Page 1

ISSN 0377-2551

¶AI¢IATPIKH

TOMO™ 64

TEYXO™ 6

ETO™ 2001

NԤ̂ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2001 . ∆fiÌÔ˜ 64 . ∆‡¯Ô˜ 6

∞ƒ£ƒO ™À¡∆∞•∏™ ∞Ú¯È΋ ÂÌÂÈÚÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÓÔÛÔÎÔÌÂȷ΋˜ Ó¢ÌÔÓ›·˜

EDITORIAL 547

¶. ∫·Ï·Ì·Ï›Î˘

P. Kalabalikis

∞¡∞™∫O¶∏™∂π™ ∂Ӊ›ÍÂȘ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ÌÂϤÙ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿

REVIEW ARTICLES 551

ª. ªÔ˘ÛÙ¿ÎË, ¶. °È¿ÏÔ˘ÚÔ˜, £. ∫·Ú¿ıÈÔ˜

∞˘ÙÔ¿ÓÔÛ˜ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ‰ÂÚÌ·ÙÔ¿ıÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜

557

ORIGINAL ARTICLES 565

¶. ∫·Ï·Ì·Ï›Î˘, ∞. ¶·ÙÛÔ‡Ú·, ∞. ª·˘ÚÔÌ¿ÙË, °. ªÚÈ·ÛÔ‡Ï˘, ∞. ÃÚ˘Û¿ÎË, ∞. ¶¿ÁηÏË, ∞. ÷Ù˙‹˜ 573

583

Spontaneous intracerebral hemorrhage in children S. Fessatou, D. Gionis, E. Ourani, A. Heliadis, I. Papadatos

589

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

™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿

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

™. ºÂÛÛ¿ÙÔ˘, ¢. °ÎÈÒÓ˘, ∂. O˘Ú·Ó‹, ∞. ∏ÏÈ¿‰Ë˜, π. ¶··‰¿ÙÔ˜

∞›ÙÈ· ı·Ó¿ÙÔ˘ Û ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ÙË 14ÂÙ›· 1986-1999

Nosocomial infections in a Paediatric Intensive Care Unit P. Kalabalikis, A. Patsoura, A. Mavromati, G. Briassoulis, A. Hrisaki, A. Pagali, A. Hatzis

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

∞˘ÙfiÌ·Ù˜ ÂÁÎÂÊ·ÏÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ ÛÙ· ·È‰È¿

Autoimmune bullous diseases of childhood M. Papakonstantinou-Chaidemenou, G. Chaidemenos

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

£ÓËÛÈÌfiÙËÙ· ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ÙË 14ÂÙ›· 1986-1999

Polygraphic sleep studies in children M. Moustaki, P. Gialouros, T. Karpathios

ª. ¶··ÎˆÓÛÙ·ÓÙ›ÓÔ˘-÷˚‰Â̤ÓÔ˘, °. ÷˚‰Â̤ÓÔ˜

¡ÔÛÔÎÔÌÂȷΤ˜ ÏÔÈÌÒÍÂȘ Û ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¶·È‰ÈÒÓ

Initial empirical treatment of nosocomial pneumonia

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

595

The relationship of television viewing to cardiovascular risk factors in children

°. ∫Ô˘Ú›‰Ë˜, ª. ∆ÔÚÓ·Ú›Ù˘, Ã. ∫Ô˘Ú›‰Ë˜, ™. ™¿‚‚·, Ã. ÷Ù˙ËÁˆÚÁ›Ô˘

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

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

Continuation of table of contents inside title page

November - December 2001 . Volume 64 . No 6


¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2001 . ∆fiÌÔ˜ 64 . ∆‡¯Ô˜ 6

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

CASE REPORTS

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ¡fiÛÔ˜ Scheuermann ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

604

K. Tsoumakas, A. Zervoudaki, I. Ignatiadis

∫. ∆ÛÔ˘Ì¿Î·˜, ∞. ∑ÂÚ‚Ô˘‰¿ÎË, π. πÁÓ·ÙÈ¿‰Ë˜

§··ÚÔÛÎÔÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â˘ÌÂÁ¤ıÔ˘˜ Û˘ÛÙÚ·Ê›۷˜ ·Ú·Û·ÏÈÁÁÈ΋˜ ·ÛÙ˘

607

610

615

GENERAL ISSUES

°∂¡π∫∞ £∂ª∞∆∞ 618

624

Accidents in childhood D. Karakaidos, H. Georgiadis, C. Karis

¢. ∫·Ú·Î·˚‰fi˜, ∏. °ÂˆÚÁÈ¿‰Ë˜, Ã. ∫·Ú‹˜

O ¿Óıڷη˜ ˆ˜ ‚ÈÔÏÔÁÈÎfi fiÏÔ

Early perinatal hospital discharge: the pros and cons C. Costalos

Ã. ∫ÒÛÙ·ÏÔ˜

∞Ù˘¯‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ·

¡eonate with sirenomelia. Case report E. Korakaki, E. Hatzidaki, A. Manoura, M. Mitsaki, D. Semertzakis, A. Voloudaki, C. Giannakopoulou

∂. ∫ÔڷοÎË, ∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ª. ªËÙÛ¿ÎË, ¢. ™ÂÌÂÚÙ˙¿Î˘1, ∞. µÔÏÔ˘‰¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

¶ÚÒÈÌË ¤ÍÔ‰Ô˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ: Ù· ˘¤Ú Î·È Ù· ηٿ

Generalized tetanus in a greek child in the year 2000 D. Karakaidos, G. Triantafillidis, A. Moutafi, L. Kanaris, P. Zosi, C. Karis

¢. ∫·Ú·Î·˚‰fi˜, °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, ∞. ªÔ˘Ù¿ÊË, §. ∫·Ó¿Ú˘, ¶. ∑ÒÛË, Ã. ∫·Ú‹˜

¡ÂÔÁÓfi Ì ÛÂÈÚËÓÔÌÂÏ›·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

Laparoscopic management of a large adnexal cyst under torsion E. Papandreou, M. Kotrotsou, N. Baltogiannis, G. Kousidis, E. Livaditi, D. Keramidas

∂. ¶··Ó‰Ú¤Ô˘, ª. ∫ÔÙÚfiÙÛÔ˘, ¡. ª·ÏÙÔÁÈ¿ÓÓ˘, °. ∫Ô˘Û›‰Ë˜, ∂. §ÂÈ‚·‰›ÙË, ¢. ∫ÂÚ·Ì›‰·˜

°ÂÓÈÎÂ˘Ì¤ÓÔ˜ ٤ٷÓÔ˜ Û ·È‰› ÛÙËÓ ∂ÏÏ¿‰· ÙÔ ¤ÙÔ˜ 2000

Scheuermann's disease in childhood. Case report

630

Anthrax as a biological weapon

Center of Disease Control Consensus Statement

Center of Disease Control Consensus Statement

™˘Ó¯›˙ÔÓÙ·È

Continued

November - December 2001 . Volume 64 . No 6


¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2001 . ∆fiÌÔ˜ 64 . ∆‡¯Ô˜ 6

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

633

PAEDIATRIC NEWS

µÈ‚ÏÈÔ·ÚÔ˘Û›·ÛË

636

Book Review

∫ÚÈÙ¤˜ ÙÔ˘ ∆fiÌÔ˘ 64

637

Reviewers of manuscripts, Volume 64

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 64

638

Author Index, Volume 64

§¤ÍÂȘ ÎÏÂȉȿ ÙÔ˘ ∆fiÌÔ˘ 64

641

Subject Index, Volume 64

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞ ¶ÚÒÈÌÔÈ ‰Â›ÎÙ˜ ‚Ï¿‚˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Û ÚfiˆÚ· ÓÂÔÁÓ¿ ¿Û¯ÔÓÙ· ·fi ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË

LITERATURE ABSTRACTS 550

Fotopoulos S, Pavlou K, Skouteli H, Papassotiriou I, Xanthou M ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™. ºˆÙfiÔ˘ÏÔ˜

∞Ó›¯Ó¢ÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÊÈÛÙÈÎÈÔ‡ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·

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

594

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

Detection of peanut allergens in breast milk of lactating women Vadas P, Wai Y, Burks W, Perelman B Greek translation: G. I. Kafritsa

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xiii

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xvii

Abbreviations

November - December 2001 . Volume 64 . No 6


¡Ô¤Ì‚ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2001

. ∆fiÌÔ˜

64

. ∆‡¯Ô˜

6

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

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

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

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

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

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

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

Scientific President Editor Members

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘

Manuscript Editing

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

English Editing Z. Papadopoulou-Couloumbis

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

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

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜

Publishing Coordinator

E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶. ∆۷ω¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 61 41 360-5 Fax: 61 41 366

SCIENTIFIC PUBLICATIONS Ltd P. Tsaldari 3, Marousi 151 22 Tel.: 61 41 360-5 Fax: 61 41 366

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

Greek Editing I. Karavranou

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹

10000 ‰Ú¯.

29,35

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5000 ‰Ú¯.

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N o v e m b e r - D e c e m b e r 2 0 0 1 .V o l u m e 6 4 . N o 6

πSSN 0377-2551 i


O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊” Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘Ó¯‹ È·ÙÚÈ΋ ÂÓË̤ڈÛË Î·È ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ì ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚȯfiÌÂÓÔ, ÁÂÓÈο ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È ˘Á›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘Ó‰ڛˆÓ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ·Ó·ÊÔÚ¤˜ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‚Ú·‚¢ı› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫◊” Î·È Ë ÔÏÈ΋ ‹ ÌÂ-

ÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927934, http://jama.ama-assn.org/info/auinst_req.html. OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚËÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word.doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜. T· ¤ÍÔ‰· ÙˆÓ ÊÈÏ̘ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ. T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢ڤ˜. TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ, ηٿÏÔÁÔ˜ Û˘ÓÙÌ‹ÛˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

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H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 ÛÂÏ›‰Â˜, ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi. T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë. K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ. K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ∂ÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ªÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. T· ∞ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ ηÈ

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‚Ú·¯Â›· Û˘˙‹ÙËÛË Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜. TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ. BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ. H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors / Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov). ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”. T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÏÂ͛Ԣ ¢, ª¿Ú· Ã, °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã. ∂Ì‚fiÏÈ·, ·ÚfiÓ Î·È Ì¤ÏÏÔÓ: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1996;59:272-279.


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

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜. £· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜ Ì ÌÔÚÊ‹ ʈÙÔÁÚ·ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

Èڛ˜ Û˘ÁÁڷʤ·: 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·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· Û ·È‰È¿ ‚ÔÚÂÈÔ‰˘ÙÈ΋˜ ∫‡ÚÔ˘ [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜;1998. ÛÂÏ. 172. 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 Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.

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

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

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∞ƒ£ƒO ™À¡∆∞•∏™

Paediatriki 2001;64:547-550

EDITORIAL

∞Ú¯È΋ ÂÌÂÈÚÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÓÔÛÔÎÔÌÂȷ΋˜ Ó¢ÌÔÓ›·˜ ¶. ∫·Ï·Ì·Ï›Î˘

Initial empirical treatment of nosocomial pneumonia P. Kalabalikis

¶ÂÚ›ÏË„Ë: ∏ ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›· (¡¶) Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ÓÔÛÔÎÔÌÂȷ΋ Ïԛ̈ÍË Ì ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ·, ΢ڛˆ˜ Â¿Ó ÚÔÛ‚¿ÏÏÂÈ ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ ‹ fiÙ·Ó ÔÊ›ÏÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∏ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË Î·Ù¿ÏÏËÏ˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ¡¶. §fiÁˆ Ù˘ ÛÔ˘‰·ÈfiÙËÙ·˜ Ù˘ ·Ú¯È΋˜ ıÂÚ·›·˜, Ë ∞ÌÂÚÈηÓÈ΋ ∂Ù·ÈÚ›· £ˆÚ·ÎÈÎÒÓ ¡fiÛˆÓ Î·ıfiÚÈÛ ÙÔ 1995 ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ·Ú¯È΋ ÂÌÂÈÚÈ΋ ·ÁˆÁ‹ Ù˘ ¡¶. ∞fi ÙfiÙÂ, ÚfiÛÊ·Ù˜ ‰ËÌÔÛȇÛÂȘ ¤¯Ô˘Ó ÚÔÛı¤ÛÂÈ ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ù· ÔÔ›· ÂӉ¯Ô̤ӈ˜ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈο Î·È Û˘Ó‰¤ÔÓÙ·È Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi Ì ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜. ∏ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Ô˘ Û˘ÓÈÛÙ¿Ù·È Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ¡¶, ÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘, ÙÔÓ Èı·Ófi ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi Î·È ÙËÓ ‡·ÚÍË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›·, ·ÓÙÈ‚›ˆÛË, ıÂÚ·›·.

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

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Paediatriki 2001;64:547-550

ÓÔÛËÏ›·˜ (ÚÒÈÌË Ó¢ÌÔÓ›·), ÔÊ›ÏÂÙ·È Û˘Ó‹ıˆ˜ Û ÌÈÎÚfi‚È· Ù˘ ¯ÏˆÚ›‰·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÂÓÒ Â¿Ó ÂΉËψı› ÌÂÙ¿ ÙËÓ 5Ë Ë̤ڷ (fi„ÈÌË Ó¢ÌÔÓ›·), Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È Û ÓÔÛÔÎÔÌÂȷο ÌÈÎÚԂȷο ÛÙÂϤ¯Ë, Ù· ÔÔ›· ¤¯Ô˘Ó ·ÔÈΛÛÂÈ ÙÔ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. Œ¯ÂÈ ·Ú·ÙËÚËı› ·ÔÈÎÈÛÌfi˜ ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· ·ÛıÂÓÒÓ 36 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ÛÙË ª∂£, ·ÎÔÏÔ‡ıËÛ ·ÔÈÎÈÛÌfi˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ ÛÙȘ 36-60 ÒÚ˜ Î·È ·ÔÈÎÈÛÌfi˜ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÛÙȘ 60-96 ÒÚ˜ (8). ∏ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ ıÓËÙfiÙËÙ·. ∂¿Ó Ì¿ÏÈÛÙ· ÚÔÛ‚¿ÏÏÂÈ ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ· ‹ Â¿Ó ÔÊ›ÏÂÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ ÌÈÎÚfi‚È·, fiˆ˜ P. aeruginosa Î·È Acinetobacter, Ë ıÓËÙfiÙËÙ· ÌÔÚ› Ó· ÍÂÂÚ¿ÛÂÈ ÙÔ 50% (2,9,10). ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ¤Î‚·ÛË ·›˙ÂÈ Ë ¤ÁηÈÚË Î·È Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË. Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Ë ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË Î·Ù¿ÏÏËÏ˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ ·˘Í¿ÓÂÈ ÛÙÔ ‰ÈÏ¿ÛÈÔ ÙȘ Èı·ÓfiÙËÙ˜ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ¡¶ (11,12). ∞ÛıÂÓ›˜ Ì ¡¶ Ô˘ ¤Ï·‚·Ó ¤ÁηÈÚ· ÛˆÛÙ‹ ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ ›¯·Ó ÙË ÌÈÎÚfiÙÂÚË ıÓËÙfiÙËÙ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ·ÔÌfiÓˆÛË ‹ ÌË ÙÔ˘ ˘‡ı˘ÓÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ (13). ∞ÓÙ›ıÂÙ·, ¿ÙÔÌ· ÛÙ· ÔÔ›· ·Ú¯Èο ¯ÔÚËÁ‹ıËΠÌË Î·Ù¿ÏÏËÏË ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Î·È ÂÓ Û˘Ó¯›· ÙÚÔÔÔÈ‹ıËΠ̠‚¿ÛË ÙÔÓ ·ıÔÁfiÓÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi Î·È ÙÔ test ¢·ÈÛıËÛ›·˜ ÙÔ˘, ›¯·Ó ·ÚfiÌÔÈ· ¤Î‚·ÛË Ì ·˘ÙÔ‡˜ Ô˘ ¿Ú¯ÈÛ·Ó Î·È Û˘Ó¤¯ÈÛ·Ó Ì ·Î·Ù¿ÏÏËÏË ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ (13). §fiÁˆ, ÏÔÈfiÓ, Ù˘ ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜ Ù˘ ¤ÁηÈÚ˘ Î·È Î·Ù¿ÏÏËÏ˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜, Ë ∞ÌÂÚÈηÓÈ΋ ∂Ù·ÈÚ›· £ˆÚ·ÎÈÎÒÓ ¡fiÛˆÓ (American Thoracic Society), Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙË ‚·Ú‡ÙËÙ· Ù˘ ¡¶, ÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ ‡·ÚÍË ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ηıfiÚÈÛ ÙÔ 1995 ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ·Ú¯È΋ ÂÌÂÈÚÈ΋ ıÂÚ·›· Ù˘ (14). ∞fi ÙfiÙ ˘¿Ú¯Ô˘Ó ‰ËÌÔÛȇÛÂȘ Ô˘ ÚÔÛı¤ÙÔ˘Ó ÛÙȘ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ (15-17). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, ˆ˜ ÛÔ-

µ·Ú‡ÙËÙ· ¡¶ ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÃÚfiÓÔ˜ ¤Ó·Ú͢ ¡¶ ¶Èı·Ó¿ ÌÈÎÚfi‚È·

‚·Ú‹ ¡¶ ¯·Ú·ÎÙËÚ›ÛÙËΠ·˘Ù‹ Ô˘ ÚÔηÏ› (14): ·) ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙË ª∂£, ‚) ÛËÌ›· ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ÒÛÙ ӷ ··ÈÙÂ›Ù·È Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ ‹ ¯ÔÚ‹ÁËÛË O2 >35% ÁÈ· Ó· ‰È·ÙËÚÂ›Ù·È ÎÔÚÂÛÌfi˜ ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ >90%, Á) Ú·Á‰·›· Âȉ›ӈÛË Ù˘ ·ÎÙÈÓÔÁÚ·ÊÈ΋˜ ÂÈÎfiÓ·˜, ηٿÏË„Ë ÂÚÈÛÛfiÙÂÚˆÓ Ó¢ÌÔÓÈÎÒÓ ÏÔ‚ÒÓ ‹ ÛËÏ·ÈÔÔ›ËÛË Û Ó‡ÌÔÓ·, ÛÙÔÓ ÔÔ›Ô ˘‹Ú¯·Ó ‰ÈËı‹ÛÂȘ Î·È ‰) ÂӉ›ÍÂȘ ÛÔ‚·Ú‹˜ ÛË„·ÈÌ›·˜ (severe sepsis) Ì ˘fiÙ·ÛË ‹/Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ. ∞ÛıÂÓ›˜ Ì ÚÒÈÌË ÂÏ·ÊÚ¿ ‹ ̤ÙÚÈ· ¡¶, ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (™¯‹Ì· 1), Â›Ó·È Èı·Ófi Ó· ¤¯Ô˘Ó ÌÔÏ˘Óı› Ì ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ·ÔÈΛ˙Ô˘Ó ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi ÙÔ˘˜ ‹ Ì ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂȉ‹ Ù˘ ÂÓÙÂÚÈ΋˜ ÙÔ˘˜ ¯ÏˆÚ›‰·˜ (ÔÌ¿‰· 1) (¶›Ó·Î·˜ 1). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ÌÔÚ› Ó· ¯ÔÚËÁËı› ÎÂÊ·ÏÔÛÔÚ›ÓË 2˘ (ÎÂÊÔ˘ÚÔÍ›ÌË) ‹ 3˘ ÁÂÓÈ¿˜ (ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙÚÈ·ÍfiÓË) ‹ Û˘Ó‰˘·ÛÌfi˜ ‚-Ï·ÎÙ¿Ì˘/·Ó·ÛÙÔϤ· ‚-Ï·ÎÙ·Ì¿Û˘ (·ÌÔÍÈÎÈÏÏ›ÓË/ ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇, ÙÈηÚÛÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇, ÈÂÚ·ÎÈÏÏ›ÓË/Ù·˙ÔÌ·ÎÙ¿ÌË). ™Â ¿ÙÔÌ· ·ÏÏÂÚÁÈο ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÌÔÚ› Ó· ¯ÔÚËÁËı› Û˘Ó‰˘·ÛÌfi˜ ·˙ÙÚÂÔÓ¿Ì˘-ÎÏÈÓ‰·Ì˘Î›Ó˘. ∂¿Ó ˘¿Ú¯Ô˘Ó ÂȉÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2) Û ÂÏ·ÊÚ¿ ‹ ̤ÙÚÈ· ¡¶, Â›Ó·È ‰˘Ó·ÙfiÓ, ÂÎÙfi˜ ÙˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ Ù˘ ÔÌ¿‰·˜ 1, Ó· ¢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¯È΋ ÂÌÂÈÚÈ΋ ıÂÚ·›· ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘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 Ì ÙÔ˘˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÙˆÓ ·ÛıÂÓÒÓ. ∂¿Ó ·ÛıÂÓ‹˜, ¯ˆÚ›˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ÂΉËÏÒÛÂÈ ÛÔ‚·Ú‹ ¡¶ ̤۷ Û 4 Ë̤Ú˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Û˘ÓÈÛÙ¿Ù·È Ë ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ ÙÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ù˘ ÔÌ¿‰·˜ 1. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘

∂Ï·ÊÚ¿ ‹ ̤ÙÚÈ·

™Ô‚·Ú‹

Ÿ¯È

¡·È

Ÿ¯È

OÈÔÛ‰‹ÔÙÂ

OÈÔÛ‰‹ÔÙÂ

1-4 Ë̤Ú˜

≥5 Ë̤Ú˜

OÈÔÛ‰‹ÔÙÂ

OÌ¿‰· 1

OÌ¿‰· 2

OÌ¿‰· 1

OÌ¿‰· 3

OÌ¿‰· 3

™¯‹Ì· 1. AÏÁfiÚÈıÌÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ·ÛıÂÓÒÓ Ì ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›· (¡¶).

548

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¶·È‰È·ÙÚÈ΋ 2001;64:547-550

Paediatriki 2001;64:547-550

¶›Ó·Î·˜ 1. ªÈÎÚfi‚È· Ô˘ ÚÔηÏÔ‡Ó ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›· Î·È ÂÌÂÈÚÈ΋ ·ÓÙÈÌÂÙÒÈÛË OÌ¿‰·

¶Èı·ÓÔ› ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ›

¶ÚÔÙÂÈÓfiÌÂÓ· ·ÓÙÈ‚ÈÔÙÈο

1

S. pneumoniae, H. influenzae, MSSA, ∂ÓÙÂÚÔ‚·ÎÙËÚÈÔÂȉ‹: E.Coli, Klebsiella, Enterobacter Proteus, Serratia.

∫ÂÊ·ÏÔÛÔÚ›Ó˜ 2˘ (ÎÂÊÔ˘ÚÔÍ›ÌË) ‹ 3˘ ÁÂÓÈ¿˜ (ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙÚÈ·ÍfiÓË) ‹ ‚-Ï·ÎÙ¿ÌË/·Ó·ÛÙÔϤ·˜ ‚-Ï·ÎÙ·Ì¿Û˘ (·ÌÈÎÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï. Ô͇, ÙÈηÚÛÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï. Ô͇, ÈÂÚ·ÛÈÏÏ›ÓË/Ù·˙ÔÌ·ÎÙ¿ÌË) ∂› ·ÏÏÂÚÁ›·˜ ÛÙȘ ÂÓÈÎÈÏϛӘ: ·˙ÙÚÂÔÓ¿ÌË + ÎÏÈÓ‰·Ì˘Î›ÓË

2

ªÈÎÚfi‚È· ÔÌ¿‰·˜ π + ·Ó·ÂÚfi‚È· S.aureus Legionella

‚-Ï·ÎÙ¿ÌË/·Ó·ÛÙÔϤ·˜ ‚-Ï·ÎÙ·Ì¿Û˘ + ÂӉ¯Ô̤ӈ˜: µ·ÓÎÔÌ˘Î›ÓË (̤¯ÚÈ Ó· ·ÔÎÏÂÈÛÙ› Ïԛ̈ÍË ·fi MRSA) ª·ÎÚÔÏ›‰Ë (ÂÚ˘ıÚÔÌ˘Î›ÓË, ÎÏ·ÚÈıÚÔÌ˘Î›ÓË)

3

ªÈÎÚfi‚È· ÔÌ¿‰·˜ π + P. aeruginosa, Acinetobacter,

∞ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë + ¤Ó· ·fi Ù· ·ÎfiÏÔ˘ı·: ∞ÓÙÈ„Â˘‰ÔÌÔÓ·‰È΋ ÂÓÈÎÈÏÏ›ÓË (ÈÂÚ·ÛÈÏÏ›ÓË, ÙÈηÚÛÈÏÏ›ÓË) ∞ÓÙÈ„Â˘‰ÔÌÔÓ·‰È΋ ‚-Ï·ÎÙ¿ÌË/·Ó·ÛÙÔϤ·˜ ‚-Ï·ÎÙ·Ì¿Û˘ (ÙÈÎ·Ú ÛÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇, ÈÂÚ·ÛÈÏÏ›ÓË/Ù·˙ÔÌ·ÎÙ¿ÌË) πÌÈÂÓ¤ÌË/ÛÈÏ·ÛÙ·Ù›ÓË, ÌÂÚÔÂÓ¤ÌË ∂Ӊ¯Ô̤ӈ˜ ÚÔÛı‹ÎË Î·È ‚·ÓÎÔÌ˘Î›Ó˘

MRSA

MSSA: ÃÚ˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ¢·›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¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ۯ¤ÛË Ì ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ô˘ ÚÔηÏÔ‡Ó ÓÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›· ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ñ ñ ñ ñ

∂ÈÛÚfiÊËÛË, ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ÎÔÈÏ›·˜ ∫ÒÌ·, ۷ί·Ú҉˘ ‰È·‚‹Ù˘, ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ∞ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·, ˘„ËϤ˜ ‰fiÛÂȘ ÛÙÂÚÔÂȉÒÓ ¶·Ú·ÙÂٷ̤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi ñ ¶·Ú·ÙÂٷ̤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, ÛÙÂÚÔÂȉ‹, ˘ÔıÚ„›·, ηÎÔ‹ıÂÈ·, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜ ñ ¶·Ú·ÙÂٷ̤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ì·ÎÚ¿ ·Ú·ÌÔÓ‹ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi

ªÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ∞Ó·ÂÚfi‚È· S. aureus Legionella Acinetobacter P. aeruginosa MRSA

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

ÂΉËψı› ÛÔ‚·Ú‹ ¡¶ ≥5 Ë̤Ú˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ‹ Â¿Ó Ô ¿ÚÚˆÛÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È Èı·ÓfiÓ ‹ ÓfiÛÔ˜ Ó· ÔÊ›ÏÂÙ·È Î·È Û ÔÏ˘·ÓıÂÎÙÈο Gram(-) ÌÈÎÚfi‚È·, fiˆ˜ P. aeruginosa ‹ Acinetobacter, fiˆ˜ Â›Û˘ Î·È ÛÙÔ ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ, ÙÔÓ ·ÓıÂÎÙÈÎfi ÛÙË ÌÂıÈÎÈÏÏ›ÓË Î·È Ë ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ ı· Ú¤ÂÈ Ó· ÛÙԯ‡ÂÈ ÂÈϤÔÓ 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.

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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

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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›· ¤ÁÎÚÈÛ˘: 05-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙ˘ ∫·Ï·Ì·Ï›Î˘ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” ¶ª∂¡ (4Ô˜ fiÚÔÊÔ˜) £Ë‚ÒÓ & §Â‚·‰›·˜, 115 27, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¶ÚÒÈÌÔÈ ‰Â›ÎÙ˜ ‚Ï¿‚˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Û ÚfiˆÚ· ÓÂÔÁÓ¿ ¿Û¯ÔÓÙ· ·fi ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ·Ó·˙‹ÙËÛË ÚÒÈÌˆÓ ‰ÂÈÎÙÒÓ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ Û ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (õ°) ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË. ÀÏÈÎfi Î·È ÌÂıÔ‰ÔÏÔÁ›·: ªÂÏÂÙ‹ıËÎ·Ó 57 õ° ÓÂÔÁÓ¿. ∆· 29 ·fi ·˘Ù¿ ›¯·Ó ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË, ÂÓÒ Ù· ˘fiÏÔÈ· 28 Ô˘ ‰ÂÓ Â›¯·Ó ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È Ïԛ̈ÍË ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û·Ó Ì¿ÚÙ˘Ú˜. ªÂÙÚ‹Û·Ì ÙÔÓ ·fiÏ˘ÙÔ ·ÚÈıÌfi ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È Ù· Â›‰· ÙˆÓ IL-1b, IL-6 Î·È TNFa ÙÔ˘ ÔÚÔ‡, ÙȘ ÚÒÙ˜ 24 ÒÚ˜, ηıÒ˜ Â›Û˘ ÙËÓ 3Ë Î·È 7Ë Ë̤ڷ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ¢Âη٤ÛÛÂÚ· ·È‰È¿ ·fi ÂΛӷ Ô˘ ›¯·Ó ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È Ïԛ̈ÍË Î·È 12 ·fi ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ÂÎÙÈÌ‹ıËÎ·Ó Ó¢ÚÔÏÔÁÈο ÛÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ. ∞ÔÙÂϤÛÌ·Ù·: µÚ‹Î·Ì fiÙÈ Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È Ù· Â›‰· Ù˘ IL-1b Î·È IL-6 ηٿ ̤ÛÔ fiÚÔ ÙËÓ 24Ë ÒÚ· Ù˘ ˙ˆ‹˜, ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ÛÙ· ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È Ïԛ̈ÍË ·’ fi,ÙÈ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (p=0,022, p=0,036, p=0,037 ·ÓÙ›ÛÙÔȯ·). ∆· Â›‰· ÙÔ˘ TNF-a ‰ÂÓ ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂϤÁ¯ıËηÓ. ™ÙË ‰ÈÔÚıˆÌ¤ÓË ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ, Ë Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË ¤‰ÂÈÍ fiÙÈ 8 ·fi Ù· 14 ·È‰È¿ Ô˘ ÂϤÁ¯ıËÎ·Ó Î·È Ô˘ ˆ˜ ÓÂÔÁÓ¿ ›¯·Ó ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È Ïԛ̈ÍË, ·ÚÔ˘Û›·˙·Ó Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÂÓÒ Î·Ó¤Ó· ·fi Ù· 12 ·È‰È¿ Ô˘ ÛÙË ÓÂÔÁÓÈ΋ ÙÔ˘˜ Â-

550

Ú›Ô‰Ô ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘Ú˜, ‰ÂÓ Â›¯Â ·ıÔÏÔÁÈο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ¢È·ÈÛÙÒıËΠfiÙÈ Ù· ·È‰È¿ Ô˘ ›¯·Ó ·ıÔÏÔÁÈο Ó¢ÚÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·ÚÔ˘Û›·˙·Ó ÛÙȘ 24 ÒÚ˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ·ÚÈıÌfi ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È ÂÈ¤‰ˆÓ IL-1b Î·È IL-6, ·’ fi,ÙÈ Ù· ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂͤÏÈÍË. ™˘ÌÂÚ¿ÛÌ·Ù·: O ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÂÚ˘ıÚÔ‚Ï·ÛÙÒÓ Î·È ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙ· ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ Î·È Ïԛ̈ÍË ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ÚÒÈÌÔÈ ‰Â›ÎÙ˜ ÂÚÈÁÂÓÓËÙÈ΋˜ ‚Ï¿‚˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Úfi‚Ï„˘ Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ÙÔ˘˜ ÂͤÏÈ͢.

1 Fotopoulos 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

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


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REVIEW ARTICLE

∂Ӊ›ÍÂȘ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ÌÂϤÙ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿ ª. ªÔ˘ÛÙ¿ÎË1, ¶. °È¿ÏÔ˘ÚÔ˜2, £. ∫·Ú¿ıÈÔ˜1

Polygraphic sleep studies in children M. Moustaki1, P. Gialouros2, T. Karpathios1

¶ÂÚ›ÏË„Ë: ∆Ô ¿ÚıÚÔ ·˘Ùfi ·Ó·ÛÎÔ› ÙȘ ÂӉ›ÍÂȘ ÂÎÙ¤ÏÂÛ˘ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ÌÂϤÙ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿ ÁÈ· ·Ó›¯Ó¢ÛË ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. OÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ, ‰ËÏ·‰‹ ÔÈ ·ÔÊÚ·ÎÙÈΤ˜ Î·È ÎÂÓÙÚÈΤ˜ ¿ÓÔȘ Î·È Ô ˘Ô·ÂÚÈÛÌfi˜, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û˘ÓÔÙÈÎfi ÙÚfiÔ. OÈ ‡ÔÙ˜ ÂΉËÏÒÛÂȘ Î·È Ù· Â˘Ú‹Ì·Ù· Û ‰È¿ÊÔÚ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ÌÔÚ› Ó· ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ·ÔÊÚ·ÎÙÈÎÒÓ ‹ ÎÂÓÙÚÈÎÒÓ ·ÓÔÈÒÓ Î·È ˘Ô·ÂÚÈÛÌÔ‡ ÂÎÙ›ıÂÓÙ·È Ì ÏÂÙÔ̤ÚÂÈ·, Ì 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 ÂӉ›ÍÂȘ Ù˘ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ÌÂϤÙ˘ ‡ÓÔ˘ Î·È Û ·È‰È¿ Ì ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÁÓˆÛÙ¿ ·ÓÔ˚ο Û‡Ó‰ÚÔÌ·.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ¿ÓÔÈ·, ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘, ÌÂϤÙË ‡ÓÔ˘, ˘Ô·ÂÚÈÛÌfi˜.

Key words: apnea, hypoventilation, disorders, sleep studies.

∏ ÛËÌ·Û›· Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó·ÓÔ‹˜ ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ˘fiÏÔÈˆÓ ˙ˆÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È ÙËÓ ÈηÓÔÔÈËÙÈ΋ ·‡ÍËÛË Î·È ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Û·ÊÒ˜ ·Ó·ÁÓˆÚÈṲ̂ÓË. ∏ ·Ó·ÓÔ‹ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈ΋ 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˘ÛÈÔÏÔÁÈο Â›‰· (1). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Ê˘ÛÈÔÏÔÁÈΤ˜ ·ÏÏ·Á¤˜ ÛÙË ÏÂÈÙÔ˘ÚÁ›· Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÈ Ôԛ˜ ÌÔ-

Ú› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÂΉ‹ÏˆÛË ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·ÓÔ‹˜ Û ·È‰È¿ Ô˘ Â›Ó·È Ê·ÈÓÔÙ˘Èο ˘ÁÈ‹, ·ÏÏ¿ Î·È Û ·È‰È¿ Ì ˘ÔΛÌÂÓ˜ ‰È·Ù·Ú·¯¤˜, Û˘ÓËı¤ÛÙÂÚ· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∞Ó ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÂÌÊ·Ó›˙ÔÓÙ·È Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Û¯ÂÙÈο ‡ÎÔÏ· ·fi ÙÔ˘˜ ÁÔÓ›˜ Î·È ÔÏϤ˜ 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· Ù˘ Ó‡¯Ù·˜. ÷ڷÎÙËÚÈÛÙÈÎfi Â›Ó·È fiÙÈ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÛÙ· ·È‰È¿ ¤ÁÈÓ ÌfiÏȘ ÙÔ 1976

1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ “ª·Î¿ÚÈÔ˜ πππ” §Â˘ÎˆÛ›·˜

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

sleep

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¶·È‰È·ÙÚÈ΋ 2001;64:551-556

·fi ÙÔÓ Guilleminault Î·È Û˘Ó (2) Î·È ·ÎÔÏÔ‡ıËÛÂ Ë ·Ó·ÁÓÒÚÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·˘ÍË̤Ó˘ ·ÓÙ›ÛÙ·Û˘ ÙˆÓ ·ÓˆÙ¤ÚˆÓ ·ÂÚ·ÁˆÁÒÓ ·fi ÙËÓ ›‰È· ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÙÔ 1982 (3). ∆Ô Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È·Ï›Ô˘Û· Ï‹ÚË ·fiÊÚ·ÍË ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Ì ‰È·ÎÔ‹ Ù˘ ÚÔ‹˜ ÙÔ˘ ·¤Ú· ·fi ÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ· ÁÈ· ÌÂÚÈο ‰Â˘ÙÂÚfiÏÂÙ·, ·Ú’ fiÙÈ ÔÈ ·Ó·Ó¢ÛÙÈΤ˜ ÚÔÛ¿ıÂȘ Û˘Ó¯›˙ÔÓÙ·È Î·ÓÔÓÈο ‹ Û˘ÓËı¤ÛÙÂÚ· Â›Ó·È ·˘ÍË̤Ó˜. ™Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ·, ·ÏÏ¿ ·ÔÊÚ·ÎÙÈÎfi˜ ˘Ô·ÂÚÈÛÌfi˜, ‰ËÏ·‰‹ ÌÂÚÈ΋ ·fiÊÚ·ÍË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡ Ì ÌÂȈ̤ÓË ‰È·Î›ÓËÛË ·¤Ú· Î·È ˘ÔÍ›· (4-6). ™ÙÔ Û‡Ó‰ÚÔÌÔ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ·ÓÙÈÛÙ¿ÛÂˆÓ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·ÂÚ·ÁˆÁÔ‡ Ù· ·È‰È¿ ÌÔÚ› Ó· ÌËÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÔÍ›· ÏfiÁˆ Ù˘ ‰˘Ó·ÙfiÙËÙ¿˜ ÙÔ˘˜ Ó· ·˘Í¿ÓÔ˘Ó ÈηÓÔÔÈËÙÈο ÙÔ ·Ó·Ó¢ÛÙÈÎfi Ì˘ïÎfi ¤ÚÁÔ (1). À¿Ú¯Ô˘Ó fï˜ ÂӉ›ÍÂȘ fiÙÈ Î·È Ë ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ‰È·ÙÚ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜. ∞ÓÙ›ıÂÙ·, ÎÂÓÙÚÈ΋ ¿ÓÔÈ· Â›Ó·È Ë ¿ÓÔÈ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·‡ÛË Ù˘ ÚÔ‹˜ ·¤Ú· ÛÙË Ì‡ÙË Î·È ÙÔ ÛÙfiÌ· Î·È Ë ·Ô˘Û›· ·Ó·Ó¢ÛÙÈÎÒÓ ÚÔÛ·ıÂÈÒÓ. ∞ÓÙ›ÛÙÔȯ·, ˘¿Ú¯ÂÈ Ô ÎÂÓÙÚÈÎfi˜ ˘Ô·ÂÚÈÛÌfi˜, ηٿ ÙÔÓ ÔÔ›Ô ÔÈ ·Ó·Ó¢ÛÙÈΤ˜ ÚÔÛ¿ıÂȘ ÌÔÚ› Ó· ÌËÓ ·Ô˘ÛÈ¿˙Ô˘Ó Ï‹Úˆ˜ ·ÏÏ¿ Ó· Â›Ó·È ÌÂȈ̤Ó˜ Î·È Ó· ÌËÓ Â·ÚÎÔ‡Ó ÁÈ· ÙËÓ ÈηÓÔÔÈËÙÈ΋ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ. ªÈÎÙ¤˜ Â›Ó·È ÔÈ ¿ÓÔȘ ηٿ ÙȘ Ôԛ˜ Û˘Ó˘¿Ú¯Ô˘Ó ÔÈ ÈÔ ¿Óˆ ‰È·Ù·Ú·¯¤˜. ∞fi ÙÔ 1976 ̤¯ÚÈ Û‹ÌÂÚ·, ÔÏ˘¿ÚÈı̘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÁÈ· ÙËÓ ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ· ·ÏÏ¿ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ ÛÙ· ·È‰È¿ ¤¯Ô˘Ó Û˘ÁÎÂÓÙÚÒÛÂÈ ÌÂÁ¿ÏÔ fiÁÎÔ ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÙË Û˘¯ÓfiÙËÙ·, Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·ÏÏ¿ Î·È ÙȘ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ ¿ÓÔÈ·˜ Î·È ÙÔ˘ ˘Ô·ÂÚÈÛÌÔ‡ ÛÙ· ·È‰È¿. ∞ÔÙ¤ÏÂÛÌ· Ù˘ Û˘ÓÂȉËÙÔÔ›ËÛ˘ Ù˘ ÛËÌ·Û›·˜ ·˘ÙÒÓ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Â›Ó·È Ë Û˘Ó¯‹˜ ·‡ÍËÛË Î·Ù¿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ù˘ ¯Ú‹Û˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË Û˘ÛÙËÌ¿ÙˆÓ Î·Ù·ÁÚ·Ê‹˜ ·Ú·Ì¤ÙÚˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ∏ Û˘Ó¯‹˜ ηٷÁÚ·Ê‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ·˘ÙÒÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÂÈÙÚ¤ÂÈ Ó· ‰È·ÈÛÙˆı› ·Ó Ë ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ηٿ ÙÔÓ ‡ÓÔ ‰È·ÎfiÙÂÙ·È ÂÂÈÛԉȷο (¿ÓÔÈ·), fiÛÔ Û˘¯Ó¿ Î·È ÁÈ· fiÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Î·È Ì ÔÈÔ Ì˯·ÓÈÛÌfi (ÎÂÓÙÚÈ΋ ‹ ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ·). ∏ ÂͤٷÛË, Â›Û˘, ÂÈÙÚ¤ÂÈ ÙËÓ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ Ù˘ Ô͢ÁfiÓˆÛ˘ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È - Û ÂÚ›ÙˆÛË ˘ÔÍ·ÈÌ›·˜ - ÙË ‰È¿ÚÎÂÈ¿ Ù˘.

552

Paediatriki 2001;64:551-556

OÈ Û‡Á¯ÚÔÓ˜ Û˘Û΢¤˜ οÓÔ˘Ó ‰˘Ó·Ù‹ ÙËÓ Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ Î·È ÔÏÏÒÓ ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘). ™ÙËÓ ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ Ú¿ÍË Î·Ù·ÁÚ¿ÊÂÙ·È Û˘Ó‹ıˆ˜ ¤Ó·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ·Ú·Ì¤ÙÚˆÓ, ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ Û˘ÓÂÚÁ·Û›·˜ ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÔÏÏÒÓ ËÏÂÎÙÚÔ‰›ˆÓ, ·ÏÏ¿ Î·È ÙÔ˘ ¯ÚfiÓÔ˘ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰Ô̤ӈÓ. OÈ ·Ó·Áη›Â˜ ·Ú¿ÌÂÙÚÔÈ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ ÛÙ· ·È‰È¿ Â›Ó·È Ô ÎÔÚÂÛÌfi˜ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ, Ô Î·Ú‰È·Îfi˜ Ú˘ıÌfi˜ Î·È ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, Ë ÚÔ‹ ÙÔ˘ ·¤Ú· ‰È·Ì¤ÛÔ˘ Ù˘ ÚÈÓÈ΋˜ Î·È ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜, Ë ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ıˆÚ·ÎÈÎÒÓ Î·È ÎÔÈÏÈ·ÎÒÓ Ì˘ÒÓ Î·È ÙÔ ÂÎÓÂfiÌÂÓÔ ‹ ‰È·‰ÂÚÌÈÎfi CO2. °È· ÙË ÛÙ·‰ÈÔÔ›ËÛË ÙÔ˘ ‡ÓÔ˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Ë Û˘Ó‰˘·Ṳ̂ÓË Î·Ù·ÁÚ·Ê‹ ÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜, ÔÊı·ÏÌÔÁÚ·Ê‹Ì·ÙÔ˜ Î·È ËÏÂÎÙÚÔÌ˘ÔÁÚ·Ê‹Ì·ÙÔ˜. ∆· ÎÚÈÙ‹ÚÈ·, fï˜, Ù˘ ÛÙ·‰ÈÔÔ›ËÛ˘ ÙÔ˘ ‡ÓÔ˘ ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ÙÔ ÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ‰ÂÓ ÌÔÚÔ‡Ó Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÛÙ· ·È‰È¿, ȉȷ›ÙÂÚ· Û ·˘Ù¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ÂÚÌËÓ›· ÙÔ˘ ÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿ Î·È Ù· ‚Ú¤ÊË ··ÈÙ› ÌÂÁ¿ÏË ·Ó¿ÏÔÁË ÂÌÂÈÚ›· ÙÔ˘ È·ÙÚÔ‡ Î·È ÚÔ¸Ôı¤ÙÂÈ ÁÓÒÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ÛÙ·‰›ˆÓ ÙÔ˘ ‡ÓÔ˘ Î·È Ò˜ ·˘Ù¿ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈο ηٿ ÙËÓ ·È‰È΋ Î·È ‚ÚÂÊÈ΋ ËÏÈΛ·. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ˘Ô„›· ÁÈ· Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÓÔÈÒÓ Ì Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, Ë Ù·˘Ùfi¯ÚÔÓË ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ ÌÂ Û˘Ó¯‹ ηٷÁÚ·Ê‹ ÙÔ˘ pH ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÌÔÚ› Ó· ÂȂ‚·ÈÒÛÂÈ ‹ Ó· ·ÔÎÏ›ÛÂÈ ÙË Û˘Û¯¤ÙÈÛË ·˘Ù‹. ∂Ӊ›ÍÂȘ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ÌÂϤÙ˘ Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙÔÓ ‡ÓÔ ∆ËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·, Ë ∞ÌÂÚÈηÓÈ΋ ∂Ù·ÈÚ›· £Òڷη (American ∆horacic Society) ¤¯ÂÈ ÂΉÒÛÂÈ Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙȘ ÂӉ›ÍÂȘ ¯Ú‹Û˘ Ù˘ ÌÂϤÙ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿ Î·È ¤¯ÂÈ Î·ıÔÚ›ÛÂÈ Ù· ·ÚÈ· ÂÚˆÙ‹Ì·Ù· Ô˘ Ú¤ÂÈ Ó· ··ÓÙÒÓÙ·È Î·Ù¿ ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ÌÂÏÂÙÒÓ ‡ÓÔ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË (7). ™‡Ìʈӷ, ÏÔÈfiÓ, Ì ÙȘ Ô‰ËÁ›Â˜ ·˘Ù¤˜, ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È Û (¶›Ó·Î·˜ 1): ∞. ∫ÏÈÓÈ΋ ˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÀÔ„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ú¤ÂÈ Ó· Ù›ıÂÙ·È Û ·È‰È¿ Ì ıÔÚ˘‚Ò‰Ë ·Ó·ÓÔ‹ ηٿ ÙÔÓ ‡ÓÔ (Û˘Ó‹ıˆ˜ ÚÔ¯·ÏËÙfi) ‹ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ ÁÔÓ›˜ ·Ó·Ê¤ÚÔ˘Ó ‰È·ÎÔ¤˜ Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙÔÓ ‡ÓÔ. ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ì ‚¿ÛË ·Ó·ÊÔÚ¤˜ ÙˆÓ ÁÔÓ¤ˆÓ 7%-10% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜


¶·È‰È·ÙÚÈ΋ 2001;64:551-556

4-5 ÂÙÒÓ ÚÔ¯·Ï›˙Ô˘Ó (8,9). ™Â Ì›· ˘ÔÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, Ù·˘Ùfi¯ÚÔÓË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ÎÔÚÂÛÌÔ‡ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ Î·È ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ‹¯ˆÓ ÙÔ˘ ·È‰ÈÔ‡ (Ì video) ¤‰ÂÈÍ fiÙÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηٿ ÙÔÓ ‡ÓÔ ˘‹Ú¯·Ó ÌfiÓÔ ÛÙÔ 0,7% ÙˆÓ ·È‰ÈÒÓ (9). ∏ ‡·ÚÍË, ÂÔ̤ӈ˜, ÚÔ¯·ÏËÙÔ‡ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‰ÂÓ Û˘Ó˘¿Ú¯ÂÈ Ì ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ·. ∆Ô ÈÛÙÔÚÈÎfi ·fi ÌfiÓÔ ÙÔ˘, ·ÎfiÌË Î·È fiÙ·Ó ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙË Ï‹„Ë ÙÔ˘, ‰ÂÓ ÌÔÚ› Ó· ‰È·ÎÚ›ÓÂÈ Ì ·ÛÊ¿ÏÂÈ· ÙÔ Î·ı’ ¤ÍÈÓ ÚÔ¯·ÏËÙfi ·fi ÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Û ·È‰È¿ Ì ηı’ ¤ÍÈÓ ÚÔ¯·ÏËÙfi Ô˘ ÂÎÙÈÌ¿Ù·È ·fi ÙÔ ıÂÚ¿ÔÓÙ· ·È‰›·ÙÚÔ fiÙÈ ¯Ú‹˙Ô˘Ó ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ (·‰ÂÓÔÂȉÂÎÙÔÌ‹, ·Ì˘Á‰·ÏÂÎÙÔÌ‹, ÂÊ·ÚÌÔÁ‹ CPAP Î.Ï.), Ë ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ Ú¤ÂÈ Ó· ÚÔËÁ›ٷÈ, Ì ÛÎÔfi ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ ηı’ ¤ÍÈÓ ÚÔ¯·ÏËÙÔ‡ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜, ·ÔÙÚ¤ÔÓÙ·˜ ÙȘ ¿ÛÎÔ˜ ıÂÚ·¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ÛÙ· ·È‰È¿ ·˘Ù¿ (10). ÀÔ„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Ú¤ÂÈ Ó· Ù›ıÂÙ·È fiÙ·Ó ·Ó·Ê¤ÚÔÓÙ·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘, fiˆ˜ Û˘¯Ó¤˜ ·Ê˘Ó›ÛÂȘ, ·ÓËÛ˘¯›·, ·Û˘Ó‹ıÂȘ ı¤ÛÂȘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ηٿ ÙÔÓ ‡ÓÔ ‹ ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, fiˆ˜ ˘ÓËÏ›· ‹ ·ÓÙ›ıÂÙ· ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ (3,5,6,11). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë ˘ÓËÏ›· ÛÙ· ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÙfiÛÔ Û˘¯Ó¿ fiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (10). ∏ ¤ÓÙÔÓË Ó˘ÎÙÂÚÈÓ‹ ÂÊ›‰ÚˆÛË Â›Ó·È Û˘¯Ó‹ ÂΉ‹ÏˆÛË Û ·È‰È¿ Ì ۇӉÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Î·È Ë ·ÚÔ˘Û›· Ù˘ Ú¤ÂÈ Ó· ÂÁ›ÚÂÈ ˘Ô„›Â˜ (3,5). ∞Ô‰›‰ÂÙ·È Û˘Ó‹ıˆ˜ ÛÙÔ ·˘ÍË̤ÓÔ Ì˘ïÎfi ¤ÚÁÔ Î·Ù¿ ÙËÓ ÂÈÛÓÔ‹ ÁÈ· ÙËÓ ˘ÂÚÓ›ÎËÛË Ù˘ ·˘ÍË̤Ó˘ ·ÓÙ›ÛÙ·Û˘ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ (10). ∏ Ó˘ÎÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË, Â›Û˘, Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜, ¯ˆÚ›˜ fï˜ Ë ·Ú·Ù‹ÚËÛË ·˘Ù‹ Ó· Âȶ›Ó·Î·˜ 1. ∂Ӊ›ÍÂȘ ÔÏ˘·Ú·ÌÂÙÚÈ΋˜ ÌÂϤÙ˘ ‡ÓÔ˘ ÛÙ· ·È‰È¿ ñ ∫ÏÈÓÈ΋ ˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ‡ÓÔ˘ ¶Ó¢ÌÔÓÈ΋ ηډ›· ¶ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›· ∫Ú·ÓÈÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜ ñ ÃÚfiÓÈ· ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù· µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›· πÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜ ÕÛıÌ· ñ ÃÚfiÓÈ· Ó¢ÚÔÌ˘ïο ÓÔÛ‹Ì·Ù· ñ ™‡Ó‰ÚÔÌÔ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ ñ ∂ÂÈÛfi‰ÈÔ ¿ÓÔÈ·˜ ·ÂÈÏËÙÈÎfi ÁÈ· ÙË ˙ˆ‹

Paediatriki 2001;64:551-556

‚‚·ÈÒÓÂÙ·È ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ Û¯ÂÙÈÎÒÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ (12,13). OÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ÛÙÔÓ ‡ÓÔ Ú¤ÂÈ Ó· ·Ó·˙ËÙÔ‡ÓÙ·È ÈÔ ÌÂıÔ‰Èο ÛÙ· ·¯‡Û·Úη ·È‰È¿, ηıÒ˜ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÂӉ›ÍÂȘ fiÙÈ Ë ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜, Ë ÔÔ›· Ì¿ÏÈÛÙ· ÛÙ· ·È‰È¿ ·˘Ù¿ ÌÔÚ› Ó· ÌË Û˘Óԉ‡ÂÙ·È ·fi ıÔÚ˘‚Ò‰Ë Û˘Ìو̷ÙÔÏÔÁ›· (14,15). ∏ ·ÚÔ˘Û›· Ó¢ÌÔÓÈ΋˜ ηډ›·˜, Ë ‡·ÚÍË ÔÏ˘Î˘ÙÙ·Ú·ÈÌ›·˜ ¯ˆÚ›˜ ˘ÔΛÌÂÓË ‰È·Ù·Ú·¯‹ Ô˘ Ó· ÙË ‰ÈηÈÔÏÔÁ›, Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·‡ÍËÛ˘ ¯ˆÚ›˜ ¿ÏÏÔ ÈηÓÔÔÈËÙÈÎfi ÏfiÁÔ Â›Ó·È Î·Ù·ÛÙ¿ÛÂȘ Ô˘ Ú¤ÂÈ Ó· ÂÁ›ÚÔ˘Ó ÙËÓ ˘Ô„›· ·ÚÔ˘Û›·˜ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ (6,16,17). ∆Ô Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Ê·›ÓÂÙ·È fiÙÈ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Î·ı˘ÛÙ¤ÚËÛË Ù˘ ·‡ÍËÛ˘ Ì ÔÏÏÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, fiˆ˜ ÙÔ ·˘ÍË̤ÓÔ ·Ó·Ó¢ÛÙÈÎfi ¤ÚÁÔ Î·È Ë ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ (18,19), Ë ÌÂȈ̤ÓË fiÚÂÍË (6) Î·È Ë ‰È·Ù·Ú·¯‹ Ù˘ Ó˘ÎÙÂÚÈÓ‹˜ ¤ÎÎÚÈÛ˘ Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ·Ê˘Ó›ÛÂˆÓ (20), ·Ó Î·È ÁÈ· ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì˯·ÓÈÛÌfi ‰ÂÓ ˘¿Ú¯Ô˘Ó Â·Ú΋ ‰Â‰Ô̤ӷ. ¶·È‰È¿ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ‰ÈÂÚ‡ÓËÛË Â›Ó·È ·˘Ù¿ Ì ÎÚ·ÓÈÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜ (Û‡Ó‰ÚÔÌ· Crouzon, Apert Î.¿.), Ì·ÎÚÔÁψÛÛ›· ‹ ÁψÛÛfiÙˆÛË (Û‡Ó‰ÚÔÌ· Beckwith, Pierre Robin, Down), Ï·Ú˘ÁÁÔ̷ϷΛ·, ÂÁη‡Ì·Ù· ÚÔÛÒÔ˘ ‹ ÙÚ·¯‹ÏÔ˘, Ï·ÁÒ¯ÂÈÏÔ ‹ Ï˘ÎfiÛÙÔÌ· ÌÂÙ¿ ·fi ‰ÈÔÚıˆÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ, ·¯ÔÓ‰ÚÔÏ·Û›·, Û‡Ó‰ÚÔÌÔ Marfan, Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ˘Ôı˘ÚÂÔÂȉÈÛÌfi, ‚ÏÂÓÓÔÔÏ˘Û·Î¯·ÚȉÒÛÂȘ, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· Î.¿. (21). ™Â ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÔÈ Û˘¯Ó¤˜ ·ÔÊÚ·ÎÙÈΤ˜ ÎÚ›ÛÂȘ Ú¤ÂÈ Ó· ÂÁ›ÚÔ˘Ó ÙËÓ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜, ‰ÈfiÙÈ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Û ˘ÔÍ·ÈÌ›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (22,23). µ. ÃÚfiÓÈ· ·Ó·Ó¢ÛÙÈο ÚÔ‚Ï‹Ì·Ù· ™Â ÌÂÚÈΤ˜ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ, ÔÈ Ê˘ÛÈÔÏÔÁÈΤ˜ ÌÂÙ·‚ÔϤ˜ Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙÔÓ ‡ÓÔ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ·ÂÚÈÛÌfi Î·È ÛÙËÓ ·ÓÙ·ÏÏ·Á‹ ÙˆÓ ·ÂÚ›ˆÓ, ¯ˆÚ›˜ ÔÈ ·ÛıÂÓ›˜ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ‹ ÎÂÓÙÚÈ΋˜ ¿ÓÔÈ·˜. ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ·È‰È¿ Ì ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈ΋ Ó¢ÌÔÓÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ ‰˘ÛΛÓËÙˆÓ ÎÚÔÛÛÒÓ, ‰È¿ÌÂÛÔ˘ Ù‡Ô˘ Ó¢ÌÔÓÔ¿ıÂÈ· Î·È ¿ÛıÌ·. ·) µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·: ∏ ÌÂϤÙË ‡ÓÔ˘ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË ÛÙ· ·È‰È¿ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ¯ÔÚ‹ÁËÛË Ô͢ÁfiÓÔ˘ ÁÈ· Ó· ‰È·ÈÛÙˆı› ·Ó

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¶·È‰È·ÙÚÈ΋ 2001;64:551-556

ÙÔ ¯ÔÚËÁÔ‡ÌÂÓÔ Ô͢ÁfiÓÔ Â›Ó·È Â·ÚΤ˜ ÁÈ· Ó· ‰È·ÙËÚ› ÙÔÓ ÎÔÚÂÛÌfi Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ >92% ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ∫ÏÈÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ‰È·Ù‹ÚËÛË ÙÔ˘ SaO2 >92% Û ‚Ú¤ÊË Ì ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›· Û˘Óԉ‡ÂÙ·È Ì ÈηÓÔÔÈËÙÈÎfiÙÂÚË ·Ó¿Ù˘ÍË (24). ∂Ȃ‚ÏË̤ÓË, Â›Û˘, Â›Ó·È Ë ÌÂϤÙË ‡ÓÔ˘ ÛÙÔ ÛÙ¿‰ÈÔ ÚÈÓ ÙË ‰È·ÎÔ‹ ¯ÔÚ‹ÁËÛ˘ Ô͢ÁfiÓÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜. ™Ù· ·È‰È¿, ÛÙ· ÔÔ›· ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ô͢ÁfiÓÔ˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÈÏÔΤ˜ fiˆ˜ Ó¢ÌÔÓÈ΋ ηډ›·, ηı˘ÛÙ¤ÚËÛË Ù˘ ·‡ÍËÛ˘, ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ‡ÓÔ ‹ ÛËÌ›· ¿ÓÔÈ·˜, Â›Ó·È ··Ú·›ÙËÙË Ë ¿ÌÂÛË Î·Ù·ÁÚ·Ê‹ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηٿ ÙÔÓ ‡ÓÔ. ‚) πÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜: ªÂϤÙË ‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È ÛÙ· ·È‰È¿ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, Ù· ÔÔ›· ‰È·ÙËÚÔ‡Ó PaO2 <70 mmHg ‹ ÎÔÚÂÛÌfi ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ <95% ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ‰ÈfiÙÈ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ÛËÌ·ÓÙÈ΋˜ ˘ÔÍ·ÈÌ›·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (25). ∆· ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ‚·Ú‡ÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ‹ ÔÈ ·Ú¿ÌÂÙÚÔÈ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÈηÓÔÔÈËÙÈÎÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÔÍ·ÈÌ›·˜ ÛÙÔÓ ‡ÓÔ (26,27). ∏ ÌÂÚÈ΋ ›ÂÛË Ô͢ÁfiÓÔ˘ ÛÙÔ ·›Ì· ÌÔÚ› Ì ÌÂÁ·Ï‡ÙÂÚË ·ÎÚ›‚ÂÈ· Ó· ·ÓȯÓ‡ÛÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÍ·ÈÌ›·˜ ηٿ ÙÔÓ ‡ÓÔ. ∞ÛıÂÓ›˜ Û ÂÁÚ‹ÁÔÚÛË Ì PaO2 <60 mmHg Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó SaO2 <90% ÁÈ· ‰È¿ÛÙËÌ· >80% Ù˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ‡ÓÔ˘. ∞ÓÙ›ıÂÙ·, ·ÛıÂÓ›˜ Û ÂÁÚ‹ÁÔÚÛË Ì PaO2 <70 mmHg ¤¯Ô˘Ó SaO2 <90% ÁÈ· ‰È¿ÛÙËÌ· ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ 20% Ù˘ Û˘ÓÔÏÈ΋˜ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ‡ÓÔ˘ (7). ∞ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ¿ÓÔȘ ‰ÂÓ Â›Ó·È Û˘Ó‹ıÂȘ Û ·È‰È¿ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ Ì ÂÍ·›ÚÂÛË ÙÔ˘˜ ·ÛıÂÓ›˜ ÂΛÓÔ˘˜ Ô˘ ¤¯Ô˘Ó ÚÈÓÈÎÔ‡˜ Ôχԉ˜. °È· Ù· ·È‰È¿ Ì ¿ÏϘ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ (.¯. Û‡Ó‰ÚÔÌÔ ‰˘ÛΛÓËÙˆÓ ÎÚÔÛÛÒÓ, ¯ÚfiÓÈ· ‰È¿ÌÂÛË Ó¢ÌÔÓÔ¿ıÂÈ· Î.¿.) ‰ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê›˜ Ô‰ËÁ›Â˜ ·Ó¿ÏÔÁ˜ ·˘ÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó Ù· ·È‰È¿ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ. ∏ ÌÂϤÙË, fï˜, Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙÔÓ ‡ÓÔ Ê·›ÓÂÙ·È fiÙÈ ÂӉ›ÎÓ˘Ù·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂΉËÏÒÓÔ˘Ó ˘ÔÍ·ÈÌ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ÏfiÁˆ ÎÈÓ‰‡ÓÔ˘ Âȉ›ӈÛ˘ Ù˘ ˘ÔÍ·ÈÌ›·˜ ηٿ ÙÔÓ ‡ÓÔ (28). Á) ÕÛıÌ·: OÈ ÙÈ̤˜ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ‰ÂÈÎÙÒÓ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÎÔÏÔ˘ıÔ‡Ó ÎÈÚο‰ÈÔ Ú˘ıÌfi. OÈ ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙȘ 4 .Ì., ·ÏÏ¿ Ë ‰È·Î‡Ì·ÓÛ‹ ÙÔ˘˜ ÛÙ· ˘ÁÈ‹ ¿ÙÔÌ· Â›Ó·È ÌÈÎÚ‹ Î·È ¯ˆÚ›˜ ÂÈÙÒÛÂȘ ÛÙÔÓ ·ÂÚÈÛÌfi (29). ™Â ·ÛıÂÓ›˜ Ì ¿ÛıÌ·, Ë ‰È·Î‡Ì·ÓÛË ·˘Ù‹ Â›Ó·È ÛËÌ·ÓÙÈ΋, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¤¯Ô˘Ó Û˘¯Ó¿ ‚‹¯· Î·È Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘

554

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Ó‡¯Ù·˜ (Ó˘ÎÙÂÚÈÓfi ¿ÛıÌ·) (30). ∂ÎÙfi˜ ·fi ÙÔÓ ÎÈÚο‰ÈÔ Ú˘ıÌfi Î·È Ë ›‰È· Ë ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ‡ÓÔ˘ Èı·ÓfiÓ ÂÈ‚·Ú‡ÓÂÈ ÙËÓ ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· Û ·ÛıÌ·ÙÈο ·È‰È¿, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ˘ÔÍ·ÈÌ›· (31). ¶ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ Û¿ÓÈ· ÂӉ›ÎÓ˘Ù·È Û ·È‰È¿ Ì ӢÎÙÂÚÈÓfi ¿ÛıÌ·. ∏ ÌÂϤÙË ‡ÓÔ˘ ÂӉ›ÎÓ˘Ù·È ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· Ó˘ÎÙÂÚÈÓÔ‡ ¿ÛıÌ·ÙÔ˜ Ô˘ ‰ÂÓ ÂϤÁ¯ÔÓÙ·È, ·Ú¿ ÙË ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹, ηıÒ˜ Î·È ÛÙ· ·È‰È¿ Ô˘ ¤¯Ô˘Ó Û˘¯ÓÔ‡˜ ÚˆÈÓÔ‡˜ ÔÓÔÎÂÊ¿ÏÔ˘˜ ‹ Ó¢ÌÔÓÈ΋ ηډ›·. °. ÃÚfiÓÈ· Ó¢ÚÔÌ˘ïο ÓÔÛ‹Ì·Ù· ™Â ·È‰È¿ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ (.¯. Û‡Ó‰ÚÔÌÔ Arnold Chiari), ÙÚ·˘Ì·ÙÈÛÌfi Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, Ì˘ï΋ ‰˘ÛÙÚÔÊ›·, ÓˆÙÈ·›· Ì˘ï΋ ·ÙÚÔÊ›·, Û˘ÁÁÂÓ›˜ ÌÂÙ·‚ÔÏÈΤ˜ ‹ ÌÈÙÔ¯ÔÓ‰ÚȷΤ˜ Ì˘Ô¿ıÂȘ, Ì˘·Ûı¤ÓÂÈ·, Ï¢ÎÔ‰˘ÛÙÚÔʛ˜, ÔÏ˘Ó¢ÚÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ Guillain Barre, ÔÏÈÔÌ˘ÂÏ›Ùȉ· Â›Ó·È Èı·ÓfiÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙÔÓ ‡ÓÔ, ȉȷ›ÙÂÚ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ REM ‡ÓÔ˘, ÏfiÁˆ ·ÔÚÚ‡ıÌÈÛ˘ ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ ·Ó·ÓÔ‹˜ Î·È Âȉ›ӈÛ˘ Ù˘ Ì˘ï΋˜ ˘ÔÙÔÓ›·˜ (32,33). ∏ ˘ÔÙÔÓ›· ÛÙÔ˘˜ Ê·Ú˘ÁÁÈÎÔ‡˜ Ì˘˜ Ô‰ËÁ› Û ·‡ÍËÛË ÙˆÓ ·ÓÙÈÛÙ¿ÛÂˆÓ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È ÂÌÊ¿ÓÈÛË ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ (34). ∆· ·È‰È¿ Ì Ó¢ÚÔÌ˘ïΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó Î·È ÙÔ ‰È¿ÊÚ·ÁÌ· (.¯. ÓˆÙÈ·›· Ì˘ï΋ ·ÙÚÔÊ›·, Ì˘Ô¿ıÂȘ, οΈÛË Ù˘ ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘) ¤¯Ô˘Ó ÂÈϤÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ˘Ô·ÂÚÈÛÌÔ‡ ‹ ¿ÓÔÈ·˜ ηٿ ÙÔ REM ‡ÓÔ, Ê¿ÛË Î·Ù¿ ÙËÓ ÔÔ›· Ë ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∆· ·Ú¯Èο Â˘Ú‹Ì·Ù· ÛÙ· ÓÔÛ‹Ì·Ù· ·˘Ù¿ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È· ˘ÂÚηÓ›· Î·È ÙÒÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ. ªÂϤÙË ‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÔÔÈÔ‰‹ÔÙ ·fi Ù· Û˘ÌÙÒÌ·Ù· ‹ Ù· ÎÏÈÓÈο ÛËÌ›· Ô˘ ı¤ÙÔ˘Ó ÙËÓ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡. ∆ÔÓ›˙ÂÙ·È fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì Ó¢ÚÔÌ˘˚ο ÓÔÛ‹Ì·Ù· Î·È ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ¿ÓÔÈ· ‹ ˘Ô·ÂÚÈÛÌfi Â›Ó·È ‰˘Ó·Ùfi Ó· ÌËÓ ÂΉËÏÒÓÔ˘Ó ıÔÚ˘‚Ò‰Ë ·Ó·ÓÔ‹ ÏfiÁˆ Ù˘ Û˘Ó˘¿Ú¯Ô˘Û·˜ Ì˘˚΋˜ ·‰˘Ó·Ì›·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ·Ô˘Û›· Ù˘ ‰ÂÓ Ú¤ÂÈ Ó· ·ÔÌ·ÎÚ‡ÓÂÈ ·fi ÙËÓ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ¿ÏϘ ÂӉ›ÍÂȘ (35). π‰È·›ÙÂÚ· ÛÎfiÈÌË ÎÚ›ÓÂÙ·È Ë ÌÂϤÙË ÙˆÓ ·ÛıÂÓÒÓ Ì ÛËÌ·ÓÙÈο ÂÈ‚·Ú˘Ì¤ÓË ·Ó·Ó¢ÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ (‚›·ÈË ˙ˆÙÈ΋ ¯ˆÚËÙÈÎfiÙËÙ· FVC <40%, ̤ÁÈÛÙË ÂÈÛÓ¢ÛÙÈ΋ ›ÂÛË PIP <15 cmH2O). ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, Ë ÌÂϤÙË ‡ÓÔ˘


¶·È‰È·ÙÚÈ΋ 2001;64:551-556

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˘ï΋ ·‰˘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¿ Ì Ó¢ÚÔÌ˘ïο ÓÔÛ‹Ì·Ù· Û˘ÓÈÛÙ¿Ù·È Â›Û˘ Ó· Á›ÓÂÙ·È ÌÂϤÙË ‡ÓÔ˘ ÚÈÓ ÔÔÈ·‰‹ÔÙ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, Ì ÛÎÔfi Ó· ‰È·ÈÛÙˆı› ·Ó ˘¿Ú¯ÂÈ ˘ÔÎÏÈÓÈÎfi˜ ˘Ô·ÂÚÈÛÌfi˜ Ô˘ ÌÔÚ› Ó· ÂȉÂÈÓˆı› Ì ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÈÛıËÛ›·˜ Î·È ·Ó·ÏÁËÙÈÎÒÓ Ê·Ú̿ΈÓ. ¢. ™‡Ó‰ÚÔÌÔ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ ∆Ô Û‡Ó‰ÚÔÌÔ ÎÂÓÙÚÈÎÔ‡ ˘Ô·ÂÚÈÛÌÔ‡ ÌÔÚ›: ·) Ó· Â›Ó·È Û˘ÁÁÂÓ¤˜ Ì ˘Ô·ÂÚÈÛÌfi Ô˘ ÂȉÂÈÓÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ·ÏÏ¿ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‹ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ Û ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· Î·È ‚) Ó· Û˘Óԉ‡ÂÈ ¿ÏϘ ·ı‹ÛÂȘ, 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, οΈÛË ‹ ·ÎÙÈÓÔ‚ÔÏ›· Î·È Û˘ÁÁÂÓ›˜ ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ (36). ªÂϤÙË ‡ÓÔ˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È Û fiÏ· Ù· ·È‰È¿ ÁÈ· Ù· ÔÔ›· ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ˘Ô„›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ ηٷÁÚ·Ê‹ ¯ÚÂÈ¿˙ÂÙ·È Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÁÈ· Ó· ·ÍÈÔÏÔÁÂ›Ù·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ Ù¯ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·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·˜ Û ÓÂÔÁÓ¿ ‹ ‚Ú¤ÊË Ì ·ÏÏ·Á‹ ¯ÚÒÌ·ÙÔ˜, ˘ÔÙÔÓ›· Î·È ÓÈÁÌÔÓ‹, ÙÔ ÔÔ›Ô ÂÎÙÈÌ‹ıËΠˆ˜ ·ÂÈÏËÙÈÎfi ÁÈ· ÙË ˙ˆ‹. ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·˘ÙÒÓ ÔÈΛÏÏÂÈ (ÏÔÈÌÒÍÂȘ, Ó¢ÚÔÏÔÁÈο ‹ ηډÈÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, ηÎÔÔ›ËÛË Î.¿.) (37). ∏ ÌÂϤÙË ‡ÓÔ˘ Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ‚ÚÂÊÒÓ Ì ÂÂÈÛfi‰ÈÔ ¿ÓÔÈ·˜, ·Ó ˘¿Ú¯ÂÈ ˘Ô„›· ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜, ‚Ú·‰˘Î·Ú‰›·˜ ‹ ÎÂÓÙÚÈ΋˜ ¿ÓÔÈ·˜. ∏ ÔÏ˘·Ú·ÌÂÙÚÈ΋ ÌÂϤÙË ‡ÓÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ‡ÓÔ˘, Ì ¤Ó·ÚÍË ÙË Û˘Ó‹ıË ÒÚ· ηٿÎÏÈÛ˘ ÙÔ˘ ·È‰ÈÔ‡. ªÂϤÙË ‡ÓÔ˘ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Û‡ÓÙÔÌÔ˘ ËÌÂÚ‹ÛÈÔ˘ ‡ÓÔ˘ (38). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ËÌÂÚ‹ÛÈÔ˘ ‡ÓÔ˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ˆÚÒÓ Ê·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó ÈηÓÔÔÈËÙÈ΋ ÂȉÈÎfiÙËÙ·, ·ÊÔ‡ ÙÔ Û‡Ó‰ÚÔÌÔ ·ÔÊÚ·ÎÙÈ΋˜ ¿ÓÔÈ·˜ Ô˘ Ù˘¯fiÓ ‰È·ÈÛÙÒÓÂÙ·È, ÂȂ‚·ÈÒÓÂÙ·È Ì Ӣ¯ÙÂÚÈÓ¤˜ ÌÂϤÙ˜ ‡ÓÔ˘ (38). º˘ÛÈÔÏÔÁÈ΋, fï˜, ÌÂϤÙË Ù˘ ·Ó·ÓÔ‹˜ ηٿ ÙÔÓ ËÌÂÚ‹ÛÈÔ ‡ÓÔ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙËÓ ‡·ÚÍË ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·ÓÔ‹˜

Paediatriki 2001;64:551-556

Ô˘ ÌÔÚ› Ó· ·ÔÎ·Ï˘ÊıÔ‡Ó Ì ÌÂϤÙË Ó˘¯ÙÂÚÈÓÔ‡ ‡ÓÔ˘ (38). ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÁÈ· ÙË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË Ù˘ ÌÂϤÙ˘ ËÌÂÚ‹ÛÈÔ˘ ‹ Ó˘ÎÙÂÚÈÓÔ‡ ‡ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ¤¯ÂÈ ÚÔËÁËı› Ë ¯ÔÚ‹ÁËÛË Î·Ù¢ӷÛÙÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ ‹ ÛÙ¤ÚËÛË ‡ÓÔ˘ (39,40). ªÂ ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ˘¿Ú¯Ô˘Û˜ Ô‰ËÁ›Â˜, Â›Ó·È ·ÚÎÂÙ‹ Ë ÌÂϤÙË ÙÔ˘ ‡ÓÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ ÌfiÓÔ Ó‡¯Ù·˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË, ¯ˆÚ›˜ fï˜ Ë Ô‰ËÁ›· ·˘Ù‹ Ó· ¤¯ÂÈ ÂȂ‚·Èˆı› Ì ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ™˘Ì¤Ú·ÛÌ· ∞fi ÙÔ 1976, fiÙ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ Ô Guilleminault ÂÚȤÁÚ·„ ·È‰È¿ Ì ·ÔÊÚ·ÎÙÈ΋ ¿ÓÔÈ·, ¤¯ÂÈ ÛËÌÂȈı› ÛËÌ·ÓÙÈ΋ ÂͤÏÈÍË ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ·Ó·ÓÔ‹˜ ÛÙ· ·È‰È¿ ηٿ ÙÔÓ ‡ÓÔ. Œ¯ÂÈ, Â›Û˘, Û˘ÓÂȉËÙÔÔÈËı› ÙfiÛÔ Ë ÛËÌ·Û›· Ù˘ ÌÂϤÙ˘ ÙÔ˘ ‡ÓÔ˘ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÔÈ Î·Ù¿ÏÏËϘ ÂӉ›ÍÂȘ, fiÛÔ Î·È Ë ·Ó¿ÁÎË ÂÚ·ÈÙ¤Úˆ ÂÚ¢ÓËÙÈÎÒÓ ÌÂÏÂÙÒÓ (7,41) Ì ÛÎÔfi ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ ÙˆÓ Û˘Ó‰ÚfiÌˆÓ ·˘ÙÒÓ, fiˆ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Î·È ÙËÓ ÂӉ¯fiÌÂÓË Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ. µÈ‚ÏÈÔÁÚ·Ê›· 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. 8. Teculescu DB, Caillier I, Perrin P, Rebstock E, Rauch A. Snoring in French preschool children. Pediatr Pulmonol 1992;13:239-244. 9. Ali NJ, Pitson DJ, Stranding JR. Snoring, sleep disturbance, and behaviour in 4-5 year olds. Arch Dis Child 1993;68:360-366. 10. Brouillette R, Hanson D, David R, Klemka L, Szatkowski A, Fernbach S et al. A diagnostic approach to suspected obstructive sleep apnea in children. J Pediatr 1984;105:10-14.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-05-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· ªÔ˘ÛÙ¿ÎË ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” B' ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, 115 27, °Ô˘‰› e-mail: march193@hol.gr


¶·È‰È·ÙÚÈ΋ 2001;64:557-564

∞¡∞™∫O¶∏™∏

Paediatriki 2001;64:557-564

REVIEW ARTICLE

∞˘ÙÔ¿ÓÔÛ˜ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ‰ÂÚÌ·ÙÔ¿ıÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ª. ¶··ÎˆÓÛÙ·ÓÙ›ÓÔ˘ - ÷˚‰Â̤ÓÔ˘1, °. ÷˚‰Â̤ÓÔ˜2

Autoimmune bullous diseases of childhood M. Papakonstantinou - Chaidemenou1, G. Chaidemenos2

¶ÂÚ›ÏË„Ë: OÈ ·˘ÙÔ¿ÓÔÛ˜ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ‰ÂÚÌ·ÙÔ¿ıÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Û˘ÓÈÛÙÔ‡Ó Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ÓfiÛˆÓ Ì ȉȷ›ÙÂÚÔ ÂÚ¢ÓËÙÈÎfi ÂӉȷʤÚÔÓ. ∏ ‰È·ÁÓˆÛÙÈ΋ ÙÔ˘˜ ÚÔÛ¤Ï·ÛË Â›Ó·È ÔÏϤ˜ ÊÔÚ¤˜ ‰‡ÛÎÔÏË, ȉȷ›ÙÂÚ· ÛÙÔÓ “·Ó˘Ô„›·ÛÙÔ” ÁÈ·ÙÚfi. OÈ ·ÛıÂÓ›˜ ηٿ ηÓfiÓ· ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙÔ ‰ÂÚÌ·ÙÔÏfiÁÔ, ·ÏÏ¿ ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÌÔÚ› Ó· ÂÈÛÎÂÊıÔ‡Ó ·Ú¯Èο ÙÔÓ ·È‰›·ÙÚÔ, ÙÔÓ ÁÂÓÈÎfi È·ÙÚfi ‹ ÙÔÓ ÛÙÔÌ·ÙÔÏfiÁÔ. ∏ ¯ÚfiÓÈ· ηÏÔ‹ı˘ ÔÌÊÔÏ˘Á҉˘ ‰ÂÚÌ·ÙÔ¿ıÂÈ· Î·È Ë ÂÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›ÙȘ ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯ÓfiÙÂÚ˜ ÓfiÛÔ˘˜ ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜. ∏ ÚÒÙË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙȘ Ê˘Û·ÏÏȉÔÔÌÊfiÏ˘Á˜ Ì ÂÈÎfiÓ· Ù‡Ô˘ “ÚÔ˙¤ÙÙ·˜”, ÙËÓ ·ÚÔ˘Û›· IgA ÁÚ·ÌÌÈ΋˜ ÂÓ·fiıÂÛ˘ ÛÙËÓ ÂͤٷÛË ÙÔ˘ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ Î·È ÙËÓ Î·Ï‹ ÚfiÁÓˆÛË Ì ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÌÂÙ¿ ÌÂÚÈο ¤ÙË. ∏ ÂÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›ÙȘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙË Û˘ÌÌÂÙÚÈ΋ ÂÌÊ¿ÓÈÛË ÎÓȉˆÙÈÎÒÓ Ï·ÎÒÓ Î·È Ê˘Û·ÏÏ›‰ˆÓ ÛÙÔ ÎÔÚÌ› Î·È Ù· ¿ÎÚ·, ÙÔ Û˘ÓÔ‰fi η‡ÛÔ Î·È ÎÓËÛÌfi, ÙË Û˘Ó‡·ÚÍË Â˘·›ÛıËÙ˘ ÛÙË ÁÏÔ˘Ù¤ÓË ÂÓÙÂÚÔ¿ıÂÈ·˜, ÙË Ì·ÎÚ¿ ÔÚ›· ·Ú¿ ÙËÓ Â˘ÓÔ˚΋ ·¿ÓÙËÛË ÛÙȘ ÛÔ˘ÏÊfiÓ˜. ∏ ÎÔÈÓ‹ ¤ÌÊÈÁ· Â›Ó·È Ôχ Û·ÓÈfiÙÂÚË Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ï·‰·Ú¤˜ ÔÌÊfiÏ˘Á˜ Ô˘ ·Ê‹ÓÔ˘Ó ÂÎÙÂٷ̤Ó˜ ‰È·‚ÚÒÛÂȘ, ÔÈ Ôԛ˜ ‰‡ÛÎÔÏ· ÂÔ˘ÏÒÓÔÓÙ·È, ·fi ÂÒ‰˘Ó˜ ÂÍÂÏÎÒÛÂȘ ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ ΢ڛˆ˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ·fi ÙËÓ ·ÚÔ˘Û›· ·Î·ÓıÔÏ˘ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ ÂͤٷÛË ÙÔ˘ ˘ı̤ӷ ÙˆÓ ÔÌÊÔχÁˆÓ Î·È ÙËÓ ÂÈÊ˘Ï·ÎÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ÚfiÁÓˆÛË, ȉȷ›ÙÂÚ· ÂÊfiÛÔÓ ‰ÂÓ ‰Ôı› ¤ÁηÈÚ· Ë Î·Ù¿ÏÏËÏË ·ÁˆÁ‹. ∏ ٤ٷÚÙË ÛÔ˘‰·ÈfiÙÂÚË ÓfiÛÔ˜ ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜, ÙÔ ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰È¿Û·ÚÙ˜ ÙÂٷ̤Ó˜ ÔÌÊfiÏ˘Á˜, ÔÈ Ôԛ˜ ·Ê‹ÓÔ˘Ó ‰È·‚ÚÒÛÂȘ Ô˘

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 ∂ÈÌÂÏ‹ÙÚÈ· ∞’, °ÂÓÈÎfi ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô “°. °ÂÓÓËÌ·Ù¿˜”, £ÂÛÛ·ÏÔÓ›ÎË 2 ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜, ¡ÔÛÔÎÔÌÂ›Ô ∞ÊÚÔ‰›ÛÈˆÓ Î·È ¢ÂÚÌ·ÙÈÎÒÓ ¡fiÛˆÓ £ÂÛÛ·ÏÔӛ΢

1 Senior Registrar, General Peripheral Hospital “G. Gennimatas”, Thessaloniki 2 Associate Director, Hospital of Venereal and Skin Diseases, Thessaloniki

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ÂÔ˘ÏÒÓÔÓÙ·È ÁÚ‹ÁÔÚ·. ªÂ ÂÍ·›ÚÂÛË ÙËÓ ¤ÌÊÈÁ·, fiϘ ÔÈ ·˘ÙÔ¿ÓÔÛ˜ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ‰ÂÚÌ·ÙÔ¿ıÂȘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ ·ıÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹ ÛÙÔ Â›Â‰Ô Î·È Î¿Ùˆ ·fi ÙÔÓ ¯ÔÚÈÔÂȉÂÚÌȉÈÎfi Û‡Ó‰ÂÛÌÔ. O ÙÂÏÂ˘Ù·›Ô˜, Ì ÙËÓ ÏËıÒÚ· ÙˆÓ ·ÓÙÈÁfiÓˆÓ Ô˘ ÂÚȤ¯ÂÈ, ÚÔÛʤÚÂÈ ¤Ó· Û˘Ó·Ú·ÛÙÈÎfi ‰›Ô ¤Ú¢ӷ˜ Î·È ÂÊ·ÚÌÔÁ‹˜ ÂȉÈÎÒÓ ıÂÚ·ÂÈÒÓ ÛÙÔ Ì¤ÏÏÔÓ, fiˆ˜ .¯. ÙË ¯ÔÚ‹ÁËÛË ÂÙȉ›ˆÓ Î·È ·ÓÙÈ-ȉÈÔÙ˘ÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ‰È·ÎfiÙÔ˘Ó ÙË Û‡Ó‰ÂÛË ÙÔ˘ ·ıÔÁfiÓÔ˘ ·˘ÙÔ·ÓÙÈÛÒÌ·ÙÔ˜ Ì ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô Â›ÙÔÔ -ÛÙfi¯Ô.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ·˘ÙÔ¿ÓÔÛË, ÔÌÊÔÏ˘Á҉˘, ·È‰È΋, ÁÚ·ÌÌÈ΋ IgA ÓfiÛÔ˜, ÂÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›ÙȘ, ¤ÌÊÈÁ·.

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

OÈ fiÚÔÈ “¤ÌÊÈÍ”, “ÔÌÊfi˜”, “ÔÌÊfiÏ˘Í”, “ÂÌÊÈÁ҉˜” Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û‹ÌÂÚ· Û fiÏÔ ÙÔÓ ÎfiÛÌÔ, ¤ÏÎÔ˘Ó ÙËÓ ÚÔ¤ÏÂ˘Û‹ ÙÔ˘˜ ·fi ÙÔ˘˜ ·Ú¯·›Ô˘˜ ŒÏÏËÓ˜. øÛÙfiÛÔ, Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ Û ‰È·ÊÔÚÂÙÈΤ˜ ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜ ¿Ú¯ÈÛ ӷ ‰È·ÌÔÚÊÒÓÂÙ·È ·fi ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1950, fiÙ·Ó Ô W.F. Lever ¯ÚËÛÈÌÔÔ›ËÛ ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÏËÚÔÊfiÚËÛË ÁÈ· Ó· ʤÚÂÈ Î¿ÔÈ· Ù¿ÍË ÛÙÔ ÂÈÎÚ·ÙÔ‡Ó ¯¿Ô˜ (1). ªÂÚÈο ¤ÙË ·ÚÁfiÙÂÚ·, Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ¤ÌÊÈÁ· Î·È ÙÔ ÂÌÊÈÁÔÂȉ¤˜ ·fi ÙÔ˘˜ Jordon Î·È Beutner, ¤ıÂÛ ÙÔ ‚¿ıÚÔ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ¯·Ú·ÎÙ‹Ú· ÙÔ˘˜ (2). ∆· ÙÂÏÂ˘Ù·›· ¤ÙË, Ë ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ (·ÓÔÛÔ-) ËÏÂÎÙÚÔÓÈ΋˜ ÌÈÎÚÔÛÎfiËÛ˘, Ù˘ ·ÓÔÛÔηı›˙ËÛ˘, Ù˘ ·ÓÔÛÔ·ÔÙ‡ˆÛ˘ Î·È Ù˘ ÌÔÚȷ΋˜ ÁÂÓÂÙÈ΋˜ ·Ó¿Ï˘Û˘ Â¤ÙÚ„ ÙÔÓ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈÎfi ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ÓfiÛˆÓ, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÛÙ· ÔÔ›· ηÙ¢ı‡ÓÔÓÙ·È Ù· ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, ÙËÓ ÎψÓÔÔ›ËÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÁÔÓȉ›ˆÓ Î·È ÙËÓ ·Ú·ÁˆÁ‹ ·Ó·Û˘Ó‰˘·ÛÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ. ∂›Ó·È Ê·ÓÂÚfi fiÙÈ Ë ·ÚÔ˘Û›· Ê˘Û·ÏÏ›‰ˆÓ ‹ ÔÌÊÔχÁˆÓ, ·ÎfiÌË Î·È ˆ˜ ÚˆÙÔÁÂÓÒÓ ÂΉËÏÒÛÂˆÓ ÓfiÛÔ˘, ‰ÂÓ Û˘ÓÈÛÙ¿ ·ÚÔ˘Û›· ·˘ÙÔ¿ÓÔÛ˘ ¿ıËÛ˘. ¶ÔÈÎÈÏ›· Ì˯·ÓÈÎÒÓ, ıÂÚÌÈÎÒÓ (.¯. ¤Áη˘Ì·), ÎÏËÚÔÓÔÌÈÎÒÓ (.¯. ÂȉÂÚÌfiÏ˘ÛË), Ê·ÚÌ·ÎÈÎÒÓ, ÌÂÙ·‚ÔÏÈÎÒÓ (.¯. ÔÚÊ˘Ú›·), ÌÈÎÚÔ‚È·ÎÒÓ (.¯. ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô), ÈÈÎÒÓ (.¯. ¤Ú˘) Î·È ¿ÏÏˆÓ ·ÈÙ›ˆÓ (¶›Ó·Î·˜ 1) ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· Ê˘Û·ÏÏȉÔÔÌÊÔÏ˘ÁÒ‰Ô˘˜ ÂÍ·Óı‹Ì·ÙÔ˜. OÈ ·˘ÙÔ¿ÓÔÛ˜ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ‰ÂÚÌ·ÙÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó Ì›· ˘ÔÔÌ¿‰·, Ë ÔÔ›· ÂӉȷʤÚÂÈ Î¿ı ÎÏÈÓÈÎfi ÁÈ·ÙÚfi. O ·È‰›·ÙÚÔ˜, Ô ÔÔ›Ô˜ Û˘¯Ó¿ ·ÔÙÂÏ› ÙÔÓ ÚÒÙÔ ÁÈ·ÙÚfi ÛÙÔÓ ÔÔ›Ô ·¢ı‡ÓÔÓÙ·È ÔÈ ÁÔÓ›˜ ÙˆÓ ÌÈÎÚÒÓ

·ÛıÂÓÒÓ, ı· ˘Ô„È·ÛÙ› ÙË ÓfiÛÔ ·fi ÙËÓ ·ÚÔ˘Û›· ÂÎÙÂÙ·Ì¤ÓˆÓ ‹/Î·È Û˘ÌÌÂÙÚÈÎÒÓ Ê˘Û·ÏÏ›‰ˆÓ Î·È ÔÌÊÔχÁˆÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·È ÂÂÎÙ›ÓÔÓÙ·È Î·Ù¿ ÂÎı‡ÛÂȘ, Û˘¯Ó¿ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÚ˘ıËÌ·ÙÒ‰ÂȘ, ÎÓȉˆÙÈÎfiÌÔÚʘ ϿΘ, ·fi ÙȘ ‰È·‚ÚÒÛÂȘ ÛÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ·fi ÙËÓ ·Ô˘Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·È ÙËÓ ·ÓÙ›ÛÙ·Û‹ ÙÔ˘˜ ÛÙËÓ ÙÔÈ΋ ıÂÚ·›·, ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È ·ÓÙÈ-ÈÛÙ·ÌÈÓÈÎÒÓ. ∫·ÙˆÙ¤Úˆ ·Ó·Ï‡ÔÓÙ·È Ù· ÎÏÈÓÈο, ·ÈÙÈÔ·ıÔÁÂÓÂÙÈο, ÈÛÙÔÏÔÁÈο, ·ÓÔÛÔ·ıÔÏÔÁÈο Î·È ıÂÚ·¢ÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ‰ÂÚÌ·ÙÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÙˆÓ ÔÔ›ˆÓ Ù· ·ÚÈ· ‰È·ÊÔÚÈο ÁÓˆÚ›ÛÌ·Ù· ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.

