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Page 1: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

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144 51 MÂÙ·ÌfiÚʈÛË

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EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·©

Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92

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xi ∂¶π™∆√§∏ ∞¶√ ∆√¡ ¢π∂À£À¡∆∏™À¡∆∞•∏™

∫. ™ÙÂÊ·Ó›‰Ë˜

∂¶π∫∞πƒ√ £∂ª∞

81 ∆Ô ÂÌ‚fiÏÈÔ HPV

∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

∞ƒ£ƒA ™À¡∆∞•∏™

83 Homocystinuria due to cystathionine

‚-synthase deficiency

S. H. Mudd

85 Prevention of unintentional injury:

relevance to paediatricians

N. Spencer

∞¡∞™∫O¶∏™∂π™

87 Creating a safer Europe for children

A. J. Nicholson, D. Van Esso, I. Malcic, A. Biver

93 ∞ÛʷϤ˜ ·È¯Ó›‰È ÛÙȘ ·È‰ÈΤ˜ ̄ ·Ú¤˜:

ÂÌfi‰È· Î·È ÚÔÔÙÈΤ˜

¶. °ÚËÁÔÚ›Ô˘, ∞. ∆ÂÚ˙›‰Ë˜, ∂. ¶ÂÙÚ›‰Ô˘

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

97 ∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ

∞. ∫·Ê¿ÙÔ˜, Ã. ÷Ù˙‹˜, ª. §ÈÓ·Ú‰¿Î˘, ¢. ∞ı·Ó·ÛfiÔ˘ÏÔ˜, Ã. §ÈÔÓ‹˜, ∂. ª·ÏˆÌÂÓ¿ÎË, ∞. ∫·ÓÈÛ¿Î˘, ∂. ™Ù·Ì·Ù¿ÎË Î·È ™˘ÓÂÚÁ·˙fiÌÂÓÔÈÂÚ¢ÓËÙ¤˜

107 ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜, Û˘¯ÓfiÙËÙ· ̆ ÔÎÏÈÓÈÎÔ‡

˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ Î·È ·˘ÙÔ·ÓÔÛ›·˜ ÛÂ

·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

∂. ∫·ÏÔ˘Ì¤ÓÔ˘, §. ¡ÙÔ‡ÓÙ·˜, ª. ∞Ï‚È˙¿ÎË, °. ª·ÛÙÔÚ¿ÎÔ˜, ∞. ª¿ÓÙ˙Ô˘, ∞. ∞ÓÙˆÓ›Ô˘, Ã. §·‰fiÔ˘ÏÔ˜, Ã. ªÂÁÁÚ¤ÏË, ¢. ÃÈÒÙ˘, π. ¶··ÛˆÙËÚ›Ô˘, ∞. ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË

115 ¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË Ôχ ̄ ·ÌËÏÔ‡

‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÛÙË ÚÔÛ¯ÔÏÈ΋

ËÏÈΛ·

∂. ªÔ‡˙·, π. ∞ÓÙˆÓÈ¿‰Ô˘, ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘, ª. ∞Ó·ÁÓˆÛÙ¿ÎÔ˘, º. ∞Ó·ÙÔÏ›ÙÔ˘, ª. ªÔÚÔ˙›ÓË, °. ™·Ú·Ê›‰Ô˘, ª. •¿ÓıÔ˘

123 ∫·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÛÂ

·È‰È¿ Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·:

¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ· ·ÔÙÂϤÛÌ·Ù·

π. ¶··ÁÈ¿ÓÓ˘, °. ∫˘Ú‚·Û›Ï˘, π. ™ÔÊÈ·Ó›‰Ô˘, ∫. §¿ÛηÚË, ª. ∫È¿ÊÊ·, ™. ∞ÔÛÙÔÏÔÔ‡ÏÔ˘, ™. ƒ¿ÌÌÔ˜

135 ÃÚ‹ÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ Î·È Û˘ÌÏËڈ̷ÙÈÎÒÓ

ıÂÚ·ÂÈÒÓ Û ·È‰È¿ Ì ηÎÔ‹ıË

ÓÂÔÏ¿ÛÌ·Ù·

∞. ¶Ô˘ÚÙÛ›‰Ë˜, ¢. ¢ÔÁ¿Ó˘, ª. ª¿Î·, ª. µ·Ú‚Ô˘ÙÛ‹, ¢. ªÔ˘¯Ô‡ÙÛÔ˘, ¶. ÷Ù˙‹, ∂. ∫ÔÛÌ›‰Ë

141 H ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿

ÚÒÙ˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÚÈÓ ÙËÓ

ÂÊ˂›· ÛÙÔ ÓÔÌfi ∞ÙÙÈ΋˜

∞. ∫·ÙÛ·Ê¿‰Ô˘, µ. ¶··Â˘·ÁÁ¤ÏÔ˘, °. ºÂÚÂÓÙ›ÓÔ˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™

146 Homocystinuria due to cystathionine

‚-synthase deficiency: two sides to the

same coin

P. Augoustides-Savvopoulou, H. Ioannou, N. Kozeis, A. Karagiannidou, M. Athanasiou-Metaxa

152 ¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ·:

ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

ª. £ÂÔ‰ˆÚ›‰Ô˘, µ. µ·ÛÈÏÔÔ‡ÏÔ˘, ∞. ∑ËÛÔ‡ÏË, °. ªÔÛÙÚÔ‡, µ. ™˘ÚÈÔÔ‡ÏÔ˘

156 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞- ¶fiÛ˜ ‰fiÛÂȘ ÙÔ˘ Ó¢ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘¯ÚÂÈ¿˙ÔÓÙ·È;

- ∆ËÏÂʈÓÈ΋ (·È‰)È·ÙÚÈ΋- ∫ÔÚÙÈÎÔÂȉ‹ Î·È Kawasaki- °Ú›Ë ÙˆÓ ÙËÓÒÓ, Í·Ó¿ Î·È Í·Ó¿- ∂ԯȷ΋ ÁÚ›Ë: ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹ fi¯È;∂. °·Ï·Ó¿Î˘

158 ∫§π¡π∫√ ∫√Àπ∑

Ã. ∫ÒÛÙ·ÏÔ˜

159 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

∂ÊË‚È΋ ÀÁ›·

¡. ¶··‰fiÔ˘ÏÔ˜

163 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

¡ÂÎÚÔÏÔÁ›·: R. J. Gorlin

Ã. ™. ª·ÚÙÛfiη˜

¶·È‰È·ÙÚÈ΋∆fiÌÔ˜ 70 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2007

∫ˆ‰ÈÎfi ̃¢È‡ı˘ÓÛË ̃∂ÔÙ›· ̃ªª∂: 3889

ISSN 0377-2551

Pediatr Mar-Apr 07 28-03-07 17:22 ™ÂÏ›‰·1

Page 2: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

Bimonthly Publication of

the Greek Paediatric Society

President

A. Constantopoulos

Editorial Board

Editor-in-Chief

C. Stefanidis

Members

S. Andronikou

P. Augoustides-Savvopoulou

A. Vazeou-Gerasimidi

G. Varlamis

∂. Galanakis

L. Thomaidou

M. Kanariou

∂. Katsarou-Pectasides

A. Kattamis

S. Kitsiou-Tzeli

∞. Papadopoulou

N. Papadopoulos

A. Siamopoulou-Mavridou

M. Tsolia

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English Editing

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K. Griveas

Publishing Coordinator

SCIENTIFIC PUBLICATIONS Ltd

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Contents

xi LETTER FROM THE EDITOR-IN-CHIEF

C. Stefanidis

CURRENT ISSUE

81 HPV vaccination

A. Constantopoulos

EDITORIAL COMMENTARIES

83 Homocystinuria due to cystathionine

‚-synthase deficiency

S. H. Mudd

85 Prevention of unintentional injury:

relevance to paediatricians

N. Spencer

REVIEW ARTICLES

87 Creating a safer Europe for children

A. J. Nicholson, D. Van Esso, I. Malcic, A. Biver

93 Safer play for children in playgrounds:

barriers and prospects

P. Grigoriou, A. Terzidis, E. Petridou

ORIGINAL ARTICLES

97 Atherogenic risk factors in preschool

children in Crete

A. Kafatos, C. Hatzis, M. Linardakis, D. Athanasopoulos, C. Lionis, E. Balomenaki,A. Kapnisakis, H. Stamataki and Collaborativeresearchers

107 Thyroid volume, prevalence of subclinical

hypothyroidism and autoimmunity in

children and adolescents

I. Kaloumenou, L. Duntas, M. Alevizaki, G. Mastorakos, E. Mantzou, A. Antoniou, C. Ladopoulos, C. Mengreli, D. Chiotis, I. Papassotiriou, C. Dacou-Voutetakis

115 Neurodevelopmental outcome of very low

birth weight neonates at preschool age

H. Bouza, I. Antoniadou, H. Antonopoulou, M. Anagnostakou, F. Anatolitou, M. Morosini, J. Sarafidou, ª. Xanthou

123 Radiofrequency catheter ablation of

accessory pathways in children: immediate

and long-term results

J. Papagiannis, G. Kirvassilis, I. Sofianidou, C. Laskari, M. Kiaffas, S. Apostolopoulou, S. Rammos

135 Use of alternative and complementary

therapy by paediatric oncology patients

in Greece

A. Pourtsidis, D. Doganis, M. Baka, M. Varvoutsi,D. Bouhoutsou, P. Xatzi, H. Kosmidis

141 The epidemiology of chickenpox in school-

age children from the prefecture of Attica

∞. Katsafadou, V. Papaevangelou, G. Ferentinos,A. Constantopoulos

CASE REPORTS

146 Homocystinuria due to cystathionine

‚-synthase deficiency: two sides to the

same coin

P. Augoustides-Savvopoulou, H. Ioannou, N. Kozeis, A. Karagiannidou, M. Athanasiou-Metaxa

152 Neurocysticercosis in childhood:

a case report

M. Theodoridou, V. Vasilopoulou, A. Zisouli, G. Mostrou, V. Syriopoulou

156 PAEDIATRIC NEWS IN BRIEF

∂. Galanakis

158 CLINICAL QUIZ

C. Costalos

159 NEWS FROM THE INTERNET

Adolescent health websites

N. Papadopoulos

163 LETTER TO THE EDITOR

Obituary: R. J. Gorlin

C. S. Bartsokas

PaediatrikiVolume 70 ñ Number 2 ñ March-April 2007

Pediatr Mar-Apr 07 28-03-07 17:22 ™ÂÏ›‰·3

Page 3: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

v™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏ EDITORIAL BOARD

ª¤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board

¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·

À‡ı˘ÓÔÈ ™‡ÓÙ·Í˘ ∂ÍÂȉÈ·ۈÓ

™Ù¤ÏÏ· ∞Ó‰ÚÔÓ›ÎÔ˘, πˆ¿ÓÓÈÓ·¡ÂÔÁÓÔÏÔÁ›·

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, £ÂÛÛ·ÏÔÓ›ÎËKÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·

∞Ó‰ÚÈ·Ó‹ µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë, ∞ı‹Ó·∂Ó‰ÔÎÚÈÓÔÏÔÁ›·

°ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘, £ÂÛÛ·ÏÔÓ›ÎË∫·Ú‰ÈÔÏÔÁ›·

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, ∏Ú¿ÎÏÂÈÔ∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·

§ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘, ∞ı‹Ó·∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó·∞ÓÔÛÔÏÔÁ›·

∂˘ÛÙ·ı›· ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë, ∞ı‹Ó·¡Â˘ÚÔÏÔÁ›·

∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ı‹Ó·∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞ı‹Ó·°ÂÓÂÙÈ΋

∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, ∞ı‹Ó·°·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ∏·ÙÔÏÔÁ›· - ¢È·ÙÚÔÊ‹

¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ı‹Ó·∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶Ó¢ÌÔÓÔÏÔÁ›·

∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, πˆ¿ÓÓÈÓ·ƒÂ˘Ì·ÙÔÏÔÁ›·

ª·Ú›˙· ∆ÛÔÏÈ¿, ∞ı‹Ó·§ÔÈ̈ÍÈÔÏÔÁ›·

Editor-in-Chief

Constantinos Stefanidis, Athens

Section Editors

Stella Andronikou, IoanninaNeonatology

Persefoni Avgoustides-Savvopoulou, ThessalonikiMetabolic Disorders

Andriani Vazaiou-Gerasimidi, AthensEndocrinology

George Varlamis, ThessalonikiCardiology

Emmanuel Galanakis, HerakleionEthics and Deontology

Loretta Thomaidou, AthensDevelopmental Pediatrics

Maria Kanariou, AthensImmunology

Eustathia Katsarou-Pektasides, AthensNeurology

Antonis Kattamis, AthensHaematology - √ncology

Sophia Kitsiou-Tzeli, AthensGenetics

Alexandra Papadopoulou, AthensGastroenterology - Hepatology - Nutrition

Nicos Papadopoulos, AthensAllergology - Pneumonology

Antigoni Siamopoulou-Mavridou, IoanninaRheumatology

Marisa Tsolia, AthensInfectious Diseases

Alexis Arzimanoglou, Paris, France

Ellis D. Avner, Milwaukee, USA

Swati Bhave, New Delhi, India

Alberto Bissot, Panama, Panama

David Branski, Jerusalem, Israel

Francesco Chiarelli, Chieti, Italy

Chok-Wan Chan, Hong Kong, China

Denis Daneman, Toronto, Canada

Jochen Ehrich, Hannover, Germany

Demetrius Ellis, Pittsburgh, USA

Yoshikatsu Eto, Tokyo, Japan

Richard N. Fine, Stony Brook, USA

Margaret C. Fisher, Philadelphia, USA

Raif Geha, Boston, USA

Adenike Grange, Lagos, Nigeria

Judith G. Hall, Vancouver, Canada

Patricia Hamilton, London, UK

Enver Hasanoglu, Ankara, Turkey

Christer Holmberg, Helsinki, Finland

Peter Hoyer, Essen, Germany

Jan Janda, Prague, Czech Republic

Jan Kimpen, Ultrecht, Netherlands

Craig B. Langman, Chicago, USA

John Manis, Boston, USA

Manuel Moya, Alicante, Spain

Hugh O'Brodovich, Toronto, Canada

Ross Petty, Vancouver, Canada

Willem Proesmans, Leuven, Belgium

Jose Ramet, Antwerp, Belgium

Alan Sinaiko, Minneapolis, USA

Nick J. Spencer, Coventry, UK

Alfred Tenore, Udine, Italy

Alkis Togias, Bethesda, USA

Eva Tsalikian, Iowa City, USA

Catherine Weil-Olivier, Paris, France

Max Zach Graz, Austria

Johannes Zschocke, Heidelberg, Germany

Pediatr Mar-Apr 07 28-03-07 17:22 ™ÂÏ›‰·5

Page 4: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

xi∂¶π™∆√§∏ ∞¶√ ∆∏ ™À¡∆∞•∏ EDITORIAL

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∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ,

™·˜ ¢¯·ÚÈÛÙԇ̠ÁÈ· Ù· ÎÔϷ΢ÙÈο Û·˜ Û¯fiÏÈ· ÁÈ· ÙȘ ‚ÂÏÙÈÒÛÂȘ Ô˘ ¤ÁÈÓ·Ó ÙfiÛÔ ÛÙËÓ ÂÌ-Ê¿ÓÈÛË fiÛÔ Î·È ÛÙÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. £· ı¤Ï·Ì ӷ Û·˜ ÂÓËÌÂÚÒÛÔ˘Ì fiÙÈ Ù· Ó¤· ̤-ÏË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ Â›Ó·È Ë Î. ™Ù¤ÏÏ· ∞Ó‰ÚÔÓ›ÎÔ˘ (¡ÂÔÁÓÔÏÔÁ›·), Ô Î. ª·ÓÒÏ˘ °·Ï·-Ó¿Î˘ (∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·), Ë Î. ™ÔÊ›· ∫›ÙÛÈÔ˘ (°ÂÓÂÙÈ΋) Î·È Ë Î. §ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘ (∞Ó·-Ù˘ÍȷΤ˜ ¢È·Ù·Ú·¯¤˜). √È Û˘Ó¿‰ÂÏÊÔÈ ·˘ÙÔ› ¤¯Ô˘Ó Ì·ÎÚfi¯ÚÔÓË Â›Ú· Î·È Â›Ì·È ‚¤‚·ÈÔ˜ fiÙÈ ı·Û˘Ì‚¿ÏÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÛÙËÓ ÂÎÏ‹ÚˆÛË ÙˆÓ ÛÙfi¯ˆÓ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. √ Î. ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·-ÏÔ˜ Î·È Ë Î. ∂ϤÓË ∞ÓÙˆÓÔÔ‡ÏÔ˘ ·Ô¯ÒÚËÛ·Ó ·fi ÙË ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹. £· ı¤Ï·Ì ӷ ÙÔ˘˜Â˘¯·ÚÈÛÙ‹ÛÔ˘Ì ÁÈ· ÙËÓ Ô˘ÛÈ·ÛÙÈ΋ Û˘Ì‚ÔÏ‹ ÙÔ˘˜.

∞fi ÙËÓ ·Ú¯‹ ÙÔ˘ ¯ÚfiÓÔ˘ Ë ÂΉÔÙÈ΋ ‰ÈÂÚÁ·Û›· Á›ÓÂÙ·È ËÏÂÎÙÚÔÓÈο Ì ÛÙfi¯Ô ÙËÓ ÂÈÙ¿¯˘ÓÛËÙ˘ ÎÚ›Û˘ ÙˆÓ ÂÚÁ·ÛÈÒÓ. °È· ÙË ‰È¢ÎfiÏ˘ÓÛ‹ Û·˜ ÌÔÚ›Ù ӷ ˘Ô‚¿ÏÏÂÙ ÙȘ ÂÚÁ·Û›Â˜ Û·˜ ËÏÂ-ÎÙÚÔÓÈο. ¶ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ ÁÈ· ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ˘Ô‚ÔÏ‹ ÂÚÁ·ÛÈÒÓ ı· ‚Ú›Ù ÛÙȘ “√‰Ë-Á›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜” ·˘ÙÔ‡ ÙÔ˘ Ù‡¯Ô˘˜. ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÙËÚÂ›Ù·È Ë ¤ÎÙ·ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓÔ˘ ηıÔÚ›˙ÂÙ·È ÛÙȘ Ô‰ËÁ›Â˜. £· ‹Ù·Ó ‰˘Ó·Ùfi Ó· ‰ËÌÔÛȇÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÁ·Û›Â˜ Û οıÂÙ‡¯Ô˜, ·Ó Ù· ΛÌÂÓ· ‹Ù·Ó Û˘ÓÙÔÌfiÙÂÚ·. ÕÏψÛÙ ÔÈ ÔÏ˘Û¤Ïȉ˜ ‰ËÌÔÛȇÛÂȘ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË·Ó·ÁÓˆÛÈÌfiÙËÙ·. °È· Ó· ÂÍÔÈÎÔÓÔÌËı› ¯ÒÚÔ˜ ÛÙÔ ÂÚÈÔ‰ÈÎfi ÔÈ “√‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜” ı·ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÌfiÓÔ ÛÙÔ ÚÒÙÔ Ù‡¯Ô˜ οı ¯ÚfiÓÔ˘ Î·È ÛÙËÓ ÈÛÙÔÛÂÏ›‰· Ù˘ “¶·È‰È·ÙÚÈ΋˜”.

∞fi ·˘Ùfi ÙÔ Ù‡¯Ô˜ ÍÂÎÈÓ¿ÂÈ Ì›· Ó¤· ÛÂÈÚ¿ ¿ÚıÚˆÓ Ì ۯÔÏÈ·ÛÌfi ÚfiÛÊ·ÙˆÓ ‰ËÌÔÛȇۈӷfi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Ù· “™‡ÓÙÔÌ· ·È‰È·ÙÚÈο Ó¤·”. ∂Ï›˙Ô˘Ì fiÙÈ ı· Ù· ‚Ú›Ù ÂӉȷʤ-ÚÔÓÙ·. ™Ù· ÂfiÌÂÓ· Ù‡¯Ë ı· ‰ËÌÔÛȇÔÓÙ·È ÌÂÙÂÎ·È‰Â˘ÙÈο ¿ÚıÚ· Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·ÈÂÚˆÙ‹ÛÂȘ ÔÏÏ·ÏÒÓ ··ÓÙ‹ÛˆÓ. ∆¤ÏÔ˜, fiÏÔÈ ÔÈ ·Ó·ÁÓÒÛÙ˜ ÌÔÚÔ‡Ó Ó· Ì·˜ ÛÙ›ÏÔ˘Ó ÂÚˆÙ‹-Ì·Ù· Ô˘ ÙÔ˘˜ ··Û¯ÔÏÔ‡Ó ÛÙË Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ ÙÔ˘˜ Ú¿ÍË. ∆· ÂÚˆÙ‹Ì·Ù· ·˘Ù¿ ı· ·ÔÙÂ-ϤÛÔ˘Ó Ù· ı¤Ì·Ù· ÁÈ· ÙË Ó¤· ÛÂÈÚ¿ ¿ÚıÚˆÓ: “ƒˆÙ‹ÛÙ ÙÔÓ ÂȉÈÎfi”.

ªÂ ıÂÚÌÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Dear colleagues,

Thank you for your kind comments on the improvements of the layout and the content of the journal.We would like to inform you that the new members of the Editorial Board are Dr Stella Andronikou(Neonatology), Dr Manolis Galanakis (Medical Ethics), Dr Sophia Kitsiou (Genetics) and Dr LorettaThomaidou (Developmental Pediatrics). These colleagues have long experience in their respective fields andwe believe that they will contribute to the success of the journal. Dr Christos Kostalos and Dr EleniAntonopoulou stepped down from the Editorial Board. We would like to thank them for their contribution.

The editorial process of the journal is handled electronically since the beginning of this year. All paperscan now be submitted by e-mail. Detailed information about the submission of articles is included in the“Instructions to authors” of this issue. We would like to emphasize the importance of compliance to thesuggested length of publications. We will be able to publish a larger number of papers if the manuscriptsare shorter. In addition shorter papers are more reader friendly. To save space you will find the“Instructions to authors” only in the first issue of each year and at the web page of the journal.

A new section: “Paediatric news in brief” will start from this issue with comments on recent pediatricarticles. We hope that you will find this section interesting. Educational articles will be included in thenext issues with multiple choice answers. Finally we invite you to send us questions that arise from yourevery day practice. These questions will become the topics of the new section: “Ask the expert”.

Warm greetings

Constantinos StefanidisEditor-in-Chief

Pediatr Mar-Apr 07 28-03-07 17:22 ™ÂÏ›‰·11

Page 5: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™

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

‰ÔÛË 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 ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·ÈÛ˘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 ÂÈÛÙËÌÔÓÈ-

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

Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰Ë-ÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ,ηıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È ËÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰Ë-ÌÔÛ›Â˘ÛË ÂÚÁ·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˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔ-ÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

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

ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤-ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘Ô-ÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎË-Ú‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó·¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆ-ˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEWPublication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó·¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔ-Á›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓÔ˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. Hηٷ¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓEÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙË-Û›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋

·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË

Û˘ÁηٿıÂÛË 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‹-

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

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

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

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

·ÁÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈ-

Ûٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿Ï-

Ϙ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜,

Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·:

ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ.

ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 1500-2500 ϤÍÂȘ Î·È ÙȘ

ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 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 ÔÓÔ-

Ì·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˘ÁÁڷʤ· 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¿ÊÔ-

ÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ ηÈ

Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfi-

ÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ

ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂ-

ϤÛÌ·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.

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

ÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈ-

ÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

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

ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹

xii

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ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂ-ÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤-ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤-ÂÈ ÙËÓ ·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· ·Ô-ÙÂϤÛÌ·Ù· 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. HÛ˘˙‹ÙËÛË 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˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏψÓÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌËÂÈÛ·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 ÙËÓ ÎÚ›ÛËÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜.

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

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

ÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi(Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·-Θ 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‡. ™‡ÓıÂÙÔÈ Î·ÈÌ·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍË-ÁÔ‡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 ÛÙȘ ÂÚÈÏ‹„ÂȘ.

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

ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·ÈÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·-ʤÚÔÓÙ·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 40 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 20 ÛÙ· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜

ÂÚÈÙÒÛÂȘ. ñ ÙȘ 10 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 Re-quirements for Manuscripts Submitted to Biomedical Journals,(http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). OÈÛ˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cu-mulated Index Medicus [List of Journals Indexed in Index Medi-cus(http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓI. ¶∂ƒπO¢π∫∞

AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·ÓÂ›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔ-ÛÙ›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·ÛËÛÙËÓ 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. EurJ Pediatr 1997;156:669-679.

™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:

Flyvbjerg A. Role of growth hormone, insulin-like growth fac-tors (IGFs) and IGF-binding proteins in the renal complicationsof diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

Èڛ˜ Û˘ÁÁڷʤ·:

National Institutes of Health Consensus DevelopmentConference. Neurofibromatosis conference statement. ArchNeurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

Schreiner GF, Lange L. Ethanol modulation of macrophageinflux in glomerulonephritis [Abstract]. J Am Soc Nephrol1991;2:562.

Should antileukotriene therapies be used instead of inhaledcorticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med1998;158:1697-1701.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculi-tis associated with levamisole and circulating autoantibodies [Let-ter]. 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. PediatricNephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999.p. 742.

™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:

Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head andneck. 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 InternationalCongress of Chemotherapy; 1962 May 29-31; New York: Interna-tional 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 accessand utilization [dissertation]. St. Louis (Mo): Washington Univ.;1995.

πππ. CD-ROM

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

IV. ™∆O ¢π∞¢π∫∆ÀO

ÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi:

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

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

cancer [Monograph, Internet]. Washington: National AcademyPress; 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˜OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿

Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·ÈÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔ-Áڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜ Î·È ı· Ú¤ÂÈ Ó··ÔÛÙ¤ÏÏÂÙ·È Û ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹ Î·È Û ·Ú¯Â›· ˘„ËÏ‹˜ ·Ó¿-Ï˘Û˘. ™Â ÂÚ›ÙˆÛË Ô˘ ·˘Ùfi ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi, ÙÔ ˘ÏÈÎfi ı··ÔÛÙ¤ÏÏÂÙ·È Ù·¯˘‰ÚÔÌÈÎÒ˜ Î·È ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ ı·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 ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈÓ· ·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· ·ÔÛÙ¤ÏÏÔÓÙ·È ÛÙËÓ ËÏÂÎÙÚÔ-

ÓÈ΋ ‰È‡ı˘ÓÛË Ù˘ ÂÙ·ÈÚ›·˜ ([email protected]). ™Â ͯˆ-ÚÈÛÙfi Ì‹Ó˘Ì· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍÔÏÔÎÏ‹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 Â-ÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘-¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡ÌʈӷÌ ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, ̤ۈ e-mail Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚ-Á·Û›· Û ÚfiÁÚ·ÌÌ· Word. ™Â ͯˆÚÈÛÙfi ·Ú¯Â›Ô ı· ÂÚÈÏ·Ì‚¿-ÓÂÙ·È ÂÈÛÙÔÏ‹ fiÔ˘ ı· ·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˘ ÙÚÔÔÔÈË̤ÓÔ˘ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

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, ÂÊfi-ÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁÚ·Ê›Â˜Ô˘ Ù· Û˘Óԉ‡ԢÓ.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ËÏÂÎÙÚÔÓÈο ÙËÓ ÂÚÁ·Û›· Û·˜, ‚Â-‚·Èˆı›Ù fiÙÈ ÙÔ ·Ú¯Â›Ô ÂÚÈÏ·Ì‚¿ÓÂÈ:

1. ™ÂÏ›‰· Ù›ÙÏÔ˘ Ô˘ ÂÚȤ¯ÂÈ: ·. 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, ËÏÂÎÙÚÔÓÈ΋ ‰È‡ı˘ÓÛË Î·È ÙËϤʈ-

ÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·. 2. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋ (200-250 ϤÍÂȘ), ‰ÔÌË̤ÓË

ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·-Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·.

3. §¤ÍÂȘ ÎÏÂȉȿ.4. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ.5. ∫›ÌÂÓÔ.6. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯Ô-

ÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢).7. µÈ‚ÏÈÔÁÚ·Ê›·.8. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).9. ∂ÈÎfiÓ˜ (Ë Î·ıÂÌ›· Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

10. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ.

“√È ÂÚ›ÔÏÔÈ Ù˘ÂÈÚ‹Ó˘”Diana Marcela Cortes,10 ¯ÚÔÓÒÓ, ∫ÔÏÔÌ‚›·¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË

“∆· Ù˘ÊÏ¿ ·È‰È¿˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“The patrol of thePeace”, Diana Marcela Cortes,10 years old, ColombiaPartially blind child

“Blind children

paint”, Anna Laoutari-Gritzala,Athens 2006

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·14

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xvi ™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

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·16

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xviii INSTRUCTIONS TO AUTHORS

A. General InformationThe Greek Paediatric Society is the owner of “Paedia-

triki”, its official scientific journal, which is distributed to

its members. Its objectives are the publication of paediatric

scientific work and the continuing education of paediatri-

cians. 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 publish-

es upon decision original papers presented at the Annual

Paediatric Conference, 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 previ-

ously, in whole or in part, and not be under consideration

by another publication. Manuscripts should acknowledge

any funding, sponsorship or other financial support. All

clinical research should have been conducted following in-

formed consent of participants or of their legal representa-

tives according to the Declarations of Helsinki and Tokyo.

In addition, the US National Institute of Health guide for

the care and use of laboratory 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

published papers do not necessarily reflect those of the jour-

nal. The Greek Paediatric Society, the Editorial Board and

the Publisher of the journal do not necessarily approve the

content of the advertisements appearing in the journal.

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

atriki” and their reproduction in whole or in part is autho-

rized only following written consent of the journal.

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

Requirements for Manuscripts Submitted to Biomedical

Journals”, recently modified and published on the web-

sites:

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

The paper should have the following structure: title page,short title, abstract in Greek and English, list of abbrevia-tions, text, acknowledgements and quoting of grants, spon-sorships or other financial support sources, references, ta-bles, figures, figure legends.

Text length shall be: ñ review articles 2000-3000 words;ñ original articles 1500-2500 words and case reports

1000-1500 words; ñ brief reports 1000-1500 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,the status of the author(s) should be cited (e.g., privatepaediatrician) and home address;

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

Abstracts

The abstract should summarize the objectives, method-ology, 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: back-ground, methods, results and conclusions.

The English abstract should cite at the beginning the ti-

tle of the paper and the authors’ names in English. The con-tent of the text should consist of the following paragraphs:background, methods, results and conclusions. The abstractin English should not differ in content from the correspond-ing Greek abstract.

Beneath the Greek and English abstracts, three to fivekey words in the respective language should be supplied, tobe used in 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 objec-tives of the paper. The description of the methods should beprecise and detailed so as to enable reproduction by other re-searchers. In addition, the statistical methods of analysis andevaluation of the results should be described. Results shouldbe presented clearly, together with the appropriate statisticalanalysis. Discussion should cover the results ensuing fromthe research, their significance and possible associations withthe observations of other researchers.

Case reports comprise a short introduction, case de-scription and brief discussion, with emphasis on differentialdiagnosis.

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

Thanks or acknowledgements (reference to grants,sponsorships or other sources of financial support) shouldbe quoted at the end of the text, before references.

Units of measures of laboratory analyses

Laboratory analyses should be expressed in the SystèmeInternational (SI) units and in the metric (Conventional)

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·18

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xix

system in parentheses. See conversion tables on the websites:

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

Abbreviations

All issues of the journal contain internationally established ab-

breviations. Complex or long terms often repeated in the text may

be replaced by abbreviations explained by the authors in a list sub-

mitted with the paper. Abbreviations are reported in parentheses

only in abstracts.

References

The reference section contains all references numbered in the

order in which they appear in the text. In the text, references are

to be indicated by Arabic numerals in parentheses. References

should be no more than:

ñ 70 in review articles;

ñ 40 in original articles;

ñ 20 in current issues and case reports;

ñ 10 in brief reports and letters.

In listing references follow the recently modified standards of

the International Committee of Medical Journal Editors/Uniform

Requirements for Manuscripts Submitted to Biomedical Journals,

(http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Ab-

breviated names of journals should conform to the Cumulated In-

dex Medicus [List of Journals Indexed in Index Medicus

(http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style

I. JOURNALS

All 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 fac-

tors (IGFs) and IGF-binding proteins in the renal complications

of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

No author:

National Institutes of Health Consensus Development Con-

ference. Neurofibromatosis conference statement. Arch Neurol

1988;45:575-578.

Article type specification:

Schreiner GF, Lange L. Ethanol modulation of macrophage in-

flux in glomerulonephritis [Abstract]. J Am Soc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of inhaled

corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med

1998;158:1697-1701.

Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculi-

tis associated with levamisole and circulating autoantibodies [Let-

ter]. Arch Dis Child 1996;75:355-356.

II. BOOKS

Chapter in book:

Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome.

In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrol-

ogy. 4th ed. Baltimore: Lippincott William Wilkins; 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 International

Congress of Chemotherapy; 1962 May 29-31; New York: Interna-

tional Society of Chemotherapy; 1963. p. 484-500.

Doctoral dissertation:

Kaplan SJ. Post hospital home health care: the elderly’s access

and utilization [dissertation]. St. Louis (Mo): Washington Univ.;

1995.

πππ. CD-ROM

Anderson SC, Poulsen KB. Anderson’s electronic atlas of

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

Wilkins; 2002.

IV. ON THE INTERNET

Article in journal

Abood S. Quality improvement initiative in nursing homes: the

ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Web-

page: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm

Monograph

Foley KM, Gelband H, editors. Improving palliative care for

cancer [Monograph, Internet]. Washington: National Academy

Press; 2001. Webpage:

http://www.nap.edu/books/0309074029/html

Websites

Cancer-Pain.org [Webpage, Internet]. New York: Association

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

pain.org/

Tables and Figures

Tables are numbered with Arabic numerals in the order in

which they appear in the text. They should have a short title and

abbreviations should be listed at the bottom. Vertical lines in ta-

bles should be avoided.

All illustration material is considered as figures (graphs, pic-

tures, etc.) should be sent in high resolution electronic files. If

this is not possible, material should be sent by post; in that case

at the back of every picture, the number of the picture and the

name of the first author should be noted in pencil, with an arrow

showing the top of the picture. The identity of patients should

not be recognizable from their pictures nor should their names

be stated.

C. Manuscript Submission and PublicationAll manuscripts should be sent to the Greek Paediatric Soci-

ety by e-mail ([email protected]). In a separate e-mail authors

should state that the paper has not been published in part or in

whole, or is not under consideration by another journal and that

the authors accept its publication in “Paediatriki”. Any funding,

sponsorship or other financial support should be acknowledged.

Once the manuscript has been accepted, the corrected version,

rewritten according to the reviewers’ recommendations should be

submitted to the Editorial Board. In a separate file a cover letter

should be submitted in Word format specifying in detail the mod-

ifications or objections to the reviewers’ suggestions.

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·19

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

Manuscripts of papers which have not been approved for pub-lication are not returned to the author. The accompanying figuresand photographs can be returned upon request within six months.

Before submitting your paper by e-mail, make sure the filecontains:

1. The title 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, e-mail and tele-

phone number;

2. English and Greek abstracts (200-250 words), with the follow-ing structure: background, methods, results and conclusions.

3. Keywords.4. List of abbreviations.5. Text.6. Acknowledgements and reference to funding, sponsorships

or other financial sources.7. References.8. Tables (one per page).9. Figures (one per page).

10. Figure titles.

“ªÔÓ·¯ÈÎfi §Ô˘ÏÔ‡‰È”Cheryl Desjardins, 15 ÂÙÒÓ, ∫·Ó·‰¿˜¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË

“∆· Ù˘ÊÏ¿ ·È‰È¿˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

“A single Flower”, Cheryl Desjardins, 15 years old, CanadaPartially blind child

“Blind children

paint”, Anna Laoutari-Gritzala,Athens 2006

xx

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·20

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81∂¶π∫∞πƒ√ £∂ª∞ CURRENT ISSUE

AÏÏËÏÔÁÚ·Ê›·:

∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜[email protected]¶Úfi‰ÚÔ˜ Ù˘ ∂ÏÏËÓÈ΋˜¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜

Correspondence:

Andreas [email protected] of the GreekPaediatric Society

¶·È‰È·ÙÚÈ΋ 2007;70:81-82

∆Ô ÂÌ‚fiÏÈÔ HPV

∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

¢Âη¤ÓÙ ‰È·ÊÔÚÂÙÈÎÔ› ÈÔ› ÙˆÓ ·ÓıÚÒÈ-

ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔÓ

ηÚΛÓÔ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜. ∂Í ·˘ÙÒÓ,

ÔÈ ÈÔ› 16 Î·È 18 ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 70% ÙˆÓ Â-

ÚÈÙÒÛÂˆÓ Î·ÚΛÓÔ˘ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹-

ÙÚ·˜. º˘ÛÈο, Ù· ÛÙÂϤ¯Ë ÙÔ˘ HPV Â›Ó·È Â-

ÚÈÛÛfiÙÂÚ· ·fi 200. √È Á˘Ó·›Î˜ Û ÔÛÔÛÙfi

70-80% ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ı· ÂÌ-

Ê·Ó›ÛÔ˘Ó Ì›· Ïԛ̈ÍË ·fi HPV. ∆Ô test ¶··-

ÓÈÎÔÏ¿Ô˘, fiÙ·Ó ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ Á˘Ó·›Î˜,

‚ÔËı¿ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈ-

ÛË ÙÔ˘ ηÚΛÓÔ˘. Œ¯ÂÈ ‚ÚÂı› fiÙÈ Û ηϿ ÔÚÁ·-

ӈ̤ӷ ÚÔÁÚ¿ÌÌ·Ù· ÏËı˘ÛÌÈ·ÎÔ‡ ÂϤÁ¯Ô˘

Ì test ¶··ÓÈÎÔÏ¿Ô˘ ÌÂÈÒÓÂÙ·È Ô Î·ÚΛÓÔ˜

ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜ ηٿ 70-75%. ∆¤ÙÔÈ-

˜ ¯ÒÚ˜ Â›Ó·È ÔÈ ™Î·Ó‰ÈÓ·‚ÈΤ˜ ¯ÒÚ˜ (¶›Ó·-

η˜ 1). ŒÙÛÈ, ÛÙË ºÈÓÏ·Ó‰›·, ÙÔ ∏ӈ̤ÓÔ µ·Û›-

ÏÂÈÔ Î·È ÙË ™Ô˘Ë‰›· Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ test ¶·-

·ÓÈÎÔÏ¿Ô˘, Ô˘ ÁÈÓfiÙ·Ó ÛÂ 85-95% ÙÔ˘ ÏË-

ı˘ÛÌÔ‡, ÌÂÈÒıËÎÂ Ô Î·ÚΛÓÔ˜ ÙÔ˘ ÙÚ·¯‹ÏÔ˘.

™ÙË ¯ÒÚ· Ì·˜ ‰˘ÛÙ˘¯Ò˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙ·-

ÙÈÛÙÈο ‰Â‰Ô̤ӷ ˆ˜ ÚÔ˜ ÙÔ test ¶··ÓÈÎÔÏ¿-

Ô˘. ™‡Ìʈӷ Ì ÔÚÈṲ̂ÓÔ˘˜ Ú·ÁÌ·ÙÔÔÈ›ٷÈ

Û ÔÛÔÛÙfi οو ÙÔ˘ 20% ÙˆÓ Á˘Ó·ÈÎÒÓ, ÂÓÒ

ηْ ¿ÏÏÔ˘˜ Û ÔÛÔÛÙfi οو ÙÔ˘ 10%.

¶ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛ ÙÔ ÂÌ‚fiÏÈÔ Gardasil

ÙÔ ÔÔ›Ô Â›Ó·È ÙÂÙÚ·‰‡Ó·ÌÔ (6,11,16 Î·È 18). ∏

·ÔÙÂÏÂÛÌ·ÙÈ΋ Î¿Ï˘„Ë ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÁÈ·

ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜ Î˘Ì·›ÓÂÙ·È ·fi 60-75%. ™˘ÓÂ-

Ò˜ ÙÔ ÂÌ‚fiÏÈÔ ‰ÂÓ “ÍÂÚÈ˙ÒÓÂÈ” ÙÔÓ Î·ÚΛÓÔ,

·ÏÏ¿ ÙÔÓ ÂÏ·ÙÙÒÓÂÈ Û ›‰È· ÂÚ›Ô˘ ÔÛÔÛÙ¿ ÌÂ

ÙÔ test ¶··ÓÈÎÔÏ¿Ô˘. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·

ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ·ÁÁ›˙ÂÈ ÙÔ 100%. ∆Ô ÂÌ‚fiÏÈÔ ¤¯ÂÈ

¿ÚÂÈ ¿‰ÂÈ· ÁÈ· ÎÔÚ›ÙÛÈ· 9-25 ÂÙÒÓ ÛÙËÓ ∂˘ÚÒ-

Ë Î·È ÙËÓ ∞ÌÂÚÈ΋, ÂÓÒ ÁÈ· ·ÁfiÚÈ· 9-15 ÂÙÒÓ

¤¯ÂÈ ¿ÚÂÈ ¿‰ÂÈ· ÌfiÓÔ ÛÙËÓ ∂˘ÚÒË. √ ·ÚÈıÌfi˜

ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÛÙ· ÔÔ›· ‰ÔÎÈÌ¿ÛÙËÎÂ ÙÔ ÂÌ‚fi-

ÏÈÔ ÚÔÙÔ‡ ¯ÔÚËÁËı› Ë ¿‰ÂÈ· ‹Ù·Ó 24.000 ÂÚ›-

Ô˘, ÂÓÒ ÙˆÓ ·ÁÔÚÈÒÓ ÌfiÓÔ 1.071. ∂›Ó·È ÚÔÙÈ-

ÌfiÙÂÚÔ Ó· ¯ÔÚËÁÂ›Ù·È ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÛÂÍÔ˘·-

ÏÈÎÒÓ Â·ÊÒÓ, ‰ÈfiÙÈ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÙÔ ÔÛÔÛÙfi

ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ÌÔχÓÔÓÙ·È Ì ÙËÓ ÚÒÙË ÛÂ-

ÍÔ˘·ÏÈ΋ ·ʋ Â›Ó·È ¿Ú· Ôχ ˘„ËÏfi. ¶·Ú¿

Ù·‡Ù· Û˘ÓÈÛÙ¿Ù·È Î·È Û ¿ÙÔÌ· Ì ÂÓÂÚÁfi ÛÂ-

ÍÔ˘·ÏÈ΋ ˙ˆ‹, ¯ˆÚ›˜ fï˜ Ó· ÁÓˆÚ›˙Ô˘Ì ·ÎÚÈ-

‚Ò˜ Û ÙÈ ÔÛÔÛÙfi ÚÔÛٷهÂÈ.

∆Ô ÂÌ‚fiÏÈÔ HPV ¯ÔÚËÁÂ›Ù·È ÂÓ‰ÔÌ˘˚ο ÛÂ

ÙÚÂȘ ‰fiÛÂȘ (0, 2 Î·È 6 Ì‹Ó˜). ¢‡Ó·Ù·È Ó· ¯ÔÚË-

ÁËı› Ù·˘Ùfi¯ÚÔÓ· Ì ÙÔ ÂÌ‚fiÏÈÔ Ù˘ Ë·Ù›Ùȉ·˜

µ, ·Ó Î·È Ù· ÂÚÈÛÙ·ÙÈο ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ

ηْ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ‹Ù·Ó Ôχ Ï›Á·, Î·È ‰ÂÓ

ÂËÚ¿˙ÂÙ·È ·fi ÙË Ï‹„Ë ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ

¶›Ó·Î·˜ 1. Test ¶··ÓÈÎÔÏ¿Ô˘ ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÒÚ˜

ÃÒÚ· ™‡ÛÙ·ÛË % Ù·ÎÙÈÎfi screened

∏ÏÈÎÈ·Îfi ‡ÚÔ˜ (¤ÙË) ªÂÛԉȿÛÙËÌ· (¤ÙË)

ºÈÓÏ·Ó‰›·1 30-60 5 93∞ÁÁÏ›·1 25-64 3-5 83™Ô˘Ë‰›·1 23-60 3 83µ¤ÏÁÈÔ2 25-64 3 78√ÏÏ·Ó‰›·1 30-60 5 77¢·Ó›·1 23-59 3 75°·ÏÏ›·1 25-65 3 69πÙ·Ï›·1 25-64 3 53-74°ÂÚÌ·Ó›·1 20-85 1 50πÛ·Ó›·2 25-65 3 27

ñ ∆Ô ÔÛÔÛÙfi ÙˆÓ Á˘Ó·ÈÎÒÓ Ô˘ ÂÍÂÙ¿˙ÔÓÙ·È Ù·ÎÙÈο ÛÙȘ ¯ÒÚ˜ ηٿ Ì‹ÎÔ˜ Ù˘ ∂˘ÚÒ˘ ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ·ñ ¢˘ÛÎÔÏ›· ÛÙËÓ Â›Ù¢ÍË ˘„ËÏ‹˜ Î¿Ï˘„˘

1. Anttila A, Ronco G, Clifford G, Bray F, Hakama M, Arbyn M, et al. Cervical cancer screening programmes andpolicies in 18 European countries. Br J Cancer 2004;91:935-941.

2. van Ballegooijen M, van den Akker-van Marle E, Patnick J, Lynge E, Arbyn M, Anttila A, et al. Overview ofimportant cervical cancer screening process values in European Union (EU) countries, and tentative predictionsof the corresponding effectiveness and cost-effectiveness. Eur J Cancer 2000;36:2177-2188.

3. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: cancer incidence. Mortality and prevalence worldwide.IARC cancer base no. 5, version 2.0. Lyon (France): IARC Press; 2004.

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Ê·Ú̿ΈÓ. ¶ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ¯Ô-Ú‹ÁËÛË Ì ٷ ¿ÏÏ· ÂÌ‚fiÏÈ· ̤¯ÚÈ Ó· Á›ÓÔ˘Ó ÔÈ ·Ó¿ÏÔ-Á˜ ÌÂϤÙ˜. ¢ÂÓ Â›Ó·È ·Ó·Áη›Ô Ó· ÚÔËÁËı› test¶··ÓÈÎÔÏ¿Ô˘ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·ÓÎ·È ‰ÂÓ ÁÓˆÚ›˙Ô˘Ì ÙÈ ÌÔÚ› Ó· Û˘Ì‚Â› Û ¤Ó· ¿ÙÔÌÔÔ˘ ¤¯ÂÈ ‹‰Ë ÌÔÏ˘Óı›. ∆Ô ÂÌ‚fiÏÈÔ ¤¯ÂÈ ¯ÔÚËÁËı›ηٿ Ï¿ıÔ˜ Î·È Û ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi ÂÁ·ˆÓ ̄ ˆÚ›˜·ÚÂÓ¤ÚÁÂȘ. ∞˘Ùfi ‚‚·›ˆ˜ ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ Ú¤ÂÈÓ· ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Î·È ÔÈ ¤ÁÎ˘Â˜. √È ·ÚÂÓ¤ÚÁÂȘ ÙÔ˘ÂÌ‚ÔÏ›Ô˘ Ô˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ Ê‡ÏÏÔ Ô‰ËÁÈÒÓ ¯Ú‹-ÛÙË Â›Ó·È ‹È˜: ÂÏ·ÊÚ¿ ÙÔÈ΋ ·ÓÙ›‰Ú·ÛË, Î·È ˘ÚÂ-Ùfi˜ ̤¯ÚÈ 38,5oC. √È ·ÓÙȉڿÛÂȘ ·˘Ù¤˜ ·Ú·ÙËÚÔ‡-ÓÙ·È ÂÓÙfi˜ 5 ËÌÂÚÒÓ ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘.°È· Ó· ÂÎÙÈÌËı› fï˜ ·Ó ¤Ó· ÂÌ‚fiÏÈÔ ¤¯ÂÈ ·ÚÂÓ¤Ú-ÁÂȘ, ı· Ú¤ÂÈ Ó· ¯ÔÚËÁËı› Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi Á˘-Ó·ÈÎÒÓ. ¶ÚÈÓ ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ ¿‰ÂÈ·˜ ÛÙÔGardasil, ·˘Ùfi ‰ÔÎÈÌ¿ÛıËΠÌfiÓÔ Û 24.000 Á˘Ó·›ÎÂ˜Î·È 1.071 ·ÁfiÚÈ·. ∞fi ÙË Ì¤¯ÚÈ ÙÒÚ· ̄ ÔÚ‹ÁËÛË Ê·›ÓÂ-Ù·È Ó· ‰ËÏÒÓÔÓÙ·È ÔÚÈṲ̂ӷ ÂÚÈÛÙ·ÙÈο Ì ·ÚÂÓ¤Ú-ÁÂȘ Ù· ÔÔ›· ·Ó·Ï‡ÔÓÙ·È Î·È ÁÚ‹ÁÔÚ· ı· ÂÚÈÁÚ·Ê›ηٿ fiÛÔ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙÔ Gardasil. ∏ ‰È¿ÚÎÂÈ·ÚÔÛÙ·Û›·˜ Â›Ó·È 4,5-5 ¯ÚfiÓÈ· ̤¯ÚÈ ÛÙÈÁÌ‹˜ Î·È ¤¯ÂÈ˘ÔÏÔÁÈÛı› fiÙÈ ı· ‰È·ÚΤÛÂÈ ÂÚ›Ô˘ 10,5 ¯ÚfiÓÈ·. √¯ÚfiÓÔ˜ ı· ‰Â›ÍÂÈ ·Ó ̄ ÚÂÈ·Ûı› ·Ó·ÌÓËÛÙÈ΋ ‰fiÛË. º˘-ÛÈο, Ô ·È‰›·ÙÚÔ˜ Â›Ó·È ÂΛÓÔ˜ Ô˘ ı· οÓÂÈ ÙÔÓ ÂÌ-‚ÔÏÈ·ÛÌfi, ‰ÈfiÙÈ ÁÓˆÚ›˙ÂÈ ÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ηχÙÂ-Ú· ·fi fiϘ ÙȘ ¿ÏϘ È·ÙÚÈΤ˜ ÂȉÈÎfiÙËÙ˜.

¶Ú¤ÂÈ ˆÛÙfiÛÔ Ó· ÛËÌÂȈı› fiÙÈ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ÂÌ‚ÔÏ›Ô˘ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È Ôχ ˘„ËÏfi (185 :).

∞˜ ‰Ô‡Ì ÙÒÚ· ÙÈ Á›ÓÂÙ·È ‰ÈÂıÓÒ˜ Ì ÙËÓ ÂÊ·Ú-ÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ̤ۈ ÏËÚÔÊÔÚÈÒÓ Ô˘ Û˘ÁÎÂ-

ÓÙÚÒÛ·Ì ·fi ÙȘ ¶·È‰È·ÙÚÈΤ˜ ÂÙ·ÈÚ›˜ ÙˆÓ ‰È·-ÊfiÚˆÓ ¯ˆÚÒÓ.

∞fi ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ ÛÙȘ ∏¶∞ ÙÔ ÂÌ-‚fiÏÈÔ Î˘ÎÏÔÊfiÚËÛ 6 Ì‹Ó˜ ÓˆÚ›ÙÂÚ· (πÔ‡ÓÈÔ˜ 2006)·’ fi,ÙÈ ÛÙËÓ ∂˘ÚÒË, ·Ú¿ Ù·‡Ù·, ÌfiÏȘ ·fi ÙÔÓ π·-ÓÔ˘¿ÚÈÔ Û˘ÓÈÛÙ¿Ù·È ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›·¶·È‰È·ÙÚÈ΋˜ Ó· Á›ÓÂÙ·È ·fi fiÔÈÔÓ ÙÔ ÂÈı˘Ì›. ∏∞˘ÛÙÚ›· Î·È Ë ∂ÛıÔÓ›· Â›Ó·È ÔÈ ‰‡Ô ÌÔÓ·‰ÈΤ˜ ¯ÒÚÂ˜Ô˘ ÙÔ ¯ÔÚËÁÔ‡Ó Û˘ÛÙËÌ·ÙÈο, ¯ˆÚ›˜ fï˜ Ó· ηχ-ÙÂÙ·È ·fi Ù· ·ÛÊ·ÏÈÛÙÈο Ù·Ì›·. ŸÏ· Ù· ·Ú·¿-Óˆ ÛÙÔȯ›· ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ ·˘Ùfi ‰È·Ê¤ÚÂÈ·fi Ù· ˘fiÏÔÈ·, ‰ÈfiÙÈ ‰ÂÓ Î·Ï‡ÙÂÈ 100% ÙÔ˘˜ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜. ª¤¯ÚÈ Ó· ÏËÊıÔ‡Ó ÔÚÈÛÙÈΤ˜ ·Ô-Ê¿ÛÂȘ ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· Ì·˙ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ı· Ú¤-ÂÈ Ó· Á›ÓÂÈ ÂÓË̤ڈÛË ÙˆÓ Á˘Ó·ÈÎÒÓ Ó· ˘Ô‚¿ÏÏÔ-ÓÙ·È ÂÙËÛ›ˆ˜ Û test ¶··ÓÈÎÔÏ¿Ô˘.

™˘ÌÂÚ·ÛÌ·ÙÈο, ı· ϤÁ·Ì fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È·ÔÙÂÏÂÛÌ·ÙÈÎfi ·ÏÏ¿ ‰ÂÓ Ï‡ÓÂÈ ÔÚÈÛÙÈο ÙÔ Úfi-‚ÏËÌ·. °È’ ·˘Ùfi ı· Ú¤ÂÈ Ó· ηıÈÂÚˆı› Û‡ÛÙËÌ·ÂÈÙ‹ÚËÛ˘ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ Ó¤ˆÓ Á˘Ó·È-ÎÒÓ Ô˘ ı· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó, ÁÈ·Ù› ÙÔ ÂÌ‚fiÏÈÔ HPV ‰ÂÓηχÙÂÈ fiÏÔ˘˜ ÙÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜, ÂÔ̤ӈ˜ ÔÈÁ˘Ó·›Î˜ ·˘Ù¤˜ ı· ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÎÈÓ‰˘ÓÂ‡Ô˘Ó Ó··Ó·Ù‡ÍÔ˘Ó Î·ÚΛÓÔ ·fi ¿ÏÏÔ˘˜ ÔÁÎÔÁfiÓÔ˘˜ ÈÔ‡˜,ÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Î·Ï‡ÙÂÈ ÙÔ ÚÔÛÊÂÚfiÌÂÓÔ ÂÌ‚fi-ÏÈÔ. £· Ú¤ÂÈ Ó· Á›ÓÂÙ·È HPV-DNA test ÙÔ ÔÔ›Ô ı·Û˘Ó‰˘¿˙ÂÙ·È Ì ÙÔ test ¶··ÓÈÎÔÏ¿Ô˘ ÛÙȘ ÂÚÈÙÒ-ÛÂȘ Ô˘ ÙÔ ÚÒÙÔ ÙÂÛÙ ı· Â›Ó·È ıÂÙÈÎfi.

∆¤ÏÔ˜, ·˜ ÛËÌÂȈı› fiÙÈ ÁÈ· οıÂ Ó¤Ô Ê¿ÚÌ·ÎÔ ‹ÂÌ‚fiÏÈÔ ¯ÚÂÈ¿˙ÂÙ·È Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛËÁÈ· ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ.

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ÃÒÚ· ∂›Ó·È ÂÌ‚fiÏÈÔ ÚÔ˘Ù›Ó·˜ ∫·Ï‡ÙÂÙ·È ·fi Ù· ·ÛÊ·ÏÈÛÙÈο Ù·Ì›· ™Â ÔÈ· ËÏÈΛ· Á›ÓÂÙ·È ∫fiÛÙÔ˜ Û ¢ÚÒ ·Ó¿ ‰fiÛË

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82 ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

Paediatriki 2007;70:81-82

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Homocystinuria due to cystathionine ‚-synthase deficiency

S. H. Mudd

83EDITORIAL COMMENTARY ∞ƒ£ƒ√ ™À¡∆∞•∏™

Laboratory of MolecularBiology, National Institute of Mental Health

Correspondence:

S. Harvey [email protected] 35, Room 1B100635 Convent DriveBethesda, MD 20892, USA

¶·È‰È·ÙÚÈ΋ 2007;70:83-84

In this issue of Paediatriki Persephone Au-goustides-Savvopoulou and coauthors describetwo cases of cystathionine ‚-synthase (C‚S) de-ficiency with emphasis on the clinical and meta-bolic identification of such patients, and the factthat proper treatment can help avoid adverse ef-fects of this genetic abnormality (1). This edito-rial attempts to clarify two nomenclatural issuesthat may make reading about this condition dif-ficult for non-specialists, and to expand uponaspects covered only briefly in the article inquestion (1).

The name of the condition. Homocystinuria(i.e. excessive urinary homocystine) was foundby Nina Carson and coworkers in 1962 amongmentally retarded Northern Irish children andindependently (and virtually simultaneously) byGerritsen and Waisman and by Barber andSpaeth in the United States (2). In 1964 deficientactivity of C‚S, the enzyme that catalyzes thecondensation of homocysteine with serine,forming cystathionine, was shown to be the un-derlying cause of the homocystinuria in Barberand Spaeth’s patient (2). For a few years there-after “homocystinuria” was used as a definitivename of a specific genetic abnormality. Howev-er, in 1969 a patient with excessive urinary ho-mocystine was shown to be unable to convert vi-tamin B12 to its coenzyme forms, methyl-B12 andadenosyl-B12, so that the methyl-B12-dependentmethylation of homocysteine back to methion-ine did not occur normally (3). This defect innow termed cblC (cobalamin C) disorder to dis-tinguish it from other inherited disorders ofcobalamin metabolism. In 1972 a different ho-mocystinuric patient was found to have yet an-other causative metabolic abnormality, severelydeficient activity of 5,10-methylenetetra-hydro-folate reductase (MTHFR), the enzyme thatforms methyltetrahydrofolate, a methyl donorfor methylation of homocysteine (4). [These re-actions are diagrammed in level (2) in Fig. 1 incitation (1)]. It thus became evident that “ho-mocystinuria” is a metabolic abnormality withmultiple causes, and that, to designate a specificdisease with this abnormality, it is important toname the underlying deficiency. In contrast tothe elevated methionine of C‚S deficiency, thetwo additional defects just discussed, as well as

others discovered more recently affecting homo-cysteine remethylation (5), are characterized bylow plasma methionine. A recent report indi-cates the brain damage of MTHFR deficiency isdue to lack of methionine rather than to elevat-ed homocysteine (6). Therefore, establishing theproper cause of a case of homocystinuria be-comes especially important: dietary methioninerestriction is often used beneficially in C‚S defi-ciency, but is contraindicated in a homocysteineremethylation defect.

Homocystine, homocysteine, and total homo-cysteine (tHcy). Homocystine is a disulfide withstructure RS-SR (where R=-CH2CH2CH(NH2)COOH, formed in the body from homocysteine,the metabolically active sulfhydryl form, RSH. Inplasma, homocystine greatly exceeds homocys-teine, and even more homocysteine moieties oc-cur as mixed disulfides bound to cysteine (RS-SR’) or protein cysteine (RS-S-Protein) (7). Ami-no acid chromatography usually measures ho-mocystine, but to measure the sum of the variousforms in which homocysteine moieties occur,modern methods cleave disulfide bonds, assaythe resulting homocysteine and term it “total ho-mocysteine” (tHcy) (7).

The present situation. Based on the experi-ence since 1962, and as described by Au-goustides-Savvopoulou et al (1), C‚S deficiencyis now known to occur in both B6-responsiveand B6-non-responsive forms, ultimately de-pendent upon the specific mutation(s) in the al-leles encoding C‚S (8). Untreated, B6-respon-sive individuals develop less severe clinical ab-normalities or manifest them more slowly. Forexample, in a survey including data for 231 B6-responsive patients and the same number of B6-non-responders, the median IQ among respon-ders was 78 versus 64 for non-responders; thechances of having been found to have dislocatedoptic lenses by age 10 years was 55% and 82%for responders and non-responders; of having athromboembolic event by age 15 years, 12% and27%; of having radiologically detectable spinalosteoporosis by age 15, 36% and 64%; and of notsurviving to age 30, 4% and 23% (9). However,there may have been ascertainment bias for thepatients included in that study, because, to be in-cluded, a patient had either to have some clinical

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·83

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manifestation, to be a family member of a diagnosed

patient, or to have been detected by elevated blood

methionine at newborn screening. More recent ge-

netic screening of newborns in Denmark (10) or Nor-

way (11), or of unrelated German control subjects

(12) indicates the prevalence of homozygosity for the

I278T C‚S mutation might be as high as 1:20,500,

1:104,000 and 1:17,800 live births, in those countries,

respectively. Since homozygosity for I278T leads to

B6-responsiveness, and because B6-responders are

usually missed in newborn screening based upon ele-

vated blood methionine concentrations (8), it re-

mains possible that some of these patients may re-

main clinically normal throughout life, or that they

may be diagnosed only later in life if they present with

thromboembolic problems. As illustrated by the re-

port of Augoustides-Savvopoulou et al (1), and sup-

ported now by a variety of further evidence, treat-

ment of responders with pyridoxine and of non-re-

sponders by dietary methionine restriction, often

with betaine in addition, is clearly beneficial (8,9,13).

Much progress has been made also for the homo-

cystinurias due to remethylation defects. Particularly

noteworthy are: The recent identification of the gene,

MMACHC, mutations in which lead to cblC disor-

ders (14). The discovery of further cobalamin disor-

ders producing functional methionine synthase defi-

ciency (cblE and cblG). The cloning of the gene for

MTHFR and identification of several mutations in it

leading to severely deficient activity of that enzyme.

The discovery of the common MTHFR polymor-

phism, C677T, that leads to formation of a thermola-

bile enzyme and, in individuals with serum folate to-

ward the lower end of the reference range, to mild el-

evations of plasma tHcy. The current report that an

Amish baby shown by genetic screening at birth to be

homozygous for a severely inactivating MTHFR mu-

tation and treated early with betaine to maintain me-

thionine levels has been free of the irreversible mental

and developmental problems that affect other indi-

viduals homozygous for the same mutation, but

treated only at older ages (6).

The situation in Greece. It is of interest to the pre-

sent author that, in-so-far as he is aware, the patients

reported by Augoustides-Savvopoulou et al (1) are

the first individuals with homocystinuria due to C‚S

deficiency identified in Greece. On the current Jan

Kraus C‚S website (http://www.uchsc.edu/sm/cbs),

among the 559 alleles responsible for C‚S deficiency

the ancestries of which are shown, none is listed as of

Greek origin. Whether the Greek population is un-

usually free of inactivating C‚S mutations, or

whether individuals with such mutations are present,

awaiting ascertainment and treatment, may pose an

intriguing question for the physicians of Greece.

References

1. Augoustides-Savvopoulou P, Ioannou H, Kozeis N, Kara-

giannidou A, Athanasiou-Metaxa M. Homocystinuria due

to cystathionine b-synthase deficiency: two sides to the

same coin. Paediatriki 2007;70:146-151.

2. Mudd SH, Finkelstein JD, Irreverre F, Laster L. Homo-

cystinuria: an enzymatic defect. Science 1964;143:1443-

1445.

3. Mudd SH, Levy HL, Abeles RH, Jennedy JP Jr. A derange-

ment in B12 metabolism leading to homocystinemia, cys-

tathioninemia and methylmalonic aciduria. Biochem Bio-

phys Res Commun 1969;35:121-126.

4. Mudd SH, Uhlendorf BW, Freeman JM, Finkelstein JD,

Shih VE. Homocystinuria associated with decreased

methylenetetrahydrofolate reductase activity. Biochem

Biophys Res Commun 1972;46:905-912.

5. Rosenblatt DS, Fenton WA. Inherited disorders of folate

and cobalamin transport and metabolism. In: Scriver CR,

Beaudet AL, Valle D, Sly WS, Childs B, Kinzler KW, editors.

The Metabolic and Molecular Bases of Inherited Disease,

8th ed. New York, N.Y.: McGraw-Hill; 2001. p. 3897-3933.

6. Strauss KA, Morton DH, Puffenberger EG, Hendrickson

C, Robinson DL, Wagner C, et al. Prevention of brain dis-

ease from severe 5,10-methylenetetrahydrofolate reduc-

tase deficiency. Mol Genet Metab 2007; in press.

7. Mudd SH, Finkelstein JD, Refsum H, Ueland PM, Mali-

now MR, Lentz SR, et al. Homocysteine and its disulfide

derivatives: a suggested consensus terminology. Arte-

rioscler Thromb Vasc Biol 2000;20:1704-1706.

8. Mudd SH, Levy HL, Kraus JP. Disorders of transsulfura-

tion. In: Scriver CR, Beaudet AL, Sly WS, Valle D, Childs

B, Kinzler KW, editors. The Metabolic and Molecular Bas-

es of Inherited Disease, 8th ed. New York: McGraw-Hill;

2001. p. 2007-2056.

9. Mudd SH, Skovby F, Levy HL, Pettigrew KD, Wilcken B,

Pyeritz RE, et al. The natural history of homocystinuria

due to cystathionine beta-synthase deficiency. Am J Hum

Genet 1985;37:1-31.

10. Gaustadnes M, Ingerslev J, Rutiger N. Prevalence of con-

genital homocystinuria in Denmark. N Engl J Med

1999;340:1513.11.

11. Refsum H, Fredriksen A, Meyer K, Ueland PM, Kase BF.

Birth prevalence of homocystinuria. J Pediatr 2004;144:

830-832.

12. Linnebank M, Homberger A, Junker R, Nowak-Goettl U,

Harms E, Koch HG. High prevalence of the I278T muta-

tion of the human cystathionine beta-synthase detected by

a novel screening application. Thromb Haemost 2001;85:

986-988.

13. Yap S, Boers GH, Wilcken B, Wilcken DE, Brenton DP,

Lee PJ, et al. Vascular outcome in patients with homo-

cystinuria due to cystathionine beta-synthase deficiency

treated chronically: a multicenter observational study. Ar-

terioscler Thromb Vasc Biol 2001;21:2080-2085.

14. Lerner-Ellis JP, Tirone JC, Pawelek PD, Dore C, Atkinson

JL, Watkins D, et al. Identification of the gene responsible

for methylmalonic aciduria and homocystinuria, cblC

type. Nat Genet 2006;38:93-100.

84 S. H. Mudd

Paediatriki 2007;70:83-84

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85EDITORIAL COMMENTARY ∞ƒ£ƒ√ ™À¡∆∞•∏™

Correspondence:

Nicholas [email protected] of WarwickCoventry, UK

¶·È‰È·ÙÚÈ΋ 2007;70:85-86

Prevention of unintentional injury: relevance to paediatricians

N. Spencer

Public health importance of unintentional

injury

As noted by Nicholson et al in this issue of

the journal, unintentional injuries are the lead-

ing cause of death and disability in European

children. Globally, it is estimated that by 2020

road traffic crashes will have moved from ninth

to third in the world disease burden ranking, as

measured in disability adjusted life years (1).

The costs in premature death and disability and

the burden on health and social care services and

families are huge. Yet injury prevention com-

mands far less attention in most countries than

smoking cessation. The tendency of doctors to

focus on the consequences of injury rather than

prevention contributes to the relatively low pro-

file of this major public health issue.

Contributory factors

European countries that have succeeded in

providing a relatively safe environment for

their children with resulting reduction in

deaths and disability associated with uninten-

tional injury, have done so as a result of a com-

bination of legislation, enforcement and public

education. Legislation, although necessary, is

not sufficient to protect children. For example,

Greece enacted legislation over 20 years ago re-

lated to seat belt wearing by children in cars

and speed limits on urban roads but continues

to have one of the highest road accident death

rates in the EU (see Nicholson et al, Tables 2

and 3). This is likely to be due to limited en-

forcement and relatively poor acceptance of

these measures by the population.

A key factor in relation to child pedestrian

and cyclist injuries is exposure to traffic (2).

Children who are exposed to high volumes of

traffic either as pedestrians or cyclists are at

high risk. Poorer children are more likely to be

exposed in this way as their parents are less

likely to own cars (3).

Effectiveness of preventive interventions

Nicholson et al’s reliance mainly on the re-

sults of individual studies as evidence of effec-

tiveness of preventive interventions to reduce

unintentional injury among children leads

them to slightly overstate the strength of the

available evidence. Good randomised con-

trolled trials in accident prevention are rare

and the evidence base tends to be weak. How-

ever, there are now a series of Cochrane sys-

tematic reviews that report reasonably robust

evidence for some preventive interventions.

For example, speed enforcement devices such

as cameras are associated with a significant re-

duction in crashes (4) and helmets for cyclists

significantly reduce head and facial injuries (5).

The Cochrane reviews highlight the need for

more robust studies of injury prevention inter-

ventions.

Relevance to paediatricians

Due to the heavy burden of death and dis-

ability resulting from unintentional injury,

paediatricians are frequently faced with the

consequences. Paediatricians, in common with

other doctors, tend to focus on curative, clini-

cal interventions at the individual level rather

than preventive approaches at the population

level. Clinical approaches to the consequences

of unintentional injury can relieve suffering but

cannot address the fundamental causes. Thus,

for paediatricians to make a contribution to re-

ducing the burden of unintentional injury, they

need to focus on preventive interventions at the

population level as well as clinical management

of the consequences in individual children.

How might paediatricians contribute?

On matters concerning children, paediatri-

cians have a powerful voice. We need to learn

how to use this power to change public policy

and public perceptions in relation to uninten-

tional injury. The individual paediatrician can

provide developmentally appropriate advice to

parents and can participate in local groups pro-

moting injury prevention strategies. Advocacy is

probably most powerful when undertaken by na-

tional paediatric organisations that can commu-

nicate directly with policy makers and politi-

cians. We, in Europe, can learn from our Ameri-

can colleagues in the American Academy of Pe-

diatrics who have a long tradition of effective

lobbying on a range of child health related issues.

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·85

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Paediatricians also have a major potential role inpromoting high quality, robust research to informpreventive strategies. Research of this nature is asimportant as drug trials.

References

1. Murray CJ, Lopez AD. Alternative projections of mortali-ty and disability by cause 1990-2020: Global Burden ofDisease Study. Lancet 1997;349:1498-1504.

2. Sonkin B, Edwards P, Roberts I, Green J. Walking, cyclingand transport safety: an analysis of child road deaths. J RSoc Med 2006;99:402-405.

3. Edwards P, Roberts I, Green J, Lutchmun S. Deaths frominjury in children and employment status in family: analy-sis of trends in class specific death rates. BMJ 2006;333:119.

4. Wilson C, Willis C, Hendrikz JK, Bellamy N. Speed en-forcement detection devices for preventing road traffic in-juries. Cochrane Database Syst Rev 2006;2:CD004607.

5. Thompson DC, Rivara FP, Thompson R. Helmets for pre-venting head and facial injuries in bicyclists. CochraneDatabase Syst Rev 2000;2:CD001855.

86 N. Spencer

Paediatriki 2007;70:85-86

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87REVIEW ARTICLE ∞¡∞™∫√¶∏™∏

¶·È‰È·ÙÚÈ΋ 2007;70:87-92

Background

Injuries are the leading cause of death and

disability for children in the European Union

(EU). In the EU, for every death from injury,

there are 30 hospital admissions and 300

emergency department attendances (1). It has

been estimated that the overall socio-economic

burden of all injuries in Europe is 400 billion

Euros annually (i.e. almost 4 times the entire EU

budget).

The leading causes of injury death for chil-

dren (1-14 years old) in the EU include road-re-

lated (48%), drowning (11%), intentional in-

juries (11%), house fires (5%), high falls (5%),

poisonings (2%) and miscellaneous (18%).

There has been improvement in all EU member

states in the reduction of child injury deaths over

the past 20 years (2-5).

Thus injuries are a neglected problem that

has devastating effects on individuals and

health budgets. Within the expanded EU, most

of the burden of injuries falls on low and mid-

dle-income countries which have undergone

great changes brought about by transition to

market-style economies since the 1990’s. Chil-

dren living in low and middle-income coun-

tries are 3.6 times more likely to die from injury

than those in high income countries (Tables 1

and 2). High income countries have increased

injury rates in socioeconomically deprived

groups and a widening gap between rich and

poor. The increased mortality risk in deprived

groups applies to most injury types including

drowning, falls, poisoning, road-related and

fire-related injuries.

Some countries in the EU, such as the

Netherlands, United Kingdom and Sweden are

among the safest places in the world and if all

countries were to match their figures, two

thirds of the lives lost every year due to injury

could be saved. Countries with low rates of in-

jury have invested in safety as a societal respon-

sibility. Legislation and enforcement to ensure

safer environments (e.g. road and housing de-

sign and the use of safety equipment) and re-

duce risk behaviors (e.g. speeding and driving

under the influence of alcohol) are key changes

at a population level (6-8). These measures

have a synergistic effect when coupled with me-

dia and educational campaigns. There are dif-

ferences that exist in countries throughout

Europe as to how they adopt effective measures

in reducing childhood deaths and serious in-

juries (Table 3).

Road-related injuries

In the area of road safety, the EU has set a

target to halve the number of deaths from road

traffic injuries by 2010.

Without doubt road-related injuries should

Accident PreventionWorking Group of theEuropean Academy ofPaediatrics

Correspondence:

Alf [email protected] Lady of Lourdes Hospital,Drogheda, Co. Louth, Ireland

Creating a safer Europe for children

A.J. Nicholson, D. Van Esso, I. Malcic, A. Biver

Abstract: Unintentional injuries are the leading cause of death and disability in European children withroad-related injuries accounting for just under half of all deaths due to injury. There is a steep socialgradient for all serious childhood injuries and children living in low- and middle-income EuropeanUnion (EU) countries are 3.6 times more likely to die from injury than those in high-income countries.Some EU countries (such as Sweden, the Netherlands and the United Kingdom) are among the safestplaces in the world and, if other EU countries were to match their performance, two thirds of lives lostper year due to injury could be saved. Legislation and enforcement to ensure safer environments (e.g.road and housing design and use of safety equipment) and reduction of risk behavior (e.g. speedingand driving under the influence of alcohol) are effective at a population level. Effective evidence-basedinterventions include reduction of speed limits, traffic calming measures, safer car fronts, correctly-fittedchild passenger restraints, bicycle helmets, swimming pool fencing, personal flotation devices, smokedetectors, child-resistant lighters and child-resistant packaging for medicines and household chemicals.Paediatricians across the EU should be aware of the extent of childhood injury deaths and assume agreater advocacy role to aid their prevention.

Key words: unintentional injury, road-related injuries, drowning, burns and scalds, falls, poisoning, choking

and suffocation.

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88 A.J. Nicholson et al.

be our first priority as these constitute 48% of all in-

jury deaths in the EU. Road-related accidents in-

clude child injury deaths to pedestrians, bicyclists

and motor vehicle passengers (9,10).

A pre-requisite for setting targets is good baseline

data on road-related injuries and this requires either

an injury surveillance system or some other means of

providing complete and accurate information on the

epidemiology of road-related injuries.

A great deal of intervention is being done in

most EU countries but there is evidence that more

lives could be saved on roads if the following strate-

gies were implemented, enforced and taught to the

public.

a. The reduction of speed limits

In the United Kingdom (11), introduction of 20

mph/hour speed limit zones has resulted in local re-

ductions of 48% in child bicycle injuries and a 70%

reduction in fatal road accidents involving pedestri-

ans. Speed cameras or radar can catch drivers who are

exceeding speed limits. Publicizing the presence of

speed cameras or radar, further increases compliance

with speed laws and substantially reduces road-relat-

ed deaths.

b. Traffic calming

Residential access roads should have speed limits

of no more than 30 km/hour and design features that

calm traffic and this has resulted in 60% reductions in

road-related childhood injuries in 30 km/hour zones

(Figure 1).

Pedestrians have twice the risk of injury where they

are not segregated from motor vehicle traffic and

studies in Denmark (12) have shown that segregated

bicycle lanes alongside urban roads reduced deaths

among cyclists by 35%.

c. Safer car fronts for pedestrians and cyclists

Engineers have known for some time how to

modify car fronts so that they do less harm to cyclists

and pedestrians and yet no EU country requires the

fronts of cars to have a crashworthy design to mini-

mize injury to pedestrians. If vehicles were required

to pass performance tests for vehicle fronts, the annu-

al number of deaths and injuries to pedestrians in the

EU could fall by 20% (13-16,23).

d. Child passenger restraints

To protect occupants, a motor vehicle should be

designed so that the passenger compartment maintains

Table 1. Injury deaths for children (0-14 years) in the EU

Source: WHO 1996-2000 National Sources Average

Malta* 2.19Sweden* 3.79

United Kingdom* 4.21Italy* 4.57

Netherlands* 4.73Finland 5.00

Germany* 5.34Denmark* 5.40

Luxembourg 5.96Austria 6.33

Spain 6.49France* 6.66Ireland* 6.70

Slovenia* 7.36Belgium* 7.44

Greece* 7.87Hungary 8.09

Czech Republic 8.47Portugal 8.95

Poland* 9.16Slovakia 10.53

Lithuania 21.01Estonia 22.60

Latvia 23.51

0.00 5.00 10.00 15.00 20.00 25.00

Rates per 100,000 population

*Some data is missing

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89

its integrity in a crash and there should be restraintsso that occupants do not eject from the vehicle ortumble about inside it, injuring themselves and otheroccupants.

When used properly, child restraints or car seatshave been shown to have an injury-reducing factorof 90-95% for rear-facing systems and 60% for for-ward-facing systems (17-19,23,24). For children 0-15 months (weight up to 13 kg), rear-facing child re-

straints optimally distribute any force of impact and

thereby reduce sever injuries by 90%. Rear-facing

child restraints should always be placed in the back

seat as many vehicles have front airbags. Child pas-

senger restraints are shown in Figure 2.

e. Bicycle helmets

Correctly fitted, bicycle helmets reduce the risk of

head and brain injury by 63-88% (23).

Drowning

Drowning is the second leading of death for chil-

dren of the EU with more than 70% of the victims be-

ing boys and the most vulnerable being 1 to 4 years of

age (21). Prompt resuscitation following immersion

is critical to survival and the outcome for most chil-

dren with immersion is determined by their status on

arrival to the emergency department - medical and

paediatric intensive care appear to have relatively lit-

tle impact on outcome. Therefore prevention is the

key to decreasing hospitalisations and deaths from

drowning. Effective prevention strategies include

swimming pool fencing (22). Other preventive strate-

gies include personal flotation systems, swimming

lessons, parental supervision and lifeguards.

1

0.8

0.6

0.4

0.2

00 20 40

Impact speed (km/h)60 80 100

Pro

bab

ilit

y o

f d

eath

Figure 1. Pedestrian fatality risk as a function of the impact speedof a car.

Table 2. Road accident deaths for children (0-14 years) in the EU

Source: WHO 1996-2000 National Sources Average

Slovakia 0.09Malta* 0.94

Sweden* 1.56United Kingdom* 1.62

Czech Republic 1.68Finland 1.84

Netherlands* 2.03Germany* 2.19

Austria 2.32Italy* 2.36

Hungary 2.55Denmark* 2.84

France* 3.04Slovenia* 3.12Belgium* 3.20

Luxembourg 3.23Spain 3.32

Ireland* 3.44Poland* 4.07Greece* 4.14

Portugal 5.02Lithuania 5.48

Estonia 5.58Latvia 5.58

0.00 1.00 2.00 3.00 4.00 5.00 6.00

Rates per 100,000 population

*Some data is missing

¶·È‰È·ÙÚÈ΋ 2007;70:87-92

Creating a safer Europe for children

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Burns and scalds

Severe burn injuries require multiple hospitalisa-

tions and lengthy treatment and may result in perma-

nent disability and disfigurement. Scalds and contact

burns occur predominantly to under 2 year-olds. Age

standardized mortality rates for children (1-14 years of

age) dying through fires in the EU show that the low-

est rate is in Italy (0.17 per 100,000) and the highest

rate is in Ireland (0.91 per 100,000). Burn and scald

injuries could be reduced in Europe, if the following

preventive measures were implemented, enforced

and promoted to the general public:

Smoke detectors are an effective, reliable and in-

expensive devices that provide an early warning and

assist in reducing residential fire deaths by 71%

(23,24).

Legislation requiring a safe pre-set temperature

(54oC) for all water heaters has proven to be a more ef-

fective method of reducing scald burns than education

to encourage parents to turn down water heaters.

In the USA, fire deaths associated with cigarette

lighters dropped by 43% with the adoption of child-

resistant designs (14).

A dramatic 75% reduction in burn unit admissions

due to sleepwear occurred following the introduction

of the Flammable Fabrics Act of 1972 in the USA.

Falls

Falls resulting in severe or fatal injuries are usual-

ly due to second storey or higher windows.

Stair gates have been shown to assist in reducing

falls downstairs. Absorbent surface material in play-

grounds and appropriate height of play equipment

for various ages provides an improvement in serious

fall injuries. Window bars have shown a 35% decrease

in deaths and a 31% decrease in reported falls.

Poisoning

Children under 2 years of age are especially vulner-

able and more than 90% of poisonings occur in the

home environment (5). Many common household

products can poison children including cleaning sup-

plies, alcohol, pesticides, medicines and cosmetics (5).

Safe storage is an effective means of preventing

poisoning with both medicinal and non-medicinal

agents (6).

Educational strategies aimed at children and par-

ents have been associated with increased knowledge

Table 3. Effective measures in reducing childhood deaths and serious injuries in Europe (Source: updated from Towner and Towner, 2004)

Bicycle Child safety Seat belt Speed Child resistant Smoke Barrier Children Adoption of No sale ofhelmets seats/ wearing limits - packaging detectors fencing, banned playground fireworks

for children restraints by children roads pharmaceuticals in home domestic from riding/ standards to childrenin cars in urban swimming driving farm

areas pools tractors

Austria 1994 1994 1994 1996 � 1995 1974

Belgium 1996 1975 � 1998 2001 2000

Czech Republic 2000 2000 2000 � 1999 2000 1999 2000

Denmark � � � � � �Estonia 2003 2003 2003 2003 2004

France 1992 � 1972 2003 1994

Germany 1992 1993 1952 1976 � �Greece 1999 1977 1962 � � �Hungary 2000 2000 �Iceland 1999 1990 1981 1988 1993 �Ireland � 1993 � 1994 �Italy 1988 1989 � 1984 1996 �Luxembourg � 2000 � � �Netherlands � 1992 � 1986 2003* � 1997 1995

Norway � 1979 � 1990 1997 � 1996

Poland 1997 1997 1997 2002 1997 �Portugal 1995 1994 � � � 1998 �Spain 1999 1992 1974 1990 � � �Sweden 1988 1988 1936 � 1973 �Switzerland 1981 1981 1959 1976 1988United Kingdom 1989 1989 1934 1994 1999 1998 1998 1997

*: New homes only, �: Indicates legislation enacted but year not known , YEAR: Indicates date legislation enacted if known, Blank: Nolegislation measure enacted

90 A.J. Nicholson et al.

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91Creating a safer Europe for children

¶·È‰È·ÙÚÈ΋ 2007;70:87-92

of poison prevention. The compulsory use of child-

resistant packaging for aspirin and paracetamol led to

a dramatic fall in the number of children admitted to

hospital as a result of these medications in England,

the Netherlands and USA (6).

Choking and suffocation

Choking occurs most commonly on small attrac-

tive products, including balloons, coins, small toy

parts, small food pieces and inedibles in food prod-

ucts. Legislative measures to be implemented include

product bans (inedibles in foodstuffs, drawstrings on

clothing); warning labels on products have reduced

deaths in those countries where this legislation has

been enforced (7).

Socioeconomic deprivation and childhood injury

In England and Wales, the risk of children dying

from fire was 16 times greater in the lowest socioeco-

nomic group (SEG) compared to the highest (10,11),

the risk of pedestrian injuries was 5 times higher in

lower SEG and the overall risk of a childhood injury

death was 3-4 times higher in children of parents in

unskilled manual jobs than children whose parents

were skilled non-manual workers (11). In Germany,

poorer families were twice as likely to be involved in

road traffic accidents (12).

Thus, there is a steep social gradient in relation to

serious childhood injuries and deaths in most EU

countries.

The impact of an expanding EU

The childhood injury death rates for the new EU

countries range from 10.8 per 100,000 in Hungary to

38.4 per 100,000 in Latvia. The only country that has

a higher childhood injury death rate than the new EU

countries is Portugal (17.8 per 100,000). Thus the

childhood injury death rate in Latvia is 8 times that in

Sweden. If the EU is committed to reducing dispari-

ties in living standards between its members, serious

commitments will need to be made to ensure that

childhood injury deaths will be reduced in candidate

countries as a matter of urgent priority.

The role of government and legislation

As of June 2001, only the UK and the Netherlands

have specific targets or specific goals as part of a na-

tional health plan aimed at reducing childhood injury

(12,13,15). It is clear that, before there can be an inte-

grated approach to child safety across the EU, there

needs to be one within each individual member state.

Legislation and its enforcement is one of the most

effective ways to create a safer environment (13).

Whilst no EU member state has adopted all ten pre-

ventive policy measures that were conducted in recent

research by Towner et al (12), Sweden and Spain do

Rearward-facing baby seat(For babies up to 13 kg)

Forward-facing seat (Weight 9-18 kg)

Booster cushion (Weight 22-36 kg)

Figure 2. Car seats at different ages.

Booster seat (Weight 15-25 kg)

Never put arearward-facingseat in the frontseat if there is a

passenger airbag!

Never put arearward-facingseat in the frontseat if there is a

passenger airbag!

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92 A.J. Nicholson et al.

Paediatriki 2007;70:87-92

show commitment to using policy to influence the re-duction of childhood injury by adopting most of themeasures outlined in Table 3. The most common mea-sures are related to motor vehicles and include child re-straints, seat belt wearing and reduced speed limits.The lowest adopted measures include bicycle helmetsand smoke alarms in private residences. Even thoughGermany and the UK introduced mandatory child-re-sistant packaging for medicines 25 years ago, only 4other countries use this proven safety measure. Even insituations where European directives exist, there isgreat variation in how EU member states enact thesedirectives in their bodies of law. Many countries with-in the EU lack even a basic structure for enforcing reg-ulations and standards for consumer products such aschild care articles and toys. Coordination at nationaland European levels is quite deficient.

The role of EU regulations and standards

The Treaty of Maastricht has extended significantlythe authority of the European Commission with re-spect to the protection of the health and safety of Euro-pean citizens. Standards play a key role in regulatingsafety in the EU as they provide technical specificationsfor existing framework legislation. European regula-tions and standards addressing child safety (e.g. child-resistant packaging) are not implemented properly orare not providing the safety measures that are current-ly needed. New directives should be developed at EUlevel for pedestrian and bicycle protection throughsafer car fronts, all under 12 year olds should be pro-tected by child restraint systems in cars, playgroundequipment should meet EU safety standards and Euro-pean regulations should be developed for inedibles infood products, flammability of clothing, cords on chil-dren’s clothes, cigarette lighter that are child-proof andbuilding code requirements for pool fencing, windowad balcony railings and amusement /riding devices.

Legislation of injury strategies and its enforcementis one of the most effective ways to create safer envi-ronments.

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23. Thompson DC, Rivara FP, Thompson RS. Effectiveness ofbicycle helmets in preventing head injuries. A case-controlstudy. JAMA 1996;276:1968-1973.

24. Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC;Task Force on Community Preventive Services. Reviews ofevidence regarding interventions to increase use of childsafety seats. Am J Prev Med 2001;21 (4 Suppl):31-47.

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∞ÛʷϤ˜ ·È¯Ó›‰È ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜: ÂÌfi‰È· Î·È ÚÔÔÙÈΤ˜

¶. °ÚËÁÔÚ›Ô˘, ∞. ∆ÂÚ˙›‰Ë˜, ∂. ¶ÂÙÚ›‰Ô˘

¶ÂÚ›ÏË„Ë: ∆· ·Ù˘¯‹Ì·Ù· ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·Ó·-Ù˘Á̤Ó˜ ¯ÒÚ˜. ∫¿ı ¯ÚfiÓÔ ÂÚÈÛÛfiÙÂÚ· ·fi 200.000 ·È‰È¿ (ËÏÈΛ·˜ ≤14 ÂÙÒÓ) ÂÈÛΤÙÔÓÙ·È Ù·Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÏfiÁˆ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Û ·È‰È΋ ¯·Ú¿ ÛÙȘ ∏.¶.∞. ∏ ËÏÈÎȷ΋ ÔÌ¿-‰· 5-9 ÂÙÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ. ∆· fiÚÁ·Ó· ·Ó·ÚÚ›¯ËÛ˘, Ë ÙÛÔ˘-Ï‹ıÚ· Î·È ÔÈ ÎÔ‡ÓȘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ù· ϤÔÓ ˘Â‡ı˘Ó· fiÚÁ·Ó· ·fi ÏÂ˘Ú¿˜ ÂÍÔÏÈÛÌÔ‡. ∞Ó Î·È ·Ú-ÎÂÙ¿ Û˘¯ÓÔ›, ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ‰ÂÓ Ô‰ËÁÔ‡Ó Û˘Ó‹ıˆ˜ Û ·Ó·ËÚ›· ‹ ı¿Ó·ÙÔ. ∫˘-ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Â›Ó·È Ë ·Á›‰Â˘ÛË Ù˘ ÎÂÊ·Ï‹˜ ÌÂ Û˘Ó¤ÂÈ· ÙÔÓ ÛÙÚ·ÁÁ·ÏÈÛÌfi Î·È ·ÎÔÏÔ˘ıÔ‡ÓÔÈ ÙÒÛÂȘ. ™Â ÌÂϤÙË ÁÈ· ÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, ˘ÔÏÔÁ›ÛıËΠfiÙÈ ÂÍ·ÈÙ›·˜ ·Ù˘¯‹Ì·ÙÔ˜ ÌÂÎÔ‡ÓÈ· 70.000 ¿ÙÔÌ· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÛÙ· ›ÁÔÓÙ· È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ οı ¯ÚfiÓÔ. ∏ ·Ó·Ì-ÊÈÛ‚‹ÙËÙË ·Í›· ÙÔ˘ ·È¯ÓȉÈÔ‡ Î·È Ù·˘Ùfi¯ÚÔÓ·, Ë ·Ó¿ÁÎË Ó· Á›ÓÂÙ·È Ë ‰È·‰Èηۛ· ·˘Ù‹ Û ·ÛʷϤ˜ Â-ÚÈ‚¿ÏÏÔÓ, ηıÈÛÙ¿ ÙË Ï‹„Ë ÚÔÏËÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ··Ú·›ÙËÙË. √È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ·Ô-ÙÂÏÔ‡Ó ÌÈ· ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ ÚfiÏ˄˘. ∫ÂÓ¿ ÛÙË ÓÔÌÔıÂÛ›·, ·Î·Ù¿ÏÏËÏË ÙÔÔı¤ÙËÛË Î·È ·ÓÂ-·Ú΋˜ Û˘ÓÙ‹ÚËÛË ÙÔ˘ ÂÍÔÏÈÛÌÔ‡, ¤ÏÏÂÈ„Ë Û˘ÌÌÂÙÔ¯‹˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi fiÏˆÓ ÙˆÓ ÂÌÏÂÎÔ̤ӈÓfiˆ˜ ÙÔ˘ È·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡ Î·È ÙˆÓ ·È‰Ô„˘¯ÔÏfiÁˆÓ Î·È ÌÂÁ¿ÏÔ ÎfiÛÙÔ˜, ‰ËÌÈÔ˘ÚÁÔ‡Ó ‰˘Û¯¤ÚÂȘÛÙËÓ Ú¿ÍË. ¶ÂÚ·ÈÙ¤Úˆ ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ Ì ¤ÌÊ·ÛË ÛÙË Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ¤ÎıÂÛ˘ Î·È ÛÙËÓ·ÍÈÔÏfiÁËÛË ÙˆÓ ÚÔÏËÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ı· Û˘Ì‚¿ÏÂÈ Ô˘ÛÈ·ÛÙÈο ÛÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ·È¯ÓȉÈÔ‡ÛÙËÓ ·È‰È΋ ¯·Ú¿.

§¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰Èο ·Ù˘¯‹Ì·Ù·, ·È‰È΋ ¯·Ú¿, ·È¯ÓȉfiÙÔÔ˜, ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜.

Safer play for children in playgrounds: barriers and prospects

P. Grigoriou, A. Terzidis, E. Petridou

Abstract: Among childhood injuries, those occurring in playgrounds have been recognized as a majorproblem. Each year in the United States, emergency departments treat more than 200,000 childrenaged 14 years and younger for playground-related injuries. Children aged 5 to 9 years have higherrates of emergency department visits for this reason than any other age group. Although common,most playground injuries are not serious enough to cause permanent disability or death. Fatalities areusually the result of asphyxiation secondary to strangulation. Swing accidents have been studiedthrough the European Home and Leisure Accident Surveillance System, and it was concluded that70,000 people are treated every year in emergency departments for swing-related injuries in the Euro-pean Union. While playground-related injuries represent a substantial proportion of childhood injuriesin most developed countries, prevention has always been a sensitive issue, as on the one hand, chil-dren must be allowed to test their skills, while on the other this process should take place in a safe en-vironment. Standards are an essential tool for the prevention of playground injuries. The absence of ap-propriate legislation, inadequate maintenance of facilities, the lack of involvement of medical person-nel, child psychologists, teachers and parents and the huge costs of safety measures complicate the im-plementation and enforcement of standards. Further epidemiological studies focusing on exposure da-ta and the evaluation of prevention strategies will contribute substantially to safer play in playgrounds.

Key words: Playground injuries, playgrounds standards.

93∞¡∞™∫√¶∏™∏ REVIEW ARTICLE

EÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ ηÈ∂ȉËÌÈÔÏÔÁ›·˜, π·ÙÚÈ΋™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘∞ıËÓÒÓ

AÏÏËÏÔÁÚ·Ê›·:

∂ϤÓË ¶ÂÙÚ›‰Ô˘[email protected]∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ ηÈ∂ȉËÌÈÔÏÔÁ›·˜π·ÙÚÈ΋ ™¯ÔÏ‹¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓª. ∞Û›·˜ 75, ∆.∫. 11527 ∞ı‹Ó·

Laboratory of Hygiene andEpidemiology, MedicalSchool, University of Athens

Correspondence:

Eleni [email protected] of Hygiene andEpidemiology Medical School, Universityof Athens 75, Mikras Asias St., 11527, Athens

¶·È‰È·ÙÚÈ΋ 2007;70:93-96

πÛÙÔÚÈ΋ ·Ó·‰ÚÔÌ‹

√ ¶Ï¿ÙˆÓ·˜ Î·È Ô ∞ÚÈÛÙÔÙ¤Ï˘ ›¯·Ó ‹‰ËÂÈÛËÌ¿ÓÂÈ ÙË ÛÔ˘‰·ÈfiÙËÙ· ÙÔ˘ ·È¯ÓȉÈÔ‡ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ Âη›‰Â˘ÛË ÙÔ˘ ·È‰È-Ô‡. ∆Ô ·È¯Ó›‰È ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ‰Ú·ÛÙËÚÈfi-ÙËÙ· ÙˆÓ ·È‰ÈÒÓ Î·È ·Ú¿ÏÏËÏ·, ¤Ó· ̤ÛÔÚÔÂÙÔÈÌ·Û›·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ “·ÏË-ıÈÓÔ‡” ÎfiÛÌÔ˘.

