂÏ-ÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, ·ÊÔ‡ ‚ÔËı¿ÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Ó¤Ô È·ÙÚfi Ô˘ οÓÂÈ Ù· ÚÒÙ· ÙÔ˘ ‚‹Ì·Ù· ÛÙË ¡ÂÔ-ÁÓÔÏÔÁ›·, ÂÓÒ ·Ú¿ÏÏËÏ· ·ÔÙÂÏ› ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô Î·È ÁÈ· ÂÌ¿˜, ÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ ÓÂÔÁÓÔÏfiÁÔ˘˜.

¶ÔÏÏ¿ Û˘Á¯·ÚËÙ‹ÚÈ· ÛÙÔÓ Î. ¡ÈÎÔÏ·˝‰Ë Î·È ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ÁÈ· ÙÔ ¤ÚÁÔ ÙÔ˘˜.

Ã. ∫ÒÛÙ·ÏÔ˜ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶° ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”

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82 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜E-mail: [email protected]

¶·È‰È·ÙÚÈ΋ 2005;68:82-83

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ¶·È‰›·ÙÚÔ˜ - ¡ÂÊÚÔÏfiÁÔ˜

∏ ∂˘Úˆ·˚΋ ∂ÈÙÚÔ‹ ÂÓ¤ÎÚÈÓ ÚfiÙ·ÛË Î·ÓÔÓÈÛÌÔ‡ ÁÈ· ÙËÓ ÚÔÒıËÛË Ê·ÚÌ¿ÎˆÓ ÁÈ·

Ù· ·È‰È¿

∆Ô Ï‹Ú˜ ΛÌÂÓÔ Ù˘ ÚfiÙ·Û˘ Â›Ó·È ÛÙË ‰È‡ı˘ÓÛË:

http://europa.eu.int/hellas/5news/5.6press290904c.htm

∏ ∂˘Úˆ·˚΋ ∂ÈÙÚÔ‹ ÂÓ¤ÎÚÈÓ ÚfiÙ·ÛË Î·ÓÔÓÈÛÌÔ‡ Û¯Â-ÙÈο Ì ٷ Ê¿Ú̷η ÁÈ· ·È‰È·ÙÚÈ΋ ¯Ú‹ÛË Ô˘ ÛÙԯ‡ÂÈ ÛÙË‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÛÂ Â›Â‰Ô ∂∂, Ì ÙË ‰È·ÛÊ¿-ÏÈÛË fiÙÈ Ù· Ê¿Ú̷η ·˘Ù¿, ÚÔÙÔ‡ ÙÂıÔ‡Ó Û ΢ÎÏÔÊÔÚ›·, ı·¤¯Ô˘Ó ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÂȉÈ΋˜ ¤Ú¢ӷ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂ-ÙÒÈÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ıÂڷ¢ÙÈÎÒÓ ·Ó·ÁÎÒÓ.

¶¿Óˆ ·fi ÙÔ 50% ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÁÈ· ·È‰È¿ ‰ÂÓ ¤¯Ô˘Ó ‰ÔÎÈ-Ì·ÛÙ› ÚÔÙÔ‡ ÙÂıÔ‡Ó ÛÙËÓ Î˘ÎÏÔÊÔÚ›·. ŒÓ· Ê¿ÚÌ·ÎÔ Ô˘ ¯Ô-ÚËÁÂ›Ù·È ÌÂ Û˘ÓÙ·Á‹ ÁÈ·ÙÚÔ‡ ¯ˆÚ›˜ fï˜ Ó· ¤¯ÂÈ ÚÔËÁÔ˘Ì¤Óˆ˜‰ÔÎÈÌ·ÛÙ› ÁÈ· Ó· ‰È·ÈÛÙˆı› ηٿ fiÛÔÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ-Îfi, ÔÈ· Â›Ó·È Ë Î·Ù¿ÏÏËÏË ‰ÔÛÔÏÔÁ›· Î·È ÔȘ Â›Ó·È ÔÈ ·ÚÂ-Ó¤ÚÁÂȤ˜ ÙÔ˘, ÌÔÚ› Ó· ‚Ï¿„ÂÈ ÛÔ‚·Ú¿ ÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ.

