Παιδιατρική | Τόμος 64 • Τεύχος 6 • Νοέμβριος - Δεκέμβριος 2001 by E-chlld

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™˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙËÏÂı¤·ÛË˜

Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁﬁÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ °. ∫Ô˘Ú›‰Ë˜, ª. ∆ÔÚÓ·Ú›ÙË˜, Ã. ∫Ô˘Ú›‰Ë˜, ™. ™¿‚‚·, Ã. Ã·Ù˙ËÁÂˆÚÁ›Ô˘

EDITORIAL

Initial empirical treatment of nosocomial pneumonia

P. Kalabalikis

REVIEW ARTICLES

Polygraphic sleep studies in children

M. Moustaki, P. Gialouros, T. Karpathios

Autoimmune bullous diseases of childhood

M. Papakonstantinou-Chaidemenou, G. Chaidemenos

ORIGINAL ARTICLES

Nosocomial infections in a Paediatric Intensive Care Unit

P. Kalabalikis, A. Patsoura, A. Mavromati, G. Briassoulis, A. Hrisaki, A. Pagali, A. Hatzis

Neonatal mortality in infants born at Ippokration General Hospital of Thessaloniki during the years 1986-1999

A. Andreou, M. Goudesidou, G. Mauridis, A. Rossiou, A. Balaska, M. Papouli

Spontaneous intracerebral hemorrhage in children

S. Fessatou, D. Gionis, E. Ourani, A. Heliadis, I. Papadatos

Causes of death in neonates born at Ippokration Hospital of Thessaloniki during the years 1986-1999

A. Andreou, A. Balaska, G. Mauridis, A. Rossiou, M. Goudesidou, M. Papouli

The relationship of television viewing to cardiovascular risk factors in children

Y. Kourides, M. Tornaritis, C. Kourides, S. Savva, H. Hadjigeorgiou

Continuation of table of contents inside title page

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O ¿ÓıÚ·Î·˜ ˆ˜ ‚ÈÔÏÔÁÈÎﬁ ﬁÏÔ Center of Disease Control Consensus Statement

CASE REPORTS

of table of contents

Scheuermann's disease in childhood. Case report

K. Tsoumakas, A. Zervoudaki, I. Ignatiadis

Laparoscopic management of a large adnexal cyst under torsion

E. Papandreou, M. Kotrotsou, N. Baltogiannis, G. Kousidis, E. Livaditi, D. Keramidas

Generalized tetanus in a greek child in the year 2000

D. Karakaidos, G. Triantafillidis, A. Moutafi, L. Kanaris, P. Zosi, C. Karis

¡eonate with sirenomelia.

Case report

E. Korakaki, E. Hatzidaki, A. Manoura, M. Mitsaki, D. Semertzakis, A. Voloudaki, C. Giannakopoulou

GENERAL ISSUES

Early perinatal hospital discharge: the pros and cons

C. Costalos

Accidents in childhood

D. Karakaidos, H. Georgiadis, C. Karis

Anthrax as a biological weapon Center of Disease Control Consensus Statement

™˘Ó¤¯ÂÈ· ÂÚÈÂ¯ÔÌ¤ÓˆÓContinuation of table of contents

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

∫ÚÈÙ¤˜ ÙÔ˘ ∆ﬁÌÔ˘ 64

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘ ∆ﬁÌÔ˘ 64

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿ ÙÔ˘ ∆ﬁÌÔ˘ 64

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·ÛÊ˘Í›· ‹ Î·È ÂÚÈÁÂÓÓËÙÈÎ‹ ÏÔ›ÌˆÍË

Fotopoulos S, Pavlou K, Skouteli H, Papassotiriou I, Xanthou M

∞ﬁ‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ™. ºˆÙﬁÔ˘ÏÔ˜

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ÛÙÔ ÌËÙÚÈÎﬁ Á¿Ï·

Vadas P, Wai Y, Burks W, Perelman B ∞ﬁ‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: °. π. ∫·ÊÚ›ÙÛ·

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PAEDIATRIC NEWS

Book Review

Reviewers of manuscripts, Volume 64

Author Index, Volume 64

Subject Index, Volume 64

LITERATURE ABSTRACTS

Early markers of brain damage in premature low-birth-weight neonates who suffered from perinatal asphyxia and/or infection

Fotopoulos S, Pavlou K, Skouteli H, Papassotiriou I, Xanthou M

Greek translation: S. Fotopoulos

Detection of peanut allergens in breast milk of lactating women

Vadas P, Wai Y, Burks W, Perelman B

Greek translation: G. I. Kafritsa

Scheduled Medical Meetings

Abbreviations

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË

E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎﬁ ÙË˜ EÏÏËÓÈÎ‹˜

¶·È‰È·ÙÚÈÎ‹˜ EÙ·ÈÚÂ›·˜

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K. °ÚÈ‚¤·˜

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MÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92

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ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·

∂ÈÌ¤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ

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∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·

ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92

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™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰ﬁÛÂˆ˜ E¶I™THMONIKE™EK¢O™EI™E.¶.E. ¶. ∆Û·Ï‰¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 61 41 360-5 Fax: 61 41 366

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹ 10000 ‰Ú¯.29,35

EÈ‰ÈÎÂ˘ﬁÌÂÓÔÈ, ºÔÈÙËÙ¤˜:5000 ‰Ú¯.14,67

Bimonthly Publication

The Official Journal of the Hellenic Paediatric Society

Publisher K. Griveas

Owner©

Hellenic Paediatric Society

Michalakopoulou 92

Athens 115 28

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

Scientific Editorial Board

President : K. Malaka

Editor : Z. Papadopoulou-Couloumbis

Members : E. Agelaki-Georgaki

: F. Athanassiadou-Piperopoulou

: M. Anthrakopoulos

: G. Varlamis

: P. Kafritsa

: A. Konstadopoulos

: Th. Tsiligiannis

: K. Tsoumakas

: S. Fotopoulos

: ∞. Hatzis

Manuscript Editing

Greek Editing

I. Karavranou

English Editing

Z. Papadopoulou-Couloumbis

Correspondence

Hellenic Paediatric Society

Michalakopoulou 92

Athens 115 28

Tel: (01) 7771 140, Fax: 7758 354

Publishing Coordinator SCIENTIFICPUBLICATIONSLtd

P. Tsaldari 3, Marousi 151 22

Tel.: 61 41 360-5 Fax: 61 41 366

Annual Subscription

All foreign countries: US $ 30

πSSN 0377-2551

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Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·ﬁ ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛË

Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù·

Û˘˙‹ÙËÛË ÌÂ ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË. T· ˘ﬁÏÔÈ·

ÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿

ÎÚ›ÛË ÙˆÓ Û˘ÁÁÚ·Ê¤ˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ Î·È ÚÈÓ ·ﬁ ÙÈ˜

‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜.

TÈÌ¤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈÌ¤˜ 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· Ì¤Û· ÛÂ ·Ú¤ÓıÂÛË. ¶›Ó·ÎÂ˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜ OÈ Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËıÂ› ‰ÈÂıÓÒ˜ ‰ËÌÔÛÈÂ‡ÔÓÙ·È ÛÂ Î¿ıÂ ÙÂ‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏÂ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ ÎÂ›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÎ·ı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁÚ·Ê›Â˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi

BÈ‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· ÙË˜ ‚È‚ÏÈÔÁÚ·Ê›·˜

‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ÌÂ ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ™ÙÔ ÎÂ›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÛÂ ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙÈ˜ 70 ÛÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜, ÙÈ˜ 30 ÛÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜, ÙÈ˜ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÂÚÈÙÒÛÂÈ˜, ÙÈ˜ 5 ÛÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ 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‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿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‰ÈÎ¿ AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ 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·ÎÙÈÎ‹ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÏÂÍ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚ﬁÏÈ·, ·ÚﬁÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈÌˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈÎ‹ Ú¿ÍË. ¶·È‰È·ÙÚÈÎ‹ 1996;59:272-279.

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

™˘ÌÏËÚˆÌ·ÙÈÎﬁ ÙÂ‡¯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.

ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:

National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.

¶ÚÔÛ‰ÈÔÚÈÛÌﬁ˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

∫Ô˘Ú›‰Ë˜ Ã, ∫Ô˘Ú›‰Ë˜ °. ¶·¯˘Û·ÚÎ›· Î·È ˘ÂÚÏÈÈ‰·ÈÌ›· ÛÂ ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈÎ‹˜ ∫‡ÚÔ˘ [¶ÂÚ›ÏË„Ë].

36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎﬁ ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜;1998. ÛÂÏ. 172.

Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract].

J Am Soc Nephrol 1991;2:562.

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

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

II. µÈ‚Ï›·

∫ÂÊ¿Ï·ÈÔ ÛÂ ‚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 ÛÂ 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.

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

Kaplan SJ. Post hospital home health care: the

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

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¶. ∫·Ï·Ì·Ï›ÎË˜

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∏ ÓÔÛÔÎÔÌÂÈ·Î‹ ÓÂ˘ÌÔÓ›· (¡¶) Â›Ó·È Û¯ÂÙÈÎ¿ Û˘Ó‹ıË˜ ÂÈÏÔÎ‹ ÙˆÓ ÓÔÛËÏÂ˘fiÌÂÓˆÓ ·ÛıÂÓÒÓ Î·È ·ÓÙÈÚÔÛˆÂ‡ÂÈ ÂÚ›Ô˘ ÙÔ 15% ÙˆÓ ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ. ∂›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ÓÔÛÔÎÔÌÂÈ·Î‹ ÏÔ›ÌˆÍË ÌÂÙ¿ ÙÈ˜ Ô˘ÚÔÏÔÈÌÒÍÂÈ˜ Î·È Ë Û˘¯ÓfiÙËÙ¿ ÙË˜ ÁÂÓÈÎ¿ Î˘Ì·›ÓÂÙ·È ·fi 5 ¤ˆ˜ 10 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 1000 ÓÔÛÔÎÔÌÂÈ·ÎÔ‡˜ ·ÛıÂÓÂ›˜ (1,2). ∆· ÔÛÔÛÙ¿ Â›Ó·È ÂÚ›Ô˘ 20 ÊÔÚ¤˜ ˘„ËÏfiÙÂÚ· ÛÙÈ˜ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜

ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Abstract: Nosocomial pneumonia (NP) is the second most common nosocomial infection with high morbidity and mortality, particularly if immunocompromised patients are affected or certain pathogens are involved. Early and appropriate antibiotic therapy increases significantly the survival rates of NP patients. Because of the importance of the initial treatment, the American Thoracic Society proposed in 1995 guidelines for the initial empiric therapy of NP. Since then, newer publications have provided newer data about the use of antibiotics which may be more effective and are associated to a lesser degree with the development of resistance. The recommended antibiotic treatment is based on the severity of NP, the time of onset, the presumptive causative pathogens and the existence of other risk factors.

Key words: nosocomial pneumonia, hospital acquired-pneumonia, antibiotics, therapy.

(ª∂£) ÂÓËÏ›ÎˆÓ, ÂÓÒ ÛÙÈ˜ ª∂£ ·È‰ÈÒÓ Î˘Ì·›ÓÔÓÙ·È ·ﬁ 1,2% ¤ˆ˜ 5,5% (3-5).

¶·Ú¿ ÙÔ fiÙÈ ÔÏÏÔ› ·Ú¿ÁÔÓÙÂ˜, fiˆ˜ Ë ˘ÔÎÂ›ÌÂÓË ÓfiÛÔ˜, Ô ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ Î·È Ë ·ÏÎ·ÏÔÔ›ËÛË ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ÂÚÈÂ¯ÔÌ¤ÓÔ˘, Â˘ÓÔÔ‡Ó ÙËÓ ·Ó¿Ù˘ÍË ¡¶, ÚˆÙ·Ú¯ÈÎ‹˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ

·ıÔÁ¤ÓÂÈ· ÙË˜ ÓﬁÛÔ˘ Â›Ó·È Ô ·ÔÈÎÈÛÌﬁ˜ Î·È Ë ‰È·Ù·Ú·¯‹ ÙË˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· (6,7). ∂¿Ó Ë ¡¶ ÂÎ‰ËÏˆıÂ› ÙÈ˜ 4 ÚÒÙÂ˜ ËÌ¤ÚÂ˜

Intensive Care Unit “Aghia Sophia” Children’s Hospital, Athens

ÓÔÛËÏÂ›·˜ (ÚÒÈÌË ÓÂ˘ÌÔÓ›·), ÔÊÂ›ÏÂÙ·È Û˘Ó‹-

ıˆ˜ ÛÂ ÌÈÎÚﬁ‚È· ÙË˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÂÓÒ

Â¿Ó ÂÎ‰ËÏˆıÂ› ÌÂÙ¿ ÙËÓ 5Ë ËÌ¤Ú· (ﬁ„ÈÌË ÓÂ˘ÌÔÓ›·), Â›Ó·È Èı·Óﬁ Ó· ÔÊÂ›ÏÂÙ·È ÛÂ ÓÔÛÔÎÔÌÂÈ·Î¿

ÌÈÎÚÔ‚È·Î¿ ÛÙÂÏ¤¯Ë, Ù· ÔÔ›· ¤¯Ô˘Ó ·ÔÈÎ›ÛÂÈ ÙÔ

ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. Œ¯ÂÈ ·Ú·ÙËÚËıÂ› ·ÔÈÎÈÛÌﬁ˜

ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· ·ÛıÂÓÒÓ 36 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ

ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙË ª∂£, ·ÎÔÏÔ‡ıËÛÂ ·ÔÈÎÈÛÌﬁ˜

ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÛÙÈ˜ 36-60 ÒÚÂ˜ Î·È ·ÔÈÎÈÛÌﬁ˜ ÙÔ˘

Î·ÙÒÙÂÚÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ÛÙÈ˜ 60-96 ÒÚÂ˜ (8).

∏ ÓﬁÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈÎ‹ ıÓËÙﬁÙËÙ·.

∂¿Ó Ì¿ÏÈÛÙ· ÚÔÛ‚¿ÏÏÂÈ ·ÓÔÛÔÎ·Ù·ÛÙ·ÏÌ¤Ó·

¿ÙÔÌ· ‹ Â¿Ó ÔÊÂ›ÏÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈÌ¤Ó· ÌÈÎÚﬁ‚È·,

ﬁˆ˜ P. aeruginosa Î·È Acinetobacter, Ë ıÓËÙﬁÙË-

Ù· ÌÔÚÂ› Ó· ÍÂÂÚ¿ÛÂÈ ÙÔ 50% (2,9,10).

™ËÌ·ÓÙÈÎﬁ ÚﬁÏÔ ÛÙËÓ ¤Î‚·ÛË ·›˙ÂÈ Ë ¤ÁÎ·ÈÚË

Î·È Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË. Œ¯ÂÈ ‰È·ÈÛÙˆıÂ› ﬁÙÈ

Ë ¤ÁÎ·ÈÚË ¯ÔÚ‹ÁËÛË Î·Ù¿ÏÏËÏË˜ ·ÓÙÈÌÈÎÚÔ‚È·Î‹˜

·ÁˆÁ‹˜ ·˘Í¿ÓÂÈ ÛÙÔ ‰ÈÏ¿ÛÈÔ ÙÈ˜ Èı·ÓﬁÙËÙÂ˜ ÂÈ-

‚›ˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ¡¶ (11,12). ∞ÛıÂÓÂ›˜ ÌÂ ¡¶ Ô˘ ¤Ï·‚·Ó ¤ÁÎ·ÈÚ· ÛˆÛÙ‹ ·ÓÙÈÌÈÎÚÔ‚È·Î‹

·ÁˆÁ‹ Â›¯·Ó ÙË ÌÈÎÚﬁÙÂÚË ıÓËÙﬁÙËÙ·, ·ÓÂÍ¿ÚÙËÙ·

ÙËÓ ·ÔÌﬁÓˆÛË ‹ ÌË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ (13). ∞ÓÙ›ıÂÙ·, ¿ÙÔÌ· ÛÙ· ÔÔ›· ·Ú¯È-

Î¿ ¯ÔÚËÁ‹ıËÎÂ ÌË Î·Ù¿ÏÏËÏË ·ÓÙÈ‚ÈÔÙÈÎ‹ ·ÁˆÁ‹

Î·È ÂÓ Û˘ÓÂ¯Â›· ÙÚÔÔÔÈ‹ıËÎÂ ÌÂ ‚¿ÛË ÙÔÓ ·-

ıÔÁﬁÓÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌﬁ Î·È ÙÔ test Â˘·ÈÛıËÛ›·˜

ÙÔ˘, Â›¯·Ó ·ÚﬁÌÔÈ· ¤Î‚·ÛË ÌÂ ·˘ÙÔ‡˜ Ô˘ ¿Ú¯È-

Û·Ó Î·È Û˘Ó¤¯ÈÛ·Ó ÌÂ ·Î·Ù¿ÏÏËÏË ·ÓÙÈÌÈÎÚÔ‚È·Î‹

·ÁˆÁ‹ (13).

§ﬁÁˆ, ÏÔÈﬁÓ, ÙË˜ ÌÂÁ¿ÏË˜ ÛËÌ·Û›·˜ ÙË˜

¤ÁÎ·ÈÚË˜ Î·È Î·Ù¿ÏÏËÏË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ·ÁˆÁ‹˜, Ë

∞ÌÂÚÈÎ·ÓÈÎ‹ ∂Ù·ÈÚÂ›· £ˆÚ·ÎÈÎÒÓ ¡ﬁÛˆÓ (American Thoracic Society), Ï·Ì‚¿ÓÔÓÙ·˜ ˘’

ﬁ„ÈÓ ÙË ‚·Ú‡ÙËÙ· ÙË˜ ¡¶, ÙÔ ¯ÚﬁÓÔ ¤Ó·ÚÍË˜ ÙË˜

ÓﬁÛÔ˘ Î·È ÙËÓ ‡·ÚÍË ÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·Áﬁ-

ÓÙˆÓ, Î·ıﬁÚÈÛÂ ÙÔ 1995 Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜ Ô‰ËÁ›Â˜

ÁÈ· ÙËÓ ·Ú¯ÈÎ‹ ÂÌÂÈÚÈÎ‹ ıÂÚ·Â›· ÙË˜ (14). ∞ﬁ

ÙﬁÙÂ ˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ‡ÛÂÈ˜ Ô˘ ÚÔÛı¤ÙÔ˘Ó

ÛÙÈ˜ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ÓÂﬁÙÂÚ· ‰Â‰ÔÌ¤Ó· (15-17). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‚·Ú‡ÙËÙ· ÙË˜ ÓﬁÛÔ˘, ˆ˜ ÛÔ-

‚·Ú‹ ¡¶ ¯·Ú·ÎÙËÚ›ÛÙËÎÂ ·˘Ù‹ Ô˘ ÚÔÎ·ÏÂ› (14): ·) ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙË ª∂£, ‚) ÛËÌÂ›· ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ÒÛÙÂ Ó· ··ÈÙÂ›Ù·È ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜ ‹ ¯ÔÚ‹ÁËÛË O2 >35% ÁÈ· Ó· ‰È·ÙËÚÂ›Ù·È ÎÔÚÂÛÌﬁ˜ ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ >90%, Á) Ú·Á‰·›· ÂÈ‰Â›ÓˆÛË ÙË˜ ·ÎÙÈÓÔÁÚ·ÊÈÎ‹˜ ÂÈÎﬁÓ·˜, Î·Ù¿ÏË„Ë ÂÚÈÛ-

ÛﬁÙÂÚˆÓ ÓÂ˘ÌÔÓÈÎÒÓ ÏÔ‚ÒÓ ‹ ÛËÏ·ÈÔÔ›ËÛË ÛÂ

ÓÂ‡ÌÔÓ·, ÛÙÔÓ ÔÔ›Ô ˘‹Ú¯·Ó ‰ÈËı‹ÛÂÈ˜ Î·È ‰)

ÂÓ‰Â›ÍÂÈ˜ ÛÔ‚·Ú‹˜ ÛË„·ÈÌ›·˜ (severe sepsis) ÌÂ ˘ﬁÙ·ÛË ‹/Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ.

∞ÛıÂÓÂ›˜ ÌÂ ÚÒÈÌË ÂÏ·ÊÚ¿ ‹ Ì¤ÙÚÈ· ¡¶, ¯ˆ-

Ú›˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (™¯‹Ì· 1), Â›Ó·È Èı·Óﬁ Ó· ¤¯Ô˘Ó ÌÔÏ˘ÓıÂ› ÌÂ ¤Ó·Ó ‹ ÂÚÈÛÛﬁÙÂÚÔ˘˜ ÌÈ-

ÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ·ÔÈÎ›˙Ô˘Ó ÙÔ ·ÓÒÙÂÚÔ ·Ó·-

ÓÂ˘ÛÙÈÎﬁ ÙÔ˘˜ ‹ ÌÂ ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂÈ‰‹ ÙË˜

ÂÓÙÂÚÈÎ‹˜ ÙÔ˘˜ ¯ÏˆÚ›‰·˜ (ÔÌ¿‰· 1) (¶›Ó·Î·˜ 1).

™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› ÎÂÊ·ÏÔÛÔÚ›ÓË 2Ë˜ (ÎÂÊÔ˘ÚÔÍ›ÌË) ‹ 3Ë˜ ÁÂÓÈ¿˜ (ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙÚÈ·ÍfiÓË) ‹ Û˘Ó‰˘·ÛÌfi˜ ‚-Ï·ÎÙ¿ÌË˜/·Ó·ÛÙÔÏ¤· ‚-Ï·ÎÙ·Ì¿ÛË˜ (·ÌÔÍÈÎÈÏÏ›ÓË/ ÎÏ·‚Ô˘Ï·ÓÈÎfi ÔÍ‡, ÙÈÎ·ÚÛÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi ÔÍ‡, ÈÂÚ·ÎÈÏÏ›ÓË/Ù·˙ÔÌ·ÎÙ¿ÌË). ™Â ¿ÙÔÌ· ·ÏÏÂÚÁÈÎ¿ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› Û˘Ó‰˘·ÛÌfi˜ ·˙ÙÚÂÔÓ¿ÌË˜-ÎÏÈÓ‰·Ì˘Î›ÓË˜. ∂¿Ó ˘¿Ú¯Ô˘Ó ÂÈ‰ÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2) ÛÂ ÂÏ·ÊÚ¿ ‹ Ì¤ÙÚÈ· ¡¶, Â›Ó·È ‰˘Ó·ÙfiÓ, ÂÎÙfi˜ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÙË˜ ÔÌ¿‰·˜ 1, Ó· Â˘ı‡ÓÔÓÙ·È Î·È ¿ÏÏÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› fiˆ˜ ÏÂÁÈÔÓ¤ÏÏ·, ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ·ÓıÂÎÙÈÎfi˜ ÛÙË ÌÂıÈÎÈÏÏ›ÓË Î·È ·Ó·ÂÚfi‚È· (ÔÌ¿‰· 2) (¶›Ó·Î·˜ 1). ∏ ·Ú¯ÈÎ‹ ÂÌÂÈÚÈÎ‹ ıÂÚ·Â›· ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‰˘·ÛÌfi ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙËÓ ÔÌ¿‰· 1 ÙˆÓ ÌÈÎÚÔ‚›ˆÓ Î·È ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ˘˜ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÙˆÓ ·ÛıÂÓÒÓ. ∂¿Ó ·ÛıÂÓ‹˜, ¯ˆÚ›˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, ÂÎ‰ËÏÒÛÂÈ ÛÔ‚·Ú‹ ¡¶ Ì¤Û· ÛÂ 4 ËÌ¤ÚÂ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, Û˘ÓÈÛÙ¿Ù·È Ë ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ÙË˜ ÔÌ¿‰·˜ 1. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘

µ·Ú‡ÙËÙ· ¡¶

‹ Ì¤ÙÚÈ· ™Ô‚·Ú‹

¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Ÿ¯È¡·ÈŸ¯È¡·È

ÃÚﬁÓÔ˜ ¤Ó·ÚÍË˜ ¡¶ OÈÔÛ‰‹ÔÙÂOÈÔÛ‰‹ÔÙÂ1-4 ËÌ¤ÚÂ˜≥5 ËÌ¤ÚÂ˜OÈÔÛ‰‹ÔÙÂ

¶Èı·Ó¿ ÌÈÎÚﬁ‚È· OÌ¿‰· 1OÌ¿‰· 2OÌ¿‰· 1OÌ¿‰· 3OÌ¿‰· 3

™¯‹Ì· 1. AÏÁﬁÚÈıÌÔ˜ ·ÓÙÈÌÂÙÒÈÛË˜ ·ÛıÂÓÒÓ ÌÂ ÓÔÛÔÎÔÌÂÈ·Î‹ ÓÂ˘ÌÔÓ›· (¡¶).

OÌ¿‰·¶Èı·ÓÔ› ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›¶ÚÔÙÂÈÓﬁÌÂÓ· ·ÓÙÈ‚ÈÔÙÈÎ¿

1 S. pneumoniae, H. influenzae, ∫ÂÊ·ÏÔÛÔÚ›ÓÂ˜ 2Ë˜ (ÎÂÊÔ˘ÚÔÍ›ÌË) ‹ 3Ë˜ ÁÂÓÈ¿˜ MSSA, ∂ÓÙÂÚÔ‚·ÎÙËÚÈÔÂÈ‰‹:(ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙÚÈ·ÍﬁÓË)

E.Coli, Klebsiella, Enterobacter‹ Proteus, Serratia.‚-Ï·ÎÙ¿ÌË/·Ó·ÛÙÔÏ¤·˜ ‚-Ï·ÎÙ·Ì¿ÛË˜ (·ÌÈÎÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï. ÔÍ‡, ÙÈÎ·ÚÛÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï. ÔÍ‡, ÈÂÚ·ÛÈÏÏ›ÓË/Ù·˙ÔÌ·ÎÙ¿ÌË)

∂› ·ÏÏÂÚÁ›·˜ ÛÙÈ˜ ÂÓÈÎÈÏÏ›ÓÂ˜: ·˙ÙÚÂÔÓ¿ÌË + ÎÏÈÓ‰·Ì˘Î›ÓË

2ªÈÎÚﬁ‚È· ÔÌ¿‰·˜ π + ·Ó·ÂÚﬁ‚È·‚-Ï·ÎÙ¿ÌË/·Ó·ÛÙÔÏ¤·˜ ‚-Ï·ÎÙ·Ì¿ÛË˜ + ÂÓ‰Â¯ÔÌ¤Óˆ˜: S.aureus

µ·ÓÎÔÌ˘Î›ÓË (Ì¤¯ÚÈ Ó· ·ÔÎÏÂÈÛÙÂ› ÏÔ›ÌˆÍË ·ﬁ MRSA)

Legionellaª·ÎÚÔÏ›‰Ë (ÂÚ˘ıÚÔÌ˘Î›ÓË, ÎÏ·ÚÈıÚÔÌ˘Î›ÓË)

3ªÈÎÚfi‚È· ÔÌ¿‰·˜ π +∞ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë + ¤Ó· ·fi Ù· ·ÎfiÏÔ˘ı·: P. aeruginosa, Acinetobacter,∞ÓÙÈ„Â˘‰ÔÌÔÓ·‰ÈÎ‹ ÂÓÈÎÈÏÏ›ÓË (ÈÂÚ·ÛÈÏÏ›ÓË, ÙÈÎ·ÚÛÈÏÏ›ÓË)

∞ÓÙÈ„Â˘‰ÔÌÔÓ·‰ÈÎ‹ ‚-Ï·ÎÙ¿ÌË/·Ó·ÛÙÔÏ¤·˜ ‚-Ï·ÎÙ·Ì¿ÛË˜ (ÙÈÎ·Ú

ÛÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎﬁ ÔÍ‡, ÈÂÚ·ÛÈÏÏ›ÓË/Ù·˙ÔÌ·ÎÙ¿ÌË)

πÌÈÂÓ¤ÌË/ÛÈÏ·ÛÙ·Ù›ÓË, ÌÂÚÔÂÓ¤ÌË

MRSA∂Ó‰Â¯ÔÌ¤Óˆ˜ ÚÔÛı‹ÎË Î·È ‚·ÓÎÔÌ˘Î›ÓË˜

MSSA: ÃÚ˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜ Â˘·›ÛıËÙÔ˜ ÛÙË ÌÂıÈÎÈÏÏ›ÓË (Methicilline sensitive S. Aureus)

MRSA: ÃÚ˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜ ·ÓıÂÎÙÈÎﬁ˜ ÛÙË ÌÂıÈÎÈÏÏ›ÓË (Methicilline resistant S. aureus)

¶›Ó·Î·˜ 2. ¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ Û¯¤ÛË ÌÂ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÓÔÛÔÎÔÌÂÈ·Î‹ ÓÂ˘ÌÔÓ›·

¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ªÈÎÚÔÔÚÁ·ÓÈÛÌﬁ˜

ñ ∂ÈÛÚﬁÊËÛË, ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË ÎÔÈÏ›·˜ ∞Ó·ÂÚﬁ‚È· ñ ∫ÒÌ·, Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜, ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· S. aureus

ñ ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ˘„ËÏ¤˜ ‰ﬁÛÂÈ˜ ÛÙÂÚÔÂÈ‰ÒÓLegionella ñ ¶·Ú·ÙÂÙ·Ì¤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÂ ·ÛıÂÓÂ›˜

Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÌË¯·ÓÈÎﬁ ·ÂÚÈÛÌﬁAcinetobacter

ñ ¶·Ú·ÙÂÙ·Ì¤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, ÛÙÂÚÔÂÈ‰‹, ˘ÔıÚÂ„›·, Î·ÎÔ‹ıÂÈ·, ÈÓÔÎ˘ÛÙÈÎ‹ ÓfiÛÔ˜ P. aeruginosa

ñ ¶·Ú·ÙÂÙ·Ì¤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ì·ÎÚ¿ ·Ú·ÌÔÓ‹

ÛÂ ÌË¯·ÓÈÎﬁ ·ÂÚÈÛÌﬁ MRSA

MRSA: ÃÚ˘Û›˙ˆÓ ÛÙ·Ê˘ÏﬁÎÔÎÎÔ˜ ·ÓıÂÎÙÈÎﬁ˜ ÛÙË ÌÂıÈÎÈÏÏ›ÓË (Methicilline resistant S. aureus)

ÂÎ‰ËÏˆıÂ› ÛÔ‚·Ú‹ ¡¶ ≥5 ËÌ¤ÚÂ˜ ·ﬁ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ‹ Â¿Ó Ô ¿ÚÚˆÛÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È

Èı·ÓfiÓ ‹ ÓfiÛÔ˜ Ó· ÔÊÂ›ÏÂÙ·È Î·È ÛÂ ÔÏ˘·ÓıÂÎÙÈÎ¿ Gram(-) ÌÈÎÚfi‚È·, fiˆ˜ P. aeruginosa ‹ Acinetobacter, fiˆ˜ Â›ÛË˜ Î·È ÛÙÔ ¯Ú˘Û›˙ÔÓÙ·

ÛÙ·Ê˘ÏﬁÎÔÎÎÔ, ÙÔÓ ·ÓıÂÎÙÈÎﬁ ÛÙË ÌÂıÈÎÈÏÏ›ÓË Î·È Ë ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· ÛÙÔ¯Â‡ÂÈ ÂÈÏ¤ÔÓ Î·È ÛÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ·˘ÙÔ‡˜.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Bellemare J, Tepas J III, Imami E, Hartland L. Complications of trauma care: Risk analysis of pneumonia in 10.001 adult trauma patients. Am Surg 1996;62:207-211.

2. Rodriguez J, Gibbons K, Bitzer L, Dechert R, Steinberg S, Flint L. Pneumonia: Incidence, risk factors and outcome in injured patients. J Trauma 1991;31:907-914.

3. Milliken J, Tait G, Ford-Jones E, Mindorff C, Gold R, Mullins G. Nosocomial infections in a pediatric intensive care unit. Crit Care Med 1988;16:233-237.

4. Fayon M, Tuccin M, Lacroix J, Farrell C, Gauthier M, Lafleur L et al. Nosocomial pneumonia and tracheitis in a pediatric intensive care unit. Am J Respir Crit Care Med 1995;155:162-169.

5. Patel J, Mollitt D, Pieper P, Tepas J III. Nosocomial pneumonia in the pediatric trauma patient: A single center’s experience. Crit Care Med 2000;28:3530-3533.

6. Sanderson P. The sources of pneumonia in ICU patients. Infect Control 1986;7:104-106.

7. Spencer R. Epidemiology of infection in ICUs. Intensive Care Med 1994;20:S2-S6.

8. Feldman C, Kassel M, Cantrell J, Kaka S, Morar R, Goolam M et al. The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation. Eur Respir J 1999;13:546-551.

9. Fagon J, Chastre J, Hance A, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: A cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281-288.

10. Baker A, Meredith J, Haponik F. Pneumonia in intubated trauma patients: Microbiology and outcomes. Am J Respir Crit Care Med 1996;153:343-349.

11. Celis R, Torres A, Gatell J, Almera M, Rodriguez-Roisin R, Agusti-Vidal A. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest 1988;93:318-324.

12. Torres A, Aznar R, Gatell J, Jimenez P, Gonzalez J, Ferrer A et al. Incidence, risk and prognostic factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523-528.

13. Luna C, Vujacich P, Niederman M, Vay C, Gherardi C, Matera J et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997;111:676-685.

14. American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies. Am J Respir Crit Care Med 1995;153:1711-1725.

15. Fiel S. Guidelines and critical pathways for severe hospitalacquired pneumonia. Chest 2001;119:412S-418S.

16. Mathai D, Lewis M, Kugler K, Pfaller M, Jones R. Antibacterial activity of 41 antimicrobials tested against

over 2773 bacterial isolates from hospitalized patients with pneumonia: Results from the SENTRY Antimicrobial Surveillance Program (North America, 1998). Diagn Microbiol Infect Dis 2001;39:105-116.

17. Niederman M. Can guidelines for the treatment of respiratory infections lead to reduced rates of antibiotic resistance? Semin Respir Infect 2001;16:203-209.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-08-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 05-10-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙË˜ ∫·Ï·Ì·Ï›ÎË˜

¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”

¶ª∂¡ (4Ô˜ ﬁÚÔÊÔ˜)

£Ë‚ÒÓ & §Â‚·‰›·˜, 115 27, ∞ı‹Ó·

™ÎÔﬁ˜: ™ÎÔﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ·Ó·˙‹ÙËÛË ÚÒÈÌˆÓ

‰ÂÈÎÙÒÓ ÙË˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ‚Ï¿‚Ë˜ ÛÂ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ (Ãµ°) ÓÂÔÁÓ¿ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ‹ Î·È ÂÚÈ-

ÁÂÓÓËÙÈÎ‹ ÏÔ›ÌˆÍË.

ÀÏÈÎﬁ Î·È ÌÂıÔ‰ÔÏÔÁ›·: ªÂÏÂÙ‹ıËÎ·Ó 57 Ãµ° ÓÂÔÁÓ¿. ∆· 29

·ﬁ ·˘Ù¿ Â›¯·Ó ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ‹ Î·È ÂÚÈÁÂÓÓËÙÈÎ‹

ÏÔ›ÌˆÍË, ÂÓÒ Ù· ˘ﬁÏÔÈ· 28 Ô˘ ‰ÂÓ Â›¯·Ó ÂÚÈÁÂÓÓËÙÈÎ‹

·ÛÊ˘Í›· ‹ Î·È ÏÔ›ÌˆÍË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û·Ó Ì¿ÚÙ˘ÚÂ˜.

ªÂÙÚ‹Û·ÌÂ ÙÔÓ ·ﬁÏ˘ÙÔ ·ÚÈıÌﬁ ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ ÙÔ˘

ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È Ù· Â›Â‰· ÙˆÓ IL-1b, IL-6 Î·È TNFa ÙÔ˘ ÔÚÔ‡, ÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜, Î·ıÒ˜ Â›ÛË˜ ÙËÓ 3Ë Î·È 7Ë

ËÌ¤Ú· ÙË˜ ˙ˆ‹˜ ÙÔ˘˜. ¢ÂÎ·Ù¤ÛÛÂÚ· ·È‰È¿ ·ﬁ ÂÎÂ›Ó· Ô˘

Â›¯·Ó ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ‹ Î·È ÏÔ›ÌˆÍË Î·È 12 ·ﬁ ÙÔ˘˜

Ì¿ÚÙ˘ÚÂ˜ ÂÎÙÈÌ‹ıËÎ·Ó ÓÂ˘ÚÔÏÔÁÈÎ¿ ÛÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈÎ›·

ÙˆÓ 18 ÌËÓÒÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·: µÚ‹Î·ÌÂ fiÙÈ Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È Ù· Â›Â‰· ÙË˜ IL-1b Î·È IL-6 Î·Ù¿ Ì¤ÛÔ fiÚÔ

ÙËÓ 24Ë ÒÚ· ÙË˜ ˙ˆ‹˜, ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏﬁÙÂÚ· ÛÙ· ÓÂÔ-

ÁÓ¿ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ‹ Î·È ÏÔ›ÌˆÍË ·’ ﬁ,ÙÈ ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ (p=0,022, p=0,036, p=0,037 ·ÓÙ›ÛÙÔÈ¯·). ∆· Â›-

Â‰· ÙÔ˘ TNF-a ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂÙ·Í‡ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ

ÓÂÔÁÓÒÓ Ô˘ ÂÏ¤Á¯ıËÎ·Ó. ™ÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈÎ›· ÙˆÓ 18 ÌË-

ÓÒÓ, Ë ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÎÙ›ÌËÛË ¤‰ÂÈÍÂ ﬁÙÈ 8 ·ﬁ Ù·

¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘ÚÂ˜, ‰ÂÓ Â›¯Â ·ıÔÏÔÁÈÎ¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·. ¢È·ÈÛÙÒıËÎÂ fiÙÈ Ù· ·È‰È¿ Ô˘ Â›¯·Ó ·ıÔÏÔÁÈÎ¿ ÓÂ˘ÚÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ·ÚÔ˘Û›·˙·Ó ÛÙÈ˜ 24 ÒÚÂ˜ ÙË˜ ˙ˆ‹˜ ÙÔ˘˜ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚÔ ·ÚÈıÌfi ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È ÂÈ¤‰ˆÓ IL-1b Î·È IL-6, ·’ fi,ÙÈ Ù· ·È‰È¿ ÌÂ

Ê˘ÛÈÔÏÔÁÈÎ‹ ÓÂ˘ÚÔÏÔÁÈÎ‹ ÂÍ¤ÏÈÍË. ™˘ÌÂÚ¿ÛÌ·Ù·: O ·˘ÍËÌ¤ÓÔ˜ ·ÚÈıÌﬁ˜ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È

ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙ· ÓÂÔÁÓ¿ ÌÂ ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ‹ Î·È ÏÔ›ÌˆÍË ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ÚÒÈÌÔÈ ‰Â›ÎÙÂ˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ‚Ï¿‚Ë˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Úﬁ‚ÏÂ„Ë˜ ÙË˜ ÓÂ˘ÚÔÏÔÁÈÎ‹˜ ÙÔ˘˜ ÂÍ¤ÏÈÍË˜. ¶ÚÒÈÌÔÈ ‰Â›ÎÙÂ˜ ‚Ï¿‚Ë˜

1Fotopoulos S, Pavlou K, Skouteli H, Papassotiriou I, Xanthou M

Early markers of brain damage in premature low-birth-weight neonates who suffered from perinatal asphyxia and/or infection Biol Neonate 2001;79:213-218

ÔÏ˘·Ú·ÌÂÙÚÈÎ‹˜

ª. ªÔ˘ÛÙ¿ÎË1,

Polygraphic sleep studies in children

M. Moustaki1, P. Gialouros2, T. Karpathios1

¶ÂÚ›ÏË„Ë: ∆Ô ¿ÚıÚÔ ·˘Ùﬁ ·Ó·ÛÎÔÂ› ÙÈ˜ ÂÓ‰Â›-

ÍÂÈ˜ ÂÎÙ¤ÏÂÛË˜ ÔÏ˘·Ú·ÌÂÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ‡ÓÔ˘

ÛÙ· ·È‰È¿ ÁÈ· ·Ó›¯ÓÂ˘ÛË ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·Ó·-

ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘.

OÈ ÛËÌ·ÓÙÈÎﬁÙÂÚÂ˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜

ÛÙÔÓ ‡ÓÔ, ‰ËÏ·‰‹ ÔÈ ·ÔÊÚ·ÎÙÈÎ¤˜ Î·È ÎÂÓÙÚÈÎ¤˜

¿ÓÔÈÂ˜ Î·È Ô ˘Ô·ÂÚÈÛÌﬁ˜, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ

Û˘ÓÔÙÈÎﬁ ÙÚﬁÔ. OÈ ‡ÔÙÂ˜ ÂÎ‰ËÏÒÛÂÈ˜ Î·È Ù·

Â˘Ú‹Ì·Ù· ÛÂ ‰È¿ÊÔÚÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ÌÔÚÂ› Ó· ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ·ÔÊÚ·ÎÙÈÎÒÓ ‹ ÎÂÓÙÚÈÎÒÓ ·ÓÔÈÒÓ Î·È ˘Ô·ÂÚÈÛÌÔ‡ ÂÎÙ›ıÂÓÙ·È ÌÂ

ÏÂÙÔÌ¤ÚÂÈ·, ÌÂ ÙÚfiÔ Ô˘ Ó· ‚ÔËıÔ‡Ó ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi Ó· ·Ú·¤Ì„ÂÈ ÙÔ ·È‰› ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ

‡ÓÔ˘. ∞ÎﬁÌË, Û˘˙ËÙÔ‡ÓÙ·È ÔÈ ÂÓ‰Â›ÍÂÈ˜ ÙË˜ ÔÏ˘-

·Ú·ÌÂÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ‡ÓÔ˘ Î·È ÛÂ ·È‰È¿ ÌÂ

¯ÚﬁÓÈÂ˜ ÓÂ˘ÌÔÓÔ¿ıÂÈÂ˜ Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÁÓˆÛÙ¿ ·ÓÔ˚Î¿ Û‡Ó‰ÚÔÌ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¿ÓÔÈ·, ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘, ÌÂÏ¤ÙË

‡ÓÔ˘, ˘Ô·ÂÚÈÛÌﬁ˜.

∏ ÛËÌ·Û›· ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ ·Ó·ÓÔ‹˜ ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ˘fiÏÔÈˆÓ ˙ˆÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È ÙËÓ ÈÎ·ÓÔÔÈËÙÈÎ‹ ·‡ÍËÛË Î·È ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Û·ÊÒ˜ ·Ó·ÁÓˆÚÈÛÌ¤ÓË. ∏ ·Ó·ÓÔ‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈÎ‹ fiÙ·Ó Ë ÚÔ‹ ÙÔ˘ ·¤Ú· ‰È·Ì¤ÛÔ˘ ÙˆÓ ·ÓÒÙÂÚˆÓ Î·È Î·ÙÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Á›ÓÂÙ·È ·ÚfiÛÎÔÙ·, ¯ˆÚ›˜ Ó· ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ÚÔÛ¿ıÂÈ· Î·È Ù· ·¤ÚÈ· ·›Ì·ÙÔ˜ ‰È·ÙËÚÔ‡ÓÙ·È ÛÂ Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· (1). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Ê˘ÛÈÔÏÔÁÈÎ¤˜ ·ÏÏ·Á¤˜ ÛÙË ÏÂÈÙÔ˘ÚÁ›· Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÈ ÔÔ›Â˜ ÌÔ-

1 µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô

∫˘ÚÈ·ÎÔ‡” 2

∫ÏÈÓÈÎ‹ ¡ÔÛÔÎÔÌÂ›Ô˘ “ª·Î¿ÚÈÔ˜ πππ” §Â˘ÎˆÛ›·˜

Abstract: This review paper examines the indications for the performance of polysomnographic sleep studies in children in order to detect the presence of breathing disorders during sleep. The main breathing disorders during sleep such as obstructive, central apnoeas and hypoventilation syndromes are briefly discussed. The clinical manifestations and findings in various conditions that should raise the suspicion for the presence of obstructive or central apnoea and hypoventilation syndromes, are described in detail in order to help clinicians identify these children and subsequently refer them to the sleep laboratory. Furthermore, the indications for performing polysomnographic studies in children with chronic lung diseases, who do not manifest the classic apnoea syndromes, are discussed in detail.

Key words: apnea, hypoventilation, sleep disorders, sleep studies. ∂Ó‰Â›ÍÂÈ˜

ÚÂ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ ÂÎ‰‹ÏˆÛË ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·Ó·ÓÔ‹˜ ÛÂ ·È‰È¿ Ô˘ Â›Ó·È Ê·ÈÓÔÙ˘ÈÎ¿ ˘ÁÈ‹, ·ÏÏ¿ Î·È ÛÂ ·È‰È¿ ÌÂ ˘ÔÎÂ›ÌÂÓÂ˜ ‰È·Ù·Ú·¯¤˜, Û˘ÓËı¤ÛÙÂÚ· ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∞Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ÙË˜ ·Ó·ÓÔ‹˜ ÂÌÊ·Ó›˙ÔÓÙ·È Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ËÌ¤Ú·˜, ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Û¯ÂÙÈÎ¿ Â‡ÎÔÏ· ·ﬁ ÙÔ˘˜ ÁÔÓÂ›˜

Î·È ÔÏÏ¤˜ ÊÔÚ¤˜ ·ﬁ Ù· ›‰È· Ù· ·È‰È¿. ŸÌˆ˜, ‰ÂÓ Û˘Ì‚·›ÓÂÈ ÙÔ ›‰ÈÔ ·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È

ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Ó‡¯Ù·˜. Ã·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È fiÙÈ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÙË˜ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ ÛÙ· ·È‰È¿ ¤ÁÈÓÂ ÌfiÏÈ˜ ÙÔ 1976

1 2nd Pediatric Clinic of University of Athens, “P. & A. Kyriakou” Children’s Hospital

2 Pediatric Clinic of “Makarios III” Hospital, Nicosia

Ú¤ÂÈ ··Ú·›ÙËÙ· Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÂÎÓÂﬁÌÂÓÔ˘ CO2, ‰ÈﬁÙÈ Ë ÚÔ˚Ô‡Û·

Ì˘ïÎ‹ ·‰˘Ó·Ì›· ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ﬁ¯È ÌﬁÓÔ ÙËÓ ˘ÔÍ·ÈÌ›· ·ÏÏ¿ Î·È ÙËÓ Î·Ù·ÎÚ¿ÙËÛË CO2. ™Ù· ·È‰È¿

ÌÂ ÓÂ˘ÚÔÌ˘ïÎ¿ ÓÔÛ‹Ì·Ù· Û˘ÓÈÛÙ¿Ù·È Â›ÛË˜ Ó· Á›-

ÓÂÙ·È ÌÂÏ¤ÙË ‡ÓÔ˘ ÚÈÓ ÔÔÈ·‰‹ÔÙÂ ÚÔÁÚ·ÌÌ·-

ÙÈÛÌ¤ÓË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË, ÌÂ ÛÎÔﬁ Ó· ‰È·È-

ÛÙˆıÂ› ·Ó ˘¿Ú¯ÂÈ ˘ÔÎÏÈÓÈÎﬁ˜ ˘Ô·ÂÚÈÛÌﬁ˜ Ô˘

ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓˆıÂ› ÌÂ ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÈÛıËÛ›·˜ Î·È ·Ó·ÏÁËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ.

¢. ™‡Ó‰ÚÔÌÔ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡

∆Ô Û‡Ó‰ÚÔÌÔ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ ÌÔÚÂ›: ·) Ó· Â›Ó·È Û˘ÁÁÂÓ¤˜ ÌÂ ˘Ô·ÂÚÈÛÌﬁ Ô˘ ÂÈ‰ÂÈÓÒ-

ÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ·ÏÏ¿ ‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÂ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ ‹ ÙÔ˘ ÓÂ˘ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ÛÂ ÌÂÙ·‚ÔÏÈÎﬁ ÓﬁÛËÌ· Î·È ‚)

Ó· Û˘ÓÔ‰Â‡ÂÈ ¿ÏÏÂ˜ ·ı‹ÛÂÈ˜, ﬁˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ

Arnold Chiari, ÙÔ Û‡Ó‰ÚÔÌÔ Prader Willi, ÙËÓ ·¯ÔÓ‰ÚÔÏ·Û›·, ÙË ÓﬁÛÔ ÙÔ˘ Leigh, ÙÔ Û‡Ó‰ÚÔÌÔ

Joubert, Â›ÎÙËÙË ‚Ï¿‚Ë ÙÔ˘ ∫¡™ ·ﬁ ﬁÁÎÔ, Î¿ÎˆÛË ‹ ·ÎÙÈÓÔ‚ÔÏ›· Î·È Û˘ÁÁÂÓÂ›˜ ·ÁÁÂÈ·Î¤˜ ‰˘ÛÏ·Û›Â˜ (36). ªÂÏ¤ÙË ‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÂ

ﬁÏ· Ù· ·È‰È¿ ÁÈ· Ù· ÔÔ›· ˘¿Ú¯ÂÈ ÎÏÈÓÈÎ‹ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚﬁÌÔ˘. ∏ Î·Ù·ÁÚ·Ê‹ ¯ÚÂÈ¿˙ÂÙ·È Ó· Â·-

Ó·Ï·Ì‚¿ÓÂÙ·È ÛÂ Ù·ÎÙ¿ ¯ÚÔÓÈÎ¿ ‰È·ÛÙ‹Ì·Ù· ÁÈ· Ó· ·ÍÈÔÏÔÁÂ›Ù·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎﬁÙËÙ· ÙË˜ ÙÂ¯ÓÈÎ‹˜

˘ÔÛÙ‹ÚÈÍË˜ ÙË˜ ·Ó·ÓÔ‹˜ Ô˘ ÂÊ·ÚÌﬁ˙ÂÙ·È, Ë

ÔÔ›· ·Ó¿ÏÔÁ· Ú¤ÂÈ Ó· ·Ó·ÚÔÛ·ÚÌﬁ˙ÂÙ·È.

∂. ∂ÂÈÛﬁ‰ÈÔ ¿ÓÔÈ·˜ ·ÂÈÏËÙÈÎﬁ ÁÈ· ÙË ˙ˆ‹

ø˜ Ù¤ÙÔÈÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÙÔ ÂÂÈÛﬁ‰ÈÔ ¿ÓÔÈ·˜

ÛÂ ÓÂÔÁÓ¿ ‹ ‚Ú¤ÊË ÌÂ ·ÏÏ·Á‹ ¯ÚÒÌ·ÙÔ˜, ˘ÔÙÔÓ›·

Î·È ÓÈÁÌÔÓ‹, ÙÔ ÔÔ›Ô ÂÎÙÈÌ‹ıËÎÂ ˆ˜ ·ÂÈÏËÙÈÎﬁ

ÁÈ· ÙË ˙ˆ‹. ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·˘ÙÒÓ

ÔÈÎ›ÏÏÂÈ (ÏÔÈÌÒÍÂÈ˜, ÓÂ˘ÚÔÏÔÁÈÎ¿ ‹ Î·Ú‰ÈÔÏÔÁÈÎ¿ ÓÔÛ‹Ì·Ù·, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈÎ‹ ·ÏÈÓ‰ÚﬁÌËÛË, ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·, Î·ÎÔÔ›ËÛË Î.¿.) (37). ∏ ÌÂÏ¤ÙË ‡ÓÔ˘ Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ‚ÚÂÊÒÓ ÌÂ ÂÂÈÛﬁ‰ÈÔ ¿ÓÔÈ·˜, ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜, ‚Ú·‰˘Î·Ú‰›·˜ ‹ ÎÂÓÙÚÈÎ‹˜ ¿ÓÔÈ·˜.

Ì¤¯ÚÈ Û‹ÌÂÚ· ˘¿Ú¯Ô˘ÛÂ˜ Ô‰ËÁ›Â˜, Â›Ó·È ·ÚÎÂÙ‹ Ë

ÌÂÏ¤ÙË ÙÔ˘ ‡ÓÔ˘ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ ÌﬁÓÔ Ó‡-

¯Ù·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË, ¯ˆÚ›˜ ﬁÌˆ˜ Ë Ô‰ËÁ›· ·˘Ù‹

Ó· ¤¯ÂÈ ÂÈ‚Â‚·ÈˆıÂ› ÌÂ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜.

™˘Ì¤Ú·ÛÌ· ∞ﬁ ÙÔ 1976, ﬁÙ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ Ô Guilleminault ÂÚÈ¤ÁÚ·„Â ·È‰È¿ ÌÂ ·ÔÊÚ·ÎÙÈÎ‹

¿ÓÔÈ·, ¤¯ÂÈ ÛËÌÂÈˆıÂ› ÛËÌ·ÓÙÈÎ‹ ÂÍ¤ÏÈÍË ÛÙËÓ

·Ó·ÁÓÒÚÈÛË ÙË˜ Û˘¯ÓﬁÙËÙ·˜ Î·È ÙˆÓ ÂÈÏÔÎÒÓ

ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·Ó·ÓÔ‹˜ ÛÙ· ·È‰È¿ Î·Ù¿

ÙÔÓ ‡ÓÔ. Œ¯ÂÈ, Â›ÛË˜, Û˘ÓÂÈ‰ËÙÔÔÈËıÂ› ÙﬁÛÔ Ë

ÛËÌ·Û›· ÙË˜ ÌÂÏ¤ÙË˜ ÙÔ˘ ‡ÓÔ˘ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÔÈ Î·Ù¿ÏÏËÏÂ˜ ÂÓ‰Â›ÍÂÈ˜, fiÛÔ Î·È Ë ·Ó¿ÁÎË ÂÚ·ÈÙ¤Úˆ ÂÚÂ˘ÓËÙÈÎÒÓ ÌÂÏÂÙÒÓ (7,41) ÌÂ ÛÎÔfi ÙÔÓ ÚÔÛ-

ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ ÙˆÓ Û˘Ó‰ÚﬁÌˆÓ ·˘-

1. Guilleminault C, Philip P. Polygraphic investigation of respiration during sleep in infants and children. J Clin Neurophysiol 1992;9:48-55.

2. Guilleminault C, Eldridge FL, Simmons FB, Dement WC. Sleep apnoea in eight children. Pediatrics 1976;58:23-30.

3. Guilleminault C, Winkle R, Korobkin R, Simmons FB. Children and nocturnal snoring: evaluation of the effects of sleep-related respiratory load and daytime functioning. Eur J Pediatr 1982;139:165-171.

4. Carroll JL, Loughlin GM. Diagnostic criteria for obstructive sleep apnea syndrome in children. Pediatr Pulmonol 1992;14:71-74.

5. Guilleminault C, Korobkin R, Winkle R. A review of 50 children with obstructive sleep apnea syndrome. Lung 1981;159:275-287.

6. Brouillette R, Fernbach S, Hunt C. Obstructive sleep apnea in infants and children. J Pediatr 1982;100:31-40.

7. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996;153:866-878.

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∏ ÔÏ˘·Ú·ÌÂÙÚÈÎ‹ ÌÂÏ¤ÙË ‡ÓÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ‡ÓÔ˘, ÌÂ ¤Ó·ÚÍË ÙË Û˘Ó‹ıË ÒÚ· Î·Ù¿ÎÏÈÛË˜ ÙÔ˘ ·È‰ÈÔ‡. ªÂÏ¤ÙË ‡ÓÔ˘ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙÂ› Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Û‡ÓÙÔÌÔ˘ ËÌÂÚ‹ÛÈÔ˘ ‡ÓÔ˘ (38). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ËÌÂÚ‹ÛÈÔ˘ ‡ÓÔ˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ˆÚÒÓ Ê·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó ÈÎ·ÓÔÔÈËÙÈÎ‹ ÂÈ‰ÈÎfiÙËÙ·, ·ÊÔ‡ ÙÔ Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈÎ‹˜ ¿ÓÔÈ·˜ Ô˘ Ù˘¯fiÓ ‰È·ÈÛÙÒÓÂÙ·È, ÂÈ‚Â‚·ÈÒÓÂÙ·È ÌÂ Ó˘¯ÙÂÚÈÓ¤˜ ÌÂÏ¤ÙÂ˜ ‡ÓÔ˘ (38). º˘ÛÈÔÏÔÁÈÎ‹, fiÌˆ˜, ÌÂÏ¤ÙË ÙË˜ ·Ó·ÓÔ‹˜ Î·Ù¿ ÙÔÓ ËÌÂÚ‹ÛÈÔ ‡ÓÔ ‰ÂÓ ·ÔÎÏÂ›ÂÈ ÙËÓ ‡·ÚÍË ‰È·Ù·Ú·¯ÒÓ ÙË˜ ·Ó·ÓÔ‹˜ Ô˘ ÌÔÚÂ› Ó· ·ÔÎ·Ï˘ÊıÔ‡Ó ÌÂ ÌÂÏ¤ÙË Ó˘¯ÙÂÚÈÓÔ‡ ‡ÓÔ˘ (38). ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÁÈ· ÙË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙË˜ ÌÂÏ¤ÙË˜ ËÌÂÚ‹ÛÈÔ˘ ‹ Ó˘ÎÙÂÚÈÓÔ‡ ‡ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ¤¯ÂÈ ÚÔËÁËıÂ› Ë ¯ÔÚ‹ÁËÛË Î·ÙÂ˘Ó·ÛÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ‹ ÛÙ¤ÚËÛË ‡ÓÔ˘ (39,40). ªÂ ÙÈ˜

11. Weider DJ, Hauri PJ. Nocturnal enuresis in children with upper airway obstruction. Int J Pediatr Otorhinolaryngol 1985;9:173-182.

12. Frank Y, Kravath RE, Pollack CP, Weitzman ED. Obstructive sleep apnoea and its therapy: clinical and polysomnographic manifestations. Pediatrics 1983;71:737-742.

13. Weider DJ, Sateia MJ, West PR. Nocturnal enuresis in children with upper airway obstruction. Otolaryngol Head Neck Surg 1991;105:427-432.

14. Marcus CL, Curtis S, Koerner CB, Joffe A, Serwint JR, Loughlin GM. Evaluation of pulmonary function and polysomnography in obese children and adolescents. Pediatr Pulmonol 1996;21:176-183.

15. Kahn A, Mozin MJ, Rebuffat E, Sottiaux M, Burniat W, Shepherd S et al. Sleep pattern alterations and brief airway obstructions in overweight infants. Sleep 1989;12:430-438.

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17. Williams EF, Woo P, Miller R, Kellman RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg 1991;104:509-516.

18. Gaultier C. Obstructive sleep apnea syndrome in infants and children: established facts and unsettled issues. Thorax 1995;50:1204-1210.

19. Marcus CL, Koerner CB, Pysik P, Loughlin GM. Determinants of growth failure in children with obstructive sleep apnea syndrome. J Pediatr 1994;125:556-562.

20. Goldstein SJ, Wu RHK, Thorpy MJ, Shprintzen J, Marion RE, Saenger P. Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea. Acta Endocrinol 1987;116:95-101.

21. Arens R. Obstructive sleep apnea in childhood. Clinical features. In: Loughlin GM, Carroll JL, Marcus CL, eds. Sleep and breathing in children. A developmental approach. N York Marcel Dekker, Inc; 2000. p. 575-579.

22. Sidman JD, Fry TL. Exacerbation of sickle cell disease by obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 1988;114:916-917.

23. Robertson Pl, Aldrich MS, Hanash SM, Goldstein GW. Stroke associated with obstructive sleep apnea in a child with sickle cell anemia. Ann Neurol 1988;23;614-616.

24. Moyer Mileur LJ, Nielson DW, Pfeffer KD, Witte Mk, Champman DL. Eliminating sleep associated hypoxemia improves growth in infants with bronchopulmonary dysplasia. Pediatrics 1996;98:779-783.

25. Montgomery M, Wiebicke W, Bibi H, Pagtakhan RD, Pasterkamp H. Home measurements of oxygen saturation during sleep in patients with cystic fibrosis. Pediatr Pulmonol 1989;7:29-34.

26. Pradal U, Braggion C, Mastella G. Transcutaneous blood gas analysis during sleep and exercise in cystic fibrosis. Pediatr Pulmonol 1990;8:162-167.

27. Goffey MJ, Fitzgerald MX, McNicholas WT. Comparison of oxygen desaturation during sleep and exercise in patients with cystic fibrosis. Chest 1991;100:659-662.

28. Gaultier C. Effects of breathing during sleep in children with chronic lung disease. In: Loughlin GM, Carroll JL, Marcus CL, eds. Sleep and breathing in children. A developmental approach. N York Marcel Dekker, Inc; 2000. p. 661-689.

29. Hetzel MR, Clark TJH. Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate. Thorax 1980;35;732-738.

30. Busse WW. Pathogenesis and pathophysiology of nocturnal asthma. Am J Med 1988;85(Suppl 1B):24-29.

31. Dagg KD, Thomson LJ, Clayton RA, Ramway SG, Thomson NC. Effect of acute alterations in inspired oxygen tension on metacholine induced brochoconstriction in patients with asthma. Thorax 1997;52:453-457.

32. Petersen MC, Wolraich M, Sherbondy A, Wagener J. Abnormalities in control of ventilation in newborn infants with myelomeningocele. J Pediatr 1995;126:1011-1015.

33. Baydur A. Respiratory muscle strength and control of ventilation in patients with neuromuscular disease. Chest 1991;99:330-338.

34. Tabachnic E, Muller NL, Bryan AC, Levison H. Changes in ventilation and chest wall mechanics during sleep in normal adolescents. J Appl Physiol 1981;110:1179-1183.

35. Aldrich MS. Neurologic aspects of sleep apnea and related respiratory disturbances. Otolaryngol Clin North Am 1990;23:761-769.

36. Keens TG, Ward SLD. Syndromes affecting respiratory control during sleep. In: Loughlin GM, Carroll JL, Marcus CL, eds. Sleep and breathing in children. A developmental approach. N York Marcel Dekker, Inc; 2000. p. 525-553.

37. Samuels MP, Poets CF, Noyes JP, Hartmann H, Hewertson J, Southall DP. Diagnosis and management after life threatening events in infants and young children who received cardiopulmonary resuscitation. BMJ 1993;306:489-492.

38. Marcus CL, Keens TG, Ward SL. Comparison of nap and overnight polysomnography in children. Pediatr Pulmonol 1992;13:16-21.

39. Canet E, Gaultier C, D’ Allest AM, Dehan M. Effects of sleep deprivation on respiratory events during sleep in healthy infants. J Appl Physiol 1989;128:984-986.

40. White DP, Douglas NJ, Pickett CK, Zwillich CW, Weil JV. Sleep deprivation and the control of ventilation. Am Rev Respir Dis 1983;128:984-986.

41. McNamara F, Sullivan CE. The genesis of adult sleep apnoea in childhood. Thorax 2000;55:964-969.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-05-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 18-10-2001

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e-mail: march193@hol.gr

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ÔÌÊÔÏ˘ÁÒ‰ÂÈ˜ ‰ÂÚÌ·ÙÔ¿ıÂÈÂ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜

ª. ¶··ÎˆÓÛÙ·ÓÙ›ÓÔ˘ - Ã·˚‰ÂÌ¤ÓÔ˘1, °. Ã·˚‰ÂÌ¤ÓÔ˜2

Autoimmune bullous diseases of childhood

M. Papakonstantinou - Chaidemenou1, G. Chaidemenos2

¶ÂÚ›ÏË„Ë: OÈ ·˘ÙÔ¿ÓÔÛÂ˜ ÔÌÊÔÏ˘ÁÒ‰ÂÈ˜ ‰ÂÚÌ·ÙÔ¿ıÂÈÂ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ Û˘ÓÈÛÙÔ‡Ó Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓﬁÛˆÓ ÌÂ È‰È·›ÙÂÚÔ ÂÚÂ˘ÓËÙÈÎﬁ ÂÓ‰È·Ê¤ÚÔÓ. ∏ ‰È·ÁÓˆÛÙÈÎ‹ ÙÔ˘˜ ÚÔÛ¤Ï·ÛË Â›Ó·È ÔÏÏ¤˜ ÊÔÚ¤˜ ‰‡ÛÎÔÏË, È‰È·›ÙÂÚ· ÛÙÔÓ

“·Ó˘Ô„›·ÛÙÔ” ÁÈ·ÙÚfi. OÈ ·ÛıÂÓÂ›˜ Î·Ù¿ Î·ÓfiÓ· ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙÔ ‰ÂÚÌ·ÙÔÏfiÁÔ, ·ÏÏ¿ ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÌÔÚÂ› Ó· ÂÈÛÎÂÊıÔ‡Ó ·Ú¯ÈÎ¿ ÙÔÓ ·È‰›·ÙÚÔ, ÙÔÓ ÁÂÓÈÎfi È·ÙÚfi ‹ ÙÔÓ ÛÙÔÌ·ÙÔÏfiÁÔ. ∏ ¯ÚfiÓÈ· Î·ÏÔ‹ıË˜ ÔÌÊÔÏ˘ÁÒ‰Ë˜ ‰ÂÚÌ·ÙÔ¿ıÂÈ· Î·È

Ë ÂÚËÙÔÂÈ‰‹˜ ‰ÂÚÌ·Ù›ÙÈ˜ ·ÔÙÂÏÔ‡Ó ÙÈ˜ Û˘¯ÓfiÙÂÚÂ˜ ÓfiÛÔ˘˜ ·˘Ù‹˜ ÙË˜ ÔÌ¿‰·˜. ∏ ÚÒÙË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙÈ˜ Ê˘Û·ÏÏÈ‰ÔÔÌÊfiÏ˘ÁÂ˜ ÌÂ ÂÈÎfiÓ· Ù‡Ô˘ “ÚÔ˙¤ÙÙ·˜”, ÙËÓ ·ÚÔ˘Û›· IgA ÁÚ·ÌÌÈÎ‹˜ ÂÓ·fiıÂÛË˜ ÛÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Î·È ÙËÓ Î·Ï‹ ÚfiÁÓˆÛË ÌÂ ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÌÂÙ¿ ÌÂÚÈÎ¿ ¤ÙË. ∏ ÂÚËÙÔÂÈ‰‹˜ ‰ÂÚÌ·Ù›ÙÈ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙË Û˘ÌÌÂÙÚÈÎ‹ ÂÌÊ¿ÓÈÛË

ÎÓÈ‰ˆÙÈÎÒÓ Ï·ÎÒÓ Î·È Ê˘Û·ÏÏ›‰ˆÓ ÛÙÔ ÎÔÚÌ› Î·È Ù· ¿ÎÚ·, ÙÔ Û˘ÓÔ‰fi Î·‡ÛÔ Î·È ÎÓËÛÌfi, ÙË Û˘Ó‡·ÚÍË Â˘·›ÛıËÙË˜ ÛÙË ÁÏÔ˘Ù¤ÓË ÂÓÙÂÚÔ¿ıÂÈ·˜, ÙË Ì·ÎÚ¿ ÔÚÂ›· ·Ú¿ ÙËÓ Â˘ÓÔ˚Î‹ ·¿ÓÙËÛË ÛÙÈ˜ ÛÔ˘ÏÊfiÓÂ˜. ∏ ÎÔÈÓ‹ ¤ÌÊÈÁ· Â›Ó·È ÔÏ‡ Û·ÓÈfiÙÂÚË Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ï·‰·Ú¤˜ ÔÌÊfiÏ˘ÁÂ˜ Ô˘ ·Ê‹ÓÔ˘Ó ÂÎÙÂÙ·Ì¤ÓÂ˜ ‰È·‚ÚÒÛÂÈ˜, ÔÈ ÔÔ›Â˜ ‰‡ÛÎÔÏ· ÂÔ˘ÏÒÓÔÓÙ·È, ·fi ÂÒ‰˘ÓÂ˜ ÂÍÂÏÎÒÛÂÈ˜ ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ Î˘Ú›ˆ˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ·fi ÙËÓ ·ÚÔ˘Û›· ·Î·ÓıÔÏ˘ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ˘ıÌ¤Ó· ÙˆÓ ÔÌÊÔÏ‡ÁˆÓ Î·È ÙËÓ ÂÈÊ˘Ï·ÎÙÈÎ‹ ÁÈ· ÙË ˙ˆ‹ ÚfiÁÓˆÛË, È‰È·›ÙÂÚ· ÂÊfiÛÔÓ ‰ÂÓ ‰ÔıÂ› ¤ÁÎ·ÈÚ· Ë Î·Ù¿ÏÏËÏË ·ÁˆÁ‹. ∏ Ù¤Ù·ÚÙË ÛÔ˘‰·ÈfiÙÂÚË ÓfiÛÔ˜ ·˘Ù‹˜ ÙË˜ Î·ÙËÁÔÚ›·˜, ÙÔ ÔÌÊÔÏ˘ÁÒ‰Â˜ ÂÌÊÈÁÔÂÈ‰¤˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi

1 ∂ÈÌÂÏ‹ÙÚÈ· ∞’, °ÂÓÈÎﬁ ¶ÂÚÈÊÂÚÂÈ·Îﬁ ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, £ÂÛÛ·ÏÔÓ›ÎË

2 ∞Ó·ÏËÚˆÙ‹˜ ¢ÈÂ˘ı˘ÓÙ‹˜, ¡ÔÛÔÎÔÌÂ›Ô ∞ÊÚÔ‰›ÛÈˆÓ Î·È ¢ÂÚÌ·ÙÈÎÒÓ ¡ﬁÛˆÓ £ÂÛÛ·ÏÔÓ›ÎË˜

Abstract: Autoimmune bullous diseases of childhood comprise a heterogeneous group of disorders with special investigational interest. Their diagnosis is often difficult for the practicing physician. Children with these disorders are usually admitted to Dermatology Departments, but they may also present initially to a Pediatrician or rarely to a general practionner or a dentist. Chronic bullous dermatosis of childhood and dermatitis herpetiformis are the most prevalent diseases in this group. The first one is characterized by the vesiculopustular “rosette-like” eruption on the lower torso and face, the IgA linear basal membrane zone deposition on direct immunofluorescence and the remission in a few years. Dermatitis herpetiformis is characterized by a symmetric herpetiform vesicular and papular eruption on the shoulders and extensor aspects of the upper extremities, the associated burning sensation and pruritus, a gluten sensitive enteropathy, and a long course despite the beneficial action of sulfones. Pemphigus vulgaris is much more rare and is characterized by the painful oral ulcerations and flaccid bullae leaving extensive, slowly healing erosions, the presence of acantholytic cells, and a poor prognosis especially in case the treatment is delayed. Bullous pemphigoid is characterized by dense bullae dispersed all over the body, which however carry a better prognosis because they heal quite easily. With the exception from Pemphigus, all the other autoimmune bullous diseases express their main pathogenic process on the dermal - epidermal junction. The latter entraps multiple antigens and represents a fascinating field of research and

1 Senior Registrar, General Peripheral Hospital “G. Gennimatas”, Thessaloniki

2 Associate Director, Hospital of Venereal and Skin Diseases, Thessaloniki

ÂÔ˘ÏÒÓÔÓÙ·È ÁÚ‹ÁÔÚ·. ªÂ ÂÍ·›ÚÂÛË ÙËÓ ¤ÌÊÈÁ·, ﬁÏÂ˜ ÔÈ ·˘ÙÔ¿ÓÔÛÂ˜ ÔÌÊÔÏ˘ÁÒ‰ÂÈ˜ ‰ÂÚÌ·ÙÔ¿ıÂÈÂ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ·ıÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹

ÛÙÔ Â›Â‰Ô Î·È Î¿Ùˆ ·ﬁ ÙÔÓ ¯ÔÚÈÔÂÈ‰ÂÚÌÈ‰ÈÎﬁ

Û‡Ó‰ÂÛÌÔ. O ÙÂÏÂ˘Ù·›Ô˜, ÌÂ ÙËÓ ÏËıÒÚ· ÙˆÓ

·ÓÙÈÁﬁÓˆÓ Ô˘ ÂÚÈ¤¯ÂÈ, ÚÔÛÊ¤ÚÂÈ ¤Ó· Û˘Ó·Ú·-

ÛÙÈÎﬁ Â‰›Ô ¤ÚÂ˘Ó·˜ Î·È ÂÊ·ÚÌÔÁ‹˜ ÂÈ‰ÈÎÒÓ ıÂÚ·-

ÂÈÒÓ ÛÙÔ Ì¤ÏÏÔÓ, ﬁˆ˜ .¯. ÙË ¯ÔÚ‹ÁËÛË ÂÙÈ-

‰›ˆÓ Î·È ·ÓÙÈ-È‰ÈÔÙ˘ÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ, Ô˘ ı·

ÌÔÚÔ‡Û·Ó Ó· ‰È·ÎfiÙÔ˘Ó ÙË Û‡Ó‰ÂÛË ÙÔ˘ ·ıÔÁfiÓÔ˘ ·˘ÙÔ·ÓÙÈÛÒÌ·ÙÔ˜ ÌÂ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô Â›ÙÔÔ -ÛÙfi¯Ô.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·˘ÙÔ¿ÓÔÛË, ÔÌÊÔÏ˘ÁÒ‰Ë˜, ·È‰ÈÎ‹, ÁÚ·ÌÌÈÎ‹ IgA ÓﬁÛÔ˜, ÂÚËÙÔÂÈ‰‹˜ ‰ÂÚÌ·Ù›ÙÈ˜, ¤ÌÊÈÁ·.

OÈ fiÚÔÈ “¤ÌÊÈÍ”, “ÔÌÊfi˜”, “ÔÌÊfiÏ˘Í”, “ÂÌ-

ÊÈÁÒ‰Â˜” Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û‹ÌÂÚ· ÛÂ ﬁÏÔ

ÙÔÓ ÎfiÛÌÔ, ¤ÏÎÔ˘Ó ÙËÓ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ ·fi ÙÔ˘˜ ·Ú¯·›Ô˘˜ ŒÏÏËÓÂ˜. øÛÙfiÛÔ, Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ÛÂ

‰È·ÊÔÚÂÙÈÎ¤˜ ÓÔÛÔÏÔÁÈÎ¤˜ ÔÓÙﬁÙËÙÂ˜ ¿Ú¯ÈÛÂ Ó·

‰È·ÌÔÚÊÒÓÂÙ·È ·ﬁ ÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘

1950, ﬁÙ·Ó Ô W.F. Lever ¯ÚËÛÈÌÔÔ›ËÛÂ ÙËÓ ÈÛÙÔ-

ÏÔÁÈÎ‹ ÏËÚÔÊﬁÚËÛË ÁÈ· Ó· Ê¤ÚÂÈ Î¿ÔÈ· Ù¿ÍË

ÛÙÔ ÂÈÎÚ·ÙÔ‡Ó ¯¿Ô˜ (1). ªÂÚÈÎ¿ ¤ÙË ·ÚÁﬁÙÂÚ·, Ô

Î·ıÔÚÈÛÌﬁ˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÚÔ˘ÛÈ¿-

˙ÔÓÙ·È ÛÙËÓ ¤ÌÊÈÁ· Î·È ÙÔ ÂÌÊÈÁÔÂÈ‰¤˜ ·ﬁ

ÙÔ˘˜ Jordon Î·È Beutner, ¤ıÂÛÂ ÙÔ ‚¿ıÚÔ ÁÈ· ÙËÓ

Î·Ù·ÓﬁËÛË ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ¯·Ú·ÎÙ‹Ú· ÙÔ˘˜ (2).

∆· ÙÂÏÂ˘Ù·›· ¤ÙË, Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙË˜ (·ÓÔÛÔ-)

ËÏÂÎÙÚÔÓÈÎ‹˜ ÌÈÎÚÔÛÎfiËÛË˜, ÙË˜ ·ÓÔÛÔÎ·ı›˙ËÛË˜, ÙË˜ ·ÓÔÛÔ·ÔÙ‡ˆÛË˜ Î·È ÙË˜ ÌÔÚÈ·Î‹˜ ÁÂÓÂÙÈÎ‹˜ ·Ó¿Ï˘ÛË˜ Â¤ÙÚÂ„Â ÙÔÓ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎfi ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ÓfiÛˆÓ, ÙËÓ

·Ó·ÁÓÒÚÈÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÛÙ· ÔÔ›· Î·ÙÂ˘ı‡ÓÔÓÙ·È Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, ÙËÓ ÎÏˆÓÔÔ›ËÛË ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ ÁÔÓÈ‰›ˆÓ Î·È ÙËÓ ·Ú·ÁˆÁ‹ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ. ∂›Ó·È Ê·ÓÂÚfi fiÙÈ Ë ·ÚÔ˘Û›· Ê˘Û·ÏÏ›‰ˆÓ ‹ ÔÌÊÔÏ‡ÁˆÓ, ·ÎfiÌË Î·È ˆ˜ ÚˆÙÔÁÂÓÒÓ ÂÎ‰ËÏÒÛÂˆÓ ÓfiÛÔ˘, ‰ÂÓ Û˘ÓÈÛÙ¿ ·ÚÔ˘Û›· ·˘ÙÔ¿ÓÔÛË˜ ¿ıËÛË˜. ¶ÔÈÎÈÏ›· ÌË¯·ÓÈÎÒÓ, ıÂÚÌÈÎÒÓ (.¯. ¤ÁÎ·˘Ì·), ÎÏËÚÔÓÔÌÈÎÒÓ (.¯. ÂÈ‰ÂÚÌfiÏ˘ÛË), Ê·ÚÌ·ÎÈÎÒÓ, ÌÂÙ·‚ÔÏÈÎÒÓ (.¯. ÔÚÊ˘Ú›·), ÌÈÎÚÔ‚È·ÎÒÓ (.¯. ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô), ÈÈÎÒÓ (.¯. ¤ÚË˜) Î·È ¿ÏÏˆÓ ·ÈÙ›ˆÓ (¶›Ó·Î·˜ 1) ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· Ê˘Û·ÏÏÈ‰ÔÔÌÊÔÏ˘ÁÒ‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜. OÈ ·˘ÙÔ¿ÓÔÛÂ˜ ÔÌÊÔÏ˘ÁÒ‰ÂÈ˜ ‰ÂÚÌ·ÙÔ¿ıÂÈÂ˜ ·ÔÙÂÏÔ‡Ó Ì›· ˘ÔÔÌ¿‰·, Ë

therapeutic interventions for the future, i.e. by the generation of peptides or antiidiotypic antibodies that could block the interaction between the autoantibody and the corresponding epitopetarget.

Key words: autoimmune, bullous, childhood, IgA linear disease, dermatitis herpetiformis, pemphigus.

‚ÏÂÓÓÔÁﬁÓÔ˘˜ ÙÔ˘ ÛÙﬁÌ·ÙÔ˜

ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ·ﬁ ÙËÓ ·Ô˘Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Î·È ÙËÓ ·ÓÙ›ÛÙ·Û‹ ÙÔ˘˜

ÛÙËÓ ÙÔÈÎ‹ ıÂÚ·Â›·, ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È ·ÓÙÈ-ÈÛÙ·ÌÈÓÈÎÒÓ. ∫·ÙˆÙ¤Úˆ ·Ó·Ï‡ÔÓÙ·È Ù· ÎÏÈÓÈÎ¿, ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎ¿, ÈÛÙÔÏÔÁÈÎ¿, ·ÓÔÛÔ·ıÔÏÔÁÈÎ¿ Î·È ıÂÚ·Â˘ÙÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ‰ÂÚÌ·ÙÔ·ıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ÙˆÓ ÔÔ›ˆÓ Ù· Î‡ÚÈ· ‰È·ÊÔÚÈÎ¿ ÁÓˆÚ›ÛÌ·Ù· ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.

∫·ÏÔ‹ıË˜ ¯ÚﬁÓÈ· ÔÌÊÔÏ˘ÁÒ‰Ë˜ ‰ÂÚÌ·ÙÔ¿ıÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜ (Chronic bullous dermatosis of childhood)

∞ÔÙÂÏÂ› ÙÔÓ Î‡ÚÈÔ ÂÎÚfiÛˆÔ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ‰ÂÚÌ·ÙÔ·ıÂÈÒÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ‰ÈfiÙÈ - ÌÂ ÂÍ·›ÚÂÛË ÙËÓ ¶ÔÏˆÓ›· - ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ·fi fiÏÂ˜ ÙÈ˜ ¿ÏÏÂ˜ ·ı‹ÛÂÈ˜ ·˘Ù‹˜ ÙË˜ Î·ÙËÁÔÚ›·˜ ÛÂ fiÏÔ ÙÔÓ ÎfiÛÌÔ (3). ∏ ÓfiÛÔ˜ ·ÔÎ·ÏÂ›Ù·È Â›ÛË˜ IgA ÁÚ·ÌÌÈÎ‹ ÓfiÛÔ˜ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ‰ÈfiÙÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË˜ Â‡ÚËÌ· Â›Ó·È Ô ÁÚ·ÌÌÈÎfi˜ ÊıÔÚÈÛÌfi˜ ÙË˜ ‚·ÛÈÎ‹˜ ÌÂÌ‚Ú¿Ó·˜ (µª) ÙË˜ ÂÈ‰ÂÚÌ›‰·˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘

¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (∂ÈÎﬁÓ· 1). ∂Î‰ËÏÒÓÂÙ·È ÌÂÙ·Í‡ ÙÔ˘ 1Ô˘ Î·È 10Ô˘ ¤ÙÔ˘˜, Û˘ÓËı¤ÛÙÂÚ· ÚÈÓ ÙÔ 6Ô ¤ÙÔ˜, ÌÂ ÙÂÙ·Ì¤ÓÂ˜ ÔÌÊﬁÏ˘ÁÂ˜ Î˘Ú›ˆ˜ ÛÙÔ

ÚfiÛˆÔ Î·È ÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ (4) (∂ÈÎfiÓ· 2). OÈ ‚Ï¿‚Â˜ ÌÔÚÔ‡Ó Ó· ÂÂÎÙ·ıÔ‡Ó ÛÂ fiÏÔ ÙÔ ÛÒÌ· ÌÂ ·Û‡ÌÌÂÙÚË ‰È¿Ù·ÍË Î·È ÙË ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÌÔÚÊ‹ ÙˆÓ ÂÈÌ‹ÎˆÓ ÔÌÊÔÏ‡ÁˆÓ Î·È ÙˆÓ Û¯ËÌ·ÙÈÛÌÒÓ Ù‡Ô˘ “ÚÔ˙¤ÙÙ·˜” (∂ÈÎfiÓ· 3). OÈ ÙÂÏÂ˘Ù·›Â˜

1. §ÔÈÌÒ‰ÂÈ˜: ·) ∞fi ‚·ÎÙËÚ›‰È·: ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô (¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜), ‰ÂÚÌ·ÙÈÎ¤˜ ÏÔÈÌÒÍÂÈ˜ ÌÂ

Û˘ÛÙËÌ·ÙÈÎ‹ Û˘ÌÌÂÙÔ¯‹ (·fi „Â˘‰ÔÌÔÓ¿‰·, ÏÈÛÙ¤ÚÈ·, ÎÏÂÌÛÈ¤Ï·, ·ÈÌfiÊÈÏÔ Î.¿.), Û‡ÊÈÏË, ÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ·ÔÊÔÏÈ‰ˆÙÈÎfi ‰ÂÚÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ (SSSS)

‚) ∞fi ÈÔ‡˜: ¤ÚË˜ ·Ïfi˜, ·ÓÂÌÂ˘ÏÔÁÈ¿, ÓfiÛÔ˜ ¯ÂÈÚfi˜-Ô‰fi˜-ÛÙfiÌ·ÙÔ˜ Á) ∞fi Ì‡ÎËÙÂ˜: ÌÔÓÈÏ›·ÛË ‰) ∞fi ·Ú¿ÛÈÙ·: „ÒÚ·

2. ªË¯·ÓÈÎ¿ Î·È ıÂÚÌÈÎ¿ ·›ÙÈ·: ¤ÁÎ·˘Ì·, ı˘Ï·Î›ÙÈ˜, È‰ÚÒ·, Ó‡ÁÌ·Ù· ÂÓÙﬁÌˆÓ

3. OÚÌÔÓÈÎ¿ ·›ÙÈ·: ÓÂÔÁÓÈÎ‹ ·ÎÌ‹

4. º¿ÚÌ·Î·: ‚ÚˆÌÈÔ‡¯·, Èˆ‰ÈÔ‡¯· Î.Ï.