√ fiÚÔ˜ “·È‰È΋ ¯·Ú¿” ·Ó·Ê¤ÚÂÙ·È Û ˘·›-

ıÚÈÔ˘˜ ¯ÒÚÔ˘˜ „˘¯·ÁˆÁ›·˜ Î·È ·È¯ÓȉÈÔ‡, Û˘-

Ó‹ıˆ˜ ‰ËÌfiÛÈ·˜ ¯Ú‹Û˘, fiˆ˜ ̤۷ Û ۯÔ-

Ï›·, ¿Úη Î·È ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜, fiÔ˘ Ô

˘¿Ú¯ˆÓ ÂÍÔÏÈÛÌfi˜ ‰È¢ÎÔχÓÂÈ, ÏËÓ Ù˘

Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋, ÎÔÈÓˆÓÈ-

΋ Î·È ‰È·ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË, ‰ËÏ·‰‹ Û˘Ì‚¿Ï-

ÏÂÈ Ô˘ÛÈ·ÛÙÈο ÛÙËÓ ÔχÏ¢ÚË ·Ó¿Ù˘ÍË

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·93

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ÙˆÓ ·È‰ÈÒÓ. ™ÙȘ ̤Ú˜ Ì·˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·È‰È-

Τ˜ ¯·Ú¤˜ Î·È Û ¯ÒÚÔ˘˜ ÔÈÎÔÁÂÓÂȷ΋˜ ·Ó·„˘¯‹˜

(ÍÂÓԉԯ›·, ÂÛÙÈ·ÙfiÚÈ· Î.Ï.) ·ÏÏ¿ Î·È Ì¤Û· ÛÂ

¯ÒÚÔ˘˜ ηÙÔÈΛ·˜. √È ·È‰ÈΤ˜ ¯·Ú¤˜ ÛÙÔ¯Â‡Ô˘Ó

ÛÙÔ Ó· ÂÈÙÚ¤„Ô˘Ó ÛÙ· ·È‰È¿ Ó· ‰ÔÎÈÌ¿ÛÔ˘Ó, ̤۷

Û ‡ÏÔÁ· ·ÛÊ·Ï‹ fiÚÈ·, ÙȘ ÈηÓfiÙËÙ¤˜ ÙÔ˘˜ Ó· ·Ï-

ÏËÏÂȉÚÔ‡Ó Ì ÙÔÓ ÎfiÛÌÔ.

∏ ÚÒÙË ·È‰È΋ ¯·Ú¿ ÛÙË ª. µÚÂÙ·Ó›· ηٷ-

Û΢¿ÛÙËΠÙÔ 1877 ÛÙÔ Birmingham. ¶ÚˆÙÔfiÚÔ˜

¯ÒÚ· ÛÙË ‰ËÌÈÔ˘ÚÁ›· ·È¯ÓȉfiÙÔˆÓ Ì ÂÍÔÏÈÛÌfi

ıˆÚÂ›Ù·È Ë ¢·Ó›·, fiÔ˘ ÁÈ· ÚÒÙË ÊÔÚ¿ „ËÊ›ÛÙË-

Î·Ó ÓfiÌÔÈ Ô˘ ·Ú›¯·Ó ‰È¢ÎÔχÓÛÂȘ ·È¯ÓȉÈÔ‡

ÂÓÙfi˜ ηÙÔÈÎÈÒÓ Î·È ·’ fiÔ˘ ÚÔ‹ÏıÂ Î·È Ë È‰¤·

ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·È‰È΋˜ ¯·Ú¿˜ “ÂÚȤÙÂÈ-

·˜”, ÌÈ·˜ ‰È·ÊÔÚÂÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÁÈ· ÙË ‰È·ÌfiÚ-

ʈÛË Ù˘ ·È‰È΋˜ ¯·Ú¿˜, fiˆ˜ ı· ‰Ô‡Ì ·Ú·Î¿-

Ùˆ. ™ÙȘ ∏.¶.∞. ÔÈ ÚÒÙ˜ ·È‰ÈΤ˜ ¯·Ú¤˜ ·Ó·Ù‡-

¯ıËÎ·Ó ÂÚ› Ù· Ù¤ÏË ÙÔ˘ 1800 Ì ÙËÓ ˘ÔÛÙ‹ÚÈÍË

ÊÈÏ·ÓıÚˆÈÎÒÓ ÔÚÁ·ÓÒÛÂˆÓ Î·È Ì ÙË ÏÔÁÈ΋ ¯Ò-

ÚˆÓ ·È¯ÓȉÈÔ‡ ·ÛʷϤÛÙÂÚˆÓ ·fi ÙÔ˘˜ ‰ÚfiÌÔ˘˜,

Ô˘ ̤¯ÚÈ ÙfiÙ ¤·È˙·Ó Ù· ·È‰È¿,. ™ÙËÓ ∂ÏÏ¿‰·

·È‰ÈΤ˜ ¯·Ú¤˜ ηٷÛ΢¿˙ÔÓÙ·È Û˘Ó‹ıˆ˜ Û ۯÔ-

Ï›·, ¿Úη, ÎÂÓÙÚÈο ÛËÌ›· ¯ˆÚÈÒÓ Î·È fiψÓ

Î·È ÁÂÓÈÎfiÙÂÚ· Û ¯ÒÚÔ˘˜ Ú·Û›ÓÔ˘ Î·È ‚Ú›ÛÎÔÓÙ·È

οو ·fi ÙËÓ ÂÔÙ›· ÙˆÓ ‰‹ÌˆÓ (1).

ŒÓ·˜ ‚·ÛÈÎfi˜ ‰È·¯ˆÚÈÛÌfi˜ Ô˘ ÌÔÚ› Ó· ÂÚÈ-

ÁÚ¿„ÂÈ Ù· ›‰Ë ÙˆÓ ˘·›ıÚÈˆÓ ¯ÒÚˆÓ ·È¯ÓȉÈÔ‡ ›-

Ó·È ·˘Ùfi˜ Ô˘ ÙÔ˘˜ ‰È·ÎÚ›ÓÂÈ Û “·Ú·‰ÔÛÈ·ÎÔ‡˜”

(traditional playgrounds) Î·È “ÂÚȤÙÂÈ·˜”

(adventure playgrounds). √È “·Ú·‰ÔÛȷΤ˜” ·È‰È-

Τ˜ ¯·Ú¤˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÍÔÏÈṲ̂Ó˜ Ì ÎÔ‡ÓȘ,

ÙÛÔ˘Ï‹ıÚ˜, ‰ÔÎÔ‡˜ ·Ó·ÚÚ›¯ËÛ˘, ̇ÏÔ˘˜ Î·È ÙÚ·-

̿Ϙ Î·È ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô ÙËÓ Î›ÓËÛË Î·È ÙË Ê˘ÛÈ-

΋ ¿ÛÎËÛË ÙÔ˘ ·È‰ÈÔ‡. √È ·È‰ÈΤ˜ ¯·Ú¤˜ “ÂÚȤ-

ÙÂÈ·˜” ‚·Û›˙ÔÓÙ·È ÛÙË ÏÔÁÈ΋ fiÙÈ ÙÔ ·È¯Ó›‰È ÌÔÚ›

Ó· Ô‰ËÁ‹ÛÂÈ Û ÌÈ· ÈÔ ÔχÏ¢ÚË ·Ó¿Ù˘ÍË ÙÔ˘

·È‰ÈÔ‡ ¤Ú·Ó Ù˘ ۈ̷ÙÈ΋˜. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ,

¿¯ÚËÛÙ· ·ÓÙÈΛÌÂÓ· fiˆ˜ Ï¿ÛÙȯ· ·˘ÙÔÎÈÓ‹ÙˆÓ,

‚·Ú¤ÏÈ· Î·È ·ÏÈ¿ Ô¯‹Ì·Ù· ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤ-

ÛÔ˘Ó ËÁ‹ ÂÚÂı›ÛÌ·ÙÔ˜ ÁÈ· Â˘Ê¿ÓÙ·ÛÙÔ Î·È ‰ËÌÈ-

Ô˘ÚÁÈÎfi ·È¯Ó›‰È Û ¤Ó· ηٿÏÏËÏ· ۯ‰ȷṲ̂ÓÔ

fï˜ ÂÚÈ‚¿ÏÏÔÓ. ∆· ·È‰È¿ Â‰Ò ÌÔÚÔ‡Ó Ó· ‰È·-

ÌÔÚÊÒÛÔ˘Ó ÙÔÓ ·È¯ÓȉfiÙÔÔ fiˆ˜ ·˘Ù¿ ÓÔÌ›˙Ô˘Ó,

Û˘Ó‹ıˆ˜ ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË ÂÓfi˜ ÂÓ‹ÏÈη. √È Â-

ÚÈÂÙÂÈÒ‰ÂȘ ·È‰ÈΤ˜ ¯·Ú¤˜, ·Ó Î·È ‚Ú‹Î·Ó ·‹¯Ë-

ÛË Û ÌÂÚÈο ÎÚ¿ÙË Ù˘ ∂˘ÚÒ˘ fiˆ˜ Ë ¢·Ó›·, ηÈ

Ë ∂Ï‚ÂÙ›·, ‰ÂÓ ¤Ù˘¯·Ó ·Ô‰Ô¯‹˜ ÛÙȘ ∏.¶.∞. ÏfiÁˆ

ÙÔ˘ Êfi‚Ô˘ ·Ù˘¯ËÌ¿ÙˆÓ (2). ∂ÓÙÔ‡ÙÔȘ, ÛÙÔ Û‡Á¯ÚÔ-

ÓÔ ·ÛÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ Â›Ó·È ·Ó·Áη›Ô Ó· ‰È·ÌÔÚʈ-

ıÔ‡Ó Î·Ù¿ÏÏËÏÔÈ ·È¯ÓȉfiÙÔÔÈ, fiÔ˘ Ù· ·È‰È¿ ı·

ÌÔÚÔ‡Ó Ó· ÂÈÚ·Ì·ÙÈÛÙÔ‡Ó Î·È Ó· ·Ó·Ù‡ÍÔ˘Ó ÙȘ

‰ÂÍÈfiÙËÙ¤˜ ÙÔ˘˜ ηıÒ˜ Î·È ÙȘ ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ

ÌÂٷ͇ ÙÔ˘˜.

∞Ù˘¯‹Ì·Ù· ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ - ¶ÂÚÈÁÚ·Ê‹

ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜

∆· ·Ù˘¯‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ·È‰ÈΤ˜

¯·Ú¤˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ˆ˜ ¤Ó· Ú·ÁÌ·ÙÈο ÛËÌ·ÓÙÈ-

Îfi Úfi‚ÏËÌ·, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·Ó·Ù˘Á̤Ó˜ ¯Ò-

Ú˜ (3). ¶·Ú’ fiÏ· ·˘Ù¿ Ë ÚfiÏË„‹ ÙÔ˘˜ ‰ÂÓ Â›Ó·È

‡ÎÔÏË, ηıÒ˜ ¤Ú¯ÂÙ·È ·ÓÙÈÌ¤ÙˆË Ì ¤Ó· Ô˘ÛÈ·-

ÛÙÈÎfi ‰›ÏËÌÌ·, ÙËÓ ·Ó¿ÁÎË ·Ó¿Ù˘Í˘ ‰ÂÍÈÔًوÓ

Î·È Â›Ù¢Í˘ ÙˆÓ ÛÙfi¯ˆÓ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ó·-

Ù‡¯ıËÎ·Ó ÔÈ ¯ÒÚÔÈ ·˘ÙÔ›, ·ÏÏ¿ Î·È ÙËÓ ·Ó¿ÁÎË Ë

‰È·‰Èηۛ· ·˘Ù‹ Ó· Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ̤۷ Û ¤Ó·

·ÛʷϤ˜ ÂÚÈ‚¿ÏÏÔÓ Î·È ÂÍÔÏÈÛÌfi.

∫¿ı ¯ÚfiÓÔ ÛÙȘ ∏.¶.∞. ÂÚÈÛÛfiÙÂÚ· ·fi

200.000 ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 14 ÂÙÒÓ ÂÈÛΤ-

ÙÔÓÙ·È Ù· Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Ïfi-

Áˆ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙËÓ ÒÚ· ÙÔ˘ ·È¯ÓȉÈÔ‡ Û οÔÈ·

·È‰È΋ ¯·Ú¿ (4). ™Â ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi (ÂÚ›Ô˘

45%) ÔÈ Î·ÎÒÛÂȘ Â›Ó·È ÛÔ‚·Ú¤˜ fiˆ˜ .¯. ηٿÁÌ·-

Ù·, ÂÛˆÙÂÚÈΤ˜ ηÎÒÛÂȘ, ‰È·Û›ÛÂȘ, ÂÍ·ÚıÚ‹Ì·Ù·

Î·È ·ÎÚˆÙËÚÈ·ÛÌÔ› (4). ∆· ÎÔÚ›ÙÛÈ· Ê·›ÓÂÙ·È fiÙÈ

˘ÂÚ¤¯Ô˘Ó ÂÏ·ÊÚ¿ Û ·˘Ùfi ÙÔ Â›‰Ô˜ ÙˆÓ ·Ù˘¯ËÌ¿-

ÙˆÓ (4), ÂÓÒ ÛÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· 5-9 ÂÙÒÓ ·ÚÔ˘-

ÛÈ¿˙ÂÙ·È Ë ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙÚ·˘Ì·ÙÈÛÌÒÓ -

ÏfiÁˆ ·˘ÍË̤Ó˘ ¤ÎıÂÛ˘- Û˘ÁÎÚÈÙÈο Ì ÔÔÈ·‰‹-

ÔÙ ¿ÏÏË ËÏÈÎȷ΋ ÔÌ¿‰· (5). ∆· fiÚÁ·Ó· ·Ó·ÚÚ›¯Ë-

Û˘, Ë ÙÛÔ˘Ï‹ıÚ· Î·È ÔÈ ÎÔ‡ÓȘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ù·

ϤÔÓ ˘Â‡ı˘Ó· fiÚÁ·Ó· ÚfiÎÏËÛ˘ ·Ù˘¯ËÌ¿ÙˆÓ

·fi ÏÂ˘Ú¿˜ ÂÍÔÏÈÛÌÔ‡. ∞Ó Î·È ·ÚÎÂÙ¿ Û˘¯ÓÔ›, ÔÈ

ÙÚ·˘Ì·ÙÈÛÌÔ› ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ‰ÂÓ Ô‰ËÁÔ‡Ó Û˘-

Ó‹ıˆ˜ Û ÌfiÓÈÌË ‚Ï¿‚Ë ‹ ı¿Ó·ÙÔ. Œ¯ÂÈ ·Ó·ÎÔÈÓˆı›

fiÙÈ Û ̛· ‰ÂηÂÙ›· (1990-2000) ÛÙË ¯ÒÚ· ·˘Ù‹ Û˘-

Ó¤‚ËÛ·Ó 147 ı¿Ó·ÙÔÈ ·È‰ÈÒÓ (15 ÂÚ›Ô˘ ·Ó¿

¤ÙÔ˜). ∞fi ·˘ÙÔ‡˜, 82 ÔÊ›ÏÔÓÙ·Ó Û ·Á›‰Â˘ÛË Ù˘

ÎÂÊ·Ï‹˜ ‹ ·fi οÔÈÔ ÚÔ‡¯Ô ‹ Û οÔÈÔ fiÚÁ·ÓÔ ÌÂ

Û˘Ó¤ÂÈ· ÙÔÓ ÛÙÚ·ÁÁ·ÏÈÛÌfi, Î·È 31 ÔÊ›ÏÔÓÙ·Ó ÛÂ

ÙÒÛË. ∂›Û˘, Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ 70% ÙˆÓ

ı·Ó·ÙËÊfiÚˆÓ ÂÚÈÙÒÛÂˆÓ ¤Ï·‚ ¯ÒÚ· Û ·È‰ÈΤ˜

¯·Ú¤˜ ȉȈÙÈ΋˜ ¯Ú‹Û˘ ̤۷ Û ηÙÔÈ˘, ÂÓÒ ÛÂ

·ÓÙ›ıÂÛË, ÙÔ 75% ÙˆÓ ÌË ı·Ó·ÙËÊfiÚˆÓ ·Ù˘¯ËÌ¿ÙˆÓ

Û˘Ì‚·›ÓÂÈ Û ·È‰ÈΤ˜ ¯·Ú¤˜ ‰ËÌfiÛÈÔ˘ ¯·Ú·ÎÙ‹Ú·

(4), ÈÔ Û˘¯Ó¿ Û ۯÔÏ›· Î·È Û ·È‰ÈÎÔ‡˜ ÛÙ·ıÌÔ‡˜

(5). ∞ÓÙ›ÛÙÔȯ· ÛÙÔÓ ∫·Ó·‰¿ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ

28.500 ·È‰È¿ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Î¿ı ¯ÚfiÓÔ ÛÙ·

Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ ÂÍ·ÈÙ›·˜ ÙÚ·˘-

Ì·ÙÈÛÌÔ‡ Û ·È‰È΋ ¯·Ú¿. À‡ı˘ÓÔ˜ Ì˯·ÓÈÛÌfi˜

ÛÙ· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›Ó·È Ë ÙÒÛË ·fi οÔÈÔ

fiÚÁ·ÓÔ Î·È Û˘¯ÓfiÙÂÚË ‰È¿ÁÓˆÛË Ù· ηٿÁÌ·Ù·, ÂÓÒ

·ÎÔÏÔ˘ıÔ‡Ó ÔÈ Î·ÎÒÛÂȘ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ (6).

™ÙÔÓ Â˘Úˆ·˚Îfi ¯ÒÚÔ, Ë Mulder Î·È ÔÈ Û˘ÓÂÚÁ¿-

Ù˜ Ù˘ ÌÂϤÙËÛ·Ó Ù· ·Ù˘¯‹Ì·Ù· ÛÙȘ ÎÔ‡ÓȘ ÛÙ·

Ï·›ÛÈ· ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ∂ÈÙ‹ÚËÛ˘

∞Ù˘¯ËÌ¿ÙˆÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ Û›ÙÈ Î·È Î·Ù¿

ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ (European Home and Leisure

94 ¶. °ÚËÁÔÚ›Ô˘ Î·È Û˘Ó.

Paediatriki 2007;70:93-96

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·94

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95∞Ù˘¯‹Ì·Ù· ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜

¶·È‰È·ÙÚÈ΋ 2007;70:93-96

Accident Surveillance System - EHLASS). ¢Â‰Ô̤ӷ

·fi 8 ¯ÒÚ˜ › Û˘ÓfiÏÔ˘ 5.000 ÂÚ›Ô˘ ·Ù˘¯ËÌ¿-

ÙˆÓ, Ô‰‹ÁËÛ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· ˆ˜ οı ¯ÚfiÓÔ

ÛÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË 70.000 ¿ÙÔÌ· ·ÓÙÈÌÂÙˆ›-

˙ÔÓÙ·È ÛÙ· ›ÁÔÓÙ· È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Ïfi-

Áˆ ·Ù˘¯‹Ì·ÙÔ˜ Ì ÎÔ‡ÓÈ· (7). ™ÙË ª. µÚÂÙ·Ó›· ¤¯ÂÈ

‰Âȯı› fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙȘ ·È‰ÈΤ˜

¯·Ú¤˜ ·Ó¤Ú¯ÂÙ·È ÛÙ· 24.000 ·Ó¿ ÂÍ¿ÌËÓÔ, Û ∞ÁÁÏ›·

Î·È √˘·Ï›· (8). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ∂ÏÏ¿‰·, ¤¯ÂÈ ˘Ô-

ÏÔÁÈÛı› fiÙÈ Ë Â›ÙˆÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ·Ù˘¯ËÌ¿-

ÙˆÓ Â›Ó·È 11 ·Ó¿ 1.000 ·È‰È¿ ·Ó¿ ¤ÙÔ˜, Ì ‰ÈÏ¿ÛÈÔ

ΛӉ˘ÓÔ Ó· Û˘Ì‚Â› ·Ù‡¯ËÌ· ÛÙȘ ‰ËÌfiÛȘ ·’ fi,ÙÈ

ÛÙȘ ȉȈÙÈΤ˜ ·È‰ÈΤ˜ ¯·Ú¤˜ (9). ∂‰Ò ı· Ú¤ÂÈ Ó·

·Ó·ÊÂÚı› fiÙÈ Û‹ÌÂÚ· ÛÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË

¤¯Ô˘Ó ÙÂı› ÔÈ ‚¿ÛÂȘ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ‰ÈÎÙ‡-

Ô˘ ·fi ‚¿ÛÂȘ ‰Â‰ÔÌ¤ÓˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ ηχ-

ÙÂÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi 5.000.000 ÂÚÈÙÒÛÂȘ ·Ù˘-

¯‹Ì·ÙÔ˜ Î·È Û˘ÓÂÒ˜ ·Ó·Ì¤ÓÂÙ·È Ó· ÚÔÛʤÚÂÈ Ô-

χÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ·Ù˘¯‹Ì·Ù· Ô˘ Û¯ÂÙ›-

˙ÔÓÙ·È Ì ·˘Ù‹ ÙËÓ ÙfiÛÔ ÛËÌ·ÓÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·

ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ϤÁÂÙ·È ·È¯Ó›‰È (10).

¶ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ Î·È ·ÍÈÔÏfiÁËÛË

√È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ‰È·ÚÎÒ˜ ÂÍÂÏ›Û-

ÛÔÓÙ·È Î·È ÙÚÔÔÔÈÔ‡ÓÙ·È, ·Ú¿ÏÏËÏ· Ì ÙȘ

ÚÔÛ¿ıÂȘ Ô˘ Á›ÓÔÓÙ·È ÁÈ· ÙËÓ ÂÓ·ÚÌÔÓÈÛ‹

ÙÔ˘˜ Û ·ÁÎfiÛÌÈ· Îϛ̷η, ηıÒ˜ ÔÈΛÏÏÔ˘Ó Â˘-

Ú¤ˆ˜ ÛÙȘ ‰È¿ÊÔÚ˜ ¯ÒÚ˜. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ

fiÙÈ fiÙ·Ó ‰ÂÓ ÙËÚÔ‡ÓÙ·È, Ù· ·È‰È¿ ÂÎÙ›ıÂÓÙ·È ÛÂ

·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ, ÂȉÈÎfiÙÂÚ· fiÙ·Ó Ë ÌË Û˘ÌÌfiÚ-

ʈÛË ¤¯ÂÈ Ó· οÓÂÈ Ì ·Ó·ÚΤ˜ ‚¿ıÔ˜ ‹ ·Î·Ù¿Ï-

ÏËÏË Â›ÛÙÚˆÛË ÙÔ˘ ‰¿ÊÔ˘˜ fiˆ˜ .¯. Ì ÙÛÈ̤-

ÓÙÔ, ¿ÛÊ·ÏÙÔ ‹ ¤ÙÚ˜ (3). ¶ÏËÓ ÙÔ˘ ·Î·Ù¿ÏÏË-

ÏÔ˘ ‰¿ÊÔ˘˜, ÙÔ ‡„Ô˜ ÙÔ˘ ÂÍÔÏÈÛÌÔ‡ Â›Ó·È ¤Ó·˜

¿ÏÏÔ˜ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ÚԂϤÂÙ·È

·fi ÙȘ ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜. ∆Ô ÛÙÔÈ¯Â›Ô ·˘-

Ùfi ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ηıÒ˜ Û¯ÂÙ›˙ÂÙ·È Î˘-

Ú›ˆ˜ Ì ÙȘ ÙÒÛÂȘ, ÙÔ Û˘¯ÓfiÙÂÚÔ Â›‰Ô˜ ·Ù˘¯‹Ì·-

ÙÔ˜ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ¯ÒÚÔ˘˜, Œ¯ÂÈ ‰Âȯı› Ì¿ÏÈÛÙ·

fiÙÈ Ë Û˘¯ÓfiÙËÙ· ·ÏÏ¿ Î·È Ë ‚·Ú‡ÙËÙ· ÙˆÓ ·Ù˘¯Ë-

Ì¿ÙˆÓ ·˘Í¿ÓÂÙ·È fiÛÔ ·˘Í¿ÓÂÙ·È ÙÔ ‡„Ô˜ ÙˆÓ ÔÚ-

Á¿ÓˆÓ. ∆Ô fiÚÈÔ ÙÔ˘ 1,5 m Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·Ô-

ÙÚÂÙÈÎfi, ·Ó Î·È ·˘Ùfi ÂÍ·ÚÙ¿Ù·È Î·È ·fi ÙËÓ ËÏÈ-

Îȷ΋ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ·Â˘ı‡ÓÂÙ·È Ë ·È‰È΋

¯·Ú¿ (3,11), fï˜ ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· fiÛÔÓ

·ÊÔÚ¿ ÙÔ Ì¤ÁÈÛÙÔ ·ÛʷϤ˜ fiÚÈÔ. ÕÏÏ· ˙ËÙ‹Ì·Ù·

Ô˘ ÚԂϤÔÓÙ·È ·fi ÙȘ Ô‰ËÁ›Â˜ ¤¯Ô˘Ó Ó· ο-

ÓÔ˘Ó Ì ÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ ÔÚÁ¿ÓˆÓ, fiˆ˜ .¯.

ÙËÓ ÂÈÏÔÁ‹ ηٿÏÏËÏˆÓ ˘ÏÈÎÒÓ ÁÈ· ÙËÓ Î·Ù·-

Û΢‹ ÙÔ˘˜ ‹ ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ··Ú·›ÙËÙˆÓ

·ÔÛÙ¿ÛÂˆÓ ÌÂٷ͇ ÙÔ˘˜.

ª¤¯ÚÈ Î·È Û‹ÌÂÚ·, Ë ÂÊ·ÚÌÔÁ‹ ÚԉȷÁÚ·ÊÒÓ

·ÛÊ·Ï›·˜ ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ Û˘Ó·ÓÙ¿ ‰˘ÛÎÔϛ˜

Ì ·ÔÙ¤ÏÂÛÌ· Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ›Ù ӷ ÌËÓ

˘ÈÔıÂÙÔ‡ÓÙ·È, ›ÙÂ Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ Ó· Â›Ó·È ÂÏÏÈ‹˜.

™Â ÌÂϤÙË Û¯ÂÙÈο Ì ÙȘ Ù¿ÛÂȘ Î·È Ù· ›‰Ë ÙˆÓ ·Ù˘-

¯ËÌ¿ÙˆÓ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ·˘ÙÔ‡˜ ÛÙȘ ∏.¶.∞. ÛÙËÓ Â-

Ú›Ô‰Ô 1992-1997 ‰ÂÓ ‰È·ÈÛÙÒıËΠԢÛÈ·ÛÙÈ΋ Ì›ˆ-

Û‹ ÙÔ˘˜ (5), Î·È ·˘Ùfi Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙ· ÂÍ‹˜:

1. ∏ ˘Â˘ı˘ÓfiÙËÙ· Û¯ÂÙÈο Ì ÙÔ˘˜ ¯ÒÚÔ˘˜ ·˘-

ÙÔ‡˜ ηٷӤÌÂÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ Ô˘ ‚Ú›ÛÎÔÓÙ·È

·˘ÙÔ› (‰‹ÌÔÈ, ȉÈÔÎً٘ Î.Ï.) Ì Èı·Ófi ·Îfi-

ÏÔ˘ıÔ ÙȘ ‰˘Û¯¤ÚÂȘ Û˘ÓÂÚÁ·Û›·˜ Î·È Û˘ÓÙÔÓÈÛÌÔ‡,

ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ÙÔ ¤ÏÏÂÈÌÌ· Û¯ÂÙÈ΋˜ ÓÔÌÔıÂÙÈ΋˜

Ú‡ıÌÈÛ˘ ‰›ÓÂÈ ÙËÓ Â˘¯¤ÚÂÈ· ÛÙÔ˘˜ ηٷÛ΢·ÛÙ¤˜

Ó· ÏÂÈÙÔ˘ÚÁÔ‡Ó Ì ‚¿ÛË ÙÔ Î¤Ú‰Ô˜ Î·È ¯ˆÚ›˜ ÂÚÈÔ-

ÚÈÛÌÔ‡˜.

2. ∏ ¤ÏÏÂÈ„Ë Î·Ù¿ÏÏËÏ˘ ÂÊ·ÚÌÔÁ‹˜ Î·È Û˘ÓÙ‹-

ÚËÛ˘ ÙÔ˘ ÂÍÔÏÈÛÌÔ‡.

3. √ Ù¯ÓÈÎfi˜ ۯ‰ȷÛÌfi˜ ·fi ÙÔ˘˜ ηٷÛ΢·-

ÛÙ¤˜ Û˘¯Ó¿ ‰ÂÓ ÚÔ¸Ôı¤ÙÂÈ ÙË Û˘ÓÂÈÛÊÔÚ¿ Î·È ÙˆÓ

¿ÏÏˆÓ ÂÌÏÂÎfiÌÂÓˆÓ, fiˆ˜ ÙÔ˘ È·ÙÚÈÎÔ‡ ÚÔÛˆÈ-

ÎÔ‡, ÙˆÓ ·È‰Ô„˘¯ÔÏfiÁˆÓ, ÙˆÓ ·È‰·ÁˆÁÒÓ, ÙˆÓ ÁÔ-

Ó¤ˆÓ ·ÏÏ¿ Î·È ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·È‰ÈÒÓ. ÕÏψÛÙ Ë

ȉ¤· Ù˘ “ÂÚÈÂÙÂÈÒ‰Ô˘˜” ·È‰È΋˜ ¯·Ú¿˜ ‹ÚıÂ

ÛÙÔÓ ÂÌÓ¢ÛÙ‹ Ù˘, ÙÔÓ ¢·Ófi ·Ú¯ÈÙ¤ÎÙÔÓ·

Sorenson, ·Ú·ÙËÚÒÓÙ·˜ fiÙÈ Ù· ·È‰È¿ ¤·È˙·Ó ÈÔ

Ôχ Ì ¿¯ÚËÛÙ· ÔÈÎÔ‰ÔÌÈο ̆ ÏÈο ·Ú¿ Ì ÙÔ˘˜ ̄ Ò-

ÚÔ˘˜ ·È¯ÓȉÈÔ‡ Ô˘ ·˘Ùfi˜ ۯ‰›·˙ (1).

4. ™˘¯Ó¿ ‰ÂÓ Ï·Ì‚¿ÓÔÓÙ·È ̆ ’ fi„ÈÓ ÔÈ ‰È·ÊÔÚ¤˜ ÛÂ

ÔÏÈÙÈÛÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο.

5. ∆Ô ÛËÌ·ÓÙÈÎfi ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ fï˜ Û ÌÈ·

ÚfiÛÊ·ÙË ·Ó·ÛÎfiËÛË ·fi ÙË ª. µÚÂÙ·Ó›· Ô‰ËÁ›-

Ù·È ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÛÙË

Ì›ˆÛË ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ‰ÂÓ Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ÌÂ-

Á¿ÏÔ˘ ÎfiÛÙÔ˘˜ Ù¤ÙÔÈˆÓ ·ÚÂÌ‚¿ÛÂˆÓ (12).

6. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ú΋ ÛÙÔȯ›· ·fi ÂȉËÌÈÔ-

ÏÔÁÈΤ˜ ¤Ú¢Ó˜ ÁÈ·:

·) ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜

ÚÔÏËÙÈÎÒÓ ·ÚÂÌ‚¿ÛˆÓ. √ MacKay Û ÌÈ· Û¯ÂÙÈ-

΋ ·Ó·ÛÎfiËÛË ‰È·›ÛÙˆÛ ÙËÓ ·ÚÔ˘Û›· ÂÓÓ¤· Ìfi-

ÓÔ ÌÂÏÂÙÒÓ (‰‡Ô Û¯ÂÙÈÎÒÓ Ì ·Ú¤Ì‚·ÛË fiÛÔÓ ·ÊÔ-

Ú¿ ÛÙËÓ Â›ÛÙÚˆÛË ÙÔ˘ ‰¿ÊÔ˘˜ Î·È ÂÙ¿ Ô˘ Û¯ÂÙ›-

˙ÔÓÙ·Ó Ì ÚÔÛ¿ıÂȘ ÛÂ Â›Â‰Ô Âη›‰Â˘Û˘)

Ô˘ ‰ÂÓ ¤Ù˘¯Â ¢Ú›·˜ ÂÊ·ÚÌÔÁ‹˜ (3),

‚) ÙËÓ Î·Ù¿‰ÂÈÍË ÂȉÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘

fiˆ˜ .¯. Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ‹ Ù· ‰È¿ÊÔÚ· ̤ÚË

ÙÔ˘ ÛÒÌ·ÙÔ˜ (3) ηÈ

Á) ÙË Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ¤ÎıÂÛ˘. ∆· ÛÙÔȯ›·

·˘Ù¿ Â›Ó·È ··Ú·›ÙËÙ· ÁÈ· ÙËÓ ÂÌ‚¿ı˘ÓÛË ÛÙÔ Úfi-

‚ÏËÌ·, ÙËÓ ÈÂÚ¿Ú¯ËÛË ÚÔÙÂÚ·ÈÔÙ‹ÙˆÓ Î·È ÙË Ï‹„Ë

¿ÌÂÛˆÓ Î·È ÔÚıÒÓ ÂÈÏÔÁÒÓ ·fi ÙÔ˘˜ ·ÚÌÔ‰›Ô˘˜

(3,11).

7. √È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó·

˘ÔηٷÛÙ‹ÛÔ˘Ó ÙÔÓ Ôχ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ù˘

·ÚÎÔ‡˜ ›‚Ï„˘ ÙÔ˘ ·È‰ÈÔ‡.

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·95

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96 ¶. °ÚËÁÔÚ›Ô˘ Î·È Û˘Ó.

Paediatriki 2007;70:93-96

¶ÚÔÔÙÈΤ˜

ªÂ ‰Â‰Ô̤ӷ ·fi ÙË ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ ·Ù˘¯ËÌ¿-

ÙˆÓ ÛÙË ¯ÒÚ· Ì·˜, ˘ÔÏÔÁ›Û·Ì ÙËÓ ·Ó·ÏÔÁ›· ·˘ÙÒÓ

Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ·È‰ÈΤ˜ ¯·Ú¤˜ Û ·È‰È¿ ËÏÈΛ·˜

3-12 ÂÙÒÓ (10). ∏ ·Ó·ÏÔÁ›· ‹Ù·Ó ÂÚ›Ô˘ 10%, Û˘-

ÁÎÚÈÙÈο ‰ÈÏ¿ÛÈ· ÙÔ˘ ¯ÚfiÓÔ˘ Ô˘ ÂÚÓ¿ ¤Ó· ·È‰›

ÛÙËÓ ·È‰È΋ ¯·Ú¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜. √

‰ÈÏ¿ÛÈÔ˜ ΛӉ˘ÓÔ˜ ¤¯ÂÈ ˘ÔÏÔÁÈÛÙ› Ì ‚¿ÛË ÙËÓ

˘fiıÂÛË fiÙÈ ¤Ó· ·È‰› ÂÚÓ¿ ηٿ ̤ÛÔÓ fiÚÔ 1 ÒÚ·

ÙËÓ Ë̤ڷ ÛÙËÓ ·È‰È΋ ¯·Ú¿ (~5% ‰ËÏ·‰‹, ηıÒ˜ Ë

‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ÁÈ· Ù· ·È‰È¿ Â›Ó·È ·fi 7 .Ì.

¤ˆ˜ 9 Ì.Ì.). øÛÙfiÛÔ, ÙÔ ·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ·ÚÔ˘ÛÈ¿-

˙ÂÈ ÂӉ¯Ô̤ӈ˜ ˘ÂÚ‚ÔÏÈÎfi ÙÔÓ Î›Ó‰˘ÓÔ ·fi ÙË

‰Ú·ÛÙËÚÈfiÙËÙ· Û ·˘Ùfi ÙÔÓ ¯ÒÚÔ, ηıÒ˜ ¤Ó· ÛËÌ·-

ÓÙÈÎfi ̤ÚÔ˜ Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ·È-

‰ÈÒÓ (.¯. Ì¿ıËÌ· ÛÙËÓ Ù¿ÍË ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙË-

ÏÂfiÚ·Û˘) ÂÓ¤¯ÂÈ ÌÈÎÚfi ΛӉ˘ÓÔ ·Ù˘¯‹Ì·ÙÔ˜. ∞˘Ùfi

‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ ·È‰ÈΤ˜ ¯·Ú¤˜ Â›Ó·È Ú¿ÁÌ·ÙÈ

·ÛÊ·Ï›˜, ·ÓÙÈı¤Ùˆ˜, ¤¯Ô˘Ì ·Ó·ÎÔÈÓÒÛÂÈ fiÙÈ ÂÚ›-

Ô˘ 50% ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ ÛÙȘ ·È‰ÈΤ˜ ¯·Ú¤˜ ı·

ÌÔÚÔ‡Û ӷ ›¯Â ·ÔÊ¢¯ı› Ì ÙȘ ηٿÏÏËϘ ·-

ÚÂÌ‚¿ÛÂȘ ۯ‰ȷÛÌÔ‡ Î·È ÂÍÔÏÈÛÌÔ‡ (9). ∞Ó¿ÏÔÁ˜

ÂÎÙÈÌ‹ÛÂȘ ¤¯Ô˘Ó Á›ÓÂÈ Î·È ÁÈ· ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ¤Ú·Ó

·˘ÙÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û ·È¯ÓȉfiÙÔÔ˘˜ Î·È Û˘ÓÔ-

ÏÈο ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ÚfiÏË„Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ

ı· Ú¤ÂÈ Ó· ÂÛÙÈ·ÛÙ› Û fiϘ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜

ÙˆÓ ·È‰ÈÒÓ ·ÓÂÍ·Úًو˜ ÙfiÔ˘ ‹ ̄ ÚfiÓÔ˘. ∂›Ó·È ›-

Û˘ ÛËÌ·ÓÙÈÎfi Ó· ·ÓÙÈÏËÊıԇ̠fiÙÈ Ë ÚfiÎÏËÛË ÙˆÓ

ÂÚÈÛÛfiÙÂÚˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘

·ÏÏËÏ›‰Ú·Û˘ ·ÙfiÌÔ˘, ̄ ÚfiÓÔ˘ Î·È ÙfiÔ˘. ¢Â‰Ô̤-

ÓÔ˘ fiÙÈ Ë ÂÓÂÚÁËÙÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È Î·È ÂÈ-

ı˘ÌËÙ‹ Î·È ·Ó·Áη›·, ΛӉ˘ÓÔ˜ ı· ˘¿Ú¯ÂÈ. ∏ ÚÔ-

Û¿ıÂÈ· Ú¤ÂÈ Ó· ÂÛÙÈ·ÛÙ› ÛÙÔ Ó· ÂÏ·¯ÈÛÙÔÔÈËı›

·˘Ùfi˜, ̄ ˆÚ›˜ Ó· ÂÚÈÔÚÈÛÙ› Ë ÂÏ¢ıÂÚ›· ÙÔ˘ ·È‰ÈÔ‡,

Ë ‰È¿ıÂÛË ÁÈ· ÂÍÂÚ‡ÓËÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ

ÚÔÎÏ‹ÛÂˆÓ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜.

ø˜ ÂÎ ÙÔ‡ÙÔ˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÚÔ·„Ô˘Ó ÙÚ›·

Û˘ÌÂÚ¿ÛÌ·Ù·:

1. ∆Ô ·È¯Ó›‰È ÛÙÔ˘˜ ·È¯ÓȉfiÙÔÔ˘˜ ¤¯ÂÈ ÂÈÚfi-

ÛıÂÙÔ Î›Ó‰˘ÓÔ Û ۯ¤ÛË Ì ¿ÏϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜,

ˆÛÙfiÛÔ Ô Î›Ó‰˘ÓÔ˜ ·˘Ùfi˜ ‰ÂÓ Â›Ó·È ··ÁÔÚ¢ÙÈÎfi˜.

2. ∆· ·Ù˘¯‹Ì·Ù· ÛÙÔ˘˜ ·È¯ÓȉfiÙÔÔ˘˜ ÌÔÚÔ‡Ó

Ó· ÚÔÏËÊıÔ‡Ó. ªÂ ‰Â‰Ô̤ÓË Ì¿ÏÈÛÙ· ÙËÓ ÂÈÎÈÓ‰˘-

ÓfiÙËÙ·, Ë ÚfiÏË„Ë Ú¤ÂÈ Ó· ¤¯ÂÈ ÚˆÙ‡ÔÓÙ· ÚfiÏÔ.

3. ∂›Ó·È ·Ó·Áη›Ô Ó· ۯ‰ȷÛÙÔ‡Ó ÂÚÈÛÛfiÙÂÚ˜

ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ı· ηχ„Ô˘Ó Ù· ÛË-

ÌÂÚÈÓ¿ ÎÂÓ¿ Û ۯ¤ÛË Ì ÙÔ ı¤Ì· ·˘Ùfi, ÒÛÙ ӷ ÏË-

ÊıÔ‡Ó Ù· ηٿÏÏËÏ· ̤ÙÚ· ‚·ÛÈṲ̂ӷ Û ÂÈÛÙËÌÔ-

ÓÈΤ˜ ·Ô‰Â›ÍÂȘ.

™˘ÛÙ¿ÛÂȘ

√È ÚԉȷÁڷʤ˜ ·ÛÊ·Ï›·˜ ı· Ú¤ÂÈ Ó· ·Ú·-

ÎÔÏÔ˘ıÔ‡Ó Î·È Ó· ÙÚÔÔÔÈÔ‡ÓÙ·È Ì ‚¿ÛË Ù· ÂÈ-

‰ËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ. ∏ ÔÏÈÙ›· ˆÛÙfiÛÔ, ›ӷÈ

·˘Ù‹ Ô˘ ʤÚÂÈ ÙËÓ Â˘ı‡ÓË ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜.

∏ ÌÂÁ·Ï‡ÙÂÚË ¯ÚËÌ·ÙÔ‰fiÙËÛË Î·È Ë ı¤ÛÈÛË ÓÔÌÔ-

ıÂÛ›·˜, fiÔ˘ ˘¿Ú¯Ô˘Ó ·ÎfiÌË ÎÂÓ¿, ı· Û˘Ì‚¿ÏÔ˘Ó

Ô˘ÛÈ·ÛÙÈο ÒÛÙ ӷ ÂÈÙ¢¯ı› ÙÔ ÂÈı˘ÌËÙfi ·Ô-

Ù¤ÏÂÛÌ·. ∆Ô ·È‰› ¤¯ÂÈ ‰Èη›ˆÌ· ÛÙÔ ·È¯Ó›‰È. ∆Ô

·È¯Ó›‰È ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘

ÚÔÛˆÈÎfiÙËÙ¿˜ ÙÔ˘. ™ÙȘ ̤Ú˜ Ì·˜ Î·È ÛÙȘ ÌÂÁ·-

ÏÔ˘fiÏÂȘ, ÔÈ ·È‰ÈΤ˜ ¯·Ú¤˜ Ù›ÓÔ˘Ó Ó· Á›ÓÔ˘Ó ÔÈ

ÌÔÓ·‰ÈÎÔ› ¯ÒÚÔÈ ·È¯ÓȉÈÔ‡. £· Ú¤ÂÈ Ó· ›ӷÈ

ÂÎÙfi˜ ·fi ¯ÒÚÔÈ „˘¯·ÁˆÁ›·˜ Î·È ¯ÒÚÔÈ ·ÛÊ·Ï›˜.

∂˘¯·ÚÈÛٛ˜

°È· ÙË Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙÔ ∫¤ÓÙÚÔ ŒÚ¢ӷ˜ ηÈ

¶ÚfiÏ˄˘ ∞Ù˘¯ËÌ¿ÙˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ·ÎÔ-

ÏÔ˘ı› ÎÔÈÓfi ÚˆÙfiÎÔÏÏÔ Ì ÙȘ ¿ÏϘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚-

΋˜ ŒÓˆÛ˘, Ô˘ ÂÔÙ‡ÂÙ·È Î·È ÂÓ Ì¤ÚÂÈ ¯ÚËÌ·ÙÔ‰ÔÙ›ٷÈ

·fi ÙË °ÂÓÈ΋ ¢È‡ı˘ÓÛË ¢ËÌfiÛÈ·˜ ÀÁ›·˜ Ù˘ ∫ÔÈÓfiÙËÙ·˜

Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ Î·È ∫ÔÈÓˆÓÈ΋˜ ∞ÏÏËÏÂÁÁ‡Ë˜.

µÈ‚ÏÈÔÁÚ·Ê›·

1. ∞˘ÁËÙ›‰Ô˘ ™ (ÂÈÌÂÏ‹ÙÚÈ·). ∆Ô ¶·È¯Ó›‰È. ™‡Á¯ÚÔÓ˜

ÂÚ¢ÓËÙÈΤ˜ Î·È ‰È‰·ÎÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ. 1Ë ¤Î‰ÔÛË,

∞ı‹Ó·: ∂ΉfiÛÂȘ ∆˘ˆı‹Ùˆ; 2001. Û. 67-370.

2. Krohe JR. Beyond playgrounds. The best advice you can give

a kid may be: Go play in the street. Illinois Issues 1996;19-26.

http://www.lib.niu.edu/ipo/1996/ii960619.html

3. MacKay M. Playground injuries: recent attempts to begin

to address what we don’t know. Inj Prev 2003;9:194-196.

4. Tinsworth D, McDonald J. Special study: Injuries and

deaths associated with children’s playground equipment.

United States Consumer Product Safety Commission.

Washington (DC), USA; 2001. Webpage: http://www.cp-

sc.gov/library/playgrnd.pdf

5. Phelan KJ, Khoury J, Kalkwarf HJ, Lanphear BP. Trends

and patterns of playground injuries in United States chil-

dren and adolescents. Ambul Pediatr 2001;1:227-233.

6. Preventing playground injuries. Injury Prevention Commit-

tee, Canadian Paediatric Society; Paediatrics & Child Health

2002;7(4): 255-256. Website: http://www.cps.ca/english/

statements/IP/IP02-01.htm

7. Mulder S, Barrow M, Bay-Neilsen H, Duval C. Swing ac-

cidents within the European region. Int J Consumer Safe-

ty 1995;2:175-189.

8. Sibert J, Stone D. Injury prevention in the UK - the Euro-

pean dimension. Inj Prev 1998;4 (Suppl): S34-S41.

9. Petridou E, Sibert J, Dedoukou X, Skalkidis I, Trichopou-

los D. Injuries in public and private playgrounds: the rela-

tive contribution of structural, equipment and human fac-

tors. Acta Paediatr 2002;91:691-697.

10. Dessypris N, Petridou E, Skalkidis Y, Moustaki M, Kout-

selinis A, Trichopoulos D. Countrywide estimation of the

burden of injuries in Greece: a limited resources approach.

J Cancer Epidemiol Prev 2002;7:123-129.

11. Norton C, Nixon J, Sibert JR. Playground injuries to chil-

dren. Arch Dis Child 2004;89:103-108.

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tive, UK; 2002.

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∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜

ËÏÈΛ·˜ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ

∞. ∫·Ê¿ÙÔ˜, Ã. ÷Ù˙‹˜, ª. §ÈÓ·Ú‰¿Î˘, ¢. ∞ı·Ó·ÛfiÔ˘ÏÔ˜, Ã. §ÈÔÓ‹˜, ∂. ª·ÏˆÌÂÓ¿ÎË, ∞. ∫·ÓÈÛ¿Î˘,

∂. ™Ù·Ì·Ù¿ÎË Î·È ™˘ÓÂÚÁ·˙fiÌÂÓÔÈ ÂÚ¢ÓËÙ¤˜*

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ∫Ú‹Ù˘.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 1189 ·È‰È¿ (591 ·ÁfiÚÈ·), ËÏÈΛ·˜ 4-7 ÂÙÒÓ. ŒÁÈÓ ̤ÙÚË-ÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ۈ̷ÙÔÌÂÙÚÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ Î·È Ï‹„Ë ·›Ì·ÙÔ˜ ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÏÈÔÚˆÙÂ-˚ÓÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·È ÙÔ˘ ۷ί¿ÚÔ˘.

∞ÔÙÂϤÛÌ·Ù·: ™‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ International Obesity Task Force (IOTF), 27,4% ÙˆÓ ·ÁÔ-ÚÈÒÓ ‹Ù·Ó ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη (10,8% ·¯‡Û·Úη) Î·È 28,5% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (9% ·¯‡Û·Úη).ªÂ ·˘ÍË̤ӷ ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (>95Ë ÂηÙÔÛÙÈ·›· ı¤ÛË) ‚Ú¤ıËΠÙÔ 7,4% ÙˆÓ ·ÁÔÚÈÒÓ Î·È7,9% ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ªÂ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË >200 mg/dl ‚Ú¤ıËΠÙÔ 14,4% ÙˆÓ ·È‰ÈÒÓ Î·È Ì LDL-C>130 mg/dl ÙÔ 13,8%. ªÂ ¤Ó·Ó ·Ú¿ÁÔÓÙ· ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ‚Ú¤ıËΠÙÔ 18,3% ÙˆÓ ·È‰ÈÒÓ,Ì ‰‡Ô ·Ú¿ÁÔÓÙ˜ ÙÔ 5,9% Î·È Ì ÙÚÂȘ ÙÔ 1,4%. ¶·È‰È¿ Ì ˘„ËÏ¿ ›‰· ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (>100mg/dl) ›¯·Ó Û ۇÁÎÚÈÛË Ì ÂΛӷ Ì ¯·ÌËÏ¿ ›‰· (≤80 mg/dl), ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË Ì¤ÛË ÙÈ-Ì‹ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ Î·È ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (p<0,05). ¶·È‰È¿ Ì ¯·ÌËÏ¿ ›‰· HDL-C (<45mg/dl) ›¯·Ó Û ۯ¤ÛË Ì ÂΛӷ Ì ˘„ËÏ¿ ›‰· (≥60 mg/dl), ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÂÚ›ÌÂÙÚÔ Ì¤-Û˘ Î·È ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (p<0,05). ∆· ·¯‡Û·Úη ·È‰È¿ ‚Ú¤ıËÎ·Ó ·ÎfiÌË Ó· ¤¯Ô˘Ó 2,87 ÊÔÚ¤˜ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· (p=0,041).

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÂÈ‚Â-‚·ÈÒÓÂÈ ÙËÓ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ·¯˘Û·ÚΛ·˜. ∏ ·ÚÔ˘Û›· ȉȷ›ÙÂÚ· Ù˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ ÛÙËÓËȷ΋ ËÏÈΛ·, Ê·›ÓÂÙ·È Ó· Û˘Ó‰¤ÂÙ·È ¿ÌÂÛ· Ì ¿ÏÏÔ˘˜ ·ıËÚÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ˘ÂÚÏÈÈ-‰·ÈÌ›·. ∏ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË Û ÁÔÓ›˜, ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Î·È ·È‰È¿ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ·ÎfiÌËËÏÈΛ· Â›Ó·È ¿ÌÂÛË ÂıÓÈ΋ ·Ó¿ÁÎË.

§¤ÍÂȘ ÎÏÂȉȿ: ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, ·ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ˘¤ÚÙ·ÛË, ·¯˘Û·ÚΛ·, ‰Â›ÎÙ˘ Ì¿˙·˜

ÛÒÌ·ÙÔ˜, ÂÚ›ÌÂÙÚÔ˜ ̤Û˘.

Atherogenic risk factors in preschool children in Crete

A. Kafatos, C. Hatzis, M. Linardakis, D. Athanasopoulos, C. Lionis, E. Balomenaki, A. Kapnisakis,

H. Stamataki and Collaborative researchers

Abstract

Background: The aim of the study was the investigation of atherogenic risk factors in preschool chil-dren of Crete.

Methods: The study population included 1189 children (591 boys), aged 4-7 years. All children wereexamined, for the following: anthropometric and blood pressure measurements. Blood was taken forserum lipoproteins and blood sugar.

Results: According to International Obesity Task Force (IOTF) criteria, 27.4% of the boys were classi-fied as overweight or obese (obese 10.8%). The respective percentage for girls was 28.5% (obese 9%).7.4% of the boys and 7.9% of the girls had blood pressure above the 95th percentile. Total cholesterol>200 mg/dl was found in 14.4% and LDL-C >130 mg/dl in 13.8% of the children. The percentage ofchildren with one, two, and three metabolic syndrome risk factors was 18.3%, 5.9% and 1.4% respec-tively. Children with high serum triglycerides (>100 mg/dl) had significantly higher mean waist cir-cumference (WC) and body mass index (BMI) compared to those with low triglycerides (≤80 mg/dl)(p<0.05). Similarly, children with lower HDL-C (<45 mg/dl) had significantly higher WC and BMI thanchildren with higher HDL-C (≥60 mg/dl) (p<0.05). Moreover, obese children had significantly higherrisk for hypetriglyceridemia as compared to non-obese children (Odds Ratio: 2.87, p=0.041).

Conclusions: These results of high prevalence of overweight and obesity in Cretan preschool children in-dicate the presence of this major public health problem in early ages. Levels of obesity and especially

97∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘,∆Ì‹Ì· π·ÙÚÈ΋˜, ∆Ô̤·˜∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜, ∫ÏÈÓÈ΋¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ ηȢȷÙÚÔÊ‹˜, ∏Ú¿ÎÏÂÈÔ∫Ú‹Ù˘

AÏÏËÏÔÁÚ·Ê›·:

∞ÓÙÒÓ˘ ∫·Ê¿ÙÔ˜ [email protected]¢È·ÛÙ·‡ÚˆÛË µÔ‡Ù˜-™Ù·˘Ú¿ÎÈ· ∆.∫. 710 03, ∆.£. 2208,∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

University of Crete, Facultyof Medicine, Department ofSocial Medicine, Division ofPreventive Medicine andNutrition, Heraklion, Crete

Correspondence:

Antonis Kafatos [email protected] Junction,71 003, Po. Box: 2208, Herakleion, Crete

¶·È‰È·ÙÚÈ΋ 2007;70:97-106

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·97

Page 29: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

98 ∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

Paediatriki 2007;70:97-106

central obesity were strongly related to other atherogenic risk factors, namely dyslipidemia. Health andnutrition education addressed to parents, teachers and children should become an urgent national pri-ority.

Key words: Preschool age, atherogenic risk factors, hypertension, obesity, body mass index, waist

circumference.

™˘ÓÙÔÌÔÁڷʛ˜

∂∂ ∂˘Úˆ·˚΋ ŒÓˆÛË ™∞¶ ™˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ¢∞¶ ¢È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË GLU ™¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ TCHOL √ÏÈ΋ ̄ ÔÏËÛÙÂÚfiÏË HDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ̆ „ËÏ‹˜

˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C ÃÔÏËÛÙÂÚfiÏË ÙˆÓ ̄ ·ÌËÏ‹˜

˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ TG ∆ÚÈÁÏ˘ÎÂÚ›‰È· TCHOL/HDL-C ∞ıËڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ ¢ª™ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¶ª ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ ¶π ¶ÂÚ›ÌÂÙÚÔ˜ ÈÛ¯›Ô˘ ¶ªπ ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜

ÈÛ¯›Ô ¶ªª ¢Â›ÎÙ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜

Ì‹ÎÔ˜ ª™ ™Ù·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈ΋

‰È·ÊÔÚ¿ OR Odds ratio IOTF International Obesity Task Force

∂ÈÛ·ÁˆÁ‹

√È Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔÈ ‰Â›ÎÙ˜ ıÓËÛÈÌfi-ÙËÙ·˜ ·fi ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· Û ¿Ó‰ÚÂ˜Î·È Á˘Ó·›Î˜ ̤Û˘ ËÏÈΛ·˜ Ù˘ ¯ÒÚ·˜ Ì·˜,Û¯ÂÙ›˙ÔÓÙ·È ÛÙÂÓ¿ Ì ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·. ∏‚·ıÌÈ·›· ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙÔÓ ·Ú·‰ÔÛÈ·ÎfiÙÚfiÔ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ ÙȘ ÙÂ-ÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ Ù·¯Â›··‡ÍËÛË ÙˆÓ ÚfiˆÚˆÓ ı·Ó¿ÙˆÓ ·fi ¤ÌÊÚ·ÁÌ·ÙÔ˘ Ì˘Ôηډ›Ô˘ (1-4).

∏ ∂ÏÏ¿‰· Â›Ó·È ·fi ÙȘ ÚÒÙ˜ ¯ÒÚ˜ ÛÙËÓ∂∂ ÛÂ Û˘¯ÓfiÙËÙ· ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ (5). ∏·ÚÔ˘Û›· ·˘ÍË̤ÓÔ˘ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ÛÙ· ·È‰È¿ Û˘Ó˘¿Ú¯ÂÈ Û˘¯Ó¿ Ì ¿ÏÏÔ˘˜ ·Ú¿-ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ ÔÈ ˘ÂÚÏÈȉ·È̛˜, Ë·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÙÔ ·˘ÍË̤ÓÔۿί·ÚÔ (GLU) ÓËÛÙ›·˜. ∂¿Ó Û ·˘ÙÔ‡˜ ÙÔ˘˜·Ú¿ÁÔÓÙ˜ Û˘Ó˘ÔÏÔÁÈÛÙ› ÙÔ ¿ÌÂÛÔ Î·È ¤Ì-ÌÂÛÔ Î¿ÓÈÛÌ·, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ô Û˘Ó‰˘·-ÛÌfi˜ ÙÔ˘˜ ÂÈÙ·¯‡ÓÂÈ ÙËÓ ·ıËÚÔÛÎÏËÚ˘ÓÙÈ΋ÂÂÍÂÚÁ·Û›·. ∏ Û˘Ó‡·ÚÍË 3 ‹ 4 ·fi ·˘ÙÔ‡˜ÙÔ˘˜ ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ÛÙ· ·È‰È¿ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È Ì ·‡ÍË-

ÛË Ù˘ ÈÓÒ‰Ô˘˜ Ͽη˜ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ ÙˆÓ ·Ú-ÙËÚÈÒÓ, Ô˘ ηٷϋÁÂÈ Û ·ıËڈ̷ÙÈ΋ ϿηÛ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (6,7).

À¤Ú‚·Ú· Î·È ·¯‡Û·Úη ·È‰È¿ [‰Â›ÎÙ˘̿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) >85Ë ÂηÙÔÛÙÈ·›· ı¤-ÛË] ¤¯Ô˘Ó 24 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ·Ó· ¤¯Ô˘Ó ·˘ÍË̤ÓË ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË(TCHOL) Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ô˘ ‚Ú›-ÛÎÔÓÙ·È Î¿Ùˆ ·fi ÙËÓ 85Ë ÂηÙÔÛÙÈ·›· ı¤ÛËÙÔ˘ ¢ª™ (8). ∞ÎfiÌË, Ô ·ÓÙ›ÛÙÔȯԘ Û¯ÂÙÈÎfi˜Î›Ó‰˘ÓÔ˜ ÁÈ· ÙË ‰È·ÛÙÔÏÈ΋ ›ÂÛË (¢∞¶) ›ӷÈ2,4 ÊÔÚ¤˜, 4,5 ÁÈ· ÙË Û˘ÛÙÔÏÈ΋ ›ÂÛË (™∞¶),3 ÁÈ· ÙËÓ LDL ¯ÔÏËÛÙÂÚfiÏË (LDL-C), 3,4 ÁÈ·ÙËÓ HDL ¯ÔÏËÛÙÂÚfiÏË (HDL-C), 7,1 ÁÈ· Ù·ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG) Î·È 12,6 ÁÈ· Ù· ›‰· ÈÓ-ÛÔ˘Ï›Ó˘ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· (8). ∂È-ϤÔÓ, Ë ¯Ú‹ÛË ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚÈÎÒÓ ÌÂÙÚ‹-ÛÂˆÓ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ·È‰ÈÒÓ Ô˘ Â›Ó·È˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη ÌÔÚ› Ó· ÚԂϤ-„ÂÈ ÙÔ 50% ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜Ô˘ ¤¯Ô˘Ó ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ıËÚÔÁfiÓÔ˘˜·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (8).

∏ ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜, ·ÎfiÌË Î·È ·fi ÙËÓÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, Û¯ÂÙ›˙ÂÙ·È Ì ˘ÂÚÏÈȉ·È-Ì›· ÛÙȘ ÌÂÙ¤ÂÈÙ· ËÏÈ˘, ȉȷ›ÙÂÚ· Û ÂΛӷٷ ·È‰È¿ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙȘ ·ÓÒÙÂÚ˜ Âη-ÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÏÈÔÚˆÙÂ˚ÓÒÓ, Ì ›ٷÛËÙ˘ ˘ÂÚÏÈȉ·ÈÌÈ΋˜ ÂÈÎfiÓ·˜ Ì ÙËÓ ÚfiÔ‰ÔÙ˘ ËÏÈΛ·˜ (9).

∏ Û¯¤ÛË ·˘Ù‹ Ê·›ÓÂÙ·È Ó· ·Ô‰›‰ÂÙ·È ÛÙËÓÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, fiÔ˘ Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ ÂÈÙ›ÓÂÙ·È Ë ˘ÂÚÏÈÈ-‰·ÈÌ›· ‹ Ë ˘¤ÚÙ·ÛË Î·È Ë ·ÓÙÔ¯‹ ÛÙË ‰Ú¿ÛËÙ˘ ÈÓÛÔ˘Ï›Ó˘ (10,40). ∏ ·Ú·¿Óˆ Û¯¤ÛËÊ·›ÓÂÙ·È, ›Û˘, Ó· Á›ÓÂÙ·È ÛÙÂÓfiÙÂÚË Ì ÙËÓ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜. ∞ÎfiÌË Î·È ÛÙËÓ ËÏÈΛ·ÙˆÓ 2-3 ÂÙÒÓ, ÔÈ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓÙ˘ ¡¤·˜ ÀfiÚ΢ ‚Ú¤ıËÎ·Ó Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂÙ· ›‰· Ù˘ ÈÓÛÔ˘Ï›Ó˘ Î·È Ù· ›‰· Ù˘C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ (10).

∏ ÌÂÁ¿ÏË ÛËÌ·Û›· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛË˜ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ·fiÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Ê¿ÓËΠ·fi ÙË ÌÂϤÙËBogalusa Heart Study ÛÙȘ ∏¶∞, fiÔ˘ ÔÈ ÏÈÔ-ÚˆÙ½Ó˜ ÙÔ˘ ÔÚÔ‡ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÙËÓ ›‰È·

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·98

Page 30: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

‰È·‰ÚÔÌ‹ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓÂÓËÏÈΛˆÛË (11). ∂›Û˘, ‰È·ÈÛÙÒıËÎÂ Û˘ÛÛÒÚ¢-ÛË Î·È Û˘Ó‡·ÚÍË ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ÛÙÔ ›‰ÈÔ ¿ÙÔÌÔ, Ì ÚÔ¤¯ÔÓÙ· ·Ú¿ÁÔÓÙ· ÙËÓ ·¯˘-Û·ÚΛ·.

™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ‰ÈÂÚ‡ÓË-ÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·È-‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ÊÔÈÙÔ‡Ó ÛÙ· ÓËÈ·Áˆ-Á›· ¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ÌÂϤÙË ‰ÈÂÍ‹¯ıË Û ÓËÈ·ÁˆÁ›· ¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ¡Ô-ÌÔ‡ ÷ÓÈÒÓ ∫Ú‹Ù˘ (÷ӛˆÓ, ∞ÎÚˆÙËÚ›Ô˘, ∂Ï¢ıÂÚ›Ô˘ µÂÓÈ-˙¤ÏÔ˘, ™Ô‡‰·˜, £ÂÚ›ÛÔ˘ Î·È ¡¤·˜ ∫˘‰ˆÓ›·˜) Ô˘ ηχ-ÙÔ˘Ó ÏËı˘ÛÌfi 81.719 ÌfiÓÈÌˆÓ Î·ÙÔ›ÎˆÓ Û ۇÓÔÏÔ150.387 ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ (∂™À∂, ·ÔÁÚ·Ê‹ 2001).

∂η›‰Â˘ÛË ˘ÁÂÈÔÓÔÌÈÎÒÓ Ù˘ ÌÂϤÙ˘

∆˘ ‰ÂÈÁÌ·ÙÔÏË„›·˜ ÚÔËÁ‹ıËΠÂη›‰Â˘ÛË ÙˆÓ ·È-‰È¿ÙÚˆÓ Î·È ÙˆÓ ÂȉÈ΢fiÌÂÓˆÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ÷ӛˆÓ “O ÕÁÈÔ˜ °ÂÒÚÁÈÔ˜”, ÙÔ˘ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡, ÙˆÓ ÂÈÛÎÂÙÚÈÒÓ ˘Á›·˜ ηÈÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÏÂÈÙÔ˘ÚÁÒÓ ÙÔ˘ K¤ÓÙÚÔ˘ I·ÙÚÔÎÔÈÓˆÓÈ΋˜ŒÚ¢ӷ˜ (∫π∂) Î·È ÙÔ˘ ¢‹ÌÔ˘ ÷ӛˆÓ ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘2004, ·fi ÙËÓ ÔÌ¿‰· Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ÁÈ· ÙËÓ ÂͤٷÛËfiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ÙˆÓ ¤ÍÈ ‰‹ÌˆÓ.

√È ˘ÁÂÈÔÓÔÌÈÎÔ› ·˘ÙÔ› Âηȉ‡ÙËÎ·Ó ÁÈ· ÙË Û˘ÏÏÔÁ‹ÙˆÓ ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÙË Ï‹„Ë ÛˆÌ·ÙÔÌÂ-ÙÚ‹ÛÂˆÓ (‚¿ÚÔ˜, Ì‹ÎÔ˜, ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜, ÂÚ›ÌÂÙÚԘ̤Û˘ Î·È ÏÂοÓ˘), ÙË Ì¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ηıÒ˜Î·È fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÌÔÏË„›· ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÏÈÔ-ÚˆÙ½ÓÒÓ Î·È Ù˘ GLU.

ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ Âη›‰Â˘Û˘, ÔÈ ÂÎ·È‰Â˘fiÌÂ-ÓÔÈ ¯ˆÚ›ÛÙËÎ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜ ·Ú¿ÏÏËÏ˘ ‰Ú¿Û˘ Ì ÁÚ·Ì-Ì·ÙÂȷ΋ ˘ÔÛÙ‹ÚÈÍË Û ÙÔÈÎfi Â›Â‰Ô ·fi ÙÔ ∫π∂. ∏ οıÂÔÌ¿‰· ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ‰‡Ô ·È‰È¿ÙÚÔ˘˜, Ì›· ÓÔÛËχÙÚÈ·Î·È ÂÈÛΤÙÚȘ ˘Á›·˜ ‹ Î·È ÎÔÈÓˆÓÈÎÔ‡˜ ÏÂÈÙÔ˘ÚÁÔ‡˜.

∂ÈÏÔÁ‹ ‰Â›ÁÌ·ÙÔ˜

∏ ÌÂϤÙË Â‰›Ô˘ ‰È‹ÚÎËÛ ٤ÛÛÂÚȘ Ì‹Ó˜ (ºÂ‚ÚÔ˘¿-ÚÈÔ˜-ª¿ÈÔ˜ 2004), fiÔ˘ ¤ÁÈÓ ÏÂÙÔÌÂÚ‹˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÈ-¤‰ˆÓ ˘Á›·˜, ıÚ¤„˘ Î·È ·Ó¿Ù˘Í˘ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎÔ‡‰Â›ÁÌ·ÙÔ˜ 1189 ÚÔÓË›ˆÓ Î·È ÓË›ˆÓ, ËÏÈΛ·˜ 4-7 ÂÙÒÓ (̤-ÛË ËÏÈΛ· 5,3±0,6 ¤ÙË), fiÏˆÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ÙˆÓ ¤ÍÈ ‰‹-ÌˆÓ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ.

∞fi Ù· 67 ÓËÈ·ÁˆÁ›· Ì 1761 ÂÁÁÂÁÚ·Ì̤ӷ ·È‰È¿,‰¤¯ıËÎ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙÔ ÚfiÁÚ·ÌÌ· 1356 ·È‰È¿, ÌÂÚ˘ıÌfi ·ÓÙ·fiÎÚÈÛ˘ 77% Î·È ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÔÚ›Ô˘ 70%Ô˘ ηıÔÚ›˙ÂÈ ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· (29). ∆ÂÏÈο, ·fi·˘Ù¿ Û˘ÌÌÂÙ›¯·Ó 1189 ·È‰È¿ (591 ·ÁfiÚÈ· Î·È 598 ÎÔÚ›ÙÛÈ·)(ÙÂÏÈ΋ Û˘ÌÌÂÙÔ¯‹ 88%). ¶ÔÛÔÛÙfi 59% ÙˆÓ ·È‰ÈÒÓ ÚÔÂÚ-¯fiÙ·Ó ·fi ·ÛÙÈ΋ ÂÚÈÔ¯‹, ÙÔ 35% ·fi ËÌÈ·ÛÙÈ΋ Î·È ÙÔ 6%·fi ·ÁÚÔÙÈ΋.

√È ÂÍÂÙ¿ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ·Ó ÛÙÔÓ ¯ÒÚÔ ÙˆÓ ÓËÈ·-ÁˆÁ›ˆÓ ÙÔ˘˜, ηÙfiÈÓ ¤ÁÎÚÈÛ˘ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ¶·È‰Â›·˜Î·È ÙÔ˘ ¶·È‰·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘, ÂÓÒ ÚÔËÁ‹ıËΠÏÂÙÔ-ÌÂÚ‹˜ ÂÓË̤ڈÛË Î·È ÂÓ˘fiÁÚ·ÊË Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ.

™˘ÏÏÔÁ‹ ‰ÂÈÁÌ¿ÙˆÓ ·›Ì·ÙÔ˜ Î·È ·Ó·Ï˘ÙÈ΋ ̤ıÔ‰Ô˜

√È ·ÈÌÔÏË„›Â˜ ¤ÁÈÓ·Ó Û 603 ·È‰È¿ ÓËȷ΋˜ ËÏÈΛ·˜

¿Óˆ ÙˆÓ 5 ÂÙÒÓ (75%), ÛÂ ‡ÙÈ· ı¤ÛË ÌÂÙ¿ ·fi 12ˆÚË ÔÏÔ-

Ó‡ÎÙÈ· ÓËÛÙ›·. ∞fi οı ·È‰› ÂÏ‹ÊıËÛ·Ó 3 ml ·›Ì·ÙÔ˜ ÌÂ

EDTA ÁÈ· ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È 5 ml ·›Ì·ÙÔ˜ Û ۈ-

ÏËÓ¿ÚÈ· ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ÔÚÔ‡.

∏ GLU ÌÂÙÚ‹ıËΠ̠ÙËÓ ÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô GOD-PAP

(12). ∏ ·ÎÚÈ‚‹˜ ÌÂıÔ‰ÔÏÔÁ›· ̤ÙÚËÛ˘ Ù˘ TCHOL, ÙˆÓ TG,

Ù˘ HDL-C Î·È Ù˘ LDL-C ÂÚÈÁÚ¿ÊÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜

‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (13-15). ∆¤ÏÔ˜, ˘ÔÏÔÁ›ÛÙËÎÂ Ô ·ıË-

ڈ̷ÙÈÎfi˜ ‰Â›ÎÙ˘ TCHOL/HDL-C.

™ˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ

™Â 1135 ·È‰È¿ (95%), ËÏÈΛ·˜ 4-7 ÂÙÒÓ, ÌÂÙÚ‹ıËΠÙÔ

‚¿ÚÔ˜, ÙÔ Ì‹ÎÔ˜, Ë ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ (¶ª) Î·È Ë ÂÚ›ÌÂÙÚÔ˜

ÈÛ¯›Ô˘ (¶π), ÂÓÒ ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ ‰Â›ÎÙ˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘

ÚÔ˜ ÈÛ¯›Ô (¶ªπ) Î·È ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ Ì‹ÎÔ˜ (¶ªª).

∞Ó·Ï˘ÙÈ΋ ÂÚÈÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ÌÂıfi‰ˆÓ ̤ÙÚËÛ˘ ·Ó·-

ʤÚÂÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ (15-17).

√ ¢ª™ ˘ÔÏÔÁ›ÛÙËΠ·fi ÙË Û¯¤ÛË ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜

ÙÔ Ì‹ÎÔ˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2 ). ∆· fiÚÈ· ÙˆÓ Ê˘-

ÛÈÔÏÔÁÈÎÒÓ, ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·ıÔÚ›ÛÙË-

Î·Ó ·fi ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ¢ª™, Ô˘ ·ÓÙÈÛÙÔȯ› Û fiÚÈ·

ÂÓËÏ›ÎˆÓ ≤25 kg/m2 , 25,1 ¤ˆ˜ 30 kg/m2 Î·È ≥30 kg/m2 (18).

ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜

∏ ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËΠ۠1134 ·È‰È¿

(95%), ËÏÈΛ·˜ 4-7 ÂÙÒÓ, Û ηıÈÛÙ‹ ı¤ÛË Î·È ÌÂÙ¿ ·fi

·Ó¿·˘ÛË 5-10 ÏÂÙÒÓ.

∏ ̤ÙÚËÛË ¤ÁÈÓ Ì ˘‰Ú·ÚÁ˘ÚÈÎfi ÛÊ˘ÁÌÔÌ·ÓfiÌÂÙÚÔ, ÌÂ

Ï¿ÙÔ˜ ÂÚȯÂÈÚ›‰·˜ Ó· ηχÙÂÈ ÙÔ 50-75% ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘

‰ÂÍÈÔ‡ ‚Ú·¯›ÔÓ·. O ÚÒÙÔ˜ Î·È ¤ÌÙÔ˜ ÙfiÓÔ˜ Korotkoff

·ÔÙ¤ÏÂÛ·Ó ·ÓÙÈÛÙÔ›¯ˆ˜, ÙË ™∞¶ Î·È ¢∞¶, Ô˘ ÌÂÙÚ‹ıËηÓ

ÙÚÂȘ ÊÔÚ¤˜ Ì ÌÂÛԉȿÛÙËÌ· 1-2 ÏÂÙÒÓ. ∞fi ÙȘ ÌÂÙÚ‹ÛÂȘ

·˘Ù¤˜ ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜ Ù˘ ‰Â‡ÙÂÚ˘ Î·È ÙÚ›Ù˘ ̤ÙÚË-

Û˘ (ÚˆÙfiÎÔÏÏÔ MONICA) (15).

∆· ·˘ÍË̤ӷ ›‰· Ù˘ ™∞¶ Î·È ¢∞¶ ηıÔÚ›ÛÙËηÓ

·fi ÙËÓ Î·Ù¿ ËÏÈΛ·-ʇÏÔ 95Ë ÂηÙÔÛÙÈ·›· ı¤ÛË Ù˘ ηٷ-

ÓÔÌ‹˜ ÙˆÓ ·È‰ÈÒÓ (˘¤ÚÙ·ÛË ˆ˜ ™∞¶ ‹/Î·È ¢∞¶ >95Ë Âη-

ÙÔÛÙÈ·›· ı¤ÛË).

ªÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ

∆Ô ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ·ÔÙÂÏ› Û˘ÁΤÓÙÚˆÛË ÙÚÈÒÓ

‹ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤ÓÙ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ

·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Â›Ó·È Ë ˘ÂÚ-

ÁÏ˘Î·ÈÌ›·, Ë ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, Ë ˘¤ÚÙ·ÛË, Ë ˘ÂÚÙÚÈ-

ÁÏ˘ÎÂÚȉ·ÈÌ›· Î·È Ë ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË (20,30-35).

øÛÙfiÛÔ, ‰ÂÓ ¤¯ÂÈ ‰È·Ù˘ˆı› ¤Ó·˜ ÎÔÈÓfi˜ ÔÚÈÛÌfi˜ ÙÔ˘ ÌÂÙ·-

‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (ÁÈ· ÂÓ‹ÏÈΘ ‹ ·È‰È¿), Ì ·ÔÙ¤ÏÂÛÌ·

‰È¿ÊÔÚÔÈ ÊÔÚ›˜, ÔÚÁ·ÓÈÛÌÔ› ‹ ÂÈÛÙËÌÔÓÈο ȉڇ̷ٷ,

fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ô ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ (31)

‹ ÙÔ National Cholesterol Education Program (NCEP ATP III)

ÙˆÓ ∏¶∞ (32-34), Ó· ‰›ÓÔ˘Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÔÚÈÛÌÔ‡˜ ηÈ

‚·Ú‡ÙËÙ· Û οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηÈ, Û˘ÓÂÒ˜,

‰È·ÊÔÚÂÙÈο ηٿ ÂÚ›ÙˆÛË fiÚÈ·.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ÁÈ· ÙÔÓ

ηıÔÚÈÛÌfi ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÂÏ‹ÊıËÛ·Ó ˘’ fi„ÈÓ

ÔÈ ·Ú·¿Óˆ ¤ÓÙ ·Ú¿ÁÔÓÙ˜. ∆· fiÚÈ¿ ÙÔ˘˜ ·ÓÙÈÛÙÔȯԇÓ:

ÛÙËÓ ˘ÂÚÁÏ˘Î·ÈÌ›· ˆ˜ GLU ≥100 mg/dl (32), ÛÙËÓ ÎÂÓÙÚÈ΋

·¯˘Û·ÚΛ· ˆ˜ ¶ª ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ Î·Ù¿ ʇÏÔ-ËÏÈΛ·

90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË, ÛÙËÓ ̆ ¤ÚÙ·ÛË ̂ ˜ ™∞¶ ‹/Î·È ¢∞¶ ÌÂ-

Á·Ï‡ÙÂÚ˜ ·fi ÙȘ ηٿ ʇÏÔ-ËÏÈΛ· 95˜ ÂηÙÔÛÙÈ·›Â˜ ı¤-

ÛÂȘ, ÛÙËÓ ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· ˆ˜ TG ≥100 mg/dl Î·È ¯·-

ÌËÏ‹ HDL-C ¤ˆ˜ <10Ë Î·Ù¿ ʇÏÔ-ËÏÈΛ· ÂηÙÔÛÙÈ·›· ı¤ÛË.

99∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

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™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË

°È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ-

‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· SPSS ¤Î‰ÔÛË 13.0.

∞fi ÙÔ ‰Â›ÁÌ· ÌÂϤÙ˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÂÚÈÁÚ·ÊÈο ̤-

ÙÚ· ı¤Ûˆ˜ Î·È ‰È·ÛÔÚ¿˜ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ ÙˆÓ ·È‰ÈÒÓ Î·È

·ÊÔÚÔ‡Û·Ó ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ÙȘ ÏÈÔÚˆÙ½Ó˜, ÙË

GLU ÔÚÔ‡ ·›Ì·ÙÔ˜ Î·È ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË. °È· ÙȘ ·Ú·Ì¤-

ÙÚÔ˘˜ ·˘Ù¤˜ ˘ÔÏÔÁ›ÛÙËηÓ, ›Û˘, ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÔÈ

Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ηٿ Spearman.

ªÂ ÙÔÓ ¤ÏÂÁ¯Ô χ2 (Chi-square test, Fisher exact test) ÂϤÁ-

¯ıËÎÂ Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ·È‰ÈÒÓ ˆ˜ ÚÔ˜ Ù· Ê˘ÛÈÔÏÔÁÈο, ·˘-

ÍË̤ӷ Î·È ·ıÔÏÔÁÈο ›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ, Ù˘ GLU

Î·È ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛˆÓ. ªÂ ÙË Ì¤ıÔ‰Ô Student t test ÂϤÁ-

¯ıËÎ·Ó ÌÂٷ͇ Ê‡ÏˆÓ Ù· ›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘

GLU Û ‰‡Ô ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜: 5,1-6,0 ÂÙÒÓ Î·È 6,1-7,0 ÂÙÒÓ.

∏ ̤ıÔ‰Ô˜ ·Ó¿Ï˘Û˘ Û˘Ó‰È·Î‡Ì·ÓÛ˘ (analysis of

covariance) ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ‡·Ú͢

ÁÚ·ÌÌÈ΋˜ Ù¿Û˘ (linear trend) ÛÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·-

ÙÔ˜ Î·È ÛÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ˆ˜ ÚÔ˜ Ù· Ê˘ÛÈÔÏÔÁÈο, ·˘-

ÍË̤ӷ Î·È ·ıÔÏÔÁÈο ›‰· ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È

Ù˘ GLU, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ

ËÏÈΛ·. ∏ ‡·ÚÍË ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÂϤÁ¯ıËΠ̠ÙÔÓ ¤ÏÂÁ¯Ô

Levene (Levene’s test).

°È· Ù· ·È‰È¿ Ì ·ıÔÏÔÁÈο ›‰· GLU Î·È ÏÈÔ-

ÚˆÙÂ˚ÓÒÓ, ÂÎÙÈÌ‹ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘Û˘ ÏÔÁÈÛÙÈ-

΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (Logistic linear regression), ÔÈ ÏfiÁÔÈ Û˘-

ÌÏËڈ̷ÙÈÎÒÓ Èı·ÓÔÙ‹ÙˆÓ ‹ Û¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ (Odds

ratio) Î·È Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘. ∏ ÂÎÙ›ÌËÛË

ÔÚ›ÛÙËΠ۠ۯ¤ÛË Ì ÂΛӷ Ù· ·È‰È¿ Ô˘ ›¯·Ó ·ıÔÏÔ-

ÁÈο ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·,

ηıÒ˜ Î·È ¢ª™ Ô˘ ηıfiÚÈ˙ ›‰· ·˘ÍË̤ÓÔ˘ ‚¿ÚÔ˘˜

(˘¤Ú‚·Ú·) Î·È ·¯˘Û·ÚΛ·˜. ø˜ ÌÂÙ·‚ÏËÙ‹ ÂϤÁ¯Ô˘ ¯ÚË-

ÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÈΛ·.

∆¤ÏÔ˜, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÂϤÁ¯Ô˘ Student

·ÏÔ‡ ‰Â›ÁÌ·ÙÔ˜ (One sample t test) ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Â˘-

ÚËÌ¿ÙˆÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ì ·Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù·

¿ÏÏˆÓ ÌÂÏÂÙÒÓ.

™Â fiϘ ÙȘ ·Ú·¿Óˆ ÌÂıfi‰Ô˘˜ ÔÚ›˙ÂÙ·È Î¿ı ÊÔÚ¿ ÙÔ

·Ô‰ÂÎÙfi Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ (p value) Ô˘ ·ÊÔÚ¿ ÛÙÔ

5%, 1% Î·È 1ò.

∞ÔÙÂϤÛÌ·Ù·

√ ¶›Ó·Î·˜ 1 ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÁÚ·ÊÈΤ˜ ÙÈ̤˜ ÙˆÓÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Ù˘ GLU, ·Ó¿ ËÏÈΛ· Î·È Ê‡ÏÔ,ÙˆÓ ·È‰ÈÒÓ ÓËȷ΋˜ ËÏÈΛ·˜ (¿Óˆ ÙˆÓ 5 ÂÙÒÓ).

∆· ÎÔÚ›ÙÛÈ·, Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·, ·ÚÔ˘ÛÈ¿-˙Ô˘Ó ÛÙ·ıÂÚ¿ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ TCHOL, LDL-C,TCHOL/HDL-C (p>0,05), ÂÓÒ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂ-Ú˜ ÙÈ̤˜ TG (p<0,05) ¤¯Ô˘Ó ÛÙȘ ËÏÈ˘ 5,1-6 ÂÙÒÓ.∂›Û˘, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ÙÈ̤˜ GLU (p<0,05) Û fiϘ ÙȘ ËÏÈ˘.

∞fi ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ ·˘ÍË̤ӷ ›Â-‰· TCHOL ›¯Â ÙÔ 12,7% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 16,3%ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05). ∞˘ÍË̤ӷ ›‰· LDL-C›¯Â, ›Û˘, ÙÔ 11,1% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 16,7%ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05).

™ÙÔÓ ¶›Ó·Î· 3 Ê·›ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÁÈ· οı·ıËÚÔÁfiÓÔ ·Ú¿ÁÔÓÙ· ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘.

ªÂ ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË ‚Ú¤ıËΠÙÔ 7,4%ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 7,9% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05).À¤Ú‚·Ú· ‚Ú¤ıËÎ·Ó ÙÔ 16,6% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ19,5% ÙˆÓ ÎÔÚÈÙÛÈÒÓ (p>0,05), ÂÓÒ Ì ·¯˘Û·ÚΛ·‚Ú¤ıËÎ·Ó ·ÓÙ›ÛÙÔȯ· ÙÔ 10,8% Î·È ÙÔ 9,0% (p>0,05).∂›Û˘, ÔÛÔÛÙfi ÌfiÏȘ 1,3% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È-‰ÈÒÓ ‚Ú¤ıËΠ̠·˘ÍË̤ӷ ›‰· GLU ·›Ì·ÙÔ˜.

™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ªÂ ‰‡Ô ·-Ú¿ÁÔÓÙ˜ ‚Ú¤ıËΠÙÔ 5,1% ÙˆÓ ·ÁÔÚÈÒÓ Î·È ÙÔ 6,9%ÙˆÓ ÎÔÚÈÙÛÈÒÓ, ÂÓÒ Ì ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ (ÌÂ-Ù·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ) ‚Ú¤ıËΠÌfiÓÔ ÙÔ 2,7% ÙˆÓ·ÁÔÚÈÒÓ (p=0,026).

™ÙÔÓ ¶›Ó·Î· 5 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Î·Ù¿ ʇÏÔ·ÏÔ› Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓÎ·È GLU ·›Ì·ÙÔ˜ Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ·›Ì·ÙÔ˜Î·È ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘.

∞˘ÍË̤ӷ ›‰· GLU Û¯ÂÙ›˙ÔÓÙ·È ÛËÌ·ÓÙÈο

¶›Ó·Î·˜ 1. ∂›Â‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È Û·Î¯¿ÚÔ˘ ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· Û ·È‰È¿ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

§ÈÔÚˆÙ½Ó˜ Î·È Û¿Î¯·ÚÔ ∏ÏÈΛ· (¤ÙË) ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ

ª¤ÛË ÙÈÌ‹ ± ∆˘È΋ ·fiÎÏÈÛË (¡)

TCHOL (mg/dl) 5,1-6,0 169,3±28,5 (237) 173,2±30,2 (244) 171,3±28,4 (481)6,1-7,0 168,3±25,5 (64) 175,5±31,5 (48) 171,4±28,3 (112)

LDL-C (mg/dl) 5,1-6,0 102,1±25,8 105,0±26,6 103,6±26,26,1-7,0 100,4±21,4 105,3±27,5 102,5±24,2

HDL-C (mg/dl) 5,1-6,0 57,3±11,4 57,0±11,6 57,1±11,56,1-7,0 57,5±11,0 59,0±10,8 58,2±10,9

TG (mg/dl) 5,1-6,0 50,4±18,8* 56,1±21,9 53,2±20,66,1-7,0 51,7±23,8 55,5±23,1 53,3±23,4

TCHOL/HDL-C 5,1-6,0 3,04±0,65 3,13±0,73 3,09±0,696,1-7,0 3,00±0,56 3,05±0,70 3,02±0,62

GLU (mg/dl) 5,1-6,0 82,1±8,5** 78,7±7,9 80,4±8,46,1-7,0 80,9±7,5* 78,1±7,5 79,7±7,6

Student t test (Ô ¤ÏÂÁ¯Ô˜ ·ÊÔÚ¿ ÛÙ· ‰‡Ô ʇϷ Û οı ËÏÈÎȷ΋ ÔÌ¿‰· ͯˆÚÈÛÙ¿) * p <0,05, ** p <0,001

100 ∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

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(p<0,05) Ì ·˘ÍË̤ÓÔ ‚¿ÚÔ˜, Ì‹ÎÔ˜, ¶ª, ¢ª™,

¶ªπ Î·È ¶ªª. ¶·ÚfiÌÔÈ·, ·˘ÍË̤ӷ ›‰· TG

Û¯ÂÙ›˙ÔÓÙ·È ÛËÌ·ÓÙÈο (p<0,05) Ì ·˘ÍË̤ӷ ›Â-

‰· ¶ª, ¢ª™ Î·È ¶ªª ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Ì ·˘ÍË̤-

Ó· ›‰· ¶ªπ Û fiÏ· Ù· ·È‰È¿. ∆¤ÏÔ˜, ·ÚÓËÙÈ΋

Û¯¤ÛË ‰È·ÈÛÙÒÓÂÙ·È ÌÂٷ͇ HDL-C Î·È ¶ª, ·ÏÏ¿

Î·È ¢ª™ Î·È ¶ªª ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,05).

™ÙÔÓ ¶›Ó·Î· 6 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Û˘Û¯ÂÙ›ÛÂȘ

ÙˆÓ ÂȤ‰ˆÓ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·ÙÔ˜ ηÈ

ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ ˆ˜ ÚÔ˜ Ù· Ê˘ÛÈÔÏÔÁÈο,

·˘ÍË̤ӷ Î·È ·ıÔÏÔÁÈο ›‰· ÙˆÓ ÏÈÔÚˆÙÂ-

˚ÓÒÓ Î·È GLU ·›Ì·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘.

∆· ›‰· ÙÔ˘ GLU Û¯ÂÙ›˙ÔÓÙ·Ó ÛËÌ·ÓÙÈο ÌÂ

ÙË ™∞¶ (94,4, 96,3 Î·È 98,7 mmHg, p<0,05). ∆· ›-

‰· ÙˆÓ TG Û¯ÂÙ›˙ÔÓÙ·Ó ÛËÌ·ÓÙÈο Ì ÙËÓ ¶ª

(55,9, 57,5 Î·È 59,7 cm, p<0,05), ÙÔÓ ¢ª™ (16,6, 17,3

Î·È 17,9 kg/m2 , p<0,05) Î·È ÙËÓ ¶ªª (0,47, 0,49 ηÈ

0,50, p<0,05). ∞ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Â›¯·Ó Ù· ›‰·

Ù˘ HDL-C Ì ÙËÓ ¶ª (57,7, 56,3 Î·È 55,5 cm,

p<0,05), ÙÔÓ ¢ª™ (17,1, 16,7 Î·È 16,5 kg/m2 ,

p<0,05), ÙËÓ ¶ªπ (0,94, 0,89 Î·È 0,88, p<0,05) ηÈ

ÙËÓ ¶ªª (0,49, 0,48 Î·È 0,47, p<0,05).

™ÙÔÓ ¶›Ó·Î· 7 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ‰Â›ÎÙ˜ Û¯ÂÙÈ-

ÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds ratio) ÙˆÓ ·È‰ÈÒÓ Ì ·ıÔÏÔÁÈ-

ο ›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È GLU ·›Ì·ÙÔ˜ Û ۯ¤-

ÛË Ì ٷ ·˘ÍË̤ӷ ›‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ·›Ì·-

ÙÔ˜, ÙËÓ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· Î·È Ù· ›‰· ˘¤Ú-

‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ì ‚¿ÛË ÙÔÓ ¢ª™.

¶›Ó·Î·˜ 2. º˘ÛÈÔÏÔÁÈο Î·È ·˘ÍË̤ӷ ›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ·È‰ÈÒÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ§ÈÔÚˆÙ½Ó˜ ÔÚÔ‡ ·›Ì·ÙÔ˜ (¡=308) (¡=295) (¡=603)

¡ (%)

TCHOL (mg/dl) ≤170 169 (54,9) 142 (48,1) 311 (51,6)171-200 100 (32,5) 105 (35,6) 205 (34,0)

>200 39 (12,7) 48 (16,3) 87 (14,4)LDL-C (mg/dl) ≤110 205 (66,8) 180 (61,2) 385 (64,1)

111-130 68 (22,1) 65 (22,1) 133 (22,1)>130 34 (11,1) 49 (16,7) 83 (13,8)

HDL-C (mg/dl) <40 13 (4,2) 15 (5,1) 28 (4,6)40-45 30 (9,7) 27 (9,2) 57 (9,5)45-60 161 (52,3) 141 (47,8) 302 (50,1)>60 104 (33,8) 112 (38,0) 216 (35,8)

TG (mg/dl) ≤80 284 (92,5) 265 (90,1) 549 (91,3)81-100 13 (4,2) 14 (4,8) 27 (4,5)>100 10 (3,3) 15 (5,1) 25 (4,2)

TCHOL / HDL-C ≤3,00 164 (53,2) 152 (51,6) 316 (52,4)3,01-4,00 124 (40,3) 114 (38,6) 238 (39,5)

>4,00 20 (6,5) 29 (9,8) 49 (8,1)

ŒÏÂÁ¯Ô˜ χ2, p>0,05

101∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

¶›Ó·Î·˜ 3. ™˘¯ÓfiÙËÙ· ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Û ·È‰È¿ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ

À¤ÚÙ·ÛË* ∂ÍÂÙ·Ûı¤ÓÙ· 565 568 1133¡ (%) 42 (7,4) 45 (7,9) 87 (7,7)

ÀÂÚ‚ÔÏÈÎfi µ¿ÚÔ˜** ∂ÍÂÙ·Ûı¤ÓÙ· 566 568 1134¡ (%) 94 (16,6) 111 (19,5) 205 (18,1)

¶·¯˘Û·ÚΛ·*** ∂ÍÂÙ·Ûı¤ÓÙ· 566 568 1134¡ (%) 61 (10,8) 51 (9,0) 112 (9,9)

ÀÂÚÁÏ˘Î·ÈÌ›·# ∂ÍÂÙ·Ûı¤ÓÙ· 308 295 603¡ (%) 4 (1,3) 4 (1,4) 8 (1,3)

* ™˘ÛÙÔÏÈ΋ ‹/Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË >95˘ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘ (ηٿ ʇÏÔ-ËÏÈΛ·) (p>0,05) ** ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û 25-30 kg/m2 (ÎÚÈÙ‹ÚÈ· IOTF). ªË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÔÛÔÛÙÔ‡ (p>0,05) Û ۯ¤ÛË Ì ٷ ·È‰È¿

Ì ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û <25 kg/m2

*** ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û >30 kg/m2 (ÎÚÈÙ‹ÚÈ· IOTF). ªË ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÔÛÔÛÙÔ‡ (p>0,05) Û ۯ¤ÛË Ì ٷ ·È‰È¿Ì ¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› Û <25 kg/m2

# ™¿Î¯·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ ≥100 mg/dl (32) (p>0,05)

¶·È‰È·ÙÚÈ΋ 2007;70:97-106

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Page 33: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

¶·È‰È¿ Ì ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· ‹ ¶ª ¿Óˆ ·fi

ÙËÓ 90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË, ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó 3,43

ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ (95% ¢∂: 1,28-9,17,

p=0,014) ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·. ¶·È‰È¿ Ì ¢ª™

Ô˘ ·ÓÙÈÛÙÔȯ› Û ›‰· ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 30

kg/m2, ¤¯Ô˘Ó 2,87 ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ (95% ¢∂:

1,05-7,85, p=0,041) ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·.

™˘˙‹ÙËÛË

∏ ÌÂϤÙË ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘

ÛÙÔ 77% fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ 67

ÓËÈ·ÁˆÁ›ˆÓ Û ¤ÍÈ ‰‹ÌÔ˘˜ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ

¤‰ÂÈÍ Ôχ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜.

¶ÚÔ¤¯ÔÓÙ˜ ÛÂ Û˘¯ÓfiÙËÙ· ·ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔ-

ÓÙ˜ ‹Ù·Ó ÙÔ ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ Î·È Ë ·¯˘Û·ÚΛ·.

