Παιδιατρική | Τόμος 64 • Τεύχος 2 • Μάρτιος - Απρίλιος 2001

E•øº.¶AI¢IATP.MAPT-A¶P

17-10-01 15:37

™ÂÏ›‰· 1

ISSN 0377-2551

M¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2001 . ∆fiÌÔ˜ 64 . ∆‡¯Ô˜ 2

°∂¡π∫√ £∂ª∞

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TOMO™ 64

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TEYXO™ 2

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ETO™ 2001

∫Ú˘„ÔÚ¯›· - ÙÚ¤¯Ô˘Û˜ ·fi„ÂȘ

GENERAL PAPER 93

°. ™·ÎÂÏÏ¿Ú˘, ∂. ∫fiÎÎÔÚË, ™. µÏ·˙¿Î˘, ∞. ∫Ú·ÛÔ˘‰¿Î˘, °. ÷ڛÛ˘

G. Sakellaris, H. Kokkori, S. Vlazakis, A. Krasoudakis, G. Charissis

ANA™KO¶H™∂π™ ™ËÌ·Û›· ÙÔ˘ Ȉ‰›Ô˘ Î·È Ù˘ ı˘ÚÔ͛Ӣ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi

REVIEW ARTICLES 101

∫. ¶·ÓÙÛÈÒÙÔ˘

√ ıˆÚ·ÎÈÎfi˜ fiÓÔ˜ ÛÙ· ·È‰È¿. ∫ÏÈÓÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË

115

125

ORIGINAL PAPERS 132

∂. ¶··‚·ÛÈÏ›Ԣ, µ. ∫¿ÏÏÈÔ˘, ¡. ∫·Ì¿˜ 136

Infectious agents and low herd immunity in the etiology of childhood leukemia M. Dalamaga, E. Petridou, D. Trichopoulos, A. Mentis, A. Skalkidou, T. Karpathios, F. Athanasiadou-Piperopoulou, M. Kalmanti, D. Koliouskas, E. Kosmidou, J. Panagiotou, F. Tzortzatou-Stathopoulou

145

Comparative trial of natural and synthetic surfactants in the treatment of respiratory distress syndrome of prematurity E. Hatzidaki, E. Korakaki, M. Christodoulaki, K.M. Margari, D. Mamoulakis, A. Manoura, C. Giannakopoulou

∂. ÷Ù˙ˉ¿ÎË, ∂. ∫ÔڷοÎË, ª. ÃÚÈÛÙÔ‰Ô˘Ï¿ÎË, ∫.ª. ª·ÚÁ¿ÚË, ¢. ª·ÌÔ˘Ï¿Î˘, ∞. ª·ÓÔ˘Ú¿, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

√ÏÈ΋ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· Ï¿ÛÌ·ÙÔ˜ ·ÛıÂÓÒÓ Ì ÎÏ·ÛÈ΋ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ˘fi ‰›·ÈÙ·

The tubercular infection index among pre-school age children in the district of Korinthos ∂. ¶··‚·ÛÈÏ›Ԣ, µ. ∫¿ÏÏÈÔ˘, ¡. ∫·Ì¿˜

ª. ¡Ù·Ï·Ì¿Áη, ∂. ¶ÂÙÚ›‰Ô˘, ¢. ∆ÚȯfiÔ˘ÏÔ˜, ∞. ªÂÓÙ‹˜, Õ. ™Î·ÏΛ‰Ô˘, £. ∫·Ú¿ıÈÔ˜, º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘, ª. ∫·ÏÌ·ÓÙ‹, ¢. ∫ÔÏÈÔ‡Ûη˜, ∂. ∫ÔÛÌ›‰Ë, π. ¶·Ó·ÁÈÒÙÔ˘, º. ∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘

™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ¯ÔÚ‹ÁËÛ˘ Ê˘ÛÈÎÔ‡ Î·È Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ

Abuse of children by their peers D. Protagora-Lianou

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

§ÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ Î·È ¯·ÌËÏ‹ Û˘ÏÏÔÁÈ΋ ·ÓÔÛ›· ÛÙËÓ ÂӉ¯fiÌÂÓË ·ÈÙÈÔÏÔÁ›· Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜

Chest pain in children.

A clinical diagnostic approach G.S. Varlamis

¡. ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡

¢Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙÔ ¡ÔÌfi ∫ÔÚÈÓı›·˜

The importance of iodine and thyroxine in the hyman organism K. Pantsiotou

°.™. µ·ÚÏ¿Ì˘

∏ ηÎÔÔ›ËÛË ·È‰ÈÒÓ ·fi ¿ÏÏ· ·È‰È¿

Current management of the undescended testis

154

Plasma total antioxidant status in phenylketonuria patients on diet

∫.∂. ™Ô‡ÏË, ™. ∆۷ΛÚ˘, °.∞. ∫·Ú›Î·˜, ª. ªÔ‡Î·˜, ¶. ª¯ڿ΢

K.H. Schulpis, S. Tsakiris, G.A. Karikas, M. Moukas, P. Behrakis

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

Continuation of table of contents inside title page

March - April 2001 . Volume 64 . No 2

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 5

ª¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2001 . ∆fiÌÔ˜ 64 . ∆‡¯Ô˜ 2

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™ ∏ ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ˆ˜ ÂΉ‹ÏˆÛË Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ Û ‚Ú¤ÊÔ˜

Continuation of table of contents

159

N. Baltogiannis, E. Papandreou, C. Chiotinis, V. Charisi, D. Keramidas

¡. ª·ÏÙÔÁÈ¿ÓÓ˘, ∂. ¶··Ó‰Ú¤Ô˘, Ã. ÃȈٛÓ˘, µ. ÷ڛÛË, ¢. ∫ÂÚ·Ì›‰·˜

¶·ÚÔ‰È΋ ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË Î·È ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ Û ÓÂÔÁÓfi

163

π. ∫·Ï¤ÁÈ·˜, ¡. π·Îˆ‚›‰Ô˘, ∂. ªÂÁ·ÏÔÁÈ¿ÓÓË, ™. ƒ¿ÌÌÔ˜, °. ∫Ô˘Ú¿Î˘, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜

™˘ÁÁÂÓ‹˜ Û‡ÊÈÏË: Ì›· Û‡Á¯ÚÔÓË ·ÂÈÏ‹

168

172

177

181

188

Disorders of thyroid function in children with insulin dependent diabetes mellitus (IDDM) A. Kaimara-Papathanasiou, C. Hadjiathanasiou, C. Theodoridis

194

LETTERS ¶.¢. §··ÙÛ¿Ó˘, Õ. ÿÏÏ· Ã. ∫·Ú‹˜, ¢. ∫·Ú·Î·˚‰fi˜

¶.¢. §··ÙÛ¿Ó˘, Õ. ÿÏÏ· Ã. ∫·Ú‹˜, ¢. ∫·Ú·Î·˚‰fi˜

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

Seizures after dermal exposure to DEET M. Narlioglou, G. Briassoulis, T. Hatzis

∞. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘, Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜

E¶π™∆√§∂™

Facial palsy caused by latent mastoiditis ∑. ∏ÏÈÔ‰ÚÔÌ›ÙË, º. æ‡¯Ô˘, π. ¡›Î·˜, •. ∫Ú›ÎÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘

ª. ¡·ÚÏ›ÔÁÏÔ˘, °. ªÚÈ·ÛÔ‡Ï˘, ∞. ÷Ù˙‹˜

¢È·Ù·Ú·¯¤˜ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û ·È‰È¿ Ì ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË

Kawasaki disease assosiated with primary Epstein-Barr virus infection G. Triantafyllidis, D. Karakaidos, P. Zosi, T. Vlachou, L. Kanaris, C. Karis

∑. ∏ÏÈÔ‰ÚÔÌ›ÙË, º. æ‡¯Ô˘, π. ¡›Î·˜, •. ∫Ú›ÎÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘

™·ÛÌÔ› ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ÂÓÙÔÌÔ·ˆıËÙÈÎfi

Congenital syphilis: a current threat E. Korakaki, E. Hatzidaki, A. Manoura, P. Smirnaki, I. Papamastoraki, C. Giannakopoulou

°. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, ¢. ∫·Ú·Î·˚‰fi˜, ¶. ∑ÒÛË, £. µÏ¿¯Ô˘, §. ∫·Ó¿Ú˘, Ã. ∫·Ú‹˜

¶¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Û ·È‰› Ì ϷÓı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ·

Transient cortical hyperostosis and elevation of alkaline phosphatase following long-term administration of prostaglandin J. Kaleyias, N. Iakovidou, E. Megaloyianni, S. Rammos, G. Kourakis, H. Dellagrammaticas

∂. ∫ÔڷοÎË, ∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ¶. ™Ì˘ÚÓ¿ÎË, π. ¶··Ì·ÛÙÔÚ¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

NfiÛÔ˜ Kawasaki Ì ·Û˘Ó‹ıË ÚˆÙÔ·ı‹ Ïԛ̈ÍË ·fi ÙÔÓ Èfi Epstein-Barr

CASE REPORTS Congenital diaphragmatic hernia presenting with acute respiratory distress in an infant

196

PAEDIATRIC NEWS

∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

∑. Papadopoulou-Couloumbis

™˘Ó¯›˙ÔÓÙ·È

Continued

ªarch - April 2001 . Volume 64 . No 2

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 6

ª¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2001 . ∆fiÌÔ˜ 64 . ∆‡¯Ô˜ 2

™˘Ó¤¯ÂÈ· ÂÚȯÔÌ¤ÓˆÓ ¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶√ ∆∏ µπµ§π√°ƒ∞ºπ∞ ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ̤ۈ Ù˘ PCR ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙ· ÙÚ·¯Âȷο ÂÎÎÚ›ÌÌ·Ù· ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ: Û˘Û¯¤ÙÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ·‰ÂÓÔ˚Ô‡˜ Ì ÙË ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·

Continuation of table of contents 100

Couroucli XI, Welty SE, Ramsay PL, Wearden ME Fuentes-Garcia FJ, Jiyuan NI, Jacobs TN Towbin JA, Bowles NE ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™. ºˆÙfiÔ˘ÏÔ˜

√ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ Î·È ÎÏÈÓÈ΋ ÔÚ›· Ïԛ̈͢ Ì RSV Û ÓÔÛËÏ¢fiÌÂÓ· Î·È ÌË ‚Ú¤ÊË

Couroucli XI, Welty SE, Ramsay PL, Wearden ME Fuentes-Garcia FJ, Jiyuan NI, Jacobs TN Towbin JA, Bowles NE Greek translation: S. Fotopoulos 124

Trefny P, Stricker T, Baerlocher C, Sennhauser FH ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: M. AÓıÚ·ÎfiÔ˘ÏÔ˜

¶·ÏÌÈ΋ Ô͢ÌÂÙÚ›·: ∆È Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ÛÙÔ ∆Ì‹Ì· º˘ÛÈÔÏÔÁÈÎÒÓ ¡ÂÔÁÓÒÓ;

135

167

171

IL-8 and neutrophil elastase levels in the respiratory tract of infants with RSV bronchiolitis Abu-Harb M, Bell F, Finn A, Rao WH Nixon L, Shale D, Everard ML Greek translation: M. Anthrakopoulos

180

Shaw MP, Bath LE, Duff J, Kelnar CJ, Wallace WHB ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

¢È·Î‡Ì·ÓÛË ÙÔ˘ fiÓÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ıÂÚ·›·˜ ÁÈ· ηÚΛÓÔ Û ·È‰È¿: ¶ÂÚÈÁÚ·ÊÈ΋ ÚÔÛ¤ÁÁÈÛË

Effect of seating position and restrained use on injuries to children in motor vehicle crashes Berg M, Cook L, Corneli H, Vernon D, Dean J Greek translation: ∆. Tsoumakas

Abu-Harb M, Bell F, Finn A, Rao WH Nixon L, Shale D, Everard ML ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: M. AÓıÚ·ÎfiÔ˘ÏÔ˜

¶·¯˘Û·ÚΛ· ÛÙÔ˘˜ ÂÈ‚ÈÒÛ·ÓÙ˜ ·fi Ï¢¯·ÈÌ›·. ∏ Û˘Ì‚ÔÏ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜

Pulse oximetry: What’s normal in the newborn nursery?

Levesque BM, Pollack P, Griffin BE, Nielsen HC Greek translation: M. Anthrakopoulos

Berg M, Cook L, Corneli H, Vernon D, Dean J ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: £. ∆ÛÔ˘Ì¿Î·˜

∂›‰· IL-8 Î·È Ô˘‰ÂÙÂÚÔÊÈÏÈ΋˜ ÂÏ·ÛÙ¿Û˘ ÛÙËÓ ·Ó·Ó¢ÛÙÈ΋ Ô‰fi ‚ÚÂÊÒÓ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi RSV

Family history of atopy and clinical course of RSV infection in ambulatory and hospitalized infants Trefny P, Stricker T, Baerlocher C, Sennhauser FH Greek translation: M. Anthrakopoulos

Levesque BM, Pollack P, Griffin BE, Nielsen HC ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: M. AÓıÚ·ÎfiÔ˘ÏÔ˜

√È Û˘Ó¤ÂȘ Ù˘ ı¤Û˘ ÛÙÔ Î¿ıÈÛÌ· ·˘ÙÔÎÈÓ‹ÙÔ˘ Î·È Ù˘ ¯Ú‹Û˘ ˙ÒÓ˘ ·ÛÊ·Ï›·˜ ÛÙȘ ηÎÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ Û ·˘ÙÔÎÈÓËÙÈÛÙÈο ·Ù˘¯‹Ì·Ù·

LITERATURE ABSTRACTS Detection of microorganisms in the tracheal aspirates of preterm infants by polymerase chain reaction: association of adenovirus infection with bronchopulmonary dysplasia

Obesity in leukemia survivors: The familial contribution Shaw MP, Bath LE, Duff J, Kelnar CJ, Wallace WHB Greek translation: F. Athanasiadou-Piperopoulou

187

Pain variations during cancer treatment in children: A descriptive survey Ljungman G, Gordh T, Sörensen S, Kreuger A Greek translation: F. Athanasiadou-Piperopoulou

Ljungman G, Gordh T, Sörensen S, Kreuger A ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xv

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xix

Abbreviations

ªarch - April 2001 . Volume 64 . No 2

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 7

M¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2001

. ∆fiÌÔ˜

64

. ∆‡¯Ô˜

2

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

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

I‰ÈÔÎÙ‹Ù˘© EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó·È 115 28

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

TËÏ:. (01) 7771 140 / 7771 663, Fax: 7758 354

Tel. (01) 7771 140 / 7771 663, Fax: 7758 354

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∫. ª·Ï·Î¿ ¢È¢ı˘ÓÙ‹˜ : ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ : °. µ·ÚÏ¿Ì˘ : ¶. ∫·ÊÚ›ÙÛ· : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ : £. ∆ÛÈÏÈÁÈ¿ÓÓ˘ : ∫. ∆ÛÔ˘Ì¿Î·˜ : ™. ºˆÙfiÔ˘ÏÔ˜ : A. ÷Ù˙‹˜

Scientific President Editor Members

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ º. ª·˘ÚÔÂȉ‹

Manuscript Editing

∂È̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

English Editing Z. Papadopoulou-Couloumbis

∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 ∞ı‹Ó·È 115 28 ∆ËÏ: (01) 7771 140, Fax: 7758 354

Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: (01) 7771 140, Fax: 7758 354

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Editorial Board : K. Malaka : Z. Papadopoulou-Couloumbis : E. Agelaki-Georgaki : F. Athanassiadou-Piperopoulou : M. Anthrakopoulos : G. Varlamis : P. Kafritsa : A. Konstadopoulos : Th. Tsiligiannis : K. Tsoumakas : S. Fotopoulos : ∞. Hatzis

Greek Editing F. Mavroidi

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March - April 2001

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Volume 64

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No 2

πSSN 0377-2551 i

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 9

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫∏" Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘Ó¯‹ È·ÙÚÈ΋ ÂÓË̤ڈÛË Î·È ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ì ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚȯfiÌÂÓÔ, ÁÂÓÈο ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È ˘Á›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘Ó‰ڛˆÓ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ·Ó·ÊÔÚ¤˜ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‚Ú·‚¢ı› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫∏" ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi "¶∞π¢π∞∆ƒπ∫∏". ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ "¶∞π¢π∞∆ƒπ∫∏" Î·È Ë ÔÏÈ΋ ‹ ÌÂ-

ÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927934, http://jama.ama-assn.org/info/auinst_req.html.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word .doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Exel ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 4 ÌËÓÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ÂÙ¿ (7) Ë̤Ú˜.

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

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢ڤ˜.

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

v

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 10

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 ÛÂÏ›‰Â˜, ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ 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˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H 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˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi.

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

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

K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T· ∞ÔÙÂϤÛÌ·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. H ™˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆ-

vi

ÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›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·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors / Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov). ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÏÂ͛Ԣ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·, ·ÚfiÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1996;59:272-279.

2001 MAPT- A¶PI§

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

elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995.

™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

¶›Ó·Î˜ Î·È ÂÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

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Laux-End R, Inaebnit D, Gerber HA, Bianchetti MG. Vasculitis associated with levamisole and circulating autoantibodies [letter]. Arch Dis Child 1996;75:355-356.

II. µÈ‚Ï›· ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ - ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜ - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ - Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ - fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ¢¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¡ÙÔ˘ÓÙÔ˘Ï¿Î˘ π. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ·È‰È¿ οو ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

Kaplan SJ. Post hospital home health care: the

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°∂¡π∫√ £∂ª∞

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GENERAL PAPER

∫Ú˘„ÔÚ¯›· - ÙÚ¤¯Ô˘Û˜ ·fi„ÂȘ °. ™·ÎÂÏÏ¿Ú˘1, ∂. ∫fiÎÎÔÚË2, ™. µÏ·˙¿Î˘1, ∞. ∫Ú·ÛÔ˘‰¿Î˘1, °. ÷ڛÛ˘1

Current management of the undescended testis G. Sakellaris1, H. Kokkori2, S. Vlazakis1, A. Krasoudakis1, G. Charissis1

¶ÂÚ›ÏË„Ë: ∏ ÎÚ˘„ÔÚ¯›· Â›Ó·È ÂÙÂÚfiÏ¢ÚÔ˜ Û ÔÛÔÛÙfi 80% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛˆÓ. £ÂÚ·‡ÂÙ·È Û¿ÓÈ· Ì ÙË ¯ÔÚ‹ÁËÛË ¯ÔÚÈÔÓÈ΋˜ ÁÔÓ·‰ÔÙÚÔ›Ó˘ (hCG) Î·È Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ¯ÂÈÚÔ˘ÚÁÈο ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ ÁÈ· Ó· ¤¯Ô˘ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Î·È Î·Ï‹ ÛÂÚÌ·ÙÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·. √ ÎÚ˘„fiگȘ ‰ÂÓ ˆÚÈÌ¿˙ÂÈ Ê˘ÛÈÔÏÔÁÈο ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ, ·Ú¿ÁÂÈ ‰Â ·ÓÙÈÛÒÌ·Ù· Ô˘ ‰ÚÔ˘Ó ‚Ï·ÙÈο Î·È ÛÙÔÓ ÔÚıfiÙÔÔ fiÚ¯È. ŸÛÔ ˘„ËÏfiÙÂÚ· ·fi ÙÔ fiÛ¯ÂÔ Â›Ó·È Ô fiگȘ, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚ˜ ÈÛÙÔÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ·ÚÔ˘ÛÈ¿˙ÂÈ. √È ˘ÔÏ·ÛÙÈÎÔ› fiÚ¯ÂȘ Ú¤ÂÈ Ó· ·Ê·ÈÚÔ‡ÓÙ·È ¤ÁηÈÚ·. °ÂÓÈο, Ú¤ÂÈ Ó· ·Ê·ÈÚÔ‡ÓÙ·È ÔÈ ÎÚ˘„fiÚ¯ÂȘ Û ˘„ËÏ‹ ı¤ÛË, Ô˘ ‰ÂÓ ¤¯Ô˘Ó ηıËψı› ¯ÂÈÚÔ˘ÚÁÈο ÛÙÔ fiÛ¯ÂÔ ÚÈÓ ÙËÓ ÂÊ˂›·.

Abstract: The undescended testes are unilateral in approroximately 80% of cases, are rarely corrected by human chorionic gonadotropin (hCG), and should be treated by orchiopexy before the patient reaches the age of 3 years to permit optimal tubular development and sperm function. A cryptorchid testis does not mature normally after the age of 2 year and may produce antibodies which may have adverse effects on the normal contralateral descended testis. The higher a cryptorchid testis resides above the scrotum, the more dysgenetic the morphology is likely to be.

Hypoplastic cryptorhid testis should be removed early. In general, high-positioned testes that have not been surgically placed into the scrotum before midadolescence should be removed.

§¤ÍÂȘ ÎÏÂȉȿ: ÎÚ˘„ÔÚ¯›·, ·ÓÙÈÌÂÙÒÈÛË.

Key words: undescended testis, management.

∂ÈÛ·ÁˆÁ‹ ∞fi Ù· ¿ÚÚÂÓ· ÓÂÔÁÓ¿, ¤Ó· ÔÛÔÛÙfi ÌÂٷ͇ 13% ¤¯ÂÈ ¿‰ÂÈÔ fiÛ¯ÂÔ, ηıÈÛÙÒÓÙ·˜ ÙËÓ ÎÚ˘„ÔÚ¯›· Ì›· ·fi ÙȘ ϤÔÓ Û˘¯Ó¤˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ·ı‹ÛÂȘ ÛÙ· ·È‰È¿. ∂ÈÚfiÛıÂÙ·, ÂÎÙfi˜ Ù˘ Â›‰Ú·Û˘ ÛÙË ÁÔÓÈÌfiÙËÙ·, Ë ÎÚ˘„ÔÚ¯›· Â›Ó·È ¤Ó·˜ ÁÓˆÛÙfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·ÚΛÓÔ˘ ÛÙÔÓ fiÚ¯È. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÎÚ˘„ÔÚ¯›·˜ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË, ·Ú' fiÏ· ·˘Ù¿ Ù· ·Ó‰ÚÔÁfiÓ· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·›˙Ô˘Ó ¤Ó· ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÔÚÌÔÓÈ΋ Ú‡ıÌÈÛË Ù˘ ÔÚ¯È΋˜ ηıfi‰Ô˘. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ÙÔÔı¤ÙËÛË ÙÔ˘ fiگˆ˜ ÛÙÔ

ËÌÈfiÛ¯ÂÔ Â›Ó·È Ë ıÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· ÙÔ˘˜ ·ÏËı›˜ ÎÚ˘„fiÚ¯ÂȘ. ¶·ıÔÁ¤ÓÂÈ· ∂Ì‚Ú˘ÔÏÔÁ›· ∏ ÂÌ‚Ú˘˚΋ ·Ó¿Ù˘ÍË ÙÔ˘ fiگˆ˜ (1) ÌÔÚ› Ó· ‰È·ÈÚÂı› Û ÙÚÂȘ Ê¿ÛÂȘ: ñ ∂Ó‰ÔÎÔÈÏȷ΋ (·fi ÙÔÓ 1Ô ¤ˆ˜ ÙÔÓ 7Ô Ì‹Ó·). ñ ∂Ó‰ÔηӷÏÈ΋ (·fi ÙÔÓ 7Ô ˆ˜ ÙÔÓ 8Ô Ì‹Ó·). ñ √Û¯Â˚΋ (8Ô˜ Î·È 9Ô˜ Ì‹Ó·˜). √È fiÚ¯ÂȘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙȘ ÂÌ‚Ú˘˚Τ˜ ÌÂÛÔÓÂÊÚÈΤ˜ ·ÎÚÔÏÔʛ˜ Âη٤ڈıÂÓ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘.

1 ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¶.¡.∏. ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘-¶·Ó¿ÓÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

1 ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¶.¡.∏. ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ˘-¶·Ó¿ÓÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

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∫·ıÒ˜ ÙÔ ÚfiÛıÈÔ ÎÔÈÏÈ·Îfi ÙÔ›¯ˆÌ· ·Ó·Ù‡ÛÛÂÙ·È, ÔÈ fiÚ¯ÂȘ ÚÔÛʇÔÓÙ·È ÛÙÔ ‚Ô˘‚ˆÓÈÎfi fiÚÔ ·fi ›Ó˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ Ô›·Î·. ªÂÙ·ÁÂÓ¤ÛÙÂÚË Û˘ÚÚ›ÎÓˆÛË ÙÔ˘ Ô›·Î· ÈÛÙ‡ÂÙ·È fiÙÈ ÚÔηÏ› ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙÔ˘ fiگˆ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ‚Ô˘‚ˆÓÈÎÔ‡ fiÚÔ˘ ηٿ ÙËÓ ÂÚ›Ô‰Ô ÙÔ˘ ¤‚‰ÔÌÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ Ì‹Ó·. ¶ÚÈÓ ÙËÓ Î¿ıÔ‰Ô, Ô fiگȘ ηχÙÂÙ·È ·fi ÂÚÈÙfiÓ·ÈÔ, ÙÔ ÔÔ›Ô ·ÎÔÏÔ‡ıˆ˜ ÌÂÙ·ÙÚ¤ÂÙ·È Û ÂÏ˘ÙÚÔÂȉ‹ ¯ÈÙÒÓ· ÛÙÔ fiÛ¯ÂÔ. √ Ô›·Î·˜ ÚÔÛʇÂÙ·È ¿ÓˆıÂÓ ÙÔ˘ ÂÁÁ‡˜ ¿ÎÚÔ˘ ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ fiÚÔ˘ Î·È ‰È·ÈÚÂ›Ù·È ÂÚÈÊÂÚÈο Û ·ÚÎÂÙ¤˜ Ù·Èӛ˜ Ô˘ Êı¿ÓÔ˘Ó Ì¤¯ÚÈ ÙÔ ‰·ÚÙfi ÛÙÔ fiÛ¯ÂÔ. ∂›Û˘, Ô fiگȘ Ê˘ÛÈÔÏÔÁÈο ·ÎÔÏÔ˘ı› ÙËÓ ¤ÎÙ·ÛË ÙÔ˘ ÔÛ¯¤Ô˘. ªÂÚÈΤ˜ ÊÔÚ¤˜, fï˜, ·ÎÔÏÔ˘ı› Î·È Ì›· ·fi ÙȘ Ù·Èӛ˜ ÙÔ˘ Ô›·Î· ÚÔ˜ ¤ÎÙÔË ı¤ÛË ÛÙÔ ÂÚ›ÓÂÔ, ˘ÂÚË‚Èο ‹ Û οÔÈ· ı¤ÛË ÙÔ˘ ÌËÚÔ‡. ŸÙ·Ó Ô fiگȘ Êı¿ÛÂÈ ÛÙÔ fiÛ¯ÂÔ Ô Ô›·Î·˜ Á›ÓÂÙ·È ‰˘Û‰È¿ÎÚÈÙÔ˜ Î·È ·ÙÚÔÊ›. ¶ÔÏϤ˜ Ï¢ڤ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂÌ‚Ú˘ÔÏÔÁÈ΋ Î·È ÌÔÚÊÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ fiگˆ˜ ·Ú·Ì¤ÓÔ˘Ó ·‰È¢ÎÚ›ÓÈÛÙ˜ ·ÎfiÌË. √ÚÌÔÓÈ΋ Â›‰Ú·ÛË ∏ οıÔ‰Ô˜ ÙÔ˘ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ ÂËÚ¿˙ÂÙ·È ·fi ÙȘ ÌËÙÚÈΤ˜ ÁÔÓ·‰ÔÙÚÔ›Ó˜, ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ÙËÓ ·Ú·ÁˆÁ‹ ·Ó‰ÚÔÁfiÓˆÓ ·fi ÙÔ˘˜ ÂÌ‚Ú˘˚ÎÔ‡˜ fiÚ¯ÂȘ (2). ∆· ·ÙÙ·Ú· Sertoli ÙÔ˘ fiگˆ˜ ·Ú¿ÁÔ˘Ó Ì›· ÂȉÈ΋ ÔÚÌfiÓË Ô˘ Â›Ó·È ÁÓˆÛÙ‹ ˆ˜ ·Ó·ÛÙÔϤ·˜ ÙÔ˘ Ì˘ÏÏÂÚ›Ԣ fiÚÔ˘ (MIF), ˘‡ı˘ÓË ÁÈ· ÙËÓ ˘ÔÛÙÚÔÊ‹ ÙˆÓ Ì˘ÏÏÂÚ›ˆÓ fiÚˆÓ. ∆· ·ÙÙ·Ú· Leyding ·Ú¿ÁÔ˘Ó ÙË ‰ÚÒÛ· ÙÔÈο ÙÂÛÙÔÛÙÂÚfiÓË, Ë ÔÔ›· Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ÌÂÛÔÓÂÊÚÈÎÔ‡ fiÚÔ˘ Û ÛÙÔȯ›· ÙÔ˘ Wolf. ∏ ¤ÎÎÚÈÛË ÙÂÛÙÔÛÙÂÚfiÓ˘ ̤۷ ÛÙËÓ ÂÌ‚Ú˘˚΋ ΢ÎÏÔÊÔÚ›· Î·È Ë ÂÚÈÊÂÚÈ΋ ÌÂÙ·ÙÚÔ‹ Ù˘ Û ‰È˘‰ÚÔÙÂÛÙÔÛÙÂÚfiÓË Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙËÓ ·ÚÚÂÓÔÔ›ËÛË ÙˆÓ ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ. ∂Ï¿Ùو̷ Û οÔÈÔ ÛÙ¿‰ÈÔ Ù˘ ÔÚ¯È΋˜ ÔÚÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ¿ÚÚÂÓ· „¢‰ÂÚÌ·ÊÚÔ‰ÈÙÈÛÌfi, Ì ‹ ¯ˆÚ›˜ ÎÚ˘„ÔÚ¯›·. À„ËϤ˜ ÙÈ̤˜ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ Â›Ó·È ·ÚÔ‡Û˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ηٿ ÙËÓ ÂÚ›Ô‰Ô ÙˆÓ 8 ÙÂÏÂ˘Ù·›ˆÓ ‚‰ÔÌ¿‰ˆÓ Ù˘ ÂÌ‚Ú˘˚΋˜ ·Ó¿Ù˘Í˘ Î·È ·ÎÔÏÔ‡ıˆ˜ Â›Ó·È Û¯Â‰fiÓ ·Ó‡·ÚÎÙ˜ ·fi ÙË Á¤ÓÓËÛË ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 10 - 12 ÂÙÒÓ, ÔfiÙ ٷ Â›‰¿ ÙÔ˘˜ ·˘Í¿ÓÔ˘Ó ÂÎ Ó¤Ô˘. ∏ ·ÔÙ˘¯›· ÙÔ˘ fiگˆ˜ Ó· η٤ÏıÂÈ ÛÙÔ fiÛ¯ÂÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ΢‹Ûˆ˜ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÂ¿ÚÎÂÈ· ÔÚÌÔÓÒÓ, Ì ·ÔÙ˘¯›· ÙÔ˘ fiگˆ˜ Ó· ··ÓÙ‹ÛÂÈ ÛÙȘ ÔÚÌfiÓ˜, Ì ·ÓÂ·Ú΋ ¤ÏÍË ·fi ÙÔÓ Ô›·Î· ‹ Ì ¿ÏÏÔ˘˜ ÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÁÈ·Ù› ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi 80% Ù˘ ÎÚ˘„ÔÚ¯›·˜ Â›Ó·È ÂÙÂÚfiÏ¢ÚÔ˜.

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¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ˘Ôı¤ÙÔ˘Ó fiÙÈ Ë ÂÓ‰ÔÎÔÈÏȷ΋ οıÔ‰Ô˜ ÙÔ˘ fiگˆ˜ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙË ‰Ú¿ÛË ÙˆÓ ·Ó‰ÚÔÁfiÓˆÓ, ·ÏÏ¿ Ù· ·Ó‰ÚÔÁfiÓ· ÂϤÁ¯Ô˘Ó ÙËÓ Î¿ıÔ‰Ô ÙÔ˘ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ Ì¤Ûˆ ÙÔ˘ ‚Ô˘‚ˆÓÈÎÔ‡ fiÚÔ˘, Ú˘ıÌ›˙ÔÓÙ·˜ ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙÔ˘ Ô›·Î· ηıÒ˜ Î·È ÙËÓ ·‡ÍËÛË Ù˘ ÂÏ˘ÙÚÔÂÚÈÙÔÓ·˚΋˜ Ù˘¯‹˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ÌËÚÔÁÂÓÓËÙÈÎÔ‡ Ó‡ÚÔ˘ (3,4). ¢ÂÓ Â›Ó·È ·Ô‰ÂÎÙfi fiÙÈ ÎÚ˘„fiÚ¯ÂȘ Ì Ì˯·ÓÈ΋ ·fiÊÚ·ÍË ÌÔÚÔ‡Ó Ó· η٤ÏıÔ˘Ó ÛÙÔ fiÛ¯ÂÔ ··ÓÙÒÓÙ·˜ Û Â͈ÁÂÓ›˜ ‹ ÂÓ‰ÔÁÂÓ›˜ ÔÚÌfiÓ˜ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÚÒÙˆÓ ÌËÓÒÓ. ∫ÂÓfi fiÛ¯ÂÔ ∆Ô fiÛ¯ÂÔ ÌÔÚ› Ó· Â›Ó·È ÎÂÓfi ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Û ÔÛÔÛÙfi 20-30% Î·È ÛÙ· ÓÂÔÁÓ¿ ηٿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Û ÔÛÔÛÙfi 1,8-4,0%. ∏ ‰È¿ÁÓˆÛË Ù˘ ·ÏËıÈÓ‹˜ ÎÚ˘„ÔÚ¯›·˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛÙ› ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ, ÂȉÈο ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿. ŒÂÈÙ·, Ô fiگȘ ÌÔÚ› Ó· Êı¿ÛÂÈ ÛÙÔ fiÛ¯ÂÔ Ì ̛· ‹È· ¤ÏÍË. ∆Ô ÎÂÓfi fiÛ¯ÂÔ ÌÔÚ› Ó· ÚÔ·ÙÂÈ ·fi ·Ó·ÛÒÌÂÓÔ˘˜ fiÚ¯ÂȘ, ·fi ·ÏËı›˜ ÎÚ˘„fiÚ¯ÂȘ (86%), ·fi ‰˘ÛÁÂÓÂÙÈÎÔ‡˜ ‹ ·ÙÚÔÊÈÎÔ‡˜ fiÚ¯ÂȘ (6%), ·fi ·Ô˘Û›· fiگˆ˜ (6%) ‹ ÂÎÙfiÔ˘ fiگˆ˜ (2%). ∫ÏÈÓÈΤ˜ ·Ú·ÏÏ·Á¤˜ Ù˘ ÎÚ˘„ÔÚ¯›·˜ ∞Ó·ÛÒÌÂÓÔÈ fiÚ¯ÂȘ Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÔÈ ÌÈÛÔ› fiÚ¯ÂȘ, Ô˘ ‰ÂÓ Â˘Ú›ÛÎÔÓÙ·È ÛÙÔ Û‡ÛÙÔÈ¯Ô ËÌÈfiÛ¯ÂÔ Û ·ÁfiÚÈ· ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜, ‚Ú›ÛÎÔÓÙ·È Û ˘„ËÏfiÙÂÚË ı¤ÛË ÏfiÁˆ Û·ÛÌÔ‡ ÙÔ˘ ÎÚÂÌ·ÛÙ‹Ú· Ì˘fi˜ Î·È ·ÔÙ˘¯›·˜ Ï‹ÚÔ˘˜ ÚfiÛÊ˘Û˘ ÙÔ˘ οو fiÏÔ˘ ÙÔ˘ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ô›·Î·. ∆È ÛËÌ·›ÓÂÈ, fï˜, Ô fiÚÔ˜ Ù˘ ˘ÂÚ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÎÚÂÌ·ÛÙ‹Ú· Ì˘fi˜, ‰ÂÓ Â›Ó·È ÍÂοı·ÚÔ. ∂¿Ó ·˘Ùfi ÛËÌ·›ÓÂÈ ˘¤ÚÌÂÙÚË Â˘·ÈÛıËÛ›·, ·Ú·ÙÂٷ̤ÓË ‰È¿ÚÎÂÈ· ·¿ÓÙËÛ˘, ÌÈÎÚfi ‰È¿ÛÙËÌ· Ï·Óı¿ÓÔ˘Û·˜ ·¿ÓÙËÛ˘ ‹ ˘ÂÚ‚ÔÏÈ΋ Ì˘˚΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙÔ. ¶Èı·Ó¿, ÏfiÁˆ ÙˆÓ ·ÌÊÈ‚ÔÏÈÒÓ ·˘ÙÒÓ, Ë ˘fiıÂÛË fiÙÈ Ë ˘ÂÚ‚ÔÏÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÎÚÂÌ·ÛÙ‹Ú· Û˘ÁÎÚ·Ù› ÙÔÓ fiÚ¯È Û ÚÔÔÛ¯Â˚΋ ı¤ÛË ‰ÂÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ›. ™Â ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ÂÚÈÁÚ¿ÊËÎ·Ó Î·È Û˘ÁÎÚ›ıËÎ·Ó Ù· ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÎÚÂÌ·ÛÙ‹Ú· Ì˘fi˜ Û ·ÁfiÚÈ· Ì ·Ó·ÛÒÌÂÓÔ˘˜ Î·È Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ fiÚ¯ÂȘ, ηıÒ˜ Î·È Û ÎÚ˘„fiÚ¯ÂȘ. ∆· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ ‹Ù·Ó fiÙÈ ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ‹ Ó· ÂÓ·ÓÙȈıÔ‡Ó ÛÙËÓ ˘fiıÂÛË Ù˘ Ì›˙ÔÓÔ˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÎÚÂÌ·ÛÙ‹Ú· Ì˘fi˜ ÛÙÔ˘˜ ·Ó·ÛÒÌÂÓÔ˘˜ fiÚ¯ÂȘ (5). √È ·Ó·ÛÒÌÂÓÔÈ fiÚ¯ÂȘ Û˘Ó‹ıˆ˜ η٤گÔÓÙ·È ÛÙÔ fiÛ¯ÂÔ ·˘ÙfiÌ·Ù·, fiÙ·Ó ÙÔ ·È‰› ÎÔÈÌ¿Ù·È ‹ Â›Ó·È ‹ÚÂÌÔ, fiˆ˜ Û ˙ÂÛÙfi Ì¿ÓÈÔ Î·È ÌÔÚ› Ó· η٤گÔÓÙ·È

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 95

¶·È‰È·ÙÚÈ΋ 2001;64:93-100

ÛÙÔ fiÛ¯ÂÔ Ì ÂÏ·ÊÚ¿ ¤ÏÍË. √È ·Ó·ÛÒÌÂÓÔÈ fiÚ¯ÂȘ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚÔÈ Î·È ·Ú·Ì¤ÓÔ˘Ó Û˘Ó‹ıˆ˜ ¿ÓˆıÂÓ ÙÔ˘ ÔÛ¯¤Ô˘ ̤¯ÚÈ Ù˘ ÂÊ˂›·˜, fiÙ·Ó ÔÈ fiÚ¯ÂȘ Á›ÓÔÓÙ·È ÌÂÁ·Ï‡ÙÂÚÔÈ Û fiÁÎÔ ·fi ÙÔ ¤Íˆ ‚Ô˘‚ˆÓÈÎfi ÛÙfiÌÈÔ Î·È Ô ÎÚÂÌ·ÛÙ‹Ú·˜ Ì˘˜ Á›ÓÂÙ·È ÏÈÁfiÙÂÚÔ ‰Ú·ÛÙÈÎfi˜. ∂¿Ó Û οÔÈ· ÛÙÈÁÌ‹ Ô fiگȘ Ê·›ÓÂÙ·È ÛÙÔ fiÛ¯ÂÔ ‹ η٤ÏıÂÈ Ì ‹È· ¤ÏÍË ÛÙÔ fiÛ¯ÂÔ, Ô ·ÛıÂÓ‹˜ ¤¯ÂÈ ·Ó·ÛÒÌÂÓÔ fiÚ¯È Î·È ÔÈ ÁÔÓ›˜ Ú¤ÂÈ Ó· ‰È·‚‚·ÈÒÓÔÓÙ·È fiÙÈ Ô fiگȘ ı· ·Ú·Ì›ÓÂÈ ÛÙË Ê˘ÛÈÔÏÔÁÈ΋ ÔÛ¯Â˚΋ ı¤ÛË ÙÂÏÈο. √ fiÁÎÔ˜ ÙÔ˘ fiگˆ˜ Î·È Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÈÛÙ‡ÂÙ·È fiÙÈ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ. ¢ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË. ŒÎÙÔÔÈ fiÚ¯ÂȘ √ ¤ÎÙÔÔ˜ fiگȘ Û˘Ó‹ıˆ˜ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÌËÚfi, ‚Ô˘‚ÒÓ· ‹ ˘ÂÚË‚Èο, ÏfiÁˆ ·ÓÒÌ·Ï˘ ÚfiÛÊ˘Û˘ ÙÔ˘ Ô›·Î·, Ì ÌÂÁ¿ÏË Èı·ÓfiÙËÙ· Ó· ˘ÔÛÙ› ÙÚ·˘Ì·ÙÈÛÌfi. ¶ÂÚ›Ô˘ 80% ·fi ÙÔ˘˜ ¤ÎÙÔÔ˘˜ fiÚ¯ÂȘ Â›Ó·È ÂÙÂÚfiÏ¢ÚÔÈ. ™˘Ó‹ıˆ˜ Â›Ó·È Î·ÓÔÓÈÎÔ› Û ̤ÁÂıÔ˜, Ì ηÓÔÓÈ΋ ÛÂÚÌ·ÙÔÁÂÓÂÙÈ΋ Î·È ÔÚÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ¶Ú¤ÂÈ Ó· ÙÔÔıÂÙËıÔ‡Ó ¯ÂÈÚÔ˘ÚÁÈο ÛÙÔ fiÛ¯ÂÔ Û Ó·ڋ ËÏÈΛ·. ÀÔÏ·ÛÙÈÎÔ› fiÚ¯ÂȘ ‹ ·Ô˘Û›· fiÚ¯ÂˆÓ ¶ÂÚ›Ô˘ ÙÔ 12% ÙˆÓ ·È‰ÈÒÓ Ì ÎÂÓfi fiÛ¯ÂÔ ı· ¤¯Ô˘Ó ·Ô˘Û›· ‹ ˘ÔÏ·Û›· fiگˆ˜. ∏ Û˘ÛÙÚÔÊ‹ ‹ ·fiÊÚ·ÍË Ù˘ ÔÚ¯È΋˜ ÚÔ‹˜ ·›Ì·ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌ‚Ú˘˚΋˜ ˙ˆ‹˜, ÈÛÙ‡ÂÙ·È fiÙÈ Â›Ó·È Ë ÌÂÁ·Ï‡ÙÂÚË ·ÈÙ›·, ηıÒ˜ Î·È ÔÚÌÔÓÈÎÔ› ·Ú¿ÁÔÓÙ˜. ªÂ ÙËÓ Ï‹ÚË ·Ô˘Û›· ÔÚ¯ÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜, Ô fiÚÔ˜ ÙÔ˘ Müller ·Ó·Ù‡ÛÛÂÙ·È Î·È ‰È·ÊÔÚÔÔÈÂ›Ù·È Û ı‹ÏÂȘ ‰Ô̤˜. ™¿ÓÈ· ¤Ó·˜ fiگȘ ·ÔÙ˘Á¯¿ÓÂÈ Ó· ·Ó·Ù˘¯ı› Û˘ÓËı¤ÛÙÂÚ· ·fi ÙË ‰ÂÍÈ¿ ÏÂ˘Ú¿ Î·È ÂÚÈÛÙ·Ûȷο Û˘Ó˘¿Ú¯ÂÈ Û‡ÛÙÔȯԘ ·ÁÂÓÂÛ›· ÙÔ˘ ÓÂÊÚÔ‡ Î·È ÙÔ˘ Ô˘ÚËÙ‹Ú·. √ ÛÂÚÌ·ÙÈÎfi˜ fiÚÔ˜ Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Â›Ó·È Û˘Ó‹ıˆ˜ ˘ÔÏ·ÛÙÈÎfi˜ Î·È Î·Ù·Ï‹ÁÂÈ Ù˘ÊÏ¿ ÛÙÔ ‡„Ô˜ ÙÔ˘ ¤Ûˆ ‚Ô˘‚ˆÓÈÎÔ‡ ÛÙÔÌ›Ô˘. ∆Ô Û‡ÛÙÔÈ¯Ô ËÌÈfiÛ¯ÂÔ Û˘Ó‹ıˆ˜ Â›Ó·È ˘ÔÏ·ÛÙÈÎfi. ∞ÓÔÚ¯›· Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È Û ¤Ó· ÔÛÔÛÙfi 6% Û ·ÁfiÚÈ· Ô˘ ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È ÁÈ· ÎÚ˘„ÔÚ¯›·. ∏ ·ÓÔÚ¯›· Û˘Ó‹ıˆ˜ Â›Ó·È ÂÙÂÚfiÏ¢ÚÔ˜ Û ÔÛÔÛÙfi 85% ÙˆÓ ÂÚÈÙÒÛˆÓ. ™Â Û¿ÓȘ ÂÚÈÙÒÛÂȘ, ·Ú·ÙËÚÂ›Ù·È ÌË ‚ÈÒÛÈÌÔ ÔÚ¯ÈÎfi ·Ú¤Á¯˘Ì· Î·È ÛÙȘ ‰‡Ô Ï¢ڤ˜. ∂›Û˘, Ù· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· Â›Ó·È Ï‹Úˆ˜ ‰È·ÊÔÚÔÔÈË̤ӷ Û ¿ÚÚÂÓ˜ ‰Ô̤˜ ÛÙË Á¤ÓÓËÛË Î·È ¤Ó·˜ ˘ÔÙ˘҉˘ ÛÂÚÌ·ÙÈÎfi˜ fiÚÔ˜ ÙÂÏÂÈÒÓÂÈ Ù˘ÊÏ¿ ÛÙËÓ ÎÔÈÏÈ¿. ∏ Û˘ÛÙÚÔÊ‹ ‹ ·fiÊÚ·ÍË Ù˘ ÔÚ¯È΋˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ÈÛÙ‡ÂÙ·È fiÙÈ ·›˙ÂÈ ÚfiÏÔ ÛÙÔÓ “ÂÍ·Ê·ÓÈÛı¤ÓÙ· fiگȔ (vanishing testis) ‹ ÛÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ÔÚ¯È΋˜ ˘ÔÛÙÚÔÊ‹˜. ∏ ÂÊ˂›· ηı˘ÛÙÂÚ›, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘„ËϤ˜ ÙÈ̤˜ FSH Î·È LH ÛÙÔ Ï¿-

Paediatriki 2001;64:93-100

ÛÌ· Î·È ¯·ÌËϤ˜ ÙÈ̤˜ ÙÂÛÙÔÛÙÂÚfiÓ˘. ÀÔÏ·ÛÙÈÎÔ› ‹ ‰˘ÛÁÂÓÂÙÈÎÔ› fiÚ¯ÂȘ ÔÙ¤ ‰ÂÓ ¤¯Ô˘Ó ÛÂÚÌ·ÙÔÁÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ·Ú¿ ÙËÓ ÔÔÈ·‰‹ÔÙ ıÂÚ·›·. ∂ÓÙÔ‡ÙÔȘ, ÔÏÏÔ› ÎÚ˘„fiÚ¯ÂȘ Ì ‰È¿ÌÂÛÔ Û˘Ó‰ÂÙÈÎfi ÈÛÙfi Î·È Î‡ÙÙ·Ú· Leyding ı· ·Ú¿ÁÔ˘Ó ÙÂÛÙÔÛÙÂÚfiÓË ÁÈ· Ó· ÚÔηϤÛÂÈ ÁÔÓÈÌfiÙËÙ·. ∂›Û˘, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ηıÒ˜ Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙÔÓ ÂÓÙÔÈÛÌfi ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ fiگˆÓ. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈÂÚ‡ÓËÛË Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ‰È¿ÁÓˆÛË, ‰ÈfiÙÈ ÔÈ ‰˘ÛÏ·ÛÙÈÎÔ› ‹ ÔÈ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ› fiÚ¯ÂȘ ¤¯Ô˘Ó ˘„ËÏ‹ ÚԉȿıÂÛË ÚÔ˜ ηÎÔ‹ıË ÂÍ·ÏÏ·Á‹. √Ú¯È΋ ÚfiıÂÛË ÛÙËÓ ÂÊ˂›· ÌÔÚ› Ó· ÙÔÔıÂÙËı› ÛÙÔ fiÛ¯ÂÔ ÁÈ· ÎÔÛÌËÙÈÎÔ‡˜ ·ÏÏ¿ Î·È „˘¯ÔÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÙÂÛÙÔÛÙÂÚfiÓ˘ ÛÙËÓ ÂÊ˂›· ÚÔηÏ› ÈηÓÔÔÈËÙÈ΋ ·¿ÓÙËÛË ÛÙË ÛÂÍÔ˘·ÏÈ΋ ˆÚ›Ì·ÓÛË ÙÔ˘ ·Ó‰Úfi˜. ∞ÏËı‹˜ ÎÚ˘„oÚ¯›· √ fiگȘ, Ô ÔÔ›Ô˜ ‰ÂÓ Î·Ù¤Ú¯ÂÙ·È ÛÙÔ fiÛ¯ÂÔ ·˘ÙfiÌ·Ù·, Ì ÔÚÌÔÓÈ΋ ıÂÚ·›· ‹ Ì ÂÁ¯Â›ÚËÛË Ì¤¯ÚÈ ÙÔ Ù¤Ù·ÚÙÔ ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜, Èı·ÓfiÓ Ó· ÌËÓ ¤¯ÂÈ Î·ÓÔÓÈ΋ ÛÂÚÌ·ÙÔÁÂÓÂÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÛÙËÓ ÂÊ˂›·. √È ÂÚÈÛÛfiÙÂÚÔÈ ÎÚ˘„fiÚ¯ÂȘ ÂÌÔ‰›˙ÔÓÙ·È ÛÙÔ Ó· Êı¿ÛÔ˘Ó ÛÙÔ fiÛ¯ÂÔ, ÁÈ·Ù› Ë ÛÂÚÌ·ÙÈ΋ ·ÚÙËÚ›· Â›Ó·È ‚Ú·¯‡ÙÂÚË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜. ¢ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿Ó Ë ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙË ÛÂÚÌ·ÙÈ΋ ·ÚÙËÚ›· ÂÓfi˜ ÌË ˘ÔÏ·ÛÙÈÎÔ‡ ÎÚ˘„fiگˆ˜ Â›Ó·È ÌÂȈ̤ÓË, Û˘ÁÎÚÈÙÈο Ì ÂÓfi˜ ÔÚıfiÙÔÔ˘ fiگˆ˜. ∫·ıÒ˜ ÂÚÈÛÛfiÙÂÚÔ ·fi 80% ÙˆÓ ·ÏËıÈÓÒÓ ÎÚ˘„fiÚ¯ÂˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÂÙÂÚfiÏ¢ڷ, ÂȉÈ΋ ÔÚÌÔÓÈ΋ ·ÓÂ¿ÚÎÂÈ· ı· ÌÔÚÔ‡Û ӷ ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ÎÚ˘„ÔÚ¯›·, Ë ÔÔ›· Â›Ó·È ‚¤‚·È· ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛÙ›. ¶·È‰È¿ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· Â›Ó·È ÈÔ Èı·Ófi Ó· ¤¯Ô˘Ó ÂÓ‰ÔÎÚÈÓÈ΋ ·ÓˆÌ·Ï›· Ì ÔÚÌÔÓÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·Ú¿ ·È‰È¿ Ì ÂÙÂÚfiÏ¢ÚË. ∫¿ıÔ‰Ô˜ ÙÔ˘ fiگˆ˜ ̤۷ ÛÙÔ˘˜ 9 ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÂÚÈÛÛfiÙÂÚ· ‚Ú¤ÊË Ì ¿‰ÂÈÔ fiÛ¯ÂÔ. ªÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, Ë ·ÏËı‹˜ ÎÚ˘„ÔÚ¯›· Â›Ó·È ·ıÔÏÔÁÈ΋ ηٿÛÙ·ÛË Î·È ·Ú·ÙËÚÂ›Ù·È ÂÚ›Ô˘ Û ÔÛÔÛÙfi 1% Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ª¤ÙÚËÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ fiگˆ˜, Ù˘ ‰È·Ì¤ÙÚÔ˘, ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÛÂÚÌ·ÙÔÁÔÓ›ˆÓ, ‰Â›¯ÓÂÈ fiÙÈ Û Ó·ڿ ·È‰È¿ ÔÈ fiÚ¯ÂȘ ¤¯Ô˘Ó ÁÚ·ÌÌÈ΋ ·Ó¿Ù˘ÍË ÚÈÓ ÙËÓ ÂÊ˂›·. µÏ·ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙÔÓ ÎÚ˘„fiÚ¯È, ‰ÚÔ˘Ó ·fi ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ¤ÙÔ˘˜ Ù˘ ˙ˆ‹˜. ¢È·ÊÔÚÂÙÈΤ˜ ·fi„ÂȘ ˘¿Ú¯Ô˘Ó fiÛÔÓ ·ÊÔÚ¿

95

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 96

¶·È‰È·ÙÚÈ΋ 2001;64:93-100

ÙËÓ ËÏÈΛ· Ô˘ ·Ú¯›˙Ô˘Ó ÔÈ ‚Ï¿‚˜ ÛÙÔÓ ÎÚ˘„fiÚ¯È. ªÂÚÈÎÔ› ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÛÂÚÌ·ÙÔÁÔÓ›ˆÓ ηıÒ˜ Î·È Ì ÙËÓ ÔÛÔÙÈ΋ ÂͤٷÛË Ù˘ ‰ÔÌ‹˜ ÙÔ˘ ‰È¿ÌÂÛÔ˘ ÈÛÙÔ‡, fiÙÈ Ô ÎÚ˘„fiگȘ ‰ÂÓ ¤¯ÂÈ ÂÌÊ·Ó›˜ ÈÛÙÔÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÒÙˆÓ ÂÙÒÓ Ù˘ ËÏÈΛ·˜ (6). ªÂÙ¿ Ù· ‰‡Ô ÚÒÙ· ¤ÙË, Ô ·ÚÈıÌfi˜ ÙˆÓ ÛÂÚÌ·ÙÔÁÔÓ›ˆÓ ÂÏ·ÙÙÒÓÂÙ·È ÛËÌ·ÓÙÈο. ∞Ú¯È΋ ÂÎʇÏÈÛË ‹ ·ÔÙ˘¯›· ·Ó¿Ù˘Í˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ˘˜ ÎÔÈÏÈ·ÎÔ‡˜ fiÚ¯ÂȘ, ÏfiÁˆ Ù˘ ˘„ËÏ‹˜ ıÂÚÌÔÎÚ·Û›·˜. ¶ÂÈÚ·Ì·ÙÈ΋ ÂÓ·fiıÂÛË fiگˆ˜ ·fi ÙÔ fiÛ¯ÂÔ Ì¤Û· ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ· ÚÔηÏ› ÂÎʇÏÈÛË ÙÔ˘ ‚Ï·ÛÙÈÎÔ‡ ÂÈıËÏ›Ô˘. ∂›Û˘, Ë Â›‰Ú·ÛË ıÂÚÌfiÙËÙ·˜ Û ÔÛ¯Â˚Îfi fiÚ¯È ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÎÊ˘ÏÈÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ (7). √ ηÓÔÓÈÎfi˜ fiÁÎÔ˜ ÙÔ˘ fiگˆ˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ˜ ·fi 1,5 ml ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÒÙˆÓ ÂÙÒÓ Ù˘ ˙ˆ‹˜ Î·È ·Ú·Ì¤ÓÂÈ ÌÈÎÚfiÙÂÚÔ˜ ·fi 3 ml ̤¯ÚÈ Ù· 11 ¯ÚfiÓÈ·. ∞ÎÔÏÔ‡ıˆ˜ ·˘Í¿ÓÂÈ Ù·¯¤ˆ˜ ÁÈ· ¤Ó· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 3-4 ÂÙÒÓ, ̤¯ÚȘ fiÙÔ˘ Êı¿ÛÂÈ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ fiگˆ˜ (1215 ml). ªÂ ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜, Ô ÎÚ˘„fiگȘ ·Ó·Ù‡ÛÛÂÈ ÂӉȿÌÂÛË ›ÓˆÛË Ì ηı˘ÛÙÂÚË̤ÓË Î·È ·ÓÒÌ·ÏË ·Ó¿Ù˘ÍË ÛˆÏËÓ·Ú›ˆÓ. ∏ ÛÂÚÌ·ÙÔÁ¤ÓÂÛË Â›Ó·È ÂÏ·Ùو̤ÓË ÏfiÁˆ ·ÙÚÔÊ›·˜ ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Ô˘ ÚÔηÏÂ›Ù·È Â›Ù ·fi Ì›ˆÛË Ù˘ ·ÁÁ›ˆÛ˘, ›Ù ·fi ÂÍ¿ψÛË Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡. √ ÂÙÂÚfiÏ¢ÚÔ˜ ÎÚ˘„fiگȘ ÌÔÚ› Ó· ·Ú¿ÁÂÈ ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· ÂËÚ¿˙Ô˘Ó ‚Ï·ÙÈο ÙËÓ ·Ó¿Ù˘ÍË Î·È ÏÂÈÙÔ˘ÚÁ›· Î·È ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Û ı¤ÛË fiگˆ˜ (8). ∆Ș ›‰È˜ ·ıÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ·Ú·ÙËÚԇ̠ÛÙ· ÛÂÚÌ·ÙÈο ÛˆÏËÓ¿ÚÈ· ÙÔ˘ ÂÙÂÚfiÏ¢ÚÔ˘ ÔÛ¯Â˚ÎÔ‡ fiگˆ˜ ÌÂÙ¿ ·fi Û˘ÛÙÚÔÊ‹ ÙÔ˘ ¿ÏÏÔ˘ fiگˆ˜ Ì ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÈÛ¯·ÈÌ›·, ¯ˆÚ›˜ Ë ÈÛ¯·ÈÌÈ΋ ÁÔÓ¿‰· Ó· ·Ê·ÈÚÂı›. ∫¿Ùˆ ·fi ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, Ë ‚·ÛÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ Ô˘ ÏÂÈÙÔ˘ÚÁ› Ê˘ÛÈÔÏÔÁÈο Û·Ó ·ÓÔÛÔÏÔÁÈÎfi˜ ÊÚ·ÁÌfi˜ ÌÔÚ› Ó· Á›ÓÂÈ ÔÚ҉˘ Î·È Ó· ÂÎı¤ÛÂÈ Ù· ÛˆÏËÓ¿ÚÈ· Û ·ÓÙÈÛÒÌ·Ù·, ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ‰ËÏ·‰‹ ·ÓÙ›‰Ú·ÛË ·ÓÙÈÁfiÓÔ˘ - ·ÓÙÈÛÒÌ·ÙÔ˜. ∂¿Ó Ô ÎÚ˘„fiگȘ ‰ÂÓ ÙÔÔıÂÙËı› ÛÙÔ fiÛ¯ÂÔ, Ë ÁÔÓÈÌfiÙËÙ· ı· Â›Ó·È ÂÏ·Ùو̤ÓË. Œ¯ÂÈ Ê·Ó› ·fi ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜ fiÙÈ Ó·ڿ ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÔÚ¯ÂÔËÍ›· ı· ·Ó·Ù‡ÍÔ˘Ó ·ÎÔÏÔ‡ıˆ˜ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ÛÂÚÌ·ÙÔÁÔÓ›ˆÓ. ¢È¿ÁÓˆÛË Ù˘ ÎÚ˘„ÔÚ¯›·˜ ™Â ÔÛÔÛÙfi ¿Óˆ ·fi 85% ÙˆÓ ·ÁÔÚÈÒÓ Ì ÎÂÓfi fiÛ¯ÂÔ, Ô fiگȘ ÌÔÚ› Ó· „ËÏ·Ê¿Ù·È ÛÙÔ ‚Ô˘‚ˆÓÈÎfi fiÚÔ ‹ Û ¤ÎÙÔË ı¤ÛË. ™¿ÓÈ· ·Ú·ÙËÚÂ›Ù·È ÌË Î·Ï¿ ·Ó·Ù˘Á̤ÓÔ fiÛ¯ÂÔ Î·È Û˘Ó‹ıˆ˜ Û˘Ó-

96

Paediatriki 2001;64:93-100

‰˘¿˙ÂÙ·È Ì ˘„ËÏfi ‚Ô˘‚ˆÓÈÎfi ‹ ÎÔÈÏÈ·Îfi ‹ ·ÙÚÔÊÈÎfi fiÚ¯È ‹ ·Ô˘Û›· Ù˘ ÁÔÓ¿‰·˜. ¶ÚÔÛÂÎÙÈ΋ ÂͤٷÛË Ì ˙ÂÛÙ¿ ¯¤ÚÈ·, Ì ÙÔ ·È‰› ‹ÚÂÌÔ Î·È Û ‡ÙÈ· ı¤ÛË, Û˘Ó‹ıˆ˜ ÂÈÙÚ¤ÂÈ Â‡ÎÔÏË ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ·Ó·ÛÒÌÂÓÔ˘ fiÚ¯È, Ô ÔÔ›Ô˜ ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ıÂÚ·›·. ŸÙ·Ó Ô fiگȘ ¢ڛÛÎÂÙ·È Û ÚÔÔÛ¯Â˚΋ ı¤ÛË, Ú¤ÂÈ Ó· ÂϤÁ¯ÂÙ·È ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘, Ë ÌÔÚÊ‹ ÙÔ˘, Ë ÛÊÚÈÁËÏfiÙËÙ¿ ÙÔ˘ Ì ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô fiÚ¯È Î·È Ì fiÚ¯ÂȘ ·È‰ÈÒÓ Ù˘ ›‰È·˜ ËÏÈΛ·˜. ªÂÙ¿ ÙËÓ „ËÏ¿ÊËÛË, Ù· ‰¿ÎÙ˘Ï· ÙÔ˘ ÂÍÂÙ·ÛÙ‹ Ȥ˙Ô˘Ó Î¿ıÂÙ· ÙÔ Î¿Ùˆ ̤ÚÔ˜ Ù˘ ÎÔÈÏÈ¿˜ ·ÎÚÈ‚Ò˜ ¿Óˆ ·fi ÙË ı¤ÛË Ô˘ „ËÏ·Ê¿Ù·È Ô fiگȘ Î·È ·ÎÔÏÔ‡ıˆ˜ ÛÈÁ¿-ÛÈÁ¿ ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ¿Óˆ ·fi ÙÔ ¤Íˆ ÛÙfiÌÈÔ ÙÔ˘ ‚Ô˘‚ˆÓÈÎÔ‡ fiÚÔ˘ Ì ÚfiıÂÛË Ó· “ÁÏÈÛÙÚ‹ÛÂÈ” Ô fiگȘ ̤۷ ÛÙÔ Û‡ÛÙÔÈ¯Ô ËÌÈfiÛ¯ÂÔ. ∆· ‰¿ÎÙ˘Ï· ÙÔ˘ ¿ÏÏÔ˘ ¯ÂÚÈÔ‡ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó È¿ÓÔÓÙ·˜ ÙÔÓ fiÚ¯È, fiÙ·Ó ·˘Ùfi˜ ÂÚ¿ÛÂÈ ÙÔÓ ·˘¯¤Ó· ÙÔ˘ ÔÛ¯¤Ô˘, ηÙ¢ı‡ÓÔÓÙ¿˜ ÙÔÓ Ì¤Û· ÛÙÔ ËÌÈfiÛ¯ÂÔ. ∞ÊÔ‡ Â·Ó·ÏËÊı› ·˘Ù‹ Ë Î›ÓËÛË ·ÚÎÂÙ¤˜ ÊÔÚ¤˜, Ë ¯·ÌËÏfiÙÂÚË ‰˘Ó·Ù‹ ı¤ÛË ÙÔ˘ fiگˆ˜ ÌÔÚ› Ó· ÛËÌÂȈı›, fiˆ˜ .¯. ˘„ËÏfi˜ ‚Ô˘‚ˆÓÈÎfi˜, ¯·ÌËÏfi˜ ‚Ô˘‚ˆÓÈÎfi˜, ÚÔÔÛ¯Â˚Îfi˜, ¯·ÌËÏfi˜ ÔÛ¯Â˚Îfi˜ (ηÓÔÓÈÎfi˜). ∂¿Ó Ô fiگȘ ‰ÂÓ „ËÏ·Ê¿Ù·È, ÂÚ·ÈÙ¤Úˆ ÂͤٷÛË Â›Ó·È ··Ú·›ÙËÙË Û fiÚıÈ· ‹ ηıÈÛÙ‹ ı¤ÛË Ì ÛÙ·˘ÚˆÌ¤Ó· fi‰È·. ™¿ÓÈ· Â›Ó·È ··Ú·›ÙËÙË Ë ¯ÔÚ‹ÁËÛË ËÚÂÌÈÛÙÈÎÒÓ Û Ôχ ‰ÈÂÁÂÚÙÈο ·È‰È¿. ∂¿Ó ÌÂÙ¿ ·fi Â·ÓÂÈÏËÌ̤Ó˜ ÂÍÂÙ¿ÛÂȘ Ô fiگȘ ‰ÂÓ „ËÏ·Ê¿Ù·È, ÙfiÙ Èı·Ó¿ Â›Ó·È ÎÔÈÏÈ·Îfi˜, ·ÙÚÔÊÈÎfi˜ ‹ ·Ô˘ÛÈ¿˙ÂÈ. ∂¿Ó Î·È ÔÈ ‰‡Ô fiÚ¯ÂȘ Â›Ó·È ·„ËÏ¿ÊËÙÔÈ, ÌÔÚ› Ó· ‰ÔÎÈÌ·Ûı› Ë Ì¤ÙÚËÛË Ù˘ ı˘Ï·ÎÈÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (FSH), ˆ¯ÚÈÓÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (LH) Î·È ÙÂÛÙÔÛÙÂÚfiÓ˘ ÛÙÔ ·›Ì· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰È¤ÁÂÚÛË HCG. ∂¿Ó ·Ú·ÙËÚËı› ·‡ÍËÛË ÌfiÓÔ ÙˆÓ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ (FSH), (LH), ÂÓÒ Ë ÙÂÛÙÔÛÙÂÚfiÓË ·Ú·Ì¤ÓÂÈ ÌÂȈ̤ÓË, Â›Ó·È Ê·ÓÂÚfi fiÙÈ fiÚ¯ÂȘ ‰ÂÓ ˘¿Ú¯Ô˘Ó (9-11). ∂¿Ó ·Ô˘ÛÈ¿˙ÂÈ ÌfiÓÔ Ô ¤Ó·˜ fiگȘ, ÎÏÈÓÈο Ë ¤Ú¢ӷ ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ˘ÂÚ˯ÔÙÔÌÔÁÚ·Ê›·, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÊÏ‚ÔÁÚ·Ê›· Ù˘ Û‡ÛÙÔȯ˘ ¤Ûˆ ÛÂÚÌ·ÙÈ΋˜ ÊϤ‚·˜, Ï··ÚÔÛÎfiËÛË Î·È Ù¤ÏÔ˜ ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÙÔÌ›· (12). £ÂÚ·›· Ù˘ ÎÚ˘„ÔÚ¯›·˜ ∞. ™˘ÓÙËÚËÙÈ΋ ıÂÚ·›· ÎÚ˘„ÔÚ¯›·˜ ∆Ô ‚·ÛÈÎfi ÎÚÈÙ‹ÚÈÔ ÁÈ· Ó· ηıÔÚÈÛı› Ë ÂÈÙ˘¯›· Ù˘ ıÂÚ·›·˜ Ù˘ ÎÚ˘„ÔÚ¯›·˜ Â›Ó·È Ë ÁÔÓÈÌfiÙËÙ·, fi¯È ·ÏÒ˜ Î·È ÌfiÓÔ Ë ·ÚÔ˘Û›· „ËÏ·ÊËÙÔ‡ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ. ∏ ıÂÚ·›· Ì ¯ÔÚÈÔÓÈ΋ ÁÔÓ·‰ÔÙÚÔ›ÓË (hCG) ‚ÔËı¿ ÙËÓ Î¿ıÔ‰Ô ÙÔ˘ fiگˆ˜ ÌfiÓÔ ÛÙÔ˘˜ ·Ó·ÛÒÌÂÓÔ˘˜ ‹ ˘„ËÏÔ‡˜ ÔÛ¯Â˚ÎÔ‡˜ fiÚ¯ÂȘ Î·È ÂÚ›Ô˘

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 97

¶·È‰È·ÙÚÈ΋ 2001;64:93-100

fiÏÔÈ Â·Ó¤Ú¯ÔÓÙ·È ÛÙËÓ ÚÔËÁÔ‡ÌÂÓË ı¤ÛË Ì¤Û· Û ¤Ó· Ì‹Ó· (13). ∏ ¯ÔÚ‹ÁËÛË hCG ‚ÔËı¿ ÛÙË ‰ÈÂÚ‡ÓËÛË ·È‰ÈÔ‡ Ì ÌË „ËÏ·ÊËÙfi fiÚ¯È Î·È ÌÔÚ› Ó· ‰È¢ÎÔχÓÂÈ ÙËÓ ÔÚ¯ÂÔËÍ›·. ¶ÔÏÏÔ› ¯ÂÈÚÔ˘ÚÁÔ› Û˘ÓÈÛÙÔ‡Ó Â¤Ì‚·ÛË Û ·È‰È¿ Ì ÎÚ˘„ÔÚ¯›· ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ, ÌfiÓÔ ÂÊfiÛÔÓ Ë ¯ÔÚ‹ÁËÛË hCG ›¯Â ·ÓÂÈÙ˘¯¤˜ ·ÔÙ¤ÏÂÛÌ·. º˘ÛÈο, ÔÏÏÔ› ÁÔÓ›˜ Â›Ó·È ·Úfiı˘ÌÔÈ ÛÙË ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÌ˘˚ÎÒÓ ÂÓ¤ÛÂˆÓ hCG ÚÈÓ ÙËÓ Â¤Ì‚·ÛË, fiÙ·Ó Ë Èı·ÓfiÙËÙ· ηıfi‰Ô˘ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 10%. À„ËϤ˜ ‰fiÛÂȘ Î·È ÁÈ· ÌÂÁ¿ÏÔ ‰È¿ÛÙËÌ· ¯ÔÚËÁ‹ÛË hCG ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÂÎʇÏÈÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ, ÚfiˆÚË ‹‚Ë Î·È ÚÒÈÌË Û‡ÁÎÏÈÛË ÂÈʇÛˆÓ. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ·Ú¿ÁÔÓÙÔ˜ ÙÔ˘ ‰ÈÂÁ›ÚÔÓÙÔ˜ ÙËÓ ˘fiÊ˘ÛË ÚÔ˜ ¤ÎÎÚÈÛË ˆ¯ÚÈÓÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (LHRH) ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ¢ڤˆ˜ ÛÙËÓ ∂˘ÚÒË, ·ÏÏ¿ ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ·ÔÙÂϤÛÌ·Ù·, Û˘ÁÎÚÈÙÈο Ì ÙËÓ hCG. ∂Âȉ‹ ÌÂÙ·‚ÔÏ›˙ÂÙ·È Ù·¯‡Ù·Ù· Ô ·Ú¿ÁˆÓ LHRH, Û˘Ó‹ıˆ˜ ¯ÔÚËÁÂ›Ù·È Ì ÙË ÌÔÚÊ‹ ÙÔ˘ ÚÈÓÈÎÔ‡ spray. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ·Ú¿ÁÔÓÙÔ˜ LH-RH Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ÙÔ 10Ô Ì‹Ó· Ù˘ ˙ˆ‹˜ Î·È Ó· ‰›‰ÂÙ·È Û ‰fiÛË 400 mg x 3 ËÌÂÚËÛ›ˆ˜ ÁÈ· Ù¤ÛÛÂÚȘ ‚‰ÔÌ¿‰Â˜. ∞Ó ‰ÂÓ ÂÈÙ‡¯ÂÈ Ô Î‡ÎÏÔ˜ ·˘Ùfi˜, Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ¯ÔÚÈÔÓÈ΋ ÁÔÓ·‰ÔÙÚÔ›ÓË (∏CG) Û ‰fiÛË 1500 πU ‚‰ÔÌ·‰È·›ˆ˜ ÂÓ‰ÔÌ˘˚ο (̤ڷ ·Ú¿ ̤ڷ), ÁÈ· ÙÚÂȘ ‚‰ÔÌ¿‰Â˜. ∂› ˘ÔÙÚÔ‹˜, Ú¤ÂÈ Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È ¤Ó·˜ Ï‹Ú˘ ·ÎÏÔ˜ LH-RH. ∞Ó ·ÔÙ‡¯ÂÈ Ë ÔÚÌÔÓÔıÂÚ·›· Ú¤ÂÈ Ó· Á›ÓÂÈ ÔÚ¯ÂÔËÍ›· Û ϛÁ˜ ‚‰ÔÌ¿‰Â˜ Î·È ¿ÓÙˆ˜ ÚÔ Ù˘ ËÏÈΛ·˜ ÙˆÓ 2 ÂÙÒÓ. ∂› ·ÏËıÔ‡˜ ÂÎÙÔ›·˜ ‹ Û˘Ó‡·Ú͢ ‚Ô˘‚ˆÓÔ΋Ï˘, Ë ÔÚÌÔÓÔıÂÚ·›· ‰ÂÓ ¤¯ÂÈ Î·Ì›· ı¤ÛË. µ. ÃÂÈÚÔ˘ÚÁÈ΋ √È Î˘ÚÈfiÙÂÚ˜ ÂӉ›ÍÂȘ ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ÙÔÔı¤ÙËÛË ÙÔ˘ ÎÚ˘„fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ Â›Ó·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÂӉ¯fiÌÂÓÔ˘ ÌÂÏÏÔÓÙÈ΋˜ ˘ÔÁÔÓÈÌfiÙËÙ·˜, Ë ‰ÈfiÚıˆÛË Ù˘ Û˘Ó˘¿Ú¯Ô˘Û·˜ ‚Ô˘‚ˆÓÔ΋Ï˘ Î·È Ë ÂÏ¿ÙÙˆÛË Ù˘ Èı·ÓfiÙËÙ·˜ ÙÚ·‡Ì·ÙÔ˜ ‹ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ fiگˆ˜. ∏ ÔÚ¯ÂÔËÍ›·, Â›Û˘, ÚÔÏ·Ì‚¿ÓÂÈ „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÁÈ· ÙÔÓ ¿Û¯ÔÓÙ· Î·È ÚÔÛʤÚÂÈ ¿ÚÈÛÙ· ÎÔÛÌËÙÈο ·ÔÙÂϤÛÌ·Ù·, ηıÒ˜ Î·È Â‡ÎÔÏË ÎÏÈÓÈ΋ ÂͤٷÛË ÁÈ· fiÁÎÔ ÙÔ˘ fiگˆ˜. ™‡Á¯ÚÔÓ˜ ıˆڋÛÂȘ Û˘ÓËÁÔÚÔ‡Ó ÛÙËÓ ¿Ô„Ë fiÙÈ Ô È‰·ÓÈÎfi˜ ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ ÔÚ¯ÂÔËÍ›· Â›Ó·È ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ Î·È Èı·ÓfiÓ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜. √ ΛӉ˘ÓÔ˜ ‚Ï¿‚˘ ÛÙ· ÛÂÚÌ·ÙÈο ·ÁÁ›· Û ÓÂÔÁÓfi Ú¤ÂÈ Ó· ÏËÊı› Ôχ ÛÔ‚·Ú¿ ˘’fi„ÈÓ, Û ·ÓÙȉȷÛÙÔÏ‹ Ì ÙÔ fiÊÂÏÔ˜ Ù˘ Ôχ ÚfiˆÚ˘ ÙÔ-

Paediatriki 2001;64:93-100

Ôı¤ÙËÛ˘ ÙÔ˘ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ. ∂Ì›˜ ÚÔÙÈÌԇ̠ÙËÓ ËÏÈΛ· ÌÂٷ͇ 18 ÌËÓÒÓ Î·È 3 ÂÙÒÓ, ¿ÓÙ· Û ۯ¤ÛË Ì ٷ ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ·È‰ÈÔ‡ (14). √ ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ ÛÙfi¯Ô˜ Ù˘ ÔÚ¯ÂÔËÍ›·˜ Â›Ó·È Ó· ÌÂÙ·‚¿ÏÏÂÈ ÙËÓ ÔÚ›· Ù˘ ÛÂÚÌ·ÙÈ΋˜ ·ÚÙËÚ›·˜ ·fi ÙÔ ÓÂÊÚÈÎfi Ì›Û¯Ô ‰È·Ì¤ÛÔ˘ ÙÔ˘ ¤Ûˆ ‚Ô˘‚ˆÓÈÎÔ‡ ÛÙÔÌ›Ô˘, ηıÒ˜ Î·È Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Â˘ı›· ÔÚ›· Ù˘ ÛÂÚÌ·ÙÈ΋˜ ·ÚÙËÚ›·˜ ·fi ÙÔ ÓÂÊÚÈÎfi Ì›Û¯Ô ÛÙÔ fiÛ¯ÂÔ. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ηı‹ÏˆÛË ÙÔ˘ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ, fiÙ·Ó ·˘Ùfi˜ Â›Ó·È „ËÏ·ÊËÙfi˜, Á›ÓÂÙ·È Ì ‚Ô˘‚ˆÓÈ΋ ÙÔÌ‹ Î·È Ë ϤÔÓ ÚÔÛÊÈÏ‹˜ Ù¯ÓÈ΋ Â›Ó·È Ë Î·Ù¿ Lattimer-Benson-Lofti ÔÚ¯ÂÔËÍ›·, Ì ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ fiگˆ˜ ÌÂٷ͇ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙÔ˘ ‰·ÚÙÔ‡ ¯ÈÙÒÓÔ˜ ÙÔ˘ ÔÛ¯¤Ô˘. ∫·Ù¿ ηÓfiÓ·, ‰È·ÓÔ›ÁÂÙ·È Ô ‚Ô˘‚ˆÓÈÎfi˜ fiÚÔ˜ ÁÈ· ÙËÓ ·Ú·Û΢‹ ÙÔ˘ ÂÚÈÙÔÓ·˚ÎÔ‡ Û¿ÎÎÔ˘ Ù˘ Û˘Ó˘¿Ú¯Ô˘Û·˜ ‚Ô˘‚ˆÓÔ΋Ï˘ Î·È ÙËÓ ˘„ËÏ‹ ·Ôϛӈۋ ÙÔ˘. °È· ÙÔ˘˜ ˘„ËÏÔ‡˜ fiÚ¯ÂȘ Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ηıËψıÔ‡Ó ÛÙÔ fiÛ¯ÂÔ Ì ÙËÓ ÚÔ·Ó·ÊÂÚı›۷ Ù¯ÓÈ΋ (ÂÚ›Ô˘ 5%), Ë Ì¤ÛË ‰È·ÎÔÈÏȷ΋ ‹ Ë ÚÔÂÚÈÙÔÓ·˚΋ ÚÔÛ¤Ï·ÛË Â›Ó·È ÂȉÈο ¯Ú‹ÛÈ̘ ÁÈ· ·È‰È¿ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ˘„ËÏ‹ ÎÚ˘„ÔÚ¯›·, ηÙÔÚıÒÓÔÓÙ·˜ Ó· ηıËψıÔ‡Ó Î·È ÔÈ ‰‡Ô fiÚ¯ÂȘ ÛÙÔ fiÛ¯ÂÔ ‰È·Ì¤ÛÔ˘ Ì›·˜ ÙÔÌ‹˜. √È ÂÂÌ‚¿ÛÂȘ ·˘Ù¤˜ ÂӉ›ÎÓ˘ÓÙ·È ÁÈ· ·È‰È¿ ÛÙ· ÔÔ›· ¤¯Ô˘Ó ηٷÛÙÚ·Ê› ÔÈ ‚Ô˘‚ˆÓÈΤ˜ ·Ó·ÙÔÌÈΤ˜ Û¯¤ÛÂȘ ·fi ÚÔËÁÔ‡ÌÂÓ˜ ÂÂÌ‚¿ÛÂȘ, ηıÒ˜ Î·È ÁÈ· ·È‰È¿ Ì ˘Ô„›· ÔÚ¯È΋˜ ·ÁÂÓÂÛ›·˜ ‹ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ʇÏÔ˘ (15). ∏ Ù¯ÓÈ΋ Fowler-Stephens ÚÔÛ‰›‰ÂÈ Ì‹ÎÔ˜ ÛÙÔÓ fiÚ¯È, ‰È·Ù¤ÌÓÔÓÙ·˜ Ù· ÛÂÚÌ·ÙÈο ·ÁÁ›· ÛÙÔÓ ÔÈÛıÔÂÚÈÙÔÓ·˚Îfi ¯ÒÚÔ, ηٿ ÙËÓ ÔÔ›· ÁÈ· ÙËÓ ·ÁÁ›ˆÛË ÙÔ˘ fiگˆ˜ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë ·ÚÙËÚ›· ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ fiÚÔ˘, ·ÁÁÂȷο ÙfiÍ· Ï¿ÁÈ· ·fi Ù· ÂÓ Ùˆ ‚¿ıÂÈ Î¿Ùˆ ÂÈÁ¿ÛÙÚÈ· ·ÁÁ›· ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ô›ÛıÈÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ ÂÏ˘ÙÚÔÂÚÈÙÔÓ·˚΋˜ Ù˘¯‹˜ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ Ô›·Î· (16). ∏ ÂÈÙ˘¯›· Ù˘ Â¤Ì‚·Û˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ fiÙÈ ‰ÂÓ ÂÎÙÂÏÔ‡ÓÙ·È ÂÎÙÂٷ̤Ó˜ ‰ÈÔÈÓ‹ÛÂȘ ÔÈÛıÔÂÚÈÙÔÓ·˚ο Î·È Ë ·ÔϛӈÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ·ÁÁ›ˆÓ Á›ÓÂÙ·È fiÛÔ „ËÏfiÙÂÚ· Â›Ó·È ‰˘Ó·ÙfiÓ. ∂Âȉ‹ Ë ·Ó¿Ù˘ÍË ·ÙÚÔÊÈÎÒÓ fiÚ¯ÂˆÓ ÌÂÙ¿ ÙË ‰È·ÙÔÌ‹ ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ·ÁÁ›ˆÓ ‰ÂÓ Â›Ó·È Û¿ÓÈ· (ÂÚ›Ô˘ 30%), ·˘Ù‹ Ë Â¤Ì‚·ÛË Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ì ÂÈʇϷÍË Î·È ÌfiÓÔ fiÙ·Ó ¿ÏϘ ÂÂÌ‚¿ÛÂȘ ÏÈÁfiÙÂÚÔ ÂÈΛӉ˘Ó˜ ‰ÂÓ Ê·›ÓÔÓÙ·È ÂÊÈÎÙ¤˜. ∏ Ï··ÚÔÛÎÔÈ΋ ÂÎÙ¤ÏÂÛË Ù˘ Ù¯ÓÈ΋˜ ·˘Ù‹˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÈ. ∏ ·ÔηٿÛÙ·ÛË Ù˘ ÎÚ˘„ÔÚ¯›·˜ Û ‰‡Ô ÛÙ¿‰È· ÚÔÙÈÌ¿Ù·È ·fi ÔÏÏÔ‡˜ ¯ÂÈÚÔ˘ÚÁÔ‡˜, ·ÓÙ› Ù˘ ηı‹ÏˆÛ˘ ÙÔ˘ fiگˆ˜ Ì ٿÛË (17).

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™ÂÏ›‰· 98

¶·È‰È·ÙÚÈ΋ 2001;64:93-100

√ fiگȘ, ηıÒ˜ Î·È Ô ÛÂÚÌ·ÙÈÎfi˜ ÙfiÓÔ˜, ÂÚÈÎÏ›ÔÓÙ·È Û ¤Ó· ÏÂÙfi Ê¿ÎÂÏÔ ·fi Silastic, ÂÏ·ÙÙÒÓÔÓÙ·˜ ¤ÙÛÈ ÙȘ Û˘ÌʇÛÂȘ Ì ÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜, ‰È¢ÎÔχÓÔÓÙ·˜ ÙË ‰Â‡ÙÂÚË Â¤Ì‚·ÛË. ªÈÎÚÔ¯ÂÈÚÔ˘ÚÁÈΤ˜ Ù¯ÓÈΤ˜ (Silber Î·È Kelly) ·Ó·ÛÙÔÌÒÓÔÓÙ·˜ Ù· ÛÂÚÌ·ÙÈο ·ÁÁ›· Ì ·˘Ù¿ ÙÔ˘ ÌËÚÔ‡ ‹ ÙfiÍ· ·fi Ù· ÂÓ Ùˆ ‚¿ıÂÈ Î¿Ùˆ ÂÈÁ¿ÛÙÚÈ· ·ÁÁ›·, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Ì ÂÚÈÛÙ·Ûȷ΋ ÂÈÙ˘¯›· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘„ËÏ‹˜ ÎÚ˘„ÔÚ¯›·˜. º˘ÛÈο ÔÈ Ù¯ÓÈΤ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÂÚÈÔÚÈṲ̂ÓË ÎÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹. ŸÙ·Ó Ô fiگȘ ‰ÂÓ ÌÔÚ› Ó· ·Ó¢ÚÂı› ÌÂÙ¿ ·fi ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ‚Ô˘‚ˆÓÈÎÔ‡ fiÚÔ˘, ÙÔ˘ ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÔ‡ ¯ÒÚÔ˘, ‰È·ÂÚÈÙÔÓ·˚΋ ÚÔÛ¤Ï·ÛË ‰È·Ì¤ÛÔ˘ Ù˘ ›‰È·˜ ‚Ô˘‚ˆÓÈ΋˜ ÙÔÌ‹˜ (¯ÂÈÚÈÛÌfi˜ La Roque) Ú¤ÂÈ Ó· ÂÎÙÂÏÂ›Ù·È ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ·ÚÔ˘Û›·˜ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ fiگˆ˜. √ ÂÓ‰ÔÎÔÈÏÈ·Îfi˜ fiگȘ ÌÔÚ› ‡ÎÔÏ· Ó· Ì·˜ ‰È·Ê‡ÁÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÈÛıÔÂÚÈÙÔÓ·˚΋˜ ‰ÈÂÚ‡ÓËÛ˘, ÁÈ·Ù› ÎÚ¤ÌÂÙ·È ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ· ·fi ÙÔ ÌÂÛfiÚ¯ÈÔ. ∏ Ï··ÚÔÛÎfiËÛË ‚ÔËı¿ ¿Ú· Ôχ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ fiگˆ˜ ‹ ÛÙËÓ ÂȂ‚·›ˆÛË Èı·Ó‹˜ ·ÓÔÚ¯›·˜ Û ·È‰È¿ Ì ÎÂÓfi fiÛ¯ÂÔ Î·È ÌË „ËÏ·ÊËÙÔ‡˜ fiÚ¯ÂȘ. ∏ Ï··ÚÔÛÎÔÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·›˙ÂÈ ÂÓÂÚÁfi ÚfiÏÔ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÎÚ˘„ÔÚ¯›·˜. ∏ Ù¯ÓÈ΋ Fowler-Stephen Ù˘ ÛÙ·‰È·Î‹˜ ÔÚ¯ÂfiÏ˘Û˘-ËÍ›·˜ ÙÔ˘ ÂÓ‰ÔÎÔÈÏÈ·ÎÔ‡ fiگˆ˜ ¤¯ÂÈ Á›ÓÂÈ ·Ô‰ÂÎÙ‹ ÙÂÏÂ˘Ù·›·, ¤ÙÛÈ ÒÛÙ ÙÔ ÚÒÙÔ ÛÙ¿‰ÈÔ Ù˘ Ù¯ÓÈ΋˜ Ó· Á›ÓÂÙ·È Ï··ÚÔÛÎÔÈο. ∏ ·Ú¯È΋ ·ÔϛӈÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ·ÁÁ›ˆÓ Ô‰ËÁ› Û ·‡ÍËÛË Ù˘ ·Ú¿Ï¢Ú˘ ·ÁÁ›ˆÛ˘ ÙÔ˘ fiگˆ˜ Î·È ÔÚ¯ÂÔËÍ›· ÌÔÚ› Ó· ÂÎÙÂÏÂÛÙ› ÂÈÙ˘¯Ò˜ 6 Ì‹Ó˜ ·ÚÁfiÙÂÚ·, Ì ·ÓÔÈÎÙ‹ ̤ıÔ‰Ô (18-20). ∆ÂÏÂ˘Ù·›·, Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Û ¤Ó· ¯ÚfiÓÔ Ï··ÚÔÛÎÔÈο Ó· ηıËψı› Ô fiگȘ ÛÙÔ Û‡ÛÙÔÈ¯Ô ËÌÈfiÛ¯ÂÔ (21-23). ¶ÂÚ›Ô˘ ÙÔ 15% ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ ı· ¤¯Ô˘Ó ·ÏËıÈÓ‹ ·Ô˘Û›· fiگˆ˜. °È· Ó· ÂȂ‚·Èˆı› Ë ‰È¿ÁÓˆÛË Ú¤ÂÈ ¯ÂÈÚÔ˘ÚÁÈο Ó· ·Ó·ÁÓˆÚÈÛıÔ‡Ó Ù· Ù˘ÊÏ¿ ¿ÎÚ· Î·È ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ·ÁÁ›ˆÓ Î·È ÙÔ˘ fiÚÔ˘, ÁÈ·Ù› ÌfiÓÔ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Ù˘ÊÏÔ‡ ¿ÎÚÔ˘ ÙÔ˘ ÛÂÚÌ·ÙÈÎÔ‡ fiÚÔ˘ ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈ΋. ªÂÚÈΤ˜ ÊÔÚ¤˜, ·ÙÚÔÊÈÎfi˜ fiگȘ ÌÔÚ› Ó· ÂÓÙÔÈÛı› ÛÙÔ ‚Ô˘‚ˆÓÈÎfi ηӿÏÈ ‹ ̤۷ ÛÙÔ fiÛ¯ÂÔ. ∂Âȉ‹ Ù¤ÙÔÈÔÈ fiÚ¯ÂȘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÚÔËÁÔ‡ÌÂÓ˘ Û˘ÛÙÚÔÊ‹˜, ÌÂÚÈÎÔ› ¯ÂÈÚÔ˘ÚÁÔ› Û˘ÓÈÛÙÔ‡Ó ÔÚ¯ÂÔËÍ›· ÛÙÔÓ ·ÓÙ›ıÂÙÔ fiÚ¯È. ∂¿Ó ¤Ó·˜ ·ÙÚÔÊÈÎfi˜ fiگȘ ·Ó¢ڛÛÎÂÙ·È Î·È Ô ·ÓÙ›Ï¢ÚÔ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜, Ú¤ÂÈ Ó· ÂÎÙÂÏÂ›Ù·È ÔÚ¯ÂÎÙÔÌ‹ Û‡ÛÙÔȯ·.

98

Paediatriki 2001;64:93-100

™˘Ó‹ıˆ˜ Ú¤ÂÈ Ó· ÂÚÈ̤ÓÔ˘Ì ¤ˆ˜ ÙËÓ ÂÊ˂›· ÁÈ· Ó· ·Ê·ÈÚ¤ÛÔ˘Ì ÙÔ˘˜ ˘ÔÏ·ÛÙÈÎÔ‡˜ fiÚ¯ÂȘ. ŸÙ·Ó Ô fiگȘ ‰ÂÓ Â˘Ú›ÛÎÂÙ·È, Ë ÔÚ¯È΋ ÚfiıÂÛË ÛÙËÓ ·Ú¯‹ Ù˘ ÂÊ˂›·˜ Â›Ó·È ··Ú·›ÙËÙË. ∞ÔÙÂϤÛÌ·Ù· ¯ÂÈÚÔ˘ÚÁÈ΋˜ ıÂÚ·›·˜ Î·È ÂÈÏÔΤ˜ ∏ ÁÔÓÈÌfiÙËÙ· Û ÌË ‰ÈÔÚıˆÌ¤ÓË ÂÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· Â›Ó·È ÌÂٷ͇ 40-65%, ·ÏÏ¿ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ì¤ÁÂıÔ˜, ÙË ÌÔÚÊÔÏÔÁ›· Î·È ÙË ı¤ÛË ÙÔ˘ fiگˆ˜. ∏ ÁÔÓÈÌfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ÂÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· ‰ÈÔÚıˆÌ¤ÓË ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ Â›Ó·È ÂÚ›Ô˘ 92%. ™Â ÂΛÓÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ Ë ÔÚ¯ÂÔËÍ›· ÂÎÙÂϤÛıËΠ۠ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·, Ë ¯·ÌËÏ‹ ÁÔÓÈÌfiÙËÙ· Î·È Ô ¯·ÌËÏfi˜ ·ÚÈıÌfi˜ ÛÂÚÌ·ÙÔ˙ˆ·Ú›ˆÓ ‰Â›¯ÓÔ˘Ó ÙË ÛÔ˘‰·ÈfiÙËÙ· Ù˘ ÁÚ‹ÁÔÚ˘ ηı‹ÏˆÛ˘ ÙÔ˘ fiگˆ˜ ÛÙÔ fiÛ¯ÂÔ. ŸÛÔ ˘„ËÏfiÙÂÚ· ·Ú·Ì¤ÓÂÈ Ô fiگȘ ¿Óˆ ·fi ÙÔ fiÛ¯ÂÔ, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚ˜ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È, Ì ¯·ÌËÏ‹ ÁÔÓÈÌfiÙËÙ· Î·È ¯·ÌËÏfi ·ÚÈıÌfi ÛÂÚÌ·ÙÔ˙ˆ·Ú›ˆÓ (24). ¶·È‰È¿ Ì ÌË ‰ÈÔÚıˆÌ¤ÓË ·ÌÊÔÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· Â›Ó·È 100% ÛÙ›ڷ. ∏ ·Ú·ÁˆÁ‹ ÙÂÛÙÔÛÙÂÚfiÓ˘ ›ӷÈ, Û˘¯Ó¿, ÂÚ›Ô˘ Ê˘ÛÈÔÏÔÁÈ΋. ∂¿Ó Ë ÔÚ¯ÂÔËÍ›· ÂÎÙÂÏÂ›Ù·È Û ·È‰È¿ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ, ÂÚÈÛÛfiÙÂÚ· ·fi ÙÔ 50% Â›Ó·È ÁfiÓÈÌ· Î·È 30% ¤¯Ô˘Ó ÓÔÚÌÔÛÂÚÌ›·. ™Â ·È‰È¿ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· Ë ˆÚ›Ì·ÓÛË ÙˆÓ ÛÂÚÌ·ÙÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ Â›Ó·È ÙÔ˘ ›‰ÈÔ˘ ‚·ıÌÔ‡ Î·È ÛÙÔ˘˜ ‰‡Ô fiÚ¯ÂȘ, Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 40%. ∆· Â›‰· Ù˘ FSH ·˘Í¿ÓÔ˘Ó ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁ· Ì ÙË ÛÂÚÌ·ÙÔÁ¤ÓÂÛË. À„ËÏ‹ LH ˘Ô‰ÂÈÎÓ‡ÂÈ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Î˘ÙÙ¿ÚˆÓ Leydig Î·È ÁÔÓ·‰È΋ ·ÙÚÔÊ›·. ∞ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÌÊÔÙÂÚfiÏ¢ÚË ÔÚ¯ÂÔËÍ›· ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ, ¤¯Ô˘Ó ÁÔÓÈÌfiÙËÙ· Á‡Úˆ ÛÙÔ 70%, ÂÓÒ ·ÛıÂÓ›˜ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÌÊÔÙÂÚfiÏ¢ÚË ÔÚ¯ÂÔËÍ›· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ, ¤¯Ô˘Ó ÁÔÓÈÌfiÙËÙ· Á‡Úˆ ÛÙÔ 15%. ªÂÙ¿ ·fi ÔÚ¯ÂÔËÍ›·, ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Ô˘ ÌÔÚ› Ó· ·Ú·ÎÈÓ‰˘Ó‡ÛÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ fiگˆ˜ ·Ú·ÙËÚÔ‡ÓÙ·È Û ÏÈÁfiÙÂÚÔ ·fi 5% ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ Ô˘ ÂÎÙÂÏÔ‡ÓÙ·È ·fi ¤ÌÂÈÚÔ˘˜ ¯ÂÈÚÔ˘ÚÁÔ‡˜. ∏ ϤÔÓ ÛÔ‚·Ú‹ ÂÈÏÔ΋ Â›Ó·È Ë ·fiÊÚ·ÍË Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ fiگˆ˜ ·fi ‚Ï¿‚Ë Î·Ù¿ ÙÔ˘˜ ¯ÂÈÚÈÛÌÔ‡˜, Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ Ì›Û¯Ô˘, Ë Û‡ÁÎÏÈÛË ÙˆÓ ÎÔÈÏÈ·ÎÒÓ Ì˘ÒÓ Ôχ ÛÊȯٿ, Ë ÛÙ¤ÓˆÛË ÙÔ˘ ·˘ÏÔ‡ ÙˆÓ ·ÁÁ›ˆÓ fiÙ·Ó Î·ıËψı› Ô fiگȘ ÛÙÔ fiÛ¯ÂÔ Ì ٿÛË. ∂Âȉ‹ Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÎÚ˘„fiگˆ˜ ‰ÂÓ Â›Ó·È Ë È‰·ÓÈ΋, Ë ÂÈÚfiÛıÂÙË ÚÔÛ‚ÔÏ‹ ÛÙÔÓ ·ÁÁÂÈ·Îfi

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 99

¶·È‰È·ÙÚÈ΋ 2001;64:93-100

Ì›Û¯Ô ¯ÂÈÚÔÙÂÚ‡ÂÈ ÙËÓ ÚfiÁÓˆÛË Û¯ÂÙÈο Ì ÙË ÏÂÈÙÔ˘ÚÁ›· ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛ‹ ÙÔ˘ ÛÙÔ fiÛ¯ÂÔ. ¶·ÚÔ‰ÈÎfi Ô›‰ËÌ· ÙÔ˘ fiگˆ˜ ·fi ÌÂÚÈ΋ ·fiÊÚ·ÍË Ù˘ ÏÂÌÊÈ΋˜ Î·È ÊÏ‚È΋˜ ΢ÎÏÔÊÔÚ›·˜ Â›Ó·È Û˘¯Ófi Î·È Û˘Ó‹ıˆ˜ ˘Ô¯ˆÚ› Û 4 ‚‰ÔÌ¿‰Â˜. ÀÔ¯ÒÚËÛË ÙÔ˘ fiگˆ˜ Û ¤Ó· ÛËÌÂ›Ô ˘„ËÏfiÙÂÚ· ·fi ÙÔ ¤Íˆ ÛÙfiÌÈÔ ÙÔ˘ ‚Ô˘‚ˆÓÈÎÔ‡ fiÚÔ˘ Â›Ó·È ·Û‡ÓËı˜ Ì ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ fiگˆ˜ ÌÂٷ͇ ‰¤ÚÌ·ÙÔ˜ Î·È ‰·ÚÙÔ‡ ÙÔ˘ ÔÛ¯¤Ô˘. ∞Ó¿Ù˘ÍË ‚Ô˘‚ˆÓÔ΋Ï˘ ÌÂÙ¿ ·fi ÔÚ¯ÂÔËÍ›· Â›Ó·È Û¿ÓÈ·. ∫·ÎÔ‹ıÂÈ· Î·È ÎÚ˘„ÔÚ¯›· ¶ÂÚ›Ô˘ ÙÔ 12% ÙˆÓ fiÁÎˆÓ ÙÔ˘ fiگˆ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÎÚ˘„fiÚ¯ÂȘ. √ ÎÚ˘„fiگȘ ¤¯ÂÈ 30-50 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·Ó·Ù‡ÍÂÈ Î·ÎÔ‹ıÂÈ· Û ۇÁÎÚÈÛË Ì ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi fiÚ¯È. ∞ÙÚÔÊÈÎÔ› Î·È ÂÓ‰ÔÎÔÈÏÈ·ÎÔ› fiÚ¯ÂȘ ¤¯Ô˘Ó 200 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·Ó·Ù‡ÍÔ˘Ó Î·ÎÔ‹ıÂÈ· (25). ∏ ̤ÛË ËÏÈΛ· ÛÙËÓ ÔÔ›· ÌÔÚ› Ó· ·Ó·Ù˘¯ı› fiÁÎÔ˜ Û ÎÚ˘„fiÚ¯ÂȘ Â›Ó·È Ù· 26 ¤ÙË. √ ΛӉ˘ÓÔ˜ ·Ó¿Ù˘Í˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Â›Ó·È ˘„ËÏfi˜ Û ·È‰È¿ Ì ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· Î·È Û ·˘Ù¿ Ì ·ÓˆÌ·Ï›Â˜ ÛÙ· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·. √È Û˘Ó‹ıÂȘ ηÎÔ‹ıÂȘ fiÁÎÔÈ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ˘˜ ÎÚ˘„fiÚ¯ÂȘ Â›Ó·È Ù· ÛÂÌÈÓÒÌ·Ù·, ÙÂÚ·ÙÔηÚÎÈÓÒÌ·Ù·, ÂÌ‚Ú˘˚ο ηÚÎÈÓÒÌ·Ù· Î·È ÙÂÚ·ÙÒÌ·Ù· ÂÓËϛΈÓ. ∏ Û˘¯ÓfiÙËÙ· ·Ó¿Ù˘Í˘ fiÁÎˆÓ fiگˆ˜ Û ÎÚ˘„fiÚ¯ÂȘ Ô˘ ηıËÏÒÓÔÓÙ·È ÛÙÔ fiÛ¯ÂÔ ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ Â›Ó·È ÌÈÎÚfiÙÂÚË, Û˘ÁÎÚÈÙÈο Ì ÂΛÓÔ˘˜ Ô˘ ηıËÏÒÓÔÓÙ·È ÛÙËÓ ÂÊ˂›·. ™‡Á¯ÚÔÓ˜ ıˆڋÛÂȘ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙËÓ ¿Ô„Ë fiÙÈ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 14 ÂÙÒÓ Ì ÂÙÂÚfiÏ¢ÚË ÎÚ˘„ÔÚ¯›· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È Û ‚ÈÔ„›·. ∂¿Ó Ô fiگȘ ‰Â›¯ÓÂÈ ˘ÔÏ·ÛÙÈÎfi˜ ‹ ‰˘ÛÏ·ÛÙÈÎfi˜ Ú¤ÂÈ Ó· ·Ê·ÈÚ›ٷÈ. ∂¿Ó ÛÙË ‚ÈÔ„›· ¤¯Ô˘ÌÂ Ê˘ÛÈÔÏÔÁÈο ÈÛÙÔÌÔÚÊÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ë ÔÚ¯ÂÔËÍ›· Â›Ó·È ··Ú·›ÙËÙË Ì ÙËÓ ÚÔ¸fiıÂÛË Ù˘ ÂÙ‹ÛÈ·˜ Â·ÓÂͤٷÛ˘ ÁÈ· Ù˘¯fiÓ ·Ó¿Ù˘ÍË Î·ÎÔ‹ıÂÈ·˜. √ ΛӉ˘ÓÔ˜ ·Ó¿Ù˘Í˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· ·˘Í¿ÓÂÈ ¿ÌÂÛ· Ì ÙËÓ ËÏÈΛ· ÛÙÔ ¯ÚfiÓÔ Ù˘ ÔÚ¯ÂÔËÍ›·˜. ¶·Ú·Ì¤ÓÂÈ, ‚¤‚·È·, ·‰È¢ÎÚ›ÓÈÛÙÔ Â¿Ó Ë ÔÚ¯ÂÔËÍ›· ÂÏ·ÙÙÒÓÂÈ ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ fiÁÎÔ˘. ∂›Û˘, Ê·›ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ÛÙÂÓ‹ Û¯¤ÛË ÌÂٷ͇ Ù˘ ·Ó¿Ù˘Í˘ ηÎÔ‹ıÂÈ·˜ ÛÙÔÓ fiÚ¯È Î·È ÙÔ˘ ‚·ıÌÔ‡ ˘ÔÏ·Û›·˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Fonkalsrud E. Undescended Testes. In: Welch K, Randolph J, Ravitch M, eds. Pediatric Surgery. 4th ed.

1986. p. 793-807.

2. Swenson’s Pediatric Surgery. 5th ed. 1990Undescended Testicle. p. 145-154.

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3. Fallat ME, Williams MPL, Farmer PJ, Galinaro RN, Stover BH , Winkersons. Histologic evaluation of inguinoscrotal migration of the gubernaculum in rodents during testicular descent and its relationship to the genitofemoral nerve. Pediatr Surg Intern 1992;7:265-270.

4. Hrabovszky Z, Farmer PJ, Hutson J. Does the sensory nucleus of the genitofemoral nerve have a role in testicular descent. J Pediatr Surg 2000;35:96-100.

5. Binqgol-Kologln M, Demirci M, BujuKpamuKcu M. Cremasteric reflexes of boys with descended, retractile, or undescended testes: An electrophysiological evaluation. J Pediatr Surg 1999;34:430-434.

6. °È·ÓÓfiÔ˘ÏÔ˜ °, ∞ÓÙ‡·˜ ™, ∫·ÎÏ·Ì¿Ó˘ ¶, µÂÚ‚ÂÚ›‰Ë˜ ª. ∫Ú˘„ÔÚ¯›·, KÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷ΋ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË. ∂ÏÏËÓ ÃÂÈÚÔ˘ÚÁ 1998;70:460-468.

7. Puri P, Nixon HH. Bilateral retractile testes: Subsequent effect on fertility. J Pediatr Surg 1997;12:563-567.

8. Murthy GG, Peress NS, Kahn SA. Demonstration of antibodies to testicular basement membrane by immunofluorescence in a patient with multiple primary endocrine deficiencies. J Clin Endocrinol Metabol 1976;42:637-640.

9. Mules LM, Holmes SJK. Human chorionic gonadotropin and laparoscopy in the treatment of impalpable testes.

J Pediatr Surg 1994;29:551-552.

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11. ¶·È‰È·ÙÚÈ΋ O˘ÚoÏÔÁ›·, º. ∞Ó‰ÚÔ˘Ï·Î¿Î˘. ∫Ú˘„ÔÚ¯›·. EΉfiÛÂȘ µ∏∆∞; 1993. ÛÂÏ. 253-258.

12. Moore RG, Peters CA, Bauer SB, Maudell J, Retik AB. Laparoscopic evaluation of the nonpalpable testis: A prospective assessment of accuracy. J Urol 1994;151:728-731.

13. Rajfer J, Handelsman DJ, Swerdloff RS, Hurwitz R, Kaplan H, Vandergast T. Hormoral therapy of cryptorchidism: A randomized double-blind study comparing HCG and gonadotropin releasing hormone.

N Engl J Med 1986;314:466-470.

14. Mengel W, Zimmerman FA, Hhecker WCh. Timing of repair for undescended testes. In: Fonkalsrud EW, Mengel W, eds. The Undescended Testis. Chicago, IL: Year Book Medical Publishers; 1981. p. 170.

15. Palacio M, Sferco A, Fenrandez A, Vilarrodona H. Inguinal Cordopexy: A simple and effective new technique for securing the testes in reoperative orchiopexy. J Pediatr Surg 1999;34:424-425.

16. ∫ÏÔÎοÚ˘ ∞, ∫ÒÙÛÈÔ˘ ª, ∑ÈÔ‡Ù˘ π, °ÂˆÚÁ¿Î˘ π, ∆ÛÈÛfiÔ˘ÏÔ˜ °, ™‚ÂÚÒÓ˘ ª Î·È Û˘Ó. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ˘„ËÏ‹˜ ÎÚ˘„ÔÚ¯›·˜ Ì ÙË Ì¤ıÔ‰Ô Stephens Fowler. ∂ÏÏËÓÈ΋ ÃÂÈÚÔ˘ÚÁÈ΋ 1995;67:626-629.

17. Corkery SJ. Staged orchiopexy: A new technique. J Pediatr Surg 1975;10:515-519.

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19. The Surgical Clinics of North America. Pediatr Surg; 1992. p. 1299-1313.

20. Bloom DA. Two-step orchiopexy with pelviscopic clip ligation of the spermatic vessels. J Urol 1991;145:1030-1033.

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24. Kieswetter WB, Shull WR, Fettermann GH. Histological changes in the testis following anatomically successful orchiopexy. J Pediatr Surg 1969;4:59-65.

25. ∞ÚÁÈ·Ó¿˜ ™, ∂ÌÌ·ÓÔ˘‹Ï °. ¢È·ÔÛ¯Â˚΋ ÔÚ¯ÂÔËÍ›·. ∂ÏÏËÓÈ΋ ÃÂÈÚÔ˘ÚÁÈ΋ 1995;67:623-625.

26. Cortes D, Thorup J, Frish M, Moller H, Jacobsen GK, Beck BL. Examination for intratubular germ cell neoplasia at operation for intratubular germ cell neoplasia at operation for undescended testis in boys. J Urol 1994;151:722-725.

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Couroucli XI, Welty SE, Ramsay PL, Wearden ME, Fuentes-Garcia FJ, Jiyuan NI, Jacobs TN, Towbin JA, Bowles NE Detection of microorganisms in the tracheal aspirates of preterm infants by polymerase chain reaction: association of adenovirus infection with bronchopulmonary dysplasia Pediatr Res 2000;47:225-232 ™‡ÚÔ˜ ºˆÙfiÔ˘ÏÔ˜

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™ËÌ·Û›· ÙÔ˘ Ȉ‰›Ô˘ Î·È Ù˘ ı˘ÚÔ͛Ӣ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ∫. ¶·ÓÙÛÈÒÙÔ˘

The importance of iodine and thyroxine in the human organism ∫. Pantsiotou

¶ÂÚ›ÏË„Ë: ∆Ô ÈÒ‰ÈÔ ˘¿Ú¯ÂÈ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi Û ·ÂÈÚÔÂÏ¿¯ÈÛÙ˜ ÔÛfiÙËÙ˜ (15 mg). ∏ ËÌÂÚ‹ÛÈ· ηٷӿψÛË Èˆ‰›Ô˘ Â›Ó·È ÌÈÎÚ‹ (150-500 Ìg), ·ÏÏ¿ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Èˆ‰ÔÂÓ›·, ÁÈ·Ù› Î·È ÛÙÔ ÊÏÔÈfi Ù˘ Á˘ ÙÔ ÈÒ‰ÈÔ ˘¿Ú¯ÂÈ Û ÌÈÎÚ‹ ÔÛfiÙËÙ·. ŒÏÏÂÈ„Ë Èˆ‰›Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÊÙˆ¯¿ ¿ÙÔÌ·, Ô˘ ˙Ô˘Ó Û ÔÚÂÈÓ¤˜ ÂÚÈÔ¯¤˜, ¯ˆÚ›˜ Û˘ÁÎÔÈӈӛ˜, Ì·ÎÚÈ¿ ·fi ÙË ı¿Ï·ÛÛ· Î·È Î·Ù·Ó·Ï›ÛÎÔ˘Ó ÌfiÓÔ Ê˘ÙÈο ÚÔ˚fiÓÙ· Ô˘ ·Ú¿ÁÔÓÙ·È ÙÔÈο, ¯ˆÚ›˜ ηٷӿψÛË ˙ˆÈÎÒÓ Î·È Û˘ÓÙËÚËÌ¤ÓˆÓ ÙÚÔÊÒÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÈÒ‰ÈÔ. ŸÙ·Ó ÙÔ 10% Î·È ¿Óˆ ÂÓfi˜ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ‰ÈÔÁΈ̤ÓÔ ı˘ÚÂÔÂȉ‹, ˘¿Ú¯ÂÈ Èˆ‰ÔÂÓ›· ÛÙËÓ ÂÚÈÔ¯‹ Î·È Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ Ȉ‰›Ô˘ ÙˆÓ Ô‡ÚˆÓ 24ÒÚÔ˘, Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 100 Ìg. ∏ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ηٿ ÙËÓ ÂÌ‚Ú˘˚΋ ˙ˆ‹ Î·È Ù· ÙÚ›· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜, ÚÔηÏ› ·ÓÂ·ÓfiÚıˆÙ˜ ‚Ï¿‚˜, Ì ηı˘ÛÙ¤ÚËÛË ÛÙËÓ „˘¯ÔÎÈÓËÙÈ΋, ÓÔËÙÈ΋, ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË (¡Â˘ÚÔÏÔÁÈÎfi˜, ª˘ÍÔȉËÌ·ÙÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜) Î·È ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÚfiˆÚˆÓ ·Ô‚ÔÏÒÓ, ÂÓÒ Î·Ù¿ ÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· ÚÔηÏ› ‚ÚÔÁ¯Ô΋ÏË, ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ·˘Í¿ÓÂÈ ÙË Û˘¯ÓfiÙËÙ· ηÚΛÓÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ÌÂÙ¿ ·fi ˘ÚËÓÈÎfi ·Ù‡¯ËÌ·, fiˆ˜ ÂΛÓÔ ÙÔ˘ Chernobyl. √ ÂÌÏÔ˘ÙÈÛÌfi˜ ÙˆÓ ÙÚÔÊÒÓ Ì ÈÒ‰ÈÔ (ÓÂÚfi, ·Ï¿ÙÈ, „ˆÌ›) ·ÔÙÂÏ› ÂıÓÈÎfi ηı‹ÎÔÓ. ™‹ÌÂÚ·, ¤Ó· ‰ÈÛÂηÙÔÌ̇ÚÈÔ ¿ÓıÚˆÔÈ (Û ÔÚÂÈÓ¤˜ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜), ۯ‰fiÓ ÙÔ 17% ÙÔ˘ Ï·Ó‹ÙË Ì·˜, ‚Ú›ÛÎÔÓÙ·È Û ¤ÏÏÂÈ„Ë. ∆Ô ÈÒ‰ÈÔ ‰Ú· ̤ۈ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Î·È ·ÔÙÂÏ› ÙÔ 64% ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ ÌÔÚ›Ô˘ Ù˘ ı˘ÚÔ͛Ӣ. √È ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ˆÚ›Ì·ÓÛË ‰È·ÊfiÚˆÓ ÈÛÙÒÓ, ·˘Í¿ÓÔ˘Ó ÙȘ η‡ÛÂȘ Î·È ÂÈÙ·¯‡ÓÔ˘Ó ÂÓ˙˘ÌÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜. ¶ÂÚÈÔ¯¤˜ Ì ‰¿ÊË

Abstract: Iodine is an essential trace element in the human body and is present only in minute quantities (9 mg). The daily consumption of iodine is small (150-500 Ìg), but iodine deficiency is often observed, because there is small quantity of iodine on the earth. In developing countries iodine deficiency is observed among the poor, who live in mountainous areas, without public transportation and far away from the sea. Those people only consume locally produced vegetable foods, and are deprived of animal and of preserved foods which contain more iodine. When one finds goiters in more than 10% of the population, then there is iodine deficiency in that district and the concentration of iodine in 24 hour urine collection is less than 100 Ìg. Iodine deficiency during intrauterine life and during the first 3 years may cause unrepaired damage with developmental, psychokinetic and intellectual delay (Neurological cretinism and Myxedematous cretinism) and an increase in fetal loses. Iodine deficiency during childhood and adolescence may cause an increase in the incidence of bronchocele, developmental retardation and an increase in the incidence of thyroid cancer following nuclear accidents such as that of Chernobyl. In adulthood iodine deficiency may cause goitre, which causes difficulty in swallowing and breathing, and hypothyroidism as well as toxic goitre and cold nodules which can be cancerous. Today iodine deficiency has been reported to be present in about one billion people (17% of the earth’s population) who live in mountainous areas in developing countries.