5. ∂Í ˘ÂÚÂ˘·ÈÛıËÛ›·˜: ÔÏ‡ÌÔÚÊÔ ÂÚ‡ıËÌ·

6. ™˘ÁÁÂÓÂ›˜: Û˘ÁÁÂÓ‹˜ ÔÌÊÔÏ˘ÁÒ‰Ë˜ ÂÈ‰ÂÚÌﬁÏ˘ÛË, ÔÌÊÔÏ˘ÁÒ‰Ë˜ È¯ı‡·ÛË

7. ∞ﬁ ÂÓ˙˘ÌÈÎ¤˜ ‰È·Ù·Ú·¯¤˜: ÔÚÊ˘Ú›Â˜

8. ∞ﬁ ¿ÏÏ· ·›ÙÈ·: Ì·ÛÙÔÎ˘ÙÙ¿ÚˆÛË, ÂÓÙÂÚÔ·ıËÙÈÎ‹ ·ÎÚÔ‰ÂÚÌ·Ù›ÙÈ˜, ÊÏ˘ÎÙ·ÈÓÒ‰Ë˜ „ˆÚ›·ÛË, ·ÎÚ¿ÙÂÈ· ÌÂÏ·Ó›ÓË˜ (Incontinentia pigmenti) Î.¿.

9. ∞ÁÓÒÛÙÔ˘ ·ÈÙ›·˜: ·ÎÚÔÊÏ˘ÎÙ·›ÓˆÛË ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ÙÔÍÈÎﬁ ÂÚ‡ıËÌ·, ÂˆÛÈÓÔÊÈÏÈÎ‹ ÊÏ˘ÎÙ·ÈÓÒ‰Ë˜ ı˘Ï·Î›ÙÈ˜ (N. Ofuzi), ·ÚÔ‰ÈÎ‹ ÊÏ˘ÎÙ·ÈÓÒ‰Ë˜ ÌÂÏ¿ÓˆÛË

10. ∞˘ÙÔ¿ÓÔÛÔ˘ ¯·Ú·ÎÙ‹Ú·: ¯ÚﬁÓÈ· Î·ÏÔ‹ıË˜ ÔÌÊÔÏ˘ÁÒ‰Ë˜ ‰ÂÚÌ·ÙÔ¿ıÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, ÂÚËÙÔÂÈ‰‹˜ ‰ÂÚÌ·Ù›ÙÈ˜, ¤ÌÊÈÁ·, ÂÌÊÈÁÔÂÈ‰¤˜ (ÔÌÊÔÏ˘ÁÒ‰Â˜, Ô˘ÏˆÙÈÎﬁ), ÔÌÊÔÏ˘ÁÒ‰Ë˜ ÂÚ˘ıËÌ·ÙÒ‰Ë˜ Ï‡ÎÔ˜, Â›ÎÙËÙË ÔÌÊÔÏ˘ÁÒ‰Ë˜ ÂÈ-

‰ÂÚÌﬁÏ˘ÛË

‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·ﬁ ÙË Û˘ÚÚÔ‹ Ó¤ˆÓ Ê˘Û·ÏÏ›‰ˆÓ

Á‡Úˆ ·ﬁ ÂÊÂÏÎÈ‰ÔÔÈËÌ¤ÓË, È·ıÂ›Û· ·Ï·ÈﬁÙÂÚË

‚Ï¿‚Ë (3,4). H ÓﬁÛÔ˜ ¤¯ÂÈ Û˘Ó‹ıˆ˜ Ù·¯Â›· ÂÈÛ‚ÔÏ‹

Î·È ‰ÂÓ Û˘ÓÔ‰Â‡ÂÙ·È ·ﬁ ÁÂÓÈÎ¿ Û˘ÌÙÒÌ·Ù·. ∏

ÚÔÛ‚ÔÏ‹ ÙˆÓ ‚ÏÂÓÓÔÁﬁÓˆÓ Â›Ó·È Û˘¯Ó‹, ·ÏÏ¿ ‰ÂÓ

Û˘ÓÔ‰Â‡ÂÙ·È ·ﬁ ˘ÔÎÂÈÌÂÓÈÎ¤˜ ÂÓÔ¯Ï‹ÛÂÈ˜ (3,5).

∏ ÈÛÙÔ·ıÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙˆÓ ÚﬁÛÊ·ÙˆÓ

‚Ï·‚ÒÓ ‰Â›¯ÓÂÈ ˘ÔÂÈ‰ÂÚÌÈ‰ÈÎ‹ ÔÌÊﬁÏ˘Á· ÌÂ

ÂˆÛÈÓfiÊÈÏ· Î·È Ô˘‰ÂÙÂÚfiÊÈÏ·. ∞Ó¿ÏÔÁË ÂÈÎfiÓ· ÌÔÚÔ‡Ó Ó· ÂÌÊ·Ó›˙Ô˘Ó Î·È ÔÈ ¿ÏÏÂ˜ ˘ÔÂÈ‰ÂÚÌÈ‰ÈÎ¤˜ ·˘ÙÔ¿ÓÔÛÂ˜ ÔÌÊÔÏ˘ÁÒ‰ÂÈ˜ ·ı‹ÛÂÈ˜, fiˆ˜ ÙÔ ÂÌÊÈÁÔÂÈ‰¤˜ (ÔÌÊÔÏ˘ÁÒ‰Â˜, Ô˘ÏˆÙÈÎfi, ‰ÂÚÌÔÏ˘ÙÈÎfi) Î·È Ë ÂÚËÙÔÂÈ‰‹˜ ‰ÂÚÌ·Ù›ÙÈ˜. ∂ÔÌ¤Óˆ˜, ··Ú·›ÙËÙË ÁÈ· ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË Â›Ó·È Ë ÂÍ¤Ù·ÛË ÙÔ˘ ÂÚÈ‚Ï·‚ÈÎÔ‡ ‰¤ÚÌ·ÙÔ˜ ÌÂ ÙËÓ ÙÂ¯ÓÈÎ‹ ÙÔ˘ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (6). ªÂ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ Î·È ÙË ¯Ú‹ÛË ·ÓÙÈ-IgA ·ÓÙÈÔÚÔ‡, ı· ·ÔÎ·Ï˘ÊıÔ‡Ó ÔÈ ·ÓÔÛÔÂÓ·Ôı¤ÛÂÈ˜ ÌÂ ÙË ÌÔÚÊ‹ ÁÚ·ÌÌÈÎ‹˜ ÂÓ·fiıÂÛË˜ IgA Î·Ù¿ Ì‹ÎÔ˜ ÙË˜ µª. ™ÙÈ˜ ¿ÏÏÂ˜ ÌÔÚÊ¤˜ ÙÔ˘ ÂÌÊÈÁÔÂÈ‰Ô‡˜ ˘¿Ú¯Ô˘Ó ÌfiÓÔ ‹ Î˘ÚÈ·Ú¯Ô‡Ó ÔÈ ÂÓ·Ôı¤ÛÂÈ˜ ÛÙË µª ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ¿ÏÏÂ˜ Ù¿ÍÂÈ˜ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, È‰È·›ÙÂÚ· ÛÙÈ˜ IgG Î·È ÙÔ ÙÌ‹Ì· C3 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÂÓÒ ÛÙËÓ ÂÚËÙÔÂÈ‰‹ ‰ÂÚÌ·Ù›ÙÈ‰· ÔÈ ÂÓ·Ôı¤ÛÂÈ˜ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÈ˜ ıËÏ¤˜ ÙÔ˘ ¯ÔÚ›Ô˘ (6). IgA ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· Î·Ù¿ ÙË˜ µª ˘¿Ú¯Ô˘Ó ÛÙÔÓ ÔÚfi ÔÛÔÛÙÔ‡ 70% ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ ÌÂ Î·ÏÔ‹ıË ¯ÚfiÓÈ· ÔÌÊÔÏ˘ÁÒ‰Ë ‰ÂÚÌ·ÙÔ¿ıÂÈ· (5).

∏ Ì¤ıÔ‰Ô˜ ÙË˜ ·ÓÔÛÔ·ÔÙ‡ˆÛË˜ (immunoblotting) ¤¯ÂÈ ·ÔÎ·Ï‡„ÂÈ ﬁÙÈ ÙÔ ·ÓÙÈÁﬁÓÔ ÚÔ˜ ÙÔ ÔÔ›Ô Î·ÙÂ˘ı‡ÓÔÓÙ·È Ù· ·ıÔÏÔÁÈÎ¿ ·˘ÙÔ·ÓÙÈÛÒ-

ÙË˜ ÓfiÛÔ˘ ¤¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 285 KD Î·È Â›Ó·È Ù·˘ÙfiÛËÌÔ ÌÂ ·˘Ùfi ÙË˜ ÓfiÛÔ˘ IgA ÙˆÓ ÂÓËÏ›ÎˆÓ (7). ¶ÚfiÛÊ·ÙÂ˜, ˆÛÙfiÛÔ, ÌÂÏ¤ÙÂ˜ ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ÂÙÂÚÔÁ¤ÓÂÈ· ÙˆÓ ·Ó·ÁÓˆÚÈ˙fiÌÂÓˆÓ ·˘ÙÔ·ÓÙÈÁfiÓˆÓ, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ ÙËÓ ÚˆÙÂ˝ÓË 97-120 KD, Ô˘ ·ÔÎ·ÏÂ›Ù·È LABD I ·ÓÙÈÁfiÓÔ, ·ÏÏ¿ Î·È ¿ÏÏÂ˜ ÚˆÙÂ˝ÓÂ˜ ÌÂ Ì.‚. 290, 230 ‹ 180 KD (8). ∂ÈÏ¤ÔÓ, ÌÂÚÈÎÔ› ·ÛıÂÓÂ›˜ ÌÂ IgA ÁÚ·ÌÌÈÎ‹ ÓfiÛÔ ÌÔÚÔ‡Ó Ó· ·ÔÙÂÏÔ‡Ó Ì›· ÍÂ¯ˆÚÈÛÙ‹ ÔÈÎÈÏ›· ÙÔ˘ ÔÌÊÔÏ˘ÁÒ‰Ô˘˜ ÂÌÊÈÁÔÂÈ‰Ô‡˜, Ë ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÂÈ IgA ·ÓÔÛÈ·Î‹ ·¿ÓÙËÛË (8). ∏ ·Ú·Ù‹ÚËÛË ÌÂ ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ·ÔÎ·Ï‡ÙÂÈ ‰ÈÏ‹ ÂÓÙfiÈÛË ÙˆÓ ·ÓÔÛÔÂÓ·Ôı¤ÛÂˆÓ, “ÌÂ ÙËÓ ÂÈÎfiÓ· Î·ıÚ¤ÙÔ˘”, Â¿Óˆ Î·È Î¿Ùˆ ·fi ÙÔ ˘ÎÓfi ÂÙ¿ÏÈÔ (lamina densa) ÙÔ˘ ¯ÔÚÈÔÂÈ‰ÂÚÌÈ‰ÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ (7).

∏ ÚfiÁÓˆÛË ÙË˜ IgA ÁÚ·ÌÌÈÎ‹˜ ÓfiÛÔ˘ ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Î·Ï‹, ÌÂ ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÌÂÙ¿ ÌÂÚÈÎ¿ ¤ÙË. ∏ ¿ıËÛË ÌÔÚÂ› Ó· ‰È·ÚÎ¤ÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 5 ¤ÙË ÛÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ (9). ¶¿ÓÙˆ˜, ÔÙ¤ ‰ÂÓ ‰È·ÚÎÂ› ¤Ú·Ó ÙË˜ ÂÊË‚Â›·˜. ÀÔÙÚÔ‹ ÙË˜

ÓﬁÛÔ˘ ¤¯ÂÈ ·Ó·ÊÂÚıÂ› ·ÎﬁÌË Î·È ÌÂÙ¿ Ì·ÎÚ¿ Â-

Ú›Ô‰Ô ‡ÊÂÛË˜, È‰È·›ÙÂÚ· ÌÂÙ¿ ·ﬁ ÏÔÈÌÒÍÂÈ˜ (3).

∂ÓÒ Ë ÓﬁÛÔ˜ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ·ÓÙÈ-

ÁﬁÓˆÓ ÈÛÙÔÛ˘Ì‚·ÙﬁÙËÙ·˜ HLA-CW7, B8, DR3, Ë

·ÚÔ˘Û›· ÙˆÓ ‰‡Ô ÙÂÏÂ˘Ù·›ˆÓ Î·È ÙÔ˘ HLA-DQ2

Èı·ÓÒ˜ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ÚÒÈÌË ÂÌÊ¿ÓÈÛË ÙˆÓ

ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ. ¶·Ú¿ÏÏËÏ·, Ë ·ÚÔ˘Û›·

TNF2

(10).

™ÙÔÈ¯ÂÈÒ‰ÂÈ˜ ‚Ï¿‚Â˜ º˘Û·ÏÏ›‰Â˜ 1-2 ÂÎÌ., ∞ÔÎÂÊ·ÏÈÛÌ¤ÓÂ˜ ‚Ï·Ù›‰Â˜, ∂Ò‰˘ÓÂ˜ ‰È·‚ÚÒÛÂÈ˜

∆ÔÔÁÚ·Ê›·

™˘ÌÙÒÌ·Ù·

ÌÂ ÂÈÎfiÓ· ÚÔ˙¤ÙÙ·˜ÂÚËÙfiÌÔÚÊÂ˜ Ê˘Û·ÏÏ›‰Â˜ÛÙfiÌ·ÙÔ˜, Ï·‰·Ú¤˜ ÔÌÊfiÏ˘ÁÂ˜, ‰˘Û›·ÙÂ˜ ÂÏÎÒÛÂÈ˜

∫ÔÚÌfi˜, ÁÏÔ˘ÙÔ›,™˘ÌÌÂÙÚÈÎ¿ ÛÙÈ˜ ÂÎÙ·ÙÈÎ¤˜ ™˘Ó‹ıˆ˜ ¤Ó·ÚÍË ·fi ÙÔ ÛÙfiÌ·

Á‡Úˆ ·fi ÙÔ ÛÙfiÌ·ÂÈÊ¿ÓÂÈÂ˜ ÙˆÓ ¿ÎÚˆÓ,Î·È Â¤ÎÙ·ÛË ÛÂ fiÏÔ ÙÔ ÛÒÌ·

Ÿ¯È Û˘Ó‹ıˆ˜

ÒÌÔÈ, Ï·ÈÌﬁ˜

∫ÓËÛÌﬁ˜ Î·È Î·‡ÛÔ˜ ¶ﬁÓÔ˜

∂Î‰ËÏÒÛÂÈ˜ ·ﬁ ÙÔ ¤ÓÙÂÚÔ Ÿ¯È¡·ÈŸ¯È

πÛÙÔÏÔÁ›·

ÀÔÂÈ‰ÂÚÌÈ‰ÈÎ‹

∞ÔÎﬁÏÏËÛË ÙˆÓ ÎÔÚ˘ÊÒÓ ∂Ó‰ÔÂÈ‰ÂÚÌÈ‰ÈÎ‹ ÔÌÊﬁÏ˘Á·

ÔÌÊﬁÏ˘Á· ÌÂÙˆÓ ¯ÔÚÈ·ÎÒÓ ıËÏÒÓ,ÌÂ ·Î·ÓıÔÏ˘ÙÈÎ¿ Î‡ÙÙ·Ú·

ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·‰È‹ıËÛË ÌÂ ÔÏ˘ÌÔÚÊ.

ÕÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌﬁ˜ °Ú·ÌÌÈÎ‹ ÂÓ·ﬁıÂÛË∫ÔÎÎÒ‰ÂÈ˜ ÂÓ·Ôı¤ÛÂÈ˜ IgA ªÂÛÔÎ˘ÙÙ¿ÚÈÔ ‰›ÎÙ˘Ô IgA ÛÙË µª Î·È C3 ÛÙÈ˜ ÎÔÚ˘Ê¤˜ ÙˆÓ ıËÏÒÓÌÂ IgG Î·È C3

Î·È ÙË µª

∂Í¤ÏÈÍË/ÚfiÁÓˆÛË ⁄ÊÂÛË ÛÂ 3-4 ¤ÙË/Î·ÏÔ‹ıË˜ ÃÚfiÓÈ·, ›Ûˆ˜ ÂÊ’ fiÚÔ˘ ˙ˆ‹ÕÍÂ›· ‹ ˘ÔÍÂ›·/‚·ÚÈ¿ /Î·ÏÔ‹ıË˜

£ÂÚ·Â›· ¢·„fiÓË 25 mg x2 ‹ ¢›·ÈÙ· ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË, ¶ÚÂ‰ÓÈ˙fiÓË ·fi ÙÔ ÛÙfiÌ·

ÛÔ˘ÏÊ·˘ÚÈ‰›ÓË 500 mgÌÂ ‹ ¯ˆÚ›˜ ‰·„ﬁÓË1-2 mg/kg

ıÂÚ·Â›· ÂÎÏÔÁ‹˜. ¶Èı·ÓﬁÙ·Ù·, ‚ÔËı¿ Ì¤Ûˆ ÙË˜

‰Ú¿ÛË˜ ÙË˜ ÛÙ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·. ∆Ô ·ÔÙ¤ÏÂ-

ÛÌ· Â›Ó·È Û˘Ó‹ıˆ˜ ¿ÌÂÛÔ ÛÙÔÓ ÎÓËÛÌﬁ Î·È Ù·¯‡

ÛÙËÓ ‡ÊÂÛË ÙˆÓ ‚Ï·‚ÒÓ (5). ∂ÈÛËÌ·›ÓÂÙ·È Ë ·Ó¿-

ÁÎË ÁÈ· ÚÔËÁÔ‡ÌÂÓÔ ¤ÏÂÁ¯Ô ÙË˜ °Ï˘ÎÔ˙Ô-6-ÊˆÛÊÔÚÈÎ‹˜ ·Ê˘‰ÚÔÁÔÓ¿ÛË˜ Î·È Ô Ù·ÎÙÈÎﬁ˜ ¤ÏÂÁ¯Ô˜

ÙˆÓ ÂÈ¤‰ˆÓ ÙË˜ ÌÂı·ÈÌÔÛÊ·ÈÚ›ÓË˜ Î·È ÙˆÓ ‰È-

ÎÙ˘ÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ·›Ì·, ÒÛÙÂ Ó· ÂÓÙÔÈÛÙÂ› ÂÁÎ·›-

Úˆ˜ Ë ·ÈÌÔÏ˘ÙÈÎ‹ ·Ó·ÈÌ›· (5). ∂Ó·ÏÏ·ÎÙÈÎ¿ ÚÔ˜

ÙË ÛÔ˘ÏÊﬁÓË ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› Ë ÛÔ˘ÏÊÔÌÂ-

ıÔÍ˘˘ÚÈ‰·˙›ÓË ÛÂ ‰ﬁÛË 500 mg ËÌÂÚËÛ›ˆ˜. ∫·-

Ù¿ ÙË ¯ÔÚ‹ÁËÛ‹ ÙË˜, Û˘ÓÈÛÙ¿Ù·È Ë Ï‹„Ë ¿ÊıÔÓˆÓ

˘ÁÚÒÓ Î·È Ë ·ÏÎ·ÏÈÓÔÔ›ËÛË ÙˆÓ Ô‡ÚˆÓ ÁÈ· ÙËÓ

·ÔÊ˘Á‹ ‚Ï¿‚Ë˜ ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ.

OˆÛ‰‹ÔÙÂ, ÂÈ‚¿ÏÏÂÙ·È Î¿ıÂ ÚÔÛ¿ıÂÈ· ÌÂ›ˆ-

ÛË˜ ‹ ‰È·ÎÔ‹˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î¿ıÂ 8-12 Ì‹ÓÂ˜, ÌÂ ÙËÓ ÚÔÛ‰ÔÎ›· ÙË˜ ÌfiÓÈÌË˜ ·˘ÙfiÌ·ÙË˜ ‡ÊÂÛË˜ ÙË˜ ÓfiÛÔ˘ (5).

∂ÚËÙÔÂÈ‰‹˜ ‰ÂÚÌ·Ù›ÙÈ‰· ∂›Ó·È Ë ÂfiÌÂÓË ÛÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛË˜ ·˘ÙÔ¿ÓÔÛË ÔÌÊÔÏ˘ÁÒ‰Ë˜ ‰ÂÚÌ·ÙÔ¿ıÂÈ· ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜. ∏ Â›ÙˆÛ‹ ÙË˜ ÔÈÎ›ÏÏÂÈ ·fi 1,2/100.000 Î·ÙÔ›ÎÔ˘˜ ÛÙËÓ ∂Ï‚ÂÙ›· ¤ˆ˜ 11/100.000 ÛÙËÓ ∞ÁÁÏ›·, ÌÂ Û˘Ó‹ıË ËÏÈÎ›· ÂÌÊ¿ÓÈÛË˜ Ù· 2 ¤ˆ˜ 7 ¤ÙË (5). ∞ÓÙ›ıÂÙ· ÚÔ˜ ÙËÓ IgA ÁÚ·ÌÌÈÎ‹ ‰ÂÚÌ·ÙÔ¿ıÂÈ·, ÔÈ ‚Ï¿‚Â˜ Û˘ÓÔ‰Â‡ÔÓÙ·È ÛÙ·ıÂÚ¿ ·fi Î·‡ÛÔ Î·È ÎÓËÛÌfi, ÂÓÙÔ›˙ÔÓÙ·È Û˘ÌÌÂÙÚÈÎ¿ ÛÙÈ˜ ÂÎÙ·ÙÈÎ¤˜ ÂÈÊ¿ÓÂÈÂ˜ ÙˆÓ ¿ÎÚˆÓ, ÙÔ Ï·ÈÌfi, ÙÔ˘˜ ÒÌÔ˘˜, Ù· ÁfiÓ·Ù· Î·È ÙÔ˘˜ ·ÁÎÒÓÂ˜ (∂ÈÎfiÓ· 4) ÌÂ ÂÚËÙÔÂÈ‰Â›˜ Ê˘Û·ÏÏ›‰Â˜ Â¿Óˆ ÛÂ ÂÚ˘ıËÌ·ÙÔ-ÔÈ‰ËÌ·ÙÒ‰ÂÈ˜, ÎÓÈ‰ˆÙÈÎfiÌÔÚÊÂ˜ Ï¿ÎÂ˜.

È‰È·›ÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË˜ ÂÚËÙÔÂÈ‰Ô‡˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜ Â›Ó·È Ë Â˘·›ÛıËÙË ÛÙË ÁÏÔ˘Ù¤ÓË ÂÓÙÂÚÔ¿ıÂÈ·, Ë ÔÔ›· Û˘Ó·ÓÙ¿Ù·È ÛÙÔ 75-90% ÙˆÓ ·ÛıÂÓÒÓ (11). ™˘Ó‹ıˆ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ‰˘Û·ÔÚÚfiÊËÛË˜, ·ÏÏ¿ ¯ÚfiÓÈ· ‰È¿ÚÚÔÈ· ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ 16-50% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ (3). ∫·ı˘ÛÙ¤ÚËÛË ÙË˜ ·Ó¿Ù˘ÍË˜, Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÂÓÙÂÚÔ¿ıÂÈ·˜, ÌÂ ·fiÎÏÈÛË Ì¤¯ÚÈ -2 ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 15% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ‰˘Û·ÔÚÚfiÊËÛË Á›ÓÂÙ·È Ê·ÓÂÚ‹ ÌÂ ÙË ‰ÔÎÈÌ·Û›· ÙË˜ D-Í˘Ïfi˙Ë˜ Î·È ÙË ÛÙÂ·ÙfiÚÚÔÈ·

ÛÙÔ 30%, ÂÓÒ Ë ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘ ·ÔÎ·Ï‡ÙÂÈ ÌÂÚÈÎ‹ ‹ ÔÏÈÎ‹ ·ÙÚÔÊ›· ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ, ·ÎﬁÌË Î·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ¯ˆÚ›˜ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ (5). ¢È·Ù·Ú·¯¤˜ ÛÙËÓ ·‰·Ì·ÓÙ›ÓË ÙˆÓ ‰ÔÓÙÈÒÓ ﬁÌÔÈÂ˜ ÌÂ ÂÎÂ›ÓÂ˜ ÙË˜ ÎÔÈÏÈÔÎ¿ÎË˜ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› Û·Ó Û˘Ó¤ÂÈ· Ï‹„Ë˜ ÁÏÔ˘Ù¤ÓË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ÂÚËÙÔÂÈ‰‹ ‰ÂÚÌ·Ù›ÙÈ‰· (12).

∏ Û˘Û¯¤ÙÈÛË ÙË˜ ÂÓÙÂÚÔ¿ıÂÈ·˜ ÙË˜ ÙÂÏÂ˘Ù·›·˜ ÌÂ ·˘Ù‹Ó ÙË˜ ÎÔÈÏÈÔÎ¿ÎË˜ Î·È Ë ·Ô˘Û›· Û·ÊÔ‡˜ ·ÓÔÛÔÏÔÁÈÎ‹˜ ‰È¿ÎÚÈÛË˜ ÙË˜ ÂÓÙÂÚÔ¿ıÂÈ·˜ ÙˆÓ ‰‡Ô ·ı‹ÛÂˆÓ, ÂÓÈÛ¯‡ÂÙ·È ·ﬁ ÙË Û˘¯Ó‹ Û˘Ó‡·ÚÍË ÙˆÓ HLA-B8, DR3(DW17) Î·È È‰È·›ÙÂÚ· ÙÔ˘ DQw2 (3,5). ∏ ·ÚÔ˘Û›· ÙÔ˘ ·ÏÏËÏ›Ô˘ DR7 Î·È Ë ·Ô˘Û›· ÙÔ˘ DR2 Û˘Ó‰˘¿˙ÂÙ·È ÌÂ È‰È·›ÙÂÚ· ÛÔ‚·Ú‹ Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ÙË˜ ÂÓÙÂÚÔ¿ıÂÈ·˜. ∂Í¿ÓıËÌ· ÂÚËÙÔÂÈ‰Ô‡˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜ ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ› ·ÎﬁÌË Î·È ÌÂÙ¿ 22 ¤ÙË ·ÚÔ˘Û›·˜ ÎÔÈÏÈÔÎ¿ÎË˜. ∞˘Ù‹ Ë

∂ÈÎfiÓ· 1. °Ú·ÌÌÈÎfi˜ ÊıÔÚÈÛÌfi˜ ÙË˜ ‚·ÛÈÎ‹˜ ÌÂÌ‚Ú¿Ó·˜ ÙË˜ ÂÈ‰ÂÚÌ›‰·˜ ÌÂ ÙËÓ ·ÓÔÛÔÛÊ·ÈÚ›ÓË IgA (ÙÂ¯ÓÈÎ‹ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ÛÙÔ ÂÚÈ‚Ï·‚ÈÎfi ‰¤ÚÌ·).

·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ IgA ‹ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ IgAÁÏÔ˘Ù¤ÓË˜ ÛÙÔ ‰¤ÚÌ· ÌÂÙ¿ ·ﬁ ‰È·ÙÚÔÊÈÎ‹ Â˘·ÈÛıËÙÔÔ›ËÛË ÛÙË ÁÏÔ˘Ù¤ÓË (13).

∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÈÎﬁÓ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ

¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÈÎÚÔ·ÔÛÙËÌ¿ÙÈ· ÛÙÈ˜ ıËÏ¤˜ ÙÔ˘ ¯ÔÚ›Ô˘, ·ÔÙÂÏÔ‡ÌÂÓ· ·fi Ô˘‰ÂÙÂÚfiÊÈÏ· Î˘Ú›ˆ˜ Î·È ÂˆÛÈÓfiÊÈÏ·. ∏ ÂÍ¤Ù·ÛË ÙÔ˘ ˘ÁÈÔ‡˜ ÂÚÈ‚Ï·‚ÈÎÔ‡ ‰¤ÚÌ·ÙÔ˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ‰Â›¯ÓÂÈ ·ıÔÁÓˆÌÔÓÈÎ‹ ÂÈÎfiÓ·, ÌÂ ÎÔÎÎÒ‰ÂÈ˜ ÂÓ·Ôı¤ÛÂÈ˜ IgA Î·È C3 ÛÙÈ˜ ıËÏ¤˜ ÙÔ˘ ¯ÔÚ›Ô˘. ∏ ·Ú·Ù‹ÚËÛË ÌÂ ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ·ÔÎ·Ï‡ÙÂÈ fiÙÈ ÔÈ ÂÓ·Ôı¤ÛÂÈ˜ ·˘Ù¤˜ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ Â›Â‰Ô ÙˆÓ ·ÁÎ˘ÚÔ‚ÔÏÔ˘ÛÒÓ ÈÓÒÓ, Î¿Ùˆ ·fi ÙÔÓ ¯ÔÚÈÔÂÈ‰ÂÚÌÈ‰ÈÎfi Û‡Ó‰ÂÛÌÔ (14). ∆· ·ÓÙÈÂÓ‰ÔÌ˘ÛÈ·Î¿ ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· Î·ÙÂ˘ı‡ÓÔÓÙ·È Î·Ù¿ ÙÔ˘ ÂÓ‰ÔÌ˘Û›Ô˘ ÙˆÓ ÏÂ›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ, ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔÓ ÔÚfi ÙÔ˘ 70% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÂÚËÙÔÂÈ‰‹ ‰ÂÚÌ·Ù›ÙÈ‰· Î·È ÂÓÙÂÚÔ¿ıÂÈ·. ∞ÔÙÂÏÔ‡Ó ¤Ó· ‰Â›ÎÙË ÛÔ‚·ÚfiÙËÙ·˜ ÙË˜ ÂÓÙÂÚÈÎ‹˜ ÓfiÛÔ˘ Î·È ˘Ô¯ˆÚÔ‡Ó ÌÂ ÙËÓ ·˘ÛÙËÚ‹ ÂÊ·ÚÌÔÁ‹ ‰È·ÙÚÔÊ‹˜ ÂÏÂ‡ıÂÚË˜ ·fi ÁÏÔ˘Ù¤ÓË (15). ∏ ÚfiÁÓˆÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È ÂÈÊ˘Ï·ÎÙÈÎ‹ ˆ˜ ÚÔ˜ ÙË ‰È¿ÚÎÂÈ¿ ÙË˜. ∏ Â˘·ÈÛıËÛ›· ÛÙË ÁÏÔ˘Ù¤ÓË

ÌÔÚÂ› Ó· ·Ú·ÌÂ›ÓÂÈ Â’ ·fiÚÈÛÙÔÓ (11). ∏ ÂÏÂ‡ıÂÚË ÁÏÔ˘Ù¤ÓË˜ ‰›·ÈÙ· ·Ó·Ì¤ÓÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ Ï‹ÚË ‰ÂÚÌ·ÙÈÎ‹ ÏÂ‡Î·ÓÛË ÂÓÙfi˜ ÂÓfi˜

∂ÈÎﬁÓ· 2. º˘Û·ÏÏ›‰Â˜ Î·È ÂÊÂÏÎ›‰Â˜ ÛÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ ·ÛıÂÓÔ‡˜ ÌÂ IgA ÁÚ·ÌÌÈÎ‹ ÓﬁÛÔ.

¤ÙÔ˘˜, ÔÏ‡ ÓˆÚ›ÙÂÚ· ·’ fi,ÙÈ ÛÙËÓ ÂÚËÙÔÂÈ‰‹ ‰ÂÚÌ·Ù›ÙÈ‰· ÙˆÓ ÂÓËÏ›ÎˆÓ (16). ∏ ‰·„fiÓË ÛÂ ËÌÂÚ‹ÛÈ· ‰fiÛË 0,5-1 mg/kg ÂÈÙ˘Á¯¿ÓÂÈ ¿ÌÂÛË ‚ÂÏÙ›ˆÛË, ·ÏÏ¿ Ë ¿ıËÛË ˘ÔÙÚÔÈ¿˙ÂÈ ÌÂ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. °È’ ·˘Ùfi ÂÈ‚¿ÏÏÂÙ·È Û˘Á¯ÚfiÓˆ˜ Ë ‰›·ÈÙ· ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË. ∏ ÙÂÏÂ˘Ù·›·, ¿ÓÙˆ˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏÂ˜ ‰˘ÛÎÔÏ›Â˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙË˜ Î·È ÔÏ‡ ˘„ËÏfi ÎfiÛÙÔ˜ (5).

∫ÔÈÓ‹ ¤ÌÊÈÁ·

∞˘Ù‹ ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÓfiÛÔ ÙˆÓ ÂÓËÏ›ÎˆÓ. ∂ÔÌ¤Óˆ˜, Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ·fi

ÙÔ ÛÙﬁÌ· Î˘ÚÈ·Ú¯Â› ‹ ÂÁÎ·ÈÓÈ¿˙ÂÈ ÙËÓ ﬁÏË ÎÏÈÓÈÎ‹

ÂÈÎﬁÓ·. ∂Ò‰˘ÓÂ˜ Î·È ‰˘Û›·ÙÂ˜ ‰È·‚ÚÒÛÂÈ˜ Î·È ÂÏÎÒÛÂÈ˜ ÛÙÔ ‚ÏÂÓÓÔÁﬁÓÔ ÙˆÓ ·ÚÂÈÒÓ Î·È Ù· Ô‡Ï·

ÌÔÚÔ‡Ó Ó· ·Ú·ÌÂ›ÓÔ˘Ó ÂÓÙÔÈÛÌ¤ÓÂ˜ Â› Ì‹ÓÂ˜

ÚÈÓ ÂÌÊ·ÓÈÛÙÔ‡Ó ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈÎ¤˜, Ï·‰·Ú¤˜, ÂÎÙÂÙ·Ì¤ÓÂ˜ ÔÌÊﬁÏ˘ÁÂ˜, ÔÈ ÔÔ›Â˜ ·Ê‹ÓÔ˘Ó

fiÙ·Ó Û¿ÛÔ˘Ó ‰‡ÛÔÛÌÂ˜ Î·È ‰˘Û›·ÙÂ˜ ‰È·‚ÚÒÛÂÈ˜ ‰È¿Û·ÚÙ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ· (∂ÈÎfiÓ· 5). ∏

‰È¿ÁÓˆÛË ÌÂ ÙÈ˜ ¿ÊıÂ˜, ÙÔ

‰‡ÛÎÔÏË ÛÙÔÓ ÌË “˘Ô„È·ÛÌ¤ÓÔ” ÎÏÈÓÈÎﬁ

¶·È‰È·ÙÚÈÎ‹ 2001;64:557-564 Paediatriki 2001;64:557-564

∂ÈÎﬁÓ· 3. ∂ÈÎﬁÓ· ÚÔ˙¤ÙÙ·˜ ‹ ¤ÚÏ·˜.

È·ÙÚfi. ∞fi 14 ÂÚÈÙÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ ÛÙÈ˜ ÔÔ›Â˜

Î·Ù·ÁÚ¿ÊËÎÂ Ë ·Ú¯ÈÎ‹ ‰È¿ÁÓˆÛË, ıÂˆÚ‹ıËÎÂ

ÂÛÊ·ÏÌ¤Ó· ﬁÙÈ ¤·Û¯·Ó ·ﬁ ÔÏ‡ÌÔÚÊÔ ÂÚ‡ıËÌ·

3 ·ÛıÂÓÂ›˜, ·ﬁ ÂÚËÙÈÎ‹ Ô˘ÏÔÛÙÔÌ·Ù›ÙÈ‰· 2, ·ﬁ

ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô 5, ·fi ÙÔÍÈÎfi ÔÌÊÔÏ˘ÁÒ‰Â˜

ÂÍ¿ÓıËÌ· 1 Î·È ÌﬁÓÔ ÛÂ Ì›· ÂÚ›ÙˆÛË ÂÙ¤ıË Ë

ÔÚı‹ ‰È¿ÁÓˆÛË ÙË˜ ÎÔÈÓ‹˜ ¤ÌÊÈÁ·˜ (17).

∂ÂÈ‰‹ Ë ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË Ô‰ËÁÂ› ÛÂ ËÈﬁÙÂ-

ÚË Î·È ·ÛÊ·Ï¤ÛÙÂÚË ıÂÚ·Â›·, ÂÈ‚¿ÏÏÂÙ·È Ô

¤ÏÂÁ¯Ô˜ Î·Ù¿ Tzanck ÛÂ Î¿ıÂ ‡ÔÙË ÂÚ›ÙˆÛË.

∞˘Ùﬁ˜ Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ÂÍ¤Ù·ÛË ÙÔ˘ ÂÈ¯Ú›ÛÌ·ÙÔ˜

ÙË˜ ‚¿ÛË˜ ÙˆÓ ÂÍÂÏÎÒÛÂˆÓ ‹ ÙˆÓ ÔÌÊÔÏ‡ÁˆÓ ÌÂ

ÙË ¯ÚÒÛË Î·Ù¿ Giemsa. £ÂÙÈÎfi ÁÈ· ÙË ÓfiÛÔ Â‡ÚËÌ· Â›Ó·È Ë ·ÔÎ¿Ï˘„Ë ÂÎÙÂÙ·Ì¤ÓË˜ ·Î·ÓıfiÏ˘ÛË˜, ‰ËÏ. Ï‡ÛË˜ ÙË˜ Û˘Ó¤¯ÂÈ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙË˜ ·Î·ÓıˆÙ‹˜ ÛÙÈ‚¿‰·˜ ÙË˜ ÂÈ‰ÂÚÌ›‰·˜. ∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ı· ·ÔÎ·Ï‡„ÂÈ ˘ÂÚ‚·ÛÈÎ‹ ·Î·ÓıÔÏ˘ÙÈÎ‹ Ê˘Û·ÏÏ›‰·, ÂÓÒ Ô ¿ÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜ ·fi ˘ÁÈ¤˜ ‹ ÂÚ˘ıËÌ·ÙÒ‰Â˜ ‰›Ï· ÛÙËÓ ÔÌÊfiÏ˘Á· ‰¤ÚÌ· ‹ ‚ÏÂÓÓÔÁfiÓÔ ı· Î·Ù·‰Â›ÍÂÈ ÂÓ·Ôı¤ÛÂÈ˜ IgG Î·È C3 ÛÙ· ÌÂÛÔÎ˘ÙÙ¿ÚÈ· ‰È·ÛÙ‹Ì·Ù· ÌÂ ÙË ÌÔÚÊ‹ ‰ÈÎÙ‡Ô˘. ∏ ¤ÌÊÈÁ· ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Û¿ÓÈ·. ¶·Ú’ fiÙÈ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÏÈÁfiÙÂÚÔÈ ·fi 80 ·ÛıÂÓÂ›˜ ÛÙË

‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Î·È ‰ÂÓ ¤¯Ô˘Ó Î·ıÔÚÈÛÙÂ› standard ıÂÚ·Â˘ÙÈÎ¤˜ Ô‰ËÁ›Â˜ (18), Ë ÂÌÂÈÚ›· ·fi ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÓfiÛÔ˘ Â›Ó·È ÛËÌ·ÓÙÈÎ‹. ∂ÓÒ ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂÈ˜ ‚ÂÏÙ›ˆÛË˜ ÌÂ Ù· ÙÔÈÎ¿ ÛÙÂÚÔÂÈ‰‹, Â›Ó·È Û¯Â‰fiÓ Û›ÁÔ˘ÚË

∂ÈÎﬁÓ· 4. ™˘ÌÌÂÙÚÈÎ‹ Î·Ù·ÓÔÌ‹ ‚Ï·‚ÒÓ ÂÚËÙÔÂÈ‰Ô‡˜

‰ÂÚÌ·Ù›ÙÈ‰·˜ ÛÙÔ˘˜ ÒÌÔ˘˜.

°È’ ·˘Ùfi ÂÈ‚¿ÏÏÂÙ·È Û˘Ó‹ıˆ˜ Ë ¯ÔÚ‹ÁËÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ ÎÔÚÙÈ˙fiÓË˜, 2 mg/kg ÙËÓ

ËÌ¤Ú· ÚÂ‰ÓÈ˙ÔÏfiÓË˜ ‹ ÈÛÔ‰‡Ó·ÌÔ˘ ·fi ÙÔ ÛÙfiÌ·, ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ·˙·ıÂÈÔÚ›ÓË. ∏ Î˘ÎÏÔÛÔÚ›ÓË ÛÂ ‰fiÛË Ô˘ ÌÔÚÂ› Ó· Êı¿ÓÂÈ Ù· 5 mg/kg ËÌÂÚËÛ›ˆ˜, ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙÔÓ ·ÔÁ·Ï·ÎÙÈÛÌfi ·fi Ù· ÛÙÂÚÔÂÈ‰‹ Î·È ÛÙËÓ

‡ÊÂÛË ÙË˜ ÓfiÛÔ˘ (19). £ÂÙÈÎfiÙÂÚË, fiÌˆ˜, fiÏˆÓ Â›Ó·È Ë ·Ú·Ù‹ÚËÛË fiÙÈ Ë ÓfiÛÔ˜ ¤¯ÂÈ Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË ·fi ÙËÓ ¤ÌÊÈÁ· ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÌÂÁ¿ÏÔ˜

·ÚÈıÌﬁ˜ ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ ÌÔÚÂ› Ó· ‰È·Îﬁ„ÂÈ ÙÂÏÈÎ¿ ÙË ıÂÚ·Â›· Î·È Ó· ÌÂ›ÓÂÈ ÂÏÂ‡ıÂÚÔ˜ ‚Ï·‚ÒÓ (18).

¶ÔÌÊÔÏ˘ÁÒ‰Â˜ ÂÌÊÈÁÔÂÈ‰¤˜ ∆Ô ÔÌÊÔÏ˘ÁÒ‰Â˜ ÂÌÊÈÁÔÂÈ‰¤˜ (¶¶) Â›Ó·È ÓfiÛÔ˜ ÙˆÓ ËÏÈÎÈˆÌ¤ÓˆÓ. ∆Ô ÓÂ·ÓÈÎfi ¶¶ Â›Ó·È Û·ÓÈfiÙ·ÙÔ, ÌÂ ‰ËÌÔÛÈÂ˘Ì¤ÓÂ˜ Ì¤¯ÚÈ ÙÔ 1993 ÌfiÏÈ˜ 40 ÂÚÈÙÒÛÂÈ˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (5). ªÂÁ¿ÏÂ˜ ÙÂÙ·Ì¤ÓÂ˜, ÌÂÚÈÎ¤˜ ÊÔÚ¤˜ ·ÈÌÔÚÚ·ÁÈÎ¤˜, Ê˘Û·ÏÏÈ‰ÔÔÌÊfiÏ˘ÁÂ˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔÓ ÎÔÚÌfi (∂ÈÎfiÓ· 6) Î·È Î˘Ú›ˆ˜ ÛÙÈ˜ ·Ú·ÙÚÈÌÌ·ÙÈÎ¤˜ ı¤ÛÂÈ˜ ÙˆÓ ¿ÎÚˆÓ, ÙÈ˜ ·Ï¿ÌÂ˜ Î·È Ù· ¤ÏÌ·Ù· (20). OÈ ‚ÏÂÓÓÔÁfiÓÔÈ Â›Ó·È Û˘Ó‹ıˆ˜ ÂÏÂ‡ıÂÚÔÈ ·fi ‚Ï¿‚Â˜. ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎ¿ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È IgG ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· Î·ÙÂ˘ı‡ÓÔÓÙ·È ÂÓ·ÓÙ›ÔÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ‰ÂÚÌ·ÙÔÂÈ‰ÂÚÌÈ‰ÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ ÌÂ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 180 Î·È 230 ∫D (21). ∆· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ·ÓÈ¯ÓÂ‡ÔÓÙ·È ÛÙÔÓ ÔÚfi ÙÔ˘ 60-70% ÙˆÓ ·ÛıÂÓÒÓ Î·È ‰È·ÈÛÙÒÓÔÓÙ·È in vivo ˆ˜ Û‡ÌÏÔÎ· ÌÂ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÈÛÙÈÎfi ·ÓÙÈÁfiÓÔ

∂ÈÎﬁÓ· 5. ¶¤ÌÊÈÁ· ÌÂ ÂÎÙÂÙ·Ì¤ÓÂ˜, ‰˘Û›·ÙÂ˜ ÂÏÎÒÛÂÈ˜.

Î·È ÙË ÌÔÚÊ‹ ÁÚ·ÌÌÈÎ‹˜ πgG ‹/Î·È C3 ÂÓ·ﬁıÂÛË˜

ÛÙË µª ÙË˜ ÂÈ‰ÂÚÌ›‰·˜ ÙÔ˘ Û˘ÓﬁÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ (6).

∏ ÂÌÊ¿ÓÈÛË ÙË˜ ¿ıËÛË˜ ÛÙ· ·È‰È¿ ÌÂÙ¿ ·fi ·fiÚÚÈ„Ë ÓÂÊÚÈÎÔ‡ ·ÏÏÔÌÔÛ¯Â‡Ì·ÙÔ˜ ˘ÔÓÔÂ› ÙË ‰ËÌÈÔ˘ÚÁ›· ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·fi ÙËÓ ·ÓÔÛÔÏÔÁÈÎ‹ ·ÓÙ›‰Ú·ÛË ÙË˜ ·fiÚÚÈ„Ë˜ Î·È ÙËÓ ·ÓÙ›‰Ú·Û‹ ÙÔ˘˜ ÌÂ ·ÓÙÈÁfiÓ·, ÙfiÛÔ ÙÔ˘ ÓÂÊÚÔ‡ fiÛÔ Î·È ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (22). ∏ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ Â›Ó·È Ì·ÎÚ¿. ªÂÚÈÎÔ› Û˘ÁÁÚ·ÊÂ›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÓfiÛÔ˜ ˘Ô¯ˆÚÂ› ÂÓÙfi˜ ‰ÈÂÙ›·˜ (23), ·ÏÏ¿ ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂÈ˜ ÌÂ ‰È¿ÚÎÂÈ· ˆ˜ ÙËÓ ÂÓËÏÈÎ›ˆÛË (5). §fiÁˆ ÙË˜ ¤ÎÙ·ÛË˜ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·ÚÒÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ıÂˆÚÂ›Ù·È ··Ú·›ÙËÙË Ë ¯ÔÚ‹ÁËÛË ÚÂ‰ÓÈ˙ÔÏfiÓË˜ ÛÂ ËÌÂÚ‹ÛÈ· ‰fiÛË 12 mg/kg Î·È ÛÂ ·ÓıÂÎÙÈÎ¤˜ ÌÔÚÊ¤˜ ÛÔ˘ÏÊfiÓË˜, ·˙·ıÂÈÔÚ›ÓË˜ ‹ ¯ÏˆÚ·Ì‚Ô˘Î›ÏË˜ (3,23).

∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·È‰Ô›Ô˘ Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿ ÌÂ ÔÌÊÔÏ˘ÁÒ‰Â˜ ÂÌÊÈÁÔÂÈ‰¤˜ Î·È ··ÓÙ¿Ù·È ÛÙÔ 40% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. ŸÙ·Ó ˘¿Ú¯Ô˘Ó Ê˘Û·ÏÏ›‰Â˜ Î·È ÂÚ‡ıËÌ·, ·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ Ù· ÙÔÈÎ¿ ÛÙÂÚÔÂÈ‰‹. ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ˘¿Ú¯ÂÈ Ô˘ÏÔÔ›ËÛË, Ë ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Ô‰Ë-

∂ÈÎﬁÓ· 6. ¶ÔÌÊÔÏ˘ÁÒ‰Â˜ ÂÌÊÈÁÔÂÈ‰¤˜ ÌÂ ÙÂÙ·Ì¤ÓÂ˜

ÔÌÊﬁÏ˘ÁÂ˜.

ÁËıÂ› ÛÂ Ì›· È‰È·›ÙÂÚË ÌÔÚÊ‹ ÂÌÊÈÁÔÂÈ‰Ô‡˜, ÙÔ ·ÔÎ·ÏÔ‡ÌÂÓÔ Ô˘ÏˆÙÈÎfi ÂÌÊÈÁÔÂÈ‰¤˜. ∏ ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ÙÈ˜ ·ÚÎÂÙ¿ Û˘¯ÓfiÙÂÚÂ˜ Î·Ù·ÛÙ¿ÛÂÈ˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Ô ¤ÚË˜ ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Î·È Ë ÛÂÍÔ˘·ÏÈÎ‹ Î·ÎÔÔ›ËÛË. ∏ ıÂÚ·Â›· ·˘Ù‹˜ ÙË˜ ÌÔÚÊ‹˜ ÙÔ˘ ÂÌÊÈÁÔÂÈ‰Ô‡˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÙË Û˘ÛÙËÌ·ÙÈÎ‹ ·ÁˆÁ‹ ‹ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹

Â¤Ì‚·ÛË (24).

™ÙÔÓ ÔÌÊÔÏ˘ÁÒ‰Ë ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‚Ï¿‚Â˜ Ù‡Ô˘ ÂÌÊÈÁÔÂÈ‰Ô‡˜, ıÂÙÈÎ¿ ·ÓÙÈ˘ÚËÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù· Î·È Ù· ÎÏÈÓÈÎ¿ ÎÚÈÙ‹ÚÈ· ÙÔ˘ ÂÚ˘ıËÌ·ÙÒ‰Ô˘˜ Ï‡ÎÔ˘, ﬁˆ˜ ¤¯Ô˘Ó Î·ıÔÚÈÛÙÂ› ·ﬁ ÙËÓ ∞ÌÂÚÈÎ·ÓÈÎ‹ ƒÂ˘Ì·ÙÔÏÔÁÈÎ‹

∂Ù·ÈÚÂ›· (25). ∆fiÛÔ Ë ¿ıËÛË ·˘Ù‹ fiÛÔ Î·È Ë Â›ÎÙËÙË ÔÌÊÔÏ˘ÁÒ‰Ë˜ ÂÈ‰ÂÚÌfiÏ˘ÛË, Ë ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÌÊfiÏ˘ÁÂ˜, Ô˘Ï¤˜ Î·È ÎÂÁ¯Ú›· ÛÙÈ˜ ı¤ÛÂÈ˜ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ‹ Û˘ÓÂ¯Ô‡˜ ÙÚÈ‚‹˜ (26), Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈÂ˜. ∆¤ÏÔ˜, ÙÔ 5-10% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ı· ÁÂÓÓËıÔ‡Ó ·fi ÌËÙ¤Ú· Ë ÔÔ›· ¿Û¯ÂÈ ·fi ÂÌÊÈÁÔÂÈ‰¤˜ ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, ı· ÂÎ‰ËÏÒÛÂÈ ¤Ó· ÎÓËÛÌÒ‰Â˜ ÂÍ¿ÓıËÌ· ÌÂ ÎÓÈ‰ˆÙÈÎ¤˜ ‚Ï·Ù›‰Â˜ Î·È Ê˘Û·ÏÏÈ‰ÔÔÌÊfiÏ˘ÁÂ˜, ÙÔ ÔÔ›Ô ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÌÂ ÂÎÂ›ÓÔ ÙË˜ ÂÚËÙÔÂÈ‰Ô‡˜ ‰ÂÚÌ·Ù›ÙÈ‰·˜ ‹ ÙÔ˘ ÔÌÊÔÏ˘ÁÒ‰Ô˘˜

ÂÌÊÈÁÔÂÈ‰Ô‡˜. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙÔ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ÙË˜ ÓfiÛÔ˘ ÙË˜ ÌËÙ¤Ú·˜. ∆Ô ÂÍ¿ÓıËÌ· ÔÊÂ›ÏÂÙ·È ÛÙË ‰È·Ï·ÎÔ‡ÓÙÂÈ· ÌÂÙ·ÊÔÚ¿ ÙÔ˘

·Ú¿ÁÔÓÙ· ∏G (Herpes Gestationis), ‰ËÏ. ÂÓfi˜ ·ÓÙÈÁfiÓÔ˘ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ 180 Kd Î·È Â›Ó·È ·ÚÔ‰ÈÎfi (5).

µÈ‚ÏÈÔÁÚ·Ê›·

1. Lever WF. Pemphigus. Medicine 1953;32:1-123.

2. Beutner EH, Jordon RE. Demonstration of skin antibodies in sera of pemphigus vulgaris patients by direct immunofluorescent staining. Proc Soc Exp Biol Med 1964;117:505-510.

3. Rabinowitz LG, Esterly NB. Inflammatory bullous diseases in children. Dermatol Clin 1993;11:565-581.

4. Wojnarowska F, Marsden RA, Bhogal B, Black MM. Chronic bullous disease of childhood, childhood cicatricial pemphigoid, and linear IgA disease of adults. A comparative study demonstrating clinical and immunopathologic overlap. J Am Acad Dermatol 1988;19:792-805.

5. Stalder JF, Lepargney ML, Pheline F. Les dermatoses bulleuses autoimmunes de l' enfant. Objectif-Peau 1993;1:30-33.

6. Chaidemenos CG, Maltezos E, Chryssomallis F, Kouskoukis K, Kapetis E, Mourellou O et al. Value of routine diagnostic criteria of bullous pemphigoid. Internat J Dermatol 1998;37:206-211.

7. Wojnarowska F, Whitehead P, Leigh IM, Bhogal BS, Black MM. Identification of the target antigen in chronic bullous disease of childhood and linear IgA disease of adults. Br J Dermatol 1991;124:157-162.

8. Arechalde A, Braun RP, Calza AM, Hertl M, Didierjean L, Saurat JH et al. Childhood bullous pemphigoid associated with IgA antibodies against BP 180 or 230 antigens. Br J Dermatol 1999;140:112-118.

9. Jablonska S, Chorzelski TP, Rosinska D, Maciejowska E. Linear IgA bullous dermatosis of childhood (chronic bullous dermatosis of childhood). Clin Dermatol 1991;9:393-401.

10. Collier PM, Wojnarowska F, Welsh K, McGuire W, Black MM. Adult linear IgA disease and chronic bullous disease of childhood: the association with human lymphocyte antigens Cw7, B8, DR3 and tumour necrosis factor influences disease expression. Br J Dermatol 1999;141:867-875.

11. Ermacora E, Prampolini L, Tribbia G, Pezzoli G, Gelmetti C, Cucchi G et al. Long-term follow-up of dermatitis herpetiformis in children. J Am Acad Dermatol 1986;15:24-30.

12. Aine L, Reunala T, Maki M. Dental enamel defects in children with dermatitis herpetiformis. J Pediatr 1991;118:572-574.

13. Demoulins-Giacco N, Gagey V, Teillac-Hamel D, Fraitag S, Caillat-Zucman S, Schmitz J et al. Dermatitis herpetiformis occurring in patients with celiac disease in childhood. Arch Pediatr 1996;3:541-548.

14. Pehamberger H, Konrad K, Holubar K. Juvenile dermatitis herpetiformis: An immunoelectron microscopic study. Br J Dermatol 1979;101:271-277.

15. Chorzelski TP, Jablonska S, Chadzynska M, Maciejowska E, Sulej J. IgA endomysium antibody in children with dermatitis herpetiformis treated with gluten-free diet. Pediatr Dermatol 1986;3:291-294.

16. Fry L. Fine points in the management of dermatitis herpetiformis. Semin Dermatol 1988;7:206-211.

17. Laskaris G, Stoufi E. Oral pemphigus vulgaris in a 6 year old girl. Oral Surg Oral Med Oral Pathol 1990;69:609-613.

18. Wananukul S, Pongprasit P. Childhood pemphigus. Int J Dermatol 1999;38:29-35.

19. Alijotas J, Pedragosa R, Bosch J, Vilardell M. Prolonged remission after cyclosporine therapy in pemphigus vulgaris. Report of two young siblings. J Am Acad Dermatol 1990;23:701-703.

20. Oranje AP, Vuzevsky VD, van Joost T, Ten Kate F, Naafs B. Bullous pemphigoid in children. Int J Dermatol 1991;30:339-342.

21. Nagano T, Tan M, Adachi A, Takanaga T, Sakamoto S, Kodama S et al. Childhood Bullous Pemphigoid: Immunohistochemical, immunoelectron microscopic and Western Blot analysis. J Am Acad Dermatol 1994;30:884-888.

22. Yamazaki S, Yokozeki H, Katayama I, Komai R, Hashimoto T, Nishioka K. Childhood bullous pemphigoid associated with chronic renal allograft rejection. Br J Dermatol 1998;138:547-548.

23. Nuyl Z, Harangi F, Varszegi D, Zombai E, Odon KF. Vesicobullous lesions in a child. Bullous pemphigoid. Arch Dermatol 1997;133:775.

24. Farrell AM, Kirtschig G, Dalziel KL, Allen J, Dootson G, Edwards S et al. Childhood vulval pemphigoid: a clinical and immunopathological study of five patients. Br J Dermatol 1999;140:308-312.

25. Kettler AH, Bean SF, Duffy JO, Gammon WR. Systemic lupus erythematosus presenting as a bullous eruption in a child. Arch Dermatol 1988;124:1083-1087.

26. Rubenstein R, Esterly NB, Fine JD. Childhood epidermolysis bullosa acquisita. Detection in a 5 year old girl. Arch Dermatol 1987;123:772-776. ¶·È‰È·ÙÚÈÎ‹

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-02-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2001

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Nosocomial infections in a Paediatric Intensive Care Unit P. Kalabalikis1, A. Patsoura1, A. Mavromati2, G. Briassoulis1, A. Hrisaki2, A. Pagali2, A. Hatzis1

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·ÚÔ˘Û›·Û·Ó ÛÙË ª∂£, ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂÏÂ-

¯ÒÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó, ÙË˜ Â˘·ÈÛıËÛ›·˜ ÙÔ˘˜ ÛÙ· ·ÓÙÈÌÈÎÚÔ‚È·Î¿ Ê¿ÚÌ·Î· Î·È ‰ÈÂÚÂ˘Ó‹ıËÎÂ Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ ÌÂ ÚÔ‰È·ıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜. ∂‚‰ÔÌ‹ÓÙ· ÂÓÓ¤· ·ÛıÂÓÂ›˜ (18,3%) ·ÚÔ˘Û›·Û·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ¡§ ÛÂ Û‡ÓÔÏÔ 113 ¡§. ∞fi ·˘Ù¤˜, ÔÛÔÛÙfi 59,3% ‹Ù·Ó ÛË„·ÈÌ›·, 30,1% ÓÂ˘ÌÔÓ›·, 8,0% Ô˘ÚÔÏÔ›ÌˆÍË, 1,7% ÏÔÈÌÒÍÂÈ˜ ‰¤ÚÌ·ÙÔ˜ Î·È Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Î·È 0,9% ÂÈÂÊ˘Î›ÙÈ˜. OÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ÚÔÎ¿ÏÂÛ·Ó ÏÔ›ÌˆÍË ‹Ù·Ó Staphylococcus ÎÔ·ÁÎÔ˘Ï¿ÛË ·ÚÓËÙÈÎfi˜ (CNS) 29,2%, ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂÈ‰‹ 27,4%, Pseudomonas spp. 14,2%, Candida spp. 9,0%, Staphylococcus aureus 8,8%, Acinetobacter spp. 7,0% Î·È Enterococcus spp. 4,4%. ¶ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ¡§ ‹Ù·Ó: Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ ÛÙË ª∂£ (22,6 ËÌ¤ÚÂ˜ ÁÈ· Ù· ·È‰È¿ ÌÂ ¡§, ¤Ó·ÓÙÈ 5,2 ·˘ÙÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ¡§, p<0,0001), Ë ‰È¿ÚÎÂÈ· ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (16,3 ËÌ¤ÚÂ˜, ¤Ó·ÓÙÈ 1,7 ·ÓÙ›ÛÙÔÈ¯·, p<0,0001), Ë ‚·Ú‡ÙËÙ· ÙË˜ ÁÂÓÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ·ÛıÂÓÒÓ (PRISM score: 10,8, ¤Ó·ÓÙÈ 5,3 ·ÓÙ›ÛÙÔÈ¯·, p<0,0001), Ë ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, Ô˘ÚÔÎ·ıÂÙ‹ÚˆÓ Î·È ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (device utilization ratio: 2,1, ¤Ó·ÓÙÈ 0,9 ·ÓÙ›ÛÙÔÈ¯·, p<0,0001), Ë ‰È¿ÚÎÂÈ· ·ÚÂÓÙÂÚÈÎ‹˜ ‰È·ÙÚÔÊ‹˜ (4,8 ËÌ¤ÚÂ˜, ¤Ó·ÓÙÈ 0,5 ·ÓÙ›ÛÙÔÈ¯·, p<0,0001), Ë ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛË˜ ∏2 ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙË˜ ÈÛÙ·Ì›ÓË˜ (4,7 ËÌ¤ÚÂ˜, ¤Ó·ÓÙÈ 2 ·ÓÙ›ÛÙÔÈ¯·, p<0,001).

Abstract: During a 2 year period a total of six hundred eighty three children (683 children) aged 15 days to 18 years were admitted to our department. In 431 of them, who stayed longer than 24 hours, the rate of intensive care unitacquired infections as well as the microorganisms that were isolated and their sensitivity were recorded. In addition, the relationship between nosocomial infections (NI) and the risk factors for these infections was investigated. Seventy nine patients (18.3%) developed at least one NI out of a total of 113 NI. Of these, 59.3% were due to sepsis, 30.1% to pneumonia, 8.0% to urinary tract infections, 1.7% to skin and soft tissue infections and 0.9% to conjunctivitis. The most frequent pathogens isolated were coagulase-negative Staphylococcus (CNS) 29.2%, enterobacteriaceae 27.4%, Pseudomonas spp. 14.2%, Candida spp. 9.0%, Staphylococcus aureus 8.8%, Acinetobacter spp. 7.0% Î·È Enterococcus spp. 4.4%. Risk factors associated with NI were: the length of ICU stay (22.6 days for the children with NI vs 5.2 for those whithout NI, p<0.0001), the duration of mechanical ventilation (16.3 vs 1.7 days respectively, p<0.0001), the severity of the general condition of the patients (PRISM score: 10.8 vs 5.3 respectively, p<0.0001), the device utilization ratio (2.1 vs 0.9 respectively, p<0.0001), the duration of total parenteral nutrition (4.8 vs 0.5 days respectively, p<0.0001) as well as the administration of H2 antagonist (4.7 vs 2 days respectively, p<0.001). Isolates of Pseudomonas aeruginosa resistant to gentamycin were 10.9%, to ceftazidime 10.0% and to imipenem 2.6%. Isolates 1 ªÔÓ¿‰·

1 Intensive Care Unit

“Aghia Sophia” Children’s Hospital, Athens

2 Microbiological Laboratory

“Aghia Sophia” Children’s Hospital, Athens

ÙË˜ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜, ıÂÙÈÎÒÓ ‰ÂÈÎÙÒÓ ÏÔ›ÌˆÍË˜.

£ÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· Ô‡ÚˆÓ Î·Ù¿ ÙËÓ Â›ÛÔ‰Ô ıÂˆÚÂ›ÙÔ Ô˘-

ÚÔÏÔ›ÌˆÍË ÂÎÙﬁ˜ ÙË˜ ª∂£ Î·È ÔÈ ·ÛıÂÓÂ›˜ ·ÔÎÏÂ›ÔÓÙ·Ó ·ﬁ

ÙË ÌÂÏ¤ÙË, ÂÓÒ ıÂÙÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ÙÈ˜ ÂﬁÌÂÓÂ˜ ËÌ¤ÚÂ˜ ıÂ-

ˆÚÂ›ÙÔ ﬁÙÈ ÔÊÂ›ÏÔÓÙ·Ó ÛÂ ¡§ ÙË˜ ª∂£.

°È· ÙÈ˜ Û˘ÁÎÚ›ÛÂÈ˜ ÔÛÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ÌÂÙ·Í‡ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÎ‰‹ÏˆÛ·Ó ¡§ Î·È ·˘ÙÒÓ Ô˘ ‰ÂÓ ÂÎ‰‹ÏˆÛ·Ó,

¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ Student’s t-test, ÂÓÒ ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÔÈÔÙÈÎÒÓ ÌÂÁÂıÒÓ (Î·ÙËÁÔÚÈÎ¿ ‰Â‰ÔÌ¤Ó·) ÂÊ·ÚÌfiÛÙËÎÂ ÙÔ Fisher’s exact test. ø˜ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎfi ıÂˆÚ‹ıËÎÂ ÙÔ ·ÔÙ¤ÏÂÛÌ· fiÔ˘ p<0,05. °È· ÙËÓ ·Ó¿Ï˘ÛË ÔÏÏ·ÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (multivariate analysis) ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ÙÔ ÌÔÓÙ¤ÏÔ

ÙË˜ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹˜ ÛÙ·‰È·Î‹˜ ÏÔÁÈÛÙÈÎ‹˜ ·ÏÈÓ‰ÚﬁÌËÛË˜ (stepwise logistic regression model). ∏ ‚·ıÌÔÓﬁÌËÛË ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ ·˘ÙÔ‡ ÛÂ ¤Ó· Ê¿ÛÌ· ÌÂÛÔ‰È·ÛÙËÌ¿ÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÂÏ¤Á-

¯ıËÎÂ ÌÂ ÙÔ Hosmer-Lemeshow goodness-of-fit test.

∞ÔÙÂÏ¤ÛÌ·Ù·

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· 2 ÂÙÒÓ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£

ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ Ì·˜ 683 ·ÛıÂÓÂ›˜, ·ﬁ ÙÔ˘˜ ÔÔ›Ô˘˜, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ Ô‰ËÁ›Â˜ Ô˘ ‰›ÓÔÓÙ·È ÁÈ· ÙËÓ

Î·Ù·ÁÚ·Ê‹ ÙˆÓ ¡§ ÛÙÔ ∂ıÓÈÎﬁ ™‡ÛÙËÌ· ∂ÔÙÂ›·˜

¡ÔÛÔÎÔÌÂÈ·ÎÒÓ §ÔÈÌÒÍÂˆÓ ÙˆÓ ∏¶∞ (1), ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂÏ¤ÙË ÔÈ 431, Ô˘ ·Ú¤ÌÂÈÓ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ ÁÈ· ¯ÚÔÓÈÎﬁ ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 24 ˆÚÒÓ.

∞ﬁ ·˘ÙÔ‡˜, Ù· 226 ‹Ù·Ó ·ÁﬁÚÈ· Î·È Ù· 205 ÎÔÚ›ÙÛÈ·, ËÏÈÎ›·˜ 15 ËÌÂÚÒÓ ¤ˆ˜ 18 ÂÙÒÓ. ∆· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿

ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∂ÓÂÓ‹ÓÙ· ÙÚ›· ·È‰È¿ (21,6%) Â›¯·Ó ÂÈÛ·¯ıÂ›

ÁÈ· ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË, 85 (19,7%) ÏfiÁˆ ÙÚ·˘Ì·ÙÈÛÌÒÓ Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÎÚ·ÓÈÔÂ-

ÁÎÂÊ·ÏÈÎ¤˜ Î·ÎÒÛÂÈ˜, ÂÓÒ 78 ·ÛıÂÓÂ›˜ (18,1%) ÂÈÛ‹¯ıËÛ·Ó ÏfiÁˆ ÛÔ‚·Ú‹˜ ÏÔ›ÌˆÍË˜ (¶›Ó·Î·˜ 1). ∏ Ì¤ÛË ‚·Ú‡ÙËÙ· ÙË˜ ÁÂÓÈÎ‹˜ ÙÔ˘˜ Î·Ù¿ÛÙ·ÛË˜ Î·Ù¿ ÙÔ ÚÒÙÔ 24ˆÚÔ ÓÔÛËÏÂ›·˜, fiˆ˜ ·˘Ù‹ ÂÎÊÚ¿ÛÙËÎÂ ÌÂ ÙÔ PRISM score, ‹Ù·Ó 6,5. ∂‚‰ÔÌ‹ÓÙ· ÂÓÓ¤· ·ÛıÂÓÂ›˜ (18,3%) ·ÚÔ˘Û›·Û·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ¡§ Â› Û˘ÓfiÏÔ˘ 113 ¡§, ÌÂ Û˘¯ÓfiÙÂÚÂ˜ ÙË ÛË„·ÈÌ›· (59,3%) Î·È ÙËÓ ÓÂ˘ÌÔÓ›· (30,1%) (¶›Ó·Î·˜ 2), ÂÓÒ ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ÚÔÎ¿ÏÂÛ·Ó ÏÔ›ÌˆÍË ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔ ™¯‹Ì· 1. ∞fi ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ

Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ¡§ Î·È ËÏÈÎ›·˜ ‹ Ê‡ÏÔ˘ ÙˆÓ

·ÛıÂÓÒÓ Ì·˜. ∞ÓÙ›ıÂÙ·, ˆ˜ ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿-

ÁÔÓÙÂ˜ ¡§ ‹Ù·Ó: Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ ÛÙË ª∂£ (22,6 ËÌ¤ÚÂ˜ ÁÈ· Ù· ·È‰È¿ ÌÂ ¡§, ¤Ó·ÓÙÈ 5,2 ËÌÂÚÒÓ ·˘ÙÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ¡§, p<0,0001), Ë ‰È¿ÚÎÂÈ· ÌË¯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (16,3, ¤Ó·ÓÙÈ 1,7

ËÌÂÚÒÓ ·ÓÙ›ÛÙÔÈ¯·, p<0,0001), Ë ‚·Ú‡ÙËÙ· ÙË˜ ÁÂÓÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ ·ÛıÂÓÒÓ (PRISM score: 11,7, ¤Ó·ÓÙÈ 6,2, p<0,0001), ÔÈ ÎÂÓÙÚÈÎÔ› Î·ıÂÙ‹ÚÂ˜, Ô˘ÚÔÎ·ıÂÙ‹ÚÂ˜ Î·È Ô ÌË¯·ÓÈÎﬁ˜ ·ÂÚÈÛÌﬁ˜

ËÌ¤Ú· ÓÔÛËÏÂ›·˜ (device utilization ratio: 2,1, ¤Ó·ÓÙÈ 0,9, p<0,0001), Ë ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ (5,9 ËÌ¤ÚÂ˜, ¤Ó·ÓÙÈ 0,3 ËÌÂÚÒÓ, p<0,0001) Î·È Ë

‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛË˜ ∏2 ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙË˜ ÈÛÙ·Ì›ÓË˜ (5,4, ¤Ó·ÓÙÈ 1,9 ËÌÂÚÒÓ, p<0,001) (¶›Ó·Î·˜ 3).

∫·Ù¿ ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ ÏÔÁÈÛÙÈÎ‹ ·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË ÔÏÏ·ÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (multivariate logistic regression analysis) ·Ú·ÙËÚ‹ıËÎÂ ﬁÙÈ Ë ÔÏÈÎ‹ ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹, Ë ¯ÚËÛÈÌÔÔ›ËÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Î·È Ô ÌË¯·ÓÈÎﬁ˜

¶›Ó·Î·˜ 1. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ·È‰ÈÒÓ Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙË ª∂£ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ Ì·˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· 2 ÂÙÒÓ

ñ ∞ÛıÂÓÂ›˜ ÌÂ ÓÔÛËÏÂ›· ≥24 ÒÚÂ˜431

ñ º‡ÏÔ (·ÁﬁÚÈ·/ÎÔÚ›ÙÛÈ·)226/205

ñ ∏ÏÈÎ›· (¤ÙË)*4,4 ± 0,3

ñ PRISM score*6,5 ± 0,3

ñ ¢È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ (ËÌ¤ÚÂ˜)*6,2 ± 0,2

ñ ¢È¿ÚÎÂÈ· ÌË¯. ·ÂÚÈÛÌÔ‡ (ËÌ¤ÚÂ˜)*2,3 ± 0,1

ñ ∞ÈÙÈÔÏÔÁ›· ÂÈÛﬁ‰Ô˘ ÛÙË ª∂£ (·Ú. ·ÛıÂÓÒÓ)

ªÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË93(21,6%)

∆Ú·˘Ì·ÙÈÛÌﬁ˜85(19,7%) §Ô›ÌˆÍË78(18,1%)

¡ﬁÛÔ˜ ·Ó·ÓÂ˘ÛÙÈÎÔ‡50(11,6%)

¡ﬁÛÔ˜ ∫¡™47(10,9%)

¡ﬁÛÔ˜ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡22(5,1%)

¡ﬁÛÔ˜ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡18(4,2%)

¡ﬁÛÔ˜ ·ÈÌ·ÙÔÏÔÁÈÎ‹13(3,0%)

¡ÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ·6(1,4%) ŒÁÎ·˘Ì·6(1,4%)

¡ﬁÛÔ˜ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡5(1,2%)

ÕÏÏÂ˜ ·ı‹ÛÂÈ˜7(1,6%)

* OÈ ÙÈÌ¤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ mean ± SEM

¶›Ó·Î·˜ 3. ¶ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙË ª∂£ (ÌÔÓÔ·Ú·ÁÔÓÙÈÎ‹ ·Ó¿Ï˘ÛË)

¶·Ú¿ÁÔÓÙ·˜∞ÛıÂÓÂ›˜ ÌÂ ¡§∞ÛıÂÓÂ›˜ ¯ˆÚ›˜ ¡§p (n=79)(n=352)

∏ÏÈÎ›· (¤ÙË)3,4 ± 0,25,8 ± 0,40,136

º‡ÏÔ (·ÁﬁÚÈ·)511750,721 PRISM score11,7 ± 0,76,2 ± 0,3<0,0001

∫·ıÂÙ‹ÚÂ˜/ËÌ¤Ú. ÓÔÛËÏÂ›·˜*2,1 ± 0,20,9 ± 0,1<0,0001

¡ÔÛËÏÂ›· ÛÙË ª∂£ (ËÌ¤ÚÂ˜)22,6 ± 2,15,2 ± 0,4<0,0001

ªË¯·ÓÈÎﬁ˜ ·ÂÚÈÛÌﬁ˜ (ËÌ¤ÚÂ˜)16,3 ± 1,71,7 ± 0,1<0,0001

¶·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ (ËÌ¤ÚÂ˜)5,9 ± 0,40,3 ± 0,02<0,0001

∏2 ·Ó·ÛÙÔÏÂ›˜ ÈÛÙ·Ì›ÓË˜ (ËÌ¤ÚÂ˜)5,4 ± 0,51,9 ± 0,2<0,001

¡§: ¡ÔÛÔÎÔÌÂÈ·Î‹ ÏÔ›ÌˆÍË

* Ÿˆ˜ ÂÎÊÚ¿˙ÔÓÙ·È ÌÂ ÙÔ device utilization ratio (6)

OÈ ÙÈÌ¤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ mean ± SEM

¶›Ó·Î·˜ 4. ∞Ó¿Ï˘ÛË ·Ú·ÁﬁÓÙˆÓ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ Èı·ÓﬁÙËÙ· ÂÎ‰‹ÏˆÛË˜ ÓÔÛÔÎÔÌÂÈ·Î‹˜ ÏÔ›ÌˆÍË˜ ÛÙË ª∂£

¶·Ú¿ÁÔÓÙ·˜Regression CoefficientStandard Errorp* ValueOdds Ratio(95% C.I.)

Intercept-4,9630,7430,000 PRISM score0,5600,3100,0211,41,09-2,96 ∫ÂÓÙÚÈÎÔ› Î·ıÂÙ‹ÚÂ˜0,6200,2800,0271,91,07-3,22

∏Ì¤ÚÂ˜ ÓÔÛËÏÂ›·˜ ÛÙË ª∂£0,1740,0480,0111,21,08-1,31 ªË¯·ÓÈÎﬁ˜ ·ÂÚÈÛÌﬁ˜1,5130,6810,0261,61,20-3,83

¶·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹1,2500,0500,0135,11,02-19,32

∏2 ·Ó·ÛÙÔÏÂ›˜ ÈÛÙ·Ì›ÓË˜0,2360,0620,0331,21,10-2,26

Regression Coefficient: ™˘ÓÙÂÏÂÛÙ‹˜ ·ÏÈÓ‰ÚﬁÌËÛË˜

Odds Ratio: §ﬁÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ

C.I.: (confidence interval) ¢È¿ÛÙËÌ· ·ÍÈÔÈÛÙ›·˜

* ÀÔÏÔÁ›ÛÙËÎÂ ÌÂ ÙÔ Wald’s - ¯2 test

ÌÂ ÓÔÛÔÎÔÌÂÈ·Î‹ ÛË„·ÈÌ›· Î·È ÓÂ˘ÌÔÓ›·. ŒÙÛÈ, ·ﬁ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ¡§ Ô˘ ·ÚÔ˘Û›·Û·Ó ÔÈ ·ÛıÂ-

ÓÂ›˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜, ÙÔ 59,3% ·ÊÔÚÔ‡ÛÂ ÂÚÈ-

ÙÒÛÂÈ˜ ÛË„·ÈÌ›·˜, Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ÚÔÎ·ÏÔ‡ÓÙ·È Î˘Ú›ˆ˜ ·fi ·ÔÈÎÈÛÌfi ÙˆÓ ÎÂÓÙÚÈÎÒÓ

Î·ıÂÙ‹ÚˆÓ, ÂÓÒ ÙÔ 30,1% ‹Ù·Ó ÓÔÛÔÎÔÌÂÈ·Î¤˜ ÓÂ˘ÌÔÓ›Â˜ Ô˘ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÂÚÈÙÒÛÂÈ˜ “ÓÂ˘ÌÔÓ›·˜ Û¯ÂÙÈ˙fiÌÂÓË˜ ÌÂ ÙÔÓ ·Ó·ÓÂ˘ÛÙ‹Ú·” (ventilator-associated pneumonia). To Û˘ÁÎÂÎÚÈÌ¤ÓÔ Â›‰Ô˜ ÓÂ˘ÌÔÓ›·˜ ÚÔÎ·ÏÂ›Ù·È ÛÂ ‰È·ÛˆÏËÓˆÌ¤ÓÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜ (15,16). ™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ·˘Ù¤˜ Á›ÓÂÙ·È ÂÈÛÚfiÊËÛË ÂÎÎÚÈÌ¿ÙˆÓ ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·, Ù· ÔÔ›· Î·Ù¤Ú¯ÔÓÙ·È ÛÙÔÓ ÓÂ‡ÌÔÓ· ÌÂÙ·ÎÈÓÔ‡ÌÂÓ· ÌÂÙ·Í‡ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙÚ·¯ÂÈÔÛˆÏ‹Ó· Î·È ÙÚ·¯Â›·˜. ∆· ÂÎÎÚ›Ì·Ù· ·˘Ù¿ ‰ÂÓ ÂÚÈ¤¯Ô˘Ó ÌÈÎÚfi‚È· ÌfiÓÔ ÙË˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·, ·ÏÏ¿ Î·È ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂÈ‰‹, Ù· ÔÔ›· ÌÂÙ·ÎÈÓÔ‡ÓÙ·È ·fi ÙÔ ¤ÓÙÂÚÔ ÚÔ˜ ÙÔ ÛÙÔÌ¿¯È Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÏÈÓ‰ÚÔÌÔ‡Ó ÚÔ˜ ÙÔ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. ∏ ‰È·ÎÔ‹ ÙË˜ ÂÓÙÂÚÈÎ‹˜ Û›ÙÈÛË˜, Ë Î·Ù¿ÚÁËÛË ÙË˜ Á·ÛÙÚÈÎ‹˜ ÔÍ‡ÙËÙ·˜ ÏfiÁˆ ¯ÔÚ‹ÁËÛË˜ ∏2 ·Ó·-

ÛÙÔÏ¤ˆÓ ÙË˜ ÈÛÙ·Ì›ÓË˜ Î·È Ë Î·Ù·ÎÂÎÏÈÌ¤ÓË ı¤ÛË ÙˆÓ ·ÚÚÒÛÙˆÓ Â›Ó·È ·Ú¿ÁÔÓÙÂ˜ Ô˘ Â˘ÓÔÔ‡Ó ·˘ÙÔ‡ ÙÔ˘ Â›‰Ô˘˜ ÙËÓ ÓÂ˘ÌÔÓ›· ÛÂ ·ÛıÂÓÂ›˜ ª∂£ (17,18).

™Â ÔÏÏ¤˜ ÂÚÁ·Û›Â˜ ¤¯ÂÈ ‰ÂÈ¯ıÂ› Ô ·˘ÍËÌ¤ÓÔ˜

Î›Ó‰˘ÓÔ˜ ¡§ ÛÂ ·ÛıÂÓÂ›˜ ÙˆÓ ª∂£ (19-21). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ¡§ ÛÙ· ÙÌ‹Ì·Ù· ·˘Ù¿ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎ‹ Î·È Û¯ÂÙ›˙ÂÙ·È ÌÂ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ (‚·Ú‡ÙËÙ· ÓfiÛÔ˘, ·ÓÔÛÔÏÔÁÈÎ‹ Î·Ù¿ÛÙ·ÛË) Î·È ÌÂ ·Ú¿ÁÔÓÙÂ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÙÚfiÔ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÙÌËÌ¿ÙˆÓ (ÂÂÌ‚·ÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ, ÎÂÓÙÚÈÎÔ› Î·ıÂÙ‹ÚÂ˜) (22,23). ™ÙË ÌÂÏ¤ÙË Ì·˜ ‰È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘ÍË˜ ¡§ ÛÂ ·È‰È·ÙÚÈÎ‹ ª∂£. ∏ ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ¤‰ÂÈÍÂ fiÙÈ Ë ‚·Ú‡ÙËÙ· ÙË˜ ÓfiÛÔ˘, Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜, Ô ÌË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, Ë ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, Ë ·ÚÂÓÙÂÚÈÎ‹ ‰È·ÙÚÔÊ‹ Î·È Ë ¯ÔÚ‹ÁËÛË ∏2 ·Ó·ÛÙÔÏ¤ˆÓ ÙË˜ ÈÛÙ·Ì›ÓË˜ Â›Ó·È ·Ú¿ÁÔÓÙÂ˜

¶›Ó·Î·˜ 5. ∞ÓÙÔ¯‹ (%) ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ ÙˆÓ Û˘¯ÓÔÙ¤ÚˆÓ Gram (-) ÌÈÎÚÔ‚›ˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙË ª∂£

∞ÓÙÈ‚ÈÔÙÈÎﬁ E. coliKlebsiella spp.E. cloacaeP. aeruginosaAcinetobacter spp.