∞ÎÔÏÔ˘ıÔ‡Ó ÔÈ ˘ÂÚÏÈȉ·È̛˜ ÛÙÔ 15% ÂÚ›Ô˘

ÙˆÓ ·È‰ÈÒÓ Î·È Ë ·˘ÍË̤ÓË ·ÚÙËÚȷ΋ ›ÂÛË ÛÙÔ

7,7%, ÂÓÒ Û ÂÙ¿ ·È‰È¿ - ·fi Ù· 603 ÛÙ· ÔÔ›·

¤ÁÈÓ ·ÈÌÔÏË„›· - ‚Ú¤ıËΠ·˘ÍË̤ÓË GLU ·›Ì·ÙÔ˜

(>100 mg/dl) ÌÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›·. ™ÙÔ 6% Â-

Ú›Ô˘ ÙˆÓ ·È‰ÈÒÓ Û˘Ó˘‹Ú¯·Ó ‰‡Ô ·Ú¿ÁÔÓÙ˜

ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ÂÓÒ ÙÔ 1,4% (8 ·ÁfiÚÈ·) ›-

¯Â ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (ÙÚÂȘ ·Ú¿ÁÔÓÙ˜).

∞˘Ù‹ Ë ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·-

Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ·ÎfiÌË

ËÏÈΛ·, ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο ·ÓËÛ˘¯ËÙÈÎfi ‡ÚËÌ·

Î·È ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÂȉËÌÈ΋ ¤Í·ÚÛË Ù˘ ·¯˘-

Û·ÚΛ·˜ Î·È fiÏˆÓ ÙˆÓ ¿ÏÏˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·Áfi-

ÓÙˆÓ Ô˘ ÙË Û˘Óԉ‡ԢÓ.

¶ÂÚÈÛÛfiÙÂÚÔ ·ÓËÛ˘¯ËÙÈÎfi Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ

·Ó·Ì¤ÓÂÙ·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ıËÚÔÁfi-

ÓˆÓ ·Ú·ÁfiÓÙˆÓ Ì ÙËÓ ËÏÈΛ·, Ì ·ÔÎÔڇʈ̷

ÙËÓ ÂÊË‚È΋ ÂÚ›Ô‰Ô. ∞fi ÚfiÛÊ·ÙË ÌÂϤÙË ÙÔ˘

ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Û ·È‰È¿ Ù˘ ∫Ú‹Ù˘, ËÏÈ-

Λ·˜ 3-17ó ÂÙÒÓ, Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜,

‚Ú¤ıËΠfiÙÈ Ô ‰Â›ÎÙ˘ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ ηı›ÛÙ·-

Ù·È ¯ÂÈÚfiÙÂÚÔ˜ Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ ·fi ÙËÓ

ÚÔÛ¯ÔÏÈ΋ ÛÙËÓ ÂÊË‚È΋. ¶·Ú¿ÏÏËÏ·, ·˘Í¿ÓÂÙ·È

ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ

·fi 2,7% ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Û 3,7% ÛÙËÓ

ÂÊË‚È΋ (19). ¶·ÁÎÔÛÌ›ˆ˜, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È-

‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ ÂÎÙÈÌ¿-

Ù·È Ó· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 4% Î·È 5% (20).

∆fiÛÔ Ë ‰È·¯ÚÔÓÈ΋ ·‡ÍËÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ

¶›Ó·Î·˜ 5. ™˘Û¯¤ÙÈÛË Û·Î¯¿ÚÔ˘ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·È ÙȘ ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ ·È‰ÈÒÓ ·fi ÓËÈ·ÁˆÁ›· Ù˘ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

™∞¶ ¢∞¶ µ¿ÚÔ˜ ª‹ÎÔ˜ ¶ª ¢ª™ ¶ªπ ¶ªª(mmHg) (mmHg) (kg) (cm) (cm) (kg/m2)

r (N)*

GLU ∞ÁfiÚÈ· 0,162 (299)** 0,050 (299) 0,257 (298)** 0,160 (298)** 0,272 (298)** 0,249 (298)** 0,124 (298)** 0,219 (298)**

(mg/dl) ∫ÔÚ›ÙÛÈ· 0,136 (279)** 0,075 (279) 0,236 (278)** 0,143 (278)** 0,245 (278)** 0,234 (278)** 0,162 (278)** 0,211 (278)**

TCHOL ∞ÁfiÚÈ· -0,086 (299) -0,124 (299)** -0,098 (298) -0,097 (298) 0,128 (298)** -0,061 (298) -0,143 (298)** -0,080 (298)(mg/dl) ∫ÔÚ›ÙÛÈ· 0,059 (279) 0,057 (279) -0,029 (278) -0,055 (278) -0,055 (278) -0,003 (278) -0,075 (278) -0,016 (278)

TG ∞ÁfiÚÈ· 0,130 (298) 0,062 (298) 0,038 (297) 0,060 (297) 0,054 (297) 0,017 (297) 0,129 (297)** 0,066 (297)(mg/dl) ∫ÔÚ›ÙÛÈ· 0,040 (278) 0,004 (278) 0,082 (277) -0,081 (277) 0,162 (277)** 0,161 (277)** 0,180 (277)** 0,277 (277)**

HDL-C ∞ÁfiÚÈ· -0,096 (299) -0,072 (299) -0,015 (298) -0,065 (298) -0,032 (298) 0,040 (298) -0,121 (298) 0,002 (298)(mg/dl) ∫ÔÚ›ÙÛÈ· 0,026 (279) 0,021 (279) -0,090 (278) -0,012 (278) -0,134 (278)** -0,117 (278) -0,172 (278)** -0,139 (278)**

LDL-C ∞ÁfiÚÈ· -0,054 (298) -0,090 (298) -0,091 (297) -0,074 (297) -0,126 (297)** -0,076 (297) -0,140 (297)** -0,099 (297)(mg/dl) ∫ÔÚ›ÙÛÈ· 0,047 (278) 0,075 (278) 0,011 (277) -0,028 (278) -0,024 (277) 0,032 (277) -0,054 (277) 0,002 (277)

TCHOL/ ∞ÁfiÚÈ· 0,013 (299) -0,022 (299) -0,044 (298) 0,004 (298) -0,055 (298) -0,075 (298) -0,012 (298) -0,058 (298)HDL-C ∫ÔÚ›ÙÛÈ· 0,031 (279) 0,054 (279) 0,059 (278) -0,028 (278) 0,075 (278) 0,097 (278) 0,091 (278) 0,102 (278)

* r=Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ Spearman (N=·ÚÈıÌfi˜ ·È‰ÈÒÓ) ** p-value <0,05

¶›Ó·Î·˜ 4. ™˘ÁΤÓÙÚˆÛË ·Ú·ÁfiÓÙˆÓ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘Û ·È‰È¿ ÓËÈ·ÁˆÁ›ˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ¶·Ú¿ÁÔÓÙ˜ ¡ (%)

0 224 (75,4) 203 (73,3) 427 (74,4)1 50 (16,8) 55 (19,9) 105 (18,3)2 15 (5,1) 19 (6,9) 34 (5,9)3 (ªÂÙ·‚ÔÏÈÎfi 8 (2,7) - 8 (1,4)Û‡Ó‰ÚÔÌÔ)™‡ÓÔÏÔ 297 277 574

ŒÏÂÁ¯Ô˜ χ2 (p=0,029)

√È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·ÊÔÚÔ‡Ó ÛÂ: 1. ˘ÂÚÁÏ˘Î·ÈÌ›·: ۿί·ÚÔ ÔÚÔ‡ ·›Ì·ÙÔ˜ ≥100 mg/dl 2. ˘¤ÚÙ·ÛË: Û˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË >95Ë ∂£ (ηٿʇÏÔ-ËÏÈΛ·) ‹ Î·È ‰È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË >95Ë ∂£(ηٿ ʇÏÔ-ËÏÈΛ·) 3. ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·: ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ >90‹ ∂£ 4. ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·: ÙÚÈÁÏ˘ÎÂÚ›‰È· ≥100 mg/dl 5. ¯·ÌËÏ‹ HDL ¯ÔÏËÛÙÂÚfiÏË: <10Ë ∂£ (ηٿ ʇÏÔ-ËÏÈΛ·)

102 ∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

Paediatriki 2007;70:97-106

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Page 34: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

·Ú·ÁfiÓÙˆÓ Î·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÛÙË

¯ÒÚ· Ì·˜ fiÛÔ Î·È Ë ·‡ÍËÛ‹ ÙÔ˘˜ Ì ÙËÓ ËÏÈΛ·,

·Ô‰›‰ÔÓÙ·È Èı·Ófiٷٷ ÛÙËÓ ˘ÈÔı¤ÙËÛË Û˘ÁÎÂ-

ÎÚÈ̤ÓÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ Ô˘ ¢ÓÔ›

ÙËÓ ·ÚÔ˘Û›· ÙÔ˘˜.

∆Ô ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È-

‰ÈÒÓ ÙÔ 1982 ‹Ù·Ó 20%, fiˆ˜ ¤‰ÂÈÍ ÌÂϤÙË Û ·ÓÙÈ-

ÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ·È‰ÈÒÓ ËÏÈΛ·˜ 9-16 ÂÙÒÓ

ÛÙÔÓ ¡ÔÌfi ∏Ú·ÎÏ›Ԣ (21). ¶·Ú¿ÏÏËÏ·, ·fi ·Ó¿-

ÏÔÁÔ ‰Â›ÁÌ· ·È‰ÈÒÓ ÙÔ 2002 ‚Ú¤ıËΠ‰ÈÏ¿ÛÈÔ Ô-

ÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (40%),

ÂÓÒ ÙÚÈÏ·ÛÈ¿ÛÙËΠÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚΈÓ

·fi 4,2% Û 12,7%. øÛÙfiÛÔ, ÙÔ Ì¤ÛÔ ‚¿ÚÔ˜ ÙˆÓ ·È-

‰ÈÒÓ ËÏÈΛ·˜ 5,5-7 ÂÙÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ

‰È·Ê¤ÚÂÈ ·fi ·È‰È¿ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ ÙÔ˘ ¡ÔÌÔ‡

÷ӛˆÓ (One sample Student test: 23 ¤Ó·ÓÙÈ 24,4 kg,

103∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿

¶›Ó·Î·˜ 6. ∂›Â‰· ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂˆÓ Û ۯ¤ÛË Ì ÙÔ Û¿Î¯·ÚÔ Î·È ÙȘ ÏÈÔÚˆÙ½Ó˜ ÔÚÔ‡ ·›Ì·ÙÔ˜ ·È‰ÈÒÓ ·fi ÓËÈ·ÁˆÁ›·Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

™∞¶ ¢∞¶ µ¿ÚÔ˜ ª‹ÎÔ˜ ¶ª ¢ª™ ¶ªπ ¶ªª(mmHg) (mmHg) (kg) (cm) (cm) (kg/m2)

¡ ª¤ÛË ÙÈÌ‹ ± ∆˘ÈÎfi ÛÊ¿ÏÌ·

GLU ≤50 ∂£* 295 94,4±0,5** 60,9±0,5 22,4±0,2** 117,1±0,3** 54,8±0,4 16,2±0,1 0,89±0,01 0,47±0,01(mg/dl) 50-90 ∂£ 233 96,3±0,6 61,8±0,5 24,2±0,3 118,4±0,3 57,6±0,4 17,2±0,1 0,90±0,01 0,49±0,01

>90 ∂£ 50 98,7±1,3 63,2±1,1 24,1±0,6 119,5±0,7 56,4±0,9 16,8±0,3 0,88±0,01 0,47±0,01TCHOL ≤170 306 95,7±0,5 61,5±0,5 23,6±0,2 118,3±0,3 56,7±0,4 16,8±0,1 0,90±0,01** 0,48±0,01(mg/dl) 171-200 192 95,7±0,6 61,9±0,6 22,9±0,3 117,4±0,4 55,4±0,5 16,5±0,2 0,88±0,01 0,47±0,01

>200 80 94,5±1,0 60,3±0,9 23,0±0,5 117,2±0,6 55,4±0,7 16,7±0,3 0,87±0,01 0,47±0,01TG ≤80 530 95,4±0,4 61,4±0,3 23,2±0,2 117,9±0,2 55,9±0,3** 16,6±0,1** 0,89±0,01 0,47±0,01**

(mg/dl) 81-100 24 98,3±1,8 62,3±1,6 24,0±0,9 117,2±1,0 57,5±1,3 17,3±0,5 0,90±0,02 0,49±0,01>100 22 96,7±1,9 62,3±1,7 25,5±0,9 118,7±1,1 59,7±1,4 17,9±0,5 0,91±0,02 0,50±0,01

HDL-C <45 70 96,2±1,8 62,3±1,6 24,0±0,5 118,4±0,6 57,7±0,8** 17,1±0,3** 0,94±0,01** 0,49±0,01**

(mg/dl) 45-60 301 95,6±0,5 61,1±0,5 23,4±0,2 117,8±0,3 56,3±0,4 16,7±0,1 0,89±0,01 0,48±0,01≥60 207 95,3±0,6 61,6±0,6 22,9±0,3 117,7±0,4 55,3±0,4 16,5±0,2 0,88±0,01 0,47±0,01

LDL-C ≤110 374 95,8±0,5 61,5±0,4** 23,6±0,2** 118,2±0,3** 56,6±0,3** 16,8±0,1 0,90±0,01 0,48±0,01(mg/dl) 111-130 125 95,6±0,8 62,5±0,7 22,8±0,4 117,3±0,5 55,3±0,6 16,5±0,2 0,88±0,01 0,47±0,01

>130 77 94,4±1,0 59,6±0,9 22,5±0,5 116,3±0,6 54,9±0,7 16,4±0,3 0,88±0,01 0,47±0,01

* ∂ηÙÔÛÙÈ·›· £¤ÛË (50‹ ∂£: ·ÁfiÚÈ· 82 / ÎÔÚ›ÙÛÈ· 79, 90‹ ∂£: ·ÁfiÚÈ· 91 / ÎÔÚ›ÙÛÈ· 88) ** p-value ≤0,05 ÁÈ· ÁÚ·ÌÌÈ΋ Ù¿ÛË (∞Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ ANCOVA: ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ¤˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Ê‡ÏÔ Î·È Ë ËÏÈΛ·.

∏ ÂÙÂÚÔÁ¤ÓÂÈ· ÂϤÁ¯ıËΠ̠ÙÔÓ ¤ÏÂÁ¯Ô Levene)

¶›Ó·Î·˜ 7. ¢Â›ÎÙ˜ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Odds ratio) ۷ί¿ÚÔ˘ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÔÚÔ‡ ·›Ì·ÙÔ˜ Û ۯ¤ÛË Ì ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË, ÙÔÓ ¢ª™ Î·È ÙËÓ Â-Ú›ÌÂÙÚÔ Ì¤Û˘ ·È‰ÈÒÓ ·fi ÓËÈ·ÁˆÁ›· Ù˘ ÂÚÈÔ¯‹˜ ÷ӛˆÓ ∫Ú‹Ù˘

™∞¶ ¢∞¶ ¶ª ¢ª™ (mm Hg) (mm Hg) (cm) (kg/m2)

>95Ë ∂£* >95Ë ∂£ >90‹ ∂£ 25-30 >30

Odds ratio [95%¢∂] (¡) p-value

GLU >90‹ ∂£ 0,65 [0,18-2,27] 0,29 [0,11-0,76] 0,54 [0,16-1,79] 1,70 [0,82-3,54] 1,38 [0,58-3,27](mg/dl) (578) ª™ (578) ª™ (576) ª™ (507) ª™ (485) ª™

TCHOL >200 0,49 [0,11-2,12] 2,00 [0,46-8,67] 0,53 [0,21-1,38] 1,17 [0,63-2,19] 0,68 [0,29-1,56](mg/dl) (578) ª™ (578) ª™ (576) ª™ (507) ª™ (485) ª™

TG >100 0,80 [0,10-6,28] 0,89 [0,11-6,91] 3,43 [1,28-9,17] 1,00 [0,28-3,60] 2,87 [1,05-7,85](mg/dl) (576) ª™ (576) ª™ (574) 0,014 (505) ª™ (483) 0,041

HDL-C <45 0,52 (0,07-3,97] 1,56 [0,45-5,42] 0,54 [0,27-1,11] 0,65 [0,34-1,25] 0,71 [0,34-1,49](mg/dl) (578) ª™ (578) ª™ (576) ª™ ª™ (485) ª™

LDL-C >130 0,43 [0,13-1,47] 1,44 [0,60-3,42] 0,70 [0,29-1,69] 0,81 [0,41-1,62] 0,56 [0,23-1,34](mg/dl) (576) ª™ (576) ª™ (574) ª™ (507) ª™ (484) ª™

# §ÔÁÈÛÙÈ΋ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘: ˆ˜ Û˘ÌÌÂÙ·‚ÏËÙ‹ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ËÏÈΛ· * ∂£: ÂηÙÔÛÙÈ·›· ı¤ÛË (Â›Ó·È ·Ó¿ÏÔÁË ÙÔ˘ ʇÏÔ˘ Î·È Ù˘ ËÏÈΛ·˜)

¶·È‰È·ÙÚÈ΋ 2007;70:97-106

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p>0,05, ·ÓÙ›ÛÙÔȯ·) Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÌfiÏȘ ÂÓÂÁÚ¿-

ÊËÛ·Ó ÛÙËÓ ∞ã Ù¿ÍË fiÏˆÓ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ

ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ ÙÔ 1992-1993 (16,22). øÛÙfiÛÔ,

ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ¢ª™ ›¯·Ó Ù· ·È‰È¿ Ù˘ ·-

ÚÔ‡Û·˜ ÌÂϤÙ˘ Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ÂÍÂÙ¿-

ÛÙËÎ·Ó ÙÔ 1992-1993 (16,7 ¤Ó·ÓÙÈ 16,3 kg/m2 ,

p<0,001, ·ÓÙ›ÛÙÔȯ·) Î·È ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ·

›‰· TCHOL (171 ¤Ó·ÓÙÈ 176 mg/dl, p<0,001,

·ÓÙ›ÛÙÔȯ·), HDL-C (57 ¤Ó·ÓÙÈ 60 mg/dl, p<0,001,

·ÓÙ›ÛÙÔȯ·) Î·È LDL-C (103 ¤Ó·ÓÙÈ 106 mg/dl,

p=0,022, ·ÓÙ›ÛÙÔȯ·).

ªÂϤÙË Û 7767 ·È‰È¿, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, ÛÙËÓ

ÂÚÈÔ¯‹ ÙˆÓ ∞ıËÓÒÓ ÙÔ 1995-1996 (23), ¤‰ÂÈÍ fiÙÈ

ÂΛӷ ËÏÈΛ·˜ 6-7 ÂÙÒÓ Â›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ·

›‰· TCHOL, Û ۇÁÎÚÈÛË Ì ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜

Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (166 ¤Ó·ÓÙÈ 171 mg/dl,

p=0,012) Î·È LDL-C (93 ¤Ó·ÓÙÈ 103,8 mg/dl, p<0,001),

ÂÓÒ Â›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ›‰· HDL-C (63

¤Ó·ÓÙÈ 56,8 mg/dl, p<0,001) Î·È TG (74 ¤Ó·ÓÙÈ 53,7

mg/dl, p<0,001). ™Â Û¯¤ÛË Ì ·È‰È¿ ËÏÈΛ·˜ 3-6 ÂÙÒÓ

·fi ÌÂϤÙË ÛÙËÓ ∆¯ÂÚ¿ÓË Û ÔÌ¿‰· 3.148 ·È‰ÈÒÓ

3-19 ÂÙÒÓ ÙÔ 1999-2000 (36), Ù· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜

ÌÂϤÙ˘ ›¯·Ó ¯·ÌËÏfiÙÂÚ· ›‰· TCHOL (172

¤Ó·ÓÙÈ 171,3 mg/dl, p>0,05), ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ·

TG (87 ¤Ó·ÓÙÈ 53 mg/dl, p<0,001) Î·È LDL-C (108

¤Ó·ÓÙÈ 103,3 mg/dl, p<0,001), ÂÓÒ Â›¯·Ó ÛËÌ·ÓÙÈο

˘„ËÏfiÙÂÚ· ›‰· HDL-C (46 ¤Ó·ÓÙÈ 57,4 mg/dl,

p<0,001). ∂›Û˘, Û ۯ¤ÛË Ì ·È‰È¿ ËÏÈΛ·˜ 6-8

ÂÙÒÓ ·fi ÙË ÌÂϤÙË NHANES III ÙˆÓ ∏¶∞ (37), Ù·

·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó ÛËÌ·ÓÙÈο ˘„Ë-

ÏfiÙÂÚ· ›‰· TCHOL (166 ¤Ó·ÓÙÈ 171,3 mg/dl,

p<0,001) Î·È HDL-C (52 ¤Ó·ÓÙÈ 57,4 mg/dl, p<0,001).

∏ ·‡ÍËÛË ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ë ·-

¯˘Û·ÚΛ· ‹ Ë ˘¤ÚÙ·ÛË ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘, ‰È·È-

ÛÙÒÓÂÙ·È ‰È·¯ÚÔÓÈο Î·È Û ¿ÏϘ ¯ÒÚ˜. ™ÙË °ÂÚÌ·-

Ó›·, ÌÂϤÙË 127.735 ·È‰ÈÒÓ ËÏÈΛ·˜ 5-6 ÂÙÒÓ ÛÙË

B·˘·Ú›· ÙÔ 1997 (24), ¤‰ÂÈÍ fiÙÈ 12,3% ÙˆÓ ·È‰ÈÒÓ

‹Ù·Ó ˘¤Ú‚·Ú· Û ۇÁÎÚÈÛË Ì ·Ó¿ÏÔÁË ÌÂϤÙË ÙÔ˘

1982 fiÔ˘ ‹Ù·Ó 8,5%. ∂ÈϤÔÓ, ÙÔ ÔÛÔÛÙfi ·¯˘-

Û·ÚΛ·˜ ·˘Í‹ıËΠ·fi 1,8% ÙÔ 1982 Û 2,8% ÙÔ 1997.

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Û ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ ‰È·È-

ÛÙÒıËÎ·Ó Ôχ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿, fiÔ˘ Ì ˘ÂÚ-

‚ÔÏÈÎfi ‚¿ÚÔ˜ ‹Ù·Ó ÙÔ 17,4% Î·È Ì ·¯˘Û·ÚΛ· ÙÔ

11%. ŸÛÔÓ ·ÊÔÚ¿ ·ÎfiÌË ÛÙ· ›‰· Ù˘ ™∞¶ ηÈ

¢∞¶, Ù· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ›¯·Ó ÛËÌ·-

ÓÙÈο ¯·ÌËÏfiÙÂÚ· ›‰· Û˘ÁÎÚÈÙÈο Ì ·È‰È¿ ËÏÈ-

Λ·˜ 5-6 ÂÙÒÓ Ù˘ πÙ·Ï›·˜ (38) (™∞¶: 94,3 ¤Ó·ÓÙÈ 100,6

mmHg, p<0,001 Î·È ¢∞¶: 60,4 ¤Ó·ÓÙÈ 63,0 mmHg,

p<0,001), ·ÏÏ¿ ˘„ËÏfiÙÂÚ· ·fi ·È‰È¿ ËÏÈΛ·˜ 4-6

ÂÙÒÓ Ù˘ ∫›Ó·˜ (39) (™∞¶: 94,3 ¤Ó·ÓÙÈ 89,5 mmHg,

p<0,001 Î·È ¢∞¶: 60,4 ¤Ó·ÓÙÈ 55,5 mmHg, p<0,001).

™ÙÔÓ ∫·Ó·‰¿, ÛÙȘ ÂÚÈÔ¯¤˜ Newfoundland ηÈ

Labrador ÙÔ 2002, Û 4161 ·È‰È¿ ËÏÈΛ·˜ 3-5 ÂÙÒÓ

(25), ‚Ú¤ıËΠۯ‰fiÓ ›‰ÈÔ˜ ¢ª™ Ì ٷ ·È‰È¿ ›‰È·˜

ËÏÈΛ·˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (One sample Student

test, 16,6 ¤Ó·ÓÙÈ 16,5 kg/m2 , p>0,05, ·ÓÙ›ÛÙÔȯ·), ÂÓÒ

·ÚfiÌÔÈ· ۯ‰fiÓ ‹Ù·Ó Î·È Ù· ÔÛÔÛÙ¿ ÙˆÓ ˘¤Ú‚·-

ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ (17,7% ¤Ó·ÓÙÈ 18,1%

Î·È 8% ¤Ó·ÓÙÈ 8,1%, ·ÓÙ›ÛÙÔȯ·).

∞fi ÙË ÌÂϤÙË Bogalusa ÛÙȘ ∏¶∞ (8) Û 9.147

·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 5-17 ÂÙÒÓ Î·Ù¿ Ù· ¤ÙË

1973 ¤ˆ˜ Î·È 1994, ‚Ú¤ıËΠ۠·È‰È¿ ËÏÈΛ·˜ 5-7

ÂÙÒÓ ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ ÌfiÏȘ 6,5%, Ì ηıÔÚÈ-

ÛÌfi ÙˆÓ ˘¤Ú‚·ÚˆÓ ¿Óˆ ·fi ÙËÓ 95‹ ÂηÙÔÛÙÈ·›·

ı¤ÛË ÙÔ˘ ¢ª™. √ ̤ÛÔ˜ ¢ª™ ÁÈ· ÙȘ ËÏÈ˘ ·˘Ù¤˜

‹Ù·Ó ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· 15,7 kg/m2, ÛËÌ·ÓÙÈο

ÌÈÎÚfiÙÂÚÔ˜ ·fi ÙÔ 16,7 kg/m2 ÙˆÓ ·È‰ÈÒÓ ›‰È·˜

ËÏÈΛ·˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ (One sample Student

test, p<0,001). øÛÙfiÛÔ, ÔÈ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ odds ratio

¤‰ÂÈÍ·Ó Î›Ó‰˘ÓÔ ÛÙ· ˘¤Ú‚·Ú· ·È‰È¿ (¢ª™ >95‹

ÂηÙÔÛÙÈ·›· ı¤ÛË) ÁÈ· ·Ó¿Ù˘ÍË ˘ÂÚ¯ÔÏËÛÙÂÚÔ-

Ï·ÈÌ›·˜ (TCHOL >200 mg/dl) 1,4 ÊÔÚ¤˜ ¤Ó·ÓÙÈ

0,68 ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤ-

Ù˘ (¢ª™ Ô˘ ·ÓÙÈÛÙÔȯ› >30 kg/m2 ÙˆÓ ÂÓËÏ›-

ΈÓ). √ ΛӉ˘ÓÔ˜ ÁÈ· ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›· (TG

>130 mg/dl) ‹Ù·Ó 7,1 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚÔ˜ ÛÙ· ·È-

‰È¿ ·fi ÙË ÌÂϤÙË Bogalusa, ÂÓÒ ÛÙ· ·È‰È¿ Ù˘ ·-

ÚÔ‡Û·˜ ÌÂϤÙ˘ ‚Ú¤ıËΠ(Ì TG >100 mg/dl) 2,87

ÊÔÚ¤˜ ˘„ËÏfiÙÂÚÔ˜. °È· ˘„ËÏ‹ LDL-C (>130 mg/dl)

Ô Î›Ó‰˘ÓÔ˜ ‹Ù·Ó ÂÚ›Ô˘ ›‰ÈÔ˜ Î·È ÛÙȘ ‰‡Ô ÌÂϤÙ˜

Ì 0,7 Î·È 0,56 ÊÔÚ¤˜, ·ÓÙ›ÛÙÔȯ·.

∏ ÂÈÎfiÓ· ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘

Ô˘ ÚÔÛ‰›‰Ô˘Ó Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙˆÓ

¤ÍÈ ‰‹ÌˆÓ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ ı· ‹Ù·Ó ·ÎfiÌ· ÏËÚ¤-

ÛÙÂÚË ÁÈ· fiÏ· Ù· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÂÊfiÛÔÓ

Û˘ÌÌÂÙ›¯·Ó ÛÙȘ ·ÈÌÔÏË„›Â˜ Î·È ·È‰È¿ ÌÈÎÚfiÙÂÚ˘

ËÏÈΛ·˜ (<5 ÂÙÒÓ). ∏ ÂÈÊ˘Ï·ÎÙÈ΋ ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤-

ˆÓ Û¯ÂÙÈο Ì ÙË Ï‹„Ë ·›Ì·ÙÔ˜ Û ·È‰È¿ ÙˆÓ ‚ÚÂ-

ÊÔÓËÈ·ÎÒÓ ÛÙ·ıÌÒÓ, ·¤ÙÚ„ ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜.

øÛÙfiÛÔ, ÛÙ· ·È‰È¿ ÓËȷ΋˜ ËÏÈΛ·˜ (≥5 ÂÙÒÓ), ÙÔ

ÔÛÔÛÙfi ÙÂÏÈ΋˜ Û˘ÌÌÂÙÔ¯‹˜ ÛÙȘ ·ÈÌÔÏË„›Â˜ ‹Ù·Ó

75%, ÂÓÒ Û˘ÌÌÂÙ›¯Â ÛÙȘ ÂÍÂÙ¿ÛÂȘ ÙÔ 68% ÙÔ˘ Û˘-

ÓfiÏÔ˘ ÙˆÓ 1761 ·È‰ÈÒÓ fiÏˆÓ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ηÈ

‚ÚÂÊÔÓËÈ·ÎÒÓ ÛÙ·ıÌÒÓ ÙˆÓ ¤ÍÈ ‰‹ÌˆÓ. ™˘ÓÔÏÈο,

ÂÍÂÙ¿ÛÙËΠÙÔ 43% ÙˆÓ 2740 ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜

ËÏÈΛ·˜ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ. ™ËÌÂÈÒÓÂÙ·È ‰Â, fiÙÈ ÙÔ

6% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ÚÔ¤Ú¯ÂÙ·È ·fi ·ÁÚÔÙÈ-

Τ˜ ÂÚÈÔ¯¤˜, ÂÓÒ Î·Ù¿ ÙÔ ¤ÙÔ˜ 2004-2005 Û˘Ó¯›˙Â-

Ù·È Ë ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙȘ

˘fiÏÔȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ¡ÔÌÔ‡.

°ÂÓÈο, ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘

‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ÔÈ ·˘Í‹ÛÂȘ ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ

‰È·ÊfiÚˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙËÓ

ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ‰ÂÓ Â›Ó·È ·ÓÂÍ¿ÚÙËÙ˜ ÌÂٷ͇

ÙÔ˘˜, ·ÏÏ¿ Û˘Ó˘¿Ú¯Ô˘Ó ȉȷ›ÙÂÚ· Ì ÙÔ ·˘ÍË̤ÓÔ

‹ Ôχ ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜.

104 ∞. ∫·Ê¿ÙÔ˜ Î·È Û˘Ó.

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∏ ·Ú·‰ÔÛȷ΋ ÂÏÏËÓÈ΋ ‰È·ÙÚÔÊ‹ Î·È Ë Ì¤ÙÚÈ·ÚÔ˜ ¤ÓÙÔÓË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Â›Ó·È Ë ÌfiÓË ‰È¤ÍÔ-‰Ô˜ ÁÈ· ÙË Ì›ˆÛË ‹ ÂÍ·Ê¿ÓÈÛË ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·-Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ. ∏ Û˘Ì-‚ÔÏ‹ Ì·ÎÚÔ¯ÚfiÓÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÎ·È‰Â˘ÙÈ΋˜·Ú¤Ì‚·Û˘ Û ·È‰È¿ ·Ó¿ÏÔÁ˘ ‹ Î·È ÌÂÁ·Ï‡ÙÂÚ˘ËÏÈΛ·˜ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰È·ÙÚÔÊ‹ ηÈÙËÓ ¿ÛÎËÛË (16,22,26,27), ıˆÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ηÈÙ· ÔʤÏË ÙÔ˘˜ Ê·›ÓÔÓÙ·È ·fi ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓÚÔÁÚ·ÌÌ¿ÙˆÓ ·˘ÙÒÓ. ∂ÈϤÔÓ ÛÙfi¯Ô Û ·ÓÂÙ˘Á-̤Ó˜ ¯ÒÚ˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÛÙȘ ∏¶∞, ·Ô-ÙÂÏÔ‡Ó ÔÈ ‰Ú¿ÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÚˆÙÔÁÂÓ‹ÚfiÏË„Ë ÙˆÓ ‰È·ÊfiÚˆÓ ·ıËÚÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ(΢ڛˆ˜ Ù˘ ·¯˘Û·ÚΛ·˜), ̤ۈ Ù˘ Âη›‰Â˘ÛË˜ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÁÈ· ÙËÓ ·fiÎÙËÛË ˘ÁÈÂÈÓÒÓ Û˘ÓË-ıÂÈÒÓ ‰È·ÙÚÔÊ‹˜ Î·È ÙÚfiÔ˘ ˙ˆ‹˜ (28). ŒÙÛÈ, ‰È·È-ÛÙÒÓÂÙ·È fiÙÈ ÛÙȘ ∏¶∞, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È-Ï·ÛÈ·ÛÌfi Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ (15% وӷȉÈÒÓ) ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜, ηı›ÛٷٷȷӷÁη›· Ë ·Ó‡ÚÂÛË ÌÂıfi‰ˆÓ Ô˘ÛÈ·ÛÙÈ΋˜ ·ÓÙÈÌÂ-ÙÒÈÛ˘ Ù¤ÙÔÈˆÓ ÂÍ¿ÚÛÂˆÓ (5,28).

øÛÙfiÛÔ, Ë ·Ó¿ÁÎË ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· Ì›· Û˘ÓÔÏÈ-΋, Û˘ÓÙÔÓÈṲ̂ÓË ÚÔÛ¿ıÂÈ· ·Ó·ÊÔÚÈο Ì ÙËÓ·ÓÙÈÌÂÙÒÈÛË ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· ÙˆÓ ÔÏÔ¤Ó·Î·È ·˘Í·ÓfiÌÂÓˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ·ÓÔÛ‹Ì·Ù·, Â›Ó·È ÂÈÙ·ÎÙÈ΋, ηıÒ˜ Ù· ÚfiÙ˘· ˙ˆ-‹˜ Î·È ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∂ÏÏ‹ÓˆÓ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È·fi ÙÔ ·ÚÂÏıfiÓ Î·È ·ÓÙÈÁÚ¿ÊÔ˘Ó ‰È·ÚÎÒ˜ ÂΛӷ¿ÏÏˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ ÛÙÔ Ï·›ÛÈÔ Ù˘ ·-ÁÎÔÛÌÈÔÔ›ËÛ˘.

°È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ¿ÌÂÛË ÚÔÙÂÚ·ÈfiÙËÙ· Â›Ó·È ËÂıÓÈ΋ ÔÏÈÙÈ΋ ÁÈ· ÙË ‰È·ÙÚÔÊ‹, ÙË ÛˆÌ·ÙÈ΋¿ÛÎËÛË Î·È ÙËÓ ·ÔÊ˘Á‹ Ô˘ÛÈÒÓ (ȉȷ›ÙÂÚ· ÙÔ˘ η-Ó›ÛÌ·ÙÔ˜ Î·È ÙˆÓ ÔÈÓÔÓÂ˘Ì·Ùˆ‰ÒÓ ÔÙÒÓ), ÌÂÚfiÙ˘Ô ÙËÓ ·Ú·‰ÔÛȷ΋ ÂÏÏËÓÈ΋ ‰È·ÙÚÔÊ‹ ηÈÁÂÓÈÎfiÙÂÚ· ÙÔÓ ÂÏÏËÓÈÎfi ÙÚfiÔ ˙ˆ‹˜. ∞ÔÙÂÏ›,›Ûˆ˜, ÙÔÓ ÌÔÓ·‰ÈÎfi ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÂÈ-‰ËÌ›·˜ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙˆÓ ·ıËÚÔÁfiÓˆÓ ·-Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ ÙË Û˘ÓÔ‰Â‡Ô˘Ó Î·È Ô‰Ë-ÁÔ‡Ó Û˘Ó¯Ҙ Û ·˘Í·ÓfiÌÂÓÔ˘˜ ‰Â›ÎÙ˜ ıÓËÛÈÌfiÙË-Ù·˜ ·fi ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·.

∂˘¯·ÚÈÛٛ˜

∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË Ù˘ ÌÂϤÙ˘ÙËÓ ÂÙ·ÈÚ›· Friesland. ∂˘¯·ÚÈÛÙÔ‡ÌÂ, ›Û˘, ÁÈ· ÙË Û˘Ì‚Ô-Ï‹ ÙÔ˘˜ ÛÙËÓ ÔÚÁ¿ÓˆÛË Î·È ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÌÂϤÙ˘: ÙË¡Ô̷گȷ΋ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ Î·È È‰È·›ÙÂÚ· ÙÔÓ ¡ÔÌ¿Ú-¯Ë Î. °ÂÒÚÁÈÔ ∫·ÙÛ·Ó‚¿ÎË, ÙÔÓ ∞ÓÙÈÓÔÌ¿Ú¯Ë Î. ¶·‡ÏÔ ƒÔ-˙¿ÎË Î·È ÙÔÓ Î. ∆¿ÛÔ ¢È·Ì·ÓÙ¿ÎË, ÙË ¢ËÌÔÙÈ΋ ∞˘ÙÔ‰ÈÔ›ÎË-ÛË Ã·Ó›ˆÓ Î·È È‰È·›ÙÂÚ· ÙÔÓ ¢‹Ì·Ú¯Ô Î. ∫˘ÚÈ¿ÎÔ µÈڂȉ¿ÎËÎ·È ÙÔ˘˜ ∞ÓÙȉËÌ¿Ú¯Ô˘˜ Î.Î. °ÚËÁfiÚË ∞Ú¯ÔÓÙ¿ÎË, °ÂÒÚÁÈÔµÔ‡Ú‚·¯Ë Î·È ∞ÚÈÛÙ›‰Ë ¶··‰ÔÁÈ¿ÓÓË, ηıÒ˜ Î·È ÙÔÓ Ô‰Ë-Áfi Î. ª·ÓÒÏË ÃȈٿÎË, ÙÔ π·ÙÚÔÎÔÈÓˆÓÈÎfi ∫¤ÓÙÚÔ Ã·Ó›ˆÓ,ÙË ¢È‡ı˘ÓÛË ¶ÚˆÙÔ‚¿ıÌÈ·˜ ∂η›‰Â˘Û˘ ÙÔ˘ ¡ÔÌÔ‡ ÷-Ó›ˆÓ, ÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ Î·È Ù· ÂÚÁ·ÛÙ‹ÚÈ· µÈÔ¯ËÌÈÎfi,

∞ÈÌ·ÙÔÏÔÁÈÎfi & ∞ÈÌÔ‰ÔÛ›·˜ ÙÔ˘ ¡Ô̷گȷÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ

÷ӛˆÓ “O ÕÁÈÔ˜ °ÂÒÚÁÈÔ˜” Î·È È‰È·›ÙÂÚ· ÙËÓ ·Ú·Û΢¿-

ÛÙÚÈ· Î. ∞Ó·ÛÙ·Û›· ª·ÚÈÓ¿ÎË. ∂›Û˘, ÙËÓ Î. ª˘ÚˆÓ›· §·-

ÓÙ˙Ô˘Ú¿ÎË ÁÈ· ÙËÓ Î·Ù·¯ÒÚÈÛË ÙˆÓ ÛÙÔȯ›ˆÓ ÛÙÔ˘˜ ∏/À.

*™˘ÓÂÚÁ·˙fiÌÂÓÔÈ ÂÚ¢ÓËÙ¤˜ ÛÙË ÌÂϤÙË

¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘: ™ÔÊ›· ºÏÔ˘Ú‹, ∂ÈÚ‹ÓË ª¿Úη-

Ù˙Ë, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ª·Ú›· √ÈÎÔÓfiÌÔ˘, ºÚfiÛˆ

ªÂÚ‚·Ó¿ÎË, ªÈ¯¿Ï˘ ∫˘Úȷο΢. ¶Â™˘¶ ∫Ú‹Ù˘: ∂ÈÚ‹ÓË

™Â‚·ÛÙ¿ÎË. ¡Ô̷گȷÎfi ¡ÔÛÔÎÔÌÂ›Ô Ã·Ó›ˆÓ: ∞ÈÌÈÏ›· ∫·Ù¿-

ÎË, ÕÚÙÂÌȘ µ·ÛÈÏÂÈ¿‰Ë, °·‚ÚȤÏÏ· ∫Ô˘ÙÛ¿ÎË-Brie, ª·Ú›·

™Î·Ïȉ¿ÎË, ™Ù¤ÏÏ· ª·ÚÌ‹, ∂ϤÓË ¢·Ó¿, πˆ¿ÓÓ· ¶·Ï-

ÎÔ˘ÛÔ˘ÚÈ¿, ¶·Ó·ÁÈÒÙ˘ °È¿ÁÎÔ˘, ºÏÒÚ· ª·Ú·ÌÔ‡ÙË,

∞Ϥ͢ ∞ÏÂÍfiÔ˘ÏÔ˜, µ·ÛÈÏÈ΋ ª·ÎÚ‹. ∞ã µ¿ıÌÈ· ∂η›‰Â˘-

ÛË ÓÔÌÔ‡ ÷ӛˆÓ: ¢ÒÚ· ¡È·Ô˘Ó¿ÎË. ¢‹ÌÔ˜ ÷ӛˆÓ: ∞ÈηÙÂÚ›-

ÓË ∫Ô˘ÓÂÏ¿ÎË. ¢È‡ı˘ÓÛË ÀÁ›·˜ ¡ÔÌ·Ú¯›·˜ ÷ӛˆÓ: ∞ı·Ó·-

Û›· ∞Ó·ÛÙ·ÛÔÔ‡ÏÔ˘, ∂˘Ù˘¯›· ∫·ÏÔÁÂÚ¿ÎË. π·ÙÚÔÎÔÈÓˆÓÈÎfi

∫¤ÓÙÚÔ Ã·Ó›ˆÓ: ¢ËÌ‹ÙÚ˘ ∫·ÙÛ·‚ÚÈ¿˜, ÕÓÓ· ∫˘ÚȷοÎË,

¢¤ÛÔÈÓ· π·ÙÚ›‰Ô˘.

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107∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈ΋ 2007;70:107-114

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜, Û˘¯ÓfiÙËÙ· ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈ-

ÛÌÔ‡ Î·È ·˘ÙÔ·ÓÔÛ›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜

∂. ∫·ÏÔ˘Ì¤ÓÔ˘1, §. ¡ÙÔ‡ÓÙ·˜2, ª. ∞Ï‚È˙¿ÎË2, °. ª·ÛÙÔÚ¿ÎÔ˜2, ∞. ª¿ÓÙ˙Ô˘2, ∞. ∞ÓÙˆÓ›Ô˘3,

Ã. §·‰fiÔ˘ÏÔ˜3, Ã. ªÂÁÁÚ¤ÏË4, ¢. ÃÈÒÙ˘1, π. ¶··ÛˆÙËÚ›Ô˘5, ∞. ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó: ·) Ë ÔÚÈÔı¤ÙËÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Ù˘ Û˘-ÁΤÓÙÚˆÛ˘ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Î·È ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ·›Ì· Î·È Ù˘ Û˘-¯ÓfiÙËÙ·˜ ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· ‚) Ô Î·ıÔÚÈÛÌfi˜ Ù˘ ÂÍÂ-ÏÈÎÙÈ΋˜ ÔÚ›·˜ ÙˆÓ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚˆÓ Ì ÙËÓ ËÏÈΛ· Î·È Ù· ÛÙ¿‰È· ÂÓ‹‚ˆÛ˘ Á) Ë Û˘Û¯¤ÙÈÛË ÙÔ˘¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Ì ÙȘ ÙÈ̤˜ Ù˘ ı˘ÚÂÔÂȉÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (TSH) Î·È ‰) Ë Û˘Û¯¤ÙÈÛË Ù˘ı˘ÚÂÔÂȉÈ΋˜ ·˘ÙÔ·ÓÔÛ›·˜ ·È‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™Â 440 ˘ÁÈ‹ ·È‰È¿, ËÏÈΛ·˜ 5-18 ÂÙÒÓ ÌÂÙÚ‹ıËÎÂ Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ·Ô‡Ú·, ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· (˘ÂÚ˯ÔÁÚ·ÊÈο), ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ Î·È Ù· ·ÓÙÈı˘-ÚÂÔÂȉÈο ·ÓÙÈÛÒÌ·Ù·. ªÂ ‚¿ÛË ÙȘ ÙÈ̤˜ Ù˘ TSH Ù˘ 97˘ ∂ηÙÔÛÙÈ·›·˜ £¤Û˘ (∂.£.) ˘ÔÏÔÁ›ÛıËΠËÛ˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡.

∞ÔÙÂϤÛÌ·Ù·: ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·˘Í‹ıËΠ̠ÙËÓ ËÏÈΛ· Î·È Ù· ÛÙ¿‰È· ÂÓ‹‚ˆÛ˘ ÂÚÈÛ-ÛfiÙÂÚÔ ÛÙ· ·ÁfiÚÈ· ·’ fi,ÙÈ ÛÙ· ÎÔÚ›ÙÛÈ·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ‹Ù·Ó 4,8%ÛÙ· ·ÁfiÚÈ· Î·È 4,4% ÛÙ· ÎÔÚ›ÙÛÈ·. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ Ì ÙȘ ÙÈ̤˜ TSH. ∏ Û˘¯ÓfiÙË-Ù· ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ˘ÂÚÔÍÂȉ¿Û˘ (·ÓÙÈ-∆ƒ√·) ‹Ù·Ó 3,2%ÛÙ· ·ÁfiÚÈ· Î·È 5,8% ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ·˘Í‹ıËΠÛÙËÓ ÂÊ˂›·, ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ÎÔÚ›ÙÛÈ· ·’ fi,ÙÈ ÛÙ··ÁfiÚÈ·. £ÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 82% ÙˆÓ ÌËÙ¤ÚˆÓ, ·È‰ÈÒÓ Ì ıÂÙÈο ·ÓÙÈÛÒÌ·Ù·, ÂÓÒ ıÂ-ÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 18% ÙˆÓ ÌËÙ¤ÚˆÓ ·È‰ÈÒÓ Ì ·ÚÓËÙÈο ·ÓÙÈÛÒÌ·Ù· (p<0,0005).

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ı· ¯ÚËÛÈ̇ÛÔ˘Ó ÛÙÔÓ ·ÎÚÈ‚¤ÛÙÂÚÔ ÔÚÈÛÌfi Ù˘ ·ıÔÏÔÁ›·˜ ÙÔ˘ı˘ÚÂÔÂȉԇ˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.

§¤ÍÂȘ ÎÏÂȉȿ: ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (˘ÂÚ˯ÔÁÚ·ÊÈο), ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉ›Ùȉ·, ˘ÔÎÏÈÓÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈ-

ÛÌfi˜, ÂÊ˂›·.

Thyroid volume, prevalence of subclinical hypothyroidism and

autoimmunity in children and adolescents

I. Kaloumenou1, L. Duntas2, M. Alevizaki2, G. Mastorakos2, E. Mantzou2, A. Antoniou3,

C. Ladopoulos3, C. Mengreli4, D. Chiotis1, I. Papassotiriou5, C. Dacou-Voutetakis1

Abstract

Background: The aim of the study was to determine, in a normal population of children: a) the values ofthyroid volume, the serum concentrations of thyroid hormones, thyroid antibodies (anti-TPOab and anti-TG) and the prevalence of subclinical hypothyroidism, b) the effect of age and puberty on these para-meters, c) the correlation of Body Mass Index (BMI) with TSH, and d) the relationship of thyroid au-toimmunity in children and their mothers.

Methods: The following parameters were assessed in 440 healthy children, aged 5-18 years: height,weight, stage of puberty according to Tanner’s criteria, BMI, BMIsds, Body Surface Area (BSA), urineiodine concentration, thyroid volume by ultrasonography, thyroid hormones, anti-TPOab and anti-TG,using validated techniques. Based on the TSH value of the 97th percentile, subclinical hypothyroidismwas determined.

Results: Thyroid volume increased with age and puberty stage, to a greater degree in boys than in girls.The prevalence of subclinical hypothyroidism was 4.8% in boys and 4.4% in girls. No correlation wasfound between BMIsds and TSH. The prevalence of positive anti-TPOab was 3.2% and 5.8% for boysand girls, respectively and it increased at puberty in girls more than in boys. When children had posi-tive anti-TPOab, 82% of their mothers had positive anti-TPOab, whereas only 18% of the mothers of an-ti-TPOab negative children had positive anti-TPOab.

1 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·,∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

2 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ªÔÓ¿‰·¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ∂˘ÁÂÓ›‰ÂÈÔ £ÂÚ·Â˘Ù‹ÚÈÔ

3 A’ ∂ÚÁ·ÛÙ‹ÚÈÔ∞ÎÙÈÓÔÏÔÁ›·˜¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ,∞ÚÂÙ·›ÂÈÔ ¡ÔÛoÎÔÌ›Ô

4 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌ›Զ·›‰ˆÓ “∞Á. ™ÔÊ›·”,∞ı‹Ó·

5 ∫ÏÈÓÈ΋ µÈÔ¯ËÌ›· ¶·›‰ˆÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

∂ÈÚ‹ÓË ∫·ÏÔ˘Ì¤ÓÔ˘[email protected]∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”,£Ë‚ÒÓ Î·È¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘,°Ô˘‰›, ∞ı‹Ó·

1 Endocrine Unit, FirstDepartment ofPaediatrics, AthensUniversity School ofMedicine

2 Endocrine Unit, AthensUniversity School ofMedicine, EvgenidionHospital

3 First Department ofRadiology AthensUniversity School ofMedicine

4 Institute of Child Health,“Aghia Sofia” Children’sHospital

5 Clinical BiochemistryLaboratory, “Aghia Sofia”Children’s Hospital,Athens

Correspondence:

Irene [email protected] Unit, A’ Dept of Paediatrics, Athens University School of Medicine, Thivon & Papadiaman-dopoulou, GoudiAthens, Greece

∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚‡ıËΠ̠ÙÔ ÃˆÚ¤ÌÂÈÔ Œ·ıÏÔ ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ƒfi‰Ô˜, 9-11 πÔ˘Ó›Ô˘ 2006

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·107

Page 39: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

108 ∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

Paediatriki 2007;70:107-114

Conclusions: The definition of normal values of various parameters related to thyroid function in ahealthy paediatric population sample will facilitate early recognition of deviations by the paediatrician.

Key words: Thyroid volume (ultrasonography), autoimmune thyroiditis, children, subclinical hypothyroidism,

puberty.

™˘ÓÙÔÌÔÁڷʛ˜

¢ª™ ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜

¢ª™sds ‰Â›ÎÙ˘ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘ ¢ª™

∂™ ∂ÈÊ¿ÓÂÈ· ™ÒÌ·ÙÔ˜

ÀÀ ˘ÔÎÏÈÓÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜

∫Ú ÎÚ·ÙÈÓ›ÓË

∂ÈÛ·ÁˆÁ‹

∏ Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜

·ÔÙÂÏ› ‚·ÛÈÎfi ·Ú¿ÁÔÓÙ·, ÁÈ· ÙË ÛˆÌ·ÙÈ΋

Î·È ‰È·ÓÔËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·ÙfiÌÔ˘. ª›· ·-

Ú¿ÌÂÙÚÔ˜ Ô˘ ÂËÚ¿˙ÂÈ Î·ıÔÚÈÛÙÈο ÙÔ Ì¤ÁÂ-

ıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· Î·È Ú˘ıÌ›˙ÂÈ ÙË ÏÂÈ-

ÙÔ˘ÚÁ›· ÙÔ˘, Â›Ó·È Ù· ›‰· Ȉ‰›Ô˘ ÛÙÔÓ ÔÚ-

Á·ÓÈÛÌfi. ∏ ‰ÈfiÁΈÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (‚ÚÔÁ-

¯Ô΋ÏË) Â›Ó·È Ë Ï¤ÔÓ Û˘¯Ó‹ ÂÓ‰ÔÎÚÈÓÈ΋ ¿-

ıËÛË Î·ıÒ˜ ··ÓÙ¿Ù·È Û ÂÚÈÛÛfiÙÂÚÔ ·fi 2,4

‰ÈÛÂηÙÔÌ̇ÚÈ· ¿ÙÔÌ· Û fiÏÔ ÙÔÓ ÎfiÛÌÔ (1).

™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ¤¯Ô˘Ó ηıÔÚÈÛı› Ù· fiÚÈ· ÙÔ˘

ı˘ÚÂÔÂȉԇ˜ ÛÙ· ·È‰È¿, Û‡Ìʈӷ Ì ÙËÓ ËÏÈ-

Λ· Î·È Ù· ÛÙ¿‰È· ÂÓ‹‚ˆÛ˘ Û ÂÚÈÔ¯¤˜ ÌÂ

·Ú΋ ÚfiÛÏË„Ë Èˆ‰›Ô˘. ∂›Û˘, ‰ÂÓ ˘¿Ú-

¯Ô˘Ó ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ·Ó·ÊÔÚÈο Ì ÙË

Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈۈ̿وÓ

Î·È ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÛÙ·

·È‰È¿ Û ÂÚÈÔ¯¤˜ Ì ¿ÚÎÂÈ· Ȉ‰›Ô˘.

ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ÔÈ Û˘ÁÁÚ·Ê›˜ Û¯Â-

‰›·Û·Ó ÌÈ· ÌÂϤÙË Ì ÛÎÔfi ÙËÓ ÔÚÈÔı¤ÙËÛË

ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤-

Ó·, ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Î·È ÙˆÓ ·ÓÙÈı˘-

ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi, ηıÒ˜ ηÈ

ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈ-

ÛÌÔ‡ (ÀÀ) Û ηٿ ÙÂÎÌ‹ÚÈÔ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔ-

Ì· ËÏÈΛ·˜ 5-18 ÂÙÒÓ. ∂ÎÙÈÌ‹ıËΠ›Û˘, Ë

›‰Ú·ÛË Ù˘ ËÏÈΛ·˜ Î·È ÂÓ‹‚ˆÛ˘ ÛÙȘ ·Ú·-

̤ÙÚÔ˘˜ ·˘Ù¤˜, ͯˆÚÈÛÙ¿ ÁÈ· Ù· ‰‡Ô ʇϷ ηÈ

Û˘Û¯ÂÙ›ÛıËÎÂ Ë ı˘ÚÂÔÂȉÈ΋ ·˘ÙÔ·ÓÔÛ›· ·È-

‰ÈÒÓ Î·È ÁÔÓ¤ˆÓ.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ÕÙÔÌ· Ô˘ ÌÂÏÂÙ‹ıËηÓ

ªÂÏÂÙ‹ıËÎ·Ó 440, ηٿ ÙÂÎÌ‹ÚÈÔ ˘ÁÈ›˜ Ì·ıËÙ¤˜

(200 ·ÁfiÚÈ· Î·È 240 ÎÔÚ›ÙÛÈ·), ËÏÈΛ·˜ 5-18 ÂÙÒÓ (̤ÛË

ËÏÈΛ· ±™∞: 10±2,9 ¤ÙË) Ô˘ ‰È¤ÌÂÓ·Ó ÛÙËÓ Â˘Ú‡ÙÂÚË

ÂÚÈÔ¯‹ ÙÔ˘ ¡ÔÌÔ‡ ∞ÙÙÈ΋˜ (ÂÚÈÔ¯‹ Ì ¿ÚÎÂÈ· Ȉ-

‰›Ô˘) Î·È 150 ÌËÙ¤Ú˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ. ∞fi fiÏÔ˘˜

ÙÔ˘˜ ÁÔÓ›˜ ˘‹ÚÍ ÁÚ·Ù‹ Û˘ÁηٿıÂÛË ÌÂÙ¿ ·fi

ÂÓË̤ڈÛË. ∏ ÌÂϤÙË Ì·˜ ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ-

‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›-

‰ˆÓ ∞ıËÓÒÓ “∞Á›· ™ÔÊ›·”.

¶ÚˆÙfiÎÔÏÏÔ

ŸÏ· Ù· ·È‰È¿ ÂÍÂÙ¿ÛıËÎ·Ó ÎÏÈÓÈο Î·È Î·Ù·ÁÚ¿-

ÊËÎ·Ó Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ÛÙ¿-

‰ÈÔ ÂÓ‹‚ˆÛ˘ ηٿ Tanner. ÀÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙ˘

Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) Ì ÙÔÓ Ù‡Ô: ¢ª™ = ‚¿ÚÔ˜ /

⁄„Ô˜2 (kg/m2) Î·È Ô ‰Â›ÎÙ˘ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›ÛÂˆÓ ÙÔ˘

¢ª™ (¢ª™sds), ‰ËÏ·‰‹, Ô ·ÚÈıÌfi˜ ÛÙ·ıÂÚÒÓ ·ÔÎÏ›-

ÛÂˆÓ Ô˘ ‰È·Ê¤ÚÂÈ Ô ¢ª™ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙË Ì¤ÛË ÙÈ-

Ì‹ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘. ∏ ÂÈÊ¿ÓÂÈ· ÛÒÌ·-

ÙÔ˜ (∂™) ˘ÔÏÔÁ›ÛıËΠ̠ÙÔÓ Ù‡Ô: ∂™ = ‚¿ÚÔ˜0,425

‡„Ô˜0,725 ñ 71,84 ñ 10-4, ÙÔ ‚¿ÚÔ˜ ÂÎÊÚ¿˙ÂÙ·È Û ÎÈÏ¿ ηÈ

ÙÔ ‡„Ô˜ Û ÂηÙÔÛÙ¿ (2). ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜

ÂÎÙÈÌ‹ıËΠ˘ÂÚ˯ÔÁÚ·ÊÈο Û fiÏ· Ù· ·È‰È¿, ·fi

ÙÔÓ ›‰ÈÔ ·ÎÙÈÓÔÏfiÁÔ. ™Â ÚˆÈÓfi Ù˘¯·›Ô ‰Â›ÁÌ· Ô‡ÚˆÓ

ÌÂÙÚ‹ıËΠÙÔ ÈÒ‰ÈÔ -¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ê·ÛÌ·ÙÔ-

ʈÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô ÙˆÓ Pino Î·È Û˘Ó (3)- ηıÒ˜ ηÈ

Ë ÎÚ·ÙÈÓ›ÓË. ∏ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÂÎÊÚ¿ÛıËÎÂ

Û ÌÈÎÚÔÁÚ·ÌÌ¿ÚÈ· Ȉ‰›Ô˘ ·Ó¿ ÁÚ·ÌÌ¿ÚÈÔ ÎÚ·ÙÈÓ›Ó˘

(Ìg I/g KÚ).

√È ÚÔÛ‰ÈÔÚÈÛÌÔ› Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·›Ì· ÛÙÔ Û‡ÓÔÏÔ

ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÈ ÂÍ‹˜: ÔÏÈ΋ ı˘ÚÔÍ›ÓË (T4), ÙÚÈȈ-

‰Ôı˘ÚÔÓ›ÓË (T3), ı˘ÚÂÔÂȉÔÙÚfiÔ˜ ÔÚÌfiÓË (TSH),

·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ˘ÂÚÔÍÂȉ¿Û˘

(·ÓÙÈ-∆ƒ√·) Î·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË. ™Â 150 ·fi Ù·

440 ·È‰È¿ ÌÂÙÚ‹ıËÎ·Ó ÂÈϤÔÓ Î·È ÔÈ ÂÍ‹˜ ·Ú¿ÌÂ-

ÙÚÔÈ ÛÙÔÓ ÔÚfi: ÂχıÂÚË ı˘ÚÔÍ›ÓË (FT4), ı˘ÚÂÔÛÊ·ÈÚÈ-

ÓÈο ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈ-Tg), ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜

ÏÈÔÚˆÙ½ÓË (LDL), ˘„ËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÏÈÔ-

ÚˆÙ½ÓË (HDL) Î·È ÙÚÈÁÏ˘ÎÂÚ›‰È·.

√È ÚÔÛ‰ÈÔÚÈÛÌÔ› Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·›Ì· ÛÙȘ ÌËÙ¤-

Ú˜ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÔÈ ÂÍ‹˜: T3, T4, FT4, TSH, ·ÓÙÈ-

TPO· Î·È Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË.

ÀÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó·

∏ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘

˘Ê‹˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ¤ÁÈÓ ·fi ÙÔÓ ›‰ÈÔ ÂÍÂȉÈ-

ÎÂ˘Ì¤ÓÔ ·ÎÙÈÓÔÏfiÁÔ Ì ˘ÂÚ˯ÔÙÔÌÔÁÚ¿ÊÔ General

Electric Pro Series Ì ÁÚ·ÌÌÈÎfi ÔÌÔ‰¤ÎÙË Û˘¯ÓfiÙË-

Ù·˜ 7,5 MHz. ∆· ·È‰È¿ ÂÍÂÙ¿˙ÔÓÙ·Ó Í·ÏˆÌ¤Ó· ÌÂ

˘ÂÚ˘„ˆÌ¤ÓÔ ÙÔ ¿Óˆ ̤ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ˘ÂÚ¤-

ÎÙ·ÛË Ù˘ ÎÂÊ·Ï‹˜. √ fiÁÎÔ˜ οı ÏÔ‚Ô‡ ÙÔ˘ ı˘ÚÂÔÂÈ-

‰Ô‡˜ ·‰¤Ó· (V) ÂÎÙÈÌ‹ıËΠ·fi ÙË Û¯¤ÛË: V (ml):

0,479 ñ ÚÔÛıÈÔ›ÛıÈ· ñ ÂÁοÚÛÈ· ñ ÎÂÊ·ÏÔ˘Ú·›· ‰È¿ÌÂ-

ÙÚÔ˜ ı˘ÚÂÔÂȉԇ˜ (4). √ Û˘ÓÔÏÈÎfi˜ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂÈ-

‰Ô‡˜ ·‰¤Ó· ‹Ù·Ó ÙÔ ¿ıÚÔÈÛÌ· ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ‰‡Ô ÏÔ-

‚ÒÓ ¯ˆÚ›˜ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÈÛıÌÔ‡.

∂›Û˘, ηٷÁÚ¿ÊËÎÂ Ë Ë¯ˆÁ¤ÓÂÈ· ÙÔ˘ ı˘ÚÂÔÂȉÈÎÔ‡

·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ·ÚÔ˘Û›· ‰È¿¯˘-

Ù˘ ‹ ÂÓÙÔÈṲ̂Ó˘ ˘Ô˯ˆÁ¤ÓÂÈ·˜, Ë ·ÚÔ˘Û›· fi˙ˆÓ,

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·ÛÙÂˆÓ ‹ ‰È·ÊÚ·ÁÌ¿ÙˆÓ (5). ÀÔÏÔÁ›ÛıËÎ·Ó Ë 50‹ Î·È Ë97Ë ∂ηÙÔÛÙÈ·›· £¤ÛË (∂.£.) ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÁÈ·ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ.

√ÚÌÔÓÈÎÔ› ÚÔÛ‰ÈÔÚÈÛÌÔ›

∏ ̤ÙÚËÛË Ù˘ T4 Î·È ∆3 ¤ÁÈÓ Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈÎfiÚÔÛ‰ÈÔÚÈÛÌfi RIA (Brahms Hennigsdorf Germany) Ì fiÚÈ·Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 5-13 Ìg/dl Î·È 80-220 ng/dl ·ÓÙ›ÛÙÔȯ·,Ù˘ ∆SH Ì ¯ËÌÂÈÔʈٷ‡ÁÂÈ· Chemiluminescence ILMA (twosite Chemiluminescence immunoassay Nichols InstituteDiagnostics) Ì fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 0,5-5 ÌU/ml. ∏ ̤-ÙÚËÛË Ù˘ FT4 ¤ÁÈÓ Ì ¯ËÌÂÈÔʈٷ‡ÁÂÈ· ChemiluminescenceAbbott (fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 9-25 pmol/L), ÙˆÓ ·ÓÙÈ-TPO· Î·È ·ÓÙÈ-Tg ¤ÁÈÓ Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfiRIA Brahms Dynotest (Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ <60 U/ml Î·È <100U/ml ·ÓÙ›ÛÙÔȯ·).

∏ ̤ÙÚËÛË Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ¤ÁÈÓ Ì ÂÓ˙˘ÌÈ΋̤ıÔ‰Ô (fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 120-200 mg/dL), Ù˘ HDLÌ ηı›˙ËÛË (Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ >35 mg/dL), ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ-‰›ˆÓ Ì ÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (fiÚÈ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ 30-130mg/dL) Î·È Ù¤ÏÔ˜, ˘ÔÏÔÁÈÛÌfi˜ Ù˘ LDL Ì ÙËÓ Â͛ۈÛË:LDL= ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË - ÙÚÈÁÏ˘ÎÂÚ›‰È·/ 5 - HDL (Ê˘ÛÈÔ-ÏÔÁÈ΋ ÙÈÌ‹ < 100 mg/dL).

™Ù·ÙÈÛÙÈ΋ ∞Ó¿Ï˘ÛË

°È· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ Î·ÙËÁÔÚÈ·ÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ¯ÚËÛÈ-ÌÔÔÈ‹Û·Ì ÙËÓ ‰ÔÎÈÌ·Û›· χ-ÙÂÙÚ¿ÁˆÓÔ (Chi-square test)Î·È ÙÔ Fisher’s exact test. ÃÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÌÔÓÙ¤ÏÔ Ù˘·Ó¿Ï˘Û˘ ‰È·Î‡Ì·ÓÛ˘ ηٿ ¤Ó· ·Ú¿ÁÔÓÙ·, ¯ˆÚ›˜ ·ӷ-ÏËÙÈΤ˜ ÌÂÙÚ‹ÛÂȘ (one way ANOVA). °È· ÙȘ ÔÏϷϤ˜Û˘ÁÎÚ›ÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ ÔÌ¿‰Â˜ ·Ó¿ 2 (pair wise multiplecomparisons) ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ Scheffer test. ŸÏ˜ ÔÈ ‰Ô-ÎÈ̷ۛ˜ Â›Ó·È ‰ÈÏ‹˜ ηÙ‡ı˘ÓÛ˘ (two-sided) Ì ›‰ÔÛËÌ·ÓÙÈÎfiÙËÙ·˜ p=0,05. ∏ Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÂ Û˘Ó¯›˜ÌÂÙ·‚ÏËÙ¤˜ ¤ÁÈÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ˘˜ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘-Û¯¤ÙÈÛ˘ ÙÔ˘ Pearson Î·È ÙÔ˘ Spearman. °È· ÙË ÛÙ·ÙÈÛÙÈ΋·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS vr10.00 (Statistical Package for the Social Sciences).

∞ÔÙÂϤÛÌ·Ù·

∆· ۈ̷ÙÔÌÂÙÚÈο ̄ ·Ú·ÎÙËÚÈÛÙÈο Î·È ÔÈ ·Ú¿ÌÂ-

ÙÚÔÈ Ô˘ ÂÍÂÙ¿ÛıËÎ·Ó ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ ηÈ

Û‡Ìʈӷ Ì ÙÔ Ê‡ÏÔ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∏ ̤ÛË ÙÈÌ‹ Ù˘ TSH ‹Ù·Ó 2,60±1,22 ÌU/ml ÛÙ·

·ÁfiÚÈ·, 2,44±1,22 ÌU/ml ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 2,51±1,22

ÌU/ml ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi, Ë 97Ë ÂηÙÔÛÙÈ·›·

ı¤ÛË (∂.£.) ‹Ù·Ó ·ÓÙÈÛÙÔ›¯ˆ˜ 5,01 ÌU/ml, 4,92

ÌU/ml Î·È 4,96 ÌU/ml Î·È Ë 5Ë ∂.£. ‹Ù·Ó 1,1 ÌU/ml,

0,84 ÌU/ml Î·È 0,97 ÌU/ml.

¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿

ÛÙË Ì¤ÛË ÙÈÌ‹ Ù˘ TSH ·Ó¿ÌÂÛ· ÛÙ· ·ÁfiÚÈ· Î·È ÛÙ·

ÎÔÚ›ÙÛÈ· (p=0,175). ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ˘ÔÎÏÈÓÈÎÔ‡

˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ (ÀÀ), (∆S∏ >97Ë ∂.£. ‹ ≥5,01

ÌU/ml ÁÈ· Ù· ·ÁfiÚÈ·, ≥4,92 ÌU/ml ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ηÈ

≥4,96 ÌU/ml ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi, ÌÂ Ê˘ÛÈÔ-

ÏÔÁÈΤ˜ ÙÈ̤˜ ∆3, ∆4), ‹Ù·Ó 4,8% ÛÙ· ·ÁfiÚÈ·, 4,4%

ÛÙ· ÎÔÚ›ÙÛÈ· Î·È 4,6% ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi.

ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙȘ ı˘ÚÂÔÂÈ-

‰ÈΤ˜ ÔÚÌfiÓ˜, ‰È·ÈÛÙÒıËÎ·Ó Ù· ÂÍ‹˜: ÛÙ· ÎÔÚ›ÙÛÈ·

Ë Ì¤ÛË ÙÈÌ‹ Ù˘ TSH, Ù˘ ∆4 Î·È Ù˘ ∆3 ‹Ù·Ó ÌÈÎÚfi-

ÙÂÚË ÛÙËÓ ÂÊ˂›· ·’ fi,ÙÈ ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ

(p=0,02, p=0,0005, p<0,0005), ÂÓÒ ÛÙ· ·ÁfiÚÈ· ÌfiÓÔ Ë

̤ÛË ÙÈÌ‹ Ù˘ ∆3 ‹Ù·Ó ÌÈÎÚfiÙÂÚË ÛÙËÓ ÂÊ˂›· ·’

fi,ÙÈ ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (p<0,0005, ¶›Ó·Î·˜ 2).

∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TPO· ‹Ù·Ó ÛÙ·

·ÁfiÚÈ· 3,2%, ÛÙ· ÎÔÚ›ÙÛÈ· 5,8% Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi

ÏËı˘ÛÌfi 4,6%, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ

·ÓÙÈ-TG ‹Ù·Ó ÛÙ· ·ÁfiÚÈ· 3,3% Î·È ÛÙ· ÎÔÚ›ÙÛÈ·

7,9%. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜

‰È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TPO·

Î·È ·ÓÙÈ-TG ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ.

¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ. √È ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ ̤ÛË ÙÈÌ‹ ±∆∞ ‹ ‰È¿ÌÂÛË Î·È‰È·Î‡Ì·ÓÛË

∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ™‡ÓÔÏÔ

∏ÏÈΛ· (¤ÙË) 10,12 ± 2,96 10,19 ± 2,87 10,15 ± 2,91¢ª™ (kg/m2) 19,98 ± 4,48 19,16 ± 3,87 19,53 ± 4,17¢ª™sds 0,21 ± 1,20 0,03 ± 1,05 0,11 ± 1,12∂™ (m2) 1,25 ± 0,34 1,23 ± 0,28 1,24 ± 0,31T3 (ng/dl) 167,61 ± 34,65 164,52 ± 35,06 165,91 ± 34,87T4 (Ìg/dl) 8,51 ± 1,35 8,62 ± 1,45 8,57 ± 1,41FT4 (pmol/L) 17,22 ± 3,08 16,91 ± 4,16 17,04 ± 3,75TSH (ÌU/ml) 2,60 ± 1,22 2,44 ± 1,22 2,51 ± 1,22T4 / T3 0,05 ± 0,01 0,05 ± 0,01 0,05 ± 0,01∞ÓÙÈ-TPO· (U/ml) 23 25 25¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË) (1,0-3000) (1,0-1716) (1,0-3000)∞ÓÙÈ-TG (U/ml) 24,6 23,2 23,45¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË) (9,6-471) (9,6-3000) (9,6-3000)ÃÔÏËÛÙÂÚ›ÓË ÔÏÈ΋ (mg/dL) 179,41 ± 27,34 180,66 ± 29,12 180,10 ± 28,3∆ÚÈÁÏ˘ÎÂÚ›‰È· (mg/dL) 69,91 ± 44,40 69,00 ± 27,04 69,35 ± 34,61LDL (mg/dL) 114,40 ± 25,08 113,65 ± 27,39 113,95 ± 26,41HDL (mg/dL) 53,93 ± 12,18 55,65 ± 18 54,98 ± 15,96πÒ‰ÈÔ/ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ (Ìg/g) 344,91± 188,22 332,62 ± 173,65 338,19 ± 180,17

109ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜

¶·È‰È·ÙÚÈ΋ 2007;70:107-114

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ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙÔÓ Ù›ÙÏÔ

ÙˆÓ ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒÛ·Ì fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ

ıÂÙÈÎÒÓ ·ÓÙÈ-TPO· ‰ÂÓ ‰È¤ÊÂÚ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-

ο ÛÙ· ‰‡Ô ʇϷ, ÙfiÛÔ ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (·Áfi-

ÚÈ·: 2,7%, ÎÔÚ›ÙÛÈ·: 2,2% p=0,824) fiÛÔ Î·È ÛÙËÓ

ÂÊ˂›· (·ÁfiÚÈ·: 4,2%, ÎÔÚ›ÙÛÈ·: 8,2%, p=0,387).

™Ù· ·ÁfiÚÈ· ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ‰È·ÊÔÚ¿ ÛÙË Û˘-

¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈ-∆ƒ√· ÌÂٷ͇ ÚÔÂÊ˂›·˜ ηÈ

ÂÊ˂›·˜ (2,7% Î·È 4,2% p=0,679), ·ÓÙ›ıÂÙ· ÛÙ· ÎÔ-

Ú›ÙÛÈ· ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂ-

ٷ͇ ÚÔÂÊË‚ÈÎÔ‡ Î·È ÂÊË‚ÈÎÔ‡ ÛÙ·‰›Ô˘ ·Ó¿Ù˘-

͢ (2,2% Ì 8,2% p=0,05).

∆· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ‰ÂÓ Â›¯·Ó ˘„Ë-

ÏfiÙÂÚ˜ ÙÈ̤˜ TSH (p=0,165).

ŸÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó·

∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó·

Û fiÏ· Ù· ·È‰È¿ ‹Ù·Ó 4,99±2,7 ml (·ÁfiÚÈ·:

4,94±2,76 ml, ÎÔÚ›ÙÛÈ·: 5,03±2,65 ml, p=0,797). ∏

50‹ Î·È 97Ë ∂.£. ÙˆÓ ÙÈÌÒÓ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂÈ-

‰Ô‡˜ ÛÙ· ·ÁfiÚÈ· Î·È ÛÙ· ÎÔÚ›ÙÛÈ·, ÛÙȘ ‰È¿ÊÔÚ˜

ËÏÈ˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3 Î·È ·ÂÈÎÔÓ›-

˙ÔÓÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1.

√ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ·˘Í¿ÓÂÙ·È ÛË-

Ì·ÓÙÈο Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜ Î·È ÛÙ· ‰‡Ô ʇ-

Ï· (·ÁfiÚÈ·: r=0,779, p<0,0005 ÎÔÚ›ÙÛÈ·: r=0,669,

p<0,0005), Ì ÙËÓ ·‡ÍËÛË Ù˘ ∂™ Î·È ÛÙ· ‰‡Ô ʇϷ

(·ÁfiÚÈ·: r =0,730, p<0,0005 ÎÔÚ›ÙÛÈ·: r=0,623,

p<0,0005), ÂÓÒ ·˘Í¿ÓÂÙ·È ·ÛıÂÓÒ˜ Ì ÙËÓ ·‡ÍËÛË

ÙÔ˘ ¢ª™sds ÌfiÓÔ ÛÙ· ·ÁfiÚÈ· (·ÁfiÚÈ·: r=0,166,

p=0,023 ÎÔÚ›ÙÛÈ·: r=0,095, p=0,150).

√ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· ·˘Í¿ÓÂÙ·È ÌÂ

ÙËÓ ÚfiÔ‰Ô Ù˘ ÂÊ˂›·˜ ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È

ÛÙ· ÎÔÚ›ÙÛÈ· (p<0,0005). ∏ ̤ÛË ÙÈÌ‹±™∞ ÙÔ˘

fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙ· ·ÁfiÚÈ· ÛÙÔ ÛÙ¿‰ÈÔ

Tanner I ‹Ù·Ó 3,42±1,31 ml Î·È ÛÙ· ÛÙ¿‰È· Tanner

II-V 7,35±2,76 ml (p<0,0005). √È ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜

ÛÙ· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 3,74±1,78 ml Î·È 5,9±2,8 ml

(p<0,0005). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·-

ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÌÂٷ͇

·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÛÙÔ ÛÙ¿‰ÈÔ Tanner I (3,42

ml ¤Ó·ÓÙÈ 3,74 ml, p=0,202), ÂÓÒ ÛÙ· ÛÙ¿‰È·

Tanner II-V Ù· ·ÁfiÚÈ· ›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ fiÁÎÔ ı˘-

ÚÂÔÂȉԇ˜ ·’ fi,ÙÈ Ù· ÎÔÚ›ÙÛÈ· (7,35 ml ¤Ó·ÓÙÈ 5,9

ml, p=0,001).

∏ ̤ÛË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ / g ÎÚ·ÙÈÓ›Ó˘

ÛÙ· Ô‡Ú· ‹Ù·Ó 338,18±180,16 Ìg π/g ∫Ú.

ŸÏ· Ù· ·È‰È¿ ›¯·Ó Û˘ÁΤÓÙÚˆÛË Èˆ‰›Ô˘ ÛÙ·

Ô‡Ú· ¿Óˆ ·fi 25 Ìg π/g ∫Ú, 99,3% ¿Óˆ ·fi 50 Ìg

π/g ∫Ú Î·È 97% ¿Óˆ ·fi 100 Ìg π/g ∫Ú.

√ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Û˘Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο

Ì ÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ / ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú·

(r =-0,260, p<0,0005). ŸÛÔ ¯·ÌËÏfiÙÂÚË Â›Ó·È Ë ·¤Î-

ÎÚÈÛË Èˆ‰›Ô˘ / ÎÚ·ÙÈÓ›ÓË ÛÙ· Ô‡Ú·, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂ-

ÚÔ˜ Â›Ó·È Ô fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· (∂ÈÎfiÓ· 2).

√ fiÁÎÔ˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ

·ÚÔ˘Û›· ·ÓÙÈ-TPO· ÌfiÓÔ ÛÙ· ÎÔÚ›ÙÛÈ·. ¢ËÏ·‰‹,

Ù· ÎÔÚ›ÙÛÈ· Ô˘ ¤¯Ô˘Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√· ¤¯Ô˘Ó ÌÂ-

Á·Ï‡ÙÂÚÔ ı˘ÚÂÔÂȉ‹ ·‰¤Ó· (8,32 ml ¤Ó·ÓÙÈ 4,84 ml

p=0,0005) Û˘ÁÎÚÈÙÈο Ì ÂΛӷ Ô˘ ¤¯Ô˘Ó ·ÚÓËÙÈο

·ÓÙÈ-TPO·. ∞Ó¿ÏÔÁË ‰È·ÊÔÚ¿ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÛÙ·

·ÁfiÚÈ· (6,76 ml ¤Ó·ÓÙÈ 4,93 ml p=0,111) (∂ÈÎfiÓ· 3).

µÚÔÁ¯Ô΋ÏË, ‰ËÏ·‰‹ fiÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ >97Ë

∂.£., ÂÌÊ¿ÓÈÛ·Ó ÙÔ 3,2% (n=14) ÙˆÓ ·È‰ÈÒÓ. ∏ ̤-

ÛË ÙÈÌ‹ ·¤ÎÎÚÈÛ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ÛÙ· ·È‰È¿ ÌÂ

‚ÚÔÁ¯Ô΋ÏË ‹Ù·Ó 216 Ìg π/g ∫Ú, Î·È ‰ÂÓ ‰È¤ÊÂÚÂ

110 ∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

5-6,9 7-8,9 9-10,9 11-12,9 13-14,9 15-18

∏ÏÈΛ· (¤ÙË)

ŸÁÎ

Ô˜

ı˘

ÚÂÔ

Âȉ

Ô‡

˜ (m

l)

97Ë ∂.£. ∞ÁfiÚÈ·97Ë ∂.£. ∫ÔÚ›ÙÛÈ·50Ë ∂.£. ∞ÁfiÚÈ·50Ë ∂.£. ∫ÔÚ›ÙÛÈ·

0

2

4

6

8

10

12

14

16

∂ÈÎfiÓ· 1. ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (ml) Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔʇÏÔ (50‹ Î·È 97Ë ∂.£.).

¶›Ó·Î·˜ 2. ª¤ÛË ÙÈÌ‹ ∆S∏, ∆4 Î·È ∆3 Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ (∆anner π) Î·È ÛÙËÓ ÂÊ˂›· (∆anner ππ-V)

TSH (ÌU/ml) T4 (Ìg/dl) T3 (ng/dl)

™Ù¿‰È· ÂÓ‹‚ˆÛ˘ I II-V p I II-V p I II-V p∞ÁfiÚÈ· 2,6 2,5 <0,3 8,6 8,3 0,15 174,7 156 0,0005∫ÔÚ›ÙÛÈ· 2,6 2,2 0,02 9,0 8,3 0,0005 174,3 157 0,0005

¶›Ó·Î·˜ 3. 50‹ ∂.£. Î·È 97Ë ∂.£. ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜(ml) Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÎÙ›ÌËÛË Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ Î·È ÙËÓËÏÈΛ·

∏ÏÈΛ· (¤ÙË) ∞ÁfiÚÈ· n ∫ÔÚ›ÙÛÈ· n

50‹ ∂.£. 97Ë ∂.£. 50‹ ∂.£. 97Ë ∂.£.

5-6,9 2,72 6,67 30 2,97 7,41 217-8,9 2,88 6,89 41 3,45 7,64 659-10,9 3,83 9,89 45 4,24 9,15 6011-12,9 5,08 10,72 37 5,4 9,82 4313-14,9 7,76 12,21 30 5,81 11,75 2915-18 11,69 14,93 17 11,50 13,33 22

Paediatriki 2007;70:107-114

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ÛËÌ·ÓÙÈο ÂΛӢ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ‚ÚÔÁ¯Ô΋ÏË

(340,2 Ìg I/g ∫Ú).

ŒÓ·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ fi˙ÔÈ ‰È·ÈÛÙÒıËÎ·Ó Û Ô-

ÛÔÛÙfi 5,1% ÂÓÒ fi˙ÔÈ Î·È ˘Ô˯ˆÁÂÓ›˜ ÂÚÈÔ¯¤˜ ÛÂ

ÔÛÔÛÙfi 4,1%.

∆· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ›¯·Ó 6 ÊÔÚ¤˜

ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ‚ÚÔÁ¯Ô-

΋ÏË (p=0,026 OR: 6,08 95% CI (1,55-23,83).

ŸÛÔÓ ·ÊÔÚ¿ ÙË Û¯¤ÛË ÙˆÓ ·ÓÙÈ-∆ƒ√· Î·È ÙˆÓ

·ÓˆÌ·ÏÈÒÓ ÛÙËÓ Ë¯ÔÌÔÚÊÔÏÔÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜,

‰È·ÈÛÙÒıËΠfiÙÈ ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√·

·ÚÔ˘Û›·˙·Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ‰È¿¯˘ÙË ‹

ÂÓÙÔÈṲ̂ÓË ˘Ô˯ˆÁ¤ÓÂÈ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·

(p=0,0005).

¢ÂÓ ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË

Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ÌÂٷ͇ ÙˆÓ ·È-

‰ÈÒÓ Ì ·ÚÓËÙÈο Î·È ıÂÙÈο ·ÓÙÈ-TPO·.

∏ Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜

(ıÂÙÈο ·ÓÙÈ-∆ƒ√· Î·È ÂÓÙÔÈṲ̂ÓË ‹ ‰È¿¯˘ÙË

˘Ô˯ˆÁ¤ÓÂÈ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·) ‹Ù·Ó 2,5%

(11 ·È‰È¿) ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ.

£ÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 82% ÙˆÓ

ÌËÙ¤ÚˆÓ ÙˆÓ ÔÔ›ˆÓ Ù· ·È‰È¿ ›¯·Ó ıÂÙÈο ·ÓÙÈÛÒ-

Ì·Ù·, ÂÓÒ ÛÙȘ ÌËÙ¤Ú˜ ·È‰ÈÒÓ Ì ·ÚÓËÙÈο ·ÓÙÈ-

∆ƒ√· Ë Û˘¯ÓfiÙËÙ· ·ÓÙÈ-∆ƒ√· ‹Ù·Ó 18% (p<0,0005).

£ÂÙÈο ·ÓÙÈ-∆ƒ√· ‰È·ÈÛÙÒıËÎ·Ó Û 30% ÙˆÓ ·È-

‰ÈÒÓ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ıÂÙÈο ·ÓÙÈÛÒÌ·-

Ù· (p<0,0005).

¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ TSH

Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∆· ·È‰È¿ Ì TSH<4 ÌU/ml

›¯·Ó ̤ÛË ÙÈÌ‹ ¯ÔÏËÛÙÂÚfiÏ˘ 179,53 mg/dL, Ù·

·È‰È¿ Ì TSH 4-5 ÌU/ml, 188,06 mg/dL Î·È Ù· ·È-

‰È¿ Ì TSH>5 ÌU/ml, 177,57 mg/dL ·ÓÙ›ÛÙÔȯ·

(p=0,243, ¶›Ó·Î·˜ 4).

™˘Û¯ÂÙ›Û·Ì ÙÔÓ ¢ª™sds Ì ÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜

‰Â›ÎÙ˜: ∆3, ∆4, T4/T3, FT4, TSH. √È ÛÙ·ÙÈÛÙÈο ÛË-

Ì·ÓÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ÁÈ· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ

‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: ∆4/∆3 (r=-0,128 p=0,009) ηÈ

FT4 (r=-0,213 p=0,01).

™˘˙‹ÙËÛË

√È ÌÂÙ·‚ÔϤ˜ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ηÈ

Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηٿ ÙËÓ ÂÊ˂›· ‰ÂÓ

¤¯Ô˘Ó ·ÎÚÈ‚Ò˜ ηıÔÚÈÛı› (6).

™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘

ÂÊ˂›·˜, ·Ú·ÙËÚ‹Û·Ì ÙÒÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘

ÙˆÓ ÙÈÌÒÓ ∆SH, ∆4, ∆3 ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÌfiÓÔ Ù˘ ∆3

ÛÙ· ·ÁfiÚÈ·. ∞ÓÙ›ÛÙÔȯ· ÔÈ Dunger Î·È Û˘Ó (7) ‰È·›-

ÛÙˆÛ·Ó ÙÒÛË Ù˘ F∆4, ∆4 Î·È F∆3 Ì ÙËÓ ÚfiÔ‰Ô

Ù˘ ÂÊ˂›·˜ ÛÙ· ÎÔÚ›ÙÛÈ· Î·È ÌfiÓÔ Ù˘ F∆4 ÛÙ·

·ÁfiÚÈ·. ™Â ÌÈ· ÂÚÁ·Û›· ·fi ÙËÓ πÛ·Ó›· (8) ÛÙËÓ

ÔÔ›· ÂÍÂÙ¿ÛıËÎ·Ó 371 ·È‰È¿ ‰È·ÈÛÙÒıËΠÙÒ-

ÛË ÙˆÓ ÙÈÌÒÓ ∆SH, F∆4, F∆3 ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È-

‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜.

∞ÓÙ›ıÂÙ· ÛÙËÓ ÂÚÁ·Û›· ÙˆÓ Elmlinger Î·È Û˘Ó (9)

‰ÂÓ ‰È·ÈÛÙÒıËΠ›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙË Û˘ÁΤ-

ÓÙÚˆÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ. ∆· ‰È·ÊÔÚÂÙÈ-

ο ·ÔÙÂϤÛÌ·Ù· Û˘ÁÎÚÈÙÈο Ì ¿ÏϘ ÌÂϤÙ˜, È-

ı·Ófiٷٷ Ó· ÔÊ›ÏÔÓÙ·È Û ÌÂıÔ‰ÔÏÔÁÈΤ˜ ‰È·ÊÔ-

Ú¤˜. √È Elmlinger Î·È Û˘Ó, ÌÂϤÙËÛ·Ó Î¿ı ÛÙ¿‰ÈÔ

ÂÓ‹‚ˆÛ˘ ͯˆÚÈÛÙ¿ (Tanner π, ππ, πππ, πV, V) ηÈ

›Ûˆ˜ Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ ‰ÂÓ ·Ó·‰‡ıËÎÂ Ë Â›‰Ú·ÛË

Ù˘ ‹‚˘ ÛÙȘ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË Ù˘ ËÏÈΛ·˜ ÛÙË Û˘-

ÁΤÓÙÚˆÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ, ‰ÂÓ ·Ó·Ê¤-

ÚÂÙ·È ÌÂÙ·‚ÔÏ‹ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ F∆3, F∆4,

111

AÁfiÚÈ· ∫ÔÚ›ÙÛÈ·M¤Û

Ë Ù

ÈÌ‹

fiÁ

ÎÔ

˘ ı

˘Ú

ÂÔÂÈ

‰Ô

‡˜

(ml) ∞ÚÓËÙÈο ·ÓÙÈ-∆ƒ√

£ÂÙÈο ·ÓÙÈ-∆ƒ√

p=0,0005p=0,111

0

2

4

6

8

10

12

∂ÈÎfiÓ· 3. ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜ (ml) Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ÌÂıÂÙÈο Î·È ·ÚÓËÙÈο ·ÓÙÈ-∆ƒ√ ·ÓÙÈÛÒÌ·Ù·.

14

12

10

8

6

4

2

0

0 200 400 600πÒ‰ÈÔ/∫Ú·ÙÈÓ›ÓË

ŸÁ

ÎÔ

˜ £

˘Ú

ÂÔÂÈ

‰Ô

‡˜

800 1000 1200

R Sq Linear=0,057

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË fiÁÎÔ˘ ı˘ÚÂÔÂȉԇ˜ (ml) Î·È Èˆ‰›Ô˘ / ÎÚ·ÙÈ-Ó›ÓË Ô‡ÚˆÓ (Ìg I/g ∫Ú), r=-0,260, p<0,0005.

¶›Ó·Î·˜ 4. ™¯¤ÛË TSH Î·È ¯ÔÏËÛÙÂÚfiÏ˘ Û ˘ÁÈ‹ ·È‰È¿

TSH (ÌU/ml) n M¤ÛË ÙÈÌ‹ ÃÔÏËÛÙÂÚfiÏ˘ p(mg/dL)

<4 383 179,53 ± 28,30 0,2434-5 38 188,06 ± 28,47>5 19 177,57 ± 27,38

¶·È‰È·ÙÚÈ΋ 2007;70:107-114

ŸÁÎÔ˜ ı˘ÚÂÔÂȉԇ˜

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·111

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TSH Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ ·fi ÔÚÈṲ̂ÓÔ˘˜

ÂÚ¢ÓËÙ¤˜ (10-12), ÂÓÒ ‰È·ÈÛÙÒıËΠÙÒÛË Ù˘

Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ F∆3, ∆3, F∆4, TSH Ì ÙËÓ ¿ÚÔ-

‰Ô Ù˘ ËÏÈΛ·˜ ·fi ¿ÏÏÔ˘˜ (13-16).

™ÙËÓ ÂÚÁ·Û›· Ì·˜ ‰ÂÓ ‰È·ÈÛÙÒÛ·Ì ÛÙ·ÙÈÛÙÈο

ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙË Ì¤ÛË ÙÈÌ‹ Ù˘ TSH ·Ó¿ÌÂ-

Û· ÛÙ· ·ÁfiÚÈ· Î·È ÛÙ· ÎÔÚ›ÙÛÈ·. ∞Ó¿ÏÔÁ· ‰Â‰Ô̤ӷ

·Ó·Ê¤ÚÔÓÙ·È ·fi ÙÔ˘˜ Franklyn Î·È Û˘Ó (10).

™¯ÂÙÈο Ì ÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ‰È¿ÊÔÚ˜

ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÛËÌ·ÓÙÈ΋ ‰È·Î‡Ì·ÓÛË ·˘ÙÔ‡

ÛÙȘ ‰È¿ÊÔÚ˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜, Ô˘ ÚÔÊ·-

ÓÒ˜ ηıÔÚ›˙ÔÓÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ‰È·-

ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ¿ÏÏÔ˘˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜

·Ú¿ÁÔÓÙ˜ (17-24).

√È Zimmermann Î·È Û˘Ó (25) ÙÔ 2004 Û ÌÈ· ˘Â-

Ú˯ÔÁÚ·ÊÈ΋ ÌÂϤÙË 3529 Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ

ËÏÈΛ·˜ 6-12 ÂÙÒÓ, ·fi ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ Îfi-

ÛÌÔ˘, Ì ¿ÚÎÂÈ· Ȉ‰›Ô˘, ‰È·›ÛÙˆÛ·Ó ÛÙ·ÙÈÛÙÈο

ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ÛÂ

Û¯¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙËÓ ∂™, ÌÂٷ͇ ÙˆÓ ‰È·Êfi-

ÚˆÓ ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô˘ ·Ô‰fiıËÎ·Ó Û ÁÂ-

ÓÂÙÈΤ˜ Î·È ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ. ™‡Ì-

ʈӷ ÏÔÈfiÓ Ì ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Â›Ó·È ··Ú·›ÙËÙÔ

Ó· ˘¿Ú¯Ô˘Ó ͯˆÚÈÛÙ¤˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ fiÁÎÔ ÙÔ˘

ı˘ÚÂÔÂȉԇ˜ ÛÙȘ ‰È¿ÊÔÚ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜.

∂›Ó·È ›Û˘ ÛËÌ·ÓÙÈÎfi ÛÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋

ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ȉȷÈÙ¤-

Úˆ˜ Û ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜, Ó· ¯ÚËÛÈÌÔ-

ÔÈÂ›Ù·È ÌÈ· ¢ڤˆ˜ ·Ô‰ÂÎÙ‹ Ù¯ÓÈ΋ ÒÛÙ ӷ ÌÂÈ-

ÒÓÂÙ·È ÙÔ ˘ÔÎÂÈÌÂÓÈÎfi ÛÊ¿ÏÌ· ÙÔ˘ ÂÍÂÙ·ÛÙ‹ (25).

™ÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ¤¯Ô˘Ó ηٷÁÚ·Ê› Ê˘ÛÈÔÏÔÁÈΤ˜

ÙÈ̤˜ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Ì ˘ÂÚ˯ÔÁÚ·ÊÈ-

΋ ÂÎÙ›ÌËÛË ·È‰ÈÒÓ Ô˘ ‰È·Ì¤ÓÔ˘Ó Ì·ÎÚÔ¯ÚfiÓÈ·

Û ÂÚÈÔ¯¤˜ Ì ¿ÚÎÂÈ· Ȉ‰›Ô˘.

ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-

∆ƒ√·, ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË ‹Ù·Ó 4,6%. ™ÙË ™·Ú‰Ë-

Ó›·, Û 29 ÂÚÈÔ¯¤˜ Ì ¿ÚÎÂÈ· Ȉ‰›Ô˘, Ë Û˘¯ÓfiÙË-

Ù· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-∆P√· Î˘Ì¿ÓıËΠ·fi 0% ¤ˆ˜

7,6% (26). ™ÙË ÌÂϤÙË ·˘Ù‹ ‰È·ÈÛÙÒıËΠfiÙÈ Ù·

·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ·ÚÔ˘Û›·˙·Ó ÈÔ Û˘¯Ó¿

ÀÀ, ‰ÂÓ ÂÌÊ¿ÓÈ˙·Ó ‚ÚÔÁ¯Ô΋ÏË Î·È ‰ÂÓ Â›¯·Ó ÌÂÁ·-

χÙÂÚË Û˘ÁΤÓÙÚˆÛË Èˆ‰›Ô˘ ÛÙ· Ô‡Ú·. ™ÙË ‰È΋ Ì·˜

ÌÂϤÙË Ù· ·È‰È¿ Ì ıÂÙÈο ·ÓÙÈ-∆ƒ√· ·ÚÔ˘Û›·˙·Ó

6 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ·˘ÍË̤-

ÓÔ fiÁÎÔ ı˘ÚÂÔÂȉԇ˜, ‰ÂÓ Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘ÁΤ-

ÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· Î·È ‰ÂÓ ·ÚÔ˘Û›·˙·Ó

Û˘¯ÓfiÙÂÚ· ÀÀ, ·ÔÙ¤ÏÂÛÌ· Û˘Ì‚·Ùfi ÌÂ Â˘Ú‹Ì·Ù·

¿ÏÏˆÓ ÌÂÏÂÙÒÓ Ô˘ ‰È·ÈÛÙÒÓÔ˘Ó fiÙÈ Ë ·˘ÙÔ¿ÓÔÛË

ı˘ÚÂÔÂȉ›Ùȉ· ÛÙ· ·È‰È¿ Â›Ó·È ·Ú¯fiÌÂÓË, Û˘Ó‹ıˆ˜

·Û˘Ìو̷ÙÈ΋ Ì ÂÏ¿¯ÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÛÙËÓ

ÙÈÌ‹ Ù˘ TSH (27).

™Â ÌÂϤÙË ÛÙË °ÂÚÌ·Ó›· Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ

ÙÔ 2003 (28), ‚Ú¤ıËÎÂ Û˘¯ÓfiÙËÙ· ıÂÙÈÎÒÓ ·ÓÙÈ-

∆ƒ√· 3,4%, ÀÀ 0,8% Î·È ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›ÙÈ-

‰·˜ 3%. ∆· ıÂÙÈο ·ÓÙÈ-∆ƒ√· ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂ

ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·, ÂÓÒ Û˘Û¯ÂÙ›˙Ô-

ÓÙ·Ó Ì ÙÔÓ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Â˘Ú‹Ì·Ù· ·Ó¿-

ÏÔÁ· Ì ·˘Ù¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘.

∏ ›‰Ú·ÛË Ù˘ ‹‚˘ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈ-

∆ƒ√· ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ·Ó·ÎÔÈÓˆı›. ™ÙË ‰È΋

Ì·˜ ÌÂϤÙË ·Ú·ÙËÚ‹Û·Ì fiÙÈ ÛÙ· ·ÁfiÚÈ· ‰ÂÓ

˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈ-∆ƒ√· ÌÂ-

ٷ͇ ÚÔÂÊË‚ÈÎÔ‡ Î·È ÂÊË‚ÈÎÔ‡ ÛÙ·‰›Ô˘ ·Ó¿Ù˘-

͢ (2,7% Î·È 4,2% ·ÓÙ›ÛÙÔȯ·, p=0,679). ∞ÓÙ›ıÂÙ·,

ÛÙ· ÎÔÚ›ÙÛÈ· ·ÓȯÓ‡ÂÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·-

ÊÔÚ¿ ÌÂٷ͇ ÚÔÂÊË‚ÈÎÔ‡ Î·È ÂÊË‚ÈÎÔ‡ ÛÙ·‰›Ô˘

·Ó¿Ù˘Í˘ (2,2% Î·È 8,2% ·ÓÙ›ÛÙÔȯ·, p=0,05). ∞fi

ÌÂϤÙ˜ Û ÂÓËÏ›ÎÔ˘˜ ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ Ê‡ÏÔ ÂË-

Ú¿˙ÂÈ ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË. ™˘ÁÎÂÎÚÈ̤ӷ

·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ·˘ÙÔ¿ÓÔ-

ÛˆÓ ·ı‹ÛÂˆÓ ÛÙȘ Á˘Ó·›Î˜ (29).

™ÙÔ ‰ÈÎfi Ì·˜ ÏËı˘ÛÌÈ·Îfi ‰Â›ÁÌ·, Ë Ì¤ÛË ·¤Î-

ÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ‹Ù·Ó 338 Ìg π/gr ∫Ú, ·Ô-

Ù¤ÏÂÛÌ· Ô˘ ηٷ‰ÂÈÎÓ‡ÂÈ ˘ÂÚ¿ÚÎÂÈ· Ȉ‰›Ô˘, Ë

‰Â Û˘¯ÓfiÙËÙ· Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ ‹Ù·Ó 3,2%. ∆· ¢ڋ-

Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó ·‡ÍËÛË Ù˘ ·¤ÎÎÚÈÛ˘ ÙÔ˘ Ȉ-

‰›Ô˘ ÛÙ· Ô‡Ú· Î·È Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ‚ÚÔÁ-

¯Ô΋Ï˘ Û ۯ¤ÛË Ì ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ·fi ÙË

¯ÒÚ· Ì·˜. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘

ÛÙ· Ô‡Ú· ÛÙËÓ ∞ı‹Ó· ÙÔ 1980, ‹Ù·Ó 95 Ìg π/gr ∫Ú

(30), ÂÓÒ ÙÔ 1999, ÏfiÁˆ ‚ÂÏÙ›ˆÛ˘ ÙˆÓ ÎÔÈÓˆÓÈÎÔÔÈ-

ÎÔÓÔÌÈÎÒÓ Û˘ÓıËÎÒÓ Î·È ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ,

Î˘Ì·ÈÓfiÙ·Ó ·fi 111-164 Ìg I/gr ∫Ú (31). ¶·Ï·ÈfiÙÂ-

Ú˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Û ÂÚÈÔ¯¤˜ Ù˘ ¯ÒÚ·˜

Ì ¤Ó‰ÂÈ· Ȉ‰›Ô˘ ¤¯Ô˘Ó ‰Â›ÍÂÈ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ·

ÌË ÙÔÍÈ΋˜ ‚ÚÔÁ¯Ô΋Ï˘ Û ÔÛÔÛÙfi 40%-60% ÛÂ

·È‰È¿ Î·È ÂÓ‹ÏÈΘ (32,33) Î·È ÂËÚ·ÛÌfi Ù˘ Ûˆ-

Ì·ÙÈ΋˜ ·Ó¿Ù˘Í˘ Û ·È‰È¿ Ì ‚ÚÔÁ¯Ô΋ÏË Ô˘

˙Ô‡Û·Ó Û Ȉ‰ÈÔÂÓÈΤ˜ ÂÚÈÔ¯¤˜ (34,36).

™ÙË ‚ÔÚÂÈÔ‰˘ÙÈ΋ ∂ÏÏ¿‰·, ÙÔ 1996 ÔÈ ∆Û·ÙÛÔ‡Ï˘

Î·È Û˘Ó ÌÂϤÙËÛ·Ó 3.916 ·È‰È¿ ËÏÈΛ·˜ 12-15 ÂÙÒÓ

Î·È ‰È·›ÛÙˆÛ·Ó Û˘¯ÓfiÙËÙ· ‚ÚÔÁ¯Ô΋Ï˘ 21%. ∏

ÂÎÙ›ÌËÛË ¤ÁÈÓ Ì „ËÏ¿ÊËÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ηÈ

ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÎÚÈÙËÚ›ˆÓ WHO (35). ™ÙËÓ ›‰È· Â-

ÚÈÔ¯‹ ÙÔ 1999 (36), Û 97 ·È‰È¿ Ì ÎÏÈÓÈο ‰È·ÁÓˆ-

Ṳ̂ÓË ‚ÚÔÁ¯Ô΋ÏË ‰È·ÈÛÙÒıËΠ̤ÛË ÙÈÌ‹ Ȉ‰›Ô˘

ÛÙ· Ô‡Ú· 84 Ìg I/L. ∂ÈÚfiÛıÂÙ·, Ù· ·È‰È¿ Ô˘ ·-

ÚÔ˘Û›·˙·Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√· ›¯·Ó ˘„ËÏfiÙÂÚË Ì¤ÛË

Û˘ÁΤÓÙÚˆÛË Èˆ‰›Ô˘ ÛÙ· Ô‡Ú·, ·ÓÙ›ıÂÙ· Ì ÙË ‰È΋

Ì·˜ ÂÚÁ·Û›· fiÔ˘ ‰ÂÓ ‰È·ÈÛÙÒÛ·Ì ٤ÙÔÈ· Û˘Û¯¤ÙÈ-

ÛË, ÚÔÊ·ÓÒ˜ ‰ÈfiÙÈ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ∞ıËÓÒÓ ˘¿Ú-

¯ÂÈ Â¿ÚÎÂÈ· Ȉ‰›Ô˘ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·.

∆Ô 2003 Û ÔÚÂÈÓ‹ ÂÚÈÔ¯‹ ÙˆÓ πˆ·ÓÓ›ÓˆÓ ÌÂÏÂ-

Ù‹ıËÎ·Ó 300 ·È‰È¿ ËÏÈΛ·˜ 12-18 ÂÙÒÓ (37). ∏ ̤-

ÛË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· ‹Ù·Ó 202 Ìg

π/L, ÛÙÔÈ¯Â›Ô Ô˘ ‰Â›¯ÓÂÈ Â·Ú΋ ÚfiÛÏË„Ë Èˆ‰›Ô˘.

112 ∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

Paediatriki 2007;70:107-114

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∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÀÀ ‹Ù·Ó 2,5%, ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-

ı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (·ÓÙÈ-∆ƒ√· ‹/Î·È ·ÓÙÈ-

∆g) 10,6%. ∏ ›وÛË Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ ˘ÂÚ˯Ô-

ÁÚ·ÊÈο ‹Ù·Ó 5% Î·È Ë Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘

ı˘ÚÂÔÂȉ›Ùȉ·˜ 9,6%.

º·›ÓÂÙ·È ÏÔÈfiÓ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Èˆ‰›Ô˘ Û ÌÈ·

Ȉ‰ÔÂÓÈ΋ ÂÚÈÔ¯‹, Ô‰ËÁ› ·Ú¯Èο Û ·‡ÍËÛË Ù˘

Û˘¯ÓfiÙËÙ·˜ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›Ùȉ·˜

(31,36,38,39), ÂÓÒ Û ÌÈ· ÂÚÈÔ¯‹ Ì ̷ÎÚ¿ ÂÚ›Ô‰Ô

¿ÚÎÂÈ·˜ Ȉ‰›Ô˘, Ë ÂÈϤÔÓ ÚfiÛÏË„Ë ‰ÂÓ Ô‰Ë-

Á› ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘-

ÚÂÔÂȉ›Ùȉ·˜ (37,40).

∞ӷʤÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÂÓ‹ÏÈΘ ÌÂ

ÂÏ·ÊÚ¿ ·˘ÍË̤ÓË TSH ¤¯Ô˘Ó ·˘ÍË̤ӷ ›‰·

¯ÔÏËÛÙÂÚfiÏ˘ (41,42). ™ÙÔÓ ‰ÈÎfi Ì·˜ ÏËı˘ÛÌfi

·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ‰ÂÓ ·Ó·‰‡ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂ-

ٷ͇ ÙˆÓ ‰˘Ô ·˘ÙÒÓ ·Ú·Ì¤ÙÚˆÓ.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ó·˙‹ÙËÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ

·Ú·Ì¤ÙÚˆÓ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÌÔÚÊÔÏÔÁ›·˜ ηÈ

ÏÂÈÙÔ˘ÚÁ›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ô˘ ˙Ô˘Ó Û Â-

ÚÈÔ¯‹ Ô˘ ¤¯ÂÈ Â¿ÚÎÂÈ· Ȉ‰›Ô˘ ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi

‰È¿ÛÙËÌ·, ¤‰ÂÈÍ ٷ ÂÍ‹˜: 1) Û˘¯ÓfiÙËÙ· ÙÔ˘ ÀÀ

4,6%, 2) Û˘¯ÓfiÙËÙ· ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-∆ƒ√· 4,6%

ÛÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi (3,2% ÛÙ· ·ÁfiÚÈ· ηÈ

5,8% ÛÙ· ÎÔÚ›ÙÛÈ·) Î·È ÙˆÓ ıÂÙÈÎÒÓ ·ÓÙÈ-TG 3,3%

ÛÙ· ·ÁfiÚÈ· Î·È 7,9% ÛÙ· ÎÔÚ›ÙÛÈ·, 3) Û˘¯ÓfiÙËÙ· ÙˆÓ

ıÂÙÈÎÒÓ ·ÓÙÈ-∆ƒ√· ÛÙÔ ÚÔÂÊË‚ÈÎfi ÛÙ¿‰ÈÔ ·Ó¿-

Ù˘Í˘ 2,7% ÛÙ· ·ÁfiÚÈ· Î·È 4,2% ÛÙ· ÎÔÚ›ÙÛÈ· ηÈ

ÛÙËÓ ÂÊ˂›· 4,2% ÛÙ· ·ÁfiÚÈ· Î·È 8,2% ÛÙ· ÎÔÚ›-

ÙÛÈ· Î·È 4) Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉ›ÙÈ-

‰·˜ (ıÂÙÈο ·ÓÙÈ-∆ƒ√· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÓÙÔÈ-

Ṳ̂ÓË ‹ ‰È¿¯˘ÙË ˘Ô˯ˆÁ¤ÓÂÈ· ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊË-

Ì·) 2,5%. ¢È·ÈÛÙÒıËΠ›Û˘, fiÙÈ Ô fiÁÎÔ˜ ÙÔ˘ ı˘-

ÚÂÔÂȉԇ˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ÙËÓ ËÏÈΛ·, ÙËÓ

ÂÊ˂›·, ÙËÓ ∂™ Î·È ÌfiÓÔ ÛÙ· ·ÁfiÚÈ·, ·ÛıÂÓÒ˜ ÌÂ

ÙÔÓ ¢ª™sds. ∆· ıÂÙÈο ·ÓÙÈ-∆ƒ√· Û˘Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

ÙÔÓ ·˘ÍË̤ÓÔ fiÁÎÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (‚ÚÔÁ¯Ô΋ÏË),

Î·È ÙËÓ ‡·ÚÍË ‰È¿¯˘Ù˘ ‹ ÂÓÙÔÈṲ̂Ó˘ ˘Ô˯ˆ-

Á¤ÓÂÈ·˜ ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ÂÓÒ

‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ ÀÀ Ô‡Ù Ì ÙËÓ ·¤ÎÎÚÈÛË

ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·. ∏ ‚ÚÔÁ¯Ô΋ÏË ‰ÂÓ Û˘Û¯ÂÙ›˙Â-

Ù·È Ì ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú·.

ŸÙ·Ó ÔÈ ÌËÙ¤Ú˜ ¤¯Ô˘Ó ıÂÙÈο ·ÓÙÈ-∆ƒ√· ˘¿Ú-

¯ÂÈ 30% Èı·ÓfiÙËÙ· Ù· ·È‰È¿ ÙÔ˘˜ Ó· ·ÔÎÙ‹ÛÔ˘Ó

ıÂÙÈο ·ÓÙÈ-∆ƒ√·.

µÈ‚ÏÈÔÁÚ·Ê›·

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26. Loviselli A, Velluzzi F, Mossa P, Cambosu MA, Secci G,Atzeni F, et al; Sardinian Schoolchildren Study Group.The Sardinian Autoimmunity Study: 3. Studies on circu-lating antithyroid antibodies in Sardinian schoolchildren:relationship to goiter prevalence and thyroid function.Thyroid 2001;11:849-857.

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28. Kabelitz M, Liesenkotter KP, Stach B, Willgerodt H,Stablein W, Singendonk W, et al. The prevalence of anti-thyroid peroxidase antibodies and autoimmune thyroidi-tis in children and adolescents in an iodine replete area.Eur J Endocrinol 2003;148 :301-307.

29. Chiovato L, Lapi P, Fiore E, Tonacchera M, Pinchera A.Thyroid autoimmunity and female gender. J EndocrinolInvest 1993;16:384-391.

30. Koutras DA, Katsouyanni K, Livadas DP, Piperingos GD,Tzonou A, Trichopoulos D. An epidemiologic survey ofthyroid enlargement among schoolchildren in a non-en-demic area. Endokrinologie 1982;79:349-354.

31. Doufas AG, Mastorakos G, Chatziioannou S, Tseleni-Balafouta S, Piperingos G, Boukis MA, et al. The predom-inant form of non-toxic goiter in Greece is now autoim-mune thyroiditis. Eur J Endocrinol 1999;140:505-511.

32. Malamos B, Koutras DA, Kostamis P, Kralios AC,Rigopoulos G, Zerefos N. Endemic goiter in Greece: epi-demiologic and genetic studies. J Clin Endocrinol Metab1966;26:688-695.

33. Malamos B, Koutras DA, Marketos SG, Rigopoulos GA,Yataganas XA, Binopoulos D, et al. Endemic goiter inGreece: an iodine balance study in the field. J Clin En-docrinol Metab 1967;27:1372-1380.

34. Koutras DA, Christakis G, Trichopoulos D, Dakou-Voutetaki A, Kyriakopoulos V, Fontanares P, et al. En-demic goiter in Greece: nutritional status, growth, andskeletal development of goitrous and non goitrous popu-lations. Am J Clin Nutr 1973;26:1360-1368.

35. Tsatsoulis A, Johnson EO, Sacharis K, Soucacos PK, Sou-cacos PN. An epidemiological survey on the prevalence ofgoitre among schoolchildren in Northwestern Greece. EurJ Inter Med 1996;7:35-39.

36. Tsatsoulis AG, Johnson EO, Andricula M, Kalogera C,Svarna E, Spyrou P, et al. Thyroid autoimmunity is associ-ated with higher urinary iodine concentrations in an io-dine-deficient area of Northwestern Greece. Thyroid 1999;9:279-283.

37. Zois C, Stavrou I, Kalogera C, Svarna E, Dimoliatis I, Se-feriadis K, et al. High prevalence of autoimmune thyroidi-tis in schoolchildren after elimination of iodine deficiencyin northwestern Greece. Thyroid 2003;13:485-489.

38. Braverman LE. Iodine-induced thyroid disease. In IngbarSH, The Thyroid. Lippincott, Philadelphia, p 738-746.

39. Papanastasiou L, Alevizaki M, Piperingos G, Mantzos E,Tseleni-Balafouta S, Koutras DA. The effect of iodine ad-ministration on the development of thyroid autoimmunityin patients with nontoxic goiter. Thyroid 2000;10:493-497.

40. Ruwhof C, Drexhage HA. Iodine and thyroid autoim-mune disease in animal models. Thyroid 2001;11:427-436.

41. Duntas LH. Thyroid disease and lipids. Thyroid 2002;12:287-293.

42. Michalopoulou G, Alevizaki M, Piperingos G, Mitsi-bounas D, Mantzos E, Adamopoulos P, et al. High serumcholesterol levels in persons with ‘high-normal’ TSH lev-els: should one extend the definition of subclinical hy-pothyroidism? Eur J Endocrinol 1998;138:141-145.

114 ∂. ∫·ÏÔ˘Ì¤ÓÔ˘ Î·È Û˘Ó.

Paediatriki 2007;70:107-114

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115∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈ΋ 2007;70:115-122

¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘

ÓÂÔÁÓÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·

∂. ªÔ‡˙·1, π. ∞ÓÙˆÓÈ¿‰Ô˘2, ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘3, ª. ∞Ó·ÁÓˆÛÙ¿ÎÔ˘1, º. ∞Ó·ÙÔÏ›ÙÔ˘1, ª. ªÔÚÔ˙›ÓË3,

°. ™·Ú·Ê›‰Ô˘2, ª. •¿ÓıÔ˘1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∆· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (¶Ãµ°) ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ·ÚÔ˘ÛÈ¿-ÛÔ˘Ó Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·. ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÔ‚·Ú¤˜ ·Ó·Ëڛ˜·ÏÏ¿ ‹È· ÚÔ‚Ï‹Ì·Ù· Ô˘ Û˘¯Ó¿ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ‹ Û¯ÔÏÈ΋ ËÏÈΛ·. √ ÛÎÔfi˜ Ù˘ ÌÂϤ-Ù˘ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË ¶Ãµ° ÓÂÔÁÓÒÓ ÛÙË ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓȯÓ¢ıÔ‡Ó Î˘Ú›ˆ˜ ‹È·Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË 40 ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1500 g. ªÂÙ¿ ÙËÓ ¤ÍÔ‰Ô·fi ÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, Ù· ·È‰È¿ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ‰È·¯ÚÔÓÈο. ™ÙËÓ ËÏÈΛ·ÙˆÓ ‰‡Ô ÂÙÒÓ ¤ÁÈÓ ÏÂÙÔÌÂÚ‹˜ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË Î·È ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ÌÈ· ÏÂÙÔ-ÌÂÚ‹˜ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Ì ¤Ó·Ó Û˘Ó‰˘·ÛÌfi ·fi ÚÔÙ˘ÔÔÈË̤Ó˜ ‰ÔÎÈ̷ۛ˜: Touwen,Griffiths Î·È Miller. ™ÙÔ˘˜ ÁÔÓ›˜ ‰fiıËΠ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ÂÓÙ‡ˆÛË Ô˘ ›¯·ÓÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜.

∞ÔÙÂϤÛÌ·Ù·: ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, Ù¤ÛÛÂÚ· ·È‰È¿ ›¯·Ó ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (10%). ∆·˘fiÏÔÈ· 36 ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ Ê˘ÛÈÔÏÔÁÈο ‹ ˆ˜ ¤¯ÔÓÙ· ‹È˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰˘ÛÎÔϛ˜. ™Â ·˘Ù¿ Ù··È‰È¿, Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ¤‰ÂÈÍ ‚·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfiÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔًوÓ. ∞fi Ù· ·È‰È¿ Ô˘ ›¯·Ó ıˆÚËı› Ê˘ÛÈÔÏÔÁÈο Û ÚÔË-ÁÔ‡ÌÂÓ˜ ËÏÈ˘, ÔÈ ‰ÔÎÈ̷ۛ˜ ¤‰ÂÈÍ·Ó ·fi‰ÔÛË Î¿Ùˆ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÁÈ· ÙȘ ÈÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈ-Τ˜ ‰ÔÎÈ̷ۛ˜. ¶·Ú’ fiÏ· ·˘Ù¿ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÔÓ›˜ ›ÛÙ¢·Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ ‰ÂÓ Â›¯Â Úfi‚ÏËÌ·.

™˘ÌÂÚ¿ÛÌ·Ù·: ◊Ș Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ·ÓȯÓ‡ıËÎ·Ó Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÛÙ· ¶Ãµ° ÓÂ-ÔÁÓ¿ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ·. ∞˘Ù¿ Ù· ÚÔ‚Ï‹Ì·Ù· ‰ÂÓ Â›¯·Ó ‰È·ÁÓˆÛÙ› Û ÚÔËÁÔ‡ÌÂÓ˜ ËÏÈ˘, ÂÓÒ ÔÈÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÎÙÈÌÔ‡Û·Ó fiÙÈ ‰ÂÓ ˘‹Ú¯Â ηӤӷ Úfi‚ÏËÌ·. ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ·Ó¿ÁÎË ÌÈ·˜ ÏÂÙÔÌÂÚÔ‡˜ Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÂÎÙ›ÌËÛ˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‚ÔËıËıÔ‡Ó Ù· ·È‰È¿ ÚÈÓÙËÓ ÂÌÊ¿ÓÈÛË Ì·ıËÛÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË, ÚfiˆÚÔ, ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·.

Neurodevelopmental outcome of very low birth weight neonates at

preschool age

H. Bouza1, I. Antoniadou2, H. Antonopoulou3, M. Anagnostakou1, F. Anatolitou1, M. Morosini3,

J. Sarafidou2, ª. Xanthou1

Abstract

Background: Very Low Birth Weight (VLBW) neonates are at increased risk of neurodevelopmental dis-abilities. Most affected children present mild deficits rather than severe handicap, often appearing at thepreschool or school age. The purpose of this study was to assess VLBW infants at the preschool age in or-der to detect neurodevelopmental disabilities, mainly mild in nature.

Methods: Forty children with a birth weight of <1500 g, participated in the study. Following discharge fromthe Neonatal Intensive Care Unit, the children were monitored longitudinally. At the age of two years theyunderwent detailed neurological assessment. At the age of four years they underwent neurodevelopmen-tal assessment with a combination of structured tests: the Touwen, the Griffiths and the Miller tests. A ques-tionnaire was completed by the parents concerning their opinion of their children’s condition.

Results: At the age of four years, four children had cerebral palsy (10%). The remaining 36 were con-sidered as normal or as having minor functional disabilities. In these children, the combination of neu-rodevelopmental tests showed suboptimal scores in coordination and performance. In the childrenwho had been considered to have a normal outcome at an earlier age, the tests showed a suboptimalperformance in most representative tasks, although 85% of the parents considered that their childrenhad no problems.

1 µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ,¡ÔÛ. ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2 ¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜ ηÈ∞Ó·Ù˘Íȷ΋˜¶·È‰È·ÙÚÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘¶·È‰ÈÔ‡, ∞ı‹Ó·

3 ™˘ÓÂÚÁ¿Ù˘¶ÚÔÁÚ¿ÌÌ·ÙÔ˜¢È·¯ÚÔÓÈ΋˜¶·Ú·ÎÔÏÔ‡ıËÛ˘¶ÚfiˆÚˆÓ µ’ ª∂¡

AÏÏËÏÔÁÚ·Ê›·:

∂ϤÓË ªÔ‡˙·[email protected]

1 2nd Neonatal IntensiveCare Unit, “Aghia Sophia” Children’sHospital, Athens, Greece

2 Department of Social andDevelopmentalPaediatrics, Institute ofChild Health, Athens,Greece

3 Collaborating Scientist inthe Neonatal ContinuingFollow-up Programme inthe 2nd NICU

Correspondence:

Helen [email protected]

∏ ÂÚÁ·Û›· ·˘Ù‹ ‚Ú·‚‡ıËΠ̠ÙÔ ‚Ú·‚Â›Ô ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ÛÙË ÌÓ‹ÌË ™. ¢ÔÍÈ¿‰Ë ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ƒfi‰Ô˜, 9-11 πÔ˘Ó›Ô˘ 2006

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·115

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116 ∂. ªÔ‡˙· Î·È Û˘Ó.

Paediatriki 2007;70:115-122

Conclusion: Subtle functional disabilities were identified in VLBW neonates at the age of four years.These disabilities had not been detected at earlier ages, and the parents of these children believed thattheir children had no problems. These findings underline the need for a detailed neurodevelopmen-tal assessment of VLBW children at the preschool age in order to intervene, where necessary, beforeschool entry.

Key words: Neurodevelopmental outcome, preterm, preschool age.

∂ÈÛ·ÁˆÁ‹

∏ ‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔ-

ÁÓÒÓ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ΢ڛˆ˜ Ì ÙËÓ

ÚfiÔ‰Ô Ù˘ Ù¯ÓÔÏÔÁ›·˜ Î·È Ì ÙË ¯Ú‹ÛË Ó¤ˆÓ

Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ, ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ·

ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÈ‚›ˆÛ˘ ÙˆÓ Ôχ

¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ (¶Ãµ¡).

¶·Ú¿ÏÏËÏ· fï˜, ·˘Í‹ıËÎÂ Î·È Ô Î›Ó‰˘ÓÔ˜ ÁÈ·

¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Î·È Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ-

‚Ï‹Ì·Ù· (1,2). ŒÙÛÈ, Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜

¤¯Ô˘Ó ‰È·ÈÛÙˆı› ÛÔ‚·Ú¿ Ó¢ÚÔ·Ó·Ù˘Íȷο

ÚÔ‚Ï‹Ì·Ù· ÛÙÔ 10-30% ·È‰ÈÒÓ ÛÙË ‰ÈÔÚıˆ-

̤ÓË ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ (3,4). ∆· ÚÔ-

‚Ï‹Ì·Ù· ·˘Ù¿ Â›Ó·È Ì›˙ÔÓ˜ Ó¢ÚÔÏÔÁÈΤ˜

‰È·Ù·Ú·¯¤˜ Î·È Î˘Ú›ˆ˜ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË,

ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË Î·È ÛÔ‚·Ú¿ Ó¢ÚÔ·ÈÛıËÙË-

Úȷο ÚÔ‚Ï‹Ì·Ù· (fiÚ·Û˘, ·ÎÔ‹˜). ∏ÈfiÙÂ-

Ú˜ ‰È·Ù·Ú·¯¤˜ ·Ú¯›˙Ô˘Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û˘-

Ó‹ıˆ˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (5-7). ∆· Ó¢-

ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ¶Ãµ¡ ›ӷÈ

‰˘Ó·Ùfi Ó· ‰È·ÁÓˆÛıÔ‡Ó ÛÙËÓ ËÏÈΛ· ·˘Ù‹ ÌÂ

ÌÈ· ÏÂÙÔÌÂÚ‹ ÂÎÙ›ÌËÛË. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘

›ӷÈ, ·ÎÚÈ‚Ò˜, Ë ÏÂÙÔÌÂÚ‹˜ ÂÎÙ›ÌËÛË ÙˆÓ

Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ Ô˘

ÓÔÛËχıËÎ·Ó ÛÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›-

·˜ ÓÂÔÁÓÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, ÌÂ

Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÁÓˆÛÙÈο ÂÚÁ·Ï›·, ÚÔÎÂÈ-

̤ÓÔ˘ Ó· ·ÓȯÓ¢ıÔ‡Ó ‹È˜ Ó¢ÚÔ·Ó·Ù˘ÍÈ·-

Τ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ‰ÂÓ Â›¯·Ó ·ÓȯÓ¢Ù› ÛÂ

ÚÔËÁÔ‡ÌÂÓ˜ ËÏÈ˘. ∞ÒÙÂÚÔ˜ ÛÎÔfi˜ ›ӷÈ

Ë ÚfiÏË„Ë ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Ì¤Ûˆ

Ù˘ ¤ÁηÈÚ˘ ·Ú¤Ì‚·Û˘.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ÀÏÈÎfi Ù˘ ÌÂϤÙ˘ ‹Ù·Ó 40 ·È‰È¿ ËÏÈΛ·˜ ÙÂÛÛ¿-

ÚˆÓ ÂÙÒÓ Ô˘ ›¯·Ó ÓÔÛËÏ¢ı› Î·È Â›¯·Ó ÂÈ˙‹ÛÂÈ ÛÙË

µ’ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ ÙÔ˘ ¡ÔÛÔ-

ÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ÌÂٷ͇ ª·˝Ô˘ 1997 ηÈ

¢ÂÎÂÌ‚Ú›Ô˘ 1998, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ οو ·fi 1500 g.

∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ›¯Â ̤ÛË ÙÈÌ‹ 1122 g Î·È ÛÙ·ıÂÚ‹

·fiÎÏÈÛË 231 g, ÂÓÒ Ë ‰È¿ÚÎÂÈ· ·ËÛ˘ ›¯Â ̤ÛË ÙÈÌ‹

29,1 ‚‰ÔÌ¿‰Â˜. Ì ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 2,3 ‚‰ÔÌ¿‰Â˜.

15 ‚Ú¤ÊË Â›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <1000 g (ÔÌ¿‰· ∞)

(̤ÛÔ ‚¿ÚÔ˜ 883 g Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 101 g, ̤ÛË

‰È¿ÚÎÂÈ· ·ËÛ˘ 28,3 ‚‰ÔÌ¿‰Â˜. Î·È ÛÙ·ıÂÚ‹ ·fiÎÏÈ-

ÛË 2,2 ‚‰ÔÌ¿‰Â˜.) Î·È 25 ›¯·Ó ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1001-

1500 g (ÔÌ¿‰· µ) (̤ÛÔ ‚¿ÚÔ˜ 1265 g Î·È ÛÙ·ıÂÚ‹ ·fi-

ÎÏÈÛË 154 g, ̤ÛË ‰È¿ÚÎÂÈ· ·ËÛ˘ 29,7 ‚‰ÔÌ¿‰Â˜ ηÈ

ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË 2,2 ‚‰ÔÌ¿‰Â˜). ªÂÙ¿ ÙËÓ ¤ÍÔ‰Ô

·fi ÙË ªÔÓ¿‰·, Ù· ·È‰È¿ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙÔ Ï·›ÛÈÔ

ÙÔ˘ ηÓÔÓÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔ-

ÏÔ‡ıËÛ˘ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 3, 6, 12

ÌËÓÒÓ, Î·È ÌÂٷ͇ 18 Î·È 24 ÌËÓÒÓ. ŸÛ· ·È‰È¿ ·-

ÚÔ˘Û›·Û·Ó Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ·Ú·¤Ì-

ÊıËÎ·Ó ÚÒÈÌ· ÁÈ· Ê˘ÛÈÔıÂڷ›·.

™ÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ ¤ÁÈÓ ÌÈ· ÏÂÙÔÌÂÚ‹˜

Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Ì ÙË Ì¤ıÔ‰Ô Dubowitz (8) ηÈ

ÌÈ· ·‰Ú‹ ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË. ∆· ·È‰È¿ ÛÙËÓ ËÏÈ-

Λ· ·˘Ù‹ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜: 1) Ê˘ÛÈÔÏÔÁÈο Â¿Ó Ë

Ó¢ÚÔÏÔÁÈ΋ Î·È Ë ·Ó·Ù˘Íȷ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔ-

ÏÔÁÈ΋, 2) Ì ‹È· ÚÔ‚Ï‹Ì·Ù· Â¿Ó Â›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ

·ÚÔ‰ÈΤ˜ ‰˘ÛÙÔӛ˜ Ô˘ ‰ÂÓ ˘‹Ú¯·Ó ϤÔÓ ÛÙËÓ ÙÂ-

ÏÂ˘Ù·›· ÂͤٷÛË ‹ Â¿Ó Ù· ·È‰È¿ ›¯·Ó ‹È· Ó¢ÚÔÏÔ-

ÁÈο ‹ ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· Î·È 3) Ì ÛÔ‚·Ú‹

·Ó·ËÚ›·, ·Ó Ù· ·È‰È¿ ›¯·Ó ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο ‹

·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·.

™ÙÔ Ï·›ÛÈÔ Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÔÈ ÁÔÓ›˜ ÂÓËÌÂ-

ÚÒÓÔÓÙ·Ó ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ù·

·È‰È¿ ‹È· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ·ÚÁfiÙÂ-

Ú·, ηıÒ˜ Î·È ÁÈ· ÙË ÛËÌ·Û›· Ù˘ ÚÔÛ¯ÔÏÈ΋˜ ÊÔ›ÙË-

Û˘. ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÚÈÒÓ ÂÙÒÓ ÔÈ ÁÔÓ›˜ ÂÓı·ÚÚ‡ÓÔ-

ÓÙ·Ó Ó· ÂÓÙ¿ÍÔ˘Ó ÙÔ ·È‰› ÛÙÔ ÔÚÁ·ÓˆÌ¤ÓÔ ÂÎ·È‰Â˘-

ÙÈÎfi ÚfiÁÚ·ÌÌ· ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡.

™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ¤ÁÈÓ ÌÈ· ÏÂÙÔÌÂ-

Ú‹˜ ÂÎÙ›ÌËÛË ‚¿ÛÂÈ ÚˆÙÔÎfiÏÏÔ˘ Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ

¤Ó·Ó Û˘Ó‰˘·ÛÌfi ·fi Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰ÔÎÈ̷ۛ˜.

1) ¡Â˘ÚÔÏÔÁÈ΋ ÂͤٷÛË ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ‹ÈˆÓ

Ó¢ÚÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·-

Û›· Touwen examination for minor neurological

dysfunctions (9).

2) ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·-

Û›· Griffiths Mental Development scales (10).

3) ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË Û‡Ìʈӷ Ì ÙË ‰ÔÎÈÌ·-

Û›· Miller Assessment for Preschoolers (11).

∂›Û˘, ÛÙÔ˘˜ ÁÔÓ›˜ ‰fiıËΠӷ Û˘ÌÏËÚÒÛÔ˘Ó

¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ÙËÓ ¿Ô„Ë Ô˘ ¤¯Ô˘Ó

ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ¤Ó·

ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ì ÏËÚÔÊÔڛ˜ Û¯ÂÙÈΤ˜ Ì ÙË ÊÔ›-

ÙËÛË Û ·È‰ÈÎfi ÛÙ·ıÌfi.

√ Û˘Ó‰˘·ÛÌfi˜ ·fi Ó¢ÚÔ·Ó·Ù˘ÍȷΤ˜ ‰ÔÎÈ̷ۛ˜

ÂÂϤÁË ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ·ÓȯÓ¢ıÔ‡Ó ‹È˜ ‰È·Ù·-

Ú·¯¤˜ Ô˘ ‰ÂÓ ‰È·ÁÓÒÛÙËÎ·Ó ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÂÍÂ-

Ù¿ÛÂȘ ‹ ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È

Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ∆Ô Touwen examination for minor

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·116

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neurological dysfunctions ÂÎÙÈÌ¿ ÙÔ˘˜ ÂÍ‹˜ Ó¢ÚÔÏÔÁÈÎÔ‡˜

ÙÔÌ›˜ ÙÔ˘ ·È‰ÈÔ‡: ÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ̤·, ÙË ÛÙ¿ÛË

ÙÔ˘ ÛÒÌ·ÙÔ˜, ÙËÓ ÈÛÔÚÚÔ›· ÙÔ˘ ÎÔÚÌÔ‡, ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ

ÎÈÓ‹ÛˆÓ, ÙËÓ ‡·ÚÍË ‰˘ÛÎÈÓËÛ›·˜, ÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·,

ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ÎÈÓ‹ÛˆÓ, ÙËÓ ‡·ÚÍË Û˘ÁÎÈÓËÛÈÒÓ Î·È ÙËÓ

fiÚ·ÛË (9). ∆· ·È‰È¿ ıˆڋıËÎ·Ó fiÙÈ Â›¯·Ó ‚·ıÌÔÏÔÁ›· οو

·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi, fiÙ·Ó Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÈÙ˘¯ÈÒÓ Û ۯ¤ÛË

Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÁÈ· ÙËÓ Î¿ı ˘ÔÎϛ̷η ‹Ù·Ó

<100%. To Griffiths Mental Development scales ÂÎÙÈÌ¿ ÙÔ˘˜

ÂÍ‹˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘: ÙËÓ ÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË, ÙËÓ ÚÔ-

ÛˆÈÎfiÙËÙ· Î·È ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ÙËÓ ·ÎÔ‹ Î·È ÙÔÓ

ÏfiÁÔ, ÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹-

ÙˆÓ Î·È ÙÔÓ Ú·ÎÙÈÎfi Û˘ÏÏÔÁÈÛÌfi (10). ∆· ·È‰È¿ ıˆڋıË-

Î·Ó fiÙÈ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο Ì ÌÈ· ‚·ıÌÔÏÔÁ›· >85, Ì ‹ÈÔ ‹

̤ÙÚÈÔ˘ ‚·ıÌÔ‡ Úfi‚ÏËÌ· Ì ‚·ıÌÔÏÔÁ›· 70-85 Î·È Ì ÛÔ-

‚·Úfi Úfi‚ÏËÌ· ÌÂ ‚·ıÌÔÏÔÁ›· <70. ∆Ô Miller Assessment for

Preschoolers Â›Ó·È ÌÈ· ‰ÔÎÈÌ·Û›· Ô˘ ÂÎÙÈÌ¿ ›Û˘ ÙËÓ ·Ó¿-

Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·. √È ÙÔÌ›˜ Ô˘

ÂÍÂÙ¿˙ÔÓÙ·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙÔ˘˜ ÂÍ‹˜ ‰Â›ÎÙ˜ ·fi‰Ô-

Û˘: ÙÔÓ ‰Â›ÎÙË ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔًوÓ, ÙÔÓ

‰Â›ÎÙË Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛˆÓ, ÙÔÓ ÏÂÎÙÈÎfi ‰Â›ÎÙË, ÙÔÓ

ÌË ÏÂÎÙÈÎfi ‰Â›ÎÙË Î·È ÙÔÓ ‰Â›ÎÙË Û˘Ó‰˘·ÛÌ¤ÓˆÓ ‰ÂÍÈÔًوÓ

(Ô˘ Û˘Ó‰˘¿˙ÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ·ÈÛıËÙÈÎÒÓ, ÎÈÓËÙÈÎÒÓ, ηÈ

ÁÓˆÛÙÈÎÒÓ ÈηÓÔًوÓ) (11) ∆· ·È‰È¿ ıˆڋıËÎ·Ó fiÙÈ ‹Ù·Ó

Ê˘ÛÈÔÏÔÁÈο Ì ‚·ıÌÔÏÔÁ›· >25, Ì ‹ÈÔ/̤ÙÚÈÔ˘ ‚·ıÌÔ‡

Úfi‚ÏËÌ· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂ

‚·ıÌÔÏÔÁ›· 6-25, Î·È ÛÔ‚·Ú‹ ·Ó·ËÚ›· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ıÂÚ·-

¢ÙÈÎfi ÚfiÁÚ·ÌÌ· Ì ‚·ıÌÔÏÔÁ›· <5.

™ÙË ÏÂÙÔÌÂÚ‹ ÂÎÙ›ÌËÛË ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ

ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Û˘ÌÌÂÙ›¯·Ó ÙÚÂȘ ÓÂÔÁÓÔÏfiÁÔÈ ÂÎ ÙˆÓ ÔÔ›-

ˆÓ Ô ¤Ó·˜ Ì ÂÍÂȉ›Î¢ÛË ÛÙË Ó¢ÚÔÏÔÁ›· ÙÔ˘ ÓÂÔÁÓÔ‡, ‰‡Ô

·Ó·Ù˘ÍÈ·ÎÔ› ·È‰›·ÙÚÔÈ Î·È ¤Ó·˜ ÂÚÁÔıÂÚ·Â˘Ù‹˜. ∞Ó¿ÏÔ-

Á· Ì ٷ ·ÔÙÂϤÛÌ·Ù·, Â¿Ó ˘‹Ú¯Â ¤Ó‰ÂÈÍË, ÚÔÙÂÈÓfiÙ·Ó

ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘: ÂÚÁÔıÂڷ›·, ÏÔÁÔıÂڷ›·, ·È-

‰·ÁˆÁÈ΋ / ÂÎ·È‰Â˘ÙÈ΋ ··Û¯fiÏËÛË ‹ ·ÏÒ˜ ÊÔ›ÙËÛË ÛÙÔ

ÚÔÓ‹ÈÔ.

™ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ Mann-

Whitney test ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘ÁÎÚÈıÔ‡Ó Ù· ·ÔÙÂϤÛÌ·Ù·

ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÛÙ· ÚfiˆÚ· Ì ‚¿-

ÚÔ˜ Á¤ÓÓËÛ˘ <1000 g (ÔÌ¿‰· ∞) Û ۇÁÎÚÈÛË Ì ·˘Ù¿ Ì ‚¿-

ÚÔ˜ Á¤ÓÓËÛ˘ 1001-1500 g (ÔÌ¿‰· µ).

∞ÔÙÂϤÛÌ·Ù·

™ÙËÓ ËÏÈΛ· ÙˆÓ 18-24 ÌËÓÒÓ ¤ÓÙ ·È‰È¿

(12,5%) ›¯·Ó ÛÔ‚·Ú‹ ·Ó·ËÚ›·, 14 (35%) ›¯·Ó

‹È· ÚÔ‚Ï‹Ì·Ù· Î·È Ù· ˘fiÏÔÈ· 21 (52,5%) ‹Ù·Ó

Ê˘ÛÈÔÏÔÁÈο.

™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, Ù¤ÛÛÂÚ· ·È‰È¿

›¯·Ó ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (10%). ∞fi ·˘Ù¿ ¤Ó·

›¯Â Û·ÛÙÈ΋ ‰ÈÏËÁ›·, ¤Ó· ›¯Â Û·ÛÙÈ΋ ÙÂÙÚ·-

ÏËÁ›· Î·È ‰‡Ô ›¯·Ó ËÌÈÏËÁ›·. ∏ ÂÁÎÂÊ·ÏÈ΋ ·-

Ú¿Ï˘ÛË Â›¯Â ‹‰Ë ‰È·ÁÓˆÛÙ› Î·È ÛÙ· Ù¤ÛÛÂÚ· ·È‰È¿

·fi ÙËÓ Âͤٷۋ ÙÔ˘˜ ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜. ∆·

˘fiÏÔÈ· 36 ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ Ê˘ÛÈÔÏÔÁÈο ‹

ˆ˜ ¤¯ÔÓÙ· ‹È˜ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜. °È· ÙËÓ

·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·ÔÎÏ›ÛıËÎ·Ó Ù·

·È‰È¿ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÂÓÒ ÂÚÈÂÏ‹ÊıË-

Û·Ó Ù· 36 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÂͤÏÈÍË ‹ Ì ‹È˜

ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜.

∆Ô Touwen examination for minor neurological

dysfunctions ¤‰ÂÈÍ fiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ ÌÂ

‚·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‹Ù·Ó ˘„ËÏfi,

΢ڛˆ˜ ÛÙÔÓ ÙÔ̤· ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛˆÓ

(36%), Ù˘ ·‰Ú‹˜ ÎÈÓËÙÈÎfiÙËÙ·˜ (45%) Î·È ÙËÓ ·-

ÚÔ˘Û›· Û˘ÁÎÈÓËÛÈÒÓ (39%) (∂ÈÎfiÓ· 1). ∏ ‚·ıÌÔÏÔ-

Á›· ÛÙÔ Griffiths Mental Development scales ‹Ù·Ó

ηٿ ̤ÛÔÓ fiÚÔ ¯·ÌËÏ‹ ÛÙÔ˘˜ ÙÔÌ›˜ ÙÔ˘ ÔÙÈÎÔÎÈ-

ÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ (̤ÛË ÙÈÌ‹=90,11, SD=15,78)

Î·È Ù˘ ÂÎÙ¤ÏÂÛ˘ ‰ÂÍÈÔÙ‹ÙˆÓ (̤ÛË ÙÈÌ‹=93,60,

SD=14,96) (∂ÈÎfiÓ· 2). ™ÙÔ Miller Assessment for

Preschoolers, ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ Ê¿ÓËÎÂ

fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ô˘

·ÊÔÚ¿ ÛÙÔ˘˜ ÙÔÌ›˜ ÙˆÓ ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈ-

ÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ (44%), ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹-

ÛÂˆÓ (56%) Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜

(44%) (∂ÈÎfiÓ· 3). ∂›Û˘ Ë ›‰È· ‰ÔÎÈÌ·Û›· ¤‰ÂÈÍÂ

ˆ˜ Û ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ·È‰ÈÒÓ ··ÈÙÂ›Ù·È ·-

ڤ̂·ÛË Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ‰ÔÎÈÌ·Û›·˜, Ô˘

·ÊÔÚ¿ ÛÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔÌ›˜, ÛÙÔÓ ÙÔ̤· ÙˆÓ ‚·ÛÈÎÒÓ

·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ (14%), ÙÔ˘ Û˘ÓÙÔ-

ÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ (14%) Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜

‰ÂÍÈfiÙËÙ˜ (14%) (∂ÈÎfiÓ· 4). √ Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ

·Ú·¿Óˆ ‰ÔÎÈÌ·ÛÈÒÓ ‰Â›¯ÓÂÈ fiÙÈ ÙÔ Û˘ÓËı¤ÛÙÂÚÔ

Úfi‚ÏËÌ· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂ-

ÔÁÓ¿ Â›Ó·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂ-

ˆÓ Î·È ÙˆÓ Û˘Óı¤ÙˆÓ ‰ÂÍÈÔًوÓ.

™˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ÚÔÒÚˆÓ ÓÂÔ-

ÁÓÒÓ, Ù· ÓÂÔÁÓ¿ Ì ¯·ÌËÏfiÙÂÚÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÛÙÔ

Griffiths Mental Development scales ›¯·Ó ÛËÌ·ÓÙÈ-

ο ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔ˘˜ ÙÔÌ›˜ Ù˘ ÚÔ-

ÛˆÈÎfiÙËÙ·˜ / ÎÔÈÓˆÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ù˘ ÂÎÙ¤-

ÏÂÛ˘ ‰ÂÍÈÔÙ‹ÙˆÓ Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi ‰Â›ÎÙË ·Ó¿-

Ù˘Í˘. ™ÙÔ Miller Assessment for Preschoolers ›-

¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔÓ ‰Â›ÎÙË

∞ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi˜

™Ù¿ÛË ÛÒÌ·ÙÔ˜

πÛÔÚÚÔ›· ÎÔÚÌÔ‡

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

¢˘ÛÎÈÓËÛ›·

∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·

¶ÔÈfiÙËÙ· ÎÈÓ‹ÛˆÓ

™˘ÁÎÈÓËۛ˜

ŸÚ·ÛË

0 10 20 30 40 50% ·È‰ÈÒÓ Ì ‚·ıÌÔÏÔÁ›·

οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡

27

21

9

36

3

45

3

39

6

∂ÈÎfiÓ· 1. ¡Â˘ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË (Touwen).

117¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÓÂÔÁÓÒÓ

¶·È‰È·ÙÚÈ΋ 2007;70:115-122

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·117

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ÙˆÓ ‚·ÛÈÎÒÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔًوÓ, ÛÙÔÓ

‰Â›ÎÙË Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛˆÓ, ÛÙÔÓ ÏÂÎÙÈÎfi

‰Â›ÎÙË Î·È ÛÙÔÓ Û˘ÓÔÏÈÎfi ‰Â›ÎÙË (¶›Ó·Î·˜ 1).

ŒÁÈÓ ۇÁÎÚÈÛË ÌÂٷ͇ Ù˘ ÂÎÙ›ÌËÛ˘ ÛÙËÓ ËÏÈ-

Λ· ÙˆÓ 18-24 ÌËÓÒÓ Î·È ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙȘ

‰È¿ÊÔÚ˜ ‰ÔÎÈ̷ۛ˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ·. ∆· ·È‰È¿

Ô˘ ›¯·Ó ıˆÚËı› ˆ˜ Ê˘ÛÈÔÏÔÁÈο ÛÙÔ˘˜ 18-24 Ì‹-

Ó˜ Î·È Â›¯·Ó ¯·ÌËÏ¿ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰ÔÎÈ̷ۛ˜

ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ·, Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∞fi

Ù· ·È‰È¿ Ô˘ ›¯·Ó ıˆÚËı› Ê˘ÛÈÔÏÔÁÈο, ›¯·Ó

ÌÂȈ̤ÓË ·fi‰ÔÛË ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ÛÙÔ Touwen

test: 19% ÛÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ̤·, 19% ÛÙÔÓ

Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È 33,3% ÛÙËÓ ·‰Ú‹ ÎÈ-

ÓËÙÈÎfiÙËÙ·. ∂›Û˘ ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË ÛÙÔ

Griffiths test: 36,8% ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈ-

ÛÌfi, Î·È 25% ÛÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔًوÓ. ∆¤ÏÔ˜ ÛÙÔ

Miller test, ›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË Î·È ¯ÚÂÈ¿˙ÔÓÙ·Ó

Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË 47,6% ÛÙÔÓ Û˘ÓÙÔÓÈ-

ÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ, ·ÏÏ¿ ۯ‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔ-

Ì›˜, ÌÂٷ͇ 28,6% Î·È 38,1%. ∂›Û˘, ·ÚÔ˘Û›·˙·Ó

ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Ô˘ ··ÈÙÔ‡Û·Ó ÂÚÁÔıÂÚ·-

›·, 14,3% ÛÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfi-

ÙËÙ˜ Î·È 9,5% ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ.

™ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ

¿Ô„Ë Ô˘ ›¯·Ó Û¯ÂÙÈο Ì ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡

ÙÔ˘˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ˙ˆ‹˜, 34 (85%) ıÂÒÚËÛ·Ó

fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, 5 (12,5%) fiÙÈ

¤¯ÂÈ Î¿ÔȘ ‰˘ÛÎÔϛ˜ Î·È 1 (2,5%) fiÙÈ ¤¯ÂÈ ÛÔ‚·-

Ú¿ ÚÔ‚Ï‹Ì·Ù·.

∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¿Ô„˘ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙ·

Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· Î·È ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙȘ ‰È¿ÊÔ-

Ú˜ ‰ÔÎÈ̷ۛ˜ ÛÙ· Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· Ê·›ÓÔÓÙ·È ÛÙÔÓ

¶›Ó·Î· 3. ∞fi Ù· ·È‰È¿ Ô˘ ıˆڋıËÎ·Ó Ê˘ÛÈÔÏÔ-

ÁÈο ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ÛÙÔ Touwen test οÔÈ·

›¯·Ó ÌÂȈ̤ÓË ·fi‰ÔÛË, ΢ڛˆ˜ ÛÙÔÓ ·ÈÛıËÙÈÎÔÎÈ-

ÓËÙÈÎfi ÙÔ̤· (26,5%), ÛÙË ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜

(20,6%), ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ (37,5%),

ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· (46,9) Î·È ÛÙȘ Û˘ÁÎÈÓËۛ˜

(40,6%). ™ÙÔ Griffiths test οÔÈ· ›¯·Ó ‹È· ‹ ̤ÙÚÈ·

ÌÂȈ̤ÓË ·fi‰ÔÛË, ΢ڛˆ˜ ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘-

ÓÙÔÓÈÛÌfi (40,6%) Î·È ÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔًوÓ

(24,2%). ™ÙÔ Miller test οÔÈ· ›¯·Ó ‰˘ÛÎÔϛ˜ Ô˘

¯ÚÂÈ¿˙ÔÓÙ·Ó Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË, ۯ‰fiÓ

Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜, 32,4% ÛÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔ-

ÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜, 44,1% ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈ-

Ó‹ÛˆÓ, 32,4% ÛÙÔÓ ÏÂÎÙÈÎfi ‰Â›ÎÙË Î·È 29,4 ÛÙȘ Û˘Ó-

‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜. ™ÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓË-

ÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜, ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È

ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ 14,7% ÙˆÓ ·È‰ÈÒÓ Â›-

¯·Ó ·fi‰ÔÛË Ô˘ ··ÈÙÔ‡Û ÂÚÁÔıÂڷ›·.

™Â Û¯¤ÛË Ì ÙËÓ ¤ÓÙ·ÍË ÛÙÔ ÔÚÁ·ÓˆÌ¤ÓÔ Úfi-

ÁÚ·ÌÌ· ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡, ÌfiÓÔ 19 (47,5%) ·È‰È¿

‹Á·ÈÓ·Ó ÛÙÔÓ ·È‰ÈÎfi ÛÙ·ıÌfi ‹ ÛÙÔ ÚÔÓ‹ÈÔ

ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ.

™˘˙‹ÙËÛË

∆· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ›-

Ó·È ·ÓÒÚÈÌÔÈ ÔÚÁ·ÓÈÛÌÔ› Ì ÂÁΤʷÏÔ ÂÍ·ÈÚÂÙÈο

1101009080ª¤ÛË ÙÈÌ‹ Î·È 95%

¢È¿ÛÙËÌ· ∂ÌÈÛÙÔÛ‡Ó˘

∞Ó·Ù˘Íȷ΋ ∂ÎÙ›ÌËÛË (Griffiths)

¶Ú·ÎÙÈÎfi˜ Û˘ÏÔÁÈÛÌfi˜

¢ÂÍÈfiÙËÙ·

√ÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓ.

∞ÎÔ‹-§fiÁÔ˜

¶ÚÔÛˆ./∫ÔÈÓˆÓ.

∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·

°ÂÓÈÎfi˜ ∞Ó·Ù˘ÍÈ·Îfi˜ ¢.

∂ÈÎfiÓ· 2. AÓ·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (Griffiths).

0 10 20 30 40 50 60% ·È‰ÈÒÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È

·Ú·ÎÔÏÔ‡ıËÛË

44

56

31

8

44

44

µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜

‰ÂÍÈfiÙËÙ˜™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

§ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

™˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜

°ÂÓÈÎfi˜ ‰Â›ÎÙ˘

∂ÈÎfiÓ· 3. ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (Miller).

µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜

‰ÂÍÈfiÙËÙ˜

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛˆÓ

§ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

™˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜

°ÂÓÈÎfi˜ ‰Â›ÎÙ˘

0 5 10 15 20 25 30

% ·È‰ÈÒÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È

ÂÚÁÔıÂڷ›·

14

14

0

0

14

3

∂ÈÎfiÓ· 4. ∞Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË (Miller).

118 ∂. ªÔ‡˙· Î·È Û˘Ó.

Paediatriki 2007;70:115-122

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Page 50: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

¢¿ÏˆÙÔ Û ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∆fiÛÔ ÂÓ-

‰ÔÌ‹ÙÚÈÔÈ fiÛÔ Î·È Â͈̋ÙÚÈÔÈ ‚Ï·ÙÈÎÔ› ·Ú¿ÁÔ-

ÓÙ˜ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ ‹ ÌÈ-

ÎÚfiÙÂÚ˜ ÂÁÎÂÊ·ÏÈΤ˜ ‚Ï¿‚˜ Ì ·ÔÙ¤ÏÂÛÌ· ÛÔ-

‚·Ú¿ ‹ ËÈfiÙÂÚ· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·.

∆Ô ÛÔ‚·ÚfiÙÂÚÔ Ó¢ÚÔÏÔÁÈÎfi Úfi‚ÏËÌ· ÛÙ· ·È‰È¿

·˘Ù¿ Â›Ó·È Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË. ™ÙË ÌÂϤÙË

Ì·˜, 10% ÙˆÓ ·È‰ÈÒÓ Â›¯Â ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË,

ÔÛÔÛÙfi ·Ó¿ÏÔÁÔ Ì ·˘Ùfi Ô˘ ·Ó·Ê¤ÚÂÙ·È Û ¿ÏϘ

ÌÂϤÙ˜ (7,7-12,6%) (12). ∆· ÛÔ‚·Ú¿ Ó¢ÚÔ·Ó·Ù˘-

Íȷο ÚÔ‚Ï‹Ì·Ù· ‰È·ÈÛÙÒÓÔÓÙ·È Î˘Ú›ˆ˜ ¤ˆ˜ ÙËÓ

ËÏÈΛ· ÙˆÓ ‰‡Ô ÂÙÒÓ. ™ÙË ÌÂϤÙË ·˘Ù‹ Ù· 4 ·È‰È¿

Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Â›¯·Ó ‹‰Ë ‰È·ÁÓˆÛÙ› ÛÂ

ÌÈÎÚ‹ ËÏÈΛ· Î·È ‚Ú›ÛÎÔÓÙ·Ó Û ÚÔÁÚ¿ÌÌ·Ù· ·Ô-

ηٿÛÙ·Û˘. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó ÌÂÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ (13,14). ™·ÓÈfiÙÂÚ·,ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ÌÈ· ˘ÂډȿÁÓˆÛË ÛÔ‚·ÚÒÓÓ¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙ· ‰‡Ô ¤ÙË,ÂÓÒ ¿ÏÏÔÈ ·Ó·Ê¤ÚÔ˘Ó ·‡ÍËÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·-Ú¿Ï˘Û˘ ÌÂٷ͇ ÂÓ¿ÌÈÛË ¤ÙÔ˘˜ Î·È ¤ÓÙ ÂÙÒÓ. £Â-ˆÚÔ‡Ó Ì¿ÏÈÛÙ· fiÙÈ Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÌÔÚ›ӷ ‰È·ÁÓˆÛÙ› ÔÚÈÛÙÈο ÛÙ· Ù¤ÛÛÂÚ· ¤ÙË (6).

√È ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ì ÙË‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ, ÙÔ ÂÓ-‰È·Ê¤ÚÔÓ ÂÛÙÈ¿˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ‹È· Ó¢ÚÔ-ÏÔÁÈο Î·È ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰ËÌÈ-Ô˘ÚÁÔ‡Ó Ì·ÎÚÔÚfiıÂÛÌ· ÚÔ‚Ï‹Ì·Ù· ÛÙË Û¯ÔÏÈ-΋ ËÏÈΛ·, ·Ú¿ ÛÙ· ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÁÈ· Ù·ÔÔ›· ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÁÓÒÛË Î·È ˆ˜ ÚÔ˜ ÙËÓÚԤϢÛË Î·È ˆ˜ ÚÔ˜ ÙÔ˘˜ ÙÚfiÔ˘˜ ¤ÁηÈÚ˘·Ú¤Ì‚·Û˘. ∏ ‰È¿ÁÓˆÛË ËÈfiÙÂÚˆÓ Ó¢ÚÔ·Ó·-Ù˘ÍÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË ·fiÙË ‰È¿ÁÓˆÛË ÛÔ‚·ÚÒÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿-ÙˆÓ, ÙfiÛÔ ÂÍ·ÈÙ›·˜ Ù˘ ËÏÈΛ·˜ ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ fiÛÔÎ·È ÂÍ·ÈÙ›·˜ Ù˘ ·Ó¿Á΢ ¯Ú‹Û˘ ÂÎÙfi˜ Ù˘ Ó¢ÚÔ-ÏÔÁÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ Î·È ÂÓfi˜ Û˘Ó‰˘·ÛÌÔ‡ ¿ÏψÓÂȉÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÂÚÁ·Ï›ˆÓ Ì ˘„ËÏ‹ ¢·È-ÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ·.

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ôχ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ-΋ ËÏÈΛ· ·ÊÔÚÔ‡Ó ·È‰È¿ ËÏÈΛ·˜ ¤ÓÙ ÂÙÒÓ. √ÈMikkola Î·È Û˘Ó (6) ÂÓÙfiÈÛ·Ó ÚÔ‚Ï‹Ì·Ù· ΢ڛˆ˜·ÈÛıËÙÈÎÔÎÈÓËÙÈο, ÔÙÈÎÔ¯ˆÚÈο, ÏÂÎÙÈ΋˜ ÌÓ‹Ì˘,

¶›Ó·Î·˜ 2. ¶·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂÎÙ›ÌËÛË ÛÙÔ˘˜ 18-24 Ì‹Ó˜ Î·È ¯·ÌËÏ¿ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙ· 4 ¯ÚfiÓÈ·

Touwen test Griffiths test Miller test

µ·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ◊È· ÚÔ‚Ï‹Ì·Ù· (∏) ¶Èı·Ó‹ ∫·ı˘ÛÙ¤ÚËÛË (∫)(<100% ÂÈÙ˘¯›Â˜) ™Ô‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (™) ÃÚÂÈ¿˙ÂÙ·È ·Ú¤Ì‚·ÛË (¶)

∞ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi˜ 4 (19%) ∫ÈÓËÙÈ΋ ·Ó¿Ù˘ÍË µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ÙÔ̤·˜ H 3 (15%) ∫ 6 (29%)™Ù¿ÛË ÛÒÌ·ÙÔ˜ 2 (9%) ™ 0 (0%) ¶ 3 (14,3%)

¶ÚÔÛˆÈÎfiÙËÙ·/ÎÔÈÓˆÓÈÎfiÙËÙ· ™˘ÓÙÔÓÈÛÌfi˜πÛÔÚÚÔ›· ÎÔÚÌÔ‡ 2 (9%) ∏ 2 (10%) ∫ 10 (48%)

™ 0 (0%) ¶ 2 (9,5%)™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛÂˆÓ 4 (19%) ∞ÎÔ‹/ÏfiÁÔ˜ §ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

∏ 1 (5%) ∫ 10 (48%)¢˘ÛÎÈÓËÛ›· 0 (0%) ™ 0 (0%) ¶ 2 (9,5%)

√ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· 7 (33%) ∏ 1 (5%) ∫ 8 (38%)

™ 0 (0%) ¶ 0¶ÔÈfiÙËÙ· ÎÈÓ‹ÛÂˆÓ 0 (0%) ¢ÂÍÈfiÙËÙ˜ ™˘Ó‰È·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜

∏ 7 (37%) ∫ 1 (5%)™˘ÁÎÈÓËۛ˜ 6 (29%) ™ 0 (0%) ¶ 0

¶Ú·ÎÙÈÎfi˜ Û˘ÏÏÔÁÈÛÌfi˜ °ÂÓÈÎfi˜ ‰Â›ÎÙ˘ŸÚ·ÛË 2 (9%) ∏ 5 (25%) ∫ 7 (33%)

™ 0 (0%) ¶ 4 (19%)™˘ÓÔÏÈÎfi ¶ËÏ›ÎÔ

∏ 3 (15%)™ 0 (0%)

119¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÓÂÔÁÓÒÓ

¶·È‰È·ÙÚÈ΋ 2007;70:115-122

¶›Ó·Î·˜ 1. ∞ÓÒÌ·Ï· Â˘Ú‹Ì·Ù· Û ۯ¤ÛË Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘(√Ì¿‰· ∞: <1000 g, √Ì¿‰· µ: 1001-1500 g)

Griffiths Mental Development scalesÚÔÛˆÈÎfiÙËÙ·/ ∞<µ p=0,045ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹ÙˆÓ ∞<µ p=0,015Û˘ÓÔÏÈÎfi˜ ‰Â›ÎÙ˘ ·Ó¿Ù˘Í˘ ∞<µ p=0,016

Miller Assessment for Preschoolers‰Â›ÎÙ˘ ÙˆÓ ‚·ÛÈÎÒÓ ∞<µ p=0,036·ÈÛıËÙÈÎÔÎÈÓËÙÈÎÒÓ ‰ÂÍÈÔÙ‹ÙˆÓ ‰Â›ÎÙ˘ Û˘ÓÙÔÓÈÛÌÔ‡ ÙˆÓ ÎÈÓ‹ÛÂˆÓ ∞<µ p=0,010ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘ ∞<µ p=0,033Û˘ÓÔÏÈÎfi˜ ‰Â›ÎÙ˘ ∞<µ p=0,010

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·119

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ÏfiÁÔ˘ Î·È ÚÔÛÔ¯‹˜. √È Hanke Î·È Û˘Ó (5) ÂÓÙfiÈ-Û·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓÔËÌÔÛ‡Ó˘,ÛÙËÓ ·ÓÙ›ÏË„Ë ÙÔ˘ ÏfiÁÔ˘, ÛÙËÓ ÚÔÛÔ¯‹ ηıÒ˜ ηÈÛÙËÓ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·. ∏ ÛËÌ·Û›· Ù˘ ÚÒÈÌ˘·Ú¤Ì‚·Û˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓÈÛ¯˘ıÔ‡Ó ÔÈ ÔÙÈÎÔ-ÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜ Î·È ÔÈ ÁÓˆÛÙÈΤ˜ ÈηÓfiÙËÙÂ˜ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÙÔÓ›-˙ÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (15). ∂¿Ó Ô ÛÙfi¯Ô˜ Ù˘ ÂÎÙ›-ÌËÛ˘ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Â›Ó·È Ë ¤ÁηÈÚË ·-ڤ̂·ÛË ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ Û¯ÔÏ›Ԣ Ì ÛÎÔfi ÙËÌ›ˆÛË Ù˘ Èı·ÓfiÙËÙ·˜ ‹ Ù˘ ‚·Ú‡ÙËÙ·˜ Ì·ıËÛÈ·-ÎÒÓ ‰˘ÛÎÔÏÈÒÓ, Ë ÂÎÙ›ÌËÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿-ÚˆÓ ÂÙÒÓ ÂӉ›ÎÓ˘Ù·È ·fiÏ˘Ù·. ◊È· Ó¢ÚÔ·Ó·-Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒӷӷʤÚÔÓÙ·È Û ¤Ó· ÔÛÔÛÙfi 34-49% (13,16,17). ∆·ÔÛÔÛÙ¿ ‰È·Ê¤ÚÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔÓ ÏËı˘ÛÌfi Ô˘ÌÂÏÂٿٷÈ, ÙÔÓ ÔÚÈÛÌfi Ù˘ ‚·Ú‡ÙËÙ·˜ ÙÔ˘ ÚÔ‚Ï‹-Ì·ÙÔ˜ Î·È ÙË ÌÂıÔ‰ÔÏÔÁ›·, Î·È Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ·˘ÍË̤ӷ ÛÙ· ÓÂÔÁÓ¿ Ì µ°<1000 g. ∂›Ó·È ΢ڛˆ˜ÚÔ‚Ï‹Ì·Ù· ÎÈÓËÙÈο, ·ÓÙÈÏËÙÈο Î·È ÁÓˆÛÙÈο(7). √ÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ÂÓÙÔ›˙Ô˘Ó ˆ˜ ·ÚÈÔ Úfi-‚ÏËÌ· ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ (6,18). ÕÏÏÔÈÂÚ¢ÓËÙ¤˜ ÂÓÙÔ›˙Ô˘Ó ÈÔ ÂÍÂȉÈÎÂ˘Ì¤Ó·, ÚÔ‚Ï‹-Ì·Ù· ÔÙÈÎÔÎÈÓËÙÈο Î·È ÔÙÈÎÔ¯ˆÚÈο (19). ªÂÁ¿-ÏÔ ÔÛÔÛÙfi ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ·,΢ڛˆ˜ ÛÙ· ·È‰È¿ Ì µ°<1000 g, ¤ˆ˜ 81%(20),ÂÌÔ‰›˙Ô˘Ó ÙÔ ·È‰› ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹, ÛÙËÓ·˘ÙÔÂ͢ËÚ¤ÙËÛË Î·È ÙÔ ·È¯Ó›‰È. √È Forslund ηÈ

Û˘Ó (21) ÂÚÈÁÚ¿ÊÔ˘Ó ¤Ó· Ó¢ÚÔÏÔÁÈÎfi ÚÔÊ›Ï ÛÙ·ÚfiˆÚ· ·È‰È¿ ÛÙ· Ù¤ÛÛÂÚ· ¤ÙË Ì ÌÈ· Û¯ÂÙÈ΋˘ÔÙÔÓ›· Î·È ‰˘ÛÎÔϛ˜ ÛÙËÓ ÈÛÔÚÚÔ›·, ÛÙÔÓ Û˘-ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÛÙËÓ ·‰Ú‹ ÎÈÓËÙÈÎfiÙË-Ù·. √È Fily Î·È Û˘Ó (22) ÛÙ· ÓÂÔÁÓ¿ Ì µ°<1500 g‰Â›¯ÓÔ˘Ó ¤Ó· ÔÛÔÛÙfi ‹ÈˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ‰˘ÛÏÂÈ-ÙÔ˘ÚÁÈÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· 28%, ÙÔ ÔÔ›Ô·ÓȯÓ‡ÂÙ·È Î·È Ì ÙÔ Touwen test Î·È Ì ¤Ó· ·ÏÔ-ÔÈË̤ÓÔ Touwen test Ì ÙËÓ ›‰È· ¢·ÈÛıËÛ›·, ÙÔÔÔ›Ô Ì¿ÏÈÛÙ· ÚÔÙ›ÓÔ˘Ó ˆ˜ ÈÔ Â‡¯ÚËÛÙÔ ÛÙ·Ï·›ÛÈ· ÂÓfi˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔ-ÏÔ‡ıËÛ˘. √È Halsey Î·È Û˘Ó (23) ·Ó·Ê¤ÚÔ˘Ó ÛÂÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÁÓˆÛÙÈΤ˜ ÈηÓfi-ÙËÙ˜ ‰˘Û·Ó¿ÏÔÁ· ¯·ÌËÏ‹ ‚·ıÌÔÏÔÁ›· Û ÙÔÌ›˜fiˆ˜ Ô ÏfiÁÔ˜, Ë ·‰Ú‹ Î·È ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÔÈÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜.

∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì¿˜ ‰Â›¯ÓÔ˘Ó fiÙÈÙÔ Û˘ÓËı¤ÛÙÂÚÔ Úfi‚ÏËÌ· ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿-ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓÂÙÒÓ Â›Ó·È ÔÈ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹-ÛÂˆÓ Î·È ÛÙȘ Û˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜ Î·È Û˘Ìʈ-ÓÔ‡Ó Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜.∆· ÚfiˆÚ· ·È‰È¿ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË Ì·˜·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο Û ¤Ó· ÔÏÔÎÏËÚˆ-̤ÓÔ ÚfiÁÚ·ÌÌ· ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘,Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÏÂÙÔÌÂÚ‹ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛËÎ·È ·‰Úfi ¤ÏÂÁ¯Ô Ù˘ „˘¯ÔÎÈÓËÙÈ΋˜ ÂͤÏÈ͢ ˆ˜ ÙËÓËÏÈΛ· ÙˆÓ ‰‡Ô ÂÙÒÓ. ∏ ÂÎÙ›ÌËÛË Ù˘ Ó¢ÚÔ·Ó·Ù˘-Íȷ΋˜ ÂͤÏÈ͢ ÛÙ· ‰‡Ô ¤ÙË ‰ÂÓ ÚÔ¤‚Ï„ ÌÂ

¶›Ó·Î·˜ 3. ¶·È‰È¿ Ô˘ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ›ÛÙ¢·Ó fiÙÈ ‰ÂÓ Â›¯·Ó Úfi‚ÏËÌ· ÛÙ· 4 ¯ÚfiÓÈ· Î·È ¯·ÌËÏ¿ ·ÔÙÂϤÛÌ·Ù· ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙ· 4 ¯ÚfiÓÈ·

Touwen test Griffiths test Miller test

µ·ıÌÔÏÔÁ›· οو ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ◊È· ÚÔ‚Ï‹Ì·Ù· (∏) ¶Èı·Ó‹ ∫·ı˘ÛÙ¤ÚËÛË (∫)(<100% ÂÈÙ˘¯›Â˜) ™Ô‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (™) ÃÚÂÈ¿˙ÂÙ·È ·Ú¤Ì‚·ÛË (¶)

∞ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi˜ 4 (19%) ∫ÈÓËÙÈ΋ ·Ó¿Ù˘ÍË µ·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜H 3 (9%) ∫ 11 (32%)

™Ù¿ÛË ÛÒÌ·ÙÔ˜ 7 (21%) ™ 1 (3%) ¶ 5 (15%)¶ÚÔÛˆÈÎfiÙËÙ·/ÎÔÈÓˆÓÈÎfiÙËÙ· ™˘ÓÙÔÓÈÛÌfi˜

πÛÔÚÚÔ›· ÎÔÚÌÔ‡ 3 (9%) ∏ 1 (3%) ∫ 15 (44%)™ 0 (0%) ¶ 5 (15%)

™˘ÓÙÔÓÈÛÌfi˜ ÎÈÓ‹ÛÂˆÓ 12 (37%) ∞ÎÔ‹/ÏfiÁÔ˜ §ÂÎÙÈÎfi˜ ‰Â›ÎÙ˘∏ 3 (9%) ∫ 11 (32%)

¢˘ÛÎÈÓËÛ›· 1 (3%) ™ 0 (0%) ¶ 0√ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ªË ÏÂÎÙÈÎfi˜ ‰Â›ÎÙ˘

∞‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· 15 (47%) ∏ 13 (41%) ∫ 3 (9%)™ 0 (0%) ¶ 0

¶ÔÈfiÙËÙ· ÎÈÓ‹ÛÂˆÓ 1 (3%) ¢ÂÍÈfiÙËÙ˜ ™˘Ó‰˘·Ṳ̂Ó˜ ‰ÂÍÈfiÙËÙ˜∏ 8 (24%) ∫ 10 (29%)

™˘ÁÎÈÓËۛ˜ 13 (41%) ™ 1 (3%) ¶ 5 (15%)¶Ú·ÎÙÈÎfi˜ Û˘ÏÏÔÁÈÛÌfi˜ °ÂÓÈÎfi˜ ‰Â›ÎÙ˘

ŸÚ·ÛË 2 (6%) ∏ 3 (9%) ∫ 15 (44%)™ 0 (0%) ¶ 1 (3%)

™˘ÓÔÏÈÎfi ¶ËÏ›ÎÔ∏ 1 (3%)™ 0 (0%)

120 ∂. ªÔ‡˙· Î·È Û˘Ó.

Paediatriki 2007;70:115-122

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121¡Â˘ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÓÂÔÁÓÒÓ

¶·È‰È·ÙÚÈ΋ 2007;70:115-122

·ÎÚ›‚ÂÈ· ÙËÓ ÂͤÏÈÍË ÛÙ· Ù¤ÛÛÂÚ· ¤ÙË, fiˆ˜ ˘Ô-

ÛÙËÚ›˙ÂÙ·È Î·È ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›·. ∫¿ÔÈ· ·fi Ù·

·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË

Û‡Ìʈӷ Ì ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ‰‡Ô ÂÙÒÓ, ›¯·Ó

ÌÂȈ̤ÓË ·fi‰ÔÛË ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ

ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ, ΢ڛˆ˜ ÛÙÔÓ ·ÈÛıËÙÈÎÔÎÈÓËÙÈÎfi ÙÔ-

̤·, ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÙËÓ ·‰Ú‹ ÎÈ-

ÓËÙÈÎfiÙËÙ· ÛÙÔ Touwen test, ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi

Û˘ÓÙÔÓÈÛÌfi, Î·È ÙËÓ ÂÎÙ¤ÏÂÛË ‰ÂÍÈÔÙ‹ÙˆÓ ÛÙÔ

Griffiths test Î·È ÛÙȘ ‚·ÛÈΤ˜ ·ÈÛıËÙÈÎÔÎÈÓËÙÈΤ˜

‰ÂÍÈfiÙËÙ˜ Î·È ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛˆÓ, ·ÏÏ¿

Î·È Û¯Â‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜ ÛÙÔ Miller test. ∏

ÚÒÙË ÂÌÊ¿ÓÈÛË ‹ÈˆÓ Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ÚÔ-

‚ÏËÌ¿ÙˆÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ¤¯ÂÈ ‰È·ÈÛÙˆı›

Î·È Û ¿ÏϘ ÌÂϤÙ˜. ™ÙË ÌÂϤÙË Ù˘ Mikkola ηÈ

Û˘Ó (6), ·fi Ù· ·È‰È¿ Ô˘ ÛÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓ¿ÌÈÛË

¤ÙÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ÛÙËÓ ËÏÈΛ· ÙˆÓ ¤ÓÙÂ

ÂÙÒÓ 1% ›¯Â ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Î·È 7% ‹È·

ÚÔ‚Ï‹Ì·Ù·. ∫·È Û ¿ÏϘ ÌÂϤÙ˜, Ô ·ÚÈıÌfi˜ ÙˆÓ

·È‰ÈÒÓ Ì ‹È· ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛ-

Û¿ÚˆÓ ‹ ¤ÓÙ ÂÙÒÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜

Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ· ÙˆÓ 24 ÌËÓÒÓ (13,16). √È

Goyen Î·È Û˘Ó (20) ·Ó·Ê¤ÚÔ˘Ó, Û ʷÈÓÔÌÂÓÈο ˘ÁÈ‹

ÚfiˆÚ· ÓÂÔÁÓ¿ µ°<1000 g Ô˘ ÂÎÙÈÌ‹ıËÎ·Ó Û ËÏÈ-

Λ· 18 ÌËÓÒÓ, ÙÚÈÒÓ Î·È ¤ÓÙ ÂÙÒÓ, ·˘ÍË̤ÓÔ Ô-

ÛÔÛÙfi ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙË ÏÂÙ‹ ÎÈÓËÙÈÎfiÙËÙ· (54%

¤ˆ˜ 64%), ÂÓÒ ·Ú·Ù‹ÚËÛ·Ó ·‡ÍËÛË ÙˆÓ ÚÔ‚ÏË-

Ì¿ÙˆÓ Ù˘ ·‰Ú‹˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÌÂٷ͇ Ù˘ ËÏÈΛ·˜

ÙˆÓ 18 ÌËÓÒÓ, ÙÚÈÒÓ ÂÙÒÓ Î·È ¤ÓÙ ÂÙÒÓ (·fi 14%

Û 81%), Èı·ÓÒ˜ ÏfiÁˆ Ù˘ ÔÏ˘ÏÔÎfiÙËÙ·˜ ÙˆÓ

‰ÔÎÈÌ·ÛÈÒÓ ÂÎÙ›ÌËÛ˘. ø˜ ·ÈÙ›· ·˘Ù‹˜ Ù˘ ‰È·ÊÔ-

Ú¿˜ ÌÂٷ͇ ‰‡Ô Î·È ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ Èı·ÓÔÏÔÁ›ٷÈ

fiÙÈ Î·ıÒ˜ ÙÔ ·È‰› ÌÂÁ·ÏÒÓÂÈ, οÔȘ ‰˘ÛÏÂÈÙÔ˘Ú-

Á›Â˜ Ô˘ ˘‹Ú¯·Ó Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ ÂÍÂÏ›ÛÛÔ-

ÓÙ·È. ∂›Û˘, ËÈfiÙÂÚ˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜ ÂÌÊ·Ó›˙Ô-

ÓÙ·È Î·ıÒ˜ ·˘Í¿ÓÔÓÙ·È ÔÈ ·Ó·Ù˘ÍȷΤ˜ ··ÈÙ‹ÛÂȘ.

∆¤ÏÔ˜, Ë ‰˘Ó·ÙfiÙËÙ· ¯Ú‹Û˘ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ-

˘ Û‡ÓıÂÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Ì ÌÂÁ¿ÏË ‰È·ÁÓˆÛÙÈ΋

‰˘Ó·ÙfiÙËÙ·, ·ÓȯÓ‡ÂÈ ‹È˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜.

√È ÁÔÓ›˜ ‰›ÓÔ˘Ó ÌÈ· ÈÔ ·ÈÛÈfi‰ÔÍË ¿Ô„Ë Ù˘

Ó¢ÚÔ·Ó·Ù˘Íȷ΋˜ ÂÈÎfiÓ·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ ÛÂ

Û¯¤ÛË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ·fi ÙȘ ‰ÔÎÈ̷ۛ˜ ·ÍÈÔ-

ÏfiÁËÛ˘. ŒÙÛÈ, ‰ÂÓ Î·Ù·ÓÔÔ‡Ó ÙËÓ ·Ó¿ÁÎË ¤ÎıÂÛ˘

Û ÂÚÂı›ÛÌ·Ù· ̤۷ ·fi ¤Ó· ÔÚÁ·ÓˆÌ¤ÓÔ ÂÎ·È‰Â˘-

ÙÈÎfi ÚfiÁÚ·ÌÌ· ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡, ·Ú¿ ÙȘ Û˘ÛÙ¿-

ÛÂȘ Ù˘ ÔÌ¿‰·˜ ÙˆÓ È·ÙÚÒÓ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‰È·-

¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™ÙË ÌÂϤÙË Ì·˜ ÌfiÓÔ

47,5% ÙˆÓ ·È‰ÈÒÓ ‹Á·ÈÓ·Ó ÛÙÔÓ ·È‰ÈÎfi ÛÙ·ıÌfi ‹

ÛÙÔ ÚÔÓ‹ÈÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ. ∞È-

ٛ˜ ‹Ù·Ó Ë ÂÔ›ıËÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ Î·Ï‹

ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È Ë ‰Â‰Ô̤ÓË ˘ÂÚÚÔ-

ÛÙ·Û›· Ô˘ Û˘ÓÙÂÏÔ‡Ó ÛÙÔ Ó· ÚÔÙÈÌÔ‡Ó ÙÔ ÈÔ

ÚÔÛÙ·ÙÂ˘Ì¤ÓÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡, ΢ڛˆ˜

·fi ÈÒÛÂȘ, ·ÓÙ› ÁÈ· ÙËÓ ÚÔÛ¯ÔÏÈ΋ Âη›‰Â˘ÛË. ∏

ÊÔ›ÙËÛË ÛÙÔÓ ·È‰ÈÎfi ÛÙ·ıÌfi Î·È ÙÔ ÓËÈ·ÁˆÁ›Ô

·›˙ÂÈ ÌÂÁ¿ÏÔ ÚfiÏÔ ÛÙËÓ ÂͤÏÈÍË ÙˆÓ ÚfiˆÚˆÓ ·È-

‰ÈÒÓ. ™ÙË ÌÂϤÙË ÙˆÓ Liebhardt Î·È Û˘Ó (18), Ù·

ÚfiˆÚ· ·È‰È¿ Ô˘ ‹Á·ÈÓ·Ó ÛÙÔ ÚÔÓ‹ÈÔ ÛÙ·

Ù¤ÛÛÂÚ· ¯ÚfiÓÈ· ›¯·Ó ηχÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙȘ

‰ÔÎÈ̷ۛ˜ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ηχÙÂ-

ÚË ÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È Î·Ï‡ÙÂÚË Û˘ÁΤ-

ÓÙÚˆÛË Î·È Û˘ÓÂÚÁ·Û›· Û ۯ¤ÛË Ì ÚfiˆÚ· Ô˘

‰ÂÓ ‹Á·ÈÓ·Ó ÛÙÔ ÚÔÓ‹ÈÔ.

∆· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ·Îfi-

ÌË Î·È ·˘Ù¿ Ô˘ ÈÛÙ‡ÂÙ·È fiÙÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó

Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù· Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ-

˘, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û ·˘ÍË̤ÓÔ ÔÛÔÛÙfi Ì·ıËÛÈ·-

Τ˜ ‰˘ÛÎÔϛ˜ ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ· (24-28). Œ¯ÂÈ ‚ÚÂ-

ı› οÔÈ· Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙË Ó¢ÚÔ·Ó·Ù˘-

Íȷ΋ ÂÈÎfiÓ· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋

ËÏÈΛ· Î·È ÛÙËÓ ·fi‰ÔÛ‹ ÙÔ˘˜ ÛÙÔ Û¯ÔÏ›Ô

(23,21,29). √È Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÛÙ· ·È‰È¿

Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· ·ÊÔÚÔ‡Ó ‰È¿ÊÔÚÔ˘˜ ÙÔ-

Ì›˜ Ù˘ Ì¿ıËÛ˘. ∏ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ ‰ÂÓ ¤¯ÂÈ ‰È¢-

ÎÚÈÓÈÛÙ› ·ÎÚÈ‚Ò˜, ·ÏÏ¿ ÈÛÙ‡ÂÙ·È fiÙÈ Û˘ÌÌÂÙ¤-

¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÁÓˆÛÙÈΤ˜, ÔÙÈÎÔÎÈÓËÙÈΤ˜, ÔÙÈ-

ÎÔ¯ˆÚÈΤ˜, ÌÓ‹Ì˘, ÏÂÎÙÈΤ˜, Î·È ÂӉ¯Ô̤ӈ˜ ¿Ï-

Ϙ Ô˘ ÚÔ˜ ÙÔ ·ÚfiÓ Â›Ó·È ¿ÁÓˆÛÙ˜ (24). √

Marlow Î·È Û˘Ó Û˘Û¯ÂÙ›˙ÂÈ ‹È˜ ÎÈÓËÙÈΤ˜ ‰˘ÛÏÂÈ-

ÙÔ˘ÚÁ›Â˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Ì ̷ıËÛȷΤ˜

‰˘ÛÎÔϛ˜, ΢ڛˆ˜ ÛÙ· Ì·ıËÌ·ÙÈο (30). √

Sommerfelt (31) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ÚÔ‚Ï‹Ì·Ù· ÛÙÔÓ

ÏfiÁÔ Î·ıÒ˜ Î·È ÔÙÈÎÔÎÈÓËÙÈΤ˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›Â˜

ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ÛÙ· ÚfiˆÚ· ·È‰È¿ ›ӷÈ

Úfi‰ÚÔÌ· Â˘Ú‹Ì·Ù· Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ.

¶·Ú¿ ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂ-

ÔÁÓÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤Ó-

ÓËÛ˘ ÓÂÔÁÓÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÔ‚·Ú¿ Î·È Î˘-

Ú›ˆ˜ ËÈfiÙÂÚ· Ó¢ÚÔ·Ó·Ù˘Íȷο ÚÔ‚Ï‹Ì·Ù·

·Ú·Ì¤ÓÂÈ ·˘ÍË̤ÓÔ. ∏ ÏÂÙÔÌÂÚ‹˜ ÂͤٷÛË ÌÂ

‰ÔÌË̤Ó˜ ‰ÔÎÈ̷ۛ˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·

·ÓȯÓ‡ÂÈ ‹È˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ‰ÂÓ Â›¯·Ó ‰È·È-

ÛÙˆı› Û ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘. ™˘ÓÂÒ˜, Ù· ÚÔ-

ÁÚ¿ÌÌ·Ù· ‰È·¯ÚÔÓÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÚÔÒÚˆÓ

·È‰ÈÒÓ ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔ-

ÁÓÒÓ, Ù· ÔÔ›· Û˘Ó‹ıˆ˜ ÛÙ·Ì·ÙÔ‡Ó ÛÙËÓ ËÏÈΛ·

ÙˆÓ ‰‡Ô ÂÙÒÓ Ú¤ÂÈ Ó· ÂÎÙ›ÓÔÓÙ·È ¤ˆ˜ ÙËÓ ÚÔ-

Û¯ÔÏÈ΋ Î·È Û¯ÔÏÈ΋ ËÏÈΛ·.

µÈ‚ÏÈÔÁÚ·Ê›·

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122 ∂. ªÔ‡˙· Î·È Û˘Ó.

Paediatriki 2007;70:115-122

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123∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈ΋ 2007;70:123-134

∫·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Û ·È‰È¿

Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·: ¿ÌÂÛ· Î·È Ì·ÎÚÔÚfiıÂÛÌ·

·ÔÙÂϤÛÌ·Ù·

π. ¶··ÁÈ¿ÓÓ˘1, °. ∫˘Ú‚·Û›Ï˘2, π. ™ÔÊÈ·Ó›‰Ô˘2, ∫. §¿ÛηÚË1, ª. ∫È¿ÊÊ·1, ™. ∞ÔÛÙÔÏÔÔ‡ÏÔ˘1, ™. ƒ¿ÌÌÔ˜1

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ˘ÂÚÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ ÛÙ· ·È‰È¿ Â›Ó·È ¤Ó· ·Ú·ÏËڈ̷ÙÈÎfi ‰Â-Ì¿ÙÈÔ (¶¢). §fiÁˆ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ, Ë ¯ÚfiÓÈ· ‹‰È¿ ‚›Ô˘ ·ÓÙÈ·ÚÚ˘ıÌÈ΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ‰ÂÓ Â›Ó·È È‰Â҉˘ χÛË. ∏ Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘-¯ÓfiÙËÙ·˜ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÚÈ˙È΋ ıÂڷ›·. ∏ ÌÂϤÙË ·˘Ù‹ ›¯Â ˆ˜ ÛÎÔfi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ¿ÌÂÛˆÓÎ·È Ì·ÎÚÔÚfiıÂÛÌˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·Ù¿Ï˘Û˘ ¶¢ ÛÙ· ·È‰È¿ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∂ÍÂÙ¿ÛÙËÎ·Ó ·Ó·‰ÚÔÌÈο Ù· ÛÙÔȯ›· 94 ·È‰ÈÒÓ, ËÏÈΛ·˜ 4-18 (12,3±3,6) ÂÙÒÓ, Ô˘˘Ô‚Ï‹ıËÎ·Ó Û ϋÚË ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È Î·Ù¿Ï˘ÛË ¶¢. √È ÂӉ›ÍÂȘ Î·Ù¿Ï˘Û˘ ÂÚÈÂ-Ï¿Ì‚·Ó·Ó: ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (78), Û˘ÁÎÔ‹ (9), Ù·¯Â›· ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹ Ì ηډÈÔÁÂÓ¤˜shock (2) Î·È ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ‚Ú·¯Â›· ÔÚıfi‰ÚÔÌË ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô ÙÔ˘ ¶¢ (5).

∞ÔÙÂϤÛÌ·Ù·: ∏ ÙÂÏÈ΋ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘ ¶¢ ÌÂÙ¿ ·fi Ù˘¯fiÓ ˘ÔÙÚÔ¤˜, ‹Ù·Ó 96%. ™Â ·ÛıÂÓ›˜Ì ÚfiÛıÈ·/‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο ¶¢ ·Ú·ÙËÚ‹ıËΠ˘„ËÏfiÙÂÚÔ˜ ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘ (p=0,05)Î·È ¯·ÌËÏfiÙÂÚË ÙÂÏÈ΋ ÂÈÙ˘¯›· (p=0,02). √È ˘fiÏÔȘ ηÙËÁÔڛ˜ ›¯·Ó ·ÚfiÌÔÈ· ÌÂٷ͇ ÙÔ˘˜ ·ÔÙÂ-ϤÛÌ·Ù·. ∆· ‰ÂÍÈ¿ Ï¿ÁÈ· ¶¢ ›¯·Ó ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (p<0,001). √È ˘Ô-ÙÚÔ¤˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚ˜ Û ·ÛıÂÓ›˜ Ì ÔÏÏ·Ï¿ ¶¢ (p=0,007). ¶·Ú·ÙËÚ‹ıËΠÌfiÓÔ Ì›· ¯ÚfiÓÈ· ÂÈ-ÏÔ΋ (·Ó¿ÚÎÂÈ· ·ÔÚÙ‹˜ ÌÂÙ¿ ·fi Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ Ì ‰È·ÔÚÙÈ΋Ù¯ÓÈ΋). ¶·ÚÔ‰ÈΤ˜ ÂÈÏÔΤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Û 3 ·ÛıÂÓ›˜ (ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ Û 2 Î·È Â-ÚÈηډȷ΋ Û˘ÏÏÔÁ‹ Û 1). ∏ ÙÂÏÈ΋ ÂÈÙ˘¯›· Ù˘ ¤̂·Û˘ Î·È Ù· ÔÛÔÛÙ¿ ˘ÔÙÚÔÒÓ Î·È ÂÈÏÔÎÒÓ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙ· Ù˘ ËÏÈΛ·˜.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Î·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÚÈ˙È΋ ıÂڷ›· Ì ˘„ËÏ¿ ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ Î·È ¯·ÌËÏfi ΛӉ˘ÓÔ ÂÈÏÔÎÒÓ, ¯ˆ-Ú›˜ ‰È·ÊÔÚ¤˜ ÛÙ· ·ÔÙÂϤÛÌ·Ù· Û ËÏÈ˘ ¿Óˆ ÙˆÓ 4 ÂÙÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ, Î·Ù¿Ï˘ÛË, Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜.

Radiofrequency catheter ablation of accessory pathways in children:

immediate and long-term results

J. Papagiannis1, G. Kirvassilis2, I. Sofianidou2, C. Laskari1, M. Kiaffas1, S. Apostolopoulou1, S. Rammos1

Abstract

Background: The most common cause of supraventricular tachycardia in children is an accessory pathway(AP). Because of the chronic course, long-term treatment with antiarrhythmic drugs is not an ideal solu-tion. Radiofrequency ablation (RFA) may offer curative treatment. The purpose of this study was to analyzethe immediate and long-term outcome of radiofrequency ablation of accessory pathways in children.

Methods: The charts were reviewed retrospectively of 94 children aged 4-18 (12.3±3.6) years who had un-dergone complete electrophysiologic study and radiofrequency ablation of AP. The indications for ablationwere: supraventricular tachycardia (78), syncope (9), rapidly occurring atrial fibrillation with cardiogenicshock (2) and asymptomatic patients with a short antegrade accessory pathway refractory period (5).

Results: The final success rate of AP ablation, after possible recurrences, was 96%. Longer fluoroscopytime (p=0.05) and a lower final success rate (p=0.02) were observed in patients with anterior/mid-sep-tal AP. The other categories had comparably favourable results. Patients with right lateral AP had ahigher prevalence of congenital heart disease (p<0.001). Recurrences were more frequent in patientswith multiple AP (p=0.007). There was only one permanent complication, a patient who had aortic in-sufficiency after retrograde transaortic ablation of left lateral AP). Transient complications were ob-served in 3 patients (temporary atrioventricular block in 2 and pericardial effusion in one). The finalsuccess, recurrence rates and complication rates were independent of age.