Enrichment of food with iodine (water, salt, bread) is

∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜

∂ndocrinologist

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ÊÙˆ¯¿ Û ÈÒ‰ÈÔ ‹ Î·È ÛÂÏ‹ÓÈÔ, ¤¯Ô˘Ó ¿ÙÔÌ· Ì ¯·ÌËÏfiÙÂÚÔ Ì¤ÛÔ ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘, „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ÂÏ·Ùو̤ÓË ·ÎÔ˘ÛÙÈ΋ Ô͇ÙËÙ·. √ Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ Â›Ó·È ·ÚfiÌÔÈ· ÌÔÚÊ‹ ÓÂ˘Ì·ÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘, fiÙ·Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛı› ÂÁη›Úˆ˜. ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘ Â›Ó·È 1:3500 ÁÂÓÓ‹ÛÂȘ. ∞˘Ù¿ Ù· ¿ÙÔÌ·, ηٿ ÙËÓ ÂÌ‚Ú˘˚΋ ˙ˆ‹ ·Ó·Ù‡ÛÛÔÓÙ·È Î·ÓÔÓÈο, ÁÈ·Ù› Ï·Ì‚¿ÓÔ˘Ó ı˘ÚÔÍ›ÓË ·fi ÙË ÌËÙ¤Ú·. ªÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ·Ó ‰Â Á›ÓÂÈ Ë ¤Ó·ÚÍË ·ÁˆÁ‹˜ Ì ı˘ÚÔÍ›ÓË, Ù· ·È‰È¿ ·Ó·Ù‡ÛÛÔ˘Ó ÌfiÓÈ̘ Ó¢ÚÔÏÔÁÈΤ˜ ‚Ï¿‚˜ Î·È „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ™ÙË ¯ÒÚ· Ì·˜, ·fi ÙÔ 1979, fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· ÂϤÁ¯ÔÓÙ·È ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ· ÁÈ· Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È Ï·Ì‚¿ÓÔ˘Ó ÂÓÙfi˜ ÌËÓfi˜ ıÂÚ·›· Ì ı˘ÚÔÍ›ÓË.

a national priority in every country. Iodine acts through the action of thyroid hormones which regulate the maturation of various tissues, increase the metabolic rate and augment the enzymatic reactions. In areas with iodine deficiency the affected population has a low index of intelligence, growth retardation and decreased hearing ability.

The incidence of congenital hypothyroidism is 1:3500 newborns in the first month of life and if untreated may cause mental retardation. During the prenatal period congenital hypothyroidism, have normal development because thyroxine is provided by their mother. Since 1979, all the newborns in our country undergo screening for congenital hypothyroidism and are treated with thyroxine within the first month of life (approximately 30 newborns are treated every year with thyroxine for hypothyroidism and have a regular follow up).

§¤ÍÂȘ ÎÏÂȉȿ: ÈÒ‰ÈÔ, Ȉ‰ÔÂÓ›·, ‚ÚÔÁ¯Ô΋ÏË, ÂÓ‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË, Ó¢ÚÔÏÔÁÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜, Ì˘ÍÔȉËÌ·ÙÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜, ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘, Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜.

Key words: iodine, iodine deficiency, goitre, endemic goitre, neurological cretinism, myxedematous cretinism, selenium deficiency, congenital hypothyroidism.

™˘ÓÙÔÌÔÁڷʛ˜ ∆4 £˘ÚÔÍ›ÓË FT4 ∂χıÂÚË £˘ÚÔÍ›ÓË ∆3 ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË RT3 ∞Ó¿ÛÙÚÔÊË ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË TSH £˘ÚÂÔÂȉÔÙÚfiÔ˜ √ÚÌfiÓË TBG √ÏÈ΋ ™Ê·ÈÚ›ÓË Ô˘ ‰ÂÛ̇ÂÈ ÙȘ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ WHO ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ UNICEF ÿ‰Ú˘Ì· ∏ÓˆÌ¤ÓˆÓ ∂ıÓÒÓ ÁÈ· ÙÔ ·È‰› ICCIDD ¢ÈÂıÓ¤˜ ™˘Ì‚Ô‡ÏÈÔ ÁÈ· ÓÔÛ‹Ì·Ù· ÏfiÁˆ ¤ÏÏÂȄ˘ πˆ‰›Ô˘

∂ÈÛ·ÁˆÁ‹ ∆Ô ÈÒ‰ÈÔ ·Ó·Î·Ï‡ÊıËΠÙÔ 1811. º‡ÎË Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ˆ˜ ÚÒÙË ‡ÏË ÁÈ· ·Ú·ÁˆÁ‹ ÓÈÙÚÈÎÔ‡ Î·Ï›Ô˘ ÁÈ· ˘Ú›Ùȉ·, ηٿ ÙË ı¤ÚÌ·ÓÛË ·ÚÔ˘Û›·Û·Ó ·ÙÌÔ‡˜ Ì È҉˜ ¯ÚÒÌ· Î·È ÌÂÙ¿ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ÎÚ‡ÛÙ·ÏÏÔÈ Èˆ‰›Ô˘. ∆Ô ÈÒ‰ÈÔ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·fi ÙÔ 1820 ˆ˜ ·ÔÏ˘Ì·ÓÙÈÎfi Î·È ·ÓÙÈÛËÙÈÎfi ÛÙ· ÙÚ·‡Ì·Ù· Î·È ÙȘ ÏËÁ¤˜, fiÔ˘ ‰Ú· ̤ۈ Ù˘ Ì˘ÂÏÔÂÚÔÍÂȉ¿Û˘ Î·È ·ÂÓÂÚÁÔÔÈ› Ù· ‚·ÎÙËÚ›‰È·. ∂›Ó·È ‰Ú·ÛÙÈÎfiÙÂÚÔ ·ÔÏ˘Ì·ÓÙÈÎfi ·fi Ù· ¿ÏÏ· ·ÏÔÁfiÓ· ¯ÏÒÚÈÔ, ‚ÚÒÌÈÔ, ÊıfiÚÈÔ. ∆Ô ÈÒ‰ÈÔ, fï˜, Â›Ó·È Î·È ¤Ó· ·fi Ù· 22 ··Ú·›ÙËÙ· ÛÙÔȯ›· (ÙÔ ‰¤Î·ÙÔ ¤ÌÙÔ Î·Ù¿ ÂηÙÔÛÙÈ·›· ·Ó·ÏÔÁ›·) Ô˘ Û˘Óı¤ÙÔ˘Ó ÙÔ ·ÓıÚÒÈÓÔ ÛÒÌ· (1). ∆Ô ÈÒ‰ÈÔ ‚Ú›ÛÎÂÙ·È Û ÌÈÎÚ‹ ÔÛfiÙËÙ· ÛÙÔ ·ÓıÚÒÈÓÔ ÛÒÌ·, Â›Ó·È È¯ÓÔÛÙÔȯ›Ô, ‰ËÏ·‰‹ ÏÈÁfiÙÂÚÔ

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·fi 100mg, ·ÏÏ¿ ‚Ú›ÛÎÂÙ·È Î·È ÛÙÔ ÊÏÔÈfi Ù˘ Á˘ Û ÌÈÎÚ‹ ÔÛfiÙËÙ·. °È· ÙËÓ ·ÎÚ›‚ÂÈ·, ¤Ó·˜ ÂÓ‹ÏÈη˜ ¤¯ÂÈ 15 mg Ȉ‰›Ô˘.∆Ô ÈÒ‰ÈÔ Ì ÙÔ ·ÌÈÓÔ͇ Ù˘ÚÔÛ›ÓË Û˘Óı¤ÙÔ˘Ó ÙȘ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ (∆3, ∆4) (∂ÈÎfiÓ· 1), Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ˆÚ›Ì·ÓÛË ‰È·ÊfiÚˆÓ ÈÛÙÒÓ, ·˘Í¿ÓÔ˘Ó ÙȘ η‡ÛÂȘ (ÌÂÙ·‚ÔÏÈÛÌfi) Î·È ÂÈÙ·¯‡ÓÔ˘Ó ‰È¿ÊÔÚÔ˘˜ ÂÓ˙˘ÌÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜. ∆Ô ÛÂÏ‹ÓÈÔ ·Ó·Î·Ï‡ÊıËΠÙÔ 1817 Î·È ıˆÚ›ÙÔ fiÙÈ ÚÔÂÚ¯fiÙ·Ó ·fi ÂÙÚÒÌ·Ù· (ÌÂÙˆڛÙ˜) Ù˘ ÛÂÏ‹Ó˘ (2). µÚ›ÛÎÂÙ·È Û ·ÂÈÚÔÂÏ¿¯ÈÛÙË ÔÛfiÙËÙ· ÛÙÔ ÊÏÔÈfi Ù˘ Á˘, ·ÏÏ¿ Â›Ó·È ··Ú·›ÙËÙÔ ÛÙËÓ Î·Ù·Û΢‹ ʈÙÔ΢ÙÙ¿ÚˆÓ ÁÈ· ÙÔ ·˘ÙfiÌ·ÙÔ ¿ÓÔÈÁÌ· Ù˘ fiÚÙ·˜. ∆Ô ÛÂÏ‹ÓÈÔ Â›Ó·È ÁÓˆÛÙfi ˆ˜ ··Ú·›ÙËÙÔ È¯ÓÔÛÙÔÈ¯Â›Ô ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ·fi ÙÔ 1957. ∆Ô ÛÂÏ‹ÓÈÔ Â›Ó·È ÙÔ 20fi ÛÙÔÈ¯Â›Ô Î·Ù¿ ÂηÙÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜ Î·È ·ÔÙÂÏ› Û˘ÛÙ·ÙÈÎfi ÔÏÏÒÓ ÂÓ˙‡ÌˆÓ (¿Óˆ ·fi 10 ¤Ó˙˘Ì· ¤¯Ô˘Ó ÙËÓ ÂÓÂÚÁfi ÔÌ¿‰· ÛÂÏËÓÔ΢ÛÙ½ÓË), fiˆ˜ Ë ˘ÂÚÔÍÂȉ¿ÛË Ù˘ ÁÏÔ˘Ù·ıÂÈfiÓ˘, Ô˘ ‰ÂÛ̇ÂÈ ÙȘ ÂχıÂÚ˜ Ú›˙˜ Ô͢ÁfiÓÔ˘ Î·È Ù· ˘ÂÚÔÍ›‰È· Ô˘ Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ. ∆Ô ÛÂÏ‹ÓÈÔ Â›Ó·È ·ÓÙÈÔÍÂȉˆÙÈÎfi Î·È ‰Ú· ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙË ‚ÈÙ·Ì›ÓË ∂. ∆· ¤Ó˙˘Ì· Ô˘ ÌÂÙ·‚ÔÏ›˙Ô˘Ó ÙËÓ ÚÔÔÚÌfiÓË ∆4 ÛÙË ‰Ú·ÛÙÈ΋ ÔÚÌfiÓË ∆3 ‹ Û ·ÓÂÓÂÚÁfi rT3, ηıÒ˜ Î·È Ù· ¤Ó˙˘Ì· Ô˘ ÌÂÙ·‚ÔÏ›˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ Ù·

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ªÔÓÔ˚ˆ‰ÔÙ˘ÚÔÛ›ÓË

¢˘˚ˆ‰ÔÙ˘ÚÔÛ›ÓË

D2,D1 -1 (5’) 3,5,3’ - ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË (∆3)

£˘ÚÔÍ›ÓË (∆4) D3 -1 (5)

3,3’ ¢˘˚ˆ‰ÔÙ˘ÚÔÛ›ÓË (∆2)

3,3’,5’ - ∆ÚÈȈ‰Ôı˘ÚÔÓ›ÓË (∞ÓÙ›ÛÙÚÔÊË - ∆3)

∂ÈÎfiÓ· 1. √È ÌÔÓÔ- Î·È ‰˘- Ȉ‰ÔÙ˘ÚÔÛ›Ó˜ Â›Ó·È Úfi‰ÚÔ̘ ÔÚÌfiÓ˜. √È ∆4 Î·È ∆3 Â›Ó·È ÔÈ ‚ÈÔÏÔÁÈο ÂÓÂÚÁ¤˜ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜. ∏ ∆3 ÂÎÎÚ›ÓÂÙ·È ·fi ÙÔ ı˘ÚÂÔÂȉ‹, ·ÏÏ¿ ΢ڛˆ˜ Û¯ËÌ·Ù›˙ÂÙ·È ÂÚÈÊÂÚÈο ·fi ÙË ı˘ÚÔÍ›ÓË Ì ÂÓ˙˘ÌÈ΋ ·Ô˚ˆ‰›ˆÛË. ∏ r∆3 Î·È Ë ∆2 Â›Ó·È ·ÓÂÓÂÚÁÔ› ÌÂÙ·‚Ôϛ٘ Ô˘ Û¯ËÌ·Ù›˙ÔÓÙ·È ·fi ÙËÓ ·Ô˚ˆ‰›ˆÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Û ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜. √È ·Ô˚ˆ‰ÈÓ¿Û˜ Ù˘ Ȉ‰Ôı˘ÚÔÓ›Ó˘ π,ππ,πππ, ÁÚ¿ÊÔÓÙ·È ˆ˜ D1, D2, D3, ·ÓÙ›ÛÙÔȯ·. ∏ D3 ·Ô˚ˆ‰ÈÒÓÂÈ ÙÔ ÈÒ‰ÈÔ 5 ÙÔ˘ ÂÛˆÙÂÚÈÎÔ‡ ‰·ÎÙ˘Ï›Ô˘ Î·È ÌÂÙ·‚¿ÏÏÂÈ ÙËÓ ∆4 Û ∆3.

ÚÔ˚fiÓÙ· Ù˘ ı˘ÚÔ͛Ӣ, ÂÚȤ¯Ô˘Ó ÛÂÏËÓÔ΢ÛÙ½ÓË (3). √ ı˘ÚÂÔÂȉ‹˜ Â›Ó·È Ô ÌÔÓ·‰ÈÎfi˜ ÂÓ‰ÔÎÚÈÓ‹˜ ·‰¤Ó·˜, Ô˘ ÂÓÒ Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÔÈfiÙËÙ· Ù˘ ˙ˆ‹˜, ÁÈ· Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ ÛˆÛÙ¿ ÂÍ·ÚÙ¿Ù·È ·fi ȯÓÔÛÙÔȯ›· ÙˆÓ ÙÚÔÊÒÓ Ô˘ ÌÔÚ› Ó· ·ÓÂ·ÚΛ ÛÙÔÓ ÙfiÔ Ô˘ ‰È·‚ÈÒÓÂÈ (¶›Ó·Î·˜ 1). ∆Ô ÈÒ‰ÈÔ Ô˘ Â›Ó·È ··Ú·›ÙËÙÔ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·Ú·ÁˆÁ‹ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Î·È ÙÔ ÛÂÏ‹ÓÈÔ ÁÈ· ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ÛÙË ‰Ú·ÛÙÈ΋ ÔÚÌfiÓË ∆3. ∏ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ∆Ô ÈÒ‰ÈÔ ÛÙ· ÛÔÓ‰˘ÏˆÙ¿ Û˘ÁÎÂÓÙÚÒÓÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ı˘ÚÂÔÂȉ‹ ÁÈ· Û‡ÓıÂÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ, ·ÏÏ¿ ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔ˘˜ ÛÈÂÏÔÁfiÓÔ˘˜ ·‰¤Ó˜, ÙÔ Á·ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ, Ù· ¯ÔÚÈÔÂȉ‹ ϤÁÌ·Ù·, ÙȘ ˆÔı‹Î˜ Î·È ÙÔ Ì·ÛÙfi, ·ÏÏ¿ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ì ·Ó ‰Ú· ˆ˜ ·ÓÙÈÛËÙÈÎfi. ŸÙ·Ó ˘¿Ú¯ÂÈ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘, Ô ı˘ÚÂÔÂȉ‹˜ ‰ÈÔÁÎÒÓÂÙ·È ÁÈ· Ó· ÚÔÛÏ¿‚ÂÈ ÙÔ ÈÒ‰ÈÔ Ì ÌÂÁ·Ï‡ÙÂÚË ÂÈÊ¿ÓÂÈ· Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ‚ÚÔÁ¯Ô΋ÏË (5). ŸÙ·Ó Ë ‰ÈfiÁΈÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 10% ÂÓfi˜ ÏËı˘ÛÌÔ‡, ˘¿Ú¯ÂÈ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ÛÙË ÂÚÈÔ¯‹ (ÂÓ‰ËÌÈ΋

‚ÚÔÁ¯Ô΋ÏË). √ ı˘ÚÂÔÂȉ‹˜ ÛÙÔÓ ÂÓ‹ÏÈη ¤¯ÂÈ ‚¿ÚÔ˜ ÂÚ›Ô˘ 20 ÁÚ·ÌÌ¿ÚÈ· ÂÓÒ ÛÙË ‚ÚÔÁ¯Ô΋ÏË ÙÔ ‚¿ÚÔ˜ Â›Ó·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰ÈÏ¿ÛÈÔ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ Î·È ÌÔÚ› Ó· Êı¿ÛÂÈ Ù· 200-250 ÁÚ·ÌÌ¿ÚÈ· (6). ◊Ù·Ó ÁÓˆÛÙfi ·fi ÂÌÂÈÚÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ, fiÙÈ ¿ÙÔÌ· Ô˘ ˙Ô˘Ó Û „ËÏ¿ ‚Ô˘Ó¿ ¤¯Ô˘Ó Û˘¯Ó¿ ‰ÈÔÁΈ̤ÓÔ ı˘ÚÂÔÂȉ‹. √ ¿ÁÁÏÔ˜ È·ÙÚfi˜ Edward Browne (1644-1708), ηٿ ÙËÓ Â›Û΄‹ ÙÔ˘ ÛÙȘ ÕÏÂȘ ¤ÁÚ·„Â: “À¿Ú¯Ô˘Ó Â‰Ò ÔÏÏÔ› ¿ÓıÚˆÔÈ Ì ‚ÚÔÁ¯Ô΋ÏË. ªÂÚÈÎÔ› Â›Ó·È Ù˘ÊÏÔ›, ¿ÏÏÔÈ ÎˆÊ¿Ï·ÏÔÈ Î·È ¿ÏÏÔÈ ÓÂ˘Ì·ÙÈο ηı˘ÛÙÂÚË̤ÓÔÈ. √È ¿ÓıÚˆÔÈ Ù˘ ·ÓÒÙÂÚ˘ Ù¿Í˘, Ô˘ ˙Ô˘Ó Û ηχÙÂÚ˜ Û˘Óı‹Î˜ Î·È ›ÓÔ˘Ó ÎÚ·Û› Î·È Î·Ï‹˜ ÔÈfiÙËÙ·˜ Ì‡Ú·, ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù·” (7). ŒÓ· ‚È‚Ï›Ô ‰Â, Ô˘ ÁÚ¿ÊÙËΠÙÔ 1180 ·fi ÙÔ ƒÔÁ‹ÚÔ, ‰È¿ÛËÌÔ ¯ÂÈÚÔ˘ÚÁfi ÛÙÔ ¶·Ï¤ÚÌÔ Ù˘ πÙ·Ï›·˜, ·Ó·Ê¤ÚÂÈ ıÂÚ·›· Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ Ì ÛÙ¿¯ÙË Î·Ì̤ÓÔ˘ ÛfiÁÁÔ˘ ‹ ʇÎÈ· (8). ªÂ ÙËÓ ·Ó·Î¿Ï˘„Ë ÙÔ˘ Ȉ‰›Ô˘ ·Ú·Û΢¿˙ÂÙ·È ÛÙÔ ¶·Ú›ÛÈ ÙÔ ˘‰·ÙÈÎfi ‰È¿Ï˘Ì· Lugol ·fi ÙÔÓ ÔÌÒÓ˘ÌÔ ¯ËÌÈÎfi, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙË ıÂÚ·›· Ù˘ ‚ÚÔÁ¯Ô΋Ï˘, ·ÏÏ¿ ÂÁηٷÏ›ÊıËΠÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ· ÏfiÁˆ ·ÚÂÓÂÚÁÂÈÒÓ (Ë Î·Ù¿¯ÚËÛË ÚÔηÏ› ˘Ôı˘ÚÂÔÂȉÈÛÌfi ·ÏÏ¿ Î·È ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi). ªfiÓÔ ÙÔ 1907 ·ԉ›¯ıËΠfiÙÈ ÙÔ ÈÒ‰ÈÔ Â›Ó·È

103

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¶›Ó·Î·˜ 1. ™ÙÔȯ›· ·Ó¿ 100 gr ÙÚÔÊ‹˜ (4)

∞̇Á‰·Ï· ∞̇Á‰·Ï· µÚ·˙ÈÏ›·˜ ºÈÛÙ›ÎÈ· ∏ÏÈfiÛÔÚÔ˜ ™fiÁÈ· ™ÎfiÚ‰Ô ª·ÓÈÙ¿ÚÈ· ™¤ÏÈÓÔ ∫ÔÙfiÔ˘ÏÔ ˆÌfi ™ÔψÌfi˜ ÎÔÓÛ¤Ú‚· ™·Ú‰¤Ï˜ ÎÔÓÛ¤Ú‚· ¶¤ÛÙÚÔÊ· ‚Ú·Ṳ̂ÓË ∆fiÓÔ˜ °·Ú›‰Â˜ ª‡‰È· ∫˘‰ÒÓÈ· ı¿Ï·ÛÛ·˜ æˆÌ› ¿ÛÚÔ

∞Û‚¤ÛÙÈÔ mg 240 170 60 110 240 19 6 41 10 93 550 36 12 150 200 130 110

ª·ÁÓ‹ÛÈÔ mg 270 410 210 390 250 25 9 5 25 30 52 31 33 42 25 51 24

··Ú·›ÙËÙÔ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ı˘ÚÂÔÂȉ‹ ·fi ÙÔÓ ·ÌÂÚÈηÓfi David Marine, Ô ÔÔ›Ô˜ ¤Î·Ó Â›Û˘, ÚÔÛ¿ıÂÈ· Ì·˙È΋˜ ÚfiÏ˄˘ Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ Ì ÈÒ‰ÈÔ ÛÙÔ √¯¿ÈÔ Ù˘ ∞ÌÂÚÈ΋˜. ∏ ‹È· ¤ˆ˜ ̤ÙÚÈ· ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ÚÔηÏ› (¶›Ó·Î·˜ 2) Ó¢ÚÔÏÔÁÈΤ˜ ‚Ï¿‚˜ (9,10) ÛÙË Û¯ÔÏÈ΋ ËÏÈΛ·, ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ·ÚÔ‰ÈÎÔ‡ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ (11,12). ∏ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηÚΛÓÔ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙ· ·È‰È¿ (13) Û ÂÚ›ÙˆÛË ˘ÚËÓÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜, fiˆ˜ ÂΛÓÔ ÙÔ˘ Chernobyl Ô˘ Û˘Ó¤‚Ë ÙËÓ 26Ë ∞ÚÈÏ›Ô˘ ÙÔ˘ 1986. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ, ÁÈ·Ù› ÙÔ Ú·‰ÈÂÓÂÚÁfi ÈÒ‰ÈÔ 131 Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ Ó¤ÊÔ˜ ÙÔ˘ ˘ÚËÓÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜ ηıÈ˙¿ÓÂÈ Î·È ‰È· ÙˆÓ ÙÚÔÊÒÓ Î·È ÙÔ˘ ·¤Ú· ÚÔÛÏ·Ì‚¿ÓÂÙ·È ·fi ÙÔ ı˘ÚÂÔÂȉ‹ Ȉ‰ÔÂÓÈÎÒÓ ·ÙfïÓ. ª·ÎÚÔ¯ÚfiÓÈ· ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ‰ËÌÈÔ˘ÚÁ› ‰ÈfiÁΈÛË ı˘ÚÂÔÂȉԇ˜ (‚ÚÔÁ¯Ô΋ÏË ÌË ÙÔÍÈ΋), Ô˘ Â›Ó·È ÂÌÊ·Ó‹˜ ·fi ÙËÓ Â͈ÙÂÚÈ΋ ÂÌÊ¿ÓÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, ÓÂ˘Ì·ÙÈ΋ Î·È „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË (14) Î·È ÂÏ·Ùو̤ÓË ÁÔÓÈÌfiÙËÙ·. ŒÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ∏ ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ¿ÙÔÌ· Ì ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙÚÔʤ˜ ÊÙˆ¯¤˜ Û ʷÈÓ˘Ï·Ï·Ó›ÓË, ÂÓÒ Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÂÈÙ˘Á¯¿ÓÂÙ·È ÌfiÓÔ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÛÂÏËÓ›Ô˘. ŒÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙË ºÈÓÏ·Ó‰›· Î·È ÛÙË ¡. ∑ËÏ·Ó‰›·, fiÔ˘ Ë ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë Â›Ó·È 30-50 Ìg, ÂÓÒ ÛÙËÓ ∞ÌÂÚÈ΋ Â›Ó·È 100-250 Ìg ËÌÂÚËÛ›ˆ˜. ∏ ¯ÔÚ‹ÁËÛË ÛÂÏËÓ›Ô˘ ÂÏ·ÙÙÒÓÂÈ ÙË

104

™›‰ËÚÔ˜ mg 3,0 2,5 2,5 6,4 9,7 1,9 0,6 0,4 0,7 1,4 2,9 1,0 1,6 1,1 7,7 26 1,6

™ÂÏ‹ÓÈÔ Ìg 4 1530 3 49 14 2 9 3 7 25 50 24 90 18 45 45 28

πÒ‰ÈÔ Ìg 2 20 20 (;) 6 3 3 (;) 10 59 23 16 14 28 120 160 6

ıÓËÙfiÙËÙ· ÙÔ˘ ηÚΛÓÔ˘ (ηÚΛÓÔ˜ ‰¤ÚÌ·ÙÔ˜ ·fi ·ÙÙ·Ú· squamous), ηıÒ˜ Î·È ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ηÚΛÓÔ˘ Ó‡ÌÔÓÔ˜, ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÚÔÛÙ¿ÙË. ªÂÌÔӈ̤ÓË ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ·Ú·ÙËÚÂ›Ù·È Â›Û˘, Û ÂÚÈÔ¯¤˜ Ù˘ ∫›Ó·˜ (·fi ‚fiÚÂÈ· ·Ó·ÙÔÏÈο ¤ˆ˜ ÓfiÙÈ· ‰˘ÙÈο Î·È ÂÎÙ›ÓÂÙ·È Ì¤¯ÚÈ ÙÔ £È‚¤Ù), ÂÓÒ ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ Î·È Èˆ‰›Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ πÌ·Ï·˝ˆÓ Î·È ÚÔηÏ› ηٷÛÙÚÔÊ‹ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (Ì˘ÍÔȉËÌ·ÙÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜) Î·È ÛÙËÓ ∫ÂÓÙÚÈ΋ ∞ÊÚÈ΋ (‚fiÚÂÈÔ Î·È ·Ó·ÙÔÏÈÎfi ∑·˝Ú) (15). ™ÙËÓ ∫›Ó·, Ë ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ Û ·È‰È¿ Î·È ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ ·˘Í¿ÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ·fi ηډÈÔÌ˘Ô¿ıÂÈ· ÙÔ˘ Keshan (ÔÊ›ÏÂÙ·È Û Èfi) Î·È ÔÛÙÂÔ·ÚıÚÔ¿ıÂÈ· ÙÔ˘ Kashin-Beck Ô˘ ¶›Ó·Î·˜ 2. ∂›‰Ú·ÛË Ù˘ ¤ÏÏÂȄ˘ πˆ‰›Ô˘ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ∞. ∂Á΢ÌÔÛ‡ÓË 1. ∞˘ÙfiÌ·ÙË ¤ÎÙÚˆÛË 2. ¶ÚÒÈÌÔ˜ ÙÔÎÂÙfi˜ 3. ∂Ì‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜ 4. ÀÔÏÂÈfiÌÂÓË ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ µ. ¶·È‰È¿ 1. ¶ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË 2. ∫·ı˘ÛÙ¤ÚËÛË „˘¯ÔÎÈÓËÙÈ΋˜ ·Ó¿Ù˘Í˘ 3. ÷ÌËÏfi ·Ó¿ÛÙËÌ· 4. ª˘˚΋ ·‰˘Ó·Ì›· 5. ¶·Ú¿Ï˘ÛË 6. ∂Ï·Ùو̤ÓË ·ÎÔ‹ Î·È ‰˘Û¯¤ÚÂÈ· ÛÙËÓ ÔÌÈÏ›· 7. ∫ÚÂÙÈÓÈÛÌfi˜ °. ∂Ó‹ÏÈΘ 1. µÚÔÁ¯Ô΋ÏË 2. ∞‰˘Ó·Ì›·, ∫·Ù·‚ÔÏ‹ 3. ∫ÚÂÙÈÓÈÛÌfi˜ 4. ∂Ï·Ùو̤ÓË ÁÔÓÈÌfiÙËÙ·

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Paediatriki 2001;64:101-114

ÚÔԉ¢ÙÈο ÂȉÂÈÓÒÓÂÙ·È. ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÔ¯¤˜ ÙÔ ÛÂÏ‹ÓÈÔ ÛÙÔ ·›Ì· Â›Ó·È 10 ng/ml, ÂÓÒ ÛÙÔ˘˜ ηÙÔ›ÎÔ˘˜ ‚ÈÔÌ˯·ÓÈÎÒÓ ÂÚÈÔ¯ÒÓ Î˘Ì·›ÓÂÙ·È ·fi 60110 ng/ml. ∏ ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ÚÔηÏ› Ó¤ÎÚˆÛË ÙÔ˘ ‹·ÙÔ˜, Ô˘ ÂȉÂÈÓÒÓÂÙ·È fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Î·È ¤ÏÏÂÈ„Ë ‚ÈÙ·Ì›Ó˘ ∂. ™ÙÔ ∑·˝Ú, ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ ¤¯Ô˘Ó ‚ÚÔÁ¯Ô΋ÏË. ∆Ô 10% ÙˆÓ ·ÙfiÌˆÓ Â›Ó·È Ì˘ÍÔȉËÌ·ÙÈÎÔ› ÎÚÂÙ›ÓÔÈ, ‰ËÏ·‰‹ ¿ÙÔÌ· Ì ÎÔÓÙfi ·Ó¿ÛÙËÌ·, ‰˘Û·Ó·ÏÔÁ›· ÛÒÌ·ÙÔ˜ (ÎÔÓÙ¿ ¿ÎÚ·), „˘¯ÔÎÈÓËÙÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ·Ô˘Û›· ‰Â˘ÙÂÚÔÁÂÓÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ʇÏÔ˘, ˘Ôı˘ÚÂÔÂȉÈÛÌfi, ‚·ÚËÎÔ˝· Î·È ‰¤ÚÌ· Ú˘ÙȉˆÌ¤ÓÔ, ÁÂÚÔÓÙÈÎfi ‹ ÔȉËÌ·Ù҉˜ (∂ÈÎfiÓ· 2). ™ÙÔ £È‚¤Ù, Ë Û˘¯ÓfiÙËÙ· ·È‰ÈÒÓ Ì ÂÓ‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË Â›Ó·È ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙÔ ∑·˝Ú, ·Ú¿ ÙË ¯·ÌËÏfiÙÂÚË ·Ô‚ÔÏ‹ Ȉ‰›Ô˘ ·fi Ù· Ô‡Ú· ÙˆÓ ·È‰ÈÒÓ. ∆· ıÂÈÔ΢·ÓÈο Ù˘ ηÛÛ¿‚·, Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÙÚÔÊ‹ ÛÙ· ·È‰È¿ ÙÔ˘ ∑·˝Ú, Â›Ó·È ¤Ó·˜ ÂÈϤÔÓ ‚ÚÔÁ¯ÔÎËÏÔÁfiÓÔ˜ ·Ú¿ÁˆÓ Ô˘ ÂȉÂÈÓÒÓÂÈ ÙËÓ ˘¿Ú¯Ô˘Û· Ȉ‰ÔÂÓ›· (16,17). ∏ ÔÛÙÂÔ·ÚıÚÔ¿ıÂÈ· Kashin-Beck ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ∑·˝Ú, ·ÎfiÌË Î·È Û ‚·ÚȤ˜ ÌÔÚʤ˜ ¤ÏÏÂȄ˘ ÛÂÏËÓ›Ô˘. ∏ ·ÚÈ· ÙÚÔÊ‹ ÙˆÓ Î·ÙÔ›ÎˆÓ ÙÔ˘ £È‚¤Ù Â›Ó·È ÙÔ ÎÚÈı¿ÚÈ. ∫¿ÔÈ· ÙÔÍ›ÓË ·fi ̇ÎËÙ˜ Ô˘ ·Ó·Ù‡ÛÛÂÙ·È ÛÙÔ ÎÚÈı¿ÚÈ, ÂȉÂÈÓÒÓÂÈ ÙËÓ ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ÛÙÔ˘˜ ηÙÔ›ÎÔ˘˜ ÙÔ˘ £È‚¤Ù, ÒÛÙ ӷ ÂΉËÏÒÛÔ˘Ó ÛÙÂÚËÙÈÎfi ÓfiÛËÌ·. ™˘¯ÓfiÙËÙ· Ù˘ ¤ÏÏÂȄ˘ ÙÔ˘ Ȉ‰›Ô˘ ÛÙÔÓ Ï·Ó‹ÙË Ì·˜ ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ‰ÈÛÂηÙÔÌ̇ÚÈÔ ¿ÙÔÌ· (ÙÔ 17%) ·fi Ù· 6 ‰ÈÛÂηÙÔÌ̇ÚÈ· Ô˘ ηÙÔÈÎÔ‡Ó ÛÙÔÓ Ï·Ó‹ÙË Ì·˜, ÎÈÓ‰˘ÓÂ‡Ô˘Ó Ó· ·Ó·Ù‡ÍÔ˘Ó ÓÔÛ‹Ì·Ù· ÏfiÁˆ ¤ÏÏÂȄ˘ Ȉ‰›Ô˘ (18). ŒÏÏÂÈ„Ë Èˆ‰›Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÂÚÈÔ¯¤˜ Ô˘ ÙÔ ¤‰·ÊÔ˜ Â›Ó·È ÊÙˆ¯fi Û ÈÒ‰ÈÔ, ÂÂȉ‹ ¤ÁÈÓ ¤ÎÏ˘ÛË ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ‰¿ÊÔ˘˜, ›Ù ÏfiÁˆ ÌÂÙ·ÊÔÚ¿˜ ·fi ·ÁÂÙÒÓ˜ Û ÚÔËÁÔ‡ÌÂÓË ÁˆÏÔÁÈ΋ ÂÔ¯‹, ›Ù ÏfiÁˆ ˘„ËÏÒÓ ‚ÚÔ¯ÔÙÒÛÂˆÓ ‹ ÏË̶›Ó·Î·˜ 3. ∆È̤˜ ÂÏ¿¯ÈÛÙ˘ Û˘ÓÈÛÙÒÌÂÓ˘ ËÌÂÚ‹ÛÈ·˜ ηٷӿψÛ˘ πˆ‰›Ô˘ ηٿ WHO

∏ÏÈÎȷ΋ √Ì¿‰· ¶ÚfiˆÚ· –¡ÂÔÁÓ¿ µÚ¤ÊË ¶·È‰È¿

∂Ó‹ÏÈΘ ∫˘ÔÊÔÚÔ‡Û˜ £ËÏ¿˙Ô˘Û˜

0-5 ÌËÓÒÓ 5-12 ÌËÓÒÓ 1-3 ÂÙÒÓ 4-6 ÂÙÒÓ 7-10 ÂÙÒÓ

∏ÌÂÚ‹ÛÈ· ∫·Ù·Ó¿ÏˆÛË ·Ó¿ ¿ÙÔÌÔ >30 Ìg 90 Ìg 90 Ìg 90 Ìg 90 Ìg 120 Ìg 150 Ìg 200 Ìg 200 Ìg

∂ÈÎfiÓ· 2. §ÂÌÊ·‰ÂÓ›ÙȘ Î·È Ì˘ÍÔ›‰ËÌ·. ¶ÂÚÔ˘‚È·Ófi ·ÁÁ›Ô.

Ì‡ÚˆÓ (19). √È ÂÚÈÔ¯¤˜ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙ· „ËÏ¿ ‚Ô˘Ó¿ (ÕÏÂȘ, πÌ·Ï¿È·, ÕÓ‰ÂȘ) Î·È Û ÂÚÈÔ¯¤˜ Ì ¯·ÌËÏfi ˘„fiÌÂÙÚÔ ÔÈ Ôԛ˜, fï˜, Û˘¯Ó¿ ÏËÌÌ˘Ú›˙Ô˘Ó, fiˆ˜ ÙÔ ª·ÁÎÏ·ÓÙ¤˜ Î·È Ë ÓfiÙÈ· ∫›Ó·. √È ÂÚÈÛÛfiÙÂÚÔÈ ÏËı˘ÛÌÔ› Ì ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ˙Ô˘Ó Û ÔÚÂÈÓ¤˜ ÂÚÈÔ¯¤˜ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ ¯ˆÚÒÓ. ∞ÏÏ¿ ·ÎfiÌË Î·È ÛÙËÓ ∂˘ÚÒË 50-100 ÂηÙÔÌ̇ÚÈ· ¿ÙÔÌ· Â›Ó·È Û ΛӉ˘ÓÔ ÏfiÁˆ Ȉ‰ÔÂÓ›·˜ (∂ÈÎfiÓ· 3) (20). ™Â ÔÏϤ˜ ÂÚÈÔ¯¤˜ Ù˘ ∂˘ÚÒ˘, ȉ›ˆ˜ Û ̤ÚË Ù˘ ÎÂÓÙÚÈ΋˜, ÓfiÙÈ·˜ Î·È ·Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘, Ë Ì¤ÛË ËÌÂÚ‹ÛÈ· ηٷӿψÛË Èˆ‰›Ô˘ Â›Ó·È Ôχ ¯·ÌËÏfiÙÂÚË Ù˘ ÂÏ¿¯ÈÛÙ˘ Û˘ÓÈÛÙÒÌÂÓ˘ ‰fiÛ˘ ÁÈ· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ (¶›Ó·Î·˜ 3). ™‹ÌÂÚ·, Ë Ì¤ÛË ËÌÂÚ‹ÛÈ· ηٷӿψÛË ıˆÚÂ›Ù·È Â·Ú΋˜ ÌfiÓÔ Û ¤ÓÙ ¯ÒÚ˜ (∞˘ÛÙÚ›·, ºÈÓÏ·Ó‰›·, ¡ÔÚ‚ËÁ›·, ™Ô˘Ë‰›·, ∂Ï‚ÂÙ›·) (¶›Ó·Î·˜ 4) Î·È ·˘Ùfi ÂÈÙ‡¯ıËΠÌÂÙ¿ ·fi ÚÔÛ¿ıÂÈ· ÔÏÏÒÓ ÂÙÒÓ (21). §ÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ Ȉ‰›Ô˘ Î·È ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ∆Ô ÈÒ‰ÈÔ Î˘ÎÏÔÊÔÚ› ÛÙÔ ·›Ì· Î·È ÚÔÛÏ·Ì‚¿ÓÂÙ·È ·fi ÙÔ Î‡ÙÙ·ÚÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÂÓÂÚÁËÙÈο, ‰ËÏ·‰‹ Ì ηٷӿψÛË ÂÓ¤ÚÁÂÈ·˜ (22). ∆· ı˘Ï·ÎÈÒ‰Ë Î‡ÙÙ·Ú· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ¤¯Ô˘Ó 30-250

105

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Paediatriki 2001;64:101-114

ºÈÓÏ·Ó‰›· >300

¡ÔÚ‚ËÁ›· 150-250

µ√ƒ∂π∞ £∞§∞™™∞

πÚÏ·Ó‰›· 60-130

™Ô˘Ë‰›· 150-330

¢·Ó›· 40-90

√ÏÏ·Ó‰›·

µ∞§∆π∫∏

∏Ó. µ·Û›ÏÂÈÔ 70-130 µ¤ÏÁÈÔ 50-60

√˘ÎÚ·Ó›·

∆Û¯›· 30-80

∞∆§∞¡∆π∫√™ ø∫∂∞¡√™ °·ÏÏ›· 60-170

∂Ï‚ÂÙ›· 130-160

πÙ·Ï›· 10-130 ¶ÔÚÙÔÁ·Ï›· 10-130

¶Ôψӛ· 40-70

°ÂÚÌ·Ó›· 20-70

∞˘ÛÙÚ›· 150

√˘ÁÁ·Ú›·

∫ÚÔ·Ù›· 90

ƒÔ˘Ì·Ó›· 40-130

ª∞Àƒ∏ £∞§∞™™∞

™ÂÚ‚›·

πÛ·Ó›· 30-110

µÔ˘ÏÁ·Ú›· 20-60

∆Ô˘ÚΛ· ª∂™√°∂π√™ £∞§∞™™∞ ∂ÏÏ¿‰· 40-130

∂ÈÎfiÓ· 3. ∂ÎÙ›ÌËÛË ËÌÂÚ‹ÛÈ·˜ ÚfiÛÏ˄˘ Ȉ‰›Ô˘ ÛÙËÓ ∂˘ÚÒË (Ìg/ËÌÂÚËÛ›ˆ˜) ÙÔ 1992. ∏ ‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ ÔÊ›ÏÂÙ·È Û ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ̤ÙÚËÛ˘ ‹ Û ÂıÓÈΤ˜ ÌÂϤÙ˜. √È ÙÈ̤˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÔÛfiÙËÙ· Ù˘ ËÌÂÚ‹ÛÈ·˜ ·Ô‚ÔÏ‹˜ ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· Ô‡Ú· 24ÒÚÔ˘ ‹ ÛÙË Û¯¤ÛË ÙÔ˘ Ȉ‰›Ô˘ ·Ó¿ ÁÚ·ÌÌ¿ÚÈÔ ÎÚ·ÙÈÓ›Ó˘ Î·È ·Ó·ÁˆÁ‹ Û Ìg/Ï›ÙÚÔ.

ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·ÓfiÚÁ·ÓÔ ÈÒ‰ÈÔ ·’fiÙÈ ÙÔ Ï¿ÛÌ·. ∆Ô ÈÒ‰ÈÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·ÔÙÂÏ› ÙÔ 80% ÙÔ˘ Ȉ‰›Ô˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∆Ô ÈÒ‰ÈÔ ÛÙÔ ·›Ì· Â›Ó·È 1 Ìg/Ï›ÙÚÔ. ∞̤ۈ˜ ÌfiÏȘ ÂÈÛ¤ÏıÂÈ ÙÔ ·ÓfiÚÁ·ÓÔ ÈÒ‰ÈÔ ÛÙÔ Î‡ÙÙ·ÚÔ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÔÍÂÈ‰Ô‡Ù·È Î·È Û˘Ó‰¤ÂÙ·È Ì ÙÔ ·ÌÈÓÔ͇ Ù˘ÚÔÛ›ÓË, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÌfiÚÈÔ Ù˘ ı˘ÚÂÔÛÊ·ÈÚ›Ó˘ ÎÈ ¤ÙÛÈ ÌÂÙ·ÙÚ¤ÂÙ·È Û ÔÚÁ·ÓÈÎfi ÈÒ‰ÈÔ. ∏ ·ÓÙ›‰Ú·ÛË ·˘Ù‹ Á›ÓÂÙ·È Ì ÙË ‚Ô‹ıÂÈ· Ì›·˜ ·ÈÌÔÚˆÙ½Ó˘, Ù˘ ˘ÂÚÔÍÂȉ¿Û˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Ô˘ Â›Ó·È ÎÔÏÏË̤ÓË ÛÙË ÌÂÌ‚Ú¿ÓË ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ·ÓÙÈÌÈÎÚÔÛˆÌȷο ·ÓÙÈÛÒÌ·Ù· ¤¯Ô˘Ó ˆ˜ ·ÓÙÈÁfiÓÔ ÙËÓ ˘ÂÚÔÍÂȉ¿ÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (23). ŒÓ· ÌfiÚÈÔ ∆4 ·ÔÙÂÏÂ›Ù·È ·fi Ù¤ÛÛÂÚ· ¿ÙÔÌ· Ȉ‰›Ô˘ Î·È ‰‡Ô ÌfiÚÈ· Ù˘ÚÔÛ›Ó˘. ∆Ô ÈÒ‰ÈÔ ·ÔÙÂÏ› ÙÔ 64% ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ù˘ ∆4.

106

∞Èٛ˜ Ù˘ ‚ÚÔÁ¯Ô΋Ï˘ ∏ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ Â›Ó·È ÙÔ Û˘ÓËı¤ÛÙÂÚÔ ·›ÙÈÔ ‚ÚÔÁ¯Ô΋Ï˘ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜ ÙÔ˘ ÎfiÛÌÔ˘ (24). ∆· ÙÚfiÊÈÌ· Ô˘ ·Ú¿ÁÔÓÙ·È Û ‰¿ÊË ÊÙˆ¯¿ Û ÈÒ‰ÈÔ, ‰ÂÓ ¤¯Ô˘Ó ÙËÓ ÔÛfiÙËÙ· Ȉ‰›Ô˘ ÙˆÓ ›‰ÈˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ·Ú¿ÁÔÓÙ·È Û ‰¿ÊË ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÈÒ‰ÈÔ. ∆Ô fiÛÈÌÔ ÓÂÚfi ‰ÂÓ ÂÚȤ¯ÂÈ Ôχ ÈÒ‰ÈÔ (Û˘Ó‹ıˆ˜ 4-10 Ìg/Ï›ÙÚÔ) Î·È ¤ÙÛÈ ‰ÂÓ Û˘Ì‚¿ÏÏÂÈ Ôχ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ·ÓıÚÒÔ˘. ∆Ô ÓÂÚfi, fï˜, ¯ÚËÛÈ̇ÂÈ ˆ˜ ‰Â›ÎÙ˘ ‡·Ú͢ ÌÈÎÚ‹˜ ‹ ηÓÔÓÈ΋˜ ÔÛfiÙËÙ·˜ Ȉ‰›Ô˘ ÛÙ· ÙÚfiÊÈÌ· Ô˘ ·Ú¿ÁÔÓÙ·È ÙÔÈο. ™Â ÂÚÈÔ¯¤˜ Ì Ȉ‰ÔÂÓ›·, ÙÔ ÈÒ‰ÈÔ ÛÙÔ ÓÂÚfi Â›Ó·È <2 Ìg/Ï›ÙÚÔ. ™Â ÂÚÈÔ¯¤˜ fiÔ˘ Ë ËÌÂÚ‹ÛÈ· ηٷӿψÛË Û ÈÒ‰ÈÔ Â›Ó·È Â·Ú΋˜, Ë Î‡ÚÈ· ·ÈÙ›· ‚ÚÔÁ¯Ô΋Ï˘ Î·È ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ Â›Ó·È Ë

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¶›Ó·Î·˜ 4. ¶ÚfiÛÏË„Ë πˆ‰›Ô˘ Î·È ·Ô‚ÔÏ‹ ÛÙ· Ô‡Ú· ÛÙËÓ ∂Ï‚ÂÙ›·, ηٿ ÙËÓ ÂÚ›Ô‰Ô 1923-1990 ÃÚÔÓÔÏÔÁ›· ¶ÚÔÛı‹ÎË πˆ‰›Ô˘ ÛÙÔ ·Ï¿ÙÈ (ppm/kg NaCl) πÒ‰ÈÔ ÛÙ· Ô‡Ú· (Ìg/gr ÎÚ·ÙÈÓ›Ó˘) 24ˆÚË ÚfiÛÏË„Ë π-131 ·fi ÙÔ £˘ÚÂÔÂȉ‹ %

1923

1960

1974-78

1981-88

0 18 ± 8

3,75

7,5 90 ± 45 27 ± 5

15 150 ± 77 22 ± 6

52 ± 13

¯ÚfiÓÈ· ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ı˘ÚÂÔÂȉ›Ùȉ· (25). ∏ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙˆÓ Ê˘ÙÈÎÒÓ Î·È ˙ˆÈÎÒÓ ÙÚÔÊÒÓ Û ÈÒ‰ÈÔ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ Ȉ‰›Ô˘ ÛÙ· ‰¿ÊË Ô˘ ·Ú¿ÁÔÓÙ·È. ∆Ô ÈÒ‰ÈÔ ÙÔ˘ ‰¿ÊÔ˘˜ Î·È ÙÔ˘ ı·Ï·ÛÛÈÓÔ‡ ÓÂÚÔ‡ ˘fi ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ËÏÈ·ÎÔ‡ ʈÙfi˜ ÔÍÂÈ‰Ô‡Ù·È Û Ȉ‰ÈÔ‡¯· Ô˘ ÂÍ·ÙÌ›˙ÔÓÙ·È ÛÙÔÓ ·¤Ú·. ∏ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙÔ ı·Ï·ÛÛÈÓfi ÓÂÚfi Â›Ó·È 50-60 Ìg/Ï›ÙÚÔ Î·È ÛÙÔÓ ·¤Ú· 0,7 Ìg/΢‚ÈÎfi ̤ÙÚÔ. ∞ÚÎÂÙ‹ ÔÛfiÙËÙ· ·fi ·˘Ùfi ÙÔ ÈÒ‰ÈÔ ·Ó‚·›ÓÂÈ ÛÙË ÛÙÚ·ÙfiÛÊ·ÈÚ· (26), ·ÏÏ¿ Ì›· ÔÛfiÙËÙ· ¤ÊÙÂÈ ÛÙË ÁË Ì ÙË ‚ÚÔ¯‹ Î·È ÂÌÏÔ˘Ù›˙ÂÈ Ù· ·ÓÒÙÂÚ· ÛÙÚÒÌ·Ù· ÙÔ˘ ‰¿ÊÔ˘˜. °È· Ó· ÂÌÏÔ˘ÙÈÛÙ› ÙÔ ¤‰·ÊÔ˜ Ì ÈÒ‰ÈÔ Ú¤ÂÈ Ó· ÂÚ¿ÛÔ˘Ó ¯ÈÏÈ¿‰Â˜ ¯ÚfiÓÈ·. °È’ ·˘ÙfiÓ ÙÔ ÏfiÁÔ, ÚfiÛÊ·Ù· ‰¿ÊË Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·Ô Î·ÙÔÏ›ÛıËÛË Â›Ó·È ÊÙˆ¯¿ Û ÈÒ‰ÈÔ, ÂÓÒ ·Ï·È¿ ‰¿ÊË ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ. ∏ ÌÂÁ¿ÏË ·fiÛÙ·ÛË Ù˘ ÂÚÈÔ¯‹˜ ·fi ÙË ı¿Ï·ÛÛ·, Ë ¿Û¯ËÌË ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË, ηıÒ˜ Î·È ÔÈ ·Ú·È¤˜ Û˘ÁÎÔÈӈӛ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÂÏ·Ùو̤ÓË ÚfiÛÏË„Ë Èˆ‰›Ô˘ Ì ÙȘ ÙÚÔʤ˜. √È ÏÔ‡ÛÈÔÈ ÏËı˘ÛÌÔ› ηٷӷÏÒÓÔ˘Ó ÈÔ Ôχ ˙ˆÈΤ˜ ÙÚÔʤ˜ Ô˘ ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÈÒ‰ÈÔ ·fi ÙȘ Ê˘ÙÈΤ˜ Î·È ·ÁÔÚ¿˙Ô˘Ó „¿ÚÈ· Î·È ¿ÏÏ· ÚÔ˚fiÓÙ· ÏÔ‡ÛÈ· Û ÈÒ‰ÈÔ, Ù· ÔÔ›· ÌÂٷʤÚÔÓÙ·È ·fi ¿ÏϘ ÂÚÈÔ¯¤˜ Î·È ‰ÂÓ ÂÍ·ÚÙÒÓÙ·È ÌfiÓÔ ·fi ÙËÓ ÙÔÈ΋ ·Ú·ÁˆÁ‹. ∂Ó‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË ÛÙËÓ ∂ÏÏ¿‰· ™ÙËÓ ∂ÏÏ¿‰· ˘‹Ú¯·Ó ·Ï·ÈfiÙÂÚ· ÂÚÈÔ¯¤˜ Ì ÂÓ‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË (27). √È ÂÚÈÔ¯¤˜ ·˘Ù¤˜ ‹Ù·Ó Ë ‰˘ÙÈ΋ ∂ÏÏ¿‰· ÛÙËÓ ÔÚÔÛÂÈÚ¿ Ù˘ ¶›Ó‰Ô˘, ÔÚÂÈÓ¤˜ ÂÚÈÔ¯¤˜ Ù˘ £ÂÛÛ·Ï›·˜, Ù˘ ∂˘Ú˘Ù·Ó›·˜, Ù˘ ºıÈÒÙȉ·˜ Î·È Ù˘ ∫Ú‹Ù˘. ∏ ‚ÚÔÁ¯Ô΋ÏË ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·È‰È¿, ÛÙÔ˘˜ ¤ÊË‚Ô˘˜ Î·È ÙȘ Á˘Ó·›Î˜. ™ÙÔ˘˜ ¿Ó‰Ú˜ ÌÂÙ¿ ÙËÓ ‹‚Ë, Ë Û˘¯ÓfiÙ˘ ÌÂÈÒÓÂÙ·È. ∫‡ÚÈÔ ·›ÙÈÔ ÂÓ‰ËÌÈ΋˜ ‚ÚÔÁ¯Ô΋Ï˘ ÛÙËÓ ∂ÏÏ¿‰· ‹Ù·Ó ·Ï·ÈfiÙÂÚ· Ë ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘,

¶›Ó·Î·˜ 5. K·Ù¿Ù·ÍË ¤ÏÏÂȄ˘ πˆ‰›Ô˘, Ù˘ ÂÎÎÚÈÓfiÌÂÓ˘ ÔÛfiÙËÙ·˜ ·fi Ù· Ô‡Ú· µ·ıÌfi˜ πˆ‰ÔÂÓ›·˜ πÒ‰ÈÔ √‡ÚˆÓ 24ÒÚÔ˘ (Ìg/L) º˘ÛÈÔÏÔÁÈ΋ ¶ÚfiÛÏË„Ë πˆ‰›Ô˘ ≥100 Ìg/L ∂Ï·ÊÚ¿ ¤ÏÏÂÈ„Ë πˆ‰›Ô˘ 50-100 Ìg/L ª¤ÙÚÈ· ¤ÏÏÂÈ„Ë πˆ‰›Ô˘ 25-50 Ìg/L µ·ÚÈ¿ ¤ÏÏÂÈ„Ë πˆ‰›Ô˘ ≤25 Ìg/L

·Ó·ÏfiÁˆ˜

ÂÓÒ Û‹ÌÂÚ· Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ‚ÈÔÎÔÈÓˆÓÈÎÔ‡ ÂÈ¤‰Ô˘ Î·È ÙȘ ·˘ÍË̤Ó˜ Û˘ÁÎÔÈӈӛ˜, ·ÚÈÔ ·›ÙÈÔ Â›Ó·È Ë ¯ÚfiÓÈ· ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ı˘ÚÂÔÂȉ›Ùȉ·. ∏ ‚ÚÔÁ¯Ô΋ÏË ÛÙËÓ ∂ÏÏ¿‰· ›¯Â ·Ô‰Âȯı› Ì ÙË Ì¤ÙÚËÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙÔ ÓÂÚfi, ÛÙÔ ¤‰·ÊÔ˜, ÛÙ· ÙÚfiÊÈÌ· ÂÓ‰ËÌÈÎÒÓ ÂÚÈÔ¯ÒÓ, ηıÒ˜ Î·È ÛÙÔ Ï¿ÛÌ· Î·È Ù· Ô‡Ú· ‚ÚÔÁ¯ÔÎËÏÔ·ıÒÓ ·ÚÚÒÛÙˆÓ (¶›Ó·Î·˜ 5). ∏ Ȉ‰ÔÂÓ›· ‹Ù·Ó ̤ÙÚÈ· ÎÈ ¤ÙÛÈ Ë ÂÓ‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ Û˘Óԉ¢fiÙ·Ó Ì ÎÚÂÙÈÓÈÛÌfi ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ∂ÓÒ fiÏÔÈ ÔÈ Î¿ÙÔÈÎÔÈ ¤¯Ô˘Ó Ȉ‰ÔÂÓ›· ÂÚ›Ô˘ ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ÛÙȘ ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜, ˆÛÙfiÛÔ ÌfiÓÔ ¤Ó· ÔÛÔÛÙfi ·’ ·˘ÙÔ‡˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚ÚÔÁ¯Ô΋ÏË, ‰ËÏ·‰‹ ÌfiÓÔ fiÛÔÈ ¤¯Ô˘Ó οÔÈ· ÚԉȿıÂÛË (ÁÂÓÂÙÈÎfi ¤ÏÏÂÈÌÌ·) (28). ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÂÓ‰ËÌÈ΋˜ ‚ÚÔÁ¯Ô΋Ï˘ ∏ ÂÓ‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË ÌÔÚ› Ó· ÂÍ·ÏÂÈÊı› ·fi ÙÔÓ Ï·Ó‹ÙË, ÁÈ·Ù› ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÔÊ›ÏÔÓÙ·È ÛÙËÓ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘. πÒ‰ÈÔ ÌÔÚ› Ó· ¯ÔÚËÁËı› Ì ÔÏÏÔ‡˜ ÙÚfiÔ˘˜. √ ηχÙÂÚÔ˜ Â›Ó·È Ë Èˆ‰›ˆÛË ÙÔ˘ ·Ï·ÙÈÔ‡, ÌÔÚ› fï˜ Ó· Á›ÓÂÈ Èˆ‰›ˆÛË ÙÔ˘ ÓÂÚÔ‡ ‹ ÙÔ˘ „ˆÌÈÔ‡. ∂ÓÒ ·fi ÙÔ 1924 ¿Ú¯ÈÛ·Ó Û ÔÏϤ˜ ¯ÒÚ˜ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÚÔÁÚ¿ÌÌ·Ù· ÂÌÏÔ˘ÙÈÛÌÔ‡ ÙˆÓ ÙÚÔÊÒÓ Ì ÈÒ‰ÈÔ, ÙÔ 1999 ÔÏÏÔ› ÏËı˘ÛÌÔ› ÓÔÛÔ‡Ó ‚·ÚÈ¿ ÏfiÁˆ ¤ÏÏÂȄ˘ Ȉ‰›Ô˘ (29). ∆Ô 1993, ÌÂÙ¿ ·fi ÎÔÈÓ‹ Û˘Ìʈӛ· ÙˆÓ ÔÚÁ·ÓÈÛÌÒÓ WHO, UNICEF Î·È ICCIDD, ÂÛÙ¿ÏË Û‡ÛÙ·ÛË Û fiÏ· Ù· ˘Ô˘ÚÁ›· ÀÁ›·˜ Ù˘ ∂˘ÚÒ˘, fiÔ˘ ·Ó·Ê¤ÚÂÙ·È Ë ‚·Ú‡ÙËÙ· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ·ÏÏ¿ Î·È Ë ·ÚfiÙÚ˘ÓÛË ÁÈ· ÂÓÂÚÁfi ‰Ú¿ÛË, ÒÛÙ ӷ ÂÍ·Ê·ÓÈÛıÔ‡Ó ÓÔÛ‹Ì·Ù· ÏfiÁˆ ¤ÏÏÂȄ˘ Ȉ‰›Ô˘ ·fi ÙËÓ ∂˘Úˆ·È΋ ∫ÔÈÓfiÙËÙ·. ∞˘Ùfi ÛËÌ·›ÓÂÈ ¯Ú‹ÛË Èˆ‰ÈˆÌ¤ÓÔ˘ ·Ï·ÙÈÔ‡ ÛÙȘ ÌÔÓ¿‰Â˜ ˙ˆÔÙÚÔÊ‹˜, ÛÙËÓ ·Ú·Û΢‹ Û˘ÓÙËÚËÌ¤ÓˆÓ ÙÚÔʛ̈Ó, ηıÒ˜ Î·È ÛÙÔ Ì·Á›ÚÂÌ· Ê·ÁËÙÒÓ ÁÈ· ¢Ú›· ηٷӿψÛË (catering) Î·È fi¯È ÌfiÓÔ Èˆ‰›ˆÛË ÙÔ˘ ÂÈÙÚ·¤˙ÈÔ˘ ·Ï·ÙÈÔ‡. ∏ ËÌÂÚ‹ÛÈ· ηٷӿψÛË ·Ï·ÙÈÔ‡, Û‹ÌÂÚ·, Â›Ó·È 8-12 ÁÚ·ÌÌ¿ÚÈ·. ™Ù· ‚ÈÔÌ˯·ÓÈο ÎÚ¿ÙË ·fi Ù· 10 ÁÚ·ÌÌ¿ÚÈ· ËÌÂÚ‹ÛÈ·˜ ηٷӿψÛ˘, ÌfiÓÔ Ù· 2 ÁÚ·ÌÌ¿ÚÈ· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÚÔÛı‹ÎË ÛÙÔ Ê·ÁËÙfi (ÂÈÙÚ·¤˙ÈÔ), ÂÓÒ ·fi ÙȘ ¤ÙÔÈ̘ ÙÚÔʤ˜ (Û¿ÏÙÛ˜, Ù˘ÚÈ¿, ·ÚÙÔÛ΢¿ÛÌ·Ù·) ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È 8 ÁÚ·ÌÌ¿ÚÈ· ËÌÂÚËÛ›ˆ˜ (∂ÈÎfiÓ· 4) (30). πÒ‰ÈÔ ÌÔÚ› Ó· Ï·Ì‚¿ÓÂÙ·È ·fi ÙÔ Á¿Ï·, fiÙ·Ó ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÔ Èˆ‰ÔÊfiÚÌÈÔ

107

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 108

¶·È‰È·ÙÚÈ΋ 2001;64:101-114

Paediatriki 2001;64:101-114

∞Ï¿ÙÈ ÁÈ· Ù¯ÓÈ΋ ¯Ú‹ÛË (fi¯È ¯Ú‹ÛË ÙÚÔÊ‹˜) ∞Ï¿ÙÈ ÁÈ· ηٷӿψÛË ·fi ˙Ò· √ÏÈÎfi ·Ï¿ÙÈ Ô˘ ·Ú¿ÁÂÙ·È ÁÈ· ηٷӿψÛË ·fi ÙÔÓ ¿ÓıÚˆÔ ∆ÚÔʤ˜

∫Ú˘Ì̤ÓÔ ·Ï¿ÙÈ

µÈÔÌ˯·Ó›· ∞Ï¿ÙÈ ÁÈ· ÔÈÎȷ΋ ¯Ú‹ÛË √ÈÎȷ΋ ¯Ú‹ÛË

∞ÒÏÂÈ· ¿Ï·ÙÔ˜ ηٿ ÙËÓ ·Ú·Û΢‹ ÙÔ˘ Ê·ÁËÙÔ‡

∞Ï¿ÙÈ Ô‡ÚˆÓ

∂ÈÎfiÓ· 4. ∏ ÚÔÛı‹ÎË Èˆ‰›Ô˘ ÛÙÔ ¿Ï·˜ Ù˘ ÙÚÔÊ‹˜. ∞: ∆Ô ÔÏÈÎfi ·Ï¿ÙÈ Ô˘ ηٷӷÏÒÓÂÙ·È ÌÔÚ› Ó· ˘ÔÏÔÁÈÛı› ·fi ÙÔ ÚÔÛÏ·Ì‚·ÓfiÌÂÓÔ ·Ï¿ÙÈ Ì ÙËÓ ÙÚÔÊ‹ ‹ ÙÔ ·Ô‚·ÏÏfiÌÂÓÔ ‰È· ÙˆÓ Ô‡ÚˆÓ. µ: ∞Ô‚ÔÏ‹ ¿Ï·ÙÔ˜ ‰È· ÙˆÓ Ô‡ÚˆÓ (ۯ‰fiÓ ›ÛË Ì ÙËÓ ÚfiÛÏË„Ë ∞). C: ∆Ô ÂÈÙÚ·¤˙ÈÔ ·Ï¿ÙÈ ÚÔÛÙ›ıÂÙ·È Î·Ù¿ ÙÔ Ì·Á›ÚÂÌ· ‹ ÛÙË ÌÂÚ›‰· ÙÔ˘ È¿ÙÔ˘. D: ∫Ú˘Ì̤ÓÔ ·Ï¿ÙÈ ˘¿Ú¯ÂÈ ÛÙ· ÂÌÔÚÈο ·Ú·ÁfiÌÂÓ· ÙÚfiÊÈÌ·. E: ∆Ô ·Ï¿ÙÈ ¯¿ÓÂÙ·È Î·Ù¿ ÙËÓ ·Ú·Û΢‹ Ù˘ ÙÚÔÊ‹˜. F: √ÏÈÎfi ·Ï¿ÙÈ Ô˘ ·Ú¿ÁÂÙ·È ÁÈ· ηٷӿψÛË ·fi ÙÔÓ ¿ÓıÚˆÔ.

ˆ˜ ·ÔÏ˘Ì·ÓÙÈÎfi ÛÙÔ ¿ÚÌÂÁÌ·, ‹ ·fi ÙÔ „ˆÌ›, fiÙ·Ó ÚÔÛÙ›ıÂÙ·È ˆ˜ Û˘ÓÙËÚËÙÈÎfi ·ÓÙ› ÙÔ˘ ‚ÚˆÌ›Ô˘ (ÂÊ·ÚÌfi˙ÂÙ·È ÛÙËÓ ∞˘ÛÙÚ·Ï›·). ™Â ¯ÒÚ˜ fiÔ˘ ÔÏÈÙÈÎÔ›, ÔÏÈÙÈÛÌÈÎÔ› Î·È ÁˆÁÚ·ÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ οÓÔ˘Ó ‰‡ÛÎÔÏÔ ÙÔ ÚfiÁÚ·ÌÌ· ÂÌÏÔ˘ÙÈÛÌÔ‡ ÙˆÓ ÙÚÔÊÒÓ Ì ÈÒ‰ÈÔ, ÚÔʇϷÍË Î·È ıÂÚ·›· Ù˘ ¤ÏÏÂȄ˘ Ȉ‰›Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÂÓ‰ÔÌ˘˚Τ˜ ÂÓ¤ÛÂȘ Ȉ‰›Ô˘, ˘fi ÌÔÚÊ‹Ó ‚Ú·‰¤ˆ˜ ·ÔÚÚÔÊÔ‡ÌÂÓÔ˘ Ï·‰ÈÔ‡. ™Â ¿ÙÔÌ· ¿Óˆ ÙˆÓ 45 ÂÙÒÓ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÈÒ‰ÈÔ ÁÈ·Ù› ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ı˘ÚÂÔÙÔ͛ΈÛË ÏfiÁˆ ˘„ËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ ÔÏ˘Ô˙Ò‰Ô˘˜ ‚ÚÔÁ¯Ô΋Ï˘ (31). πˆ‰ÈÔ̤ÓÔ Ï¿‰È ¯ÔÚËÁÂ›Ù·È Û‹ÌÂÚ· Û ÂÚÈÔ¯¤˜ Ù˘ ∫›Ó·˜, ÛÙȘ Á˘Ó·›Î˜ ÙËÓ Ë̤ڷ ÙÔ˘ Á¿ÌÔ˘ ÙÔ˘˜. ∞˘Ù¤˜ Û‡ÓÙÔÌ· ı· Ì›ÓÔ˘Ó ¤ÁÎ˘Â˜ Î·È ÙÔ ÈÒ‰ÈÔ ÙȘ ‚ÔËı¿ Ó· ¤¯Ô˘Ó ÙÂÏÂÈfiÌËÓË Î‡ËÛË Î·È ÁÂÚfi ·È‰›, ¯ˆÚ›˜ ÓÔÛ‹Ì·Ù· ÏfiÁˆ ¤ÏÏÂȄ˘ Ȉ‰›Ô˘. πˆ‰ÈÔ̤ÓÔ Ï¿‰È ÂÚȤ¯Ô˘Ó Î·È Ù· Ú·‰ÈÔÁÚ·ÊÈο ÛÎÈ·ÁÚ·ÊÈο Ô˘ ·ÔÙÂÏÔ‡ÓÙ·È ·fi ·Èı˘ÏÈÎÔ‡˜ ÂÛÙ¤Ú˜ Ù˘ ÌÔÓÔ- ‰È- Î·È ÙÚÈ- Ȉ‰ÔÙ˘ÚÔÛ›Ó˘ Ì ÏÈÓÔÏÂ˚Îfi, ÂÏ·˚Îfi, ·ÏÌÈÙÈÎfi Î·È ÛÙ·ÙÈÎfi Ô͇. ªÂ ÙÔÓ ÂÌÏÔ˘ÙÈÛÌfi ÙˆÓ ÙÚÔÊ›ÌˆÓ Û ÈÒ‰ÈÔ, ‰ÈÔÚıÒÓÂÙ·È Ë ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È ÚÔԉ¢ÙÈο ÂÍ·Ê·Ó›˙ÂÙ·È Ë ‚ÚÔÁ¯Ô΋ÏË Î·È ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È ÂÓ‰ËÌÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜ Î·È ¤ÎÙˆÛË Ù˘ ÓÂ˘Ì·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∞˘Í¿ÓÂÈ ÌÂÙ¤ÂÈÙ·, fï˜, Ë Û˘¯ÓfiÙËÙ· ÙÔÍÈ΋˜ ÔÏ˘Ô˙Ò‰Ô˘˜ ‚ÚÔÁ¯Ô΋Ï˘ (32).

108

™ÙË ¯ÒÚ· Ì·˜ ΢ÎÏÔÊÔÚ› ÂÈÙÚ·¤˙ÈÔ ·Ï¿ÙÈ Ì ‰‡Ô ÌÔÚʤ˜, ·Ïfi Î·È Èˆ‰ÈˆÌ¤ÓÔ Î·È ÂÈϤÁÂÈ Ô Î·Ù·Ó·ÏˆÙ‹˜ ÂΛÓÔ Ô˘ ı· ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ. ªÂ ÙËÓ Èˆ‰›ˆÛË ÙÔ˘ ·Ï·ÙÈÔ‡ ÚÔÛÙ›ıÂÙ·È ¤Ó· ̤ÚÔ˜ Ȉ‰ÈÔ‡¯Ô˘ Î·Ï›Ô˘ (∫π), ‹ ηχÙÂÚ· Ȉ‰ÈÎÔ‡ Î·Ï›Ô˘ (∫π√3), ÁÈ·Ù› ‰ÂÓ ÂÍ·ÙÌ›˙ÂÙ·È, ·Ó¿ 25-50 ¯ÈÏÈ¿‰Â˜ ̤ÚË (ppm) ¯ÏˆÚÈÔ‡¯Ô˘ Ó·ÙÚ›Ô˘ (33,34). ∂ÙÛÈ, Ì ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ·Ï·ÙÈÔ‡ 2,5-5 gr ÚÔÛÏ·Ì‚¿ÓÔÓÙ·È 100-200 Ìg Ȉ‰›Ô˘. ∏ ËÌÂÚ‹ÛÈ· ηٷӿψÛË Èˆ‰›Ô˘ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Â›Ó·È 150-500 Ìg (0,15-0,5 mg). ™˘ÌÙÒÌ·Ù· ÏfiÁˆ ¤ÏÏÂȄ˘ ‹ ηٿ¯ÚËÛ˘ Ȉ‰›Ô˘ ŸÙ·Ó Ë ËÌÂÚ‹ÛÈ· ηٷӿψÛË Èˆ‰›Ô˘ Â›Ó·È 2550 Ìg, ·Ú·ÙËÚÂ›Ù·È Èˆ‰ÔÂÓÈ΋ ‚ÚÔÁ¯Ô΋ÏË. ŸÙ·Ó, fï˜, Ë ËÌÂÚ‹ÛÈ· ηٷӿψÛË Èˆ‰›Ô˘ Â›Ó·È ÏÈÁfiÙÂÚË ·fi 25 Ìg, ¤¯Ô˘Ì ÂÓ‰ËÌÈÎfi ÎÚÂÙÈÓÈÛÌfi. À¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ ÂÓ‰ËÌÈÎÔ‡ ÎÚÂÙÈÓÈÛÌÔ‡: ·) Ô Ì˘ÍÔȉËÌ·ÙÈÎfi˜ (¯ˆÚ›˜ ‚ÚÔÁ¯Ô΋ÏË, ÁÈ·Ù› Ô ı˘ÚÂÔÂȉ‹˜ ¤¯ÂÈ Î·Ù·ÛÙÚ·Ê›), Ô˘ ÔÊ›ÏÂÙ·È Û ˘Ôı˘ÚÂÔÂȉÈÛÌfi ·Ô ‚·ÚÈ¿ Ȉ‰ÔÂÓ›·, ηıÒ˜ Î·È ¤ÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘, ‚) Ô Ó¢ÚÔÏÔÁÈÎfi˜ (Ì ‚ÚÔÁ¯Ô΋ÏË ÏfiÁˆ ‰È¤ÁÂÚÛ˘ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·fi ÙËÓ ·˘ÍË̤ÓË TSH), Ô˘ ÔÊ›ÏÂÙ·È Û ‚·ÚÈ¿ Ȉ‰ÔÂÓ›· ·fi ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ˙ˆ‹˜. ™ÙÔÓ ˘Ôı˘ÚÂÔÂȉÈÛÌfi ÏfiÁˆ Ȉ‰ÔÂÓ›·˜, Ë ·˘ÍË̤ÓË ‰È¤ÁÂÚÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·fi ÙËÓ TSH ÚÔηÏ› ·‡ÍËÛË ÙˆÓ ÂχıÂÚˆÓ ÚÈ˙ÒÓ Î·È ÙÔ˘ ˘ÂÚÔÍÂȉ›Ô˘ ÙÔ˘ ˘‰ÚÔÁfiÓÔ˘ (∏2√2) ÛÙ· ı˘ÚÂÔÂȉÈο ·ÙÙ·Ú·. §fiÁˆ ¤ÏÏÂȄ˘ ÛÂÏËÓ›Ô˘, ÙÔ ¤Ó˙˘ÌÔ ˘ÂÚÔÍÂȉ¿ÛË Ù˘ ÁÏÔ˘Ù·ıÂÈfiÓ˘ Â›Ó·È ·ÓÂÓÂÚÁfi Î·È ÔÈ ÂχıÂÚ˜ Ú›˙˜ Ô͢ÁfiÓÔ˘ ‰ÂÓ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È, ·ÏÏ¿ Û˘ÛÛˆÚ‡ÔÓÙ·È Î·È Î·Ù·ÛÙÚ¤ÊÔ˘Ó ÙÔ ı˘ÚÂÔÂȉÈÎfi ·ÙÙ·ÚÔ. ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ηٿ¯ÚËÛË Èˆ‰›Ô˘ ÚÔηÏ› ·ÚÂÓ¤ÚÁÂȘ (.¯. ‰ÂηÏ¿ÛÈ· ÔÛfiÙËÙ· ·fi ÙȘ ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ, 2 mg ËÌÂÚËÛ›ˆ˜). ∂˘ı˘ÚÂÔÂȉÈο ¿ÙÔÌ· Ì ¯ÚfiÓÈ· ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ı˘ÚÂÔÂȉ›Ùȉ· (ı˘ÚÂÔÂȉ›ÙȘ Hashimoto), ‹ Ì ÓfiÛÔ Graves Ô˘ ‚Ú›ÛÎÂÙ·È Û ‡ÊÂÛË, ‹ Á˘Ó·›Î˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ı˘ÚÂÔÂȉ›Ùȉ· ÌÂÙ¿ ·fi ÙÔÎÂÙfi, ‹ ¤¯Ô˘Ó ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘˜ ˘ÔÍ›· ı˘ÚÂÔÂȉ›Ùȉ·, ı· ·Ó·Ù‡ÍÔ˘Ó ˘Ôı˘ÚÂÔÂȉÈÛÌfi ÏfiÁˆ ηٿ¯ÚËÛ˘ Ȉ‰›Ô˘. ∞ÏÏ¿ Î·È ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ ÏfiÁˆ ηٿ¯ÚËÛ˘ Ȉ‰›Ô˘ ÂÌÊ·Ó›˙ÂÙ·È, Û˘¯ÓfiÙÂÚ· Û ËÏÈÎȈ̤ӷ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ·, ·ÏÏ¿ Î·È Û ¿ÙÔÌ· Ì Ô˙Ò‰Ë ‚ÚÔÁ¯Ô΋ÏË, ȉ›ˆ˜ Û ÂÚÈÔ¯¤˜ Ì ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘. ∆· ¿ÙÔÌ·, fï˜, Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÁÂÓÂÙÈο ‹ ÂÚÈ‚·ÏÏÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ı˘ÚÂÔÂȉ‹, ı· ·Ú·Ì›ÓÔ˘Ó Â˘ı˘ÚÂÔÂȉÈο ·ÎfiÌË Î·È fiÙ·Ó ÂÎÙÂıÔ‡Ó Û ÌÂÁ¿ÏË ÔÛfiÙËÙ· Ȉ‰›Ô˘, Èı·ÓfiÓ ÏfiÁˆ ·˘ÙÔÚÚ‡ıÌÈÛ˘ Î·È ÂÏ¿ÙÙˆÛ˘ Ù˘ ÌÂÙ·ÊÔÚ¿˜ Ȉ‰›Ô˘ ÛÙÔ ı˘ÚÂÔÂȉ‹ (35). ∞˘ÍË̤ÓË ÚfiÛÏË„Ë Èˆ‰›Ô˘ ·fi ÙÔ ı˘ÚÂÔÂȉ‹ Ô‰ËÁ› Û ·Ó·-

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 109

¶·È‰È·ÙÚÈ΋ 2001;64:101-114

ÛÙÔÏ‹ Ù˘ Û‡ÓıÂÛ˘ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ (Ê·ÈÓfiÌÂÓÔ Wolf-Chaikoff) Î·È ÙÂÏÈο Û ‚ÚÔÁ¯Ô΋ÏË Î·È Ì˘ÍÔ›‰ËÌ· (36,37). ™ËÌ·Û›· ÙÔ˘ Ȉ‰›Ô˘ Î·È Ù˘ ı˘ÚÔ͛Ӣ ηٿ ÙËÓ Î‡ËÛË ¶ÚÈÓ ·Ú¯›ÛÂÈ Ó· ÏÂÈÙÔ˘ÚÁ› Ô ı˘ÚÂÔÂȉ‹˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ÙÔÓ ÙÚ›ÙÔ ÂÚ›Ô˘ Ì‹Ó· Ù˘ ÂÌ‚Ú˘˚΋˜ ˙ˆ‹˜, Â›Ó·È ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ¤ÛÙˆ Î·È ÌÈÎÚÒÓ ÔÛÔÙ‹ÙˆÓ Èˆ‰›Ô˘ Î·È ı˘ÚÔ͛Ӣ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰È·ÎÏ·‰ÒÛÂˆÓ ÙˆÓ Ó¢ÚÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙË ÛˆÛÙ‹ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ó¢ÚÈÎÔ‡ ÈÛÙÔ‡ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (38,39). ŸÙ·Ó ˘¿Ú¯ÂÈ ¤ÏÏÂÈ„Ë ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ÛÙ· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ·Ú·ÙËÚÔ‡ÓÙ·È ‚·ÚȤ˜ Ó¢ÚÔÏÔÁÈΤ˜ ÚÔÛ‚ÔϤ˜ (ÎÒʈÛË, Û·ÛÙÈ΋ ·Ú·ÏËÁ›·) (40). ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·Ú¯›˙ÂÈ ·fi ÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ Ù˘ ÂÌ‚Ú˘ÔÓÈ΋˜ ˙ˆ‹˜ Î·È Û¯Â‰fiÓ ÙÂÏÂÈÒÓÂÈ 3 ¯ÚfiÓÈ· ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ì ·ÏÏËÏԉȷ‰Ô¯Èο ÛÙ¿‰È· ˆÚ›Ì·ÓÛ˘ Î·È ÔÚÁ·ÓÔÁ¤ÓÂÛ˘, ·‡ÍËÛË Ó¢ÚÔÏÔÁÈÎÒÓ Î˘Ù¿ÚˆÓ, ÌÂٷΛÓËÛË Î˘ÙÙ¿ÚˆÓ, ‰ËÌÈÔ˘ÚÁ›· Û˘Ó¿„ÂˆÓ Î·È Ì˘ÂϛӈÛ˘. √ Ï·ÎÔ‡ÓÙ·˜ Ú˘ıÌ›˙ÂÈ ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ȉ‰›Ô˘ Î·È ı˘ÚÔ͛Ӣ ηı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, ̤ۈ ‰Ú¿Û˘ ÙˆÓ ·Ô˚ˆ‰ÈÓ·ÛÒÓ ππ Î·È πππ (41). ∏ ¤ÁÎ˘Ô˜ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚ˜ ·Ó¿ÁΘ Û ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜, ÏfiÁˆ ·˘ÍË̤Ó˘ ÓÂÊÚÈ΋˜ οı·ÚÛ˘ Î·È Ï‹„˘ Ûȉ‹ÚÔ˘ ˆ˜ Û˘Ìϋڈ̷ ÛÙËÓ ÙÚÔÊ‹ (42,43), ·ÏÏ¿ Î·È ÏfiÁˆ Èı·Ó‹˜ ‚ÚÒÛˆ˜ ÌÔÏ˘ÛÌ¤ÓˆÓ ÙÚÔÊÒÓ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ ‹ Ï‹„ˆ˜ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (44,45). ∏ ∆4 ·˘Í¿ÓÂÈ Ê˘ÛÈÔÏÔÁÈο ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È Â›Ó·È ÂÚ›Ô˘ 14 Ìg/dl ÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ (ÏfiÁˆ ·‡ÍËÛ˘ Ù˘ TBG), ·ÏÏ¿ ·˘Ùfi ‰ÂÓ Û˘Ì‚·›ÓÂÈ fiÙ·Ó Ë ÚfiÛÏË„Ë Èˆ‰›Ô˘ Â›Ó·È Ôχ ¯·ÌËÏ‹. ™Â ÂÚÈÔ¯¤˜ fiÔ˘ Ô Ó¢ÚÔÏÔÁÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜ ˘ÂÚÈÛ¯‡ÂÈ, 50% ÙˆÓ ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ ¤¯Ô˘Ó ÙÈ̤˜ ∆4 ÌÈÎÚfiÙÂÚ˜ ÙÔ˘ 6 Ìg/dl. ∫ÏÈÓÈο Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ‰ÂÓ Â›Ó·È ÂÌÊ·Ó‹ Û ·˘Ù¤˜ ÙȘ Á˘Ó·›Î˜. ∏ ‰Ú·ÛÙÈ΋ ÔÚÌfiÓË ∆3 Â›Ó·È Û˘¯Ó¿ Ê˘ÛÈÔÏÔÁÈ΋, ·Ó Î·È Â›Ó·È ·˘ÍË̤ÓË Ë ÙÈÌ‹ Ù˘ TSH. ŸÙ·Ó Ë ¤ÁÎ˘Ô˜ ¤¯ÂÈ ¯·ÌËÏ‹ ÂÎÙfi˜ ·fi ÙËÓ ∆4 Î·È ÙËÓ ∆3, ¤¯ÂÈ ‚·Ú‡ ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È Â›Ó·È Èı·Ófi Ó· ·Ô‚¿ÏÏÂÈ ÙÔ ¤Ì‚Ú˘Ô. ª¤ÙÚËÛË Ù˘ TSH Î·È ÙˆÓ ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û fiϘ ÙȘ Á˘Ó·›Î˜ Ô˘ ÂÈı˘ÌÔ‡Ó Ó· Û˘ÏÏ¿‚Ô˘Ó ·È‰› (46) Î·È ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi Ì ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜, ·ÏÏ¿ Î·È ÛÙȘ ¤ÁÎ˘Â˜, ÁÈ·Ù› Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ Â›Ó·È Û˘¯Ófi˜, ÂÓÒ Ù· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ÂÌÊ·Ó‹ Î·È ÔÈ ÂÈÙÒÛÂȘ ÛÙÔ ¤Ì‚Ú˘Ô ÌÂÁ¿Ï˜ Î·È ÌË ·Ó·Ù¿ÍÈ̘ (47). ™ÙȘ ¤ÁÎ˘Â˜ Ì ÁÓˆÛÙfi ˘Ôı˘ÚÂÔÂȉÈÛÌfi Ú¤ÂÈ Ó· ·˘Í¿ÓÂÙ·È Ë ‰fiÛË Ù˘

Paediatriki 2001;64:101-114

ı˘ÚÔ͛Ӣ (48). ¶·È‰È¿ ·fi ÌËÙ¤Ú˜ Ì ˘Ôı˘ÚÂÔÂȉÈÛÌfi ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË ÓÂ˘Ì·ÙÈ΋ ÈηÓfiÙËÙ· (49). ∞ÏÏ¿ Î·È ·È‰È¿ Ô˘ ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ˘„ËÏfi Ù›ÙÏÔ ·ÓÙÈÌÈÎÚÔÛˆÌÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ·ÏÏ¿ Ê˘ÛÈÔÏÔÁÈ΋ ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ‚Ú¤ıËΠӷ ¤¯Ô˘Ó ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ ¯·ÌËÏfiÙÂÚÔ Î·Ù¿ 10 ‚·ıÌÔ‡˜ ·fi ·È‰È¿ ÌËÙ¤ÚˆÓ Ô˘ ‰ÂÓ Â›¯·Ó ·ÓÙÈÛÒÌ·Ù· (50). ∞ÎfiÌË Î·È fiÙ·Ó Ë Èˆ‰ÔÂÓ›· Â›Ó·È Ì¤ÙÚÈ·, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ∞˘Ùfi ·Ô‰ÂÈÎÓ‡ÂÙ·È, Û˘ÁÎÚ›ÓÔÓÙ·˜ ÙÔ Ì¤ÛÔ fiÚÔ ÓÔËÌÔÛ‡Ó˘ ÏËı˘ÛÌÔ‡ ·fi Ȉ‰ÔÂÓÈΤ˜ ÂÚÈÔ¯¤˜ Ì ÙÔ Ì¤ÛÔ fiÚÔ ÓÔËÌÔÛ‡Ó˘ ÏËı˘ÛÌÒÓ ·fi ÌË Èˆ‰ÔÂÓÈΤ˜ ÂÚÈÔ¯¤˜ (51). °È’ ·˘Ùfi Ë Î·Ù·ÔϤÌËÛË ·ÎfiÌË Î·È Ì¤ÙÚÈ·˜ Ȉ‰ÔÂÓ›·˜ ·ÔÙÂÏ› ÂıÓÈÎfi ηı‹ÎÔÓ. §ÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘ Ȉ‰›Ô˘ Î·È ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ÛÙÔ ¤Ì‚Ú˘Ô ¶ÂÈÚ¿Ì·Ù· Û ÔÓÙ›ÎÈ· ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ ˘ԉԯ›˜ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙ· ·Ó·Ù˘ÛÛfiÌÂÓ· ¤Ì‚Ú˘· ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜. ∏ ∆3 Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ Î·È ·Ú¿ÁÂÙ·È Ì¤Ûˆ ÙÔ˘ ÂÓ˙‡ÌÔ˘ 5’ ·Ô˚ˆ‰ÈÓ¿Û˘ ππ, Ô˘ ˘¿Ú¯ÂÈ ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ·ÙÙ·ÚÔ Î·È ÌÂÙ·‚ÔÏ›˙ÂÈ ÙÔÈο ÙËÓ ∆4. ∏ ÂÌ‚Ú˘˚΋ ∆3 Â›Ó·È ¯·ÌËÏ‹ ÛÙÔ ·›Ì· ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ Ù˘ ·ËÛ˘, ÂÏ·ÊÚÒ˜ ·˘Í¿ÓÂÈ ÙÔ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· Ù˘ ·ËÛ˘ Î·È Êı¿ÓÂÈ ÙȘ ÙÈ̤˜ ÂÓËÏ›ÎˆÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. √È FT4, TBG Î·È TSH ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔԉ¢ÙÈο ·‡ÍËÛË ·fi ÌfiÏȘ ·ÓȯÓ‡ÛÈ̘ ÙÈ̤˜, ÙË 12Ë Â‚‰ÔÌ¿‰· ·ËÛ˘, Û ÙÈ̤˜ ÂÓËÏ›ÎˆÓ ÙËÓ 36Ë Â‚‰ÔÌ¿‰·. √ ı˘ÚÂÔÂȉ‹˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ·Ú¯›˙ÂÈ Ó· ÏÂÈÙÔ˘ÚÁ› ÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∆fiÙ ˘¿Ú¯ÂÈ Ù·¯Â›· ·‡ÍËÛË ¯Ú‹Û˘ Ù˘ ∆4 Û ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜, ·ÏÏ¿ Ë ÌÂÙ·ÊÔÚ¿ Ù˘ ∆4 ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô Û˘Ó¯›˙ÂÙ·È, ÒÛÙ ӷ Á›ÓÂÙ·È Ê˘ÛÈÔÏÔÁÈο Ë ·Ó¿Ù˘ÍË Î·È Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ Û ÂÚ›ÙˆÛË ·ÁÂÓÂÛ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (52). ™Â ‚·ÚÈ¿ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘, Ë ÌËÙ¤Ú· Î·È ÙÔ ¤Ì‚Ú˘Ô ¤¯Ô˘Ó ¤ÏÏÂÈ„Ë ∆4 Î·È Ô ÂÌ‚Ú˘˚Îfi˜ ÂÁΤʷÏÔ˜ ¤¯ÂÈ ¤ÏÏÂÈ„Ë ∆3. ∏ ÌËÙ¤Ú· Â›Ó·È Ë ÌfiÓË ËÁ‹ ∆4 ÁÈ· ÙÔ ·ÓıÚÒÈÓÔ ¤Ì‚Ú˘Ô Î·Ù¿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Î·È Ì¤ÚÔ˜ ÙÔ˘ ‰Â˘Ù¤ÚÔ˘ ÙÚÈÌ‹ÓÔ˘ (53). ™ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, Ë FT4 ÛÙÔ ¤Ì‚Ú˘Ô ¤¯ÂÈ Û¯Â‰fiÓ ÙËÓ ›‰È· ÙÈÌ‹ Ì ÂΛÓË ÙˆÓ ÂÓËϛΈÓ. ∞ÏÏ¿ ·fi Ȉ‰ÔÂÓÈ΋ ΢ÔÊÔÚÔ‡Û·, Ë FT4 ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ Â›Ó·È ˘„ËÏfiÙÂÚË ·Ô ÂΛÓË Ù˘ ÌËÙ¤Ú·˜. ™Ù· ÓÂÔÁÓ¿, Ë FT4 Â›Ó·È ·Ó¿ÏÔÁË Ù˘ ËÏÈΛ·˜ ·ËÛ˘. ™Â ¤ÁÎ˘Ô ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›·, Ô˘ ʤÚÂÈ ¤Ì‚Ú˘Ô ÌÂ

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Paediatriki 2001;64:101-114

ŒÓ·ÚÍË ÌÂÁ¿ÏˆÓ ‚Ï·‚ÒÓ ÛÙÔ ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ· ∂Ó‰ËÌÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜ ÏfiÁˆ ¤ÏÏÂȄ˘ Ȉ‰›Ô˘, ¤Ó·ÓÙÈ Û˘ÁÁÂÓÔ‡˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ªÈÎÙ¿ Ó¢ÚÔÏÔÁÈο Î·È ˘Ôı˘ÚÂÔÂȉÈο Â˘Ú‹Ì·Ù· ?

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∂ÈÎfiÓ· 5. ¢È¿ÁÚ·ÌÌ· ÌÔÚÊÔÏÔÁÈÎÒÓ Î·È ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÂÍÂÏ›ÍÂˆÓ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Ô˘ ÂËÚ¿˙ÔÓÙ·È ·fi ÙË ‰È·ıÂÛÈÌfiÙËÙ· ÙÔ˘ Ȉ‰›Ô˘ Î·È Ù˘ ı˘ÚÔ͛Ӣ.

Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi, Ô ÂÌ‚Ú˘˚Îfi˜ ÂÁΤʷÏÔ˜ ‰ÂÓ ¤¯ÂÈ ·ÍÈfiÏÔÁË ¤ÏÏÂÈ„Ë ∆3 ̤¯ÚÈ ÙÔÓ ÙÔÎÂÙfi. ªÂÙ¿, fï˜, Ë ÌËÙÚÈ΋ ÌÂÙ·ÊÔÚ¿ Ù˘ ∆4 ‰È·ÎfiÙÂÙ·È. ∏ ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Á›ÓÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, fiÙ·Ó ÂÏ·ÙÙˆıÔ‡Ó ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜. ªÔÚ› Ó· ·ÔÊ¢¯ı› Ì ÚÒÈÌË ¤Ó·ÚÍË ıÂÚ·›·˜ Ì ı˘ÚÔÍ›ÓË ‹ Ì ÌËÙÚÈÎfi ıËÏ·ÛÌfi, fiÔ˘ ÌÂٷʤÚÂÙ·È ¤Ó· ̤ÚÔ˜ Ù˘ ı˘ÚÔ͛Ӣ ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ÓÂÔÁÓfi. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÔÈ ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È Ì ‚Ú·‰‡ Ú˘ıÌfi Î·È Ë ∆4 ¤¯ÂÈ ËÌÈÂÚ›Ô‰Ô ˙ˆ‹˜ 6 Ë̤Ú˜. √È Ôχ ¯·ÌËϤ˜ ÙÈ̤˜ Ù˘ ÌËÙÚÈ΋˜ ∆4 ÏfiÁˆ Ȉ‰ÔÂÓ›·˜, ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘, ÙÔ˘ ˘·Ú·¯ÓÔÂȉԇ˜ ¯ÒÚÔ˘, ÙÔ˘ Îԯϛ·, ÙÔ˘ Ú·‚‰ˆÙÔ‡ ÛÒÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÊÏÔÈÔ‡ ÛÙÔÓ ÂÁΤʷÏÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (∂ÈÎfiÓ· 5) (54). °›ÓÂÙ·È ‰ÂÎÙfi Û‹ÌÂÚ·, fiÙÈ ÔÈ Ó¢ÚÔÏÔÁÈΤ˜ ‚Ï¿‚˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙË Û˘Ó‰˘·Ṳ̂ÓË ¯·ÌËÏ‹ ı˘ÚÔÍ›ÓË ÛÙË ÌËÙ¤Ú· Î·È ÙÔ ¤Ì‚Ú˘Ô, ·ÏÏ¿ Î·È ÛÙËÓ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ Ô˘ ÂËÚ¿˙ÂÈ ÙË ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ. ¶ÚÔˆÚfiÙËÙ· Î·È ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ∞̤ۈ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ÙÔ ·È‰› ·fi ÙÔ ˙ÂÛÙfi ÂÚÈ‚¿ÏÏÔÓ Ù˘ Ì‹ÙÚ·˜ ÂͤگÂÙ·È ÛÙÔ ÎÚ‡Ô Â͈ÙÂ-

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ÚÈÎfi ÂÚÈ‚¿ÏÏÔÓ Î·È Ú¤ÂÈ Ó· ·˘Í‹ÛÂÈ ÙȘ η‡ÛÂȘ. ∆Ô ÙÚ›ÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, Ë ÌÂÙ·ÊÔÚ¿ Ù˘ ∆4 ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô ‰È·ÎfiÙÂÙ·È ·fiÙÔÌ· ÙË ÛÙÈÁÌ‹ Ù˘ Á¤ÓÓËÛ˘. √ ı˘ÚÂÔÂȉ‹˜ ÂÓfi˜ ÙÂÏÂÈfiÌËÓÔ˘ ÓÂÔÁÓÔ‡ ÂÚȤ¯ÂÈ ÂÚ›Ô˘ 100 Ìg Ȉ‰›Ô˘. ∆· ÚfiˆÚ· ÓÂÔÁÓ¿ ·ÔÙÂÏÔ‡Ó ¤Ó· ÏËı˘ÛÌfi Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ·Ó·Ù˘ÍȷΤ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ¤ÏÏÂÈ„Ë ÙÔ˘ Ȉ‰›Ô˘, ·ÎfiÌ· Î·È fiÙ·Ó Ë ÚfiÛÏË„Ë Èˆ‰›Ô˘ ·Ô ÙË ÌËÙ¤Ú· Â›Ó·È Â·Ú΋˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË (55,56),ȉ›ˆ˜ fiÙ·Ó ‰È·ÙÚ¤ÊÔÓÙ·È Ì ٷ Û˘Ó‹ıË ‰È·ÈÙÔÏfiÁÈ· ÙÔ˘ ÂÌÔÚ›Ô˘ Ô˘ ‰ÂÓ Â›Ó·È ÂÌÏÔ˘ÙÈṲ̂ӷ Ì ÈÒ‰ÈÔ (57). ™Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Ë FT4 ·˘Í¿ÓÂÈ, ·ÏÏ¿ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ÂÏ·ÙÙÒÓÂÙ·È. ∏ ÙÒÛË Î·È Ë ‰È¿ÚÎÂÈ¿ Ù˘ (·ÚÔ‰ÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜) Â›Ó·È ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚË, fiÛÔ ÌÈÎÚfiÙÂÚË Â›Ó·È Ë ËÏÈΛ· ·ËÛ˘. ∏ ÙÒÛË Ù˘ FT4 ·ÎÔÏÔ˘ı› ÌÂÙ¿ Ì›· ‚‰ÔÌ¿‰· ·‡ÍËÛ˘ Ù˘ TSH Î·È ·˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ Ô ¿ÍÔÓ·˜ ˘Ôı¿Ï·ÌÔ˜-˘fiÊ˘ÛË-ı˘ÚÂÔÂȉ‹˜, ηıÒ˜ Î·È Ë ·ÚÓËÙÈ΋ ·Ï›Ó‰ÚÔÌË ·ÏÏËÏÔÚ‡ıÌÈÛË ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Â›Ó·È ·ÓÂ·Ú΋˜ Î·È Î·ı˘ÛÙÂÚË̤ÓË. ∫·Ù¿ ÙÔÓ ÚfiˆÚÔ ÙÔÎÂÙfi, Ë ÌËÙÚÈ΋ ÌÂÙ·ÊÔÚ¿ Ȉ‰›Ô˘ Î·È ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ‰È·ÎfiÙÂÙ·È ÚÈÓ ÁÂÌ›ÛÂÈ Ô ı˘ÚÂÔÂȉ‹˜ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ·˘ÍË̤Ó˜ ·Ó¿ÁΘ. ÃÚÂÈ¿˙ÂÙ·È Î¿ÔÈÔ˜ ¯ÚfiÓÔ˜ ÌÂÙ¿

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¶·È‰È·ÙÚÈ΋ 2001;64:101-114

ÙÔÓ ÙÔÎÂÙfi, ÒÛÙÂ Ô ·ÓÒÚÈÌÔ˜ ı˘ÚÂÔÂȉ‹˜ Ó· ÚÔÛ·ÚÌÔÛÙ› ÛÙËÓ ·ÒÏÂÈ· Ù˘ ÌËÙÚÈ΋˜ ÚÔÛÊÔÚ¿˜. ™˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ª›· ¿ÏÏË ÌÔÚÊ‹ ÓÂ˘Ì·ÙÈ΋˜ - „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ÏfiÁˆ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡, Â›Ó·È Ô Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜. ™ÙË ¯ÒÚ· Ì·˜ ·fi ÙÔ 1979 (Î·È ÛÙȘ ¿ÏϘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ÙÔ˘ ÎfiÛÌÔ˘ ÓˆÚ›ÙÂÚ·), ÂÊ·ÚÌfi˙ÂÙ·È ·ÓȯÓ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ (58). ŸÏ· Ù· ·È‰È¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Û ¡ÔÛÔÎÔÌ›· ‹ π‰ÈˆÙÈΤ˜ ∫ÏÈÓÈΤ˜ ÂϤÁ¯ÔÓÙ·È, Ï·Ì‚¿ÓÔÓÙ·˜ ·fi ÙË ÊÙ¤ÚÓ· ÙËÓ 3Ë-7Ë Ë̤ڷ Ù˘ ˙ˆ‹˜ ÙÔ˘˜, Ì›· ÛÙ·ÁfiÓ· ·›Ì·ÙÔ˜ Ô˘ ÙÔÔıÂÙÂ›Ù·È Û ‰ÈËıËÙÈÎfi ¯·ÚÙ›. ∆Ô ¯·ÚÙ› ·˘Ùfi ·ÔÛÙ¤ÏÏÂÙ·È Ì ʿÎÂÏÔ Ù·¯˘‰ÚÔÌÈο ÛÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÛÙËÓ ∞ı‹Ó·. ∂Λ ÌÂÙÚ¿Ù·È Ú·‰ÈÔ·ÓÔÛÔÏÔÁÈο ·fi ÙËÓ ·ÔÍËڷ̤ÓË ÛÙ·ÁfiÓ· ·›Ì·ÙÔ˜ Ë TSH. ŸÙ·Ó Ë TSH >30 ÌI U/L, ÂȉÔÔÈÔ‡ÓÙ·È ÔÈ ÁÔÓ›˜ ÙÔ˘ ·È‰ÈÔ‡. ∞˘Ùfi Á›ÓÂÙ·È Û‡ÓÙÔÌ·, ÂÓÙfi˜ ‰¤Î· ¤ÓÙ ËÌÂÚÒÓ ·fi ÙËÓ Ë̤ڷ Ù˘ ·ÈÌÔÏË„›·˜, ÒÛÙ ӷ ·Ú¯›ÛÔ˘Ó ıÂÚ·›· Ì ı˘ÚÔÍ›ÓË, ÚÈÓ Á›ÓÔ˘Ó ÌfiÓÈ̘ ‚Ï¿‚˜ ÛÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÛÙÔÓ ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 1 ·Ó¿ 3427 ÁÂÓÓ‹ÛÂȘ. ª¤¯ÚÈ ÙÔ 1996 ¤¯Ô˘Ó ‰È·ÁÓˆÛı› ÛÙËÓ ∂ÏÏ¿‰· 545 ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi (59). ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ, ·Ó Ô Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ‰È·ÁÓˆÛı› ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ˙ˆ‹˜ Î·È ·Ú¯›ÛÂÈ ıÂÚ·›· Ì ı˘ÚÔÍ›ÓË, ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ÛÙÔ ·È‰›, ÂÓÒ ·Ó ηı˘ÛÙÂÚ‹ÛÂÈ Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÌfiÓÈ̘ „˘¯ÔÎÈÓËÙÈΤ˜ ‚Ï¿‚˜ Î·È Ë ÓÔËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·È‰ÈÒÓ Â›Ó·È ¯·ÌËÏ‹. ∆· ·È‰È¿ ·˘Ù¿ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ú·ÎÔÏÔ˘ı‹ÛÔ˘Ó Ù· Ì·ı‹Ì·Ù· Û ηÓÔÓÈÎfi Û¯ÔÏ›Ô, ·ÏÏ¿ Ú¤ÂÈ Ó· ÓÔÛËχÔÓÙ·È Û ÂȉÈο ȉڇ̷ٷ ÁÈ· ·Ó›·Ù· ·È‰È¿. ∆Ô ÎfiÛÙÔ˜ ÙÔ˘ ÂıÓÈÎÔ‡ ÚÔ¸ÔÏÔÁÈÛÌÔ‡ ÁÈ· ÙË Û˘ÓÙ‹ÚËÛË ·˘ÙÒÓ ÙˆÓ π‰Ú˘Ì¿ÙˆÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ ÎfiÛÙÔ˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ì ÙÔ ·ÓȯÓ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ·È‰ÈÒÓ ÌÂ Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ¶·Ú¿ ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÓÂ˘Ì·ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙˆÓ ·ÙfiÌˆÓ ÌÂ Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi, ¤Ó· ÔÛÔÛÙfi 10% ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ˘ÔÏ›ÂÙ·È ÛÙËÓ „˘¯ÔÎÈÓËÙÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ·Ó¿Ù˘ÍË. ∞Èٛ˜ Û˘ÁÁÂÓÔ‡˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ √ Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÔÊ›ÏÂÙ·È Î·Ù¿ 85% ÛÙËÓ ¤ÏÏÂÈ„Ë ÙÔ˘ ·‰¤Ó· (¤ÎÙÔÔ˜ 40%, ·ÁÂÓÂÛ›· 40%, ˘ÔÏ·ÛÙÈÎfi˜ 5%) Î·È Î·Ù¿ 15% Û ÁÂÓÂÙÈο ÂÏÏ›ÌÌ·Ù· ÁÈ· ÙË ‚ÈÔÛ‡ÓıÂÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ. À¿Ú¯ÂÈ Î·È Ô ·ÚÔ‰ÈÎfi˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÛÂ Û˘¯ÓfiÙËÙ· 1 ·Ó¿ 10.000 ÓÂÔÁ¤ÓÓË-

Paediatriki 2001;64:101-114

Ù· Î·È ÔÊ›ÏÂÙ·È ÛÙË ÌÂÙ·ÊÔÚ¿ ‰È· ÙÔ˘ Ï·ÎÔ‡ÓÙ· ηٷÛÙ·ÏÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Ù˘ TSH ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô (60), ·ÏÏ¿ ΢ڛˆ˜ ÛÙËÓ ·˘ÍË̤ÓË ÔÛfiÙËÙ· Ȉ‰›Ô˘ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ (·Ôχ̷ÓÛË ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘) Ô˘ ·ÚÂÌÔ‰›˙ÂÈ ·ÚÔ‰Èο ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÛÙÔ ÓÂÔÁ¤ÓÓËÙÔ ‹ ÛÙËÓ Î·Ù¿¯ÚËÛË ¯Ú‹Û˘ Ȉ‰›Ô˘ ·fi ÙË ÌËÙ¤Ú· (61,62). ª¤¯ÚÈ ÚfiÛÊ·Ù· ıˆÚ›ÙÔ fiÙÈ Ô Û˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ Ì ·Ï·Û›· ‹ ·ÁÂÓÂÛ›· ·‰¤ÓÔ˜ ÔÊÂÈÏfiÙ·Ó ÛÂ Ù˘¯·›· ·›ÙÈ· (ÛÔÚ·‰ÈÎfi˜) Î·È ‰ÂÓ ÌÂÙ·‚È‚¿˙ÂÙ·È ÛÙÔ˘˜ ·ÔÁfiÓÔ˘˜. ŸÌˆ˜, ·Ó¢ڤıËÛ·Ó ÙÚ›· ÁÔÓ›‰È· Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙË ÌÔÚÊÔÁ¤ÓÂÛË Î·È ÙËÓ Î¿ıÔ‰Ô ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, ηıÒ˜ Î·È ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ı˘Ï·ÎȈ‰ÒÓ ı˘ÚÂÔÂȉÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙÚÂȘ ÌÂÙ·ÁÚ·ÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (63). ∞˘ÙÔ› Â›Ó·È Ô ı˘ÚÂÔÂȉÈÎfi˜ ÌÂÙ·ÁÚ·ÊÈÎfi˜ ·Ú¿ÁˆÓ 1 (∆∆F-1), Ô ı˘ÚÂÔÂȉÈÎfi˜ ÌÂÙ·ÁÚ·ÊÈÎfi˜ ·Ú¿ÁˆÓ 2 (∆∆F-2) Î·È Ô Pax 8. ¶ÔÓÙ›ÎÈ· ÛÙ· ÔÔ›· ··Ï›ÊıËÎ·Ó (Knock out) ·˘Ù¿ Ù· ÁÔÓ›‰È·, ÁÂÓÓÈÔ‡ÓÙ·È Ì Ï‹ÚË ·Ô˘Û›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ‹ Ì ¤ÎÙÔÔ ı˘ÚÂÔÂȉ‹. ∂ÙÂÚfi˙˘ÁÔ ¤ÏÏÂÈÌÌ· ·˘ÙÒÓ ÙˆÓ ÁÔÓȉ›ˆÓ ¤¯ÂÈ ÂÓÙÔÈÛÙ› Û ÓÂÔÁ¤ÓÓËÙ· ÌÂ Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È ‚·ÚÈ¿ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ‹ ·ÙÚËÛ›· ¯Ô¿Ó˘ ‹ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÓÂÊÚÒÓ. ªÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ PAX 8 ·Ó¢ڤıË Û ‰‡Ô ·È‰È¿ Ì ÛÔÚ·‰È΋ ·ÁÂÓÂÛ›· ÙÔ˘ ı˘ÚÂÔÂȉ‹ Î·È Û ÙÚ›· ̤ÏË Ì›·˜ ¿ÏÏ˘ ÚÔÛ‚·ÏÏfiÌÂÓ˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ™ÙÔ 15% ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ Ô˘ ÔÊ›ÏÂÙ·È Û ‰˘ÛÔÚÌÔÓÔÁ¤ÓÂÛË, ˘¿Ú¯ÂÈ ÁÂ-

∂ÈÎfiÓ· 6. ¶Ï¿ÁÈ· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ô˘ ‰Â›¯ÓÂÈ ÙË Û¯¤ÛË ÙÔ˘ ı˘ÚÂÔÂȉ‹ Ì ÁÂÈÙÔÓÈο fiÚÁ·Ó· (ÙÚ·¯Â›·, ÔÈÛÔÊ¿ÁÔ˜, ÎÚÈÎÔÂȉ‹˜ ¯fiÓ‰ÚÔ˜).

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Paediatriki 2001;64:101-114

∂ÈÎfiÓ· 7. °˘Ó·›Î· ·fi ÔÚÂÈÓ‹ ÂÚÈÔ¯‹ Ù˘ ∫Ú‹Ù˘ Ì ¤ÓÙÔÓË ‰ÈfiÁΈÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (ÂÚÈÛÙ·ÙÈÎfi Û˘ÁÁڷʤˆ˜).

ÓÂÙÈÎfi ¤ÏÏÂÈÌÌ· ÛÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÁÈ· ÙË Û‡ÓıÂÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ. ªÂÁ¿ÏÔ Â‡ÚÔ˜ ÌÂÙ·ÏÏ¿ÍÂˆÓ ¤¯ÂÈ ‚ÚÂı›, Ô˘ ΢ڛˆ˜ ÔÊ›ÏÂÙ·È Û ٤ÛÛÂÚ· ÁÔÓ›‰È·. ∞˘Ù¿ ›ӷÈ: 1) £˘ÚÂÔÛÊ·ÈÚ›Ó˘, 2) £˘ÚÂÔÂÚÔÍÂȉ¿Û˘ (64), 3) ¡¿ÙÚÈÔ – πÒ‰ÈÔ Û˘ÌÌÂÙ·ÊÔÚ¤·˜ (65), 4) Pendrel (66). µÚ¤ıËΠ·ÎfiÌË ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÚˆÙ½Ó˘ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ TSH (67) Ô˘ ÚÔηÏ› ÎÏËÚÔÓÔÌÈÎfi Û˘ÁÁÂÓ‹ ˘Ôı˘ÚÂÔÂȉÈÛÌfi Ì ˘ÔÏ·ÛÙÈÎfi ·‰¤Ó·. ÕÏÏË ÌÂÙ¿ÏÏ·ÍË Ô˘ ·Ó¢ڤıË Â›Ó·È ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ‚-˘ÔÔÌ¿‰·˜ Ù˘ TSH Ô˘ ÚÔηÏ› ·Ï·Û›· ÙÔ˘ ·‰¤Ó· Î·È ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È ‰ÂÓ ·ÓȯÓ‡ÂÙ·È ÛÙË ÛÙ·ÁfiÓ· ·›Ì·ÙÔ˜, fiÙ·Ó ÌÂÙÚ¿Ù·È ÌfiÓÔ Ë TSH Î·È fi¯È Ë ∆4 (68). ™˘ÌÂÚ¿ÛÌ·Ù· ∏ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ηٿ ÙËÓ ÂÌ‚Ú˘˚΋ ˙ˆ‹ ÚÔηÏ› ·ÓÂ·ÓfiÚıˆÙ˜ ‚Ï¿‚˜ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ù· ·È‰È¿ Ô˘ ı· ÁÂÓÓËıÔ‡Ó ÌÔÚ› Ó· Â›Ó·È ÎÚÂÙ›ÓÔÈ (69). ŒÏÏÂÈ„Ë Èˆ‰›Ô˘ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ÚÔηÏ› ˘Ôı˘ÚÂÔÂȉÈÛÌfi, ÓÂ˘Ì·ÙÈ΋ - „˘¯ÔÎÈÓËÙÈ΋ Î·È ÛˆÌ·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË. ŒÏÏÂÈ„Ë Èˆ‰›Ô˘ ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· ÚÔηÏ› ˘Ôı˘ÚÂÔÂȉÈÛÌfi Î·È Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘, Ô˘ ·Ó·ÏËÚÒÓÂÙ·È ÌÂÙ¿ ÙË ıÂÚ·›· Ì ı˘ÚÔÍ›ÓË. ∏ ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘ ÛÙ· ·È‰È¿ ·ÏÏ¿ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ÚÔηÏ› ‚ÚÔÁ¯Ô΋ÏË, Ë ÔÔ›·, fiÙ·Ó Â›Ó·È ÌÂÁ¿ÏË, ÚÔηÏ› ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ· ÛÙÔÓ ÔÈÛÔÊ¿ÁÔ Î·È ÛÙËÓ ÙÚ·¯Â›· Î·È ‰˘Û¯¤ÚÂÈ· ÛÙËÓ Î·Ù¿ÔÛË Î·È ÛÙËÓ ·Ó·ÓÔ‹ Û ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ (∂ÈÎfiÓ· 6). ªÔÚ› Ô ‰ÈÔÁΈ̤ÓÔ˜ ı˘ÚÂÔÂȉ‹˜, ·Ú¿ ÙÔ ÌÂÁ¿ÏÔ Ì¤ÁÂıÔ˜, Ó· ÌËÓ ·-

112

Ú¿ÁÂÈ Â·Ú΋ ÔÛfiÙËÙ· ı˘ÚÔ͛Ӣ Î·È Ó· ¤¯Ô˘Ì ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ªÔÚ› fï˜ ÌÂÚÈÎÔ› fi˙ÔÈ ÙÔ˘ ‰ÈÔÁΈ̤ÓÔ˘ ı˘ÚÂÔÂȉԇ˜ Ó· ·ÔÎÙ‹ÛÔ˘Ó ·˘ÙÔÓÔÌ›·, Ó· ˘ÂÚÏÂÈÙÔ˘ÚÁÔ‡Ó Î·È Ó· ¤¯Ô˘Ì ÙÔÍÈ΋ ÔÏ˘Ô˙Ò‰Ë ‚ÚÔÁ¯Ô΋ÏË. ªÂÚÈÎÔ› „˘¯ÚÔ› fi˙ÔÈ ÛÙËÓ ÔÏ˘Ô˙Ò‰Ë ‚ÚÔÁ¯Ô΋ÏË ÌÔÚ› Ó· ÂÍ·ÏÏ·¯ıÔ‡Ó Û ηÚΛÓÔ. ŒÏÏÂÈ„Ë Èˆ‰›Ô˘, ‰˘ÛÙ˘¯Ò˜, ˘¿Ú¯ÂÈ ÛÙȘ Ë̤Ú˜ Ì·˜ (∂ÈÎfiÓ· 7) (70) Û ÔÏϤ˜ ÔÚÂÈÓ¤˜, ÊÙˆ¯¤˜, ·ÔÌÔӈ̤Ó˜ ·fi ÙÔÓ ˘fiÏÔÈÔ ÎfiÛÌÔ ÂÚÈÔ¯¤˜, Û ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ÙÔ˘ Ï·Ó‹ÙË Ì·˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Ì·ÎÚÈ¿ ·fi ÙË ı¿Ï·ÛÛ· Î·È ÚÔηÏ› ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ‚ÚÔÁ¯Ô΋ÏË. √ ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ ÓÂÚÔ‡, ÙÔ˘ „ˆÌÈÔ‡ ‹ ÙÔ˘ ·Ï·ÙÈÔ‡ Ì ÈÒ‰ÈÔ, ÁÈ· ˘ÁÈ›˜ ۈ̷ÙÈο Î·È ÓÂ˘Ì·ÙÈο ·ÓıÚÒÔ˘˜ Û ÂÚÈÔ¯¤˜ Ì ¤ÏÏÂÈ„Ë Èˆ‰›Ô˘, ·ÔÙÂÏ› ÂıÓÈÎfi ηı‹ÎÔÓ Î¿ı ¯ÒÚ·˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Martin ND. ¡ÂÚfi Î·È ·ÓfiÚÁ·Ó· ÛÙÔȯ›·. ™ÙÔ: Martin WD, Mayes AP, Rodwell WV ÂΉ. Harper’s µÈÔ¯ËÌ›· ∆fiÌÔ˜ µ. ∞ı‹Ó·, ÂÈÛÙ ÂΉ ¶·ÚÈÛÈ¿ÓÔ˜; 1985. ÛÂÏ. 597-610.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-06-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 08-01-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫˘Ú·ÙÛԇϷ ¶·ÓÙÛÈÒÙÔ˘ ¢ÚfiÛË 11, °Î‡˙Ë

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√ ıˆÚ·ÎÈÎfi˜ fiÓÔ˜ ÛÙ· ·È‰È¿. KÏÈÓÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË °. ™. µ·ÚÏ¿Ì˘

Chest pain in children. A clinical diagnostic approach G. S. Varlamis

¶ÂÚ›ÏË„Ë: √ ıˆÚ·ÎÈÎfi˜ fiÓÔ˜, ÁÓˆÛÙfi˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È ˆ˜ “ÚÔοډÈÔ˜ fiÓÔ˜”, Â›Ó·È ¤Ó· ·fi Ù· Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È Ôχ Û˘¯Ó‹ ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ ·È‰ÈÒÓ ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi ∂͈ÙÂÚÈÎfi π·ÙÚ›Ô. ∏ ηډÈÔÊÔ‚›· ÙˆÓ ÁÔÓ¤ˆÓ Â›Ó·È ‚·ÛÈ΋ ·ÈÙ›· ÚfiÛıÂÙÔ˘ ¿Á¯Ô˘˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘, ·ÏÏ¿ Î·È Ô ›‰ÈÔ˜ Ô ıˆÚ·ÎÈÎfi˜ fiÓÔ˜ ·ÔÙÂÏ› Û˘¯Ó¿ ‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ·, ·Ó Ë ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È Û ÎÏÈÓÈο ÌfiÓÔ ÎÚÈÙ‹ÚÈ·. ™ÙËÓ ·Ó·ÛÎfiËÛË ·˘Ù‹ ‰ÈÂÚÂ˘Ó¿Ù·È ÙÔ ı¤Ì· ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ fiÓÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ì ÁÓÒÌÔÓ· ÙȘ ȉȷÈÙÂÚfiÙËÙ˜ Ù˘ ËÏÈΛ·˜ ·˘Ù‹˜, ηıÒ˜ Î·È Ù· ‰Â‰Ô̤ӷ ·fi ÙË ‰È·ÁÓˆÛÙÈ΋ ÙˆÓ ÂÓËϛΈÓ. ∂ÈϤÔÓ, ÌÂıԉ‡ÂÙ·È Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ Î·È ÙÔ˘ ÁÂÓÈÎÔ‡ ÁÈ·ÙÚÔ‡, Ë ÔÔ›·, ÂÎÙfi˜ ÙˆÓ ¿ÏψÓ, ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·ÈÙÈÔÏÔÁ›· Î·È ÛÙËÓ È‰È·›ÙÂÚË ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›·, ·ÏÏ¿ Î·È ÛÙ· ‰Â‰Ô̤ӷ ·fi ÙËÓ Î›ÓËÛË ÙÔ˘ ¶·È‰ÔηډÈÔÏÔÁÈÎÔ‡ ∂͈ÙÂÚÈÎÔ‡ π·ÙÚ›Ԣ Î·È ÙÔ˘ ¶·È‰ÔηډÈÔÏÔÁÈÎÔ‡ ¢È·ÁÓˆÛÙÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Ù˘ ∫ÏÈÓÈ΋˜ Ì·˜. π‰È·›ÙÂÚË ‚·Ú‡ÙËÙ· ‰›‰ÂÙ·È ÛÙËÓ ÂÚÈÁÚ·Ê‹ ÙˆÓ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ÙˆÓ Î·Ú‰ÈÔÏÔÁÈÎÒÓ ·ÈÙ›ˆÓ ıˆÚ·ÎÈÎÔ‡ fiÓÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÒÛÙ ·˘Ù¿ Ó· ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Î·È Ó· ÂȂ‚·ÈÒÓÔÓÙ·È ‹ Ó· ·ÔÎÏ›ÔÓÙ·È Ù·¯¤ˆ˜, ÏfiÁˆ Ù˘ ÁÂÓÈο ·Ô‰ÂÎÙ‹˜ Ì›˙ÔÓÔ˜ ÚÔÁÓˆÛÙÈ΋˜ ÛËÌ·Û›·˜ ÙÔ˘˜, ·Ú¿ ÙË ÛÙ·ÙÈÛÙÈο Û¯ÂÙÈο ¯·ÌËÏ‹ ·Ó·ÏÔÁ›· ÙÔ˘˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÈÙ›ˆÓ ıˆÚ·ÎÈÎÔ‡ fiÓÔ˘ ÛÙ· ·È‰È¿. ∆¤ÏÔ˜, ‰›‰ÂÙ·È Ô ‰È·ÁÓˆÛÙÈÎfi˜ ·ÏÁfiÚÈıÌÔ˜, Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙÔ ¶·È‰È·ÙÚÈÎfi Î·È ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi ∂͈ÙÂÚÈÎfi π·ÙÚÂ›Ô Ù˘ ∫ÏÈÓÈ΋˜ Ì·˜.