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∫·ÏÔ‹ı˘ ¯ÚfiÓÈ· ÔÌÊÔÏ˘Á҉˘ ‰ÂÚÌ·ÙÔ¿ıÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (Chronic bullous dermatosis of childhood) ∞ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ÂÎÚfiÛˆÔ ÙˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ‰ÂÚÌ·ÙÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ‰ÈfiÙÈ - Ì ÂÍ·›ÚÂÛË ÙËÓ ¶Ôψӛ· - ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ·fi fiϘ ÙȘ ¿ÏϘ ·ı‹ÛÂȘ ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ (3). ∏ ÓfiÛÔ˜ ·ÔηÏÂ›Ù·È Â›Û˘ IgA ÁÚ·ÌÌÈ΋ ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ‰ÈfiÙÈ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ‡ÚËÌ· Â›Ó·È Ô ÁÚ·ÌÌÈÎfi˜ ÊıÔÚÈÛÌfi˜ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó·˜ (µª) Ù˘ ÂȉÂÚÌ›‰·˜ Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ (∂ÈÎfiÓ· 1). ∂ΉËÏÒÓÂÙ·È ÌÂٷ͇ ÙÔ˘ 1Ô˘ Î·È 10Ô˘ ¤ÙÔ˘˜, Û˘ÓËı¤ÛÙÂÚ· ÚÈÓ ÙÔ 6Ô ¤ÙÔ˜, Ì ÙÂٷ̤Ó˜ ÔÌÊfiÏ˘Á˜ ΢ڛˆ˜ ÛÙÔ ÚfiÛˆÔ Î·È ÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ (4) (∂ÈÎfiÓ· 2). OÈ ‚Ï¿‚˜ ÌÔÚÔ‡Ó Ó· ÂÂÎÙ·ıÔ‡Ó Û fiÏÔ ÙÔ ÛÒÌ· Ì ·Û‡ÌÌÂÙÚË ‰È¿Ù·ÍË Î·È ÙË ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚÊ‹ ÙˆÓ ÂÈÌ‹ÎˆÓ ÔÌÊÔχÁˆÓ Î·È ÙˆÓ Û¯ËÌ·ÙÈÛÌÒÓ Ù‡Ô˘ “ÚÔ˙¤ÙÙ·˜” (∂ÈÎfiÓ· 3). OÈ ÙÂÏÂ˘Ù·›Â˜


¶·È‰È·ÙÚÈ΋ 2001;64:557-564

Paediatriki 2001;64:557-564

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ÙˆÓ Û˘ÓËı¤ÛÙÂÚˆÓ Ê˘Û·ÏÏȉÔ-ÔÌÊÔÏ˘Áˆ‰ÒÓ ‰ÂÚÌ·ÙÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ 1. §ÔÈÌÒ‰ÂȘ: ·) ∞fi ‚·ÎÙËÚ›‰È·: ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô (¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, ‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜), ‰ÂÚÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ Û˘ÌÌÂÙÔ¯‹ (·fi „¢‰ÔÌÔÓ¿‰·, ÏÈÛÙ¤ÚÈ·, ÎÏÂÌÛȤϷ, ·ÈÌfiÊÈÏÔ Î.¿.), Û‡ÊÈÏË, ÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ·ÔÊÔÏȉˆÙÈÎfi ‰ÂÚÌ·ÙÈÎfi Û‡Ó‰ÚÔÌÔ (SSSS) ‚) ∞fi ÈÔ‡˜: ¤Ú˘ ·Ïfi˜, ·ÓÂÌ¢ÏÔÁÈ¿, ÓfiÛÔ˜ ¯ÂÈÚfi˜-Ô‰fi˜-ÛÙfiÌ·ÙÔ˜ Á) ∞fi ̇ÎËÙ˜: ÌÔÓÈÏ›·ÛË ‰) ∞fi ·Ú¿ÛÈÙ·: „ÒÚ· 2. ªË¯·ÓÈο Î·È ıÂÚÌÈο ·›ÙÈ·: ¤Áη˘Ì·, ı˘Ï·Î›ÙȘ, ȉÚÒ·, Ó‡ÁÌ·Ù· ÂÓÙfiÌˆÓ 3. OÚÌÔÓÈο ·›ÙÈ·: ÓÂÔÁÓÈ΋ ·ÎÌ‹ 4. º¿Ú̷η: ‚ÚˆÌÈÔ‡¯·, Ȉ‰ÈÔ‡¯· Î.Ï. 5. ∂Í ˘ÂÚ¢·ÈÛıËÛ›·˜: ÔχÌÔÚÊÔ ÂÚ‡ıËÌ· 6. ™˘ÁÁÂÓ›˜: Û˘ÁÁÂÓ‹˜ ÔÌÊÔÏ˘Á҉˘ ÂȉÂÚÌfiÏ˘ÛË, ÔÌÊÔÏ˘Á҉˘ ȯı‡·ÛË 7. ∞fi ÂÓ˙˘ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜: ÔÚÊ˘Ú›Â˜ 8. ∞fi ¿ÏÏ· ·›ÙÈ·: Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË, ÂÓÙÂÚÔ·ıËÙÈ΋ ·ÎÚÔ‰ÂÚÌ·Ù›ÙȘ, ÊÏ˘ÎÙ·ÈÓ҉˘ „ˆÚ›·ÛË, ·ÎÚ¿ÙÂÈ· ÌÂÏ·Ó›Ó˘ (Incontinentia pigmenti) Î.¿. 9. ∞ÁÓÒÛÙÔ˘ ·ÈÙ›·˜: ·ÎÚÔÊÏ˘ÎÙ·›ÓˆÛË Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÙÔÍÈÎfi ÂÚ‡ıËÌ·, ˆÛÈÓÔÊÈÏÈ΋ ÊÏ˘ÎÙ·ÈÓ҉˘ ı˘Ï·Î›ÙȘ (N. Ofuzi), ·ÚÔ‰È΋ ÊÏ˘ÎÙ·ÈÓ҉˘ ÌÂÏ¿ÓˆÛË 10. ∞˘ÙÔ¿ÓÔÛÔ˘ ¯·Ú·ÎÙ‹Ú·: ¯ÚfiÓÈ· ηÏÔ‹ı˘ ÔÌÊÔÏ˘Á҉˘ ‰ÂÚÌ·ÙÔ¿ıÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÂÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›ÙȘ, ¤ÌÊÈÁ·, ÂÌÊÈÁÔÂȉ¤˜ (ÔÌÊÔÏ˘Á҉˜, Ô˘ÏˆÙÈÎfi), ÔÌÊÔÏ˘Á҉˘ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, Â›ÎÙËÙË ÔÌÊÔÏ˘Á҉˘ ÂȉÂÚÌfiÏ˘ÛË

‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙË Û˘ÚÚÔ‹ Ó¤ˆÓ Ê˘Û·ÏÏ›‰ˆÓ Á‡Úˆ ·fi ÂÊÂÏÎȉÔÔÈË̤ÓË, È·ı›۷ ·Ï·ÈfiÙÂÚË ‚Ï¿‚Ë (3,4). H ÓfiÛÔ˜ ¤¯ÂÈ Û˘Ó‹ıˆ˜ Ù·¯Â›· ÂÈÛ‚ÔÏ‹ Î·È ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ÁÂÓÈο Û˘ÌÙÒÌ·Ù·. ∏ ÚÔÛ‚ÔÏ‹ ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ Â›Ó·È Û˘¯Ó‹, ·ÏÏ¿ ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ˘ÔÎÂÈÌÂÓÈΤ˜ ÂÓԯϋÛÂȘ (3,5). ∏ ÈÛÙÔ·ıÔÏÔÁÈ΋ ÂͤٷÛË ÙˆÓ ÚfiÛÊ·ÙˆÓ ‚Ï·‚ÒÓ ‰Â›¯ÓÂÈ ˘ÔÂȉÂÚÌȉÈ΋ ÔÌÊfiÏ˘Á· Ì ˆÛÈÓfiÊÈÏ· Î·È Ô˘‰ÂÙÂÚfiÊÈÏ·. ∞Ó¿ÏÔÁË ÂÈÎfiÓ· ÌÔÚÔ‡Ó Ó· ÂÌÊ·Ó›˙Ô˘Ó Î·È ÔÈ ¿ÏϘ ˘ÔÂȉÂÚÌȉÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ ÔÌÊÔÏ˘ÁÒ‰ÂȘ ·ı‹ÛÂȘ, fiˆ˜ ÙÔ ÂÌÊÈÁÔÂȉ¤˜ (ÔÌÊÔÏ˘Á҉˜, Ô˘ÏˆÙÈÎfi, ‰ÂÚÌÔÏ˘ÙÈÎfi) Î·È Ë ÂÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›ÙȘ. ∂Ô̤ӈ˜, ··Ú·›ÙËÙË ÁÈ· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È Ë ÂͤٷÛË ÙÔ˘ ÂÚÈ‚Ï·‚ÈÎÔ‡ ‰¤ÚÌ·ÙÔ˜ Ì ÙËÓ Ù¯ÓÈ΋ 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¤ÛÂȘ Ì ÙË ÌÔÚÊ‹ ÁÚ·ÌÌÈ΋˜ ÂÓ·fiıÂÛ˘ IgA ηٿ Ì‹ÎÔ˜ Ù˘ µª. ™ÙȘ ¿ÏϘ ÌÔÚʤ˜ ÙÔ˘ ÂÌÊÈÁÔÂȉԇ˜ ˘¿Ú¯Ô˘Ó ÌfiÓÔ ‹ ΢ÚÈ·Ú¯Ô‡Ó ÔÈ ÂÓ·Ôı¤ÛÂȘ ÛÙË µª ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ¿ÏϘ Ù¿ÍÂȘ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ȉȷ›ÙÂÚ· ÛÙȘ IgG Î·È ÙÔ ÙÌ‹Ì· C3 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜, ÂÓÒ ÛÙËÓ ÂÚËÙÔÂȉ‹ ‰ÂÚÌ·Ù›Ùȉ· ÔÈ ÂÓ·Ôı¤ÛÂȘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙȘ ıËϤ˜ ÙÔ˘ ¯ÔÚ›Ô˘ (6). IgA ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ηٿ Ù˘ µª ˘¿Ú¯Ô˘Ó ÛÙÔÓ ÔÚfi ÔÛÔÛÙÔ‡ 70% ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ Ì ηÏÔ‹ıË ¯ÚfiÓÈ· ÔÌÊÔÏ˘ÁÒ‰Ë ‰ÂÚÌ·ÙÔ¿ıÂÈ· (5). ∏ ̤ıÔ‰Ô˜ Ù˘ ·ÓÔÛÔ·ÔÙ‡ˆÛ˘ (immunoblotting) ¤¯ÂÈ ·Ôηχ„ÂÈ fiÙÈ ÙÔ ·ÓÙÈÁfiÓÔ ÚÔ˜ ÙÔ ÔÔ›Ô Î·Ù¢ı‡ÓÔÓÙ·È Ù· ·ıÔÏÔÁÈο ·˘ÙÔ·ÓÙÈÛÒ-

Ì·Ù· Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 285 KD Î·È Â›Ó·È Ù·˘ÙfiÛËÌÔ Ì ·˘Ùfi Ù˘ ÓfiÛÔ˘ IgA ÙˆÓ ÂÓËÏ›ÎˆÓ (7). ¶ÚfiÛÊ·Ù˜, ˆÛÙfiÛÔ, ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÙˆÓ ·Ó·ÁÓˆÚÈ˙fiÌÂÓˆÓ ·˘ÙÔ·ÓÙÈÁfiÓˆÓ, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ ÙËÓ ÚˆÙ½ÓË 97-120 KD, Ô˘ ·ÔηÏÂ›Ù·È LABD I ·ÓÙÈÁfiÓÔ, ·ÏÏ¿ Î·È ¿ÏϘ ÚˆÙ½Ó˜ Ì Ì.‚. 290, 230 ‹ 180 KD (8). ∂ÈϤÔÓ, ÌÂÚÈÎÔ› ·ÛıÂÓ›˜ Ì IgA ÁÚ·ÌÌÈ΋ ÓfiÛÔ ÌÔÚÔ‡Ó Ó· ·ÔÙÂÏÔ‡Ó Ì›· ͯˆÚÈÛÙ‹ ÔÈÎÈÏ›· ÙÔ˘ ÔÌÊÔÏ˘ÁÒ‰Ô˘˜ ÂÌÊÈÁÔÂȉԇ˜, Ë ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÂÈ IgA ·ÓÔÛȷ΋ ·¿ÓÙËÛË (8). ∏ ·Ú·Ù‹ÚËÛË Ì ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ·ÔηχÙÂÈ ‰ÈÏ‹ ÂÓÙfiÈÛË ÙˆÓ ·ÓÔÛÔÂÓ·Ôı¤ÛˆÓ, “Ì ÙËÓ ÂÈÎfiÓ· ηıÚ¤ÙÔ˘”, Â¿Óˆ Î·È Î¿Ùˆ ·fi ÙÔ ˘ÎÓfi ÂÙ¿ÏÈÔ (lamina densa) ÙÔ˘ ¯ÔÚÈÔÂȉÂÚÌȉÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ (7). ∏ ÚfiÁÓˆÛË Ù˘ IgA ÁÚ·ÌÌÈ΋˜ ÓfiÛÔ˘ ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Î·Ï‹, Ì ·˘ÙfiÌ·ÙË ‡ÊÂÛË ÌÂÙ¿ ÌÂÚÈο ¤ÙË. ∏ ¿ıËÛË ÌÔÚ› Ó· ‰È·ÚΤÛÂÈ ÂÚÈÛÛfiÙÂÚÔ ·fi 5 ¤ÙË ÛÙÔ 1/3 ÙˆÓ ·ÛıÂÓÒÓ (9). ¶¿ÓÙˆ˜, ÔÙ¤ ‰ÂÓ ‰È·ÚΛ ¤Ú·Ó Ù˘ ÂÊ˂›·˜. ÀÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ·Ó·ÊÂÚı› ·ÎfiÌË Î·È ÌÂÙ¿ Ì·ÎÚ¿ ÂÚ›Ô‰Ô ‡ÊÂÛ˘, ȉȷ›ÙÂÚ· ÌÂÙ¿ ·fi ÏÔÈÌÒÍÂȘ (3). ∂ÓÒ Ë ÓfiÛÔ˜ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ·ÓÙÈÁfiÓˆÓ 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 Ì ÙËÓ ÚÒÈÌË ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛˆÓ. ¶·Ú¿ÏÏËÏ·, Ë ·ÚÔ˘Û›· ÙÔ˘ TNF2 Û¯ÂÙ›˙ÂÙ·È Ì ̷ÎÚfi¯ÚÔÓË ÔÚ›· Ù˘ ÓfiÛÔ˘ (10). ∏ ÛÔ˘ÏÊfiÓË Û ËÌÂÚ‹ÛÈ· ‰fiÛË 1-2 mg/kg, Û˘Ó‹ıˆ˜ 50 mg ‰È·ÈÚÂ̤ӷ Û ‰‡Ô Ï‹„ÂȘ, ıˆÚ›ٷÈ

559


¶·È‰È·ÙÚÈ΋ 2001;64:557-564

Paediatriki 2001;64:557-564

¶›Ó·Î·˜ 2. ¢È·ÊÔÚÈο ÁÓˆÚ›ÛÌ·Ù· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ·˘ÙÔ¿ÓÔÛˆÓ ÔÌÊÔÏ˘Áˆ‰ÒÓ ‰ÂÚÌ·ÙÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ IgA ÁÚ·ÌÌÈ΋ ÓfiÛÔ˜

∂ÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù.

¶¤ÌÊÈÁ·

™ÙÔȯÂÈÒ‰ÂȘ ‚Ï¿‚˜

º˘Û·ÏÏ›‰Â˜ 1-2 ÂÎÌ., Ì ÂÈÎfiÓ· ÚÔ˙¤ÙÙ·˜

∞ÔÎÂÊ·ÏÈṲ̂Ó˜ ‚Ï·Ù›‰Â˜, ÂÚËÙfiÌÔÚʘ Ê˘Û·ÏÏ›‰Â˜

∆ÔÔÁÚ·Ê›·

∫ÔÚÌfi˜, ÁÏÔ˘ÙÔ›, Á‡Úˆ ·fi ÙÔ ÛÙfiÌ·

™˘ÌÌÂÙÚÈο ÛÙȘ ÂÎÙ·ÙÈΤ˜ ÂÈÊ¿ÓÂȘ ÙˆÓ ¿ÎÚˆÓ, ÒÌÔÈ, Ï·ÈÌfi˜ ∫ÓËÛÌfi˜ Î·È Î·‡ÛÔ˜ ¡·È ∞ÔÎfiÏÏËÛË ÙˆÓ ÎÔÚ˘ÊÒÓ ÙˆÓ ¯ÔÚÈ·ÎÒÓ ıËÏÒÓ, ‰È‹ıËÛË Ì ÔÏ˘ÌÔÚÊ. ∫ÔÎÎÒ‰ÂȘ ÂÓ·Ôı¤ÛÂȘ IgA Î·È C3 ÛÙȘ ÎÔÚ˘Ê¤˜ ÙˆÓ ıËÏÒÓ Î·È ÙË µª ÃÚfiÓÈ·, ›Ûˆ˜ ÂÊ’ fiÚÔ˘ ˙ˆ‹˜ /ηÏÔ‹ı˘ ¢›·ÈÙ· ¯ˆÚ›˜ ÁÏÔ˘Ù¤ÓË, Ì ‹ ¯ˆÚ›˜ ‰·„fiÓË

∂Ò‰˘Ó˜ ‰È·‚ÚÒÛÂȘ ÛÙfiÌ·ÙÔ˜, Ï·‰·Ú¤˜ ÔÌÊfiÏ˘Á˜, ‰˘Û›·Ù˜ ÂÏÎÒÛÂȘ ™˘Ó‹ıˆ˜ ¤Ó·ÚÍË ·fi ÙÔ ÛÙfiÌ· Î·È Â¤ÎÙ·ÛË Û fiÏÔ ÙÔ ÛÒÌ·

™˘ÌÙÒÌ·Ù· Ÿ¯È Û˘Ó‹ıˆ˜ ∂ΉËÏÒÛÂȘ ·fi ÙÔ ¤ÓÙÂÚÔ Ÿ¯È πÛÙÔÏÔÁ›· ÀÔÂȉÂÚÌȉÈ΋ ÔÌÊfiÏ˘Á· Ì ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ÕÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜ °Ú·ÌÌÈ΋ ÂÓ·fiıÂÛË IgA ÛÙË µª ∂ͤÏÈÍË/ÚfiÁÓˆÛË

⁄ÊÂÛË Û 3-4 ¤ÙË/ηÏÔ‹ı˘

£ÂÚ·›·

¢·„fiÓË 25 mg x2 ‹ ÛÔ˘ÏÊ·˘Úȉ›ÓË 500 mg

ıÂÚ·›· ÂÎÏÔÁ‹˜. ¶Èı·Ófiٷٷ, ‚ÔËı¿ ̤ۈ Ù˘ ‰Ú¿Û˘ Ù˘ ÛÙ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·. ∆Ô ·ÔÙ¤ÏÂÛÌ· 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 Ù˘ °Ï˘ÎÔ˙Ô-6-ʈÛÊÔÚÈ΋˜ ·Ê˘‰ÚÔÁÔÓ¿Û˘ Î·È Ô Ù·ÎÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ÌÂı·ÈÌÔÛÊ·ÈÚ›Ó˘ Î·È ÙˆÓ ‰ÈÎÙ˘Ô΢ÙÙ¿ÚˆÓ ÛÙÔ ·›Ì·, ÒÛÙ ӷ ÂÓÙÔÈÛÙ› ÂÁη›Úˆ˜ Ë ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· (5). ∂Ó·ÏÏ·ÎÙÈο ÚÔ˜ ÙË ÛÔ˘ÏÊfiÓË ÌÔÚ› Ó· ¯ÔÚËÁËı› Ë ÛÔ˘ÏÊÔÌÂıÔ͢˘Úȉ·˙›ÓË Û ‰fiÛË 500 mg ËÌÂÚËÛ›ˆ˜. ∫·Ù¿ ÙË ¯ÔÚ‹ÁËÛ‹ Ù˘, Û˘ÓÈÛÙ¿Ù·È Ë Ï‹„Ë ¿ÊıÔÓˆÓ ˘ÁÚÒÓ Î·È Ë ·ÏηÏÈÓÔÔ›ËÛË ÙˆÓ Ô‡ÚˆÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ‚Ï¿‚˘ ÙˆÓ ÓÂÊÚÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ. OˆÛ‰‹ÔÙÂ, ÂÈ‚¿ÏÏÂÙ·È Î¿ı ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ ‹ ‰È·ÎÔ‹˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î¿ı 8-12 Ì‹Ó˜, Ì ÙËÓ ÚÔÛ‰ÔΛ· Ù˘ ÌfiÓÈÌ˘ ·˘ÙfiÌ·Ù˘ ‡ÊÂÛ˘ Ù˘ ÓfiÛÔ˘ (5). ∂ÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›Ùȉ· ∂›Ó·È Ë ÂfiÌÂÓË ÛÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·˘ÙÔ¿ÓÔÛË ÔÌÊÔÏ˘Á҉˘ ‰ÂÚÌ·ÙÔ¿ıÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ Â›ÙˆÛ‹ Ù˘ ÔÈΛÏÏÂÈ ·fi 1,2/100.000 ηÙÔ›ÎÔ˘˜ ÛÙËÓ ∂Ï‚ÂÙ›· ¤ˆ˜ 11/100.000 ÛÙËÓ ∞ÁÁÏ›·, ÌÂ Û˘Ó‹ıË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù· 2 ¤ˆ˜ 7 ¤ÙË (5). ∞ÓÙ›ıÂÙ· ÚÔ˜ ÙËÓ IgA ÁÚ·ÌÌÈ΋ ‰ÂÚÌ·ÙÔ¿ıÂÈ·, ÔÈ ‚Ï¿‚˜ Û˘Óԉ‡ÔÓÙ·È ÛÙ·ıÂÚ¿ ·fi η‡ÛÔ Î·È ÎÓËÛÌfi, ÂÓÙÔ›˙ÔÓÙ·È Û˘ÌÌÂÙÚÈο ÛÙȘ ÂÎÙ·ÙÈΤ˜ ÂÈÊ¿ÓÂȘ ÙˆÓ ¿ÎÚˆÓ, ÙÔ Ï·ÈÌfi, ÙÔ˘˜ ÒÌÔ˘˜, Ù· ÁfiÓ·Ù· Î·È ÙÔ˘˜ ·ÁÎÒÓ˜ (∂ÈÎfiÓ· 4) Ì ÂÚËÙÔÂȉ›˜ Ê˘Û·ÏÏ›‰Â˜ Â¿Óˆ Û ÂÚ˘ıËÌ·ÙÔ-ÔȉËÌ·ÙÒ‰ÂȘ, ÎÓȉˆÙÈÎfiÌÔÚʘ ϿΘ.

560

¶fiÓÔ˜ Ÿ¯È ∂Ó‰ÔÂȉÂÚÌȉÈ΋ ÔÌÊfiÏ˘Á· Ì ·Î·ÓıÔÏ˘ÙÈο ·ÙÙ·Ú· ªÂÛÔ΢ÙÙ¿ÚÈÔ ‰›ÎÙ˘Ô Ì IgG Î·È C3 OÍ›· ‹ ˘ÔÍ›·/‚·ÚÈ¿ ¶Ú‰ÓÈ˙fiÓË ·fi ÙÔ ÛÙfiÌ· 1-2 mg/kg

∆Ô ϤÔÓ È‰È·›ÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÂÚËÙÔÂȉԇ˜ ‰ÂÚÌ·Ù›Ùȉ·˜ 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·ÓÙÈΤ˜ ÂΉËÏÒÛÂȘ ‰˘Û·ÔÚÚfiÊËÛ˘, ·ÏÏ¿ ¯ÚfiÓÈ· ‰È¿ÚÚÔÈ· ‰È·ÈÛÙÒÓÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ 16-50% ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ (3). ∫·ı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, Û·Ó ·ÔÙ¤ÏÂÛÌ· Ù˘ ÂÓÙÂÚÔ¿ıÂÈ·˜, Ì ·fiÎÏÈÛË Ì¤¯ÚÈ -2 ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 15% ÙˆÓ ·ÛıÂÓÒÓ. ∏ ‰˘Û·ÔÚÚfiÊËÛË Á›ÓÂÙ·È Ê·ÓÂÚ‹ Ì ÙË ‰ÔÎÈÌ·Û›· Ù˘ D-͢Ïfi˙˘ Î·È ÙË ÛÙ·ÙfiÚÚÔÈ· ÛÙÔ 30%, ÂÓÒ Ë ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ ·ÔηχÙÂÈ ÌÂÚÈ΋ ‹ ÔÏÈ΋ ·ÙÚÔÊ›· ÛÙÔ 90% ÙˆÓ ÂÚÈÙÒÛˆÓ, ·ÎfiÌË Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ (5). ¢È·Ù·Ú·¯¤˜ ÛÙËÓ ·‰·Ì·ÓÙ›ÓË ÙˆÓ ‰ÔÓÙÈÒÓ fiÌÔȘ Ì ÂΛӘ Ù˘ ÎÔÈÏÈÔο΢ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û·Ó Û˘Ó¤ÂÈ· Ï‹„˘ ÁÏÔ˘Ù¤Ó˘ Û ·ÛıÂÓ›˜ Ì ÂÚËÙÔÂȉ‹ ‰ÂÚÌ·Ù›Ùȉ· (12). ∏ Û˘Û¯¤ÙÈÛË Ù˘ ÂÓÙÂÚÔ¿ıÂÈ·˜ Ù˘ ÙÂÏÂ˘Ù·›·˜ Ì ·˘Ù‹Ó Ù˘ ÎÔÈÏÈÔο΢ Î·È Ë ·Ô˘Û›· Û·ÊÔ‡˜ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È¿ÎÚÈÛ˘ Ù˘ ÂÓÙÂÚÔ¿ıÂÈ·˜ ÙˆÓ ‰‡Ô ·ı‹ÛˆÓ, 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 Ì ȉȷ›ÙÂÚ· ÛÔ‚·Ú‹ Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ ÂÓÙÂÚÔ¿ıÂÈ·˜. ∂Í¿ÓıËÌ· ÂÚËÙÔÂȉԇ˜ ‰ÂÚÌ·Ù›Ùȉ·˜ ÌÔÚ› Ó· ·Ú·ÙËÚËı› ·ÎfiÌË Î·È ÌÂÙ¿ 22 ¤ÙË ·ÚÔ˘Û›·˜ ÎÔÈÏÈÔο΢. ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË Î·È ÙÔ ÔÈΛÏÔ ‰È¿ÛÙËÌ· Ê˘ÛÈÔÏÔÁÈ΋˜ ‰È·ÙÚÔÊ‹˜ Ô˘ ÚÔËÁÂ›Ù·È ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ ‰ÈηÈÔÏÔÁÔ‡ÓÙ·È ·fi ÙÔÓ ·Ó·Áη›Ô ¯ÚfiÓÔ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ÚÔԉ¢ÙÈ΋ Û˘ÁΤÓÙÚˆÛË


¶·È‰È·ÙÚÈ΋ 2001;64:557-564

Paediatriki 2001;64:557-564

∂ÈÎfiÓ· 1. °Ú·ÌÌÈÎfi˜ ÊıÔÚÈÛÌfi˜ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó·˜ Ù˘ ÂȉÂÚÌ›‰·˜ Ì ÙËÓ ·ÓÔÛÔÛÊ·ÈÚ›ÓË IgA (Ù¯ÓÈ΋ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ÛÙÔ ÂÚÈ‚Ï·‚ÈÎfi ‰¤ÚÌ·).

·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ IgA ‹ ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ IgAÁÏÔ˘Ù¤Ó˘ ÛÙÔ ‰¤ÚÌ· ÌÂÙ¿ ·fi ‰È·ÙÚÔÊÈ΋ ¢·ÈÛıËÙÔÔ›ËÛË ÛÙË ÁÏÔ˘Ù¤ÓË (13). ∏ ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÈÎÚÔ·ÔÛÙËÌ¿ÙÈ· ÛÙȘ ıËϤ˜ ÙÔ˘ ¯ÔÚ›Ô˘, ·ÔÙÂÏÔ‡ÌÂÓ· ·fi Ô˘‰ÂÙÂÚfiÊÈÏ· ΢ڛˆ˜ Î·È ÂˆÛÈÓfiÊÈÏ·. ∏ ÂͤٷÛË ÙÔ˘ ˘ÁÈÔ‡˜ ÂÚÈ‚Ï·‚ÈÎÔ‡ ‰¤ÚÌ·ÙÔ˜ Ì ÙË Ì¤ıÔ‰Ô ÙÔ˘ ¿ÌÂÛÔ˘ ·ÓÔÛÔÊıÔÚÈÛÌÔ‡ ‰Â›¯ÓÂÈ ·ıÔÁÓˆÌÔÓÈ΋ ÂÈÎfiÓ·, Ì ÎÔÎÎÒ‰ÂȘ ÂÓ·Ôı¤ÛÂȘ IgA Î·È C3 ÛÙȘ ıËϤ˜ ÙÔ˘ ¯ÔÚ›Ô˘. ∏ ·Ú·Ù‹ÚËÛË Ì ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ·ÔηχÙÂÈ fiÙÈ ÔÈ ÂÓ·Ôı¤ÛÂȘ ·˘Ù¤˜ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ Â›Â‰Ô ÙˆÓ ·Á΢ÚÔ‚ÔÏÔ˘ÛÒÓ ÈÓÒÓ, οو ·fi ÙÔÓ ¯ÔÚÈÔÂȉÂÚÌȉÈÎfi Û‡Ó‰ÂÛÌÔ (14). ∆· ·ÓÙÈÂÓ‰ÔÌ˘Ûȷο ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· ηÙ¢ı‡ÓÔÓÙ·È Î·Ù¿ ÙÔ˘ ÂÓ‰ÔÌ˘Û›Ô˘ ÙˆÓ Ï›ˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ, ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔÓ ÔÚfi ÙÔ˘ 70% ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÚËÙÔÂȉ‹ ‰ÂÚÌ·Ù›Ùȉ· Î·È ÂÓÙÂÚÔ¿ıÂÈ·. ∞ÔÙÂÏÔ‡Ó ¤Ó· ‰Â›ÎÙË ÛÔ‚·ÚfiÙËÙ·˜ Ù˘ ÂÓÙÂÚÈ΋˜ ÓfiÛÔ˘ Î·È ˘Ô¯ˆÚÔ‡Ó Ì ÙËÓ ·˘ÛÙËÚ‹ ÂÊ·ÚÌÔÁ‹ ‰È·ÙÚÔÊ‹˜ ÂχıÂÚ˘ ·fi ÁÏÔ˘Ù¤ÓË (15). ∏ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ÂÈÊ˘Ï·ÎÙÈ΋ ˆ˜ ÚÔ˜ ÙË ‰È¿ÚÎÂÈ¿ Ù˘. ∏ ¢·ÈÛıËÛ›· ÛÙË ÁÏÔ˘Ù¤ÓË ÌÔÚ› Ó· ·Ú·Ì›ÓÂÈ Â’ ·fiÚÈÛÙÔÓ (11). ∏ ÂχıÂÚË ÁÏÔ˘Ù¤Ó˘ ‰›·ÈÙ· ·Ó·Ì¤ÓÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ Ï‹ÚË ‰ÂÚÌ·ÙÈ΋ χηÓÛË ÂÓÙfi˜ ÂÓfi˜

∂ÈÎfiÓ· 2. º˘Û·ÏÏ›‰Â˜ Î·È ÂÊÂÏΛ‰Â˜ ÛÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ ·ÛıÂÓÔ‡˜ Ì IgA ÁÚ·ÌÌÈ΋ ÓfiÛÔ.

¤ÙÔ˘˜, Ôχ ÓˆÚ›ÙÂÚ· ·’ fi,ÙÈ ÛÙËÓ ÂÚËÙÔÂȉ‹ ‰ÂÚÌ·Ù›Ùȉ· ÙˆÓ ÂÓËÏ›ÎˆÓ (16). ∏ ‰·„fiÓË Û ËÌÂÚ‹ÛÈ· ‰fiÛË 0,5-1 mg/kg ÂÈÙ˘Á¯¿ÓÂÈ ¿ÌÂÛË ‚ÂÏÙ›ˆÛË, ·ÏÏ¿ Ë ¿ıËÛË ˘ÔÙÚÔÈ¿˙ÂÈ Ì 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¿Ï˜ ‰˘ÛÎÔϛ˜ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Î·È Ôχ ˘„ËÏfi ÎfiÛÙÔ˜ (5). ∫ÔÈÓ‹ ¤ÌÊÈÁ· ∞˘Ù‹ ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÓfiÛÔ ÙˆÓ ÂÓËϛΈÓ. ∂Ô̤ӈ˜, Ë Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ ÛÙfiÌ· ΢Úȷگ› ‹ ÂÁηÈÓÈ¿˙ÂÈ ÙËÓ fiÏË ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ∂Ò‰˘Ó˜ Î·È ‰˘Û›·Ù˜ ‰È·‚ÚÒÛÂȘ Î·È ÂÏÎÒÛÂȘ ÛÙÔ ‚ÏÂÓÓÔÁfiÓÔ ÙˆÓ ·ÚÂÈÒÓ Î·È Ù· ԇϷ ÌÔÚÔ‡Ó Ó· ·Ú·Ì›ÓÔ˘Ó ÂÓÙÔÈṲ̂Ó˜ Â› Ì‹Ó˜ ÚÈÓ ÂÌÊ·ÓÈÛÙÔ‡Ó ÔÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜, Ï·‰·Ú¤˜, ÂÎÙÂٷ̤Ó˜ ÔÌÊfiÏ˘Á˜, ÔÈ Ôԛ˜ ·Ê‹ÓÔ˘Ó fiÙ·Ó Û¿ÛÔ˘Ó ‰‡ÛÔÛ̘ Î·È ‰˘Û›·Ù˜ ‰È·‚ÚÒÛÂȘ ‰È¿Û·ÚÙ· ÛÙÔÓ ÎÔÚÌfi Î·È Ù· ¿ÎÚ· (∂ÈÎfiÓ· 5). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ì ÙȘ ¿Êı˜, ÙÔ ÔχÌÔÚÊÔ ÂÚ‡ıËÌ· ‹ Ù· ÂÓ·Óı‹Ì·Ù· ·fi ÈÔ‡˜ Â›Ó·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ‰‡ÛÎÔÏË ÛÙÔÓ ÌË “˘Ô„È·Ṳ̂ÓÔ” ÎÏÈÓÈÎfi

561


¶·È‰È·ÙÚÈ΋ 2001;64:557-564

Paediatriki 2001;64:557-564

∂ÈÎfiÓ· 4. ™˘ÌÌÂÙÚÈ΋ ηٷÓÔÌ‹ ‚Ï·‚ÒÓ ÂÚËÙÔÂȉԇ˜ ‰ÂÚÌ·Ù›Ùȉ·˜ ÛÙÔ˘˜ ÒÌÔ˘˜.

∂ÈÎfiÓ· 3. ∂ÈÎfiÓ· ÚÔ˙¤ÙÙ·˜ ‹ ¤ÚÏ·˜.

È·ÙÚfi. ∞fi 14 ÂÚÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙȘ Ôԛ˜ ηٷÁÚ¿ÊËÎÂ Ë ·Ú¯È΋ ‰È¿ÁÓˆÛË, ıˆڋıËΠÂÛÊ·Ï̤ӷ fiÙÈ ¤·Û¯·Ó ·fi ÔχÌÔÚÊÔ ÂÚ‡ıËÌ· 3 ·ÛıÂÓ›˜, ·fi ÂÚËÙÈ΋ Ô˘ÏÔÛÙÔÌ·Ù›Ùȉ· 2, ·fi ÌÔÏ˘ÛÌ·ÙÈÎfi ÎËÚ›Ô 5, ·fi ÙÔÍÈÎfi ÔÌÊÔÏ˘Á҉˜ ÂÍ¿ÓıËÌ· 1 Î·È ÌfiÓÔ Û ̛· ÂÚ›ÙˆÛË ÂÙ¤ıË Ë ÔÚı‹ ‰È¿ÁÓˆÛË Ù˘ ÎÔÈÓ‹˜ ¤ÌÊÈÁ·˜ (17). ∂Âȉ‹ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ô‰ËÁ› Û ËÈfiÙÂÚË Î·È ·ÛʷϤÛÙÂÚË ıÂÚ·›·, ÂÈ‚¿ÏÏÂÙ·È Ô ¤ÏÂÁ¯Ô˜ ηٿ Tzanck Û οı ‡ÔÙË ÂÚ›ÙˆÛË. ∞˘Ùfi˜ Û˘Ó›ÛÙ·Ù·È ÛÙËÓ ÂͤٷÛË ÙÔ˘ ÂȯڛÛÌ·ÙÔ˜ Ù˘ ‚¿Û˘ ÙˆÓ ÂÍÂÏÎÒÛÂˆÓ ‹ ÙˆÓ ÔÌÊÔχÁˆÓ Ì ÙË ¯ÚÒÛË Î·Ù¿ Giemsa. £ÂÙÈÎfi ÁÈ· ÙË ÓfiÛÔ Â‡ÚËÌ· Â›Ó·È Ë ·ÔÎ¿Ï˘„Ë ÂÎÙÂٷ̤Ó˘ ·Î·ÓıfiÏ˘Û˘, ‰ËÏ. χÛ˘ Ù˘ Û˘Ó¤¯ÂÈ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ·Î·ÓıˆÙ‹˜ ÛÙÈ‚¿‰·˜ Ù˘ ÂȉÂÚÌ›‰·˜. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ı· ·Ôηχ„ÂÈ ˘ÂÚ‚·ÛÈ΋ ·Î·ÓıÔÏ˘ÙÈ΋ Ê˘Û·ÏÏ›‰·, ÂÓÒ Ô ¿ÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜ ·fi ˘ÁȤ˜ ‹ ÂÚ˘ıËÌ·Ù҉˜ ‰›Ï· ÛÙËÓ ÔÌÊfiÏ˘Á· ‰¤ÚÌ· ‹ ‚ÏÂÓÓÔÁfiÓÔ ı· ηٷ‰Â›ÍÂÈ ÂÓ·Ôı¤ÛÂȘ IgG Î·È C3 ÛÙ· ÌÂÛÔ΢ÙÙ¿ÚÈ· ‰È·ÛÙ‹Ì·Ù· Ì ÙË ÌÔÚÊ‹ ‰ÈÎÙ‡Ô˘. ∏ ¤ÌÊÈÁ· ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Û¿ÓÈ·. ¶·Ú’ fiÙÈ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÏÈÁfiÙÂÚÔÈ ·fi 80 ·ÛıÂÓ›˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Î·È ‰ÂÓ ¤¯Ô˘Ó ηıÔÚÈÛÙ› standard ıÂÚ·¢ÙÈΤ˜ Ô‰ËÁ›Â˜ (18), Ë ÂÌÂÈÚ›· ·fi ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ÛËÌ·ÓÙÈ΋. ∂ÓÒ ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂȘ ‚ÂÏÙ›ˆÛ˘ Ì ٷ ÙÔÈο ÛÙÂÚÔÂȉ‹, Â›Ó·È Û¯Â‰fiÓ Û›ÁÔ˘ÚË Ë ÙÂÏÈ΋

562

Â¤ÎÙ·ÛË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ Û fiÏÔ ÙÔ ÛÒÌ· Ì ÙȘ Â·ÎfiÏÔ˘ı˜ ηٷÛÙÚÂÙÈΤ˜ ÁÈ· ÙÔÓ ÔÚÁ·ÓÈÛÌfi Û˘Ó¤ÂȘ ·fi ÙȘ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÙȘ ÏÔÈÌÒÍÂȘ. °È’ ·˘Ùfi ÂÈ‚¿ÏÏÂÙ·È Û˘Ó‹ıˆ˜ Ë ¯ÔÚ‹ÁËÛË ˘„ËÏÒÓ ‰fiÛÂˆÓ ÎÔÚÙÈ˙fiÓ˘, 2 mg/kg ÙËÓ Ë̤ڷ Ú‰ÓÈ˙ÔÏfiÓ˘ ‹ ÈÛÔ‰‡Ó·ÌÔ˘ ·fi ÙÔ ÛÙfiÌ·, ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·˙·ıÂÈÔÚ›ÓË. ∏ ΢ÎÏÔÛÔÚ›ÓË Û ‰fiÛË Ô˘ ÌÔÚ› Ó· Êı¿ÓÂÈ Ù· 5 mg/kg ËÌÂÚËÛ›ˆ˜, ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙÔÓ ·ÔÁ·Ï·ÎÙÈÛÌfi ·fi Ù· ÛÙÂÚÔÂȉ‹ Î·È ÛÙËÓ ‡ÊÂÛË Ù˘ ÓfiÛÔ˘ (19). £ÂÙÈÎfiÙÂÚË, fï˜, 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ÔÚ› Ó· ‰È·Îfi„ÂÈ ÙÂÏÈο ÙË ıÂÚ·›· Î·È Ó· Ì›ÓÂÈ ÂχıÂÚÔ˜ ‚Ï·‚ÒÓ (18). ¶ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜ ∆Ô ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜ (¶¶) Â›Ó·È ÓfiÛÔ˜ ÙˆÓ ËÏÈÎȈ̤ӈÓ. ∆Ô Ó·ÓÈÎfi ¶¶ Â›Ó·È Û·ÓÈfiÙ·ÙÔ, Ì ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ̤¯ÚÈ ÙÔ 1993 ÌfiÏȘ 40 ÂÚÈÙÒÛÂȘ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (5). ªÂÁ¿Ï˜ ÙÂٷ̤Ó˜, ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·ÈÌÔÚÚ·ÁÈΤ˜, Ê˘Û·ÏÏȉÔÔÌÊfiÏ˘Á˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔÓ ÎÔÚÌfi (∂ÈÎfiÓ· 6) Î·È Î˘Ú›ˆ˜ ÛÙȘ ·Ú·ÙÚÈÌÌ·ÙÈΤ˜ ı¤ÛÂȘ ÙˆÓ ¿ÎÚˆÓ, ÙȘ ·Ï¿Ì˜ Î·È Ù· ¤ÏÌ·Ù· (20). OÈ ‚ÏÂÓÓÔÁfiÓÔÈ Â›Ó·È Û˘Ó‹ıˆ˜ ÂχıÂÚÔÈ ·fi ‚Ï¿‚˜. ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈο ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È IgG ·˘ÙÔ·ÓÙÈÛÒÌ·Ù·, Ù· ÔÔ›· ηÙ¢ı‡ÓÔÓÙ·È ÂÓ·ÓÙ›ÔÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ‰ÂÚÌ·ÙÔÂȉÂÚÌȉÈÎÔ‡ Û˘Ó‰¤ÛÌÔ˘ Ì ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 180 Î·È 230 ∫D (21). ∆· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ·ÓȯÓ‡ÔÓÙ·È ÛÙÔÓ ÔÚfi ÙÔ˘ 60-70% ÙˆÓ ·ÛıÂÓÒÓ Î·È ‰È·ÈÛÙÒÓÔÓÙ·È in vivo ˆ˜ Û‡ÌÏÔη Ì ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÈÛÙÈÎfi ·ÓÙÈÁfiÓÔ


¶·È‰È·ÙÚÈ΋ 2001;64:557-564

Paediatriki 2001;64:557-564

∂ÈÎfiÓ· 6. ¶ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜ Ì ÙÂٷ̤Ó˜ ÔÌÊfiÏ˘Á˜. ∂ÈÎfiÓ· 5. ¶¤ÌÊÈÁ· Ì ÂÎÙÂٷ̤Ó˜, ‰˘Û›·Ù˜ ÂÏÎÒÛÂȘ.

Î·È ÙË ÌÔÚÊ‹ ÁÚ·ÌÌÈ΋˜ πgG ‹/Î·È C3 ÂÓ·fiıÂÛ˘ ÛÙË µª Ù˘ ÂȉÂÚÌ›‰·˜ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ (6). ∏ ÂÌÊ¿ÓÈÛË Ù˘ ¿ıËÛ˘ ÛÙ· ·È‰È¿ ÌÂÙ¿ ·fi ·fiÚÚÈ„Ë ÓÂÊÚÈÎÔ‡ ·ÏÏÔÌÔۯ‡̷ÙÔ˜ ˘ÔÓÔ› ÙË ‰ËÌÈÔ˘ÚÁ›· ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ·fi ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË Ù˘ ·fiÚÚȄ˘ Î·È ÙËÓ ·ÓÙ›‰Ú·Û‹ ÙÔ˘˜ Ì ·ÓÙÈÁfiÓ·, ÙfiÛÔ ÙÔ˘ ÓÂÊÚÔ‡ fiÛÔ Î·È ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (22). ∏ ÔÚ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È Ì·ÎÚ¿. ªÂÚÈÎÔ› Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÓfiÛÔ˜ ˘Ô¯ˆÚ› ÂÓÙfi˜ ‰ÈÂÙ›·˜ (23), ·ÏÏ¿ ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ Ì ‰È¿ÚÎÂÈ· ˆ˜ ÙËÓ ÂÓËÏÈΛˆÛË (5). §fiÁˆ Ù˘ ¤ÎÙ·Û˘ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÛÔ‚·ÚÒÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ıˆÚÂ›Ù·È ··Ú·›ÙËÙË Ë ¯ÔÚ‹ÁËÛË Ú‰ÓÈ˙ÔÏfiÓ˘ Û ËÌÂÚ‹ÛÈ· ‰fiÛË 12 mg/kg Î·È Û ·ÓıÂÎÙÈΤ˜ ÌÔÚʤ˜ ÛÔ˘ÏÊfiÓ˘, ·˙·ıÂÈÔÚ›Ó˘ ‹ ¯ÏˆÚ·Ì‚ԢΛÏ˘ (3,23). ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·È‰Ô›Ô˘ Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿ Ì ÔÌÊÔÏ˘Á҉˜ ÂÌÊÈÁÔÂȉ¤˜ Î·È ··ÓÙ¿Ù·È ÛÙÔ 40% ÙˆÓ ÂÚÈÙÒÛˆÓ. ŸÙ·Ó ˘¿Ú¯Ô˘Ó Ê˘Û·ÏÏ›‰Â˜ Î·È ÂÚ‡ıËÌ·, ·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ Ù· ÙÔÈο ÛÙÂÚÔÂȉ‹. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯ÂÈ Ô˘ÏÔÔ›ËÛË, Ë ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Ô‰Ë-

ÁËı› Û ̛· ȉȷ›ÙÂÚË ÌÔÚÊ‹ ÂÌÊÈÁÔÂȉԇ˜, ÙÔ ·ÔηÏÔ‡ÌÂÓÔ Ô˘ÏˆÙÈÎfi ÂÌÊÈÁÔÂȉ¤˜. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ÙȘ ·ÚÎÂÙ¿ Û˘¯ÓfiÙÂÚ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Ô ¤Ú˘ ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Î·È Ë ÛÂÍÔ˘·ÏÈ΋ ηÎÔÔ›ËÛË. ∏ ıÂÚ·›· ·˘Ù‹˜ Ù˘ ÌÔÚÊ‹˜ ÙÔ˘ ÂÌÊÈÁÔÂȉԇ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÙË Û˘ÛÙËÌ·ÙÈ΋ ·ÁˆÁ‹ ‹ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (24). ™ÙÔÓ ÔÌÊÔÏ˘ÁÒ‰Ë ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ‚Ï¿‚˜ Ù‡Ô˘ ÂÌÊÈÁÔÂȉԇ˜, ıÂÙÈο ·ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù· Î·È Ù· ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ ÂÚ˘ıËÌ·ÙÒ‰Ô˘˜ χÎÔ˘, fiˆ˜ ¤¯Ô˘Ó ηıÔÚÈÛÙ› ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ƒÂ˘Ì·ÙÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (25). ∆fiÛÔ Ë ¿ıËÛË ·˘Ù‹ fiÛÔ Î·È Ë Â›ÎÙËÙË ÔÌÊÔÏ˘Á҉˘ ÂȉÂÚÌfiÏ˘ÛË, Ë ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ÔÌÊfiÏ˘Á˜, Ô˘Ï¤˜ Î·È ÎÂÁ¯Ú›· ÛÙȘ ı¤ÛÂȘ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ‹ Û˘Ó¯ԇ˜ ÙÚÈ‚‹˜ (26), Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓȘ. ∆¤ÏÔ˜, ÙÔ 5-10% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ı· ÁÂÓÓËıÔ‡Ó ·fi ÌËÙ¤Ú· Ë ÔÔ›· ¿Û¯ÂÈ ·fi ÂÌÊÈÁÔÂȉ¤˜ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ı· ÂΉËÏÒÛÂÈ ¤Ó· ÎÓËÛÌ҉˜ ÂÍ¿ÓıËÌ· Ì ÎÓȉˆÙÈΤ˜ ‚Ï·Ù›‰Â˜ Î·È Ê˘Û·ÏÏȉÔÔÌÊfiÏ˘Á˜, ÙÔ ÔÔ›Ô ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο Ì ÂΛÓÔ Ù˘ ÂÚËÙÔÂȉԇ˜ ‰ÂÚÌ·Ù›Ùȉ·˜ ‹ ÙÔ˘ ÔÌÊÔÏ˘ÁÒ‰Ô˘˜

563


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ÂÌÊÈÁÔÂȉԇ˜. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙÔ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi Ù˘ ÓfiÛÔ˘ Ù˘ ÌËÙ¤Ú·˜. ∆Ô ÂÍ¿ÓıËÌ· ÔÊ›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.

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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.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-02-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª. ¶··ÎˆÓÛÙ·ÓÙ›ÓÔ˘-÷˚‰Â̤ÓÔ˘ OÚ¤ÛÙÔ˘ 26, 546 42, £ÂÛÛ·ÏÔÓ›ÎË ∂-mail: giorgoschaid@yahoo.com


¶·È‰È·ÙÚÈ΋ 2001;64:565-572

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ORIGINAL ARTICLE

¡ÔÛÔÎÔÌÂȷΤ˜ ÏÔÈÌÒÍÂȘ Û ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¶·È‰ÈÒÓ ¶. ∫·Ï·Ì·Ï›Î˘1, ∞. ¶·ÙÛÔ‡Ú·1, ∞. ª·˘ÚÔÌ¿ÙË2, °. ªÚÈ·ÛÔ‡Ï˘1, ∞. ÃÚ˘Û¿ÎË2, ∞. ¶¿ÁηÏË2, ∞. ÷Ù˙‹˜1

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

¶ÂÚ›ÏË„Ë: ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· 2 ÂÙÒÓ ÓÔÛËχıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ 683 ·È‰È¿ ËÏÈΛ·˜ 15 ËÌÂÚÒÓ ¤ˆ˜ 18 ÂÙÒÓ. ™Â 431 ·fi ·˘Ù¿, Ù· ÔÔ›· ·Ú¤ÌÂÈÓ·Ó ÂÚÈÛÛfiÙÂÚÔ ·fi 24 ÒÚ˜, ¤ÁÈÓ ηٷÁÚ·Ê‹ ÙˆÓ ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ (¡§) Ô˘ ·ÚÔ˘Û›·Û·Ó ÛÙË ª∂£, ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ Ô˘ ·ÔÌÔÓÒıËηÓ, Ù˘ ¢·ÈÛıËÛ›·˜ ÙÔ˘˜ ÛÙ· ·ÓÙÈÌÈÎÚԂȷο Ê¿Ú̷η Î·È ‰ÈÂÚ¢ӋıËÎÂ Ë Û˘Û¯¤ÙÈÛË ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ Ì ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∂‚‰ÔÌ‹ÓÙ· ÂÓÓ¤· ·ÛıÂÓ›˜ (18,3%) ·ÚÔ˘Û›·Û·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ¡§ Û ۇÓÔÏÔ 113 ¡§. ∞fi ·˘Ù¤˜, ÔÛÔÛÙfi 59,3% ‹Ù·Ó ÛË„·ÈÌ›·, 30,1% Ó¢ÌÔÓ›·, 8,0% Ô˘ÚÔÏԛ̈ÍË, 1,7% ÏÔÈÌÒÍÂȘ ‰¤ÚÌ·ÙÔ˜ Î·È Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Î·È 0,9% ÂÈÂÊ˘Î›ÙȘ. OÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ÚÔοÏÂÛ·Ó Ïԛ̈ÍË ‹Ù·Ó Staphylococcus ÎÔ·ÁÎÔ˘Ï¿ÛË ·ÚÓËÙÈÎfi˜ (CNS) 29,2%, ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂȉ‹ 27,4%, Pseudomonas spp. 14,2%, Candida spp. 9,0%, Staphylococcus aureus 8,8%, Acinetobacter spp. 7,0% Î·È Enterococcus spp. 4,4%. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¡§ ‹Ù·Ó: Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÛÙË ª∂£ (22,6 Ë̤Ú˜ ÁÈ· Ù· ·È‰È¿ Ì ¡§, ¤Ó·ÓÙÈ 5,2 ·˘ÙÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ¡§, p<0,0001), Ë ‰È¿ÚÎÂÈ· Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (16,3 Ë̤Ú˜, ¤Ó·ÓÙÈ 1,7 ·ÓÙ›ÛÙÔȯ·, p<0,0001), Ë ‚·Ú‡ÙËÙ· Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·ÛıÂÓÒÓ (PRISM score: 10,8, ¤Ó·ÓÙÈ 5,3 ·ÓÙ›ÛÙÔȯ·, p<0,0001), Ë ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, Ô˘ÚÔηıÂÙ‹ÚˆÓ Î·È Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (device utilization ratio: 2,1, ¤Ó·ÓÙÈ 0,9 ·ÓÙ›ÛÙÔȯ·, p<0,0001), Ë ‰È¿ÚÎÂÈ· ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ (4,8 Ë̤Ú˜, ¤Ó·ÓÙÈ 0,5 ·ÓÙ›ÛÙÔȯ·, p<0,0001), Ë ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ∏2 ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ÈÛÙ·Ì›Ó˘ (4,7 Ë̤Ú˜, ¤Ó·ÓÙÈ 2 ·ÓÙ›ÛÙÔȯ·, 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¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1 Intensive Care Unit “Aghia Sophia” Children’s Hospital, Athens 2 Microbiological Laboratory “Aghia Sophia” Children’s Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2001;64:565-572

Paediatriki 2001;64:565-572

™ÙÂϤ¯Ë Pseudomonas aeruginosa ·ÓıÂÎÙÈο ÛÙË ÁÂÓÙ·ÌÈΛÓË ‹Ù·Ó 10,9%, ÛÙËÓ ÎÂÊÙ·˙ÈÓÙ›ÌË 10,0% Î·È ÛÙËÓ ÈÌÈÂÓ¤ÌË 2,6%. ¢ÂÓ ·ÔÌÔÓÒıËÎ·Ó ÛÙÂϤ¯Ë CNS ·ÓıÂÎÙÈο ÛÙË ‚·ÓÎÔÌ˘Î›ÓË. ∫·Ù¤ÏËÍ ÙÔ 10,0% ÙˆÓ ·ÛıÂÓÒÓ. ™Â η̛· ÂÚ›ÙˆÛË Ô ı¿Ó·ÙÔ˜ ‰ÂÓ ·Ô‰fiıËΠ۠¡§.

of CNS resistant to vancomycin were not detected. Ten per cent of our patients died. However no case of death was attributed to NI.

§¤ÍÂȘ ÎÏÂȉȿ: ÓÔÛÔÎÔÌÂȷ΋ Ïԛ̈ÍË, ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜.

Key words: nosocomial infection, risk factor, intensive care unit.

∂ÈÛ·ÁˆÁ‹ ¡ÔÛÔÎÔÌÂȷ΋ ıˆÚÂ›Ù·È Î¿ı Ïԛ̈ÍË Ô˘ ÂÌÊ·Ó›˙ÂÙ·È Û ÓÔÛËÏ¢fiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ Î·È Ë ÔÔ›· ‰ÂÓ ÚÔ¸‹Ú¯Â, Ô‡Ù ‚ÚÈÛÎfiÙ·Ó ÛÙÔ ÛÙ¿‰ÈÔ Ù˘ ÂÒ·Û˘ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ·ÏÏ¿ ÂÍÂÏ›¯ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ‹ ̤۷ Û 48 ÒÚ˜ ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô (1). OÈ ÓÔÛÔÎÔÌÂȷΤ˜ ÏÔÈÌÒÍÂȘ (¡§) ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ‰ÈÂıÓÒ˜ Î·È Â˘ı‡ÓÔÓÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÁÈ· ÙË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ· ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ ·ÛıÂÓÒÓ. ∂ÓÒ, fï˜, ÔÈ ¡§ Î˘Ì·›ÓÔÓÙ·È ÁÂÓÈο ÛÙÔ 5%-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÓÔÛËÏ¢fiÌÂÓˆÓ, ÙÔ ÔÛÔÛÙfi Â›Ó·È ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ (ª∂£). ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙȘ ª∂£ ·È‰ÈÒÓ, ÔÈ ¡§ Î˘Ì·›ÓÔÓÙ·È ÛÙÔ 20% Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 4% ÙˆÓ ı·Ó¿ÙˆÓ (2,3). ∆Ô ˘„ËÏfi ÔÛÔÛÙfi ¡§ ÛÙȘ ª∂£ ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ ÛÙ· Û˘ÁÎÂÎÚÈ̤ӷ ÙÌ‹Ì·Ù· ˘¿Ú¯Ô˘Ó ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙËÓ ·Ó¿Ù˘ÍË ÏÔÈÌÒ͈Ó. ŒÙÛÈ, ÏÔÈfiÓ, Ë ÛÔ‚·Ú‹ ηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ, Ë ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, ÔÈ Û˘Û΢¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ıÂÚ·¢ÙÈÎÔ‡˜ ‹ ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜ (ÂÓ‰ÔÙÚ·¯ÂÈ·ÎÔ› ۈϋÓ˜, ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜, ηıÂÙ‹Ú˜ Ó¢ÌÔÓÈ΋˜) Î·È Ë ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Â›Ó·È ÔÚÈṲ̂ÓÔÈ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¡§ (4). ™˘Ó¤ÂÈ· ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Ë Â˘Ú›· ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ ª∂£, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ó¿Ù˘ÍË ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ ÌÈÎÚÔ‚›ˆÓ. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ Â›Ó·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ Â›ÙˆÛ˘ ¡§ Û ·È‰È·ÙÚÈ΋ ª∂£. °›ÓÂÙ·È ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ Ì ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ηٷÁÚ¿ÊÔÓÙ·È Ù· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó Î·È Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο.

™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÁÈÓfiÙ·Ó Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ʇÏÔ˘, Ù˘ ËÏÈΛ·˜, Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÁÂÓÈ΋˜ ÙÔ˘˜ ηٿÛÙ·Û˘ ηٿ ÙËÓ Â›ÛÔ‰Ô, fiˆ˜ ÂÎÊÚ¿˙ÂÙ·È Ì ÙÔ PRISM score (5), ÙˆÓ Î·ıÂÙ‹ÚˆÓ, Ù˘ ‰È¿ÚÎÂÈ·˜ ÓÔÛËÏ›·˜ ÛÙË ª∂£, Ù˘ ‰È¿ÚÎÂÈ·˜ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, Ù˘ ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜, Ù˘ ¯ÔÚ‹ÁËÛ˘ ∏2 ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ÈÛÙ·Ì›Ó˘, ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ¯ÔÚËÁÔ‡ÌÂÓÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Î·ıÂÙ‹ÚˆÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë “·Ó·ÏÔÁ›· ¯ÚËÛÈÌÔÔ›ËÛ˘ Û˘Û΢ÒÓ” (device utilization ratio), Ë ÔÔ›· - Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ÙÔ˘ ∫¤ÓÙÚÔ˘ ∂ϤÁ¯Ô˘ ¡ÔÛËÌ¿ÙˆÓ (Centers of Disease Control, CDC) ÙˆÓ ∏¶∞ - ÈÛÔ‡Ù·È ÌÂ: [(Ë̤Ú˜ ·Ú·ÌÔÓ‹˜ ÎÂÓÙÚÈÎÒÓ ÊÏ‚ÈÎÒÓ Î·ıÂÙ‹ÚˆÓ)+(Ë̤Ú˜ ·Ú·ÌÔÓ‹˜ Ô˘ÚÔηıÂÙ‹Ú·)+(Ë̤Ú˜ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡)] / ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (6). ™Â οı ·ÛıÂÓ‹ Ï·Ì‚¿ÓÔÓÙ·Ó Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ηٿ ÙËÓ Â›ÛÔ‰Ô Î·È Â› ˘ÚÂÙÔ‡, ηÏÏȤÚÁÂȘ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹ ‚ÚÔÁ¯ÈÎÔ‡ ÂÎÎڛ̷ÙÔ˜ (ÂÊfiÛÔÓ ‹Ù·Ó ‰È·ÛˆÏËӈ̤ÓÔ˜), Ô‡ÚˆÓ, ˘ÏÈÎÔ‡ ‰ÂÚÌ·ÙÈ΋˜ ‚Ï¿‚˘ (Â¿Ó ˘‹Ú¯Â) ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Î·È ·Ó¿ 3‹ÌÂÚÔ, ηıÒ˜ Î·È Î·ÏÏȤÚÁÂȘ ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ fiÙ·Ó ·˘ÙÔ› ·Ê·ÈÚÔ‡ÓÙ·Ó. ∂›Û˘, ÛÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó: ÁÂÓÈ΋ ÂͤٷÛË ·›Ì·ÙÔ˜, C·ÓÙȉÚÒÛ· ÚˆÙ½ÓË Î·È ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Â› ˘Ô„›·˜ Ïԛ̈͢. ø˜ ¡§ Ù˘ ª∂£ ıˆڋıËΠοı Ïԛ̈ÍË Ô˘ ÂΉËÏÒıËΠÛÙÔ ÙÌ‹Ì· Ì·˜ ÌÂÙ¿ ÙÔÓ ·ÔÎÏÂÈÛÌfi ÏÔÈÌÒÍÂˆÓ Ô˘ ÚÔ¸‹Ú¯·Ó ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ‰ËÏ·‰‹ ÏÔÈÌÒÍÂˆÓ Ù˘ ÎÔÈÓfiÙËÙ·˜ ‹ ÏÔÈÌÒÍÂˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ¿ÏϘ ÎÏÈÓÈΤ˜, ÛÙȘ Ôԛ˜ ›¯Â ÓÔÛËÏ¢ı› ÚÔËÁÔ˘Ì¤Óˆ˜ Ô ·ÛıÂÓ‹˜. O ηıÔÚÈÛÌfi˜ ÙÔ˘ ›‰Ô˘˜ Ù˘ ¡§ ¤ÁÈÓ Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ CDC (1,7,8). ™˘ÁÎÂÎÚÈ̤ӷ, ˆ˜ ‚·ÎÙËÚÈ·ÈÌ›· Ù˘ ª∂£ ıˆڋıËÎÂ Ë ·ÔÌfiÓˆÛË ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ ·fi ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, Ô˘ ›¯Â ÏËÊı› ÙÔ˘Ï¿¯ÈÛÙÔÓ 72 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔ ÙÌ‹Ì· Ì·˜ Î·È Ë ÔÔ›· ‰ÂÓ Û¯ÂÙÈ˙fiÙ·Ó Ì ÚÔ¸¿Ú¯Ô˘Û· Ïԛ̈ÍË. ∏ ‰È¿ÎÚÈÛË ÌÂٷ͇ ÂÈÌfiÏ˘ÓÛ˘ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Î·È ÛË„·ÈÌ›·˜ ÁÈÓfiÙ·Ó ÌÂ Û˘ÓÂÎÙ›ÌËÛË Î·È ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ, fiˆ˜ ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ›¯Â ·ÔÌÔÓˆı›, Ù˘ ‡·Ú͢ ˘ÚÂÙÔ‡, ÙˆÓ ‰ÂÈÎÙÒÓ Ïԛ̈͢ (·‡ÍËÛË ·ÚÈıÌÔ‡ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ, ¿ÓÔ‰Ô˜ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘). £ÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹ ‚ÚÔÁ¯ÈÎÔ‡ ÂÎÎڛ̷ÙÔ˜ ηٿ ÙËÓ Â›ÛÔ‰Ô ıˆÚ›ÙÔ ·ÔÈÎÈÛÌfi˜ ÂÎÙfi˜ Ù˘ ª∂£ Î·È ÔÈ ·ÛıÂÓ›˜ ·ÔÎÏ›ÔÓÙ·Ó ·fi ÙË ÌÂϤÙË. ∏ ·ÔÌfiÓˆÛË ‰È·ÊÔÚÂÙÈÎÒÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ Û ÂfiÌÂÓ˜ ηÏÏȤÚÁÂȘ ÙȘ ηıÈÛÙÔ‡Û ıÂÙÈΤ˜. ∏ ‰È¿ÎÚÈÛË ÌÂٷ͇ ·ÔÈÎÈÛÌÔ‡ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‹ Ïԛ̈͢ ÁÈÓfiÙ·Ó ÌÂ Û˘ÓÂÎÙ›ÌËÛË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘, ˘ÚÂÙÔ‡, ‡ÎÓˆÛ˘ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, Âȉ›ӈÛ˘

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ ™ÙËÓ ÚÔÔÙÈ΋ ·˘Ù‹ ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó Ù· ·È‰È¿ Ô˘ ÓÔÛËχıËÎ·Ó ÛÙË ª∂£ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” ·fi 1 π·ÓÔ˘·Ú›Ô˘ 1998 ¤ˆ˜ 31 ¢ÂÎÂÌ‚Ú›Ô˘ 1999.

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¶·È‰È·ÙÚÈ΋ 2001;64:565-572

Paediatriki 2001;64:565-572

Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ıÂÙÈÎÒÓ ‰ÂÈÎÙÒÓ Ïԛ̈͢. £ÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ Î·Ù¿ ÙËÓ Â›ÛÔ‰Ô ıˆÚ›ÙÔ Ô˘ÚÔÏԛ̈ÍË ÂÎÙfi˜ Ù˘ ª∂£ Î·È ÔÈ ·ÛıÂÓ›˜ ·ÔÎÏ›ÔÓÙ·Ó ·fi ÙË ÌÂϤÙË, ÂÓÒ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ÙȘ ÂfiÌÂÓ˜ Ë̤Ú˜ ıˆÚ›ÙÔ fiÙÈ ÔÊ›ÏÔÓÙ·Ó Û ¡§ Ù˘ ª∂£. °È· ÙȘ Û˘ÁÎÚ›ÛÂȘ ÔÛÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂΉ‹ÏˆÛ·Ó ¡§ Î·È ·˘ÙÒÓ Ô˘ ‰ÂÓ ÂΉ‹ÏˆÛ·Ó, ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ Student’s t-test, ÂÓÒ ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÔÈÔÙÈÎÒÓ ÌÂÁÂıÒÓ (ηÙËÁÔÚÈο ‰Â‰Ô̤ӷ) ÂÊ·ÚÌfiÛÙËΠÙÔ Fisher’s exact test. ø˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ıˆڋıËΠÙÔ ·ÔÙ¤ÏÂÛÌ· fiÔ˘ p<0,05. °È· ÙËÓ ·Ó¿Ï˘ÛË ÔÏÏ·ÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (multivariate analysis) ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÌÔÓÙ¤ÏÔ Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ÛÙ·‰È·Î‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ (stepwise logistic regression model). ∏ ‚·ıÌÔÓfiÌËÛË ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ ·˘ÙÔ‡ Û ¤Ó· Ê¿ÛÌ· ÌÂÛԉȷÛÙËÌ¿ÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÂϤÁ¯ıËΠ̠ÙÔ Hosmer-Lemeshow goodness-of-fit test.

ÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ, ÂÓÒ 78 ·ÛıÂÓ›˜ (18,1%) ÂÈÛ‹¯ıËÛ·Ó ÏfiÁˆ ÛÔ‚·Ú‹˜ Ïԛ̈͢ (¶›Ó·Î·˜ 1). ∏ ̤ÛË ‚·Ú‡ÙËÙ· Ù˘ ÁÂÓÈ΋˜ ÙÔ˘˜ ηٿÛÙ·Û˘ ηٿ ÙÔ ÚÒÙÔ 24ˆÚÔ ÓÔÛËÏ›·˜, fiˆ˜ ·˘Ù‹ ÂÎÊÚ¿ÛÙËΠ̠ÙÔ PRISM score, ‹Ù·Ó 6,5. ∂‚‰ÔÌ‹ÓÙ· ÂÓÓ¤· ·ÛıÂÓ›˜ (18,3%) ·ÚÔ˘Û›·Û·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì›· ¡§ Â› Û˘ÓfiÏÔ˘ 113 ¡§, ÌÂ Û˘¯ÓfiÙÂÚ˜ ÙË ÛË„·ÈÌ›· (59,3%) Î·È ÙËÓ Ó¢ÌÔÓ›· (30,1%) (¶›Ó·Î·˜ 2), ÂÓÒ ÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ÚÔοÏÂÛ·Ó Ïԛ̈ÍË ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔ ™¯‹Ì· 1. ∞fi ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ¡§ Î·È ËÏÈΛ·˜ ‹ ʇÏÔ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜. ∞ÓÙ›ıÂÙ·, ˆ˜ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¡§ ‹Ù·Ó: Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÛÙË ª∂£ (22,6 Ë̤Ú˜ ÁÈ· Ù· ·È‰È¿ Ì ¡§, ¤Ó·ÓÙÈ 5,2 ËÌÂÚÒÓ ·˘ÙÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ¡§, p<0,0001), Ë ‰È¿ÚÎÂÈ· Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (16,3, ¤Ó·ÓÙÈ 1,7 ËÌÂÚÒÓ ·ÓÙ›ÛÙÔȯ·, p<0,0001), Ë ‚·Ú‡ÙËÙ· Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·ÛıÂÓÒÓ (PRISM score: 11,7, ¤Ó·ÓÙÈ 6,2, p<0,0001), ÔÈ ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜, Ô˘ÚÔηıÂÙ‹Ú˜ Î·È Ô Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ ·Ó¿ Ë̤ڷ ÓÔÛËÏ›·˜ (device utilization ratio: 2,1, ¤Ó·ÓÙÈ 0,9, p<0,0001), Ë ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ (5,9 Ë̤Ú˜, ¤Ó·ÓÙÈ 0,3 ËÌÂÚÒÓ, p<0,0001) Î·È Ë ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ˘ ∏2 ·ÓÙ·ÁˆÓÈÛÙÒÓ Ù˘ ÈÛÙ·Ì›Ó˘ (5,4, ¤Ó·ÓÙÈ 1,9 ËÌÂÚÒÓ, p<0,001) (¶›Ó·Î·˜ 3). ∫·Ù¿ ÙËÓ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ÏÔÁÈÛÙÈ΋ ·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË ÔÏÏ·ÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (multivariate logistic regression analysis) ·Ú·ÙËÚ‹ıËΠfiÙÈ Ë ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹, Ë ¯ÚËÛÈÌÔÔ›ËÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Î·È Ô Ì˯·ÓÈÎfi˜

∞ÔÙÂϤÛÌ·Ù· ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· 2 ÂÙÒÓ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Ì·˜ 683 ·ÛıÂÓ›˜, ·fi ÙÔ˘˜ ÔÔ›Ô˘˜, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ô˘ ‰›ÓÔÓÙ·È ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ ¡§ ÛÙÔ ∂ıÓÈÎfi ™‡ÛÙËÌ· ∂ÔÙ›·˜ ¡ÔÛÔÎÔÌÂÈ·ÎÒÓ §ÔÈÌÒÍÂˆÓ ÙˆÓ ∏¶∞ (1), ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË 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·, ËÏÈΛ·˜ 15 ËÌÂÚÒÓ ¤ˆ˜ 18 ÂÙÒÓ. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∂ÓÂÓ‹ÓÙ· ÙÚ›· ·È‰È¿ (21,6%) ›¯·Ó ÂÈÛ·¯ı› ÁÈ· ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, 85 (19,7%) ÏfiÁˆ ÙÚ·˘Ì·ÙÈÛÌÒÓ Ô˘ ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÎÚ·ÓÈÔÂ-

¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ·È‰ÈÒÓ Ô˘ ÓÔÛËχıËÎ·Ó ÛÙË ª∂£ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· 2 ÂÙÒÓ ñ ∞ÛıÂÓ›˜ Ì ÓÔÛËÏ›· ≥24 ÒÚ˜ ñ º‡ÏÔ (·ÁfiÚÈ·/ÎÔÚ›ÙÛÈ·) ñ ∏ÏÈΛ· (¤ÙË)* ñ PRISM score* ñ ¢È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (Ë̤Ú˜)* ñ ¢È¿ÚÎÂÈ· Ì˯. ·ÂÚÈÛÌÔ‡ (Ë̤Ú˜)* ñ ∞ÈÙÈÔÏÔÁ›· ÂÈÛfi‰Ô˘ ÛÙË ª∂£ (·Ú. ·ÛıÂÓÒÓ) ªÂÙÂÁ¯ÂÈÚËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ∆Ú·˘Ì·ÙÈÛÌfi˜ §Ô›ÌˆÍË ¡fiÛÔ˜ ·Ó·Ó¢ÛÙÈÎÔ‡ ¡fiÛÔ˜ ∫¡™ ¡fiÛÔ˜ ηډȷÁÁÂÈ·ÎÔ‡ ¡fiÛÔ˜ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ¡fiÛÔ˜ ·ÈÌ·ÙÔÏÔÁÈ΋ ¡ÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ŒÁη˘Ì· ¡fiÛÔ˜ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ ÕÏϘ ·ı‹ÛÂȘ

431 226/205 4,4 ± 0,3 6,5 ± 0,3 6,2 ± 0,2 2,3 ± 0,1 93 85 78 50 47 22 18 13 6 6 5 7

(21,6%) (19,7%) (18,1%) (11,6%) (10,9%) (5,1%) (4,2%) (3,0%) (1,4%) (1,4%) (1,2%) (1,6%)

* OÈ ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ mean ± SEM

567


¶·È‰È·ÙÚÈ΋ 2001;64:565-572

Paediatriki 2001;64:565-572

¶›Ó·Î·˜ 2. ∂›‰Ô˜ ÓÔÛÔÎÔÌÂȷ΋˜ Ïԛ̈͢ ÛÙË ª∂£ ∂›‰Ô˜ Ïԛ̈͢

∞ÚÈıÌfi˜ ÏÔÈÌÒ͈Ó

¶ÔÛÔÛÙfi (%)

ñ ™Ë„·ÈÌ›· ñ ¶Ó¢ÌÔÓ›· ñ O˘ÚÔÏԛ̈ÍË ñ §Ô›ÌˆÍË ‰¤ÚÌ·ÙÔ˜/ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ñ ∂ÈÂÊ˘Î›ÙȘ

67 34 9

59,3 30,1 8,0

2 1

1,7 0,9

™‡ÓÔÏÔ

113

100

Candida 9,0% ∂ÓÙÂÚÔ‚·ÎÙËÚÔÂȉ‹ 27,4% CNS 29,2% S. aureus 8,8%

Pseudomonas 14,2%

·ÂÚÈÛÌfi˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ ·Ó¿Ù˘Í˘ ¡§ (¶›Ó·Î·˜ 4). ŒÙÛÈ, ÔÈ ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Â›Ó·È 5 ÊÔÚ¤˜ Èı·ÓfiÙÂÚÔ Ó· ÂΉËÏÒÛÔ˘Ó ¡§ Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ Ï·Ì‚¿ÓÔ˘Ó ·ÚÂÓÙÂÚÈ΋ Û›ÙÈÛË (ÏfiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ [odds ratio, OR]=5,1, 95% ‰È¿ÛÙËÌ· ·ÍÈÔÈÛÙ›·˜ [confidence interval, C.I.]=1,03-19,32). OÈ ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜ ·˘Í¿ÓÔ˘Ó Î·Ù¿ 2 ÂÚ›Ô˘ ÊÔÚ¤˜ ÙȘ Èı·ÓfiÙËÙ˜ ÂΉ‹ÏˆÛ˘ ¡§ (OR=1,9, 95% CI=1,07-3,21), ÂÓÒ ÔÈ ·ÛıÂÓ›˜ Ô˘ ·Ú·Ì¤ÓÔ˘Ó Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi ¤¯Ô˘Ó 1,6 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ÂΉËÏÒÛÔ˘Ó ¡§ (OR=1,6, 95% CI=1,20-3,83). ∆¤ÏÔ˜, Ë ‚·ÚÈ¿ ÁÂÓÈ΋ ηٿÛÙ·ÛË, fiˆ˜ ÂÎÊÚ¿˙ÂÙ·È Ì ÙÔ ˘„ËÏfi PRISM score (OR=1,4, 95% CI=1,092,96) Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÛÙË ª∂£ (OR=1,2, 95% CI=1,08-1,30) ·˘Í¿ÓÔ˘Ó, Â›Û˘, ÙȘ Èı·ÓfiÙËÙ˜ ÂΉ‹ÏˆÛ˘ ¡§. ∏ ¢·ÈÛıËÛ›· ÛÙ· ·ÓÙÈÌÈÎÚԂȷο Ê¿Ú̷η ÙˆÓ ‚·ÎÙËÚ›ˆÓ, Ù· ÔÔ›· ›Ù ›¯·Ó ÚÔηϤÛÂÈ ¡§ ›Ù ›¯·Ó ÌfiÓÔ ·ÔÈΛÛÂÈ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ª∂£, ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 5 Î·È 6. ™ÙÂϤ¯Ë Pseudomonas aeruginosa ·ÓıÂÎÙÈο ÛÙË ÁÂÓÙ·ÌÈΛÓË ‹Ù·Ó 10,9%, ÛÙË ÎÂÊÙ·˙ÈÓÙ›ÌË 10,0% Î·È ÛÙËÓ ÈÌÈÂÓ¤ÌË 2,6%. ∞ÓıÂÎÙÈο ÛÙË ÌÂıÈÎÈÏÏ›ÓË ‹Ù·Ó 14,1% ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ S. aureus Î·È 76,7% ÙˆÓ CNS, ÂÓÒ ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ÛÙÂϤ¯Ë CNS ·ÓıÂÎÙÈο ÛÙË ‚·ÓÎÔÌ˘Î›ÓË. ™˘¯ÓfiÙÂÚ· ¯ÔÚËÁÔ‡ÌÂÓÔ ·ÓÙÈ‚ÈÔÙÈÎfi ‹Ù·Ó Û˘Ó‰˘·ÛÌfi˜ ‚Ï·ÎÙ¿Ì˘/·Ó·ÛÙÔϤ· ‚-Ï·ÎÙ·Ì¿Û˘ (47,4%). ∫·Ù¤ÏËÍ·Ó 43 ·È‰È¿ (10,0%). ¶·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ¡§ Î·È ıÓËÙfiÙËÙ·˜, ·Ú¿ ÙÔ fiÙÈ Û η̛· ÂÚ›ÙˆÛË Ô ı¿Ó·ÙÔ˜ ‰ÂÓ ·Ô‰fiıËΠ¿ÌÂÛ· Û ¡§. ¶ÚÔÊ·ÓÒ˜, Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ÔÈ ¡§ ÂÈ‰Â›ÓˆÛ·Ó ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ Û˘ÓÙÂÏÒÓÙ·˜ ÛÙËÓ Â¤Ï¢ÛË ÙÔ˘ ı·Ó¿ÙÔ˘, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ηٷϋÍÂÈ Î·Ó›˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ·fi ·ÓÂͤÏÂÁÎÙË ¡§. ŒÙÛÈ, ·fi ÙÔ˘˜ 79 ·ÛıÂÓ›˜ Ì ¡§ η٤ÏËÍ·Ó 22 (27,8%), ÂÓÒ Ë ıÓËÙfiÙËÙ· ·˘ÙÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ¡§ ‹Ù·Ó 6,0% (21/352) (p<0,01).

568

Enterococcus 4,4% Acinetobacter 7,0%

™¯‹Ì· 1. ªÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ·ÛıÂÓ›˜ Ì ÓÔÛÔÎÔÌÂȷ΋ Ïԛ̈ÍË ÛÙË ª∂£.

™˘˙‹ÙËÛË ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ¡§ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ Ù˘ ª∂£. OÈ ¡§ Â›Ó·È Û·ÓÈfiÙÂÚ˜ Û ηډÈÔÏÔÁÈΤ˜ ÌÔÓ¿‰Â˜ Î·È Û˘¯ÓfiÙÂÚ˜ Û ÌÔÓ¿‰Â˜ ÓÂÔÁÓÒÓ, ÌÔÓ¿‰Â˜ ÂÁη˘Ì¿ÙˆÓ Î·È ÌÔÓ¿‰Â˜ ÙÚ·‡Ì·ÙÔ˜ (9,10). ∏ ª∂£, fiÔ˘ ¤ÁÈÓÂ Ë ·ÚÔ‡Û· ÌÂϤÙË Î·È ÛÙËÓ ÔÔ›· ‰ÂÓ ÓÔÛËχÔÓÙ·È ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È Î·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈÎÔ› ·ÛıÂÓ›˜, ‰¤¯ÂÙ·È ·ÛıÂÓ›˜ Ì ·È‰È·ÙÚÈο ÓÔÛ‹Ì·Ù·, ηıÒ˜ Â›Û˘ ÔÏ˘ÙÚ·˘Ì·Ù›Â˜, ÂÁη˘Ì·Ù›Â˜ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜ ·ÛıÂÓ›˜. ∆Ô ÔÛÔÛÙfi 18,3% ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ Ô˘ ·ÚÔ˘Û›·Û·Ó ¡§, ¢ڛÛÎÂÙ·È ÛÙ· Â›‰· Ô˘ ÂÈÎÚ·ÙÔ‡Ó ‰ÈÂıÓÒ˜. ™Â Ì›· Û¯ÂÙÈο ÚfiÛÊ·ÙË ÌÂϤÙË ÌÂٷ͇ 17 Â˘Úˆ·˚ÎÒÓ ¯ˆÚÒÓ, ÙÔ Û˘ÓÔÏÈÎfi ÔÛÔÛÙfi ¡§ ÛÙȘ ª∂£ ÂÓËÏ›ÎˆÓ ·Ó‹Ïı ÛÙÔ 20,6%, Ì ÛËÌ·ÓÙÈΤ˜ fï˜ ·ÔÎÏ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ˘fi ÌÂϤÙË ¯ˆÚÒÓ, Ô˘ Î˘Ì¿ÓıËÎ·Ó ÌÂٷ͇ 9,7% (ÛÙȘ ª∂£ Ù˘ ∂Ï‚ÂÙ›·˜) Î·È 31,6% (ÛÙËÓ πÙ·Ï›·) (11). ™Ù· ›‰È· ÂÚ›Ô˘ Â›‰· Î˘Ì¿ÓıËÎ·Ó ÔÈ ¡§ Û ·Ó¿ÏÔÁË Â˘Úˆ·˚΋ ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË ÌÂٷ͇ ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ, fiÔ˘ ÙÔ ÔÛÔÛÙfi ¡§ ÛÙȘ ª∂£ ‹Ù·Ó 23,6% (12). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÔÈ Û˘ÁÎÚ›ÛÂȘ ÙˆÓ ¡§ ÌÂٷ͇ ª∂£ ‰ÂÓ Â›Ó·È Ô‡Ù ‡ÎÔϘ, Ô‡Ù ¿ÓÙÔÙ ·ÍÈfiÈÛÙ˜. OÈ ‰È·Î˘Ì¿ÓÛÂȘ ÙˆÓ ÔÛÔÛÙÒÓ ¡§ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È Û ‰È·ÊÔÚ¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ·ÊÂÓfi˜ Ì ÙË ÌÂıÔ‰ÔÏÔÁ›· Ù˘ ¤Ú¢ӷ˜, Î·È ·ÊÂÙ¤ÚÔ˘ Ì ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ÌÔÓ¿‰Â˜, fiˆ˜ Û˘Óı‹Î˜ ·ÓÙÈÛË„›·˜ Î·È ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ (13). ∏ ÂÚÁ·Û›· Ì·˜ ¤ÁÈÓ Ì ‚¿ÛË ÙÔ˘˜ ÔÚÈÛÌÔ‡˜ Î·È ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ∂ÔÙ›·˜ ¡ÔÛÔÎÔÌÂÈ·ÎÒÓ §ÔÈÌÒÍÂˆÓ ÙˆÓ ∏¶∞ (1,14). ∆· ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ¡§ ÙˆÓ ª∂£ Û ۯ¤ÛË Ì ÂΛӷ ÙˆÓ ¿ÏÏˆÓ ÎÏÈÓÈÎÒÓ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÔÊ›ÏÔÓÙ·È ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ÂÚÈÛÙ·ÙÈÎÒÓ


¶·È‰È·ÙÚÈ΋ 2001;64:565-572

Paediatriki 2001;64:565-572

¶›Ó·Î·˜ 3. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÓÔÛÔÎÔÌÂÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙË ª∂£ (ÌÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË) ¶·Ú¿ÁÔÓÙ·˜ ∏ÏÈΛ· (¤ÙË) º‡ÏÔ (·ÁfiÚÈ·) PRISM score ∫·ıÂÙ‹Ú˜/Ë̤Ú. ÓÔÛËÏ›·˜* ¡ÔÛËÏ›· ÛÙË ª∂£ (Ë̤Ú˜) ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ (Ë̤Ú˜) ¶·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ (Ë̤Ú˜) ∏2 ·Ó·ÛÙÔÏ›˜ ÈÛÙ·Ì›Ó˘ (Ë̤Ú˜)

∞ÛıÂÓ›˜ Ì ¡§ (n=79)

∞ÛıÂÓ›˜ ¯ˆÚ›˜ ¡§ (n=352)

p

3,4 ± 0,2 51 11,7 ± 0,7 2,1 ± 0,2 22,6 ± 2,1 16,3 ± 1,7 5,9 ± 0,4 5,4 ± 0,5

5,8 ± 0,4 175 6,2 ± 0,3 0,9 ± 0,1 5,2 ± 0,4 1,7 ± 0,1 0,3 ± 0,02 1,9 ± 0,2

0,136 0,721 <0,0001 <0,0001 <0,0001 <0,0001 <0,0001 <0,001

¡§: ¡ÔÛÔÎÔÌÂȷ΋ Ïԛ̈ÍË * Ÿˆ˜ ÂÎÊÚ¿˙ÔÓÙ·È Ì ÙÔ device utilization ratio (6) OÈ ÙÈ̤˜ ÂÎÊÚ¿˙ÔÓÙ·È ˆ˜ mean ± SEM

¶›Ó·Î·˜ 4. ∞Ó¿Ï˘ÛË ·Ú·ÁfiÓÙˆÓ Û ۯ¤ÛË Ì ÙËÓ Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ÓÔÛÔÎÔÌÂȷ΋˜ Ïԛ̈͢ ÛÙË ª∂£ ¶·Ú¿ÁÔÓÙ·˜ Intercept PRISM score ∫ÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜ ∏̤Ú˜ ÓÔÛËÏ›·˜ ÛÙË ª∂£ ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ ¶·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ∏2 ·Ó·ÛÙÔÏ›˜ ÈÛÙ·Ì›Ó˘

Regression Coefficient

Standard Error

p* Value

Odds Ratio

(95% C.I.)

-4,963 0,560 0,620 0,174 1,513 1,250 0,236

0,743 0,310 0,280 0,048 0,681 0,050 0,062

0,000 0,021 0,027 0,011 0,026 0,013 0,033

1,4 1,9 1,2 1,6 5,1 1,2

1,09-2,96 1,07-3,22 1,08-1,31 1,20-3,83 1,02-19,32 1,10-2,26

Regression Coefficient: ™˘ÓÙÂÏÂÛÙ‹˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Odds Ratio: §fiÁÔ˜ Èı·ÓÔÙ‹ÙˆÓ C.I.: (confidence interval) ¢È¿ÛÙËÌ· ·ÍÈÔÈÛÙ›·˜ * ÀÔÏÔÁ›ÛÙËΠ̠ÙÔ Wald’s - ¯2 test

Ì ÓÔÛÔÎÔÌÂȷ΋ ÛË„·ÈÌ›· Î·È Ó¢ÌÔÓ›·. ŒÙÛÈ, ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ¡§ Ô˘ ·ÚÔ˘Û›·Û·Ó ÔÈ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜, ÙÔ 59,3% ·ÊÔÚÔ‡Û ÂÚÈÙÒÛÂȘ ÛË„·ÈÌ›·˜, Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ÚÔηÏÔ‡ÓÙ·È Î˘Ú›ˆ˜ ·fi ·ÔÈÎÈÛÌfi ÙˆÓ ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, ÂÓÒ ÙÔ 30,1% ‹Ù·Ó ÓÔÛÔÎÔÌÂȷΤ˜ Ó¢ÌÔӛ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÂÚÈÙÒÛÂȘ “Ó¢ÌÔÓ›·˜ Û¯ÂÙÈ˙fiÌÂÓ˘ Ì ÙÔÓ ·Ó·Ó¢ÛÙ‹Ú·” (ventilator-associated pneumonia). To Û˘ÁÎÂÎÚÈ̤ÓÔ Â›‰Ô˜ Ó¢ÌÔÓ›·˜ ÚÔηÏÂ›Ù·È Û ‰È·ÛˆÏËӈ̤ÓÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ (15,16). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Á›ÓÂÙ·È ÂÈÛÚfiÊËÛË ÂÎÎÚÈÌ¿ÙˆÓ ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·, Ù· ÔÔ›· η٤گÔÓÙ·È ÛÙÔÓ Ó‡ÌÔÓ· ÌÂÙ·ÎÈÓÔ‡ÌÂÓ· ÌÂٷ͇ ÙÔȯÒÌ·ÙÔ˜ ÙÚ·¯ÂÈÔۈϋӷ Î·È ÙÚ·¯Â›·˜. ∆· ÂÎÎڛ̷ٷ ·˘Ù¿ ‰ÂÓ ÂÚȤ¯Ô˘Ó ÌÈÎÚfi‚È· ÌfiÓÔ Ù˘ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·, ·ÏÏ¿ Î·È ÂÓÙÂÚÔ‚·ÎÙËÚÈÔÂȉ‹, 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‹ Ù˘ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘, Ë Î·Ù¿ÚÁËÛË Ù˘ Á·ÛÙÚÈ΋˜ Ô͇ÙËÙ·˜ ÏfiÁˆ ¯ÔÚ‹ÁËÛ˘ ∏2 ·Ó·-

ÛÙÔϤˆÓ Ù˘ ÈÛÙ·Ì›Ó˘ Î·È Ë Î·Ù·ÎÂÎÏÈ̤ÓË ı¤ÛË ÙˆÓ ·ÚÚÒÛÙˆÓ Â›Ó·È ·Ú¿ÁÔÓÙ˜ Ô˘ ¢ÓÔÔ‡Ó ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜ ÙËÓ Ó¢ÌÔÓ›· Û ·ÛıÂÓ›˜ ª∂£ (17,18). ™Â ÔÏϤ˜ ÂÚÁ·Û›Â˜ ¤¯ÂÈ ‰Âȯı› Ô ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ¡§ Û ·ÛıÂÓ›˜ ÙˆÓ ª∂£ (19-21). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ¡§ ÛÙ· ÙÌ‹Ì·Ù· ·˘Ù¿ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ Î·È Û¯ÂÙ›˙ÂÙ·È Ì ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ (‚·Ú‡ÙËÙ· ÓfiÛÔ˘, ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË) Î·È Ì ·Ú¿ÁÔÓÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÙÚfiÔ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÙÌËÌ¿ÙˆÓ (ÂÂÌ‚·ÙÈΤ˜ ̤ıÔ‰ÔÈ, ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜) (22,23). ™ÙË ÌÂϤÙË Ì·˜ ‰È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ¡§ Û ·È‰È·ÙÚÈ΋ ª∂£. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘, Ë ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, Ô Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜, Ë ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, Ë ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Î·È Ë ¯ÔÚ‹ÁËÛË ∏2 ·Ó·ÛÙÔϤˆÓ Ù˘ ÈÛÙ·Ì›Ó˘ Â›Ó·È ·Ú¿ÁÔÓÙ˜ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ·Ó¿Ù˘ÍË ¡§. OÈ ‰È·ÈÛÙÒÛÂȘ ·˘Ù¤˜ ÂȂ‚·ÈÒÓÔ˘Ó Ù· Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ ·ÚfiÌÔÈˆÓ ÌÂÏÂÙÒÓ, fiˆ˜ ÙˆÓ Ponce

569


¶·È‰È·ÙÚÈ΋ 2001;64:565-572

Paediatriki 2001;64:565-572

¶›Ó·Î·˜ 5. ∞ÓÙÔ¯‹ (%) ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÙˆÓ Û˘¯ÓÔÙ¤ÚˆÓ Gram (-) ÌÈÎÚÔ‚›ˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙË ª∂£ ∞ÓÙÈ‚ÈÔÙÈÎfi ∞ÌÈÎÈÏÏ›ÓË ∞˙ÙÚÂÔÓ¿ÌË ∫ÂÊ·ÏÔı›ÓË ∫ÂÊÔÙ·Í›ÌË ∫ÂÊÙ·˙ÈÓÙ›ÌË °ÂÓÙ·ÌÈΛÓË ∆ÔÌÚ·Ì˘Î›ÓË ¡ÂÙÈÏÌÈΛÓË ∞ÌÈηۛÓË ÃψڷÌÊÂÓÈÎfiÏË ∆ÚÈÌÂıÔ./™Ô˘Ï. πÌÈÂÓ¤ÌË ∞ÌÔÍÈÎÈÏ./∫Ï·‚Ô˘Ï. ¶ÈÂÚ·ÎÈÏ./∆·˙ÔÌ.

E. coli

Klebsiella spp.

E. cloacae

P. aeruginosa

Acinetobacter spp.

50,0 8,3 38,5 11,1 12,5 0,0 8,3 7,7 7,7 0,0 0,0 0,0 12,5 0,0

96,2 75,0 80,9 55,6 78,8 46,8 72,5 73,5 58,1 21,1 38,5 0,0 29,4 0,0

93,6 43,3 96,7 55,2 55,6 29,0 44,0 21,4 13,3 35,7 35,5 3,1 73,9 0,0

25,0 100 72,4 10,0 10,9 5,6 5,4 8,8 2,6 100 13,9

100 97,7 100 88,6 84,1 59,1 77,3 70,7 45,5 100 84,1 0,0 93,2 0,0

¶›Ó·Î·˜ 6. ∞ÓÙÔ¯‹ (%) ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÙˆÓ Û˘¯ÓÔÙ¤ÚˆÓ Gram (+) ÌÈÎÚÔ‚›ˆÓ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙË ª∂£ ∞ÓÙÈ‚ÈÔÙÈÎfi ¶ÂÓÈÎÈÏÏ›ÓË G OÍ·ÎÈÏÏ›ÓË ∞ÌÔÍÈÎÈÏ./∫Ï·‚. °ÂÓÙ·ÌÈΛÓË ∆ÔÌÚ·Ì˘Î›ÓË ¡ÂÙÈÏÌÈΛÓË ∞ÌÈηۛÓË ∂Ú˘ıÚÔÌ˘Î›ÓË ∫ÏÈÓ‰·Ì˘Î›ÓË ƒÈÊ·ÌÈΛÓË ÃψڷÌÊÂÓÈÎfiÏË ∆ÚÈÌÂıÔ./™Ô˘ÏÊ. µ·ÓÎÔÌ˘Î›ÓË ∆Â˚ÎÔÏ·Ó›ÓË

Staphylococcus aureus

CNS

Enterococcus spp.