1 ¶·È‰ÔηډÈÔÏÔÁÈÎfi∆Ì‹Ì·, øÓ¿ÛÂÈÔ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi∫¤ÓÙÚÔ, ∞ı‹Ó·

2 ¶·È‰Ô·Ó·ÈÛıËÛÈÔÏÔÁÈÎfi∆Ì‹Ì·, øÓ¿ÛÂÈÔ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi∫¤ÓÙÚÔ, ∞ı‹Ó·

AÏÏËÏÔÁÚ·Ê›·:

πˆ¿ÓÓ˘ ¶··ÁÈ¿ÓÓ˘ [email protected] øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi∫¤ÓÙÚÔ §. ™˘ÁÁÚÔ‡ 356,∆.∫. 176 74, ∫·ÏÏÈı¤·

1 Paediatric CardiologyDepartment, OnassisCardiac Surgery Center,Athens

2 PaediatricAnaesthesiologyDepartment, OnassisCardiac Surgery Center,Athens

Correspondence:

John Papagiannis [email protected] Cardiac SurgeryCenter 356, Sygrou Ave. 176 74, Kallithea, Athens

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·123

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Conclusions: Radiofrequency catheter ablation of accessory pathways in children may offer a perma-nent cure, with high success and low complication rates and without differences in outcome in patientsabove 4 years of age.

Key words: Supraventricular tachycardia, accessory pathway, radiofrequency ablation.

™˘ÓÙÔÌÔÁڷʛ˜

À∆ ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· ¶¢ ¶·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ ƒƒ ƒÂ‡Ì· Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ∏ºª ∏ÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ™∫ ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·

∂ÈÛ·ÁˆÁ‹

∏ ˘ÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (À∆) ·ÔÙÂÏ›ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ ÛÙËÓ ·È‰È΋ËÏÈΛ·, Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÓÔ¯ÏËÙÈÎ¿Û˘ÌÙÒÌ·Ù·, ÂÈÛΤ„ÂȘ Û ÙÌ‹Ì·Ù· ÂÂÈÁfi-ÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ·ÔÎÏÂÈÛÌfi ·fi ·ıÏËÙÈ-Τ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ¿Á¯Ô˜, ÂÓÒ - Û·ÓÈfiÙÂ-Ú· - ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ Î›Ó‰˘ÓÔ ÁÈ· ÙË ˙ˆ‹.∏ Û˘¯ÓfiÙËÙ· Ù˘ À∆ ÛÙ· ·È‰È¿ ÂÎÙÈÌ¿Ù·È fiÙÈÂ›Ó·È ÂÚ›Ô˘ 1:250 ·È‰È¿ (1). ∏ Û˘¯ÓfiÙÂÚË·ÈÙ›· À∆ ÛÙ· ·È‰È¿ Â›Ó·È ¤Ó· ·Ú·ÏËڈ̷ÙÈ-Îfi ‰ÂÌ¿ÙÈÔ (¶¢), Ô˘ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÙ·ÈÌ ÙË ÌÔÚÊ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Wolff-Parkinson-White (‰ËÏ·‰‹ ‚Ú·¯‡ ‰È¿ÛÙËÌ· PR Î·È Î‡Ì· ‰ÛÙÔ ∏∫°) fiÙ·Ó ¤¯ÂÈ ÔÚıfi‰ÚÔÌË ·ÁˆÁ‹ ‹ Ó· ·-ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° ËÚÂÌ›·˜ fiÙ·Ó‰ÂÓ ¤¯ÂÈ ÔÚıfi‰ÚÔÌË ·ÁˆÁ‹. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÛ‡Ó‰ÚÔÌÔ Wolff-Parkinson-White, ˘¿Ú¯Ô˘ÓÌÂϤÙ˜ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ÙfiÛÔ Û ÂÓ‹ÏÈ-Θ fiÛÔ Î·È Û ·È‰È¿, Ô˘ ‰Â›¯ÓÔ˘Ó Ì›· Û˘-¯ÓfiÙËÙ· ·fi 1,48ò (2) ¤ˆ˜ 3ò (3). ∏ ıÂÚ·-›· Ù˘ À∆ Ì ʿÚ̷η ÌÔÚ› Ó· ¤¯ÂÈ ÛËÌ·-ÓÙÈΤ˜ ·ÚÂÓ¤ÚÁÂȘ ‹ Ó· ÌËÓ Â›Ó·È Ï‹Úˆ˜·ÔÙÂÏÂÛÌ·ÙÈ΋. ∞ÎfiÌË Î·È fiÙ·Ó Â›Ó·È ÂÈÙ˘-¯‹˜, ‰ÂÓ ·ÔÙÂÏ› ȉÂÒ‰Ë Ï‡ÛË, ÏfiÁˆ Ù˘ ·Ó¿-Á΢ ÁÈ· Ì·ÎÚÔ¯ÚfiÓÈ· Û˘Ó¤¯ÈÛ‹ Ù˘ Û ·ÛıÂ-Ó›˜ Ô˘ ¤¯Ô˘Ó ·ÎfiÌË ÔÏϤ˜ ‰ÂηÂٛ˜ ÂÓÂÚ-ÁÔ‡ ˙ˆ‹˜. ∏ ıÂڷ›· ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Ì ÙËÓÙ¯ÓÈ΋ Ù˘ ¯ÔÚ‹ÁËÛ˘ Ú‡̷ÙÔ˜ Ú·‰ÈÔÛ˘¯Ófi-ÙËÙ·˜ (ƒƒ) ̤ۈ ηıÂÙ‹Ú·, ¤¯ÂÈ ·Ó·Ù˘¯ı›ڷÁ‰·›· Ù· ÙÂÏÂ˘Ù·›· 15 ¯ÚfiÓÈ· Î·È ¤¯ÂÈ Î·Ù·-Ï¿‚ÂÈ ÚˆÙÂ‡Ô˘Û· ı¤ÛË (5-11). ∏ ̤ıÔ‰Ô˜ Û˘-Ó›ÛÙ·Ù·È Û ÂÊ·ÚÌÔÁ‹ Ú‡̷ÙÔ˜ Ú·‰ÈÔÛ˘¯Ófi-ÙËÙ·˜ ̤ۈ ÂÓfi˜ ËÏÂÎÙÚÔ‰›Ô˘-ηıÂÙ‹Ú· ÛÙÔÌÔÚÊÔÏÔÁÈÎfi ˘fiÛÙڈ̷ Ù˘ ·ÚÚ˘ıÌ›·˜(fiˆ˜ .¯. ¤Ó· ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ), Ì·ÎfiÏÔ˘ıË ÚfiÎÏËÛË ÈÛÙÈ΋˜ ı¤ÚÌ·ÓÛ˘ ηÈÙÔÈ΋˜ Ó¤ÎÚˆÛ˘. °È· Ó· ÂÓÙÔÈÛÙ› Ë ı¤ÛËÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ Ù˘ ·ÚÚ˘ıÌ›·˜, ÂÎÙÂÏ›ٷÈËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ¯·ÚÙÔÁÚ¿ÊËÛË. ∞Ó Î·È Ë

ÂÂÌ‚·ÙÈ΋ ıÂڷ›· Á›ÓÂÙ·È Â‡ÎÔÏ· ·Ô‰Â-

ÎÙ‹ Û ÂÓ‹ÏÈΘ, Û˘¯Ó¿ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÌÂ

ÛÎÂÙÈÎÈÛÌfi fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·È‰È·ÙÚÈÎÔ‡˜

·ÛıÂÓ›˜. √ Êfi‚Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· Èı·Ó¤˜

ÂÈÏÔΤ˜ Î·È Û˘¯Ó¿ Ë ÂÏÏÈ‹˜ ÂÓË̤ڈÛË

ÙˆÓ ıÂÚ·fiÓÙˆÓ È·ÙÚÒÓ Ô˘ ·Ú¤¯Ô˘Ó ÙËÓ

ÚˆÙÔÁÂÓ‹ ÊÚÔÓÙ›‰· ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ

·ÔÙÂÏÔ‡Ó ·Ó·ÛÙ·ÏÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ

¢ڇÙÂÚË ÂÊ·ÚÌÔÁ‹ ·˘Ù‹˜ Ù˘ ıÂڷ›·˜ ÛÙ·

·È‰È¿. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÚÈÁÚ¿ÊÂÙ·È Ë

ÂÌÂÈÚ›· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙËÓ Î·Ù¿Ï˘ÛË ¶¢

Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÛÙ· ·È‰È¿.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∏ ÌÂϤÙË ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ 94 ·ÛıÂÓ›˜ (37 ÎÔÚ›-

ÙÛÈ·, 57 ·ÁfiÚÈ·) Ì ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ (¶¢),

Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË

(∏ºª) Î·È Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ÛÙÔ

øÓ¿ÛÂÈÔ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ, ηٿ ÙËÓ ÂÚ›Ô‰Ô

01/07/1994 ¤ˆ˜ 30/06/2003. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ

‹Ù·Ó ·fi 4 ¤ˆ˜ 18 ¤ÙË (̤ÛË: 12,3±3,6, ‰È¿ÌÂÛË: 12).

√È ÂӉ›ÍÂȘ Î·Ù¿Ï˘Û˘ ÂÚÈÂÏ¿Ì‚·Ó·Ó: ˘ÂÚÎÔÈÏȷ΋

Ù·¯˘Î·Ú‰›· (78 ·ÛıÂÓ›˜), Û˘ÁÎÔ‹ (9 ·ÛıÂÓ›˜), ÂÂÈ-

Ûfi‰È· Ù·¯Â›·˜ ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Ì ηډÈÔÁÂÓ¤˜

shock (2 ·ÛıÂÓ›˜) Î·È ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ÌÂ

‚Ú·¯Â›· ÔÚıfi‰ÚÔÌË ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô ÙÔ˘ ·Ú·-

ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ (<250 msec) (5 ·ÛıÂÓ›˜). ∏

‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÂÙ¿ ÙËÓ Î·Ù¿Ï˘ÛË ‹Ù·Ó

·fi 2 ¤ˆ˜ 11 ¤ÙË (‰È¿ÌÂÛË: 5). ¢ÂÓ ÂÚÈÂÏ‹ÊıËÛ·Ó

·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Î·Ù¿Ï˘ÛË Ù· ÙÂÏÂ˘Ù·›·

2 ¯ÚfiÓÈ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘¿Ú¯ÂÈ ÈηÓfi˜ ¯ÚfiÓÔ˜ ·-

Ú·ÎÔÏÔ‡ıËÛ˘. ¶ÚÈÓ ·fi ÙËÓ ÂÎÙ¤ÏÂÛË Ù˘ ∏ºª ηÈ

ÙË ‰ÈÂÓ¤ÚÁÂÈ· Î·Ù¿Ï˘Û˘, Ï·Ì‚·ÓfiÙ·Ó ÁÚ·Ù‹ ‰‹ÏˆÛË

Û˘ÁηٿıÂÛ˘ ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·ÛıÂÓÒÓ, ÌÂÙ¿ ·fi

ÏÂÙÔÌÂÚ‹ ÂÂÍ‹ÁËÛË ÙˆÓ ÔÛÔÛÙÒÓ ÂÈÙ˘¯›·˜ ηÈ

ÙˆÓ Èı·ÓÒÓ ÂÈÏÔÎÒÓ.

√È ·ÛıÂÓ›˜ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ϋÚË ∏ºª Î·È Î·-

Ù¿Ï˘ÛË ÙÔ˘ ·ÚÚ˘ıÌÈÔÁfiÓÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜, ›Ù ˘fi

ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›· ›Ù ˘fi ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Î·È Î·-

Ù·ÛÙÔÏ‹ Ì ÂÓ‰ÔÊϤ‚È· ËÚÂÌÈÛÙÈο Î·È ·Ó·ÏÁËÙÈο. ∏

ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›· ÚÔÙÈÌ‹ıËΠÛÙ· ·È‰È¿ ËÏÈΛ·˜ ÌÈ-

ÎÚfiÙÂÚ˘ ÙˆÓ 15 ÂÙÒÓ, ·ÏÏ¿ Î·È Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿

fiÙ·Ó ‹Ù·Ó Ë ÂÈı˘Ì›· ÙÔ˘ ·ÛıÂÓÔ‡˜. ™Ù· ˘fiÏÔÈ· ÌÂ-

Á·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ¯ÔÚËÁ‹ıËΠÂÓ‰Ô-

ÊϤ‚È· ηٷÛÙÔÏ‹ Ì Ìȉ·˙ÔÏ¿ÌË Î·È Âıȉ›ÓË ‹ ÌÔÚ-

Ê›ÓË Î·È ÙÔÈ΋ ·Ó·ÈÛıËÛ›· Ì ˘Ô‰fiÚÈ· ¯ÔÚ‹ÁËÛË Í˘-

ÏÔη˝Ó˘ 1% ÛÙȘ ÂÚÈÔ¯¤˜ ·Ú·Î¤ÓÙËÛ˘. ™Â fiÏÔ˘˜

ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ÔÚËÁÔ‡ÓÙ·Ó ÚÔÏËÙÈ΋ ·ÓÙÈ‚›ˆÛË (1

‰fiÛË ÎÂÊ·ÏÔı›Ó˘ ÂÓ‰ÔÊϤ‚È· ‹ - Û ·ÏÏÂÚÁÈο ÛÙËÓ

ÂÓÈÎÈÏÏ›ÓË ¿ÙÔÌ· - 1 ‰fiÛË ‚·ÓÎÔÌ˘Î›Ó˘) ÚÈÓ ÙËÓ ÂÈ-

Û·ÁˆÁ‹ ÙˆÓ Î·ıÂÙ‹ÚˆÓ.

124 π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Paediatriki 2007;70:123-134

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·124

Page 56: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

∏ ÂÈÛ·ÁˆÁ‹ ÙˆÓ Î·ıÂÙ‹ÚˆÓ-ËÏÂÎÙÚÔ‰›ˆÓ ÁÈÓfiÙ·Ó ‰È·-‰ÂÚÌÈο ÌÂÙ¿ ·fi ·ÔÛÙ›ڈÛË ÙˆÓ ÂÚÈÔ¯ÒÓ ·Ú·Î¤ÓÙË-Û˘ (ÌËÚÈ·›Â˜ ¯ÒÚ˜ ± ÛÊ·Á›Ùȉ˜ ‹ ˘ÔÎÏ›‰È˜ ÂÚÈÔ¯¤˜).∆ÔÔıÂÙÔ‡ÓÙ·Ó Î·ıÂÙ‹Ú˜ (Ì 4-10 ËÏÂÎÙÚfi‰È·) ‰È·Ì¤ÙÚÔ˘4-7 Fr. √È Î·ıÂÙ‹Ú˜ ÙÔÔıÂÙÔ‡ÓÙ·Ó ÛÙȘ Û˘Ó‹ıÂȘ ı¤ÛÂȘ(˘„ËÏfi˜ ‰ÂÍÈfi˜ ÎfiÏÔ˜ ‹ ˆÙ›Ô ‰ÂÍÈÔ‡ ÎfiÏÔ˘ ÁÈ· ηٷÁÚ·-Ê‹ ÎÔÏÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË,‰·ÎÙ‡ÏÈÔ˜ ÙÚÈÁÏÒ¯ÈÓÔ˜ ÁÈ· ηٷÁÚ·Ê‹ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÙÔ˘‰ÂÌ·Ù›Ô˘ ÙÔ˘ His, ÛÙÂÊ·ÓÈ·›Ô˜ ÎfiÏÔ˜ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÈÙÚÔÂȉÈÎÔ‡ ‰·-ÎÙ˘Ï›Ô˘-·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Î·È ÎÔÚ˘Ê‹ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ÁÈ· ηٷÁÚ·Ê‹ Ù˘ ÎÔÈÏȷ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÎÔÈÏȷ΋‚ËÌ·ÙÔ‰fiÙËÛË).

∏ÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË

∏ ‚·ÛÈ΋ ∏ºª ¿Ú¯È˙ Ì ÙË Ì¤ÙÚËÛË ÙˆÓ ‚·ÛÈÎÒÓ ‰È·-ÛÙËÌ¿ÙˆÓ (ÌÂÙÚ‹ÛÂȘ ÙˆÓ ‰È·ÛÙËÌ¿ÙˆÓ PR, QRS, QT, RR·fi ÙÔ ∏∫° ÂÈÊ·Ó›·˜, ηıÒ˜ Î·È ÙˆÓ ‰È·ÛÙËÌ¿ÙˆÓ PA,AH Î·È HV ·fi Ù· ÂÓ‰Ôηډȷο ËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù·). ∞ÎÔ-ÏÔ˘ıÔ‡Û ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÎÔÏÈ΋ ‰È¤ÁÂÚÛË Ì ÎÔÏÈοÚÒÈÌ· ÂÚÂı›ÛÌ·Ù· Î·È ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÌÂ Û˘Ó¯ҘÌÂÈÔ‡ÌÂÓÔ Ì‹ÎÔ˜ ·ÎÏÔ˘ (decremental atrial pacing). ∂›Û˘,Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·Ó ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË Î·Ù¿ ÚȤ˜(burst atrial pacing) Ì ÛÎÔfi ÙËÓ ÚfiÎÏËÛË Ù·¯˘Î·Ú‰ÈÒÓ,Û ÂÚ›ÙˆÛË Ô˘ ·˘Ù¤˜ ‰ÂÓ ÚÔηÏÔ‡ÓÙ·Ó Ì ÙËÓ ÚÔ-ÁÚ·ÌÌ·ÙÈṲ̂ÓË ÎÔÏÈ΋ ‚ËÌ·ÙÔ‰fiÙËÛË.

π‰È·›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈÓfiÙ·Ó ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·ÓÂÚ¤ıÈ-ÛÙ˘ ÂÚÈfi‰Ô˘ ÙÔ˘ ¶¢. À„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ¯·Ú·ÎÙËÚ›ÛÙËηÓÙ· ¶¢ Ì ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô <250 msec.

∞ÎÔÏÔ‡ıˆ˜ ÁÈÓfiÙ·Ó ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ÎÔÈÏȷ΋ ‚ËÌ·-ÙÔ‰fiÙËÛË Ì ÚÒÈÌ· ÎÔÈÏȷο ÂÚÂı›ÛÌ·Ù· Ì ‰È·ÚÎÒ˜ ÌÂÈ-Ô‡ÌÂÓÔ Û˘˙¢ÎÙÈÎfi ‰È¿ÛÙËÌ· Î·È ÎÔÈÏȷ΋ ‚ËÌ·ÙÔ‰fiÙËÛË ÌÂÛ˘Ó¯Ҙ ÌÂÈÔ‡ÌÂÓÔ Ì‹ÎÔ˜ ·ÎÏÔ˘ (decremental ventricularpacing). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÔÈÏȷ΋˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘ ‹Ù˘ Ù·¯˘Î·Ú‰›·˜, ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ‰ÈÓfiÙ·Ó ÛÙËÓ ·ÏÏËÏÔ˘-¯›· Ù˘ ·Ï›Ó‰ÚÔÌ˘ ÎÔÏÈ΋˜ ÂÎfiψÛ˘, Â¿Ó ‰ËÏ·‰‹ ·˘-Ù‹ ·ÎÔÏÔ˘ıÔ‡Û ÎÂÓÙÚÈ΋ ÔÚ›· ̤ۈ ÙÔ˘ ‰ÂÌ·Ù›Ô˘ ÙÔ˘His ‹ ¤ÎÎÂÓÙÚË, ̤ۈ ÂÓfi˜ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘(∂ÈÎfiÓ· 1). ™Â ÂÚ›ÙˆÛË Ô˘ Ë Ù·¯˘Î·Ú‰›· ‰ÂÓ ‹Ù·Ó ÚÔ-

ÎÏËÙ‹ ηٿ ÙË ‚·ÛÈ΋ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË, ¯ÔÚË-ÁÔ‡ÓÙ·Ó ÈÛÔÚÔÙÂÚÂÓfiÏË ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË Ì 0,01mcg/kg/min ·Ú¯Èο Î·È ·˘Í·ÓfiÌÂÓË Ì¤¯ÚȘ fiÙÔ˘ ·Ú·ÙËÚË-ı› Ì›ˆÛË ÙÔ˘ ‚·ÛÈÎÔ‡ Ì‹ÎÔ˘˜ ·ÎÏÔ˘ (·‡ÍËÛË Ù˘ ‚·ÛÈ-΋˜ Û˘¯ÓfiÙËÙ·˜) ηٿ 25-30%. ∫·ÙfiÈÓ, ·ÎÔÏÔ˘ıÔ‡Û ·-Ó·ÏËÙÈ΋ ∏ºª ˘fi ¯ÔÚ‹ÁËÛË ÈÛÔÚÔÙÂÚÂÓfiÏ˘.

∫·Ù¿Ï˘ÛË

ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ∏ºª Î·È ÂÊfiÛÔÓ ·ÔÊ·ÛÈ˙fi-Ù·Ó Ë ÂÚ·ÈÙ¤Úˆ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ·ÎÔÏÔ˘ıÔ‡Û ˯·ÚÙÔÁÚ¿ÊËÛË ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·È Ë Î·Ù¿Ï˘Û‹ ÙÔ˘˜. °È· ÙÔÓÛÎÔfi ·˘Ùfi ÂÈÛ¿ÁÔÓÙ·Ó Ô ÂȉÈÎfi˜ ηıÂÙ‹Ú·˜ Î·Ù¿Ï˘Û˘, ‰È·-̤ÙÚÔ˘ 5-7 Fr (·Ó¿ÏÔÁ· Ì ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜). ∏ ÂÈÛ·-ÁˆÁ‹ ÙÔ˘ ηıÂÙ‹Ú· ¯·ÚÙÔÁÚ¿ÊËÛ˘-Î·Ù¿Ï˘Û˘ ÛÙȘ ÂÚÈÛÛfi-ÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÁÈÓfiÙ·Ó ·fi ÙË ÌËÚÈ·›· ÊϤ‚·. ™Â ·ÛıÂÓ›˜Ì ·ÚÈÛÙÂÚ¿ ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·, Ë ÚfiÛ‚·ÛË ÁÈÓfiÙ·Ó›Ù ·Ï›Ó‰ÚÔÌ· ‰È·Ì¤ÛÔ˘ Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ (∂ÈÎfiÓ· 2),›Ù Ì ÙË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ (transseptal) Ù¯ÓÈ΋ (∂ÈÎfiÓ· 3).∏ ¯ÔÚ‹ÁËÛË Ú‡̷ÙÔ˜ ÁÈÓfiÙ·Ó ·fi Ì›· Û˘Û΢‹ Ô˘ ›¯Â Ùˉ˘Ó·ÙfiÙËÙ· ¯ÔÚ‹ÁËÛ˘ Û˘Ó¯ԇ˜ ËÌÈÙÔÓÔÂȉԇ˜ ÌË ÙÚÔÔ-ÔÈË̤ÓÔ˘ ·̷ÙÔ˜, Ì ̤ÁÈÛÙË ÈÛ¯‡ 50 Watts, Ì ‰˘Ó·ÙfiÙËÙ·Û˘Ó¯ԇ˜ ÂϤÁ¯Ô˘ Î·È ·˘ÙfiÌ·Ù˘ ·Ó·ÚÔÛ·ÚÌÔÁ‹˜ Ù˘ ¯ÔÚË-ÁÔ‡ÌÂÓ˘ ÈÛ¯‡Ô˜ ·Ó¿ÏÔÁ· Ì ÙË ÌÂÙÚÔ‡ÌÂÓË ıÂÚÌÔÎÚ·Û›· ÛÙÔ¿ÎÚÔ ÙÔ˘ ηıÂÙ‹Ú·. ∏ ÂÓ¤ÚÁÂÈ· ¯ÔÚËÁ›ÙÔ ÌÂٷ͇ ÙÔ˘ ÙÂÏÈÎÔ‡ËÏÂÎÙÚÔ‰›Ô˘ ÙÔ˘ ηıÂÙ‹Ú· Î·È ÂÓfi˜ ËÏÂÎÙÚÔ‰›Ô˘-Ͽη˜ Ô˘ÙÔÔıÂÙ›ÙÔ ÛÙËÓ Ï¿ÙË ‹ ÛÙÔÓ ÌËÚfi ÙÔ˘ ·ÛıÂÓÔ‡˜. ∏ ıÂÚÌÔ-ÎÚ·Û›·-ÛÙfi¯Ô˜ ÁÈ· Ù· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ‹Ù·Ó 60-70ÔC (ÂÎÙfi˜ ·fi Ù· ÚfiÛıÈ· ‹ ‰È¿ÌÂÛ· ‰È·ÊÚ·ÁÌ·ÙÈο, ÔfiÙÂË Ì¤ÁÈÛÙË ıÂÚÌÔÎÚ·Û›· ‹Ù·Ó 50-55ÔC). ∏ ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘Ú‡̷ÙÔ˜ ‹Ù·Ó 30-60 sec. ™ÙȘ ÂÚÈÙÒÛÂȘ ÂÈÙ˘¯Ô‡˜ ‚Ï¿‚˘,¯ÔÚËÁÔ‡ÓÙ·Ó Û˘¯Ó¿ Ì›· ÂÈϤÔÓ Û˘Ó‰ڛ· (bonus) ÁÈ· ÔÚÈ-ÛÙÈÎÔÔ›ËÛË ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜.

∏ Î·Ù¿Ï˘ÛË Î·ıÔ‰ËÁ›ÙÔ Â›Ù Ì ÙËÓ ·Ó‡ÚÂÛË Ù˘ Úˆ-ÈÌfiÙÂÚ˘ ·Ï›Ó‰ÚÔÌ˘ ÎÔÏÈ΋˜ ÂÎfiψÛ˘ ηٿ ÙË ‰È¿Ú-ÎÂÈ· Ù˘ Ù·¯˘Î·Ú‰›·˜ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÎÔÈÏȷ΋˜ ‚ËÌ·ÙÔ-‰fiÙËÛ˘, ›Ù Ì ÙËÓ ·Ó‡ÚÂÛË Ù˘ ÚˆÈÌfiÙÂÚ˘ ÎÔÈÏȷ΋˜ÂÎfiψÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÊÏ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ ‹ ÎÔÏ-È΋˜ ‚ËÌ·ÙÔ‰fiÙËÛ˘.

ªÂÙ¿ ÙËÓ ÂÈÙ˘¯‹ Î·Ù¿Ï˘ÛË, ·ÎÔÏÔ˘ıÔ‡Û ÂÚ›Ô‰Ô˜·Ó·ÌÔÓ‹˜ 30-45 min, ÌÂÙ¿ ÙËÓ ÔÔ›· ÁÈÓfiÙ·Ó Â·Ó·ÏËÙÈ΋∏ºª, ÌÂ Î·È ¯ˆÚ›˜ ÈÛÔÚÔÙÂÚÂÓfiÏË. ∂¿Ó ‰ÂÓ ÚÔηÏ›ÙÔÙ·¯˘Î·Ú‰›· ‹ ·ÓÂÌÊ¿ÓÈÛË ÚԉȤÁÂÚÛ˘, Ë Â¤Ì‚·ÛËÙÂÚÌ·ÙÈ˙fiÙ·Ó.

125∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

∂ÈÎfiÓ· 1. ∫ÔÏÔÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· ·ÓÂÈÛfi‰Ô˘, ÔÊÂÈÏfiÌÂÓËÛ ·ÚÈÛÙÂÚfi ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ. ∫·Ù·ÁÚ¿ÊÔÓÙ·È Î·Ù¿ÛÂÈÚ¿ ÔÈ ··ÁˆÁ¤˜ ÂÈÊ·Ó›·˜ (π ¤ˆ˜ V6) Î·È Ù· ÂÓ‰ÔηډȷοËÏÂÎÙÚÔÁÚ¿ÌÌ·Ù· ·fi ÙÔÓ ‰ÂÍÈfi ÎfiÏÔ (HRA), ‰ÂÌ¿ÙÈÔ ÙÔ˘ His(HBEP, HBED), ÛÙÂÊ·ÓÈ·›Ô ÎfiÏÔ (CS), ‰ÂÍÈ¿ ÎÔÈÏ›· (RV). ∂È-ϤÔÓ, ηٷÁÚ¿ÊÂÙ·È ÙÔ ËÏÂÎÙÚfiÁÚ·ÌÌ· ·fi ÙÔÓ Î·ıÂÙ‹Ú· ¯·Ú-ÙÔÁÚ¿ÊËÛ˘-Î·Ù¿Ï˘Û˘ (MAP), ÛÙÔ ÔÔ›Ô Î·Ù·ÁÚ¿ÊÂÙ·È ‰˘Ó·-ÌÈÎfi ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ (KENT).

HIS

CS

ABL

HR A

∂ÈÎfiÓ· 2. ∫·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ Ï¿ÁÈÔ˘ ·Ú·ÏËڈ̷ÙÈÎÔ‡ ‰Â-Ì·Ù›Ô˘ Ì ÙËÓ ·Ï›Ó‰ÚÔÌË ‰È·ÔÚÙÈ΋ Ù¯ÓÈ΋. ∞ÂÈÎÔÓ›˙ÔÓÙ·È ÔÈηıÂÙ‹Ú˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘ (HRA), HIS Î·È ÛÙÂÊ·ÓÈ·›Ô˘ ÎfiÏ-Ô˘ (CS), ηıÒ˜ Î·È Ô Î·ıÂÙ‹Ú·˜ Î·Ù¿Ï˘Û˘ (ABL).

POSSIBLE KENTV

A

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™Â fiϘ ÙȘ ·ÚÈÛÙÂÚfiÏ¢Ú˜ ÂÂÌ‚¿ÛÂȘ ¯ÔÚËÁ›ÙÔË·Ú›ÓË ÌÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÙˆÓ ËÏÂÎÙÚÔ‰›ˆÓ (50-100 iu/kg·Ú¯È΋ ‰fiÛË Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ‰fiÛÂȘ), ÒÛÙ ӷ ‰È·-ÙËÚÂ›Ù·È o ACT (activated clotting time) >250 sec. ™ÙÔ Ù¤ÏÔ˜Ù˘ ¤̂·Û˘, Ë ‰Ú¿ÛË Ù˘ Ë·Ú›Ó˘ ·Ó·ÛÙÚ¤ÊÔÓÙ·Ó ÌÂıÂÈÈ΋ ÚˆÙ·Ì›ÓË Â¿Ó o ACT ‹Ù·Ó >180 sec.

ªÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ıËηڛˆÓ Î·È ÙËÓ ÂÈÌÂÏ‹ ·È-ÌfiÛÙ·ÛË, Ô ·ÛıÂÓ‹˜ ÌÂÙ·ÊÂÚfiÙ·Ó ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfiÙÌ‹Ì· fiÔ˘ ÂÙ›ıÂÙÔ ÛÂ Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂmonitor. √ ·ÛıÂÓ‹˜ ÂÏÂÁ¯fiÙ·Ó Ì ∏∫° ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ¤̂·ÛË Î·È Û 24 ÒÚ˜, ηıÒ˜ Î·È Ì ˘ÂÚ˯ÔηډÈÔ-ÁÚ¿ÊËÌ· Î·È Holter 24ÒÚÔ˘ ÙËÓ ÂfiÌÂÓË Ë̤ڷ. ∂ÊfiÛÔÓ‰ÂÓ ˘‹Ú¯·Ó ÂÈÏÔΤ˜, Ô ·ÛıÂÓ‹˜ ÂÍ‹Ú¯ÂÙÔ ÙÔ˘ ¡ÔÛÔÎÔ-Ì›Ԣ ÌÂÙ¿ 24-48 ÒÚ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, ˘fi ·ÓÙÈ·ÈÌÔÂ-Ù·Ïȷ΋ ·ÁˆÁ‹ Ì ·ÛÈÚ›ÓË (5 mg/kg) ÁÈ· 2 Ì‹Ó˜.

∂·Ó¤ÏÂÁ¯Ô˜ ÁÈÓfiÙ·Ó ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÛÙÔ˘˜ 2, 6Î·È 12 Ì‹Ó˜ Î·È Î·ÙfiÈÓ ·Ó¿ ¤ÙÔ˜ ‹ ‰ÈÂÙ›·, Ì ÎÏÈÓÈ΋ Âͤ-Ù·ÛË Î·È ∏∫°. ŒÓ· ÙÔ˘Ï¿¯ÈÛÙÔÓ Holter 24ÒÚÔ˘ Î·È Ì›· ˘Â-Ú˯ÔÁÚ·ÊÈ΋ ÂͤٷÛË ÁÈÓfiÙ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ™ÂÂÚ›ÙˆÛË ˘ÔÙÚÔ‹˜, ÚÔÙÂÈÓfiÙ·Ó Â·Ó·ÏËÙÈ΋ ÌÂϤÙËÎ·È Î·Ù¿Ï˘ÛË Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜.

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË

√È ÙÈ̤˜ ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ̤Û˜ Ì ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. ∏·Ó¿Ï˘ÛË ÙˆÓ ÔÛÔÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓ Ì t-test, ÂÓÒ ÙˆÓÔÈÔÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ Ì Fisher’s exact test. √È ·Ú¿ÌÂÙÚÔÈÂÓÙfi˜ ÙˆÓ ÔÌ¿‰ˆÓ Ì ÙȘ ‰È¿ÊÔÚ˜ ÂÓÙÔ›ÛÂȘ ¶¢ ·Ó·Ï‡ıË-Î·Ó ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô one-way ANOVA. ∆È̤˜p<0,05 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜.

∞ÔÙÂϤÛÌ·Ù·

∂ÓÙfiÈÛË/Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·

∏ ηٷÓÔÌ‹ ÙˆÓ ¶¢ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 4.

¶ÔÏÏ·Ï¿ ‰ÂÌ¿ÙÈ· ‚Ú¤ıËÎ·Ó Î˘Ú›ˆ˜ Û ·ÛıÂÓ›˜ ÌÂ

·ÚÈÛÙÂÚ¿ ‰ÂÌ¿ÙÈ· (6 ·ÛıÂÓ›˜, 3 ÂÎ ÙˆÓ ÔÔ›ˆÓ ›-

¯·Ó 2 ‰ÂÌ¿ÙÈ· Î·È 3 ›¯·Ó 3 ‰ÂÌ¿ÙÈ·). ¢‡Ô ‰ÂÍÈ¿ ‰Â-

Ì¿ÙÈ· ‚Ú¤ıËÎ·Ó Û ¤Ó·Ó ·ÛıÂÓ‹.

™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· (™∫) Û˘Ó˘‹Ú¯Â Û 14

·ÛıÂÓ›˜ (14,8%). √ Ù‡Ô˜ Ù˘ ™∫ Û ۯ¤ÛË Ì ÙËÓ

ÂÓÙfiÈÛË ÙˆÓ ¶¢ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √È ·ÛıÂ-

Ó›˜ ¯ˆÚ›˜ ™∫ ›¯·Ó ÔÏÏ·Ï¿ ‰ÂÌ¿ÙÈ· Û ÔÛÔÛÙfi

6% (5/82), ÂÓÒ ·˘ÙÔ› Ì ™∫ ›¯·Ó ÔÏÏ·Ï¿ ‰ÂÌ¿-

ÙÈ· ÛÂ ÔÛÔÛÙfi 25% (3/12) (p=0,06).

∞ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË

√È ÂÂÌ‚·ÙÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ (·ÚÈıÌfi˜ ‚Ï·‚ÒÓ,

¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘, ÂÈÏÔΤ˜), ηıÒ˜ Î·È Ù·

·ÔÙÂϤÛÌ·Ù· Ù˘ Î·Ù¿Ï˘Û˘ (¿ÌÂÛ· Î·È Ì·ÎÚÔ-

ÚfiıÂÛÌ·) Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ¶¢ Ê·›-

ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∫·Ù·ÁÚ¿ÊÂÙ·È, ›Û˘, Ë Û˘-

¯ÓfiÙËÙ· ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Û ۯ¤ÛË ÌÂ

ÙËÓ ÂÓÙfiÈÛË. §fiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÔÌ¿-

‰ˆÓ, ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ·Ó¿Ï˘Û˘,

Ù· ‰ÂÍÈ¿ ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο Î·È ‰ÂÍÈ¿ ‰È¿ÌÂÛ·

‰ÂÌ¿ÙÈ· Û˘ÌÙ‡¯ıËÎ·Ó Û ̛· ηÙËÁÔÚ›·, ·Ó ηÈ

·Ó·Ê¤ÚÔÓÙ·È ¯ˆÚÈÛÙ¿ ÛÙÔÓ ›Ó·Î· ÒÛÙ ӷ Â›Ó·È ÂÌ-

Ê·Ó›˜ ÔÈ ‰È·ÊÔÚ¤˜.

¢ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔ-

Ú¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ ÌÂٷ͇ ÙˆÓ ‰È·-

ÊfiÚˆÓ ı¤ÛÂˆÓ (p=0,249). ∞Ó Î·È Ô ÌÈÎÚfi˜ ·ÚÈıÌfi˜

ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ ÁÂÓÈ΢-

Ì¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ Ù· ‰ÂÍÈ¿

ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· ¯ÚÂÈ¿ÛÙËÎ·Ó ÌÂÁ·-

χÙÂÚÔ ·ÚÈıÌfi ‚Ï·‚ÒÓ. √ ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘

126 π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Paediatriki 2007;70:123-134

His

¢¶¢5

¢¢¢5

¢¶9 ∆V MV

∞√¢

¢√¢28

11

CS

∞¶ 38

∂ÈÎfiÓ· 4. ∂ÓÙfiÈÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ. ™¯ËÌ·ÙÈ΋·ÂÈÎfiÓÈÛË ÙˆÓ ‰‡Ô ÎÔÏÔÎÔÈÏÈ·ÎÒÓ ‚·Ï‚›‰ˆÓ Î·È ÙÔ˘ ÛÙÂÊ·ÓÈ-·›Ô˘ ÎfiÏÔ˘ Û ÂÁοÚÛÈ· ‰È·ÙÔÌ‹. ∞ÂÈÎÔÓ›˙ÂÙ·È Ë ı¤ÛË ÙˆÓ ‰È·-ÊfiÚˆÓ ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ Î·È Ô ·ÚÈıÌfi˜ ·˘ÙÒÓ Û ο-ı ı¤ÛË. ∞√¢: ·ÚÈÛÙÂÚfi Ô›ÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, A¶: ·ÚÈÛÙÂÚfiÏ¿ÁÈÔ, ¢¢¢: ‰ÂÍÈfi ‰È¿ÌÂÛÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢√¢: ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢¶: ‰ÂÍÈfi Ï¿ÁÈÔ, ¢¶¢: ‰ÂÍÈfi ÚÔÛıÈÔ-‰È·ÊÚ·Á-Ì·ÙÈÎfi, His: ‰ÂÌ¿ÙÈÔ ÙÔ˘ His, TV: ÙÚÈÁÏÒ¯ÈÓ ‚·Ï‚›‰·, MV: ÌÈÙÚÔ-Âȉ‹˜ ‚·Ï‚›‰·, CS: ÛÙÂÊ·ÓÈ·›Ô˜ ÎfiÏÔ˜.

**

· ‚

*

*

Á ‰

∂ÈÎfiÓ· 3. ∫·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡ ÔÈÛıÈÔÏ¿ÁÈÔ˘ ·Ú·ÏËÚˆ-Ì·ÙÈÎÔ‡ ‰ÂÌ·Ù›Ô˘ Ì ÙË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ (transseptal) Ù¯ÓÈ-΋: ∞fi ·ÚÈÛÙÂÚ¿ ¿ӈ: ·) ·Ú·Î¤ÓÙËÛË ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡‰È·ÊÚ¿ÁÌ·ÙÔ˜ Ì ÙËÓ ÂȉÈ΋ ‚ÂÏfiÓ· (*), ‚) ›ÛÔ‰Ô˜ Ù˘ ‚ÂÏfi-Ó·˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ (*), Á) ›ÛÔ‰Ô˜ ÙÔ˘ Ì·ÎÚÔ‡ ıËÎ·Ú›Ô˘Î·È ÛÎÈ·ÁÚ¿ÊËÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Î·È ‰) ›ÛÔ‰Ô˜ ÙÔ˘ η-ıÂÙ‹Ú· Î·Ù¿Ï˘Û˘ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ıËηڛԢ Î·È ÙÔÔı¤ÙËÛ‹ÙÔ˘ ÛÙËÓ ÎÔÏÔÎÔÈÏȷ΋ ·‡Ï·Î· (*).

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‹Ù·Ó ÔÚȷο ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·ÚÈÛÙÂÚ¿ ÔÈÛıÈÔ-

‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· (p=0,0556), ·’ fi,ÙÈ ÛÙȘ

˘fiÏÔȘ ı¤ÛÂȘ. ∞Ó Î·È Ô ·ÚÈıÌfi˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜

Â›Ó·È ÌÈÎÚfi˜, Ù· ‰ÂÍÈ¿ ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο ‰Â-

Ì¿ÙÈ· ›¯·Ó ›Û˘ ˘„ËÏfi Û¯ÂÙÈο ¯ÚfiÓÔ ·ÎÙÈÓÔ-

ÛÎfiËÛ˘ Û ۇÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ı¤ÛÂȘ. ∆Ô ÁÂ-

ÁÔÓfi˜ ·˘Ùfi Û˘Ì‚·‰›˙ÂÈ Ì ÙÔÓ ˘„ËÏfi ·ÚÈıÌfi ‚Ï·-

‚ÒÓ Ô˘ ·Ó·Ê¤ÚıËΠÚÔËÁÔ˘Ì¤Óˆ˜.

∂ÈÏÔΤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ ÛÙ· ‰ÂÍÈ¿ ÔÈ-

ÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο Î·È ·ÚÈÛÙÂÚ¿ Ï¿ÁÈ· ‰ÂÌ¿ÙÈ·.

¢ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ Ô-

ÛÔÛÙfi ÂÈÏÔÎÒÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ı¤ÛˆÓ

(p=0,726). ¢‡Ô ·ÛıÂÓ›˜ Ì ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·Á-

Ì·ÙÈÎfi ‰ÂÌ¿ÙÈÔ ÂÌÊ¿ÓÈÛ·Ó ·ÚÔ‰ÈΤ˜ ‰È·Ù·Ú·¯¤˜

Ù˘ ÎÔÏÔÎÔÈÏȷ΋˜ ·ÁˆÁ‹˜. ™ÙÔÓ ¤Ó· ·Ú·ÙËÚ‹ıË-

ÎÂ ÎÔÏoÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ 3Ô˘ ‚·ıÌÔ‡ Ô˘

˘Ô¯ÒÚËÛ ÛÙ·‰È·Î¿ Û 5 Ë̤Ú˜, ÂÓÒ ÛÙÔÓ ¿ÏÏÔ

‰È·ÈÛÙÒıËΠÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ ‰È¿Ú-

ÎÂÈ·˜ Ï›ÁˆÓ ÏÂÙÒÓ Ô˘ ·Ú‹Ïı ·˘ÙfiÌ·Ù· ηٿ ÙË

‰È¿ÚÎÂÈ· Ù˘ ¤̂·Û˘. ∫·Ó›˜ ¿ÏÏÔ˜ ·ÛıÂÓ‹˜ ‰ÂÓ

ÂÌÊ¿ÓÈÛ ‰È·Ù·Ú·¯¤˜ Ù˘ ÎÔÏÔÎÔÈÏȷ΋˜ ·ÁˆÁ‹˜.

ŒÓ·˜ ·ÛıÂÓ‹˜ Ì ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ ¶¢ Ô˘ ˘Ô‚Ï‹-

ıËΠÛÂ Î·Ù¿Ï˘ÛË Ì ÙË ‰È·ÔÚÙÈ΋ Ù¯ÓÈ΋, ÂÌÊ¿ÓÈÛÂ

·‡ÍËÛË Ù˘ ·ÔÚÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ·fi 1Ô˘ Û 2Ô˘

‚·ıÌÔ‡. ™ÙÔÓ ·ÛıÂÓ‹ ·˘Ùfi ‰È·ÈÛÙÒıËΠ‰›Ù˘¯Ë

·ÔÚÙÈ΋ ‚·Ï‚›‰· ÌÂÙ¿ ÙËÓ Î·Ù¿Ï˘ÛË. ŒÓ·˜ ¿ÏÏÔ˜

·ÛıÂÓ‹˜ Ô˘ ˘Ô‚Ï‹ıËΠÛÂ Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚÔ‡

¶¢ Ì ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ (transseptal) ÚÔۤϷÛË,

ÂÌÊ¿ÓÈÛ ̛· ÌÈÎÚ‹ ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹ Ô˘

·ÔÚÚÔÊ‹ıËΠ·˘ÙfiÌ·Ù· ÙËÓ ÂfiÌÂÓË Ë̤ڷ.

∏ ·Ú¯È΋ ÂÈÙ˘¯›· ‹Ù·Ó ˘„ËÏ‹ Î·È Û˘ÁÎÚ›ÛÈÌË

Û fiϘ ÙȘ ηÙËÁÔڛ˜, ¯ˆÚ›˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ-

Τ˜ ‰È·ÊÔÚ¤˜ (p=0,0916 Ì Fisher’s exact test). ∏ ÙÂ-

ÏÈ΋ ÂÈÙ˘¯›· ·Ú¤ÌÂÈÓ ¯·ÌËÏfiÙÂÚË ÛÙ· ‰È¿ÌÂÛ·

‰È·ÊÚ·ÁÌ·ÙÈο, ÏfiÁˆ ˘„ËÏfiÙÂÚÔ˘ ÔÛÔÛÙÔ‡ ˘Ô-

ÙÚÔ‹˜ Î·È ÌË Â·Ó¿Ï˄˘ Ù˘ ¤̂·Û˘ ÏfiÁˆ

ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi. ∆Ô

ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ ÛÙ· ‰È¿ÌÂÛ·

‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·, ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó

ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. √È ˘ÔÙÚÔ¤˜ ‹Ù·Ó ÛËÌ·-

ÓÙÈο Û˘¯ÓfiÙÂÚ˜ Û ·ÛıÂÓ›˜ Ì ÔÏÏ·Ï¿ ·Ú·-

ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· (‰ÂÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›-

ӷη 2), Û ÔÛÔÛÙfi 57% ¤Ó·ÓÙÈ 11% (p=0,0075).

π‰È·›ÙÂÚ· Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÔÈ ÂÚÈÙÒÛÂȘ

‰‡Ô ·ÛıÂÓÒÓ Ì ÔÏÏ·Ï¿ ¶¢ Ô˘ ¯ÚÂÈ¿ÛÙËηÓ

·ӷÏËÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ. ª›· ·ÛıÂÓ‹˜ 18 ÂÙÒÓ

Ì ·Ó‡ڢÛÌ· ÙÔ˘ ·Ú¯ÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÛÙÂÊ·ÓÈ-

·›Ô˘ ÎfiÏÔ˘ ›¯Â ÔÏÏ·Ï¿ ÂÈηډȷο ‰ÂÌ¿ÙÈ·

ÛÙÔ ¤‰·ÊÔ˜ ÙÔ˘ ·Ó¢ڇÛÌ·ÙÔ˜ Î·È ÂÓÙfi˜ Ù˘ ̤Û˘

ηډȷ΋˜ ÊϤ‚·˜. ∏ Î·Ù¿Ï˘ÛË fiÏˆÓ ÙˆÓ ‰ÂÌ·Ù›ˆÓ

ÂÂÙ‡¯ıË Ì ‰‡Ô ÚÔÛ¿ıÂȘ. ŒÓ·˜ ·ÛıÂÓ‹˜ 12

127∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

¶›Ó·Î·˜ 2. ∂ÂÌ‚·ÙÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ Î·È ·ÔÙ¤ÏÂÛÌ· Û ۯ¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ¶¢

∂ÓÙfiÈÛË ∞ÚÈıÌfi˜ ∞ÚÈıÌfi˜ ÃÚfiÓÔ˜ ∞ÚÈıÌfi˜ AÚ¯È΋ ∞ÚÈıÌfi˜ ∆ÂÏÈ΋ ™˘ÁÁÂÓ‹˜ ·ÛıÂÓÒÓ ‚Ï·‚ÒÓ ·ÎÙÈÓÔÛÎfiËÛ˘ ÂÈÏÔÎÒÓ ÂÈÙ˘¯›· ˘ÔÙÚÔÒÓ ÂÈÙ˘¯›· ηډÈÔ¿ıÂÈ·

(min)

¢¢¢ 5 10,8±4,3 15,0±20,6 0 5 (100%) 2 (40%) 3 (60%)* 1 (20%)¢¶¢ 5 26,8±17,2 51,8±31,4* 0 5 (100%) 1 (20%) 5 (100%) 0¢¶ 9 12,7±17,7 22,3±17,6 0 8 (89%) 1 (12,5%) 8 (89%) 6 (66%)*¢√¢ 27 11,8±14,1 27,7±29,7 2 (7,1%) 27 (100%) 2 (7,1%) 27 (100%) 2 (7,1%)∞√¢ 10 12,3±15,4 52,5±50,6* 0 9 (90%) 1 (10%) 9 (90%) 2 (20%)∞¶ 38 9,4±6,5 31,2±17,2 2 (5,2%) 37 (97%) 7 (18,4%) 38 (100%) 3 (7,8%)™‡ÓÔÏÔ 94 14±13 33,4±27,9 4 (4%) 91 (96,8%) 15 (15,9%) 90 (95,7%)∆ÈÌ‹ p 0,2496 0,0556 0,762 0,0916 0,0837 0,0211 <0,0001

∞√¢: ·ÚÈÛÙÂÚfi Ô›ÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, A¶: ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ, ¢¢¢: ‰ÂÍÈfi ‰È¿ÌÂÛÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢√¢: ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·-ÊÚ·ÁÌ·ÙÈÎfi, ¢¶: ‰ÂÍÈfi Ï¿ÁÈÔ, ¢¶¢: ‰ÂÍÈfi ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi *∆È̤˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۇÁÎÚÈÛË Ì ÙȘ ˘fiÏÔȘ Ù˘ ›‰È·˜ ηÙËÁÔÚ›·˜

¶›Ó·Î·˜ 1. ™˘Ó˘¿Ú¯Ô˘Û˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ

∆‡Ô˜ Û˘ÁÁÂÓÔ‡˜ ∞ÚÈıÌfi˜ £¤ÛË ¶¢ ηډÈÔ¿ıÂÈ·˜ ·ÛıÂÓÒÓ (·ÚÈıÌfi˜ ‰ÂÌ·Ù›ˆÓ)

∞ӈ̷ϛ· Ebstein 4 ¢¶ (4), ¢√¢ (1)Ù˘ ÙÚÈÁÏÒ¯ÈÓÔ˜ªÂÛÔÎÔÈÏȷ΋ 2 ∞¶ÂÈÎÔÈÓˆÓ›·L-TGA, ·ÓˆÌ·Ï›· 1 ∞√¢Ebstein Ù˘ ∞∫µ∆ÂÙÚ·ÏÔÁ›· Fallot 1 ¢¶ÀÔ‚·Ï‚ȉÈ΋ 1 ¢¢¢ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜DORV, Situs inversus 1 ¢¶¢›Ù˘¯Ë ·ÔÚÙÈ΋ ‚·Ï‚›‰· 1 ∞¶∂ÎÎfiψ̷ 1 ∞√¢ (3)ÛÙÂÊ·ÓÈ·›Ô˘ ÎfiÏÔ˘™‡ÓÔÏÔ 12

AKB: ·ÚÈÛÙÂÚ‹ ÎÔÏÔÎÔÈÏȷ΋ ‚·Ï‚›‰·, ∞√¢: ·ÚÈÛÙÂÚfiÔ›ÛıÈÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, A¶: ·ÚÈÛÙÂÚfi Ï¿ÁÈÔ, ¢¢¢: ‰ÂÍÈfi‰È¿ÌÂÛÔ ‰È·ÊÚ·ÁÌ·ÙÈÎfi, ¢√¢: ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈ-Îfi, ¢¶: ‰ÂÍÈfi Ï¿ÁÈÔ, ¢¶¢: ‰ÂÍÈfi ÚÔÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi,DORV: ‰ÈÏÔ¤ÍÔ‰Ô˜ ‰ÂÍÈ¿ ÎÔÈÏ›·, L-TGA: Û˘ÁÁÂÓÒ˜ ‰ÈÔÚ-ıˆÌ¤ÓË ÌÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ

¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·127

Page 59: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

ÂÙÒÓ Ì 3 ¶¢ (·ÚÈÛÙÂÚfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi ηÈ

2 Ï¿ÁÈ·), ηıÒ˜ Î·È ÎÔÌ‚È΋ Ù·¯˘Î·Ú‰›· ·ÓÂÈÛfi-

‰Ô˘, ¯ÚÂÈ¿ÛÙËΠ٤ÛÛÂÚȘ Û˘ÓÔÏÈο ÂÂÌ‚¿ÛÂȘ ÁÈ·

ÙËÓ ÙÂÏÈ΋ ÂÈÙ˘¯›·. ªÂÙ¿ ÙÔ ¤Ú·˜ ÙˆÓ ÂÂÌ‚¿ÛÂ-

ˆÓ ·˘ÙÒÓ Ô ·ÛıÂÓ‹˜ Â›Ó·È ÂχıÂÚÔ˜ Ù·¯˘Î·Ú‰ÈÒÓ.

T· ÔÛÔÛÙ¿ Û˘Ó˘¿Ú¯Ô˘Û·˜ ™∫, fiˆ˜ ÚÔ·Ó·-

ʤÚıËÎÂ, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙ· ‰ÂÍÈ¿ Ï¿ÁÈ· ·Ú·-

ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ·fi ÔÔÈ·‰‹ÔÙ ¿ÏÏË Î·-

ÙËÁÔÚ›· (p<0,0001). ∏ ‡·ÚÍË Û˘ÁÁÂÓÔ‡˜ ηډÈÔ-

¿ıÂÈ·˜ ‰ÂÓ ÂËÚ¤·Û ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙË

ÛÂÈÚ¿ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜.

∞ÛıÂÓ›˜ Ì ·Î·Ù¿·˘ÛÙË Ù·¯˘Î·Ú‰›·

ÔÊÂÈÏfiÌÂÓË Û ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·

‚Ú·‰Â›·˜ ·ÁˆÁ‹˜

¶¤ÓÙ ·ÛıÂÓ›˜ Ì ‰ÂÍÈfi ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈÎfi

‰ÂÌ¿ÙÈÔ Î·È 2 ·ÛıÂÓ›˜ Ì ·ÚÈÛÙÂÚfi ÔÈÛıÈÔ-‰È·-

ÊÚ·ÁÌ·ÙÈÎfi ‰ÂÌ¿ÙÈÔ Â›¯·Ó ·Î·Ù¿·˘ÛÙË Ù·¯˘Î·Ú-

‰›· ÏfiÁˆ ‚Ú·‰Â›·˜ ·Ï›Ó‰ÚÔÌ˘ ÌfiÓÔ ·ÁˆÁ‹˜ ̤ۈ

ÙÔ˘ ‰ÂÌ·Ù›Ô˘ (permanent junctional reciprocating

tachycardia). ∏ Î·Ù¿Ï˘ÛË ‹Ù·Ó ÂÈÙ˘¯‹˜ Û fiÏÔ˘˜

ÙÔ˘˜ ·ÛıÂÓ›˜, ÂÎÙfi˜ ·fi ¤Ó·Ó Ì ·ÚÈÛÙÂÚfi ÔÈÛıÈÔ-

‰È·ÊÚ·ÁÌ·ÙÈÎfi ‰ÂÌ¿ÙÈÔ. ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜,

3 ›¯·Ó Ì˘ÔηډÈÔ¿ıÂÈ· ÂÎ Ù·¯˘Î·Ú‰›·˜. ∫·È

ÛÙÔ˘˜ 3, ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ·ÔηٷÛÙ¿ıËΠÛÙÔ

Ê˘ÛÈÔÏÔÁÈÎfi ÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË.

¢ÂÓ ˘‹ÚÍ·Ó ÂÈÏÔΤ˜, Ô‡Ù ˘ÔÙÚÔ¤˜ Û ·˘Ù‹

ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ.

™‡ÁÎÚÈÛË ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋˜ Ì ·Ï›Ó‰ÚÔÌË

Ù¯ÓÈ΋ ÁÈ· ÙËÓ Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚfiÏÂ˘ÚˆÓ

‰ÂÌ·Ù›ˆÓ

∏ Û‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô Ù¯ÓÈÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ

‚·ıÌfi ‰˘ÛÎÔÏ›·˜ (·ÚÈıÌfi˜ ‚Ï·‚ÒÓ, ¯ÚfiÓÔ˜ ·ÎÙÈÓÔ-

ÛÎfiËÛ˘, ‰È¿ÚÎÂÈ· ¤̂·Û˘), Ù· ÔÛÔÛÙ¿ ÂÈÙ˘-

¯›·˜ Î·È ˘ÔÙÚÔÒÓ, ÙȘ ÂÈÏÔΤ˜ Î·È Ù· ÔÛÔÛÙ¿

·ÏÏ·Á‹˜ ÚÔÛ¤ÁÁÈÛ˘ ·fi ÙË Ì›· Ù¯ÓÈ΋ ÛÙËÓ ¿ÏÏË,

‰ÂÓ ¤‰ÂÈÍ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ∏ ÙÂÏÈ-

΋ ÂÈÙ˘¯›· ‹Ù·Ó 100% Î·È Ì ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜.

™˘Û¯¤ÙÈÛË ËÏÈΛ·˜ Î·È ·ÔÙÂϤÛÌ·ÙÔ˜ (ÂÈÙ˘¯›·,

ÔÛÔÛÙ¿ ̆ ÔÙÚÔ‹˜, ÔÛÔÛÙ¿ ÂÈÏÔÎÒÓ)

™ÙÔÓ ¶›Ó·Î· 3 ηٷÁÚ¿ÊÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù·

Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·. ∏ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ô˘

›¯·Ó ÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ÂÏ·ÊÚÒ˜ ÌÂÁ·Ï‡-

ÙÂÚË ·fi ÂΛÓË ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÓÂÈÙ˘¯¤˜ ·ÔÙ¤-

ÏÂÛÌ·, ¯ˆÚ›˜ Ë ‰È·ÊÔÚ¿ ·˘Ù‹ Ó· Â›Ó·È ÛÙ·ÙÈÛÙÈο

ÛËÌ·ÓÙÈ΋. ¢ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ËÏÈΛ·˜

Î·È ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ ‹ ˘ÔÙÚÔÒÓ.

™˘˙‹ÙËÛË

∏ ıÂڷ›· ÙˆÓ ˘ÂÚÎÔÈÏÈ·ÎÒÓ Ù·¯˘Î·Ú‰ÈÒÓ

¿ÏÏ·Í ‰Ú·Ì·ÙÈο ·fi ÙÔ 1968, ÌÂÙ¿ ÙËÓ ÚÒÙË ¯ÂÈ-

ÚÔ˘ÚÁÈ΋ ıÂڷ›· ·ÛıÂÓÔ‡˜ Ì ۇӉÚÔÌÔ Wolff-Parkinson-White ·fi ÙÔ˘˜ Sealy Î·È Û˘Ó (4), ·ÏÏ¿·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ ÌÂÙ¿ ÙËÓ Â˘Ú›· ÂÊ·ÚÌÔÁ‹ ÙË˜Î·Ù¿Ï˘Û˘ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ·fi ÙÔ 1987Î·È ÌÂÙ¿ (5).

∞fi ÙËÓ ·Ú¯‹ Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Î·Ù¿Ï˘Û˘ ̃ƒ ¿Ú¯ÈÛ ̛· Û˘ÛÙËÌ·ÙÈ΋ ηٷÁÚ·Ê‹ ÙˆÓ ÂÂÌ-‚¿ÛÂˆÓ ·˘ÙÒÓ ÛÙ· ·È‰È¿ ΢ڛˆ˜ ÛÙȘ ∏¶∞(Pediatric Radiofrequency Ablation Registry), Ì ÙË‚Ô‹ıÂÈ· Ù˘ ÔÔ›·˜ Û˘ÁÎÂÓÙÚÒıËÎ·Ó Î·È ·Ú·ÎÔ-ÏÔ˘ıÔ‡ÓÙ·È ÔÏϤ˜ ¯ÈÏÈ¿‰Â˜ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓÔ˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Î·Ù¿Ï˘ÛË (6,7).

™ÙË ¯ÒÚ· Ì·˜, Ë Î·Ù¿Ï˘ÛË ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·Ú-Ú˘ıÌÈÒÓ ¿Ú¯ÈÛ ‹‰Ë ·fi ÙÔ 1994, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó·ÚÔ˘ÛÈ·ÛÙ› Û˘ÁÎÂÓÙÚˆÙÈο ¿ÌÂÛ· Î·È Ì·ÎÚÔÚfi-ıÂÛÌ· ·ÔÙÂϤÛÌ·Ù·, ÂÎÙfi˜ ·fi ¤Ó·Ó ÌÈÎÚfi ·ÚÈıÌfi·ÛıÂÓÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ (8). ∏ ·ÚÔ‡Û· ÌÂ-ϤÙË Â›Ó·È Ë ÚÒÙË Û˘ÛÙËÌ·ÙÈ΋ ÂÚÈÁÚ·Ê‹ ÙˆÓ·ÔÙÂÏÂÛÌ¿ÙˆÓ Î·Ù¿Ï˘Û˘ ¶¢ Û ̛· ÛÂÈÚ¿ ·È‰È·-ÙÚÈÎÒÓ ·ÛıÂÓÒÓ Ì ·Ó·ÊÔÚ¿ ÛÙ· ¿ÌÂÛ· Î·È Ì·ÎÚÔ-ÚfiıÂÛÌ· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤̂·Û˘ ·˘Ù‹˜ ÛÙ˯ÒÚ· Ì·˜.

∂ÓÙfiÈÛË ¶¢ - ∏ÏÈΛ· ·ÛıÂÓÒÓ

∏ ηٷÓÔÌ‹ ÂÓÙfiÈÛ˘ ÙˆÓ ¶¢ ÛÙËÓ ·ÚÔ‡Û·ÌÂϤÙË Û˘ÌʈÓ› Ì ÂΛÓË Ô˘ ÂÚÈÁÚ¿ÊËΠۉȿÊÔÚ˜ ‰ÈÂıÓ›˜ ÛÂÈÚ¤˜: ‰ÂÍÈ¿ ‰È¿ÌÂÛ· ‰È·ÊÚ·Á-Ì·ÙÈο ‰ÂÌ¿ÙÈ· Û 4% ÙˆÓ ·ÛıÂÓÒÓ, ÚÔÛıÈÔ-‰È·-ÊÚ·ÁÌ·ÙÈο Û 6%, ‰ÂÍÈ¿ Ï¿ÁÈ· Û 12%, ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο Û ÂÚ›Ô˘ 30% Î·È ·ÚÈÛÙÂÚ¿ Ï¿-ÁÈ· Û 40-70% (9-11).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ, ÁÂÓÈÎÒ˜Û˘ÓÈÛÙ¿Ù·È ·ÔÊ˘Á‹ Î·Ù¿Ï˘Û˘ Û ·ÛıÂÓ›˜ ÌÈÎÚÒÓËÏÈÎÈÒÓ Î·È ÂȉÈÎfiÙÂÚ· Û ‚Ú¤ÊË, ‰Â‰Ô̤Ó˘ Ù˘˘„ËÏfiÙÂÚ˘ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈÎ›Â˜Î·È Û ·ÛıÂÓ›˜ Ì ¯·ÌËÏfiÙÂÚÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜,Ô˘ ¤¯ÂÈ ·Ú·ÙËÚËı› ÙfiÛÔ Û ÎÏÈÓÈΤ˜ ÌÂϤÙ˜(6,12) fiÛÔ Î·È Û ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ Û ˙Ò·(13,14). ∂Í¿ÏÏÔ˘, ¤¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Û ¤Ó· ÛË-Ì·ÓÙÈÎfi ·ÚÈıÌfi ‚ÚÂÊÒÓ Ì ·Ú·ÏËڈ̷ÙÈÎfi ‰Â-Ì¿ÙÈÔ, ÔÈ Ù·¯˘Î·Ú‰›Â˜ ·‡Ô˘Ó ÔÚÈÛÙÈο ÌÂÙ¿ ·fiÌÂÚÈÎÔ‡˜ Ì‹Ó˜ ‹ ‰È·ÎfiÙÔÓÙ·È ÁÈ· ¯ÚÔÓÈÎfi ‰È¿-ÛÙËÌ· ÔÏÏÒÓ ÂÙÒÓ (15) Î·È ¤ÙÛÈ ÔÏÏÔ› ·ÛıÂÓ›˜

128 π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Paediatriki 2007;70:123-134

¶›Ó·Î·˜ 3. ∞ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·

∂ÈÙ˘¯›· 12,4±3,6 ¤ÙË p=0,541∞ÔÙ˘¯›· 9,7±3,8 ¤ÙË

Èڛ˜ ˘ÔÙÚÔ‹ 12,3±3,6 ¤ÙË p=0,620ªÂ ˘ÔÙÚÔ‹ 12,9±3,8 ¤ÙË

Èڛ˜ ÂÈÏÔΤ˜ 12,7±3,6 ¤ÙË p=0,861M ÂÈÏÔΤ˜ 12,9±3,9 ¤ÙË

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·128

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‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ ÌÔÚ› Ó· ÌË ¯ÚÂÈ·ÛÙÔ‡Ó ÔÙ¤

ÂÂÌ‚·ÙÈ΋ ıÂڷ›·.

™˘Û¯¤ÙÈÛË ÌÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ

∂›Ó·È ÁÓˆÛÙ‹ Ë Û˘¯Ó‹ Û˘Ó‡·ÚÍË ™∫ Û ·È‰È·-

ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì À∆. ∏ Û˘¯ÓfiÙËÙ· Â›Ó·È ÌÂÁ·Ï‡-

ÙÂÚË ÛÙ· ‚Ú¤ÊË (¤ˆ˜ Î·È 30%) (16) Î·È Û ·ÛıÂÓ›˜

Ì ‰ÂÍÈ¿ Ï¿ÁÈ· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·, ÏfiÁˆ

Ù˘ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ΢ڛˆ˜ Ì ·ÓˆÌ·-

Ï›· Ebstein (16-18). ™Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, Ë Û˘-

¯ÓfiÙËÙ· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 10% Î·È 30% (6,19), Ô-

ÛÔÛÙfi Ô˘ Û˘ÌʈÓ› Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜

ÌÂϤÙ˘ (14,8%). ™ÙË ÛÂÈÚ¿ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ Û˘-

ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ ˘‹Ú¯Â ¤Ó· ȉȷ›ÙÂÚ· ˘„ËÏfi

ÔÛÔÛÙfi ™∫ Û ·ÛıÂÓ›˜ Ì ‰ÂÍÈ¿ Ï¿ÁÈ· ·Ú·ÏË-

ڈ̷ÙÈο ‰ÂÌ¿ÙÈ· (66%). ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙ·

·ÔÙÂϤÛÌ·Ù· ÌÂٷ͇ ·ÛıÂÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ ™∫, ·Ó

Î·È Ô ÌÈÎÚfi˜ Û¯ÂÙÈο ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ™∫

Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ

ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û˘ÌÂÚ·ÛÌ¿-

ÙˆÓ. ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ¯·ÌË-

ÏfiÙÂÚÔ ÔÛÔÛÙfi ÙÂÏÈ΋˜ ÂÈÙ˘¯›·˜ (68%) Û ·ÛıÂ-

Ó›˜ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· (20).

™‡ÁÎÚÈÛË Ì ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ

∏ ·Ú¯È΋ ¤̂·ÛË Î·Ù¿Ï˘Û˘ fiÏˆÓ ÙˆÓ ·ÛıÂ-

ÓÒÓ Ì ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ÛÙË ÛÂÈÚ¿ Ù˘

·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ÂÈÙ˘¯‹˜ Û 91/94 ·ÛıÂÓ›˜

(ÔÛÔÛÙfi 96,8%), Ì ÙÂÏÈÎfi ÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ·

ÌÂÙ¿ ·fi ˘ÔÙÚÔ¤˜ Î·È Â·Ó·ÏËÙÈΤ˜ ÂÂÌ‚¿-

ÛÂȘ Û 90/94 (95,7%). √È Tanel Î·È Û˘Ó ·Ó¤ÊÂÚ·Ó

·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù·, Ì ÔÛÔÛÙfi ÂÈÙ˘¯›·˜

96% (21).

∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Â›Ó·È ÂÏ·ÊÚÒ˜ ηχÙÂÚ·

·fi Ù· Û˘ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ Pediatric

Radiofrequency Ablation Registry, fiÔ˘ ÛÂ Û‡ÓÔÏÔ

3110 ·ÛıÂÓÒÓ Ì ¶¢, Ë ·Ú¯È΋ ¤̂·ÛË ‹Ù·Ó ÂÈ-

Ù˘¯‹˜ Û 90% ÙˆÓ ·ÛıÂÓÒÓ (7). ∆· ·ÔÙÂϤÛÌ·Ù·

Î·Ù¿Ï˘Û˘ Û ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ‚ÂÏ-

ÙȈı› ÛËÌ·ÓÙÈο Ì ÙËÓ ·‡ÍËÛË Ù˘ ÂÌÂÈÚ›·˜. ∏

Û‡ÁÎÚÈÛË ‰‡Ô ¯ÚÔÓÈÎÒÓ ÂÚÈfi‰ˆÓ (1991-1995 ηÈ

1995-1999) ¤‰ÂÈÍ Ì›ˆÛË ÙˆÓ ·ÔÙ˘¯ËÌ¤ÓˆÓ ÂÂÌ-

‚¿ÛÂˆÓ ·fi 9,6% Û 4,8% (22).

∏ ı¤ÛË ÂÓÙfiÈÛ˘ ÙÔ˘ ¶¢ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ÌÂ

ÙËÓ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙ· Û˘-

ÁÎÂÓÙÚˆÙÈο ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ Pediatric

Radiofrequency Ablation Registry, ˘„ËÏfiÙÂÚ· ÔÛÔ-

ÛÙ¿ ÂÈÙ˘¯›·˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙ· ·ÚÈÛÙÂÚ¿ Ï¿-

ÁÈ· ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· (95%) Î·È ¯·ÌËÏfi-

ÙÂÚ· ÛÙ· ‰È·ÊÚ·ÁÌ·ÙÈο (87%) Î·È ÛÙ· ‰ÂÍÈ¿ Ï¿-

ÁÈ· (86%) (7). ¶·ÚÔÌÔ›ˆ˜, ÔÈ Park Î·È Û˘Ó (22) ÛÂ

Ì›· ÛÂÈÚ¿ 443 ·ÛıÂÓÒÓ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ·È‰È¿

Î·È ÂÓ‹ÏÈΘ, ›¯·Ó ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜

ÛÙ· ‰ÂÍÈ¿ Î·È ÛÙ· ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· (85% ηÈ

88%, ·ÓÙ›ÛÙÔȯ·) Û ۯ¤ÛË Ì ٷ ·ÚÈÛÙÂÚ¿ (97%).

™‡Ìʈӷ Ì ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ·Ú¯È΋ ÂÈÙ˘-

¯›· ‹Ù·Ó ·ÚfiÌÔÈ· Û fiϘ ÙȘ ı¤ÛÂȘ.

ÀÔÙÚÔ‹ ·Ú·ÙËÚ‹ıËÎÂ ÛÂ 13,8% ÙˆÓ ·ÛıÂ-

ÓÒÓ, ÔÛÔÛÙfi Ô˘ ›Û˘ Â›Ó·È Û¯ÂÙÈο ηχÙÂÚÔ

·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ Pediatric Radiofrequency

Ablation Registry, fiÔ˘ ·Ú·ÙËÚ‹ıËÎÂ ˘ÔÙÚÔ‹

Û 23% ÙˆÓ ·ÛıÂÓÒÓ Ì ·Ú·ÏËڈ̷ÙÈÎfi ‰ÂÌ¿ÙÈÔ

(7). ¶·ÚfiÌÔÈ· ÔÛÔÛÙ¿ ˘ÔÙÚÔ‹˜ Ì ÙËÓ ·ÚÔ‡Û·

ÂÚÁ·Û›· (13%) ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·fi ¿ÏÏÔ˘˜ Û˘Á-

ÁÚ·Ê›˜ (24), ÂÓÒ Û ¿ÏϘ ÛÂÈÚ¤˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı›

ÌÈÎÚfiÙÂÚ· ÔÛÔÛÙ¿ (25). √È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·-

Ê›˜ Û˘ÌʈÓÔ‡Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ ›ӷÈ

˘„ËÏfiÙÂÚÔ ÛÙ· ‰ÂÍÈ¿ ·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ· ÛÂ

Û‡ÁÎÚÈÛË Ì ÙȘ ¿ÏϘ ηÙËÁÔڛ˜, Ì ÔÛÔÛÙ¿ ˘Ô-

ÙÚÔ‹˜ ·fi 17-24% (26-28).

∞ÔÙÂϤÛÌ·Ù· Î·Ù¿Ï˘Û˘ ·Ú·ÏËڈ̷ÙÈÎÒÓ

‰ÂÌ·Ù›ˆÓ Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·

Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3, ‰ÂÓ ˘‹Ú¯Â ÛÙ·-

ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ›‰Ú·ÛË Ù˘ ËÏÈΛ·˜, fiÛÔÓ ·ÊÔ-

Ú¿ ÛÙËÓ ÂÈÙ˘¯›· ÙˆÓ ÂÂÌ‚¿ÛˆÓ, ÛÙÔ ÔÛÔÛÙfi

˘ÔÙÚÔÒÓ Î·È ÛÙȘ ÂÈÏÔΤ˜.

™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÛËÌ·ÓÙÈΤ˜

‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘

Ô˘ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ËÏÈΛ· (6,23,29). ª¿ÏÈ-

ÛÙ·, Û ÔÚÈṲ̂Ó˜ ηÙËÁÔڛ˜ ·ÛıÂÓÒÓ, ÙÔ ÌÈÎÚfiÙÂ-

ÚÔ ÛˆÌ·ÙÈÎfi ̤ÁÂıÔ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ˘„ËÏfiÙÂ-

ÚÔ ÔÛÔÛÙfi ÂÈÙ˘¯›·˜. ∞Ó¿Ï˘ÛË ÙˆÓ Î·Ù·Ï‡ÛÂˆÓ ÛÂ

·ÛıÂÓ›˜ Ì ·ÓˆÌ·Ï›· Ebstein ¤‰ÂÈÍ fiÙÈ ÔÈ ·ÛıÂÓ›˜

Ì ÌÈÎÚfiÙÂÚË ÛˆÌ·ÙÈ΋ ÂÈÊ¿ÓÂÈ· ›¯·Ó ˘„ËÏfiÙÂÚ·

ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ (30).

¢È¿ÊÔÚÔÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó Û˘ÁÎÚ›ÓÂÈ Ù· ·ÔÙÂ-

ϤÛÌ·Ù¿ ÙÔ˘˜ ÛÙËÓ Î·Ù¿Ï˘ÛË ·ÚÚ˘ıÌÈÒÓ Û ·È‰È¿

Î·È ÂÓ‹ÏÈΘ. √È Park Î·È Û˘Ó (23) ÌÂϤÙËÛ·Ó Ù·

·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ Û 413 ·ÛıÂÓ›˜ Ô˘ ÙÔ˘˜ ‰È¤-

ÎÚÈÓ·Ó Û ·È‰È¿ (2-12 ÂÙÒÓ), ÂÊ‹‚Ô˘˜ (13-19 ÂÙÒÓ)

Î·È ÂÓ‹ÏÈΘ (>20 ÂÙÒÓ). ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ÛÙËÓ

ÂÈÙ˘¯›· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ËÏÈÎÈÒÓ (93-95%),

Ô‡Ù ÛÙË Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ¤̂·Û˘, ÙÔÓ ¯ÚfiÓÔ

·ÎÙÈÓÔÛÎfiËÛ˘ Î·È ÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ. ™Â fiϘ

ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜, Ë Î·Ù¿Ï˘ÛË ‰ÂÍÈÒÓ Î·È ‰È·-

ÊÚ·ÁÌ·ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ‹Ù·Ó ‰˘ÛÎÔÏfiÙÂÚË Î·È ÌÂ

¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜. √È Manolis Î·È Û˘Ó

(31), ›Û˘, ÌÂϤÙËÛ·Ó Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ ÛÂ

·È‰È¿ Î·È ÂÓ‹ÏÈΘ (47 ·È‰È¿ Î·È 280 ÂÓ‹ÏÈΘ) ηÈ

‰ÂÓ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û¯ÂÙÈ˙fiÌÂÓ˜ ÌÂ

ÙËÓ ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ.

∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ηٷ‰ÂÈÎÓ‡Ô˘Ó ÙÔ ÁÂÁÔ-

Ófi˜ fiÙÈ Ë Î·Ù¿Ï˘ÛË Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜

ÌÔÚ› Ó· Ú·ÁÌ·ÙÔÔÈËı› Ì ÙËÓ ›‰È· ·ÛÊ¿ÏÂÈ· ηÈ

ÂÈÙ˘¯›· Î·È ÛÙ· ·È‰È¿ fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ,

129∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·129

Page 61: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

·ÚΛ ‚‚·›ˆ˜ Ó· Á›ÓÂÙ·È ·fi ¤ÌÂÈÚÔ˘˜ ¯ÂÈÚÈÛÙ¤˜.

∂Í·›ÚÂÛË ›Ûˆ˜ ·ÔÙÂÏ› Ë ÔÌ¿‰· ÙˆÓ ‚ÚÂÊÒÓ, ÛÙËÓ

ÔÔ›· - fiˆ˜ ı· ·Ó·ÊÂÚı› ·Ú·Î¿Ùˆ - ÌÔÚ› ÌÂÓ

Ë Î·Ù¿Ï˘ÛË Ó· ¤¯ÂÈ ·ÚfiÌÔÈ· ÂÈÙ˘¯›· fiˆ˜ ηÈ

ÛÙȘ ¿ÏϘ ÔÌ¿‰Â˜ (29), ·ÏÏ¿ Ë Èı·ÓfiÙËÙ· ÛÔ‚·-

ÚÒÓ ÂÈÏÔÎÒÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË.

∂ȉÈΤ˜ ÂÚÈÙÒÛÂȘ

ª›· ÂȉÈ΋ ηÙËÁÔÚ›· ¶¢ Â›Ó·È ·˘Ù¿ Ô˘ ¤¯Ô˘Ó

‚Ú·‰Â›· Î·È ÌfiÓÔ ·Ï›Ó‰ÚÔÌË ·ÁˆÁ‹. §fiÁˆ Ù˘

‚Ú·‰Â›·˜ ·˘Ù‹˜ ·ÁˆÁ‹˜, ÔÈ ·ÛıÂÓ›˜ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜

ÌÈ· ·Î·Ù¿·˘ÛÙË Ù·¯˘Î·Ú‰›·, ‰ÈfiÙÈ Ô ÎÔÏÔÎÔÈÏÈ·-

Îfi˜ ÎfiÌ‚Ô˜ Â›Ó·È Û˘Ó¯Ҙ ¤ÙÔÈÌÔ˜ Ó· ‰Â¯ı› Î·È Ó·

¿ÁÂÈ ÚÔ˜ ÙȘ ÎÔÈϛ˜ Ù· ÂÚÂı›ÛÌ·Ù· Ô˘ ¿ÁÔÓÙ·È

·Ï›Ó‰ÚÔÌ· ·fi ÙÔ ‰ÂÌ¿ÙÈÔ. ∏ Ù·¯˘Î·Ú‰›· ÙˆÓ

·ÛıÂÓÒÓ ·˘ÙÒÓ ¤¯ÂÈ ÔÓÔÌ·ÛÙ› “permanent

junctional reciprocating tachycardia” (PJRT), ÏfiÁˆ

Ù˘ ¯ÚÔÓÈfiÙËÙ¿˜ Ù˘. ™ÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤ-

Ù˘ ˘‹Ú¯·Ó 7 ·ÛıÂÓ›˜ Ì ·˘Ù‹ ÙËÓ Ù·¯˘Î·Ú‰›·, ÌÂ

ÂÈÙ˘¯‹ Î·Ù¿Ï˘ÛË ÛÙÔ˘˜ 6, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËıÔ‡Ó

ÂÈÏÔΤ˜ ‹ ˘ÔÙÚÔ¤˜. ∞Ó Î·È ¤¯Ô˘Ó ·Ó·ÊÂÚı›

ÂÚÈÙÒÛÂȘ ·˘ÙfiÌ·Ù˘ ›·Û˘ Ù˘ Ù·¯˘Î·Ú‰›·˜ ·˘-

Ù‹˜, Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÔ˘Ó Û ‚Ú¤ÊË. ∂Âȉ‹ Ë Ù·¯˘-

ηډ›· Â›Ó·È ¯ÚfiÓÈ· Î·È ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Â‡ÎÔÏ·

ÛÙ· ·ÓÙÈ·ÚÚ˘ıÌÈο Ê¿Ú̷η, ÌÔÚ› Ó· ÚÔÎÏËı›

‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ÂÎ Ù·¯˘Î·Ú‰›·˜. Œ¯Ô˘Ó

Ì¿ÏÈÛÙ· ·Ó·ÊÂÚı› Î·È ·ÈÊÓ›‰ÈÔÈ ı¿Ó·ÙÔÈ Û ·Û˘-

Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ÌÂ Ì˘ÔηډÈÔ¿ıÂÈ· (32).

°È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, Ë Î·Ù¿Ï˘ÛË Â›Ó·È ÚÔÙÈÌfi-

ÙÂÚË ·fi ÙË ¯ÚfiÓÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹.

ª›· ¿ÏÏË ÂȉÈ΋ ÔÌ¿‰·, ÁÈ· ÙËÓ ÔÔ›· ¤¯ÂÈ Á›ÓÂÈ

ÌÂÁ¿ÏË Û˘˙‹ÙËÛË Î·È ˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· ˆ˜ ÚÔ˜

ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘, ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ ·Û˘ÌÙˆ-

Ì·ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÂÌÊ·Ó‹ ÚԉȤÁÂÚÛË ÛÙÔ ∏∫°

(·Û˘Ìو̷ÙÈÎfi Û‡Ó‰ÚÔÌÔ WPW). ∂›Ó·È ÁÓˆÛÙfi

·fi ÔÏÏ¿ ¯ÚfiÓÈ· fiÙÈ ·ÎfiÌË Î·È ·Û˘Ìو̷ÙÈÎÔ›

·ÛıÂÓ›˜ ¤¯Ô˘Ó ¤Ó·Ó ÌÈÎÚfi, ·ÏÏ¿ ˘·ÚÎÙfi ΛӉ˘ÓÔ

·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, Ô˘ ÔÊ›ÏÂÙ·È Û ٷ¯Â›· ·ÁˆÁ‹

̤ۈ ÙÔ˘ ¶¢ ηٿ ÙË ‰È¿ÚÎÂÈ· ÎÔÏÈ΋˜ Ì·ÚÌ·Ú˘-

Á‹˜, Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘-

Á‹. ¶·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ˆ˜ ÚÔ˜

ÙËÓ Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘. ∂ÂÈ-

‰‹ Ë Úfi‚ÏÂ„Ë ·fi ÙȘ ·Ó·›Ì·ÎÙ˜ ÂÍÂÙ¿ÛÂȘ (Holter

24ÒÚÔ˘, ‰ÔÎÈÌ·Û›· ÎÔÒÛˆ˜) Â›Ó·È ·‚¤‚·ÈË, ÔÈ Â-

ÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÓÈÛÙÔ‡Ó ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ-

‰‡ÓÔ˘ Ì ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË, ›Ù ‰ÈÔÈÛÔ-

Ê·ÁÈ΋ ›Ù ÂÓ‰Ôηډȷ΋. ªÈ· ÚfiÛÊ·ÙË ÚÔÔÙÈ-

΋ ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ·ÛıÂÓ›˜ Ì ·Û˘Ìو̷ÙÈÎfi

Û‡Ó‰ÚÔÌÔ WPW Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÚÔÏËÙÈ΋

Î·Ù¿Ï˘ÛË, ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÔÛÔÛÙfi

Û˘Ì‚·Ì¿ÙˆÓ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ÛÙËÓ

ÔÔ›· ˘‹ÚÍ·Ó Î·È ‰‡Ô ·ÛıÂÓ›˜ Ì ÎÔÈÏȷ΋ Ì·ÚÌ·-

Ú˘Á‹, ÂÎ ÙˆÓ ÔÔ›ˆÓ Ô ¤Ó·˜ ¤ı·Ó ·ÈÊÓ›‰È· (33).

£ÂˆÚÂ›Ù·È fiÙÈ Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ ‰ÈηÈÔÏÔÁÔ‡Ó ÙË Û˘-

ÁÎÂÎÚÈ̤ÓË Ú·ÎÙÈ΋, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· fiÏÔÈ ÔÈ

·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Wolff-Parkinson-White (ÂÎÙfi˜

·˘ÙÒÓ Ì ۿÓÈ·, ‰È·ÏÂ›Ô˘Û· ÚԉȤÁÂÚÛË) ˘Ô-

‚¿ÏÏÔÓÙ·È Û ∏ºª, ÂÓÒ Â¿Ó Ë ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô˜

ÙÔ˘ ‰ÂÌ·Ù›Ô˘ Â›Ó·È <250 msec, ‹ ÚÔηÏÂ›Ù·È ÎÔÏÈ-

΋ Ì·ÚÌ·Ú˘Á‹ Ì ٷ¯Â›· ÎÔÈÏȷ΋ ·ÓÙ·fiÎÚÈÛË, Ú¤-

ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È Î·Ù¿Ï˘ÛË.

∂ÈÏÔΤ˜

∏ ˘„ËÏ‹ ÂÈÙ˘¯›· Ù˘ Î·Ù¿Ï˘Û˘ ·ÚÚ˘ıÌÈÒÓ ÌÂ

Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ı· Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌ¿Ù·È

ÌÂ ÙË ÌÈÎÚ‹, ·ÏÏ¿ ˘·ÚÎÙ‹ Èı·ÓfiÙËÙ· ÂÈÏÔÎÒÓ.

√È ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ Â›Ó·È ·ÚÔ‰ÈΤ˜ Î·È ·˘-

ÙÔ˚¿ÛÈ̘, fiˆ˜ Ë ·Ó¿Ù˘ÍË ·ÈÌ·ÙÒÌ·ÙÔ˜ ÛÙ· ÛË-

Ì›· ÂÈÛ·ÁˆÁ‹˜ ÙˆÓ Î·ıÂÙ‹ÚˆÓ, Ë ÌÂȈ̤ÓË ·ÚÙË-

Úȷ΋ ΢ÎÏÔÊÔÚ›· Û ÂÚÈÙÒÛÂȘ ·Ï›Ó‰ÚÔÌÔ˘ η-

ıÂÙËÚÈ·ÛÌÔ‡ Ù˘ ·ÔÚÙ‹˜ ·fi Ù· ÌËÚÈ·›· ·ÁÁ›· ηÈ

¿ÏϘ ·ÚÔ‰ÈΤ˜ ÂÈÏÔΤ˜. √È Ì›˙ÔÓ˜ ÂÈÏÔΤ˜,

fiˆ˜ ‚Ï¿‚Ë ÙˆÓ Î·Ú‰È·ÎÒÓ ‚·Ï‚›‰ˆÓ, ÎÔÏÔÎÔÈ-

ÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜ 2Ô˘ Î·È 3Ô˘ ‚·ıÌÔ‡, ηډȷ΋

‰È¿ÙÚËÛË, ÂÚÈηډȷÎfi ˘ÁÚfi, ıÚÔÌ‚ÔÂÌ‚ÔÏÈο Ê·È-

ÓfiÌÂÓ·, ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ‚Ú·¯ÈÔÓ›Ô˘ ϤÁÌ·ÙÔ˜

Î·È Ó¢ÌÔıÒڷη˜, Â›Ó·È Â˘Ù˘¯Ò˜ Û¿ÓȘ.

µÏ¿‚Ë Î·Ú‰È·ÎÒÓ ‚·Ï‚›‰ˆÓ, ΢ڛˆ˜ Ù˘ ·ÔÚÙ‹˜

Î·È Û·ÓÈfiÙÂÚ· Ù˘ ÌÈÙÚÔÂȉԇ˜, ÌÔÚ› Ó· ·Ú·ÙË-

ÚËı› ΢ڛˆ˜ ηٿ ÙÔÓ ·Ï›Ó‰ÚÔÌÔ Î·ıÂÙËÚÈÛÌfi

Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ ÁÈ· Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚfiÏ¢-

ÚˆÓ ˘ÔÛÙÚˆÌ¿ÙˆÓ Ù·¯˘Î·Ú‰›·˜. ∞ÓÙ›ıÂÙ·, Ì ÙË

‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ Ù¯ÓÈ΋ ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ‰È¿-

ÙÚËÛ˘ ÙÔ˘ ÎÔÏÈÎÔ‡ Ì˘Ôηډ›Ô˘ Î·È Ù˘ ÂÌ‚ÔÏ‹˜

‰È’ ·¤ÚÔ˜. ™ÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ

˘‹Ú¯Â ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù¯ÓÈ-

ÎÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ, ÂÈÏÔÎÒÓ,

ÙËÓ ·Ó¿ÁÎË ·ÏÏ·Á‹˜ ·fi ÙË Ì›· Ù¯ÓÈ΋ ÛÙËÓ ¿ÏÏË,

ÙȘ ˘ÔÙÚÔ¤˜ Î·È ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ·. °ÂÓÈο

ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ô ¯ÚfiÓÔ˜ ·ÎÙÈÓÔÛÎfiËÛ˘ Î·È Ë

Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ¤̂·Û˘, ηıÒ˜ Î·È Ô Û˘ÓÔÏÈ-

Îfi˜ ·ÚÈıÌfi˜ ÙˆÓ ‚Ï·‚ÒÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο

ÌÂٷ͇ ÙˆÓ ‰‡Ô Ù¯ÓÈÎÒÓ (34-36). ™ÙËÓ ·È‰È·ÙÚÈ΋

‚È‚ÏÈÔÁÚ·Ê›·, Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË Ù˘ ‰È·ÔÚÙÈ΋˜ ÌÂ

ÙËÓ ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ΋ ÚÔۤϷÛË ¤ÁÈÓ ·fi ÙÔ˘˜

Law Î·È Û˘Ó (37) Û 136 ·ÛıÂÓ›˜, ̤Û˘ ËÏÈΛ·˜

12,2 ÂÙÒÓ (30 ‰È·ÔÚÙÈΤ˜ Î·È 106 ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ-

Τ˜ ÚÔÛÂÏ¿ÛÂȘ). √È ‰È·ÔÚÙÈΤ˜ ÚÔÛÂÏ¿ÛÂȘ

··›ÙËÛ·Ó ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ηıÂÙ‹ÚˆÓ, ¯ÚfiÓÔ

·ÎÙÈÓÔÛÎfiËÛ˘ (71,3 ¤Ó·ÓÙÈ 43 min) Î·È ¯ÚfiÓÔ

¤̂·Û˘ (5,0 ¤Ó·ÓÙÈ 4,1 ÒÚ˜). ¢ÂÓ ˘‹ÚÍ ÛÙ·ÙÈ-

ÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙÂÏÈ΋

ÂÈÙ˘¯›·, ÙÔÓ ·ÚÈıÌfi ‚Ï·‚ÒÓ Î·È ÙȘ ÂÈÏÔΤ˜. °Â-

ÓÈο ÛÙËÓ ·È‰È·ÙÚÈ΋ ÂÌÂÈÚ›·, Ë ‰È·-‰È·ÊÚ·ÁÌ·ÙÈ-

΋ ÚÔۤϷÛË ÚÔÙÈÌ¿Ù·È Ù˘ ‰È·ÔÚÙÈ΋˜, ÏfiÁˆ

Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ ¢ÎÔÏ›·˜ ¯ÂÈÚÈÛÌÒÓ Û ۇÁÎÚÈÛË

130 π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Paediatriki 2007;70:123-134

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·130

Page 62: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

Ì ÙË ‰È·ÔÚÙÈ΋, ÙÔ˘ ÌÈÎÚfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘ ‚Ï¿‚˘

Ù˘ ·ÔÚÙÈ΋˜ Î·È ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ Î·È Ù˘

·ÔÊ˘Á‹˜ ‚Ï·‚ÒÓ ÛÙÔ ÎÔÈÏÈ·Îfi Ì˘ÔοډÈÔ.

∏ Î·Ù¿Ï˘ÛË ‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ¤¯ÂÈ Û˘-

Û¯ÂÙÈÛÙ› Ì ˘„ËÏfi Û¯ÂÙÈο ‚·ıÌfi ‰˘ÛÎÔÏ›·˜ Î·È ÌÂ

ÙÔÓ Î›Ó‰˘ÓÔ ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. √È

Mandapati Î·È Û˘Ó (38), Û ̛· ÛÂÈÚ¿ 127 ·È‰È·ÙÚÈ-

ÎÒÓ ·ÛıÂÓÒÓ (0,3-18 ÂÙÒÓ) Ì ‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿-

ÙÈ·, ›¯·Ó ·Ú¯È΋ ÂÈÙ˘¯›· Û ÔÛÔÛÙfi 95,6%. √È

˘ÔÙÚÔ¤˜ ‹Ù·Ó ˘„ËÏfiÙÂÚ˜ ÛÙ· ‰ÂÍÈ¿ ‰È¿ÌÂÛ· ηÈ

ÚfiÛıÈ· ‰È·ÊÚ·ÁÌ·ÙÈο (12 Î·È 14%, ·ÓÙ›ÛÙÔȯ·) ÛÂ

Û¯¤ÛË Ì ٷ ˘fiÏÔÈ· ‰ÂÌ¿ÙÈ· (3-4%), fiˆ˜ ηÈ

ÛÙË ÛÂÈÚ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∫ÔÏÔÎÔÈÏÈ·Îfi˜

·ÔÎÏÂÈÛÌfi˜ ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ÔÛÔÛÙfi 3% ÙˆÓ

·ÛıÂÓÒÓ. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Â›Ó·È ·Ó¿ÏÔÁ· Ì ·˘Ù¿

Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘ÓÔÏÈ΋

·Ú¯È΋ ÂÈÙ˘¯›· (98%) Î·È ÛÙȘ ˘ÔÙÚÔ¤˜ (12,5%).

∂ÎÙfi˜ ·fi ‰‡Ô ·ÛıÂÓ›˜ Ì ·ÚÔ‰ÈÎfi ÎÔÏÔÎÔÈÏÈ·-

Îfi ·ÔÎÏÂÈÛÌfi, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ¿ÏϘ ‰È·Ù·-

Ú·¯¤˜ Ù˘ ·ÁˆÁ‹˜.

™Ù· ·È‰È¿, Ë Î·Ù¿Ï˘ÛË ·ÚÈÛÙÂÚfiÏÂ˘ÚˆÓ Ù·¯˘-

ηډÈÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ·

ÂÈÏÔÎÒÓ, ·ÎfiÌË Î·È ıÓËÙfiÙËÙ·. √È Schaffer ηÈ

Û˘Ó (12) ·Ó¤ÊÂÚ·Ó ıÓËÙfiÙËÙ· 0,22%, Û¯ÂÙÈ˙fiÌÂÓË

ÌÂ Ì˘Ôηډȷ΋ ‚Ï¿‚Ë, ‰È¿ÙÚËÛË, ·ÈÌÔÂÚÈοډÈÔ,

ıÚÔÌ‚ÔÂÌ‚ÔÏÈΤ˜ ÂÈÏÔΤ˜ ·fi Ù· ÛÙÂÊ·ÓÈ·›· ‹

ÂÁÎÂÊ·ÏÈο ·ÁÁ›· Î·È ÎÔÈÏȷ΋ ·ÚÚ˘ıÌ›·. ŸÏ˜ ÔÈ

ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Û·Ó Û ·ÚÈÛÙÂÚfiÏ¢Ú˜ ÂÂÌ-

‚¿ÛÂȘ, ›Ù ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ Â›Ù ÛÙËÓ ·ÚÈÛÙÂ-

Ú¿ ÎÔÈÏ›·.