Abstract: Chest pain or precordial pain is a frequent symptom in childhood and a very frequent cause for seeking examination by a pediatric cardiologist. The fear of heart disease on the part of the parents is the main cause for an additional anxiety to the pediatrician, but also chest pain itself is often a difficult problem to solve if the diagnosis is based entirely on clinical criteria.

This review analyzes chest pain in children with emphasis on the particularities pertinent to the young age group as well as on the available data accumulated from studies in adults. Moreover, the diagnostic approach on the part of the pediatrician is meticulously analyzed which, among others, is based on the etiology and the specific clinical signs, as well as on the data derived from our outpatient cardiology clinic. Specific emphasis is given on the description of the clinical signs, as well as on the various etiologic factors. Despite the low incidence of the cardiac causes of chest pain in childhood, their prompt recognition by the clinician is essential since it will contribute significantly to the overall prognosis. A diagnostic algorithm is finally presented which is used in our pediatric and pediatric cardiology clinics of our hospital.

§¤ÍÂȘ ÎÏÂȉȿ: ıˆÚ·ÎÈÎfi˜ fiÓÔ˜, ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË.

Key words: chest pain, diagnostic approach.

¶·È‰›·ÙÚÔ˜ - ¶·È‰ÔηډÈÔÏfiÁÔ˜, ∞Ó. ∫·ıËÁËÙ‹˜ ∞.¶.£. ¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., ¡ÔÛÔÎÔÌÂ›Ô ∞.Ã.∂.¶.∞. £ÂÛÛ·ÏÔÓ›ÎË

Associate Professor of Pediatrics - Pediatric Cardiology 4th Pediatric Clinic, Aristotelion University of Thessaloniki A.H.E.P.A. Hospital, Thessaloniki

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Paediatriki 2001;64:115-124

∂ÈÛ·ÁˆÁ‹ √ ıˆÚ·ÎÈÎfi˜ fiÓÔ˜ (£¶) ÂÎÏ·Ì‚¿ÓÂÙ·È ·ÙÔÌÈο Î·È ÎÔÈÓˆÓÈο ˆ˜ ÚÔ¿ÁÁÂÏÔ˜ ÛËÌ·ÓÙÈÎÒÓ Î·È Î˘Ú›ˆ˜ ηډȷÎÒÓ ·ı‹ÛˆÓ, ÁÂÁÔÓfi˜ Ô˘ ÙÔ˘ ÚÔÛ‰›‰ÂÈ ÙËÓ È‰ÈfiÙËÙ· ÂÓfi˜ “Û˘ÌÙÒÌ·ÙÔ˜ Û˘Ó·ÁÂÚÌÔ‡”. ™Â ·˘Ùfi Û˘Ì‚¿ÏÏÂÈ Ë Ú·ÁÌ·ÙÈ΋ ·‡ÍËÛË Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È Ë ÂÏÏÈ‹˜ ÏËÚÔÊfiÚËÛË ·fi Ù· ª¤Û· ª·˙È΋˜ ∂ÓË̤ڈÛ˘, Ô˘ Û˘Ó‰¤Ô˘Ó Û˘¯Ó¿ ÙÔÓ £¶ Ì ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ Ó¤ˆÓ Û˘Ó‹ıˆ˜ ·ÙfïÓ. √È ÈÔ ¿Óˆ ÏfiÁÔÈ Î·È Ë ÌÂÁ¿ÏË ÔÈÎÈÏ›· ·ÈÙ›ˆÓ ÙÔ˘ £¶ ÛÙ· ·È‰È¿, ηıÈÛÙÔ‡Ó ÙÔÓ £¶, Û˘¯Ó¿, ‰˘ÛÂ›Ï˘ÙÔ Úfi‚ÏËÌ· ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ (1,2). ™ÎÔfi˜ Ù˘ ·Ó·ÛÎfiËÛ˘ ·˘Ù‹˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ı¤Ì·ÙÔ˜ ÙÔ˘ £¶ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ë ‰È·ÌfiÚʈÛË ÌÂıfi‰Â˘Û˘ ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ·fi ÙÔÓ ›‰ÈÔ ÙÔÓ ÔÈÎÔÁÂÓÂÈ·Îfi ·È‰›·ÙÚÔ ‹ ÙÔ ÁÈ·ÙÚfi ÁÂÓÈ΋˜ π·ÙÚÈ΋˜, Ô˘ ‚·Û›˙ÂÙ·È ÛÙ· ‰Â‰Ô̤ӷ Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ·ÏÏ¿ Î·È Ù˘ ΛÓËÛ˘ ÙÔ˘ ¶·È‰ÔηډÈÔÏÔÁÈÎÔ‡ ∂͈ÙÂÚÈÎÔ‡ π·ÙÚ›Ԣ Î·È ÙÔ˘ ¶·È‰ÔηډÈÔÏÔÁÈÎÔ‡ ¢È·ÁÓˆÛÙÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Ù˘ ∫ÏÈÓÈ΋˜ Ì·˜. ∏ ·ÓÙ›ÏË„Ë Î·È Ë ÂÎÙ›ÌËÛË ÙÔ˘ fiÓÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· “¶fiÓÔ˜ Â›Ó·È ÙÔ ·›ÛıËÌ·, ηٿ ÙÔ ÔÔ›Ô ·Ú·ÙËÚÂ›Ù·È ˘„ËÏfi˜ Û˘Ó·ÈÛıËÌ·ÙÈÎfi˜ ÙfiÓÔ˜ ‰˘Û¿ÚÂÛÙ˘ ¯ÚÔÈ¿˜” (Houssay, 1963) (3). ∏ “¢ÈÂıÓ‹˜ ŒÓˆÛË ÁÈ· ÙË ªÂϤÙË ÙÔ˘ ¶fiÓÔ˘” ‰›ÓÂÈ 16 ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ÙÔÓ ·ÎfiÏÔ˘ıÔ ÔÚÈÛÌfi: “¶fiÓÔ˜ Â›Ó·È ‰˘Û¿ÚÂÛÙË ·ÈÛıËÛȷ΋ Î·È Û˘ÁÎÈÓËÛȷ΋ ÂÌÂÈÚ›·, Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì Ú·ÁÌ·ÙÈ΋ ‰˘ÓËÙÈ΋ ÈÛÙÈ΋ ÚÔÛ‚ÔÏ‹” (4). ¶·Ú¿ ÙËÓ ¤ÎÙ·ÛË Ù˘ ¤Ú¢ӷ˜ ÙÔ˘ fiÓÔ˘, ÏËÚ¤ÛÙÂÚÔ˜ ÔÚÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ ‰Ôı› Î·È ·Ú·Ì¤ÓÔ˘Ó ·Ó·¿ÓÙËÙ· ÔÏÏ¿ ·ÎfiÌË ÂÚˆÙ‹Ì·Ù· (1,5,6). ∏ ÌÂÁ¿ÏË ÂͤÏÈÍË Ù˘ Ó¢ÚÔÊ˘ÛÈÔÏÔÁ›·˜ ·¤‰ÂÈÍ ÙËÓ ‡·ÚÍË Î·ÙÈÔ‡Û·˜ ·Ó·ÙÔÌÈ΋˜ Ô‰Ô‡, ÂÎÙfi˜ ·fi ÙË ÁÓˆÛÙ‹ ÎÂÓÙÚÔÌfiÏÔ Ô‰fi, ηıÒ˜ Î·È ÔÈÎÈÏ›· Ó¢ÚÔÌÂÙ·‚È‚·ÛÙÈÎÒÓ Î·È Ó¢ÚÔ·ÏÏÔȈÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ Ô˘ÛÈÒÓ, ¯ˆÚ›˜ ·fiÏ˘ÙË ‰È¢ÎÚ›ÓÈÛË Ù˘ ‰Ú¿Û˘ ÙÔ˘˜ (6,7). Œ¯ÂÈ, Â›Û˘, ·Ô‰ÂȯÙ› fiÙÈ Ë ‡·ÚÍË ÙˆÓ ·Ó·ÙÔÌÈÎÒÓ Ô‰ÒÓ Î·È Ë ‰Ú¿ÛË ÙˆÓ Ó¢ÚÔÚ˘ıÌÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ·fi ÙË Á¤ÓÓËÛË, ·ÎfiÌË Î·È Û ÚfiˆÚ· ÓÂ-

ÔÁÓ¿ Î·È Ù¤ÏÔ˜ fiÙÈ Ë ·ÓÙ›ÏË„Ë ÙÔ˘ fiÓÔ˘ ‰È·Ê¤ÚÂÈ ·fi ¿ÙÔÌÔ Û ¿ÙÔÌÔ, ÌÂٷ͇ ÙˆÓ Ê‡ÏˆÓ, ÛÙ· ›‰È· Ù· ¿ÙÔÌ· ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·, ÂÓÒ ˘¿Ú¯Ô˘Ó Î·È ÂıÓÈΤ˜ ‰È·ÊÔÚ¤˜ ηıÒ˜ Î·È ‰È·ÊÔÚ¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ „˘¯ÔÏÔÁÈÎfi ÂÚÈ‚¿ÏÏÔÓ (2,8). ∏ ÂÎÙ›ÌËÛË ÙÔ˘ fiÓÔ˘ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ Â›Ó·È ¤Ó· ·fi Ù· ‰˘ÛÎÔÏfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù·, ÂÂȉ‹ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ Î·È ·ÏÔ˘ÛÙÂ˘Ì¤ÓÔ˜ ÎÏÈÓÈÎfi˜ ÙÚfiÔ˜. √ ¤ÏÂÁ¯Ô˜ ÙˆÓ Ì˯·ÓÈÛÌÒÓ Ê˘ÛÈÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÛÙÔ stress ÌÔÚ› Ó· Á›ÓÂÈ ÂÈÚ·Ì·ÙÈο Ì ÔÏϤ˜ ÌÂıfi‰Ô˘˜, ÛÔ˘‰·ÈfiÙÂÚË ·fi ÙȘ Ôԛ˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ ÚÔÛÒÔ˘. ™ÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, η̛· ̤ıÔ‰Ô˜ ‰ÂÓ Â·ÚΛ, ‰ÈfiÙÈ ÛÙËÓ ·ÓÙ›ÏË„Ë Ù˘ ¤ÓÙ·Û˘ Î·È Ù˘ ÂÓÙfiÈÛ˘ ÙÔ˘ fiÓÔ˘ ÛÔ˘‰·ÈfiÙÂÚÔ˜ ·Ú¿ÁˆÓ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë ËÏÈΛ·. ∏ ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔÓ ›‰ÈÔ ‚·ıÌfi ·ÏÁÂÈÓÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜ Â›Ó·È ÙfiÛÔ ÈÔ ÛÙ·ıÂÚ‹ Î·È Û·Ê‹˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ËÏÈΛ· ÙÔ˘ (¶›Ó·Î·˜ 1) (1,2,9-11). ø˜ ÚfiÛıÂÙÔÈ ·Ú¿ÁÔÓÙ˜ ÈηÓÔ› Ó· ÂËÚ¿ÛÔ˘Ó ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ¤ÓÙ·Û˘ Î·È Ù˘ ÂÓÙfiÈÛ˘ ÙÔ˘ fiÓÔ˘ ·Ó·Ê¤ÚÔÓÙ·È: ·) Ë ÎÔÈÓˆÓÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡, Ô˘ Â›Ó·È ˘‡ı˘ÓË ÁÈ· ÙÔÓ £¶ ·fi Ì›ÌËÛË, ηٿ ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· Î·È ÁÈ· ÙÔÓ £¶ - ÂΉ‹ÏˆÛË ÎÙËÙÈ΋˜ ‹ ·ÓÙȉڷÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ÁÔÓ›˜, ηٿ ÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î·È ‚) Ë ˘ÔÎÂÈÌÂÓÈ΋ ÙÔÔı¤ÙËÛË ÔÏÏÒÓ ÁÈ·ÙÚÒÓ, ÔÈ ÔÔ›ÔÈ Û˘¯Ó¿ ˘ÂÚÂÎÙÈÌÔ‡Ó ÙÔÓ fiÓÔ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘, ÂÓÒ ÙÔÓ ˘ÔÙÈÌÔ‡Ó ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ (1,5,11). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·Ô˘Û›· ·ÓÙÈÎÂÈÌÂÓÈ΋˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘ fiÓÔ˘, Ë Û˘ÓÂȉËÙÔÔ›ËÛ‹ ÙÔ˘, Ô˘ ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ÙËÓ ËÏÈΛ·, Ë ·ÙÔÌÈ΋ ·ÓÔ¯‹ Û’ ·˘ÙfiÓ, Ë „˘¯ÔÎÔÈÓˆÓÈ΋ ˆÚ›Ì·ÓÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÔÈ ÂÓ‰ÔÔÈÎÔÁÂÓÂȷΤ˜ Û¯¤ÛÂȘ Â›Ó·È ·Ú¿ÁÔÓÙ˜ Ô˘ Ù›ÓÔ˘Ó Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÂÈÎfiÓ· ·Û¿ÊÂÈ·˜ Á‡Úˆ ·fi ÙÔ Û‡Ìو̷ “fiÓÔ˜” Î·È ·˘Í¿ÓÔ˘Ó ·fiÙÔÌ· ÙË Û˘¯ÓfiÙËÙ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 7-9 ¯ÚfiÓˆÓ. ªÔÚʤ˜ Î·È Û˘¯ÓfiÙËÙ· ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ fiÓÔ˘ ÛÙ· ·È‰È¿ √ £¶ ‰È·ÎÚ›ÓÂÙ·È Û Ô͇, ¯ÚfiÓÈÔ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ ‹ ÂÚÈÔ‰ÈÎfi.

¶›Ó·Î·˜ 1. ∏ ÚfiÔ‰Ô˜ Ù˘ ·ÓÙ›Ï˄˘ ÙÔ˘ fiÓÔ˘ Ì ÙËÓ ËÏÈΛ· (1,10,11) ∏§π∫π∂™ °¤ÓÓËÛË-3ÌËÓÒÓ 6-18 ÌËÓÒÓ 18-36 ÌËÓÒÓ 3-7 ¯ÚfiÓˆÓ 7-9 ¯ÚfiÓˆÓ >9 ¯ÚfiÓˆÓ

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∞¡∆π§∏æ∏ ¶√¡√À ªÓ‹ÌË ÂÒ‰˘ÓÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ ‹ ·˘ÙfiÌ·ÙÔ˘ fiÓÔ˘. ∞ÓÙ›‰Ú·ÛË ÔÚÁ‹˜ – Êfi‚Ô˘. ∫·Ï‡ÙÂÚË ¤ÓÓÔÈ·, ηχÙÂÚÔ˜ ÂÓÙÔÈÛÌfi˜. ŒÓ·ÚÍË ÏÂÎÙÈ΋˜ ÂÚÈÁÚ·Ê‹˜. ™˘Ó‹ı˘ Ë ˘ÂÚÂÎÙ›ÌËÛË Ù˘ ¤ÓÙ·Û˘. ™·Ê‹˜ Û˘ÓÂȉËÙÔÔ›ËÛË fiÓÔ˘ Î·È ·ÚÚÒÛÙÈ·˜. ŒÓ·ÚÍË Ì›ÌËÛ˘ fiÓÔ˘. ∂›‰Ú·ÛË ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ¶Ï‹Ú˘ Û˘ÓÂȉËÙÔÔ›ËÛË Ù˘ ·ÚÚÒÛÙÈ·˜ ˆ˜ ·ÈÙ›·˜.

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™˘¯ÓfiÙÂÚÔ Úfi‚ÏËÌ· ÛÙ· ·È‰È¿ ıˆÚÂ›Ù·È Ô Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˜ ‹ ÂÚÈÔ‰ÈÎfi˜ £¶, ·Ó ηÈ, ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ηٷÁڷʤ˜ Û˘¯ÓfiÙËÙ·˜, ‰ÂÓ Á›ÓÂÙ·È ¿ÓÙÔÙÂ Ë ‰È¿ÎÚÈÛË ·˘Ù‹ (6,7,12). √È Selbst Î·È Û˘Ó (13) ·Ó·Ê¤ÚÔ˘Ó Û˘¯ÓfiÙËÙ· ÚÔÛ¤Ï¢Û˘ Û ·È‰È·ÙÚÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ÁÈ· £¶, 6:1000. √ £¶ ·Ó·Ê¤ÚÂÙ·È ·fi ÙÔ˘˜ Brenner Î·È Û˘Ó (14) Î·È ·fi ÙÔÓ Fyfe (15) ˆ˜ Ë ‰Â‡ÙÂÚË ÌÂÙ¿ Ù· Ê˘Û‹Ì·Ù· ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ Û ·È‰ÔηډÈÔÏÔÁÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚ›Ô. ™ÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ £¶ ÛÙÔ ·È‰È·ÙÚÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ‹Ù·Ó, ÛÙË ÌÂϤÙË ÙˆÓ ∫Ô˘ÎÔ˘ÙÛ¿ÎË Î·È Û˘Ó (16), 0,18% ‹ ÂÚ›Ô˘ 2:1000. ™ÙË ‰È΋ Ì·˜ ∫ÏÈÓÈ΋, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ £¶ ˆ˜ ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ ÛÙÔ Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ÂÂÈÁfiÓÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‹Ù·Ó 77 Û 18570 ÂÚÈÙÒÛÂȘ (0,45%), ÂÓÒ ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚ›Ô, ‹Ù·Ó 7 ÛÙ· 100 ·È‰È¿ ηٿ ̤ÛÔ fiÚÔ, ·ÔÙÂÏÒÓÙ·˜ ÙËÓ 3Ë ·ÈÙ›· ÚÔÛ¤Ï¢Û˘ (17). ∆¤ÏÔ˜, Ë ‰ÈÂÚ‡ÓËÛË Ù˘¯fiÓ Î·Ú‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ Û ·È‰È¿ Ì £¶ ··Û¯fiÏËÛ ηٿ ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÂÓÙ·ÂÙ›· ÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi ¢È·ÁÓˆÛÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈfi Ì·˜ Û ·Ó·ÏÔÁ›· 2,59% (58/2236 ÂÚÈÙÒÛÂȘ). ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ £¶ ·Ó¤Ú¯ÂÙ·È Ì ÙËÓ ËÏÈΛ·, Ì ÎÔڇʈÛË ÛÙËÓ ÚÔÂÊË‚È΋. ª¤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Ì £¶ Â›Ó·È ·˘Ù‹ ÙˆÓ 13 ¯ÚfiÓˆÓ. ¢ÂÓ ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ (Û¯¤ÛË ·ÁÔÚÈÒÓ:ÎÔÚÈÙÛÈÒÓ = 1:1), ˘¿Ú¯Ô˘Ó fï˜ ‰È·ÊÔÚ¤˜ ˆ˜ ÚÔ˜ ÙȘ Â› ̤ÚÔ˘˜ Û˘¯ÓfiÙËÙ˜, ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÈÙÈÔÏÔÁ›·. ÷ڷÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· ·ÔÙÂÏ› ÙÔ fiÙÈ Ë Û¯ÂÙÈο ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙˆÓ

Paediatriki 2001;64:115-124

ηډÈÔ·Ó·Ó¢ÛÙÈÎÒÓ ·ÈÙ›ˆÓ ·Ó·Ì¤ÓÂÙ·È Û ËÏÈ˘ οو ÙˆÓ 12 ¯ÚfiÓˆÓ, ÂÓÒ ÙˆÓ „˘¯ÔÁÂÓÒÓ ·ÈÙ›ˆÓ Î·È Ù˘ ÔÛÙÂÔ¯ÔÓ‰Ú›Ùȉ·˜, Û ÎÔÚ›ÙÛÈ· ¿Óˆ ÙˆÓ 12 ¯ÚfiÓˆÓ. √ ¯ÚfiÓÈÔ˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˜ £¶ ‰È·ÚΛ ̤¯ÚÈ 3 ¯ÚfiÓÈ· Û ÔÛÔÛÙfi 45-69% Î·È ¿Óˆ ·fi 3 ¯ÚfiÓÈ· ÛÙÔ 19% ÙˆÓ ·È‰ÈÒÓ Ì £¶, ÂÓÒ Î·Ó¤Ó· ·fi Ù· ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 3 ¯ÚfiÓÈ·, ‰ÂÓ ·Ó¤Ù˘Í οÔÈ· ÛÔ‚·Ú‹ ¿ıËÛË (18-22). ∞fi ÙÔ˘˜ 103 ‰ÈÎÔ‡˜ Ì·˜ ·ÛıÂÓ›˜ Ì £¶, ¯ÚfiÓÈÔ˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˜ (ÂÚÈÔ‰ÈÎfi˜) £¶ ˘‹Ú¯Â ÛÙÔ 65%. ∞ÈÙÈÔÏÔÁ›· ÙÔ˘ £¶ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∫Ú›ÓÂÙ·È ÛÎfiÈÌË Ë ·Ú¿ıÂÛË ÙÔ˘ ›Ó·Î· 2, Ì ٷ ›‰Ë ÙÔ˘ £¶ ηډȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ÙÔ˘ ÂÓ‹ÏÈÎÔ˘ (24,25), Ì ٷ ÔÔ›· ÌÔÚ› Ó· Á›ÓÂÙ·È ‰È·ÁÓˆÛÙÈ΋ Û‡Á¯˘ÛË Î·È Ù· ÔÔ›· ÌÔÚ› Ó· ÌÈÌÔ‡ÓÙ·È ÔÏÏ¿ ·È‰È¿ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜. ™ÙÔÓ ÂÓ‹ÏÈÎÔ, Ù· ηډȷÁÁÂȷο ·›ÙÈ· Â›Ó·È ·ÈÙ›· £¶ Û ÌÂÁ·Ï‡ÙÂÚË ·Ó·ÏÔÁ›· Û˘ÁÎÚÈÙÈο Ì ÙËÓ ·È‰È΋ ËÏÈΛ·. ™Â fiϘ fï˜ ÙȘ ËÏÈ˘, ۯ‰fiÓ Î¿ı ÛËÌÂ›Ô ÙÔ˘ ıÒڷη ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÂÛÙ›· Á¤ÓÂÛ˘ £¶ (™¯‹Ì· 1) (24-26). ∏ ‰È¿ÎÚÈÛË ÙÔ˘ £¶ Û Ô͇ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ ‹ ÂÚÈÔ‰ÈÎfi ‰È¢ÎÔχÓÂÈ Î·Ï‡ÙÂÚ· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Î·È ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË (27). ™ÙÔÓ ›Ó·Î· 3 ·Ó·ÁÚ¿ÊÔÓÙ·È Ù· ΢ÚÈfiÙÂÚ· ·›ÙÈ· ÙÔ˘ ÔͤԘ £¶ (10,13-15,20,21,28) Î·È ÛÙÔÓ ›Ó·Î· 4, ÙÔ˘ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˘ ‹ ÂÚÈÔ‰ÈÎÔ‡ £¶ ÙˆÓ ·È‰ÈÒÓ (7,13-15,19,20,22). ∂Ӊ›ÍÂȘ ÛÔ‚·ÚfiÙËÙ·˜ ÙÔ˘ ÔͤԘ £¶ ›ӷÈ: Ë ˆ¯ÚfiÙËÙ·, Ë

¶›Ó·Î·˜ 2. √ £¶ ηډȷÁÁÂȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ÛÙÔÓ ÂÓ‹ÏÈη. √ÚÈÛÌÔ› Î·È ÎÏÈÓÈ΋ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË (4,23-25) ™ÙÔ Ô͇ ¤ÌÊÚ·ÁÌ·, Ô £¶ Â›Ó·È Ô͇˜, ̤ÙÚÈ·˜ ‹ ÌÂÁ¿Ï˘ ¤ÓÙ·Û˘, ‰È¿ÚÎÂÈ·˜ >30 min, Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÈÎfiÓ· Î·È ÂÓÙfiÈÛË ÛÙÔ ÚfiÛıÈÔ ıˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ· Î·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÂÂÎÙ¿ÛÂȘ, fiˆ˜ ‚¿ÚÔ˜, ›ÂÛË, ο„ÈÌÔ ‹ ÛÊ›ÍÈÌÔ, Û˘¯Ó¿ ÂÂÎÙÂÈÓfiÌÂÓÔ ÛÙÔÓ ÙÚ¿¯ËÏÔ, ÙËÓ Î¿Ùˆ ÁÓ¿ıÔ, ÙË Ú¿¯Ë Î·È Ù· ¿Óˆ ¿ÎÚ·. √ fiÓÔ˜ ·˘Ùfi˜ ‰ÂÓ ˘Ê›ÂÙ·È Ì ÙË ¯Ú‹ÛË ÓÈÙÚˆ‰ÒÓ. ∏ ÛÙ·ıÂÚ‹ ‹ Ù˘È΋ ÛÙËı¿Á¯Ë ÚÔÛ¿ıÂÈ·˜ Â›Ó·È ÚÔοډÈÔ˜ fiÓÔ˜, Ô˘ ¤¯ÂÈ ÙÔ˘˜ ›‰ÈÔ˘˜, fiˆ˜ ÈÔ ¿Óˆ, ÎÏÈÓÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜, ·ÏÏ¿ ÂÌÊ·Ó›˙ÂÙ·È ÛÙË ‰È¿ÚÎÂÈ· ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘ ‹ „˘¯È΋˜ ¤ÓÙ·Û˘, ‰ËÏ. fiÙ·Ó ·˘Í¿ÓÔÓÙ·È ÔÈ ·Ó¿ÁΘ ÙÔ˘ Ì˘Ôηډ›Ô˘ Û Ô͢ÁfiÓÔ. ∆· ÈÔ ¿Óˆ Ê·ÈÓfiÌÂÓ· ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ·fi 5 min ÂÚ›Ô˘, Ì ÙË ‰È·ÎÔ‹ Ù˘ ÚÔÛ¿ıÂÈ·˜ ‹ ÙË Ï‹„Ë ˘ÔÁÏÒÛÛÈˆÓ ÓÈÙÚˆ‰ÒÓ ‰ÈÛΛˆÓ. ∏ ·ÛÙ·ı‹˜ ÛÙËı¿Á¯Ë ÔÊ›ÏÂÙ·È Û ÂÏ·Ùو̤ÓË ÚÔÛÊÔÚ¿ Ô͢ÁfiÓÔ˘ ÛÙÔ Ì˘ÔοډÈÔ ÏfiÁˆ ÂÏ¿ÙÙˆÛ˘ Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙȘ ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËڛ˜ ·fi ıÚfiÌ‚Ô ‹ ·fi Û·ÛÌfi Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÛÙËı·Á¯È΋˜ Û˘Ìو̷ÙÔÏÔÁ›·˜ Û ÌÈÎÚ‹ ÎfiˆÛË ‹ Î·È Î·Ù¿ ÙËÓ ËÚÂÌ›·. ÷ڷÎÙËÚÈÛÙÈο, Â¤Ú¯ÂÙ·È Ì ÎÚ›ÛÂȘ Î·È ¤¯Ô˘Ó ÚÔÙ·ı› 3 ÛÙ¿‰È· ‚·Ú‡ÙËÙ·˜: 1) ¶ÚfiÛÊ·ÙË ÛÙËı¿Á¯Ë – ÂÚÈÛÛfiÙÂÚ˜ ·fi 3 ÎÚ›ÛÂȘ ÙËÓ Ë̤ڷ - fi¯È ÛÙËı¿Á¯Ë ·Ó¿·˘Û˘, 2) ÀÔÍ›· ÛÙËı¿Á¯Ë ·Ó¿·˘Û˘, .¯. Â› 1 Ì‹Ó· Î·È 3) ™ÙËı¿Á¯Ë ·Ó¿·˘Û˘ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 48 ÒÚ˜. ∂ÎÙfi˜ ·fi ÙËÓ ·ıËÚÔÛÎÏËÚ˘ÓÙÈ΋ Ͽη, ¿ÏϘ ·Èٛ˜ ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜ Â›Ó·È ·˘Ù¤˜ Ô˘ ÂÏ·ÙÙÒÓÔ˘Ó ÙËÓ ÚÔÛÊÔÚ¿ Ô͢ÁfiÓÔ˘ ÛÙÔ Ì˘ÔοډÈÔ ‹ Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ Î·Ù·Ó¿ÏˆÛË Ô͢ÁfiÓÔ˘ ÙÔ˘ Ì˘Ôηډ›Ô˘, fiˆ˜ Ë ·Ó·ÈÌ›·, Ë ˘fiÙ·ÛË, Ë ˘¤ÚÙ·ÛË, Ô ˘ÚÂÙfi˜, ÔÈ ·ÚÚ˘ı̛˜, Ë ˘ÔÍ›· Î·È Ë ı˘ÚÂÔÙÔ͛ΈÛË. ∏ ÌÈÎÚ·ÁÁÂȷ΋ ÛÙËı¿Á¯Ë (‹ Û‡Ó‰ÚÔÌÔ Ã), Û˘¯ÓfiÙÂÚË ÛÙȘ Á˘Ó·›Î˜, Â›Ó·È Ù˘È΋ ÛÙËı¿Á¯Ë, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ·fiÊÚ·ÍË, Ô‡Ù Û·ÛÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ ·ÏÏ¿ Ô‡Ù ÎÈ ÂÛÊ·Ï̤ÓË ·ÓÙ›ÏË„Ë ÙÔ˘ fiÓÔ˘. §¤ÁÂÙ·È ÌÈÎÚ·ÁÁÂȷ΋, ÂÂȉ‹ ‚Ï¿‚˜ ‚Ú›ÛÎÔÓÙ·È ÌfiÓÔ ÛÙȘ ÌÈÎÚ¤˜ ·ÚÙËڛ˜, Ù· ·ÚÙËÚ›‰È· Î·È Èı·ÓÒ˜ ÛÙÔ Ì˘ÔηډȷÎfi ·ÙÙ·ÚÔ. √ fiÓÔ˜ Ù˘ Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜ ÌÔÈ¿˙ÂÈ Ì ÙË ÛÙËı¿Á¯Ë, ·ÏÏ¿ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ï¿ÁÈÔ ıˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ· ÎÈ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ÎÏÈÓ‹ÚÂȘ ·ÚÚÒÛÙÔ˘˜. √ fiÓÔ˜ ÙÔ˘ ·ÔÚÙÈÎÔ‡ ‰È·¯ˆÚÈÛÌÔ‡ Â›Ó·È ·ÈÊÓ›‰ÈÔ˜ Û ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ·ÚÙËÚȷ΋˜ ˘¤ÚÙ·Û˘, ·ÓÙ·Ó·ÎÏ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÛÙË Ú¿¯Ë Î·È ÂÈÙ›ÓÂÙ·È Ù·¯‡Ù·Ù·, ̤۷ Û 3 min, ÂÁηı›ÛÙ·Ù·È Î·È ÌÔÚ› Ó· ÂÈ̤ÓÂÈ ÁÈ· ÔÏϤ˜ ÒÚ˜, ·Ú¿ ÙȘ ÌÂÁ¿Ï˜ ‰fiÛÂȘ ·Ó·ÏÁËÙÈÎÒÓ Ê·Ú̿ΈÓ.

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¶·È‰È·ÙÚÈ΋ 2001;64:115-124

∂ÁΤʷÏÔ˜ √ÈÛÔÊ¿ÁÔ˜ ∆Ú·¯Â›· ∫Ï›‰Â˜ ∂Ï¿ÛÛˆÓ £ˆÚ·ÎÈÎfi˜ ª˘˜ ªÂ›˙ˆÓ £ˆÚ·ÎÈÎfi˜ ª˘˜ £ˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ· µÚfiÁ¯ÔÈ ¶Ó‡ÌÔÓ˜ ∫·Ú‰È¿ ™ÙfiÌ·¯Ô˜ ¶¿ÁÎÚ·˜ - ¢ˆ‰Âη‰¿ÎÙ˘ÏÔ

Paediatriki 2001;64:115-124

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™¯‹Ì· 1. ∂Ó‰ÂÈÎÙÈ΋ ÙÔÔÁÚ·ÊÈ΋ ·Ó·ÙÔÌÈ΋ ÂÓÙfiÈÛË ÙÔ˘ £¶.

·Ó·Ó¢ÛÙÈ΋ ‰‡ÛÓÔÈ·, Ë ·Ó·Ó¢ÛÙÈ΋ ÚÔÛ¿ıÂÈ· Î·È Ë Î˘¿ÓˆÛË. ø˜ ÚÔ˜ ÙË ÁÂÓÈ΋ Û˘¯ÓfiÙËÙ·, ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, Û¿ÓÈ· Á›ÓÂÙ·È Û·Ê‹˜ ‰È¿ÎÚÈÛË ÌÂٷ͇ ÔͤԘ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˘ £¶, ÂÓÒ ÔÈ Â› ̤ÚÔ˘˜ Û˘¯ÓfiÙËÙ˜ ÙˆÓ ·ÈÙ›ˆÓ ÙÔ˘ £¶ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ¤ÊË‚Ô˘˜ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Û˘ÁÁڷʤˆÓ, ·Ó¿ÏÔÁ· Ì ÙËÓ ÚԤϢÛË ÙˆÓ ·ÚÚÒÛÙˆÓ (·È‰È·ÙÚÈÎfi, ·È‰ÔηډÈÔÏÔÁÈÎfi ÎÏ. Â͈ÙÂÚÈÎfi È·ÙÚ›Ô). √È ‚È‚ÏÈÔÁÚ·ÊÈο ·Ó·ÊÂÚfiÌÂÓ˜ ·ÈÙÈÔÏÔÁÈΤ˜ Û˘¯ÓfiÙËÙ˜ ÌÔÚÔ‡Ó Ó· Û˘ÓÔ„ÈÛÙÔ‡Ó ÛÙ· ·Ú·Î¿Ùˆ: ·) “ȉÈÔ·ı‹˜” ·ÈÙÈÔÏÔÁ›·: 12-85%, ‚) Ì˘ÔÛÎÂÏÂÙÈο ·›ÙÈ·: 15-31%, Á) Ó¢ÌÔÓÈο ·›ÙÈ·: 12-21%, ‰) „˘¯È·ÙÚÈο-„˘¯Ôۈ̷ÙÈο ·›ÙÈ·: 5-17%, Â) Á·ÛÙÚÂÓÙÂÚÈο ·›ÙÈ·: 4-7%, ÛÙ) ‰È¿ÊÔÚ· ·›ÙÈ·: 4-21% Î·È ˙) ηډÈÔÁÂÓ‹ ·›ÙÈ·: 1-6% (1,7,15-17,19-22,26-30). ∞fi ÔÚÈṲ̂ÓÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÈÛÙ‡ÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ ȉÈÔ·ıÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· Â›Ó·È ÌÈÎÚ‹, ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÈÎÚfiÙÂÚË ·’ fiÛÔ ıˆÚÔ‡ÓÙ·Ó Ì¤¯ÚÈ Û‹ÌÂÚ·. ™ÙÔÓ ›Ó·Î· 5 ηٷÁÚ¿ÊÔÓÙ·È ÏÂÙÔÌÂÚÒ˜ Ù· Â͈ηډȷο ·›ÙÈ· £¶ ÛÙ· ·È‰È¿ (7,13-15,19,21,22,26,31,32). ∞fi ÙÔ ¶·È‰È·ÙÚÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô Ù˘ ‰È΋˜ Ì·˜ ∫ÏÈÓÈ΋˜, ·Ú·¤ÌÊıËÎ·Ó Ì¤Û· Û 2,5 ¯ÚfiÓÈ· ÁÈ· ·È‰ÔηډÈÔÏÔÁÈ΋ ÂͤٷÛË 103 ·È‰È¿ Ì £¶, Ù· ÔÔ›· ÌÂÏÂÙ‹ıËÎ·Ó Î·Ú‰ÈÔÏÔÁÈο ¶›Ó·Î·˜ 3. ™˘Ó‹ıË ·›ÙÈ· ÙÔ˘ ÔͤԘ £¶ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (10,13-15,19,20,27) ∫∞ƒ¢π∞∫∞ ∞π∆π∞ ∂•ø∫∞ƒ¢π∞∫∞ ∞π∆π∞ 1. ¶ÂÚÈηډ›Ùȉ· 1. ¶Ó¢ÌÔÓÈο ·›ÙÈ·: 2. ∆Ú·‡Ì· - ·ÈÌÔÂÚÈοډÈÔ ·. ¶Ó¢ÌÔıÒڷη˜ 3. ∞ÚÚ˘ı̛˜ ‚. ¶Ó¢ÌÔÓ›· + Ï¢ڛÙȉ· 4. ÃÚ‹ÛË ÎÔη˝Ó˘ Á. ¶Ï¢ÚÔ‰˘Ó›· 2. √ÈÛÔÊ·ÁÈο ·›ÙÈ·: ·. √Í›· ÔÈÛÔÊ·Á›Ùȉ· ‚. ∫·Ù¿ÔÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜

118

(ÂÎÙfi˜ ·fi ‰ÔÎÈ̷ۛ˜ ÎfiˆÛ˘). ™Â 34 ·fi ·˘Ù¿ (33%) ˘‹Ú¯·Ó ηډÈÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ô˘ ÌÔÚÔ‡Ó Ó· Û¯ÂÙÈÛıÔ‡Ó Ì ÙÔÓ ·Ó·ÊÂÚfiÌÂÓÔ ·fi Ù· ·È‰È¿ £¶. ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ ÙˆÓ ˘fiÏÔÈˆÓ ·¤‰ÂÈÍÂ Ì˘ÔÛÎÂÏÂÙÈ΋ ·ÈÙÈÔÏÔÁ›· Û 20 (19,4%), Ó¢ÌÔÓÈ΋ Û 4 (3,8%), „˘¯Ôۈ̷ÙÈ΋ Û 21 (20,3%), Á·ÛÙÚÂÓÙÂÚÈ΋ Û 8 (7,7%). ™Â 16 ·È‰È¿ (15,6%) ‰ÂÓ ·ԉ›¯ÙËΠη̛· ·ÈÙ›·. ø˜ ÚÔ˜ Ù· ηډÈÔÏÔÁÈο ·›ÙÈ·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙÈÌÔ‡Ó ÙËÓ Ù·ÍÈÓfiÌËÛ‹ ÙÔ˘˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ·Ó·ÙÔÌÈ΋ ‚Ï¿‚Ë (14,16,26). ∏ Â› ̤ÚÔ˘˜ ·Ó·ÏÔÁ›· ÙˆÓ Î·Ú‰ÈÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û 34/103 ‰ÈÎÔ‡˜ Ì·˜ Â͈ÙÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì £¶ ‹Ù·Ó: ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ 47%, ·ÚÚ˘ı̛˜ 38,2%, ¿ÏϘ ‰È·Ù·Ú·¯¤˜ Ù˘ ÌÈÙÚÔÂȉԇ˜ (·Ï‹ ‰È¿Ù·ÛË ‰·ÎÙ˘Ï›Ô˘, ÌÂÌÔӈ̤ÓË ¿¯˘ÓÛË Áψ¯›Ó·˜ ÎÏ.) 8,8%, ÂÚÈηډ›Ùȉ· 2,9%, Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ 2,9% (™¯‹Ì· 2). √ £¶ ¤¯ÂÈ È‰È¿˙Ô˘Û· ÛËÌ·Û›· fiÙ·Ó ·ÔηχÙÂÙ·È Î·Ú‰ÈÔÏÔÁÈ΋ ·ÈÙ›·. ∂ȉÈ΋, fï˜, ÚÔÁÓˆÛÙÈ΋ ‚·Ú‡ÙËÙ· ¤¯ÂÈ ÛÙȘ ·ı‹ÛÂȘ Ù˘ ·ÔÚÙ‹˜ Î·È ÛÙȘ Ì˘ÔηډÈÔ¿ıÂȘ, fiÔ˘ Ë ÂÌÊ¿ÓÈÛË ÙÔ˘ fiÓÔ˘ ÛËÌ·›ÓÂÈ ÂÏ¿ÙÙˆÛË ·ÚÔ¯‹˜ Ô͢ÁfiÓÔ˘ ÛÙÔÓ Î·Ú‰È·Îfi Ì˘, ÔfiÙ ÌÔÚ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Û˘ÁÎÔÈ΋ ÎÚ›ÛË, ·ÈÊÓ›‰È· ·ÚÚ˘ıÌ›· ‹ ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜. ™ÙȘ ·ı‹ÛÂȘ ·˘Ù¤˜ Ô £¶ ÂÌÊ·Ó›˙ÂÙ·È Ì ÙËÓ ÂÈÎfiÓ· Ù˘ ÛÙËı¿Á¯Ë˜, fiˆ˜ ·˘Ù‹ Â›Ó·È ÁÓˆÛÙ‹ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÁÈ’·˘Ùfi Î·È ·ÔÎÙ¿ Ôχ ÌÂÁ¿ÏË ‰È·ÁÓˆÛÙÈ΋ Î·È ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· Ë Û˘Û¯¤ÙÈÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ £¶ Ì ÙË ÛˆÌ·ÙÈ΋ ÎfiˆÛË ‹ ÙÔ „˘¯ÈÎfi stress. ÕÏϘ ηډȷΤ˜ ·ı‹ÛÂȘ, fiˆ˜ .¯. Ë ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ôχ Û˘¯Ó¿ (̤¯ÚÈ Î·È 30%) £¶, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (29,31,32), ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· ÙËÓ ·È‰È΋ ËÏÈΛ·. ∫ÏÈÓÈο Û‡Ó‰ÚÔÌ· Ì £¶ ȉȷ›ÙÂÚ˘ ÛËÌ·Û›·˜ ªË ηډȷ΋˜ ·ÈÙÈÔÏÔÁ›·˜ 1. ¶Ï¢ÚÔ¯ÔÓ‰Ú›Ùȉ·: ∂›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 119

¶·È‰È·ÙÚÈ΋ 2001;64:115-124

·Èٛ˜ £¶ Ì˘ÔÛÎÂÏÂÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜. ¶ÔÏÏÔ› ÛÙÔÓ ›‰ÈÔ fiÚÔ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔ “Ï¢ÚÔÛÙÂÚÓÈÎfi Û‡Ó‰ÚÔÌÔ”, ÙÔ “ıˆÚ·ÎÈÎfi Û‡Ó‰ÚÔÌÔ” Î·È ÙËÓ “Ï¢ÚÔÛÙÂÚÓÈ΋ ¯ÔÓ‰ÚÔ‰˘Ó›·”. ∏ Ï¢ÚÔ¯ÔÓ‰Ú›Ùȉ· Û˘Ó‰˘¿˙ÂÙ·È Ì Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Ì ÎfiˆÛË. √ fiÓÔ˜ Â›Ó·È ·ÚÎÂÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎfi˜: ÂÓÙÔ›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙÔ ‡„Ô˜ Ù˘ 4˘6˘ ÏÂ˘Ú¿˜, ‹ ÂÂÎÙ›ÓÂÙ·È ÛÙËÓ Ï¿ÙË ‹ ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ (27).

2. ™‡Ó‰ÚÔÌÔ ÙÔ˘ ÚÔοډÈÔ˘ ȷ̷ۛÙÔ˜ (“precordial catch syndrome”): ∂›Ó·È Ô͇˜ fiÓÔ˜ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜, Ì ÂÈÎfiÓ· „¢‰ÔÛÙËı¿Á¯Ë˜, ‰È¿ÚÎÂÈ·˜ 0,5-5 min, Ì ÂÓÙfiÈÛË ÛÙËÓ ÎÔÚ˘Ê‹ Ù˘ ηډȿ˜. ∂·Ó·Ï·Ì‚¿ÓÂÙ·È ÔÏϤ˜ ÊÔÚ¤˜ ÙËÓ Ë̤ڷ Î·È Â¤Ú¯ÂÙ·È Î·Ù¿ ÎÚ›ÛÂȘ Ô˘ ‚·ıÌÈ·›· ·Ú·ÈÒÓÔ˘Ó (26,33).

3. ™‡Ó‰ÚÔÌÔ Tietze: Œ¯ÂÈ ÂÈÎfiÓ· ·ÚfiÌÔÈ· Ì ÙË Ï¢ÚÔ¯ÔÓ‰Ú›Ùȉ·, ·ÏÏ¿ ·fi ÙÔ ÈÛÙÔÚÈÎfi ·ÔηχÙÂÙ·È ÌÈÎÚfi˜ ‹ Î·È ·Ê·Ó‹˜ ÙÚ·˘Ì·ÙÈÛÌfi˜. ∏

Paediatriki 2001;64:115-124

ÎÏÈÓÈ΋ ‰È¿ÎÚÈÛ‹ ÙÔ˘ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ÂÙÂÚfiÏ¢ÚÔ˘ ·ÙÚ·ÎÙfiÌÔÚÊÔ˘ Ôȉ‹Ì·ÙÔ˜, ÂÓÒ Ô fiÓÔ˜ Á›ÓÂÙ·È ÈÔ ¤ÓÙÔÓÔ˜ Ì ÙÔ ‚‹¯·, ÙÔ ÊÙ¿ÚÓÈÛÌ· Î·È ÙËÓ Î›ÓËÛË. ∂›Ó·È Û¿ÓÈÔ ÛÙ· ·È‰È¿ (26). √È ÈÔ ¿Óˆ ·ÚÎÂÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂÈÎfiÓ˜ ʤÚÔÓÙ·È Î·È Ì ÙËÓ ÔÓÔÌ·Û›· “Û‡Ó‰ÚÔÌÔ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜” (27).

4. æ˘¯ÔÁÂÓ‹ ·›ÙÈ·: ∆· „˘¯ÔÁÂÓ‹ ·›ÙÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ˆ˜ ·ÈÙ›· £¶ ÂÌÊ·Ó›˙ÔÓÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 7-9 ¯ÚfiÓˆÓ. ∏ ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ Û˘¯ÓfiÙËÙ·˜ ÌÂٷ͇ ÙˆÓ Û˘ÁÁڷʤˆÓ ÔÊ›ÏÂÙ·È Ì¿ÏÏÔÓ ÛÙÔ fiÙÈ Ù· „˘¯ÔÁÂÓ‹ ·›ÙÈ· Ù·˘Ù›˙ÔÓÙ·Ó Ì ٷ ȉÈÔ·ı‹ (5-17%). ™Ù· „˘¯ÔÁÂÓ‹ ·›ÙÈ· ηٷٿÛÛÔÓÙ·È ÔÈ „˘¯ÔÓÂ˘ÚˆÙÈΤ˜ ·ÓÙȉڿÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÏfiÁˆ ·ÚÓËÙÈÛÌÔ‡ ‹ ÏfiÁˆ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÊÔÚÙÈṲ̂ÓÔ˘ Ì ¤ÓÙÔÓÔ „˘¯ÔÏÔÁÈÎfi stress, ÙÔ Û‡Ó‰ÚÔÌÔ ˘ÂÚ·ÂÚÈÛÌÔ‡, Ë „˘¯ÔÁÂÓ‹˜ ‚Ô˘ÏÈÌ›· (Ë ÔÔ›· ÚÔηÏ› ÔÈÛÔÊ·Á›Ùȉ·) Î·È ÙÚ·‡Ì·Ù· ÙÔ˘ ıÒڷη ·fi ηÎÔÌÂÙ·¯Â›ÚÈÛË ÙÔ˘ ·È‰ÈÔ‡

¶›Ó·Î·˜ 4. ™˘Ó‹ıË ·›ÙÈ· ÙÔ˘ Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˘ (˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜) £¶ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (7,13-15,19,20,22) ∫∞ƒ¢π∞∫∞ ∞π∆π∞ ∞. ªÂ ÈÛ¯·ÈÌ›· Ì˘Ôηډ›Ô˘ 1. ªÂÁ¿ÏË ˘ÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ·. ∞ÔÊÚ·ÎÙÈΤ˜ ‚Ï¿‚˜ ‚. ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË 2. ¡fiÛÔ˜ Kawasaki µ. ªÂ ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹ 1. π‰ÈÔ·ı‹˜ (ÈÔÁÂÓ‹˜) ÂÚÈηډ›Ùȉ· 2. ™‡Ó‰ÚÔÌÔ ÌÂÙ¿ ÂÚÈηډÈÔÙÔÌ‹ °. ∞ÚÚ˘ı̛˜ ¢. ¶ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜

∂•ø∫∞ƒ¢π∞∫∞ ∞π∆π∞ ∞. ªË ÔÚÁ·ÓÈο ·›ÙÈ· 1. π‰ÈÔ·ı‹˜ 2. æ˘¯ÔÁÂÓ‹˜ µ. ÕÏÏ· ·›ÙÈ· 1. ¶Ï¢ÚÔ¯ÔÓ‰Ú›Ùȉ· 2. √ÈÛÔÊ·Á›Ùȉ· 3. ÕÛıÌ· ÂÎÏ˘fiÌÂÓÔ Ì ¿ÛÎËÛË 4. ¢ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÎÚ›ÛË

¶›Ó·Î·˜ 5. ∞Ó·Ï˘ÙÈ΋ ·ÈÙÈÔÏÔÁ›· ÙˆÓ Â͈ηډȷÎÒÓ ·ÈÙ›ˆÓ £¶ ÛÙ· ·È‰È¿ (7,13-15,19,21,22,26,31,32) ∞. ªÀ√™∫∂§∂∆π∫∞ – £øƒ∞∫π∫∞ ∞π∆π∞ ª˘˚΋ ˘ÂÚÎfiˆÛË, Ï¢ÚÔ¯ÔÓ‰Ú›Ùȉ·, Û‡Ó‰ÚÔÌÔ ÚÔοډÈÔ˘ ȷ̷ۛÙÔ˜ (catch), Û‡Ó‰ÚÔÌÔ Tietze, ÙÚ·‡Ì·, ηÎÔÌÂÙ·¯Â›ÚÈÛË ·È‰ÈÔ‡, οٷÁÌ·-Û‡ÓıÏÈ„Ë ÏÂ˘Ú¿˜ ‹ ÎÏÂȉÒÓ, ÍÈÊÔÂȉ·ÏÁ›·, ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·, Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷, Ì˘ÔÛ›Ùȉ·, ·Á΢ÏÔÔÈËÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ·, ÛÔÓ‰˘ÏÔÏ›ÛıËÛË, ÛÔÓ‰˘ÏfiÏ˘ÛË, ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·, ΋ÏË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, Á˘Ó·ÈÎÔÌ·ÛÙ›· (Û ·ÁfiÚÈ·), ıËÏ·Ú¯‹ (Û ÎÔÚ›ÙÛÈ·), ΢ÛÙÈ΋ Ì·ÛÙÔ¿ıÂÈ·. µ. ¶¡∂Àª√¡π∫∞ ∞π∆π∞ ¶Ó¢ÌÔıÒڷη˜, Ó¢ÌÔÌÂÛÔÓ¢ÌfiÓÈÔ, Ó¢ÌÔÓ›· (fiϘ ÔÈ ·ÈÙÈÔÏÔÁ›Â˜), ¯ÚfiÓÈÔ˜ ‚‹¯·˜, ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹, Ï¢ÚÔ‰˘Ó›·, Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹, ÂÈÛÓÔ‹ ͤÓÔ˘ ÛÒÌ·ÙÔ˜, ÚˆÙÔ·ı¤˜ ‹ ‰Â˘ÙÂÚÔ·ı¤˜ ·‰¤ÓˆÌ· ‹ ηÚΛӈ̷, ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·. °. æÀÃ√™øª∞∆π∫∞ ∞π∆π∞ ∞ÌÈÁ›˜ „˘¯Ôۈ̷ÙÈΤ˜ ÂΉËÏÒÛÂȘ, stress, „˘¯ÔÏÔÁÈ΋ ›ÂÛË, Û‡Ó‰ÚÔÌÔ ˘ÂÚ·ÂÚÈÛÌÔ‡, ÎÚ›ÛÂȘ ·ÓÈÎÔ‡, Ó¢ÚÔÁÂÓ‹˜ ‚Ô˘ÏÈÌ›·, ηٷӷÁηÛÙÈ΋ „¢‰ÔÏÔÁ›·. ¢. °∞™∆ƒ∂¡∆∂ƒπ∫∞ ∞π∆π∞ √ÈÛÔÊ·Á›Ùȉ·, ·ÛÙÂȘ ÔÈÛÔÊ¿ÁÔ˘, Û·ÛÌfi˜ ÔÈÛÔÊ¿ÁÔ˘, Ú‹ÍË ÔÈÛÔÊ¿ÁÔ˘, ·¯·Ï·Û›·, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, Á·ÛÙÚ›Ùȉ·, ÂÙÈÎfi ¤ÏÎÔ˜, Û‡Ó‰ÚÔÌÔ Zollinger-Elison, ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ηٿÔÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜, ¯ÔÏÔ΢ÛÙ›Ùȉ·, ·ÁÎÚ·ٛÙȉ·, ˘ԉȷÊÚ·ÁÌ·ÙÈÎfi ·fiÛÙËÌ·. ∂. ∞§§∞ ∞π∆π∞ 1. ÃÚ‹ÛË: ÎÔη˝Ó˘, ηÓÔ‡, Û˘Ì·ıËÙÈÎÔÌÈÌËÙÈÎÒÓ Ô˘ÛÈÒÓ.

2. ŸÁÎÔÈ: ÓfiÛÔ˜ Hodgkin, ÏÂÌÊÒÌ·Ù·, ı˘ÌÒÌ·Ù·, ÙÂÚ·ÙÒÌ·Ù·, ÏÈÔÛ¿ÚΈ̷.

3. ¢È¿ÊÔÚ·: ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜, ΢ÛÙÈ΋ ›ÓˆÛË, Ó¢ÚÔ˚ӈ̿وÛË, Û‡Ó‰ÚÔÌÔ Marfan, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÌÂÛÔÁÂÈ·Îfi˜ ˘ÚÂÙfi˜, ¯ÈÓÔÎÔÎΛ·ÛË.

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N=103

N=34 5 3% 4 3%

1 16%

1

3 9%

1

2

2 2 13%

3 2 38%

1 47%

4 5

6 66%

3 3 3% 4 1% 5 1%

4 5 6

™¯‹Ì· 2. ∞Ó·ÏÔÁ›· % ÙˆÓ Î·Ú‰ÈÔÏÔÁÈÎÒÓ ‰È·ÁÓÒÛÂˆÓ Û 34/103 ·È‰È¿ Ì £¶ ˆ˜ ·ÚÈÔ Û‡Ìو̷. ∞ÚÈÛÙÂÚ¿: ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ 34 ·È‰ÈÒÓ, Ì ηډÈÔÏÔÁÈÎfi ‡ÚËÌ·. ¢ÂÍÈ¿: ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ 103 ·È‰ÈÒÓ Ì £¶. ∂Í‹ÁËÛË ˘ÔÌÓ‹Ì·ÙÔ˜: 1 = ¶ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜, 2 = ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡, 3 = ¿ÏϘ ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÌÈÙÚÔÂȉԇ˜, 4 = ÂÚÈηډ›Ùȉ·, 5 = Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ.

·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ (21,34). ™ÙË ‰È΋ Ì·˜ ÔÌ¿‰· ÙˆÓ 103 ·È‰ÈÒÓ Ì £¶, ÂÓÒ Ù· ·ÌÈÁÒ˜ „˘¯ÔÁÂÓ‹ ·›ÙÈ· ÌfiÏȘ ˘ÂÚ¤‚·ÈÓ·Ó ÙÔ 20%, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ÁÂÓÂÛÈÔ˘ÚÁfi ·ÈÙ›·, ‚Ú¤ıËΠfiÙÈ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÈÙ›·, ÙÔ 45,6% (47 ·È‰È¿) ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· £¶.

5. ∏ ¯Ú‹ÛË ÎÔη˝Ó˘ Î·È ÓÈÎÔÙ›Ó˘ ·fi ¤ÊË‚Ô˘˜ Â›Ó·È Èı·Ó‹ ·ÈÙ›· £¶ Î·È Ì¿ÏÈÛÙ· Ì ηډÈÔÏÔÁÈ΋ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·. ∏ ÎÔη˝ÓË ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ¤ÎÙ·ÎÙ˜ Û˘ÛÙÔϤ˜ Î·È ·›ÛıËÌ· ·ÏÌÒÓ, ·ÁÁÂÈÔÛ·ÛÌfi ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ, ·ÎfiÌË Î·È Ú·ÁÌ·ÙÈÎfi ¤ÌÊÚ·ÁÌ·. ∏ ¯Ú‹ÛË ÓÈÎÔÙ›Ó˘ ÂÈʤÚÂÈ ¯ÚfiÓÈÔ ‚‹¯·, ÂÓÒ Ë Î·Ù¿¯ÚËÛ‹ Ù˘ ÌÔÚ› Ó· ÂÈʤÚÂÈ ¤ÎÙ·ÎÙ˜ Û˘ÛÙÔϤ˜ Î·È ·ÁÁÂÈÔÛ·ÛÌfi ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ (35). ∫·Ú‰È·Î‹˜ ·ÈÙÈÔÏÔÁ›·˜ 1. ¶ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜: ™ÙËÓ ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ Ô fiÓÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ·ÚÎÂÙ¿ Û˘¯Ó¿ (̤¯ÚÈ Î·È ÛÙÔ 31% ÙˆÓ ÂÚÈÙÒÛˆÓ), ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‰ÂÓ ¤¯ÂÈ ÚÔÁÓˆÛÙÈ΋ ÛËÌ·Û›· Î·È ÔÊ›ÏÂÙ·È Èı·ÓfiÓ (30-32) Û ÌË Ê˘ÛÈÔÏÔÁÈ΋ Û‡Û·ÛË ÙˆÓ ıËÏÔÂȉÒÓ Ì˘ÒÓ ‹ -Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ- Û Ì›ˆÛË ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡. ¶Ôχ Û˘¯Ó‹ Â›Ó·È fï˜ Î·È Ë ÂÌÊ¿ÓÈÛË ·ÚÚ˘ıÌÈÒÓ ÛÙËÓ ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ (18-25% Û ÂÓ‹ÏÈΘ), ÔfiÙÂ Â›Ó·È ÂӉ¯fiÌÂÓÔ Ô £¶ Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÚÚ˘ıÌ›·, fiÙ·Ó ·˘Ù‹ ÂÈʤÚÂÈ ÂÏ¿ÙÙˆÛË Ù˘ ·ÚÔ¯‹˜ ÛÙȘ ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËڛ˜. ∆fiÛÔ ÔÈ ·ÚÚ˘ı̛˜, fiÛÔ Î·È Ù· ÂÂÈÛfi‰È· £¶ Û ÚfiÙˆÛË, ˘Ô¯ˆÚÔ‡Ó ‹ ÂÍ·Ê·Ó›˙ÔÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË ÁÈ· Ï›Á˜ ‚‰ÔÌ¿‰Â˜ ‚-·‰ÚÂÓÂÚÁÈÎÒÓ ·ÔÎÏÂÈÛÙÒÓ ·fi ÙÔ ÛÙfiÌ· (23,30-32,36). ªÂ ‚¿ÛË Ù· ‰Èο Ì·˜ ‰Â‰Ô̤ӷ ·fi ÙË ÌÂϤÙË ÙˆÓ 103 ·È‰ÈÒÓ Ì £¶ Ì›·˜ ‰ÈÂÙ›·˜, Ë ·Ó·ÏÔÁ›· 16 ·È‰ÈÒÓ Ì ÚfiÙˆÛË

120

ÌÈÙÚÔÂȉԇ˜ Û 103 ·È‰È¿ Ì £¶ (15,5%) Â›Ó·È Ê·ÈÓÔÌÂÓÈο ÌÂÁ¿ÏË. ∞Ó, fï˜, ‰Â¯ıԇ̠fiÙÈ ÂÚ›Ô˘ ÙÔ 5% ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜, ÙfiÙÂ Ë Èı·ÓfiÙËÙ· £¶ ÛÙ· ·È‰È¿ Ì ÚfiÙˆÛË ˘ÔÏÔÁ›˙ÂÙ·È ÌfiÏȘ ÛÙÔ 1,7%.

2. ∏ ÓfiÛÔ˜ ÙÔ˘ Kawasaki: ™ÙË ÓfiÛÔ ÙÔ˘ Kawasaki, £¶ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ηٿ ÙÔ 1Ô ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, ηٿ ÙÔ ÔÔ›Ô Ë Î·Ú‰È¿ Û˘ÌÌÂÙ¤¯ÂÈ Ì ÂÚÈηډ›Ùȉ· ‹/Î·È Ì˘Ôηډ›Ùȉ· ̤¯ÚÈ ÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ÔÊ›ÏÂÙ·È Û˘Ó‹ıˆ˜ Û fiÓÔ ˘Â˙ˆÎÔÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜. ™ÙÔ Ù¤ÏÔ˜, fï˜, ÙÔ˘ 2Ô˘ Ì ·Ú¯¤˜ 3Ô˘ ÛÙ·‰›Ô˘, ÂÌÊ·Ó›˙ÔÓÙ·È Ù· ·Ó¢ڇÛÌ·Ù· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ. √ £¶ ÏfiÁˆ ·Ó¢ڇÛÌ·ÙÔ˜ Û˘Ó‹ıˆ˜ ÔÊ›ÏÂÙ·È Û ¤ÌÊÚ·ÁÌ·, ÔfiÙÂ Û˘Ó˘¿Ú¯ÂÈ Ë ÎÏ·ÛÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· (¶›Ó·Î·˜ 2) Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ (37). √ ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË √È ‰˘ÛÎÔϛ˜ Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ÙÔ˘ £¶ Û ·È‰› ÌÔÚÔ‡Ó Ó· Û˘ÓÔ„ÈÛÙÔ‡Ó ÛÙ· ÂÍ‹˜: ·) ∏ ÂÚÈÁÚ·Ê‹ Î·È Ë ·ÎÚÈ‚‹˜ ÂÓÙfiÈÛË ÙÔ˘ fiÓÔ˘ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡. ‚) ∏ ÂͤٷÛË Û˘¯Ó¿ Á›ÓÂÙ·È ˘fi ÙÔ ¿Á¯Ô˜ Ù˘ ηډÈÔÊÔ‚›·˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ Ì ·fiÎÚ˘„Ë Û˘ÓıËÎÒÓ Î·È Ì ÂÓÔ¯¤˜ ÙˆÓ ÁÔÓ¤ˆÓ. Á) √ fiÓÔ˜ ‰ÂÓ ÌÔÚ› Ó· ÌÂÙÚËı› ·ÓÙÈÎÂÈÌÂÓÈο. ‰) √È Èı·Ó¤˜ ·Èٛ˜ Â›Ó·È ¿Ú· ÔÏϤ˜, ÂÓÒ ÂÏ¿¯ÈÛÙ˜ ·fi ·˘Ù¤˜ ·ÔÙÂÏÔ‡Ó ·Èٛ˜ Ú·ÁÌ·ÙÈ΋˜ ·ÓËÛ˘¯›·˜. Œ¯ÔÓÙ·˜ ˘fi„Ë: ·) ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ £¶ ÛÙ·

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Û¿ÓÈÔ ÛÙ· ·È‰È¿ £¶ ·fi Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹.

3. ™˘Ó‰˘·ÛÌfi˜ ÂÒ‰˘ÓÔ˘ Û·ÛÌÔ‡ + ˘ÚÂÙÔ‡ + ‹¯Ô˘ ÙÚÈ‚‹˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi˜ ÚÔÛ‚ÔÏ‹˜ ·fi Èfi Coxsackie.

4. ∂ÈÛÎfiËÛË: ¢‡ÛÓÔÈ· Î·È Î˘¿ÓˆÛË + £¶ ·ÔÙÂÏÔ‡Ó ¤Ó‰ÂÈÍË Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜.

5. ∞ÎÚfi·ÛË: ªÔÚÔ‡Ó Ó· ‰È·ÁÓˆÛıÔ‡Ó Ë Ó¢ÌÔÓ›· Î·È ÔÈ ·ÔÊÚ·ÎÙÈΤ˜ Ó¢ÌÔÓÈΤ˜ ·ı‹ÛÂȘ.

6. æËÏ¿ÊËÛË: ªÔÚÔ‡Ó Ó· ‰È·ÁÓˆÛıÔ‡Ó ÙÔ Ó¢ÌÔÌÂÛÔÓ¢ÌfiÓÈÔ, ÙÔ ˘Ô‰fiÚÈÔ ÂÌʇÛËÌ· Î·È ÔÈ Î·ÎÒÛÂȘ ÙˆÓ Ï¢ÚÒÓ.

7. ∂›ÎÚÔ˘ÛË Î·È ·ÎÚfi·ÛË: ªÔÚ› Ó· ‰È·ÁÓˆÛı› ˘Â˙ˆÎÔÙÈ΋ Û˘ÏÏÔÁ‹. √‰ËÁ¿ ÎÏÈÓÈο ÛËÌ›· Ì˘ÔÛÎÂÏÂÙÈÎÒÓ ·ÈÙ›ˆÓ ∆· Ì˘ÔÛÎÂÏÂÙÈο ·›ÙÈ· Â›Ó·È Î·Ù¿ ÁÂÓÈ΋ ·Ú·‰Ô¯‹ Ù· ÈÔ Û˘¯Ó¿ ÛÙ· ·È‰È¿. ∏ ·Ó·ÏÔÁ›· ÙÔ˘˜ Â›Ó·È ·fi 1:6 ̤¯ÚÈ 1:3 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì £¶. √ ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜ ÌÔÚ› Ó· ηıÔ‰ËÁËı› ·fi Ù· ·Ú·Î¿Ùˆ (1,7,13-15,19-22,26) (¶›Ó·Î·˜ 5): 1. ∏ÏÈΛ·: ∂›Ó·È Û˘¯ÓfiÙÂÚ· Û ËÏÈ˘ ¿Óˆ ·fi 12 ¯ÚfiÓˆÓ.

2. º‡ÏÔ: ∏ Ï¢ÚÔ¯ÔÓ‰Ú›Ùȉ· Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ÎÔÚ›ÙÛÈ·.

3. πÛÙÔÚÈÎfi: √È ¤ÊË‚ÔÈ Ì £¶ ÛÙȘ ÈÔ Ù˘ÈΤ˜ ÂÚÈÙÒÛÂȘ, Û˘Ó‹ıˆ˜ ·ıÏÔ‡ÓÙ·È.

4. æËÏ¿ÊËÛË: ªÔÚ› Ó· ·Ôηχ„ÂÈ ÙÚ·‡Ì· Ì˘˚ÎÒÓ Ì·˙ÒÓ ‹ Ï¢ÚÒÓ. √‰ËÁ¿ ÎÏÈÓÈο ÛËÌ›· ηډÈÔÏÔÁÈÎÒÓ ·ÈÙ›ˆÓ √ ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜ ÌÔÚ› Ó· ‚ÔËıËı› ·fi Ù· ·Ú·Î¿Ùˆ:

·È‰È¿, ‚) ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜ ÙÔ˘ fiÓÔ˘ ηډȷ΋˜ Î·È ¿ÏÏ˘ Â›ÁÔ˘Û·˜ ·ÈÙÈÔÏÔÁ›·˜ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ηıÒ˜ Î·È Á) ÙË ‚·ÛÈ΋ ‰È¿ÎÚÈÛË Û Ô͇ Î·È ¯ÚfiÓÈÔ £¶, ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi ∂͈ÙÂÚÈÎfi π·ÙÚÂ›Ô Î·È ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi ¢È·ÁÓˆÛÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ Ù˘ ∫ÏÈÓÈ΋˜ Ì·˜ ÂÊ·ÚÌfi˙Ô˘Ì ÙÔÓ ·ÏÁfiÚÈıÌÔ ÙÔ˘ Û¯‹Ì·ÙÔ˜ 3. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡ Ì £¶ ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ Ú¿ÍË. √ ‚·ÛÈÎfi˜ ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÂÚÈÔÚ›˙ÂÙ·È ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÔÏ›ÁˆÓ ÂÎÂ›ÓˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ϤÔÓ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ È·ÙÚÔ‡. ™ÙȘ ÂȉÈΤ˜ ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ ı· ÌÔÚÔ‡Û·Ó Ó· Û˘ÛÙËıÔ‡Ó: ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·, ·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒڷη, ̤ÙÚËÛË ÙÔ˘ pH ÙÔ˘ ÛÙÔÌ¿¯Ô˘, ·ÎÙÈÓÔÁڷʛ˜ ÛÎÂÏÂÙÔ‡ ıÒڷη, ÁÂÓÈ΋ ÂͤٷÛË Ô‡ÚˆÓ, ÙÔÍÈÎÔÏÔÁÈ΋ ÂͤٷÛË Ô‡ÚˆÓ, ÂÍÂÙ¿ÛÂȘ ·›Ì·ÙÔ˜ ηْ ÂÈÏÔÁ‹ (19,26,27). √‰ËÁ¿ ÎÏÈÓÈο ÛËÌ›· Ó¢ÌÔÓÈÎÒÓ ·ÈÙ›ˆÓ √È Ó¢ÌÔÓÈΤ˜ ·Èٛ˜ £¶ ÛÙ· ·È‰È¿ Â›Ó·È Û˘¯Ó¤˜, ۯ‰fiÓ 1:5-6 ·È‰È¿ Ì £¶. √ ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜ ÌÔÚ› Ó· ηıÔ‰ËÁËı› ·fi Ù· ·Ú·Î¿Ùˆ (19,22,26) (¶›Ó·Î·˜ 5 ): 1. ∏ÏÈΛ·: ∆· Ó¢ÌÔÓÈο ·›ÙÈ· ˆ˜ ·ÈÙ›· £¶ Â›Ó·È Û˘¯ÓfiÙÂÚ· Û ·È‰È¿ οو ÙˆÓ 12 ¯ÚfiÓˆÓ.

2. πÛÙÔÚÈÎfi Ï‹„˘ ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ Î·È ÓfiÛËÛ˘ ·fi ˘ÂÚËÎÙÈο Û‡Ó‰ÚÔÌ· Â›Ó·È ÂÓ‰ÂÈÎÙÈο ÁÈ· ÙÔÓ

µ∏ª∞

µ∞™π∫√™ ¶ƒ√™∞¡∞∆√§π™ª√™

√•À™ £.¶. ①

∂ÎÙ›ÌËÛË ¯·Ú·ÎÙ‹Ú· ∂¶∂π°√¡∆√™ Ã√¡π√™ £.¶.

②

③

∂ÎÙ›ÌËÛË ¯·Ú·ÎÙ‹ÚˆÓ ™∆∏£∞°Ã∏™

§‹„Ë ÈÛÙÔÚÈÎÔ‡

™¯¤ÛË Ì ÎfiˆÛË: ªfiÓÈÌË ¶ÚÔÎÏËÙ‹ ∞ÛÙ·ı‹˜

¢π∞º√ƒπ∫∏ ¢π∞°¡ø™∏-∂¡∂ƒ°∂π∞

™ÙËı¿Á¯Ë ¶Ó¢ÌÔıÒڷη˜ ∆Ú·˘Ì·ÙÈÛÌfi˜ •¤ÓÔ ÛÒÌ·

∂π™∞°ø°∏ °π∞ ∂¶∂π°√À™∞ £∂ƒ∞¶∂π∞

ñ ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ ¿Û¯ÔÓÙÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜ ñ ¶Èı·ÓÔ› „˘¯ÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜

∏∫°: ∞ÚÚ˘ıÌ›·; ÀÂÚÙÚÔÊ›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜; ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜: ªÂÁ·ÏÔηډ›·; ∂π™∞°ø°∏ °π∞ ∂ƒ∂À¡∞

∫‡ÚÈÔÈ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹Ú˜

flÚ· Â¤Ï¢Û˘, ‰È¿ÚÎÂÈ·, Û˘¯ÓfiÙËÙ·, ÂÚÈÁÚ·Ê‹, ¤ÓÙ·ÛË, ÂÓÙfiÈÛË, ÛËÌ›· ·ÎÙÈÓÔ‚ÔÏ›·˜, ·Ó·ÎÔ˘ÊÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜.

¢Â˘ÙÂÚ‡ÔÓÙ˜ ÎÏÈÓÈÎÔ› ¯·Ú·ÎÙ‹Ú˜

¢Ú·ÛÙËÚÈfiÙËÙ˜, ›‰Ô˜ ·ıÏËÙÈÛÌÔ‡, ÙÚfiÔ˜ ‡ÓÔ˘, ÛÙ¿ÛË ÛÒÌ·ÙÔ˜, ÙÚfiÔ˜ ˙ˆ‹˜, ÎÈÓËÙÈÎfiÙËÙ·, ÚÔ‹ Û ÙÚ·˘Ì·ÙÈÛÌÔ‡˜, Û¯¤ÛË Ì ϋ„Ë Á‡̷ÙÔ˜.

™¯‹Ì· 3. £ˆÚ·ÎÈÎfi˜ fiÓÔ˜ ÛÙ· ·È‰È¿. ∞ÏÁfiÚÈıÌÔ˜ Ù·¯Â›·˜ ‰È¿ÁÓˆÛ˘ Î·È ·ÓÙÈÌÂÙÒÈÛ˘.

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∞) √‰ËÁ¿ ÛËÌ›· Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (13-15,19,26,27,35-37) (¶›Ó·Î·˜ 6): 1. πÛÙÔÚÈÎfi Î·È ÎÏÈÓÈ΋ ·Ó›¯Ó¢ÛË ÛËÌ›ˆÓ ηډȷ΋˜ ÓfiÛÔ˘ (ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ΢¿ÓˆÛË, ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, ‡ÎÔÏË ÎfiˆÛË, ÌÂÁ·ÏÔηډ›·, ·ÚÚ˘ıÌ›·, ʇÛËÌ· Ì ÔÚÁ·ÓÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜).

2. √ÚÁ·ÓÈÎfi ʇÛËÌ·: ∆Ú·¯‡, Ì ‹ ¯ˆÚ›˜ ÚÔ›˙Ô, ¤ÓÙ·Û˘ 1-6/6, Ì ÛËÌ·ÓÙÈΤ˜ ÂÂÎÙ¿ÛÂȘ, Û˘¯Ó¿ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ Ù˘ ¿ıËÛ˘ (.¯. ÛÙË ÌÂÛÔÏ¿ÙÈ· ¯ÒÚ· ÛÙË ÛÙ¤ÓˆÛË ÙÔ˘ ÈÛıÌÔ‡ Ù˘ ·ÔÚÙ‹˜).

3. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒڷη: ∂ÍÂÙ¿˙ÔÓÙ·È: ·) ̤ÁÂıÔ˜ ηډȷ΋˜ ÛÎÈ¿˜ (ÌÂÁ·ÏÔηډ›· ‹/Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi Û¯‹Ì· Â›Ó·È ÂӉ›ÍÂȘ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜), ‚) ·ÁÁ›ˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ (·˘ÍË̤ÓË Û ·ı‹ÛÂȘ Ì ‰È·Ê˘Á‹ ·fi ·ÚÈÛÙÂÚ¿ ÚÔ˜ Ù· ‰ÂÍÈ¿, ÂÏ·Ùو̤ÓË Û ·ı‹ÛÂȘ Ì ·Ï‹ ‹ Û˘Ó˘¿Ú¯Ô˘Û· ÛÙ¤ÓˆÛË Ù˘ Ó¢ÌÔÓÈ΋˜, Ê˘ÛÈÔÏÔÁÈ΋ Û ·ı‹ÛÂȘ Ì ÌÈÎÚ‹ ‰È·Ê˘Á‹, ÌÈÎÚ‹ ÛÙ¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ Î·È Û ·ı‹ÛÂȘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜).

4. ∏∫°: ∞·Ú·›ÙËÙÔ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ıˆÚ·ÎÈÎfi fiÓÔ Î·È ˘fiÓÔÈ· Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜, ·Ô‰ÂÈÎÓ‡ÂÈ Û˘Ó˘¿Ú¯Ô˘Û· ÈÛ¯·ÈÌ›· ‹ ·ÚÚ˘ıÌ›· Î·È ˘Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘

Paediatriki 2001;64:115-124

Ì˘Ôηډ›Ô˘.

5. ÀÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·: ∞·Ú·›ÙËÙÔ Û ÈÛ¯˘Ú‹ ˘fiÓÔÈ· Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ Î·È ·ÔÙÂÏ› ¤Ó· ÈÛ¯˘Úfi, ˆ˜ Î·È ÙÔ ·fiÏ˘ÙÔ, ‰È·ÁÓˆÛÙÈÎfi ̤ÛÔ. µ) √‰ËÁ¿ ÛËÌ›· Â›ÎÙËÙˆÓ Î·Ú‰ÈÔ·ıÂÈÒÓ (13-15,19,26,27,34-37) (¶›Ó·Î·˜ 7): √È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ ÂΉËÏÒÓÔÓÙ·È Ì ‰È·ÊÔÚÂÙÈ΋, Ë Î¿ı ̛·, ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÙÔ˘ ÎÏÈÓÈÎÔ‡ ÁÈ·ÙÚÔ‡ Ú¤ÂÈ Ó· Â›Ó·È Î·Ù¿ÏÏËÏÔ Î·È Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ fiϘ ÙȘ Èı·Ó¤˜ Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ. ŒÙÛÈ: 1. ∏ ÂÚÈηډ›Ùȉ· ÂΉËÏÒÓÂÙ·È Ì £¶ Î·È ‰‡ÛÓÔÈ· (ȉ›ˆ˜ ÛÙËÓ Î·Ù¿ÎÏÈÛË) ÛÙË ‰È¿ÚÎÂÈ· ‹ ÌÂÙ¿ ·fi ÈÔÁÂÓ‹ ‹ ¿ÏÏË Ïԛ̈ÍË.

2. ∏ Ì˘Ôηډ›Ùȉ· ÂΉËÏÒÓÂÙ·È Ì ‡ÎÔÏË ÎfiˆÛË, ‰‡ÛÓÔÈ· Î·È ¿ÏÏ· ÛËÌ›· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ̤¯ÚÈ Î·Ú‰È·Î‹ ηٷÏËÍ›· (collapsus).

3. ∏ ÂÓ‰Ôηډ›Ùȉ·, Ì ‚·ÚÈ¿ ÛËÙÈ΋ ÂÈÎfiÓ· Î·È ÂÌÊ¿ÓÈÛË Ê˘Û‹Ì·ÙÔ˜ Ô˘ ‰ÂÓ ÚÔ¸‹Ú¯Â ‹ ÙÚÔÔÔ›ËÛË Ê˘Û‹Ì·ÙÔ˜ Ô˘ ÚÔ¸‹Ú¯Â.

4. ∆Ô Û¿ÓÈÔ ÛÙ· ·È‰È¿ ¤ÌÊÚ·ÁÌ· Ì˘Ôηډ›Ô˘ ‰›ÓÂÈ £¶ Ì ηı·ÚÔ‡˜ ¯·Ú·ÎÙ‹Ú˜ ÛÙËı¿Á¯Ë˜, fiˆ˜ ·˘ÙÔ› Â›Ó·È ÁÓˆÛÙÔ› ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ·ÚfiÌÔÈÔ £¶ ¤¯ÂÈ Î·È Ë ‚·ÚÈ¿ ‚·Ï‚ȉÈ΋ ηÈ

¶›Ó·Î·˜ 6. √‰ËÁ¿ ÎÏÈÓÈο ÛËÌ›· ÛÙȘ ΢ÚÈfiÙÂÚ˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Ì Èı·ÓfiÙËÙ· £¶ ÛÙ· ·È‰È¿ (13-15,19,26,27,35-37) ™À°°∂¡∏™ ∫∞ƒ¢π√¶∞£∂π∞ 1. ™ÙÂÓÒÛÂȘ ‚·Ï‚›‰·˜ ·ÔÚÙ‹˜ 2. ™Ù¤ÓˆÛË ÈÛıÌÔ‡ ·ÔÚÙ‹˜ 3. ƒ‹ÍË ·Ó¢ڇÛÌ·ÙÔ˜ Valsalva 4. ∞ÓÒÌ·ÏË ¤ÎÊ˘ÛË ™∞ ·fi ÙËÓ Ó¢ÌÔÓÈ΋ 5. ™˘ÁÁÂÓ›˜ ÛÙÂÓÒÛÂȘ ™∞ 6. ™Ô‚·Ú‹ ÛÙ¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ 7. ¶ÚfiÙˆÛË ÌÈÙÚÔÂȉԇ˜ 8. ∞ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰ÂÍÈ¿ ÎÔÈÏ›· º = ʇÛËÌ·, ™∞ = ÛÙÂÊ·ÓÈ·›·(˜) ·ÚÙËÚ›·(˜)

√¢∏°∞ ∫§π¡π∫∞ ™∏ª∂π∞ º, ¯·ÌËÏfi˜ ÛÊ˘ÁÌfi˜ º, ‰È·ÊÔÚ¿ ÛÊ˘ÁÌÔ‡ Î·È ∞¶ ÌÂٷ͇ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚˆÓ º ± º, ¯·Ú·ÎÙËÚÈÛÙÈÎfi ∏∫° ÷ڷÎÙËÚÈÛÙÈÎfi ∏∫° º, ∏∫°, ÂÏ·Ùو̤ÓË ·ÁÁ›ˆÛË Ó¢ÌfiÓˆÓ ∫ÏÈÎ ± º ± ‰˘ÛÏ·Û›· ıÒڷη ∞ÚÚ˘ıÌ›·, Û˘ÁÎÔÈ΋ ÚÔÛ‚ÔÏ‹

¶›Ó·Î·˜ 7. √‰ËÁ¿ ÎÏÈÓÈο ÛËÌ›· ÛÙȘ ΢ÚÈfiÙÂÚ˜ Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ Ì Èı·ÓfiÙËÙ· £¶ ÛÙ· ·È‰È¿ (13-15,20,27,28,36-38) ∂¶π∫∆∏∆∏ ∫∞ƒ¢π√¶∞£∂π∞ 1. ª˘ÔηډÈÔ¿ıÂȘ 2. ∂Ó‰Ô-Ì˘Ô-ηډ›Ùȉ· 3. ¡fiÛÔ˜ Kawasaki 4. ÀÂÚÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· 5. ÕÏϘ ·ÚÚ˘ı̛˜ 6. ¶ÂÚÈηډ›Ùȉ·

√¢∏°∞ ∫§π¡π∫∞ ™∏ª∂π∞ ªÂÁ·ÏÔηډ›· ± º ± ∫∞ ™ËÙÈ΋ ÂÈÎfiÓ· ± º ± ÌÂÁ·ÏÔηډ›· ± ∫∞ ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∆·¯˘Î·Ú‰›· + ∫∞, ∏∫° ∞ÚÚ˘ıÌ›·, ÏÈÔı˘Ì›·, ∏∫° ¢‡ÛÓÔÈ·, ÌÂÁ·ÏÔηډ›· ± ‹¯Ô˜ ÙÚÈ‚‹˜ ± ·Ú¿‰ÔÍÔ˜ ÛÊ˘ÁÌfi˜ 7. ¶ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ - ¤ÌÊÚ·ÁÌ· ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ‰˘ÛÏÈȉ·ÈÌ›·, ∏∫° 8. ∞ÁÁÂÈÔÛ·ÛÌfi˜ ™∞ ÃÚ‹ÛË Ô˘ÛÈÒÓ - Ê·Ú̿ΈÓ, ∏∫° º= ʇÛËÌ·, ∫∞= ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ™∞= ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËڛ˜

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¶·È‰È·ÙÚÈ΋ 2001;64:115-124

˘Ô‚·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜.

5. √È Ì˘ÔηډÈÔ¿ıÂȘ ÂΉËÏÒÓÔÓÙ·È: ∏ ‰È·Ù·ÙÈ΋ Ì ‡ÎÔÏË ÎfiˆÛË ‚·ıÌˉfiÓ ÂȉÂÈÓÔ‡ÌÂÓË, ·›ÛıËÌ· ·ÏÌÒÓ, ηÏ·ÛÙÈÎfi Ú˘ıÌfi Î·È Ê‡ÛËÌ· ·ÓÂ¿ÚÎÂÈ·˜ Ù˘ ÌÈÙÚÔÂȉԇ˜ Î·È Ë ˘ÂÚÙÚÔÊÈ΋ ÌÂ Û˘ÛÙÔÏÈÎfi Â͈ıËÙÈÎfi ʇÛËÌ·, Ô˘ Á›ÓÂÙ·È ÈÔ ÈÛ¯˘Úfi Ì ÙËÓ ¿ÛÎËÛË, ÂÓÒ Ô £¶ ÂÌÊ·Ó›˙ÂÙ·È Ì ÙËÓ ¿ÛÎËÛË (Ù‡Ô˘ ÛÙËı¿Á¯Ë˜) Î·È ·Ó·Î·Ï‡ÙÂÙ·È Û˘¯Ó¿ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÏfiÁˆ Ù˘ ÁÓˆÛÙ‹˜ ÌÂÁ¿Ï˘ Èı·ÓfiÙËÙ·˜ (ÂÚ›Ô˘ 50%) ·Ó‡ÚÂÛ˘ ÎÏËÚÔÓÔÌÈ΋˜ Û¯¤Û˘ ÛÙËÓ ¿ıËÛË ·˘Ù‹. °) √‰ËÁ¿ ÎÏÈÓÈο ÛËÌ›· ·ÚÚ˘ıÌÈÒÓ (1315,19,26,34-36): 1. √ Û˘Ó‰˘·ÛÌfi˜ “·›ÛıËÌ· ·ÏÌÒÓ” Î·È £¶ ‚¿˙ÂÈ ÙËÓ ˘fiÓÔÈ· οÔÈ·˜ ·ÚÚ˘ıÌ›·˜ ˆ˜ ·ÈÙ›·˜ ÙÔ˘ £¶.

2. √ Û˘Ó‰˘·ÛÌfi˜ “·›ÛıËÌ· ·ÏÌÒÓ” + £¶ + ÏÈÔı˘Ì›· ‹ Ù¿ÛË ÁÈ· ÏÈÔı˘Ì›· ± ÛËÌ›· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ± shock, ı¤ÙÔ˘Ó ÙË ‰È¿ÁÓˆÛË ÛÔ‚·Ú‹˜ ·ÚÚ˘ıÌ›·˜ Ô˘ Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ¿ÌÂÛ·.

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17. µ·ÚÏ¿Ì˘ °, ™·Ì·Ú¿˜ ∫, §·˙·Ú›‰Ô˘-ª·Ï¿ÛË ™. ∫·Ú‰ÈÔÏÔÁÈ΋ ÂͤٷÛË ·È‰ÈÒÓ ÛÙÔ ·È‰ÔηډÈÔÏÔÁÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚ›Ô. ™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË 1555 ÂÍÂÙ¿ÛˆÓ. ¶·È‰È·ÙÚÈ΋ 1988;51:348-358.

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33. Pickering D. Precordial catch syndrome. Arch Dis Child 1981;56:401-403.

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34. Poikolainen K, Kanerva R, Lonnqvist J. Life events and other risk factors for somatic symptoms in adolescence.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 12-07-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-12-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÂÒÚÁÈÔ˜ ™. µ·ÚÏ¿Ì˘ µ·Û. ŸÏÁ·˜ 85, 546 43, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ Î·È ÎÏÈÓÈ΋ ÔÚ›· Ïԛ̈͢ Ì RSV Û ÓÔÛËÏ¢fiÌÂÓ· Î·È ÌË ‚Ú¤ÊË1 ™ÎÔfi˜: √ ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜ (RSV) ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÔ‚·Ú‹ Ïԛ̈ÍË ÛÙ· ·È‰È¿. √È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·Ú‹˜ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ËÏÈΛ· οو ÙˆÓ 6 ÌËÓÒÓ, ÚÔˆÚfiÙËÙ·, ÚÔ¸¿Ú¯Ô˘Û· ηډȷ΋ ‹ Ó¢ÌÔÓÈ΋ ÓfiÛÔ ‹ ‰˘ÛÏ·Û›·, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË Î·È ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Â›‰Ú·Û˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÏÏÂÚÁ›·˜ ÛÙËÓ ÎÏÈÓÈ΋ ÔÚ›· Ù˘ Ïԛ̈͢ Ì RSV ÓÔÛËÏ¢fiÌÂÓˆÓ Î·È ÌË ‚ÚÂÊÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο 172 ·ÛıÂÓ›˜ ËÏÈΛ·˜ οو ÙˆÓ 12 ÌËÓÒÓ (99 ÓÔÛËÏ¢fiÌÂÓÔÈ Î·È 73 ÌË ¯Ú‹˙ÔÓÙ˜ ÓÔÛËÏ›·˜). ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ ¤ÁÈÓ ·fi ÙÔ˘˜ ʷΤÏÔ˘˜ ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Î·È ·fi ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ÛÙ¿ÏıËÎ·Ó Û ·È‰È¿ÙÚÔ˘˜. ∞ÔÙÂϤÛÌ·Ù·: ∆· ÓÔÛËÏ¢ı¤ÓÙ· ‚Ú¤ÊË Â›¯·Ó ÛËÌ·ÓÙÈο Û˘¯ÓfiÙÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ·fi Ù· ‚Ú¤ÊË Ô˘ ‰ÂÓ ¯ÚÂÈ¿ÛıËÎ·Ó ÓÔÛËÏ›·, 62% Î·È 29% ·ÓÙÈÛÙÔ›¯ˆ˜ (p<0,001). ∏ ‰È¿ÁÓˆÛË Ù˘ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÙÔÈÎfi «ÊÔÚÙ›Ô» ·’ fiÙÈ Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ·Ó¿ÏÔÁÔ ÈÛÙÔÚÈÎfi, 89% ¤Ó·ÓÙÈ 74% ·ÓÙÈÛÙÔ›¯ˆ˜ (p<0,02). √È ÓÔÛËÏ¢ı¤ÓÙ˜ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ·fi ÂΛÓÔ˘˜ ¯ˆÚ›˜ ·ÚfiÌÔÈÔ ÈÛÙÔÚÈÎfi, 7,4±3,7 Ë̤Ú˜ ηÈ

124

6,1±2,3 Ë̤Ú˜ ·ÓÙÈÛÙÔ›¯ˆ˜ (p<0,04). ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜, ÏËÓ Ù˘ ËÏÈΛ·˜, Ô˘ ıˆÚÔ‡ÓÙ·È ÚԉȷıÂÛÈÎÔ› ‚·ÚÈ¿˜ Ïԛ̈͢ Ì RSV (ÚÔˆÚfiÙËÙ·, ÚÔ¸¿Ú¯Ô˘Û· ηډȷ΋ ‹ Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ‹ ‰˘ÛÏ·Û›·, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË), ‰ÂÓ ÂȂ‚·ÈÒıËÎ·Ó ˆ˜ Ù¤ÙÔÈÔÈ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ù· ‚Ú¤ÊË Ì ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÙÔ›·˜ ‰È·ÙÚ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÛÔ‚·Ú‹˜ Ïԛ̈͢ Ì RSV, fiˆ˜ Ê·›ÓÂÙ·È ·fi Ù· ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿, ÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ Î·È ÙË Û˘¯ÓfiÙÂÚË ÚÔÛ‚ÔÏ‹ ·fi ‚ÚÔÁ¯ÈÔÏ›Ùȉ·.

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P, Stricker T, Baerlocher C, Sennhauser FH Family history of atopy and clinical course of RSV infection in ambulatory and hospitalized infants Pediatr Pulmonol 2000;30:302-306 ªÈ¯¿Ï˘ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ¶·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˜ ∂ÈÌÂÏËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ

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REVIEW ARTICLE

∏ ηÎÔÔ›ËÛË ·È‰ÈÒÓ ·fi ¿ÏÏ· ·È‰È¿ ¡. ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡

Abuse of children by their peers D. Protagora-Lianou

¶ÂÚ›ÏË„Ë: ∆· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· ¤¯ÂÈ ÂÈÎÚ·Ù‹ÛÂÈ Ë ¿Ô„Ë fiÙÈ ÔÈ ÛˆÌ·ÙÈΤ˜ Î·È ÊÚ·ÛÙÈΤ˜ ÂÈı¤ÛÂȘ ·È‰ÈÒÓ ¤Ó·ÓÙÈ Û˘ÓÔÌ‹ÏÈΈÓ, ÔÈ ÔÔ›ÔÈ ·‰˘Ó·ÙÔ‡Ó Ó· ·Ì˘ÓıÔ‡Ó, ·ÔÙÂÏ› ÌÔÚÊ‹ ηÎÔÔ›ËÛ˘. Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ÔÚÈṲ̂ӷ ·È‰È¿ ÂÌϤÎÔÓÙ·È Î·Ù’ Â·Ó¿ÏË„Ë Û ٤ÙÔÈ· ÂÂÈÛfi‰È·, ˆ˜ ı‡Ì·Ù· ‹ ı‡Ù˜. √È ÂÌÂÈڛ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ ÛÙËÓ „˘¯È΋ Î·È ÛˆÌ·ÙÈ΋ ÙÔ˘˜ ˘Á›·, ÙËÓ ÎÔÈÓˆÓÈ΋ ·Ó¿Ù˘ÍË Î·È ÙË Û¯ÔÏÈ΋ ÚfiÔ‰Ô. ∆· ·È‰È¿ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ ·ÔÙÂÏÔ‡Ó ÔÌ¿‰· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ù¤ÙÔÈÔ˘ ›‰Ô˘˜ ηÎÔÔ›ËÛË ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜. ∏ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ¤¯ÂÈ ˆ˜ ÛÎÔfi ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Û’·˘Ùfi ÙÔ ı¤Ì·. ¶·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›·, Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÌÏÂÎfiÌÂÓˆÓ ·È‰ÈÒÓ, ÔÈ ÂÈÙÒÛÂȘ ÛÙËÓ ˘Á›· ηıÒ˜ Î·È Ì¤ÙÚ· ·ÓÙÈÌÂÙÒÈÛ˘.

Abstract: Over the past twenty years, in developed countries, there is a growing conviction that bullying constitutes a form of child abuse. It has been found that some children are repeatedly involved in such incidents, either as bullies or as victims. These experiences have adverse consequences on their mental and physical health, social development and academic progress. In particular, children with special needs are at increased risk for victimization. The purpose of this review is to heighten the pediatrician’s awareness of this problem. Epidemiological data, characteristics of bullies and victims, health consequences and intervention modalities are discussed.

§¤ÍÂȘ ÎÏÂȉȿ: ηÎÔÔ›ËÛË ·È‰ÈÒÓ, ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ ·È‰ÈÒÓ, ·È‰È¿ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ.

Key words: bullying, victimization, peer relationships, children with special needs.

∂ÈÛ·ÁˆÁ‹ √È Û˘ÁÎÚÔ‡ÛÂȘ ÌÂٷ͇ ·È‰ÈÒÓ ·ÔÙÂÏÔ‡Ó Ê˘ÛÈÔÏÔÁÈÎfi, ·Ô‰ÂÎÙfi Ê·ÈÓfiÌÂÓÔ fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· “‰Ô‡Ó·È Î·È Ï·‚›Ӕ ÛÙ· Ï·›ÛÈ· ÈÛfiÙÈÌ˘ Û¯¤Û˘. ø˜ ηÎÔÔ›ËÛË ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜, “peer abuse” ηٿ ÙËÓ ·ÁÁÏÈ΋ ÔÚÔÏÔÁ›·, ÔÚ›˙ÂÙ·È Ë Û˘ÛÙËÌ·ÙÈ΋, ÂÛÎÂÌ̤ÓË Î·È ·ÚÔÎ¿Ï˘ÙË ÂÈıÂÙÈÎfiÙËÙ· ·fi ̤ÚÔ˘˜ ÈÛ¯˘ÚfiÙÂÚÔ˘ ·ÙfiÌÔ˘ (‹ ÔÌ¿‰·˜ ·ÙfïÓ) ¤Ó·ÓÙÈ ·ÙfiÌÔ˘ Ô˘ ·‰˘Ó·Ù› Ó· ˘ÂÚ·ÛÈÛÙ› ÙÔÓ Â·˘Ùfi ÙÔ˘. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Û·Ó›ˆ˜ ÂÌϤÎÂÙ·È Û ٤ÙÔÈ· ÂÂÈÛfi‰È·. À¿Ú¯Ô˘Ó, fï˜, ¿ÙÔÌ· Ù· ÔÔ›· ηْÂ·Ó¿ÏË„Ë ÂÈÙ›ıÂÓÙ·È Û ¿Ï-

ÏÔ˘˜ Î·È ¿ÙÔÌ· Ù· ÔÔ›· Û˘ÛÙËÌ·ÙÈο ‰¤¯ÔÓÙ·È Ù¤ÙÔȘ ÂÈı¤ÛÂȘ (1). ∏ ηÎÔÔ›ËÛË ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜ ÌÔÚ› Ó· Ï¿‚ÂÈ ‰È¿ÊÔÚ˜ ÌÔÚʤ˜: ۈ̷ÙÈ΋ ‚›·, ÊÚ·ÛÙÈΤ˜ ÂÈı¤ÛÂȘ, ·ÔÎÏÂÈÛÌfi˜ ·fi ÎÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ, ·Ê·›ÚÂÛË ‹ ηٷÛÙÚÔÊ‹ ÚÔÛˆÈÎÒÓ ·ÓÙÈÎÂÈ̤ӈÓ. ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, Ë Î·ÎÔÔ›ËÛË ·È‰ÈÒÓ ·fi ÂÓ‹ÏÈΘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ÚÔÛ΋ÓÈÔ ÙÔ˘ ÂӉȷʤÚÔÓÙÔ˜. ∂›Ó·È ϤÔÓ ÁÓˆÛÙfi fiÙÈ Ù· ı‡Ì·Ù· Û˘Ó‹ıˆ˜ ‰ÂÓ ·Ó·˙ËÙÔ‡Ó ‚Ô‹ıÂÈ· Î·È ÁÈ’·˘ÙfiÓ ÙÔ ÏfiÁÔ Û˘ÓÈÛÙ¿Ù·È Â·ÁÚ‡ÓËÛË ·fi ̤ÚÔ˘˜ ÙˆÓ ·È‰È¿ÙÚˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· Ú·ÁÌ·ÙÔÔÈËı› Ë

∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ ∞’ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ ∞’ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

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ηٿÏÏËÏË ·Ú¤Ì‚·ÛË. ∂›Û˘, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·È‰È¿ Ô˘ ηÎÔÔÈÔ‡ÓÙ·È ·fi ¿ÏÏ· ·È‰È¿ ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ÙÔ Úfi‚ÏËÌ· Û ÂÓ‹ÏÈΘ ÏfiÁˆ ÓÙÚÔ‹˜ Î·È Êfi‚Ô˘ ÁÈ· ·ÓÙ›ÔÈÓ· (2,3). ∂ȉËÌÈÔÏÔÁ›· ∆ÔÓ √ÎÙÒ‚ÚÈÔ Î·È ¡Ô¤Ì‚ÚÈÔ ÙÔ˘ 1999 Ú·ÁÌ·ÙÔÔÈ‹ıËΠÌÂϤÙË Û ‰Â›ÁÌ· 350 Ì·ıËÙÒÓ Ï˘Î›Ԣ Ù˘ ËÂÈÚˆÙÈ΋˜ ∂ÏÏ¿‰·˜. ∫·Ù¿ ÙË ‰‹ÏˆÛ‹ ÙÔ˘˜, ÙÔ 11,6% ÙˆÓ Ì·ıËÙÒÓ Â›¯Â ˘¿ÚÍÂÈ ı‡Ì· ۈ̷ÙÈ΋˜ ‹ ÏÂÎÙÈ΋˜ ‚›·˜. ∆Ô Ê·ÈÓfiÌÂÓÔ Â›Ó·È ÈÔ Û˘¯Ófi ÛÙȘ ËÌÈ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ (17,4%) Î·È ÏÈÁfiÙÂÚÔ ÛÙȘ ·ÁÚÔÙÈΤ˜ (8,5%). ¶ÈÔ Û˘¯Ó¿ Û˘Ì‚·›ÓÂÈ ÛÙ· ·ÁfiÚÈ· (16,8%) ·’ fiÙÈ ÛÙ· ÎÔÚ›ÙÛÈ· (6,6%). ∆Ô ÔÛÔÛÙfi ÙˆÓ Ì·ıËÙÒÓ Ô˘ ›¯·Ó ·Û΋ÛÂÈ ‚›· ¤Ó·ÓÙÈ ¿ÏÏˆÓ ‹Ù·Ó 23,2%, Ì ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ (36,5%) ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (10,4%). √È Ì·ıËÙ¤˜ Ì ¯·ÌËÏ‹ Û¯ÔÏÈ΋ ·fi‰ÔÛË Û˘ÌÌÂÙ¤¯Ô˘Ó ÈÔ Û˘¯Ó¿ Û ÂÂÈÛfi‰È· ‚›·˜, ˆ˜ ı‡Ì·Ù· (22,7% ¤Ó·ÓÙÈ 3,5% ÙˆÓ “·Ú›ÛÙˆÓ”) ‹ ˆ˜ ı‡Ù˜ (26,1% ¤Ó·ÓÙÈ 10,2% ÙˆÓ “·Ú›ÛÙˆÓ”). √È Èı·ÓfiÙËÙ˜ ÂÌÏÔ΋˜ ÌÂٷ͇ ∂ÏÏ‹ÓˆÓ Ì·ıËÙÒÓ Î·È ·ÓÙ›ÛÙÔȯˆÓ ·ÏÏÔ‰·ÒÓ Û ÂÂÈÛfi‰ÈÔ ‚›·˜, Â›Ó·È ·˘ÍË̤Ó˜ (29,4% ÙˆÓ Ì·ıËÙÒÓ) (6). ÕÏÏË ¤Ú¢ӷ, ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∫ÔÈÓˆÓÈÎÒÓ ªÂÏÂÙÒÓ, ¤‰ÂÈÍ fiÙÈ Û Ú¿ÍÂȘ ‚›·È˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÚÔ‚·›ÓÂÈ ÙÔ 29% ÙˆÓ Ì·ıËÙÒÓ ËÏÈΛ·˜ 12-15 ÂÙÒÓ Î·È ÙÔ 49% ÙˆÓ Ì·ıËÙÒÓ ËÏÈΛ·˜ 16-19 ÂÙÒÓ. ∏ Û˘¯ÓfiÙËÙ· Ù¤ÙÔÈˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÔÈΛÏÏÂÈ ÛÙȘ ‰È¿ÊÔÚ˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ: ÙÔ 42% ÙˆÓ ·È‰ÈÒÓ ¿ÓÂÚÁˆÓ ÁÔÓÈÒÓ, ÙÔ 36% ·È‰ÈÒÓ ÂȯÂÈÚËÌ·ÙÈÒÓ Î·È Â·ÁÁÂÏÌ·ÙÈÒÓ Î·È ÙÔ 26% ·È‰ÈÒÓ ·ÁÚÔÙÒÓ Î·È ·ÓÂȉ›ÎÂ˘ÙˆÓ ÂÚÁ·ÙÒÓ (7). ŒÚ¢Ó˜ Û ‰È¿ÊÔÚ˜ ¯ÒÚ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Î·ÎÔÔ›ËÛË ·È‰ÈÒÓ ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜ ·ÔÙÂÏ› ‰ÈÂıÓ¤˜ Ê·ÈÓfiÌÂÓÔ. ™ÙËÓ ÚˆÙÔÔÚȷ΋ ¤Ú¢ӷ ÙÔ˘ Olweus ÙÔ 1977 ÛÙË ¡ÔÚ‚ËÁ›·, Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ‰È·ÓÂÌ‹ıËΠ۠13.000 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 8-16 ÂÙÒÓ, ‚Ú¤ıËΠfiÙÈ ÙÔ 8% ·fi ·˘ÙÔ‡˜ Â·ÓÂÈÏËÌ̤ӷ ηÎÔÔÈÔ‡Û ¿ÏÏÔ˘˜, ÂÓÒ ÙÔ 9% ‹Ù·Ó ı‡Ì·Ù· (1). ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, Ù· ÔÛÔÛÙ¿ ÂÌÏÔ΋˜ Û ηÎÔÔ›ËÛË (ˆ˜ ı‡Ì·Ù· ‹ ı‡Ù˜) ‹Ù·Ó 27% ÛÙÔ ‰ËÌÔÙÈÎfi/Á˘ÌÓ¿ÛÈÔ Î·È 10% ÛÙÔ Ï‡ÎÂÈÔ (4), ÂÓÒ Û ¿ÏϘ ¯ÒÚ˜, fiˆ˜ ÛÙËÓ πÛ·Ó›·, Â›Ó·È 17%, ÛÙËÓ ∞˘ÛÙÚ·Ï›· 17% Î·È ÛÙȘ ∏¶∞ 15% (5). ø˜ ÚÔ˜ ÙËÓ ËÏÈΛ·, Ù· ÔÛÔÛÙ¿ ÙˆÓ ·È‰ÈÒÓ Ô˘ ηÎÔÔÈÔ‡ÓÙ·È ÂÏ·ÙÙÒÓÔÓÙ·È Ì ÙÔ ¤Ú·ÛÌ· ·fi ÙÔ ‰ËÌÔÙÈÎfi ÛÙÔ Á˘ÌÓ¿ÛÈÔ, ÂÓÒ Ù· ÔÛÔÛÙ¿ ÙˆÓ ÂÈıÂÙÈÎÒÓ ·È‰ÈÒÓ, Â›Û˘ ÂÏ·ÙÙÒÓÔÓÙ·È ·ÏÏ¿ Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi (ÌÂÚÈÎÔ› ÛÙÚ¤ÊÔÓÙ·È ÙfiÙ Û ÌÈÎÚfiÙÂÚ· ·È‰È¿) (1,4,8). ∆· ·ÁfiÚÈ· ηÎÔÔÈÔ‡Ó Î·È Î·ÎÔÔÈÔ‡ÓÙ·È ÈÔ Û˘¯Ó¿ ·fi Ù· ÎÔÚ›ÙÛÈ·. ∂›Û˘, Ù· ·ÁfiÚÈ· ÈÔ Û˘¯Ó¿ ·fi Ù· ÎÔÚ›ÙÛÈ· ·ÛÎÔ‡Ó ÛˆÌ·ÙÈ΋ ‚›·, ÂÓÒ ·ÓÙ›ıÂÙ· Ù· ÎÔÚ›ÙÛÈ· ¯ÚËÛÈÌÔÔÈÔ‡Ó Û˘¯ÓfiÙÂÚ· ÊÚ·ÛÙÈΤ˜ ÂÈı¤ÛÂȘ Î·È ÎÔÈÓˆÓÈÎfi ·Ô-

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ÎÏÂÈÛÌfi. ∆· ·ÁfiÚÈ· ÂÈÙ›ıÂÓÙ·È Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, ÂÓÒ Ù· ÎÔÚ›ÙÛÈ· ÂÈÙ›ıÂÓÙ·È Û˘Ó‹ıˆ˜ Û ¿ÏÏ· ÎÔÚ›ÙÛÈ· (1,4,8). ø˜ ÚÔ˜ ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË, ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ˘Ô‚·ıÌÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ (4,8). ∂›Û˘, Â›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· ÔÈ Èı·ÓfiÙËÙ˜ ηÎÔÔ›ËÛ˘ Â›Ó·È ·˘ÍË̤Ó˜ ÁÈ· ·È‰È¿ ÂıÓÈÎÒÓ ÌÂÈÔÓÔÙ‹ÙˆÓ (3). ÷ڷÎÙËÚÈÛÙÈο ÙˆÓ ÂÌÏÂÎfiÌÂÓˆÓ ·È‰ÈÒÓ ¢È·ÎÚ›ÓÔÓÙ·È ÔÈ ·ÎfiÏÔ˘ı˜ ηÙËÁÔڛ˜ ·È‰ÈÒÓ Ô˘ ÂÌϤÎÔÓÙ·È Ù·ÎÙÈο Û ÂÂÈÛfi‰È· ηÎÔÔ›ËÛ˘: ÂÈıÂÙÈο ·È‰È¿, ηÎÔÔÈË̤ӷ ·È‰È¿ Î·È ÚÔÎÏËÙÈο ı‡Ì·Ù·, Ù· ÔÔ›· Î·È ÂÈÙ›ıÂÓÙ·È Î·È Î·ÎÔÔÈÔ‡ÓÙ·È: ∂ÈıÂÙÈο ·È‰È¿: ∏ ȉÈÔÛ˘ÁÎÚ·Û›· (temperament) Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¢ÂÚÂıÈÛÙfiÙËÙ· ÎÈ Â‡ÎÔϘ ÂÎÚ‹ÍÂȘ ı˘ÌÔ‡, Úԉȷı¤ÙÂÈ ÁÈ· ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Ô˘ ÌÔÚ› Ó· ÂΉËÏÒÓÂÙ·È ‹‰Ë ÛÙËÓ ÚÒÈÌË ÓËȷ΋ ËÏÈΛ· (9,10). ∆· ÂÈıÂÙÈο ·È‰È¿ ¤¯Ô˘Ó ıÂÙÈ΋ ÛÙ¿ÛË ·¤Ó·ÓÙÈ ÛÙË ‚›· (11). ∞ӷ̤ÓÔ˘Ó Ó· ·ÔÎÔÌ›ÛÔ˘Ó ÔʤÏË ·fi ‚›·È˜ Ú¿ÍÂȘ Î·È ÙÔ ıˆÚÔ‡Ó Î·ÙfiÚıˆÌ·. √ fiÓÔ˜ ÂÓfi˜ ı‡Ì·ÙÔ˜ Ô˘ ÚÔηÏ› Û˘ÌfiÓÈ· Î·È ‰˘ÛÊÔÚ›· ÛÙ· ÂÚÈÛÛfiÙÂÚ· ¿ÙÔÌ·, ÚÔÛʤÚÂÈ ÈηÓÔÔ›ËÛË Î·È ·›ÛıËÛË ‰‡Ó·Ì˘ Û’ ·˘Ù¿ Ù· ·È‰È¿ (12). ™˘Ó‹ıˆ˜ ¤¯Ô˘Ó ˘„ËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË Î·È ·ÓËÛ˘¯Ô‡Ó ÂÏ¿¯ÈÛÙ· ÁÈ· ·fiÚÚÈ„Ë ·fi Û˘ÌÌ·ıËÙ¤˜ ÎÈ ÂÈÏ‹ÍÂȘ ·fi ‰·ÛοÏÔ˘˜ (13). ∂›Ó·È ÏÈÁfiÙÂÚÔ ‰ËÌÔÊÈÏ‹ ·fi Ù· ÌË ÂÈıÂÙÈο ·È‰È¿ (·ÏÏ¿ ÈÔ ‰ËÌÔÊÈÏ‹ ·fi Ù· ı‡Ì·Ù·). ∞fi ÌÂϤÙ˜ Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÚÔ·ÙÂÈ fï˜, fiÙÈ Û˘Ó‹ıˆ˜ ıˆÚÔ‡Ó ÙÔÓ Â·˘Ùfi ÙÔ˘˜ ÈÔ ‰ËÌÔÊÈÏ‹ ·’ fiÙÈ Â›Ó·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· (Û ۇÁÎÚÈÛË Ì ÙȘ ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ Û˘ÌÌ·ıËÙÒÓ ÙÔ˘˜) (14). ∆· ÂÈıÂÙÈο ·ÁfiÚÈ· ¤¯Ô˘Ó ηٿ ̤ÛÔ fiÚÔ ÌÂÁ·Ï‡ÙÂÚË ÛˆÌ·ÙÈ΋ ‰‡Ó·ÌË. ∏ Û¯ÔÏÈ΋ ÙÔ˘˜ ·fi‰ÔÛË Â›Ó·È Û˘Ó‹ıˆ˜ ̤ÙÚÈ· ‹ ·ÚÎÂÙ¿ οو ÙÔ˘ ÌÂÙÚ›Ô˘ (15).