94,0 14,1 14,1 6,5 6,9 5,0 0,0 14,6 2,6 8,8 2,1 2,5 0,0 0,0

88,1 76,7 76,7 52,9 65,1 38,5 66,7 84,0 63,0 13,6 25,0 64,2 0,0 1,3

21,4 11,1 16,7 25,0 0,0 0,0

de Leon-Rosales Î·È Û˘Ó Î·È ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ∂ÔÙ›·˜ ¡ÔÛÔÎÔÌÂÈ·ÎÒÓ §ÔÈÌÒÍÂˆÓ ÙˆÓ ∏¶∞, Ô˘ ·ÊÔÚÔ‡Ó fï˜ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜ (24,25). ™ÙȘ ‰‡Ô ÌÂϤÙ˜ ÙˆÓ Singh-Naz Î·È Û˘Ó Û ·È‰È·ÙÚÈΤ˜ ª∂£ ÙÂÎÌËÚÈÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÔÈ ›‰ÈÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (26,27). ™ÙȘ ÂÚÁ·Û›Â˜ ·˘Ù¤˜, Ë ÌÈÎÚ‹ ËÏÈΛ· Î·È ÙÔ ¯·ÌËÏfi ۈ̷ÙÈÎfi ‚¿ÚÔ˜ ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ¡§, οÙÈ Ô˘ fï˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠÛÙË ‰È΋ Ì·˜ ÌÂϤÙË. ∆¤ÏÔ˜, Û ̛· ÚfiÛÊ·ÙË ÚÔÔÙÈ΋ ÌÂϤÙË ÙˆÓ Gilio Î·È Û˘Ó ÌÂٷ͇ ‚·ÚÈ¿ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ, ‰›ÓÂÙ·È È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ, ÛÙË ¯Ú‹ÛË ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Î·È ÛÙË ¯ÔÚ‹ÁËÛË ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜, ˆ˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·Ó¿Ù˘Í˘ ¡§ (28). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙ· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËηÓ, Ë ÂÚÁ·Û›· Ì·˜ Â›Ó·È Û‡ÌʈÓË Ì ¿ÏϘ ·ÚfiÌÔȘ ÂÚÁ·Û›Â˜ (16,29,30). ™ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È, fiˆ˜ Î·È ÛÙË ‰È΋ Ì·˜, ÙÔ

570

˘„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¿ fï˜ ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ·ÓıÂÎÙÈο ÛÙÂϤ¯Ë ÛÙË ‚·ÓÎÔÌ˘Î›ÓË. ª›· ¿ÏÏË ÛËÌ·ÓÙÈ΋ ‰È·›ÛÙˆÛË ‹Ù·Ó ÙÔ ¯·ÌËÏfi ÔÛÔÛÙfi S. aureus ·ÓıÂÎÙÈÎÔ‡ ÛÙË ÌÂıÈÎÈÏÏ›ÓË (MRSA) Ô˘ ¤Êı·Û ÙÔ 14,1% ÛÙËÓ ÂÚÁ·Û›· Ì·˜ Î·È ‹Ù·Ó Û¯ÂÙÈο ÌÈÎÚfiÙÂÚÔ ·˘ÙÔ‡ Ù˘ Â˘Úˆ·˚΋˜ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ ÛÙ· ·È‰È¿ (12), ÛÙËÓ ÔÔ›· Ô MRSA ÍÂÂÚÓÔ‡Û ÙÔ 18%. £· Ú¤ÂÈ Ó· ÛËÌÂȈı›, ˆÛÙfiÛÔ, fiÙÈ Ù· ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È È‰È·›ÙÂÚ· ¯·ÌËÏ¿, Â¿Ó Û˘ÁÎÚÈıÔ‡Ó Ì ÙËÓ Â˘Úˆ·˚΋ ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË ÛÙȘ ª∂£ ÂÓËÏ›ÎˆÓ (11) Î·È ÙËÓ πÛ·ÓÈ΋ ÌÂϤÙË Û 123 ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜ (31), fiÔ˘ Ù· ÔÛÔÛÙ¿ MRSA ‹Ù·Ó 72% Î·È 57%, ·ÓÙ›ÛÙÔȯ·. ∞ÓÙ›ıÂÙ· Ì ¿ÏϘ ÌÂϤÙ˜ Î·È Î˘Ú›ˆ˜ ·fi ª∂£ ÂÓËϛΈÓ, ÙÔ 4,4% ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·fi ÂÓÙÂÚfiÎÔÎÎÔ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜


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ıˆÚÂ›Ù·È Ì¿ÏÏÔÓ ¯·ÌËÏfi Î·È Â›Ó·È ıÂÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ·ÔÌÔÓÒıËÎ·Ó ÔÏ˘·ÓıÂÎÙÈο ÛÙÂϤ¯Ë ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. øÛÙfiÛÔ, Ì›· ·ÎfiÌË ·ÍÈfiÏÔÁË ·Ú·Ù‹ÚËÛË ‹Ù·Ó Ô ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÏÔÈÌÒÍÂˆÓ ·fi „¢‰ÔÌÔÓ¿‰· Ô˘ ¤Êı·Û ÙÔ 14,2% ÙˆÓ ¡§ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜. ∂Óı·ÚÚ˘ÓÙÈο ‚¤‚·È· Â›Ó·È Ù· ÌÈÎÚ¿ ÔÛÔÛÙ¿ ·ÓÙÔ¯‹˜ Ù˘ P. aeruginosa ÛÙ· ·ÓÙÈÌÈÎÚԂȷο Ê¿Ú̷η Ô˘ Â›Ó·È Û·ÊÒ˜ ¯·ÌËÏfiÙÂÚ· Û ۯ¤ÛË Ì ·˘Ù¿ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ Ù˘ ∞ÌÂÚÈ΋˜ (32) Î·È Ù˘ ªÂÁ¿Ï˘ µÚÂÙ·Ó›·˜ (33) Î·È ı· Ú¤ÂÈ Ó· ·Ô‰ÔıÔ‡Ó Ì¿ÏÏÔÓ ÛÙËÓ ÔÚıÔÏÔÁÈ΋ ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙÔ ÙÌ‹Ì· Ì·˜. ∂›Û˘, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·Û›·˜ Ì·˜ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó Ôχ ·fi ·˘Ù¿ Ù˘ ª∂£ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, fiÔ˘ Ë ·ÓÙÔ¯‹ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ‚·ÎÙËÚȉ›Ô˘ ÛÙËÓ ÎÂÊÙ·˙ȉ›ÌË, ÙȘ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ Î·È ÙËÓ ÈÌÈÂÓ¤ÌË ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· 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 fï˜ ·ÚÎÂÙ¿ ¯·ÌËÏfiÙÂÚÔ Û ۯ¤ÛË Ì ÙÔ 17% ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ÏÔÈÌÒÍÂˆÓ Ù˘ Â˘Úˆ·˚΋˜ ÌÂϤÙ˘ Û ·È‰È·ÙÚÈΤ˜ ª∂£ (12). ∆Ô ·˘Í·ÓfiÌÂÓÔ ÔÛÔÛÙfi ¡§ ÛÙȘ ª∂£ ·fi Candida ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· Â›Ó·È È‰È·›ÙÂÚ· ·ÓËÛ˘¯ËÙÈÎfi Î·È ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·˘ÍË̤ÓË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â˘Ú¤ˆ˜ Ê¿ÛÌ·ÙÔ˜, ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÎÂÓÙÚÈÎÒÓ Î·ıÂÙ‹ÚˆÓ, ·ÏÏ¿ Î·È ÛÙË ¯ÔÚ‹ÁËÛË ÔÏÈ΋˜ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ (35-37). ∞ÚÎÂÙÔ›, Ù¤ÏÔ˜, Û˘ÁÁÚ·Ê›˜ ‰È·›ÛÙˆÛ·Ó Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ¡§ Î·È ıÓËÙfiÙËÙ·˜ ÛÙȘ ª∂£ (3840). ∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ë ÂÚÁ·Û›· ÙˆÓ Fry Î·È Û˘Ó Û ÔÏ˘ÙÚ·˘Ì·Ù›Â˜ Ô˘ ÓÔÛËχıËÎ·Ó Û ª∂£. OÈ Û˘ÁÁÚ·Ê›˜ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ Â¿Ó ÔÈ ·ÛıÂÓ›˜ ÂÈ˙Ô‡Û·Ó ¤Ú·Ó ÙˆÓ 72 ˆÚÒÓ, Ë ÂΉ‹ÏˆÛË ÔÏ˘ÔÚÁ·ÓÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È Ë ÂÈ‚›ˆÛ‹ ÙÔ˘˜ ÂÍ·ÚÙfiÙ·Ó Î˘Ú›ˆ˜ ·fi ÙËÓ ·Ó¿Ù˘ÍË ¡§ (38). ∏ ÌÂϤÙË ÂÍ¿ÏÏÔ˘ ÙˆÓ Bueno-Cavanillas Î·È Û˘Ó ¤‰ÂÈÍ fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ¡§ ›¯·Ó ‰ÈÏ¿ÛȘ Èı·ÓfiÙËÙ˜ Ó· ηٷϋÍÔ˘Ó (OR=2,1), Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ¡§ (39). ¶·ÚfiÌÔÈ· ‹Ù·Ó Ù· Â˘Ú‹Ì·Ù· Ù˘ ÂÚÁ·Û›·˜ Ì·˜. ¶·Ú¿ ÙÔ fiÙÈ Î·Ó›˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ‰ÂÓ Î·Ù¤ÏËÍ ·fi ¡§, Ë ıÓËÙfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ì ¡§ ‹Ù·Ó Ôχ ˘„ËÏfiÙÂÚË Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó Ù¤ÙÔÈ· Ïԛ̈ÍË (27,8% ¤Ó·ÓÙÈ 6,0%), ÁÂÁÔÓfi˜ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ ¡§, ¯ˆÚ›˜ ÔÈ ›‰È˜ Ó· ÚÔηϤÛÔ˘Ó ·¢ı›·˜ ÙÔ ı¿Ó·ÙÔ, ÂÈ‰Â›ÓˆÛ·Ó Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ, Û˘ÓÙÂÏÒÓÙ·˜ ¤ÌÌÂÛ· ÛÙËÓ Â¤Ï¢ÛË ÙÔ˘ ı·Ó¿ÙÔ˘. Ÿˆ˜ Ê·›ÓÂÙ·È ¿ÏψÛÙÂ Î·È ·fi ¿ÏϘ ·ÚfiÌÔȘ ÂÚÁ·Û›Â˜, ÔÈ ¡§ ÂÈ‚·Ú‡ÓÔ˘Ó ÙËÓ ‹‰Ë ‚·ÚÈ¿

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ηٿÛÙ·ÛË ÙˆÓ ·ÛıÂÓÒÓ ÙˆÓ ª∂£ Î·È Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ·˘ÍË̤ÓË ıÓËÙfiÙËÙ·, ¯ˆÚ›˜ ¿ÓÙ· Ó· ¢ı‡ÓÔÓÙ·È ¿ÌÂÛ· ÁÈ· ÙÔ ı¿Ó·ÙÔ. ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ÌÂϤÙË ÙˆÓ Smith Î·È Û˘Ó Ô˘ ¤ÁÈÓ Û ª∂£ Ù˘ ¡¤·˜ ÀfiÚ΢ (40). ™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹, Ë ·Ó·ÌÂÓfiÌÂÓË ıÓËÙfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Û‡Ìʈӷ Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÁÂÓÈ΋˜ ÙÔ˘˜ ηٿÛÙ·Û˘ (APACHE II score) ‹Ù·Ó 54%. ∂ÓÒ, fï˜, ·Ó·ÌÂÓfiÌÂÓË Î·È ·Ú·ÙËÚËı›۷ ıÓËÙfiÙËÙ· ‹Ù·Ó ·ÚfiÌÔȘ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ ¯ˆÚ›˜ ¡§, ·˘ÙÔ› Ô˘ ·ÚÔ˘Û›·Û·Ó ¡§ η٤ÏËÍ·Ó Û ÔÛÔÛÙfi 82%, Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ ÔÈ Û˘ÁÎÂÎÚÈ̤Ó˜ ÏÔÈÌÒÍÂȘ ·‡ÍËÛ·Ó ¿ÌÂÛ· Î·È ¤ÌÌÂÛ· ÙË ıÓËÙfiÙËÙ· ηٿ 28%. £· Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ÛËÌÂȈı› fiÙÈ ÔÈ ¡§ ·˘Í¿ÓÔ˘Ó ÙË ıÓËÙfiÙËÙ· ÙˆÓ ·ÛıÂÓÒÓ Ì ̤ÙÚÈ· ‚·Ú‡ÙËÙ·, ÂÓÒ ‰ÂÓ Û˘Ì‚·›ÓÂÈ ÙÔ ›‰ÈÔ Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ‚·ÚÈ¿ ηٿÛÙ·ÛË, ÔÈ ÔÔ›ÔÈ Û˘¯Ó¿ ηٷϋÁÔ˘Ó ÚÈÓ ÙËÓ ÂΉ‹ÏˆÛË ¡§, Ô‡Ù Ì ·˘ÙÔ‡˜ Ô˘ ¿Û¯Ô˘Ó ·fi Û¯ÂÙÈο ‹È· ˘ÔΛÌÂÓË ÓfiÛÔ (13). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ¡§ Î·È Î˘Ú›ˆ˜ Ë ÛË„·ÈÌ›· Î·È Ë Ó¢ÌÔÓ›· Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¤˜ Û ·È‰È·ÙÚÈΤ˜ ª∂£, Û¯ÂÙ›˙ÔÓÙ·È Ì ÔÈΛÏÔ˘˜ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È Û˘ÓÙÂÏÔ‡Ó Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÛÙËÓ ·˘ÍË̤ÓË ıÓËÙfiÙËÙ· ÙˆÓ ÙÌËÌ¿ÙˆÓ ·˘ÙÒÓ. ™ËÌ·ÓÙÈÎfi ›ӷÈ, Â›Û˘, ÙÔ ÔÛÔÛÙfi ·ÓÙÔ¯‹˜ ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ Ô˘ ·ÔÌÔÓÒıËηÓ. ª›· ÛÙÚ·ÙËÁÈ΋ ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ı· ‹Ù·Ó ‰˘Ó·Ùfi Ó· ÂÏ·ÙÙÒÛÂÈ ÙfiÛÔ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ¡§, fiÛÔ ÂӉ¯Ô̤ӈ˜ Î·È ÙÔ ÔÛÔÛÙfi ·Ó¿Ù˘Í˘ ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Emori G, Culver D, Horan T, Jarvis W, White J, Olson D et al. National nosocomial infections surveillance system (NNIS): Description of surveillance methods. Am J Infect Control 1991;19:19-35. 2. Jarvis W. Epidemiology of nosocomial infections in pediatric patients. Pediatr Infect Dis J 1987;6:344-351. 3. Donovitz L, Wenzel R, Hoyt J. High risk of hospitalacquired infection in the ICU patients. Crit Care Med 1982;10:355-357. 4. Skippen P, Cox P, Langley J, Matlow A, Barker G, FordJones L. Nosocomial infections in the PICU: Epidemiology and control. In: Fuhrman B, Zimmerman J, editors. Pediatric Critical Care. St. Louis: Mosby-Year Book; 1992. p. 965-987. 5. Pollack M, Ruttimann U, Getson R. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988;16:1110-1116. 6. Report from the National Nosocomial Infections Surveillance System (NNISS). Nosocomial infection rates for interhospital comparison: Limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609-621. 7. Garnes J, Jarvis W, Emori T, Horan T, Hughes J. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128-140.

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8. Haley R, Quade D, Freeman H. Study on the efficacy of nosocomial infection control (SENIC Project): Summary of study design. Appendix E. Algorithms for diagnosing infection. Am J Epidemiol 1980;111:635-643. 9. Wenzel R, Thompson R, Landry S, Russell B, Miller P, Ponce de Leon S et al. Hospital-acquired infections in intensive care units: An overview with emphasis on epidemics. Infect Control 1983;4:371-375. 10. Chandrasekar P, Kruse J, Matthews M. Nosocomial infection among patients in different types of intensive care units at a city hospital. Crit Care Med 1986; 14:508-510. 11. Vincent JL, Bihari D, Suter P, Bruining H, White J, NicolasChanoin MH et al. The prevalence of nosocomial infection in Intensive Care Units in Europe. JAMA 1995;274:639-644. 12. Raymond J, Aujard Y. Nosocomial infections in pediatric patients: A european, multicenter prospective study. Infect Control Hosp Epidemiol 2000;21:260-263. 13. Martin M. Nosocomial infections in Intensive Care Units: An overview of their epidemiology, outcome and prevention. New Horizons 1993;2:162-171. 14. Gaynes R, Culver D, Emori T et al. The national nosocomial infections surveillance system: Plans for the 1990s and beyond. Am J Med 1991;(Suppl 3B):116S-120S. 15. Fagon JY, 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. 16. Patel J, Mollitt D, Pieper P, Tepas J. Nosocomial pneumonia in the pediatric trauma patients: A single center’s experience. Crit Care Med 2000;28:3530-3533. 17. Sanderson P. The sources of pneumonia in ITU patients. Infect Control 1986;7:104-106. 18. Spencer R. Epidemiology of infection in ICUs. Intensive Care Med 1994;20:S2-S6. 19. Haley R, Culver D, White J, Morgan W, Emori T. The nationwide nosocomial infection rate: A new need for vital statistics. Am J Epidemiol 1985;121:159-167. 20. Richards M, Edwards J, Culver D, Gaynes R. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510-515. 21. Craven D, Kunches L, Lichtenberg D, Kollisch N, Barry M, Heeren T et al. Nosocomial infections and fatality in medical and surgical intensive care unit patients. 1988;148:1161-1168. 22. Scott G. Prevention and control of infections in intensive care. Intensive Care Med 2000;26:S22-S25. 23. Freeman J, Goldman D, McGowan J. Methodologic issues in hospital epidemiology. IV. Risk ratios, confounding, effect modification, and the analysis of multiple variables. Rev Infect Dis 1988;10:1118-1141. 24. Ponce de Leon-Rosales S, Molinar-Ramos F, DominguezCherit G, Rangel-Frausto S, Vazquez-Ramos V. Prevalence of infections in intensive care units in Mexico: A multicenter study. Crit Care Med 2000;28:1316-1321. 25. Jarvis W, Edwards J, Culver D, Hughes J, Horan T, Emori T et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91:185S-189S. 26. Singh-Naz N, Sprague B, Patel K, Pollack M. Risk factors

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for nosocomial infection in critically ill children: A prospective cohort study. Crit Care Med 1996;24:875-878. Singh-Naz N, Sprague B, Patel K, Pollack M. Risk assessment and standardized nosocomial infection rate in critically ill children. Crit Care Med 2000;28:2069-2075. Gilio A, Stape A, Pereira C, Cardoso MF, Silva C, Troster E. Risk factors for nosocomial infections in a critically ill pediatric population: A 25-month prospective cohort study. Infect Control Hosp Epidemiol 2000;21:340-342. Edgeworth D, Treacher D, Eykyn S. A 25-year study of nosocomial bacteremia in an adult intensive care unit. Crit Care Med 1999;27:1421-1428. Darby J, Linden P, Pasculle W, Saul M. Utilization and diagnostic yield of blood cultures in a surgical intensive care unit. Crit Care Med 1997;25:989-994. EPINE Working Group. Prevalence of hospital-acquired infections in Spain. J Hosp Infect 1992;20:1-13. Itokazu G, Quinn J, Bell-Dixon C, Kahn F, Weinstein R. Antimicrobial resistance rates among aerobic gramnegative bacilli in Intensive Care Units: Evaluation of a national postmarketing surveillance program. Clin Infect Dis 1996;23:779-784. Chen H, Yuan M, Ibrahim-Elmagboul I, Livermore O. National survey of susceptibility to antimicrobials against isolates of Pseudomonas aeruginosa. J Antimicrob Chemother 1995;35:521-534. ∫Ô˘¿ÚË °, ∫·Ï·Ì·Ï›Î˘ ¶, ∑·ÊÂÈÚÔÔ‡ÏÔ˘ ∞, ™Ù¿ÌÔ˜ °, ¢ÂÏËÁÈ¿ÓÓË, ∫·ÊÂÙ˙‹˜ ¢ Î·È Û˘Ó. §ÔÈÌÒÍÂȘ Î·È ·ÔÈÎÈÛÌfi˜ ·fi Pseudomonas spp Û ·È‰È¿ Ù˘ ªÔÓ¿‰·˜ ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜. ¢ÂÏÙ ∂ÏÏËÓ ªÈÎÚÔ‚ÈÔÏ ∂Ù·ÈÚ 1998;43:187-194. Rangel-Frausto S, Wiblin T, Blumberg H, Saiman L, Patterson J, Rinaldi M et al. National Epidemiology of Mycoses Survey (NEMIS): Variations in rates of bloodsteam infections due to Candida species in seven surgical intensive care units. Clin Infect Dis 1999; 29:253-258. Flanagan P, Barnes R. Fungal infection in the intensive care unit. J Hosp Infect 1998;38:163-177. Vincent J, Anaissie E, Bruining H, Demajo W, El-Abiary M, Haber J. Epidemiology, diagnosis and treatment of systemic Candida infection in surgical patients under intensive care. 1998;24:206-216. Fry D, Pearlstein L, Fulton R, Polk H. Multiple system organ failure: The role of uncontrolled infection. Arch Surg 1980;115:136-140. Bueno-Cavanillas A, Delgado-Rodriguez M, Lopez-Lique A, Schaffino-Cano S, Galvez-Vargas R. Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med 1994;22:55-60. Smith R, Meixler S, Simberkoff M. Excess mortality in critically ill patients with nosocomial bloodsteam infections. Chest 1991;100:164-167.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-03-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶. ∫·Ï·Ì·Ï›Î˘ ¶ª∂¡ (4Ô˜ fiÚÔÊÔ˜), ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & §Â‚·‰›·˜, 115 27, ∞ı‹Ó·


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Paediatriki 2001;64:573-582

ORIGINAL ARTICLE

£ÓËÛÈÌfiÙËÙ· ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ÙË 14ÂÙ›· 1986-1999 ∞. ∞Ó‰Ú¤Ô˘, ª. °Ô˘‰ÂÛ›‰Ô˘, °. ª·˘Ú›‰Ë˜, ∞. ƒÒÛÛÈÔ˘, ∞. ª·Ï¿Ûη, 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˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ó· ηٷÁÚ·ÊÔ‡Ó ‰È·¯ÚÔÓÈο ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙË ÓÂÔÁÓÈ΋ 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·ÏÔӛ΢. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó fiÏ· Ù· ÁÂÓÓËı¤ÓÙ· ˙ÒÓÙ· ÓÂÔÁÓ¿ ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛ/ӛ΢ Î·È ÔÈ ı¿Ó·ÙÔ› ÙÔ˘˜ ·fi ÙÔ 1986 ¤ˆ˜ Î·È ÙÔ 1999. ÀÔÏÔÁ›ÛÙËÎÂ Ë ÔÏÈ΋ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· (∂¡£) Î·È Ë ÂȉÈ΋ ·Ó¿ ηÙËÁÔÚ›· ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (µ°) Î·È ‰È¿ÚÎÂÈ· ·ËÛ˘ (¢∫) ∂¡£. OÈ ı¿Ó·ÙÔÈ ‰È·ÎÚ›ıËÎ·Ó Û ‰˘ÓËÙÈο ·ÔÙÚÂÙÔ‡˜ Î·È ·Ó·fiÙÚÂÙÔ˘˜. ÀÔÏÔÁ›ÛÙËÎ·Ó ·ÎfiÌ· ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙÔ Ì·È¢ÙÈÎfi ÏËı˘ÛÌfi Î·È ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ‰È‰‡ÌˆÓ Î·È ÙˆÓ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ (µ°≤2000 g). ∆Ô ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ ÌÂϤÙ˘ ‰È·ÈÚ¤ıËΠ۠3 ÂÚÈfi‰Ô˘˜: ÙËÓ ∞ (¤ÙË 19861990), ÙË µ (¤ÙË 1991-1995) Î·È ÙË ° (¤ÙË 19961999). OÈ ÂÚ›Ô‰ÔÈ ·˘ÙÔ› Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙË ıÓËÛÈÌfiÙËÙ· Î·È ÙÔ˘˜ ¿ÏÏÔ˘˜ ÚÔ·Ó·ÊÂÚı¤ÓÙ˜ ·Ú¿ÁÔÓÙ˜. O ·ÚÈıÌfi˜ ÙˆÓ ¿Á·ÌˆÓ ÌËÙ¤ÚˆÓ ·˘Í‹ıËΠ·fi 1,5% ÛÙËÓ ∞ ÂÚ›Ô‰Ô, Û 4,5% ÛÙË µ ÂÚ›Ô‰Ô Î·È 7,5% ÛÙË ° Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÏÏÔ‰·ÒÓ ·fi 0% Û 6% Î·È 14% ·ÓÙ›ÛÙÔȯ· (p<0,00001). ™˘Á¯ÚfiÓˆ˜, ·˘Í‹ıËÎ·Ó ‰È·¯ÚÔÓÈο ̤¯ÚÈ ‰ÈÏ·ÛÈ·ÛÌÔ‡ (p<0,05): ·) Ù· ÓÂÔÁÓ¿ Ì µ°≤1000 g (0,67%, 0,95%, 1,38% ÁÈ· ÙȘ ÂÚÈfi‰Ô˘˜ ∞, µ, °,), ‚) Ù· ÓÂÔÁÓ¿ Ì µ° 10011500 g (1,2%,1,5%, 2,5%) Î·È Á) Ù· ÓÂÔÁÓ¿ Ì µ° 1501-2000 g (1,7%, 2,3%, 3,35%). ∏ ‰ÈÔÚıˆÌ¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· (¢∂¡£) (ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· Ì›ÔÓ ·Ó·fiÙÚÂÙÔÈ ı¿Ó·ÙÔÈ) ÛÙËÓ ∞ ÂÚ›Ô‰Ô ‹Ù·Ó 12,5ò, ÛÙË µ ÂÚ›Ô‰Ô

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).

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À πÔÎÚ¿ÙÂÈÔ °¶¡ £ÂÛÛ·ÏÔӛ΢

Division of Neonatology Ippokration General Hospital, Thessaloniki

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¶·È‰È·ÙÚÈ΋ 2001;64:573-582

Paediatriki 2001;64:573-582

9,5ò (ÙÒÛË 24%) Î·È ÛÙË ° ÂÚ›Ô‰Ô 6,5ò (ÙÒÛË 48% Û ۯ¤ÛË Ì 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· ÙȘ ÂÚÈfi‰Ô˘˜ ∞, µ, ° ·ÓÙ›ÛÙÔȯ· 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·¯ÚÔÓÈ΋ ÂÏ¿ÙÙˆÛ‹ Ù˘ ·ÊÔÚÔ‡Û·Ó ÓÂÔÁÓ¿ Ì µ°≤800 g. ∞Ê·ÈÚÒÓÙ·˜ ·fi ÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· ÙÔ˘˜ ı·Ó¿ÙÔ˘˜ ÓÂÔÁÓÒÓ Ì µ°≤700 g Î·È ÙÔ˘˜ ·Ó·fiÙÚÂÙÔ˘˜ ı·Ó¿ÙÔ˘˜, ‚Ú¤ıËΠ¤Ó· ÏÂfiÓ·ÛÌ· ıÓËÛÈÌfiÙËÙ·˜ 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‹ÚÍ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ÂÈ‚›ˆÛ˘ ÙˆÓ Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (¶Ãµ°) (≤1500 g) Î·È ÙˆÓ ¿Ú· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (¶¶Ãµ°) (≤1000 g) ÓÂÔÁÓÒÓ. OÈ ı¿Ó·ÙÔÈ Ô˘ ÌÔÚ› Ó· ·ÔÙÚ·Ô‡Ó Â›Ó·È ÙÒÚ· ÏÈÁfiÙÂÚÔÈ ·’ fiÙÈ ·Ú¯Èο (3,75ò ¤Ó·ÓÙÈ 10,7ò). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ Úfi‚ÏËÌ· ÛÙË ıÓËÛÈÌfiÙËÙ· ÂÓÙÔ›˙ÂÙ·È ÛÙ· ÓÂÔÁÓ¿ Ì µ°≤800 g.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ÓÂÔÁÓ¿, ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·, ÂȉÈ΋ ıÓËÛÈÌfiÙËÙ·.

Key words: neonates, general mortality, specific mortality.

∂ÈÛ·ÁˆÁ‹ ∆· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·, ÔÈ ÚfiÔ‰ÔÈ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ Î·È ÓÂÔÁÓÈ΋ ÊÚÔÓÙ›‰· Î·È Ë Â˘Ú›· ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ Ù¯ÓÔÏÔÁÈÒÓ Î·È ıÂÚ·ÂÈÒÓ Ô‰‹ÁËÛ·Ó Û ÛÙ·ıÂÚ‹ Ì›ˆÛË Ù˘ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÛÙȘ ‚ÈÔÌ˯·ÓÈΤ˜ ¯ÒÚ˜ (1-3). π‰È·›ÙÂÚ· ÌÂÁ¿ÏË Â›Ó·È Ë ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÛÙ· ¶Ãµ° ÓÂÔÁÓ¿ (4). ∏ ıÓËÛÈÌfiÙËÙ· ÙˆÓ ¶Ãµ° ÓÂÔÁÓÒÓ ·ÚÔ˘Û›·Û ·fiÙÔÌË ÙÒÛË ÌÂÙ¿ ÙË ¯Ú‹ÛË ÙÔ˘ Â͈ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· (5). ™ÙËÓ ∂ÏÏ¿‰·, Ë ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ (ª∂¡¡), ηٿ Ù· ‰ÈÂıÓ‹ ÚfiÙ˘·, ÍÂΛÓËÛ ·fi ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80. ∞’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ÛÙË ‰È¿ÚÎÂÈ· ·˘ÙÒÓ ÙˆÓ 15-20 ÂÚ›Ô˘ ¯ÚfiÓˆÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ª∂¡¡, ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰ËÌÔÛȇÛÂȘ Ì ·ÎÚÈ‚‹ ‰Â‰Ô̤ӷ ÁÈ· ÙË ‰È·¯ÚÔÓÈ΋ ÂͤÏÈÍË Ù˘ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙˆÓ ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘ ÙˆÓ ÓÂÔÁÓÒÓ. ∆¤ÙÔÈ· ‰Â‰Ô̤ӷ, ηıÒ˜ Î·È ‰Â‰Ô̤ӷ ·fi ÙË ‚ÚÂÊÈ΋ ıÓËÛÈÌfiÙËÙ· Â›Ó·È ÎÚ›ÛÈÌ˘ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÁ·ˆÓ Î·È ÓÂÔÁÓÒÓ, ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÁÈ· ÙÔ Û¯Â‰È·ÛÌfi Ù˘ ·Ú¯fiÌÂÓ˘ ÓÂÔÁÓÈ΋˜ ÊÚÔÓÙ›‰·˜. OÈ ‰‡Ô ·ÓÂÏÏ‹ÓȘ ÌÂϤÙ˜ ÁÈ· ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ / ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘, Ô˘ ¤ÁÈÓ·Ó ÙÔ 1983 Î·È ÙÔ 1998, ‰Â›¯ÓÔ˘Ó ÌÂÁ¿ÏË ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ (6,7). OÈ ÌÂϤÙ˜

·˘Ù¤˜, fï˜, ¤¯Ô˘Ó ÌÂÁ¿Ï˜ ÂÏÏ›„ÂȘ Û ԢÛÈÒ‰Ë ‰Â‰Ô̤ӷ Î·È ÔÏϤ˜ ·‰˘Ó·Ì›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÎÙ¤ÏÂÛ‹ ÙÔ˘˜. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ‰Â‰Ô̤ӷ Ù˘ ∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀËÚÂÛ›·˜ ∂ÏÏ¿‰Ô˜ Ô˘ ‚·Û›˙ÔÓÙ·È ÛÙÔ ÈÛÙÔÔÈËÙÈÎfi Á¤ÓÓËÛ˘ Î·È ı·Ó¿ÙÔ˘ (8). ¢Â‰Ô̤ӷ ·fi ¡ÂÔÁÓÔÏÔÁÈο ∆Ì‹Ì·Ù· Ù˘ ∂ÏÏ¿‰·˜ ˘¿Ú¯Ô˘Ó, ›Ù ·ÔÛ·ÛÌ·ÙÈο - ¯ˆÚ›˜ ‰È·¯ÚÔÓÈ΋ ÂÂÍÂÚÁ·Û›·, ›Ù Ì ·ÚÎÂÙ¤˜ ÂÏÏ›„ÂȘ (9-13). ∏ ÂÚÁ·Û›· ·˘Ù‹ ·Û¯ÔÏÂ›Ù·È Ì ÙËÓ ·Ó·ÛÎfiËÛË fiÏˆÓ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ Û ¤Ó· ÂÚÈÊÂÚÂÈ·Îfi ÙÚÈÙÔ‚¿ıÌÈÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ΤÓÙÚÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ 14ÂÙ›·˜, ·fi ÙËÓ Ë̤ڷ Ù˘ ¤Ó·Ú͢ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘, ÙÔ 1986, ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1999. ™ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ÔÈ ·Ú¿ÌÂÙÚÔÈ Ù˘ ȉ·ÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙÔ˘ ·Ó·fiÙÚÂÙÔ˘ ı·Ó¿ÙÔ˘ ÁÈ· ÙËÓ ·Ó¿‰ÂÈÍË ÙˆÓ Ô˘ÛÈ·ÛÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi ÌÂÏÏÔÓÙÈÎÒÓ ÛÙfi¯ˆÓ.

574

YÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆Ô ˘ÏÈÎfi ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÓÂÔÁÓ¿, Ì µ°>500 g, Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛ/ӛ΢ Î·È ÓÔÛËχıËÎ·Ó ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ∂™À ÙÔ˘ ›‰ÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÙË 14ÂÙ›· 1986-1999. ∆· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ Ì µ°≤500 g ‹Ù·Ó Û˘ÓÔÏÈο 12. ™Â


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

ηӤӷ ·fi ·˘Ù¿ ‰ÂÓ ¤ÁÈÓ ÚÔÛ¿ıÂÈ· ·Ó¿Ó˄˘, Ô‡Ù ÂÊ·ÚÌfiÛÙËÎ·Ó ÂÓÙ·ÙÈο ̤۷ ıÂÚ·›·˜ Î·È fiÏ· ¤ı·Ó·Ó ÙȘ ÚÒÙ˜ ÒÚ˜ ˙ˆ‹˜. ∞ӷχıËÎ·Ó ·Ó·‰ÚÔÌÈο Ù· ‰Â‰Ô̤ӷ Ô˘ ÂÏ‹ÊıËÛ·Ó ·fi: ·) Ù· ·Ú¯Â›· È·ÙÚÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ fiÏˆÓ ÙˆÓ ÁÂÓÓ‹ÛˆÓ, fiÔ˘ ηٷÁÚ¿ÊÔÓÙ·È Ë ËÌÂÚÔÌËÓ›· Á¤ÓÓËÛ˘, Ë ËÌÂÚÔÌËÓ›· ÂÈÛ·ÁˆÁ‹˜, Ô ÙfiÔ˜ Á¤ÓÓËÛ˘, ÙÔ µ°, Ë ¢∫, Ù· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, Ù· ÚÔ‚Ï‹Ì·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, Ë ¤Î‚·ÛË Î·È Ë ËÌÂÚÔÌËÓ›· ÂÍfi‰Ô˘ ‹ ı·Ó¿ÙÔ˘ ÙÔ˘˜, ‚) Ù· ‚È‚Ï›· ÙˆÓ ‰ÈÔÈÎËÙÈÎÒÓ ˘ËÚÂÛÈÒÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÁÈ· ÙËÓ ˘ËÎÔfiÙËÙ· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙËÓ Î·Ù¿ÛÙ·ÛË Á¿ÌÔ˘ Ù˘ ÌËÙ¤Ú·˜. ∆· ‰Â‰Ô̤ӷ ·Ó·Ï‡ıËÎ·Ó ‰‡Ô ÊÔÚ¤˜, ·fi ‰‡Ô ‰È·ÊÔÚÂÙÈΤ˜ ÔÌ¿‰Â˜ ÁÈ·ÙÚÒÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ï¿ıÔ˘˜. ∆Ô ‰È¿ÛÙËÌ· ÙˆÓ 14 ¯ÚfiÓˆÓ ‰È·ÈÚ¤ıËΠ۠ÙÚÂȘ ÂÚÈfi‰Ô˘˜: ∏ ÚÒÙË ÂÚ›Ô‰Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ٷ ÚÒÙ· ¤ÓÙ ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÙÌ‹Ì·ÙÔ˜, 1986-1990 (ÂÚ›Ô‰Ô˜ ∞). ∏ ‰Â‡ÙÂÚË ÂÚ›Ô‰Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ÙËÓ ÂÓÙ·ÂÙ›· 1991-1995 Î·È Ë ¤Ó·ÚÍ‹ Ù˘ ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi ÙÚÂȘ ÌÂÁ¿Ï˜ ·ÏÏ·Á¤˜: ·) ÙË ‰ËÌÈÔ˘ÚÁ›· Î·È ‰Â‡ÙÂÚÔ˘ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÛÙÔ ›‰ÈÔ ¡ÔÛÔÎÔÌ›Ô, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌÂȈı› ηٿ ÙÔ ‹ÌÈÛ˘ Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÛˆÙÂÚÈÎÒÓ ÓÂÔÁÓÒÓ, ‚) ÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙÔ˘ Â͈ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙË ıÂÚ·›· ÙˆÓ ÓÂÔÁÓÒÓ Ì ۇӉÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È Á) ÙËÓ ·ÚÔ˘Û›· ÛËÌ·ÓÙÈÎÔ‡ ·ÚÈıÌÔ‡ ÌÂÙ·Ó·ÛÙÒÓ ÂÁ·ˆÓ (ÂÚ›Ô‰Ô˜ µ). ∏ ÙÚ›ÙË ÂÚ›Ô‰Ô˜ ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi ÚÈ˙È΋ ·Ó·Î·›ÓÈÛË Ù˘ ˘Ô‰ÔÌ‹˜ Ù˘ ª∂¡¡ Î·È ·Ó·Ó¤ˆÛË Î·È ÂÌÏÔ˘ÙÈÛÌfi ÙÔ˘ Ì˯·ÓÈÎÔ‡ ÂÍÔÏÈÛÌÔ‡ Ù˘ Î·È ÂÚÈÂÏ¿Ì‚·Ó ÙËÓ ÙÂÙÚ·ÂÙ›· 1996-1999 (ÂÚ›Ô‰Ô˜ °). OÈ ÙÚÂȘ ¯ÚÔÓÈΤ˜ ÂÚ›Ô‰ÔÈ Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ·, ÙÔ Â›‰Ô˜ ÙÔ˘ Ì·È¢ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÙÔÓ ·ÚÈıÌfi Î·È ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ, ÙÔ ÔÛÔÛÙfi ÙˆÓ ‰È‰‡ÌˆÓ. ∏ ª∂¡¡ ¿Ú¯ÈÛ ÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÙÔ 1986, Û ¯ÒÚÔ Ô˘ ‰ÂÓ ‹Ù·Ó ۯ‰ȷṲ̂ÓÔ˜ ÁÈ’ ·˘Ùfi ÙÔ ÛÎÔfi. ™Â fiÏ· Ù· ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ˘‹ÚÍ·Ó Û˘Ó¯›˜ ·ÏÏ·Á¤˜ ÛÙÔ ÙÌ‹Ì· Î·È ÔÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ‹Ù·Ó ÛËÌ·ÓÙÈΤ˜ (¶›Ó·Î˜ 1 Î·È 2). ∏ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· ˘ÔÏÔÁ›ÛÙËΠ̠4 ÙÚfiÔ˘˜ Î·È ‰È·ÎÚ›ıËΠ·Ó¿ÏÔÁ· ÛÂ: ·) ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· (¡£) Ô˘ ÂÚÈÂÏ¿Ì‚·Ó fiÏ· Ù· ÓÂÔÁÓ¿ Ô˘ ¤ı·Ó·Ó ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ÙȘ ÚÒÙ˜ 28 Ë̤Ú˜ ˙ˆ‹˜, ‚) ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· (∂¡£) Ô˘ ÂÚÈÂÏ¿Ì‚·Ó fiÏ· Ù· ÓÂÔÁÓ¿ Ô˘ ¤ı·Ó·Ó ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜ ÛÙÔ ¡ÔÛÔÎÔÌ›Ô, Á) ‰ÈÔÚıˆÌ¤ÓË ¡£ (¢¡£) Ô˘ ÚÔ·ÙÂÈ ·fi ÙË ¡£ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¤ı·Ó·Ó ·fi ·›ÙÈ· Ô˘ ıˆڋıËÎ·Ó ·Ó·fiÙÚÂÙ· Û‡Ìʈӷ Ì ٷ ˘¿Ú¯ÔÓÙ· È·ÙÚÈο ̤۷ Î·È ‰) ‰ÈÔÚıˆÌ¤ÓË ∂¡£ (¢∂¡£) Ô˘ Â›Ó·È Ë ∂¡£ ÂÎÙfi˜ ÙˆÓ ı·Ó¿ÙˆÓ ·fi ·Ó·fiÙÚÂÙ· ·›ÙÈ·. ∆· ·Ó·fiÙÚÂÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ™ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ¢∂¡£, Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ Ì ·Ó·fiÙÚÂÙ· ·›ÙÈ· ı·Ó¿ÙˆÓ ·Ê·ÈÚ¤ıËÎÂ Î·È ·fi ÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi ı·Ó¿ÙˆÓ Î·È ·fi ÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿. ∏ ¢∂¡£ ıˆڋıËÎÂ Ô ÈÔ Ô˘ÛÈ҉˘ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ¯ÚËÛÈ̇ÛÔ˘Ó ÁÈ· ÌÂÏÏÔÓÙÈÎÔ‡˜ ۯ‰ȷÛÌÔ‡˜. ªÂ ‚¿ÛË ·˘Ù‹Ó, ¤ÁÈÓ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·Ó¿ ηÙËÁÔÚ›· µ° Î·È ¢∫. ∏ ηÙËÁÔÚ›· µ° ÂÚÈÏ·Ì‚¿ÓÂÈ 4 ÔÌ¿‰Â˜ ÓÂÔÁÓÒÓ Ì µ°: ·) 501-1000 g, ‚) 10011500 g, Á) 1501-2000 g, ‰) >2000 g. ∏ ÔÌ¿‰· Ì µ° 501-1000

Paediatriki 2001;64:573-582

¶›Ó·Î·˜ 1. µ·ÛÈÎfi˜ ÂÍÔÏÈÛÌfi˜ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ∂™À πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛ/ӛ΢ ∂ÍÔÏÈÛÌfi˜ ñ ∞Ó·Ó¢ÛÙ‹Ú˜ ™˘Ì‚·ÙÈÎÔ› ∂ÓÂÚÁÔÔÈÔ‡ÌÂÓÔÈ ·fi ·ÛıÂÓ‹ À„›Û˘¯ÓÔÈ ñ ∂ÏÂÁÎÙ¤˜ (Monitors) ηډÈÔ·Ó·Ó¢ÛÙÈÎÔ› ∞¶, ‰È·‰ÂÚÌÈÎÔ› ∞¶, ·ÈÌ·ÙËÚÔ› ñ ªÂÙÚËÙ¤˜ ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜ ñ µÈÔ¯ËÌÈÎÔ› ·Ó·Ï˘Ù¤˜ ñ ºÔÚËÙfi˜ ˘ÂÚ˯ÔÁÚ¿ÊÔ˜ ñ ºÔÚËÙfi ·ÎÙÈÓÔÏÔÁÈÎfi ñ ™˘Û΢‹ ÁÈ· ¡O ñ £ÂÚÌÔÎÔÈÙ›‰Â˜ ÎÏÂÈÛÙ¤˜ ÎÔÈÓ¤˜ servo ñ £ÂÚÌÔÎÔÈÙ›‰Â˜ ·ÓÔÈÎÙ¤˜ ñ ∆Ú¿Â˙˜ ·Ó¿Ó˄˘

ŒÙÔ˜ 1986

1999

5 -

9 5 2

3 1/2* 1/2* -

18 6 2 1 1 1 1 1

28 8 1

20 10 3

*∆Ô ó ÛËÌ·›ÓÂÈ fiÙÈ ÙÔ Ì˯¿ÓËÌ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó ·fi ‰‡Ô ÙÌ‹Ì·Ù· Û˘Á¯ÚfiÓˆ˜

¶›Ó·Î·˜ 2. ¶ÚÔÛˆÈÎfi ¡ÂÔÁÓÔÏÔÁÈÎÒÓ ªÔÓ¿‰ˆÓ Ù‡Ô˘ πI Î·È ππI πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛ/ӛ΢ (∆Ì‹Ì· ∂™À) ¶ÚÔÛˆÈÎfi ñ π·ÙÚÈÎfi ¡ÂÔÁÓÔÏfiÁÔÈ ∂ȉÈ΢fiÌÂÓÔÈ ÛÙË ª∂¡¡ ∂ȉÈ΢fiÌÂÓÔÈ ·È‰›·ÙÚÔÈ ñ ¡ÔÛËÏ¢ÙÈÎfi (Ì·›Â˜) ñ µÔËıÔ› ÓÔÛËÏÂ˘Ù¤˜ ñ ª·›·/ÎÚ‚¿ÙÈ ª∂¡¡ ñ ∆¯ÓÔÏfiÁÔÈ ÂÚÁ·ÛÙËÚ›Ô˘ ñ º˘ÛÈÔıÂÚ·Â˘Ù¤˜ ñ À‡ı˘Ó˜ Ì·›Â˜ ª∂¡¡

ŒÙÔ˜ 1986

1999

4 17 1:5 1 -

10 4 4 38 2 1:2-3 2 1 2

¶›Ó·Î·˜ 3. ∫·ÙËÁÔڛ˜ ·Ó·fiÙÚÂÙˆÓ ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘ 1. ™‡ÌÏÔΘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ 2. ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Ì ‚·ÚÈ¿ Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· 3. ∆ÚÈۈ̛˜ / ÃÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ 4. ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· 5. ªÂ›˙ÔÓ˜ ÔÏÏ·Ϥ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜/Û‡Ó‰ÚÔÌ· 6. ∂Ì‚Ú˘˚Îfi˜ ‡‰Úˆ·˜ 7. µ·ÚȤ˜ ‰È·Ì·Úٛ˜ ∫¡™ 8. ™Ô‚·Ú¿ ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· 9. ¡ÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜ g ·Ó·Ï‡ıËΠÂÚ·ÈÙ¤Úˆ Û ˘ÔÔÌ¿‰Â˜ Ì µ° ·˘Í·ÓfiÌÂÓÔ Î·Ù¿ 100 g. ∏ ηÙËÁÔÚ›· ¢∫ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙȘ ÂÍ‹˜ ÔÌ¿‰Â˜ ÛÂ Û˘ÌÏËڈ̤Ó˜ ‚‰ÔÌ¿‰Â˜ ·ËÛ˘: ·) 24-25, ‚) 26-27, Á) 28-29, ‰) 30-32, Â) 33-36 Î·È ÛÙ) >36. ∏ ¢∫ ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙËÓ ÙÂÏÂ˘Ù·›· ¤ÌÌËÓË Ú‡ÛË, Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ˘˜ ˘ÂÚ‹¯Ô˘˜ ÛÙȘ ·Ú¯¤˜ Ù˘ ·ËÛ˘ ηÈ, fiÙ·Ó ‰ÂÓ ˘‹Ú¯·Ó

575


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

Paediatriki 2001;64:573-582

·˘Ù¿, Ì ÙË ‚·ıÌÔÏÔÁ›· ÂÎÙ›ÌËÛ˘ Ù˘ ˆÚÈÌfiÙËÙ·˜ ηٿ BALLARD (14). §fiÁˆ ÙˆÓ ÁÓˆÛÙÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔÓ ÙÚfiÔ ˘ÔÏÔÁÈÛÌÔ‡ Î·È ·Ó·ÊÔÚ¿˜ Ù˘ ¢∫, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·Ó·Ï‡ÛÂȘ ‚·Û›ÛÙËÎ·Ó ÌfiÓÔ ÛÙÔ µ° (15). O ˘ÔÏÔÁÈÛÌfi˜ Ù˘ ¢∫ Â›Ó·È ÏÈÁfiÙÂÚÔ ·ÍÈfiÈÛÙÔ˜ ÁÈ· ÙȘ ÌÈÎÚfiÙÂÚ˜ ¢∫ Ì ٿÛË ˘ÂÚÂÎÙ›ÌËÛ‹˜ Ù˘ (16). ™ÙÔÓ ÏËı˘ÛÌfi Ì·˜, fiÔ˘ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÂÁ·ˆÓ ‹Ù·Ó ¯·ÌËÏÔ‡ ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ Ì ÂÏÏÈ‹ ‹ Î·È Î·ıfiÏÔ˘ Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, Ô ˘ÔÏÔÁÈÛÌfi˜ Ù˘ ¢∫ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ·ÎÚÈ‚‹˜. ∏ ∂∂¡£ ˘ÔÏÔÁ›ÛÙËΠ·fi ÙËÓ ÔÏÈ΋ ∂¡£ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·Ó Û ·›ÙÈ· Ô˘ ıˆڋıËÎ·Ó fiÙÈ Â›Ó·È ·Ó·fiÙÚÂÙ· Ì ÙȘ ÛËÌÂÚÈÓ¤˜ ‰˘Ó·ÙfiÙËÙ˜ Ù˘ È·ÙÚÈ΋˜ ·Ú¤Ì‚·Û˘, ηıÒ˜ Î·È ÙˆÓ ÓÂÔÁÓÒÓ Ì µ°≤700 g. £ÂˆÚ‹Û·Ì 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¿ Ì ·˘Ùfi ÙÔ µ° ÔÈ ı¿Ó·ÙÔÈ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·ÔÙÚ·Ô‡Ó ·Ú¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ fiÏˆÓ ÙˆÓ Ì¤ÙÚˆÓ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ Î·È Î·Ù¿ÏÏËÏ˘ È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜. ∆Ô ·Ó·ÊÂÚfiÌÂÓÔ ·ÓÒÙÂÚÔ fiÚÈÔ µ° ÙˆÓ 700 g Û˘Ì‚·‰›˙ÂÈ Ì ÂΛÓÔ ¿ÏÏˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 600750 g (17). ∏ ∂∂¡£ ·ÔÙÂÏ› “ÂÚÈÛÛ¢ԇÌÂÓË” ıÓËÛÈÌfiÙËÙ·, Ô˘ ·Ó ·Ó·¯ı› Â› ÙÔȘ ¯ÈÏ›ÔȘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÁÂÓÓ‹ÛˆÓ, ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÎÙ›ÌËÛ˘ ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ‰˘ÓËÙÈο ÌÔÚÔ‡Ó Ó· ÚÔÏËÊıÔ‡Ó Ì ٷ ˘¿Ú¯ÔÓÙ· È·ÙÚÈο ̤۷. ™ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ∂∂¡£, Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ¤ı·Ó·Ó ·fi ·Ó·fiÙÚÂÙ· ·›ÙÈ· Î·È ·˘ÙÒÓ Ô˘ ¤ı·Ó·Ó Ì 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‹ıËÎ·Ó ˙ˆÓÙ·Ó¿. ™ÙȘ ÚÒÙ˜ 2 ÂÚÈfi‰Ô˘˜, Ù· ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ Ì ·È‰Ô- Î·È Î·Ú‰ÈÔ- ¯ÂÈÚÔ˘ÚÁÈο ÚÔ‚Ï‹Ì·Ù· Ô˘ ÌÂٷʤÚıËÎ·Ó Û ¿ÏÏ· ∫¤ÓÙÚ· ·Ú¤ÌÂÈÓ·Ó Û ·˘Ù¿ ̤¯ÚÈ ÙËÓ ÙÂÏÈ΋ ¤Î‚·ÛË Î·È ÔÈ ı¿Ó·ÙÔÈ Ô˘ Û˘Ó¤‚ËÛ·Ó Û ÔÚÈṲ̂ӷ ·fi ·˘Ù¿ ‰ÂÓ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÛÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·. ∆ËÓ ÙÂÏÂ˘Ù·›· ÂÚ›Ô‰Ô, ۯ‰fiÓ fiÏ· Ù· ‚·ÚÈ¿ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ÂÚÈÛÙ·ÙÈο ÓÔÛËχıËÎ·Ó ÛÙË ª∂¡¡ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô. OÈ ·ÚÈıÌÔ› Ô˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔ˘˜ ›Ó·Î˜ ÛÙÚÔÁÁ˘Ï‡ÙËÎ·Ó ÛÙÔ ÏËÛȤÛÙÂÚÔ ÔÏÈÎfi ÚÒÙÔ ‰Âη‰ÈÎfi ‹ ÙÔ Ì¤ÛÔ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ‰Âη‰ÈÎÔ‡ ÁÈ· ¯¿ÚË Ù˘ Û˘˙‹ÙËÛ˘. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ Û‡ÁÎÚÈÛË ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÂÚÈfi‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ¯2.

∞ÔÙÂϤÛÌ·Ù· ª·È¢ÙÈÎfi˜ ÏËı˘ÛÌfi˜ OÈ ÌËÙ¤Ú˜ ·fi ÌÈÎÙÔ‡˜ Á¿ÌÔ˘˜, Ì ÙÔÓ ¤Ó· ·fi ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ ∂ÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜ Î·È ˘ËÎÔfiÙËÙ·˜ Î·È ÙÔÓ ¿ÏÏÔ ·ÏÏÔ‰·fi, ·ÔÙÂÏÔ‡Û·Ó ÙÔ 3% ÙÔ˘ Ì·È¢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 ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ, µ Î·È ° ‹Ù·Ó ÛÙ·ÙÈÛÙÈο Ôχ ÛËÌ·ÓÙÈ΋ (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 ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ, µ Î·È ° ‹Ù·Ó ÛÙ·ÙÈÛÙÈο Ôχ ÛËÌ·ÓÙÈ΋ (p<0,00001) (¶›Ó·Î·˜ 4). ™¯Â‰fiÓ fiϘ ÔÈ ·Ó‡·ÓÙÚ˜ ÌËÙ¤Ú˜ ηٿ ÙËÓ ∞ ÂÚ›Ô‰Ô ‹Ù·Ó ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜, ÂÓÒ Î·Ù¿ ÙË µ Î·È ° ÂÚ›Ô‰Ô ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ ‹Ù·Ó ·ÏÏÔ‰·¤˜. ™ÙËÓ ∞ ÂÚ›Ô‰Ô, ÌfiÏȘ 45 ÓÂÔÁÓ¿ ÚÔ‹Ïı·Ó ·fi ÁÔÓ›˜ Ô˘ ›¯·Ó Î·È ÔÈ ‰‡Ô ͤ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·ÙÈÛÙÈο, Ë ·‡ÍËÛË ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ, µ Î·È ° ‹Ù·Ó Ôχ ÛËÌ·ÓÙÈ΋ (p<0,00001) (¶›Ó·Î·˜ 4). ™ËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÌËÙ¤ÚˆÓ Ì ∂ÏÏËÓÈ΋ ˘ËÎÔfiÙËÙ· ηٿ ÙË ° ÂÚ›Ô‰Ô ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ¿ÙÔÌ· ·ÏÏÔ‰·‹˜ ÚÔ¤Ï¢Û˘ (∞Ï‚·Ó›·, °ÂˆÚÁ›·) Ô˘ ·¤ÎÙËÛ·Ó ÙËÓ ∂ÏÏËÓÈ΋ ˘ËÎÔfiÙËÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∆Ô ÎÔÈÓˆÓÈÎÔ-ÔÈÎÔÓÔÌÈÎfi Â›‰Ô, ÁÈ· ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯Ô˘Ì ·ÎÚÈ‚‹ ÛÙÔȯ›·, ‹Ù·Ó ηٿ ÁÂÓÈ΋ ÂÎÙ›ÌËÛË ¯·ÌËÏfi Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ÂÁ·ˆÓ. ¡ÂÔÁÓÈÎfi˜ ÏËı˘ÛÌfi˜ ∫·Ù·ÓÔÌ‹ ÙˆÓ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ (õ°¡) (µ°<2000 g): ™ÙÔÓ ¶›Ó·Î· 5 Ê·›ÓÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ Ãµ°¡. À‹ÚÍ ÛÙ·‰È·Î‹ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ·fi ÙËÓ ∞ ÚÔ˜ ÙË ° ÂÚ›Ô‰Ô Î·È ÁÈ· ÙȘ 3 ηÙËÁÔڛ˜ ÙˆÓ Ãµ°¡. À‹ÚÍ 100% ·‡ÍËÛË ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È ° ÁÈ· Ù· ÓÂÔÁÓ¿ Ì µ° 501-1000 g Î·È 1001-500 g (p<0,00001). °È·

¶›Ó·Î·˜ 4. ∂ȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ì·È¢ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡ ∂›‰Ô˜ ÏËı˘ÛÌÔ‡ 1987-1990 (∞)

ÃÚÔÓÔÏÔÁ›· 1991-1995 (µ)

1. ∞ÏÏÔ‰·Ô› ∞Ï‚·ÓÔ› ¶ÚÒËÓ ∂™™¢ ÕÏÏÔÈ 2. ªÈÎÙÔ› Á¿ÌÔÈ 3. ∞Ó‡·ÓÙÚ˜ ÌËÙ¤Ú˜

580/9409 (6%)ñ 307 253 20 630 (6,7%) 438 (4,5%)

45/15839*(0,28%) 45 484 (3%) 236 (1,5%)

* ·ÚÈıÌfi˜ ÂȉÈ΋˜ ηÙËÁÔÚ›·˜ ÂÁ·ˆÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÂÁ·ˆÓ ñ % ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÂÁ·ˆÓ ¨ p<0,00001 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, µ Î·È °, ∞ Î·È °

576

1996-1999 (°) 961/6949 (14%)¨ 601 335 25 726 (10,5%)¨ 528 (7,5%)¨


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

Paediatriki 2001;64:573-582

Ù· ÓÂÔÁÓ¿ Ì µ° 1501-2000 g, Ë ·‡ÍËÛË ‹Ù·Ó 97% (p<0,00001). ∏ ·‡ÍËÛË ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,05) Î·È ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ µ Î·È °. ∆ËÓ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ Ãµ°¡ ÙËÓ ·Ô‰ÒÛ·Ì ÛÙËÓ ·‡ÍËÛË ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ, ÏfiÁˆ ÛËÌ·ÓÙÈ΋˜ ·‡ÍËÛ˘ ÙˆÓ Â͈ۈ̷ÙÈÎÒÓ Î˘‹ÛÂˆÓ Î·È ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆ËÓ ∞ ÂÚ›Ô‰Ô ÁÂÓÓ‹ıËηÓ, ÌÂÙ¿ ·fi Â͈ۈ̷ÙÈ΋ ·ËÛË, 3 ÓÂÔÁÓ¿, ÙË µ ÂÚ›Ô‰Ô 18 Î·È ÙË ° ÂÚ›Ô‰Ô 111. ¶ÚfiˆÚ· Î·È Ôχ‰˘Ì˜ ΢‹ÛÂȘ: ™ÙÔÓ ¶›Ó·Î· 6 Ê·›ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÚÔÒÚˆÓ ÓÂÔÁÓÒÓ (¢∫<37 ‚‰ÔÌ¿‰Â˜) Î·È ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi Ôχ‰˘Ì˜ ΢‹ÛÂȘ. À‹ÚÍ Ôχ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÂÚÈfi‰ˆÓ (p<0,00001) Î·È ÛÙȘ ‰‡Ô ·˘Ù¤˜ ηÙËÁÔڛ˜ ÓÂÔÁÓÒÓ. ¡ÂÔÁÓ¿ ÌÂÙ·ÊÂÚı¤ÓÙ· Û ¿ÏÏ· ∫¤ÓÙÚ·: À‹ÚÍ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÌÂٷʤÚıËÎ·Ó Û ¿ÏÏ· ΤÓÙÚ· ÌÂٷ͇ Ù˘ ∞ Î·È Ù˘ ° ÂÚÈfi‰Ô˘. ∏ ÂÏ¿ÙÙˆÛË ·˘Ù‹ ·ÊÔÚÔ‡Û ٷ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ÂÚÈÛÙ·ÙÈο (¶›Ó·Î·˜ 7). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, fiÏ· Ù· ÛÔ‚·Ú¿ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ÂÚÈÛÙ·ÙÈο ÓÔÛËχÔÓÙ·Ó - ÚÈÓ Î·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô - ÛÙÔ ∆Ì‹Ì· Ì·˜. OÏÈ΋ ıÓËÛÈÌfiÙËÙ·: ∏ ¡£, Ë ∂¡£, Ë ¢¡£ Î·È Ë ¢∂¡£ ÛÙȘ 3 ÂÚÈfi‰Ô˘˜ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 8 Ì·˙› Ì ÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿. OÈ ‰È·ÊÔÚ¤˜ ÛÙÔÓ ÔÏÈÎfi ·ÚÈıÌfi

˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÌÂٷ͇ Ù˘ ∞ Î·È µ ÂÚÈfi‰Ô˘ ÔÊ›ÏÔÓÙ·Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· Î·È ‰Â‡ÙÂÚÔ˘ ¡ÂÔÁÓÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÛÙÔ ›‰ÈÔ ¡ÔÛÔÎÔÌ›Ô, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌÔÈÚ¿˙ÔÓÙ·È Ù· ÓÂÔÁÓ¿ ÛÙ· 2 ÙÌ‹Ì·Ù·. OÈ ‰È·ÊÔÚ¤˜ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÌÂٷ͇ Ù˘ µ Î·È ° ÂÚÈfi‰Ô˘ ÔÊ›ÏÔÓÙ·Ó ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈıÌfi ÂÙÒÓ Ô˘ ›¯Â Ë Î¿ı ÂÚ›Ô‰Ô˜ (5 ¤Ó·ÓÙÈ 4). °ÂÓÈο ˘‹ÚÍ ÂÏ¿ÙÙˆÛË, ÂÚ›Ô˘ 10%, ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ‰È·Ì¤ÛÔ˘ ÙˆÓ ÂÙÒÓ. £ÓËÛÈÌfiÙËÙ·: ∏ ÂηÙÔÛÙÈ·›· ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ‰È·Ê¤ÚÂÈ ·Ó¿ÏÔÁ· Ì ÙÔÓ ÙÚfiÔ ˘ÔÏÔÁÈÛÌÔ‡ Ù˘ (¶›Ó·Î·˜ 8). ∏ ¢∂¡£, Ô˘ Â›Ó·È Î·È Ë ÈÔ Ô˘ÛÈ҉˘, ·ÚÔ˘Û›·Û ÂÏ¿ÙÙˆÛË 24% ÌÂٷ͇ Ù˘ ∞ Î·È Ù˘ µ ÂÚÈfi‰Ô˘ Î·È 48% ÌÂٷ͇ Ù˘ ∞ Î·È Ù˘ ° (¶›Ó·Î·˜ 9). ∏ ¢∂¡£ ·ÚÔ˘Û›·Û ÙÒÛË Î·Ù¿ 68%, 83,7%, 77% Î·È 88,5% ÌÂٷ͇ Ù˘ ∞ Î·È Ù˘ ° ÂÚÈfi‰Ô˘ ÁÈ· ÙȘ ηÙËÁÔڛ˜ ÙˆÓ ÓÂÔÁÓÒÓ Ì µ° 501-1000 g, 1001-1500 g, 15012000 g Î·È >2000 g ·ÓÙ›ÛÙÔȯ· (¶›Ó·Î·˜ 9). °È· ÙȘ ηÙËÁÔڛ˜ ÙˆÓ ÓÂÔÁÓÒÓ Ì µ° 601-700 g, 701-800 g, 801-900 g Î·È 901-1000 g, Ë ÙÒÛË Ù˘ ¢∂¡£ ÌÂٷ͇ Ù˘ ∞ Î·È Ù˘ ° ÂÚÈfi‰Ô˘ ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· 25%, 46%, 83,7% Î·È 100% (¶›Ó·Î·˜ 10). ™ÙËÓ Î·ÙËÁÔÚ›· Ì µ° 501-600 g, Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 100% Î·È ÛÙȘ 3 ÂÚÈfi‰Ô˘˜. °È· ÙȘ ηÙËÁÔڛ˜ ÓÂÔÁÓÒÓ Ì ¢∫ 24-25 ‚‰ÔÌ¿‰Â˜, 26-27 ‚‰ÔÌ¿‰Â˜, 28-29 ‚‰ÔÌ¿‰Â˜, 30-32 ‚‰ÔÌ¿‰Â˜, 33-36 ‚‰ÔÌ¿‰Â˜, >36 ‚‰ÔÌ¿‰Â˜, Ë

¶›Ó·Î·˜ 5. ∫·Ù·ÓÔÌ‹ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ ÃÚÔÓÔÏÔÁ›· 1986-1990 (∞) 1991-1995 (µ) 1996-1999 (°)

501-1000

µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g) 1001-1500

1501-2000

133/19833*(0,67%)ñ 90/9405 (0,95%) 96/6948 (1,38%)¨

235/19833 (1,2%) 141/9405 (1,5%) 176/6948 (2,5%)¨

345/19833 (1,7%) 217/9405 (2,3%) 233/6948 (3,35%)¨

* ·ÚÈıÌfi˜ õ° 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 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, µ Î·È °, ∞ Î·È °, ÁÈ· fiϘ ÙȘ ηÙËÁÔڛ˜ µ°

¶›Ó·Î·˜ 6. ∫·Ù·ÓÔÌ‹ Î·È ∂¡£ ÚfiˆÚˆÓ (¢∫≤36 ‚‰.) Î·È Ôχ‰˘ÌˆÓ ÓÂÔÁÓÒÓ ÃÚÔÓÔÏÔÁ›· ∫·ÙËÁÔÚ›· ÓÂÔÁÓÒÓ °ÂÓÓËı¤ÓÙ· ˙ÒÓÙ· ÓÂÔÁÓ¿ ¶ÚfiˆÚ· ™‡ÓÔÏÔ ı·Ó¿ÙˆÓ £¿Ó·ÙÔÈ ÚÔÒÚˆÓ ¶Ôχ‰˘Ì· £¿Ó·ÙÔÈ ÔÏ˘‰‡ÌˆÓ

1986-1990 (∞) ¡Ô ÓÂÔÁÓÒÓ 19833 1297 299 255 326 48

(6,5)* (85,8)** (1,6)* (7)**

1991-1995 (µ) ¡Ô ÓÂÔÁÓÒÓ 9405 811 117 99 245 15

(8,5)* (84,5)** (2,5)* (6)**

1996-1999 (°) ¡Ô ÓÂÔÁÓÒÓ 6924 859 69 61 353 16

(12,5)*¨ (88,5)** (5)*¨ (4,5)**

*( ): % ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ** ( ): % ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ı·Ó¿ÙˆÓ ¨ p<0,00001 ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, µ Î·È °, ∞ Î·È °

577


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

Paediatriki 2001;64:573-582

ÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ı· ÂÚÈÂÏ¿Ì‚·ÓÂ Î·È ‰Â‰Ô̤ӷ ·fi ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË ‚·Ú¤ˆ˜ ·Û¯fiÓÙˆÓ ÓÂÔÁÓÒÓ, fiˆ˜ Û˘Ì‚·›ÓÂÈ Û ¿ÏÏ· ÎÚ¿ÙË (16-19). ∆· ‰Â‰Ô̤ӷ Ì·˜ ·Ó·Ê¤ÚÔÓÙ·È Û ¤Ó· Ì·È¢ÙÈÎfi ÏËı˘ÛÌfi Ô˘ ¿ÏÏ·Í ÛËÌ·ÓÙÈο ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ 14 ¯ÚfiÓˆÓ. °ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÏËı˘ÛÌÔ‡ ·˘ÙÔ‡ ‹Ù·Ó Ë ‰È·¯ÚÔÓÈ΋ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÁ·ˆÓ Ô˘ ›¯·Ó ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›‰Ô, ‹Ù·Ó ·ÏÏÔ‰·¤˜, ¿Á·Ì˜, ›¯·Ó ÂÏÏÈ‹ Ì·È¢ÙÈ΋ ÊÚÔÓÙ›‰·, ηıÒ˜ Î·È Ë ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹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˘ Â͢ËÚÂÙÂ›Ù·È ·fi ÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙË ÌÂÁ¿ÏË ÏËı˘ÛÌȷ΋ ÂÚÈÔ¯‹ Ù˘ £ÂÛÛ·ÏÔӛ΢ Î·È Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ·fi ÙËÓ ˘fiÏÔÈË ÂÚÈÔ¯‹ Ù˘ ª·Î‰ÔÓ›·˜. ™Ù· 14 ¯ÚfiÓÈ· ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ˘‹ÚÍ ÌÂÁ¿ÏË ÂÏ¿ÙÙˆÛË Ù˘ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ (48% ÂÏ¿ÙÙˆÛË Ù˘ ¢∂¡£). π‰È·›ÙÂÚ· ÛÙ· ¶Ãµ° ÓÂÔÁÓ¿, Ë ÙÒÛË Ù˘ ¢∂¡£ ‹Ù·Ó ÂÓÙ˘ˆÛȷ΋ Î·È ¤ÊÙ·Û Û ÔÛÔÛÙfi 68% ÁÈ· Ù· ÓÂÔÁÓ¿ Ì µ°≤1000 g Î·È 84% ÁÈ· Ù· ÓÂÔÁÓ¿ Ì µ° 1001-1500 g (¶›Ó·Î·˜ 9). ™˘ÁÎÚ›ÛÂȘ Ì ‰Â‰Ô̤ӷ ·fi ¿ÏÏ· ÙÌ‹Ì·Ù· Ù˘ ∂ÏÏ¿‰·˜ Î·È Ù˘ ·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 Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ Â›‰Ô˜ ÙÔ˘ Ì·È¢ÙÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÙË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ Ù˘ ÌÂϤÙ˘, ÙÔ Â›‰Ô˜ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·ıÒ˜ Î·È ÙË ÛÙÂϤ¯ˆÛË, ÙÔÓ ÂÍÔÏÈÛÌfi Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ª∂¡¡ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ¡ÂÔÁÓÔÏÔÁÈÎÒÓ ÙÌËÌ¿ÙˆÓ. ¶·ÓÂÏÏ‹ÓÈ· ¤¯Ô˘Ó Á›ÓÂÈ ‰‡Ô ÌÂϤÙ˜ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜, Ë Ì›· ÙÔ 1983 Î·È Ë ¿ÏÏË ÙÔ 1998, fiÔ˘ ηٷÁÚ¿ÊËÎÂ Ë ÂÚÈÁÂÓÓËÙÈ΋ Î·È ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· Û ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ Ì‹Ó·, Ù·˘Ùfi¯ÚÔÓ· Û fiÏË ÙËÓ ∂ÏÏ¿‰·. OÈ ÌÂϤÙ˜ ·˘Ù¤˜ ¤‰ÂÈÍ·Ó ÌÂÁ¿ÏË ÙÒÛË Ù˘ ÓÂÔÁÓÈ΋˜ (ËÏÈΛ·: 0-28 Ë̤Ú˜ ˙ˆ‹˜) ıÓËÛÈÌfiÙËÙ·˜ ·fi 14,5ò ÙÔ 1983

ÂÏ¿ÙÙˆÛË Ù˘ ¢∂¡£ ÌÂٷ͇ Ù˘ ∞ Î·È Ù˘ ° ÂÚÈfi‰Ô˘ ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· 41%, 76,8%, 78,5%, 77,7%, 87,5%, 76,2% (¶›Ó·Î·˜ 11). ∏ ∂∂¡£ ·ÚÔ˘Û›·Û ÂÏ¿ÙÙˆÛË 65,4% ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È ° (¶›Ó·Î·˜ 12). O ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ Ô˘ ¤ı·Ó·Ó ÙË ° ÂÚ›Ô‰Ô ‹Ù·Ó 26 (ÔÛÔÛÙfi 3,75ò). ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ı·Ó¿ÙˆÓ ·ÊÔÚÔ‡Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ¢∫≤36 ‚‰ÔÌ¿‰Â˜ Î·È ÛÙȘ 3 ÂÚÈfi‰Ô˘˜ Ì ÔÛÔÛÙ¿ 85,2%, 84,5% Î·È 88,5% ÁÈ· ÙȘ ∞, µ Î·È ° ÂÚÈfi‰Ô˘˜ ·ÓÙ›ÛÙÔȯ· (¶›Ó·Î·˜ 9). ™˘˙‹ÙËÛË ∏ ÌÂϤÙË Ì·˜ ηχÙÂÈ Û˘Ó¯‹ ÂÚ›Ô‰Ô 14 ¯ÚfiÓˆÓ, ·fi ÙËÓ ·Ú¯‹ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ª∂¡ ̤¯ÚÈ Û‹ÌÂÚ·, Ì ηϋ ηٷÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ·ÏÏ·ÁÒÓ Ô˘ Û˘Ó¤‚ËÛ·Ó Û ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ· Î·È ÙˆÓ ÂÈÙÒÛÂˆÓ ÛÙË ıÓËÛÈÌfiÙËÙ·. ∏ ·Í›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÌÂÌÔÓˆÌ¤ÓˆÓ ÙÌËÌ¿ÙˆÓ, ·Ú¿ ÙËÓ ÂÚÈÔÚÈṲ̂ÓË ÂÌ‚¤ÏÂÈ¿ ÙÔ˘˜, Â›Ó·È ÌÂÁ¿Ï˘ ÛÔ˘‰·ÈfiÙËÙ·˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ›‰Ô˘˜ Ù˘ ·Ú¯fiÌÂÓ˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È Ù˘ ÔÚÁ¿ÓˆÛ˘ ÙˆÓ ª∂¡¡, ηıÒ˜ Î·È ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ. ∆Ô È‰·ÓÈÎfi Î·È Û˘Ó¿Ì· ÂÊÈÎÙfi - Û‡Ìʈӷ Ì ÙÔ È·ÙÚÈÎfi ‰˘Ó·ÌÈÎfi Î·È ÙËÓ ÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË Ù˘ ∂ÏÏ¿‰·˜ - ı· ‹Ù·Ó Ó· ˘‹Ú¯Â ÂÓÈ·›· ‚¿ÛË ÂÚÈÁÂÓÓËÙÈÎÒÓ/ÓÂÔÁÓÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· οı ÂÚÈʤÚÂÈ· Ô˘ ηχÙÂÙ·È ·fi ¤Ó· ¶ÂÚÈÁÂÓÓËÙÈÎfi/ ¡ÂÔÁÓÈÎfi ∫¤ÓÙÚÔ, Ë ÔÔ›· ÂÎÙfi˜ ·fi ÙË ıÓËÛÈÌfi¶›Ó·Î·˜ 7. ¡ÂÔÁÓ¿ Ô˘ ªÂٷʤÚıËÎ·Ó Û ¿ÏÏ· ¡ÔÛÔÎÔÌ›· ÃÚÔÓÔÏÔÁ›·

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

™‡ÓÔÏÔ ¡Ô

¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ¡Ô (ı¿Ó·ÙÔÈ)

∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈο ¡Ô (ı¿Ó·ÙÔÈ)

56 35 10

38 29 3

18 6 7

(5) (5)

(11) (2) (1)

¡Ô: ·ÚÈıÌfi˜ ÓÂÔÁÓÒÓ

¶›Ó·Î·˜ 8. ∂¡£, ¡£, ¢∂¡£ Î·È ¢¡£ ÃÚÔÓÔÏÔÁ›· 1986-1990 (∞) 1991-1995 (µ) 1996-1999 (°)

∂¡£ ¡Ô

ò

299/19833 117/9405 69/6948

15 12,4 9,9

¡£ (0-28 ËÌ.) ¡Ô ò 260/19833 104/9405 64/6948

* ·Ê·ÈÚÔ‡ÓÙ·È ÔÈ ı¿Ó·ÙÔÈ ·fi ·Ó·fiÙÚÂÙ· ·›ÙÈ· No: ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÚÔ˜ ·ÚÈıÌfi ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ ∂¡£: ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ¡£: ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ¢∂¡£: ‰ÈÔÚıˆÌ¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ¢¡£: ‰ÈÔÚıˆÌ¤ÓË ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ·

578

13,1 11 9,2

¢∂¡£* ¡Ô

ò

249/19783 89/9377 45/6924

12,5 9,5 6,5

¢¡£*(0-28 ËÌ.) ¡Ô ò 215/19783 82/9377 42/6924

10,8 8,7 6


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

Paediatriki 2001;64:573-582

¶›Ó·Î·˜ 9. ∂ȉÈ΋ ·Ó¿ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ¢∂¡£ µ° (g)

ÃÚÔÓÔÏÔÁ›· 1991-1995 (µ) ¡Ô %

1986-1990 (∞) ¡Ô % 501-1000 1001-1500 1501-2000 >2000 ™‡ÓÔÏÔ

116/130* 83/229 25/335 25/19089 249/19783

88,5 36,2 7,5 0,13 (12,5)**

48/83 18/135 6/212 17/8947 89/9377

1996-1999 (°) ¡Ô %

57,8 13,3 2,8 0,19 (9,5)

30/90 10/170 4/229 1/6435 45/6924

33,3 6 1,7 0,015 (6,5)

% ÂÏ¿ÙÙˆÛË ÌÂٷ͇ ∞&µ, µ&°, ∞&° 33,5 63,5 62 -31,5ñ 24%

42,5 56,5 39,3 92 31,5%

68,3 83,7 77 88,5 48%

* ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ ** ( ): ı¿Ó·ÙÔÈ Â› ò ñ ·‡ÍËÛË ÌÂٷ͇ ∞ & µ

¶›Ó·Î·˜ 10. ∂ȉÈ΋ ·Ó¿ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ¢∂¡£ Û ¶¶Ãµ° ÓÂÔÁÓ¿ µ° (g) 1986-1990 (∞) ¡Ô % 501-600 601-700 701-800 801-900 901-1000 ™‡ÓÔÏÔ

10/10* 26/26 29/30 23/25 28/39 116/130

100 100 96,5 92 70 89,2

ÃÚÔÓÔÏÔÁ›· 1991-1995 (µ) ¡Ô % 6/6 10/11 15/21 8/17 9/28 48/83

100 90 71,5 47 32 57,8

1996-1999 (°) ¡Ô %

% ÂÏ¿ÙÙˆÛË ÌÂٷ͇ ∞&µ, µ&°, ∞&°

4/4 9/12 12/23 5/33 0/18 30/90

0 10 26 49 57,7 35,2

100 75 52 15 0 33,3

0 16,5 27 68 100 42,5

0 25 46 83,7 100 62,5

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

Û 6ò ÙÔ 1998 (6,7). ™Â ·Ó¿ÏÔÁ˜ ÂÚÈfi‰Ô˘˜ ÛÙÔ ÙÌ‹Ì· Ì·˜ (∞ Î·È °), Ë ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ÂÏ·ÙÙÒıËΠ·fi 13,1ò Û 9,2ò, ‹Ù·Ó ‰ËÏ·‰‹ 50% ÌÂÁ·Ï‡ÙÂÚË ·’ fiÙÈ ÛÙËÓ ·ÓÂÏÏ‹ÓÈ· ÌÂϤÙË (¶›Ó·Î·˜ 8). OÈ ·ÓÂÏÏ‹ÓȘ, fï˜, ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Î·È fi¯È Û ÏËı˘ÛÌfi ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔ ÙÌ‹Ì· Ì·˜ Î·È Ë ‰È·ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ· Ù˘ Ù¿Í˘ ÙÔ˘ 50% Â›Ó·È ·fiÏ˘Ù· ‰ÈηÈÔÏÔÁË̤ÓË Î·È Î·Ù¿ ÙËÓ ÂÎÙ›ÌËÛ‹ Ì·˜ ÌÈÎÚ‹. ∂ÈϤÔÓ, ÔÈ ‰‡Ô ·˘Ù¤˜ ·ÓÂÏÏ‹ÓȘ ÌÂϤÙ˜ ›¯·Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ·ÍÈÔÈÛÙ›·˜, ·fi ÙÔ ÁÂÁÔÓfi˜ Î·È ÌfiÓÔ fiÙÈ Û ·˘Ù¤˜ Û˘ÌÌÂÙ›¯·Ó ‰Âο‰Â˜ ¿ÙÔÌ·, ·È‰›·ÙÚÔÈ, È·ÙÚÔ›, Ì·›Â˜, ÓÔÛËχÙÚȘ Î.Ï., Ì ‰È·ÊÔÚÂÙÈ΋ ÂÎ·›‰Â˘ÛË Î·È ÂÌÂÈÚ›· Î·È Î·Ì›· Âȉ›Î¢ÛË ÛÙË ÓÂÔÁÓÔÏÔÁ›·/ÂÚÈÁÂÓÓËÙÈ΋. °ÂÓÈο, ÔÈ ·ÓÂıÓÈΤ˜ ÌÂϤÙ˜ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ‰ÂÓ ıˆÚÔ‡ÓÙ·È È‰È·›ÙÂÚ· ·ÍÈfiÈÛÙ˜, ·ÎfiÌ· Î·È Û ¯ÒÚ˜ Ì ηϋ ηٷÁÚ·Ê‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Û ËÏÂÎÙÚÔÓÈο Û˘ÛÙ‹Ì·Ù· ·fi ηٿ ÙÂÎÌ‹ÚÈÔ ÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi (15). ¢Â‰Ô̤ӷ ·fi Ù· ȉȈÙÈο Ì·ÈÂ˘Ù‹ÚÈ· “ªËÙ¤Ú·” (1984-1996) Î·È “π·ÛÒ” (1996-1998) ÙˆÓ ∞ıËÓÒÓ, ¤‰ÂÈÍ·Ó Ôχ ¯·ÌËÏ‹ ∂¡£ ıÓËÛÈÌfiÙËÙ·, Î˘Ì·ÈÓfiÌÂÓË ·fi 5,5ò (·Ú¯Èο) ¤ˆ˜ 2,5ò (ÚfiÛÊ·Ù·) (9,10). ∏ ÌfiÓË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ ÁÈ· ÙËÓ

ÔÔ›· ÌÔÚ› Ó· ˘¿ÚÍÂÈ Î¿ÔÈ· “Û‡ÁÎÚÈÛË” ÌÂٷ͇ ÙÔ˘ ÙÌ‹Ì·Ùfi˜ Ì·˜ Î·È ÙˆÓ Ì·È¢ÙËÚ›ˆÓ Â›Ó·È Ë ° (1996-1999), fiÔ˘ ÔÈ ‰È·ÊÔÚ¤˜ ÛÙË ıÓËÛÈÌfiÙËÙ· Â›Ó·È ÂÎ ÚÒÙ˘ fi„ˆ˜ Ôχ ÌÂÁ¿Ï˜ (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˘‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ‰‡Ô Ì·ÈÂ˘Ù‹ÚÈ· ‹Ù·Ó ·Ó·ÏÔÁÈο Ôχ ÏÈÁfiÙÂÚ˜ ·’ fiÙÈ ÛÙÔ ÙÌ‹Ì· Ì·˜. ∞˘Ùfi Ê·›ÓÂÙ·È ·fi ÙÔ ÔÛÔÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ì µ°<1500 g (ÂΛ ‰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 (̤¯ÚÈ Î·È 45%) Ì µ°<1500 g Î·È ÔÚÈṲ̂ӷ ÓÂÔÁÓ¿ Ì µ°>1500 g Ì ‚·ÚÈ¿ ÚÔ‚Ï‹Ì·Ù·, ÌÂٷʤÚıËÎ·Ó Û ¿ÏÏ· ¡ÔÛÔÎÔÌ›· Î·È ‰ÂÓ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÛÙË ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ·. ∞ÓÙ›ıÂÙ·, ·fi ÙÔ ÙÌ‹Ì· Ì·˜ ÌÂٷʤÚıËΠ۠¿ÏÏ· ¡ÔÛÔÎÔÌ›· ÌÈÎÚfi˜ ÌfiÓÔ ·ÚÈıÌfi˜ ηډÈÔ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ÙˆÓ ÔÔ›ˆÓ Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó ÙfiÛÔ ÌÈÎÚ‹ Ô˘ ·Ó Û˘Ó˘ÔÏÔÁÈ˙fiÙ·Ó ÛÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ·, ÂÏ¿¯ÈÛÙ· ı· ÙËÓ ÂËÚ¤·˙ (¶›Ó·Î·˜ 7). ŒÙÛÈ, ·Ú’ fiÙÈ Ë ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙÔ ÙÌ‹Ì· Ì·˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË, Ë ÂȉÈ΋ ıÓËÛÈÌfiÙËÙ· ÁÈ· Ù· ¶Ãµ° ÓÂÔÁÓ¿, Ù· ¶¶Ãµ° ÓÂÔÁÓ¿ Î·È ÛÙ· ÓÂÔÁÓ¿ Ì ¢∫<32 ‚‰ÔÌ¿‰Â˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚË. ™Â Û‡ÁÎÚÈÛË Ì ٷ ‰Â‰Ô̤ӷ

579


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

Paediatriki 2001;64:573-582

¶›Ó·Î·˜ 11. ∂ȉÈ΋ ·Ó¿ ¢∫ ¢∂¡£ ¢∫ (‚‰.)

ÃÚÔÓÔÏÔÁ›· 1991-1995 (µ) ¡Ô %

1986-1990 (∞) ¡Ô % <24 24-25 26-27 28-29 30-32 33-36 >36 ™‡ÓÔÏÔ

17/18* 32/33 70/80 47/93 46/299 12/741 24/18519 249/19783

94,5 97 87,5 50,5 15,7 1,5 0,13 (12,5)

9/9 20/25 20/53 7/44 15/72 6/472 12/8702 89/9377

1996-1999 (°) ¡Ô %

100 80 37,7 16 8,7 1,25 0,13 (9,5)

3/4 12/21 12/59 8/74 7/128 1/474 2/6164 45/6924

% ÂÏ¿ÙÙˆÛË ÌÂٷ͇ ∞&µ, µ&°, ∞&°

75 57 20,3 10,8 3,5 0,2 0,032 (6,5)

-5,5** 17,5 60 68,5 44,5 21,8 0

25 28,5 46 32 59,7 84 76

20,5 41 76,8 78,5 77,7 87,5 76

* ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÚÔ˜ ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ ** ·‡ÍËÛË 5,5 %

¶›Ó·Î·˜ 12. ∂Íȉ·ÓÈÎÂ˘Ì¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· (∂∂¡£) ÃÚÔÓÔÏÔÁ›· 1986-1990 1991-1995 1996-1999

∞ÚÈıÌfi˜ ÓÂÔÁÓÒÓ

™‡ÓÔÏÔ ı·Ó¿ÙˆÓ

∞Ó·fiÙÚÂÙÔÈ ı¿Ó·ÙÔÈ

£¿Ó·ÙÔÈ µ°<700 g

∂∂¡£

∞Ó·ÏÔÁ›· ò

19833 9405 6948

299 117 69

50 28 24

37 19 19

212/19746* 70/9358 26/6905

10,7 7,5 3,75

* ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ Û ۯ¤ÛË Ì ÔÏÈÎfi ·ÚÈıÌfi ÓÂÔÁÓÒÓ

·fi Ù· ‚ÈÔÌ˯·ÓÈο ÎÚ¿ÙË, ¤¯Ô˘Ì ÌÂÁ·Ï‡ÙÂÚË ıÓËÛÈÌfiÙËÙ·, ÈÔ ÂÎÛÂÛËÌ·Ṳ̂ÓË Û ÓÂÔÁÓ¿ Ì µ°≤800 g (2-4,16,20,21). OÈ ÏÂÈÙÔ˘ÚÁÈΤ˜ Î·È ‰ÔÌÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙÔ˘ ÙÌ‹Ì·Ùfi˜ Ì·˜ Î·È ÙˆÓ ÎÚ·ÙÒÓ ·˘ÙÒÓ Â›Ó·È, fiˆ˜ ÚԷӷʤÚıËÎÂ, ÔÏϤ˜ Î·È ÌÂÁ¿Ï˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ‰‡ÛÎÔÏË ¤ˆ˜ ·‰‡Ó·ÙË Ë ·ÎÚÈ‚‹˜ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÈÙ›ˆÓ ·˘Ù‹˜ Ù˘ ‰È·ÊÔÚ¿˜ ÛÙË ıÓËÛÈÌfiÙËÙ·. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 14 ¯ÚfiÓˆÓ ·Ú·ÙËÚ‹ıËÎÂ Û˘Ó¯‹˜ ·‡ÍËÛË ÙˆÓ Ãµ°¡, ̤¯ÚÈ ‰ÈÏ·ÛÈ·ÛÌÔ‡ (¶›Ó·Î·˜ 5). ∏ ·‡ÍËÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È ¤Ó· ÛÙ·ÙÈÛÙÈÎfi Ê·ÈÓfiÌÂÓÔ Î·È ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È Û ΤÓÙÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ (17,22-24). ÀÔı¤ÙÔ˘Ì fiÙÈ ÔÊ›ÏÂÙ·È ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ ÏfiÁˆ Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘, ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ Ì·È¢ÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ô˘ ÂÈÙÚ¤ÂÈ ÂÚÈÛÛfiÙÂÚ· õ°¡ Ó· ÁÂÓÓÈÔ‡ÓÙ·È ˙ˆÓÙ·Ó¿. ™Â Û¯¤ÛË Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ΢‹ÛÂȘ, ÔÈ Î˘‹ÛÂȘ Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘ Û˘Óԉ‡ÔÓÙ·È, Û ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ·, ·fi ÚfiˆÚÔ˘˜ ÙÔÎÂÙÔ‡˜, ÙÔÎÂÙÔ‡˜ ÓÂÔÁÓÒÓ Ì õ° Î·È Ôχ‰˘Ì˜ ΢‹ÛÂȘ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·˘ÍË̤ÓË ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ· (25-27). ∏ ÙÒÛË Ù˘ ÔÏÈ΋˜ ¢∂¡£ ÌÂٷ͇ Ù˘ ∞ Î·È µ ÂÚÈfi‰Ô˘ ‹Ù·Ó 24%. ∏ ÙÒÛË fï˜ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÛÙ· ¶Ãµ° ÓÂÔÁÓ¿ ‹Ù·Ó ÈÔ ÌÂÁ¿ÏË (63,5%

580

ÛÙ· ÓÂÔÁÓ¿ Ì µ° 1001-1500 g Î·È 33,5% ÛÙ· ÓÂÔÁÓ¿ Ì µ° 501-1000 g). ∫·Ù¿ ¤Ó· ̤ÚÔ˜, ·˘Ù‹ Ë ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙË ¯Ú‹ÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, Û‡Ìʈӷ Î·È Ì ÂÌÂÈڛ˜ ·fi ¿ÏÏ· ¡ÂÔÁÓÔÏÔÁÈο ∫¤ÓÙÚ· (5,18,28). ∞˘Ùfi ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ÙË ‰È·›ÛÙˆÛË fiÙÈ ‰ÂÓ ˘‹Ú¯Â ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÛÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ÛÙȘ ‰‡Ô ·˘Ù¤˜ ÂÚÈfi‰Ô˘˜ (¶›Ó·Î·˜ 9). ∏ ÚÔÁÂÓÓËÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈ˙fiÓ˘ ÛÙȘ ÌËÙ¤Ú˜ Ì ÚfiˆÚË ¤Ó·ÚÍË ÙÔÎÂÙÔ‡ ¿Ú¯ÈÛ ӷ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ·fi ÙËÓ ·Ú¯‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜, ›Ûˆ˜ ÏÈÁfiÙÂÚÔ Û˘ÛÙËÌ·ÙÈο ·Ú¯Èο ·’ fiÙÈ ·ÚÁfiÙÂÚ·. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ô ÚfiÏÔ˜ Ù˘ ÛÙËÓ ÙÒÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÌÂٷ͇ ÙˆÓ ÂÚÈfi‰ˆÓ ∞ Î·È µ ‰ÂÓ Ú¤ÂÈ Ó· ‹Ù·Ó ÌÂÁ¿ÏÔ˜. ∏ ÙÒÛË Î·Ù¿ 31,5% Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ÌÂٷ͇ µ Î·È ° ÂÚÈfi‰Ô˘ ıˆÚԇ̠fiÙÈ Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÔÊ›ÏÂÙ·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÚÔfi‰ˆÓ ÛÙË ÓÂÔÁÓÈ΋ ÊÚÔÓÙ›‰· Î·È ÙË ¯Ú‹ÛË ÙˆÓ Ó¤ˆÓ Ù¯ÓÔÏÔÁÈÒÓ Î·È ıÂÚ·ÂÈÒÓ. ∞˘Ùfi ÂÓÈÛ¯‡ÂÙ·È ·fi ÙËÓ ·Ú·ÙËÚËı›۷ ÂÏ¿ÙÙˆÛË ÙË ıÓËÛÈÌfiÙËÙ·˜, fi¯È ÌfiÓÔ ÛÙ· õ°¡ ·ÏÏ¿ Î·È ÛÙ· ÓÂÔÁÓ¿ Ì µ°>2000 g Ô˘ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È ÙÂÏÂÈfiÌËÓ· ‹ ۯ‰fiÓ ÙÂÏÂÈfiÌËÓ· (¶›Ó·Î·˜ 9). ∫·È ÛÙȘ ÙÚÂȘ ÂÚÈfi‰Ô˘˜, Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ Û˘Ó¤‚·Ï·Ó ηٿ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÛÙËÓ ÔÏÈ΋ ıÓËÛÈÌfiÙËÙ· (¶›Ó·Î·˜ 6).