∞ÌÈÎÈÏÏ›ÓË50,096,293,6-100 ∞˙ÙÚÂÔÓ¿ÌË8,375,043,325,097,7 ∫ÂÊ·ÏÔı›ÓË38,580,996,7100100 ∫ÂÊÔÙ·Í›ÌË11,155,655,272,488,6

∫ÂÊÙ·˙ÈÓÙ›ÌË12,578,855,610,084,1 °ÂÓÙ·ÌÈÎ›ÓË0,046,829,010,959,1 ∆ÔÌÚ·Ì˘Î›ÓË8,372,544,05,677,3 ¡ÂÙÈÏÌÈÎ›ÓË7,773,521,45,470,7 ∞ÌÈÎ·Û›ÓË7,758,113,38,845,5 ÃÏˆÚ·ÌÊÂÓÈÎﬁÏË0,021,135,7-100 ∆ÚÈÌÂıÔ./™Ô˘Ï.0,038,535,5-84,1 πÌÈÂÓ¤ÌË0,00,03,12,60,0 ∞ÌÔÍÈÎÈÏ./∫Ï·‚Ô˘Ï.12,529,473,910093,2 ¶ÈÂÚ·ÎÈÏ./∆·˙ÔÌ.0,00,00,013,90,0

¶›Ó·Î·˜ 6. ∞ÓÙÔ¯‹ (%) ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ ÙˆÓ Û˘¯ÓÔÙ¤ÚˆÓ Gram (+) ÌÈÎÚÔ‚›ˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙË ª∂£

∞ÓÙÈ‚ÈÔÙÈÎﬁ Staphylococcus aureus CNS Enterococcus spp.

¶ÂÓÈÎÈÏÏ›ÓË G94,088,121,4 OÍ·ÎÈÏÏ›ÓË14,176,7∞ÌÔÍÈÎÈÏ./∫Ï·‚.14,176,711,1 °ÂÓÙ·ÌÈÎ›ÓË6,552,916,7 ∆ÔÌÚ·Ì˘Î›ÓË6,965,1¡ÂÙÈÏÌÈÎ›ÓË5,038,5∞ÌÈÎ·Û›ÓË0,066,7∂Ú˘ıÚÔÌ˘Î›ÓË14,684,0∫ÏÈÓ‰·Ì˘Î›ÓË2,663,0ƒÈÊ·ÌÈÎ›ÓË8,813,6ÃÏˆÚ·ÌÊÂÓÈÎﬁÏË2,125,025,0 ∆ÚÈÌÂıÔ./™Ô˘ÏÊ.2,564,2µ·ÓÎÔÌ˘Î›ÓË0,00,00,0 ∆Â˚ÎÔÏ·Ó›ÓË0,01,30,0

de Leon-Rosales Î·È Û˘Ó Î·È ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ∂ÔÙÂ›·˜ ¡ÔÛÔÎÔÌÂÈ·ÎÒÓ §ÔÈÌÒÍÂˆÓ ÙˆÓ

∏¶∞, Ô˘ ·ÊÔÚÔ‡Ó ﬁÌˆ˜ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÂÓ‹ÏÈÎÂ˜ ·ÛıÂÓÂ›˜ (24,25). ™ÙÈ˜ ‰‡Ô ÌÂÏ¤ÙÂ˜ ÙˆÓ

Singh-Naz Î·È Û˘Ó ÛÂ ·È‰È·ÙÚÈÎ¤˜ ª∂£ ÙÂÎÌËÚÈÒıËÎ·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÔÈ ›‰ÈÔÈ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ (26,27). ™ÙÈ˜ ÂÚÁ·Û›Â˜ ·˘Ù¤˜, Ë ÌÈÎÚ‹ ËÏÈÎ›· Î·È ÙÔ ¯·ÌËÏfi ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ÚÔ‰È·ıÂÛÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ ¡§, Î¿ÙÈ Ô˘ fiÌˆ˜ ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ ÛÙË ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË. ∆¤-

ÏÔ˜, ÛÂ Ì›· ÚﬁÛÊ·ÙË ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË ÙˆÓ Gilio Î·È Û˘Ó ÌÂÙ·Í‡ ‚·ÚÈ¿ ·Û¯ﬁÓÙˆÓ ·È‰ÈÒÓ, ‰›ÓÂÙ·È

È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ ÙˆÓ ·ÛıÂÓÒÓ, ÛÙË ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Î·È ÛÙË ¯ÔÚ‹ÁËÛË ÔÏÈÎ‹˜ ·ÚÂÓÙÂÚÈÎ‹˜ ‰È·ÙÚÔÊ‹˜,

ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘ÍË˜ ¡§ (28). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ÌÈÎÚÔ‚È·Î¿ ÛÙÂÏ¤¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó, Ë ÂÚÁ·Û›· Ì·˜ Â›Ó·È Û‡ÌÊˆÓË ÌÂ ¿ÏÏÂ˜ ·ÚfiÌÔÈÂ˜ ÂÚÁ·Û›Â˜ (16,29,30). ™ÙÈ˜ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È, fiˆ˜ Î·È ÛÙË ‰ÈÎ‹ Ì·˜, ÙÔ

˘„ËÏfi ÔÛÔÛÙfi ÏÔÈÌÒÍÂˆÓ ·fi Gram (+) ÎfiÎÎÔ˘˜ Î·È Î˘Ú›ˆ˜ ·fi ÙÔÓ CNS. ™ÙËÓ ÂÚÁ·Û›· Ì·˜, Ë ·ÓÙÔ¯‹ ÙÔ˘ CNS ‹Ù·Ó ˘„ËÏ‹, ·ÏÏ¿ fiÌˆ˜ ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ·ÓıÂÎÙÈÎ¿ ÛÙÂÏ¤¯Ë ÛÙË ‚·ÓÎÔÌ˘Î›ÓË. ª›· ¿ÏÏË ÛËÌ·ÓÙÈÎ‹ ‰È·›ÛÙˆÛË ‹Ù·Ó ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi S. aureus ·ÓıÂÎÙÈÎÔ‡ ÛÙË ÌÂıÈÎÈÏÏ›ÓË (MRSA) Ô˘ ¤Êı·ÛÂ ÙÔ 14,1% ÛÙËÓ ÂÚÁ·Û›· Ì·˜ Î·È ‹Ù·Ó Û¯ÂÙÈÎ¿ ÌÈÎÚfiÙÂÚÔ ·˘ÙÔ‡ ÙË˜ Â˘Úˆ·˚Î‹˜ ÔÏ˘ÎÂÓÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ÛÙ· ·È‰È¿ (12), ÛÙËÓ ÔÔ›· Ô MRSA ÍÂÂÚÓÔ‡ÛÂ ÙÔ 18%. £· Ú¤ÂÈ Ó· ÛËÌÂÈˆıÂ›, ˆÛÙfiÛÔ, fiÙÈ Ù· ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È È‰È·›ÙÂÚ· ¯·ÌËÏ¿, Â¿Ó Û˘ÁÎÚÈıÔ‡Ó ÌÂ ÙËÓ Â˘Úˆ·˚Î‹ ÔÏ˘ÎÂÓÙÚÈÎ‹ ÌÂÏ¤ÙË ÛÙÈ˜ ª∂£ ÂÓËÏ›ÎˆÓ (11) Î·È ÙËÓ πÛ·ÓÈÎ‹ ÌÂÏ¤ÙË ÛÂ 123 ÓÔÛÔÎÔÌÂ›· ÙË˜ ¯ÒÚ·˜ (31), fiÔ˘ Ù· ÔÛÔÛÙ¿ MRSA ‹Ù·Ó 72% Î·È 57%, ·ÓÙ›ÛÙÔÈ¯·.

∞ÓÙ›ıÂÙ· ÌÂ ¿ÏÏÂ˜ ÌÂÏ¤ÙÂ˜ Î·È Î˘Ú›ˆ˜ ·ﬁ ª∂£ ÂÓËÏ›ÎˆÓ, ÙÔ 4,4% ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·ﬁ ÂÓÙÂ-

Ô˘ ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜

ıÂˆÚÂ›Ù·È Ì¿ÏÏÔÓ ¯·ÌËÏﬁ Î·È Â›Ó·È ıÂÙÈÎﬁ ÙÔ ÁÂ-

ÁÔÓﬁ˜ ﬁÙÈ ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ÔÏ˘·ÓıÂÎÙÈÎ¿ ÛÙÂÏ¤¯Ë ÙÔ˘ ÌÈÎÚÔ‚›Ô˘.

øÛÙfiÛÔ, Ì›· ·ÎfiÌË ·ÍÈfiÏÔÁË ·Ú·Ù‹ÚËÛË

‹Ù·Ó Ô ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÏÔÈÌÒÍÂˆÓ ·fi „Â˘-

‰ÔÌÔÓ¿‰· Ô˘ ¤Êı·ÛÂ ÙÔ 14,2% ÙˆÓ ¡§ ÙˆÓ

·ÛıÂÓÒÓ Ì·˜. ∂Óı·ÚÚ˘ÓÙÈÎ¿ ‚¤‚·È· Â›Ó·È Ù· ÌÈÎÚ¿

ÔÛÔÛÙ¿ ·ÓÙÔ¯‹˜ ÙË˜ P. aeruginosa ÛÙ· ·ÓÙÈÌÈ-

ÎÚÔ‚È·Î¿ Ê¿ÚÌ·Î· Ô˘ Â›Ó·È Û·ÊÒ˜ ¯·ÌËÏﬁÙÂÚ·

ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÔÏ˘ÎÂÓÙÚÈÎ‹˜ ÌÂÏ¤ÙË˜ ÙË˜

∞ÌÂÚÈÎ‹˜ (32) Î·È ÙË˜ ªÂÁ¿ÏË˜ µÚÂÙ·Ó›·˜ (33) Î·È

ı· Ú¤ÂÈ Ó· ·Ô‰ÔıÔ‡Ó Ì¿ÏÏÔÓ ÛÙËÓ ÔÚıÔÏÔÁÈÎ‹

¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔ ÙÌ‹Ì· Ì·˜. ∂›ÛË˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÂÚÁ·Û›·˜ Ì·˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÔÏ‡ ·fi ·˘Ù¿ ÙË˜ ª∂£ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, fiÔ˘ Ë ·ÓÙÔ¯‹ ÙÔ˘ Û˘ÁÎÂÎÚÈÌ¤ÓÔ˘ ‚·ÎÙËÚÈ‰›Ô˘ ÛÙËÓ ÎÂÊÙ·˙È‰›ÌË, ÙÈ˜ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ Î·È ÙËÓ ÈÌÈÂÓ¤ÌË

‹Ù·Ó ·ÓÙ›ÛÙÔÈ¯· 22,2%, 11,1% Î·È 3,7% (34).

∞ÍÈﬁÏÔÁÔ ‹Ù·Ó, Ù¤ÏÔ˜, ÙÔ ÔÛÔÛÙﬁ Ì˘ÎËÙÈ·ÛÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ (9%), Ô˘ Â›Ó·È

fiÌˆ˜ ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚÔ ÛÂ Û¯¤ÛË ÌÂ ÙÔ 17% ÙˆÓ ·ÓÙ›ÛÙÔÈ¯ˆÓ ÏÔÈÌÒÍÂˆÓ ÙË˜ Â˘Úˆ·˚Î‹˜ ÌÂÏ¤ÙË˜ ÛÂ ·È‰È·ÙÚÈÎ¤˜ ª∂£ (12). ∆Ô ·˘Í·ÓfiÌÂÓÔ ÔÛÔÛÙfi ¡§ ÛÙÈ˜ ª∂£ ·fi Candida Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›· Â›Ó·È È‰È·›ÙÂÚ· ·ÓËÛ˘¯ËÙÈÎfi Î·È ·Ô-

‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·˘ÍËÌ¤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â˘Ú¤ˆ˜ Ê¿ÛÌ·ÙÔ˜, ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, ·ÏÏ¿ Î·È ÛÙË ¯ÔÚ‹ÁËÛË ÔÏÈÎ‹˜

·ÚÂÓÙÂÚÈÎ‹˜ ‰È·ÙÚÔÊ‹˜ (35-37).

∞ÚÎÂÙÔ›, Ù¤ÏÔ˜, Û˘ÁÁÚ·ÊÂ›˜ ‰È·›ÛÙˆÛ·Ó Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ¡§ Î·È ıÓËÙﬁÙËÙ·˜ ÛÙÈ˜ ª∂£ (3840). ∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ Ë ÂÚÁ·Û›· ÙˆÓ Fry Î·È

Û˘Ó ÛÂ ÔÏ˘ÙÚ·˘Ì·Ù›Â˜ Ô˘ ÓÔÛËÏÂ‡ıËÎ·Ó ÛÂ ª∂£. OÈ Û˘ÁÁÚ·ÊÂ›˜ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Â¿Ó ÔÈ ·ÛıÂÓÂ›˜ ÂÈ˙Ô‡Û·Ó ¤Ú·Ó ÙˆÓ 72 ˆÚÒÓ, Ë ÂÎ‰‹ÏˆÛË ÔÏ˘ÔÚÁ·ÓÈÎ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È Ë ÂÈ‚›ˆÛ‹ ÙÔ˘˜ ÂÍ·ÚÙfiÙ·Ó Î˘Ú›ˆ˜ ·fi ÙËÓ ·Ó¿Ù˘ÍË ¡§ (38). ∏ ÌÂÏ¤ÙË ÂÍ¿ÏÏÔ˘ ÙˆÓ Bueno-Cavanillas Î·È Û˘Ó ¤‰ÂÈÍÂ fiÙÈ ÔÈ ·ÛıÂÓÂ›˜ ÌÂ ¡§ Â›¯·Ó ‰ÈÏ¿ÛÈÂ˜

Èı·ÓﬁÙËÙÂ˜ Ó· Î·Ù·Ï‹ÍÔ˘Ó (OR=2,1), ÛÂ Û¯¤ÛË ÌÂ ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ¡§ (39). ¶·ÚﬁÌÔÈ· ‹Ù·Ó Ù· Â˘Ú‹Ì·Ù· ÙË˜ ÂÚÁ·Û›·˜ Ì·˜. ¶·Ú¿

ÙÔ fiÙÈ Î·ÓÂ›˜ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ì·˜ ‰ÂÓ Î·Ù¤ÏËÍÂ ·fi ¡§, Ë ıÓËÙfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ÌÂ ¡§ ‹Ù·Ó ÔÏ‡ ˘„ËÏfiÙÂÚË ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó Ù¤ÙÔÈ· ÏÔ›ÌˆÍË (27,8% ¤Ó·ÓÙÈ 6,0%), ÁÂÁÔÓfi˜

Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ ¡§, ¯ˆÚ›˜ ÔÈ ›‰ÈÂ˜ Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ·Â˘ıÂ›·˜ ÙÔ ı¿Ó·ÙÔ, ÂÈ‰Â›ÓˆÛ·Ó ÛÂ ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂÈ˜ ÙËÓ ˘ÔÎÂ›ÌÂÓË ÓfiÛÔ, Û˘ÓÙÂÏÒÓÙ·˜ ¤ÌÌÂÛ· ÛÙËÓ Â¤ÏÂ˘ÛË ÙÔ˘ ı·Ó¿ÙÔ˘. Ÿˆ˜ Ê·›ÓÂÙ·È ¿ÏÏˆÛÙÂ Î·È ·fi ¿ÏÏÂ˜ ·ÚfiÌÔÈÂ˜ ÂÚÁ·Û›Â˜, ÔÈ ¡§ ÂÈ‚·Ú‡ÓÔ˘Ó ÙËÓ ‹‰Ë ‚·ÚÈ¿

Î·Ù¿ÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ ÙˆÓ ª∂£ Î·È Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ·˘ÍËÌ¤ÓË ıÓËÙﬁÙËÙ·, ¯ˆÚ›˜ ¿ÓÙ· Ó· Â˘ı‡-

ÓÔÓÙ·È ¿ÌÂÛ· ÁÈ· ÙÔ ı¿Ó·ÙÔ. Ã·Ú·ÎÙËÚÈÛÙÈÎ‹ Â›Ó·È

Ë ÌÂÏ¤ÙË ÙˆÓ Smith Î·È Û˘Ó Ô˘ ¤ÁÈÓÂ ÛÂ ª∂£ ÙË˜ ¡¤·˜ ÀﬁÚÎË˜ (40). ™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹, Ë ·Ó·ÌÂÓﬁ-

ÌÂÓË ıÓËÙﬁÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Û‡ÌÊˆÓ· ÌÂ ÙË ‚·-

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Ú·ÙËÚËıÂ›Û· ıÓËÙﬁÙËÙ· ‹Ù·Ó ·ÚﬁÌÔÈÂ˜ ÁÈ· ÙÔ˘˜

·ÛıÂÓÂ›˜ ¯ˆÚ›˜ ¡§, ·˘ÙÔ› Ô˘ ·ÚÔ˘Û›·Û·Ó ¡§ Î·Ù¤ÏËÍ·Ó ÛÂ ÔÛÔÛÙﬁ 82%, Ô˘ ÛËÌ·›ÓÂÈ ﬁÙÈ ÔÈ

Û˘ÁÎÂÎÚÈÌ¤ÓÂ˜ ÏÔÈÌÒÍÂÈ˜ ·‡ÍËÛ·Ó ¿ÌÂÛ· Î·È ¤Ì-

ÌÂÛ· ÙË ıÓËÙfiÙËÙ· Î·Ù¿ 28%. £· Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ÛËÌÂÈˆıÂ› fiÙÈ ÔÈ ¡§ ·˘Í¿ÓÔ˘Ó ÙË ıÓËÙfiÙËÙ· ÙˆÓ

·ÛıÂÓÒÓ ÌÂ Ì¤ÙÚÈ· ‚·Ú‡ÙËÙ·, ÂÓÒ ‰ÂÓ Û˘Ì‚·›ÓÂÈ

ÙÔ ›‰ÈÔ ÌÂ ÙÔ˘˜ ·ÛıÂÓÂ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÂ ‚·ÚÈ¿

Î·Ù¿ÛÙ·ÛË, ÔÈ ÔÔ›ÔÈ Û˘¯Ó¿ Î·Ù·Ï‹ÁÔ˘Ó ÚÈÓ ÙËÓ ÂÎ‰‹ÏˆÛË ¡§, Ô‡ÙÂ ÌÂ ·˘ÙÔ‡˜ Ô˘ ¿Û¯Ô˘Ó ·ﬁ Û¯ÂÙÈÎ¿ ‹È· ˘ÔÎÂ›ÌÂÓË ÓﬁÛÔ (13).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÔÈ ¡§ Î·È Î˘Ú›ˆ˜ Ë ÛË„·ÈÌ›·

Ë ÓÂ˘ÌÔÓ›· Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¤˜ ÛÂ

ª∂£, Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÔÈÎ›ÏÔ˘˜ ÚÔ‰È·ıÂÛÈ-

·Ú¿ÁÔÓÙÂ˜ Î·È Û˘ÓÙÂÏÔ‡Ó ÛÂ ÛËÌ·ÓÙÈÎﬁ

ÛÙËÓ ·˘ÍËÌ¤ÓË ıÓËÙfiÙËÙ· ÙˆÓ ÙÌËÌ¿ÙˆÓ ·˘ÙÒÓ. ™ËÌ·ÓÙÈÎfi Â›Ó·È, Â›ÛË˜, ÙÔ ÔÛÔÛÙfi ·ÓÙÔ¯‹˜ ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂÏÂ¯ÒÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó. ª›· ÛÙÚ·ÙËÁÈÎ‹ ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ı· ‹Ù·Ó ‰˘Ó·Ùfi Ó· ÂÏ·ÙÙÒÛÂÈ ÙfiÛÔ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ¡§, fiÛÔ ÂÓ‰Â¯ÔÌ¤Óˆ˜ Î·È ÙÔ ÔÛÔÛÙfi ·Ó¿Ù˘ÍË˜ ÔÏ˘·ÓıÂ-

µÈ‚ÏÈÔÁÚ·Ê›·

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-03-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶. ∫·Ï·Ì·Ï›ÎË˜

¶ª∂¡ (4Ô˜ ﬁÚÔÊÔ˜), ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”

£Ë‚ÒÓ & §Â‚·‰›·˜, 115 27, ∞ı‹Ó·

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ARTICLE

£ÓËÛÈÌﬁÙËÙ·

ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ

¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ ÙË 14ÂÙ›· 1986-1999

∞. ∞Ó‰Ú¤Ô˘, ª. °Ô˘‰ÂÛ›‰Ô˘, °. ª·˘Ú›‰Ë˜, ∞. ƒÒÛÛÈÔ˘, ∞. ª·Ï¿ÛÎ·, ª. ¶·Ô‡ÏË

Neonatal mortality in infants born at Ippokration General Hospital of Thessaloniki during the years 1986-1999

A. Andreou, M. Goudesidou, G. Mauridis, A. Rossiou, A. Balaska, M. Papouli

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ó· Î·Ù·ÁÚ·ÊÔ‡Ó ‰È·¯ÚÔÓÈÎ¿ ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙË ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌfiÙËÙ· ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ 14 ¯ÚfiÓˆÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÙÚÈÙÔ‚¿ıÌÈÔ˘ ÂÚÈÊÂÚÂÈ·ÎÔ‡ ÓÂÔÁÓÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ∂™À ÛÙÔ πÔÎÚ¿ÙÂÈÔ

¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜. ™ÙË ÌÂÏ¤ÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ﬁÏ· Ù· ÁÂÓÓËı¤ÓÙ· ˙ÒÓÙ· ÓÂÔÁÓ¿ ÛÙÔ

πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛ/Ó›ÎË˜ Î·È ÔÈ ı¿Ó·ÙÔ›

ÙÔ˘˜ ·ﬁ ÙÔ 1986 ¤ˆ˜ Î·È ÙÔ 1999. ÀÔÏÔÁ›ÛÙËÎÂ

Ë ÔÏÈÎ‹ ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÛÈÌﬁÙËÙ· (∂¡£) Î·È

Ë ÂÈ‰ÈÎ‹ ·Ó¿ Î·ÙËÁÔÚ›· ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ (µ°) Î·È

‰È¿ÚÎÂÈ· Î‡ËÛË˜ (¢∫) ∂¡£. OÈ ı¿Ó·ÙÔÈ ‰È·ÎÚ›ıËÎ·Ó ÛÂ ‰˘ÓËÙÈÎ¿ ·ÔÙÚÂÙÔ‡˜ Î·È ·Ó·fiÙÚÂÙÔ˘˜. ÀÔÏÔÁ›ÛÙËÎ·Ó ·ÎfiÌ· ÔÈ ÌÂÙ·‚ÔÏ¤˜ ÛÙÔ Ì·ÈÂ˘ÙÈÎfi ÏËı˘ÛÌfi Î·È ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ‰È‰‡ÌˆÓ Î·È ÙˆÓ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓÒÓ (µ°≤2000 g). ∆Ô ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙË˜ ÌÂÏ¤ÙË˜ ‰È·ÈÚ¤ıËÎÂ ÛÂ 3 ÂÚÈfi‰Ô˘˜: ÙËÓ ∞ (¤ÙË 19861990), ÙË µ (¤ÙË 1991-1995) Î·È ÙË ° (¤ÙË 19961999). OÈ ÂÚ›Ô‰ÔÈ ·˘ÙÔ› Û˘ÁÎÚ›ıËÎ·Ó ÌÂÙ·Í‡ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙË ıÓËÛÈÌfiÙËÙ· Î·È ÙÔ˘˜ ¿ÏÏÔ˘˜ ÚÔ·Ó·ÊÂÚı¤ÓÙÂ˜ ·Ú¿ÁÔÓÙÂ˜. O ·ÚÈıÌfi˜ ÙˆÓ ¿Á·ÌˆÓ ÌËÙ¤ÚˆÓ ·˘Í‹ıËÎÂ ·fi 1,5% ÛÙËÓ ∞ ÂÚ›Ô‰Ô, ÛÂ 4,5% ÛÙË µ ÂÚ›Ô‰Ô Î·È 7,5% ÛÙË ° Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÏÏÔ‰·ÒÓ ·fi 0% ÛÂ 6% Î·È 14% ·ÓÙ›ÛÙÔÈ¯· (p<0,00001). ™˘Á¯ÚfiÓˆ˜, ·˘Í‹ıËÎ·Ó ‰È·¯ÚÔÓÈÎ¿ Ì¤¯ÚÈ ‰ÈÏ·ÛÈ·ÛÌÔ‡ (p<0,05): ·) Ù· ÓÂÔÁÓ¿ ÌÂ µ°≤1000 g (0,67%, 0,95%, 1,38% ÁÈ· ÙÈ˜ ÂÚÈfi‰Ô˘˜ ∞, µ, °,), ‚) Ù· ÓÂÔÁÓ¿ ÌÂ µ° 10011500 g (1,2%,1,5%, 2,5%) Î·È Á) Ù· ÓÂÔÁÓ¿ ÌÂ µ° 1501-2000 g (1,7%, 2,3%, 3,35%). ∏ ‰ÈÔÚıˆÌ¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌfiÙËÙ· (¢∂¡£) (ÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· ÌÂ›ÔÓ ·Ó·fiÙÚÂÙÔÈ ı¿Ó·ÙÔÈ) ÛÙËÓ ∞ ÂÚ›Ô‰Ô ‹Ù·Ó 12,5ò, ÛÙË

¡ÂÔÁÓÔÏÔÁÈÎﬁ ∆Ì‹Ì· ∂™À

πÔÎÚ¿ÙÂÈÔ °¶¡ £ÂÛÛ·ÏÔÓ›ÎË˜

Abstract: The aim of the study was to record the serial changes in neonatal mortality rates during the 14 years of function of the level III Neonatal Department (NHS) of Ippokration General Hospital of Thessaloniki. All live births and neonatal deaths that occurred between 1986 and 1999 were included in the study. The overall in-hospital mortality rate, as well as the specific mortality rates based on birth weight and gestational age, were evaluated. Deaths were divided in preventable and no preventable. Changes in obstetric population, in distribution of twins and of low birth weight neonates (BW≤2000 g) were also evaluated. The 14-year duration of the study was divided into 3 periods. Period A included the years 1986-1990, period B the years 1991-1995, and period C the years 1996-1999. These periods were compared in regards to mortality rates and to the previously mentioned factors. Our results showed that the number of unmarried mothers increased from 1.5% in period A, to 4.5% in period B and 7.5% in period C, while the number of foreign mothers increased from 0%, to 6%, and 14% respectively (p<0.00001). Simultaneously, through the years, there was an up to twofold increase (p<0.05) in the number of neonates with a) BW≤1000 g (A: 0.67%, B: 0.95%, C: 1.38%), b) BW between 1001-1500 g (A: 1.2%, B: 1.5%, C: 2.5%), and c) BW between 1501-2000 g (A: 1.7%, B: 2.3%, C: 3.35%). The corrected in-hospital neonatal mortality rate (CINMR) (overall mortality rate minus unpreventable deaths) in period A was 12.5ò, in period B 9.55ò (24% fall), and in period C was 6.5ò (a decrease of 48% compared to period A).

Division of Neonatology Ippokration General Hospital, Thessaloniki

9,5ò (ÙÒÛË 24%) Î·È ÛÙË ° ÂÚ›Ô‰Ô 6,5ò (ÙÒÛË 48% ÛÂ Û¯¤ÛË ÌÂ ÙËÓ A ÂÚ›Ô‰Ô). ∏ ¢∂¡£

‹Ù·Ó ÛÙ· ÓÂÔÁÓ¿ ÌÂ: ·) µ°≤1000 g: 89,5% ÛÙËÓ ∞

ÂÚ›Ô‰Ô, 45% ÛÙË µ Î·È 36,5% ÛÙË °, ‚) µ° 10011500 g: 37,5%, 16% Î·È 9,5% ÁÈ· ÙÈ˜ ÂÚÈﬁ‰Ô˘˜ ∞, µ, ° ·ÓÙ›ÛÙÔÈ¯· Î·È Á) µ° 1501-2000 g: 10,5% ÛÙËÓ

∞ ÂÚ›Ô‰Ô, 5,5% ÛÙË µ Î·È 3,5% ÛÙË °. ∏ ÌÂÁ·Ï‡-

ÙÂÚË ıÓËÛÈÌﬁÙËÙ· Î·È Ë ÌÈÎÚﬁÙÂÚË ‰È·¯ÚÔÓÈÎ‹

ÂÏ¿ÙÙˆÛ‹ ÙË˜ ·ÊÔÚÔ‡Û·Ó ÓÂÔÁÓ¿ ÌÂ µ°≤800 g.

∞Ê·ÈÚÒÓÙ·˜ ·ﬁ ÙËÓ ÔÏÈÎ‹ ıÓËÛÈÌﬁÙËÙ· ÙÔ˘˜ ı·-

Ó¿ÙÔ˘˜ ÓÂÔÁÓÒÓ ÌÂ µ°≤700 g Î·È ÙÔ˘˜ ·Ó·ﬁÙÚÂ-

ÙÔ˘˜ ı·Ó¿ÙÔ˘˜, ‚Ú¤ıËÎÂ ¤Ó· ÏÂﬁÓ·ÛÌ· ıÓËÛÈ-

ÌﬁÙËÙ·˜ Ô˘ ÁÈ· ÙËÓ ÂÚ›Ô‰Ô ∞ ‹Ù·Ó 10,7ò, ÁÈ·

ÙËÓ ÂÚ›Ô‰Ô µ 7,5ò Î·È ÁÈ· ÙËÓ ÂÚ›Ô‰Ô ° 3,75ò. À‹ÚÍÂ ÌÂÁ¿ÏË ·‡ÍËÛË ÙË˜ ÂÈ‚›ˆÛË˜

ÙˆÓ ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ (¶Ãµ°) (≤1500 g) Î·È ÙˆÓ ¿Ú· ÔÏ‡ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ (¶¶Ãµ°) (≤1000 g) ÓÂÔÁÓÒÓ. OÈ ı¿Ó·-

ÙÔÈ Ô˘ ÌÔÚÂ› Ó· ·ÔÙÚ·Ô‡Ó Â›Ó·È ÙÒÚ· ÏÈÁﬁÙÂ-

ÚÔÈ ·’ fiÙÈ ·Ú¯ÈÎ¿ (3,75ò ¤Ó·ÓÙÈ 10,7ò). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ÛÙË ıÓËÛÈÌfiÙËÙ· ÂÓÙÔ›˙ÂÙ·È

ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ°≤800 g.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓÂÔÁÓ¿, ÔÏÈÎ‹ ıÓËÛÈÌﬁÙËÙ·, ÂÈ‰ÈÎ‹

ıÓËÛÈÌﬁÙËÙ·.

∂ÈÛ·ÁˆÁ‹ ∆· ÙÂÏÂ˘Ù·›· 30 ¯ÚﬁÓÈ·, ÔÈ ÚﬁÔ‰ÔÈ ÛÙËÓ ÂÚÈ-

ÁÂÓÓËÙÈÎ‹ Î·È ÓÂÔÁÓÈÎ‹ ÊÚÔÓÙ›‰· Î·È Ë Â˘ÚÂ›·

ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ ÙÂ¯ÓÔÏÔÁÈÒÓ Î·È ıÂÚ·ÂÈÒÓ Ô‰‹-

ÁËÛ·Ó ÛÂ ÛÙ·ıÂÚ‹ ÌÂ›ˆÛË ÙË˜ ÓÂÔÁÓÈÎ‹˜ ıÓËÛÈÌﬁ-

ÙËÙ·˜ ÛÙÈ˜ ‚ÈÔÌË¯·ÓÈÎ¤˜ ¯ÒÚÂ˜ (1-3). π‰È·›ÙÂÚ· ÌÂ-

Á¿ÏË Â›Ó·È Ë ÙÒÛË ÙË˜ ıÓËÛÈÌﬁÙËÙ·˜ ÛÙ· ¶Ãµ°

ÓÂÔÁÓ¿ (4). ∏ ıÓËÛÈÌﬁÙËÙ· ÙˆÓ ¶Ãµ° ÓÂÔÁÓÒÓ ·ÚÔ˘Û›·ÛÂ ·ﬁÙÔÌË ÙÒÛË ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ ÂÍˆ-

ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (5).

™ÙËÓ ∂ÏÏ¿‰·, Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·-

ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ (ª∂¡¡), Î·Ù¿ Ù· ‰ÈÂıÓ‹

ÚﬁÙ˘·, ÍÂÎ›ÓËÛÂ ·ﬁ ÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜

ÙÔ˘ ’80. ∞’ ﬁÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ÛÙË ‰È¿ÚÎÂÈ· ·˘ÙÒÓ

ÙˆÓ 15-20 ÂÚ›Ô˘ ¯ÚﬁÓˆÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ

ª∂¡¡, ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÌÂ ·ÎÚÈ‚‹ ‰Â‰ÔÌ¤Ó· ÁÈ· ÙË ‰È·¯ÚÔÓÈÎ‹ ÂÍ¤ÏÈÍË ÙË˜ ÓÂÔÁÓÈÎ‹˜

ıÓËÛÈÌﬁÙËÙ·˜ Î·È ÙˆÓ ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘ ÙˆÓ ÓÂÔÁÓÒÓ. ∆¤ÙÔÈ· ‰Â‰ÔÌ¤Ó·, Î·ıÒ˜ Î·È ‰Â‰ÔÌ¤Ó· ·ﬁ

ÙË ‚ÚÂÊÈÎ‹ ıÓËÛÈÌﬁÙËÙ· Â›Ó·È ÎÚ›ÛÈÌË˜ ÛËÌ·Û›·˜

ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÁÎ‡ˆÓ Î·È ÓÂÔÁÓÒÓ, ÁÈ· ÙËÓ

ÂÓËÌ¤ÚˆÛË ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÁÈ· ÙÔ Û¯Â‰È·ÛÌﬁ ÙË˜

·ÚÂ¯ﬁÌÂÓË˜ ÓÂÔÁÓÈÎ‹˜ ÊÚÔÓÙ›‰·˜. OÈ ‰‡Ô ·ÓÂÏÏ‹ÓÈÂ˜ ÌÂÏ¤ÙÂ˜ ÁÈ· ÙËÓ ÂÚÈÁÂÓ-

ÓËÙÈÎ‹ / ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌﬁÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿-

ÙÔ˘, Ô˘ ¤ÁÈÓ·Ó ÙÔ 1983 Î·È ÙÔ 1998, ‰Â›¯ÓÔ˘Ó ÌÂÁ¿ÏË ÙÒÛË ÙË˜ ıÓËÛÈÌﬁÙËÙ·˜ (6,7). OÈ ÌÂÏ¤ÙÂ˜

The CINMR in neonates with: a) BW≤1000 g was 89.5% in period A, 45% in period B and 36.5% in period C, b) in neonates with BW 1001-1500 g was 37.5%, 16% and 9.5% for periods A, B, C respectively and c) in neonates with BW 15012000 g was 10.5% in period A, 5.5% in period B and 3.5% in period C. Greater mortality rate and lesser decrease through the years was noted in neonates with BW 800 g. By excluding deaths of neonates with BW≤700g and unpreventable deaths from the overall mortality rate, we found a mortality (excess mortality) which was 10.7% for period A, 7.5% for period B and 3.75% for period C. In conclusion, during the 14 year period there was a substantial increase in survival of very low birth weight (≤1500 g) and of extremely low birth weight (≤1000 g) neonates. Preventable deaths are fewer now than in the past (3.75ò versus 10.7ò). The greatest problem in mortality is confined in neonates with BW≤800 g.

Key words: neonates, general mortality, specific mortality.

·˘Ù¤˜, fiÌˆ˜, ¤¯Ô˘Ó ÌÂÁ¿ÏÂ˜ ÂÏÏÂ›„ÂÈ˜ ÛÂ Ô˘ÛÈÒ‰Ë ‰Â‰ÔÌ¤Ó· Î·È ÔÏÏ¤˜ ·‰˘Ó·Ì›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÎÙ¤ÏÂÛ‹ ÙÔ˘˜. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ‰Â‰ÔÌ¤Ó· ÙË˜ ∂ıÓÈÎ‹˜ ™Ù·ÙÈÛÙÈÎ‹˜ ÀËÚÂÛ›·˜ ∂ÏÏ¿‰Ô˜ Ô˘ ‚·Û›˙ÔÓÙ·È ÛÙÔ ÈÛÙÔÔÈËÙÈÎfi Á¤ÓÓËÛË˜

Î·È ı·Ó¿ÙÔ˘ (8). ¢Â‰ÔÌ¤Ó· ·ﬁ ¡ÂÔÁÓÔÏÔÁÈÎ¿ ∆Ì‹Ì·Ù· ÙË˜

∂ÏÏ¿‰·˜ ˘¿Ú¯Ô˘Ó, Â›ÙÂ ·ÔÛ·ÛÌ·ÙÈÎ¿ - ¯ˆÚ›˜ ‰È·¯ÚÔÓÈÎ‹ ÂÂÍÂÚÁ·Û›·, Â›ÙÂ ÌÂ ·ÚÎÂÙ¤˜ ÂÏÏÂ›„ÂÈ˜ (9-13). ∏ ÂÚÁ·Û›· ·˘Ù‹ ·Û¯ÔÏÂ›Ù·È ÌÂ ÙËÓ ·Ó·ÛÎfiËÛË fiÏˆÓ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ ÛÂ ¤Ó· ÂÚÈÊÂÚÂÈ·Îfi ÙÚÈÙÔ‚¿ıÌÈÔ ¡ÂÔÁÓÔÏÔÁÈÎfi Î¤ÓÙÚÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ 14ÂÙ›·˜, ·fi ÙËÓ ËÌ¤Ú· ÙË˜ ¤Ó·ÚÍË˜ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘, ÙÔ 1986, Ì¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1999. ™ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ÔÈ ·Ú¿ÌÂÙÚÔÈ ÙË˜ È‰·ÓÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙÔ˘ ·Ó·fiÙÚÂÙÔ˘ ı·Ó¿ÙÔ˘ ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË ÙˆÓ Ô˘ÛÈ·ÛÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi

ÌÂÏÏÔÓÙÈÎÒÓ ÛÙﬁ¯ˆÓ.

YÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ

∆Ô ˘ÏÈÎfi ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÓÂÔÁÓ¿, ÌÂ µ°>500 g, Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛ/Ó›ÎË˜ Î·È ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ∂™À ÙÔ˘ ›‰ÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ÙË 14ÂÙ›· 1986-1999. ∆· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ÌÂ µ°≤500 g ‹Ù·Ó Û˘ÓÔÏÈÎ¿ 12. ™Â

·˘Ù¿, ÌÂ ÙË ‚·ıÌÔÏÔÁ›· ÂÎÙ›ÌËÛË˜ ÙË˜ ˆÚÈÌﬁÙËÙ·˜ Î·Ù¿

BALLARD (14). §ﬁÁˆ ÙˆÓ ÁÓˆÛÙÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔÓ ÙÚﬁ-

Ô ˘ÔÏÔÁÈÛÌÔ‡ Î·È ·Ó·ÊÔÚ¿˜ ÙË˜ ¢∫, ÔÈ ÂÚÈÛÛﬁÙÂÚÂ˜

·Ó·Ï‡ÛÂÈ˜ ‚·Û›ÛÙËÎ·Ó ÌﬁÓÔ ÛÙÔ µ° (15). O ˘ÔÏÔÁÈÛÌﬁ˜ ÙË˜

¢∫ Â›Ó·È ÏÈÁfiÙÂÚÔ ·ÍÈfiÈÛÙÔ˜ ÁÈ· ÙÈ˜ ÌÈÎÚfiÙÂÚÂ˜ ¢∫ ÌÂ Ù¿ÛË

˘ÂÚÂÎÙ›ÌËÛ‹˜ ÙË˜ (16). ™ÙÔÓ ÏËı˘ÛÌfi Ì·˜, fiÔ˘ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÂÁÎ‡ˆÓ ‹Ù·Ó ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡

ÂÈ¤‰Ô˘ ÌÂ ÂÏÏÈ‹ ‹ Î·È Î·ıﬁÏÔ˘ Ì·ÈÂ˘ÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıË-

ÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÁÎ˘ÌÔÛ‡ÓË˜, Ô ˘ÔÏÔÁÈÛÌﬁ˜ ÙË˜

¢∫ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ·ÎÚÈ‚‹˜. ∏ ∂∂¡£ ˘ÔÏÔÁ›ÛÙËÎÂ ·ﬁ ÙËÓ ÔÏÈÎ‹ ∂¡£ ÌÂÙ¿ ÙËÓ

·Ê·›ÚÂÛË ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ÔÊÂ›ÏÔÓÙ·Ó ÛÂ ·›ÙÈ· Ô˘ ıÂˆÚ‹-

ıËÎ·Ó fiÙÈ Â›Ó·È ·Ó·fiÙÚÂÙ· ÌÂ ÙÈ˜ ÛËÌÂÚÈÓ¤˜ ‰˘Ó·ÙfiÙËÙÂ˜

ÙË˜ È·ÙÚÈÎ‹˜ ·Ú¤Ì‚·ÛË˜, Î·ıÒ˜ Î·È ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ

µ°≤700 g. £ÂˆÚ‹Û·ÌÂ ÙËÓ ·Ú¿ÌÂÙÚÔ µ°≤700 g Û·Ó ¤Ó·

·Ú¿ÁÔÓÙ· ·Ó·ﬁÙÚÂÙÔ˘ ı·Ó¿ÙÔ˘, ‚·ÛÈ˙ﬁÌÂÓÔÈ ÛÙËÓ ¿Ô-

„Ë fiÙÈ ÛÙ· ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ ÌÂ ·˘Ùfi ÙÔ µ° ÔÈ ı¿Ó·ÙÔÈ

‰ÂÓ ÌÔÚÔ‡Ó Ó· ·ÔÙÚ·Ô‡Ó ·Ú¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ﬁÏˆÓ ÙˆÓ

Ì¤ÙÚˆÓ ÂÓÙ·ÙÈÎ‹˜ ÓÔÛËÏÂ›·˜ Î·È Î·Ù¿ÏÏËÏË˜ È·ÙÚÈÎ‹˜ ÊÚÔ-

ÓÙ›‰·˜. ∆Ô ·Ó·ÊÂÚﬁÌÂÓÔ ·ÓÒÙÂÚÔ ﬁÚÈÔ µ° ÙˆÓ 700 g Û˘Ì‚·-

‰›˙ÂÈ ÌÂ ÂÎÂ›ÓÔ ¿ÏÏˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ Î˘Ì·›ÓÂÙ·È ÌÂÙ·Í‡ 600750 g (17).

∏ ∂∂¡£ ·ÔÙÂÏÂ› “ÂÚÈÛÛÂ˘Ô‡ÌÂÓË” ıÓËÛÈÌﬁÙËÙ·, Ô˘

·Ó ·Ó·¯ıÂ› Â› ÙÔÈ˜ ¯ÈÏ›ÔÈ˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ, ‰›ÓÂÈ ÙË ‰˘Ó·ÙﬁÙËÙ· ÂÎÙ›ÌËÛË˜ ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ‰˘ÓËÙÈÎ¿

ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó ÌÂ Ù· ˘¿Ú¯ÔÓÙ· È·ÙÚÈÎ¿ Ì¤Û·.

™ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙË˜ ∂∂¡£, Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¤ı·Ó·Ó ·fi ·Ó·fiÙÚÂÙ·

¤ı·Ó·Ó ÌÂ µ°≤700 g ·Ê·ÈÚ¤ıËÎÂ Î·È ·fi ÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi ı·Ó¿ÙˆÓ Î·È ·fi ÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıË-

Î·Ó ˙ˆÓÙ·Ó¿. ™ÙÈ˜ ÚÒÙÂ˜ 2 ÂÚÈﬁ‰Ô˘˜, Ù· ÂÚÈÛÛﬁÙÂÚ· ÓÂÔÁÓ¿ ÌÂ

·È‰Ô- Î·È Î·Ú‰ÈÔ- ¯ÂÈÚÔ˘ÚÁÈÎ¿ ÚÔ‚Ï‹Ì·Ù· Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÛÂ ¿ÏÏ· ∫¤ÓÙÚ· ·Ú¤ÌÂÈÓ·Ó ÛÂ ·˘Ù¿ Ì¤¯ÚÈ ÙËÓ ÙÂÏÈ-

Î‹ ¤Î‚·ÛË Î·È ÔÈ ı¿Ó·ÙÔÈ Ô˘ Û˘Ó¤‚ËÛ·Ó ÛÂ ÔÚÈÛÌ¤Ó· ·ﬁ ·˘Ù¿ ‰ÂÓ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÛÙËÓ ÔÏÈÎ‹ ıÓËÛÈÌﬁÙËÙ·. ∆ËÓ ÙÂ-

ÏÂ˘Ù·›· ÂÚ›Ô‰Ô, Û¯Â‰ﬁÓ ﬁÏ· Ù· ‚·ÚÈ¿ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ¿

ÂÚÈÛÙ·ÙÈÎ¿ ÓÔÛËÏÂ‡ıËÎ·Ó ÛÙË ª∂¡¡ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô.

OÈ ·ÚÈıÌÔ› Ô˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ˘˜ ›Ó·ÎÂ˜ ÛÙÚÔÁÁ˘-

ÏÂ‡ÙËÎ·Ó ÛÙÔ ÏËÛÈ¤ÛÙÂÚÔ ÔÏÈÎﬁ ÚÒÙÔ ‰ÂÎ·‰ÈÎﬁ ‹ ÙÔ Ì¤ÛÔ

ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‰ÂÎ·‰ÈÎÔ‡ ÁÈ· ¯¿ÚË ÙË˜ Û˘˙‹ÙËÛË˜. °È· ÙË

ÛÙ·ÙÈÛÙÈÎ‹ Û‡ÁÎÚÈÛË ‰È·ÊﬁÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂÙ·Í‡ ÙˆÓ

ÙÚÈÒÓ ÂÚÈﬁ‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ¯2.

∞ÔÙÂÏ¤ÛÌ·Ù· ª·ÈÂ˘ÙÈÎﬁ˜ ÏËı˘ÛÌﬁ˜

OÈ ÌËÙ¤ÚÂ˜ ·ﬁ ÌÈÎÙÔ‡˜ Á¿ÌÔ˘˜, ÌÂ ÙÔÓ ¤Ó· ·ﬁ ÙÔ˘˜ ‰‡Ô ÁÔÓÂ›˜ ∂ÏÏËÓÈÎ‹˜ Î·Ù·ÁˆÁ‹˜ Î·È

˘ËÎÔﬁÙËÙ·˜ Î·È ÙÔÓ ¿ÏÏÔ ·ÏÏÔ‰·ﬁ, ·ÔÙÂÏÔ‡Û·Ó ÙÔ 3% ÙÔ˘ Ì·ÈÂ˘ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÛÙËÓ ∞ ÂÚ›Ô‰Ô, ÙÔ 6,7% ÛÙË µ ÂÚ›Ô‰Ô Î·È ÙÔ 10,5% ÛÙË °

ÂÚ›Ô‰Ô. ∏ ·‡ÍËÛË ÌÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ, µ Î·È ° ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ (p<0,00001) (¶›Ó·Î·˜ 4). ∆Ô ÔÛÔÛÙfi ÙˆÓ ·Ó‡·ÓÙÚˆÓ ÌËÙ¤ÚˆÓ ‹Ù·Ó 1,5% ÛÙËÓ ∞ ÂÚ›Ô‰Ô, 4,5% ÛÙË µ ÂÚ›Ô‰Ô Î·È 7,5% ÛÙË ° ÂÚ›Ô‰Ô. ∏ ·‡ÍËÛË ÌÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ, µ Î·È ° ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ (p<0,00001) (¶›Ó·Î·˜ 4). ™¯Â‰fiÓ fiÏÂ˜ ÔÈ ·Ó‡·ÓÙÚÂ˜ ÌËÙ¤ÚÂ˜ Î·Ù¿ ÙËÓ ∞ ÂÚ›Ô‰Ô ‹Ù·Ó ÂÏÏËÓÈÎ‹˜ Î·Ù·ÁˆÁ‹˜, ÂÓÒ Î·Ù¿ ÙË µ Î·È ° ÂÚ›Ô‰Ô ÔÈ ÂÚÈÛÛfiÙÂÚÂ˜ ·fi ·˘Ù¤˜ ‹Ù·Ó ·ÏÏÔ‰·¤˜. ™ÙËÓ ∞ ÂÚ›Ô‰Ô, ÌfiÏÈ˜ 45 ÓÂÔÁÓ¿ ÚÔ‹Ïı·Ó

ÁÔÓÂ›˜ Ô˘ Â›¯·Ó Î·È ÔÈ ‰‡Ô Í¤ÓË ˘ËÎÔfiÙËÙ·, ÛÙË µ ÂÚ›Ô‰Ô Ù· ÓÂÔÁÓ¿ ·˘Ù¿ ·ÔÙÂÏÔ‡Û·Ó ÙÔ 6% ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ Î·È ÛÙË ° ÂÚ›Ô‰Ô ÙÔ 14%. ™Ù·ÙÈÛÙÈÎ¿, Ë ·‡ÍËÛË ÌÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ, µ Î·È ° ‹Ù·Ó ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ (p<0,00001) (¶›Ó·Î·˜ 4). ™ËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÌËÙ¤ÚˆÓ ÌÂ ∂ÏÏËÓÈÎ‹ ˘ËÎÔfiÙËÙ· Î·Ù¿ ÙË ° ÂÚ›Ô‰Ô ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ¿ÙÔÌ· ·ÏÏÔ‰·‹˜ ÚÔ¤ÏÂ˘ÛË˜ (∞Ï‚·Ó›·, °ÂˆÚÁ›·) Ô˘ ·¤ÎÙËÛ·Ó ÙËÓ ∂ÏÏËÓÈÎ‹ ˘ËÎÔfiÙËÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∆Ô ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô, ÁÈ· ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯Ô˘ÌÂ ·ÎÚÈ‚‹ ÛÙÔÈ¯Â›·, ‹Ù·Ó Î·Ù¿ ÁÂÓÈÎ‹ ÂÎÙ›ÌËÛË ¯·ÌËÏfi ÛÂ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ÂÁÎ‡ˆÓ.

¡ÂÔÁÓÈÎﬁ˜ ÏËı˘ÛÌﬁ˜

∫·Ù·ÓÔÌ‹ ÙˆÓ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓÒÓ (Ãµ°¡) (µ°<2000 g): ™ÙÔÓ ¶›Ó·Î· 5 Ê·›ÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ Ãµ°¡. À‹ÚÍÂ ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ·ﬁ ÙËÓ ∞ ÚÔ˜ ÙË ° ÂÚ›Ô‰Ô Î·È ÁÈ· ÙÈ˜ 3 Î·ÙËÁÔÚ›Â˜ ÙˆÓ Ãµ°¡. À‹ÚÍÂ 100% ·‡ÍËÛË ÌÂÙ·Í‡ ÙˆÓ ÂÚÈﬁ‰ˆÓ ∞ Î·È ° ÁÈ· Ù· ÓÂÔÁÓ¿ ÌÂ µ° 501-1000 g Î·È 1001-500 g (p<0,00001). °È·

∂›‰Ô˜ ÏËı˘ÛÌÔ‡ÃÚÔÓÔÏÔÁ›·

¶›Ó·Î·˜ 4. ∂È‰ËÌÈÔÏÔÁÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Ì·ÈÂ˘ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡ 1987-1990 (∞)1991-1995 (µ)1996-1999 (°)

1. ∞ÏÏÔ‰·Ô›45/15839*(0,28%)580/9409 (6%)ñ961/6949 (14%)¨ ∞Ï‚·ÓÔ›-307601

¶ÚÒËÓ ∂™™¢-253335 ÕÏÏÔÈ452025

2. ªÈÎÙÔ› Á¿ÌÔÈ 484 (3%)630 (6,7%)726 (10,5%)¨

3. ∞Ó‡·ÓÙÚÂ˜ ÌËÙ¤ÚÂ˜ 236 (1,5%)438 (4,5%)528 (7,5%)¨

* ·ÚÈıÌfi˜ ÂÈ‰ÈÎ‹˜ Î·ÙËÁÔÚ›·˜ ÂÁÎ‡ˆÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÂÁÎ‡ˆÓ ñ % ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÂÁÎ‡ˆÓ ¨ p<0,00001 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, µ Î·È °, ∞ Î·È °

¶·È‰È·ÙÚÈÎ‹ 2001;64:573-582 Paediatriki 2001;64:573-582

Ù· ÓÂÔÁÓ¿ ÌÂ µ° 1501-2000 g, Ë ·‡ÍËÛË ‹Ù·Ó 97% (p<0,00001). ∏ ·‡ÍËÛË ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ (p<0,05) Î·È ÌÂÙ·Í‡ ÙˆÓ ÂÚÈﬁ‰ˆÓ µ Î·È °. ∆ËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ Ãµ°¡ ÙËÓ ·Ô‰ÒÛ·ÌÂ

ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ, ÏﬁÁˆ ÛËÌ·ÓÙÈÎ‹˜ ·‡ÍËÛË˜ ÙˆÓ ÂÍˆÛˆÌ·ÙÈÎÒÓ Î˘‹ÛÂˆÓ Î·È

ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡

ÎÈÓ‰‡ÓÔ˘. ∆ËÓ ∞ ÂÚ›Ô‰Ô ÁÂÓÓ‹ıËÎ·Ó, ÌÂÙ¿ ·ﬁ

ÂÍˆÛˆÌ·ÙÈÎ‹ Î‡ËÛË, 3 ÓÂÔÁÓ¿, ÙË µ ÂÚ›Ô‰Ô 18 Î·È

ÙË ° ÂÚ›Ô‰Ô 111. ¶ÚﬁˆÚ· Î·È ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜: ™ÙÔÓ ¶›Ó·Î· 6

Ê·›ÓÂÙ·È Ô ·ÚÈıÌﬁ˜ ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ (¢∫<37 Â‚‰ÔÌ¿‰Â˜) Î·È ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·ﬁ

ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜. À‹ÚÍÂ ÔÏ‡ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÌÂÙ·Í‡ ÙˆÓ ÙÚÈÒÓ ÂÚÈﬁ‰ˆÓ (p<0,00001) Î·È

ÛÙÈ˜ ‰‡Ô ·˘Ù¤˜ Î·ÙËÁÔÚ›Â˜ ÓÂÔÁÓÒÓ.

¡ÂÔÁÓ¿ ÌÂÙ·ÊÂÚı¤ÓÙ· ÛÂ ¿ÏÏ· ∫¤ÓÙÚ·: À‹ÚÍÂ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÛÂ ¿ÏÏ· Î¤ÓÙÚ· ÌÂÙ·Í‡ ÙË˜ ∞ Î·È ÙË˜ °

ÂÚÈﬁ‰Ô˘. ∏ ÂÏ¿ÙÙˆÛË ·˘Ù‹ ·ÊÔÚÔ‡ÛÂ Ù· ·È‰Ô-

¯ÂÈÚÔ˘ÚÁÈÎ¿ ÂÚÈÛÙ·ÙÈÎ¿ (¶›Ó·Î·˜ 7). ∆· ÙÂÏÂ˘Ù·›· ¯ÚﬁÓÈ·, ﬁÏ· Ù· ÛÔ‚·Ú¿ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ¿ Â-

ÚÈÛÙ·ÙÈÎ¿ ÓÔÛËÏÂ‡ÔÓÙ·Ó - ÚÈÓ Î·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ

¯ÂÈÚÔ˘ÚÁÂ›Ô - ÛÙÔ ∆Ì‹Ì· Ì·˜.

OÏÈÎ‹ ıÓËÛÈÌﬁÙËÙ·: ∏ ¡£, Ë ∂¡£, Ë ¢¡£ Î·È Ë

¢∂¡£ ÛÙÈ˜ 3 ÂÚÈfi‰Ô˘˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 8 Ì·˙› ÌÂ ÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿. OÈ ‰È·ÊÔÚ¤˜ ÛÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi

¶›Ó·Î·˜ 5. ∫·Ù·ÓÔÌ‹ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓÒÓ

˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÌÂÙ·Í‡ ÙË˜ ∞ Î·È µ ÂÚÈﬁ‰Ô˘

ÔÊÂ›ÏÔÓÙ·Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· Î·È ‰Â‡ÙÂÚÔ˘ ¡ÂÔÁÓÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÛÙÔ ›‰ÈÔ ¡ÔÛÔÎÔÌÂ›Ô, ÌÂ ·ÔÙ¤ÏÂ-

ÛÌ· Ó· ÌÔÈÚ¿˙ÔÓÙ·È Ù· ÓÂÔÁÓ¿ ÛÙ· 2 ÙÌ‹Ì·Ù·. OÈ

‰È·ÊÔÚ¤˜ ÛÙÔÓ ·ÚÈıÌﬁ ÙˆÓ ˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÌÂÙ·Í‡ ÙË˜ µ Î·È ° ÂÚÈﬁ‰Ô˘ ÔÊÂ›ÏÔÓÙ·Ó ÛÙÔ ‰È·ÊÔ-

ÚÂÙÈÎfi ·ÚÈıÌfi ÂÙÒÓ Ô˘ Â›¯Â Ë Î¿ıÂ ÂÚ›Ô‰Ô˜ (5 ¤Ó·ÓÙÈ 4). °ÂÓÈÎ¿ ˘‹ÚÍÂ ÂÏ¿ÙÙˆÛË, ÂÚ›Ô˘ 10%, ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÂÙÒÓ. £ÓËÛÈÌfiÙËÙ·: ∏ ÂÎ·ÙÔÛÙÈ·›· ÂÏ¿ÙÙˆÛË ÙË˜

ıÓËÛÈÌﬁÙËÙ·˜ ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· ÌÂ ÙÔÓ ÙÚﬁÔ

˘ÔÏÔÁÈÛÌÔ‡ ÙË˜ (¶›Ó·Î·˜ 8). ∏ ¢∂¡£, Ô˘ Â›Ó·È

Î·È Ë ÈÔ Ô˘ÛÈÒ‰Ë˜, ·ÚÔ˘Û›·ÛÂ ÂÏ¿ÙÙˆÛË 24%

ÌÂÙ·Í‡ ÙË˜ ∞ Î·È ÙË˜ µ ÂÚÈﬁ‰Ô˘ Î·È 48% ÌÂÙ·Í‡

ÙË˜ ∞ Î·È ÙË˜ ° (¶›Ó·Î·˜ 9). ∏ ¢∂¡£ ·ÚÔ˘Û›·ÛÂ

ÙÒÛË Î·Ù¿ 68%, 83,7%, 77% Î·È 88,5% ÌÂÙ·Í‡

ÙË˜ ∞ Î·È ÙË˜ ° ÂÚÈﬁ‰Ô˘ ÁÈ· ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ÙˆÓ

ÓÂÔÁÓÒÓ ÌÂ µ° 501-1000 g, 1001-1500 g, 15012000 g Î·È >2000 g ·ÓÙ›ÛÙÔÈ¯· (¶›Ó·Î·˜ 9).

°È· ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ µ° 601-700 g, 701-800 g, 801-900 g Î·È 901-1000 g, Ë ÙÒÛË

ÙË˜ ¢∂¡£ ÌÂÙ·Í‡ ÙË˜ ∞ Î·È ÙË˜ ° ÂÚÈfi‰Ô˘ ‹Ù·Ó ·ÓÙ›ÛÙÔÈ¯· 25%, 46%, 83,7% Î·È 100% (¶›Ó·Î·˜ 10). ™ÙËÓ Î·ÙËÁÔÚ›· ÌÂ µ° 501-600 g, Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 100% Î·È ÛÙÈ˜ 3 ÂÚÈfi‰Ô˘˜.

°È· ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ÓÂÔÁÓÒÓ ÌÂ ¢∫ 24-25 Â‚‰ÔÌ¿‰Â˜, 26-27 Â‚‰ÔÌ¿‰Â˜, 28-29 Â‚‰ÔÌ¿‰Â˜, 30-32 Â‚‰ÔÌ¿‰Â˜, 33-36 Â‚‰ÔÌ¿‰Â˜, >36 Â‚‰ÔÌ¿‰Â˜, Ë

ÃÚÔÓÔÏÔÁ›·µ¿ÚÔ˜ Á¤ÓÓËÛË˜ (g) 501-10001001-15001501-2000

1986-1990 (∞)133/19833*(0,67%)ñ235/19833 (1,2%) 345/19833 (1,7%) 1991-1995 (µ)90/9405 (0,95%)141/9405 (1,5%) 217/9405 (2,3%) 1996-1999 (°)96/6948 (1,38%)¨176/6948 (2,5%)¨233/6948 (3,35%)¨

* ·ÚÈıÌfi˜ Ãµ° ÓÂÔÁÓÒÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ñ % ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ¨ p<0,05 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, µ Î·È °, ∞ Î·È °, ÁÈ· fiÏÂ˜ ÙÈ˜ Î·ÙËÁÔÚ›Â˜ µ°

¶›Ó·Î·˜ 6. ∫·Ù·ÓÔÌ‹ Î·È ∂¡£ ÚﬁˆÚˆÓ (¢∫≤36 Â‚‰.) Î·È ÔÏ‡‰˘ÌˆÓ ÓÂÔÁÓÒÓ

1986-1990 (∞)1991-1995 (µ)1996-1999 (°)

∫·ÙËÁÔÚ›· ÓÂÔÁÓÒÓ ¡Ô ÓÂÔÁÓÒÓ¡Ô ÓÂÔÁÓÒÓ¡Ô ÓÂÔÁÓÒÓ

°ÂÓÓËı¤ÓÙ· ˙ÒÓÙ· ÓÂÔÁÓ¿1983394056924

¶ÚﬁˆÚ·1297(6,5)*811(8,5)*859(12,5)*¨ ™‡ÓÔÏÔ ı·Ó¿ÙˆÓ29911769

£¿Ó·ÙÔÈ ÚÔÒÚˆÓ255(85,8)**99(84,5)**61(88,5)** ¶ÔÏ‡‰˘Ì·326(1,6)*245(2,5)*353(5)*¨ £¿Ó·ÙÔÈ ÔÏ˘‰‡ÌˆÓ48(7)**15(6)**16(4,5)**

*( ): % ÙÔ˘ Û˘ÓﬁÏÔ˘ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ

** ( ): % ÙÔ˘ Û˘ÓﬁÏÔ˘ ÙˆÓ ı·Ó¿ÙˆÓ ¨ p<0,00001 ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, µ Î·È °, ∞ Î·È ° ÃÚÔÓÔÏÔÁ›·

ÂÏ¿ÙÙˆÛË ÙË˜ ¢∂¡£ ÌÂÙ·Í‡ ÙË˜ ∞ Î·È ÙË˜ ° Â-

ÚÈﬁ‰Ô˘ ‹Ù·Ó ·ÓÙ›ÛÙÔÈ¯· 41%, 76,8%, 78,5%, 77,7%, 87,5%, 76,2% (¶›Ó·Î·˜ 11).

∏ ∂∂¡£ ·ÚÔ˘Û›·ÛÂ ÂÏ¿ÙÙˆÛË 65,4% ÌÂÙ·Í‡

ÙˆÓ ÂÚÈﬁ‰ˆÓ ∞ Î·È ° (¶›Ó·Î·˜ 12). O ÔÏÈÎﬁ˜ ·ÚÈı-

Ìﬁ˜ ÙˆÓ ÓÂÔÁÓÒÓ ·˘Ù‹˜ ÙË˜ Î·ÙËÁÔÚ›·˜ Ô˘ ¤-

ı·Ó·Ó ÙË ° ÂÚ›Ô‰Ô ‹Ù·Ó 26 (ÔÛÔÛÙﬁ 3,75ò).

∏ ÏÂÈÔÓﬁÙËÙ· ÙˆÓ ı·Ó¿ÙˆÓ ·ÊÔÚÔ‡ÛÂ Úﬁˆ-

Ú· ÓÂÔÁÓ¿ ÌÂ ¢∫≤36 Â‚‰ÔÌ¿‰Â˜ Î·È ÛÙÈ˜ 3 ÂÚÈﬁ-

‰Ô˘˜ ÌÂ ÔÛÔÛÙ¿ 85,2%, 84,5% Î·È 88,5% ÁÈ· ÙÈ˜

∞, µ Î·È ° ÂÚÈﬁ‰Ô˘˜ ·ÓÙ›ÛÙÔÈ¯· (¶›Ó·Î·˜ 9).

™˘˙‹ÙËÛË ∏ ÌÂÏ¤ÙË Ì·˜ Î·Ï‡ÙÂÈ Û˘ÓÂ¯‹ ÂÚ›Ô‰Ô 14

¯ÚﬁÓˆÓ, ·ﬁ ÙËÓ ·Ú¯‹ ÏÂÈÙÔ˘ÚÁ›·˜ ÙË˜ ª∂¡ Ì¤¯ÚÈ

Û‹ÌÂÚ·, ÌÂ Î·Ï‹ Î·Ù·ÁÚ·Ê‹ ﬁÏˆÓ ÙˆÓ ·ÏÏ·ÁÒÓ

Ô˘ Û˘Ó¤‚ËÛ·Ó ÛÂ ·˘Ùﬁ ÙÔ ‰È¿ÛÙËÌ· Î·È ÙˆÓ ÂÈ-

ÙÒÛÂˆÓ ÛÙË ıÓËÛÈÌﬁÙËÙ·. ∏ ·Í›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ

ÌÂÌÔÓˆÌ¤ÓˆÓ ÙÌËÌ¿ÙˆÓ, ·Ú¿ ÙËÓ ÂÚÈÔÚÈÛÌ¤ÓË

ÂÌ‚¤ÏÂÈ¿ ÙÔ˘˜, Â›Ó·È ÌÂÁ¿ÏË˜ ÛÔ˘‰·ÈﬁÙËÙ·˜ ÁÈ·

ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ Â›‰Ô˘˜ ÙË˜ ·ÚÂ¯ﬁÌÂÓË˜ ÂÚÈ-

ÁÂÓÓËÙÈÎ‹˜ ÊÚÔÓÙ›‰·˜ Î·È ÙË˜ ÔÚÁ¿ÓˆÛË˜ ÙˆÓ

ª∂¡¡, Î·ıÒ˜ Î·È ÁÈ· ÙËÓ ÂÓËÌ¤ÚˆÛË ÙˆÓ ÁÔÓ¤ˆÓ.

∆Ô È‰·ÓÈÎﬁ Î·È Û˘Ó¿Ì· ÂÊÈÎÙﬁ - Û‡ÌÊˆÓ· ÌÂ ÙÔ È·-

ÙÚÈÎﬁ ‰˘Ó·ÌÈÎﬁ Î·È ÙËÓ ÔÈÎÔÓÔÌÈÎ‹ Î·Ù¿ÛÙ·ÛË ÙË˜ ∂ÏÏ¿‰·˜ - ı· ‹Ù·Ó Ó· ˘‹Ú¯Â ÂÓÈ·›· ‚¿ÛË ÂÚÈ-

ÁÂÓÓËÙÈÎÒÓ/ÓÂÔÁÓÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· Î¿ıÂ ÂÚÈÊ¤ÚÂÈ· Ô˘ Î·Ï‡ÙÂÙ·È ·ﬁ ¤Ó· ¶ÂÚÈÁÂÓÓËÙÈÎﬁ/

¶›Ó·Î·˜ 7. ¡ÂÔÁÓ¿ Ô˘ ªÂÙ·Ê¤ÚıËÎ·Ó ÛÂ ¿ÏÏ· ¡ÔÛÔ-

ÎÔÌÂ›·

ÃÚÔÓÔÏÔÁ›·™‡ÓÔÏÔ¶·È‰Ô-∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ¿¯ÂÈÚÔ˘ÚÁÈÎ¿ ¡Ô¡Ô(ı¿Ó·ÙÔÈ)¡Ô(ı¿Ó·ÙÔÈ)

1986-1990 (∞)5638(5)18(11) 1991-1995 (µ)3529(5)6(2) 1996-1999 (°)103 7(1)

¡Ô: ·ÚÈıÌﬁ˜ ÓÂÔÁÓÒÓ

ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ÓÂÔÁÓÒÓ, fiˆ˜ Û˘Ì‚·›ÓÂÈ ÛÂ ¿ÏÏ· ÎÚ¿ÙË (16-19).

∆· ‰Â‰ÔÌ¤Ó· Ì·˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÂ ¤Ó· Ì·ÈÂ˘ÙÈÎfi ÏËı˘ÛÌfi Ô˘ ¿ÏÏ·ÍÂ ÛËÌ·ÓÙÈÎ¿ ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ 14 ¯ÚfiÓˆÓ. °ÂÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ÙÔ˘ ÏËı˘ÛÌÔ‡ ·˘ÙÔ‡ ‹Ù·Ó Ë ‰È·¯ÚÔÓÈÎ‹ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÁÎ‡ˆÓ Ô˘ Â›¯·Ó ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô, ‹Ù·Ó ·ÏÏÔ‰·¤˜, ¿Á·ÌÂ˜, Â›¯·Ó ÂÏÏÈ‹ Ì·ÈÂ˘ÙÈÎ‹ ÊÚÔÓÙ›‰·, Î·ıÒ˜ Î·È Ë

ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙˆÓ ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ (¶›Ó·Î·˜ 4). ∞ÔÙ¤ÏÂÛÌ· fiÏˆÓ ·˘ÙÒÓ ‹Ù·Ó Ë ÌÂÁ¿ÏË ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. O ÏËı˘ÛÌfi˜ Ô˘ ÂÍ˘ËÚÂÙÂ›Ù·È ·fi ÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙË ÌÂÁ¿ÏË ÏËı˘ÛÌÈ·Î‹ ÂÚÈÔ¯‹ ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ Î·È ÛÂ ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ·fi ÙËÓ ˘fiÏÔÈË ÂÚÈÔ¯‹

ÙË˜ ª·ÎÂ‰ÔÓ›·˜. ™Ù· 14 ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ˘‹ÚÍÂ ÌÂÁ¿ÏË ÂÏ¿ÙÙˆÛË ÙË˜ ÓÂÔÁÓÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ (48% ÂÏ¿ÙÙˆÛË ÙË˜ ¢∂¡£). π‰È·›ÙÂÚ· ÛÙ· ¶Ãµ° ÓÂÔÁÓ¿, Ë ÙÒÛË ÙË˜ ¢∂¡£ ‹Ù·Ó ÂÓÙ˘ˆÛÈ·Î‹ Î·È ¤ÊÙ·ÛÂ ÛÂ ÔÛÔÛÙfi 68% ÁÈ· Ù· ÓÂÔÁÓ¿ ÌÂ µ°≤1000 g Î·È 84% ÁÈ· Ù· ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g (¶›Ó·Î·˜ 9). ™˘ÁÎÚ›ÛÂÈ˜ ÌÂ

‰Â‰ÔÌ¤Ó· ·fi ¿ÏÏ· ÙÌ‹Ì·Ù· ÙË˜ ∂ÏÏ¿‰·˜ Î·È ÙË˜ ·ÏÏÔ‰·‹˜ ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ/‰˘Ó·Ùfi Ó· Á›ÓÔ˘Ó ÏfiÁˆ ÙˆÓ ÌÂÁ¿ÏˆÓ ‰È·ÊÔÚÒÓ Î·È È‰È·ÈÙÂÚÔÙ‹ÙˆÓ

¡ÂÔÁÓÈÎfi ∫¤ÓÙÚÔ, Ë ÔÔ›· ÂÎÙfi˜ ·fi ÙË ıÓËÛÈÌfiÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ı· ÂÚÈÂÏ¿Ì‚·ÓÂ Î·È ‰Â-

Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ Â›‰Ô˜ ÙÔ˘ Ì·ÈÂ˘ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÙË ¯ÚÔÓÈÎ‹ ÛÙÈÁÌ‹ ÙË˜ ÌÂÏ¤ÙË˜, ÙÔ Â›‰Ô˜ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·ıÒ˜ Î·È ÙË ÛÙÂÏ¤¯ˆÛË, ÙÔÓ ÂÍÔÏÈÛÌﬁ Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ª∂¡¡ ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊﬁÚˆÓ ¡ÂÔÁÓÔÏÔÁÈÎÒÓ ÙÌËÌ¿ÙˆÓ.

¶·ÓÂÏÏ‹ÓÈ· ¤¯Ô˘Ó Á›ÓÂÈ ‰‡Ô ÌÂÏ¤ÙÂ˜ ÓÂÔÁÓÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜, Ë Ì›· ÙÔ 1983 Î·È Ë ¿ÏÏË ÙÔ 1998, fiÔ˘ Î·Ù·ÁÚ¿ÊËÎÂ Ë ÂÚÈÁÂÓÓËÙÈÎ‹ Î·È ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌfiÙËÙ· ÛÂ ¤Ó· Û˘ÁÎÂÎÚÈÌ¤ÓÔ Ì‹Ó·, Ù·˘Ùfi¯ÚÔÓ· ÛÂ fiÏË ÙËÓ ∂ÏÏ¿‰·. OÈ ÌÂÏ¤ÙÂ˜ ·˘Ù¤˜ ¤‰ÂÈÍ·Ó ÌÂÁ¿ÏË ÙÒÛË ÙË˜ ÓÂÔÁÓÈÎ‹˜ (ËÏÈÎ›·: 0-28 ËÌ¤ÚÂ˜ ˙ˆ‹˜) ıÓËÛÈÌfiÙËÙ·˜ ·fi 14,5ò ÙÔ 1983

¶›Ó·Î·˜ 8. ∂¡£, ¡£, ¢∂¡£ Î·È ¢¡£ ÃÚÔÓÔÏÔÁ›·∂¡£¡£ (0-28 ËÌ.)¢∂¡£*¢¡£*(0-28 ËÌ.) ¡Ôò¡Ôò¡Ôò¡Ôò

1986-1990 (∞)299/1983315260/1983313,1249/1978312,5215/1978310,8

1991-1995 (µ)117/940512,4104/94051189/93779,582/93778,7

1996-1999 (°)69/69489,964/69489,245/69246,542/69246

* ·Ê·ÈÚÔ‡ÓÙ·È ÔÈ ı¿Ó·ÙÔÈ ·ﬁ ·Ó·ﬁÙÚÂÙ· ·›ÙÈ·

No: ·ÚÈıÌﬁ˜ ı·Ó¿ÙˆÓ ÚÔ˜ ·ÚÈıÌﬁ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ

∂¡£: ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÛÈÌﬁÙËÙ·

¡£: ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌﬁÙËÙ·

¢∂¡£: ‰ÈÔÚıˆÌ¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÛÈÌﬁÙËÙ·

¢¡£: ‰ÈÔÚıˆÌ¤ÓË ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌﬁÙËÙ·

9. ∂È‰ÈÎ‹ ·Ó¿ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ¢∂¡£

µ° (g)ÃÚÔÓÔÏÔÁ›·

1986-1990 (∞)1991-1995 (µ)1996-1999 (°)% ÂÏ¿ÙÙˆÛË ÌÂÙ·Í‡ ¡Ô%¡Ô%¡Ô%∞&µ,µ&°,∞&° 501-1000116/130* 88,548/8357,830/9033,333,542,568,3 1001-150083/22936,218/13513,310/170663,556,583,7 1501-200025/3357,56/2122,84/2291,76239,377 >200025/190890,1317/8947 0,191/64350,015-31,5ñ9288,5

™‡ÓÔÏÔ 249/19783(12,5)** 89/9377(9,5)45/6924(6,5)24%31,5%48% * ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ

** ( ): ı¿Ó·ÙÔÈ Â› ò

ñ ·‡ÍËÛË ÌÂÙ·Í‡ ∞ & µ

¶›Ó·Î·˜ 10. ∂È‰ÈÎ‹ ·Ó¿ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ¢∂¡£ ÛÂ ¶¶Ãµ° ÓÂÔÁÓ¿ µ° (g)ÃÚÔÓÔÏÔÁ›· 1986-1990 (∞)1991-1995 (µ)1996-1999 (°)% ÂÏ¿ÙÙˆÛË ÌÂÙ·Í‡ ¡Ô%¡Ô%¡Ô%∞&µ,µ&°,∞&° 501-60010/10*1006/61004/4100000 601-70026/2610010/11909/12751016,525 701-80029/3096,515/2171,512/2352262746 801-90023/25928/17475/3315496883,7 901-100028/39709/28320/18057,7100100 ™‡ÓÔÏÔ 116/13089,248/8357,830/9033,335,242,562,5

* ·ÚÈıÌﬁ˜ ı·Ó¿ÙˆÓ ÚÔ˜ ·ÚÈıÌﬁ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ¶¶Ãµ°: ¿Ú· ÔÏ‡

ÛÂ 6ò ÙÔ 1998 (6,7). ™Â ·Ó¿ÏÔÁÂ˜ ÂÚÈﬁ‰Ô˘˜ ÛÙÔ

ÙÌ‹Ì· Ì·˜ (∞ Î·È °), Ë ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌfiÙËÙ· ÂÏ·ÙÙÒıËÎÂ ·fi 13,1ò ÛÂ 9,2ò, ‹Ù·Ó ‰ËÏ·‰‹ 50% ÌÂÁ·Ï‡ÙÂÚË ·’ fiÙÈ ÛÙËÓ ·ÓÂÏÏ‹ÓÈ· ÌÂÏ¤ÙË (¶›Ó·Î·˜ 8). OÈ ·ÓÂÏÏ‹ÓÈÂ˜, fiÌˆ˜, ÌÂÏ¤ÙÂ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Î·È fi¯È ÛÂ ÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔ ÙÌ‹Ì· Ì·˜

Î·È Ë ‰È·ÊÔÚ¿ ÛÙË ıÓËÛÈÌﬁÙËÙ· ÙË˜ Ù¿ÍË˜ ÙÔ˘ 50% Â›Ó·È ·ﬁÏ˘Ù· ‰ÈÎ·ÈÔÏÔÁËÌ¤ÓË Î·È Î·Ù¿ ÙËÓ

ÂÎÙ›ÌËÛ‹ Ì·˜ ÌÈÎÚ‹. ∂ÈÏ¤ÔÓ, ÔÈ ‰‡Ô ·˘Ù¤˜ ·ÓÂÏÏ‹ÓÈÂ˜ ÌÂÏ¤ÙÂ˜ Â›¯·Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ·ÍÈÔÈÛÙ›·˜, ·fi ÙÔ ÁÂÁÔÓfi˜ Î·È ÌfiÓÔ fiÙÈ ÛÂ ·˘Ù¤˜ Û˘ÌÌÂÙÂ›¯·Ó ‰ÂÎ¿‰Â˜ ¿ÙÔÌ·, ·È‰›·ÙÚÔÈ, È·ÙÚÔ›, Ì·›Â˜, ÓÔÛËÏÂ‡ÙÚÈÂ˜ Î.Ï., ÌÂ ‰È·ÊÔÚÂÙÈÎ‹ ÂÎ·›‰Â˘ÛË Î·È ÂÌÂÈÚ›· Î·È Î·Ì›· ÂÈ‰›ÎÂ˘ÛË ÛÙË ÓÂÔÁÓÔÏÔÁ›·/ÂÚÈÁÂÓÓËÙÈÎ‹. °ÂÓÈÎ¿, ÔÈ ·ÓÂıÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ ÓÂÔÁÓÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ ‰ÂÓ ıÂˆÚÔ‡ÓÙ·È È‰È·›ÙÂÚ· ·ÍÈfiÈÛÙÂ˜, ·ÎfiÌ· Î·È ÛÂ ¯ÒÚÂ˜ ÌÂ Î·Ï‹ Î·Ù·ÁÚ·Ê‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÛÂ ËÏÂÎÙÚÔÓÈÎ¿ Û˘ÛÙ‹Ì·Ù· ·fi Î·Ù¿ ÙÂÎÌ‹ÚÈÔ ÂÈ‰ÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi (15). ¢Â‰ÔÌ¤Ó· ·fi Ù· È‰ÈˆÙÈÎ¿ Ì·ÈÂ˘Ù‹ÚÈ· “ªËÙ¤Ú·” (1984-1996) Î·È “π·ÛÒ” (1996-1998) ÙˆÓ ∞ıËÓÒÓ, ¤‰ÂÈÍ·Ó ÔÏ‡ ¯·ÌËÏ‹ ∂¡£ ıÓËÛÈÌfiÙËÙ·, Î˘Ì·ÈÓfiÌÂÓË ·fi 5,5ò (·Ú¯ÈÎ¿) ¤ˆ˜ 2,5ò (ÚfiÛÊ·Ù·) (9,10). ∏ ÌfiÓË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô˜ ÁÈ· ÙËÓ

ÔÔ›· ÌÔÚÂ› Ó· ˘¿ÚÍÂÈ Î¿ÔÈ· “Û‡ÁÎÚÈÛË” ÌÂÙ·Í‡ ÙÔ˘ ÙÌ‹Ì·Ùfi˜ Ì·˜ Î·È ÙˆÓ Ì·ÈÂ˘ÙËÚ›ˆÓ Â›Ó·È Ë ° (1996-1999), fiÔ˘ ÔÈ ‰È·ÊÔÚ¤˜ ÛÙË ıÓËÛÈÌfiÙËÙ· Â›Ó·È ÂÎ ÚÒÙË˜ fi„Âˆ˜ ÔÏ‡ ÌÂÁ¿ÏÂ˜ (9ò ÛÙÔ

ÙÌ‹Ì· Ì·˜ ¤Ó·ÓÙÈ ~2,5ò ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ·) Î·È ·Í›˙ÂÈ Ó· Û¯ÔÏÈ·ÛÙÔ‡Ó. ∫·Ù’ ·Ú¯¿˜, ÔÈ Î˘‹ÛÂÈ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ‰‡Ô Ì·ÈÂ˘Ù‹ÚÈ· ‹Ù·Ó ·Ó·ÏÔÁÈÎ¿

ÔÏ‡ ÏÈÁfiÙÂÚÂ˜ ·’ fiÙÈ ÛÙÔ ÙÌ‹Ì· Ì·˜. ∞˘Ùfi Ê·›ÓÂÙ·È ·fi ÙÔ ÔÛÔÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ µ°<1500 g

(ÂÎÂ› ‰ËÏ·‰‹ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ı¿Ó·ÙÔÈ) Ô˘ ÛÙÔ ÙÌ‹Ì· Ì·˜ ‹Ù·Ó 4-7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ ·’ fiÙÈ ÛÙ· ‰‡Ô Ì·ÈÂ˘Ù‹ÚÈ·. ™Ù· ‰‡Ô Ì·ÈÂ˘Ù‹ÚÈ·, ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÓÂÔÁÓÒÓ (Ì¤¯ÚÈ Î·È 45%)

ÌÂ µ°<1500 g Î·È ÔÚÈÛÌ¤Ó· ÓÂÔÁÓ¿ ÌÂ µ°>1500 g

ÌÂ ‚·ÚÈ¿ ÚÔ‚Ï‹Ì·Ù·, ÌÂÙ·Ê¤ÚıËÎ·Ó ÛÂ ¿ÏÏ·

¡ÔÛÔÎÔÌÂ›· Î·È ‰ÂÓ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÛÙË ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌfiÙËÙ·. ∞ÓÙ›ıÂÙ·, ·fi ÙÔ ÙÌ‹Ì· Ì·˜ ÌÂÙ·Ê¤ÚıËÎÂ ÛÂ ¿ÏÏ· ¡ÔÛÔÎÔÌÂ›· ÌÈÎÚfi˜ ÌfiÓÔ ·ÚÈıÌfi˜ Î·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ÙˆÓ ÔÔ›ˆÓ Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó ÙfiÛÔ ÌÈÎÚ‹ Ô˘ ·Ó Û˘Ó˘-

ÔÏÔÁÈ˙ﬁÙ·Ó ÛÙËÓ ÔÏÈÎ‹ ıÓËÛÈÌﬁÙËÙ·, ÂÏ¿¯ÈÛÙ· ı·

ÙËÓ ÂËÚ¤·˙Â (¶›Ó·Î·˜ 7). ŒÙÛÈ, ·Ú’ ﬁÙÈ Ë ÔÏÈÎ‹

ÛÙÔ ÙÌ‹Ì· Ì·˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË, Ë

ıÓËÛÈÌﬁÙËÙ· ÁÈ· Ù· ¶Ãµ° ÓÂÔÁÓ¿, Ù· ¶¶Ãµ° ÓÂÔÁÓ¿ Î·È ÛÙ· ÓÂÔÁÓ¿ ÌÂ ¢∫<32 Â‚‰ÔÌ¿‰Â˜ ‹Ù·Ó ÌÈÎÚﬁÙÂÚË. ™Â Û‡ÁÎÚÈÛË ÌÂ Ù· ‰Â‰ÔÌ¤Ó·

¶›Ó·Î·˜ 11. ∂È‰ÈÎ‹ ·Ó¿ ¢∫ ¢∂¡£

¢∫ (Â‚‰.)ÃÚÔÓÔÏÔÁ›·

1986-1990 (∞)1991-1995 (µ)1996-1999 (°)% ÂÏ¿ÙÙˆÛË ÌÂÙ·Í‡

¡Ô%¡Ô%¡Ô%∞&µ,µ&°,∞&° <2417/18*94,59/91003/475-5,5**2520,5 24-2532/339720/258012/215717,528,541 26-2770/8087,520/5337,712/5920,3604676,8 28-2947/9350,57/44168/7410,868,53278,5 30-3246/29915,715/728,77/1283,544,559,7 77,7 33-3612/7411,56/4721,251/4740,221,88487,5 >3624/185190,1312/87020,132/61640,03207676

™‡ÓÔÏÔ 249/19783(12,5)89/9377(9,5)45/6924(6,5)

* ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ

** ·‡ÍËÛË 5,5 %

¶›Ó·Î·˜ 12. ∂ÍÈ‰·ÓÈÎÂ˘Ì¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÛÈÌﬁÙËÙ· (∂∂¡£)

ÃÚÔÓÔÏÔÁ›·∞ÚÈıÌﬁ˜ ™‡ÓÔÏÔ ∞Ó·ﬁÙÚÂÙÔÈ £¿Ó·ÙÔÈ ∂∂¡£∞Ó·ÏÔÁ›· ò

ÓÂÔÁÓÒÓı·Ó¿ÙˆÓı¿Ó·ÙÔÈµ°<700 g 1986-1990198332995037212/19746*10,7 1991-19959405117281970/93587,5 1996-1999694869241926/69053,75 * ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÛÂ Û¯¤ÛË ÌÂ ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ

·ﬁ Ù· ‚ÈÔÌË¯·ÓÈÎ¿ ÎÚ¿ÙË, ¤¯Ô˘ÌÂ ÌÂÁ·Ï‡ÙÂÚË

ıÓËÛÈÌﬁÙËÙ·, ÈÔ ÂÎÛÂÛËÌ·ÛÌ¤ÓË ÛÂ ÓÂÔÁÓ¿ ÌÂ

µ°≤800 g (2-4,16,20,21). OÈ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ Î·È ‰Ô-

ÌÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙÔ˘ ÙÌ‹Ì·Ùﬁ˜ Ì·˜ Î·È ÙˆÓ

ÎÚ·ÙÒÓ ·˘ÙÒÓ Â›Ó·È, ﬁˆ˜ ÚÔ·Ó·Ê¤ÚıËÎÂ, ÔÏ-

Ï¤˜ Î·È ÌÂÁ¿ÏÂ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ‰‡ÛÎÔÏË

¤ˆ˜ ·‰‡Ó·ÙË Ë ·ÎÚÈ‚‹˜ ·ÍÈÔÏﬁÁËÛË ÙˆÓ ·ÈÙ›ˆÓ

·˘Ù‹˜ ÙË˜ ‰È·ÊÔÚ¿˜ ÛÙË ıÓËÛÈÌﬁÙËÙ·.

∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 14 ¯ÚﬁÓˆÓ ·Ú·ÙËÚ‹ıË-

ÎÂ Û˘ÓÂ¯‹˜ ·‡ÍËÛË ÙˆÓ Ãµ°¡, Ì¤¯ÚÈ ‰ÈÏ·ÛÈ·-

ÛÌÔ‡ (¶›Ó·Î·˜ 5). ∏ ·‡ÍËÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È ¤Ó·

ÛÙ·ÙÈÛÙÈÎﬁ Ê·ÈÓﬁÌÂÓÔ Î·È ¤¯ÂÈ ·Ú·ÙËÚËıÂ› Î·È ÛÂ

Î¤ÓÙÚ· ÙÔ˘ ÂÍˆÙÂÚÈÎÔ‡ (17,22-24). ÀÔı¤ÙÔ˘ÌÂ

ﬁÙÈ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÔÏ‡‰˘ÌˆÓ Î˘‹ÛÂˆÓ ÏﬁÁˆ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›Ë-

ÛË˜, ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘‹ÛÂˆÓ ˘„Ë-

ÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÛÙË ‚ÂÏÙ›ˆÛË ÙË˜ Ì·ÈÂ˘ÙÈÎ‹˜

ÊÚÔÓÙ›‰·˜ Ô˘ ÂÈÙÚ¤ÂÈ ÂÚÈÛÛﬁÙÂÚ· Ãµ°¡ Ó·

ÁÂÓÓÈÔ‡ÓÙ·È ˙ˆÓÙ·Ó¿. ™Â Û¯¤ÛË ÌÂ ÙÈ˜ Ê˘ÛÈÔÏÔÁÈÎ¤˜ Î˘‹ÛÂÈ˜, ÔÈ Î˘‹ÛÂÈ˜ ÂÍˆÛˆÌ·ÙÈÎ‹˜ ÁÔÓÈÌÔÔ›ËÛË˜ Û˘ÓÔ‰Â‡ÔÓÙ·È, ÛÂ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ·, ·fi ÚfiˆÚÔ˘˜ ÙÔÎÂÙÔ‡˜, ÙÔÎÂÙÔ‡˜ ÓÂÔÁÓÒÓ ÌÂ Ãµ° Î·È ÔÏ‡‰˘ÌÂ˜ Î˘‹ÛÂÈ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·˘ÍËÌ¤ÓË ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ· (25-27). ∏ ÙÒÛË ÙË˜ ÔÏÈÎ‹˜ ¢∂¡£ ÌÂÙ·Í‡ ÙË˜ ∞ Î·È µ

ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ° 1001-1500 g Î·È 33,5% ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ° 501-1000 g). ∫·Ù¿ ¤Ó· Ì¤ÚÔ˜, ·˘Ù‹ Ë ÂÏ¿ÙÙˆÛË ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ÌÔÚÂ› Ó· ·Ô‰ÔıÂ› ÛÙË ¯Ú‹ÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, Û‡ÌÊˆÓ· Î·È ÌÂ ÂÌÂÈÚ›Â˜ ·fi ¿ÏÏ· ¡ÂÔÁÓÔÏÔÁÈÎ¿ ∫¤ÓÙÚ· (5,18,28). ∞˘Ùfi ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ÙË

‰È·›ÛÙˆÛË fiÙÈ ‰ÂÓ ˘‹Ú¯Â ÂÏ¿ÙÙˆÛË ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ÛÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÛÙÈ˜ ‰‡Ô ·˘Ù¤˜

ÂÚÈﬁ‰Ô˘˜ (¶›Ó·Î·˜ 9).

∏ ÚÔÁÂÓÓËÙÈÎ‹ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙ﬁÓË˜ ÛÙÈ˜ ÌËÙ¤ÚÂ˜ ÌÂ ÚﬁˆÚË ¤Ó·ÚÍË ÙÔÎÂÙÔ‡ ¿Ú¯ÈÛÂ Ó· ¯ÚË-

ÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ·fi ÙËÓ ·Ú¯‹ ÙË˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜, ›Ûˆ˜ ÏÈÁfiÙÂÚÔ Û˘ÛÙËÌ·ÙÈÎ¿ ·Ú¯ÈÎ¿ ·’ fiÙÈ ·ÚÁfiÙÂÚ·. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ô ÚfiÏÔ˜ ÙË˜ ÛÙËÓ ÙÒÛË ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ÌÂÙ·Í‡ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ ‰ÂÓ Ú¤ÂÈ Ó· ‹Ù·Ó ÌÂÁ¿ÏÔ˜.

∏ ÙÒÛË Î·Ù¿ 31,5% ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ÌÂÙ·Í‡ µ Î·È ° ÂÚÈfi‰Ô˘ ıÂˆÚÔ‡ÌÂ fiÙÈ Î·Ù¿ Î‡ÚÈÔ ÏfiÁÔ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÚÔfi‰ˆÓ ÛÙË

ÓÂÔÁÓÈÎ‹ ÊÚÔÓÙ›‰· Î·È ÙË ¯Ú‹ÛË ÙˆÓ Ó¤ˆÓ ÙÂ¯ÓÔ-

ÏÔÁÈÒÓ Î·È ıÂÚ·ÂÈÒÓ. ∞˘Ùﬁ ÂÓÈÛ¯‡ÂÙ·È ·ﬁ ÙËÓ

·Ú·ÙËÚËıÂ›Û· ÂÏ¿ÙÙˆÛË ÙË ıÓËÛÈÌﬁÙËÙ·˜, ﬁ¯È

ÌfiÓÔ ÛÙ· Ãµ°¡ ·ÏÏ¿ Î·È ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ°>2000 g Ô˘ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È ÙÂÏÂÈfiÌËÓ· ‹ Û¯Â‰fiÓ ÙÂÏÂÈfiÌËÓ· (¶›Ó·Î·˜ 9). ∫·È ÛÙÈ˜ ÙÚÂÈ˜ ÂÚÈfi‰Ô˘˜, Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ Û˘Ó¤‚·Ï·Ó Î·Ù¿ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÛÙËÓ ÔÏÈÎ‹ ıÓËÛÈÌfiÙËÙ· (¶›Ó·Î·˜ 6).

∆Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ Úfi‚ÏËÌ· ÛÙË ıÓËÛÈÌfiÙËÙ· ·ÊÔÚÔ‡ÛÂ Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ÌÂ µ°<1,0 kg, Ô˘

ÂÓÒ ‹Ù·Ó ÙÔ 1,34% ﬁÏˆÓ ÙˆÓ ˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ

ÛÙË ° ÂÚ›Ô‰Ô, Â˘ı‡ÓÔÓÙ·Ó ÁÈ· ÙÔ 66% ﬁÏˆÓ ÙˆÓ

ı·Ó¿ÙˆÓ. ™ÙËÓ ›‰È· ÂÚ›Ô‰Ô, ÔÈ ı¿Ó·ÙÔÈ ÛÙ· ÓÂÔ-

ÁÓ¿ ÌÂ µ°<800 g ·ÓÙÈÚÔÛÒÂ˘·Ó ÙÔ 52% ÙË˜ ÔÏÈÎ‹˜ ıÓËÛÈÌﬁÙËÙ·˜, ÂÓÒ ÔÈ ı¿Ó·ÙÔÈ ÓÂÔÁÓÒÓ ÌÂ

µ°<700 g ÙÔ 25%. ∏ ÂÈ‚›ˆÛË ÙˆÓ ÚÔÒÚˆÓ ·˘ÙÒÓ Û˘ÓÔ‰Â‡ÂÙ·È Û˘¯Ó¿ ·ﬁ ÛÔ‚·Ú¤˜ ·Ó·ËÚ›Â˜

·ﬁ ÙÔ ∫¡™ Î·È Ù· ·ÈÛıËÙ‹ÚÈ· ﬁÚÁ·Ó·. ™˘ÓÂÒ˜, ÔÈ ÚÔÛ¿ıÂÈÂ˜ ‰È¿ÛˆÛ‹˜ ÙÔ˘˜, È‰È·›ÙÂÚ· ·˘ÙÒÓ

ÌÂ µ°<700 g, ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÈÏÂÎÙÈÎ¤˜, ·ÎfiÌ· Î·È ·Ó ¤¯Ô˘Ó ·ÓÙ›ıÂÙË ¿Ô„Ë ÔÈ ÁÔÓÂ›˜. °ÂÓÈÎ¿, ÁÈ· Ù· ÚfiˆÚ· ÌÂ µ°<1,0 kg Ô˘ ÂÈ‚ÈÒÓÔ˘Ó, ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ ÎÚ·ÙÈÎ‹ Ì¤ÚÈÌÓ· ÌÂ ÙË ‰ËÌÈÔ˘ÚÁ›· Î¤ÓÙÚˆÓ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛË˜, ÓÔÛËÏÂ›·˜ Î·È ¤ÁÎ·ÈÚË˜ ·Ú¤Ì‚·ÛË˜, ÂÈ‰ÈÎ¿ Û¯ÔÏÂ›· Î.Ï.

∫¿ıÂ ÓÂÔÁÓfi ÛÂ ˘„ËÏfi Î›Ó‰˘ÓÔ ÌÔÚÂ› Ó· Û˘ÓÂ¯›ÛÂÈ Ó· ¤¯ÂÈ ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ ÌÂÙ¿ ÙÔ ÂÍÈÙ‹ÚÈÔ ·fi ÙÔ ¡ÔÛÔÎÔÌÂ›Ô Î·È ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ·’ fiÙÈ ÔÈ Û˘ÓÔÌ‹ÏÈÎÔ› ÙÔ˘ (29,30). OÚÈÛÌ¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÛÙ· ÓÂÔÁÓ¿ ÌÂ µ°<750 g Ë ÂÈıÂÙÈÎ‹ ıÂÚ·Â›· ‰ÂÓ ÂËÚ¤·ÛÂ ÙË ıÓËÛÈÌfiÙËÙ·, ·ÏÏ¿ ·‡ÍËÛÂ ÙË Ì¤ÛË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ (31,32). °È· Ù· ÓÂÔÁÓ¿ ÌÂ µ°<500 g ıÂˆÚÂ›Ù·È fiÙÈ ‰ÂÓ ·Í›˙ÂÈ Ó· Á›ÓÔ˘Ó ÚÔÛ¿ıÂÈÂ˜ ·Ó¿ÓË„Ë˜ ‰ÈfiÙÈ ·ÎfiÌ· Î·È ÛÙ·

Î·Ï‡ÙÂÚ· ¡ÂÔÁÓÔÏÔÁÈÎ¿ Î¤ÓÙÚ· ¤¯Ô˘Ó ıÓËÛÈÌfiÙËÙ· 85-90%, ÂÓÒ ·fi Ù· ÂÈ˙ÒÓÙ· ÌfiÓÔ 2%-3,5%

‰ÂÓ ¤¯ÂÈ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (4,33). ∆· ÂÚÈÛÛfiÙÂÚ· ¡ÂÔÁÓÔÏÔÁÈÎ¿ Î¤ÓÙÚ· Û˘ÌÊˆÓÔ‡Ó fiÙÈ fiÏ· Ù·

ÓÂÔÁÓ¿ ÌÂ µ°>750 g ‹ ¢∫>25 Û˘ÌÏËÚˆÌ¤ÓÂ˜

Â‚‰ÔÌ¿‰Â˜ Î‡ËÛË˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï‹ÚË ·Ó¿ÓË-

„Ë Î·È ÂÓÙ·ÙÈÎ‹ ˘ÔÛÙ‹ÚÈÍË (31).

∆Ô ÔÛÔÛÙfi ÙË˜ ·Ó·fiÙÚÂÙË˜ ıÓËÛÈÌfiÙËÙ·˜

ÁÈ· Ù· ÓÂÔÁÓ¿ ÌÂ µ°>1,0 kg ‹Ù·Ó 2,62% ÙËÓ ° ÂÚ›Ô‰Ô, ·ÚfiÌÔÈÔ ÌÂ ÙÔ 2,6% Ô˘ Ô Usher (36) ÚÈÓ 3 ‰ÂÎ·ÂÙ›Â˜ Â›¯Â ˘ÔÏÔÁ›ÛÂÈ ˆ˜ ÙÔ ÂÏ¿¯ÈÛÙÔ ÌË ÂÏ·ÙÙÒÛÈÌÔ. ªfiÓÔ ÔÈ ÚfiÔ‰ÔÈ ÛÙË ÁÂÓÂÙÈÎ‹ ÙÔ˘ ·ÓıÚÒÔ˘ Î·È ÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË Î·È ·Ú¤Ì‚·ÛË ı· ÌÔÚÔ‡Û·Ó Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙÔ ÔÛÔÛÙfi ·˘Ùfi.

ªÂ ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙË˜ ÂÍÈ‰·ÓÈÎÂ˘Ì¤ÓË˜ ıÓËÛÈÌfiÙËÙ·˜, ÔÈ ı¿Ó·ÙÔÈ ÙˆÓ ÓÂÔÁÓÒÓ ÛÙÈ˜ ÂÚÈfi‰Ô˘˜ ∞, µ, ° ‹Ù·Ó 212 (ÔÛÔÛÙfi 10,7ò), 70 (ÔÛÔÛÙfi 7,48ò) Î·È 26 (ÔÛÔÛÙfi 3,7ò) ·ÓÙ›ÛÙÔÈ¯·, Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ÔÏ‡ ÏÈÁfiÙÂÚÔÈ ‰˘ÓËÙÈÎ¿ ·ÔÙÚÂÙÔ› ı¿Ó·ÙÔÈ Û˘Ì‚·›ÓÔ˘Ó ÙÒÚ· ·’ fiÙÈ ÛÙÔ ·ÚÂÏıfiÓ (¶›Ó·Î·˜ 12). OÈ 26 ı¿Ó·ÙÔÈ ÓÂÔÁÓÒÓ Ô˘ Û˘Ó¤‚ËÛ·Ó ÙË ° ÂÚ›Ô‰Ô ·ÔÙÂÏÔ‡Ó ÙË ıÓËÛÈÌfiÙËÙ·

ÓÔÛËÏÂ˘ÙÈÎÔ‡/È·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡,

ÂÍÔÏÈÛÌﬁ ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ Î·ıÒ˜ Î·È ÙËÓ ˘ÔÛÙ‹ÚÈÍË ·ﬁ ¿ÏÏÔ˘˜ ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙ· ÓÂÔÁÓ¿

ÂÈÛÙËÌÔÓÈÎÔ‡˜ ÎÏ¿‰Ô˘˜. ¶ÚfiÎÂÈÙ·È ‰ËÏ·‰‹ ÁÈ· “Â·Ó·ÛÙ·ÙÈÎ¤˜” ·ÏÏ·Á¤˜ ÛÙÔ ÀÁÂÈÔÓÔÌÈÎfi ™‡ÛÙËÌ· ÙË˜ ∂ÏÏ¿‰·˜. ¡ÔÌÔıÂÙÈÎ¤˜, Î˘Ú›ˆ˜, ÂÏÏÂ›„ÂÈ˜ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·ÓÂÍ¤ÏÂÁÎÙ·, ¯ˆÚ›˜ ÚÔ¸Ôı¤ÛÂÈ˜ Î·È ÚfiÙ˘·, ¡ÂÔÁÓÔÏÔÁÈÎ¿ ∆Ì‹Ì·Ù·, È‰ÈˆÙÈÎ¿ Î·È ‰ËÌfiÛÈ·, Ô˘ ÓÔÛËÏÂ‡Ô˘Ó

‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ÓÂÔÁÓ¿ ¯ˆÚ›˜ Ó· ¤¯Ô˘Ó ÙËÓ ÙÚÈÙÔ‚¿ıÌÈ· ˘Ô‰ÔÌ‹ Ô˘ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ù¤-

ÙÔÈ· ÂÚÈÛÙ·ÙÈÎ¿. ∞˘Ùﬁ ı· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ·

ÙËÓ ·Ô‰˘Ó¿ÌˆÛË ÙˆÓ ‹‰Ë ˘·Ú¯ﬁÓÙˆÓ ∆ÚÈÙÔ‚¿ıÌÈˆÓ ¡ÂÔÁÓÔÏÔÁÈÎÒÓ ∫¤ÓÙÚˆÓ ·ÓÂÏÏ·‰ÈÎ¿, ÌÂ Û˘-

Ó¤ÂÈ· ÙËÓ ·‡ÍËÛË ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ Î·È ÙËÓ ·Ú¿ÏÏËÏË ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÓÔÛËÏÂ›·˜. ªÂÏ¤ÙÂ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ıÓËÛÈÌfiÙËÙ·

ÁÈ· Ù· ¶Ãµ° ÓÂÔÁÓ¿ Î·È, Èı·ÓfiÙ·Ù· ÛÂ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi, Ë ÓÔÛËÚfiÙËÙ· Â›Ó·È ÛËÌ·ÓÙÈÎ¿ ÌÈÎÚfiÙÂÚÂ˜ ÛÙ· ∆ÚÈÙÔ‚¿ıÌÈ· ∫¤ÓÙÚ·

1. Wegman ME. Annual summary of vital statistics. Pediatrics 1993;92:743-754.

2. Tenovuo A, Kero P, Piekkala P, Sillanpaa M, Erkkola R. Advances in perinatal care and declining regional neonatal mortality in Finland 1968-82. Acta Pediatr Scand 1986;75:362-369.

3. Heinonen K, Hakuliken A, Jokela V. Survival of the smallest; time trends and determinants of mortality in a very preterm population during the 1980. Lancet 1988;2:204-207.

4. Hack M, Friedman H, Fanaroff AA. Outcome of extremely low birth weight infants. Pediatrics 1996;98:931-937.

5. Horbar JD, Wright EC, Onstad L. Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601 to 1300 grams at birth. Pediatrics 1993;92:191-196.

6. ∆˙Ô˘Ì¿Î·-ª·ÎÔ‡Ï· Ã. ¶·ÓÂÏÏ‹ÓÈ· ¶ÂÚÈÁÂÓÓËÙÈÎ‹ ŒÚÂ˘Ó· [¢È·ÙÚÈ‚‹ ÁÈ· ÀÊËÁÂÛ›·]. ∞ı‹Ó·: ∞’ ¶·È‰È·ÙÚÈÎ‹ ÎÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; ∞Ú›ÏË˜ 1983.

7. ∆˙Ô˘Ì¿Î·-ª·ÎÔ‡Ï· Ã, §ÂÎ¤·-∫·Ú·Ó›Î· µ, ∫·‚‚·‰›·˜ °, ª·ÙÛ·ÓÈÒÙË˜ ¡. ¢ÂÎ·¤ÓÙÂ ¯ÚfiÓÈ· ÚÔfi‰Ô˘ (19831998): ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· ÛÙË ¯ÒÚ· Ì·˜ Û‹ÌÂÚ·. 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 2830 ª·˚Ô˘; 1999.

8. ∂ıÓÈÎ‹ ™Ù·ÙÈÛÙÈÎ‹ ÀËÚÂÛ›· ∂ÏÏ¿‰Ô˜: ∆ÂÏÂ˘Ù·›· ÛÙ·ÙÈÛÙÈÎ¿ ‰Â‰ÔÌ¤Ó· 1996 (ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›·).

9. ªËÙ¤Ú· ª·ÈÂ˘ÙÈÎfi Î·È ÃÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ ∞∂: ∂ÓËÌÂÚˆÙÈÎfi ‰ÂÏÙ›Ô ÙË˜ ªÔÓ¿‰·˜ ¶ÚÔÒÚˆÓ Î·È ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ. πÔ‡ÓÈÔ˜ 2000, ∞ı‹Ó·.

10. π·ÛÒ. ∂ÓËÌÂÚˆÙÈÎﬁ ¢ÂÏÙ›Ô ªÔÓ¿‰·˜ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜

¡ÂÔÁÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô˘ π·ÛÒ ª∂¡¡ 2000.

11. ™ÔÊ·Ù˙‹˜ π, ™·Ï‚¿ÓÔ˜ ∏, µ·Ú‚·Ú›ÁÔ˜ π, ¶·¿˜ ∫. ¶ÂÚÈ-

ÁÂÓÓËÙÈÎ‹ ¤Î‚·ÛË 170 Î˘‹ÛÂˆÓ ˆÚÈÌﬁÙËÙ·˜ 22-31 Â‚‰ÔÌ¿‰ˆÓ. ∞Ó·ÎÔ›ÓˆÛË. ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÁÂÓÓËÙÈ-

Î‹˜ π·ÙÚÈÎ‹˜; 1996 27-28 ∞ÚÈÏ›Ô˘; ¡·‡ÏÈÔ; 1996.

12. ¶··ıˆÌ¿ ∂, OÈÎÔÓÔÌ›‰Ô˘ O, Ã·Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑, ¶ÚÂ‚Â‰Ô˘Ú¿ÎË ¶, ∫·›ÎË ∞, ¡ÈÎÔÏﬁÔ˘ÏÔ˜ ¢. ∂ÓÙ·ÙÈÎ‹ ÓÔÛË-

ÏÂ›· Î·È ¤Î‚·ÛË ÙˆÓ ÚﬁˆÚˆÓ ÔÏ‡ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜. 9Ô

¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÁÂÓÓËÙÈÎ‹˜ π·ÙÚÈÎ‹˜; 1996 2728 ∞ÚÈÏ›Ô˘; ¡·‡ÏÈÔ; 1996. 13. ∆ÔÌ¿ÎË˜ £, ™ÎÔÚ‰¿Ï· ª, °ÎÔ˘ÁÈ·ÌÙ˙‹ ∂, ™ÈÁ¿Ï·˜ π. ¡ÂÔÁÓÈÎ‹ ıÓËÛÈÌﬁÙËÙ· ÛÙËÓ ÙÚÈÂÙ›· 1993-1995 ÛÙÔ °¶¡ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË˜. ∞Ó·ÎÔ›ÓˆÛË. 9Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÁÂÓÓËÙÈÎ‹˜ π·ÙÚÈÎ‹˜; 1996 27-28 ∞ÚÈÏ›Ô˘; ¡·‡ÏÈÔ; 1996.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-01-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ï¤Í·Ó‰ÚÔ˜ ∞Ó‰Ú¤Ô˘ ÃÂÈÌˆÓ›‰Ô˘ 15, 551 33, ∫·Ï·Ì·ÚÈ¿ E-mail: aalex@spark.net.gr

™. ºÂÛÛ¿ÙÔ˘, ¢. °ÎÈÒÓË˜, ∂. O˘Ú·Ó‹, ∞. ∏ÏÈ¿‰Ë˜, π.

Spontaneous intracerebral hemorrhage in children

S. Fessatou, D. Gionis, E. Ourani, A. Heliadis, I. Papadatos

¶ÂÚ›ÏË„Ë: ∏ ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›· Â›Ó·È Ì›·

ÌÔÚÊ‹ ÔÍ¤Ô˜ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÙÔ ÔÔ›Ô Û˘¯Ó¿ ·Óı›ÛÙ·Ù·È ÛÙË ıÂÚ·Â›·. ∞Ó·ÛÎÔ-

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π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1991 ¤ˆ˜ ÙÔ ¢ÂÎ¤Ì‚ÚÈÔ ÙÔ˘ 1998.

ÈÔ Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· ‹Ù·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘

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‰È‹ÚÎÂÛÂ ·fi 9 Ì‹ÓÂ˜ ˆ˜ 7ó ¤ÙË, ¤Ó·˜ ·ÛıÂÓ‹˜ ·Â‚›ˆÛÂ, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Â›Ó·È ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË (6 ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ÓÂ˘ÚÔÏfiÁÔ

Î·È Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈÎ‹ ·ÁˆÁ‹). ∏ ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›· ‰ÂÓ Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿, fiÌˆ˜ ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ÙËÓ ¤¯Ô˘Ó ˘’ fi„ÈÓ ÙÔ˘˜, ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÂÈ‰ÈÎ¿ Û˘ÌÙÒÌ·Ù·. O ÂÌ‚ÔÏÈÛÌfi˜, Â›ÛË˜, Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Î·È ·ÛÊ·Ï‹˜ ıÂÚ·Â˘ÙÈÎ‹ ÙÂ¯ÓÈÎ‹ ÁÈ· ÙÈ˜ ∞º¢˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. §¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›·,

Abstract: Cerebral hemorrhage is a form of acute stroke that is particularly resistant to effective therapy. We reviewed our experience in 16 children, aged between 30 days to 14ó years old, with spontaneous intracerebral hemorrhage (ICH), who were admitted to ICU between January 1991 and December 1998. The most frequent presenting symptoms were conscience disorder in 11 patients (68,75%), followed by headache in 8 patients (50%). Glasgow coma scale on admission was 611 in 56% of patients. The location of ICH was cerebral in 11 children. Cerebral angiography was performed on 10 patients, and was diagnostic in 8. The leading cause of spontaneous bleeding was arteriovenous malformations (AVMs) (7 children). Two children were treated with embolization with 100% success; surgical excision was performed in 5 cases with 60% survival, while conservative treatment had 66,66% mortality. The in-hospital survival rate of all patients was 56,25%. On followup, that extended from 9 months to 7ó years, one patient had died, while the rest have made a good recovery (6 are attended by a neurologist and receive antiepileptic drugs). Physicians should keep in mind the diagnosis of ICH in children, even though the presenting symptoms may be nonspecific and the incidence of ICH is very low in children. Embolization appears to be an efficient and safe technique in the treatment of brain AVMs.

Key words: spontaneous intracerebral hemorrhage, stroke.

ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜, ¶ÂÚÈÊÂÚÂÈ·Îﬁ °ÂÓÈÎﬁ

¶·›‰ˆÓ “¶.& ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Intensive Care Unit, “P. & A. Kyriakou” General Peripheral Children’s Hospital, Athens

∂ÈÎfiÓ· 1. CT ÂÁÎÂÊ¿ÏÔ˘ ÌÂ ÂÎÙÂÙ·Ì¤ÓÔ ÂÓ‰ÔÂÁÎÂÊ·ÏÈÎfi ·ÈÌ¿ÙˆÌ· ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ, ÂÚÈ‚·ÏÏfiÌÂÓÔ ·fi ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Ô›‰ËÌ· Ô˘ ÚÔÎ·ÏÂ› ·ÒıËÛË ÙˆÓ ‰ÔÌÒÓ ÙË˜ Ì¤ÛË˜ ÁÚ·ÌÌ‹˜.

ÂıÓfiÙËÙÂ˜ (4). ∏ Ê˘ÛÈÎ‹ ÈÛÙÔÚ›· ÙˆÓ ∞∂∂ ÛÙ· ·È‰È¿ ‰È·Ê¤ÚÂÈ ·fi ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÚÔ‰È·ıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜, ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤ÏÈÍË Î·È ÙÈ˜ ·Ó·ÙÔÌÈÎ¤˜ ı¤ÛÂÈ˜ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ (5). ∆· ·È‰È·ÙÚÈÎ¿ ∞∂∂ ¤¯Ô˘Ó ÂÙÂÚÔÁÂÓ‹ ·ÈÙÈÔÏÔÁ›·, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜. ∆Ô 1/3 ·fi ·˘Ù¿ Â›Ó·È ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È ˆ˜ È‰ÈÔ·ı‹. ∞˘Ùfi Â›Ó·È ÂÓÙÂÏÒ˜ ·ÓÙ›ıÂÙÔ ÛÂ Û¯¤ÛË ÌÂ ÙÔÓ ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi, ÛÙÔÓ ÔÔ›Ô Ë ·ÈÙÈÔÏÔÁ›· Û˘Ó‹ıˆ˜ ¿ÓÙ· ‚Ú›ÛÎÂÙ·È Î·È Â›Ó·È Û˘¯ÓfiÙÂÚ· Û¯ÂÙÈ˙fiÌÂÓË ÌÂ ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË ‹ ˘¤ÚÙ·ÛË (6). ™Ù· ·È‰È¿, fiÌˆ˜, ÈÔ Û˘¯Ó¿ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜, ÏÔÈÌÒÍÂÈ˜, ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·, ·ÈÌÔÚÚ·ÁÈÎ‹ ‰È¿ıÂÛË, ·ÁÁÂÈ›ÙÈ‰Â˜ Î˘Ú›ˆ˜ ·˘ÙÔ¿ÓÔÛË˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ·ÁÁÂÈ·Î¤˜ ‰˘ÛÏ·Û›Â˜ (7).

∆ÚÂÈ˜ ÌË¯·ÓÈÛÌÔ› ÚÔÎ·ÏÔ‡Ó ∞∂∂ ÛÙ· ·È‰È¿: ıÚfiÌ‚ˆÛË, ÂÌ‚ÔÏ‹ Î·È ·ÈÌÔÚÚ·Á›·. ∞ÈÌÔÚÚ·Á›· Û˘Ì‚·›ÓÂÈ fiÙ·Ó ·›Ì· ÂÏÂ˘ıÂÚÒÓÂÙ·È ÛÙÔÓ ÂÍˆ·ÁÁÂÈ·Îfi, ÂÓ‰ÔÎÚ·ÓÈ·Îfi ‹ ÂÓ‰ÔÛÔÓ‰˘ÏÈÎfi ¯ÒÚÔ. ™’ ·˘Ù¤˜ ÙÈ˜ Î·Ù·ÛÙ¿ÛÂÈ˜, Ë ÂÓÙÔÈÛÌ¤ÓË ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÙÔ˘ ¡ª Û˘Ì‚·›ÓÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ‰‡Ô ·Ú·ÁfiÓÙˆÓ: ÙË˜ ›ÂÛË˜ ÏfiÁˆ ÙË˜ Î·Ù¿ÏË-

∂ÈÎﬁÓ· 2. MRI ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ‰Â›¯ÓÂÈ ÂÓ‰ÔÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›· ÛÙÔ Ô›ÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ ÌÂÙˆÈ·›Ô˘ ÏÔ‚Ô‡ ‰È·Ì¤ÙÚÔ˘ 4 cm. ™ÙËÓ ¤Ûˆ ·Ú˘Ê‹ ÙË˜ ·ÈÌÔÚÚ·Á›·˜ ·ÂÈÎÔÓ›˙ÂÙ·È

ﬁ˙Ô˜ ‰È·Ì¤ÙÚÔ˘ 1 cm. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ô›‰ËÌ· ÚÔÎ·ÏÔ‡Ó Û˘Ì›ÂÛË ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘ Î·È ÙË˜ ‰ÂÍÈ¿˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ Î·È ÂÏ·ÊÚ¿ ÌÂÙ·ÙﬁÈÛË ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿ ÙÔ˘ ‰ÚÂ¿ÓÔ˘. ¶·Ú·ÙËÚÂ›Ù·È Â›ÛË˜ ÌÈÎÚ‹˜ ÂÎÙ¿ÛÂˆ˜ ˘ÔÛÎÏËÚ›‰ÈÔ ·ÈÌ¿ÙˆÌ· Î·Ù¿ Ì‹ÎÔ˜ ÙË˜ ‰ÂÍÈ¿˜ ·Ú˘Ê‹˜ ÙÔ˘ ÛÎËÓÈ‰›Ô˘ Î·È ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÈ·›·, ÎÚÔÙ·ÊÈÎ‹ Î·È ‚ÚÂÁÌ·ÙÈÎ‹ ¯ÒÚ·.

„Ë˜ ÙÔ˘ ¯ÒÚÔ˘ ·fi ÙÔÓ fiÁÎÔ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ·fi ÙËÓ ÈÛ¯·ÈÌ›· ÏfiÁˆ ÙË˜ ·ÈÌÔÚÚ·Á›·˜. ∞˘Ù¤˜ ÔÈ ‚Ï¿‚Â˜ ÌÔÚÂ› Ó· ÂÈ‰ÂÈÓˆıÔ‡Ó ·fi ÙÈ˜ ‚Ï·ÙÈÎ¤˜ ÂÈ‰Ú¿ÛÂÈ˜ ÛÙÔ ÓÂ˘ÚÈÎfi ÈÛÙfi ·fi ÙÈ˜ Ô˘Û›Â˜ Ô˘ ·ÂÏÂ˘ıÂÚÒÓÔÓÙ·È ·fi ÙÔ ·›Ì· (7).

∞Ó Î·È ÌÂÚÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ ÙË˜ ‹ÍË˜ ÂÈÊ¤ÚÔ˘Ó ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÈÛ¯·ÈÌÈÎ¿ ∞∂∂, ÌÂÚÈÎ¤˜ ¿ÏÏÂ˜ ÚÔ¿ÁÔ˘Ó ÙÈ˜ ÂÁÎÂÊ·ÏÈÎ¤˜ ·ÈÌÔÚÚ·Á›Â˜. ∆¤ÙÔÈÂ˜ Â›Ó·È ÔÈ ·ÈÌÔÚÚÔÊÈÏ›Â˜ ∞ Î·È µ Î·È Ë ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÎ˘ÙÙ·ÚÔÂÓ›· ÔÔÈ·Û‰‹ÔÙÂ ·ÈÙÈÔÏÔÁ›·˜. ™Ù· ·È‰È¿, Ë ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›· Â˘ı‡ÓÂÙ·È Î˘Ú›ˆ˜ ÁÈ· ¤ÌÊÚ·ÎÙ· Î·È ÏÈÁﬁÙÂÚÔ ÁÈ· ·ÈÌÔÚÚ·Á›·. ÕÏÏÂ˜ ·ÈÙ›Â˜ ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ·

·È‰È¿ Â›Ó·È Ë Moyamoya ÌÂ Ì›· ÌÔÓ·‰ÈÎ‹ ·ÎÙÈÓÔÏÔÁÈÎ‹ ÂÈÎfiÓ·, fiÌˆ˜ Ë ‚Ï¿‚Ë Ô˘ ÚÔÎ·ÏÂ› Â›Ó·È Û˘Ó‹ıˆ˜ ÈÛ¯·ÈÌ›· Î·È Û·ÓÈfiÙÂÚ· ÂÁÎÂÊ·ÏÈÎ‹ ‹ ˘·Ú·¯ÓÔÂÈ‰‹˜ ·ÈÌÔÚÚ·Á›· (7).

Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û·Ó ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›· (17). °È’ ·˘Ùfi ÚÔÙÂ›ÓÂÙ·È ·fi ÌÂÚÈÎÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ Ì›· 2Ë ·ÁÁÂÈÔÁÚ·Ê›· ·ÚÁfiÙÂÚ·, Ô˘ ÌÔÚÂ› Ó· Â›Ó·È ÈÔ ‰È·ÊˆÙÈÛÙÈÎ‹. ¶¿ÓÙˆ˜, ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÌÔÚÂ› Ó· Û˘Ì‚Â› ·˘ÙfiÌ·ÙË ÂÁÎÂ-

Ê·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›· ¯ˆÚ›˜ ÂÍ‹ÁËÛË (18).

Œ¯ÔÓÙ·˜ ‚ÚÂÈ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÌÂ ÙÈ˜ ·Ú·¿Óˆ

ÌÂıﬁ‰Ô˘˜, ÙÔ ÂﬁÌÂÓÔ ‚‹Ì· Â›Ó·È Ë ıÂÚ·Â›· ÙË˜

˘ÔÎÂ›ÌÂÓË˜ ‰È·Ù·Ú·¯‹˜, fiÔ˘ ·˘Ùfi Â›Ó·È ‰˘Ó·Ùfi.

™ÙÈ˜ ·ÁÁÂÈ·Î¤˜ ‚Ï¿‚Â˜, Ô ÛÙﬁ¯Ô˜ ÙË˜ ıÂÚ·Â›·˜

Ú¤ÂÈ Ó· Â›Ó·È Ë ÂÍ·Ê¿ÓÈÛ‹ ÙÔ˘˜, Ú¿ÁÌ· Ô˘ ·Ô-

ÙÂÏÂ› ÙË ÌﬁÓË ÂÁÁ‡ËÛË ÁÈ· ÙËÓ ·ÔÙÚÔ‹ ÂÌÊ¿ÓÈ-

ÛË˜ ·ÈÌÔÚÚ·Á›·˜. ∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË ·Ú·Ì¤ÓÂÈ Ë ÈÔ ·ÍÈﬁÈÛÙË ıÂÚ·Â›·, È‰È·›ÙÂÚ· ÛÙ· ·È‰È¿.

ŸÙ·Ó ÚﬁÎÂÈÙ·È ÁÈ· ·ÁÁÂÈ·Î¤˜ ‰˘ÛÏ·Û›Â˜ Ô˘ Â‰Ú¿˙ÔÓÙ·È ÛÂ ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ÂÚÈÔ¯¤˜ ‹ Â›Ó·È ÌÂÁ¿ÏÂ˜, ÌÔÚÂ› Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÍ·›ÚÂÛË Ó· Û˘Ó‰˘¿˙Â-

Ù·È ÌÂ ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈÎ‹ ‹ ÂÌ‚ÔÏÈÛÌﬁ. ∞ﬁ ÙË ÌÂÏ¤ÙË ÙˆÓ Hladky Î·È Û˘Ó (19) Û˘ÛÙ‹ÓÔÓÙ·È ÔÈ ÂÈÏÔÁ¤˜ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3.

µÈ‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ó·ÊÔÚ¤˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÂ 75%85% ÙˆÓ ·È‰ÈÒÓ Ô˘ ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È ÌÂ ∞º¢˜, ÔÏÈÎ‹ ÂÍ·›ÚÂÛË ÂÈÙ˘Á¯¿ÓÂÙ·È ÛÂ ÔÛÔÛÙfi 72%90%. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ıÓËÙfiÙËÙ· ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi 8,5%-11%, ÛÂ ·ÓÙ›ıÂÛË ÌÂ ÙË ıÓËÙfiÙËÙ· ÙË˜ Û˘ÓÙËÚËÙÈÎ‹˜ ıÂÚ·Â›·˜ Ô˘ Â›Ó·È 23%57%. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ıÓËÙfiÙËÙ· Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙ· ·È‰È¿ ÛÂ Û¯¤ÛË ÌÂ ÙÔ˘˜ ÂÓ‹ÏÈÎÂ˜ Î·È ‚¤‚·È· ·˘Í¿ÓÂÈ ÔÏ‡ ·Ó Ë ·ÁÁÂÈ·Î‹ ‰˘ÛÏ·Û›· ¤¯ÂÈ Ú·ÁÂ› (20-22).

ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈÎ‹ ıÂÚ·Â›·, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ‰È·Ê¤ÚÔ˘Ó ·Ó¿ÏÔÁ· ÌÂ ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙËÓ ·ÈÌ·ÙÈÎ‹ ÚÔ‹ ÙË˜ ‰˘ÛÏ·Û›·˜ (7,19).

ŸÙ·Ó Ë ‰È·Ù·Ú·¯‹ Â›Ó·È ÌÈÎÚ‹ Î·È Ë ·ÈÌ·ÙÈÎ‹ ÚÔ‹

Â›ÛË˜ ¯·ÌËÏ‹, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· Û›ÁÔ˘Ú· Â›Ó·È Î·Ï‡ÙÂÚ·. ∏ ‚Ï¿‚Ë ·ﬁ ÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· ÛÙÔ ∫¡™

ÂÏ·ÙÙÒÓÂÈ ÙË ‚ÂÏÙ›ˆÛË ÛÂ 3% ÙˆÓ ·ÛıÂÓÒÓ (7). O ÂÌ‚ÔÏÈÛÌﬁ˜, Â›ÛË˜, ·Ó·Ê¤ÚÂÙ·È ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ Î·È ·ÛÊ·Ï‹˜ ÙÂ¯ÓÈÎ‹ ıÂÚ·Â›·˜ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·ÛÈÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, È‰È·›ÙÂÚ· ÚÈÓ ‹ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÂÎÙÔÌ‹ Î·È ÚÈÓ ÙËÓ ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË. §›ÁÔÈ Û˘ÁÁÚ·ÊÂ›˜ ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ Ï‹ÚË ÂÍ·Ê¿ÓÈÛË ÙË˜ ·ÁÁÂÈ·Î‹˜ ‰˘ÛÏ·Û›·˜ ÌÂ ÂÌ‚ÔÏÈÛÌﬁ. OÈ ÂÈÏÔÎ¤˜ ‰ÂÓ Â›Ó·È

Û˘¯Ó¤˜ Î·È ÂÍ·ÚÙÒÓÙ·È ·ﬁ ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ıÂ-

Ú·Â˘Ù‹ (7,19).

∞Ó Î·È Û˘ÓÈÛÙ¿Ù·È ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿ Ó· Á›ÓÂÙ·È Ó¤·

·ÁÁÂÈÔÁÚ·Ê›· ÁÈ· Ó· ÂÎÙÈÌËıÂ› Ë ÂÈÙ˘¯›· ÙË˜

Â¤Ì‚·ÛË˜, ÂÓÙÔ‡ÙÔÈ˜ ¤¯Ô˘Ó ·Ó·ÊÂÚıÂ› ÂÚÈÛÙ·ÙÈÎ¿ Ô˘ ÂÓÒ Ë 2Ë ·ÁÁÂÈÔÁÚ·Ê›· ¤‰ÂÈ¯ÓÂ Ï‹ÚË

ÂÍ·Ê¿ÓÈÛË ÙË˜ ‰˘ÛÏ·Û›·˜, ÌÂÙ¿ ·fi ·ÚÎÂÙfi Î·ÈÚfi Â·ÓÂÌÊ·ÓÈ˙fiÙ·Ó. ∞˘Ùfi ÈÛÙÂ‡ÂÙ·È fiÙÈ ÔÊÂ›ÏÂÙ·È ÛÂ ÌÈÎÚÔÂÈÎÔÈÓˆÓ›Â˜ (microshunt) Ô˘ ÌÔÚÂ› Ó· ·Ú·Ì¤ÓÔ˘Ó “·fiÚ·ÙÂ˜” ÛÙËÓ 1Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹

·ÁÁÂÈÔÁÚ·Ê›·, ·ÏÏ¿ Ô˘ ÌÔÚÂ› Ó· ·˘ÍËıÔ‡Ó ÛÂ

Ì¤ÁÂıÔ˜ ÛÙÔ˘˜ ÂﬁÌÂÓÔ˘˜ Ì‹ÓÂ˜. ŒÙÛÈ, ÚÔÙÂ›ÓÂÙ·È ·ﬁ ÌÂÚÈÎÔ‡˜ ÂÚÂ˘ÓËÙ¤˜ Ì›· 2Ë ·ÁÁÂÈÔÁÚ·Ê›·

ÌÂÙÂÁ¯ÂÈÚËÙÈÎ¿ ÛÂ 18-24 Ì‹ÓÂ˜, ÒÛÙÂ Ó· ÂÈ‚Â‚·È-

ÒÓÂÙ·È Ë ÔÏÈÎ‹ ÂÍ·›ÚÂÛË Î·È Ó· ·ÔÎÏÂ›ÂÙ·È Ë ˘Ô-

ÙÚÔ‹ ÙË˜ ·ÈÌÔÚÚ·Á›·˜ (19).

∞Ó·ÊÂÚfiÌÂÓÔÈ ÛÙËÓ ÚfiÁÓˆÛË ÙˆÓ ·˘ÙfiÌ·ÙˆÓ

ÂÁÎÂÊ·ÏÈÎÒÓ ·ÈÌÔÚÚ·ÁÈÒÓ ÛÙ· ·È‰È¿, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Î·Ï‡ÙÂÚË ÛÂ Û¯¤ÛË ÌÂ ÙˆÓ ÂÓËÏ›ÎˆÓ (6,23). ∞˘Ùfi Û˘Ó‰¤ÂÙ·È ÌÂÚÈÎÒ˜ Î·È ÌÂ ÙËÓ Ï·ÛÙÈÎfiÙËÙ·

ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ·È‰ÈÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘. O ·È‰ÈÎfi˜ ÂÁÎ¤Ê·ÏÔ˜ ¤¯ÂÈ ÌÂÁ¿ÏË ÈÎ·ÓfiÙËÙ· ÁÈ· ·Ó¿Ú-

ÁÈ· ÁÚ‹ÁÔÚË Â·ÓfiÚıˆÛË, ÒÛÙÂ Ó· ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ï‡ÙÂÚË ·Ó¿ÚÚˆÛË. ªfiÏÈ˜ ÙÂıÂ› Ë ˘Ô„›· ∞∂∂, fiÏÂ˜ ÔÈ ÚÔ-

Ó· ÂÈÎÂÓÙÚÒÓÔÓÙ·È ÛÙËÓ ÂÈ‚Â‚·›ˆÛË ÙÔ˘ Û˘Ì‚¿ÓÙÔ˜ Î·È ÛÙËÓ ·ÔÎ¿Ï˘„Ë ÙË˜

·ÈÙ›·˜, ÒÛÙÂ Ë ıÂÚ·Â˘ÙÈÎ‹ Â¤Ì‚·ÛË Ó· Â›Ó·È Ë ÈÔ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË. OÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ¿ÓÙ· ˘’ fi„ÈÓ ÙÔ˘˜ ÙËÓ Èı·ÓfiÙËÙ·

ÂÁÎÂÊ·ÏÈÎ‹˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿ ¯ˆÚ›˜ ÂÈ‰ÈÎ¿

Û˘ÌÙÒÌ·Ù·, ·Ó Î·È Ë Û˘¯ÓﬁÙËÙ¿ ÙË˜ Â›Ó·È Û¿ÓÈ·.

∏ ·ÓÂ‡ÚÂÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ˘ÔÎÂ›ÌÂÓË˜ ‚Ï¿‚Ë˜ Ô˘ Ô‰‹ÁËÛÂ ÛÙËÓ ·ÈÌÔÚÚ·Á›· Â›Ó·È Ë ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÂÚ·Â›·.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Banker BQ. Cerebrovascular disease in infancy and childhood: I. Occlusive vascular disease. Neuropathol Exp Neurol 1961;20:127-140.

2. Toffol GT, Swiontoniowski M. Stroke in young adults. Postgrad Med J 1992;91:123-128.

3. Lin CL, Howng SL. Nontraumatic intracerebral hemorrhage in young adults. Kaohsiung J Med Sci 1997;13:237-242.

4. Shoenberg BS, Mellinger JF, Schoenberg DG.

·Ê·›ÚÂÛË <4cm → ÏÂÈÙÔ˘ÚÁÈÎ¤˜ ÂÚÈÔ¯¤˜ → ÂÌ‚ÔÏÈÛÌﬁ˜

Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival. Neurology 1978;28:763-768.

5. Riela AR, Roach SE. Etiology of stroke in children. J Child Neurol 1993;8:201-220.

6. Giroud M, Lemesle M, Madinier G, Manceau E, Osseby GV, Dumas R. Stroke in children under 16 years of age. Clinical and etiological difference with adults. Acta Neurol Scand 1997;96:401-406.

7. Rivkin JM, Volpe JJ. Strokes in children. Pediatrics in Review 1996;17:265-278.

8. Amacher AL, Drake CG. The results of operating upon cerebral aneurysms and angiomas in children and adolescents. I. Cerebral aneurysms. Childs Brain 1979;5:151-165.

9. Ciricillo SF, Cogen PH, Edwards MSB. Pediatric cryptic vascular malformations: presentation, diagnosis and treatment. Pediatr Neurosurg 1994;20:137-147.

10. Martin NA, Edwards MSB, Wilson CB. Management of intracranial vascular malformations in children and adolescents. Concepts Pediatr Neurosurg 1983;4:264-290.

11. Scott M, Barnes P, Kupsky W, Adelman L. Cavernous angiomas of central nervous system in children. J Neurosurg 1992;76:38-46.

12. Lanska MJ, Lanska DJ, Horwitz SJ, Aram DM. Presentation clinical course, and outcome of childhood stroke. Pediatr Neurol 1991;7:333-341.

13. Rigamonti D, Drayer BP, Johnson PC, Hadley MN, Zabramski J, Spetzler RF. The magnetic resonance imaging appearance of cavernous malformation (angiomas). J Neurosurg 1987;67:518-524.

14. Ross JS, Masaryk TJ, Modic MT, Haric SI, Wiznitzer M, Selman WK. Magnetic resonance angiography of the extracranial carotid arteries and intracranial vessels: a review. Neurology 1989;39:1369-1376.

15. Bitoh S, Hasegawa H, Fujiwara M, Sakurai M. Angiographically occult vascular malformations causing intracranial hemorrhage. Surg Neurol 1982;17:35-42.

16. Terao H, Hori T, Matsutani M, Okeda R. Detection of cryptic vascular malformations by computed tomography. J Neurosurg 1979;51:546-551.

17. Bioth S, Hasegawa H, Ohtsuki H, Obashi J, Fujwara M, Sakurai M. Cerebral neoplasms initially presenting with massive intracerebral hemorrhage. Surg Neurol 1984;22:57-62.

18. Ropper AH, Davis KR. Lobar cerebral hemorrhages: Acute clinical syndromes in 26 cases. Ann Neurol 1980;8:141-147.

19. Hladky JP, Lejeune JP, Blond S, Pruvo JP, Dhellemmes P. Cerebral arteriovenous malformations in children: report on 62 cases. Child’s Nerv Syst 1994;10:328-333.

20. Humphreys RP, Hendrick EB, Hoffman HJ. Arteriovenous malformations of brain. Concepts Pediatr Neurosurg 1988;8:146-164.

21. Frong D, Chan ST. Arteriovenous malformation in children. Child’s Nerv Syst 1988;4:199-203.

22. So SC. Cerebral arteriovenous malformations in children. Child’s Brain 1978;4:242-250.

23. Broderick J, Talbot T, Prenger E, Leach A, Brott T. Stroke in children within a major metropolitan area: The surprising importance of intracerebral hemorrhage. J Child Neurol 1993;8:250-255.

24. Lin CL, Loh JK, Kwan AL, Howng SL. Spontaneous intracerebral hemorrhage in children. Kaohsiung J Med Sci 1999;15:146-151.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 13-03-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™Ì·Ú·Á‰‹ ºÂÛÛ¿ÙÔ˘

¡ÈÎËÙ·Ú¿ 4, 143 42, ¡. ºÈÏ·‰¤ÏÊÂÈ·

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ORIGINAL ARTICLE

∞›ÙÈ·

ı·Ó¿ÙÔ˘ ÛÂ ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô

£ÂÛÛ·ÏÔÓ›ÎË˜ ÙË 14ÂÙ›· 1986-1999

∞. ∞Ó‰Ú¤Ô˘, ∞. ª·Ï¿ÛÎ·, °. ª·˘Ú›‰Ë˜, ∞. ƒÒÛÛÈÔ˘, ª. °Ô˘‰ÂÛ›‰Ô˘, ª. ¶·Ô‡ÏË

Causes of death in neonates born at Ippokration Hospital of Thessaloniki during the years 1986-1999

A. Andreou, A. Balaska, G. Mauridis, A. Rossiou, M. Goudesidou, M. Papouli

¶ÂÚ›ÏË„Ë: ™ÎÔﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ Â›Ó·È Ó· Î·Ù·ÁÚ·ÊÔ‡Ó Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ‚¿ÛÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ

Î·ÙËÁÔÚÈÒÓ ·ı‹ÛÂˆÓ ÌÂ ÎÏÈÓÈÎ‹ ÛËÌ·Û›· ÛÂ ﬁÏ·

Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ÛÙÔ πÔÎÚ¿-

ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔÓ›ÎË˜ Î·È ÓÔÛËÏÂ‡ıËÎ·Ó

ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ∂™À ÙÔ˘ ›‰ÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘, Î·ıÒ˜ Î·È Ó· Î·Ù·ÁÚ·ÊÔ‡Ó ÔÈ ‰È·¯ÚÔÓÈÎ¤˜ ÌÂÙ·‚ÔÏ¤˜ ÙÔ˘˜. ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿ Ù· ·›ÙÈ· fiÏˆÓ ÙˆÓ ÓÂÔÁÓÈÎÒÓ ı·Ó¿ÙˆÓ Ô˘ Û˘Ó¤‚ËÛ·Ó ÛÙ· 14 ¤ÙË ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜. ∆Ô ¯ÚÔÓÈÎfi ·˘Ùfi ‰È¿ÛÙËÌ· ‰È·ÈÚ¤ıËÎÂ ÛÂ 3 ÂÚÈfi‰Ô˘˜ [∞ (1986-1990), µ (1991-1995), ° (1996-1999)] Ô˘

Û˘ÁÎÚ›ıËÎ·Ó ÌÂÙ·Í‡ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙË ıÓËÛÈÌﬁÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘. ∆· Î˘ÚÈﬁÙÂÚ· ·›ÙÈ· ı·Ó¿ÙÔ˘ ·ÚÔ˘Û›·Û·Ó ÙÈ˜ ·Ú·Î¿Ùˆ ÌÂÙ·‚ÔÏ¤˜ ÛÙÈ˜

ÂÚÈfi‰Ô˘˜ ∞, µ, ° ·ÓÙ›ÛÙÔÈ¯·: Û‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜ (™∞¢) Î·È ÂÈÏÔÎ¤˜ ÙÔ˘ 29,4%, 27,3% Î·È 24,55%, Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ (™∞) 18%, 24% Î·È 33%, ÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿ (∂Ãµ°¡) 11,7%, 13,5% Î·È 18,85%, ÏÔÈÌÒÍÂÈ˜ 19%, 10,2% Î·È 5,8%, ÓÂÎÚˆÙÈÎ‹ ÂÓÙÂÚÔÎÔÏ›ÙÈ‰· (¡∂∫) Û‹„Ë 8,3%, 10,2% Î·È 7,2% Î·È, Ù¤ÏÔ˜, ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ± Û‡Ó‰ÚÔÌÔ ÂÈÛÚfiÊËÛË˜ ÌËÎˆÓ›Ô˘ (¶∞ ™∂ª) 4,7%, 8,5% Î·È 2,9%. ¶·Ú·ÙËÚ‹ıËÎÂ ‰È·¯ÚÔÓÈÎ‹ ÌÂÙ·‚ÔÏ‹ ÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘, ¤ÙÛÈ ÒÛÙÂ ÙÔ ™∞¢ - ·fi Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ - Ó· Â›Ó·È Û‹ÌÂÚ· ‰Â‡ÙÂÚË ·ÈÙ›·, ÂÓÒ ÙËÓ ÚÒÙË ı¤ÛË Î·Ù¤¯ÂÈ Ë Î·ÙËÁÔÚ›· ÙˆÓ ™∞. ∆Ô ÔÛÔÛÙfi ı·Ó¿ÙˆÓ ·fi ÏÔÈÌÒÍÂÈ˜, ¶∞ Î·È ¡∂∫ ·ÚÔ˘Û›·ÛÂ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË, ÂÓÒ ·˘Í‹ıËÎÂ ÙÔ ÔÛÔÛÙfi ı·Ó¿-

Abstract: The aim of the study was to record the causes of death on the basis of specific categories of diseases with clinical significance, in all neonates born at Ippokratio Hospital, of Thessaloniki and admitted in the Neonatal Department (NHS) of the same Hospital, as well as to record the variations observed through the years. We studied retrospectively all causes of neonatal deaths that occurred during the 14 years of function of our Department. The 14 years were divided in 3 periods: period A (1986-1990), period B (19911995), and period C (1996-1999) - which were subsequently compared according to the categories of the various causes of death. The following changes were observed during the periods A, B, C respectively as to the principal causes of death: RDS and its complications 29.4%, 27.3%, 24.55%, congenital anomalies (CA) 18%, 24%, 33%, extremely low birth weight neonates (ELBWN) 11.7%, 13.5%, 18.85%, infections 19%, 10.2%, 5.8%, necrotizing enterocolitis (NEC) sepsis 8.3%, 10.2%, 7.2% and perinatal asphyxia ± meconium aspiration syndrome (PA MAS) 4.7%, 8.5%, 2.9%. In conclusion, there was a change in the order of frequency of death causes, as RDS is no longer the main cause of death while congenital anomalies are now first on the list. The number of deaths from infections, perinatal asphyxia, and NEC have decreased significantly, while deaths in the category of extremely low birth weight neonates have increased.

Key words: neonates, causes of death.

¡ÂÔÁÓÔÏÔÁÈÎﬁ ∆Ì‹Ì· ∂™À

Department of Neonatology (NHS) Ippokration General Hospital, Thessaloniki

ÏfiÁˆ ÙÔ˘ Û¯ÂÙÈÎ¿ ˘ÔÏÔÁ›ÛÈÌÔ˘ ÔÛÔÛÙÔ‡ ı·Ó¿ÙˆÓ ·fi ·˘Ù‹Ó. ™Â fiÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë ¡∂∫ ÚÔÎ¿ÏÂÛÂ ÙÔ ı¿Ó·ÙÔ, ˘‹Ú¯Â Î·È ‰È¿ÙÚËÛË ÂÓÙ¤ÚÔ˘ ÌÂ ÂÚÈÙÔÓ›ÙÈ‰·. ™Â ·ÚÎÂÙ¤˜

ÂÚÈÙÒÛÂÈ˜, Ë ¡∂∫ ‰ÂÓ Û˘ÓÔ‰Â˘ﬁÙ·Ó ·ﬁ ÏÔ›ÌˆÍË ‚¿ÛÂÈ

ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·›Ì·ÙÔ˜ Î·È ÂÚÈÙÔÓ·˚ÎÔ‡ ˘ÁÚÔ‡.

¢È¿ÊÔÚ·: ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ÂÚÈÂÏ‹ÊıËÛ·Ó ÏÈÁﬁÙÂÚÔ

Û˘¯Ó¿ ·›ÙÈ· ı·Ó¿ÙÔ˘, fiˆ˜ ÓÂ˘ÌÔÓÈÎ‹ ˘¤ÚÙ·ÛË, ÂÁÎÂÊ·ÏÈÎ‹ ·ÈÌÔÚÚ·Á›·, Û˘ÁÁÂÓÂ›˜ ÏÔÈÌÒÍÂÈ˜ ·fi Û‡Ó‰ÚÔÌÔ TORCH, ¯ÚfiÓÈ· ÓÂ˘ÌÔÓÔ¿ıÂÈ· Î.¿., Î·ıÒ˜ Î·È ·‰ÈÂ˘ÎÚ›ÓÈÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘. ™Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó Î·È ·˘Ù¿ Ô˘ ıÂˆÚ‹ıËÎ·Ó Û·Ó ·Ó·fiÙÚÂÙ· È·ÙÚÈÎ¿. ™Â Î¿ıÂ ÂÚ›Ô‰Ô ˘ÔÏÔÁ›-

ÛÙËÎÂ Ô ·ÚÈıÌﬁ˜ ÙˆÓ ÓÂÔÁÓÒÓ ÛÂ ﬁÏÂ˜ ÙÈ˜ Î·ÙËÁÔÚ›Â˜ ı·Ó¿-

ÙÔ˘, Î·ıÒ˜ Î·È ÙÔ ÔÛÔÛÙﬁ Î¿ıÂ Î·ÙËÁÔÚ›·˜ ı·Ó¿ÙÔ˘ ÛÙÔ

Û‡ÓÔÏÔ ÙˆÓ ı·Ó¿ÙˆÓ.

∞ÔÙÂÏ¤ÛÌ·Ù·

¢È·¯ÚÔÓÈÎ¿ ˘‹ÚÍÂ Ì›· Û˘ÓÂ¯‹˜ ·ÏÏ·Á‹ ÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘ (¶›Ó·Î·˜ 2). ∞ﬁ Ù· ·›ÙÈ· ı·Ó¿ÙˆÓ, ÙÔ

™∞¢ ‹Ù·Ó Ë Î‡ÚÈ· ·ÈÙ›· ÛÙËÓ ∞ Î·È µ ÂÚ›Ô‰Ô ÌÂ Ô-

·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂÙ¿ ÙÈ˜ ™∞. O ·ÚÈıÌﬁ˜ ÙˆÓ

ÓÂÔÁÓÒÓ ÌÂ µ°>1,0 kg Ô˘ ¤ı·Ó·Ó ·ﬁ ™∞¢ ÙËÓ ∞

‹Ù·Ó 51, ÙË µ ÂÚ›Ô‰Ô 15 Î·È ÙË ° ÂÚ›Ô‰Ô

5. ∆Ë ° ÂÚ›Ô‰Ô, ÌﬁÓÔ ¤Ó· ÓÂÔÁÓﬁ ÌÂ µ°>1,5 kg ¤-

ı·ÓÂ ·ﬁ ™∞¢. OÈ ™∞ ·ÔÙÂÏÔ‡Û·Ó ÙËÓ ∞ ÂÚ›Ô‰Ô ÙÔ 18% ÙˆÓ ı·Ó¿ÙˆÓ Î·È ÙË ° ÂÚ›Ô‰Ô ÙÔ 33% (·‡ÍËÛË 83%) Î·È

Û‹ÌÂÚ· Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ (¶›Ó·Î·˜ 2). ∞ﬁ ÙÈ˜ ™∞, Ë ÈÔ Û˘¯Ó‹ Î·ÙËÁÔÚ›· ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘

ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ 14 ÂÙÒÓ ‹Ù·Ó ÔÈ ™∫¶ (ÔÛÔÛÙfi 19%) Î·È ÌÂÙ¿ ÔÈ ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ ∫¡™ (ÔÛÔÛÙfi 16,2%) Î·È Ù· ÓÂÊÚ¿ (ÔÛÔÛÙfi 15%) (¶›Ó·Î·˜ 3). OÈ

™∫¶ ‹Ù·Ó ·ﬁ ÙÈ˜ Î˘ÚÈﬁÙÂÚÂ˜ ·ÈÙ›Â˜ ı·Ó¿ÙÔ˘ ÙÈ˜ ‰‡Ô

ÚÒÙÂ˜ ÂÚÈﬁ‰Ô˘˜. ∞Ó Û˘Ó˘ÔÏÔÁÈÛÙÔ‡Ó Î·È ÔÈ ı¿Ó·ÙÔÈ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™∫¶ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÛÂ

∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ¿ ∫¤ÓÙÚ·, ÙfiÙÂ ÔÈ ™∫¶ ‹Ù·Ó Ì·ÎÚ¿Ó Ë Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂ ÔÛÔÛÙfi 28,5%. ™ÙË ° ÂÚ›Ô‰Ô, ·fi ÙÈ˜ ™∞, ÔÈ ÔÏÏ·Ï¤˜ Û˘Á-

ÛÔÛÙﬁ 29,5% Î·È 27,3%, ·ÓÙ›ÛÙÔÈ¯·. ™ÙË ° ÂÚ›Ô‰Ô, ÙÔ ™∞¢ ·ÚÔ˘Û›·ÛÂ ÙÒÛË 17% ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ∞ ÂÚ›Ô‰Ô Î·È ÌÂ ÔÛÔÛÙﬁ 24,5% ÙˆÓ ı·Ó¿ÙˆÓ ‹Ù·Ó Ë

¶›Ó·Î·˜ 2. ∞›ÙÈ· ÓÂÔÁÓÈÎÒÓ ı·Ó¿ÙˆÓ

∞›ÙÈ·

ÃÚÔÓÔÏÔÁ›·

1986-1990 (∞)1991-1995 (µ)1996-1999 (°)

™∞¢29,4* (88)ñ27,3(32)24,6(17)

§ÔÈÌÒÍÂÈ˜19(57)10,2(12)5,8(4)

¡∂∫ ± Û‹„Ë8,3(25)10,2(12)7,2(5)

™˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜18(54)23,9(28)33(23)

¶ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ± ™∂ª4,7(14)8,5(10)2,9(2)

µ° ≤700 g11,7(35)13,6(16)18,8(13) ÕÏÏ·8,7(26)6(7)7,2(5)

* %

ñ (·ÚÈıÌﬁ˜ ı·Ó¿ÙˆÓ)

¶›Ó·Î·˜ 3. £¿Ó·ÙÔÈ ·ﬁ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜

∂›‰Ô˜ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓÃÚÔÓÔÏÔÁ›·™‡ÓÔÏÔ% ı·Ó¿ÙˆÓ 1986-1990(∞)1991-1995(µ)1996-1999(°)

¡Ô ı·Ó¿ÙˆÓ (% ÙÔ˘ Û˘ÓﬁÏÔ˘)

™∫¶12(22,2)7(23,5)1(4,7)2019 ∫¡™13(24)3(10)1(4,7)1716,1 ¡ÂÊÚÈÎ¤˜8(14,8)4(13,3)4(19,5)1615,2

∆ÚÈÛˆÌ›Â˜8(14,8)4(13,3)2(9,5)1413,3

¶ÔÏÏ·Ï¤˜ Û˘Á. ·ÓˆÌ.4(7,4)1(3,3)5(23,5)109,5

∂Ì‚Ú˘˚Îﬁ˜ ‡‰Úˆ·˜3(5,5)2(6,6)1(4,7)65,7

¶ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›·1(1,8)5(16,5)3(14,5)98,5

™Á¢Ê∫Ï-1(3,3)1(4,7)21,9 ¢È¿ÊÔÚ·5(8,8)3(10)3(14,5)1110,5 ™‡ÓÔÏÔ 543021105

™∫¶: ™˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ ™Á¢Ê∫Ï: ™˘ÁÁÂÓ‹˜ ‰È·ÁÚ·ÁÌ·ÙÔÎ‹ÏË

Î·È ÙÔ˘˜ ÓÂ‡ÌÔÓÂ˜ (¶›Ó·Î·˜ 3), ÂÓÒ ÔÈ ™∫¶ ‹Ù·Ó Ë 6Ë ·ÈÙ›· ı·Ó¿ÙÔ˘, ·ÎﬁÌ· Î·È ÌÂÙ¿ ÙÔ Û˘Ó˘ÔÏÔ-

ÁÈÛÌﬁ ÙˆÓ ı·Ó¿ÙˆÓ ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™∫¶ Ô˘ ÌÂ-

Ù·Ê¤ÚıËÎ·Ó ÛÂ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ¿ ∫¤ÓÙÚ·.

™ÙÈ˜ ‰‡Ô ÚÒÙÂ˜ ÂÚÈﬁ‰Ô˘˜ ‰ÂÓ Û˘Ó˘ÔÏÔÁ›-

ÛÙËÎ·Ó ÔÈ Ï›ÁÔÈ ı¿Ó·ÙÔÈ ÓÂÔÁÓÒÓ ·ﬁ ™∞ Ô˘ ÌÂ-

Ù·Ê¤ÚıËÎ·Ó Î·È ¤ı·Ó·Ó ÛÙ· ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ¿

∆Ì‹Ì·Ù· (¶›Ó·Î·˜ 4). O Û˘Ó˘ÔÏÔÁÈÛÌfi˜ ·˘Ùfi˜ ı· ·‡Í·ÓÂ ÂÚÈÛÛfiÙÂÚÔ ÙÔ ÔÛÔÛÙfi ı·Ó¿ÙˆÓ ÛÙÈ˜

Î·ÙËÁÔÚ›Â˜ “Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË” Î·È

“‰È¿ÊÔÚ·” ÛÙÈ˜ ÂÚÈﬁ‰Ô˘˜ ∞ Î·È µ.

∞ﬁ Ù· ·Ó·ﬁÙÚÂÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘, ÔÈ ÈÔ

Û˘¯Ó¤˜ ı·Ó·ÙËÊﬁÚÂ˜ ™∞ ‹Ù·Ó Î·Ù¿ ÛÂÈÚ¿ ·ﬁ

ÙÔ ∫¡™ (ÔÛÔÛÙﬁ 16,8%), ÙÔ˘˜ ÓÂÊÚÔ‡˜ (15,5%)

Î·È ÌÂÙ¿ ÔÈ ™∫¶ Ì·˙› ÌÂ ÙÈ˜ ÙÚÈÛˆÌ›Â˜ (13,7%) (¶›Ó·Î·˜ 5).

OÈ ı¿Ó·ÙÔÈ ÛÙËÓ Î·ÙËÁÔÚ›· ∂Ãµ°¡ ·ÚÔ˘Û›·-

Û·Ó ·‡ÍËÛË ÌÂÙ·Í‡ ÙÔ˘ Û˘ÓﬁÏÔ˘ ÙˆÓ ı·Ó¿ÙˆÓ

·ﬁ 11,7% ÛÂ 13,6% Î·È 18,8% Î·Ù¿ ÙÈ˜ ÂÚÈﬁ-

‰Ô˘˜ ∞, µ Î·È °, ·ÓÙ›ÛÙÔÈ¯·. ∏ ·‡ÍËÛË ÌÂÙ·Í‡ ∞

Î·È ° ÂÚÈﬁ‰Ô˘ ‹Ù·Ó 60% (¶›Ó·Î·˜ 2).

OÈ ÏÔÈÌÒÍÂÈ˜ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË

Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘ ·ﬁ 19% ÙËÓ ∞ ÂÚ›Ô‰Ô ÛÂ

10,2% ÙË µ Î·È 5,6% ÙË ° ÂÚ›Ô‰Ô. ∏ ÌÂ›ˆÛË ÌÂ-

Ù·Í‡ ∞ Î·È ° ÂÚÈﬁ‰Ô˘ ‹Ù·Ó 69% (¶›Ó·Î·˜ 2).

¶›Ó·Î·˜ 4. ¡ÂÔÁÓ¿ Ô˘ ÌÂÙ·Ê¤ÚıËÎ·Ó ÛÂ ¿ÏÏ· ÓÔÛÔÎÔÌÂ›·

ÃÚÔÓÔÏÔÁ›·™‡ÓÔÏÔ¶·È‰Ô-∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎ¿¯ÂÈÚÔ˘ÚÁÈÎ¿ ¡Ô¡Ô (ı¿Ó·ÙÔÈ)¡Ô (ı¿Ó·ÙÔÈ)

1986-1990 (∞)5638(5)18(11)

1991-1995 (µ)3529(5)6(2)

1996-1999 (°)1037(1)

¡Ô: ·ÚÈıÌﬁ˜ ÓÂÔÁÓÒÓ

¶›Ó·Î·˜ 5. £ÓËÛÈÌfiÙËÙ· ·fi ·Ó·fiÙÚÂÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘

∏ Î·ÙËÁÔÚ›· ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ™∂ª Â˘ı˘ÓﬁÙ·Ó ÁÈ· ÙÔ 4,7% ÙˆÓ ı·Ó¿ÙˆÓ ÛÙËÓ ∞ ÂÚ›Ô‰Ô, ÙÔ 8,5% ÛÙË µ ÂÚ›Ô‰Ô Î·È ÁÈ· ÙÔ 3% ÛÙË °, ‰ËÏ·‰‹ ÌÂ›ˆÛË Î·Ù¿ 38% ÌÂÙ·Í‡ ∞ Î·È ° ÂÚÈﬁ‰Ô˘ (¶›Ó·Î·˜ 2).

∏ Î·ÙËÁÔÚ›· ¡∂∫ ± Û‹„Ë ·ÚÔ˘Û›·ÛÂ ·˘ÍÔÌÂ›ˆÛË ÌÂÙ·Í‡ ÙˆÓ ÙÚÈÒÓ ÂÚÈﬁ‰ˆÓ: 8,3% ÙËÓ ∞ ÂÚ›Ô‰Ô, 10,2% ÙË µ Î·È 7,2% ÙË ° (¶›Ó·Î·˜ 2).

™˘˙‹ÙËÛË ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 14 ¯ÚfiÓˆÓ ÙË˜ ÌÂÏ¤ÙË˜ ˘‹ÚÍ·Ó ÛËÌ·ÓÙÈÎ¤˜ ·ÏÏ·Á¤˜ ÛÙÔ Ì·ÈÂ˘ÙÈÎfi ÏËı˘ÛÌfi, ÛÙÔ ÚÔÛˆÈÎfi Î·È ÛÙÔÓ ÂÍÔÏÈÛÌfi ÙÔ˘

¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜. ∏ ıÓËÛÈÌﬁÙËÙ· ·ÚÔ˘-

Û›·ÛÂ ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË (¶›Ó·Î·˜ 6) Î·È ÂÚÈÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈÎ¿ ÛÂ ¿ÏÏË ÂÚÁ·Û›· (5). ∆· ·›ÙÈ· ı·Ó¿ÙÔ˘ Ù· ·Ô‰ÒÛ·ÌÂ ÛÂ Ì›· ÌﬁÓÔ

ÎÏÈÓÈÎ‹ Î·ÙËÁÔÚ›·, fiˆ˜ .¯. ™∞¢ Î·È fi¯È ÛÂ ¤Ó· ÙÂÏÂÈˆÙÈÎfi Î·Ù·ÛÙÚÔÊÈÎfi Û˘Ì‚¿Ó, fiˆ˜ ÂÁÎÂÊ·-

ÏÈÎ‹ ·ÈÌÔÚÚ·Á›·. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ Ô ÙÚfiÔ˜ ·˘Ùfi˜

Ó· Á›ÓÂÈ ÂÛÙ›·ÛË ÛÙÔ˘˜ ÙÚﬁÔ˘˜ Ô˘ ·Ô-

ÙÔ˘˜ ı·Ó¿ÙÔ˘˜, Ì¤Û· ÛÙ· Ï·›ÛÈ· ÙÔ˘ È·-

Û˘ÛÙ‹Ì·ÙÔ˜ ÊÚÔÓÙ›‰·˜ (7). ¢È·¯ÚÔÓÈÎ¿, ˘‹ÚÍÂ Ì›· ÌÂÙ·‚ÔÏ‹ ÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘. ∆Ô ™∞¢ Î·È ÔÈ ÏÔÈÌÒÍÂÈ˜ - Ô˘ ‹Ù·Ó ÔÈ ‰‡Ô Î‡ÚÈÂ˜ ·ÈÙ›Â˜ ı·Ó¿ÙÔ˘ - ÂÏ·ÙÙÒıËÎ·Ó ÛËÌ·ÓÙÈÎ¿, ÌÂ ·ÔÙ¤ÏÂÛÌ· Û‹ÌÂÚ· Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ Ó· Â›Ó·È ÔÈ ™∞. OÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ Î·È ÛÙ· ‚ÈÔÌË¯·ÓÈÎ¿ ÎÚ¿ÙË Â‰Ò Î·È ·ÚÎÂÙ¿ ¯ÚﬁÓÈ· (6,9,10).

∏ ÛËÌ·ÓÙÈÎ‹ ÂÏ¿ÙÙˆÛË ÙˆÓ ı·Ó¿ÙˆÓ ·ﬁ ™∞¢

ÈÛÙÂ‡Ô˘ÌÂ ﬁÙÈ ÔÊÂ›ÏÂÙ·È Î·È ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘

ÂÍˆÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙË ıÂÚ·Â›· ÙÔ˘ ™∞¢ (11,12).

¶·Ú¿ ÙËÓ ÂÏ¿ÙÙˆÛ‹ ÙÔ˘˜, ÔÈ ı¿Ó·ÙÔÈ ·ﬁ ™∞¢

·Ú·Ì¤ÓÔ˘Ó ÛÂ ÛËÌ·ÓÙÈÎ¿ ˘„ËÏﬁÙÂÚÔ ÔÛÔÛÙﬁ

∞›ÙÈ· ı·Ó¿ÙÔ˘ ÃÚÔÓÔÏÔÁ›·

1986-1990 (∞)1991-1995 (µ)1996-1999 (°) ™‡ÓÔÏÔ%*

¡ÂÊÚÈÎ¤˜ ·ÓˆÌ·Ï›Â˜8**441615,5

™‡ÌÏÔÎÂ˜ ™∫¶9411413,7

™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË-1122 ∆ÚÈÛˆÌ›Â˜8421413,7

¶ÓÂ˘ÌÔÓÈÎ‹ ˘ÔÏ·Û›·343109,8

¶ÔÏÏ·Ï¤˜ ·ÓˆÌ·Ï›Â˜ (¯ˆÚ›˜ ™∫¶)4251110,8

∂Ì‚Ú˘˚Îﬁ˜ ‡‰Úˆ·˜25187,8

¢È·Ì·ÚÙ›Â˜ ∫¡™13311716,8

™‡ÌÊ˘ÙÂ˜ ‰È·Ù·Ú·¯¤˜

ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡--222 ¢È¿ÊÔÚ·31487,8 ™‡ÓÔÏÔ 502824102

* % ÙÔ˘ Û˘ÓﬁÏÔ˘ ** ·ÚÈıÌﬁ˜ ı·Ó¿ÙˆÓ

¶›Ó·Î·˜ 6. ∂¡£, ¡£, ¢∂¡£ Î·È ¢¡£

ÃÚÔÓÔÏÔÁ›·

(0-28 ËÌ.)¢∂¡£*¢¡£*(0-28 ËÌ.)

¡Ôò¡Ôò¡Ôò¡Ôò

1986-1990 (∞)299/1983315260/1983313,1249/1978312,5215/1978310,8 1991-1995 (µ)117/940512,4104/94051189/93779,582/93778,7 1996-1999 (°)69/69489,964/69489,245/69246,542/69246

* ∞Ê·ÈÚÔ‡ÓÙ·È ÔÈ ı¿Ó·ÙÔÈ ·ﬁ ·Ó·ﬁÙÚÂÙ· ·›ÙÈ·

No: ·ÚÈıÌﬁ˜ ı·Ó¿ÙˆÓ ÚÔ˜ ·ÚÈıÌﬁ ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ

∂¡£: ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÛÈÌﬁÙËÙ·

¡£: ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌﬁÙËÙ·

¢∂¡£: ‰ÈÔÚıˆÌ¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÛÈÌﬁÙËÙ·

¢¡£: ‰ÈÔÚıˆÌ¤ÓË ÓÂÔÁÓÈÎ‹ ıÓËÛÈÌﬁÙËÙ·

·’ fi,ÙÈ ·Ó·Ê¤ÚÂÙ·È ÛÂ ÌÂÏ¤ÙÂ˜ ÚÔËÁÌ¤ÓˆÓ ÎÚ·ÙÒÓ (6,7,9-12). ŒÓ·˜ ÛËÌ·ÓÙÈÎfi˜ ÏfiÁÔ˜ ÁÈ· ÙË ‰È·ÊÔÚ¿ ·˘Ù‹ ıÂˆÚÔ‡ÌÂ fiÙÈ ÔÊÂ›ÏÂÙ·È ÛÂ ˘ÂÚÂÎÙ›ÌËÛË ÙÔ˘ ™∞¢ ÛÙË ÌÂÏ¤ÙË Ì·˜. ∂›Ó·È Èı·Ófi, ÛÂ ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë ·ÈÙ›· ı·Ó¿ÙÔ˘ ·Ô‰fiıËÎÂ ÛÙÔ ™∞¢, Ë ·ÈÙ›· ı·Ó¿ÙÔ˘ Ó· ‹Ù·Ó Û˘ÁÁÂÓ‹˜ ÏÔ›ÌˆÍË, fiˆ˜ Û˘ÁÁÂÓ‹˜ ÓÂ˘ÌÔÓ›·. ªÂÏ¤ÙÂ˜ Ô˘

ÛÙËÚ›¯ıËÎ·Ó ÛÂ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ¿/ÓÂÎÚÔÙÔÌÈÎ¿ Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó ﬁÙÈ Ì¤¯ÚÈ Î·È 60% ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ÔÏ‡ ¯·ÌËÏﬁ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ Ô˘ ¯·Ú·ÎÙËÚ›-

ÛÙËÎ·Ó ÎÏÈÓÈÎ¿ ﬁÙÈ ¤ı·Ó·Ó ·ﬁ ™∞¢, ¤ı·Ó·Ó

ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ·fi Û˘ÁÁÂÓ‹ ÏÔ›ÌˆÍË (13,14). ∞ÎfiÌ·, ÛÙ· ÓÂÔÁÓ¿ ÛÙ· ÔÔ›· ¤ÚÂÂ Ó·

Á›ÓÂÈ ÂÈÏÔÁ‹ ÛÙËÓ ·ÈÙ›· ı·Ó¿ÙÔ˘ ·Ó¿ÌÂÛ· ÛÙÔ

™∞¢ Î·È ÙË ¯ÚﬁÓÈ· ÓÂ˘ÌÔÓÔ¿ıÂÈ·, ÚÔÙÈÌ‹ıËÎÂ

Ë ‰È¿ÁÓˆÛË ÙÔ˘ ™∞¢.