µ·ÛÈÎÔ› ÛÙfi¯ÔÈ ÙÔ˘ ÚÔÙÂÈÓfiÌÂÓÔ˘ ηÓÔÓÈÛÌÔ‡ Â›Ó·È Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ Ê·ÚÌ¿ÎˆÓ Ô˘ ÚÔÔÚ›˙Ô-ÓÙ·È ÂȉÈο ÁÈ· Ù· ·È‰È¿, ηıÒ˜ Î·È Ë ÂÍ·ÛÊ¿ÏÈÛË ÙÔ˘ ·˘ÛÙËÚÔ‡ ÂϤÁ¯Ô˘ Ù˘ ÔÈfiÙËÙ¿˜ ÙÔ˘˜ ÚÔÙÔ‡ ÙÂ-ıÔ‡Ó Û ΢ÎÏÔÊÔÚ›·, ‰›¯ˆ˜ fï˜ Ù· ·È‰È¿ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÚÈÙÙ¤˜ ÎÏÈÓÈΤ˜ ‰ÔÎÈ̤˜. ∏ ÚfiÙ·ÛËÛÙԯ‡ÂÈ Â›Û˘ ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ‰È·ı¤ÛÈÌ˘ ÏËÚÔÊfiÚËÛ˘ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· Ê¿Ú̷η ÁÈ· ·È‰È¿.

¢ËÌÔÛȇıËÎÂ Ë ÀÔ˘ÚÁÈ΋ ∞fiÊ·ÛË ÁÈ· ÙË ™‡ÛÙ·ÛË Î·È ÙÔÓ ∫·ÓÔÓÈÛÌfi §ÂÈÙÔ˘ÚÁ›·˜ Ù˘

∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ¢ÂÔÓÙÔÏÔÁ›·˜ ÁÈ· ÙȘ ∫ÏÈÓÈΤ˜ ªÂϤÙ˜

∆Ô Î›ÌÂÓÔ Ù˘ ÀÔ˘ÚÁÈ΋˜ ∞fiÊ·Û˘ Â›Ó·È ÛÙË ‰È‡ı˘ÓÛË: http://www.sfee.gr/download/english/387

™ÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ º·Ú̷΢ÙÈÎÔ‡ ™˘ÏÏfiÁÔ˘ ∞ÙÙÈ΋˜

ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÏËÚÔÊÔڛ˜ ÁÈ· 989 ÓÔÛÔÎÔÌÂȷο

Ê¿Ú̷η

OÈ ÏËÚÔÊÔڛ˜ ·˘Ù¤˜ Â›Ó·È ÛÙËÓ ÈÛÙÔÛÂÏ›‰·: http://www.fsa.gr

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NEWS FROM THE INTERNET

∏ ÈÛÙÔÛÂÏ›‰· Ù˘ ∞ÌÂÚÈηÓÈ΋˜ π·ÙÚÈ΋˜ µÈ‚ÏÈÔı‹Î˘

(NLM) ÂÚÈÏ·Ì‚¿ÓÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· Ê¿Ú̷η, Ë

¯ÔÚ‹ÁËÛË ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ÂÈΛӉ˘ÓË ÁÈ· Ù· ·È‰È¿

OÈ ÏËÚÔÊÔڛ˜ ·˘Ù¤˜ Â›Ó·È ÛÙËÓ ÈÛÙÔÛÂÏ›‰·:

http://www.nlm.nih.gov/medlineplus/druginformation.html

∂›Û˘, ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· Ê¿Ú̷η ˘¿Ú¯Ô˘Ó ÛÙËÓ

ÈÛÙÔÛÂÏ›‰·: http://www.rxlist.com

ŒÓ· ¯Ú‹ÛÈÌÔ ‚È‚Ï›Ô ÁÈ· ÙËÓ ·ÚÂÓÙÂÚÈ΋ ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿-

ÎˆÓ (∆he Handbook of Parenteral Drug Administration) ‚Ú›-

ÛÎÂÙ·È ÛÙÔ ‰È·‰›ÎÙ˘Ô ÛÙË ‰È‡ı˘ÓÛË:

http://members.ozemail.com.au/~jamesbc/frames.htm

ÃÚ‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÁÔÓ›˜ ·È‰ÈÒÓ Ì ÓÂÊÚˆÛÈÎfi