¶·È‰È·ÙÚÈ΋ 2001;64:573-582

∆Ô ÛËÌ·ÓÙÈÎfiÙÂÚÔ Úfi‚ÏËÌ· ÛÙË ıÓËÛÈÌfiÙËÙ· ·ÊÔÚÔ‡Û ٷ ÚfiˆÚ· ÓÂÔÁÓ¿ Ì µ°<1,0 kg, Ô˘ ÂÓÒ ‹Ù·Ó ÙÔ 1,34% fiÏˆÓ ÙˆÓ ˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÛÙË ° ÂÚ›Ô‰Ô, ¢ı‡ÓÔÓÙ·Ó ÁÈ· ÙÔ 66% fiÏˆÓ ÙˆÓ ı·Ó¿ÙˆÓ. ™ÙËÓ ›‰È· ÂÚ›Ô‰Ô, ÔÈ ı¿Ó·ÙÔÈ ÛÙ· ÓÂÔÁÓ¿ Ì µ°<800 g ·ÓÙÈÚÔÛÒ¢·Ó ÙÔ 52% Ù˘ ÔÏÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜, ÂÓÒ ÔÈ ı¿Ó·ÙÔÈ ÓÂÔÁÓÒÓ Ì µ°<700 g ÙÔ 25%. ∏ ÂÈ‚›ˆÛË ÙˆÓ ÚÔÒÚˆÓ ·˘ÙÒÓ Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ÛÔ‚·Ú¤˜ ·Ó·Ëڛ˜ ·fi ÙÔ ∫¡™ Î·È Ù· ·ÈÛıËÙ‹ÚÈ· fiÚÁ·Ó·. ™˘ÓÂÒ˜, ÔÈ ÚÔÛ¿ıÂȘ ‰È¿ÛˆÛ‹˜ ÙÔ˘˜, ȉȷ›ÙÂÚ· ·˘ÙÒÓ Ì µ°<700 g, ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÈÏÂÎÙÈΤ˜, ·ÎfiÌ· Î·È ·Ó ¤¯Ô˘Ó ·ÓÙ›ıÂÙË ¿Ô„Ë ÔÈ ÁÔÓ›˜. °ÂÓÈο, ÁÈ· Ù· ÚfiˆÚ· Ì µ°<1,0 kg Ô˘ ÂÈ‚ÈÒÓÔ˘Ó, ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ ÎÚ·ÙÈ΋ ̤ÚÈÌÓ· Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ΤÓÙÚˆÓ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, ÓÔÛËÏ›·˜ Î·È ¤ÁηÈÚ˘ ·Ú¤Ì‚·Û˘, ÂȉÈο Û¯ÔÏ›· Î.Ï. ∫¿ı ÓÂÔÁÓfi Û ˘„ËÏfi ΛӉ˘ÓÔ ÌÔÚ› Ó· Û˘Ó¯›ÛÂÈ Ó· ¤¯ÂÈ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ 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). OÚÈṲ̂Ó˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÛÙ· ÓÂÔÁÓ¿ Ì µ°<750 g Ë ÂÈıÂÙÈ΋ ıÂÚ·›· ‰ÂÓ ÂËÚ¤·Û ÙË ıÓËÛÈÌfiÙËÙ·, ·ÏÏ¿ ·‡ÍËÛ ÙË Ì¤ÛË ‰È¿ÚÎÂÈ· ˙ˆ‹˜ (31,32). °È· Ù· ÓÂÔÁÓ¿ Ì µ°<500 g ıˆÚÂ›Ù·È fiÙÈ ‰ÂÓ ·Í›˙ÂÈ Ó· Á›ÓÔ˘Ó ÚÔÛ¿ıÂȘ ·Ó¿Ó˄˘ ‰ÈfiÙÈ ·ÎfiÌ· Î·È ÛÙ· ηχÙÂÚ· ¡ÂÔÁÓÔÏÔÁÈο ΤÓÙÚ· ¤¯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· ¡ÂÔÁÓÔÏÔÁÈο ΤÓÙÚ· Û˘ÌʈÓÔ‡Ó fiÙÈ fiÏ· Ù· ÓÂÔÁÓ¿ Ì µ°>750 g ‹ ¢∫>25 Û˘ÌÏËڈ̤Ó˜ ‚‰ÔÌ¿‰Â˜ ·ËÛ˘ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï‹ÚË ·Ó¿ÓË„Ë Î·È ÂÓÙ·ÙÈ΋ ˘ÔÛÙ‹ÚÈÍË (31). ∆Ô ÔÛÔÛÙfi Ù˘ ·Ó·fiÙÚÂÙ˘ ıÓËÛÈÌfiÙËÙ·˜ ÁÈ· Ù· ÓÂÔÁÓ¿ Ì µ°>1,0 kg ‹Ù·Ó 2,62% ÙËÓ ° ÂÚ›Ô‰Ô, ·ÚfiÌÔÈÔ Ì ÙÔ 2,6% Ô˘ Ô Usher (36) ÚÈÓ 3 ‰ÂηÂٛ˜ ›¯Â ˘ÔÏÔÁ›ÛÂÈ ˆ˜ ÙÔ ÂÏ¿¯ÈÛÙÔ ÌË ÂÏ·ÙÙÒÛÈÌÔ. ªfiÓÔ ÔÈ ÚfiÔ‰ÔÈ ÛÙË ÁÂÓÂÙÈ΋ ÙÔ˘ ·ÓıÚÒÔ˘ Î·È ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Î·È ·Ú¤Ì‚·ÛË ı· ÌÔÚÔ‡Û·Ó Ó· ÂÏ·ÙÙÒÛÔ˘Ó ÙÔ ÔÛÔÛÙfi ·˘Ùfi. ªÂ ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ÂÍȉ·ÓÈÎÂ˘Ì¤Ó˘ ıÓËÛÈÌfiÙËÙ·˜, ÔÈ ı¿Ó·ÙÔÈ ÙˆÓ ÓÂÔÁÓÒÓ ÛÙȘ ÂÚÈfi‰Ô˘˜ ∞, µ, ° ‹Ù·Ó 212 (ÔÛÔÛÙfi 10,7ò), 70 (ÔÛÔÛÙfi 7,48ò) Î·È 26 (ÔÛÔÛÙfi 3,7ò) ·ÓÙ›ÛÙÔȯ·, Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Ôχ ÏÈÁfiÙÂÚÔÈ ‰˘ÓËÙÈο ·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· Ô˘ ÌÔÚ› Ó· ÂÏ·ÙÙˆı› ÂÚ·ÈÙ¤Úˆ Î·È Ú¤ÂÈ Ó· ·ÔÙÂϤÛÂÈ ¤Ó· ÌÂÏÏÔÓÙÈÎfi Ì·˜ ÛÙfi¯Ô. ∞˘Ùfi ÚÔ-

Paediatriki 2001;64:573-582

¸Ôı¤ÙÂÈ ÚÈ˙ÈΤ˜ ·ÏÏ·Á¤˜ ÛÙÔÓ ·ÚÈıÌfi Î·È ÙËÓ ÂÍÂȉ›Î¢ÛË ÙÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡/È·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡, ÛÙÔÓ ÂÍÔÏÈÛÌfi ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ηıÒ˜ Î·È ÙËÓ ˘ÔÛÙ‹ÚÈÍË ·fi ¿ÏÏÔ˘˜ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙ· ÓÂÔÁÓ¿ ÂÈÛÙËÌÔÓÈÎÔ‡˜ ÎÏ¿‰Ô˘˜. ¶ÚfiÎÂÈÙ·È ‰ËÏ·‰‹ ÁÈ· “Â·Ó·ÛÙ·ÙÈΤ˜” ·ÏÏ·Á¤˜ ÛÙÔ ÀÁÂÈÔÓÔÌÈÎfi ™‡ÛÙËÌ· Ù˘ ∂ÏÏ¿‰·˜. ¡ÔÌÔıÂÙÈΤ˜, ΢ڛˆ˜, ÂÏÏ›„ÂȘ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·ÓÂͤÏÂÁÎÙ·, ¯ˆÚ›˜ ÚÔ¸Ôı¤ÛÂȘ Î·È ÚfiÙ˘·, ¡ÂÔÁÓÔÏÔÁÈο ∆Ì‹Ì·Ù·, ȉȈÙÈο 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·ÙÈο. ∞˘Ùfi ı· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·Ô‰˘Ó¿ÌˆÛË ÙˆÓ ‹‰Ë ˘·Ú¯fiÓÙˆÓ ∆ÚÈÙÔ‚¿ıÌÈˆÓ ¡ÂÔÁÓÔÏÔÁÈÎÒÓ ∫¤ÓÙÚˆÓ ·ÓÂÏÏ·‰Èο, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ·‡ÍËÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ Î·È ÙËÓ ·Ú¿ÏÏËÏË ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÓÔÛËÏ›·˜. ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ıÓËÛÈÌfiÙËÙ· ÁÈ· Ù· ¶Ãµ° ÓÂÔÁÓ¿ ηÈ, Èı·Ófiٷٷ Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi, Ë ÓÔÛËÚfiÙËÙ· Â›Ó·È ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚ˜ ÛÙ· ∆ÚÈÙÔ‚¿ıÌÈ· ∫¤ÓÙÚ· Î·È Ì¿ÏÈÛÙ· Û ·˘Ù¿ Ô˘ ¤¯Ô˘Ó ¿Óˆ ·fi 15 Î·Ï˘Ì̤Ó˜ ı¤ÛÂȘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ Û ηıËÌÂÚÈÓ‹ ‚¿ÛË (34,35). µÈ‚ÏÈÔÁÚ·Ê›· 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·ÎԇϷ Ã. ¶·ÓÂÏÏ‹ÓÈ· ¶ÂÚÈÁÂÓÓËÙÈ΋ ŒÚ¢ӷ [¢È·ÙÚÈ‚‹ ÁÈ· ÀÊËÁÂÛ›·]. ∞ı‹Ó·: ∞’ ¶·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; ∞Ú›Ï˘ 1983. 7. ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ Ã, §ÂΤ·-∫·Ú·Ó›Î· µ, ∫·‚‚·‰›·˜ °, ª·ÙÛ·ÓÈÒÙ˘ ¡. ¢Âη¤ÓÙ ¯ÚfiÓÈ· ÚÔfi‰Ô˘ (19831998): ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙË ¯ÒÚ· Ì·˜ Û‹ÌÂÚ·. 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 2830 ª·˚Ô˘; 1999. 8. ∂ıÓÈ΋ ™Ù·ÙÈÛÙÈ΋ ÀËÚÂÛ›· ∂ÏÏ¿‰Ô˜: ∆ÂÏÂ˘Ù·›· ÛÙ·ÙÈÛÙÈο ‰Â‰Ô̤ӷ 1996 (ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·). 9. ªËÙ¤Ú· ª·È¢ÙÈÎfi Î·È ÃÂÈÚÔ˘ÚÁÈÎfi ∫¤ÓÙÚÔ ∞∂: ∂ÓËÌÂÚˆÙÈÎfi ‰ÂÏÙ›Ô Ù˘ ªÔÓ¿‰·˜ ¶ÚÔÒÚˆÓ Î·È ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ. πÔ‡ÓÈÔ˜ 2000, ∞ı‹Ó·. 10. π·ÛÒ. ∂ÓËÌÂÚˆÙÈÎfi ¢ÂÏÙ›Ô ªÔÓ¿‰·˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜

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¡ÂÔÁÓÒÓ ¡ÔÛÔÎÔÌ›Ԣ π·ÛÒ ª∂¡¡ 2000. 11. ™ÔÊ·Ù˙‹˜ π, ™·Ï‚¿ÓÔ˜ ∏, µ·Ú‚·Ú›ÁÔ˜ π, ¶·¿˜ ∫. ¶ÂÚÈÁÂÓÓËÙÈ΋ ¤Î‚·ÛË 170 ΢‹ÛÂˆÓ ˆÚÈÌfiÙËÙ·˜ 22-31 ‚‰ÔÌ¿‰ˆÓ. ∞Ó·ÎÔ›ÓˆÛË. ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÁÂÓÓËÙÈ΋˜ π·ÙÚÈ΋˜; 1996 27-28 ∞ÚÈÏ›Ô˘; ¡·‡ÏÈÔ; 1996. 12. ¶··ıˆÌ¿ ∂, OÈÎÔÓÔÌ›‰Ô˘ O, ÷Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑, ¶ÚÂ‚Â‰Ô˘Ú¿ÎË ¶, ∫·›ÎË ∞, ¡ÈÎÔÏfiÔ˘ÏÔ˜ ¢. ∂ÓÙ·ÙÈ΋ ÓÔÛËÏ›· Î·È ¤Î‚·ÛË ÙˆÓ ÚfiˆÚˆÓ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜. 9Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÁÂÓÓËÙÈ΋˜ π·ÙÚÈ΋˜; 1996 2728 ∞ÚÈÏ›Ô˘; ¡·‡ÏÈÔ; 1996. 13. ∆ÔÌ¿Î˘ £, ™ÎÔÚ‰¿Ï· ª, °ÎÔ˘ÁÈ·ÌÙ˙‹ ∂, ™ÈÁ¿Ï·˜ π. ¡ÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ÙÚÈÂÙ›· 1993-1995 ÛÙÔ °¶¡ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏ˘. ∞Ó·ÎÔ›ÓˆÛË. 9Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶ÂÚÈÁÂÓÓËÙÈ΋˜ π·ÙÚÈ΋˜; 1996 27-28 ∞ÚÈÏ›Ô˘; ¡·‡ÏÈÔ; 1996. 14. Ballard JL, Novak KK, Driver M. A simplified score for assessment of fetal maturation of newly born infants. J Pediatr 1979;95:769-774. 15. 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. 16. Synnes AR, Ling EWY, Whitfield MF, Mackinnon M, Lopes L, Wong F et al. Peritanal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation). J Pediatr 1994;125:952-960. 17. 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. 18. Philip AGS. Neonatal mortality rate: Is further improvement possible? J Pediatr 1995;126:427-433. 19. Gould JB, Benitz WE, Liu H. Mortality and time to death in very low birth weight infants: California, 1987 and 1993. Pediatrics 2000;105:pE37. 20. Hernandez JA, Hall DM, Goldson BJ, Chase M, Garrett C. Impact of infants born at the threshold of viability on the neonatal mortality rate in Colorado. J Perinatol 2000;1:21-26. 21. ¶··ÁˆÚÁ›Ô˘ A. Early IUGR: An Obstetrical and ¡eonatal Challenge. ∂ÈÛ‹ÁËÛË Û ™ÂÌÈÓ¿ÚÈÔ Ù˘ ∞’ ¶·ÓÂÈÛÙËÌȷ΋˜ ª·È¢ÙÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞¶£ Ì ı¤Ì· “∂Ó‰ÔÌ‹ÙÚÈ· µÚ·‰‡ÙËÙ· ∞Ó¿Ù˘Í˘”. £ÂÛÛ·ÏÔÓ›ÎË, 1415 OÎÙˆ‚Ú›Ô˘ 2000. 22. Luke B, Bigger HR, Leurgens S, Sietsema D. The cost of prematurity: a case-control study of twins vs singletons. Am J Public Health 1996;86:809-814. 23. Ment LR, Oh W, Ehrekranz RA, Philip AGS, Dunkan CC, Makuch RW. Antenatal steroids, delivery mode and intraventricular hemorrhage in preterm infants. Am J

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Obstet Gynecol 1995;172:795-800. 24. Powell SL, Holt VL, Hickok DE, Easterling T, Connell FA. Recent changes in delivery site of low-birth-weight infants in Washington: impact on birth-weight specific mortality. Am J Obstet Gynecol 1995;173:1585-1592. 25. Wennerholm UB, Wennerholm JM, Kiellmer I. Pregnancy Complications and short-term follow-up of infants born after in vitro fertilization and embryo transfer (IVF/ET). Acta Obstet Gynecol Scand 1991;70:565-573. 26. Tough SC, Green CA, Svenson LW, Belik J. Effects of in vitro fertilization on low birth weight pre-term delivery, and multiple birth. J Pediatr 2000;136:618-622. 27. Anonymous. Pregnancies and births resulting from in vitro fertilization: French National Registry, Analysis of data 1986-1990 FIVNAT. Fertil Steril 1995;64:746-756. 28. Wegman ME. Annual summary of vital statistics 1990. Pediatrics 1991;88:1081-1092. 29. Blackburn S. Problems of preterm infants after discharge. J Obstet Gynecol Neonatal Nurs 1995;24:43-49. 30. McCormick MC. Has the prevalence of handicapped infants increased with improved survival of the low birthweight infants? Clin Perinatol 1993;20:263-277. 31. Hack M, Fanaroff A. Outcomes of extremely low birthweight infants between 1982 and 1989. N Eng J Med 1989;321:1642-1647. 32. Allen MC, Donahue PK, Dusman AE. The limit of viability: neonatal outcomes of infants born at 22 to 25 weeks gestation. N Engl J Med 1993;329:1597-1601. 33. Sauve RS, Robertson C, Etches P et al. Before viability: a geographically based outcome study of infants weighing 500 grams or less at birth. Pediatrics 1998;101:438-445. 34. Phibbs CS, Bronstein JM, Buxton E, Phibbs RH. The effects of patient volume and level of care at the hospital of birth on neonatal mortality. JAMA 1996;276:1054-1059. 35. Menard MK, Lin Q, Holgren AE, Sappenfield MW. Neonatal mortality for very low birth weight deliveries in South Carolina by level of hospital perinatal service. Am J Obstet Gynecol 1998;179:374-381. 36. Usher R. Clinical implications of perinatal mortality statistics. Clin Obstet Gynecol 1971;14:885-892.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-01-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ϤͷӉÚÔ˜ ∞Ó‰Ú¤Ô˘ ÃÂÈ̈ӛ‰Ô˘ 15, 551 33, ∫·Ï·Ì·ÚÈ¿ E-mail: aalex@spark.net.gr


¶·È‰È·ÙÚÈ΋ 2001;64:583-588

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Paediatriki 2001;64:583-588

ORIGINAL ARTICLE

∞˘ÙfiÌ·Ù˜ ÂÁÎÂÊ·ÏÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ ÛÙ· ·È‰È¿ ™. ºÂÛÛ¿ÙÔ˘, ¢. °ÎÈÒÓ˘, ∂. O˘Ú·Ó‹, ∞. ∏ÏÈ¿‰Ë˜, π. ¶··‰¿ÙÔ˜

Spontaneous intracerebral hemorrhage in children S. Fessatou, D. Gionis, E. Ourani, A. Heliadis, I. Papadatos

¶ÂÚ›ÏË„Ë: ∏ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· Â›Ó·È Ì›· ÌÔÚÊ‹ ÔͤԘ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÙÔ ÔÔ›Ô Û˘¯Ó¿ ·Óı›ÛÙ·Ù·È ÛÙË ıÂÚ·›·. ∞Ó·ÛÎÔ‹Û·Ì ÙËÓ ÂÌÂÈÚ›· Ì·˜ Û 16 ·È‰È¿ Ì ·˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ËÏÈΛ·˜ ·fi 30 ËÌÂÚÒÓ ¤ˆ˜ 14ó ÂÙÒÓ, Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1991 ¤ˆ˜ ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1998. ∆· ÈÔ Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· ‹Ù·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ Û 11 ·È‰È¿ (68,75%) Î·È Ë ¤ÓÙÔÓË ÎÂÊ·Ï·ÏÁ›· Û 8 ·È‰È¿ (50%). ∏ Îϛ̷η °Ï·ÛÎ҂˘ ‹Ù·Ó 6-11 Û ÔÛÔÛÙfi 56% ÙˆÓ ·ÛıÂÓÒÓ. ∏ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜ ‹Ù·Ó ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Û 11 ·ÛıÂÓ›˜. ∞ÁÁÂÈÔÁÚ·Ê›· ¤ÁÈÓ Û 10 ·ÛıÂÓ›˜ Î·È ‹Ù·Ó ‰È·ÁÓˆÛÙÈ΋ Û 8. ∏ ·ÚÈ· ·ÈÙ›· ·˘ÙfiÌ·Ù˘ ·ÈÌÔÚÚ·Á›·˜ ‹Ù·Ó ÔÈ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ (7 ·È‰È¿). £ÂÚ·¢ÙÈο, Û 2 ·È‰È¿ ¤ÁÈÓ ÂÌ‚ÔÏÈÛÌfi˜ Ì 100% ÂÈÙ˘¯›·, ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ¤ÁÈÓ Û 5 Ì 60% ÂÈ‚›ˆÛË, ÂÓÒ Ë Û˘ÓÙËÚËÙÈ΋ ıÂÚ·›· ›¯Â 66,66% ıÓËÙfiÙËÙ·. ∏ Û˘ÓÔÏÈ΋ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÂÈ‚›ˆÛË ‹Ù·Ó 56,25%. ™ÙÔ follow-up Ô˘ ‰È‹ÚÎÂÛ ·fi 9 Ì‹Ó˜ ˆ˜ 7ó ¤ÙË, ¤Ó·˜ ·ÛıÂÓ‹˜ ·‚›ˆÛÂ, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ Â›Ó·È Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË (6 ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi Ó¢ÚÔÏfiÁÔ Î·È Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹). ∏ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ‰ÂÓ Â›Ó·È Û˘¯Ó‹ ÛÙ· ·È‰È¿, fï˜ ÔÈ ÁÈ·ÙÚÔ› Ú¤ÂÈ Ó· ÙËÓ ¤¯Ô˘Ó ˘’ fi„ÈÓ ÙÔ˘˜, ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÂȉÈο Û˘ÌÙÒÌ·Ù·. O ÂÌ‚ÔÏÈÛÌfi˜, Â›Û˘, Ê·›ÓÂÙ·È Ó· Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ·ÛÊ·Ï‹˜ ıÂÚ·¢ÙÈ΋ Ù¯ÓÈ΋ ÁÈ· ÙȘ ∞º¢˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ·˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È·.

Key words: spontaneous intracerebral hemorrhage, stroke.

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶.& ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Intensive Care Unit, “P. & A. Kyriakou” General Peripheral Children’s Hospital, Athens

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∞ÚÙËÚÈÔÊÏ‚҉ÂȘ ‰˘ÛϷۛ˜ ∞ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¡ˆÙÈ·›Ô˜ Ì˘ÂÏfi˜ ∞ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ ∫ϛ̷η ÎÒÌ·ÙÔ˜ °Ï·ÛÎ҂˘

∂ÈÛ·ÁˆÁ‹ OÈ ·ÁÁÂȷΤ˜ ÓfiÛÔÈ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌfiÓÔ Û ÂÓ‹ÏÈΘ, ·ÏÏ¿ Î·È Û ·È‰È¿, ·ÎfiÌ· Î·È Û ¤Ì‚Ú˘·. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÓfiÛˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹. O Banker ÙÔ 1961 ·Ó·Ê¤ÚÂÈ fiÙÈ Û ˘ÏÈÎfi ·fi ‚ÈÔ„›Â˜ ÂÁÎÂÊ¿ÏˆÓ ·È‰ÈÒÓ, ÙÔ 8,7% ÙˆÓ ı·Ó¿ÙˆÓ ÔÊÂÈÏfiÙ·Ó Û ·ÁÁÂȷΤ˜ ·ı‹ÛÂȘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÛÙȘ ÂÈÏÔΤ˜ ÙÔ˘˜ (1). OÈ ·Èٛ˜ ÙˆÓ ·˘ÙfiÌ·ÙˆÓ ·ÈÌÔÚÚ·ÁÈÒÓ ÛÙ· ·È‰È¿ ‰È·Ê¤ÚÔ˘Ó ·fi ÂΛӘ ÙˆÓ ÂÓËÏ›ÎˆÓ (2,3). ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ ∏ ÌÂϤÙË ÂÚÈÁÚ¿ÊÂÈ ÙËÓ ÂÌÂÈÚ›· Ì·˜ ·fi 16 ·È‰È¿ Ì ·˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ™ÎÔfi˜ Ì·˜ Â›Ó·È Ó· ηıÔÚ›ÛÔ˘Ì ÙË Û˘¯ÓfiÙËÙ·, ÙËÓ ·ÈÙÈÔÏÔÁ›·, Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙËÓ ¤Î‚·ÛË ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ. ∏ ÌÂϤÙË Â›Ó·È ·Ó·‰ÚÔÌÈ΋. ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1991 ¤ˆ˜ ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1998 ·Ó¢ڤıËÛ·Ó fiϘ ÔÈ ·˘ÙfiÌ·Ù˜ ÂÁÎÂÊ·ÏÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ ÙÔ˘ ¶°¡ ¶·›‰ˆÓ “¶·Ó. & ∞ÁÏ. ∫˘ÚÈ·ÎÔ‡”. ∞fi ÙË ÌÂϤÙË Ì·˜ ÂÍ·ÈÚ¤ıËÎ·Ó ·ÛıÂÓ›˜ Ì ÚˆÙÔ·ı‹ ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›· ‹ ÈÛÙÔÚÈÎfi ÂÁÎÂÊ·ÏÈÎÔ‡ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ‹ ·È‰È¿ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·È‰ÈÒÓ Ì Ï¢¯·ÈÌ›·, ıÚÔÌ‚ÔÂÓ›· ‹ ¢∂¶ ηÙfiÈÓ ÛË„·ÈÌ›·˜. ∂›Û˘, ÂÍ·ÈÚ¤ıËÎ·Ó ÓÂÔÁÓ¿ ËÏÈΛ·˜ <15 ËÌÂÚÒÓ. ŸÏ˜ ÔÈ ÂÁÎÂÊ·ÏÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ ÂȂ‚·ÈÒıËÎ·Ó Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT) ÂÁÎÂÊ¿ÏÔ˘, ÂÓÒ 4 ·ÛıÂÓ›˜ ¤Î·Ó·Ó Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI). ∞ÁÁÂÈÔÁڷʛ˜ ¤ÁÈÓ·Ó Û 10 ·ÛıÂÓ›˜. ÃÂÈÚÔ˘ÚÁ‹ıËÎ·Ó 5 ·ÛıÂÓ›˜ Î·È Û 3 Ù¤ıËΠÂ͈ÙÂÚÈ΋ ·ÚÔ¯¤Ù¢ÛË ÛÙȘ ÎÔÈϛ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (Û ‰‡Ô ÏfiÁˆ ÂÓ‰ÔÂÁÎÂÊ·ÏÈÎÔ‡ ·ÈÌ·ÙÒÌ·ÙÔ˜, ÙÔ ÔÔ›Ô ÂÚÚ¿ÁË ÚÔ˜ ÙÔ ÎÔÈÏÈ·Îfi Û‡ÛÙËÌ· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Û ¤Ó· ÏfiÁˆ ÂÓ‰ÔÎÔÈÏȷ΋˜ ·ÈÌÔÚÚ·Á›·˜). ™Â 2 ·ÛıÂÓ›˜ ¤ÁÈÓ ÂÌ‚ÔÏÈÛÌfi˜ Î·È ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 6 ¤ÁÈÓÂ Û˘ÓÙËÚËÙÈ΋ ıÂÚ·›·. ∂ÓÓ¤· ·ÛıÂÓ›˜ Â¤˙ËÛ·Ó ÌÂÙ¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜.

∞ÔÙÂϤÛÌ·Ù· ∞ÓÙÈÌÂÙˆ›Û·Ì 16 ·ÛıÂÓ›˜ (5 ·ÁfiÚÈ· Î·È 11 ÎÔÚ›ÙÛÈ·) ËÏÈΛ·˜ 30 ËÌÂÚÒÓ ¤ˆ˜ 14ó ÂÙÒÓ (mean 9 ÂÙÒÓ) Ô˘ ‰È·ÁÓÒÛÙËΠfiÙÈ Â›¯·Ó ·˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ∆· Û˘ÌÙÒÌ·Ù· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ·ÈÊÓ›‰È· Û 40% ÙˆÓ ·ÛıÂÓÒÓ (ÎÒÌ·, ËÌÈÏËÁ›·, Û·ÛÌÔ›), ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ ·ÚÔ˘Û›·˙·Ó ‚·ıÌÈ·›· ÂȉÂÈÓÔ‡ÌÂÓË Û˘Ìو̷ÙÔÏÔÁ›·. ∞fi Ù· Û˘ÌÙÒÌ·Ù·, ÈÔ Û˘¯Ó¿ ‹Ù·Ó ÔÈ ‰È·-

584

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Ù·Ú·¯¤˜ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ (ÓˆıÚfiÙËÙ·, ˘ÓËÏ›·, ÎÒÌ·) Ô˘ ÂÌÊ¿ÓÈÛ·Ó 11 ·È‰È¿ (68,75%) Î·È Ë ¤ÓÙÔÓË ÎÂÊ·Ï·ÏÁ›· Û 8 ·È‰È¿ (50%). ™·ÛÌÔ‡˜ ·ÚÔ˘Û›·Û·Ó 2 ·È‰È¿ (12,5%), ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ ¤Ó· ÂÛÙÈ·ÎÔ‡˜, ÂÓÒ ¤Ó· ·È‰› ÂÌÊ¿ÓÈÛ ‰È·Ù·Ú·¯¤˜ Ù˘ fiÚ·Û˘ (6,25%). ∏ ÂÓÙfiÈÛË Ù˘ ‚Ï¿‚˘ ¤ÁÈÓ ‰˘Ó·Ù‹ Ì CT Î·È MRI Û 14 ·ÛıÂÓ›˜ (∂ÈÎfiÓ· 1 Î·È 2). ∏ ÈÔ Û˘¯Ó‹ ı¤ÛË ‹Ù·Ó ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Û 11 ·È‰È¿, fiÔ˘ Û 2 Û˘Ó˘‹Ú¯Â ˘·Ú·¯ÓÔÂȉ‹˜ Î·È ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›·. ™Ù· ‚·ÛÈο Á¿ÁÁÏÈ· ·Ú·ÙËÚ‹ıËΠ۠4 ·ÛıÂÓ›˜ Î·È Û˘Óԉ‡ÔÓÙ·Ó ·fi ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›·. ¢‡Ô ·fi ·˘ÙÔ‡˜ ›¯·Ó ·ÈÌÔÚÚ·Á›· Î·È ÛÙÔ ı¿Ï·ÌÔ Î·È ÛÙÔÓ ˘·Ú·¯ÓÔÂȉ‹ ¯ÒÚÔ, ÂÓÒ ¤Ó·˜ ·ÛıÂÓ‹˜ 5 ÂÙÒÓ Â›¯Â ÂÓ‰ÔÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›·. ∏ ·ÈÙ›· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ‚Ú¤ıËΠ۠9 ·È‰È¿ (56,25%). ∂Ù¿ ›¯·Ó ∞º¢˜, 1 ›¯Â ·Ó‡ڢÛÌ· Î·È Û 1 ·ÔηχÊıËΠfiÁÎÔ˜. ¢¤Î· ·ÛıÂÓ›˜ ¤Î·Ó·Ó ·ÁÁÂÈÔÁÚ·Ê›· fiÔ˘ ‚Ú¤ıËÎ·Ó 6 ∞º¢˜ (60%), 1 ·Ó‡ڢÛÌ· ÚfiÛıÈ·˜ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, 1 Û˘Ì›ÂÛË ‰ÂÍÈ¿˜ Ô›ÛıÈ·˜ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Ì ·ÈÌÔÚÚ·Á›· ·fi fiÁÎÔ, ÂÓÒ 2 ·ÁÁÂÈÔÁڷʛ˜ ‰ÂÓ ·ÔÎ¿Ï˘„·Ó η̛· ·ıÔÏÔÁ›·. §fiÁˆ Ù˘ Ù·¯‡Ù·Ù˘ Âȉ›ӈÛ˘ ÙˆÓ ÎÏÈÓÈÎÒÓ Û˘Ìو̿وÓ, ‰ÂÓ ¤ÁÈÓ ·ÁÁÂÈÔÁÚ·Ê›· ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 6 ·ÛıÂÓ›˜. ∏ È·ÙÚÔ‰ÈηÛÙÈ΋ ÌÂϤÙË ·ÔÎ¿Ï˘„ 1 ∞º¢, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ 5 ÂÚÈÙÒÛÂȘ ‰ÂÓ ‚Ú¤ıËΠοÙÈ Ô˘ Ó· ·ÈÙÈÔÏÔÁ› ÙËÓ ·ÈÌÔÚÚ·Á›·. ∏ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ÂÈ‚›ˆÛË ‹Ù·Ó 56,25%. ™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÂÙ·È Ë ÂÈ‚›ˆÛË ÛÙȘ Ù¤ÛÛÂÚȘ ıÂÚ·¢ÙÈΤ˜ ÔÌ¿‰Â˜, ÂÓÒ ÛÙÔÓ ¶›Ó·Î· 2 Ë ıÓËÙfiÙËÙ· Û ۯ¤ÛË Ì ÙÔ CGS ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹. ™ÙÔ follow-up Ô˘ ‰È‹ÚÎÂÛ ·fi 9 Ì‹Ó˜ ˆ˜ 7ó ¯ÚfiÓÈ·, ‰È·ÈÛÙÒıËΠfiÙÈ ¤Ó· ·È‰› ·‚›ˆÛÂ Î·È ‹Ù·Ó ÙÔ ·È‰› Ì ÙÔÓ fiÁÎÔ, ÙÔ ÔÔ›Ô ÌÂÙ¿ ·fi ÚÔÛˆÚÈÓ‹ ‚ÂÏÙ›ˆÛË ·fi ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÂÌÊ¿ÓÈÛ ı·Ó·ÙËÊfiÚ˜ ÂÈÏÔΤ˜ ·fi ÙË ¯ËÌÂÈÔıÂÚ·›·. ŒÓ· ·È‰› ÂÌÊ·Ó›˙ÂÈ ‰Èψ›· ÌÂÙ¿ ·fi 5 ¯ÚfiÓÈ·. ŒÍÈ ·ÛıÂÓ›˜ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi Ó¢ÚÔÏfiÁÔ Î·È ·›ÚÓÔ˘Ó ·ÁˆÁ‹ Ì ·ÓÙ›-∂, ¯ˆÚ›˜ fï˜ Ó· ÂÌÊ·Ó›˙Ô˘Ó Î¿ÔÈ· ÎÈÓËÙÈ΋ ‹ ÓÔËÙÈ΋ ‰È·Ù·Ú·¯‹, ÏËÓ ÂÓfi˜ Ì ‰È·Ù·Ú·¯¤˜ ÌÓ‹Ì˘. ŒÓ·˜ ·ÛıÂÓ‹˜ Ì·˜ ¤¯ÂÈ ÛÙ·Ì·Ù‹ÛÂÈ ÙËÓ ·ÓÙ›-∂ ·ÁˆÁ‹ ÁÈ· 2ó ¯ÚfiÓÈ· ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Î·Ó¤Ó· Úfi‚ÏËÌ·. ¢ÂÓ ¤¯Ô˘Ì ÛÙË ÌÂϤÙË Ì·˜ ÂÚ›ÙˆÛË Â·ÓÂÌÊ¿ÓÈÛ˘ ·ÈÌÔÚÚ·Á›·˜. ™˘˙‹ÙËÛË ∆· ·ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÛÙ· ·È‰È¿ ¤¯Ô˘Ó ÂÙ‹ÛÈ· Û˘¯ÓfiÙËÙ· 2,5/100.000 ·È‰È¿, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Û ÌÂϤÙ˜ ·fi ‰È¿ÊÔÚ˜ Ê˘Ï¤˜ ηÈ


¶·È‰È·ÙÚÈ΋ 2001;64:583-588

∂ÈÎfiÓ· 1. CT ÂÁÎÂÊ¿ÏÔ˘ Ì ÂÎÙÂٷ̤ÓÔ ÂÓ‰ÔÂÁÎÂÊ·ÏÈÎfi ·È̿و̷ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ, ÂÚÈ‚·ÏÏfiÌÂÓÔ ·fi ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Ô›‰ËÌ· Ô˘ ÚÔηÏ› ·ÒıËÛË ÙˆÓ ‰ÔÌÒÓ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜.

ÂıÓfiÙËÙ˜ (4). ∏ Ê˘ÛÈ΋ ÈÛÙÔÚ›· ÙˆÓ ∞∂∂ ÛÙ· ·È‰È¿ ‰È·Ê¤ÚÂÈ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÙËÓ ÎÏÈÓÈ΋ ÂͤÏÈÍË Î·È ÙȘ ·Ó·ÙÔÌÈΤ˜ ı¤ÛÂȘ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ (5). ∆· ·È‰È·ÙÚÈο ∞∂∂ ¤¯Ô˘Ó ÂÙÂÚÔÁÂÓ‹ ·ÈÙÈÔÏÔÁ›·, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆Ô 1/3 ·fi ·˘Ù¿ Â›Ó·È ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù·ÍÈÓÔÌÔ‡ÓÙ·È ˆ˜ ȉÈÔ·ı‹. ∞˘Ùfi Â›Ó·È ÂÓÙÂÏÒ˜ ·ÓÙ›ıÂÙÔ Û ۯ¤ÛË Ì 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 Ì ·ÚÙËÚÈÔÛÎÏ‹Ú˘ÓÛË ‹ ˘¤ÚÙ·ÛË (6). ™Ù· ·È‰È¿, fï˜, ÈÔ Û˘¯Ó¿ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, ÏÔÈÌÒÍÂȘ, ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, ·ÁÁÂÈ›Ùȉ˜ ΢ڛˆ˜ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ (7). ∆ÚÂȘ Ì˯·ÓÈÛÌÔ› ÚÔηÏÔ‡Ó ∞∂∂ ÛÙ· ·È‰È¿: ıÚfiÌ‚ˆÛË, ÂÌ‚ÔÏ‹ Î·È ·ÈÌÔÚÚ·Á›·. ∞ÈÌÔÚÚ·Á›· Û˘Ì‚·›ÓÂÈ fiÙ·Ó ·›Ì· ÂÏ¢ıÂÚÒÓÂÙ·È ÛÙÔÓ Â͈·ÁÁÂÈ·Îfi, ÂÓ‰ÔÎÚ·ÓÈ·Îfi ‹ ÂÓ‰ÔÛÔÓ‰˘ÏÈÎfi ¯ÒÚÔ. ™’ ·˘Ù¤˜ ÙȘ ηٷÛÙ¿ÛÂȘ, Ë ÂÓÙÔÈṲ̂ÓË ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÙÔ˘ ¡ª Û˘Ì‚·›ÓÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ‰‡Ô ·Ú·ÁfiÓÙˆÓ: Ù˘ ›ÂÛ˘ ÏfiÁˆ Ù˘ ηٿÏË-

Paediatriki 2001;64:583-588

∂ÈÎfiÓ· 2. MRI ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ‰Â›¯ÓÂÈ ÂÓ‰ÔÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙÔ Ô›ÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ ÌÂÙˆÈ·›Ô˘ ÏÔ‚Ô‡ ‰È·Ì¤ÙÚÔ˘ 4 cm. ™ÙËÓ ¤Ûˆ ·Ú˘Ê‹ Ù˘ ·ÈÌÔÚÚ·Á›·˜ ·ÂÈÎÔÓ›˙ÂÙ·È fi˙Ô˜ ‰È·Ì¤ÙÚÔ˘ 1 cm. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Î·È ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ô›‰ËÌ· ÚÔηÏÔ‡Ó Û˘Ì›ÂÛË ÙÔ˘ ÌÂÛÔÏÔ‚›Ô˘ Î·È Ù˘ ‰ÂÍÈ¿˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜ Î·È ÂÏ·ÊÚ¿ ÌÂÙ·ÙfiÈÛË ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿ ÙÔ˘ ‰ÚÂ¿ÓÔ˘. ¶·Ú·ÙËÚÂ›Ù·È Â›Û˘ ÌÈÎÚ‹˜ ÂÎÙ¿Ûˆ˜ ˘ÔÛÎÏËÚ›‰ÈÔ ·È̿و̷ ηٿ Ì‹ÎÔ˜ Ù˘ ‰ÂÍÈ¿˜ ·Ú˘Ê‹˜ ÙÔ˘ ÛÎËÓȉ›Ô˘ Î·È ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÈ·›·, ÎÚÔÙ·ÊÈ΋ Î·È ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ·.

„˘ ÙÔ˘ ¯ÒÚÔ˘ ·fi ÙÔÓ fiÁÎÔ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ·fi ÙËÓ ÈÛ¯·ÈÌ›· ÏfiÁˆ Ù˘ ·ÈÌÔÚÚ·Á›·˜. ∞˘Ù¤˜ ÔÈ ‚Ï¿‚˜ ÌÔÚ› Ó· ÂȉÂÈÓˆıÔ‡Ó ·fi ÙȘ ‚Ï·ÙÈΤ˜ ÂȉڿÛÂȘ ÛÙÔ Ó¢ÚÈÎfi ÈÛÙfi ·fi ÙȘ Ô˘Û›Â˜ Ô˘ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È ·fi ÙÔ ·›Ì· (7). ∞Ó Î·È ÌÂÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‹Í˘ ÂÈʤÚÔ˘Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÈÛ¯·ÈÌÈο ∞∂∂, ÌÂÚÈΤ˜ ¿ÏϘ ÚÔ¿ÁÔ˘Ó ÙȘ ÂÁÎÂÊ·ÏÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜. ∆¤ÙÔȘ Â›Ó·È ÔÈ ·ÈÌÔÚÚÔÊÈϛ˜ ∞ Î·È µ Î·È Ë ÛÔ‚·Ú‹ ıÚÔÌ‚Ô΢ÙÙ·ÚÔÂÓ›· ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜. ™Ù· ·È‰È¿, Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· ¢ı‡ÓÂÙ·È Î˘Ú›ˆ˜ ÁÈ· ¤ÌÊÚ·ÎÙ· Î·È ÏÈÁfiÙÂÚÔ ÁÈ· ·ÈÌÔÚÚ·Á›·. ÕÏϘ ·Èٛ˜ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿ Â›Ó·È Ë Moyamoya Ì ̛· ÌÔÓ·‰È΋ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ·, fï˜ Ë ‚Ï¿‚Ë Ô˘ ÚÔηÏ› Â›Ó·È Û˘Ó‹ıˆ˜ ÈÛ¯·ÈÌ›· Î·È Û·ÓÈfiÙÂÚ· ÂÁÎÂÊ·ÏÈ΋ ‹ ˘·Ú·¯ÓÔÂȉ‹˜ ·ÈÌÔÚÚ·Á›· (7). OÈ ∞º¢˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ·ÈÙ›·

585


¶·È‰È·ÙÚÈ΋ 2001;64:583-588

Paediatriki 2001;64:583-588

¶›Ó·Î·˜ 1. ∂Ó‰ÔÓÔÛÔÎÔÌÂȷ΋ ÂÈ‚›ˆÛË ·Ó¿ ıÂÚ·¢ÙÈ΋ ÔÌ¿‰· ÃÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ∂͈ÙÂÚÈ΋ ·ÚÔ¯¤Ù¢ÛË ™˘ÓÙËÚËÙÈ΋ ıÂÚ·›· ∂Ì‚ÔÏÈÛÌfi˜

5 3 6 2

Â¤˙ËÛ·Ó Â¤˙ËÛ·Ó Â¤˙ËÛ·Ó Â¤˙ËÛ·Ó

3 2 2 2

(60%) (66,66%) (33,33%) (100%)

ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿ Î·È Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ·ÁfiÚÈ· (7). ∞˘Ù‹ Ë ·ÓˆÌ·Ï›· Ù˘ ‰È¿Ï·Û˘ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ ÂÌÊ·Ó›˙ÂÙ·È Ì ·ÈÌÔÚÚ·Á›· ÈÔ Û˘¯Ó¿ ÛÙ· ·È‰È¿ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ (8,9). ∏ ÈÔ Û˘¯Ó‹ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ∞º¢˜ ÛÙ· ·È‰È¿ Â›Ó·È ÔÈ Û·ÛÌÔ›. ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ∞º¢˜ Â›Ó·È ÛÙ· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· Ì ·‡ÍËÛË Î·Ù¿ 10% ÛÙÔÓ Ô›ÛıÈÔ ‚fiıÚÔ (7). OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ·ÈÌÔÚÚ·Á›·˜ Ô˘ ÔÊ›ÏÂÙ·È Û ∞º¢ ÌÔÚ› Ó· Â›Ó·È ·ÈÊÓ›‰È· ¤Ó·ÚÍË ÂÓÙÔÈṲ̂Ó˘ Ó¢ÚÔÏÔÁÈ΋˜ ·ıÔÏÔÁÈ΋˜ ÛËÌÂÈÔÏÔÁ›·˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÚÈÔ¯‹ Ô˘ ¤ÁÈÓÂ Ë ·ÈÌÔÚÚ·Á›·. O ΛӉ˘ÓÔ˜ ·ÈÌÔÚÚ·Á›·˜ ÁÈ· ÙȘ ∞º¢˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó Ú·Á› Â›Ó·È ÂÚ›Ô˘ 3% ÙÔ ¯ÚfiÓÔ (7,10). ∆· ÂÓ‰ÔÎÚ·Óȷο ·Ó¢ڇÛÌ·Ù· Â›Ó·È Â›Û˘ Û˘¯Ó‹ ·ÈÙ›· ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜ Û ·ÛıÂÓ›˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 20 ÂÙÒÓ. ∆· Û·ÎÎÔÂȉ‹ ·Ó¢ڇÛÌ·Ù· Â›Ó·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·ÁfiÚÈ·. ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë ÈÔ Û˘¯Ó‹ ı¤ÛË ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿ Â›Ó·È Î·Ù¿ Ì‹ÎÔ˜ ÙÔ˘ ÂÓ‰ÔÎÚ¿ÓÈÔ˘ ÙÌ‹Ì·ÙÔ˜ Ù˘ ¤Ûˆ ηڈٛ‰·˜. OÈ ÛÔÓ‰˘ÏÈΤ˜ Î·È ÔÈ ‚·ÛÈΤ˜ ·ÚÙËڛ˜ Â›Ó·È Â›Û˘ Û˘¯Ó¤˜ ı¤ÛÂȘ. ∆· ÂÓ‰ÔÎÚ·Óȷο ·Ó¢ڇÛÌ·Ù· ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Û˘Ó‹ıˆ˜ ÌÂÁ·Ï‡ÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÂÓËϛΈÓ. ∆· ÂÚÈÛÛfiÙÂÚ· ÔÊ›ÏÔÓÙ·È Û ·ÓˆÌ·Ï›Â˜ ÛÙË ‰È¿Ï·ÛË ÙˆÓ ·ÁÁ›ˆÓ, fï˜ ˘¿Ú¯Ô˘Ó Î·È ¿ÏϘ ·Èٛ˜ fiˆ˜ ÓfiÛÔÈ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, Ehler-Danlos, ÙÔ Û‡Ó‰ÚÔÌÔ Marfan, Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi Û·ÎÎÔÂȉ‹ ÂÁÎÂÊ·ÏÈο ·Ó¢ڇÛÌ·Ù· (7,11). ∆· ÂÓ‰ÔÎÚ·Óȷο ·Ó¢ڇÛÌ·Ù· Â›Ó·È ÈÔ Û˘¯Ó¿ Û ·ÛıÂÓ›˜ Ì ÔÏ˘Î˘ÛÙÈÎÔ‡˜ ÓÂÊÚÔ‡˜ Î·È Û’ ·˘ÙÔ‡˜ Ì ÈÛıÌÈ΋ ÛÙ¤ÓˆÛË ·ÔÚÙ‹˜ (6,7). OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙËÓ ÂÓÙfiÈÛË Î·È ÙËÓ ¤ÎÙ·ÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜. ∞Ó Ë ·ÈÌÔÚÚ·Á›· Û˘Ì‚Â› ÛÙÔ ·Ú¤Á¯˘Ì·, ÂÌÊ·Ó›˙ÔÓÙ·È ÂÓÙÔÈṲ̂Ó˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ. ŒÓ· Û˘ÓËıÈṲ̂ÓÔ ÚfiÙ˘Ô ÂÌÊ¿ÓÈÛ˘ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Â›Ó·È Ë ·ÈÊÓ›‰È· ¤Ó·ÚÍË ËÌÈÏËÁ›·˜, Ë ÔÔ›· ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ¿ÏÏ· ÛËÌ›·, fiˆ˜ ‰È·Ù·Ú·¯¤˜ ÔÙÈÎÒÓ ‰›ˆÓ Î·È ‰˘ÛÊ·Û›·, Û ·ÓÙ›ıÂÛË Ì ٷ ÌÈÎÚfiÙÂÚ· ·È‰È¿ Ô˘ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Ì Û·ÛÌÔ‡˜ Î·È ÎÒÌ· Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ËÌÈÏËÁ›·. ∂›Û˘, Ô ÔÓÔΤʷÏÔ˜, ÔÈ ¤ÌÂÙÔÈ, Ë ·ÓËÛ˘¯›·, ·ÎfiÌ· Î·È „˘¯È·ÙÚÈο

586

¶›Ó·Î·˜ 2. £ÓËÙfiÙËÙ· Û¯ÂÙÈ˙fiÌÂÓË Ì CGS ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ CGS 12-15 CGS 6-11 CGS 3-5

3 ·ÛıÂÓ›˜  9 ·ÛıÂÓ›˜  4 ·ÛıÂÓ›˜ 

·‚›ˆÛ ·‚›ˆÛ·Ó ·‚›ˆÛ·Ó

1 3 3

(33,33%) (33,33%) (60%)

Û˘ÌÙÒÌ·Ù· ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÌÔÚ› Ó· Â›Ó·È ÔÈ ÌÔÓ·‰ÈΤ˜ ÂΉËÏÒÛÂȘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿. ∞Ó Ë ·ÈÌÔÚÚ·Á›· Û˘Ì‚Â› ÛÙÔÓ ˘·Ú·¯ÓÔÂȉ‹ ¯ÒÚÔ ÂÌÊ·Ó›˙ÂÙ·È ÛÔ‚·Ú‹ ÎÂÊ·Ï·ÏÁ›·, ·˘¯ÂÓÈ΋ ‰˘Ûη̄›· Î·È ıÂÙÈο ÌËÓÈÁÁÈο ÛËÌ›· (12). ™ÙË ÌÂϤÙË Ì·˜, Ù· ÈÔ Û˘¯Ó¿ Û˘ÌÙÒÌ·Ù· ‹Ù·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘ Î·È Ë ¤ÓÙÔÓË ÎÂÊ·Ï·ÏÁ›·. ŒÓ· ηÏfi ÈÛÙÔÚÈÎfi, ηϋ ÎÏÈÓÈ΋ ÂͤٷÛË, ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô‰ËÁÔ‡Ó ÙÔ ÁÈ·ÙÚfi Ì ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔȯ›· ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜. ∏ Ú·ÁÌ·ÙÈ΋ Û˘¯ÓfiÙËÙ· Ù˘ ·˘ÙfiÌ·Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿ ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ‰˘ÛÎÚ·ÛÈÒÓ ·›Ì·ÙÔ˜ ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙ‹. ™ÙË ÌÂϤÙË Ì·˜, Ë ·ÈÙÈÔÏÔÁ›· ‚Ú¤ıËΠ۠9 ·fi Ù· 16 ·È‰È¿ Î·È ÔÈ ∞º¢˜ ‹Ù·Ó Ë Î‡ÚÈ· ·ÈÙ›·. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë MRI Î·È Ë ‚ÂÏÙ›ˆÛË ÙˆÓ Ù¯ÓÈÎÒÓ ÙˆÓ ·ÁÁÂÈÔÁÚ·ÊÈÒÓ Ô‰‹ÁËÛ·Ó Û ηχÙÂÚË Î·Ù·ÓfiËÛË ÔÏÏÒÓ Û˘ÁÁÂÓÒÓ ·ÁÁÂÈ·ÎÒÓ ÓfiÛˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ∞º¢˜, ÙˆÓ ÛËÚ·ÁÁˆ‰ÒÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ Î·È ÊÏ‚ÈÎÒÓ ·ÁÁÂȈ̿وÓ. ªfiÏȘ ÙÂı› Ë ˘Ô„›· ∞∂∂, ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ ÚÔÛ¿ıÂȘ ÂÈÎÂÓÙÚÒÓÔÓÙ·È ÛÙËÓ ·fi‰ÂÈÍË ÙÔ˘ Û˘Ì‚¿ÓÙÔ˜ Î·È ÛÙËÓ ·ÔÎ¿Ï˘„Ë Ù˘ ·ÈÙ›·˜. ∏ CT Î·È Ë MRI ‰Â›¯ÓÔ˘Ó ÁÚ‹ÁÔÚ· ÙËÓ ÙÔÔÁÚ·Ê›· Ù˘ ‚Ï¿‚˘. ∏ CT Á›ÓÂÙ·È Ù·¯‡ÙÂÚ· Î·È ‰Â›¯ÓÂÈ Î·ı·ÚfiÙÂÚ· ÙËÓ ·ÈÌÔÚÚ·Á›·. ∏ MRI, Ì ÙËÓ ÔÔ›· ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ·Ó¿Ï˘ÛË Î·È ÏÂÙÔ̤ÚÂÈ· ·fi ÙË CT, ·ÔηχÙÂÈ ÌÈÎÚfiÙÂÚ˜ ÂÌÊÚ¿ÍÂȘ Î·È ÊÏ‚Èο ·ÁÁÂÈÒÌ·Ù· (13). ∏ MRI ·ÁÁÂÈÔÁÚ·Ê›· ·ÔʤÚÂÈ ·ÍÈfiÈÛÙ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ÚÔ‹ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙËÓ ·Ú¯ÈÙÂÎÙÔÓÈ΋ ÙˆÓ ÌÂÁ¿ÏˆÓ ÙÚ·¯ËÏÈÎÒÓ Î·È ÂÓ‰ÔÎÚ·ÓÈ·ÎÒÓ ·ÁÁ›ˆÓ, ÂÓÒ ¤¯ÂÈ ÌÈÎÚ‹ ¢ÎÚ›ÓÂÈ· ÛÙ· ÌÈÎÚ¿ ÂÁÎÂÊ·ÏÈο ·ÁÁ›·. £ÂˆÚÂ›Ù·È È‰·ÓÈ΋ ·ÂÈÎÔÓÈÛÙÈ΋ Ù¯ÓÈ΋ Û ·ÛıÂÓ›˜ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÈÏÔÎÒÓ ·fi ÙËÓ ÎÏ·ÛÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (14). ∏ ÎÏ·ÛÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ·Ú·Ì¤ÓÂÈ Ë ·ÂÈÎÔÓÈÛÙÈ΋ ÂͤٷÛË ÂÎÏÔÁ‹˜ fiÙ·Ó ·Ó·˙ËÙÔ‡ÓÙ·È ÏÂÙÔ̤ÚÂȘ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ (15). ™ÙË ÌÂϤÙË Ì·˜, 7 ·ÛıÂÓ›˜ (43,75%) ›¯·Ó ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· Î·È ‰ÂÓ ·ÔηχÊıËÎÂ Ë ·ÈÙ›· Ù˘ Î·È Û 2 ·fi ·˘ÙÔ‡˜ Ô˘ ¤ÁÈÓ ·ÁÁÂÈÔÁÚ·Ê›· ‰ÂÓ ·ÔηχÊıËΠη̛· ‚Ï¿‚Ë. ∏ ·ÁÁÂÈÔÁÚ·Ê›· ÌÔÚ› Ó· ÌË ‰Â›¯ÓÂÈ “ÎÚ˘Ê¤˜” ·ÁÁÂȷΤ˜ ‚Ï¿‚˜ (16). ∏ CT Î·È Ë ·ÁÁÂÈÔÁÚ·Ê›· ÌÔÚ› Â›Û˘ Ó· ·ÔÙ‡¯Ô˘Ó Ó· Ù·˘ÙÔÔÈ‹ÛÔ˘Ó ¤Ó·Ó fiÁÎÔ


¶·È‰È·ÙÚÈ΋ 2001;64:583-588

Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û·Ó ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· (17). °È’ ·˘Ùfi ÚÔÙ›ÓÂÙ·È ·fi ÌÂÚÈÎÔ‡˜ ÂÚ¢ÓËÙ¤˜ Ì›· 2Ë ·ÁÁÂÈÔÁÚ·Ê›· ·ÚÁfiÙÂÚ·, Ô˘ ÌÔÚ› Ó· Â›Ó·È ÈÔ ‰È·ÊˆÙÈÛÙÈ΋. ¶¿ÓÙˆ˜, ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ ÌÔÚ› Ó· Û˘Ì‚Â› ·˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ¯ˆÚ›˜ ÂÍ‹ÁËÛË (18). Œ¯ÔÓÙ·˜ ‚ÚÂÈ ÙËÓ ·ÈÙÈÔÏÔÁ›· Ì ÙȘ ·Ú·¿Óˆ ÌÂıfi‰Ô˘˜, ÙÔ ÂfiÌÂÓÔ ‚‹Ì· Â›Ó·È Ë ıÂÚ·›· Ù˘ ˘ÔΛÌÂÓ˘ ‰È·Ù·Ú·¯‹˜, fiÔ˘ ·˘Ùfi Â›Ó·È ‰˘Ó·Ùfi. ™ÙȘ ·ÁÁÂȷΤ˜ ‚Ï¿‚˜, Ô ÛÙfi¯Ô˜ Ù˘ ıÂÚ·›·˜ Ú¤ÂÈ Ó· Â›Ó·È Ë ÂÍ·Ê¿ÓÈÛ‹ ÙÔ˘˜, Ú¿ÁÌ· Ô˘ ·ÔÙÂÏ› ÙË ÌfiÓË ÂÁÁ‡ËÛË ÁÈ· ÙËÓ ·ÔÙÚÔ‹ ÂÌÊ¿ÓÈÛ˘ ·ÈÌÔÚÚ·Á›·˜. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ·Ú·Ì¤ÓÂÈ Ë ÈÔ ·ÍÈfiÈÛÙË ıÂÚ·›·, ȉȷ›ÙÂÚ· ÛÙ· ·È‰È¿. ŸÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ Ô˘ ‰ڿ˙ÔÓÙ·È Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ÂÚÈÔ¯¤˜ ‹ Â›Ó·È ÌÂÁ¿Ï˜, ÌÔÚ› Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋ ‹ ÂÌ‚ÔÏÈÛÌfi. ∞fi ÙË ÌÂϤÙË ÙˆÓ Hladky Î·È Û˘Ó (19) Û˘ÛÙ‹ÓÔÓÙ·È ÔÈ ÂÈÏÔÁ¤˜ Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. µÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Û 75%85% ÙˆÓ ·È‰ÈÒÓ Ô˘ ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È Ì ∞º¢˜, ÔÏÈ΋ ÂÍ·›ÚÂÛË ÂÈÙ˘Á¯¿ÓÂÙ·È Û ÔÛÔÛÙfi 72%90%. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ıÓËÙfiÙËÙ· ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi 8,5%-11%, Û ·ÓÙ›ıÂÛË Ì ÙË ıÓËÙfiÙËÙ· Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ıÂÚ·›·˜ Ô˘ Â›Ó·È 23%57%. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ıÓËÙfiÙËÙ· Â›Ó·È ÌÈÎÚfiÙÂÚË ÛÙ· ·È‰È¿ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ‚¤‚·È· ·˘Í¿ÓÂÈ Ôχ ·Ó Ë ·ÁÁÂȷ΋ ‰˘ÛÏ·Û›· ¤¯ÂÈ Ú·Á› (20-22). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›·, Ù· ·ÔÙÂϤÛÌ·Ù· ‰È·Ê¤ÚÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙËÓ ·ÈÌ·ÙÈ΋ ÚÔ‹ Ù˘ ‰˘ÛÏ·Û›·˜ (7,19). ŸÙ·Ó Ë ‰È·Ù·Ú·¯‹ Â›Ó·È ÌÈÎÚ‹ Î·È Ë ·ÈÌ·ÙÈ΋ ÚÔ‹ Â›Û˘ ¯·ÌËÏ‹, Ù· ·ÔÙÂϤÛÌ·Ù· Û›ÁÔ˘Ú· Â›Ó·È Î·Ï‡ÙÂÚ·. ∏ ‚Ï¿‚Ë ·fi ÙËÓ ·ÎÙÈÓÔ‚ÔÏ›· ÛÙÔ ∫¡™ ÂÏ·ÙÙÒÓÂÈ ÙË ‚ÂÏÙ›ˆÛË Û 3% ÙˆÓ ·ÛıÂÓÒÓ (7). O ÂÌ‚ÔÏÈÛÌfi˜, Â›Û˘, ·Ó·Ê¤ÚÂÙ·È ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ·ÛÊ·Ï‹˜ Ù¯ÓÈ΋ ıÂÚ·›·˜ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·ÛÈÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ȉȷ›ÙÂÚ· ÚÈÓ ‹ ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÎÙÔÌ‹ Î·È ÚÈÓ ÙËÓ ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË. §›ÁÔÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ Ï‹ÚË ÂÍ·Ê¿ÓÈÛË Ù˘ ·ÁÁÂȷ΋˜ ‰˘ÛÏ·Û›·˜ Ì ÂÌ‚ÔÏÈÛÌfi. OÈ ÂÈÏÔΤ˜ ‰ÂÓ Â›Ó·È Û˘¯Ó¤˜ Î·È ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ıÂ-

Paediatriki 2001;64:583-588

Ú·Â˘Ù‹ (7,19). ∞Ó Î·È Û˘ÓÈÛÙ¿Ù·È ÌÂÙÂÁ¯ÂÈÚËÙÈο Ó· Á›ÓÂÙ·È Ó¤· ·ÁÁÂÈÔÁÚ·Ê›· ÁÈ· Ó· ÂÎÙÈÌËı› Ë ÂÈÙ˘¯›· Ù˘ Â¤Ì‚·Û˘, ÂÓÙÔ‡ÙÔȘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÂÚÈÛÙ·ÙÈο Ô˘ ÂÓÒ Ë 2Ë ·ÁÁÂÈÔÁÚ·Ê›· ¤‰ÂȯÓ Ï‹ÚË ÂÍ·Ê¿ÓÈÛË Ù˘ ‰˘ÛÏ·Û›·˜, ÌÂÙ¿ ·fi ·ÚÎÂÙfi ηÈÚfi Â·ÓÂÌÊ·ÓÈ˙fiÙ·Ó. ∞˘Ùfi ÈÛÙ‡ÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Û ÌÈÎÚÔÂÈÎÔÈӈӛ˜ (microshunt) Ô˘ ÌÔÚ› Ó· ·Ú·Ì¤ÓÔ˘Ó “·fiÚ·Ù˜” ÛÙËÓ 1Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›·, ·ÏÏ¿ Ô˘ ÌÔÚ› Ó· ·˘ÍËıÔ‡Ó Û ̤ÁÂıÔ˜ ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜. ŒÙÛÈ, ÚÔÙ›ÓÂÙ·È ·fi ÌÂÚÈÎÔ‡˜ ÂÚ¢ÓËÙ¤˜ Ì›· 2Ë ·ÁÁÂÈÔÁÚ·Ê›· ÌÂÙÂÁ¯ÂÈÚËÙÈο Û 18-24 Ì‹Ó˜, ÒÛÙ ӷ ÂȂ‚·ÈÒÓÂÙ·È Ë ÔÏÈ΋ ÂÍ·›ÚÂÛË Î·È Ó· ·ÔÎÏ›ÂÙ·È Ë ˘ÔÙÚÔ‹ Ù˘ ·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 Û ۯ¤ÛË ÌÂ ÙˆÓ ÂÓËÏ›ÎˆÓ (6,23). ∞˘Ùfi Û˘Ó‰¤ÂÙ·È ÌÂÚÈÎÒ˜ Î·È Ì ÙËÓ Ï·ÛÙÈÎfiÙËÙ· ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ·È‰ÈÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘. O ·È‰ÈÎfi˜ ÂÁΤʷÏÔ˜ ¤¯ÂÈ ÌÂÁ¿ÏË ÈηÓfiÙËÙ· ÁÈ· ·Ó¿ÚÚˆÛË ·fi Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù· ÏfiÁˆ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ (24). °È’ ·˘Ùfi Û fiÏ· Ù· ·È‰È¿ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ÚÔÛ¿ıÂȘ ÁÈ· ÁÚ‹ÁÔÚË Â·ÓfiÚıˆÛË, ÒÛÙ ӷ ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ï‡ÙÂÚË ·Ó¿ÚÚˆÛË. ªfiÏȘ ÙÂı› Ë ˘Ô„›· ∞∂∂, fiϘ ÔÈ ÚÔÛ¿ıÂȘ Ú¤ÂÈ Ó· ÂÈÎÂÓÙÚÒÓÔÓÙ·È ÛÙËÓ ÂȂ‚·›ˆÛË ÙÔ˘ Û˘Ì‚¿ÓÙÔ˜ Î·È ÛÙËÓ ·ÔÎ¿Ï˘„Ë Ù˘ ˘ÔΛÌÂÓ˘ ·ÈÙ›·˜, ÒÛÙÂ Ë ıÂÚ·¢ÙÈ΋ 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·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿ ¯ˆÚ›˜ ÂȉÈο Û˘ÌÙÒÌ·Ù·, ·Ó Î·È Ë Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È Û¿ÓÈ·. ∏ ·Ó‡ÚÂÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÔΛÌÂÓ˘ ‚Ï¿‚˘ Ô˘ Ô‰‹ÁËÛ ÛÙËÓ ·ÈÌÔÚÚ·Á›· Â›Ó·È Ë ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·›·. 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.

¶›Ó·Î·˜ 3. £ÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ∞º¢˜ ÛÙ· ·È‰È¿ ñ ∂Ó Ùˆ ‚¿ıÂÈ ∞º¢˜: ñ ∂ÈÔÏ‹˜ ∞º¢˜:

ÌÈÎÚ¤˜  ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋ ÌÂÁ¿Ï˜  ÂÌ‚ÔÏÈÛÌfi˜ ± ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋ <4cm  ÌË ÏÂÈÙÔ˘ÚÁÈΤ˜ ÂÚÈÔ¯¤˜  ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË <4cm  ÏÂÈÙÔ˘ÚÁÈΤ˜ ÂÚÈÔ¯¤˜  ÂÌ‚ÔÏÈÛÌfi˜ ± ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ± ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋ >4cm  ÌË ÏÂÈÙÔ˘ÚÁÈΤ˜ ÂÚÈÔ¯¤˜  ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ± ÂÌ‚ÔÏÈÛÌfi˜ >4cm  ÏÂÈÙÔ˘ÚÁÈΤ˜ ÂÚÈÔ¯¤˜  ÂÌ‚ÔÏÈÛÌfi˜ ± ·ÎÙÈÓÔ¯ÂÈÚÔ˘ÚÁÈ΋

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5. 6.

7. 8.

9.

10.

11.

12.

13.

14.

15.

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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.

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ORIGINAL ARTICLE

∞›ÙÈ· ı·Ó¿ÙÔ˘ Û ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ÙË 14ÂÙ›· 1986-1999 ∞. ∞Ó‰Ú¤Ô˘, ∞. ª·Ï¿Ûη, °. 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˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È Ó· ηٷÁÚ·ÊÔ‡Ó Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ‚¿ÛÂÈ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î·ÙËÁÔÚÈÒÓ ·ı‹ÛÂˆÓ Ì ÎÏÈÓÈ΋ ÛËÌ·Û›· Û fiÏ· Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ Î·È ÓÔÛËχıËÎ·Ó ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ∂™À ÙÔ˘ ›‰ÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, ηıÒ˜ Î·È Ó· ηٷÁÚ·ÊÔ‡Ó ÔÈ ‰È·¯ÚÔÓÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÙÔ˘˜. ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο 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¤ıËΠ۠3 ÂÚÈfi‰Ô˘˜ [∞ (1986-1990), µ (1991-1995), ° (1996-1999)] Ô˘ Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙË ıÓËÛÈÌfiÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘. ∆· ΢ÚÈfiÙÂÚ· ·›ÙÈ· ı·Ó¿ÙÔ˘ ·ÚÔ˘Û›·Û·Ó ÙȘ ·Ú·Î¿Ùˆ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ÂÚÈfi‰Ô˘˜ ∞, µ, ° ·ÓÙ›ÛÙÔȯ·: Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (™∞¢) Î·È ÂÈÏÔΤ˜ ÙÔ˘ 29,4%, 27,3% Î·È 24,55%, Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (™∞) 18%, 24% Î·È 33%, ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ (∂õ°¡) 11,7%, 13,5% Î·È 18,85%, ÏÔÈÌÒÍÂȘ 19%, 10,2% Î·È 5,8%, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (¡∂∫) Û‹„Ë 8,3%, 10,2% Î·È 7,2% ηÈ, Ù¤ÏÔ˜, ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ± Û‡Ó‰ÚÔÌÔ ÂÈÛÚfiÊËÛ˘ ÌËÎˆÓ›Ô˘ (¶∞ ™∂ª) 4,7%, 8,5% Î·È 2,9%. ¶·Ú·ÙËÚ‹ıËΠ‰È·¯ÚÔÓÈ΋ ÌÂÙ·‚ÔÏ‹ ÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘, ¤ÙÛÈ ÒÛÙ ÙÔ ™∞¢ - ·fi ·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 ÏÔÈÌÒÍÂȘ, ¶∞ Î·È ¡∂∫ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË, ÂÓÒ ·˘Í‹ıËΠÙÔ ÔÛÔÛÙfi ı·Ó¿ÙˆÓ Ù˘ ηÙËÁÔÚ›·˜ ∂õ°¡.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ÓÂÔÁÓ¿, ·›ÙÈ· ı·Ó¿ÙÔ˘.

Key words: neonates, causes of death.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À πÔÎÚ¿ÙÂÈÔ °¶¡ £ÂÛÛ·ÏÔӛ΢

Department of Neonatology (NHS) Ippokration General Hospital, Thessaloniki

589


¶·È‰È·ÙÚÈ΋ 2001;64:589-594

∂ÈÛ·ÁˆÁ‹ ∏ ηٷÁÚ·Ê‹ ÙÔ˘ “fiÙ” Î·È “ÁÈ·Ù›” Ù· ÓÂÔÁÓ¿ Âı·›ÓÔ˘Ó ÂÈÙÚ¤ÂÈ Ì›· ÂÎÙ›ÌËÛË ÁÈ· ÙȘ ÛÙÚ·ÙËÁÈΤ˜ Ô˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏ·ÙÙˆı› Ë ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ·. ∏ ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó¢ÚÂı› Ë ·ÎÚÈ‚‹˜ ·ÈÙ›· ı·Ó¿ÙÔ˘ ·fi ÙÔ ÈÛÙÔÔÈËÙÈÎfi ı·Ó¿ÙÔ˘ ‹ ÙȘ ÂıÓÈΤ˜ ÛÙ·ÙÈÛÙÈΤ˜ ÌÂϤÙ˜ Â›Ó·È ‰ÈÂıÓÒ˜ ÌË ÈηÓÔÔÈËÙÈ΋ (1). ∂Í·ÈÙ›·˜ ÙˆÓ ·Ó·ÎÚÈ‚ÂÈÒÓ Î·È ·ÓÂ·ÚÎÂÈÒÓ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· ‰Â‰Ô̤ӷ ÙˆÓ ∂ıÓÈÎÒÓ ™Ù·ÙÈÛÙÈÎÒÓ ÌÂÏÂÙÒÓ, Û˘ÛÙ‹ÓÂÙ·È ÛÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ Ù˘ ˘Á›·˜ Ó· ‚·Û›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ ÙÚÈÙÔ‚¿ıÌÈˆÓ Î¤ÓÙÚˆÓ Ô˘ ηχÙÔ˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ÂÚÈÔ¯¤˜ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ (1). ™ÙËÓ ∂ÏÏ¿‰·, Â›Û˘, ÙfiÛÔ ÔÈ ‰‡Ô ¶·ÓÂÏÏ‹ÓȘ ¶ÂÚÈÁÂÓÓËÙÈΤ˜ ÌÂϤÙ˜ (2,3), fiÛÔ Î·È Ë ∂ıÓÈ΋ ™Ù·ÙÈÛÙÈ΋ ÀËÚÂÛ›· ∂ÏÏ¿‰·˜ (4) ¤¯Ô˘Ó ‰Â‰Ô̤ӷ ÁÈ· ÙË ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· Î·È Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘, Ô˘ ‰ÂÓ Ù· ¯·Ú·ÎÙËÚ›˙Ô˘Ó Ë ÏÂÙÔÌÂÚ‹˜ ηٷÁÚ·Ê‹ Î·È Ë ÌÂÁ¿ÏË ·ÎÚ›‚ÂÈ·, ÁÈ· ÏfiÁÔ˘˜ Ô˘ ÂÎı¤Û·Ì Û ¿ÏÏË ÂÚÁ·Û›· (5). ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ ∆Ô ˘ÏÈÎfi ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ·›ÙÈ· fiÏˆÓ ÙˆÓ ı·Ó¿ÙˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (µ°) >500 g, Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ ÛÙÔ πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô Î·È ÓÔÛËχıËÎ·Ó ÛÙÔ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ∂™À ÙÔ˘ ›‰ÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ηٿ ÙË 14ÂÙ›· 1986-1999. ∆· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ˙ˆÓÙ·Ó¿ Ì µ°>500 g ‹Ù·Ó Û˘ÓÔÏÈο 12. ™Â ηӤӷ ·fi ·˘Ù¿ ‰ÂÓ ¤ÁÈÓ ÚÔÛ¿ıÂÈ· ·Ó¿Ó˄˘, Ô‡Ù ÂÊ·ÚÌfiÛÙËÎ·Ó ÂÓÙ·ÙÈο ̤۷ ıÂÚ·›·˜ Î·È fiÏ· ¤ı·Ó·Ó ÙȘ ÚÒÙ˜ ÒÚ˜ ˙ˆ‹˜. ∆· ‰Â‰Ô̤ӷ ·Ó·Ï‡ıËÎ·Ó ·Ó·‰ÚÔÌÈο Î·È ÂÏ‹ÊıËÛ·Ó ·fi Ù· È·ÙÚÈο ‚È‚Ï›· ÂÈÛ·ÁˆÁÒÓ, fiÔ˘ ηٷÁÚ¿ÊÔÓÙ·È Ë ËÌÂÚÔÌËÓ›· Á¤ÓÓËÛ˘, Ë ËÌÂÚÔÌËÓ›· ÂÈÛ·ÁˆÁ‹˜, Ô ÙfiÔ˜ Á¤ÓÓËÛ˘, ÙÔ µ°, Ë ‰È¿ÚÎÂÈ· ·ËÛ˘ (¢∫), Ù· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, Ù· ÚÔ‚Ï‹Ì·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜, Ë ¤Î‚·ÛË Î·È Ë ËÌÂÚÔÌËÓ›· ÂÍfi‰Ô˘ ‹ ı·Ó¿ÙÔ˘ ÙÔ˘˜. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘ ¤ÁÈÓ ‰‡o ÊÔÚ¤˜, ·fi ‰‡Ô ‰È·ÊÔÚÂÙÈΤ˜ ÔÌ¿‰Â˜ ÁÈ·ÙÚÒÓ, ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ï·ıÒÓ. ∆Ô ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÙˆÓ 14 ÂÙÒÓ ‰È·ÈÚ¤ıËΠ۠ÙÚÂȘ ÂÚÈfi‰Ô˘˜: ÙËÓ ∞ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ٷ ¤ÙË 1986-1990, ÙË µ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ٷ ¤ÙË 1991-1995 Î·È ÙË ° Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ٷ ¤ÙË 1996-1999. OÈ ÂÚ›Ô‰ÔÈ ·˘ÙÔ› Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ· Î·È Ù· ·›ÙÈ· ÙˆÓ ı·Ó¿ÙˆÓ. ∆· ·›ÙÈ· ı·Ó¿ÙÔ˘ ‰È·ÎÚ›ıËηÓ, Û‡Ìʈӷ Ì ÙȘ ˘¿Ú¯Ô˘Û˜ Û‹ÌÂÚ· È·ÙÚÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜, Û ‰˘ÓËÙÈο ·ÔÙÚÂÙ¿ Î·È Û ·Ó·fiÙÚÂÙ· (¶›Ó·Î·˜ 1). OÚÈṲ̂ӷ ·fi Ù· ·›ÙÈ· ıˆڋıËÎ·Ó ·Ó·fiÙÚÂÙ· ˘fi ÚÔ¸Ôı¤ÛÂȘ, .¯. Ô ı¿Ó·ÙÔ˜ ·fi ÌÈ· Û˘ÁÁÂÓ‹ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ıˆڋıËΠ·Ó·fiÙÚÂÙÔ˜ ÌfiÓÔÓ fiÙ·Ó Û˘Ó˘‹Ú¯Â ‚·ÚÈ¿ ˘ÔÏ·Û›· ÙˆÓ Ó¢ÌfiÓˆÓ, ÌÈ· ·ÓˆÌ·Ï›· ÙÔ˘ ∫¡™ fiÙ·Ó Û˘Óԉ¢fiÙ·Ó ·fi ÌÂÁ¿ÏË ·ÒÏÂÈ· ÂÁÎÂÊ·ÏÈ΋˜ Ô˘Û›·˜, Î.Ô.Î. ™ÙÔ˘˜ ·Ó·fiÙÚÂÙÔ˘˜ ı·Ó¿ÙÔ˘˜ ·fi Û‡ÌÏÔΘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ÂÚÈÂÏ‹ÊıËÛ·Ó Î·È fiϘ ÔÈ ÂÚÈÙÒÛÂȘ ˘ÔÏ·Û›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ·Ó Î·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û ÔÚÈṲ̂ӷ ΤÓÙÚ· ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ·ÚÎÂÙ¤˜ ·fi ·˘Ù¤˜ ¯ÂÈÚÔ˘ÚÁÔ‡ÓÙ·È ÂÈÙ˘¯Ò˜. °Â-

590

Paediatriki 2001;64:589-594

ÓÈο, Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ‰È·ÎÚ›ıËÎ·Ó Û 6 ÎÏÈÓÈΤ˜ ηÙËÁÔڛ˜: ·) ™∞¢ Î·È ÂÈÏÔΤ˜ ÙÔ˘, ‚) ÏÔÈÌÒÍÂȘ, Á) ¡∂∫ ± Û‹„Ë, ‰) ¶∞ ± ™∂ª, Â) ∂õ°¡, fiÔ˘ ÂÚÈÂÏ‹ÊıËÛ·Ó fiÏ· Ù· ÓÂÔÁÓ¿ Ì µ°≤700 g, ÛÙ) ™∞ Î·È ˙) ‰È¿ÊÔÚ· (¶›Ó·Î·˜ 2). ∏ ·ÚÈ· ·ÈÙ›· Ô˘ ÚÔοÏÂÛ ÙÔ ı¿Ó·ÙÔ ÂÈϤ¯ıËÎÂ Û·Ó Ë ÎÏÈÓÈ΋ ·ÈÙ›· ı·Ó¿ÙÔ˘, .¯. ·Ó ¤Ó· ÓÂÔÁÓfi Ì ™∞¢ ¤ı·Ó ·fi Û‹„Ë, ˆ˜ ·ÈÙ›· ı·Ó¿ÙÔ˘ ηٷÏÔÁ›ÛÙËÎÂ Ë Û‹„Ë, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ·Ó ·˘Ù‹ ·fi ÌfiÓË Ù˘ ‰ÂÓ ı· ÚÔηÏÔ‡Û ı¿Ó·ÙÔ ·Ó ‰ÂÓ ˘‹Ú¯Â ™∞¢. ∫¿ı ÓÂÔÁÓfi Ì µ°≤700 g, ¯ˆÚ›˜ ı·Ó·ÙËÊfiÚ˜ ™∞ ÂÚÈÂÏ‹ÊıËΠÛÙËÓ Î·ÙËÁÔÚ›· ∂õ°¡, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ·Ó ˘‹Ú¯·Ó ¿ÏÏ· ·›ÙÈ· ı·Ó¿ÙÔ˘ fiˆ˜ ™∞¢, Û‹„Ë Î.¿. ∂õ°¡: ∏ ÂÈÏÔÁ‹ ˆ˜ ·ÓÒÙÂÚÔ˘ ÔÚ›Ô˘ µ° Ù· 700 g ÁÈ· ÙÔÓ ÔÚÈÛÌfi ÙˆÓ Eõ°¡ Ï‹ÊıËΠÁÈ· Ó· ¯·Ú·ÎÙËÚ›ÛÂÈ Ì›· ηÙËÁÔÚ›· Û¯ÂÙÈο ·Ó·fiÙÚÂÙˆÓ ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘ Î·È Û˘Ì‚·‰›˙ÂÈ Ì ·˘Ù‹ ¿ÏÏˆÓ ÂÚÁ·ÛÈÒÓ, fiÔ˘ ÙÔ ·ÓÒÙÂÚÔ fiÚÈÔ Î˘Ì·›ÓÂÙ·È ·fi 600-750 g (6). ªÂ ÙȘ Ӥ˜ Ù¯ÓÔÏÔÁ›Â˜, ·ÚÎÂÙ¿ ÓÂÔÁÓ¿ Ì µ°≤700 g ÛÒ˙ÔÓÙ·È Û‹ÌÂÚ· ÛÙ· ÚÔËÁ̤ӷ ÎÚ¿ÙË, ·ÏÏ¿ Ì ٷ ÛËÌÂÚÈÓ¿ ‰Â‰Ô̤ӷ Ï›ÁÔÈ ı· ÂÚ›ÌÂÓ·Ó fiÙÈ fiÏÔÈ ÔÈ ı¿Ó·ÙÔÈ ÛÙ· ÓÂÔÁÓ¿ ·˘Ù¿ ı· ÌÔÚÔ‡Û·Ó Ó· ›¯·Ó ÚÔÏËÊı› È·ÙÚÈο. ™∞: ŸÏÔÈ ÔÈ ı¿Ó·ÙÔÈ Ô˘ ÚÔÎÏ‹ıËÎ·Ó ·fi ™∞ ‹ Û‡Ó‰ÚÔÌ· ÌË Û˘Ì‚·Ù¿ Ì ÙË ˙ˆ‹ ηٷÏÔÁ›ÛÙËÎ·Ó Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ µ°. ™∞¢: ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›¯ıËΠÛÙ· ÎÏ·ÛÈο ·ÎÙÈÓÔÏÔÁÈο Î·È ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, ÛÙËÓ ·¿ÓÙËÛË ÛÙÔÓ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi ·Ú¿ÁÔÓÙ· Î·È ÛÙȘ ·ÚÓËÙÈΤ˜ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜. ∆Ô ™∞¢ ÔÚ›ÛÙËÎÂ Û·Ó Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ fiÙ·Ó ‹Ù·Ó ‚·Ú‡, ·ÎfiÌË Î·È fiÙ·Ó ˘‹Ú¯·Ó ¿ÏϘ ̤ÁÈÛÙ˜ ‰È·ÁÓÒÛÂȘ, fiˆ˜ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ™ÙËÓ Î·ÙËÁÔÚ›· ÂÈÏÔΤ˜ ÙÔ˘ ™∞¢ ÂÚÈÂÏ‹ÊıËÛ·Ó Î˘Ú›ˆ˜ fiϘ ÔÈ ÌÔÚʤ˜ Ù˘ ÂÓ‰ÔÓ¢ÌÔÓÈ΋˜ ‰È·Ê˘Á‹˜ ·¤Ú·. ŸÙ·Ó ÙÔ ™∞¢ ‹Ù·Ó ‹ÈÔ ‹ ̤ÙÚÈÔ, Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘ ÏÔÁÈ˙fiÙ·Ó Ë ÈÔ Èı·Ó‹ ·fi ÙȘ Û˘Ó˘¿Ú¯Ô˘Û˜ ‰È·ÁÓÒÛÂȘ, fiˆ˜ .¯. ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ™‹„Ë: ∏ ‰È¿ÁÓˆÛË Ù˘ Û‹„˘ ÛÙËÚ›¯ıËΠ۠ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ·, ÛÂ Û˘Ó‰˘·ÛÌfi ¿ÓÙÔÙ Ì ÙËÓ ·Ó‡ÚÂÛË ıÂÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ ·›Ì·ÙÔ˜ Ô˘ ÂÏ‹ÊıËÛ·Ó ÚÈÓ ‹ ÌÂÙ¿ ÙÔ ı¿Ó·ÙÔ. ŸÙ·Ó Û˘Ó˘‹Ú¯Â ¡∂∫, ÔÈ ı¿Ó·ÙÔÈ Î·Ù·ÁÚ¿ÊÔÓÙ·Ó ÛÙËÓ Î·ÙËÁÔÚ›· ¡∂∫ Û‹„Ë. ¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ± ™∂ª: ∏ ‰È¿ÁÓˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ·ÛÊ˘Í›·˜ ÛÙËÚ›¯ıËΠÛÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi, ÙȘ ·ÏÏÔÈÒÛÂȘ ·ÏÌÒÓ, ÙÔ Î¯ڈṲ̂ÓÔ ÂÓ¿ÌÓÈÔ, ÙË ¯·ÌËÏ‹ ‚·ıÌÔÏÔÁ›· ∞pgar ÛÙÔ 1Ô Î·È 5Ô ÏÂÙfi (<6 ÁÈ· Ù· ÌÂÁ¿Ï· ÓÂÔÁÓ¿) Î·È ··Ú·›ÙËÙ· ÛÙËÓ ·Ú·ÙÂٷ̤ÓË ÎÏÈÓÈ΋ ÂÈÎfiÓ· ·ÛÙ¿ıÂÈ·˜ Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘. ∆Ô ™∂ª ˘ÔÏÔÁ›ÛÙËΠÛÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ÁÈ·Ù› ηٿ ηÓfiÓ· Û˘Óԉ¢fiÙ·Ó ·fi ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·. ¡∂∫ ± Û‹„Ë: ∏ ¡∂∫ ÂÚÈÏ‹ÊıËÎÂ Û·Ó ÂȉÈ΋ ηÙËÁÔÚ›· ¶›Ó·Î·˜ 1. ∫·ÙËÁÔڛ˜ ·Ó·fiÙÚÂÙˆÓ ·ÈÙ›ˆÓ ı·Ó¿ÙÔ˘ ñ ™‡ÌÏÔΘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ñ ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË Ì ‚·ÚÈ¿ Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ñ ∆ÚÈۈ̛˜ / ÃÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ñ ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ñ ªÂ›˙ÔÓ˜ ÔÏÏ·Ϥ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ / Û‡Ó‰ÚÔÌ· ñ ∂Ì‚Ú˘˚Îfi˜ ‡‰Úˆ·˜ ñ µ·ÚȤ˜ ‰È·Ì·Úٛ˜ ∫¡™ ñ ™Ô‚·Ú¿ ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· ñ ¡ÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜


¶·È‰È·ÙÚÈ΋ 2001;64:589-594

Paediatriki 2001;64:589-594

ÏfiÁˆ ÙÔ˘ Û¯ÂÙÈο ˘ÔÏÔÁ›ÛÈÌÔ˘ ÔÛÔÛÙÔ‡ ı·Ó¿ÙˆÓ ·fi ·˘Ù‹Ó. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ¡∂∫ ÚÔοÏÂÛ ÙÔ ı¿Ó·ÙÔ, ˘‹Ú¯Â Î·È ‰È¿ÙÚËÛË ÂÓÙ¤ÚÔ˘ Ì ÂÚÈÙÔÓ›Ùȉ·. ™Â ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ, Ë ¡∂∫ ‰ÂÓ Û˘Óԉ¢fiÙ·Ó ·fi Ïԛ̈ÍË ‚¿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˜ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ·fi Û‡Ó‰ÚÔÌÔ TORCH, ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ· Î.¿., ηıÒ˜ Î·È ·‰È¢ÎÚ›ÓÈÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘. ™Ù· ·›ÙÈ· ı·Ó¿ÙÔ˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó Î·È ·˘Ù¿ Ô˘ ıˆڋıËÎ·Ó Û·Ó ·Ó·fiÙÚÂÙ· È·ÙÚÈο. ™Â οı ÂÚ›Ô‰Ô ˘ÔÏÔÁ›ÛÙËÎÂ Ô ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ Û fiϘ ÙȘ ηÙËÁÔڛ˜ ı·Ó¿ÙÔ˘, ηıÒ˜ Î·È ÙÔ ÔÛÔÛÙfi οı ηÙËÁÔÚ›·˜ ı·Ó¿ÙÔ˘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ı·Ó¿ÙˆÓ.

ÂÚ›Ô‰Ô Î·È Ì ÔÛÔÛÙfi 24,5% ÙˆÓ ı·Ó¿ÙˆÓ ‹Ù·Ó Ë ‰Â‡ÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÌÂÙ¿ ÙȘ ™∞. O ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ Ì µ°>1,0 kg Ô˘ ¤ı·Ó·Ó ·fi ™∞¢ ÙËÓ ∞ ÂÚ›Ô‰Ô ‹Ù·Ó 51, ÙË µ ÂÚ›Ô‰Ô 15 Î·È ÙË ° ÂÚ›Ô‰Ô 5. ∆Ë ° ÂÚ›Ô‰Ô, ÌfiÓÔ ¤Ó· ÓÂÔÁÓfi Ì µ°>1,5 kg ¤ı·Ó ·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 ÙȘ ™∞, Ë ÈÔ Û˘¯Ó‹ ηÙËÁÔÚ›· ·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 ÙȘ ΢ÚÈfiÙÂÚ˜ ·Èٛ˜ ı·Ó¿ÙÔ˘ ÙȘ ‰‡Ô ÚÒÙ˜ ÂÚÈfi‰Ô˘˜. ∞Ó Û˘Ó˘ÔÏÔÁÈÛÙÔ‡Ó Î·È ÔÈ ı¿Ó·ÙÔÈ ÙˆÓ ÓÂÔÁÓÒÓ Ì ™∫¶ Ô˘ ÌÂٷʤÚıËÎ·Ó Û ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈο ∫¤ÓÙÚ·, ÙfiÙ ÔÈ ™∫¶ ‹Ù·Ó Ì·ÎÚ¿Ó Ë Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Ì ÔÛÔÛÙfi 28,5%. ™ÙË ° ÂÚ›Ô‰Ô, ·fi ÙȘ ™∞, ÔÈ ÔÏÏ·Ϥ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ‹Ù·Ó Ë Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘, ·ÎÔÏÔ˘ıÔ‡ÌÂÓ˜ ·fi ÙȘ ·ÓˆÌ·Ï›Â˜ ÛÙ· ÓÂÊÚ¿

∞ÔÙÂϤÛÌ·Ù· ¢È·¯ÚÔÓÈο ˘‹ÚÍ ̛· Û˘Ó¯‹˜ ·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 Ì ÔÛÔÛÙfi 29,5% Î·È 27,3%, ·ÓÙ›ÛÙÔȯ·. ™ÙË ° ÂÚ›Ô‰Ô, ÙÔ ™∞¢ ·ÚÔ˘Û›·Û ÙÒÛË 17% Û ۯ¤ÛË Ì ÙËÓ ∞

¶›Ó·Î·˜ 2. ∞›ÙÈ· ÓÂÔÁÓÈÎÒÓ ı·Ó¿ÙˆÓ ∞›ÙÈ·

1986-1990 (∞)

ÃÚÔÓÔÏÔÁ›· 1991-1995 (µ)

1996-1999 (°)

™∞¢ §ÔÈÌÒÍÂȘ ¡∂∫ ± Û‹„Ë ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ± ™∂ª µ° ≤700 g ÕÏÏ·

29,4* 19 8,3 18 4,7 11,7 8,7

27,3 10,2 10,2 23,9 8,5 13,6 6

24,6 5,8 7,2 33 2,9 18,8 7,2

(88)ñ (57) (25) (54) (14) (35) (26)

(32) (12) (12) (28) (10) (16) (7)

(17) (4) (5) (23) (2) (13) (5)

*% ñ (·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ)

¶›Ó·Î·˜ 3. £¿Ó·ÙÔÈ ·fi Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ∂›‰Ô˜ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ 1986-1990(∞) ™∫¶ ∫¡™ ¡ÂÊÚÈΤ˜ ∆ÚÈۈ̛˜ ¶ÔÏÏ·Ϥ˜ Û˘Á. ·ÓˆÌ. ∂Ì‚Ú˘˚Îfi˜ ‡‰Úˆ·˜ ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ™Á¢Ê∫Ï ¢È¿ÊÔÚ· ™‡ÓÔÏÔ

12 13 8 8 4 3 1 5

(22,2) (24) (14,8) (14,8) (7,4) (5,5) (1,8) (8,8) 54

ÃÚÔÓÔÏÔÁ›· 1991-1995(µ) 1996-1999(°) ¡Ô ı·Ó¿ÙˆÓ (% ÙÔ˘ Û˘ÓfiÏÔ˘) 7 3 4 4 1 2 5 1 3

(23,5) (10) (13,3) (13,3) (3,3) (6,6) (16,5) (3,3) (10) 30

1 1 4 2 5 1 3 1 3

(4,7) (4,7) (19,5) (9,5) (23,5) (4,7) (14,5) (4,7) (14,5) 21

™‡ÓÔÏÔ

20 17 16 14 10 6 9 2 11 105

% ı·Ó¿ÙˆÓ

19 16,1 15,2 13,3 9,5 5,7 8,5 1,9 10,5

™∫¶: ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ™Á¢Ê∫Ï: ™˘ÁÁÂÓ‹˜ ‰È·ÁÚ·ÁÌ·ÙÔ΋ÏË

591


¶·È‰È·ÙÚÈ΋ 2001;64:589-594

Paediatriki 2001;64:589-594

Î·È ÙÔ˘˜ Ó‡ÌÔÓ˜ (¶›Ó·Î·˜ 3), ÂÓÒ ÔÈ ™∫¶ ‹Ù·Ó Ë 6Ë ·ÈÙ›· ı·Ó¿ÙÔ˘, ·ÎfiÌ· Î·È ÌÂÙ¿ ÙÔ Û˘Ó˘ÔÏÔÁÈÛÌfi ÙˆÓ ı·Ó¿ÙˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ì ™∫¶ Ô˘ ÌÂٷʤÚıËÎ·Ó Û ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈο ∫¤ÓÙÚ·. ™ÙȘ ‰‡Ô ÚÒÙ˜ ÂÚÈfi‰Ô˘˜ ‰ÂÓ Û˘Ó˘ÔÏÔÁ›ÛÙËÎ·Ó ÔÈ Ï›ÁÔÈ ı¿Ó·ÙÔÈ ÓÂÔÁÓÒÓ ·fi ™∞ Ô˘ ÌÂٷʤÚıËÎ·Ó Î·È ¤ı·Ó·Ó ÛÙ· ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ∆Ì‹Ì·Ù· (¶›Ó·Î·˜ 4). O Û˘Ó˘ÔÏÔÁÈÛÌfi˜ ·˘Ùfi˜ ı· ·‡Í·Ó ÂÚÈÛÛfiÙÂÚÔ ÙÔ ÔÛÔÛÙfi ı·Ó¿ÙˆÓ ÛÙȘ ηÙËÁÔڛ˜ “Û˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË” Î·È “‰È¿ÊÔÚ·” ÛÙȘ ÂÚÈfi‰Ô˘˜ ∞ Î·È µ. ∞fi Ù· ·Ó·fiÙÚÂÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘, ÔÈ ÈÔ Û˘¯Ó¤˜ ı·Ó·ÙËÊfiÚ˜ ™∞ ‹Ù·Ó ηٿ ÛÂÈÚ¿ ·fi ÙÔ ∫¡™ (ÔÛÔÛÙfi 16,8%), ÙÔ˘˜ ÓÂÊÚÔ‡˜ (15,5%) Î·È ÌÂÙ¿ ÔÈ ™∫¶ Ì·˙› Ì ÙȘ ÙÚÈۈ̛˜ (13,7%) (¶›Ó·Î·˜ 5). OÈ ı¿Ó·ÙÔÈ ÛÙËÓ Î·ÙËÁÔÚ›· ∂õ°¡ ·ÚÔ˘Û›·Û·Ó ·‡ÍËÛË ÌÂٷ͇ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ı·Ó¿ÙˆÓ ·fi 11,7% Û 13,6% Î·È 18,8% ηٿ ÙȘ ÂÚÈfi‰Ô˘˜ ∞, µ Î·È °, ·ÓÙ›ÛÙÔȯ·. ∏ ·‡ÍËÛË ÌÂٷ͇ ∞ Î·È ° ÂÚÈfi‰Ô˘ ‹Ù·Ó 60% (¶›Ó·Î·˜ 2). OÈ ÏÔÈÌÒÍÂȘ ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘ ·fi 19% ÙËÓ ∞ ÂÚ›Ô‰Ô Û 10,2% ÙË µ Î·È 5,6% ÙË ° ÂÚ›Ô‰Ô. ∏ Ì›ˆÛË ÌÂٷ͇ ∞ Î·È ° ÂÚÈfi‰Ô˘ ‹Ù·Ó 69% (¶›Ó·Î·˜ 2).