K·ÎÔÔÈË̤ӷ ·È‰È¿: ª¤Û· ÛÙ· Ê˘ÛÈÔÏÔÁÈο Ï·›ÛÈ·, ÔÈ È‰È·ÈÙÂÚfiÙËÙ˜ Ù˘ ÂÌÊ¿ÓÈÛ˘ (Á˘·ÏÈ¿, ·¯˘Û·ÚΛ· ÎÏ.) ‰ÂÓ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ, ¿Ú· ÌfiÓÔ ˆ˜ ·ÊÔÚÌ‹. ªÂϤÙ˜ ÛÙȘ Ôԛ˜ Û˘ÁÎÚ›ıËÎ·Ó Ù· Ê˘ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ηÎÔÔÈËÌ¤ÓˆÓ ·È‰ÈÒÓ Ì ¿ÏψÓ, ‰ÂÓ ‚Ú‹Î·Ó ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· “·ÚÂÎÎϛۈӔ. °È· Ù· ·ÁfiÚÈ·, Ë Ì˘˚΋ ‰‡Ó·ÌË Â›Ó·È ÛËÌ·ÓÙÈ΋ Î·È Ù· ·‰‡Ó·Ì· ¿ÙÔÌ· Û˘¯Ó¿ ¤ÊÙÔ˘Ó ı‡Ì·Ù· ÂÈı¤ÛˆÓ. ∂›Û˘, Ù· ·ÁfiÚÈ· Ì ÎÔÓÙfi ·Ó¿ÛÙËÌ· ηÎÔÔÈÔ‡ÓÙ·È ÈÔ Û˘¯Ó¿. ∆· ηÎÔÔÈË̤ӷ ÎÔÚ›ÙÛÈ· ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛÂ Ì˘˚΋ ‰‡Ó·ÌË ‹ ¿ÏÏ· ۈ̷ÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·fi Ù· ˘fiÏÔÈ· (1,3). ∫·Ù¿ ̤ÛÔ fiÚÔ ¤¯Ô˘Ó οˆ˜ ¯·ÌËÏfiÙÂÚË Â›‰ÔÛË ÛÙÔ Û¯ÔÏÂ›Ô ·fi Ù· ¿ÏÏ· ·È‰È¿. ¶·È‰È¿ Ô˘ ηÎÔÔÈÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈο

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·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·‰È·Î‹ ÙÒÛË Â›‰ÔÛ˘ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜. ŸÙ·Ó ηÎÔÔÈÔ‡ÓÙ·È ÌfiÓÔ ÁÈ· ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË ·fi‰ÔÛË Û’ ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ· Î·È ·Ó·Î¿ÌÙÔ˘Ó fiÙ·Ó Ë Î·Ù¿ÛÙ·ÛË ‚ÂÏÙȈı› (16,17). ∆· ·È‰È¿ ·˘Ù¿ ·ÈÛı¿ÓÔÓÙ·È ÌÔÓ·ÍÈ¿ ÛÙÔ Û¯ÔÏ›Ô, ·ÓÙÈ¿ıÂÈ· ÚÔ˜ ·˘Ùfi Î·È ı¤ÏÔ˘Ó Ó· ÙÔ ·ÔʇÁÔ˘Ó. ™·Ó Û˘Ó¤ÂÈ·, ¤¯Ô˘Ó ÔÏϤ˜ ·Ô˘Û›Â˜, ̤ÓÔ˘Ó ›Ûˆ ÛÙË Û¯ÔÏÈ΋ ‰Ô˘ÏÂÈ¿ Î·È Ë ÂÈÛÙÚÔÊ‹ Á›ÓÂÙ·È fiÏÔ Î·È ÈÔ ‰‡ÛÎÔÏË. √È ÁÔÓ›˜ Î·È ÔÈ ‰¿ÛηÏÔÈ Ôχ Û˘¯Ó¿ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó ÙȘ ·Èٛ˜ ·˘Ù‹˜ Ù˘ ηٿÛÙ·Û˘ (18). ™Â ÎÔÈÓˆÓÈΤ˜ Û˘Ó·Ó·ÛÙÚÔʤ˜, ÔÈ ·ÓÙȉڿÛÂȘ ÙÔ˘˜ Â›Ó·È Û˘¯Ó¿ ·‰¤ÍȘ Î·È ·Î·Ù¿ÏÏËϘ ÁÈ· ÙËÓ ÂÚ›ÛÙ·ÛË (19,20). ŸÙ·Ó ‰¤¯ÔÓÙ·È ÂÈı¤ÛÂȘ ·ÓÙȉÚÔ‡Ó ·ıËÙÈο, ÎÏ·›Ó ‹ ·Ú·‰›‰Ô˘Ó Ù· Ú¿ÁÌ·Ù¿ ÙÔ˘˜ (21,22). ∞˘Ù‹ Ë Û˘ÌÂÚÈÊÔÚ¿ ‰›ÓÂÈ ÙÔ Ì‹Ó˘Ì· fiÙÈ ÔÈ ÂÈı¤ÛÂȘ fi¯È ÌfiÓÔ ‰ÂÓ ı· ÙÈ̈ÚËıÔ‡Ó ·ÏÏ¿ Î·È ı· ÂÈ‚Ú·‚¢ıÔ‡Ó (23). ∆›ÓÔ˘Ó Ó· ·›˙Ô˘Ó ÌfiÓ· ÙÔ˘˜ Î·È Û·Ó›ˆ˜ ·›ÚÓÔ˘Ó ÚˆÙÔ‚Ô˘Ï›Â˜ ÁÈ· ÎÔÈÓˆÓÈΤ˜ Â·Ê¤˜. Œ¯Ô˘Ó Ï›ÁÔ˘˜ Ê›ÏÔ˘˜ (‹ ηıfiÏÔ˘) Î·È ÔÈ ÊÈϛ˜ ÙÔ˘˜ ÚÔÛʤÚÔ˘Ó ÏÈÁfiÙÂÚË ÈηÓÔÔ›ËÛË Î·È ˘ÔÛÙ‹ÚÈÍË Û ۇÁÎÚÈÛË Ì ÂΛӘ ÙˆÓ ¿ÏÏˆÓ ·È‰ÈÒÓ (24,25). ∏ Û¯¤ÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÚÔÛˆÈÎfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÛÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÈ ÎÔÈÓˆÓÈΤ˜ ηٷÛÙ¿ÛÂȘ Â›Ó·È ÂÌÊ·Ó‹˜ ·fi Ôχ ÌÈÎÚ‹ ËÏÈΛ·. ™Â ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Ì ·È‰È¿ ËÏÈΛ·˜ 15 Î·È 21 ÌËÓÒÓ, ÂΛӷ Ù· ÔÔ›· ‹Ù·Ó Ôχ ÚÔÛÎÔÏÏË̤ӷ ÛÙË ÌËÙ¤Ú· ÙÔ˘˜ Î·È ‰ÂÓ ÂÍÂÚ¢ÓÔ‡Û·Ó ÙÔ ÂÚÈ‚¿ÏÏÔÓ ‚Ú¤ıËÎ·Ó ·ÚÁfiÙÂÚ· (ÛÙÔ ÓËÈ·ÁˆÁ›Ô) Ó· Â›Ó·È Û˘ÓÂÛÙ·Ï̤ӷ ÎÔÈÓˆÓÈο Î·È Ó· ¤ÊÙÔ˘Ó, Û˘¯Ó¿, ı‡Ì·Ù· ÂÈı¤ÛˆÓ. ∞ÈÛı¿ÓÔÓÙ·È ¿Á¯Ô˜ Î·È ·Ó·ÛÊ¿ÏÂÈ· Û ÎÔÈÓˆÓÈΤ˜ ηٷÛÙ¿ÛÂȘ, ÙȘ Ôԛ˜ ¿ÏÏÔÈ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ì ¿ÓÂÛË (26,27). ¶Èı·ÓÒ˜ ¤¯Ô˘Ó ÂÍ·Ú¯‹˜ ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË Ô˘ Ù· ηıÈÛÙ¿ ÈÔ Â˘¿ÏˆÙ·, ·ÏÏ¿ Ù· Â·ÓÂÈÏËÌ̤ӷ ·ÚÓËÙÈο ÌËӇ̷ٷ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ù· ÂËÚ¿˙Ô˘Ó Â›Û˘. ™Â ÂÚˆÙËÌ·ÙÔÏfiÁÈ·, Ù· ı‡Ì·Ù· ηÎÔÔ›ËÛ˘ ‚·ıÌÔÏÔÁÔ‡Ó ÙÔÓ Â·˘Ùfi ÙÔ˘˜ ÈÔ ¯·ÌËÏ¿ Û ۇÁÎÚÈÛË Ì ¿ÏÏ· ·È‰È¿, ·fi ¿Ô„Ë ÂÌÊ¿ÓÈÛ˘, ÓÔËÌÔÛ‡Ó˘ Î·È ·ıÏËÙÈÎÒÓ ÈηÓÔًوÓ, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·ÓÙÈÎÂÈÌÂÓÈο ‰ÂÓ ˘ÛÙÂÚÔ‡Ó (27,28). ¶ÚÔÎÏËÙÈο ı‡Ì·Ù·: ¶ÔÏÏ¿ ·fi ·˘Ù¿ Ù· ·È‰È¿ Â›Ó·È ˘ÂÚÎÈÓËÙÈο Î·È ·ÚÔÚÌËÙÈο. £˘ÌÒÓÔ˘Ó Â‡ÎÔÏ·, ·ÏÏ¿ Ë ÂÈıÂÙÈÎfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È Û·Û̈‰È΋, ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È Î·Ù·ÛÙ¤ÏÏÂÙ·È Â‡ÎÔÏ· (29). ªfiÓÔ Ì›· ÌÂÈÔÓfiÙËÙ· ı˘Ì¿ÙˆÓ Ê·›ÓÂÙ·È Ó· ÚÔηÏ› ·ÓÙ·ÁˆÓÈÛÌfi Ì ÙË Û˘ÌÂÚÈÊÔÚ¿ Ù˘. ∏ ηÎÔÔ›ËÛË ·È‰ÈÒÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ À¿Ú¯Ô˘Ó ·ԉ›ÍÂȘ fiÙÈ Ù· ·È‰È¿ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ηÎÔÔ›ËÛË ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜. ∞˘Ù‹ Ë ·ÚÓËÙÈ΋ ÛÙ¿ÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÂÌfi‰ÈÔ

Paediatriki 2001;64:125-131

ÁÈ· ÙËÓ ÂÈÙ˘¯‹ ¤ÓÙ·Í‹ ÙÔ˘˜ ÛÙÔ Û¯ÔÏÈÎfi Û‡ÛÙËÌ·. ™ˆÌ·ÙÈΤ˜ ·Ó·Ëڛ˜: ∏ Èı·ÓfiÙËÙ· Ó· ηÎÔÔÈËı› ¤Ó· ·È‰› Ì ÂÌÊ·Ó‹ ۈ̷ÙÈ΋ ·Ó·ËÚ›·, fiˆ˜ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, Ì˘˚΋ ‰˘ÛÙÚÔÊ›·, ‰Èۯȉ‹ Ú¿¯Ë ‹ ·‰ÂÍÈfiÙËÙ·, Â›Ó·È ‰ÈÏ¿ÛÈ· ·˘Ù‹˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ, ·ÎfiÌË ÎÈ ·Ó ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ÓÔËÌÔÛ‡ÓË. ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· ‰È·ÈÛÙÒıËΠfiÙÈ ÛÙÔ ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ÌÔÚ› Ó· ηÎÔÔÈÂ›Ù·È ÙÔ 30% ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ. √È ÊÚ·ÛÙÈΤ˜ ÂÈı¤ÛÂȘ Û˘¯Ó¿ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ·Ó·ËÚ›·. √È Èı·ÓfiÙËÙ˜ ηÎÔÔ›ËÛ˘ Â›Ó·È ·˘ÍË̤Ó˜ ·Ó ÙÔ ·È‰›, ·Ú¿ÏÏËÏ· Ì ÙËÓ ·Ó·ËÚ›·, ¤¯ÂÈ Î·È Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ‹ Â›Ó·È ÎÔÈÓˆÓÈο ·ÔÌÔӈ̤ÓÔ Î·È ‰ÂÓ ¤¯ÂÈ Ê›ÏÔ˘˜ (30). ∞ÓÙÈı¤Ùˆ˜, fiÙ·Ó ÙÔ ·Ó¿ËÚÔ ·È‰› ¤¯ÂÈ ˘„ËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË, ÂÚÈÔÈË̤ÓË ÂÌÊ¿ÓÈÛË Î·È Â›Ó·È ÈηÓfi Ó· ÌÈÏ¿ÂÈ ·ÓÔȯٿ ÁÈ· ÙÔ Úfi‚ÏËÌ¿ ÙÔ˘, ÔÈ Èı·ÓfiÙËÙ˜ ηÎÔÔ›ËÛ˘ ÂÏ·ÙÙÒÓÔÓÙ·È (31). ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜: ∏ Û˘¯ÓfiÙËÙ· ηÎÔÔ›ËÛ˘ ·È‰ÈÒÓ Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Â›Ó·È ‰ÈÏ¿ÛÈ· ·˘Ù‹˜ ÙˆÓ ¿ÏÏˆÓ ·È‰ÈÒÓ (32). ∏ ÈÔ ÚÔÊ·Ó‹˜ ÂÚÌËÓ›· ·˘ÙÔ‡ ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Â›Ó·È fiÙÈ ÙÔ ·È‰› ıˆÚÂ›Ù·È ·fi ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘ ÓÔËÙÈο ηÙÒÙÂÚÔ. ∂ÈϤÔÓ fï˜, ·È‰È¿ Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔÓ ÙÔ̤· Ù˘ ÎÔÈÓˆÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜, ÂȉÈο (·ÏÏ¿ fi¯È ÌfiÓÔ) fiÙ·Ó Â›Ó·È ˘ÂÚÎÈÓËÙÈο (33). ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ÏfiÁÔ˘: ¶·È‰È¿ Ì ‰È·Ù·Ú·¯¤˜ ·ÓÙÈÏËÙÈÎÔ‡ ‹ ÂÎÊÚ·ÛÙÈÎÔ‡ ÏfiÁÔ˘ Î·È ÚÔ·ÓÙfi˜ Ù· ·È‰È¿ Ì ·ÒÏÂÈ· ·ÎÔ‹˜, Û˘¯Ó¿ ·ÔÚÚ›ÙÔÓÙ·È ·fi ¿ÏÏ· ·È‰È¿ (34). √ ÙÚ·˘ÏÈÛÌfi˜ Â›Ó·È Û¯ÂÙÈο ‹È· ‰È·Ù·Ú·¯‹, ·ÏÏ¿ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ì ·˘Ùfi ÙÔ Úfi‚ÏËÌ· ˘Ê›ÛÙ·Ù·È Î·Î‹ ÌÂÙ·¯Â›ÚÈÛË ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜. √È ÌÈÛÔ› ÂÓ‹ÏÈΘ, ÔÈ ÔÔ›ÔÈ ÙÚ·‡ÏÈ˙·Ó ˆ˜ ·È‰È¿, ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ÔÈ ·ÚÓËÙÈΤ˜ „˘¯ÔÏÔÁÈΤ˜ ÂÈÙÒÛÂȘ ·Ú·Ì¤ÓÔ˘Ó (35). ¢È·Ù·Ú·¯‹ ÚÔÛÔ¯‹˜: ¶·È‰È¿ Ì ‰È·Ù·Ú·¯‹ ÚÔÛÔ¯‹˜ ‰˘ÛÎÔχÔÓÙ·È Ó· ÂÈÎÂÓÙÚˆıÔ‡Ó Û ÛËÌ·ÓÙÈο ÂÚÂı›ÛÌ·Ù·, fi¯È ÌfiÓÔ Ì¤Û· ÛÙËÓ Ù¿ÍË ·ÏÏ¿ Î·È Û ÎÔÈÓˆÓÈΤ˜ ηٷÛÙ¿ÛÂȘ. ŒÙÛÈ, ÂÌÊ·Ó›˙ÔÓÙ·È ÂÁˆÎÂÓÙÚÈο Î·È ·‰È¿ÊÔÚ· Û ÎÔÈÓˆÓÈο ÌËӇ̷ٷ. §fiÁˆ ·ÚÔÚÌËÙÈÎfiÙËÙ·˜, ‰ÂÓ Â›Ó·È Èηӿ Ó· ÂϤÁÍÔ˘Ó Â·ÚÎÒ˜ ÙȘ ·ÓÙȉڿÛÂȘ ÙÔ˘˜ ÚÔ˜ ÙÔ˘˜ ¿ÏÏÔ˘˜. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù¿ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ·fiÚÚÈ„Ë Î·È Î·ÎÔÔ›ËÛË (33). ¶·È‰È¿ Ì ‰È·Ù·Ú·¯‹ ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Û˘¯Ó¿ ÂΉËÏÒÓÔ˘Ó ·ÔÛ·ÛÌ·ÙÈ΋ Î·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÈıÂÙÈÎfiÙËÙ·, Ë ÔÔ›· ÚÔηÏ› ·ÓÙȉڿÛÂȘ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘˜ (ÚÔÎÏËÙÈο ı‡Ì·Ù·) (29). √ÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË √ÈÎÔÁ¤ÓÂȘ ÂÈıÂÙÈÎÒÓ ·È‰ÈÒÓ: ŸÙ·Ó ÙÔ ·È‰› Û˘ÛÙËÌ·ÙÈο ηÎÔÔÈ› Û˘ÓÔÌ‹ÏÈÎÔ˘˜, ÔÈ Èı·ÓfiÙËÙ˜

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¶·È‰È·ÙÚÈ΋ 2001;64:125-131

Ó· ˘¿Ú¯Ô˘Ó ÎÔÈÓˆÓÈο/ÔÈÎÔÓoÌÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Â›Ó·È ÙÚÈÏ¿ÛȘ Û ۯ¤ÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, ÙÔ 50% ÙˆÓ ÂÈıÂÙÈÎÒÓ ·ÁÔÚÈÒÓ ‰ÂÓ Â›¯Â ·Ù¤Ú· ÛÙÔ Û›ÙÈ (15% Û ÔÌ¿‰· ÂϤÁ¯Ô˘) (3). ™ÙȘ ÂÓ‰ÔÔÈÎÔÁÂÓÂȷΤ˜ Û¯¤ÛÂȘ, ÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÛÙÔ ·È‰› ›ӷÈ: ·) Ë ¤ÏÏÂÈ„Ë ıÂÙÈÎÔ‡ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ ‰ÂÛÌÔ‡ ÙÔ˘ ÁÔÓ¤· Ì ÙÔ ·È‰›, ‚) ÔÈ ·˘Ù·Ú¯ÈΤ˜ ̤ıÔ‰ÔÈ ‰È··È‰·ÁÒÁËÛ˘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‡‚ÚÂȘ, ·ÂÈϤ˜ Î·È ÛˆÌ·ÙÈ΋ ‚›· Î·È Á) Ë ·ÓÂÎÙÈ΋ ÛÙ¿ÛË ·¤Ó·ÓÙÈ ÛÙË ‚›·ÈË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ (35). √ÈÎÔÁ¤ÓÂȘ ı˘Ì¿ÙˆÓ: √È ÔÈÎÔÁ¤ÓÂȘ ·˘Ù¤˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ·fi ¿ÏϘ, ·fi ¿Ô„Ë ÎÔÈÓˆÓÈÎÔ‡/ÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ (1). √È „˘¯ÔÏfiÁÔÈ ¤¯Ô˘Ó ·Ú·ÙËÚ‹ÛÂÈ fiÙÈ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ Û˘ÓÔÌ‹ÏÈÎÔ˘˜, Ù· ηÎÔÔÈË̤ӷ ·È‰È¿ Â›Ó·È ÈÔ Û˘Ó‰Â‰Â̤ӷ Ì ÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·ԉ›ÍÂȘ fiÙÈ Ë ˘ÂÚÚÔÛÙ·Û›· ηıÈÛÙ¿ ÙÔ ·È‰› ÈÔ Â˘¿ÏˆÙÔ. ∂›Ó·È Èı·Ófi, Ô ÁÔÓ¤·˜ Ó· Û˘ÓÂȉËÙÔÔÈ› ÙȘ ‰˘ÛÎÔϛ˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· ÚÔÛ·ı› Ó· ÙÔ ÚÔÛٷ٤„ÂÈ ·fi ÂÒ‰˘Ó˜ ÂÌÂÈڛ˜. ∂ÈϤÔÓ, ÙÔ ·È‰› Ô˘ ·ÔÚÚ›ÙÂÙ·È ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜ ·Ú·Ì¤ÓÂÈ ·Ó·ÁηÛÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ Û›ÙÈ (1,3). √ÈÎÔÁ¤ÓÂȘ ÚÔÎÏËÙÈÎÒÓ ı˘Ì¿ÙˆÓ: √È ÔÈÎÔÁ¤ÓÂȘ ·˘Ù¤˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÂÍ·ÈÚÂÙÈο ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· (38%) ¤ÎıÂÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Û ‚›· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (29). √È ÂÈÙÒÛÂȘ ÛÙËÓ ˘Á›· ∫·ÎÔÔÈË̤ӷ ·È‰È¿: ™Â Û‡ÁÎÚÈÛË Ì ÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘˜, Ù· ηÎÔÔÈË̤ӷ ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈÔ Û˘¯Ó¿ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË, ÎÂÊ·Ï·ÏÁ›Â˜, ·¸Ó›· Î·È ÂÓÔ‡ÚËÛË Û fiϘ ÙȘ Û¯ÔÏÈΤ˜ ËÏÈ˘ (37-40). ¡ÔÛÔ‡Ó ÈÔ Û˘¯Ó¿ ·fi ÈÒÛÂȘ Î·È ·ÊıÒ‰Ë ÛÙÔÌ·Ù›Ùȉ· Î·È ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ ·Ô˘Û›Â˜ ÏfiÁˆ ·Ûı¤ÓÂÈ·˜ (38,40). ™ÙË ™ÎˆÙ›·, ·Ó·ÛÎfiËÛË ÙˆÓ ÈÛÙÔÚÈÎÒÓ Û Â͈ÙÂÚÈο È·ÙÚ›· ÓÔÛÔÎÔÌ›Ԣ ¤‰ÂÈÍ fiÙÈ, Û ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜, ÙÔ 8% ÙˆÓ ·È‰È·ÙÚÈÎÒÓ Î·ÎÒÛÂˆÓ ÔÊÂÈÏfiÙ·Ó Û ‚›· ·fi ̤ÚÔ˘˜ ¿ÏÏˆÓ ·È‰ÈÒÓ (41). ∆Ô ¿ÙÔÌÔ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÛˆÛÙÚ¤ÊÂÈ· Î·È ¿Á¯Ô˜ Â›Ó·È ·fi ÙËÓ ·Ú¯‹ ÈÔ Â˘¿ÏˆÙÔ Û ÂÈı¤ÛÂȘ, fï˜ Ë ÂÌÂÈÚ›· Ù˘ ηÎÔÔ›ËÛ˘ ÂÈʤÚÂÈ ÚfiÛıÂÙ˜ ÂÈÙÒÛÂȘ. ™Â ÌÂϤÙ˜ fiÔ˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ·È‰È¿ ÓËÈ·ÁˆÁ›Ԣ ·fi ÙËÓ ·Ú¯‹ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ Û¯ÔÏÈÎÔ‡ ¤ÙÔ˘˜, ÂΛӷ Ù· ÔÔ›· ÛÙËÓ ÔÚ›· ηÎÔÔÈ‹ıËÎ·Ó ‰ÂÓ Â›¯·Ó ‰ËÏÒÛÂÈ ÛÙÂÓÔ¯ÒÚÈ· Î·È ·ÚÔı˘Ì›· Ó· ¿Ó ۯÔÏÂ›Ô ÛÙËÓ ·Ú¯‹ ÙÔ˘ ¤ÙÔ˘˜, ·ÏÏ¿ ÌfiÓÔ ·ÚÁfiÙÂÚ· (16). ∞Ó¿Ï˘ÛË ÌÂÏÂÙÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· ‰Â›¯ÓÂÈ fiÙÈ ·È‰È¿ ηÎÔÔÈË̤ӷ ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, Û ۇÁÎÚÈÛË Ì ¿ÏÏ· ·È‰È¿. ∆¤ÙÔÈ· ÚÔ‚Ï‹Ì·Ù·

128

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‰È·ÈÛÙÒÓÔÓÙ·È Î·È ÛÙ· ‰‡Ô ʇϷ, Û fiϘ ÙȘ ËÏÈ˘ Î·È Ì fiϘ ÙȘ ÌÔÚʤ˜ ηÎÔÔ›ËÛ˘ (38,44). √È ‰È·Ù·Ú·¯¤˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Â›Ó·È: ηٿıÏÈ„Ë, ·›ÛıËÌ· ÌÔÓ·ÍÈ¿˜, ¯·ÌËÏ‹ ·˘ÙoÂÎÙ›ÌËÛË Î·È ¿Á¯Ô˜ (18,27,39,40,45,46). ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, Ô Êfi‚Ô˜ ÁÈ· ÂÈı¤ÛÂȘ ·fi Û˘ÌÌ·ıËÙ¤˜ Â›Ó·È Ì›· ·fi ÙȘ ΢ÚÈfiÙÂÚ˜ ·Èٛ˜ ·Ô˘ÛÈÒÓ ·fi ÙÔ Û¯ÔÏÂ›Ô (47). ∂ÈıÂÙÈο ·È‰È¿: ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·ÌËÏfiÙÂÚË ÓÔÛËÚfiÙËÙ· ·fi Ù· ı‡Ì·Ù¿ ÙÔ˘˜, ·ÏÏ¿ ˘„ËÏfiÙÂÚË ·fi Ù· ˘fiÏÔÈ· ·È‰È¿ (38). ™Â ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ·È‰ÈÒÓ, Ë Û˘¯ÓfiÙËÙ· ·Óı˘ÁÈÂÈÓ‹˜ Î·È ÚÈ„ÔΛӉ˘Ó˘ Û˘ÌÂÚÈÊÔÚ¿˜ Â›Ó·È ·˘ÍË̤ÓË: οÓÈÛÌ·, ηٷӿψÛË ÔÈÓÔÓ‡̷ÙÔ˜, ¿ÚÓËÛË ¯Ú‹Û˘ ÎÚ¿ÓÔ˘˜ ‹ ˙ÒÓ˘ ·ÛÊ·Ï›·˜ ÛÙ· Ô¯‹Ì·Ù· (40). ∂›Û˘, ·Ú·¤ÌÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÁÈ· „˘¯È·ÙÚÈΤ˜ ÂÍÂÙ¿ÛÂȘ Û ۯ¤ÛË Ì ¿ÏÏ· ·È‰È¿ (44). ª·ÎÚÔÚfiıÂÛÌË ÚÔÔÙÈ΋ ™Â ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÂÈıÂÙÈο ·È‰È¿ Î·È ı‡Ì·Ù· ËÏÈΛ·˜ 8 ¤ˆ˜ 16 ÂÙÒÓ. ¢È·ÈÛÙÒıËΠfiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ÂΉËÏÒÓÂÈ ·˘Ù‹ ÙË Û˘ÌÂÚÈÊÔÚ¿, ÚÔ·ÓÙfi˜ fiÛÔÓ ·ÊÔÚ¿ Ù· ηÎÔÔÈË̤ӷ ·ÁfiÚÈ·. ∏ ‡·ÚÍË „˘¯Ô·ıÔÏÔÁ›·˜ Û ËÏÈΛ· 8 ÂÙÒÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂÈıÂÙÈÎfiÙËÙ·˜ ‹ ηÎÔÔ›ËÛ˘ ·fi ¿ÏÏÔ˘˜ ÛÙËÓ ÂÊ˂›· (49,50). ™ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, Ù· ·È‰È¿ Ô˘ ·ÔÚÚ›ÙÔÓÙ·È ·fi ÙÔ˘˜ Û˘ÓÔÌ‹ÏÈÎÔ‡˜ ÙÔ˘˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚ· „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (¿Á¯Ô˜, ηٿıÏÈ„Ë) Û ۇÁÎÚÈÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (51). ™Â ÚÔÔÙÈ΋ ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙË ¡ÔÚ‚ËÁ›· Û ÔÌ¿‰· ·ÁÔÚÈÒÓ Ô˘ ηÎÔÔÈÔ‡ÓÙ·Ó Û˘ÛÙËÌ·ÙÈο ·fi ÙËÓ ¤ÎÙË Ì¤¯ÚÈ ÙËÓ ¤Ó·ÙË Ù¿ÍË Î·È Â·ÓÂÍÂÙ¿ÛÙËÎ·Ó Û ËÏÈΛ· 23 ÂÙÒÓ, ‰È·ÈÛÙÒıËΠfiÙÈ ÏÂÈÙÔ˘ÚÁÔ‡Û·Ó ϤÔÓ ¯ˆÚ›˜ ȉȷ›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù·, ·ÏÏ¿ ›¯·Ó ¯·ÌËÏfiÙÂÚË ·˘ÙÔÂÎÙ›ÌËÛË Î·È ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ηٿıÏȄ˘ Û ۇÁÎÚÈÛË Ì ̿ÚÙ˘Ú˜ (49). ™Â ¿ÏÏË -·Ó·‰ÚÔÌÈ΋- ÌÂϤÙË Ì ÂÙÂÚfiÊ˘ÏÔ˘˜ ¿Ó‰Ú˜, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ‰˘ÛÎÔϛ˜ ÛÙȘ ÂÚˆÙÈΤ˜ ÙÔ˘˜ Û¯¤ÛÂȘ, ·Ú·ÙËÚ‹ıËΠfiÙÈ Û˘¯Ó¿ ‰‹ÏˆÓ·Ó ı‡Ì·Ù· ηÎÔÔ›ËÛ˘ ·fi Û˘ÓÔÌ‹ÏÈÎÔ˘˜ ÛÙ· ·È‰Èο ÙÔ˘˜ ¯ÚfiÓÈ· (51). ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ·È‰È¿ Ô˘ ηÎÔÔÈÔ‡Ó ¿ÏÏÔ˘˜ Ì·ı·›ÓÔ˘Ó fiÙÈ Ë ‚›· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÁÈ· ÙËÓ Â›Ù¢ÍË ‰È¿ÊÔÚˆÓ ÛÙfi¯ˆÓ. ™Â ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÛÙË ¡ÔÚ‚ËÁ›· Î·È ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, fiÔ˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó Ù¤ÙÔÈ· ·È‰È¿ ËÏÈΛ·˜ ̤¯ÚÈ 24 ÂÙÒÓ, ‚Ú¤ıËΠfiÙÈ Â›¯·Ó ÙÂÙÚ·Ï¿ÛÈ· Èı·ÓfiÙËÙ· ‰ÈηÛÙÈ΋˜ ηٷ‰›Î˘ ηıÒ˜ Î·È ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÂÌÏÔ΋˜ Û ηÎÔ˘ÚÁ‹Ì·Ù· (4,15). √ ÚfiÏÔ˜ ÙˆÓ ÁÔÓ¤ˆÓ ŸÙ·Ó ÔÈ ÁÔÓ›˜ ‰È·ÈÛÙÒÛÔ˘Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Ù˘¯·›ÓÂÈ Î·ÎÔÌÂÙ·¯Â›ÚÈÛ˘ ·fi ¿ÏÏ· ·È‰È¿, ˘¿Ú¯Ô˘Ó

2001 MAPT- A¶PI§

17-10-01 15:34

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¶·È‰È·ÙÚÈ΋ 2001;64:125-131

̤ÙÚ· Ô˘ ÌÔÚÔ‡Ó Ó· ¿ÚÔ˘Ó ÁÈ· Ó· ÂÓÈÛ¯‡ÛÔ˘Ó ÙËÓ ·˘ÙÔÂÔ›ıËÛË Î·È ÙȘ ÎÔÈÓˆÓÈΤ˜ ‰ÂÍÈfiÙËÙ¤˜ ÙÔ˘. ∞Ó ÙÔ ÂÈÙ‡¯Ô˘Ó, ÙÔ ·È‰› ‰ÂÓ ı· ‰›ÓÂÈ ÙËÓ ÂÓÙ‡ˆÛË Â‡ÎÔÏ˘ Ï›·˜ ÛÙ· ÂÈıÂÙÈο ·È‰È¿. ª¤ÙÚ· Ô˘ ¤¯Ô˘Ó ·Ô‰Âȯı› ·ÔÙÂÏÂÛÌ·ÙÈο (1,25,53-56) ›ӷÈ: ·) Ë ·Ó¿Ù˘ÍË Ù˘ ۈ̷ÙÈ΋˜ ‰‡Ó·Ì˘ Î·È ‰ÂÍÈfiÙËÙ·˜ ̤ۈ ·ıÏËÙÈÛÌÔ‡, ‚) Ë Î·ÏÏȤÚÁÂÈ· ÂȉÈÎÒÓ Ù·Ï¤ÓÙˆÓ Î·È Ë ·Ó¿Ù˘ÍË ÂӉȷÊÂÚfiÓÙˆÓ Ô˘ ‚ÔËıÔ‡Ó ÙÔ ¿ÙÔÌÔ Ó· ‰È·ÎÚÈı›, Á) Ë ÚÔÒıËÛË ÎÔÈÓˆÓÈÎÒÓ Â·ÊÒÓ ÙÔ˘ ·È‰ÈÔ‡ (.¯. ÊÈÏÔÍÂÓ›· ÛÙÔ Û›ÙÈ, ‰ÈÔÚÁ¿ÓˆÛË ÂΉÚÔÌÒÓ Ì ʛÏÔ˘˜), ‰) Ë ·ÔÊ˘Á‹ ˘ÂÚÚÔÛÙ·Û›·˜, ‰›ÓÔÓÙ·˜ ÛÙÔ ·È‰› ÙËÓ Â˘Î·ÈÚ›· Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ Î·Ù·ÛÙ¿ÛÂȘ ÌfiÓÔ ÙÔ˘ fiÔÙ ÌÔÚ›, Â) Ë Û˘ÛÙËÌ·ÙÈ΋ ηıÔ‰‹ÁËÛË ÁÈ· ÙËÓ ·fiÎÙËÛË ÎÔÈÓˆÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ·˘ÙÔÂÔ›ıËÛË Î·È ÊÈÏÈÎfiÙËÙ· (Ì ÂÍ¿ÛÎËÛË ÛÙÔ ·ÛʷϤ˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ) Î·È ÛÙ) Ë Â·Ê‹ Ì ÙÔ Û¯ÔÏÂ›Ô (ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ¢·›ÛıËÙÔ˘ Î·È ‰È·ÎÚÈÙÈÎÔ‡ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÁÈ· ‚Ô‹ıÂÈ·). ™ÙËÓ ·È‰·ÁˆÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÈıÂÙÈÎÒÓ ·È‰ÈÒÓ ¤¯ÂÈ ·ÊÈÂÚˆı› ¿ÊıÔÓË ‚È‚ÏÈÔÁÚ·Ê›·. √È ‚·ÛÈΤ˜ ·Ú¯¤˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Â›Ó·È (1,3): ·) ·ÔÊ˘Á‹ Ù˘ ÊÚ·ÛÙÈ΋˜ Î·È ÛˆÌ·ÙÈ΋˜ ‚›·˜ ÛÙÔ Û›ÙÈ, ‚) ηÏÏȤÚÁÂÈ· Îϛ̷ÙÔ˜ ·Á¿˘ Î·È ·Ô‰Ô¯‹˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, Á) ı¤ÛÈÛË Û·ÊÒÓ ÔÚ›ˆÓ ·Ô‰ÂÎÙ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜, ‰) ÂÓ›Û¯˘ÛË Ù˘ ÂÈı˘ÌËÙ‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ·È‰ÈÔ‡ Ì Â·›ÓÔ˘˜ Î·È ÂÈ‚Ú¿‚¢ÛË Î·È Â) ·Ôı¿ÚÚ˘ÓÛË Ù˘ ‚›·È˘ Û˘ÌÂÚÈÊÔÚ¿˜, Ì ÙÈ̈ڛ˜ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È ÌÂ Û˘Ó¤ÂÈ·. ŸÏÔÈ ÔÈ ÂӉȷÊÂÚfiÌÂÓÔÈ ÁÔÓ›˜ ÔÊ›ÏÔ˘Ó Ó· ·Ó·˙ËÙÔ‡Ó ‚Ô‹ıÂÈ· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂӉ¯fiÌÂÓˆÓ Ì·ıËÛÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Î·È Û ÂȉÈΤ˜ ÂÚÈÙÒÛÂȘ Ó· ÚÔÛʇÁÔ˘Ó Î·È ÛÙȘ ˘ËÚÂۛ˜ „˘¯È΋˜ ˘Á›·˜. √ ÚfiÏÔ˜ ÙÔ˘ Û¯ÔÏ›Ԣ ¶ÚÈÓ ·fi 30 ¯ÚfiÓÈ·, Ô ¡ÔÚ‚ËÁfi˜ ηıËÁËÙ‹˜ „˘¯ÔÏÔÁ›·˜ Dan Olweus ˘ÔÛÙ‹ÚÈÍ ÙË ı¤ÛË fiÙÈ “Â›Ó·È ıÂÌÂÏÈ҉˜ ‰ËÌÔÎÚ·ÙÈÎfi ‰Èη›ˆÌ· ÙÔ˘ οı ·È‰ÈÔ‡ Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ˙ˆ‹ ÙÔ˘ Û¯ÔÏ›Ԣ ¯ˆÚ›˜ Ó· ·ÚÂÓԯϛٷȔ (1). ŒÎÙÔÙÂ, ¿Ú¯ÈÛ ӷ ÂÈÎÚ·Ù› Ë ¿Ô„Ë fiÙÈ ÔÈ ÂÓ‹ÏÈΘ ¤¯Ô˘Ó ¢ı‡ÓË ÁÈ· ÙËÓ ÂÈÙ‹ÚËÛË ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ Û˘Ó·ÏÏ·ÁÒÓ ÌÂٷ͇ ·È‰ÈÒÓ. ∆· ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ηÎÔÔ›ËÛ˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ Û¯ÔÏÂ›Ô ‹ ÛÙË ‰È·‰ÚÔÌ‹ ÚÔ˜ ·˘Ùfi. ¢ÂÓ Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ̤۷ Û’ ¤Ó· ÎÂÓfi, ·ÏÏ¿ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙË ÛÙ¿ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Î·È ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì·ıËÙÒÓ. ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, ·’ fiÏÔ˘˜ ÙÔ˘˜ Û¯ÔÏÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› (ÎÔÈÓˆÓÈÎfi-ÔÈÎÔÓoÌÈÎfi Â›Â‰Ô ÙˆÓ Ì·ıËÙÒÓ, ̤ÁÂıÔ˜ ÙÔ˘ Û¯ÔÏ›Ԣ, ·ÚÈıÌfi˜ Ì·ıËÙÒÓ ÛÙËÓ Ù¿ÍË Î·È ¿ÏÏ·), ‚Ú¤ıËΠfiÙÈ Ë ÛÙ¿ÛË ÙÔ˘ Û¯ÔÏÈÎÔ‡ ÚÔÛˆÈÎÔ‡ ·ÔÙÂÏ› ÙÔÓ ÈÔ ÛËÌ·ÓÙÈÎfi. ™¯ÔÏ›·, ÙˆÓ ÔÔ›ˆÓ ÙÔ ÚÔÛˆÈÎfi ¤¯ÂÈ Û·Ê‹ ·ÚÓËÙÈ΋ ÛÙ¿ÛË ·¤Ó·-

Paediatriki 2001;64:125-131

ÓÙÈ ÛÙË ‚›· ÌÂٷ͇ ÙˆÓ Ì·ıËÙÒÓ, ÂȂϤÂÈ Ù· ·È‰È¿ ÛÙ· ‰È·Ï›ÌÌ·Ù· Î·È ıˆÚ› fiÙÈ ¤¯ÂÈ Î·ı‹ÎÔÓ Ó· ·Ú¤Ì‚ÂÈ, Û¯ÔÏ›· ¤¯Ô˘Ó ÙË ¯·ÌËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ηÎÔÔ›ËÛ˘ (1,3,49). ∞·ÓÙÒÓÙ·˜ Û ÂÚˆÙËÌ·ÙÔÏfiÁÈ·, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Ì·ıËÙ¤˜ ÂÎÊÚ¿˙Ô˘Ó ·ÚÓËÙÈο Û˘Ó·ÈÛı‹Ì·Ù· ÁÈ· ÙËÓ Î·ÎÔÔ›ËÛË ÌÂٷ͇ ·È‰ÈÒÓ, ·ÏÏ¿ ÔÌÔÏÔÁÔ‡Ó fiÙÈ ‰ÂÓ ÚÔÛ·ıÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÙÔ ı‡Ì· ‹ Ó· ·Ó·Ê¤ÚÔ˘Ó ÙÔ ÂÚÈÛÙ·ÙÈÎfi Û ÂÓ‹ÏÈΘ. ∆· ·È‰È¿ ı· ‹ıÂÏ·Ó Ó· ·ÚÂÌ‚·›ÓÔ˘Ó ÔÈ ÂÓ‹ÏÈΘ, ·ÏÏ¿ ‰ÂÓ ÈÛÙÂ‡Ô˘Ó fiÙÈ ÂΛÓÔÈ ÂӉȷʤÚÔÓÙ·È (57). ™ÙË ¡ÔÚ‚ËÁ›· ÂÊ·ÚÌfiÛÙËΠ·ÚÂÌ‚·ÙÈÎfi ÚfiÁÚ·ÌÌ· ÛÙ· Û¯ÔÏ›· fiÏ˘ Ù˘ ¯ÒÚ·˜ Ì ‚¿ÛË ÙËÓ ·Ú¯‹ fiÙÈ “ÙÔ Û¯ÔÏÂ›Ô ¤¯ÂÈ Â˘ı‡ÓË ÁÈ· ÙË Û˘ÓÔÏÈ΋ Û¯ÔÏÈ΋ ÂÌÂÈÚ›· ÙˆÓ Ì·ıËÙÒÓ”. ∏ Û˘¯ÓfiÙËÙ· ηÎÔÔ›ËÛ˘ ÌÂٷ͇ Ì·ıËÙÒÓ ÌÂÈÒıËΠηٿ 50% Û ‰‡Ô ¯ÚfiÓÈ· (48). ¶ÔÏÏ¿ ÚÔÁÚ¿ÌÌ·Ù· ¤¯Ô˘Ó ·ÎÔÏÔ˘ı‹ÛÂÈ Î·È Û ¿ÏϘ ¯ÒÚ˜, ΢ڛˆ˜ ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, Ì ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· (57,58). ∆Ô Û¯ÔÏ›Ô, Â›Û˘, ÌÔÚ› Ó· ÚÔˆı‹ÛÂÈ ÙË ıÂÙÈ΋ ÛÙ¿ÛË ÙˆÓ ·È‰ÈÒÓ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ Û˘ÌÌ·ıËÙ¤˜ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ Ú·ÁÌ·ÙÔÔÈÒÓÙ·˜: ·) ÂÓË̤ڈÛË ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ÙˆÓ ·ÙfiÌˆÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ ̤ۈ Ù˘ Û¯ÔÏÈ΋˜ ‡Ï˘ Î·È ıÂÙÈÎÒÓ ·Ó·ÊÔÚÒÓ Û ٤ÙÔÈ· ¿ÙÔÌ· ÛÙË ÏÔÁÔÙ¯ӛ· Î·È ‚) ÚÔÒıËÛË ÙˆÓ Â·ÊÒÓ ÌÂٷ͇ “Ê˘ÛÈÔÏÔÁÈÎÒÓ” ·È‰ÈÒÓ Î·È ÂÎÂ›ÓˆÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ, fiÔ˘ fiÏÔÈ Û˘ÌÌÂÙ¤¯Ô˘Ó ÈÛfiÙÈÌ· Û ̛· ÔÈÎÈÏ›· ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ (ÔÌ·‰ÈΤ˜ ÂÈÛÙËÌÔÓÈΤ˜ Î·È ÔÏÈÙÈÛÙÈΤ˜ ÚÔÛ¿ıÂȘ ·ÓÙ› ÙÔ˘ Û˘Ó·ÁˆÓÈÛÌÔ‡) (31,59,60). √ ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ™ÙÔÓ È·ÙÚÈÎfi Ù‡Ô Ù˘ ªÂÁ¿Ï˘ µÚÂÙ·Ó›·˜ ÙÔÓ›˙ÂÙ·È Ù·ÎÙÈο fiÙÈ Ô ·È‰›·ÙÚÔ˜ ¤¯ÂÈ “ηı‹ÎÔÓ” Ó· ÂӉȷʤÚÂÙ·È ÁÈ· ÙȘ Û¯¤ÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ ÌÂ Û˘ÓÔÌ‹ÏÈÎÔ˘˜ ηıÒ˜ Î·È Ó· ˘Ô„È¿˙ÂÙ·È ÙËÓ Èı·Ó‹ ‡·ÚÍË ÚÔ‚ÏËÌ¿ÙˆÓ Û ·È‰È¿ Ì „˘¯Ôۈ̷ÙÈο Û˘ÌÙÒÌ·Ù· ‹ Û˘¯Ó¤˜ ηÎÒÛÂȘ (2,3,58). ToÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1999, Ë ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ ‰ËÌÔÛ›Â˘Û ‰‹ÏˆÛË (Policy Statement), ÛÙËÓ ÔÔ›· ¤ÙÚÂ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ó· ·Ó·Ï¿‚Ô˘Ó Â˘ı‡ÓË ÁÈ· ÙËÓ ÚfiÏË„Ë, ·Ó›¯Ó¢ÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‚›·È˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÂΠ̤ÚÔ˘˜ ·È‰ÈÒÓ Î·È ÓÂÔÏ·›·˜ (61). ™ÙÔ “Pediatrics in Review” (Ù‡¯Ô˜ πÔ˘Ó›Ô˘ 2000), ·ÚÔ˘ÛÈ¿ÛÙËΠÁÈ· ÚÒÙË ÊÔÚ¿ ·Ó·ÛÎfiËÛË ÙÔ˘ ı¤Ì·ÙÔ˜ (62). √ ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ·›ÍÂÈ ıÂÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚÔ·ÁˆÁ‹ ˘ÁÈÔ‡˜ ÎÔÈÓˆÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙ· ·È‰È¿ Ì ÔÈΛÏÔ˘˜ ÙÚfiÔ˘˜ Î·È Û fiÏ· Ù· ÛÙ¿‰È· Ù˘ ·Ó¿Ù˘Í‹˜ ÙÔ˘˜ (2,57,61): (·) ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ÎÔÈÓˆÓÈÎfi ÈÛÙÔÚÈÎfi ‰È·ÈÛÙÒÓÂÈ ·Ó ˘¿Ú¯Ô˘Ó ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÛÙÔ ·È‰› Î·È ‰›ÓÂÈ È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË Û˘Ì‚Ô˘Ï¢ÙÈ΋, (‚) ·Ú·ÎÔÏÔ˘ı› ÛÙÂÓ¿ ÙËÓ

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ÎÔÈÓˆÓÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ, (Á) ÛÙ· Ï·›ÛÈ· Ù·ÎÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó ÛÙÔ È·ÙÚÂ›Ô ÛËÌ›· ˘ÂÚ‚ÔÏÈο ÂÈıÂÙÈ΋˜ ‹ Û˘ÓÂÛÙ·Ï̤Ó˘ Û˘ÌÂÚÈÊÔÚ¿˜ Ô˘ ÂӉ¯Ô̤ӈ˜ Ó· Úԉȷı¤ÙÔ˘Ó ÁÈ· ÚÔ‚Ï‹Ì·Ù·, (‰) Ë ÂͤٷÛË ·È‰ÈÒÓ Ì ηÎÒÛÂȘ, ÚÔ·ÓÙfi˜ fiÙ·Ó ¤¯Ô˘Ó ÚÔÎÏËı› ÛÙÔ Û¯ÔÏ›Ô, Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚˆÙ‹ÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙȘ ÂÚÈÛÙ¿ÛÂȘ Î·È fi¯È ÌfiÓÔ ÙÔ Ì˯·ÓÈÛÌfi Ù˘ οΈÛ˘, (Â) ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· Û˘ÌÙÒÌ·Ù·, fiˆ˜ ÎÔÈÏȷο ¿ÏÁË, ÎÂÊ·Ï·ÏÁ›Â˜ Î·È ÂÓÔ‡ÚËÛË, ˘Ô‚¿ÏÏÔÓÙ·È Û ÂÍÂÙ¿ÛÂȘ ÁÈ· ÔÚÁ·ÓÈÎfi Úfi‚ÏËÌ·. ŸÙ·Ó Ô ¤ÏÂÁ¯Ô˜ ·Ԃ› ·ÚÓËÙÈÎfi˜ ‹ ‰ÂÓ ‰ÈηÈÔÏÔÁ› ÙËÓ ¤ÓÙ·ÛË ÙˆÓ Û˘Ìو̿وÓ, Ë ÚÔÛÔ¯‹ ÂÛÙÈ¿˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Û „˘¯ÔÎÔÈÓˆÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∆Ô ·È‰› Ú¤ÂÈ Ó· ÂÚˆÙËı› ÁÈ· ÙȘ Û¯¤ÛÂȘ ÙÔ˘ ÌÂ Û˘ÓÔÌ‹ÏÈÎÔ˘˜ Î·È Ë Ù˘¯fiÓ ·Ó·ÊÂÚfiÌÂÓË ·fiÚÚÈ„Ë ‹ ηÎÔÔ›ËÛË Ó· ÏËÊı› ÛÔ‚·Ú¿ ˘fi„Ë, (ÛÙ) fiÙ·Ó ÙÔ ·È‰› ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘ÌÙÒÌ·Ù· ¿Á¯Ô˘˜ ‹ ηٿıÏȄ˘ ·Ó·˙ËÙÔ‡ÓÙ·È ÔÈ ·Èٛ˜, (˙) fiÙ·Ó ÙÔ ·È‰› ·Ô˘ÛÈ¿˙ÂÈ Ôχ Û˘¯Ó¿ ·fi ÙÔ Û¯ÔÏÂ›Ô ‹ ·ÚÔ˘ÛÈ¿˙ÂÈ ‚·ıÌÈ·›· ÙÒÛË ÛÙËÓ ·fi‰ÔÛ‹ ÙÔ˘, Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Ë Èı·ÓfiÙËÙ· ηÎÔÔ›ËÛ˘ ·fi Û˘ÌÌ·ıËÙ¤˜ Î·È (Ë) fiÙ·Ó ÎÚ›ÓÂÙ·È ·Ó·Áη›· Ë ·Ú·ÔÌ‹ Û „˘¯ÔÏfiÁÔ ‹ ÎÔÈÓˆÓÈÎfi ÏÂÈÙÔ˘ÚÁfi, ÌÔÚ› Ó· ‰È¢ÎÔχÓÂÈ ÙË ‰È·‰Èηۛ· Î·È Ó· ‚ÔËı‹ÛÂÈ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Ó· ÙÔ ·ÓÙÈÏËÊı› ˆ˜ Úfi‚ÏËÌ· ˘Á›·˜. ™˘Ì¤Ú·ÛÌ· ∏ ηÎÔÔ›ËÛË ·È‰ÈÒÓ ·fi ¿ÏÏ· ·È‰È¿ Â›Ó·È ¤Ó· ·ÚÓËÙÈÎfi ÎÔÈÓˆÓÈÎfi Ê·ÈÓfiÌÂÓÔ, ÛÙÔ ÔÔ›Ô ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰Ôı› Ë Ú¤Ô˘Û· ÚÔÛÔ¯‹. ™¯ÂÙ›˙ÂÙ·È Ì ‰˘ÛÌÂÓ›˜ ÂÈÙÒÛÂȘ ÁÈ· ÙË ÛˆÌ·ÙÈ΋ Î·È „˘¯È΋ ˘Á›· ÙˆÓ ÂÌÏÂÎfiÌÂÓˆÓ. ∂Âȉ‹ Ù· ı‡Ì·Ù· Û˘Ó‹ıˆ˜ ‰ÂÓ ·Ó·Ê¤ÚÔ˘Ó ÙÔ Úfi‚ÏËÌ·, ··ÈÙÂ›Ù·È Û˘Ó¯‹˜ Â·ÁÚ‡ÓËÛË Î·È ÂÈÙ‹ÚËÛË ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÔÓ¤ˆÓ, ‰·ÛÎ¿ÏˆÓ Î·È ·È‰È¿ÙÚˆÓ. ∏ ·ÔÎ¿Ï˘„Ë ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Â›Ó·È ÛÎfiÈÌË, ÁÈ·Ù› ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·Ú¤Ì‚·ÛË. ™ÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ¤¯ÂÈ Á›ÓÂÈ ϤÔÓ ·Ô‰ÂÎÙfi fiÙÈ Ë Î·ÎÔÔ›ËÛË ·È‰ÈÒÓ ·fi ¿ÏÏ· ·È‰È¿ ·ÔÙÂÏ› ·È‰È·ÙÚÈÎfi Úfi‚ÏËÌ·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Olweus D. Bullying at school. London: Blackwell Publishers, Ltd; 1993. p.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-09-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-12-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÙÔÏfiÚ˜ ¶ÚˆÙ·ÁfiÚ·-§È·ÓÔ‡ ¢ÈÔÓ‡ÛÔ˘ 15, ∫¿ÓÙ˙· ∞ÙÙÈ΋˜, 153 51 E-mail: Sophieirene53@hotmail.com

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ORIGINAL PAPER

¢Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙÔ ¡ÔÌfi ∫ÔÚÈÓı›·˜ ∂. ¶··‚·ÛÈÏ›Ԣ1, µ. ∫¿ÏÏÈÔ˘1, ¡. ∫·Ì¿˜2

The tubercular infection index among pre-school age children in the district of Korinthos ∂. ¶··‚·ÛÈÏ›Ԣ1, µ. ∫¿ÏÏÈÔ˘1, ¡. ∫·Ì¿˜2

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ‰Â›ÎÙË ‰È·ÌfiÏ˘ÓÛ˘ Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙÔ ¡. ∫ÔÚÈÓı›·˜. ¶‹Ú·Ó ̤ÚÔ˜ 248 ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ (180 ŒÏÏËÓ˜, 68 ·ÏÏÔ‰·Ô›), ÛÙ· ÔÔ›· ¤ÁÈÓ ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux. §·Ì‚¿ÓÔÓÙ·˜ ˆ˜ ·ÚÓËÙÈ΋ ÙË ‰È‹ıËÛË 0-4 mm, ·ÌÊ›‚ÔÏË ÙË ‰È‹ıËÛË 5-9 mm Î·È ıÂÙÈ΋ ÂΛÓË Ô˘ Â›Ó·È ≥10 mm, ‰È·ÈÛÙÒÛ·Ì fiÙÈ Ô ‰Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙÔ ¡. ∫ÔÚÈÓı›·˜ Â›Ó·È ¯·ÌËÏfi˜, ‰ËÏ. 1,2%. ∆Ô ÔÛÔÛÙfi ·˘Ùfi ÔÊ›ÏÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ ·ÏÏÔ‰·fi ÏËı˘ÛÌfi Ù˘ fiÏ˘ Ì·˜.

Abstract: The aim of this study was to determine the tubercular infection index in the district of Korinthos. We studied 248 children of pre-school age (180 Greeks, 68 immigrants) in whom we performed the Mantoux test. We considered as negative reaction a diameter of 0-4 mm, uncertain reaction a diameter of 5-9 mm, and positive reaction a diameter ≥10 mm. We conclude that the tubercular infection index in Korinthos is low (1,2%) and it is primarily due to the immigrant population of our town.

§¤ÍÂȘ ÎÏÂȉȿ: Ê˘Ì·Ù›ˆÛË, ‰Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘, ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux.

Key words: tuberculosis, pre-school tubercular infection index, Mantoux test.

∂ÈÛ·ÁˆÁ‹ H Ê˘Ì·Ù›ˆÛË ÛÎÔÙÒÓÂÈ 2.000.000 ·ÓıÚÒÔ˘˜ οı ¯ÚfiÓÔ. ∏ Ù·¯‡ÙËÙ· ÂÍ¿ψÛ˘ ÙÔ˘ AIDS, Ë ·ÓıÈÛÙ¿ÌÂÓË ÛÙË Û˘Ó‰˘·Ṳ̂ÓË ıÂÚ·›· Ê˘Ì·Ù›ˆÛË Î·È Ë ·‡ÍËÛË Ù˘ ÌÂٷΛÓËÛ˘ ÙÔ˘ ÏËı˘ÛÌÔ‡, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ Âȉ›ӈÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘. ªÂٷ͇ ÙˆÓ ÂÙÒÓ 2000 Î·È 2020, ÂÚ›Ô˘ 1 ‰ÈÛÂηÙÔÌ̇ÚÈÔ ¿ÓıÚˆÔÈ ı· ¤¯Ô˘Ó ÌÔÏ˘Óı›, 200 ÂηÙÔÌ̇ÚÈ· ¿ÓıÚˆÔÈ ı· ·ÚÚˆÛÙ‹ÛÔ˘Ó Î·È 35 ÂηÙÔÌ̇ÚÈ· ı· Âı¿ÓÔ˘Ó ·fi Ê˘Ì·Ù›ˆÛË, ·Ó Ô ¤ÏÂÁ¯Ô˜ ‰ÂÓ Á›ÓÂÈ ·˘ÛÙËÚfiÙÂÚÔ˜. ™‡Ìʈӷ Ì ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜, οı ¯ÚfiÓÔ ÂÚ›Ô˘ ÙÔ 1% ÙÔ˘ ·ÁÎfiÛÌÈÔ˘ ÏËı˘ÛÌÔ‡ ÌÔχÓÂÙ·È ·fi Ê˘Ì·Ù›ˆÛË, ÂÓÒ ÙÔ 5-10% ÙˆÓ ·Ó-

ıÚÒˆÓ Ô˘ ›¯·Ó ÌÔÏ˘Óı›, ı· ·ÚÚˆÛÙ‹ÛÔ˘Ó Î¿ÔÈ· ÛÙÈÁÌ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ (1). ™ÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ·Ú·ÙËÚÂ›Ù·È Ì›· ÛËÌ·ÓÙÈ΋ ‡ÊÂÛË Î·È ÌÂٷΛÓËÛË Ù˘ Ê˘Ì·Ù›ˆÛ˘ ·fi ÙËÓ ·È‰È΋ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (2). ∏ Èı·ÓfiÙËÙ· ÂÍ¿ÏÂȄ˘ Ù˘ ÓfiÛÔ˘ Ê·ÈÓfiÙ·Ó Ú·ÁÌ·ÙÔÔÈ‹ÛÈÌË, Ë ·‡ÍËÛË, fï˜, ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÙÔ˘ AIDS Î·È Ù˘ ÌÂٷΛÓËÛ˘ ÏËı˘ÛÌÒÓ ·fi ¯ÒÚ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ·Ó‚¿˙Ô˘Ó ÙÔ ÔÛÔÛÙfi ÙˆÓ Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·Ù¿ 0-30%. ™ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ë Î·Ù¿ÛÙ·ÛË Â›Ó·È ‰Ú·Ì·ÙÈ΋. √ Ê˘Ì·ÙÈÓÈÎfi˜ ‰Â›ÎÙ˘ ηχÙÂÈ ¿Óˆ ·fi Ù· 2/3 ÙÔ˘ ÏËı˘ÛÌÔ‡. π‰È·›ÙÂÚÔ Úfi‚ÏËÌ· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÔÈ ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Ô˘

°ÂÓÈÎfi ¡Ô̷گȷÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫ÔÚ›ÓıÔ˘ 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ 2 °˘Ó·ÈÎÔÏÔÁÈ΋ - ª·È¢ÙÈ΋ ∫ÏÈÓÈ΋

132

General Prefecture Hospital of Korinthos 1 Pediatric Clinic 2 Obstetrics - Gynecology Clinic

age,

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‚Ú›ÛÎÔÓÙ·È Î¿Ùˆ ·fi ÙË ™·¯¿Ú·, fiÔ˘ 1.500.000 ÂÚÈÙÒÛÂȘ Ê˘Ì·Ù›ˆÛ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î¿ı ¯ÚfiÓÔ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂȉËÌ›·˜ ÙÔ˘ AIDS (1,3-5). π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ÁÈ· ÙË ¯ÒÚ· Ì·˜ ·ÔÙÂÏÔ‡Ó Ù· Ó¤· ÂÚÈÛÙ·ÙÈο Î·È ÔÈ ı¿Ó·ÙÔÈ ·fi Ê˘Ì·Ù›ˆÛË ÛÙȘ ¯ÒÚ˜ Ù˘ ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙȘ ¯ÒÚ˜ ·˘Ù¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÙÔ ¯ÚfiÓÔ 250.000 ÂÚÈÙÒÛÂȘ Ê˘Ì·Ù›ˆÛ˘ (1). ∆· ÛÙÔȯ›· ·˘Ù¿, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·‡ÍËÛË Ù˘ ÌÂٷΛÓËÛ˘ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÏËı˘ÛÌÒÓ ÛÙËÓ ∂ÏÏ¿‰· Î·È È‰È·›ÙÂÚ· ÛÙËÓ fiÏË Ù˘ ∫ÔÚ›ÓıÔ˘, ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ·ÊÔÚÌ‹ Ù˘ ÌÂϤÙ˘ Ì·˜ Ì ÛÎÔfi ÙËÓ Î·Ù·ÁÚ·Ê‹ Î·È ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ‰Â›ÎÙË ‰È·ÌfiÏ˘ÓÛ˘ Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘, Ì ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·ÏÏÔ‰·ÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË Ì·˜, Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠηٿ ÙËÓ ÂÚ›Ô‰Ô ÙÔ˘ ¤ÙÔ˘˜ 1999, ‹Ú·Ó ̤ÚÔ˜ 248 ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ 4-6 ¯ÚfiÓˆÓ (180 ∂ÏÏËÓfiÔ˘Ï·, 68 ·ÏÏÔ‰·Ô›) ·fi 6 ÎÚ·ÙÈÎÔ‡˜ Î·È 2 ȉȈÙÈÎÔ‡˜ ‚ÚÂÊÔÓËÈ·ÎÔ‡˜ ÛÙ·ıÌÔ‡˜. ∆· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜ ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÙÔ 12% ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙ· ÚÔ·Ó·ÊÂÚı¤ÓÙ· ËÏÈÎȷο Ï·›ÛÈ· ÙÔ˘ ¡ÔÌÔ‡ ∫ÔÚÈÓı›·˜ (ÌË Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·ı›ÁÁ·ÓˆÓ). ŒÁÈÓ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ÙÔÌÈÎÒÓ ‚È‚ÏÈ·Ú›ˆÓ ˘Á›·˜ Ì ÛÎÔfi Ó· ‰È·ÈÛÙˆı› Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ‹ fi¯È Ì BCG. ™ÙË Û˘Ó¤¯ÂÈ·, ¯ÔÚËÁ‹Û·Ì ÂÓ‰Ô‰ÂÚÌÈο ÛÙÔ Ì¤ÛÔ Ù˘ ηÌÙÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ·ÓÙÈ‚Ú·¯›Ô˘ 0,1 ml ÎÂηı·Ṳ́Ó˘ Ê˘Ì·Ù›Ó˘ PPD ÙÔ˘ ÈÓÛÙÈÙÔ‡ÙÔ˘ Pasteur ÂÚÈÂÎÙÈÎfiÙËÙ·˜ 5 ÌÔÓ¿‰ˆÓ ·Ó¿ 0,1 ml. ¢ËÌÈÔ˘ÚÁ‹ıËΠÔÌÊfi˜ 6-10 mm. ∆· ·ÔÙÂϤÛÌ·Ù· ÂϤÁ¯ıËÛ·Ó ÌÂÙ¿ ·fi 48 ÒÚ˜. §¿‚·Ì ˆ˜ ·ÚÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙË ‰È‹ıËÛË 0-4 mm, ˆ˜ ·ÌÊ›‚ÔÏÔ ÙË ‰È‹ıËÛË 5-9 mm Î·È ˆ˜ ıÂÙÈÎfi ÙË ‰È‹ıËÛË Ô˘ ‹Ù·Ó ≥10 mm. ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô ¯2.

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 248 ·È‰ÈÒÓ, Ù· 236 ›¯·Ó ·ÚÓËÙÈ΋ Mantoux, ÔÛÔÛÙfi 95,2%, ¤Ó·ÓÙÈ 12 ·È‰ÈÒÓ Ì ıÂÙÈ΋ Mantoux Î·È ÔÛÔÛÙfi 4,8% (∂ÈÎfiÓ· 1). √ ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ ·Ó¿ ÂıÓÈÎfiÙËÙ· Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 2. ™˘ÁÎÂÎÚÈ̤ӷ, ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 180 ∂ÏÏËÓÔ·›‰ˆÓ Ù˘ ÌÂϤÙ˘ Ì·˜, Ù· 175 ›¯·Ó ·ÚÓËÙÈ΋ Mantoux (ÔÛÔÛÙfi 97,2%) Î·È 5 ·ÚÔ˘Û›·Û·Ó ıÂÙÈ΋ Mantoux (ÔÛÔÛÙfi 2,8%). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 68 ·ÏÏÔ‰·ÒÓ, Ù· 61 ›¯·Ó ·ÚÓËÙÈ΋ Mantoux (ÔÛÔÛÙfi 90%) Î·È 7 ·ÚÔ˘Û›·Û·Ó ıÂÙÈ΋ Mantoux (ÔÛÔÛÙfi 10%) (¶›Ó·Î·˜ 1). §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë Ù· ‚È‚Ï›· ÙˆÓ Â͈ÙÂÚÈÎÒÓ È·ÙÚ›ˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÎÏÈÓÈ΋˜, ÙÔ 90% ÙˆÓ ÂÍÂÙ·˙fiÌÂÓˆÓ ·ÏÏÔ‰·ÒÓ Â›Ó·È ∞Ï‚·ÓÔ›.

Paediatriki 2001;64:132-135

4,80%

95,20% ∞ÚÓËÙÈ΋

£ÂÙÈ΋

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙ¿ ·ÔÙÂϤÛÌ·ÙÔ˜ ‰ÂÚÌÔ·ÓÙ›‰Ú·Û˘ Mantoux.

∞fi Ù· 12 ·È‰È¿ (ŒÏÏËÓ˜ Î·È ·ÏÏÔ‰·Ô›) Ô˘ ·ÚÔ˘Û›·Û·Ó ıÂÙÈ΋ Mantoux (¶›Ó·Î·˜ 1), Ù· 9 ›¯·Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ÂÌ‚ÔÏÈ·ÛÙ› Ì ÂÌ‚fiÏÈÔ BCG (·ÚÔ˘Û›·Û·Ó Ê˘ÛÈÔÏÔÁÈÎÒ˜ ıÂÙÈ΋ Mantoux) Î·È ÔÛÔÛÙfi 3,6%, ÂÓÒ ·ıÔÏÔÁÈÎÒ˜ ıÂÙÈ΋ ·ÚÔ˘Û›·Û·Ó 3 ·È‰È¿ (·ÏÏÔ‰·Ô›), ÔÛÔÛÙfi 1,2%. ™˘˙‹ÙËÛË √ ‰Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ ·ÔÙÂÏ› ÙÔÓ ÈÔ ·ÍÈfiÈÛÙÔ ‰Â›ÎÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÎÈ ÂÎÊÚ¿˙ÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ıÂÙÈÎÒÓ ‰ÂÚÌÔ·ÓÙȉڿÛÂˆÓ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÌÈ·˜ ÎÔÈÓˆÓ›·˜ (6). ™Ô‚·Úfi ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ·, fï˜, ·ÔÙÂÏ› Ë ·ÍÈÔÏfiÁËÛË Ù˘ ‰ÂÚÌÔ·ÓÙ›‰Ú·Û˘ Mantoux ÌÂÙ¿ ·fi Ê˘ÛÈ΋ ÌfiÏ˘ÓÛË ·fi ÂΛÓË, ÌÂÙ¿ ·fi ÂÌ‚ÔÏÈ·ÛÌfi Ì BCG. ªÂÙ¿ ·fi ÂÌ‚fiÏÈÔ BCG, ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ‰È‹ıËÛ˘ Êı¿ÓÂÈ ¤ˆ˜ 15 mm, ·ÏÏ¿ ÌÔÚ› Ó· ‰È·Î˘Ì·Óı› ·fi 3-30 mm (7). ™‡Ìʈӷ Ì ÙËÓ ∞ÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∞η‰ËÌ›·, Ì›· Mantoux >10 mm Û ·È‰› ÌÂÙ¿ BCG, Èı·ÓÒ˜ ˘Ô‰ËÏÒÓÂÈ ÌfiÏ˘ÓÛË (8). £· Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Ï‹„Ë Î·ÏÔ‡ Î·È ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔÚÈÎÔ‡, Ì ¤ÌÊ·ÛË: 1) ÛÙË ¯ÒÚ· ÚÔ¤Ï¢Û˘ ÙÔ˘ ·È‰ÈÔ‡. ¶ÂÚÈÔ¯¤˜ fiˆ˜ Ë ∞Ó·ÙÔÏÈ΋ ∂˘ÚÒË, Ë ∞Û›·, Ë ¡∞ ∞ÌÂÚÈ΋, Ë ∞ÊÚÈ΋ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÂÚÈÛÙ·ÙÈÎÒÓ Ê˘Ì·Ù›ˆÛ˘, 2) ÛÙÔ ¯ÚfiÓÔ ÂÌ‚ÔÏÈ·ÛÌÔ˘ ÙÔ˘ ·È‰ÈÔ‡, 3) ÛÙÔ ·Ó ˘¿Ú¯ÂÈ Ô˘Ï‹ ÛÙË ı¤ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, 4) ÛÙÔ ·Ó ÙÔ ·È‰› ¤¯ÂÈ ¤ÚıÂÈ Û Â·Ê‹ Ì ÂÓ‹ÏÈÎÔ, ¿Û¯ÔÓÙ· ·fi ÂÓÂÚÁfi Ê˘Ì·Ù›ˆÛË (9). ™ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ‰ÂÚÌÔ·ÓÙ›‰Ú·Û˘ Mantoux Ú¤ÂÈ Ó· Ï¿‚Ô˘Ì ˘fi„Ë Ù˘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∂Ù·ÈÚ›·˜ £ÒÚ·ÎÔ˜ (10), Û‡Ìʈӷ Ì ÙȘ Ôԛ˜: ñ Mantoux Ì ‰È¿ÌÂÙÚÔ >5 mm ıˆÚ›ٷÈ

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¶›Ó·Î·˜ 1. ∞ÔÙÂϤÛÌ·Ù· ‰ÂÚÌÔ·ÓÙ›‰Ú·Û˘ Mantoux. ∞ÚÈıÌfi˜ ·È‰ÈÒÓ ·Ó¿ ÂıÓÈÎfiÙËÙ·

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ıÂÙÈ΋ Û ¿ÙÔÌ·: ·) Ì HIV ÓfiÛÔ, ‚) ¤¯ÔÓÙ· ÛÙÂÓ‹ Â·Ê‹ Ì ÂÓ‹ÏÈÎÔ Ì ÂÓÂÚÁfi ÓfiÛÔ, Á) Ì ÂÈÎfiÓ· ÂÔ˘ÏˆÌ¤Ó˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙË Ro ıÒÚ·ÎÔ˜. ñ Mantoux Ì ‰È¿ÌÂÙÚÔ ≥10 mm ıˆÚÂ›Ù·È ıÂÙÈ΋: ·) Û ÌÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ‚) Û ÌÂÈÔÓfiÙËÙ˜, Á) Û ÙÚfiÊÈÌÔ˘˜ È‰Ú˘Ì¿ÙˆÓ, Ê˘Ï·ÎÈṲ̂ÓÔ˘˜, ‰) Û ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ·, Â) Û ‚Ú¤ÊË <3 ¯ÚfiÓˆÓ, ÛÙ) Û ȷÙÚÈÎfi Î·È ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi. ñ Mantoux Ì ‰È¿ÌÂÙÚÔ >15 mm ıˆÚÂ›Ù·È ıÂÙÈ΋ Û fiϘ ÙȘ ˘fiÏÔÈ˜ ηÙËÁÔڛ˜ ÙÔ˘ ÏËı˘ÛÌÔ‡. √È Ô‰ËÁ›Â˜ ·˘Ù¤˜ ‰‡ÛÎÔÏ· ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÛÙË ¯ÒÚ· Ì·˜, ·ÊÔ‡ Ô ·ÚÈıÌfi˜ ÙˆÓ HIV ÓÔÛÔ‡ÓÙˆÓ Â›Ó·È Û¯ÂÙÈο ÌÈÎÚfi˜, fiˆ˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ Â›Ó·È Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÌÔχÓÛÂˆÓ ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (7). ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË ¯·Ú·ÎÙËÚ›Û·ÌÂ Ê˘ÛÈÔÏÔÁÈÎÒ˜ ıÂÙÈ΋ ÙË Mantoux 9 ·È‰ÈÒÓ (5 ∂ÏÏËÓfiÔ˘Ï· Î·È 4 ·ÏÏÔ‰·Ô›), ÂÂȉ‹ ›¯Â ÚÔËÁËı› ÂÌ‚fiÏÈÔ ÚÔ 1ó ¤ÙÔ˘˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ‰È‹ıËÛ˘ ‹Ù·Ó ›ÛÔ Ì 10 mm. ∆· 5 ∂ÏÏËÓfiÔ˘Ï· ›¯·Ó ÂÌ‚ÔÏÈ·ÛÙ› ÂÂȉ‹ ·Ó‹Î·Ó Û ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘˜ ˘‹Ú¯Â ÂÓ‹ÏÈÎÔ˜, ¿Û¯ˆÓ ·fi ÂÓÂÚÁfi ÓfiÛÔ). ŸÛÔÓ ·ÊÔÚ¿ ÙÔ˘˜ ·ÏÏÔ‰·Ô‡˜, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È ÁÈ· Ê˘Ì·Ù›ˆÛË Ì¤Û· ÛÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ¶·ıÔÏÔÁÈÎÒ˜ ıÂÙÈ΋ ¯·Ú·ÎÙËÚ›Û·Ì ÙËÓ Mantoux Û 3 ·È‰È¿ (fiÏ· ÚÔÂÚ¯fiÌÂÓ· ·fi ÙËÓ ∞Ï‚·Ó›·). ∆· 2 ÂÍ ·˘ÙÒÓ ·ÚÔ˘Û›·Û·Ó ‰È‹ıËÛË >10 mm ¯ˆÚ›˜ Ó· ¤¯ÂÈ ÚÔËÁËı› ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì BCG, ÂÓÒ ÙÔ 1 ·È‰› ›¯Â ÂÌ‚ÔÏÈ·ÛÙ› ÚÔ 5ÂÙ›·˜, ·ÚÔ˘Û›·˙ fï˜ ‰È‹ıËÛË >17 mm Î·È ·fi ÙÔ ÈÛÙÔ-

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ÚÈÎfi ÙÔ˘ ÚԤ΢Ù Â·Ê‹ ÌÂ Ê˘Ì·ÙÈÎfi ÂÓ‹ÏÈη. ∫·È ÛÙ· 3 ·È‰È¿ ¤ÁÈÓ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Î·È ¯ÔÚËÁ‹Û·Ì ¯ËÌÂÈÔÚÔʇϷÍË Ì ÈÛÔÓÈ·˙›‰Ë. √ ‰Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ ÛÙËÓ fiÏË Ù˘ ∫ÔÚ›ÓıÔ˘ Â›Ó·È ¯·ÌËÏfi˜ 1,2% Î·È Ê·›ÓÂÙ·È fiÙÈ ÙÔ ÔÛÔÛÙfi ·˘Ùfi ÔÊ›ÏÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ ·ÏÏÔ‰·fi ÏËı˘ÛÌfi Ù˘ ÂÚÈÔ¯‹˜ Ì·˜. ∆· ÛÙÔȯ›· Ì·˜ Û˘ÌʈÓÔ‡Ó Ì ÂΛӷ Ù˘ ÂȉËÌÈÔÏÔÁÈ΋˜ ÌÂϤÙ˘ ÁÈ· ÙË Ê˘Ì·Ù›ˆÛË ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ÛÙÔ ¡. ∞ÙÙÈ΋˜ ηٿ ÙËÓ ÂÚ›Ô‰Ô 1987-1998, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ·ÏÏÔ‰·Ô‡˜ Î·È Â·Ó··ÙÚÈÛı¤ÓÙ˜ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÂÚ›Ô‰Ô (11). ™ÙÔ Û‡ÓÔÏÔ Ù˘ ¯ÒÚ·˜ Ì·˜, Ô ‰Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È ÛÙÔ 1,8% (˘„ËÏfiÙÂÚÔ˜ ÛÙË µ. ∂ÏÏ¿‰· Î·È ¯·ÌËÏfiÙÂÚÔ˜ ÛÙË ÓËÛȈÙÈ΋) (2). ™‡Ìʈӷ Ì ÛÙÔȯ›· ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ¶ÚfiÓÔÈ·˜, ¤ˆ˜ ÙÔ ¤ÙÔ˜ 1995 ›¯Â ‰È·ÈÛÙˆı› ÙÒÛË ÙÔ˘ ‰Â›ÎÙË ‰È·ÌfiÏ˘ÓÛ˘ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ÁÂÁÔÓfi˜ Ô˘ ÂÎÊÚ¿˙ÂÈ ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ ηıÒ˜ Î·È ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÎÔÈÓˆÓÈÎÒÓ Î·È ÔÈÎÔÓÔÌÈÎÒÓ. ∆Ô ·˘ÍË̤ÓÔ, fï˜, ÌÂÙ·Ó·ÛÙ¢ÙÈÎfi ·̷ ·fi ¯ÒÚ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ú¤ÂÈ Ó· ı¤ÛÂÈ ÛÂ Û˘Ó·ÁÂÚÌfi ÙȘ ˘ÁÂÈÔÓÔÌÈΤ˜ ˘ËÚÂۛ˜ Ù˘ ¯ÒÚ·˜ Ì·˜. ÃÚÂÈ¿˙ÂÙ·È ·Ó›¯Ó¢ÛË ·ÛıÂÓÒÓ Ì ÂÓÂÚÁfi Ê˘Ì·Ù›ˆÛË, ηٿÏÏËÏË ıÂÚ·›·, ¯ËÌÂÈÔÚÔʇϷÍË ÌÔÏ˘Ṳ̂ӈÓ, ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì BCG, ‰ÈÂÓ¤ÚÁÂÈ· Mantoux ÛÙȘ ηٿÏÏËϘ ËÏÈ˘: ·) 12-15 ÌËÓÒÓ, ‚) 6 ÂÙÒÓ, Á) 11 ÂÙÒÓ, ·Ó ‰ÂÓ ¤¯ÂÈ ‹‰Ë Á›ÓÂÈ ÂÌ‚ÔÏÈ·ÛÌfi˜. ªfiÓÔ ¤ÙÛÈ ı· ÌÔÚ¤ÛÔ˘Ì ӷ ÂÈÙ‡¯Ô˘Ì ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ Î·È Ó· ÂÚÈÔÚ›ÛÔ˘Ì ÙÔ ‰Â›ÎÙË ‰È·ÌfiÏ˘ÓÛ˘ <1% Î·È ÛÙËÓ ∂ÏÏ¿‰·. µÈ‚ÏÈÔÁÚ·Ê›· 1. WHO fact sheet No 104 Revised; April 2000.

2. ∆ÛfiÏ·˜ °. ∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘. ¶·È‰È·ÙÚÈ΋ 1994;57:109-118.

3. °È·ÙÚÔ̷ӈϿ΢ ¡, ª·¯ÏÈÙ˙·Ó¿Î˘ ¡. ∂ȉËÌÈÔÏÔÁ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∂ÏÏËÓÈ΋˜ ¶Ó¢ÌÔÓÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜; 1994. ÛÂÏ. 57-61.

4. Leich AG. Control of Tuberculosis in low prevalence countries. In: Clinical Tuberculosis; PDO Davies, ed.

London: Chapman and Hall Medical; 1994.

5. Graf P. Tuberculosis control in high-prevalence countries. πn: Clinical Tuberculosis. ed PDO Davies. London: Chapman and Hall Medical; 1994.

6. °È·ÙÚÔ̷ӈϿ΢ ¡. ∂ȉËÌÈÔÏÔÁ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘. ∞ı‹Ó·: ∂ΉfiÛÂȘ ∂ÏÏËÓÈ΋˜ ¶Ó¢ÌÔÓÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜; 1994. ÛÂÏ. 61-71.

7. ™˘Ú›‰Ë˜ ¶. ÀÂÚ¢·ÈÛıËÛ›· ÂÈ‚Ú·‰˘ÓfiÌÂÓÔ˘ Ù‡Ô˘ ÚÔ˜ ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Î·È Ê˘Ì·ÙÈÓÔ·ÓÙȉڿÛÂȘ. ¶·È‰È·ÙÚÈ΋ 1995;58:571-582.

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8. American Academy of Pediatrics: Report of the committee on infectious diseases. Tuberculosis 1994;480-503.

9. Snider D. Bacille Calmete–Guerin and Tuberculin skin tests. JAMA 1985;253:3483-3489.

10. American Thoracic Society. Diagnostic standards and classification of Tuberculosis. Am Rev Respir Dis 1990;142:450-456.

11. ™˘Ú›‰Ë˜ ¶, ™ÈÓ·ÓÈÒÙ˘ ∫, ∆ÛfiÏÈ· ª, °ÂÏÂ̤ ∞, ™˘Ú›‰Ë˜ °, ª·ıÈÔ˘‰¿Î˘ π Î·È Û˘Ó. ∂ȉËÌÈÔÏÔÁÈ΋ ªÂϤÙË Ù˘

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Ê˘Ì·Ù›ˆÛ˘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ÛÙÔ ¡. ∞ÙÙÈ΋˜; 19871998. ¶·È‰È·ÙÚÈ΋ 1999;62:482-489.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-09-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 08-01-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¡ÈÎfiÏ·Ô˜ ∫·Ì¿˜ ª. ∞ÔÛÙÔÏ›‰Ë 14, ∆.∫. 203 00, §Ô˘ÙÚ¿ÎÈ-∫ÔÚÈÓı›·˜

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¶·ÏÌÈ΋ Ô͢ÌÂÙÚ›·: ∆È Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ÛÙÔ ∆Ì‹Ì· º˘ÛÈÔÏÔÁÈÎÒÓ ¡ÂÔÁÓÒÓ;1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ÎÔÚÂÛÌÔ‡ Ì ·ÏÌÈ΋ Ô͢ÌÂÙÚ›· (∫¶√) Û ˘ÁÈ‹ ÓÂÔÁ¤ÓÓËÙ· ‚Ú¤ÊË. √È ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ÛÙË ‰ÂÍÈ¿ (¢) ¿ÎÚ· ¯Â›Ú· Î·È ¢ ¿ÎÚÔ fi‰· ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, 24 ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È ÚÈÓ ·fi ÙÔ ÂÍÈÙ‹ÚÈÔ ÙˆÓ ÓÂÔÁÓÒÓ. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËΠηٷÁÚ·Ê‹ ÙˆÓ ÂÍ‹˜ ÏËÚÔÊÔÚÈÒÓ: ËÏÈΛ·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ηٿÛÙ·Û˘ ÂÁÚ‹ÁÔÚÛ˘, ʇÏÔ˘, ËÏÈΛ·˜ ·ËÛ˘, ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ›‰Ô˘˜ ÙÔÎÂÙÔ‡ Î·È ‚·ıÌÔÏÔÁ›·˜ APGAR. ŒÁÈÓ ·Ó·ÛÎfiËÛË ÙˆÓ Ê·Î¤ÏˆÓ Î·È ÂÏ‹ÊıËÛ·Ó ÂÚ·ÈÙ¤Úˆ ÏËÚÔÊÔڛ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ù· ÓÂÔÁÓ¿ ·ÚÔ˘Û›·Û·Ó ∫¶√ ≤92%. ∏ ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎÂ Û˘ÌÂÚȤϷ‚Â Ê˘ÛÈÔÏÔÁÈο ÓÂÔÁÓ¿, ÂÓÒ ·ÔÎÏ›ÛıËÎ·Ó fiÛ· Ï¿Ì‚·Ó·Ó ıÂÚ·›· Ì Ô͢ÁfiÓÔ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 718 ÓÂÔÁÓ¿: 51% ¿ÚÚÂÓ·, 28% ÁÂÓÓË̤ӷ Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹. ∏ ËÏÈΛ· ·ËÛ˘ ‹Ù·Ó 39,3±1,6 ‚‰ÔÌ¿‰Â˜ (̤ÛË ÙÈÌ‹ ± ™∞), ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3370±550 g Î·È Ë ‰È¿ÌÂÛË ‚·ıÌÔÏÔÁ›· APGAR 8 ÛÙÔ ÚÒÙÔ Î·È 9 ÛÙÔ ¤ÌÙÔ ÏÂÙfi. ∞ÔÙÂϤÛÌ·Ù·: √ ̤ÛÔ˜ ∫¶√ ¢ڤıË 97,2±1,6% Î·È Ë ‰È¿ÌÂÛË ÙÈÌ‹ ‹Ù·Ó 97%. ªfiÓÔ Ë ËÏÈΛ· ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÂËÚ¤·˙ ÛËÌ·ÓÙÈο ÙÔÓ ∫¶√. √ ∫¶√ ·˘Í‹ıËΠηٿ 0,17% ·Ó¿ 24ˆÚÔ (p = 0,0001). √È ÙÈ̤˜ ∫¶√ Ô˘ ÌÂÙÚ‹ıËÎ·Ó fiÙ·Ó Ù· ÓÂÔÁÓ¿ ‹Ù·Ó ·Ó‹Û˘¯· Î·È ¤ÎÏ·ÈÁ·Ó ‹Û·Ó

¯·ÌËÏfiÙÂÚ˜ ÂÎÂ›ÓˆÓ Ô˘ ÌÂÙÚ‹ıËÎ·Ó Î·Ù¿ ÙÔÓ ‡ÓÔ [̤ÛË ÂÏ¿ÙÙˆÛË 0,44% Â› ·ÓËÛ˘¯›·˜ (p = 0,001), 0,98% Ì ÎÏ¿Ì· (p = 0,0001)]. ™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ù· ÓÂÔÁ¤ÓÓËÙ· ÛÙÔ ∆Ì‹Ì· º˘ÛÈÔÏÔÁÈÎÒÓ ¡ÂÔÁÓÒÓ ¤¯Ô˘Ó ÁÂÓÈÎfi ̤ÛÔ ∫¶√ 97,2% (±2 ™∞: 94-100%). √ ̤ÛÔ˜ ∫¶√ ·˘Í¿ÓÂÙ·È Ï›ÁÔ Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ ÙˆÓ ‚ÚÂÊÒÓ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. √È ÙÈ̤˜ ∫¶√ ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Ô˘ Â›Ó·È ·Ó‹Û˘¯· ‹ ÎÏ·›ÓÂ Â›Ó·È ¯·ÌËÏfiÙÂÚ˜ ÂÎÂ›ÓˆÓ Ô˘ ÌÂÙÚÔ‡ÓÙ·È Û ηٿÛÙ·ÛË ËÚÂÌ›·˜ ‹ ηٿ ÙÔÓ ‡ÓÔ. √È ÙÈ̤˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ∫¶√ Û ÓÂÔÁ¤ÓÓËÙ· ‚Ú¤ÊË Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù·.

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BM, Pollack P, Griffin BE, Nielsen HC Pulse oximetry: What’s normal in the newborn nursery?

Pediatr Pulmonol 2000;30:406-412 ªÈ¯¿Ï˘ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ¶·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˜ ∂ÈÌÂÏËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ

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§ÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ Î·È ¯·ÌËÏ‹ Û˘ÏÏÔÁÈ΋ ·ÓÔÛ›· ÛÙËÓ ÂӉ¯fiÌÂÓË ·ÈÙÈÔÏÔÁ›· Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ ª. ¡Ù·Ï·Ì¿Áη1, ∂. ¶ÂÙÚ›‰Ô˘1,2, ¢. ∆ÚȯfiÔ˘ÏÔ˜1,2, ∞. ªÂÓÙ‹˜3, Õ. ™Î·ÏΛ‰Ô˘1, £. ∫·Ú¿ıÈÔ˜4, º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘5, ª. ∫·ÏÌ·ÓÙ‹6, ¢. ∫ÔÏÈÔ‡Ûη˜7, ∂. ∫ÔÛÌ›‰Ë8, π. ¶·Ó·ÁÈÒÙÔ˘9, º. ∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘10

Infectious agents and low herd immunity in the etiology of childhood leukemia M. Dalamaga1, E. Petridou1,2, D. Trichopoulos2, A. Mentis3, A. Skalkidou1, T. Karpathios4, F. Athanasiadou-Piperopoulou5, M. Kalmanti6, D. Koliouskas7, E. Kosmidou8, J. Panagiotou9, F. Tzortzatou-Stathopoulou10

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ó· ‰ÈÂÚ¢ÓËı› Ë ˘fiıÂÛË ·Ó ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ (ALL) ÙˆÓ ·È‰ÈÒÓ ÂÓ‰¤¯ÂÙ·È Ó· ·ÔÙÂÏÔ‡Ó ÙÔ Û¿ÓÈÔ ·ÔÙ¤ÏÂÛÌ· ηı˘ÛÙÂÚË̤Ó˘ ÌË-ÂȉÈ΋˜ Ïԛ̈͢ Û ˘fiÛÙڈ̷ ¯·ÌËÏ‹˜ Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜. ∏ ˘fiıÂÛË ÂÚÁ·Û›·˜ ‹Ù·Ó fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ALL ı· ›¯·Ó Û˘ÓÔÏÈο ¯·ÌËÏfiÙÂÚ· Â›‰· ¤ÎıÂÛ˘ ÛÙÔ Ê¿ÛÌ· ÙˆÓ ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂÍÂÙ¿ÛÙËÎÂ, Ì ÂÍ·›ÚÂÛË ÙË ıÂÙÈ΋ ·ÓÔÛÔÏÔÁÈ΋ ·fiÎÚÈÛË ÛÙÔ ÏÔÈÌÔÁfiÓÔ ÂΛÓÔ ·Ú¿ÁÔÓÙ· Ô˘ ıˆÚÂ›Ù·È fiÙÈ ˘ÚÔ‰fiÙËÛ ÙËÓ ¤Ó·ÚÍË Ù˘ ALL. ™˘ÁÎÚ›ıËηÓ, ˆ˜ ÚÔ˜ ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÔÚÔÏÔÁÈ΋ ·fiÎÚÈÛË Û 10 ÎÔÈÓÔ‡˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, 94 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ô˘ ÓÂԉȷÁÓÒÛÙËÎ·Ó Ì ÔÍ›· Ï¢¯·ÈÌ›·

Abstract: It has been suggested that acute lymphoblastic leukemia (ALL) in children may be a rare outcome of a delayed non specific infection in situations of low herd immunity to a relatively wide range of infectious agents. We assumed that newly diagnosed childhood leukemia cases, in comparison to their controls, would be characterised by a more seronegative spectrum to the infectious agents examined, with the exception of a strongly positive response to that infectious agent, which is assumed to trigger ALL. A case control study was undertaken in Greece of 94 newly diagnosed cases of ALL who were compared to an equal number of hospitalized children (controls) for minor noninfectious conditions, and who were matched for

1 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ∆Ì‹Ì· ∂ȉËÌÈÔÏÔÁ›·˜, ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ ¶·ÓÂÈÛÙËÌ›Ô˘ Harvard, ∏¶∞ 3 ¢È·ÁÓˆÛÙÈÎfi ∆Ì‹Ì· ∂ÏÏËÓÈÎfi πÓÛÙÈÙÔ‡ÙÔ Pasteur, ∞ı‹Ó· 4 µ’ ¶·Ó/΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ‘∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” 5 ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞ 6 ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ 7 ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜ πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ 8 ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” 9 ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” 10 ªÔÓ¿‰· ∞ÈÌ·ÙÔÏÔÁ›·˜-√ÁÎÔÏÔÁ›·˜, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

1 Department of Hygiene and Epidemiology Athens University Medical School 2 Department of Epidemiology Harvard School of Public Health, USA 3 Diagnostic Services Department Hellenic Pasteur Institute, Athens 4 Second Department of Pediatrics, Athens University Medical School, A. Kyriakou Children’s Hospital 5 Second Department of Paediatrics Aristoteleion University of Thessaloniki AHEPA General Hospital 6 Department of Paediatric Haematology-Oncology University Hospital of Heraklion 7 Department of Paediatric Haematology-Oncology Ippokration General Hospital, Thessaloniki 8 Department of Paediatric Haematology-Oncology A. Kyriakou Children’s Hospital, Athens 9 Department of Paediatric Haematology-Oncology Agia Sophia Children’s Hospital, Athens 10 Unit of Childhood Haematology-Oncology, First Department of Paediatrics, Athens University Medical School, Agia Sophia Children’s Hospital

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ÛÙ· ¤ÍÈ ·È‰È·ÙÚÈο ·ÈÌ·ÙÔÏÔÁÈο-ÔÁÎÔÏÔÁÈο ÙÌ‹Ì·Ù· Ù˘ ¯ÒÚ·˜ Ì ÈÛÔ‰‡Ó·ÌÔ ·ÚÈıÌfi, ÂÍÔÌÔÈˆÌ¤ÓˆÓ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ·, Ì·ÚÙ‡ÚˆÓ, ÔÈ ÔÔ›ÔÈ ÓÔÛËχÙËÎ·Ó ÛÙ· ›‰È· ÓÔÛÔÎÔÌ›· ÁÈ· ÌËÏÔÈÌÒ‰ÂȘ ÓfiÛÔ˘˜. √È ÂӉ›ÍÂȘ Û˘Û¯¤ÙÈÛ˘ Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ì ÙËÓ ÔÚÔıÂÙÈ΋ ·¿ÓÙËÛË ÛÙÔ Ê¿ÛÌ· ÙˆÓ ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ, Â›Ó·È ÌÈÎÚ¤˜ ÁÈ· Ù· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ. ∞ÓÙÈı¤Ùˆ˜, ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 5-14 ÂÙÒÓ ‚Ú¤ıËΠıÂÙÈ΋ Î·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ÓfiÛÔ˘ Ì ÙÔÓ Èfi Ù˘ ·Ú·ÁÚ›˘ Î·È Ì›· ÛÂÈÚ¿ ·ÓÙ›ÛÙÚÔÊˆÓ Û˘Û¯ÂÙ›ÛÂˆÓ Ì ÙÔ˘˜ ÈÔ‡˜ Epstein-Barr, ∞ÓıÚÒÈÓÔ ∂ÚËÙÔ˚fi-6, ¶·Ú‚Ô˚fi µ 19, ηıÒ˜ Î·È ÙÔ ª˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ™Ù· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 5 ÂÙÒÓ, Ô Èı·Ófi˜ ΛӉ˘ÓÔ˜ Ï¢¯·ÈÌ›·˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ fiÙ·Ó Û ÂÚÈÙÒÛÂȘ ¯·ÌËÏ‹˜ Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜ ÁÈ· ·ÚÎÂÙÔ‡˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÙÔ ·ÓÔÛÔÔÈËÙÈÎfi ÙÔ˘˜ Û‡ÛÙËÌ· ‰ÔÎÈÌ¿˙ÂÙ·È ·fi ÌÈ· ηı˘ÛÙÂÚË̤ÓË Ïԛ̈ÍË, Ë ÔÔ›·, Û˘Ó‹ıˆ˜, ÚÔÛ‚¿ÏÏÂÈ ·È‰È¿ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜.

age and gender. To assess past exposure against a range of infectious agents, a battery of ten serological tests was used. The results showed that in children less than five years of age there was little evidence for an association of childhood leukemia with the serology of any of the ten studied. In contrast, among children over five years of age, there was a statistically significant positive association of leukemia with the Parainfluenza virus and a series of inverse associations with Epstein Barr virus, Human Herpes Virus-6, Mycoplasma pneumonia and Parvovirus B19. In conclusion, among children five years of age or older, the risk of leukemia is higher when in cases of low herd immunity for several agents their immune system is challenged by late infection from an infectious agent which, as a rule, affects children at a younger age.

§¤ÍÂȘ ÎÏÂȉȿ: ·È‰›, ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·, ·ÈÙÈÔÏÔÁ›·, Û˘ÏÏÔÁÈ΋ ·ÓÔÛ›·, ηı˘ÛÙÂÚË̤ÓË Ïԛ̈ÍË, ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ (Èfi˜ ÁÚ›˘ ∞, Èfi˜ ÁÚ›˘ µ, ·Ó·Ó¢ÛÙÈÎfi˜ Û˘Á΢ÙÈ·Îfi˜ Èfi˜, ÈÔ› ·Ú·ÁÚ›˘, ·‰ÂÓÔ˚fi˜, ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜, ·Ú‚Ô˚fi˜ µ 19, ·ÓıÚÒÈÓÔ˜ ÂÚËÙÔ˚fi˜-6, Èfi˜ EpsteinBarr, Ì˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜).

Key words: child, acute childhood leukemia, etiology, herd immunity, delayed infection, infectious agents (Influenza virus A, Influenza virus B, Adenovirus, Respiratory Syncytial Virus, parainfluenza viruses, Cytomegalovirus, EpsteinBarr virus, Human Herpesvirus-6, Parvovirus B19, Mycoplasma pneumoniae).

∂ÈÛ·ÁˆÁ‹ ªÂ ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÈÔ› ¤¯Ô˘Ó ·Ó·ÊÂÚı› ˆ˜ ·›ÙÈ· Ï¢¯·ÈÌ›·˜ ·ÚÎÂÙÒÓ ÔÈÎÈ·ÎÒÓ ˙ÒˆÓ, ηıÒ˜ Â›Û˘ Î·È ·fi ÙËÓ ÂÌÏÔ΋ ÙÔ˘ ÈÔ‡ HTLV-1 ÛÙËÓ ·ÈÙÈÔÏÔÁ›· Ì›·˜ Û¿ÓÈ·˜ ÌÔÚÊ‹˜ Ï¢¯·ÈÌ›·˜ ÛÙÔÓ ¿ÓıÚˆÔ, ¤¯ÂÈ ‰È·Ù˘ˆı› Ë ˘fiıÂÛË fiÙÈ Ë ·È‰È΋ Ï¢¯·ÈÌ›· ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÏÔÈÌÒ‰Ô˘˜ ·Ú¯‹˜. √È ÂȉËÌÈÔÏÔÁÈΤ˜ ÂӉ›ÍÂȘ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ˘fiıÂÛË Ù˘ ÏÔÈÌÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜ ÛÙËÓ Èı·Ó‹ ÚfiÎÏËÛË ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi: ·) ÌÂϤÙ˜, fiÔ˘ ‰È·Ê·›ÓÂÙ·È Ë ÙÔÔ¯ÚÔÓÈ΋ Û˘ÚÚÔ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ (1), ‚) ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ, fiÙÈ ÙÔ ÚÒÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ¤¯ÂÈ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Û ۯ¤ÛË Ì ٷ ˘fiÏÔÈ· ηٿ ÛÂÈÚ¿ Á¤ÓÓËÛ˘ (2,3), Á) ‰ËÌÔÛȇÛÂȘ, Ô˘ Û˘Û¯ÂÙ›˙Ô˘Ó ÙËÓ ·È‰È΋ Ï¢¯·ÈÌ›· Ì ηı˘ÛÙÂÚË̤ÓË ·Ó¿Ù˘ÍË Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜ (herd immunity) (4) Î·È ‰) Â˘Ú‹Ì·Ù· ·fi ηٷÛÙ¿ÛÂȘ fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ÏËı˘ÛÌȷ΋ ·Ó¿ÌÂÈÍË Î·È ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ˆ˜ Ê˘ÛÈο ÂÈÚ¿Ì·Ù· ÁÈ· ÙË

‰ÈÂÚ‡ÓËÛË Ù˘ ÙÔÔ¯ÚÔÓÈ΋˜ Û˘ÚÚÔ‹˜ Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Û ÂÚÈÙÒÛÂȘ ¯·ÌËÏ‹˜ Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜. ∞ÚÎÂÙÔ› ·fi ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜, Ô˘ ıÂÒÚËÛ·Ó ˆ˜ Èı·Ó‹ ÙË ÏÔÈÌÒ‰Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ (2,4,5,7-10), ÚÔÛ¿ıËÛ·Ó Ó· ·Ó·Ù‡ÍÔ˘Ó ÂÈÛÙËÌÔÓÈΤ˜ ˘Ôı¤ÛÂȘ, ÔÈ Ôԛ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÎÂÙ¿ ÎÔÈÓ¿ ÛÙÔȯ›·, Ù· ÔÔ›· Ô Greaves ÂÓۈ̿وÛ Û ¤Ó· ÌÔÓÙ¤ÏÔ Û˘ÁÎÏÈÓÔ˘ÛÒÓ ˘Ôı¤ÛÂˆÓ (10). ™‡Ìʈӷ Ì ·˘Ù‹ ÙËÓ ˘fiıÂÛË, Ë ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (ALL) Î·È ÂȉÈÎfiÙÂÚ· Ô Ù‡Ô˜ c-ALL (ÎÔÈÓ‹ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·) ·ÔÙÂÏ› ÓfiÛÔ ÙˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ÎÔÈÓˆÓÈÒÓ Î·È ÌÔÚ› Ó· ıˆÚËı› fiÙÈ ·ÔÙÂÏ› ÙË Û¿ÓÈ· ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË Û ÂÚ›ÙˆÛË Ô˘ ÙÔ ·È‰› ÓÔÛ‹ÛÂÈ Û ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ·fi ÙËÓ ·Ó·ÌÂÓfiÌÂÓË ËÏÈΛ· ·fi Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ. ªÂ ‚¿ÛË ÙË ‚ÈÔÏÔÁÈ΋ ÛÙ·ıÂÚ¿, ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ, Ë ÚÔÛ‚ÔÏ‹ Û˘Ì‚·›ÓÂÈ ÓˆÚ›˜ ÛÙË ˙ˆ‹ ÂÓfi˜ ·È‰ÈÔ‡ Î·È Ë ÌÂÙ¿‰ÔÛË Á›ÓÂÙ·È Ì¤Ûˆ Ù˘ ÌËÙ¤Ú·˜ ‹ ¿ÏÏˆÓ ·ÙfiÌˆÓ ÙÔ˘ ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜,

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fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ·fi ·‰¤ÏÊÈ· ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. ™ÙȘ Û‡Á¯ÚÔÓ˜ ÎÔÈӈӛ˜, Ë ÚÒÈÌË ¤ÎıÂÛË ‚ÚÂÊÒÓ Î·È ÓË›ˆÓ Û ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ηı˘ÛÙÂÚ›, ÂÍ·ÈÙ›·˜ ·ÊÂÓfi˜ Ù˘ ‚ÂÏÙ›ˆÛ˘ ÙˆÓ Û˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ Î·È ·ÊÂÙ¤ÚÔ˘ ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ·ÏÏ·ÁÒÓ. ∏ ηı˘ÛÙÂÚË̤ÓË ¤ÎıÂÛË Û ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÂÓ‰¤¯ÂÙ·È Ó· ‚Ú·‰‡ÓÂÈ ÙËÓ ÙÂÏÈ΋ ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· Ë Ïԛ̈ÍË ÙÔ˘ ·È‰ÈÔ‡ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ·fi ¤Ó· ÎÔÈÓfi ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi Ó· ÚÔηϤÛÂÈ, Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, ÙËÓ ÈÛ¯˘Ú‹ ·¿ÓÙËÛË ÂÓfi˜ ·ÓÒÚÈÌÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ì Â·ÎfiÏÔ˘ıË ÎψÓÈ΋ ÂÎÙÚÔ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ (12). ™‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË Ù˘ ηı˘ÛÙÂÚË̤Ó˘ Ïԛ̈͢, ·Ó·Ì¤ÓÂÙ·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ ı· Â›Ó·È ·˘ÍË̤ÓÔ˜ fiÙ·Ó ÌÂÈÒÓÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÏÔÈÌÒÍÂˆÓ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (4,9-11,13). ™ÙË ÌÂϤÙË ·˘Ù‹ Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· Ó· ·ÍÈÔÏÔÁËı› Ë ˘fiıÂÛË Ù˘ ηı˘ÛÙÂÚË̤Ó˘ Ïԛ̈͢ Ì ÂÚ¢ÓËÙÈÎfi ۯ‰ȷÛÌfi Ù‡Ô˘ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ (case control study). ∞ӷ̤ÓÂÙ·È fiÙÈ ÔÈ Ó¤Â˜ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ÔÍ›· ·È‰È΋ Ï¢¯·ÈÌ›· ı· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜ ¯·ÌËÏfiÙÂÚ· Â›‰· ¤ÎıÂÛ˘ Û ¤Ó· ¢ڇ Ê¿ÛÌ· ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ Ì¿ÚÙ˘Ú˜, Ì ÂÍ·›ÚÂÛË ÙË ıÂÙÈ΋ ·ÓÔÛÔÏÔÁÈ΋ ·fiÎÚÈÛË ÛÙÔ ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ·, Ô˘ ıˆÚÂ›Ù·È fiÙÈ ˘ÚÔ‰ÔÙ› ÙËÓ ¤Ó·ÚÍË Ù˘ ALL. ™ÙË ÌÂϤÙË ·˘Ù‹ ‰ÂÓ ˘Ô‰ÂÈÎÓ‡ÂÙ·È, ˆ˜ ·ÈÙÈÔÏÔÁÈÎfi˜, οÔÈÔ˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˜ ÏÔÈÌÔÁfiÓÔ˜ ·Ú¿ÁÔÓÙ·˜ ‹ ÔÈ È‰ÈfiÙËÙ¤˜ ÙÔ˘, ·ÏÏ¿ ÙÔ ˙ËÙÔ‡ÌÂÓÔ Â›Ó·È ·Ó Ë Ïԛ̈ÍË Î·ı˘ÛÙÂÚ› Û ۇÁÎÚÈÛË Ì ÙË Û˘Ó‹ıË ËÏÈΛ· ÚÔÛ‚ÔÏ‹˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓÙ·ÂÙ›·˜ 1993-1997 ¤ÁÈÓ ÛÙË ¯ÒÚ· Ì·˜, ·fi ÙÔ ‰›ÎÙ˘Ô ·È‰È¿ÙÚˆÓ ·ÈÌ·ÙÔÏfiÁˆÓ-ÔÁÎÔÏfiÁˆÓ, ‰È¿ÁÓˆÛË 450 Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ ·È‰È΋˜ (0-14 ÂÙÒÓ) Ï¢¯·ÈÌ›·˜, Ô˘ ÂȂ‚·ÈÒıËÎ·Ó ÌÂ Ì˘ÂÏfiÁÚ·ÌÌ·. √È 388 ÂÚÈÙÒÛÂȘ ·Ó‹ÎÔ˘Ó ÛÙÔÓ Ù‡Ô Ù˘ ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜. °È· 104 ÂÚÈÙÒÛÂȘ ALL, Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Û˘ÏÏÔÁ‹ ·›Ì·ÙÔ˜ ÚÈÓ ÙËÓ Î¿ı ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Î·È Ë ÂÈÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ÚÔÛ‰ÈÔÚ›ÛÙËΠÌfiÓÔ ·fi ‰ÈÔÈÎËÙÈΤ˜ ‹ Ù¯ÓÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, Ô˘ ‰ÂÓ Â›¯·Ó fï˜ Û¯¤ÛË Ì ÙȘ ÔÚÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ÂÍÂÙ¿˙ÔÓÙ·È. ∂Í¿ÏÏÔ˘, Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ ʇÏÔ˘ Î·È Ù˘ ËÏÈΛ·˜ ÛÙÔ ÂÍÂÙ·˙fiÌÂÓÔ ‰Â›ÁÌ· ‹Ù·Ó ·ÚfiÌÔÈ· Ì ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ ÛÙÔ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÙÒÓ 1995-1997, Û ÔÚÈṲ̂ӷ ·fi Ù· Û˘ÌÌÂÙ¤¯ÔÓÙ· ÓÔÛÔÎÔÌ›· ‰ÂÓ ‰ÈÂÓÂÚÁ‹ıËÎ·Ó Ï‹„ÂȘ ·›Ì·ÙÔ˜ (128 ÂÚÈÙÒÛÂȘ) Î·È ¿ÏÈ ÁÈ· ‰È·‰ÈηÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜, ÂÓÒ ÁÈ· ÙȘ ¿ÏϘ 126 ÂÚÈÙÒÛÂȘ Ë Û˘ÏÏÔÁ‹ ·›Ì·ÙÔ˜ ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÁÂÓÈÎÒ˜ ‹ ÚÈÓ ÙËÓ ·Ú¯‹ Ù˘ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘. ∆· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜

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‹Ù·Ó ÙÂÏÈο ·ÓÂ·Ú΋ ‹ ·Î·Ù¿ÏÏËÏ· ÁÈ· 10 ·fi ÙȘ 104 ÂÚÈÙÒÛÂȘ ALL Î·È Û˘ÓÂÒ˜ ‰ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ·Ó¿Ï˘ÛË. ∆ÂÏÈÎÒ˜, ‹Ù·Ó ‰È·ı¤ÛÈÌ· 94 ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ·ÛıÂÓÒÓ Ì ·È‰È΋ Ï¢¯·ÈÌ›·. ™˘ÌÏËڈ̷ÙÈο ÛÙÔȯ›· ·Ú›¯·Ó ÔÈ ÁÔÓ›˜ ‹ ÔÈ Û˘ÓÔ‰Ô› ÙˆÓ ·È‰ÈÒÓ Ì ALL, ÔÈ ÔÔ›ÔÈ, Ì ÙË ‚Ô‹ıÂÈ· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡, ·¿ÓÙËÛ·Ó Û ¤Ó· Έ‰ÈÎÔÔÈË̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. °È· οı ·ÛıÂÓ‹, ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ‚ÚÂı› ÌÂ Ù˘¯·›· ‰ÂÈÁÌ·ÙÔÏË„›· ¤Ó·˜ Ì¿ÚÙ˘Ú·˜ ÂÍÔÌÔȈ̤ÓÔ˜ (matched control) ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· (± 6 Ì‹Ó˜), Ô˘ ÓÔÛËÏ¢fiÙ·Ó ÛÙÔ ›‰ÈÔ ÓÔÛÔÎÔÌÂ›Ô Ì ‹È·, ÌË ÏÔÈÌÒ‰Ë ÓfiÛÔ Î·È 17 ·fi ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ·ÓÙÈηٷÛÙ¿ıËÎ·Ó Î·Ù·Ïϋψ˜, ÂÂȉ‹ ‰ÂÓ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· Û˘ÌÌÂÙÔ¯‹˜ ÛÙË ÌÂϤÙË.

1. EÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ: ªÂÙ¿ ÙË Ï‹„Ë ÊÏ‚ÈÎÔ‡ ·›Ì·ÙÔ˜, Ù· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ¤ËÍ·Ó Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, Ê˘ÁÔÎÂÓÙÚ‹ıËÎ·Ó Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ù· ‰Â›ÁÌ·Ù· ÙˆÓ ÔÚÒÓ ‰È·¯ˆÚ›ÛÙËηÓ, ·ÔıË·ÙËÎ·Ó ÛÙËÓ Î·Ù¿„˘ÍË (-20Æ C) Î·È ÌÂٷʤÚıËÎ·Ó ÛÙÔ ¢È·ÁÓˆÛÙÈÎfi ∆Ì‹Ì· ÙÔ˘ ∂ÏÏËÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ Pasteur, fiÔ˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ù˘ÊÏfi˜ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ¤Ó· Û‡ÓÔÏÔ ‰¤Î· ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ, ¯ˆÚ›˜ ‰ËÏ·‰‹ Ó· Â›Ó·È ÁÓˆÛÙfi ÛÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ·Ó Ô ÔÚfi˜ ·Ó‹ÎÂÈ Û ‚·ÛÈΤ˜ ÂÚÈÙÒÛÂȘ ‹ Û ̿ÚÙ˘Ú˜. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ÈÒÓ ÁÚ›˘ ∞, µ, ·‰ÂÓÔ˚Ô‡, ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘Á΢ÙÈ·ÎÔ‡ ÈÔ‡ (RSV) Î·È ÈÒÓ ·Ú·ÁÚ›˘, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÛÂÈÚ¿ ÙˆÓ ¤ÙÔÈÌˆÓ ·ÓÙȉڷÛÙËÚ›ˆÓ ELISA ÙÔ˘ Ô›ÎÔ˘ Genzyme Virotech Gmbh, Û‡Ìʈӷ Ì ÙȘ ¤ÓıÂÙ˜ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. ∆· ·ÓÙÈÁfiÓ· Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙȘ ‰ÔÎÈ̷ۛ˜ ›ӷÈ: ÂÓ·ÈÒÚËÌ· ÛÙÂϤ¯Ô˘˜ ∞-Ù‡Ô˘ ÁÈ· ÙÔÓ Èfi ÁÚ›˘ ∞, ÂÓ·ÈÒÚËÌ· ÛÙÂϤ¯Ô˘˜ µ-Ù‡Ô˘ ÁÈ· ÙÔÓ Èfi ÁÚ›˘ µ, ˘ÂÚΛÌÂÓÔ ÚÔۂ‚ÏËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ ·fi ·‰ÂÓÔ˚fi 6 Î·È ÈÒÓ ·Ú·ÁÚ›˘ 1, 2, 3 ÁÈ· ÙÔÓ ·‰ÂÓÔ˚fi Î·È ÙÔ˘˜ ÈÔ‡˜ ·Ú·ÁÚ›˘ 1, 2, 3, ηıÒ˜ Î·È ˘ÂÚΛÌÂÓÔ ÚÔۂ‚ÏËÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ ·fi RSV (RSV-ª·ÎÚ‡ Û٤ϯԘ) ÁÈ· ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi. ∏ ÌÂıÔ‰ÔÏÔÁ›· ÚÔÛ‰ÈÔÚÈÛÌÔ‡ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ Â›Ó·È fiÌÔÈ· ÁÈ· οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú·¿Óˆ ÈÔ‡˜. ∞ÎÔÏÔ‡ıˆ˜, Ù· ÚԷڷȈ̤ӷ ‰Â›ÁÌ·Ù· ÔÚÒÓ ÚÔÛÙ¤ıËÎ·Ó ÛÙ· ÊÚ¿ÙÈ· Ï·ÎÒÓ, fiÔ˘ ‚Ú›ÛÎÔÓÙ·Ó Î·ıËψ̤ӷ Ù· ·ÓÙ›ÛÙÔȯ· ·ÓÙÈÁfiÓ·. ªÂÙ¿ ·fi ÂÒ·ÛË Î·È ¤ÎÏ˘ÛË ÙˆÓ ÊÚ·ٛˆÓ, ÚÔÛÙ¤ıËΠÙÔ ÂÓ˙˘ÌÈÎfi Û‡ÌÏÂÁÌ·, ÙÔ ÔÔ›Ô ·ÔÙÂÏÂ›Ù·È ·fi ȯÓËıÂÙË̤ӷ Ì ˘ÂÚÔÍÂȉ¿ÛË ·ÓÙÈÛÒÌ·Ù· ›Ô˘ ¤Ó·ÓÙÈ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ G. ªÂÙ¿ ÙËÓ ÚÔÛı‹ÎË ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ (ÙÂÙÚ·ÌÂı˘ÏÔ‚ÂÓ˙ȉ›ÓË 3,3’,5,5’-∆ªµ) ·ÎÔÏÔ˘ıÔ‡Û ‰È¿Û·Û‹ ÙÔ˘, Ô˘ Û˘Óԉ¢fiÙ·Ó ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÌÏ ¯ÚÒÌ·ÙÔ˜. ∏ ÂÓ˙˘ÌÈ΋ ·ÓÙ›‰Ú·ÛË ÛÙ·Ì·ÙÔ‡Û Ì ÙËÓ ÂÌÊ¿ÓÈÛË Î›ÙÚÈÓÔ˘ ¯ÚÒÌ·ÙÔ˜ ‡ÛÙÂÚ· ·fi ÚÔÛı‹ÎË ÎÈÙÚÈÎÔ‡ ÔͤԘ. √È ÙÈ̤˜ ÔÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÌÂÙÚ‹ıËÎ·Ó Û ̋ÎË Î‡Ì·ÙÔ˜ 450 nm, Ì ̋ÎÔ˜ ·Ó·ÊÔÚ¿˜ Ù· 620 nm, Û ʷÛÌ·ÙÔʈÙfiÌÂÙÚÔ ÌÈÎÚÔÏ·ÎÒÓ ELISA (Hitachi ELISA reader). ∆· ·ÔÙÂϤÛÌ·Ù· ÚԤ΢„·Ó ‰È·ÈÚÒÓÙ·˜ ÙËÓ ÙÈÌ‹ Ù˘ ÔÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Ì ÙËÓ ÙÈÌ‹ Ù˘ ÔÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Ô˘ ¤¯ÂÈ ÔÚÈÛı› ˆ˜ Ô˘‰fi˜ (cut-off) Î·È ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·˜ ÙÔ ËÏ›ÎÔ Ì ÙÔ 10. ∆· ·ÔÙÂϤÛÌ·Ù· ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ÂÍ‹˜: 0,0-9,0: ·ÚÓËÙÈο, 9-11: ·ÌÊ›‚ÔÏ·, >11: ıÂÙÈο. ∆· ıÂÙÈο ‰Â›ÁÌ·Ù· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ÂÚ·ÈÙ¤Úˆ ·ÛıÂÓÒ˜ (+), ÌÂÙÚ›ˆ˜ (++) Î·È ÈÛ¯˘ÚÒ˜ (+++) ıÂÙÈο,

2001 MAPT- A¶PI§

17-10-01 15:34

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¶·È‰È·ÙÚÈ΋ 2001;64:136-144

¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ô˘‰Ô‡˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Î·Ù¿ ÚÔÛ¤ÁÁÈÛË Û ·ÎÚ·›· ÂηÙÔÛÙÈ·›· ÙÚÈÙËÌfiÚÈ·.