Û‡Ó‰ÚÔÌÔ -

http://www.e-child.gr/NefrosikoSyndromo.pdf

™ÙËÓ ÈÛÙÔÛÂÏ›‰· Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ¤Î-‰ÔÛË ÙÔ˘ ¡ÂÊÚÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞.∫˘ÚÈ·ÎÔ‡” “ÃÚ‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÁÔÓ›˜ ·È‰ÈÒÓ Ì ÓÂÊÚˆÛÈÎfiÛ‡Ó‰ÚÔÌÔ”, ÂÈ̤ÏÂÈ·: ∫. ™ÙÂÊ·Ó›‰Ë˜ Î·È ∞. ∏Ï›·.

¶·È‰È·ÙÚÈ΋ 2005;68:82-83

83

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84 CLINICAL QUIZ

¶·È‰È·ÙÚÈ΋ 2005;68:80,84

∫ÏÈÓÈÎfi QUIZ

∞¶∞¡∆∏™∏

¶Èı·Ó‹ ‰È¿ÁÓˆÛË:

¡Ô 4. NfiÛÔ˜ ηٷÎÚ¿ÙËÛ˘ ¯˘ÏÔÌÈÎÚÒÓ

™¯fiÏÈÔ

∏ ÓfiÛÔ˜ ηٷÎÚ¿ÙËÛ˘ ¯˘ÏÔÌÈÎÚÒÓ (ÓfiÛÔ˜

Anderson) Â›Ó·È Û¿ÓÈ· ÓfiÛÔ˜ Ô˘ ÌÂÙ·‚È‚¿˙ÂÙ·È

Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· ηÈ

ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ Ù˘ ÂÓ‰Ô΢ÙÙ¿ÚÈ·˜ ÌÂÙ·-

ÊÔÚ¿˜ Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ µ48, Ì ·ÔÙ¤ÏÂ-

ÛÌ· ÙËÓ ·‰˘Ó·Ì›· Û˘ÁΤÓÙÚˆÛ˘ ‹/Î·È ÂÍÔ·ÙÙˆ-

Û˘ ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ ·fi ÙÔ ¤ÓÙÂÚÔ (1,2). ∫ÏÈÓÈο