¶›Ó·Î·˜ 4. ¡ÂÔÁÓ¿ Ô˘ ÌÂٷʤÚıËÎ·Ó Û ¿ÏÏ· ÓÔÛÔÎÔÌ›· ÃÚÔÓÔÏÔÁ›·

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

™‡ÓÔÏÔ ¡Ô

¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈο ¡Ô (ı¿Ó·ÙÔÈ)

∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈο ¡Ô (ı¿Ó·ÙÔÈ)

56 35 10

38 29 3

18 6 7

(5) (5)

¡Ô: ·ÚÈıÌfi˜ ÓÂÔÁÓÒÓ

(11) (2) (1)

∏ ηÙËÁÔÚ›· ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ™∂ª ¢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·‰‹ Ì›ˆÛË Î·Ù¿ 38% ÌÂٷ͇ ∞ Î·È ° ÂÚÈfi‰Ô˘ (¶›Ó·Î·˜ 2). ∏ ηÙËÁÔÚ›· ¡∂∫ ± Û‹„Ë ·ÚÔ˘Û›·Û ·˘ÍÔÌ›ˆÛË ÌÂٷ͇ 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 Ù˘ ÌÂϤÙ˘ ˘‹ÚÍ·Ó ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙÔ Ì·È¢ÙÈÎfi ÏËı˘ÛÌfi, ÛÙÔ ÚÔÛˆÈÎfi Î·È ÛÙÔÓ ÂÍÔÏÈÛÌfi ÙÔ˘ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜. ∏ ıÓËÛÈÌfiÙËÙ· ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË (¶›Ó·Î·˜ 6) Î·È ÂÚÈÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈο Û ¿ÏÏË ÂÚÁ·Û›· (5). ∆· ·›ÙÈ· ı·Ó¿ÙÔ˘ Ù· ·Ô‰ÒÛ·Ì Û ̛· ÌfiÓÔ ÎÏÈÓÈ΋ ηÙËÁÔÚ›·, fiˆ˜ .¯. ™∞¢ Î·È fi¯È Û ¤Ó· ÙÂÏÂȈÙÈÎfi ηٷÛÙÚÔÊÈÎfi Û˘Ì‚¿Ó, fiˆ˜ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ¶ÈÛÙ‡ÂÙ·È fiÙÈ Ô ÙÚfiÔ˜ ·˘Ùfi˜ ‚ÔËı¿ÂÈ Ó· Á›ÓÂÈ ÂÛÙ›·ÛË ÛÙÔ˘˜ ÙÚfiÔ˘˜ Ô˘ ·ÔÙÚ¤Ô˘Ó ÙÔ˘˜ ı·Ó¿ÙÔ˘˜, ̤۷ ÛÙ· Ï·›ÛÈ· ÙÔ˘ È·ÙÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÊÚÔÓÙ›‰·˜ (7). ¢È·¯ÚÔÓÈο, ˘‹ÚÍ ̛· ÌÂÙ·‚ÔÏ‹ ÛÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘. ∆Ô ™∞¢ Î·È ÔÈ ÏÔÈÌÒÍÂȘ - Ô˘ ‹Ù·Ó ÔÈ ‰‡Ô ·ÚȘ ·Èٛ˜ ı·Ó¿ÙÔ˘ - ÂÏ·ÙÙÒıËÎ·Ó ÛËÌ·ÓÙÈο, Ì ·ÔÙ¤ÏÂÛÌ· Û‹ÌÂÚ· Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ Ó· Â›Ó·È ÔÈ ™∞. OÈ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ Î·È ÛÙ· ‚ÈÔÌ˯·ÓÈο ÎÚ¿ÙË Â‰Ò Î·È ·ÚÎÂÙ¿ ¯ÚfiÓÈ· (6,9,10). ∏ ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙˆÓ ı·Ó¿ÙˆÓ ·fi ™∞¢ ÈÛÙ‡ԢÌ fiÙÈ ÔÊ›ÏÂÙ·È Î·È ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ Â͈ÁÂÓÔ‡˜ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙË ıÂÚ·›· ÙÔ˘ ™∞¢ (11,12). ¶·Ú¿ ÙËÓ ÂÏ¿ÙÙˆÛ‹ ÙÔ˘˜, ÔÈ ı¿Ó·ÙÔÈ ·fi ™∞¢ ·Ú·Ì¤ÓÔ˘Ó Û ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi

¶›Ó·Î·˜ 5. £ÓËÛÈÌfiÙËÙ· ·fi ·Ó·fiÙÚÂÙ· ·›ÙÈ· ı·Ó¿ÙÔ˘ ∞›ÙÈ· ı·Ó¿ÙÔ˘ ÃÚÔÓÔÏÔÁ›· 1986-1990 (∞) 1991-1995 (µ) ¡ÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜ ™‡ÌÏÔΘ ™∫¶ ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ∆ÚÈۈ̛˜ ¶Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ¶ÔÏÏ·Ϥ˜ ·ÓˆÌ·Ï›Â˜ (¯ˆÚ›˜ ™∫¶) ∂Ì‚Ú˘˚Îfi˜ ‡‰Úˆ·˜ ¢È·Ì·Úٛ˜ ∫¡™ ™‡ÌÊ˘Ù˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ¢È¿ÊÔÚ· ™‡ÓÔÏÔ * % ÙÔ˘ Û˘ÓfiÏÔ˘ ** ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ

592

1996-1999 (°)

™‡ÓÔÏÔ

%*

8** 9 8 3 4 2 13

4 4 1 4 4 2 5 3

4 1 1 2 3 5 1 1

16 14 2 14 10 11 8 17

15,5 13,7 2 13,7 9,8 10,8 7,8 16,8

3 50

1 28

2 4 24

2 8 102

2 7,8


¶·È‰È·ÙÚÈ΋ 2001;64:589-594

Paediatriki 2001;64:589-594

¶›Ó·Î·˜ 6. ∂¡£, ¡£, ¢∂¡£ Î·È ¢¡£ ÃÚÔÓÔÏÔÁ›· 1986-1990 (∞) 1991-1995 (µ) 1996-1999 (°)

∂¡£ ¡Ô

ò

299/19833 117/9405 69/6948

15 12,4 9,9

¡£ (0-28 ËÌ.) ¡Ô ò 260/19833 104/9405 64/6948

13,1 11 9,2

¢∂¡£* ¡Ô ò 249/19783 89/9377 45/6924

12,5 9,5 6,5

¢¡£*(0-28 ËÌ.) ¡Ô ò 215/19783 82/9377 42/6924

10,8 8,7 6

* ∞Ê·ÈÚÔ‡ÓÙ·È ÔÈ ı¿Ó·ÙÔÈ ·fi ·Ó·fiÙÚÂÙ· ·›ÙÈ· No: ·ÚÈıÌfi˜ ı·Ó¿ÙˆÓ ÚÔ˜ ·ÚÈıÌfi ˙ÒÓÙˆÓ ÓÂÔÁÓÒÓ ∂¡£: ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ¡£: ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ¢∂¡£: ‰ÈÔÚıˆÌ¤ÓË ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÛÈÌfiÙËÙ· ¢¡£: ‰ÈÔÚıˆÌ¤ÓË ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ·

·’ fi,ÙÈ ·Ó·Ê¤ÚÂÙ·È Û ÌÂϤÙ˜ ÚÔËÁÌ¤ÓˆÓ ÎÚ·ÙÒÓ (6,7,9-12). ŒÓ·˜ ÛËÌ·ÓÙÈÎfi˜ ÏfiÁÔ˜ ÁÈ· ÙË ‰È·ÊÔÚ¿ ·˘Ù‹ ıˆÚԇ̠fiÙÈ ÔÊ›ÏÂÙ·È Û ˘ÂÚÂÎÙ›ÌËÛË ÙÔ˘ ™∞¢ ÛÙË ÌÂϤÙË Ì·˜. ∂›Ó·È Èı·Ófi, Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ Ô˘ Ë ·ÈÙ›· ı·Ó¿ÙÔ˘ ·Ô‰fiıËΠÛÙÔ ™∞¢, Ë ·ÈÙ›· ı·Ó¿ÙÔ˘ Ó· ‹Ù·Ó Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË, fiˆ˜ Û˘ÁÁÂÓ‹˜ Ó¢ÌÔÓ›·. ªÂϤÙ˜ Ô˘ ÛÙËÚ›¯ıËÎ·Ó Û ·ıÔÏÔÁÔ·Ó·ÙÔÌÈο/ÓÂÎÚÔÙÔÌÈο Â˘Ú‹Ì·Ù· ¤‰ÂÈÍ·Ó fiÙÈ Ì¤¯ÚÈ Î·È 60% ÙˆÓ ÓÂÔÁÓÒÓ Ì Ôχ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Ô˘ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ÎÏÈÓÈο fiÙÈ ¤ı·Ó·Ó ·fi ™∞¢, ¤ı·Ó·Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ·fi Û˘ÁÁÂÓ‹ Ïԛ̈ÍË (13,14). ∞ÎfiÌ·, ÛÙ· ÓÂÔÁÓ¿ ÛÙ· ÔÔ›· ¤ÚÂ ӷ Á›ÓÂÈ ÂÈÏÔÁ‹ ÛÙËÓ ·ÈÙ›· ı·Ó¿ÙÔ˘ ·Ó¿ÌÂÛ· ÛÙÔ ™∞¢ Î·È ÙË ¯ÚfiÓÈ· Ó¢ÌÔÓÔ¿ıÂÈ·, ÚÔÙÈÌ‹ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ ™∞¢. ∞fi ÙȘ ™∞, Û˘¯ÓfiÙÂÚË Î·ÙËÁÔÚ›· ı·Ó¿ÙˆÓ ‹Ù·Ó ÔÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ (™∫¶) ÛÙȘ ÂÚÈfi‰Ô˘˜ ∞ Î·È µ, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È Û ¿ÏϘ 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˘ÚÁÈÎÔ‡ ∫¤ÓÙÚÔ˘ ÛÙËÓ ∂ÏÏ¿‰·, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÙ˘¯¤ÛÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ. ∆· ∂õ° ÓÂÔÁÓ¿ (≤700 g) ·ÔÙÂÏÔ‡Ó ÙËÓ ÙÚ›ÙË Î˘ÚÈfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ Û‹ÌÂÚ· ÛÙÔ ∆Ì‹Ì· Ì·˜, ÂÓÒ ÛÙ· ∫¤ÓÙÚ· ÙˆÓ ‚ÈÔÌ˯·ÓÈÎÒÓ ÎÚ·ÙÒÓ Â›Ó·È Ë ‰Â‡ÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙȘ ™∞ (7,9,10). ™ÙËÓ Î·ÙËÁÔÚ›· Ù˘ Û‹„˘ Ô˘ ·ÚÔ˘Û›·Û ÂÏ¿ÙÙˆÛË Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘, ÂÚÈÂÏ‹ÊıËÛ·Ó Î·È ÂÚÈÛÙ·ÙÈο Ì ¯ÚfiÓÈ· ‚·ÚÈ¿ ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ‚·Ú‡Ù·Ù˜ ÂÁÎÂÊ·ÏÈΤ˜ ‚Ï¿‚˜, ÛÙ· ÔÔ›· ›¯Â ·ÔÊ·ÛÈÛÙ› Ë ÌË ·ÚÔ¯‹ “ËÚˆÈÎÒÓ Ì¤ÙÚˆÓ” Î·È Ù· ÔÔ›· ÙÂÏÈο ¤ı·Ó·Ó “·Ú·ÌÂÏË̤ӷ” ·fi Û‹„Ë. ∆Ô ÔÛÔÛÙfi Ù˘ ¡∂∫ ÛÙ· ·›ÙÈ· ı·Ó¿ÙˆÓ Î˘Ì¿ÓıËΠ۠Â›‰· 7%-10%. ∏ Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ¡∂∫ ÛÙ· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Ì ÎÔÈÏȷΤ˜ ·ÚÔ¯ÂÙ‡ÛÂȘ ¤¯ÂÈ

ÂÏ·ÙÙÒÛÂÈ Ï›ÁÔ ÙË ıÓËÙfiÙËÙ· ·fi ÙË ¡∂∫. ∏ ıÓËÙfiÙËÙ· ı· ÌÔÚÔ‡Û ӷ ÂÏ·ÙÙˆı› ÛËÌ·ÓÙÈο ·Ó ˘‹Ú¯·Ó ·Ó·ÈÛıËÛÈÔÏfiÁÔÈ Î·È ·È‰Ô¯ÂÈÚÔ˘ÚÁÔ› Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂÎÙÂϤÛÔ˘Ó ·Ú·ÎÏ›ÓȘ Ï··ÚÔÙÔÌÈΤ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÛÙË ª∂¡. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ‰È·¯ÚÔÓÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙ· ·›ÙÈ· ı·Ó¿ÙˆÓ Â›Ó·È ·ÚfiÌÔȘ Ì ·˘Ù¤˜ ÙˆÓ ‚ÈÔÌ˯·ÓÈÎÒÓ ÎÚ·ÙÒÓ. ¶·Ú·ÙËÚ‹ıËΠÂÏ¿ÙÙˆÛË ÙˆÓ ı·Ó¿ÙˆÓ ·fi ™∞¢, ÏÔÈÌÒÍÂȘ Î·È ¶∞, Ì ·ÔÙ¤ÏÂÛÌ· ÛÙ· ·ÚÈ· ·›ÙÈ· ı·Ó¿ÙÔ˘ Ó· ÂÈÎÚ·ÙÔ‡Ó ÔÈ ·Ó·fiÙÚÂÙ˜ ηÙËÁÔڛ˜ ı·Ó¿ÙˆÓ, fiˆ˜ ÔÈ ™∞ Î·È Ù· ∂õ°¡. °È· Ù· ∂õ°¡, Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ Û˘Ó¯È˙fiÌÂÓˆÓ ÚÔfi‰ˆÓ ÛÙËÓ È·ÙÚÈ΋ Î·È ÙËÓ Ù¯ÓÔÏÔÁ›· Û ÔÚÈṲ̂ӷ ΤÓÙÚ· ‰Â›¯ÓÂÈ fiÙÈ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ‰˘Ó·ÙfiÙËÙ· ÂÏ¿ÙÙˆÛ˘ Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ÓÂÔÁÓÒÓ. ∆Ô ÎfiÛÙÔ˜, fï˜, ·fi ÙËÓ ·ÚÔ¯‹ Ù¤ÙÔÈ·˜ ÓÔÛËÏ›·˜ Â›Ó·È ÌÂÁ¿ÏÔ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÛÙË ª∂¡ Î·È ÛÙË ÌÂÙ¤ÂÈÙ· Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË Î·È ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ˘Á›·˜. ŒÓ· ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·fi ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ∂õ°¡ Ô˘ ÂÈ‚ÈÒÓÔ˘Ó, ·ÚÔ˘ÛÈ¿˙ÂÈ ÌfiÓÈ̘ ‹ Ì·ÎÚÔ¯ÚfiÓȘ ·Ó·Ëڛ˜ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ·ÓÙÈÌÂÙÒÈÛË Û ÂȉÈο ΤÓÙÚ·, ¯ˆÚ›˜ Ó· Â›Ó·È ÈηÓÔÔÈËÙÈ΋ Ë ÙÂÏÈ΋ ¤Î‚·ÛË ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ (15). °È· ÙȘ ™∞ ¤¯Ô˘Ó ˘¿ÚÍÂÈ Î¿ÔȘ ÚfiÔ‰ÔÈ ÛÙË Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ¿˜ ÙÔ˘˜, ΢ڛˆ˜ Ì ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ. ∏ ÌÂÁ¿ÏË, fï˜, ÂÏ¿ÙÙˆÛË ÛÙË ıÓËÛÈÌfiÙËÙ· Î·È ÓÔÛËÚfiÙËÙ· Û ·˘Ù¤˜ ÙȘ ‰‡Ô ηÙËÁÔڛ˜ ı·Ó¿ÙÔ˘ ÌÔÚ› Ó· Û˘Ì‚Â› ÌfiÓÔ ÌÂ: ·) ÙËÓ ·Ó‡ÚÂÛË ÙÚfiˆÓ Ì›ˆÛ˘ Ù˘ Á¤ÓÓËÛ˘ ∂õ°¡ Î·È ‚) ÙËÓ ·Ó‡ÚÂÛË Ó¤ˆÓ Ù¯ÓÈÎÒÓ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ ÙˆÓ Û˘ÁÁÂÓÒÓ Î·È ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÙËÓ Â·ÎfiÏÔ˘ıË ‰È·ÎÔ‹ Ù˘ ·ËÛ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Carver JD, McDermott RJ, Jacobson HN, Sherin KM, Kanarek K, Pimentel B et al. Infant mortality statistics do

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not adequately reflect the impact of short gestation. Pediatrics 1993;92:229-232. ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ Ã. ¶·ÓÂÏÏ‹ÓÈ· ¶ÂÚÈÁÂÓÓËÙÈ΋ ŒÚ¢ӷ [¢È·ÙÚÈ‚‹ ÁÈ· ÀÊËÁÂÛ›·]. ∞ı‹Ó·: ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; ∞Ú›Ï˘ 1983. ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ Ã, §ÂΤ·-∫·Ú·Ó›Î· µ, ∫·‚‚·‰›·˜ °, ª·ÙÛ·ÓÈÒÙ˘ ¡. ¢Âη¤ÓÙ ¯ÚfiÓÈ· ÚÔfi‰Ô˘ (19831998): ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙË ¯ÒÚ· Ì·˜ Û‹ÌÂÚ·. 37Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1999 28-30 ª·˝Ô˘; £ÂÛÛ·ÏÔÓ›ÎË; 1999. ∂ıÓÈ΋ ™Ù·ÙÈÛÙÈ΋ ÀËÚÂÛ›· ∂ÏÏ¿‰Ô˜. ∆ÂÏÂ˘Ù·›· ÛÙ·ÙÈÛÙÈο ‰Â‰Ô̤ӷ 1996 (ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·). ∞Ó‰Ú¤Ô˘ ∞, °Ô˘‰ÂÛ›‰Ô˘ ª, ª·˘Ú›‰Ë˜ °, ƒÒÛÈÔ˘ ∫, ª·Ï¿Ûη ∞, ¶·Ô‡ÏË ª. £ÓËÛÈÌfiÙËÙ· ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ πÔÎÚ¿ÙÂÈÔ °ÂÓÈÎfi ¶ÂÚÈÊÂÚÂÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ ÙË 14ÂÙ›· 1986-1999. ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À. ¶·È‰È·ÙÚÈ΋ (˘fi ‰ËÌÔÛ›Â˘ÛË). 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. Hein HA. Evaluation of a rural perinatal care system. Pediatrics 1980;66:540-546. 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. 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

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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›· ¤ÁÎÚÈÛ˘: 21-09-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ϤͷӉÚÔ˜ ∞Ó‰Ú¤Ô˘ ÃÂÈ̈ӛ‰Ô˘ 15, 551 33, ∫·Ï·Ì·ÚÈ¿ E-mail: aalex@spark.net.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∞Ó›¯Ó¢ÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÊÈÛÙÈÎÈÔ‡ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·1 ∂ÈÛ·ÁˆÁ‹: ∏ ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË ÌÂÙ¿ ·fi ÙË ‚ÚÒÛË ÊÈÛÙÈÎÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙËÓ ÚÒÙË Â·Ê‹ Ì ÙÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. ª›· Èı·Ó‹, ·ÏÏ¿ ·Ó·fi‰ÂÈÎÙË, Ô‰fi˜ ÚÒÈÌ˘ ¤ÎıÂÛ˘ Î·È Â˘·ÈÛıËÙÔÔ›ËÛ˘ ÛÙÔ ÊÈÛÙ›ÎÈ ·ÔÙÂÏ› ÙÔ ÌËÙÚÈÎfi Á¿Ï· ̤ۈ ÙÔ˘ ıËÏ·ÛÌÔ‡. ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› ηٿ fiÛÔ Ë ÚˆÙ½ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ÌÔÚ› Ó· ÂÚ¿ÛÂÈ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Ù˘ ıËÏ¿˙Ô˘Û·˜ ÌËÙ¤Ú·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 23 ˘ÁÈ›˜ ıËÏ¿˙Ô˘Û˜ ÌËÙ¤Ú˜ ËÏÈΛ·˜ 21-35 ÂÙÒÓ ·ÔÙ¤ÏÂÛ·Ó ÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘. ∫¿ı ÌËÙ¤Ú· ηٷӿψÓ 50 g ÊÈÛÙ›ÎÈ· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‰Â›ÁÌ·Ù· ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Û˘ÏϤÁÔÓÙ·Ó ·Ó¿ ÒÚ·. ™Â οı ‰Â›ÁÌ· Á¿Ï·ÎÙÔ˜ ·ÓȯÓ‡ıËΠÙÔ ÔÛfi Ù˘ ÚˆÙ½Ó˘ ÊÈÛÙÈÎÈÔ‡ ηıÒ˜ Î·È 2 ·ÚÈ· ·ÏÏÂÚÁÈÔÁfiÓ· Ara h 1 Î·È Ara h 2. ∞ÔÙÂϤÛÌ·Ù·: ∏ ÚˆÙ½ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ·ÓȯÓ‡ıËΠ۠11 ·fi ÙȘ 23 ÌËÙ¤Ú˜. ™Â 10 ÌËÙ¤Ú˜ ·ÓȯÓ‡ıËΠ2 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË Î·È Û ̛· ÂÓÙfi˜ 6 ˆÚÒÓ. ∏ ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ ̤ÁÈÛÙ˘ ÔÏÈ΋˜ ÚˆÙ½Ó˘ ÊÈÛÙÈÎÈÔ‡ ÛÙ· ‰Â›ÁÌ·Ù· ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ‹Ù·Ó 200 ng/ml (̤ÛË 222 ng/ml, ‡ÚÔ˜ 120-430

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ng/ml). ∞ÓȯÓ‡ıËÎ·Ó Â›Û˘ Î·È Ù· ‰‡Ô ·ÚÈ· ·ÏÏÂÚÁÈÔÁfiÓ· Ara h 1 Î·È ∞ra h 2. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÚˆÙ½ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ÂÎÎÚ›ÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ÌÂÙ¿ ·fi ηٷӿψÛË ÊÈÛÙÈÎÈÒÓ ·fi ÙË ıËÏ¿˙Ô˘Û· ÌËÙ¤Ú·. ∏ ¤ÎıÂÛË ÛÙËÓ ÚˆÙ½ÓË ÙÔ˘ ÊÈÛÙÈÎÈÔ‡ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ‚ÚÂÊÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘.

1 Vadas P, Wai Y, Burks W, Perelman B Detection of peanut allergens in breast milk of lactating women JAMA 2001;285:1746-1748

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Paediatriki 2001;64:595-603

ORIGINAL ARTICLE

™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ °. ∫Ô˘Ú›‰Ë˜, ª. ∆ÔÚÓ·Ú›Ù˘, Ã. ∫Ô˘Ú›‰Ë˜, ™. ™¿‚‚·, Ã. ÷Ù˙ËÁˆÚÁ›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˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Û˘Û¯¤ÙÈÛË Ù˘ ˘¤ÚÌÂÙÚ˘ ÙËÏÂı¤·Û˘ Ì ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ËÏÈΛ·˜ 1112 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ªÂÏÂÙ‹ıËÎ·Ó 1337 ·È‰È¿ (703 ·ÁfiÚÈ·, 634 ÎÔÚ›ÙÛÈ·), ·ÛÙÈÎÒÓ (678) Î·È ·ÁÚÔÙÈÎÒÓ (659) ÂÚÈÔ¯ÒÓ Ù˘ Â·Ú¯›·˜ ¶¿ÊÔ˘, ËÏÈΛ·˜ 11-12 ÂÙÒÓ, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· Û¯ÔÏ›· ·fi ÙÔ ª¿ÚÙÈÔ 1998 ̤¯ÚÈ ÙÔÓ πÔ‡ÓÈÔ 1999. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙÔȯ›· ·fi ÙËÓ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ (ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË, ‰ÔÎÈ̷ۛ˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ·Ó¿Ï˘ÛË ËÌÂÚ‹ÛÈÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘, ÏÈÔÚˆÙ½Ó˜, ÏÈ›‰È· Î·È ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘, Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È Â‚‰ÔÌ·‰È·›·˜ ηٷӿψÛ˘ ÙÚÔʛ̈Ó. ∞Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘ Ù· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û 3 ÔÌ¿‰Â˜ (1Ë ≤14, 2Ë 15-28 Î·È 3Ë >28 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·) Î·È ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÁÈ· fiϘ ÙȘ ·ÓˆÙ¤Úˆ ·Ú·Ì¤ÙÚÔ˘˜ Ì ÙË ‰ÔÎÈÌ·Û›· oneway ANOVA Î·È ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ 3 Î·È 1 Ì ÙË ‰ÔÎÈÌ·Û›· t-test. ¶ÔÛÔÛÙfi 32,6% ÙˆÓ ·ÁÔÚÈÒÓ ·Ú·ÎÔÏÔ˘ıÔ‡Û ÙËÏÂfiÚ·ÛË ≤14 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·, 51,3% 15-28 ÒÚ˜ Î·È 16,1% >28 ÒÚ˜. ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 31,7%, 50,1% Î·È 18,1%. ∆· ·ÁfiÚÈ· Ù˘ 3˘, Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰·, ›¯·Ó ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (µ™) (43,9 v 41,3 kg, p=0,037), ·˘ÍË̤ÓË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ (18,4 v 14,7 mm, p<0,001), ‚Ú›ÛÎÔÓÙ·Ó Û ÌÂÈÔÓÂÎÙÈÎfiÙÂÚË Ê˘ÛÈ΋ ηٿÛÙ·ÛË Ì ‰›ψÛË ·fi ‰ڷ›· ı¤ÛË 14,5 v 16,3 cm (p=0,013), ̤ÁÈÛÙÔ ·ÚÈıÌfi ÎÔÈÏÈ·ÎÒÓ Û 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 ÌÂȈ̤ÓË HDL-C (58,6 v 62,0 mg/dl, p=0,050) Î·È ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· ∂Ú¢ÓËÙÈÎfi Î·È ∂Î·È‰Â˘ÙÈÎfi ¶ÚfiÁÚ·ÌÌ· ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∫‡ÚÔ˜

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, Research and Education Program for Child’s Health, Cyprus

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¶·È‰È·ÙÚÈ΋ 2001;64:595-603

Paediatriki 2001;64:595-603

(67,2 v 60,2 mg/dl, p=0,024). ∆· ÎÔÚ›ÙÛÈ· Ù˘ 3˘, Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰·, ›¯·Ó ·˘ÍË̤ÓÔ µ™ (44,9 v 42,3 kg, p=0,038), ·˘ÍË̤ÓË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ (19,1 v 16,7 mm, p=0,002), ÌÂȈ̤ÓË ·fi‰ÔÛË Û ̤ÁÈÛÙÔ ·ÚÈıÌfi ÎÔÈÏÈ·ÎÒÓ Û 30 sec (20,9 v 21,8, p=0,048), ·˘ÍË̤ÓË ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (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 ÌÂȈ̤ÓË HDL-C (56,3 v 60,1 mg/dl, p=0,014) Î·È ·˘ÍË̤ÓÔ ÏfiÁÔ LDL-C/HDL-C (1,82 v 1,56, p<0,001). ∆· ·ÁfiÚÈ·, fiˆ˜ Î·È Ù· ÎÔÚ›ÙÛÈ·, Ù˘ 3˘ ÔÌ¿‰·˜, Û ۯ¤ÛË Ì ÙËÓ 1Ë, Î·Ù·Ó¿ÏˆÓ·Ó ÂÚÈÛÛfiÙÂÚ˜ ıÂÚÌ›‰Â˜ ËÌÂÚËÛ›ˆ˜ (·ÁfiÚÈ· 2151 v 1997, p=0,013, ÎÔÚ›ÙÛÈ· 1975 v 1839, p=0,045), ÂÚÈÛÛfiÙÂÚ˜ ÛÔÎÔÏ¿Ù˜ 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· Îfiη-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·ÙÈο, Ë ˘¤ÚÌÂÙÚË ÙËÏÂı¤·ÛË ÛÙ· ·È‰È¿ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ηډȷÁÁÂÈ·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘. OÈ ·È‰›·ÙÚÔÈ Î·È ÔÈ ˘fiÏÔÈÔÈ ÏÂÈÙÔ˘ÚÁÔ› ˘Á›·˜ ı· Ú¤ÂÈ Ó· ÂÓÙ¿ÍÔ˘Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Ô‰ËÁÈÒÓ ÚÔÏËÙÈ΋˜ È·ÙÚÈ΋˜ Î·È ÙÔ˘˜ ηÓfiÓ˜ ÛˆÛÙ‹˜ ÙËÏÂı¤·Û˘.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ÙËÏÂı¤·ÛË, ηډȷÁÁÂÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ·È‰È¿.

Key words: television viewing, cardiovascular risk factors, children.

™˘ÓÙÔÌÔÁڷʛ˜

fiˆ˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ë ·¯˘Û·ÚΛ·, Ë ÌÂȈ̤ÓË Ê˘ÛÈ΋ ¿ÛÎËÛË, ÙÔ Î¿ÓÈÛÌ·, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ Î·È Ë ÎÏËÚÔÓÔÌÈÎfiÙËÙ· Û˘Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË (36). ∞fi ÙȘ ÌÂϤÙ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ ÚÔ·ÙÂÈ fiÙÈ ÛÙ· ·È‰È¿ ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ηډȷÁÁÂÈ·ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ (∫¶∫), fi¯È ÌfiÓÔ Û ÔÏϤ˜ ÚÔËÁ̤Ó˜ ¯ÒÚ˜ (7,8) ·ÏÏ¿ Î·È ÛÙËÓ ∫‡ÚÔ (9,10). π‰È·›ÙÂÚ· ÛÙËÓ ¶¿ÊÔ ˘¿Ú¯ÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜, ·ÊÔ‡ ̤۷ Û 7,5 ¯ÚfiÓÈ· (1990-91 ̤¯ÚÈ 1998) Ù· ·È‰È¿ ËÏÈΛ·˜ 11 ÂÙÒÓ ÂÌÊ·Ó›˙Ô˘Ó ·‡ÍËÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÙÚÈÎÂÊ¿ÏÔ˘ (¢¶∆) ηٿ 25% (11,12). ∂ÈϤÔÓ, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÔÏÏÒÓ Î·Ó·ÏÈÒÓ ÙËÏÂfiÚ·Û˘ Ô˘ ÂÎ¤ÌÔ˘Ó Û 24ˆÚË ‚¿ÛË, ÔÏÏ¿ ·È‰È¿ ·ÊÈÂÚÒÓÔ˘Ó 4 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ËÌÂÚËÛ›ˆ˜ ·Ú·ÎÔÏÔ˘ıÒÓÙ·˜ ÙËÏÂfiÚ·ÛË (1316). ∏ ˘¤ÚÌÂÙÚË ÙËÏÂı¤·ÛË ·fi Ù· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ¤¯ÂÈ Û˘Ó‰Âı› Ì ÔÏÏ·Ï¿ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ï·‚ÂÚ¤˜ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ (17-19), ÌÂȈ̤ÓË Ê˘ÛÈ΋ ¿ÛÎËÛË (20,21), ·¯˘Û·ÚΛ·

95% CI µ™ ¢∞¶ ¢∂£ ¢ª™ ¢¶∆ HDL-C ∫¶∫ LDL-C ª∞∫ ª™ ¶∆∞ ™∞¶ TC TG Ã∆

95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ¢È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË ¢›ψÛË ·fi ‰ڷ›· ı¤ÛË ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ ÃÔÏËÛÙÂÚfiÏË ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ∫·Ú‰È·ÁÁÂÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÃÔÏËÛÙÂÚfiÏË ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ ª¤ÁÈÛÙÔ˜ ·ÚÈıÌfi˜ ÎÔÈÏÈ·ÎÒÓ Û 30 sec ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ ™˘ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ∆ÚÈÁÏ˘ÎÂÚ›‰È· ÃÚfiÓÔ˜ ÙËÏÂı¤·Û˘ (Û ÒÚ˜ ·Ó¿ ‚‰ÔÌ¿‰·)

∂ÈÛ·ÁˆÁ‹ ∏ ÈÛ¯·ÈÌÈ΋ ηډÈÔ¿ıÂÈ· ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜. ∏ ·ıËÚoÛÎÏ‹ÚˆÛË, Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÂÚ¢ÓÒÓ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ, ·Ú¯›˙ÂÈ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ì ‚Ú·‰Â›· ÂͤÏÈÍË Î·Ù·Ï‹ÁÂÈ ÛÙË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (1,2). ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘

596


¶·È‰È·ÙÚÈ΋ 2001;64:595-603

(16,22-24), ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (25), ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (26) Î·È ÌÂȈ̤ÓË Û¯ÔÏÈ΋ Â›‰ÔÛË (27). À¿Ú¯Ô˘Ó fï˜ Î·È ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ‰ÂÓ ‚Ú¤ıËΠۯ¤ÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È ·¯˘Û·ÚΛ·˜ (28) ‹ ÂËÚ·ÛÌfi˜ Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ (29), ÂÓÒ Ë Û˘Û¯¤ÙÈÛË Ì ÙËÓ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·fi ÙÔ˘˜ Wong Î·È Û˘Ó (25) ‰ÂÓ ÂȂ‚·ÈÒıËΠ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ Ù˘ ˘¤ÚÌÂÙÚ˘ ÙËÏÂı¤·Û˘ Î·È ÙˆÓ ∫¶∫ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÏËı˘ÛÌfi˜ ªÂÏÂÙ‹ıËÎ·Ó 1337 ·È‰È¿ (703 ·ÁfiÚÈ·, 634 ÎÔÚ›ÙÛÈ·), ·ÛÙÈÎÒÓ (678) Î·È ·ÁÚÔÙÈÎÒÓ (659) ÂÚÈÔ¯ÒÓ Ù˘ Â·Ú¯›·˜ ¶¿ÊÔ˘, ËÏÈΛ·˜ 11-12 ÂÙÒÓ, Ù· ÔÔ›· ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙ· ¢ËÌÔÙÈο Û¯ÔÏ›· ·fi ÙÔ ª¿ÚÙÈÔ 1998 ̤¯ÚÈ ÙÔÓ πÔ‡ÓÈÔ 1999 ÛÙ· Ï·›ÛÈ· ÙÔ˘ ∂Ú¢ÓËÙÈÎÔ‡ Î·È ∂Î·È‰Â˘ÙÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡”. ∆Ô ¶ÚfiÁÚ·ÌÌ· “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡” Á›ÓÂÙ·È ÛÂ Û˘ÓÂÚÁ·Û›· Ì ٷ ÀÔ˘ÚÁ›· ÀÁ›·˜ Î·È ¶·È‰Â›·˜ Ù˘ ∫‡ÚÔ˘ Î·È ÙËÓ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, Ì ÛÎÔfi ÙËÓ ·Ó›¯Ó¢ÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· Î·È ÌÂÚÈΤ˜ ÌÔÚʤ˜ ηÚΛÓÔ˘ ÛÙ· ·È‰È¿, ηıÒ˜ Î·È ÙËÓ ·ÚÔ¯‹ ·ÙÔÌÈÎÒÓ Î·È ÁÂÓÈÎÒÓ Ô‰ËÁÈÒÓ ÚfiÏ˄˘. ∫·Ù¿ ÙË Û¯ÔÏÈ΋ ¯ÚÔÓÈ¿ 1997-98 ÂÍÂÙ¿ÛÙËÎ·Ó 994 ·È‰È¿ ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 1060 Ì·ıËÙÒÓ ™∆’ Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Ù˘ Â·Ú¯›·˜ ¶¿ÊÔ˘ (93,8%) Î·È ÙËÓ ÂfiÌÂÓË Û¯ÔÏÈ΋ ¯ÚÔÓÈ¿ 939 ·fi Ù· 972 ·È‰È¿ (96,6%), ÌÂÙ¿ ·fi ÁÚ·Ù‹ ÂÓË̤ڈÛË Î·È Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ¢fiıËÎ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÁÈ· ÙȘ Û˘Ó‹ıÂȘ ÙËÏÂı¤·Û˘ Û 1418 ·È‰È¿ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ·fi ÙÔ ª¿ÚÙÈÔ 1998 ̤¯ÚÈ ÙÔÓ πÔ‡ÓÈÔ 1999. ∞fi ·˘Ù¿ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó 1337 ·È‰È¿ (94,3%) ÁÈ· Ù· ÔÔ›· ··ÓÙ‹ıËÎ·Ó ÔÈ ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÙËÓ ÙËÏÂı¤·ÛË. ∂ÚˆÙËÌ·ÙÔÏfiÁÈ· ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÛÙ¤ÏÓÔÓÙ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ Ì·˙› Ì ÙË ‰‹ÏˆÛË Û˘ÌÌÂÙÔ¯‹˜ Î·È ÂϤÁ¯ÔÓÙ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘ Ì ÚÔÛˆÈ΋ Û˘Ó¤ÓÙ¢ÍË ÙÔ˘ Ì·ıËÙ‹ ·fi ÙÔÓ È·ÙÚfi. ∞fi ÙÔ ª¿ÚÙÈÔ Ì¤¯ÚÈ ÙÔÓ πÔ‡ÓÈÔ 1998 ÔÈ ÁÔÓ›˜ ηÏÔ‡ÓÙ·Ó Ó· ηıÔÚ›ÛÔ˘Ó fiÛ˜ ÒÚ˜ ·Ú·ÎÔÏÔ˘ı› ÙÔ ·È‰› ÙËÏÂfiÚ·ÛË ÙȘ ηıËÌÂÚÈÓ¤˜ Ë̤Ú˜ Î·È fiÛ˜ Ù· ™·‚‚·ÙÔ·Úȷη. ∆ËÓ ÂfiÌÂÓË Û¯ÔÏÈ΋ ¯ÚÔÓÈ¿, ÁÈ· ÌÂÁ·Ï‡ÙÂÚË Â˘ÎÔÏ›· Î·È ·ÎÚ›‚ÂÈ·, ηıÔÚ›˙ÔÓÙ·Ó ÔÈ ÒÚ˜ ÙËÏÂı¤·Û˘ ÁÈ· οı Ë̤ڷ Ù˘ ‚‰ÔÌ¿‰·˜ ͯˆÚÈÛÙ¿. ∞fi Ù· ÛÙÔȯ›· ·˘Ù¿ ˘ÔÏÔÁ›˙ÔÓÙ·Ó ÔÈ ÒÚ˜ ÙËÏÂı¤·Û˘ ·Ó¿ ‚‰ÔÌ¿‰· (Ã∆). °È· ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË Î·Ù¤ÁÚ·Ê·Ó ÙÔ Û‡ÓÔÏÔ ÙˆÓ ˆÚÒÓ ¿ıÏËÛ˘ (ÔÔÈ·Û‰‹ÔÙ ÌÔÚÊ‹˜, ÂÓ‰ÔÛ¯ÔÏÈ΋˜ ‹ fi¯È) ÁÈ· fiÏË ÙËÓ Â‚‰ÔÌ¿‰·. °È· ÙË Û¯ÔÏÈ΋ ¯ÚÔÓÈ¿ 1998-1999 ÚÔÛÙ¤ıËÎ·Ó ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙȘ ÒÚ˜ ÙËÏÂı¤·Û˘ ·Ó¿ ‚‰ÔÌ¿‰· ÙˆÓ ÁÔÓ¤ˆÓ, ÙË Û˘¯ÓfiÙËÙ· ·Ó¿ ‚‰ÔÌ¿‰· Ù˘ ¤ÓÙÔÓ˘ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 20 ÏÂÙ¿) ¿ıÏËÛ˘ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ Â‚‰ÔÌ·‰È·›· ηٷӿψÛË ÙÚÔÊ›ÌˆÓ Î·È ÔÙÒÓ. ∞ÓıÚˆÔÌÂÙÚÈο ‰Â‰Ô̤ӷ ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (µ™) ÌÂÙÚ‹ıËΠ̠ÊÔÚËÙ‹ ˙˘Á·ÚÈ¿ Seca ·ÎÚȂ›·˜ ±0,5 kg Ì ٷ ·È‰È¿ ÓÙ˘Ì¤Ó· ÂÏ·ÊÚ¿. ∆Ô

Paediatriki 2001;64:595-603

Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (ª™) ÌÂÙÚ‹ıËΠ۠fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ· Ì ·Ó·ÛÙËÌfiÌÂÙÚÔ ÙÔ›¯Ô˘. O ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (µ™/ª™2). ∏ ¢¶∆ ÌÂÙÚ‹ıËΠ̠Ù˘¯fiÌÂÙÚÔ Ù‡Ô˘ Jamar ·ÎÚȂ›·˜ ±1 mm ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÙÔ˘ ·ÎÚˆÌ›Ô˘ Î·È ÙÔ˘ ˆÏÂÎÚ¿ÓÔ˘ ÛÙËÓ Ô›ÛıÈ· ÂÈÊ¿ÓÂÈ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ‚Ú·¯›ÔÓ·. ∏ ·ÚÙËÚȷ΋ ›ÂÛË ÌÂÙÚ‹ıËΠ̠˘‰Ú·ÚÁ˘ÚÈÎfi ÈÂÛfiÌÂÙÚÔ Û ηıÈÛÙ‹ ı¤ÛË ÛÙÔ ‰ÂÍÈfi ‚Ú·¯›ÔÓ·. ™·Ó ‰È·ÛÙÔÏÈ΋ ›ÂÛË (¢∞¶) ıˆڋıËÎÂ Ë ·fiÙÔÌË ÂÍ·Ûı¤ÓÈÛË ÙˆÓ ‹¯ˆÓ (Korotkoff forth phase). ™Ù· ·È‰È¿ Ì ·˘ÍË̤Ó˜ ÙÈ̤˜, Ë Ì¤ÙÚËÛË Â·Ó·Ï‹ÊıËΠÌÂÙ¿ ·fi Ï›Á· ÏÂÙ¿. ŒÏÂÁ¯Ô˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ O ¤ÏÂÁ¯Ô˜ Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÁÈÓfiÙ·Ó ·fi ηıËÁËÙ‹ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ Ì 4 ·fi ÙȘ 5 ‰ÔÎÈ̷ۛ˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÚˆÙfiÎÔÏÏÔ EUROFIT (30,31): A) ¢›ψÛË ·fi ‰ڷ›· ı¤ÛË (¢∂£), ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ Â˘Ï˘ÁÈÛ›·˜ Ù˘ ̤Û˘, ÙˆÓ ÁÏÔ˘ÙÈ·›ˆÓ Î·È ÙˆÓ Ô›ÛıÈˆÓ ÌËÚÈ·›ˆÓ Ì˘ÒÓ. O Ì·ıËÙ‹˜ ·fi ‰ڷ›· ı¤ÛË Î·È Ì ٷ fi‰È· ÙÂÓو̤ӷ, Û·‚ÂÈ Î·È ÊÙ¿ÓÂÈ Ì ٷ ¯¤ÚÈ· fiÛÔ ÈÔ Ì·ÎÚÈ¿ ÌÔÚ› ¿Óˆ ÛÂ Û˘Û΢‹ Ì Îϛ̷η ·fi 0-50 cm. B) ª¤ÁÈÛÙÔ˜ ·ÚÈıÌfi˜ ÎÔÈÏÈ·ÎÒÓ Û 30 sec (ª∞∫), ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ·ÓÙÔ¯‹˜ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ Ì˘ÒÓ. O Ì·ıËÙ‹˜ ·fi ‡ÙÈ· ı¤ÛË Î¿ÓÂÈ fiÛ˜ ÈÔ ÔÏϤ˜ ‰ÈÏÒÛÂȘ ÌÔÚ› ̤۷ Û 30 sec. °) ÕÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊÔÚ¿, ÁÈ· ÙË Ì¤ÙÚËÛË Ù˘ ‰‡Ó·Ì˘ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ. O Ì·ıËÙ‹˜ οÓÂÈ ¤Ó· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚÔ ¿ÏÌ· Û ̋ÎÔ˜, ¯ˆÚ›˜ ÊÔÚ¿ Î·È Ì ٷ ‰‡Ô fi‰È· Ì·˙›. ¢) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (¶∆∞), ÁÈ· ÙËÓ ¤ÌÌÂÛË Ì¤ÙÚËÛË Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜. OÈ Ì·ıËÙ¤˜ ¯ˆÚ›˙ÔÓÙ·È Û ÌÈÎÚ¤˜ ÔÌ¿‰Â˜ 4-5 ·ÙfiÌˆÓ Î·È Î·ÏÔ‡ÓÙ·È Ó· ‰È·Ó‡ÛÔ˘Ó, fiÛÔ ÈÔ ÔÏϤ˜ ÊÔÚ¤˜ ÌÔÚÔ‡Ó, Ì›· ·fiÛÙ·ÛË 20 ̤ÙÚˆÓ ÌÂٷ͇ ‰‡Ô ÁÚ·ÌÌÒÓ. ∏ Ù·¯‡ÙËÙ· Ì ÙËÓ ÔÔ›· ÎÈÓÔ‡ÓÙ·È ÌÂٷ͇ ÙˆÓ ‰‡Ô ÁÚ·ÌÌÒÓ Î·ıÔÚ›˙ÂÙ·È ·fi ¤Ó· Ì·ÁÓËÙÔʈÓË̤ÓÔ Ë¯ËÙÈÎfi Û‹Ì· Ô˘ Á›ÓÂÙ·È ÛÙ·‰È·Î¿ fiÏÔ Î·È ÈÔ ÁÚ‹ÁÔÚÔ Î·È ÙÔ ÔÔ›Ô Â›Û˘ ηıÔÚ›˙ÂÈ ÙÔ ÛÙ¿‰ÈÔ ÛÙÔ ÔÔ›Ô Î·Ù·Ê¤ÚÓÂÈ Ó· ÊÙ¿ÛÂÈ Ô Î¿ı ̷ıËÙ‹˜. ¢È·ÈÙÔÏÔÁÈο ‰Â‰Ô̤ӷ ÃÚËÛÈÌÔÔÈ‹ıËΠ‰È·ÈÙÔÏÔÁÈÎfi ÈÛÙÔÚÈÎfi Ì›·˜ Ë̤ڷ˜, ÙÔ ÔÔ›Ô ¤·ÈÚÓÂ Ë ‰È·ÈÙÔÏfiÁÔ˜ Ì ÚÔÛˆÈ΋ Û˘Ó¤ÓÙ¢ÍË ·fi οı ̷ıËÙ‹, Ì ÙË ‚Ô‹ıÂÈ· ÂÈÎfiÓˆÓ ÁÈ· ÙÔÓ ·ÎÚÈ‚‹ ηıÔÚÈÛÌfi Ù˘ ÔÛfiÙËÙ·˜. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ¤ÁÈÓ ÛÙÔÓ ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹ Ì ÂȉÈÎfi ÚfiÁÚ·ÌÌ·, ÙÔ ÔÔ›Ô Ì·˜ ·Ú·¯ˆÚ‹ıËΠ·fi ÙËÓ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ (32). °È· οı ·È‰› ˘ÔÏÔÁÈ˙fiÙ·Ó Ë ËÌÂÚ‹ÛÈ· ηٷӿψÛË ÙˆÓ ÂÍ‹˜ Û˘ÛÙ·ÙÈÎÒÓ: ıÂÚÌ›‰Â˜, ÔÏÈÎfi Ï›Ô˜, ÔÏ˘·ÎfiÚÂÛÙ·, ÌÔÓÔ·ÎfiÚÂÛÙ· Î·È ÎÔÚÂṲ̂ӷ ÏÈ·Ú¿, ¯ÔÏËÛÙÂÚfiÏË, ˘‰·Ù¿ÓıڷΘ, Ê˘ÙÈΤ˜ ›Ó˜, ÚˆÙ½Ó˜, Û›‰ËÚÔ˜, ·Û‚¤ÛÙÈÔ, ÊÒÛÊÔÚÔ˜, Ì·ÁÓ‹ÛÈÔ, οÏÈÔ, Ó¿ÙÚÈÔ Î·È ‚Èٷ̛Ә ∞, µ1, µ2, µ6 Î·È C. ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ OÈ ·ÈÌÔÏË„›Â˜ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÓËÛÙ›· 12 ˆÚÒÓ. ∞fi οı ̷ıËÙ‹ ÂÏ‹ÊıËÛ·Ó 5 ml ·›Ì·ÙÔ˜ ¯ˆÚ›˜ ·ÓÙÈËÎÙÈÎfi ÁÈ· ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È 3-5 ml Ì EDTA ÁÈ· ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ. ∆· ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÁÈ· ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÙÔÔıÂÙÔ‡ÓÙ·Ó Û ÊÔÚËÙfi „˘ÁÂ›Ô Ì ·ÁÔ·ÛÙÂȘ Î·È ÌÂٷʤÚÔÓÙ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ̤۷ Û 2-3 ÒÚ˜. OÈ ÂÍÂÙ¿ÛÂȘ ¤ÁÈÓ·Ó Ì ·Ó·Ï˘Ù‹ HITACHI 717 Ù˘ Boehringer Mannheim ›Ù ÙËÓ ›‰È· Ë̤ڷ, ›Ù ÙËÓ ÂÔ̤ÓË, ÔfiÙÂ Ô ÔÚfi˜ Ê˘Ï·ÁfiÙ·Ó ÛÙËÓ Î·Ù¿„˘ÍË. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ (TC) ηÈ

597


¶·È‰È·ÙÚÈ΋ 2001;64:595-603

ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ (TG) ¤ÁÈÓ Ì ÂÓ˙˘ÌÈ΋ ¯ÚˆÌ·ÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô (33,34) Î·È Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ÙˆÓ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (∏DL-C) Ì ¿ÌÂÛË Ì¤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÔÏ˘ÌÂÚ‹ (35). ∏ ¯ÔÏËÛÙÂÚfiÏË ÙˆÓ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ (LDL-C) ˘ÔÏÔÁ›ÛÙËΠ·fi ÙÔÓ Ù‡Ô: LDL-C=TC-(HDL-C+TG/5) (36). ∆Ô ÂÚÁ·ÛÙ‹ÚÈÔ ¤¯ÂÈ ÙfiÛÔ ÂÛˆÙÂÚÈÎfi (beringer, local), fiÛÔ Î·È Â͈ÙÂÚÈÎfi ÙÚÈÏfi ¤ÏÂÁ¯Ô ÔÈfiÙËÙ·˜ Ì ÚÔÙ˘ÔÔ›ËÛË Ù˘ ªurex, ÙÔ˘ International EQAS, WHO Î·È ÙÔ˘ ∂™∂∞¶ (∂ıÓÈÎfi ™‡ÛÙËÌ· ∂͈ÙÂÚÈ΋˜ ∞ÍÈÔÏfiÁËÛ˘ ¶ÔÈfiÙËÙ·˜ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÛÙËÓ ÎÏÈÓÈ΋ ¯ËÌ›·, ∂˘·ÁÁÂÏÈÛÌfi˜, ∞ı‹Ó·). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ŸÏ· Ù· ÛÙÔȯ›· ÙˆÓ ·È‰ÈÒÓ Ì˯·ÓÔÁÚ·Ê‹ıËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· Epi Info 6 (CDC USA, WHO) Î·È ÌÂٷʤÚıËÎ·Ó ÁÈ· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÛÙÔ ÚfiÁÚ·ÌÌ· SPSS. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ÛÙÔȯ›· ·fi ÙËÓ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ (ۈ̷ÙÔÌÂÙÚ‹ÛÂȘ, ·ÚÙËÚȷ΋ ›ÂÛË, ‰ÔÎÈ̷ۛ˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ·Ó¿Ï˘ÛË ËÌÂÚ‹ÛÈÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘, ÏÈÔÚˆÙ½Ó˜, ÏÈ›‰È· Î·È ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û¯ÂÙÈο Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘, Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È Â‚‰ÔÌ·‰È·›·˜ ηٷӿψÛ˘ ÙÚÔʛ̈Ó. ∞Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘, Ù· ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û 3 ÔÌ¿-

Paediatriki 2001;64:595-603

‰Â˜ (1Ë ≤14 ÒÚ˜, 2Ë 15-28 Î·È 3Ë >28 ÒÚ˜ ·Ó¿ ‚‰ÔÌ¿‰·), ͯˆÚÈÛÙ¿ ÁÈ· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Î·È ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÁÈ· fiϘ ÙȘ ·ÓˆÙ¤Úˆ ·Ú·Ì¤ÙÚÔ˘˜ Ì ÙË ‰ÔÎÈÌ·Û›· oneway ANOVA Î·È ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ 3 Î·È 1 Ì ÙË ‰ÔÎÈÌ·Û›· t-test.

∞ÔÙÂϤÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ 3 ÔÌ¿‰ˆÓ ÙËÏÂı¤·Û˘ Ì ÙË ‰ÔÎÈÌ·Û›· oneway ANOVA Î·È ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ 3 Î·È 1 Ì 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‡Û ÙËÏÂfiÚ·ÛË ≤14 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰·, 51,3% 15-28 ÒÚ˜ Î·È 16,1% >28 ÒÚ˜. ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ‹Ù·Ó 31,7%, 50,1% Î·È 18,1%. O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ÙËÏÂı¤·Û˘ ÛÙ· ·ÁfiÚÈ· ‹Ù·Ó 19,2 Î·È ÛÙ· ÎÔÚ›ÙÛÈ· 20,3 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰· (p=0,035), ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ 18,6 Î·È ÛÙȘ ·ÁÚÔÙÈΤ˜ 20,9 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰· (p<0,001). O

¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ·ÁÔÚÈÒÓ ·Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘ (̤ÛË ÙÈÌ‹, 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜) ¶·Ú¿ÌÂÙÚÔ˜

¡

∞ÁfiÚÈ· (N) ∞ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ ∞ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ∏ÏÈΛ· (¤ÙË) ∆Ú›¯ˆÛË ÂÊË‚·›Ô˘ ÃÚfiÓÔ˜ ÙËÏÂı¤·Û˘ Ã∆ ·Ù¤Ú· Ã∆ ÌËÙ¤Ú·˜

703 361 342 703 702 703 234 238

µ™ (kg) ¢ª™ (kg/m2) ¢¶∆ (mm) ™∞¶ (mmHg) ¢∞¶ (mmHg)

700 700 698 703 703

¢∂£ (cm) ∞ªÃº (cm) ª∞∫ ¶∆∞ (ÛÙ¿‰È·)

692 697 695 693

TC (mg/dl) HDL-C (mg/dl) LDL-C (mg/dl) LDL-C/HDL-C TG (mg/dl) °Ï˘Îfi˙Ë (mg/dl)

691 691 691 691 691 690

Ã∆≤14 ÒÚ˜/‚‰.

Ã∆=15-28 ÒÚ˜/‚‰. °ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο 229 (32,6%) 361 (51,3%) 134 (37,1%) 189 (52,3%) 95 (27,8%) 172 (50,3%) 11,5 (11,4-11,6) 11,6 (11,5-11,6) 2,4 (2,3-2,5) 2,4 (2,4-2,5) 10,4 (10,0-10,7) 20,1 (19,7-20,6) 11,1 (9,7-12,4) 13,1 (11,7-14,6) 12,4 (10,7-14,1) 12,8 (11,4-14,2) ™ˆÌ·ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο 41,3 (39,9-42,6) 41,5 (40,4-42,6) 18,7 (18,3-19,2) 18,9 (18,5-19,3) 14,7 (13,8-15,6) 15,4 (14,7-16,1) 114,5 (112,8-116,2) 113,7 (112,6-114,9) 74,3 (73,1-75,6) 74,1 (73,2-75,1) º˘ÛÈ΋ ηٿÛÙ·ÛË 16,3 (15,5-17,1) 15,8 (15,1-16,5) 153,6 (150,9-156,4) 153,4 (151,0-155,7) 23,7 (23,2-24,2) 23,3 (22,9-23,8) 5,0 (4,8-5,3) 4,9 (4,7-5,1) ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ 170,6 (166,7-174,5) 171,1 (168,0-174,2) 62,0 (60,2-63,8) 61,7 (60,1-63,2) 95,9 (92,4-99,4) 94,8 (91,9-97,8) 1,63 (1,55-1,71) 1,65 (1,58-1,72) 60,2 (56,7-63,7) 63,9 (60,8-66,9) 82,8 (81,7-83,8) 81,7 (80,9-82,5)

Ã∆>28 ÒÚ˜/‚‰.

P*

P**

113 (16,1%) 38 (10,5%) 75 (21,9%) 11,7 (11,6-11,8) 2,5 (2,3-2,6) 34,4 (33,4-35,3) 15,5 (10,9-20,2) 15,4 (11,3-19,6)

0,012 NS <0,001 0,040 NS

0,018 NS <0,001 0,013 NS

43,9 (41,7-46,1) 19,5 (18,8-20,3) 18,4 (16,9-20,0) 113,0 (110,9-115,1) 72,3 (70,8-73,9)

NS NS <0,001 NS NS

0,037 NS <0,001 NS NS

14,5 (13,4-15,6) 150,0 (145,7-154,3) 22,3 (21,5-23,1) 4,5 (4,1-4,9)

0,056 NS 0,012 0,045

0,013 NS 0,002 0,012

172,1 (166,9-177,2) 58,6 (55,5-61,7) 96,7 (92,0-101,4) 1,78 (1,65-1,90) 67,2 (62,0-72,3) 81,5 (80,1-82,9)

NS NS NS NS NS NS

NS 0,050 NS 0,052 0,024 NS

P*= Oneway ANOVA, P**= ™‡ÁÎÚÈÛË ÌÂٷ͇ ÔÌ¿‰ˆÓ 1 Î·È 3 Ì ÙÔ t-test ∆Ú›¯ˆÛË ÂÊË‚·›Ô˘ Û ÛÙ¿‰È· Tanner, Ã∆= ÃÚfiÓÔ˜ ÙËÏÂı¤·Û˘ Û ÒÚ˜ ·Ó¿ ‚‰ÔÌ¿‰· µ™= µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ¢ª™= ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¢¶∆= ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ ™∞¶ Î·È ¢∞¶= ™˘ÛÙÔÏÈ΋ Î·È ¢È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, ¢∂£= ¢›ψÛË ·fi ‰ڷ›· ı¤ÛË ∞ªÃº= ÕÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊÔÚ¿, ª∞∫= ª¤ÁÈÛÙÔ˜ ·ÚÈıÌfi˜ ÎÔÈÏÈ·ÎÒÓ Û 30 sec ¶∆∞= ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, TC= OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË HDL-C= ÃÔÏËÛÙÂÚfiÏË ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C= ÃÔÏËÛÙÂÚfiÏË ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ, TG= ∆ÚÈÁÏ˘ÎÂÚ›‰È·

598


¶·È‰È·ÙÚÈ΋ 2001;64:595-603

¯ÚfiÓÔ˜ ÙËÏÂı¤·Û˘ ÛÙ· ·ÁfiÚÈ· Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ Ã∆ ÙˆÓ ·Ù¤ÚˆÓ (p=0,040) Î·È ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ì ÙÔ Ã∆ ÙˆÓ ÌËÙ¤ÚˆÓ (p=0,037). OÈ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ‹Ù·Ó ·˘ÍË̤ÓÔÈ ÛÙ· ·È‰È¿ Ì ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË. ∆· ·ÁfiÚÈ· Ù˘ 3˘ Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· ›¯·Ó ·˘ÍË̤ÓÔ ‚¿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 ·˘ÍË̤ÓË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈΤʷÏÔ˘ (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·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ¶·ÚfiÌÔȘ ‰È·ÊÔÚ¤˜ ·ÚÔ˘Û›·˙·Ó Î·È Ù· ÎÔÚ›ÙÛÈ·. ∏ 3Ë, Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰·, ›¯Â ·˘ÍË̤ÓÔ µ™ (44,9 kg, CI: 42,9-47,0 v 42,3 kg, CI: 40,9-43,7, p=0,038) Î·È ·˘ÍË̤ÓË ¢¶∆ (19,1 mm, CI: 17,7-20,5 v 16,7 mm, CI: 15,8-17,6, p=0,002). ∏ ·ÚÙËÚȷ΋ ›ÂÛË ÛÙ· ·ÁfiÚÈ· ‰ÂÓ ·ÚÔ˘Û›·˙ ‰È·ÊÔÚ¤˜, ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· Ë ¢∞¶ ‹Ù·Ó ÌÂȈ̤ÓË ÛÙËÓ ÔÌ¿‰· Ì ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË.

Paediatriki 2001;64:595-603

∆· ·ÁfiÚÈ· Ì ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË ‚Ú›ÛÎÔÓÙ·Ó Û ÌÂÈÔÓÂÎÙÈÎfiÙÂÚË Ê˘ÛÈ΋ ηٿÛÙ·ÛË. ∏ 3Ë Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· ηٿÊÂÚÓ ÛÙË ‰›ψÛË ·fi ‰ڷ›· ı¤ÛË 14,5 cm, CI: 13,4-15,6 v 16,3 cm CI: 15,5-17,1 (p=0,013), ̤ÁÈÛÙÔ ·ÚÈıÌfi ÎÔÈÏÈ·ÎÒÓ Û 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 ÌÈÎÚfiÙÂÚ˜ ‰È·ÊÔÚ¤˜ Î·È ÌfiÓÔ ÛÙÔ ª∞∫ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿. ∏ 3Ë Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· ¤Î·Ó 20,9, CI: 20,2-21,7 v 21,8, CI: 21,3-22,3 ÎÔÈÏÈ·ÎÔ‡˜ Û 30 sec (p=0,048). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ·Ó·ÊÂÚfiÌÂÓ˜ ÒÚ˜ Î·È ÙË Û˘¯ÓfiÙËÙ· Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÙÚÈÒÓ ÔÌ¿‰ˆÓ ÙËÏÂı¤·Û˘. ∆· ·È‰È¿ Ì ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË, ΢ڛˆ˜ Ù· ÎÔÚ›ÙÛÈ·, ›¯·Ó ‰˘ÛÌÂÓ¤ÛÙÂÚ· Â›‰· ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ÏÈȉ›ˆÓ Î·È Î·ÌÈ¿ ÌÂÙ·‚ÔÏ‹ ÛÙË ÁÏ˘Îfi˙Ë.

¶›Ó·Î·˜ 2. ÷ڷÎÙËÚÈÛÙÈο ÎÔÚÈÙÛÈÒÓ ·Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘ (̤ÛË ÙÈÌ‹, 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜) ¶·Ú¿ÌÂÙÚÔ˜

¡

∫ÔÚ›ÙÛÈ· (N) ∞ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ ∞ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ ∏ÏÈΛ· (¤ÙË) ∆Ú›¯ˆÛË ÂÊË‚·›Ô˘ ª·ÛÙÔ› ÃÚfiÓÔ˜ ÙËÏÂı¤·Û˘ Ã∆ ·Ù¤Ú· Ã∆ ÌËÙ¤Ú·˜

634 317 317 634 626 627 634 219 230

µ™ (kg) ¢ª™ (kg/m2) ¢¶∆ (mm) ™∞¶ (mmHg) ¢∞¶ (mmHg)

633 633 630 630 629

¢∂£ (cm) ∞ªÃº (cm) ª∞∫ ¶∆∞ (ÛÙ¿‰È·)

629 629 625 615

TC (mg/dl) HDL-C (mg/dl) LDL-C (mg/dl) LDL-C/HDL-C TG (mg/dl) °Ï˘Îfi˙Ë (mg/dl)

625 625 625 625 625 624

Ã∆≤14 ÒÚ˜/‚‰.

Ã∆=15-28 ÒÚ˜/‚‰. °ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο 201 (31,7%) 318 (50,1%) 110 (34,7%) 160 (50,5%) 91 (28,7%) 146 (46,0%) 11,5 (11,5-11,6) 11,6 (11,5-11,6) 3,1 (3,0-3,2) 3,2 (3,1-3,3) 3,0 (2,9-3,1) 3,0 (2,9-3,1) 10,6 (10,2-10,9) 20,6 (20,2-21,0) 10,9 (9,1-12,6) 11,7 (10,3-13,1) 9,7 (8,3-11,2) 12,1 (10,7-13,4) ™ˆÌ·ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο 42,3 (40,9-43,7) 44,0 (42,8-45,2) 18,7 (18,2-19,2) 19,2 (18,8-19,6) 16,7 (15,8-17,6) 17,8 (17,1-18,6) 115,6 (114,1-117,1) 114,8 (113,5-116,2) 77,0 (75,7-78,2) 75,5 (74,5-76,6) º˘ÛÈ΋ ηٿÛÙ·ÛË 18,2 (17,2-19,2) 18,4 (17,6-19,2) 141,1 (138,3-144,0) 141,2 (138,8-143,6) 21,8 (21,3-22,3) 21,4 (20,9-21,8) 3,5 (3,2-3,7) 3,5 (3,4-3,7) ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ 163,8 (160,3-167,3) 166,7 (163,7-169,7) 60,1 (58,3-61,9) 57,7 (56,1-59,2) 89,5 (86,3-92,7) 93,4 (90,7-96,1) 1,56 (1,49-1,64) 1,72 (1,65-1,79) 70,5 (66,1-74,9) 71,9 (68,5-72,2) 80,7 (79,6-81,8) 80,6 (79,7-81,4)

Ã∆>28 ÒÚ˜/‚‰.

P*

P**

115 (18,1%) 47 (14,8%) 68 (21,4%) 11,6 (11,5-11,7) 3,3 (3,2-3,5) 3,0 (2,9-3,1) 36,9 (35,4-38,3) 13,7 (9,8-17,5) 13,6 (9,6-17,5)

NS NS NS <0,001 NS 0,037

NS 0,036 NS <0,001 NS 0,028

44,9 (42,9-47,0) 19,4 (18,7-20,1) 19,1 (17,7-20,5) 113,6 (111,2-115,9) 74,5 (72,8-76,2)

NS NS 0,008 NS NS

0,038 NS 0,002 NS 0,021

17,3 (16,0-18,6) 139,9 (135,8-144,0) 20,9 (20,2-21,7) 3,5 (3,2-3,8)

NS NS NS NS

NS NS 0,048 NS

169,8 (164,7-174,9) 56,3 (53,7-58,8) 96,0 (91,5-100,4) 1,82 (1,69-1,94) 76,7 (69,2-84,3) 80,8 (79,2-82,4)

NS 0,035 0,051 0,001 NS NS

0,049 0,014 0,018 <0,001 NS NS

P*= Oneway ANOVA, P**= ™‡ÁÎÚÈÛË ÌÂٷ͇ ÔÌ¿‰ˆÓ 1 Î·È 3 Ì ÙÔ t-test ∆Ú›¯ˆÛË ÂÊË‚·›Ô˘ Î·È Ì·ÛÙÔ› Û ÛÙ¿‰È· Tanner, Ã∆= ÃÚfiÓÔ˜ ÙËÏÂı¤·Û˘ Û ÒÚ˜ ·Ó¿ ‚‰ÔÌ¿‰· µ™= µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ¢ª™= ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ¢¶∆= ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈÎÂÊ¿ÏÔ˘ ™∞¶ Î·È ¢∞¶= ™˘ÛÙÔÏÈ΋ Î·È ¢È·ÛÙÔÏÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË, ¢∂£= ¢›ψÛË ·fi ‰ڷ›· ı¤ÛË ∞ªÃº= ÕÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊÔÚ¿, ª∞∫= ª¤ÁÈÛÙÔ˜ ·ÚÈıÌfi˜ ÎÔÈÏÈ·ÎÒÓ Û 30 sec ¶∆∞= ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜, TC= OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË HDL-C= ÃÔÏËÛÙÂÚfiÏË ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ LDL-C= ÃÔÏËÛÙÂÚfiÏË ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ÏÈÔÚˆÙÂ˚ÓÒÓ, TG= ∆ÚÈÁÏ˘ÎÂÚ›‰È·

599


¶·È‰È·ÙÚÈ΋ 2001;64:595-603

Paediatriki 2001;64:595-603

∆· ·ÁfiÚÈ· Ù˘ 3˘ Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· ›¯·Ó ÌÂȈ̤ÓË 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 ·˘ÍË̤ӷ 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· Ù˘ 3˘ Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· ›¯·Ó ·˘ÍË̤ÓË ÔÏÈ΋ ¯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), ÌÂȈ̤ÓË 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 ·˘ÍË̤ÓÔ 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 ÛÙÔȯ›ˆÓ Ô˘ ·Ó·Ï‡ıËÎ·Ó ·fi ÙÔ ‰È·ÈÙÔÏfiÁÈÔ Ì›·˜ Ë̤ڷ˜, ‹ Ù˘ ‚‰ÔÌ·‰È·›·˜ ηٷӿψÛ˘ ÙÚÔÊ›ÌˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∞Ó Î·È ÁÈ· Ù· ÂÚÈÛÛfiÙÂÚ· ‰ÂÓ ˘‹Ú¯·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜, Ù· ·ÁfiÚÈ·, fiˆ˜ Î·È Ù· ÎÔÚ›ÙÛÈ·, Ù˘ 3˘ Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· Î·Ù·Ó¿ÏˆÓ·Ó ÂÚÈÛÛfiÙÂÚ˜ 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), ÂÚÈÛÛfiÙÂÚ˜ ÛÔÎÔÏ¿Ù˜ 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· Îfiη-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). ∂›Û˘, 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 Ù˘ Â·Ú¯›·˜ ¶¿ÊÔ˘ (67,4% ÙˆÓ ·ÁÔÚÈÒÓ Î·È 68,2% ÙˆÓ ÎÔÚÈÙÛÈÒÓ) ·Ú·ÎÔÏÔ˘ı› 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·ÎÙËÚÈÛÙÈÎfi Î·È Û ¿ÏϘ ÂÚÈÔ¯¤˜, ·ÊÔ‡ ÛÙËÓ ∂ÏÏ¿‰· Ô Ì¤ÛÔ˜ Ã∆ ÁÈ· ÙȘ ËÏÈ˘ 7-12 ÂÙÒÓ Â›Ó·È 24,8 ÒÚ˜ ÙËÓ Â‚‰ÔÌ¿‰· (13-15) Î·È ÛÙȘ ∏¶∞ Ô Ì¤ÛÔ˜ Ã∆ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Â›Ó·È 3 ÒÚ˜ ËÌÂÚËÛ›ˆ˜ (37). ¢ÈÂÚ¢ӋıËÎ·Ó 5 ηÙËÁÔڛ˜ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·: ·¯˘Û·ÚΛ·, ·ÚÙËÚȷ΋ ›ÂÛË, ¿ÛÎËÛË-Ê˘ÛÈ΋ ηٿÛÙ·ÛË, Â›‰· ۷ί¿ÚÔ˘ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ. °È· ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË Î·È Ù· Â›‰· ۷ί¿ÚÔ˘ ‰ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜, ÂÎÙfi˜ ·fi ˘ÂÚÔ¯‹ ÙˆÓ ÎÔÚÈÙÛÈÒÓ Ì ÌÂÁ·Ï‡ÙÂÚË ÙËÏÂı¤·ÛË ÛÙË ¢∞¶. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·Ú¿ÁÔÓÙ˜ ˘ÂÚÙÂÚÔ‡Û·Ó Ù· ·È‰È¿ Ì ¯·ÌËÏ‹ ÙËÏÂı¤·ÛË, Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· ·ÁfiÚÈ· Û µ™, ¢¶∆, ¢∂£, ª∞∫, ¶∆∞, HDL-C Î·È TG Î·È ÛÙ· ÎÔÚ›ÙÛÈ· Û µ™, ¢¶∆, ª∞∫, TC, HDL-C, LDL-C Î·È LDL-C/HDL-C. ∏ ·¯˘Û·ÚΛ· Û ۯ¤ÛË Ì ÙËÓ ÙËÏÂı¤·ÛË Â›Ó·È ·fi ÙÔ˘˜ ∫¶∫ Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› ÂÚÈÛÛfiÙÂÚÔ. OÈ Andersen et al ÂÍÂÙ¿˙ÔÓÙ·˜ 4063 ·È‰È¿ 8-16 ÂÙÒÓ ÛÙȘ ∏¶∞, ‚Ú‹Î·Ó ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙÔ ¢ª™ Î·È ÛÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ ˆÌÔÏ¿Ù˘ Î·È Ï·ÁÔÓ›Ô˘ Û ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙËÏÂfiÚ·ÛË 4 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÙËÓ Ë̤ڷ, Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ¤‚ÏÂ·Ó ÏÈÁfiÙÂÚÔ ·fi 2 ÒÚ˜ (16). ∏ ·¯˘Û·ÚΛ· Û˘Û¯ÂÙÈ˙fiÙ·Ó Î·Ï‡ÙÂÚ· Ì ÙȘ ÒÚ˜ ÙËÏÂı¤·Û˘, ·Ú¿

¶›Ó·Î·˜ 3. ∫·Ù·Ó¿ÏˆÛË ÌÂÚÈÎÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÛÙÔȯ›ˆÓ ·Ó¿ÏÔÁ· Ì ÙÔ ¯ÚfiÓÔ ÙËÏÂı¤·Û˘ (̤ÛË ÙÈÌ‹, 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜) ¶·Ú¿ÌÂÙÚÔ˜

¡

Ã∆≤14 ÒÚ˜/‚‰.

£ÂÚÌ›‰Â˜ (Kcal/ËÌ) §›Ë (%) ∫ÔÚÂṲ̂ӷ Ï›Ë (%) ÃÔÏËÛÙÂÚfiÏË (g/ËÌ) ∆ÛÈ˜ (Û·ÎÔ˘Ï/‚‰) °Ï˘Î¿ (ÎÔ˘Ù·Ï/‚‰) ™ÔÎÔÏ¿Ù˜ (·Ó¿ ‚‰) ∫fiη-ÎfiÏ· (ÔÙ/‚‰)

693 693 693 693 413 383 424 419

1997 (1935-2059) 42,6 (41,6-43,7) 18,2 (17,7-18,7) 308,6 (278,9-338,3) 3,3 (2,9-3,7) 3,8 (3,1-4,5) 3,9 (3,4-4,4) 3,5 (2,9-4,1)

£ÂÚÌ›‰Â˜ (Kcal/ËÌ) §›Ë (%) ∫ÔÚÂṲ̂ӷ Ï›Ë (%) ÃÔÏËÛÙÂÚfiÏË (g/ËÌ) ∆ÛÈ˜ (Û·ÎÔ˘Ï/‚‰) °Ï˘Î¿ (ÎÔ˘Ù·Ï/‚‰) ™ÔÎÔÏ¿Ù˜ (·Ó¿ ‚‰) ∫fiη-ÎfiÏ· (ÔÙ/‚‰)

630 630 630 630 390 355 395 373

1839 (1774-1905) 42,7 (41,6-43,7) 18,3 (17,7-18,9) 259,4 (237,9-280,9) 2,8 (2,4-3,3) 3,0 (2,5-3,4) 2,9 (2,5-3,2) 2,1 (1,8-2,4)

Ã∆=15-28 ÒÚ˜/‚‰. ∞ÁfiÚÈ· 2007 (1958-2056) 41,5 (40,7-42,3) 17,7 (17,3-18,2) 269,5 (251,7-287,4) 3,4 (3,1-3,8) 4,1 (3,4-4,7) 3,9 (3,5-4,3) 3,8 (3,4-4,3) ∫ÔÚ›ÙÛÈ· 1883 (1833-1933) 41,6 (40,7-42,6) 17,8 (17,3-18,3) 252,0 (232,9-271,1) 3,3 (2,8-3,8) 3,5 (2,7-4,2) 3,6 (3,2-4,0) 2,5 (2,2-2,8)

P*= Oneway ANOVA, P**= ™‡ÁÎÚÈÛË ÌÂٷ͇ ÔÌ¿‰ˆÓ 1 Î·È 3 Ì ÙÔ t-test

600

Ã∆>28 ÒÚ˜/‚‰.

P*

P**

2151 (2045-2257) 41,7 (40,2-43,1) 18,0 (17,3-18,7) 303,9 (267,8-340,0) 4,1 (2,7-5,5) 2,2 (1,4-2,9) 5,4 (4,1-6,7) 6,0 (3,6-8,3)

0,013 NS NS 0,039 NS NS 0,020 0,003

0,009 NS NS NS NS 0,024 0,016 0,003

1975 (1886-2064) 41,8 (40,4-43,3) 17,0 (16,3-17,9) 283,9 (250,9-317,0) 3,9 (3,1-4,7) 2,9 (1,9-3,9) 4,0 (3,1-5,0) 3,6 (2,7-4,6)

0,045 0,015 NS NS 0,054 0,013 NS NS NS 0,018 NS NS 0,013 0,004 <0,001 <0,001


¶·È‰È·ÙÚÈ΋ 2001;64:595-603

Ì ÙË Û˘¯ÓfiÙËÙ· Ù˘ ¤ÓÙÔÓ˘ ¿ÛÎËÛ˘. ◊‰Ë, ÔÈ Dietz Î·È Gortmaker ›¯·Ó ˘ÔÏÔÁ›ÛÂÈ fiÙÈ Û ·È‰È¿ ËÏÈΛ·˜ 12-17 ÂÙÒÓ, Ë ·¯˘Û·ÚΛ· ·˘Í¿ÓÂÙ·È Î·Ù¿ 2% ÁÈ· οı ÂÈÚfiÛıÂÙË ÒÚ· ÙËÏÂı¤·Û˘ (22). £ÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È ·¯˘Û·ÚΛ·˜ ‚Ú‹Î·Ó Â›Û˘ ÔÈ Gortmaker et al ÂÍÂÙ¿˙ÔÓÙ·˜ 746 ·È‰È¿ 10-15 ÂÙÒÓ ÛÙȘ ∏¶∞ (23), ÂÓÒ ÔÈ Guillaume et al ÛÙÔ µ¤ÏÁÈÔ ‚Ú‹Î·Ó Û˘Û¯¤ÙÈÛË Ì ÙÔ ¢ª™ ÌfiÓÔ ÛÙ· ·ÁfiÚÈ· (24). ∂›Û˘, ÔÈ Robinson et al ‰ÂÓ ‚Ú‹Î·Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Û ÎÔÚ›ÙÛÈ·, ÂÍÂÙ¿˙ÔÓÙ·˜ 971 Ì·ı‹ÙÚȘ ̤Û˘ ËÏÈΛ·˜ 12,4 ÂÙÒÓ (28). ∞fi ÙË ‰È΋ Ì·˜ ÌÂϤÙË ÚÔ·ÙÂÈ Û·Ê‹˜ ·‡ÍËÛË Ù˘ ¢¶∆ (p<0,001) Î·È ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÙÔ˘ µ™ (p=0,037) Î·È ÙÔ˘ ¢ª™ (p=NS) ÛÙËÓ 3Ë ÔÌ¿‰· Û ۯ¤ÛË Ì ÙËÓ 1Ë. ™Â ÚfiÛÊ·Ù˜ ÂÚÁ·Û›Â˜ Ì·˜ Ì ¶·Á·ÚÈÔ ‰Â›ÁÌ· ·È‰ÈÒÓ ›‰È·˜ ËÏÈΛ·˜, ›¯·Ì ‚ÚÂÈ fiÙÈ Ë ·‡ÍËÛË Ù˘ ¢¶∆ ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ·˘ÍË̤ӷ Â›‰· LDL-C Î·È ÂÏ·Ùو̤ÓË ·fi‰ÔÛË ÛÙÔ ¶∆∞, ÂÓÒ Ô ¢ª™ ·Ú¤ÌÂÓ ›‰ÈÔ˜ Û fiϘ ÙȘ ÂÚÈÔ¯¤˜ (12), ηıÒ˜ Î·È fiÙÈ Ë ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ Î·È Ô ÏfiÁÔ˜ Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘-ÈÛ¯›Ô˘ Â›Ó·È Î·Ï‡ÙÂÚÔÈ ‰Â›ÎÙ˜ ÁÈ· ÙÔ˘˜ ∫¶∫ ·fi fi,ÙÈ Ô ¢ª™ (38). ∆· ·ÔÙÂϤÛÌ·Ù¿ Ì·˜ ÁÈ· ÙËÓ ·ÚÙËÚȷ΋ ›ÂÛË ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ·fi ·˘Ù¿ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ Ô˘ ‰ÂÓ ‚Ú›ÛÎÔ˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË (24,25). ¶Ú¤ÂÈ Ó· ÙÔÓ›ÛÔ˘Ì ÙȘ ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ‰˘ÛÎÔϛ˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙË Ì¤ÙÚËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙ· Û¯ÔÏ›·, ·ÊÔ‡ Û ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ÂÍ·Ï›„Ô˘Ì ÂÓÙÂÏÒ˜ ÙÔ ¿Á¯Ô˜ ·fi Ù· ·È‰È¿. ∏ Û¯¤ÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È ‰È·ÙÚÔÊ‹˜ ¤¯ÂÈ ÌÂÏÂÙËı› ΢ڛˆ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·Ê‹ÌÈÛ˘ ÛÙËÓ ÂÎÏÔÁ‹ ÙÚÔÊ‹˜. OÈ Taras et al, Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û 66 ÌËÙ¤Ú˜ ·È‰ÈÒÓ 3-8 ÂÙÒÓ, ‚Ú‹Î·Ó Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ¯ÚËÛÈÌÔÔ›ËÛ˘ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔÊÒÓ Î·È Ù˘ ·˘ÍË̤Ó˘ ÚfiÛÏ˄˘ ıÂÚÌ›‰ˆÓ (17). ∏ Â›‰Ú·ÛË, ÂÔ̤ӈ˜, 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· Û ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹ ¯ÒÚ˜ (18,37). ∞fi ÙË ÌÂϤÙË ÙˆÓ Anastassea-Vlachou et al Û 4876 ·È‰È¿ ÛÙËÓ ∂ÏÏ¿‰·, ÚÔ·ÙÂÈ fiÙÈ ÔÛÔÛÙfi 34,5% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 7-12 ÂÙÒÓ ÙÚÒÂÈ ÂÓÒ ·Ú·ÎÔÏÔ˘ı› ÙËÏÂfiÚ·ÛË (14) Î·È ·fi ÙË ÌÂϤÙË ÙˆÓ ºÂÛÛ¿ÙÔ˘ Î·È Û˘Ó, Ô˘ ÂÍ¤Ù·Û·Ó 412 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 9-14 ÂÙÒÓ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·˘Í¿ÓÂÙ·È Ë Î·Ù·Ó¿ÏˆÛË ·Óı˘ÁÈÂÈÓÒÓ ÌÈÎÚÔÛ˘Û΢·ÛÈÒÓ (19). ™ÙË ‰È΋ 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 ·˘ÍË̤ÓË ÛÙȘ ÔÌ¿‰Â˜ ˘¤ÚÌÂÙÚ˘ ÙË-

Paediatriki 2001;64:595-603

ÏÂı¤·Û˘ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·. ∂›Û˘, Ù· ÎÔÚ›ÙÛÈ· Î·Ù·Ó¿ÏˆÓ·Ó ÂÚÈÛÛfiÙÂÚ· ÙÛÈ˜ ÙËÓ Â‚‰ÔÌ¿‰·. ∆· ·È‰È¿, ÂÔ̤ӈ˜, Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÔÏϤ˜ ÒÚ˜ ÙËÏÂfiÚ·ÛË, ÙÚÒÓ ÂÚÈÛÛfiÙÂÚÔ ·ÏÏ¿ Î·È ¯ÂÈÚfiÙÂÚ· ·fi Ù· ¿ÏÏ· ·È‰È¿. OÈ ÔÏϤ˜ ÒÚ˜ ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË Ô‰ËÁÔ‡Ó Û ηıÈÛÙÈ΋ ˙ˆ‹, Ì›ˆÛË Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÙˆÓ ·È‰ÈÒÓ. OÈ Pate et al, ÂÍÂÙ¿˙ÔÓÙ·˜ 361 ·È‰È¿ ̤Û˘ ËÏÈΛ·˜ 11 ÂÙÒÓ, ‚Ú‹Î·Ó ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘ Î·È ÙËÏÂı¤·Û˘ (20). OÈ Bungum Î·È Vincent ·Ó·Ê¤ÚÔ˘Ó ·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· Û 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˘ÛÈ΋ ηٿÛÙ·ÛË, ÔÈ Tucker Î·È Hager ‰ÂÓ ‚Ú‹Î·Ó ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÙËÏÂı¤·ÛË Û 262 ·È‰È¿ 9-10 ÂÙÒÓ (29). ∞ÓÙ›ıÂÙ·, Û ·Ó¿ÏÔÁË ÌÂϤÙË Û 379 ¿ÚÚÂÓ˜ ÂÊ‹‚Ô˘˜, Ô Tucker ›¯Â ‚ÚÂÈ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙËÏÂı¤·Û˘ Î·È ÙˆÓ 6 ‰ÔÎÈÌ·ÛÈÒÓ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ (39). ∞fi Ù· ‰Èο Ì·˜ ·ÔÙÂϤÛÌ·Ù· ÚÔ·ÙÂÈ Û·Ê‹˜ ˘ÂÚÔ¯‹ ÙˆÓ ·È‰ÈÒÓ Ù˘ 1˘ ÔÌ¿‰·˜ ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ‰ÔÎÈ̷ۛ˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ ÚˆÙfiÎÔÏÏÔ EUROFIT, ·Ó Î·È ‰ÂÓ ‚ڋηÌ ‰È·ÊÔÚ¿ ÛÙȘ ·Ó·ÊÂÚfiÌÂÓ˜ ÒÚ˜ ¿ıÏËÛ˘, fiˆ˜ ‰ÂÓ ‚Ú‹Î·Ó ÔÈ ºÂÛÛ¿ÙÔ˘ Î·È Û˘Ó (19). ∂ÊfiÛÔÓ, fï˜, Ù· ·È‰È¿ Ù˘ 1˘ ÔÌ¿‰·˜ ¤¯Ô˘Ó ηχÙÂÚË Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ÌÔÚ› Ó· ˘ÔÛÙËÚȯı› fiÙÈ Èı·Ófiٷٷ Á˘ÌÓ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÈÔ ¤ÓÙÔÓ·. ∏ Â›‰Ú·ÛË Ù˘ ˘¤ÚÌÂÙÚ˘ ÙËÏÂı¤·Û˘ ÛÙ· ÏÈ›‰È· Î·È ÙȘ ÏÈÔÚˆÙ½Ó˜ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› ·ÚÎÂÙ¿. OÈ Wong et al, ÂÍÂÙ¿˙ÔÓÙ·˜ 1081 ·È‰È¿ 220 ÂÙÒÓ, ÌÂϤÙËÛ·Ó ÙË Û¯¤ÛË Ì ÙËÓ ÙËÏÂı¤·ÛË ÌfiÓÔ Ù˘ TC (25). µÚ‹Î·Ó fiÙÈ Ù· ·È‰È¿ Ì ÙËÏÂı¤·ÛË 2-4 ÒÚ˜ ›¯·Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ¤¯Ô˘Ó TC ≥200 mg/dl ηٿ 2,2 Î·È Ì ÙËÏÂı¤·ÛË >4 ÒÚ˜ ηٿ 4,8 Û ۯ¤ÛË Ì ٷ ˘fiÏÔÈ· ·È‰È¿. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, Ù· ·È‰È¿ Ù˘ 3˘ Û ۯ¤ÛË Ì ÙËÓ 1Ë ÔÌ¿‰· ›¯·Ó ÌÂȈ̤ÓË HDL-C. ∆· ·ÁfiÚÈ· ›¯·Ó Â›Û˘ ·˘ÍË̤ӷ TG Î·È Ù· ÎÔÚ›ÙÛÈ· ·˘ÍË̤ӷ Â›‰· TC Î·È LDL-C. ŸÏÔÈ ÔÈ ·ÓˆÙ¤Úˆ ·Ú¿ÁÔÓÙ˜ (·¯˘Û·ÚΛ·, ÌÂȈ̤ÓË Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ‰˘ÛÌÂÓ‹ Â›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ) ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ·ıËÚÔÛÎÏ‹ÚˆÛ˘. ∞fi ÙË ÌÂϤÙË Ù˘ Bogalusa Heart Study Û ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi ‚Ú¤ıËΠfiÙÈ fiÛÔ ·˘Í¿ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, ÙfiÛÔ ·˘Í¿ÓÔÓÙ·È ÔÈ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ‚Ï¿‚˜ ÛÙ· ÛÙÂÊ·ÓÈ·›· ·ÁÁ›· ÙˆÓ ·È‰ÈÒÓ (6). ∞fi ÙÔ ‰ÈÎfi Ì·˜ ¶·Á·ÚÈÔ ˘ÏÈÎfi ÚÔ·ÙÂÈ fiÙÈ 1:2 ·È‰È¿ ¤¯Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ·, 1:6 ¤¯Ô˘Ó

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‰‡Ô Î·È 1:20 ·È‰È¿ ¤¯Ô˘Ó ÙÚÂȘ (10). O ΛӉ˘ÓÔ˜ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ›ӷÈ, ÂÔ̤ӈ˜, ÌÂÁ¿ÏÔ˜ Î·È ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹ Ê·›ÓÂÙ·È fiÙÈ ‰È·‰Ú·Ì·Ù›˙ÂÈ Ë ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË. ™˘ÌÂÚ¿ÛÌ·Ù· ∏ ˘¤ÚÌÂÙÚË ÙËÏÂı¤·ÛË ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ÛÙ· ·È‰È¿. OÈ ·È‰›·ÙÚÔÈ Î·È ÔÈ ˘fiÏÔÈÔÈ ÏÂÈÙÔ˘ÚÁÔ› ˘Á›·˜ ı· Ú¤ÂÈ Ó· ÂÓÙ¿ÍÔ˘Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Ô‰ËÁÈÒÓ ÚÔÏËÙÈ΋˜ È·ÙÚÈ΋˜ Î·È ÙÔ˘˜ ηÓfiÓ˜ ÛˆÛÙ‹˜ ÙËÏÂı¤·Û˘ (37). ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ Î·È ÙÔ ÚÔÛˆÈÎfi ÙÔ˘ ÃËÌ›Ԣ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ §Â˘ÎˆÛ›·˜ ÁÈ· ÙË ‰ÈÂÎÂÚ·›ˆÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛˆÓ. ∆Ô ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È ¶ÔÏÈÙÈÛÌÔ‡, ÙÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Î·È ÙÔ˘˜ ‰·ÛοÏÔ˘˜ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ ÁÈ· ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘˜. ∆Ë §·˚΋ ∆Ú¿Â˙· ÁÈ· ÙË ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡”. ∆Ô˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜: ÙËÓ ·ÈÌÔÏ‹ÙÚÈ· ∂ϤÓË ™ÔÊÔÎÏ¤Ô˘˜, ÙË ‰È·ÈÙÔÏfiÁÔ ÿÚȉ· ™Ù·˘ÚÈÓ›‰Ô˘, ÙÔÓ Î·ıËÁËÙ‹ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ ¶. ∞ÏÌ·ÓÔ‡‰Ë Î·È ÙÔÓ ˘‡ı˘ÓÔ Ì˯·ÓÔÁÚ¿ÊËÛ˘ ÃÚ. ÷Ù˙ËȈ¿ÓÓÔ˘. ∆· ·È‰È¿ Ù˘ ™∆' Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ηıÒ˜ Î·È fiÏÔ˘˜ fiÛÔ˘˜ Û˘Ó¤‚·Ï·Ó ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜.

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7. American Academy of Pediatrics. Report of the expert panel on blood cholesterol levels in children and adolescents. National Cholesterol Education Program. Pediatrics 1992;89:525-584. 8. Schulpis K, Karikas GA. Serum cholesterol and triglyceride distribution in 7767 school-aged Greek children. Pediatrics 1998;101:861-864. 9. ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ∆ÔÚÓ·Ú›Ù˘ ª, ÷Ù˙ËȈ¿ÓÓÔ˘ ª, °È·ÓÎÔ˘Ï‹ ∞, µÚ·¯›Ì˘ ƒ. ¶ÚfiÁÚ·ÌÌ· “ÀÁ›· ÙÔ˘ ¶·È‰ÈÔ‡”, ∫‡ÚÔ˜. ŒÏÂÁ¯Ô˜ ÂÈ¤‰Ô˘ ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·¯˘Û·ÚΛ·˜ Û 1132 ·È‰È¿ Ù˘ ™∆’ Ù¿Í˘ ÙˆÓ ¢ËÌÔÙÈÎÒÓ ™¯ÔÏ›ˆÓ Ù˘ Â·Ú¯›·˜ §Â˘ÎˆÛ›·˜. ¶·È‰È·ÙÚ µ ∂ÏÏ 1998;10:238-244. 10. ™¿‚‚· ™, ∆ÔÚÓ·Ú›Ù˘ ª, Ã"°ÂˆÚÁ›Ô˘ Ã, ∫Ô˘Ú›‰Ë˜ °, ™È·ÌÔ‡ÓÎË ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚· ª. ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÔÏÏ·ÏÒÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ¶·È‰È·ÙÚÈ΋ 1999;62:468-473. 11. ∫Ô˘Ú›‰Ë˜ °∞. ∂ÎÙ›ÌËÛË Ù˘ ıÚ¤„˘ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ¶¿ÊÔ˘. ¶·È‰È·ÙÚ µ ∂ÏÏ 1997;9:190-193. 12. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›Ù˘ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∏ ·¯˘Û·ÚΛ· ÛÙËÓ ∫‡ÚÔ Û ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ·. ¶·È‰È·ÙÚÈ΋ 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·ÓÈÒÙ˘ ¡. ∏ Â›‰Ú·ÛË Ù˘ ÙËÏÂfiÚ·Û˘ ÛÙ· ∂ÏÏËÓfiÔ˘Ï· ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ· Î·È Ô ¶·È‰›·ÙÚÔ˜. ¶·È‰È·ÙÚÈ΋ 1993;56:300-316. 14. Anastassea-Vlachou K, Fryssira-Kanioura H, Papathanasiou-Klontza D, Xipolita-Zachariadi A, Matsaniotis N. The effects of television viewing in Greece, and the role of the paediatrician: a familiar triangle revisited. Eur J Pediatr 1996;155:1057-1060. 15. ∞ÁÔÚ›ÙÛ· ™, ∫ˆÛÙ·Ú›‰Ô˘ ™, ™ˆÙËÚÔÔ‡ÏÔ˘ º, ª·ÓÈ¿ ¢, ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫. ∂›Ó·È Î·È Ù· ·È‰È¿ Ù˘ Â·Ú¯›·˜ Ê·Ó·ÙÈÎÔ› ÙËÏÂı·٤˜; ¶·È‰È·ÙÚÈ΋ 1997;60:703-708. 16. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children. JAMA 1998;279:938-942. 17. Taras HL, Sallis JF, Patterson TL, Nader PR, Nelson JA. Television's influence on children's diet and physical activity. J Dev Behav Pediatr 1989;10:176-180. 18. Stony M, Faulkner P. The prime time diet: a content analysis of eating behavior and food messages in television program content and commercials. Am J Public Health 1990;80:738-740. 19. ºÂÛÛ¿ÙÔ˘ ™, ¶ÂÙÚ›‰Ô˘ ∂, ¢ÂÛ‡Ú˘ ¡, ºÏ˘Ù˙¿ÓË µ, ∫·Ú¿ıÈÔ˜ £. ∆ËÏÂfiÚ·ÛË: ˆÊÂÏ› ‹ ‚Ï¿ÙÂÈ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ ÙÔ˘ ·È‰ÈÔ‡; ¶·È‰È·ÙÚÈ΋ 1999;62:379-386. 20. Pate RR, Trost SG, Felton GM, Ward DS, Dowda M, Saunders R. Correlates of physical activity behavior in rural youth. Res Q Exerc Sport 1997;68:241-248. 21. Bungum TJ, Vincent ML. Determinants of physical activity among female adolescents. Am J Prev Med 1997;13:115-122. 22. Dietz WH Jr, Gortmaker SL. Do we fatten our children at


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the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985;75:807-812. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med 1996;150:356-362. Guillaume M, Lapidus L, Bjorntorp P, Lambert A. Physical activity, obesity, and cardiovascular risk factors in children. The Belgian Luxembourg Child Study II. Obes Res 1997;5:549-556. Wong ND, Hei TK, Qaqundah PY, Davidson DM, Bassin SL, Gold KV. Television viewing and pediatric hypercholesterolemia. Pediatrics 1992;90:75-79. Gadow KD, Sprafkin J. Field experiments of television violence with children: Evidence for an environmental hazard? Pediatrics 1989;83:399-405. Felter M. Television viewing and school achievement. J Commun 1984;34:104. Robinson TN, Hammer LD, Killen JD, Kraemer HC, Wilson DM, Hayward C et al. Does television viewing increase obesity and reduce physical activity? Cross-sectional and longitudinal analyses among adolescent girls. Pediatrics 1993;91:273-280. Tucker LA, Hager RL. Television viewing and muscular fitness of children. Percept Mot Skills 1996;82:1316-1318. Committee of Experts on Sports Research. EUROFIT. Rome: Edigraf Editoriale Grafica, 1988. Georgiadis G, Klissouras V. Assessement of youth fitness: the European perspective. Am J Clin Nutr 1989;49:1048-1053. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, ÷Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢ Î·È Û˘Ó. ∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ “∞ÁˆÁ‹ ÀÁ›·˜” ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1998;61:483-497.

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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›· ¤ÁÎÚÈÛ˘: 24-07-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °È¿ÓÓ˘ ∫Ô˘Ú›‰Ë˜ ¶·È‰›·ÙÚÔ˜ ∞ÏÂÍ·Ó‰ÚÔ˘fiψ˜ 71, CY-8027 ¶¿ÊÔ˜, ∫‡ÚÔ˜ E-mail: yiakou@avacom.net

603


¶·È‰È·ÙÚÈ΋ 2001;64:604-606

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2001;64:604-606

CASE REPORT

¡fiÛÔ˜ Scheuermann ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫. ∆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: ∏ ȉÈÔ·ı‹˜ Ó·ÓÈ΋ ·ʈÛË (ÓfiÛÔ˜ Sheuermann) Û˘Ó·ÓÙ¿Ù·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÊ˂›· Î·È ÚÔ‚¿ÏÏÂÈ Ì ¿ÏÁÔ˜ ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË. ¶ÚÔηÏ› ÔÍ›· ÁˆÓ›ˆÛË Ù˘ Ú¿¯Ë˜ Ô˘ ‰ÂÓ ·Ôηı›ÛÙ·Ù·È Ì ˘ÂÚ¤ÎÙ·ÛË Î·È Û ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ ·Ú·ÙËÚÂ›Ù·È Ó¢ÚÔÏÔÁÈ΋ Û˘ÌÌÂÙÔ¯‹. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹, ΢ڛˆ˜ fï˜ ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞ÓÙÈÌÂÙˆ›˙ÂÙ·È Û˘ÓÙËÚËÙÈο ÌÂ Ê˘ÛÈÔıÂÚ·›· Î·È ·Ó·ÏÁËÙÈο Î·È Û¿ÓÈ· ¯ÚÂÈ¿˙ÂÙ·È ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ú¤Ì‚·ÛË.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ Scheuermann, Ó·ÓÈ΋ ȉÈÔ·ı‹˜ ·ʈÛË, ÔÛÊ˘·ÏÁ›·.

Key words: Scheuermann's disease, Scheuermann's kyphosis, backache.

∂ÈÛ·ÁˆÁ‹ ø˜ ·ʈÛË ÔÚ›˙ÂÙ·È Ë ·‡ÍËÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ΢ÚÙfiÙËÙ·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ (™™) ¿Óˆ ÙˆÓ 40o ηٿ ÙÔÓ ÚÔÛıÔ›ÛıÈÔ ¿ÍÔÓ¿ Ù˘. ∏ ȉÈÔ·ı‹˜ ·ʈÛË Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· ·ʈÛ˘ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ (1). ∂›Ó·È ‰ÔÌÈ΋ ·Ú·ÌfiÚʈÛË Ù˘ ıˆÚ·ÎÈ΋˜ ‹ Ù˘ ıˆÚ·ÎÔ-ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÌÂ Û˘¯ÓfiÙÂÚÔ Û‡Ìو̷ ÙËÓ ÔÛÊ˘·ÏÁ›· ‹ Ú·¯È·ÏÁ›·. OÈ ·ÛıÂÓ›˜ ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ‹È· Û˘Ó‹ıˆ˜ ÔÛÊ˘·ÏÁ›·, ÂÓÒ ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ˘¿Ú¯ÂÈ ‰˘ÛÌÔÚÊ›· Ù˘ ™™ Î·È ·ÎfiÌË Û·ÓÈfiÙÂÚ· ·Ú·ÏËÁ›·. ∫ÏÈÓÈο ·Ú·ÙËÚÂ›Ù·È ÁˆÓ›ˆÛË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ηٿ ÙËÓ Â›Î˘„Ë Î·È ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ‚Ú›ÛÎÔÓÙ·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ÛÊËÓÔÂȉ›˜ ·Ú·ÌÔÚÊÒÛÂȘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ Î·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ.

¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ȉÈÔ·ı‹ Ó·ÓÈ΋ ·ʈÛË ÛÙË ıˆÚ·ÎÔ-ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘.

¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ ∞ÙÙÈ΋˜ ¶·È‰ÔÔÚıÔ·È‰ÈÎfi ∆Ì‹Ì·, ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ ∞ÙÙÈ΋˜

Pediatric Division, Peripheral General Hospital KAT of Attiki, Athens Pediatric-Orthopedic Division, Peripheral General Hospital KAT of Attiki, Athens

604

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 12 ÂÙÒÓ ÚÔÛ‹Ïı ÛÙ· Â͈ÙÂÚÈο ·È‰È·ÙÚÈο È·ÙÚ›· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∫∞∆, ηıÒ˜ Â‰Ò Î·È ¤Ó· ÂÚ›Ô˘ ¯ÚfiÓÔ Â›¯Â ÚÔԉ¢ÙÈο ÂȉÂÈÓÒÌÂÓÔ ¿ÏÁÔ˜ ÛÙË ıˆÚ·ÎÈ΋ ÌÔ›Ú· Ù˘ ™™. ∆Ô ¿ÏÁÔ˜ ›¯Â ÂÍ¿ÚÛÂȘ Î·È ˘Ê¤ÛÂȘ, ‰ÂÓ Â›¯Â ·ÔÙÂϤÛÂÈ ÔÙ¤ ·ÈÙ›· ·Ê‡ÓÈÛ˘ ÙË Ó‡¯Ù·, ·ÏÏ¿ ·Ó¤ÊÂÚ fiÙÈ ÁÈÓfiÙ·Ó ÂÓÙÔÓfiÙÂÚÔ ÚÔ˜ ÙÔ Ù¤ÏÔ˜ Ù˘ Ë̤ڷ˜, ΢ڛˆ˜ ÌÂÙ¿ ·fi ¿ÛÎËÛË ‹ ÂÚ¿ÙËÌ·. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ·Ú·ÙËÚ‹ıËΠ¢·ÈÛıËÛ›· ÛÙËÓ ›ÂÛË Ù˘ ıˆÚ·ÎÔ-ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ™™, Û·ÛÌfi˜ ÙˆÓ ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì˘ÒÓ Ì ‰˘ÛÎÔÏ›· ο̄˘ Ù˘ ÔÛʇԘ, ÂÓÒ Î·Ù¿


¶·È‰È·ÙÚÈ΋ 2001;64:604-606

ÙËÓ Â›Î˘„Ë ‰È·ÈÛÙÒıËΠÁˆÓ›ˆÛË Ù˘ ™™ ÛÙËÓ ¿Û¯Ô˘Û· ÂÚÈÔ¯‹ 45o. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ 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, ηıÒ˜ Î·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ (∂ÈÎfiÓ· 1 Î·È 2). ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË (∂ÈÎfiÓ· 3). O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÓÔÛ‹Ì·Ù· ÎÔÏÏ·ÁfiÓÔ˘ Î·È ÁÂÓÈÎfiÙÂÚ· ÁÈ· Ì˘ÔÛÎÂÏÂÙÈο ÚÔ‚Ï‹Ì·Ù· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆Ô ·È‰› ·ÓÙÈÌÂÙˆ›ÛÙËÎÂ Û˘ÓÙËÚËÙÈο Ì ·Ó·ÏÁËÙÈο Î·È Ê˘ÛÈÎÔıÂÚ·›·. ¶·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘ÛÙËÌ·ÙÈο Û·Ó Â͈ÙÂÚÈ΋ ·ÛıÂÓ‹˜ Î·È Â›Ó·È Û ¿ÚÈÛÙË Î·Ù¿ÛÙ·ÛË. ™˘˙‹ÙËÛË ∏ ·ʈÛË ÛÙ· ·È‰È¿ ÌÔÚ› Ó· ›ӷÈ: ·) ÌË ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, ‚) Û˘ÁÁÂÓ‹˜ Î·È Á) ȉÈÔ·ı‹˜. ∏ ÌË ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ·ʈÛË ÔÊ›ÏÂÙ·È Û η΋ ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Û˘¯Ó¿ ·ÓËÛ˘¯Â› ÙÔ˘˜ ÁÔÓ›˜ (2). ¢È·ÁÈÁÓÒÛÎÂÙ·È Â‡ÎÔÏ·, ηıÒ˜ ÙÔ ·È‰› ÌÔÚ› Ó· ‰ÈÔÚıÒÛÂÈ ÂÎÔ‡ÛÈ· ÙËÓ Î‡ÊˆÛË, ›Ù Û fiÚıÈ· ›Ù Û ‡ÙÈ· ı¤ÛË. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È ·ÚÓËÙÈÎfi˜ Î·È ·Ú’ fiÏÔ Ô˘ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ Â›Ù·ÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ΢ÚÙfiÙËÙ·˜ Ù˘ ™™, ·˘Ù‹ ÂÍ·Ê·Ó›˙ÂÙ·È Û ‡ÙÈ· ı¤ÛË. ∏ Û˘ÁÁÂÓ‹˜ ·ʈÛË ÔÊ›ÏÂÙ·È Û ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÔÓ‰‡ÏˆÓ (2). ∞˘Ù¤˜ ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ηÎÔ‡ Û¯ËÌ·ÙÈÛÌÔ‡ ÙˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ÛˆÌ¿ÙˆÓ Ì ٷ˘Ùfi¯ÚÔÓË ‰È·Ù‹ÚËÛË ÙˆÓ ÛÙÔȯ›ˆÓ ÙÔ˘ Ô›ÛıÈÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ ™™ (ÚfiÛıÈ· ÔÛÙÈ΋ Á¤Ê˘Ú·). OÈ ÛÔ‚·ÚfiÙÂÚ˜ Û˘ÁÁÂÓ›˜ ΢ÊÒÛÂȘ ›-

∂ÈÎfiÓ· 1. ∞Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıˆÚ·ÎÔ-ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ™™. º·›ÓÂÙ·È Ë ÛÙ¤ÓˆÛË ÙˆÓ ÌÂÛÔÛÔÓ‰‡ÏÈˆÓ ‰È·ÛÙËÌ¿ÙˆÓ, Ë ÂÏ¿ÙÙˆÛË ÙÔ˘ ‡„Ô˘˜ ÛÙÔ ÚfiÛıÈÔ ÙÌ‹Ì· ÙˆÓ ÛÔÓ‰‡ÏˆÓ £8-O2 Ì ·ÔÙ¤ÏÂÛÌ· ÛÊËÓÔÂȉ‹ ·Ú·ÌfiÚʈÛË Î·È ÔÈ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ.

Paediatriki 2001;64:604-606

Ó·È ÂÌÊ·Ó›˜ ·fi ÙË Á¤ÓÓËÛË Î·È ÂȉÂÈÓÒÓÔÓÙ·È ÚÔԉ¢ÙÈο. OÈ ÏÈÁfiÙÂÚÔ ‚·ÚȤ˜ ÌÔÚʤ˜ ÌÔÚ› Ó· Á›ÓÔ˘Ó ·ÓÙÈÏËÙ¤˜ ÔÏÏ¿ ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·. ∏ Âȉ›ӈÛË ÛÙ·Ì·Ù¿ ÌfiÓÔ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ ÛÎÂÏÂÙÔ‡. §fiÁˆ Ù˘ ‚·Ú‡ÙËÙ¿˜ ÙÔ˘˜, Ë ıÂÚ·›· Â›Ó·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ¯ÂÈÚÔ˘ÚÁÈ΋. ∏ ȉÈÔ·ı‹˜ Ó·ÓÈ΋ ·ʈÛË ‹ 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¯‹ Ù˘ ÂÊ˂›·˜. ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Î˘Ì·›ÓÂÙ·È ·fi 1-8% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ·ÏÏ¿ Ë Ú·ÁÌ·ÙÈ΋ Ù˘ Û˘¯ÓfiÙËÙ· ÈÛÙ‡ÂÙ·È fiÙÈ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË, ηıÒ˜ ‡ÎÔÏ· ‰È·Ï·Óı¿ÓÂÈ ÙË ‰È¿ÁÓˆÛË ‹ ‰È·ÁÓÒÛÎÂÙ·È ˆ˜ ÌË ÔÚÁ·ÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (1-4). À¿Ú¯ÂÈ ÔÈÎÔÁÂÓ‹˜ ÚԉȿıÂÛË, Ô ÙÚfiÔ˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, fï˜, ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi˜. ∂Èο˙ÂÙ·È fiÙÈ ÌÔÚ› Ó· ÎÏËÚÔÓÔÌÂ›Ù·È ˆ˜ ÂÈÎÚ·ÙÒÓ ÛˆÌ·ÙÈÎfi˜ ÁfiÓÔ˜ Ì ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·. ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ Â›Ó·È ¿ÁÓˆÛÙË. ∆· ·È‰È¿ Ì ÙË ÓfiÛÔ Ù›ÓÔ˘Ó Ó· ¤¯Ô˘Ó ˘„ËÏfiÙÂÚÔ ·Ó¿ÛÙËÌ· Î·È Û ·ÛıÂÓ›˜ ¤¯Ô˘Ó ‚ÚÂı› ·˘ÍË̤ӷ Â›‰· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (1). µÈÔ¯ËÌÈΤ˜ Î·È ÈÛÙÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ô˘ ¤¯Ô˘Ó ‚ÚÂı› ÛÙ· ÔÛÙ¿ Â›Ó·È ·Û·Ê¤˜ ·Ó ¤¯Ô˘Ó ·ÈÙÈÔÏÔÁÈ΋ ÛËÌ·Û›· ‹ Â›Ó·È ‰Â˘ÙÂÚÔ·ı›˜ (1). OÈ ¿Û¯ÔÓÙ˜ ·Ú·ÔÓÔ‡ÓÙ·È ÁÈ· ¿ÏÁÔ˜, Û˘Ó‹ıˆ˜ ‹ÈÔ, ÙÔ ÔÔ›Ô Á›ÓÂÙ·È ÂÓÙÔÓfiÙÂÚÔ ÚÔ˜ ÙÔ Ù¤ÏÔ˜ Ù˘ Ë̤ڷ˜ ‹ ÌÂÙ¿ ·fi ÎfiˆÛË, Û·ÓÈfiÙÂÚ· ‰Â ÁÈ· ‰˘ÛÌÔÚÊ›· Ù˘ ™™. ∫ÏÈÓÈο, ηٿ ÙËÓ Â›Î˘„Ë, ·Ú·ÙËÚÂ›Ù·È ÔÍ›· ÁˆÓ›ˆÛË Ù˘ Ú¿¯Ë˜ ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙËÓ ÔÔ›· ‰ÂÓ ÌÔÚ› Ó· ‰ÈÔÚıÒÛÂÈ Ì ˘ÂÚ¤ÎÙ·ÛË ÛÙËÓ fiÚıÈ· ‹ ÙËÓ ÚËÓ‹ ı¤ÛË. ∂›Û˘, ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ˘ÂÚÏfiÚ‰ˆÛË

∂ÈÎfiÓ· 2. ∂ÈΤÓÙÚˆÛË Û ¤Ó· ÛfiÓ‰˘ÏÔ, fiÔ˘ Ê·›ÓÔÓÙ·È ÔÈ ·ÏÏÔÈÒÛÂȘ Ì ÌÂÁ·Ï‡ÙÂÚË ÏÂÙÔ̤ÚÂÈ·.

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›· Î·È ·Ú·ÎÔÏÔ‡ıËÛË. ™Â ·Ó·Ù˘ÛÛfiÌÂÓ· ·È‰È¿ Ì ΢ÚÙfiÙËÙ· >50o, ·ÏÏ¿ <70o Ô˘ ¤¯Ô˘Ó Ù¿ÛË Âȉ›ӈÛ˘ Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÎˉÂÌfiÓ·˜. O fiÓÔ˜ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë. ∞Ó Ë Î˘ÚÙfiÙËÙ· Â›Ó·È >70o, Ô fiÓÔ˜ Â›Ó·È Â›ÌÔÓÔ˜ ‹ ˘¿Ú¯Ô˘Ó Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÙfiÙÂ Ë ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ¯ÂÈÚÔ˘ÚÁÈ΋. ™ÙËÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë Î˘ÚÙfiÙËÙ· ‹Ù·Ó <50o Î·È ÙÔ ¿ÏÁÔ˜ ˘Ô¯ˆÚÔ‡Û ‡ÎÔÏ· Ì ·Ó·ÏÁËÙÈο. ŒÙÛÈ, Ë ıÂÚ·›· ‹Ù·Ó Û˘ÓÙËÚËÙÈ΋. ∏ ·Ú·ÎÔÏÔ‡ıËÛË, fï˜, ·Ú¤ÌÂÈÓ ÛÙÂÓ‹, ‰ÈfiÙÈ Ë ·Ó¿Ù˘ÍË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÔÏÔÎÏËÚˆı›. ∂ÈÎfiÓ· 3. ∂Ȃ‚·›ˆÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÛÙËÓ ·ÍÔÓÈ΋.

Ù˘ ÔÛÊ˘˚΋˜ ‹ Ù˘ ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜ Ù˘ ™™. ∆¤ÏÔ˜, ÌÔÚ› Ó· ·Ú·ÙËÚËı› Û‡Û·ÛË ÙˆÓ ·Ú·ÛÔÓ‰‡ÏÈˆÓ Ì˘ÒÓ, ηıÒ˜ Î·È ¿ÏÁÔ˜ ηٿ ÙËÓ ›ÂÛË ÛÙËÓ ¿Û¯Ô˘Û· ÂÚÈÔ¯‹. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ÙÔ ÈÛÙÔÚÈÎfi Î·È Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÛÙÔ ·È‰› ‹Ù·Ó ÎÏ·ÛÈο Î·È ¯·Ú·ÎÙËÚÈÛÙÈο Ì›·˜ ‹È·˜ ÌÔÚÊ‹˜ Ù˘ ÓfiÛÔ˘. ∆· ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙ¤ÓˆÛË ÙˆÓ ÌÂÛÔÛÔÓ‰‡ÏÈˆÓ ‰È·ÛÙËÌ¿ÙˆÓ, ·‡ÍËÛË Ù˘ ÚÔÛıÔ›ÛıÈ·˜ ‰È·Ì¤ÙÚÔ˘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÛÊËÓÔÂȉ‹ ·Ú·ÌfiÚʈÛË ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÂÏ¿ÙÙˆÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘˜ Î·È ÚÔ‚ÔÏ‹ ÙÔ˘ ËÎÙÔÂȉԇ˜ ˘Ú‹Ó· (5-7). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È, ‰ÂÓ ˘‹Ú¯Â ÚÔ‚ÔÏ‹ ËÎÙÔÂȉԇ˜ ˘Ú‹Ó·, Ô‡Ù ÂÏ¿ÙÙˆÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘˜. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ·fi ÙË ÏÔÈÌÒ‰Ë ÛÔÓ‰˘Ï›Ùȉ·, ÙË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·, Ù· ηٿÁÌ·Ù· ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÙËÓ ·Á΢ÏÔÔÈËÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ· Î·È Ù· ÓÂÔÏ¿ÛÌ·Ù·. ∏ ÓfiÛÔ˜ ÂÍÂÏ›ÛÛÂÙ·È Ì¤¯ÚÈ Ó· ÔÏÔÎÏËÚˆı› Ë ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡. ∏ ıÂÚ·›· ÌÔÚ› Ó· Â›Ó·È Û˘ÓÙËÚËÙÈ΋ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ·Ú·ÌfiÚʈÛ˘, ÙËÓ ·ÚÔ˘Û›· ¤ÓÙÔÓÔ˘ ¿ÏÁÔ˘˜ Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜ (1,3,4). ™Â ‹È· ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ (΢ÚÙfiÙËÙ· <50o) Û˘ÓÈÛÙ¿Ù·È Ê˘ÛÈÎÔıÂÚ·-

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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‹˜ Ó·ÓÈ΋ ·ʈÛË (ÓfiÛÔ˜ Scheuermann). ∞ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û ·Û˘Ìو̷ÙÈÎfi ¤ÊË‚Ô. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂ ∞ıËÓÒÓ 1999;46:155-157.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-02-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ó·ÛÙ·Û›· ∑ÂÚ‚Ô˘‰¿ÎË ºÚ·ÁÎÔÎÎÏËÛÈ¿˜ 55, 151 25, ¶Ôχ‰ÚÔÛÔ ∞Ì·ÚÔ˘Û›Ô˘


¶·È‰È·ÙÚÈ΋ 2001;64:607-609

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2001;64:607-609

CASE REPORT

§··ÚÔÛÎÔÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â˘ÌÂÁ¤ıÔ˘˜ Û˘ÛÙÚ·Ê›۷˜ ·Ú·Û·ÏÈÁÁÈ΋˜ ·ÛÙ˘ ∂. ¶··Ó‰Ú¤Ô˘, ª. ∫ÔÙÚfiÙÛÔ˘, ¡. ª·ÏÙÔÁÈ¿ÓÓ˘, °. ∫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È΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ı‹ÛÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‰ÂÓ ¤¯ÂÈ Â˘Ú›· ÂÊ·ÚÌÔÁ‹ ÛÙËÓ ∂ÏÏ¿‰·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË, Û ·È‰È·ÙÚÈÎfi ÓÔÛÔÎÔÌ›Ô, ·ÛıÂÓÔ‡˜ Ì ¢ÌÂÁ¤ıË Û˘ÛÙÚ·Ê›۷ ·Ú·Û·ÏÈÁÁÈ΋ ·ÛÙË, Ë ÔÔ›· ‰È·ÁÓÒÛÙËÎÂ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠϷ·ÚÔÛÎÔÈÎÒ˜. ∏ ·ÛıÂÓ‹˜, ËÏÈΛ·˜ 14 ÂÙÒÓ, ÚÔÛ‹Ïı ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ì ¤ÓÙÔÓÔ ¿ÏÁÔ˜ ˘ÔÁ·ÛÙÚ›Ô˘ Î·È Â›Û¯ÂÛË Ô‡ÚˆÓ. ∞fi ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠ΢ÛÙÈÎfi ÌfiÚʈ̷ ˘¤ÏÔ˘ ‰È·ÛÙ¿ÛÂˆÓ 12,8x10x8 cm, Èı·ÓÒ˜ ÂÍÔÚÌÒÌÂÓÔ ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ ˆÔı‹ÎË. ªÂ ÙËÓ ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÛÎfiËÛË ‰È·ÈÛÙÒıËΠfiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· Û˘ÛÙÚ·Ê›۷ ·Ú·Û·ÏÈÁÁÈ΋ ·ÛÙË. ∏ ÂÎÙÔÌ‹ Î·È Ë ·Ê·›ÚÂÛË Ù˘ ·ÛÙ˘ ¤ÁÈÓ·Ó Ï··ÚÔÛÎÔÈÎÒ˜. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÛÙÂȘ, ·ÛÙÂȘ ÂÍ·ÚÙËÌ¿ÙˆÓ Ì‹ÙÚ·˜, Ï··ÚÔÛÎfiËÛË, ·È‰È΋ ËÏÈΛ·.

Key words: cysts, adnexal cysts, laparoscopic surgery, childhood.

∂ÈÛ·ÁˆÁ‹ ™‡Ìʈӷ Ì ÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ ˘¿Ú¯ÂÈ ÚÔËÁÔ‡ÌÂÓË ·Ó·ÊÔÚ¿ ÛÙË Ï··ÚÔÛÎÔÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·ı‹ÛÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ıËϤˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ô˘ ÓÔÛËχÙËÎ·Ó Û ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›· Ù˘ ∂ÏÏ¿‰·˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÚÒÙË ÂÚ›ÙˆÛË Ì ¢ÌÂÁ¤ıË Û˘ÛÙÚ·Ê›۷ ·Ú·Û·ÏÈÁÁÈ΋ ·ÛÙË Ô˘ ‰È·ÁÓÒÛÙËÎÂ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠϷ·ÚÔÛÎÔÈο.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÛıÂÓ‹˜ ËÏÈΛ·˜ 14 ÂÙÒÓ, Ì ۈ̷ÙÈÎfi ‚¿ÚÔ˜ 70 kg, Ì ¤ÓÙÔÓÔ ¿ÏÁÔ˜ ˘ÔÁ·ÛÙÚ›Ô˘ Î·È Â›Û¯ÂÛË Ô‡ÚˆÓ, ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜. ∏ ·ÛıÂÓ‹˜ ›¯Â ÂχıÂÚÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∆ÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ·ÚÔ˘Û›·˙ ÂÓԯϋÛÂȘ ÛÙÔ ˘ÔÁ¿ÛÙÚÈÔ, ÚÔԉ¢ÙÈ΋ ‰ÈfiÁΈÛË ÎÔÈÏ›·˜, ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Ô‡ÚËÛË Î·È ÛÙȘ ÎÂÓÒÛÂȘ. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎÂ

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

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

607


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‰ÈfiÁΈÛË ÎÔÈÏ›·˜ Ì ¤ÓÙÔÓË Â˘·ÈÛıËÛ›· ÛÙÔ ˘ÔÁ¿ÛÙÚÈÔ. ŒÁÈÓ ‰·ÎÙ˘ÏÈ΋ ÂͤٷÛË ·fi ÙÔ ÔÚıfi Î·È ÂÓÙÔ›ÛÙËΠÂÏ·ÛÙÈ΋ ¢›ÂÛÙË Ì¿˙· ˘¤ÏÔ˘, Ë ÔÔ›· ›Â˙ ÙÔ ÔÚıfi. ∆ÔÔıÂÙ‹ıËΠηıÂÙ‹Ú·˜ Folley. ∞fi ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÚԤ΢„ fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ΢ÛÙÈÎfi ÌfiÚʈ̷ ÂÏ¿ÛÛÔÓÔ˜ ˘¤ÏÔ˘, ÚÔÂÚ¯fiÌÂÓÔ Èı·ÓÒ˜ ·fi ÙËÓ ˆÔı‹ÎË (∂ÈÎfiÓ· 1). ∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠Ϸ·ÚÔÛÎfiËÛË, Ë ÔÔ›· ¤‰ÂÈÍ ÌÂÁ¿ÏË Â˘›ÂÛÙË Ì¿˙· ÛÙËÓ ‡ÂÏÔ, Ô˘ Û˘ÌÊ˘fiÙ·Ó Ì ÙÔ Ì›˙ÔÓ Â›ÏÔ˘Ó Î·È ›Â˙ ÙÔ ÔÚıÔÛÈÁÌÔÂȉ¤˜ Î·È ÙËÓ Ô˘ÚÔ‰fi¯Ô ·ÛÙË. ∂ÚfiÎÂÈÙÔ ÁÈ· ¢ÌÂÁ¤ıË ·Ú·Û·ÏÈÁÁÈ΋ ·ÛÙË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÂÍ·ÚÙ‹Ì·ÙÔ˜ Ù˘ Ì‹ÙÚ·˜, Ë ÔÔ›· ·ÚÔ˘Û›·˙ ÈÛ¯·ÈÌ›· ÏfiÁˆ Û˘ÛÙÚÔÊ‹˜. OÈ ‰‡Ô ˆÔı‹Î˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. §··ÚÔÛÎÔÈÎÒ˜ ¤ÁÈÓ ÎÈÓËÙÔÔ›ËÛË Ù˘ Û˘ÛÙÚ·Ê›۷˜ ·ÛÙ˘, ÂÎΤӈÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ Ô˘ ‹Ù·Ó ‰È·˘Á¤˜ ·¯˘Úfi¯ÚÔ˘Ó ˘ÁÚfi Î·È ·Ê·›ÚÂÛË ·˘Ù‹˜ Ì ۿÎÎÔ ÂÚÈÛ˘ÏÏÔÁ‹˜ ÔÚÁ¿ÓˆÓ ̤ۈ Ù˘ ı‹Î˘ ÙÔ˘ trocar ‰È·Ì¤ÙÚÔ˘ 1 cm (∂ÈÎfiÓ· 2). ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ·Ú·Û·ÏÈÁÁÈ΋ ˘‰¿Ùȉ· ·ÛÙË Morgagni. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ. ™˘˙‹ÙËÛË ∏ Ï··ÚÔÛÎÔÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ÌÔÚ› ϤÔÓ Ó· ¤¯ÂÈ ÂÊ·ÚÌÔÁ‹ ÙfiÛÔ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË fiÛÔ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·ı‹ÛÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙˆÓ ıËϤˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1-5). ™Â Û‡ÓÔÏÔ 26 ·ÛıÂÓÒÓ Ì ηÏÔ‹ıÂȘ ·ı‹ÛÂȘ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ Ô˘ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô

∂ÈÎfiÓ· 1. ª¿˙· ˘ÔÁ·ÛÙÚ›Ô˘ Î·È ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ·Ú·Û·ÏÈÁÁÈ΋˜ ·ÛÙ˘.

608

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1995-2001, Ë Ï··ÚÔÛÎÔÈ΋ ‰È¿ÁÓˆÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ·ÊÔÚ¿ ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ë ÔÔ›· Â›Ó·È Ë ÚÒÙË Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠϷ·ÚÔÛÎÔÈÎÒ˜ Û ÂÏÏËÓÈÎfi ÓÔÛÔÎÔÌÂ›Ô ·›‰ˆÓ. ∆· ΢ÛÙÈο ÌÔÚÊÒÌ·Ù· ÙˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ Ù˘ Ì‹ÙÚ·˜ ÂÌÊ·Ó›˙ÔÓÙ·È 1/3000-5000 ÁÂÓÓ‹ÛÂȘ Î·È ÌfiÓÔ ÔÛÔÛÙfi 25%-35% ·˘ÙÒÓ ·ÔÙÂÏÔ‡Ó Î·ÎÔ‹ıÂȘ ΢ÛÙÈΤ˜ ‚Ï¿‚˜ (5). ™˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ·Û˘Ìو̷ÙÈΤ˜ ÎÔÈÏȷΤ˜ Ì¿˙˜, ÔÈ Ôԛ˜ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Î·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‹ ÂÈÛËÌ·›ÓÔÓÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜. OÈ Î·ÏÔ‹ıÂȘ ·ÛÙÂȘ ÙˆÓ ˆÔıËÎÒÓ ÛÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û·Ó ·Ϥ˜ ÌÔÓfi¯ˆÚ˜ Ì ˘Ô˯Ô˚Îfi ÂÚȯfiÌÂÓÔ (2,4,6-8). OÈ Î‡ÛÙÂȘ ÙˆÓ ˆÔıËÎÒÓ Ô˘ Â›Ó·È ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 5 cm, ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ˘ÂÚ˯ÔÁÚ·ÊÈο Î·È ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ¯ÂÈÚÔ˘ÚÁÈο ÌfiÓÔ fiÙ·Ó ‰ÂÓ ˘ÔÛÙÚ¤ÊÔÓÙ·È ‹ ·˘Í¿ÓÔ˘Ó Û ̤ÁÂıÔ˜, ÂÓÒ ÔÈ Î‡ÛÙÂȘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÈÏÔΤ˜ (Û˘ÛÙÚÔÊ‹, ·ÈÌÔÚÚ·Á›·, Ú‹ÍË) ¤¯Ô˘Ó ¤Ó‰ÂÈÍË ÁÈ· ¿ÌÂÛË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (4,5,9-11). OÈ ÌÂÁ¿Ï˜ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ Î‡ÛÙÂˆÓ ˆÔı‹Î˘, ÙˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ Ù˘ Ì‹ÙÚ·˜ ηıÒ˜ Î·È ÔÈ ÂÈÏÔΤ˜ ·˘ÙÒÓ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙË Ï··ÚÔÛÎÔÈ΋ ·ÓÙÈÌÂÙÒÈÛË (1,2,5,12,13). ™ÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, Ë Î‡ÛÙË Â›¯Â ‰È·ÛÙ¿ÛÂȘ 12,8x10x8 cm ÂÍÔÚÌÒÌÂÓË ·fi ÙÔ ‰ÂÍÈfi ÂÍ¿ÚÙËÌ· Ù˘ Ì‹ÙÚ·˜, ·ÚÔ˘Û›·˙ ÂÈÎfiÓ· ·Ú·ÌÂÏË̤Ó˘ Û˘ÛÙÚÔÊ‹˜ Ì ӤÎÚˆÛË Ù˘ Û‡ÛÙÔȯ˘ Û¿ÏÈÁÁ·˜ Î·È Û˘ÌʇÛÂȘ Ì ÙÔ Ì›˙ÔÓ Â›ÏÔ˘Ó Î·È ÙÔÓ ÔÚÔÁfiÓÔ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ÙÔȯˆÌ¿ÙˆÓ. OÈ Ï··ÚÔÛÎÔÈÎÔ› ¯ÂÈÚÈÛÌÔ› ·ÔÎfiÏÏËÛ˘ ÙÔ˘ Ì›˙ÔÓÔ˜ ÂÈÏfiÔ˘, Ë ÎÈÓËÙÔÔ›ËÛË Ù˘ ·ÛÙ˘ Î·È Ë ÂÎÙÔÌ‹ ·˘Ù‹˜ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ȉȷ›ÙÂÚË ‰˘ÛÎÔÏ›·.

∂ÈÎfiÓ· 2. §··ÚÔÛÎÔÈ΋ ÚÔÛ¤Ï·ÛË. ŒÓıÂÙ·: Ù¤ÛÛÂÚȘ ÂÈÎfiÓ˜ ·fi ÙË Ï··ÚÔÛÎÔÈ΋ ·Ó·ÁÓÒÚÈÛË Î·È ·Ê·›ÚÂÛË ÙÔ˘ ΢ÛÙÈÎÔ‡ ÌÔÚÊÒÌ·ÙÔ˜.


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∆Ô ÂÚȯfiÌÂÓÔ Ù˘ ·ÛÙ˘ ÂÎÎÂÓÒıËΠ̠·Ó·ÚÚfiÊËÛË, Ë ‰Â ÎÂÓ‹ ·ÛÙË ·Ê·ÈÚ¤ıËΠ·fi ÙËÓ ‡ÂÏÔ Ï··ÚÔÛÎÔÈÎÒ˜ Ì ۿÎÔ ÂÚÈÛ˘ÏÏÔÁ‹˜ ÔÚÁ¿ÓˆÓ. ∆· ΢ÛÙÈο ÌÔÚÊÒÌ·Ù· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ï··ÚÔÛÎÔÈÎÒ˜, ‰ÈfiÙÈ Û ۯ¤ÛË Ì ÙË Ï··ÚÔÙÔÌ›· ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ô ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi˜ fiÓÔ˜, ÌÂÈÒÓÂÙ·È Ô ¯ÚfiÓÔ˜ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÓÔÛËÏ›·˜ Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ï‡ÙÂÚÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. O ̤ÛÔ˜ fiÚÔ˜ ÓÔÛËÏ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÓÔÈÎÙ‹ ÂÁ¯Â›ÚËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î‡ÛÙÂˆÓ ÙˆÓ ÂÍ·ÚÙËÌ¿ÙˆÓ Ù˘ Ì‹ÙÚ·˜ ‹Ù·Ó 6 Ë̤Ú˜, ÂÓÒ Ë ·ÛıÂÓ‹˜ Ô˘ ·ÓÙÈÌÂÙˆ›Û·Ì Ϸ·ÚÔÛÎÔÈÎÒ˜ ÂÍ‹Ïı ÙË 2Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ. ∏ Ï··ÚÔÛÎÔÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ¤¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË, ÙfiÛÔ ÛÙË ‰È¿ÁÓˆÛË fiÛÔ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Î·ÏÔ‹ıˆÓ ·ÛÙÂˆÓ ÙˆÓ ¤Ûˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙˆÓ ıËϤˆÓ. 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

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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›· ¤ÁÎÚÈÛ˘: 18-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∂˘¿ÁÁÂÏÔ˜ ¶··Ó‰Ú¤Ô˘ ∆ÚÈfiψ˜ 1, 151 27, ªÂÏ›ÛÛÈ·

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

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CASE REPORT

°ÂÓÈÎÂ˘Ì¤ÓÔ˜ ٤ٷÓÔ˜ Û ·È‰› ÛÙËÓ ∂ÏÏ¿‰· ÙÔ ¤ÙÔ˜ 2000 ¢. ∫·Ú·Î·˚‰fi˜, °. ∆ÚÈ·ÓÙ·Ê˘ÏÏ›‰Ë˜, ∞. ªÔ˘Ù¿ÊË, §. ∫·Ó¿Ú˘, ¶. ∑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

¶ÂÚ›ÏË„Ë: O ٤ٷÓÔ˜ ·ÔÙÂÏ› ÛÔ‚·Ú‹, ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚo ÓfiÛÔ, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚÙÔÓ›· Î·È Û·ÛÌÔ‡˜ Î·È ÔÊ›ÏÂÙ·È ÛÙË Ó¢ÚÔÙÔÍ›ÓË ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ ÙÔ˘ ÙÂÙ¿ÓÔ˘, ÙÂÙ·ÓÔÛ·ÛÌ›ÓË. O ÂÎÙÂٷ̤ÓÔ˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤¯ÂÈ Û¯Â‰fiÓ ÂÎÌˉÂÓ›ÛÂÈ ÙȘ ÂÚÈÙÒÛÂȘ ÙÂÙ¿ÓÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÛÙË ¯ÒÚ· Ì·˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ ÙÂÙ¿ÓÔ˘ Û ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ, ·ÓÂÌ‚ÔÏ›·ÛÙÔ, ÌÂÙ¿ ·fi ÙÚ·‡Ì· ÛÙÔ ‰ÂÍÈfi ¿ÎÚÔ fi‰·. ∆Ô ·È‰› ·ÚÔ˘Û›·Û ۯ‰fiÓ Ï‹ÚË ·Ó¿ÚÚˆÛË 2 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. ∞Ó·ÛÎÔÂ›Ù·È Ë ‰ÈÂıÓ‹˜ Î·È ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, ΢ڛˆ˜ ˆ˜ ÚÔ˜ ÙËÓ ÂȉËÌÈÔÏÔÁ›· Î·È ÙËÓ ÚfiÏË„Ë Ù˘ ÓfiÛÔ˘.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ٤ٷÓÔ˜, ·È‰È΋ ËÏÈΛ·, ÂȉËÌÈÔÏÔÁ›·, ·ÓÙÈÙÂÙ·ÓÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜.

Key words: tetanus, childhood, epidemiology, vaccination against tetanus.

∂ÈÛ·ÁˆÁ‹ O ٤ٷÓÔ˜ Â›Ó·È Ó¢ÚÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÍË̤ÓÔ Ì˘˚Îfi ÙfiÓÔ, Û·ÛÌÔ‡˜ Î·È ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÙÂÙ·ÓÔÛ·ÛÌ›ÓË, Ì›· ÈÛ¯˘ÚfiÙ·ÙË Ó¢ÚÔÙÔÍ›ÓË Ô˘ ·Ú¿ÁÂÙ·È ·fi ÙÔ ÎψÛÙËÚ›‰ÈÔ ÙÔ˘ ÙÂÙ¿ÓÔ˘ (1). ¢È·ÎÚ›ÓÔ˘Ì ‰È¿ÊÔÚ˜ ÎÏÈÓÈΤ˜ ÌÔÚʤ˜ ÙÂÙ¿ÓÔ˘, fiˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˜, ÂÓÙÔÈṲ̂ÓÔ˜, ÓÂÔÁÓÈÎfi˜. ∏ ÓfiÛÔ˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ıÓËÛÈÌfiÙËÙ·˜, ȉ›ˆ˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÂÓÒ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÂÎÙÂÙ·Ì¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤¯ÂÈ ÂÚÈÔÚÈÛÙ› ÛËÌ·ÓÙÈο Î·È Ôχ Û¿ÓÈ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÎÚÔ‡ÛÌ· ÙÂÙ¿ÓÔ˘ Û ·È‰› (1-6).

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ 4 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÁÈ·Ù› ·fi 24ÒÚÔ˘ ÂÌÊ¿ÓÈ˙ ·‰˘Ó·Ì›· ‰È¿ÓÔÈ͢ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ÂÏÌ·ÙÈ·›· Î¿Ì„Ë Î¿Ùˆ ¿ÎÚˆÓ, ȉ›ˆ˜ ‰ÂÍÈ¿. ¢¤Î· ÂÚ›Ô˘ ̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È ÙÚ·˘Ì·ÙÈÛÌfi˜ ÛÙËÓ ÂÏÌ·ÙÈ·›· ¯ÒÚ· ÙÔ˘ ‰ÂÍÈÔ‡ οو ¿ÎÚÔ˘ ÁÈ· ÙÔÓ ÔÔ›Ô ‰ÂÓ ˘‹ÚÍ η̛· ·ÓÙÈÌÂÙÒÈÛË. ¢ÂÓ ·Ó·Ê¤ÚÂÙ·È, Â›Û˘, Ï‹„Ë ÔÔÈÔ˘‰‹ÔÙ ʷÚÌ¿ÎÔ˘. ∏ ÌÈÎÚ‹ ·ÛıÂÓ‹˜, fiˆ˜ Î·È Ù· ¿ÏÏ· 8 ·‰¤ÏÊÈ· Ù˘, ·ı›ÁÁ·ÓÔÈ ÛÙËÓ Î·Ù·ÁˆÁ‹, ‹Ù·Ó Ï‹Úˆ˜ ·ÓÂÌ‚ÔÏ›·ÛÙË. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ·È‰ÈÔ‡ ¤ˆ˜ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È Ê˘ÛÈÔÏÔÁÈ΋, ÂÓÒ ÙÔ ˘fiÏÔÈÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∏ ÎÏÈÓÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ¤Ó· ·È‰›

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

Pediatric Department of General Hospital “Agios Panteleimon”, Nikea-Piraeus

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‰˘ÛÙÚÔÊÈÎfi Ì ‡„Ô˜ 88 cm (<3 ∂£), ‚¿ÚÔ˜ 12 kg (<3 ∂£), ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 44 cm (<3 ∂£) Î·È ·ÚÔ˘Û›·˙ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ·‰˘Ó·Ì›· ‰È¿ÓÔÈ͢ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Ì ·ÔÎ¿Ï˘„Ë ÙˆÓ Ô‰fiÓÙˆÓ ÏfiÁˆ Û·ÛÌÔ‡ ÙˆÓ Ì·ÛËÙ‹ÚˆÓ (Û·Ú‰fiÓÈÔ˜ Á¤ÏˆÙ·˜), ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›· Ì˘ÒÓ, ȉ›ˆ˜ Ù˘ Ú¿¯Ë˜ Ì ÔÈÛıfiÙÔÓÔ (∂ÈÎfiÓ· 1), ¤ÎÙ·ÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Ì ÂÏÌ·ÙÈ·›· Î¿Ì„Ë È‰›ˆ˜ ‰ÂÍÈ¿ (∂ÈÎfiÓ· 2), ¯·›ÓÔÓ, Ú˘·Úfi ÙÚ·‡Ì· ÛÙËÓ ÂÏÌ·ÙÈ·›· ÂÈÊ¿ÓÂÈ· ÙÔ˘ ‰ÂÍÈÔ‡ 3333 οو ¿ÎÚÔ˘. ∆Ô Â›Â‰Ô Û˘Ó›‰ËÛ˘ ‰ÂÓ ‹Ù·Ó ÂËÚ·Ṳ̂ÓÔ, ÂÓÒ ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ‹Ù·Ó Ë ÂͤٷÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ÙÔ˘ ΢ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ô ·ÎfiÏÔ˘ıÔ˜: °ÂÓÈ΋ ·›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, ÁÂÓÈ΋ Ô‡ÚˆÓ ÎÊ, ÁÂÓÈ΋ ∂¡À ÎÊ, Î/· ·›Ì·ÙÔ˜ ÛÙ›ڷ, Î/· ∂¡À ÛÙ›ڷ, PCR (ÎfiÚ·Ó·) ÁÈ· Èfi ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ·ÚÓËÙÈ΋, MRI ÂÁÎÂÊ¿ÏÔ˘ ÎÊ. ªÂ ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ 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˘˚ο 750 IU ·ÓıÚÒÈÓ˘ ÙÂÙ·ÓÈ΋˜ ·ÓÙÈÙÔ͛Ӣ. ∂›Û˘, ¤ÁÈÓ ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Î·È ÙÔ ·È‰› ÂÙ¤ıË Û 10‹ÌÂÚË ÂÓ‰ÔÊϤ‚È· ·ÁˆÁ‹ Ì ÂÓÈÎÈÏ›ÓË (100.000 IU/kgµ™/24h). ŒÓ·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÒÓ

¤ÁÈÓ ÙfiÛÔ ÛÙËÓ ·ÛıÂÓ‹ fiÛÔ Î·È ÛÙ· ·ÓÂÌ‚ÔÏ›·ÛÙ· ·‰¤ÏÊÈ· Ù˘. ∆Ô ·È‰› ÓÔÛËχÙËΠ۠·ÔÌÔӈ̤ÓÔ ı¿Ï·ÌÔ Ì fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÏÈÁfiÙÂÚ· ÂÚÂı›ÛÌ·Ù·, ÂÓÒ Ë Û›ÙÈÛË, ÏfiÁˆ ‰˘Û¯ÂÚÂÈÒÓ ÛÙËÓ Î·Ù¿ÔÛË, ÛÙ· ÚÒÙ· 7 ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ÓÔÛËÏ›·˜ ¤ÁÈÓ ·ÚÂÓÙÂÚÈο. ∆Ô ·È‰› ·ÚÔ˘Û›·Û ÌÈÎÚ‹ Âȉ›ӈÛË Ù· ÚÒÙ· 3-4 ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ·, Ì ·‡ÍËÛË Ù˘ ˘ÂÚÙÔÓ›·˜ Î·È ÂÈ‚¿Ú˘ÓÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ΢ڛˆ˜ ÏfiÁˆ Û˘ÛÛÒÚ¢Û˘ ÂÎÎÚÈÌ¿ÙˆÓ, ¯ˆÚ›˜ fï˜ ÂÌÊ¿ÓÈÛË ÁÂÓÈÎÂ˘Ì¤ÓˆÓ Û·ÛÌÒÓ ‹ ηٷÎÚ¿ÙËÛË Ô‡ÚˆÓ Î·È ÎÔÚ¿ÓˆÓ. ∞fi ÙÔ 6Ô 24ˆÚÔ ÓÔÛËÏ›·˜ ¿Ú¯ÈÛ ÚÔԉ¢ÙÈ΋, ‚Ú·‰Â›· ‚ÂÏÙ›ˆÛË, ÂÓÒ ·fi ÙÔ 8Ô 24ˆÚÔ ‹Ù·Ó ‰˘Ó·Ù‹ Ë ¯ÔÚ‹ÁËÛË ˘‰·ÚÒÓ ÙÚÔÊÒÓ ·fi ÙÔ ÛÙfiÌ·. ∏ ÙÈ̤˜ ÙˆÓ CPK, LDH Î·È SGOT ÌÂÈÒıËÎ·Ó ÛÙ·‰È·Î¿ Î·È ‹Ù·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ ·fi ÙÔ 25Ô 24ˆÚÔ ÓÔÛËÏ›·˜ (CPK 158 U/L, LDH 95 U/L, SGOT 37 U/L). ∆Ô ·È‰› ÂÍ‹Ïı ÌÂÙ¿ ·fi 40 Ë̤Ú˜ ÓÔÛËÏ›·˜ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ì ۯ‰fiÓ Ï‹ÚË ˘Ô¯ÒÚËÛË ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, ÂÎÙfi˜ ·fi ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ˘ÂÚÙÔÓ›· ÛÙË ‰ÂÍÈ¿ Ô‰ÔÎÓËÌÈ΋ ¿ÚıÚˆÛË. ™Â Â·ÓÂÎÙ›ÌËÛË, ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô (2,5 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘), ˘‹Ú¯Â Ï‹Ú˘ ·ÔηٿÛÙ·ÛË.

∂ÈÎfiÓ· 1. ∏ ·ÛıÂÓ‹˜ ÂÌÊ¿ÓÈ˙ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ·‰˘Ó·Ì›· ‰È¿ÓÔÈ͢ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ÔÈÛıfiÙÔÓÔ.

∂ÈÎfiÓ· 2. ∏ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ¤ÎÙ·ÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Ì ÂÏÌ·ÙÈ·›· ο̄Ë, ȉ›ˆ˜ ‰ÂÍÈ¿.

™˘˙‹ÙËÛË ∆Ô ÎψÛÙËÚ›‰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 ÔÏϤ˜ ÊÔÚ¤˜ Î·È ÙˆÓ ·ÓıÚÒˆÓ (1). ∂›Ó·È ·ÚÎÂÙ¿ ·ÓıÂÎÙÈÎÔ› ÛÙȘ Û˘Ó‹ıÂȘ ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ Û˘Óı‹Î˜ Î·È ÛÙÔ ‚Ú·ÛÌfi (3). ∆¤Ù·ÓÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi ÂÈÌfiÏ˘ÓÛË ÙÚ·‡Ì·ÙÔ˜ Ì ÛfiÚÔ˘˜ ÙÔ˘ ÎψÛÙËÚȉ›Ô˘. ∞˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ·Ú·ÙËÚÂ›Ù·È Û ÙÚ·‡Ì·Ù· Ô˘

611


¶·È‰È·ÙÚÈ΋ 2001;64:610-614

ÊÏÂÁÌ·›ÓÔ˘Ó (fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜), Ô˘ ¤¯Ô˘Ó ηÙÂÛÙÚ·Ì̤ÓÔ˘˜ ÈÛÙÔ‡˜, ͤӷ ÛÒÌ·Ù·, Â›Ó·È ‚·ıÈ¿ Î·È ÎÏÂÈÛÙ¿ Î·È ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÂÚÈ‚¿ÏÏÔÓ ¯·ÌËÏ‹˜ ›ÂÛ˘ Ô͢ÁfiÓÔ˘ Ô˘ ·ÔÙÂÏ› ȉ·ÓÈΤ˜ Û˘Óı‹Î˜ ÁÈ· ·Ó¿Ù˘ÍË ÙˆÓ ÛfiÚˆÓ Û ‚Ï·ÛÙÈΤ˜ ÌÔÚʤ˜ (1,2,6). ™˘¯Ó¿, fï˜, Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ Â›Ó·È Ù¤ÙÔÈ·˜ ‚·Ú‡ÙËÙ·˜ Ô˘ ‰ÂÓ ··ÈÙ› È·ÙÚÈ΋ ·Ú¤Ì‚·ÛË (1). O ٤ٷÓÔ˜, fï˜, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ˆ˜ ÂÈÏÔ΋ Î·È Û ¿ÏϘ ηٷÛÙ¿ÛÂȘ, fiˆ˜ ÛÙ· ‰ÂÚÌ·ÙÈο ¤ÏÎË, Ù· ·ÔÛÙ‹Ì·Ù·, ÙË Á¿ÁÁÚ·ÈÓ·, Ù· ÂÁη‡Ì·Ù·, Ù· ‰‹ÁÌ·Ù· ˙ÒˆÓ, ÙËÓ ÔÍ›· ̤ÛË ˆÙ›Ùȉ· (1), ÙÔÓ ÙÔÎÂÙfi, ÙËÓ ÂÁ¯Â›ÚËÛË Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ‹ ÌÂÙ¿ ·fi ÂÓ‰ÔÌ˘˚΋ ¯ÔÚ‹ÁËÛË (3,5). ™¿ÓÈ· ‰ÂÓ ·Ó¢ڛÛÎÂÙ·È Î·Ì›· ÂÛÙ›· (1). OÈ ‚Ï·ÛÙÈΤ˜ ÌÔÚʤ˜ ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È ÌfiÓÔ ÙÔÈο ÛÙÔ ÛËÌÂ›Ô ÂÓÔÊı·ÏÌÈÛÌÔ‡ ¯ˆÚ›˜ Ó· ‰ËÌÈÔ˘ÚÁÔ‡Ó ÊÏÂÁÌÔÓ‹ (5,6), ·Ú¿ÁÔÓÙ·˜ fï˜ ‰‡Ô ÙÔ͛Ә, ÙËÓ ·ÈÌÔÏ˘Û›ÓË Î·È ÙËÓ ÙÂÙ·ÓÔÛ·ÛÌ›ÓË, Ì›· ÈÛ¯˘ÚfiÙ·ÙË Ó¢ÚÔÙÔÍ›ÓË, ÙË ‰Â‡ÙÂÚË Û ÙÔÍÈÎfiÙËÙ· ÌÂÙ¿ ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Ù˘ ·ÏÏ·ÓÙ›·Û˘, Ì ÙËÓ ÔÔ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈΤ˜ ·Ó·ÏÔÁ›Â˜ ÛÙË ‰ÔÌ‹ (1,2). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë ı·Ó·ÙËÊfiÚ· ‰fiÛË ÁÈ· ÙÔÓ ¿ÓıÚˆÔ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 150 Ìg (2-4). ªÂÙ¿ ÙËÓ Â›ÛÔ‰Ô ÛÙÔ˘˜ ÓÂ˘Ú¿ÍÔÓ˜, Ë ÙÔÍ›ÓË ÌÂٷʤÚÂÙ·È Ì ٷ¯‡ÙËÙ· ÂÚ›Ô˘ 25 cm/24ˆÚÔ ÚÔ˜ Ù· ÚfiÛıÈ· Τڷٷ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, fiÔ˘ ÂÌÔ‰›˙ÂÈ Ù· ·Ó·ÛÙ·ÏÙÈο ÌËӇ̷ٷ ÚÔ˜ ÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ ̇˜, ÚÔηÏÒÓÙ·˜ ·Ú¯Èο ·‡ÍËÛË ÙÔ˘ Ì˘˚ÎÔ‡ ÙfiÓÔ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¤ÎÏ˘ÛË Û·ÛÌÒÓ (1,2,5). ∏ Â›‰Ú·ÛË Ù˘ ÙÔ͛Ӣ ÛÙÔ Û˘Ì·ıËÙÈÎfi Û‡ÛÙËÌ· Â›Ó·È Â˘Ô‰ˆÙÈ΋, ÚÔηÏÒÓÙ·˜ Ù·¯˘Î·Ú‰›·, ˘¤ÚÙ·ÛË, ·ÚÚ˘ı̛˜ (2,5). ∏ ·ÚÔ˘Û›· ÌÂÁ¿ÏˆÓ ÔÛÔÙ‹ÙˆÓ ÙÂÙ·ÓÔÛ·ÛÌ›Ó˘ ÛÙȘ Ó¢ÚÔÌ˘˚Τ˜ Û˘Ó¿„ÂȘ ÂÌÔ‰›˙ÂÈ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘, ÚÔηÏÒÓÙ·˜ ¤ˆ˜ Î·È ·Ú¿Ï˘ÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ Ì˘ÒÓ (2,5). Œ¯ÂÈ ·Ô‰Âȯı› Â›Û˘ Î·È ¿ÌÂÛË Â›‰Ú·ÛË Ù˘ ÙÂÙ·ÓÔÛ·ÛÌ›Ó˘ ÛÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ ̇˜ (2), ÁÂÁÔÓfi˜ Ô˘ ÂÍËÁ› ÙȘ ·˘ÍË̤Ó˜ ÙÈ̤˜ CPK ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜. ∏ ÙÔÍ›ÓË, fiÙ·Ó ÌÂٷʤÚÂÙ·È Ì¤Ûˆ Ù˘ ·ÈÌ·ÙÈ΋˜ Î·È ÏÂÌÊÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ Û ·ÔÌ·ÎÚ˘Ṳ̂ӷ Ó‡ڷ, ÚÔηÏ› ÙË ÁÂÓÈÎÂ˘Ì¤ÓË ÌÔÚÊ‹, ÂÓÒ fiÙ·Ó ·Ú·Ì¤ÓÂÈ ÛÙ· Ó‡ڷ ÏËÛ›ÔÓ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, ÚÔηÏ› ÙËÓ ÂÓÙÔÈṲ̂ÓË Ì ËÈfiÙÂÚË ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ (2). ∏ ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·Û ÁÂÓÈÎÂ˘Ì¤ÓË ÓfiÛÔ, Ì ÂÓÙÔÓfiÙÂÚË fï˜ Û˘Ìو̷ÙÔÏÔÁ›· ÏËÛ›ÔÓ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Ô˘ ÔÊÂÈÏfiÙ·Ó Èı·ÓfiÓ Û ·˘ÍË̤ÓË ÔÛfiÙËÙ· ÙÂÙ·ÓÔÛ·ÛÌ›Ó˘ ÛÙËÓ ·ÓˆÙ¤Úˆ ÂÚÈÔ¯‹. ∏ ÂÌÊ¿ÓÈÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Á›ÓÂÙ·È, ÛÙÔ 75% ÙˆÓ ÂÚÈÙÒÛˆÓ, Û ¯ÚfiÓÔ ·fi 3 ¤ˆ˜ 14 Ë̤Ú˜ ÌÂÙ¿ ÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi, ÛÙÔ 10% Û ¯ÚfiÓÔ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 14 ËÌÂÚÒÓ Ô˘ ÌÔÚ› Ó· Â›Ó·È Î·È Ì‹Ó˜, ÂÓÒ ÛÙÔ 15% Û ¯ÚfiÓÔ

612

Paediatriki 2001;64:610-614

ÌÈÎÚfiÙÂÚÔ ÙˆÓ 3 ËÌÂÚÒÓ (1). ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Ù›ıÂÙ·È ‚¿ÛÂÈ Ù˘ ¯·Ú·ÎÙËÚÈÛÙÈ΋˜ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÙÔ˘ ÌË ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È ÙÔ˘ ÚfiÛÊ·ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌÔ‡ (1,2,5,6), fiˆ˜ ¤ÁÈÓ ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜. ∏ ·ÔÌfiÓˆÛË ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ Á›ÓÂÙ·È ÌfiÓÔ ÛÙÔ 1/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ (1,3,4), ÂÓÒ ·ÓÙ›ıÂÙ·, Ë ·Ó‡ÚÂÛ‹ ÙÔ˘ fiÙ·Ó ‰ÂÓ Û˘Óԉ‡ÂÙ·È Ì ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‰ÂÓ ÛËÌ·›ÓÂÈ Û η̛· ÂÚ›ÙˆÛË ·Ó¿Ù˘ÍË ÙÂÙ¿ÓÔ˘ (1,3). O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÓfiÛÔ˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù·, fiˆ˜ Â›Û˘ ÂȉÈο Â˘Ú‹Ì·Ù· ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ ∏∫° Î·È ÛÙÔ ∏ª° (3,4). OÈ Î·Ù·ÛÙ¿ÛÂȘ Ô˘ Ú¤ÂÈ Ó· ‰È·ÊÔÚԉȷÁÓˆÛÙÔ‡Ó ·fi ÙÔÓ Ù¤Ù·ÓÔ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Â›Ó·È ÔÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙÔ ÔÈÛıÔÊ·Ú˘ÁÁÈÎfi Î·È ·Ú·Ê·Ú˘ÁÁÈÎfi ·fiÛÙËÌ·, Ë ÔÏÈÔÌ˘ÂÏ›Ùȉ·, Ë Ï‡ÛÛ·, Ë ‰˘ÛÙÔÓÈ΋ ·ÓÙ›‰Ú·ÛË ÛÙË Ê·ÈÓÔıÂÈ·˙›ÓË Î·È ÛÙË ÌÂÙÔÎÏÔÚÔ·Ì›‰Ë Î·È Ë ˘·Û‚ÂÛÙÈ·ÈÌ›· (3,5). OÈ ·Ú·¿Óˆ ηٷÛÙ¿ÛÂȘ ‡ÎÔÏ· ·ÔÎÏ›ÛÙËÎ·Ó ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙËÓ ÔÚ›· Î·È ÙÔÓ ·Ú¯ÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. O ٤ٷÓÔ˜ Â›Ó·È ÓfiÛÔ˜ ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚÔ˜. ∏ ıÓËÙfiÙËÙ¿ ÙÔ˘ ¤¯ÂÈ ÌÂȈı› ÛËÌ·ÓÙÈο ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ΢ڛˆ˜ ÏfiÁˆ Ù˘ ‚ÂÏÙ›ˆÛ˘ ÙˆÓ Û˘ÓıËÎÒÓ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ (1,3) (ÛÙȘ ∏¶∞, Ë ıÓËÙfiÙËÙ· ·fi 66% ÙË ‰ÂηÂÙ›· ÙÔ˘ ’50 ÌÂÈÒıËΠÛÙȘ ̤Ú˜ Ì·˜ ÛÙÔ 26-31%, ÂÓÒ ÛÙË ¯ÒÚ· Ì·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·Ó·Ê¤ÚÂÙ·È ıÓËÙfiÙËÙ· 20,5%) (4,7). ™ËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ·Ó¿ÌÂÛ· ÛÙȘ ‰È¿ÊÔÚ˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘, Ì ÙË ıÓËÙfiÙËÙ· Ó· Â›Ó·È ÌÈÎÚfiÙÂÚË ÙÔ˘ 1% ÛÙËÓ ÂÓÙÔÈṲ̂ÓË ÌÔÚÊ‹, ÂÓÒ ÛÙÔ ÓÂÔÁÓÈÎfi ٤ٷÓÔ Ó· ÍÂÂÚÓ¿ ÙÔ 60% (4). ¢˘ÛÌÂÓ‹ ÚÔÁÓˆÛÙÈο ÛËÌ›· ·ÔÙÂÏÔ‡Ó Ë ÌÈÎÚ‹ Î·È Ë ÌÂÁ¿ÏË ËÏÈΛ·, ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÈÎÚfiÙÂÚÔ ÙˆÓ 7 ËÌÂÚÒÓ ·Ó¿ÌÂÛ· ÛÙÔÓ ÙÚ·˘Ì·ÙÈÛÌfi Î·È ÛÙÔÓ ÙÚÈÛÌfi Î·È ÌÈÎÚfiÙÂÚÔ ÙˆÓ 3 ËÌÂÚÒÓ ·Ó¿ÌÂÛ· ÛÙÔÓ ÙÚÈÛÌfi Î·È ÙËÓ ÂÌÊ¿ÓÈÛË Û·ÛÌÒÓ, ÂÓÒ ·ÓÙ›ıÂÙ·, ηχÙÂÚË ÚfiÁÓˆÛË ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÓÙÔÈṲ̂ÓË ÌÔÚÊ‹ (14). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ Â¤Ú¯ÂÙ·È Ô ı¿Ó·ÙÔ˜, ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ¤¯Ô˘ÌÂ Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi 4-6 ‚‰ÔÌ¿‰Â˜ (1), ¯ÚfiÓÔ˜ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· ÙËÓ ·Ó·Á¤ÓÓËÛË ÙˆÓ Û˘Ó¿„ˆÓ, ηı’ fiÙÈ Ë Û‡Ó‰ÂÛË Ù˘ ÙÂÙ·ÓÔÛ·ÛÌ›Ó˘ Ì ·˘Ù¤˜ Â›Ó·È ÌË ·Ó·ÛÙÚ¤„ÈÌË (2,4). ¶Ï‹Ú˘ ·Ó¿ÚÚˆÛË Â¤Ú¯ÂÙ·È ·ÎfiÌ· ·ÚÁfiÙÂÚ·, ·ÊÔ‡ ÂÚ›Ô˘ ÙÔ 1/2 ÙˆÓ ÂÈ˙ÒÓÙˆÓ ·ÚÔ˘Û›·˙ÂÈ, 6 Ì‹Ó˜ ¤ˆ˜ 1 ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, Ì˘ÔÎÏÔӛ˜ Î·È ÂÂÈÛfi‰È· Û·ÛÌÒÓ (ÂÚ›Ô˘ 1 ÂÂÈÛfi‰ÈÔ Î¿ı 2 Ì‹Ó˜), ÂÓÒ ÙÔ 1/3 ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ ¤ˆ˜ Î·È 3 ¯ÚfiÓÈ· ÌÂÙ¿ (1,2). ∏ ÂȉËÌÈÔÏÔÁ›· ÙÔ˘ ÙÂÙ¿ÓÔ˘ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο ·Ó¿ÌÂÛ· ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ηÈ


¶·È‰È·ÙÚÈ΋ 2001;64:610-614

Û˘ ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ 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›· Ù˘ ™Ù·ÙÈÛÙÈ΋˜ ∫ÔÈÓˆÓÈ΋˜ ¶ÚfiÓÔÈ·˜ Î·È ÀÁÈÂÈÓ‹˜ Ù˘ ∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀËÚÂÛ›·˜ (·ÚÈıÌfi˜ ÂÍÂÏıfiÓÙˆÓ ·ÛıÂÓÒÓ Ì ‰È¿ÁÓˆÛË ÙÂÙ¿ÓÔ˘) (11). OÈ ·Ú·ÙËÚÔ‡ÌÂÓ˜ ‰È·ÊÔÚ¤˜ Èı·ÓfiÓ Ó· ÔÊ›ÏÔÓÙ·È ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi ÙÚfiÔ Î·Ù·ÁÚ·Ê‹˜ Ô˘ ·ÎÔÏÔ˘ı› οı ËÁ‹. ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ÂÎÙfi˜ ·fi ÙËÓ ·ÛıÂÓ‹ Ì·˜, ¤¯Ô˘Ó ηٷÁÚ·Ê› ¿ÏϘ 6 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ÙËÓ ÂÚ›Ô‰Ô 1991-1995 (11). ∆Ô ¤ÙÔ˜ 2000, fiϘ ÔÈ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ¿ÙÔÌ· ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 53 ÂÙÒÓ (9). ¶·Ú¿ ÙÔ ÛËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ ÓfiÛÔ˘ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, Ë ÚÔÛ¿ıÂÈ· ÂÎÚ›˙ˆÛ‹˜ Ù˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ‰˘ÛÎÔϛ˜: ·) ÙÔ ÎψÛÙËÚ›‰ÈÔ Â›Ó·È Â˘Ú‡Ù·Ù· ‰È·‰Â‰Ô̤ÓÔ ÛÙË Ê‡ÛË, ‚) Ë Ê˘ÛÈ΋ ·ÓÔÛ›·, ·ÎfiÌ· Î·È ÌÂÙ¿ ·fi ÓfiÛËÛË, Â›Ó·È Û¯Â‰fiÓ ·Ó‡·ÚÎÙË (5,10), ·ÊÔ‡ ÂÏ¿¯ÈÛÙË ÔÛfiÙËÙ· ÙÂÙ·ÓÔÛ·ÛÌ›Ó˘ Â·ÚΛ Ó· ÚÔηϤÛÂÈ ÓfiÛÔ, fi¯È fï˜ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË (1), Á) ‰ÂÓ ˘¿Ú¯ÂÈ ·ÓÔÛ›· ·Á¤Ï˘ 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 ‚·ÛÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Â›Ó·È ·ÚÔ‰È΋ (6) (ÛÙȘ ∏¶∞, ÔÛÔÛÙfi 88% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 6 ¤ˆ˜ 11 ÂÙÒÓ ¤¯ÂÈ Â·Ú΋ Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÌfiÓÔ 27% ÙˆÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 70 ÂÙÒÓ, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ·Ó·Ê¤ÚÂÈ ÈÛÙÔÚÈÎfi ÂÌ‚ÔÏÈ·ÛÌÔ‡) (1). ∆· ·Ú·¿Óˆ ηıÈÛÙÔ‡Ó ·Ó·Áη›· ÙË ‰ÈÂÓ¤ÚÁÂÈ· Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂˆÓ Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜. O ·ÓÙÈÙÂÙ·ÓÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ˘Ô¯ÚˆÙÈÎfi˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ÁÂÓÈο ÎÚ›ÓÂÙ·È ˆ˜ ÂÈÙ˘¯‹˜: ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 98% ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ ¤¯ÂÈ Î·Ï˘Êı› ∂∫∂¶∞¶ ¶ÂÚÈÙÒÛÂȘ ÙÂÙ¿ÓÔ˘

·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ™ÙȘ ÚÒÙ˜, Ô Ù¤Ù·ÓÔ˜ Î·È È‰›ˆ˜ Ë ÓÂÔÁÓÈ΋ ÙÔ˘ ÌÔÚÊ‹ ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜: ÂÚ›Ô˘ 500.000 ÓÂÔÁÓ¿ Âı·›ÓÔ˘Ó Î¿ı ¯ÚfiÓÔ (ÙÔ 80% Û 12 ÙÚÔÈΤ˜ ¯ÒÚ˜ Ù˘ ∞Û›·˜ Î·È Ù˘ ∞ÊÚÈ΋˜) (1,3,4). ∞fi ÙË ÓfiÛÔ, Â›Û˘, Âı·›ÓÔ˘Ó Î¿ı ¯ÚfiÓÔ 15.000-30.000 Á˘Ó·›Î˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi (3). ∏ ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÓÂÔÁÓÈÎÔ‡ ÙÂÙ¿ÓÔ˘ ÛÙȘ ¯ÒÚ˜ ·˘Ù¤˜ ÂÍËÁÂ›Ù·È ·fi ÙȘ ηΤ˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ ηٿ ÙÔÓ ÙÔÎÂÙfi Î·È ÙÔÓ ·ÓÂ·Ú΋ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ Á˘Ó·ÈÎÒÓ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜ (4). ∂›Û˘, ÙÔ ıÂÚÌfi Î·È ˘ÁÚfi Îϛ̷ ÛÙȘ ¯ÒÚ˜ ·˘Ù¤˜ Ê·›ÓÂÙ·È Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·˘ÍË̤ÓË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘, ›Ù ¢ÓÔÒÓÙ·˜ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÎψÛÙËÚȉ›Ô˘, ›Ù ·˘Í¿ÓÔÓÙ·˜ ÙËÓ Èı·ÓfiÙËÙ· ÁÈ· ¤ÎıÂÛË Û ·˘Ùfi (4). ∞ÓÙ›ıÂÙ·, Ù· ÂÎÙÂٷ̤ӷ ÚÔÁÚ¿ÌÌ·Ù· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ¤¯Ô˘Ó ÂÚÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ· Û ·˘Ù¤˜ Î·È ÔÈ Ï›Á˜ ÂÚÈÙÒÛÂȘ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ¿ÙÔÌ· ÌÂÁ¿Ï˘ ËÏÈΛ·˜. ™ÙȘ ∏¶∞ ·Ó·Ê¤ÚÔÓÙ·È ÂÚ›Ô˘ 50 ÂÚÈÙÒÛÂȘ οı ¯ÚfiÓÔ (3,6), ·fi ÙȘ Ôԛ˜ ÙÔ 95% Â›Ó·È ¿ÙÔÌ· ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 20 ÂÙÒÓ Î·È ÙÔ 53% ÌÂÁ·Ï‡ÙÂÚ˘ 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ÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙ› Ôχ Û¿ÓÈ· Û ¿ÙÔÌ· Ï‹Úˆ˜ ÂÌ‚ÔÏÈ·Ṳ̂ӷ (ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÂÚÈÙÒÛˆÓ) (6,8), ÛÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ·ÊÔÚ¿ ¿ÙÔÌ· Ô˘ ›Ù ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙ› (fiˆ˜ Ë ·ÛıÂÓ‹˜ Ì·˜), ›Ù ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·ÛÙ› ÌÂÚÈÎÒ˜, ›Ù ¤¯Ô˘Ó οÓÂÈ ÙÔÓ ·Ú¯ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ·ÏÏ¿ ¤¯Ô˘Ó ·ÔÙ‡¯ÂÈ Ó· ‰È·ÙËÚ‹ÛÔ˘Ó ÙËÓ ·ÓÔÛÔÁÔÓÈÎfiÙËÙ· Ì Â·Ó·ÏËÙÈΤ˜ ‰fiÛÂȘ (4,6). ™ÙËÓ ∂ÏÏ¿‰·, Ë ÂȉËÌÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È ·Ó¿ÏÔÁË ÙˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ. O ˘Ô¯ÚˆÙÈÎfi˜ ·ÓÙÈÙÂÙ·ÓÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, ȉ›ˆ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌˉÂÓÈÎfi˜ ·ÚÈıÌfi˜ ÂÚÈÙÒÛÂˆÓ ÌÂÙ¿ ÙÔ 1995 (9). ∆Ë ‰ÂηÂÙ›· ÙÔ˘ ’70, ÌfiÓÔ ÛÙË µ. ∂ÏÏ¿‰· ·Ó·Ê¤ÚÔÓÙ·È Î·Ù¿ ̤ÛÔ fiÚÔ 24 ÂÚÈÙÒÛÂȘ ÙÂÙ¿ÓÔ˘ ·Ó¿ ¤ÙÔ˜ Ì ÙÔ 63% Ó· ·ÊÔÚ¿ ÂÓËÏ›ÎÔ˘˜, ÙÔ 29% ÓÂÔÁÓ¿ Î·È ÙÔ 8% ·È‰È¿ (ÂÚ›Ô˘ 2 ÂÚÈÙÒÛÂȘ ·Ó¿ ¤ÙÔ˜) (10). ™ÙËÓ ›‰È· ÂÚÈÔ¯‹, ÔÈ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈÎÔ‡ ÙÂÙ¿ÓÔ˘ ÌÂÈÒıËÎ·Ó ·fi 18/100.000 ÁÂÓÓ‹ÛÂȘ ÛÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’70 Û 3,4/100.000 ÛÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ÂÚÈÙÒÛÂˆÓ ·Ó‹Î Û ÌÂÈÔÓÔÙÈΤ˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ (10). ™ÙÔ ™¯‹Ì· 1 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ÂÚÈÙÒÛÂȘ ÙÂÙ¿ÓÔ˘ ÛÙË ¯ÒÚ· Ì·˜ ·fi ÙÔ 1981 ¤ˆ˜ Û‹ÌÂÚ·. ∆· ÛÙÔȯ›· ÚÔ¤Ú¯ÔÓÙ·È ÙfiÛÔ ·fi ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¶·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¶·Ú¤Ì‚·-

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Ì ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ‰fiÛÂȘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (12). À¿Ú¯Ô˘Ó fï˜ ÂÈ̤ÚÔ˘˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ Âȉ¤¯ÔÓÙ·È ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË: ÌfiÓÔ ÙÔ 80% ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ Î¿ÓÂÈ 5 ‰fiÛÂȘ ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÁÈ· 4 ‰fiÛÂȘ ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ ‰ÂÓ ÍÂÂÚÓ¿ ÙÔ 69% Ì ÛÙfi¯Ô ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ OÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ ÁÈ· ÙÔ 1995 ÔÛÔÛÙ¿ ÌÂÁ·Ï‡ÙÂÚ· ÙÔ˘ 95% Î·È ÛÙȘ ‰‡Ô ηÙËÁÔڛ˜ (12). ™ÙȘ ηı˘ÛÙÂÚ‹ÛÂȘ ·˘Ù¤˜ Èı·ÓfiÓ Ó· ¤¯ÂÈ Û˘Ì‚¿ÏÂÈ Ë - Û˘¯Ó¿ ·ÚÔÁÚ·ÌÌ¿ÙÈÛÙË Î·È ¯ˆÚ›˜ Â·Ú΋ ÂÓË̤ڈÛË - ›ÛÔ‰Ô˜ ÔÏÏÒÓ Ó¤ˆÓ ÂÌ‚ÔÏ›ˆÓ, ·ÚÎÂÙ¿ ÂÎ ÙˆÓ ÔÔ›ˆÓ Ì ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓÔ fiÊÂÏÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· Û‡Á¯˘Û˘ Û ÁÔÓ›˜ 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 Û ÂȉÈΤ˜ ÔÌ¿‰Â˜ ÏËı˘ÛÌÔ‡ (·ı›ÁÁ·ÓÔÈ fiˆ˜ Ë ·ÛıÂÓ‹˜ Ì·˜ Î·È Ù· ·‰¤ÏÊÈ· Ù˘, ·ÏÏÔ‰·Ô›, ÌÔ˘ÛÔ˘ÏÌ¿ÓÔÈ) ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Û ÔÛÔÛÙfi ηٿ Ôχ ÌÈÎÚfiÙÂÚÔ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ (ÌfiÓÔ ÙÔ 28%-46% ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ·Ú·¿Óˆ ÔÌ¿‰ˆÓ ¤¯ÂÈ ÂÌ‚ÔÏÈ·ÛÙ› Ì 4 ‰fiÛÂȘ ¤ˆ˜ ÙËÓ ËÏÈΛ· 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˘ ÂӉȷʤÚÔÓ, ·ÏÏ¿ Î·È ÁÈ· Ó· ÙÔÓÈÛÙ› 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·ÓÙÈο ‚‹Ì·Ù·, ÂÓÙÔ‡ÙÔȘ, ¯ÚÂÈ¿˙ÂÙ·È Û˘Ó¯‹˜ ÚÔÛ¿ıÂÈ· ÙfiÛÔ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÔÏÈÙ›·˜, fiÛÔ Î·È ·fi ÙËÓ È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ· Ô˘ Ú¤ÂÈ Î˘Ú›ˆ˜ Ó· ÂÛÙÈ·ÛÙ› Û ÙÚÂȘ ·Ú·Ì¤ÙÚÔ˘˜: ·) ÛÙËÓ ¤ÁηÈÚË ¤Ó·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÒÓ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ‚) ÛÙËÓ ÏËÚÔÊfiÚËÛË ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Â·Ó·ÏËÙÈÎÒÓ ‰fiÛÂˆÓ Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜ Î·È Á) ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ ÂȉÈÎÒÓ 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

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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·ÓÈÒÙ˘ ¡, ∫·Ú¿ıÈÔ˜ £ Î·È Û˘Ó. ¶·È‰È·ÙÚÈ΋. ∞ı‹Ó·: π·ÙÚÈΤ˜ ∂ΉfiÛÂȘ §›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·ÙÈ΋˜ £ÂÚ·›·˜. ¢¤Î· ¯ÚfiÓÈ· ÂÌÂÈÚ›·˜. π·ÙÚÈ΋ 1996;69:413-417. 8. Vinson DR. Immunisation does not rule out tetanus. BMJ 2000;320:383. 9. ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¶·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¶·Ú¤Ì‚·Û˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ & ¶ÚfiÓoÈ·˜ (∂∫∂¶∞¶). ∫·Ù·ÁÂÁÚ·Ì̤Ó˜ ÂÚÈÙÒÛÂȘ ÙÂÙ¿ÓÔ˘ ÛÙËÓ ∂ÏÏ¿‰· ÙËÓ ÂÚ›Ô‰Ô 1981-2000 (ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·). 10. ª¿ÓÈÔ˜ ™°. ∆¤Ù·ÓÔ˜. ™ÙÔ: ¶ÚfiÔ‰ÔÈ ÛÙËÓ ¶·È‰È·ÙÚÈ΋. University Studio Press; 1985. ÛÂÏ. 35-39. 11. ™Ù·ÙÈÛÙÈ΋ ∫ÔÈÓˆÓÈ΋˜ ¶ÚfiÓÔÈ·˜ Î·È ÀÁÈÂÈÓ‹˜, ÂÙ‹ÛÈ· ‰ÂÏÙ›· (1981-1995), ∂.™.À.∂., ∞ı‹Ó·. 12. ¶·Ó·ÁȈÙfiÔ˘ÏÔ˜ ∆, µ·Ï¿ÛÛË-∞‰¿Ì ∂. ŒÎıÂÛË. ¶·ÓÂÏÏ·‰È΋ ªÂϤÙË ∫·Ù¿ÛÙ·Û˘ ∂Ì‚ÔÏÈ·ÛÌÔ‡. ∞ı‹Ó·: πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, 1998.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-04-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-09-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚ›ÛÙÔ˜ ∫·Ú‹˜ ¶·È‰›·ÙÚÔ˜-¢È¢ı˘ÓÙ‹˜ ∑·Î‡ÓıÔ˘ 2, ÷ϿӉÚÈ


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Paediatriki 2001;64:615-617

CASE REPORT

¡ÂÔÁÓfi Ì ÛÂÈÚËÓÔÌÂÏ›·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ∫ÔڷοÎË1, ∂. ÷Ù˙ˉ¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ª. ªËÙÛ¿ÎË1, ¢. ™ÂÌÂÚÙ˙¿Î˘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 “Û‡Ó‰ÚÔÌÔ ÁÔÚÁfiÓ·˜”, ·ÔÙÂÏ› Ì›· ÂÍ·ÈÚÂÙÈο 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˘Û˜ ·ÓˆÌ·Ï›Â˜. ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È 1,5-4,2 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÁÂÓÓ‹ÛÂȘ. ∆· ÓÂÔÁÓ¿ Ì ÛÂÈÚËÓÔÌÂÏ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÔÛÙÒÓ Ù˘ ˘¤ÏÔ˘ Î·È Ù˘ ÔÛÊ˘Ô˚ÂÚ‹˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ 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›· Ó¢ÌfiÓˆÓ. ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ‰È·Ù·Ú·¯‹˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ Ù˘ ·ÁÁ›ˆÛ˘ Î·È Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ Ô˘Ú·›Ô˘ ¿ÎÚÔ˘ ÙÔ˘ ÌÂÛÔ‰¤ÚÌ·ÙÔ˜ ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ·ËÛ˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ Ì ÛÂÈÚËÓÔÌÂÏ›· Î·È Á›ÓÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË Ù˘ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·˜ Ù˘ ‰È·Ù·Ú·¯‹˜.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ÛÂÈÚËÓÔÌÂÏ›·, ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË.

Key words: sirenomelia, prenatal diagnosis.

∂ÈÛ·ÁˆÁ‹ ∏ ÛÂÈÚËÓÔÌÂÏ›· ·ÔÙÂÏ› Ì›· ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·, ·Û‡Ì‚·ÙË Ì 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˘Û˜ ÛÏ·¯ÓÈΤ˜ ·ÓˆÌ·Ï›Â˜. ∂›Ó·È Â›Û˘ ÁÓˆÛÙ‹ Î·È Û·Ó “Û‡Ó‰ÚÔÌÔ ÁÔÚÁfiÓ·˜”, fiÚÔ˜ Ô˘ ÚÔ¤Ú¯ÂÙ·È ·fi ÂÚÈÁڷʤ˜ Ì˘ıÈÎÒÓ Ï·ÛÌ¿ÙˆÓ Ù˘ ·Ú¯·ÈfiÙËÙ·˜, ÌÂ Ô˘Ú¿ „·ÚÈÔ‡ Î·È ÎÔÚÌfi ·ÓıÚÒÔ˘. ∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ¤ÁÈÓ ÙÔ 1542 ·fi ÙÔÓ Rocheus Î·È ¤ÎÙÔÙ ˘¿Ú¯Ô˘Ó ÂÏ¿¯ÈÛÙ˜ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (1). ∏ Û˘¯ÓfiÙËÙ¿ Ù˘ Â›Ó·È 1,5-4,2 ÂÚÈÙÒÛÂȘ ·Ó¿

100.000 ÁÂÓÓ‹ÛÂȘ. ¶·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·ÁfiÚÈ· Ì ·Ó·ÏÔÁ›· 2,7:1. ∆Ô 15% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ó·Ê¤ÚÂÙ·È Û ‰›‰˘Ì˜ ΢‹ÛÂȘ, Û˘¯ÓfiÙÂÚ· ÌÔÓÔ˙˘ÁˆÙÈΤ˜. ™˘Óԉ‡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·Ê› ÌfiÓÔ ‰‡Ô ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÒÓ Ì ÛÂÈÚËÓÔÌÂÏ›· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›· Ô˘ ÂÈ‚›ˆÛ·Ó (2). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ Ì ÛÂÈÚËÓÔÌÂÏ›· Î·È Á›ÓÂÙ·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË Ù˘ ‰È·Ù·Ú·¯‹˜.

1 ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ 2 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ ∞ÂÈÎfiÓÈÛ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

1 Department of Neonatology of University of Crete 2 Medical Imaging Laboratory of University of Crete

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Paediatriki 2001;64:615-617

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÓfi, ÙÔ ÚÒÙÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÌË ÂͤÏÈ͢ ÙÔ˘ ÙÔÎÂÙÔ‡. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ‹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· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∏ Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ‹Ù·Ó ·ÓÂ·Ú΋˜. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ Î·È ‰ÂÓ ·Ó·Ê¤ÚıËΠ¯Ú‹ÛË Ê·Ú̷΢ÙÈÎÒÓ ‹ ¿ÏÏˆÓ Ô˘ÛÈÒÓ ·fi ÙË ÌËÙ¤Ú·. ∆Ô ÓÂÔÁÓfi ÌÂٷʤÚıËΠÛÙÔ ÙÌ‹Ì· Ì·˜, ·fi π‰ÈˆÙÈ΋ ∫ÏÈÓÈ΋ Ù˘ ¢ڇÙÂÚ˘ ÂÚÈʤÚÂÈ·˜ ÙÔ˘ ÓËÛÈÔ‡, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘ Î·È ‚ÚÈÛÎfiÙ·Ó Û Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜. ∞fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËηÓ: ÂÈ¤‰ˆÛË ÙÔ˘ ·ÎÚÔÚÈÓ›Ô˘, ˘ÂÚÙÂÏÔÚÈÛÌfi˜, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ·˘ÙÈÒÓ Î·È ÌÈÎÚÔÁÓ·ı›· (¯·Ú·ÎÙËÚÈÛÙÈο ÚÔÛˆ›Ԣ Potter’s), Û˘ÓÂӈ̤ӷ οو ¿ÎÚ· ·fi ÙËÓ ‡ÂÏÔ ¤ˆ˜ ÙȘ Ô‰ÔÎÓËÌÈΤ˜ ·ÚıÚÒÛÂȘ, Ê˘ÛÈÔÏÔÁÈο ¿ÎÚ· fi‰È· Î·È ‰¿ÎÙ˘Ï·. OÈ ·ÚıÚÒÛÂȘ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ ‹Ù·Ó „ËÏ·ÊËÙ¤˜ ·ÌÊÔÙÂÚfiÏ¢ڷ. ∆· Û˘ÓÂӈ̤ӷ οو ¿ÎÚ· ‚Ú›ÛÎÔÓÙ·Ó ÛÂ Î¿Ì„Ë 90o ÛÙËÓ ‡ÂÏÔ. ¢È·ÈÛÙÒıËΠÂ›Û˘ ·Ô˘Û›· ÔÚıÔ‡ Î·È ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ηıÒ˜ Î·È ÌÔÓ‹Ú˘ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·. ∞fi ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, Ù· ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, Ë ‡ÂÏÔ˜ Î·È Ë ÔÛÊ˘Ô˚ÂÚ‹ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ·ÂÈÎÔÓ›ÛÙËÎ·Ó Ê˘ÛÈÔÏÔÁÈο (∂ÈÎfiÓ· 1). ∞fi ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‰È·ÈÛÙÒıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜ ηډȿ˜. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¤‰ÂÈÍ ·Ô˘Û›· ‰ÂÍÈÔ‡ ÓÂÊÚÔ‡, ˘ÔÏ·ÛÙÈÎfi ·ÚÈÛÙÂÚfi ÓÂÊÚfi Î·È ·Ô˘Û›· Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙˆ˜ (∂ÈÎfiÓ· 2). ∆Ô ÓÂÔÁÓfi η٤ÏËÍ ϛÁ˜ ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋.

™˘˙‹ÙËÛË ∏ ÛÂÈÚËÓÔÌÂÏ›· ·ÔÙÂÏ› ÙËÓ ÈÔ ÛÔ‚·Ú‹ ÂΉ‹ÏˆÛË ˘ÔÛÙÚÔÊ‹˜ ÙÔ˘ Ô˘Ú·›Ô˘ ÂÌ‚Ú˘˚ÎÔ‡ ¿ÎÚÔ˘. ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ‰È·Ù·Ú·¯‹˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ∆Ô 1961 Ô Duhamel ·Ó¤ÊÂÚ fiÙÈ ¤Ó· ¤ÏÏÂÈÌÌ· ηٿ 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¿ÊÔÚ˜ ˘Ôı¤ÛÂȘ ˆ˜ ÚÔ˜ ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ‰È·Ù·Ú·¯‹˜. ™‹ÌÂÚ· ÈÛÙ‡ÂÙ·È fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Û˘ÁÁÂÓ‹ ‰ÔÌÈ΋ ·ÓˆÌ·Ï›· Ô˘ ÔÊ›ÏÂÙ·È Û ‰È·Ù·Ú·¯‹ Ù˘ ·ÁÁ›ˆÛ˘ Î·È Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ Ô˘Ú·›Ô˘ ¿ÎÚÔ˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÛÂÈÚËÓÔÌÂÏ›·˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ¤¯ÂÈ ‰È·ÈÛÙˆı› ÌÔÓ‹Ú˘ ÔÌÊ·ÏÈ΋ ·ÚÙËÚ›·. ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ ·›Ì· ·fi ÙÔ ¤Ì‚Ú˘Ô ‰ÈÔ¯ÂÙ‡ÂÙ·È ÛÙÔÓ Ï·ÎÔ‡ÓÙ· fi¯È ̤ۈ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙȘ Ï·ÁfiÓȘ ·ÚÙËڛ˜, ·ÏÏ¿ ·fi ¤Ó· ÌÂÁ¿ÏÔ ÌÔÓ‹Ú˜ ·ÁÁÂ›Ô Ô˘ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·ÔÚÙ‹ ¤ÎÙÔ·, ÛÙËÓ ¿Óˆ ÎÔÈÏȷ΋ ÎÔÈÏfiÙËÙ·, ·ÎÚÈ‚Ò˜ οو ·fi ÙÔ ‰È¿ÊÚ·ÁÌ·. ∏ ÎÔÈÏȷ΋ ·ÔÚÙ‹ Û˘¯Ó¿ Â›Ó·È ˘ÔÏ·ÛÙÈ΋ Î·È ·ÓÒÌ·ÏË Î·È Û ÔÏϤ˜ ·fi ÙȘ ·Ó·ÊÂÚfiÌÂÓ˜ ÂÚÈÙÒÛÂȘ ‰ÂÓ ‰È·ÎÏ·‰›˙ÂÙ·È Û ÓÂÊÚÈ΋ Î·È Î¿Ùˆ ÌÂÛÂÓÙ¤ÚÈ· ·ÚÙËÚ›· ÚÈÓ ‰ÒÛÂÈ ÙÔ˘˜ ÎÏ¿‰Ô˘˜ ÙˆÓ Ï·ÁÔÓ›ˆÓ ·ÚÙËÚÈÒÓ. ∏ ·ÈÌ·ÙÈ΋ ÚÔ‹ ÛÙÔ Ô˘Ú·›Ô ¿ÎÚÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ̤ۈ ÙÔ˘ ·ÓÒÌ·ÏÔ˘ ·ÁÁÂÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘, Â›Ó·È Û·ÊÒ˜ ÌÂȈ̤ÓË 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·¯‹ Ù˘ ·ÁÁ›ˆÛ˘ ‰ÂÓ ÂÚÌËÓ‡ÂÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰ÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ÓÂÔÁÓ¿ Ì ÛÂÈÚËÓÔÌÂÏ›· (2).

∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ÛÎÂÏÂÙÔ‡, fiÔ˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È Ê˘ÛÈÔÏÔÁÈο Ù· ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, Ë ‡ÂÏÔ˜ Î·È Ë ÔÛÊ˘Ô˚ÂÚ‹ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘.

∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜, ÛÙËÓ ÔÔ›· ·ÂÈÎÔÓ›˙ÂÙ·È ·Ô˘Û›· ‰ÂÍÈÔ‡ ÓÂÊÚÔ‡ Î·È ˘ÔÏ·ÛÙÈÎfi˜ ·ÚÈÛÙÂÚfi˜ ÓÂÊÚfi˜.

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¶·È‰È·ÙÚÈ΋ 2001;64:615-617

°ÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ‰ÂÓ Èı·ÓÔÏÔÁ›ٷÈ, ηıÒ˜ ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ. ∂›Û˘, Ô ¯ÚˆÌÔÛˆÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi˜ (4). ∏ ‰È·Ù·Ú·¯‹ Ù˘ ÂÌ‚Ú˘ÔÁ¤ÓÂÛ˘ ıˆÚÂ›Ù·È fiÙÈ Û˘Ì‚·›ÓÂÈ ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ·ËÛ˘, ÌÂٷ͇ Ù˘ 28˘ Î·È Ù˘ 32˘ Ë̤ڷ˜ Î·È ·ÊÔÚ¿ ÛÙÔ Ô˘Ú·›Ô ÙÌ‹Ì· ÙÔ˘ ÌÂÛÔ‰¤ÚÌ·ÙÔ˜. OÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰ÂÓ Â›Ó·È ÁÓˆÛÙÔ›. Œ¯ÂÈ ·Ó·ÊÂÚı› ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ‰È·Ù·Ú·¯‹˜ Û ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, ηıÒ˜ Î·È Û ÓÂÔÁÓ¿ Ô˘ Ë ÌËÙ¤Ú· ÙÔ˘˜ ¤Î·Ó ¯Ú‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ. ∂›Û˘, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Û ÂÈÚ·Ì·Ùfi˙ˆ· Ì ¤ÎıÂÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ Û ÚÂÙÈÓÔ˚Îfi Ô͇ Î·È Î˘ÎÏÔʈÛÊ·Ì›‰Ë (1,3). ∏ ÛÂÈÚËÓÔÌÂÏ›· ·Ú·Ì¤ÓÂÈ Ì›· Û¿ÓÈ· ‰È·Ù·Ú·¯‹. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰È·Ù·Ú·¯‹˜ Û fiϘ ÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÈÙÒÛÂȘ, fiˆ˜ Î·È ÛÙË ‰È΋ Ì·˜, Â›Ó·È ÎÔÈÓ¿. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi Û˘Á¯ÒÓ¢ÛË ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÙÚÂȘ Ù‡ÔÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÎÙ·ÛË Ù˘ Û˘Á¯ÒÓ¢Û˘. ∏ Û˘Ì̤ÏÂÈ· “¯ˆÚ›˜ fi‰È·” Â›Ó·È Ô Û˘¯ÓfiÙÂÚÔ˜ Î·È ÈÔ Ï‹Ú˘ Ù‡Ô˜, ηıÒ˜ ˘¿Ú¯Ô˘Ó Ù· ÔÛÙ¿ ÌfiÓÔ ÙÔ˘ ÂÓfi˜ ·fi Ù· ‰‡Ô οو ¿ÎÚ·. ™ÙÔ˘˜ Ù‡Ô˘˜ “Ì ¤Ó· fi‰È” Î·È “Ì ‰‡Ô fi‰È·” ˘¿Ú¯Ô˘Ó Ù· ÔÛÙ¿ Î·È ÙˆÓ ‰‡Ô οو ¿ÎÚˆÓ Î·È ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙÔ˘˜ ˆ˜ ÚÔ˜ ÙËÓ ¤ÎÙ·ÛË Ù˘ Û˘Á¯ÒÓ¢Û˘. ™ÙÔÓ Ù‡Ô “Ì ¤Ó· fi‰È”, Ë Û˘Á¯ÒÓ¢ÛË ÂÂÎÙ›ÓÂÙ·È Î·È ÛÙ· ÔÛÙ¿ ÙÔ˘ ¿ÎÚÔ˘ Ô‰fi˜ (7). ∆· ÓÂÔÁÓ¿ Ì ÛÂÈÚËÓÔÌÂÏ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ÛÔ‚·Ú¤˜ Û˘ÓÔ‰¤˜ ·ÓˆÌ·Ï›Â˜. ™‡Ìʈӷ Ì ÌÂϤÙË ÙˆÓ Källen et al, Û ÔÛÔÛÙfi 7% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÂÈÚËÓÔÌÂÏ›·˜ Û˘Ó˘¿Ú¯Ô˘Ó ÂÏÏ›ÌÌ·Ù· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, Û 8% ·ÙÚËÛ›· ÔÈÛÔÊ¿ÁÔ˘, Û 8% ÌÂÛÔÎÔÈÏȷο Î·È ÌÂÛÔÎÔÏÈο ÂÏÏ›ÌÌ·Ù· Î·È Û 6% ·Ï·Û›· ÎÂÚΛ‰·˜ (7). ∂›Û˘, Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ·ÙÚËÛ›· ÔÚıÔ‡ Î·È ‰˘ÛÁÂÓÂÛ›· ̤¯ÚÈ ·ÁÂÓÂÛ›· ÙˆÓ ÓÂÊÚÒÓ Î·È Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙˆ˜, ÂÓÒ Ù· ÁÂÓÓËÙÈο fiÚÁ·Ó· ÌÔÚ› Ó· ·Ô˘ÛÈ¿˙Ô˘Ó. ÕÏϘ ·ÓˆÌ·Ï›Â˜ Ô˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó Ì ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ·, Â›Ó·È ·ÓˆÌ·Ï›Â˜ Ù˘ ˘¤ÏÔ˘ Î·È Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ˘‰ÚÔΤʷÏÔ˜ Î·È ÔÏ˘‰·ÎÙ˘Ï›·. OÈ Û˘ÓÔ‰¤˜ ÛÏ·¯ÓÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‰ÂÓ Â›Ó·È Û˘Ì‚·Ù¤˜ Ì ÙË ˙ˆ‹. ∏ ÂÌ‚Ú˘˚΋ ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÚÔηÏ› ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ Ô˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ˘ÔÏ·Û›· Ó¢ÌfiÓˆÓ Â˘ı‡ÓÔÓÙ·È ÁÈ· ÙË ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛË ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ (7). O ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜. ∆· ÔÛÙ¿ Î·È ÙÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÌÔÚÔ‡Ó Ó· ·Ó·ÁÓˆÚÈ-

Paediatriki 2001;64:615-617

ÛÙÔ‡Ó ˘ÂÚ˯ÔÁÚ·ÊÈο ·fi ÙË 12Ë Ì 20Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ (6). ∏ ‰È¿ÁÓˆÛË Â›Ó·È ‰‡ÛÎÔÏË, ȉȷ›ÙÂÚ· fiÙ·Ó ˘¿Ú¯Ô˘Ó Ù· ÔÛÙ¿ Î·È ÙˆÓ ‰‡Ô οو ¿ÎÚˆÓ. ∏ Û‡ÁÎÏÈÛË ÙˆÓ ÔÛÙÒÓ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ Î·È Ë ·ÌÂÙ¿‚ÏËÙË ı¤ÛË ÙÔ˘˜ Û ۯ¤ÛË Ì ÙÔ ¯ÚfiÓÔ ÂÓÈÛ¯‡ÂÈ ÙËÓ ˘fiÓÔÈ· ‡·Ú͢ Ù˘ ‰È·Ù·Ú·¯‹˜. ∆Ô ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ Ô˘ Û˘Ó˘¿Ú¯ÂÈ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÌÂÈÒÓÂÈ ÙË ‰È·ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜. ∏ ·ÂÈÎfiÓÈÛË ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ì ¤Á¯ÚˆÌÔ Doppler ·Ú¤¯ÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ (5). ∏ ·ÌÓÈÔ¤Á¯˘ÛË ÌÔÚ› Ó· Â›Ó·È ‚ÔËıËÙÈ΋ (7). ∂›Û˘, Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ÚÔÁÂÓÓËÙÈο, ‚ÔËı¿ ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∆ÔÓ›˙ÂÙ·È fiÙÈ Ë ı·Ó·ÙËÊfiÚ· ¤Î‚·ÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ÔÊ›ÏÂÙ·È ÛÙȘ Û˘ÓÔ‰¤˜ ÛÏ·¯ÓÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È fi¯È ÛÙËÓ ›‰È· ÙË ÛÂÈÚËÓÔÌÂÏ›·. O ÚÔÁÂÓÓËÙÈÎfi˜ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜, ·Ó Î·È ‰‡ÛÎÔÏÔ˜ ÏfiÁˆ ÙÔ˘ Û˘Ó˘¿Ú¯ÔÓÙÔ˜ ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ˘, Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ‰È·Ù·Ú·¯‹˜. ™Â ÂÚÈÙÒÛÂȘ ÛÔ‚·ÚÔ‡ ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ˘, ȉȷ›ÙÂÚ· fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ ·ÌÊÔÙÂÚfiÏ¢ÚË ·ÁÂÓÂÛ›· ÓÂÊÚÒÓ, Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ˘Ô„È¿˙ÂÙ·È ÙË ÛÂÈÚËÓÔÌÂÏ›· Î·È Ó· ÂϤÁ¯ÔÓÙ·È ÔÈ ÔÌÊ·ÏÈΤ˜ ·ÚÙËڛ˜ Î·È Ù· ÔÛÙ¿ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ. µÈ‚ÏÈÔÁÚ·Ê›· 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 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-10-2001 ¢È‡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

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Paediatriki 2001;64:618-623

GENERAL ISSUES

¶ÚÒÈÌË ¤ÍÔ‰Ô˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ: Ù· ˘¤Ú Î·È Ù· ηٿ Ã. ∫ÒÛÙ·ÏÔ˜

Early perinatal hospital discharge: the pros and cons C. Costalos

¶ÂÚ›ÏË„Ë: ªÂÁ¿ÏË ‰ËÌÔÛÈfiÙËÙ· ¤¯ÂÈ ‰Ôı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Ù¿ÛË Ô˘ ÂÈÎÚ·Ù› Ó· ‰›ÓÂÙ·È ÂÍÈÙ‹ÚÈÔ Û ÌËÙ¤Ú· Î·È ÓÂÔÁÓfi ̤۷ ÛÙȘ ÚÒÙ˜ 48 ÒÚ˜ ˙ˆ‹˜. OÈ ÔϤÌÈÔÈ ·˘Ù‹˜ Ù˘ Ù·ÎÙÈ΋˜ ıˆÚÔ‡Ó fiÙÈ Ë ÚÒÈÌË ¤ÍÔ‰Ô˜ ÂÁ΢ÌÔÓ› ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ ÓÂÔÁÓfi, ÏfiÁˆ ÂÏÏÈÔ‡˜ ÌÂÙ·‚ÔÏÈÎÔ‡ ÂϤÁ¯Ô˘, ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, ÂÏÏÈÔ‡˜ ÂÎ·›‰Â˘Û˘ Ù˘ ÌËÙ¤Ú·˜ ¿Óˆ ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÎÈÓ‰‡ÓÔ˘ Ó· ‰È·Ê‡ÁÂÈ ÛÔ‚·Ú‹ Ïԛ̈ÍË ‹ Û˘ÁÁÂÓ‹˜ ·ÓˆÌ·Ï›· ηıÒ˜ Î·È ÏfiÁˆ ·˘ÍË̤Ó˘ Èı·ÓfiÙËÙ·˜ ηÎÔÔ›ËÛ˘ ‹ ·Ú·Ì¤ÏËÛ˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜. ™Ù· Èı·Ó¿ ÔʤÏË ·Ó·Ê¤ÚÔÓÙ·È ÙÔ ÎÔÈÓˆÓÈÎfi Î·È ÙÔ ÔÈÎÔÓÔÌÈÎfi. ∞˘Ùfi fï˜ 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‹˜, ȉ›ˆ˜ Ë ÚÒÈÌË ¤ÍÔ‰Ô˜, ¯ˆÚ›˜ ÂÎÙ›ÌËÛË ÙˆÓ È·ÙÚÈÎÒÓ Î·È „˘¯ÔÎÔÈÓˆÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Î·È ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ‰ÂÓ ·ÔÙÂÏ› ÛˆÛÙ‹ È·ÙÚÈ΋ ÊÚÔÓÙ›‰·. ∞ÓÙ›ıÂÙ·, ÚÒÈÌË ¤ÍÔ‰Ô˜, ÂÊfiÛÔÓ Â›Ó·È Î·Ï¿ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Î·È ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ÂÈÛΤ„ÂȘ ηْ Ô›ÎÔÓ ·fi ÂÈÛΤÙÚÈ· ·‰ÂÏÊ‹ Û ÔÈÎÔÁ¤ÓÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ÌÔÚ› Ó· ‰È·ÛÊ·Ï›ÛÂÈ ÙËÓ ˘Á›· ÙÔ˘ ÓÂÔÁÓÔ‡ Ì Ôχ ÌÈÎÚfiÙÂÚÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ ηÈ, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, Ôχ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ÙËÓ ·Ú·ÙÂٷ̤ÓË ·Ú·ÌÔÓ‹ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ¤ÍÔ‰Ô˜ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ‚Ú¤ÊÔ˜, ÓÂÔÁÓfi.