To Û‡ÛÙËÌ· IMX CMV IgG Ù˘ Abott, ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙÔÓ ËÌÈÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡ ÛÙÔÓ ÔÚfi ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ. ™‡Ìʈӷ Ì ÙË ªÈÎÚÔۈ̷Ùȉȷ΋ ∞ÓÔÛÔÂÓ˙˘ÌÈ΋ ª¤ıÔ‰Ô (ª∂π∞), Ô ÔÚfi˜ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Âˆ¿˙ÂÙ·È Ì ٷ ÚÔÛÚÔÊË̤ӷ ÌÈÎÚÔۈ̷ٛ‰È· ÛÙÂÚ¿˜ Ê¿Û˘ ÙÔ˘ CMV. ∆Ô Ì›ÁÌ· ÌÂٷʤÚÂÙ·È Û ̛· Á˘¿ÏÈÓË Ì‹ÙÚ·, Ë ÔÔ›· ‰ÂÛ̇ÂÈ Ù· ÌÈÎÚÔۈ̷ٛ‰È·, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ ·Ó·ÚÚfiÊËÛË Î·È ¤ÎÏ˘ÛË ÙÔ˘ ÌË-ÚÔÛËψı¤ÓÙÔ˜ ˘ÏÈÎÔ‡ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ. °È· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ Û‡˙¢Í˘ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È CMV ·ÓÙÈÁfiÓÔ˘ Û ÛÙÂÚ¿ Ê¿ÛË, ¯ÚËÛÈÌÔÔÈ‹ıËΠۇ˙¢ÁÌ· ÙÔ ÔÔ›Ô ·ÔÙÂÏÂ›Ù·È ·fi ·ÓÙÈÛÒÌ·Ù· ·ÈÁfi˜ ¤Ó·ÓÙÈ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ G, ÎÂηı·Ṳ́ӷ Ì ¯ÚˆÌ·ÙÔÁÚ·Ê›· ˘„ËÏ‹˜ Û˘ÁÁ¤ÓÂÈ·˜ Î·È È¯ÓËıÂÙË̤ӷ Ì ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Î·È ÌÂı˘ÏÔ˘Ì‚ÂÏÈÊÂÚÔÓÈÎfi ʈÛÊÔÚÈÎfi Ô͇. √ Ú˘ıÌfi˜ ÊıÔÚÈÛÌÔ‡ Ô˘ ·Ó·Ù‡ÛÛÂÙ·È ·fi ÙÔ ·ÔʈÛÊÔÚ˘ÏȈ̤ÓÔ ÌÂı˘ÏÔ˘Ì‚ÂÏÈÊÂÚÔÓÈÎfi Ô͇ ÌÂÙÚ‹ıËΠÛÙÔ ÊıÔÚÈÛÈfiÌÂÙÚÔ ÂÓÙfi˜ ÙÔ˘ ·Ó·Ï˘Ù‹ IMX. ∆· ·ÔÙÂϤÛÌ·Ù· ÚԤ΢„·Ó ‰È·ÈÚÒÓÙ·˜ ÙËÓ ÙÈÌ‹ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Ì ÙËÓ ÙÈÌ‹ ÙÔ˘ ÚÔÙ‡Ô˘ ÔÚÔ‡ ÂϤÁ¯Ô˘ (calibrator) οı ÂÍÂÙ·ÛÙÈ΋˜ ÛÂÈÚ¿˜. ∏ ·ÚÔ˘Û›· Û˘ÁΤÓÙÚˆÛ˘ 15 AU/ml Î·È ¿Óˆ ÛÙÔÓ ÔÚfi ‰Â›ÁÌ·ÙÔ˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ·Ï·È¿˜ ¤ÎıÂÛ˘ ÛÙÔÓ CMV. ∆· ıÂÙÈο ‰Â›ÁÌ·Ù· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ÂÚ·ÈÙ¤Úˆ ·ÛıÂÓÒ˜ (+), ÌÂÙÚ›ˆ˜ (++) Î·È ÈÛ¯˘ÚÒ˜ (+++) ıÂÙÈο., ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ô˘‰Ô‡˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Î·Ù¿ ÚÔÛ¤ÁÁÈÛË Û ·ÎÚ·›· ÙÚÈÙËÌfiÚÈ·. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ Î·„ȉÈÎÒÓ ·ÓÙÈÁfiÓˆÓ (VCA) ÙÔ˘ ÈÔ‡ EpsteinBarr, ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· οı ‰Â›ÁÌ· Ë Ì¤ıÔ‰Ô˜ ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (IFA VCA IgG) ÙÔ˘ Ô›ÎÔ˘ Gull, Û‡Ìʈӷ Ì ÙȘ ¤ÓıÂÙ˜ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. ø˜ ˘fiÛÙڈ̷ VCA ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ HR1 ·fi ÏÂÌÊÔ·ÙÙ·Ú· ·ÛıÂÓÒÓ Ì ϤÌʈ̷ Burkitt. √È ÔÚÔ› ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú·ÈÒıËÎ·Ó 1:20 Î·È ÚÔÛÙ¤ıËÎ·Ó ÛÙ· ÊÚ¿ÙÈ·, fiÔ˘ ÛÙÔÓ ˘ı̤ӷ ÙÔ˘˜ ‚Ú›ÛÎÂÙ·È Î·ıËψ̤ÓÔ ÙÔ VCA ·ÓÙÈÁfiÓÔ. ªÂÙ¿ ÙËÓ ¤ÎÏ˘ÛË ÚÔÛÙ¤ıËΠÛÙ· ÊÚ¿ÙÈ· Ë ÛËÌ·Ṳ̂ÓË Ì ÊıÔÚÈÛ½ÓË ·ÓÙÈ·ÓıÚÒÂÈÔ˜ ·ÓÙÈ-IgG ÛÊ·ÈÚ›ÓË, Ë ÔÔ›· ÂÓÒÓÂÙ·È Ì ÙÔ Û‡ÌÏÂÁÌ· ·ÓÙÈÁfiÓÔ˘-·ÓÙÈÛÒÌ·ÙÔ˜. °È· ÙËÓ ·Ó¿ÁÓˆÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Û ÌÂÁ¤ı˘ÓÛË 200Ã, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ¤Ó· ÌÈÎÚÔÛÎfiÈÔ ÊıÔÚÈÛÌÔ‡ Zeiss Ì FITC ‰ÈÂÁÂÚÙÈÎfi ËıÌfi ÌÏ ʈÙfi˜ Î·È ¤Ó·˜ ËıÌfi˜ÊÚ·ÁÌfi˜ 515 nm. ∂› ıÂÙÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÓÙ›‰Ú·Û˘ ¤Ó·˜ ÎÈÙÚÈÓÔÚ¿ÛÈÓÔ˜ ÊıÔÚÈÛÌfi˜ Û ÎfiÎÎÈÓÔ ˘¤‰·ÊÔ˜. ∏ ıÂÙÈ΋ ·ÓÙ›‰Ú·ÛË Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ·Ï·È¿˜ ¤ÎıÂÛ˘ ÛÙÔÓ Èfi EBV. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ HHV-6, ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· οı ‰Â›ÁÌ· Ë Ì¤ıÔ‰Ô˜ ÙÔ˘ ¤ÌÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ÙÔ˘ °ÂÚÌ·ÓÈÎÔ‡ Ô›ÎÔ˘ BIOS Gmbh, Û‡Ìʈӷ Ì ÙȘ ¤ÓıÂÙ˜ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. √È ÔÚÔ› ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú·ÈÒıËÎ·Ó 1:20, ÚÔÛÙ¤ıËÎ·Ó Î·È Âˆ¿ÛÙËÎ·Ó ÛÙ· ÊÚ¿ÙÈ· ÙˆÓ Ï·Îȉ›ˆÓ, fiÔ˘ ÛÙÔÓ ˘ı̤ӷ ÙÔ˘˜ ‚Ú›ÛÎÂÙ·È Î·ıËψ̤ÓÔ Î·ÏÏȤÚÁËÌ· ΢ÙÙ¿ÚˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ·fi HHV-6. ªÂÙ¿ ÙËÓ ¤ÎÏ˘ÛË ÚÔÛÙ¤ıËΠÛÙ· ÊÚ¿ÙÈ· Ë ÛËÌ·Ṳ̂ÓË Ì ÊıÔÚÈÛ½ÓË ·ÓÙÈ·ÓıÚÒÂÈÔ˜ ·ÓÙÈ-IgG ÛÊ·ÈÚ›ÓË, Ë ÔÔ›· ÂÓÒÓÂÙ·È Ì ÙÔ Û‡ÌÏÂÁÌ· ·ÓÙÈÁfiÓÔ˘-·ÓÙÈÛÒÌ·ÙÔ˜. °È· ÙËÓ ·Ó¿ÁÓˆ-

Paediatriki 2001;64:136-144

ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Û ÌÂÁ¤ı˘ÓÛË 200Ã, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ¤Ó· ÌÈÎÚÔÛÎfiÈÔ ÊıÔÚÈÛÌÔ‡ Zeiss Ì FITC ‰ÈÂÁÂÚÙÈÎfi ËıÌfi ÌÏ ʈÙfi˜ Î·È ¤Ó·˜ ËıÌfi˜-ÊÚ·ÁÌfi˜ 515 nm. ∂› ıÂÙÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÓÙ›‰Ú·Û˘ ¤Ó·˜ ÎÈÙÚÈÓÔÚ¿ÛÈÓÔ˜ ÊıÔÚÈÛÌfi˜. ∏ ıÂÙÈ΋ ·ÓÙ›‰Ú·ÛË Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ·Ï·È¿˜ ¤ÎıÂÛ˘ ÛÙÔÓ Èfi HHV-6. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȉÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ·Ú‚Ô˚Ô‡ µ-19 ÛÙÔ˘˜ ÔÚÔ‡˜ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÛÂÈÚ¿ ÙˆÓ ·ÓÙȉڷÛÙËÚ›ˆÓ ELISA ÙÔ˘ Ô›ÎÔ˘ Biotrin Parvovirus B 19 IgG (3˘ ÁÂÓÈ¿˜ ∞ÓÔÛÔÂÓ˙˘ÌÈ΋ ª¤ıÔ‰Ô˜), Û‡Ìʈӷ Ì ÙȘ ¤ÓıÂÙ˜ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. ∆· ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ·Ú‚Ô˚Ô‡ µ 19 ÛÙÔÓ ÔÚfi ·ÓÙȉÚÔ‡Ó Ì ÙËÓ ÎÂηı·Ṳ́ÓË Î·È ·Ó·Û˘Ó‰˘·Ṳ̂ÓË VP 2 ÚˆÙ½ÓË ÙÔ˘ ·Ú‚Ô˚Ô‡, Ë ÔÔ›· ‚Ú›ÛÎÂÙ·È Î·ıËψ̤ÓË ÛÙÔÓ ˘ı̤ӷ ÙˆÓ ÊÚ·ٛˆÓ. ªÂÙ¿ ·fi ÂÒ·ÛË Î·È ¤ÎÏ˘ÛË ÙˆÓ ÊÚ·ٛˆÓ, ÚÔÛÙ¤ıËΠÙÔ ÂÓ˙˘ÌÈÎfi Û‡˙¢ÁÌ·, ÙÔ ÔÔ›Ô ·ÔÙÂÏÂ›Ù·È ·fi ȯÓËıÂÙË̤ӷ Ì ˘ÂÚÔÍÂȉ¿ÛË ·ÓÙÈÛÒÌ·Ù· ÎÔÓ›ÎÏÔ˘ ¤Ó·ÓÙÈ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ G. ∆Ô fiÏÔ Û‡ÌÏÂÁÌ· ·ÓȯÓ‡ÂÙ·È Ì ÙËÓ ÚÔÛı‹ÎË ∆ªµ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÌÏ ¯ÚÒÌ·ÙÔ˜ ·ÚÔ˘Û›· ˘ÂÚÔÍÂȉ¿Û˘. ªÂ ÙËÓ ÚÔÛı‹ÎË 1¡ ıÂ˚ÎÔ‡ ÔͤԘ, ·Ú¿ÁÂÙ·È ÙÔ ÙÂÏÈÎfi ÚÔ˚fiÓ Ù˘ ·ÓÙ›‰Ú·Û˘ ¯ÚÒÌ·ÙÔ˜ ΛÙÚÈÓÔ˘. √È ÙÈ̤˜ ÔÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÌÂÙÚ‹ıËÎ·Ó Û ̋ÎË Î‡Ì·ÙÔ˜ 450 nm, Ì ̋ÎÔ˜ ·Ó·ÊÔÚ¿˜ Ù· 620 nm, Û ʷÛÌ·ÙÔʈÙfiÌÂÙÚÔ ÌÈÎÚÔÏ·ÎÒÓ ELISA (Hitachi ELISA reader). ∏ ÙÈÌ‹ Ù˘ Ô˘‰Ô‡ (cut-off, COV) ÌÂÙÚ‹ıËΠۇÌʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. √È Ï·Ì‚·ÓfiÌÂÓ˜ ÙÈ̤˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ÂÍ‹˜: ·ÔÚÚfiÊËÛË <0,9 COV: ·ÚÓËÙÈÎfi ‰Â›ÁÌ·, ·ÔÚÚfiÊËÛË >1,1 COV ıÂÙÈÎfi ‰Â›ÁÌ·. ¢Â›ÁÌ·Ù· Ô˘ ‰ÂÓ ‹Ù·Ó ıÂÙÈο ‹ ·ÚÓËÙÈο ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ ·ÌÊ›‚ÔÏ·. ∆· ıÂÙÈο ‰Â›ÁÌ·Ù· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ÂÚ·ÈÙ¤Úˆ ·ÛıÂÓÒ˜ (+), ÌÂÙÚ›ˆ˜ (++) Î·È ÈÛ¯˘ÚÒ˜ (+++) ıÂÙÈο, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÛËÌ›· Ô˘‰ÒÓ (cut-off) ÈÛÔ‰‡Ó·Ì· Ì ÙË ‰È¿ÌÂÛÔ. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȉÈÎÒÓ ÔÏÈÎÒÓ IgG ·ÓÙÈÛˆÌ¿ÙˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‰ÔÎÈÌ·Û›· ·Ó¿ÛÙÚÔÊ˘ ELISA ÙÔ˘ Ô›ÎÔ˘ Mp-Savyon Diagnostics SeroELISA, Û‡Ìʈӷ Ì ÙȘ ¤ÓıÂÙ˜ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹. ∂Ó Û˘ÓÙÔÌ›·, ÔÈ ÔÚÔ› ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Î·È ÔÈ ÔÚÔ› ÂϤÁ¯Ô˘ Âˆ¿ÛÙËÎ·Ó Ù·˘Ùfi¯ÚÔÓ· Ì ·ÓÙÈÁfiÓ· ª. Ó¢ÌÔÓ›·˜ Ô˘ Â›Ó·È Û˘˙¢Á̤ӷ Ì ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Î·È Ì ÂȉÈ΋ ·ÓıÚÒÈÓË ·ÓÔÛÔÛÊ·ÈÚ›ÓË Î·ıËψ̤ÓË ÛÙÔÓ ˘ı̤ӷ ÙˆÓ ÊÚ·ٛˆÓ Ù˘ ÌÈÎÚÔϿη˜. ªÂ ‰È·‰Ô¯ÈΤ˜ ÂÎχÛÂȘ ·Ó·ÚÚÔÊ‹ıËΠÙÔ ÌË-ÚÔÛËψı¤Ó ˘ÏÈÎfi ηıÒ˜ Î·È Ù· ÌË-‰ÂÛÌÂ˘Ì¤Ó· Û˘ÛÙ·ÙÈο ÙÔ˘ ÔÚÔ‡. ™ÙË Û˘Ó¤¯ÂÈ· ÚÔÛÙ¤ıËΠÙÔ ÂÓ˙˘ÌÈÎfi ˘fiÛÙڈ̷ (·Ú·-ÓÈÙÚÔÊ·ÈÓ˘ÏÈÎfi ʈÛÊÔÚÈÎfi Ô͇). √È ÙÈ̤˜ ÔÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ ÌÂÙÚ‹ıËÎ·Ó ÛÙ· 405 nm (Hitachi ELISA reader). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÂȉÈÎÒÓ ÔÏÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ª. Ó¢ÌÔÓ›·˜ ÛÙÔÓ ÔÚfi ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÁÓˆÛÙÔ‡˜ ÚfiÙ˘Ô˘˜ ÔÚÔ‡˜ (calibrators). ∏ ıÂÙÈ΋ ·ÓÙ›‰Ú·ÛË Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ·Ï·È¿˜ ¤ÎıÂÛ˘ ÛÙÔ ª. Ó¢ÌÔÓ›·˜.

2. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ∞Ú¯Èο, ¤ÁÈÓ ηٿٷÍË ÙˆÓ ÛÙÔȯ›ˆÓ Î·È ·ÍÈÔÏfiÁËÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ì¤Ûˆ ‰È·ÍÔÓÈÎÒÓ ÈÓ¿ÎˆÓ (two by two table). ∞ÎÔÏÔ‡ıˆ˜, Ë ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙË ¯Ú‹ÛË ÔÏÏ·Ï‹˜ ÏÔÁ·ÚÈıÌÈÛÙÈ΋˜ ÂÍ¿ÚÙËÛ˘ (multiple logistic regression), Ì ·ÌÔÈ‚·›Ô ¤ÏÂÁ¯Ô, ÙfiÛÔ ÁÈ· ÌË-ÔÚÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘,

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Paediatriki 2001;64:136-144

fiÛÔ Î·È ÁÈ· ÙȘ ÔÚÔÏÔÁÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ. ŸÙ·Ó Ë ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Û˘ÌÂÚȤϷ‚ fiÏ· Ù· ‰Â‰Ô̤ӷ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‰ÂÛÌÂ˘Ì¤ÓË ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË (conditional logistic regression) ˆ˜ ̤ıÔ‰Ô˜ ÂÎÏÔÁ‹˜. ªÂ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ·È‰ÈÒÓ Û ‰‡Ô ÔÌ¿‰Â˜ (οو ÙˆÓ 5 Î·È ¿Óˆ ÙˆÓ 5 ÂÙÒÓ), Ë ‰ÂÛÌÂ˘Ì¤ÓË ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË ÂÈÙÚ¤ÂÈ ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÛÙÔȯ›ˆÓ ÁÈ· fiÏÔ˘˜ fiÛÔ˘˜ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ¯ˆÚ›˜ ·ÒÏÂÈ· Ù˘ ÂÁ΢ÚfiÙËÙ·˜, Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ı· ÏËÊıÔ‡Ó ˘fi„Ë ÔÈ ·Ú¿ÁÔÓÙ˜ ÂÍÔÌÔ›ˆÛ˘ (matching factors).

∞ÔÙÂϤÛÌ·Ù· √ ›Ó·Î·˜ 1 ·ÚÔ˘ÛÈ¿˙ÂÈ ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ Î·È ‰ËÌÔÁÚ·ÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ʇÏÔ Î·È ËÏÈΛ·, ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË Î·È ÌÔÚ-

ʈÙÈÎfi Â›Â‰Ô Ù˘ ÌËÙ¤Ú·˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Î·È ÙˆÓ ÂÍÔÌÔÈˆÌ¤ÓˆÓ Ì·ÚÙ‡ÚˆÓ. ™˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó, Â›Û˘, Ù¤ÛÛÂÚȘ ¿ÏϘ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ÛÙȘ ÌÔÓÔ·Ú·ÁÔÓÙÈΤ˜ ·Ó·Ï‡ÛÂȘ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙË ÓfiÛÔ. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È Ë ÛÂÈÚ¿ Á¤ÓÓËÛ˘, ÔÈ ÁÓˆÛÙÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·È‰È΋ Ï¢¯·ÈÌ›·, ηıÒ˜ Â›Û˘ Î·È ÙÔ È‰ÈfiÎÙËÙÔ Û›ÙÈ ˆ˜ ‰Â›ÎÙ˘ ÂÎÙ›ÌËÛ˘ Ù˘ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈ΋˜ Ù¿Í˘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Ë ·Ó·ÈÌ›· Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·È‰È΋ Ï¢¯·ÈÌ›·. ª·˙› Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÂÍÔÌÔ›ˆÛ˘, ÔÈ ÌÂÙ·‚ÏËÙ¤˜ ·˘Ù¤˜ ·ÔÙ¤ÏÂÛ·Ó ÙÔ ÎÂÓÙÚÈÎfi ÌÔÓÙ¤ÏÔ

¶›Ó·Î·˜ 1. ∫ÔÈÓˆÓÈΤ˜ Î·È ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ Î·È Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙÔ› ·Ú·ÁfiÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û 94 Ӥ˜ ÂÚÈÙÒÛÂȘ ALL Î·È Û 94 ÂÍÔÌÔȈ̤ÓÔ˘˜ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· Ì¿ÚÙ˘Ú˜ ªÂÙ·‚ÏËÙ‹ º‡ÏÔ ÕÚÚÂÓ £‹Ï˘ ∏ÏÈΛ· (¤ÙË) ≤4 ¤ÙË 5+ √ÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË ¤ÁÁ·ÌË ‰È¿ÊÔÚ· ªÔÚʈÙÈÎfi Â›Â‰Ô ≤6 ¤ÙË 7-9 10-12 ≥13 π‰ÈÔÎÙËÛ›· ÛÈÙÈÔ‡ ¡·È Ÿ¯È ™ÂÈÚ¿ Á¤ÓÓËÛ˘ ¶ÚÒÙË ÕÏÏË ∞Ó·ÈÌ›· ·ËÛ˘ Ÿ¯È ¡·È µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g) <2750 2750-2999 3000-3249 3250-3499 3500-3749 ≥3750

140

∞ÛıÂÓ›˜ N (%)

ª¿ÚÙ˘Ú˜ N (%)

56 38

59,6 40,4

56 38

59,6 40,4

52 42

55,3 44,7

48 46

51,1 48,9

88 6

93,6 6,4

88 6

93,6 6,4

27 16 32 19

28,7 17,0 34,1 20,2

23 20 30 21

24,5 21,3 31,9 22,3

74 20

78,7 21,3

59 35

62,7 37,2

55 39

58,5 41,5

41 53

43,6 56,4

73 21

77,7 22,3

83 11

88,3 11,7

6 10 17 19 20 22

6,4 10,6 18,1 20,2 21,3 23,4

18 8 18 17 17 16

19,1 8,5 19,1 18,1 18,1 17,1

∆ÈÌ‹ p ·fi ‰ÔÎÈÌ·Û›· ¯2 ªÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ∂ÍÔÌÔȈ̤ÓË ÌÂÙ·‚ÏËÙ‹

∂ÍÔÌÔȈ̤ÓË ÌÂÙ·‚ÏËÙ‹

1,00

0,69

0,02

0,04

0,05

0,03

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ÙˆÓ ·Ó·Ï‡ÛˆÓ. ∆Ô ÎÂÓÙÚÈÎfi ÌÔÓÙ¤ÏÔ, ÙÔ ÔÔ›Ô ÚÔ·ÙÂÈ ·fi ÙË ‰ÂÛÌÂ˘Ì¤ÓË Î·È ÙË ÌË ‰ÂÛÌÂ˘Ì¤ÓË ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ›Ó·Î· 2. ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙȘ ‰‡Ô ÌÂıfi‰Ô˘˜ ·Ó¿Ï˘Û˘ Â›Ó·È Û˘ÁÎÚ›ÛÈÌ· ·ÔÙÂϤÛÌ·Ù·. √ ›Ó·Î·˜ 3 ·ÂÈÎÔÓ›˙ÂÈ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÔÚÔÏÔÁÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Û ·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜. ¶·Ú·ÙËÚÂ›Ù·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ì ÓfiÛËÛË ·fi ÈÔ‡˜ Ù˘ ·Ú·ÁÚ›˘ Î·È ·ÓÙ›ÛÙÚÔʘ (ÂÓ‰ÂÈÎÙÈΤ˜ ·ÏÏ¿ ÛÙ·ÙÈÛÙÈÎÒ˜ ÌË ÛËÌ·ÓÙÈΤ˜) Û˘Û¯ÂÙ›ÛÂȘ Ì ÙÔÓ Èfi Epstein-Barr Î·È ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜. ™ÙÔÓ ›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÂÎÙÈÌÒÌÂÓ· ÌÂÙ¿ ·fi ¤ÏÂÁ¯Ô ÁÈ· ÂӉ¯fiÌÂÓÔ˘˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ - Ëϛη ‰È·ÁÒÓÈˆÓ ·Ó·ÏÔÁÈÒÓ (Û¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ) ÁÈ· ·È‰È΋ Ï¢¯·ÈÌ›· ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙÔ ‚·ıÌfi ÔÚÔıÂÙÈÎfiÙËÙ·˜ ÛÙÔ˘˜ ‰¤Î· ÏÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÎÙÈÌ‹ıËÎ·Ó ÔÈ Û¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ Ï¢¯·ÈÌ›·˜ Û ‰‡Ô ÔÌ¿‰Â˜ ËÏÈÎÈÒÓ, οو ÙˆÓ 5 Î·È ¿Óˆ ÙˆÓ 5 ÂÙÒÓ. ∆· Â˘Ú‹Ì·Ù· ÁÈ· ÙË Û¯¤ÛË Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ì ÙËÓ ÔÚÔÏÔÁÈ΋ οÙÔ„Ë (profile) ÙˆÓ ·È‰ÈÒÓ Û οı ¤Ó·Ó ·fi ÙÔ˘˜ ÌÂÏÂÙÒÌÂÓÔ˘˜ ÏÔÈÌÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈο, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ. ™Â ·ÓÙ›ıÂÛË Ì ٷ ·Ú·¿Óˆ, ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 5 ÂÙÒÓ ·Ó·‰ÂÈÎÓ‡ÂÙ·È Ì›· ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ì ÙÔ˘˜ ÈÔ‡˜ Ù˘ ·Ú·ÁÚ›˘ (p = 0,01), ηıÒ˜ Î·È Ì›· ÛÂÈÚ¿ ÛËÌ·ÓÙÈÎÒÓ ‹ ÂÓ‰ÂÈÎÙÈÎÒÓ ·ÚÓËÙÈÎÒÓ Û˘Û¯ÂÙ›ÛÂˆÓ Ù˘ ÓfiÛÔ˘ Ì ÙÔÓ Èfi Epstein-Barr (p = 0,11), ÙÔÓ Èfi HHV-6 (p = 0,05), ÙÔ ª˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ (p = 0,02) Î·È ÙÔÓ ¶·Ú‚Ô˚fi µ 19 (p = 0,07). ¶Ú¿ÁÌ·ÙÈ, ÔÈ ÙÚÂȘ ·fi ÙȘ ·ÚÓËÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ, ȉȷ›-

ÙÂÚ· ·˘Ù¤˜ Ì ÙÔ˘˜ ÈÔ‡˜ Epstein-Barr, ∞ÓıÚÒÈÓÔ ∂ÚËÙÔ˚fi-6 Î·È ÙÔ ª˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, Â›Ó·È ·ÚÎÂÙ¿ ÛËÌ·ÓÙÈΤ˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰Â‰Ô̤ӈÓ, Êı¿ÓÔÓÙ·˜ ¤Ó· ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi Â›‰Ô, ÙÔ˘Ï¿¯ÈÛÙÔÓ Û ¤Ó· ·fi Ù· ‰‡Ô ÂÓ·ÏÏ·ÎÙÈο ÌÔÓ٤Ϸ. ∂ÈϤÔÓ, ÛÙË ÌÂϤÙË ·˘Ù‹ ·ÍÈÔÏÔÁ‹ıËΠÂÚ·ÈÙ¤Úˆ Ë ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ì ÙÔ˘˜ ÈÔ‡˜ ·Ú·ÁÚ›˘ Î·È Ù·˘Ùfi¯ÚÔÓ· ·ÓÙ›ÛÙÚÔÊ˘ Û˘Û¯¤ÙÈÛ‹˜ Ù˘ Ì ÙÔ˘˜ ÈÔ‡˜ EBV, HHV-6 Î·È ÙÔ ª˘ÎfiÏ·ÛÌ· Û ·ÙÔÌÈÎfi Â›‰Ô. ∞fi ÙȘ 94 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ·È‰È΋ Ï¢¯·ÈÌ›·, 16 ‚Ú¤ıËÎ·Ó Ù·˘Ùfi¯ÚÔÓ· ÔÚÔıÂÙÈΤ˜ ˆ˜ ÚÔ˜ ÙÔ˘˜ ÈÔ‡˜ ·Ú·ÁÚ›˘ Î·È ÔÚÔ·ÚÓËÙÈΤ˜ ˆ˜ ÚÔ˜ ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÂÓÒ Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ Ì·ÚÙ‡ÚˆÓ ‹Ù·Ó 10 (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜: 1,7, p = 0,20). ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË Û 52 ·ÛıÂÓ›˜ Î·È 48 Ì¿ÚÙ˘Ú˜ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜: 0,9, p = 0,87). øÛÙfiÛÔ, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 5 ÂÙÒÓ, Ë Û˘Û¯¤ÙÈÛË Â›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜: 3,9, p = 0,04). ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Ï¢¯·ÈÌ›·˜ ÛÙ· ·È‰È¿ ¿Óˆ ÙˆÓ 5 ÂÙÒÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ fiÙ·Ó Ë ¯·ÌËÏ‹ Û˘ÏÏÔÁÈ΋ ÙÔ˘˜ ·ÓÔÛ›· ÁÈ· ÔÏÏÔ‡˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‰ÔÎÈÌ¿˙ÂÙ·È ·fi οÔÈ· ηı˘ÛÙÂÚË̤ÓË Ïԛ̈ÍË, Ù˘ ÔÔ›·˜ Ô ÏÔÈÌ҉˘ ·Ú¿ÁÔÓÙ·˜ ÚÔÛ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ (80%) ·È‰È¿ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜. ™˘˙‹ÙËÛË ∏ ‰ÈÂÍ·ÁˆÁ‹ ÚÔÔÙÈÎÒÓ ÂÚ¢ÓÒÓ ÁÈ· ÙË ÌÂϤÙË Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ì ٷ˘Ùfi¯ÚÔÓË ·ÈÌÔÏË„›· Â›Ó·È ·ÚÎÂÙ¿ ‰‡ÛÎÔÏÔ ¤ÚÁÔ. ∂Í¿ÏÏÔ˘, Ë ‰ÈÂÓ¤ÚÁÂÈ· ÏËı˘ÛÌȷ΋˜ ¤Ú¢ӷ˜ Ù‡Ô˘ ·ÛıÂÓÒÓÌ·ÚÙ‡ÚˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‹ ÔÚÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ÙfiÛÔ Ù¯ÓÈ-

¶›Ó·Î·˜ 2. ™¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ (ORs) Î·È 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (95% CI) ÁÈ· ·Ó¿Ù˘ÍË ·È‰È΋˜ ALL ÛÂ Û˘Ó¿ÚÙËÛË Ì ÁÂÓÈΤ˜ (ÌË ÔÚÔÏÔÁÈΤ˜) ÌÂÙ·‚ÏËÙ¤˜ (ÎÂÓÙÚÈÎfi ÌÔÓÙ¤ÏÔ): ÔÏÏ·Ï‹ (‰ÂÛÌÂ˘Ì¤ÓË ‹ ÌË ‰ÂÛÌÂ˘Ì¤ÓË) ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË ªÂÙ·‚ÏËÙ‹

∏ÏÈΛ· º‡ÏÔ ™ÂÈÚ¿ Á¤ÓÓËÛ˘ π‰ÈÔÎÙËÛ›· ÛÈÙÈÔ‡ ∞Ó·ÈÌ›· ·ËÛ˘ µ¿ÚÔ˜ Á¤ÓÓËÛ˘

∫·ÙËÁÔÚ›· ‹ ∞‡ÍËÛË

¢ÂÛÌÂ˘Ì¤ÓË OR 95% CI

1 ¤ÙÔ˜ Î·È ¿Óˆ ÕÚÚÂÓ £‹Ï˘ ¶ÚÒÙË ÕÏÏË ¡·È Ÿ¯È Ÿ¯È ¡·È ∞‡ÍËÛË 250 g

∂ÍÔÌÔȈ̤ÓË ÌÂÙ·‚ÏËÙ‹ ∂ÍÔÌÔȈ̤ÓË ÌÂÙ·‚ÏËÙ‹ 1 0,48 1 0,56 1 2,63 1,33

0,25-0,93 0,28-1,11 1,03-6,77 1,05-1,68

ªË ‰ÂÛÌÂ˘Ì¤ÓË OR 95% CI 0,99 1 1,14 1 0,51 1 0,53 1 2,17 1,21

0,92-1,07 0,61-2,14 0,28-0,95 0,27-1,03 0,94-5,00 1,00-1,46

141

2001 MAPT- A¶PI§

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™ÂÏ›‰· 142

¶·È‰È·ÙÚÈ΋ 2001;64:136-144

Paediatriki 2001;64:136-144

¶›Ó·Î·˜ 3. √ÚÔÏÔÁÈο ·ÔÙÂϤÛÌ·Ù· ÁÈ· 10 ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Û ·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜ ¶·Ú¿ÁˆÓ

∞‰ÂÓÔ˚fi˜ ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ ∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ Epstein Barr ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ ∞ÓıÚÒÈÓÔ˜ ∂ÚËÙÔ˚fi˜-6 ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ πfi˜ °Ú›˘ A ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ πfi˜ °Ú›˘ B ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ πÔ› ¶·Ú·ÁÚ›˘ 1,2,3 ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ ¶·Ú‚Ô˚fi˜ B19 ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ ∞Ó·Ó¢ÛÙÈÎfi˜ ™˘Á΢ÙÈ·Îfi˜ πfi˜ ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜ ª˘ÎfiÏ·ÛÌ· ¶Ó¢ÌÔÓ›·˜ ·ÛıÂÓ›˜ Ì¿ÚÙ˘Ú˜

·ÚÓËÙÈο

·ÌÊ›‚ÔÏ·

ıÂÙÈο (Ó·È ÂÓ. fi¯È,+)

ıÂÙÈο (++)

ıÂÙÈο (+++)

N

N

N

N

N

20 25

4 2

27 26

28 25

15 16

+0,63

28 42

3 1

28 14

20 21

15 16

+0,27

41 31

2 0

51 63

-

-

-0,09

58 52

8 7

28 35

-

-

-0,31

30 32

11 7

14 22

23 13

16 20

+ 0,92

43 43

7 6

10 20

17 12

17 13

+ 0,57

9 10

1 1

22 34

24 31

38 18

+ 0,03

68 70

3 1

15 8

8 15

-

-0,74

15 13

1 5

26 25

23 29

29 22

+ 0,66

90 81

1 8

3 5

-

-

-0,07

Τ˜ ‰˘Û¯¤ÚÂȘ fiÛÔ Î·È ËıÈο ‰ÈÏ‹ÌÌ·Ù·. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿ fï˜, ÔÈ ¤Ú¢Ó˜ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ Ô˘ ‰ÈÂÍ¿ÁÔÓÙ·È Û ÓÔÛÔÎÔÌÂÈ·Îfi ÏËı˘ÛÌfi ·ÔÙ¤ÏÂÛ·Ó Î·Ù¿ ÙÔ ·ÚÂÏıfiÓ ı¤Ì· ¤ÓÙÔÓ˘ ÎÚÈÙÈ΋˜ ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘ Èı·ÓfiÙËÙ·˜ Ô˘ ›¯·Ó ÁÈ· ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜ Î·È ÏËÚÔÊfiÚËÛ˘ (15). ™ÙË ÌÂϤÙË ·˘Ù‹ ‰ÂÓ ¤ÁÈÓ ϋ„Ë ·›Ì·ÙÔ˜ Û ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·È‰ÈÒÓ (284 ·fi Ù· 388) ÂÍ·ÈÙ›·˜ ÙÔ˘ ·ÔÎÏÂÈÛÌÔ‡ ÙÔ˘˜ ·fi ÙËÓ ¤Ú¢ӷ ÁÈ· ‰ÈÔÈËÎËÙÈÎÔ‡˜ ‹ Ù¯ÓÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂›Ó·È, fï˜,

142

ÎÏ›ÛË (+ or -) Î·È ∆ÈÌ‹ p

·‰‡Ó·ÙÔ ÔÈ ÏfiÁÔÈ ·˘ÙÔ› Ó· Ô‰‹ÁËÛ·Ó Û ÛÊ¿ÏÌ·Ù· ÂÈÏÔÁ‹˜, ·ÊÔ‡ ·ÚÎÂÙ¿ ·È‰È¿ ·ÔÎÏ›ÛÙËÎ·Ó ÁÈ·Ù› Ë ‰È¿ÁÓˆÛË Î·È Ë ¤Ó·ÚÍË Ù˘ ¯ËÌÂÈÔıÂÚ·›·˜ ¤ÁÈÓ ηٿ ÙË ‰È¿ÚÎÂÈ· ·ÚÁÈÒÓ, ÚÈÓ ÙË Ï‹„Ë ·›Ì·ÙÔ˜ ·fi ÙÔ˘˜ Ù¯ÓÈÎÔ‡˜ Û˘ÓÂÚÁ¿Ù˜ Ù˘ ¤Ú¢ӷ˜. ∂›Û˘, Ë ÌÂϤÙË ‰ÂÓ ˘fiÎÂÈÙ·È Û ÛÊ¿ÏÌ·Ù· ÏËÚÔÊfiÚËÛ˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÂÈÏÔÁ‹ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ‹Ù·Ó Ù˘¯·›· ·Ó¿ÌÂÛ· Û ·ÛıÂÓ›˜ Ì ÌË-ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ‹ ηٷÛÙ¿ÛÂȘ. ∞ÚÎÂÙ¿ ·È‰È¿ ̠Ϣ¯·ÈÌ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓË ÂÈÚÚ¤ÂÈ· ÛÂ

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 143

¶·È‰È·ÙÚÈ΋ 2001;64:136-144

Paediatriki 2001;64:136-144

¶›Ó·Î·˜ 4. ™¯ÂÙÈÎÔ› ΛӉ˘ÓÔÈ1 (ORs) and 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (95% CI) ÁÈ· ·Ó¿Ù˘ÍË ·È‰È΋˜ ALL Û ۯ¤ÛË Ì ËÓ ÔÚÔıÂÙÈÎfiÙËÙ· Û 10 ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜: ÔÏÏ·Ï‹ ÏÔÁ·ÚÈıÌÈÛÙÈ΋ ÂÍ¿ÚÙËÛË (‰ÂÛÌÂ˘Ì¤ÓË Î·È ÌË ÌË ‰ÂÛÌÂ˘Ì¤ÓË) Ì ·ÌÔÈ‚·›· ÚÔÙ‡ˆÛË ¶·Ú¿ÁˆÓ ™‡ÓÔÏÔ ·È‰ÈÒÓ 0-4 ÂÙÒÓ 5+ ÂÙÒÓ ¢ÂÛÌÂ˘Ì¤ÓË ªË ‰ÂÛÌÂ˘Ì¤ÓË ¢ÂÛÌÂ˘Ì¤ÓË ªË ‰ÂÛÌÂ˘Ì¤ÓË πÔ› OR 95% CI OR 95% CI OR 95% CI OR 95% CI ∞‰ÂÓÔ˚fi˜ 1,10 0,73-1,66 1,07 0,82-1,39 1,27 0,86-1,88 1,13 0,67-1,89 Epstein-Barr 0,40* 0,21-0,75 0,65* 0,45-0,93 0,66* 0,40-1,08 0,58* 0,30-1,12 ∂ÚËÙÔ˚fi˜-6 0,50* 0,29-0,87 0,71* 0,49-1,03 0,80 0,47-1,37 0,52* 0,27-1,01 πfi˜ °Ú›˘ A 0,85 0,60-1,22 0,97 0,75-1,26 0,99 0,68-1,44 0,84 0,53-1,34 πfi˜ °Ú›˘ B 0,98 0,69-1,41 1,12 0,89-1,42 1,05 0,76-1,44 1,31 0,84-2,02 πÔ› ¶·Ú·ÁÚ›˘ 1,2,3 1,85* 1,06-3,22 1,39* 1,01-1,91 1,29 0,87-1,93 3,01* 1,30-6,95 ¶·Ú‚Ô˚fi˜ B19 1,14 0,69-1,90 0,97 0,71-1,35 1,24 0,74-2,10 0,61* 0,35-1,05 ∞Ó·Ó¢ÛÙÈÎfi˜ ™˘Á΢ÙÈ·Îfi˜ πfi˜ 0,99 0,66-1,48 1,02 0.76-1,36 1,02 0,72-1,46 0,87 0,44-1,74 ∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ 1,14 0,87-1,49 1,03 0,83-1,27 0,91 0,67-1,24 1.00 0,69-1,46 ª˘ÎfiÏ·ÛÌ· 0,37* 0,12-1,20 0,44* 0,20-0,97 0,66 0,21-2,15 0,12* 0,02-0,69 1

Ì ÚÔÙ‡ˆÛË Î·È ÁÈ· ÙȘ ÌÂÙ·‚ÏËÙ¤˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÌÔÓÙ¤ÏÔ˘ * fiÙ·Ó p <0,10

ÏÔÈÌÒÍÂȘ ÚÈÓ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ÓfiÛÔ˘. ∏ ηٿÛÙ·ÛË ·˘Ù‹ ı· ‰ËÌÈÔ˘ÚÁÔ‡Û fï˜ ·‡ÍËÛË ÙˆÓ ıÂÙÈÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙȘ ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ, ÁÂÁÔÓfi˜, Ô˘ ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ٷ ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘. ∂ÈϤÔÓ, ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È ·ÚÎÂÙ¿ ÌÂÁ¿ÏÔ ÁÈ· ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ‰ÈÂÚ¢ÓÒÓÙ·È. ∂ÈÛËÌ·›ÓÂÙ·È, Ù¤ÏÔ˜, fiÙÈ ÛÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔ˘˜ ÂӉ¯fiÌÂÓÔ˘˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¢ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Î·È ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ. ∞ÓÙÈı¤Ùˆ˜, Ù· ‰Â‰Ô̤ӷ ÁÈ· Ù· ·È‰È¿ ¿Óˆ ÙˆÓ 5 ÂÙÒÓ Â›Ó·È Û˘Ì‚·Ù¿ Ì ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ˘fiıÂÛË Ô˘ ‰È·Ù˘ÒıËÎÂ. ŒÙÛÈ, Ë Û˘ÏÏÔÁÈ΋ ·ÓÔÛ›·, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙÔ ÔÚÔÏÔÁÈÎfi Ê¿ÛÌ· Ô˘ ‰È·ÈÛÙÒıËÎÂ, Â›Ó·È ÁÂÓÈÎÒ˜ ¯·ÌËÏfiÙÂÚË ÛÙ· ·È‰È¿ Ì ALL ·Ú¿ ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘. ∂Í¿ÏÏÔ˘, Ù· ·È‰È¿ Ì ALL ·ÚÔ˘Û›·Û·Ó ÈÛ¯˘Ú‹ ·ÓÔÛÔÏÔÁÈ΋ ·fiÎÚÈÛË Û ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ·, ·˘ÙfiÓ Ô˘ ÂÈο˙ÂÙ·È fiÙÈ ˘ÚÔ‰fiÙËÛ ÙË Ï¢¯·ÈÌ›·. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÚÔÙÂÈÓfiÌÂÓË ˘fiıÂÛË ÙÂÎÌËÚÈÒÓÂÙ·È ÙfiÛÔ ÛÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÔÌ¿‰Â˜ (¶›Ó·Î·˜ 4) fiÛÔ Î·È ÛÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ Û ·ÙÔÌÈÎfi Â›Â‰Ô (ÙÂÏÂ˘Ù·›· ·Ú¿ÁÚ·ÊÔ˜ ÛÙ· ·ÔÙÂϤÛÌ·Ù·). ™ÙË ÌÂϤÙË ·˘Ù‹ ‰ÂÓ ÂÈÛËÌ¿ÓıËΠ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ÔÚfiÙ˘ÔÈ ÙˆÓ ÈÒÓ ·Ú·ÁÚ›˘ ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙËÓ ÚfiÎÏËÛË ·È‰È΋˜ Ï¢¯·ÈÌ›·˜. ∞ÓÙÈı¤Ùˆ˜, ıˆÚÂ›Ù·È fiÙÈ ·˘ÙÔ› ÔÈ ÈÔ› ·ÔÙÂÏÔ‡Ó ¤Ó· ˘ÔÛ‡ÓÔÏÔ ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÏÔÈÌÔÁfi-

ÓˆÓ ·Ú·ÁfiÓÙˆÓ, ÔÈ ÔÔ›ÔÈ ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙË Ê‡ÛË Ù˘ ÂȉËÌ›·˜, ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Û˘ÏÏÔÁÈ΋ ·ÓÔÛ›· Î·È ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÍÂÓÈÛÙ‹ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÎÂÓÙÚÈÎfi ÚfiÏÔ ÛÙËÓ Èı·Ó‹ ÚfiÎÏËÛË ·È‰È΋˜ ALL. ¢ÂÓ ˘¿Ú¯Ô˘Ó ·ÍÈfiÈÛÙ· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙȘ ÂȉËÌÈÔÏÔÁÈΤ˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ ηٿ ÙËÓ ÂÚ›Ô‰Ô ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ηÈ, ηٿ Û˘Ó¤ÂÈ·, ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹ Ë ÛÙÔȯÂÈÔı¤ÙËÛË Ù˘ ‡·Ú͢ ÂȉËÌ›·˜ ·fi ÈÔ‡˜ ·Ú·ÁÚ›˘ ÛÙ· ·È‰È¿ ηٿ ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›Ô‰Ô. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È ÁÂÓÈÎÒ˜ Û˘Ì‚·Ù¿ Ì ÙȘ ȉ¤Â˜ Ô˘ ·Ó¤Ù˘ÍÂ Ô Kinlen (1,5,8,9) Î·È Û˘Ófi„ÈÛÂ Ô Greaves (11). ŸÌˆ˜ ˘¿Ú¯Ô˘Ó ·ÔÎÏ›ÛÂȘ. ŒÙÛÈ, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ Â›Ó·È ÈÔ ÂÌÊ·Ó‹ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ Û˘ÁÁڷʤˆÓ ÂÈÎÂÓÙÚÒıËÎ·Ó Û ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜ ·È‰È¿. ∂ÓÙÔ‡ÙÔȘ, Ù· ·ÔÙ¤ÏÂÛÌ· Ù˘ ¤Ú¢ӷ˜ ·˘Ù‹˜ Û˘Ì‚·‰›˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ Ì ٷ ÎÏ·ÛÈο ·Ú·‰Â›ÁÌ·Ù· Ù˘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (16) Î·È ›Ûˆ˜ Ù˘ ÛÎÏ‹Ú˘ÓÛ˘ ηٿ Ͽη˜ (17,18). ∂ÈϤÔÓ, Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ·È‰È΋˜ ALL ÛÙ· ÌÈÎÚfiÙÂÚ· ·È‰È¿ ÌÔÚ› Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÂÓ‰ÔÌ‹ÙÚÈ· Û˘Ì‚¿Ì·Ù· Î·È Î·Ù·ÛÙ¿ÛÂȘ (9,19-25). ™ÙË ÌÂϤÙË ·˘Ù‹ ·ÍÈÔÏÔÁ‹ıËÎÂ Ë ˘fiıÂÛË fiÙÈ Ë ·È‰È΋ Ï¢¯·ÈÌ›· ·ÔÙÂÏ› ›Ûˆ˜ Ì›· Û¿ÓÈ· ÂΉ‹ÏˆÛË ÌÈ·˜ ηı˘ÛÙÂÚË̤Ó˘ ÌË-ÂȉÈ΋˜ Ïԛ̈͢, Ô˘ Á›ÓÂÙ·È Û ¤Ó· ˘fiÛÙڈ̷ ¯·ÌËÏ‹˜ Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜. ÃÚËÛÈÌÔÔÈ‹ıËΠÌÈ· Ó¤· ÚÔÛ¤ÁÁÈÛË Ô˘ ηχÙÂÈ fiϘ ÙȘ Ï¢ڤ˜ Ù˘ ˘fiıÂÛ˘: ÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ·Ó¿Ù˘ÍË Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜

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Î·È ÙÔÓ ÂÎÏ˘ÙÈÎfi ÚfiÏÔ Î¿ÔÈ·˜ Ïԛ̈͢. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Â›Ó·È Û˘Ì‚·Ù¿ Ì ÙËÓ ÚÔÙ·ı›۷ ˘fiıÂÛË. ∂Âȉ‹ ÌÂÏÂÙ‹ıËÎ·Ó ‰¤Î· ÌfiÓÔ ÏÔÈÌÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜, Ù· ‰Â‰Ô̤ӷ ÔÚÈÛÌ¤ÓˆÓ ·È‰ÈÒÓ ‰ÂÓ Â›Ó·È Û˘Ì‚·Ù¿ Ì ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ÚfiÙ˘Ô, ·ÏÏ¿ ηıÔÏÈ΋ Û˘Ì‚·ÙfiÙËÙ· ‰ÂÓ ·Ó·Ì¤ÓÂÙ·È ÛÙË ‰ÈÂÚ‡ÓËÛË ÔÏ˘·ÈÙÈÔÏÔÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ù· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ÛÙËÚ›˙Ô˘Ó ÙËÓ ˘fiıÂÛË fiÙÈ Èı·ÓÒ˜ Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ALL ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 5 ÂÙÒÓ ¤¯ÂÈ Û˘¯Ó¿ ÏÔÈÌÒ‰Ë ·ÈÙÈÔÏÔÁ›·. ∂˘¯·ÚÈÛٛ˜ √È Û˘ÁÁÚ·Ê›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ı· ‹ıÂÏ·Ó Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ÙÔÓ Î. ¡›ÎÔ ¢ÂÛ‡ÚË ÁÈ· ÙË Û˘Ì‚ÔÏ‹ ÙÔ˘ ÛÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰Ô̤ӈÓ.

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24. Stewart AM. Leukemia and other neoplasms in childhood following radiation exposure in utero - a general survey of present knowledge. Br J Radiol 1968;41:718-719.

25. Greaves MF. Workshop report. Infant leukaemia biology, aetiology and treatment. Leukemia 1996;10:372-377.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-12-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-02-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂ϤÓË ¶ÂÙÚ›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ªÈÎÚ¿˜ ∞Û›·˜ 75, 115 27, °Ô˘‰›, ∞ı‹Ó· e-mail: epetrid@cc.uoa.gr

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ORIGINAL PAPER

™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ¯ÔÚ‹ÁËÛ˘ Ê˘ÛÈÎÔ‡ Î·È Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ∂. ÷Ù˙ˉ¿ÎË, ∂. ∫ÔڷοÎË, ª. ÃÚÈÛÙÔ‰Ô˘Ï¿ÎË, ∫.ª. ª·ÚÁ¿ÚË, ¢. ª·ÌÔ˘Ï¿Î˘, ∞. ª·ÓÔ˘Ú¿, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Comparative trial of natural and synthetic surfactants in the treatment of respiratory distress syndrome of prematurity E. Hatzidaki, E. Korakaki, M. Christodoulaki, K.M. Margari, D. Mamoulakis, A. Manoura, C. Giannakopoulou

¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ·ÈÙÈÔÏÔÁÈο, ÁÂÓÈο Ì ÙËÓ Ó¢ÌÔÓÈ΋ ·ÓˆÚÈÌfiÙËÙ· ·ÏÏ¿ Î·È ÂȉÈÎfiÙÂÚ· Ì ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∏ Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ıˆÚÂ›Ù·È Û‹ÌÂÚ· ıÂÚ·›· ÂÎÏÔÁ‹˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë Û‡ÁÎÚÈÛË Ù˘ ÎÏÈÓÈ΋˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ê˘ÛÈ΋˜ (alvofact) Î·È Û˘ÓıÂÙÈ΋˜ (exosurf) ÚÔ¤Ï¢Û˘ ÛÙËÓ ÔÚ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÛÙËÓ ¤Î‚·ÛË ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ªÂÏÂÙ‹ıËÎ·Ó 92 ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ∞fi Ù· ÓÂÔÁÓ¿ Ô˘ Û˘ÌÂÚÈÏ¿‚·Ì ÛÙË ÌÂϤÙË Ì·˜ ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹, Û 42 ¯ÔÚËÁ‹ıËÎÂ Û˘ÓıÂÙÈÎfi˜ Î·È Û 50 Ê˘ÛÈÎfi˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. √ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ¯ÔÚËÁ‹ıËΠ۠1 ˆ˜ 3 ‰fiÛÂȘ, ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢. ∆· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ¤‰ÂÈÍ·Ó fiÙÈ Ô ¯ÚfiÓÔ˜ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÚÒÙ˘ ‰fiÛ˘ Â›Ó·È Ï›ÁÔ ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡, Ë ‰È¿ÚÎÂÈ· Ù˘ Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·Ó·ÓÔ‹˜, Ù˘ ¯ÔÚ‹ÁËÛ˘ √2 Î·È Ù˘ ÓÔÛËÏ›·˜ Â›Ó·È ÂÏ·ÊÚÒ˜ ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÂÓÒ Ë ÂηÙÔÛÙÈ·›· ·‡ÍËÛË ÙÔ˘ ·ÚÙËÚÈÔ΢„ÂÏȉÈÎÔ‡ ËÏ›ÎÔ˘ (a/AP√2) ›ӷÈÂÏ·ÊÚÒ˜ ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡. ∏ ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

Abstract: Respiratory distress syndrome is related etiologically to lung immaturity and more particularly to insufficient surfactant. Exogenous administration of surfactant is considered, nowadays, to be the treatment of choice for preterm newborn infants with respiratory distress syndrome. Our aim was to compare the clinical efficacy of therapeutic administration of either a synthetic (exosurf) or a natural (alvofact) surfactant in the clinical course of respiratory distress syndrome as well as on the outcome of the preterm newborns. The study involved 92 preterm newborns with respiratory distress syndrome who were treated in the Department of Neonatology of the University of Crete. Of the newborns selected at random for the study, 42 received synthetic surfactant and 50 natural surfactant. Both types of surfactant were administered in 1 to 3 doses as needed. The results showed that there was a slight delay in the administration of the first dose of the natural surfactant compared to the synthetic. The duration of oxygen administration, ventilatory support and hospitalization was slightly higher in the group treated with synthetic surfactant, whereas the percent increase of the arterial alveolar partial pressure oxygen ratio was slightly higher in the group given natural surfactant. In addition, the mortality rate in the neonatal period was higher in the synthetic surfactant group than in the group receiving natural surfactant (38.1% versus 24%),

Department of Neonatology of the University of Crete

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ıÓËÛÈÌfiÙËÙ· ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (28Ë Ë̤ڷ) ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· Ô˘ ‹ÚÂ Û˘Óı-ÂÙÈÎfi, Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· Ô˘ ‹ÚÂ Ê˘ÛÈÎfi ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ· (38,1% ¤Ó·ÓÙÈ 24%). ∏ ›‰È· Ù¿ÛË ·Ú·ÙËÚ‹ıËÎÂ Î·È ÛÙȘ ÂÈÏÔΤ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚÔˆÚfiÙËÙ· Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, fiˆ˜ ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ Ó¢ÌÔıÒڷη (11,2% ¤Ó·ÓÙÈ 5,2%, RR 0,90), ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ (34,6% ¤Ó·ÓÙÈ 21,1%, RR 0,90), ÛË„·ÈÌ›·˜ (11,5% ¤Ó·ÓÙÈ 5,2%, RR 0,94) Î·È ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ (12,5% ¤Ó·ÓÙÈ 2,8%, RR 0,91). ∞ÓÙ›ıÂÙ·, Ë Û˘¯ÓfiÙËÙ· Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙ· ÓÂÔÁÓ¿ Ô˘ ‹Ú·Ó Û˘ÓıÂÙÈÎfi ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ· (3,8% ¤Ó·ÓÙÈ 7,9%, RR 0,90). ™˘ÌÂÚ·›ÓÔ˘ÌÂ, ÏÔÈfiÓ, fiÙÈ Ë ¯Ú‹ÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ê˘ÛÈ΋˜ ÚÔ¤Ï¢Û˘ Ê·›ÓÂÙ·È Ó· ÏÂÔÓÂÎÙ› Û˘ÁÎÚÈÙÈο Ì ÙË ¯Ú‹ÛË ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡.

as were the complications associated with prematurity and RDS such as pneumothorax (11.2% to 5.2%, RR 0.90); intraventricular hemorrhage (34.6% to 21.1%, RR 0.90); septicemia (11.5% to 5.2%, RR 0.94) and bronchopulmonary dysplasia (12.5% to 2.8%, RR 0.91). In contrast the pulmonary hemorrhage rate was lower in the group given synthetic surfactant (3.8% versus 7.9%, RR 0.90). In conclusion, the administration of natural surfactant in preterm newborns with respiratory distress syndrome seems to be more advantageous in comparison with the synthetic one.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (Ê˘ÛÈÎfi˜, Û˘ÓıÂÙÈÎfi˜), Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜.

Key words: surfactant (natural, synthetic), respiratory distress syndrome.

™˘ÓÙÔÌÔÁڷʛ˜ a/APO2 ·ÚÙËÚÈÔ΢„ÂÏȉÈÎfi ËÏ›ÎÔ FiO2 Û˘ÁΤÓÙÚˆÛË Ô͢ÁfiÓÔ˘

∂ÈÛ·ÁˆÁ‹ ∆Ô Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ·ÔÙÂÏ› ‚·ÛÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿. ∏ Û˘¯ÓfiÙËÙ· Î·È Ë ‚·Ú‡ÙËÙ¿ ÙÔ˘ ·˘Í¿ÓÔÓÙ·È fiÛÔ Ë ËÏÈΛ· ·ËÛ˘ ÂÏ·ÙÙÒÓÂÙ·È, Ì ·ÔÙ¤ÏÂÛÌ· Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÚÈÓ ·fi ÙËÓ 32Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ Ó· ¯ÚÂÈ¿˙ÔÓÙ·È, Û˘Ó‹ıˆ˜, Ì˯·ÓÈ΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË (1,2). ∆Ô Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› ·ÈÙÈÔÏÔÁÈο, ÁÂÓÈο Ì ÙËÓ Ó¢ÌÔÓÈ΋ ·ÓˆÚÈÌfiÙËÙ· ·ÏÏ¿ Î·È ÂÓ Ì¤ÚÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (3). ªÂ ÙÔÓ fiÚÔ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ ÂÓÓÔԇ̠οÔÈ· ÂÓÈ·›· ÌÔÓÔÌÔÚȷ΋ Ô˘Û›·, ·ÏÏ¿ Û‡ÌÏÔÎÔ Ì›ÁÌ· Ô˘ÛÈÒÓ. ∆· ΢ÚÈfiÙÂÚ· Û˘ÛÙ·ÙÈο ÙÔ˘ Â›Ó·È ÊˆÛÊÔÏÈ›‰È·, Ô˘‰¤ÙÂÚ· Ï›Ë Î·È ÚˆÙ½Ó˜ (4-7). ¢Ú· ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙËÓ ÂÈÊ·ÓÂȷ΋ Ù¿ÛË ÌÂٷ͇ ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ÂÌÔ‰›˙ÔÓÙ·˜ ÙË Û‡ÌÙˆÛ‹ ÙÔ˘˜. ∂›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È ÙËÓ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ (2,4). ∆Ô 80% ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ ·ÔÙÂÏ› Ë ÊˆÛÊ·Ùȉ˘ÏÔ¯ÔÏ›ÓË. ∂›Ó·È Ë Ô˘Û›· Ô˘ ηÙÂÍÔ¯‹Ó ÌÂÈÒÓÂÈ ÙËÓ ÂÈÊ·ÓÂȷ΋ Ù¿ÛË (8).

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µÚ›ÛÎÂÙ·È, fï˜, Û ÎÚ˘ÛÙ·ÏÏÈ΋ ÌÔÚÊ‹ Î·È ‰ÂÓ ¤¯ÂÈ ·fi ÌfiÓË Ù˘ ÙËÓ ÈηÓfiÙËÙ· Ù·¯Â›·˜ Â›ÛÙÚˆÛ˘ ÛÙÔ ÙÔ›¯ˆÌ· ÙˆÓ Î˘„ÂÏ›‰ˆÓ (6). °È’ ·˘ÙfiÓ ÙÔ ÏfiÁÔ, ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ÙˆÓ ÏÈfiÊÈÏˆÓ ÚˆÙÂ˚ÓÒÓ B Î·È C, Ô˘ ‚ÔËıÔ‡Ó ÛÙËÓ Î·Ï‡ÙÂÚË ÚÔÛÚfiÊËÛË Î·È Â›ÛÙÚˆÛË ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Î˘„ÂÏ›‰ˆÓ (7). ∏ Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ıˆÚÂ›Ù·È Û‹ÌÂÚ· ıÂÚ·›· ÂÎÏÔÁ‹˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ (9). ÃÔÚËÁÂ›Ù·È ıÂÚ·¢ÙÈο Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ·ÏÏ¿ Î·È ÚÔÊ˘Ï·ÎÙÈο Û ÚfiˆÚ· ÓÂÔÁÓ¿ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ì ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÛÙËÓ ¤ÁÎ˘Ô Ì ÛÎÔfi ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ˆÚ›Ì·ÓÛ˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙËÓ Â͈ÁÂÓ‹ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ΢ڛˆ˜ ‚¤‚·È· ÙËÓ ÚÔÊ˘Ï·ÎÙÈ΋, ¤¯ÂÈ ÌÂȈı› ÛËÌ·ÓÙÈο Ë ÓÔÛËÚfiÙËÙ· ·ÏÏ¿ Î·È Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (10-13). ∏ Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Â›Ó·È ·ÛÊ·Ï‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋. ∏ ¯ÔÚ‹ÁËÛË, fï˜, Û΢·ÛÌ¿ÙˆÓ Ô˘ ÂÚȤ¯Ô˘Ó ͤÓ˜ ˙ˆ˚Τ˜ ÚˆÙ½Ó˜ ¤¯ÂÈ ÚÔηϤÛÂÈ ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ·ÓÔÛÔ‚ÈÔÏfiÁˆÓ, ÂÍ·ÈÙ›·˜ ÙÔ˘

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ıˆÚËÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ·ÓÙÈۈ̿وÓ. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, fï˜, ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· Ô˘ Ó· ÂÓÔ¯ÔÔÈÔ‡Ó ÙÔÓ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÚfiÎÏËÛË Î¿ÔÈ·˜ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ (10-12,14). ŒÓ·˜ ¿ÏÏÔ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ‰ËÌÈÔ˘ÚÁ‹ıËΠ·fi ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ Ë Ù·¯Â›· ‰Ú¿ÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Û˘Óԉ‡ÂÙ·È ·fi ÚÔÛˆÚÈÓ¤˜ ÌÂÙ·‚ÔϤ˜ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÚÔ‹˜ ·›Ì·ÙÔ˜ Î·È ÙÒÛË Ù˘ ›ÂÛ˘ ÛÙË Ì¤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›·. ∏ ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌ›· Ô˘ ÚÔηÏÂ›Ù·È ÌÔÚ› ‰˘ÓËÙÈο Ó· Úԉȷı¤ÛÂÈ Û ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ∞fi ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (9,15,16). ∆· Û΢¿ÛÌ·Ù· Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÚÔ¤Ú¯ÔÓÙ·È ·fi ˙Ò· (Ê˘ÛÈÎÔ› ·Ú¿ÁÔÓÙ˜) ‹ ·Ú·Û΢¿˙ÔÓÙ·È ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ (Û˘ÓıÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· Ù˘ ¯Ú‹Û˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, Ê˘ÛÈ΋˜ ‹ Û˘ÓıÂÙÈ΋˜ ÚÔ¤Ï¢Û˘ (17-19). ∆Ô Û··ÛÌ· alvofact ÂÚȤ¯ÂÈ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ· Ê˘ÛÈ΋˜ ÚÔ¤Ï¢Û˘ Ô˘ ·ÔÌÔÓÒÓÂÙ·È ·fi ÙÔ˘˜ Ó‡ÌÔÓ˜ ˘ÁÈÒÓ ‚ÔÔÂȉÒÓ Ì ¤ÎÏ˘ÛË, ÂÓÒ ÙÔ exosurf Â›Ó·È Û··ÛÌ· ÌÂ Û˘ÓıÂÙÈÎfi ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ·, ÂχıÂÚÔ ÚˆÙ½Ó˘, Ì ·ÚÈÔ Û˘ÓıÂÙÈÎfi ÙÔ ÊˆÛÊÔÏÈ›‰ÈÔ ‰È·ÏÌÈÙÔʈÛÊ·Ùȉ˘ÏÔ¯ÔÏ›ÓË. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÎÏÈÓÈ΋˜ ÌÂϤÙ˘ ·ÔÙÂÏ› Ë ÂÎÙ›ÌËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ Ê˘ÛÈÎÔ‡ (alvofact) Î·È Û˘ÓıÂÙÈÎÔ‡ (exosurf) ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙËÓ ÔÚ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ ÙfiÛÔ ¿ÌÂÛˆÓ, fiˆ˜ Ó¢ÌÔıÒڷη, Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÏÔÈÌÒ͈Ó, ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜, ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘, fiÛÔ Î·È ·ÒÙÂÚˆÓ, fiˆ˜ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜, ˘‰ÚÔΤʷÏÔ˘ Î·È ÂÚÈÎÔÈÏȷ΋˜ Ï¢ÎÔ̷ϷΛ·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË Ì·˜ Û˘ÌÂÚÈÏ¿‚·Ì 92 ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÛÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1993 Î·È 1999. ∞fi ·˘Ù¿, Û 42 Ù˘¯·›· ÂÈÏÂÁ̤ӷ ÓÂÔÁÓ¿ ¯ÔÚËÁ‹ıËΠÙÔ Û··ÛÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (exosurf) Î·È Û 50 ÙÔ Û··ÛÌ· ÙÔ˘ Ê˘ÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· (alvofact). ∏ ÂÈÏÔÁ‹ ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ Ë̤ڷ Ù˘ ‚‰ÔÌ¿‰·˜ Ô˘ ¤ÁÈÓÂ Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙËÓ ÎÏÈÓÈ΋. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙ· ÓÂÔÁÓ¿ Ô˘ Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ¤ÁÈÓÂ

Paediatriki 2001;64:145-153

ÙȘ Ë̤Ú˜ ¢Â˘Ù¤Ú·, ∆ÂÙ¿ÚÙË ‹ ¶·Ú·Û΢‹ ¯ÔÚËÁ‹ıËΠÙÔ Û··ÛÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡, ÂÓÒ Û ÂΛӷ Ô˘ Ë ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ¤ÁÈÓ ÙȘ Ë̤Ú˜ ∆Ú›ÙË, ¶¤ÌÙË ‹ ™¿‚‚·ÙÔ ¯ÔÚËÁ‹ıËΠÙÔ Û··ÛÌ· ÙÔ˘ Ê˘ÛÈÎÔ‡. ∞fi ÙË ÌÂϤÙË ÂÍ·ÈÚ¤ıËÎ·Ó ÓÂÔÁÓ¿ Ì ÔÏÏ·Ϥ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Î·È Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ. ∫ÚÈÙ‹ÚÈ· ¯ÔÚ‹ÁËÛ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È ÂÈÛfi‰Ô˘ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙË ÌÂϤÙË ‹Ù·Ó: ·) ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ‚) ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 72 ˆÚÒÓ, Á) ·Ó¿ÁÎË ‰È·ÛˆÏ‹ÓˆÛ˘ Î·È Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·Ó·ÓÔ‹˜ Î·È ‰) ÙÈÌ‹ ÙÔ˘ a/AP√2 ÌÈÎÚfiÙÂÚË ·fi 0,22 Û 2 ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ. ∆Ô Û··ÛÌ· ÙÔ˘ Ê˘ÛÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (alvofact) ¯ÔÚËÁ‹ıËΠ۠‰ÔÛÔÏÔÁ›· 1,2 ml ·Ó¿ kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜, Ô˘ ·ÓÙÈÛÙÔȯ› Û 50 mg ÔÏÈÎÒÓ ÊˆÛÊÔÏÈȉ›ˆÓ ·Ó¿ kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜. ∞Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ·Ó·Ó¢ÛÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ë ·Ú¯È΋ ‰fiÛË Â·Ó·Ï·Ì‚·ÓfiÙ·Ó Ì ÌÂÛԉȷÛÙ‹Ì·Ù· 12-24 ˆÚÒÓ, ¯ˆÚ›˜ Ó· ˘ÂÚ‚·›ÓÔÓÙ·È ÔÈ 4 Û˘ÓÔÏÈο ‰fiÛÂȘ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û 200 mg ÔÏÈÎÒÓ ÊˆÛÊÔÏÈȉ›ˆÓ ·Ó¿ kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜. ∆Ô Û··ÛÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (exosurf) ¯ÔÚËÁ‹ıËΠ۠‰ÔÛÔÏÔÁ›· 5 ml ·Ó¿ kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ Ô˘ ·ÓÙÈÛÙÔȯ› Û 67,5 mg ‰È·ÏÌ˘ÙÔ˘ÏʈÛÊ·Ùȉ˘ÏÔ¯ÔÏ›Ó˘ ·Ó¿ kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜. ∏ ·Ú¯È΋ ‰fiÛË Â·Ó·Ï·Ì‚·ÓfiÙ·Ó 12 ÒÚ˜ ·ÚÁfiÙÂÚ·, ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ·Ó·Ó¢ÛÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢. °È· ÙË Ì˯·ÓÈ΋ ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÓÂÔÁÓÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·Ó·Ó¢ÛÙ‹Ú˜ ȤÛˆ˜ [Dr·ger, babylog 1 HF(8407800)]. ™Ù· ÓÂÔÁÓ¿ Î·È ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Ô˘ ÌÂÏÂÙ‹Û·Ì ÔÈ ·Ú¿ÌÂÙÚÔÈ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ ÚÔÛ·ÚÌfi˙ÔÓÙ·Ó ¿ÌÂÛ·, ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË Î·È ÙȘ ÌÂÙ·‚ÔϤ˜ Ù˘ ÔÍÂÔ‚·ÛÈ΋˜ ÈÛÔÚÚÔ›·˜. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙË ÌË ·Ú·ÌÂÙÚÈ΋ ̤ıÔ‰Ô Mann-Whitney U test Î·È ÙÔ x2 test. ™Â ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ Fisher exact test Î·È ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (RR). ¶ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ‰È·‰Ô¯ÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÙÔ˘ ·ÚÙËÚÈÔ΢„ÂÏȉÈÎÔ‡ ËÏ›ÎÔ˘ ÚÈÓ, ÛÙÔ 2ˆÚÔ, ÙÔ 6ˆÚÔ Î·È ÌÂÙ¿ ÙÔ 6ˆÚÔ ÙˆÓ ÙÈÌÒÓ ¯ˆÚÈÛÙ¿ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ Î·È ÙÔ˘ Ê˘ÛÈÎÔ‡, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë one way ANOVA.

∞ÔÙÂϤÛÌ·Ù· ¢ÂÓ ˘‹ÚÍ·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Û¯ÂÙÈο Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÙËÓ ËÏÈΛ· ·ËÛ˘, ÙÔÓ ÙÚfiÔ Á¤ÓÓËÛ˘ (ηÈÛ·ÚÈ΋ ÙÔÌ‹ ‹ Ê˘ÛÈÔÏÔÁÈÎfi˜ ÎÔÏÈÎfi˜ ÙÔÎÂÙfi˜) Î·È ÙȘ Û˘Óı‹Î˜ ·Ó¿Ó˄˘ Î·È ·fi Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Û¯ÂÙÈο Ì ÙË Ì¤ÁÈÛÙË Fi√2 ‹ ÙË Û¯¤ÛË a/APO2, ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (¶›Ó·Î·˜ 1). ŒÍÈ ÚfiˆÚ·, ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËÎÂ Û˘ÓıÂÙÈÎfi˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, ·‚›ˆÛ·Ó ÂÓÙfi˜ 36 ˆÚÒÓ ·fi ÙË Á¤ÓÓËÛË. ™ÙËÓ ÔÌ¿‰· Ô˘ ¯ÔÚËÁ‹ıËÎÂ Ê˘ÛÈÎfi˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜

147

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Paediatriki 2001;64:145-153

¶›Ó·Î·˜ 1. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ·Ó¿ÏÔÁ· Ì ÙËÓ ÔÌ¿‰· ÛÙËÓ ÔÔ›· ηٷٿ¯ÙËÎ·Ó Û˘ÓıÂÙÈÎfi˜ exosurf (42) mean±SE (95% CI) B° ∏∫ ∞ÚÈıÌfi˜ ‰fiÛÂˆÓ º˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ ∫·ÈÛ·ÚÈ΋ ÙÔÌ‹

1288,0±55,0 30,5±0,4 1,19±0,07 15 27

(1176,8; 1399,2) (29,7; 31,4) (1,04; 1,33) 53,6 42,2

Ê˘ÛÈÎfi˜ alvofact (50) mean±SE (95% CI) 1365,0±67,3 30,2±0,3 1,82±0,10 13 37

(1229,5; 1500,4) (29,4; 31,0) (1,61; 2,02) 46,4 57,8

SE: standard error of the mean, CI: ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ µ°: ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ∏∫: ËÏÈΛ· ·ËÛ˘ * U=537,5 z=-4,559 2-tailed p=0,0000

·Ú¿ÁÔÓÙ·˜ ‰ÂÓ ÛËÌÂÈÒıËΠÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜. ™ÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡, Ô ¯ÚfiÓÔ˜ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÚÒÙ˘ ‰fiÛ˘ Â›Ó·È ÂÏ·ÊÚÒ˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ Û˘ÁÎÚÈÙÈο Ì ÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡. ∏ ‰È·ÊÔÚ¿ ÛÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÌÂٷ͇ ÙˆÓ 2 ÔÌ¿‰ˆÓ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (U=2016, z=- 0,503, 2 tailed p= 0,615). ¶·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙÔ˘ ·ÚÙËÚÈÔ΢„ÂÏȉÈÎÔ‡ ËÏ›ÎÔ˘ Û ۇÁÎÚÈÛË Ì ÙÔ ·Ú¯ÈÎfi Î·È ÛÙȘ ‰˘Ô ÔÌ¿‰Â˜. ∏ ·‡ÍËÛË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· ‹Ù·Ó 89,4%, 78,9% Î·È 57,8% ÛÙȘ 2, 6 Î·È >6 ÒÚ˜ ·ÓÙ›ÛÙÔȯ·. ™ÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡, ÔÈ ·ÓÙ›ÛÙÔȯ˜ ·˘Í‹ÛÂȘ ‹Ù·Ó 52,6%, 63,2% Î·È 47,3%. ¶ÚÔÊ·Ó¤˜ Â›Ó·È fiÙÈ Û fiϘ ÙȘ ÌÂÙÚ‹ÛÂȘ Ë ·ÓÙ·fiÎÚÈÛË ‹Ù·Ó ηχÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· (¶›Ó·Î·˜ 2). ∞Ó·ÊÔÚÈο Ì ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ·ÚÙËÚÈÔ΢„ÂÏȉÈÎÔ‡ ËÏ›ÎÔ˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Û˘ÓıÂÙÈÎÔ‡ Î·È Ê˘ÛÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙȘ ¯ÚÔÓÈΤ˜ ÂÚÈfi‰Ô˘˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË, ÛÙȘ 2, 6 Î·È >6 ÒÚ˜, ÔÈ ‰È·ÊÔÚ¤˜ ÂÎÙÈÌ‹ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ one way ANOVA. ™ËÌ·ÓÙÈΤ˜ ‹Ù·Ó ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ·ÚÙËÚÈÔ΢„ÂÏȉÈÎÔ‡ ËÏ›ÎÔ˘ ÛÙȘ 2, 6 Î·È >6 ÒÚ˜, Û˘ÁÎÚÈÙÈο Ì ÙȘ ÙÈ̤˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÙfiÛÔ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (p=0,003 Î·È p=0,015, ·ÓÙ›ÛÙÔȯ·). ∞Ó Î·È ÔÈ ‰È·ÊÔÚ¤˜ ÛÙË Ì¤ÛË ‰È¿ÚÎÂÈ· Ù˘ Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·Ó·ÓÔ‹˜, Ù˘ ¯ÔÚ‹ÁËÛ˘ √2 Î·È Ù˘ ÓÔÛËÏ›·˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ (¶›Ó·Î·˜ 3), ÔÈ ÙÈ̤˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˜ ÛÙ· ÚfiˆÚ· ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÙÔ Û··ÛÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∏ Â›‰Ú·ÛË Ù˘ ¯ÔÚ‹ÁËÛ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈ-

148

ÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙË ıÓËÛÈÌfiÙËÙ· Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 4. ¶·Ú·ÙËÚÂ›Ù·È fiÙÈ Ë ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂȈ̤ÓË ıÓËÛÈÌfiÙËÙ· 24,0% (12/50), Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· 38,1% (16/42), Ì ·ÓÙ›ÛÙÔÈ¯Ô Û¯ÂÙÈÎfi ΛӉ˘ÓÔ RR=0,81 (0,61; 1,08). ∂Í·ÈÚÒÓÙ·˜ ÙÔ˘˜ 6 ÚÒÈÌÔ˘˜ ı·Ó¿ÙÔ˘˜ ÙˆÓ 36 ÚÒÙˆÓ ˆÚÒÓ ˙ˆ‹˜, Ë ‰È·ÊÔÚ¿ ÛÙÔ Û¯ÂÙÈÎfi ΛӉ˘ÓÔ ·Ó¿ÌÂÛ· ÛÙȘ 2 ÔÌ¿‰Â˜ ÂÚÈÔÚ›˙ÂÙ·È [RR=0,95 (0,74; 1,23)]. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏÔÎÒÓ Ì ÂÍ·›ÚÂÛË ÙËÓ Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· Â›Ó·È Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¯ÔÚËÁ‹ıËÎÂ Û˘ÓıÂÙÈÎfi˜, Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡. ŒÙÛÈ, ‰ÈÏ¿ÛȘ ÂÚ›Ô˘ Û ÔÛÔÛÙfi Â›Ó·È ÔÈ ÂÚÈÙÒÛÂȘ Ó¢ÌÔıÒڷη Î·È ÛË„·ÈÌ›·˜ Î·È Û¯Â‰fiÓ ÙÂÙÚ·Ï¿ÛȘ ÔÈ ÂÚÈÙÒÛÂȘ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ (¶›Ó·Î·˜ 5) ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡. ∞ÓÙ›ıÂÙ·, ·‡ÍËÛË ÛÙÔ ‰ÈÏ¿ÛÈÔ ÂÚ›Ô˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛËÌÂÈÒÓÂÙ·È ÛÙ· ÚfiˆÚ· Ô˘ ¤Ï·‚·Ó Ê˘ÛÈÎfi ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ·. ™ÙÔ˘˜ ›Ó·Î˜ 6 Î·È 7 Ê·›ÓÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÂÈÏÔΤ˜ Û οı ÔÌ¿‰· ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∏ ËÏÈΛ· ı·Ó¿ÙÔ˘ ‹Ù·Ó ÂÏ·ÊÚÒ˜ ÌÈÎÚfiÙÂÚË ÛÙ· ÚfiˆÚ· Ù˘ ÔÌ¿‰·˜ ÙÔ˘ Ê˘ÛÈÎÔ‡, Û˘ÁÎÚÈÙÈο ÚÔ˜ ÂΛӷ Ô˘ ¤Ï·‚·Ó ÙÔ Û··ÛÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ (8,9 ± 0,37 ¤Ó·ÓÙÈ 11,7 ± 0,38 Ë̤Ú˜), ¯ˆÚ›˜ ˆÛÙfiÛÔ Ë ‰È·ÊÔÚ¿ Ó· Â›Ó·È ÛËÌ·ÓÙÈ΋ (U= 124,0 , z=- 0,311 , 2-Tailed p=0,76). ™˘˙‹ÙËÛË √È ÚÒÙ˜ ÚÔÛ¿ıÂȘ ¯ÔÚ‹ÁËÛ˘ ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘ Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÛÙË ‰ÂηÂÙ›· ÙÔ˘ 1960 ‰ÂÓ ·¤‰ˆÛ·Ó Ù· ·Ó·ÌÂÓfiÌÂÓ· ·ÔÙÂϤÛÌ·Ù·. ∞˘Ùfi ·Ô‰fiıËΠÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Û··ÛÌ· Ô˘ ¯ÔÚËÁ‹ıËΠÂÚÈ›¯Â ÌfiÓÔ ÙÔ ÊˆÛÊÔÏÈ›‰ÈÔ ÊˆÛÊ·Ùȉ˘ÏÔ¯ÔÏ›ÓË (20). ∆Ô 1980

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™ÂÏ›‰· 149

¶·È‰È·ÙÚÈ΋ 2001;64:145-153

Paediatriki 2001;64:145-153

¶›Ó·Î·˜ 2. ∞¿ÓÙËÛË ÛÙË ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·

ŒÓ·ÚÍË ¯ÔÚ‹ÁËÛ˘ (min) ªÂÁ›ÛÙË ÙÈÌ‹ Fi√2 a/∞PO2** ÚÈÓ a/APO2 ÛÙÔ 2ˆÚÔ a/APO2 ÛÙÔ 6ˆÚÔ a/APO2 ÌÂÙ¿ ÙÔ 6ˆÚÔ

√Ì¿‰· Û˘ÓıÂÙÈÎÔ‡ (¡Ô 42) mean± SE (95% CI)

√Ì¿‰· Ê˘ÛÈÎÔ‡ (¡Ô 50) mean± SE (95% CI)

168,5±11,3(145,7; 191,5) 0,59± 0,03 (0,50; 0,60) 0,19± 0,02 (0,6; 0,23) 0,29± 0,02 (0,4; 0,34) 0,31± 0,02 (0,26; 0,37) 0,28± 0,02 (0,23; 0,32)

183,6± 17,5(148,5; 218,7) 0,57± 0,04 (0,48; 0,66) 0,19±0,02 (0,16; 0,23) 0,36± 0,03 (0,29;0,43) 0,34± 0,02 (0,28; 0,39) 0,30± 0,02 (0,25; 0,35)

p

>0,05 >0,05 0,970 0,142 0,935 0,4013

SE: standard error of the mean, CI: ¢È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ ** ∞ÚÙËÚÈÔ΢„ÂÏȉÈÎfi ¶ËÏ›ÎÔ

¶›Ó·Î·˜ 3. ª¤ÛË ‰È¿ÚÎÂÈ· (Ë̤Ú˜) ˘Ô‚Ô‹ıËÛ˘ Ù˘ ·Ó·ÓÔ‹˜, ¯ÔÚ‹ÁËÛ˘ Ô͢ÁfiÓÔ˘ Î·È Û˘ÓÔÏÈ΋˜ ‰È¿ÚÎÂÈ·˜ ÓÔÛËÏ›·˜ ÛÙȘ 2 ÔÌ¿‰Â˜ ÓÂÔÁÓÒÓ

¢È¿ÚÎÂÈ·

√Ì¿‰· Û˘ÓıÂÙÈÎÔ‡ ∂¶ mean±S.E. (95% CI)

∞Ó·Ó¢ÛÙÈ΋˜ ÀÔÛÙ‹ÚÈ͢ ÃÔÚ‹ÁËÛ˘ O2 ¡ÔÛËÏ›·˜

8,9± 1,9 19,2± 7,9 40,4± 8,2

(5,0; 12,8) (3,2; 35,2) (23,9; 56,9)

√Ì¿‰· Ê˘ÛÈÎÔ‡ ∂¶ mean±S.E. (95% CI)

6,0± 1,0 11,7± 1,9 35,1± 5,1

(3,7; 8,1) (7,7; 15,6) (24,7; 45,4)

p

0,366 0,856 0,776

∂¶: ∂ÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ¶·Ú¿ÁÔÓÙ·˜

ÔÈ Fujiwara Î·È Û˘ÓÂÚÁ¿Ù˜, ¯ÔÚ‹ÁËÛ·Ó Âί‡ÏÈÛÌ· ‚Ô›Ԣ Ó‡ÌÔÓ· Û ÓÂÔÁÓ¿ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ·Ó·Ê¤ÚÔÓÙ·˜ ı·̷ÙÈο ·ÔÙÂϤÛÌ·Ù· (21). ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ¤‰ˆÛ ÙÔ ¤Ó·˘ÛÌ· ÁÈ· ηχÙÂÚË Î·È ÏÂÙÔÌÂÚ¤ÛÙÂÚË ÌÂϤÙË Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ∏ ηٷÓfiËÛË Ù˘ Û‡ÓıÂÛ‹˜ ÙÔ˘ Â¤ÙÚ„ ÙË Ì·˙È΋ ·Ú·ÁˆÁ‹ Î·È ‰È¿ıÂÛË Û ·ÂÚÈfiÚÈÛÙ˜ ÔÛfiÙËÙ˜ ‰È·ÊfiÚˆÓ ‰Ú·ÛÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ Ù· ÙÂÏÂ˘Ù·›· 10 ¯ÚfiÓÈ· Â¤ÊÂÚ·Ó Â·Ó¿ÛÙ·ÛË ÛÙË ıÂÚ·›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (22). √È ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙÔ ÂÌfiÚÈÔ ÚÔ¤Ú¯ÔÓÙ·È ·fi ˙Ò· (Ê˘ÛÈÎÔ› ·Ú¿ÁÔÓÙ˜) ‹ ·Ú·Û΢¿˙ÔÓÙ·È ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ (Û˘ÓıÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜). √È Ê˘ÛÈÎÔ› Ï·Ì‚¿ÓÔÓÙ·È Â›Ù ·fi ·ÌÓÈ·Îfi ˘ÁÚfi ›Ù ·fi ÙÔ˘˜ Ó‡ÌÔÓ˜ ‰È·ÊfiÚˆÓ ˙ÒˆÓ. √È Ê˘ÛÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÂÎÙfi˜ ·fi ʈÛÊÔÏÔ›‰È·, ÂÚȤ¯Ô˘Ó Î·È ÙȘ ÚˆÙ½Ó˜ B Î·È C. ∞ÓÙ›ıÂÙ·, ÔÈ Û˘ÓıÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ÂÚȤ¯Ô˘Ó ηıfiÏÔ˘ ÚˆÙ½Ó˜ (23). ∞fi ÚfiÛÊ·Ù˜ ·Ó·ÊÔÚ¤˜ (19,24,25), ·ÏÏ¿ Î·È ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜, Ê·›ÓÂÙ·È fiÙÈ Ë ‰Ú¿ÛË ÙÔ˘ Ê˘ÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· Â›Ó·È Ù·¯‡ÙÂÚË Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ·

ÛÙËÓ Ô͢ÁfiÓˆÛË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÓÂÔÁÓÔ‡, fiˆ˜ Î·È ÛÙËÓ ÂÈ‚›ˆÛË. ∞˘Ùfi ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÏÈfiÊÈÏˆÓ ÂȉÈÎÒÓ ÚˆÙÂ˚ÓÒÓ B Î·È C ÛÙ· Û΢¿ÛÌ·Ù· Ê˘ÛÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, Ô˘ ‚ÂÏÙÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÚÔÛÚfiÊËÛË ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ·¤Ú· ˘ÁÚÔ‡ (26). ∏ Ù·¯‡ÙÂÚË Î·È Î·Ï‡ÙÂÚË ·ÓÙ·fiÎÚÈÛË ÂÈÙÚ¤ÂÈ ÛÙÔÓ ÎÏÈÓÈÎfi Ó· ‚ÂÏÙÈÒÛÂÈ ¿ÌÂÛ· ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢, ÁÂÁÔÓfi˜ ηıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ÙfiÛÔ Ù˘ Û˘¯ÓfiÙËÙ·˜ fiÛÔ Î·È Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙˆÓ ÂÈÏÔÎÒÓ Ù˘. ∏ ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ Û˘Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ ÚÔˆÚfiÙËÙ·. ¢È¿ÊÔÚÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ηٿ ηÈÚÔ‡˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘, fiˆ˜ Ë ˘ÂÚ‚ÔÏÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ, Ë ·ÚÔ˘Û›· ·ÓÔÈÎÙÔ‡ ‚ÔÙÙ¿ÏÂÈÔ˘ fiÚÔ˘, ÔÈ ÏÔÈÌÒÍÂȘ. ∏ ÌÂÁ·Ï‡ÙÂÚË, fï˜, ¤ÌÊ·ÛË ¤¯ÂÈ ‰Ôı› ÛÙÔ ÚfiÏÔ ÙÔ˘ Ô͢ÁfiÓÔ˘ Î·È ÙÔ˘ ‚·ÚÔÙÚ·‡Ì·ÙÔ˜ ÛÙÔÓ ·ÓÒÚÈÌÔ Ó‡ÌÔÓ· (27). ∂›Ó·È ÁÓˆÛÙfi, Â›Û˘, fiÙÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· Ó¢ÌÔıÒڷη ÛÙÔÓ ·ÓÒÚÈÌÔ Ó‡ÌÔÓ· ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ Â›Ó·È Ë ˘„ËÏ‹ ıÂÙÈ΋ ÙÂÏÔÂÎÓ¢ÛÙÈ΋ ›ÂÛË, ÔÈ ÌÂÁ¿ÏÔÈ ¯ÚfiÓÔÈ ÂÈÛÓÔ‹˜, Ë ˘„ËÏ‹ ̤ÛË ›ÂÛË ÙˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ Î·È Ô ÌË Û˘Á¯ÚÔÓÈÛÌfi˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Ì ÙÔÓ ·Ó·Ó¢ÛÙ‹Ú· (2).

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™ÂÏ›‰· 150

¶·È‰È·ÙÚÈ΋ 2001;64:145-153

Paediatriki 2001;64:145-153

¶›Ó·Î·˜ 4. £·ÓfiÓÙ· Î·È ÂÈ‚ÈÒÛ·ÓÙ· ÓÂÔÁÓ¿ √Ì¿‰· Û˘ÓıÂÙÈÎÔ‡ ∂¶ ∏ÏÈΛ· (Ë̤Ú˜)

√Ì¿‰· Ê˘ÛÈÎÔ‡ ∂¶

0-28Ë ñ 28Ë

£·ÓfiÓÙ· ¡Ô (%) 16 (38,1) 2 (4,8)

˙ÒÓÙ· ¡Ô (%) 26 (61,9) 24 (57,1)

ı·ÓfiÓÙ· ¡Ô (%) 12 (24,0) 2 (4,0)

˙ÒÓÙ· ¡Ô (%) 38 (76,0) 36 (72,0)

™‡ÓÔÏÔ

18 (42,9)

24 (57,1)

14 (28,0)

36 (72,0)

p 0,216* 0,895**

* Mantel-Haenszel, Yates ‰ÈfiÚıˆÛË x2 = 1,53 ** Mantel-Haenszel, Yates ‰ÈfiÚıˆÛË x2 = 0,02 ∂¶: ∂ÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ¶·Ú¿ÁÔÓÙ·˜

¶›Ó·Î·˜ 5. ∂ÈÏÔΤ˜ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ÂÈ‚›ˆÛ·Ó ̤¯ÚÈ ÙËÓ 28Ë Ë̤ڷ ˙ˆ‹˜ √Ì¿‰· Û˘ÓıÂÙÈÎÔ‡ ¶Ó¢ÌÔıÒڷη˜ ¶Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ∂ÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ™Ë„·ÈÌ›· µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¢˘ÛÏ·Û›· * ** *** **** *****

Mantel-Haenszel, Mantel-Haenszel, Mantel-Haenszel, Mantel-Haenszel, Mantel-Haenszel,

√Ì¿‰· Ê˘ÛÈÎÔ‡

¡Ô 5/26 1/26 9/26 3/26

% 11,2 3,8 34,6 11,5

¡Ô 2/38 3/38 8/38 2/38

% 5,3 7,9 21,1 5,3

3/24

12,5

1/36

2,8

Yates Yates Yates Yates Yates

‰ÈfiÚıˆÛË ‰ÈfiÚıˆÛË ‰ÈfiÚıˆÛË ‰ÈfiÚıˆÛË ‰ÈfiÚıˆÛË

x2 x2 x2 x2 x2

= = = = =

0,90 1,04 0,90 0,94

RR (0,76; (0,93; (0,71; (0,82;

1,08) 1,16) 1,14) 1,09)

0,91 (0,79; 1,05)

1,34 0,01 0,40 0,14 0,39

¶›Ó·Î·˜ 6. ∂ÈÏÔΤ˜ ÛÙ· ı·ÓfiÓÙ· Î·È ˙ÒÓÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· £·ÓfiÓÙ·

¶Ó¢ÌÔıÒڷη˜ ¶Ó¢ÌÔÓÈ΋ ∞ÈÌ. ∂ÁÎÂÊ·ÏÈ΋ ∞ÈÌ. ™Ë„·ÈÌ›· ¡∂∫ ∞∞¶ À‰ÚÔΤʷÏÔ˜ ™·ÛÌÔ› ÀÔÂÂÓ‰˘Ì·ÙÈ΋ ∞ÈÌ. ªËÓÈÁÁ›Ùȉ· µ¶¢ K‡ÛÙË ∫¡™ ∞ÈÌ.: ¡∂∫: ∞∞¶: µ¶¢: ∫¡™:

150

< 1,5 ËÌ.

1,5-28 ËÌ.

3 1 2 1 -

2 7 2 1 2 1 1 -

∞ÈÌÔÚÚ·Á›· ¡ÂÎÚˆÙÈ΋ ∂ÓÙÂÚÔÎÔÏ›Ùȉ· ∞ÓÔÈÎÙfi˜ ∞ÚÙËÚÈ·Îfi˜ ¶fiÚÔ˜ µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¢˘ÛÏ·Û›· ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ·

∑ÒÓÙ· >28 ËÌ.

2 1 1 1 -

∑ÒÓÙ· 28Ë ËÌ.

™‡ÓÔÏÔ

3 1 4 4 4 2 3 3 1

8 1 12 8 1 7 1 6 2 3 3 1

p 0,246* 0,925** 0,524*** 0,707**** 0,395*****

2001 MAPT- A¶PI§

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™ÂÏ›‰· 151

¶·È‰È·ÙÚÈ΋ 2001;64:145-153

Paediatriki 2001;64:145-153

¶›Ó·Î·˜ 7. ∂ÈÏÔΤ˜ ÛÙ· ı·ÓfiÓÙ· Î·È ˙ÒÓÙ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ÙÔ˘ Ê˘ÛÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· £·ÓfiÓÙ· < 1,5 ËÌ.

1,5-28 ËÌ.

>28 ËÌ.

∑ÒÓÙ· 28Ë ËÌ.

-

2 3 8 2 -

1 1 1 1 1

6 1 6 1 9 4

9 3 9 9 2 10 5

-

-

-

1 3 1 1

1 3 1 1

-

-

-

2 1

2 1

¶Ó¢ÌÔıÒڷη˜ ¶Ó¢ÌÔÓÈ΋ ∞ÈÌ. ∂ÁÎÂÊ·ÏÈ΋ ∞ÈÌ. ™Ë„·ÈÌ›· ¡∂∫ ∞∞¶ ™·ÛÌÔ› ÀÔÂÂÓ‰˘Ì·ÙÈ΋ ·ÈÌÔÚÚ·Á›· ªËÓÈÁÁ›Ùȉ· µ¶¢ K‡ÛÙË ∫¡™ ¶ÂÚÈÎÔÈÏȷ΋ Ï¢ÎÔ̷ϷΛ· À‰ÚÔΤʷÏÔ˜ ∞ÈÌ.: ¡∂∫: ∞∞¶: B¶¢: ∫¡™:

∑ÒÓÙ· ™‡ÓÔÏÔ

∞ÈÌÔÚÚ·Á›· ¡ÂÎÚˆÙÈ΋ ∂ÓÙÂÚÔÎÔÏ›Ùȉ· ∞ÓÔÈÎÙfi˜ ∞ÚÙËÚÈ·Îfi˜ ¶fiÚÔ˜ µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¢˘ÛÏ·Û›· ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ·

∏ ÂÚÈÎÔÈÏȷ΋ Î·È Ë ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›· ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ıÓËÛÈÌfiÙËÙ·˜, ·ÏÏ¿ Î·È ÓÔÛËÚfiÙËÙ·˜, ÛÙ· ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. ∏ ˘ÔÂÂÓ‰˘Ì·ÙÈ΋ ‚Ï·ÛÙÈ΋ ÛÙÈ‚¿‰· Â›Ó·È Ì›· ·ÁÁÂÈÔ‚ÚÈı‹˜ ÂÚÈÔ¯‹. ∫¿ı ÁÂÁÔÓfi˜ Ô˘ ‰È·Ù·Ú¿ÛÛÂÈ ÙËÓ ÂÓ‰Ô·ÁÁÂȷ΋ ›ÂÛË Î·È ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙ· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, fiˆ˜ ˘ÔÍ›·, ÔͤˆÛË, Ó¢ÌÔıÒڷη˜, ÌË Û˘Á¯ÚÔÓÈÛÌfi˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Ì ÙÔÓ ·Ó·Ó¢ÛÙ‹Ú· ·ÎfiÌ· Î·È ·Ó·ÚÚfiÊËÛË Ù˘ ÙÚ·¯Â›·˜, ÌÔÚ› ‰˘ÓËÙÈο Ó· ÚÔηϤÛÂÈ ÙË Ú‹ÍË ÙˆÓ Â˘¿ÏˆÙˆÓ ·ÁÁ›ˆÓ Ù˘ ‚Ï·ÛÙÈ΋˜ ÛÙÈ‚¿‰·˜ (2,16). √È ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó Ì›·, Â›Û˘, ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜. √È È·ÙÚÈÎÔ› ¯ÂÈÚÈÛÌÔ›, fiˆ˜ Ô Î·ıÂÙËÚÈ·ÛÌfi˜ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ, Ë ‰È·ÛˆÏ‹ÓˆÛË Ù˘ ÙÚ·¯Â›·˜, Ë ¯ÔÚ‹ÁËÛË ·ÚÂÓÙÂÚÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ, Ë ·Ú·ÌÔÓ‹ ·ÁÁÂÈ·ÎÒÓ Î·ıÂÙ‹ÚˆÓ, Úԉȷı¤ÙÔ˘Ó ÙËÓ ÂÁηٿÛÙ·ÛË Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ÌÈÎÚÔ‚›ˆÓ. ∏ ÁÚ‹ÁÔÚË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È Ë ‰˘Ó·ÙfiÙËÙ· Ô˘ ·Ú¤¯ÂÙ·È ÛÙÔÓ ÎÏÈÓÈÎfi Ó· ÂÚÈÔÚ›˙ÂÈ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÙÔ˘˜ È·ÙÚÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜, ¤¯Ô˘Ó ηıÔÚÈÛÙÈ΋ ÛËÌ·Û›· ÁÈ· ÙËÓ ¤Î‚·ÛË. ™ÙËÓ ÂÚÁ·Û›· Ì·˜ ÌÂÏÂÙ‹Û·Ì ̛· Ù˘¯·ÈÔÔÈË̤ÓË ÛÂÈÚ¿ ÚÔÒÚˆÓ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ ›‰ÈÔ ÙÌ‹Ì·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÙÔ ‰Â›ÁÌ· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÔÌÔÈÔÁÂÓ¤˜ Î·È ÔÈ Û˘Óı‹Î˜ ÓÔÛËÏ›·˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ È·ÙÚÈ΋ Î·È ÙË ÓÔÛËÏ¢ÙÈ΋ ÊÚÔÓÙ›‰·, Â›Ó·È ·Ó¿ÏÔÁ˜. ™ÙË ÌÂϤÙË Ì·˜ Û˘ÌÂ-

ÚÈÏ¿‚·Ì ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Ì·˜, ·ÏÏ¿ Î·È ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Û ȉȈÙÈΤ˜ ÎÏÈÓÈΤ˜ Î·È ¡ÔÛÔÎÔÌ›· Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÓËÛÈÔ‡. ∏ ÌÂÙ·ÊÔÚ¿ ÙÔ˘˜ ÛÙÔ ÙÌ‹Ì· Ì·˜, Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ, Â›Ó·È Î·ı˘ÛÙÂÚË̤ÓË, ÁÂÁÔÓfi˜ Ô˘ ÔÊ›ÏÂÙ·È ·ÊÂÓfi˜ ÌÂÓ ÛÙË ¯ÈÏÈÔÌÂÙÚÈ΋ ·fiÛÙ·ÛË Î·È ·ÊÂÙ¤ÚÔ˘ ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÍ·ÛÊ¿ÏÈÛ˘ ηٿÏÏËÏˆÓ Û˘ÓıËÎÒÓ. ∞˘Ùfi Ê·›ÓÂÙ·È Î·È ÛÙÔ ¯ÚfiÓÔ ¯ÔÚ‹ÁËÛ˘ Ù˘ ÚÒÙ˘ ‰fiÛ˘ ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, Ô˘ Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È Î·ı˘ÛÙÂÚË̤ÓÔ˜. ∏ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡ Ô˘ ÌÂٷʤÚÂÙ·È, ÌÔÚ› Ó· Â›Ó·È ÌÂÁ¿ÏË Î·È, fiˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚı›, ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÙÂÏÈ΋ ¤Î‚·ÛË (28). ∏ ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ‰fiÛÂˆÓ ÌÂٷ͇ ÙˆÓ 2 ÔÌ¿‰ˆÓ ‰ÈηÈÔÏÔÁÂ›Ù·È ·fi ÙË ÌÈÎÚfiÙÂÚË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ‰Ú¿Û˘ ÙÔ˘ Ê˘ÛÈÎÔ‡ (alvofact) <6 ˆÚÒÓ, fiˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ·fi ÙȘ ÌÂÙÚ‹ÛÂȘ ÙÔ˘ ·ÚÙËÚÈÔ΢„ÂÏȉÈÎÔ‡ ËÏ›ÎÔ˘ a/AP√2, Û˘ÁÎÚÈÙÈο Ì ÙË ‰Ú¿ÛË ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (exosurf). ∆· ÓÂÔÁÓ¿ ÙˆÓ ‰‡Ô ˘fi ÌÂϤÙË ÔÌ¿‰ˆÓ, ›¯·Ó ·Ó¿ÏÔÁ˜ ÙÈ̤˜ ̤ÁÈÛÙ˘ Fi√2 Î·È a/APO2 ÛÙȘ ÚÔ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÌÂÙÚ‹ÛÂȘ. ªÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÔÈ ÌÂÙÚ‹ÛÂȘ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ˘¤Ú ÙÔ˘ Ê˘ÛÈÎÔ‡, Ì ·˘Í‹ÛÂȘ ÙÔ˘ a/APO2 ηٿ 89,4%, 78,9%, Î·È 57,8% ·ÓÙ›ÛÙÔȯ· ÚÔ˜ ÙÔ˘˜ ¯ÚfiÓÔ˘˜ 2, 6 Î·È >6 ÒÚ˜ ÌÂÙ¿ ÙË ¯Ô-

151

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Ú‹ÁËÛË. ªÈÎÚfiÙÂÚ˜ ‹Ù·Ó ÔÈ ·˘Í‹ÛÂȘ Ì ÙÔ Û··ÛÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡. ™ËÌ·ÓÙÈΤ˜ ‹Ù·Ó ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ a/APO2 ÛÙÔ˘˜ ¯ÚfiÓÔ˘˜ 2, 6 Î·È >6 ÒÚ˜ Û˘ÁÎÚÈÙÈο Ì ÙȘ ÙÈ̤˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÙfiÛÔ ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡, fiÛÔ Î·È ÛÙËÓ ÔÌ¿‰· ÙÔ˘ Ê˘ÛÈÎÔ‡. ∞Ó·ÊÔÚÈο Ì ÙË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Ù˘ Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢, ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜. ¶Ú¤ÂÈ, ¿ÓÙˆ˜, Ó· ÛËÌÂȈı› fiÙÈ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, fiˆ˜ Î·È ÛÙË ÌÂϤÙË Ì·˜, ÙfiÛÔ Ë ‰È¿ÚÎÂÈ· fiÛÔ Î·È Ë ˘ÎÓfiÙËÙ· ÙÔ˘ ¯ÔÚËÁËı¤ÓÙÔ˜ √2 Â›Ó·È ÌÈÎÚfiÙÂÚ˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ‹Ú·Ó Û··ÛÌ· Ê˘ÛÈ΋˜ ÚÔ¤Ï¢Û˘ (17-19,24,25,29). ªÈÎÚfiÙÂÚË ÛËÌÂÈÒıËÎÂ Ë Û˘¯ÓfiÙËÙ· Ó¢ÌÔıÒڷη, ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÛË„·ÈÌ›·˜ Î·È ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ‹Ú·Ó ÙÔ Û··ÛÌ· ÙÔ˘ Ê˘ÛÈÎÔ‡. O ·ÓÙ›ÛÙÔȯԘ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ‹Ù·Ó RR 0,90 (0,76; 1,08), 0,90 (0,71-1,14), 0,94 (0,82; 1,09) Î·È 0,91 (0,79; 1,05). ∂ÓÙÔ‡ÙÔȘ, ‰È·ÊÔÚÂÙÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ¿ÏÏÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ô˘ ‰ÂÓ ·Ú·Ù‹ÚËÛ·Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ı·Ó¿ÙˆÓ ‹ ÙˆÓ ¯ÚfiÓÈˆÓ ÂÈÏÔÎÒÓ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘ (18,19,24). ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ÎfiÛÙÔ˜ ÙˆÓ ‰‡Ô Û΢·ÛÌ¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËηÓ, Â›Ó·È ·Ó¿ÏÔÁÔ ¯ˆÚ›˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜. ™ËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ· ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ Â›Ó·È Ë ‰˘Ó·ÙfiÙËÙ· ‡ÎÔÏ˘ ÌÂÙ·ÊÔÚ¿˜ ¯ˆÚ›˜ Ó· ··ÈÙÂ›Ù·È „˘Á›Ô, ηıÒ˜ Â›Û˘ Î·È Ô ÂÚÈÔÚÈÛÌfi˜ ÙÔ˘ ıˆÚËÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿‰ÔÛ˘ ÈÔÁÂÓÒÓ ‹ ÌË ÏÔÈÌÒÍÂˆÓ Ô˘ ÂӉ¯Ô̤ӈ˜ ‰ÂÓ ·‰Ú·ÓÔÔÈÔ‡ÓÙ·È Ì ٷ Û˘Ó‹ıË Ì¤Û· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·Ù¿ ÙËÓ ÚÔÂÙÔÈÌ·Û›· ÁÈ· ÎÏÈÓÈ΋ ¯Ú‹ÛË. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Û˘ÓÂ¿ÁÂÙ·È ¤Á¯˘ÛË ÌÂÁ·Ï‡ÙÂÚÔ˘ fiÁÎÔ˘ ˘ÁÚÒÓ ÛÙËÓ ÙÚ·¯Â›·, Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ‚Ú·‰˘Î·Ú‰›·, ˘ÔÍ›·, ÌÂÙ·‚ÔÏ‹ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙ· ÂÁÎÂÊ·ÏÈο ·ÁÁ›·. ∏ Â͈ÁÂÓ‹˜ ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ıˆÚÂ›Ù·È ıÂÚ·›· ÂÎÏÔÁ‹˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. √ Ê˘ÛÈÎfi˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ê·›ÓÂÙ·È Ó· ÏÂÔÓÂÎÙ› ÙÔ˘ Û˘ÓıÂÙÈÎÔ‡. ∏ ‰Ú¿ÛË ÙÔ˘ Â›Ó·È Ù·¯‡ÙÂÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË. √È ‰È·ÊÔÚ¤˜ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·fi ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ ¤¯Ô˘Ó Â·ÚÎÒ˜ ÙÂÎÌËÚȈı› ·fi ÈηÓÔÔÈËÙÈÎfi ·ÚÈıÌfi ÌÂÏÂÙÒÓ. ∏ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Û ÌÂÁ·Ï‡ÙÂÚ˜ ÛÂÈÚ¤˜ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÎÚ›ÓÂÙ·È ÂȂ‚ÏË̤ÓË.

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2. Martin RJ, Fanaroff AA. The respiratory distress syndrome and its management. In: Fanaroff AA, Martin RJ, editors.

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15. Skinner J. The effects of surfactant on haemodynamics in hyaline membrane disease. Arch Dis Child 1997;76:F67-F69.

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24. da Costa DE, Pai MG, Al Khusaiby SM. Comparative trial of artificial and natural surfactans in the treatment of respiratory distress syndrome of prematurity: experiences in a developing country. Pediatr Pulmonol 1999;27:312-317.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 27-07-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-01-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, 713 05, ∏Ú¿ÎÏÂÈÔ

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ORIGINAL PAPER

√ÏÈ΋ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· Ï¿ÛÌ·ÙÔ˜ ·ÛıÂÓÒÓ Ì ÎÏ·ÛÈ΋ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ˘fi ‰›·ÈÙ· ∫.∂. ™Ô‡ÏË1, ™. ∆۷ΛÚ˘2, °.∞. ∫·Ú›Î·˜3, ª. ªÔ‡Î·˜2, ¶. ª¯ڿ΢2

Plasma total antioxidant status in phenylketonuria patients on diet K.H. Schulpis1, S. Tsakiris2, G.A. Karikas3, M. Moukas2, P. Behrakis2

¶ÂÚ›ÏË„Ë: ∏ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· (PKU) Â›Ó·È ¤Ó· ÎÏËÚÔÓÔÌÈÎfi ÓfiÛËÌ· ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙÔ˘ ·ÌÈÓÔͤԘ Ê·ÈÓ˘Ï·Ï·Ó›ÓË (Phe), Ô˘ Ú˘ıÌ›˙ÂÙ·È Ì ÂȉÈ΋ ‰›·ÈÙ· ·ÚfiÌÔÈ· ÙˆÓ Ê˘ÙÔÊ¿ÁˆÓ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÔÏÈ΋˜ ·ÓÙÈÔÍÂȉˆÙÈ΋˜ ÈηÓfiÙËÙ·˜ (√∞π) ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÙˆÓ PKU ·ÛıÂÓÒÓ, ηı’ fiÛÔÓ Ë “ÂȉÈ΋” ÙÔ˘˜ ‰›·ÈÙ· ÂÊ·ÚÌfi˙ÂÙ·È ÂÊ' fiÚÔ˘ ˙ˆ‹˜. ªÂÏÂÙ‹Û·Ì 22 ·ÛıÂÓ›˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÙË ‰›·ÈÙ· (ÔÌ¿‰· ∞) Î·È 24 Ô˘ ÙËÓ ·ÎÔÏÔ˘ıÔ‡Û·Ó “¯·Ï·Ú¿” (ÔÌ¿‰· µ). ™·Ú¿ÓÙ· (¡=40) ˘ÁÈ‹ ·È‰È¿ ‹Ù·Ó Ë ÔÌ¿‰· ÂϤÁ¯Ô˘ (Ì¿ÚÙ˘Ú˜). ÀÔÏÔÁ›ÛÙËÎ·Ó Ù· ‰È·ÈÙËÙÈο ÛÙÔȯ›· Ù˘ ‰È·ÙÚÔÊ‹˜, fiˆ˜ Â›Û˘ ÌÂÙÚ‹ıËÎ·Ó ÛÙÔ ·›Ì· Ù· ÏÈ›‰È·, ‚-ηڈ٤ÓÈ·, ·-ÙÔÎÔÊÂÚfiÏË Î·È ‚ÈÙ·Ì›ÓË C Ì HPLC Î·È Û˘Û¯ÂÙ›ÛÙËÎ·Ó Ì ÙËÓ ÔÏÈ΋ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· (√∞π) ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÙˆÓ ÔÌ¿‰ˆÓ Ô˘ ˘ÔÏÔÁ›ÛÙËΠ̠ʈÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô. ∆· Â›‰· ÛÙÔ Ï¿ÛÌ· Î·È Ë ÚfiÛÏË„Ë Ù˘ ‚ÈÙ·Ì›Ó˘ C ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ. ∞ÓÙ›ıÂÙ·, ÔÈ ÚÔÛÏ‹„ÂȘ Î·È Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ, ‚ηڈÙÂÓ›ˆÓ Î·È ·-ÙÔÎÔÊÂÚfiÏ˘ ÛÙËÓ ÔÌ¿‰· ∞ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈο (p <0,001) Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÂΛӷ Ù˘ ÔÌ¿‰·˜ µ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ (0,7±0,09, 0,49±0,02, 0,3±0,09 Ìmol/l ÁÈ· Ù· ηڈ٤ÓÈ· Î·È 28,0±0,9, 22,7±0,6, 21,0±0,6 Ìmol/l ÁÈ· ÙËÓ ·-ÙÔÎÔÊÂÚfiÏË). ∏ ÚfiÛÏË„Ë ÙˆÓ ÏÈȉ›ˆÓ Î·È Ù· Â›‰¿ ÙÔ˘˜ ÛÙÔ ·›Ì· ‹Ù·Ó Û·ÊÒ˜ ÌÂȈ̤ӷ ÛÙËÓ ÔÌ¿‰· ∞, ÂÓÒ Ë √∞π ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÛÙËÓ ›‰È· ÔÌ¿‰·. £ÂÙÈΤ˜ Û˘Û¯ÂÙ›ÛÂȘ ‚Ú¤ıËÎ·Ó ÌÂٷ͇ Ù˘ √∞π Î·È ÙˆÓ ÚÔ·Ó·ÊÂÚoÌ¤ÓˆÓ ‚ÈÙ·ÌÈÓÒÓ, ȉȷ›ÙÂÚ· ÛÙËÓ ÔÌ¿‰· ∞. ŒÙÛÈ, ÌÔÚÔ‡ÌÂ

Ó· Û˘ÌÂÚ¿ÓÔ˘ÌÂ

1 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” 2 ¶ÂÈÚ·Ì·ÙÈ΋ º˘ÛÈÔÏÔÁ›·, ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 3 ªÔÓ¿‰· º·ÚÌ·ÎÔÎÈÓËÙÈ΋˜ Î·È ¶·ÚÂÓÙÂÚÈ΋˜ ¢È·ÙÚÔÊ‹˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

1 Institute of Child Health Children’s Hospital “Agia Sophia” 2 Experimental Physiology Lab, University of Athens 3 Pharmacokinetics and Parental Nutrition Unit Children’s Hospital “Agia Sophia”

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fiÙÈ Ë ·˘ÍË̤ÓË √Aπ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ Â›‰Ô˜ Ù˘ ‰›·ÈÙ·˜ Ô˘ ÁÈ· ıÂÚ·¢ÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ·ÎÔÏÔ˘ıÔ‡Ó.

especially in group A. In conclusion, PKU patients on a strict diet showed a significantly higher antioxidant status as compared to that of group B (1.6 and 0.99 mmol/l resp p <0.001). This is possibly related to the high amounts of antioxidants present in their special low Phe vegetarian diet.

§¤ÍÂȘ ÎÏÂȉȿ: ÔÏÈ΋ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÈηÓfiÙ˘, Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·, ‚-ηڈ٤ÓÈ·, ·-ÙÔÎÔÊÂÚfiÏË, ‚ÈÙ·Ì›ÓË C.

Key words: antioxidant status, phenylketonuria, ‚carotene, ·-tocopherol, vitamin C, vegetarian diet.