∞ﬁ ÙÈ˜ ™∞, Û˘¯ÓﬁÙÂÚË Î·ÙËÁÔÚ›· ı·Ó¿ÙˆÓ

‹Ù·Ó ÔÈ Û˘ÁÁÂÓÂ›˜ Î·Ú‰ÈÔ¿ıÂÈÂ˜ (™∫¶) ÛÙÈ˜ ÂÚÈfi‰Ô˘˜ ∞ Î·È µ, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÂ ¿ÏÏÂ˜ ÂÚÁ·Û›Â˜ (7,9,10). ™ÙË ° ÂÚ›Ô‰Ô, ÔÈ ı¿Ó·ÙÔÈ ·fi

™∫¶ ÂÏ·ÙÙÒıËÎ·Ó Î·È Û’ ·˘Ùﬁ Èı·ÓﬁÓ Û˘Ó¤‚·ÏÂ Î·È Ë ‰ËÌÈÔ˘ÚÁ›· Î·È ‰Â‡ÙÂÚÔ˘ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈ-

ÎÔ‡ ∫¤ÓÙÚÔ˘ ÛÙËÓ ∂ÏÏ¿‰·, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÙ˘¯¤ÛÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ. ∆· ∂Ãµ° ÓÂÔÁÓ¿ (≤700 g) ·ÔÙÂÏÔ‡Ó ÙËÓ ÙÚ›ÙË Î˘ÚÈﬁÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Û‹ÌÂÚ· ÛÙÔ ∆Ì‹Ì· Ì·˜, ÂÓÒ ÛÙ· ∫¤ÓÙÚ· ÙˆÓ ‚ÈÔÌË¯·ÓÈÎÒÓ ÎÚ·ÙÒÓ Â›Ó·È Ë

‰Â‡ÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÈ˜ ™∞ (7,9,10).

™ÙËÓ Î·ÙËÁÔÚ›· ÙË˜ Û‹„Ë˜ Ô˘ ·ÚÔ˘Û›·ÛÂ

ÂÏ¿ÙÙˆÛË Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘, ÂÚÈÂÏ‹ÊıËÛ·Ó Î·È

ÂÚÈÛÙ·ÙÈÎ¿ ÌÂ ¯ÚﬁÓÈ· ‚·ÚÈ¿ ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÓÂ-

¿ÚÎÂÈ· Î·È ‚·Ú‡Ù·ÙÂ˜ ÂÁÎÂÊ·ÏÈÎ¤˜ ‚Ï¿‚Â˜, ÛÙ·

ÔÔ›· Â›¯Â ·ÔÊ·ÛÈÛÙÂ› Ë ÌË ·ÚÔ¯‹ “ËÚˆÈÎÒÓ Ì¤ÙÚˆÓ” Î·È Ù· ÔÔ›· ÙÂÏÈÎ¿ ¤ı·Ó·Ó “·Ú·ÌÂÏËÌ¤Ó·” ·ﬁ Û‹„Ë.

ÚÔﬁ‰ˆÓ ÛÙËÓ È·ÙÚÈÎ‹ Î·È ÙËÓ ÙÂ¯ÓÔÏÔÁ›· ÛÂ ÔÚÈÛÌ¤Ó· Î¤ÓÙÚ· ‰Â›¯ÓÂÈ ﬁÙÈ ˘¿Ú¯ÂÈ

ÛËÌ·ÓÙÈÎ‹ ‰˘Ó·ÙfiÙËÙ· ÂÏ¿ÙÙˆÛË˜ ÙË˜ ıÓËÛÈÌfiÙËÙ·˜ ÛÂ ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ÓÂÔÁÓÒÓ. ∆Ô ÎfiÛÙÔ˜, fiÌˆ˜, ·fi ÙËÓ ·ÚÔ¯‹ Ù¤ÙÔÈ·˜ ÓÔÛËÏÂ›·˜ Â›Ó·È

ÌÂÁ¿ÏÔ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏÂ›·˜ ÛÙË ª∂¡ Î·È ÛÙË ÌÂÙ¤ÂÈÙ· Ì·ÎÚÔ¯ÚﬁÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË

Î·È ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜. ŒÓ· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·fi ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ∂Ãµ°¡ Ô˘ ÂÈ‚ÈÒÓÔ˘Ó, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌfiÓÈÌÂ˜ ‹ Ì·ÎÚÔ¯ÚfiÓÈÂ˜ ·Ó·-

ËÚ›Â˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ·ÓÙÈÌÂÙÒÈÛË ÛÂ ÂÈ‰ÈÎ¿ Î¤ÓÙÚ·, ¯ˆÚ›˜ Ó· Â›Ó·È ÈÎ·ÓÔÔÈËÙÈÎ‹ Ë ÙÂÏÈÎ‹ ¤Î‚·ÛË ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ (15). °È· ÙÈ˜ ™∞ ¤¯Ô˘Ó ˘¿ÚÍÂÈ Î¿ÔÈÂ˜ ÚfiÔ‰ÔÈ ÛÙË ÌÂ›ˆÛË ÙË˜ ıÓËÛÈÌfiÙËÙ¿˜ ÙÔ˘˜, Î˘Ú›ˆ˜ ÌÂ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ.

∏ ÌÂÁ¿ÏË, ﬁÌˆ˜, ÂÏ¿ÙÙˆÛË ÛÙË ıÓËÛÈÌﬁÙËÙ· Î·È

ÓÔÛËÚfiÙËÙ· ÛÂ ·˘Ù¤˜ ÙÈ˜ ‰‡Ô Î·ÙËÁÔÚ›Â˜ ı·Ó¿ÙÔ˘ ÌÔÚÂ› Ó· Û˘Ì‚Â› ÌfiÓÔ ÌÂ: ·) ÙËÓ ·ÓÂ‡ÚÂÛË ÙÚfiˆÓ ÌÂ›ˆÛË˜ ÙË˜ Á¤ÓÓËÛË˜ ∂Ãµ°¡ Î·È ‚) ÙËÓ ·ÓÂ‡ÚÂÛË Ó¤ˆÓ ÙÂ¯ÓÈÎÒÓ ÚÔÁÂÓÓËÙÈÎ‹˜ ‰È¿ÁÓˆÛË˜ ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ

ÙËÓ Â·ÎﬁÏÔ˘ıË ‰È·ÎÔ‹ ÙË˜ Î‡ËÛË˜.

1. Carver JD, McDermott RJ, Jacobson HN, Sherin KM, Kanarek K, Pimentel B et al. Infant mortality statistics do

not adequately reflect the impact of short gestation. Pediatrics 1993;92:229-232.

2. ∆˙Ô˘Ì¿Î·-ª·ÎÔ‡Ï· Ã. ¶·ÓÂÏÏ‹ÓÈ· ¶ÂÚÈÁÂÓÓËÙÈÎ‹

ŒÚÂ˘Ó· [¢È·ÙÚÈ‚‹ ÁÈ· ÀÊËÁÂÛ›·]. ∞ı‹Ó·: ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; ∞Ú›ÏË˜ 1983.

3. ∆˙Ô˘Ì¿Î·-ª·ÎÔ‡Ï· Ã, §ÂÎ¤·-∫·Ú·Ó›Î· µ, ∫·‚‚·‰›·˜ °, ª·ÙÛ·ÓÈÒÙË˜ ¡. ¢ÂÎ·¤ÓÙÂ ¯ÚfiÓÈ· ÚÔfi‰Ô˘ (19831998): ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· ÛÙË ¯ÒÚ· Ì·˜ Û‹ÌÂÚ·. 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 28-30 ª·˝Ô˘; £ÂÛÛ·ÏÔÓ›ÎË; 1999.

4. ∂ıÓÈÎ‹ ™Ù·ÙÈÛÙÈÎ‹ ÀËÚÂÛ›· ∂ÏÏ¿‰Ô˜. ∆ÂÏÂ˘Ù·›· ÛÙ·ÙÈÛÙÈÎ¿ ‰Â‰ÔÌ¤Ó· 1996 (ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›·).

5. ∞Ó‰Ú¤Ô˘ ∞, °Ô˘‰ÂÛ›‰Ô˘ ª, ª·˘Ú›‰Ë˜ °, ƒÒÛÈÔ˘ ∫, ª·Ï¿ÛÎ· ∞, ¶·Ô‡ÏË ª. £ÓËÛÈÌfiÙËÙ· ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô

£ÂÛÛ·ÏÔÓ›ÎË˜ ÙË 14ÂÙ›· 1986-1999. ¡ÂÔÁÓÔÏÔÁÈÎﬁ ∆Ì‹Ì· ∂™À. ¶·È‰È·ÙÚÈÎ‹ (˘ﬁ ‰ËÌÔÛ›Â˘ÛË).

6. Hein HA, Lofgren MA. The changing pattern of neonatal mortality in a regionalized system of perinatal care: a current update. Pediatrics 1999;104:1064-1069.

7. Hein HA. Evaluation of a rural perinatal care system. Pediatrics 1980;66:540-546.

8. American Academy of Pediatrics, Committee on Fetus and Newborn, American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. Perinatal care at the thresold of viability. Pediatrics 1995;96:974-976.

9. Tenovuo A, Kero P, Piekkala P, Sillanpaa M, Erkkola R. Advances in perinatal care and declining regional neonatal mortality in Finland 1968-82. Acta Pediatr Scand 1986;75:362-369.

10. Philip AGS. Neonatal mortality rate: Is further improvement possible? J Pediatr 1995;126:427-433.

11. Wegman ME. Annual summary of vital statistics. Pediatrics 1993;92:743-754.

12. Horbar JD, Wright EC, Onstad L et al. Decreasing mortality associated with the introduction of surfactant therapy: An observational study of neonates weighing 601 to 1300 grams at birth. Pediatrics 1993;92:191-196.

13. Barton L, Hogman JE, Pavlove Z. Causes of death in the extremely low birth weight infant. Pediatrics 1999;103:446-451.

14. Nakamura Y, Hosokawa Y, Yano H et al. Primary causes of perinatal death: an autopsy study of 1000 cases in Japanese infants. Hum Pathol 1982;13:54-61.

15. Hack M, Friedman H, Fanaroff AA. Outcome of extremely low birth weight infants. Pediatrics 1996;98:931-937.

16. Ruess ML, Gordon HR. Obstetrical judgments of viability and perinatal survival of extremely low birth weight infants. Am J Public Health 1995;85:362-366.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 13-03-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ï¤Í·Ó‰ÚÔ˜ ∞Ó‰Ú¤Ô˘

ÃÂÈÌˆÓ›‰Ô˘ 15, 551 33, ∫·Ï·Ì·ÚÈ¿ E-mail: aalex@spark.net.gr

∞Ó›¯ÓÂ˘ÛË ·ÏÏÂÚÁÈÔÁﬁÓˆÓ ÊÈÛÙÈÎÈÔ‡ ÛÙÔ ÌËÙÚÈÎﬁ Á¿Ï·1

∂ÈÛ·ÁˆÁ‹: ∏ ·ÏÏÂÚÁÈÎ‹ ·ÓÙ›‰Ú·ÛË ÌÂÙ¿ ·ﬁ ÙË ‚ÚÒÛË ÊÈ-

ÛÙÈÎÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ ÚÒÙË Â·Ê‹ ÌÂ

ÙÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. ª›· Èı·Ó‹, ·ÏÏ¿ ·Ó·fi‰ÂÈÎÙË, Ô‰fi˜ ÚÒ-

ÈÌË˜ ¤ÎıÂÛË˜ Î·È Â˘·ÈÛıËÙÔÔ›ËÛË˜ ÛÙÔ ÊÈÛÙ›ÎÈ ·ÔÙÂÏÂ› ÙÔ

ÌËÙÚÈÎﬁ Á¿Ï· Ì¤Ûˆ ÙÔ˘ ıËÏ·ÛÌÔ‡.

™ÎÔfi˜: ™ÎÔfi˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ‰ÈÂÚÂ˘ÓËıÂ› Î·Ù¿ fi-

ÛÔ Ë ÚˆÙÂ˝ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ÌÔÚÂ› Ó· ÂÚ¿ÛÂÈ ÛÙÔ ÌËÙÚÈÎﬁ

Á¿Ï· ÙË˜ ıËÏ¿˙Ô˘Û·˜ ÌËÙ¤Ú·˜.

ÀÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ: 23 ˘ÁÈÂ›˜ ıËÏ¿˙Ô˘ÛÂ˜ ÌËÙ¤ÚÂ˜ ËÏÈÎ›·˜ 21-35 ÂÙÒÓ ·ÔÙ¤ÏÂÛ·Ó ÙÔ ˘ÏÈÎﬁ ÙË˜ ÌÂÏ¤ÙË˜. ∫¿ıÂ ÌËÙ¤Ú·

Î·Ù·Ó¿ÏˆÓÂ 50 g ÊÈÛÙ›ÎÈ· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰Â›ÁÌ·Ù· ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Û˘ÏÏ¤ÁÔÓÙ·Ó ·Ó¿ ÒÚ·. ™Â Î¿ıÂ ‰Â›ÁÌ· Á¿Ï·ÎÙÔ˜ ·ÓÈ¯ÓÂ‡ıËÎÂ ÙÔ ÔÛfi ÙË˜ ÚˆÙÂ˝ÓË˜ ÊÈÛÙÈÎÈÔ‡ Î·ıÒ˜ Î·È 2 Î‡ÚÈ· ·ÏÏÂÚÁÈÔÁfiÓ· Ara h 1 Î·È Ara h 2. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∏ ÚˆÙÂ˝ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ·ÓÈ¯ÓÂ‡ıËÎÂ ÛÂ 11 ·fi ÙÈ˜ 23 ÌËÙ¤ÚÂ˜. ™Â 10 ÌËÙ¤ÚÂ˜ ·ÓÈ¯ÓÂ‡ıËÎÂ 2 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË Î·È ÛÂ Ì›· ÂÓÙfi˜ 6 ˆÚÒÓ. ∏ ‰È¿ÌÂÛË ÙÈÌ‹ ÙË˜ Ì¤ÁÈÛÙË˜ ÔÏÈÎ‹˜ ÚˆÙÂ˝ÓË˜ ÊÈÛÙÈÎÈÔ‡ ÛÙ· ‰Â›ÁÌ·Ù· ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ‹Ù·Ó 200 ng/ml (Ì¤ÛË 222 ng/ml, Â‡ÚÔ˜ 120-430 ng/ml). ∞ÓÈ¯ÓÂ‡ıËÎ·Ó Â›ÛË˜ Î·È Ù· ‰‡Ô Î‡ÚÈ· ·ÏÏÂÚÁÈÔÁfiÓ· Ara h 1 Î·È ∞ra h 2. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÚˆÙÂ˝ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ÌÂÙ¿ ·fi Î·Ù·Ó¿ÏˆÛË ÊÈÛÙÈÎÈÒÓ ·fi ÙË ıËÏ¿˙Ô˘Û· ÌËÙ¤Ú·. ∏ ¤ÎıÂÛË ÛÙËÓ ÚˆÙÂ˝ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÌÔÚÂ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ‚ÚÂÊÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

1Vadas P, Wai Y, Burks W, Perelman B Detection of peanut allergens in breast milk of lactating women JAMA 2001;285:1746-1748

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ·

¶·È‰›·ÙÚÔ˜-°·ÛÙÚÂÓÙÂÚÔÏﬁÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

∂ƒ∂À¡∏∆π∫∏

™˘Û¯¤ÙÈÛË

ÌÂÙ·Í‡ ÙËÏÂı¤·ÛË˜ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁﬁÓÙˆÓ

ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ °. ∫Ô˘Ú›‰Ë˜, ª. ∆ÔÚÓ·Ú›ÙË˜, Ã. ∫Ô˘Ú›‰Ë˜, ™. ™¿‚‚·, Ã. Ã·Ù˙ËÁÂˆÚÁ›Ô˘

The relationship of television viewing to cardiovascular risk factors in children Y. Kourides, M. Tornaritis, C. Kourides, S. Savva, H. Hadjigeorgiou

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ ÙË˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Û˘Û¯¤ÙÈÛË ÙË˜ ˘¤ÚÌÂÙÚË˜ ÙËÏÂı¤·ÛË˜ ÌÂ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 1112 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ªÂÏÂÙ‹ıËÎ·Ó 1337 ·È‰È¿ (703 ·ÁfiÚÈ·, 634 ÎÔÚ›ÙÛÈ·), ·ÛÙÈÎÒÓ (678) Î·È ·ÁÚÔÙÈÎÒÓ (659) ÂÚÈÔ¯ÒÓ ÙË˜ Â·Ú¯›·˜ ¶¿ÊÔ˘, ËÏÈÎ›·˜ 11-12 ÂÙÒÓ, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· Û¯ÔÏÂ›· ·fi ÙÔ ª¿ÚÙÈÔ 1998 Ì¤¯ÚÈ ÙÔÓ πÔ‡ÓÈÔ 1999. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙÔÈ¯Â›· ·fi ÙËÓ ÂÍ¤Ù·ÛË ÙˆÓ ·È‰ÈÒÓ (ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜, ·ÚÙËÚÈ·Î‹ ›ÂÛË, ‰ÔÎÈÌ·Û›Â˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜, ·Ó¿Ï˘ÛË

ËÌÂÚ‹ÛÈÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘, ÏÈÔÚˆÙÂ˝ÓÂ˜, ÏÈ›‰È· Î·È ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜) ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·ÛË˜, Ê˘ÛÈÎ‹˜ ¿ÛÎËÛË˜ Î·È Â‚‰ÔÌ·‰È·›·˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ. ∞Ó¿ÏÔÁ· ÌÂ ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·ÛË˜ Ù· ·È‰È¿

¯ˆÚ›ÛÙËÎ·Ó ÛÂ 3 ÔÌ¿‰Â˜ (1Ë ≤14, 2Ë 15-28 Î·È 3Ë >28 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰·) Î·È ¤ÁÈÓÂ Û‡ÁÎÚÈÛË ÙˆÓ

Ì¤ÛˆÓ ÙÈÌÒÓ ÁÈ· fiÏÂ˜ ÙÈ˜ ·ÓˆÙ¤Úˆ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂ ÙË ‰ÔÎÈÌ·Û›· oneway ANOVA Î·È ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ 3 Î·È 1 ÌÂ ÙË ‰ÔÎÈÌ·Û›· t-test. ¶ÔÛÔÛÙfi 32,6% ÙˆÓ ·ÁÔÚÈÒÓ ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ ÙËÏÂfiÚ·ÛË ≤14 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰·, 51,3% 15-28 ÒÚÂ˜ Î·È 16,1% >28 ÒÚÂ˜. ∆· ·ÓÙ›ÛÙÔÈ¯· ÔÛÔÛÙ¿ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 31,7%, 50,1% Î·È 18,1%. ∆· ·ÁfiÚÈ· ÙË˜ 3Ë˜, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰·, Â›¯·Ó ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (µ™) (43,9 v 41,3 kg, p=0,037), ·˘ÍËÌ¤ÓË ‰ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ (18,4 v 14,7 mm, p<0,001), ‚Ú›ÛÎÔÓÙ·Ó ÛÂ ÌÂÈÔÓÂÎÙÈÎfiÙÂÚË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË ÌÂ ‰›ÏˆÛË ·fi Â‰Ú·›· ı¤ÛË 14,5 v 16,3 cm (p=0,013), Ì¤ÁÈÛÙÔ ·ÚÈıÌfi ÎÔÈÏÈ·ÎÒÓ ÛÂ 30 sec 22,3 v 23,7 (p=0,002) Î·È ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ 4,5 v 5,0 ÛÙ¿‰È· (p=0,012). ∂›¯·Ó ÌÂÈˆÌ¤ÓË HDL-C (58,6 v 62,0 mg/dl, p=0,050) Î·È ·˘ÍËÌ¤Ó· ÙÚÈÁÏ˘ÎÂÚ›‰È·

∂ÚÂ˘ÓËÙÈÎfi Î·È ∂Î·È‰Â˘ÙÈÎfi ¶ÚfiÁÚ·ÌÌ· ÀÁÂ›·˜

Abstract: The purpose of this study was to determine whether there is a relationship between excessive television viewing and certain cardiovascular risk factors in children 11 to12 years of age, in Cyprus. A total of 1337 children (boys 703, girls 634), who were equally distributed in urban to rural areas of Pafos district, were evaluated at their schools between March 1998 through June 1999. The evaluation included anthropometric and arterial blood pressure measurements, physical fitness EUROFIT test, 24-hour dietary recall analysis, and serum glucose and lipid profile. A specific questionnaire was sent at home prior to the day of evaluation, and completed by the parents in regard to physical activity, time spent in television viewing and 1-week’s recording of food consumption. Children were divided into three groups according to time spent in television viewing (Group 1 ≤14, Group 2 14-28, and Group 3 >28 hours/per week). The oneway ANOVA test was used to assess any differences between the three groups, and the student’s t-test for differences between Group 1 and Group 3. The proportion of children in each of the three groups consisted of 32.6% boys and 31.7% girls in Group 1, 51.3% and 50.1% in Group 2 and 16.1% and 18.1% in Group 3 respectively. Boys in Group 3 had a significantly increased weight as compared to Group 1 (43.9 vs 41.3 kg, p=0.037), increased triceps skinfold thickness (18.4 vs 14.7 mm p<0.001), and decreased performance in sit and reach test of flexibility (14.5 vs 16.3 cm, p=0.013), sit ups in 30 sec (22.3 vs 23.7 p=0.002), and 20m shuttle run test (4.5 vs 5.0 stages, p=0.012). They had also decreased HDL-C levels (58.6 vs 62.0 mg/dl,

ÙÔ˘ ¶·È‰ÈÔ‡, ∫‡ÚÔ˜ Research and Education Program for Child’s Health, Cyprus

(67,2 v 60,2 mg/dl, p=0,024). ∆· ÎÔÚ›ÙÛÈ· ÙË˜ 3Ë˜, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰·, Â›¯·Ó ·˘ÍËÌ¤ÓÔ µ™

(44,9 v 42,3 kg, p=0,038), ·˘ÍËÌ¤ÓË ‰ÂÚÌ·ÙÈÎ‹

Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ (19,1 v 16,7 mm, p=0,002), ÌÂÈˆÌ¤ÓË ·ﬁ‰ÔÛË ÛÂ Ì¤ÁÈÛÙÔ ·ÚÈıÌﬁ ÎÔÈÏÈ·ÎÒÓ ÛÂ

30 sec (20,9 v 21,8, p=0,048), ·˘ÍËÌ¤ÓË ÔÏÈÎ‹ ¯Ô-

ÏËÛÙÂÚﬁÏË (169,8 v 163,8 mg/dl, p=0,049) Î·È

LDL-C (96,0 v 89,5 mg/dl, p=0,018). ¶·ÚÔ˘Û›·˙·Ó

ÌÂÈˆÌ¤ÓË HDL-C (56,3 v 60,1 mg/dl, p=0,014) Î·È

·˘ÍËÌ¤ÓÔ ÏfiÁÔ LDL-C/HDL-C (1,82 v 1,56, p<0,001). ∆· ·ÁfiÚÈ·, fiˆ˜ Î·È Ù· ÎÔÚ›ÙÛÈ·, ÙË˜

3Ë˜ ÔÌ¿‰·˜, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë, Î·Ù·Ó¿ÏˆÓ·Ó

ÂÚÈÛÛfiÙÂÚÂ˜ ıÂÚÌ›‰Â˜ ËÌÂÚËÛ›ˆ˜ (·ÁfiÚÈ· 2151 v 1997, p=0,013, ÎÔÚ›ÙÛÈ· 1975 v 1839, p=0,045), ÂÚÈÛÛfiÙÂÚÂ˜ ÛÔÎÔÏ¿ÙÂ˜ ÙËÓ Â‚‰ÔÌ¿‰· (·ÁfiÚÈ· 5,4 v 3,9, p=0,020, ÎÔÚ›ÙÛÈ· 4,0 v 2,9, p=0,013)

Î·È ÂÚÈÛÛfiÙÂÚ· ÔÙ‹ÚÈ· ÎfiÎ·-ÎfiÏ· ÙËÓ Â‚‰ÔÌ¿‰· (·ÁfiÚÈ· 6,0 v 3,5, p=0,003, ÎÔÚ›ÙÛÈ· 3,6 v 2,1, p<0,001). ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ˘¤ÚÌÂÙÚË ÙËÏÂı¤-

·ÛË ÛÙ· ·È‰È¿ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Î·Ú‰È·ÁÁÂÈ·ÎÔ‡˜

·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘. OÈ ·È‰›·ÙÚÔÈ Î·È ÔÈ ˘ﬁÏÔÈÔÈ ÏÂÈÙÔ˘ÚÁÔ› ˘ÁÂ›·˜ ı· Ú¤ÂÈ Ó· ÂÓÙ¿ÍÔ˘Ó

ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Ô‰ËÁÈÒÓ ÚÔÏËÙÈÎ‹˜ È·ÙÚÈÎ‹˜ Î·È ÙÔ˘˜ Î·ÓﬁÓÂ˜ ÛˆÛÙ‹˜ ÙËÏÂı¤·ÛË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÙËÏÂı¤·ÛË, Î·Ú‰È·ÁÁÂÈ·ÎÔ›

ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, ·È‰È¿.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

95% CI95% ﬁÚÈ· ·ÍÈÔÈÛÙ›·˜

µ™µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜

¢∞¶¢È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË

¢∂£¢›ÏˆÛË ·ﬁ Â‰Ú·›· ı¤ÛË

¢ª™¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜

¢¶∆¢ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘

HDL-CÃÔÏËÛÙÂÚﬁÏË ˘„ËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ

∫¶∫∫·Ú‰È·ÁÁÂÈ·ÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘

LDL-CÃÔÏËÛÙÂÚﬁÏË ¯·ÌËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ

ª∞∫ª¤ÁÈÛÙÔ˜ ·ÚÈıÌﬁ˜ ÎÔÈÏÈ·ÎÒÓ ÛÂ 30 sec

ª™ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜

¶∆∞¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜

™∞¶™˘ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË

TCOÏÈÎ‹ ¯ÔÏËÛÙÂÚﬁÏË

TG∆ÚÈÁÏ˘ÎÂÚ›‰È· Ã∆ÃÚﬁÓÔ˜ ÙËÏÂı¤·ÛË˜ (ÛÂ ÒÚÂ˜ ·Ó¿ Â‚‰ÔÌ¿‰·)

∂ÈÛ·ÁˆÁ‹

ÈÛ¯·ÈÌÈÎ‹ Î·Ú‰ÈÔ¿ıÂÈ· ·ÔÙÂÏÂ› ÙËÓ Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙÈ˜ ·Ó·Ù˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜. ∏ ·ıËÚoÛÎÏ‹ÚˆÛË, Û‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·

ÂÚÂ˘ÓÒÓ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚﬁÓˆÓ, ·Ú¯›˙ÂÈ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È ÌÂ ‚Ú·‰Â›· ÂÍ¤ÏÈÍË Î·Ù·Ï‹ÁÂÈ

ÛÙË ÛÙÂÊ·ÓÈ·›· ÓﬁÛÔ (1,2). ¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘

p=0.050), and increased triglyceride levels (67.2 vs 60.2 mg/dl, p=0.024). Girls in Group 3 had increased weight as compared to Group 1 (44.9 vs 42.3 kg, p=0.038), increased triceps skinfold thickness (19.1 vs 16.7 mm, p=0.002), decreased performance in sit ups in 30 sec (20.9 vs 21.8, p=0.048), increased serum total cholesterol (169.8 vs 163.8 mg/dl, p=0.049) and LDL-C levels (96.0 vs 89.5 mg/dl, p=0.018), decreased HDL-C levels (56.3 vs 60.1 mg/dl, p=0.014), and increased LDL-C/HDL-C ratio (1.82 vs 1.56, p<0.001). Both boys and girls in Group 3 consumed more calories per day in relation to Group 1 (boys 2151 vs 1997 kcal, p=0.013, girls 1975 vs 1839 kcal, p=0.045), more chocolates per week (boys 5.4 vs 3.9, p=0.020, girls 4.0 vs 2.9, p=0.013), and more cola-type soft drinks per week (boys 6.0 vs 3.5, p=0.003, girls 3.6 vs 2.1, p<0.001). In conclusion, excessive television viewing is associated with an increase in the prevalence of certain cardiovascular risk factors in children. Pediatricians and other health care professionals should instruct children and their caregivers on the proper rules on television viewing.

Key words: television viewing, cardiovascular risk factors, children.

ﬁˆ˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈÈ‰›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ, Ë ·ÚÙËÚÈ·Î‹ ˘¤ÚÙ·ÛË, Ë ·¯˘Û·ÚÎ›·, Ë

ÌÂÈˆÌ¤ÓË Ê˘ÛÈÎ‹ ¿ÛÎËÛË, ÙÔ Î¿ÓÈÛÌ·, Ô Û·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜ Î·È Ë ÎÏËÚÔÓÔÌÈÎfiÙËÙ· Û˘Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ÌÂ ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË (36). ∞fi ÙÈ˜ ÌÂÏ¤ÙÂ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ ÚÔÎ‡ÙÂÈ fiÙÈ ÛÙ· ·È‰È¿ ·Ú·ÙËÚÂ›Ù·È ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ (∫¶∫), fi¯È ÌfiÓÔ ÛÂ ÔÏÏ¤˜ ÚÔËÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ (7,8) ·ÏÏ¿ Î·È ÛÙËÓ ∫‡ÚÔ (9,10). π‰È·›ÙÂÚ· ÛÙËÓ ¶¿ÊÔ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÙË˜ ·¯˘Û·ÚÎ›·˜, ·ÊÔ‡ Ì¤Û· ÛÂ 7,5 ¯ÚfiÓÈ· (1990-91 Ì¤¯ÚÈ 1998) Ù· ·È‰È¿ ËÏÈÎ›·˜ 11 ÂÙÒÓ ÂÌÊ·Ó›˙Ô˘Ó ·‡ÍËÛË ÙË˜ ‰ÂÚÌ·ÙÈÎ‹˜ Ù˘¯‹˜ ÙÚÈÎÂÊ¿ÏÔ˘ (¢¶∆) Î·Ù¿ 25% (11,12).

∂ÈÏ¤ÔÓ, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÔÏÏÒÓ Î·Ó·ÏÈÒÓ ÙËÏÂfiÚ·ÛË˜ Ô˘ ÂÎ¤ÌÔ˘Ó ÛÂ 24ˆÚË ‚¿ÛË, ÔÏÏ¿ ·È‰È¿ ·ÊÈÂÚÒÓÔ˘Ó 4 ‹ ÂÚÈÛÛfiÙÂÚÂ˜ ÒÚÂ˜ ËÌÂÚËÛ›ˆ˜ ·Ú·ÎÔÏÔ˘ıÒÓÙ·˜ ÙËÏÂfiÚ·ÛË (1316). ∏ ˘¤ÚÌÂÙÚË ÙËÏÂı¤·ÛË ·fi Ù· ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ¤¯ÂÈ Û˘Ó‰ÂıÂ› ÌÂ ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù· ˘ÁÂ›·˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ï·‚ÂÚ¤˜ ‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ (17-19), ÌÂÈˆÌ¤ÓË Ê˘ÛÈÎ‹ ¿ÛÎËÛË (20,21), ·¯˘Û·ÚÎ›·

ÙˆÓ ÙÚÈÁÏ˘ÎÂÚÈ‰›ˆÓ (TG) ¤ÁÈÓÂ ÌÂ ÂÓ˙˘ÌÈÎ‹ ¯ÚˆÌ·ÙÔÌÂÙÚÈÎ‹

Ì¤ıÔ‰Ô (33,34) Î·È ÙË˜ ¯ÔÏËÛÙÂÚﬁÏË˜ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (∏DL-C) ÌÂ ¿ÌÂÛË Ì¤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈÒ-

ÓÙ·˜ ÔÏ˘ÌÂÚ‹ (35). ∏ ¯ÔÏËÛÙÂÚﬁÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓﬁÙË-

Ù·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL-C) ˘ÔÏÔÁ›ÛÙËÎÂ ·ﬁ ÙÔÓ Ù‡Ô:

LDL-C=TC-(HDL-C+TG/5) (36).

∆Ô ÂÚÁ·ÛÙ‹ÚÈÔ ¤¯ÂÈ ÙfiÛÔ ÂÛˆÙÂÚÈÎfi (beringer, local), fiÛÔ Î·È ÂÍˆÙÂÚÈÎfi ÙÚÈÏfi ¤ÏÂÁ¯Ô ÔÈfiÙËÙ·˜ ÌÂ ÚÔÙ˘ÔÔ›ËÛË ÙË˜ ªurex, ÙÔ˘ International EQAS, WHO Î·È ÙÔ˘ ∂™∂∞¶ (∂ıÓÈÎfi ™‡ÛÙËÌ· ∂ÍˆÙÂÚÈÎ‹˜ ∞ÍÈÔÏfiÁËÛË˜ ¶ÔÈfiÙËÙ·˜ ·Ô-

ÙÂÏÂÛÌ¿ÙˆÓ ÛÙËÓ ÎÏÈÓÈÎ‹ ¯ËÌÂ›·, ∂˘·ÁÁÂÏÈÛÌﬁ˜, ∞ı‹Ó·).

™Ù·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË

ŸÏ· Ù· ÛÙÔÈ¯Â›· ÙˆÓ ·È‰ÈÒÓ ÌË¯·ÓÔÁÚ·Ê‹ıËÎ·Ó ÛÙÔ

ÚﬁÁÚ·ÌÌ· Epi Info 6 (CDC USA, WHO) Î·È ÌÂÙ·Ê¤ÚıËÎ·Ó

ÁÈ· ÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË ÛÙÔ ÚﬁÁÚ·ÌÌ· SPSS.

ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ÛÙÔÈ¯Â›· ·ﬁ ÙËÓ ÂÍ¤Ù·ÛË ÙˆÓ ·È-

‰ÈÒÓ (ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÈ˜, ·ÚÙËÚÈ·Î‹ ›ÂÛË, ‰ÔÎÈÌ·Û›Â˜ Ê˘ÛÈ-

Î‹˜ Î·Ù¿ÛÙ·ÛË˜, ·Ó¿Ï˘ÛË ËÌÂÚ‹ÛÈÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘, ÏÈÔ-

ÚˆÙÂ˝ÓÂ˜, ÏÈ›‰È· Î·È ÁÏ˘Îﬁ˙Ë ·›Ì·ÙÔ˜) ÛÂ Û˘Ó‰˘·ÛÌﬁ ÌÂ

ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈÎ¿ ÌÂ ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·ÛË˜, Ê˘ÛÈÎ‹˜ ¿ÛÎËÛË˜ Î·È Â‚‰ÔÌ·‰È·›·˜ Î·Ù·Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ. ∞Ó¿ÏÔÁ· ÌÂ ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·ÛË˜, Ù· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó ÛÂ 3 ÔÌ¿-

‰Â˜ (1Ë ≤14 ÒÚÂ˜, 2Ë 15-28 Î·È 3Ë >28 ÒÚÂ˜ ·Ó¿ Â‚‰ÔÌ¿‰·), ÍÂ¯ˆÚÈÛÙ¿ ÁÈ· ·ÁﬁÚÈ· Î·È ÎÔÚ›ÙÛÈ· Î·È ¤ÁÈÓÂ Û‡ÁÎÚÈÛË

ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÁÈ· ﬁÏÂ˜ ÙÈ˜ ·ÓˆÙ¤Úˆ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂ ÙË

‰ÔÎÈÌ·Û›· oneway ANOVA Î·È ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ 3 Î·È 1 ÌÂ

ÙË ‰ÔÎÈÌ·Û›· t-test.

∞ÔÙÂÏ¤ÛÌ·Ù·

∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·ﬁ ÙË Û‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÙˆÓ 3 ÔÌ¿‰ˆÓ ÙËÏÂı¤·ÛË˜ ÌÂ ÙË ‰ÔÎÈÌ·Û›· oneway ANOVA Î·È ÌÂÙ·Í‡ ÙˆÓ ÔÌ¿‰ˆÓ 3 Î·È 1 ÌÂ

ÙË ‰ÔÎÈÌ·Û›· t-test ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1

ÁÈ· Ù· ·ÁfiÚÈ· Î·È ÛÙÔÓ ¶›Ó·Î· 2 ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ¶ÔÛÔÛÙfi 32,6% ÙˆÓ ·ÁÔÚÈÒÓ ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ ÙËÏÂfiÚ·ÛË ≤14 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰·, 51,3% 15-28 ÒÚÂ˜ Î·È 16,1% >28 ÒÚÂ˜. ∆· ·ÓÙ›ÛÙÔÈ¯·

ÔÛÔÛÙ¿ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 31,7%, 50,1% Î·È 18,1%. O Ì¤ÛÔ˜ ¯ÚﬁÓÔ˜ ÙËÏÂı¤·ÛË˜ ÛÙ· ·ÁﬁÚÈ· ‹Ù·Ó 19,2 Î·È ÛÙ· ÎÔÚ›ÙÛÈ· 20,3 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰· (p=0,035), ÛÙÈ˜ ·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ 18,6 Î·È ÛÙÈ˜ ·ÁÚÔÙÈÎ¤˜ 20,9 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰· (p<0,001). O

¶›Ó·Î·˜ 1. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÁÔÚÈÒÓ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ¯ÚﬁÓÔ ÙËÏÂı¤·ÛË˜ (Ì¤ÛË ÙÈÌ‹, 95% ﬁÚÈ· ·ÍÈÔÈÛÙ›·˜)

¶·Ú¿ÌÂÙÚÔ˜¡Ã∆≤14 ÒÚÂ˜/Â‚‰.Ã∆=15-28 ÒÚÂ˜/Â‚‰.Ã∆>28 ÒÚÂ˜/Â‚‰.P*P** °ÂÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿

∞ÁﬁÚÈ· (N)703229 (32,6%)361 (51,3%)113 (16,1%)

∞ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜361134 (37,1%)189 (52,3%)38 (10,5%)

∞ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜ 34295 (27,8%)172 (50,3%)75 (21,9%)

∏ÏÈÎ›· (¤ÙË)70311,5 (11,4-11,6)11,6 (11,5-11,6)11,7 (11,6-11,8)0,0120,018

∆Ú›¯ˆÛË ÂÊË‚·›Ô˘7022,4 (2,3-2,5)2,4 (2,4-2,5)2,5 (2,3-2,6)NSNS

ÃÚﬁÓÔ˜ ÙËÏÂı¤·ÛË˜70310,4 (10,0-10,7)20,1 (19,7-20,6)34,4 (33,4-35,3)<0,001<0,001

Ã∆ ·Ù¤Ú·23411,1 (9,7-12,4)13,1 (11,7-14,6)15,5 (10,9-20,2)0,0400,013

Ã∆ ÌËÙ¤Ú·˜23812,4 (10,7-14,1)12,8 (11,4-14,2)15,4 (11,3-19,6)NSNS

µ™ (kg)70041,3 (39,9-42,6)41,5 (40,4-42,6)43,9 (41,7-46,1)NS0,037

¢ª™ (kg/m2) 70018,7 (18,3-19,2)18,9 (18,5-19,3)19,5 (18,8-20,3)NSNS

¢¶∆ (mm)69814,7 (13,8-15,6)15,4 (14,7-16,1)18,4 (16,9-20,0)<0,001<0,001

™∞¶ (mmHg)703114,5 (112,8-116,2)113,7 (112,6-114,9)113,0 (110,9-115,1)NSNS

¢∞¶ (mmHg)70374,3 (73,1-75,6)74,1 (73,2-75,1)72,3 (70,8-73,9)NSNS

º˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË

¢∂£ (cm)69216,3 (15,5-17,1)15,8 (15,1-16,5)14,5 (13,4-15,6)0,0560,013

∞ªÃº (cm)697153,6 (150,9-156,4)153,4 (151,0-155,7)150,0 (145,7-154,3)NSNS

ª∞∫ 69523,7 (23,2-24,2)23,3 (22,9-23,8)22,3 (21,5-23,1)0,0120,002

¶∆∞ (ÛÙ¿‰È·)6935,0 (4,8-5,3)4,9 (4,7-5,1)4,5 (4,1-4,9)0,0450,012 ∂ÚÁ·ÛÙËÚÈ·Î¤˜

ÂÍÂÙ¿ÛÂÈ˜

TC (mg/dl)691170,6 (166,7-174,5)171,1 (168,0-174,2)172,1 (166,9-177,2)NSNS

HDL-C (mg/dl)69162,0 (60,2-63,8)61,7 (60,1-63,2)58,6 (55,5-61,7)NS0,050

LDL-C (mg/dl)69195,9 (92,4-99,4)94,8 (91,9-97,8)96,7 (92,0-101,4)NSNS

LDL-C/HDL-C6911,63 (1,55-1,71)1,65 (1,58-1,72)1,78 (1,65-1,90)NS0,052

TG (mg/dl)69160,2 (56,7-63,7)63,9 (60,8-66,9)67,2 (62,0-72,3)NS0,024

°Ï˘Îﬁ˙Ë (mg/dl)69082,8 (81,7-83,8)81,7 (80,9-82,5)81,5 (80,1-82,9)NSNS

P*= Oneway ANOVA, P**= ™‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÔÌ¿‰ˆÓ 1 Î·È 3 ÌÂ ÙÔ t-test

∆Ú›¯ˆÛË ÂÊË‚·›Ô˘ ÛÂ ÛÙ¿‰È· Tanner, Ã∆= ÃÚﬁÓÔ˜ ÙËÏÂı¤·ÛË˜ ÛÂ ÒÚÂ˜ ·Ó¿ Â‚‰ÔÌ¿‰·

µ™= µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ¢ª™= ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¢¶∆= ¢ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ ™∞¶ Î·È ¢∞¶= ™˘ÛÙÔÏÈÎ‹ Î·È ¢È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ¢∂£= ¢›ÏˆÛË ·ﬁ Â‰Ú·›· ı¤ÛË

∞ªÃº= ÕÏÌ· ÛÂ Ì‹ÎÔ˜ ¯ˆÚ›˜ ÊÔÚ¿, ª∞∫= ª¤ÁÈÛÙÔ˜ ·ÚÈıÌﬁ˜

¶∆∞= ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, TC= OÏÈÎ‹ ¯ÔÏËÛÙÂÚﬁÏË

HDL-C= ÃÔÏËÛÙÂÚﬁÏË ˘„ËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ

ÛÂ 30 sec

LDL-C= ÃÔÏËÛÙÂÚﬁÏË ¯·ÌËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ, TG= ∆ÚÈÁÏ˘ÎÂÚ›‰È·

¯ÚfiÓÔ˜ ÙËÏÂı¤·ÛË˜ ÛÙ· ·ÁfiÚÈ· Û˘Û¯ÂÙÈ˙fiÙ·Ó ÌÂ

ÙÔ Ã∆ ÙˆÓ ·Ù¤ÚˆÓ (p=0,040) Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ

ÌÂ ÙÔ Ã∆ ÙˆÓ ÌËÙ¤ÚˆÓ (p=0,037).

OÈ ‰Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ‹Ù·Ó ·˘ÍËÌ¤ÓÔÈ ÛÙ·

·È‰È¿ ÌÂ ·˘ÍËÌ¤ÓË ÙËÏÂı¤·ÛË. ∆· ·ÁﬁÚÈ· ÙË˜ 3Ë˜

ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· Â›¯·Ó ·˘ÍËÌ¤ÓÔ ‚¿ÚÔ˜

ÛÒÌ·ÙÔ˜ (43,9 kg, 95% ﬁÚÈ· ·ÍÈÔÈÛÙ›·˜ (CI): 41,7-46,1 v 41,3 kg, CI: 39,9-42,6, p=0,037) Î·È ·˘-

ÍËÌ¤ÓË ‰ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎ¤Ê·ÏÔ˘ (18,4 mm, CI: 16,9-20,0 v 14,7 mm, CI: 13,8-15,6, p<0,001), ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ÛÙÔ ¢ª™ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛË-

Ì·ÓÙÈÎ‹. ¶·ÚﬁÌÔÈÂ˜ ‰È·ÊÔÚ¤˜ ·ÚÔ˘Û›·˙·Ó Î·È Ù·

ÎÔÚ›ÙÛÈ·. ∏ 3Ë, ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰·, Â›¯Â ·˘ÍËÌ¤ÓÔ µ™ (44,9 kg, CI: 42,9-47,0 v 42,3 kg, CI: 40,9-43,7, p=0,038) Î·È ·˘ÍËÌ¤ÓË ¢¶∆ (19,1 mm, CI: 17,7-20,5 v 16,7 mm, CI: 15,8-17,6, p=0,002).

∏ ·ÚÙËÚÈ·Î‹ ›ÂÛË ÛÙ· ·ÁﬁÚÈ· ‰ÂÓ ·ÚÔ˘Û›·˙Â ‰È·ÊÔÚ¤˜, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· Ë ¢∞¶ ‹Ù·Ó ÌÂÈˆÌ¤ÓË ÛÙËÓ ÔÌ¿‰· ÌÂ ·˘ÍËÌ¤ÓË ÙËÏÂı¤·ÛË.

·ÁﬁÚÈ· ÌÂ ·˘ÍËÌ¤ÓË ÙËÏÂı¤·ÛË ‚Ú›ÛÎÔÓÙ·Ó

ÛÂ ÌÂÈÔÓÂÎÙÈÎﬁÙÂÚË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË. ∏ 3Ë ÛÂ

Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· Î·Ù¿ÊÂÚÓÂ ÛÙË ‰›ÏˆÛË

·ﬁ Â‰Ú·›· ı¤ÛË 14,5 cm, CI: 13,4-15,6 v 16,3 cm CI: 15,5-17,1 (p=0,013), Ì¤ÁÈÛÙÔ ·ÚÈıÌﬁ ÎÔÈÏÈ·ÎÒÓ

ÛÂ 30 sec (ª∞∫) 22,3, CI: 21,5-23,1 v 23,7, CI: 23,2-24,2 (p=0,002) Î·È ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ-

¯‹˜ 4,5 ÛÙ¿‰È·, CI: 4,1-4,9 v 5,0 ÛÙ¿‰È·, CI: 4,8-5,3 (p=0,012). ∆· ÎÔÚ›ÙÛÈ· ·ÚÔ˘Û›·˙·Ó ÌÈÎÚﬁÙÂÚÂ˜

‰È·ÊÔÚ¤˜ Î·È ÌﬁÓÔ ÛÙÔ ª∞∫ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈÎ¿

ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿. ∏ 3Ë ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· ¤Î·ÓÂ 20,9, CI: 20,2-21,7 v 21,8, CI: 21,3-22,3

ÎÔÈÏÈ·ÎÔ‡˜ ÛÂ 30 sec (p=0,048). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÈ˜

·Ó·ÊÂÚﬁÌÂÓÂ˜ ÒÚÂ˜ Î·È ÙË Û˘¯ÓﬁÙËÙ· Ê˘ÛÈÎ‹˜

¿ÛÎËÛË˜ ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜ ÌÂÙ·Í‡ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÙËÏÂı¤·ÛË˜.

·È‰È¿ ÌÂ ·˘ÍËÌ¤ÓË ÙËÏÂı¤·ÛË, Î˘Ú›ˆ˜ Ù· ÎÔÚ›ÙÛÈ·, Â›¯·Ó ‰˘ÛÌÂÓ¤ÛÙÂÚ· Â›Â‰· ¯ÔÏËÛÙÂÚﬁ-

Î·È ÏÈÈ‰›ˆÓ Î·È Î·ÌÈ¿ ÌÂÙ·‚ÔÏ‹ ÛÙË ÁÏ˘Îﬁ˙Ë.

¶›Ó·Î·˜ 2. Ã·Ú·ÎÙËÚÈÛÙÈÎ¿ ÎÔÚÈÙÛÈÒÓ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ¯ÚﬁÓÔ ÙËÏÂı¤·ÛË˜ (Ì¤ÛË ÙÈÌ‹, 95% ﬁÚÈ· ·ÍÈÔÈÛÙ›·˜)

¶·Ú¿ÌÂÙÚÔ˜¡Ã∆≤14 ÒÚÂ˜/Â‚‰.Ã∆=15-28 ÒÚÂ˜/Â‚‰.Ã∆>28 ÒÚÂ˜/Â‚‰.P*P** °ÂÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿

∫ÔÚ›ÙÛÈ· (N)634201 (31,7%)318 (50,1%)115 (18,1%)

∞ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜317110 (34,7%)160 (50,5%)47 (14,8%)

∞ÁÚÔÙÈÎ¤˜ ÂÚÈÔ¯¤˜31791 (28,7%)146 (46,0%)68 (21,4%)

∏ÏÈÎ›· (¤ÙË)63411,5 (11,5-11,6)11,6 (11,5-11,6)11,6 (11,5-11,7)NSNS

∆Ú›¯ˆÛË ÂÊË‚·›Ô˘6263,1 (3,0-3,2)3,2 (3,1-3,3)3,3 (3,2-3,5)NS0,036

ª·ÛÙÔ›6273,0 (2,9-3,1)3,0 (2,9-3,1)3,0 (2,9-3,1)NSNS

ÃÚﬁÓÔ˜ ÙËÏÂı¤·ÛË˜63410,6 (10,2-10,9)20,6 (20,2-21,0)36,9 (35,4-38,3)<0,001<0,001

Ã∆ ·Ù¤Ú·21910,9 (9,1-12,6)11,7 (10,3-13,1)13,7 (9,8-17,5)NSNS

Ã∆ ÌËÙ¤Ú·˜2309,7 (8,3-11,2)12,1 (10,7-13,4)13,6 (9,6-17,5)0,0370,028

™ˆÌ·ÙÔÌÂÙÚÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿

µ™ (kg)63342,3 (40,9-43,7)44,0 (42,8-45,2)44,9 (42,9-47,0)NS0,038

¢ª™ (kg/m2) 63318,7 (18,2-19,2)19,2 (18,8-19,6)19,4 (18,7-20,1)NSNS

¢¶∆ (mm)63016,7 (15,8-17,6)17,8 (17,1-18,6)19,1 (17,7-20,5)0,0080,002

™∞¶ (mmHg)630115,6 (114,1-117,1)114,8 (113,5-116,2)113,6 (111,2-115,9)NSNS

¢∞¶ (mmHg)62977,0 (75,7-78,2)75,5 (74,5-76,6)74,5 (72,8-76,2)NS0,021

Î·Ù¿ÛÙ·ÛË

¢∂£ (cm)62918,2 (17,2-19,2)18,4 (17,6-19,2)17,3 (16,0-18,6)NSNS

∞ªÃº (cm)629141,1 (138,3-144,0)141,2 (138,8-143,6)139,9 (135,8-144,0)NSNS

ª∞∫ 62521,8 (21,3-22,3)21,4 (20,9-21,8)20,9 (20,2-21,7)NS0,048

¶∆∞ (ÛÙ¿‰È·)6153,5 (3,2-3,7)3,5 (3,4-3,7)3,5 (3,2-3,8)NSNS

TC (mg/dl)625163,8 (160,3-167,3)166,7 (163,7-169,7)169,8 (164,7-174,9)NS0,049

HDL-C (mg/dl)62560,1 (58,3-61,9)57,7 (56,1-59,2)56,3 (53,7-58,8)0,0350,014

LDL-C (mg/dl)62589,5 (86,3-92,7)93,4 (90,7-96,1)96,0 (91,5-100,4)0,0510,018

LDL-C/HDL-C6251,56 (1,49-1,64)1,72 (1,65-1,79)1,82 (1,69-1,94)0,001<0,001

TG (mg/dl)62570,5 (66,1-74,9)71,9 (68,5-72,2)76,7 (69,2-84,3)NSNS

°Ï˘Îﬁ˙Ë (mg/dl)62480,7 (79,6-81,8)80,6 (79,7-81,4)80,8 (79,2-82,4)NSNS

P*= Oneway ANOVA, P**= ™‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÔÌ¿‰ˆÓ 1 Î·È 3 ÌÂ ÙÔ t-test

∆Ú›¯ˆÛË ÂÊË‚·›Ô˘ Î·È Ì·ÛÙÔ› ÛÂ ÛÙ¿‰È· Tanner, Ã∆= ÃÚﬁÓÔ˜ ÙËÏÂı¤·ÛË˜ ÛÂ ÒÚÂ˜ ·Ó¿ Â‚‰ÔÌ¿‰·

µ™= µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ¢ª™= ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¢¶∆= ¢ÂÚÌ·ÙÈÎ‹ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘

™∞¶ Î·È ¢∞¶= ™˘ÛÙÔÏÈÎ‹ Î·È ¢È·ÛÙÔÏÈÎ‹ ·ÚÙËÚÈ·Î‹ ›ÂÛË, ¢∂£= ¢›ÏˆÛË ·fi Â‰Ú·›· ı¤ÛË ∞ªÃº= ÕÏÌ· ÛÂ Ì‹ÎÔ˜ ¯ˆÚ›˜ ÊÔÚ¿, ª∞∫= ª¤ÁÈÛÙÔ˜ ·ÚÈıÌfi˜ ÎÔÈÏÈ·ÎÒÓ ÛÂ 30 sec ¶∆∞= ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, TC= OÏÈÎ‹ ¯ÔÏËÛÙÂÚfiÏË

HDL-C= ÃÔÏËÛÙÂÚﬁÏË ˘„ËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ

LDL-C= ÃÔÏËÛÙÂÚﬁÏË ¯·ÌËÏ‹˜ ˘ÎÓﬁÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ, TG= ∆ÚÈÁÏ˘ÎÂÚ›‰È·

∆· ·ÁﬁÚÈ· ÙË˜ 3Ë˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· Â›-

¯·Ó ÌÂÈˆÌ¤ÓË HDL-C (58,6 mg/dl, CI: 55,5-61,7 v 62,0 mg/dl, CI: 60,2-63,8, p=0,050) Î·È ·˘ÍËÌ¤Ó·

ÙÚÈÁÏ˘ÎÂÚ›‰È· (67,2 mg/dl, CI: 62,0-72,3 v 60,2 mg/dl, CI: 56,7-63,7, p=0,024). ∆· ÎÔÚ›ÙÛÈ· ÙË˜

3Ë˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· Â›¯·Ó ·˘ÍËÌ¤ÓË

ÔÏÈÎ‹ ¯ÔÏËÛÙÂÚﬁÏË (169,8 mg/dl, CI: 164,7-174,9 v 163,8 mg/dl, CI: 160,3-167,3, p=0,049) Î·È LDLC (96,0 mg/dl, CI: 91,5-100,4 v 89,5 mg/dl, CI: 86,3-92,7, p=0,018), ÌÂÈˆÌ¤ÓË HDL-C (56,3 mg/dl, CI: 53,7-58,8 v 60,1 mg/dl, CI: 58,3-61,9, p=0,014)

Î·È ·˘ÍËÌ¤ÓÔ ÏﬁÁÔ LDL-C/HDL-C (1,82, CI: 1,691,94 v 1,56, CI: 1,49-1,64, p<0,001).

OÈ ‰È·ÊÔÚ¤˜ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË ÌÂÚÈÎÒÓ ‰È·-

ÙÚÔÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ Ô˘ ·Ó·Ï‡ıËÎ·Ó ·ﬁ ÙÔ ‰È·È-

ÙÔÏﬁÁÈÔ Ì›·˜ ËÌ¤Ú·˜, ‹ ÙË˜ Â‚‰ÔÌ·‰È·›·˜ Î·Ù·-

Ó¿ÏˆÛË˜ ÙÚÔÊ›ÌˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î·

3. ∞Ó Î·È ÁÈ· Ù· ÂÚÈÛÛﬁÙÂÚ· ‰ÂÓ ˘‹Ú¯·Ó ÛÙ·ÙÈ-

ÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ¤˜ ‰È·ÊÔÚ¤˜, Ù· ·ÁﬁÚÈ·, ﬁˆ˜ Î·È

Ù· ÎÔÚ›ÙÛÈ·, ÙË˜ 3Ë˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· Î·Ù·Ó¿ÏˆÓ·Ó ÂÚÈÛÛfiÙÂÚÂ˜ ıÂÚÌ›‰Â˜ ËÌÂÚËÛ›ˆ˜ (·ÁfiÚÈ· 2151, CI: 2045-2257 v 1997, CI: 19352059, p=0,009, ÎÔÚ›ÙÛÈ· 1975, CI: 1886-2064 v 1839, CI: 1774-1905, p=0,015), ÂÚÈÛÛfiÙÂÚÂ˜ ÛÔÎÔÏ¿ÙÂ˜ ÙËÓ Â‚‰ÔÌ¿‰· (·ÁfiÚÈ· 5,4, CI: 4,1-6,7 v 3,9, CI: 3,4-4,4, p=0,016, ÎÔÚ›ÙÛÈ· 4,0, CI: 3,1-5,0 v 2,9, CI: 2,5-3,2, p=0,004) Î·È ÂÚÈÛÛfiÙÂÚ· ÔÙ‹ÚÈ· ÎfiÎ·-ÎfiÏ· ÙËÓ Â‚‰ÔÌ¿‰· (·ÁfiÚÈ· 6,0, CI: 3,6-8,3 v 3,5, CI: 2,9-4,1, p=0,003, ÎÔÚ›ÙÛÈ· 3,6, CI: 2,7-4,6 v 2,1, CI: 1,8-2,4, p<0,001). ∂›ÛË˜, Ù· ÎÔÚ›ÙÛÈ· ¤ÙÚˆÁ·Ó ÂÚÈÛÛfiÙÂÚ· Û·ÎÔ˘Ï¿ÎÈ· ÙÛÈ˜ ÙËÓ Â‚‰ÔÌ¿‰· (3,9, CI: 3,1-4,7 v 2,8, CI: 2,4-3,3, p=0,018).

™˘˙‹ÙËÛË ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ÙË˜ Â·Ú¯›·˜ ¶¿ÊÔ˘ (67,4% ÙˆÓ ·ÁÔÚÈÒÓ Î·È 68,2% ÙˆÓ ÎÔÚÈÙÛÈÒÓ) ·Ú·ÎÔÏÔ˘ıÂ› ÙËÏÂﬁÚ·ÛË ¤Ú·Ó ·ﬁ Ù·

ÂÈÙÚÂÙ¿ ﬁÚÈ· ÙˆÓ 1-2 ˆÚÒÓ ËÌÂÚËÛ›ˆ˜ (37). ∏

˘¤ÚÌÂÙÚË ÙËÏÂı¤·ÛË ÛÙ· ·È‰È¿ Â›Ó·È ¯·Ú·ÎÙË-

ÚÈÛÙÈÎﬁ Î·È ÛÂ ¿ÏÏÂ˜ ÂÚÈÔ¯¤˜, ·ÊÔ‡ ÛÙËÓ ∂ÏÏ¿‰·

Ô Ì¤ÛÔ˜ Ã∆ ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 7-12 ÂÙÒÓ Â›Ó·È 24,8 ÒÚÂ˜ ÙËÓ Â‚‰ÔÌ¿‰· (13-15) Î·È ÛÙÈ˜ ∏¶∞ Ô Ì¤ÛÔ˜ Ã∆ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Â›Ó·È 3 ÒÚÂ˜ ËÌÂÚËÛ›ˆ˜ (37).

¢ÈÂÚÂ˘Ó‹ıËÎ·Ó 5 Î·ÙËÁÔÚ›Â˜ ·Ú·ÁﬁÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Î·Ú‰È·ÁÁÂÈ·Î¿ ÓÔÛ‹Ì·Ù·: ·¯˘Û·ÚÎ›·, ·ÚÙËÚÈ·Î‹ ›ÂÛË, ¿ÛÎËÛË-Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË, Â›-

Â‰· Û·Î¯¿ÚÔ˘ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ. °È· ÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË Î·È Ù· Â›Â‰· Û·Î¯¿ÚÔ˘ ‰ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜, ÂÎÙfi˜ ·fi ˘ÂÚÔ¯‹ ÙˆÓ ÎÔÚÈÙÛÈÒÓ ÌÂ ÌÂÁ·Ï‡ÙÂÚË ÙËÏÂı¤·ÛË ÛÙË ¢∞¶. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ˘ÂÚÙÂÚÔ‡Û·Ó Ù· ·È‰È¿ ÌÂ ¯·ÌËÏ‹ ÙËÏÂı¤·ÛË, ÌÂ ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ‰È·ÊÔÚ¿ ÛÙ· ·ÁfiÚÈ· ÛÂ µ™, ¢¶∆, ¢∂£, ª∞∫, ¶∆∞, HDL-C Î·È TG Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÂ µ™, ¢¶∆, ª∞∫, TC, HDL-C, LDL-C Î·È LDL-C/HDL-C. ∏ ·¯˘Û·ÚÎ›· ÛÂ Û¯¤ÛË ÌÂ ÙËÓ ÙËÏÂı¤·ÛË Â›Ó·È ·fi ÙÔ˘˜ ∫¶∫ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËıÂ› ÂÚÈÛÛfiÙÂÚÔ. OÈ Andersen et al ÂÍÂÙ¿˙ÔÓÙ·˜ 4063 ·È‰È¿ 8-16 ÂÙÒÓ ÛÙÈ˜ ∏¶∞, ‚Ú‹Î·Ó ÛËÌ·ÓÙÈÎ‹ ·‡ÍËÛË ÛÙÔ ¢ª™ Î·È ÛÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ ˆÌÔÏ¿ÙË˜ Î·È Ï·ÁÔÓ›Ô˘ ÛÂ ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙËÏÂfiÚ·ÛË 4 ‹ ÂÚÈÛÛfiÙÂÚÂ˜ ÒÚÂ˜ ÙËÓ ËÌ¤Ú·, ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ Ô˘ ¤‚ÏÂ·Ó

ÏÈÁfiÙÂÚÔ ·fi 2 ÒÚÂ˜ (16). ∏ ·¯˘Û·ÚÎ›· Û˘Û¯ÂÙÈ˙fiÙ·Ó Î·Ï‡ÙÂÚ· ÌÂ ÙÈ˜ ÒÚÂ˜ ÙËÏÂı¤·ÛË˜, ·Ú¿

¶›Ó·Î·˜ 3. ∫·Ù·Ó¿ÏˆÛË ÌÂÚÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔÈ¯Â›ˆÓ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ¯ÚﬁÓÔ ÙËÏÂı¤·ÛË˜ (Ì¤ÛË ÙÈÌ‹, 95% ﬁÚÈ· ·ÍÈÔÈÛÙ›·˜)

¶·Ú¿ÌÂÙÚÔ˜¡Ã∆≤14 ÒÚÂ˜/Â‚‰.Ã∆=15-28 ÒÚÂ˜/Â‚‰.Ã∆>28 ÒÚÂ˜/Â‚‰.P*P**

∞ÁﬁÚÈ·

£ÂÚÌ›‰Â˜ (Kcal/ËÌ)6931997 (1935-2059)2007 (1958-2056)2151 (2045-2257)0,0130,009

§›Ë (%)69342,6 (41,6-43,7)41,5 (40,7-42,3)41,7 (40,2-43,1)NSNS

∫ÔÚÂÛÌ¤Ó· Ï›Ë (%)69318,2 (17,7-18,7)17,7 (17,3-18,2)18,0 (17,3-18,7)NSNS

ÃÔÏËÛÙÂÚﬁÏË (g/ËÌ)693308,6 (278,9-338,3)269,5 (251,7-287,4)303,9 (267,8-340,0)0,039NS

∆ÛÈ˜ (Û·ÎÔ˘Ï/Â‚‰)4133,3 (2,9-3,7)3,4 (3,1-3,8)4,1 (2,7-5,5)NSNS

°Ï˘Î¿ (ÎÔ˘Ù·Ï/Â‚‰)3833,8 (3,1-4,5)4,1 (3,4-4,7)2,2 (1,4-2,9)NS0,024

™ÔÎÔÏ¿ÙÂ˜ (·Ó¿ Â‚‰)4243,9 (3,4-4,4)3,9 (3,5-4,3)5,4 (4,1-6,7)0,0200,016

∫ﬁÎ·-ÎﬁÏ· (ÔÙ/Â‚‰)4193,5 (2,9-4,1)3,8 (3,4-4,3)6,0 (3,6-8,3)0,0030,003

∫ÔÚ›ÙÛÈ·

£ÂÚÌ›‰Â˜ (Kcal/ËÌ)6301839 (1774-1905)1883 (1833-1933)1975 (1886-2064)0,0450,015

§›Ë (%)63042,7 (41,6-43,7)41,6 (40,7-42,6)41,8 (40,4-43,3)NSNS

∫ÔÚÂÛÌ¤Ó· Ï›Ë (%)63018,3 (17,7-18,9)17,8 (17,3-18,3)17,0 (16,3-17,9)0,0540,013

ÃÔÏËÛÙÂÚﬁÏË (g/ËÌ)630259,4 (237,9-280,9)252,0 (232,9-271,1)283,9 (250,9-317,0)NSNS

∆ÛÈ˜ (Û·ÎÔ˘Ï/Â‚‰)3902,8 (2,4-3,3)3,3 (2,8-3,8)3,9 (3,1-4,7)NS0,018

°Ï˘Î¿ (ÎÔ˘Ù·Ï/Â‚‰)3553,0 (2,5-3,4)3,5 (2,7-4,2)2,9 (1,9-3,9)NSNS

™ÔÎÔÏ¿ÙÂ˜ (·Ó¿ Â‚‰)3952,9 (2,5-3,2)3,6 (3,2-4,0)4,0 (3,1-5,0)0,0130,004

∫ﬁÎ·-ÎﬁÏ· (ÔÙ/Â‚‰)3732,1 (1,8-2,4)2,5 (2,2-2,8)3,6 (2,7-4,6)<0,001<0,001

P*= Oneway ANOVA, P**= ™‡ÁÎÚÈÛË ÌÂÙ·Í‡ ÔÌ¿‰ˆÓ 1 Î·È 3 ÌÂ ÙÔ t-test

ÌÂ ÙË Û˘¯ÓﬁÙËÙ· ÙË˜ ¤ÓÙÔÓË˜ ¿ÛÎËÛË˜. ◊‰Ë, ÔÈ

Dietz Î·È Gortmaker Â›¯·Ó ˘ÔÏÔÁ›ÛÂÈ ﬁÙÈ ÛÂ ·È‰È¿

ËÏÈÎ›·˜ 12-17 ÂÙÒÓ, Ë ·¯˘Û·ÚÎ›· ·˘Í¿ÓÂÙ·È Î·Ù¿

2% ÁÈ· Î¿ıÂ ÂÈÚﬁÛıÂÙË ÒÚ· ÙËÏÂı¤·ÛË˜ (22).

£ÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙËÏÂı¤·ÛË˜ Î·È ·¯˘Û·ÚÎ›·˜ ‚Ú‹Î·Ó Â›ÛË˜ ÔÈ Gortmaker et al ÂÍÂÙ¿˙ÔÓÙ·˜ 746 ·È‰È¿ 10-15 ÂÙÒÓ ÛÙÈ˜ ∏¶∞ (23), ÂÓÒ ÔÈ Guillaume et al ÛÙÔ µ¤ÏÁÈÔ ‚Ú‹Î·Ó Û˘Û¯¤ÙÈÛË ÌÂ ÙÔ ¢ª™ ÌﬁÓÔ ÛÙ· ·ÁﬁÚÈ· (24). ∂›ÛË˜, ÔÈ Robinson et al ‰ÂÓ ‚Ú‹Î·Ó ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÛÂ ÎÔÚ›ÙÛÈ·, ÂÍÂÙ¿˙ÔÓÙ·˜ 971 Ì·ı‹ÙÚÈÂ˜ Ì¤ÛË˜ ËÏÈÎ›·˜ 12,4

ÂÙÒÓ (28).

∞ﬁ ÙË ‰ÈÎ‹ Ì·˜ ÌÂÏ¤ÙË ÚÔÎ‡ÙÂÈ Û·Ê‹˜ ·‡ÍËÛË ÙË˜ ¢¶∆ (p<0,001) Î·È ÌÈÎÚﬁÙÂÚË ·‡ÍËÛË

ÙÔ˘ µ™ (p=0,037) Î·È ÙÔ˘ ¢ª™ (p=NS) ÛÙËÓ 3Ë

ÔÌ¿‰· ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë. ™Â ÚﬁÛÊ·ÙÂ˜ ÂÚÁ·-

Û›Â˜ Ì·˜ ÌÂ ¶·ÁÎ‡ÚÈÔ ‰Â›ÁÌ· ·È‰ÈÒÓ ›‰È·˜ ËÏÈ-

Î›·˜, Â›¯·ÌÂ ‚ÚÂÈ ﬁÙÈ Ë ·‡ÍËÛË ÙË˜ ¢¶∆ ÛÙÈ˜ ·ÛÙÈ-

Î¤˜ ÂÚÈÔ¯¤˜ Û˘Û¯ÂÙÈ˙ﬁÙ·Ó ÌÂ ·˘ÍËÌ¤Ó· Â›Â‰·

LDL-C Î·È ÂÏ·ÙÙˆÌ¤ÓË ·fi‰ÔÛË ÛÙÔ ¶∆∞, ÂÓÒ Ô ¢ª™ ·Ú¤ÌÂÓÂ ›‰ÈÔ˜ ÛÂ fiÏÂ˜ ÙÈ˜ ÂÚÈÔ¯¤˜ (12), Î·ıÒ˜ Î·È fiÙÈ Ë ÂÚ›ÌÂÙÚÔ˜ Ì¤ÛË˜ Î·È Ô ÏfiÁÔ˜ ÙË˜

ÂÚÈÌ¤ÙÚÔ˘ Ì¤ÛË˜-ÈÛ¯›Ô˘ Â›Ó·È Î·Ï‡ÙÂÚÔÈ ‰Â›ÎÙÂ˜ ÁÈ· ÙÔ˘˜ ∫¶∫ ·ﬁ ﬁ,ÙÈ Ô ¢ª™ (38). ∆· ·ÔÙÂÏ¤ÛÌ·Ù¿ Ì·˜ ÁÈ· ÙËÓ ·ÚÙËÚÈ·Î‹ ›ÂÛË

‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ·ﬁ ·˘Ù¿ ¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ Ô˘

‰ÂÓ ‚Ú›ÛÎÔ˘Ó ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË (24,25). ¶Ú¤ÂÈ Ó· ÙÔÓ›ÛÔ˘ÌÂ ÙÈ˜ ·ÓÙÈÎÂÈÌÂÓÈÎ¤˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙË Ì¤ÙÚËÛË ÙË˜ ·ÚÙËÚÈ·Î‹˜ ›ÂÛË˜ ÛÙ· Û¯ÔÏÂ›·, ·ÊÔ‡ ÛÂ ÌÂÚÈÎ¤˜ ÂÚÈÙÒÛÂÈ˜ ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ÂÍ·ÏÂ›„Ô˘ÌÂ ÂÓÙÂÏÒ˜

ÙÔ ¿Á¯Ô˜ ·ﬁ Ù· ·È‰È¿. ∏ Û¯¤ÛË ÌÂÙ·Í‡ ÙËÏÂı¤·ÛË˜ Î·È ‰È·ÙÚÔÊ‹˜

¤¯ÂÈ ÌÂÏÂÙËıÂ› Î˘Ú›ˆ˜ ﬁÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË ÙË˜ ‰È·Ê‹ÌÈÛË˜ ÛÙËÓ ÂÎÏÔÁ‹ ÙÚÔÊ‹˜. OÈ Taras et al, ÌÂ ÂÚˆÙËÌ·ÙÔÏﬁÁÈÔ ÛÂ 66 ÌËÙ¤ÚÂ˜ ·È‰ÈÒÓ 3-8

ÂÙÒÓ, ‚Ú‹Î·Ó Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ¯ÚËÛÈÌÔÔ›ËÛË˜ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔÊÒÓ Î·È ÙË˜ ·˘ÍËÌ¤ÓË˜ ÚfiÛÏË„Ë˜ ıÂÚÌ›‰ˆÓ (17). ∏ Â›‰Ú·ÛË, ÂÔÌ¤Óˆ˜, ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔÊÒÓ Î·È ·Ó·Ì¤ÓÂÙ·È Ó· ÌËÓ Â›Ó·È ›‰È· ÛÂ ‰È·ÊÔÚÂÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ‹ ¯ÒÚÂ˜ (18,37). ∞fi ÙË ÌÂÏ¤ÙË

ÙˆÓ Anastassea-Vlachou et al ÛÂ 4876 ·È‰È¿ ÛÙËÓ

∂ÏÏ¿‰·, ÚÔÎ‡ÙÂÈ fiÙÈ ÔÛÔÛÙfi 34,5% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 7-12 ÂÙÒÓ ÙÚÒÂÈ ÂÓÒ ·Ú·ÎÔÏÔ˘ıÂ› ÙËÏÂfiÚ·ÛË (14) Î·È ·fi ÙË ÌÂÏ¤ÙË ÙˆÓ ºÂÛÛ¿ÙÔ˘

Î·È Û˘Ó, Ô˘ ÂÍ¤Ù·Û·Ó 412 Ì·ıËÙ¤˜ ËÏÈÎ›·˜ 9-14 ÂÙÒÓ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·˘Í¿ÓÂÙ·È Ë Î·Ù·Ó¿ÏˆÛË ·Óı˘ÁÈÂÈÓÒÓ ÌÈÎÚÔÛ˘ÛÎÂ˘·ÛÈÒÓ (19). ™ÙË ‰ÈÎ‹ Ì·˜ ÂÚÁ·Û›· ÂÓÈÛ¯‡ÔÓÙ·È Î·È Ù· ‰‡Ô ·ÓˆÙ¤Úˆ Â˘Ú‹Ì·Ù·. ∏ ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ Î·È Ë Î·Ù·Ó¿ÏˆÛË ÂÚÈÛÛfiÙÂÚˆÓ ÛÔÎÔÏ·ÙÒÓ Î·È ·Ó·„˘ÎÙÈÎÒÓ Ù‡Ô˘ ÎfiÏ· ‹Ù·Ó ·˘ÍËÌ¤ÓË

ÛÂ ·ÁﬁÚÈ· Î·È ÎÔÚ›ÙÛÈ·. ∂›ÛË˜, Ù· ÎÔ-

Î·Ù·Ó¿ÏˆÓ·Ó ÂÚÈÛÛﬁÙÂÚ· ÙÛÈ˜ ÙËÓ Â‚‰ÔÌ¿‰·. ∆· ·È‰È¿, ÂÔÌ¤Óˆ˜, Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó

ÔÏÏ¤˜ ÒÚÂ˜ ÙËÏÂﬁÚ·ÛË, ÙÚÒÓÂ ÂÚÈÛÛﬁÙÂÚÔ ·Ï-

Ï¿ Î·È ¯ÂÈÚﬁÙÂÚ· ·ﬁ Ù· ¿ÏÏ· ·È‰È¿.

OÈ ÔÏÏ¤˜ ÒÚÂ˜ ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂﬁÚ·ÛË

Ô‰ËÁÔ‡Ó ÛÂ Î·ıÈÛÙÈÎ‹ ˙ˆ‹, ÌÂ›ˆÛË ÙË˜ Ê˘ÛÈÎ‹˜

‰Ú·ÛÙËÚÈﬁÙËÙ·˜ Î·È ÙË˜ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ ÙˆÓ

·È‰ÈÒÓ. OÈ Pate et al, ÂÍÂÙ¿˙ÔÓÙ·˜ 361 ·È‰È¿ Ì¤ÛË˜ ËÏÈÎ›·˜ 11 ÂÙÒÓ, ‚Ú‹Î·Ó ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË

ÌÂÙ·Í‡ Ê˘ÛÈÎ‹˜ ¿ÛÎËÛË˜ Î·È ÙËÏÂı¤·ÛË˜ (20). OÈ Bungum Î·È Vincent ·Ó·Ê¤ÚÔ˘Ó ·ÚﬁÌÔÈ· ·ÔÙÂÏ¤ÛÌ·Ù· ÛÂ 852 ÎÔÚ›ÙÛÈ· 14-18 ÂÙÒÓ (21), ﬁˆ˜ Î·È ÔÈ Wong et al ÛÙ· 1081 ·È‰È¿ Ô˘ ÂÍ¤Ù·Û·Ó (25). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË, ÔÈ Tucker Î·È Hager ‰ÂÓ ‚Ú‹Î·Ó ıÂÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ ÙËÓ ÙËÏÂı¤·ÛË ÛÂ 262 ·È‰È¿ 9-10 ÂÙÒÓ (29). ∞ÓÙ›ıÂÙ·, ÛÂ ·Ó¿ÏÔÁË ÌÂÏ¤ÙË ÛÂ 379 ¿ÚÚÂÓÂ˜ ÂÊ‹‚Ô˘˜, Ô Tucker Â›¯Â ‚ÚÂÈ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂ-

Ù·Í‡ ÙËÏÂı¤·ÛË˜ Î·È ÙˆÓ 6 ‰ÔÎÈÌ·ÛÈÒÓ Ê˘ÛÈÎ‹˜ Î·Ù¿ÛÙ·ÛË˜ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛÂ (39). ∞ﬁ Ù· ‰ÈÎ¿ Ì·˜ ·ÔÙÂÏ¤ÛÌ·Ù· ÚÔÎ‡ÙÂÈ Û·Ê‹˜ ˘ÂÚÔ¯‹

·È‰ÈÒÓ ÙË˜ 1Ë˜ ÔÌ¿‰·˜ ÁÈ· ÙÈ˜ ÂÚÈÛÛﬁÙÂÚÂ˜

ÙÈ˜ ‰ÔÎÈÌ·Û›Â˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÚˆÙﬁÎÔÏÏÔ EUROFIT, ·Ó Î·È ‰ÂÓ ‚Ú‹Î·ÌÂ ‰È·ÊÔÚ¿

·Ó·ÊÂÚfiÌÂÓÂ˜ ÒÚÂ˜ ¿ıÏËÛË˜, fiˆ˜ ‰ÂÓ ‚Ú‹Î·Ó ÔÈ ºÂÛÛ¿ÙÔ˘ Î·È Û˘Ó (19). ∂ÊfiÛÔÓ, fiÌˆ˜, Ù· ·È‰È¿ ÙË˜ 1Ë˜ ÔÌ¿‰·˜ ¤¯Ô˘Ó Î·Ï‡ÙÂÚË Ê˘ÛÈÎ‹

Î·Ù¿ÛÙ·ÛË, ÌÔÚÂ› Ó· ˘ÔÛÙËÚÈ¯ıÂ› fiÙÈ Èı·ÓfiÙ·Ù· Á˘ÌÓ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÈÔ ¤ÓÙÔÓ·.

∏ Â›‰Ú·ÛË ÙË˜ ˘¤ÚÌÂÙÚË˜ ÙËÏÂı¤·ÛË˜ ÛÙ·

ÏÈ›‰È· Î·È ÙÈ˜ ÏÈÔÚˆÙÂ˝ÓÂ˜ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËıÂ› ·ÚÎÂÙ¿. OÈ Wong et al, ÂÍÂÙ¿˙ÔÓÙ·˜ 1081 ·È‰È¿ 220 ÂÙÒÓ, ÌÂÏ¤ÙËÛ·Ó ÙË Û¯¤ÛË ÌÂ ÙËÓ ÙËÏÂı¤·ÛË

ÌﬁÓÔ ÙË˜ TC (25). µÚ‹Î·Ó ﬁÙÈ Ù· ·È‰È¿ ÌÂ ÙËÏÂı¤·ÛË 2-4 ÒÚÂ˜ Â›¯·Ó ·˘ÍËÌ¤ÓÔ Î›Ó‰˘ÓÔ Ó· ¤¯Ô˘Ó TC ≥200 mg/dl Î·Ù¿ 2,2 Î·È ÌÂ ÙËÏÂı¤·ÛË >4 ÒÚÂ˜

Î·Ù¿ 4,8 ÛÂ Û¯¤ÛË ÌÂ Ù· ˘ﬁÏÔÈ· ·È‰È¿. ™ÙË ‰È-

Î‹ Ì·˜ ÌÂÏ¤ÙË, Ù· ·È‰È¿ ÙË˜ 3Ë˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ 1Ë ÔÌ¿‰· Â›¯·Ó ÌÂÈˆÌ¤ÓË HDL-C. ∆· ·ÁﬁÚÈ· Â›¯·Ó

Â›ÛË˜ ·˘ÍËÌ¤Ó· TG Î·È Ù· ÎÔÚ›ÙÛÈ· ·˘ÍËÌ¤Ó· Â›-

Â‰· TC Î·È LDL-C.

ŸÏÔÈ ÔÈ ·ÓˆÙ¤Úˆ ·Ú¿ÁÔÓÙÂ˜ (·¯˘Û·ÚÎ›·, ÌÂÈˆÌ¤ÓË Ê˘ÛÈÎ‹ Î·Ù¿ÛÙ·ÛË, ‰˘ÛÌÂÓ‹ Â›Â‰· ÏÈ-

ÔÚˆÙÂ˚ÓÒÓ) ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ·ıËÚÔÛÎÏ‹ÚˆÛË˜. ∞ﬁ ÙË ÌÂÏ¤ÙË ÙË˜ Bogalusa Heart Study

ÛÂ ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi ‚Ú¤ıËÎÂ fiÙÈ fiÛÔ ·˘Í¿ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ÙfiÛÔ ·˘Í¿ÓÔÓÙ·È ÔÈ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎ¤˜ ‚Ï¿‚Â˜ ÛÙ· ÛÙÂÊ·ÓÈ·›· ·ÁÁÂ›· ÙˆÓ ·È‰ÈÒÓ (6). ∞fi ÙÔ ‰ÈÎfi Ì·˜ ¶·ÁÎ‡ÚÈÔ ˘ÏÈÎfi ÚÔÎ‡ÙÂÈ fiÙÈ 1:2 ·È‰È¿ ¤¯Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ÚÔ‰È·ıÂÛÈÎfi ·Ú¿ÁÔÓÙ·, 1:6 ¤¯Ô˘Ó

‰‡Ô Î·È 1:20 ·È‰È¿ ¤¯Ô˘Ó ÙÚÂÈ˜ (10). O Î›Ó‰˘ÓÔ˜

·ıËÚÔÛÎÏ‹ÚˆÛË˜ Â›Ó·È, ÂÔÌ¤Óˆ˜, ÌÂÁ¿ÏÔ˜ Î·È

ÛËÌ·ÓÙÈÎﬁ ÚﬁÏÔ ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹ Ê·›ÓÂÙ·È

ﬁÙÈ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë ·˘ÍËÌ¤ÓË ÙËÏÂı¤·ÛË.