Key words: hospital discharge, infant, newborn.

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

Division of Neonatology “Alexandra” General Hospital, Athens

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ª¤¯ÚÈ ÚÈÓ ·fi ÙÔ ‰Â‡ÙÂÚÔ ·ÁÎfiÛÌÈÔ fiÏÂÌÔ, Ë Ì¤ÛË ·Ú·ÌÔÓ‹ Ù˘ Á˘Ó·›Î·˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó 7-10 Ë̤Ú˜ (1). O ¯ÚfiÓÔ˜ ·˘Ùfi˜ ÌÂÈÒıËΠÚÔԉ¢ÙÈο, ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙÔÓ fiÏÂÌÔ, ÛÙȘ 3-5 Ë̤Ú˜ (2). ∏ Ù¿ÛË Ô˘ ÂÈÎÚ·Ù› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â›Ó·È Ó· ‰›ÓÂÙ·È ÂÍÈÙ‹ÚÈÔ Û ÌËÙ¤Ú· Î·È ÓÂÔÁ¤ÓÓËÙÔ Ì¤Û· ÛÙȘ ÚÒÙ˜ 48 ÒÚ˜ ˙ˆ‹˜. ∏ ÚÒÈÌË ¤ÍÔ‰Ô˜ ·Ú¯Èο ÂÊ·ÚÌfiÛÙËΠÁÈ· Á˘Ó·›Î˜ “¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘”, ‰ËÏ·‰‹ ÁÈ· ÌËÙ¤Ú˜ ˘ÁÈ›˜ ¯ˆÚ›˜ ÂÈ‚·Ú˘Ì¤ÓÔ ÈÛÙÔÚÈÎfi, ÌÔÚʈ̤Ó˜ Î·È Ì ÈηÓÔÔÈËÙÈÎfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›‰Ô. ∆Ô Ì¤ÙÚÔ ·˘Ùfi, fï˜, ÚÔԉ¢ÙÈο ÂÂÎÙ¿ıËÎÂ Î·È Û ¿ÏϘ ηÙËÁÔڛ˜ Á˘Ó·ÈÎÒÓ. ŒÙÛÈ, ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1970 Î·È 1992, Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÌÂÈÒıËΠηٿ 37%, ‰ËÏ·‰‹ ·fi 4,1 Ë̤Ú˜ Û 2,6 Ë̤Ú˜ (3). ™Â ÔÚÈṲ̂Ó˜ ‰Â, ¯ÒÚ˜ Ù˘ ¢. ∂˘ÚÒ˘, ÙÔ 35% ÂÚ›Ô˘ ÙˆÓ Á˘Ó·ÈÎÒÓ ‰ÂÓ ·Ú·Ì¤ÓÂÈ Î·ıfiÏÔ˘ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·ÊÔ‡ ÁÂÓÓÔ‡Ó Â›Ù ηْ Ô›ÎÔÓ ‹ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ Ì·È¢ÙËÚ›Ô˘. ∆· ·›ÙÈ· Ô˘ Ô‰‹ÁËÛ·Ó Û’ ·˘Ù‹ ÙË ‰Ú·ÛÙÈ΋ Ì›ˆÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ Â›¯·Ó Û·Ó ÛÙfi¯Ô ÙË Ì›ˆÛË ÙÔ˘ ÎfiÛÙÔ˘˜ Î·È ÙËÓ ÂÍÔÈÎÔÓfiÌËÛË Ì·È¢ÙÈÎÒÓ ÎÏÈÓÒÓ (4). ∞ÎÔÏÔ˘ıÔ‡Û·Ó fï˜ Î·È ÙË ÁÂÓÈ΋ Ù¿ÛË Ô˘ ˘¿Ú¯ÂÈ Û‹ÌÂÚ· Ó· ÌÂÈÒÓÂÙ·È Ô ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙ· ÓÔÛÔÎÔÌ›· ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ·fiÏ˘Ù· ··Ú·›ÙËÙÔ, ·ÎfiÌ· Î·È ÁÈ· ·ÛıÂÓ›˜ Ì ÛÔ‚·Ú¤˜ ·Ûı¤ÓÂȘ. ¶fiÛÔ Ì¿ÏÏÔÓ, ÏÔÈfiÓ, ÁÈ· ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ fiˆ˜ Â›Ó·È Ô ÌË ÂÈÏÂÁ̤ÓÔ˜ ÙÔÎÂÙfi˜. ∏ ÚÒÈÌË ¤ÍÔ‰Ô˜ ‰›ÓÂÈ ¤ÙÛÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙË Á˘Ó·›Î· Ó· ‚ÚÂı› Ù·¯‡ÙÂÚ· ÛÙË ı·ÏˆÚ‹ Î·È ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ Ù˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. OÈ ÔϤÌÈÔÈ ·˘Ù‹˜ Ù˘ Ù·ÎÙÈ΋˜ ıˆÚÔ‡Ó fiÙÈ Ë ÚÒÈÌË ¤ÍÔ‰Ô˜ ÂÁ΢ÌÔÓ› ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙÔ ÓÂÔÁÓfi ÏfiÁˆ ÂÏÏÈÔ‡˜ ÌÂÙ·‚ÔÏÈÎÔ‡ ÂϤÁ¯Ô˘, ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, ÂÏÏÈÔ‡˜ ÂÎ·›‰Â˘Û˘ Ù˘ ÌËÙ¤Ú·˜ ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ηıÒ˜ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ó· ÌË Á›ÓÂÈ ÂÁη›Úˆ˜ ·ÓÙÈÏËÙ‹ ÛÔ‚·Ú‹ Ïԛ̈ÍË ‹ Û˘ÁÁÂÓ‹˜ ·ÓˆÌ·Ï›· (5,6). ™·Ó ÂȂ‚·›ˆÛË Ù˘ ¿Ô„‹˜ ÙÔ˘˜ ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ˘ÚËÓÈÎÔ‡ ÈÎÙ¤ÚÔ˘ Î·È ·Ê˘‰¿ÙˆÛ˘ (7) Û ÓÂÔ-

Paediatriki 2001;64:618-623

ÁÓ¿ Ô˘ ÂÍ‹Ïı·Ó ÓˆÚ›˜ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·ÏÏ¿ Î·È ÙÔ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi Â·ÓÂÈÛ·ÁˆÁ‹˜ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. OÈ ˘¤ÚÌ·¯ÔÈ Ù˘ ÚÒÈÌ˘ ÂÍfi‰Ô˘ ·ÓÙÈÙ›ÓÔ˘Ó fiÙÈ Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ Â›Ó·È ·ÛÊ·Ï‹˜, ÂÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ÌËÙ¤Ú· Î·È ÓÂÔÁÓfi (¶›Ó·Î·˜ 1) (8) Î·È ÂÊfiÛÔÓ, Â›Û˘, ÏËÚÔ‡ÓÙ·È fiϘ ÔÈ ÚÔ¸Ôı¤ÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (9). ™ÙË Û˘Ó¤¯ÂÈ· ı· ·Ó·ÊÂÚıԇ̠ÂÎÙÂÓÒ˜ ÛÙ· Èı·Ó¿ ÚÔ‚Ï‹Ì·Ù·, ·ÏÏ¿ Î·È ÛÙ· ÔʤÏË Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔ·„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˜ ·ÔÙÂÏ› ÙËÓ ·ÈÙ›· ÂÈÛ·ÁˆÁ‹˜. ∞fi ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Ê·›ÓÂÙ·È fiÙÈ Ë ¤ÍÔ‰Ô˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÚÈÓ Û˘ÌÏËÚÒÛÂÈ ÙȘ 72 ÒÚ˜ ˙ˆ‹˜, ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ Û ۇÁÎÚÈÛË Ì ÓÂÔÁÓ¿ Ô˘ ·›ÚÓÔ˘Ó ÂÍÈÙ‹ÚÈÔ ÌÂÙ¿ ÙȘ 72 ÒÚ˜ ˙ˆ‹˜ (10). ŒÙÛÈ, ÔÈ Lee Î·È Û˘Ó ‚Ú‹Î·Ó fiÙÈ ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1987 Î·È 1994, fiÛÔ Ô ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂȈÓfiÙ·Ó ·fi 4,5 Û 2,7 Ë̤Ú˜, ÙfiÛÔ ·‡Í·ÓÂ Ë Û˘¯ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁ‹˜ ·fi 3,3 Û 9,3/1000 ˙ÒÓÙ· ÓÂÔÁÓ¿ (11). ∆Ô ϤÔÓ ·ÓËÛ˘¯ËÙÈÎfi ‹Ù·Ó fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ Â·ÓÂÈÛ‹¯ıËÛ·Ó Ì Â›‰· ¯ÔÏÂÚ˘ıÚ›Ó˘ ¿Óˆ ·fi 30 mg/dL ÂÙ·Ï·ÛÈ¿ÛÙËΠ·fi 0,05 Û 0,38/1000 ÁÂÓÓ‹ÛÂȘ. OÈ Catz Î·È Û˘Ó ‚Ú‹Î·Ó fiÙÈ ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1991 Î·È 1995 ηٷÁÚ¿ÊËÎ·Ó 22 ÂÚÈÙÒÛÂȘ ÙÂÏÂÈfiÌËÓˆÓ ‹ ۯ‰fiÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ó¤Ù˘Í·Ó ˘ÚËÓÈÎfi ›ÎÙÂÚÔ. ŸÏ· ›¯·Ó ¿ÚÂÈ ÂÍÈÙ‹ÚÈÔ Ì¤Û· ÛÙȘ ÚÒÙ˜ 48 ÒÚ˜ ˙ˆ‹˜ (12). ÃÚÂÈ¿˙ÂÙ·È ÏÔÈfiÓ È‰È·›ÙÂÚË ÚÔÛÔ¯‹ ÛÙÔ ı¤Ì· ÙÔ˘ ÈÎÙ¤ÚÔ˘, ÂȉÈο Û ÓÂÔÁÓ¿ Ì ·Û˘Ì‚·ÙfiÙËÙ· Rhesus Î·È ∞µO, Û ·˘Ù¿ Ì ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ G6PD, ηıÒ˜ Î·È Û ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ¤¯ÂÈ Ï¿‚ÂÈ Ô΢ÙÔΛÓË. π‰È·›ÙÂÚ· ÎÈÓ‰˘ÓÂ‡Ô˘Ó Â›Û˘ ÓÂÔÁÓ¿ ÌÂٷ͇ 37-38 ‚‰ÔÌ¿‰ˆÓ ·ËÛ˘ (13). ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ÈÎÙ¤ÚÔ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ·ÛÈÛÙ› Ë ¤ÍÔ‰Ô˜ ÙÔ˘ ÓÂÔÁÓÔ‡, ‰ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ ÎÏÈÓÈο, ·ÊÔ‡ Â›Ó·È ÁÓˆÛÙ‹ Ë ·Ó·ÍÈÔÈÛÙ›·

¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„ÈÓ Î·Ù¿ ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Ù˘ ÂÍfi‰Ô˘ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ∞fi ÙË ÌËÙ¤Ú· ñ ∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο ÚÔ‚Ï‹Ì·Ù·: ÂÏÏÈ‹˜ ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ·Ó‡·ÓÙÚË, ‰È·˙¢Á̤ÓË, Ôχ Ó·ڋ ËÏÈΛ·, ηΤ˜ ÔÈÎÔÁÂÓÂȷΤ˜ Û¯¤ÛÂȘ, ηÎÔÔ›ËÛË ñ ¶·ı‹ÛÂȘ: ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ı˘ÚÂÔÂȉÔ¿ıÂÈ·, ÎÔÏÏ·ÁÔÓÒÛÂȘ, ÙÔÍÈÓ·ÈÌ›·, „˘¯È·ÙÚÈο ÚÔ‚Ï‹Ì·Ù· ñ §‹„Ë Ê·Ú̿ΈÓ: Ó·ÚΈÙÈο, ·ÓÙȉȷ‚ËÙÈο, ·ÓÙÈÂÈÏËÙÈο, ·ÓÙÈηٷıÏÈÙÈο ñ ¶ÂÚÈÁÂÓÓËÙÈο Û˘Ì‚¿Ì·Ù·: ·ÛÊ˘Í›·, Èۯȷ΋ ÚÔ‚ÔÏ‹, ηÎÒÛÂȘ ÙÔÎÂÙÔ‡ ∞fi ÙÔ ÓÂÔÁÓfi ñ ∂Ó‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘, Ì·ÎÚÔۈ̛·

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Paediatriki 2001;64:618-623

¶›Ó·Î·˜ 2. ∂Ï¿¯ÈÛÙ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ñ ¶ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ¯ˆÚ›˜ ÂÈÏÔΤ˜ ñ ∆ÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi ηÓÔÓÈÎÔ‡ ‚¿ÚÔ˘˜, Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ ñ ∑ˆÙÈο ÛËÌ›· ÛÙ·ıÂÚ¿ ÁÈ· 12 ÒÚ˜ ñ ∫·ÓÔÓÈ΋ 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˘ ̤۷ ÛÙÔ ÚÒÙÔ 24ˆÚÔ ñ ªËÙ¤Ú· ÙÂÎÌËÚȈ̤ӷ ÈηӋ Ó· ÛÈÙ›ÛÂÈ Î·È Ó· ÊÚÔÓÙ›ÛÂÈ ÙÔ ÓÂÔÁÓfi ñ πηÓÔÔÈËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ñ OÏÔÎÏ‹ÚˆÛË ÂϤÁ¯Ô˘ ÁÈ· ÔÌ¿‰· ·›Ì·ÙÔ˜, Rhesus, Û‡ÊÈÏË ñ ¶ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ Â·ÓÂϤÁ¯Ô˘ Û 48 ÒÚ˜ ·fi ÙËÓ ¤ÍÔ‰Ô

Ù˘ ·Ï‹˜ ·Ú·Ù‹ÚËÛ˘. ∞Ó Î·È ÎÏÈÓÈο 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¿Ï˜ ‰È·Î˘Ì¿ÓÛÂȘ ˆ˜ ÚÔ˜ ÙËÓ ÂÏ¿¯ÈÛÙË ÙÈÌ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘, ÛÙËÓ ÔÔ›· Á›ÓÂÙ·È ÎÏÈÓÈο ÂÌÊ·Ó‹˜ Ô ›ÎÙÂÚÔ˜, 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‹ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ·›Ì·ÙÔ˜ (14). ŒÓ·˜ ηÏfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÁÈ· ÙËÓ Èı·Ó‹ ÂͤÏÈÍË ÙÔ˘ ÈÎÙ¤ÚÔ˘ ·ÔÙÂÏ› Ë ÙÈÌ‹ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ÙÔ ÚÒÙÔ 24ˆÚÔ ˙ˆ‹˜. ∞Ó Ë ÙÈÌ‹ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ‰ÂÓ ˘ÂÚ‚·›ÓÂÈ Ù· 5 mg, Ë Èı·ÓfiÙËÙ· Ù· Â›‰¿ Ù˘ Ó· ˘ÂÚ‚Ô‡Ó Ù· 17 mg ÛÙȘ 72 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ˙ˆ‹˜ Â›Ó·È ÌˉÂÓÈΤ˜ (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· ηχÙÂÚ˘ ÂÎÌ¿ıËÛ˘ Î·È ÂÌ¤‰ˆÛ˘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, Ë ‚È‚ÏÈÔÁÚ·Ê›· Â› ÙÔ˘ ÚÔÎÂÈ̤ÓÔ˘ 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›Ùȉ·, ·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 Ù˘ ÌËÙ¤Ú·˜ Ó· ·Ú¯›ÛÂÈ Ôχ ÓˆÚ›ÙÂÚ·, ·fi Ù· ÚÒÙ· ‰ËÏ·‰‹ ÛÙ¿‰È· Ù˘ ·ËÛ˘ Î·È Ó· Û˘Ó¯›˙ÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ·ÏÏ¿ Î·È ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·fi ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÂÈÛΤÙÚȘ ·‰ÂÏʤ˜. ¢ÂÓ ˘¿Ú¯ÂÈ ÏÔÈfiÓ ·ÌÊÈ‚ÔÏ›· fiÙÈ Ë ·ÓÂ·Ú΋˜ ÂÎ·›‰Â˘ÛË ÏfiÁˆ Ù˘ Ì›ˆÛ˘ ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜, ȉ›ˆ˜ Û ÚˆÙfiÙÔΘ ÌËÙ¤Ú˜, ÌÔÚ› Ó· ¤¯ÂÈ ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (18). ∫›Ó‰˘ÓÔ˜ ÛÔ‚·Ú‹˜ Ïԛ̈͢ ª›· ¿ÏÏË ÛÔ‚·Ú‹ ·ÓËÛ˘¯›· Â›Ó·È Ì‹ˆ˜ Ì ÙËÓ ÚÒÈÌË ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ‰ÂÓ Á›ÓÂÈ ÂÁη›Úˆ˜ ·ÓÙÈÏËÙ‹ οÔÈ· ÛÔ‚·Ú‹ Ïԛ̈ÍË. ∏ Û˘¯ÓfiÙËÙ· ÛË„·ÈÌ›·˜ ÛÙÔ ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi Â›Ó·È 1-5 ÂÚÈ-

620

¶›Ó·Î·˜ 3. ™˘¯ÓfiÙËÙ· ·ÚÓËÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÎÔ‡ ÂϤÁ¯Ô˘ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ ÙË Ï‹„Ë ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·›Ì·ÙÔ˜ ∏ÏÈΛ· ÓÂÔÁÓÔ‡ ηٿ ÙËÓ ·ÈÌÔÏË„›· (ÒÚ˜)

梉Ҙ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· (%)

<12 18-24 24-48 48-72

33 9,7 2,4 0,14

ÙÒÛÂȘ/1000 ÁÂÓÓ‹ÛÂȘ. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· Ïԛ̈͢ Â›Ó·È Ë Ú‹ÍË ı˘Ï·Î›Ô˘ ¿Óˆ ·fi 24 ÒÚ˜ (·‡ÍËÛË ÛÙÔ ‰ÂηÏ¿ÛÈÔ), Ë ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ· Ô˘ fiÙ·Ó ÚÔÛÙÂı› ÛÙË Ú‹ÍË ÙÔ˘ ı˘Ï·Î›Ô˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ Ïԛ̈͢ ηٿ 80 ÊÔÚ¤˜ (87 ÓÂÔÁÓ¿/1000 ÁÂÓÓ‹ÛÂȘ), Ë ·ÚÔ˘Û›· ˘ÚÂÙÔ‡ ÛÙË ÌËÙ¤Ú· ‹ ıÂÙÈ΋˜ ÎÔÏÈ΋˜ ηÏÏȤÚÁÂÈ·˜ ÁÈ· ÛÙÚÂÙfiÎÔÎÎÔ Ù˘ ÔÌ¿‰·˜ µ, ÙÔ ¯·ÌËÏfi Apgar score (19). ∂ÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, Ë ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÔÚÈṲ̂ÓÔ˘˜ ‰Â›ÎÙ˜ Ïԛ̈͢ ı· ηıÔÚ›ÛÔ˘Ó ÙË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ∞Ó Ë ÎÏÈÓÈ΋ ÂͤٷÛË Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ë CRP Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ Î·Ù¿ ʇÛË, ‰ÂÓ Û˘ÓÙÚ¤¯ÂÈ ÏfiÁÔ˜ ·Ú¿Ù·Û˘ Ù˘ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ÙÌ‹Ì· (20,21). ªÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· O ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ Á›ÓÂÙ·È Û fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ· ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË ÌÂÙ·‚ÔÏÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ “οÚÙ·˜” ÍÂΛÓËÛ ˆ˜ ÁÓˆÛÙfiÓ ÛÙȘ ∏¶∞ ÙÔ 1961 ·fi ÙÔ˘˜ Guthrie Î·È Susi (22). O ¤ÏÂÁ¯Ô˜ ·˘Ùfi˜ ·ÊÔÚÔ‡Û ·Ú¯Èο ÌfiÓÔ ÙË Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·, ÂÂÎÙ¿ıËΠfï˜ ÚÔԉ¢ÙÈο Î·È Û ¿ÏÏ· ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, .¯. Á·Ï·ÎÙÔ˙·ÈÌ›·, ÓfiÛÔ ÛÊÂÓ‰¿ÌÔ˘, ÔÌÔ΢ÛÙÈÓÔ˘Ú›·, ˘Ôı˘ÚÂÔÂȉÈÛÌfi. °È· ÓÔÛ‹Ì·Ù· ÛÙ·


¶·È‰È·ÙÚÈ΋ 2001;64:618-623

ÔÔ›· Ë ·Ó›¯Ó¢ÛË Ì ÙËÓ Î¿ÚÙ· Á›ÓÂÙ·È Ì¤Ûˆ Ù˘ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÂÈ¤‰ˆÓ ÔÚÈÛÌ¤ÓˆÓ ÂÓ˙‡ÌˆÓ, .¯. Á·Ï·ÎÙÔ˙Ô-1-Ô˘Úȉ˘Ï-ÙÚ·ÓÛÊÂÚ¿Û˘ ÁÈ· Á·Ï·ÎÙÔ˙·ÈÌ›·, Ô ¤ÏÂÁ¯Ô˜ Â›Ó·È ·ÍÈfiÈÛÙÔ˜ ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ ¯ÚfiÓÔ Ï‹„˘ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·›Ì·ÙÔ˜. °È· ¿ÏÏ· fï˜ ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ Ë ·Ó›¯Ó¢ÛË ÛÙËÚ›˙ÂÙ·È ÛÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ·›Ì·ÙÔ˜ Ì›·˜ ÌÂÙ·‚ÔÏÈ΋˜ Ô˘Û›·˜ (.¯. Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ÛÙË Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·) ÁÈ· Ó· Â›Ó·È ·ÍÈfiÈÛÙË Ë ÂͤٷÛË ··ÈÙÂ›Ù·È Â·Ú΋˜ ¯ÚfiÓÔ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘ÛÛˆÚ¢Ù› Ë Ô˘Û›· ·˘Ù‹ ÛÙÔ ·›Ì· Û ÈηÓÔÔÈËÙÈο Â›‰·. ŒÙÛÈ, fiˆ˜ ‰Â›¯ÓÂÈ Î·È Ô ¶›Ó·Î·˜ 3, Ë Èı·ÓfiÙËÙ· Ó· ÌËÓ ·ÓȯÓ¢ı› Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· Â›Ó·È ÌÂÁ¿ÏË, ·Ó ÙÔ ÓÂÔÁÓfi ÂͤÏıÂÈ ÙÔ˘ Ì·È¢ÙËÚ›Ô˘ ÚÈÓ Û˘ÌÏËÚÒÛÂÈ ÙȘ 48 ÒÚ˜ ˙ˆ‹˜ (23). ∞˘Ùfi˜ Â›Ó·È Î·È Ô ÏfiÁÔ˜ Ô˘ Ë ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ Û˘ÛÙ‹ÓÂÈ fiÙÈ Û οı ÓÂÔÁÓfi Ô˘ ÂͤگÂÙ·È ÚÈÓ Û˘ÌÏËÚÒÛÂÈ ÙȘ 24 ÒÚ˜ ˙ˆ‹˜ ı· Ú¤ÂÈ Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È Ô ÌÂÙ·‚ÔÏÈÎfi˜ ¤ÏÂÁ¯Ô˜ ̤۷ ÛÙȘ ÂfiÌÂÓ˜ 14 Ë̤Ú˜ ˙ˆ‹˜ (24). O ›‰ÈÔ˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ı˘ÚÂÔÂȉÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÙȘ ÚÒÙ˜ 72 ÒÚ˜ ˙ˆ‹˜ Ù· Â›‰· Ù˘ ∆3 Î·È ∆4 Â›Ó·È ˘„ËÏ¿ ÏfiÁˆ Ù˘ ˘ÂÚ¤ÎÎÚÈÛ˘ ∆SH ηٿ ÙË Á¤ÓÓËÛË. ∞˘Ùfi ‰˘Û¯ÂÚ·›ÓÂÈ ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ˘Ôı˘ÚÂÔÂȉÈÛÌÔ‡ ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜ (24). ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ OÈ ÂÚÈÛÛfiÙÂÚ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ì Â͈ÙÂÚÈο ÁÓˆÚ›ÛÌ·Ù·, .¯. Ï·ÁÒ¯ÂÈÏÔ˜, Ì˘ÂÏÔÌËÓÈÁÁÔ΋ÏË, ·ÓȯÓ‡ÔÓÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Ì ÙËÓ ÚÒÙË ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ÓÂÔÁÓÔ‡. ÕÏϘ fï˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜, .¯. ηډÈÔ¿ıÂȘ, ÓÂÊÚÔ¿ıÂȘ, ·ÙÚËۛ˜ ÂÙÈÎÔ‡, ÌÔÚ› Ó· ÌËÓ Â›Ó·È ¿ÌÂÛ· ÂÌÊ·Ó›˜ ·ÏÏ¿ Ó· ÂΉËψıÔ‡Ó ·ÚÁfiÙÂÚ·, ·ÊÔ‡ ÔÏÔÎÏËÚˆı› Ë ‰È·‰Èηۛ· ÌÂÙ¿‚·Û˘ ·fi ÙËÓ ÂÌ‚Ú˘˚΋ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. À¿Ú¯ÂÈ, ÂÔ̤ӈ˜, Ô Êfi‚Ô˜ ·Ó ÙÔ ÓÂÔÁÓfi ÂͤÏıÂÈ ÓˆÚ›˜ ÚÔÙÔ‡ ÔÏÔÎÏËÚˆı› Ë ÌÂÙ·‚·ÙÈ΋ ÂÚ›Ô‰Ô˜, Ó· ÍÂʇÁÂÈ Î¿ÔÈ· Û˘ÁÁÂÓ‹˜ ·ÓˆÌ·Ï›·. OÈ Moss Î·È Û˘Ó (25) ÂÍ¤Ù·Û·Ó ÙËÓ ·Í›· Ì›·˜ ‰Â‡ÙÂÚ˘ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙËÓ ·Ó›¯Ó¢ÛË Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. µÚ‹Î·Ó, ÏÔÈfiÓ, fiÙÈ ÂÓÒ Ì ÙËÓ ÚÒÙË ÂͤٷÛË ·ÓȯÓ‡ıËÎ·Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ 8,8% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, Ì ÙË ‰Â‡ÙÂÚË ÂͤٷÛË ·ÓȯÓ‡ıËÎ·Ó ÂÈϤÔÓ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Û ¿ÏÏÔ ¤Ó· 4,4% ÙˆÓ ÓÂÔÁÓÒÓ. OÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó fiÙÈ 7 ·fi ÙȘ 63 ·ÓˆÌ·Ï›Â˜ Ô˘ ·ÓȯÓ‡ıËÎ·Ó Ì ÙË ‰Â‡ÙÂÚË ÂͤٷÛË Í¤Ê˘Á·Ó ·fi ÙËÓ ÚÒÙË. ∞fi ·˘Ù¤˜, Ù¤ÛÛÂÚȘ ·ÊÔÚÔ‡Û·Ó Û˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ· ÙÔ˘ ÈÛ¯›Ô˘, Ì›· Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, Ì›· ·ÙÚËÛ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ηÈ

Paediatriki 2001;64:618-623

Ì›· ·ÔÊÚ·ÎÙÈÎfi ›ÎÙÂÚÔ. OÈ Soskolne Î·È Û˘Ó (26) ‚Ú‹Î·Ó fiÙÈ ÓÂÔÁÓ¿ Ô˘ ·Ú¤ÌÂÈÓ·Ó ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 72 ˆÚÒÓ, ›¯·Ó ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ªÂÁ·Ï‡ÙÂÚÔ ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜ ÔÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ·ÊÂÓfi˜ ÁÈ·Ù› Ë ·ÚÔ˘Û›· ÙÔ˘ ‚ÔÙ·ÏÏ›Ԣ fiÚÔ˘, ÙÔ˘ ˆÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ Î·È Ë Û¯ÂÙÈ΋ ÛÙÂÓfiÙËÙ· ÙˆÓ ÎÏ¿‰ˆÓ Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜ ·ÚÔ‰Èο Ê·ÈÓfiÌÂÓ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó η̛· ÛËÌ·Û›· Î·È ·ÊÂÙ¤ÚÔ˘ ¿ÏϘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Â›Ó·È ‰˘Ó·Ùfi Ó· ÌË ‰›ÓÔ˘Ó ÎÏÈÓÈο ÛËÌ›· ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜, ÏfiÁˆ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Ô˘ ‰ÂÓ Â˘ÓÔÔ‡Ó ÙË ‰ËÌÈÔ˘ÚÁ›· Ê˘ÛËÌ¿ÙˆÓ, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙË ÌÂÛÔÎÔÏÈ΋ ‹ ÙË ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·. ŒÙÛÈ, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ ›Ù Ù˘ ‰È¿ÁÓˆÛ˘ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ÂΛ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ, ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ¿ÛÎÔË ·Ú¿Ù·ÛË Ù˘ ·Ú·ÌÔÓ‹˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ›Ù Ù˘ ÌË ·Ó›¯Ó¢Û˘ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ ÂΛ Ô˘ ˘¿Ú¯ÂÈ (27). ∆Ô ›‰ÈÔ Úfi‚ÏËÌ· Ì ·˘Ùfi ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ ÚÔ·ÙÂÈ Î·È ÁÈ· ÙÔ Û˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ· ÙÔ˘ ÈÛ¯›Ô˘. ∏ ¯·Ï·ÚfiÙËÙ· ÙˆÓ ÈÛ¯›ˆÓ ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜, ηıÒ˜ Î·È Ë ·ÚÔ˘Û›· “„¢‰ÔÎϛΔ, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ϷÓı·Ṳ̂ÓË ‰È¿ÁÓˆÛË ·ÛÙ¿ıÂÈ·˜ ÙˆÓ ÈÛ¯›ˆÓ ‹ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜. ∂ÓÒ, Â›Ó·È ‰˘Ó·Ùfi Ó· ÌË ‰È·ÁÓˆÛÙ› Ì ÙËÓ ÚÒÙË ÂͤٷÛË ¤Ó· Ú·ÁÌ·ÙÈÎfi ÂÍ¿ÚıÚËÌ· ÙˆÓ ÈÛ¯›ˆÓ. ŒÙÛÈ ÂÈ‚¿ÏÏÂÙ·È, ·Ó ÙÔ ÓÂÔÁÓfi ÂͤÏıÂÈ ÚÈÓ Û˘ÌÏËÚÒÛÂÈ ÙÔ ÚÒÙÔ 48ˆÚÔ ˙ˆ‹˜, Ó· Á›ÓÂÈ ‰Â‡ÙÂÚË ÂͤٷÛË, ·ÊÔ‡ Â›Ó·È ÁÓˆÛÙfi fiÙÈ fiÛÔ ÈÔ ÁÚ‹ÁÔÚ· Á›ÓÂÈ Ë ‰È¿ÁÓˆÛË ÙfiÛÔ ÈÔ Î·Ï‹ Â›Ó·È Î·È Ë ÚfiÁÓˆÛË (28). ∞fi Ù· ·Ú·¿Óˆ Û˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ÂÓÒ Â›Ó·È ‚¤‚·ÈÔ fiÙÈ Ë Ì·ÎÚfiÙÂÚË ·Ú·ÌÔÓ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ Ô‰ËÁ› Û ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ‰È¿ÁÓˆÛ˘ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ, Â›Ó·È ÂÍ›ÛÔ˘ ‚¤‚·ÈÔ fiÙÈ ÔÚÈṲ̂Ó˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ı· ÍÂʇÁÔ˘Ó ÙË ‰È¿ÁÓˆÛË, ·ÎfiÌ· Î·È Ì ÂÈϤÔÓ ·‡ÍËÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ÃÚ‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ ∏ ¯Ú‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ ÌÔÚ› Ó· ¤¯ÂÈ ÙfiÛÔ ÛˆÌ·ÙÈΤ˜ fiÛÔ Î·È „˘¯ÔÎÈÓËÙÈΤ˜ Û˘Ó¤ÂȘ ÁÈ· ÙÔ ÓÂÔÁÓfi. ∞Ó Î·È ÌfiÓÔ Ë ·ÏÎÔfiÏË ·ԉ‰ÂÈÁ̤ӷ Ô‰ËÁ› ÛÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (29) Î·È ÔÈ ¿ÏϘ ÂıÈÛÙÈΤ˜ Ô˘Û›Â˜, .¯. ÎÔη˝ÓË, ÌÔÚÔ‡Ó Ó· ‚Ï¿„Ô˘Ó ÙÔ ¤Ì‚Ú˘Ô (30). ∏ ÈÔ Û˘¯Ó‹ ÂÈÏÔ΋ ·fi ÙË ¯Ú‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ÓÂÔÁÓ¿

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¶·È‰È·ÙÚÈ΋ 2001;64:618-623

Ó·ÚÎÔÌ·ÓÒÓ. ∞˘Ùfi ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÌÂÙ¿ ·fi ¯Ú‹ÛË ÔÈÔ‡¯ˆÓ Ô˘ÛÈÒÓ Î·È ¿ÏÏˆÓ Î·Ù·ÛÙ·ÏÙÈÎÒÓ ÙÔ˘ ∫¡™, .¯. Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È Ôχ Û·ÓÈfiÙÂÚ· ÌÂÙ¿ ·fi ¯Ú‹ÛË ÎÔη˝Ó˘ ‹ ·ÌÊÂÙ·Ì›Ó˘. ŸÛÔ ÈÔ ÌÂÁ¿ÏË Â›Ó·È Ë ÔÛfiÙËÙ· ÙÔ˘ Ó·ÚΈÙÈÎÔ‡, ÙfiÛÔ ÈÔ ¤ÓÙÔÓË Â›Ó·È Ë ÂΉ‹ÏˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔ ÓÂÔÁÓfi (31). ∏ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÔÚ› Ó· Á›ÓÂÈ Ï›Á· ÏÂÙ¿ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ¤ˆ˜ Î·È 2 ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·, ·Ó Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Ì¤Û· ÛÙȘ ÚÒÙ˜ 72 ÒÚ˜ ˙ˆ‹˜. ∂Âȉ‹ Ô ¯ÚfiÓÔ˜ ˘Ô‰ÈÏ·ÛÈ·ÛÌÔ‡ Ù˘ ËÚˆ›Ó˘ Â›Ó·È Û¯ÂÙÈο ‚Ú·¯‡˜ (ÂÚ›Ô˘ 8 ÒÚ˜), ÙÔ Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È Ì¤Û· ÛÙÔ ÚÒÙÔ 24ˆÚÔ ˙ˆ‹˜. ∞ÓÙ›ıÂÙ·, ·Ó Ë ÌËÙ¤Ú· ·›ÚÓÂÈ ÌÂı·‰fiÓË - Ù˘ ÔÔ›·˜ Ô ¯ÚfiÓÔ˜ ˘Ô‰ÈÏ·ÛÈ·ÛÌÔ‡ Â›Ó·È ¿Óˆ ·fi 24 ÒÚ˜ - Ë ÂΉ‹ÏˆÛË Û˘ÌÙˆÌ¿ÙˆÓ ÌÔÚ› Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÁÈ· ·ÚÎÂÙ¤˜ Ë̤Ú˜ (32). ∏ ·‰˘Ó·Ì›· ·ÎÚÈ‚Ô‡˜ Úfi‚Ï„˘ ÙÔ˘ ¯ÚfiÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙ¤ÚËÛ˘ ηıÈÛÙ¿ ·˘Ù¿ Ù· ÓÂÔÁÓ¿ “˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘”, ·ÔÎÏ›ÔÓÙ·˜ ¤ÙÛÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÚÒÈÌ˘ ÂÍfi‰Ô˘ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ∫·ÎÔÔ›ËÛË - ·Ú·Ì¤ÏËÛË ÓÂÔÁÓÔ‡ ∏ ‚Ú·¯Â›· ·Ú·ÌÔÓ‹ ÛÙÔ ÙÌ‹Ì· ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙË ÛˆÛÙ‹ „˘¯ÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË Î·È ÙËÓ ¤ÁηÈÚË ·Ó›¯Ó¢ÛË ÎÔÈÓˆÓÈÎÒÓ, „˘¯ÔÏÔÁÈÎÒÓ ‹ Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ù˘ ÌËÙ¤Ú·˜ ‹ Î·È ÙÔ˘ ¿ÌÂÛÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ Ù˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Ì¤¯ÚÈ Î·È Û ηÎÔÔ›ËÛË ‹ ·Ú·Ì¤ÏËÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜. ∂›Ó·È fï˜ ·ÊÂϤ˜ Ó· ÈÛÙ‡ÂÈ Î·Ó›˜ fiÙÈ ÌÔÚ› Ó· ÔÏÔÎÏËÚÒÛÂÈ Ì ÂÈÙ˘¯›· ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÌËÙ¤Ú·˜ ·ÏÏ¿ Î·È ÙÔ˘ ¢ڇÙÂÚÔ˘ ÂÚÈ‚¿ÏÏÔÓÙfi˜ Ù˘ fiÛÔ ·Ú·ÙÂٷ̤ÓË ÎÈ ·Ó Â›Ó·È Ë ·Ú·ÌÔÓ‹ Ù˘ Á˘Ó·›Î·˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. ∆Ô Úfi‚ÏËÌ· Ù˘ ηÎÔÔ›ËÛ˘ ‚ÚÂÊÒÓ ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ··Û¯ÔÏ› fiÏÔ Î·È Û˘¯ÓfiÙÂÚ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙfiÛÔ ÙȘ ˘ËÚÂۛ˜ ˘Á›·˜ fiÛÔ Î·È Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘. ∏ Û˘¯ÓfiÙËÙ· ηÎÔÔ›ËÛ˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 1% Î·È 3% ÙˆÓ ÓÂÔÁÓÒÓ (33). ªÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó ¤‰ÂÈÍ·Ó fiÙÈ ÔÛÔÛÙfi 76% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ı· ÌÔÚÔ‡Û ӷ ›¯Â ÚÔ‚ÏÂÊı› ÂÍÂÙ¿˙ÔÓÙ·˜ ÚÔÛÂÎÙÈÎfiÙÂÚ· ÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ÎÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ı· ÌÔÚÔ‡Û ӷ ›¯Â ·ÔÊ¢¯ı› Ì ÚÒÈÌË ·Ú¤Ì‚·ÛË (34). ¢Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÂÚÈÔÚÈÛÌ¤ÓˆÓ Ì¤ÛˆÓ ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ˘ËÚÂÛÈÒÓ, Ë ÂÛÙ›·ÛË ÂÈÏÂÎÙÈο Û ÔÚÈṲ̂Ó˜ ÔÈÎÔÁ¤ÓÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ı· ÌÔÚÔ‡Û ӷ Â›Ó·È ·Ô‰ÔÙÈ΋. ™·Ó ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È Ë ¿ÚÓËÛË Ù˘ ·ËÛ˘ ‹ ·fiÂÈÚ· ¤ÎÙÚˆÛ˘, Ë ¤ÎÊÚ·ÛË ‰˘Û·Ú¤ÛÎÂÈ·˜ Î·È ·ÚÓËÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÁÈ· ÙÔ Ê‡ÏÔ ‹ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡, Ë ·ÔÛÙÚÔÊ‹ ÙÔ˘ ‚ϤÌÌ·ÙÔ˜, ηıÒ˜ Î·È Ë

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¤ÓÙÔÓË ÂÓfi¯ÏËÛË ·fi ÙÔ ÎÏ¿Ì· ‹ ÙË ÏÂڈ̤ÓË ¿Ó· ÙÔ˘ ‚Ú¤ÊÔ˘˜. ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Â·ÓÂÈÛ·ÁˆÁÒÓ ™ÙÔȯ›· ·fi 281.306 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ηÈÛ·ÚÈ΋ ¤‰ÂÈÍ·Ó ·˘ÍË̤ÓÔ ÔÛÔÛÙfi Â·ÓÂÈÛ·ÁˆÁÒÓ ÁÈ· Ù· ÓÂÔÁÓ¿ ÂΛӷ Ô˘ ÂÍ‹Ïı·Ó ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ 24ˆÚÔ ˙ˆ‹˜ (26). ∆¤ÏÔ˜, ÛÙ· ÚÔ‚Ï‹Ì·Ù· Ù˘ ÚÒÈÌ˘ ÂÍfi‰Ô˘ ı· Ú¤ÂÈ Ó· ÚÔÛÙÂı› ÙÔ ¿Á¯Ô˜ Î·È Ë ‰˘Û·Ú¤ÛÎÂÈ· Ù˘ Ó¤·˜ ÌËÙ¤Ú·˜ Ô˘ ËÁ¿˙ÂÈ ·fi ÙËÓ ·ÓÂ·Ú΋ ¤ˆ˜ ·Ó‡·ÚÎÙË ÂÎ·›‰Â˘Û‹ Ù˘ ¿Óˆ ÛÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔÁÓÔ‡. ∆· Èı·Ó¿ ÔʤÏË Ù˘ Ù·¯Â›·˜ ÂÍfi‰Ô˘ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ∂ÎÙfi˜ ·fi ÙÔ ÎÔÈÓˆÓÈÎfi fiÊÂÏÔ˜ Ù˘ Ù·¯‡ÙÂÚ˘ ÂÈÛÙÚÔÊ‹˜ ÌËÙ¤Ú·˜ - ·È‰ÈÔ‡ ÛÙÔ Ê˘ÛÈÎfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ, Ôχ˜ ÏfiÁÔ˜ Á›ÓÂÙ·È ÙÂÏÂ˘Ù·›· Î·È ÁÈ· ÙÔ ÔÈÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ Ù˘ ÚÒÈÌ˘ ÂÍfi‰Ô˘ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ. OÈ Downs Î·È Loda (35) ıˆÚÔ‡Ó fiÙÈ Ë ·Ú·ÌÔÓ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ 2 ÚfiÛıÂÙ˜ Ë̤Ú˜ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÂÈ‚·Ú‡ÓÂÈ Ù· ·ÛÊ·ÏÈÛÙÈο Ù·Ì›· ηٿ 995 ‰ÔÏ¿ÚÈ·. ÕÏϘ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó Ì›ˆÛË ÙˆÓ ÂÍfi‰ˆÓ ηٿ 30% (36). ∆¤ÏÔ˜, ÙÚ›ÙË ÔÈÎÔÓÔÌÈ΋ ÌÂϤÙË Ô˘ ‰ÈÂÍ‹¯ıË ÛÙȘ ∏¶∞ ÂȂ‚·›ˆÛ fiÙÈ Ë Ì›ˆÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜ ηٿ Ì›· Ë̤ڷ Û ÂıÓÈÎfi Â›Â‰Ô ÌÂÈÒÓÂÈ ÙÔ ÎfiÛÙÔ˜ ÓÔÛËÏ›·˜ ηٿ 620-936 ÂηÙÔÌ̇ÚÈ· ‰ÔÏ¿ÚÈ· (37). À¿Ú¯Ô˘Ó fï˜ Î·È ·fi„ÂȘ Ô˘ ‰È·ÊˆÓÔ‡Ó ˆ˜ ÚÔ˜ ÙÔ ÔÈÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ÚÒÈÌË ¤ÍÔ‰Ô. ™˘ÁÎÂÎÚÈ̤ӷ, ÌÂϤÙË ·fi ÙËÓ ∞˘ÛÙÚ·Ï›· ¤‰ÂÈÍ fiÙÈ ·Ó ÛÙÔ ·Ú¯ÈÎfi ÎfiÛÙÔ˜ ÓÔÛËÏ›·˜ ÚÔÛÙÂı› Î·È Ë ·ÌÔÈ‚‹ ÂÈÛÎÂÙÚÈÒÓ ·‰ÂÏÊÒÓ Î·Ù’ Ô›ÎÔÓ ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ÙÔ ÙÂÏÈÎfi ÔÈÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ ›Ûˆ˜ Ó· ÌËÓ Â›Ó·È ÙfiÛÔ ÛËÌ·ÓÙÈÎfi fiÛÔ Â›¯Â ÂÎÙÈÌËı› ·Ú¯Èο (38). ∆ÂÏÈο, ˆÊÂÏ› ‹ ‚Ï¿ÙÂÈ Ë ‚Ú¿¯˘ÓÛË ÙÔ˘ ¯ÚfiÓÔ˘ ·Ú·ÌÔÓ‹˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜; ™ÙÔ ÂÚÒÙËÌ· ·˘Ùfi ‰ÂÓ ÌÔÚ› Ó· ‰Ôı› Û·Ê‹˜ ·¿ÓÙËÛË. ∫È ·˘Ùfi ÁÈ·Ù› Ô ¯ÚfiÓÔ˜ ÂÍfi‰Ô˘ ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ‰ÂÓ ÌÔÚ› Î·È ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÓÈ·›Ô˜ ÁÈ· fiÏ· Ù· ÓÂÔÁÓ¿, ·ÏÏ¿ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘ οı ÓÂÔÁÓÔ‡ Î·È Ù˘ οı ÌËÙ¤Ú·˜. Œ¯ÂÈ ‚ÚÂı› fiÙÈ ·˘Ùfi Ô˘ ¤¯ÂÈ Ôχ ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ÓÂÔÁÓÔ‡ ‰ÂÓ Â›Ó·È Ô ¯ÚfiÓÔ˜ ÂÍfi‰Ô˘ ÙÔ˘ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ·ÏÏ¿ Ë ÛˆÛÙ‹ ÂÎ·›‰Â˘ÛË Ù˘ ÌËÙ¤Ú·˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ·ÏÏ¿ Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ¿Óˆ ÛÙÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi Î·È ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔÁÓÔ‡ ÁÂÓÈÎfiÙÂÚ·, Ë ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ fiÔ˘ ··ÈÙ›ٷÈ, ÔÈ ÛˆÛÙ¤˜ Ô‰ËÁ›Â˜ ηٿ ÙËÓ ¤ÍÔ‰Ô Î·È Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÙ¿ ÙËÓ ¤ÍÔ‰Ô


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·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ, ÁÂÁÔÓfi˜ Ô˘ ÚÔ¸Ôı¤ÙÂÈ ÙËÓ ‡·ÚÍË ÂÓfi˜ Ôχ ηϿ ÔÚÁ·ÓˆÌ¤ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘. ∏ ÚÒÈÌË ¤ÍÔ‰Ô˜, ÂÊfiÛÔÓ Â›Ó·È Î·Ï¿ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË, ÌÔÚ› Ó· ‰È·ÛÊ·Ï›ÛÂÈ ÙËÓ ˘Á›· ÙÔ˘ ÓÂÔÁÓÔ‡ Ì Ôχ ÌÈÎÚfiÙÂÚÔ ÔÈÎÔÓÔÌÈÎfi ÎfiÛÙÔ˜ ηÈ, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ÙËÓ ·Ú·ÙÂٷ̤ÓË ·Ú·ÌÔÓ‹ ÛÙÔ 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

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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¿Î˘ π. ¶ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ÙÔ˘ Û˘ÁÁÂÓÔ‡˜ ÂÍ·ÚıÚ‹Ì·ÙÔ˜ ÙÔ˘ ÈÛ¯›Ô˘ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁ¤ÓÓËÙ·. ¶·È‰È·ÙÚÈ΋ 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.

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Paediatriki 2001;64:624-629

GENERAL ISSUES

∞Ù˘¯‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¢. ∫·Ú·Î·˚‰fi˜, ∏. °ÂˆÚÁÈ¿‰Ë˜, Ã. ∫·Ú‹˜

Accidents in childhood D. Karakaidos, H. Georgiadis, C. Karis

¶ÂÚ›ÏË„Ë: ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó Û˘¯Ó‹ ·ÈÙ›· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∞Ó·ÛÎÔÔ‡ÓÙ·È ·Ó¿ ËÏÈΛ· ÔÈ Û˘¯ÓfiÙÂÚ˜ ÌÔÚʤ˜ ·Ù˘¯ËÌ¿ÙˆÓ ˆ˜ ÚÔ˜ ÙËÓ ÂȉËÌÈÔÏÔÁ›·, ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Ù· ÂËÚ¿˙Ô˘Ó Î·È Û˘˙ËÙÔ‡ÓÙ·È Ì¤ÙÚ· Ô˘ ı· Ô‰ËÁ‹ÛÔ˘Ó ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ÙÔ˘˜.

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.

§¤ÍÂȘ ÎÏÂȉȿ: ·Ù˘¯‹Ì·Ù·, ·È‰È΋ ËÏÈΛ·, ÙÚÔ¯·›Ô, ‰ËÏËÙËÚ›·ÛË, ÚfiÏË„Ë.

Key words: accident, childhood, motor-vehicle accident, poisoning, prevention.

∂ÈÛ·ÁˆÁ‹ - °ÂÓÈÎfiÙËÙ˜ ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ªÂÙ¿ ·fi ÔÏÏ¿ ¯ÚfiÓÈ· ·‰È·ÊÔÚ›·˜ ÙÔ˘ È·ÙÚÈÎÔ‡ ÎfiÛÌÔ˘ Î·È Ù˘ ¶ÔÏÈÙ›·˜, Û‹ÌÂÚ· ÙÔ ·È‰ÈÎfi ·Ù‡¯ËÌ· Î·È Ë ÚfiÏË„‹ ÙÔ˘ ·ÔÙÂÏ› ÚÒÙÈÛÙË ÊÚÔÓÙ›‰· ÙˆÓ ˘ËÚÂÛÈÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Û fiÏ· Ù· ÚÔËÁ̤ӷ ÎÚ¿ÙË. ∏ ϤÍË ·Ù‡¯ËÌ· ÛËÌ·›ÓÂÈ ÙÔ Û˘Ì‚¿Ó Ô˘ ÔÊ›ÏÂÙ·È Û ¤ÏÏÂÈ„Ë Ù‡¯Ë˜ Î·È ÂÔ̤ӈ˜ Â›Ó·È ·Úfi‚ÏÂÙÔ. ™‹ÌÂÚ·, ‚¤‚·È·, ÈÛÙ‡ԢÌ fiÙÈ ¤Ó· ·Ù‡¯ËÌ· ‰ÂÓ ÚÔηÏÂ›Ù·È ÌfiÓÔ ·fi ¤ÏÏÂÈ„Ë Ù‡¯Ë˜, ·ÏÏ¿ Û˘Ì‚¿ÏÏÔ˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ÛÙË Á¤ÓÂÛ‹ ÙÔ˘ (1). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Â›Ó·È È‰È·›ÙÂÚ· ÂÈÚÚÂ›˜ ÛÙ· ·Ù˘¯‹Ì·Ù· Î·È ÔÈ ÏfiÁÔÈ Â›Ó·È ÔÏÏÔ› (2): ·) ∏ ·ÓÙÈÏËÙÈ΋ ÈηÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ˆÚÈÌ¿˙ÂÈ Ï‹Úˆ˜ ÚÈÓ ÙËÓ ÂÊ˂›·. ‚) ™˘ÓÂȉËÙÔÔÈÔ‡Ó ÙË Û¯¤ÛË ·ÈÙ›Ô˘-·ÔÙÂϤÛÌ·ÙÔ˜, ÔÏϤ˜ ÊÔÚ¤˜ ÌÂÙ¿ ·fi ‰˘Û¿ÚÂÛÙ˜ ÂÌÂÈڛ˜. Á) ∫·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ ˘¿Ú¯ÂÈ Ù¿ÛË ÁÈ· ÂÍÂÚ‡ÓËÛË. ‰) ∏ ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ· ·Ó·Ù‡ÛÛÂÙ·È ÚÔԉ¢ÙÈο.

Â) ∆Ô ·È‰› Ù˘ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛΤ„Ë ·ÓÒÚÈÌË, ·Ú¿ÏÔÁË Î·È ÂÁˆÎÂÓÙÚÈ΋. ÛÙ) ∆· ·È‰È¿ Ù˘ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÚÔ‚·›ÓÔ˘Ó Û˘¯Ó¿ Û Ú¿ÍÂȘ ··ÁÔÚÂ˘Ì¤Ó˜, ÙÔÏÌËÚ¤˜ Î·È ÚÈ„ÔΛӉ˘Ó˜. ™ÙȘ ÚÔËÁ̤Ó˜ ¯ÒÚ˜, Ù· ·Ù˘¯‹Ì·Ù· ÍÂÂÚÓÔ‡Ó ÙÔ 50% ÙˆÓ ·ÈÙÈÒÓ ı·Ó¿ÙÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∞ÎÔÏÔ˘ıÔ‡Ó Ù· ÓÂÔÏ¿ÛÌ·Ù· Û ÔÛÔÛÙfi 15% Î·È ÔÈ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Û ÔÛÔÛÙfi 8%. ∆· 3/4 (63%-80%) ÙˆÓ ı·Ó¿ÙˆÓ ·fi ·Ù˘¯‹Ì·Ù· ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· ÔÊ›ÏÔÓÙ·È Û ÙÚÔ¯·›·, Ì ÙËÓ Â˘Ú›· ¤ÓÓÔÈ· Ù˘ Ϥ͢, ÂÓÒ Ù· ÌÈÛ¿ ·fi ·˘Ù¿ ·ÊÔÚÔ‡Ó ÂÈ‚¿Ù˜ ÙÚÔ¯ÔÊfiÚˆÓ Ô¯ËÌ¿ÙˆÓ ËÏÈΛ·˜ 5-14 ÂÙÒÓ. ∆· ÂÁη‡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¿ οو ÙˆÓ 5 ÂÙÒÓ Î·È Û˘Ì‚·›ÓÔ˘Ó Û˘¯ÓfiÙÂÚ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ·È¯ÓȉÈÔ‡. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÂÓÒ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ Û˘Ì‚·›ÓÂÈ Û Ôχ ÌÈÎÚ¿ ·È‰È¿ (85% ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙÔ Û›ÙÈ) Î·È ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ 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ÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜) (1,3).

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

624

Peripheral General Hospital of Nikea - Piraeus, Athens “St. Panteleimon” Pediatric Clinic


¶·È‰È·ÙÚÈ΋ 2001;64:624-629

Paediatriki 2001;64:624-629

∏ Â›ÙˆÛË ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Û¯ÂÙ›˙ÂÙ·È Ì ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ËÏÈΛ· (ϤÔÓ ÂÈÚÚÂ‹˜ Â›Ó·È Ë ËÏÈΛ· ÙˆÓ 12-36 ÌËÓÒÓ), ÙÔ Ê‡ÏÔ (Ù· ·ÁfiÚÈ· ÙÚ·˘Ì·Ù›˙ÔÓÙ·È ‰‡Ô ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· ·fi Ù· ÎÔÚ›ÙÛÈ·), Ë ÒÚ· Ù˘ Ë̤ڷ˜ (Û˘¯ÓfiÙÂÚÔÈ Â›Ó·È ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ηٿ ÙȘ ÚˆÈÓ¤˜ Î·È ·ÔÁÂ˘Ì·ÙÈÓ¤˜ ÒÚ˜) Î·È Ë ÂÔ¯‹ ÙÔ˘ ¯ÚfiÓÔ˘ (ÔÈ Î·ÏÔηÈÚÈÓÔ› Ì‹Ó˜ Â›Ó·È ÔÈ ϤÔÓ “ÂÈΛӉ˘ÓÔÈ”). §ÈÁfiÙÂÚÔ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·ÔÙÂÏÔ‡Ó Ë ÌÈÎÚ‹ ËÏÈΛ· ÙÔ˘ ·Ù¤Ú·, ÙÔ “·ÓÂ¿ÁÁÂÏÙÔ” Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ ÂÈ‚·Ú˘Ì¤ÓÔ ÈÛÙÔÚÈÎfi ·Ù˘¯ËÌ¿ÙˆÓ (1,3-5). ™ÙË Û˘Ó¤¯ÂÈ· ı· ÂÍÂÙ·ÛÙÔ‡Ó ·Ó¿ ËÏÈΛ· ÔÈ Û˘¯ÓfiÙÂÚ˜ ÌÔÚʤ˜ ·Ù˘¯ËÌ¿ÙˆÓ (¶›Ó·Î·˜ 1) (1). ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· (¤ˆ˜ 5 ÂÙÒÓ) ¶ÙÒÛÂȘ ™ÙȘ ËÏÈ˘ ·˘Ù¤˜ ÔÈ ÙÒÛÂȘ ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ·Ù˘¯ËÌ¿ÙˆÓ Ì ÔÛÔÛÙfi Ô˘ ˘ÂÚ‚·›ÓÂÈ ÙÔ 50% (4) Î·È Â›Ó·È ‰ÈÏ¿ÛȘ ·’ fiÙÈ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿, ÂÓÒ ÔÈ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ ‚Ï¿‚Ë (3,6). ŒÓ· ÛÙ· 12 ·È‰È¿ οو ÙˆÓ 5 ÂÙÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÓÔÛËÏ›· ÁÈ· ÙÒÛË Ô˘ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Ì¤Û· ÛÙÔ Û›ÙÈ Î·È ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ Â›ψÛË Î·È ÙȘ ÛοϘ ÙÔ˘ ÛÈÙÈÔ‡. ¶Ôχ Û˘¯Ó¿, Ù· ·Ù˘¯‹Ì·Ù· ÛÙÔ Û›ÙÈ Û˘Ì‚·›ÓÔ˘Ó ·Ú¿ ÙËÓ ·ÚÔ˘Û›· οÔÈÔ˘ ÂÓ‹ÏÈη. ∆· ‚Ú¤ÊË ¤ÊÙÔ˘Ó Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÎÔ‡ÓÈ· ‹ ·fi ÙÔ ÎÚ‚·Ù¿ÎÈ ÙÔ˘˜ fiÙ·Ó ÔÈ ÌÂÁ¿ÏÔÈ ·fi ·Ì¤ÏÂÈ· ‹ ¿ÁÓÔÈ· ‰ÂÓ ÙÔÔıÂÙÔ‡Ó ÙÔ ÚÔÛٷ٢ÙÈÎfi ÎÈÁÎÏ›‰ˆÌ·, ‹ ·fi ηڤÎϘ Î·È ¿ÏÏ· ¤ÈÏ· ÛÙ· ÔÔ›· ¤¯Ô˘Ó ÚÔÛˆÚÈÓ¿ ·ÊÂı›. ∞ÎfiÌ· ÌÔÚ› Ó· ¤ÛÔ˘Ó ·fi ·ÓÔȯٿ ·Ú¿ı˘Ú· (11%) (7), ·Ó·ÛÊ¿ÏÈÛÙ˜ fiÚÙ˜ ·˘ÙÔÎÈÓ‹ÙˆÓ ‹ ·fi ÙËÓ ·ÁηÏÈ¿ ÂÓfi˜ ÌÂÁ¿ÏÔ˘. ∆Ô ‚ÚÂÊÈÎfi ÛηÌÓ¿ÎÈ (baby relax) Â›Ó·È Ôχ ¯Ú‹ÛÈÌÔ, ·ÏÏ¿ Î·È ÂÍ›ÛÔ˘ ÂÈΛӉ˘ÓÔ fiÙ·Ó ÙÔÔıÂÙÂ›Ù·È ¿Óˆ Û ηڤÎÏ· ‹ ÙÚ·¤˙È. ∏ ¤ÏÏÂÈ„Ë ÛˆÛÙÔ‡ ʈÙÈÛÌÔ‡, Ù· ‰¿‰· Ô˘ ÁÏÈÛÙÚÔ‡Ó, ·ÓÙÈΛÌÂÓ· Î·È ·È¯Ó›‰È· ÛÎÔÚÈṲ̂ӷ ÛÙÔ ‰¿‰Ô, ·Ô‡ÙÛÈ· Ì ηÙÂÛÙÚ·Ì̤Ó˜ ÊÙ¤ÚÓ˜ ‹ Ï˘Ì¤Ó· ÎÔÚ‰fiÓÈ·, ÂÚÁ·Ï›· ÛÎÔÚÈṲ̂ӷ ÛÙËÓ ·˘Ï‹ ·ÔÙÂÏÔ‡Ó Û˘¯Ó¿ ·›ÙÈ· ÙÒÛÂˆÓ (8). ¶ÔÏÏÔ› Ó·ÚÔ› ÁÔÓ›˜ ‰ÂÓ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ÙÔ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ Ï›ÁˆÓ ÌËÓÒÓ ÌÔÚ› Ó· ÌÂÙ·ÎÈÓËı› Î·È ÂÔ̤ӈ˜ ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ó· Ì›ÓÂÈ Û ÂÈΛӉ˘ÓË ı¤ÛË Ô‡Ù ¶›Ó·Î·˜ 1. ªÔÚʤ˜ ·Ù˘¯ËÌ¿ÙˆÓ ·Ó¿ ËÏÈΛ· µÚ¤ÊË ñ¶ÙÒÛÂȘ ñ∂ÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ñ¢ËÏËÙËÚÈ¿ÛÂȘ ñEÁη‡Ì·Ù·

¶·È‰È¿ 2-5 ÂÙÒÓ ñ¶ÙÒÛÂȘ ñ¶ÓÈÁÌfi˜ ñ∆ÚÔ¯·›· ñ¢ËÏËÙËÚÈ¿ÛÂȘ ñ∂Áη‡Ì·Ù·

¶·È‰È¿ 6-14 ÂÙÒÓ ñ∆ÚÔ¯·›· ñ¶ÓÈÁÌfi˜ ñ∂Áη‡Ì·Ù· ñ¢ËÏËÙËÚÈ¿ÛÂȘ

Ì›· ÛÙÈÁÌ‹. ¶·Ú’ fiÙÈ Ù· ÔʤÏË ·fi ÙËÓ ÂÚ·ÙÔ‡Ú· ·ÌÊÈÛ‚ËÙÔ‡ÓÙ·È ¤ÓÙÔÓ·, Ë ¯Ú‹ÛË Ù˘ ·˘Í¿ÓÂÈ Ì·˙› Ì ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ÙȘ ¢ηÈڛ˜ ÁÈ· ·Ù‡¯ËÌ·. ∏ ÂÚ·ÙÔ‡Ú· ÌÔÚ› ‡ÎÔÏ· Ó· ·Ó·ÙÚ·› fiÙ·Ó ÙÔ ·È‰› ÂÚÓ¿ÂÈ Ì ·˘Ù‹ ·fi ‰È·ÊÔÚÂÙÈ΋˜ ˘Ê‹˜ ÂÈÊ¿ÓÂȘ (fiˆ˜ ·fi ÌÔΤٷ Û ̈۷˚Îfi) ‹ ·Ó ‚ÚÂÈ fiÚÙ· ·ÓÔȯً Ô˘ Ô‰ËÁ› Û ÛοϘ. ŒÍˆ ·fi ÙÔ Û›ÙÈ Û˘¯Ó¤˜ Â›Ó·È ÔÈ ÙÒÛÂȘ ÛÙËÓ ·È‰È΋ ¯·Ú¿ ‹ ·fi ÙÔ Î·ÚfiÙÛÈ (1,8). ∂ÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ∆Ô ‚Ú¤ÊÔ˜ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ Â›Ó·È ÈηÓfi Ó· ‚¿ÏÂÈ ÛÙÔ ÛÙfiÌ· ÙÔ˘ Ô,Ùȉ‹ÔÙ ÎÚ·Ù¿ÂÈ ÛÙ· ¯¤ÚÈ· ÙÔ˘. ™ÙËÓ ËÏÈΛ· ·˘Ù‹ Ù· ·È‰È¿ Ì·ı·›ÓÔ˘Ó ÙÔÓ Â·˘Ùfi ÙÔ˘˜, ÂÚÈÛÛfiÙÂÚÔ Ì ÙËÓ „ËÏ¿ÊËÛË ·Ú¿ Ì ÙËÓ ·Ú·Ù‹ÚËÛË Î·È ‰È·ÛΉ¿˙Ô˘Ó ˆıÒÓÙ·˜ ÌÈÎÚÔ·ÓÙÈΛÌÂÓ· ̤۷ ÛÂ Ê˘ÛÈÔÏÔÁÈο ÛÙfiÌÈ· (ÛÙfiÌ·, ̇ÙË, ·ÎÔ˘ÛÙÈÎfi˜ fiÚÔ˜, ÎfiÏÔ˜). ªÂ ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÂÈÛÚfiÊËÛ˘ ͤÓÔ˘ ÛÒÌ·ÙÔ˜ ·˘Í¿ÓÂÈ Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ̤¯ÚÈ ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ fiÔ˘ ÍÂÎÈÓ¿ Ó· ÌÂÈÒÓÂÙ·È, ¤ÙÛÈ ÒÛÙ ÛÙËÓ ËÏÈΛ· ÙˆÓ ÂÙ¿ ÂÙÒÓ Ë Û˘¯ÓfiÙËÙ· ÌˉÂÓ›˙ÂÙ·È. ™Ù·˘ÚÔ˘‰¿ÎÈ·, ηÚÊ›ÙÛ˜ ·ÛÊ·Ï›·˜, ÍËÚÔ› ηÚÔ› Â›Ó·È Û˘Ó‹ıË ·ÓÙÈΛÌÂÓ· Ô˘ ·Ê·ÈÚÔ‡ÓÙ·È ·fi ÙÔ Ï¿Ú˘ÁÁ· ‹ ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜ ‚ÚÂÊÒÓ Î·È ÌÈÎÚÒÓ ·È‰ÈÒÓ (1). ∂ÎÙfi˜ ·fi ÙËÓ ·ÚÔÛÂÍ›· Î·È ÙËÓ ·Ì¤ÏÂÈ·, ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Â˘ÓÔ˚Τ˜ Û˘Óı‹Î˜ ÁÈ· ηٿÔÛË ‹ ÂÈÛÚfiÊËÛË Í¤ÓˆÓ ÛˆÌ¿ÙˆÓ (1,8): ·) ∏ ·ÚÔ˘Û›· ÌÂÁ¿ÏˆÓ, ÛÎÏËÚÒÓ ‹ ·È¯ÌËÚÒÓ ÙÂÌ·¯›ˆÓ ˘ÔÏÂÈÌÌ¿ÙˆÓ ÙÚÔÊÒÓ Ì¤Û· ÛÙÔ Ê·ÁËÙfi (ÎfiηϷ, ÎÔ˘ÎÔ‡ÙÛÈ·, ÙÛfiÊÏÈ· ·fi ·˘Á¿). ‚) ∏ ‚È·ÛÙÈ΋ ‹ ·ÚfiÛÂÎÙË Ï‹„Ë ÙÚÔÊ‹˜ Ô˘ ¢ÓÔ› ÙËÓ ·‰˘Ó·Ì›· ÂÓÙfiÈÛ˘ ÙˆÓ ·Ú·¿Óˆ ·Ó·ÊÂÚfiÌÂÓˆÓ ·ÓÙÈÎÂÈ̤ӈÓ. Á) ∏ Û˘Ó‹ıÂÈ· Ó· ÂÈÙÚ¤ÂÙ·È ÛÙ· ·È‰È¿ Ó· ·›˙Ô˘Ó ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ê·ÁËÙÔ‡ Ì ÌÈÎÚÔ·ÓÙÈΛÌÂÓ· fiˆ˜ ÎÔ˘ÌÈ¿, ÓÔÌ›ÛÌ·Ù· ‹ Êı·Ṳ́Ó˜ È›Ï˜ ·fi ÛÈÏÈÎfiÓË. ‰) ∏ ÚÔÙÚÔ‹ Û ÌÈÎÚ¿ ·È‰È¿ Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· Ì·Û‹ÛÔ˘Ó, Ó· ÙÚÒÓ ÛÎÏËÚ¤˜ ÙÚÔʤ˜ fiˆ˜ ÍËÚÔ‡˜ ηÚÔ‡˜ Î·È fiÛÚÈ·. ∂Áη‡Ì·Ù· OÈ ÊˆÙȤ˜ ÚÔηÏÔ‡Ó ÙÔ 1% ÙˆÓ ÓfiÛˆÓ ·ÁÎfiÛÌÈ·. ∆· ÙÛÈÁ¿Ú· Â›Ó·È Ë Î‡ÚÈ· ·ÈÙ›· ÙˆÓ ÂÁη˘Ì¿ÙˆÓ, ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ÙÔ˘˜ ·Ó·Ù‹Ú˜ ÙÛÈÁ¿ÚˆÓ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÂÚ›Ô˘ 1 ÂηÙÔÌ̇ÚÈÔ ÊˆÙȤ˜ ÙÔ ¯ÚfiÓÔ ÛÙÔ˘˜ ·È‰fiÙÔÔ˘˜ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô (9). ∂Áη‡Ì·Ù· ÚÔηÏÔ‡ÓÙ·È Â›Û˘ ·fi ˙ÂÌ¿ÙÈÛÌ·, ÊÏfiÁ·, ËÏÂÎÙÚÈÎfi Ú‡̷, ˘ÂÚÈÒ‰Ë ·ÎÙÈÓÔ‚ÔÏ›·, ηÓfi, ¯ËÌÈΤ˜ Ô˘Û›Â˜ Î·È ÂÍ Â·Ê‹˜ (ÙÚÈ‚‹). ∆· ÂÁη‡Ì·Ù· Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚ· ÛÙȘ

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ËÏÈ˘ ¤ˆ˜ 5 ÂÙÒÓ Î·È ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË ÛÙ· ·È‰È¿ Ô˘ ˙Ô˘Ó Û ‰È·ÌÂÚ›ÛÌ·Ù· ÔÏ˘Î·ÙÔÈÎÈÒÓ, ηıÒ˜ Î·È ÛÙ· ·ÁfiÚÈ· ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (2:1). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ı·›ÓÔ˘Ó ÂÁη‡Ì·Ù· Â›Ó·È ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 12 ÌËÓÒÓ (10). ∆Ô Û›ÙÈ, ÂȉÈÎfiÙÂÚ· ÙÔ ‰ˆÌ¿ÙÈÔ ·È¯ÓȉÈÔ‡ (·È‰fiÙÔÔ˜) Î·È ÙÔ ‰ˆÌ¿ÙÈÔ ‡ÓÔ˘, Â›Ó·È ÙÔ ÈÔ Û˘¯Ófi ÛËÌÂ›Ô Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ·Ù˘¯‹Ì·Ù· ·fi ÂÁη‡Ì·Ù· (4), ÂÓÒ Ù· ·È‰È¿ ËÏÈΛ·˜ 1-4 ÂÙÒÓ ·ÔÙÂÏÔ‡Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ ı˘Ì¿ÙˆÓ (11). ™Ù· ·È‰È¿ ËÏÈΛ·˜ ¤ˆ˜ 2 ÂÙÒÓ, Û˘¯Ó‹ ·ÈÙ›· ÂÁη‡Ì·ÙÔ˜ Â›Ó·È Ë ·Ó·ÙÚÔ‹ ‰Ô¯Â›Ô˘ Ì ˙ÂÛÙfi ÓÂÚfi ·fi ÙËÓ ÂÛÙ›· Ù˘ ÎÔ˘˙›Ó·˜ ‹ ·fi ÙÔ ÙÚ·¤˙È, ÂÓÒ ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Û˘¯Ó‹ ·ÈÙ›· ÂÁη‡Ì·ÙÔ˜ ·ÔÙÂÏ› Ë Û‡ÁÎÚÔ˘Û‹ ÙÔ˘˜ Ì ÂÓ‹ÏÈη Ô˘ ÌÂٷʤÚÂÈ ‰Ô¯Â›Ô Ì ˙ÂÛÙfi ÓÂÚfi. ∂Ï·Ùو̷ÙÈΤ˜ ıÂÚÌ¿ÛÙÚ˜ ËÏÂÎÙÚÈÎÔ‡ ‹ ÂÙÚÂÏ·›Ô˘ ·ÔÙÂÏÔ‡Ó Û¿ÓȘ ·Èٛ˜ ÂÁη˘Ì¿ÙˆÓ. OÈ ËÏÂÎÙÚÔÏË͛˜ ¤¯Ô˘Ó ÂÚÈÔÚÈÛÙ› ÙÂÏÂ˘Ù·›·, ÏfiÁˆ Ù˘ ÙÔÔı¤ÙËÛ˘ ÂȉÈÎÒÓ ·˘ÙfiÌ·ÙˆÓ ‰È·ÎÔÙÒÓ ÛÙ· ÂÚÈÛÛfiÙÂÚ· Û›ÙÈ·, ÂÓÒ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÂÌÊ·Ó›˙ÂÙ·È Î·È ¤Ó·˜ Ó¤Ô˜ Ù‡Ô˜ ÂÁη‡Ì·ÙÔ˜ ·fi ÙË ¯Ú‹ÛË ÙˆÓ ÊÔ‡ÚÓˆÓ ÌÈÎÚÔÎ˘Ì¿ÙˆÓ. ŸÙ·Ó Ê·ÁËÙfi ˙ÂÛÙ·›ÓÂÙ·È Û ٤ÙÔÈÔ ÊÔ‡ÚÓÔ, ÙÔ Û·Ԙ ̤ÓÂÈ ÎÚ‡Ô ÂÓÒ ÙÔ ÂÚȯfiÌÂÓÔ Â›Ó·È Î·˘Ùfi. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ, ÌÔÚ› ‡ÎÔÏ· οÔÈÔ˜ Ó· ‰ÒÛÂÈ Î·˘Ùfi Ê·ÁËÙfi ‹ Á¿Ï· Û ·È‰›, Â¿Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ‰ÂÓ ÙÔ ¤¯ÂÈ ‰ÔÎÈÌ¿ÛÂÈ. ™ÙȘ ∏¶∞, 7500 ·È‰È¿ Âı·›ÓÔ˘Ó Î¿ı ¯ÚfiÓÔ ·fi ÂÁη‡Ì·Ù· (1,3,8). ¢ËÏËÙËÚÈ¿ÛÂȘ OÈ ‰ËÏËÙËÚÈ¿ÛÂȘ Â›Ó·È 10 ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ˜ ÛÙȘ ËÏÈ˘ 0-5 ÂÙÒÓ Û ۯ¤ÛË Ì ٷ ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∏ ¤ÓÙÔÓË ÂÚȤÚÁÂÈ·, Ë ˘ÂÚ‚ÔÏÈ΋ ˙ˆËÚ¿‰·, ÙÔ ›ÛÌ·, Ë ÌÂÁ¿ÏË ÂÈı˘Ì›· Ô˘ ¤¯Ô˘Ó Ù· ·È‰È¿ ÙˆÓ ËÏÈÎÈÒÓ ·˘ÙÒÓ Ó· ‚¿˙Ô˘Ó ÛÙÔ ÛÙfiÌ· ÙÔ˘˜ ·ÓÙÈΛÌÂÓ· ›Ù ÁÈ· Ó· ‰È·ÈÛÙÒÛÔ˘Ó ÙË Ê‡ÛË ÙÔ˘˜, ›Ù ÁÈ· Ó· ÈηÓÔÔÈËıÔ‡Ó Á¢ÛÙÈο, Â›Ó·È ÌÂÚÈÎÔ› ÏfiÁÔÈ Ô˘ ÂÍËÁÔ‡Ó ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ ÛÙȘ ·Ú·¿Óˆ ËÏÈ˘, ·Ú’ fiÙÈ ‰ÂÓ Â›Ó·È Û¿ÓÈÔ Ó· Ï·Ì‚¿ÓÔÓÙ·È Ô˘Û›Â˜ Ô˘ Ô‡Ù ÂÏ΢ÛÙÈΤ˜ ÛÙËÓ fi„Ë Â›Ó·È, Ô‡Ù ¢¯¿ÚÈÛÙ˜ ÛÙË Á‡ÛË. ∞Ó Î·È ÔÈ ÂÚÈÛÛfiÙÂÚ˜ Ô˘Û›Â˜ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Â›Ó·È ·Î·Ù¿ÏÏËϘ ÁÈ· ‚ÚÒÛË, ÌfiÓÔ ÌÂÚÈΤ˜ ÚÔηÏÔ‡Ó Û˘ÌÙÒÌ·Ù· fiÙ·Ó ÏËÊıÔ‡Ó Û ÌÂÁ¿Ï˜ ÔÛfiÙËÙ˜ Î·È Â˘Ù˘¯Ò˜ ÂÏ¿¯ÈÛÙ˜ Â›Ó·È ÙÔÍÈΤ˜, ·ÎfiÌË Î·È Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ (1,3). ∆Ô Â›‰Ô˜ Ù˘ Ô˘Û›·˜ ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ·Ú¿ÁÔÓÙ˜, fiˆ˜ (1): ·) ÙÔ ÔÈÎÔÓÔÌÈÎfi-‚ÈÔÙÈÎfi Â›Â‰Ô (40% ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ ÛÙȘ ˘Ô·Ó¿Ù˘ÎÙ˜ ¯ÒÚ˜ ÔÊ›ÏÂÙ·È ÛÙÔ ÂÙڤϷÈÔ, ÏfiÁˆ Ù˘ ¢Ú›·˜ ¯Ú‹Û˘ ÙÔ˘ ÁÈ· ʈÙÈÛÌfi Î·È ı¤ÚÌ·ÓÛË), ‚) ÙȘ Û˘Ó‹ıÂȘ Ù˘ ˙ˆ‹˜ οı Ϸԇ (ÛÙË µÚÂÙ·-

626

Paediatriki 2001;64:624-629

Ó›·, ÔÈ ‰ËÏËÙËÚÈ¿ÛÂȘ Ì ÌÔÓÔÍ›‰ÈÔ ÙÔ˘ ¿Óıڷη Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó¤˜ ÏfiÁˆ Ù˘ ¯Ú‹Û˘ ÙÔ˘ Ê˘ÛÈÎÔ‡ ·ÂÚ›Ô˘ ÁÈ· ·Ú·Û΢‹ Ê·ÁËÙÔ‡ Î·È ı¤ÚÌ·ÓÛË), Á) ÙË Û‡ÓıÂÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ (·È‰È¿ ·ÁÚÔÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Ï·Ì‚¿ÓÔ˘Ó Û˘¯ÓfiÙÂÚ· Ê˘ÙÔÊ¿Ú̷η, ÂÓÙÔÌÔÎÙfiÓ· Î·È ÂÙڤϷÈÔ, ÂÓÒ ÛÙȘ ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ ÔÈ ‰ËÏËÙËÚÈ¿ÛÂȘ Ì ʿÚ̷η) Î·È ‰) ÙÔ Ú‡̷ Ù˘ Û‡Á¯ÚÔÓ˘ Û˘ÓÙ·ÁÔÁÚ·Ê›·˜. ∞fi ÙÔ 1975 ÏÂÈÙÔ˘ÚÁ› ÙÔ ÌÔÓ·‰ÈÎfi ∫¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛÂˆÓ ÛÙËÓ ∂ÏÏ¿‰·, ·fi Ù· ÛÙÔȯ›· ÙÔ˘ ÔÔ›Ô˘ ·Ú¤¯ÂÙ·È Ë ÂÈÎfiÓ· ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ ÛÙË ¯ÒÚ· Ì·˜. ™‡Ìʈӷ ÏÔÈfiÓ Ì ·˘Ù¿, ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ Û˘Ì‚·›ÓÔ˘Ó ÛÙȘ ËÏÈ˘ 2-4 ÂÙÒÓ (33%), ÂÓÒ Ù· Ê¿Ú̷η ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· (΢ڛˆ˜ ËÚÂÌÈÛÙÈο, ·Á¯ÔÏ˘ÙÈο Î·È ·˘Û›ÔÓ·) (42,4%). OÈ ‰ËÏËÙËÚÈ¿ÛÂȘ Ì ÁˆÚÁÈο Ê¿Ú̷η Â›Ó·È Û¿ÓȘ ·ÏÏ¿ ÂÈΛӉ˘Ó˜, Ô ¯ÒÚÔ˜ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Û˘¯ÓfiÙÂÚ· Â›Ó·È ÙÔ Û›ÙÈ (86%), ÂÓÒ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ÔÊ›ÏÔÓÙ·È ÛÂ Ù˘¯·›· Ï‹„Ë (81,5%). ™ËÌ·ÓÙÈÎfi Â›Ó·È Î·È ÙÔ ÔÛÔÛÙfi ÙˆÓ ·˘ÙÔÎÙÔÓÈÒÓ (13,7%). ∆Ô 1994 ÛËÌÂÈÒıËÎ·Ó 36 ı¿Ó·ÙÔÈ ·fi ‰ËÏËÙËÚÈ¿ÛÂȘ ÛÙË ¯ÒÚ· Ì·˜, ΢ڛˆ˜ ·fi ÁˆÚÁÈο Ê¿Ú̷η (ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ·˘ÙÔÎÙÔӛ˜) (1,3). ¶·ÚfiÌÔÈ· ÂÈÎfiÓ· ‰›ÓÂÈ Î·È ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË Ù˘ ÎÏÈÓÈ΋˜ Ì·˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‰ÈÂÙ›· 19941996, fiÔ˘ ÔÈ ‰ËÏËÙËÚÈ¿ÛÂȘ ·ÔÙÂÏÔ‡Û·Ó ÙÔ 7,3% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ, Ù· Ê¿Ú̷η ‹Ù·Ó Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· Ì ÔÛÔÛÙfi 54,7% Î·È ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë Ì¿ÛËÛË ÙÛÈÁ¿ÚÔ˘, Ù· ›‰Ë ÔÈÎȷ΋˜ ¯Ú‹Û˘, ÔÈ ÔÚÁ·ÓÈÎÔ› ‰È·Ï‡Ù˜ (9,7%), Ù· ÂÙÚÂÏ·ÈÔÂȉ‹ (2,9%) Î·È Ù· ÂÓÙÔÌÔÎÙfiÓ· (2,2%) (12). ∆· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Â›Ó·È Û·ÓÈfiÙÂÚ· ÛÙ· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Û ۯ¤ÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· Î·È ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ Ù· ·È‰È¿ Û·Ó ÂÈ‚¿Ù˜ ÙÚÔ¯ÔÊfiÚˆÓ Î·È ÏÈÁfiÙÂÚÔ Û·Ó Â˙Ô‡˜. ™¯oÏÈ΋ ËÏÈΛ· (6-12 ÂÙÒÓ) ∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ∆· ·È‰È¿ ÂÌϤÎÔÓÙ·È Û ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ›ÙÂ Û·Ó Â˙Ô›, ›ÙÂ Û·Ó ÂÈ‚¿Ù˜ ÙÚÔ¯ÔÊfiÚÔ˘. ™ÙËÓ ËÏÈΛ· ÙˆÓ 6-12 ÂÙÒÓ ‰È·ÈÛÙÒÓÂÙ·È ‰ÈÏ¿ÛÈÔ˜ ·ÚÈıÌfi˜ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ·’ fiÙÈ ÛÙ· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∏ ∂ÏÏ¿‰· ‰È·ÙËÚ› ÙË ıÏÈ‚ÂÚ‹ ÚˆÙÈ¿ ÛÙÔ˘˜ ı·Ó¿ÙÔ˘˜ ·fi ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·. ∫¿ı ¯ÚfiÓÔ ÛÙË ¯ÒÚ· Ì·˜ ÛÎÔÙÒÓÔÓÙ·È 20 ¿ÙÔÌ· ·Ó¿ 100.000 ηÙÔ›ÎÔ˘˜ (6 ÓÂÎÚÔ› ËÌÂÚËÛ›ˆ˜), ¤Ó·ÓÙÈ 11 Ô˘ Â›Ó·È Ô Ì¤ÛÔ˜ fiÚÔ˜ ·ÁÎÔÛÌ›ˆ˜, ÂÓÒ Î¿ı ¯ÚfiÓÔ ‰È·ÈÛÙÒÓÂÙ·È Î·È ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ ·Ù˘¯ËÌ¿ÙˆÓ, ÙË ÛÙÈÁÌ‹ Ô˘ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ¯ˆÚÒÓ Ù˘ ∂˘ÚÒ˘ ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË (13,14). ™ÙȘ


¶·È‰È·ÙÚÈ΋ 2001;64:624-629

∏¶∞, 1700 ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 15 ÂÙÒÓ ÛÎÔÙÒÓÔÓÙ·È Î·Ù¿ ̤ÛÔ fiÚÔ Û·Ó ÂÈ‚¿Ù˜ ÙÚÔ¯ÔÊfiÚÔ˘ οı ¯ÚfiÓÔ (15). ∆Ô Ô‰ÈÎfi ‰›ÎÙ˘Ô Ù˘ ·ÙÚ›‰·˜ Ì·˜ ‰ÂÓ Û˘ÁÎÂÓÙÚÒÓÂÈ ÙȘ ÚÔ¸Ôı¤ÛÂȘ ·ÛÊ·Ï›·˜. OÈ “·ÛÊ·Ï›˜” Ù·¯‡ÙËÙ˜ Â›Ó·È ÁÂÓÈο ¯·ÌËϤ˜ Î·È ÌfiÓÔ ÛÙÔ 10% ÙÔ˘ ‰ÈÎÙ‡Ô˘ Ì·˜ ÌÔÚÔ‡Ó Ó· ·Ó·Ù˘¯ıÔ‡Ó Ù·¯‡ÙËÙ˜ ¿Óˆ ·fi 70 km/h. ∆Ô 31% ÙˆÓ ı˘Ì¿ÙˆÓ ·fi ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Â›Ó·È Â˙Ô›, ÂÓÒ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘˜ ·ÓÙÈÛÙÔȯ› ÛÙÔ 2,5% ÙÔ˘ ·Î·ı¿ÚÈÛÙÔ˘ ÂıÓÈÎÔ‡ ÚÔ˚fiÓÙÔ˜, ¤Ó·ÓÙÈ 0,84% ÛÙË ™Ô˘Ë‰›· Î·È 1,5% ÛÙȘ ∏¶∞ (1,13). ∆Ô ·È‰› Û·Ó ÂÈ‚¿Ù˘ ÙÚÔ¯ÔÊfiÚÔ˘ °È· ÙËÓ ·ÛÊ·Ï‹ ÌÂÙ·ÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ˘¿Ú¯Ô˘Ó ηÓfiÓ˜, Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÔ›ˆÓ fï˜ ÔÈΛÏÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ·. ™ÙȘ ∏¶∞, fiˆ˜ ‰Â›¯ÓÂÈ ¤Ú¢ӷ Ô˘ ¤ÁÈÓ ÙÔ 1995, ÙÔ 70% ÙˆÓ ·È‰ÈÒÓ Ù·Íȉ‡ÂÈ ¯ˆÚ›˜ ηӤӷ ̤ÙÚÔ ÚÔÛÙ·Û›·˜ Î·È ÌfiÓÔ ÙÔ 8% Ì fiÏ· Ù· ̤ÙÚ· ·ÛÊ¿ÏÂÈ·˜. ∆ËÓ ÂÈÎfiÓ· ÛÙË ¯ÒÚ· Ì·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚfiÛÊ·ÙË ÌÂϤÙË, ÛÙËÓ ÔÔ›· ÙÔÓ›˙ÂÙ·È fiÙÈ (16,13): ·) Ë ∂ÏÏ¿‰· ¤¯ÂÈ ÙËÓ ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙËÓ ∂˘ÚÒË, ‚) Ù· ÙÚÔ¯·›· ·ÔÙÂÏÔ‡Ó ÙËÓ Ù¤Ù·ÚÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÁÈ· Ù· ∂ÏÏËÓfiÔ˘Ï·, Á) Ë ¤ÎıÂÛË Û ΛӉ˘ÓÔ ÙÚÔ¯·›Ô˘ ÁÈ· ·È‰È¿ Î·È ‚Ú¤ÊË ¤ÁÈÓ ٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÂÁ·Ï‡ÙÂÚË, ÏfiÁˆ Ù˘ ·˘Í·ÓfiÌÂÓ˘ ¯ÚËÛÈÌÔÔ›ËÛ˘ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ Î·È Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ Û˘¯ÓfiÙËÙ·˜ ÂΉÚÔÌÒÓ ·fi ÙËÓ ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ·, ‰) ·È‰ÈÎfi οıÈÛÌ· ¤¯ÂÈ ·ÁÔÚ¿ÛÂÈ ÌfiÓÔ ÙÔ 52,3% ÙˆÓ ÁÔÓ¤ˆÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ∞ÙÙÈ΋, ÂÓÒ ÁÈ· ÙÔ˘˜ ‰È·Ì¤ÓÔÓÙ˜ ÂÎÙfi˜ ∞ÙÙÈ΋˜ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi Â›Ó·È 31,4%, Â) ÛÙÔ ·È‰ÈÎfi οıÈÛÌ· ·Ô‰›‰ÂÙ·È Ë Ì›ˆÛË ÙˆÓ ÛÔ‚·ÚÒÓ Î·ÎÒÛÂˆÓ Î·Ù¿ 60% Î·È Ô ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ ı·Ó·ÙËÊfiÚˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ Î·Ù¿ 70% Î·È ÛÙ) ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ı· ÌÂÈÒÓÔÓÙ·Ó ÔÈ ı¿Ó·ÙÔÈ Î·Ù¿ 27%, ·Ó fiÏÔÈ ÔÈ ÂÈ‚¿Ù˜ ÊÔÚÔ‡Û·Ó ˙ÒÓË ·ÛÊ·Ï›·˜ (17). ∏ ·Ó·ÁηÈfiÙËÙ· ÙÔ˘ ·È‰ÈÎÔ‡ ηı›ÛÌ·ÙÔ˜ Ê·›ÓÂÙ·È ·fi Ù· ÛÙÔȯ›· Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ·. Œ¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ ¤Ó·˜ ÂÓ‹ÏÈη˜ ¯¿ÓÂÈ ÙËÓ ÈηÓfiÙËÙ· Û˘ÁÎÚ¿ÙËÛ˘ fiÙ·Ó Ë ‰‡Ó·ÌË ·fiÛ·Û˘ ÍÂÂÚÓ¿ Ù· 100 Newton, ÂÓÒ Û ۇÁÎÚÔ˘ÛË Ì ٷ¯‡ÙËÙ· 40 km/h, ¤Ó· ‚Ú¤ÊÔ˜ 6 ÌËÓÒÓ ‚¿ÚÔ˘˜ 8 kg ·ÔÎÙ¿ ‰‡Ó·ÌË ·fiÛ·Û˘ 3800 Newton. Œ¯ÂÈ Â›Û˘ ˘ÔÏÔÁÈÛÙ› fiÙÈ Ë Û‡ÁÎÚÔ˘ÛË Ì ÙËÓ ›‰È· Ù·¯‡ÙËÙ· ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÙËÓ ÙÒÛË ·ÙfiÌÔ˘ ·fi ÙÔÓ ÙÚ›ÙÔ fiÚÔÊÔ (‡„Ô˜ 7,5-10 ̤ÙÚˆÓ) (16). O ΛӉ˘ÓÔ˜ ı·Ó¿ÙÔ˘ ÁÈ· ·È‰› ÙÔÔıÂÙË̤ÓÔ ÛÙÔ ÂȉÈÎfi οıÈÛÌ· Â›Ó·È 1/3150, ÂÓÒ ÁÈ· ·È‰› Ô˘ ‰ÂÓ Û˘ÁÎÚ·ÙÂ›Ù·È 1/227. ∞Ó ÔÈ ÌÂÙ·ÎÈÓ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·Ó Û‡Ìʈӷ Ì ÙËÓ ÂοÛÙÔÙ ÓÔÌÔıÂÛ›·, ÔÈ ı¿Ó·ÙÔÈ ı· ÌÂÈÒÓÔÓÙ·Ó Î·Ù¿ 93%. ∆· ÙÂÏÂ˘Ù·›ˆÓ ÚԉȷÁÚ·ÊÒÓ Î·ı›ÛÌ·Ù· ·ÛÊ·Ï›·˜ ʤÚÔ˘Ó ÙÔ Û‹Ì· ECE R 4403

Paediatriki 2001;64:624-629

Î·È ÛÙË Û˘Û΢·Û›· (18). À¿Ú¯Ô˘Ó 4 ÂȉÒÓ ·È‰Èο ηı›ÛÌ·Ù·: ·) ηı›ÛÌ·Ù· ÛÙÚ·Ì̤ӷ ÚÔ˜ Ù· ›Ûˆ, ÁÈ· ·È‰È¿ Ì ‚¿ÚÔ˜ ¤ˆ˜ 10 kg, ‚) ηı›ÛÌ·Ù· ‰ÈÏ‹˜ ηÙ‡ı˘ÓÛ˘, ÁÈ· ·È‰È¿ Ì ‚¿ÚÔ˜ ¤ˆ˜ 20 kg, Á) ηı›ÛÌ·Ù· ÛÙÚ·Ì̤ӷ ÚÔ˜ Ù· ÂÌÚfi˜, ÁÈ· ·È‰È¿ ‚¿ÚÔ˘˜ 10-25 kg Î·È ‰) ·Ó˘„ˆÙÈο ηı›ÛÌ·Ù·, ÁÈ· ·È‰È¿ ‚¿ÚÔ˘˜ 15-35 kg (18). ∆· ÂȉÈο ηı›ÛÌ·Ù· ÙÔÔıÂÙÔ‡ÓÙ·È ¿ÓÙ· ÛÙÔ ›Ûˆ οıÈÛÌ· ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘ Î·È È‰È·›ÙÂÚ· ÛÙË Ì¤ÛË ·˘ÙÔ‡, ÂÓÒ fiÙ·Ó ÙÔ ·È‰› ÊÙ¿ÛÂÈ ÛÙËÓ ËÏÈΛ· Î·È ÙÔ ‚¿ÚÔ˜ (>6 ÂÙÒÓ Î·È >20 kg) Ó· ÚÔÛ‰Âı› Ì ˙ÒÓË ·ÛÊ·Ï›·˜ Ù‡Ô˘ ÂÓ‹ÏÈη, Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· Û˘Ó¯›˙ÂÈ Ó· οıÂÙ·È ÛÙÔ ›Ûˆ οıÈÛÌ· ÙÔ˘ Ô¯‹Ì·ÙÔ˜ (19,20). ∞˘Ù‹ Ë ı¤ÛË ÙÔ˘ ÚÔÛʤÚÂÈ 70% ÂÚÈÛÛfiÙÂÚË ·ÛÊ¿ÏÂÈ· Û ۯ¤ÛË Ì ÙË ı¤ÛË ÙÔ˘ Û˘ÓÔ‰ËÁÔ‡ (21). ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ·Ó Ú¤ÂÈ Ó· ηı›ÛÂÈ ÙÔ ·È‰› ÛÙÔ ÌÚÔÛÙÈÓfi οıÈÛÌ· ·˘ÙÔÎÈÓ‹ÙÔ˘, ÁÈ· ·Ú¿‰ÂÈÁÌ· Û fi¯ËÌ· ‰Èı¤ÛÈÔ˘ Ù‡Ô˘, ÙfiÙÂ Ô ·ÂÚfiÛ·ÎÔ˜ ı· Ú¤ÂÈ Ó· ·ÂÓÂÚÁÔÔÈËı›. °ÂÓÈο, Â›Ó·È ·Ó·Áη›· Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ›Ûˆ ˙ˆÓÒÓ ·ÛÊ·Ï›·˜ ÙˆÓ Ô¯ËÌ¿ÙˆÓ (·ÛÊ¿ÏÂÈ· 22% ÁÈ· ı¿Ó·ÙÔ, 50% ÁÈ· ÙÚ·˘Ì·ÙÈÛÌfi) (18), ÂÓÒ ÔÈ ·ÁˆÓÈÛÙÈÎÔ‡ Ù‡Ô˘ ˙ÒÓ˜ ·ÛÊ·Ï›·˜ Û “Û¯‹Ì· ∏” ÌÂÈÒÓÔ˘Ó ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ Û ÙÚÔ¯·›Ô (22,23). ∆· ı·Ó·ÙËÊfiÚ· ·Ù˘¯‹Ì·Ù· Û˘Ì‚·›ÓÔ˘Ó Î˘Ú›ˆ˜ Û ÛÙÂÁÓÔ‡˜ ‰ÚfiÌÔ˘˜, Ì ¯·ÌËϤ˜ Ù·¯‡ÙËÙ˜, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜ Î·È ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ¯Ú‹ÛË ·ÏÎÔfiÏ ·fi ÙÔ˘˜ ÁÔÓ›˜. ∆Ô 90% ÙˆÓ ·ÙfïÓ, Ô˘ ÎÚ·ÙÔ‡Û·Ó ·È‰› ÛÙËÓ ·ÁηÏÈ¿ ÙÔ˘˜ ÙÔ ÔÔ›Ô ÛÎÔÙÒıËÎÂ, ÛÒıËΠÁÈ·Ù› ÙÔ ·È‰› ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Û·Ó ÚÔÛٷ٢ÙÈ΋ ·Û›‰·. ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ı·Ó¿ÙÔ˘ ·È‰ÈÒÓ Ô˘ ‹Ù·Ó ÂÈ‚¿Ù˜ Ô¯ËÌ¿ÙˆÓ Î·È ÂÓÂÏ¿ÎËÛ·Ó Û ÙÚÔ¯·›Ô ·Ù‡¯ËÌ·, ¯ˆÚ›˜ Ó· ¤¯Ô˘Ó ηٿÏÏËÏ· ÚÔÛ‰Âı›, Â›Ó·È ÔÈ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ, ÂÓÒ ¤¯ÂÈ ˘ÔÏÔÁÈÛÙ› fiÙÈ ÛÙËÓ ∂ÏÏ¿‰· Ù· 2/3 ÙˆÓ ÙÚ·˘Ì·ÙÈÛÌÒÓ ·È‰ÈÒÓ Û ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ı· ›¯·Ó ÚÔÏËÊı› Â¿Ó ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÛˆÛÙ¿ Ù· ÂȉÈο ηı›ÛÌ·Ù· ÁÈ· ·È‰È¿ (24). ™˘ÓÔ„›˙ÔÓÙ·˜, Ù· ·È‰È¿ Ú¤ÂÈ (1,16,25): ·) Ó· Ù·ÍÈ‰Â‡Ô˘Ó ¿ÓÙ· ÛÙÔ ›Ûˆ οıÈÛÌ· Î·È ÔÙ¤ ÛÙÔ ÌÚÔÛÙÈÓfi, ‚) Ó· ÌËÓ Ù·ÍÈ‰Â‡Ô˘Ó ÛÙËÓ ·ÁηÏÈ¿ ÂÓfi˜ ÂÓ‹ÏÈη, Á) Ó· ÌËÓ ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙÔ ÔÚÙ-ÌÂÌ¤ fiÙ·Ó Â›Ó·È ‚Ú¤ÊË ‹ Ó‹È· Î·È Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Ù· ÂȉÈο ηı›ÛÌ·Ù·, ‰) Ó· ÌËÓ ÎÚ·ÙÔ‡Ó ·È¯ÌËÚ¿ ·ÓÙÈΛÌÂÓ·, Â) Ó· ÌËÓ ÙÔÔıÂÙÔ‡ÓÙ·È ‰‡Ô Ì·˙› Û ̛· ˙ÒÓË ·ÛÊ·Ï›·˜ Î·È ÔÙ¤ Û ˙ÒÓË Ô˘ ‰ÂÓ Â›Ó·È ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ Î·È ÛÙ) Ó· ÌËÓ ¤¯Ô˘Ó ‰˘Ó·ÙfiÙËÙ· ‡ÎÔÏ˘ ··ÛÊ¿ÏÈÛ˘ ÛÙȘ fiÚÙ˜ ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘, ÔÈ Ôԛ˜ Ú¤ÂÈ Ó· ·ÛÊ·Ï›˙ÔÓÙ·È. ∆Ô ·È‰› ˆ˜ Â˙fi˜ ¶ÂÚ›Ô˘ ÙÔ 30% fiÏˆÓ ÙˆÓ ÓÂÎÚÒÓ ·fi Ô‰Èο

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ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Â›Ó·È Â˙Ô› Î·È Î˘Ú›ˆ˜ ·È‰È¿ Î·È ¤ÊË‚ÔÈ. ∆Ô ·È‰› ˆ˜ Â˙fi˜ ÌÂÈÔÓÂÎÙ› Î·È ÎÈÓ‰˘Ó‡ÂÈ ÂÚÈÛÛfiÙÂÚÔ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ ÁÈ·Ù›: ·) ÙÔ ¯·ÌËÏfi ·Ó¿ÛÙËÌ¿ ÙÔ˘ ÂÚÈÔÚ›˙ÂÈ ·ÈÛıËÙ¿ ÙÔ ÔÙÈÎfi ÙÔ˘ ‰›Ô, ‚) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÈÛıËÙËÚȷ΋ Î·È „˘¯ÔÎÈÓËÙÈ΋ ·ÓˆÚÈÌfiÙËÙ·, Á) ·‰˘Ó·Ù› Ó· ηٷÓÔ‹ÛÂÈ Ù· ۇ̂ÔÏ· Î·È Ù· Û‹Ì·Ù· Ù˘ ÙÚÔ¯·›·˜ Î·È ‰) ¤¯ÂÈ ¤ÌÊ˘ÙË ÔÚÌËÙÈÎfiÙËÙ· Î·È Ô Î›Ó‰˘ÓÔ˜ ·ÛΛ ¿Óˆ ÙÔ˘ ÌÈ· ÁÔËÙ›·. °È· ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜, ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘Ó¯‹ ÂÈÙ‹ÚËÛË fiÙ·Ó ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ‰ÚfiÌÔ, ·È‰È¿ ËÏÈΛ·˜ 9 ÂÙÒÓ ÌÔÚÔ‡Ó Ó· ‰È·Û¯›ÛÔ˘Ó ‰ÚfiÌÔ Î¿Ùˆ ·fi Ô̷Ϥ˜ ΢ÎÏÔÊÔÚȷΤ˜ Û˘Óı‹Î˜ Ì ۯÂÙÈ΋ ·ÛÊ¿ÏÂÈ·, ·Ó ÌfiÏȘ ÚÈÓ ¤¯Ô˘Ó ‰È‰·¯ı› ÙÈ ı· οÓÔ˘Ó, ÂÓÒ ÌfiÓÔ ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 12 ÂÙÒÓ ÌÔÚÔ‡Ó Ó· Û˘ÌÂÚÈÊÂÚıÔ‡Ó ÛˆÛÙ¿ Û·Ó Â˙Ô› ‹ Ô‰ËÏ¿Ù˜ (1). ∂ÎÙfi˜ ·fi ÙËÓ ËÏÈΛ·, ˘¿Ú¯Ô˘Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÙÚÔ¯·›ˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ì ı‡Ì·Ù· ·È‰È¿ Â˙Ô‡˜. ∞˘Ù¿ Û˘Ì‚·›ÓÔ˘Ó Û˘¯ÓfiÙÂÚ· Û ·È‰È¿ ËÏÈΛ·˜ 1-4 ÂÙÒÓ, ÛÙ· ·ÁfiÚÈ·, Û ·È‰È¿ ÌË ÚÔÓÔÌÈÔ‡¯ˆÓ ÎÔÈÓˆÓÈÎÒÓ Ù¿ÍˆÓ, ÙËÓ ¿ÓÔÈÍË Î·È ÙÔ Î·ÏÔη›ÚÈ, ηٿ ÙȘ ÒÚ˜ ÚÔÛ¤Ï¢Û˘ ÙˆÓ ·È‰ÈÒÓ ÛÙÔ Û¯ÔÏÂ›Ô Î·È ·Ô¯ÒÚËÛ‹˜ ÙÔ˘˜ ·fi ·˘Ùfi, ÙÔ ·fiÁÂ˘Ì· Ô˘ Ù· ·È‰È¿ ·›˙Ô˘Ó ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜, ÛÙ· ·ÛÙÈο ΤÓÙÚ·, ÛÙȘ ‰È·ÛÙ·˘ÚÒÛÂȘ ÌÂÁ¿ÏˆÓ ‰ÚfïÓ. ∆ËÓ ›‰È· ÛÙÈÁÌ‹, ÂÓ‹ÏÈΘ - Â˙Ô› ‹ Ô‰ËÁÔ› - Á›ÓÔÓÙ·È ·ÚÓËÙÈο ÚfiÙ˘· Î·È ·Ú·Û‡ÚÔ˘Ó Ù· ·È‰È¿ Û ·Ú·‚¿ÛÂȘ (1,26). ¶ÚfiÛÊ·ÙË ÌÂϤÙË ÛÙË ¯ÒÚ· Ì·˜ ¤‰ÂÈÍ fiÙÈ Ë Èı·ÓfiÙËÙ· ÁÈ· ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÂÓfi˜ ÙÔ˘Ú›ÛÙ· ·fi ·ÓÂÙ˘Á̤ÓË ¯ÒÚ·, Â›Ó·È Î·Ù¿ 30% ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ¤Ó·Ó ŒÏÏËÓ·, ÏfiÁˆ Ù˘ ΢ÎÏÔÊÔÚȷ΋˜ ÂÈı·Ú¯›·˜ Î·È Ù˘ ηϋ˜ ÂÓË̤ڈÛ˘ ÙˆÓ ·ÏÏÔ‰·ÒÓ (27).