∂ÈÛ·ÁˆÁ‹ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ, ¤¯ÂÈ ‰È·ÈÛÙˆı› Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ Î·È ÙÔ˘ ÔÍÂȉˆÙÈÎÔ‡ ÛÙÚ˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1,2). π‰È·›ÙÂÚ· ÔÚÈṲ̂Ó˜ Ô˘Û›Â˜, fiˆ˜ ÔÈ ‚Èٷ̛Ә, ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚfiÏË„Ë ‹ ÙËÓ ·ÓÙÈÛÙÚÔÊ‹ Ì›·˜ ÔÍÂȉˆÙÈ΋˜ ‚Ï¿‚˘. ∏ ˘‰·ÙÔ‰È·Ï˘Ù‹ ‚ÈÙ·Ì›ÓË C ‚Ú›ÛÎÂÙ·È Û ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ (2-10 mmol/L) ÛÙÔ Î˘ÙÔÛfiÏÈÔ, ÂÓÒ ÔÈ ÏÈÔ‰È·Ï˘Ù¤˜ · Î·È Á ÙÔÎÔÊÂÚfiϘ (‚ÈÙ·Ì›ÓË ∂) Â›Ó·È Û˘ÛÙ·ÙÈÎfi ÙˆÓ ÏÈȉ›ˆÓ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ, fiÔ˘ ÚÔÏ·Ì‚¿ÓÔ˘Ó ‹ ÌÂÈÒÓÔ˘Ó ÙË ÏÈȉÈ΋ ˘ÂÚÔÍ›‰ˆÛË (3). ∂Í¿ÏÏÔ˘, ÔÏϤ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ¤ÏÏÂÈ„Ë ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Î·Ú‰È·Î‹˜ ÓfiÛÔ˘ (4), ·ÊÔ‡ Ù· ·ÓÙÈÔÍÂȉˆÙÈο ‚-ηڈ٤ÓÈ·, ·ÙÔÎÔÊÂÚfiÏË Î·È ‚ÈÙ·Ì›ÓË C ¤¯Ô˘Ó ‚ÚÂı› Ó· ¤¯Ô˘Ó ¿ÌÂÛË Û¯¤ÛË ÛÙËÓ ÚfiÏË„Ë Ù˘ ·ıËڈ̿وÛ˘ Ì ÙËÓ ·Ú¤Ì‚·Û‹ ÙÔ˘˜ ÛÙËÓ ÔÍ›‰ˆÛË Ù˘ LDL ¯ÔÏËÛÙÂÚfiÏ˘. ∏ ÌÂÁ·Ï‡ÙÂÚË Û¯¤ÛË Û'·˘Ù‹ ÙË ‰ÈÂÚÁ·Û›· Â›Ó·È ÂΛÓË Ù˘ ‚ÈÙ·Ì›Ó˘ ∂ ˘fi Ù‡ÔÓ Û˘ÌÏËÚÒÌ·ÙÔ˜ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ, ÂÓÒ Ù· ‚-ηڈ٤ÓÈ· Î·È Ë ‚ÈÙ·Ì›ÓË C ÛÙË ‰È·ÙÚÔÊ‹ Ê·›ÓÂÙ·È fiÙÈ Û˘ÌÌÂÙ¤¯Ô˘Ó Ôχ ÏÈÁfiÙÂÚÔ ÛÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډȷ΋˜ ÓfiÛÔ˘ (5,6). ∏ ÎÏ·ÛÈ΋ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· (PKU) Â›Ó·È ¤Ó· ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ·, ÙÔ ÔÔ›Ô Ú˘ıÌ›˙ÂÙ·È Ì ÙË ¯·ÌËÏ‹ ÚfiÛÏË„Ë ÙÔ˘ ·ÌÈÓÔͤԘ Ê·ÈÓ˘Ï·Ï·Ó›ÓË (Phe). ∏ ÂȉÈ΋ ·˘Ù‹ ‰›·ÈÙ· ·Ú¯›˙ÂÈ ·fi ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜, ÒÛÙ ӷ ÚÔÏËÊı› Ë „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË. £· ÌÔÚÔ‡Û ӷ ¯·Ú·ÎÙËÚÈÛÙ› ˆ˜ ‰›·ÈÙ· ÌË-·ıËڈ̷ÙÔÁfiÓÔ˜, ÛÙÔ ‚·ıÌfi Ô˘ Ë ÚˆÙ½ÓË Ù˘ Â›Ó·È Î˘Ú›ˆ˜ Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È ÂÌÂÚȤ¯ÂÈ ÔÏϤ˜ Ê˘ÙÈΤ˜ ›Ó˜ (7). ™˘ÓÂÒ˜, Ù· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔÓ ÔÚfi ÙˆÓ PKU ·ÛıÂÓÒÓ Â›Ó·È ¯·ÌËÏ¿. ∂Âȉ‹ Ë ÂȉÈ΋ ·˘Ù‹ ‰›·ÈÙ· Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÙÔ˘˜ PKU ·ÛıÂÓ›˜ ηı' fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜, ÂȯÂÈÚ‹Û·Ì ӷ ÌÂÏÂÙ‹ÛÔ˘Ì ÙËÓ Â›‰Ú·Û‹ Ù˘ ÛÙËÓ √ÏÈ΋ ∞ÓÙÈÔÍÂȉˆÙÈ΋ πηÓfiÙËÙ· (√∞π) ÙÔ˘ Ï¿ÛÌ·ÙÔ˜ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™·Ú¿ÓÙ· ¤ÍÈ (¡=46) ·ÛıÂÓ›˜ Ì PKU ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ÔÈfiÙËÙ· Ù˘ ‰›·ÈÙ·˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Û·Ó, fiˆ˜ ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi ÙÔÓ Ì¤ÛÔ fiÚÔ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Phe ÛÙÔ ·›Ì· ÙÔ˘˜ ηٿ ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ¯ÚfiÓÔ. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì PKU ›¯·Ó ·ÓȯÓ¢ı› Ì ÙÔÓ ¶ÚÔÏËÙÈÎfi ŒÏÂÁ¯Ô ¡ÂÔÁÓÒÓ (Screening) Î·È ¤ÁÈÓ·Ó Û ·˘ÙÔ‡˜ fiϘ ÔÈ ··Ú·›ÙËÙ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· Ó· ‰È·ÁÓˆÛı› Ô Ù‡Ô˜ Ù˘ ÓfiÛÔ˘ (.¯. ÊfiÚÙÈÛË Ì ÙÂÙÚ·¸‰ÚÔÙÂÚ›ÓË µ∏4). √È ËÌÂÚ‹ÛȘ ·Ó¿ÁΘ ÙÔ˘˜ Û ÚˆÙ½ÓË Î·Ï‡ÙÔÓÙ·Ó Î·Ù¿ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ Ì ÙË ¯ÔÚ‹ÁËÛË ÂȉÈÎÔ‡ ÚˆÙÂ˚ÓÔ‡¯Ô˘ Û΢¿ÛÌ·ÙÔ˜ (PKU2) Ô˘ ‰ÂÓ ÂÚȤ¯ÂÈ Phe Î·È Ï›Ë, ·ÏÏ¿ ÂÚȤ¯ÂÈ ÚfiÛıÂÙ·, ‚Èٷ̛Ә Î·È È¯ÓÔÛÙÔȯ›·. ∏ ÔÌ¿‰· ∞ ÙˆÓ PKU ·ÛıÂÓÒÓ (¡=22) ›¯Â ̤ÛË ËÏÈΛ· 7,7 ± 3,2 ¯ÚfiÓÈ· Î·È Â›‰· Phe 192 ± 60 Ìmol/L, Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ù· ̤ÏË Ù˘ ·ÎÔÏÔ‡ıËÛ·Ó ÛˆÛÙ¿ ÙËÓ “ÂȉÈ΋ ‰›·ÈÙ·”. ∏ ÔÌ¿‰· µ (¡=24) ›¯Â ̤ÛË ËÏÈΛ· 8,0 ± 3,6 Î·È Ì¤ÛË ÙÈÌ‹ Phe 595 ± 104 Ìmol/L, Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ Î·Î‹ “ÔÈfiÙËÙ·” Ù˘ ‰›·ÈÙ¿˜ ÙÔ˘˜, ·ÊÔ‡ ·ÎÔÏÔ‡ıËÛ·Ó ¯·Ï·Ú¿ ÙË Û˘ÛÙËÓfiÌÂÓË ÁÈ· ÙË ÓfiÛÔ ÙÔ˘˜ “ÂȉÈ΋” ‰›·ÈÙ·. ™·Ú¿ÓÙ· (¡=40) ˘ÁÈ‹ ·È‰È¿ ·ÚfiÌÔÈ·˜ ËÏÈΛ·˜ (7,68 ± 2,6 ¯ÚfiÓÈ·), ·oÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∆fiÛÔ ÔÈ ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ fiÛÔ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ Û˘ÌÏ‹ÚˆÛ·Ó ‰ÂÏÙ›Ô Î·ıËÌÂÚÈÓÔ‡ ‰È·ÈÙÔÏÔÁ›Ô˘ Â› 30 Ë̤Ú˜. ∆· ÛÙÔȯ›· ‰È·ÙÚÔÊ‹˜ ÚԤ΢„·Ó ηÙfiÈÓ ˘ÔÏÔÁÈÛÌÔ‡, Ô ÔÔ›Ô˜ ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÒÓ Î·Ù·ÏfiÁˆÓ ‰È·ÙÚÔÊ‹˜ (8). ªÂÙ¿ ·fi 10-15 ÒÚ˜ ÓËÛÙ›·˜ ¤ÁÈÓ ·ÈÌÔÏË„›· (5,0 ml ·›Ì·) ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ, ÙÔ˘ √∞π, Ù˘ Phe Î·È ÙˆÓ ÏÈȉ›ˆÓ. ∆· Â›‰· ÙˆÓ ‚ÈÙ·ÌÈÓÒÓ, ‚-ηڈÙÂÓ›ˆÓ, ‚ÈÙ·Ì›Ó˘ C Î·È ·-ÙÔÎÔÊÂÚfiÏ˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì HPLC ÌÂıfi‰Ô˘˜ (9-11). ∆· ÏÈ›‰È· ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Û‡Ìʈӷ Ì ̛· ̤ıÔ‰Ô ÚÔ˘Ù›Ó·˜ (12), ÂÓÒ Ù· Â›‰· Ù˘ Phe Ì ÔÛÔÙÈÎfi ÂÓ˙˘ÌÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi (13). ∏ √∞π ˘ÔÏÔÁ›ÛÙËΠۇÌʈӷ Ì ÙË Ì¤ıÔ‰Ô Miller Î·È Û˘Ó (14). ∆· ‰Â›ÁÌ·Ù· ‰È·ÙËÚ‹ıËÎ·Ó ˘fi „‡ÍË ÁÈ· 14 Ë̤Ú˜ ÚÈÓ ÙËÓ ·Ó¿Ï˘ÛË. ∆Ô Â‡ÚÔ˜ ·Ó¿Ï˘Û˘ √∞π Î˘Ì¿ÓıËΠ·fi 0-2,5 mmol/l. ∆· ‰Â›ÁÌ·Ù· Ô˘ ›¯·Ó Û˘ÁÎÂÓÙÚÒÛÂȘ ¿Óˆ ÙˆÓ 2,5 mmol ·Ú·ÈÒıËÎ·Ó ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi Î·È Â·Ó·Ï‹ÊıËÎÂ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ ̤ÛË ÙÈÌ‹ ± ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË. ∏ Û‡ÁÎÚÈÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ Î·È ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ¤ÁÈÓ Ì A¡OVA ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ÙË ‰ÔÎÈÌ·Û›· Dunnet, ÂÓÒ ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ÙÔ˘˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Ì ÙË ‰ÔÎÈÌ·Û›· Spearman.

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¶·È‰È·ÙÚÈ΋ 2001;64:154-158

AÔÙÂϤÛÌ·Ù· ¢È·ÙÚÔÊÈο ÛÙÔȯ›·: Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ›Ó·Î· 1, Ë ıÂÚÌȉÈ΋ Î·È Ë ÚˆÙÂ˚ÓÈ΋ ÚfiÛÏË„Ë ‰ÂÓ ‰È¤ÊÂÚ ÌÂٷ͇ ÙˆÓ 3 ÔÌ¿‰ˆÓ, ·ÏÏ¿ Ë ÚfiÛÏË„Ë Ê˘ÙÈÎÒÓ ÈÓÒÓ Î·È ÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈÒÓ ‰È¤ÊÂÚ ηٿ Ôχ ÛÙËÓ ÔÌ¿‰· A. ∞ÎfiÌË, Ë ÚfiÛÏË„Ë Ï›Ô˘˜, ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈÒÓ Î·È Ô ÏfiÁÔ˜ ÔÏ˘·ÎfiÚÂÛÙˆÓ/ÎÔÚÂÛÌ¤ÓˆÓ ÏÈÒÓ, ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ηıÒ˜ Â›Û˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ·ÛıÂÓÒÓ. ∂›Û˘, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ‰È¤ÊÂÚ·Ó ÔÈ ÚÔÛÏ‹„ÂȘ ‚-ηڈÙÂÓ›ˆÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ fiˆ˜ Î·È Ù˘ ·-ÙÔÎÔÊÂÚfiÏ˘ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∏ ÚfiÛÏË„Ë Ù˘ ‚ÈÙ·Ì›Ó˘ C ‰ÂÓ ‰È¤ÊÂÚ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ. µÈÔ¯ËÌÈο Â˘Ú‹Ì·Ù·: ™ÙÔÓ ›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ C ÛÙÔ Ï¿ÛÌ· Ô˘ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ. ∞ÓÙ›ıÂÙ·, Ù· ‚ηڈ٤ÓÈ· ›¯·Ó ‰ÈÏ¿ÛÈ· ÛÙ¿ıÌË ÛÙËÓ ÔÌ¿‰· ∞ Î·È Ë ·-ÙÔÎÔÊÂÚfiÏË ‰È¤ÊÂÚ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌfiÓÔ ÛÙËÓ ÔÌ¿‰· ∞ ÙˆÓ PKU ·ÛıÂÓÒÓ. √ ÏfiÁÔ˜ ·-ÙÔÎÔÊÂÚfiÏË/¯ÔÏËÛÙÂÚfiÏË ‰È¤ÊÂÚ ÙfiÛÔ ÌÂٷ͇ ÙˆÓ ‰‡Ô PKU - ÔÌ¿‰ˆÓ, fiÛÔ Î·È ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∏ √∞π ÛÙÔ Ï¿ÛÌ· ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÌ¿‰·˜ ∞ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË, Û˘ÁÎÚÈÓfiÌÂÓË Ì ÂΛÓË Ù˘ µ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∆· Â›‰· ÙÔ˘ ·ÌÈÓÔͤԘ Phe, fiˆ˜ ¿ÏψÛÙ ·Ó·ÌÂÓfiÙ·Ó, ‹Ù·Ó Û·ÊÒ˜ ˘„ËÏfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· µ. ™ÙÔÓ ›Ó·Î· 3 Ê·›ÓÔÓÙ·È ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ÛÙÔȯ›ˆÓ ‰È·ÙÚÔÊ‹˜, fiˆ˜ Â›Û˘ Î·È ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÙÔ˘˜ ÛÙÔ Ï¿ÛÌ·

Paediatriki 2001;64:154-158

Û ۯ¤ÛË Ì ÙÔ √∞π ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ PKU ·ÛıÂÓÒÓ. ∏ ÚÔÛÏ·Ì‚·ÓfiÌÂÓË ‚ÈÙ·Ì›ÓË C Û˘Û¯ÂÙ›˙ÂÙ·È ÛÙÂÓ¿ Ì ÙÔ √∞π Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ, ÂÓÒ Ù· ‚-ηڈ٤ÓÈ· Î·È Ë ·-ÙÔÎÔÊÂÚfiÏË ÌfiÓÔ ÛÙËÓ ÔÌ¿‰· ∞. Ÿˆ˜ ‹Ù·Ó ·Ó·ÌÂÓfiÌÂÓÔ, Ù· Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ C ÛÙÔ Ï¿ÛÌ· Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÛÙÂÓ¿ Ì ÙÔ √∞π Î·È ÛÙȘ ‰‡Ô PKU-ÔÌ¿‰Â˜, ÂÓÒ Ë ·ÙÔÎÔÊÂÚfiÏË Î·È Ô ÏfiÁÔ˜ ·-ÙÔÎÔÊÂÚfiÏË/¯ÔÏËÛÙÂÚ›ÓË Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ÌfiÓÔ ÛÙËÓ ÔÌ¿‰· ∞. ∆· Â›‰· ÙÔ˘ ·ÌÈÓÔͤԘ Phe ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ √∞π Û η̛· ÔÌ¿‰· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜. ™˘˙‹ÙËÛË ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ (15-17) ¤¯Ô˘Ó ‹‰Ë ·ԉ›ÍÂÈ fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Â›Ó·È Û·ÊÒ˜ ÌÈÎÚfiÙÂÚÔ˜ ÛÙÔ˘˜ Ê˘ÙÔÊ¿ÁÔ˘˜ (vegetarian), fiˆ˜ Â›Û˘ Â›Ó·È ¯·ÌËÏfiÙÂÚ· Ù· Â›‰· ÏÈȉ›ˆÓ ÔÚÔ‡ ÛÙËÓ ÔÌ¿‰· ·˘Ù‹. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ÛÙ· Â›‰· ÙˆÓ ÏÈȉ›ˆÓ ÂÍËÁÂ›Ù·È ·fi ÙË ÌÂȈ̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· ÏÈÒÓ ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜ Î·È ÙËÓ ‡·ÚÍË Ê˘ÙÈÎÒÓ ÈÓÒÓ (16), ·fi ÙËÓ ¿Ô„Ë fiÙÈ Ë ÂȉÈ΋ ¯·ÌËÏ‹ ÙÈÌ‹ Û Phe ‰›·ÈÙ· Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÔÈ ·ÛıÂÓ›˜ Ì·˜ ı· ÌÔÚÔ‡Û ӷ ¯·Ú·ÎÙËÚÈÛı› ˆ˜ ‰›·ÈÙ· Ê˘ÙÔÊ¿ÁˆÓ, ÛÙÔ ‚·ıÌfi Ô˘ ÔÈ PKU ·ÛıÂÓ›˜ ·ÔʇÁÔ˘Ó Û˘ÛÙËÌ·ÙÈο ÙË Ï‹„Ë ÎÚ¤·ÙÔ˜, „·ÚÈÔ‡, ·˘ÁÔ‡ ÎÏ. (18). ¢˘ÛÙ˘¯Ò˜, fï˜, ÔÏÏÔ› ·fi ÙÔ˘˜ PKU ·ÛıÂÓ›˜ ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Ó Ì ·ÎÚ›‚ÂÈ· ÙËÓ “ÂȉÈ΋” ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ‰›·ÈÙ· ‹ ÙËÓ ·ÎÔÏÔ˘ıÔ‡Ó ¯·Ï·Ú¿, fiˆ˜ Ù· ̤ÏË Ù˘ ÔÌ¿‰·˜ µ. ∞ÓÙ›ıÂÙ·, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÌÂ

¶›Ó·Î·˜ 1. ∏ÌÂÚ‹ÛÈ· ‰È·ÙÚÔÊÈο ÛÙÔȯ›· (ª¤ÛË ∆ÈÌ‹ ± ™∞) ÙˆÓ ÔÌ¿‰ˆÓ ÙˆÓ º·ÈÓ˘ÏÎÂÙÔÓÔ˘ÚÈÎÒÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ª·ÚÙ‡ÚˆÓ

™ÙÔȯ›· ¢È·ÙÚÔÊ‹˜ £ÂÚÌ›‰Â˜ (kcal) À‰·Ù¿ÓıڷΘ (g) ¶ÚˆÙ½ÓË (g) º˘Ù. ÿÓ˜ (g) √ÏÈÎfi §›Ô˜ (g) ∫ÔÚÂÛÌ. §›Ô˜ (g) ªÔÓÔ·ÎfiÚÂÛÙÔ §›Ô˜ (g) ¶ÔÏ˘·ÎfiÚÂÛÙÔ §›Ô˜ (g) ¶ÔÏ˘·ÎfiÚ./∫ÔÚÂÛÌ. ÃÔÏËÛÙÂÚfiÏË (g) µÈÙ·Ì›ÓË C (mg) ‚-∫·ÚˆÙ¤ÓÈ· (mg) ·-∆ÔÎÔÊÂÚfiÏË (mg) ™.∞.: ™Ù·ıÂÚ‹ ∞fiÎÏÈÛË

156

¢È·ÙÚÔÊÈ΋ ¶ÚfiÛÏË„Ë (ª¤ÛË ÙÈÌ‹ ± ™∞) √Ì¿‰· A √Ì¿‰· B ª¿ÚÙ˘Ú˜ N=22 N=24 N=40 2020 ± 400 2038 ± 450 2078 ± 1470 268,2 ± 10 232,0 ± 20 230 ± 56 70 ± 12 72,0 ± 2,0 73,0 ± 17 30 ± 8 21 ± 8,0 16,6 ± 4,0 80 ± 25,0 87 ± 4,0 99,0 ± 5,0 29 ± 10 45,0 ± 11 56 ± 11 25 ± 8 32 ± 9 33 ± 8 26 ± 7 11,7 ± 4 11,0 ± 3,5 0,90 ± 0,2 0,3 ± 0,1 0,2 ± 0,1 312 ± 140 330 ± 120 355 ± 110 108 ± 14 102 ± 16 98 ± 11 2011 ± 110 1352 ± 118 1290 ± 120 14,0 ± 1,0 10,0 ± 1,0 9,0 ± 1,0

™Ù·Ù. ™ËÌ·ÓÙÈΤ˜ ¢È·Ê.

(P) A vs B vs A vs ª¿ÚÙ˘Ú˜ ª¿ÚÙ˘Ú˜ B 0,05 0,05 0,001 0,012 0,001 0,01 0,001 0,002 0,0001 0,007 0,03 0,001 0,001 0,001 0,0001 0,01 0,001 0,001 0,01 -

2001 MAPT- A¶PI§

17-10-01 15:34

™ÂÏ›‰· 157

¶·È‰È·ÙÚÈ΋ 2001;64:154-158

Paediatriki 2001;64:154-158

¶›Ó·Î·˜ 2. µÈÔ¯ËÌÈο Â˘Ú‹Ì·Ù· ÛÙȘ √Ì¿‰Â˜ ÙˆÓ º·ÈÓ˘Ï/ÎÒÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ª·ÚÙ‡ÚˆÓ

‚-∫·ÚˆÙ¤ÓÈ· (Ìmol/l) ·-ToÎÔÊÂÚfiÏË (Ìmol/l) µÈÙ·Ì›ÓË C (Ìmol/l) ÃÔÏËÛÙÂÚfiÏË (mg/dl) ·-∆ÔÎÔÊÂÚfiÏË/ÃÔÏËÛÙÂÚfiÏË HDL (mg/dl) LDL (mg/dl) √ÏÈ΋ ∞ÓÙÈÔÍÂȉˆÙÈ΋ πηÓfiÙËÙ· (√∞π) (mmol/l) º·ÈÓ˘Ï·Ï·Ó›ÓË (Ìmol/l)

√Ì¿‰· A (N=22) 0,7 ± 0,09 28 ± 0,9 36,3 ± 1,1 140 ± 12,0 5,0 ± 0,4 43,0 ± 6,0 80,6 ± 22,0

√Ì¿‰· B (N=24) 0,49 ± 0,02 22,0 ± 0,6 34,5 ± 1,1 190 ± 10,6 3,78 ± 0,1 41,2 ± 6,6 112 ± 20

ª¿ÚÙ˘Ú˜ (N=40) 0,3 ± 0,09 21,0 ± 0,6 37,2 ± 1,01 196 ± 12,0 3,3 ± 0,1 44,0 ± 5,6 116 ± 21

AvsC 0,001 0,03 0,001 0,001 0,001

P ÙÈÌ‹ BvsC 0,01 -

AvsB 0,0001 0,03 0,001 0,001 0,001

1,597 ± 0,208 0,992±0,190 192±60 595±104

1,01 ± 0,180 120±51

0,01 0,01

0,001

0,001 0,001

Û˘Ó¤ÂÈ· ÙË ‰›·ÈÙ¿ ÙÔ˘˜ (ÔÌ¿‰· ∞), ÙfiÛÔ Ù· Â›‰· ÙˆÓ ‚-ηڈÙÂÓ›ˆÓ fiÛÔ Î·È Ù˘ ·-ÙÔÎÔÊÂÚfiÏ˘ ÌÂÙÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ ÛÙÔ Ï¿ÛÌ· ÙÔ˘˜. ∆· Â›‰· Ù˘ ‚ÈÙ·Ì›Ó˘ C ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ù˘ ÌÂϤÙ˘, ·ÊÔ‡ Ù· ÂÛÂÚȉÔÂȉ‹ (.¯. ÔÚÙÔοÏÈ·, ÏÂÌfiÓÈ· Î.Ï.) ηٷӷÏÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ ·fi fiÏ· Ù· ∂ÏÏËÓfiÔ˘Ï·. ∞ÎfiÌ·, fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ë ÏÔ‡ÛÈ· Û Ϸ¯·ÓÈο Î·È ÊÚÔ‡Ù· ‰›·ÈÙ· Ô˘ ·ÎÔÏÔ˘ı› Ë ÔÌ¿‰· ∞, Â›Ó·È ÏÔ‡ÛÈ· ÛÙȘ ·ÓÙÈÔÍÂȉˆÙÈΤ˜ ‚Èٷ̛Ә, Ê˘ÙÈΤ˜ ›Ó˜ Î·È È¯ÓÔÛÙÔȯ›· (19). ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ (20,21) Û˘Û¯ÂÙ›˙Ô˘Ó ÙËÓ ·˘ÍË̤ÓË ÚfiÛÏË„Ë Ù˘ ‚ÈÙ·Ì›Ó˘ C Ì Ì›ˆÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ ηډȷÎÒÓ ÂÌÊÚ·ÁÌ¿ÙˆÓ. ™ÙË ÌÂϤÙË ÙÔ˘ Rotterdam, ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ›‰È· ¢ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù·, fiÙ·Ó Ù· ‚-ηڈ٤ÓÈ· ÚÔÛÏ·Ì‚¿¶›Ó·Î·˜ 3. ™˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ Ù˘ √ÏÈ΋˜ ∞ÓÙÈÔÍÂȉˆÙÈ΋˜ πηÓfiÙËÙ·˜ (√∞π) ÛÙÔ Ï¿ÛÌ· Î·È ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ‚ÈÙ·ÌÈÓÒÓ Ù˘ ¢È·ÙÚÔÊ‹˜ Î·È ÙÔ˘ ¶Ï¿ÛÌ·ÙÔ˜ ∞ÛıÂÓÒÓ Ì º·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ¢È·ÙÚÔÊ‹ πηÓ. µÈÙ·Ì›ÓË C ‚-K·ÚˆÙ¤ÓÈ· ·-∆ÔÎÔÊÂÚfiÏË ¶Ï¿ÛÌ· µÈÙ·Ì›ÓË C ‚-∫·ÚˆÙ¤ÓÈ· ·-∆ÔÎÔÊÂÚfiÏË ·-∆ÔÎÔÊ./ÃÔÏËÛÙ. º·ÈÓ˘Ï·Ï·Ó›ÓË * p <0,01 ** p <0,001

√Ì¿‰Â˜

√ÏÈ΋ ∞ÓÙÈÔÍÂȉˆÙÈ΋

A B A B A B

0,72** 0,42* 0,44* 0,15 0,69** 0,26

A B A B A B A B A B

0,63** 0,41* 0,52* 0,20 0,66** 0,22 0,77** 0,10 0,12 0,21

ÓÔÓÙ·Ó Û ·˘ÍË̤Ó˜ ÔÛfiÙËÙ˜. ∆Ô ÙÂÏÂ˘Ù·›Ô ‰ÂÓ Û˘Ó¤‚·ÈÓ Ì ÙËÓ ·˘ÍË̤ÓË ÚfiÛÏË„Ë ‚ÈÙ·Ì›Ó˘ ∂ (4). Ÿˆ˜ Â›Ó·È Â›Û˘ ÁÓˆÛÙfi, Ë ÔÍÂȉˆÌ¤ÓË LDL ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ·Ó¿Ù˘ÍË Î·Ú‰È·ÁÁÂȷ΋˜ ÓfiÛÔ˘ Ô˘ ÂËÚ¿˙ÂÙ·È Î·È ·fi ¿ÏÏÔ˘˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÂÎÙfi˜ ÙˆÓ ·ÓÙÈÔÍÂȉˆÙÈÎÒÓ ‚ÈÙ·ÌÈÓÒÓ. ™ÙËÓ ÂÚ›ÙˆÛË ÙˆÓ PKU ·ÛıÂÓÒÓ (ÔÌ¿‰· ∞) ‚Ú¤ıËÎ·Ó ¯·ÌËÏ¿ Ù· Â›‰· Ù˘ LDL (17) ·fi ÙË ÌÂȈ̤ÓË ÚfiÛÏË„Ë ÏÈÒÓ, ÂÓÒ Ë ˘„ËÏ‹ ÛÙ¿ıÌË Ù˘ ‚ÈÙ·Ì›Ó˘ ∂ Ô˘ ÂÌÂÚȤ¯ÂÙ·È ÛÙ· ÔÏ˘·ÎfiÚÂÛÙ·, ÚÔÊ˘Ï¿ÛÛÂÈ ÙËÓ ÔÍ›‰ˆÛË Ù˘ LDL (6,22).

T· ·ÓˆÙ¤Úˆ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Â›Ó·È Û Ï‹ÚË Û˘Ìʈӛ· Ì ٷ ‰Èο Ì·˜ Â˘Ú‹Ì·Ù· Î·È ÙȘ Û˘Û¯ÂÙ›ÛÂȘ, fiˆ˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î· 3. ™ÙÔÓ ›‰ÈÔ ›Ó·Î·, οı ·ÓÙÈÔÍÂȉˆÙÈ΋ ‚ÈÙ·Ì›ÓË, ÙfiÛÔ Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ Ì ÙȘ ÙÚÔʤ˜, fiÛÔ Î·È Ù˘ ÌÂÙÚËı›۷˜ ÛÙÔ Ï¿ÛÌ· ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ÌÂϤÙË, Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ √∞π. ∆Ô √∞π, Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËΠ۠PKU ·ÛıÂÓ›˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ÂÎÂ›ÓˆÓ Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ¯·Ï·Ú¿ ÙËÓ ÂȉÈ΋ ‰›·ÈÙ· (ÔÌ¿‰· µ), Ô˘ Èı·Ó¿ ÔÊ›ÏÂÙ·È Î·È ÛÙ· ˘„ËÏfiÙÂÚ· Â›‰· Ù˘ LDL Î·È Ù· ¯·ÌËÏfiÙÂÚ· ÙˆÓ ‚-ηڈÙÂÓ›ˆÓ Î·È ·-ÙÔÎÔÊÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· ÙÔ˘˜. ∏ ·Ú·ÙËÚÔ‡ÌÂÓË ·˘ÍË̤ÓË ÙÈÌ‹ Ù˘ Phe ÛÙÔ ·›Ì· ÙÔ˘˜ ı· ÌÔÚÔ‡Û ÂÈÚfiÛıÂÙ· Ó· ·›˙ÂÈ ÚfiÏÔ “·‰‡Ó·ÌÔ˘ Û·ÚˆÙ‹ √∏ ÔÌ¿‰ˆÓ” ÛÙÔ ‚·ıÌfi Ô˘ ¤¯ÂÈ ‚ÚÂı› Ë ‰ËÌÈÔ˘ÚÁ›· Ô-, Ì-, - Ù˘ÚÔÛÈÓÒÓ (22,23) Ù˘ Phe Ì ÙȘ ÂÚȤ¯Ô˘Û˜ √∏ ÂχıÂÚ˜ Ú›˙˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ·ÛıÂÓ›˜ Ì PKU Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÛˆÛÙ¿ ÙËÓ ÂȉÈ΋ ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ‰›·ÈÙ· ¤¯Ô˘Ó ˘„ËÏ‹ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÈηÓfiÙËÙ· Ï¿ÛÌ·ÙÔ˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔ Â›‰Ô˜ Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ (Ê˘ÙÔÊ¿ÁÔÈ). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ı· ÌÔÚÔ‡Û Èı·Ó¿ Ó· ·›ÍÂÈ ÚÔÛٷ٢ÙÈÎfi ÚfiÏÔ ÁÈ· ÙȘ ·Ûı¤ÓÂȘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ÂÏ¢ı¤ÚˆÓ ÚÈ˙ÒÓ.

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∂˘¯·ÚÈÛٛ˜ √È Û˘ÁÁÚ·Ê›˜ ıˆÚÔ‡Ó ˘Ô¯Ú¤ˆÛ‹ ÙÔ˘˜ Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ÙËÓ Î. ∫. ∆·ÛÛÔÔ‡ÏÔ˘ ÁÈ· ÙËÓ ÂÈÌÂÏË̤ÓË ‰·ÎÙ˘ÏÔÁÚ¿ÊËÛË Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜.

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5. Parks EJ, German JB, Davis PA. Reduced oxidative susceptibility of LDL from patients participating in an intensive atherosclerosis treatment program. Am J Clin Nutr 1998;778-785.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 31-08-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-01-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ÏÂÔ¿ÙÚ· ∂. ™Ô‡ÏË πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, 115 27, ∞ı‹Ó·

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CASE REPORT

∏ ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ˆ˜ ÂΉ‹ÏˆÛË Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ Û ‚Ú¤ÊÔ˜ ¡. ª·ÏÙÔÁÈ¿ÓÓ˘, ∂. ¶··Ó‰Ú¤Ô˘, Ã. ÃȈٛÓ˘, µ. ÷ڛÛË, ¢. ∫ÂÚ·Ì›‰·˜

Congenital diaphragmatic hernia presenting with acute respiratory distress in an infant N. Baltogiannis, E. Papandreou, C. Chiotinis, V. Charisi, D. Keramidas

¶ÂÚ›ÏË„Ë: ∏ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ Ù‡Ô˘ Bochdalek Ì ÂÈÎfiÓ· ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È Î˘¿ÓˆÛË Â›Ó·È Û¿ÓÈ· ÛÙË ÌË ÓÂÔÁÓÈ΋ ËÏÈΛ·. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ÙÔÓÈÛÙ› fiÙÈ Ë Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ·ÙfiÌˆÓ ‚ÚÂÊÈ΋˜ Î·È ·È‰È΋˜ ËÏÈΛ·˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ Ô˘ ·ÚÔ˘Û›·Û ·ÈÊÓ›‰È· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ÌÂÙ¿ ÙË Ï‹„Ë Á‡̷ÙÔ˜. ªÂٷʤÚıËΠ۠°ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô fiÔ˘ ·ÓÙÈÌÂÙˆ›ÛıËΠ̠ÙÔÔı¤ÙËÛË ÎÏÂÈÛÙ‹˜ ·ÚÔ¯¤Ù¢Û˘ ÛÙÔ ˘ÁȤ˜ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ ÌÂÙ¿ ÙËÓ ÂÎÙ¤ÏÂÛË ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·ÎÔ˜, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÂÈ‚¿Ú˘ÓÛ‹ ÙÔ˘. ∏ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Î·È Ë Â·Ó¿ÏË„Ë Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ÌÂÙ¿ ÙËÓ ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ۈϋӷ, Ô‰‹ÁËÛ·Ó ÛÙË ‰È¿ÁÓˆÛË ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ Bochdalek ·ÚÈÛÙÂÚ¿, ·Ê·›ÚÂÛË Ù˘ ·ÚÔ¯¤Ù¢Û˘ ÙÔ˘ ‰ÂÍÈÔ‡ ËÌÈıˆÚ·Î›Ô˘ Î·È Â›ÁÔ˘Û· ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜ Ì ηϋ ¤Î‚·ÛË. ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË Ù¤ÙÔÈˆÓ ÂÚÈÙÒÛÂˆÓ ··ÈÙ› ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÁÓÒÛÂȘ, ÂÓÒ Ë Î·ı˘ÛÙÂÚË̤ÓË ÌÂÙ·ÊÔÚ¿ Û ÂȉÈο ·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ΤÓÙÚ· ÌÔÚ› Ó· ηٷϋÍÂÈ Û ·ÒÏÂÈ· ÙÔ˘ ·ÛıÂÓ‹.

Abstract: The clinical presentation of congenital diaphragmatic hernia (CDH), Bochdalek type, with acute respiratory distress and cyanosis has rarely been reported to occur in the post-neonatal period. The purpose of this report is to stress the need to include CDH in the differential diagnosis of acute respiratory distress in infants and older children. A 3 month old boy is presented, who developed acute respiratory distress following ingestion of a normal meal. He was admitted to a General Hospital where a closed chest drainage was inserted in the normal right pleural cavity, which led to further deterioration. He was then transferred to our Hospital where, following the insertion of a nasogastric tube, a repeat chest xray led to the diagnosis of CDH. Following removal of the closed chest drainage he underwent emergency surgical correction of the congenital abnormality, which led to an uneventful recovery.

We conclude that such cases require expertise knowledge and awareness of this condition and that delayed recognition and transfer to specialized pediatric surgical units may have deleterious results.

§¤ÍÂȘ ÎÏÂȉȿ: ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ·ÚÈÛÙÂÚ¿.

Key words: respiratory distress, left congenital diaphragmatic hernia.

∂ÈÛ·ÁˆÁ‹ ∏ ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· (√∞¢) ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ÌÔÚ›, Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ, Ó· Â›Ó·È ÙÔ ·Ú¯ÈÎfi Û‡Ìو̷ ¤ÎÊÚ·Û˘ Ù˘ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ (™¢). ∏ ηı˘ÛÙÂ-

ÚË̤ÓË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ™¢, ÌÂÙ¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÂÌÊ·Ó›˙ÂÙ·È Û ÔÛÔÛÙfi 5–25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (1,2). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ÙÔÓÈÛÙ› fiÙÈ Ë Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘

µ’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

2nd Surgical Department “Agia Sophia” Children’s Hospital, Athens

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∂ÈÎfiÓ· 1. µÚ¤ÊÔ˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ. ⁄·ÚÍË ÎÔ›ÏÔ˘ ÛÏ¿¯ÓÔ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ, ÌÂÙ·ÙfiÈÛË ÌÂÛÔıˆÚ·Î›Ô˘ ‰ÂÍÈ¿, ˘Ô·ÂÚÈÛÌfi˜ Ó‡ÌÔÓ· ‰ÂÍÈ¿ Î·È ÛˆÏ‹Ó·˜ ÎÏÂÈÛÙ‹˜ ·ÚÔ¯¤Ù¢Û˘ ıÒڷη ‰ÂÍÈ¿.

·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ·ÙfiÌˆÓ ‚ÚÂÊÈ΋˜ Î·È ·È‰È΋˜ ËÏÈΛ·˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 3 ÌËÓÒÓ Ì ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ·ÚÈÛÙÂÚ¿. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ, ËÏÈΛ·˜ 3 ÌËÓÒÓ, ÂÈÛ‹¯ıË ÂÂÈÁfiÓÙˆ˜ Û ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÂÚÈÊÂÚÂÈ·ÎÔ‡ ÓÔÛÔÎÔÌ›Ԣ ÌÂ Û˘ÌÙÒÌ·Ù· ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Ô˘ ÂΉËÏÒıËÎ·Ó ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ Û›ÙÈÛ˘. ∆Ô ‚Ú¤ÊÔ˜ ‹Ù·Ó Ê·ÈÓÔÌÂÓÈο ˘ÁȤ˜ Ì ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂχıÂÚÔ. ŒÁÈÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Ù˘ ÔÔ›·˜ Ù· Â˘Ú‹Ì·Ù· ‰ÂÓ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛˆÛÙ¿. ∂ÓÒ Â›¯Â ÌÂÙ·ÙfiÈÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÚÔ˜ ÙËÓ ˘ÁÈ‹ ÏÂ˘Ú¿, ‡·ÚÍË ÎÔ›ÏÔ˘ ÛÏ¿¯ÓÔ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÛËÌ›· Ó¢ÌÔıÒڷη ‹ Ï¢ÚÈÙÈ΋˜ Û˘ÏÏÔÁ‹˜ ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ (∂ÈÎfiÓ· 1), ÙÔÔıÂÙ‹ıËΠÎÏÂÈÛÙ‹ ·ÚÔ¯¤Ù¢ÛË ÛÙË ‰ÂÍÈ¿ ˘ÁÈ‹ ıˆÚ·ÎÈ΋ ÎÔÈÏfiÙËÙ· Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂȉÂÈÓˆı› Ë √∞¢. √ ·ÛıÂÓ‹˜ ÌÂٷʤÚıËΠÂÛ¢Ṳ̂ӷ ·ÂÚÔÔÚÈÎÒ˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·˙ ¤ÓÙÔÓË ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ΢¿ÓˆÛË, „˘¯Ú¿ ¿ÎÚ·, Ù·¯˘Î·Ú‰›· Î·È ÂÈfiÏ·ÈË ·Ó·ÓÔ‹. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ‰È·ÈÛÙÒıËΠ̛ˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ ·ÚÈÛÙÂÚ¿

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∂ÈÎfiÓ· 2. µÚ¤ÊÔ˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ. ·/· ıÒÚ·ÎÔ˜ – ÎÔÈÏ›·˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË 500ml Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘: Ô ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ۈϋӷ˜ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ (‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Bochdalek). ªÂÛÔıˆÚ¿ÎÈÔ ÛÙË Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË Î·È ‚ÂÏÙ›ˆÛË Ù˘ ·ÎÙÈÓÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜ ÙÔ˘ ‰ÂÍÈÔ‡ ËÌÈıˆÚ·Î›Ô˘ (ÂͤٷÛË ÂÎÏÔÁ‹s ÁÈ· ÙËÓ ·ÎÚÈ‚‹ ‰È¿ÁÓˆÛË).

Î·È ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘. ∆ÔÔıÂÙ‹ıËΠÚÈÓÔÁ·ÛÙÚÈÎfi˜ ۈϋӷ˜ (·Ê·ÈÚ¤ıËÎ·Ó ÂÚ›Ô˘ 500 ml Á·ÛÙÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘) Î·È ¤ÁÈÓ ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó·˙ˆÔÁfiÓˆÛË. ∞fi ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÚԤ΢„Â Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Bochdalek ·ÚÈÛÙÂÚ¿, Ì ·ÚÔ˘Û›· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÂÓÙ¤ÚÔ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ (∂ÈÎfiÓ· 2). ªÂÙ¿ ÙË ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ÙËÓ Â·Ó·ÊÔÚ¿ ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰·, ÙÔ ‚Ú¤ÊÔ˜ ¯ÂÈÚÔ˘ÚÁ‹ıËΠÌÂÙ¿ 6ÒÚÔ˘ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. ™ÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ ‹Ù·Ó Ô ÛÙfiÌ·¯Ô˜, Ô ÛÏ‹Ó·˜, ÏÂÙfi ¤ÓÙÂÚÔ Î·È ÙÌ‹Ì· ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘. ŒÁÈÓ ·Ó¿Ù·ÍË ÙˆÓ ÛÏ¿¯ÓˆÓ ÛÙËÓ ÂÚÈÙÔÓ·˚΋ ÎÔÈÏfiÙËÙ· Î·È ÙÔ ¯¿ÛÌ· ÙÔ˘ ËÌȉȷÊÚ¿ÁÌ·ÙÔ˜ (∂ÈÎfiÓ· 3) ·ÔηٷÛÙ¿ıËΠ̠Ï·ÛÙÈ΋ Mayo. ∏ ·ÚÈÛÙÂÚ‹ ˘Â˙ˆÎÔÙÈ΋ ÎÔÈÏfiÙËÙ· ·ÚÔ¯ÂÙ‡ÙËΠ̠ÎÏÂÈÛÙfi Û‡ÛÙËÌ·. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È Ô ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙË 14Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ (∂ÈÎfiÓ· 4).

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∂ÈÎfiÓ· 3. µÚ¤ÊÔ˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ. ¢ÈÂÁ¯ÂÈÚËÙÈ΋ ʈÙÔÁÚ·Ê›·: ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Bochdalek ·ÚÈÛÙÂÚ¿. ªÂÁ¿ÏÔ ¯¿ÛÌ· ·ÚÈÛÙÂÚÔ‡ ËÌȉȷÊÚ¿ÁÌ·ÙÔ˜ Ì ٷ ÂÓ‰ÔÎÔÈÏȷο ÛÏ¿¯Ó· ÂÓÙfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈıˆÚ·Î›Ô˘ (ÛÙfiÌ·¯Ô˜, ÛÏ‹Ó·˜, ÏÂÙfi Î·È ÙÌ‹Ì· ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘).

™˘˙‹ÙËÛË ∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Bochdalek (™¢) Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ÌÂ Û˘¯ÓfiÙËÙ· 1 ÂÚ›ÙˆÛË Û οı 2–4000 ÁÂÓÓ‹ÛÂȘ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ. ™Â ‚Ú¤ÊË Ê·ÈÓÔÌÂÓÈο ˘ÁÈ‹ Ì ηϋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÔÚ› Ó· ‰È·ÁÓˆÛı› ™¢ ·ÚÎÂÙÔ‡˜ Ì‹Ó˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Û˘Ó‹ıˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ Ïԛ̈͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‹ Û ηٷÛÙ¿ÛÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ·‡ÍËÛË Ù˘ ÂÓ‰ÔÎÔÈÏȷ΋˜ ›ÂÛ˘, fiˆ˜ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, ¤ÌÂÙÔÈ Î·È ÌÂÙˆÚÈÛÌfi˜ ÎÔÈÏ›·˜ (.¯. ÂÓÙÂÚ›ÙȘ) (3,4). ∞ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ηı˘ÛÙÂÚË̤Ó˘ ÂÌÊ¿ÓÈÛ˘ Û˘ÁÁÂÓÔ‡˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. √ Osebold Î·È Ô Soper ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ÌÂÙ¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ 5% ÙˆÓ ÂÚÈÙÒÛˆÓ, ·ÏÏ¿ Û ¿ÏÏË ÌÂϤÙË Ô Newman Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ·Ó‚¿˙Ô˘Ó ÙÔ ÔÛÔÛÙfi ·˘Ùfi Û 25% (1,2). ∏ ËÏÈΛ· Ô˘ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È, Î˘Ì·›ÓÂÙ·È ·fi ÙÔ˘˜ 3 Ì‹Ó˜ ¤ˆ˜ Ù· 5 ¤ÙË Î·È ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Êı¿ÓÔ˘Ó ÛÙËÓ ÂÚ›Ô‰Ô ÙÔ˘ ÂÓ‹ÏÈη (5). ∫ÏÈÓÈο, Ë Î·ı˘ÛÙÂÚË̤ÓË ™¢ ÂÌÊ·Ó›˙ÂÙ·È Ì Â̤ÙÔ˘˜ Î·È Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, Û·ÓÈfiÙÂÚ· Ì ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÌÂÙˆÚÈÛÌfi Î·È ‰È¿ÚÚÔÈ·. ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, Ë √∞¢ ÂÌÊ·Ó›ÛÙËΠÏfiÁˆ ‰È¿Ù·Û˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÔÊÂÈÏfiÌÂÓË Û ÌÂÁ¿ÏÔ Á‡̷. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÙÔ ‚Ú¤ÊÔ˜ ‹Ù·Ó ˘ÁȤ˜ Î·È ‰ÂÓ Â›¯Â ·ÚÔ˘ÛÈ¿ÛÂÈ Ì¤¯ÚÈ ÙfiÙ ÎÏÈÓÈο ÛËÌ›·. ∏ ÂÌÊ¿ÓÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂÙ¿ ÙÔ Á‡̷, Ì ‰È·Ï›ÔÓÙ· ‹ Î·È Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ¯·Ú·ÎÙ‹Ú·, Û˘ÓËÁÔÚÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË Ù˘ ηı˘ÛÙÂÚË̤Ó˘ ™¢ (5-8). ∫·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ ‰È·ÈÛÙÒÓÔÓÙ·È ÂÓÙÂ-

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∂ÈÎfiÓ· 4. µÚ¤ÊÔ˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ. ∞ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË Ù˘ ‰È·ÊÚ·ÁÌ·ÙÔ΋Ï˘ ·ÚÈÛÙÂÚ¿ (14Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ).

ÚÈÎÔ› ‹¯ÔÈ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ Î·È Ì›ˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜, ÌÂÙ·ÙfiÈÛË ÚÔ˜ Ù· ‰ÂÍÈ¿ Ù˘ ·ÎÚfi·Û˘ Ù˘ ÎÔÚ˘Ê‹˜ Ù˘ ηډȿ˜ Î·È ÛηÊÔÂȉ‹˜ ÎÔÈÏ›·. Œ¯ÂÈ ·Ó·ÊÂÚı› ‡·ÚÍË ˘ÚÂÙÔ‡ ÏfiÁˆ Ù˘ ·Ê˘‰¿ÙˆÛ˘ ‹ Ù˘ ÂӉ¯fiÌÂÓ˘ ‰È¿ÙÚËÛ˘ ÎÔ›ÏÔ˘ ÛÏ¿¯ÓÔ˘ (5,7). √ ·ÎÙÈÓÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚ› ‡ÎÔÏ· Ó· Ô‰ËÁ‹ÛÂÈ Û ϷÓı·Ṳ̂ÓË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÏfiÁˆ ÂÛÊ·Ï̤Ó˘ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ. ∆Ô‡ÙÔ Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› ÔÈ ·ÎÙÈÓÔÏÔÁÈΤ˜ ÂÈÎfiÓ˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙË ‰È¿ÁÓˆÛË ˘fi Ù¿ÛË Ó¢ÌÔıÒڷη, Û˘ÁÁÂÓÔ‡˜ ·ÛÙ˘ ÙÔ˘ Ó‡ÌÔÓ·, Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘, Ó¢ÌÔÓ›·˜ ‹ ·ÙÂÏÂÎÙ·Û›·˜ Ì ‹ ¯ˆÚ›˜ ÓÂ˘Ì·ÙÔ·ÛÙÂȘ Î·È Ù¤ÏÔ˜ Ï¢ÚÈÙÈ΋˜ Û˘ÏÏÔÁ‹˜ (7-10) (∂ÈÎfiÓ· 1). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ù˘ ÚÒÙ˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·ÎÔ˜ Ô˘ ¤ÁÈÓ ÛÙÔ Â·Ú¯È·Îfi ÓÔÛÔÎÔÌÂ›Ô ‹Ù·Ó ÂÛÊ·Ï̤ÓË, ‰ÈfiÙÈ ‰ÂÓ ·ÍÈÔÏÔÁ‹ıËÎÂ Ë ‡·ÚÍË ÎÔ›ÏÔ˘ ÛÏ¿¯ÓÔ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈıˆÚ¿ÎÈÔ, Ë ÌÂÙ·ÙfiÈÛË Ù˘ ηډȿ˜ ÛÙÔ ‰ÂÍÈfi ËÌÈıˆÚ¿ÎÈÔ Î·ıÒ˜ Î·È Ë ·Ô˘Û›· Ó¢ÌÔıÒڷη ‰ÂÍÈ¿. ∆Ô‡ÙÔ Û˘Ó¤‚Ë ÁÈ·Ù› ÚÈÓ ÙË Ï‹„Ë Ù˘ ·ÎÙÈÓÔÁÚ·Ê›·˜ ‰ÂÓ Â›¯Â ÙÔÔıÂÙËı› ÚÈÓÔÁ·ÛÙÚÈÎfi˜ ۈϋӷ˜ (∂ÈÎfiÓ· 1). ÕÏϘ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ·fi ‰È¿ÊÔÚÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÁÈ· ÙËÓ ÂÍ·ÎÚ›‚ˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ ·ÓˆÌ·Ï›·˜, Â›Ó·È Ë Ï‹„Ë ·ÎÙÈÓÔÁÚ·Ê›·˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ Î·È Ô ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ (6-8,11). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, ηٿ ÙËÓ ·Ó¿ÓË„Ë ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÔÔıÂÙ‹ıËΠÚÈÓÔÁ·ÛÙÚÈÎfi˜ ۈϋӷ˜ Levin ÎÈ ¤ÁÈÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Ë ÔÔ›· ·Ó¤‰ÂÈÍ ÙËÓ ‡·ÚÍË

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Ù˘ ™¢ (∂ÈÎfiÓ· 2), ÌÂ Û˘Ó¤ÂÈ· ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ Ì ηϋ ¤Î‚·ÛË. ∏ Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ÏÔÈfiÓ, ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. ∏ ÚÔÛÂÎÙÈ΋ ÌÂϤÙË ÙˆÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ ÙÔ˘ ıÒڷη ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÛÊ·Ï̤Ó˘ ‰È¿ÁÓˆÛ˘ Î·È Î·ı˘ÛÙ¤ÚËÛ˘ ÛÙË ıÂÚ·›· ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ. ∏ Û‡Á¯˘ÛË Ì ¿ÏϘ ·ı‹ÛÂȘ ·ÔʇÁÂÙ·È Ì ÙËÓ ÙÔÔı¤ÙËÛË ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ۈϋӷ Î·È ÙËÓ ·ÔÛ˘Ì›ÂÛË ÙÔ˘ ‰È·ÙÂٷ̤ÓÔ˘ ÛÙÔÌ¿¯Ô˘ Ô˘ ÚÔηÏ› ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· (12). ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË Ù¤ÙÔÈˆÓ ÂÚÈÙÒÛÂˆÓ ··ÈÙ› ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÁÓÒÛÂȘ, ÂÓÒ Ë Î·ı˘ÛÙÂÚË̤ÓË ÌÂÙ·ÊÔÚ¿ Û ÂȉÈο ·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ΤÓÙÚ· ÌÔÚ› Ó· ηٷϋÍÂÈ Û ·ÒÏÂÈ· ÙÔ˘ ·ÛıÂÓ‹.

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µÈ‚ÏÈÔÁÚ·Ê›· 1. Osebold WR, Soper RT. Congenital posterolateral diaphragmatic hernia past infancy. Am J Surg 1976;131:748-754.

2. Newman B, Afshani E, Kapp W. Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg 1986;121:813-816.

3. Graivier L, Dorman GW, Votteler TP. Congenital diaphragmatic hernia in children. Surg Gynecol Obstet 1971;132:408.

4. Brill P, Gershwind M, Krasna H. Massive gastric enlargement with delayed presentation of congenital diaphragmatic hernia: report of three cases and review of the literature. J Pediatr Surg 1977;12:66-67.

5. Betremieux P, Dadabie A, Chapuis M, Pladys P, Treguier C, Fremond B. Late presenting Bochdalec hernia

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containing colon: misdiagnosis risk. Eur J Pediatr Surg 1995;5:113-115.

Berman L, Stringer D, Ein SH, Shandling B. The late presenting pediatric Bochdalek hernia: a 20-year review. J Pediatr Surg 1988;23:735-739.

De Foer, Breysem L, Smet MH, Baert AL. Late-onset Bochdalek hernia with a rare postoperative complication: case report. Pediatr Radiol 1994;24:306-307.

Fotter R, Schimpl G, Sorantin E, Fritz K, Landler U. Delayed presentation of congenital diaphragmatic hernia.

Pediatr Radiol 1992;22:187-191.

Gayer G, Bilik R, Vardi A. CT diagnosis of delayed presentation of congenital diaphragmatic hernia simulating massive pleuropneumonia. Eur Radiol 1999;9:1672-1674.

Tsang J, Ryan F. Delayed diaphragmatic herniation masquerading as a complicated parapneumonic effusion.

Can Respir J 1999;6:361-366.

Schimpl G, Fotter R, Sauer H. Congenital diaphragmatic hernia presenting after the newborn period. Eur J Pediatr 1993;152:765-768.

Paut O, Mely L, Viard L, Silicani MA, Guys JM, Camboulives J. Acute presentation of congenital diaphragmatic hernia past the neonatal period: a life threatening emergency. Can Anaesth 1996;43:621-625.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 23-05-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 01-12-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂. ¶··Ó‰Ú¤Ô˘ ∆ÚÈfiψ˜ 1, 151 27, ªÂÏ›ÛÛÈ·

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2001;64:163-167

CASE REPORT

¶·ÚÔ‰È΋ ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË Î·È ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ Û ÓÂÔÁÓfi π. ∫·Ï¤ÁÈ·˜1, ¡. π·Îˆ‚›‰Ô˘1, ∂. ªÂÁ·ÏÔÁÈ¿ÓÓË1, ™. ƒ¿ÌÌÔ˜2, °. ∫Ô˘Ú¿Î˘, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜1

Transient cortical hyperostosis and elevation of alkaline phosphatase following long-term administration of prostaglandin J. Kaleyias1, N. Iakovidou1, E. Megaloyianni1, S. Rammos2, G. Kourakis, H. Dellagrammaticas1

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓÂÔÁÓfi ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Ô˘ ·ÚÔ˘Û›·Û ·‡ÍËÛË Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Î·È ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË ÌÂÙ¿ ·fi Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ (PGE1). ∆Ô ÓÂÔÁÓfi ¯ÂÈÚÔ˘ÚÁ‹ıËΠ۠ËÏÈΛ· 70 ËÌÂÚÒÓ ÔfiÙÂ Î·È ‰È·ÎfiËÎÂ Ë PGE1. ∏ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Â·Ó‹Ïı ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· ÛÙ·‰È·Î¿ Î·È Ë ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË ˘Ô¯ÒÚËÛ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ PGE1, ÛÙÔȯ›· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ·ÚÔ‰È΋˜ ʇÛ˘ Ù˘ ÔÛÙÂÔ¿ıÂÈ·˜ ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË.

Abstract: We report an infant with ductusdependent congenital heart disease who was treated with prostaglandin E1 (PGE1) on a longterm basis. On the 25th day of treatment the alkaline phoshatase was found to be elevated while radiography revealed the presence of cortical hyperostosis of the bones. The infant was successfully operated at the age of 70 days and PGE1 was subsequently discontinued. Alkaline phosphatase levels slowly returned to normal values and the cortical hyperostosis receded, which suggests that the prostaglandin-induced osteopathy may be reversible.

§¤ÍÂȘ ÎÏÂȉȿ: ÚÔÛÙ·ÁÏ·Ó‰›ÓË, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË, ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË, ÔÛÙÂÔ¿ıÂÈ· ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË.

Key words: prostaglandin, alkaline phosphatase, cortical hyperostosis, prostaglandin-osteopathy.

∂ÈÛ·ÁˆÁ‹ ∏ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ ∂1 (PGE1) Â›Ó·È ··Ú·›ÙËÙË Û ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ÂÍ·ÚÙÒÌÂÓ˜ ·fi ÙËÓ ·Ú·ÌÔÓ‹ ·ÓÔÈÎÙÔ‡ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘, ˆ˜ ¿ÌÂÛË ·Ú¤Ì‚·ÛË Ì¤¯ÚÈ ÙË ‰ÈÔÚıˆÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (1). ª·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÂÊ·ÚÌfi˙ÂÙ·È ˆ˜ ·ÚË-

ÁÔÚËÙÈ΋ ıÂÚ·›· Û ÌË ¯ÂÈÚÔ˘ÚÁ‹ÛÈ̘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ‹ Û ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ·Ó·ÌÔÓ‹ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜. ™ÙȘ ÂÈÏÔΤ˜ ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ PGE1 Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ¿ÓÔȘ, ‚Ú·‰˘Î·Ú‰›·, ‰È¿ÚÚÔȘ, ˘ÚÂÙfi˜, ˘fiÙ·ÛË, Ô›‰ËÌ· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Î·È ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË (2,3). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ Ô˘ ·ÚÔ˘Û›·Û ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË Î·È ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· ÙËÓ 25Ë Ë̤ڷ ¯ÔÚ‹ÁËÛ˘ PGE1, Ô˘ ˘Ô¯ÒÚËÛ·Ó ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘.

1 ∆Ì‹Ì· ¡ÂÔÁ¤ÓÓËÙˆÓ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” 2 ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ “øÓ¿ÛÂÈÔ”

1 Neonatology Division of B’ Pediatric Clinic of University of Athens Children’s Hospital “P. & A. Kyriakou” 2 Cardiosurgical Center “Onassis”

™˘ÓÙÔÌÔÁڷʛ˜ Aº ∞ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË ÔÚÔ‡ PGE1 ¶ÚÔÛÙ·ÁÏ·Ó‰›ÓË

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¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¡ÂÔÁÓfi ı‹Ï˘ Ô˘ ÁÂÓÓ‹ıËΠÌÂÙ¿ ·fi ·ËÛË 35 ‚‰ÔÌ¿‰ˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 2.500 ÁÚ., ·ÚÔ˘Û›·Û ΢¿ÓˆÛË ·fi ÙË Á¤ÓÓËÛË Î·È ÂÈÛ‹¯ıË ÛÙÔ ∆Ì‹Ì· ÙËÓ 5Ë ÒÚ· ˙ˆ‹˜ Û ̤ÙÚÈ· ÁÂÓÈ΋ ηٿÛÙ·ÛË. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ¤‰ÂÈÍÂ, ÂÎÙfi˜ ·fi ÙËÓ ÎÂÓÙÚÈ΋ ΢¿ÓˆÛË, ¤ÓÙÔÓÔ Û˘ÛÙÔÏÈÎfi ʇÛËÌ· πππ/πV ·ÎÔ˘ÛÙfi Û fiÏÔ ÙÔ ÚÔοډÈÔ. √ ÎÔÚÂÛÌfi˜ Ù˘ Hb ‹Ù·Ó 72%. ªÂ ÙËÓ Èı·Ó‹ ‰È¿ÁÓˆÛË Ù˘ ΢·ÓˆÙÈ΋˜ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ÍÂΛÓËÛ ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ (PGE1) Î·È ¤ÁÈÓ ηډÈÔÏÔÁÈ΋ ÂͤٷÛË Ô˘ Û˘ÌÂÚÈÂÏ¿Ì‚·Ó ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È Î·ıÂÙËÚÈ·ÛÌfi ηډȿ˜. ∆¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ Û‡ÌÏÔ΢ ΢·ÓˆÙÈ΋˜ ηډÈÔ¿ıÂÈ·˜ Ì ÙȘ ·ÎfiÏÔ˘ı˜ ·ÓˆÌ·Ï›Â˜: 1) ·Ó·ÛÙÚÔÊ‹ ÛÏ¿¯ÓˆÓ (situs inversus) Ì ÌÂÛÔηډ›·, 2) ÎÔÏÔÎÔÈÏȷ΋ Î·È ÎÔÈÏÈÔ·ÚÙËÚȷ΋ ‰˘Û·ÚÌÔÓ›·, 3) ·ÙÚËÛ›· Ó¢ÌÔÓÈ΋˜ ‚·Ï‚›‰·˜, 4) ÌÂÁ¿ÏË ‰Â˘ÙÂÚÔÁÂÓ‹ ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·, 5) ˘ÔÏ·ÛÙÈÎfi Û٤ϯԘ Ó¢ÌÔÓÈ΋˜, 6) ·ÔÚÙÈÎfi ÙfiÍÔ ˆ˜ Â› LÌÂÙ¿ıÂÛ˘. ∏ ÚfiÁÓˆÛË ÁÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË ‹Ù·Ó ÂÍ·ÈÚÂÙÈο ‰˘ÛÌÂÓ‹˜. √È ÁÔÓ›˜ ·ÚÓ‹ıËÎ·Ó ·Ú¯Èο Ó· Á›ÓÂÈ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ Â¤Ì‚·ÛË. ÃÔÚËÁ‹ıËΠÚÔÛÙ·ÁÏ·Ó‰›ÓË ÂÓ‰ÔÊϤ‚È· ÁÈ· 50 Ë̤Ú˜, ÔfiÙÂ Î·È ·ÔÊ·Û›ÛÙËΠӷ Á›ÓÂÈ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ Â¤Ì‚·ÛË. ∏ ‰fiÛË Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ ÙÈÙÏÔÔÈ‹ıËΠ̠‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡, ¤ÙÛÈ ÒÛÙ ӷ ‰È·ÙËÚÂ›Ù·È ·ÓÔÈÎÙfi˜ Ô ·ÚÙËÚÈ·Îfi˜ fiÚÔ˜ Ì ÙËÓ ÂÏ¿¯ÈÛÙË ‰˘Ó·Ù‹ ‰fiÛË. ŒÙÛÈ, Ë ·Ú¯È΋ ‰fiÛË ‹Ù·Ó 0,1, ÙË 15Ë Ë̤ڷ 0,075 Î·È ·fi ÙËÓ 25Ë 0,05 Ìg/∫/min Ô˘ ‹Ù·Ó Î·È Ë ÌÈÎÚfiÙÂÚË ¯ÔÚËÁÔ‡ÌÂÓË Ì ÙËÓ ÔÔ›·

˘‹Ú¯Â ÙÔ ÂÈı˘ÌËÙfi ÎÏÈÓÈÎfi ·ÔÙ¤ÏÂÛÌ·, ‰ËÏ·‰‹ ÙË ‰È·Ù‹ÚËÛË ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ™Ù· Ï·›ÛÈ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡, ÂÏ‹ÊıËÛ·Ó ‰È·‰Ô¯ÈΤ˜ ÙÈ̤˜ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (∞º) ÔÚÔ‡. ™ÙËÓ ÂÈÛ·ÁˆÁ‹ Ë ∞º ‹Ù·Ó 160 IU/L, ÙËÓ 5Ë Ë̤ڷ 300 IU/L, ÙË 15Ë 400 IU/L, ÙËÓ 25Ë 1550 IU/L, ÂÓÒ Ï›Á˜ Ë̤Ú˜ ÚÈÓ ÙËÓ Î·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ·ÚÔ˘Û›·Û ÙË Ì¤ÁÈÛÙË ÙÈÌ‹ 2100 IU/L (∂ÈÎfiÓ· 1). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÈÛÔÂÓ˙‡ÌˆÓ Ù˘ ∞º ¤‰ÂÈÍ fiÙÈ ‹Ù·Ó ÔÛÙÈ΋˜ ÚÔ¤Ï¢Û˘. √ ˘fiÏÔÈÔ˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (·Û‚¤ÛÙÈÔ, ÊÒÛÊÔÚÔ˜, ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿Û˜, Á-ÁÏÔ˘Ù¿ÌÈÏÔ-ÙÚ·ÓÛÊÂÚ¿ÛË) ‹Ù·Ó Û fiϘ ÙȘ ÌÂÙÚ‹ÛÂȘ ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. √ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÔÛÙÒÓ ÙËÓ 25Ë Ë̤ڷ ˙ˆ‹˜ ¤‰ÂÈÍÂ Û˘ÌÌÂÙÚÈ΋ ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË. ∂ÓÒ ÙËÓ 1Ë Ë̤ڷ ˙ˆ‹˜ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‰ÂÓ ‰È·ÎÚ›ÓÔÓÙ·È ÔÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ, ÙËÓ 25Ë Ë̤ڷ ‰È·ÈÛÙÒıËΠÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË Ô˘ ·ÊÔÚÔ‡Û ٷ ÔÛÙ¿ ÙˆÓ ¿Óˆ ¿ÎÚˆÓ, ÙȘ ÎÏ›‰Â˜, ÙȘ Ï¢ڤ˜ (∂ÈÎfiÓ· 2), ηıÒ˜ Î·È Ù· ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ (∂ÈÎfiÓ· 3). ¢ÂÓ Û˘Ó˘‹Ú¯·Ó ÎÏÈÓÈο ÛËÌ›·, fiˆ˜ Ô›‰ËÌ· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ÂÚ˘ıÚfiÙËÙ· ‹ ¢·ÈÛıËÛ›·, ·ÓÙ›ÛÙÔȯ· ÙˆÓ ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. √ ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ¢ÂÓ ÌÂÏÂÙ‹ıËÎ·Ó ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÙÔ˘ ÔÛÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ (ÔÛÙÂÔηÏÛ›ÓË, ÌÂÙ·‚Ôϛ٘ ‚ÈÙ·Ì›Ó˘ ¢, ·Ú·ıÔÚÌfiÓË ÎÏ). ™Â ËÏÈΛ· 70 ËÌÂÚÒÓ ¤ÁÈÓ ÙÚÔÔÔÈË̤ÓË Â¤Ì‚·ÛË Blalock Taussig Ì ÙÔÔı¤ÙËÛË ÎÂÓÙÚÈ΋˜ ·Ú¿Î·Ì„˘ (shunt) ·fi ÙËÓ ·ÚÈÛÙÂÚ¿

2500

2000

Aº(πU/L)

2001 MAPT- A¶PI§

PGE1 0,05 Ìg/k/min.

1500

PGE1 0,075 Ìg/k/min.

¢È·ÎÔ‹ PGE1

1000 PGE1 0,1 Ìg/k/min.

500

0 1 ËÌ.

5 ËÌ.

15 ËÌ.

25 ËÌ.

70 ËÌ.

90 ËÌ.

6 ÌËÓÒÓ

14 ÌËÓÒÓ

3 ÂÙÒÓ

∏ÏÈΛ· ¡ÂÔÁÓÔ‡ ∂ÈÎfiÓ· 1. ¶ÔÚ›· Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (∞º) ÔÚÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ Ù˘ PGE1 Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘.

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∂ÈÎfiÓ· 2. ºÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË Ì·ÎÚÒÓ ÔÛÙÒÓ ¿Óˆ ¿ÎÚÔ˘, ÎÏ›‰·˜ Î·È Ï¢ÚÒÓ ÙËÓ 25Ë Ë̤ڷ ¯ÔÚ‹ÁËÛ˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘.

∂ÈÎfiÓ· 3. ºÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË ÔÛÙÒÓ Î¿Ùˆ ¿ÎÚÔ˘ ÙËÓ 25Ë Ë̤ڷ ¯ÔÚ‹ÁËÛ˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘.

ΛÌÂÓË ·ÓÒÓ˘ÌË ·ÚÙËÚ›· ÛÙËÓ ¤ÎÊ˘ÛË Ù˘ ·ÚÈÛÙÂÚ¿ ΛÌÂÓ˘ Î·È ÌÔÚÊÔÏÔÁÈο ‰ÂÍÈ¿˜ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ Ì ·ÔϛӈÛË ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘. ªÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ¤ÁÈÓ ‰È·ÎÔ‹ Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ PGE1. ™Â ËÏÈΛ· 14 ÌËÓÒÓ ÙÔ ÓÂÔÁÓfi Â·ÓÂÁ¯ÂÈÚ‹ıËÎÂ. ŒÁÈÓ ‰È·›ÚÂÛË ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ ÎÂÓÙÚÈ΋˜ ·Ú¿Î·Ì„˘, Ï·ÛÙÈ΋ ‰ÂÍÈ¿˜ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ Ì ·˘ÙfiÏÔÁÔ ÂÚÈηډȷÎfi ÂÌ‚¿ÏˆÌ· Î·È ÙÔÔı¤ÙËÛË ·ÚÈÛÙÂÚÔ‡ ·ÌÊ›‰ÚÔÌÔ˘ Glenn shunt. ∏ ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË ‹Ù·Ó 462 IU/L Î·È ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó Â˘Ú‹Ì·Ù· ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘ (∂ÈÎfiÓ· 4). ∆ÒÚ·, Û ËÏÈΛ· 3 ÂÙÒÓ, ÙÔ ·È‰› ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÎÙÈÓÔÏÔÁÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· (∞º 180 IU/L) ÔÛÙÂÔ¿ıÂÈ·˜ ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË.

·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘, ÂÓÒ Ù· 42 (53%) ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›·. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÚfiÛÙˆÛË ·˘Í·ÓfiÙ·Ó ·Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ ¯ÔÚ‹ÁËÛ˘ Ù˘ PGE1. ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÌÊ¿ÓÈÛ·Ó ˘ÂÚfiÛÙˆÛË, ÙÔ 42% ÙËÓ ·ÚÔ˘Û›·Û ÙËÓ 30Ë Ë̤ڷ, ÙÔ 87% ÙËÓ 60Ë Î·È ÙÔ 100% ÙËÓ 60Ë. ∏ Û˘¯ÓfiÙËÙ· ·ÏÏ¿ Î·È Ë ‚·Ú‡ÙËÙ· Ù˘ ˘ÂÚfiÛÙˆÛ˘ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ Î·È ÙË Û˘ÓÔÏÈ΋ ‰fiÛË Ù˘ PGE1. À„ËÏfiÙÂÚ˜ ÙÈ̤˜ ∞º ›¯·Ó ÔÈ ·ÛıÂÓ›˜ Ì ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË. ∂›Û˘, ÙÔ ÔÛÔÛÙfi ÓÂÔÁÓÒÓ Ì ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· ‹Ù·Ó ·Ó¿ÏÔÁÔ ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ˘ÂÚfiÛÙˆÛ˘ (26% Û ·È‰È¿ ¯ˆÚ›˜ ÔÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ, 59% Û ·È‰È¿ Ì ‹Ș Î·È 85% Û ÂΛӷ Ì ‚·ÚȤ˜ ·ÏÏÔÈÒÛÂȘ). ∏ PGE1, fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, ¤¯ÂÈ ÔÛÙÂÔ‚Ï·ÛÙÈ΋ ‰Ú¿ÛË. ŒÓ˙˘Ì· Ô˘ ÙË ‰È·ÛÔ‡Ó, fiˆ˜ Ë 15-˘‰Úfi͢-‰Â¸‰ÚÔÁÂÓ¿ÛË Î·È Ë ¢-13-·Ó·ÁˆÁ¿ÛË, ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔ˘˜ Ó‡ÌÔÓ˜, fiÔ˘ Î·È ÙËÓ ·ÔÈÎÔ‰ÔÌÔ‡Ó Ù·¯‡Ù·Ù·. ¡ÂÔÁÓ¿ Ì ۇÌÏÔÎË Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Ì ‰È·Ê˘Á‹ ̤ۈ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘ ‹/Î·È ÙÔ˘ ˆÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜, ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ PGE1, ÏfiÁˆ ·Ú¿Î·Ì„˘ ÙˆÓ Ó¢ÌfiÓˆÓ (5,9). ∆· ‰Â‰Ô̤ӷ ·˘Ù¿ Û˘Ì›ÙÔ˘Ó Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÂÚ›ÙˆÛ˘ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È. ∆Ô ÓÂÔÁÓfi ›¯Â ·Ú¿Î·Ì„Ë Ù˘ Ó¢ÌÔÓÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ Î·È ¿Ú·

™˘˙‹ÙËÛË ∆Ô 1981, fiÙ·Ó ÔÈ Lewis Î·È Û˘Ó (2) ÂÚȤÁÚ·„·Ó ÙȘ ·ÚÂÓ¤ÚÁÂȘ Ù˘ PGE1 Û 492 ·ÛıÂÓ›˜, Ë ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚·ÓfiÙ·Ó. ∞ÎÔÏÔ‡ıˆ˜, ÛÔÚ·‰Èο ÂÚÈÁÚ¿ÊËÎ·Ó ÂÚÈÛÙ·ÙÈο fiÔ˘ ·Ó¤ÊÂÚ·Ó ÙË ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË ˆ˜ ÂÈÏÔ΋ ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ (4-9). √È Karen Î·È Û˘Ó (10) ÌÂϤÙËÛ·Ó ·Ó·‰ÚÔÌÈο 86 ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· ›¯Â ¯ÔÚËÁËı› PGE1 ÂÓ ·Ó·ÌÔÓ‹ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ηډȿ˜. ∆· 53 ÓÂÔÁÓ¿ (62%) ›¯·Ó

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∂ÈÎfiÓ· 4. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Î·È ¿Óˆ ¿ÎÚˆÓ Û ËÏÈΛ· 14 ÌËÓÒÓ (11 Ì‹Ó˜ Î·È 20 Ë̤Ú˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘). ∏ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÂÚÈÔÛÙ¤Ô˘ ¤¯ÂÈ ÂÍ·Ê·ÓÈÛı›.

·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Î˘ÎÏÔÊÔÚ›·˜ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ ÛÙÔÓ ÔÚfi. ¶·ÚÔ˘Û›·Û ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· ÛÙÔÓ ·Ó·ÌÂÓfiÌÂÓÔ ·fi Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ¯ÚfiÓÔ Î·È ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡. §·Ì‚¿ÓÔÓÙ·˜ ˘’fi„ÈÓ fiÙÈ Ù· Â›‰· ∞º Â›Ó·È ·Ó¿ÏÔÁ· Ì ÙÔ ‚·ıÌfi Ù˘ ˘ÂÚfiÛÙˆÛ˘, ‰È·ÈÛÙÒÛ·Ì fiÙÈ ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· Î·È ÛÔ‚·Ú‹ ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË. ∏ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘ ‰ÂÓ Â›Ó·È Û˘Ó‹ı˘. ∂Í·ÈÚÂÙÈο Û¿ÓÈ· ÌÔÚ› Ó· ÚÔ‚¿ÏÏÂÈ ˆ˜ Ô›‰ËÌ· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Î·È ÂÚ˘ıÚfiÙËÙ· ˘ÂÚΛÌÂÓÔ˘ ‰¤ÚÌ·ÙÔ˜. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È fiÙÈ Â¿Ó Û ·˘Ù‹ ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÈÚÔÛÙÂıÔ‡Ó ÁÓˆÛÙ¤˜ ·ÚÂÓ¤ÚÁÂȘ Ù˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ fiˆ˜ ˘ÂÚıÂÚÌ›·, ˘fiÙ·ÛË, ¿ÓÔÈ·, ÙfiÙ ٛıÂÙ·È ÈÛ¯˘Ú¿ Ë ˘Ô„›· ÛË„·ÈÌ›·˜-ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ (12). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ‰ÂÓ Â›¯Â ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘. ™ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ‚ÚÂÊÈ΋ ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË (ÓfiÛÔ˜ Caffey), Ë ˘ÂÚ‚Èٷ̛ӈÛË ∞, ÙÔ ÛÎÔÚ‚Ô‡ÙÔ, Ë Û‡ÊÈÏË, ÙÔ ÙÚ·‡Ì·, Ô fiÁÎÔ˜, Ë Ïԛ̈ÍË Î·È Ë ·ÈÌÔÚÚ·Á›·. ∆· ÂÚÈÛÛfiÙÂÚ· ÓÔÛ‹Ì·Ù·, Ì ÂÍ·›ÚÂÛË ÙË ‚ÚÂÊÈ΋ ÊÏÔÈÒ‰Ë ˘ÂÚfiÛÙˆÛË, Â›Ó·È Â‡ÎÔÏÔ Ó· ‰È·ÊÔÚԉȷÁÓˆÛÙÔ‡Ó Ì ‚¿ÛË ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÙÔ ÈÛÙÔÚÈÎfi Î·È Ù· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË Ô˘ ÔÊ›ÏÂÙ·È Û ̷ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ÚÔÛÙ·ÁÏ·Ó‰›Ó˘, ÔÌÔÈ¿˙ÂÈ Ì ÙË ÓfiÛÔ Caffey ÛÙËÓ ÔÔ›·, fï˜, ¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛ‚¿ÏÏÂÙ·È Ë Î¿Ùˆ ÁÓ¿ıÔ˜. ∂›Û˘, Ë ˘Ô¯ÒÚËÛË Ù˘ ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘

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ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ PGE1 ·ÔÎÏ›ÂÈ ÙË ÓfiÛÔ ÙÔ˘ Caffey (10,13) ∏ ÊÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË PGE1 Â›Ó·È ·Ó·ÛÙÚ¤„ÈÌË, ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË Î·È ˘Ô¯ˆÚ› Û 6-12 Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ (13). ªÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ PGE1 ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ‰È·ÈÛÙÒıËΠÛÙ·‰È·Î‹ ·ÔηٿÛÙ·ÛË Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ Î·È ˘Ô¯ÒÚËÛË Ù˘ ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘. ∏ ˘Ô¯ÒÚËÛË Ù˘ ÔÛÙÂÔ¿ıÂÈ·˜ ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÁڷʤ˜ Èı·ÓÔÏÔÁÂ›Ù·È Î·È ‰ÂÓ ÙÂÎÌËÚÈÒÓÂÙ·È Ì ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, ·ÊÔ‡ ‰˘ÛÙ˘¯Ò˜ Û˘¯Ó¿ ·˘ÙÔ› ηٷϋÁÔ˘Ó, ÏfiÁˆ Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ηٿÛÙ·Û˘ (7,11). √È Jorgensen Î·È Û˘Ó (11) ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ·ÚÔ‰È΋ ʇÛË Ù˘ ÔÛÙÂÔ¿ıÂÈ·˜ ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË ·fi ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜ ÙÔ˘˜ Ô˘ η٤ÏËÍÂ, Ù· ÔÔ›· ‹Ù·Ó Û˘Ì‚·Ù¿ Ì ˘Ô¯ÒÚËÛË Ù˘ ÊÏÔÈÒ‰Ô˘˜ ˘ÂÚfiÛÙˆÛ˘. √È Host Î·È Û˘Ó (13) ÙÂÎÌËÚÈÒÓÔ˘Ó ÙËÓ ·Ó·ÛÙÚ„ÈÌfiÙËÙ· Ù˘ ‚Ï¿‚˘ Ì ·Ú·ÎÔÏÔ‡ıËÛË Î·È ·ÎÙÈÓÔÏÔÁÈ΋ ÂȂ‚·›ˆÛË, fiˆ˜ Î·È ÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È. ∫Ú›ÓÂÙ·È ÛÎfiÈÌË Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÙÈÌÒÓ Ù˘ ∞º ÔÚÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ÚÔÛÙ·ÁÏ·Ó‰›Ó˘ ˆ˜ ‰Â›ÎÙË Ù˘ ÔÛÙÂÔ‚Ï·ÛÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ Ù˘. ∂›Û˘, ·Ó Â›Ó·È ÂÊÈÎÙfi, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÙÈÙÏÔÔ›ËÛË Ù˘ ‰fiÛ˘, ÒÛÙ ӷ ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë Â›‰Ú·Û‹ Ù˘ ÛÙÔÓ ·ÚÙËÚÈ·Îfi fiÚÔ, ÌÂÈÒÓÔÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· ÙËÓ Èı·ÓfiÙËÙ· ·ÚÂÓÂÚÁÂÈÒÓ. §fiÁˆ ÙÔ˘ Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓÔ˘ ·ÚÈıÌÔ‡ ÓÂÔÁÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÚÔÛÙ·ÁÏ·Ó‰›ÓË Ì·ÎÚÔ¯ÚfiÓÈ·, Ë ÔÛÙÂÔ¿ıÂÈ· ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË ·Ó·Ì¤ÓÂÙ·È fiÙÈ ı· Û˘Ó·ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ·fi ÙÔÓ ·È‰›·ÙÚÔ. ∏ ÔÓÙfiÙËÙ· ·˘Ù‹ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’fi„ÈÓ Û οı ‚Ú¤ÊÔ˜ Ô˘ Ï·Ì‚¿ÓÂÈ ÚÔÛÙ·ÁÏ·Ó‰›ÓË Ì·ÎÚÔ¯ÚfiÓÈ·, fiˆ˜ ÂΛӷ Ô˘ Â›Ó·È ˘Ô„‹ÊÈ· ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜. ∂›Û˘, ÂÂȉ‹ ÔÈ ÔÛÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ ·Ú·Ì¤ÓÔ˘Ó ·ÚÎÂÙÔ‡˜ Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ PGE1, Ô ÎÏÈÓÈÎfi˜ È·ÙÚfi˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ ‚Ú¤ÊË Ô˘ ÙÔ˘˜ ¯ÔÚËÁ‹ıËΠÚÔÛÙ·ÁÏ·Ó‰›ÓË, ı· Ú¤ÂÈ Ó· ·Ó·Ì¤ÓÂÈ ÙË ‚Ú·‰Â›· ·ÔηٿÛÙ·ÛË Ù˘ ÔÛÙÂÔ¿ıÂÈ·˜ ·ÔʇÁÔÓÙ·˜ ¿ÛÎÔ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ·Ó¿ÚÚˆÛ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Freed M, Heymann M, Lewis A, Roehl S, Kensey R. Prostaglandin E1 in infants with ductus arteriosus dependent congenital heart disease. Circulation 1981;64:899-905.

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Gardiner JS, Zauk AM, Donchey SS, McInerney VK. Prostaglandin-induced cortical hyperostosis. Case report and review of the literature. J Bone Joint Surg Am 1995;77:932-936.

Drvaric DM, Parks WJ, Wyly JB, Dooley KJ, Plauth WH Jr, Schmitt EW. Prostaglandin-induced hyperostosis. A case report. Clin Orthop 1989;246:300-304.

Karen W, Janet E, Joyce P. Cortical hyperostosis: a complication of prolonged prostaglandin infusion in

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infants awaiting cardiac transplantation. Pediatr Radiol 1994;93:417-420.

11. Jorgensen HRI, Svanholm H, Host A. Bone formation induced in an infant by systemic prostaglandin E2 administration. Acta Orthop Scand 1988;59:464-465.

12. Adevis K, Hush F, de Moor M. Cortical hyperostosis simulating osteomyelitis after short-term PGE1 infusion.

Eur J Pediatr 1996;155:173-174.

13. Host A, Halken S, Andersen P. Reversibility of cortical hyperostosis following long-term prostaglandin E1 therapy in infants with ductus-dependet congenital heart disease.

Pediatr Radiol 1998;18:149-153.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 31-10-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 20-12-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆÛ‹Ê ∫·Ï¤ÁÈ·˜ ÃÚ˘Û·Óı¤ÌˆÓ 79, 157 72, ∑ˆÁÚ¿ÊÔ˘

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· √È Û˘Ó¤ÂȘ Ù˘ ı¤Û˘ ÛÙÔ Î¿ıÈÛÌ· ·˘ÙÔÎÈÓ‹ÙÔ˘ Î·È Ù˘ ¯Ú‹Û˘ ˙ÒÓ˘ ·ÛÊ·Ï›·˜ ÛÙȘ ηÎÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ Û ·˘ÙÔÎÈÓËÙÈÛÙÈο ·Ù˘¯‹Ì·Ù· ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ë ÂÎÙ›ÌËÛË ÙˆÓ Û˘ÓÂÂÈÒÓ Ù˘ ¯Ú‹Û˘ ˙ÒÓ˘ ·ÛÊ·Ï›·˜ Î·È Ù˘ ı¤Û˘ ÛÙÔ ·˘ÙÔΛÓËÙÔ Û ۯ¤ÛË Ì ÙËÓ ÚfiÎÏËÛË Î·ÎÒÛÂˆÓ Û ·È‰È¿ Û ÂÚÈÙÒÛÂȘ ·˘ÙÔÎÈÓËÙÈÛÙÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¶ÂÚÈÂÏ‹ÊıËÎ·Ó ·È‰È¿ οو ÙˆÓ 15 ÂÙÒÓ, Ù· ÔÔ›· ÙÚ·˘Ì·Ù›ÛÙËÎ·Ó Û ÛÔ‚·Ú¿ ·˘ÙÔÎÈÓËÙÈÛÙÈο ·Ù˘¯‹Ì·Ù· ·fi ÙÔ 1992 ¤ˆ˜ ÙÔ 1996. fl˜ ÛÔ‚·Ú¿ ·Ù˘¯‹Ì·Ù· ÔÚ›˙ÔÓÙ·È ÂΛӷ Ô˘ ›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÚ·˘Ì·ÙÈÛÌfi Ì ηٿÁÌ·Ù· ÔÛÙÒÓ ‹ ÛËÌ·ÓÙÈ΋ ·ÈÌÔÚÚ·Á›· ‹ ˘ÏÈ΋ ˙ËÌÈ¿ Ô˘ ÍÂÂÚÓÔ‡Û ٷ 750 ‰ÔÏÏ¿ÚÈ·. ŒÁÈÓ ·Ó¿Ï˘ÛË ÙˆÓ ÛÙÔȯ›ˆÓ Î·È Û˘Û¯ÂÙÈÛÌfi˜ Ì ÙËÓ ËÏÈΛ·, ÙË ¯Ú‹ÛË ˙ÒÓ˘ ·ÛÊ·Ï›·˜, ÙË ı¤ÛË ÙÔ˘ ÂÈ‚¿ÙË-·È‰ÈÔ‡ Î·È ÙÔÓ Ù‡Ô Ù˘ Û‡ÁÎÚÔ˘Û˘. ∞ÔÙÂϤÛÌ·Ù·: ªÂÏÂÙ‹ıËÎ·Ó 5751 ·È‰È¿ Î·È ‚Ú¤ıËΠfiÙÈ ÙÔ 53% ‹Ù·Ó ÂÈ‚¿Ù˜ ηı‹ÌÂÓÔÈ ÛÙÔ ›Ûˆ οıÈÛÌ· ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘. ¶ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ·fi ÙÔ 50% ‹Ù·Ó ¯ˆÚ›˜ ˙ÒÓË ·ÛÊ·Ï›·˜. ∏ ı¤ÛË ÛÙÔ ›Ûˆ οıÈÛÌ· ÚÔÛ¤ÊÂÚ ̛· ÛËÌ·ÓÙÈ΋ ÚÔÛÙ·Û›· Î·È Ë ¯Ú‹ÛË ˙ÒÓ˘ ·ÛÊ·Ï›·˜ ÂÓ›Û¯˘Â ÙÔ ·ÔÙ¤ÏÂÛÌ·. ∆Ô Ì¤ÛÔ ÎfiÛÙÔ˜ ÓÔÛËÏ›·˜ ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÁÈ· ÙÔ˘˜ ÂÈ‚¿Ù˜-·È‰È¿ ÙÔ˘ ÌÚÔÛÙÈÓÔ‡ ηı›ÛÌ·ÙÔ˜ ·˘ÙÔÎÈÓ‹ÙÔ˘.

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·È‰È¿ Ô˘ οıÔÓÙ·È ÛÙÔ ›Ûˆ οıÈÛÌ· ·˘ÙÔÎÈÓ‹ÙÔ˘, Û ÂÚ›ÙˆÛË ·˘ÙÔÎÈÓËÙÈÛÙÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜, ¤¯Ô˘Ó ηχÙÂÚË ÚÔÛÙ·Û›·. ∏ ¯Ú‹ÛË ˙ÒÓ˘ ·ÛÊ·Ï›·˜ ÂÓÈÛ¯‡ÂÈ ÙËÓ ÚÔÛÙ·Û›·. ∏ ¯Ú‹ÛË Ù˘ fï˜, Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. ∏ ÚÔÛÙ·Û›· ·fi ÙË ı¤ÛË ÛÙÔ ›Ûˆ οıÈÛÌ· ·˘ÙÔÎÈÓ‹ÙÔ˘ ·ıÚÔ›˙ÂÙ·È ÛÙËÓ ÚÔÛÙ·Û›· Ô˘ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ·fi ÙË ¯Ú‹ÛË ˙ÒÓ˘ ·ÛÊ·Ï›·˜, ·ÏÏ¿Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ·˘Ù‹.

Berg M, Cook L, Corneli H, Vernon D, Dean J Effect of Seating position and restrained use on injuries to children in motor vehicle crashes Pediatrics 2000;105(4):831-835 ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ £. ∆ÛÔ˘Ì¿Î·˜ ¶·È‰›·ÙÚÔ˜-¢È¢ı˘ÓÙ‹˜ ∂.™.À. ¡ÔÛÔÎÔÌÂ›Ô ∫.∞.∆. ∞ÙÙÈ΋˜

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

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CASE REPORT

™˘ÁÁÂÓ‹˜ Û‡ÊÈÏË: Ì›· Û‡Á¯ÚÔÓË ·ÂÈÏ‹ ∂. ∫ÔڷοÎË, ∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ¶. ™Ì˘ÚÓ¿ÎË, π. ¶··Ì·ÛÙÔÚ¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Congenital syphilis: a current threat E. Korakaki, E. Hatzidaki, A. Manoura, P. Smirnaki, I. Papamastoraki, C. Giannakopoulou

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÔÓÙ·È Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·Û˘Ìو̷ÙÈÎÒÓ ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ Û‡ÊÈÏË, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ÙÚÈÂÙ›·. ∏ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¤ÁÈÓ ۇÌʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ∫¤ÓÙÚÔ˘ ∂ϤÁ¯Ô˘ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ∞ÌÂÚÈ΋˜. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ÓÂÔÁÓfi ·fi ¿Á·ÌÔ˘˜ ÁÔÓ›˜, ·ÏÈÓÓÔÛÙÔ‡ÓÙ˜ ŒÏÏËÓ˜ ·fi ¯ÒÚ˜ Ù˘ ÚÒËÓ ™Ô‚ÈÂÙÈ΋˜ ŒÓˆÛ˘. ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ô ·Ù¤Ú·˜ ‹Ù·Ó Ó·˘ÙÈÎfi˜, ÛÙËÓ ÙÚ›ÙË ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ÂÎÙfi˜ Á¿ÌÔ˘, ÂÓÒ Ë ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ·ÏÏÔ‰·Ô‡˜ ÁÔÓ›˜ Ô˘ ›¯·Ó ÌÂÙ·Ó·ÛÙ‡ÛÂÈ ÚfiÛÊ·Ù· ÛÙË ¯ÒÚ· Ì·˜ ·Ó·˙ËÙÒÓÙ·˜ ÂÚÁ·Û›·. ™Â η̛· ·fi ÙȘ ÌËÙ¤Ú˜ ‰ÂÓ Â›¯Â ¯ÔÚËÁËı› ÛˆÛÙ‹ Î·È Â·Ú΋˜ ıÂÚ·›· ÚÔÁÂÓÓËÙÈο. ∏ ¢Ú›· ÌÂٷΛÓËÛË ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Î·È Ë ÂÏ¢ıÂÚ›· ÛÙ· ‹ıË Ù˘ ÛËÌÂÚÈÓ‹˜ ˙ˆ‹˜ ¤¯Ô˘Ó ʤÚÂÈ ÙË Û˘ÁÁÂÓ‹ Û‡ÊÈÏË Í·Ó¿ ÛÙËÓ ÂÈηÈÚfiÙËÙ·.

Abstract: Four cases of asymptomatic full-term neonates with congenital syphilis are described who were hospitalized in our department during the last three years. The cases were classified according ÙÔ the recommendations of the Centers of Disease Control and Prevention (CDC). The first neonate was born to a mother who was unmarried and had immigrated to Greece, the father of the second neonate was a sailor, the third neonate was born also to an unmarried mother, and the last neonate was born to a mother who had recently immigrated to Greece. All infants were born to seropositive mothers who were inadequately treated. In recent years reemergence of congenital syphilis has occurred, probably as a result of the large population movements as well as the to low ethical standards of the society.

§¤ÍÂȘ ÎÏÂȉȿ: Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË, ·Û˘Ìو̷ÙÈÎfi ÓÂÔÁÓfi.

Key words: congenital syphilis, asymptomatic neonate.

∂ÈÛ·ÁˆÁ‹ ∏ Û‡ÊÈÏË Û˘Ó¯›˙ÂÈ Ó· ·ÔÙÂÏ› ÛÔ‚·Úfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ Û ÔÏÏ¿ ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘. ¶ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙ· ̤۷ ÙÔ˘ ‰¤Î·ÙÔ˘ ¤ÌÙÔ˘ ·ÈÒÓ· Î·È ‹Ú ÙÔ fiÓÔÌ¿ Ù˘ ·fi ¤Ó·Ó ¿Û¯ÔÓÙ· ‚ÔÛÎfi, ÙÔ ™‡ÊÈÏÔ (1). ™Ù· Ù¤ÏË ÙÔ˘ ‰¤Î·ÙÔ˘ ¤Ó·ÙÔ˘ ·ÈÒÓ· Î·È ÛÙȘ ·Ú¯¤˜ ÙÔ˘ ÂÈÎÔÛÙÔ‡ ‹Ù·Ó Û ¤Í·ÚÛË, ÂÓÒ Ì ÙËÓ ·Ó·Î¿Ï˘„Ë Ù˘ ÂÓÈÎÈÏ›Ó˘ ÂÚÈÔÚ›ÛÙËΠÛËÌ·ÓÙÈο. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ú·ÙËÚËı› ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ¿˜ Ù˘, ΢ڛˆ˜ ÌÂٷ͇ Ó·ÚÒÓ ·ÙfïÓ, ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ÙËÓ Â˘Ú›· ÌÂ-

ٷΛÓËÛË ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Î·È ÙËÓ ÂÏ¢ıÂÚ›· ËıÒÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ ÛËÌÂÚÈÓfi ÙÚfiÔ ˙ˆ‹˜ (2,3). ∏ ÓfiÛÔ˜ ÌÂÙ·‰›‰ÂÙ·È ·fi ÙËÓ ¤ÁÎ˘Ô ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô, Û˘Ó‹ıˆ˜ ‰È·Ï·ÎÔ˘ÓÙȷο ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ‹ ÂÍ Â·Ê‹˜ ηٿ ÙÔÓ ÙÔÎÂÙfi. √ ΛӉ˘ÓÔ˜ ÌÂÙ¿‰ÔÛ‹˜ Ù˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÌÂÙ¿ ÙË 16Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘. ™ÙÔ ÚˆÙÔÁÂÓ¤˜ Î·È ‰Â˘ÙÂÚÔÁÂÓ¤˜ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ÊÙ¿ÓÂÈ ÙÔ 100%. ∏ ‰È¿ÁÓˆÛ‹ Ù˘ Á›ÓÂÙ·È Ì ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô. ∏ ÂÓÈÎÈÏ›ÓË ıˆÚÂ›Ù·È ıÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ¤ÁÎ˘Ô ÌËÙ¤Ú· Î·È ÚÔÛٷهÂÈ ÙÔ ¤Ì‚Ú˘Ô,

¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

Department of Neonatology of the University of Crete

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ÚÔÏ·Ì‚¿ÓÔÓÙ·˜ ÙËÓ Î¿ıÂÙË ÌÂÙ¿‰ÔÛË. ™Â ·ÏÏÂÚÁ›· Ù˘ ÂÁ·Ԣ ÛÙËÓ ÂÓÈÎÈÏ›ÓË Û˘ÓÈÛÙ¿Ù·È ·¢·ÈÛıËÙÔÔ›ËÛË (1,4). ∏ ÛÔ‚·ÚfiÙËÙ· Ù˘ ÚÔÛ‚ÔÏ‹˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ηٿ ÙË ÌÂÙ¿‰ÔÛË. ∏ Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË Â›Ó·È ·ÈÙ›· ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘, ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÂÔÁÓÈ΋˜ ÓÔÛËÚfiÙËÙ·˜. ∆Ô ÚÔۂ‚ÏË̤ÓÔ ÓÂÔÁÓfi ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ‚ÏÂÓÓÔÁÔÓÔ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜, ÔÛÙÂÔ¯ÔÓ‰Ú›Ùȉ·, „¢‰Ô·Ú¿Ï˘ÛË, ÂÍ¿ÓıËÌ·, ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· Î·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫ÂÓÙÚÈÎÔ‡ ¡Â˘ÚÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜. ∏ Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÚÒÈÌË fiÙ·Ó ÂÌÊ·ÓÈÛÙÔ‡Ó Ù· Û˘ÌÙÒÌ·Ù· ηٿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ Î·È ˆ˜ fi„ÈÌË fiÙ·Ó ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÚÁfiÙÂÚ·, ÈÔ Û˘¯Ó¿ ÎÔÓÙ¿ ÛÙËÓ ÂÊ˂›·. ∆· 2/3 ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÓÂÔÁÓÒÓ Â›Ó·È ·Û˘Ìو̷ÙÈο ÛÙË Á¤ÓÓËÛË Î·È Ô ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÂÁ·Ԣ Â›Ó·È Î·ıÔÚÈÛÙÈÎfi˜, ÙfiÛÔ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË fiÛÔ Î·È ÁÈ· ÙËÓ ¤Î‚·ÛË ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ (1,4). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·Û˘Ìو̷ÙÈÎÒÓ ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ Û‡ÊÈÏË, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ÙÚÈÂÙ›·. ∏ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¤ÁÈÓ ۇÌʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ∫¤ÓÙÚÔ˘ ∂ϤÁ¯Ô˘ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ∞ÌÂÚÈ΋˜ (Centers for Disease Control and Prevention). ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÙÂÏÂ˘Ù·›·˜ ÙÚÈÂÙ›·˜ ÓÔÛËχÙËÎ·Ó Ù¤ÛÛÂÚ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ Û‡ÊÈÏË. ∆· ÚÔËÁÔ‡ÌÂÓ· 6 ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ÎÏÈÓÈ΋˜ Ì·˜ ‰ÂÓ ÓÔÛËχÙËΠηӤӷ ÓÂÔÁÓfi Ì ۇÊÈÏË, Ô‡Ù ·Ó·Ê¤ÚıËΠÂÓ‰ÔÌ‹ÙÚÈÔ˜ ‹ ÂÚÈÁÂÓÓËÙÈÎfi˜ ı¿Ó·ÙÔ˜ ÓÂÔÁÓÔ‡ ÌËÙ¤Ú·˜ Ì ۇÊÈÏË. ∆· Ù¤ÛÛÂÚ· ÓÂÔÁÓ¿ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ì ‹Ù·Ó ·Û˘Ìو̷ÙÈο ÙÂÏÂÈfiÌËÓ·, Ì ̤ÛÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3.755 g (± 465.22 g). ∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ÓÂÔÁÓfi ·fi ¿Á·ÌÔ˘˜ ÁÔÓ›˜, ·ÏÈÓÓÔÛÙÔ‡ÓÙ˜ ŒÏÏËÓ˜ ·fi ¯ÒÚ˜ Ù˘ ÚÒËÓ ™Ô‚ÈÂÙÈ΋˜ ŒÓˆÛ˘. ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ô ·Ù¤Ú·˜ ‹Ù·Ó Ó·˘ÙÈÎfi˜, ÛÙËÓ ÙÚ›ÙË ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ÂÎÙfi˜ Á¿ÌÔ˘, ÂÓÒ Ë ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ·ÏÏÔ‰·Ô‡˜ Ô˘ ›¯·Ó ÌÂÙ·Ó·ÛÙ‡ÛÂÈ ÚfiÛÊ·Ù· ÛÙË ¯ÒÚ· Ì·˜ ·Ó·˙ËÙÒÓÙ·˜ ÂÚÁ·Û›·. ∏ ̤ÛË ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ ‹Ù·Ó Ù· 27 ¤ÙË (‡ÚÔ˜ 21-30 ¤ÙË). ¢ÂÓ ·Ó·Ê¤ÚıËΠ¯Ú‹ÛË ÂÍ·ÚÙËÛÈÔÁfiÓˆÓ Ô˘ÛÈÒÓ ·fi η̛· ÌËÙ¤Ú·. ™ÙȘ ÙÚÂȘ ÂÚÈÙÒÛÂȘ (75%), Ë ÓfiÛËÛË Ù˘ ÌËÙ¤Ú·˜ ‰È·ÈÛÙÒıËΠÛÙÔÓ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô Ì ÙÚÂÔÓËÌÈΤ˜ Î·È ÌË ÙÚÂÔÓËÌÈΤ˜ ‰ÔÎÈ̷ۛ˜, ÂÓÒ Û ̛· ÂÚ›ÙˆÛË (25%) Ë ÓfiÛËÛË ‹Ù·Ó ÁÓˆÛÙ‹ ÚÈÓ ·fi ÙËÓ Î‡ËÛË. ∆· ‰‡Ô ÓÂÔÁÓ¿ ÁÂÓÓ‹ıË-

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Î·Ó ·fi ÌËÙ¤Ú˜ Ô˘ ‰ÂÓ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó Ù·ÎÙÈο ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ (<3 Û˘ÓÔÏÈο ÂÈÛΤ„ÂȘ ÚÈÓ ÙÔÓ ÙÔÎÂÙfi). ™Â η̛· ·fi ÙȘ ÌËÙ¤Ú˜ ‰ÂÓ Â›¯Â ¯ÔÚËÁËı› ÛˆÛÙ‹ Î·È Â·Ú΋˜ ıÂÚ·›· ÚÔÁÂÓÓËÙÈο. ŸÏ· Ù· ÓÂÔÁÓ¿ ‹Ù·Ó ÔÚÔıÂÙÈο ÛÙȘ ÌË ÂȉÈΤ˜ (VDRL) Î·È ÂȉÈΤ˜ (FTAABS) ÙÚÂÔÓËÌÈΤ˜ ‰ÔÎÈ̷ۛ˜, Ì ٛÙÏÔ˘˜ ¯·ÌËÏfiÙÂÚÔ˘˜ ·fi ÂΛÓÔ˘˜ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘˜. √ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ë·Ù›Ùȉ· µ Î·È C Î·È ÁÈ· HIV ‹Ù·Ó ·ÚÓËÙÈÎfi˜. √ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ·ÔÎ¿Ï˘„ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Î·È Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ Ô˘ ¤ÁÈÓ Û fiÏ· Ù· ÓÂÔÁÓ¿ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∫·È ÛÙ· Ù¤ÛÛÂÚ· ÓÂÔÁÓ¿ ¯ÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· ÎÚ˘ÛÙ·ÏÏÈ΋ ÂÓÈÎÈÏ›ÓË G ÁÈ· 10 Ë̤Ú˜. µÚ›ÛÎÔÓÙ·È ÛÂ Û˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ·fi ÙÔ Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô Ù˘ ÎÏÈÓÈ΋˜ Ì·˜ Î·È ¤¯Ô˘Ó ÔÌ·Ï‹ ÔÚ›·. ™˘˙‹ÙËÛË ∏ Û‡ÊÈÏË ·ÔÙÂÏ› ÛÔ‚·Úfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ Î·È Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ¤¯ÂÈ ·˘ÍËı› ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ¶ÚÔÛ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ Á˘Ó·›Î˜ Ó·ڋ˜ ËÏÈΛ·˜, ¿Á·Ì˜, ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘, Ô˘ οÓÔ˘Ó ¯Ú‹ÛË ÂÍ·ÚÙËÛÈÔÁfiÓˆÓ Ô˘ÛÈÒÓ, ÌÂ Û˘¯Ó‹ ÂÓ·ÏÏ·Á‹ ÛÂÍÔ˘·ÏÈÎÒÓ Û˘ÓÙÚfiÊˆÓ Î·È ÈÛÙÔÚÈÎfi ÛÂÍÔ˘·ÏÈÎÒ˜ ÌÂÙ·‰È‰fiÌÂÓÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ¶·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· Û ÂΛӘ Ô˘ ηÙÔÈÎÔ‡Ó Û ÊÙˆ¯¤˜ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ÏËı˘ÛÌÔ‡˜ ÂıÓÈÎÒÓ ÌÂÈÔÓÔًوÓ. √È Á˘Ó·›Î˜ ·˘Ù¤˜ Û˘Ó‹ıˆ˜ ÂÍÂÙ¿˙ÔÓÙ·È ÛÙ· Â›ÁÔÓÙ· È·ÙÚ›· ÙˆÓ ¡ÔÛÔÎÔÌ›ˆÓ Î·È ‰ÂÓ ¤¯Ô˘Ó Â·Ú΋ ÚÔÁÂÓÓËÙÈ΋ Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ (3,5,6). °È· ÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ¤Á΢ڷ ÛÙ·ÙÈÛÙÈο ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙË Û˘¯ÓfiÙËÙ· Ù˘ Û˘ÁÁÂÓÔ‡˜ Û‡ÊÈÏ˘. ∞fi ÙËÓ ∞’ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ·Ó·Ê¤ÚıËΠfiÙÈ ÛÙËÓ ÂÍ·ÂÙ›· 1985-1991 ‰ÂÓ ÓÔÛËχÙËΠηӤӷ ·È‰› ÌÂ Û˘ÁÁÂÓ‹ Û‡ÊÈÏË, ÂÓÒ Î·Ù¿ ÙËÓ ÙÚÈÂÙ›· 1991-1994 ÓÔÛËχÙËÎ·Ó Ù¤ÛÛÂÚ· ·È‰È¿, ÁÂÁÔÓfi˜ Ô˘ ηٿ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ˘Ô‰ËÏÒÓÂÈ Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜. ∞fi ÙÔÓ ∞Ó‰Ú¤Ô˘ Î·È ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ‰ËÌÔÛȇÙËΠfiÙÈ Î·Ù¿ ÙË ‰ˆ‰ÂηÂÙ›· 1976-1988 ÓÔÛËχÙËÎ·Ó Û ‰‡Ô ÂÚÈÊÂÚÂȷο ÓÔÛÔÎÔÌ›· Ù˘ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ 14 ‚Ú¤ÊË, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ›¯·Ó Û‡ÊÈÏË Î·Ù¿ ÙËÓ Î‡ËÛË. ∆· ‰‡Ô ·˘Ù¿ ¡ÔÛÔÎÔÌ›· ‰¤¯ÔÓÙ·È ·ÛıÂÓ›˜ ·fi ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ Ù˘ µfiÚÂÈ·˜ ∂ÏÏ¿‰·˜ ηÈ, fiˆ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÔÈ Û˘ÁÁÚ·Ê›˜, Ù· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ ‰ÂÓ ·ÓÙ·Ó·ÎÏÔ‡Ó Î¿ÔÈ· ÂӉ¯fiÌÂÓË ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘

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ÓfiÛÔ˘ ÁÈ· ÙË Û˘ÁÎÂÎÚÈ̤ÓË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô (2,7). ™ÙÔ ·ÚÂÏıfiÓ, Ë ‰È¿ÁÓˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ Û‡ÊÈÏ˘ ÛÙËÚÈ˙fiÙ·Ó ÛÙ· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È ÌfiÓÔ Ù· ÓÂÔÁÓ¿ Ì ÎÏÈÓÈο ÂÌÊ·Ó‹ ÓfiÛÔ ‹ Ì ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο Û˘ÁÁÂÓÔ‡˜ Û‡ÊÈÏ˘ ıˆÚÔ‡ÓÙ·Ó ÚÔۂ‚ÏË̤ӷ. ∆Ô 1988 ÙÔ ∫¤ÓÙÚÔ ∂ϤÁ¯Ô˘ ¡ÔÛËÌ¿ÙˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ∞ÌÂÚÈ΋˜ (CDC) fiÚÈÛ ÎÚÈÙ‹ÚÈ· ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ Û˘ÁÁÂÓÔ‡˜ Û‡ÊÈÏ˘. ™‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ·˘Ù¿, ıˆÚÔ‡ÓÙ·È Èı·Ó¿ ÚÔۂ‚ÏË̤ӷ Î·È Ú¤ÂÈ Ó· ıÂÚ·‡ÔÓÙ·È Ù· ÓÂÔÁÓ¿ Ô˘ Â›Ó·È Û˘Ìو̷ÙÈο, ηıÒ˜ Î·È ÂΛӷ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ·Û˘Ìو̷ÙÈο (·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ Ù›ÙÏÔ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘˜) ·fi ÌËÙ¤Ú˜ ÔÚÔıÂÙÈΤ˜ ÁÈ· Û‡ÊÈÏË, ÌË ıÂÚ·Â˘Ì¤Ó˜ ‹ ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤Ó˜. ∞ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓË ıˆÚÂ›Ù·È Ë ÌËÙ¤Ú· fiÙ·Ó ÙÔ Â›‰Ô˜ Ù˘ ıÂÚ·›·˜ Â›Ó·È ¿ÁÓˆÛÙÔ, ÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi Ô˘ Ù˘ ¯ÔÚËÁ‹ıËÎÂ Â›Ó·È ‰È·ÊÔÚÂÙÈÎfi ·fi ÙËÓ ÂÓÈÎÈÏ›ÓË, Ë ·ÁˆÁ‹ Ì ÂÓÈÎÈÏ›ÓË ¤ÁÈÓ ̤۷ ÛÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ÚÈÓ ·fi ÙÔÓ ÙÔÎÂÙfi, ‰ÂÓ ˘‹ÚÍ ÔÚÔÏÔÁÈ΋ ·ÓÙ·fiÎÚÈÛË ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ıÂÚ·›·˜ ‹ ‰ÂÓ ÂÎÙÈÌ‹ıËÎÂ Ë ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›·, ·ÊÔ‡ Ô ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÓÂ·Ú΋˜ (8-10). ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÂȉÈΤ˜ ÔÚÔÏÔÁÈΤ˜ ‰ÔÎÈ̷ۛ˜, ÙȘ ÌË ÙÚÂÔÓËÌÈΤ˜ (VDRL, RPR) Î·È ÙȘ ÙÚÂÔÓËÌÈΤ˜ (FTA-ABS, MHA-TP). ∂Ȃ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÛÂÈÚÔ¯·ÈÙÒÓ Ì ÌÈÎÚÔÛÎfiËÛË Û ÛÎÔÙÂÈÓfi ‰›Ô ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi, ÛÙÔÓ Ï·ÎÔ‡ÓÙ·, ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi, ÛÙȘ Û˘ÊÈÏȉÈΤ˜ ϿΘ, ÛÙȘ ÂÎÎÚ›ÛÂȘ ‚ÏÂÓÓÔÁfiÓˆÓ, ηıÒ˜ Î·È Ì ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ÙÚÂÔÓ‹Ì·ÙÔ˜, Ì ÙË ¯Ú‹ÛË Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR). √ ¤ÏÂÁ¯Ô˜ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ∫ÂÓÙÚÈÎÔ‡ ¡Â˘ÚÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ Á›ÓÂÙ·È Ì ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜, ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È Ù˘ VDRL ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (4,8). £ÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· Ù· ÓÂÔÁÓ¿ ·˘Ù¿ ·Ú·Ì¤ÓÂÈ Ë ¯ÔÚ‹ÁËÛË ¤Ó˘‰Ú˘ ÎÚ˘ÛÙ·ÏÏÈ΋˜ ÂÓÈÎÈÏ›Ó˘ G Û ‰fiÛË 100.000-150.000 IU/kg/24ˆÚÔ ÂÓ‰ÔÊϤ‚È·, ηٷÓÂÌË̤ÓË Û 2-3 ËÌÂÚ‹ÛȘ ‰fiÛÂȘ Â› 10 ¤ˆ˜ 14 Ë̤Ú˜. ∏ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ¤Î‚·ÛË (4,8). ªÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È ··Ú·›ÙËÙË Ë Â·Ó¿ÏË„Ë ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, ÁÈ· Ó· ‰È·ÈÛÙˆı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘. ∏ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ ÚÔÙ›ÓÂÈ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÂÁ·Ԣ ÛÙËÓ ·Ú¯‹ Ù˘ ·ËÛ˘ Î·È ÛÙÔÓ ÙÔÎÂÙfi, ÂÓÒ ÛÙȘ ¤ÁÎ˘Â˜ ˘„ËÏÔ‡

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ÎÈÓ‰‡ÓÔ˘ Î·È Î·Ù¿ ÙËÓ 28Ë Â‚‰ÔÌ¿‰·. ∫·Ó¤Ó· ÓÂÔÁÓfi ÌË ÂÏÂÁ̤Ó˘ ÌËÙ¤Ú·˜ ‰ÂÓ Ú¤ÂÈ Ó· ʇÁÂÈ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÚÈÓ ÂÎÙÈÌËı› ÔÚÔÏÔÁÈο Ë ÌËÙ¤Ú· ÙÔ˘ ÁÈ· Û‡ÊÈÏË (4,8,10). ∆· ÓÂÔÁÓ¿ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ì ÁÂÓÓ‹ıËÎ·Ó ·fi ÌËÙ¤Ú˜ Ô˘ ·Ó‹Î·Ó ÛÙȘ ηÙËÁÔڛ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ¢‡Ô ·È‰È¿ ·fi ¿Á·Ì˜ ÌËÙ¤Ú˜, ‰‡Ô ·È‰È¿ ·fi ·ÏÏÔ‰·Ô‡˜ ÁÔÓ›˜ Î·È Ù¤ÏÔ˜, ¤Ó· ·È‰› ·fi ·Ù¤Ú· Ó·˘ÙÈÎfi. ∏ ÓfiÛÔ˜ ‰È·ÈÛÙÒıËΠ۠‰‡Ô ÂÚÈÙÒÛÂȘ ÛÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ÛÙËÓ ·Ú¯‹ Ù˘ ·ËÛ˘, Û ̛· ÛÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ, ÂÓÒ ÛÙËÓ ÙÂÏÂ˘Ù·›· ‹Ù·Ó ÁÓˆÛÙ‹ ÚÈÓ ·fi ÙËÓ Î‡ËÛË. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ë ıÂÚ·›· ‰ÂÓ ‹Ù·Ó ÛˆÛÙ‹ Î·È Â·Ú΋˜ Î·È Ë ·Ú·ÎÔÏÔ‡ıËÛË ÂÏÏÈ‹˜. ∏ Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË Ê·›ÓÂÙ·È fiÙÈ ¤Ú¯ÂÙ·È Í·Ó¿ ÛÙËÓ ÂÈηÈÚfiÙËÙ· Î·È ·ÔÙÂÏ› Ì›· Û‡Á¯ÚÔÓË ·ÂÈÏ‹ ÁÈ· ÙË ¯ÒÚ· Ì·˜. ∏ ÌÂٷΛÓËÛË ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Î·È Ë ÂÏ¢ıÂÚ›· ÛÙ· ‹ıË Ù˘ ÛËÌÂÚÈÓ‹˜ ˙ˆ‹˜ ¤¯Ô˘Ó ÂӉ¯Ô̤ӈ˜ ‰È·‰Ú·Ì·Ù›ÛÂÈ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ. √ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÂÁ·Ԣ ‰ÂÓ Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È ‰Â‰Ô̤ÓÔ˜. ∏ ÂÈÌÔÓ‹ ·fi ÙÔÓ ÎÏÈÓÈÎfi È·ÙÚfi Î·È Ë ·Ó·˙‹ÙËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó›¯Ó¢ÛË, ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Î¿ı ÂÚ›ÙˆÛ˘ ÓÂÔÁÓÔ‡ Ô˘ ÁÂÓÓÈ¤Ù·È ·fi ÌËÙ¤Ú· Ì ÂÓÂÚÁ‹, ÌË ıÂÚ·Â˘Ì¤ÓË, ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓË, ‹ ·ÎfiÌ· Î·È ·‰È¿ÁÓˆÛÙË Û‡ÊÈÏË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Ingall D, Sanchez PJ, Musher DM. Syphilis. In: Remington JS, Klein JO, eds. Infectious diseases of the fetus and newborn infant. 4th ed. Philadelphia, PA: W.B. Saunders; 1995. p. 529-564.