™˘ÌÂÚ¿ÛÌ·Ù·

∏ ˘¤ÚÌÂÙÚË ÙËÏÂı¤·ÛË ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎﬁ

·Ú¿ÁÔÓÙ· ·˘ÍËÌ¤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÛÎÏ‹Úˆ-

ÛË˜ ÛÙ· ·È‰È¿. OÈ ·È‰›·ÙÚÔÈ Î·È ÔÈ ˘ﬁÏÔÈÔÈ ÏÂÈ-

ÙÔ˘ÚÁÔ› ˘ÁÂ›·˜ ı· Ú¤ÂÈ Ó· ÂÓÙ¿ÍÔ˘Ó ÛÙÔÓ Î·Ù¿-

ÏÔÁÔ ÙˆÓ Ô‰ËÁÈÒÓ ÚÔÏËÙÈÎ‹˜ È·ÙÚÈÎ‹˜ Î·È ÙÔ˘˜

Î·ÓﬁÓÂ˜ ÛˆÛÙ‹˜ ÙËÏÂı¤·ÛË˜ (37).

∂˘¯·ÚÈÛÙ›Â˜

∂˘¯·ÚÈÛÙÔ‡ÌÂ ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁÂ›·˜ Î·È ÙÔ ÚÔÛˆÈÎﬁ ÙÔ˘

ÃËÌÂ›Ô˘ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ §Â˘ÎˆÛ›·˜ ÁÈ· ÙË ‰ÈÂÎÂ-

Ú·›ˆÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ.

∆Ô ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È ¶ÔÏÈÙÈÛÌÔ‡, ÙÔ˘˜ ‰ÈÂ˘ı˘ÓÙ¤˜ Î·È ÙÔ˘˜ ‰·ÛÎ¿ÏÔ˘˜ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏÂ›ˆÓ ÁÈ· ÙË

‚Ô‹ıÂÈ¿ ÙÔ˘˜.

∆Ë §·˚Î‹ ∆Ú¿Â˙· ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰ﬁÙËÛË ÙÔ˘ ¶ÚÔÁÚ¿Ì-

Ì·ÙÔ˜ “ÀÁÂ›· ÙÔ˘ ¶·È‰ÈÔ‡”.

∆Ô˘˜ Û˘ÓÂÚÁ¿ÙÂ˜ ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜: ÙËÓ ·ÈÌÔÏ‹ÙÚÈ·

∂Ï¤ÓË ™ÔÊÔÎÏ¤Ô˘˜, ÙË ‰È·ÈÙÔÏﬁÁÔ ÿÚÈ‰· ™Ù·˘ÚÈÓ›‰Ô˘, ÙÔÓ Î·-

ıËÁËÙ‹ Ê˘ÛÈÎ‹˜ ·ÁˆÁ‹˜ ¶. ∞ÏÌ·ÓÔ‡‰Ë Î·È ÙÔÓ ˘Â‡ı˘ÓÔ

ÌË¯·ÓÔÁÚ¿ÊËÛË˜ ÃÚ. Ã·Ù˙ËÈˆ¿ÓÓÔ˘. ∆· ·È‰È¿ ÙË˜ ™∆' Ù¿ÍË˜ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏÂ›ˆÓ Î·È

ÙÔ˘˜,

µÈ‚ÏÈÔÁÚ·Ê›·

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9. Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›ÙË˜ ª, Ã·Ù˙ËÈˆ¿ÓÓÔ˘ ª, °È·ÓÎÔ˘Ï‹ ∞, µÚ·¯›ÌË˜ ƒ. ¶ÚﬁÁÚ·ÌÌ· “ÀÁÂ›· ÙÔ˘ ¶·È‰ÈÔ‡”, ∫‡ÚÔ˜. ŒÏÂÁ¯Ô˜ ÂÈ¤‰Ô˘ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·¯˘Û·ÚÎ›·˜ ÛÂ 1132 ·È‰È¿ ÙË˜ ™∆’ Ù¿ÍË˜ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏÂ›ˆÓ ÙË˜ Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜. ¶·È‰È·ÙÚ µ ∂ÏÏ 1998;10:238-244.

10. ™¿‚‚· ™, ∆ÔÚÓ·Ú›ÙË˜ ª, Ã"°ÂˆÚÁ›Ô˘ Ã, ∫Ô˘Ú›‰Ë˜ °, ™È·ÌÔ‡ÓÎË ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚· ª. ∞˘ÍËÌ¤ÓË Û˘¯ÓﬁÙËÙ· ÔÏÏ·ÏÒÓ ÚÔ‰È·ıÂÛÈÎÒÓ ·Ú·ÁﬁÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ¶·È‰È·ÙÚÈÎ‹ 1999;62:468-473.

11. ∫Ô˘Ú›‰Ë˜ °∞. ∂ÎÙ›ÌËÛË ÙË˜ ıÚ¤„Ë˜ ÛÂ ·È‰È¿ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÙË˜ ¶¿ÊÔ˘. ¶·È‰È·ÙÚ µ ∂ÏÏ 1997;9:190-193.

12. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›ÙË˜ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∏ ·¯˘Û·ÚÎ›· ÛÙËÓ ∫‡ÚÔ ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 11-12 ÂÙÒÓ. ™ËÌ·ÓÙÈÎ‹ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ·. ¶·È‰È·ÙÚÈÎ‹ 2000;63:137-144. 13. ºÚ˘Û›Ú·-∫·ÓÈÔ‡Ú· ∂, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫, ¶··ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, •˘ÔÏ˘Ù¿-∑·¯·ÚÈ¿‰Ë ∞, ª·ÙÛ·ÓÈÒÙË˜ ¡. ∏ Â›‰Ú·ÛË ÙË˜ ÙËÏÂfiÚ·ÛË˜ ÛÙ· ∂ÏÏËÓfiÔ˘Ï· ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ· Î·È Ô ¶·È‰›·ÙÚÔ˜. ¶·È‰È·ÙÚÈÎ‹ 1993;56:300-316.

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29. Tucker LA, Hager RL. Television viewing and muscular fitness of children. Percept Mot Skills 1996;82:1316-1318.

30. Committee of Experts on Sports Research. EUROFIT. Rome: Edigraf Editoriale Grafica, 1988.

31. Georgiadis G, Klissouras V. Assessement of youth fitness: the European perspective. Am J Clin Nutr 1989;49:1048-1053.

32. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, Ã·Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ “∞ÁˆÁ‹ ÀÁÂ›·˜” ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈÎ‹˜ ·Ú¤Ì‚·ÛË˜ ÛÙ· ‰ËÌÔÙÈÎ¿ Û¯ÔÏÂ›· ÙË˜ ∫Ú‹ÙË˜.

¶·È‰È·ÙÚÈÎ‹ 1998;61:483-497.

33. Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem 1974;20:470-475.

34. Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem 1982;28:2077-2080.

35. Shirai K, Nema T, Hiroh Y, Itoh Y, Miyashita Y, Watanabe H. Clinical efficacy of the direct assay method using polymers for the serum high density lipoprotein cholesterol. J Clin Lab Anal 1997;11:82-86.

36. Friedewald W, Levy RI, Fredrikson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.

37. American Academy of Pediatrics, Committee on Public Education. Children, adolescents, and television. Pediatrics 2001;107:423-426.

38. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes 2000;24:1453-1458.

39. Tucker LA. The relationship of television viewing to physical fitness and obesity. Adolescence 1986;84:797-806.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-03-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 24-07-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °È¿ÓÓË˜ ∫Ô˘Ú›‰Ë˜

¶·È‰›·ÙÚÔ˜

∞ÏÂÍ·Ó‰ÚÔ˘ﬁÏÂˆ˜ 71, CY-8027 ¶¿ÊÔ˜, ∫‡ÚÔ˜

E-mail: yiakou@avacom.net

¡ﬁÛÔ˜ Scheuermann ÛÙËÓ

∫. ∆ÛÔ˘Ì¿Î·˜, ∞. ∑ÂÚ‚Ô˘‰¿ÎË, π. πÁÓ·ÙÈ¿‰Ë˜

Scheuermann's disease in childhood. Case report

K. Tsoumakas, A. Zervoudaki, I. Ignatiadis

¶ÂÚ›ÏË„Ë: ∏ È‰ÈÔ·ı‹˜ ÓÂ·ÓÈÎ‹ Î‡ÊˆÛË (ÓﬁÛÔ˜ Sheuermann) Û˘Ó·ÓÙ¿Ù·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÊË‚Â›· Î·È ÚÔ‚¿ÏÏÂÈ ÌÂ ¿ÏÁÔ˜ ÛÙË ÛÔÓ‰˘ÏÈÎ‹ ÛÙ‹ÏË. ¶ÚÔÎ·ÏÂ› ÔÍÂ›· ÁˆÓ›ˆÛË ÙË˜ Ú¿¯Ë˜

·ÔÎ·ı›ÛÙ·Ù·È ÌÂ ˘ÂÚ¤ÎÙ·ÛË Î·È ÛÂ ‚·ÚÈ¤˜ ÂÚÈÙÒÛÂÈ˜ ·Ú·ÙËÚÂ›Ù·È ÓÂ˘ÚÔÏÔÁÈÎ‹

∏ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹, Î˘Ú›ˆ˜ ﬁÌˆ˜ ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘-

Ú‹Ì·Ù·. ∞ÓÙÈÌÂÙˆ›˙ÂÙ·È Û˘ÓÙËÚËÙÈÎ¿ ÌÂ Ê˘ÛÈÔıÂÚ·Â›· Î·È ·Ó·ÏÁËÙÈÎ¿

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓﬁÛÔ˜ Scheuermann, ÓÂ·ÓÈÎ‹

È‰ÈÔ·ı‹˜ Î‡ÊˆÛË, ÔÛÊ˘·ÏÁ›·.

∂ÈÛ·ÁˆÁ‹

ø˜ Î‡ÊˆÛË ÔÚ›˙ÂÙ·È Ë ·‡ÍËÛË ÙË˜ Ê˘ÛÈÔÏÔÁÈ-

Î‹˜ Î˘ÚÙﬁÙËÙ·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ (™™)

¿Óˆ ÙˆÓ 40o Î·Ù¿ ÙÔÓ ÚÔÛıÔ›ÛıÈÔ ¿ÍÔÓ¿ ÙË˜. ∏

È‰ÈÔ·ı‹˜ Î‡ÊˆÛË Â›Ó·È Ë Û˘¯ÓﬁÙÂÚË ·ÈÙ›· Î‡Êˆ-

ÛË˜ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ (1). ∂›Ó·È ‰ÔÌÈÎ‹ ·Ú·ÌﬁÚ-

ÊˆÛË ÙË˜ ıˆÚ·ÎÈÎ‹˜ ‹ ÙË˜ ıˆÚ·ÎÔ-ÔÛÊ˘˚Î‹˜

ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ÌÂ Û˘¯ÓﬁÙÂÚÔ Û‡ÌÙˆÌ· ÙËÓ ÔÛÊ˘·ÏÁ›· ‹ Ú·¯È·ÏÁ›·. OÈ ·ÛıÂ-

ÓÂ›˜ ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ‹È· Û˘Ó‹ıˆ˜ ÔÛÊ˘·Ï-

Á›·, ÂÓÒ ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ˘¿Ú¯ÂÈ ‰˘ÛÌÔÚÊ›· ÙË˜ ™™ Î·È ·ÎfiÌË Û·ÓÈfiÙÂÚ· ·Ú·ÏËÁ›·. ∫ÏÈÓÈÎ¿

·Ú·ÙËÚÂ›Ù·È ÁˆÓ›ˆÛË ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ Î·Ù¿ ÙËÓ Â›Î˘„Ë Î·È ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎﬁ ¤ÏÂÁ¯Ô

Î·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ

ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ.

¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ ∞ÙÙÈÎ‹˜

¶·È‰ÔÔÚıÔ·È‰ÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ ∞ÙÙÈÎ‹˜

Abstract: Scheuermann’s kyphosis (Scheuermann’s disease) occurs primarily in late childhood and adolescence, and presents with pain over the area of the spine. ∆he disease causes acute kyphotic deformity of the thoracic spine not restored by overextension, and infrequently in severe cases neurological problems. The diagnosis is based on the clinical presentation and mainly on the characteristic radiological findings. Treatment is usually conservative with analgesics and physiotherapy, rarely necessitating surgical intervention.

Key words: Scheuermann's disease, Scheuermann's kyphosis, backache.

¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ÌÂ È‰ÈÔ·ı‹ ÓÂ·ÓÈÎ‹ Î‡ÊˆÛË ÛÙË ıˆÚ·ÎÔ-ÔÛÊ˘˚Î‹ ÌÔ›Ú· ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 12 ÂÙÒÓ ÚÔÛ‹ÏıÂ ÛÙ· ÂÍˆÙÂÚÈÎ¿ ·È‰È·ÙÚÈÎ¿ È·ÙÚÂ›· ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ∫∞∆, Î·ıÒ˜ Â‰Ò Î·È ¤Ó· ÂÚ›Ô˘ ¯ÚfiÓÔ Â›¯Â ÚÔÔ‰Â˘ÙÈÎ¿ ÂÈ‰ÂÈÓÒÌÂÓÔ ¿ÏÁÔ˜ ÛÙË ıˆÚ·ÎÈÎ‹ ÌÔ›Ú· ÙË˜ ™™. ∆Ô ¿ÏÁÔ˜ Â›¯Â ÂÍ¿ÚÛÂÈ˜ Î·È ˘Ê¤ÛÂÈ˜, ‰ÂÓ Â›¯Â ·ÔÙÂÏ¤ÛÂÈ ÔÙ¤ ·ÈÙ›· ·Ê‡ÓÈÛË˜ ÙË Ó‡¯Ù·, ·ÏÏ¿ ·Ó¤ÊÂÚÂ fiÙÈ ÁÈÓfiÙ·Ó ÂÓÙÔÓfiÙÂÚÔ ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙË˜ ËÌ¤Ú·˜, Î˘Ú›ˆ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË ‹ ÂÚ¿ÙËÌ·. ∫·Ù¿ ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ·Ú·ÙËÚ‹ıËÎÂ Â˘·ÈÛıËÛ›· ÛÙËÓ ›ÂÛË ÙË˜ ıˆÚ·ÎÔ-ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ ÙË˜ ™™, Û·ÛÌfi˜ ÙˆÓ ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì˘ÒÓ ÌÂ ‰˘ÛÎÔÏ›· Î¿Ì„Ë˜ ÙË˜ ÔÛÊ‡Ô˜, ÂÓÒ Î·Ù¿

Pediatric Division, Peripheral General Hospital KAT of Attiki, Athens Pediatric-Orthopedic Division, Peripheral General Hospital KAT of Attiki, Athens

ÙËÓ Â›Î˘„Ë ‰È·ÈÛÙÒıËÎÂ ÁˆÓ›ˆÛË ÙË˜ ™™ ÛÙËÓ

¿Û¯Ô˘Û· ÂÚÈÔ¯‹ 45o. O ·ÎÙÈÓÔÏÔÁÈÎﬁ˜ ¤ÏÂÁ¯Ô˜

¤‰ÂÈÍÂ ÛÙ¤ÓˆÛË ÙˆÓ ÌÂÛÔÛÔÓ‰‡ÏÈˆÓ ‰È·ÛÙËÌ¿-

ÙˆÓ £8-O2, ÂÏ¿ÙÙˆÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÚﬁÛıÈÔ˘

ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙˆÓ ÛÔÓ‰‡ÏˆÓ ·˘ÙÒÓ, Î·ıÒ˜ Î·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ (∂ÈÎfiÓ· 1 Î·È 2). ∏ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÂÈ‚Â‚·›ˆÛÂ ÙË ‰È¿ÁÓˆÛË (∂ÈÎfiÓ· 3). O ÂÚÁ·ÛÙËÚÈ·Îfi˜

¤ÏÂÁ¯Ô˜ ÁÈ· ÓÔÛ‹Ì·Ù· ÎÔÏÏ·ÁfiÓÔ˘ Î·È ÁÂÓÈÎfiÙÂÚ· ÁÈ· Ì˘ÔÛÎÂÏÂÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆Ô

·È‰› ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Û˘ÓÙËÚËÙÈÎ¿ ÌÂ ·Ó·ÏÁËÙÈÎ¿

Î·È Ê˘ÛÈÎÔıÂÚ·Â›·. ¶·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎ¿ Û·Ó ÂÍˆÙÂÚÈÎ‹ ·ÛıÂÓ‹˜ Î·È Â›Ó·È ÛÂ ¿ÚÈÛÙË Î·Ù¿ÛÙ·ÛË.

™˘˙‹ÙËÛË

∏ Î‡ÊˆÛË ÛÙ· ·È‰È¿ ÌÔÚÂ› Ó· Â›Ó·È: ·) ÌË ÔÚÁ·ÓÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜, ‚) Û˘ÁÁÂÓ‹˜ Î·È Á) È‰ÈÔ·ı‹˜.

∏ ÌË ÔÚÁ·ÓÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ Î‡ÊˆÛË ÔÊÂ›ÏÂÙ·È

ÛÂ Î·Î‹ ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Û˘¯Ó¿ ·ÓËÛ˘¯Â› ÙÔ˘˜ ÁÔÓÂ›˜ (2). ¢È·ÁÈÁÓÒÛÎÂÙ·È Â‡ÎÔÏ·, Î·ıÒ˜ ÙÔ

·È‰› ÌÔÚÂ› Ó· ‰ÈÔÚıÒÛÂÈ ÂÎÔ‡ÛÈ· ÙËÓ Î‡ÊˆÛË, Â›ÙÂ ÛÂ fiÚıÈ· Â›ÙÂ ÛÂ ‡ÙÈ· ı¤ÛË. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È ·ÚÓËÙÈÎfi˜ Î·È ·Ú’ fiÏÔ Ô˘ ÌÔÚÂ›

Ó· ˘¿Ú¯ÂÈ Â›Ù·ÛË ÙË˜ Ê˘ÛÈÔÏÔÁÈÎ‹˜ Î˘ÚÙﬁÙËÙ·˜ ÙË˜ ™™, ·˘Ù‹ ÂÍ·Ê·Ó›˙ÂÙ·È ÛÂ ‡ÙÈ· ı¤ÛË.

∏ Û˘ÁÁÂÓ‹˜ Î‡ÊˆÛË ÔÊÂ›ÏÂÙ·È ÛÂ ·ÓˆÌ·Ï›Â˜

ÙˆÓ ÛÔÓ‰‡ÏˆÓ (2). ∞˘Ù¤˜ ÌÔÚÂ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Î·ÎÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡ ÙˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ÛˆÌ¿ÙˆÓ ÌÂ Ù·˘Ùfi¯ÚÔÓË ‰È·Ù‹ÚËÛË ÙˆÓ ÛÙÔÈ¯Â›ˆÓ ÙÔ˘ Ô›ÛıÈÔ˘ ÙÔÈ¯ÒÌ·ÙÔ˜ ÙË˜ ™™ (ÚfiÛıÈ· ÔÛÙÈÎ‹ Á¤Ê˘Ú·). OÈ ÛÔ‚·ÚfiÙÂÚÂ˜ Û˘ÁÁÂÓÂ›˜ Î˘ÊÒÛÂÈ˜ Â›-

∂ÈÎﬁÓ·

Ó·È ÂÌÊ·ÓÂ›˜ ·fi ÙË Á¤ÓÓËÛË Î·È ÂÈ‰ÂÈÓÒÓÔÓÙ·È ÚÔÔ‰Â˘ÙÈÎ¿. OÈ ÏÈÁfiÙÂÚÔ ‚·ÚÈ¤˜ ÌÔÚÊ¤˜ ÌÔÚÂ› Ó· Á›ÓÔ˘Ó ·ÓÙÈÏËÙ¤˜ ÔÏÏ¿ ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·. ∏

ÂÈ‰Â›ÓˆÛË ÛÙ·Ì·Ù¿ ÌﬁÓÔ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË

ÙË˜ ·Ó¿Ù˘ÍË˜ ÙÔ˘ ÛÎÂÏÂÙÔ‡. §ﬁÁˆ ÙË˜ ‚·Ú‡ÙËÙ¿˜ ÙÔ˘˜, Ë ıÂÚ·Â›· Â›Ó·È Û¯Â‰ﬁÓ ·ÔÎÏÂÈÛÙÈÎ¿

¯ÂÈÚÔ˘ÚÁÈÎ‹.

∏ È‰ÈÔ·ı‹˜ ÓÂ·ÓÈÎ‹ Î‡ÊˆÛË ‹ ÓfiÛÔ˜ ÙÔ˘ Sheuermann Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· ÔÛÊ˘·ÏÁ›·˜ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (3). ¶ÚÔÛ‚¿ÏÏÂÈ ÂÍ›ÛÔ˘ ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, Û˘Ó‹ıˆ˜ ÛÙËÓ ·Ú¯‹ ÙË˜ ÂÊË‚Â›·˜. ∏ Û˘¯ÓfiÙËÙ¿

ÙË˜ Î˘Ì·›ÓÂÙ·È ·fi 1-8% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ·ÏÏ¿ Ë Ú·ÁÌ·ÙÈÎ‹ ÙË˜ Û˘¯ÓfiÙËÙ· ÈÛÙÂ‡ÂÙ·È fiÙÈ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, Î·ıÒ˜ Â‡ÎÔÏ· ‰È·Ï·Óı¿ÓÂÈ ÙË

‰È¿ÁÓˆÛË ‹ ‰È·ÁÓÒÛÎÂÙ·È ˆ˜ ÌË ÔÚÁ·ÓÈÎ‹˜ ·ÈÙÈÔÏÔÁ›·˜ (1-4). À¿Ú¯ÂÈ ÔÈÎÔÁÂÓ‹˜ ÚÔ‰È¿ıÂÛË, Ô

ÙÚfiÔ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, fiÌˆ˜, ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. ∂ÈÎ¿˙ÂÙ·È fiÙÈ ÌÔÚÂ› Ó· ÎÏËÚÔÓÔÌÂ›Ù·È ˆ˜

ÂÈÎÚ·ÙÒÓ ÛˆÌ·ÙÈÎfi˜ ÁfiÓÔ˜ ÌÂ ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·. ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ Â›Ó·È ¿ÁÓˆÛÙË. ∆· ·È‰È¿ ÌÂ ÙË ÓfiÛÔ ÙÂ›ÓÔ˘Ó Ó· ¤¯Ô˘Ó ˘„ËÏfiÙÂÚÔ ·Ó¿ÛÙËÌ·

ÛÂ ·ÛıÂÓÂ›˜ ¤¯Ô˘Ó ‚ÚÂıÂ› ·˘ÍËÌ¤Ó· Â›Â‰·

ÔÚÌﬁÓË˜ (1). µÈÔ¯ËÌÈÎ¤˜ Î·È ÈÛÙÔÏÔÁÈÎ¤˜ ·ÏÏÔÈÒÛÂÈ˜ Ô˘ ¤¯Ô˘Ó ‚ÚÂıÂ› ÛÙ· ÔÛÙ¿ Â›Ó·È ·Û·Ê¤˜ ·Ó ¤¯Ô˘Ó ·ÈÙÈÔÏÔÁÈÎ‹ ÛËÌ·Û›· ‹ Â›Ó·È ‰Â˘ÙÂÚÔ·ıÂ›˜ (1). OÈ ¿Û¯ÔÓÙÂ˜ ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ¿ÏÁÔ˜, Û˘Ó‹ıˆ˜ ‹ÈÔ, ÙÔ ÔÔ›Ô Á›ÓÂÙ·È ÂÓÙÔÓﬁÙÂÚÔ

ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙË˜ ËÌ¤Ú·˜ ‹ ÌÂÙ¿ ·fi ÎfiˆÛË, Û·ÓÈfiÙÂÚ· ‰Â ÁÈ· ‰˘ÛÌÔÚÊ›· ÙË˜ ™™. ∫ÏÈÓÈÎ¿, Î·Ù¿ ÙËÓ Â›Î˘„Ë, ·Ú·ÙËÚÂ›Ù·È ÔÍÂ›· ÁˆÓ›ˆÛË ÙË˜ Ú¿¯Ë˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙËÓ ÔÔ›· ‰ÂÓ ÌÔÚÂ› Ó· ‰ÈÔÚıÒÛÂÈ ÌÂ ˘ÂÚ¤ÎÙ·ÛË ÛÙËÓ fiÚıÈ· ‹ ÙËÓ ÚËÓ‹

∂›ÛË˜, ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ˘ÂÚÏﬁÚ‰ˆÛË

∂ÈÎﬁÓ· 3. ∂È‚Â‚·›ˆÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÛÙËÓ ·ÍÔÓÈÎ‹.

ÙË˜ ÔÛÊ˘˚Î‹˜ ‹ ÙË˜ ·˘¯ÂÓÈÎ‹˜ ÌÔ›Ú·˜ ÙË˜ ™™. ∆¤-

ÏÔ˜, ÌÔÚÂ› Ó· ·Ú·ÙËÚËıÂ› Û‡Û·ÛË

ÛÔÓ‰‡ÏÈˆÓ Ì˘ÒÓ, Î·ıÒ˜ Î·È ¿ÏÁÔ˜ Î·Ù¿ ÙËÓ ›ÂÛË ÛÙËÓ

ÂÚ›ÙˆÛË

ÂÚÈÁÚ¿ÊÂÙ·È, ÙÔ ÈÛÙÔÚÈÎﬁ Î·È Ù· ÎÏÈÓÈÎ¿ Â˘Ú‹Ì·-

ÛÙÔ ·È‰› ‹Ù·Ó ÎÏ·ÛÈÎ¿ Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Ì›·˜ ‹È·˜ ÌÔÚÊ‹˜ ÙË˜ ÓﬁÛÔ˘. ∆· ·ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó

ÛÙ¤ÓˆÛË ÙˆÓ ÌÂÛÔÛÔÓ‰‡ÏÈˆÓ ‰È·ÛÙËÌ¿ÙˆÓ, ·‡ÍËÛË ÙË˜ ÚÔÛıÔ›ÛıÈ·˜ ‰È·Ì¤ÙÚÔ˘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÛÊËÓÔÂÈ‰‹ ·Ú·ÌﬁÚÊˆÛË ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÂÏ¿ÙÙˆÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘˜ Î·È ÚÔ‚ÔÏ‹ ÙÔ˘ ËÎÙÔÂÈ‰Ô‡˜ ˘Ú‹Ó· (5-7). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È, ‰ÂÓ ˘‹Ú¯Â ÚÔ‚ÔÏ‹ ËÎÙÔÂÈ‰Ô‡˜ ˘Ú‹Ó·, Ô‡ÙÂ ÂÏ¿ÙÙˆÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘˜. ¢È·ÊÔ-

ÚÈÎ‹ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ·ﬁ ÙË ÏÔÈÌÒ‰Ë ÛÔÓ‰˘Ï›ÙÈ‰·, ÙË ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·, Ù· Î·Ù¿ÁÌ·Ù· ÙˆÓ

ÛÔÓ‰‡ÏˆÓ, ÙËÓ ·ÁÎ˘ÏÔÔÈËÙÈÎ‹ ÛÔÓ‰˘Ï›ÙÈ‰· Î·È Ù· ÓÂÔÏ¿ÛÌ·Ù·. ∏ ÓﬁÛÔ˜ ÂÍÂÏ›ÛÛÂÙ·È Ì¤¯ÚÈ Ó·

ÔÏÔÎÏËÚˆıÂ› Ë ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡.

∏ ıÂÚ·Â›· ÌÔÚÂ› Ó· Â›Ó·È Û˘ÓÙËÚËÙÈÎ‹ ‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ·Ó¿ÏÔÁ· ÌÂ ÙË ‚·Ú‡ÙËÙ· ÙË˜ ·Ú·ÌﬁÚ-

ÊˆÛË˜, ÙËÓ ·ÚÔ˘Û›· ¤ÓÙÔÓÔ˘ ¿ÏÁÔ˘˜ Î·È ÙËÓ ËÏÈÎ›· ÙÔ˘ ·ÛıÂÓÔ‡˜ (1,3,4). ™Â ‹È· ÌÔÚÊ‹ ÙË˜

ÓﬁÛÔ˘ (Î˘ÚÙﬁÙËÙ· <50o) Û˘ÓÈÛÙ¿Ù·È Ê˘ÛÈÎÔıÂÚ·-

Â›· Î·È ·Ú·ÎÔÏÔ‡ıËÛË. ™Â ·Ó·Ù˘ÛÛfiÌÂÓ· ·È‰È¿ ÌÂ Î˘ÚÙfiÙËÙ· >50o, ·ÏÏ¿ <70o Ô˘ ¤¯Ô˘Ó Ù¿ÛË ÂÈ‰Â›ÓˆÛË˜ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÎË‰ÂÌfiÓ·˜. O fiÓÔ˜ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ÌÂ ÌË ÛÙÂÚÔÂÈ‰‹

·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë. ∞Ó Ë Î˘ÚÙﬁÙËÙ· Â›Ó·È >70o, Ô ﬁÓÔ˜ Â›Ó·È Â›ÌÔÓÔ˜ ‹ ˘¿Ú¯Ô˘Ó ÓÂ˘ÚÔÏÔÁÈÎ¤˜

‰È·Ù·Ú·¯¤˜, ÙﬁÙÂ Ë ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ¯ÂÈÚÔ˘ÚÁÈÎ‹. ™ÙËÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë Î˘ÚÙﬁÙËÙ· ‹Ù·Ó <50o Î·È ÙÔ ¿ÏÁÔ˜ ˘Ô¯ˆÚÔ‡ÛÂ Â‡ÎÔÏ· ÌÂ

·Ó·ÏÁËÙÈÎ¿. ŒÙÛÈ, Ë ıÂÚ·Â›· ‹Ù·Ó Û˘ÓÙËÚËÙÈÎ‹. ∏ ·Ú·ÎÔÏÔ‡ıËÛË, fiÌˆ˜, ·Ú¤ÌÂÈÓÂ ÛÙÂÓ‹, ‰ÈfiÙÈ Ë ·Ó¿Ù˘ÍË ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÔÏÔÎÏËÚˆıÂ›.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Lowe GT. Scheuermann’s disease. Orth Clin N Am 1999;30:475-485.

2. Thompson GH, Scoles PV. Kyphosis. In: Nelson WE, Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics. 15th ed. WB Saunders Co; 1996. p. 1946-1947.

3. Wenger DR, Frick SL. Scheuermann kyphosis. Spine1999;24:263-339.

4. Ali RM, Green DM, Patel TC. Scheuermann’s kyphosis. Curr Opin Pediatr 1999;11:70-75.

5. Lemire JJ, Mierau DR, Crawford CM, Dzus AK. Sheuermann’s juvenile kyphosis. J Manipul Physiol Ther 1996;19:195-201.

6. Tribus CB. Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orth Surg 1998;6:36-43.

7. ªËÏ›ÁÎÔ˜ µ, ∫·ÏÔÁÂÚ‹˜ ª, ∂˘ÏÔÁÈ¿˜ ¡, °È·ÓÓ·Ú¿ÎÔ˜ °, ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. π‰ÈÔ·ı‹˜ ÓÂ·ÓÈÎ‹ Î‡ÊˆÛË (ÓfiÛÔ˜ Scheuermann). ∞ÎÙÈÓÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ÛÂ ·Û˘ÌÙˆÌ·ÙÈÎfi ¤ÊË‚Ô. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ¶·ÓÂ ∞ıËÓÒÓ 1999;46:155-157.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-02-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 18-10-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ó·ÛÙ·Û›· ∑ÂÚ‚Ô˘‰¿ÎË

ºÚ·ÁÎÔÎÎÏËÛÈ¿˜ 55, 151 25, ¶ÔÏ‡‰ÚÔÛÔ ∞Ì·ÚÔ˘Û›Ô˘

∂¡¢π∞º∂ƒOÀ™∞

·Ú·Û·ÏÈÁÁÈÎ‹˜ Î‡ÛÙË˜

∂. ¶··Ó‰Ú¤Ô˘, ª. ∫ÔÙÚﬁÙÛÔ˘, ¡. ª·ÏÙÔÁÈ¿ÓÓË˜, °. ∫Ô˘Û›‰Ë˜, ∂. §ÂÈ‚·‰›ÙË, ¢. ∫ÂÚ·Ì›‰·˜

Laparoscopic management of a large adnexal cyst under torsion

E. Papandreou, M. Kotrotsou, N. Baltogiannis, G. Kousidis, E. Livaditi, D. Keramidas

¶ÂÚ›ÏË„Ë: ∏ Ï··ÚÔÛÎÔÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ

·ı‹ÛÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙË˜ ·È-

‰ÈÎ‹˜ ËÏÈÎ›·˜ ‰ÂÓ ¤¯ÂÈ Â˘ÚÂ›· ÂÊ·ÚÌÔÁ‹ ÛÙËÓ

∂ÏÏ¿‰·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË, ÛÂ

·È‰È·ÙÚÈÎﬁ ÓÔÛÔÎÔÌÂ›Ô, ·ÛıÂÓÔ‡˜ ÌÂ Â˘ÌÂÁ¤ıË

Û˘ÛÙÚ·ÊÂ›Û· ·Ú·Û·ÏÈÁÁÈÎ‹ Î‡ÛÙË, Ë ÔÔ›· ‰È·ÁÓÒÛÙËÎÂ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Ï··ÚÔÛÎÔÈÎÒ˜. ∏ ·ÛıÂÓ‹˜, ËÏÈÎ›·˜ 14 ÂÙÒÓ, ÚÔÛ‹ÏıÂ ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÌÂ ¤ÓÙÔÓÔ ¿ÏÁÔ˜ ˘ÔÁ·ÛÙÚ›Ô˘ Î·È Â›Û¯ÂÛË Ô‡ÚˆÓ. ∞fi ÙÔÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎÂ Î˘ÛÙÈÎfi ÌfiÚÊˆÌ· ˘¤ÏÔ˘ ‰È·ÛÙ¿ÛÂˆÓ 12,8x10x8 cm, Èı·ÓÒ˜ ÂÍÔÚÌÒÌÂÓÔ ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ ˆÔı‹ÎË. ªÂ ÙËÓ ÂÚÂ˘ÓËÙÈÎ‹ Ï··ÚÔÛÎfiËÛË ‰È·ÈÛÙÒıËÎÂ fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· Û˘ÛÙÚ·ÊÂ›Û· ·Ú·Û·ÏÈÁÁÈÎ‹ Î‡ÛÙË. ∏ ÂÎÙÔÌ‹ Î·È Ë

·Ê·›ÚÂÛË ÙË˜ Î‡ÛÙË˜ ¤ÁÈÓ·Ó Ï··ÚÔÛÎÔÈÎÒ˜. ∏

ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ÔÚÂ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È Ë ·ÛıÂÓ‹˜

ÂÍ‹ÏıÂ ÙË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ËÌ¤Ú·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Î‡ÛÙÂÈ˜, Î‡ÛÙÂÈ˜ ÂÍ·ÚÙËÌ¿ÙˆÓ Ì‹-

ÙÚ·˜, Ï··ÚÔÛÎﬁËÛË, ·È‰ÈÎ‹ ËÏÈÎ›·.

Abstract: Laparoscopic surgery is not commonly used for the treatment of adnexal masses in children’s hospitals in Greece. We report the first case in a pediatric hospital of a 14-year old girl with a large cyst of the fallopian tube that had undergone torsion which was diagnosed and removed laparoscopically. The patient presented with acute lower abdominal pain and urinary retention. The abdominal U/S revealed a cystic mass in the pelvic region measuring 12.8x10x8 cm, most likely originating from the left ovary. On diagnostic laparoscopy, the cyst was found to be of adnexal origin and under torsion. The resection and removal of the cyst was performed laparoscopically. The postoperative course was uneventful and the patient was discharged from hospital on the 2nd postoperative day.

Key words: cysts, adnexal cysts, laparoscopic surgery, childhood. §··ÚÔÛÎÔÈÎ‹

∂ÈÛ·ÁˆÁ‹ ™‡ÌÊˆÓ· ÌÂ ÙËÓ ÂÏÏËÓÈÎ‹ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ˘¿Ú¯ÂÈ ÚÔËÁÔ‡ÌÂÓË ·Ó·ÊÔÚ¿ ÛÙË Ï··ÚÔÛÎÔÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ·ı‹ÛÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ıËÏ¤ˆÓ ÙË˜ ·È‰ÈÎ‹˜ ËÏÈÎ›·˜, Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÂ ·È‰È·ÙÚÈÎ¿ ÓÔÛÔÎÔÌÂ›· ÙË˜ ∂ÏÏ¿‰·˜.

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË ÌÂ Â˘ÌÂÁ¤ıË Û˘ÛÙÚ·ÊÂ›Û· ·Ú·Û·ÏÈÁÁÈÎ‹ Î‡ÛÙË Ô˘ ‰È·ÁÓÒÛÙËÎÂ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Ï··ÚÔÛÎÔÈÎ¿.

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

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜ ∞ÛıÂÓ‹˜ ËÏÈÎ›·˜ 14 ÂÙÒÓ, ÌÂ ÛˆÌ·ÙÈÎﬁ ‚¿ÚÔ˜ 70 kg, ÌÂ ¤ÓÙÔÓÔ ¿ÏÁÔ˜ ˘ÔÁ·ÛÙÚ›Ô˘ Î·È Â›Û¯ÂÛË

Ô‡ÚˆÓ, ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜. ∏ ·ÛıÂÓ‹˜

Â›¯Â ÂÏÂ‡ıÂÚÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi.

∆ÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ·ÚÔ˘Û›·˙Â ÂÓÔ¯Ï‹ÛÂÈ˜ ÛÙÔ

˘ÔÁ¿ÛÙÚÈÔ, ÚÔÔ‰Â˘ÙÈÎ‹ ‰ÈﬁÁÎˆÛË ÎÔÈÏ›·˜, ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Ô‡ÚËÛË Î·È ÛÙÈ˜ ÎÂÓÒÛÂÈ˜.

∞ﬁ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎÂ

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

‰ÈﬁÁÎˆÛË ÎÔÈÏ›·˜ ÌÂ ¤ÓÙÔÓË Â˘·ÈÛıËÛ›· ÛÙÔ ˘Ô-

Á¿ÛÙÚÈÔ. ŒÁÈÓÂ ‰·ÎÙ˘ÏÈÎ‹ ÂÍ¤Ù·ÛË ·ﬁ ÙÔ ÔÚıﬁ

Î·È ÂÓÙÔ›ÛÙËÎÂ ÂÏ·ÛÙÈÎ‹ Â˘›ÂÛÙË Ì¿˙· ˘¤ÏÔ˘, Ë

ÔÔ›· ›Â˙Â ÙÔ ÔÚıﬁ. ∆ÔÔıÂÙ‹ıËÎÂ Î·ıÂÙ‹Ú·˜

Folley. ∞fi ÙÔÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÚÔ¤Î˘„Â fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· Î˘ÛÙÈÎfi ÌfiÚÊˆÌ· ÂÏ¿ÛÛÔÓÔ˜

˘¤ÏÔ˘, ÚÔÂÚ¯ﬁÌÂÓÔ Èı·ÓÒ˜ ·ﬁ ÙËÓ ˆÔı‹ÎË

(∂ÈÎﬁÓ· 1).

∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ ÌÂ Ï··ÚÔÛÎﬁË-

ÛË, Ë ÔÔ›· ¤‰ÂÈÍÂ ÌÂÁ¿ÏË Â˘›ÂÛÙË Ì¿˙· ÛÙËÓ

‡ÂÏÔ, Ô˘ Û˘ÌÊ˘ﬁÙ·Ó ÌÂ ÙÔ ÌÂ›˙ÔÓ Â›ÏÔ˘Ó Î·È

›Â˙Â ÙÔ ÔÚıÔÛÈÁÌÔÂÈ‰¤˜ Î·È ÙËÓ Ô˘ÚÔ‰ﬁ¯Ô Î‡ÛÙË.

∂ÚﬁÎÂÈÙÔ ÁÈ· Â˘ÌÂÁ¤ıË ·Ú·Û·ÏÈÁÁÈÎ‹ Î‡ÛÙË

ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÂÍ·ÚÙ‹Ì·ÙÔ˜ ÙË˜ Ì‹ÙÚ·˜, Ë ÔÔ›·

·ÚÔ˘Û›·˙Â ÈÛ¯·ÈÌ›· ÏﬁÁˆ Û˘ÛÙÚÔÊ‹˜. OÈ ‰‡Ô

ˆÔı‹ÎÂ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎ¤˜. §··ÚÔÛÎÔÈÎÒ˜

¤ÁÈÓÂ ÎÈÓËÙÔÔ›ËÛË ÙË˜ Û˘ÛÙÚ·ÊÂ›Û·˜ Î‡ÛÙË˜, ÂÎ-

Î¤ÓˆÛË ÙÔ˘ ÂÚÈÂ¯ÔÌ¤ÓÔ˘ ÙË˜ Ô˘ ‹Ù·Ó ‰È·˘Á¤˜

·¯˘Úﬁ¯ÚÔ˘Ó ˘ÁÚﬁ Î·È ·Ê·›ÚÂÛË ·˘Ù‹˜ ÌÂ Û¿ÎÎÔ

ÂÚÈÛ˘ÏÏÔÁ‹˜ ÔÚÁ¿ÓˆÓ Ì¤Ûˆ ÙË˜ ı‹ÎË˜ ÙÔ˘ trocar ‰È·Ì¤ÙÚÔ˘ 1 cm (∂ÈÎﬁÓ· 2).

∏ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ﬁÙÈ ÂÚﬁÎÂÈÙÔ ÁÈ·

·Ú·Û·ÏÈÁÁÈÎ‹ ˘‰¿ÙÈ‰· Î‡ÛÙË Morgagni. ∏ ÌÂ-

ÙÂÁ¯ÂÈÚËÙÈÎ‹ ÔÚÂ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È Ë ·ÛıÂÓ‹˜

ÂÍ‹ÏıÂ ÙË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ËÌ¤Ú·.

™˘˙‹ÙËÛË

∏ Ï··ÚÔÛÎÔÈÎ‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ÌÔÚÂ› Ï¤ÔÓ

Ó· ¤¯ÂÈ ÂÊ·ÚÌÔÁ‹ ÙﬁÛÔ ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Á-

ÁÈÛË ﬁÛÔ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ı‹ÛÂˆÓ ÙˆÓ

¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙˆÓ ıËÏ¤ˆÓ ÛÙËÓ ·È‰È-

Î‹ ËÏÈÎ›· (1-5).

™Â Û‡ÓÔÏÔ 26 ·ÛıÂÓÒÓ ÌÂ Î·ÏÔ‹ıÂÈ˜ ·ı‹ÛÂÈ˜

ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ Î·Ù¿ ÙË ¯ÚÔÓÈÎ‹ ÂÚ›Ô‰Ô

∂ÈÎﬁÓ· 1.

1995-2001, Ë Ï··ÚÔÛÎÔÈÎ‹ ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ·ÊÔÚ¿ ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ë ÔÔ›· Â›Ó·È Ë ÚÒÙË Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Ï··ÚÔÛÎÔÈÎÒ˜ ÛÂ ÂÏÏËÓÈÎfi ÓÔÛÔÎÔÌÂ›Ô ·›‰ˆÓ. ∆· Î˘ÛÙÈÎ¿ ÌÔÚÊÒÌ·Ù· ÙˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ ÙË˜ Ì‹ÙÚ·˜ ÂÌÊ·Ó›˙ÔÓÙ·È 1/3000-5000 ÁÂÓÓ‹ÛÂÈ˜ Î·È ÌfiÓÔ ÔÛÔÛÙfi 25%-35% ·˘ÙÒÓ ·ÔÙÂÏÔ‡Ó Î·ÎÔ‹ıÂÈ˜ Î˘ÛÙÈÎ¤˜ ‚Ï¿‚Â˜ (5). ™˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ·Û˘ÌÙˆÌ·ÙÈÎ¤˜ ÎÔÈÏÈ·Î¤˜ Ì¿˙Â˜, ÔÈ ÔÔ›Â˜ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Î·Ù¿ ÙË Ê˘ÛÈÎ‹ ÂÍ¤Ù·ÛË ‹ ÂÈÛËÌ·›ÓÔÓÙ·È ·fi ÙÔ˘˜ ÁÔÓÂ›˜. OÈ Î·ÏÔ‹ıÂÈ˜ Î‡ÛÙÂÈ˜ ÙˆÓ ˆÔıËÎÒÓ ÛÙÔÓ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô

·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û·Ó ·Ï¤˜ ÌÔÓfi¯ˆÚÂ˜ ÌÂ ˘ÔË¯Ô˚Îfi ÂÚÈÂ¯fiÌÂÓÔ (2,4,6-8). OÈ Î‡ÛÙÂÈ˜ ÙˆÓ ˆÔıËÎÒÓ Ô˘ Â›Ó·È ÌÈÎÚfiÙÂÚÂ˜ ÙˆÓ 5 cm, ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ Î·È ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È

¯ÂÈÚÔ˘ÚÁÈÎ¿ ÌﬁÓÔ ﬁÙ·Ó ‰ÂÓ ˘ÔÛÙÚ¤ÊÔÓÙ·È ‹ ·˘Í¿ÓÔ˘Ó ÛÂ Ì¤ÁÂıÔ˜, ÂÓÒ ÔÈ Î‡ÛÙÂÈ˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÈÏÔÎ¤˜ (Û˘ÛÙÚÔÊ‹, ·ÈÌÔÚÚ·Á›·, Ú‹ÍË)

¤¯Ô˘Ó ¤Ó‰ÂÈÍË ÁÈ· ¿ÌÂÛË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË (4,5,9-11). OÈ ÌÂÁ¿ÏÂ˜ ‰È·ÛÙ¿ÛÂÈ˜ ÙˆÓ Î‡ÛÙÂˆÓ ˆÔı‹ÎË˜, ÙˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ ÙË˜ Ì‹ÙÚ·˜ Î·ıÒ˜ Î·È ÔÈ ÂÈÏÔÎ¤˜ ·˘ÙÒÓ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙË Ï··ÚÔÛÎÔÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË (1,2,5,12,13).

™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, Ë Î‡ÛÙË Â›¯Â ‰È·ÛÙ¿ÛÂÈ˜ 12,8x10x8 cm ÂÍÔÚÌÒÌÂÓË ·fi ÙÔ ‰ÂÍÈfi ÂÍ¿ÚÙËÌ· ÙË˜ Ì‹ÙÚ·˜, ·ÚÔ˘Û›·˙Â ÂÈÎfiÓ· ·Ú·ÌÂÏËÌ¤ÓË˜ Û˘ÛÙÚÔÊ‹˜ ÌÂ Ó¤ÎÚˆÛË ÙË˜ Û‡ÛÙÔÈ¯Ë˜ Û¿ÏÈÁÁ·˜ Î·È Û˘ÌÊ‡ÛÂÈ˜ ÌÂ ÙÔ ÌÂ›˙ÔÓ Â›ÏÔ˘Ó Î·È ÙÔÓ ÔÚÔÁfiÓÔ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ÙÔÈ¯ˆÌ¿ÙˆÓ. OÈ Ï··ÚÔÛÎÔÈÎÔ› ¯ÂÈÚÈÛÌÔ› ·ÔÎfiÏÏËÛË˜ ÙÔ˘ ÌÂ›˙ÔÓÔ˜ ÂÈÏfiÔ˘, Ë ÎÈÓËÙÔÔ›ËÛË ÙË˜ Î‡ÛÙË˜ Î·È Ë ÂÎÙÔÌ‹ ·˘Ù‹˜ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó È‰È·›ÙÂÚË ‰˘ÛÎÔÏ›·.

∂ÈÎfiÓ· 2. §··ÚÔÛÎÔÈÎ‹ ÚÔÛ¤Ï·ÛË. ŒÓıÂÙ·: Ù¤ÛÛÂÚÈ˜ ÂÈÎfiÓÂ˜ ·fi ÙË Ï··ÚÔÛÎÔÈÎ‹ ·Ó·ÁÓÒÚÈÛË Î·È ·Ê·›ÚÂÛË ÙÔ˘ Î˘ÛÙÈÎÔ‡ ÌÔÚÊÒÌ·ÙÔ˜.

∆Ô ÂÚÈÂ¯fiÌÂÓÔ ÙË˜ Î‡ÛÙË˜ ÂÎÎÂÓÒıËÎÂ ÌÂ ·Ó·ÚÚfiÊËÛË, Ë ‰Â ÎÂÓ‹ Î‡ÛÙË ·Ê·ÈÚ¤ıËÎÂ ·fi ÙËÓ

‡ÂÏÔ Ï··ÚÔÛÎÔÈÎÒ˜ ÌÂ Û¿ÎÔ ÂÚÈÛ˘ÏÏÔÁ‹˜

ÔÚÁ¿ÓˆÓ.

∆· Î˘ÛÙÈÎ¿ ÌÔÚÊÒÌ·Ù· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ï··ÚÔÛÎÔÈÎÒ˜, ‰ÈfiÙÈ ÛÂ Û¯¤ÛË ÌÂ ÙË Ï··ÚÔÙÔÌ›· ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ô ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi˜ fiÓÔ˜, ÌÂÈÒÓÂÙ·È Ô ¯ÚfiÓÔ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹˜ ÓÔÛËÏÂ›·˜ Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ï‡ÙÂÚÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. O Ì¤ÛÔ˜ fiÚÔ˜ ÓÔÛËÏÂ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó ÛÂ ·ÓÔÈÎÙ‹ ÂÁ¯Â›ÚËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î‡ÛÙÂˆÓ ÙˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ ÙË˜ Ì‹ÙÚ·˜ ‹Ù·Ó 6 ËÌ¤ÚÂ˜, ÂÓÒ Ë ·ÛıÂÓ‹˜ Ô˘ ·ÓÙÈÌÂÙˆ›Û·ÌÂ Ï··ÚÔÛÎÔÈÎÒ˜ ÂÍ‹ÏıÂ ÙË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈÎ‹ ËÌ¤Ú·. ∏ Ï··ÚÔÛÎÔÈÎ‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹ ¤¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË, ÙfiÛÔ ÛÙË ‰È¿ÁÓˆÛË fiÛÔ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Î·ÏÔ‹ıˆÓ Î‡ÛÙÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙˆÓ ıËÏ¤ˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Jawad AJ, Al Meshari A. Laparoscopy for ovarian pathology in infancy and childhood. Pediatr Surg Int 1998;14:62-65.

2. Steyaert H, Meynol F, Valla JS. Torsion of the adnexa in children: the value of laparoscopy. Pediatr Surg Int 1998;13:384-387.

3. Van der Zee DC, Van Seumeren IG, Bax Klaas MA, Rövekamp Mechelien H, Pull ter Gunne AJ. Laparoscopic approach to surgical management of ovarian cysts in the newborn. J Pediatr Surg 1995;30:42-43.

4. Schmahmann S, Haller JO. Neonatal ovarian cysts: pathogenesis, diagnosis and management. Pediatr Radiol 1997;27:101-105.

5. Helmrath MA, Shin CE, Warner BW. Ovarian cysts in the pediatric population. Semin Pediatr Surg 1998;7:19-28.

6. Heloury Y, Guiberteau V, Sagot P, Plattner V, Baron M, Rogez JM. Laparoscopy in adnexal pathology in the child: A study of 28 cases. Eur J Pediatr Surg 1993;3:75-78.

7. Rottem S, Levit N, Thaler I, Yoffe N, Bronshtein M, Manor D et al. Classification of ovarian lesions by high frequency transvaginal sonography. J Clin Ultrasound 1990;18:359-363.

8. Siegel MJ, Surratt JT. Pediatric gynecologic imaging. Obstet Gynecol Clin N Am 1992;19:103-127.

9. Bagolan P, Rivosecchi M, Giorlandino C, Bilancioni E, Nahom A, Zaccara A et al. Prenatal diagnosis and clinical outcome of ovarian cysts. J Pediatr Surg 1992;27:879-881.

10. Giorlandino C, Bilancioni E, Bagolan P, Muzii L, Rivosecchi M, Nahom A. Antenatal ultrasonographic diagnosis and management of fetal ovarian cysts. Int J Gynecol Obstet 1994;44:27-31.

11. Brandt ML, Luks FI, Filiatrault D, Garel L, Desjardins JG, Youssef S. Surgical indications in antenatally diagnosed ovarian cysts. J Pediatr Surg 1991;26:276-281.

12. Hasson HM. Laparoscopic management of ovarian cysts. J Reprod Med 1990;35:863-867.

13. Schwobel MG, Stauffer UG. Surgical treatment of ovarian tumors in childhood. Prog Pediatr Surg 1991;26:112-123.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-06-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 18-10-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂˘¿ÁÁÂÏÔ˜ ¶··Ó‰Ú¤Ô˘

∆ÚÈﬁÏÂˆ˜ 1, 151 27, ªÂÏ›ÛÛÈ·

∂ÏÏ¿‰· ÙÔ ¤ÙÔ˜ 2000

¢. ∫·Ú·Î·˚‰ﬁ˜, °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, ∞. ªÔ˘Ù¿ÊË, §. ∫·Ó¿ÚË˜, ¶. ∑ÒÛË, Ã. ∫·Ú‹˜

Generalized tetanus in a greek child in the year 2000

D. Karakaidos, G. Triantafillidis, A. Moutafi, L. Kanaris, P. Zosi, C. Karis ∂¡¢π∞º∂ƒOÀ™∞

¶ÂÚ›ÏË„Ë: O Ù¤Ù·ÓÔ˜ ·ÔÙÂÏÂ› ÛÔ‚·Ú‹, ‰˘ÓËÙÈÎ¿ ı·Ó·ÙËÊfiÚo ÓfiÛÔ, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi

˘ÂÚÙÔÓ›· Î·È Û·ÛÌÔ‡˜ Î·È ÔÊÂ›ÏÂÙ·È ÛÙË ÓÂ˘ÚÔ-

ÙÔÍ›ÓË ÙÔ˘ ÎÏˆÛÙËÚÈ‰›Ô˘ ÙÔ˘ ÙÂÙ¿ÓÔ˘, ÙÂÙ·ÓÔÛ·-

ÛÌ›ÓË. O ÂÎÙÂÙ·Ì¤ÓÔ˜ ÂÌ‚ÔÏÈ·ÛÌﬁ˜ ¤¯ÂÈ Û¯Â‰ﬁÓ

ÂÎÌË‰ÂÓ›ÛÂÈ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÙÂÙ¿ÓÔ˘ ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›· ÛÙË ¯ÒÚ· Ì·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›·. ¶Â-

ÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÙÂÙ¿ÓÔ˘ ÛÂ

ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ, ·ÓÂÌ‚ÔÏ›·ÛÙÔ, ÌÂÙ¿ ·ﬁ ÙÚ·‡Ì·

ÛÙÔ ‰ÂÍÈfi ¿ÎÚÔ fi‰·. ∆Ô ·È‰› ·ÚÔ˘Û›·ÛÂ Û¯Â‰fiÓ Ï‹ÚË ·Ó¿ÚÚˆÛË 2 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ÓﬁÛÔ˘. ∞Ó·ÛÎÔÂ›Ù·È Ë ‰ÈÂıÓ‹˜ Î·È ÂÏÏËÓÈÎ‹

‚È‚ÏÈÔÁÚ·Ê›·, Î˘Ú›ˆ˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›·

Î·È ÙËÓ ÚﬁÏË„Ë ÙË˜ ÓﬁÛÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Ù¤Ù·ÓÔ˜, ·È‰ÈÎ‹ ËÏÈÎ›·, ÂÈ‰ËÌÈÔ-

ÏÔÁ›·, ·ÓÙÈÙÂÙ·ÓÈÎﬁ˜ ÂÌ‚ÔÏÈ·ÛÌﬁ˜.

∂ÈÛ·ÁˆÁ‹ O Ù¤Ù·ÓÔ˜ Â›Ó·È ÓÂ˘ÚÔÏÔÁÈÎ‹ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍËÌ¤ÓÔ Ì˘˚Îfi ÙfiÓÔ, Û·ÛÌÔ‡˜ Î·È ÚÔÎ·ÏÂ›Ù·È ·fi ÙËÓ ÙÂÙ·ÓÔÛ·ÛÌ›ÓË, Ì›· ÈÛ¯˘ÚfiÙ·ÙË ÓÂ˘ÚÔÙÔÍ›ÓË Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙÔ ÎÏˆÛÙËÚ›‰ÈÔ ÙÔ˘ ÙÂÙ¿ÓÔ˘ (1). ¢È·ÎÚ›-

ÓÔ˘ÌÂ ‰È¿ÊÔÚÂ˜ ÎÏÈÓÈÎ¤˜ ÌÔÚÊ¤˜ ÙÂÙ¿ÓÔ˘, ﬁˆ˜

ÁÂÓÈÎÂ˘Ì¤ÓÔ˜, ÂÓÙÔÈÛÌ¤ÓÔ˜, ÓÂÔÁÓÈÎﬁ˜. ∏ ÓﬁÛÔ˜

ÛÙÈ˜ ·Ó·Ù˘ÛÛﬁÌÂÓÂ˜ ¯ÒÚÂ˜ ÂÍ·ÎÔÏÔ˘ıÂ› Ó· ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ıÓËÛÈÌﬁÙËÙ·˜, È‰›ˆ˜

ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›·, ÂÓÒ ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ÌÂ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎÙÂÙ·Ì¤ÓˆÓ ÚÔÁÚ·ÌÌ¿-

ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤¯ÂÈ ÂÚÈÔÚÈÛÙÂ› ÛËÌ·ÓÙÈÎ¿ Î·È

ÔÏ‡ Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÎÚÔ‡ÛÌ· ÙÂÙ¿ÓÔ˘ ÛÂ

·È‰› (1-6).

¶ÂÚÈÊÂÚÂÈ·Îﬁ °ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô “ÕÁÈÔ˜ ¶·ÓÙÂÏÂ‹ÌˆÓ”

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹, ¡›Î·È·-¶ÂÈÚ·È¿˜

Abstract: Tetanus is a serious, potentially lethal disease, characterized by hypertonicity and convulsions, caused by tetanospasmin, a neurotoxin produced by C. tetanus. In the last decade, cases of tetanus were scarcely encountered in our country during childhood, because of the extended use of the tetanus vaccine. A case of a 4-year old unvaccinated girl with generalized tetanus, as a result of a wound in the right foot, is described. The child recovered fully two months after the onset of the disease. The international as well as the greek literature is reviewed regarding the epidemiology of the disease and its prevention.

Key words: tetanus, childhood, epidemiology, vaccination against tetanus. °ÂÓÈÎÂ˘Ì¤ÓÔ˜

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

∫ÔÚ›ÙÛÈ 4 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÁÈ·Ù› ·fi 24ÒÚÔ˘ ÂÌÊ¿ÓÈ˙Â ·‰˘Ó·Ì›· ‰È¿ÓÔÈÍË˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ÂÏÌ·ÙÈ·›· Î¿Ì„Ë Î¿Ùˆ ¿ÎÚˆÓ, È‰›ˆ˜ ‰ÂÍÈ¿. ¢¤Î· ÂÚ›Ô˘ Ì¤ÚÂ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È ÙÚ·˘Ì·ÙÈÛÌfi˜ ÛÙËÓ ÂÏÌ·ÙÈ·›· ¯ÒÚ· ÙÔ˘ ‰ÂÍÈÔ‡ Î¿Ùˆ ¿ÎÚÔ˘ ÁÈ· ÙÔÓ ÔÔ›Ô ‰ÂÓ ˘‹ÚÍÂ Î·Ì›· ·ÓÙÈÌÂÙÒÈÛË. ¢ÂÓ ·Ó·Ê¤ÚÂÙ·È, Â›ÛË˜, Ï‹„Ë ÔÔÈÔ˘‰‹ÔÙÂ Ê·ÚÌ¿ÎÔ˘. ∏ ÌÈÎÚ‹ ·ÛıÂÓ‹˜, fiˆ˜ Î·È Ù· ¿ÏÏ· 8 ·‰¤ÏÊÈ· ÙË˜, ·ı›ÁÁ·ÓÔÈ ÛÙËÓ Î·Ù·ÁˆÁ‹, ‹Ù·Ó Ï‹Úˆ˜ ·ÓÂÌ‚ÔÏ›·ÛÙË. ∏ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ¤ˆ˜ ÙËÓ

ÂÈÛ·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È Ê˘ÛÈÔÏÔÁÈÎ‹, ÂÓÒ ÙÔ ˘fiÏÔÈÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂÏÂ‡ıÂÚÔ. ∏ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ¤‰ÂÈÍÂ ¤Ó· ·È‰›

Pediatric Department of General Hospital “Agios Panteleimon”, Nikea-Piraeus

¶·È‰È·ÙÚÈÎ‹ 2001;64:610-614 Paediatriki 2001;64:610-614

‰˘ÛÙÚÔÊÈÎﬁ ÌÂ ‡„Ô˜ 88 cm (<3 ∂£), ‚¿ÚÔ˜ 12 kg (<3 ∂£), ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 44 cm (<3 ∂£) Î·È

·ÚÔ˘Û›·˙Â Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·‰˘Ó·Ì›· ‰È¿-

ÓÔÈÍË˜ ÙÔ˘ ÛÙﬁÌ·ÙÔ˜ ÌÂ ·ÔÎ¿Ï˘„Ë ÙˆÓ Ô‰ﬁÓÙˆÓ

ÏfiÁˆ Û·ÛÌÔ‡ ÙˆÓ Ì·ÛËÙ‹ÚˆÓ (Û·Ú‰fiÓÈÔ˜ Á¤ÏˆÙ·˜), ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›· Ì˘ÒÓ, È‰›ˆ˜ ÙË˜ Ú¿¯Ë˜ ÌÂ ÔÈÛıfiÙÔÓÔ (∂ÈÎfiÓ· 1), ¤ÎÙ·ÛË ÙˆÓ Î¿Ùˆ

¿ÎÚˆÓ ÌÂ ÂÏÌ·ÙÈ·›· Î¿Ì„Ë È‰›ˆ˜ ‰ÂÍÈ¿ (∂ÈÎﬁÓ· 2), ¯·›ÓÔÓ, Ú˘·Úﬁ ÙÚ·‡Ì· ÛÙËÓ ÂÏÌ·ÙÈ·›· ÂÈ-

Ê¿ÓÂÈ· ÙÔ˘ ‰ÂÍÈÔ‡ 3333 Î¿Ùˆ ¿ÎÚÔ˘. ∆Ô Â›Â‰Ô

Û˘ÓÂ›‰ËÛË˜ ‰ÂÓ ‹Ù·Ó ÂËÚÂ·ÛÌ¤ÓÔ, ÂÓÒ ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù· ‹Ù·Ó Ë ÂÍ¤Ù·ÛË ÙÔ˘ ·Ó·-

ÓÂ˘ÛÙÈÎÔ‡ Î·È ÙÔ˘ Î˘ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. O ÂÚÁ·ÛÙËÚÈ·Îﬁ˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ô ·ÎﬁÏÔ˘ıÔ˜:

°ÂÓÈÎ‹ ·›Ì·ÙÔ˜: Ht 35%, Hb 11,9 g/dl, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·: 12.800/mm3 (¶ 58%, § 36%), AÈÌÔÂÙ¿ÏÈ·: 286.000/mm3, CRP <2 mg/L, ∆∫∂ 17 mm/1h, Ca 9,5 mg/dL, P 4,3 mg/dL, ¡a 136 mEq/L, K 3,8 mEq/L, Cl 102 mEq/L, Mg 1,6 mg/dL, TP 7,2 gr/dL, ALB 4,2 gr/dL, SGOT 126 U/L, SGPT 72 U/L, CPK 2425 U/L (ÊÙ ¤ˆ˜ 240 U/L), LDH 368 U/L (ÊÙ ¤ˆ˜ 190 U/L), Ô˘Ú›· 9 mg/dL, Cr 0,4 mg/dL, ÁÂÓÈÎ‹ Ô‡ÚˆÓ ÎÊ, ÁÂÓÈÎ‹ ∂¡À ÎÊ, Î/· ·›Ì·ÙÔ˜ ÛÙÂ›Ú·, Î/·

∂¡À ÛÙÂ›Ú·, PCR (ÎﬁÚ·Ó·) ÁÈ· Èﬁ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜ ·ÚÓËÙÈÎ‹, MRI ÂÁÎÂÊ¿ÏÔ˘ ÎÊ.

ªÂ ‚¿ÛË ÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ·, ÙÔ ÈÛÙÔÚÈÎﬁ ÙÔ˘

ÚfiÛÊ·ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ

·È‰› ‹Ù·Ó ·ÓÂÌ‚ÔÏ›·ÛÙÔ, ÂÙ¤ıË Ë ‰È¿ÁÓˆÛË ÙÔ˘

ÙÂÙ¿ÓÔ˘ Î·È ¯ÔÚËÁ‹ıËÎ·Ó ÂÓ‰ÔÌ˘˚Î¿ 750 IU ·ÓıÚÒÈÓË˜ ÙÂÙ·ÓÈÎ‹˜ ·ÓÙÈÙÔÍ›ÓË˜. ∂›ÛË˜, ¤ÁÈÓÂ ¯ÂÈÚÔ˘ÚÁÈÎﬁ˜ Î·ı·ÚÈÛÌﬁ˜ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È ÙÔ ·È‰› ÂÙ¤ıË ÛÂ 10‹ÌÂÚË ÂÓ‰ÔÊÏ¤‚È· ·ÁˆÁ‹ ÌÂ ÂÓÈÎÈÏ›ÓË (100.000 IU/kgµ™/24h). ŒÓ·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÒÓ

¤ÁÈÓÂ ÙﬁÛÔ ÛÙËÓ ·ÛıÂÓ‹ ﬁÛÔ Î·È ÛÙ· ·ÓÂÌ‚ÔÏ›·ÛÙ· ·‰¤ÏÊÈ· ÙË˜. ∆Ô ·È‰› ÓÔÛËÏÂ‡ÙËÎÂ ÛÂ ·Ô-

ÌÔÓˆÌ¤ÓÔ ı¿Ï·ÌÔ ÌÂ fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÏÈÁfiÙÂÚ· ÂÚÂı›ÛÌ·Ù·, ÂÓÒ Ë Û›ÙÈÛË, ÏfiÁˆ ‰˘Û¯ÂÚÂÈÒÓ ÛÙËÓ

Î·Ù¿ÔÛË, ÛÙ· ÚÒÙ· 7 ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ÓÔÛËÏÂ›-

¤ÁÈÓÂ ·ÚÂÓÙÂÚÈÎ¿. ∆Ô ·È‰› ·ÚÔ˘Û›·ÛÂ ÌÈÎÚ‹

ÂÈ‰Â›ÓˆÛË Ù· ÚÒÙ· 3-4 ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ·, ÌÂ ·‡-

ÍËÛË ÙË˜ ˘ÂÚÙÔÓ›·˜ Î·È ÂÈ‚¿Ú˘ÓÛË ÙË˜ ·Ó·-

ÓÂ˘ÛÙÈÎ‹˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î˘Ú›ˆ˜ ÏfiÁˆ Û˘ÛÛÒÚÂ˘ÛË˜ ÂÎÎÚÈÌ¿ÙˆÓ, ¯ˆÚ›˜ fiÌˆ˜ ÂÌÊ¿ÓÈÛË ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û·ÛÌÒÓ ‹ Î·Ù·ÎÚ¿ÙËÛË Ô‡ÚˆÓ Î·È ÎÔÚ¿ÓˆÓ. ∞fi ÙÔ 6Ô 24ˆÚÔ ÓÔÛËÏÂ›·˜ ¿Ú¯ÈÛÂ ÚÔÔ‰Â˘ÙÈÎ‹, ‚Ú·‰Â›· ‚ÂÏÙ›ˆÛË, ÂÓÒ ·fi ÙÔ 8Ô 24ˆÚÔ

‹Ù·Ó ‰˘Ó·Ù‹ Ë ¯ÔÚ‹ÁËÛË ˘‰·ÚÒÓ ÙÚÔÊÒÓ ·ﬁ ÙÔ

ÛÙfiÌ·. ∏ ÙÈÌ¤˜ ÙˆÓ CPK, LDH Î·È SGOT ÌÂÈÒıËÎ·Ó ÛÙ·‰È·Î¿ Î·È ‹Ù·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ·fi ÙÔ 25Ô 24ˆÚÔ ÓÔÛËÏÂ›·˜ (CPK 158 U/L, LDH 95 U/L, SGOT 37 U/L). ∆Ô ·È‰› ÂÍ‹ÏıÂ ÌÂÙ¿ ·fi 40 ËÌ¤ÚÂ˜ ÓÔÛËÏÂ›-

ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË, ÌÂ Û¯Â‰ﬁÓ Ï‹ÚË

ÓÂ˘ÚÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, ÂÎÙﬁ˜

ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ˘ÂÚÙÔÓ›· ÛÙË ‰ÂÍÈ¿ Ô‰ÔÎÓËÌÈÎ‹ ¿ÚıÚˆÛË. ™Â Â·ÓÂÎÙ›ÌËÛË, ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô (2,5 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ÓﬁÛÔ˘), ˘‹Ú¯Â Ï‹ÚË˜ ·ÔÎ·Ù¿ÛÙ·ÛË.

∆Ô ÎÏˆÛÙËÚ›‰ÈÔ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Â›Ó·È Gram+ ·Ó·ÂÚfi‚ÈÔ ÛÔÚÔÁfiÓÔ ‚·ÎÙËÚ›‰ÈÔ. OÈ ÛfiÚÔÈ ÙÔ˘ ·ÊıÔÓÔ‡Ó ÛÙÔ ¤‰·ÊÔ˜, ÛÙË ÛÎfiÓË, ÛÙ· ÎfiÚ·Ó· ÙˆÓ ˙ÒˆÓ (5) Î·È ÔÏÏ¤˜ ÊÔÚ¤˜ Î·È ÙˆÓ ·ÓıÚÒˆÓ (1). ∂›Ó·È ·ÚÎÂÙ¿ ·ÓıÂÎÙÈÎÔ› ÛÙÈ˜ Û˘Ó‹ıÂÈ˜ ÂÚÈ‚·ÏÏÔÓÙÈÎ¤˜ Û˘Óı‹ÎÂ˜ Î·È ÛÙÔ ‚Ú·ÛÌfi (3). ∆¤Ù·ÓÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi ÂÈÌfiÏ˘ÓÛË ÙÚ·‡Ì·ÙÔ˜ ÌÂ ÛfiÚÔ˘˜ ÙÔ˘ ÎÏˆÛÙËÚÈ‰›Ô˘. ∞˘ÍËÌ¤ÓÔ˜ Î›Ó‰˘ÓÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÂ ÙÚ·‡Ì·Ù·

·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜. ™ÙÈ˜ ÚÒÙÂ˜, Ô Ù¤Ù·ÓÔ˜ Î·È

È‰›ˆ˜ Ë ÓÂÔÁÓÈÎ‹ ÙÔ˘ ÌÔÚÊ‹ ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎ‹ ·ÈÙ›· ÓÔÛËÚﬁÙËÙ·˜ Î·È ıÓËÛÈÌﬁÙËÙ·˜: ÂÚ›Ô˘

500.000 ÓÂÔÁÓ¿ Âı·›ÓÔ˘Ó Î¿ıÂ ¯ÚﬁÓÔ (ÙÔ 80% ÛÂ

12 ÙÚÔÈÎ¤˜ ¯ÒÚÂ˜ ÙË˜ ∞Û›·˜ Î·È ÙË˜ ∞ÊÚÈÎ‹˜) (1,3,4). ∞fi ÙË ÓfiÛÔ, Â›ÛË˜, Âı·›ÓÔ˘Ó Î¿ıÂ ¯ÚfiÓÔ 15.000-30.000 Á˘Ó·›ÎÂ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi (3). ∏ ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÓÂÔÁÓÈÎÔ‡ ÙÂÙ¿ÓÔ˘ ÛÙÈ˜ ¯ÒÚÂ˜ ·˘Ù¤˜ ÂÍËÁÂ›Ù·È ·fi ÙÈ˜ Î·Î¤˜ Û˘Óı‹ÎÂ˜ ˘ÁÈÂÈÓ‹˜

Î·Ù¿ ÙÔÓ ÙÔÎÂÙﬁ Î·È ÙÔÓ ·ÓÂ·ÚÎ‹ ÂÌ‚ÔÏÈ·ÛÌﬁ ÙˆÓ

Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈÎ‹˜ ËÏÈÎ›·˜ (4). ∂›ÛË˜, ÙÔ

ıÂÚÌﬁ Î·È ˘ÁÚﬁ ÎÏ›Ì· ÛÙÈ˜ ¯ÒÚÂ˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È

Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·˘ÍËÌ¤ÓË Â›ÙˆÛË ÙË˜ ÓfiÛÔ˘, Â›ÙÂ Â˘ÓÔÒÓÙ·˜ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÎÏˆÛÙËÚÈ‰›Ô˘, Â›ÙÂ ·˘Í¿ÓÔÓÙ·˜ ÙËÓ Èı·ÓfiÙËÙ· ÁÈ· ¤ÎıÂÛË ÛÂ ·˘Ùfi (4). ∞ÓÙ›ıÂÙ·, Ù· ÂÎÙÂÙ·Ì¤Ó· ÚÔÁÚ¿ÌÌ·Ù· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙÈ˜ ·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜ ¤¯Ô˘Ó ÂÚÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈÎ¿ ÙË Û˘¯ÓfiÙËÙ· ÛÂ ·˘Ù¤˜ Î·È ÔÈ Ï›ÁÂ˜

ÂÚÈÙÒÛÂÈ˜ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ¿ÙÔÌ· ÌÂÁ¿ÏË˜ ËÏÈÎ›·˜. ™ÙÈ˜ ∏¶∞ ·Ó·Ê¤ÚÔÓÙ·È ÂÚ›Ô˘ 50 ÂÚÈÙÒÛÂÈ˜ Î¿ıÂ ¯ÚﬁÓÔ (3,6), ·ﬁ ÙÈ˜ ÔÔ›Â˜ ÙÔ 95% Â›Ó·È

¿ÙÔÌ· ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 20 ÂÙÒÓ Î·È ÙÔ 53% ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 70 ÂÙÒÓ (1). ™ÙËÓ ÏÂÈÔÓﬁÙËÙ¿ ÙÔ˘˜ Â›Ó·È ¿ÙÔÌ· Ô˘ ˙Ô˘Ó ‹ ÂÚÁ¿˙ÔÓÙ·È ÛÙÔ

‡·ÈıÚÔ. ∞Ó Î·È Ù¤Ù·ÓÔ˜ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÂ›

ÔÏ‡ Û¿ÓÈ· ÛÂ ¿ÙÔÌ· Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·ÛÌ¤Ó· (ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ) (6,8), ÛÙË Û˘ÓÙÚÈÙÈÎ‹ ÏÂÈÔ„ËÊ›· ·ÊÔÚ¿ ¿ÙÔÌ· Ô˘ Â›ÙÂ ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙÂ› (fiˆ˜ Ë ·ÛıÂÓ‹˜ Ì·˜), Â›ÙÂ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙÂ› ÌÂÚÈÎÒ˜, Â›ÙÂ ¤¯Ô˘Ó Î¿ÓÂÈ ÙÔÓ ·Ú¯ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ·ÏÏ¿ ¤¯Ô˘Ó

·ÔÙ‡¯ÂÈ Ó· ‰È·ÙËÚ‹ÛÔ˘Ó ÙËÓ ·ÓÔÛÔÁÔÓÈÎﬁÙËÙ· ÌÂ

Â·Ó·ÏËÙÈÎ¤˜ ‰ﬁÛÂÈ˜ (4,6).

™ÙËÓ ∂ÏÏ¿‰·, Ë ÂÈ‰ËÌÈÔÏÔÁ›· ÙË˜ ÓﬁÛÔ˘ Â›Ó·È

·Ó¿ÏÔÁË ÙˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ. O ˘Ô¯ÚÂˆÙÈÎfi˜ ·ÓÙÈÙÂÙ·ÓÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Â›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ÙË˜ Â›ÙˆÛË˜ ÙË˜ ÓfiÛÔ˘ ÛÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜, È‰›ˆ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌË‰ÂÓÈÎfi˜ ·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ ÌÂÙ¿ ÙÔ 1995 (9). ∆Ë ‰ÂÎ·ÂÙ›· ÙÔ˘ ’70, ÌfiÓÔ ÛÙË µ. ∂ÏÏ¿‰· ·Ó·Ê¤ÚÔÓÙ·È Î·Ù¿ Ì¤ÛÔ fiÚÔ 24 ÂÚÈÙÒÛÂÈ˜ ÙÂÙ¿ÓÔ˘ ·Ó¿ ¤ÙÔ˜ ÌÂ ÙÔ 63% Ó· ·ÊÔÚ¿ ÂÓËÏ›ÎÔ˘˜, ÙÔ 29% ÓÂÔÁÓ¿ Î·È ÙÔ 8% ·È‰È¿ (ÂÚ›Ô˘ 2 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ ¤ÙÔ˜) (10). ™ÙËÓ ›‰È· ÂÚÈÔ¯‹, ÔÈ ÂÚÈÙÒÛÂÈ˜ ÓÂÔÁÓÈÎÔ‡ ÙÂÙ¿ÓÔ˘ ÌÂÈÒıËÎ·Ó ·fi 18/100.000 ÁÂÓÓ‹ÛÂÈ˜ ÛÙÈ˜ ·Ú¯¤˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜ ÙÔ˘ ’70 ÛÂ 3,4/100.000 ÛÙÔ Ù¤ÏÔ˜ ÙË˜ ‰ÂÎ·ÂÙ›·˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ÂÚÈÙÒÛÂˆÓ ·Ó‹ÎÂ ÛÂ ÌÂÈÔÓÔÙÈÎ¤˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ (10). ™ÙÔ ™¯‹Ì· 1 Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ ÂÚÈÙÒÛÂÈ˜ ÙÂÙ¿ÓÔ˘ ÛÙË ¯ÒÚ· Ì·˜ ·fi ÙÔ 1981 ¤ˆ˜ Û‹ÌÂÚ·. ∆· ÛÙÔÈ¯Â›· ÚÔ¤Ú¯ÔÓÙ·È ÙfiÛÔ

ÛË˜ ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ Î·È ¶ÚfiÓÔÈ·˜ (∂∫∂¶∞¶) (ÎÚÔ‡ÛÌ·Ù· ÙÂÙ¿ÓÔ˘ Ô˘ ‰ËÏÒÓÔÓÙ·Ó ÛÙ· ÙÌ‹Ì·Ù· ˘ÁÈÂÈÓ‹˜ ÙˆÓ Î·Ù¿ ÙfiÔ˘˜ ÓÔÌ·Ú¯ÈÒÓ ¤ˆ˜ ÙÔ 1998 Î·È ·fi ÙÔ 1998 ÛÙÔ ∂∫∂¶∞¶) (9), fiÛÔ Î·È ·fi Ù· ÂÙ‹ÛÈ· ‰ÂÏÙ›· ÙË˜ ™Ù·ÙÈÛÙÈÎ‹˜ ∫ÔÈ-

ÓˆÓÈÎ‹˜ ¶ÚﬁÓÔÈ·˜ Î·È ÀÁÈÂÈÓ‹˜ ÙË˜ ∂ıÓÈÎ‹˜ ™Ù·ÙÈ-

ÛÙÈÎ‹˜ ÀËÚÂÛ›·˜ (·ÚÈıÌﬁ˜ ÂÍÂÏıﬁÓÙˆÓ ·ÛıÂÓÒÓ

ÌÂ ‰È¿ÁÓˆÛË ÙÂÙ¿ÓÔ˘) (11). OÈ ·Ú·ÙËÚÔ‡ÌÂÓÂ˜

‰È·ÊÔÚ¤˜ Èı·ÓﬁÓ Ó· ÔÊÂ›ÏÔÓÙ·È ÛÙÔ ‰È·ÊÔÚÂÙÈÎﬁ

ÙÚﬁÔ Î·Ù·ÁÚ·Ê‹˜ Ô˘ ·ÎÔÏÔ˘ıÂ› Î¿ıÂ ËÁ‹.

∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂÎ·ÂÙ›·, ÂÎÙﬁ˜ ·ﬁ ÙËÓ ·ÛıÂÓ‹

Ì·˜, ¤¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ› ¿ÏÏÂ˜ 6 ÂÚÈÙÒÛÂÈ˜ ·È-

‰ÈÒÓ ÙËÓ ÂÚ›Ô‰Ô 1991-1995 (11). ∆Ô ¤ÙÔ˜ 2000,

ﬁÏÂ˜ ÔÈ ˘ﬁÏÔÈÂ˜ ÂÚÈÙÒÛÂÈ˜ ‹Ù·Ó ¿ÙÔÌ· ÌÂÁ·-

Ï‡ÙÂÚ· ÙˆÓ 53 ÂÙÒÓ (9).

¶·Ú¿ ÙÔ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙË˜ ÓfiÛÔ˘ ÛÙÈ˜

·ÓÂÙ˘ÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, Ë ÚÔÛ¿ıÂÈ· ÂÎÚ›˙ˆÛ‹˜

ÙË˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰˘ÛÎÔÏ›Â˜: ·) ÙÔ ÎÏˆÛÙËÚ›‰ÈÔ Â›Ó·È Â˘Ú‡Ù·Ù· ‰È·‰Â‰ÔÌ¤ÓÔ ÛÙË Ê‡ÛË, ‚) Ë Ê˘ÛÈÎ‹ ·ÓÔÛ›·, ·ÎfiÌ· Î·È ÌÂÙ¿ ·fi ÓfiÛËÛË, Â›Ó·È Û¯Â‰fiÓ ·Ó‡·ÚÎÙË (5,10), ·ÊÔ‡ ÂÏ¿¯ÈÛÙË ÔÛfiÙËÙ· ÙÂÙ·ÓÔÛ·ÛÌ›ÓË˜ Â·ÚÎÂ› Ó· ÚÔÎ·Ï¤ÛÂÈ ÓfiÛÔ, fi¯È fiÌˆ˜ ·ÓÔÛÔÏÔÁÈÎ‹ ·¿ÓÙËÛË (1), Á) ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÔÛ›· ·Á¤ÏË˜ Î·È ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ··ÈÙÂ›Ù·È ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ Î·È ‰) Ë ·ÓÔÛ›· Ô˘ ·ÔÎÙ¿Ù·È ÌÂÙ¿ ·fi ÙÔ ‚·ÛÈ-

Â›Ó·È ·ÚÔ‰ÈÎ‹ (6) (ÛÙÈ˜ ∏¶∞, ÔÛÔÛÙfi 88% ÙˆÓ ·È‰ÈÒÓ ËÏÈÎ›·˜ 6 ¤ˆ˜ 11 ÂÙÒÓ ¤¯ÂÈ Â·ÚÎ‹ Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÌfiÓÔ 27% ÙˆÓ ·ÙfiÌˆÓ ËÏÈÎ›·˜ ÌÂÁ·Ï‡ÙÂÚË˜ ÙˆÓ 70 ÂÙÒÓ, Ë

ÏÂÈÔÓﬁÙËÙ· ÙˆÓ ÔÔ›ˆÓ ·Ó·Ê¤ÚÂÈ ÈÛÙÔÚÈÎﬁ ÂÌ‚ÔÏÈ·ÛÌÔ‡) (1). ∆· ·Ú·¿Óˆ Î·ıÈÛÙÔ‡Ó ·Ó·ÁÎ·›·

ÙË ‰ÈÂÓ¤ÚÁÂÈ· Â·Ó·ÏËÙÈÎÒÓ ‰ﬁÛÂˆÓ Î·ı’ ﬁÏË ÙË

‰È¿ÚÎÂÈ· ÙË˜ ÂÓ‹ÏÈÎË˜ ˙ˆ‹˜.