ÂΉËÏÒÓÂÙ·È Ì ÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜ Î·È ÛÙ·-

ÙfiÚÚÔÈ· (3,4). ™Â ÂÚ›ÙˆÛË ÌË ¤ÁηÈÚ˘ ‰È¿ÁÓˆ-

Û˘, Ô‰ËÁ› Û ·Ó¿ÚÎÂÈ· ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈ-

ÓÒÓ Î·È Ó¢ÚÔÏÔÁÈΤ˜ Î·È ÔÊı·ÏÌÔÏÔÁÈΤ˜ ‰È·Ù·-

Ú·¯¤˜. ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿-ÓÔ˘Ó ÌÂȈ̤ӷ ›‰· Ù˘ ¯ÔÏËÛÙÂÚ›Ó˘ ÛÙÔÔÚfi, Ù˘ LDL, Ù˘ HDL Î·È ÙˆÓ ·ÔÏÈÔÚˆÙÂ˚-ÓÒÓ A Î·È B, ÌÂ Ê˘ÛÈÔÏÔÁÈο Ù· ›‰· ÙˆÓ ÙÚÈ-ÁÏ˘ÎÂÚȉ›ˆÓ. ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ÌË ·‡ÍËÛËÙˆÓ ·Ú·¿Óˆ ÛÙÔÓ ÔÚfi ÌÂÙ¿ ÙË ÊfiÚÙÈÛË Ì ϛ-Ô˜ Î·È Ë Ï‹Ú˘ ·Ô˘Û›· ÙˆÓ ¯˘ÏÔÌÈÎÚÒÓ (3,4).∏ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Á›ÓÂÙ·È Ì ÙË ÌÔÚ-ÊÔÌÂÙÚÈ΋ ÌÂϤÙË ÙÔ˘ ÈÛÙÔÙÂÌ·¯›Ô˘ Ù˘ ‚ÈÔ„›·˜ÂÓÙ¤ÚÔ˘ ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ, fiÔ˘·Ó¢ڛÛÎÔÓÙ·È ÔÏ˘¿ÚÈıÌ·, ¯·Ú·ÎÙËÚÈÛÙÈο ÏÈÔ-ÛÙ·ÁÔÓ›‰È· ÛÙÔÓ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ ¯ÒÚÔ ÙˆÓ ÂÓÙÂÚÔ-΢ÙÙ¿ÚˆÓ Ì ·ÓÙÂÏ‹ ·Ô˘Û›· Ï›Ô˘˜ ÛÙÔÓ Â͈-΢ÙÙ¿ÚÈÔ ¯ÒÚÔ (5). ∏ ¯·ÌËÏ‹ Û ÏÈ·Ú¿ ‰›·ÈÙ· ÌÂÚÔÛı‹ÎË Ì¤Û˘ ·Ï‡ÛÔ˘ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ Î·È Ë Û˘-ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ÏÈÔ‰È·Ï˘ÙÒÓ ‚ÈÙ·ÌÈ-ÓÒÓ fiÙ·Ó ¯ÚÂÈ¿˙ÔÓÙ·È, ·ÔÙÂÏÔ‡Ó ÂÁÁ‡ËÛË ÁÈ· ÙËÓÔÌ·Ï‹ ·Ó¿Ù˘ÍË ÙÔ˘ ·ÛıÂÓÔ‡˜.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Levy E, Marcel Y, Deckelbaum RJ, Milne R, Lepage G, Seid-man E et al. Intestinal apoB synthesis, lipids, and lipopro-teins in chylomicron retention disease. J Lipid Res1987;28:1263-1274.

2. Raabe M, Kim E, Veniant M, Nielsen LB, Young SG. Usinggenetically engineered mice to understand apolipoprotein-Bdeficiency syndromes in humans. Proc Assoc Am Physicians1998;110:521-530.

3. Roy CC, Levy E, Green PH, Sniderman A, Letarte J, Buts JPet al. Malabsorption, hypocholesterolemia, and fat-filled en-terocytes with increased intestinal apoprotein B. Chylomi-cron retention disease. Gastroenterology 1987;92:390-399.

4. Lacaille F, Bratos M, Bouma ME, Jos J, Schmitz J, Rey J. An-derson’s disease. Clinical and morphologic study of 7 cases.Arch Fr Pediatr 1989;46:491-498.

5. Boldrini R, Biselli R, Bosman C. Chylomicron retention dis-ease - the role of ultrastructural examination in differentialdiagnosis. Pathol Res Pract 2001;197:753-757.

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xxv¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

3-4 ª·ÚÙ›Ô˘ 2005 2nd International Conference on Infant London,

Development in Neonatal Intensive Care England

¶ÏËÚÔÊÔڛ˜: Maria McHugh∆ËÏ.: 01 414 341 500E-mail: [email protected]

4-6 ª·ÚÙ›Ô˘ 2005 Updates on Hernia Repair, 1st Winter Meeting ∫·ÚÂÓ‹ÛÈ

•ÂÓÔ‰Ô¯Â›Ô Club Montana ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 7711 673, 210 7756 336 Fax: +30 210 7711 289 E-mail: [email protected]

17-20 ª·ÚÙ›Ô˘ 2005 9Ô ¶·ÓÂÏÏ‹ÓÈÔ ¢È·‚ËÙÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ ƒfi‰Ô˜

•ÂÓÔ‰Ô¯Â›Ô Rodos Palace ∂ÏÏËÓÈ΋ ¢È·‚ËÙÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: Œ„ÈÏÔÓ Congress ∆ËÏ.: +30 210 7254 360-2 Fax: +30 210 7254 363 E-mail: [email protected] Website: www.diab2005.epsiloncongress.gr

31 ª·ÚÙ›Ô˘- 32o ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶¿ÙÚ·

2 ∞ÚÈÏ›Ô˘ 2005 ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ Î·È ªÂÙ·‚ÔÏÈÛÌÔ‡