∏ Î·Ù¿Ï˘ÛË ·ÚÚ˘ıÌÈÒÓ Û ‚Ú¤ÊË ·ÔÙÂÏ› ÛË-

ÌÂ›Ô ‰È·ÊˆÓ›·˜. ∞Ó Î·È ÔÈ Blaufox Î·È Û˘Ó (29) ‰ÂÓ

‚Ú‹Î·Ó ‰È·ÊÔÚÂÙÈÎfi ÔÛÔÛÙfi ÂÈÏÔÎÒÓ Û ۯ¤ÛË ÌÂ

Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Û ̛· ÛÂÈÚ¿ ‚ÚÂÊÒÓ ËÏÈΛ·˜

≤18 ÌËÓÒÓ, ‰ÂÓ ı· Ú¤ÂÈ Ó· ÏËÛÌÔÓÂ›Ù·È fiÙÈ Ù· ‚Ú¤-

ÊË ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ·Ó¿Ù˘Í˘ ÂÈ-

ÏÔÎÒÓ Û‡Ìʈӷ Ì ¿ÏÏ· ÎÏÈÓÈο (6,39) Î·È ÂÈÚ·-

Ì·ÙÈο (13,14) ‰Â‰Ô̤ӷ. ∆Ô ‚ÚÂÊÈÎfi Ì˘ÔοډÈÔ

·ÓÙȉڿ ‰È·ÊÔÚÂÙÈο ÛÙȘ ÂÊ·ÚÌÔÁ¤˜ Ú‡̷ÙÔ˜ Ú·-

‰ÈÔÛ˘¯ÓfiÙËÙ·˜, Ì ۯËÌ·ÙÈÛÌfi ÌÂÁ·Ï‡ÙÂÚˆÓ ‚Ï·‚ÒÓ,

ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ÂÂÎÙ·ıÔ‡Ó Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘

¯ÚfiÓÔ˘ Î·È Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ·ÓÒ̷Ϙ ·Ú˘Ê¤˜,

ȉ›ˆ˜ fiÙ·Ó ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙÔ ÎÔÈÏÈ·Îfi Ì˘ÔοډÈÔ

(13). ∂›Û˘, Ù· ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· ‚Ú›ÛÎÔÓÙ·È ÂÁÁ‡-

ÙÂÚ· ÛÙÔ ÛËÌÂ›Ô ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÂÓ¤ÚÁÂÈ·˜ Ì Ú‡̷

Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Î·È ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÌÂÚÈ-

΋ ‹ Û¿ÓÈ· ÔÏÈ΋ ·fiÊÚ·ÍË, fiˆ˜ ¤¯ÂÈ ‰Âȯı› ÛÂ

ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ (14) Î·È Û ۿÓȘ ÎÏÈÓÈΤ˜

ÂÚÈÙÒÛÂȘ (40,41). °È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, Ë ¯Ú‹-

ÛË ÂÂÌ‚·ÙÈ΋˜ ıÂڷ›·˜ Ì Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙË-

Ù·˜ ÛÙ· ‚Ú¤ÊË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ ÁÈ· ıÂÚ·-

›· ÂÚÈÙÒÛÂˆÓ ·ÂÈÏËÙÈÎÒÓ ÁÈ· ÙË ˙ˆ‹ Î·È ÌfiÓÔ

ÌÂÙ¿ ·fi ÂÍ¿ÓÙÏËÛË ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ ÌÂıfi‰ˆÓ.

∏ ÚfiÎÏËÛË ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ ÌÂÙ¿

·fi ÂÂÌ‚¿ÛÂȘ Î·Ù¿Ï˘Û˘ ¶¢ Û ·È‰È¿ Â›Ó·È Â˘-

Ù˘¯Ò˜ Û¿ÓÈ·. √È Schaffer Î·È Û˘Ó (42) ·Ó¤ÊÂÚ·Ó

ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi Û 23/1964 ηٷχÛÂȘ

(1,2% ÙˆÓ ÂÚÈÙÒÛˆÓ). ™Â 14 ÂÚÈÙÒÛÂȘ Ô ·Ô-

ÎÏÂÈÛÌfi˜ ‹Ù·Ó Ï‹Ú˘ Î·È Û ÂÓÓ¤· 2Ô˘ ‚·ıÌÔ‡. ∏

·Ó¿Ù˘ÍË ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ Û¯ÂÙÈ˙fi-

Ù·Ó Ì ÙË ı¤ÛË Î·Ù¿Ï˘Û˘ (2,7% ÁÈ· ‰ÂÍÈ¿ ÚÔÛıÈÔ-

‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·, 10,4% ÁÈ· ‰ÂÍÈ¿ ‰È¿ÌÂÛ·

‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ· Î·È 1% ÁÈ· ‰ÂÍÈ¿ ÔÈÛıÈÔ-

‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿ÙÈ·). ∏ ÂÌÂÈÚ›· ÙÔ˘ ¯ÂÈÚÈÛÙ‹

‹Ù·Ó ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÎÔÏ-

ÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. ∂Âȉ‹ ÛÙËÓ ·ÚÔ‡Û·

ÌÂϤÙË ÔÈ ÌfiÓÔÈ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ·ÚÔ‰ÈÎfi

ÎÔÏÔÎÔÈÏÈ·Îfi ·ÔÎÏÂÈÛÌfi ‹Ù·Ó ‰‡Ô ·ÛıÂÓ›˜ ËÏÈ-

Λ·˜ 5 ÂÙÒÓ Ì ‰ÂÍÈ¿ ÔÈÛıÈÔ-‰È·ÊÚ·ÁÌ·ÙÈο ‰ÂÌ¿-

ÙÈ·, ıˆÚÂ›Ù·È fiÙÈ Ë Î·Ù¿Ï˘ÛË ‰È·ÊÚ·ÁÌ·ÙÈÎÒÓ ‰Â-

Ì·Ù›ˆÓ Û ÌÈÎÚ¤˜ ËÏÈ˘ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ

› ·ÂÈÏËÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ ·‰˘Ó·Ì›·˜ ÂϤÁ-

¯Ô˘ Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹.

∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÍ¿ÏÏÔ˘ ¤¯ÂÈ ·Ó·Ù˘¯ı›

Î·È Ë Ù¯ÓÈ΋ Ù˘ ÎÚ˘ÔËÍ›·˜, Ì ÙËÓ ÔÔ›· ÌÔÚ›

Ó· Ú·ÁÌ·ÙÔÔÈËı› Ì ·ÛÊ¿ÏÂÈ· Î·Ù¿Ï˘ÛË ¶¢

Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÛÙÂÓ‹ ÁÂÈÙÓ›·ÛË ÌÂ ÙÔÓ ÎÔÏÔ-

ÎÔÈÏÈ·Îfi ÎfiÌ‚Ô, ·ÏÏ¿ Î·È ÎÔÌ‚È΋˜ Ù·¯˘Î·Ú‰›·˜

(43,44). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ·Ó·Ì¤ÓÂÙ·È Ó· ·›ÍÂÈ ÛË-

Ì·ÓÙÈÎfi ÚfiÏÔ Û ÂÚÈÙÒÛÂȘ Ô˘ Ë Î·Ù¿Ï˘ÛË ÌÂ

Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ

ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡.

ŒÎıÂÛË ÛÙËÓ ·ÎÙÈÓÔ‚ÔÏ›·

√È ÂÚÈÛÛfiÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ Î·Ù¿Ï˘Û˘ ÌÂ

Ú‡̷ Ú·‰ÈÔÛ˘¯ÓfiÙËÙ·˜ Â›Ó·È ÂÌÊ·Ó›˜ ·Ì¤Ûˆ˜ ÌÂ-

Ù¿ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ ¤̂·Û˘. ∞ÓÙ›ıÂÙ·, ÔÈ

Èı·Ó¤˜ ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ Ù˘ ¤ÎıÂÛ˘ Û ·ÎÙÈ-

ÓÔ‚ÔÏ›· ‰ÂÓ Â›Ó·È Û˘Ó‹ıˆ˜ ¿ÌÂÛ· ÔÚ·Ù¤˜. ÕÌÂÛ˜

ÂÈÏÔΤ˜ Ù˘ ·ÎÙÈÓÔ‚ÔÏ›·˜, fiˆ˜ ‰ÂÚÌ·Ù›Ùȉ· ‹

Ó¢ÌÔÓ›Ùȉ·, ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Û¿ÓÈ· ÌÂÙ¿

·fi ÂÍ·ÈÚÂÙÈο ˘„ËϤ˜ ‰fiÛÂȘ. √È Ì·ÎÚÔ¯ÚfiÓȘ

ÂÈÏÔΤ˜, fiˆ˜ Ë ·Ó¿Ù˘ÍË Î·ÎÔ‹ıˆÓ ÓÂÔÏ·-

ÛÈÒÓ, ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÔÛÙÒÓ, ÙÂÚ·-

ÙÔÁÂÓ¤ÛÂȘ ‹ ηٷÚÚ¿ÎÙ˘, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó

ÌÂÙ¿ ·fi ¿Ú· ÔÏÏ¿ ¯ÚfiÓÈ·.

√È Geise Î·È Û˘Ó (45) ÌÂϤÙËÛ·Ó Ì›· ÔÌ¿‰· 9

·ÛıÂÓÒÓ, ËÏÈΛ·˜ 2-20 ÂÙÒÓ Î·È ‚¿ÚÔ˘˜ 13-72 kg. ∏

̤ÁÈÛÙË ‰ÂÚÌ·ÙÈ΋ ‰fiÛË ÌÂÙÚ‹ıËΠÌÂٷ͇ 0,01-

2,35 Gy (1-233 rad). ∂ӉȷʤÚÔÓ Â›Ó·È fiÙÈ Ô ‚·ıÌfi˜

¤ÎıÂÛ˘ ·˘Í¿ÓÂÙ·È ÂÎıÂÙÈο Ì ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÛÒ-

Ì·ÙÔ˜ Î·È ‰ÈÏ·ÛÈ¿˙ÂÙ·È ÁÈ· οı 2-4 cm ·‡ÍËÛ˘

ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ∏ ̤ÁÈÛÙË

‰ÂÚÌ·ÙÈ΋ ‰fiÛË (2,35 Gy) ‚Ú¤ıËΠ۠¤Ó·Ó ·ÛıÂÓ‹

ËÏÈΛ·˜ 20 ÂÙÒÓ Ô˘ ›¯Â ¯ÚfiÓÔ ·ÎÙÈÓÔÛÎfiËÛ˘

105 min.

131∫·Ù¿Ï˘ÛË ·Ú·ÏËڈ̷ÙÈÎÒÓ ‰ÂÌ·Ù›ˆÓ ÛÙ· ·È‰È¿

¶·È‰È·ÙÚÈ΋ 2007;70:123-134

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·131

Page 63: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

√È Calkins Î·È Û˘Ó (46) Î·È ÔÈ Lindsay Î·È Û˘Ó

(47) ÂÎÙ›ÌËÛ·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi ·‡ÍËÛ˘ ÙÔ˘ ÎÈÓ‰‡-

ÓÔ˘ ηÎÔ‹ıÂÈ·˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ·ÎÙÈÓÔ‚ÔÏ›·

ÁÈ· 60 min, ‹Ù·Ó ·fi 1/1000 ¤ˆ˜ 1/745 ÂÚÈÛÙ·ÙÈ-

ο. ∂¿Ó ˘ÔÏÔÁÈÛÙ› fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÂÓfi˜ ÂÓ‹ÏÈη

ÁÂÓÈο ÁÈ· ηÎÔ‹ıÂÈ· Â›Ó·È 10-20% Î·È fiÙÈ Ë ÂÚÈ-

‚·ÏÏÔÓÙÈ΋ ‰fiÛË ·ÎÙÈÓÔ‚ÔÏ›·˜ Â›Ó·È 10-30 Gy ·Ó¿

¤ÙÔ˜, ÙÔ ÔÛÔÛÙfi ·‡ÍËÛ˘ Â›Ó·È Ôχ ÌÈÎÚfi. √È

Û˘ÁÁÚ·Ê›˜ ·˘ÙÔ› ÂÎÙ›ÌËÛ·Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÂÓÂÙÈ-

ÎÒÓ ‚Ï·‚ÒÓ ‹Ù·Ó ¿Ú· Ôχ ¯·ÌËÏfi˜ (0,001-

0,002%).

∞Ó Î·È ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ·Â˘ı›·˜ ÌÂ-

ÙÚ‹ÛÂȘ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ·ÎÙÈÓÔ‚ÔÏ›·˜ Î·È Ù˘ ‰fi-

Û˘ Ô˘ ¤Ï·‚·Ó ÔÈ ·ÛıÂÓ›˜, Ô ¯ÚfiÓÔ˜ ¤ÎıÂÛ˘ ÛÙËÓ

·ÎÙÈÓÔ‚ÔÏ›· ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó ̤۷ ÛÙ·

·Ú·¿Óˆ Ï·›ÛÈ·: Ô Ì¤ÛÔ˜ fiÚÔ˜ ¤ÎıÂÛ˘ ‹Ù·Ó

32,1±26,3 (6-135) min. ™Â ηӤӷ ·ÛıÂÓ‹ ‰ÂÓ ·Ú·-

ÙËÚ‹ıËÎ·Ó ¿ÌÂÛ˜ Ô‡Ù ̷ÎÚÔÚfiıÂÛ̘ ÂÈÏÔ-

Τ˜ ηٿ ÙËÓ ¤ˆ˜ ÙÒÚ· ·Ú·ÎÔÏÔ‡ıËÛË (̤¯ÚÈ Î·È

10 ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË).

∆· ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù· ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ¤ÎıÂ-

ÛË ÛÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· ηٿ ÙȘ ÂÂÌ‚¿ÛÂȘ Î·Ù¿Ï˘-

Û˘, ÙfiÛÔ ÛÙËÓ ·ÚÔ‡Û· fiÛÔ Î·È ÛÙË ‰ÈÂıÓ‹ ÂÌÂÈ-

Ú›·, Â›Ó·È ÁÂÓÈο ̤۷ ÛÙ· ÂÈÙÚÂÙ¿ fiÚÈ· ·ÛÊ·Ï›-

·˜. ¶·Ú’ fiÏ· ·˘Ù¿, ··ÈÙÂ›Ù·È Û˘Ó¯‹˜ ·ÁÚ‡ÓË-

ÛË Î·È ÚÔÛ¿ıÂÈ· ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚ˘ Ì›ˆÛ˘

Ù˘ ¤ÎıÂÛ˘, Ì ÛÎÔfi ÙÔÓ ÂÚÈÔÚÈÛÌfi Èı·ÓÒÓ

·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ. ∏ ·Ó¿Ù˘ÍË ÓÂfiÙÂÚˆÓ Ù¯ÓÈ-

ÎÒÓ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË ‹

Î·È ÂÍ¿ÏÂÈ„Ë Ù˘ ¤ÎıÂÛ˘ Û ·ÎÙÈÓÔ‚ÔÏ›·, ÁÂÁÔÓfi˜

Ô˘ ÌÔÚ› Ó· ÌÂÈÒÛÂÈ Ì¤ÚÔ˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ù˘

¤̂·Û˘ Û ·Ó·Ù˘ÛÛfiÌÂÓÔ˘˜ Ó·ÚÔ‡˜ ÔÚÁ·ÓÈ-

ÛÌÔ‡˜, οÙÈ Ô˘ Ô‰ËÁ› ·ÚÎÂÙÔ‡˜ ·ÛıÂÓ›˜ Î·È È·-

ÙÚÔ‡˜ Û ÛÎÂÙÈÎÈÛÌfi ˆ˜ ÚÔ˜ ÙȘ ÂÂÌ‚¿ÛÂȘ ·˘-

Ù¤˜. ∏ ¯Ú‹ÛË ÙÚÈۉȿÛÙ·ÙˆÓ Ù¯ÓÈÎÒÓ ¯·ÚÙÔÁÚ¿ÊË-

Û˘ (48) ·ÔÙÂÏ› Ì›· Ôχ ÛËÌ·ÓÙÈ΋ ÂͤÏÈÍË Ô˘

‹‰Ë ÂÊ·ÚÌfi˙ÂÙ·È Ì ÌÂÁ¿ÏË ÂÈÙ˘¯›·, ÙfiÛÔ ÛÙÔ Û˘-

ÁÎÂÎÚÈ̤ÓÔ ÓÔÛÔÎÔÌÂ›Ô fiÛÔ Î·È ‰ÈÂıÓÒ˜ Î·È ‚ÔËı¿

Û Ôχ ÌÂÁ¿ÏÔ ‚·ıÌfi ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË ·˘Ù‹.

ªÂ ÙȘ ÓÂfiÙÂÚ˜ ÌÂıfi‰Ô˘˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È

Ù· ÙÂÏÂ˘Ù·›· 2 ¯ÚfiÓÈ·, Ô ¯ÚfiÓÔ˜ ¤ÎıÂÛ˘ ¤¯ÂÈ ÌÂȈ-

ı› ÂÚ›Ô˘ ÛÙ· 10 min (49).

∂Ӊ›ÍÂȘ Î·Ù¿Ï˘Û˘ Û ·È‰È¿ ÌÂ

·Ú·ÏËڈ̷ÙÈο ‰ÂÌ¿ÙÈ·

ªÂ ‚¿ÛË ÙfiÛÔ ÙË ‰ÈÂıÓ‹ ÂÌÂÈÚ›·, Ô˘ Û˘ÓÔ„›-

ÛÙËΠ̛۠· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË (50), fiÛÔ Î·È

Ù· ·ÔÙÂϤÛÌ·Ù· ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ô˘ ‰ÈÂÓÂÚÁ‹ıË-

ÎÂ Ë ·ÚÔ‡Û· ÌÂϤÙË, ÔÈ ÂӉ›ÍÂȘ ÂÂÌ‚¿ÛÂˆÓ Î·-

Ù¿Ï˘Û˘ Û ·È‰È¿ Ì ¶¢ ¤¯Ô˘Ó ‰È·ÌÔÚʈı› ˆ˜

·ÎÔÏÔ‡ıˆ˜:

∫Ï¿ÛË π (°ÂÓÈ΋ Û˘Ìʈӛ· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤Ó-

‰ÂÈÍË):

·) ∞ÛıÂÓ‹˜ Ì ۇӉÚÔÌÔ Wolff-Parkinson-WhiteÌ ÂÂÈÛfi‰ÈÔ ·ÔÛÔ‚Ëı¤ÓÙÔ˜ ·ÈÊÓȉ›Ô˘ ı·Ó¿ÙÔ˘.

‚) ™‡Ó‰ÚÔÌÔ Wolff-Parkinson-White Û¯ÂÙÈ˙fiÌÂ-ÓÔ ÌÂ Û˘ÁÎÔ‹ Î·È ‚Ú·¯Â›· ·ÓÂÚ¤ıÈÛÙË ÂÚ›Ô‰Ô ÙÔ˘‰ÂÌ·Ù›Ô˘ (<250 msec) ‹ Ù·¯¤ˆ˜ ·ÁfiÌÂÓË ÎÔÏÈ΋̷ÚÌ·Ú˘Á‹ (‚Ú·¯‡ÙÂÚÔ ÚÔ‰ÈÂÁÂṲ́ÓÔ ‰È¿ÛÙËÌ·RR <250 msec).

Á) ÃÚfiÓÈ· À∆ Ì ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÎÔÈÏÈÒÓ - Ì˘Ô-ηډÈÔ¿ıÂÈ·.

∫Ï¿ÛË ππ∞ (√È ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘Ìʈ-ÓÔ‡Ó):

·) ÀÔÙÚÔÈ¿˙Ô˘Û·, Û˘Ìو̷ÙÈ΋ À∆, ·ÓıÂ-ÎÙÈ΋ ÛÙË Û˘Ó‹ıË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹.

‚) ∞›ÛıËÌ· ·ÏÌÒÓ Ì ÚÔÎÏËÙ‹ À∆ ηٿ ÙˉȿÚÎÂÈ· ∏ºª.

Á) ∂ÈΛÌÂÓË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË Ô˘ ÌÔ-Ú› Ó· ÙÚÔÔÔÈ‹ÛÂÈ ÙËÓ ÂÓ‰Ôηډȷ΋ ·Ó·ÙÔÌ›·Î·È Ó· ηٷÛÙ‹ÛÂÈ Èı·Ó‹ Î·Ù¿Ï˘ÛË ÛÙÔ Ì¤ÏÏÔÓ Ô-χ ‰‡ÛÎÔÏË ‹ ·‰‡Ó·ÙË.

‰) ∞ηٿ·˘ÛÙË Ù·¯˘Î·Ú‰›· ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·.

∫Ï¿ÛË ππµ (À¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ‰È·ÊˆÓ›· fiÛÔÓ·ÊÔÚ¿ ÛÙËÓ ¤Ó‰ÂÈÍË):

·) ∞Û˘Ìو̷ÙÈÎfi˜ ·ÛıÂÓ‹˜ Ì ۇӉÚÔÌÔWolff-Parkinson-White, ËÏÈΛ·˜ >5 ÂÙÒÓ, ·ÊÔ‡ ÂÍË-ÁËıÔ‡Ó Ù· ÔʤÏË Î·È ÔÈ Î›Ó‰˘ÓÔÈ Ù˘ ¤̂·Û˘,ηıÒ˜ Î·È Ô Î›Ó‰˘ÓÔ˜ Èı·Ó‹˜ ·ÚÚ˘ıÌ›·˜.

‚) À∆ Û ËÏÈΛ· >5 ÂÙÒÓ, ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋ χÛ˯ÚfiÓÈ·˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Ô˘ Â›Ó·È ·ÔÙÂÏÂ-ÛÌ·ÙÈ΋.

Á) À∆ Û ·ÛıÂÓ›˜ <5 ÂÙÒÓ, fiÙ·Ó Ë ¯ÚfiÓÈ· Ê·Ú-̷΢ÙÈ΋ ·ÁˆÁ‹ (ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È ÛÔÙ·Ïfi-Ï˘ ‹ ·ÌÈÔ‰·ÚfiÓ˘) Â›Ó·È ·ÓÂÈÙ˘¯‹˜ ‹ ¤¯ÂÈ ·ÚÂ-Ó¤ÚÁÂȘ.

∫Ï¿ÛË πππ (À¿Ú¯ÂÈ Û˘Ìʈӛ· fiÙÈ Ë Î·Ù¿Ï˘ÛË·ÓÙÂӉ›ÎÓ˘Ù·È ‹ Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fiÙ· ÔʤÏË):

·) ∞Û˘Ìو̷ÙÈÎfi˜ ·ÛıÂÓ‹˜ <5 ÂÙÒÓ Ì ۇÓ-‰ÚÔÌÔ Wolff-Parkinson-White.

‚) À∆ ÂÏÂÁ¯fiÌÂÓË ÌÂ Û˘Ó‹ıË ·ÓÙÈ·ÚÚ˘ıÌÈοʿÚ̷η Û ·ÛıÂÓ‹ ËÏÈΛ·˜ <5 ÂÙÒÓ.

Á) ∂ÂÈÛfi‰È· ÌË ÂÌ̤ÓÔ˘Û·˜ À∆, Û ÔÏÈÁÔÛ˘-Ìو̷ÙÈÎÔ‡˜ ‹ ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜.

µÈ‚ÏÈÔÁÚ·Ê›·

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132 π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Paediatriki 2007;70:123-134

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14. Paul T, Bokenkamp R, Mahnert B, Trappe HJ. Coronary

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47. Lindsay BD, Eichling JO, Ambos HD, Cain ME. Radiationexposure to patients and medical personnel during ra-diofrequency catheter ablation for supraventricular tachy-cardia. Am J Cardiol 1992;70:218-223.

48. Drago F, Silvetti MS, Di Pino A, Grutter G, Bevilacqua M,Leibovich S. Exclusion of fluoroscopy during ablationtreatment of right accessory pathway in children. J Car-diovasc Electrophysiol 2002;13:778-782.

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134 π. ¶··ÁÈ¿ÓÓ˘ Î·È Û˘Ó.

Paediatriki 2007;70:123-134

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ÃÚ‹ÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ Î·È Û˘ÌÏËڈ̷ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ÛÂ

·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·

∞. ¶Ô˘ÚÙÛ›‰Ë˜, ¢. ¢ÔÁ¿Ó˘, ª. ª¿Î·, ª. µ·Ú‚Ô˘ÙÛ‹, ¢. ªÔ˘¯Ô‡ÙÛÔ˘, ¶. ÷Ù˙‹, ∂. ∫ÔÛÌ›‰Ë

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ∏ ¯Ú‹ÛË Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ (™∂£) Â›Ó·È Û˘¯Ó‹ Î·È ·ÚÔ˘ÛÈ¿-˙ÂÈ ·ÓÔ‰È΋ Ù¿ÛË, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌ‹ÛÔ˘Ì ÙË Û˘¯ÓfiÙËÙ· Ù˘ ¯Ú‹Û˘ ™∂£ Î·È ÙȘ ·Èٛ˜ Ô˘ Ô‰‹-ÁËÛ·Ó ÛÙË ¯Ú‹ÛË, Ù·¯˘‰ÚÔÌ‹ıËΠÛÙÔ˘˜ ÁÔÓ›˜ 184 ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ¤Ó· ·ÓÒÓ˘ÌÔÂÚˆÙËÌ·ÙÔÏfiÁÈÔ.

∞ÔÙÂϤÛÌ·Ù·: ∞·ÓÙ‹ıËÎ·Ó 110 ·fi Ù· 184 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (59,8%). 23/110 ÔÈÎÔÁ¤ÓÂȘ (21%)¯ÚËÛÈÌÔÔ›ËÛ·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÌÔÚÊ‹ ™∂£. √È Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ™∂£ ‹Ù·Ó ÚÔÛ¢¯¤˜/ÙÂÏÂÙÔ˘ÚÁ›Â˜ 18/23 (78%), ıÂڷ›˜ Ù¤¯Ó˘ 4, ‰È·ÈÙËÙÈο Û˘ÌÏËÚÒÌ·Ù· 3, Ì·Û¿˙ 3, ÔÌÔÈÔ·ıËÙÈ΋2 Î·È ‚fiÙ·Ó· 2. √È ÏfiÁÔÈ ¯Ú‹Û˘ ™∂£ ‹Ù·Ó Ó· Á›ÓÂÈ ÙÔ ·È‰› ÈÔ ‰˘Ó·Ùfi (17/23), Ë ÂÏ›‰· fiÙÈ ı· ÛÙ·-Ì·Ù‹ÛÂÈ Ë ÂͤÏÈÍË ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ (11/23) Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Ù˘ ıÂ-ڷ›·˜ Î·È Ù˘ ÓfiÛÔ˘ (6/23). √È ÁÔÓ›˜ Ô˘ ‰ÂÓ ¤Î·Ó·Ó ¯Ú‹ÛË ™∂£ ·Ó¤ÊÂÚ·Ó ˆ˜ ÏfiÁÔ˘˜ ÙËÓ ÂÌÈ-ÛÙÔÛ‡ÓË ÛÙË ıÂڷ¢ÙÈ΋ ÔÌ¿‰· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ï‹ ÔÚ›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ (84%), ÙËÓ ¤Ï-ÏÂÈ„Ë ÏËÚÔÊfiÚËÛ˘ (24%) ÂÓÒ 7,5% ‰ÂÓ ·¤ÎÏÂÈ·Ó a priori ÙË ¯Ú‹ÛË ÙÔ˘˜. ∏ ¯Ú‹ÛË ™∂£ ‰ÂÓ Û¯ÂÙÈ-˙fiÙ·Ó Ì ËÏÈΛ·, ʇÏÔ, ÂıÓÈÎfiÙËÙ·, ÌfiÚʈÛË, ¿ÁÁÂÏÌ· ÁÔÓÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘, Ô‡Ù ÌÂÙË ‰È¿ÁÓˆÛË, ÙÔÓ ÙÚfiÔ ıÂڷ›·˜ Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙË ‰È¿ÁÓˆÛË.

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË ™∂£ ÛÙȘ ÂÏÏËÓÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Ê·›ÓÂÙ·È fiÙȉÂÓ Â›Ó·È È‰È·›ÙÂÚ· ‰ËÌÔÊÈÏ‹˜. √È ÂÌÂÈڛ˜ ·fi ÙË ¯Ú‹ÛË ‹Ù·Ó ÁÂÓÈο ıÂÙÈΤ˜.

§¤ÍÂȘ ÎÏÂȉȿ: ™˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂڷ›˜, ·È‰›, ηÎfiËı˜ ÓÂfiÏ·ÛÌ·.

Use of alternative and complementary therapy by paediatric

oncology patients in Greece

A. Pourtsidis, D. Doganis, M. Baka, M. Varvoutsi, D. Bouhoutsou, P. Xatzi, H. Kosmidis

Abstract

Background: Complementary and alternative medicine (CAM) therapies are used by increasing num-bers of children with cancer.

Methods: A self-reported questionnaire was given to parents of 184 children with cancer. The preva-lence of the use and non-use of CAM therapies and factors that influence the use were estimated.

Results: Based on the 110 questionnaires which were completed (59.8% of the families), 23 families(21%) had used at least one alternative treatment. The most common forms of CAM therapy were: spir-itual healing/prayer/blessings 18/23 (78%), art therapies 4, dietary supplements 3, massage 3, home-opathy 2, and herbal treatments 2. The reasons given for use of CAM included: making the childstronger 17/23, hope of stopping the cancerous process 11/23, and coping with side effects 6/23.Those parents not using CAM referred to their confidence to the medical team, and the child doing welland therefore their not seeing the need for CAM use (84%), or not being aware of CAM (24%); an-other 7.5 % had considered using it. In bivariate analysis, CAM use was not found to be associated ei-ther with the age, sex, nationality, education or occupation of the respondents at the time of the sur-vey, or with the diagnosis, mode of therapy or the age of the child at diagnosis.

Conclusions: The use of CAM therapies by Greek families for their children with cancer does not ap-pear to be very popular, although the experiences of those who did use them were generally positive.

Key words: Complementary and alternative therapies, child, cancer.

135∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

√ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì·¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

AÏÏËÏÔÁÚ·Ê›·:

∞. °. ¶Ô˘ÚÙÛ›‰Ë˜[email protected]∞Ê·›·˜ 14, ∆.∫. 15452, æ˘¯ÈÎfi

Oncology Department, “P. & A. Kyriakou”Children’s Hospital

Correspondence:

A. G. Pourtsidis [email protected], Aphaias St., 15452 Psychiko, Athens, Greece

¶·È‰È·ÙÚÈ΋ 2007;70:135-140

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·135

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MM∂ ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘

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∂ÈÛ·ÁˆÁ‹

∏ ÌË Û˘Ì‚·ÙÈ΋ È·ÙÚÈ΋, ÁÓˆÛÙ‹ ›Û˘ ˆ˜ Û˘-

ÌÏËڈ̷ÙÈ΋ Î·È ÂÓ·ÏÏ·ÎÙÈ΋ È·ÙÚÈ΋ (™∂π), ›ӷÈ

ÛËÌ·ÓÙÈ΋ Î·È Ë ¯Ú‹ÛË Ù˘ ‰È·ÚÎÒ˜ ·˘Í·ÓfiÌÂÓË,

ȉȷ›ÙÂÚ· ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi η-

ÎfiËı˜ ÓÂfiÏ·ÛÌ·. º·›ÓÂÙ·È fiÙÈ Ë ÏÂÈÔ„ËÊ›· ¯ÚË-

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È·ÙÚÈ΋˜ Î·È fi¯È ÂÓ·ÏÏ·ÎÙÈο (1). ∫·Ù¿ ÙÔ˘˜

Eisenberg Î·È Û˘Ó. (2), ˆ˜ ™∂π ÔÚ›˙ÂÙ·È ÔÌ¿‰· ‰È·ÊÔ-

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Ú·ÎÙÈÎÒÓ Î·È ÚÔ˚fiÓÙˆÓ Ù· ÔÔ›· ̤¯ÚÈ Û‹ÌÂÚ·

‰ÂÓ ·ÔÙÂÏÔ‡Ó Ì¤ÚÔ˜ Ù˘ Û˘Ì‚·ÙÈ΋˜ È·ÙÚÈ΋˜ Ô‡ÙÂ

·ÓÙÈΛÌÂÓÔ ‰È‰·Ûηϛ·˜ ÛÙȘ È·ÙÚÈΤ˜ Û¯ÔϤ˜. ∞Ô-

ÙÂÏÂ›Ù·È ·fi ÔÈΛϘ Ù¯ÓÈΤ˜ fiˆ˜ ÚÔÛ¢¯¤˜,

ıÚËÛ΢ÙÈΤ˜ ÙÂÏÂÙÔ˘ÚÁ›Â˜, ÔÓÂÈÚÔfiÏËÛË, ̄ ·Ï¿Úˆ-

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Î·È ‚ÂÏÔÓÈÛÌfi, (¶›Ó·Î·˜ 1). √˘ÛÈ·ÛÙÈο Û˘ÌÂÚÈ-

Ï·Ì‚¿ÓÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi “ıÂÚ·ÂÈÒÓ” ·fi ÙËÓ ÔÌÔÈ-

Ô·ıËÙÈ΋ ̤¯ÚÈ ÙË yoga (3), Ô˘ Û˘Ó‹ıˆ˜ ¯ÚËÛÈÌÔ-

ÔÈÔ‡ÓÙ·È ˆ˜ ‚ÔËıËÙÈΤ˜ ÁÈ· ÙË ıÂڷ›· ÙÔ˘ η-

ÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Î·È ÁÈ· ·Ó·ÎÔ‡ÊÈÛË ·fi Ù·

Û˘ÌÙÒÌ·Ù· (4-6). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ë ·ÁÎfi-

ÛÌÈ· ‚È‚ÏÈÔÁÚ·Ê›· ¤¯ÂÈ Î·Ù·ÎÏ˘Ûı› ·fi ÌÂϤÙ˜ ÁÈ·

Û˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂڷ›˜

(™∂£) Ì ÔÛÔÛÙ¿ ¯ÚËÛÙÒÓ ·fi 22% ¤ˆ˜ 73%, ·Ï-

Ï¿ Ù· ·ÔÙÂϤÛÌ·Ù· ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ÌÂϤÙË

Î·È ¤Ú¢ӷ (7). ŒÓ· ·fi Ù· ϤÔÓ ‰‡ÛÎÔÏ· ÚÔ‚Ï‹-

Ì·Ù· ÙˆÓ ÂÚ¢ÓÒÓ Â›Ó·È Ô ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ ÏÂÁfiÌÂ-

ÓˆÓ ·ÏÒÓ “˘ÔÛÙËÚÈÎÙÈÎÒÓ” Ì¤ÛˆÓ (.¯. ıÂڷ¢-ÙÈ΋ ·ʋ, Ì·Û¿˙, ‚ÂÏÔÓÈÛÌfi˜, ÚÔÛÊ˘Á‹ ÛÙË ıÚË-ÛΛ·) ·fi ÂΛӘ Ì ϋ„Ë Ê·Ú̿ΈÓ, ‚ÈÙ·ÌÈÓÒÓ ‹·Ú·Û΢·ÛÌ¿ÙˆÓ ·fi ‚fiÙ·Ó· Ô˘ ·ÔÛÎÔÔ‡ÓÛÙËÓ “¢ÓÔ˚΋ ÙÚÔÔÔ›ËÛË Ù˘ ÓÔÛÔÁfiÓÔ˘ ‰È·‰È-ηۛ·˜, ÛÙËÓ ÂÓ‰˘Ó¿ÌˆÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÓÔÛ›·˜‹ ÛÙË Ì›ˆÛË Ù˘ ÙÔÍÈÎfiÙËÙ·˜ Ù˘ ıÂڷ›·˜” ÔÈÔԛ˜ Â›Ó·È ÔÈ Ï¤ÔÓ ÛÔ‚·Ú¤˜ Î·È ÚÔ‚ÏËÌ·ÙÈΤ˜ÌË Û˘Ì‚·ÙÈΤ˜ “ıÂڷ›˜” (8). ∏ ÚÔÛÊ˘Á‹ ÛÙȘ™∂£ ÂÌÊ·Ó›˙ÂÙ·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Î·È ÛÙËӷȉȷÙÚÈ΋, ȉ›ˆ˜ ÌÂٷ͇ ÙˆÓ ÁÔÓÈÒÓ Ì ˘„ËÏfi ÂÈ-Ûfi‰ËÌ· Î·È ÌfiÚʈÛË (9). ∆· ÔÛÔÛÙ¿ ÁÈ· ·È‰È¿ ̯ÚfiÓȘ Î·È ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ˜ ·ÚÚÒÛÙȘ fiˆ˜Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ¿ÛıÌ·, ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ·,΢ÛÙÈ΋ ›ÓˆÛË Î˘Ì·›ÓÔÓÙ·È ·fi 30-70% (10). √È ÌÂ-ϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ ’70 Î·È ’80 ˘Ô-ÛÙ‹ÚÈÍ·Ó fiÙÈ Ë ¯Ú‹ÛË ™∂£ ‹Ù·Ó οو ÙÔ˘ 20%, ·Ï-Ï¿ ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ 31 ¤ˆ˜ ηÈ84% ÙˆÓ ·È‰ÈÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ¯ÚËÛÈ-ÌÔÔ›ËÛ·Ó Ù¤ÙÔȘ ıÂڷ›˜. √ ÙÚfiÔ˜ Ô˘ ·ÓÙÈ-Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ÁÔÓ›˜ ÙË ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË.¯. Ë ÂÈı˘Ì›· “Ó· ‰ÔÎÈÌ¿ÛÔ˘Ì ٷ ¿ÓÙ·” ·›˙ÂÈÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·fiÊ·Û‹ ÙÔ˘˜ Ó· ¯ÚËÛÈÌÔ-ÔÈ‹ÛÔ˘Ó ™∂£. ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó Û˘-Û¯ÂÙÈÛı› Â›Ó·È Ë Î·Î‹ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, ËÚÔËÁÔ‡ÌÂÓË ÂÌÂÈÚ›· ·fi ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ·ÚÂÌ-‚¿ÛˆÓ, ÙÔ ˘„ËÏfi ÌÔÚʈÙÈÎfi Î·È ÔÈÎÔÓÔÌÈÎfi ›-‰Ô, Ë ÌÂÁ¿ÏË ËÏÈΛ·, Î·È ÙÔ ·Ó·Ù˘Á̤ÓÔ ıÚË-Û΢ÙÈÎfi Û˘Ó·›ÛıËÌ· (11).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ªÂ ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ¯Ú‹Û˘

™∂£ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÛÙË

¶›Ó·Î·˜ 1. ∫·ÙËÁÔڛ˜ Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ·fi ÙÔ ∂ıÓÈÎfi ΤÓÙÚÔ ™∂π ÛÙȘ ∏¶∞

∆‡Ô˜ ™∂π √ÚÈÛÌfi˜ ¶·Ú·‰Â›ÁÌ·Ù·

∂Ó·ÏÏ·ÎÙÈο Û˘ÛÙ‹Ì·Ù· ¶Ï‹ÚË Û˘ÛÙ‹Ì·Ù· ıˆڛ·˜ Î·È Ú¿Í˘ √ÌÔÈÔ·ıËÙÈ΋, ·Ú·‰ÔÛȷ΋ ÎÈÓ¤˙ÈÎË È·ÙÚÈ΋, π·ÙÚÈ΋˜ ayurvedic È·ÙÚÈ΋, Ê˘ÛÈÔıÂڷ›·

æ˘¯Ôۈ̷ÙÈ΋ È·ÙÚÈ΋ ¶ÔÈÎÈÏ›· Ù¯ÓÈÎÒÓ Û¯Â‰È·ÛÌ¤ÓˆÓ ∞˘ÙÔÛ˘ÁΤÓÙÚˆÛË (ÛÙÔ¯·ÛÌfi˜), ÚÔÛ¢¯‹, Ó· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· ÔÌ¿‰Â˜ ÛÙ‹ÚÈ͢ ·ÛıÂÓÒÓ, Ù¤¯ÓË, ÌÔ˘ÛÈ΋, ÙÔ˘ Ó‡̷ÙÔ˜ Ó· ÂËÚ¿˙ÂÈ ¯ÔÚfi˜, ¯·Ï¿ÚˆÛË, ÂÓfiÚ·ÛË, ˘ÓÔıÂڷ›·, yogaۈ̷ÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÙÒÌ·Ù·

µÈÔÏÔÁÈΤ˜ ıÂڷ›˜ √˘Û›Â˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙË Ê‡ÛË ¢È·ÈÙËÙÈο Û˘ÌÏËÚÒÌ·Ù·, ‚Èٷ̛Ә, ‚fiÙ·Ó·,‰È¿ÊÔÚ· Âί˘Ï›ÛÌ·Ù· Î·È ¿ÏϘ “Ê˘ÛÈΤ˜”ıÂڷ›˜ ·ÏÏ¿ ·Ó·ÚΛ˜ Ì ÂÈÛÙËÌÔÓÈοÎÚÈÙ‹ÚÈ· (.¯. ¯fiÓ‰ÚÔ˜ ·fi ηگ·Ú›·)

∂ȉ¤ÍÈÔÈ ¯ÂÈÚÈÛÌÔ› º˘ÛÈÎÔıÂڷ›· Î·È / ‹ ÎÈÓ‹ÛÂȘ ÃÂÈÚÔÚ·ÎÙÈ΋ ‹ ÔÛÙÈ΋ Ê˘ÛÈÎÔıÂڷ›·, Ì·Û¿˙Ì ٷ ¯¤ÚÈ· ÌÂÚÒÓ ÙÔ˘ ÛÒÌ·ÙÔ˜

£Âڷ›˜ ÂÓ¤ÚÁÂÈ·˜ - µÈÔÂÓÂÚÁËÙÈΤ˜ ıÂڷ›˜ ™Ùfi¯Ô ¤¯Ô˘Ó Ó· ÂËÚ¿˙Ô˘Ó ÂÓÂÚÁÂȷο Qi gong, Reiki, ıÂڷ¢ÙÈÎfi ¿ÁÁÈÁÌ·

‰›· Ô˘ ÛËÌÂÈÔÏÔÁÈο ÂÚÈ‚¿ÏÔ˘Ó Î·È ÂÈÛ¯ˆÚÔ‡Ó ÛÙÔ ·ÓıÚÒÈÓÔ ÛÒÌ·

- µÈÔËÏÂÎÙÚÔÌ·ÁÓËÙÈΤ˜ ªË Û˘Ì‚·ÙÈ΋ ¯Ú‹ÛË ∆ÔÓÈο ‰›·, Ì·ÁÓËÙÈο ‰›·, ÂÓ·ÏÏ·ÛÛfiÌÂÓ· ËÏÂÎÙÚÔÌ·ÁÓËÙÈÎÒÓ Â‰›ˆÓ ÙÚ¤¯ÔÓÙ· ‹ ¿ÌÂÛ· ÙÚ¤¯ÔÓÙ· ‰›·

136 ∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.

Paediatriki 2007;70:135-140

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·136

Page 68: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

¯ÒÚ· Ì·˜, ÙËÓ ·ÈÙÈÔÏfiÁËÛË ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÔÓÈÒÓ Ù˘

Ú·ÎÙÈ΋˜ ·˘Ù‹˜ ηıÒ˜ Î·È ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÛÙË

¯ÒÚ· Ì·˜ Ì ÂΛӷ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÚÔ¯ˆÚ‹-

Û·Ì ÛÙË Û‡ÓÙ·ÍË ¤ÓÙ˘Ô˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ì ÙÚ›· ‰›·:

1. ∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ

(ʇÏÔ, ËÏÈΛ·, ¿ÁÁÂÏÌ·, Û˘ÁÁÂÓÈ΋ Û¯¤ÛË Ì ÙÔ ·È‰›,

ÂıÓÈÎfiÙËÙ·) Î·È ÛÙÔȯ›· ÁÈ· ÙÔ ·È‰› Î·È ÙË ÓfiÛÔ ÙÔ˘ (ʇÏÔ,

ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË, ›‰Ô˜ ÓfiÛÔ˘, ›‰Ô˜ ıÂڷ›·˜, ¯Úfi-

ÓÔ ·fi ÙË ‰È¿ÁÓˆÛË ‹ ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂڷ›·˜ Î·È ÙÔ ·Ó Ë Ófi-

ÛÔ˜ ‚Ú›ÛÎÂÙ·È Û ‡ÊÂÛË ‹ fi¯È ηٿ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆ-

ÙËÌ·ÙÔÏÔÁ›Ô˘).

2. ∞˘ÙÔ› Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ ·Ó¤ÊÂÚ·Ó ÙÔ Â›‰Ô˜

ÙÔ˘˜, Ù· ÔʤÏË Ô˘ ÚԤ΢„·Ó, Ù· ΛÓËÙÚ· Ô˘ ÙÔ˘˜ Ô‰‹-

ÁËÛ·Ó ÛÙË ¯Ú‹ÛË ÙÔ˘˜, ÙÔ˘˜ ‰È·‡ÏÔ˘˜ ÏËÚÔÊfiÚËÛ˘ ÁÈ’ ·˘-

Ù¤˜ ÙȘ ıÂڷ›˜, ÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ ¯Ú‹Û˘ ÙÔ˘˜, ÙË Û˘-

¯ÓfiÙËÙ· ¯Ú‹Û˘ ÙÔ˘˜ ηıÒ˜ Î·È ÙËÓ ÚfiıÂÛ‹ ÙÔ˘˜ Ó· ÂÓË-

ÌÂÚÒÛÔ˘Ó ¿ÏÏÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘˜. ∆¤ÏÔ˜ ·ÍÈÔ-

ÏfiÁËÛ·Ó ÙËÓ ¯ÚËÛÈÌfiÙËÙ¿ ÙÔ˘˜ ‚·ıÌÔÏÔÁÒÓÙ·˜ ÙËÓ ·ÔÙÂ-

ÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ Ì ‚¿ÛË ÙËÓ Îϛ̷η 1-10.

3. ∞˘ÙÔ› Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ ·Ó¤Ï˘Û·Ó ÙÔ˘˜

ÏfiÁÔ˘˜ Ù˘ ÂÈÏÔÁ‹˜ ÙÔ˘˜.

√ ÏËı˘ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ÂÚÈÂÏ¿Ì‚·Ó ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ

·È‰ÈÒÓ Ô˘ ‰È·ÁÓÒÛıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ ·fi ÙËÓ 1Ë π·-

ÓÔ˘·Ú›Ô˘ 2001 ¤ˆ˜ Î·È ÙËÓ 31Ë ¢ÂÎÂÌ‚Ú›Ô˘ 2003 Î·È Ù· ÔÔ›·

‹Ù·Ó ÂÓ ˙ˆ‹ ηٿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ÌÂϤÙ˘ (ÙÂÏÂ˘Ù·›Ô ÙÚ›-

ÌËÓÔ ÙÔ˘ 2004). ∆·¯˘‰ÚÔÌ‹ıËÎ·Ó 184 ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÌÂ

ÙËÓ ·Ú¿ÎÏËÛË Ó· ÂÈÛÙÚ·ÊÔ‡Ó ··ÓÙË̤ӷ ¯ˆÚ›˜ Ó· ·Ó·-

ʤÚÔÓÙ·È ÛÙÔȯ›· Ô˘ Ó· ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ Ù·˘ÙfiÙËÙ· ÙˆÓ

ÂÚˆÙËı¤ÓÙˆÓ ÛÙËÓ ··ÓÙËÙÈ΋ ÂÈÛÙÔÏ‹. ∞ÊÔ‡ ¤ÁÈÓÂ Û˘ÏÏÔ-

Á‹ ÙˆÓ ÂÈÛÙÔÏÒÓ, Ù· ÛÙÔȯ›· ηٷÁÚ¿ÊËÎ·Ó Î·È ·Ó·Ï‡ıË-

Î·Ó ÛÙ·ÙÈÛÙÈο. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıË-

Î·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ Fisher’s exact test, chi-square test Î·È non

parametric Mann Whitney test. ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ

ÂÈÙÚÔ‹ ËıÈ΋˜ Î·È ‰ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ.

∞ÔÙÂϤÛÌ·Ù·

∞·ÓÙ‹ıËÎ·Ó 110 ·fi Ù· 184 ÂÚˆÙËÌ·ÙÔÏfiÁÈ·

(59,8%). ™∂£ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‹ ‹Ù·Ó Û ¯Ú‹ÛË

ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘ Û 23 ·È‰È¿ (21%).

∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÛÙË ÌÂϤÙË

Î·È ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∆Ô

ʇÏÔ, Ë ËÏÈΛ·, Ë ÂıÓÈÎfiÙËÙ· Î·È ÙÔ Â¿ÁÁÂÏÌ· ·˘-

ÙÒÓ Ô˘ ·¿ÓÙËÛ·Ó ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙËÓ

ÂÈÏÔÁ‹ ‹ fi¯È Ù˘ ¯Ú‹Û˘ ™∂£. ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜

·ÛıÂÓ›˜, ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ·ÊÔÚÔ‡Û 68 ·ÁfiÚÈ·

(61,8%) Î·È 42 ÎÔÚ›ÙÛÈ· (38,2%). ∆Ô Ê‡ÏÔ, Ë ËÏÈΛ·

Î·È ÙÔ Â›‰Ô˜ Ù˘ ıÂڷ›·˜ ‰ÂÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó ÌÂ

ÙËÓ ÂÈÏÔÁ‹ ̄ Ú‹Û˘ ™∂£. ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ

·È‰ÈÒÓ ¤·Û¯·Ó ·fi ÔÍ›· Ï¢¯·ÈÌ›· (48/110), ·Ï-

Ï¿ Ô ·ÚÈıÌfi˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ‰ÂÓ Â¤ÙÚ„ ӷ

ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙË Û¯¤ÛË

Ù˘ ÓfiÛÔ˘ Ì ÙËÓ ÂÈÏÔÁ‹ ¯Ú‹Û˘ ™∂£. √ ¯ÚfiÓÔ˜

Ô˘ ÌÂÛÔÏ¿‚ËÛ ·fi ÙË ‰È¿ÁÓˆÛË ¤ˆ˜ ÙË Û˘ÌÏ‹-

ÚˆÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Î˘Ì¿ÓıËΠ·fi 1-102

Ì‹Ó˜ (‰È¿ÌÂÛË ÙÈÌ‹ 28) Î·È ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜ ÛÙËÓ

ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ¯Ú‹ÛË ™∂£ (22 ¤Ó·ÓÙÈ 30 ÌË-

ÓÒÓ, p=0,035). 30/110 ·È‰È¿ (27,3%) ‚Ú›ÛÎÔÓÙ·Ó

˘fi ıÂڷ›· ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘. °È· Ù·

˘fiÏÔÈ· (72,7%) Ô ¯ÚfiÓÔ˜ Ô˘ ÌÂÛÔÏ¿‚ËÛÂ ·fi ÙÔ

Ù¤ÏÔ˜ Ù˘ ıÂڷ›·˜ ¤ˆ˜ ÙË Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÂÚˆ-

ÙËÌ·ÙÔÏÔÁ›Ô˘ Î˘Ì¿ÓıËΠ·fi 1-45 Ì‹Ó˜ (‰È¿ÌÂÛË

ÙÈÌ‹ 15) Î·È ‰ÂÓ Û¯ÂÙ›ÛıËΠ̠ÙËÓ ÂÈÏÔÁ‹ ¯Ú‹Û˘.

™Â 95/110 ·È‰È¿ (86,4%) Ë ÓfiÛÔ˜ ‹Ù·Ó Û ‡ÊÂÛË,

ÂÓÒ ÛÂ ˘ÔÙÚÔ‹ ‹ ÌÂÙ¿ ·fi ˘ÔÙÚÔ‹ ÛÙ· 15

(13,6%), ·ÏÏ¿ ‰ÂÓ ‰È·ÈÛÙÒıËΠۯ¤ÛË ¯Ú‹Û˘ ™∂£

Ì ÙËÓ ‡ÊÂÛË ‹ ÙËÓ ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ . ŸÛÔÓ

·ÊÔÚ¿ ÙÔ˘˜ ÏfiÁÔ˘˜ ¯Ú‹Û˘ ™∂£, 11/23 ·¿ÓÙËÛ·Ó

fiÙÈ ‹ıÂÏ·Ó Ó· ÂÍ·ÓÙÏ‹ÛÔ˘Ó Î¿ı ıÂڷ¢ÙÈ΋ ‰˘Ó·-

ÙfiÙËÙ·, 2/23 ÏfiÁˆ ·ÚfiÙÚ˘ÓÛ˘ οÔÈÔ˘ ¿ÏÏÔ˘,

4/23 Ì ÙËÓ ÚÔÛ‰ÔΛ· Ì›ˆÛ˘ ·ÚÂÓÂÚÁÂÈÒÓ Ù˘

Û˘Ì‚·ÙÈ΋˜ ıÂڷ›·˜ ÂÓÒ Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙȘ

¯ÚËÛÈÌÔÔ›ËÛ ÁÈ· Ó· ÚÔ·Á¿ÁÂÈ ÙËÓ „˘¯ÔÏÔÁÈ΋

¢ÂÍ›· ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ (17/23).

™ÙË ÌÂÁ¿ÏË ÙÔ˘˜ ÏÂÈÔ„ËÊ›· ˆ˜ ™∂£ ¯ÚËÛÈÌÔ-

ÔÈ‹ıËÎ·Ó ÚÔÛ¢¯¤˜ / ıÚËÛ΢ÙÈΤ˜ ÙÂÏÂÙÔ˘ÚÁ›Â˜

(18/23) Î·È Û ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ¿ÏϘ “ıÂڷ›-

˜” (¶›Ó·Î·˜ 3). ŸÛÔÓ ·ÊÔÚ¿ Ù· ÔʤÏË ·fi ÙË ¯Ú‹-

ÛË Ù¤ÙÔÈˆÓ “ıÂÚ·ÂÈÒÓ”, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ (21/23)

·Ó¤ÊÂÚ·Ó ˆ˜ fiÊÂÏÔ˜ ÙËÓ „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË, 5

ÙË Ì›ˆÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ, 5 ÙË ‰Ú¿ÛË ¤Ó·ÓÙÈ Ù˘

ÓfiÛÔ˘ Î·È ¤Ó·˜ ·¿ÓÙËÛ fiÙÈ ‰ÂÓ ‰È·›ÛÙˆÛ ηӤӷ

fiÊÂÏÔ˜. ªÂ Îϛ̷η ÈηÓÔÔ›ËÛ˘ ·fi 1 ¤ˆ˜ 10, Ë

Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ‹Ù·Ó Û·ÊÒ˜ ÈηÓÔÔÈË̤ÓË

ÂÈϤÁÔÓÙ·˜ ÙÔÓ ‚·ıÌfi 10, ÂÓÒ 22/23 ı· Û˘ÓÈÛÙÔ‡Û·Ó

Î·È Û ¿ÏÏÔ˘˜ ÁÔÓ›˜ ÙË “ıÂڷ›·” Ô˘ ÂÊ¿ÚÌÔÛ·Ó

ÛÙÔ ·È‰› ÙÔ˘˜. ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ·˘ÙÒÓ Ô˘ ‰ÂÓ

¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ (68/81, 84%) ·ÈÙÈÔÏfiÁËÛ·Ó ÙË

ÛÙ¿ÛË ÙÔ˘˜ ˆ˜ ÂÌÈÛÙÔÛ‡ÓË ÛÙËÓ È·ÙÚÈ΋ ÔÌ¿‰· ÛÂ

Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Î·Ï‹ ÔÚ›· Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰È-

Ô‡ ÙÔ˘˜, 19/81 (23,5%) ·¿ÓÙËÛ·Ó fiÙÈ ‰ÂÓ ‹ÍÂÚ·Ó Ù›-

ÔÙ· Û¯ÂÙÈο Ì ·˘Ù¤˜ ÙȘ “ıÂڷ›˜”, ÂÓÒ 6/81 ı·

ÙȘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ·Ó Û˘Ó¤ÙÚ¯·Ó ÂȉÈÎÔ› ÏfiÁÔÈ

(η΋ ÔÚ›· Ù˘ ÓfiÛÔ˘).

™˘˙‹ÙËÛË

∆Ô ÔÛÔÛÙfi ··ÓÙ‹ÛÂˆÓ ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ

(110/184, 59,8%) ‹Ù·Ó Û¯ÂÙÈο ¯·ÌËÏfi, ·ÏÏ¿ ˆ˜

·ÚÈıÌfi˜ (110 ··ÓÙ‹ÛÂȘ) Â›Ó·È ·fi ÙÔ˘˜ ÌÂÁ·Ï‡ÙÂ-

ÚÔ˘˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÂÈÎÔÛ·ÂÙ›·˜.

™‡Ìʈӷ Ì ÙȘ ··ÓÙ‹ÛÂȘ ÌfiÓÔ ÛÙÔ 21% ¯ÚËÛÈÌÔ-

ÔÈ‹ıËΠοÔÈ· ÌÔÚÊ‹ ™∂£ Î·È ÙÔ ÔÛÔÛÙfi ·˘Ùfi

Â›Ó·È È‰È·›ÙÂÚ· ¯·ÌËÏfi Î·È ‰ÂÓ Û˘ÌʈÓ› Ì ٷ ¢-

Ú‹Ì·Ù· ·ÚfiÌÔÈˆÓ ÌÂÏÂÙÒÓ. ¶Ú¤ÂÈ Ó· ÛËÌÂÈÒÛÔ˘-

Ì fiÙÈ ‰ÂÓ ÛÙ¿ÏıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÛÙÔ˘˜ ÁÔÓ›˜

ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Â‚›ˆÛ·Ó ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘

ÌÂϤÙ˘ Î·È ·˘Ùfi Èı·ÓfiÓ Ó· ÂËÚ¤·Û ÙÔÓ ·ÚÈıÌfi

ÙˆÓ ıÂÙÈÎÒÓ ··ÓÙ‹ÛˆÓ, ·ÏÏ¿ ÈÛÙ‡ԢÌ fiÙÈ Ë

Û˘ÁÎÂÎÚÈ̤ÓË ÔÌ¿‰· ÁÔÓÈÒÓ ‰ÂÓ ¤Ú ӷ Û˘ÌÂ-

ÚÈÏËÊı› ÁÈ· ¢ÓfiËÙÔ˘˜ ÏfiÁÔ˘˜. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·

·Ó·Ê¤ÚÔÓÙ·È ¯Ú‹ÛË ÌË Û˘Ì‚·ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ÛÂ

ÔÛÔÛÙ¿ ·fi 36 ¤ˆ˜ 84% (6,10,12-14) Û ·È‰È¿ ÌÂ

137∂Ó·ÏÏ·ÎÙÈΤ˜ ıÂڷ›˜ Û ·È‰È¿ Ì ηÎÔ‹ıÂȘ

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ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·. √È ÌÂÁ¿Ï˜ ‰È·ÊÔÚ¤˜ ÌÔ-

Ú› Ó· ÔÊ›ÏÔÓÙ·È Î·È ÛÙËÓ ÂÚ›Ô‰Ô ·Ó¿ÎÏËÛ˘ Ù˘

ÌÓ‹Ì˘ Ë ÔÔ›· ÛÙËÓ ‰È΋ Ì·˜ ÌÂϤÙË ‹Ù·Ó Ôχ

ÌÂÁ·Ï‡ÙÂÚË (3 ¯ÚfiÓÈ·) Û ۇÁÎÚÈÛË Ì ٷ ÌÈÎÚfiÙÂÚ·

‰È·ÛÙ‹Ì·Ù· (2-12 Ì‹Ó˜) ÙˆÓ ·ÓˆÙ¤Úˆ ÌÂÏÂÙÒÓ.

™ÙË ÌÂϤÙË Ì·˜ fiÏÔÈ ÔÈ ÁÔÓ›˜ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£

Û˘Á¯ÚfiÓˆ˜ Ì ÙË Û˘Ì‚·ÙÈ΋ ıÂڷ›·, fiˆ˜ ηÈ

ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÌÂÏÂÙÒÓ Û ·È‰È¿ Ì ηÎÔ‹-

ıË ÓÂÔÏ¿ÛÌ·Ù· (5,6,12,13) Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë

ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ (16/23) ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó

ηıËÌÂÚÈÓ¿ ·˘Ù¤˜ ÙȘ “ıÂڷ›˜” ÂȂ‚·ÈÒÓÂÈ ÙËÓ

·Ú¿Ï¢ÚË ¯Ú‹ÛË ÙÔ˘˜.

¶ÚÔÛ¢¯¤˜ / £Â›· ̄ ¿ÚȘ / ıÚËÛ΢ÙÈΤ˜ ÙÂÏÂÙÔ˘Ú-

Á›Â˜ ‹Ù·Ó Ë ÈÔ Û˘¯Ó‹ ™∂£ ÛÙË ÌÂϤÙË Ì·˜ (18/23,

78%) Î·È ·˘Ùfi Û˘ÌʈÓ› Ì ÌÈÎÚfi ·ÚÈıÌfi ¿ÏψÓ

ÌÂÏÂÙÒÓ fiˆ˜ ÙˆÓ Friedman Î·È Û˘Ó. (4) Î·È ÙˆÓ

Yeh Î·È Û˘Ó. (14) Ô˘ ·Ó¤ÊÂÚ·Ó ÔÛÔÛÙ¿ 64% ηÈ

40% ·ÓÙÈÛÙÔ›¯ˆ˜. ∆Ô ˘„ËÏfi ÔÛÔÛÙfi Ù˘ ‰È΋˜ Ì·˜

¶›Ó·Î·˜ 2. ÷ڷÎÙËÚÈÛÙÈο Û˘ÌÌÂÙ¯fiÓÙˆÓ Î·È ·È‰ÈÒÓ

™‡ÓÔÏÔ ∂Ó·ÏÏ·ÎÙÈΤ˜ ∂Ó·ÏÏ·ÎÙÈΤ˜ p¡·È Ÿ¯È

º‡ÏÔ Û˘ÌÌÂÙ¤¯ÔÓÙÔ˜ÕÚÚÂÓ 33 5 28£‹Ï˘ 75 17 58 >0,05ÕÚÚÂÓ & ı‹Ï˘ 2 1 1™˘ÁÁÂÓÈ΋ Û¯¤Û˶·Ù¤Ú·˜ 33 5 28ªËÙ¤Ú· 73 16 57¶·Ù¤Ú·˜ & ÌËÙ¤Ú· 2 1 1 >0,05ÕÏÏÔ 2 1 1¢È¿ÌÂÛË ËÏÈΛ· (¤ÙË) 39 (26-57) 40 39∂ıÓÈÎfiÙËÙ·ŒÏÏËÓ˜ 98 19 79 >0,05∞ÏÏÔ‰·Ô› 12 4 8∂¿ÁÁÂÏÌ·√ÈÎȷο 36 9 27¢ËÌfiÛÈÔÈ ˘¿ÏÏËÏÔÈ 26 5 21π‰ÈˆÙÈÎÔ› ˘¿ÏÏËÏÔÈ-·˘ÙÔ··Û¯ÔÏÔ‡ÌÂÓÔÈ 43 8 35 >0,05™Ô˘‰·ÛÙ¤˜ 1 1ÕÓÂÚÁÔÈ 4 4º‡ÏÔ ·È‰ÈÔ‡ÕÚÚÂÓ 68 14 54£‹Ï˘ 42 9 33 >0,05¢È¿ÌÂÛË ËÏÈΛ· (¤ÙË) 7 9 ó 7¡fiÛÔ˜§Â˘¯·ÈÌ›· 48 6 42§¤Ìʈ̷ 16 5 11™¿ÚΈ̷ 13 6 7¡ÂÊÚÔ‚Ï¿Ûو̷ 8 8 >0,05¡Â˘ÚÔ‚Ï¿Ûو̷ 4 4ŸÁÎÔÈ ∫¡™ 4 3 1ÕÏÏÔ 17 3 14∂›‰Ô˜ ıÂڷ›·˜ÃËÌÂÈÔıÂڷ›· (ã) 51 7 44ÃÂÈÚÔ˘ÚÁÂ›Ô (Ã∂πƒ) 7 2 5∞ÎÙÈÓÔıÂڷ›· (A£) 1 1ã+Ã∂πƒ+∞£ 9 3 6 >0,05ã+Ã∂πƒ 25 6 19ã+∞£ 16 5 11∫·Ì›· 1 1

¶›Ó·Î·˜ 3. ∂›‰Ô˜ ÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ Û 23 ·ÛıÂÓ›˜

¶ÚÔÛ¢¯¤˜ 18ªÔ˘ÛÈ΋ / ˙ˆÁÚ·ÊÈ΋ 4¢›·ÈÙ˜ 3ª·Û¿˙ 3√ÌÔÈÔ·ıËÙÈ΋ 2∂ί˘Ï›ÛÌ·Ù· Ê˘ÙÒÓ 1∫ÈÓ¤˙ÈÎË È·ÙÚÈ΋ 1ÕÛÎËÛË / Á˘ÌÓ·ÛÙÈ΋ 1¶ÓÂ˘Ì·ÙÈΤ˜ / „˘¯ÔÏÔÁÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ 1

138 ∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.

Paediatriki 2007;70:135-140

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ÌÂϤÙ˘ (78%) ÌÔÚ› Ó· ÂÍËÁËı› fi¯È ÌfiÓÔ ·fi ÙËÓÔÏÈÙÈÛÌÈ΋ Î·È ıÚËÛ΢ÙÈ΋ ·È‰Â›· ÙÔ˘ Ï·Ô‡ Ì·˜·ÏÏ¿ Î·È ·fi ÙÔ ¤ÓÙÔÓÔ ıÚËÛ΢ÙÈÎfi Û˘Ó·›ÛıËÌ· ηÈÙËÓ Ôχ Û˘¯Ó‹ Ù¿ÛË ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆÓ›· Ó·¯ÚËÛÈÌÔÔÈ› ÙËÓ Â›ÎÏËÛË Ù˘ ıÚËÛΛ·˜ ˆ˜ Û˘-ÌÏËڈ̷ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Û οı ÛÔ‚·Úfi Úfi‚ÏË-Ì·. ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÁÔÓ›˜Ô˘, Û ˘ÂÚ‚ÔÏÈÎfi ‚·ıÌfi, ÛÙÚ¿ÊËÎ·Ó ÛÙËÓ ÂÎÎÏË-Û›·, Ù· Ì˘ÛÙ‹ÚÈ· Î·È ÙȘ ÚÔÛ¢¯¤˜, ÂÓÒ Ôχ Û˘¯Ó¿·Ó·˙‹ÙËÛ·Ó ‚Ô‹ıÂÈ· ·fi ‰ËÌÔÊÈÏ‹ ÌÔÓ·ÛÙ‹ÚÈ· ÛÂfiÏË ÙËÓ ÂÈÎÚ¿ÙÂÈ·, fiˆ˜ Ô ÕÁÈÔ˜ ƒ·Ê·‹Ï, Î·È ÙÔÔ-ı¤ÙËÛ·Ó ÏËıÒÚ· ÂÈÎfiÓˆÓ ·Á›ˆÓ, ÛÙ·˘ÚÔ˘‰¿ÎÈ·, Ù›-ÌÈÔ Í‡ÏÔ Î.Ï. fi¯È ÌfiÓÔ Î¿Ùˆ ·fi ÙÔ Ì·ÍÈÏ¿ÚÈ Î·È ÙÔÛÙÚÒÌ· ÙÔ˘ ·È‰ÈÔ‡ ·ÏÏ¿ ·ÎfiÌË Î·È Ì¤Û· Û ʷΤ-ÏÔ˘˜ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Î·È ¿ÏÏˆÓ ÂÍÂÙ¿ÛˆÓ. ∏ ‰Â‡ÙÂ-ÚË ÛÂ Û˘¯ÓfiÙËÙ· ¯Ú‹Û˘ ™∂£ ‹Ù·Ó ÙÔ˘ “Ó‡̷ÙÔ˜ /ÛÒÌ·ÙÔ˜” fiˆ˜ ÌÔ˘ÛÈ΋ / ˙ˆÁÚ·ÊÈ΋ 4/23, Ì·Û¿˙ 3,·Û΋ÛÂȘ ÛÒÌ·ÙÔ˜ Î·È Ó‡̷ÙÔ˜ 2 ÌÂ Û˘ÓÔÏÈ΋ Û˘-¯ÓfiÙËÙ· 39%. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È ·ÚfiÌÔÈÔ ÌÂÂΛӷ ÙˆÓ ÌÂÏÂÙÒÓ Fernadez Î·È Û˘Ó (6) ηÈFriedman Î·È Û˘Ó (4). ∂‰Ò Ú¤ÂÈ Ó· ÛËÌÂÈÒÛÔ˘ÌÂfiÙÈ Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÔÁÎÔÏÔÁÈÎÒÓ Î¤ÓÙÚˆÓ ÛÙËÓ∂˘ÚÒË Î·È ÙËÓ ∞ÌÂÚÈ΋ ÔÈ ·Ú·¿Óˆ ÌÔÚʤ˜ Û˘-ÌÏËڈ̷ÙÈ΋˜ ıÂڷ›·˜ ÚÔÛʤÚÔÓÙ·È ÛÙ· Ï·›-ÛÈ· Ù˘ ÔÏÈÛÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂ-ÔÏ¿ÛÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆¤ÏÔ˜,ÛÙËÓ ÙÚ›ÙË ÌÂÁ¿ÏË Î·ÙËÁÔÚ›· ™∂£ Ì ‚fiÙ·Ó· / ÔÌÔÈ-Ô·ıËÙÈ΋ / ÂȉÈΤ˜ ‰›·ÈÙ˜ / ‚Èٷ̛Ә, ÙÔ ÔÛÔÛÙfiÙˆÓ ¯ÚËÛÙÒÓ ÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌË-ÏfiÙÂÚÔ (7/23, 30%) Û ۯ¤ÛË Ì ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓÌÂÏÂÙÒÓ Ù˘ ÙÂÏÂ˘Ù·›·˜ 20ÂÙ›·˜ Î·È ·˘Ùfi ηٿ ·ÚÈÔÏfiÁÔ ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›·¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÚÔÊ‹ Û ٤ÙÔÈ-Ô˘ ›‰Ô˘˜ ÚÔ˚fiÓÙ· Î·È ·ÚÂÌ‚¿ÛÂȘ. ¶ÈÛÙ‡ԢÌÂÏÔÈfiÓ fiÙÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ·˘Ù¿ ı· Á›ÓÔ˘ÓÔχ ‰ËÌÔÊÈÏ‹, fiˆ˜ ‹‰Ë Â›Ó·È Û ¿ÏϘ ¯ÒÚ˜ Ù˘∂˘ÚÒ˘ Î·È Ù˘ ∞ÌÂÚÈ΋˜ (15).

√È ÁÔÓ›˜ ÏËÚÔÊÔÚ‹ıËÎ·Ó ÁÈ· ÙȘ ™∂£ ΢ڛˆ˜·fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È ·fi ÂÈÛÙ‹ÌÔ-Ó˜ ˘Á›·˜ (14/18), ÂÓÒ ÂÏ¿¯ÈÛÙÔÈ ·Ó¤ÊÂÚ·Ó ˆ˜ Ë-Á¤˜ Ù· ªª∂ Î·È ÙÔ ¢È·‰›ÎÙ˘Ô, οÙÈ Ô˘ ¤Ú¯ÂÙ·È Û·ÓÙ›ıÂÛË Ì ¿ÏϘ ÌÂϤÙ˜ (16). ŸÏÔÈ ÔÈ ÁÔÓ›˜ Ù˘ÌÂϤÙ˘ Ì·˜, ÏËÓ ÂÓfi˜, Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ™∂£ÂÎÊÚ¿˙Ô˘Ó ÈηÓÔÔ›ËÛË. °È· ÙÔ˘˜ ÁÔÓ›˜ ÔÈ ÏfiÁÔȯڋÛ˘ Ù¤ÙÔÈˆÓ ıÂÚ·ÂÈÒÓ ‹Ù·Ó ÁÈ· Ó· οÓÔ˘Ó ÙԷȉ› ÈÔ ‰˘Ó·Ùfi (17/23), Ë ÂÏ›‰· fiÙÈ ı· ÛÙ·Ì·Ù‹-ÛÔ˘Ó ÙËÓ ÚfiÔ‰Ô ÙÔ˘ ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜(11/23) Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Ù˘ıÂڷ›·˜ Î·È Ù˘ ÓfiÛÔ˘ (6/23). √È ı¤ÛÂȘ ·˘Ù¤˜ ÙˆÓÁÔÓÈÒÓ Â›Ó·È Û ·fiÏ˘ÙË Û˘Ìʈӛ· Ì ÔÏϤ˜ ¿ÏϘ·ÚfiÌÔȘ ÌÂϤÙ˜ (6,12). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ˯ڋÛË ™∂£ ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ,ÙËÓ ÂıÓÈÎfiÙËÙ·, ÙË ÌfiÚʈÛË, Î·È ÙÔ Â¿ÁÁÂÏÌ· ÙˆÓÁÔÓÈÒÓ, Î·È Ì ÙË ‰È¿ÁÓˆÛË, ÙÔÓ ÙÚfiÔ ıÂڷ›·˜

Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙË ‰È¿ÁÓˆÛË,. ∞Ó¿-ÏÔÁ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ̆ ÔÛÙËÚ›ÍÂÈ Û˘Û¯ÂÙ›ÛÂȘ Ì ÙËÓÂıÓÈÎfiÙËÙ· Î·È Ù· ÔÏÈÙÈÛÙÈο ‰Â‰Ô̤ӷ ÙˆÓ ÎÔÈÓˆ-ÓÈÒÓ (17,18), ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô ÙˆÓÁÔÓÈÒÓ (18), ÙÔ Â›Â‰Ô Âη›‰Â˘Û˘ ÙˆÓ ÁÔÓÈÒÓ(6), ÙËÓ ·ÚÔ˘Û›· ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘ (19), ÙËÓÚÔËÁÔ‡ÌÂÓË ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ıÂÚ·ÂÈÒÓ (6) Î·È ÙÔ·Ó·Ù˘Á̤ÓÔ ıÚËÛ΢ÙÈÎfi Û˘Ó·›ÛıËÌ· (18,20).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¯Ú‹ÛË Û˘ÌÏËڈ̷ÙÈÎÒÓ Î·ÈÂÓ·ÏÏ·ÎÙÈÎÒÓ ıÂÚ·ÂÈÒÓ ÛÙ· ·È‰È¿ Â›Ó·È Û˘¯Ó‹ ÛÙ··È‰È¿ Ì ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· . °È· Ó· ··ÓÙËı›ÙÔ ÂÚÒÙËÌ· Â¿Ó ·ÚÂÌ‚¿ÛÂȘ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ¤¯Ô˘Ó·ÔÙ¤ÏÂÛÌ·, ı· Ú¤ÂÈ ÂÌ›˜ ˆ˜ ÁÈ·ÙÚÔ› Ó· ‰È¢ÎÚÈ-Ó›˙Ô˘Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ Î·È ÙȘ ÚÔÛ‰Ô˘ ÙˆÓ ÁÔÓÈÒÓˆ˜ ÚÔ˜ ÙË ıÂڷ›·, Ó· ÂÓËÌÂÚˆÓfiÌ·ÛÙ ÁÈ· ÙȘ Ô˘-ۛ˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÔÈ ·ÛıÂÓ›˜ Ì·˜, Ó· οÓÔ˘ÌÂ Û˘-ÁÎÂÎÚÈ̤Ó˜ Î·È Û·Ê›˜ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙȘ ıÂڷ›˜·˘Ù¤˜ Î·È Ó· Ï·Ì‚¿ÓÔ˘Ì ˘’ fi„ÈÓ Ì·˜ ÙË ‰È·ÏÔ΋ÌÂٷ͇ ÂÈÛÙËÌÔÓÈ΋˜ ÏËÚÔÊfiÚËÛ˘ Î·È ‰˘Ó¿ÌˆÓÙ˘ ·ÁÔÚ¿˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ ‰È·ıÂÛÈÌfiÙËÙ· ηÈÙÔ ÎfiÛÙÔ˜ ÙÔ˘˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË ¯ÒÚ· Ì·˜ ÔˆÛ‰‹-ÔÙ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ Î·Ù·ÁÚ·Ê‹ fiÏˆÓ ÙˆÓ Û˘-ÌÏËڈ̷ÙÈÎÒÓ Î·È ÂÓ·ÏÏ·ÎÙÈÎÒÓ ÚÔ˚fiÓÙˆÓ Ô˘Î˘ÎÏÔÊÔÚÔ‡Ó, ÓfiÌÈÌ· ‹ fi¯È, Î·È Ó· ‰ÔıÔ‡Ó ÙÂÎÌË-ÚȈ̤Ó˜ ηÙ¢ı‡ÓÛÂȘ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·,ÙȘ ·ÚÂÓ¤ÚÁÂȘ Î·È ÙȘ ·ÏÏËÏÂȉڿÛÂȘ Ì ¿ÏÏ·Ê¿Ú̷η. √ÚÈṲ̂ӷ Ê˘ÙÈο Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔ-Ê‹˜ ÌÔÚÔ‡Ó Ó· ÚÔÛʤÚÔ˘Ó ÛÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜,Î·È Î¿ÔȘ ÂÓ·ÏÏ·ÎÙÈΤ˜ ÌÔÚʤ˜ ÌÔÚÔ‡Ó Ó· ‚ÔË-ı‹ÛÔ˘Ó ÛÙËÓ Î·Ï‡ÙÂÚË „˘¯È΋, ۈ̷ÙÈ΋ Î·È Ó¢-Ì·ÙÈ΋ ηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ηÎÔ‹ıË ÓÂÔÏ¿-ÛÌ·Ù· (21). ∏ ·fiÚÚÈ„‹ ÙÔ˘˜ ¯ˆÚ›˜ Û˘˙‹ÙËÛË Î·È¤Ú¢ӷ Â›Ó·È ·ÎÚ·›· ÛÙ¿ÛË ·ÏÏ¿ ÙÔ ›‰ÈÔ ‹ Î·È ¯ÂÈÚfi-ÙÂÚÔ Â›Ó·È Ó· Ù· ‰Â¯fiÌ·ÛÙ ˆ˜ ı·˘Ì·ÙÔ˘ÚÁ¿, Ó· Ù·ÏËÚÒÓÔ˘Ì ȉȷ›ÙÂÚ· ·ÎÚÈ‚¿ Î·È Ó· ÙÚ¤¯Ô˘Ì ÛÙ·¤Ú·Ù· ÙÔ˘ ÎfiÛÌÔ˘ ÁÈ· Ó· Ù· ¿ÚÔ˘ÌÂ. ∂ÈÁÚ·ÌÌ·ÙÈ-ο ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Â›ÛË̘ ı¤ÛÂȘ Î·È Ô‰ËÁ›Â˜ Ù˘¶·ÁÎfiÛÌÈ·˜ ŒÓˆÛ˘ ¶·È‰È¿ÙÚˆÓ √ÁÎÔÏfiÁˆÓ ÁÈ· Ù˯ڋÛË Ù¤ÙÔÈˆÓ ıÂÚ·ÂÈÒÓ (22). √È Ô‰ËÁ›Â˜ ·˘Ù¤˜ ‰ÂÓ¤¯Ô˘Ó ˆ˜ ÛÙfi¯Ô Ó· ÂÚÈÁÚ¿„Ô˘Ó fiϘ ÙȘ ÂÈ‚Ï·‚›˜ÌË Û˘Ì‚·ÙÈΤ˜ ıÂڷ›˜, ·ÏÏ¿ Ó· ÂÓı·ÚÚ‡ÓÔ˘Ó ÙÔ˘˜ÁÔÓ›˜, ÚÈÓ ·ÔÊ·Û›ÛÔ˘Ó Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙËÓ·ÁˆÁ‹ ÙÔ˘ ıÂÚ¿ÔÓÙ· ÁÈ·ÙÚÔ‡, Ó· Û˘˙ËÙ‹ÛÔ˘Ó Ì·˙›ÙÔ˘ Â¿Ó Ë Û˘ÁÎÂÎÚÈ̤ÓË ·Ú¤Ì‚·ÛË ı· ÌÔÚÔ‡Û ӷ‚Ï¿„ÂÈ ÙÔ ·È‰› ÙÔ˘˜. √È ÁÔÓ›˜ ı· Ú¤ÂÈ Ó· ›ӷÈȉȷ›ÙÂÚ· ÂÈÊ˘Ï·ÎÙÈÎÔ› ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÔÔÈ·Û‰‹-ÔÙ ¿ÏÏ˘ ÏËÓ Ù˘ Û˘Ì‚·ÙÈ΋˜ ıÂڷ›·˜ fiÙ·Ó ËÌË Û˘Ì‚·ÙÈ΋ “ıÂڷ›·” Â›Ó·È ¤Ó· “Ì˘ÛÙÈÎfi” Ô˘ÌfiÓÔ ÔÚÈṲ̂ӷ ¿ÙÔÌ· ÙËÓ ÚÔÌËıÂ‡Ô˘Ó Î·È ˘fiÛ¯Â-Ù·È ›·ÛË ÁÈ· fiÏ· Ù· ›‰Ë ηÎÔ‹ıÔ˘˜ ÓÂÔÏ¿ÛÌ·ÙÔ˜Î·È fiÙ·Ó ÂΛÓÔÈ Ô˘ ÙËÓ ·Ú¤¯Ô˘Ó ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈηٷ‰ÈÒÎÔÓÙ·È ·fi ÙÔ È·ÙÚÈÎfi “ηÙÂÛÙË̤ÓÔ”, ÂÈÙ›-ıÂÓÙ·È ÛÙËÓ È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ· ‹ Î·È È‰È·›ÙÂÚ· fiÙ·Ó··ÈÙÔ‡Ó ÌÂÁ¿ÏÔ ÔÛfi ¯ÚËÌ¿ÙˆÓ ·fi ÙËÓ ·Ú¯‹ (23).

139∂Ó·ÏÏ·ÎÙÈΤ˜ ıÂڷ›˜ Û ·È‰È¿ Ì ηÎÔ‹ıÂȘ

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µÈ‚ÏÈÔÁÚ·Ê›·

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23. ¶Ô˘ÚÙÛ›‰Ë˜ ∞. ™˘ÌÏËڈ̷ÙÈΤ˜ Î·È ÂÓ·ÏÏ·ÎÙÈΤ˜

ıÂڷ›˜ ÛÙÔÓ Î·ÚΛÓÔ. ™ÙÔ: ∂. µ·ÛÈÏ¿ÙÔ˘ ∫ÔÛÌ›‰Ë,

ÂÈ̤ÏÂÈ· ¤Î‰ÔÛ˘. æ˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡

Ì ηÚΛÓÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘. 2005. Û. 836-852.

140 ∞. ¶Ô˘ÚÙÛ›‰Ë˜ Î·È Û˘Ó.

Paediatriki 2007;70:135-140

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141∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ ORIGINAL ARTICLE

¶·È‰È·ÙÚÈ΋ 2007;70:141-145

∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ ÚÒÙ˘ Û¯ÔÏÈ΋˜

ËÏÈΛ·˜ Î·È ÚÈÓ ÙËÓ ÂÊ˂›· ÛÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜

∞. ∫·ÙÛ·Ê¿‰Ô˘, µ. ¶··Â˘·ÁÁ¤ÏÔ˘, °. ºÂÚÂÓÙ›ÓÔ˜, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

¶ÂÚ›ÏË„Ë

∂ÈÛ·ÁˆÁ‹: ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ ÚÒÙ˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (∞’‰ËÌÔÙÈÎÔ‡) Î·È ÚÈÓ ÙËÓ ÂÊ˂›· (™∆’ ‰ËÌÔÙÈÎÔ‡), Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™˘ÌÏËÚÒıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ Ì·ıËÙÒÓ ÛÙ· ÔÔ›· ηٷ-ÁÚ¿ÊËÎ·Ó ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›·, ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ‹ Î·È ÓÔÛËÏ›·˜ ÏfiÁˆ ÂÈÏÔÎÒÓ·ÓÂÌ¢ÏÔÁÈ¿˜, ÈÛÙÔÚÈÎfi ÂÌÊ¿ÓÈÛ˘ ¤ÚËÙ· ˙ˆÛÙ‹Ú·, Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘ Î·È Ë ËÏÈΛ· ¤Ó·Ú͢ ·È‰ÈÎÔ‡ÛÙ·ıÌÔ‡. ∞ӷχıËÎ·Ó 19.381 ÂÚˆÙËÌ·ÙÔÏfiÁÈ·: 48,45% ·ÊÔÚÔ‡Û·Ó ·È‰È¿ Ù˘ ∞’ ‰ËÌÔÙÈÎÔ‡ ηÈ51,55% ·È‰È¿ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡.

∞ÔÙÂϤÛÌ·Ù·: πÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ›¯Â ÙÔ 66,65% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ Ù¿Í˘ ηÈ78,69% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ™∆’ Ù¿Í˘. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ‹Ù·Ó ·ÓÙÈÛÙÔ›¯ˆ˜ 3,97 Î·È 5,37 ¤ÙË(p<0,001). πÛÙÔÚÈÎfi ¤ÚËÙ· ˙ˆÛÙ‹Ú· ›¯Â ÙÔ 0,48%. ∆Ô 1,62% ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ú·Û·Ó ·ÓÂÌ¢ÏÔÁÈ¿ÓÔÛËχÙËΠÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘. ∆· ·È‰È¿ Ô˘ ‹Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi (72,85%) ›¯·Ó ̤-ÛË ËÏÈΛ· ÓfiÛËÛ˘ 4,46 ¤ÙË, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ·fi ·˘Ù‹ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰ÂÓ ‹Á·Ó(5,69 ¤ÙË, (p<0,001)). ∂›Û˘ Ù· ·È‰È¿ Ô˘ ‹Ù·Ó ÚˆÙfiÙÔη ÓfiÛËÛ·Ó Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Û ۇ-ÁÎÚÈÛË Ì ٷ ·È‰È¿ Ô˘ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ·, Ì ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 5,13 Î·È 4,36 ¤ÙË, ·ÓÙ›-ÛÙÔȯ· (p <0,001). ∆¤ÏÔ˜, ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙË Ì¤ÛË ËÏÈΛ·˜ ÓfiÛËÛ˘ ÌÂٷ͇ ·È‰ÈÒÓ ÂÏÏËÓÈ-΋˜ ηٷÁˆÁ‹˜ Î·È ÌÂÙ·Ó·ÛÙÒÓ, ‰ÈfiÙÈ, Ù· ÚÒÙ· ·Ú·ÎÔÏÔ‡ıËÛ·Ó Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂ-ÚÔ ÔÛÔÛÙfi ·È‰ÈÎfi ÛÙ·ıÌfi Û ۯ¤ÛË Ì ٷ ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ.

™˘ÌÂÚ¿ÛÌ·Ù·: ∞fi Ù· ÛÙÔȯ›· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È‰ÈÒÓ Ô˘ Ë-Á·›ÓÔ˘Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ ̤Û˘ ËÏÈΛ·˜ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘.

§¤ÍÂȘ ÎÏÂȉȿ: ∞ÓÂÌ¢ÏÔÁÈ¿, ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË, ÂÌ‚fiÏÈÔ ·ÓÂÌ¢ÏÔÁÈ¿˜, ·È‰ÈÎfi˜ ÛÙ·ıÌfi˜.

The epidemiology of chickenpox in school-age children from the

prefecture of Attica

∞. Katsafadou, V. Papaevangelou, G. Ferentinos, A. Constantopoulos

Abstract

Background: Epidemiologic data are described regarding varicella in primary school children from theentire prefecture of Attica.

Methods: Parents of children attending the 1st and 6th grades of primary school completed aquestionnaire including questions on demographic data, the history of chickenpox, hospitalizationsecondary to chickenpox complications and herpes zoster, and the age at which the children firstattended day care.

Results: On analysis of 19,381 questionnaires, 48.45% from 1st grade and 51.55% from 6th gradechildren, a history of varicella was reported in 66.65% of 1st grade children and 78.69% of 6th gradechildren, and the mean age of the children at the varicella illness was 3.93 and 5.37 years respectively(p<0.001). A history of herpes zoster was reported in 0.48%, and 1.62% of the children had beenhospitalized because of a varicella-associated complication. Children who had attended day care(72.85%) and children with older siblings were reported to have contracted chickenpox at a youngerage (mean age 4.46 years and 4.36 years, respectively) compared to children who had not attendedday care or who were firstborn (mean age: 5.69 and 5.13 years, respectively, p<0.001). Children ofimmigrants were reported to have had varicella at a comparatively later age but this might besecondary to their low attendance rate at day care (59.3%).

Conclusions: A significant lowering in the mean age at which varicella is contracted by children inAttica was observed, probably due to the increasing rate of children attending day care.

Key words: Varicella, epidemiology, varicella vaccine, day care.

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ,¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

AÏÏËÏÔÁÚ·Ê›·:

∫·ÙÛ·Ê¿‰Ô˘ ∞ÏÂÍ¿Ó‰Ú·[email protected]™˘ÁÁÚÔ‡ 59, ∆.∫. 15125, ª·ÚÔ‡ÛÈ

2nd Paediatric Clinic of theUniversity of Athens, “P. & A. Kyriakou”Children’s Hospital, Athens, Greece

Correspondence:

Katsafadou [email protected], Syggrou St. 15125, Maroussi, Greece

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142 ∞. ∫·ÙÛ·Ê¿‰Ô˘ Î·È Û˘Ó.

Paediatriki 2007;70:141-145

∂ÈÛ·ÁˆÁ‹

√ Èfi˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜-˙ˆÛÙ‹Ú· (VZV) ·Ó‹ÎÂÈ

ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÂÚËÙÔ˚ÒÓ (·ÓıÚÒÂÈÔ˜ ÂÚË-

ÙÔ˚fi˜ 3: HHV-3). √ VZV ·ÔÙÂÏÂ›Ù·È ·fi ÌÈ· ‰ÈÏ‹

·Ï˘Û›‰· DNA Ô˘ Έ‰ÈÎÔÔÈ› ÂÚ› ÙȘ 75 Úˆ-

Ù½Ó˜ Î·È ¤Ó· Î¿Ï˘ÌÌ· ·fi ÏÈ›‰È· Î·È ÁÏ˘ÎÔÚˆ-

Ù½Ó˜. ∏ Ïԛ̈ÍË ·fi ÙÔÓ VZV ÌÔÚ› Ó· ÂΉËψ-

ı› Ì ‰‡Ô ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, ÙËÓ ·ÓÂÌ¢ÏÔÁÈ¿

Î·È ÙÔÓ ¤ÚËÙ· ˙ˆÛÙ‹Ú· (1).

∏ ·ÓÂÌ¢ÏÔÁÈ¿ Â›Ó·È Ë ÚˆÙÔÁÂÓ‹˜ Ïԛ̈ÍË.

¶ÚfiÎÂÈÙ·È ÁÈ· ‹È· ·È‰È΋ ÓfiÛÔ Ì ˘„ËÏ‹ ÌÂÙ·‰Ô-

ÙÈÎfiÙËÙ·. √È ÂÈÏÔΤ˜ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ·ÔÙÂ-

ÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô.

™˘¯ÓfiÙÂÚ˜ Â›Ó·È ÔÈ ‰ÂÚÌ·ÙÈΤ˜ ÂÈÏÔÈÌÒÍÂȘ ·fi

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ÎÔ ÔÌ¿‰·˜ ∞ Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ΢ÙÙ·Ú›ÙÈ-

‰·, Ì˘ÔÛ›Ùȉ·, ÓÂÎÚˆÙÈ΋ ÂÚÈÙÔÓ›Ùȉ·, Ó¢ÌÔÓ›·,

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ÙÔÍÈÎÔ‡ shock (2). √È ÂÈÏÔΤ˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi

Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰È¿¯˘ÙË ÂÁÎÂ-

Ê·Ï›Ùȉ· Ô˘ Â›Ó·È È‰È·›ÙÂÚ· ÂÈΛӉ˘ÓË (10% ıÓË-

ÛÈÌfiÙËÙ·), ÙËÓ ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›· Î·È ÙÔ Û‡Ó-

‰ÚÔÌÔ Reye, ÙÔ Û¯ÂÙÈ˙fiÌÂÓÔ Ì ÙËÓ Ï‹„Ë Û·ÏÈ΢ÏÈ-

ÎÒÓ. ∏ Ó¢ÌÔÓ›· ·fi VZV Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙÔ˘˜

ÂÓ‹ÏÈΘ. ∫ÏÈÓÈ΋ Ë·Ù›Ùȉ· ·fi VZV Â›Ó·È Û¿ÓÈ·

Û ˘ÁÈ‹ ¿ÙÔÌ·, ·ÏÏ¿ Ë ·Û˘Ìو̷ÙÈ΋ ·‡ÍËÛË ÙˆÓ

ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Â›Ó·È Û˘Ó‹ı˘ (1,3,4).

√ ¤ÚËÙ·˜ ˙ˆÛÙ‹Ú·˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ‰Â-

ηÂٛ˜ ÌÂÙ¿ ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË. √Ê›ÏÂÙ·È

ÛÙËÓ Â·Ó·‰Ú·ÛÙËÚÈÔÔ›ËÛË ÙÔ˘ ÈÔ‡ Ô˘ ·Ú·Ì¤-

ÓÂÈ Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË Ì¤Û· ÛÙ· Á¿ÁÁÏÈ· ÙˆÓ

Ô›ÛıÈˆÓ Ó¢ÚÈÎÒÓ ÚÈ˙ÒÓ ÌÂÙ¿ ÙËÓ ÚˆÙÔ·ı‹ ÏÔ›-

̈ÍË. ∂›Ó·È Û¿ÓÈÔ˜ Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘

ÙˆÓ 10 ÂÙÒÓ Î·È Û˘Ó‹ıˆ˜ ÙÔ ÂÍ¿ÓıËÌ· Â›Ó·È ‹ÈÔ ÛÂ

Ê˘ÛÈÔÏÔÁÈο ·È‰È¿, Î·È Ù· Û˘ÌÙÒÌ·Ù· Ù˘ ÔÍ›·˜

Ó¢ڛÙȉ·˜ ÂÏ¿¯ÈÛÙ·. ¶ÚÈÓ ÙÔ ÂÍ¿ÓıËÌ· ÚÔËÁ›ٷÈ

ÂÓÙÔÈṲ̂ÓÔ˜ fiÓÔ˜, ˘ÂÚ¢·ÈÛıËÛ›·, ÎÓËÛÌfi˜ ηÈ

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Θ Â›Ó·È Ë ÌÂıÂÚËÙÈ΋ Ó¢ڷÏÁ›· (1,3,4).

∞fi ÔÚÔÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ˘ÔÏÔÁ›˙ÂÙ·È

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¯ÔÓÙ·È Û ·ʋ Ì ÙÔÓ VZV ÛÙËÓ ·È‰È΋ ËÏÈΛ·

(1). ™ÙȘ ÙÚÔÈΤ˜ ÂÚÈÔ¯¤˜ Ë ÔÚÔıÂÙÈÎfiÙËÙ· ÙˆÓ

ÂÓËÏ›ÎˆÓ Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚË. ™ÙȘ ∏¶∞ ÙË ‰Âη-

ÂÙ›· ÙÔ˘ 1980 Ë ÂÎÙÈÌÒÌÂÓË ËÏÈÎȷ΋ ηٷÓÔÌ‹ ÙˆÓ

ÂÚÈÛÙ·ÙÈÎÒÓ ·ÓÂÌ¢ÏÔÁÈ¿˜ ‹Ù·Ó 33% Û ·È‰È¿

ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ (1-4 ÂÙÒÓ) Î·È 44% ÙˆÓ ÂÚÈ-

ÛÙ·ÙÈÎÒÓ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (5-9 ÂÙÒÓ).