2. ∞Ó‰ÚÈÒÙË ª, ∆ÛÔ˘Ì¿Î·˜ ∫, °È·ÓÓÔ‡ÏÈ·-∫·Ú·ÓÙ·Ó¿ ∞, ∫·ÙÂÚ¤ÏÔ˜ Ã. ¶ÚÒÈÌË Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË. ¢ÂÏÙ ∞’ ¶·È‰È·ÙÚ ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 1994;41:350-355.

3. Sison CG, Ostrea EM Jr, Reyes MP, Salary V. The resurgence of congenital syphilis: a cocaine-related problem. J Pediatr 1997;130:289-292.

4. American Academy of Pediatrics. Syphilis. In: Pickering LK, ed. 2000 Red Book: Report of the Committee of Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000. p. 547-559.

5. Coles FB, Hipp SS, Silberstein GS, Chen JH. Congenital syphilis surveillance in upstate New York, 1989-1992: implications for prevention and clinical management. J Infect Dis 1995;171:732-735.

6. Kilmarx PH, Zaidi AA, Thomas JC, Nakashima AK, St Louis ME, Flock ML et al. Sociodemographic factors and the variation in syphilis rates among US counties, 1984 through 1993: an ecological analysis. Am J Public Health 1997;87:1937-1943.

7. ∞Ó‰Ú¤Ô˘ ∞, ¶Ú·ÙÛ›‰Ô˘ ¶, ∫Ô˘ÓÙÔ˘Ú¤ÏÏË ∫, ÷ϷÙÛfi-

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ÁÏÔ˘ ª, ∫·¤Ù˘ ∂. ¶ÚÒÈÌË Û˘ÁÁÂÓ‹˜ Û‡ÊÈÏË: ŒÓ· Úfi‚ÏËÌ· Ô˘ ¤¯ÂÈ ·Ú·ÏËÊı›. ¶·È‰È·ÙÚÈ΋ 1990;53:162-168.

8. Darville T. Syphilis. Pediatr Rev 1999;20:160-164.

9. Centers for Disease Control. Guidelines for the prevention and control of congenital syphilis. MMWR 1988;37:S1-S13.

10. Finelly L, Crayne EM, Spitalny KC. Treatment of infants with reactive syphilis serology, New Jersey: 1992 to 1996.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-10-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 08-01-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, 713 05 ∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∂›‰· IL-8 Î·È Ô˘‰ÂÙÂÚÔÊÈÏÈ΋˜ ÂÏ·ÛÙ¿Û˘ ÛÙËÓ ·Ó·Ó¢ÛÙÈ΋ Ô‰fi ‚ÚÂÊÒÓ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi RSV1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ Î·Ù¿ fiÛÔÓ ·ÂÏ¢ıÂÚÒÓÂÙ·È Ë ÈÓÙÂÚÏ¢ΛÓË (IL)-8 ÛÙȘ ·ÓÒÙÂÚ˜ ·Ó·Ó¢ÛÙÈΤ˜ Ô‰Ô‡˜ ÙˆÓ ‚ÚÂÊÒÓ Î·Ù¿ ÙËÓ ÂΉ‹ÏˆÛË ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV) Î·È Î·Ù¿ fiÛÔÓ Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, Ô˘ ·Ó¢ڛÛÎÔÓÙ·È Û ÌÂÁ¿ÏÔ˘˜ ·ÚÈıÌÔ‡˜ ÛÙÔ ‚ÚÔÁ¯ÈÎfi ‰¤Ó‰ÚÔ ÙˆÓ ‚ÚÂÊÒÓ ·˘ÙÒÓ, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ÊÏÂÁÌÔÓ‹ ̤ۈ ·Ú·ÁˆÁ‹˜ ÌÂÛÔÏ·‚ËÙÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 27 ‚Ú¤ÊË Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ· ¯ÂÈÌÂÚÈÓ‹˜ ÂȉËÌ›·˜ Î·È 20 ‚Ú¤ÊË ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÌÂϤÙË ÂÌ‚ÔÏ›Ô˘ ÛÙËÓ ÎÔÈÓfiÙËÙ·. ¢Â›ÁÌ·Ù· ˘ÁÚÔ‡ ·fi ÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ ÂÏ‹ÊıËÛ·Ó Ì ÚÈÓÈ΋ ¤ÎÏ˘ÛË. ∆· ·ÙÙ·Ú· ·ÔÌ·ÎÚ‡ÓıËÎ·Ó ÌÂ Ê˘ÁÔΤÓÙÚËÛË ·fi ÙÔ ¤ÎÏ˘Ì· Î·È ÙÔ ˘ÂÚΛÌÂÓÔ ˘ÁÚfi Ê˘Ï¿¯ıËΠÛÙÔ˘˜ -70oC. ∞ÎÔÏÔ‡ıËÛ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÁÈ· ÙËÓ ·ÚÔ˘Û›· IL-8 Î·È ÔÏÈ΋˜ ·ÓıÚÒÈÓ˘ Ô˘‰ÂÙÂÚÔÊÈÏÈ΋˜ ÂÏ·ÛÙ¿Û˘ (human neutrophil elastase, HNE), ηıÒ˜ Î·È ÁÈ· ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ Ô˘‰ÂÙÂÚÔÊÈÏÈ΋˜ ÂÏ·ÛÙ¿Û˘. ∞ÔÙÂϤÛÌ·Ù·: ™Ù· ·È‰È¿ Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ·Ó¢ڤıËÛ·Ó ˘„ËÏ¿ Â›‰· IL-8 (‰È¿ÌÂÛÔ˜ (‡ÚÔ˜) 1,53 (0-153), ¤Ó·ÓÙÈ 0 (0-5,6) ng.mL–1), HNE (136 (32-694), ¤Ó·ÓÙÈ 14 (0-516) ng.mL–1) Î·È ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÂÏ·ÛÙ¿Û˘ (4 (1-220), ¤Ó·ÓÙÈ 1 (0-339) mU.mL–1).

™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ, Â› ÚÔÛ‚ÔÏ‹˜ Ì ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, ·ÂÏ¢ıÂÚÒÓÂÙ·È ÈÓÙÂÚÏ¢ΛÓË-8 ÛÙȘ ·ÓÒÙÂÚ˜ ·Ó·Ó¢ÛÙÈΤ˜ Ô‰Ô‡˜ Î·È fiÙÈ Ù· ÚÔ˚fiÓÙ· ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î˘ÙÙ¿ÚˆÓ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi ÛÙ· ‚Ú¤ÊË Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ¤Ú¯ÔÓÙ·È Û ·ÓÙ›ıÂÛË Ì ÂΛӷ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ Î·Ù’ ÂÍÔ¯‹Ó ˈÛÈÓÔÊÈÏÈ΋ ·¿ÓÙËÛË Ô˘ ÚÔηÏÂ›Ù·È Û ·ÙÔÈ΋ ÓfiÛÔ ÙÔ˘ ·ÓÒÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡.

1Abu-Harb

M, Bell F, Finn A, Rao WH, Nixon L, Shale D, Everard ML IL-8 and neutrophil elastase levels in the respiratory tract of infants with RSV bronchiolitis Eur Respir J 1999;14:139-143 ªÈ¯¿Ï˘ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ¶·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˜ ∂ÈÌÂÏËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ

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CASE REPORT

¡fiÛÔ˜ Kawasaki Ì ·Û˘Ó‹ıË ÚˆÙÔ·ı‹ Ïԛ̈ÍË ·fi ÙÔÓ Èfi Epstein-Barr °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, ¢. ∫·Ú·Î·˚‰fi˜, ¶. ∑ÒÛË, £. µÏ¿¯Ô˘, §. ∫·Ó¿Ú˘, Ã. ∫·Ú‹˜

Kawasaki disease assosiated with primary Epstein-Barr virus infection G. Triantafyllidis, D. Karakaidos, P. Zosi, T. Vlachou, L. Kanaris, C. Karis

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 11 ¯ÚfiÓˆÓ, ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÓfiÛÔ˘ Kawasaki ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÚˆÙÔ·ı‹ ÂÓÂÚÁfi Ïԛ̈ÍË ·fi ÙÔÓ Èfi Epstein-Barr. ∏ ‰È¿ÁÓˆÛË Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ ÛÙËÚ›¯ıËΠÛÙËÓ ·ÚÔ˘Û›· ıÂÙÈÎÒÓ IgM ·ÓÙÈη„ȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÛÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ ÛÙÔ˘˜ µ Î·È T ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡˜ ˘ÔÏËı˘ÛÌÔ‡˜. °›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Î·È ·Ó·˙ËÙÂ›Ù·È Ë Èı·Ó‹ Û¯¤ÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÓÔÛËÌ¿ÙˆÓ.

Abstract: A case of an eleven year old boy, who presented with Kawasaki disease in association with an active primary Epstein-Barr viral infection is described. The diagnosis of infectious mononucleosis was based on the presence of positive IgM VCA antibody titers along with subtle lymphocyte subset abnormalities. The relevant literature is reviewed and the possible link between the two diseases is sought.

§¤ÍÂȘ ÎÏÂȉȿ: Èfi˜ ∂pstein-Barr, ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË, ÓfiÛÔ˜ Kawasaki.

∫eywords: Epstein-Barr virus, infectious mononucleosis, Kawasaki disease.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂ÓÙÂο¯ÚÔÓÔ ·ÁfiÚÈ ÚÔÛÎÔÌ›ÛıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÏfiÁˆ ˘ÚÂÙÔ‡ (ıÂÚÌÔÎÚ·Û›· 39,5oC), Ô ÔÔ›Ô˜ ÂÌÊ·Ó›ÛÙËΠ¤ÓÙ ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ÚÈÓ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Î·È ‰ÂÓ ˘Ô¯ˆÚÔ‡Û Ì ÙË Ï‹„Ë ·ÓÙÈ˘ÚÂÙÈÎÒÓ. ¢‡Ô ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, Ù· ˘ÚÂÙÈο ·̷ٷ ÂÓÙ¿ıËηÓ, ÂÓÒ ÛÙ· Û˘ÌÙÒÌ·Ù· ÚÔÛÙ¤ıËÎ·Ó ¤ÌÂÙÔÈ (4-5 ËÌÂÚËÛ›ˆ˜, ÌË ¯ÔÏÒ‰ÂȘ), ηıÒ˜ Î·È ˘‰·Ú›˜ ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ (3-4 ËÌÂÚËÛ›ˆ˜) Ì ÚfiÛÌÈÍË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ‚ϤÓÓ˘. ™ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘, ·Ó·ÊÂÚfiÙ·Ó ÚÔ 20Ë̤ÚÔ˘ ÂÌ‡ÚÂÙË Ïԛ̈ÍË ‰È¿ÚÎÂÈ·˜ 6 ËÌÂÚÒÓ, fiÔ˘ Û Â͈ÙÂÚÈÎfi ¤ÏÂÁ¯Ô ‰È·ÁÓÒÛıËΠÔÍ›· ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË ·fi ÙÔÓ Èfi Epstein-Barr (ıÂÙÈο IgM ·ÓÙÈη„ȉÈο ·ÓÙÈÛÒÌ·Ù·, ·ÚÓËÙÈο IgG). ∆Ô ·È‰› ·Ú¤ÌÂÈÓ ·‡ÚÂÙÔ ÁÈ· 10 Ë̤Ú˜ Î·È 5 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Â·ÓÂÌÊ¿ÓÈÛ ˘ÚÂÙfi ¤ˆ˜ 39oC. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÙÔ˘

ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÂÌÊ¿ÓÈ˙ ηٷ‚ÔÏ‹, ‰È·ÙËÚÒÓÙ·˜ ·Ú¿ÏÏËÏ· ¿ÚÙÈÔ Â›Â‰Ô Û˘Ó›‰ËÛ˘ Î·È ÂÈÎÔÈÓˆÓ›·˜ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∏ ıÂÚÌÔÎÚ·Û›· ÂÈÛfi‰Ô˘ ‹Ù·Ó 39,7oC, ÂÓÒ Ù· ˙ˆÙÈο ÙÔ˘ ÛËÌ›· ›¯·Ó ˆ˜ ÂÍ‹˜: ·Ó·ÓÔ¤˜: 25/min, ÛʇÍÂȘ: 123/min Î·È ∞¶: 126/73 mmHg. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÂÓÙÔÓfiÙ·ÙË ÂÚ˘ıÚfiÙËÙ· ·ÚÈÛıÌ›ˆÓ, ÁÏÒÛÛ·˜ Î·È Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·, ÂÓÒ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÚfiÛıÈ· ÙÚ·¯ËÏÈ΋ ¯ÒÚ· „ËÏ·Ê‹ıËΠ·ÓÒ‰˘ÓË Î·È Â˘Î›ÓËÙË ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË, ‰È·ÛÙ¿ÛÂˆÓ 3x4 ÂÎ. √ ÛÏ‹Ó·˜ „ËÏ·Ê‹ıËΠ2 ÂÎ. οو ·fi ÙÔ ·ÚÈÛÙÂÚfi Ï¢ÚÈÎfi ÙfiÍÔ, ÂÓÒ ÙÔ ‹·Ú ‹Ù·Ó ·„ËÏ¿ÊËÙÔ. ∂ÎÙfi˜ ·fi Ì›· ‹È· Ù·¯˘Î·Ú‰›·, Ë ˘fiÏÔÈË Ê˘ÛÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ™ÙÔ ÂfiÌÂÓÔ ÂÈÎÔÛÈÙÂÙÚ¿ˆÚÔ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ·È‰› ·ÚÔ˘Û›·Û ¤ÓÙÔÓË Â˘ÂÚÂıÈÛÙfiÙËÙ· Î·È ·ÓËÛ˘¯›·, Â›Ù·ÛË Ù˘ ÚÔ¸¿Ú¯Ô˘Û·˜

¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜ - ¶ÂÈÚ·È¿ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ - ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋

¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜ - ¶ÂÈÚ·È¿ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ - ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋

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Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ·˜ Ì ¤ÓÙÔÓË ÍËÚfiÙËÙ· ÙˆÓ ¯ÂÈϤˆÓ, ÂÓÒ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÚÔÛÙ¤ıËΠÌÈÎÚÔÎËÏȉ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ·. ¶ÂÚ› ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ÂÈÎÔÛÈÙÂÙÚ·ÒÚÔ˘ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Î·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ‰Â‡ÙÂÚÔ˘, ÂΉËÏÒıËΠ·ÌÊÔÙÂÚfiÏ¢ÚË ÂÈÂÊ˘Î›Ùȉ·, Ë ÔÔ›· ‰Â Û˘Óԉ¢fiÙ·Ó ·fi ¤ÎÎÚÈÌ· ‹ ‡Ô, Ô›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ Î·È ·Ï·ÌÒÓ Î·È ‰È¿¯˘ÙÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜. ªÂ ÙËÓ ˘Ô„›· Ù˘ ÓfiÛÔ˘ Kawasaki, ¯ÔÚËÁ‹ıËÎ·Ó ·Ì¤Ûˆ˜ ˘ÂÚ¿ÓÔÛË Á-ÛÊ·ÈÚ›ÓË (2 g/kg) Î·È ·ÛÈÚ›ÓË Û ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰fiÛË (100 mg/kg). ŒÓ· 48ˆÚÔ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ Á-ÛÊ·ÈÚ›Ó˘, Â‹Ïı ۷ʤÛÙ·ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡, Ì ٷ˘Ùfi¯ÚÔÓË ˘Ô¯ÒÚËÛË ÙÔ˘ ˘ÚÂÙÔ‡, ÂÓÒ ·fi ÙËÓ 5Ë Ë̤ڷ ÓÔÛËÏ›·˜ ÙÔ˘ ·Ú·ÙËÚ‹ıËΠ·ÔϤÈÛË, ·Ú¯Èο ÂÚÈÛÙÔÌ·ÙÈο Î·È ÂÚÈÔÓ˘¯Èο ÛÙ· οو ¿ÎÚ· Î·È Î·ÙfiÈÓ ÛÙȘ ·Ï¿Ì˜. ªÂÙ¿ ÙÔ ‰Â‡ÙÂÚÔ 24ˆÚÔ ·fi ÙË ¯ÔÚ‹ÁËÛË Ù˘ Á-ÛÊ·ÈÚ›Ó˘, Ë ÂÈÂÊ˘Î›Ùȉ· Î·È Ë Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ· ¿Ú¯ÈÛ·Ó Ó· ˘Ô¯ˆÚÔ‡Ó, ÂÓÒ ÌÂÙ¿ ÙÔ ¤ÌÙÔ 24ˆÚÔ, ÙÔ ·È‰› ‹Ù·Ó ÙÂÏ›ˆ˜ ηϿ Ì ÙË ‚ÂÏÙ›ˆÛË Î·È ˘Ô¯ÒÚËÛË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜. ¢Ò‰Âη Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, Ù· ·ÈÌÔÂÙ¿ÏÈ· ¤ÊÙ·Û·Ó ÙȘ 870.000/ÌL (¶›Ó·Î·˜ 1). ∆· ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· ηډȿ˜, Ù· ÔÔ›· ¤ÁÈÓ·Ó ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ·ÁÁÂÈ›ÙȉԘ, ·ÏÏ¿ Î·È Î·Ù¿ ÙËÓ ¤ÍÔ‰Ô, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο (¶›Ó·Î·˜ 1). √È ÔÚÔÏÔÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ÂȂ‚·›ˆÛ·Ó ÂÓÂÚÁfi ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË (ıÂÙÈο IgM ·ÓÙÈη„ȉÈο ·ÓÙÈÛÒÌ·Ù· Î·È ·ÚÓËÙÈο ·ÓÙÈ˘ÚËÓÈο: anti-EBNA: <1/20), ÂÓÒ Ù· ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÏÂÙfiÛÂÈÚ· ·Ô‰fiıËÎ·Ó ÛÙËÓ ÔÏ˘ÎψÓÈ΋ ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›·, ÙËÓ ÔÔ›· ÚÔοÏÂÛÂ Ë ‰È¤ÁÂÚÛË ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·fi ÙÔÓ Èfi. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ˘ÔÏËı˘ÛÌÒÓ Î·È ÙˆÓ ÏÂÌ-

ÊÔ΢ÙÙ·ÚÈÎÒÓ ‰ÂÈÎÙÒÓ ·ÔÎ¿Ï˘„ ·‡ÍËÛË ÙˆÓ CD3+ T-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ·ÓÂÛÙÚ·Ì̤ÓÔ ÏfiÁÔ T‚ÔËıËÙÈÎÒÓ / T-ηٷÛÙ·ÏÙÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ CD20+ B-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘. ∞Ó·Ï˘ÙÈο, ÔÈ ÔÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ηıÒ˜ Î·È Ù· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔ˘˜ ›Ó·Î˜ 3 Î·È 2, ·ÓÙ›ÛÙÔȯ·. ªÂÙ¿ ÙËÓ Â·Ó¿ÏË„Ë ÙÔ˘ ηډȷÎÔ‡ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜, ¯ÔÚËÁ‹ıËΠ·ÛÈÚ›ÓË Û ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ΋ ‰fiÛË (5 mg/kg) Î·È Ô ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ™˘˙‹ÙËÛË ∏ ÓfiÛÔ˜ Kawasaki (KS), Â›Ó·È Ì›· ÂÌ‡ÚÂÙË ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ·ÁÁÂÈ›Ùȉ·, Ë ÔÔ›· ÂÎχÂÙ·È Ì ·ÓÔÛÔÏÔÁÈÎfi Ì˯·ÓÈÛÌfi ÎÈ ÂÈÏÂÎÙÈο ÚÔÛ‚¿ÏÏÂÈ ÙË ‚ÚÂÊÈ΋ Î·È ÚÒÈÌË ·È‰È΋ ËÏÈΛ·. ¶ÚˆÙÔÂÚÈÁÚ¿ÊËΠÛÙËÓ π·ˆÓ›· ÙÔ 1967, Ë ÔÔ›· ·ÎfiÌË Î·Ù¤¯ÂÈ ÙÔ ÚÔ‚¿‰ÈÛÌ· ÛÙÔÓ ÂÙ‹ÛÈÔ ·ÚÈıÌfi ÂÚÈÛÙ·ÙÈÎÒÓ Ù˘ ÓfiÛÔ˘. ∏ ˘ÔÛÙ‹ÚÈÍË Ù˘ ¿Ԅ˘ fiÙÈ Èı·Ófiٷٷ ÚfiÎÂÈÙ·È ÁÈ· ÏÔÈÌ҉˜ ÓfiÛËÌ· ÛÙËÚ›˙ÂÙ·È: ·) ÛÙËÓ ·ÈÊÓ›‰È· ÂÈÛ‚ÔÏ‹ Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (˘ÚÂÙfi˜, ÂÍ¿ÓıËÌ·, ÏÂÌÊ·‰ÂÓ›Ùȉ·), ‚) ÛÙËÓ ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÎÏÈÓÈ΋ ÙÔ˘ ÔÚ›·, Á) ÛÙËÓ Ù·ÎÙÈ΋ ÂÌÊ¿ÓÈÛË ÂȉËÌÈÒÓ ÛÙËÓ ÎÔÈÓfiÙËÙ· Î·È ‰) ÛÙË Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈ΋ ËÏÈÎȷ΋ ÙÔ˘ ηٷÓÔÌ‹, Ì ÎÔÚ˘Ê·›· Â›ÙˆÛË ÛÙȘ ËÏÈ˘ οو ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ (1). ∏ ÙÂÏÂ˘Ù·›· ·Ú·Ù‹ÚËÛË ÌÔÚ› Ó· Û˘Ó‰¤ÛÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Ì ÚˆÙÔ·ı›˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ËÏÈÎÈ·ÎÔ‡ Ê¿ÛÌ·ÙÔ˜. ∏ Û˘Û¯¤ÙÈÛË Ù˘ ÓfiÛÔ˘ Ì ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË ·fi ÙÔÓ Èfi Epstein-Barr, ¤¯ÂÈ Èı·ÓÔÏÔÁËı› Ì ÙËÓ Î·Ù·ÁÚ·Ê‹ Î·È ÂÚÈÁÚ·Ê‹ ÔÏÏÒÓ

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È ·Ú·ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Eπ™√¢√™ Ú·) ñ °ÂÓÈ΋ ·›Ì·ÙÔ˜: Hb: 12 g/dL, Ht: 38% §Â˘Î¿: 5500/mmÑ (¶: 67%, §: 21%, ª: 4%) ∞ª¶: 115.000/ÌL, ∆∫∂: 26 mm/h ñ µÈÔ¯ËÌÈÎfi˜¤ÏÂÁ¯Ô˜: CRP: 11 mg/dL, Na+: 136 mEq/L, K+: 4,6 mEq/L, o˘Ú›·: 24 mg/dL ∫Ú·ÙÈÓ›ÓË: 0,7 mg/dL AST: 52 U/L, ALT: 62 U/L ñ °ÂÓÈ΋ Ô‡ÚˆÓ: ∂µ: 1025, pH: 5, Û¿ÓÈ· ÂÚ˘ıÚ¿ Î·È ˘ÔÛÊ·›ÚÈ· ñ Î/· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜: Ê˘ÛÈÔÏÔÁÈ΋ ¯ÏˆÚ›‰· ñ Î/˜ ·›Ì·ÙÔ˜: ÛÙ›Ú˜

¢∂À∆∂ƒ∏ ª∂ƒ∞ U/S ηډȿ˜: º˘ÛÈÔÏÔÁÈÎfi

Ro £ÒÚ·ÎÔ˜: Î.Ê.

12Ë ∏ª∂ƒ∞

∏b: 10,4 g/dL, §Â˘Î¿: 8020/mmÑ (¶: 62%, §: 30%, M: 6%) ∞ª¶: 870.000/ÌL ALT: 47 U/L AST: 38 U/L

∂•√¢√™(18Ë Ë̤U/S ηډȿ˜: º˘ÛÈÔÏÔÁÈÎfi Hb: 11,29/dL Ht: 35,6% §: 8.270/mm3 (¶: 48% §: 42% M: 10%) ∞ª¶: 503.000/ÌL ∆∫∂: 20 mm/h

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¶·È‰È·ÙÚÈ΋ 2001;64:172-176

Paediatriki 2001;64:173-176

ÂÚÈÙÒÛˆÓ, ÔÈ Ôԛ˜ ÂȯÂÈÚÔ‡Ó Ó· Û˘Ó‰¤ÛÔ˘Ó ÙÔ ¤Ó· ÓfiÛËÌ· Ì ÙÔ ¿ÏÏÔ (1-6). ∏ ËÏÈÎȷ΋ ηٷÓÔÌ‹ Î·È ÙˆÓ ‰‡Ô Â›Ó·È ·ÚfiÌÔÈ· (3-4 ¤ÙË). ∏ ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË ˘ÚÂÙÔ‡, ÂÍ·Óı‹Ì·ÙÔ˜ Î·È ÏÂÌÊ·‰ÂÓ›Ùȉ·˜ Â›Ó·È ÛÙÔȯ›· Î·È ÙˆÓ ‰‡Ô, Ë ÂÍȉڈ̷ÙÈ΋ ·Ì˘Á‰·Ï›Ùȉ· (Â›¯ÚÈÛÌ·), fï˜, Û¿ÓÈ· ·Ú·ÙËÚÂ›Ù·È ÛÙË ÓfiÛÔ Kawasaki. ∏ ·ÔϤÈÛË ÙˆÓ ·Ï·ÌÒÓ Î·ıÒ˜ Î·È Ë ·Ó¢ڢÛÌ·ÙÈ΋ ‰È¿Ù·ÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ, ÔÈ Ôԛ˜ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ Ù˘ ·ÁÁÂÈ›Ùȉ·˜, ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙË ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË. ∏ Û˘Ó‹ı˘ ÛÏËÓÔÌÂÁ·Ï›· Ù˘ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘ Â›Ó·È Û¿ÓÈ· ÛÙË ÓfiÛÔ Kawasaki, ÂÓÒ Ë ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË Ù˘ ÙÂÏÂ˘Ù·›·˜, ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙËÓ ¿Ù˘Ë ÏÂÌÊÔ΢ÙÙ¿ÚˆÛË Ù˘ Ïԛ̈͢ ·fi Epstein-Barr (1). √ Kikuta Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘, ÛÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜ Ó· Û˘Û¯ÂÙ›ÛÔ˘Ó Ù· ‰‡Ô ÓÔÛ‹Ì·Ù·, ‚Ú‹Î·Ó fiÙÈ ÙÔ 40% (18 ·fi 45) ÙˆÓ ·ÛıÂÓÒÓ Ì Kawasaki ›¯·Ó ıÂÙÈ΋ ·ÓÙÈۈ̷ÙÈ΋ ·fiÎÚÈÛË ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡, Û ۯ¤ÛË Ì ÙÔ 72% (111 ·fi 153) ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ˆ˜ ÙÔ 73% ·˘ÙÒÓ ÙˆÓ ÔÚÔıÂÙÈÎÒÓ ÁÈ· ∂µ ·ÛıÂÓÒÓ Ì Kawasaki ¤ÊÂÚ·Ó ·ÓÙÈη„ȉÈο πgM ·ÓÙÈÛÒÌ·Ù·, Û ·ÓÙ›ıÂÛË Ì ÌfiÏȘ

ÙÔ 6% ÙˆÓ ÔÚÔıÂÙÈÎÒÓ Ì·ÚÙ‡ÚˆÓ. ∂ÈÚfiÛıÂÙ·, fiÏÔÈ ÔÈ 18 (100%) ÔÚÔıÂÙÈÎÔ› ·ÛıÂÓ›˜ ›¯·Ó ·ÚÓËÙÈÎfi Ù›ÙÏÔ ˘ÚËÓÈÎÒÓ (EBNA) ·ÓÙÈۈ̿وÓ, Û ·ÓÙ›ıÂÛË Ì ÌfiÓÔ ÙÔ 25% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÔÚÔıÂÙÈÎÒÓ Ì·ÚÙ‡ÚˆÓ. ∂ÓÙ˘ˆÛȷ΋ ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË ˆ˜ fiÏÔÈ ÔÈ ıÂÙÈÎÔ› ·ÓÙÈۈ̷ÙÈÎÔ› Ù›ÙÏÔÈ ÙˆÓ ·ÛıÂÓÒÓ Ì Kawasaki ·ÚÓËÙÈÎÔÔÈ‹ıËÎ·Ó ‰‡Ô ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÙÔ˘˜ ·Ó›¯Ó¢ÛË, οÙÈ Ô˘ ‰ÂÓ Â·ÏËı‡ÙËΠÁÈ· ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆¤ÏÔ˜, ·ÍÈfiÏÔÁË ·Ú·Ù‹ÚËÛË Û˘ÓÈÛÙ¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 11% ·fi ÙÔ˘˜ ·Ú¯Èο ÔÚÔ·ÚÓËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ıÂÙÈÎÔÔ›ËÛ·Ó ÙÔ˘˜ ·ÓÙÈۈ̷ÙÈÎÔ‡˜ ÙÔ˘˜ Ù›ÙÏÔ˘˜ ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁÁÂÈ›Ùȉ·˜ (5). ™˘ÌÂÚ·ÛÌ·ÙÈο ÏÔÈfiÓ, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ˆ˜ Ì›· ÌË Ê˘ÛÈÔÏÔÁÈ΋ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÓÂÚÁ‹˜ Epstein-Barr Ïԛ̈͢, ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ‚ÏÂÓÓÔÁÔÓÔ‰ÂÚÌ·ÙÈÎÔ‡ ÏÂÌÊ·‰ÂÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘. ∆·˘Ùfi¯ÚÔÓ·, Ê·›ÓÂÙ·È fiÙÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Kawasaki ηı˘ÛÙÂÚ› ·Û˘Ó‹ıÈÛÙ· ‹ Î·È ·ÎfiÌË Î·Ù·ÛÙ¤ÏÏÂÙ·È Ë ·ÓÙÈۈ̷ÙÈ΋ ·fiÎÚÈÛË Î·Ù¿ ÙÔ˘ ∂pstein-Barr (3-5). ∆ËÓ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ·Ú·Ù‹ÚËÛË ÚÔÛÂÁÁ›˙ÂÈ Î·È Ë ÌÂϤÙË ÙÔ˘ πwanaga Î·È ÙˆÓ Û˘ÓÂÚÁ·ÙÒÓ

¶›Ó·Î·˜ 2. ∫ÏÈÓÈο Û˘ÌÙÒÌ·Ù· ∫§π¡π∫∏ ™Àª¶∆øª∞∆√§√°π∞ 1

∏ª∂ƒ∂™ ª∂∆∞ ∆∏¡ ∂π™∞°ø°∏ Ã√ƒ∏°∏™∏ Á-™º∞πƒπ¡∏™ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

¶Àƒ∂∆√™ ∂•∞¡£∏ª∞ ∂¶π¶∂ºÀ∫π∆π¢∞ √À§√™∆√ª∞∆π∆π¢∞ ∞¶√§∂¶π™∏ ¶∞§∞ªø¡ ∆ƒ∞Ã∏§π∫∏ §∂ªº∞¢∂¡π∆π¢∞ ∫√π§π∞∫√ ∞§°√™

¶›Ó·Î·˜ 3. √ÚÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ - ¢Â›ÎÙ˜ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ √ƒ√§√°π∫√™ ∂§∂°Ã√™ ∞ÓÙÈÛÒÌ·Ù· ÁÈ· ∂BV: IgM VCA (+) IgG VCA: 1/320 Anti-EBNA: <1/20 Leptospira: IgM: (+) IgG: 256 IU/ml Mycoplasma pneumoniae: IgM: >50 IU/ml IgG: 20 IU/ml πgM Î·È IgG ·ÓÙÈÛÒÌ·Ù· ÁÈ· πÏ·Ú¿ Rickettsia conori ·ÚÓËÙÈο Coxsiella burnetti Borrelia burgdorferi Anti-ANA: ·ÚÓËÙÈο Anti-DNA: ·ÚÓËÙÈο

}

174

T-·ÙÙ·Ú· CD3+: 83% CD4+: 33% CD8+: 46% CD4/CD8: 0,7

§∂ªº√∫À∆∆∞ƒπ∫√π ¢∂π∫∆∂™ µ-·ÙÙ·Ú· ∞ÓÔÛÔÛÊ·ÈÚ›Ó˜ CD19+: 2% IgG: 2504 mg/dL CD20+: 2% IgA: 212 mg/dL IgM: 550 mg/dL C3: 79 mg/dL C4: 19 mg/dL

2001 MAPT- A¶PI§

17-10-01 15:35

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¶·È‰È·ÙÚÈ΋ 2001;64:172-176

ÙÔ˘, fiÔ˘ Û ÂȉËÌ›· Kawasaki, ÌfiÓÔ ÙÔ 3% (2 ÛÙÔ˘˜ 69) ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ÔÚÔıÂÙÈÎÔ› ÁÈ· ÙÔÓ Èfi, Û ·ÓÙ›ıÂÛË Ì ÙÔ 84% (58 ÛÙÔ˘˜ 69) ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÌÂϤÙË ıˆڋıËΠÂÍ·ÈÚÂÙÈο ·›ı·ÓÔ (p<0,001) Ó· ÔÊ›ÏÂÙ·È ÛÂ Ù˘¯·›Ô ÁÂÁÔÓfi˜ ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·Ó˘·ÚÍ›·˜ ·ÓÙÈÈÈÎÒÓ ·ÓÙÈۈ̿وÓ, ÙË ÛÙÈÁÌ‹ Ì¿ÏÈÛÙ· Ô˘ fiÏÔÈ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ ·ÛıÂÓÒÓ ¤ÊÂÚ·Ó ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ Epstein-Barr (3). √ ÂÓ ÏfiÁˆ Èfi˜ Ê·›ÓÂÙ·È Ó· ÂÌϤÎÂÙ·È Â›Û˘ Î·È Ì ÙȘ ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ Kawasaki. ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ ·È‰È¿, ÛÙ· ÔÔ›· Ô Ù›ÙÏÔ˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡ ‰ÂÓ ·ÔÎ¿Ï˘Ù ·Ï·È¿ Ïԛ̈ÍË (‰ÂÓ ˘‹Ú¯·Ó ‰ËÏ·‰‹ anti-EBNA ·ÓÙÈÛÒÌ·Ù·), ›¯·Ó ÚԉȿıÂÛË Ó· Â·ÓÂÌÊ·Ó›ÛÔ˘Ó ÙËÓ ·ÁÁÂÈ›Ùȉ·, Û ۯ¤ÛË Ì ÂΛӷ Ù· ÔÔ›· ¤ÊÂÚ·Ó ÛÙÔÓ ÔÚfi ÙÔ˘˜ ·ÓÙÈÛÒÌ·Ù· ÂÓ‰ÂÈÎÙÈο ·Ï·È¿˜ Ïԛ̈͢ (7). ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ·Ú·ÙËÚËı›۷ ηٷÛÙÔÏ‹ Ù˘ ·ÓÙÈۈ̷ÙÈ΋˜ ·fiÎÚÈÛ˘ ηٿ ÙÔ˘ ÈÔ‡ ÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ ·fi Kawasaki, Ë ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ Ïԛ̈ÍË ·fi Epstein-Barr, Ë ÔÔ›· ÎÏÈÓÈο ÂΉËÏÒÓÂÙ·È Ì ˘ÚÂÙfi, ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÛÏËÓÔÌÂÁ·Ï›·, Ë·Ù›Ùȉ·, ‰È¿ÌÂÛË Ó¢ÌÔÓ›Ùȉ·, Ú·ÁÔÂȉ›Ùȉ· Î·È ÂÚÁ·ÛÙËÚȷο Ì ·Ó·ÈÌ›·, Ï¢ÎÔÂÓ›· Î·È ıÚÔÌ‚Ô΢ÙÙÔÂÓ›·, ÚÔηÏ› ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· Ì ¤ÓÙÔÓË ·ÓÔÛÔÏÔÁÈ΋ Î·È ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË Î·Ù¿ ÙÔ˘ ÈÔ‡. ∏ ÂÌÊ¿ÓÈÛË ·Ó¢ڢÛÌ¿ÙˆÓ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ, ·ÚfiÌÔÈ· Ì ·˘Ù‹ Ù˘ Kawasaki, Û ¤‰·ÊÔ˜ ¯ÚfiÓÈ·˜ ÂÓÂÚÁÔ‡ ÏÔÈÌÒ‰Ô˘˜ ÌÔÓÔ˘Ú‹ÓˆÛ˘, ÂÓÈÛ¯‡ÂÈ ÙËÓ ¿Ô„Ë fiÙÈ Ô Èfi˜ ‰˘ÓËÙÈο ÌÔÚ› Ó· ÂÓ¤¯ÂÙ·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘˜. ∂Ó‰ÂÈÎÙÈ΋ ÙˆÓ ·ÓˆÙ¤Úˆ Â›Ó·È Î·È Ë ·ÚÔ˘Û›· ÁÔÓȉÈÒÌ·Ùfi˜ ÙÔ˘ Û ÙÚ›· ‰Â›ÁÌ·Ù· ‚ÈÔ„›·˜ ηډȷÎÔ‡ ÈÛÙÔ‡, fiÔ˘ ·ÓȯÓ‡ıËΠ̠ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ Ù˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) (8). ∆¤ÏÔ˜, ·Ú¿‰ÔÍÔ ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ Ù˘ ÂÓÙfiÈÛ˘ ÙÔ˘ ÈÈÎÔ‡ ÁÔÓȉÈÒÌ·ÙÔ˜ Ì ˘‚ÚȉÈ΋ (southern blot) ̤ıÔ‰Ô, ÛÙ· CD4+ ∆-‚ÔËıËÙÈο ÏÂÌÊÔ·ÙÙ·Ú·, ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯ÚfiÓÈ· ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË, ÙË ÛÙÈÁÌ‹ Ô˘ Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ë gp350/220 ÁÏ˘ÎÔÚˆÙ½ÓË ÙÔ˘ ÈÈÎÔ‡ ÂÚÈ‚Ï‹Ì·ÙÔ˜ Û˘Ó‰¤ÂÙ·È ÂÈÏÂÎÙÈο Ì ÙÔÓ CR2 (CD21) ˘Ô‰Ô¯¤· ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (9,10). ∞ÚÎÂÙ¤˜ Ù˘¯¤˜ Ù˘ ÓfiÛÔ˘ Kawasaki, fï˜, ÚÔ‚ÏËÌ·Ù›˙Ô˘Ó ÁÈ· ÙÔ Î·Ù¿ fiÛÔ ÌÔÚ› ÙÂÏÈο Ô Epstein-Barr Ó· Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·ıÔÁ¤ÓÂÛ‹ ÙÔ˘. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, Ë ·ÓÔÛÔÏÔÁÈ΋ ΢ÙÙ·ÚÈ΋ ·fiÎÚÈÛË ÛÙËÓ ·ÁÁÂÈ›Ùȉ·, Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙÔ˘ CD3+ T-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡ ˘ÔÏËı˘ÛÌÔ‡ Î·È ÛÙËÓ Ù·˘Ùfi¯ÚÔÓË ·‡ÍËÛË ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ CD20+ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ‡. ∂ÈϤÔÓ, ˘¿Ú¯ÂÈ Î·È Ì›· ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ηÈ

Paediatriki 2001;64:173-176

Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ T-ηٷÛÙ·ÏÙÈÎÒÓ (CD8+) ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ·ÈÙ›· Ù˘ ÔÏ˘ÎψÓÈ΋˜ µ-ÏÂÌÊÔ΢ÙÙ·ÚÈ΋˜ ‰È¤ÁÂÚÛ˘ Î·È ·˘ÍË̤Ó˘ ·Ú·ÁˆÁ‹˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘, Êı¿ÓÔÓÙ·˜ ÛÙËÓ ÎÔڇʈۋ Ù˘ ÙË 2Ë3Ë Â‚‰ÔÌ¿‰· Ù˘ ÓfiÛÔ˘. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÛÙËÓ ÔÍ›· ÏÔÈÌÒ‰Ë ÌÔÓÔ˘Ú‹ÓˆÛË ÔÈ ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ÏËı˘ÛÌÔ› ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ CD3+ TÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÂÏ¿ÙÙˆÛË ·˘ÙÔ‡ ÙˆÓ CD20+ B-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∆· ηٷÛÙ·ÏÙÈο (CD8+) TÏÂÌÊÔ·ÙÙ·Ú· Â›Ó·È ·˘ÍË̤ӷ, Ô ÏfiÁÔ˜ ÙˆÓ T‚ÔËıËÙÈÎÒÓ ÚÔ˜ Ù· T-ηٷÛÙ·ÏÙÈο ·ÓÂÛÙÚ·Ì̤ÓÔ˜ Î·È Ë ¤ÎÊÚ·ÛË ÙˆÓ HLA-DR ·ÓÙÈÁfiÓˆÓ ÛÙ· T-·ÙÙ·Ú· ÂÓÈÛ¯˘Ì¤ÓË, Ê·ÈÓfiÌÂÓ· Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ T-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊËÎÂ, Ô ·ÛıÂÓ‹˜ Ì·˜ ›¯Â ·Ó·ÌÊÈÛ‚‹ÙËÙË Ïԛ̈ÍË Ì EpsteinBarr, Ë ÔÔ›· Ì·ÚÙ˘ÚÂ›Ù·È ·fi: (·) ÙË ıÂÙÈ΋ ·ÚÔ˘Û›· IgM ·ÓÙÈη„ȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ÙËÓ Ù·˘Ùfi¯ÚÔÓË ·Ô˘Û›· ·ÓÙÈ˘ÚËÓÈÎÒÓ (anti-EBNA: <1/20), (‚) ÙÔ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi CD3+ (83%) Î·È CD8+ (46%) T-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ ·ÓÙ›ÛÙÔȯ·, (Á) ÙÔÓ ·ÓÂÛÙÚ·Ì̤ÓÔ ÏfiÁÔ CD4+ /CD8+ (0,7) Î·È (‰) ÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ CD19+ Î·È CD20+ B-ÏÂÌÊÔ΢ÙÙ·ÚÈÎÒÓ ˘ÔÏËı˘ÛÌÒÓ (ÌfiÏȘ 2%). ∏ ·Ú¿ÏÏËÏË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Kawasaki, Ù¤ıËΠ‚¿ÛÂÈ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÎÚÈÙËÚ›ˆÓ (·Ú·ÙÂٷ̤ÓÔ˜ ˘ÚÂÙfi˜, ÎËÏȉ҉˜ ÂÍ¿ÓıËÌ·, ÙÚ·¯ËÏÈ΋ ÂÙÂÚfiÏ¢ÚË ÏÂÌÊ·‰ÂÓ›Ùȉ·, ·ÌÊÔÙÂÚfiÏ¢ÚË ÌË ˘Ò‰Ë˜ ÂÈÂÊ˘Î›Ùȉ·, Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ· Î·È ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ) (11). ∂ÓÙ˘ˆÛȷ΋ Î·È ›Ûˆ˜ ÂÓ‰ÂÈÎÙÈ΋ Ù˘ Èı·Ó‹˜ Û¯¤Û˘ ÙÔ˘ Epstein-Barr Ì ÙËÓ ·ÁÁÂÈ›Ùȉ· Â›Ó·È Î·È Ë ÂÌÊ¿ÓÈÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜, Ë ËÏÈΛ· ÙÔ˘ ÔÔ›Ô˘ ‰ÂÓ Â›Ó·È ·Ó·ÌÂÓfiÌÂÓË ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Û¯¤ÛË ÌÂٷ͇ Ù˘ Ïԛ̈͢ ·fi ÙÔÓ Epstein-Barr Î·È Ù˘ ÓfiÛÔ˘ Kawasaki Û˘ÓÔ„›˙ÂÙ·È ÛÙȘ ÂÍ‹˜ ÙÚÂȘ ÂΉԯ¤˜: ·) Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ ÌÔÚ› ·ÏÔ‡Ûٷٷ Ó· ÔÊ›ÏÂÙ·È ÛÂ Ù˘¯·›· Û‡ÌÙˆÛË, ηıÒ˜ Ë ‚ÚÂÊÈ΋ Î·È ÚÒÈÌË ·È‰È΋ ËÏÈΛ· ·ÔÙÂÏÔ‡Ó ÂÚÈfi‰Ô˘˜ ηٿ ÙȘ Ôԛ˜ Ë ÔÚÔÌÂÙ·ÙÚÔ‹ Â›Ó·È ÙfiÛÔ Û˘ÓËıÈṲ̂ÓË fiÛÔ Î·È ÁÂÓÈο ·Û˘Ìو̷ÙÈ΋, ‚) Ë ÓfiÛÔ˜ Kawasaki ÌÔÚ› Ó· ·ÓÙÈÚÔÛˆ‡ÂÈ Ì›· ·Ï˘Û›‰· ·ÓÔÛÔÏÔÁÈÎÒÓ ··ÓÙ‹ÛÂˆÓ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÔÈ Ôԛ˜ ÂӉ¯Ô̤ӈ˜ ÂÎχÔÓÙ·È ·fi ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÈÔÁÂÓ‹ Ïԛ̈ÍË ‹ Î·È ·fi Ïԛ̈ÍË Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È Á) ÎÔÈÓÔ› ÈÔ›, ÔÈ ÔÔ›ÔÈ ÌÔχÓÔ˘Ó ·ÛıÂÓ›˜ Ì Kawasaki, ÌÔÚ› Ó· ¤¯Ô˘Ó “ÚÔˆıËÙÈÎfi” ÚfiÏÔ ÛÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ·ÏËıÈÓÔ‡ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·.

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¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÛÙÂÚÂfiÙ˘Ë ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ Kawasaki ηıÈÛÙ¿ Ì¿ÏÏÔÓ ·›ı·ÓË ÙËÓ ÔÏÏ·Ï‹ ·ÈÙÈÔÏÔÁ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÂÎÙÂٷ̤Ó˜ ̤¯ÚÈ ÙÒÚ· ¤Ú¢Ó˜ ‰ÂÓ ¤¯Ô˘Ó ηٷʤÚÂÈ Ó· ÂÓÔ¯ÔÔÈ‹ÛÔ˘Ó Û˘ÁÎÂÎÚÈ̤ÓÔ ·›ÙÈÔ. √ EpsteinBarr Ê·›ÓÂÙ·È Ó· ‰È·‰Ú·Ì·Ù›˙ÂÈ Ô˘ÛÈ·ÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘, ·Ó Î·È ··ÈÙÂ›Ù·È ·ÎfiÌË ·ÚÎÂÙ‹ ¤Ú¢ӷ ¤ˆ˜ fiÙÔ˘ ÙÂÎÌËÚȈı› Ï‹Úˆ˜ οÙÈ Ù¤ÙÔÈÔ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Marchette NJ, Melish ME, Hicks R, Kihara S, Sam E, Ching D. Epstein-Barr virus and other herpesvirus infections in Kawasaki syndrome. J Infect Dis 1990;161:680-684.

2. Melekian B. Kawasaki-like infectious mononucleosis. Acta Paediatr Scand 1982;71:843-844.

3. Iwanaga M, Takada K, Osato T, Saeki Y, Noro S, Sakurada N. Kawasaki disease and Epstein-Barr virus. Lancet 1981;1:938-939.

4. Okano M, Hase N, Sakiyama Y, Matsumoto S. Long term observation in patients with Kawasaki syndrome and their relation to Epstein-Barr virus infection. Pediatr Infect Dis J 1990;9:139-141.

5. Kikuta H, Mizuno F, Osato T, Konno M, Ishikawa N, Noro S et al. Kawasaki disease and an unusual primary infection with Epstein-Barr virus. Pediatrics 1984;73:413-414.

6. Barbour AG, Krueger GG, Feorino PM, Smith CB. Kawasakilike disease in a young adult. Association with primary Epstein-Barr virus infection. JAMA 1979;241:397-398.

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7. Kikuta H, Matsumoto S, Yanase Y, Kawasaki T, Mizuno F, Osato T. Recurrence of Kawasaki disease and EpsteinBarr virus infection. J Infect Dis 1990;162:1215.

8. Kikuta H, Sakiyama Y, Matsumoto S, Hamada I, Yazaki M, Iwaki T et al. Detection of Epstein-Barr virus DNA in cardiac and aortic tissues from chronic active Epstein-Barr virus infection associated with Kawasaki disease like coronary artery aneurysms. J Pediatr 1993;123:90-92.

9. Kikuta H, Taguchi Y, Tomizawa K, Kojima K, Kawamura N, Ishizaka A et al. Epstein-Barr virus genome-positive Tlymphocytes in a boy with chronic active EBV infection associated with Kawasaki-like disease. Nature 1998;333:455-457.

10. Tanner J, Weis J, Fearon D, Whang Y, Kieff E. Epstein-Barr gp350/220 binding to the B-lymphocyte C3d receptor mediates absorption, capping and endocytosis. Cell 1987;50:203-213.

11. Burns JC, Mason WC, Glode MP, Shulman ST, Melish ME, Meissner C et al. Clinical and epidemiologic characteristics of petients referred for evaluation of possible Kawasaki disease. J Pediatr 1991;188:680-686.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-10-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 19-12-2000 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚ›ÛÙÔ˜ ∫·Ú‹˜ ¶·È‰›·ÙÚÔ˜ - ¢È¢ı˘ÓÙ‹˜ ∑·Î‡ÓıÔ˘ 2, ÷ϿӉÚÈ

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

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CASE REPORT

¶¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Û ·È‰› Ì ϷÓı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· ∑. ∏ÏÈÔ‰ÚÔÌ›ÙË1, º. æ‡¯Ô˘1, π. ¡›Î·˜2, •. ∫Ú›ÎÔ˜1, ¶. ¡ÈÎÔÏ·˝‰Ô˘1

Facial palsy caused by latent mastoiditis ∑. ∏ÏÈÔ‰ÚÔÌ›ÙË1, º. æ‡¯Ô˘1, π. ¡›Î·˜2, •. ∫Ú›ÎÔ˜1, ¶. ¡ÈÎÔÏ·˝‰Ô˘1

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ·ÁfiÚÈ ËÏÈΛ·˜ 19 ÌËÓÒÓ Ì ϷÓı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· Ô˘ ‰È·ÁÓÒÛÙËΠÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË ¿ÚÂÛ˘ ÚÔÛˆÈÎÔ‡. ¶ÚÔËÁ‹ıËÎ·Ó ÂÂÈÛfi‰È· ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜. ∏ ‰È¿ÁÓˆÛË Ù˘ Ï·Óı¿ÓÔ˘Û·˜ Ì·ÛÙÔÂȉ›Ùȉ·˜ ÂÙ¤ıË Ì ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ ÏÈıÔÂȉÒÓ. √ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Û˘ÓÙËÚËÙÈο Ì ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹. ∫·Ù¿ ÙËÓ Â·ÓÂͤٷÛË, ÌÂÙ¿ ·fi ‰‡Ô Ì‹Ó˜, ‰È·ÈÛÙÒıËΠÏ‹Ú˘ ·ÔηٿÛÙ·ÛË Ù˘ ¿ÚÂÛ˘.

Abstract: This is the case of a 19 month old boy with latent mastoiditis, who presented with facial palsy. The patient had recurrent episodes of acute otitis media. The diagnosis of latent mastoiditis was made by high-resolution C/T of the temporal bone. The patient was treated conservatively with antibiotics. On follow-up two months later his facial palsy had completely resolved.

§¤ÍÂȘ ÎÏÂȉȿ: Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ·, ¿ÚÂÛË ÚÔÛˆÈÎÔ‡, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·.

Key words: latent mastoiditis, facial palsy, C/T scan.

∂ÈÛ·ÁˆÁ‹ ∏ Ì·ÛÙÔÂȉ›Ùȉ· Â›Ó·È ÊÏÂÁÌÔÓ‹ Ù˘ Ô›ÛıÈ·˜ ·fiÊ˘Û˘ ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÔÛÙÔ‡. ∞ÎÔÏÔ˘ı› Ïԛ̈ÍË ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ (1). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ¿ÓÔ‰Ô ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, Ë ÔÔ›· ·Ô‰›‰ÂÙ·È ÛÙËÓ ·˘ÍË̤ÓË ¯Ú‹ÛË ÙˆÓ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ Î·È ÙËÓ ·˘Í·ÓfiÌÂÓË ·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο (2). ¢È·ÎÚ›ÓÂÙ·È Û ÔÍ›·, ¯ÚfiÓÈ· Î·È Ï·Óı¿ÓÔ˘Û·. ∏ ÔÍ›· Ì·ÛÙÔÂȉ›Ùȉ· ·Ú·ÙËÚÂ›Ù·È Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· (55-65%) Û ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ ÙÂÛÛ¿ÚˆÓ ¯ÚfiÓˆÓ. ∞ÎÔÏÔ˘ı› ÔÍ›· ̤ÛË ˆÙ›Ùȉ·, Ë ÔÔ›· ‰ÂÓ ÂϤÁ¯ıËΠ̠ÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹. ∞Ô‰›‰ÂÙ·È Û ·fiÊÚ·ÍË Ù˘ ÂÈÛfi‰Ô˘ ÙÔ˘ Ì·ÛÙÔÂȉÈÎÔ‡ ¿ÓÙÚÔ˘ ·fi ÎÔÎÎȈ̷ÙÒ‰Ë ÈÛÙfi, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·ÚÂÌÔ‰›˙ÂÙ·È Ô ·ÂÚÈÛÌfi˜ Î·È Ë ·ÚÔ¯¤Ù¢ÛË ÙˆÓ Ì·ÛÙÔÂȉÈÎÒÓ Î˘„ÂÏÒÓ Î·È Ó· ¢ÓÔÂ›Ù·È Ë ·Ó¿Ù˘ÍË

Ïԛ̈͢. ¶ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ Ì ˘ÚÂÙfi, ˆÙ·ÏÁ›· Î·È ÔÈÛıÔˆÙÈ·›· ‰ÈfiÁΈÛË (1,2). ™ÙË ¯ÚfiÓÈ· Ì·ÛÙÔÂȉ›Ùȉ· ˘¿Ú¯ÂÈ ¿ÓÙ· ÈÛÙÔÚÈÎfi ¯ÚfiÓÈ·˜ ̤Û˘ ˆÙ›Ùȉ·˜. ¶ÚÔ‚¿ÏÏÂÈ Ì ˆÙ·ÏÁ›· Î·È ·ÎÔ˘ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. À¿Ú¯Ô˘Ó ¿ÓÙ· ˆÙÔÛÎÔÈο Â˘Ú‹Ì·Ù·, fiˆ˜ ÚÔ‚ÔÏ‹ ‹ ıÔÏÂÚfiÙËÙ· ÙÔ˘ Ù˘Ì¿ÓÔ˘, ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ· Ù˘ Ù˘Ì·ÓÈ΋˜ ÌÂÌ‚Ú¿Ó˘, ˘ÁÚfi ÛÙÔ Ì¤ÛÔ Ô˘˜, ˆÙfiÚÚÔÈ· Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ¯ÔÏÔÛÙ¿و̷ (2). ™ÙË Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜. ∏ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ‰ÂÓ Â›Ó·È ıÔÚ˘‚҉˘, ÁÈ·Ù› Ë ÔÛÙ½Ùȉ· ÙÔ˘ Ì·ÛÙÔÂȉԇ˜ ÔÛÙÔ‡ ·Ó·Ù‡ÛÛÂÙ·È ‚Ú·‰¤ˆ˜ Î·È ‰ÂÓ ÚÔηÏÂ›Ù·È fiÓÔ˜ Î·È ‰ÈfiÁΈÛË. ∏ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ, .¯. ÂÓ‰ÔÎÚ¿ÓÈÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜, ÌËÓÈÁÁ›Ùȉ·˜ ‹ ¿ÚÂÛ˘ ÚÔÛˆÈÎÔ‡ (3).

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” 2 ∆Ì‹Ì· ∞ÍÔÓÈÎÔ‡ Î·È ª·ÁÓËÙÈÎÔ‡ ∆ÔÌÔÁÚ¿ÊÔ˘ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1 ∞’ Pediatric Clinic of University of Athens Children’s Hospital “St. Sophia” 2 Division of Axial and Magnetic Tomography Children’s Hospital “St. Sophia”, Athens

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¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 19 ÌËÓÒÓ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Ô˘ ÔÊÂÈÏfiÙ·Ó Û ϷÓı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 19 ÌËÓÒÓ ÚÔÛÎÔÌ›ÛÙËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜, ÁÈ·Ù› 5 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·ÚÔ˘Û›·Û ·ÈÊÓ›‰È· ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ·ÚÈÛÙÂÚ¿. √ ·ÛıÂÓ‹˜ Â›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ó¤ˆÓ Î·È ˘ÁÈÒÓ ÁÔÓ¤ˆÓ Ì ÂχıÂÚÔ ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi. °ÂÓÓ‹ıËΠÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Ê˘ÛÈÔÏÔÁÈ΋ ·ËÛË Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÚÔËÁËı›Û˘ (ηÈÛ·ÚÈ΋˜ ÙÔÌ‹˜) Î·È ‚¿ÚÔ˜, Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ ·Ó¿ÌÂÛ· ÛÙË 10Ë Î·È 25Ë ∂£. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ Î·È Ë ·Ó·Ù˘Íȷ΋ ÙÔ˘ ÂͤÏÈÍË ‹Ù·Ó ÛÂ Ê˘ÛÈÔÏÔÁÈο Ï·›ÛÈ·. ∂Ì‚ÔÏÈ¿ÛÙËΠηÓÔÓÈο ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ (DTP: 3¢, Sabin: 3¢, MMR: 1¢, Hib titer: 3¢). ™ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ ·ÚÔ˘Û›·Û ÁÈ· ÚÒÙË ÊÔÚ¿ ÔÍ›· ̤ÛË ˆÙ›Ùȉ·. ∞ÎÔÏÔ‡ıËÛ·Ó ¿ÏÏ· 3 ÂÂÈÛfi‰È· ˆÙ›Ùȉ·˜, ÙÔ ÙÂÏÂ˘Ù·›Ô 4 Ì‹Ó˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ¿ÏÏÔÙ Ì ÙÔ Û˘Ó‰˘·ÛÌfi ·ÌÔÍÈÎÈÏÏ›Ó˘ Î·È ÎÏ·‚Ô˘Ï·ÓÈÎÔ‡ ÔͤԘ Î·È ¿ÏÏÔÙ Ì ÛÂÊ·ÎÏfiÚË. ŒÓ· Ì‹Ó· ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ·È‰› ·ÚÔ˘Û›·Û Ïԛ̈ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠÌfiÓÔ Ì ·ÓÙÈ˘ÚÂÙÈο. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ô ·ÛıÂÓ‹˜ ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ·‡ÚÂÙÔ˜, ÌÂ Ù˘È΋ ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ·ÚÈÛÙÂÚ¿. ¶·ÚÔ˘Û›·˙ ·‰˘Ó·Ì›· Û‡ÁÎÏÂÈÛ˘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÔ‡, ÂÍ·Ê¿ÓÈÛË Ù˘ ÚÈÓÔ¯ÂÈÏÈ΋˜ ·‡Ï·Î·˜ ·ÚÈÛÙÂÚ¿ Î·È ¤ÏÍË Ù˘ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰ÂÍÈ¿, ÂÚÈÛÛfiÙÂÚÔ ÂÌÊ·Ó‹ fiÙ·Ó ¤ÎÏ·ÈÁ ‹ ÁÂÏÔ‡ÛÂ. ∞fi ÙËÓ ˘fiÏÔÈË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ÂͤٷÛË ‰ÂÓ ÚԤ΢„·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó 89/49 mmHg (25Ë-50Ë ∂£). ∏ ‚˘ıÔÛÎfiËÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∆ËÓ ÂÔ̤ÓË Ù˘ ÂÈÛ·ÁˆÁ‹˜, ÙÔ ·È‰› ·ÚÔ˘Û›·Û Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜, ¤Ó· ˘ÚÂÙÈÎfi ·̷ ˆ˜ 38,2oC, ·ÓËÛ˘¯›·, ¢ÂÚÂıÈÛÙfiÙËÙ· Î·È ¤Ó·Ó ¤ÌÂÙÔ. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: Hb 11 gr/dl, Ht 33%, ÏÂ˘Î¿ 13700/mm3, ¶: 22%, §: 68%, ªª: 10%, ·ÈÌÔÂÙ¿ÏÈ· 342000/mm3, TKE 18 mm (1Ë ÒÚ·), CRP 17 mg/dl, Ô˘Ú›· 28 mg/dl, ÎÚ·ÙÈÓ›ÓË 0,7 mg/dl, ÁÏ˘Îfi˙Ë 98 mg/dl, Ca 9 mg/dl, SGOT 41 U/L, SGPT 17 U/L, ∞º 185 U/L, ÁÂÓÈ΋ Ô‡ÚˆÓ Î·Ù¿ ʇÛË, Î/· ·›Ì·ÙÔ˜ ÛÙ›ڷ, ÁÂÓÈ΋ ∂¡À: ·ÙÙ·Ú· 0Îί, § <20mg/dl, ™ 60 mg/dl, Î/· ∂¡À ÛÙ›ڷ, ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ HSV1,2 ÛÙÔ ∂¡À: ·ÚÓËÙÈο, ·ÓÙÈÛÒÌ·Ù· ÔÚÔ‡ ¤Ó·ÓÙÈ HSV1,2, EBV, CMV, borrelia burgdorferi ·ÚÓËÙÈο, πgG 1135 mg/dl, IgA 120 mg/dl, IgM 175 mg/dl. ∏ ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔ-

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ÁÚ·Ê›· ÏÈıÔÂȉÒÓ Û ÂÁοÚÛÈÔ Â›Â‰Ô Ì ÏÂÙ¤˜ ÙÔ̤˜ ¿¯Ô˘˜ 1,5 ¯ÈÏ. Î·È Ù¯ÓÈ΋ ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜, ¤‰ÂÈÍ ·ÌÊÔÙÂÚfiÏ¢ÚË Î·Ù¿ÏË„Ë ÙˆÓ ‰ÔÌÒÓ ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ Ì ‚·Ú‡ÙÂÚË ÂÈÎfiÓ· ·ÚÈÛÙÂÚ¿. ™ÙÔ ·ÚÈÛÙÂÚfi ÏÈıÔÂȉ¤˜ ·Ú·ÙËÚ‹ıËΠÏ‹Ú˘ ·Ô˘Û›· ·¤ÚˆÛ˘, ÙfiÛÔ Ù˘ Ù˘Ì·ÓÈ΋˜ ÎÔÈÏfiÙËÙ·˜ fiÛÔ Î·È ÙˆÓ Ì·ÛÙÔÂȉÒÓ Î˘„ÂÏÒÓ, ÌÂ Û˘Ó˘¿Ú¯Ô˘Û· ηٷÛÙÚÔÊ‹ ÔÛÙ¤ÈÓˆÓ ‰È·ÊÚ·ÁÌ¿ÙˆÓ, ÂÈÎfiÓ· ÂÓÂÚÁÔ‡ Ì·ÛÙÔÂȉ›Ùȉ·˜. ªÂ ÙË ‰È¿ÁÓˆÛË Ù˘ Ì·ÛÙÔÂȉ›Ùȉ·˜, Ô ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÎÂÊÔÙ·Í›Ì˘ Î·È ÎÏÈÓ‰·Ì˘Î›Ó˘. ŒÓ· 24ˆÚÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ô ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛÂ, ÂÓÒ ·Ú¤ÌÂÈÓ ‹È· ¢ÂÚÂıÈÛÙfiÙËÙ· Î·È ·ÓËÛ˘¯›·. ∆Ș ÂfiÌÂÓ˜ Ë̤Ú˜ ÙÔ ·È‰› ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ÌÈÎÚ‹ ‚ÂÏÙ›ˆÛË Ù˘ ¿ÚÂÛ˘ ¿Ú¯ÈÛ ӷ ÛËÌÂÈÒÓÂÙ·È ÙÔ 7Ô 24ˆÚÔ ÓÔÛËÏ›·˜. ªÂÙ¿ ÙË Û˘ÌÏ‹ÚˆÛË 14 ËÌÂÚÒÓ ·ÚÂÓÙÂÚÈ΋˜ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜, ÂÍ‹Ïı ·fi ÙËÓ ÎÏÈÓÈ΋ Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË Ì ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ¿ÚÂÛ˘ Ô˘ ‹Ù·Ó ÂÌÊ·Ó‹˜ ϤÔÓ ÌfiÓÔ Î·Ù¿ ÙÔ ÎÏ¿Ì·. ∆·˘Ùfi¯ÚÔÓ·, Û˘ÛÙ‹ıËÎÂ Ë Û˘Ó¤¯ÈÛË Ù˘ ıÂÚ·›·˜ ÌÂ Û˘Ó‰˘·ÛÌfi ·ÌÔÍÈÎÈÏÏ›Ó˘ Î·È ÎÏ·‚Ô˘Ï·ÓÈÎÔ‡ ÔͤԘ ÁÈ· ¿ÏϘ 14 Ë̤Ú˜. ∫·Ù¿ ÙËÓ Â·ÓÂͤٷÛË, ‰‡Ô Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙËÓ ÎÏÈÓÈ΋, ‰È·ÈÛÙÒıËΠÏ‹Ú˘ ·ÔηٿÛÙ·ÛË Ù˘ ¿ÚÂÛ˘. ™˘˙‹ÙËÛË ∏ ȉÈÔ·ı‹˜ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÛÙ· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 2 ÂÙÒÓ. ™˘¯ÓfiÙÂÚË ˘ÔΛÌÂÓË ·ÈÙ›· Â›Ó·È Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ Î·È Ë Ïԛ̈ÍË ÈÔÁÂÓ‹˜ ‹ ÌÈÎÚԂȷ΋ Ì ÙË ÌÔÚÊ‹ ˆÙ›Ùȉ·˜ ‹ Ì·ÛÙÔÂȉ›Ùȉ·˜. ™Â ‰È¿ÊÔÚ˜ ÌÂϤÙ˜, ÙÔ 9-24% ÙˆÓ ·Ú¤ÛÂˆÓ ÚÔÛˆÈÎÔ‡ Û ·È‰È¿ ·Ô‰fiıËΠ۠ÔÍ›· ̤ÛË ˆÙ›Ùȉ· (4). √ ·ÛıÂÓ‹˜ Ì·˜, ËÏÈΛ·˜ 19 ÌËÓÒÓ, ·ÚÔ˘Û›·Û ÂÚÈÊÂÚÈ΋ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÔÊÂÈÏfiÌÂÓË Û ϷÓı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ·. ∏ ‰È¿ÁÓˆÛË Ù˘ Ì·ÛÙÔÂȉ›Ùȉ·˜ ı· ÌÔÚÔ‡Û ӷ ‰È·Ê‡ÁÂÈ ÏfiÁˆ Ù˘ ·‚Ï˯ڋ˜ ÎÏÈÓÈ΋˜ ÚÔ‚ÔÏ‹˜, ·Ó ‰ÂÓ Í¤ÓÈ˙Â Ë ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜. ∏ Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· ·ÊÔÚ¿ Û˘Ó‹ıˆ˜ ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ·, ÓÂÔÁÓ¿, ·ÛıÂÓ›˜ Ì ΢ÛÙÈ΋ ›ÓˆÛË Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÌÔÚ› fï˜ Ó· ·Ú·ÙËÚËı› Î·È Û ¿ÙÔÌ· ¯ˆÚ›˜ ˘ÔΛÌÂÓÔ ÓfiÛËÌ· 15 Ë̤Ú˜ - 3 Ì‹Ó˜ ÌÂÙ¿ ·fi ·ÓÂ·ÚÎÒ˜ ıÂÚ·Â˘Ì¤Ó· ÂÂÈÛfi‰È· ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ (6). √ ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ Â›¯Â ·ÓÔÛÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹ ‹ ¿ÏÏÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ Î·È ·ÚÔ˘Û›·˙ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ˆÙ›Ùȉ·˜. ™ÙË Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ·, Ù· Â˘Ú‹Ì·Ù· Ù˘ ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ‚ÂÏÙȈı› ÌÂ

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ÙËÓ ÚÔËÁËı›۷ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Î·È Ë ·Ï‹ ˆÙÔÛÎfiËÛË Â›Ó·È Û˘¯Ó¿ ·ÚÓËÙÈ΋. ™ÙË ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ηÙ¢ı‡ÓÔ˘Ó Ë ˆÙÔÛÎfiËÛË Ì ÂÌʇÛËÛË ·¤Ú·, Ô˘ ‰Â›¯ÓÂÈ ÚÔ‚ÔÏ‹ Î·È ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ Ù˘Ì¿ÓÔ˘ Î·È ÙÔ ·ÎÔ˘fiÁÚ·ÌÌ·, Ô˘ ‰Â›¯ÓÂÈ ‹È· ‹ ̤ÙÚÈ· ·ÒÏÂÈ· ·ÎÔ‹˜ Ù‡Ô˘ ·ÁˆÁÈÌfiÙËÙ·˜ (‰È·ÊÔÚ¿ ÛÙËÓ ·ÁˆÁ‹ ÙÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ ̤ۈ ÙÔ˘ ·¤Ú· Î·È ÙÔ˘ ÔÛÙÔ‡). ™ÙÔÓ ·ÛıÂÓ‹ Ì·˜ ‰ÂÓ ¤ÁÈÓ ·ÎÔ˘fiÁÚ·ÌÌ· ÏfiÁˆ Ù˘ ÌÈÎÚ‹˜ ÙÔ˘ ËÏÈΛ·˜. ∆Ô ·ÎÔ˘fiÁÚ·ÌÌ· Á›ÓÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ‹ 5 ¯ÚfiÓˆÓ (3,5). ∏ ‰È¿ÁÓˆÛË Ù˘ Ï·Óı¿ÓÔ˘Û·˜ Ì·ÛÙÔÂȉ›Ùȉ·˜ Á›ÓÂÙ·È Ì ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÏÈıÔÂȉÒÓ ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. ™ËÌ›· Ì·ÛÙÔÂȉ›Ùȉ·˜ Â›Ó·È Ë ıÔÏÂÚfiÙËÙ· ÙˆÓ Ì·ÛÙÔÂȉÒÓ Î˘„ÂÏÒÓ Î·È Ë ÌÂȈ̤ÓË ÓÂ˘Ì¿ÙˆÛ‹ ÙÔ˘˜, Ë ·Û·ÊÔÔ›ËÛË ÙÔ˘ ÂÚÈÁÚ¿ÌÌ·ÙÔ˜ ÙÔ˘ Ì·ÛÙÔÂȉԇ˜ ÔÛÙÔ‡, Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÔÛÙÈÎÒÓ ‰ÔΛ‰ˆÓ Î·È Ù˘ ΢„ÂÏȉÈ΋˜ ‰ÔÌ‹˜ Ù˘ Ì·ÛÙÔÂȉԇ˜ ·fiÊ˘Û˘. ∏ ı¤ÛË Ù˘ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Â›Ó·È ÛËÌ·ÓÙÈ΋ Î·È ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ̤ÛÔ˘ ˆÙfi˜ (ÁÈ· ¯ÔÏÔÛÙ¿و̷) Î·È ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ Ì·ÛÙÔÂȉ›Ùȉ·˜ fiˆ˜ Ï·‚˘ÚÈÓı›Ùȉ·˜, ÂÓ‰ÔÎÚ¿ÓÈÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜, ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ ÙÔ˘ ÎÚÔÙ·ÊÈÎÔ‡ ÔÛÙÔ‡ (3,7). ¶·Ï·ÈfiÙÂÚ·, Ë ıÂÚ·›· Ù˘ Ì·ÛÙÔÂȉ›Ùȉ·˜ ‹Ù·Ó ۯ‰fiÓ ¿ÓÙ· ¯ÂÈÚÔ˘ÚÁÈ΋. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÛÙËÓ ÔÍ›· Ì·ÛÙÔÂȉ›Ùȉ· ¯ˆÚ›˜ ÂÈÏÔΤ˜ ¯ÔÚËÁÂ›Ù·È ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ Î·È Ì˘ÚÈÁÁÔÙÔÌ‹ Á›ÓÂÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ, ‰ËÏ·‰‹ Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ÛÙÔ Ì¤ÛÔ Ô˘˜ Î·È ÚÔ‚ÔÏ‹ ‹ ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ Ù˘Ì¿ÓÔ˘. ∂¿Ó Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ Â› 48-72 ÒÚ˜ ‰ÂÓ ÂÈʤÚÂÈ ‚ÂÏÙ›ˆÛË (˘Ô¯ÒÚËÛË ÙÔ˘ ˘ÚÂÙÔ‡, Ù˘ ˆÙ·ÏÁ›·˜ Î·È Ù˘ ÔÈÛıÔˆÙÈ·›·˜ ‰ÈfiÁΈÛ˘), ÂȯÂÈÚÂ›Ù·È Ì·ÛÙÔÂȉÂÎÙÔÌ‹ (8,9). ∏ ¯ÚfiÓÈ· Ì·ÛÙÔÂȉ›Ùȉ· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ¯ÂÈÚÔ˘ÚÁÈο fiÙ·Ó ˘¿Ú¯ÂÈ ¯ÔÏÔÛÙ¿و̷ ‹ Û ·ÔÙ˘¯›· Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ·ÁˆÁ‹˜ (1). ∂Âȉ‹ Ë Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· ‰È·ÁÈÁÓÒÛÎÂÙ·È Û˘Ó‹ıˆ˜ ·fi ÙȘ ÂÈÏÔΤ˜ Ù˘, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ıÂÚ·›· Ù˘ Ì·ÛÙÔÂȉ›Ùȉ·˜ Î·È Ù˘ ÂÈÏÔ΋˜. ŸÙ·Ó Ë Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· ÂÈϤÎÂÙ·È Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ¯ÔÚËÁÂ›Ù·È ·Ú¯Èο ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Î·È ÂÊ’ fiÛÔÓ ‰ÂÓ ·Ú·ÙËÚËı› ‚ÂÏÙ›ˆÛË Ù˘ ¿ÚÂÛ˘, Á›ÓÂÙ·È Ì·ÛÙÔÂȉÂÎÙÔÌ‹ (3,10). ™‡Ìʈӷ Ì ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜, Ù· ÌÈÎÚfi‚È· Ô˘ ·ÔÌÔÓÒÓÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙËÓ ÔÍ›· Ì·ÛÙÔÂȉ›Ùȉ· Â›Ó·È Ó¢ÌÔÓÈfiÎÔÎÎÔ˜, ÛÙÚÂÙfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ ∞, ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ Î·È ÌÔڷͤÏÏ·. ™ÙË Ï·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· ·ÔÌÔÓÒÓÔÓÙ·È, Â›Û˘, ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È· (1,2,3). ªÂ ‚¿ÛË ÙËÓ ·Ú·¿Óˆ ÁÓÒÛË Î·È Ì ¿ÁÓˆÛÙÔ ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·, ¯ÔÚËÁ‹Û·Ì ÛÙÔÓ ·ÛıÂÓ‹ Ì·˜ ÎÏÈÓ‰·Ì˘Î›ÓË Î·È ÎÂÊÔÙ·Í›ÌË Ì ηÏfi

Paediatriki 2001;64:177-180

ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. ∏ ÂÎÙ›ÌËÛË Ù˘ ÔÚ›·˜ Ù˘ ¿ÚÂÛ˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ηÏfi Â›Ó·È Ó· Á›ÓÂÙ·È Ì ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ÁÈ·Ù› Ë ÎÏÈÓÈ΋ ‰ÂÓ ·ÔÙÂÏ› ηÏfi ÎÚÈÙ‹ÚÈÔ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂÚ·›·˜ (11,12). √ ̤ÛÔ˜ ¯ÚfiÓÔ˜ ·ÔηٿÛÙ·Û˘ Â›Ó·È Ì·ÎÚfi˜, ÂÚ›Ô˘ 7 ˆ˜ 8 ‚‰ÔÌ¿‰Â˜ (7). √ ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·Û ٷ¯‡Ù·ÙË ‚ÂÏÙ›ˆÛË Ù˘ ¿ÚÂÛ˘ (̤۷ Û ̛· ‚‰ÔÌ¿‰· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜) Î·È ‰ÂÓ ¯ÚÂÈ¿ÛÙËΠÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÛÙ· ·È‰È¿ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙÔ ÈÛÙÔÚÈÎfi Î·È Ù· Â˘Ú‹Ì·Ù· Ù˘ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘. ™Ù· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ, Ë È‰ÈÔ·ı‹˜ ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Â›Ó·È Ôχ Û¿ÓÈ· Î·È Ë ÎÏÈÓÈ΋ ÂͤٷÛË Û˘¯Ó¿ ·Ó·ÍÈfiÈÛÙË. ¶Ú¤ÂÈ, Û˘ÓÂÒ˜, Ó· ·Ó·˙ËÙÂ›Ù·È Û˘ÛÙËÌ·ÙÈο ˘ÔΛÌÂÓË ‚Ï¿‚Ë. ™Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, ÈÛÙÔÚÈÎfi ÙÚ·˘Ì·ÙÈÛÌÔ‡, Â·ÓÂÈÏËÌÌ¤ÓˆÓ ˆÙ›ÙȉˆÓ ‹ ÚfiÛÊ·Ù˘ ˆÙ›Ùȉ·˜, Ë Û˘ÁÁÂÓ‹˜ ¿ÚÂÛË, Ë ÚÔÛ‚ÔÏ‹ ÂÓfi˜ ÌfiÓÔ ÎÏ¿‰Ô˘ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ‹ Î·È ¿ÏÏˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ Û˘˙˘ÁÈÒÓ, Ë ÎÂÓÙÚÈ΋ ¿ÚÂÛË Ú¤ÂÈ Ó· ‰ÈÂÚ¢ÓÒÓÙ·È Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÏÈıÔÂȉÒÓ ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ (13). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ Ì ¿ÚÂÛË ÚÔÛˆÈÎÔ‡, ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÚfiÁÓˆÛË Î·È ÙËÓ ·Ó¿ÁÎË ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÔÛ˘Ì›ÂÛ˘ ‰›ÓÔ˘Ó ÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ·, Ë Ù·¯‡ÙËÙ· ·ÁˆÁ‹˜ Ó‡ÚÔ˘ Î·È ÙÔ ËÏÂÎÙÚÔÓ¢ÚÔÁÚ¿ÊËÌ·. √È ‰ÔÎÈ̷ۛ˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÙȘ ÚÒÙ˜ 48-72 ÒÚ˜ Ù˘ ÓfiÛÔ˘ Î·È Ó· Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Î¿ı 34 ̤Ú˜ ÁÈ· ‰È¿ÛÙËÌ· 3 ‚‰ÔÌ¿‰ˆÓ. ∆Ô ˘„ËÏfi ÎfiÛÙÔ˜, Ë ·Ó¿ÁÎË Û˘ÓÂÚÁ·Û›·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, Ë ··ÈÙÔ‡ÌÂÓË ÂÌÂÈÚ›· ÙÔ˘ ÂÍÂÙ¿˙ÔÓÙÔ˜ Î·È Ë Î·Ï‹ Û˘Ó‹ıˆ˜ ÔÚ›· Ù˘ ¿ÚÂÛ˘ ÚÔÛˆÈÎÔ‡ ÛÙ· ·È‰È¿ ÂÚÈÔÚ›˙Ô˘Ó ÛËÌ·ÓÙÈο ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ·˘ÙÒÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (12). ™˘ÌÂÚ·ÛÌ·ÙÈο, Û οı ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ ÂÚÈÊÂÚÈÎÔ‡ Ù‡Ô˘ Û ·È‰› ÌÈÎÚ‹˜ ËÏÈΛ·˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË, ·ÎÔ˘fiÁÚ·ÌÌ· (ÂÊ’ fiÛÔÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 4 ¯ÚfiÓˆÓ Î·È Û˘ÓÂÚÁ¿˙ÂÙ·È), ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÏÈıÔÂȉÒÓ ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜ Î·È ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ËÏÂÎÙÚÔÓ¢ÚÔÁÚ¿ÊËÌ· ÙȘ ÚÒÙ˜ 48-72 ÒÚ˜ Ù˘ ÓfiÛÔ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙË 18Ë - 21Ë Ì¤Ú·), ÌfiÓÔ Û ÂÚ›ÙˆÛË Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ‚ÂÏÙ›ˆÛË Ì ÙË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Bitar C, Kluka E, Steele R. Mastoiditis in children. Clin Pediatr 1996;391-395.

2. Hoppe JE, Koster S, Bootz F, Niethammer D. Acute

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mastoidits. Infection 1994;22:178-182.

3. Holt R, Gates G. Masked mastoiditis. Laryngoscope 1983;93:1034-1037.

4. Grundfast K, Guarisco L, Thomsen J, Koch B. Diverse etiologies of facial paralysis in children. Internat J Peadiatr Otorhinolaryg 1990;19:223-239.

5. Nelson W, Vaughan V. Hearing loss. In: Behrman R, eds.

Textbook of Pediatrics. 14th ed. Philadelphia: WB Saunders; 1992. p. 1602-1608.

6. Faye-Lund H. Acute and latent mastoiditis. J Latyngol Otol 1989;103:1158-1160.

7. Fritz P, Rieden K, Lenarz T, Haels J, Winkel K. Radiological evaluation of temporal bone disease: High-resolution computed tomografy versus conventional X-ray diagnosis.

British J Radiol 1989;62:107-113.

8. Wang E, Burg J. Mastoiditis: A case-based rewiew. Pediatr Emerg Care 1988;14:290-292.

9. Nadal D, Hermann P, Baumann A, Fanconi A. Acute mastoiditis: clinical, microbiological, and therapeutic aspects. Eur J Pediatr 1990;149:560-564.

10. Fukuda T, Sugie H, Ito M, Kikawada T. Bilateral facial palsy

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caused by bilateral mastoiditis. Pediatr Neurol 1998;18: 351-353.

11. Ginsburg CM, Rudoy R, Nelson JD. Acute mastoiditis in infants and children. Clin Pediatr 1980;19:549-553.

12. Fisch U. Maximal nerve excitability testing versus electroneurography. Arch Otolaryngol 1980;106:352-357.

13. Inamura H, Aoyagi M, Tojima H, Kohsyu H, Koike Y. Facial nerve palsy in children: clinical aspects of diagnosis and treatment. Acta Otolorangol 1994;511(Suppl):150-152.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-09-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-02-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∑ˆ‹ ∏ÏÈÔ‰ÚÔÌ›ÙË ∫Ú·ÙÂÚÔ‡ 25, 157 71, πÏ›ÛÈ·, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¶·¯˘Û·ÚΛ· ÛÙÔ˘˜ ÂÈ‚ÈÒÛ·ÓÙ˜ ·fi Ï¢¯·ÈÌ›·. ∏ Û˘Ì‚ÔÏ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜1 Œ¯ÂÈ ÂÚÈÁÚ·Ê› ˘„ËÏfi ÔÛÔÛÙfi ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ Ô˘ ÂÈ‚›ˆÛ·Ó ·fi ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· (ALL), ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› Ë ÁÂÓÂÙÈ΋ Î·È ÎÔÈÓˆÓÈ΋ Â›‰Ú·ÛË ÛÙËÓ ·¯˘Û·ÚΛ· ÛÙËÓ ÔÌ¿‰· ·˘Ù‹ ÙˆÓ ·ÛıÂÓÒÓ. √È Û˘ÁÁÚ·Ê›˜ ÌÂϤÙËÛ·Ó 33 ¿ÙÔÌ· Ì ̷ÎÚ¿ ÂÈ‚›ˆÛË (25 ı‹ÏÂȘ Î·È 8 ¿ÚÚÂÓ˜) Û ÚÒÙË ‡ÊÂÛË, Ô˘ ›¯·Ó Êı¿ÛÂÈ ÙÔ ÙÂÏÈÎfi ÙÔ˘˜ ‡„Ô˜. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÎÙÈÓÔ‚ÔÏ›· ÎÚ·Ó›Ô˘, ˆ˜ ̤ÚÔ˜ Ù˘ ıÂÚ·›·˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Û ηӤӷ ‰Â ¯ÔÚËÁ‹ıËΠ·˘ÍËÙÈ΋ ÔÚÌfiÓË. √ ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (µªπ: ‚¿ÚÔ˜/‡„Ô˜2) ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓ ÙÔ˘˜ ÁÔÓ¤ˆÓ ˘ÔÏÔÁ›ÛıËÎ·Ó Î·È ¤ÁÈÓ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. ™·Ó ·¯‡Û·ÚÎÔÈ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ÔÈ ·ÛıÂÓ›˜ ÂΛÓÔÈ ÙˆÓ ÔÔ›ˆÓ Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ÙËÓ 85Ë ÂηÙÔÛÙÈ·›· ı¤ÛË. ªÂٷ͇ ÙˆÓ ·ÚÚ¤ÓˆÓ ‰ÂÓ ‚Ú¤ıËΠ˘ÂÚ‚ÔÏÈ΋ ·¯˘Û·ÚΛ· ÁÈ· ÙÔ ÙÂÏÈÎfi ‡„Ô˜, ÂÓÒ

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ÁÈ· ÙȘ ı‹ÏÂȘ ÙÔ 56% ‹Ù·Ó ·¯‡Û·ÚΘ. ∞’ ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÙˆÓ 14 ·¯‡Û·ÚÎˆÓ Á˘Ó·ÈÎÒÓ ÙÔ 59% ›¯·Ó ·¯‡Û·ÚÎË ÌËÙ¤Ú·, ·ÏÏ¿ ÌfiÓÔ ÙÔ 14% ·¯‡Û·ÚÎÔ ·Ù¤Ú·. ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó ÛËÌ·ÓÙÈ΋ ÌËÙÚÈ΋ Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ÚԉȿıÂÛË ÁÈ· ·¯˘Û·ÚΛ·.

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MP, Bath LE, Duff J, Kelnar CJ, Wallace WHB Obesity in leukemia survivors: The familial contribution Pediatr Hematol Oncol 2000;17:231-237 º. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ ∞Ó·Ï. ∫·ıËÁ‹ÙÚÈ·

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2001;64:181-187

CASE REPORT

™·ÛÌÔ› ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ÂÓÙÔÌÔ·ˆıËÙÈÎfi ª. ¡·ÚÏ›ÔÁÏÔ˘, °. ªÚÈ·ÛÔ‡Ï˘, ∞. ÷Ù˙‹˜

Seizures after dermal exposure to DEET M. Narlioglou, G. Briassoulis, T. Hatzis

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 18 ÌËÓÒÓ, ÙÔ ÔÔ›Ô ÂΉ‹ÏˆÛ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Û·ÛÌÔ‡˜ ÌÂÙ¿ ·fi ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ¤ÎıÂÛË Û ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ (17,6%) ‰È·Èı˘ÏÈ΋ ÙÔÏÔ˘·Ì›‰Ë (DEET). ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ·ÚÓËÙÈÎfi ÁÈ· Û·ÛÌÔ‡˜ ‹ ¿ÏÏË Ó¢ÚÔÏÔÁÈ΋ ÓfiÛÔ Î·È Ë ·Ó¿Ù˘ÍË ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. √ ·ÛıÂÓ‹˜ ÂΉ‹ÏˆÛ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜, ¿ÚÚ˘ıÌË ·Ó·ÓÔ‹ Î·È ‹Ù·Ó Û Έ̷ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË, ˘ÂÚÙÔÓÈÎfi˜ Ì ‰È·Ï›ÔÓÙ· ÂÂÈÛfi‰È· ÔÈÛıfiÙÔÓÔ˘. √È ÎfiÚ˜ ‹Ù·Ó ›Û˜ Î·È ·ÓÙȉÚÒÛ˜ ÛÙÔ Êˆ˜ Î·È ‰ÂÓ ˘‹Ú¯·Ó ÂÍ·Óı‹Ì·Ù·. √ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ Î·È Ë ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·, Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. √ ·ÛıÂÓ‹˜ ·Ó¤Î·Ì„Â Î·È ·Ú¤ÌÂÓ ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù· 12 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÓfiÛÔ. ∞Ó·ÛÎfiËÛË Ù˘ ÙÚ¤¯Ô˘Û·˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ ·ÔÎ¿Ï˘„ 17 ÂÚÈÙÒÛÂȘ ÙÔÍÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ·fi ‰È·Èı˘ÏÈ΋ ÙÔÏÔ˘·Ì›‰Ë Û ·È‰È¿. ∏ ıÓËÛÈÌfiÙËÙ· (16,6%) ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó ÛËÌ·ÓÙÈο Ì ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ DEET, ÙË ‰È¿ÚÎÂÈ· ¤ÎıÂÛ˘, ÙÔ Â›‰Ô˜ Ù˘ ¤ÎıÂÛ˘ ÛÙÔÓ ÙÔÍÈÎfi ·Ú¿ÁÔÓÙ·, ÙËÓ ËÏÈΛ· ‹ ÙÔ Ê‡ÏÔ. ¶ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˜ ÙÔÍÈÎÔÏÔÁÈΤ˜ Î·È ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ··ÈÙÔ‡ÓÙ·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·¯ıÔ‡Ó ·ÛʷϤÛÙÂÚ· Û˘ÌÂÚ¿ÛÌ·Ù· Û¯ÂÙÈο Ì ÙËÓ ÙÔÍÈÎfiÙËÙ· Ù˘ ‰È·Èı˘ÏÈ΋˜ ÙÔÏÔ˘·Ì›‰Ë˜, ÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Â·ÚÎÔ‡˜ ÙÂÎÌËÚ›ˆÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Û -ÚÔۂ‚ÏË̤ӷ Î·È ÌË·È‰È¿ Ô˘ ‹Úı·Ó Û Â·Ê‹ Ì ÂÓÙÔÌÔÎÙfiÓ· ÂÚȤ¯ÔÓÙ· DEET.

Abstract: Respiratory distress and seizures developed in an 18-month-old boy following a brief exposure to low strength (17,6%) N, N-diethyl-mtoluamide (DEET). Family history was negative, with no evidence of a seizure disorder or other neurologic disease. The child’s development had been normal. The patient manifested generalized seizures, respiratory difficulty, and was hypertonic with intermittent episodes of opisthotonus. Pupils were equal and reactive to light. There were no rashes, and the CSF findings as well as CT scan of the brain were normal. An EEG performed a week later was normal. The child recovered and remained well 12 months after the initial illness. A review of the literature revealed 17 reports of DEET-induced encephalopathy in children.

Mortality (16,6%) did not correlate significantly with the concentration of the DEET liquid used, the duration of skin exposure, the type of exposure to the toxic substance, the age, or sex. Careful toxicologic and epidemiologic studies must be conducted, including adequate documentation of DEET levels in affected and unaffected children who are exposed to insect repellents containing DEET, in order to draw definitive conclusions regarding the toxicity of diethyl toluamide.

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·", ∞ı‹Ó·

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·", ∞ı‹Ó·

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§¤ÍÂȘ ÎÏÂȉȿ: ‰È·Èı˘ÏÈ΋ ÙÔÏÔ˘·Ì›‰Ë (DEET), ÂÓÙÔÌÔ·ˆıËÙÈÎfi, ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Û·ÛÌÔ›, ·È‰È¿.

™˘ÓÙÔÌÔÁڷʛ˜ DEET ª∂£ ∫À SaO2

N,N-‰È·Èı˘Ï-Ì-ÙÔÏÔ˘·Ì›‰Ë ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ∫¤ÓÙÚÔ ÀÁ›·˜ ∫ÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ

∂ÈÛ·ÁˆÁ‹ ∏ ‰È·Èı˘ÏÈ΋ ÙÔÏÔ˘·Ì›‰Ë (DEET) Â›Ó·È ¤Ó· ¢ڤˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ ÂÓÙÔÌÔ·ˆıËÙÈÎfi. ¶·Ú¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ Î·È ÙËÓ Â˘Ú›· ¯Ú‹ÛË Ù˘ ·fi ÂηÙÔÌ̇ÚÈ· ·ÓıÚÒÔ˘˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÙÒÛÂȘ ÛÔ‚·ÚÒÓ -ÂÓ›ÔÙ ı·Ó·ÙËÊfiÚˆÓ- ·ÓÙȉڿÛˆÓ, Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÙË ¯Ú‹ÛË Ù˘ (1,2). √È ÙÔÍÈΤ˜ ·˘Ù¤˜ ·ÓÙȉڿÛÂȘ Â›Ó·È ÙfiÛÔ ÙÔÈΤ˜ fiÛÔ Î·È Û˘ÛÙËÌ·ÙÈΤ˜. ∆ÔÈο ÂΉËÏÒÓÔÓÙ·È Î˘Ú›ˆ˜ Ì ÙË ÌÔÚÊ‹ Ù˘ ÓÂÎÚˆÙÈ΋˜ ‰ÂÚÌ·Ù›Ùȉ·˜, ÎÓ›‰ˆÛ˘ Î·È ·Ó·Ê˘Ï·Í›·˜ ÌÂÙ¿ ·fi ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹ (3). ™ÙȘ Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ ÎÒÌ·, ÔÈ Û·ÛÌÔ›, Ë ˘ÂÚÙÔÓ›·, Ë ·Ù·Í›·, Ë ˘fiÙ·ÛË, Ë ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È „˘¯ˆÛÈΤ˜ ‹ Ì·ÓȷΤ˜ ÂΉËÏÒÛÂȘ (4). ¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó, Â›Û˘, ‰Â›ÍÂÈ ‚Ï·ÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ DEET ÛÙȘ ÁÔÓ¿‰Â˜ Î·È Ù· ¤Ì‚Ú˘· (5). ∂›Û˘, Ù· ·È‰È¿ Â›Ó·È Ôχ ÈÔ Â˘·›ÛıËÙ· Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜ ÛÙËÓ ÙÔÍÈ΋ ‰Ú¿ÛË Ù˘ DEET. ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ ÔÈ ÌfiÓÔÈ ı¿Ó·ÙÔÈ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ¤ˆ˜ Û‹ÌÂÚ· ·ÊÔÚÔ‡Ó ·È‰È¿ Ô˘ ›¯·Ó ÂΉËÏÒÛÂÈ ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· (1,2). ¶·ÚfiÙÈ fï˜ Ù· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚ· ¢¿ÏˆÙ· ÛÙË ‰ÂÚÌ·ÙÈ΋ Â·Ê‹ Ì ÙÔÓ ÙÔÍÈÎfi ·Ú¿ÁÔÓÙ·, ÏfiÁˆ ÙÔ˘ Ôχ ÏÂÙÔ‡ ‰¤ÚÌ·ÙÔ˜ Î·È ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÏfiÁÔ˘ ÂÈÊ¿ÓÂÈ·˜: Ì¿˙·˜ ÛÒÌ·ÙÔ˜, Ô ÌÂÙ·‚ÔÏÈÛÌfi˜ Î·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÌ¿ÎÚ˘ÓÛ˘ Ù˘ DEET ·fi ÙÔÓ ÔÚÁ·ÓÈÛÌfi ‰ÂÓ ¤¯Ô˘Ó ̤¯ÚÈ Û‹ÌÂÚ· ÌÂÏÂÙËı›. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ ¤ÎıÂÛË Û DEET Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠÛÙË ÌÔÓ¿‰· Ì·˜. ∞fi ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, ‚ڋηÌ ¿ÏϘ 17 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Î¿Ùˆ ÙˆÓ 16 ÂÙÒÓ, Ù· ÔÔ›· Â›Û˘ ÂΉ‹ÏˆÛ·Ó Û˘ÌÙÒÌ·Ù· ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÙË ‰È·Èı˘ÏÈ΋ ÙÔÏÔ˘·Ì›‰Ë. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó, Ì ÙËÓ Â˘Î·ÈÚ›· Ù˘ ÂÚÈÁÚ·Ê‹˜ ÙÔ˘ ÂӉȷʤÚÔÓÙÔ˜ ·˘ÙÔ‡ ÂÚÈÛÙ·ÙÈÎÔ‡, Ó· ·Ó·Ï‡ÛÔ˘Ì ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ‚·Ú‡ÙËÙ· Ù˘ ÂΉ‹ÏˆÛ˘ Ù˘ ÙÔÍÈ΋˜ ·˘Ù‹˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿.

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Key words: N, N-diethyl-m-toluamide, DEET, insect repellents, toxic-encephalopathy, seizures, children.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 18 ÌËÓÒÓ ÌÂٷʤÚıËΠ‰È·ÛˆÏËӈ̤ÓÔ ·fi ∫¤ÓÙÚÔ ÀÁ›·˜ (∫À) ÌÈÎÚÔ‡ ÓËÛÈÔ‡ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ (ª∂£) ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Ì·˜, ÏfiÁˆ Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ (status) Ô˘ Û˘Óԉ‡ÔÓÙ·Ó ·fi ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ 4Ô ·È‰› 6ÌÂÏÔ‡˜ ÔÈÎÔÁ¤ÓÂÈ·˜ ·ı›ÁÁ·ÓˆÓ Ì ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi Î·È Î·Ï‹ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. √È ÁÔÓ›˜ ÌÈÎÚÔˆÏËÙ¤˜, ÚÔ ÔÏ›ÁˆÓ ËÌÂÚÒÓ Â›¯·Ó ÂÈÛÎÂÊı› ÙÔ ÓËÛ› ÁÈ· Â·ÁÁÂÏÌ·ÙÈÎÔ‡˜ ÏfiÁÔ˘˜. ∂›¯·Ó ‰Â ηٷÛÎËÓÒÛÂÈ Î·È ‰È·Ó˘ÎÙ¤Ú¢·Ó ÛÙËÓ ‡·ÈıÚÔ. ∂ΛÓÔ ÙÔ ÚˆÈÓfi, ÙÔ ÌÈÎÚfiÙÂÚÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂٷʤÚıËΠÂÂÈÁfiÓÙˆ˜ ÛÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ ÙÔ˘ ÓËÛÈÔ‡, ÂÂȉ‹ Ï›ÁË ÒÚ· ÌÂÙ¿ ÙËÓ ·Ê‡ÓÈÛ‹ ÙÔ˘ ·ÚÔ˘Û›·Û ÂÂÈÛfi‰ÈÔ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ. ∆Ô ·È‰› ηٿ ÙËÓ ¿ÊÈÍ‹ ÙÔ˘ ÛÙÔ ∫À Û˘Ó¤¯ÈÛ ӷ οÓÂÈ Û·ÛÌÔ‡˜ Î·È Ó· ÌËÓ ¤¯ÂÈ Â·Ê‹ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∏ ·Ó·ÓÔ‹ ÙÔ˘ ‹Ù·Ó ¿ÚÚ˘ıÌË Î·È ÙÔ ·È‰› ΢·ÓˆÙÈÎfi, ¤¯ÔÓÙ·˜ SaO2 72%. √È ÎfiÚ˜ ÙÔ˘ ‹Û·Ó ÈÛÔÌÂÁ¤ıÂȘ, ·ÓÙȉÚÒÛ˜ ÛÙÔ Êˆ˜. √È Û·ÛÌÔ› ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ¯ÔÚ‹ÁËÛË ‰È·˙Â¿Ì˘ ·fi ÙÔ ÔÚıfi Î·È ‰ÈÊ·ÈÓ˘Ï˘‰·ÓÙÔ˝Ó˘ ÂÓ‰ÔÊÏ‚›ˆ˜ (ÊfiÚÙÈÛË). √ ·ÛıÂÓ‹˜, ÂÓÙÔ‡ÙÔȘ, ·Ú¤ÌÂÈÓ Û Έ̷ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË Ì ¿ÚÚ˘ıÌË ·Ó·ÓÔ‹ Î·È ˘ÂÚÙÔÓ›·. ∞ÎÔÏÔ‡ıËÛ Â›ÁÔ˘Û· ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË Î·È ·ÂÚÔÌÂÙ·ÊÔÚ¿ ÛÙË ª∂£ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË Î·È ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û·ÛÌÒÓ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙË ª∂£, Ô ·ÛıÂÓ‹˜ ›¯Â ıÂÚÌÔÎÚ·Û›· 37ÆC, ÛʇÍÂȘ 160/min, ∞¶ 100/60 mmHg. ∆¤ıËΠ۠Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi ˘fi ηٷÛÙÔÏ‹ Î·È Ì˘Ô¯¿Ï·ÛË. √È ÎfiÚ˜ ‹Ù·Ó ÈÛÔÌÂÁ¤ıÂȘ, ·ÓÙȉÚÒÛ˜ ÛÙÔ Êˆ˜ Î·È ÛÙ· ͢Ó‹Ì·Ù· Ô ·ÛıÂÓ‹˜ ‹Ù·Ó ˘ÂÚÙÔÓÈÎfi˜ Î·È ·ÚÔ˘Û›·˙ ÙÚfiÌÔ. ¢ÂÓ ˘‹Ú¯Â ÂÍ¿ÓıËÌ·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: °ÂÓÈ΋ ·›Ì·ÙÔ˜: Hb 10 gr/dL, Ht 31%, §Â˘Î¿ 10.400/mm3 (¶/56, §/36, ª/8), ∞ÈÌÔÂÙ¿ÏÈ· 345.000/mm3. ∂¡À: ·ÙÙ·Ú· 2/mm3, χÎ. <20mg/dL, ÁÏ. 50mg/dL. CRP ·ÚÓËÙÈ΋. √˘Ú›· 30 mg/dL, ÎÚ·ÙÈÓ›ÓË 0,4 mg/dL, ÁÏ˘Îfi˙Ë 157 mg/dL, Na 132 mEq/L, K 3,7 mEq/L, Cl 98 mEq/L, Ca 9,4 mg/dL. SGOT 245 U/L, SGPT 223 U/L, ÁGT 27 mg/dL, ∞º 332 U/L ÃÔÏÂÚ˘ıÚ›ÓË ÔÏÈ΋ 0,3 mg/dL, NH3 80 mg/dL. √ÏÈο Ï¢ÎÒÌ·Ù· 6,1 g/dL, ·Ï‚Ô˘Ì›ÓË 3,6 g/dL. °·Ï·ÎÙÈÎfi Ô͇ ÔÚÔ‡ 15,4 mg/dL (º∆ 5,7-22). ¶˘ÚÔÛÙ·Ê˘ÏÈÎfi Ô͇ ÔÚÔ‡ 0,47 mg/dL (º∆

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¶·È‰È·ÙÚÈ΋ 2001;64:181-187

0,3-0,7). ∞ÌÈÓfiÁÚ·ÌÌ· ÔÚÔ‡, ·ÌÈÓfiÁÚ·ÌÌ· Ô‡ÚˆÓ Î·È ÔÚÁ·ÓÈο Ôͤ· Ô‡ÚˆÓ Ê˘ÛÈÔÏÔÁÈο. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ∏∫° Î·È ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډ›·˜ Ê˘ÛÈÔÏÔÁÈο. ∫·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, ∂¡À, ‚ÚÔÁ¯ÈÎÔ‡, Ô‡ÚˆÓ ÛÙ›Ú˜. PCR ÛÙÔ ∂¡À ÁÈ· ÂÚËÙÔ˚Ô‡˜ Î·È ÂÓÙÂÚÔ˚Ô‡˜ ·ÚÓËÙÈ΋. ∆ÔÍÈÎÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ¿ÏϘ ÙÔÍÈΤ˜ Ô˘Û›Â˜ (-). ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏∂° (ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹) ‚Ú·‰˘·ÚÚ˘ıÌÈÎfi, ¯ˆÚ›˜ ·È¯ÌËÚ¤˜ ÂÎÊÔÚÙ›ÛÂȘ ‹ ·ÚÔ͢ÓÙÈο ‰˘Ó·ÌÈο. ∏ ·ÓÙÈÌÂÙÒÈÛË ÛÙË ª∂£ ÂÚÈÂÏ¿Ì‚·ÓÂ Û˘Ó¯‹ ηٷÁÚ·Ê‹ ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ, ·ÚÂÓÙÂÚÈ΋ ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ, Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ Î·È ÛÙ¿Á‰ËÓ Û˘Ó¯‹ ÂÓ‰ÔÊϤ‚È· ¤Á¯˘ÛË Ìȉ·˙ÔÏ¿Ì˘. √ ·ÛıÂÓ‹˜ ·ÔÛˆÏËÓÒıËΠÌÂÙ¿ ·fi 24 ÒÚ˜. ∂ÎÙfi˜ ·fi ‹È· ˘ÂÚÙÔÓ›·, ÙÚfiÌÔ, ‰È¤ÁÂÚÛË Î·È ÔÈÛıfiÙÔÓÔ, ‰ÂÓ ·ÚÔ˘Û›·˙ ¿ÏÏ· ·ıÔÏÔÁÈο Ó¢ÚÔÏÔÁÈο ÛËÌ›· Î·È Â›¯Â ÈηÓÔÔÈËÙÈ΋ Â·Ê‹ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ. ™Â ‰‡Ô 24ˆÚ· Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·ÔηٷÛÙ¿ıËΠÏ‹Úˆ˜ Î·È Ë ‹È· Ó¢ÚÔÏÔÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ˘Ô¯ÒÚËÛÂ. ∆Ô ∏∂° Ô˘ ¤ÁÈÓ ÌÂÙ¿ ·Ô 7 Ë̤Ú˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. √ ·ÛıÂÓ‹˜ ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË. ŒÓ· ¯ÚfiÓÔ ÌÂÙ¿ ÙÔ Û˘Ì‚¿Ó, ÙÔ ·È‰› ‰ÂÓ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ¿ÏÏÔ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ, ÂÍ·ÎÔÏÔ˘ı› Ó· Â›Ó·È Î·Ï¿ Î·È Ó· ¤¯ÂÈ Î·Ï‹ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. ∂›ÌÔÓË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ·ÔÎ¿Ï˘„ fiÙÈ ÙË Ó‡ÎÙ· Ô˘ ÚÔËÁ‹ıËÎÂ ÙˆÓ Û·ÛÌÒÓ (12 ÒÚ˜ ÚÈÓ), Ë ÌËÙ¤Ú· ›¯Â Â·Ï›„ÂÈ ÙÔ ÂÎÙÈı¤ÌÂÓÔ ÛÙ· ÎÔ˘ÓÔ‡È· ‰¤ÚÌ· ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÚÎÂÙ‹ ÔÛfiÙËÙ· ÂÓÙÔÌÔ·ˆıËÙÈÎÔ‡ (Autan) Ô˘ ÂÚȤ¯ÂÈ 17,6% DEET. ∞Ó·ÙÚ¤¯ÔÓÙ·˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ‚Ú¤ıËÎ·Ó ¿ÏϘ 17 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ (<16 ÂÙÒÓ), Ù· ÔÔ›· ÂΉ‹ÏˆÛ·Ó Û˘ÌÙÒÌ·Ù· ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË ÛÙË DEET. ∆· ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ, Ë ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Î·È ÔÈ ·Ú¿ÌÂÙÚÔÈ ¤ÎıÂÛ˘ ÛÙÔÓ ÙÔÍÈÎfi ·Ú¿ÁÔÓÙ·, Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∞Ó¿Ï˘ÛË ™˘ÓÔÏÈο ·Ó·Ï‡ıËÎ·Ó 18 ÂÚÈÛÙ·ÙÈο, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÙÔ˘ ·ÚfiÓÙÔ˜, ÚÔÂÚ¯fiÌÂÓ· ·fi 12 ‰ËÌÔÛȇÛÂȘ ·fi 6 ¯ÒÚ˜ (¶›Ó·Î·˜ 1). ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó 7,5 ± 4,7 ¤ÙË, 28% ·fi Ù· ÔÔ›· ‹Ù·Ó οو ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ Ë ·Ó·ÏÔÁ›· ·ÁÔÚÈÒÓ – ÎÔÚÈÙÛÈÒÓ ‹Ù·Ó 7:10. ∏ ·Ó¿Ï˘ÛË fiÏˆÓ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ¤‰ÂÈÍ fiÙÈ Ë ÚÔηÏÔ‡ÌÂÓË ·fi DEET ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Û ·È‰È¿ ‰ÂÓ ÚÔÂÚ¯fiÙ·Ó ÌfiÓÔ ·fi Ù˘¯·›· ηٿÔÛË ‹ Û˘¯Ó‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÓÙÔÌÔ·ˆıËÙÈÎÔ‡. ∂‹ÏıÂ Î·È ÌÂÙ¿ ·fi ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ˆÚÒÓ ‰ÂÚÌ·ÙÈ΋ ¤ÎıÂÛË ÛÙÔÓ ÙÔÍÈÎfi ·Ú¿ÁÔÓÙ· (17%) ‹ Î·È Â·Ó·ÏËÙÈ΋ Â›ıÂÛË ‰È¿Ú-

Paediatriki 2001;64:181-187

ÎÂÈ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 3 ËÌÂÚÒÓ (28%). ∂›Û˘, ÛËÌ·ÓÙÈ΋ ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÙÔ 33% ÙˆÓ ·ÛıÂÓÒÓ ÂΉ‹ÏˆÛ·Ó ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ ¤ÎıÂÛË Û ÂÓÙÔÌÔ·ˆıËÙÈÎfi Ì ÂÚÈÂÎÙÈÎfiÙËÙ· Û DEET <20% ! √È Û·ÛÌÔ› ·ÔÙ¤ÏÂÛ·Ó ÙËÓ Î‡ÚÈ· ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË (72%) ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ Â·Ê‹ (p<0,01). ∂›Û˘, fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ¤ı·Ó·Ó ÂΉ‹ÏˆÛ·Ó ÙËÓ ÙÔÍÈ΋ Û˘Ó‰ÚÔÌ‹ ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ Â·Ê‹. ¶ÔÏÏ·Ï‹ ÏÔÁÈÛÙÈ΋ ·Ó¿Ï˘ÛË ·ÏÈÓ‰ÚfiÌËÛ˘ ¤‰ÂÈÍ fiÙÈ Ë ıÓËÛÈÌfiÙËÙ· (16,6%) ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó ÛËÌ·ÓÙÈο Ì ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ DEET ÛÙ· ‰È·Ï‡Ì·Ù·, ÙË ‰È¿ÚÎÂÈ· Ù˘ ¤ÎıÂÛ˘, ÙÔ Â›‰Ô˜ Ù˘ ¤ÎıÂÛ˘, ÙËÓ ËÏÈΛ· ‹ ÙÔ Ê‡ÏÔ. √È ¿ÏϘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ ÎÒÌ· (39%), ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (28%), ÔÈÛıfiÙÔÓÔ˜ ‹ ˘ÂÚÙÔÓ›· (11%) Î·È Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (5,5%), ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ¤ÎıÂÛË ÛÙÔÓ ÙÔÍÈÎfi ·Ú¿ÁÔÓÙ· ÌÂÙ¿ ·fi ηٿÔÛË ‹ ̤ۈ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ªfiÓÔ Û 3 ÂÚÈÙÒÛÂȘ ÙÔ ∂¡À ¤‰ÂÈÍ ÏÂÌÊÔ΢ÙÙ¿ÚˆÛË ‹ ˘„ËÏ¿ Â›‰· ÚˆÙ½Ó˘. ™Â ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ÌÂ Ê˘ÛÈÏÔÁÈÎfi ∂¡À, ÙÔ ∏∂° ‹Ù·Ó ·ıÔÏÔÁÈÎfi, ÂÓÒ ÌfiÓÔ ¤Ó·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ˘ÂÚ·Ì̈ÓÈ·ÈÌ›·. ∏ ˘ÔÏÔÁÈÛÙÈ΋ Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ÂÊfiÛÔÓ ·Ó·Ê¤ÚÔÓÙ·Ó, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ™˘ÓÔÏÈο, Ê˘ÛÈÔÏÔÁÈο ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·Ó·ÎÔÈÓÒıËÎ·Ó Û 8 ÂÚÈÙÒÛÂȘ (44%), ÂÓÒ ÛÙÔ 28% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ ‹Ù·Ó ‰È·ı¤ÛÈÌ· (¶›Ó·Î·˜ 1). ∂Ó·ÏÏ·ÎÙÈ΋ ‰È¿ÁÓˆÛË ‰ÂÓ ˘‹Ú¯Â ÛÙÔ 56% ÙˆÓ ÂÚÈÙÒÛˆÓ. √È Èı·Ó¤˜ ÂÓ·ÏÏ·ÎÙÈΤ˜ ‰È·ÁÓÒÛÂȘ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·ÊÔÚÔ‡Û·Ó È‰ÈÔ·ı›˜ Û·ÛÌÔ‡˜ (22%) ‹ ÂÁÎÂÊ·Ï›Ùȉ· (22%), ‰ÂÓ ‹Ù·Ó fï˜ ‰˘Ó·ÙfiÓ Ó· ÙÂÎÌËÚȈıÔ‡Ó ÛÙÔ ‰È¿ÛÙËÌ· ̤¯ÚÈ ÙË ‰ËÌÔÛ›Â˘ÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ. ™˘˙‹ÙËÛË ∏ DEET ·Ú·Û΢¿ÛıËΠÙÔ 1946 ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô °ÂˆÚÁ›·˜ ÙˆÓ ∏¶∞ Î·È ÙÔ 1957 ÂÁÎÚ›ıËÎÂ Ë ¯Ú‹ÛË Ù˘ ÁÈ· ÙÔ Â˘Ú‡ ÎÔÈÓfi. ∞ÔÙÂÏ› ÙÔ ÂÓÂÚÁfi Û˘ÛÙ·ÙÈÎfi ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ÂÓÙÔÌÔ·ˆıËÙÈÎÒÓ ÁÈ· ÎÔ˘ÓÔ‡È·, ̇Á˜, ÛÎÓ›˜, ÙÛÈÌÔ‡ÚÈ· Î·È „‡ÏÏÔ˘˜. ™ÙÔ ÂÌfiÚÈÔ ‰È·Ù›ıÂÙ·È Â›Ù Û ˘ÁÚ‹ ÌÔÚÊ‹, ›Ù ˘fi ÌÔÚÊ‹ ·ÂÚÔ˙fiÏ, spray, ÏÔÛÈfiÓ, Îڤ̷˜, sticks Î·È ˘ÁÚÒÓ Ì·ÓÙËÏÈÒÓ, Û ÂÚÈÂÎÙÈÎfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 5-100% (1). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ ·ÔÚÚÔÊ¿Ù·È Ì¤Ûˆ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È 9% Ù˘ ÂÊ·ÚÌÔÛı›۷˜ ÔÛfiÙËÙ·˜ ¤¯ÂÈ ·ÔÚÚÔÊËı› ̤۷ Û 12 ÒÚ˜, ÂÓÒ 10-14% Ù˘ ‰fiÛ˘ ·ÂÎÎÚ›ÓÂÙ·È ·Ó·ÏÏÔ›ˆÙË ·fi Ù· Ô‡Ú· ÙËÓ ÚÒÙË ÒÚ·. ∏ DEET ÔÍÂȉÒÓÂÙ·È ÛÙ· Ë·ÙÈο ÌÈÎÚÔÛÒÌ·Ù· Î·È ÔÈ ÌÂÙ·‚Ôϛ٘ Ù˘ ÌÔÚ› Ó· ·Ú·Ì›ÓÔ˘Ó ÛÙÔ ‰¤ÚÌ· ‹ ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ÁÈ· 1 ‹ 2 Ì‹Ó˜. ∏ ̤ÛË ı·Ó·ÙËÊfiÚÔ˜ ‰fiÛË (LD50) ÌÂÙ¿ ·fi

183

2001 MAPT- A¶PI§

17-10-01 15:35

™ÂÏ›‰· 184

¶·È‰È·ÙÚÈ΋ 2001;64:181-187

Paediatriki 2001;64:181-187

¶›Ó·Î·˜ 1. ¢ËÌÔÛÈ¢ı›Û˜ ÂÚÈÙÒÛÂȘ ÙÔÍÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÌÂÙ¿ ·fi ¤ÎıÂÛË Û DEET Û ·È‰È¿ ∞ÛıÂÓ‹˜ ∏ÏÈΛ· (¤ÙË)

º‡ÏÔ

%DEET

¶ÔÛfiÙËÙ· ÃÚfiÓÔ˜ ÂÊ·ÚÌÔÁ‹˜

∆ÚfiÔ˜ Â·Ê‹˜

™˘ÌÙÒÌ·Ù·

1

1,5

∞

17,6

™‡ÓÙÔÌË (ÒÚ˜)

¢ÂÚÌ·ÙÈ΋

™·ÛÌÔ›, ÔÈÛıfiÙÔÓÔ˜, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÎÒÌ· ∫ÂÊ·Ï·ÏÁ›Â˜, ™·ÛÌÔ›, ∞Ù·Í›·, ¢È¤ÁÂÚÛË ¢È¤ÁÂÚÛË, ÔÈÛıfiÙÔÓÔ˜

2

5

∫

10

∫¿ı Ӈ¯Ù· x 3 Ì‹Ó˜

¢ÂÚÌ·ÙÈ΋

3

1,5

∫

10

ªÈÎÚ‹

∫·Ù¿ÔÛË

4 5 6

3,5 14 1

∫ ∫ ∫

15 95 47,5

∏ÌÂÚ‹ÛÈ· x 2 ‚‰ÔÌ¿‰Â˜ 50ml 25ml

¢ÂÚÌ·ÙÈ΋ ∫·Ù¿ÔÛË ∫·Ù¿ÔÛË

7 8

16 8

∫ ∫

95 15 Î·È 100

50ml ™‡ÓÙÔÌË (2 Ë̤Ú˜) + ™‡ÓÙÔÌË (2 Ë̤Ú˜)