™˘Ó‰ÚÈ·Îfi Î·È ¶ÔÏÈÙÈÛÙÈÎfi ∫¤ÓÙÚÔ ¶·Ó/Ì›Ô˘ ¶·ÙÚÒÓ ∂ÏÏËÓÈ΋ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¶·ÓÂÏÏ‹ÓÈ· ŒÓˆÛË ∂Ó‰ÔÎÚÈÓÔÏfiÁˆÓ ¶ÏËÚÔÊÔڛ˜: ™˘Ó¤‰Ú· ∆ËÏ.: +30 2610 432 200, 2610 461 551Fax: +30 2610 430 884 E-mail: [email protected]: www.synedra.gr

7-9 ∞ÚÈÏ›Ô˘ 2005 6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ ∞ı‹Ó·

& ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜

ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ & ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜¶ÏËÚÔÊÔڛ˜: Œ„ÈÏÔÓ Congress ∆ËÏ.: +30 210 7254 360-2 Fax: +30 210 7254 363 E-mail: [email protected] Website: www.epsiloncongress.gr

17-21 ª·˝Ô˘ 2005 31Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó·

•ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: +30 210 7211 845, 7243 161 Fax: +30 210 7215 082 E-mail: [email protected] Website: www.mednet.gr

26-29 ª·˝Ô˘ 2005 4Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰Ô„˘¯È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó·

¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +30 210 7499 300 Fax: +30 210 7705 752 E-mail: [email protected]

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17-19 πÔ˘Ó›Ô˘ 2005 43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∫ˆ˜

•ÂÓÔ‰Ô¯Â›Ô Kipriotis Village ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International∆ËÏ.: +30 210 6889 100 Fax. +30 210 6844 777 E-mail: [email protected] Website: www.pediatric2005.gr

4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005 ESPGHAN Summer School on Nutrition ∞Ó¿‚˘ÛÛÔ˜

“Research Challenges in Clinical Nutrition”

European Society for Paediatric Gastroenterology,Hepatology and Nutrition Eden Beach Hotel Club ¶ÏËÚÔÊÔڛ˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 77 26 355, 6945 29 30 71 E-mail: [email protected]

7-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005 The History of Diabetes Mellitus ¢ÂÏÊÔ›

¢ÔÚ˘ÊÔÚÈÎfi ™˘ÌfiÛÈÔ ÚÈÓ ·fi ÙÔ ÂÙ‹ÛÈÔ Û˘Ó¤‰ÚÈÔ Ù˘ EASD ¶ÏËÚÔÊÔڛ˜: C&C International∆ËÏ.: +30 210 6889 100Fax. +30 210 6844 777E-mail: [email protected] Website: www.easdsymposium2005.com

10-15 ™ÂÙÂÌ‚Ú›Ô˘ 2005 41st Annual Meeting of the European ∞ı‹Ó·

Association for the Study of Diabetes

™Ù¿‰ÈÔ ∂ÈÚ‹Ó˘ & ºÈÏ›·˜ ∆ËÏ.: +30 210 7297 565, 7230 680, 7201 730 Fax: +30 210 7239 472 E-mail: [email protected] Website: www.easd2005athens.gr

14-18 ™ÂÙÂÌ‚Ú›Ô˘ 2005 29th UMEMPS - Union Middle Eastern & Istanbul,

Mediterranean Pediatric Societies Congress Turkey

•ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: Pr. Enver Hasanoglu Fax: +90 312 2237 469, +90 216 3477 095 E-mail: [email protected] Website: www.istanbul-umemps2005.org

29 ™ÂÙÂÌ‚Ú›Ô˘- 4th Aegean Postgraduate Radiology Course ƒfi‰Ô˜

2 OÎÙˆ‚Ú›Ô˘ 2005 •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 7711 673, 210 7756 336 Fax: +30 210 7711 289 E-mail: [email protected]

25-30 ∞˘ÁÔ‡ÛÙÔ˘ 2007 25th International Congress of Pediatrics ∞ı‹Ó·

¶ÏËÚÔÊÔڛ˜: C&C International∆ËÏ.: +30 210 6889 100 Fax. +30 210 6844 777 E-mail: [email protected] Website: www.icp2007.gr

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