™˘ÓÔÏÈο ¿Óˆ ·fi 90% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ·ÊÔ-

ÚÔ‡Û·Ó ¿ÙÔÌ· οو ÙˆÓ 15 ÂÙÒÓ. ¶ÚÈÓ ÙËÓ ÂÊ·ÚÌÔ-

Á‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ ·ÓÂ-

Ì¢ÏÔÁÈ¿˜ ˘‹Ú¯Â ÌÈ· Ù¿ÛË ÁÈ· Ì›ˆÛË Ù˘ ËÏÈΛ·˜

ÂΉ‹ÏˆÛ˘ Ù˘ ÓfiÛÔ˘, Ô˘ ÈÛÙ‡ÂÙ·È fiÙÈ Û¯ÂÙÈ˙fi-

Ù·Ó Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È‰ÈÒÓ Ô˘

·Ú·ÎÔÏÔ˘ıÔ‡Ó ·È‰ÈÎfi ÛÙ·ıÌfi (3,5,6).

∆o ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ·ÔÙÂÏÂ›Ù·È ·fi

˙ÒÓÙ˜ ÂÍ·ÛıÂÓË̤ÓÔ˘˜ ÈÔ‡˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Oka. √

√ÚÁ·ÓÈÛÌfi˜ ∆ÚÔÊ›ÌˆÓ Î·È º¿ÚÌ·ÎˆÓ ÙˆÓ ∏¶∞

(FDA) ¯ÔÚ‹ÁËÛ ¿‰ÂÈ· ΢ÎÏÔÊÔÚ›·˜ ÛÙÔ ÂÌ‚fiÏÈÔ

·fi ÙÔÓ ª¿ÚÙÈÔ ÙÔ˘ 1995. √ ¤ÏÂÁ¯Ô˜ Ù˘ ·ÓÂÌ¢ÏÔ-

ÁÈ¿˜ Û‡Ìʈӷ Ì ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜

ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ Ì ¢Ú›· ÂÌ‚ÔÏÈ·ÛÙÈ΋

Î¿Ï˘„Ë (5).

°È· ÙÔÓ Û¯Â‰È·ÛÌfi ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÛÙÚ·ÙËÁÈ΋˜

·fi ÙȘ ÀËÚÂۛ˜ ÀÁ›·˜ Â›Ó·È ··Ú·›ÙËÙË Ë ÁÓÒ-

ÛË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘ ÛÙË ¯ÒÚ· Ì·˜ ηÈ

ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ Ù· ÔÛÔÛÙ¿ Ê˘ÛÈ΋˜ ·ÓÔÛ›·˜ ·Ó¿

ËÏÈΛ·, Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ

ÂÈÏÔÎÒÓ Î·È Ù· ÔÛÔÛÙ¿ ÓÔÛËÏ›·˜ (7). ∆· ÂÈ-

‰ËÌÈÔÏÔÁÈο ·˘Ù¿ ÛÙÔȯ›· ı· ¯ÚËÛÈ̇ÛÔ˘Ó Â›-

Û˘, ÛÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜

ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙË ¯ÒÚ· Ì·˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·-

˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡.

∏ ÌÂϤÙË ·ÔÛÎÔ› ÛÙËÓ ·ÔÙ‡ˆÛË ÈÛÙÔÚÈ-

ÎÔ‡ Ê˘ÛÈ΋˜ Ïԛ̈͢ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ÌÂÁ¿ÏÔ

‰Â›ÁÌ· ·È‰ÈÒÓ ÚÒÙ˘ Û¯ÔÏÈ΋˜ Î·È ÚÔÂÊË‚È΋˜

ËÏÈΛ·˜ Ô˘ ‰È·Ì¤ÓÔ˘Ó ÛÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜, ηٿ ÙËÓ

ÂÚ›Ô‰Ô Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ Ù˘ ·ÓÂ-

Ì¢ÏÔÁÈ¿˜ ÛÙËÓ ∂ÏÏ¿‰·.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

ªÂÙ¿ ·fi ¤ÁÎÚÈÛË Ù˘ ÌÂϤÙ˘ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È-

‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÂÛÙ¿ÏËÛ·Ó Û fiÏ· Ù· ‰ËÌÔÙÈο

Û¯ÔÏ›· ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈ΋˜ (1046 ‰ËÌfiÛÈ· Û¯ÔÏ›· Î·È 109

ȉȈÙÈο Û¯ÔÏ›·) ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ù· ÔÔ›· ̤ۈ ÙˆÓ ÂÎ-

·È‰Â˘ÙÈÎÒÓ ‰È·ÓÂÌ‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ Ì·ıËÙÒÓ Ù˘

∞’ Î·È ™∆’ ‰ËÌÔÙÈÎÔ‡. ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Û¯ÔÏ›ˆÓ ÛÙËÓ

¤Ú¢ӷ Î·È Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ‹Ù·Ó ÚÔ·ÈÚÂ-

ÙÈ΋. √È ÁÔÓ›˜ Û˘ÌÏ‹ÚˆÛ·Ó ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (ÁÈ·

ÙË ‰È·ÛÊ¿ÏÈÛË ÙˆÓ ÚÔÛˆÈÎÒÓ ‰Â‰Ô̤ӈÓ) Ì ‰ËÌÔÁÚ·ÊÈ-

ο ÛÙÔȯ›·, ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, ÈÛÙÔÚÈÎfi

ÓÔÛËÏ›·˜ ÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘ Î·È ÈÛÙÔÚÈÎfi ÂÌÊ¿ÓÈ-

Û˘ ¤ÚËÙ· ˙ˆÛÙ‹Ú· ÌÂÙ¿ ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË. ∂›Û˘,

ηٷÁÚ¿ÊËÎÂ Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ë ·ÎÚÈ‚‹˜

ËÏÈΛ· ¤Ó·Ú͢ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡. ™ÙË Û˘Ó¤¯ÂÈ· ˘ÔÏÔÁ›-

ÛÙËÎÂ Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ Î·È ¤ÁÈÓ ۇÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ

·È‰ÈÒÓ: ·) ∞’ Î·È ™∆’ ‰ËÌÔÙÈÎÔ‡, ‚) Ô˘ ‹Á·Ó ·È‰ÈÎfi

ÛÙ·ıÌfi ‹ fi¯È Î·È Á) Ô˘ ‹Ù·Ó ÚˆÙfiÙÔη ‹ ›¯·Ó ÌÂÁ·Ï‡ÙÂ-

Ú· ·‰¤ÏÊÈ·. ∂ÈϤÔÓ Î·ıÔÚ›ÛÙËΠÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ

Ô˘ ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜ ÏfiÁˆ ·ÓÂÌ¢ÏÔÁÈ¿˜ Î·È ¯ÚÂÈ¿-

ÛÙËΠӷ ÓÔÛËÏ¢ıÔ‡Ó, Î·È ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ¤Ú-

ËÙ· ˙ˆÛÙ‹Ú· ÌÂÙ¿ ·fi ÙËÓ ÚˆÙÔ·ı‹ Ïԛ̈ÍË.

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË

°È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ Úfi-

ÁÚ·ÌÌ· Stata SE 8.0 ÁÈ· Windows. ∏ Û‡ÁÎÚÈÛË ÙÔ˘ ÔÛÔÛÙÔ‡

ÓfiÛËÛ˘ ÌÂٷ͇ ÙˆÓ ˘ÔÔÌ¿‰ˆÓ Ù˘ ÌÂϤÙ˘ ¤ÁÈÓ Ì ÙÔ

ÛÙ·ÙÈÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ¯-ÙÂÙÚ¿ÁˆÓÔ ÙÔ˘ Pearson (Pearson’s chi

square). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ËÏÈÎÈÒÓ ÓfiÛËÛ˘ ÌÂٷ͇ ÙˆÓ

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·142

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˘ÔÔÌ¿‰ˆÓ Î·È ·ÊÔ‡ ›¯·Ì ÂϤÁÍÂÈ ÚÒÙ· ÙËÓ Î·ÓÔÓÈÎfiÙË-

Ù· Ù˘ ÌÂÙ·‚ÏËÙ‹˜ “ËÏÈΛ· ÓfiÛËÛ˘” Ì ÙË ‚Ô‹ıÂÈ· ÈÛÙÔ-

ÁÚ·ÌÌ¿ÙˆÓ Î·È ÙÔ˘ sktest (Skewness and kurtosis test for

normality - ‰ÔÎÈÌ·Û›· ÏÔÍfiÙËÙ·˜ Î·È Î‡ÚÙˆÛ˘ ÁÈ· ÙÔÓ ¤ÏÂÁ-

¯Ô Ù˘ ηÓÔÓÈÎfiÙËÙ·˜), ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÎÚÈ-

Ù‹ÚÈÔ t-test (Û‡ÁÎÚÈÛË Ì¤ÛˆÓ ÙÈÌÒÓ ‰ÂÈÁÌ¿ÙˆÓ). °È· fiÏ· Ù·

·ÓˆÙ¤Úˆ test ÙÔ Â›Â‰Ô Ù˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜

ÔÚ›ÛÙËÎÂ ÛÙÔ 0,05.

∞ÔÙÂϤÛÌ·Ù·

∞·ÓÙËÙÈÎÔ› ʷΤÏÔÈ ÂÏ‹ÊıËÛ·Ó ·fi ÙÔ 43,5%ÙˆÓ ‰ËÌfiÛÈˆÓ Û¯ÔÏ›ˆÓ Î·È ÙÔ 21% ÙˆÓ È‰ÈˆÙÈÎÒÓÛ¯ÔÏ›ˆÓ. ∞ӷχıËÎ·Ó 19.381 ÂÚˆÙËÌ·ÙÔÏfiÁÈ·.∞fi ·˘Ù¿ ÙÔ 48,45% ·ÊÔÚÔ‡Û·Ó ·È‰È¿ Ù˘ ∞’ ‰Ë-ÌÔÙÈÎÔ‡ Î·È 51,55% ·È‰È¿ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡ ·ÓÙ›-ÛÙÔȯ·. ∆Ô 45,39% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·ÁfiÚÈ·. ∆Ô94,57% ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ ηÈÙÔ 5,43% ‹Ù·Ó ÌÂÙ·Ó¿ÛÙ˜. £ÂÙÈÎfi ÈÛÙÔÚÈÎfi ÓfiÛË-Û˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ›¯·Ó 13.816 Ì·ıËÙ¤˜(72,85%). ∆Ô 66,65% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ∞’ Ù¿Í˘ ηÈ78,69% ÙˆÓ Ì·ıËÙÒÓ Ù˘ ™∆’ Ù¿Í˘ ·Ó¤ÊÂÚ ÓfiÛË-ÛË ·fi ·ÓÂÌ¢ÏÔÁÈ¿. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ÛÙ··È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó 4,75 (sd±2,36) ¤ÙË,·Ó·Ï˘ÙÈο, ÛÙËÓ ∞ã Î·È ™∆ã ‰ËÌÔÙÈÎÔ‡ ‹Ù·Ó 3,97(sd±1,48) Î·È 5,37 (sd±2,71) ¤ÙË ·ÓÙ›ÛÙÔȯ·(p<0,001). πÛÙÔÚÈÎfi ¤ÚËÙ· ˙ˆÛÙ‹Ú· ·Ó¤ÊÂÚ ÙÔ0,48% ÂÓÒ 1,62% ÙˆÓ ·È‰ÈÒÓ Ì ÈÛÙÔÚÈÎfi ·ÓÂÌ¢-ÏÔÁÈ¿˜ ÓÔÛËχÙËΠÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘.∆· ·È‰È¿ Ô˘ ‹Á·Ó ·È‰ÈÎfi ÛÙ·ıÌfi (72,85%) ›-¯·Ó ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 4,46 (sd±2,6) ¤ÙË, ÂÓÒ Ù··È‰È¿ Ô˘ ‹Á·Ó ÌfiÓÔ ÓËÈ·ÁˆÁ›Ô, ›¯·Ó ̤ÛËËÏÈΛ· ÓfiÛËÛ˘ 5,69 (±2,6) ¤ÙË (p<0,001). ∞Ó·Ï˘ÙÈ-

ο, Ù· ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ Ô˘ ·Ú·ÎÔÏÔ‡ıË۷ӷȉÈÎfi ÛÙ·ıÌfi, ÓfiÛËÛ·Ó Û ̤ÛË ËÏÈΛ· 3,88(sd±1,88) ¤ÙË, ¤Ó·ÓÙÈ Ù˘ ̤Û˘ ËÏÈΛ·˜ ÙˆÓ 4,42(sd±1,62) ¤ÙË Ô˘ ÓfiÛËÛ·Ó Ù· ·È‰È¿ Ô˘ ‰ÂÓ ‹-Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi (p<0,001). °È· Ù· ·È‰È¿ ™∆’Ù¿Í˘, ÔÈ Ì¤Û˜ ËÏÈ˘ Â›Ó·È 5,02 Î·È 6,20 ¤ÙË ·ÓÙ›-ÛÙÔȯ· (p<0,001). ™˘ÓÔÏÈο, Ù· ÚˆÙfiÙÔη ·È‰È¿Â›¯·Ó ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ 5,13 (sd±2,6) ¤ÙË Û ۇ-ÁÎÚÈÛË Ì ٷ ·È‰È¿ Ì ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· (̤ÛËËÏÈΛ· ÓfiÛËÛ˘ 4,36(sd±2,2) ¤ÙË, (p<0,001). °È· Ù··È‰È¿ Ù˘ ∞’ Ù¿Í˘ Ô˘ Â›Ó·È ÚˆÙfiÙÔη ‹ ¤¯Ô˘ÓÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ·, Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ›ӷÈ4,26 Î·È 3,66 ¤ÙË ·ÓÙ›ÛÙÔȯ· (p<0,001). °È· Ù· ·È-‰È¿ ™∆’ Ù¿Í˘, Ë Ì¤ÛË ËÏÈΛ· Â›Ó·È 5,82 Î·È 4,91 ¤ÙË,·ÓÙ›ÛÙÔȯ· (p<0,001) (∂ÈÎfiÓ· 1). ∆Ô ÔÛÔÛÙfi ÓfiÛË-Û˘ ÛÙ· ÚˆÙfiÙÔη ·È‰È¿ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·’ fi,ÙÈÛÙ· ·È‰È¿ Ô˘ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· ÛÙËÓ ∞’Ù¿ÍË (63,42% Î·È 71,18%, ·ÓÙ›ÛÙÔȯ·, p<0,001), ˉȷÊÔÚ¿ ·˘Ù‹ fï˜, ÂÍ·Ï›ÊÂÙ·È Ì ÙÔ ¤Ú·ÛÌ·ÙˆÓ ¯ÚfiÓˆÓ Î·È ¤ÙÛÈ ÛÙ· ·È‰È¿ Ù˘ ™∆ã Ù¿Í˘ ‰ÂÓ·Ú·ÙËÚÂ›Ù·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔÔÛÔÛÙfi ÓfiÛËÛ˘ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ·È‰ÈÒÓ(79,19% Î·È 78,49%, ·ÓÙ›ÛÙÔȯ·, p=0,799). ™ËÌ·-ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi ÓfiÛËÛ˘ ·ÏÏ¿ Î·È ÛÙË̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ ·È-‰ÈÒÓ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Û ۯ¤ÛË Ì ·È‰È¿ ÌÂ-Ù·Ó·ÛÙÒÓ. ∆Ô ÔÛÔÛÙfi ÓfiÛËÛ˘ ‹Ù·Ó 73,75% ηÈ59,12%, ÂÓÒ Ë Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ‹Ù·Ó 4,72(sd±2,3) Î·È 6,25 (sd±2,7) ¤ÙË, ·ÓÙ›ÛÙÔȯ·(p<0,001). ∆Ô ÔÛÔÛÙfi ÊÔ›ÙËÛ˘ Û ·È‰ÈÎfi ÛÙ·ı-Ìfi ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ Â›Ó·È 75,08% ÁÈ· Ù·

∞ã ∆¿ÍË™∆ã ∆¿ÍË∞ã ∆¿ÍË

™∆ã ∆¿ÍË

4,265,82

3,66

4,91

0

1

2

3

4

5

6

MH ¶ƒø∆√∆√∫∞ ¶ƒø∆√∆√∫∞

ª¤Û

Ë Ë

ÏÈÎ

›· Ó

fiÛ

ËÛ

˘

(¤Ù

Ë)

ª¤Û

Ë Ë

ÏÈÎ

›· Ó

fiÛ

ËÛ

˘

(¤Ù

Ë)

¶∏°∞¡ ¶∞π¢π∫√ ™∆∞£ª√ ¢∂¡ ¶∏°∞¡ ¶∞π¢π∫√ ™∆∞£ª√

p<0,001

7

p<0,001

4,42

6,2

3,88 5,02

0

1

2

3

4

5

6

∂ÈÎfiÓ· 1. ∏ ̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿, ÙfiÛÔ Û ·È‰È¿ Ù˘ ∞’ fiÛÔ Î·È Û ·È‰È¿ Ù˘ ™∆’ ‰ËÌÔÙÈÎÔ‡, ‹Ù·Ó ÌÈÎÚfiÙÂÚË Û·ȉȿ Ô˘ ‹Á·Ó ·È‰ÈÎfi ÛÙ·ıÌfi ‹ ›¯·Ó ÌÂÁ·Ï‡ÙÂÚ· ·‰¤ÏÊÈ· (p<0,001).

143∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜

¶·È‰È·ÙÚÈ΋ 2007;70:141-145

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·143

Page 75: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

144 ∞. ∫·ÙÛ·Ê¿‰Ô˘ Î·È Û˘Ó.

Paediatriki 2007;70:141-145

·È‰È¿ ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È 59,35% ÁÈ· ÙÔ˘˜

ÌÂÙ·Ó¿ÛÙ˜ (p<0,001).

ø˜ ÚÔ˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ

ÂÌÊ¿ÓÈÛË ¤ÚËÙ· ˙ˆÛÙ‹Ú· (∂∑) ÛÙËÓ ·È‰È΋ ËÏÈ-

Λ·, ·Ó·Ï‡ÔÓÙ·˜ Ù· ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ Ì·˜, ‚Ú¤-

ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Èı·ÓfiÙËÙ·

ÂÌÊ¿ÓÈÛ˘ ∂∑ ÛÙ· ·È‰È¿ Ì ÌÈÎÚfiÙÂÚË ËÏÈΛ· Ófi-

ÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Î·È ÛÙ· ·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ.

∏ ̤ÛË ËÏÈΛ· ÚˆÙÔÏԛ̈͢ Û ·È‰È¿ Ì ∂∑

‹Ù·Ó 3,89 (sd±2,44) Î·È ÛÙ· ·È‰È¿ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈ-

Û·Ó ¤ÚËÙ· ˙ˆÛÙ‹Ú· 4,75 (sd±2,36) ¤ÙË, ·ÓÙ›ÛÙÔȯ·

(p<0,003). ∏ ÂıÓÈÎfiÙËÙ· ›Û˘ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ

ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË ¤ÚËÙ· ˙ˆÛÙ‹Ú·

·ÊÔ‡, ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó

¤ÚËÙ· ˙ˆÛÙ‹Ú·, ÙÔ 16% ‹Ù·Ó ÌÂÙ·Ó¿ÛÙ˜, ÂÓÒ

ÛÙÔÓ ÏËı˘ÛÌfi Ù˘ ÌÂϤÙ˘ Ì·˜ ·ÔÙÂÏÔ‡Û·Ó ÙÔ

5,43% (p<0,000).

™˘˙‹ÙËÛË

∏ ·ÓÂÌ¢ÏÔÁÈ¿ ·ÔÙÂÏ› ÌÈ· Û˘¯Ó‹ Î·È ‹È·,

ÌÂÙ·‰ÔÙÈ΋ ÓfiÛÔ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∆· ÙÂÏ¢-

Ù·›· ¯ÚfiÓÈ· ·Ú·ÙËÚÂ›Ù·È ‰ÈÂıÓÒ˜ ·‡ÍËÛË ÙˆÓ ÂÈ-

Û·ÁˆÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ȉȷ›ÙÂÚ· Û ·È‰È¿ <4

ÂÙÒÓ ÏfiÁˆ ÂÈÏÔÎÒÓ Ù˘ ÓfiÛÔ˘. ∞fi ÙÔ 1995

ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ ∏¶∞ Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·-

ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÛËÌ·ÓÙÈ΋

Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜, ·ÏÏ¿ Î·È Ù˘ ıÓËÙfiÙËÙ¿˜

Ù˘ (4). ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÌÂÙ¿

ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙȘ ∏¶∞,

ÌÂÈÒıËÎÂ Ë ÓÔÛËÏ›· ·fi ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘ η-

Ù¿ 50% Î·È 75% ÌÂÙ¿ Ù¤ÛÛÂÚ· Î·È Û ¤ÍÈ ¯ÚfiÓÈ·,

·ÓÙ›ÛÙÔȯ· (8), Î·È ‰È·ÈÛÙÒıËΠÌÂÁ¿ÏË Ì›ˆÛË

ÙˆÓ ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ÂÍfi‰ˆÓ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹

ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ (9). ∂›Û˘, Ù· ·È‰È¿

Ô˘ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙ› ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜

¤¯Ô˘Ó ÌÂȈ̤Ó˜ Èı·ÓfiÙËÙ˜ Ó· ÓÔÛ‹ÛÔ˘Ó ·ÚÁfi-

ÙÂÚ· ·fi ¤ÚËÙ· ˙ˆÛÙ‹Ú·, Û ۇÁÎÚÈÛË Ì ٷ ·È-

‰È¿ ÌÂ Ê˘ÛÈ΋ Ïԛ̈ÍË (10,11).

∆Ô ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Â›Ó·È ·ÛʷϤ˜. √È

·Ú·ÙËÚÔ‡ÌÂÓ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ›ӷÈ

Û¿ÓȘ. √È ÈÔ Û˘¯Ó¤˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ›-

Ó·È ÔÈ ÙÔÈΤ˜ ·ÓÙȉڿÛÂȘ Î·È Ë ‹È· ˘ÚÂÙÈ΋ Λ-

ÓËÛË (12,13). ¶ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛÂ Î·È ÛÙËÓ

∂ÏÏ¿‰· ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. √ ¤ÏÂÁ¯Ô˜

Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ÌÔÚ› Ó· ÂÈÙ¢¯ı› ÌfiÓÔ ÌÂ

˘„ËÏ‹ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ·ÓÂÏÏ‹ÓÈ·, ÂÓÒ ·Ó

‰ÂÓ ÂÈÙ¢¯ı› ˘„ËÏ‹ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ˘¿Ú-

¯ÂÈ Î›Ó‰˘ÓÔ˜ ÌÂÙ·ÙfiÈÛ˘ ÙÔ˘ ›ÓÔÛÔ˘ ÏËı˘ÛÌÔ‡

Û ¿ÙÔÌ· ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. ∫¿ÙÈ Ù¤ÙÔÈÔ ı· ›¯Â

ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ófi-

ÛÔ˘ Û ÂÊ‹‚Ô˘˜ Î·È ÂÓ‹ÏÈΘ, fiÔ˘ ÔÈ ÂÈÏÔΤ˜ ›-

Ó·È Û˘¯ÓfiÙÂÚ˜ Î·È ÛÔ‚·ÚfiÙÂÚ˜.

°È· ÙÔÓ Û¯Â‰È·ÛÌfi Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÛÙÚ·ÙËÁÈ-

΋˜, ·ÏÏ¿ Î·È ÁÈ· ÙË ÌÂϤÙË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙË-

Ù·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÁÓˆÚ›˙Ô˘ÌÂ

ÙËÓ ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Î·È ÙˆÓ ÂÈÏÔ-

ÎÒÓ ·˘Ù‹˜ ÛÙËÓ ∂ÏÏ¿‰·, ÚÈÓ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÔ‡

ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∏ ÌÂϤÙË ·˘Ù‹ ·ÔÙÂÏ› ÙÌ‹Ì· ÌÈ·˜

¶·ÓÂÏÏ‹ÓÈ·˜ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¤Ú¢ӷ˜, fiÔ˘ ·Ó·-

χıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙÔÓ ÓÔÌfi ∞ÙÙÈ΋˜. ∆Ô

ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ÂÎÏ‹ıËÛ·Ó ÔÈ ÁÔÓ›˜ Ó· Û˘-

ÌÏËÚÒÛÔ˘Ó ‹Ù·Ó ·Ïfi Û‡ÓÙÔÌÔ Î·È Û·Ê¤˜. ¶·ÚfiÏÔ

Ô˘ ÔÏÏ¿ Û¯ÔÏ›· ¤ÏÂÍ·Ó Ó· ÌË Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË

ÌÂϤÙË, Û˘Ó‹ıˆ˜ ÏfiÁˆ ·˘ÍË̤ÓÔ˘ ÊfiÚÙÔ˘ ÂÚÁ·Û›·˜,

ÙÔ ‰Â›ÁÌ· Â›Ó·È ÌÂÁ¿ÏÔ (>19.000 ·È‰È¿).

∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ

ÂÚ›Ô˘ ‰‡Ô ÛÙ· ÙÚ›· ·È‰È¿ Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙËÓ

ÚˆÙÔ‚¿ıÌÈ· Âη›‰Â˘ÛË ¤¯Ô˘Ó ‹‰Ë ÓÔÛ‹ÛÂÈ ·fi

·ÓÂÌ¢ÏÔÁÈ¿, fiˆ˜ Î·È Ù¤ÛÛÂÚ· ÛÙ· ¤ÓÙ ·È‰È¿

Ô˘ ÙÂÏÂÈÒÓÔ˘Ó ÙÔ ‰ËÌÔÙÈÎfi Û¯ÔÏ›Ô. ∏ ̤ÛË ËÏÈ-

Λ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Â›Ó·È Û‹ÌÂÚ· ÌÈÎÚfi-

ÙÂÚË Û ۯ¤ÛË Ì ·Ï·ÈfiÙÂÚ˜ ÂÏÏËÓÈΤ˜ ÂȉËÌÈÔ-

ÏÔÁÈΤ˜ ÌÂϤÙ˜ (14,15). ∏ ̤ÛË ËÏÈΛ· Ô˘ ÓÔÛÔ‡Ó

Ù· ·È‰È¿ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û‹ÌÂÚ·, Â›Ó·È Ù· 4,75

¤ÙË, ÂÓÒ ÚÈÓ ·fi 15 ¯ÚfiÓÈ· ˆ˜ ̤ÛË ËÏÈΛ· ÓfiÛË-

Û˘ Û˘ÓÔÏÈο, ·Ó·Ê¤ÚÔÓÙ·Ó Ù· 6,5 ¤ÙË (15-18). ∆·

·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ·˘Ù¿ ¿ÏÏˆÓ Â˘-

Úˆ·˚ÎÒÓ ¯ˆÚÒÓ fiÔ˘ ¤¯ÂÈ ÌÂȈı› ÛËÌ·ÓÙÈο Ô

̤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ÚˆÙÔÏԛ̈͢ ·fi ·ÓÂÌ¢ÏÔ-

ÁÈ¿, Èı·Ófiٷٷ ÏfiÁˆ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·È‰ÈÒÓ

Ô˘ ËÁ·›ÓÔ˘Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi (6,7,19-20). ∏

̤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ‰ÂÓ ‰È·Ê¤ÚÂÈ

ÛËÌ·ÓÙÈο ·fi ÙȘ ¿ÏϘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ (8).

∂Ȃ‚·ÈÒÓÔÓÙ·˜ Ù· ·Ú·¿Óˆ, ‚Ú¤ıËΠfiÙÈ Ë Ì¤ÛË

ËÏÈΛ· ÓfiÛËÛ˘ ÛÙ· ·È‰È¿ Ô˘ ‹Á·Ó Û ·È‰ÈÎfi

ÛÙ·ıÌfi Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ÛÂ

Û‡ÁÎÚÈÛË Ì ÂΛӷ Ô˘ ‰ÂÓ ‹Á·Ó. ÕÏÏÔÈ ·Ú¿ÁÔ-

ÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË Ì¤ÛË ËÏÈΛ· ÓfiÛËÛ˘ ·fi

·ÓÂÌ¢ÏÔÁÈ¿, Â›Ó·È Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ ÛÂ

Û¯¤ÛË Ì ٷ ·‰¤ÏÊÈ· ÙÔ˘. ∏ ËÏÈΛ· ÓfiÛËÛ˘ ·fi

·ÓÂÌ¢ÏÔÁÈ¿ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ·

·‰¤ÏÊÈ· Â›Ó·È ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·˘Ù‹˜ ÙˆÓ Úˆ-

ÙfiÙÔÎˆÓ ·È‰ÈÒÓ, ÂÓÒ ÌÂÈÒÓÂÙ·È ÎÈ ¿ÏÏÔ ÛÙ· ·È‰È¿

Ô˘ ‹Á·Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi Î·È ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂ-

Ú· ·‰¤ÏÊÈ·, ÚÔÊ·ÓÒ˜ ÁÈ·Ù› ¤Ú¯ÔÓÙ·È Û ·ʋ ÌÂ

¿ÏÏ· ·È‰È¿ ·fi ÌÈÎÚ‹ ËÏÈΛ· Î·È ·˘Í¿ÓÔÓÙ·È ÔÈ È-

ı·ÓfiÙËÙ˜ Ó· ÂÎÙÂıÔ‡Ó ÛÙÔÓ Èfi Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜.

∂›Û˘, Ù· ∂ÏÏËÓfiÔ˘Ï· ÓÔÛÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ Ô-

ÛÔÛÙfi Î·È Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· ·fi Ù· ·È‰È¿ ÌÂÙ·-

Ó·ÛÙÒÓ, Èı·Ófiٷٷ ÁÈ·Ù› ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·fi Ù·

·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ ËÁ·›ÓÔ˘Ó Û ·È‰ÈÎfi ÛÙ·ıÌfi.

∆¤ÏÔ˜, fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›·

(1,3), ‚ڋηÌ fiÙÈ ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ∂∑ ηٿ

ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ¤¯Ô˘Ó ÓÔÛ‹ÛÂÈ ·fi

·ÓÂÌ¢ÏÔÁÈ¿ Û ÌÈÎÚ‹ ËÏÈΛ·. ¶·È‰È¿ ÌÂÙ·Ó·ÛÙÒÓ,

·Ó Î·È ÓfiÛËÛ·Ó ·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ÌÂÁ·Ï‡ÙÂÚË

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ËÏÈΛ· Û ۯ¤ÛË Ì ٷ ∂ÏÏËÓfiÔ˘Ï·, ÂÌÊ¿ÓÈÛ·Ó ∂∑Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi. ∆Ô Â‡ÚËÌ· ·˘Ùfi ı· ÌÔ-ÚÔ‡Û ıˆÚËÙÈο Ó· ÂÍËÁËı› ·fi ·˘ÍË̤ÓÔ ÛÙÚÂ˜ÙˆÓ ·È‰ÈÒÓ ÌÂÙ·Ó·ÛÙÒÓ, ·ÏÏ¿ ¯Ú‹˙ÂÈ ÂȂ‚·›ˆ-Û˘ ·fi ¿ÏϘ ÌÂϤÙ˜.

™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ∂ÏÏËÓfiÔ˘Ï· Û‹ÌÂÚ·, ÓÔ-ÛÔ‡Ó ·fi ·ÓÂÌ¢ÏÔÁÈ¿ ηٿ ÙËÓ ÚÒÙË ·È‰È΋ËÏÈΛ· (<5 ÂÙÒÓ), ÔfiÙÂ Î·È ÔÈ Èı·ÓfiÙËÙ˜ ÂÈ-ÏÔÎÒÓ Â›Ó·È ·˘ÍË̤Ó˜ (4,21,22), ÁÂÁÔÓfi˜ Ô˘Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·-ÛÌÔ‡ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. ™‡Ìʈӷ Ì ٷ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ıˆÚԇ̠fiÙÈ ÔÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Ú¤ÂÈ Ó·Á›ÓÂÙ·È ¤ÁηÈÚ· ηٿ ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ ˙ˆ‹˜, ÚÈÓÙËÓ ¤Ó·ÚÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÛÙ·ıÌÔ‡, fiˆ˜ Û˘ÓÈÛÙ¿-Ù·È ÛÙȘ ∏¶∞ Î·È Û ÔÏϤ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜. ªÂ‚¿ÛË Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ Î·È ÌÂÙ¿ ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓÛÙÔȯ›ˆÓ ·fi ÙËÓ ˘fiÏÔÈË ∂ÏÏ¿‰·, ı· Ú¤ÂÈ Ó·˘ÔÏÔÁÈÛÙ› Ô ÏfiÁÔ˜ ÙÔ˘ ÎfiÛÙÔ˘˜-ÔʤÏÔ˘˜ ·fiÙËÓ ÂÊ·ÚÌÔÁ‹ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ó·ÓÙÈ Ù˘·ÓÂÌ¢ÏÔÁÈ¿˜ ÛÙË ¯ÒÚ· Ì·˜.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Ann M. Arvin. Varicella Zoster Virus. Textbook Nelson.15th ed. 2000; p. 1413-1418.

2. Patel RA, Binns HJ, Shulman ST. Reduction in pediatrichospitalization for varicella-related invasive group Astreptococcal infection in the varicella vaccine era. J Pedi-atr 2004;144:68-74.

3. Weller T. Varicella and herpes zoster: a perspective andoverview. J Infect Dis 1992;166 (1 Suppl):S1-S6.

4. Choo PW, Donahue JG, Manson JE, Platt R. The epi-demiology of varicella and its complications. J Infect Dis1995;172:706-712.

5. Centers for Disease Control and Prevention. Prevention ofvaricella: recommendations of the Advisory Committeeon Immunization Practices (ACIP). MMWR RecommRep 1996;45:1-36

6. Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R,Brownell M, et al. Epidemiology of varicella zoster virusinfection in Canada and the United Kingdom. EpidemiolInfect 2001;127:305-314.

7. ¶··Â˘·ÁÁ¤ÏÔ˘ µ, ™˘ÚÈÔÔ‡ÏÔ˘ µ, ªÔÛÙÚÔ‡ °,°ÎÈ˙¿Ú˘ µ, £ÂÔ‰ˆÚ›‰Ô˘ ª. ∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË·ÓÔÛ›·˜ ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ.π·ÙÚÈ΋ 2001;79:544-546.

8. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality

due to varicella after implementation of varicella vaccina-tion in the United States. N Engl J Med 2005;352:450-458.

9. Lieu TA, Cochi SL, Black SB, Halloran ME, Shinefield HR,Holmes SJ, et al. Cost-effectiveness of a routine varicellavaccination program for US children. JAMA 1994;271:375-381.

10. Seward JF, Watson BM, Peterson CL, Mascola L, PelosiJW, Zhang JX, et al. Varicella disease after introduction ofvaricella vaccine in the United States 1995-2000. JAMA2002;287:606-611.

11. Goldman GS. Universal varicella vaccination: efficacytrends and effect on herpes zoster. Int J Toxicol 2005;24:205-213.

12. American Academy of Pediatrics. Committee on Infec-tious Diseases. Varicella vaccine update. Pediatrics2000;105:136-141.

13. Wise RP, Salive ME, Braun MM, Mootrey GT, Seward JF,Rider LG, et al. Postlicensure safety surveillance for vari-cella vaccine. JAMA 2000; 284:1271-1279.

14. à ¢ÚfiÛÔ˜. ∏ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ Û ·È‰È¿ Ì·ÓÂÌ¢ÏÔÁÈ¿. ¶·È‰È·ÙÚÈ΋ 1998;51:236-240.

15. °∫ §·Áfi˜. ∂ÈÏÔΤ˜ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂÙ¿·fi ·ÓÂÌ¢ÏÔÁÈ¿. ∂ÁΤʷÏÔ˜ 1988;25:182-185.

16. µ·˙·›Ô˘ £, µ·ÛÈÏ¿ÎÔ˘ µ, ¢ÂÏ‹˜ ¢, ª·ÚÙÛfiη˜ Ã,¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆. ∂Ï¿ÙÙˆÛË Ù˘ ËÏÈΛ·˜ ÓfiÛËÛ˘·fi ·ÓÂÌ¢ÏÔÁÈ¿ Û ·È‰ÈÎfi ÏËı˘ÛÌfi, 1989-1997. 38Ô¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 2000. Û. 220.

17. ¶··Â˘·ÁÁ¤ÏÔ˘ µ, ∫·ÙÛ·Ê¿‰Ô˘ ∞, §È¿Ë °, ¶ÈÙÛÔ‡ÏË∂, ºÂÚÂÓÙ›ÓÔ˜ °, ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ∂ȉËÌÈÔÏÔÁ›··ÓÂÌ¢ÏÔÁÈ¿˜ ÛÂ Ù˘¯·›Ô ‰Â›ÁÌ· ·È‰ÈÒÓ. 42Ô¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 2004.

18. ∫·‚·ÏÈÒÙ˘ π, ∫·ÓÛÔ˘˙›‰Ô˘ ∞, ∫·Ú·Ì·ÍfiÁÏÔ˘ ¢,∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘ º, ¶ÂÙÚ›‰Ô˘ ™, ∆Û·ÁηÚÔÔ‡ÏÔ˘ ∏,÷Ù˙Ë·ÁfiÚÔ˘ ∂. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ÈÔ‡ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Û ·È‰È¿ Ù˘ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜.38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 2000. Û. 139.

19. Davis MM, Patel MS, Gebremariam A. Decline in varicel-la-related hospitalizations and expenditures for childrenand adults after introduction of varicella vaccine in theUnited States. Pediatrics 2004;114:786-792.

20. Rentier B, Gershon AA. European Working Group onVaricella. Consensus: varicella vaccination of healthy chil-dren - a challenge for Europe. Pediatr Infect Dis J 2004;23:379-389.

21. ∂ ∞ÏÂÍfiÔ˘ÏÔ˜, ∞ ™·Ï·‚Ô‡Ú·, µ ¶··Â˘·ÁÁ¤ÏÔ˘, °ªÔÛÙÚÔ‡, ∂ ∫ˆÛÙ·‰‹Ì·, ª £ÂÔ‰ˆÚ›‰Ô˘. ∂ÌÂÈÚ›· ·fiÙË ÓÔÛËÏ›· ·È‰ÈÒÓ Ì ·ÓÂÌ¢ÏÔÁÈ¿ (1993-1997).¶·È‰È·ÙÚÈ΋ 1999;62:499-502.

22. Kavaliotis J, Petridou S, Karabaxoglou D. How reliable isthe history of chickenpox? Varicella serology among chil-dren up to 14 years of age. Int J Infect Dis 2003;7:274-277.

145∂ȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜

¶·È‰È·ÙÚÈ΋ 2007;70:141-145

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·145

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146 CASE REPORT ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2007;70:146-151

Introduction

Homocystinuria (HCU) due to cystathionine

‚-synthase deficiency (C‚Sd) (OMIM#+236200)

is a potentially lethal autosomal recessive defect

of methionine (Me) metabolism resulting in the

accumulation of homocysteine (Hcy) and Me in

body fluids (Figure 1) (1). It is considered the

second most common treatable inherited disor-

der of amino acid metabolism (2). The world-

wide incidence of C‚Sd based on data from

newborn screening is ~1: 344.000 live births but

the true incidence is estimated to be much high-

er (3,4). The most frequent clinical manifesta-

tions of C‚Sd affect four organ systems: the eye

(ectopia lentis), the skeleton (dolichostenomelia,

osteoporosis), the central nervous system (psy-

chiatric problems, mental retardation) and the

vascular system, with thromboembolic events

being the commonest cause of death (2,3). The

age of presentation and extent to which affected

patients manifest these abnormalities varies

widely (2). The main target of treatment is the

high Hcy levels. Two clinical forms of the dis-

ease have been delineated on the basis of respon-

siveness to pharmacological doses of vitamin

B6 (pyridoxine), a precursor of pyridoxal phos-

phate, the coenzyme for C‚S. About 50% of pa-

tients respond to B6 therapy, whereas 50% do

not, requiring additional treatment strategies,

including a low Me, cystine-supplemented diet

and/or betaine (5,6). Two patients with C‚Sd

are described: a B6-responsive boy and a B6-non-

responsive girl, in order to highlight the clinical

heterogeneity of this disorder, the crucial impor-

tance of early diagnosis and treatment, and the

difficulties encountered in the treatment of B6-

non-responsive patients.

Case reports

Patient 1

A 9-year-old boy, offspring of unrelated par-

ents, was admitted to the pediatric ICU of our

hospital in a comatose state. On admission, brain

magnetic resonance imaging (MRI) revealed

thrombosis of the superior sagittal sinus (Figure

2) and a regimen of anticoagulants, anticonvul-

sants and antimicrobial agents was immediately

initiated. On day six of hospitalization the pa-

tient was transferred to our pediatric department

for further evaluation and treatment. On day 11

Homocystinuria due to cystathionine ‚-synthase deficiency:

two sides to the same coin

P. Augoustides-Savvopoulou1, H. Ioannou1, N. Kozeis2, A. Karagiannidou3, M. Athanasiou-Metaxa1

Abstract: Cystathionine ‚-synthase (C‚S) deficiency (OMIM#236200) is a rare, autosomal recessivedefect of methionine metabolism, considered to be the most frequent cause of homocystinuria. Clinicalfeatures include severe myopia, ectopia lentis, marfanoid skeletal abnormalities with osteoporosis, mentalretardation and thromboembolism which is the most frequent cause of death. The mainstay of therapy ispyridoxine, the precursor of the coenzyme for C‚S, but only 50% of patients respond. Two patients withC‚S deficiency are described, a B6-responsive boy and a B6-non-responsive girl, with the objective ofhighlighting: 1) the clinical heterogeneity of this disorder, 2) the crucial importance of early diagnosis andtreatment and 3) the difficulties in management of B6 non-responsive patients. Patient 1 was admitted atthe age of 10 because of a cerebrovascular stroke. His history included severe progressive myopia from ayoung age and ectopia lentis. Patient 2, a nine year old girl with pseudophakia and a clinical diagnosis ofMarfan’s syndrome, presented with severe behavioural symptoms. In both patients, a metabolic workuprevealed high plasma levels of total homocysteine and methionine and C‚S deficiency was confirmed byenzyme assay. Pyridoxine administration resulted in a dramatic decrease of homocysteine and methioninelevels in patient 1 but not in patient 2 necessitating alternative therapeutic measures. It is concluded thatC‚S deficiency is a clinically heterogenous disorder which if untreated can lead to life-threateningconsequences. Plasma total homocysteine should be a first-line test in patients with early onset of severemyopia, ectopia lentis, skeletal changes reminiscent of Marfan’s syndrome, thromboembolism, mentalretardation with psychiatric symptoms, bearing in mind that the complete clinical spectrum may notalways be apparent.

Key words: C‚S deficiency, homocystinuria, ectopia lentis, marfanoid, thromboembolism, pyridoxine.

1 University 1st PediatricDepartment, HippocrationGeneral Hospital ofThessaloniki, Greece

2 OphthalmologyDepartment, HippocrationGeneral Hospital ofThessaloniki, Greece

3 University 3rd PediatricDepartment, HippocrationGeneral Hospital ofThessaloniki, Greece

Correspondence:

Persephone [email protected] 1st PediatricDepartment-Metabolic LabHippocration GeneralHospital of Thessaloniki49, Constantinoupoleos St.Thessaloniki 546 42, Greece

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he developed thrombosis of the right popliteal vein,

whereupon his anticoagulant regimen was intensified.

Physical examination revealed a tall, obese male with

weight and height above the 97th percentile, mild genu

valgum, marginal disproportion of limbs to trunk, and

long digits (Figures 3, 4). Opthalmological examina-

tion revealed bilateral ectopia lentis with total subluxa-

tion of the left lens into the anterior chamber. Ac-

cording to his history myopia (3.5 diopters) was first

diagnosed at age six when he entered primary school.

Thereafter there was a rapid increase in myopia to 6.5

diopters, iridodonesis and phakodonesis was observed

and 2.5 years later total subluxation of the lens oc-

curred. From the family history his father had been

treated surgically for thrombophlebitis in a lower limb

two years previously.

A coagulation screen for thrombophilic factors

(FV Leiden, FII prothrombin, factors VII, VIII, IX,

Protein C, Protein S, anti-cardiolipin) was unremark-

able but measurement of plasma total homocysteine

[(tHcy) (FPIA IMX, Abbott Labs)] revealed a highly

increased level: 256 Ìmol/L (reference range 3-10).

Quantitative analysis of deproteinized plasma amino

acids (post-column cation-exchange HPLC) showed

increased unbound (free) homocystine (fHcy) (101

Ìmol/l, ref. range 0-5) and methionine (181 Ìmol/l,

ref. range 9-36). Investigation of cobalamin and folate

status of the patient revealed low levels of vitamin B12

(195 pg/ml, ref. range 223-1132) and folic acid (2.2

ng/ml, ref. range 2.8-16.9). He was shown to be ho-

mozygous (677TT) for the 677C→T polymorphism

in the gene that encodes 5, 10-methylenetetrahydro-

folate reductase (MTHFR).

The clinical features of this patient in combination

with the very high plasma tHcy and methionine levels

were conclusive for C‚Sd. Vitamin supplementation

with a B1, B6, B12 complex (Trivimine 125 mg+125 mg

+0.125 mg X 2/d) as well as folic acid (5 mg/d) was

immediately initiated. Trivimine was initially used in

spite of the lack of indication for B1 because it was the

only product commercially available. C‚Sd was fur-

ther confirmed when assay of the activity of CbS in

cultured skin fibroblasts revealed a very low value:

0.05 nmol cystathionine/ h/mg protein (control

range: 2.3-18.2, homozygote range: 0.0-0.19). A mol-

ecular screen for the common B6-responsive C‚S

147

¶·È‰È·ÙÚÈ΋ 2007;70:146-151

(2) Folic acid (3) Diet

Tetrahydrofolate

5,10-Methylene-tetrahydrofolate

Methionine synthase (2) B12

5-Methyl-tetrahydrofolate

MTHFR deficiency

+

+

+

Methionine

S-Adenosyl -methionine

N,N Dimethyl glycine

Betaine homocysteine

methyltransferase

Betaine (4)Homocysteine

S-Adenosyl homocysteine

(1) Pyridoxine(B6)

Cystathionine beta-synthase

Cystathionine

(3) Cysteine

Figure 1. Metabolic pathway of methionine and potential sites oftherapeutic intervention in C‚S deficiency.

The transsulfuration pathway is the chief route of disposal ofMe, converting the sulfur atom of Me into the sulfur atom ofcysteine. Two additional metabolic sequences are thetransmethylation reactions whereby 1) the methyl group of Me isultimately used in the formation of many methylated compoundsand 2) the reformation of Me by methylation of Hcy.Remethylation of Hcy is dependent on B12 (active form,methylcobalamin) and folic acid (active form, MTFHR), and itstransmethylation to cystathionine is dependent on C‚S coenzymeB6 (active form 5 pyridoxyl phosphate).

The level of C‚Sd is shown by X. Potential sites of therapeuticintervention are shown by (1) B6, (2) B12 & folic acid, which increaseremethylation of Hcy to Me; (3) low-protein, low-Me, cystinesupplemented diet; (4 ) betaine, a donor of methyl groups thatincreases remethylation of Hcy to Me.

Figure 2. Brain MRI scan of patient 1 showing thrombosis of thesuperior sagittal sinus.

Figure 3. Photographs showing long digits in hand (3a) and feet(3b) of patient 1.

3a 3b

Homocystinuria due to C‚S deficiency

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mutation T833C (I278T) was negative. After 20 con-

secutive days of treatment with the vitamin supple-

ments, striking decreases of tHcy to 32 Ìmol/l, fHcy to

0 Ìmol/l, and Me to 30 Ìmol/l were found. Family in-

vestigation revealed normal plasma tHcy and Me lev-

els in the patient’s sibling whereas both his father and

mother had increased tHcy (49 Ìmol/l and 21 Ìmol/l

respectively) with normal levels of Me, B12 and folic

acid. Plasma tHcy values of his parents normalized 14

days after initiation of 5 mg/d folic acid therapy.

In view of the diagnosis, he was assessed for osteo-

porosis by a DEXA bone scan, which was normal. In

addition, psychological assessment did not reveal

signs of mental retardation or psychiatric distur-

bances. Re-evaluation of the patient before discharge

showed major improvement in brain MRI imaging

and adequate flow of the popliteal vein. To date (2

years after diagnosis), the patient has not had anoth-

er vascular episode and his plasma tHcy levels are

within the normal range (~10-15 Ìmol/l). Anticoag-

ulant (warfarin) and anticonvulsant (phenytoin)

therapy was discontinued after one year, but supple-

mentation with vitamins B6, B12, and folic acid is be-

ing continued as a life-long regimen with regular

monitoring of tHcy levels. The follow-up protocol for

this patient includes opthalmological examination

every 6 months and yearly monitoring of bone-densi-

ty (DEXA scan) and his vascular system (triplex Dop-

pler scan).

Patient 2

This 9-year-old girl, who had been clinically diag-

nosed as having Marfan’s syndrome at age 8, was re-

ferred for investigation because of learning problems

and severe behavioral symptoms (negative attitude,

frequent outbursts of crying). Physical examination

revealed a body weight and height above the 75th and

97th percentile respectively. Her limbs were dispro-

portionately long in relation to her trunk

(dolichostenomelia). She had pes cavus, genu valgum,

arachnodactyly and a narrow-face with a high-arched

palate (Figures 5, 6, 7) Cardiac ultrasonography was

normal. She had a history of very severe myopia (10

diopters) and astigmatism (1.5 diopters) from age 6.

By age 8, myopia had increased to 18 diopters and

astigmatism had doubled. At age 8 years, 5 months

she had manifested right lens subluxation for which

she was surgically treated with a lens implant. Three

months later, because of the resulting difference in re-

fractive error (anisometropia) the lens of the left eye

was also replaced. Psychological assessment con-

firmed the cognitive deficits and emotional lability

(affective inappropriateness). Her family history was

unremarkable.

In view of the clinical combination of tall stature

with marfanoid skeletal dysmorphy and ectopia lentis,

the initial aim of the diagnostic workup was to ascer-

tain if she had Marfan’s syndrome or C‚Sd. Amino

acid analysis revealed very high plasma levels of tHcy

(268 Ìmol/l), fHcy (93 Ìmol/l) and Me (630 Ìmol/l),

indicating CBS deficiency. This was confirmed by the

fact that CbS activity in cultured skin fibroblasts was

not detected (0.0 nmol cystathionine/ h/mg protein).

Other abnormal laboratory results were the reduced

serum levels of both vitamin B12 (190 pg/ml) and folic

acid. Results of routine haematology and biochem-

istry analyses were unremarkable.

A trial of B6 therapy (250 g/d) was initiated. Ami-

no acid analysis performed 20 days later showed only

slight reduction of the tHcy level to 260 Ìmol/l,

whereas the Me level was essentially unchanged. Con-

sequently, over a period of 2 weeks B6 dosage was

gradually increased to 500 mg/day but, after two

weeks plasma levels of tHcy and Me remained elevat-

ed (535 and 248 Ìmol/l respectively), indicating that

the patient was not responding to pyridoxine. In view

of these findings she was placed on a low protein, Me-

restricted diet with a Me-free amino acid supplement

148 P. Augoustides-Savvopoulou et al.

Paediatriki 2007;70:146-151

Figure 5. Photograph of: a) feet of patient 2 depicting long digitsand pes cavum and b) hands with long digits (arachnodactyly).

5a 5b

Figures 4a, 4b. Photographs of patient 1 showing genu valgum andmild disproportion of limbs to trunk

4a 4b

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rich in cystine and other essential amino acids (Hom-

2 Secunda, SHS). In addition, betaine (Cystadane,

Orphan Europe) was administered in a dosage of 4

g/day. Subsequent monitoring of amino acids re-

vealed a significant reduction in plasma tHcy to 156

Ìmol/l, but also a significant increase in Me to 1238

Ìmol/l. In view of the potential risk of cerebral edema

due to severe hypermethioninemia, the betaine

dosage was reduced, and methionine restriction in-

tensified. With frequent monitoring of this regimen

plasma tHcy levels below 100 Ìmol/l (~90 Ìmol/l)

and Me levels ~600 Ìmol/l were achieved. Assessment

of bone-density (DXA scan) has revealed incipient

osteoporosis of the spinal vertebrae. A vascular screen

was negative (normal Triplex Doppler test), and

brain MRI scans are essentially normal. Monitoring

of these parameters is carried out on a yearly basis.

Discussion

Despite the presence of major clinical features ofC‚Sd in both our patients, they remained undiag-nosed until late childhood, with severe and nearly fa-tal consequences. As shown in Table 1, these two pa-tients had common features, but also significant dif-ferences that illustrate the clinical heterogeneity ofC‚Sd. The striking clinical clues common to bothwere the opthalmological findings of severe myopiafrom a young age and ectopia lentis (Figure 8). Ectopialentis occurs in about 85% of C‚S-deficient patientsbut often a systemic disorder is not suspected, or thepatients are misdiagnosed as having Marfan’s syn-drome (2,7,8). Indeed, such a misdiagnosis was madefor both our patients. Marfan’s syndrome is a rela-tively common (~1:5-10000 live births), but as yetuntreatable, autosomal dominant disorder of connec-tive tissue in which lens dislocation also occurs. How-ever, such patients do not have the increased levels ofplasma tHcy and Me characteristic of C‚Sd (2,3,8).The lenticular origin of myopia in C‚S deficient pa-tients is not always recognized. Clues for lenticularmyopia are abnormally rapid progression of myopia,severe myopia in children and progressive myopia inadults (7). Nevertheless, it should be stressed that anormal ophthalmological examination at any agedoes not exclude the diagnosis of C‚Sd (2,9,10). Fur-ther similarities between patients with Marfan’s syn-drome and those with C‚Sd are that both typicallyhave increased limb length and genu valgum. Patient2 was marfanoid in structure, but she had osteoporo-sis and signs of involvement of the central nervoussystem which are distinguishing features of C‚Sd (2).In accord with the findings in our patients, spinal os-teoporosis and other skeletal abnormalities generallyoccur earlier in pyridoxine non-responsive patientsthan in those responsive to pyridoxine (2).

Thromboembolism, affecting both large and smallarteries and veins, is the most striking cause of mor-bidity and mortality in C‚Sd. Sagittal sinus thrombo-sis was the presenting feature in patient 1. Because the

149Homocystinuria due to C‚S deficiency

¶·È‰È·ÙÚÈ΋ 2007;70:146-151

Table 1. Comparison of clinical features of patient 1 andpatient 2

Patient 1 Patient 2

Severe myopia + +++Ectopia lentis + +Marfanoid habitus + +++Osteoporosis - +Vascular events + -Mental retardation - +B6 response + -Age at diagnosis 10 y 9 y

Figure 6. Photograph depicting high palate of patient 2.

Figures 7a, 7b. Marfanoid habitus of patient 2 (dolichostenomelia,genu valgum, pes cavus) is depicted.

7a 7b

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150 P. Augoustides-Savvopoulou et al.

Paediatriki 2007;70:146-151

laboratory workup for thrombotic events included

measurement of tHcy in plasma, the diagnosis of

C‚Sd was made. This life-threatening complication

in our B6-responsive patient is in agreement with ob-

servations that, although such responsive patients

tend to have less severe clinical manifestations than

do B6-non-responsive patients, the probability of un-

treated patients of both types having vascular events

is about the same (2). Homozygosity (677TT) for the

MTFHR polymorphism in our patient together with

low folic acid and B12 levels may have been an addi-

tional contributory factor (11).

Mental retardation is the most frequent central

nervous system abnormality and, together with psy-

chiatric symptoms, may be the first recognizable sign

of C‚Sd (9). It is of note that the cognitive deficits

and psychiatric problems of patient 2 were the main

reasons for which her parents sought help.

The prognosis for an individual diagnosed with

C‚Sd, if untreated, is one of progressive morbidity and

mortality, as documented by Mudd et al in the largest

to-date survey of C‚S-deficient patients (2). Treatment

of this disorder usually halts progression of skeletal,

neurological and vascular problems, but advanced

opthalmological problems are more difficult to control

(6). In a multicenter study involving 158 patients with

2822 patient-years of treatment, homocysteine-lower-

ing treatment was shown to reduce the vascular risk sig-

nificantly, despite imperfect biochemical control (5).

The main target of treatment in CbSd is to control or

eliminate the severe hyperhomocystinemia characteris-

tic of this disorder, the ultimate goal being to prevent

the life-endangering thromboembolic events and to

prevent further escalation of complications already

present. The basic treatment strategy is: 1) to increase,

where possible, the residual enzyme activity by admin-

istration of the coenzyme precursor, pyridoxine; 2) to

decrease the load on the affected pathway with a low

protein, low Me diet; 3) to supplement deficient prod-

ucts (cystine); 4) and/or to use alternative pathways to

remove toxic substrates or their metabolites (betaine)

(Figure 1) (6). As evidenced by the dramatic response

in patient 1, this is achieved relatively easily in the pyri-

doxine-responsive patient by the administration of

pharmacological doses of B6, together with folic acid 5

mg/d and B12. Patients not given folic acid while on

pyridoxine therapy become folate-depleted, hampering

the biochemical response in a potentially B6-responsive

patient (6,12). All newly diagnosed patients should be

given a pyridoxine trial while remaining on a normal

diet. Biochemically, vitamin responsiveness is indicated

by decreasing Hcy and Me levels. If tHcy and Me levels

remain persistently elevated while on high (500 mg/d)

pyridoxine for several weeks, the patient is deemed bio-

chemically pyridoxine-non-responsive and is com-

menced on a Me restricted diet. Doses of pyridoxine re-

quired for a response vary markedly among pyridoxine

responders and have been associated with different

mutations within the CbS gene (13). Rarely, very high

(2-6 g/d) doses of B6 have caused reversible peripheral

neuropathy but, as yet, this has been seen only in non-

C‚S-deficient patients (12). Treatment of the B6-non-

responsive patient is a challenge because many patients

will not comply with the unpalatable, low protein, Me-

restricted, cystine-supplemented diet which, in addi-

tion, requires frequent biochemical monitoring. Be-

taine may be useful in pyridoxine-non-responsive pa-

tients who will not tolerate Me restriction, or as an ad-

junct to such a diet. This compound acts as a methyl

donor, increasing the rate of remethylation of Hcy to

Me by betaine-homocysteine methyltransferase. Until

recently it was believed that the resultant hyperme-

thioninaemia did not influence the pathophysiology of

the disease. However there has been more than one re-

port of progressive cerebral edema associated with very

high levels of Me (>1000 Ìmol/l) indicating that regu-

lar biochemical monitoring of Me levels should be per-

formed in B6-non-responsive patients on betaine ther-

apy (14,15). The very high levels of Me in patient 2 were

a cause for concern, necessitating intensification of the

low Me diet and regulation of the betaine dose with

concomitant titration of Me.

The biochemical hallmark of C‚Sd is hyperhomo-

cystinaemia in combination with hypermethioni-

naemia. It should be stressed that hypermethionine-

mia is not completely obligatory in C‚Sd (absent in

about 6% of cases) and isolated hyperhomocysti-

naemia does not confirm C‚Sd (2). Pitfalls in the

measurements of Hcy levels can be avoided if blood

samples are from fasting patients and promptly

Figure 8. Photograph of eye of patient with C‚Sd depicting totalsubluxation of the lens (from the Atlas of International Council ofOphthalmology).

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151Homocystinuria due to C‚S deficiency

¶·È‰È·ÙÚÈ΋ 2007;70:146-151

processed. Diagnosis is confirmed if C‚S enzyme ac-tivity in cultured skin fibroblasts is non-detectable orup to 15% of mean control levels. In addition to theabove tests, C‚S mutational screening is another op-tion. There are now at least 139 known disease-caus-ing C‚S mutations. (13) The two most common arethe G307S, also known as the “Celtic” mutation, andthe 833 T>C (I278T) mutation. The former is associ-ated with the more severe pyridoxine-non-responsivephenotype whereas the latter is associated with themilder pyridoxine-responsive phenotype. I278T wasnot present in our B6-responsive patient. Althoughmutation analysis is a tool for better understandingthe variability of the clinical phenotype, the existenceof a large number of very rare, often private, muta-tions limits the usefulness of this approach in routinediagnosis. Prenatal diagnosis of C‚Sd is available ei-ther by metabolite or enzyme analysis in amniotic flu-id/cells or mutation analysis in chorionic villi (16).Regarding the detection of C‚Sd by newborn screen-ing by searching for hypermethioninemia, a cause ofconcern is the high number of false-negative results.Pyridoxine-responsive disease is often missed by suchnewborn screening because increased Me levels arenot prominent in these newborns. Newborn screen-ing for common mutations has been suggested bysome workers (4).

In conclusion, C‚Sd is a potentially treatable con-dition, especially if detected and treated early. Un-treated, this disorder can lead to life-threateningcomplications. Its clinical heterogeneity necessitatesincreased awareness of the variety of clinical presen-tations. The recognition of myopia in patients withthromboembolism, skeletal abnormalities or centralnervous system complications, aptly coined by Cruys-berg et al (7) as “myopia plus”, should alert physi-cians to the possibility of C‚Sd. Plasma total homo-cysteine should be a first-line test in patients with ear-ly onset of severe myopia, ectopia lentis, skeletalchanges reminiscent of Marfan’s syndrome, throm-boembolism, mental retardation with psychiatricsymptoms, bearing in mind that these features maybe isolated or in combination.

Accurate diagnosis of a genetic disease has impor-tant consequences for the patient and his family be-cause of the implications for appropriate therapy andgenetic counseling. In the event of diagnosis, high-risk family members should be investigated as well.

Acknowledgements

We express our gratitude to Dr S Harvey Mudd for re-viewing the manuscript and for his advice as regards the man-agement of our patients and to Dr Leo Kluijtmans for his helpwith the enzyme and molecular assays.

References

1. Mudd SH, Finkelstein JD, Irreverre F, Laster L. Homo-cystinuria: an enzymatic defect. Science 1964;143:1443-1445.

2. Mudd SH, Skovby F, Levy HL, Pettigrew KD, Wilcken B,Pyeritz RE, et al. The natural history of homocystinuriadue to cystathionine beta-synthase deficiency. Am J HumGenet 1985;37:1-31

3. Mudd SH, Levy HL, Kraus JP. Disorders of transsulfura-tion. In: Scriver CR, Beaudet AL, Sly WS, Valle D, ChildsB, Kinzler KW, editors. The Metabolic and Molecular Bas-es of Inherited Disease, 8th ed. New York: McGraw-Hill;2001. p. 2007-2056.

4. Refsum H, Fredriksen A, Meyer K, Ueland PM, Kase BF.Birth prevalence of homocystinuria. J Pediatr 2004;144:830-832.

5. Yap S, Boers GH, Wilcken B, Wilcken DE, Brenton DP,Lee PJ, et al. Vascular outcome in patients with homo-cystinuria due to cystathionine beta-synthase deficiencytreated chronically: a multicenter observational study. Ar-terioscler Thromb Vasc Biol 2001;21:2080-2085.

6. Walter JH, Wraith JE, White FJ, Bridge C, Till J. Strategiesfor the treatment of cystathionine beta-synthase deficien-cy: the experience of the Willink Biochemical GeneticsUnit over the past 30 years. Eur J Pediatr 1998;157 (Suppl2):S71-S76.

7. Cruysberg JR, Boers GH, Trijbels JM, Deutman AF. Delayin diagnosis of homocystinuria: retrospective study ofconsecutive patients. BMJ 1996;313:1037-1040.

8. Boers GH, Polder TW, Cruysberg JR, SchoonderwaldtHC, Peetoom JJ, van Ruyven TW, et al. Homocystinuriaversus Marfan’s syndrome: the therapeutic relevance ofthe differential diagnosis. Neth J Med 1984;27:206-212.

9. Li SC, Stewart PM. Homocystinuria and psychiatric disor-der: a case report. Pathology 1999;31:221-224.

10. Lu CY, Hou JW, Wang PJ, Chiu HH, Wang TR. Homo-cystinuria presenting as fatal common carotid artery oc-clusion. Pediatr Neurol 1996;15:159-162.

11. Kluijtmans LA, Boers GH, Verbruggen B, Trijbels JM, No-vaãkovaã IR, Blom HJ. Homozygous cystathionine beta-synthase deficiency, combined with factor V Leiden orthermolabile methylenetetrahydrofolate reductase in therisk of venous thrombosis. Blood 1998;91:2015-2018.

12. Boers GH, Yap S, Naughten E, Wilcken B. The treatmentof high homocysteine concentrations in homocystinuria:Biochemical control in patients and their vascular out-come. In: K. Robinson, ed. Homocysteine and vasculardisease. Dordrecht, The Netherlands: Kluwer AcademicPublishers; 2000. p. 349-411.

13. Krauslab Homepage. [Webpage, Internet]. Denver,Colorado. University of Colorado Health Sciences Center:http://www.uchsc.edu/sm/cbs.

14. Braverman NE, Mudd SH, Barker PB, Pomper MG. Char-acteristic MR imaging changes in severe hypermethionine-mic states. AJNR Am J Neuroradiol 2005;26:2705-2706.

15. Devlin AM, Hajipour L, Gholkar A, Fernandes H, RameshV, Morris AA. Cerebral edema associated with betainetreatment in classical homocystinuria. J Pediatr 2004;144:545-548.

16. Fowler B, Jakobs C. Post- and prenatal diagnostic methodsfor the homocystinurias. Eur J Pediatr 1998;157 (Suppl 2):S88-S93.

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152 ∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ CASE REPORT

Paediatriki 2007;70:152-155

™˘ÓÙÔÌÔÁڷʛ˜

EITB enzyme-linked immunoelectrotransfer blotassay

ELISA enzyme-linked immunosorbent assay∂¡À ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfiMRI Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·CT ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

∂ÈÛ·ÁˆÁ‹

∏ ΢ÛÙÈΤÚΈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡Û˘ÛÙ‹Ì·ÙÔ˜ (Ó¢ÚÔ΢ÛÙÈΤÚΈÛË) ÚÔηÏ›-Ù·È ·fi ÙȘ ÚÔÓ‡Ìʘ (΢ÛÙ›ÎÂÚÎÔÈ) Ù˘ Ù·È-Ó›·˜ ÙÔ˘ ¯Ô›ÚÔ˘ (Taenia solium). √ ·ÎÏÔ˜ ˙ˆ-‹˜ ÙÔ˘ ·Ú·Û›ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ¿ÓıÚˆÔˆ˜ ·ÚÈÔ Î·È ÙÔÓ ¯Ô›ÚÔ ˆ˜ ÂӉȿÌÂÛÔ ÍÂÓÈÛÙ‹.

¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ·:

ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

ª. £ÂÔ‰ˆÚ›‰Ô˘, µ. µ·ÛÈÏÔÔ‡ÏÔ˘, ∞. ∑ËÛÔ‡ÏË, °. ªÔÛÙÚÔ‡, µ. ™˘ÚÈÔÔ‡ÏÔ˘

¶ÂÚ›ÏË„Ë: ∏ ΢ÛÙÈΤÚΈÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (Ó¢ÚÔ΢ÛÙÈΤÚΈÛË) ·ÔÙÂÏ› ÙËÛ˘¯ÓfiÙÂÚË Ó¢ÚÔÏÔÁÈ΋ ÓfiÛÔ Ô˘ ÚÔηÏÂ›Ù·È ·fi ·Ú¿ÛÈÙ·, ΢ڛˆ˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜.™ÙËÓ ∂˘ÚÒË Î·Ù·ÁÚ¿ÊÔÓÙ·È ÛÔÚ·‰Èο ÎÚÔ‡ÛÌ·Ù·, ·ÚfiÙÈ Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ˘ÁÂÈÔÓÔÌÈÎÒÓ Û˘ÓıË-ÎÒÓ Î·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô ·ÈÒÓ· Û˘ÓÂÙ¤ÏÂÛ ÛÙÔÓ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ ÓfiÛÔ˘. √È ÂÈÏËÙÈΤ˜ ÎÚ›-ÛÂȘ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÛÙ· ·È‰È¿. ∏ ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·ÔÙÂ-Ï› ÙÔ ÚÒÙÔ ‰ËÌÔÛÈÂ˘Ì¤ÓÔ ÂÚÈÛÙ·ÙÈÎfi ·ÚÂÁ¯˘Ì·ÙÈ΋˜ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ Û ·È‰› ÛÙËÓ ∂ÏÏ¿‰·.∂ΉËÏÒıËΠÎÏÈÓÈο Ì ۷ÛÌÔ‡˜, ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘ Î·È ÂÙÂÚfiÏ¢-ÚË ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘. ∏ ·ÍÔÓÈ΋ (CT) Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI)ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„·Ó ÔÏϷϤ˜ ˘fi˘ÎÓ˜ ‹ ÈÛfi˘ÎÓ˜ ‚Ï¿‚˜ Ì ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ· ÛÙ· ÂÁÎÂ-Ê·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂÁÎÂÊ·Ï›‰·, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘ÛÙÔÓ ÔÚfi Ì ELISA ·¤‚Ë ıÂÙÈÎfi˜. ÃÔÚËÁ‹ıËÎ·Ó Û˘ÓÔÏÈο ÙÚ›· Û¯‹Ì·Ù· ·Ï‚ÂÓ‰·˙fiÏ˘, ‰È¿ÚÎÂÈ·˜ 28ËÌÂÚÒÓ ¤Î·ÛÙÔ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÁÈ· ¤Ó· Ì‹Ó·. ŒÓ· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ·, ÙÔ ·È‰›‹Ù·Ó ˘ÁȤ˜ Î·È ÛÙËÓ MRI ·ÂÈÎÔÓÈ˙fiÙ·Ó ÌfiÓÔ Ì›· ÌÈÎÚ‹, ·ÔÙÈٷӈ̤ÓË ‚Ï¿‚Ë ÛÙÔÓ ÌÂوȷ›Ô ÏÔ‚fi‰ÂÍÈ¿. ∏ ¤ÁηÈÚË ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ¯ÔÚ‹ÁË-ÛË ·ÓÙÈÂÈÏËÙÈ΋˜ Î·È ·ÓÙÈ·Ú·ÛÈÙÈ΋˜ ·ÁˆÁ‹˜, Û˘ÓÂÙ¤ÏÂÛ·Ó ÛÙËÓ ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË. ∏ ·ÚÔ˘-Û›·ÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ ·ÔÛÎÔ› ÛÙÔ Ó· ÙÔÓ›ÛÂÈ fiÙÈ Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Ú¤ÂÈ Ó·ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Î¿ı ·È‰ÈÔ‡ Ì ۷ÛÌÔ‡˜ Î·È ÂÛÙȷ΋ Ó¢ÚÔÏÔÁÈ΋ Û˘Ì-و̷ÙÔÏÔÁ›·, ·ÎfiÌ· Î·È Û ¯ÒÚ˜ fiÔ˘ Ë ÓfiÛÔ˜ ‰ÂÓ ÂÓ‰ËÌ›.

§¤ÍÂȘ ÎÏÂȉȿ: ∫˘ÛÙÈΤÚΈÛË, Ó¢ÚÔ΢ÛÙÈΤÚΈÛË, ·È‰È¿, Taenia solium.

Neurocysticercosis in childhood: a case report

M. Theodoridou, V. Vasilopoulou, A. Zisouli, G. Mostrou, V. Syriopoulou

Abstract: Cysticercosis of the central nervous system (neurocysticercosis) is the commonest parasiticdisease of the human nervous system, affecting mainly populations of developing countries. InEurope, sporadic cases still occur, although the progress in sanitation during the last century hascontributed to the elimination of the disease. Affected children usually present with epilepticseizures. The case reported is the first published case of childhood parenchymal neurocysticercosisin Greece. The child presented with seizures, signs and symptoms of increased intracranial pressureand unilateral peripheral facial palsy. Brain CT and MRI showed multiple hypodense and isodenselesions with peripheral oedema in the cerebral hemispheres and the cerebellum, while the ELISA testfor serum anticysticercal antibodies was positive. Three courses of albendazole were administered,each of 28 days, combined with corticosteroids for one month. One year later the child was healthyand MRI showed only one calcified lesion in the right frontal lobe. Early diagnosis followed byantiepileptic and antiparasitic therapy contributed to a successful outcome. This case report aims topoint out that neurocysticercosis should be included in the differential diagnosis of every childpresenting with seizures and focal neurologic deficits, even in non-endemic countries.

Key words: Cysticercosis, neurocysticercosis, children, Taenia solium.

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

AÏÏËÏÔÁÚ·Ê›·:

µ·ÛÈÏÈ΋ ™˘ÚÈÔÔ‡ÏÔ˘[email protected]∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”£Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 11527, ∞ı‹Ó·

First Department ofPaediatrics, Aghia SofiaChildren’s Hospital,University of Athens, Greece

Correspondence:

Vasiliki [email protected] Department of Paediatrics, University of AthensAghia Sofia Children’sHospital, Thivon and Levadias St., 11527, Athens, Greece

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√È ¯Ô›ÚÔÈ ÌÔχÓÔÓÙ·È Ï·Ì‚¿ÓÔÓÙ·˜ Ì ÙËÓ ÙÚÔÊ‹

ÙÔ˘˜ ˆ¿ Ù˘ T. solium ·fi ·ÓıÚÒÈÓ· ÎfiÚ·Ó·, Ô˘

ÂÍÂÏ›ÛÛÔÓÙ·È ÛÙÔ˘˜ Ì˘˜ Î·È ÛÙÔÓ ÂÁΤʷÏÔ ÙˆÓ ˙ÒˆÓ

Û ΢ÛÙ›ÎÂÚÎÔ˘˜. ∏ ηٷӿψÛË ·fi ÙÔ˘˜ ·ÓıÚÒ-

Ô˘˜ ·ÙÂÏÒ˜ „Ë̤ÓÔ˘ ¯ÔÈÚÈÓÔ‡ ÎÚ¤·ÙÔ˜ Ô˘ ÂÚȤ-

¯ÂÈ ˙ˆÓÙ·ÓÔ‡˜ ΢ÛÙ›ÎÂÚÎÔ˘˜ ÚÔηÏ› ·Ú·ÛÈÙÈ΋

Ïԛ̈ÍË ÙÔ˘ ÂÓÙ¤ÚÔ˘, ·ÏÏ¿ fi¯È Ó¢ÚÔ΢ÛÙÈΤÚΈÛË.

√È ¿ÓıÚˆÔÈ ÌÔÚ› Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó Î·È ˆ˜ ÂӉȿ-

ÌÂÛÔÈ ÍÂÓÈÛÙ¤˜ Ì ·Â˘ı›·˜ ÌÂÙ¿‰ÔÛË ÙÔ˘ ·Ú·Û›-

ÙÔ˘ ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ, ̤ۈ Ù˘ ÎÔÚ·ÓÔ-

ÛÙÔÌ·ÙÈ΋˜ Ô‰Ô‡. ∆· ˆ¿, ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ÌÂ-

Ù·ÙÚ¤ÔÓÙ·È Û ΢ÛÙ›ÎÂÚÎÔ˘˜ Ô˘ ‰ÈÂÈÛ‰‡Ô˘Ó ÛÙÔÓ

‚ÏÂÓÓÔÁfiÓÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ÛÙÔ˘˜

Ì˘˜, ÛÙÔÓ ˘Ô‰fiÚÈÔ ÈÛÙfi ‹ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡-

ÛÙËÌ·, fiÔ˘ ÛÙ·‰È·Î¿ ̂ ÚÈÌ¿˙Ô˘Ó Û ·ÛÙÂȘ Ô˘ Â-

ÚȤ¯Ô˘Ó ÙÔ ·Ú¿ÛÈÙÔ Î·È Ô·Ï›˙ÔÓ ˘ÁÚfi (1,2).

√È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÔ˘Ó Î·È ÂÍ·ÚÙÒ-

ÓÙ·È ·fi ÙÔÓ ·ÚÈıÌfi Î·È ÙËÓ ÂÓÙfiÈÛË ÙˆÓ Î‡ÛÙˆÓ

ηıÒ˜ Î·È ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ÍÂÓÈ-

ÛÙ‹. ∏ Ïԛ̈ÍË ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÙÂÏ›ˆ˜ ·Û˘-

Ìو̷ÙÈ΋. ∆· Ó¢ÚÔÏÔÁÈο Û˘ÌÙÒÌ·Ù· Û˘Ó‹-

ıˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È fiÙ·Ó ÙÔ ·Ú¿ÛÈÙÔ Ô˘ ÂÚȤ¯ÂÙ·È

ÛÙËÓ Î‡ÛÙË Î·Ù·ÛÙÚ·Ê›, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÎÈÓË-

ÙÔÔ›ËÛË ·fi ÙÔÓ ÍÂÓÈÛÙ‹ ÙÔÈ΋˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜

·ÓÙ›‰Ú·Û˘.

∞’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, Ë ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘-

ÛÈ¿˙ÂÙ·È ·ÔÙÂÏ› ÙÔ ÚÒÙÔ ‰ËÌÔÛÈÂ˘Ì¤ÓÔ ÂÚÈÛÙ·-

ÙÈÎfi ·ÚÂÁ¯˘Ì·ÙÈ΋˜ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ Û ·È‰›

ÛÙËÓ ∂ÏÏ¿‰·.

¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡

∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 14 ÂÙÒÓ, Ì ÂχıÂÚÔ ·ÙÔÌÈÎfi

·Ó·ÌÓËÛÙÈÎfi, ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ÏfiÁˆ

Û·ÛÌÒÓ Î·È ÂÚÈÊÂÚÈ΋˜ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈ-

ÎÔ‡ Ó‡ÚÔ˘. ∫·Ù¿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ·ÚÔ˘Û›·˙Â

Ó·˘Ù›·, Â̤ÙÔ˘˜, ÎÂÊ·Ï·ÏÁ›· Î·È ¯·ÌËÏ‹ ˘ÚÂÙÈ΋

ΛÓËÛË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ‰ÂÓ ·ÚÔ˘Û›·˙ ¿Ï-

Ï· Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù·, ÂÓÒ ·fi ÙË Ê˘ÛÈ΋

ÂͤٷÛË ‰ÂÓ ÚԤ΢„·Ó ÂÚ·ÈÙ¤Úˆ ·ıÔÏÔÁÈο ¢-

Ú‹Ì·Ù·, ÏËÓ ‰‡Ô ÌÈÎÚÒÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÂÛÙÈÒÓ

ÛÙÔÓ ·ÚÈÛÙÂÚfi ‚˘ıfi ηٿ ÙËÓ ÔÊı·ÏÌÔÛÎfiËÛË.

ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆ-

ÛË ÂÚÈÂÏ¿Ì‚·Ó ÏÔÈÌÒÍÂȘ (ÂÁÎÂÊ·Ï›Ùȉ·, ÌËÓÈÁÁ›-

Ùȉ·, ÂÁÎÂÊ·ÏÈÎfi ·fiÛÙËÌ·) Î·È ÓÂÔϷۛ˜ ÙÔ˘

∫¡™, ηıÒ˜ Î·È ¿ÏÏ· Û·ÓÈfiÙÂÚ· ·›ÙÈ· fiˆ˜ ·ÁÁÂÈ-

›Ùȉ·, ÙÔÍÔÏ¿Û̈ÛË, Ê˘Ì·Ù›ˆÛË, ‚Ï·ÛÙÔ̇ΈÛË,

ÈÛÙÔÏ¿Û̈ÛË, ·ÛÂÚÁ›ÏψÛË, ηÓÙÈÓÙ›·ÛË, ÎÚ˘-

ÙÔÎfiÎΈÛË, ¯ÈÓÔÎÔÎΛ·ÛË Î·È Û·ÚÎÔ›‰ˆÛË. ∏

·ÍÔÓÈ΋ (CT) Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI)

ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„·Ó ÔÏϷϤ˜ ‚Ï¿‚˜ ÛÙ·

ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂÁÎÂÊ·Ï›‰·

(∂ÈÎfiÓ· 1). √ÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÂÚÈ‚¿ÏÏÔÓÙ·Ó

·fi ÂÚÈÔ¯¤˜ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ¿ÏϘ ˘fi-

˘ÎÓ˜ ‹ ÈÛfi˘ÎÓ˜ ‚Ï¿‚˜, Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó

·fi ÂÚÈÊÂÚÈÎfi Ô›‰ËÌ· Î·È ‰·ÎÙ˘ÏÈÔÂȉ‹ ›ٷÛË

ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡. ∏

·ÎÙÈÓÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‰ÂÓ ·Ó¤‰ÂÈÍ ÂÈϤÔÓ

‚Ï¿‚˜. ™ÙÔ ÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ηٷÁÚ¿ÊËΠ·‡ÍË-

ÛË ÙˆÓ Î˘Ì¿ÙˆÓ ı.

√È Û˘Ó‹ıÂȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ‹Ù·Ó Ê˘-

ÛÈÔÏÔÁÈΤ˜, ˆÛÙfiÛÔ Ë IgA ·ÓÔÛÔÛÊ·ÈÚ›ÓË ‹Ù·Ó ·˘-

ÍË̤ÓË ÛÙÔÓ ÔÚfi. ™ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À)

‰È·ÈÛÙÒıËΠÙÒÛË Ù˘ ÁÏ˘Îfi˙˘, ·‡ÍËÛË ÙÔ˘

Ï¢ÎÒÌ·ÙÔ˜ Î·È ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË, ηıÒ˜

Î·È ·‡ÍËÛË ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ IgG Î·È IgA. √

ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÍfiÏ·ÛÌ·, ·Û¤ÚÁÈÏÏÔ,

Candinda albicans, Cryptococcus neoformans ηÈ

Echinococcus granulosus ·¤‚Ë ·ÚÓËÙÈÎfi˜. ∆· ·ÓÙÈ-

ÛÒÌ·Ù· ÔÚÔ‡ Î·È ∂¡À ηٿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘, ·Ú¯È-

ο, ‹Ù·Ó ›Û˘ ·ÚÓËÙÈο. ∏ Ê˘Ì·Ù›ˆÛË ·ÔÎÏ›-

ÛÙËÎÂ, ηıÒ˜ Ë ‰ÔÎÈÌ·Û›· Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·Û˘

‹Ù·Ó ·ÚÓËÙÈ΋ Î·È Ô ¤ÏÂÁ¯Ô˜ Ì PCR ÁÈ· DNA ÙÔ˘

Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙÔ ∂¡À Î·È ÛÙÔ

Á·ÛÙÚÈÎfi ˘ÁÚfi ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∞fi ÙÔ ÈÛÙÔÚÈÎfi ‰ÂÓ

·Ó·ÊÂÚfiÙ·Ó Ù·Í›‰È Û ÂÓ‰ËÌÈ΋ ¯ÒÚ· ·fi ÙÔ ·È‰›

‹ ¿ÏÏÔ Ì¤ÏÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ô‡Ù ÂÎÙÚÔÊ‹ ¯Ô›ÚˆÓ

·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∂›Û˘ ·fi ÙËÓ ÂͤٷÛË ÎÔ-

Ú¿ÓˆÓ ‰ÂÓ ‰È·ÈÛÙÒıËΠÊÔÚ›· ÙÔ˘ ·Ú·Û›ÙÔ˘

ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡.

ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο, ÂÚÁ·ÛÙËÚȷο Î·È ·ÂÈÎÔÓÈ-

ÛÙÈο Â˘Ú‹Ì·Ù· Ë ·ÛıÂÓ‹˜ ÂÙ¤ıË Û ·ÁˆÁ‹ Ì ʷÈ-

Ó˘ÙÔ˝ÓË, ‰ÂÍ·ÌÂı·˙fiÓË (0,4 mg/kg/Ë̤ڷ) Î·È ·Ï-

‚ÂÓ‰·˙fiÏË (15 mg/kg/Ë̤ڷ). ∞Í›˙ÂÈ Ó· ÛËÌÂȈı›

fiÙÈ ÙËÓ fiÁ‰ÔË Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜

ÙÔ ·È‰› ·Ú·ÔÓ¤ıËΠÁÈ· ÎÂÊ·Ï·ÏÁ›·, Â̤ÙÔ˘˜

Î·È ‰Èψ›·, Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ˘Ô¯ÒÚËÛ·Ó

Û ̛· ‚‰ÔÌ¿‰·. ¡¤Ô˜ ¤ÏÂÁ¯Ô˜ Ì ELISA ÁÈ· ·ÓÙÈ-

ÛÒÌ·Ù· ηٿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘ ÛÙÔÓ ÔÚfi ·¤‚Ë ıÂ-

ÙÈÎfi˜. ŒÓ· Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ë

·ÛıÂÓ‹˜ ‹Ù·Ó ·Û˘Ìو̷ÙÈ΋, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜

ÂÍÂÙ¿ÛÂȘ ÛÙÔÓ ÔÚfi Î·È ÛÙÔ ∂¡À, ÂÓÒ ÛÙËÓ MRI ·-

ÚÔ˘Û›·˙ ‚ÂÏÙ›ˆÛË. ŒÏ·‚Â Û˘ÓÔÏÈο ÙÚ›· Û¯‹Ì·Ù·

·Ï‚ÂÓ‰·˙fiÏ˘, ‰È¿ÚÎÂÈ·˜ 28 ËÌÂÚÒÓ ¤Î·ÛÙÔ, ÛÂ

Û˘Ó‰˘·ÛÌfi Ì ÌËÓÈ·›Ô ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È Ë·ÙÈÎfi

¤ÏÂÁ¯Ô. ∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ¯ÔÚËÁ‹ıËÎ·Ó ÌfiÓÔ

ηٿ ÙÔÓ ÚÒÙÔ Ì‹Ó· ıÂڷ›·˜. ŒÓ· ¯ÚfiÓÔ ·ÚÁfi-

ÙÂÚ·, ÙÔ ·È‰› ‹Ù·Ó ˘ÁȤ˜ Î·È ÛÙËÓ MRI ·ÂÈÎÔÓÈ˙fi-

Ù·Ó ÌfiÓÔ Ì›· ÌÈÎÚ‹, ·ÔÙÈٷӈ̤ÓË ‚Ï¿‚Ë ÛÙÔÓ ÌÂ-

وȷ›Ô ÏÔ‚fi ‰ÂÍÈ¿ (∂ÈÎfiÓ· 1).

™˘˙‹ÙËÛË

∏ Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË

·Ú·ÛÈÙÈ΋ Ïԛ̈ÍË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘-

ÛÙ‹Ì·ÙÔ˜. ™Â ¯ÒÚ˜ fiÔ˘ Ë T. solium ÂÓ‰ËÌ›, Ë Î˘-

ÛÙÈΤÚΈÛË ·ÔÙÂÏ› ·fi ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·È-

ٛ˜ ÂÈÏË„›·˜. ∂Ó‰ËÌ› ÛÙË ÓfiÙÈ· Î·È ÎÂÓÙÚÈ΋

153¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

¶·È‰È·ÙÚÈ΋ 2007;70:152-155

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·153

Page 85: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

∞ÌÂÚÈ΋, ÛÙËÓ ∫›Ó·, ÛÙËÓ ÈÓ‰È΋ ¯ÂÚÛfiÓËÛÔ, ÛÙË ÓÔ-

ÙÈÔ·Ó·ÙÔÏÈ΋ ∞Û›· Î·È ÛÙËÓ ˘ÔÛ·¯¿ÚÈ· ∞ÊÚÈ΋, ÌÂ

ÂÈÔÏ·ÛÌfi ¿Óˆ ·fi 1% (2). ¶ÂÚÈÛÙ·ÙÈο ηٷ-

ÁÚ¿ÊÔÓÙ·È Â›Û˘ Û ÈÔ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜

(∏¶∞, ¶ÔÚÙÔÁ·Ï›·, πÛ·Ó›·, °·ÏÏ›·, °ÂÚÌ·Ó›·,

¡ÔÚ‚ËÁ›·, ¶Ôψӛ·). ∏ ·‡ÍËÛË ÙˆÓ ÌÂÙ·ÎÈÓ‹ÛˆÓ

‰ÈÂıÓÒ˜, Ô ·˘Í·ÓfiÌÂÓÔ˜ ·ÚÈıÌfi˜ ÌÂÙ·Ó·ÛÙÒÓ ·fi

·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Î·È Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ‰È·ÁÓˆ-

ÛÙÈÎÒÓ Ù¯ÓÈÎÒÓ Ô‰‹ÁËÛ·Ó ÛÙË ‰È·›ÛÙˆÛË fiÙÈ Ë

Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› Û˘¯Ó‹ Ïԛ̈ÍË.

øÛÙfiÛÔ, Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ› Û¿ÓÈ·

ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ÛÙËÓ ∂ÏÏ¿‰·. ™ÙË ‰ÈÂıÓ‹ ‚È-

‚ÏÈÔÁÚ·Ê›· ·Ó¢ڛÛÎÔÓÙ·È Ï›Á˜ ÌfiÓÔ ·Ó·ÊÔÚ¤˜ Â-

ÚÈÙÒÛÂˆÓ ÂÓËÏ›ÎˆÓ ·fi ÙËÓ ∂ÏÏ¿‰· (3). ∆Ô ÓfiÛË-

Ì· ‰ÂÓ ·Ó‹ÎÂÈ ÛÙ· ˘Ô¯ÚˆÙÈο ‰ËÏÔ‡ÌÂÓ·, ·ÚfiÙÈ

Ë ¶·ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁ›·˜ ¤¯ÂÈ ÂÓı·ÚÚ‡ÓÂÈ ÙËÓ

ÂȉËÌÈÔÏÔÁÈ΋ ÂÈÙ‹ÚËÛË Î·È ÙË ‰‹ÏˆÛË ÙÔ˘ ÓÔ-

Û‹Ì·ÙÔ˜ Û ÂıÓÈÎfi Â›Â‰Ô (4).

∏ ·ÚÂÁ¯˘Ì·ÙÈ΋ Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ·ÔÙÂÏ›

ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Î·È ··ÓÙ¿Ù·È ÛÂ

>60% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Û‡Ìʈӷ Ì ÚfiÛÊ·Ù˜

ÌÂϤÙ˜ (5). ∂ÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ

70%-90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ·ÔÙÂÏÔ‡Ó ÙË Û˘-

¯ÓfiÙÂÚË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÛÙ· ·È‰È¿ (6,7). ÕÏÏ·

Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù·

·˘ÍË̤Ó˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛ˘ fiˆ˜ ÎÂÊ·Ï·ÏÁ›·,

Ó·˘Ù›·, ¤ÌÂÙÔÈ Î·È Ô›‰ËÌ· ÔÙÈ΋˜ ıËÏ‹˜. ∂›Û˘,

ÌÔÚ› Ó· ÂΉËÏÒÓÂÙ·È Ì ËÌÈ¿ÚÂÛË, ·ÈÛıËÙÈΤ˜

‰È·Ù·Ú·¯¤˜, ·ÚÂÁÎÂÊ·ÏȉÈ΋ ·Ù·Í›·, Â͈˘Ú·ÌȉÈ-

ο ÛËÌ›·, ‰È·Ù·Ú·¯¤˜ Ù˘ fiÚ·Û˘, ÌËÓÈÁÁ›Ùȉ· ‹

¿ÓÔÈ·. ÕÏϘ ÈÔ Û¿ÓȘ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘

·ÔÙÂÏÔ‡Ó ÔÈ „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜, Ë ·Ê·Û›· ÂÎ-

ÔÌ‹˜ Î·È Ë ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· (8). √ ˘‰ÚÔ-

ΤʷÏÔ˜ Î·È ÔÈ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Û˘˙˘-

ÁÈÒÓ Û˘Ó‰¤ÔÓÙ·È Û˘Ó‹ıˆ˜ Ì ˘·Ú·¯ÓÔÂȉÈΤ˜ ηÈ

ÂÓ‰ÔÎÔÈÏȷΤ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ (1). ∏ ·ÛıÂÓ‹˜

Ì·˜ ·ÚÔ˘Û›·Û ۷ÛÌÔ‡˜, ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù·

ÂÓ‰ÔÎÚ¿ÓÈ·˜ ˘¤ÚÙ·Û˘ fiˆ˜ Ó·˘Ù›·, Â̤ÙÔ˘˜, ÎÂ-

Ê·Ï·ÏÁ›· Î·È ·ıÔÏÔÁÈ΋ ‚˘ıÔÛÎfiËÛË, ηıÒ˜ ηÈ

ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘.

∞fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ÂÓÙÔ›-

ÛÙËÎ·Ó ¿ÏϘ Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ÂÓËÏ›ÎˆÓ ÌÂ

Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Î·È ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘

ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ (9-11). ™Â Ì›· ·fi ·˘Ù¤˜, Á˘-

Ó·›Î· 28 ÂÙÒÓ Ì ÈÛÙÔÚÈÎfi ÎÂÊ·Ï·ÏÁ›·˜, Â̤وÓ, Ó˘-

ÛÙ·ÁÌÔ‡ Î·È ËÌÈ¿ÚÂÛ˘ ·fi ÂÍ·Ì‹ÓÔ˘, Û˘Û¯ÂÙ›-

ÛÙËΠÁÈ· ÚÒÙË ÊÔÚ¿ Ë ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘

ÚÔÛˆÈÎÔ‡ (Û‡ÛÙÔÈ¯Ô ‹ÌÈÛ˘ ÙÔ˘ ÚÔÛÒÔ˘) ÌÂ

ÙËÓ ÂÓÙfiÈÛË Î‡ÛÙÂˆÓ ÛÙË ÁÂÊ˘ÚÔ-·ÚÂÁÎÂÊ·ÏȉÈ-

΋ ·‡Ï·Î·. √È Î‡ÛÙÂȘ Ê·›ÓÂÙ·È fiÙÈ È¤˙Ô˘Ó ÙÔ ÛÙ¤-

ϯԘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙÔÓ ÎÈÓËÙÈ-

Îfi ˘Ú‹Ó· ÙÔ˘ ÚÔÛˆÈÎÔ‡ ‹ ÙÔ ›‰ÈÔ ÙÔ Ó‡ÚÔ (10).

∞ÓÙ›ıÂÙ·, Â¿Ó Ë ·Ú¿Ï˘ÛË ·ÊÔÚ¿ ÌfiÓÔ ÙÔ Î·ÙÒÙÂÚÔ

ÙÌ‹Ì· ÙÔ˘ ÚÔÛÒÔ˘ (ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘ ¿ÚÂÛË ÙÔ˘ÚÔÛˆÈÎÔ‡), Ú¤ÂÈ Ó· ·Ó·˙ËÙËı› ÎÂÓÙÚÈ΋(˘ÂÚ˘ÚËÓÈ΋) ÂÓÙfiÈÛË Ù˘ ‚Ï¿‚˘. ™ÙËÓ ·ÛıÂÓ‹Ì·˜, ÔÈ CT Î·È MRI ·Ó¤‰ÂÈÍ·Ó ÔÏϷϤ˜ ·ÛÙÂȘ,ÂÎÙfi˜ ·fi Ù· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂ-ÁÎÂÊ·Ï›‰·, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ˆ˜ Èı·-Ó‹ ·ÈÙ›· Ù˘ ÂÚÈÊÂÚÈ΋˜ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡.