∫·Ù¿ÔÛË ¢ÂÚÌ·ÙÈ΋

9

1,5

∫

20

∏ÌÂÚ‹ÛÈ· x 3 Ì‹Ó˜

¢ÂÚÌ·ÙÈ΋

10

6

∫

15

10 Â·Ï›„ÂȘ

¢ÂÚÌ·ÙÈ΋

11

1,4

∫

10 ‹ 20

∏ÌÂÚ‹ÛÈ· x 3 ‚‰ÔÌ¿‰Â˜

¢ÂÚÌ·ÙÈ΋

∫ÒÌ·, ·Ù·Í›·, Reye-like syndrome ∫ÒÌ·, ™·ÛÌÔ›

12

5

∞

100 Î·È 15

™‡ÓÙÔÌË (ÒÚ˜)

¢ÂÚÌ·ÙÈ΋

™·ÛÌÔ›

13-16

3-7

17

15

∞ ∞ ∞ ∞ ∞

ÔÈΛÏË ÔÈΛÏË ÔÈΛÏË ÔÈΛÏË ¡∞

™‡ÓÙÔÌË (<3 Ë̤Ú˜) ™‡ÓÙÔÌË (<3 Ë̤Ú˜) ™‡ÓÙÔÌË (<3 Ë̤Ú˜) ™‡ÓÙÔÌË (<3 Ë̤Ú˜) 50-100ml

¢ÂÚÌ·ÙÈ΋ ¢ÂÚÌ·ÙÈ΋ ¢ÂÚÌ·ÙÈ΋ ¢ÂÚÌ·ÙÈ΋ ∫·Ù¿ÔÛË

18

8

NA

30 ‹ >30

™‡ÓÙÔÌË (ÒÚ˜)

¢ÂÚÌ·ÙÈ΋

™·ÛÌÔ› ™·ÛÌÔ› ™·ÛÌÔ› ™·ÛÌÔ›, ∫Ó›‰ˆÛË ∫ÒÌ·, ˘fiÙ·ÛË, ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÓÂ¿ÚÎÂÈ·, ÙÔÍÈ΋ Ë·Ù›Ùȉ· ™·ÛÌÔ›

™·ÛÌÔ› ∫ÒÌ·, ÀfiÙ·ÛË, ÀÂÚÙÔÓ›· ∫ÒÌ·, Û·ÛÌÔ›, ˘ÂÚÙÔÓ›·, ÔÈÛıfiÙÔÓÔ˜ ∫ÒÌ· ∂Í¿ÓıËÌ·, ™·ÛÌÔ›, ªÂÙ·‚ÔÏ‹ Û˘ÌÂÚÈÊÔÚ¿˜, ‰È¤ÁÂÚÛË, ·ÓËÛ˘¯›·, ¿Á¯Ô˜ ∞Ù·Í›·, ÂÚ›ÂÚÁ˜ ÎÈÓ‹ÛÂȘ, ÛÈÂÏfiÚÚÔÈ·,ÔÈÛıfiÙÔÓÔ˜, Ì˘ÔÎÏÔӛ˜, ÙÚfiÌÔ˜

∞=·ÁfiÚÈ, ∫=ÎÔÚ›ÙÛÈ, NA=ÌË ‰È·ı¤ÛÈÌ· ‰Â‰Ô̤ӷ, ∆¶=·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi, ∫º=ηٿ ʇÛË, AT=·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·,

Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË Û ÂÈÚ·Ì·Ùfi˙ˆ· Â›Ó·È ÂÚ›Ô˘ 2 g/kg, ÂÓÒ ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ Â·Ê‹ Â›Ó·È 10 ml/kg (1). √È ¤Ú¢Ó˜, ÔÈ Ôԛ˜ ¤¯Ô˘Ó Á›ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·, ¤‰ÂÈÍ·Ó ÂΉËÏÒÛÂȘ ÙÔÍÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÛÙ· ÂÈÚ·Ì·Ùfi˙ˆ· ÌÂÙ¿ ·fi Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË, fiˆ˜ ÂÚÁÒ‰Ë ·Ó·ÓÔ‹, ·Ù·Í›·, Û·ÛÌÔ‡˜. ™ÙÔ˘˜ ·ÓıÚÒÔ˘˜, Â›Û˘, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÙfiÛÔ ÙÔÈΤ˜ fiÛÔ Î·È Û˘ÛÙËÌ·ÙÈΤ˜ ÙÔÍÈΤ˜ ÂΉËÏÒÛÂȘ. √È ÙÔÈΤ˜ ÂΉËÏÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ‰ÂÚÌ·Ù›Ùȉ· ÌÂÙ¿ ·fi ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹. ™ÙȘ Û˘-

184

ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ Û·ÛÌÔ›, ÙÔ ÎÒÌ·, Ë ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Ë ˘fiÙ·ÛË, ÂΉËÏÒÛÂȘ ÔÈ Ôԛ˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÙfiÛÔ ÌÂÙ¿ ·fi Ù˘¯·›· ηٿÔÛË fiÛÔ Î·È ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ DEET. ™·ÓÈfiÙÂÚ·, ·Ó·Ê¤ÚÔÓÙ·È ÂÂÈÛfi‰È· Û‡Á¯˘Û˘ ‹ ‰È¤ÁÂÚÛ˘, ÙÚfiÌÔ˘ Î·È ÔÈÛıfiÙÔÓÔ˘ (8), Û˘ÌÙÒÌ·Ù· Ô˘ Ôͤˆ˜ ·ÚÔ˘Û›·Û ÎÈ Ô ·ÛıÂÓ‹˜ Ì·˜. ∏ ¯Ú‹ÛË Ù˘ DEET Â›Ó·È ÂÎÙÂÓ‹˜ Û ÔÏfiÎÏËÚÔ ÙÔÓ ÎfiÛÌÔ Û‹ÌÂÚ·. ¶·Ú¿ ÙËÓ Â˘Ú›· ¯Ú‹ÛË Ù˘, ηٿ ‰È·ÛÙ‹Ì·Ù· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÙÒÛÂȘ

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∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·

ŒÎ‚·ÛË

¶Èı·Ó¤˜ ÂÓ·ÏÏ·ÎÙÈΤ˜ ‰È·ÁÓÒÛÂȘ

ÃÒÚ·

∂¡À:∫º, ∞∆:∫º

ÿ·ÛË

∂¡À: ∫‡ÙÙ·Ú· 165/mm3 ∂¡À:∫‡ÙÙ·Ú· Ï›Á·

£¿Ó·ÙÔ˜

∫·Ì›·

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Ʀ

¡fiÙÈÔ˜ ∞ÊÚÈ΋ ¡fiÙÈÔ˜ ∞ÊÚÈ΋

19 19

∂¡À:∫º NA NA

ÿ·ÛË ÿ·ÛË ÿ·ÛË

∏¶∞ ∫·Ó·‰¿˜ ∫·Ó·‰¿˜

13 2 2

NA ∂¡À:∫º, ∏∫°=·ıÔÏÔÁÈÎfi

ÿ·ÛË ÿ·ÛË

∫·Ì›· π‰ÈÔ·ı›˜ Û·ÛÌÔ›, ªË ÂȉÈÎfi ÂÍ¿ÓıËÌ·

∫·Ó·‰¿˜ ∫·Ó·‰¿˜

2 10

∂¡À: ·ÙÙ·Ú· 14/ mm3 ∞∆:∫º

ÿ·ÛË

∏¶∞

9

∫·Ó·‰¿˜

20

√˘ÚÔ˘ÁÔ˘¿Ë

12

ÿ·ÛË

∂ÁÎÂÊ·Ï›Ùȉ·, ·Ú·ÏÔÈÌ҉˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Ì˘ÔÎÏÔÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Reye syndrome ‹ Û˘ÁÁÂÓ‹˜ OCT ·ÓÂ¿ÚÎÂÈ· √Í›· ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ π‰ÈÔ·ı›˜ Û·ÛÌÔ›

∂¡À:∫º, ÀÂÚ·Ì̈ÓÈ·ÈÌ›·

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∂¡À:∫º, ∞∆:∫º ∫º ∞∆:∫º M∆:∫º

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∫·Ì›· ∫·Ì›· ∫·Ì›· ∫·Ì›· ∫·Ì›·

∏¶∞ ∏¶∞ ∏¶∞ ∏¶∞ ƒˆÛ›·

18 18 18 18 21

NA

ÿ·ÛË

∫·Ì›·

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22

ÿ·ÛË

∂ÁÎÂÊ·Ï›ÙȘ, ¶·Ú·ÏÔÈÌ҉˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ∂ÁÎÂÊ·Ï›ÙȘ, ¶·Ú·ÏÔÈÌ҉˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· π‰ÈÔ·ı›˜ Û·ÛÌÔ› ∫·Ì›· ∫·Ì›·

µÈ‚ÏÈÔÁÚ·Ê›·

ª∆=Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, OCT=ornithine carbamoyl transferase

ÙÔÈÎÒÓ ‹ Û˘ÛÙËÌ·ÙÈÎÒÓ ÙÔÍÈÎÒÓ ÂΉËÏÒÛˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ·ÚÔ‡Û· ·Ó¿Ï˘ÛË, Ë ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ·fi DEET Û˘Óԉ‡ÂÙ·È ·fi ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· ÛÙ· ·È‰È¿ (9). √ ·ÛıÂÓ‹˜ Ì·˜ ÂΉ‹ÏˆÛ Â·ÓÂÈÏËÌ̤ӷ ÂÂÈÛfi‰È· Û·ÛÌÒÓ Ï›Á˜ ÒÚ˜ ÌÂÙ¿ ·fi ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ ¤ÎıÂÛË Û DEET, Ô ‰Â ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ·ÎÔÏÔ‡ıËÛ ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û·ÛÌÒÓ ·¤‚Ë ·ÚÓËÙÈÎfi˜, fiˆ˜ Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ÚÔËÁÔ‡ÌÂÓˆÓ ‰ËÌÔÛȇۈÓ. ∏ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ Â›Ó·È Ë ÚÒÙË ÂÚ›-

ÙˆÛË ÙÔÍÈÎfiÙËÙ·˜ ·fi DEET ÛÙË ¯ÒÚ· Ì·˜. √È ÂÚÈÙÒÛÂȘ ÂΉ‹ÏˆÛ˘ ÙÔÍÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ Î·È ı·Ó¿ÙÔ˘ Â›Ó·È Û¿ÓȘ, ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ·È‰È¿. ∞fi ÙÔ 1961 ̤¯ÚÈ Û‹ÌÂÚ·, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· 17 ÂÈϤÔÓ ÂÚÈÙÒÛÂȘ ÙÔÍÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ·fi DEET Û ·È‰È¿. ∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·˘ÙÒÓ ÛÙ· Ï·›ÛÈ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ÚԤ΢„ fiÙÈ ÙÔ 28% ·ÊÔÚÔ‡Û ·È‰È¿ ËÏÈΛ·˜ <18 ÌËÓÒÓ, fiˆ˜ ·ÎÚÈ‚Ò˜ Ô ·ÛıÂÓ‹˜ Ì·˜. π‰È·›ÙÂÚ· ÂÓÙ˘ˆÛȷ΋ ‹Ù·Ó Ë ‰È·›ÛÙˆÛË fiÙÈ 12 ·È‰È¿ (70,5%)

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ÂΉ‹ÏˆÛ·Ó Û˘ÌÙÒÌ·Ù· ÙÔÍÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ ¤ÎıÂÛË Î·È 5 ÌfiÓÔ ·È‰È¿ (29,5%) ÌÂÙ¿ ·fi Ù˘¯·›· ηٿÔÛË DEET. ∞Ó·ÌÊ›‚ÔÏ·, ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ·fi DEET Û ·È‰È¿ ÌÔÚ› Ó· ÂΉËψı› fi¯È ÌfiÓÔ ÌÂÙ¿ ·fi Û˘¯Ó‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÓÙÔÌÔ·ˆıËÙÈÎÔ‡, ·ÏÏ¿ Î·È ÌÂÙ¿ ·fi ÂÊ¿·Í ÂÊ·ÚÌÔÁ‹ ·˘ÙÔ‡ (10-12), fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÔ˘ÌÂ. ™˘ÓÔÏÈο, ÙÔ 18% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ËÏËÙËÚÈ¿Ûˆ˜ Ì DEET ÛÙ· ·È‰È¿ ›¯Â ı·Ó·ÙËÊfiÚÔ ¤Î‚·ÛË (3 ı¿Ó·ÙÔÈ), ÂÓÒ ÔÈ ÌfiÓÔÈ ı¿Ó·ÙÔÈ Ô˘ ¤¯Ô˘Ó Û˘Ì‚Â› ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ ·ÊÔÚÔ‡Û·Ó ·È‰È¿. ∏ ÌÔÓ·‰ÈÎfiÙËÙ· Ù˘ ¢¿ıÂÈ·˜ ·˘Ù‹˜ ÙˆÓ ·È‰ÈÒÓ ·Ú·Ì¤ÓÂÈ ·ÓÂÍ‹ÁËÙË. ∞Ó Î·È Ù· ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙȘ Û˘Óı‹Î˜ ÙÔÍÈÎfiÙËÙ·˜ Ù˘ DEET Â›Ó·È ·ÎfiÌË ÂÏÏÈ‹, ·fi ÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÛÙÔȯ›ˆÓ Ù˘ ÚÔÛÈÙ‹˜ ¤ˆ˜ Û‹ÌÂÚ· ‚È‚ÏÈÔÁÚ·Ê›·˜, Ê·›ÓÂÙ·È fiÙÈ Ù· ·È‰È¿ Â›Ó·È ÈÔ Â˘·›ÛıËÙ· Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈÎÔ˘˜ ÛÙËÓ ÙÔÍÈ΋ ‰Ú¿ÛË Ù˘ DEET (12). ŒÓ· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi (33%) ÙˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ·Ó¿Ï˘Û˘ ·Ó¤Ù˘Í·Ó ÛËÌ›· ÙÔÍÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ ¤ÎıÂÛË Û ·Ú·ÈˆÌ¤ÓÔ DEET 10% (13), 15% (14) ‹ 20% (15). ∆· ÂÓÙÔÌÔÎÙfiÓ· Ì DEET Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙË ¯ÒÚ· Ì·˜ ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ Ù¿Í˘ ÙˆÓ 9,6-20%. ∂ÓÙÔ‡ÙÔȘ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·Ú¯È΋ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ‰È·Ï‡Ì·ÙÔ˜, Ë ÂÍ¿ÙÌÈÛË ÙÔ˘ ·ÏÎÔÔÏÔ‡¯Ô˘ ‰È·Ï‡ÙË ·Ê‹ÓÂÈ Û˘¯Ó¿ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÙÔÍÈ΋ Ô˘Û›· Û Â·Ê‹ Ì ÙËÓ ÂȉÂÚÌ›‰· (16). ∂›Û˘, Â›Ó·È Èı·ÓfiÓ fiÙÈ Ë ·Èı·ÓfiÏË, Ô ‰È·Ï‡Ù˘ Ù˘ DEET, ÂÓÈÛ¯‡ÂÈ ÙË ‰È·ÂÚ·ÙfiÙËÙ· Ù˘ ÙÔÏÔ˘fiÏ˘ Ôχ ÂÚÈÛÛfiÙÂÚÔ ‰È· ̤ÛÔ˘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ ·’ fiÙÈ ÙˆÓ ÂÓËϛΈÓ, ÏfiÁˆ Ù˘ ÏÂÙfiÙËÙ¿˜ ÙÔ˘ Î·È Ù˘ ÌÂÁ¿Ï˘ ·Ó·ÏÔÁÈο Ì ÙË Ì¿˙· ÙÔ˘ ÛÒÌ·ÙÔ˜ ÂÈÊ¿ÓÂÈ·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi Î·È Ì¤¯ÚȘ fiÙÔ˘ ¤¯Ô˘Ì Â·ÚΤÛÙÂÚË ÏËÚÔÊfiÚËÛË, Ë Û‡ÛÙ·ÛË Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∞η‰ËÌ›·˜ ÁÈ· ··ÁfiÚ¢ÛË Ù˘ ¯Ú‹Û˘ Û ·È‰È¿ Û΢·ÛÌ¿ÙˆÓ Ì ÂÚÈÂÎÙÈÎfiÙËÙ· >10%, Ú¤ÂÈ Ó· ·Ú·Ì›ÓÂÈ Ë Î·Ù¢ı˘ÓÙ‹ÚÈ· ÁÚ·ÌÌ‹ (17). √È Û·ÛÌÔ› ·ÔÙÂÏÔ‡Ó ÙÔ Û˘¯ÓfiÙÂÚÔ Û‡Ìو̷ ÙÔÍÈ΋˜ ÂΉ‹ÏˆÛ˘ ·fi DEET, ȉ›ˆ˜ ÌÂÙ¿ ·fi ‰ÂÚÌ·ÙÈ΋ Â·Ê‹ (18). ∞ÎÔÏÔ˘ıÔ‡Ó ÙÔ ÎÒÌ·, Ë ˘ÂÚÙÔÓ›· Î·È Ô ÔÈÛıfiÙÔÓÔ˜, Ë ·Ù·Í›·, Ë ‰È¤ÁÂÚÛË, Ë ˘fiÙ·ÛË Î·È ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜. ™Â ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi, ‚Ú¤ıËΠԛ‰ËÌ· ÂÁÎÂÊ¿ÏÔ˘ Î·È Û˘ÌÊfiÚËÛË ÙˆÓ ÌËÓ›ÁÁˆÓ (19). ∏ Ó¢ÚÔÙÔÍÈÎfiÙËÙ·, ˆ˜ ·ÚÈ· ÂΉ‹ÏˆÛË ÙÔÍÈÎfiÙËÙ·˜ ·fi ÙË DEET, ›Ûˆ˜ ÂÚÌËÓ‡ÂÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë DEET Â›Ó·È ÏÈÔ‰È·Ï˘Ù‹ Ô˘Û›· Î·È Û˘ÛÛˆÚ‡ÂÙ·È ÛÙÔÓ ÂÁΤʷÏÔ. ∏ ÌÂÁ¿ÏË ÔÌÔÈfiÙËÙ· Ô˘ ˘¿Ú¯ÂÈ ÛÙË ‰ÔÌ‹ Ù˘ Ì ÙË ÓÈÎÂÙ·Ì›‰Ë, Ì›· Ô˘Û›· Ô˘ ÚÔηÏ› Û·ÛÌÔ‡˜, ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙË ÌÂÁ¿ÏË ·˘Ù‹ Û˘¯Ófi-

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ÙËÙ· Û·ÛÌÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·È‰È¿ Ì ÙÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ·fi DEET. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÂÓÙÔÌÔ·ˆıËÙÈο Ô˘ ÂÚȤ¯Ô˘Ó ÙË ‰Ú·ÛÙÈ΋ Ô˘Û›· DEET Û ‰È¿ÊÔÚ˜ ÌÔÚʤ˜ (lotion, spray, stick) ‰ÂÓ Â›Ó·È ·ÛÊ·Ï‹ fiÙ·Ó ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙÔ ‰¤ÚÌ· ·È‰ÈÒÓ, Ú¤ÂÈ ‰Â Ó· ·ÔʇÁÂÙ·È Ë Â¿ÏÂÈ„‹ ÙÔ˘˜ Û ‚Ú¤ÊË Î·È ÌÈÎÚ¿ ·È‰È¿. ∫·ıÒ˜ Ë ‰˘ÓËÙÈ΋ ÙÔÍÈÎfiÙËÙ· Ù˘ DEET Â›Ó·È Ôχ ˘„ËÏ‹, ·ÚfiÌÔÈ· ÂÓÙÔÌÔÎÙfiÓ·, ÔÔÈ·Û‰‹ÔÙÂ Û˘ÁΤÓÙÚˆÛ˘ DEET, Ú¤ÂÈ Èı·ÓfiÓ Ó· ·ÓÙÈηٷÛÙ·ıÔ‡Ó ·fi ¿ÏÏ·, ϤÔÓ ·ÛÊ·Ï‹ Û΢¿ÛÌ·Ù·. µÈ‚ÏÈÔÁÚ·Ê›· 1. Are insect repellents safe? [editorial]. Lancet 1988;2:610-611.

2. Tenenbein M. Severe toxic reactions and death following the ingestion of diethyltoluamide-containing insect repellents. JAMA 1987;258:1509-1511.

3. Miller JD. Anaphylaxis associated with insect repellent. N Engl J Med 1982;307:1341-1342.

4. Snyder JW, Poe RO, Stubbins JF, Garrettson LK. Acute manic psychosis following the dermal application of N,NDiethyl-m-toluamide (DEET) in an adult. Clin Toxicol 1986;24:429-439.

5. Vaskov VI, Gleiberman SE, Volkova AP. A study of the long-term effects of the use of repellents. Meditzinskaya Parazit i Parazitarnye Bdezni 1976;720-725.

6. Gilbert IH. Evaluation and use of mosquito repellents.

JAMA 1966;196:253-255.

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16. Curtis CF. Making insect repellents safe [letter]. Lancet 1988;2:1020.

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Birth to age 5. New York: Bantam Books; 1994.

18. Oransky S, Roseman B, Fish D, Gentile T, Melius J, Cartter ML et al. Seizures temporally associated with use of DEET insect repellent. New York and Connecticut. MMWR 1989;38:678-680.

19. Zadikoff CM. Toxic encephalopathy associated with use of insect repellent. J Pediatr 1979;95:140-142.

20. Heick HMC, Shipman RT, Norman MG, James W. Reyelike syndrome associated with use of insect repellent in a presumed heterozygote for ornithine carbamoyl transferase deficiency. J Pediatr 1980;97:471-473.

21. Konovalov GA, Romanov AN. Early hemodialysis in the treatment of severe poisonings with the repellents, DETA, benphthalate and dimethylphthalate. Anesteziol Reanimatol 1980;2:54-55.

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22. Oransky S. Letter dated 7/16/91, on file with the Department of Environment, Bureau of Pesticides Management, Albany, NY.

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CONTINUING MEDICAL EDUCATION

¢È·Ù·Ú·¯¤˜ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Û ·È‰È¿ Ì ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË ∞. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘, Ã. ÷Ù˙Ë·ı·Ó·Û›Ô˘, Ã. £ÂÔ‰ˆÚ›‰Ë˜

Disorders of thyroid function in children with insulin dependent diabetes mellitus (IDDM) A. Kaimara-Papathanasiou, C. Hadjiathanasiou, C. Theodoridis

¶ÂÚ›ÏË„Ë: √È ‰È·Ù·Ú·¯¤˜ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È Û˘¯Ó¤˜ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË. ∂ÌÊ·Ó›˙ÔÓÙ·È Â›Ù ˆ˜ ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉÈ΋ ÓfiÛÔ˜, ‰ËÏ·‰‹ ·ÚÔ˘Û›· ·ÓÙÈı˘ÚÂÔÂȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (∞£∞) ÌfiÓÔÓ, ›Ù ˆ˜ ı˘ÚÂÔÂȉ›ÙȘ Hashimoto (‚ÚÔÁ¯Ô΋ÏË Ì ıÂÙÈο ∞£∞ Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂÈÎfiÓ·), ›Ù ˆ˜ ˘Ô- ‹ ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·Ó‡ÚÂÛ˘ ∞£∞ {ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ı˘ÚÂÔÂȉÈ΋˜ ˘ÂÚÔÍÂȉ¿Û˘ (·ÓÙÈ- TPO)} Û ‰È·‚ËÙÈο ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi 25-40%, fiÛÔ ÂÚ›Ô˘ Î·È Ë Û˘¯ÓfiÙËÙ· Ù˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto. √È ‰È·Ù·Ú·¯¤˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó ÙË Ú‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË, ÂÓÒ Ë ·ÔÚÚ‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙȘ ‰ÔÎÈ̷ۛ˜ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∆· Û˘ÌÙÒÌ·Ù· ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÌÔÚ› Ó· Â›Ó·È ‹È·, fiˆ˜ ηı˘ÛÙ¤ÚËÛË Ù˘ ηı’ ‡„Ô˜ ·Ó¿Ù˘Í˘, ÂÌÊ¿ÓÈÛË ‚ÚÔÁ¯Ô΋Ï˘ ‹ ÂÌÊ¿ÓÈÛË ˘ÔÁÏ˘Î·ÈÌÈÒÓ, ÂÓÒ Ô ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ ÂÎÙfi˜ ·fi Ù· Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· (Ù·¯˘Î·Ú‰›Â˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·) ÌÔÚ› Ó· ÚÔηϤÛÂÈ ˘ÂÚÁÏ˘Î·ÈÌ›·. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË Ì „ËÏ¿ÊËÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜, Ë Î·Ù·ÁÚ·Ê‹ Ù˘ ηÌ‡Ï˘ ·Ó¿Ù˘Í˘ ηıÒ˜ Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ∞£∞ Â›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÔÓÙ·È ÛÙ· ‰È·‚ËÙÈο ·È‰È¿ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÁÓˆÛÙ› Î·È Ó· ıÂÚ·¢Ù› ¤ÁηÈÚ· Ù˘¯fiÓ ı˘ÚÂÔÂȉÔ¿ıÂÈ·. ™Ù· ‰È·‚ËÙÈο ·È‰È¿ Ì ıÂÙÈο ∞£∞ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÙˆÓ Û˘ÁÁÂÓÒÓ Ì ÚÔÛ‰ÈÔÚÈÛÌfi ∞£∞ ÁÈ· ÙË ‰È·›ÛÙˆÛË Ù˘¯fiÓ ·‰È¿ÁÓˆÛÙ˘ ı˘ÚÂÔÂȉÔ¿ıÂÈ·˜, ηıÒ˜ Î·È ÚÔÛ‰ÈÔÚÈÛÌfi˜ ¿ÏÏˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· ÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÂÈΛÌÂÓˆÓ ·ÓÂ·ÚÎÂÈÒÓ ¿ÏÏˆÓ ÂÓ‰ÔÎÚÈÓÒÓ ·‰¤ÓˆÓ.

Abstract: Disorders of thyroid function are common in children with IDDM. They present either as an autoimmune thyroid disease (presence of thyroid autoantibodies only), or as Hashimoto thyroiditis (goiter with positive antithyroid antibodies and characteristic u/s appearance), or as hypo- or hyperthyroidism. The frequency of detection of antithyroid antibodies {against thyroid hyperoxidase (anti- TPO)} in diabetic children ranges between 25-40%, a frequency which is similar to the prevalence of Hashimoto thyroiditis. Thyroid function disorders may influence the control of diabetes, and conversely uncontrolled diabetes can influence the results of the thyroid function tests.

Signs of hypothyroidism can be mild, as for example growth delay, development of signs of goiter or of hypoglycemia. Hyperthyroidism, besides the usual symptoms (tachycardia, weight loss, hyperkinesis), may also cause hyperglycemia.

Diabetic children should be carefully examined for the presence of signs of thyroid dysfunction.

Clinical examination should include palpation of the thyroid, careful monitoring of the growth curve and determination of antithyroid antibodies in order to detect promptly the presence of thyroid dysfunction and initiate therapy. In diabetic children with positive antithyroid antibodies, their first degree relatives should be screened for the presence of antithyroid antibodies in order to make an early diagnosis of thyroid dysfunction, as well as the presence of other autoantibodies for the prompt detection of impending failure of other endocrine organs.

∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

Department of Pediatric Endocrinology Children’s Hospital “P. & A. Kyriakou”, Athens

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§¤ÍÂȘ ÎÏÂȉȿ: ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ·È‰È¿, ı˘ÚÂÔÂȉ›ÙȘ, ·ÓÙÈı˘ÚÂÔÂȉÈο ·ÓÙÈÛÒÌ·Ù·.

Key words: diabetes mellitus, children, thyroiditis, antithyroid antibodies.

∂ÈÛ·ÁˆÁ‹ H Û˘Û¯¤ÙÈÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ì ¿ÏϘ ÂÓ‰ÔÎÚÈÓÈΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È ÁÓˆÛÙ‹ ·fi Ù· Ù¤ÏË ÙÔ˘ ÂÚ·Ṳ̂ÓÔ˘ ·ÈÒÓ· (1). √È ·Ú¯ÈΤ˜ ÂӉ›ÍÂȘ fiÙÈ Ô ‰È·‚‹Ù˘ ¤¯ÂÈ Û¯¤ÛË Ì ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÚÔ‹Ïı·Ó ·fi ÈÛÙÔÏÔÁÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ ·ÁÎÚ¤·ÙÔ˜ ÛÙȘ Ôԛ˜ ˘‹Ú¯Â ‰È‹ıËÛË ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ∆Ô 1974 Ì ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ ÓËÛȉ›ˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ ÂȂ‚·ÈÒıËΠfiÙÈ Ô ‰È·‚‹Ù˘ Â›Ó·È ·˘ÙÔ¿ÓÔÛË ÓfiÛÔ˜ (2,3). ŒÎÙÔÙÂ, ÔÏϤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÙËÓ ·ÚÔ˘Û›· ÂȉÈÎÒÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Û ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ÛÂ Û˘ÁÁÂÓ›˜ ÚÒÙÔ˘ ‚·ıÌÔ‡, ÂÓÒ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÂÓÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘, ÔÈ Ôԛ˜ ÚÔ·ÙÔ˘Ó ·fi ÌÂϤÙ˜ ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙÔ˜ HLA8, Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË, ÙË ı˘ÚÂÔÙÔ͛ΈÛË Î·È ÙË ÓfiÛÔ ÙÔ˘ Addison (4,5). ¶·Ú¿ ÙËÓ ÙÂÚ¿ÛÙÈ· ÚfiÔ‰Ô Ô˘ ¤¯ÂÈ Á›ÓÂÈ ÛÙÔ˘˜ ÙÔÌ›˜ Ù˘ ·ÓÔÛÔÏÔÁ›·˜ Î·È ÁÂÓÂÙÈ΋˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛı› Ï‹Úˆ˜ Ô Ì˯·ÓÈÛÌfi˜ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ‰È·‰Èηۛ·˜ Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Î·È Û˘ÓÔ‰ÒÓ ÂÓ‰ÔÎÚÈÓÔ·ıÂÈÒÓ. √È ‰È·Ù·Ú·¯¤˜ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÙȘ ·ÎfiÏÔ˘ı˜ ÌÔÚʤ˜: ·) ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉÈ΋ ÓfiÛÔ˜, ‚) ı˘ÚÂÔÂȉ›ÙȘ Hashimoto, Á) ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, ‰) ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜.

ÎÒÓ ·ÓÙÈۈ̿وÓ. ™Â 136 ·ÛıÂÓ›˜ (17,6%) ·Ó¢ڤıËÎ·Ó ıÂÙÈο ·ÓÙÈ- TPO Î·È Ë ·Ó·ÏÔÁ›· ÎÔÚÈÙÛÈÒÓ ÚÔ˜ ·ÁfiÚÈ· ‹Ù·Ó 2/1. ∆· ·ÓÙÈ- ∆g ‹Ù·Ó ıÂÙÈο Û ÔÛÔÛÙfi 1,6%, ÙÔ ÔÔ›Ô ‰ÂÓ ‰È¤ÊÂÚ ·fi ÔÌ¿‰· Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ (11). ™Â 117 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ıÂÙÈο ·ÓÙÈ- ∆ƒ√ ÌÂÏÂÙ‹ıËÎÂ Ë ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ù· ÂfiÌÂÓ· 5 ¯ÚfiÓÈ·. √ÎÙÒ ·ÛıÂÓ›˜ (7%) ‹Ù·Ó ˘ÂÚı˘ÚÂÔÂȉÈÎÔ›, 45 (38%) ˘Ôı˘ÚÂÔÂȉÈÎÔ›, ÂÓÒ 64 (55%) ·Ú¤ÌÂÈÓ·Ó Â˘ı˘ÚÂÔÂȉÈÎÔ›, Ì ÙÈÌ‹ fï˜ TSH ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Î·È ÂχıÂÚË T4 ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË Û ۯ¤ÛË Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÙÈ̤˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÚÓËÙÈο ·ÓÙÈ- ∆ƒ√. √ ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ Û 7 ·fi ÙÔ˘˜ 8 ·ÛıÂÓ›˜ ‰È·ÁÓÒÛıËΠÚÈÓ ‹ ηٿ ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË, ÂÓÒ Û ¤Ó· ·ÛıÂÓ‹ ·ÚÔ˘ÛÈ¿ÛÙËΠÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛ‹ ÙÔ˘. ∞fi ÙÔ˘˜ 45 ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÈÛÙÒıËΠ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, Û 4 Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ‰È·‚‹ÙË, Û 10 ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Î·È Û 31 ·fi ·˘ÙÔ‡˜ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ·fi ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ‰È·‚‹ÙË. ¡Â·ÚÔ› ·ÛıÂÓ›˜ Ì ‰È·‚‹ÙË Ù‡Ô˘ π ·ÚÔ˘Û›·˙·Ó ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ıÂÙÈο ∞£∞ ηıÒ˜ Î·È ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔȯˆÌ·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (PCA) Û ÂÓÙ·Ï¿ÛÈ· Û˘¯ÓfiÙËÙ· Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÔÌ¿‰· ÂϤÁ¯Ô˘ ÌË ‰È·‚ËÙÈÎÒÓ ·È‰ÈÒÓ ›‰È·˜ ËÏÈΛ·˜. √È Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ Èı·ÓfiÓ Ë ·˘ÙÔ¿ÓÔÛË ‰È·‰Èηۛ· Ó· ·Ú¯›˙ÂÈ Û˘Á¯ÚfiÓˆ˜ ÛÙÔ ı˘ÚÂÔÂȉ‹, ÙÔ Á·ÛÙÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ Î·È Ù· ÓËÛ›‰È· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ (9). ™Â ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ·ÚÁfiÙÂÚ· Û ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ (371 ·ÛıÂÓ›˜ ËÏÈΛ·˜ 3-22 ÂÙÒÓ, Ì ‰È¿ÚÎÂÈ· ‰È·‚‹ÙË 0-17 ¯ÚfiÓÈ·) ‚Ú¤ıËÎ·Ó ıÂÙÈο ·ÓÙÈ- TPO Û ÔÛÔÛÙfi 15,9%, ·ÓÙÈ- Tg Û 7,5% Î·È ·ÚÔ˘Û›· Î·È ÙˆÓ 2 ·ÓÙÈÛˆÌ¿ÙˆÓ Û 4,3% ÙˆÓ ·ÛıÂÓÒÓ. √ Ú˘ıÌfi˜ ıÂÙÈÎÔÔ›ËÛ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó ÛËÌ·ÓÙÈÎfi˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÊ˂›·˜ (12).

∞˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉÈ΋ ÓfiÛÔ˜ (Autoimmune thyroid disease, AITD) ∞ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ· ÛÙ· ·È‰È¿ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË. ÷ڷÎÙËÚÈÛÙÈÎfi Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ı˘ÚÂÔÂȉÔ¿ıÂÈ·˜ Â›Ó·È Ë ·Ó‡ÚÂÛË ∞£∞ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ, ‰ËÏ·‰‹ ·ÓÙÈÌÈÎÚÔÛˆÌÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (·ÓÙÈ- ª), Ù· ÔÔ›· Â›Ó·È Ù·˘ÙfiÛËÌ· Ì ٷ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ˘ÂÚÔÍÂȉ¿Û˘ (·ÓÙÈ- TPO), ηıÒ˜ Î·È ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ı˘ÚÂÔÛÊ·ÈÚ›Ó˘ (·ÓÙÈ- Tg). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·Ó›¯Ó¢Û˘ ∞£∞ Û ‰È·‚ËÙÈο ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Î˘Ì·›ÓÂÙ·È ·fi 7-40% Î·È Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Ù˘ ·ÓÙ›ÛÙÔȯ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (6-10). ∏ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÔÊ›ÏÂÙ·È ÛÙȘ ‰È·ÊÔÚ¤˜ ÌÂıÔ‰ÔÏÔÁ›·˜, ËÏÈΛ·˜, ʇÏÔ˘ Î·È ÂıÓÈÎfiÙËÙ·˜ ÛÙȘ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ. ∆Ô 1981 Ô Riley ÌÂϤÙËÛ 771 Ó·ÚÔ‡˜ ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π ÁÈ· ÙËÓ ·ÚÔ˘Û›· ∞£∞ ηıÒ˜ Î·È ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔȯˆÌ·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ (PCA) Î·È ·ÓÙÈÂÈÓÂÊÚȉȷ-

£˘ÚÂÔÂȉ›ÙȘ Hashimoto ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ‚ÚÔÁ¯Ô΋Ï˘ Î·È ˘„ËÏÔ‡ Ù›ÙÏÔ˘ ∞£∞. ™¿ÓÈ· ÔÈ ·ÛıÂÓ›˜ ÌÔÚ› Ó· ÌËÓ ¤¯Ô˘Ó ‚ÚÔÁ¯Ô΋ÏË, ÔfiÙÂ Ë ·ÚÔ˘Û›· ∞£∞ Â›Ó·È Ë ÌfiÓË ¤Ó‰ÂÈÍË ı˘ÚÂÔÂȉ›Ùȉ·˜. ∏ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· ·Ó¿Ù˘ÍË ‰È·Ù·Ú·¯‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ‰ÂÓ Â›Ó·È ÛËÌ·ÓÙÈ΋, ȉ›ˆ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ŒÓ· ÌÈÎÚfi ÔÛÔÛÙfi ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈο ÛËÌ›· ˘Ô- ‹ ˘ÂÚÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜

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¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ (13). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto Ì ‚¿ÛË ÙËÓ ·ÚÔ˘Û›· ‚ÚÔÁ¯Ô΋Ï˘ Î·È ˘„ËÏÔ‡ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 40% ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ (14). ∂¿Ó ÛÙ· ÎÚÈÙ‹ÚÈ· Ù˘ ‰È¿ÁÓˆÛ˘ ÚÔÛÙÂı› ÙÔ U/S ı˘ÚÂÔÂȉԇ˜ ‹ Ë ‚ÈÔ„›· ‰È¿ ÏÂÙ‹˜ ‚ÂÏfiÓ˘, Ë Û˘¯ÓfiÙËÙ· Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚË (3,9%) (15). ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È Û·ÊÒ˜ ˘„ËÏfiÙÂÚÔ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÛÙÔ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi (16). ∫ÏÈÓÈ΋ ÂÈÎfiÓ·: ∏ ‚ÚÔÁ¯Ô΋ÏË ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ÛÙ·‰È·Î¿, Â›Ó·È ÌÈÎÚÔ‡ ‹ ÌÂÙÚ›Ô˘ ÌÂÁ¤ıÔ˘˜ Î·È ¤¯ÂÈ ·ÓÒÌ·ÏË ÂÈÊ¿ÓÂÈ· Î·È ÂÏ·ÛÙÈ΋ Û‡ÛÙ·ÛË. ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Â›Ó·È ÎÏÈÓÈο ¢ı˘ÚÂÔÂȉÈο Î·È ·Û˘Ìو̷ÙÈο, ÂÓÒ ÌÂÚÈο ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ·›ÛıËÌ· ›ÂÛ˘ ÛÙÔ Ï·ÈÌfi ‹ ‰˘ÛÎÔϛ˜ ηٿÔÛ˘. ∏ ‚ÚÔÁ¯Ô΋ÏË ÌÔÚ› Ó· ÂÏ·ÙÙˆı› Û ̤ÁÂıÔ˜ Î·È Ó· ÂÍ·Ê·ÓÈÛı› ‹ Ó· ·Ú·Ì›ÓÂÈ ·ÌÂÙ¿‚ÏËÙË ÁÈ· ¯ÚfiÓÈ·. ∞ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ Â›Ó·È Â˘ı˘ÚÂÔÂȉÈÎÔ› ·Ú¯Èο, ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô ÌËÓÒÓ ‹ ÂÙÒÓ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·: √È ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈΤ˜, ÂÓÒ Ë TSH ÌÔÚ› Ó· Â›Ó·È ÂÏ·ÊÚ¿ ‹ ̤ÙÚÈ· ·˘ÍË̤ÓË Û ÎÏÈÓÈο ¢ı˘ÚÂÔÂȉÈÎÔ‡˜ ·ÛıÂÓ›˜. ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ·ÓÂ·ÚΛ Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Ì ÙÒÛË ·Ú¯Èο Ù˘ ∆4, ÂÓ Û˘Ó¯›· Ù˘ ∆3 Î·È ¿ÓÔ‰Ô Ù˘ TSH. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ·ÚÎÂÙÔ› ·ÛıÂÓ›˜ Ì ‚ÚÔÁ¯Ô΋ÏË ‰ÂÓ ¤¯Ô˘Ó ·˘ÍË̤ÓË TSH ÔÊ›ÏÂÙ·È Èı·ÓfiÓ ÛÙË ‰Ú¿ÛË ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ÙËÓ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ (Thyroid Stimulating Immunoglobulins). ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÈÎfiÓ· Ì ·ÓÒÌ·ÏË ÚfiÛÏË„Ë ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ηٿ ÂÚÈÔ¯¤˜. H ÂÈÎfiÓ· ·˘Ù‹, Ë ÔÔ›· Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ‰ÂÓ ÂÌÊ·Ó›˙ÂÙ·È ¿ÓÙ· ÛÙ· ·È‰È¿. ∞ÓÙ›ıÂÙ·, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÈÎfiÓ· Ì ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·‰¤Ó· Î·È ·ÓÔÌÔÈÔÁ¤ÓÂÈ· Ù˘ ˘Ê‹˜ ÙÔ˘, Ì ‰È¿Û·ÚÙ˜ ÌÈÎÚ¤˜ ˘Ô˯ÔÁÂÓ›˜ ÂÚÈÔ¯¤˜. ∆· ·ÓÙÈ– TPO Â›Ó·È ıÂÙÈο Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 90%, ÂÓÒ Ù· ·ÓÙÈ– Tg Û ÔÛÔÛÙfi ÂÚ›Ô˘ 50%. °ÂÓÂÙÈ΋ ÚԉȿıÂÛË: ™Â ÌÂϤÙË 255 ·ÙfiÌˆÓ Ô˘ ›¯·Ó ‰È·‚‹ÙË Ù‡Ô˘ π Û ·È‰È΋ ËÏÈΛ· Î·È 597 Û˘ÁÁÂÓÒÓ ÙÔ˘˜ ÚÒÙÔ˘ ‚·ıÌÔ‡ ‚Ú¤ıËΠ·˘ÍË̤ÓË Â›ÙˆÛË ı˘ÚÂÔÂȉ›Ùȉ·˜ Hashimoto ΢ڛˆ˜ ÛÙȘ Á˘Ó·›Î˜ (54% Û ËÏÈ˘ <40 ÂÙÒÓ, ¤ˆ˜ 75% Û ËÏÈ˘ >50 ÂÙÒÓ) (22). √È ÌÈÛÔ› ÂÚ›Ô˘ ·fi ·˘ÙÔ‡˜ ‹Ù·Ó ¢ı˘ÚÂÔÂȉÈÎÔ› Î·È ·ÚÔ˘Û›·Û·Ó Î·È ¿ÏÏ· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ‹ ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ‰È·‚ËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ‹Ù·Ó ˘Ôı˘ÚÂÔÂȉÈÎÔ› ‹ ‰ÂÓ Â›¯·Ó ı˘ÚÂÔÂȉÔ¿ıÂÈ·. ∏ ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ ‰ÈÏ¿ÛÈ·

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·‡ÍËÛË ÛÙÔÓ ·ÏfiÙ˘Ô DQA1*0501-DQB1*0201 ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ı˘ÚÂÔÂȉ›Ùȉ· Hashimoto. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È ÂÓ Ì¤ÚÂÈ Û ÎÔÈÓ¿ ÁÔÓ›‰È· Ù· ÔÔ›· Úԉȷı¤ÙÔ˘Ó ÛÙȘ ÓfiÛÔ˘˜ (22). £ÂÚ·›·: ŸÙ·Ó Ë ı˘ÚÂÔÂȉ›Ùȉ· ÚÔηÏ› ˘ÔÎÏÈÓÈÎfi ‹ ¤Î‰ËÏÔ ˘Ôı˘ÚÂÔÂȉÈÛÌfi Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È ÔˆÛ‰‹ÔÙ ı˘ÚÔÍ›ÓË Û ‰fiÛË ˘ÔηٿÛÙ·Û˘. ¢ÂÓ ˘¿Ú¯ÂÈ Û˘Ìʈӛ· fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·›· ÙˆÓ Â˘ı˘ÚÂÔÂȉÈÎÒÓ ·ÛıÂÓÒÓ. ™Â Ì›· ÌÂϤÙË 32 ·È‰ÈÒÓ Ù· ÔÔ›· ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· 3 ¯ÚfiÓÈ·, ¤Ó· ÔÛÔÛÙfi 8% ‰ÂÓ ¯ÚÂÈ¿ÛÙËΠıÂÚ·›·, ÙÔ 33% Ô˘ ¿Ú¯ÈÛ ·Ì¤Ûˆ˜ ÌfiÚÂÛ ӷ ÙË ‰È·Îfi„ÂÈ ÌÂÙ¿ ·fi ¤Ó· ‹ ‰‡Ô ¯ÚfiÓÈ·, ÂÓÒ ÙÔ 59% Ô˘ ‰ÂÓ ¿Ú¯ÈÛ ·Ì¤Ûˆ˜ ıÂÚ·›· ·Ó·ÁοÛÙËΠӷ ·Ú¯›ÛÂÈ ÌÂÙ¿ ·fi ¤Ó· ‹ ‰‡Ô ¯ÚfiÓÈ·. ™˘ÓÂÒ˜, Ë ıÂÚ·›· Èı·ÓfiÓ Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ˆ˜ ÚfiÏË„Ë Û ¢ı˘ÚÂÔÂȉÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ı˘ÚÂÔÂȉ›Ùȉ· Hashimoto (25). ¢ÂÓ ˘¿Ú¯Ô˘Ó ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ Ô˘ Ó· ÚԂϤÔ˘Ó ÙË Ê˘ÛÈ΋ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘. ∂¿Ó Ë ıÂÚ·›· ‰È·ÎÔ› ÏfiÁˆ Â›Ù¢Í˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Â›Ó·È ··Ú·›ÙËÙË. £· Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ∞£∞ Â›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÂÙ·È Û·Ó ÂͤٷÛË ÚÔ˘Ù›Ó·˜ Û οı ‰È·‚ËÙÈÎfi ·È‰›, Ë ·Ó‡ÚÂÛË ‰Â, ıÂÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË ˘Ô- ‹ ˘ÂÚı˘ÚÂÔÂȉÈÛÌÔ‡. ™Â οı Â›ÛÎÂ„Ë ·È‰ÈÔ‡ ÛÙÔ ‰È·‚ËÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô ÂÎÙfi˜ ·fi ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ‡„Ô˘˜ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÛÙ· ‰È·ÁÚ¿ÌÌ·Ù·, Ú¤ÂÈ ¿ÓÙ· Ó· „ËÏ·Ê¿Ù·È Ô ı˘ÚÂÔÂȉ‹˜ ÁÈ· Èı·Ó‹ ‰ÈfiÁΈÛË Î·È Ì ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ó· ·Ó·Î·Ï‡ÙÂÙ·È ¤ÁηÈÚ· Î·È Ó· ıÂÚ·‡ÂÙ·È Ë ı˘ÚÂÔÂȉ›ÙȘ. ÀÔı˘ÚÂÔÂȉÈÛÌfi˜ ŒÎ‰ËÏÔ˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ (ÂÌÊ¿ÓÈÛË ÎÏÈÓÈÎÒÓ Û˘Ìو̿وÓ, ÂÏ¿ÙÙˆÛË Ù˘ ∆4, ·‡ÍËÛË Ù˘ TSH) ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û ÔÛÔÛÙfi 1-3% ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÚÔ˘Û›· ‹ ÌË ∞£∞. √È ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ıÂÙÈο ·ÓÙÈÛÒÌ·Ù· ·Ó·Ù‡ÛÛÔ˘Ó Û˘¯ÓfiÙÂÚ· ˘Ôı˘ÚÂÔÂȉÈÛÌfi. √ ˘ÔÎÏÈÓÈÎfi˜ ‹ ·ÓÙÈÚÚÔÔ‡ÌÂÓÔ˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ê˘ÛÈÔÏÔÁÈ΋ ∆4, ·˘ÍË̤ÓË TSH Î·È ¤ÏÏÂÈ„Ë Û˘ÌÙˆÌ¿ÙˆÓ Î·È ·Ú·ÙËÚÂ›Ù·È Û 1,4-10% ÙˆÓ Ó·ÚÒÓ ‰È·‚ËÙÈÎÒÓ ·ÛıÂÓÒÓ, ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ∞£∞ (17). ∫ÏÈÓÈ΋ ÂÈÎfiÓ·: ∆· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÌÔÚ› Ó· Â›Ó·È ‹È· Î·È Ó· ‰È·Ê‡ÁÔ˘Ó Ù˘ ÚÔÛÔ¯‹˜ ‹ Ó· ·Ô‰ÔıÔ‡Ó Û η΋ Ú‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË (18). ∏ ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘

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ÌÔÚ› Ó· ˘ÔÎÚ‡ÙÂÈ ˘Ôı˘ÚÂÔÂȉÈÛÌfi. ∂Ô̤ӈ˜, Â›Ó·È ··Ú·›ÙËÙË Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘ ÙˆÓ ‰È·‚ËÙÈÎÒÓ ·È‰ÈÒÓ Î·È Ë „ËÏ¿ÊËÛË ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ÁÈ· ÂÎÙ›ÌËÛË Ù˘¯fiÓ ‰ÈfiÁΈÛ˘ ÙÔ˘ ·‰¤Ó·. ™Â ÌÂϤÙË 184 ‰È·‚ËÙÈÎÒÓ ·È‰ÈÒÓ Ôfi ÙËÓ √ÍÊfiÚ‰Ë ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÙÔ ‡„Ô˜ ηٿ ÙË ‰È¿ÁÓˆÛË ‰ÂÓ ‰È¤ÊÂÚ ·fi ÙÔ ‡„Ô˜ ÌË ‰È·‚ËÙÈÎÒÓ ·È‰ÈÒÓ Ù˘ ›‰È·˜ ËÏÈΛ·˜ (19). ∆Ô ÂÊË‚ÈÎfi ¿ÏÌ· ‡„Ô˘˜ ‹Ù·Ó ÌÂȈ̤ÓÔ Î˘Ú›ˆ˜ ÛÙ· ÎÔÚ›ÙÛÈ·. ∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ˘ÔÏÂÈfiÙ·Ó Û ·È‰È¿ ÛÙ· ÔÔ›· Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ Û ËÏÈΛ· 0 - 5 ÂÙÒÓ, ÂÓÒ ‰È·ÙËÚÔ‡ÓÙ·Ó Û ·È‰È¿ ÛÙ· ÔÔ›· Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ (19). ÕÏÏ· ÎÏÈÓÈο ÛËÌ›· ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ Â›Ó·È Ë ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜, Ë ÙÚ·¯‡ÙËÙ· ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ÚÔÛÒÔ˘, Ë ÍËÚfiÙËÙ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, Ë ·Ú·›ˆÛË Ù˘ ÙÚ›¯ˆÛ˘, Ë ‚Ú·‰‡ÙËÙ· ÙˆÓ ·ÓÙȉڿÛˆÓ, Ë ÙÒÛË Ù˘ Û¯ÔÏÈ΋˜ ·fi‰ÔÛ˘ Î·È ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ÂÌÌ‹ÓÔ˘ Ú‡Ûˆ˜ ÛÙ· ÎÔÚ›ÙÛÈ·. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·: ∞Ó¢ڛÛÎÂÙ·È ·ÓÙÈÚÚÔÔ‡ÌÂÓÔ˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ∆3, ∆4 Î·È ·‡ÍËÛË Ù˘ TSH ‹ ¤Î‰ËÏÔ˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ Ì ÂÏ¿ÙÙˆÛË Ù˘ ∆3, ∆4 Î·È ·‡ÍËÛË Ù˘ TSH. √È ‰È·Ù·Ú·¯¤˜ Ù˘ Ú‡ıÌÈÛ˘ ÙÔ˘ ‰È·‚‹ÙË ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ ÛÙÔ ·›Ì·. ™Â ˘ÁÈ›˜ ÔÚÁ·ÓÈÛÌÔ‡˜ Ë ∆4 ÌÂÙ·ÙÚ¤ÂÙ·È ÂÚ›Ô˘ ›Û· Û ∆3 Î·È ·Ó¿ÛÙÚÔÊË ∆3 (rT3) ·ÏÏ¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÓfiÛÔ˘ ·Ú¿ÁÂÙ·È ÏÈÁfiÙÂÚË ∆3, ÂÓÒ ÂÚÈÛÛfiÙÂÚË ÌÂÙ·ÙÚ¤ÂÙ·È ÛÙËÓ ·ÓÂÓÂÚÁ‹ ÌÔÚÊ‹ rT3. ™Â ÌË ÂÏÂÁ¯fiÌÂÓË ˘ÂÚÁÏ˘Î·ÈÌ›· ‹ ÎÂÙÔͤˆÛË ÂÏ·ÙÙÒÓÂÙ·È Ë ÔÏÈ΋ ı˘ÚÔÍ›ÓË Î·È Ë TBG, Ë fT4 Î·È Ë TSH ·Ú·Ì¤ÓÔ˘Ó Ê˘ÛÈÔÏÔÁÈΤ˜ Î·È ÂÏ·ÙÙÒÓÂÙ·È Â›Û˘ Ë fT3, ÂÓÒ ·˘Í¿ÓÂÙ·È Ë rT3 (18). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ Â›Ó·È ‰‡ÛÎÔÏË Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙË Ê¿ÛË Ù˘ ÌÂÙ·‚ÔÏÈ΋˜ ‰È·Ù·Ú·¯‹˜ Ô˘ ÂÈÎÚ·Ù›. √ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ‰È·Ù·Ú·¯¤˜ ÛÙÔ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ˘‰·Ù·ÓıÚ¿ÎˆÓ Î·È ÏÈÒÓ (20) Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÂÏ¿ÙÙˆÛË Ù˘ ÓÂÔÁÏ˘ÎÔÁ¤ÓÂÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· ÂÌÊ¿ÓÈÛË ˘ÔÁÏ˘Î·ÈÌÈÒÓ Î·ıÒ˜ Î·È Û˘ÛÛÒÚ¢ÛË Ï›Ô˘˜ Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ. £ÂÚ·›·: ŸÙ·Ó Ë TSH ·Ó¢ڛÛÎÂÙ·È ¿Óˆ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi, Ô ·ÛıÂÓ‹˜ Ú¤ÂÈ Ó· ıÂÚ·‡ÂÙ·È Ì L-ı˘ÚÔÍ›ÓË Û ‰fiÛË 25-150 Ìg/Ë̤ڷ, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· (100 Ìg/m2/Ë̤ڷ ‹ 2,5 Ìg/kg/Ë̤ڷ). ∏ ‚ÚÔÁ¯Ô΋ÏË ÌÔÚ› Ó· ÂÏ·ÙÙˆı› Û ̤ÁÂıÔ˜ ‹ Ó· ·Ú·Ì›ÓÂÈ ·ÌÂÙ¿‚ÏËÙË, Ù· ‰Â ·ÓÙÈÛÒÌ·Ù· ¤¯Ô˘Ó ‰È·Î˘Ì¿ÓÛÂȘ, ÙfiÛÔ Û ·ÛıÂÓ›˜ Ô˘ ıÂÚ·‡ÙËÎ·Ó fiÛÔ Î·È Û ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ‹Ú·Ó ıÂÚ·-

Paediatriki 2001;64:188-193

›·. ∂¿Ó, ·Ú¿ ÙËÓ Î·Ù·ÛÙ·ÏÙÈ΋ ıÂÚ·›·, ‰ËÌÈÔ˘ÚÁËıÔ‡Ó fi˙ÔÈ ÔÈ ÔÔ›ÔÈ ·˘Í¿ÓÔÓÙ·È Û ̤ÁÂıÔ˜, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Î·È ·Ê·›ÚÂÛË, ‰ÈfiÙÈ Â›Ó·È ‰˘Ó·ÙfiÓ Û ÌÈÎÚfi ÔÛÔÛÙfi Ó· ·Ó·Ù˘¯ı› ηÚΛÓÔ˜ Â› ‰¿ÊÔ˘˜ ı˘ÚÂÔÂȉ›Ùȉ·˜. ŸÙ·Ó Ë ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â·Ó¤ÏıÂÈ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ù˘ ‰fiÛ˘ Ù˘ ÈÓÛÔ˘Ï›Ó˘. ¶Ú¤ÂÈ ¿ÓÙ· Ó· ˘Ô„È·˙fiÌ·ÛÙ ˘Ôı˘ÚÂÔÂȉÈÛÌfi fiÙ·Ó ÙÔ ‰È·‚ËÙÈÎfi ·È‰› ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÂÍ‹ÁËÙ· ˘ÔÁÏ˘Î·È̛˜ ‹ ÙÒÛË ÙÔ˘ Ú˘ıÌÔ‡ ·Ó¿Ù˘Í˘. ∏ ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ¿ÓÙ· ηٿ ÙËÓ ÚÒÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‰È·‚‹ÙË ÌÂÙ¿ ÙË ‰ÈfiÚıˆÛË Ù˘ ÎÂÙÔͤˆÛ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ÊÔÚ¿ ÙÔ ¯ÚfiÓÔ ·ÎfiÌ· Î·È Û ·ÛıÂÓ›˜ Ì ∞£∞. ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi Ó· ‰È·ÈÛÙÒÛÔ˘Ì ¤ÁηÈÚ· ÙÔÓ ˘ÔÎÏÈÓÈÎfi ˘Ôı˘ÚÂÔÂȉÈÛÌfi Û ¤Ó· ·È‰› Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË, ÁÈ·Ù› ·˘Ùfi˜ ÌÔÚ› Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÙÔ Ú˘ıÌfi ·Ó¿Ù˘Í˘ Î·È ÙËÓ ÂÊË‚È΋ ˆÚ›Ì·ÓÛË. √ ‰È·‚‹Ù˘ Ô˘ ‰ÂÓ Ú˘ıÌ›˙ÂÙ·È Î·Ï¿ ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ÂȉÂÈÓˆıÔ‡Ó fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜. ∂Ô̤ӈ˜ ÂÈ‚¿ÏÏÂÙ·È Î·Ï‹ Ú‡ıÌÈÛË ÙÔ˘ ‰È·‚‹ÙË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘¯fiÓ Û˘Ó˘¿Ú¯ÔÓÙÔ˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡. ÀÂÚı˘ÚÂÔÂȉÈÛÌfi˜ √ ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Û ‰È·‚ËÙÈο ·È‰È¿ Û ۯ¤ÛË Ì ÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Î·È ˘ÔÏÔÁ›˙ÂÙ·È Û ÔÛÔÛÙfi 0,5-7% ÙˆÓ ·È‰ÈÒÓ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË (21,23). °ÂÓÈο ‰ÂÓ Â›Ó·È ÙfiÛÔ Û˘¯Ófi˜ fiÛÔ Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ ‹ Ë ı˘ÚÂÔÂȉ›ÙȘ Hashimoto. ™˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ‰È·‚‹ÙË, Û ÌÂÚÈΤ˜ fï˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ÚÔËÁÂ›Ù·È ‹ Ó· ÂÌÊ·ÓÈÛı› Û˘Á¯ÚfiÓˆ˜ Ì ÙÔ ‰È·‚‹ÙË. ∫ÏÈÓÈ΋ ÂÈÎfiÓ·: ∆· Û˘ÌÙÒÌ·Ù· Â›Ó·È Ù·¯˘Î·Ú‰›·, ÙÚfiÌÔ˜ Î·È ‰˘Û·ÓÂÍ›· ÛÙË ˙¤ÛÙË. ™˘ÁÎÈÓËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· ÌÔÚÔ‡Ó Ó· ÂÌÊ·ÓÈÛıÔ‡Ó ÓˆÚ›˜. ∏ ‚ÚÔÁ¯Ô΋ÏË ÌÔÚ› Ó· Â›Ó·È ÌÈÎÚÔ‡ ‹ ÌÂÙÚ›Ô˘ ÌÂÁ¤ıÔ˘˜, Û˘Ó‹ıˆ˜ ‰Â ˘¿Ú¯ÂÈ Î·È ÂÍfiÊı·ÏÌÔ˜. ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·: √È ÙÈ̤˜ Ù˘ ∆3, ∆4, fT3 Î·È f∆4 Â›Ó·È ·˘ÍË̤Ó˜, ÂÓÒ Ë TSH ηÙÂÛÙ·Ï̤ÓË. ™Â ÂÚÈÙÒÛÂȘ ÔÚȷο ·˘ÍËÌ¤ÓˆÓ ÙÈÌÒÓ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÔÚÌÔÓÒÓ ‹ ·Ô˘Û›·˜ ÂÌÊ·ÓÒÓ Û˘Ìو̿وÓ, Ë ‰ÔÎÈÌ·Û›· TRH ÂȂ‚·ÈÒÓÂÈ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ˘ÂÚı˘ÚÂÔÂȉÈÛÌÔ‡. ™ÙÔÓ ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi Ë ÌÂÙ·‚ÔÏÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ˘ÂÚÈÛ¯‡ÂÈ Â›Ó·È Ë ˘ÂÚÁÏ˘Î·ÈÌ›·. √Ê›ÏÂÙ·È Û ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ˘˜ ÂÚÈÊÂÚÈÎÔ‡˜ ÈÛÙÔ‡˜ Î·È ‰È·Ù·Ú·¯‹ Ù˘ ÈηÓfiÙËÙ·˜ ηٷÛÙÔÏ‹˜ Ù˘ ·Ú·ÁˆÁ‹˜ ÁÏ˘Îfi˙˘ ·fi ÙÔ ‹·Ú.

191

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∫·Ù¿ Û˘Ó¤ÂÈ· Ú¤ÂÈ Ó· ¯ÔÚËÁÔ‡ÓÙ·È Â·ÚΛ˜ ÔÛfiÙËÙ˜ ÈÓÛÔ˘Ï›Ó˘ ÁÈ· Ó· ·ÓÙÈÛÙ·ıÌ›ÛÔ˘Ó ÙËÓ ˘ÂÚÁÏ˘Î·ÈÌ›·. £ÂÚ·›·: ÃÔÚËÁÔ‡ÓÙ·È ı˘ÚÂÔÛÙ·ÙÈο, fiˆ˜ Ë ÚÔ˘ÏıÂÈԢڷΛÏË, Ë ÌÂıÈÌ·˙fiÏË Î·È Ë Î·Ú‚ÈÌ·˙fiÏË. ∆· Ê¿Ú̷η ·˘Ù¿ ‰ÂÛÌÂ‡Ô˘Ó ÙÔ ¤Ó˙˘ÌÔ ı˘ÚÂÔÂȉÈ΋ ˘ÂÚÔÍÂȉ¿ÛË, ÙÔ ÔÔ›Ô ¯ÚÂÈ¿˙ÂÙ·È ÁÈ· ÙËÓ ÔÚÁ·ÓÔÔ›ËÛË ÙÔ˘ Ȉ‰›Ô˘ ÛÙÔ ı˘ÚÂÔÂȉ‹, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÏ·ÙÙÒÓÂÙ·È Ë ·Ú·ÁˆÁ‹ ÙˆÓ ı˘ÚÂÔÂȉÈÎÒÓ ÔÚÌÔÓÒÓ. ∂ÈÚÔÛı¤Ùˆ˜, Ë ÚÔ˘ÏıÂÈԢڷΛÏË ‰Ú· ÂÚÈÊÂÚÈο, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ ∆4 Û ∆3. ∏ ‰fiÛË Ù˘ ηڂÈÌ·˙fiÏ˘ Â›Ó·È 0,5–1 mg/kg Ì ̤ÁÈÛÙË ‰fiÛË 30 mg/24ˆÚÔ Î·È Ú¤ÂÈ Ó· ÂÏ·ÙÙÒÓÂÙ·È ÛÙ·‰È·Î¿ ¤ˆ˜ ÙË ¯·ÌËÏfiÙÂÚË ‰˘Ó·Ù‹ ‰fiÛË, Ë ÔÔ›· ÂÍ·ÛÊ·Ï›˙ÂÈ Ê˘ÛÈÔÏÔÁÈ΋ ı˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ∫ÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË ·Ú·ÙËÚÂ›Ù·È ÌÂÙ¿ 2–3 ‚‰ÔÌ¿‰Â˜ Î·È ıÂÚ·›· ÙÔ˘ ˘ÂÚı˘ÚÂÔÂȉÈÛÌÔ‡ Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi 1-3 Ì‹Ó˜. ÃÚÂÈ¿˙ÂÙ·È Û˘Ó¯‹˜ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ıÂÚ·›·˜, ‰ÈfiÙÈ ·˘Í·ÓfiÌÂÓ· Â›‰· TSH Â›Ó·È ÂÓ‰ÂÈÎÙÈο ˘„ËÏ‹˜ ‰fiÛ˘ Ù˘ ıÂÚ·›·˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ó·ÊÂÚı› ·fi ÌÂÚÈÎÔ‡˜ Û˘ÁÁÚ·Ê›˜ Ë ¯ÔÚ‹ÁËÛË Ú·‰ÈÂÓÂÚÁÔ‡ Ȉ‰›Ô˘ Û ·È‰È¿ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi Ì ηϿ ·ÔÙÂϤÛÌ·Ù· (23). √È ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ıÂÚ·‡ÔÓÙ·È ÈηÓÔÔÈËÙÈο ÁÈ· ÙÔÓ ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi Û˘Ó‹ıˆ˜ ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ÌÂÁ¿Ï˜ ·ÏÏ·Á¤˜ ÛÙË ‰fiÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘. ™˘Û¯¤ÙÈÛË Ì ¿ÏϘ ÂÓ‰ÔÎÚÈÓÔ¿ıÂȘ: ∞ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ·˘ÙÔ¿ÓÔÛË ı˘ÚÂÔÂȉÔ¿ıÂÈ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·Ù‡ÍÔ˘Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘ÙÒÓ ÛÙÔ ‰È·‚‹ÙË Â›Ó·È ¯·ÌËÏ‹ (2-4%), Â›Ó·È ‰˘Ó·ÙfiÓ 20-40% ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÂÈÓÂÊÚȉȷ΋ ·ÓÂ¿ÚÎÂÈ·. ∆· Û˘ÌÙÒÌ·Ù· ›ӷÈ: ÌÂÏ¿Á¯ÚˆÛË ÙˆÓ Ù˘¯ÒÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ, ·‰˘Ó·Ì›·, ˘fiÙ·ÛË, ÂÏ¿ÙÙˆÛË ÙˆÓ ·Ó·ÁÎÒÓ Û ÈÓÛÔ˘Ï›ÓË Î·È ÂÌÊ¿ÓÈÛË ˘ÔÁÏ˘Î·ÈÌÈÒÓ, ηıÒ˜ Î·È ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (˘ÔÓ·ÙÚÈ·ÈÌ›·, ˘ÂÚηÏÈ·ÈÌ›·). ªÂÚÈÎÔ› ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜, ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ Î·È ÙÔ˘ ‚ÏÂÓÓÔÁfiÓÔ˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÛÙ· Ï·›ÛÈ· Û˘Ó‰ÚfiÌÔ˘ ·˘ÙÔ¿ÓÔÛ˘ ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜ (11). ¢È·ÎÚ›ÓÔÓÙ·È 2 Ù‡ÔÈ Û˘Ó‰ÚfiÌÔ˘ ·˘ÙÔ¿ÓÔÛ˘ ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜: Ô Ù‡Ô˜ π (˘Ô·Ú·ı˘ÚÂÔÂȉÈÛÌfi˜, ÓfiÛÔ˜ ÙÔ˘ Addison, ÌÔÓÈÏ›·ÛË), fiÔ˘ Ë ÂÌÊ¿ÓÈÛË ‰È·‚‹ÙË Â›Ó·È Û¿ÓÈ· (26) Î·È Ô Ù‡Ô˜ ππ (ı˘ÚÂÔÂȉ›ÙȘ, ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ÓfiÛÔ˜ ÙÔ˘ Addison), ÛÙÔÓ ÔÔ›Ô Ô ‰È·‚‹Ù˘ Â›Ó·È Û˘¯Ófi˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ˘ÂÚı˘ÚÂÔÂȉÈÛÌfi˜ Â›Ó·È Û¿ÓÈÔ˜ Î·È ÚÔ‚¿ÏÏÂÈ ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÌÂ Ù˘È΋ Û˘Ìو̷ÙÔÏÔÁ›·, ı· Ú¤ÂÈ ÂÓÙÔ‡ÙÔȘ Ó·

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¤¯Ô˘Ì ˘’ fi„ÈÓ Ì·˜ fiÙÈ ÌÔÚ› Ó· ÂΉËψı› Î·È Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù·, fiˆ˜ .¯. ‰È·Ù·Ú·¯¤˜ Ù˘ Ú‡ıÌÈÛ˘ (˘ÂÚÁÏ˘Î·È̛˜), Â˘Û˘ÁÎÈÓËÛ›·, Ó¢ÚÈÎfiÙËÙ·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÎÏÔ˘ ,Ù· ÔÔ›· Û˘Ó‹ıˆ˜ ·Ô‰›‰ÔÓÙ·È ÛÙËÓ ÂÊ˂›·. ¢È·‚ËÙÈÎÔ› ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ıÂÙÈο ∞£∞ ÌÔÚ› Ó· ÂΉËÏÒÛÔ˘Ó ÌÂÏÏÔÓÙÈο fiÏÔ ÙÔ Ê¿ÛÌ· Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜. √È ·ÛıÂÓ›˜ ·˘ÙÔ› ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ÁÈ· ÙËÓ ·ÚÔ˘Û›· ¿ÏÏˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ (·ÓÙÈÙÔȯˆÌ·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔÌ¿¯Ô˘, ·ÓÙÈÂÈÓÂÊÚȉȷÎÒÓ, Î.Ï.). π‰È·›ÙÂÚ· Û˘¯Ó¤˜ Â›Ó·È ÔÈ Î·Ù·ÛÙ¿ÛÂȘ ·˘Ù¤˜ fiÙ·Ó ˘¿Ú¯Ô˘Ó ¯ÚˆÌÔÛˆÌȷΤ˜ ·ÓˆÌ·Ï›Â˜ (Û. Turner, Û. Down) (27). µÈ‚ÏÈÔÁÚ·Ê›· 1. Ogle JW. St Georges Hospital Rep; 1886.

2. Bottazzo GF, Florin-Christensen A, Doniach D. Islet cell antibodies in diabetes mellitus with autoimmune polyendocrine deficiencies. Lancet 1974;2:1279-1283.

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6. Bright GM, Blizzard RM, Kaiser DL, Clarke WL. Organ specific autoantibodies in children with common endocrine diseases. J Pediatr 1982;100: 8-14.

7. Landin-Olsson M, Karlsson A, Dahlquist G, Blom L, Lernmark A, Sundkvist G. Islet cell and other organ-specific autoantibodies in all children developing type I insulindependent diabetes mellitus in Sweden during one year and in matched controls. Diabetologia 1989;32:387-393.

8. Neufeld M, Maclaren NK, Riley WJ, Lezotte D, McLaughlin JV, Silverstein J et al. Islet cell and other organ - specific antibodies in U.S caucasians and blacks with insulindependent diabetes mellitus. Diabetes 1980;29:589-592.

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11. Riley WJ, MacLaren NK, Lezotte DC. Thyroid autoimmunity in insulin dependent diabetes. The case for routine screening. J Pediatr 1981;98:350-354.

12. McKenna M, Herskowitz R, Wolfsdorf Jl. Screening for thyroid disease in children with IDDM. Diabetes Care 1990;13:801-803.

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26. ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞, ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã, ¶··ıÂÔ‰ÒÚÔ˘ ∞, ∫·Ú‹˜ Ã, ¢¤ÏÏÈÔ˜ ¢, £ÂÔ‰ˆÚ›‰Ë˜ Ã. ™‡Ó‰ÚÔÌÔ ·˘ÙÔ¿ÓÔÛ˘ ÔÏ˘ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ·˜ Ù‡Ô˘ π. π·ÙÚÈ΋ 1996;70:263-266.

27. Dacou Voutetakis C, Sertedaki A, Maniati-Christidis M, Sarri C, Karadima G, Petersen MB et al. Insulin dependent diabetes mellitus (IDDM) and autoimmune thyroiditis in a boy with a ring chromosome 18: additional evidence of autoimmunity or IDDM gene(s) on chromosome 18. J Med Genet 1999;36:156-158.

28. ƒÔ‡ÛË ª, ¡¤Ô˘ ¶, ∫·ÛÛÈÔ‡ ∫, °ÏËÓ¤ÏÏË ∂, ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ∫·Ú·ÁÈ¿ÓÓË Ã Î·È Û˘Ó. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó· Û ·È‰È¿ Ì ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË [¶ÂÚ›ÏË„Ë]. 28o ¶·ÓÂÏ ¶·È‰ ™˘Ó; 1990 2-3 πÔ˘Ó›Ô˘; £ÂÛÛ·ÏÔÓ›ÎË;1990.

29. ∫·Ú·ÁÈ¿ÓÓË Ã, ∫·Ú‹˜ Ã, ∫ÔÓÙ·Í¿ÎË Ã, ºˆÙÂÈÓÔ‡ ∞, ºÔ˘ÛÙÔ‡ÎÔ˘ ª, £ÂÔ‰ˆÚ›‰Ë˜ Ã Î·È Û˘Ó. £˘ÚÂÔÂȉ›ÙȘ Hashimoto Î·È ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ˜ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ [¶ÂÚ›ÏË„Ë]. 32o ¶·ÓÂÏ. ¶·È‰. ™˘Ó. 1994 16-18 πÔ˘Ó›Ô˘; ∫¤Ú΢ڷ; 1994. ÛÂÏ. 59.

30. ∑ÒÛË ¶, °ÂˆÚÁÈ¿‰Ë˜ ∏, ¶ÂÙÚÔÔ‡ÏÔ˘ Ã, ÷Ù˙Ë‚·ÛÈÏ›Ԣ ∞, µÏ¿¯Ô˘ £, ∫·Ú‹˜ Ã. £˘ÚÂÔÂȉÈ΋ ÏÂÈÙÔ˘ÚÁ›· Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ·È‰ÈÒÓ Ì ÈÓÛÔ˘ÏÈÓÔÂÍ·ÚÙÒÌÂÓÔ Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË [¶ÂÚ›ÏË„Ë]. 37o ¶·ÓÂÏ. ¶·È‰. ™˘Ó.

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31. §·‰‹˜ µ, £ÂÔ‰ˆÚ›‰Ë˜ Ã, ªÂÚ‰Ô‡ÛË ∂, ∞ı·Ó·Û¿ÎË ∫, ∫ˆÛÙ·Ú›‰Ô˘ ™, ∫·ÙÙ¿Ì˘ Ã. ∂Ó‰ÔÎÚÈÓÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û ¿Û¯ÔÓÙ˜ Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 33o ¶·ÓÂÏ. ¶·È‰. ™˘Ó. 1995 9-11 πÔ˘Ó›Ô˘. §‹ÌÓÔ˜; 1995. ÛÂÏ. 38.

32. Kassiou K, Neou P, Foustoukou M, Skoutari M, Terzopoulou K, Bartsokas CH. Thyroid function and autoantibodies in Greek children with IDDM. XVI th ISGD Annual Meeting; 1990 September 6-9; Oslo, Norway; 1990. p. 24.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-06-2000 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 08-01-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. ∫·˚Ì¿Ú·–¶··ı·Ó·Û›Ô˘ ª¿ÚÎÔ˘ ªfiÙÛ·ÚË 8, 152 36 ∞ı‹Ó·

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Paediatriki 2001;64:194-195

LETTERS

∞ÍÈfiÙÈÌÔÈ ∫‡ÚÈÔÈ, ™¯ÂÙÈο Ì ÙËÓ ÂÚ›ÙˆÛË ‚ÈÙ·ÌÈÓÔÂÍ·ÚÙÒÌÂÓÔ˘ Ú·¯ÈÙÈÛÌÔ‡ Ù‡Ô˘ π (VDDR-I) Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ ¿ÚıÚÔ ÙˆÓ ∫·Ú·Î·˚‰Ô‡ Î·È Û˘Ó [¶∞π¢π∞∆ƒπ∫∏ 2000;63(5):426-429] Û¯ÔÏÈ¿˙Ô˘Ì ÌÂÚÈο Â˘Ú‹Ì·Ù·. ™‡Ìʈӷ Ì ٷ ÛÙÔȯ›· Ô˘ ·Ú·Ù›ıÂÓÙ·È ‰È·ÙËÚԇ̠ÂÈÊ˘Ï¿ÍÂȘ ˆ˜ ÚÔ˜ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‚ÈÙ·ÌÈÓÔÂÍ·ÚÙÒÌÂÓÔ˘ Ú·¯ÈÙÈÛÌÔ‡ Ù‡Ô˘ π (VDDR-I) ‹ ÙÚÔÊÈÎÔ‡ Ú·¯ÈÙÈÛÌÔ‡, fiˆ˜ ›¯Â ·Ú¯Èο ÙÂı› Ë ‰È¿ÁÓˆÛË. ∆· ÛËÌ›· Ô˘ Ù›ıÂÓÙ·È ˘fi ·ÌÊÈÛ‚‹ÙËÛË Â›Ó·È Ù· ·Ú·Î¿Ùˆ: ·) ∏ ÁÚ‹ÁÔÚË Î·È ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ·Û‚ÂÛÙ›Ô˘ (Ca), ʈÛÊfiÚÔ˘ (Pi) Î·È ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÔÏ›ÁˆÓ ËÌÂÚÒÓ ÓÔÛËÏ›·˜ ÏfiÁˆ ηχÙÂÚˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓıËÎÒÓ Î·È ÚÈÓ ÙËÓ ·ÁˆÁ‹ Ì 1,25 (√∏)2 ‚ÈÙ·Ì›ÓË D, Ô˘ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÛÙÔÓ VDDR-I. ¢ÂÓ ·Ó·Ê¤ÚÂÙ·È Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ D. ‚) ∆· ÌË ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ù· ÔÔ›· ı· ¤ÚÂ ӷ ›¯·Ó ÂÌÊ·ÓÈÛÙ›. ™Â ·Ó¿ÏÔÁË ÂÚ›ÙˆÛË VDDR-I ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ (·‰ÂÚÊ¿ÎÈ ‹‰Ë ‰È·ÁÓˆṲ̂ÓÔ˘ VDDR-I), ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÂÌÊ·Ó›ÛÙËÎ·Ó ·fi ÙÔÓ 3Ô Ì‹Ó· ˙ˆ‹˜. Á) ∏ ˘„ËÏ‹ ÙÈÌ‹ ·Ú·ıÔÚÌfiÓ˘ ÛÙÔÓ ÔÚfi ··ÓÙ¿Ù·È Î·È ÛÙÔÓ ÙÚÔÊÈÎfi Ú·¯ÈÙÈÛÌfi. ‰) √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Pi Û ԇڷ 24ÒÚÔ˘ ‰ÂÓ Â›Ó·È ·Ô‰ÂÎÙfi˜ ‰Â›ÎÙ˘ ·¤ÎÎÚÈÛ˘. ∏ ÛˆÏËÓ·Úȷ΋ Â·Ó·ÚÚfiÊËÛË ÙÔ˘ Pi (TRP) ‹ Ë Ì¤ÁÈÛÙË ÛˆÏËÓ·Úȷ΋ Â·Ó·ÚÚfiÊËÛ‹ ÙÔ˘ (TmP/GFR) Û ‰Â›ÁÌ· Ô‡ÚˆÓ ÚÈÓ ÙË Ï‹„Ë ÙÚÔÊ‹˜, ÁÈ’ ·˘Ù‹ ÙËÓ ËÏÈΛ·, Â›Ó·È ÈÔ ·ÍÈfiÈÛÙÔÈ ‰Â›ÎÙ˜. Â) √È ÙÈ̤˜ ÙÔ˘ ÔÏÈÎÔ‡ Ca ÔÚÔ‡ ‹Ù·Ó ̤۷ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Î·È ÔÙ˘ ÈÔÓÈṲ̂ÓÔ˘ ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο. ™˘Ó‹ıˆ˜, ÛÙÔÓ VDDR-I ÔÈ ÙÈ̤˜ ÙÔ˘ Ca ÔÚÔ‡ Â›Ó·È ÛËÌ·ÓÙÈο ¯·ÌËϤ˜ ÚÈÓ ÙË ıÂÚ·›·, ·ÎfiÌË Î·È Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ÛÙ) ∆· Â›‰· Ù˘ 1,25(√∏)2D ‚Ú¤ıËÎ·Ó ¯·ÌËÏ¿ Û¯ÂÙÈο Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ô˘ ·Ú·Ù›ıÂÓÙ·È, ·ÏÏ¿ fi¯È ÙfiÛÔ ¯·ÌËÏ¿ ÒÛÙ ӷ ÂȂ‚·ÈÒÛÔ˘Ó Î·ÙËÁÔÚËÌ·ÙÈο ÙË ‰È¿ÁÓˆÛË. ¶·Ú’ fiÙÈ fiˆ˜ ÂÈÛËÌ·›ÓÔ˘Ó ÔÈ Û˘ÁÁÚ·Ê›˜ ÙÔ ·È‰› ¤Ê˘Á ·fi ÙËÓ ∂ÏÏ¿‰· Î·È ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ùfi Ó· Á›ÓÂÈ ÂÈÛٷ̤ӈ˜ Ë ‰ÈÂÚ‡ÓËÛË Î·È Â·Ï‹ı¢ÛË ÁÈ· VDDR-I, Ë ‰È΋ Ì·˜ ÁÓÒÌË Ù›ÓÂÈ Ó· Û˘ÌʈӋÛÂÈ Ì ÙËÓ ·Ú¯È΋ ¿Ô„Ë ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÂÚ›ÙˆÛË ÙÚÔÊÈÎÔ‡ ‚ÈÔ¯ËÌÈÎÔ‡ Ú·¯ÈÙÈÛÌÔ‡ ¯ˆÚ›˜ ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·. Œ¯ÂÈ ·Ó·ÊÂÚı› Î·È Û ¿ÏϘ ¯ÒÚ˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÎfiÛÌÔ˘ (1,2) fiÙÈ Ì›· ¿ÏÏË ·ÈÙ›· ÙÚÔÊÈÎÔ‡ Ú·¯ÈÙÈÛÌÔ‡ Â›Ó·È Ë ·ÓÂ·Ú΋˜ ÚfiÛÏË„Ë ÌÂÙ¿ÏÏˆÓ Î·È Î˘Ú›ˆ˜ ·Û‚ÂÛÙ›Ô˘ ‹/Î·È ÊˆÛÊÔÚÈÎÒÓ Â›Ù ̤ۈ ıËÏ·ÛÌÔ‡ ‹/Î·È Ì¤Ûˆ ¿ÏÏˆÓ ‰È·ÙÚÔÊÈÎÒÓ Û˘ÓËıÂÈÒÓ (fiˆ˜ ¯ÔÚÙÔÊ¿Á˜ ‰›·ÈÙ˜). ∞˘Ù‹ Ë ·ÓÂ¿ÚÎÂÈ· Ô‰ËÁ› Û ڷ¯ÈÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ Û ‚Ú¤ÊË ¿Óˆ ÙˆÓ 6 ÌËÓÒÓ ÔÏϤ˜ ÊÔÚ¤˜ ÌÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· 25OHD ÛÙÔÓ ÔÚfi (ÛÙ· 25 ng/ml) Î·È ÙÈ̤˜ ·Û‚ÂÛÙ›Ô˘ ÛÙÔÓ ÔÚfi ˘„ËÏfiÙÂÚ˜ ·fi 9 mg/dl Î·È ÂÓ›ÔÙ ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ 1,25(OH)2D (3,4). ™ÙËÓ ∂ÏÏ¿‰· ÔÈ Lapatsanis Î·È Û˘Ó (1976) ·Ó·Ê¤ÚÔ˘Ó Â›Û˘ ÂÚÈÙÒÛÂȘ ÙÚÔÊÈÎÔ‡ Ú·¯ÈÙÈÛÌÔ‡ Ì ڷ¯ÈÙÈΤ˜ ·ÏÏÔÈÒÛÂȘ Û ‚Ú¤ÊË ËÏÈΛ·˜ 2-12 ÌËÓÒÓ Ì ˘ÔʈÛÊ·Ù·Û·ÈÌ›· ÌfiÓÔ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ·Û‚¤ÛÙÈÔ(5). ªÂ ÙÈÌ‹ ¶¤ÙÚÔ˜ ¢. §··ÙÛ¿Ó˘ √Ì. ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ¶·Ó/Ì›Ô˘ πˆ·ÓÓ›ÓˆÓ

ÕÓÓ· ÿÏÏ· ∂›ÎÔ˘ÚË ∫·ıËÁ‹ÙÚÈ· ∆Ô̤· ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡

µÈ‚ÏÈÔÁÚ·Ê›· 1. Pfitzner MA, Thacker TD, Pettifor JM, Zoakah AI, Lawson JO, Isichei CO, Fischet PR. Absence of vitamin D deficiency in young Nigerian children. J Pediatr 1998;133:740-744.

2. Oggini LM, Worsfold M, Oyelami OA, Sharp CA, Powell DE, Davie MWJ. Etiology of rickets in Nigerian children. J Pediatr 1996;128:692-694.

3. Hellebostad M, Markestad T, Halvorsen KS. Vitamin D deficiency rickets and vitamin B12 deficiency in vegetarian children. Acta Paediatr Scand 1985;74:191-195.

4. Kruse K. Pathophysiology of calcium metabolism in children with vitamin D deficiency rickets. J Pediatr 1995;126:736-741.

5. Lapatsanis P, Makaronis G, Vretos C, Doxiadis S. Two types of nutritional rickets in infants. Am J Clin Nutr 1976;29:1222-1226.

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™¯ÂÙÈο Ì ÙËÓ ·fi 19-12-2000 ÂÈÛÙoÏ‹ ÙÔ˘ Û‚·ÛÙÔ‡ ηıËÁËÙ‹ Î. §··ÙÛ¿ÓË Î·È Ù˘ Î. ÿÏÏ· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ÂÚÁ·Û›· Ì·˜ Ì ı¤Ì· «ƒ·¯›Ùȉ· ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ‚ÈÙ·Ì›ÓË D Ù‡Ô˘ 1» Ô˘ ‰ËÌÔÛȇÙËΠÛÙËÓ ¶∞π¢π∞∆ƒπ∫∏ 2000;63:426-429, ı· ı¤Ï·Ì ӷ ‰È¢ÎÚÈÓ›ÛÔ˘Ì ٷ ·ÎfiÏÔ˘ı·: - ∏ ¤ÏÏÂÈ„Ë ·ÎÙÈÓÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ (ÏËÓ Ù˘ ÌÂÁ¿Ï˘ ÚfiÛıÈ·˜ ËÁ‹˜), ÈÛÙ‡ԢÌ fiÙÈ ÔÊ›ÏÂÙ·È ·Ê’ ÂÓfi˜ ÛÙË ÌÈÎÚ‹ ËÏÈΛ· Ù˘ ·ÛıÂÓÔ‡˜ Î·È ·Ê’ ÂÙ¤ÚÔ˘ ÛÙÔ fiÙÈ Ë ¤ÏÏÂÈ„Ë Ù˘ 1,25(OH)2D ‰ÂÓ ‹Ù·Ó Ï‹Ú˘.

- ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·¤ÎÎÚÈÛË ƒ ÛÙ· Ô‡Ú·, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ‰Â›ÎÙ˘ Ë ÛˆÏËÓ·Úȷ΋ Â·Ó·ÚÚfiÊËÛË ƒ Ô˘ ‹Ù·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (94%) Î·È ÁÈ· ÏfiÁÔ˘˜ ÌfiÓÔ Û˘ÓÙÔÌ›·˜ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Î›ÌÂÓÔ Û·Ó Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ 24h ÁÈ· Ca ƒ, Î.Ï. ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ.

- ∆Ô ·È‰› ·Ú·ÎÔÏÔ˘ı‹ıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ ÌËÓfi˜ ¤ˆ˜ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜. ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi ¤ÁÈÓ Â·Ó¿ÏË„Ë Ù˘ ̤ÙÚËÛ˘ ÙˆÓ ÙÈÌÒÓ 25(√∏)D Î·È 1,25(OH)2D Ô˘ ‹Ù·Ó ·Ó¿ÏÔÁ˜ ÙˆÓ ·Ú¯ÈÎÒÓ [25(√∏)=28 pg/ml, 1,25(OH)2D=16 pg/ml] Î·È ÁÈ’ ·˘Ùfi ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ÂÚÁ·Û›· Ì·˜.

- Ÿˆ˜ ÛËÌÂÈÒÓÂÙ·È ÛÙË Û˘˙‹ÙËÛË (¶›Ó·Î·˜ 1) Î·È Ô ÙÚÔÊÈÎfi˜ Ú·¯ÈÙÈÛÌfi˜ ¤¯ÂÈ Â˘Ú‹Ì·Ù· ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘ÂÚ·Ú·ı˘ÚÂÔÂȉÈÛÌÔ‡, ·ÏÏ¿ ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Û ·˘ÙfiÓ Â›Ó·È Ù· ¯·ÌËÏ¿ Â›‰· Ù˘ 25(√∏)D, ÂÓÒ ÛÙȘ Û¿ÓȘ ÂÚÈÙÒÛÂȘ (fiˆ˜ ·˘Ù¤˜ Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÔÈ Û˘ÁÁÚ·Ê›˜ Ù˘ Â›ÛÙÔÏ‹˜ ÛÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ÙÔ˘˜ ·Ú·ÔÌ¤˜) Ô˘ ÔÊ›ÏÔÓÙ·È Û ¤ÏÏÂÈ„Ë Ca, P Î·È È¯ÓÔÛÙÔȯ›ˆÓ, Ù· Â›‰· Ù˘ 25(√∏)D Â›Ó·È Ê˘ÛÈÔÏÔÁÈο, Ë 1,25(√∏)2D Â›Ó·È ·˘ÍË̤ÓË Â›Ù Û ·fiÏ˘Ù˜ ÙÈ̤˜, ›Ù Û ۯ¤ÛË Ì ٷ Â›‰· Ù˘ 25(√∏)D. √È ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù˘ 1,25(√∏)2D Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô ¯·ÌËÏfi˜ ƒ, ÙÔ ¯·ÌËÏfi Ca Î·È Ë ·˘ÍË̤ÓË ƒ∆∏ ·˘Í¿ÓÔ˘Ó ÙË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ 1·˘‰ÚÔÍ˘Ï¿Û˘ (1), (2), (3). ∞ÓÙ›ıÂÙ· ÛÙËÓ ·ÛıÂÓ‹ Ì·˜, Ë 25(√∏)D Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ë 1,25(√∏)2D (·Ú¿ ÙÔ ¯·ÌËÏfi ƒ, ÙÔ ¯·ÌËÏfi Ca Î·È ÙËÓ ·˘ÍË̤ÓË ƒ∆∏) Â›Ó·È ÌÂȈ̤ÓË, ÁÂÁÔÓfi˜ Ô˘ ‰Â›¯ÓÂÈ fiÙÈ ˘¿Ú¯ÂÈ ÌÂȈ̤ÓË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ 1·-˘‰ÚÔÍ˘Ï¿Û˘. ∆ËÓ ·¿ÓÙËÛË ÛÙÔ ÂÚÒÙËÌ· ·Ó ˘¿Ú¯ÂÈ ‰ÔÌÈ΋ ‚Ï¿‚Ë Ù˘ 1·-˘‰ÚÔÍ˘Ï¿Û˘ ‹ Â›‰Ú·ÛË Î¿ÔÈÔ˘ ¿ÁÓˆÛÙÔ˘ ·Ú¿ÁÔÓÙ· Ô˘ ÌÂÈÒÓÂÈ ÙË ‰Ú·ÛÙÈÎfiÙËÙ¿ Ù˘, ı· ¤‰ÈÓÂ Ë ·Ó¿Ï˘ÛË ÙÔ˘ DNA ÙÔ˘ ÁfiÓÔ˘ Ù˘ 1·-˘‰ÚÔÍ˘Ï¿Û˘, ̤ıÔ‰Ô˜ Ô˘ ÚÔ˜ ÙÔ ·ÚfiÓ ‰ÂÓ Â›Ó·È ÂÊ·ÚÌfiÛÈÌË, ·Ú¿ ÌfiÓÔ Û ÂÚ¢ÓËÙÈÎfi Â›‰Ô. µÈ‚ÏÈÔÁÚ·Ê›· 1. Herny HL. Vitamin D hydroxylases. J Cell Biochem 1992;49:4-9.

2. Breslaw NA. Normal and abnormal regulation of 1,25(OH)2D synthesis. Am J Med Sci 1998;296:417-425.

3. Takeyama K, Kitanaka S, Sato T, Kobori M, Yanagisawa J, Koto S. 25-Hydroxyvitamin D3.1 alpha hydroxylase and vitamin D synthesis. Science 1997;277:1827-1830.

ªÂ ÂÎÙ›ÌËÛË ∫·Ú‹˜ ÃÚ›ÛÙÔ˜ ¢È¢ı˘ÓÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ¶.°.¡. ¡›Î·È·˜

∫·Ú·Î·˚‰fi˜ ¢ÈÔÓ‡ÛÈÔ˜ ¶·È‰›·ÙÚÔ˜

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Paediatriki 2001;64:196

PEADIATRIC NEWS

∞. ¶ÚÔ¸Ôı¤ÛÂȘ ∞fiÎÙËÛ˘ ¶ÈÛÙÔÔÈËÙÈÎÔ‡ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘ Î·È ŒÁÎÚÈÛË ¡¤ˆÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ ◊‰Ë ¤¯ÂÈ Û˘ÌÏËÚˆı› ¤Ó·˜ ¯ÚfiÓÔ˜ ·fi ÙËÓ Â›ÛËÌË ¤Ó·ÚÍË Ù˘ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘ (™¶∂) ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜. √È ¶·È‰›·ÙÚÔÈ Ô˘ ¤¯Ô˘Ó Û˘ÁÎÂÓÙÚÒÛÂÈ 50 ÌfiÚÈ· ™¶∂ ÌÔÚÔ‡Ó Ó· ˘Ô‚¿ÏÔ˘Ó Ù· ÚˆÙfiÙ˘· ÙˆÓ ÈÛÙÔÔÈËÙÈÎÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÂÁÎÂÎÚÈ̤ӷ ·fi ÙËÓ ∂ÈÙÚÔ‹ ™¶∂ ∂ÈÛÙËÌÔÓÈÎÒÓ ∂ΉËÏÒÛˆÓ, ÒÛÙ ӷ ÂΉÔı› ÙÔ ÈÛÙÔÔÈËÙÈÎfi ™¶∂, ÙÔ ÔÔ›Ô Î·È ı· ÙÔ˘˜ ·ÔÛÙ·Ï›. ∂›Û˘, ·È‰›·ÙÚÔÈ Ô˘ ı· Û˘ÁÎÂÓÙÚÒÛÔ˘Ó 50 ÌfiÚÈ· ™¶∂ ̤¯ÚÈ 31 ¢ÂÎÂÌ‚Ú›Ô˘ 2000, ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÔ˘Ó Ù· ÈÛÙÔÔÈËÙÈο ·Ú·ÎÔÏÔ‡ıËÛ˘, ÁÈ· Ó· ÙÔ˘˜ ¯ÔÚËÁËıÔ‡Ó Ù· ÈÛÙÔÔÈËÙÈο ™¶∂. ∂Âȉ‹ Ë ¤Ó·ÚÍË Ù˘ ™¶∂ ÍÂΛÓËÛ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ Ì‹Ó˜ ÙÔ˘ 1999 Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ‰ÂÓ ˘‹Ú¯Â Â·Ú΋˜ ¯ÚfiÓÔ˜ ÁÈ· Û˘ÌÏ‹ÚˆÛË ÙˆÓ ··ÈÙÔ‡ÌÂÓˆÓ ÌÔÚ›ˆÓ ̤۷ ÛÙÔ ›‰ÈÔ ¤ÙÔ˜, ηْ ÂÍ·›ÚÂÛË, Ù· ÌfiÚÈ· ÙÔ˘ 1999 ÌÔÚÔ‡Ó Ó· ÌÂÙ·ÊÂÚıÔ‡Ó ÁÈ· ÙÔ ¤ÙÔ˜ 2000. ∆· ÚˆÙfiÙ˘· ‰ÈηÈÔÏÔÁËÙÈο Û˘ÌÌÂÙÔ¯‹˜ ÛÙË Û˘Ó¯È˙fiÌÂÓË ÂÎ·›‰Â˘ÛË, ÁÈ· ÙËÓ ¤Î‰ÔÛË ÙÔ˘ ÈÛÙÔÔÈËÙÈÎÔ‡ ™¶∂, ÌÔÚÔ‡Ó Ó· ÚÔÛÎÔÌÈÛıÔ‡Ó ‹ ·ÔÛÙ·ÏÔ‡Ó, ÌÂ Û˘ÛÙË̤ÓÔ ÁÚ¿ÌÌ· ‹ Ì ÌÂÙ·ÊÔÚÈ΋ ÂÙ·ÈÚ›·, ÛÙ· ÁÚ·Ê›· Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜. √È ·È‰›·ÙÚÔÈ, ÚÈÓ ·ÔÛÙ›ÏÔ˘Ó Ù· ‰ÈηÈÔÏÔÁËÙÈο, ı· Ú¤ÂÈ Ó· ÎÚ·Ù‹ÛÔ˘Ó Ì›· Ï‹ÚË ÛÂÈÚ¿ ʈÙÔÙ˘ÈÒÓ, ÁÈ· ÙË ‰È¢ı¤ÙËÛË ÂӉ¯fiÌÂÓ˘ ÌÂÏÏÔÓÙÈ΋˜ ‰È·ÊÔÚ¿˜. ŸÛÔÈ ·È‰›·ÙÚÔÈ ‰ÂÓ ı· ηÙÔÚıÒÛÔ˘Ó Ó· Û˘ÁÎÂÓÙÚÒÛÔ˘Ó 50 ÌfiÚÈ· ™¶∂ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘2000, ÌÔÚÔ‡Ó Ó· ÛÙԯ‡ÛÔ˘Ó ÛÙË Û˘ÁΤÓÙÚˆÛË 150 ÌÔÚ›ˆÓ ™¶∂ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2002, ÁÈ· ·fiÎÙËÛË ÈÛÙÔÔÈËÙÈÎÔ‡ ÙÚÈÂÙÔ‡˜ ‰È¿ÚÎÂÈ·˜. ™ÙË Û˘Ó‰ڛ·ÛË Ù˘ ∂ÈÙÚÔ‹˜ ™¶∂, ÛÙȘ 01-11-2000, ÂÁÎÚ›ıËÎ·Ó ÔÈ ·ÎfiÏÔ˘ı˜ ÂÈÛÙËÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ: 1. ∏ÌÂÚ›‰· «∂ÍÂÏ›ÍÂȘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·, ∏·ÙÔÏÔÁ›· Î·È ¢È·ÙÚÔÊ‹» Ô˘ ÔÚÁ·ÓÒÓÂÙ·È ·fi ÙËÓ ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ∏·ÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜: 6 ÌfiÚÈ· ÁÈ· ¶·È‰ÔÁ·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˘˜ Î·È 3 ÌfiÚÈ· ÁÈ· °ÂÓÈÎÔ‡˜ ¶·È‰È¿ÙÚÔ˘˜ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔًوÓ.

2. ™˘ÌfiÛÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ∏·ÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜: 3 ÌfiÚÈ· ÁÈ· ¶·È‰ÔÁ·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˘˜, 2 ÌfiÚÈ· ÁÈ· °ÂÓÈÎÔ‡˜ ¶·È‰È¿ÙÚÔ˘˜ Î·È ¶·È‰È¿ÙÚÔ˘˜ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔًوÓ.

3. ™ÂÌÈÓ¿ÚÈÔ «¶·È‰È·ÙÚÈÎÒÓ §ÔÈÌÒ͈ӻ £ÂÛÛ·ÏÔӛ΢, ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ §ÔÈÌÒ͈Ó: 4 ÌfiÚÈ·. ∫·ıËÁËÙ‹˜ ¡ÈÎfiÏ·Ô˜ °. ªÂÚ¿Ù˘ ¶Úfi‰ÚÔ˜ ™¶∂

∫·ıËÁ‹ÙÚÈ· ∞. ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘ ¶Úfi‰ÚÔ˜ ∂¶∂

µ. µÚ¿‚¢ÛË ÙÔ˘ ∫¤ÓÙÚÔ˘ ¢ËÏËÙËÚÈ¿ÛÂˆÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡» ™ÙȘ 28 ¢ÂÎÂÌ‚Ú›Ô˘ 2000, Ë ∞η‰ËÌ›· ∞ıËÓÒÓ ·¤ÓÂÈÌ µÚ·‚Â›Ô ÛÙÔ ∫¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡» Ì ÙËÓ Â˘Î·ÈÚ›· Û˘ÌÏ‹ÚˆÛ˘ 25 ¯ÚfiÓˆÓ Û˘Ó¯ԇ˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘. ∆Ô ‚Ú·‚¢fiÌÂÓÔ ∫¤ÓÙÚÔ, ÙÔ ÌÔÓ·‰ÈÎfi ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰ËÏËÙËÚÈ¿ÛˆÓ, ÏÂÈÙÔ˘ÚÁ› ·fi ÙÔ 1975, ηχÙÂÈ fiÏË ÙË ¯ÒÚ· ηÈ, ·fi 7ÂÙ›·˜ Î·È ÙËÓ ∫‡ÚÔ. ™ÙÔ ∫¤ÓÙÚÔ ÏÂÈÙÔ˘ÚÁ› ·Ú·Ïϋψ˜ Î·È ˘ËÚÂÛ›· «¶·ÚÔ¯‹˜ ¶ÏËÚÔÊÔÚÈÒÓ ∆ÂÚ·ÙÔÁ¤ÓÂÛ˘» Ô˘ ÏËÚÔÊÔÚ› ÙÔ˘˜ È·ÙÚÔ‡˜-ª·ÈÂ˘Ù‹Ú˜ Î·È ÙȘ ÌËÙ¤Ú˜ ÁÈ· ÙËÓ Èı·Ó‹ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË Ê·ÚÌ¿ÎˆÓ Ô˘ ¤¯Ô˘Ó ÏËÊı› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ™ËÌ·ÓÙÈ΋ Â›Ó·È Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÛÙËÓ ÂÎ·›‰Â˘ÛË ÊÔÈÙËÙÒÓ π·ÙÚÈ΋˜ Î·È ÌÂÙÂÎ·›‰Â˘ÛË ÓÔÛËÏ¢ÙÒÓ, Ê·ÚÌ·ÎÔÔÈÒÓ Î·È ÁÈ·ÙÚÒÓ, ηıÒ˜ Î·È ÛÙÔÓ ÙÔ̤· ÂÓË̤ڈÛ˘ ÙÔ˘ ÎÔÈÓÔ‡ Î·È Î˘Ú›ˆ˜ ÙˆÓ ÁÔÓ¤ˆÓ, ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ ÛÙ· ·È‰È¿. ∏ ∂ÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ ÙÔ˘ ¶ÂÚÈÔ‰ÈÎÔ‡ «¶∞π¢π∞∆ƒπ∫∏» ·¢ı‡ÓÂÈ ıÂÚÌ¿ Û˘Á¯·ÚËÙ‹ÚÈ· ÚÔ˜ ÙÔÓ ¿ÌÈÛıÔ ∂›ÎÔ˘ÚÔ ∫·ıËÁËÙ‹ Î. ¶·‡ÏÔ ∫. µÏ¿¯Ô, √ÚÁ·ÓˆÙ‹ Î·È ¢È¢ı˘ÓÙ‹ ÙÔ˘ ∫¤ÓÙÚÔ˘ Â› 25ÂÙ›·˜. °. ÿ‰Ú˘ÛË Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¢ÂÚÌ·ÙÔÏÔÁ›·˜ ∏ ∂ÈÛÙËÌÔÓÈ΋ ∂ÈÙÚÔ‹ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ì·˜, Ì ȉȷ›ÙÂÚË ¯·Ú¿, Û·˜ ÂÓËÌÂÚÒÓÂÈ ÁÈ· ÙËÓ ›‰Ú˘ÛË Ù˘ «∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¢ÂÚÌ·ÙÔÏÔÁ›·˜». ∆· È‰Ú˘ÙÈο ̤ÏË ·ÔÙÂÏÔ‡Ó ‰ÂÚÌ·ÙÔÏfiÁÔÈ Î·È ·È‰›·ÙÚÔÈ Ì ÂȉÈÎfi ÂӉȷʤÚÔÓ ÛÙË ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰ÂÚÌ·ÙÔÏÔÁÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ. ∂˘¯fiÌÂı· ηϋ ÂÈÙ˘¯›· ÛÙÔ ¤ÚÁÔ ÙÔ˘˜

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17-20 ∞ÚÈÏ›Ô˘

22nd Course of Pediatric Dermatology ¶ÏËÚÔÊÔڛ˜: e-mail: alain.taieb@dermatol.u-bordeaux2.fr

Arcachon, °·ÏÏ›·

28 ∞ÚÈÏ›Ô˘ – 1 ª·˝Ô˘

Pediatric Academic Societies Annual Meeting Baltimore Convention Center Baltimore, Maryland ¶ÏËÚÔÊÔڛ˜: Program Office ∆ËÏ.: ++281 419 0052 Fax: ++281 419 0082 e-mail: info@aps-spr.org

µ·ÏÙÈÌfiÚË, ∏¶∞

5-6 ª·˝Ô˘

10Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ ∂Î·È‰Â˘ÙÈÎfi ∫¤ÓÙÚÔ ∞ÁÚÔÙÈ΋˜ ∆Ú¿Â˙·˜, ¡. ∂Ú˘ıÚ·›·, ∞ı‹Ó· √ÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· °¡¶¶ ™˘ÓÂÚÁ·Û›·: ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÌÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· °¡¶¶ 152 36, ¶. ¶ÂÓÙ¤ÏË ∆ËÏ.: 01 80 36 472 Fax: 01 61 31 173 e-mail: kpriftis@otenet.gr

∞ı‹Ó·

18-20 ª·˝Ô˘

13Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ £¤Ì·: π·ÙÚÔÎÔÈÓˆÓÈΤ˜ ÂÈÙÒÛÂȘ ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ¶ÏËÚÔÊÔڛ˜: ∂ϤÓË ¶ÂÙÚ›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÂÈÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ª. ∞Û›·˜ 75, 115 27, ∞ı‹Ó· ∆ËÏ.: 775 9962 – 0944 974249 Fax: 777 3840 – 748 5872 ∏ÏÂÎÙÚÔÓÈ΋ ‰È‡ı˘ÓÛË Ù˘ ∂Ù·ÈÚ›·˜ ÁÈ· ˘Ô‚ÔÏ‹ ÂÚÈÏ‹„ˆÓ: http://www.socped.gr ‹ e-mail: epetrid@cc.uoa.gr

¶¿ÙÚ·

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∞ ¡ ∞ ∫ √ π ¡ ø ™ ∏

1-3 πÔ˘Ó›Ô˘

39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: C & C International Convention & Congresses ¶·Ú·‰Â›ÛÔ˘ 16, 151 25, ∞ı‹Ó· ∆ËÏ.: 01 68 89 100 Fax: 01 68 44 777

∫Ú‹ÙË

European Society for Paediatric Hematology and Oncology (ESPHI)

Lucerne, ∂Ï‚ÂÙ›·

¶ ƒ ø ∆ ∏

2001 MAPT- A¶PI§

1-3 π√À¡π√À 2 0 0 1 C R E TA M A R I S H OT E L Kƒ∏∆∏

EììèîéëÜ ¦áéäéáôòéëÜ EôáéòåÝá Îôï÷ éäòàóåö÷ 1931

17-20 πÔ˘Ó›Ô˘

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™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ·ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

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EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) 9 giga- (10 ) 6 mega-(10 ) 3 kilo- (10 ) 2 hecto(10 ) 1 deca (10 ) -1 deci (10 ) -2 centi- (10 ) -3 milli(10 ) -5 micro (10 ) -9 nano (10 ) -12 pico (10 ) -15 femto (10 ) -18 atto (10 )

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Combining prefixes T G M k h da d c m Ì n p f a

2001 MAPT- A¶PI§

17-10-01 15:35

™ÂÏ›‰· 205

™˘ÓÙ·ÁÔÁÚ·ÊÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ¢È·ÊËÌÈ˙fiÌÂÓˆÓ ¶ÚÔ˚fiÓÙˆÓ

CECLOR: ¶∂ƒπ§∏æ∏ Ã∞ƒ∞∫∆∏ƒπ™∆π∫ø¡ ¶ƒO´O¡∆O™ ∂N¢EI•EI™: ∆Ô CECLOR® ÂӉ›ÎÓ˘Ù·È ÛÙË ıÂÚ·›· ÙˆÓ ·ÎfiÏÔ˘ıˆÓ ÏÔÈÌÒ͈Ó, fiÙ·Ó ·˘Ù¤˜ ÚÔηÏÔ‡ÓÙ·È ·fi Ù· ·Ó·ÊÂÚfiÌÂÓ· ηو٤ڈ ÛÙÂϤ¯Ë ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÂÊfiÛÔÓ ·˘Ù¿ Â›Ó·È Â˘·›ÛıËÙ· Û ·˘Ùfi: §ÔÈÌÒÍÂȘ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ô‰ÒÓ. ª¤ÛË ˘Ò‰Ë˜ ˆÙ›Ùȉ·: ÚÔηÏÔ‡ÌÂÓË ·fi S. pneumoniae, H. influenzae, Staphylococci (ÂÍ·ÈÚÔ˘Ì¤ÓˆÓ ÙˆÓ ÛÙÂϯÒÓ Ô˘ Â›Ó·È ·ÓıÂÎÙÈο ÛÙË ÌÂıÈÎÈÏÏ›ÓË), ‚-·ÈÌÔÏ˘ÙÈÎfi ™ÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞ Î·È ª. catarrhalis. º·Ú˘ÁÁ›Ùȉ· Î·È ·Ì˘Á‰·Ï›Ùȉ·, ·fi ‚-·ÈÌÔÏ˘ÙÈÎfi ™ÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞.¶·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ· ·fi ¢·›ÛıËÙ· ÛÙÂϤ¯Ë H. influenzae ( ‚-Ï·ÎÙ·Ì¿ÛË ±), ‚-·ÈÌÔÏ˘ÙÈÎfi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ ∞, S. pneumoniae, M. catarrhalis Î·È S. aureus ( ‚-Ï·ÎÙ·Ì¿Û˘ ±). ™ÙË ¯ÚfiÓÈ· ÌÔÚÊ‹ ··ÈÙÂ›Ù·È Û˘Ó‹ıˆ˜ ÚÔÛı‹ÎË Î·È ÂÓfi˜ ¿ÏÏÔ˘ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡ ·Ú¿ÁÔÓÙ·, ‰Ú·ÛÙÈÎÔ‡ ÛÙÔ˘˜ ·Ó·ÂÚfi‚ÈÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜. §ÔÈÌÒÍÂȘ ÙˆÓ Î·ÙˆÙ¤ÚˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ô‰ÒÓ: √Í›· ‚ÚÔÁ¯›Ùȉ·, Î·È ÔÍ›˜ ÂÍ¿ÚÛÂȘ ¯ÚfiÓÈ·˜ ‚ÚÔÁ¯›Ùȉ·˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi S. pneumoniae, H. influenzae (‚-Ï·ÎÙ·Ì¿ÛË ±), H. parainfluenzae, M. catarrhalis (‚-Ï·ÎÙ·Ì¿ÛË ±), S. aureus. ¶Ó¢ÌÔÓ›· Û ·ÛıÂÓ›˜ Ù˘ ÎÔÈÓfiÙËÙ·˜ Ô˘ ÚÔηÏÂ›Ù·È ·Ô S. pneumoniae, H. influenzae (‚-Ï·ÎÙ·Ì¿Û˱) Î·È M. catarrhalis(‚-Ï·ÎÙ·Ì¿Û˱). ªË ÂÈÂÏÂÁ̤Ó˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Ù˘ ˘ÂÏÔÓÂÊÚ›Ùȉ·˜ Î·È Î˘ÛÙ›Ùȉ·˜, (Ì ٷ˘Ùfi¯ÚÔÓË Î¿Ï˘„Ë ÁÈ· Ù· ·Ó·ÂÚfi‚È· ) Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ∂. coli, P. mirabilis, Klebsiella spp. §ÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi Staphylococcus aureus (‚-Ï·ÎÙ·Ì¿Û˱) Î·È ‚-·ÈÌÔÏ˘ÙÈÎÒÓ ÛÙÚÂÙÔÎfiÎÎˆÓ ÔÌ¿‰·˜ ∞. ANTEN¢EI•EI™: °ÓˆÛÙ‹ ˘ÂÚ¢·ÈÛıËÛ›· ÛÙË ÎÂÊ·ÎÏfiÚË Î·È ¿ÏϘ ÎÂÊ·ÏÔÛÔÚ›Ó˜ ηıÒ˜ Î·È ÈÛÙÔÚÈÎfi ·Ó·Ê˘Ï·ÎÙÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÛÙȘ ÂÓÈÎÈÏϛӘ. ∞¡∂¶π£Àª∏∆∂™ ∂¡∂ƒ°∂π∂™: ∞ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ (‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ·ÏÏÂÚÁ›· Ì ÙȘ ÂÓÈÎÈÏϛӘ10%). ¡·˘Ù›·,¤ÌÂÙÔÈ, ‰È¿ÚÚÔȘ, ÂÈÁ·ÛÙÚÈÎfi˜ ÊfiÚÙÔ˜. ∞§§∏§∂¶π¢ƒ∞™∂π™: ∏ Û‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË ÚÔ‚ÂÓÂÛ›‰Ë˜ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·¤ÎÎÚÈÛË ÙÔ˘ CECLOR® ·fi ÙÔ˘˜ ÓÂÊÚÔ‡˜ fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È Ì ¿ÏÏ· ·ÓÙÈ‚ÈÔÙÈο. ™‡Á¯ÚÔÓË ¯ÔÚ‹ÁËÛË Ì ÙÂÙڷ΢ÎϛӘ ‹ ¯ÏˆÚ·ÌÊÂÓÈÎfiÏË, ¤¯ÂÈ ·ÓÙ·ÁˆÓÈÛÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. ŸÙ·Ó ¯ÔÚËÁÂ›Ù·È Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ Ì·˙› Ì ¿ÏÏ· ÓÂÊÚÔÙÔÍÈο Ê¿Ú̷η, fiˆ˜ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜, ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÓÂÊÚÔÙÔÍÈÎfiÙËÙ·˜ ¢√™√§√°π∞: XÔÚËÁÂ›Ù·È ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, Ì ‹ ¯ˆÚ›˜ Ê·ÁËÙfi. ∂Ó‹ÏÈΘ: 250 mg οı 8 ÒÚ˜, ‰ÈÏ·ÛÈ·˙fiÌÂÓË Û ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ. M¤ÁÈÛÙË ‰fiÛË ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ 4 gr ËÌÂÚËÛ›ˆ˜ ¶·È‰È¿: 20-40 mg/kg ËÌÂÚËÛ›ˆ˜ ‰È·ÈÚÂ̤ÓË Û ÙÚÂȘ ›Û˜ ‰fiÛÂȘ. ™ÙË ıÂÚ·›· Ù˘ ̤Û˘ ˆÙ›Ùȉ·˜ Î·È Ê·Ú˘ÁÁ›Ùȉ·˜, Ë Û˘ÓÔÏÈ΋ ËÌÂÚ‹ÛÈ· ‰fiÛË ÌÔÚ› Ó· ‰È·ÈÚÂı› Î·È Ó· ¯ÔÚËÁËı› ·Ó¿ 12ˆÚÔ. ª¤ÁÈÛÙË Û˘ÓÈÛÙÒÌÂÓË ‰fiÛË ÛÙ· ·È‰È¿ Â›Ó·È 1 gr ËÌÂÚËÛ›ˆ˜. ªOƒº∂™: Susp 125mg/5ml, 60ml, Susp 250mg/5ml, 60ml, Susp 375mg/5ml, 60ml, Caps 500mg Û ÎÔ˘Ù› ÙˆÓ 12. ¶ÔÛÔÛÙfi ÂȯÔÚ‹ÁËÛ˘ ·fi Ù· Ù·Ì›·: 75 %

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