O ·ÓÙÈÙÂÙ·ÓÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ˘Ô¯ÚÂˆÙÈÎfi˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· Î·È ÁÂÓÈÎ¿ ÎÚ›ÓÂÙ·È ˆ˜ ÂÈÙ˘¯‹˜: ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 98% ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈÎ›· ÙˆÓ 6 ÂÙÒÓ ¤¯ÂÈ Î·Ï˘ÊıÂ›

∂∫∂¶∞¶ ∂.™.À.∂.

ÌÂ ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ‰ﬁÛÂÈ˜ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (12).

À¿Ú¯Ô˘Ó ﬁÌˆ˜ ÂÈÌ¤ÚÔ˘˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÈ-

‰¤¯ÔÓÙ·È ÛËÌ·ÓÙÈÎ‹ ‚ÂÏÙ›ˆÛË: ÌﬁÓÔ ÙÔ 80% ÙˆÓ

·È‰ÈÒÓ ¤¯ÂÈ Î¿ÓÂÈ 5 ‰ﬁÛÂÈ˜ ¤ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ 6

ÂÙÒÓ, ÂÓÒ ÙÔ ÔÛÔÛÙﬁ ÁÈ· 4 ‰ﬁÛÂÈ˜ ¤ˆ˜ ÙËÓ ËÏÈÎ›·

ÙˆÓ 2 ÂÙÒÓ ‰ÂÓ ÍÂÂÚÓ¿ ÙÔ 69% ÌÂ ÛÙﬁ¯Ô ÙÔ˘ ¶·-

ÁÎﬁÛÌÈÔ˘ OÚÁ·ÓÈÛÌÔ‡ ÀÁÂ›·˜ ÁÈ· ÙÔ 1995 ÔÛÔ-

ÛÙ¿ ÌÂÁ·Ï‡ÙÂÚ· ÙÔ˘ 95% Î·È ÛÙÈ˜ ‰‡Ô Î·ÙËÁÔÚ›Â˜ (12). ™ÙÈ˜ Î·ı˘ÛÙÂÚ‹ÛÂÈ˜ ·˘Ù¤˜ Èı·ÓﬁÓ Ó· ¤¯ÂÈ

Û˘Ì‚¿ÏÂÈ Ë - Û˘¯Ó¿ ·ÚÔÁÚ·ÌÌ¿ÙÈÛÙË Î·È ¯ˆÚ›˜

Â·ÚÎ‹ ÂÓËÌ¤ÚˆÛË - Â›ÛÔ‰Ô˜ ÔÏÏÒÓ Ó¤ˆÓ ÂÌ‚Ô-

Ï›ˆÓ, ·ÚÎÂÙ¿ ÂÎ ÙˆÓ ÔÔ›ˆÓ ÌÂ ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓÔ

ﬁÊÂÏÔ˜, ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· Û‡Á¯˘ÛË˜

ÛÂ ÁÔÓÂ›˜ Î·È ·È‰È¿ÙÚÔ˘˜ Î·È ÙËÓ ·Ú·Ì¤ÏËÛË

ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ.

∆· ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó ÛÂ ÂÈ‰ÈÎ¤˜ ÔÌ¿‰Â˜ ÏËı˘-

ÛÌÔ‡ (·ı›ÁÁ·ÓÔÈ ﬁˆ˜ Ë ·ÛıÂÓ‹˜ Ì·˜ Î·È Ù· ·‰¤Ï-

ÊÈ· ÙË˜, ·ÏÏÔ‰·Ô›, ÌÔ˘ÛÔ˘ÏÌ¿ÓÔÈ) ÂÌ‚ÔÏÈ¿˙Ô-

ÓÙ·È ÛÂ ÔÛÔÛÙfi Î·Ù¿ ÔÏ‡ ÌÈÎÚfiÙÂÚÔ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ (ÌfiÓÔ ÙÔ 28%-46% ÙˆÓ ·È‰ÈÒÓ

ÙˆÓ ·Ú·¿Óˆ ÔÌ¿‰ˆÓ ¤¯ÂÈ ÂÌ‚ÔÏÈ·ÛÙÂ› ÌÂ 4 ‰ﬁ-

ÛÂÈ˜ ¤ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ 2 ÂÙÒÓ, ¤Ó·ÓÙÈ ÔÛÔÛÙÔ‡ 69% ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi) (12). ∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÙ·È fi¯È ÌfiÓÔ ÁÈ· ÙÔ

ÎÏÈÓÈÎﬁ ÙÔ˘ ÂÓ‰È·Ê¤ÚÔÓ, ·ÏÏ¿ Î·È ÁÈ· Ó· ÙÔÓÈÛÙÂ›

fiÙÈ Ë ÓfiÛÔ˜ Â›Ó·È ˘·ÚÎÙ‹ ÛÙË ¯ÒÚ· Ì·˜ ·ÎfiÌ·

Î·È Û‹ÌÂÚ·. ∞Ó Î·È Ô ·ÁÒÓ·˜ ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘

ÙÂÙ¿ÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰· ¤¯ÂÈ Î¿ÓÂÈ ÛËÌ·ÓÙÈÎ¿ ‚‹Ì·-

Ù·, ÂÓÙÔ‡ÙÔÈ˜, ¯ÚÂÈ¿˙ÂÙ·È Û˘ÓÂ¯‹˜ ÚÔÛ¿ıÂÈ· Ùﬁ-

ÛÔ ·fi ÙËÓ ÏÂ˘Ú¿ ÙË˜ ÔÏÈÙÂ›·˜, fiÛÔ Î·È ·fi ÙËÓ

È·ÙÚÈÎ‹ ÎÔÈÓﬁÙËÙ· Ô˘ Ú¤ÂÈ Î˘Ú›ˆ˜ Ó· ÂÛÙÈ·ÛÙÂ›

ÛÂ ÙÚÂÈ˜ ·Ú·Ì¤ÙÚÔ˘˜: ·) ÛÙËÓ ¤ÁÎ·ÈÚË ¤Ó·ÚÍË

ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·, ‚) ÛÙËÓ ÏËÚÔ-

ÊfiÚËÛË ÁÈ· ÙËÓ ·Ó·ÁÎ·ÈfiÙËÙ· Â·Ó·ÏËÙÈÎÒÓ ‰fi-

ÛÂˆÓ Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÂÓ‹ÏÈÎË˜ ˙ˆ‹˜ Î·È Á) ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÈ‰ÈÎÒÓ ÔÌ¿‰ˆÓ ÏËı˘ÛÌÔ‡.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Abrutin E. Tetanus. In: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, editors. Harrison’s Principles of Internal Medicine. 14th

ed. New York: Mc Graw Hill; 1998. p. 901-904.

2. Menkes JH. Tetanus. In: Menkes JH, Sarnat HB, editors. Child Neurology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 764-766.

3. Arnon SS. Tetanus. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 16th ed. Philadephia: W.B. Saunders Company; 2000. p. 878-880.

4. Dunkle LM, Brook I. Clostridium tetani. In: Mc Millan J, De Angelis CD, Feigin RD, Warshaw JB, editors. Oski’s Pediatrics: Principles and Practice. 3rd ed. Philadelphia: Lippicott Williams & Wilkins; 1999. p. 938-940.

5. ∆¤Ù·ÓÔ˜. ™ÙÔ: ª·ÙÛ·ÓÈÒÙË˜ ¡, ∫·Ú¿ıÈÔ˜ £ Î·È Û˘Ó. ¶·È‰È·ÙÚÈÎ‹. ∞ı‹Ó·: π·ÙÚÈÎ¤˜ ∂Î‰ﬁÛÂÈ˜ §›ÙÛ·˜; 1995. ÛÂÏ. 304-308.

6. American Academy of Pediatrics. Tetanus. In: Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2000. p. 563-568.

7. °ÚËÁÔÚ¿ÎÔ˜ §, ¢ËÌﬁÔ˘ÏÔ˜ °. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÙÂÙ¿ÓÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜. ¢¤Î· ¯ÚﬁÓÈ· ÂÌÂÈÚ›·˜. π·ÙÚÈÎ‹ 1996;69:413-417.

8. Vinson DR. Immunisation does not rule out tetanus. BMJ 2000;320:383.

9. ∂ıÓÈÎﬁ ∫¤ÓÙÚÔ ∂È‰ËÌÈÔÏÔÁÈÎ‹˜ ¶·Ú·ÎÔÏÔ‡ıËÛË˜ Î·È ¶·Ú¤Ì‚·ÛË˜ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ & ¶ÚﬁÓoÈ·˜ (∂∫∂¶∞¶). ∫·Ù·ÁÂÁÚ·ÌÌ¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ÙÂÙ¿ÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰· ÙËÓ ÂÚ›Ô‰Ô 1981-2000 (ÚÔÛˆÈÎ‹ ÂÈÎÔÈÓˆÓ›·).

10. ª¿ÓÈÔ˜ ™°. ∆¤Ù·ÓÔ˜. ™ÙÔ: ¶ÚﬁÔ‰ÔÈ ÛÙËÓ ¶·È‰È·ÙÚÈÎ‹. University Studio Press; 1985. ÛÂÏ. 35-39.

11. ™Ù·ÙÈÛÙÈÎ‹ ∫ÔÈÓˆÓÈÎ‹˜ ¶ÚﬁÓÔÈ·˜ Î·È ÀÁÈÂÈÓ‹˜, ÂÙ‹ÛÈ· ‰ÂÏÙ›· (1981-1995), ∂.™.À.∂., ∞ı‹Ó·.

12. ¶·Ó·ÁÈˆÙﬁÔ˘ÏÔ˜ ∆, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË. ¶·ÓÂÏÏ·‰ÈÎ‹ ªÂÏ¤ÙË ∫·Ù¿ÛÙ·ÛË˜ ∂Ì‚ÔÏÈ·ÛÌÔ‡. ∞ı‹Ó·: πÓÛÙÈÙÔ‡ÙÔ ÀÁÂ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, 1998.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-04-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 25-09-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚ›ÛÙÔ˜ ∫·Ú‹˜

¶·È‰›·ÙÚÔ˜-¢ÈÂ˘ı˘ÓÙ‹˜ ∑·Î‡ÓıÔ˘ 2, Ã·Ï¿Ó‰ÚÈ

∂¡¢π∞º∂ƒOÀ™∞

¡ÂÔÁÓﬁ ÌÂ ÛÂÈÚËÓÔÌÂÏ›·. ¶ÂÚÈÁÚ·Ê‹

∂. ∫ÔÚ·Î¿ÎË1, ∂. Ã·Ù˙Ë‰¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ª. ªËÙÛ¿ÎË1, ¢. ™ÂÌÂÚÙ˙¿ÎË˜1, ∞. µÔÏÔ˘‰¿ÎË2, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘1

¡eonate with sirenomelia. Case report

E. Korakaki1, E. Hatzidaki1, A. Manoura1, M. Mitsaki1, D. Semertzakis1, A. Voloudaki2, C. Giannakopoulou1

¶ÂÚ›ÏË„Ë: ∏ ÛÂÈÚËÓÔÌÂÏ›·, ÁÓˆÛÙ‹ Î·È Û·Ó

ÁÔÚÁﬁÓ·˜”, ·ÔÙÂÏÂ› Ì›· ÂÍ·ÈÚÂÙÈÎ¿

Û¿ÓÈ· Û˘ÁÁÂÓ‹ ·ÓˆÌ·Ï›· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È

·ﬁ Û˘Ó¤ÓˆÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Î·È Û˘Ó˘¿Ú¯Ô˘-

ÛÂ˜ ·ÓˆÌ·Ï›Â˜. ∏ Û˘¯ÓﬁÙËÙ¿ ÙË˜ Â›Ó·È 1,5-4,2 Â-

ÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000 ÁÂÓÓ‹ÛÂÈ˜. ∆· ÓÂÔÁÓ¿ ÌÂ

ÛÂÈÚËÓÔÌÂÏ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÔÛÙÒÓ ÙË˜ ˘¤ÏÔ˘ Î·È ÙË˜ ÔÛÊ˘Ô˚ÂÚ‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ Î·È ·ÓˆÌ·Ï›Â˜ ÔÚÁ¿ÓˆÓ, Û˘ÓËı¤ÛÙÂÚ· ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ™˘¯Ó¿ ¤¯Ô˘Ó ÚÔÛˆÂ›Ô Û˘Ó‰ÚfiÌÔ˘ Potter’s Î·È ˘ÔÏ·Û›· ÓÂ˘ÌfiÓˆÓ. ∏ ·ıÔÁ¤ÓÂÈ· ÙË˜ ‰È·Ù·Ú·¯‹˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ¶ÈÛÙÂ‡ÂÙ·È fiÙÈ ÔÊÂ›ÏÂÙ·È ÛÂ ‰È·Ù·Ú·¯‹

ÙË˜ ·ÁÁÂ›ˆÛË˜ Î·È ÙË˜ ·ÈÌ¿ÙˆÛË˜ ÙÔ˘ Ô˘Ú·›Ô˘

¿ÎÚÔ˘ ÙÔ˘ ÌÂÛÔ‰¤ÚÌ·ÙÔ˜ ÙÔÓ ÚÒÙÔ Ì‹Ó· ÙË˜

Î‡ËÛË˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ ÌÂ

ÛÂÈÚËÓÔÌÂÏ›· Î·È Á›ÓÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÛÎﬁ-

ËÛË ÙË˜ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·˜ ÙË˜ ‰È·Ù·Ú·¯‹˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÛÂÈÚËÓÔÌÂÏ›·, ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË.

∂ÈÛ·ÁˆÁ‹ ∏ ÛÂÈÚËÓÔÌÂÏ›· ·ÔÙÂÏÂ› Ì›· ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ·, ·Û‡Ì‚·ÙË ÌÂ ÙË ˙ˆ‹, Û˘ÁÁÂÓ‹ ·ÓˆÌ·Ï›· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û˘Ó¤ÓˆÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Î·È Û˘Ó˘¿Ú¯Ô˘ÛÂ˜ ÛÏ·¯ÓÈÎ¤˜ ·ÓˆÌ·Ï›Â˜. ∂›Ó·È Â›ÛË˜ ÁÓˆÛÙ‹ Î·È Û·Ó “Û‡Ó‰ÚÔÌÔ ÁÔÚÁfiÓ·˜”, fiÚÔ˜ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÂÚÈÁÚ·Ê¤˜ Ì˘ıÈÎÒÓ Ï·ÛÌ¿ÙˆÓ ÙË˜ ·Ú¯·ÈfiÙËÙ·˜, ÌÂ Ô˘Ú¿ „·ÚÈÔ‡ Î·È ÎÔÚÌfi ·ÓıÚÒÔ˘. ∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ¤ÁÈÓÂ ÙÔ 1542 ·fi ÙÔÓ Rocheus Î·È ¤ÎÙÔÙÂ ˘¿Ú¯Ô˘Ó ÂÏ¿-

¯ÈÛÙÂ˜ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (1).

∏ Û˘¯ÓﬁÙËÙ¿ ÙË˜ Â›Ó·È 1,5-4,2 ÂÚÈÙÒÛÂÈ˜ ·Ó¿

Abstract: Sirenomelia, or the “mermaid syndrome”, is an extremely rare lethal congenital malformation with an incidence of 1,5-4,2 cases per 100.000 births. It is characterized by fusion of the lower limbs and severe visceral anomalies. It is associated with congenital anomalies including renal agenesis, renal dysplasia, agenesis of the bladder, abnormalities of the genital organs, imperforate anus and abnormalities of the pelvic bones and spine. Neonates usually present with Potter’s facies and pulmonary hypoplasia. The exact pathogenesis of the disease remains unclear. It is proposed that the disease may be due to a vascular compromise of the caudal portion of the embryo during the 1st month of gestation. This report describes a case of sirenomelia in a neonate. The theories regarding the pathogenesis of sirenomelia are also reviewed.

Key words: sirenomelia, prenatal diagnosis.

100.000 ÁÂÓÓ‹ÛÂÈ˜. ¶·Ú·ÙËÚÂ›Ù·È Û˘¯ÓﬁÙÂÚ· ÛÙ· ·ÁﬁÚÈ· ÌÂ ·Ó·ÏÔÁ›· 2,7:1. ∆Ô 15% ÂÚ›Ô˘ ÙˆÓ

ÂÚÈÙÒÛÂˆÓ ·Ó·Ê¤ÚÂÙ·È ÛÂ ‰›‰˘ÌÂ˜ Î˘‹ÛÂÈ˜, Û˘¯ÓﬁÙÂÚ· ÌÔÓÔ˙˘ÁˆÙÈÎ¤˜. ™˘ÓÔ‰Â‡ÂÙ·È ·ﬁ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Î·È

ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. Œ¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÌﬁÓÔ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ ÓÂÔÁÓÒÓ ÌÂ ÛÂÈÚËÓÔÌÂÏ›· Î·È Ê˘ÛÈÔÏÔÁÈÎ‹ ÓÂÊÚÈÎ‹ ÏÂÈÙÔ˘ÚÁ›· Ô˘ ÂÈ‚›ˆÛ·Ó (2).

ÌÂ ÛÂÈÚËÓÔÌÂÏ›· Î·È Á›ÓÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈÎ‹ ·Ó·ÛÎﬁËÛË

1 Department of Neonatology of University of Crete

2 Medical Imaging Laboratory of University of Crete

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

¶ÚﬁÎÂÈÙ·È ÁÈ· ÓÂÔÁÓﬁ, ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘-

ÈÎ¿ ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÁÂÓÓ‹ıËÎÂ ÙÂÏÂÈﬁÌËÓÔ ÌÂ

Î·ÈÛ·ÚÈÎ‹ ÙÔÌ‹ ÏﬁÁˆ ÌË ÂÍ¤ÏÈÍË˜ ÙÔ˘ ÙÔÎÂÙÔ‡. ∆Ô

‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ‹Ù·Ó 2250 g, ÙÔ Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜

47 cm Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ 34 cm. ¢ÂÓ ·Ó·-

Ê¤ÚıËÎ·Ó È‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

ÙË˜ Î‡ËÛË˜. ∏ Ì·ÈÂ˘ÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË ‹Ù·Ó

·ÓÂ·ÚÎ‹˜. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îﬁ ÈÛÙÔÚÈÎﬁ ‹Ù·Ó ÂÏÂ‡-

ıÂÚÔ Î·È ‰ÂÓ ·Ó·Ê¤ÚıËÎÂ ¯Ú‹ÛË Ê·ÚÌ·ÎÂ˘ÙÈÎÒÓ

‹ ¿ÏÏˆÓ Ô˘ÛÈÒÓ ·ﬁ ÙË ÌËÙ¤Ú·.

∆Ô ÓÂÔÁÓﬁ ÌÂÙ·Ê¤ÚıËÎÂ ÛÙÔ ÙÌ‹Ì· Ì·˜, ·ﬁ

π‰ÈˆÙÈÎ‹ ∫ÏÈÓÈÎ‹ ÙË˜ Â˘Ú‡ÙÂÚË˜ ÂÚÈÊ¤ÚÂÈ·˜ ÙÔ˘

ÓËÛÈÔ‡, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘ Î·È ‚ÚÈÛÎﬁ-

Ù·Ó ÛÂ ÌË¯·ÓÈÎ‹ ˘ÔÛÙ‹ÚÈÍË ÙË˜ ·Ó·ÓÔ‹˜. ∞ﬁ

ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‰È·ÈÛÙÒıËÎ·Ó: ÂÈ¤‰ˆÛË

ÙÔ˘ ·ÎÚÔÚÈÓ›Ô˘, ˘ÂÚÙÂÏÔÚÈÛÌﬁ˜, ¯·ÌËÏ‹ Úﬁ-

ÛÊ˘ÛË ·˘ÙÈÒÓ Î·È ÌÈÎÚÔÁÓ·ı›· (¯·Ú·ÎÙËÚÈÛÙÈÎ¿

ÚÔÛˆÂ›Ô˘ Potter’s), Û˘ÓÂÓˆÌ¤Ó· Î¿Ùˆ ¿ÎÚ·

·ﬁ ÙËÓ ‡ÂÏÔ ¤ˆ˜ ÙÈ˜ Ô‰ÔÎÓËÌÈÎ¤˜ ·ÚıÚÒÛÂÈ˜, Ê˘ÛÈÔÏÔÁÈÎ¿ ¿ÎÚ· ﬁ‰È· Î·È ‰¿ÎÙ˘Ï·. OÈ ·ÚıÚÒ-

ÛÂÈ˜ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ‹Ù·Ó „ËÏ·ÊËÙ¤˜ ·ÌÊÔÙÂÚﬁÏÂ˘Ú·. ∆· Û˘ÓÂÓˆÌ¤Ó· Î¿Ùˆ ¿ÎÚ· ‚Ú›ÛÎÔÓÙ·Ó

ÛÂ Î¿Ì„Ë 90o ÛÙËÓ ‡ÂÏÔ. ¢È·ÈÛÙÒıËÎÂ Â›ÛË˜ ·Ô˘Û›· ÔÚıÔ‡ Î·È ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, Î·ıÒ˜ Î·È ÌÔÓ‹ÚË˜ ÔÌÊ·ÏÈÎ‹ ·ÚÙËÚ›·.

∞ﬁ ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎﬁ ¤ÏÂÁ¯Ô, Ù· ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, Ë ‡ÂÏÔ˜ Î·È Ë ÔÛÊ˘Ô˚ÂÚ‹ ÌÔ›Ú· ÙË˜

ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ·ÂÈÎÔÓ›ÛÙËÎ·Ó Ê˘ÛÈÔÏÔÁÈÎ¿ (∂ÈÎfiÓ· 1). ∞fi ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·Î· ‰È·ÈÛÙÒıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi Ì¤ÁÂıÔ˜ Î·Ú‰È¿˜. ∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ¤‰ÂÈÍÂ ·Ô˘Û›· ‰ÂÍÈÔ‡ ÓÂÊÚÔ‡, ˘ÔÏ·ÛÙÈÎfi ·ÚÈÛÙÂÚfi ÓÂÊÚfi Î·È ·Ô˘Û›· Ô˘ÚÔ-

‰ﬁ¯Ô˘ Î‡ÛÙÂˆ˜ (∂ÈÎﬁÓ· 2).

∆Ô ÓÂÔÁÓﬁ Î·Ù¤ÏËÍÂ Ï›ÁÂ˜ ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·-

ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈÎ‹.

∂ÈÎﬁÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ÛÎÂÏÂÙÔ‡,

Ù· ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, Ë ‡ÂÏÔ˜ Î·È Ë ÔÛÊ˘Ô˚ÂÚ‹ ÌÔ›Ú· ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜.

™˘˙‹ÙËÛË ∏ ÛÂÈÚËÓÔÌÂÏ›· ·ÔÙÂÏÂ› ÙËÓ ÈÔ ÛÔ‚·Ú‹ ÂÎ-

‰‹ÏˆÛË ˘ÔÛÙÚÔÊ‹˜ ÙÔ˘ Ô˘Ú·›Ô˘ ÂÌ‚Ú˘˚ÎÔ‡

¿ÎÚÔ˘. ∏ ·ıÔÁ¤ÓÂÈ· ÙË˜ ‰È·Ù·Ú·¯‹˜ ·Ú·Ì¤ÓÂÈ

¿ÁÓˆÛÙË. ∆Ô 1961 Ô Duhamel ·Ó¤ÊÂÚÂ ﬁÙÈ ¤Ó· ¤ÏÏÂÈÌÌ· Î·Ù¿ ÙÔ Û¯ËÌ·ÙÈÛÌﬁ ÙÔ˘ Ô˘Ú·›Ô˘ ÂÌ‚Ú˘˚-

ÎÔ‡ ¿ÎÚÔ˘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË

ÔÈÎ›ÏˆÓ Û˘ÁÁÂÓÒÓ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, ﬁˆ˜ Â›Ó·È Ë ·ÙÚËÛ›· ÙÔ˘ ÔÚıÔ‡ Î·È Ë ÛÂÈÚËÓÔÌÂÏ›· (3). ∞ÎÔÏÔ‡ıËÛ·Ó ‰È¿ÊÔÚÂ˜ ˘Ôı¤ÛÂÈ˜ ˆ˜ ÚÔ˜ ÙËÓ

·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· ÙË˜ ‰È·Ù·Ú·¯‹˜. ™‹ÌÂÚ· ÈÛÙÂ‡ÂÙ·È ﬁÙÈ ÚﬁÎÂÈÙ·È ÁÈ· Û˘ÁÁÂÓ‹ ‰ÔÌÈÎ‹ ·ÓˆÌ·Ï›·

Ô˘ ÔÊÂ›ÏÂÙ·È ÛÂ ‰È·Ù·Ú·¯‹ ÙË˜ ·ÁÁÂ›ˆÛË˜ Î·È

ÙË˜ ·ÈÌ¿ÙˆÛË˜ ÙÔ˘ Ô˘Ú·›Ô˘ ¿ÎÚÔ˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘.

™ÙÈ˜ ÂÚÈÛÛﬁÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÛÂÈÚËÓÔÌÂÏ›·˜

Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ¤¯ÂÈ ‰È·ÈÛÙˆ-

ıÂ› ÌÔÓ‹ÚË˜ ÔÌÊ·ÏÈÎ‹ ·ÚÙËÚ›·. ™˘ÁÎÂÎÚÈÌ¤Ó·, ÙÔ ·›Ì· ·fi ÙÔ ¤Ì‚Ú˘Ô ‰ÈÔ¯ÂÙÂ‡ÂÙ·È ÛÙÔÓ Ï·ÎÔ‡ÓÙ· fi¯È Ì¤Ûˆ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÈ˜ Ï·ÁfiÓÈÂ˜ ·ÚÙËÚ›Â˜, ·ÏÏ¿ ·fi ¤Ó· ÌÂÁ¿ÏÔ ÌÔÓ‹ÚÂ˜ ·ÁÁÂ›Ô Ô˘ Û˘Ó‰¤ÂÙ·È ÌÂ ÙËÓ ·ÔÚÙ‹

¤ÎÙÔ·, ÛÙËÓ ¿Óˆ ÎÔÈÏÈ·Î‹ ÎÔÈÏfiÙËÙ·, ·ÎÚÈ‚Ò˜ Î¿Ùˆ ·fi ÙÔ ‰È¿ÊÚ·ÁÌ·. ∏ ÎÔÈÏÈ·Î‹ ·ÔÚÙ‹ Û˘¯Ó¿ Â›Ó·È ˘ÔÏ·ÛÙÈÎ‹ Î·È ·ÓÒÌ·ÏË Î·È ÛÂ ÔÏÏ¤˜ ·fi

ÙÈ˜ ·Ó·ÊÂÚﬁÌÂÓÂ˜ ÂÚÈÙÒÛÂÈ˜ ‰ÂÓ ‰È·ÎÏ·‰›˙ÂÙ·È ÛÂ ÓÂÊÚÈÎ‹ Î·È Î¿Ùˆ ÌÂÛÂÓÙ¤ÚÈ· ·ÚÙËÚ›· ÚÈÓ ‰ÒÛÂÈ ÙÔ˘˜ ÎÏ¿‰Ô˘˜ ÙˆÓ Ï·ÁÔÓ›ˆÓ ·ÚÙËÚÈÒÓ. ∏ ·ÈÌ·ÙÈÎ‹ ÚÔ‹ ÛÙÔ Ô˘Ú·›Ô ¿ÎÚÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘, Ì¤Ûˆ

ÙÔ˘ ·ÓÒÌ·ÏÔ˘ ·ÁÁÂÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘, Â›Ó·È Û·ÊÒ˜

ÌÂÈˆÌ¤ÓË Î·È ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔÙ˘¯›· ‰È·¯ˆÚÈÛÌÔ‡ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Î·È ÙËÓ ÚﬁÎÏËÛË

Û˘ÓÔ‰ÒÓ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ (1,2,4,5). ∏ ‰È·Ù·Ú·¯‹ ÙË˜ ·ÁÁÂ›ˆÛË˜ ‰ÂÓ ÂÚÌËÓÂ‡ÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·ÊÂ› ÛÂ ÓÂÔÁÓ¿ ÌÂ ÛÂÈÚËÓÔÌÂÏ›· (2).

∂ÈÎfiÓ· 2. ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜, ÛÙËÓ ÔÔ›· ·ÂÈÎÔÓ›˙ÂÙ·È ·Ô˘Û›· ‰ÂÍÈÔ‡ ÓÂÊÚÔ‡ Î·È ˘ÔÏ·ÛÙÈÎfi˜ ·ÚÈÛÙÂÚfi˜ ÓÂÊÚfi˜.

°ÂÓÂÙÈÎﬁ˜ ÌË¯·ÓÈÛÌﬁ˜ ‰ÂÓ Èı·ÓÔÏÔÁÂ›Ù·È, Î·-

ıÒ˜ ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÔÈÎÔÁÂÓÂ›˜ ÂÚÈÙÒÛÂÈ˜.

∂›ÛË˜, Ô ¯ÚˆÌÔÛˆÌÈÎﬁ˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎﬁ˜ (4).

∏ ‰È·Ù·Ú·¯‹ ÙË˜ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË˜ ıÂˆÚÂ›Ù·È ﬁÙÈ

Û˘Ì‚·›ÓÂÈ ÙÔÓ ÚÒÙÔ Ì‹Ó· ÙË˜ Î‡ËÛË˜, ÌÂÙ·Í‡ ÙË˜ 28Ë˜ Î·È ÙË˜ 32Ë˜ ËÌ¤Ú·˜ Î·È ·ÊÔÚ¿ ÛÙÔ Ô˘Ú·›Ô ÙÌ‹Ì· ÙÔ˘ ÌÂÛÔ‰¤ÚÌ·ÙÔ˜. OÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·-

Ú¿ÁÔÓÙÂ˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙÔ›. Œ¯ÂÈ ·Ó·ÊÂÚıÂ› ·˘-

ÍËÌ¤ÓË Û˘¯ÓﬁÙËÙ· ÂÌÊ¿ÓÈÛË˜ ÙË˜ ‰È·Ù·Ú·¯‹˜ ÛÂ

ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, Î·ıÒ˜ Î·È ÛÂ ÓÂÔÁÓ¿

Ô˘ Ë ÌËÙ¤Ú· ÙÔ˘˜ ¤Î·ÓÂ ¯Ú‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘-

ÛÈÒÓ. ∂›ÛË˜, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙÂ› ÛÂ ÂÈÚ·Ì·Ùﬁ˙ˆ·

ÌÂ ¤ÎıÂÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ ÛÂ ÚÂÙÈ-

ÓÔ˚Îﬁ ÔÍ‡ Î·È Î˘ÎÏÔÊˆÛÊ·Ì›‰Ë (1,3).

∏ ÛÂÈÚËÓÔÌÂÏ›· ·Ú·Ì¤ÓÂÈ Ì›· Û¿ÓÈ· ‰È·Ù·-

Ú·¯‹. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ÙÂ› ÂÏ¿¯ÈÛÙÂ˜

ÂÚÈÙÒÛÂÈ˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∆· ¯·Ú·-

ÎÙËÚÈÛÙÈÎ¿ ÙË˜ ‰È·Ù·Ú·¯‹˜ ÛÂ ﬁÏÂ˜ ÙÈ˜ ‰ËÌÔÛÈÂ˘-

Ì¤ÓÂ˜ ÂÚÈÙÒÛÂÈ˜, ﬁˆ˜ Î·È ÛÙË ‰ÈÎ‹ Ì·˜, Â›Ó·È

ÎÔÈÓ¿. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·ﬁ Û˘Á¯ÒÓÂ˘ÛË ÙˆÓ Î¿Ùˆ

¿ÎÚˆÓ. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÙÚÂÈ˜ Ù‡ÔÈ ·Ó¿ÏÔÁ· ÌÂ

ÙËÓ ¤ÎÙ·ÛË ÙË˜ Û˘Á¯ÒÓÂ˘ÛË˜. ∏ Û˘ÌÌ¤ÏÂÈ· “¯ˆÚ›˜ ﬁ‰È·” Â›Ó·È Ô Û˘¯ÓﬁÙÂÚÔ˜ Î·È ÈÔ Ï‹ÚË˜ Ù‡-

Ô˜, Î·ıÒ˜ ˘¿Ú¯Ô˘Ó Ù· ÔÛÙ¿ ÌfiÓÔ ÙÔ˘ ÂÓfi˜ ·fi Ù· ‰‡Ô Î¿Ùˆ ¿ÎÚ·. ™ÙÔ˘˜ Ù‡Ô˘˜ “ÌÂ ¤Ó· fi‰È” Î·È “ÌÂ ‰‡Ô fi‰È·” ˘¿Ú¯Ô˘Ó Ù· ÔÛÙ¿ Î·È ÙˆÓ ‰‡Ô Î¿Ùˆ ¿ÎÚˆÓ Î·È ‰È·Ê¤ÚÔ˘Ó ÌÂÙ·Í‡ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙËÓ ¤ÎÙ·ÛË ÙË˜ Û˘Á¯ÒÓÂ˘ÛË˜. ™ÙÔÓ Ù‡Ô “ÌÂ ¤Ó· fi‰È”, Ë Û˘Á¯ÒÓÂ˘ÛË ÂÂÎÙÂ›ÓÂÙ·È Î·È ÛÙ· ÔÛÙ¿ ÙÔ˘

¿ÎÚÔ˘ Ô‰ﬁ˜ (7).

∆· ÓÂÔÁÓ¿ ÌÂ ÛÂÈÚËÓÔÌÂÏ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘-

¯Ó¿ ÛÔ‚·Ú¤˜ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜. ™‡ÌÊˆÓ· ÌÂ ÌÂÏ¤ÙË ÙˆÓ Källen et al, ÛÂ ÔÛÔÛÙfi 7% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÂÈÚËÓÔÌÂÏ›·˜ Û˘Ó˘¿Ú¯Ô˘Ó ÂÏÏÂ›ÌÌ·Ù· ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ÛÂ 8% ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘, ÛÂ 8% ÌÂÛÔÎÔÈÏÈ·Î¿ Î·È ÌÂÛÔÎÔÏÈÎ¿ ÂÏÏÂ›ÌÌ·Ù· Î·È ÛÂ 6% ·Ï·Û›· ÎÂÚÎ›‰·˜ (7). ∂›ÛË˜, Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ·ÙÚËÛ›· ÔÚıÔ‡ Î·È ‰˘ÛÁÂÓÂÛ›· Ì¤¯ÚÈ ·ÁÂÓÂÛ›· ÙˆÓ ÓÂÊÚÒÓ Î·È ÙË˜ Ô˘ÚÔ‰fi¯Ô˘ Î‡ÛÙÂˆ˜, ÂÓÒ Ù· ÁÂÓÓËÙÈÎ¿ fiÚÁ·Ó· ÌÔÚÂ› Ó· ·Ô˘ÛÈ¿˙Ô˘Ó. ÕÏÏÂ˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÌÂ ÌÂÈˆÌ¤ÓË Û˘¯ÓfiÙËÙ·, Â›Ó·È ·ÓˆÌ·Ï›Â˜ ÙË˜ ˘¤ÏÔ˘ Î·È ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ‰È·ÊÚ·ÁÌ·ÙÔÎ‹ÏË, ˘‰ÚÔÎ¤Ê·ÏÔ˜ Î·È ÔÏ˘‰·ÎÙ˘Ï›·. OÈ Û˘ÓÔ‰¤˜ ÛÏ·¯ÓÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ ‰ÂÓ Â›Ó·È Û˘Ì‚·Ù¤˜ ÌÂ ÙË ˙ˆ‹. ∏ ÂÌ‚Ú˘˚Î‹ ÓÂÊÚÈÎ‹ ·ÓÂ¿ÚÎÂÈ· ÚÔÎ·ÏÂ› ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ Ô˘ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÙËÓ ˘ÔÏ·Û›· ÓÂ˘ÌfiÓˆÓ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙË ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛË ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ (7). O ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ Î‡ËÛË˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÙË˜ ‰È·Ù·Ú·¯‹˜. ∆· ÔÛÙ¿ Î·È ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÌÔÚÔ‡Ó Ó· ·Ó·ÁÓˆÚÈ-

˘ÂÚË¯ÔÁÚ·ÊÈÎ¿ ·ﬁ ÙË 12Ë ÌÂ 20Ë Â‚‰ÔÌ¿‰· ÙË˜ Î‡ËÛË˜ (6). ∏ ‰È¿ÁÓˆÛË Â›Ó·È ‰‡ÛÎÔÏË, È‰È·›ÙÂÚ· ﬁÙ·Ó ˘¿Ú¯Ô˘Ó Ù· ÔÛÙ¿ Î·È ÙˆÓ ‰‡Ô Î¿Ùˆ ¿ÎÚˆÓ. ∏ Û‡ÁÎÏÈÛË ÙˆÓ ÔÛÙÒÓ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ

Î·È Ë ·ÌÂÙ¿‚ÏËÙË ı¤ÛË ÙÔ˘˜ ÛÂ Û¯¤ÛË ÌÂ ÙÔ ¯ÚﬁÓÔ ÂÓÈÛ¯‡ÂÈ ÙËÓ ˘ﬁÓÔÈ· ‡·ÚÍË˜ ÙË˜ ‰È·Ù·Ú·¯‹˜.

∆Ô ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ Ô˘ Û˘Ó˘¿Ú¯ÂÈ ÛÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂÈÒÓÂÈ ÙË ‰È·ÁÓˆÛÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜. ∏ ·ÂÈÎfiÓÈÛË ÙˆÓ

·ÁÁÂ›ˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÌÂ ¤Á¯ÚˆÌÔ Doppler ·Ú¤¯ÂÈ ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ (5). ∏ ·ÌÓÈÔ¤Á¯˘ÛË

ÌÔÚÂ› Ó· Â›Ó·È ‚ÔËıËÙÈÎ‹ (7). ∂›ÛË˜, Ë Ì·ÁÓËÙÈ-

Î‹ ÙÔÌÔÁÚ·Ê›·, ÚÔÁÂÓÓËÙÈÎ¿, ‚ÔËı¿ ÛÙËÓ ·Ó›-

¯ÓÂ˘ÛË ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘.

∆ÔÓ›˙ÂÙ·È ﬁÙÈ Ë ı·Ó·ÙËÊﬁÚ· ¤Î‚·ÛË ÙË˜ ‰È·Ù·-

Ú·¯‹˜ ÔÊÂ›ÏÂÙ·È ÛÙÈ˜ Û˘ÓÔ‰¤˜ ÛÏ·¯ÓÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ Î·È ﬁ¯È ÛÙËÓ ›‰È· ÙË ÛÂÈÚËÓÔÌÂÏ›·. O ÚÔÁÂÓ-

ÓËÙÈÎfi˜ ˘ÂÚË¯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜, ·Ó Î·È ‰‡ÛÎÔÏÔ˜ ÏfiÁˆ ÙÔ˘ Û˘Ó˘¿Ú¯ÔÓÙÔ˜ ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ˘, Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË ÙË˜ ‰È·Ù·Ú·¯‹˜. ™Â ÂÚÈÙÒÛÂÈ˜ ÛÔ‚·ÚÔ‡ ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ˘, È‰È·›ÙÂÚ· fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ·ÌÊÔÙÂÚfiÏÂ˘ÚË

ÓÂÊÚÒÓ, Ô ÁÈ·ÙÚﬁ˜ Ú¤ÂÈ

1. Murphy JJ, Fraser GC, Blair GK. Sirenomelia: case of the surviving mermaid. J Pediatr Surg 1992;27:1265-1268.

2. McCoy MC, Chescheir NC, Kuller JA, Altman GC, Flannagan LM. A fetus with sirenomelia, omphalocele, and meningomyelocele, but normal kidneys. Teratology 1994;50:168-171.

3. Di Lorenzo M, Brandt ML, Veilleux A. Sirenomelia in an identical twin: a case report. J Pediatr Surg 1991;26:1334-1336.

4. Egan JF, Petrikovsky BM, Vintzileos AM, Rodis JF, Campbell WM. Combined pentalogy of Cantrell and sirenomelia: a case report with speculation about a common etiology. Am J Perinatol 1993;10:327-329.

5. Sepulveda W, Romero R, Pryde PG, Wolfe HM, Addis JR, Cotton DB. Prenatal diagnosis of sirenomelus with color doppler ultrasonography. Am J Obstet Gynecol 1994;170:1377-1379.

6. Honda N, Shimokawa H, Yamaguchi Y, Satoh S, Nakano H. Antenatal diagnosis of sirenomelia (sympus apus). J Clin Ultrasound 1988;16:675-677.

7. Langer B, Stoll C, Nicolau R, Gasser B, Schlaeder G. Sirenomelia and situs inversus: case report and review of the literature. Fetal Diagn Ther 1996;11:79-84.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-05-2001

¤ÁÎÚÈÛË˜: 26-10-2001 ¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ÃÚÈÛÙ›Ó· ∞ÙÏ·ÓÙ›‰Ô˜ 37, 713 05, ∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË e-mail: Aligisak@danae.med.uch.gr

Ã. ∫ÒÛÙ·ÏÔ˜

Early perinatal hospital discharge: the pros and cons

C. Costalos

¶ÂÚ›ÏË„Ë: ªÂÁ¿ÏË ‰ËÌÔÛÈﬁÙËÙ· ¤¯ÂÈ ‰ÔıÂ› Ù·

ÙÂÏÂ˘Ù·›· ¯ÚﬁÓÈ· ﬁÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Ù¿ÛË Ô˘ ÂÈ-

ÎÚ·ÙÂ› Ó· ‰›ÓÂÙ·È ÂÍÈÙ‹ÚÈÔ ÛÂ ÌËÙ¤Ú· Î·È ÓÂÔÁÓﬁ

Ì¤Û· ÛÙÈ˜ ÚÒÙÂ˜ 48 ÒÚÂ˜ ˙ˆ‹˜. OÈ ÔÏ¤ÌÈÔÈ ·˘-

Ù‹˜ ÙË˜ Ù·ÎÙÈÎ‹˜ ıÂˆÚÔ‡Ó fiÙÈ Ë ÚÒÈÌË ¤ÍÔ‰Ô˜ ÂÁÎ˘ÌÔÓÂ› ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ ÓÂÔÁÓfi, ÏfiÁˆ ÂÏÏÈ-

Ô‡˜ ÌÂÙ·‚ÔÏÈÎÔ‡ ÂÏ¤Á¯Ô˘, ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·È-

Ì›·˜, ÂÏÏÈÔ‡˜ ÂÎ·›‰Â˘ÛË˜ ÙË˜ ÌËÙ¤Ú·˜

ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÎÈÓ‰‡ÓÔ˘ Ó· ‰È·Ê‡ÁÂÈ ÛÔ‚·Ú‹ ÏÔ›ÌˆÍË ‹ Û˘ÁÁÂÓ‹˜ ·ÓˆÌ·Ï›· Î·ıÒ˜ Î·È ÏfiÁˆ

‹ ·-

Ú·Ì¤ÏËÛË˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜. ™Ù· Èı·Ó¿ ÔÊ¤ÏË ·Ó·-

Ê¤ÚÔÓÙ·È ÙÔ ÎÔÈÓˆÓÈÎfi Î·È ÙÔ ÔÈÎÔÓÔÌÈÎfi. ∞˘Ùfi

ﬁÌˆ˜ Ô˘ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ‰ÂÓ Â›Ó·È Ë

‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡, ·ÏÏ¿ Ë ÛˆÛÙ‹

ÂÈÏÔÁ‹ ÙÔ˘ ¯ÚﬁÓÔ˘ ÂÍﬁ‰Ô˘ ÌËÙ¤Ú·˜ Î·È ·È‰ÈÔ‡

·ﬁ ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ∏ ¤ÍÔ‰Ô˜, ·ÓÂÍ¿ÚÙËÙ· ·ﬁ ÙÔ

¯ÚﬁÓÔ ·Ú·ÌÔÓ‹˜, È‰›ˆ˜ Ë ÚÒÈÌË ¤ÍÔ‰Ô˜, ¯ˆÚ›˜

ÂÎÙ›ÌËÛË ÙˆÓ È·ÙÚÈÎÒÓ Î·È „˘¯ÔÎÔÈÓˆÓÈÎÒÓ ·Ú·-

ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Î·È ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙË˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ‰ÂÓ ·ÔÙÂÏÂ› ÛˆÛÙ‹ È·ÙÚÈÎ‹ ÊÚÔÓÙ›‰·. ∞ÓÙ›ıÂÙ·, ÚÒÈÌË ¤ÍÔ‰Ô˜, ÂÊfiÛÔÓ Â›Ó·È Î·Ï¿ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË Î·È ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÈÛÎ¤„ÂÈ˜ Î·Ù’ Ô›ÎÔÓ ·fi ÂÈÛÎ¤ÙÚÈ· ·‰ÂÏÊ‹ ÛÂ ÔÈÎÔÁ¤ÓÂÈÂ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÌÔÚÂ› Ó· ‰È·ÛÊ·Ï›ÛÂÈ ÙËÓ ˘ÁÂ›· ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂ ÔÏ‡ ÌÈÎÚfiÙÂÚÔ ÔÈÎÔÓÔÌÈÎfi

ÎfiÛÙÔ˜ Î·È, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ÔÏ‡ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ¿ ·fi ÙËÓ ·Ú·ÙÂÙ·Ì¤ÓË ·Ú·ÌÔÓ‹ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ.

Key words: hospital discharge, infant, newborn. ¶ÚÒÈÌË

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¤ÍÔ‰Ô˜ ·ﬁ ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ‚Ú¤ÊÔ˜, ÓÂÔÁÓﬁ.

Abstract: The issue of early newborn discharge has received widespread attention over the past few years. Early discharge is defined as hospital stay of 48 hours or less. Many problems have been associated with early discharge such as incomplete metabolic screening, hyperbilirubinemia, non initiation or premature cessation of breast feeding, missed identification of congenital anomalies, risk of missing neonatal sepsis, increased risk of child abuse and neglect, and failure to detect psychosocial risks. Among the possible benefits is early return home and decrease in health care cost. The important issue however should be the appropriateness of the infant’s discharge rather than the length of postparum stay. Discharge at anytime, particularly early discharge, without carefully assessing medical risks, psychosocial factors and the family’s strengths, is considered as improper health care delivery. Early discharge, if well planned and followed by home visits by trained nurses to families identified to be at risk of developing complications, might protect the health of infants not only at a fraction of the cost but, more importantly, much more effectively as compared to prolonged hospitalization.

Division of Neonatology “Alexandra” General Hospital,

ª¤¯ÚÈ ÚÈÓ ·fi ÙÔ ‰Â‡ÙÂÚÔ ·ÁÎfiÛÌÈÔ fiÏÂÌÔ, Ë Ì¤ÛË ·Ú·ÌÔÓ‹ ÙË˜ Á˘Ó·›Î·˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ

ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó 7-10 ËÌ¤ÚÂ˜ (1). O ¯ÚfiÓÔ˜ ·˘Ùfi˜ ÌÂÈÒıËÎÂ ÚÔÔ‰Â˘ÙÈÎ¿, ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿

ÙÔÓ ﬁÏÂÌÔ, ÛÙÈ˜ 3-5 ËÌ¤ÚÂ˜ (2). ∏ Ù¿ÛË Ô˘ ÂÈÎÚ·ÙÂ› Ù· ÙÂÏÂ˘Ù·›· ¯ÚﬁÓÈ· Â›Ó·È Ó· ‰›ÓÂÙ·È ÂÍÈÙ‹-

ÚÈÔ ÛÂ ÌËÙ¤Ú· Î·È ÓÂÔÁ¤ÓÓËÙÔ Ì¤Û· ÛÙÈ˜ ÚÒÙÂ˜

48 ÒÚÂ˜ ˙ˆ‹˜.

∏

ÚÒÈÌË ¤ÍÔ‰Ô˜ ·Ú¯ÈÎ¿ ÂÊ·ÚÌﬁÛÙËÎÂ ÁÈ· Á˘Ó·›ÎÂ˜ “¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘”, ‰ËÏ·‰‹ ÁÈ· ÌËÙ¤ÚÂ˜

˘ÁÈÂ›˜ ¯ˆÚ›˜ ÂÈ‚·Ú˘Ì¤ÓÔ ÈÛÙÔÚÈÎﬁ, ÌÔÚÊˆÌ¤ÓÂ˜

Î·È ÌÂ ÈÎ·ÓÔÔÈËÙÈÎﬁ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎﬁ Â›Â‰Ô.

∆Ô Ì¤ÙÚÔ ·˘Ùﬁ, ﬁÌˆ˜, ÚÔÔ‰Â˘ÙÈÎ¿ ÂÂÎÙ¿ıËÎÂ

Î·È ÛÂ ¿ÏÏÂ˜ Î·ÙËÁÔÚ›Â˜ Á˘Ó·ÈÎÒÓ. ŒÙÛÈ, ÌÂÙ·Í‡

ÙˆÓ ÂÙÒÓ 1970 Î·È 1992, Ô Ì¤ÛÔ˜ ¯ÚﬁÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÌÂÈÒıËÎÂ Î·Ù¿ 37%, ‰ËÏ·‰‹

·ﬁ 4,1 ËÌ¤ÚÂ˜ ÛÂ 2,6 ËÌ¤ÚÂ˜ (3). ™Â ÔÚÈÛÌ¤ÓÂ˜ ‰Â, ¯ÒÚÂ˜ ÙË˜ ¢. ∂˘ÚÒË˜, ÙÔ 35% ÂÚ›Ô˘ ÙˆÓ

Á˘Ó·ÈÎÒÓ ‰ÂÓ ·Ú·Ì¤ÓÂÈ Î·ıﬁÏÔ˘ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ,

·ÊÔ‡ ÁÂÓÓÔ‡Ó Â›ÙÂ Î·Ù’ Ô›ÎÔÓ ‹ ÛÙ· ÂÍˆÙÂÚÈÎ¿ È·ÙÚÂ›· ÙÔ˘ Ì·ÈÂ˘ÙËÚ›Ô˘.

Ô˘ Ô‰‹ÁËÛ·Ó Û’ ·˘Ù‹ ÙË ‰Ú·ÛÙÈÎ‹ ÌÂ›ˆÛË ÙÔ˘ ¯ÚﬁÓÔ˘ ·Ú·ÌÔÓ‹˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ Â›-

Û·Ó ÛÙﬁ¯Ô ÙË ÌÂ›ˆÛË ÙÔ˘ ÎﬁÛÙÔ˘˜ Î·È ÙËÓ

ÂÍÔÈÎÔÓﬁÌËÛË Ì·ÈÂ˘ÙÈÎÒÓ ÎÏÈÓÒÓ (4). ∞ÎÔÏÔ˘ıÔ‡Û·Ó ﬁÌˆ˜ Î·È ÙË ÁÂÓÈÎ‹ Ù¿ÛË Ô˘ ˘¿Ú¯ÂÈ Û‹ÌÂÚ·

Ó· ÌÂÈÒÓÂÙ·È Ô ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙ· ÓÔÛÔÎÔÌÂ›· ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ·fiÏ˘Ù· ··Ú·›ÙËÙÔ, ·Îfi-

Ì· Î·È ÁÈ· ·ÛıÂÓÂ›˜ ÌÂ ÛÔ‚·Ú¤˜ ·Ûı¤ÓÂÈÂ˜. ¶ﬁÛÔ

Ì¿ÏÏÔÓ, ÏÔÈfiÓ, ÁÈ· ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ

ﬁˆ˜ Â›Ó·È Ô ÌË ÂÈÏÂÁÌ¤ÓÔ˜ ÙÔÎÂÙﬁ˜. ∏ ÚÒÈÌË

¤ÍÔ‰Ô˜ ‰›ÓÂÈ ¤ÙÛÈ ÙË ‰˘Ó·ÙﬁÙËÙ· ÛÙË Á˘Ó·›Î· Ó·

‚ÚÂıÂ› Ù·¯‡ÙÂÚ· ÛÙË ı·ÏˆÚ‹ Î·È ÙË ÊÚÔÓÙ›‰·

ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÙË˜ ÂÚÈ‚¿ÏÏÔÓÙÔ˜.

OÈ ÔÏ¤ÌÈÔÈ ·˘Ù‹˜ ÙË˜ Ù·ÎÙÈÎ‹˜ ıÂˆÚÔ‡Ó ﬁÙÈ Ë

ÚÒÈÌË ¤ÍÔ‰Ô˜ ÂÁÎ˘ÌÔÓÂ› ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ ÓÂÔÁÓﬁ

ÏfiÁˆ ÂÏÏÈÔ‡˜ ÌÂÙ·‚ÔÏÈÎÔ‡ ÂÏ¤Á¯Ô˘, ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, ÂÏÏÈÔ‡˜ ÂÎ·›‰Â˘ÛË˜ ÙË˜ ÌËÙ¤Ú·˜ ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, Î·ıÒ˜ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ó· ÌË Á›ÓÂÈ ÂÁÎ·›Úˆ˜ ·ÓÙÈÏËÙ‹ ÛÔ‚·Ú‹ ÏÔ›ÌˆÍË ‹ Û˘ÁÁÂÓ‹˜ ·ÓˆÌ·Ï›· (5,6). ™·Ó ÂÈ‚Â‚·›ˆÛË ÙË˜ ¿Ô„‹˜ ÙÔ˘˜ ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ· ˘ÚËÓÈÎÔ‡ ÈÎÙ¤ÚÔ˘ Î·È ·Ê˘‰¿ÙˆÛË˜ (7) ÛÂ ÓÂÔ-

¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’

ÙË ÌËÙ¤Ú·

ÁÓ¿ Ô˘ ÂÍ‹Ïı·Ó ÓˆÚ›˜ ·ﬁ ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·ÏÏ¿

Î·È ÙÔ ·˘ÍËÌ¤ÓÔ ÔÛÔÛÙfi Â·ÓÂÈÛ·ÁˆÁ‹˜ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô. OÈ ˘¤ÚÌ·¯ÔÈ ÙË˜ ÚÒÈÌË˜ ÂÍfi‰Ô˘ ·ÓÙÈÙÂ›ÓÔ˘Ó fiÙÈ Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ Â›Ó·È ·ÛÊ·Ï‹˜, ÂÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘

ÛÂ ÌËÙ¤Ú· Î·È ÓÂÔÁÓfi (¶›Ó·Î·˜ 1) (8) Î·È ÂÊfiÛÔÓ, Â›ÛË˜, ÏËÚÔ‡ÓÙ·È fiÏÂ˜ ÔÈ ÚÔ¸Ôı¤ÛÂÈ˜ Ô˘ Â-

ÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (9).

™ÙË Û˘Ó¤¯ÂÈ· ı· ·Ó·ÊÂÚıÔ‡ÌÂ ÂÎÙÂÓÒ˜ ÛÙ· È-

ı·Ó¿ ÚÔ‚Ï‹Ì·Ù·, ·ÏÏ¿ Î·È ÛÙ· ÔÊ¤ÏË Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔÎ‡„Ô˘Ó ·ﬁ ÙËÓ ÚÒÈÌË ¤ÍÔ‰Ô.

ÿÎÙÂÚÔ˜

∞fi ÙÔ 1-4% ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ Ô˘ Â·ÓÂÈÛ¿ÁÔÓÙ·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜, ÛÙÔ 85% Ô ›ÎÙÂÚÔ˜ ·ÔÙÂÏÂ› ÙËÓ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜. ∞fi ÌÂÏ¤ÙÂ˜ Ô˘ ¤ÁÈÓ·Ó Ê·›ÓÂÙ·È fiÙÈ Ë ¤ÍÔ‰Ô˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÚÈÓ Û˘ÌÏËÚÒÛÂÈ ÙÈ˜ 72 ÒÚÂ˜ ˙ˆ‹˜, ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ ÓÂÔÁÓ¿ Ô˘ ·›ÚÓÔ˘Ó ÂÍÈÙ‹ÚÈÔ ÌÂÙ¿ ÙÈ˜ 72 ÒÚÂ˜ ˙ˆ‹˜ (10). ŒÙÛÈ, ÔÈ Lee Î·È Û˘Ó ‚Ú‹Î·Ó fiÙÈ ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1987 Î·È 1994, fiÛÔ Ô ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÈˆÓfiÙ·Ó ·fi 4,5 ÛÂ 2,7 ËÌ¤ÚÂ˜, ÙfiÛÔ ·‡Í·ÓÂ Ë Û˘¯ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁ‹˜ ·fi 3,3 ÛÂ 9,3/1000 ˙ÒÓÙ· ÓÂÔÁÓ¿ (11). ∆Ô Ï¤ÔÓ ·ÓËÛ˘¯ËÙÈÎfi ‹Ù·Ó fiÙÈ Ô ·ÚÈıÌfi˜

ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ Â·ÓÂÈÛ‹¯ıËÛ·Ó ÌÂ Â›Â‰· ¯ÔÏÂÚ˘ıÚ›ÓË˜ ¿Óˆ ·ﬁ 30 mg/dL ÂÙ·Ï·ÛÈ¿ÛÙËÎÂ ·ﬁ 0,05 ÛÂ 0,38/1000 ÁÂÓÓ‹ÛÂÈ˜. OÈ Catz Î·È Û˘Ó

‚Ú‹Î·Ó fiÙÈ ÌÂÙ·Í‡ ÙˆÓ ÂÙÒÓ 1991 Î·È 1995 Î·Ù·ÁÚ¿ÊËÎ·Ó 22 ÂÚÈÙÒÛÂÈ˜ ÙÂÏÂÈfiÌËÓˆÓ ‹ Û¯Â‰fiÓ

ÙÂÏÂÈﬁÌËÓˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ó¤Ù˘Í·Ó ˘ÚËÓÈÎﬁ ›ÎÙÂÚÔ. ŸÏ· Â›¯·Ó ¿ÚÂÈ ÂÍÈÙ‹ÚÈÔ Ì¤Û· ÛÙÈ˜ ÚÒÙÂ˜ 48 ÒÚÂ˜ ˙ˆ‹˜ (12).

ÃÚÂÈ¿˙ÂÙ·È ÏÔÈﬁÓ È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙÔ ı¤Ì· ÙÔ˘ ÈÎÙ¤ÚÔ˘, ÂÈ‰ÈÎ¿ ÛÂ ÓÂÔÁÓ¿ ÌÂ ·Û˘Ì‚·ÙﬁÙËÙ· Rhesus Î·È ∞µO, ÛÂ ·˘Ù¿ ÌÂ ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ G6PD, Î·ıÒ˜ Î·È ÛÂ ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ¤¯ÂÈ Ï¿‚ÂÈ ÔÎ˘ÙÔÎ›ÓË. π‰È·›ÙÂÚ· ÎÈÓ‰˘ÓÂ‡Ô˘Ó Â›ÛË˜ ÓÂÔÁÓ¿ ÌÂÙ·Í‡ 37-38 Â‚‰ÔÌ¿‰ˆÓ Î‡ËÛË˜ (13). ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ÈÎÙ¤ÚÔ˘, ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ·ÔÊ·ÛÈ-

ÛÙÂ› Ë ¤ÍÔ‰Ô˜ ÙÔ˘ ÓÂÔÁÓÔ‡, ‰ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌﬁÓÔ ÎÏÈÓÈÎ¿, ·ÊÔ‡ Â›Ó·È ÁÓˆÛÙ‹ Ë ·Ó·ÍÈÔÈÛÙ›·

ñ ∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎ¿ ÚÔ‚Ï‹Ì·Ù·: ÂÏÏÈ‹˜ ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ·Ó‡·ÓÙÚË, ‰È·˙Â˘ÁÌ¤ÓË, ÔÏ‡ ÓÂ·Ú‹ ËÏÈÎ›·, Î·Î¤˜ ÔÈÎÔÁÂÓÂÈ·Î¤˜ Û¯¤ÛÂÈ˜, Î·ÎÔÔ›ËÛË ñ ¶·ı‹ÛÂÈ˜: ™·Î¯·ÚÒ‰Ë˜ ‰È·‚‹ÙË˜, ı˘ÚÂÔÂÈ‰Ô¿ıÂÈ·, ÎÔÏÏ·ÁÔÓÒÛÂÈ˜, ÙÔÍÈÓ·ÈÌ›·, „˘¯È·ÙÚÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ñ §‹„Ë Ê·ÚÌ¿ÎˆÓ: Ó·ÚÎˆÙÈÎ¿, ·ÓÙÈ‰È·‚ËÙÈÎ¿, ·ÓÙÈÂÈÏËÙÈÎ¿, ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ ñ ¶ÂÚÈÁÂÓÓËÙÈÎ¿ Û˘Ì‚¿Ì·Ù·: ·ÛÊ˘Í›·, ÈÛ¯È·Î‹ ÚÔ‚ÔÏ‹, Î·ÎÒÛÂÈ˜ ÙÔÎÂÙÔ‡ ∞fi ÙÔ ÓÂÔÁÓfi

ñ ∂Ó‰ÔÌ‹ÙÚÈ· Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘ÍË˜, Ì·ÎÚÔÛˆÌ›·

¶›Ó·Î·˜ 2. ∂Ï¿¯ÈÛÙÂ˜ ÚÔ¸Ôı¤ÛÂÈ˜ ÁÈ· ÙËÓ ¤ÍÔ‰Ô ÙÔ˘

ñ ¶ÂÚÈÁÂÓÓËÙÈÎﬁ ÈÛÙÔÚÈÎﬁ ¯ˆÚ›˜ ÂÈÏÔÎ¤˜

ñ ∆ÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi Î·ÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜, Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜

ñ ∑ˆÙÈÎ¿ ÛËÌÂ›· ÛÙ·ıÂÚ¿ ÁÈ· 12 ÒÚÂ˜

ñ ∫·ÓÔÓÈÎ‹ Ô‡ÚËÛË Î·È ·Êﬁ‰Â˘ÛË

ñ §‹„Ë ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÂ˘Ì¿ÙˆÓ ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù·

ñ AÔ˘Û›· Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ Ó· ··ÈÙÔ‡Ó ·Ú·ÌÔÓ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô

ñ ∞Ô˘Û›· ÈÎÙ¤ÚÔ˘ Ì¤Û· ÛÙÔ ÚÒÙÔ 24ˆÚÔ

ñ ªËÙ¤Ú· ÙÂÎÌËÚÈˆÌ¤Ó· ÈÎ·Ó‹ Ó· ÛÈÙ›ÛÂÈ Î·È Ó· ÊÚÔÓÙ›ÛÂÈ ÙÔ ÓÂÔÁÓﬁ

ñ πÎ·ÓÔÔÈËÙÈÎﬁ ÔÈÎÔÁÂÓÂÈ·Îﬁ ÂÚÈ‚¿ÏÏÔÓ

ñ OÏÔÎÏ‹ÚˆÛË ÂÏ¤Á¯Ô˘ ÁÈ· ÔÌ¿‰· ·›Ì·ÙÔ˜, Rhesus, Û‡ÊÈÏË

ñ ¶ÚÔÁÚ·ÌÌ·ÙÈÛÌﬁ˜ Â·ÓÂÏ¤Á¯Ô˘ ÛÂ 48 ÒÚÂ˜ ·ﬁ ÙËÓ ¤ÍÔ‰Ô

ÙË˜ ·Ï‹˜ ·Ú·Ù‹ÚËÛË˜. ∞Ó Î·È ÎÏÈÓÈÎ¿ ÂÌÊ·Ó‹˜

›ÎÙÂÚÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ﬁÙ·Ó Ë ¯ÔÏÂÚ˘ıÚ›ÓË Êı¿ÛÂÈ

Ù· 5 mg/dL, Â›Ó·È ÁÓˆÛÙﬁ ﬁÙÈ ˘¿Ú¯Ô˘Ó ÌÂÁ¿ÏÂ˜

‰È·Î˘Ì¿ÓÛÂÈ˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÏ¿¯ÈÛÙË ÙÈÌ‹ ¯ÔÏÂÚ˘-

ıÚ›ÓË˜, ÛÙËÓ ÔÔ›· Á›ÓÂÙ·È ÎÏÈÓÈÎ¿ ÂÌÊ·Ó‹˜ Ô ›ÎÙÂ-

ÚÔ˜, Ô˘ Î˘Ì·›ÓÔÓÙ·È ·ﬁ 3 mg ¤ˆ˜ 10-12 mg/dL.

ŒÙÛÈ, ı· Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌ¿Ù·È ¿ÓÙ· Ë ÙÈÌ‹ ÙË˜

¯ÔÏÂÚ˘ıÚ›ÓË˜ ·›Ì·ÙÔ˜ (14). ŒÓ·˜ Î·Ïﬁ˜ ÚÔÁÓˆÛÙÈÎﬁ˜ ‰Â›ÎÙË˜ ÁÈ· ÙËÓ Èı·Ó‹ ÂÍ¤ÏÈÍË ÙÔ˘ ÈÎÙ¤ÚÔ˘

·ÔÙÂÏÂ› Ë ÙÈÌ‹ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ÙÔ ÚÒÙÔ

24ˆÚÔ ˙ˆ‹˜. ∞Ó Ë ÙÈÌ‹ ÙË˜ ¯ÔÏÂÚ˘ıÚ›ÓË˜ ‰ÂÓ

˘ÂÚ‚·›ÓÂÈ Ù· 5 mg, Ë Èı·ÓﬁÙËÙ· Ù· Â›Â‰¿ ÙË˜

Ó· ˘ÂÚ‚Ô‡Ó Ù· 17 mg ÛÙÈ˜ 72 ‹ ÂÚÈÛÛﬁÙÂÚÂ˜

ÒÚÂ˜ ˙ˆ‹˜ Â›Ó·È ÌË‰ÂÓÈÎ¤˜ (15).

∂›‰Ú·ÛË ÛÙËÓ ÂÌ¤‰ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

∞Ó Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙÔ

Ì·ÈÂ˘Ù‹ÚÈÔ ‰›ÓÂÈ ÙË ‰˘Ó·ÙﬁÙËÙ· Î·Ï‡ÙÂÚË˜ ÂÎÌ¿-

ıËÛË˜ Î·È ÂÌ¤‰ˆÛË˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, Ë

‚È‚ÏÈÔÁÚ·Ê›· Â› ÙÔ˘ ÚÔÎÂÈÌ¤ÓÔ˘ Â›Ó·È ·ÓÙÈÎÚÔ˘-

fiÌÂÓË. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› ÔÏÏ¿ ·fi Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, .¯. Ú·Á¿‰Â˜ ıËÏÒÓ, Ì·ÛÙ›ÙÈ‰·, ·ÓÂ¿ÚÎÂÈ· Á¿Ï·-

ÎÙÔ˜ Î·È ·Ê˘‰¿ÙˆÛË, ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁﬁÙÂÚ· (16,17). ŸÌˆ˜, ÁÈ· Ó· ÂÙ‡¯ÂÈ Ô ÌËÙÚÈÎﬁ˜ ıËÏ·-

ÛÌﬁ˜ ı· Ú¤ÂÈ Ë ÂÎ·›‰Â˘ÛË ÙË˜ ÌËÙ¤Ú·˜ Ó· ·Ú-

¯›ÛÂÈ ÔÏ‡ ÓˆÚ›ÙÂÚ·, ·ﬁ Ù· ÚÒÙ· ‰ËÏ·‰‹ ÛÙ¿‰È·

ÙË˜ Î‡ËÛË˜ Î·È Ó· Û˘ÓÂ¯›˙ÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙﬁ, ·Ï-

Ï¿ Î·È ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·fi ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÂ˜ ÂÈÛÎ¤ÙÚÈÂ˜ ·‰ÂÏÊ¤˜. ¢ÂÓ ˘¿Ú¯ÂÈ ÏÔÈfiÓ ·ÌÊÈ‚ÔÏ›· fiÙÈ Ë ·ÓÂ·ÚÎ‹˜ ÂÎ·›‰Â˘ÛË ÏfiÁˆ ÙË˜ ÌÂ›ˆÛË˜ ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜, È‰›ˆ˜ ÛÂ ÚˆÙfiÙÔÎÂ˜ ÌËÙ¤ÚÂ˜, ÌÔÚÂ› Ó· ¤¯ÂÈ ·ÚÓËÙÈÎ‹ Â›‰Ú·ÛË ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (18).

¶›Ó·Î·˜ 3. ™˘¯ÓﬁÙËÙ· ·ÚÓËÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÎÔ‡ ÂÏ¤Á¯Ô˘ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘ ÓÂÔÁÓÔ‡ Î·Ù¿ ÙË

Ï‹„Ë ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·›Ì·ÙÔ˜ ∏ÏÈÎ›· ÓÂÔÁÓÔ‡ æÂ˘‰Ò˜ ·ÚÓËÙÈÎ¿ Î·Ù¿ ÙËÓ ·ÈÌÔÏË„›··ÔÙÂÏ¤ÛÌ·Ù· (ÒÚÂ˜)(%) <1233 18-249,7 24-482,4 48-720,14

ÏÔ›ÌˆÍË˜ Â›Ó·È Ë Ú‹ÍË ı˘Ï·Î›Ô˘ ¿Óˆ ·ﬁ 24 ÒÚÂ˜ (·‡ÍËÛË ÛÙÔ ‰ÂÎ·Ï¿ÛÈÔ), Ë ¯ÔÚÈÔ·ÌÓÈÔÓ›ÙÈ‰· Ô˘ ﬁÙ·Ó ÚÔÛÙÂıÂ›

ÛÙË Ú‹ÍË ÙÔ˘ ı˘Ï·Î›Ô˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÏÔ›ÌˆÍË˜ Î·Ù¿ 80 ÊÔÚ¤˜ (87 ÓÂÔÁÓ¿/1000 ÁÂÓÓ‹ÛÂÈ˜), Ë ·ÚÔ˘Û›· ˘ÚÂÙÔ‡ ÛÙË ÌËÙ¤Ú· ‹ ıÂÙÈÎ‹˜ ÎÔÏÈÎ‹˜

Î·ÏÏÈ¤ÚÁÂÈ·˜ ÁÈ· ÛÙÚÂÙfiÎÔÎÎÔ ÙË˜ ÔÌ¿‰·˜ µ, ÙÔ ¯·ÌËÏfi Apgar score (19). ∂ÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, Ë ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÂ Û˘Ó‰˘·ÛÌfi ÌÂ ÔÚÈÛÌ¤ÓÔ˘˜ ‰Â›ÎÙÂ˜ ÏÔ›ÌˆÍË˜ ı· Î·ıÔÚ›ÛÔ˘Ó ÙË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ∞Ó Ë ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎ‹ Î·È Ë CRP Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·Ù¿ Ê‡ÛË, ‰ÂÓ Û˘ÓÙÚ¤¯ÂÈ ÏfiÁÔ˜ ·Ú¿Ù·ÛË˜ ÙË˜ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ÙÌ‹Ì· (20,21).

ªÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù· O ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Á›ÓÂÙ·È ÛÂ fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯ÓÂ˘ÛË ÌÂÙ·‚ÔÏÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ “Î¿ÚÙ·˜” ÍÂÎ›ÓËÛÂ ˆ˜ ÁÓˆÛÙfiÓ ÛÙÈ˜ ∏¶∞ ÙÔ 1961 ·fi ÙÔ˘˜ Guthrie Î·È Susi (22). O ¤ÏÂÁ¯Ô˜ ·˘Ùfi˜ ·ÊÔÚÔ‡ÛÂ ·Ú¯ÈÎ¿ ÌfiÓÔ ÙË Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·, ÂÂÎÙ¿ıËÎÂ fiÌˆ˜ ÚÔÔ‰Â˘ÙÈÎ¿ Î·È ÛÂ ¿ÏÏ· ÌÂÙ·‚ÔÏÈÎ¿ ÓÔÛ‹Ì·Ù·, .¯. Á·Ï·ÎÙÔ˙·ÈÌ›·, ÓfiÛÔ ÛÊÂÓ‰¿ÌÔ˘, ÔÌÔÎ˘ÛÙÈÓÔ˘Ú›·, ˘Ôı˘ÚÂÔÂÈ‰ÈÛÌfi. °È· ÓÔÛ‹Ì·Ù· ÛÙ·

·ﬁ ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ÁÂÁÔÓﬁ˜ Ô˘ ÚÔ¸Ôı¤ÙÂÈ ÙËÓ

ÂÓﬁ˜ ÔÏ‡ Î·Ï¿ ÔÚÁ·ÓˆÌ¤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜.

∏ ÚÒÈÌË ¤ÍÔ‰Ô˜, ÂÊfiÛÔÓ Â›Ó·È Î·Ï¿ ÚÔÁÚ·ÌÌ·ÙÈÛÌ¤ÓË, ÌÔÚÂ› Ó· ‰È·ÛÊ·Ï›ÛÂÈ ÙËÓ ˘ÁÂ›· ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂ ÔÏ‡ ÌÈÎÚfiÙÂÚÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ Î·È, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎ¿

Ì·ÈÂ˘Ù‹ÚÈÔ.

µÈ‚ÏÈÔÁÚ·Ê›·

1. Welt S, Cole J, Myers M. Feasibility of postpartum rapid hospital discharge. A study from a community hospital population. Am J Perinatol 1993;10:384-389.

2. CDC. Trends in length of stay for hospital deliveries-United States,1970-1992. MMWR 1995;44:335-341.

3. Thilo EH, Townsend SF, Merenstein GB. The history of policy and practice related to the perinatal hospital stay. Clin Perinatol 1998;28:257-270.

4. Gazmararian JA, Koplan JP. Economic aspects of the perinatal hospital stay. Clin Perinatol 1998;25:483-498.

5. Braveman P, Kessel W, Egerter S. Early discharge and evidence based practice: Good science and good judgement. JAMA 1997;278:334-339.

6. Kessel W, Kiely M, Nora AH. Early discharge: In the end, it is judgement. Pediatrics 1995;96:739-743.

7. Arthurton MW, Bamford FN. Paediatric aspects of the early discharge of maternity patients. BMJ 1967;3:517-521.

8. Britton JR. The transition to extrauterine life and disorders of transition. Clin Perinatol 1998;25:271-294.

9. American Academy of Pediatrics, Committee on Fetus and Newborn. Hospital stay for healthy term newborns. Pediatrics 1995;96:788-793.

10. Kiely M, Drum A, Kessel W. Early discharge. Benefits and who decides. Clin Perinatol 1998;25:539-553.

11. Lee KS, Perlman M, Ballantyne M. Association between duration of neonatal hospital stay and readmission. J Pediatr 1995;127:758-764.

12. Catz C, Hanson JW, Simpson L, Yaffe SJ. Summary of workshop. Early discharge and neonatal hyperbilirubinemia. Pediatrics 1995;96(4Pt 1):743-745.

13. Maisels JM, Newman TB. Jaundice in full-term and nearterm babies who leave the hospital within 36 hours. Clin Perinatol 1998;25:295-302.

14. Johnson L, Bhutani VK. Guidelines for management of the jaundiced term and near-term infant. Clin Perinatol 1998;25:555-574.

15. Bhutani VK, Johnson LH. Probability of subsequent hyperbilirubinemia in term healthy newborns with no ABO/Rh disease. Pediatr Res 1996;39:197A.

16. Braveman P, Egerter S, Pearl M, ªarchi K, Miller C. Problems associated with early discharge of newborns and mothers: A critical review of the literature. Pediatrics 1995;96:716-726.

17. Kotagal UR, Tsang RC. Impact of early discharge on newborn. J Pediatr Gastroenterol Nutr 1996;22:402-407.

18. Neilert MR. The optimization of breast-feeding in the perinatal period. Clin Perinatol 1998;25:303-326.

19. Gerdes JS. Clinicopathologic approach to the diagnosis of

neonatal sepsis. Clin Perinatol 1991;18:361-381.

20. Escobar GJ, Li DK, Armstrong MA, Gardner MN, Folck BF, Verdi JE et al. Neonatal sepsis workups in infants ≥2000 grams at birth: A population-based study. Pediatrics 2000;106(2 Pt 1):256-263.

21. Philip AG, Mills PC. Use of C-reactive protein in minimizing antibiotic exposure: experience with infants initially admitted to a well-baby nursery. Pediatrics 2000;106:E4.

22. Guthrie R, Susi A. A simple phenylalanine method for detecting phenylketonuria in large populations of newborn infants. Pediatrics 1963;32:338-345.

23. McCabe E, McCabe L, Mosher G. Newborn screening for phenylketonuria: Predictive validity as a function of age. Pediatrics 1983;72:390-396.

24. Fisher DA. Effectiveness of newborn screening programs for congenital hypothyroidism: Prevalence of missed cases. Pediatr Clin North Am 1987;34:881-890.

25. Moss G, Cartlidge P, Chambers T. Routine examination in the neonatal period. BMJ 1991;302:878-884.

26. Soskolne EI, Schumacher R, Fryock C. The effects of early discharge and other factors on readmissions rate of newborns. Arch Pediatr Adolesc Med 1996;150:413-420.

27. Braudo M, Rowe RD. Auscultation of the heart-early neonatal period. Am J Dis Child 1961;101:575-586.

28. ¡ÙÔ˘ÓÙÔ˘Ï¿ÎË˜ π. ¶ÚÒÈÌË ‰È¿ÁÓˆÛË

ÙÔ˘ ÈÛ¯›Ô˘ ÛÂ ÙÂÏÂÈﬁÌËÓ· ÓÂÔÁ¤ÓÓËÙ·. ¶·È‰È·ÙÚÈÎ‹ 2000;63:156-162.

29. American Academy of Pediatrics on Substance Abuse and Children with Disability: Fetal alcohol syndrome and fetal alcohol effects. Pediatrics 1993;91:1004-1007.

30. Volpe JJ. Effect of cocaine use on the fetus. N Engl J Med 1992;327:399-401.

31. Kandall SR, Doberczak TM, Mauer KR. Opiate v CNS depressant therapy in neonatal drug abstinence syndrome. Am J Dis Child 1983;137:378-384.

32. Rosen TS, Pippenger CE. Pharmacologic observation on the neonatal withdrawal syndrome. J Pediatr 1976;88:1044-1048.

33. Knutson JF. Psychological characteristics of maltreated children. Putative risk factors and consequences. Annual Rev Psychol 1995;46:401-431.

34. Gray JD, Cutler CA, Dean JG. Prediction and prevention of child abuse. Semin Perinatol 1979;3:85-90.

35. Downs SM, Loda F. Duration of hospital stay for apparently healthy newborn infants. J Pediatr 1995;127:736-743.

36.Yanover MJ, Jones D, Miller MD. Perinatal care of low-risk mothers and infants. N Engl J Med 1976;294:702-706.

37. Strong TH, Brown WL. Experience with early postcesarean hospital dismissal. Am J Obstet Gynecol 1993;169:116-125.

38. Scott A. Cost analysis of early discharge and domiciliary visits versus standard hospital care for low-risk obstetric clients. Aust J Public Health 1994;18:96-101.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-03-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-09-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã. ∫ÒÛÙ·ÏÔ˜

∞ÚÙ¤ÌÈ‰Ô˜ 130, 175 62, ¶. º¿ÏËÚÔ

¢. ∫·Ú·Î·˚‰ﬁ˜, ∏. °ÂˆÚÁÈ¿‰Ë˜, Ã. ∫·Ú‹˜

Accidents in childhood

D. Karakaidos, H. Georgiadis, C. Karis °∂¡π∫∞

¶ÂÚ›ÏË„Ë: ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó Û˘¯Ó‹ ·ÈÙ›· ÓÔÛËÚﬁÙËÙ·˜ Î·È ıÓËÛÈÌﬁÙËÙ·˜ ÛÙËÓ ·È‰ÈÎ‹

ËÏÈÎ›·. ∞Ó·ÛÎÔÔ‡ÓÙ·È ·Ó¿ ËÏÈÎ›· ÔÈ Û˘¯ÓﬁÙÂÚÂ˜

ÌÔÚÊ¤˜ ·Ù˘¯ËÌ¿ÙˆÓ ˆ˜ ÚÔ˜ ÙËÓ ÂÈ‰ËÌÈÔÏÔÁ›·, ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ Ô˘ Ù· ÂËÚÂ¿˙Ô˘Ó Î·È Û˘˙ËÙÔ‡ÓÙ·È Ì¤ÙÚ·

ÛÌﬁ ÙÔ˘˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ·Ù˘¯‹Ì·Ù·, ·È‰ÈÎ‹ ËÏÈÎ›·, ÙÚÔ-

¯·›Ô, ‰ËÏËÙËÚ›·ÛË, ÚﬁÏË„Ë.

∂ÈÛ·ÁˆÁ‹ - °ÂÓÈÎﬁÙËÙÂ˜ ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓﬁÙÂÚË ·ÈÙ›·

ı·Ó¿ÙÔ˘ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ªÂÙ¿ ·fi ÔÏÏ¿ ¯ÚfiÓÈ· ·‰È·ÊÔÚ›·˜ ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ Î·È ÙË˜ ¶ÔÏÈÙÂ›·˜, Û‹ÌÂÚ· ÙÔ ·È‰ÈÎfi ·Ù‡¯ËÌ· Î·È Ë ÚfiÏË„‹

ÙÔ˘ ·ÔÙÂÏÂ› ÚÒÙÈÛÙË ÊÚÔÓÙ›‰· ÙˆÓ ˘ËÚÂÛÈÒÓ

‰ËÌﬁÛÈ·˜ ˘ÁÂ›·˜ ÛÂ ﬁÏ· Ù· ÚÔËÁÌ¤Ó· ÎÚ¿ÙË.

∏ Ï¤ÍË ·Ù‡¯ËÌ· ÛËÌ·›ÓÂÈ ÙÔ Û˘Ì‚¿Ó Ô˘ ÔÊÂ›-

ÏÂÙ·È ÛÂ ¤ÏÏÂÈ„Ë Ù‡¯Ë˜ Î·È ÂÔÌ¤Óˆ˜ Â›Ó·È ·Úﬁ-

‚ÏÂÙÔ. ™‹ÌÂÚ·, ‚¤‚·È·, ÈÛÙÂ‡Ô˘ÌÂ ﬁÙÈ ¤Ó· ·Ù‡-

¯ËÌ· ‰ÂÓ ÚÔÎ·ÏÂ›Ù·È ÌﬁÓÔ ·ﬁ ¤ÏÏÂÈ„Ë Ù‡¯Ë˜, ·ÏÏ¿ Û˘Ì‚¿ÏÏÔ˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙÂ˜ ÛÙË Á¤ÓÂÛ‹ ÙÔ˘ (1). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Â›Ó·È È‰È·›ÙÂÚ· ÂÈÚÚÂ-

Â›˜ ÛÙ· ·Ù˘¯‹Ì·Ù· Î·È ÔÈ ÏfiÁÔÈ Â›Ó·È ÔÏÏÔ› (2): ·) ∏ ·ÓÙÈÏËÙÈÎ‹ ÈÎ·ÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ˆÚÈÌ¿˙ÂÈ Ï‹Úˆ˜ ÚÈÓ ÙËÓ ÂÊË‚Â›·. ‚) ™˘ÓÂÈ‰ËÙÔÔÈÔ‡Ó ÙË Û¯¤ÛË ·ÈÙ›Ô˘-·ÔÙÂÏ¤ÛÌ·ÙÔ˜, ÔÏÏ¤˜ ÊÔÚ¤˜ ÌÂÙ¿ ·fi ‰˘Û¿ÚÂÛÙÂ˜ ÂÌÂÈÚ›Â˜. Á) ∫·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ ÙË˜ ˙ˆ‹˜ ˘¿Ú¯ÂÈ Ù¿ÛË ÁÈ· ÂÍÂÚÂ‡ÓËÛË. ‰) ∏ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· ·Ó·Ù‡ÛÛÂÙ·È ÚÔÔ‰Â˘ÙÈÎ¿.