√È Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·ÔÙÂÏÔ‡Ó ÙÔ·ÚÈÔ ‰È·ÁÓˆÛÙÈÎfi ̤ÛÔ (7). ∏ CT Â›Ó·È Î·Ï‡ÙÂÚËÛÙËÓ ·ÂÈÎfiÓÈÛË ·ÔÙÈÙ·ÓÒÛÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·ÈÌ ·Ï·ÈfiÙÂÚË Ïԛ̈ÍË (12). ∏ MRI Â›Ó·È ÈÔ Â˘·›-ÛıËÙË ÛÙËÓ ·ÔÎ¿Ï˘„Ë ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ‹ ˘·Ú·-¯ÓÔÂȉÈÎÒÓ Î‡ÛÙˆÓ. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·(∏∂°) Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈÎfi ‹ ·Ó¢ڛÛÎÔÓÙ·ÈÌË ÂȉÈΤ˜ ·ÓˆÌ·Ï›Â˜, Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È ·ÛıÂÓҘ̠ٷ Û˘ÌÙÒÌ·Ù· Î·È ÙȘ ‚Ï¿‚˜ ÛÙË CT. ∏ ·ÛıÂ-Ó‹˜ Ì·˜ ·ÚÔ˘Û›·˙ ·‡ÍËÛË ÙˆÓ Î˘Ì¿ÙˆÓ ı ÛÙÔ∏∂°. ™ÙȘ CT Î·È MRI ·Ó‚ڤıËÎ·Ó ÔÏϷϤ˜‚Ï¿‚˜ ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Î·È ÛÙËÓ ·ÚÂ-ÁÎÂÊ·Ï›‰·, ÂÓÒ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂڷ›·˜ ¤Ó·¯ÚfiÓÔ ·ÚÁfiÙÂÚ·, ·ÂÈÎÔÓ›ÛÙËΠÌfiÓÔ Ì›· ·ÔÙÈÙ·-ӈ̤ÓË ÂÛÙ›·.

∏ ÂÓÂÚÁfi˜ ÓfiÛÔ˜ Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ӷ ›Â-‰· Ï¢ÎÒÌ·ÙÔ˜ ÛÙÔ ∂¡À, ¯·ÌËÏ‹ ÁÏ˘Îfi˙Ë Î·È ÏÂÌ-ÊÔ΢ÙÙ·ÚÈ΋ ÏÂÈÔ·ÙÙˆÛË Ì ϛÁ· ˈÛÈÓfiÊÈÏ·,Ô˘ ·ÔÙÂÏ› ·fi‰ÂÈÍË ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ÙÔ˘ ÍÂÓÈÛÙ‹ ηٿ ÙÔ˘ ·Ú·Û›ÙÔ˘. ∏ ÂͤٷÛË ÙÔ˘∂¡À ÛÙËÓ ·ÛıÂÓ‹ Ì·˜ ¤‰ÂÈÍ ·˘ÍË̤ÓÔ Ï‡Έ̷,¯·ÌËÏ‹ ÁÏ˘Îfi˙Ë Î·È ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ‰È‹ıËÛË.

√È Ì¤ıÔ‰ÔÈ EITB Î·È ELISA, Ô˘ ·ÓȯÓ‡ԢӷÓÙÈÛÒÌ·Ù· ηٿ Ù˘ T. solium ‹ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘,¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û˘¯ÓfiÙÂÚ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜Î˘ÛÙÈΤÚΈÛ˘ ÛÙÔÓ ¿ÓıÚˆÔ. ∏ ¢·ÈÛıËÛ›· Ù˘EITB ˘ÔÏÔÁ›˙ÂÙ·È Û 100% Î·È Ù˘ ELISA Û 74%(12). ™ÙËÓ ·ÛıÂÓ‹ Ì·˜ Ë ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠÌÂÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ΢ÛÙ›ÎÂÚÎÔ˘

154 ª. £ÂÔ‰ˆÚ›‰Ô˘ Î·È Û˘Ó.

Paediatriki 2007;70:152-155

∂ÈÎfiÓ· 1. MRI ÂÁÎÂÊ¿ÏÔ˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ·ÛıÂÓÔ‡˜ (·ÚÈ-ÛÙÂÚ¿). MRI ÂÁÎÂÊ¿ÏÔ˘ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·ÁˆÁ‹˜ ÁÈ·Ó¢ÚÔ΢ÛÙÈΤÚΈÛË (‰ÂÍÈ¿).

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·154

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155¡Â˘ÚÔ΢ÛÙÈΤÚΈÛË: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

¶·È‰È·ÙÚÈ΋ 2007;70:152-155

ÛÙÔÓ ÔÚfi, Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·Áˆ-

Á‹˜, ·ÚfiÙÈ ·Ú¯Èο ‹Ù·Ó ·ÚÓËÙÈο. ¶Èı·Ó‹ ÂÍ‹ÁËÛË

·ÔÙÂÏ› ÙÔ fiÙÈ Ì ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ·Ú·ÛÈÙÈ΋˜

ıÂڷ›·˜ ηٷÛÙÚ¿ÊËÎ·Ó ÔÈ Î‡ÛÙÂȘ, ·ÂÏ¢ıÂÚÒ-

ÓÔÓÙ·˜ ·ÓÙÈÁÔÓÈΤ˜ Ô˘Û›Â˜ Ô˘ ÎÈÓËÙÔÔ›ËÛ·Ó

ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË.

∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ Ú¤-

ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È Ì ‚¿ÛË ÙËÓ ·ıÔÁ¤ÓÂÈ· ηÈ

ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘ Û οı ·ÛıÂÓ‹. ∏ ¯Úfi-

ÓÈ· ·ÚÂÁ¯˘Ì·ÙÈ΋ Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Ù˘Èο ÂÎ-

‰ËÏÒÓÂÙ·È Ì ۷ÛÌÔ‡˜, Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÌÂ

·ÓÙÈÂÈÏËÙÈ΋ ıÂڷ›·. ¶·ÚfiÙÈ ·ÓÙÈ·Ú·ÛÈÙÈο

Ê¿Ú̷η fiˆ˜ Ë ·Ï‚ÂÓ‰·˙fiÏË Î·È Ë Ú·˙ÈÎÔ˘·ÓÙ¤-

ÏË ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜, ˘¿Ú¯ÂÈ ÚÔ‚ÏËÌ·ÙÈ-

ÛÌfi˜ ‰ÈÂıÓÒ˜ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘˜ (7). ∫·ıÒ˜ ÔÈ ÌÂÌÔ-

ӈ̤Ó˜ ‚Ï¿‚˜ ˘Ô¯ˆÚÔ‡Ó Û˘Ó‹ıˆ˜ ·˘ÙfiÌ·Ù·, ÔÈ

ÂÚÈÛÛfiÙÂÚÔÈ ÂȉÈÎÔ› Û˘ÓÈÛÙÔ‡Ó ÙËÓ ·ÓÙÈ·Ú·ÛÈÙÈ΋

ıÂڷ›· Û ·È‰È¿ Ì ÔÏϷϤ˜ ·ÛÙÂȘ ‹ Ì ˙Ò-

Û˜ ·ÛÙÂȘ (¯ˆÚ›˜ ÛËÌ›· ·ÔÙÈÙ¿ÓˆÛ˘ ‹ Ôȉ‹Ì·-

ÙÔ˜ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô). ∏ ÂÊ·ÚÌÔÁ‹ ‰È-

ÏÒÓ - Ù˘ÊÏÒÓ ÌÂÏÂÙÒÓ Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂÎÙ›-

ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÓÙÈ·Ú·ÛÈÙÈ-

ÎÒÓ ÛÙË Ó¢ÚÔ΢ÛÙÈΤÚΈÛË Î·È ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi

ÙÔ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ‰ÔÛÔÏÔÁÈ-

ÎÔ‡ Û¯‹Ì·ÙÔ˜. ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, Ì·ÓÓÈÙfiÏË Î·È

·Ó·ÏÁËÙÈο ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Û˘. ∏ Ó¢ÚÔ¯ÂÈ-

ÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË ÌÔÚ› Ó· Â›Ó·È ·Ó·Áη›· ÛÂ

˘‰ÚÔΤʷÏÔ Ô˘ ··ÈÙ› ÎÔÈÏÈÔÂÚÈÙÔÓ·˚΋ ·Ú¿-

Î·Ì„Ë ‹ Û ÂÓ‰ÔÎÔÈÏȷΤ˜ ·ÛÙÂȘ.

™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È, ¯ÔÚËÁ‹ıË-

Î·Ó 3 ·ÎÏÔÈ ·Ï‚ÂÓ‰·˙fiÏ˘ (28 Ë̤Ú˜ ¤Î·ÛÙÔ˜),

̤¯ÚÈ ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ.

ÕÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙ›ÓÔ˘Ó Û˘ÓÙÔÌfiÙÂÚ· ıÂÚ·-

¢ÙÈο Û¯‹Ì·Ù· (10).

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ó¢ÚÔ΢ÛÙÈΤÚΈÛË, ÂÎÙfi˜

·fi ÙÔ˘˜ Û·ÛÌÔ‡˜, ÌÔÚ› Ó· ÂΉËψı› Ì ÌÂÁ¿-

ÏË ÔÈÎÈÏ›· Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ, ÌÂٷ͇ ÙˆÓ

ÔÔ›ˆÓ Ë ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡-

ÚÔ˘. ∆· Â˘Ú‹Ì·Ù· ÙˆÓ CT Î·È MRI Â›Ó·È Î·ıÔÚÈÛÙÈ-

ο ÁÈ· ÙË ‰È¿ÁÓˆÛË. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi

ÂÓ‰¤¯ÂÙ·È Ó· ˘Ô‰ËÏÒÓÂÈ fiÙÈ ˘ÔÂÎÙÈÌ¿Ù·È Ô ÂÈ-ÔÏ·ÛÌfi˜ Ù˘ Ó¢ÚÔ΢ÛÙÈΤÚΈÛ˘ ÛÙËÓ ∂ÏÏ¿‰·Î·È fiÙÈ ı· ‹Ù·Ó ¯Ú‹ÛÈ̘ ÂÚ·ÈÙ¤Úˆ ÂȉËÌÈÔÏÔÁÈ-Τ˜ ÌÂϤÙ˜ ‹ Î·È Î·ıȤڈÛË ˘Ô¯ÚˆÙÈ΋˜ ‰‹Ïˆ-Û˘ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. √È ·È‰›·ÙÚÔÈ ı· Ú¤ÂÈ Ó· Û˘-ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË Ó¢ÚÔ΢ÛÙÈΤÚΈÛË ÛÙË ‰È·-ÊÔÚÈ΋ ÙÔ˘˜ ‰È¿ÁÓˆÛË, fiÙ·Ó ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ·È‰È¿Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û·ÛÌÔ‡˜ Î·È ÂÛÙȷ΋ Ó¢ÚÔÏÔ-ÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, ·ÎfiÌ· Î·È Û ÌË-ÂÓ‰ËÌÈΤ˜¯ÒÚ˜, fiˆ˜ Ë ∂ÏÏ¿‰·.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Caprio A. Neurocysticercosis: an update. Lancet Infect Dis2002;2:751-762.

2. WHO 56th World Health Assembly. A56/10. Control ofneurocysticercosis. Report by the Secretariat 6 March2003. [Internet]. Webpage: http://www.who.int/gb/eb-wha/pdf_files/WHA56/ea5610.pdf

3. Palasis S, Drevelengas A. Extramedullary spinal cysticerco-sis. Eur J Radiol 1991;12:216-218.

4. Roman G, Sotelo J, Del Brutto O, Flisser A, Dumas M,Wadia N, et al. A proposal to declare neurocysticercosis aninternational reportable disease. Bull World Health Organ2000;78:399-406.

5. Botero D, Tanowitz HB, Weiss LM, Wittner M. Taeniasisand cysticercosis. Infect Dis Clin N Am 1993;7:683-697.

6. Riley T, White AC Jr. Management of neurocysticercosis.CNS Drugs 2003;17:577-591.

7. Singhi P, Singhi S. Neurocysticercosis in children. J ChildNeurol 2004;19:482-492.

8. Sawhney IM, Singh G, Lekhra OP, Mathuriya SN, PariharPS, Prabhakar S. Uncommon presentations of neurocys-ticercosis. J Neurol Sci 1998;154:94-100.

9. Valenca MM, Valenca LP, Lima MC. Idiopathic facialparalysis (Bell's palsy): a study of 180 patients. Arq Neurop-siquiatr 2001;59:733-739.

10. Del Brutto OH. Cysticercosis of the cerebellopontine angle:treatment with single-dose praziquantel. Rev Neurol 2000;31:835-837.

11. Bouillot S, Monteil P, Dautheribes M, Rougier A, Guerin J,Vital A. Two cases of neurocysticercosis mimicking braintumor. Ann Pathol 2003;23:355-357.

12. Yancey LS, Diaz-Marchan PJ, White AC. Cysticercosis:Recent advances in diagnosis and management of neuro-cysticercosis. Curr Infect Dis Rep 2005;7:39-47.

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AÏÏËÏÔÁÚ·Ê›·:

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘[email protected]¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

¶fiÛ˜ ‰fiÛÂȘ ÙÔ˘ Ó¢ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È;

∆· Û¯‹Ì·Ù· ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÔÈΛÏÏÔ˘Ó ·fi ηÈÚfi Û ηÈÚfi ÎÈ ·fi ¯ÒÚ· Û ¯ÒÚ·, Î·È fi¯È Û¿-ÓÈ· ‰ËÌÈÔ˘ÚÁÂ›Ù·È Î¿ÔÈ· Û‡Á¯˘ÛË. ¶ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙȘ ∏¶∞ ÛÙÔ Lancet ÙÔ˘ √ÎÙˆ‚Ú›Ô˘ 2006(Lancet 2006;368:1495) ·Û¯ÔÏ‹ıËΠ̠ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÙ·‰‡Ó·ÌÔ˘ Û˘˙¢Á̤ÓÔ˘Ó¢ÌÔÓÈÔÎÔÎÎÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ Û ‰È¿ÊÔÚ· ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù·. ∞Ó·ÛÎÔ‹ıËÎ·Ó 782 ·È‰È¿ ËÏÈ-Λ·˜ 3-59 ÌËÓÒÓ Ì ‰ÈÂÈÛ‰˘ÙÈ΋ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ Ïԛ̈ÍË Î·È ÙÚÈÏ¿ÛÈÔ˜ ÏËı˘ÛÌfi˜ Ì·ÚÙ‡ÚˆÓ›‰È·˜ ËÏÈΛ·˜ Î·È ‰È·ÌÔÓ‹˜. °È· Ù· ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ 7 ÌËÓÒÓ, Ì›· ÌfiÓÔ ‰fiÛË ÂÌ‚ÔÏ›Ô˘ ·Ú›¯Â ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 73% ÛÙËÓ ÚfiÏË„Ë Ù˘ Ïԛ̈͢, ÂÓÒ ÔÈ 2 Î·È 3 ‰fiÛÂȘ ·Ú›¯·Ó 96% Î·È 95%,·ÓÙ›ÛÙÔȯ·. ∆ÚÂȘ ‹ 4 ‰fiÛÂȘ Ô˘ ›¯·Ó ‰Ôı› Û ‰È¿ÊÔÚ· Û¯‹Ì·Ù·, ·ÏÏ¿ Ì ¤Ó·ÚÍË ÚÈÓ ÙÔ˘˜ 7 Ì‹-Ó˜ ›¯·Ó ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ›ÛË ‹ ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 98%. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÓË›ˆÓ 12-23 ÌËÓÒÓÔ˘ ‰ÂÓ Â›¯·Ó ÂÌ‚ÔÏÈ·Ûı› ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ›¯Â ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 93% Ì ̛· ‰fiÛË Î·È 96%Ì ‰‡Ô ‰fiÛÂȘ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÓË›ˆÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Ì 1 ‰fiÛË Â›¯Â ·ÔÙÂÏÂÛÌ·ÙÈÎfi-ÙËÙ· 94%. ∆Ô Û¯‹Ì· 3 ‰fiÛÂˆÓ ÚÈÓ ÙÔ˘˜ 7 Ì‹Ó˜ ¯ˆÚ›˜ ·Ó·ÌÓËÛÙÈ΋ ‰fiÛË ‹Ù·Ó ÏÈÁfiÙÂÚÔ ·ÔÙÂÏÂ-ÛÌ·ÙÈÎfi (p=0,03) ·fi ÙÔ ÔÏÔÎÏËڈ̤ÓÔ Û¯‹Ì· Ì ·Ó·ÌÓËÛÙÈ΋ ‰fiÛË (Û‡ÓÔÏÔ 4 ‰fiÛˆÓ). π‰È·›ÙÂ-ÚÔ ÂӉȷʤÚÔÓ ¤¯ÂÈ ÙÔ Â‡ÚËÌ· fiÙÈ Ì›· ¯·Ì¤ÓË ‰fiÛË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙÔ˘˜ ÚÒÙÔ˘˜ 6 Ì‹Ó˜ ‰ÂÓ Ô‰Ë-Á› Û ԢÛÈ·ÛÙÈ΋ Ì›ˆÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·ÚΛ Ó· ¯ÔÚËÁËı› Ë ·Ó·ÌÓË-ÛÙÈ΋ ÙˆÓ 12-16 ÌËÓÒÓ (·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· 98%). √ ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹Ù·Ó ‰Ú·ÛÙÈÎfi˜ ÁÈ· ÙËÓ Úfi-ÏË„Ë Î·È ÙˆÓ 7 ÔÚÔÙ‡ˆÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ Ô˘ ÂÚȤ¯ÔÓÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ Î·È ÂÈϤÔÓ ÁÈ· ÙÔÓÔÚfiÙ˘Ô 6∞. √È Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi Û ·ÚÎÂÙ¿ ÂÌ‚Ô-ÏÈ·ÛÙÈο Û¯‹Ì·Ù· Î·È Â‡¯ÔÓÙ·È ÙËÓ Â¤ÎÙ·Û‹ ÙÔ˘ Î·È ÛÙȘ ÊÙˆ¯fiÙÂÚ˜ ¯ÒÚ˜. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ

ÂÌ‚fiÏÈÔ ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ 800.000 Ì 1.000.000 ı·Ó¿ÙÔ˘˜ ·È‰ÈÒÓ ÂÙËÛ›ˆ˜.

∆ËÏÂʈÓÈ΋ (·È‰)È·ÙÚÈ΋

∏ ·fi ÙËÏÂÊÒÓÔ˘ È·ÙÚÈ΋, Ì ٷ ˘¤Ú Î·È Ù· ηٿ Ù˘, Ê·›ÓÂÙ·È fiÙÈ ·ÏÒÓÂÙ·È ‰˘Ó·ÌÈο ÛÙÔÛËÌÂÚÈÓfi ‰›ÎÙ˘Ô ·ÚÔ¯‹˜ ˘ËÚÂÛÈÒÓ ˘Á›·˜. √È ÙËÏÂʈÓÈΤ˜ Û˘Ì‚Ô˘Ï¤˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Î·Ù·ÁÚ¿ÊÔ-ÓÙ·È (Î·È ‰ÂÓ ·Ì›‚ÔÓÙ·È) ÌÂ Û˘Ó¤ÂÈ· Ó· Â›Ó·È ‰‡ÛÎÔÏË Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È Ù˘ ·Ô-ÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿˜ ÙÔ˘˜. ™Â ÌÈ· ÌÂϤÙË (Pediatrics 2007;119:e305) ·fi ÙÔ Children’s Hospital ÙÔ˘Denver ÛÙÔ Colorado ÙˆÓ ∏¶∞, Û 8.980 ÁÔÓ›˜ Ô˘ ˙‹ÙËÛ·Ó ÙËÏÂʈÓÈ΋ Û˘Ì‚Ô˘Ï‹ ·fi ÙÔ ˘ÁÂÈÔ-ÓÔÌÈÎfi ÚÔÛˆÈÎfi ·ÓÙ›ÛÙÔȯ˘ ÙËÏÂʈÓÈ΋˜ ˘ËÚÂÛ›·˜ (Û ÒÚ· ÂÊËÌÂÚ›·˜) ÂÙ¤ıË ÂÍ·Ú¯‹˜ ÙÔ ·-ڷοو ·ÓÔÈÎÙfi ÂÚÒÙËÌ·: “£· Ì·˜ ›Ù ÙÈ ı· οӷÙÂ, ·Ó ‰ÂÓ ÌÔÚÔ‡Û·Ù ӷ Ì·˜ ηϤÛÂÙ ·fi-„Â;”. ∞fi ÙÔ˘˜ ÁÔÓ›˜, 46% ı· ‹Á·ÈÓ·Ó ÙÔ ·È‰› ÙÔ˘˜ Û ÂÊËÌÂÚ‡ÔÓ ÓÔÛÔÎÔÌ›Ô, 21% ı· ·ÓÙÈÌÂ-ÙÒÈ˙·Ó ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·È‰ÈÔ‡ ÌfiÓÔÈ ÙÔ˘˜ ÛÙÔ Û›ÙÈ, 12% ı· ÂÈÎÔÈÓˆÓÔ‡Û·Ó Ì ÙÔÓ ÁÈ·ÙÚfi ÙËÓÂfiÌÂÓË Ë̤ڷ, Î·È 13% ı· ÚˆÙÔ‡Û·Ó ÁÓˆÛÙÔ‡˜. ∞fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ÁÔÓ›˜ ›·Ó fiÙÈ ı·‹Á·ÈÓ·Ó ÛÙÔ ÂÊËÌÂÚ‡ÔÓ ÓÔÛÔÎÔÌ›Ô, ÌfiÓÔ ÛÙÔ 13,5% ‰fiıËΠÙÂÏÈο Û˘Ì‚Ô˘Ï‹ Ó· οÓÔ˘Ó Î¿ÙÈÙ¤ÙÔÈÔ. ∂ӉȷʤÚÔÓ Â›Ó·È fiÙÈ Î·È ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÙˆÓ ÁÔÓÈÒÓ Ô˘ ‰ÂÓ ı· ‹Á·ÈÓ·Ó Ô˘ıÂÓ¿, ÛÙÔ15% ‰fiıËÎÂ Û˘Ì‚Ô˘Ï‹ Ó· ¿Ó ÂÂÈÁfiÓÙˆ˜ Û ÂÊËÌÂÚ‡ÔÓ ÓÔÛÔÎÔÌ›Ô. ™Â Â›Â‰Ô ÙÔÈÎÔ‡ Îfi-ÛÙÔ˘˜ ̆ ÔÏÔÁ›ÛÙËΠfiÙÈ Î¿ı ÙËÏÂÊÒÓËÌ· ·¤ÊÂÚ 42,6 ‰ÔÏ¿ÚÈ· ΤډԘ ÛÙÔ Û‡ÛÙËÌ· ÂÚ›ı·Ï„˘.∏ ÔÚÁ¿ÓˆÛË Ù˘ ¤ÎÙ·ÎÙ˘ ·È‰È·ÙÚÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ‰È·Ê¤ÚÂÈ Ôχ ·fi ¯ÒÚ· Û ¯ÒÚ· Î·È Â›Ó·È·‚¤‚·ÈÔ Î·Ù¿ fiÛÔ Ù· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ı· ›Û¯˘·Ó ÁÈ· ÙËÓ ∂ÏÏ¿‰·. ŸÏÔÈ fï˜ ÔÈ ¶·È‰›·ÙÚÔÈ Ù˘¯ÒÚ·˜ Ì·˜ ÁÓˆÚ›˙Ô˘Ó Ôχ ηϿ ÙË ÛËÌ·Û›· Ù˘ ÙËÏÂʈÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘·È‰ÈÔ‡. ∞Ó·ÛÎfiËÛË Ù˘ ÙËÏÂʈÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ Ì ¯Ú‹ÛÈ̘ Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜ ¤¯ÂÈ ‹‰Ë ‰Ë-ÌÔÛÈ¢ı› ÛÙËÓ “¶·È‰È·ÙÚÈ΋” (¶·È‰È·ÙÚÈ΋ 2005;68:29-35).

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘

156 ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞

Paediatriki 2007;70:156-157

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·156

Page 88: Παιδιατρική | Τόμος 70 • Τεύχος 2 • Μάρτιος - Απρίλιος 2007

157PAEDIATRIC NEWS IN BRIEF

¶·È‰È·ÙÚÈ΋ 2007;70:156-157

∫ÔÚÙÈÎÔÂȉ‹ Î·È Kawasaki

∏ ÚÔÛı‹ÎË ÂÓ‰ÔÊϤ‚È·˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ (‹‰Ë ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980) ÛÙÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì· Ù˘ÓfiÛÔ˘ Kawasaki Â›Ó·È È· ÁÓˆÛÙfi fiÙÈ ÌÂÈÒÓÂÈ, ·ÏÏ¿ ‰ÂÓ ÌˉÂÓ›˙ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÂÈÏÔÎÒÓ ·fi Ù· ÛÙÂÊ·-ÓÈ·›· ·ÁÁ›·. ∞fi ÙËÓ ¿ÏÏË ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ˘Ô‰Â›ÍÂÈ Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÙˆÓ ÎÔÚÙÈÎÔÂȉÒÓ ÛÙËÓfiÛÔ Kawasaki. ∆Ô Â‡ÏÔÁÔ ÂÚÒÙËÌ·, ηٿ fiÛÔ Ë ÚÔÛı‹ÎË ÂÓ‰ÔÊϤ‚È·˜ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÛÙÔ Û‡ÓËı˜ۯ‹Ì· ÂÓ‰ÔÊϤ‚È·˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ı· ‚ÔËıÔ‡Û ٷ ·È‰È¿ Ì ÓfiÛÔ Kawasaki, ÂÍÂÙ¿ÛÙËΠ۠Ôχ ηϿ Û¯Â-‰È·Ṳ̂ÓË ÌÂϤÙË 199 ·È‰ÈÒÓ ·fi 8 ΤÓÙÚ· ÙˆÓ ∏¶∞ Î·È ÙÔ˘ ∫·Ó·‰¿ Ô˘ ‰ËÌÔÛȇıËΠÚfiÛÊ·Ù· (N EnglJ Med 2007;356:663). ∆· ·È‰È¿ Ô˘ ‹Ú·Ó Î·È ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË Î·È ÂÓ‰ÔÊϤ‚È· ·ÓÔÛÔÛÊ·ÈÚ›ÓË Â›¯·Ó ο-ˆ˜ ‚Ú·¯‡ÙÂÚÔ ¯ÚfiÓÔ ·Ú¯È΋˜ ÓÔÛËÏ›·˜ (p=0,05) Î·È ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ Ù·¯‡ÙËÙ·˜ ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ Î·ÈC-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ ÛÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· (p=0,02 Î·È p=0,07) Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ‹Ú·Ó ÌfiÓÔÂÓ‰ÔÊϤ‚È· ·ÓÔÛÔÛÊ·ÈÚ›ÓË Î·È placebo. øÛÙfiÛÔ Ë ÚÔÛı‹ÎË Ù˘ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ‰ÂÓ ‚Ú¤ıËΠӷ ÂË-Ú¿˙ÂÈ ÙË Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡, ÙËÓ ·Ó¿ÁÎË Â·Ó·¯ÔÚ‹ÁËÛ˘ ÂÓ‰ÔÊϤ‚È·˜·ÓÔÛÔÛÊ·ÈÚ›Ó˘, ÙË Û˘¯ÓfiÙËÙ· ·ÚÂÓÂÚÁÂÈÒÓ Î·È, ÙÔ Î˘ÚÈfiÙÂÚÔ, ‰ÂÓ ‚Ú¤ıËΠӷ ÂËÚ¿˙ÂÈ ÙȘ ‰È·ÛÙ¿ÛÂÈ˜ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. √È ÂÚ¢ÓËÙ¤˜ ηٷϋÁÔ˘Ó fiÙÈ Ù· ‰Â‰Ô̤ӷ ÙÔ˘˜ ‰ÂÓ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ÚÔÛı‹ÎËÂÓ‰ÔÊϤ‚È·˜ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ÛÙÔ Î·ıÈÂڈ̤ÓÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì· ÙˆÓ ·È‰ÈÒÓ Ì ÓfiÛÔ Kawasaki. ™ÙÔ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ˘¿Ú¯ÂÈ Û¯ÔÏÈ·ÛÌfi˜ ÙÔ˘ ¿ÚıÚÔ˘ Ì·˙› Ì ÌÈ· ·Ó·ÛÎfiËÛË ÙˆÓ ·ÈÓÈÁÌ¿ÙˆÓ Î·È ÙˆÓÚÔÎÏ‹ÛÂˆÓ Ù˘ ÓfiÛÔ˘ Kawasaki ÁÈ· 40 ÙfiÛ· ¯ÚfiÓÈ·, Î·È ‰‡Ô ÁÂÓȤ˜ ÁÈ·ÙÚÒÓ ÌÂÙ¿ ÙËÓ ÂÚÈÁÚ·Ê‹ Ù˘ ·fi ÙÔÓTomisaku Kawasaki (N Engl J Med 2007;356:659). ∆Ô Ù‡¯Ô˜ ª·ÚÙ›Ô˘ 2007 ÙÔ˘ Pediatric Infectious DiseaseJournal ÂÚȤ¯ÂÈ ¿ÏÏË ÌÈ· ÂӉȷʤÚÔ˘Û· ÌÂϤÙË (PIDJ 2007;26:256) ·fi ÙÔ San Diego ÙˆÓ ∏¶∞: Ô ·˘ÍË̤ÓԘΛӉ˘ÓÔ˜ ·Ó¢ڢÛÌ¿ÙˆÓ ÛÙ· ÛÙÂÊ·ÓÈ·›· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔ˘˜ ÁÈ·-ÙÚÔ‡˜ Î·È fi¯È Ì ÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ·Ó·˙‹ÙËÛË È·ÙÚÈ΋˜ ‚Ô‹ıÂÈ·˜ ·fi ÙÔ˘˜ ÁÔÓ›˜.

°Ú›Ë ÙˆÓ ÙËÓÒÓ, Í·Ó¿ Î·È Í·Ó¿

∆Ô SARS Ì¿˜ ÙÚfiÌ·Í ÚÈÓ Ï›Á· ¯ÚfiÓÈ· ·ÏÏ¿ ‰ÂÓ Ì·˜ Ôχ··Û¯ÔÏ› ¤ÎÙÔÙÂ, ·ÂÓ·ÓÙ›·˜ Ë ÁÚ›Ë ÙˆÓÙËÓÒÓ ÛÙ¤ÏÓÂÈ Î¿ı ÙfiÛÔ ·ÓËÛ˘¯ËÙÈο ÌËӇ̷ٷ: ̤۷ ÛÙÔ ÚÒÙÔ ‰›ÌËÓÔ ÙÔ˘ 2007 ·Ó·Ê¤ÚıËÎ·Ó ÎÚÔ‡-ÛÌ·Ù· fi¯È ÌfiÓÔ Û ÔÏϤ˜ ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜, ·ÏÏ¿ Î·È ÛÙËÓ ∞ÁÁÏ›· (Ì ÙȘ ¯ÈÏÈ¿‰Â˜ Á·ÏÔԇϘ Ô˘ ı·Ó·-ÙÒıËÎ·Ó ÚÔÏËÙÈο) Î·È ÛÙËÓ ∞›Á˘ÙÔ Ì ·Ó·ÊÔÚ¿ ÎÚÔ‡ÛÌ·ÙÔ˜ Û ·È‰› ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ. °È· ÙË ÓfiÛÔ¯ÔÚËÁÂ›Ù·È ÙÔ ·ÓÙÈ-ÈÈÎfi ÔÛÂÏÙ·ÌÈ‚›ÚË (oseltamivir/Tamiflu, Roche Laboratories), ·Ó·ÛÙÔϤ·˜ Ù˘ Ó¢ÚÔ·-ÌÈÓȉ¿Û˘, ÁÓˆÛÙfi ·fi ÙË ıÂڷ›· Ù˘ “ÎÏ·ÛÈ΋˜” Áڛ˘ ∞ Î·È µ. ™ÙËÓ ∂ÏÏ¿‰· ‰ÂÓ Â›Ó·È ‰È·‰Â‰Ô̤ÓËË ¯Ú‹ÛË ÙÔ˘, ˆÛÙfiÛÔ ÛÙȘ ∏¶∞ ÙÔ ·ÓÙÈ-ÈÈÎfi Â›Ó·È ÂÁÎÂÎÚÈ̤ÓÔ Î·È ÁÈ· ·È‰È¿ ¿Óˆ ÙÔ˘ ¤ÙÔ˘˜ Î·È ˘¿Ú¯ÂÈ‹‰Ë ÂÍ·ÈÚÂÙÈ΋ ÂÌÂÈÚ›· ·fi ÙËÓ π·ˆÓ›· (Clin Infect Dis 2006;43:439, Clin Infect Dis 2006;43:445). ∞ÓË-Û˘¯ËÙÈ΋ ˆÛÙfiÛÔ (Science 2007,315:448) Â›Ó·È Ë ÂÌÊ¿ÓÈÛË Î¿ÔÈ·˜ ·ÓÙÔ¯‹˜ ÙÔ˘ ÈÔ‡ Ù˘ Áڛ˘ ÙˆÓ ÙË-ÓÒÓ (∞ H5N1) ÛÙËÓ ÔÛÂÏÙ·ÌÈ‚›ÚË, Ô˘ ÂȂ‚·ÈÒıËΠ۠‰‡Ô ÌÔÈÚ·›· ÎÚÔ‡ÛÌ·Ù· ÛÙËÓ ∞›Á˘ÙÔ ÙÔÓ Â-Ú·Ṳ̂ÓÔ ¢ÂΤ̂ÚÈÔ (ÙÔ ¤Ó· Ì¿ÏÈÛÙ· Û ÎÔÚ›ÙÛÈ 16 ÂÙÒÓ). ∏ ‰ÂÈÁÌ·ÙÔÏË„›· ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ›¯Â Á›ÓÂÈÌfiÏȘ ‰‡Ô Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ Ù˘ ÔÛÂÏÙ·ÌÈ‚›Ú˘, Î·È Û˘ÓÂÒ˜ Â›Ó·È Â‡ÏÔÁË Ë ˘fiıÂÛËfiÙÈ ÔÈ ·ÛıÂÓ›˜ ›¯·Ó ÌÔÏ˘Óı› ÂÍ·Ú¯‹˜ Ì ·ÓıÂÎÙÈÎfi Èfi. ∞Ó ˘¿Ú¯Ô˘Ó ÎÈ ¿ÏÏ· ÙËÓ¿ Ì ·ÓıÂÎÙÈÎfi Èfi, Ù··ÁÎfiÛÌÈ· ·Ôı¤Ì·Ù· ÔÛÂÏÙ·ÌÈ‚›Ú˘ ÂӉ¯Ô̤ӈ˜ ·¯ÚËÛÙ‡ÔÓÙ·È. ∫·È ÂÈϤÔÓ, ÛÙÔ Ù‡¯Ô˜ ÙÔ˘ BritishMedical Journal Ù˘ 3˘ ª·ÚÙ›Ô˘ (BMJ 2007;334:442) ÂÌÊ·Ó›˙ÂÙ·È Ë Úfi‚ÏÂ„Ë ·fi ÙÔ European Centre forDisease Prevention and Control (‰ڿ˙ÂÙ·È ÛÙË ™ÙÔίfiÏÌË) fiÙÈ Ë ∂˘ÚÒË ¯ÚÂÈ¿˙ÂÙ·È ·ÎfiÌË ‰‡Ô Ì ÙÚ›·¯ÚfiÓÈ· ÁÈ· Ó· ıˆÚËı› ¤ÙÔÈÌË Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÂӉ¯fiÌÂÓË ·Ó‰ËÌ›· Ù˘ Áڛ˘ ÙˆÓ ÙËÓÒÓ.

∂ԯȷ΋ ÁÚ›Ë: ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹ fi¯È;

∏ ÂÙ‹ÛÈ· Âԯȷ΋ ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Áڛ˘ ÛÙ· ·È‰È¿ ¤Ú·Û ‹ ‚Ú›ÛÎÂÙ·È ÛÙ· ÙÂÏÂ˘Ù·›· Ù˘ ÛÙ˯ÒÚ· Ì·˜. ∆Ô ÂÚÒÙËÌ· ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÁÚ›Ë Â›Ó·È ·ÏÈfi Î·È ·Ú·Ì¤ÓÂÈ, Î·È ı· ·ӤÏıÂÈÙÔ ÊıÈÓfiˆÚÔ. ∞ÏÏÔ‡ ÂÊ·ÚÌfi˙ÂÙ·È Î·ıÔÏÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ (.¯., ÛÙȘ ∏¶∞ ÁÈ· Ù· ‚ÚÂÊÔÓ‹È· 6-23 ÌËÓÒÓ) ηȷÏÏÔ‡ ÚÔÙÈÌ¿Ù·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌfiÓÔ ÔÌ¿‰ˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (.¯., ÛÙËÓ ∂ÏÏ¿‰·). √ ηıÔÏÈÎfi˜ ‹ fi¯È ÂÌ‚Ô-ÏÈ·ÛÌfi˜ ·Ú·Ì¤ÓÂÈ ÏÔÈfiÓ ̆ fi Û˘˙‹ÙËÛË, Ë ·ÛÊ¿ÏÂÈ· ¿ÓÙˆ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ‰Â‰Ô̤ÓË Î·È Ê·›ÓÂÙ·È Ó· ÙÂÎ-ÌËÚÈÒÓÂÙ·È Î·È ·fi ÌÈ· ·ÎfiÌË ÚfiÛÊ·ÙË ÌÂϤÙË, ·Ó·‰ÚÔÌÈ΋ Î·È ÙË ÌÂÁ·Ï‡ÙÂÚË ÛÙÔ Â›‰Ô˜ Ù˘ (JAMA2006;296:1990) Ô˘ Û˘ÌÂÚȤϷ‚ 45.356 ·È‰È¿ 6-23 ÌËÓÒÓ Ô˘ ÂÌ‚ÔÏÈ¿ÛÙËÎ·Ó Ì 69.359 ‰fiÛÂȘ ÙÚȉ‡Ó·ÌÔ˘·‰Ú·ÓÔÔÈË̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ Ù˘ Áڛ˘ ÛÙȘ ∏¶∞ ·fi ÙÔ 1991 ˆ˜ ÙÔ 2003. ªÂ Ôχ ÚÔÛÂÎÙÈ΋ ·Ó¿Ï˘ÛË, Ë ÌÂ-Á¿ÏË ·˘Ù‹ ÌÂϤÙË ÂȂ‚·›ˆÛ ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ù˘ Áڛ˘ Î·È ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 6-23 ÌËÓÒÓ.

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158 ∫§π¡π∫√ ∫√Àπ∑

Paediatriki 2007;70:158,162

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶.°.¡ÔÛÔÎÔÌ›Ԣ ∞ÏÂÍ¿Ó‰Ú·

AÏÏËÏÔÁÚ·Ê›·:

Ã. ∫ÒÛÙ·ÏÔ˜[email protected]¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶.°.¡ÔÛÔÎÔÌ›Ԣ ∞ÏÂÍ¿Ó‰Ú·

Ã. ∫ÒÛÙ·ÏÔ˜

¶ÚfiˆÚÔ ı‹Ï˘ ÓÂÔÁÓfi ËÏÈΛ·˜ ·ËÛ˘ 32‚‰ÔÌ¿‰ˆÓ Î·È ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ 900 g Ì ÂÓ‰Ô-Ì‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ÁÂÓÓ‹ıËÎÂÌ ηÈÛ·ÚÈ΋ ÙÔÌ‹. ∆Ô Apgar score ‹Ù·Ó 8 ÛÙÔ 1ÔÏÂÙfi Î·È 8 ÛÙÔ 5Ô ÏÂÙfi ˙ˆ‹˜. §fiÁˆ ·Ó·Ó¢-ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙÔÔıÂÙ‹ıËΠÎÂÓÙÚÈÎfi˜ ÊÏÂ-‚ÈÎfi˜ ηıÂÙ‹Ú·˜ ̤ۈ Ù˘ ‰ÂÍÈ¿˜ ‚Ú·¯ÈÔÓ›Ô˘ ·Ú-ÙËÚ›·˜ ÁÈ· ÙËÓ ·ÚÔ¯‹ ·ÚÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘.

∆ËÓ 10Ë Ë̤ڷ ˙ˆ‹˜ ·ÚÔ˘Û›·Û ϋı·ÚÁÔ,ˆ¯ÚÔ··ÓÔ ¯ÚÒÌ·, ÂÂÈÛfi‰È· ¿ÓÔÈ·˜ Î·È ‚Ú·‰˘-ηډ›·. ªÂ ÙËÓ ˘Ô„›· Ïԛ̈͢ ÂÏ‹ÊıËÛ·Ó Î·Ï-ÏȤÚÁÂȘ ·›Ì·ÙÔ˜, Ô‡ÚˆÓ Î·È ∂¡À Î·È Î·Ï‡ÊıËÎÂÌ ÎÂÊÔÙ·Í›ÌË, ·ÌÈηۛÓË Î·È ‚·ÓÎÔÌ˘Î›ÓË.

∆ËÓ 12Ë Ë̤ڷ ˙ˆ‹˜ Ë ÁÂÓÈ΋ ÙÔ˘ ηٿÛÙ·ÛËÂȉÂÈÓÒıËΠ̠η΋ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›·,

Ù·¯˘Î·Ú‰›·, ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·, Ë·ÙÔÛÏËÓÈ-Îfi. ∫·Ù¿ ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ ‰È·ÈÛÙÒıËÎÂηϷÛÙÈÎfi˜ Ú˘ıÌfi˜, Û˘ÛÙÔÏÈÎfi ÎÏÈÎ Î·È ÔÏÔÛ˘-ÛÙÔÏÈÎfi ʇÛËÌ· 3Ô˘ ‚·ıÌÔ‡ ·ÚÈÛÙÂÚ¿ ·Ú·-ÛÙÂÚÓÈο ÛÙÔ 4Ô ÌÂÛÔχÚÈÔ ‰È¿ÛÙËÌ·. ∏ ÂÚÁ·-ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ¤‰ÂÈÍ ÌÈÎÚÔÛÎÔÈ΋ ·ÈÌ·-ÙÔ˘Ú›·, ıÚÔÌ‚ÔÂÓ›·, ÔÏÈÎfi ·ÚÈıÌfi Ï¢ÎÒÓ ·ÈÌÔ-ÛÊ·ÈÚ›ˆÓ 5000/Ìl Ì 39% ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, ·È-ÌÔÛÊ·ÈÚ›ÓË 10,4 g/dl Î·È ·˘ÍË̤ÓË CRP. ∂›¯Â ›-Û˘ ÂÏ·ÊÚ¿ ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË. ™ÙËÓ Î·ÏÏȤÚ-ÁÂÈ· ·›Ì·ÙÔ˜ ·Ó·Ù‡¯ıËΠÂȉÂÚÌÈÎfi˜ ÛÙ·Ê˘-ÏfiÎÔÎÎÔ˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ ÌÂÁ·-ÏÔηډ›·. ŒÁÈÓ ›Û˘ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηÚ-‰È¿˜ (∂ÈÎfiÓ· 1).

¶ÔÈ¿ Â›Ó·È Ë ‰È¿ÁÓˆÛË;

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 162

∂ÈÎfiÓ· 1.

RV

LV

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159¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

¢ÈÎÙ˘·ÎÔ› ÙfiÔÈ ÁÈ· ÙËÓ ÂÊË‚È΋ ËÏÈΛ·

∏ ÂÊ˂›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈΤ˜ ۈ̷ÙÈΤ˜ Î·È „˘¯ÈΤ˜ ÌÂÙ·‚ÔϤ˜ Î·È ··ÈÙ› ȉÈ-·›ÙÂÚË ÚÔÛÔ¯‹. ™ÙÔ ‰È·‰›ÎÙ˘Ô ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏ›· sites Û¯ÂÙÈÎÒÓ Ì ÙËÓ ÂÊË‚È΋ ÂÚ›Ô‰Ô,Ì ÂÌÏÔ˘ÙÈṲ̂ÓÔ ÂÚȯfiÌÂÓÔ, ÂӉȷʤÚÔÓÙ· ¿ÚıÚ·, ·ÔÙÂϤÛÌ·Ù· ÂÚ¢ÓÒÓ, forums, È·ÙÚÈοӤ· Î·È ·Ó·ÎÔÈÓÒÛÂȘ Û˘Ó‰ڛˆÓ.

IÛÙÔÛÂÏ›‰· ÁÈ· ÙËÓ ÀÁ›· ÙÔ˘ ∂Ê‹‚Ô˘ Ù˘ ∞ª∞ -

http://www.ama-assn.org/ama/pub/category/ 1947.html

ªÂ ÙÔ ÏÔÁfiÛËÌÔ “Helping Doctors help Patients” ·˘Ù‹ ËÈÛÙÔÛÂÏ›‰· ÁÈ· ÙËÓ ÀÁ›· ÙÔ˘ ∂Ê‹‚Ô˘, ‚Ú›ÛÎÂÙ·È ÛÙÔ Ï·›-ÛÈÔ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ π·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ (∞ª∞). ¶·Ú¤¯ÂÈÛÙÔ˘˜ ÂÈÛΤÙ˜ Ù˘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈΤ˜ Ì ÙËÓ ÂÊË-‚È΋ ËÏÈΛ· ̤ۈ ·Ó·ÎÔÈÓÒÛÂˆÓ Ù‡Ô˘ Î·È ÚÂÔÚÙ¿˙. ™ÙÔsite ̆ ¿Ú¯ÂÈ ·ÎfiÌË ÛˆÚ›· ¿ÚıÚˆÓ Ô˘ ·ÊÔÚÔ‡Ó ÊϤÁÔÓÙ·˙ËÙ‹Ì·Ù· Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜, fiˆ˜ Ë ‰È·ÙÚÔÊ‹, Ë Ê˘ÛÈ-΋ ηٿÛÙ·ÛË Î·È Ë ‚ÂÏÙ›ˆÛ‹ Ù˘, Ë Ì›ˆÛË ÙˆÓ ·Ù˘¯ËÌ¿-ÙˆÓ, Ë ‚›·, Ù· „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, ÙÔ ·ÏÎÔfiÏ, Ù· Ó·Ú-ΈÙÈο, ÙÔ Î¿ÓÈÛÌ·, Ë ÂÁ΢ÌÔÛ‡ÓË Î·È Ù· ÛÂÍÔ˘·ÏÈÎÒ˜ÌÂÙ·‰È‰fiÌÂÓ· ÓÔÛ‹Ì·Ù·. √ ÂÈÛΤÙ˘ ÌÔÚ› ·ÎfiÌË Ó·ÂÓËÌÂÚˆı› ÁÈ· ÙËÓ È·ÙÚÈ΋ ÂÈηÈÚfiÙËÙ· ‰È·‚¿˙ÔÓÙ·˜·ÔÛ¿ÛÌ·Ù· ·fi ÂÈÏÂÁ̤ӷ È·ÙÚÈο ÂÚÈÔ‰Èο.

¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈ· ÈÛÙÔÛÂÏ›‰· ·ÈÛıËÙÈο ·Ï‹ Î·È Û˘Ó¿Ì· ·ÚÎÂÙ¿ ÂÍÂȉÈÎÂ˘Ì¤ÓË Ô˘ ·Â˘ı‡ÓÂÙ·È΢ڛˆ˜ Û ÁÈ·ÙÚÔ‡˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÚÔÛʤÚÂÈ ÔÌ·‰ÔÔÈË̤ӷ ÔÏÏ¿ links Û¯ÂÙÈÎÒÓ ÔÚÁ·ÓÈÛÌÒÓ(Adolescent health links), Î·È ËÁ¤˜ Ì ÏÔ‡ÛÈÔ ˘ÏÈÎfi ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ÙˆÓ È·ÙÚ›ˆÓ ÙÔ˘˜. ¶ÂÚÈÏ·Ì-‚¿ÓÂÙ·È ·ÎfiÌË Î·È agenda ÁÈ· ÙÔ ÚfiÁÚ·ÌÌ· ÙˆÓ Û˘Ó‰ڛˆÓ ÔÏÏÒÓ È·ÙÚÈÎÒÓ ÔÚÁ·ÓÒÛˆÓ.

∂Ù·ÈÚ›· ∂ÊË‚È΋˜ π·ÙÚÈ΋˜ - http://www.adolescenthealth.org/

ÿÛˆ˜ ¤Ó· ·fi Ù· ηχÙÂÚ· site ÛÙÔ Â›‰Ô˜ ÙÔ˘. √ ÔÚÁ·-ÓÈÛÌfi˜ SAM (The Society for Adolescent Medicine) ·ÔÙ¤-ÏÂÛÌ· Û˘ÓÂÚÁ·Û›·˜ ÂȉÈÎÒÓ ÂÈÛÙËÌfiÓˆÓ, ·Ú¤¯ÂÈ Ì¤ÛˆÙ˘ ÈÛÙÔÛÂÏ›‰·˜ ÙÔ˘ Û˘Ì‚Ô˘Ï¤˜, ·ÚıÚÔÁÚ·Ê›·, ÂÈÌÔÚ-ʈÙÈΤ˜ ‰È·‰Èηۛ˜ ÁÈ· ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÂÓË̤ڈÛË Û¯Â-ÙÈο Ì ÙË ‰ÈÂÍ·ÁˆÁ‹ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÂÚ¢ÓÒÓ,ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÓ‰˘Ó¿ÌˆÛ˘ Ù˘ ‰ËÌfiÛÈ·˜ ÂÓË̤ڈ-Û˘ ÁÈ· Ù· ÂÊË‚Èο ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜. ∆Ô site Â›Ó·È ‰È·-¯ˆÚÈṲ̂ÓÔ Û ÙÔ̤· ·ÁÁÂÏÌ·ÙÈÎÒÓ ËÁÒÓ ÚÔ˜ ÂÓË̤-ÚˆÛË ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Î·È Û ‰ËÌfiÛÈÔ ÙÔ̤·, fiÔ˘ ÔȤÊË‚ÔÈ ·ÏÏ¿ Î·È Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘˜ ÌÔÚÔ‡ÓÓ· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó

Î·È ÂȉÈÎfiÙÂÚ· ÁÈ· ÙÔÓ ÙÚfiÔ ¯ÂÈÚÈÛÌÔ‡ ·˘Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ÂÚÈfi‰Ô˘. ™ÙËÓ ·ÚÈÛÙÂÚ‹ ÛÙ‹ÏË, ÔÂÈÛΤÙ˘ ‚Ú›ÛÎÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ· ·Ó‡ÚÂÛ˘ ÁÈ·ÙÚÔ‡ (ÛÙËÓ ∞ÌÂÚÈ΋), ·Ó·ÎÔÈÓÒÛÂȘ Ù‡Ô˘ ηȷӷÁÁÂϛ˜ ÙˆÓ ÂÙ‹ÛÈˆÓ Û˘Ó‰ڛˆÓ.

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

AÏÏËÏÔÁÚ·Ê›·:

¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜[email protected]

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∂ÊË‚È΋ ÀÁ›· - http://www.adolescenthealth.com/menu.html

∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ site ·Â˘ı‡ÓÂÙ·È ÙfiÛÔ ÛÂÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ÂÓ Á¤ÓÂÈ, fiÛÔ Î·ÈÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜. ∆Ô ÂÚȯfiÌÂÓfi ÙÔ˘ ·Ô-ÙÂÏÂ›Ù·È ·fi ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Î·È È‰¤Â˜ÚÔÎÂÈ̤ÓÔ˘ ÔÈ Ó¤ÔÈ Ó· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÌÈ· ˘ÁÈ-ÂÈÓ‹ ˙ˆ‹ Î·È Ó· ÛÙ·ıÂÚÔÔÈËıÔ‡Ó Û ÌÈ· ηٿ-ÛÙ·ÛË ÛˆÌ·ÙÈ΋˜ Î·È ÓÂ˘Ì·ÙÈ΋˜ ¢ÂÍ›·˜. ∆Ôsite ÙÔ ÔÔ›Ô ·Ó·ÓÂÒÓÂÙ·È ·Ó¿ Ù·ÎÙ¿ ¯ÚÔÓÈο‰È·ÛÙ‹Ì·Ù·, ‰È·¯ˆÚ›˙ÂÙ·È Û ÙÔ̤· ·Ó‰ÚÈÎfi ηÈÁ˘Ó·ÈΛÔ, ÚÔÛʤÚÔÓÙ·˜ ¤ÙÛÈ ‰È·ÊÔÚÔÔÈË̤-Ó˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ Î¿ı ʇÏÔ.

∆Ô ÂÚȯfiÌÂÓÔ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ËÁ¿˙ÂÈ·fi ·ÁÁÂÏ̷ٛ˜ ÁÈ·ÙÚÔ‡˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ∂ÊË-‚È΋˜ / ¡Â·ÓÈ΋˜ π·ÙÚÈ΋˜ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓÙ˘ µÔÛÙfiÓ˘. ™ÙÔ site ˘ÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÔÈ ÏË-

ÚÔÊÔڛ˜ ·Ú¤¯ÔÓÙ·È ÁÈ· ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Î·È fi¯È ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜, ÂÓÒ ÔÈ ¤ÊË‚ÔÈ Û˘ÌÌÂ-Ù¤¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙË Û˘ÁÁÚ·Ê‹ Î·È ÙËÓ ÔÚÁ¿ÓˆÛË ÙÔ˘ ˘ÏÈÎÔ‡. ∞ÎfiÌË, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ Û¯Â‰È·-ÛÌfi ÙÔ˘ design ·ÏÏ¿ Î·È Ù˘ ıÂÌ·ÙÔÏÔÁ›·˜. To site, ̤۷ ·fi ÌÈ· ÏËıÒÚ· ¿ÚıÚˆÓ (·ÓÙÈÛ‡ÏÏË-„Ë, ηٿıÏÈ„Ë, ·ÎÌ‹, AIDS Î.¿), ·Ú·ÎÈÓ› ÙÔ˘˜ Ó¤Ô˘˜ Ó· ÂÍÂÙ¿˙ÔÓÙ·È Û˘¯Ó¿ Î·È Ó· ÚÔÛ¤¯Ô˘ÓÙÔ ÛÒÌ· ÙÔ˘˜ ÌÂ Û˘¯Ó¤˜ ÂÈÛΤ„ÂȘ Û ÂȉÈÎÔ‡˜ ÁÈ·ÙÚÔ‡˜.

“Your body is a complicated machine, and like all machines it needs regular maintenance”

Teen Health FX - http://www.teenhealthfx.com/answers/ans_index.php

¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· site ȉȷ›ÙÂÚ· ‡¯ÚËÛÙÔ ÌÂÂӉȷʤÚÔÓ, ›ηÈÚÔ Î·È ·Ó·Óˆ̤ÓÔ ÂÚȯfi-ÌÂÓÔ. ∞¢ı‡ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙÔ˘˜ ¤ÊË‚Ô˘˜Î·È ÛÙ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÛÙËÓηıËÌÂÚÈÓfiÙËÙ¿ ÙÔ˘˜.

ªÂ ÂÈÎÔÓÔÁÚ¿ÊËÛË ˘„ËÏ‹˜ ÔÈfiÙËÙ·˜ Î·È ıÂ-Ì·ÙÔÏÔÁ›· ‰È·¯ˆÚÈṲ̂ÓË Û ËÏÂÎÙÚÔÓÈÎfi ›Â-‰Ô (4 top tabs), ÙÔ site ÎÂÚ‰›˙ÂÈ ÙȘ ÂÓÙ˘ÒÛÂȘ.

√È ÛÎÔÔ› ·Ó·Ê¤ÚÔÓÙ·È Û·ÊÒ˜ - ÔÈ ˘Â‡ı˘ÓÔÈÙÔ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ˆ˜ online ËÁ‹ ··ÓÙ‹ÛˆÓÁÈ· ÌÈ· ÏËıÒÚ· ÂÚˆÙ‹ÛÂˆÓ Ô˘ Ù›ıÂÓÙ·È ·fiÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ·ÊÔÚÔ‡Ó ÙËÓ ˘Á›·ÙÔ˘˜, ÙȘ Û¯¤ÛÂȘ, ÙÔ ÛÒÌ· Î·È ÙË ÛÂÍÔ˘·ÏÈÎfiÙË-Ù¿ ÙÔ˘˜. ™ÙË Û˘Ó¤¯ÂÈ·, ·ÎÔÏÔ˘ı› ÙÔ FX Answers

tab ̤ۈ ÙÔ˘ ÔÔ›Ô˘ Ô ¯Ú‹ÛÙ˘ ¤¯ÂÈ ÚfiÛ‚·ÛË Û ÌÈ· ÔÈÎÈÏ›· ·ÚıÚÔÁÚ·Ê›·˜ Û¯ÂÙÈ΋ Ì ÙÔ˘˜ÈÔ‡˜, ÙË ‰È·ÙÚÔÊ‹, ÙË ÛÂÍÔ˘·ÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ÙÔ ·ÏÎÔfiÏ, ÙÔ Î¿ÓÈÛÌ· Î.¿., ÂÓÒ ·ÍÈÔÛËÌ›ˆÙÔÂ›Ó·È ÙÔ ÁÂÁÔÓfi˜ Û‡Ìʈӷ Ì ÙÔ ÔÔ›Ô ÙÔ ›‰ÈÔ ÙÔ site ‰È·ÎËÚ‡ÛÛÂÈ ÙË ‰ËÌÔÙÈÎfiÙËÙ¿ ÙÔ˘ ÛÙÔ WhoWe Are tab, Ì ÙËÓ ·Ó·ÊÔÚ¿ 5.000.000 ¯ÚËÛÙÒÓ ·fi ÙÔ ™Â٤̂ÚÈÔ ÙÔ˘ 1999.

™ÙÔ Links tab ηٷ¯ˆÚÔ‡ÓÙ·È ¿ÚıÚ· ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚȯfiÌÂÓÔ, fiˆ˜ Û¯ÂÙÈο Ì ‰È·Ù·Ú·¯¤˜‰È·ÙÚÔÊ‹˜ Î.¿., ÂÓÒ ¤Í˘ÓË ·Ú¤Ì‚·ÛË Â›Ó·È Î·È Ù· quiz ηıÒ˜ Î·È Ù· link Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂıÂ-ÏÔÓÙÈ΋ ÂÚÁ·Û›· ÛÙÔÓ ÙÔ̤· Ù˘ ˘Á›·˜.

∆¤ÏÔ˜, ÙÔ Emergency Help tab, ÚÔÛʤÚÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ó· ‚ÚÔ˘Ó ÙÚfiÔ˘˜ ‰ÈÂ-Ífi‰Ô˘ ·fi ‰‡ÛÎÔϘ ηٷÛÙ¿ÛÂȘ ηıÒ˜ ÂΛ ‚Ú›ÛÎÂÙ·È Ï›ÛÙ· ÙËÏÂÊÒÓˆÓ ÚÒÙˆÓ ‚ÔËıÂÈÒÓ (ÛÙȘ∏.¶.∞.). ∞Ó ÙÔ ÚÔÙ›ÓÂÙ Û ÂÊ‹‚Ô˘˜ ı· Ê·Ó›Ù ȉȷ›ÙÂÚ· ÂÓËÌÂڈ̤ÓÔÈ!

160 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

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161NEWS FROM THE INTERNET

¶·È‰È·ÙÚÈ΋ 2007;70:159-161

Global Teenager Project - http://www.globalteenager.org/

∆Ô site ÙÔ˘ Global Teenager Project ¯·Ú·ÎÙË-Ú›˙ÂÙ·È ·fi ¤ÓÙÔÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ‰È·-‰Ú·ÛÙÈÎfi ÂÚȯfiÌÂÓÔ. ∫‡ÚÈÔ˜ ÛÙfi¯Ô˜ ÙÔ˘ ›-Ó·È Ë ‡·ÚÍË ÌÈ·˜ ÁÚ·ÌÌ‹˜ ÂÈÎÔÈÓˆÓ›·˜ ÌÂ-ٷ͇ Ì·ıËÙÒÓ Î·È Î·ıËÁËÙÒÓ, ‰ËÏ·‰‹ ÂÊ‹-‚ˆÓ Î·È ÂÓ‹ÏÈÎˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÍ¿ÁÔÓÙ·ÈÂӉȷʤÚÔÓÙ˜ Û˘˙ËÙ‹ÛÂȘ ÁÈ· ÙÚ¤¯ÔÓÙ· ˙ËÙ‹-Ì·Ù· Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ Ó¤ÔÈ ÛÙËÓ Î·ıË-ÌÂÚÈÓfiÙËÙ¿ ÙÔ˘˜. ™ËÌ·ÓÙÈÎfi ÛÙÔÈ¯Â›Ô Â›Ó·È ÔÌË ÙÔÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ÂÚȯÔ̤ÓÔ˘, ÔÔÔ›Ô˜ ÂÛÙÈ¿˙ÂÈ Û ʷÈÓfiÌÂÓ· ·ÁÎfiÛÌÈ·˜ ÎÏ›-̷η˜ fiˆ˜ ÙÔ HIV/AIDS Î·È Ë Ú‡·ÓÛË ÙÔ˘ÂÚÈ‚¿ÏÏÔÓÙÔ˜.

™˘ÌÌÂÙ¤¯ÔÓÙ˜ ÛÙÔ project Â›Ó·È 6000 ÂÚ›-Ô˘ Ì·ıËÙ¤˜ ·fi 30 ¯ÒÚ˜, ÂÓÒ ÔÈ ·ÚÈıÌÔ› ÂÌ-Ê·Ó›˙Ô˘Ó ·˘ÍËÙÈ΋ Ù¿ÛË ·fi ÙÔ ¤ÙÔ˜ ȉڇÛÂ-Ò˜ ÙÔ˘, ÙÔ 1999. ¶ÂÚ·ÈÙ¤Úˆ ÛÙfi¯Ô˜ Â›Ó·È Ë

ÛÊ·ÈÚÈ΋ ÂÈÌfiÚʈÛË ÙˆÓ Ó¤ˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍÂÏȯıÔ‡Ó ÛÂ Û˘ÓÂȉËÙÔÔÈË̤ÓÔ˘˜ Ôϛ٘ ÙÔ˘ÎfiÛÌÔ˘. ∆Ô site ‰È·¯ˆÚ›˙ÂÙ·È Û ÙÔÌ›˜ Ì ÛÔ‚·Ú‹ ıÂÌ·ÙÔÏÔÁ›·, fiˆ˜ ÔÈ ÌÂÈÔÓfiÙËÙ˜, ÂÈÌÔÚʈ-ÙÈÎÔ› ÙÔÌ›˜, Ó¤· ·fi ÔÏÏ¿ ‰È·ÊÔÚÂÙÈο ̤ÚË ÙÔ˘ Ï·Ó‹ÙË ·ÏÏ¿ Î·È chatrooms fiÔ˘ ÔÈ Ì·ıËÙ¤˜ÌÔÚÔ‡Ó Ó· ·ÓÙ·ÏÏ¿ÍÔ˘Ó È‰¤Â˜ Î·È Ó· ‰È¢ڇÓÔ˘Ó ÙÔÓ ÎÔÈÓˆÓÈÎfi ÙÔ˘˜ ·ÎÏÔ. ™Ù· Ï·›ÛÈ· Ù˘ÈÛÙÔÛÂÏ›‰·˜ ÂÓÙ¿ÛÛÂÙ·È Î·È ÙÔ ÂÙ‹ÛÈÔ Johan Kooij Fellowship Workshop ÙÔ ÔÔ›Ô ¯ÚËÌ·ÙÔ‰ÔÙ›ٷȷfi ÙÔ Global Teenager Project Î·È Î‡ÚÈÔ˜ ÛÙfi¯Ô˜ ÙÔ˘ Â›Ó·È Ë ‰ÈÔÚÁ¿ÓˆÛË Û˘Ó‰ڛˆÓ Î·È ÔÌÈÏÈÒÓ¤ÙÛÈ ÒÛÙ ÙÔ project Ó· ·ÔÎÙ¿ Ú·ÁÌ·ÙÈÎfi ¯·Ú·ÎÙ‹Ú· ¤Ú· ·fi ÙÔÓ ÂÈÎÔÓÈÎfi. ªÈ· Ï›ÛÙ· ·fi ÂÓ-‰È·Ê¤ÚÔÓÙ· URL Û¯ÂÙÈο Ì ÙË Ê‡ÛË, Ù· ·ÓıÚÒÈÓ· ‰ÈηÈÒÌ·Ù·, Î·È ¿ÏÏ· ÁÂÓÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘,¤Ú¯ÔÓÙ·È Ó· ÚÔÛÙÂıÔ‡Ó ÛÙË Ì˯·Ó‹ ÙÔ˘ site. ¶ÚÔÙ›ÓÂÙ·È ÁÈ· ÂÊ‹‚Ô˘˜ Ì ·ÓÂÙ˘Á̤ÓË ÎÔÈÓˆÓÈ-

΋ Û˘Ó›‰ËÛË.

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162 CLINICAL QUIZ

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∫ÏÈÓÈÎfi QUIZ

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∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰Â›¯ÓÂÈ ıÚfiÌ‚Ô ÛÙËÓÙÚÈÁÏÒ¯ÈÓ· ‚·Ï‚›‰·. ™ÙÔ ÓÂÔÁÓfi ¯ÔÚËÁ‹ıËÎÂÂÓÂÚÁÔÔÈËÙ‹˜ ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ (Actilyse)ÂÓ‰ÔÊϤ‚È·, ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË. ª¤Û· Û 48ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ ·Ú·ÙË-Ú‹ıËΠÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË Ì ÂÍ·Ê¿ÓÈÛË ÙÔ˘Î·Ú‰È·ÎÔ‡ Ê˘Û‹Ì·ÙÔ˜. ∆Ô ÓÂÔÁÓfi ¤Ï·‚ ÙËÓ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÂÙ¿ Ë̤Ú˜. ¡¤Ô ˘Â-Ú˯ÔÁÚ¿ÊËÌ· ¤‰ÂÈÍ ϋÚË Ï‡ÛË ÙÔ˘ ÂÓ‰Ô-ηډȷÎÔ‡ ıÚfiÌ‚Ô˘. √È ÂÍÂÙ¿ÛÂȘ ËÎÙÈÎfiÙË-Ù·˜ ÙÔ˘ ·›Ì·ÙÔ˜-¯ÚfiÓÔ˜ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·-ÛÙ›Ó˘, ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘, ÈÓˆ‰ÔÁfiÓÔ,‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∆Ô ÓÂÔÁÓfi ¤Ï·‚Â Û˘ÓÔÏÈο3 ‚‰ÔÌ¿‰Â˜ ·ÓÙÈ‚›ˆÛ˘ Î·È Ë ÂÚ·ÈÙ¤Úˆ Ô-Ú›· ÙÔ˘ ‹Ù·Ó ηϋ. Doppler ˘ÂÚ˯ÔÁÚ·Ê›·Î·Ú‰È¿˜ Î·È ÂÁÎÂÊ¿ÏÔ˘ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ ηıÒ˜Î·È ÙÚÂȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο.

£ÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È· ·Ú·ÙËÚÔ‡ÓÙ·È Û˘-¯Ó¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘¯Ú‹Û˘ ÎÂÓÙÚÈÎÒÓ ÊÏ‚ÈÎÒÓ Î·ıÂÙ‹ÚˆÓ ÛÙȘÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ ÓÂÔÁÓÒÓ (1,2).∆· ·›ÙÈ· ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Û˘ÁÁÂ-Ó‹ ‹ ›ÎÙËÙ·.

™Ù· Û˘ÁÁÂÓ‹ ·›ÙÈ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È: 1. ªÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ·Ú¿ÁÔÓÙ· V

(·Ú¿ÁˆÓ V Leiden) 2. ªÂÙ¿ÏÏ·ÍË ÛÙÔ ÁÔÓ›‰ÈÔ Ù˘ ÚÔıÚÔÌ‚›Ó˘

(ÚÔıÚÔÌ‚›ÓË 20210∞)3. ∞Ó¿ÚÎÂÈ· Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ 4. ∞Ó¿ÚÎÂÈ· Ù˘ ÚˆÙ½Ó˘ C ‹ S 5. √ÌÔ΢ÛÙÂ˚Ó·ÈÌ›·6. ¢˘ÛÈÓˆ‰ÔÁÔÓ·ÈÌ›· (3)

™Ù· ›ÎÙËÙ· ·›ÙÈ· ˘¿ÁÔÓÙ·È: 1. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·2. √È ÏÔÈÌÒÍÂȘ3. ∏ ·ÚÔ˘Û›· ÂÓ‰Ô·ÁÁÂÈ·ÎÒÓ Î·ıÂÙ‹ÚˆÓ4. ∏ ÔÏ˘ÂÚ˘ıÚ·ÈÌ›·5. √È Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ 6. ∆· ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (4)

√È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· ÌÂÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ıÚfiÌ‚Ô˘:

·. ∂› ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›-ˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È Û·ÛÌÔ›, ËÌÈÏËÁ›·.

‚. ∂› ÚÔÛ‚ÔÏ‹˜ Ù˘ ηډȿ˜ ·Ú·ÙËÚ›-Ù·È Î·Ú‰È·Î‹ ·Ó¿ÚÎÂÈ·.

Á. ™Â ÂÓÙfiÈÛË ÛÙ· ÓÂÊÚ¿ ·Ú·ÙËÚÂ›Ù·È ·È-Ì·ÙÔ˘Ú›·, Ôȉ‹Ì·Ù·, ˘¤ÚÙ·ÛË.

‰. ∂› ÚÔÛ‚ÔÏ‹˜ Ù˘ ·ÔÚÙ‹˜ ·Ú·ÙËÚ›ٷÈÈÛ¯·ÈÌ›· ÙˆÓ ¿ÎÚˆÓ.

Â. ™Â ÚÔÛ‚ÔÏ‹ Ù˘ ¿Óˆ ÎÔ›Ï˘ ·Ú·ÙËÚ›-Ù·È Ô›‰ËÌ· ÙˆÓ ¿Óˆ ¿ÎÚˆÓ Î·È Ù˘ ÎÂÊ·Ï‹˜ (5).

ÛÙ. ∞fi ÙÔ ‰¤ÚÌ· ·Ú·ÙËÚÂ›Ù·È ÎÂÚ·˘ÓÔ‚fi-ÏÔ˜ ÔÚʇڷ (6).

§fiÁˆ Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ÚԉȿıÂÛ˘ Ô˘˘¿Ú¯ÂÈ, Û οı ÂÚ›ÙˆÛË ıÚÔÌ‚ˆÙÈÎÔ‡ÂÂÈÛÔ‰›Ô˘ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÙfiÛÔ ÙÔÓÂÔÁÓfi fiÛÔ Î·È Ë ÌËÙ¤Ú·, ·ÏÏ¿ Î·È Ô ·Ù¤Ú·˜ÁÈ· ÙËÓ ‡·ÚÍË ÔÈÎÔÁÂÓÂȷ΋˜ ÚԉȿıÂÛ˘.√È ÂÍÂÙ¿ÛÂȘ ·˘Ù¤˜ Á›ÓÔÓÙ·È Û ÂȉÈο ÌfiÓÔΤÓÙÚ·.

∏ ıÂڷ›· Ì ÂÓÂÚÁÔÔÈËÙ¤˜ ÙÔ˘ Ï·ÛÌÈ-ÓÔÁfiÓÔ˘ ÚÔÙÈÌ¿Ù·È ¤Ó·ÓÙÈ ÙˆÓ ·Ï·ÈÔÙ¤ÚˆÓÊ·Ú̿ΈÓ, ‰ËÏ·‰‹ Ù˘ Ô˘ÚÔÎÈÓ¿Û˘, ÁÈ·Ù›ÚÔηÏ› ÏÈÁfiÙÂÚ˜ ·ÏÏÂÚÁÈΤ˜ ÂΉËÏÒÛÂÈ˜Î·È ¤¯ÂÈ ÌfiÓÔ ÙÔÈ΋ ‰Ú¿ÛË Â› ÙÔ˘ ıÚfiÌ‚Ô˘¯ˆÚ›˜ Ó· ÂËÚ¿˙ÂÈ ÙË ÁÂÓÈÎfiÙÂÚË ËÎÙÈÎfiÙË-Ù· ÙÔ˘ ·›Ì·ÙÔ˜ (7).

™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿„·ÌÂ, Ô ¤ÏÂÁ-¯Ô˜ ·¤ÎÏÂÈÛ ÙËÓ ‡·ÚÍË Û˘ÁÁÂÓÒÓ Úԉȷ-ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ë ıÚfiÌ‚ˆÛË ·Ô‰fi-ıËΠÛÙÔÓ Û˘Ó‰˘·ÛÌfi Ïԛ̈͢ Î·È Ù˘ ·-ÚÔ˘Û›·˜ ·ÁÁÂÈ·ÎÔ‡ ηıÂÙ‹Ú·.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Hoppe C, Matsunaga A. Pediatric thrombosis. Pedi-atr Clin North Am 2002;49:1257-1283.

2. Edstrom C, Christensen RD. Evaluation and treat-ment of thrombosis in the neonatal intensive careunit. Clin Perinatol 2000;27:623-641.

3. Rao AK, Sheth S, Kaplan R. Inherited hypercoagula-ble states. Vasc Med 1997;2:313-320.

4. Schmidt B, Andrew M. Neonatal thrombosis: reportof a prospective Canadian and international reg-istry. Pediatrics 1995;96:939-943.

5. Ellis D, Kaye RD, Bontempo FA. Aortic and renalartery thrombosis in a neonate: recovery with throm-bolytic therapy. Pediatr Nephrol 1997;11:641-644.

6. Marlar RA, Neumann A. Neonatal purpura fulmi-nans due to homozygous protein C or protein S de-ficiencies. Semin Thromb Hemost 1990;16:299-309.

7. Van Overmeire B, Van Reempts PJ, Van Acker KJ.Intracardiac thrombus formation with rapidly pro-gressive heart failure in the neonate: treatment withtissue type plasminogen activator. Arch Dis Child1992;67:443-445.

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163∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ LETTER TO THE EDITOR

¶·È‰È·ÙÚÈ΋ 2007;70:163-164

£ÂˆÚÒ ˘Ô¯Ú¤ˆÛË Ó· ÂÓËÌÂÚÒÛˆ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ÁÈ· ÙÔÓ ÚfiÛÊ·ÙÔ ı¿Ó·ÙÔ ÙÔ˘ Robert JamesGorlin (1923-2006), ÁÓˆÛÙÔ‡ ÛÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ·fi ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙË ÁÂÓÂÙÈÎ‹ÙˆÓ ·È‰È·ÙÚÈÎÒÓ Û˘Ó‰ÚfïÓ.

√ Bob Gorlin ¤Û‚ËÛ Û ËÏÈΛ· 83 ÂÙÒÓ, ¯Ù˘Ë̤ÓÔ˜ ·fi ÙËÓ Â¿Ú·ÙËÓfiÛÔ, ÛÙȘ 29 ∞˘ÁÔ‡ÛÙÔ˘ 2006. √ Gorlin ˘‹ÚÍ ÌÈ· ÌÂÁ¿ÏË ÂÈÛÙËÌÔÓÈ΋ÚÔÛˆÈÎfiÙËÙ·, ·Ó·ÁÓˆÚÈṲ̂ÓÔ˜ ‰ÈÂıÓÒ˜ ˆ˜ ÎÏÈÓÈÎfi˜, ÂÚ¢ÓËÙ‹˜ Î·È ‰È·ÓÔ-Ô‡ÌÂÓÔ˜. ∞Ó Î·È ‰ÂÓ ‹Ù·Ó ·È‰›·ÙÚÔ˜, Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙË ÁÂÓÂÙÈ΋ Û˘ÁÁÂÓÒӷӈ̷ÏÈÒÓ Î·È Û˘Ó‰ÚfiÌˆÓ ˘‹ÚÍ ÂÓÙ˘ˆÛȷ΋. ¶ÂÚȤÁÚ·„ ÂÚÈÛÛfiÙÂÚ··fi 100 Û‡Ó‰ÚÔÌ·, ÂÎ ÙˆÓ ÔÔ›ˆÓ 6 ʤÚÔ˘Ó ÙÔ fiÓÔÌ¿ ÙÔ˘.

√ Gorlin ÁÂÓÓ‹ıËΠÛÙÔ Hudson Ù˘ ÔÏÈÙ›·˜ ¡¤·˜ ÀfiÚ΢ ÙÔ 1923. √ÈÎÔÏÂÁȷΤ˜ ÛÔ˘‰¤˜ ÙÔ˘ ÔÏÔÎÏËÚÒıËÎ·Ó ÛÙÔ ∫ÔϤÁÈÔ Columbia Ù˘ ¡¤·˜ÀfiÚ΢ Î·È ·ÊÔ‡ ˘ËÚ¤ÙËÛ Ì ÙÔÓ ·ÌÂÚÈηÓÈÎfi ÛÙÚ·Ùfi ÛÙÔÓ µã ¶·ÁÎfiÛÌÈÔ¶fiÏÂÌÔ, ÛÔ‡‰·Û ÛÙËÓ √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘Washington fiÔ˘ ·ÂÊÔ›ÙËÛ ÙÔ 1947. ™ÙË Û˘Ó¤¯ÂÈ· ¤Ï·‚ Master’s ofScience ÛÙË ÃËÌ›· ÛÙÔ ¶ÔÏÈÙÂÈ·Îfi ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ Iowa. ∂·ÎÔÏÔ‡ıË-Û·Ó ‰ÈÔÚÈÛÌÔ› Û ·Î·‰ËÌ·˚Τ˜ ı¤ÛÂȘ ̤¯ÚÈ ÙÔ 1956, fiÔÙ ÌÂÙ·ÎÈÓ‹ıËÎÂÛÙËÓ √‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ Minnesota. ™ÙË Û¯ÔÏ‹ ·˘-Ù‹ ÂÍÂϤÁË ∫·ıËÁËÙ‹˜ Î·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔ-ÌÈ΋˜ ÙÔ˘ ™ÙfiÌ·ÙÔ˜ ÙÔ 1958 Î·È regents-ηıËÁËÙ‹˜ ÙÔ 1979.

∏ ¤ÚÂ˘Ó¿ ÙÔ˘ ÂÈÎÂÓÙÚÒıËΠÛÙ· ÎÚ·ÓÈÔÚÔÛˆÈο Û‡Ó‰ÚÔÌ·, ηıÒ˜ ηÈÛÙ· Û‡Ó‰ÚÔÌ· Ì ÎÒʈÛË. ∏ ÛËÌ·ÓÙÈÎfiÙÂÚË ÂÈÛÙËÌÔÓÈ΋ ÚÔÛÊÔÚ¿ ÙÔ˘

˘‹ÚÍÂ Ë ·Ó·ÁÓÒÚÈÛË ÎÚ·ÓÈÔÚÔÛˆÈÎÒÓ Û˘Ó‰ÚfïÓ, ¤¯ÔÓÙ·˜ ‰ËÌÔÛȇÛÂÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi 400 ÂÚ-Á·Û›Â˜ ÛÙÔ Â‰›Ô ·˘Ùfi. ∆Ô ÂÎ 1000 ÂÚ›Ô˘ ÛÂÏ›‰ˆÓ Û‡ÁÁÚ·ÌÌ¿ ÙÔ˘: “Syndromes of the Head and Neck”,3Ë ¤Î‰ÔÛË ·fi ÙÔÓ Oxford University Press, ·ÔÙÂÏ› ÎÏ·ÛÈ΋ ÌÔÓÔÁÚ·Ê›· ÛÙÔ ı¤Ì· ·˘Ùfi.

∆Ô 1974 Ô Gorlin ‚Ú·‚‡ıËΠ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Washington ˆ˜ ‰È·ÎÂÎÚÈ̤ÓÔ˜ ·fiÊÔÈÙÔ˜.∞fi ÙÔ 2000 Ô Ù›ÙÏÔ˜ ÙÔ˘ ‹Ù·Ó Regents’. √ÌfiÙÈÌÔ˜ ∫·ıËÁËÙ‹˜ ™ÙÔÌ·ÙÈ΋˜ ¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜Î·È °ÂÓÂÙÈ΋˜, ÂÓÒ Â›¯Â ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙÔ˘ ηıËÁËÙ‹ Ù˘ ·ıÔÏÔÁÈ΋˜ ·Ó·ÙÔÌÈ΋˜, Ù˘ ‰ÂÚÌ·ÙÔÏÔÁ›·˜,Ù˘ ·È‰È·ÙÚÈ΋˜, Ù˘ Ì·È¢ÙÈ΋˜ Î·È Á˘Ó·ÈÎÔÏÔÁ›·˜ Î·È Ù˘ ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁ›·˜. ∂›¯Â ÂÎÏÂÁ›Úfi‰ÚÔ˜ Ù˘ ¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚ›·˜ √‰ÔÓÙÈ·ÙÚÈ΋˜ ŒÚ¢ӷ˜, Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ™ÙÔÌ·ÙÈ΋˜¶·ıÔÏÔÁÈ΋˜ ∞Ó·ÙÔÌÈ΋˜ Î·È Ù˘ ¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚ›·˜ ∫Ú·ÓÈÔÚÔÛˆÈ΋˜ µÈÔÏÔÁ›·˜. À‹ÚÍ ›Û˘·fi ÙÔ˘˜ È‰Ú˘Ù¤˜ Î·È ‰Èψ̷ÙÔ‡¯Ô˘˜ ÙÔ˘ American Board of Medical Genetics/Clinical.

∂›Û˘, › 30ÂÙ›· Û˘Ó¤‚·Ï ÛËÌ·ÓÙÈο ˆ˜ Û˘ÓÙ¿Î˘ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ™ÙÔÌ·ÙÈ΋˜ ¶·ıÔÏÔÁÈ΋˜∞Ó·ÙÔÌÈ΋˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ The Journal of Oral Surgery, Oral Medicine and Oral Pathology. ¢ÈÂÙ¤ÏÂÛÂ̤ÏÔ˜ Ù˘ Û˘ÓÙ·ÎÙÈ΋˜ ÂÈÙÚÔ‹˜ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ American Journal of Medical Genetics ·fi ÙÔ 1977Î·È Dysmorphology and Clinical Genetics ·fi ÙÔ 1982.

∆ÈÌ‹ıËΠ̠ÙÔ ÈÙ·ÏÈÎfi ‚Ú·‚Â›Ô Premio Anni Verdi ÛÙÔ Spoleto, ηıÒ˜ Î·È Ì ÔÏϤ˜ ‰ÈÂıÓ›˜ ÙÈ-ÌËÙÈΤ˜ ‰È·ÎÚ›ÛÂȘ, fiˆ˜ Î·È ÙÔ˘ ÂÈÙ›ÌÔ˘ ‰È‰¿ÎÙÔÚ· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ◊Ù·Ó ·ÓÒÙÂÚÔ Ì¤-ÏÔ˜ ÙÔ˘ (·ÌÂÚÈηÓÈÎÔ‡) πÓÛÙÈÙÔ‡ÙÔ˘ π·ÙÚÈ΋˜ Î·È Ù˘ ∂ıÓÈ΋˜ ∞η‰ËÌ›·˜ ∂ÈÛÙËÌÒÓ. À‹ÚÍ ÚÔ-ÛÎÂÎÏË̤ÓÔ˜ ÔÌÈÏËÙ‹˜ ÙÔ˘ π‰Ú‡Ì·ÙÔ˜ Nobel ÛÙË ™ÙÔίfiÏÌË ÁÈ· ÙË ÁÂÓÂÙÈ΋ Û˘Ì‚ÔÏ‹ ÛÙËÓ ·Ó¿Ù˘-ÍË Î·È Ù· ÓÔÛ‹Ì·Ù·.

ªÂٷ͇ ÙˆÓ Û˘ÁÁÚ·ÌÌ¿ÙˆÓ ÙÔ˘ Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó Ù· ÂÍ‹˜:

ñ R. J. Gorlin, Jens JÔ/rgen Pindborg (1921-1995): Syndromes of the Head and Neck. 1st edition,McGraw-Hill, New York, 1964.

ñ R.J. Gorlin, J.J. Pindborg, M. M. Cohen. Syndromes of the Head and Neck. 2nd edition; 1976.

ñ R.J. Gorlin, M.M. Cohen Jr., L. Stefan Levin. Syndromes of the Head and Neck. 3rd edition. New York:Oxford University Press; 1990.

ñ M. M. Cohen, F. C. Fraser, R. J. Gorlin: Craniofacial disorders. In: Principles and Practice of MedicalGenetics, edited by A.E. Emery and D. Rimoin. London: Churchill Livingstone; 1990.

ñ Hereditary Hearing Loss and its Syndromes: Edited by Robert J. Gorlin, University of MinnesotaSchool of Dentistry, Minneapolis, Helga V. Toriello, Michigan State University, Grand Rapids, and M.Michael Cohen, Jr., Dalhousie University. New York: Oxford University Press; 1995.

¡ÂÎÚÔÏÔÁ›·: R. J. Gorlin

√ Robert Gorlin ÛÂ Û˘-Ó¤‰ÚÈÔ ÛÙËÓ ∫¤Ú΢ڷ(1990)

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∞fi Ù· ÂÒÓ˘Ì· Û‡Ó‰ÚÔÌ· Î·È Ù· ÎÏÈÓÈο ÛËÌ›· Ô˘ ÂÚȤÁÚ·„Â Ô Gorlin Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó ÙÔ Û‡Ó-‰ÚÔÌÔ Goltz-Gorlin, Ë Î‡ÛÙË Gorlin, ÙÔ ÛËÌÂ›Ô Gorlin, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin II, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin III, ÙÔ Û‡Ó-‰ÚÔÌÔ Gorlin-Chaudry-Moss, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin-Cohen, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin-Goltz, ÙÔ Û‡Ó‰ÚÔÌÔ Gorlin-Sedano.

π‰È·›ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ¤¯ÂÈ Ë ÈÛfi‚È· Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Û¿ÓÈˆÓ ÌÔÚÊÒÓ ÓÔ-ÛËÌ¿ÙˆÓ Î·È Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Ì ·Ó·˙‹ÙËÛË ÛÙÔȯ›ˆÓ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË. ∏ Û˘ÁÁÚ·ÊÈ΋ ‰Ú·-ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ ˘ÂÚ¤‚Ë ÙȘ 600 ‰ËÌÔÛȇÛÂȘ. π‰È·›ÙÂÚ· ÁÓˆÛÙfi˜ ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ¿ÏψÛÙ ‰ÈÂÙ¤ÏÂÛ ηÈηıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜, Ô Gorlin ηÏ›ÙÔ Ôχ Û˘¯Ó¿ ÛÙ· ÓÔÛÔÎÔÌ›· Ù˘ ªÈÓÓ¿ÔÏ˘ Î·È ÙÔ˘ St. Paul, fiÙ·ÓÁÂÓÓÈfiÙ·Ó ‚Ú¤ÊÔ˜ Ì ÎÚ·ÓÈÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜. ∞Ó·ÁÓÒÚÈ˙ ÙÔ Û‡Ó‰ÚÔÌÔ, ηıÔ‰ËÁÔ‡Û ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ÁÈ·Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÌÊ·ÓÈÛıÔ‡Ó Î·È ·Ú›¯Â ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÛÙÔ˘˜ ÁÔÓ›˜.

∞Ó Î·È Û˘ÓÙ·ÍÈÔ‰ÔÙ‹ıËΠÙÔ 1993, Ô Gorlin ·Ú¤ÌÂÈÓ ‰Ú·ÛÙ‹ÚÈÔ˜, ‰›ÓÔÓÙ·˜ ‰È·Ï¤ÍÂȘ, Û˘ÁÁÚ¿ÊÔÓÙ·˜ ηÈÛ˘Ì‚Ô˘Ï‡ÔÓÙ·˜. ¢ÈÂıÓÒ˜ ÁÓˆÛÙfi˜ ›¯Â ÙÈÌËı› ˆ˜ ›ÙÈÌÔ˜ ‰È‰¿ÎÙˆÚ fi¯È ÌfiÓÔ ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ,·ÏÏ¿ Î·È ÙÔ˘ ¢Ô˘‚Ï›ÓÔ˘ Î·È Ù˘ ∫ÔÂÁ¯¿Á˘ ÌÂٷ͇ ¿ÏψÓ.

™ÙËÓ ∂ÏÏ¿‰·, Ô˘ Û˘¯Ó¿ ÂÈÛÎÂÙfiÙ·Ó, ›¯Â ÔÏÏÔ‡˜ Ê›ÏÔ˘˜. ∂›¯Â Ì›ÓÂÈ Ì¿ÏÈÛÙ· Î·È ÛÙÔ ÕÁÈÔ ŸÚÔ˜. À‹Ú-Í ·Ú¿‰ÂÈÁÌ· ÚÔ˜ Ì›ÌËÛË ÁÈ· ÙËÓ ÂÚÁ·ÙÈÎfiÙËÙ·, Â˘Ú˘Ì¿ıÂÈ·, ÌÂÙÚÈÔÊÚÔÛ‡ÓË, ·Ú¿ ÙÔ “ÁÈÁ¿ÓÙÈÔ” ٷϤÓÙÔ Î·È·Ó¿ÛÙËÌ¿ ÙÔ˘. √ ı¿Ó·Ùfi˜ ÙÔ˘ ·ÔÙÂÏ› ÌÈ· ÌÂÁ¿ÏË ·ÒÏÂÈ· ÁÈ· ÙËÓ ∫ÏÈÓÈ΋ °ÂÓÂÙÈ΋. ÿÛˆ˜ ·ÔÙÂÏ› Î·È ÙÔ Ù¤-ÏÔ˜ Ù˘ ÂÚÈfi‰Ô˘ ·Ó¿Ù˘Í˘ Î·È ‰È¿‰ÔÛ‹˜ Ù˘ ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜, ÌÈ· Î·È ÙË ‰È·‰¤¯ÂÙ·È Ï¤ÔÓ Ë °ÔÓȉȈ̷ÙÈ-΋ Î·È ÔÈ ÎÏÈÓÈΤ˜ ÂÈÙÒÛÂȘ Ù˘.

ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛfiη˜

164

Paediatriki 2007;70:163-164

Abduazimova Govhar,

13 ¯ÚÔÓÒÓ,O˘˙ÌÂÎÈÛÙ¿Ó¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË

“∆· Ù˘ÊÏ¿ ·È‰È¿˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006

Abduazimova Govhar,

12 years old, UzbekistanPartially blind child

“Blind children

paint”, Anna Laoutari-Gritzala,Athens 2006

45PaiPediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·164

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xxv¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

31 ª·ÚÙ›Ô˘ 2007 5Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· ∂˘ÚˆÎÏÈÓÈ΋˜ ¶·›‰ˆÓ ∞ı‹Ó·

∞›ıÔ˘Û· Olympia•ÂÓÔ‰Ô¯Â›Ô Royal Olympic¶ÏËÚÔÊÔڛ˜: FIRSTEVENT ∂¶∂∆ËÏ.: 210 8228950Fax: 210 8228901E-mail: [email protected]

25-28 ∞ÚÈÏ›Ô˘ 2007 18th Annual Congress of the European Society Brugge,

for Paediatric Urology (ESPU) Belgium

HALL Ambassadeur, Oud-Sint Jan, ZonnekemeersWebsite: www.espu2007.com/

28 ∞ÚÈÏ›Ô˘ 2007 55 ÃÚfiÓÈ· ¶ÚˆÙÔ·ı›˜ ∞ÓÔÛÔ·Ó¿ÚÎÂȘ ∞ı‹Ó·

∂ÌÂÈÚ›·, ∂ÍÂÏ›ÍÂȘ, ¶ÚÔÔÙÈΤ˜ ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ

Î·È ÛÙËÓ ∫ÏÈÓÈ΋ ¶Ú¿ÍË

¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”∆ËÏ.: 210 7467766Fax: 210 7757401Website: www.esid.org

2-4 ª·˝Ô˘ 2007 25th European Congress for Pediatric Porto,

Infectious Diseases Portugal

Centro de Congressos e Exposiço~esContact: Kenes International / ESPID 200717, Rue du Cendrier, PO Box 1726CH-1211 Geneva 1, Switzerland Tel: +41 22 908 0488 Fax: +41 22 732 2850E-mail: [email protected]: www.kenes.com/espid/

2-5 ª·˝Ô˘ 2007 15th TRANSMED: 15th European / Mediterranean Cairo,

Congress about Mother & Child Health Egypt

Contact: Kamel BARGAOUITel.: 33-607-686-118Fax: 33-143-839-985E-mail: [email protected]

2-5 ª·˝Ô˘ 2007 33Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ∞ı‹Ó·

•ÂÓÔ‰Ô¯Â›Ô Hilton¢ÈÔÚÁ¿ÓˆÛË: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓª·È¿Ó‰ÚÔ˘ 23, 11528, ∞ı‹Ó·∆ËÏ.: 210 7211845Fax: 210 7215082E-mail: [email protected]

9-12 ª·˝Ô˘ 2007 40th Annual meeting of the European Society Barcelona,

for Paediatric Gastroenterology, Hepatology Spain

and Nutrition (ESPGHAN)

Catalunya Congress PalaceContact: ESPGHAN 2007 C/o Colloquium 12, rue de la Croix Faubin 75557 Paris Cedex 11 - France Tel.: 33 (0) 1 44 64 15 15 Fax: 33 (0) 1 44 64 15 16 E-mail: [email protected]

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xxvi

11-13 ª·˝Ô˘ 2007 37o ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰Ô‰ÔÓÙÈÎfi ™˘Ó¤‰ÚÈÔ ∫·‚¿Ï·

™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ ¡ÔÌ·Ú¯›·˜ ∫·‚¿Ï·˜∆ËÏ.: 210 6107213∂-mail: [email protected]

25-27 ª·˝Ô˘ 2007 45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ™ÈıˆÓ›·,

™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ Porto Carras “Olympic” ÷ÏÎȉÈ΋

¶ÏËÚÔÊÔڛ˜: AC&C International S.A. ∆ËÏ.: 210 6889 100Fax: 210 6844 777 ∂-mail: [email protected]: www.pediatric2007.gr

7-10 πÔ˘Ó›Ô˘ 2007 5Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ ∞ı‹Ó·

∂Ù·ÈÚ›·˜ ∂ÏÏ¿‰Ô˜

ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: AC&C International∆ËÏ.: 210 6889100 Fax: 210 6844777E-mail: [email protected]: www.hscapcongress2007.com/

27-30 πÔ˘Ó›Ô˘ 2007 46th European Society for Pediatric Helsinki,

Endocrinology Meeting Finland

Contact: Meeting SecretariatCongrex Sweden ABP.O. Box 5619, SE-114 86 Stockholm, SwedenTel.: +46 8 459 66 00Fax: +46 8 661 91 25E-mail: [email protected]: www.espe2007.org/

5-7 πÔ˘Ï›Ô˘ 2007 17th Annual Meeting of the European ∞ı‹Ó·

Childhood Obesity Group (ECOG)

Athenaeum Intercontinental¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress S.A15, Mesogion Avenue. 115 26 Athens, Greece∆ËÏ.: 210 7499 372 / 304 / 300 Fax: 210 7713 795E-mail: [email protected]: www.ecog2007.gr

25-30 A˘ÁÔ‡ÛÙÔ˘ 2007 25th International Congress of Pediatrics ∞ı‹Ó·

ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ∞C&C International, PCOTel: 210 68 89 100Fax: 210 68 44 777E-mail: [email protected]: www.icp2007.gr

31 ∞˘ÁÔ‡ÛÙÔ˘ - 14th Congress of the International Pediatric µÔ˘‰·¤ÛÙË,

4 ™ÂÙÂÌ‚Ú›Ô˘ 2007 Nephrology Association √˘ÁÁ·Ú›·

Blaguss Congress BureauTel.: +36 1 374 7030, Fax: +36 1 312 1582E-mail: [email protected]: www.ipna2007.com

Pediatr Mar-Apr 07 28-03-07 17:23 ™ÂÏ›‰·168