¶ÂÚÈÊÂÚÂÈ·Îﬁ

Abstract: Accidents constitute a major cause of morbidity and mortality in childhood. The most common forms of accidents according to age are reviewed in relation to epidemiology as well as to other contributing factors. The measures that should be taken to reduce their incidence are discussed.

Key words: accident, childhood, motor-vehicle accident, poisoning, prevention. ∞Ù˘¯‹Ì·Ù· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

Â) ∆Ô ·È‰› ÙË˜ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÎ¤„Ë ·ÓÒÚÈÌË, ·Ú¿ÏÔÁË Î·È ÂÁˆÎÂÓÙÚÈÎ‹. ÛÙ) ∆· ·È‰È¿ ÙË˜ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÚÔ‚·›ÓÔ˘Ó Û˘¯Ó¿ ÛÂ Ú¿ÍÂÈ˜ ··ÁÔÚÂ˘Ì¤ÓÂ˜, ÙÔÏÌËÚ¤˜ Î·È ÚÈ„ÔÎ›Ó‰˘ÓÂ˜. ™ÙÈ˜ ÚÔËÁÌ¤ÓÂ˜ ¯ÒÚÂ˜, Ù· ·Ù˘¯‹Ì·Ù· ÍÂÂÚÓÔ‡Ó ÙÔ 50% ÙˆÓ ·ÈÙÈÒÓ ı·Ó¿ÙÔ˘ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ∞ÎÔÏÔ˘ıÔ‡Ó Ù· ÓÂÔÏ¿ÛÌ·Ù· ÛÂ ÔÛÔÛÙfi 15% Î·È ÔÈ Û˘ÁÁÂÓÂ›˜ ‰È·Ì·ÚÙ›Â˜ ÛÂ ÔÛÔÛÙfi 8%. ∆· 3/4 (63%-80%) ÙˆÓ ı·Ó¿ÙˆÓ ·fi ·Ù˘¯‹Ì·Ù·

ÛÙËÓ ·È‰ÈÎ‹ Î·È ÂÊË‚ÈÎ‹ ËÏÈÎ›· ÔÊÂ›ÏÔÓÙ·È ÛÂ

ÙÚÔ¯·›·, ÌÂ ÙËÓ Â˘ÚÂ›· ¤ÓÓÔÈ· ÙË˜ Ï¤ÍË˜, ÂÓÒ Ù· ÌÈÛ¿ ·ﬁ ·˘Ù¿ ·ÊÔÚÔ‡Ó ÂÈ‚¿ÙÂ˜ ÙÚÔ¯ÔÊﬁÚˆÓ

Ô¯ËÌ¿ÙˆÓ ËÏÈÎ›·˜ 5-14 ÂÙÒÓ. ∆· ÂÁÎ·‡Ì·Ù· Î·È Ô

ÓÈÁÌﬁ˜ ·ÔÙÂÏÔ‡Ó ÙË ‰Â‡ÙÂÚË Î·È ÙÚ›ÙË Î·Ù¿ ÛÂÈÚ¿ ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿ Î¿Ùˆ ÙˆÓ 5 ÂÙÒÓ Î·È

Û˘Ì‚·›ÓÔ˘Ó Û˘¯ÓﬁÙÂÚ· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ·È¯ÓÈ‰ÈÔ‡. ∞ﬁ ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÂÓÒ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ

Ì¤ÚÔ˜ ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ Û˘Ì‚·›ÓÂÈ ÛÂ ÔÏ‡ ÌÈÎÚ¿ ·È‰È¿ (85% ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙÔ Û›ÙÈ) Î·È

ÛÔ‚·Ú¤˜ ÂÈÏÔÎ¤˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÌfiÓÔ ÛÙÔ 2,5% ÙÔ˘ Û˘ÓfiÏÔ˘, ÔÈ ı¿Ó·ÙÔÈ Â›Ó·È ÈÔ Û˘¯ÓÔ› ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ (·fiÂÈÚÂ˜ ·˘ÙÔÎÙÔÓ›·˜) (1,3).

Peripheral General Hospital of Nikea - Piraeus, Athens “St. Panteleimon” Pediatric Clinic

¶·È‰È·ÙÚÈÎ‹ 2001;64:624-629 Paediatriki 2001;64:624-629

ÂÈ‰ÈÎÂ˘ﬁÌÂÓˆÓ È·ÙÚÒÓ ÁÈ· Î·Ï‡ÙÂÚË ÁÓÒÛË Î·È

·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜, ‰) ÂÓËÌ¤ÚˆÛË ÁÔÓ¤ˆÓ-·È‰ÈÒÓ Ì¤Ûˆ ÙÔ˘ Û¯ÔÏÂ›Ô˘ Î·È ÙˆÓ

Ì¤ÛˆÓ Ì·˙ÈÎ‹˜ ÂÓËÌ¤ÚˆÛË˜, Â) ·˘ÛÙËÚ‹ Ù‹ÚËÛË

ÙÔ˘ ∫O∫ Î·È ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ÔÚı‹ Ù‹ÚËÛË ÙˆÓ Î·ÓﬁÓˆÓ ÌÂÙ·ÊÔÚ¿˜ ÙˆÓ ·È‰ÈÒÓ, ÛÙ) ‰È·ÌﬁÚÊˆÛË

ÙÔ˘ ¯ˆÚÔÙ·ÍÈÎÔ‡ Î·È Î˘ÎÏÔÊÔÚÈ·ÎÔ‡ ÂÚ›Á˘ÚÔ˘

(Û¯Â‰È·ÛÌfi˜ ‰ÚfiÌˆÓ, ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ Î˘ÎÏÔÊÔÚ›·˜, Î.Ï.), ÌÂ ÙÚfiÔ Ô˘ Ó· ÌÂÈÒÓÂÙ·È Ë Èı·ÓfiÙËÙ· ·Ù˘¯‹Ì·ÙÔ˜. O È·ÙÚÈÎfi˜ ÎfiÛÌÔ˜ Î·È È‰›ˆ˜ ÔÈ ·È‰›·ÙÚÔÈ, Î·Ù¤¯Ô˘Ó Ì›· ÛÙÚ·ÙËÁÈÎ‹ ı¤ÛË ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜. O ·È‰›·ÙÚÔ˜, Â˘ÚÈÛÎfiÌÂÓÔ˜ ‰›Ï· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÏËÚÔÊÔÚ‹ÛÂÈ ÁÔÓÂ›˜ Î·È ·È‰È¿, Ó· Ï‡ÛÂÈ ·ÔÚ›Â˜, Ó· ÂÈÛËÌ¿ÓÂÈ ÎÈÓ‰‡ÓÔ˘˜ Î·È Â›Ó·È ·˘Ùfi˜ Ô˘ ı· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÚÒÙÔ˜ ÙÔ ·È‰ÈÎfi ·Ù‡¯ËÌ·, Û˘Ì‚¿ÏÏÔÓÙ·˜ ÌÂ ÙËÓ ¤ÁÎ·ÈÚË

Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ·Ú¤Ì‚·Û‹ ÙÔ˘ ÛÙËÓ ÂÏ·¯È-

ÛÙÔÔ›ËÛË ÙˆÓ ÂÈÙÒÛÂˆÓ ·’ ·˘Ùﬁ (1,3,16,29).

™ÙÔÓ ¶›Ó·Î· 2 ·Ú·ı¤ÙÔ˘ÌÂ ÔÚÈÛÌ¤ÓÂ˜ Ú·ÎÙÈ-

Î¤˜ Û˘Ì‚Ô˘Ï¤˜ ÚÔ˜ ÙÔ˘˜ ÁÔÓÂ›˜, Ë ÂÊ·ÚÌÔÁ‹

ÙˆÓ ÔÔ›ˆÓ ı· ‚ÔËı‹ÛÂÈ ÛÙÔÓ ÂÚÈÔÚÈÛÌﬁ ÙË˜ Û˘-

¯ÓﬁÙËÙ·˜ ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›·

1. ¢¤ÛÌË Î·Ù’ ÂÈÏÔÁ‹Ó ˘Ô¯ÚÂˆÙÈÎÒÓ Ì·ıËÌ¿ÙˆÓ ÛÙËÓ ¶·È-

‰È·ÙÚÈÎ‹ ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘

∞ıËÓÒÓ - ∆Ì‹Ì· π·ÙÚÈÎ‹˜: ∞Ù˘¯‹Ì·Ù· Î·È ¢ËÏËÙËÚÈ¿ÛÂÈ˜

ÛÙ· ·È‰È¿; ∞ı‹Ó· 1988.

2. ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫. ∞Ù˘¯‹Ì·Ù· ÛÙËÓ ÂÊË‚Â›·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚ ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 1997;44:138-141.

3. ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· ÃÂÈÚÔ˘ÚÁÒÓ ¶·›‰ˆÓ: ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙· - ∆Ô ·È‰ÈÎﬁ ·Ù‡¯ËÌ·, ¡›Î·È·-∞ÙÙÈÎ‹; 1999.

4. Lam LT, Ross FI, Cass DT. Children at play: the death and injury pattern in New South Wales, Australia, July 1990June 1994. J Pediatr Child Health 1999;35:572-577.

5. Petridou E, Zervos I, Christopoulos G, Revinthi K, Papoutsakis G, Trichopoulos D. Biosocial variables and auditory acuity as risk factors for non-fatal childhood injuries in Greece. Inj Prev 1995;1:92-96.

6. Murray JA, Chen D, Velmahos GC, Alo K, Belzberg H, Asensio JA et al. Pediatric falls: is height a predictor of injury and outcome? Am Surg 2000;66:863-865.

7. Benoit R, Watts DD, Dwyer K, Kaufmann C, Fakhry S. Windows 99: a source of suburban pediatric trauma. J Trauma 2000;49:477-481.

8. Ã·Ù˙ËÛ˘ÌÂÒÓ-Ã·Ù˙Ë‚·ÛÈÏÂÈ¿‰Ë ª. ∞Ù˘¯‹Ì·Ù· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ¢ÂÏÙ ∞’ ¶·È‰È·ÙÚ KÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 1992;39:254-262.

9. Leistikow BN, Martin DC, Milano CE. Fire injuries, disasters, and costs from cigarette lights: a global overview. Prev Med 2000;31(2 pt1):91-99.

10. Fukunishi K, Takahashi H, Kitagishi H, Matsushima T, Kanai T, Ohsawa H et al. Epidemiology of childhood burns in the critical care medical center of Kinki University Hospital in Osaka, Japan. Burns 2000;26:465-469.

11. Chadova L, Buska I, Toupalik P. Lethal burn trauma in children. Acta Chir Plast 2000;42:60-63.

12. µÏ¿¯Ô˘ £, ∫ÔÓÙ·Í¿ÎË Ã, ∆Û·Î›ÚË˜ ∞, ∆·¯ÏÈ·ÌÔ‡ÚË˜ ¡, ∑ÒÛË ¶, µ·ÛÈÏÂÈ¿‰Ë˜ ¶ Î·È Û˘Ó. ¢ËÏËÙËÚÈ¿ÛÂÈ˜ ÛÙ· ·È‰È¿ - ¢È·ÈÛÙÒÛÂÈ˜ - ¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ›. 35Ô ¶·ÓÂÏÏ‹ÓÈo ¶·È‰È·ÙÚÈÎﬁ ™˘Ó¤‰ÚÈÔ; 1997 13-15 πÔ˘Ó›Ô˘; ∞Á›· ¶ÂÏ·Á›·∫Ú‹ÙË; 1997;I:54.

13. ∫ÙÂÓ¿˜ ∂. O‰ÈÎ¿ ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ÛÙËÓ ∂ÏÏ¿‰·, 19741991. π·ÙÚÈÎ‹ 1994;65:181-183.

14. Kardara M, Kondakis X. Road traffic accidents in Greece: recent trends (1981-1991). Eur J Epidemiol 1997;13:765-770.

15. MMWR Morb Mortal Wkly Rep 1998;47:59-60.

16. ∫ˆÛÙ·Ú›‰Ô˘ ™, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ¶, ™ˆÙËÚÔÔ‡ÏÔ˘ º, ¶·Ó·ÁÔÔ‡ÏÔ˘ ª, ¶·Ó·ÁÔÔ‡ÏÔ˘ °, ∑·¯·ÚÈ¿‰Ë ∞ Î·È Û˘Ó. ¶ÚﬁÏË„Ë ÙÚÔ¯·›ˆÓ Î·ÎÒÛÂˆÓ: ™˘Óı‹ÎÂ˜ ÌÂÙ·ÊÔÚ¿˜ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÌÂ ÙÔ ·˘ÙÔÎ›ÓËÙÔ. ¶·È‰È·ÙÚÈÎ‹ 1996;59:325-333.

17. Petridou E, Skalkidou A, Ioannou N, Trichopoulos D. Fatalities from non-use of seat belts and helmets in Greece: a nationwide appraisal. Hellenic Road Traffic Police. Accid Anal Prev 1998;30:87-91.

18. ∆ÛÔ˘Ì¿Î·˜ ∫. ∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù·-O‰ËÁ›Â˜ ÚﬁÏË„Ë˜. ¶·È‰È·ÙÚÈÎ‹ 2000;63:337-338.

19. ¶·‹˜ ∫, Ã·Ù˙ËÎˆÛÙ·ÓÙ¿˜ °. ∆ÚÔ¯·›Â˜ Î·ÎÒÛÂÈ˜ ÛÙ· ·È-

·ÛÊ·ÏÂ›·˜ ÛÙÔ ·˘ÙÔÎ›ÓËÙÔ Î·È Ë Û˘ÓÔ‰Â›· ÛÙË

ÙˆÓ ‰ÚﬁÌˆÓ. ¶·È‰È·ÙÚÈÎ‹ 1986;49:146-153.

20. Ferguson SA, Wells JK, Williams AF. Child seating position and restraint use in three states. Inj Prev 2000;6:24-28.

21. Berg MD, Cook L, Corneli HM, Vernon DD, Dean JM. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics 2000;105:831-835.

22. Robertson LS. Reduced fatalities related to rear seat shoulder belts. Inj Prev 1999;5:62-64.

23. Durbin DR. Preventing motor vehicle injuries. Curr Opin Pediatr 1999;11:583-587.

24. Petridou E, Skalkidou A, Lescohier I, Trichopoulos D. Car restraints and seating position for prevention of motor vehicle injuries in Greece. Arch Dis Child 1998;78:335-339.

25. Agran P, Winn D, Anderson C. Child occupant protection in motor vehicle. Pediatr Rev 1997;18:413-422.

26. Christoffel K, Scheidt P, Agran P, Kraus J, McLoughlin E, Paulson J. Standard definitions for childhood injury research: Excerpts of a conference report. Pediatrics 1992;89:1027-1034.

27. Petridou E, Askitopoulou H, Vourvahakis D, Skalkidis Y, Trichopoulos D. Epidemiology of road traffic accidents during pleasure traveling: the evidence from the island of Crete. Accid Anal Prev 1997;29:687-693.

28. Chliaoutakis JE, Darviri C, Demakakos PT. The impact of young drivers’ lifestyle on their road traffic accident risk in greater Athens area. Accid Anal Prev 1999;31:771-780.

29. Silbert J, Kemp A. Prevention of child accidents in Europe. Matern Child Health 1992;314.

07-02-2001

20-07-2001

Center of Disease Control Consensus Statement

Anthrax as a biological weapon1

Center of Disease Control Consensus Statement °∂¡π∫∞ £∂ª∞∆∞GENERAL ISSUES

∂ÈÛ·ÁˆÁ‹ O ¿ÓıÚ·Î·˜ Î·Ù¤¯ÂÈ ÂÍ¤¯Ô˘Û· ı¤ÛË ·Ó¿ÌÂÛ·

ÛÙÔ˘˜ ÔÏ˘¿ÚÈıÌÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙÂ˜

ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Û·Ó ‚ÈÔÏÔÁÈÎ¿

ÔÏÏÔ‡˜ ·ÈÒÓÂ˜,

Î›ÓËÛÂ ÚÈÓ 80 ¯ÚfiÓÈ· ÂÚ›Ô˘. ™‹ÌÂÚ·, ÈÛÙÂ‡ÂÙ·È fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 17 ÎÚ¿ÙË ¤¯Ô˘Ó ÚfiÁÚ·ÌÌ· Î·Ù·ÛÎÂ˘‹˜ ‚ÈÔÏÔÁÈÎÒÓ fiÏˆÓ.

ÙÔ˘ ¿ÓıÚ·Î· ·ÂÚÔÁÂÓÒ˜ ÛÂ ÌÔÚÊ‹

ÛÙ·ÁÔÓÈ‰›ˆÓ (·ÂÚÔ˙ﬁÏ) ıÂˆÚÂ›Ù·È Û·Ó ÙËÓ ÈÔ Â›-

ÊÔ‚Ë ÌÔÚÊ‹ ¯Ú‹ÛË˜ ÙÔ˘ ˆ˜ ﬁÏÔ. ŒÓ· ·ÂÚÔ˙ﬁÏ

¿ÓıÚ·Î· ÌÂÙ¿ ÙËÓ ·ÂÏÂ˘ı¤ÚˆÛ‹ ÙÔ˘ ı· ‹Ù·Ó ·ﬁ-

Ú·ÙÔ Î·È ¿ÔÛÌÔ Î·È ı· Â›¯Â ÙË ‰˘Ó·ÙﬁÙËÙ· ‰È·ÛÔ-

Ú¿˜ ÛÂ ·ÎÙ›Ó· ÔÏÏÒÓ ¯ÈÏÈÔÌ¤ÙÚˆÓ.

∆Ô 1979, ¤Ó· ·Ù‡¯ËÌ· ÛÂ ¤Ó· ÂÚÁÔÛÙ¿ÛÈÔ ·-

Ú·ÁˆÁ‹˜ ‚ÈÔÏÔÁÈÎÒÓ ﬁÏˆÓ ÛÙÔ Sverdlovsk ÙË˜

ÚÒËÓ ∂™™¢, fiÔ˘ ÂÏÂ˘ıÂÚÒıËÎÂ ÏÈÁfiÙÂÚÔ ·fi

1 g ¿ÓıÚ·Î· ÛÂ ÌÔÚÊ‹ ·ÂÚÔ˙ﬁÏ, Â›¯Â Û·Ó ·ÔÙ¤ÏÂ-

ÛÌ· 68 ı·Ó¿ÙÔ˘˜.

∆Ô 1970, Ë ¶·ÁÎﬁÛÌÈ· OÚÁ¿ÓˆÛË ÀÁÂ›·˜ ˘Ô-

ÏﬁÁÈÛÂ ﬁÙÈ Ë ·ÂÏÂ˘ı¤ÚˆÛË ÌÂ ·ÂÚÔÏ¿ÓÔ 50 kg

¿ÓıÚ·Î· ¿Óˆ ·ﬁ Ì›· ·ÛÙÈÎ‹ ÂÚÈÔ¯‹ ÌÂ ÏËı˘ÛÌﬁ 5 ÂÎ·ÙÔÌÌ‡ÚÈ· ·ÓıÚÒÔ˘˜, ı· ÚÔÎ·ÏÔ‡ÛÂ

250.000 ı·Ó¿ÙÔ˘˜. ∞˘Ù‹ Ë ÂÎÙÈÌÒÌÂÓË ıÓËÙﬁÙËÙ· Â›Ó·È ÈÛÔ‰‡Ó·ÌË ‹ Î·È ÍÂÂÚÓ¿ ÙÔ ·ÔÙ¤ÏÂÛÌ· ·ﬁ

ÙË Ú›„Ë Ì›·˜ ‚ﬁÌ‚·˜ ˘‰ÚÔÁﬁÓÔ˘.

∂È‰ËÌÈÔÏÔÁ›·

O ¿ÓıÚ·Î·˜ Â›Ó·È Ì›· ˙ˆÔÓfiÛÔ˜ ÂÓ‰ËÌÈÎ‹ ÛÂ ‰È¿ÊÔÚ· ÛËÌÂ›· ÙÔ˘ Ï·Ó‹ÙË. º˘ÛÈÎ‹ ÌfiÏ˘ÓÛË ÛÙÔÓ ¿ÓıÚˆÔ ·fi ¿ÓıÚ·Î· Û˘Ì‚·›ÓÂÈ

2000 ÎÚÔ‡ÛÌ·Ù· ÂÙËÛ›ˆ˜ ·Ó¿ ÙÔÓ ÎﬁÛÌÔ. ∏ ·Ó·-

ÌÔÚÊ‹ Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ Û¿ÓÈ·: ÌﬁÓÔ 18

·Ó·Ê¤ÚıËÎ·Ó ÛÙÈ˜ ∏.¶.∞. ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ·. ™ÙËÓ ÂÚ›ÙˆÛË ¯Ú‹ÛË˜ ¿Ó-

Û·Ó ‚ÈÔÏÔÁÈÎﬁ

ÌÂ ‰È·ÛÔÚ¿ ·ÂÚÔ˙fiÏ, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÈÔ Û˘¯Ó‹ Î·È ÈÔ ı·Ó·ÙËÊfiÚ·

Ë ·Ó·ÓÂ˘ÛÙÈÎ‹ ÌÔÚÊ‹.

ªÈÎÚÔ‚ÈÔÏÔÁ›· O Bacillus anthracis Â›Ó·È ¤Ó· ·ÂÚfi‚ÈÔ ÛÔÚÔÁfiÓÔ Gram ıÂÙÈÎfi ‚·ÎÙËÚ›‰ÈÔ. OÈ ÛfiÚÔÈ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÂ fiÏ· Ù· Û˘Ó‹ıË ıÚÂÙÈÎ¿ ˘ÏÈÎ¿ ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ ÛÂ ıÂÚÌÔÎÚ·Û›· 37ÔC. OÈ ‚¿ÎÈÏÏÔÈ Û¯ËÌ·Ù›˙Ô˘Ó ÛfiÚÔ˘˜ ÌfiÓÔ fiÙ·Ó ÂÍ·ÓÙÏËıÔ‡Ó ÔÈ ËÁ¤˜ ÂÓ¤ÚÁÂÈ·˜, .¯. fiÙ·Ó ÌÔÏ˘ÛÌ¤Ó· ·fi ÙÔÓ ¿ÓıÚ·Î·

‚ÈÔÏÔÁÈÎ¿ ˘ÏÈÎ¿ ÂÎÙÂıÔ‡Ó ÛÙÔÓ ·ÙÌÔÛÊ·ÈÚÈÎﬁ ·¤Ú·. OÈ ÛﬁÚÔÈ ÙÔ˘ ¿ÓıÚ·Î· Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ·ÓıÂÎÙÈÎÔ› Î·È ÌÔÚÔ‡Ó Ó· ÂÈ˙‹ÛÔ˘Ó ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ÔÏÏ¤˜ ‰ÂÎ·ÂÙ›Â˜.

¶·ıÔÁ¤ÓÂÈ· Î·È ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜

∞Ó·ÓÂ˘ÛÙÈÎﬁ˜ ¿ÓıÚ·Î·˜

O ·Ó·ÓÂ˘ÛÙÈÎfi˜ ¿ÓıÚ·Î·˜ ÚÔÎ·ÏÂ›Ù·È ·fi ÙËÓ Â›ÛÔ‰Ô ÛfiÚˆÓ ÙÔ˘ ‚·Î›ÏÔ˘ ÛÙ· Î˘„ÂÏÈ‰ÈÎ¿ ‰È·ÛÙ‹Ì·Ù·. ∞˘Ù¿ Ê·ÁÔÎ˘ÙÙ·ÚÒÓÔÓÙ·È ·fi Ì·ÎÚÔÊ¿Á· Î·È ÌÂÙ·Ê¤ÚÔÓÙ·È ÛÙÔ˘˜ ÌÂÛÔıˆÚ·ÎÈÎÔ‡˜ ÏÂÌÊ·‰¤ÓÂ˜,

1 JAMA 1999;281:1735-1745

Ô˘ÛÈÒ‰Ë˜. ŸÏ· Ù· ¿ÙÔÌ· ÌÂ ˘ÚÂÙﬁ ‹ Û˘ÛÙËÌ·ÙÈ-

Î‹ ÓﬁÛÔ ÛÂ Ì›· ÂÚÈÔ¯‹ Ô˘ ÂÎ‰ËÏÒıËÎÂ ÂÚÈÛÙ·-

ÙÈÎﬁ ¿ÓıÚ·Î·, Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó ·ÓÙÈ‚ÈÔÙÈÎ¿. ™ÙÔ

·ÚÂÏıﬁÓ, ÁÈ· ÙË ıÂÚ·Â›· ÙÔ˘ ¿ÓıÚ·Î· ¯ÚËÛÈÌÔ-

ÔÈÔ‡Û·Ó ÂÓÈÎÈÏÏ›ÓË ‹ ‰ÔÍ˘Î˘ÎÏ›ÓË. ∆ÂÏÂ˘Ù·›·,

ﬁÌˆ˜, ¤¯Ô˘Ó ‰ËÌÔÛÈÂ˘ıÂ› ÏËÚÔÊÔÚ›Â˜ ÁÈ· ·Ú·-

ÁˆÁ‹ ÙÚÔÔÔÈËÌ¤ÓˆÓ ‚·Î›ÏˆÓ, ·ÓıÂÎÙÈÎÒÓ ÛÙÈ˜

ÂÓÈÎÈÏÏ›ÓÂ˜ Î·È ÙÂÙÚ·Î˘ÎÏ›ÓÂ˜. ™˘ÓÈÛÙ¿Ù·È, ÏÔÈ-

ﬁÓ, Û·Ó ÚÔÙÈÌÒÌÂÓË ıÂÚ·Â›·, Ë ¯ÔÚ‹ÁËÛË

Ciprofloxacin 400 mg IV Î¿ıÂ 12 ÒÚÂ˜ (ÁÈ· ·È‰È¿

20-30 mg/kg IV ÛÂ ‰‡Ô ‰ﬁÛÂÈ˜, ﬁ¯È ¿Óˆ ÙÔ˘ 1 g/ËÌ¤Ú·). ∞Ó ÙÔ ÛÙ¤ÏÂ¯Ô˜ ·Ô‰ÂÈ¯ıÂ› Â˘·›ÛıËÙÔ, ÌÔÚÂ› Ó· ¯ÔÚËÁËıÂ› Penicillin G 4 million U IV/4 ÒÚÂ˜ Î·È Doxycycline 100 mg IV/12 ÒÚÂ˜. ™Â ÂÚ›-

ÙˆÛË Ì·˙ÈÎÔ‡ ·ÚÈıÌÔ‡ ÎÚÔ˘ÛÌ¿ÙˆÓ Ô˘ Î·ıÈÛÙ¿

Ú·ÎÙÈÎ¿ ·‰‡Ó·ÙË ÙËÓ ÂÓ‰ÔÊÏ¤‚È· ¯ÔÚ‹ÁËÛË, Û˘-

ÓÈÛÙ¿Ù·È Ciprofloxacin 500 mg per os Î¿ıÂ 12

ÒÚÂ˜ (ÁÈ· ·È‰È¿ 20-30 mg/kg ÛÂ ‰‡Ô ‰ﬁÛÂÈ˜, ﬁ¯È

¿Óˆ ÙÔ˘ 1 g/ËÌ¤Ú·). ∏ Û˘ÓÈÛÙÒÌÂÓË ‰È¿ÚÎÂÈ· ÙË˜

ıÂÚ·Â›·˜ Â›Ó·È 60 ËÌ¤ÚÂ˜. °È· ÙË ıÂÚ·Â›· ÙÔ˘

‰ÂÚÌ·ÙÈÎÔ‡ ¿ÓıÚ·Î·, Û˘ÓÈÛÙ¿Ù·È ÙÔ ›‰ÈÔ Û¯‹Ì·.

™Â ¤ÏÏÂÈ„Ë ÙˆÓ ·Ú·¿Óˆ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Ì·ÎÚÔÏ›‰Â˜, ÎÏÈÓ‰·Ì˘Î›ÓË, ¯ÏˆÚ·ÌÊÂÓÈÎﬁÏË, Â˘Ú¤ˆ˜ Ê¿ÛÌ·ÙÔ˜ ÂÓÈÎÈÏÏ›ÓÂ˜, ÎÂÊ·ÏÔÛÔÚ›ÓÂ˜ ·’ ÁÂÓÈ¿˜, ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ Î·È ‚·ÓÎÔÌ˘Î›ÓË. O Bacillus anthracis ¤¯ÂÈ Ê˘ÛÈÎ‹ ·ÓÙÔ¯‹ ÛÙËÓ ÙÚÈÌÂıÔÚ›ÌË/ÛÔ˘ÏÊ·ÌÂıÔÍ·˙ﬁ-

ÏË, ÎÂÊÔ˘ÚÔÍ›ÌË, ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙ·˙È‰›ÌË Î·È ·˙ÙÚÂÔÓ¿ÌË.

¶ÚÔÊ‡Ï·ÍË ÌÂÙ¿ ·ﬁ ¤ÎıÂÛË

ªÂÙ¿ ·ﬁ ÙË ¯Ú‹ÛË ¿ÓıÚ·Î· Û·Ó ‚ÈÔÏÔÁÈÎﬁ

ﬁÏÔ, ÔÈ ÙÔÈÎ¤˜ ˘ÁÂÈÔÓÔÌÈÎ¤˜ ·Ú¯¤˜ Ú¤ÂÈ Ó·

·ÔÊ·Û›ÛÔ˘Ó ÔÈÔÈ ÏËı˘ÛÌÔ› Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó

ÚÔÊ˘Ï·ÎÙÈÎ‹ ·ÁˆÁ‹. ∞˘Ù‹ Ë ·ﬁÊ·ÛË ÂÍ·ÚÙ¿Ù·È

·fi ÙÔÓ ÙfiÔ Î·È ÙÔ ¯ÚfiÓÔ ÙË˜ ¤ÎıÂÛË˜, Î·ıÒ˜ Î·È ·fi ÙÈ˜ Î·ÈÚÈÎ¤˜ Û˘Óı‹ÎÂ˜, Â¿Ó ÂÏÂ˘ıÂÚÒıËÎÂ

¿ÓıÚ·Î·˜ ÛÂ ÂÍˆÙÂÚÈÎﬁ ¯ÒÚÔ. °È· ÚÔÊ˘Ï·ÎÙÈÎ‹ ·ÁˆÁ‹, Û˘ÓÈÛÙ¿Ù·È per os ÙÔ ÚÔ·Ó·ÊÂÚı¤Ó ‰ÔÛÔÏÔÁÈÎﬁ Û¯‹Ì· ÁÈ· 60 ËÌ¤ÚÂ˜.

ŒÏÂÁ¯Ô˜ ÏÔÈÌÒÍÂˆÓ O ¿ÓıÚ·Î·˜ ‰ÂÓ ÌÂÙ·‰›‰ÂÙ·È ·ﬁ ¿ÓıÚˆÔ ÛÂ ¿ÓıÚˆÔ. ™˘ÓÂÒ˜, ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚ· Ì¤ÙÚ· ·ÔÌﬁÓˆÛË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ¿ÓıÚ·Î·, ·ÏÏ¿ ·Ï‹ Ù‹ÚËÛË ÙˆÓ Û˘ÓËıÈÛÌ¤ÓˆÓ Ì¤ÙÚˆÓ

Ï·ÍË˜. ∂›ÛË˜, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ¯ÔÚ‹ÁËÛË ÚÔÊ˘-

·ÁˆÁ‹˜ ÛÂ ¿ÙÔÌ· Ô˘ ¤Ú¯ÔÓÙ·È ÛÂ Â·Ê‹ ÌÂ ÙÔÓ ·ÛıÂÓ‹, ÂÎÙﬁ˜ Â¿Ó ÂÎÙ¤ıËÎ·Ó Î·È ·˘ÙÔ› ÛÙÔÓ ¿ÓıÚ·Î· ÙË ÛÙÈÁÌ‹ ÙË˜ Â›ıÂÛË˜.

°È· ÙËÓ ·ÔÏ‡Ì·ÓÛË ÂÈÊ·ÓÂÈÒÓ Ô˘ ‹Úı·Ó ÛÂ Â·Ê‹ ÌÂ ÌÔÏ˘ÛÌ¤Ó· ÛˆÌ·ÙÈÎ¿ ˘ÁÚ¿ ÙÔ˘

·ÛıÂÓ‹, Â›Ó·È Î·Ù¿ÏÏËÏ· Ù· Û˘Ó‹ıË ·ÔÏ˘Ì·ÓÙÈ-

Î¿ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô, .¯. ˘‰ÚÔ¯ÏˆÚ›ÙË˜.

∞ÔÏ‡Ì·ÓÛË O ÌÂÁ·Ï‡ÙÂÚÔ˜ Î›Ó‰˘ÓÔ˜ ÌﬁÏ˘ÓÛË˜ ÌÂÙ¿ ÙËÓ

·ÂÏÂ˘ı¤ÚˆÛË ·ÂÚÔÁÂÓÒ˜ ÛfiÚˆÓ ¿ÓıÚ·Î·, ‰È·ÚÎÂ› fiÛÔ ÔÈ ÛfiÚÔÈ ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ ·¤Ú· ÛÂ

ÌÔÚÊ‹ ·ÂÚÔ˙fiÏ (primary aerosolization). ∆· ·ÂÚÔ˙fiÏ ÂÎÙÈÌ¿Ù·È fiÙÈ ı· ‰È·ÛÎÔÚÈÛÙÔ‡Ó Ï‹Úˆ˜

ÂÓÙﬁ˜ ÔÏ›ÁˆÓ ˆÚÒÓ ‹ ÙÔ Ì¤ÁÈÛÙÔ ÂÓÙﬁ˜ 24 ˆÚÒÓ.

™ﬁÚÔÈ ¿ÓıÚ·Î· ÌÔÚÂ› Î·ÙﬁÈÓ Ó· ·ÓÈ¯ÓÂ˘ıÔ‡Ó

ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ·ÏÏ¿ ‰ÂÓ ˘¿Ú-

ÂÓ‰Â›ÍÂÈ˜ ﬁÙÈ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· Í·Ó·Á›ÓÔ˘Ó ·ÂÚÔ˙ﬁÏ (secondary aerosolization). ™ÙÔÈ¯Â›·

Sverdlovsk ÙË˜

·ÂÚÔ˙ﬁÏ. ∞Ó¿ÏÔÁ· ‰Â‰ÔÌ¤Ó·

ÛÙÚ·ÙÔ‡, Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·fi ‰Â˘ÙÂÚÔÁÂÓ‹ ·ÂÚÔ˙fiÏ ‰ÂÓ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜. ™˘ÓÂÒ˜, Ë ·ÔÏ‡Ì·ÓÛË ÂÎÙÂÙ·Ì¤ÓˆÓ ÂÚÈÔ¯ÒÓ ‹ ·ÎfiÌ· Î·È ÂÓfi˜ ÎÙÈÚ›Ô˘ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË ÛÂ

·ÂÚÔ˙ﬁÏ ¿ÓıÚ·Î· ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂÓ‰Â›ÎÓ˘Ù·È, ·ÏÏ¿ Î·È Â›Ó·È ÂÍ·ÈÚÂÙÈÎ¿ ‰˘Û¯ÂÚ‹˜.

∆· ¿ÙÔÌ· Ô˘ ı· ¤ÚıÔ˘Ó ÛÂ ¿ÌÂÛË Â·Ê‹ ÌÂ ‡ÔÙÔ ÁÈ· ¿ÓıÚ·Î· ˘ÏÈÎfi, ··ÈÙÂ›Ù·È Ó· Ï‡ÓÔ˘Ó Û¯ÔÏ·ÛÙÈÎ¿ ÙÔ ÂÎÙÂıÂÈÌ¤ÓÔ ‰¤ÚÌ· Î·È Ù· ÚÔ‡¯· ÌÂ ÓÂÚfi Î·È Û·Ô‡ÓÈ. ¶ÂÚ·ÈÙ¤Úˆ ·ÔÏ‡Ì·ÓÛË ‰ÂÓ ÂÓ‰Â›ÎÓ˘Ù·È. ∂ÈÏ¤ÔÓ, Ù· ¿ÙÔÌ· ·˘Ù¿ Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó ÚÔÊ˘Ï·ÎÙÈÎ¿ ·ÁˆÁ‹, Ì¤¯ÚÈ Ó· ·Ô‰ÂÈ¯ıÂ› fiÙÈ ÙÔ ‡ÔÙÔ ˘ÏÈÎfi ‰ÂÓ ‹Ù·Ó ¿ÓıÚ·Î·˜.

∆· ·Ú·¿Óˆ ÚÔ¤Ú¯ÔÓÙ·È ·ﬁ: CDC Consensus Statement Working Group on Civilian Biodefense

Inglesby TV et al. JAMA 1999;281:1735-1745

ªÂÙ¿ÊÚ·ÛË-∂ÈÌ¤ÏÂÈ·: ¶/¯Ë˜ (π) °. ∆ﬁÙÔ˜ ¶¡

¶ÚﬁÁÚ·ÌÌ·

∆Ô ÚfiÁÚ·ÌÌ· ™˘ÓÂ¯È˙fiÌÂÓË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Î·›‰Â˘ÛË˜ (™¶∂) ‰È·Ó‡ÂÈ ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Î·È Ù· ÚÒÙ· ÈÛÙÔÔÈËÙÈÎ¿ ™¶∂ ¤¯Ô˘Ó ·ÔÛÙ·ÏÂ› ÛÙÔ˘˜ ‰ÈÎ·ÈÔ‡¯Ô˘˜ ¶·È‰È¿ÙÚÔ˘˜, ÔÈ ÔÔ›ÔÈ Û˘ÁÎ¤ÓÙÚˆÛ·Ó Ù· ··ÈÙÔ‡ÌÂÓ· 50 ÌfiÚÈ· ™¶∂ ÙÔ ¤ÙÔ˜ 2000.

Ÿˆ˜ ¤¯ÂÈ ·Ó·ÎÔÈÓˆıÂ› (1), ÙÔ ÚfiÁÚ·ÌÌ· ™¶∂ ‚·Û›˙ÂÙ·È ÛÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ Confederation of European Specialists in Pediatrics (CESP), fiˆ˜ ·˘Ù¤˜ ‰È·ÌÔÚÊÒıËÎ·Ó ·fi ÙËÓ Committee for Continuing Medical Education in Pediatrics Î·È ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÛÙÔ European Journal of Pediatrics (2).

ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÁÈ· ÙËÓ ·fiÎÙËÛË ÈÛÙÔÔÈËÙÈÎÔ‡ ™¶∂ ··ÈÙÔ‡ÓÙ·È 50 ÌfiÚÈ· (credits) ·Ó¿ ¤ÙÔ˜ ‹ 150 ÌfiÚÈ· ÁÈ· 3 ¯ÚfiÓÈ·. ™Â Î¿ıÂ Ì›· ÒÚ· ‰È‰·ÛÎ·Ï›·˜ ·ÓÙÈÛÙÔÈ¯Â› ¤Ó· ÌfiÚÈÔ. O ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÌÔÚ›ˆÓ ·Ó¿ ËÌ¤Ú· Ô˘ ÌÔÚÂ› Ó· ·Ó·ÁÓˆÚÈÛÙÂ›, ·Û¯¤Ùˆ˜ ÙˆÓ ˆÚÒÓ Ô˘ ‰È·ÚÎÂ› ÔÔÈ·‰‹ÔÙÂ ÂÈÛÙËÌÔÓÈÎ‹ ÂÎ‰‹ÏˆÛË (™˘Ó¤‰ÚÈÔ, ™ÂÌÈÓ¿ÚÈÔ, ∏ÌÂÚ›‰· Î.Ï.) Â›Ó·È 6. ∂›ÛË˜, ÔÈ ÂÈÛÙËÌÔÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙˆÓ ‰È·ÊfiÚˆÓ ·È‰È·ÙÚÈÎÒÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ ‰›ÓÔ˘Ó 1 ÌfiÚÈÔ ·Ó¿ ÒÚ· ‰È‰·ÛÎ·Ï›·˜ ÁÈ· ÙÔ˘˜ ¶·È‰È¿ÙÚÔ˘˜ ÙË˜ Û˘ÁÎÂÎÚÈÌ¤ÓË˜ ˘ÔÂÈ‰ÈÎfiÙËÙ·˜, ·ÏÏ¿ 0,5 ÌfiÚÈÔ ÁÈ·

ÔÈ ÔÚÁ·ÓˆÙ¤˜ ÙˆÓ ÂÁÎÂÎÚÈÌ¤ÓˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ Ó· ·Ó·ÁÚ¿ÊÔ˘Ó ÛÙ· ÈÛÙÔÔÈËÙÈÎ¿ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÙÔÓ ·ÚÈıÌﬁ ÌÔÚ›ˆÓ ™¶∂ Ô˘

1. ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·

18 ÌﬁÚÈ· ÙÔ ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎﬁ ™˘Ó¤‰ÚÈÔ

1 ÌﬁÚÈÔ ·Ó¿ ÒÚ· ÁÈ· ÔÔÈ·‰‹ÔÙÂ ¿ÏÏË ÂÎ‰‹ÏˆÛË ÙË˜ ∂¶∂

2. ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

Ë ÂÎ‰‹ÏˆÛË, ÙËÓ ÔÔ›· ÔÚÁ·ÓÒÓÔ˘Ó.

1 ÌﬁÚÈÔ ÙÔ ∂‚‰ÔÌ·‰È·›Ô ªÂÙÂÎ·È‰Â˘ÙÈÎﬁ ª¿ıËÌ·, Î¿ıÂ ∆Ú›ÙË

1 ÌﬁÚÈÔ Ë ∂‚‰ÔÌ·‰È·›· ¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡, Î¿ıÂ ¶¤ÌÙË

8 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

3. µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

1 ÌﬁÚÈÔ ÙÔ ∂‚‰ÔÌ·‰È·›Ô ªÂÙÂÎ·È‰Â˘ÙÈÎﬁ ª¿ıËÌ·, Î¿ıÂ ∆Ú›ÙË

8 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

4. ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜

4 ÌﬁÚÈ·

10. ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘

8 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

11. ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿ÎË˜

5 ÌﬁÚÈ· Ë ¢ÈÂÙ‹˜ ∂Î‰‹ÏˆÛË

12. ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·Ï›·˜

5 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

13. ¡ÂÔÁÓÔÏÔÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜

4 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

14. ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¡ÔÛËÏÂ˘ÙÈÎ‹

∞ıËÓÒÓ 4 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

15. ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·

8 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

2 ÌﬁÚÈ· Ë ªËÓÈ·›· ∂Î‰‹ÏˆÛË ºÚÔÓÙÈÛÙ‹ÚÈÔ

3 ÌﬁÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ

6 ÌfiÚÈ· ¡ÂÔÁÓÔÏfiÁÔÈ Î·È ∂ÓÙ·ÙÈÎÔÏfiÁÔÈ

16. ¶·ÁÎÚ‹ÙÈ· ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·

8 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

17. ∞ÈÌ·ÙÔÏÔÁÈÎ‹-OÁÎÔÏÔÁÈÎ‹

∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË: 8 ÌfiÚÈ· ¶·È‰Ô·ÈÌ·ÙÔÏfiÁÔÈ-OÁÎÔÏfiÁÔÈ

4 ÌﬁÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ

18. ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· ∂ÊË‚ÈÎ‹˜ π·ÙÚÈÎ‹˜

∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË:

8 ÌﬁÚÈ· ¶·È‰›·ÙÚÔÈ Ì¤ÏË ÙË˜ ∂Ù·ÈÚÂ›·˜ ∂ÊË‚ÈÎ‹˜

4 ÌﬁÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

19. ¶·È‰ÔÓÂ˘ÚÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË:

2 ÌﬁÚÈ· ¶·È‰ÔÓÂ˘ÚÔÏﬁÁÔÈ

1 ÌﬁÚÈÔ °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

20. µ’ ¶·ıÔÏÔÁÈÎﬁ˜ ∆ÔÌ¤·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

8 ÌﬁÚÈ· Ë ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË

21. ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË: 8 ÌﬁÚÈ· ¶·È‰›·ÙÚÔÈ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜, °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

22. ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ £ÂÚ·Â›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· ∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË: 8 ÌﬁÚÈ· ¶·È‰›·ÙÚÔÈ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜

4 ÌﬁÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

26. ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· ¶·È‰È·ÙÚÈÎ‹˜ Î·È ∂ÊË‚ÈÎ‹˜

∂Ù‹ÛÈ· ∂Î‰‹ÏˆÛË:

4 ÌfiÚÈ· ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏfiÁÔÈ 2 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ

¿ÏÏˆÓ ˘ÔÂÈ‰ÈÎÔÙ‹ÙˆÓ

27. ∂ÏÏËÓÈÎ‹ ¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁÈÎ‹ ∂Ù·ÈÚÂ›· ÛÂ Û˘ÓÂÚÁ·Û›·

ÌÂ ªÔÓ¿‰· ¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁ›·˜ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ

∏ÌÂÚ›‰· ·Ó¿ ‰ÈÂÙ›·: ¶ÚÒÙÔ˜ Î‡ÎÏÔ˜: 3 ÌﬁÚÈ· ÁÈ· ¶·È‰›·ÙÚÔ˘˜ Î·È ¶·È‰ÔÓÂ˘ÌÔÓÔÏﬁÁÔ˘˜

¢Â‡ÙÂÚÔ˜ Î‡ÎÏÔ˜: 3 ÌfiÚÈ· ÌfiÓÔ ÁÈ· ¶·È‰ÔÓÂ˘ÌÔÓÔÏfiÁÔ˘˜

28. ∂ÏÏËÓÈÎ‹ ∂Ù·ÈÚÂ›· §ÔÈÌÒÍÂˆÓ 4 ÌﬁÚÈ· ™ÂÌÈÓ¿ÚÈÔ

∏ ∂ÈÙÚÔ‹ ™˘ÓÂ¯È˙ﬁÌÂÓË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Î·›‰Â˘ÛË˜, ÛÂ Û˘ÓÂÚÁ·Û›· ÌÂ ÙËÓ ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·, ı· ‰ËÌÔÛÈÂ‡ÂÈ ÂÙËÛ›ˆ˜ ÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ ÂÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ™¶∂, ÒÛÙÂ Ó· Â›Ó·È ÚÔÛ·ÚÌÔÛÌ¤ÓÔ˜ ÛÙËÓ ÂÎ¿ÛÙÔÙÂ ÂÈÎÚ·ÙÔ‡Û·

∏ ¶ÚfiÂ‰ÚÔ˜ ÙË˜ ∂ÏÏËÓÈÎ‹Õ ¶ÚfiÂ‰ÚÔ˜ ÙË˜ ∂ÈÙÚÔ‹˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Ù·ÈÚÂ›·˜™˘ÓÂ¯È˙fiÌÂÓË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Î·›‰Â˘ÛË˜

∞ÈÎ·ÙÂÚ›ÓË ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘¡ÈÎﬁÏ·Ô˜ °. ªÂÚ¿ÙË˜

µÈ‚ÏÈÔÁÚ·Ê›·

1. ªÂÚ¿ÙË˜ ¡°, ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ŒÓ·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ™˘ÓÂ¯È˙fiÌÂÓË˜ ¶·È‰È·ÙÚÈÎ‹˜ ∂Î·›‰Â˘ÛË˜ ˘fi ÙËÓ ∂ÏÏËÓÈÎ‹ ¶·È‰È·ÙÚÈÎ‹ ∂Ù·ÈÚÂ›·. ¶·È‰È·ÙÚÈÎ‹ 1999;62:508-510.

2. D’ Apuzzo V, Helwig H, Siimes M. Charter on continuing medical education in paediatrics in the European Union. Eur J Pediatr 1998;157:192-193.

BÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

George Laskaris:

“Color Atlas of Oral Diseases in Children and Adolescents”, Thieme Verlag, 2000”

Atlas Colorido de Doencas Bucais da Infância e da Adolescência”, Santos & Artmed, 2001

“Patologias de la Cavidad Bucal en Ni¡os y Adolescentes”, Amolca, 2001

¢ÂÓ ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· ﬁÙÈ Ë ÂÚÈÔÚÈÛÌ¤ÓË ÁÂˆÁÚ·ÊÈÎ¿ ¯Ú‹ÛË ÙË˜ ÂÏÏËÓÈÎ‹˜ ÁÏÒÛÛ·˜ ·ÔÙÂÏÂ› ÙÚÔ¯Ô¤‰Ë ÛÙË ‰ÈÂıÓ‹ ÚÔ‚ÔÏ‹ Î·È ·ÎÙÈÓÔ‚ÔÏ›· ÙˆÓ ÂÈÙÂ˘ÁÌ¿ÙˆÓ ÙË˜ ÂÏÏËÓÈÎ‹˜ ÂÈÛÙ‹ÌË˜. ∞ÎﬁÌË Î·È ÔÈ ÌÂÙ·ÊÚ¿ÛÂÈ˜ ÂÏÏËÓÈÎÒÓ ÏÔÁÔÙÂ¯ÓÈÎÒÓ ‚È‚Ï›ˆÓ Ê·›ÓÔÓÙ·È Ó· ˘ÛÙÂÚÔ‡Ó ÙÔ˘ ÁÏˆÛÛÈÎÔ‡ Î·È ÏÔÁÔÏ·ÛÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· Î·È ÙË˜ È‰ÈÔÌÔÚÊ›·˜ Ô˘ Î¿ÓÂÈ ÙÔÓ Û˘ÁÁÚ·Ê¤· Ó· ÍÂ¯ˆÚ›˙ÂÈ ÛÙËÓ ∂ÏÏ¿‰·.

ÙÔ˘˜ Û‡Á¯ÚÔÓÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Ì·˜, ·ÚÎÂÙÔ› Â˘Ù‡¯ËÛ·Ó

ÂÎ‰ﬁÛÂÈ˜ ÙˆÓ ‚È‚Ï›ˆÓ ÙÔ˘˜

ÁÏÒÛÛÂ˜. ªÂ ı·˘Ì·ÛÌfi ı· ‰Ô‡ÌÂ ÛÙÔ ÂÍˆÙÂÚÈÎfi ÙÈ˜ ÌÂÙ·ÊÚ¿ÛÂÈ˜ ‚È‚Ï›ˆÓ Û˘ÁÁÚ·Ê¤ˆÓ fiˆ˜ Ô ¡. ∫·˙·ÓÙ˙¿ÎË˜, Ô °. ƒ›ÙÛÔ˜, Ô ™·Ì·Ú¿ÎË˜ ‹ ÔÈËÙÒÓ fiˆ˜ Ô ∫. ∫·‚¿ÊË˜, Ô ∫. ¶·Ï·Ì¿˜, Ô °. ™ÂÊ¤ÚË˜, Ô O. ∂Ï‡ÙË˜ Î.¿. ™Ù· Ú¿ÊÈ· ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂÎ‰fiÛÂˆÓ

§¿ÛÎ·ÚË, Ô˘ ·Ú¯ÈÎ¿ Î˘ÎÏÔÊfiÚËÛÂ ·fi ÙÔÓ ∂Î‰ÔÙÈÎfi O›ÎÔ Thieme Verlag ÙÔ 2000, ÌÂ Ù›ÙÏÔ “Color Atlas of Oral Diseases in Children and Adolescents”. ∂Ê¤ÙÔ˜ ÙÔ ‚È‚Ï›Ô ·˘Ùfi ÂÎ‰fiıËÎÂ ÛÙËÓ ¶ÔÚÙÔÁ·ÏÏÈÎ‹ (“Atlas Colorido de Doencas Bucais da Infância e da Adolescência”) Î·È ÙËÓ πÛ·ÓÈÎ‹ ÁÏÒÛÛ· “Patologias de la Cavidad Bucal en Ni¡os y Adolescentes” Î·È … ¤ÂÙ·È Û˘Ó¤¯ÂÈ·, ÏfiÁˆ ÙË˜ ˙ËÙ‹ÛÂÒ˜ ÙÔ˘. ∞Í›˙ÂÈ Ó· ÛËÌÂÈˆıÂ› fiÙÈ ¤Ó· ¿ÏÏÔ ‚È‚Ï›Ô ÙÔ˘ °. §¿ÛÎ·ÚË ÌÂ Ù›ÙÏÔ “™ÙÔÌ·ÙÔÏÔÁ›·” ¤¯ÂÈ ÂÎ‰ÔıÂ› ÛÂ Ù¤ÛÛÂÚÈ˜ ·ÎfiÌË ÁÏÒÛÛÂ˜. OÈ ÍÂÓfiÁÏˆÛÛÂ˜ ÂÎ‰fiÛÂÈ˜ ÙÔ˘ ‚È‚Ï›Ô˘

ÌÂÁ¿ÏË ÙÈÌ‹, ·Ó·ÁÓÒÚÈÛË Î·È Î·Ù·Í›ˆÛË Î·È ÚÔ‚¿ÏÏÔ˘Ó ÙËÓ ÂÏÏËÓÈÎ‹ È·ÙÚÈÎ‹ ÛÙÔ ‰ÈÂıÓ‹ ¯ÒÚÔ. £ÂÚÌ¿ Û˘Á¯·ÚËÙ‹ÚÈ· ·Í›˙Ô˘Ó ÛÙÔÓ Û˘ÁÁÚ·Ê¤· Î. °. §¿ÛÎ·ÚË ÁÈ· ÙÔ ÛËÌ·ÓÙÈÎﬁ

∂˘¯·ÚÈÛÙ›Â˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ ÙË˜ “¶·È‰È·ÙÚÈÎ‹˜”

∏ ¢ÈÂ‡ı˘ÓÛË Î·È Ù· Ì¤ÏË ÙË˜ ∂ÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜

Â˘¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈÎ‹” Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ Â›Ú· Î·È ÙÔ ¯ÚﬁÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈÎ¤˜, ÙÂÎÌËÚÈˆÌ¤ÓÂ˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈÎ¤˜ ·ÍÈÔÏÔÁ‹ÛÂÈ˜ ÁÈ· ÙÈ˜ ÂÈÛÙËÌÔÓÈÎ¤˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2001.

∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛÈÂ‡ıËÎ·Ó ÛÙÔÓ ÙﬁÌÔ 64 ÙÔ˘ ¤ÙÔ˘˜ 2001

∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º·Ó‹

∞˚‚¿˙Ë˜ µ›ÎÙˆÚ·˜

∞Ó‰Ú¤Ô˘ ∞Ï¤Í·Ó‰ÚÔ˜

∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹

∞Ó‰ÚÔ˘Ï·Î¿ÎË˜ ª·ÓÒÏË˜

∞ÓıÚ·ÎﬁÔ˘ÏÔ˜ ªÈ¯¿ÏË˜

∞ÓÙ‡·˜ ™‡ÚÔ˜

∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘ πˆ¿ÓÓ·

∞ÚÒÓË-µÔ˘ÚÓ¿ ™ÔÊ›·

µ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›·

µ·ÚÏ¿ÌË˜ °ÂÒÚÁÈÔ˜

µ¤ÎÈÔ˘-™·Ì·Ú¿ ∞ıËÓ¿

°·Ï·Ó¿ÎË˜ ∂ÌÌ·ÓÔ˘‹Ï

°ÈÔ˘ÚÔ‡ÎÔ˜ ™ˆÙ‹ÚÈÔ˜

°ÎÈÒÓË˜ ¢ËÌ‹ÙÚÈÔ˜

¢·‚¿ÎË˜ ªÈ¯·‹Ï

¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈÎ·˜ ∏Ú·ÎÏ‹˜

¢ËÌËÙÚ›Ô˘ πˆ¿ÓÓË˜

¢ÚﬁÛÔ˘-∞Á·Î›‰Ô˘ µ·ÛÈÏÈÎ‹

∑·ÊÂÈÚ›Ô˘ ¢ËÌ‹ÙÚÈÔ˜

∑ÂÚ‚ﬁ˜ °ÂÚ¿ÛÈÌÔ˜

£·ÓﬁÔ˘ÏÔ˜ µ·Û›ÏÂÈÔ˜

£ˆÌ·˝‰Ô˘ ¢¿ÊÓË-§ˆÚ¤Ù·

πÔÚ‰·Ó›‰Ô˘ ∞ÓÙÈÁﬁÓË

∫·‚·ÏÈÒÙË˜ πˆ¿ÓÓË˜

∫·Ó·ÎÔ‡‰Ë-∆Û·Î·Ï›‰Ô˘ ºÏˆÚÂÓÙ›·

∫·Ú·Ó›Î·˜ ∏Ï›·˜

∫·Ú‹˜ ÃÚ›ÛÙÔ˜

∫·ÙÛ·Ú‰‹˜ Ã·Ú¿Ï·ÌÔ˜

∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›·

∫·ÙÙ¿ÌË˜ ∞ÓÙÒÓÈÔ˜

∫ÂÚ·Ì›‰·˜ ¢ËÌ‹ÙÚÈÔ˜

∫Ô‚¿ÓË˜ ∞ı·Ó¿ÛÈÔ˜

∫ÔÓÙﬁÔ˘ÏÔ˜ ∂ÏÂ˘ı¤ÚÈÔ˜

∫ﬁÚÎ·˜ ∞Ó·ÛÙ¿ÛÈÔ˜

∫ÔÛÌ›‰Ë-µ·ÛÈÏ¿ÙÔ˘ ∂Ï¤ÓË

∫Ô˘ÙÛÔ˘ÏÈ¤ÚË˜ ∏Ï›·˜

∫ÚÂÌÂÓﬁÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜

∫ˆÓÛÙ·ÓÙﬁÔ˘ÏÔ˜ ∞Ó‰Ú¤·˜

∫ÒÛÙ·ÏÔ˜ ÃÚ‹ÛÙÔ˜

∫ˆÛÙÔÔ‡ÏÔ˘-º·ÚÚ‹ ∂˘·ÁÁÂÏ›·

§·Áﬁ˜ ¶·Ó·ÁÈÒÙË˜

§·Ì·‰·Ú›‰Ë˜ πˆ¿ÓÓË˜

ª·Ï·Ì›ÙÛË-¶Ô‡¯ÓÂÚ ∞ÚÈ¿‰ÓË

ª¿Ó‰˘Ï·-™Ê¿ÁÁÔ˘ ∂Ï¤ÓË

ª·ÓÈ¿ÙË ÃÚÈÛÙ›‰Ë ª·Ú›·

ª·ÓÙ·Áﬁ˜ ™Ù¤Ê·ÓÔ˜

ª·ÓÙ˙Ô˘Ú¿ÓË ∂˘·ÁÁÂÏ›·

ª·ÚÁÂÙ¿ÎË˜

ªÈ¯·Ï¿ÎÔ˜ ™Ù¤Ê·ÓÔ˜

¡·Ó¿˜ ÃÚ‹ÛÙÔ˜

¡ÈÎÔÏ·˝‰Ô˘ ¶ÔÏ˘Í¤ÓË ¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË

¡Ù·Ú›ÏÏË˜ ∂˘Á¤ÓÈÔ˜-∂ÌÌ·ÓÔ˘‹Ï •¿ÓıÔ˘ ª·ÚÈ¤ÙÙ·

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∞‚Ú·Ì›‰Ô˘ ∫.76

∞ÁÁÂÏ¿ÎÔ˘ µ.460

∞ÁÁÂÏﬁÔ˘ÏÔ˜ ™.493

∞ÁÁÔ˘ÚÈ‰¿ÎË Ã.481

∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º.72,136

∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª.76,504

∞ÏÂÍﬁÔ˘ÏÔ˜ ∂.49

∞ÏÌ·Ó›‰Ë˜ £.493

∞Ó‰Ú¤Ô˘ ∞.573,589

∞Ó‰ÚÔ˘Ï·Î¿ÎË˜ º.∞.395

∞ÓıÚ·ÎﬁÔ˘ÏÔ˜ ª.351

∞ÓÙˆÓÈ¿‰Ë˜ ∞.72

∞ÛÎÔ‡ÓË-™ÙÚÔ‡ÌÔ˘ ∞.¢.410

µ·Ï¿ÚË ª.223

µ·ÚÏ¿ÌË˜ °.™.115,481

µÏ·˙¿ÎË˜ ™.93

µÏ¿¯Ô˘ £.172

µÔÏÔÓ¿ÎË˜ ª.∫.330

µÔÏÔ˘‰¿ÎË ∞.615

µÔ˘ÁÈÔ‡Î· Ÿ.233

°·‚Ú›ÏË ™.55

°·ÏÏ‹-∆ÛÈÓÔÔ‡ÏÔ˘ ∞.65

°ÂÚÌÂÓ‹˜ ∞.81

°ÂˆÚÁ¿ÎË-∞ÁÁÂÏ¿ÎË ∂.¡.247,472

°ÂˆÚÁÈ¿‰Ë˜ ∏.624

°ÂˆÚÁÈ¿‰Ô˘ ∂.59

°È·ÏÔ‡ÚÔ˜ ¶.551

°È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã.145,168,319,615

°ÈÔ˘ÚÔ‡ÎÔ˜ ™.391

°Î·Ì›ÏË˜ ¡.87

°ÎÈÒÓË˜ ¢.583

°ÔÌ¿ÎË˜ ¡.76,504

°Ô˘‰ÂÛ›‰Ô˘ ª.573,589

°Ô˘ÚÁÈÒÙË˜ ¢.465

°Ô˘Û¤ÙË˜ ∂.202

°Ú·Ê¿ÎÔ˜ ™.276

¢ÂÏËÁÂÒÚÔÁÏÔ˘ ∂.400

¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈÎ·˜ ∏.163

¢Ô˘ÏÁÂÚ¿ÎË Õ.527

ª.59,336,481 ∑

∑¿‚Ú·˜ ¡.472

∑·ÌÔ‡ÏË ¢.76

∑¿¯Ô˘ £.300

∑ÂÚ‚Ô˘‰¿ÎË ∞.448,604

∑ÒÛË ¶.172,514,610

∏ÏÈ¿‰Ë˜ ∞.583

∞.14

∑.177

Ã.188

ª.81

§.365

¡.163

π.604

ª.81

∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞.188

∫·Ï·Ì·Ï›ÎË˜ ¶.472,499,547,565

∫·Ï¤ÁÈ·˜ π.163

∫¿ÏÏÈÔ˘ µ.132

∫·ÏÌ·ÓÙ‹ ª.136,280

∫·Ì¿˜ ¡.132

∫·Ó·Î¿-Gantenbein Ã.406

∫·Ó¿ÚË˜ §.172,610

∫·Ó¿ÚÈÔ˘ ª.°.229

∫·ÓÈ¿ÚË˜ °.514

∫·ﬁÁÈ·ÓÓË˜ ∞.472

∫·Ú·‚¿Ó· °.493

∫·Ú·‚·Ó¿ÎË-∫·Ú·Ó¿ÛÈÔ˘ ∫.518

∫·Ú·Î·˚‰ﬁ˜ ¢.172,514,610,624

∫·Ú·ÎﬁÏË Õ.26

∫·Ú·Ì¤ÚË˜ ™.481

∫·Ú·Ù˙¿-•ÈÊÏ›‰Ô˘ ∂.508

∫·Ú·Ê¤˙Ë ª.514

∫·Ú‹˜ Ã.172,514,610,624

∫·Ú›Î·˜ °.∞.55,154,488

∫·Ú¿ıÈÔ˜ £.136,551

∫·ÙÛ·Ú‰‹˜ Ã.µ.342

∫·ÙÙ¿ÌË˜ ∞.202

∫ÂÚ·Ì›‰·˜ ¢.159,312,607

∫›ÙÚ· µ.34

∫Ô˚‰Ô‡-∆ÛÈÏÈÁÈ¿ÓÓË ∞.315

∫ﬁÎÎÔÚË ∂.93

∫ÔÏÈÔ‡ÛÎ·˜ ¢.136

∫ÔÏÏÈﬁ˜ ∫.¢.241

∫ÔÚ·Î¿ÎË ∂.145,168,615

∫ÔÛÌ›‰Ë ∂.136

∫ÔÙÚﬁÙÛÔ˘ ª.607

∫Ô˘ÎÔ˘ÙÛ¿ÎË˜ ¶.465

∫Ô˘Ú¿ÎË˜ °.163

∫Ô˘Ú›‰Ë˜ °.595

∫Ô˘Ú›‰Ë˜ Ã.595

∫Ô‡ÛË ∞.504

∫Ô˘Û›‰Ë˜ °.607

∫Ô‡ÛÎÔ˘Ú·˜ ∫.72

∫Ú·ÛÔ˘‰¿ÎË˜ ∞.93

∫Ú›ÎÔ˜ •.177

∫ˆÛÙ·‰‹Ì· ∂.49

∫ÒÛÙ·ÏÔ˜ Ã.208,618

µ.∞.285

¢.460

§ÂÈ‚·‰›ÙË ∂.607

§ÂˆÓ›‰·˜ π.197

ª·ÁÎÏ·‚¤Ú·˜ ¡.59

ª·ÌÔ˘Ï¿ÎË˜ ¢.145

ª·ÓÔ˘Ú¿ ∞.145,168,615

ª·ÚÁ¿ÚË ∫.ª.145

ª·˘Ú›‰Ë˜ °.573,589

ª·˘ÚÔÌ¿ÙË ∞.565

ªÂÁ·ÏÔÁÈ¿ÓÓË ∂.163

ªÂÓÙ‹˜ ∞.136

ªËÙÛ¿ÎË ª.615

ªÔÛÙÚÔ‡ °.81

ªÔ‡Î·˜ ª.154

ªÔ˘ÛÙ¿ÎË ª.551

ªÔ˘Ù¿ÊË ∞.514,610

ª·Ï¿ÛÎ· ∞.573,589

ª·ÏÙÔÁÈ¿ÓÓË˜ ¡.159,607

ªÂ¯Ú¿ÎË˜ ¶.154

ªÚÈ·ÛÔ‡ÏË˜ °.181,472,499,565

¡·ÚÏ›ÔÁÏÔ˘ ª.181,499

¡›Î·˜ π.177

¡ÈÎÔÏ·˝‰Ô˘ ¶.177

¡ÈÎÔÏ¿Ô˘-¶··Ó·ÁÈÒÙÔ˘ ∞.376

¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË ™.65,290

¡Ù·Ï·Ì¿ÁÎ· ª.136

¡ÙÔ˘ÓÙÔ˘Ó¿ÎË˜ ™.308

ª.65 •˘ÓÈ¿˜ π.508 O

OÈÎÔÓﬁÌÔ˘ ª.504

O˘Ú·Ó‹ ∂.583

¶¿ÁÎ·ÏË ∞.565

¶·Ó·ÁÈˆÙÔÔ‡ÏÔ˘-°·ÚÙ·Á¿ÓË ¶.355

¶·Ó·ÁÈÒÙÔ˘ π.¶.39,136

¶·Ó·ÁÈÒÙÔ˘-∞ÁÁÂÏ·ÎÔÔ‡ÏÔ˘ π.4

¶·ÓÙ·˙‹ Õ.493

¶·ÓÙÂÏÈ¿‰Ë˜ Ã.¶.508

¶·ÓÙÛÈÒÙÔ˘ ∫.101

¶··‚·ÛÈÏÂ›Ô˘ ∂.132

¶··ÁÈ¿ÓÓË˜ π.424

¶··ÁÈ·ÓÓÔ‡ÏË-§·ÛÎ·Ú›‰Ë §.304

¶··‰¿ÙÔ˜ π.583 ¶··‰ﬁÔ˘ÏÔ˜ °.™.420

¶·¿˙ÔÁÏÔ˘ ∫.268

¶··ÎˆÓÛÙ·ÓÙ›ÓÔ˘-Ã·˚‰ÂÌ¤ÓÔ˘ ª.557

¶··Ì·ÛÙÔÚ¿ÎË π.168

¶··Ó‰Ú¤Ô˘ ∂.159,607

¶··ÛÙ·‡ÚÔ˘-ª·˘ÚÔ˘‰‹ £.215

¶·Ô‡ÏË ª.573,589

¶·ÙÛÔ‡Ú· ∞.565

¶ÂÙÚ›‰Ô˘ ∂.136

¶ÂÙÚﬁÔ˘ÏÔ˜ ¢.45

¶Ï·ÙÔÎÔ‡ÎË-∫ÔÌÈÙÔÔ‡ÏÔ˘ ∂.30

¶Ô˘ÚÙÛ›‰Ë˜ ∞.535

¶Ú›ÊÙË˜ ∫.¡.211

¶ÚˆÙ·ÁﬁÚ·-§È·ÓÔ‡ ¡.125

ƒ¿ÌÌÔ˜ ™.163

ƒÂÁÎÔ‡Ù·˜ ™.488

ƒÔËÏ›‰Ë˜ ∂.272

ƒÔ˘ÌÈ¤˜ ¡.65

ƒÒÛÛÈÔ˘ ∞.573,589

™¿‚‚· ™.595

™·ÎÂÏÏ¿ÚË˜ °.93

™ÂÌÂÚÙ˙¿ÎË˜ ¢.615

™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞.237

™È·Ê¿Î·˜ ∫.4

™È‰ÂÚ¿ ª.85

™ÈÓ·ÓÈÒÙË˜ ∫.465

™Î·ÏÎ›‰Ô˘ Õ.136

¶·È‰È·ÙÚÈÎ‹

™ÎÂÓÙ¤ÚË˜ ¡.49,430

™Ì˘ÚÓ¿ÎË ¶.168

™Ô‡ÎÈ·˜ ¡.49

™Ô‡ÏË ∫.∂.55,154,488,527

™˘Ú›‰Ë˜ ¶.465

™‡ÚÔÁÏÔ˘ ∫.293

™˘ÚÔÔ‡ÏÔ˘ ª.¡.441

™Ù·ÌÔ‡ÏË˜ ¶.59

™Ù¿ÌÔ˘-∆ÛÈ·Ú¿˙Ë ª.72

™Ù·˘ÚÈÓ¿‰Ë˜ Ã.465

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∆

∆ÂÓÙ˙›‰Ô˘ ∫.65

∆˙·ÌÔ˘Ú¿ÓË π.488

∆˙›Ì·-∆Û›ÙÛÈÎ· ∂.370

∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘ º.136

∆ÔÚÓ·Ú›ÙË˜ ª.595

∆Ú·ÁÈ·ÓÓ›‰Ë˜ £.493

∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜ °.172,610

∆Ú›ÁÎ· ª.219

∆ÚÈ¯ﬁÔ˘ÏÔ˜ ¢.136

∆Û·‚‰·Ú›‰Ô˘ µ.481

∆Û·Î›ÚË˜ ™.154,488,527

∆Û·Ó¿Î·˜ π.¡.361

∆Û¿ÓÙ·ÏË Ã.76,504

∆Û¤Ë˜ ¡.59

∆Û›ÎÔ˘Ï·˜ π.384

∆ÛÈÏÈÁÈ¿ÓÓË˜ £.1,347

∆ÛÈÏÈÁÎÈÚﬁÁÏÔ˘-º·¯·ÓÙ›‰Ô˘ Õ.436

∆ÛÈÏÈÌÈÁÎ¿ÎË-ÃÚËÛÙ¿ÎË ∞.417

∆ÛﬁÏ·˜ °.87,465

∆ÛÔ˘Î·Ï¿ ™.465

∆ÛÔ˘Ì¿Î·˜ ∫.261,448,604

ºÂÛÛ¿ÙÔ˘ ™.583

ºÏ¿ÚË˜ ¡.508

Ã·˚‰¿˜ ™.49

Ã·˚‰ÂÌ¤ÓÔ˜ °.557

Ã·˚‰ÔÔ‡ÏÔ˘ ∫.72,481

Ã·Ú›ÛË µ.159

Ã·Ú›ÛË˜ °.93

Ã·ÚˆÓ›ÙË π.460

Ã·Ù˙Ë·ı·Ó·Û›Ô˘ Ã.188

Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã.595

Ã·Ù˙Ë‰¿ÎË ∂.145,168,319,615

Ã·Ù˙ËÎˆÓÛÙ·ÓÙ›ÓÔ˘ ¡.493

∞.85 Ã·Ù˙Ë·ÓÙÂÏ‹˜ ∂.76 Ã·Ù˙‹˜ ∞.181,472,499,565 Ã·Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª.481 ÃÈˆÙ›ÓË˜ Ã.159 ÃÔÏ¤‚·˜ ¢.465 ÃÚÈÛÙÔ‰Ô˘Ï¿ÎË ª.145 ÃÚ˘Û¿ÎË ∞.565 ÃÚ˘Û·ÓıﬁÔ˘ÏÔ˜ Ã.59 æ æ‡¯Ô˘ º.177

C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË481 DDAVP14

Growth factors1

Lp (·)55

Lung development1

∞

∞ÁÁÂÈ·Î¿ ÂÁÎÂÊ·ÏÈÎ¿ ÂÂÈÛﬁ‰È·583

∞ÁÎ˘ÏÔÔÈËÙÈÎ‹ ÛÔÓ‰˘Ï›ÙÈ‰·233

∞‰ÂÍÈﬁÙËÙ· 391

∞ıÏËÙÈÛÌﬁ˜ 430

∞ÈÌ·ÙÔ˘Ú›· 255

∞ÈÌÔ‰È‹ıËÛË472

∞ÈÌÔÎ¿ı·ÚÛË472

∞›ÙÈ· ·ÔÙ˘¯›·˜ 347

∞›ÙÈ· ı·Ó¿ÙÔ˘589

∞ÈÙÈÔÏÔÁ›· 136

∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜424

∞ÏÎ·ÏÈÎ‹ ÊˆÛÊ·Ù¿ÛË87,163

∞ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰Ô˜219

∞ÏÏÂÚÁÈÎﬁ ¿ÛıÌ·330

∞ÏÏÔÁÂÓ‹˜ ÌÂÙ·ÌﬁÛ¯Â˘ÛË

Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ45

∞ÌÈÁ‹˜ ·Ï·Û›· ÙË˜ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜34

∞Ó·ÈÌ›· Diamond-Blackfan45

∞Ó·ÈÌ›· Fanconi45

∞Ó··Ú·ÁˆÁ‹ 400

∞Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·159

∞Ó·ÔÙÂÏÂÛÌ·ÙÈÎ‹ ıÚÔÌ‚ÔÔ›ËÛË30

∞Ó¿Ù˘ÍË527

∞Ó¿Ù˘ÍË ÏﬁÁÔ˘370

∞Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ 365

∞Ó·Ù˘ÍÈ·Î¤˜ ‰È·Ù·Ú·¯¤˜365

∞Ó·Ù˘ÍÈ·Î‹ ‰È·ÁÓˆÛÙÈÎ‹ 376

∞Ó·Ê˘Ï·Í›· 215

∞ÓÂ˘Ú‡ÛÌ·Ù· ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ420

∞ÓËÛ˘¯ËÙÈÎ¿ ÛËÌÂ›· ·Ó¿Ù˘ÍË˜ ÏﬁÁÔ˘370

∞ÓıÂÎÙÈÎﬁ ÛÙË ıÂÚ·Â›· ¿ÛıÌ·336

∞ÓÔÛÔÎ·Ù·ÛÙÔÏ‹ 39,272

∞ÓÔÛÔÏÔÁÈÎ‹ ·ﬁÎÚÈÛË237

∞ÓÙÈ‚ÈÔÙÈÎ¿ 223

∞ÓÙÈ‚›ˆÛË547

∞ÓÙÈÂÈÏËÙÈÎ¿ Ê¿ÚÌ·Î·460

∞ÓÙÈı˘ÚÂÔÂÈ‰ÈÎ¿ ·ÓÙÈÛÒÌ·Ù·188

∞ÓÙÈÌÂÙÒÈÛË 93,215,268,436

∞ÓÙÈÙÂÙ·ÓÈÎﬁ˜ ÂÌ‚ÔÏÈ·ÛÌﬁ˜610

∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·177

∞¤ÎÎÚÈÛË ·Û‚ÂÛÙ›Ô˘465

∞Ï·Û›· 30

∞Ï·ÛÙÈÎ‹ ·Ó·ÈÌ›·39,45

ÕÓÔÈ·551

∞ÒÏÂÈ· ·ÎÔ‹˜370 ∞ÚıÚ›ÙÈ‰· ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÂÓÙ¤ÚÔ˘ 233 ∞ÚÙËÚÈ·Î‹ ›ÂÛË448 ÕÛıÌ· 330,336

∞Û˘ÌÙˆÌ·ÙÈÎfi ÓÂÔÁÓfi168 ·-ÙÔÎÔÊÂÚfiÏË 154

261,624

ÔÚÌﬁÓË 406 ∞˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜527

µ·ÏÚÔ˚Îﬁ ÔÍ‡488

µ·Ú‡ ¿ÛıÌ·336

µÈÔÙÈÓÈ‰¿ÛË488

∂65

154

µÏ¿‚Â˜ ·ﬁ ·Ù˘¯‹Ì·Ù·410

µÚÂÊÈÎ‹ ËÏÈÎ›·504

µÚ¤ÊÔ˜ 351,618

µÚÔÁ¯ÈÎﬁ ¿ÛıÌ·330

µÚÔÁ¯ÈÔÏ›ÙÈ‰· 351

°ÂÓÓËÙÈÎﬁ Û‡ÛÙËÌ·400

°ÈÁ·ÓÙÈ·›· ·ÈÌÔÂÙ¿ÏÈ·76

IgA ÓﬁÛÔ˜557

‰È·ÌﬁÏ˘ÓÛË˜132

Mantoux132

ÂÓ‰ÔÛÎﬁËÛË290

¢È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤ÁÁÈÛË115

¢È·Èı˘ÏÈÎ‹ ÙÔÏÔ˘·Ì›‰Ë 181

¢È·ÈÙËÙÈÎ¿ ÂÏÏÂ›ÌÌ·Ù·237

¢È·Ï˘ÙÔ› ˘Ô‰Ô¯Â›˜ ÙË˜ ÈÓÙÂÚÏÂ˘Î›ÓË˜ 2481

¢È·ÛÙ·˘ÚÔ‡ÌÂÓË ÓÂÊÚÈÎ‹ ÂÎÙÔ›·514

¢È·Ù·Ú·¯¤˜ ·Ó¿Ù˘ÍË˜406

¢È·Ù·Ú·¯¤˜ ÏﬁÁÔ˘370

¢È·Ù·Ú·¯¤˜ Ì¿ıËÛË˜ 387

¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘551

¢ÔÎÈÌ·Û›· ÚﬁÎÏËÛË˜

ÌÂ Á¿Ï· ·ÁÂÏ¿‰Ô˜219

¢‡ÛÎÔÏÔ ¿ÛıÌ·336

¢˘ÛÏÂÍ›· 387,391

∂

ŒÁÎ·˘Ì·499

∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚﬁ85

∂ÁÎÏËÌ·ÙÈÎﬁÙËÙ·410

∂È‰ÈÎ‹ IgE ÁÈ· ÚˆÙÂ˝ÓÂ˜ ÙÔ˘

Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰Ô˜ 219

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™‡Ó‰ÚÔÌÔ ·Ó·ÓÂ˘ÛÙÈÎ‹˜ ‰˘Û¯¤ÚÂÈ·˜145

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3-4

¡ÔÂÌ‚Ú›Ô˘ 2001 ªÂÙÂÎ·È‰Â˘ÙÈÎﬁ ™ÂÌÈÓ¿ÚÈÔ

10 ¡ÔÂÌ‚Ú›Ô˘ 20016Ô

∆ËÏ.: 7467 303-6 & 7792 200 Fax: 7792 200

Î·È

22-25 ¡ÔÂÌ‚Ú›Ô˘ 2001 7th Mediterranean Epilepsy Conference∞ı‹Ó· ¶ÏËÚÔÊÔÚ›Â˜: C&C International S.A. (Î. ¡. ∆Û¿ÎˆÓ·˜)

∆ËÏ.: 68.89.217 Fax: 68.44.777

“Holiday Inn”

23-24 ¡ÔÂÌ‚Ú›Ô˘ 2001

2nd European Conference Kent, United Kingdom on Pediatric Asthma

Information: Castle House Med. Conf. 3 Linden Clase

Tunbridge Wells, Kent TN 48 HH, UK

∆ËÏ.: (44) 1892-539606

Fax: (44) 1892-517773

E-mail: asthma@castlehouse.co.uk 15

(01) 4123 552 Fax: (01) 4128 535

9-10 ºÂ‚ÚÔ˘·Ú›Ô˘ 2002 3Ë ¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁÈÎ‹

ÙÔ˘ ·Ó·ÓÂ˘ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜”

¶ÏËÚÔÊÔÚ›Â˜: ª. ∞ÓıÚ·ÎﬁÔ˘ÏÔ˜-TYPORAMA

∆ËÏ.: (061) 999 544, 999 612

Fax: (061) 994 533

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

AIDS

AMP, ADP, ATP

ATPase cal

CSF ‹ ENY

CNS ‹ ∫¡™ cm

CoA

cmÑ

cm2

cAMP

ÆC

CRP

DNA

ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA

ESR ‹ ∆∫∂ EDTA

g Hct

HLA

Ig ICU ‹ ª∂£

i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol

ªW ‹ MB

MCH

MCV

mRNA m min

n N

NS ‹ ª™

Ôsm

% PCR

PCO2

PO2 p

ABBREVIATIONS

EÏÏËÓÈÎÔ› ﬁÚÔÈ

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜

ıÂÚÌ›‰·

ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚﬁ

ÎÂÓÙÚÈÎﬁ ÓÂ˘ÚÈÎﬁ Û‡ÛÙËÌ·

ÂÎ·ÙÔÛÙﬁ

Û˘Ó¤Ó˙˘ÌÔ ∞

Î˘‚ÈÎﬁ ÂÎ·ÙÔÛÙﬁ

ÙÂÙÚ·ÁˆÓÈÎﬁ ÂÎ·ÙÔÛÙﬁ

Î˘ÎÏÈÎﬁ AMP

‚·ıÌﬁ˜ KÂÏÛ›Ô˘

C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË

‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎﬁ ÔÍ‡

ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·

ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·

¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚﬁÊËÛË˜

ÚÔÛ‰ÈÔÚÈÛÌﬁ˜

Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓ

Âı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îﬁ ÔÍ‡

ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁﬁÓÔ ÈÛÙÔÛ˘Ì‚·ÙﬁÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓË

ÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜

‰ÈÂıÓ‹˜ ÌÔÓ¿‰·

ÂÓ‰ÔÌ˘˚Î¿ ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ ÂÓ‰ÔÊÏ¤‚È·

Ï›ÙÚÔ(·)

ÏÔÁ¿ÚÈıÌÔ˜

ÁÚ·ÌÌÔÌﬁÚÈÔ

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