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¶ÚÔÂÊË‚È΋ Î·È ÂÊË‚È΋ ËÏÈΛ· (13-19 ÂÙÒÓ) ™ÙËÓ ËÏÈΛ· ·˘Ù‹ Û˘¯Ó¤˜ Â›Ó·È ÔÈ ·ıÏËÙÈΤ˜ ηÎÒÛÂȘ. ™ÙȘ ∏¶∞, 1 ÛÙÔ˘˜ 14 ÂÊ‹‚Ô˘˜ ¯ÚÂÈ¿˙ÂÙ·È ÓÔÛÔÎÔÌÂȷ΋ ÂÚ›ı·Ï„Ë ÁÈ· ·Ù˘¯‹Ì·Ù· ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜. ∆· ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· Â›Ó·È 6 ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· ·’ fiÙÈ ÛÙȘ ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ Î·È Î‡ÚȘ ·Èٛ˜ Â›Ó·È Ë Î·Ù·Ó¿ÏˆÛË ·ÏÎÔfiÏ, ·ÏÏ¿ Î·È Ë “Ô‰‹ÁËÛË ¯ˆÚ›˜ ÚÔÔÚÈÛÌfi”. O ÓÈÁÌfi˜ ·ÔÙÂÏ› ÙË ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ·fi ·Ù‡¯ËÌ· ÛÙËÓ ÂÊ˂›·. ¶ÈÔ Û˘¯Ó¿ Ó›ÁÔÓÙ·È ¿ÚÚÂÓ˜ ¤ÊË‚ÔÈ ÌÂÙ¿ ·fi ηٷӿψÛË ·ÏÎÔfiÏ ‹ ¯Ú‹ÛË Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ, ·ÏÏ¿ Î·È ÂÈÏËÙÈÎÔ›. ™Â οı ı¿Ó·ÙÔ Ô˘ ÚÔ·ÙÂÈ ·fi ÓÈÁÌfi ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 6-10 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ ÎÈÓ‰‡ÓÂ˘Û·Ó Ó· ÓÈÁÔ‡Ó Î·È Ô˘ 10% ·˘ÙÒÓ ÂÈ˙› Ì ÌfiÓÈÌ· Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ∆· ÂÁη‡Ì·Ù· ÛÙËÓ ËÏÈΛ· ·˘Ù‹ Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ÂÚÁ·Ûȷ΋ ··Û¯fiÏËÛË ÙÔ˘ ÂÊ‹‚Ô˘. ™˘¯Ó¿ Â›Û˘ Â›Ó·È Ù· ·Ù˘¯‹Ì·Ù· ·fi ¯Ú‹ÛË Ó·ÚΈÙÈÎÒÓ, ÔÈ ÂÈÙ˘¯Â›˜ ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ Î·È ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ·fi ˘ÚÔ‚fiÏ· fiÏ· (ÛÙȘ ∏¶∞, ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ·fi ˘ÚÔ‚fiÏ· fiÏ· ·ÔÙÂÏÔ‡Ó ÙËÓ ÙÚ›ÙË ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙȘ ËÏÈ˘ 10-19 ÂÙÒÓ) (1,3,26). ¶ÚfiÏË„Ë ∏ ÚÔÛ¿ıÂÈ· ÚfiÏ˄˘ ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜ ¯ÚÂÈ¿˙ÂÙ·È Û˘Ó·ÚˆÁÔ‡˜ ÔÏÈÙ›·, È·ÙÚÈÎfi ÎfiÛÌÔ Î·È ÔÈÎÔÁ¤ÓÂÈ·. ∏ ÔÏÈÙ›· ÌÔÚ› Ó· Û˘Ì‚¿ÏÏÂÈ Ì ̤ÙÚ· fiˆ˜: ·) ÓÔÌÔıÂÙÈΤ˜ ·ÏÏ·Á¤˜ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ ·ÛÊ·ÏÒÓ ÚÔ˚fiÓÙˆÓ, ȉ›ˆ˜ ÛÙÔÓ ÙÔ̤· ÙˆÓ Ê·ÚÌ¿ÎˆÓ (ÂȉÈο ÒÌ·Ù·, Ï›Á˜ ‰fiÛÂȘ Ê·ÚÌ¿ÎÔ˘ ·Ó¿ Û˘Û΢·Û›·, ‰ÈÛΛ· ¯ˆÚ›˜ ÂÏ΢ÛÙÈ΋ fi„Ë, Î.Ï.), ‚) ÂÓ›Û¯˘ÛË ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ ∫¤ÓÙÚÔ˘ ¢ËÏËÙËÚÈ¿ÛÂˆÓ Î·È ÚÔÒıËÛË ›‰Ú˘Û˘ Ó¤ˆÓ, Á) ·Ú¤Ì‚·ÛË ÛÙÔ ÂÎ·È‰Â˘ÙÈÎfi ÚfiÁÚ·ÌÌ· ÙˆÓ

¶›Ó·Î·˜ 2. ¶Ú·ÎÙÈΤ˜ Û˘Ì‚Ô˘Ï¤˜ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ñ ∏ ÂÈÙ‹ÚËÛË ÙˆÓ ·È‰ÈÒÓ, ȉ›ˆ˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 4 ÂÙÒÓ, Ú¤ÂÈ Ó· Â›Ó·È ·˘ÛÙËÚ‹ Î·È Ó· Á›ÓÂÙ·È ·˘ÛÙËÚfiÙÂÚË Û ÂÚÈÙÒÛÂȘ ·Ó·ÙÚÔ‹˜ Ù˘ ηıËÌÂÚÈÓ‹˜ ÚÔ˘Ù›Ó·˜ (ÌÂÙ·ÎfiÌÈÛË, ·Ûı¤ÓÂÈ·, ı¿Ó·ÙÔ˜, ÁÈÔÚÙ‹ Î.Ï.). ñ ∞ÛÊ·Ï›ÛÙ fiÚÙ˜ Î·È ÛοϘ Ì ÂȉÈο οÁÎÂÏ·. ñ ∆ÔÔıÂÙ›ÛÙ ʿÚ̷η, ÍËÚÔ‡˜ ηÚÔ‡˜, ÙÛÈÁ¿Ú· fiˆ˜ Î·È ·ÓÙÈΛÌÂÓ· Ô˘ ÌÔÚ› Ó· ηٷÔıÔ‡Ó, Û ÛËÌ›· ÌË ÚÔÛÂÏ¿ÛÈÌ· ÛÙ· ·È‰È¿. ñ ∞ÛÊ·Ï›ÛÙ ÙȘ Ú›˙˜ Ì ÂȉÈο ηχÌÌ·Ù· Î·È ÙÔÔıÂÙ›ÛÙ ۇÛÙËÌ· ·˘ÙfiÌ·Ù˘ ‰È·ÎÔ‹˜ Ú‡̷ÙÔ˜ (ÚÂϤ). ñ ªËÓ ·Ê‹ÓÂÙ ·È‰È¿ ¯ˆÚ›˜ Â›‚ÏÂ„Ë ÛÙÔ ¯ÒÚÔ Ù˘ ÎÔ˘˙›Ó·˜. ∆ÔÔıÂÙ›ÛÙ ÙȘ Ï·‚¤˜ ÙˆÓ Ì·ÁÂÈÚÈÎÒÓ Û΢ÒÓ ÚÔ˜ ÙËÓ ÂÛˆÙÂÚÈ΋ ÏÂ˘Ú¿ Ù˘ ÎÔ˘˙›Ó·˜, ·ÛÊ·Ï›ÛÙÂ Û˘ÚÙ¿ÚÈ·, ·ÔÌ·ÎÚ‡ÓÂÙ ̷¯·›ÚÈ· Î·È ¿ÏÏ· ·È¯ÌËÚ¿ ·ÓÙÈΛÌÂÓ·, fiˆ˜ Î·È ‰Ô¯Â›· Ì ˙ÂÛÙ¿ ˘ÁÚ¿, ·fi ÚÔÛÂÏ¿ÛÈÌ· ÛËÌ›·. ñ ∆ÔÔıÂÙ›ÛÙ ϤÁÌ· ÛÙ· οÁÎÂÏ· ÙÔ˘ Ì·ÏÎÔÓÈÔ‡. ñ ™Ù·ıÂÚÔÔÈ›ÛÙ ٷ ¤ÈÏ· Ô˘ ·Ó·ÙÚ¤ÔÓÙ·È Â‡ÎÔÏ· Î·È Î·Ï‡„Ù ٷ Ôͤ· ¿ÎÚ· ÙÔ˘˜. ñ ŸÙ·Ó ÌÂٷʤÚÂÙ ‰Ô¯Â›· Ì ˙ÂÛÙ¿ ˘ÁÚ¿ ·ÔʇÁÂÙ ÙËÓ Â·Ê‹ Ì ·È‰È¿. ñ ªËÓ ·Ê‹ÓÂÙ ·È‰È¿ ¯ˆÚ›˜ ÂÈÙ‹ÚËÛË ÛÙÔ ¯ÒÚÔ ÙÔ˘ Ì¿ÓÈÔ˘. À¿Ú¯ÂÈ Èı·ÓfiÙËÙ· Ó· ÓÈÁÔ‡Ó ÛÙÔ ÓÂÚfi Ù˘ Ì·ÓȤڷ˜, ÛÙÔ ÓÂÚfi ÙÔ˘ ÛÈÊÔÓÈÔ‡ Ù˘ ÏÂοÓ˘ ‹ Ó· Î·Ô‡Ó Ì ˙ÂÛÙfi ÓÂÚfi. ñ ªËÓ ÙÔÔıÂÙ›Ù ÌÚÔÛÙ¿ Û ·Ú¿ı˘Ú· ηڤÎϘ ‹ ¿ÏÏ· ·ÓÙÈΛÌÂÓ· Ô˘ ÌÔÚÔ‡Ó Ó· ÛηÚÊ·ÏÒÛÔ˘Ó Ù· ·È‰È¿. ñ ∞Ó ¤¯ÂÙ fiÏ·, ·ÛÊ·Ï›ÛÙ ٷ Û ÛËÌ›· ·ÚÔÛ¤Ï·ÛÙ· ÛÙ· ·È‰È¿.

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ÂȉÈ΢fiÌÂÓˆÓ È·ÙÚÒÓ ÁÈ· ηχÙÂÚË ÁÓÒÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜, ‰) ÂÓË̤ڈÛË ÁÔÓ¤ˆÓ-·È‰ÈÒÓ Ì¤Ûˆ ÙÔ˘ Û¯ÔÏ›Ԣ Î·È ÙˆÓ Ì¤ÛˆÓ Ì·˙È΋˜ ÂÓË̤ڈÛ˘, 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·ÌfiÚʈÛË ÙÔ˘ ¯ˆÚÔÙ·ÍÈÎÔ‡ Î·È Î˘ÎÏÔÊÔÚÈ·ÎÔ‡ ÂÚ›Á˘ÚÔ˘ (ۯ‰ȷÛÌfi˜ ‰ÚfïÓ, ¯·Ú·ÎÙËÚÈÛÙÈο ΢ÎÏÔÊÔÚ›·˜, Î.Ï.), Ì ÙÚfiÔ Ô˘ Ó· ÌÂÈÒÓÂÙ·È Ë Èı·ÓfiÙËÙ· ·Ù˘¯‹Ì·ÙÔ˜. O È·ÙÚÈÎfi˜ ÎfiÛÌÔ˜ Î·È È‰›ˆ˜ ÔÈ ·È‰›·ÙÚÔÈ, η٤¯Ô˘Ó Ì›· ÛÙÚ·ÙËÁÈ΋ ı¤ÛË ÛÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜. O ·È‰›·ÙÚÔ˜, ¢ÚÈÛÎfiÌÂÓÔ˜ ‰›Ï· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÏËÚÔÊÔÚ‹ÛÂÈ ÁÔÓ›˜ Î·È ·È‰È¿, Ó· χÛÂÈ ·Ôڛ˜, 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·˜ Ì ÙËÓ ¤ÁηÈÚË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·Ú¤Ì‚·Û‹ ÙÔ˘ ÛÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ ÂÈÙÒÛÂˆÓ ·’ ·˘Ùfi (1,3,16,29). ™ÙÔÓ ¶›Ó·Î· 2 ·Ú·ı¤ÙÔ˘Ì ÔÚÈṲ̂Ó˜ Ú·ÎÙÈΤ˜ Û˘Ì‚Ô˘Ï¤˜ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜, Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÔÔ›ˆÓ ı· ‚ÔËı‹ÛÂÈ ÛÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ·È‰ÈÎÔ‡ ·Ù˘¯‹Ì·ÙÔ˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. ¢¤ÛÌË Î·Ù’ ÂÈÏÔÁ‹Ó ˘Ô¯ÚˆÙÈÎÒÓ Ì·ıËÌ¿ÙˆÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ - ∆Ì‹Ì· π·ÙÚÈ΋˜: ∞Ù˘¯‹Ì·Ù· Î·È ¢ËÏËÙËÚÈ¿ÛÂȘ ÛÙ· ·È‰È¿; ∞ı‹Ó· 1988. 2. ∞Ó·ÛÙ·Û¤·-µÏ¿¯Ô˘ ∫. ∞Ù˘¯‹Ì·Ù· ÛÙËÓ ÂÊ˂›·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚ ∫ÏÈÓ ¶·ÓÂ ∞ıËÓÒÓ 1997;44:138-141. 3. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ÃÂÈÚÔ˘ÚÁÒÓ ¶·›‰ˆÓ: ™ÙÚÔÁÁ˘Ï‹ ∆Ú¿Â˙· - ∆Ô ·È‰ÈÎfi ·Ù‡¯ËÌ·, ¡›Î·È·-∞ÙÙÈ΋; 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. ÷Ù˙ËÛ˘ÌÂÒÓ-÷Ù˙Ë‚·ÛÈÏÂÈ¿‰Ë ª. ∞Ù˘¯‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¢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.

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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, ∆۷ΛÚ˘ ∞, ∆·¯ÏÈ·ÌÔ‡Ú˘ ¡, ∑ÒÛË ¶, µ·ÛÈÏÂÈ¿‰Ë˜ ¶ Î·È Û˘Ó. ¢ËÏËÙËÚÈ¿ÛÂȘ ÛÙ· ·È‰È¿ - ¢È·ÈÛÙÒÛÂȘ - ¶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‰Èο ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ÛÙËÓ ∂ÏÏ¿‰·, 19741991. π·ÙÚÈ΋ 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 ηÎÒÛˆÓ: ™˘Óı‹Î˜ ÌÂÙ·ÊÔÚ¿˜ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ì ÙÔ ·˘ÙÔΛÓËÙÔ. ¶·È‰È·ÙÚÈ΋ 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˜ ÚfiÏ˄˘. ¶·È‰È·ÙÚÈ΋ 2000;63:337-338. 19. ¶·‹˜ ∫, ÷Ù˙ËΈÛÙ·ÓÙ¿˜ °. ∆ÚÔ¯·›Â˜ ηÎÒÛÂȘ ÛÙ· ·È‰È¿. ∏ ˙ÒÓË ·ÛÊ·Ï›·˜ ÛÙÔ ·˘ÙÔΛÓËÙÔ Î·È Ë Û˘Óԉ›· ÛÙË ‰È·ÛÙ·‡ÚˆÛË ÙˆÓ ‰ÚfïÓ. ¶·È‰È·ÙÚÈ΋ 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. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 07-02-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 20-07-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚ›ÛÙÔ˜ ∫·Ú‹˜ ¶·È‰›·ÙÚÔ˜-¢È¢ı˘ÓÙ‹˜ ∑·Î‡ÓıÔ˘ 2, ÷ϿӉÚÈ

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GENERAL ISSUES

O ¿Óıڷη˜ ˆ˜ ‚ÈÔÏÔÁÈÎfi fiÏÔ1 Center of Disease Control Consensus Statement

Anthrax as a biological weapon1 Center of Disease Control Consensus Statement

∂ÈÛ·ÁˆÁ‹ O ¿Óıڷη˜ η٤¯ÂÈ Âͤ¯Ô˘Û· ı¤ÛË ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÔÏ˘¿ÚÈıÌÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Û·Ó ‚ÈÔÏÔÁÈο fiÏ·. °È· ÔÏÏÔ‡˜ ·ÈÒÓ˜, Ô ¿Óıڷη˜ ¤¯ÂÈ ÚÔηϤÛÂÈ ·Ûı¤ÓÂÈ· ÛÙ· ˙Ò· Î·È Û·Ó›ˆ˜ ÛÔ‚·Ú‹ ·Ûı¤ÓÂÈ· Û ·ÓıÚÒÔ˘˜ Û ·ÁÎfiÛÌÈ· Îϛ̷η. ∏ ¤Ú¢ӷ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ¿Óıڷη Û·Ó ‚ÈÔÏÔÁÈÎfi fiÏÔ ÍÂΛÓËÛ ÚÈÓ 80 ¯ÚfiÓÈ· ÂÚ›Ô˘. ™‹ÌÂÚ·, ÈÛÙ‡ÂÙ·È fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 17 ÎÚ¿ÙË ¤¯Ô˘Ó ÚfiÁÚ·ÌÌ· ηٷÛ΢‹˜ ‚ÈÔÏÔÁÈÎÒÓ fiψÓ. ∏ ‰È·ÛÔÚ¿ ÙÔ˘ ¿Óıڷη ·ÂÚÔÁÂÓÒ˜ Û ÌÔÚÊ‹ ÛÙ·ÁÔÓȉ›ˆÓ (·ÂÚÔ˙fiÏ) ıˆÚÂ›Ù·È Û·Ó ÙËÓ ÈÔ Â›ÊÔ‚Ë ÌÔÚÊ‹ ¯Ú‹Û˘ ÙÔ˘ ˆ˜ fiÏÔ. ŒÓ· ·ÂÚÔ˙fiÏ ¿Óıڷη ÌÂÙ¿ ÙËÓ ·ÂÏ¢ı¤ÚˆÛ‹ ÙÔ˘ ı· ‹Ù·Ó ·fiÚ·ÙÔ Î·È ¿ÔÛÌÔ Î·È ı· ›¯Â ÙË ‰˘Ó·ÙfiÙËÙ· ‰È·ÛÔÚ¿˜ Û ·ÎÙ›Ó· ÔÏÏÒÓ ¯ÈÏÈÔ̤ÙÚˆÓ. ∆Ô 1979, ¤Ó· ·Ù‡¯ËÌ· Û ¤Ó· ÂÚÁÔÛÙ¿ÛÈÔ ·Ú·ÁˆÁ‹˜ ‚ÈÔÏÔÁÈÎÒÓ fiÏˆÓ ÛÙÔ Sverdlovsk Ù˘ ÚÒËÓ ∂™™¢, fiÔ˘ ÂÏ¢ıÂÚÒıËΠÏÈÁfiÙÂÚÔ ·fi 1 g ¿Óıڷη Û ÌÔÚÊ‹ ·ÂÚÔ˙fiÏ, ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· 68 ı·Ó¿ÙÔ˘˜. ∆Ô 1970, Ë ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ ˘ÔÏfiÁÈÛ fiÙÈ Ë ·ÂÏ¢ı¤ÚˆÛË Ì ·ÂÚÔÏ¿ÓÔ 50 kg ¿Óıڷη ¿Óˆ ·fi Ì›· ·ÛÙÈ΋ ÂÚÈÔ¯‹ Ì ÏËı˘ÛÌfi 5 ÂηÙÔÌ̇ÚÈ· ·ÓıÚÒÔ˘˜, ı· ÚÔηÏÔ‡Û 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˘. ∂ȉËÌÈÔÏÔÁ›· O ¿Óıڷη˜ Â›Ó·È Ì›· ˙ˆÔÓfiÛÔ˜ ÂÓ‰ËÌÈ΋ Û ‰È¿ÊÔÚ· ÛËÌ›· ÙÔ˘ Ï·Ó‹ÙË. º˘ÛÈ΋ ÌfiÏ˘ÓÛË ÛÙÔÓ ¿ÓıÚˆÔ ·fi ¿Óıڷη Û˘Ì‚·›ÓÂÈ ÌÂÙ¿ ·fi Â·Ê‹ Ì ÌÔÏ˘Ṳ̂ӷ ˙Ò· ‹ ˙ˆÈο ÚÔ˚fiÓÙ·. O ¿Óıڷη˜ ÈÛÙ‡ÂÙ·È ˆ˜ ‰ÂÓ ÌÂÙ·‰›‰ÂÙ·È 1

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·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ·¢ı›·˜ ÌfiÏ˘ÓÛ˘ ÓÂÚÔ‡ ‹ ÙÚÔÊ›ÌˆÓ ·fi ÛfiÚÔ˘˜ ÙÔ˘ ¿Óıڷη. ™ÙÔÓ ¿ÓıÚˆÔ ˘¿Ú¯Ô˘Ó 3 ÌÔÚʤ˜ Ù˘ ·Ûı¤ÓÂÈ·˜: ·Ó·Ó¢ÛÙÈ΋, ‰ÂÚÌ·ÙÈ΋ Î·È Á·ÛÙÚÂÓÙÂÚÈ΋. ¶ÈÔ Û˘¯Ó‹ Â›Ó·È Ë ‰ÂÚÌ·ÙÈ΋ ÌÔÚÊ‹, Ì ÂÚ›Ô˘ 2000 ÎÚÔ‡ÛÌ·Ù· ÂÙËÛ›ˆ˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ. ∏ ·Ó·Ó¢ÛÙÈ΋ ÌÔÚÊ‹ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·: ÌfiÓÔ 18 ÂÚÈÛÙ·ÙÈο ·Ó·Ê¤ÚıËÎ·Ó ÛÙȘ ∏.¶.∞. ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 20Ô‡ ·ÈÒÓ·. ™ÙËÓ ÂÚ›ÙˆÛË ¯Ú‹Û˘ ¿Óıڷη Û·Ó ‚ÈÔÏÔÁÈÎfi fiÏÔ Ì ‰È·ÛÔÚ¿ ·ÂÚÔ˙fiÏ, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÈÔ Û˘¯Ó‹ Î·È ÈÔ ı·Ó·ÙËÊfiÚ· ı· Â›Ó·È Ë ·Ó·Ó¢ÛÙÈ΋ 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 Û fiÏ· Ù· Û˘Ó‹ıË ıÚÂÙÈο ˘ÏÈο ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ Û 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˘Ṳ̂ӷ ·fi ÙÔÓ ¿Óıڷη ‚ÈÔÏÔÁÈο ˘ÏÈο ÂÎÙÂıÔ‡Ó ÛÙÔÓ ·ÙÌÔÛÊ·ÈÚÈÎfi ·¤Ú·. OÈ ÛfiÚÔÈ ÙÔ˘ ¿Óıڷη Â›Ó·È ÂÍ·ÈÚÂÙÈο ·ÓıÂÎÙÈÎÔ› Î·È ÌÔÚÔ‡Ó Ó· ÂÈ˙‹ÛÔ˘Ó ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ÔÏϤ˜ ‰ÂηÂٛ˜. ¶·ıÔÁ¤ÓÂÈ· Î·È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ∞Ó·Ó¢ÛÙÈÎfi˜ ¿Óıڷη˜ O ·Ó·Ó¢ÛÙÈÎfi˜ ¿Óıڷη˜ ÚÔηÏÂ›Ù·È ·fi ÙËÓ Â›ÛÔ‰Ô ÛfiÚˆÓ ÙÔ˘ ‚·Î›ÏÔ˘ ÛÙ· ΢„ÂÏȉÈο ‰È·ÛÙ‹Ì·Ù·. ∞˘Ù¿ Ê·ÁÔ΢ÙÙ·ÚÒÓÔÓÙ·È ·fi Ì·ÎÚÔÊ¿Á· Î·È ÌÂٷʤÚÔÓÙ·È ÛÙÔ˘˜ ÌÂÛÔıˆÚ·ÎÈÎÔ‡˜ ÏÂÌÊ·‰¤Ó˜, fiÔ˘ ÌÔÚ› Ó· ‚Ï·ÛÙ‹ÛÔ˘Ó ·ÎfiÌ· Î·È ÌÂÙ¿ ·fi 60 Ë̤Ú˜. ªÂÙ¿ ÙË ‚Ï¿ÛÙËÛË, Ë ·Ûı¤ÓÂÈ· ÂΉËÏÒÓÂÙ·È Ú·Á‰·›·. OÈ ÔÏÏ·Ï·ÛÈ·˙fiÌÂÓÔÈ ‚¿ÎÈÏÔÈ ·ÂÏ¢ıÂÚÒÓÔ˘Ó ÙÔ͛Ә Ô˘ 1

JAMA 1999;281:1735-1745


¶·È‰È·ÙÚÈ΋ 2001;64:630-632

ÚÔηÏÔ‡Ó ·ÈÌÔÚÚ·Á›·, Ô›‰ËÌ· Î·È Ó¤ÎÚˆÛË. ∞Ó Ë ·Ú·ÁˆÁ‹ ÙÔ͛Ӣ ÍÂÂÚ¿ÛÂÈ ¤Ó· ÎÚ›ÛÈÌÔ fiÚÈÔ, Â¤Ú¯ÂÙ·È ı¿Ó·ÙÔ˜ ·ÎfiÌ· Î·È ·Ó ¤¯Ô˘Ó ηٷÛÙÚ·Ê› ·fi ·ÓÙÈ‚ÈÔÙÈο fiÏ· Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ÛÙÔ ·›Ì· ‚·ÎÙËÚ›‰È·. ∏ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ¿Óıڷη Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË Î·È ı· ··ÈÙÔ‡Û ˘„ËÏfi ‰Â›ÎÙË ˘Ô„›·˜. ∆· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Â›Ó·È ÌË ÂȉÈο Î·È Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÚÂÙfi, ‚‹¯·, ‰‡ÛÓÔÈ·, ÎÂÊ·Ï·ÏÁ›·, ¤ÌÂÙÔ, Ú›ÁË, ·‰˘Ó·Ì›· Î·È fiÓÔ ÛÙÔ ÛÙ‹ıÔ˜. ∞˘Ù¿ Ù· Û˘ÌÙÒÌ·Ù· ‰È·ÚÎÔ‡Ó ÁÈ· Ï›Á˜ ÒÚ˜ ‹ Ë̤Ú˜ Î·È Û˘¯Ó¿ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi Ì›· ÌÈÎÚ‹ ÂÚ›Ô‰Ô ‚ÂÏÙ›ˆÛ˘. ∆· ÙÂÏÈο Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Í·ÊÓÈο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÚÂÙfi, ‰‡ÛÓÔÈ·, Û˘ÚÈÁÌfi, ÂÊ›‰ÚˆÛË, Ì·˙È΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Î·Ù·ÏËÍ›·. ∞ÎÙÈÓÔÁÚ·ÊÈο Û˘Ó‹ıˆ˜ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ‰È·Ï¿Ù˘ÓÛ˘ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘. ™ÙÔ˘˜ ÌÈÛÔ‡˜ ÂÚ›Ô˘ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙ÂÙ·È Î·È ·ÈÌÔÚÚ·ÁÈ΋ ÌËÓÈÁÁ›Ùȉ· Ì ÛËÌ›· ÌËÓÈÁÁÈÙȉÈÛÌÔ‡, ·Ú·Ï‹ÚËÌ· Î·È ‚Ú·‰˘„˘¯ÈÛÌfi. ™Â ·˘Ùfi ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, Ë ÂͤÏÈÍË Â›Ó·È Ú·Á‰·›· Ì ΢¿ÓˆÛË Î·È ˘fiÙ·ÛË. ™˘Ó‹ıˆ˜, Ô ı¿Ó·ÙÔ˜ Â¤Ú¯ÂÙ·È ÂÓÙfi˜ ÔÏ›ÁˆÓ ˆÚÒÓ. ¢ÂÚÌ·ÙÈÎfi˜ ¿Óıڷη˜ O ‰ÂÚÌ·ÙÈÎfi˜ ¿Óıڷη˜ ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÓ·fiıÂÛË ÛfiÚˆÓ ‚·Î›ÏÔ˘ ÛÙÔ ‰¤ÚÌ· fiÙ·Ó ˘¿Ú¯Ô˘Ó ·Ì˘¯¤˜ ‹ Á‰·Ú̷ۛٷ. ªÂÙ¿ ÙË ‚Ï¿ÛÙËÛË ÙˆÓ ÛfiÚˆÓ, Ë ·Ú·ÁˆÁ‹ ÙÔ͛Ӣ ÚÔηÏ› ÙÔÈÎfi Ô›‰ËÌ·. ∞Ú¯Èο, Û¯ËÌ·Ù›˙ÂÙ·È Ì›· ÎÓËÛÌ҉˘ ‚Ï·Ù›‰· ‹ ÎËÏ›‰· Ô˘ Ù·¯¤ˆ˜ ÂÍÂÏÎÒÓÂÙ·È. ∞ÎÔÏÔ‡ıˆ˜, ÂÌÊ·Ó›˙ÔÓÙ·È Ê˘Û·Ï›‰Â˜ ÌÂÁ¤ıÔ˘˜ 1-3 mm Ì ÂÎÚÔ‹ ‰È·˘ÁÔ‡˜ ‹ ÔÚÔ·ÈÌ·ÙËÚÔ‡ ˘ÁÚÔ‡ Ô˘ Â›Ó·È ÁÂÌ¿ÙÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜. ∞ÎÔÏÔ‡ıˆ˜, Û¯ËÌ·Ù›˙ÂÙ·È Ì›· ·ÓÒ‰˘ÓË Ì·‡ÚË ÂÛ¯¿Ú· Ô˘ ÍÂÚ·›ÓÂÙ·È, ¯·Ï·ÚÒÓÂÈ Î·È ·Ô›ÙÂÈ Û 1-2 ‚‰ÔÌ¿‰Â˜. §ÂÌÊ·‰ÂÓ›Ùȉ· Î·È Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó. ∏ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰ÂÓ ÂËÚ¿˙ÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ ‚Ï¿‚˘, ·ÏÏ¿ ÂÏ·ÙÙÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘. Èڛ˜ ·ÓÙÈ‚ÈÔÙÈ΋ ıÂÚ·›·, Ë ıÓËÙfiÙËÙ· Â›Ó·È 20%. °·ÛÙÚÂÓÙÂÚÈÎfi˜ ¿Óıڷη˜ O Á·ÛÙÚÂÓÙÂÚÈÎfi˜ ¿Óıڷη˜ ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÓ·fiıÂÛË Î·È ÛÙË Û˘Ó¤¯ÂÈ· ‚Ï¿ÛÙËÛË ÛfiÚˆÓ ÛÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ. ∞ÎÔÏÔ˘ı› Ë ÂÌÊ¿ÓÈÛË ÛÙÔÌ·ÙÈÎÔ‡ ‹ ÔÈÛÔÊ·ÁÈÎÔ‡ ¤ÏÎÔ˘˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ô›‰ËÌ· Î·È Û‹„Ë. ŒÂÈÙ·, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÂÓÙÂÚÈΤ˜ ‚Ï¿‚˜, ΢ڛˆ˜ ÛÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi ‹ ÙÔ Ù˘ÊÏfi, Ô˘ ÂΉËÏÒÓÔÓÙ·È ·Ú¯Èο Ì ӷ˘Ù›·, ¤ÌÂÙÔ Î·È Î·ÎÔ˘¯›·. ∏ ÂͤÏÈÍË Â›Ó·È Ú·Á‰·›·, Ì ·ÈÌ·ÙËÚ¤˜ ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ, ÔÍ›· ÎÔÈÏ›· Î·È Û‹„Ë. ™˘¯Ó¿, ˘¿Ú¯ÂÈ ÂÎÙÂٷ̤ÓÔ˜ ·ÛΛÙ˘. ∏ ıÓËÙfiÙËÙ· Â›Ó·È ÂÍ·ÈÚÂÙÈο ˘„ËÏ‹.

Paediatriki 2001;64:630-632

¢È¿ÁÓˆÛË ™Â ÂÚ›ÙˆÛË ¯Ú‹Û˘ ÙÔ˘ ¿Óıڷη Û·Ó ‚ÈÔÏÔÁÈÎfi fiÏÔ, ÙÔ ÈÔ Èı·Ófi Â›Ó·È Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Î˘Ú›ˆ˜ ·ÛıÂÓ›˜ ÌÂ Û˘ÌÙÒÌ·Ù· ·Ó·Ó¢ÛÙÈÎÔ‡ ¿Óıڷη. ∏ Í·ÊÓÈ΋ ÂÌÊ¿ÓÈÛË Û ̛· ÂÚÈÔ¯‹ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·ÛıÂÓÒÓ Ì ÔÍ›· Û˘ÌÙÒÌ·Ù· ÁÚÈÒ‰Ô˘˜ Û˘Ó‰ÚÔÌ‹˜ Î·È Ì ıÓËÙfiÙËÙ· 80%, Ì ÙÔ ı¿Ó·ÙÔ Ó· Â¤Ú¯ÂÙ·È Ì¤Û· Û 24-48 ÒÚ˜, Â›Ó·È Ôχ Èı·Ófi Ó· ÔÊ›ÏÂÙ·È Û ¿Óıڷη. ∞Ó ·Ú¯Èο ÂÌÊ·ÓÈÛÙÔ‡Ó ÌfiÓÔ Ï›Á· ÂÚÈÛÙ·ÙÈο Û˘Á¯ÚfiÓˆ˜, ÙfiÙÂ Ë ÔÌÔÈfiÙËÙ· Ù˘ ·Ú¯È΋˜ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ì ¿ÏϘ ÔÍ›˜ ·ı‹ÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÌÔÚ› Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ÙË ‰È¿ÁÓˆÛË ÁÈ· ·ÚÎÂÙ¤˜ Ë̤Ú˜. ∂ȉÈο ‰È·ÁÓˆÛÙÈο ÙÂÛÙ ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ¿Óıڷη Â›Ó·È Û˘Ó‹ıˆ˜ ¯ÚÔÓÔ‚fiÚ· Î·È Á›ÓÔÓÙ·È ÌfiÓÔ Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ΤÓÙÚ·. ™˘ÓÂÒ˜, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Ì¤ÚÔ˜ Ù˘ ‰È¿ÁÓˆÛ˘ Â›Ó·È Ô ˘„ËÏfi˜ ‰Â›ÎÙ˘ ˘Ô„›·˜. ∏ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ‰È·Ï¿Ù˘ÓÛ˘ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Û ¤Ó·Ó ·ÛıÂÓ‹ Ì ıÔÚ˘‚Ò‰Ë ÁÚÈÒ‰Ë Û˘Ó‰ÚÔÌ‹ Â›Ó·È Ô˘ÛÈ·ÛÙÈο ·ıÔÁÓˆÌÈ΋ ÚÔ¯ˆÚË̤ÓÔ˘ ¿Óıڷη Î·È ··ÈÙ› ¿ÌÂÛË ÂÓ¤ÚÁÂÈ·. ªÈÎÚÔ‚ÈÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÌÔÚÔ‡Ó Ó· ÂȂ‚·ÈÒÛÔ˘Ó ÙËÓ ·ÚÔ˘Û›· Bacillus anthracis. ™Â ÚÔ¯ˆÚË̤ÓÔ ¿Óıڷη, Ì›· Gram ¯ÚÒÛË ·Ê˘ÁÔΤÓÙÚËÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÌÔÚ› Ó· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË. ∏ ÈÔ ¯Ú‹ÛÈÌË ÌÈÎÚÔ‚ÈÔÏÔÁÈ΋ ÂͤٷÛË Â›Ó·È Ë Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, Ô˘ Û˘Ó‹ıˆ˜ ‰›ÓÂÈ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ̤۷ Û 6-24 ÒÚ˜. ¶ÚÔËÁÔ‡ÌÂÓË Û˘ÓÂÓÓfiËÛË Ì ÙÔ ÌÈÎÚÔ‚ÈÔÏÔÁÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ ÁÈ· ÙËÓ ˘Ô„›· ¿Óıڷη Â›Ó·È ÛËÌ·ÓÙÈ΋, ‰ÈfiÙÈ Û˘¯Ó¿ ÔÈ ·ÈÌÔηÏÏȤÚÁÂȘ ÂÈÌÔχÓÔÓÙ·È Ì ¿ÏÏÔ˘˜ ÌË ·ıÔÁfiÓÔ˘˜ ‚·Î›ÏÔ˘˜ Ô˘ ‰ÂÓ ·ÍÈÔÏÔÁÔ‡ÓÙ·È ·fi ÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ. ∫·ÏÏȤÚÁÂÈ· Î·È Gram ¯ÚÒÛË Ù˘¤ÏˆÓ ‰ÂÓ ‚ÔËıÔ‡Ó ÙË ‰È¿ÁÓˆÛË, ·ÊÔ‡ ÚfiÎÂÈÙ·È ÁÈ· ¿ıËÛË ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È fi¯È Ó¢ÌÔÓ›·. ™ÙÔ ‰ÂÚÌ·ÙÈÎfi ¿Óıڷη, ηÏÏȤÚÁÂÈ· Î·È Gram ¯ÚÒÛË ÙÔ˘ ÔÚÒ‰Ô˘˜ ˘ÁÚÔ‡ ÂȂ‚·ÈÒÓÔ˘Ó ÙË ‰È¿ÁÓˆÛË. ∂Ì‚ÔÏÈ·ÛÌfi˜ ∆Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ¿Óıڷη Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ·fi ÙÔÓ ·ÌÂÚÈηÓÈÎfi ÛÙÚ·Ùfi, ÂÁÎÚ›ıËΠÙÔ 1970 Î·È ‰ÂÓ ÂÚȤ¯ÂÈ ÔÏfiÎÏËÚ· ‚·ÎÙËÚ›‰È·. ÃÔÚËÁÂ›Ù·È ˘Ô‰ÔÚ›ˆ˜ Û ۯ‹Ì· 6 ‰fiÛÂˆÓ Û ‰È¿ÛÙËÌ· 18 ÌËÓÒÓ Î·È ··ÈÙÔ‡ÓÙ·È ÂÙ‹ÛȘ ·Ó·ÌÓËÛÙÈΤ˜ ‰fiÛÂȘ. ∆Ô ÂÌ‚fiÏÈÔ ·Ú·Û΢¿˙ÂÙ·È ·fi ηÏÏȤÚÁÂÈ· ÂÍ·ÛıÂÓË̤ÓÔ˘ ÛÙÂϤ¯Ô˘˜ ÙÔ˘ ‚·Î›ÏÔ˘, ÙÔ ÔÔ›Ô ÊÈÏÙÚ¿ÚÂÙ·È ÒÛÙ ӷ ÂÚȤ¯ÂÈ Î·Ù¿ ‚¿ÛË ÙÔ ÚÔÛٷ٢ÙÈÎfi ·ÓÙÈÁfiÓÔ. ∞fi ÙÔ 1998, fiÏÔ ÙÔ ÚÔÛˆÈÎfi ÙˆÓ ÂÓfiÏˆÓ ‰˘Ó¿ÌÂˆÓ ÙˆÓ ∏.¶.∞. ÂÌ‚ÔÏÈ¿˙ÂÙ·È ˘Ô¯ÚˆÙÈο. ∏ ·Ú·ÁˆÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓ ÂÚÈÔÚÈṲ̂ÓË Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÏËı˘ÛÌÒÓ.

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¶·È‰È·ÙÚÈ΋ 2001;64:630-632

£ÂÚ·›· ∏ ¿ÌÂÛË ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â›Ó·È Ô˘ÛÈ҉˘. ŸÏ· Ù· ¿ÙÔÌ· Ì ˘ÚÂÙfi ‹ Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ Û ̛· ÂÚÈÔ¯‹ Ô˘ ÂΉËÏÒıËΠÂÚÈÛÙ·ÙÈÎfi ¿Óıڷη, Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó ·ÓÙÈ‚ÈÔÙÈο. ™ÙÔ ·ÚÂÏıfiÓ, ÁÈ· ÙË ıÂÚ·›· ÙÔ˘ ¿Óıڷη ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÂÓÈÎÈÏÏ›ÓË ‹ ‰Ô͢΢ÎÏ›ÓË. ∆ÂÏÂ˘Ù·›·, fï˜, ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÏËÚÔÊÔڛ˜ ÁÈ· ·Ú·ÁˆÁ‹ ÙÚÔÔÔÈËÌ¤ÓˆÓ ‚·Î›ÏˆÓ, ·ÓıÂÎÙÈÎÒÓ ÛÙȘ ÂÓÈÎÈÏϛӘ Î·È ÙÂÙڷ΢ÎϛӘ. ™˘ÓÈÛٿٷÈ, ÏÔÈfiÓ, Û·Ó ÚÔÙÈÌÒÌÂÓË ıÂÚ·›·, Ë ¯ÔÚ‹ÁËÛË Ciprofloxacin 400 mg IV οı 12 ÒÚ˜ (ÁÈ· ·È‰È¿ 20-30 mg/kg IV Û ‰‡Ô ‰fiÛÂȘ, fi¯È ¿Óˆ ÙÔ˘ 1 g/Ë̤ڷ). ∞Ó ÙÔ Û٤ϯԘ ·Ô‰Âȯı› ¢·›ÛıËÙÔ, ÌÔÚ› Ó· ¯ÔÚËÁËı› Penicillin G 4 million U IV/4 ÒÚ˜ Î·È Doxycycline 100 mg IV/12 ÒÚ˜. ™Â ÂÚ›ÙˆÛË Ì·˙ÈÎÔ‡ ·ÚÈıÌÔ‡ ÎÚÔ˘ÛÌ¿ÙˆÓ Ô˘ ηıÈÛÙ¿ Ú·ÎÙÈο ·‰‡Ó·ÙË ÙËÓ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË, Û˘ÓÈÛÙ¿Ù·È Ciprofloxacin 500 mg per os οı 12 ÒÚ˜ (ÁÈ· ·È‰È¿ 20-30 mg/kg Û ‰‡Ô ‰fiÛÂȘ, fi¯È ¿Óˆ ÙÔ˘ 1 g/Ë̤ڷ). ∏ Û˘ÓÈÛÙÒÌÂÓË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Â›Ó·È 60 Ë̤Ú˜. °È· ÙË ıÂÚ·›· ÙÔ˘ ‰ÂÚÌ·ÙÈÎÔ‡ ¿Óıڷη, 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, ¢ڤˆ˜ Ê¿ÛÌ·ÙÔ˜ ÂÓÈÎÈÏϛӘ, ÎÂÊ·ÏÔÛÔÚ›Ó˜ ·’ ÁÂÓÈ¿˜, ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ Î·È ‚·ÓÎÔÌ˘Î›ÓË. O Bacillus anthracis ¤¯ÂÈ Ê˘ÛÈ΋ ·ÓÙÔ¯‹ ÛÙËÓ ÙÚÈÌÂıÔÚ›ÌË/ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË, ÎÂÊÔ˘ÚÔÍ›ÌË, ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙ·˙ȉ›ÌË Î·È ·˙ÙÚÂÔÓ¿ÌË. ¶ÚÔʇϷÍË ÌÂÙ¿ ·fi ¤ÎıÂÛË ªÂÙ¿ ·fi ÙË ¯Ú‹ÛË ¿Óıڷη Û·Ó ‚ÈÔÏÔÁÈÎfi fiÏÔ, ÔÈ ÙÔÈΤ˜ ˘ÁÂÈÔÓÔÌÈΤ˜ ·Ú¯¤˜ Ú¤ÂÈ Ó· ·ÔÊ·Û›ÛÔ˘Ó ÔÈÔÈ ÏËı˘ÛÌÔ› Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó ÚÔÊ˘Ï·ÎÙÈ΋ ·ÁˆÁ‹. ∞˘Ù‹ Ë ·fiÊ·ÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ÙfiÔ Î·È ÙÔ ¯ÚfiÓÔ Ù˘ ¤ÎıÂÛ˘, ηıÒ˜ Î·È ·fi ÙȘ ηÈÚÈΤ˜ Û˘Óı‹Î˜, Â¿Ó ÂÏ¢ıÂÚÒıËΠ¿Óıڷη˜ Û Â͈ÙÂÚÈÎfi ¯ÒÚÔ. °È· ÚÔÊ˘Ï·ÎÙÈ΋ ·ÁˆÁ‹, Û˘ÓÈÛÙ¿Ù·È per os ÙÔ ÚÔ·Ó·ÊÂÚı¤Ó ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· ÁÈ· 60 Ë̤Ú˜. ŒÏÂÁ¯Ô˜ ÏÔÈÌÒÍÂˆÓ O ¿Óıڷη˜ ‰ÂÓ ÌÂÙ·‰›‰ÂÙ·È ·fi ¿ÓıÚˆÔ Û ¿ÓıÚˆÔ. ™˘ÓÂÒ˜, ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È È‰È·›ÙÂÚ· ̤ÙÚ· ·ÔÌfiÓˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ¿Óıڷη, ·ÏÏ¿ ·Ï‹ Ù‹ÚËÛË ÙˆÓ Û˘ÓËıÈÛÌ¤ÓˆÓ Ì¤ÙÚˆÓ ÚÔʇ-

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Ï·Í˘. ∂›Û˘, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ¯ÔÚ‹ÁËÛË ÚÔÊ˘Ï·ÎÙÈ΋˜ ·ÁˆÁ‹˜ Û ¿ÙÔÌ· Ô˘ ¤Ú¯ÔÓÙ·È Û Â·Ê‹ Ì ÙÔÓ ·ÛıÂÓ‹, ÂÎÙfi˜ Â¿Ó ÂÎÙ¤ıËÎ·Ó Î·È ·˘ÙÔ› ÛÙÔÓ ¿Óıڷη ÙË ÛÙÈÁÌ‹ Ù˘ Â›ıÂÛ˘. °È· ÙËÓ ·Ôχ̷ÓÛË ÂÈÊ·ÓÂÈÒÓ Ô˘ ‹Úı·Ó Û Â·Ê‹ Ì ÌÔÏ˘Ṳ̂ӷ ۈ̷ÙÈο ˘ÁÚ¿ ÙÔ˘ ·ÛıÂÓ‹, Â›Ó·È Î·Ù¿ÏÏËÏ· Ù· Û˘Ó‹ıË ·ÔÏ˘Ì·ÓÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙÔ ÓÔÛÔÎÔÌ›Ô, .¯. ˘‰ÚԯψڛÙ˘. ∞Ôχ̷ÓÛË O ÌÂÁ·Ï‡ÙÂÚÔ˜ ΛӉ˘ÓÔ˜ ÌfiÏ˘ÓÛ˘ ÌÂÙ¿ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ·ÂÚÔÁÂÓÒ˜ ÛfiÚˆÓ ¿Óıڷη, ‰È·ÚΛ fiÛÔ ÔÈ ÛfiÚÔÈ ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ ·¤Ú· Û 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 ¿Óıڷη ÌÔÚ› ηÙfiÈÓ Ó· ·ÓȯÓ¢ıÔ‡Ó Û ÂÈÊ¿ÓÂȘ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ·ÏÏ¿ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ Ó· Í·Ó·Á›ÓÔ˘Ó ·ÂÚÔ˙fiÏ (secondary aerosolization). ™ÙÔȯ›· ·fi ÙÔ ·Ù‡¯ËÌ· ÛÙÔ Sverdlovsk Ù˘ ÚÒËÓ ∂™™¢ ‰Â›¯ÓÔ˘Ó fiÙÈ ‰ÂÓ ˘‹ÚÍ·Ó ÂÚÈÛÙ·ÙÈο ÌfiÏ˘ÓÛ˘ Ì ‰Â˘ÙÂÚÔÁÂÓ‹ ·ÂÚÔ˙fiÏ. ∞Ó¿ÏÔÁ· ‰Â‰Ô̤ӷ ÚÔ·ÙÔ˘Ó Î·È ·fi ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ÙÔ˘ ·ÌÂÚÈηÓÈÎÔ‡ 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 ·Ôχ̷ÓÛË ÂÎÙÂÙ·Ì¤ÓˆÓ ÂÚÈÔ¯ÒÓ ‹ ·ÎfiÌ· Î·È ÂÓfi˜ ÎÙÈÚ›Ô˘ ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË Û ·ÂÚÔ˙fiÏ ¿Óıڷη ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂӉ›ÎÓ˘Ù·È, ·ÏÏ¿ Î·È Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰˘Û¯ÂÚ‹˜. ∆· ¿ÙÔÌ· Ô˘ ı· ¤ÚıÔ˘Ó Û ¿ÌÂÛË Â·Ê‹ Ì ‡ÔÙÔ ÁÈ· ¿Óıڷη ˘ÏÈÎfi, ··ÈÙÂ›Ù·È Ó· χÓÔ˘Ó Û¯ÔÏ·ÛÙÈο ÙÔ ÂÎÙÂıÂÈ̤ÓÔ ‰¤ÚÌ· Î·È Ù· ÚÔ‡¯· Ì ÓÂÚfi Î·È Û·Ô‡ÓÈ. ¶ÂÚ·ÈÙ¤Úˆ ·Ôχ̷ÓÛË ‰ÂÓ ÂӉ›ÎÓ˘Ù·È. ∂ÈϤÔÓ, Ù· ¿ÙÔÌ· ·˘Ù¿ Ú¤ÂÈ Ó· Ï¿‚Ô˘Ó ÚÔÊ˘Ï·ÎÙÈο ·ÁˆÁ‹, ̤¯ÚÈ Ó· ·Ô‰Âȯı› fiÙÈ ÙÔ ‡ÔÙÔ ˘ÏÈÎfi ‰ÂÓ ‹Ù·Ó ¿Óıڷη˜.

∆· ·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-∂È̤ÏÂÈ·: ¶/¯Ë˜ (π) °. ∆fiÙÔ˜ ¶¡


¶·È‰È·ÙÚÈ΋ 2001;64:633-635

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PEDIATRIC NEWS

¶ÚfiÁÚ·ÌÌ· ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘ ˘fi ÙËÓ ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ∆Ô ÚfiÁÚ·ÌÌ· ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘ (™¶∂) ‰È·Ó‡ÂÈ ÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘ Î·È Ù· ÚÒÙ· ÈÛÙÔÔÈËÙÈο ™¶∂ ¤¯Ô˘Ó ·ÔÛÙ·Ï› ÛÙÔ˘˜ ‰ÈηÈÔ‡¯Ô˘˜ ¶·È‰È¿ÙÚÔ˘˜, ÔÈ ÔÔ›ÔÈ Û˘ÁΤÓÙÚˆÛ·Ó Ù· ··ÈÙÔ‡ÌÂÓ· 50 ÌfiÚÈ· ™¶∂ ÙÔ ¤ÙÔ˜ 2000. Ÿˆ˜ ¤¯ÂÈ ·Ó·ÎÔÈÓˆı› (1), ÙÔ ÚfiÁÚ·ÌÌ· ™¶∂ ‚·Û›˙ÂÙ·È ÛÙȘ ÚԉȷÁڷʤ˜ Ù˘ Confederation of European Specialists in Pediatrics (CESP), fiˆ˜ ·˘Ù¤˜ ‰È·ÌÔÚÊÒıËÎ·Ó ·fi ÙËÓ Committee for Continuing Medical Education in Pediatrics Î·È ‰ËÌÔÛȇıËÎ·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 οı ̛· ÒÚ· ‰È‰·Ûηϛ·˜ ·ÓÙÈÛÙÔȯ› ¤Ó· ÌfiÚÈÔ. O ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÌÔÚ›ˆÓ ·Ó¿ Ë̤ڷ Ô˘ ÌÔÚ› Ó· ·Ó·ÁÓˆÚÈÛÙ›, ·Û¯¤Ùˆ˜ ÙˆÓ ˆÚÒÓ Ô˘ ‰È·ÚΛ ÔÔÈ·‰‹ÔÙ ÂÈÛÙËÌÔÓÈ΋ ÂΉ‹ÏˆÛË (™˘Ó¤‰ÚÈÔ, ™ÂÌÈÓ¿ÚÈÔ, ∏ÌÂÚ›‰· Î.Ï.) Â›Ó·È 6. ∂›Û˘, ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙˆÓ ‰È·ÊfiÚˆÓ ·È‰È·ÙÚÈÎÒÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ ‰›ÓÔ˘Ó 1 ÌfiÚÈÔ ·Ó¿ ÒÚ· ‰È‰·Ûηϛ·˜ ÁÈ· ÙÔ˘˜ ¶·È‰È¿ÙÚÔ˘˜ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ˘ÔÂȉÈÎfiÙËÙ·˜, ·ÏÏ¿ 0,5 ÌfiÚÈÔ ÁÈ· ÙÔ˘˜ ÁÂÓÈÎÔ‡˜ ¶·È‰È¿ÙÚÔ˘˜ ‹ ¶·È‰È¿ÙÚÔ˘˜ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔًوÓ. OÈ ¶·È‰›·ÙÚÔÈ Ô˘ Û˘ÁÎÂÓÙÚÒÓÔ˘Ó 50 ‹ ÂÚÈÛÛfiÙÂÚ· ÌfiÚÈ· ™¶∂ ̤۷ Û ¤Ó· ËÌÂÚÔÏÔÁÈ·Îfi ¤ÙÔ˜ ‹ 150 ÌfiÚÈ· ̤۷ Û 3 ËÌÂÚÔÏÔÁȷο ¤ÙË ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÔ˘Ó ‹ Ó· ·ÔÛÙ›ÏÔ˘Ó ÌÂ Û˘ÛÙË̤ÓË ·ÔÛÙÔÏ‹ Ù· Û¯ÂÙÈο ÈÛÙÔÔÈËÙÈο ÛÙËÓ ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·, ÁÈ· ÙËÓ ∂ÈÙÚÔ‹ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘, ÒÛÙ ӷ ÂΉÔıÔ‡Ó Ù· ÈÛÙÔÔÈËÙÈο ™¶∂. ∞ÎÔÏÔ˘ı› ηٿÏÔÁÔ˜ ÙˆÓ ™˘Ó‰ڛˆÓ, ™ÂÌÈÓ·Ú›ˆÓ, ∏ÌÂÚ›‰ˆÓ Î·È ∂ÈÛÙËÌÔÓÈÎÒÓ ∂ΉËÏÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ̤¯ÚÈ Û‹ÌÂÚ· ·fi ÙËÓ ∂ÈÙÚÔ‹ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘, fiˆ˜ Â›Û˘ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÔÚ›ˆÓ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û οı ̛· ·fi ·˘Ù¤˜ ÙȘ ÂΉËÏÒÛÂȘ. ¶·Ú·Î·ÏÔ‡ÓÙ·È ÔÈ ÔÚÁ·ÓˆÙ¤˜ ÙˆÓ ÂÁÎÂÎÚÈÌ¤ÓˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ó· ·Ó·ÁÚ¿ÊÔ˘Ó ÛÙ· ÈÛÙÔÔÈËÙÈο ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔÓ ·ÚÈıÌfi ÌÔÚ›ˆÓ ™¶∂ Ô˘ ¯ÔÚËÁ› Ë ÂΉ‹ÏˆÛË, ÙËÓ ÔÔ›· ÔÚÁ·ÓÒÓÔ˘Ó. 1. ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· 18 ÌfiÚÈ· ÙÔ ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ 1 ÌfiÚÈÔ ·Ó¿ ÒÚ· ÁÈ· ÔÔÈ·‰‹ÔÙ ¿ÏÏË ÂΉ‹ÏˆÛË Ù˘ ∂¶∂ 2. ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1 ÌfiÚÈÔ ÙÔ ∂‚‰ÔÌ·‰È·›Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ª¿ıËÌ·, οı ∆Ú›ÙË 1 ÌfiÚÈÔ Ë ∂‚‰ÔÌ·‰È·›· ¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡, οı ¶¤ÌÙË 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 3. µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1 ÌfiÚÈÔ ÙÔ ∂‚‰ÔÌ·‰È·›Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ª¿ıËÌ·, οı ∆Ú›ÙË 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 4. ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 5. µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 6. °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 7. ¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 8. ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ 1 ÌfiÚÈÔ ÙÔ ∂‚‰ÔÌ·‰È·›Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ª¿ıËÌ·, οı ∆ÂÙ¿ÚÙË 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 5 ÌfiÚÈ· ÙÔ ÎÏÈÓÈÎfi ÊÚÔÓÙÈÛÙ‹ÚÈÔ ·È‰ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜

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9. ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ 1 ÌfiÚÈÔ ÙÔ ∂‚‰ÔÌ·‰È·›Ô ªÂÙÂÎ·È‰Â˘ÙÈÎfi ª¿ıËÌ·, οı ∆ÂÙ¿ÚÙË 1 ÌfiÚÈÔ ÔÈ ∏ÌÂÚ›‰Â˜ 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 10. ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ¶·ÁÎÚ‹ÙÈÔ ¶·ÓÂÈÛÙËÌÈ·Îfi ™˘ÌfiÛÈÔ 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 11. ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘ 5 ÌfiÚÈ· Ë ¢ÈÂÙ‹˜ ∂Ή‹ÏˆÛË 12. ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·Ï›·˜ 5 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 13. ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 14. ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛËÏ¢ÙÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 15. ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 2 ÌfiÚÈ· Ë ªËÓÈ·›· ∂Ή‹ÏˆÛË ºÚÔÓÙÈÛÙ‹ÚÈÔ ∞Ó·˙ˆÔÁfiÓËÛ˘ ¡ÂÔÁÓÔ‡-µÚ¤ÊÔ˘˜-¶·È‰ÈÔ‡: 3 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ 6 ÌfiÚÈ· ¡ÂÔÁÓÔÏfiÁÔÈ Î·È ∂ÓÙ·ÙÈÎÔÏfiÁÔÈ ¶·È‰›·ÙÚÔÈ 16. ¶·ÁÎÚ‹ÙÈ· ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 17. ∞ÈÌ·ÙÔÏÔÁÈ΋-OÁÎÔÏÔÁÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 8 ÌfiÚÈ· ¶·È‰Ô·ÈÌ·ÙÔÏfiÁÔÈ-OÁÎÔÏfiÁÔÈ 4 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 18. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∂ÊË‚È΋˜ π·ÙÚÈ΋˜ ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 8 ÌfiÚÈ· ¶·È‰›·ÙÚÔÈ Ì¤ÏË Ù˘ ∂Ù·ÈÚ›·˜ ∂ÊË‚È΋˜ π·ÙÚÈ΋˜ 4 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 19. ¶·È‰ÔÓ¢ÚÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 2 ÌfiÚÈ· ¶·È‰ÔÓ¢ÚÔÏfiÁÔÈ 1 ÌfiÚÈÔ °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 20. µ’ ¶·ıÔÏÔÁÈÎfi˜ ∆Ô̤·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 8 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 21. ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 8 ÌfiÚÈ· ¶·È‰›·ÙÚÔÈ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜, °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 22. ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 8 ÌfiÚÈ· ¶·È‰›·ÙÚÔÈ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ 4 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 23. µ’ ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 4 ÌfiÚÈ· Ë ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË 24. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ∏·ÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜ ∏ÌÂÚ›‰·: 6 ÌfiÚÈ· ¶·È‰ÔÁ·ÛÙÚÂÓÙÂÚÔÏfiÁÔÈ 3 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ ™˘ÌfiÛÈÔ: 3 ÌfiÚÈ· ¶·È‰ÔÁ·ÛÙÚÂÓÙÂÚÔÏfiÁÔÈ

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2 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 25. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 5 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 26. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ Î·È ∂ÊË‚È΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ ∂Ù‹ÛÈ· ∂Ή‹ÏˆÛË: 4 ÌfiÚÈ· ¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏfiÁÔÈ 2 ÌfiÚÈ· °ÂÓÈÎÔ› ¶·È‰›·ÙÚÔÈ Î·È ¶·È‰›·ÙÚÔÈ ¿ÏÏˆÓ ˘ÔÂȉÈÎÔÙ‹ÙˆÓ 27. ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ÛÂ Û˘ÓÂÚÁ·Û›· Ì ªÔÓ¿‰· ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁ›·˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ∏ÌÂÚ›‰· ·Ó¿ ‰ÈÂÙ›·: ¶ÚÒÙÔ˜ ·ÎÏÔ˜: 3 ÌfiÚÈ· ÁÈ· ¶·È‰›·ÙÚÔ˘˜ Î·È ¶·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˘˜ ¢Â‡ÙÂÚÔ˜ ·ÎÏÔ˜: 3 ÌfiÚÈ· ÌfiÓÔ ÁÈ· ¶·È‰ÔÓ¢ÌÔÓÔÏfiÁÔ˘˜ 28. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· §ÔÈÌÒÍÂˆÓ 4 ÌfiÚÈ· ™ÂÌÈÓ¿ÚÈÔ ∏ ∂ÈÙÚÔ‹ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·, ı· ‰ËÌÔÛȇÂÈ ÂÙËÛ›ˆ˜ ÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ ÂÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ™¶∂, ÒÛÙ ӷ Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ÓÔ˜ ÛÙËÓ ÂοÛÙÔÙ ÂÈÎÚ·ÙÔ‡Û· ηٿÛÙ·ÛË. ∏ ¶Úfi‰ÚÔ˜ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜

O ¶Úfi‰ÚÔ˜ Ù˘ ∂ÈÙÚÔ‹˜ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘

∞ÈηÙÂÚ›ÓË ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘

¡ÈÎfiÏ·Ô˜ °. ªÂÚ¿Ù˘

µÈ‚ÏÈÔÁÚ·Ê›· 1. ªÂÚ¿Ù˘ ¡°, ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞. ŒÓ·ÚÍË ÚÔÁÚ¿ÌÌ·ÙÔ˜ ™˘Ó¯È˙fiÌÂÓ˘ ¶·È‰È·ÙÚÈ΋˜ ∂Î·›‰Â˘Û˘ ˘fi ÙËÓ ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·. ¶·È‰È·ÙÚÈ΋ 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.

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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 ÂÚÈÔÚÈṲ̂ÓË ÁˆÁÚ·ÊÈο ¯Ú‹ÛË Ù˘ ÂÏÏËÓÈ΋˜ ÁÏÒÛÛ·˜ ·ÔÙÂÏ› ÙÚÔ¯Ô¤‰Ë ÛÙË ‰ÈÂıÓ‹ ÚÔ‚ÔÏ‹ Î·È ·ÎÙÈÓÔ‚ÔÏ›· ÙˆÓ ÂÈÙ¢ÁÌ¿ÙˆÓ Ù˘ ÂÏÏËÓÈ΋˜ ÂÈÛÙ‹Ì˘. ∞ÎfiÌË Î·È ÔÈ ÌÂÙ·ÊÚ¿ÛÂȘ ÂÏÏËÓÈÎÒÓ ÏÔÁÔÙ¯ÓÈÎÒÓ ‚È‚Ï›ˆÓ Ê·›ÓÔÓÙ·È Ó· ˘ÛÙÂÚÔ‡Ó ÙÔ˘ ÁψÛÛÈÎÔ‡ Î·È ÏÔÁÔÏ·ÛÙÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· Î·È Ù˘ ȉÈÔÌÔÚÊ›·˜ Ô˘ οÓÂÈ ÙÔÓ Û˘ÁÁڷʤ· Ó· ͯˆÚ›˙ÂÈ ÛÙËÓ ∂ÏÏ¿‰·. ∞fi ÙÔ˘˜ Û‡Á¯ÚÔÓÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ì·˜, ·ÚÎÂÙÔ› Â˘Ù‡¯ËÛ·Ó Ó· ‚ϤÔ˘Ó ÂΉfiÛÂȘ ÙˆÓ ‚È‚Ï›ˆÓ ÙÔ˘˜ Û ͤÓ˜ ÁÏÒÛÛ˜. ªÂ ı·˘Ì·ÛÌfi ı· ‰Ô‡Ì ÛÙÔ Â͈ÙÂÚÈÎfi ÙȘ ÌÂÙ·ÊÚ¿ÛÂȘ ‚È‚Ï›ˆÓ Û˘ÁÁڷʤˆÓ fiˆ˜ Ô ¡. ∫·˙·ÓÙ˙¿Î˘, Ô °. ƒ›ÙÛÔ˜, Ô ™·Ì·Ú¿Î˘ ‹ ÔÈËÙÒÓ fiˆ˜ Ô ∫. ∫·‚¿Ê˘, Ô ∫. ¶·Ï·Ì¿˜, Ô °. ™ÂʤÚ˘, Ô O. ∂χÙ˘ Î.¿. ™Ù· Ú¿ÊÈ· ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉfiÛÂˆÓ Î·È ‰Ë ÙˆÓ ÂÈÛÙËÌÒÓ ˘Á›·˜ Û·Ó›˙Ô˘Ó, Â›Ó·È Û¯Â‰fiÓ ·Ó‡·ÚÎÙ˜ ÌÂÙ·ÊÚ¿ÛÂȘ ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ Î·È Ù· ÂÏÏËÓÈο ÔÓfiÌ·Ù· Û˘ÁÁڷʤˆÓ ÚÔ¤Ú¯ÔÓÙ·È Û˘Ó‹ıˆ˜ ·fi ÙÔ˘˜ Û˘Ì·ÙÚÈÒÙ˜ Ì·˜ Ù˘ ‰È·ÛÔÚ¿˜. ∂ÓÙ˘ˆÛȷ΋ ÂÍ·›ÚÂÛË fï˜ Û‹ÌÂÚ· ·ÔÙÂÏ› ÙÔ ‚È‚Ï›Ô ÙÔ˘ ∞Ó·Ï. ∫·ıËÁËÙ‹ Î·È ¢È¢ı˘ÓÙ‹ ÙÔ˘ ™ÙÔÌ·ÙÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ “∞Ó‰Ú¤·˜ ™˘ÁÁÚfi˜” Î. °ÈÒÚÁÔ˘ §¿ÛηÚË, Ô˘ ·Ú¯Èο ΢ÎÏÔÊfiÚËÛ ·fi ÙÔÓ ∂ΉÔÙÈÎfi O›ÎÔ Thieme Verlag ÙÔ 2000, Ì ٛÙÏÔ “Color Atlas of Oral Diseases in Children and Adolescents”. ∂ʤÙÔ˜ ÙÔ ‚È‚Ï›Ô ·˘Ùfi ÂΉfiıËΠÛÙËÓ ¶ÔÚÙÔÁ·ÏÏÈ΋ (“Atlas Colorido de Doencas Bucais da Infância e da Adolescência”) Î·È ÙËÓ πÛ·ÓÈ΋ ÁÏÒÛÛ· “Patologias de la Cavidad Bucal en Ni¡os y Adolescentes” Î·È … ¤ÂÙ·È Û˘Ó¤¯ÂÈ·, ÏfiÁˆ Ù˘ ˙ËÙ‹ÛÂÒ˜ ÙÔ˘. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ¤Ó· ¿ÏÏÔ ‚È‚Ï›Ô ÙÔ˘ °. §¿ÛηÚË Ì ٛÙÏÔ “™ÙÔÌ·ÙÔÏÔÁ›·” ¤¯ÂÈ ÂΉÔı› Û ٤ÛÛÂÚȘ ·ÎfiÌË ÁÏÒÛÛ˜. OÈ ÍÂÓfiÁψÛÛ˜ ÂΉfiÛÂȘ ÙÔ˘ ‚È‚Ï›Ô˘ ·ÔÙÂÏÔ‡Ó Ú·ÁÌ·ÙÈο ÌÂÁ¿ÏË ÙÈÌ‹, ·Ó·ÁÓÒÚÈÛË Î·È Î·Ù·Í›ˆÛË Î·È ÚÔ‚¿ÏÏÔ˘Ó ÙËÓ ÂÏÏËÓÈ΋ È·ÙÚÈ΋ ÛÙÔ ‰ÈÂıÓ‹ ¯ÒÚÔ. £ÂÚÌ¿ Û˘Á¯·ÚËÙ‹ÚÈ· ·Í›˙Ô˘Ó ÛÙÔÓ Û˘ÁÁڷʤ· Î. °. §¿ÛηÚË ÁÈ· ÙÔ ÛËÌ·ÓÙÈÎfi ¤ÚÁÔ ÙÔ˘. ∆Ô˘ ¢¯fiÌ·ÛÙ ӷ ÙÔ Û˘Ó¯›ÛÂÈ!

ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛfiη˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜

∞ÁÁÏÈ΋ ŒÎ‰ÔÛË

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¶ÔÚÙÔÁ·ÏÏÈ΋ ŒÎ‰ÔÛË

πÛ·ÓÈ΋ ŒÎ‰ÔÛË


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∂˘¯·ÚÈÛٛ˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ∏ ¢È‡ı˘ÓÛË Î·È Ù· ̤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ¢¯·ÚÈÛÙÔ‡Ó ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ ›ڷ Î·È ÙÔ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘ÌÂ Û˘ÛÙËÌ·ÙÈΤ˜, ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2001.

∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 64 ÙÔ˘ ¤ÙÔ˘˜ 2001

∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º·Ó‹ ∞˚‚¿˙˘ µ›ÎÙˆÚ·˜ ∞Ó‰Ú¤Ô˘ ∞ϤͷӉÚÔ˜ ∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹ ∞Ó‰ÚÔ˘Ï·Î¿Î˘ ª·ÓÒÏ˘ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ªÈ¯¿Ï˘ ∞ÓÙ‡·˜ ™‡ÚÔ˜ ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘ πˆ¿ÓÓ· ∞ÚÒÓË-µÔ˘ÚÓ¿ ™ÔÊ›· µ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›· µ·ÚÏ¿Ì˘ °ÂÒÚÁÈÔ˜ µ¤ÎÈÔ˘-™·Ì·Ú¿ ∞ıËÓ¿ °·Ï·Ó¿Î˘ ∂ÌÌ·ÓÔ˘‹Ï °ÈÔ˘ÚÔ‡ÎÔ˜ ™ˆÙ‹ÚÈÔ˜ °ÎÈÒÓ˘ ¢ËÌ‹ÙÚÈÔ˜ ¢·‚¿Î˘ ªÈ¯·‹Ï ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜ ∏Ú·ÎÏ‹˜ ¢ËÌËÙÚ›Ô˘ πˆ¿ÓÓ˘ ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ·ÛÈÏÈ΋ ∑·ÊÂÈÚ›Ô˘ ¢ËÌ‹ÙÚÈÔ˜ ∑ÂÚ‚fi˜ °ÂÚ¿ÛÈÌÔ˜ £·ÓfiÔ˘ÏÔ˜ µ·Û›ÏÂÈÔ˜ £ˆÌ·˝‰Ô˘ ¢¿ÊÓË-§ˆÚ¤Ù· πÔÚ‰·Ó›‰Ô˘ ∞ÓÙÈÁfiÓË ∫·‚·ÏÈÒÙ˘ πˆ¿ÓÓ˘ ∫·Ó·ÎÔ‡‰Ë-∆۷ηϛ‰Ô˘ ºÏˆÚÂÓÙ›· ∫·Ú·Ó›Î·˜ ∏Ï›·˜ ∫·Ú‹˜ ÃÚ›ÛÙÔ˜ ∫·ÙÛ·Ú‰‹˜ ÷ڿϷÌÔ˜ ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›· ∫·ÙÙ¿Ì˘ ∞ÓÙÒÓÈÔ˜ ∫ÂÚ·Ì›‰·˜ ¢ËÌ‹ÙÚÈÔ˜ ∫Ô‚¿Ó˘ ∞ı·Ó¿ÛÈÔ˜ ∫ÔÓÙfiÔ˘ÏÔ˜ ∂Ï¢ı¤ÚÈÔ˜ ∫fiÚη˜ ∞Ó·ÛÙ¿ÛÈÔ˜ ∫ÔÛÌ›‰Ë-µ·ÛÈÏ¿ÙÔ˘ ∂ϤÓË ∫Ô˘ÙÛÔ˘ÏȤÚ˘ ∏Ï›·˜ ∫ÚÂÌÂÓfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∞Ó‰Ú¤·˜ ∫ÒÛÙ·ÏÔ˜ ÃÚ‹ÛÙÔ˜ ∫ˆÛÙÔÔ‡ÏÔ˘-º·ÚÚ‹ ∂˘·ÁÁÂÏ›·

§·Áfi˜ ¶·Ó·ÁÈÒÙ˘ ∆˙ˆÚÙ˙¿ÙÔ˘-™Ù·ıÔÔ‡ÏÔ˘ ºˆÙÂÈÓ‹ ∆ڇʈӷ˜ °ÂÒÚÁÈÔ˜ §·Ì·‰·Ú›‰Ë˜ πˆ¿ÓÓ˘ ∆۷ӿη˜ ¡. πˆ¿ÓÓ˘ ª·Ï·Ì›ÙÛË-¶Ô‡¯ÓÂÚ ∞ÚÈ¿‰ÓË ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ ∆¿ÏÈ· ª¿Ó‰˘Ï·-™Ê¿ÁÁÔ˘ ∂ϤÓË ∆ÛÈÏÈÁÈ¿ÓÓ˘ £ÂÔÊ¿Ó˘ ª·ÓÈ¿ÙË ÃÚÈÛÙ›‰Ë ª·Ú›· ∆Û›ÙÔ˘Ú· ™Ù¤ÏÏ· ª·ÓÙ·Áfi˜ ™Ù¤Ê·ÓÔ˜ ∆ÛÔ˘Ì¿Î·˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ª·ÓÙ˙Ô˘Ú¿ÓË ∂˘·ÁÁÂÏ›· ºˆÙfiÔ˘ÏÔ˜ ™˘Ú›‰ˆÓ ª·ÚÁÂÙ¿Î˘ ∞Ó‰Ú¤·˜ ÷Ù˙‹˜ ∞Ó·ÛÙ¿ÛÈÔ˜ ª·˘ÚÔÌÌ¿Ù˘ ¶·Ó·ÁÈÒÙ˘ ÃÚÈÛÙfiÔ˘ÏÔ˜ °ÂÒÚÁÈÔ˜ ªËÙÛÈÒÓË ∞Ó‰ÚÔÌ¿¯Ë ªÈ¯·Ï¿ÎÔ˜ ™Ù¤Ê·ÓÔ˜ ¡·Ó¿˜ ÃÚ‹ÛÙÔ˜ ¡ÈÎÔÏ·˝‰Ô˘ ¶ÔÏ˘Í¤ÓË ¡Ô‡ÛÈ·-∞Ú‚·ÓÈÙ¿ÎË ™¿ÓÙ· ¡Ù·Ú›ÏÏ˘ ∂˘Á¤ÓÈÔ˜-∂ÌÌ·ÓÔ˘‹Ï •¿ÓıÔ˘ ª·ÚȤÙÙ· ¶·Ó·ÁÈÒÙÔ˘-∞ÁÁÂÏ·ÎÔÔ‡ÏÔ˘ πˆ¿ÓÓ· ¶·ÓÙÂÏÈ¿‰Ë˜ ÃÚ‹ÛÙÔ˜ ¶··Á·ÚÔ˘Ê¿Ï˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··‰¿ÙÔ˜ πˆ¿ÓÓ˘ ¶··‰ÔÔ‡ÏÔ˘ ∞ÏÂÍ¿Ó‰Ú· ¶··Â˘·ÁÁ¤ÏÔ˘ µ·ÛÈÏÈ΋ ¶··¯·Ù˙‹-∫·ÏÌ·ÓÙ‹ ª·Ú›· ¶··¯Ú‹ÛÙÔ˘ ºÒÙÈÔ˜ ¶ÂÙÚ›‰Ô˘-™Î·ÏΛ‰Ô˘ ∂ϤÓË ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™ÔÊ›· ¶Ú›ÊÙ˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶ÚÔ‰ÚfiÌÔ˘ ¡ÂfiÊ˘ÙÔ˜ ƒ¿ÌÌÔ˜ ™˘Ú›‰ˆÓ ƒÔËÏ›‰Ë˜ ∂ÌÌ·ÓÔ˘‹Ï ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ ºˆÙÂÈÓ‹ ™·ÚÚ‹-∆˙·‚¤Ï· ∑·¯·ÚԇϷ ™ÎÂÓÙ¤Ú˘ ¡›ÎÔ˜ ™ÎÔ˘Ù¤ÏË ∂ϤÓË ™ËÏÈÒÙË-°Îڤη µ·ÛÈÏÈ΋ ™˘Ú›‰Ë˜ ¶·Ó·ÁÈÒÙ˘ ™ÙÂÊ·Ó›‰Ë˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÈ‚·ÎÙ¿ÎË-¶··‰¿ÎË ∂ÚÁ¿ÓË ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞ÓÙÈÁfiÓË ™ˆÙËÚ›Ô˘ πˆ¿ÓÓ˘ ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ ÃÚ‡Û·

637


¶·È‰È·ÙÚÈ΋ 2001;64:638-640

Paediatriki 2001;64:638-640

∂˘ÚÂÙ‹ÚÈÔ ™˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 64 ∞ ∞‚Ú·Ì›‰Ô˘ ∫. ∞ÁÁÂÏ¿ÎÔ˘ µ. ∞ÁÁÂÏfiÔ˘ÏÔ˜ ™. ∞ÁÁÔ˘Úȉ¿ÎË Ã. ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. ∞ÏÂÍfiÔ˘ÏÔ˜ ∂. ∞ÏÌ·Ó›‰Ë˜ £. ∞Ó‰Ú¤Ô˘ ∞. ∞Ó‰ÚÔ˘Ï·Î¿Î˘ º.∞. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª. ∞ÓÙˆÓÈ¿‰Ë˜ ∞. ∞ÛÎÔ‡ÓË-™ÙÚÔ‡ÌÔ˘ ∞.¢.

76 460 493 481 72,136 76,504 49 493 573,589 395 351 72 410

µ µ·Ï¿ÚË ª. µ·ÚÏ¿Ì˘ °.™. µÏ·˙¿Î˘ ™. µÏ¿¯Ô˘ £. µÔÏÔÓ¿Î˘ ª.∫. µÔÏÔ˘‰¿ÎË ∞. µÔ˘ÁÈԇη Ÿ.

223 115,481 93 172 330 615 233

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638

55 65 81 247,472 624 59 551 145,168,319,615 391 87 583 76,504 573,589 465 202 276

400 163 527

59,336,481

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472 76 300 448,604 172,514,610

∏ ∏ÏÈ¿‰Ë˜ ∞. ∏Ï›·˜ ∞. ∏ÏÈÔ‰ÚÔÌ›ÙË ∑.

583 14 177

£ £ÂÔ‰ˆÚ›‰Ë˜ Ã. £ÂÔ‰ˆÚ›‰Ô˘ ª. £ˆÌ·˝‰Ô˘ §.

188 81 365

π π·Îˆ‚›‰Ô˘ ¡. πÁÓ·ÙÈ¿‰Ë˜ π. πˆ¿ÓÓÔ˘ ª.

163 604 81

∫ ∫·˚Ì¿Ú·-¶··ı·Ó·Û›Ô˘ ∞. ∫·Ï·Ì·Ï›Î˘ ¶. ∫·Ï¤ÁÈ·˜ π. ∫¿ÏÏÈÔ˘ µ. ∫·ÏÌ·ÓÙ‹ ª. ∫·Ì¿˜ ¡. ∫·Ó·Î¿-Gantenbein Ã. ∫·Ó¿Ú˘ §. ∫·Ó¿ÚÈÔ˘ ª.°. ∫·ÓÈ¿Ú˘ °. ∫·fiÁÈ·ÓÓ˘ ∞. ∫·Ú·‚¿Ó· °. ∫·Ú·‚·Ó¿ÎË-∫·Ú·Ó¿ÛÈÔ˘ ∫. ∫·Ú·Î·˚‰fi˜ ¢. ∫·Ú·ÎfiÏË Õ. ∫·Ú·Ì¤Ú˘ ™. ∫·Ú·Ù˙¿-•ÈÊÏ›‰Ô˘ ∂. ∫·Ú·Ê¤˙Ë ª. ∫·Ú‹˜ Ã. ∫·Ú›Î·˜ °.∞. ∫·Ú¿ıÈÔ˜ £. ∫·ÙÛ·Ú‰‹˜ Ã.µ. ∫·ÙÙ¿Ì˘ ∞. ∫ÂÚ·Ì›‰·˜ ¢. ∫›ÙÚ· µ. ∫Ô˚‰Ô‡-∆ÛÈÏÈÁÈ¿ÓÓË ∞.

188 472,499,547,565 163 132 136,280 132 406 172,610 229 514 472 493 518 172,514,610,624 26 481 508 514 172,514,610,624 55,154,488 136,551 342 202 159,312,607 34 315


¶·È‰È·ÙÚÈ΋ 2001;64:638-640

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Paediatriki 2001;64:638-640

93 136 241 145,168,615 136 607 465 163 595 595 504 607 72 93 177 49 208,618

285 460 607 197

59 145 145,168,615 145 573,589 565 163 136 615 81 154 551 514,610 573,589 159,607 154 181,472,499,565

181,499 177 177 376 65,290 136 308

• •ÂÊÙ¤ÚË ª. •˘ÓÈ¿˜ π.

65 508

O OÈÎÔÓfiÌÔ˘ ª. O˘Ú·Ó‹ ∂.

504 583

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565 355 39,136 4 493 508 101 132 424 304 583 420 268 557 168 159,607 215 573,589 565 136 45 30 535 211 125

ƒ ƒ¿ÌÌÔ˜ ™. ƒÂÁÎÔ‡Ù·˜ ™. ƒÔËÏ›‰Ë˜ ∂. ƒÔ˘ÌȤ˜ ¡. ƒÒÛÛÈÔ˘ ∞.

163 488 272 65 573,589

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595 93 615 237 4 85 465 136

639


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640

Paediatriki 2001;64:638-640

49,430 168 49 55,154,488,527 465 293 441 59 72 465 255 387

65 488 370 136 595 493 172,610 219 136 481 154,488,527 361 76,504 59 384 1,347 436 417 87,465 465 261,448,604

583 508

49 557 72,481 159 93 460 188 595 145,168,319,615 493

÷Ù˙Ë·Ó·Á‹˜ ∞. ÷Ù˙Ë·ÓÙÂÏ‹˜ ∂. ÷Ù˙‹˜ ∞. ÷Ù˙ËÛÙ˘ÏÈ·ÓÔ‡ ª. ÃȈٛÓ˘ Ã. ÃÔϤ‚·˜ ¢. ÃÚÈÛÙÔ‰Ô˘Ï¿ÎË ª. ÃÚ˘Û¿ÎË ∞. ÃÚ˘Û·ÓıfiÔ˘ÏÔ˜ Ã. æ æ‡¯Ô˘ º.

85 76 181,472,499,565 481 159 465 145 565 59

177


¶·È‰È·ÙÚÈ΋ 2001;64:641-644

Paediatriki 2001;64:641-644

∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍˆÓ-ÎÏÂȉÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 64 C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË DDAVP Growth factors Lp (·) Lung development

481 14 1 55 1

∞ ∞ÁÁÂȷο ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· 583 ∞Á΢ÏÔÔÈËÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ· 233 ∞‰ÂÍÈfiÙËÙ· 391 ∞ıÏËÙÈÛÌfi˜ 430 ∞ÈÌ·ÙÔ˘Ú›· 255 ∞ÈÌԉȋıËÛË 472 ∞ÈÌÔοı·ÚÛË 472 ∞›ÙÈ· ·ÔÙ˘¯›·˜ 347 ∞›ÙÈ· ı·Ó¿ÙÔ˘ 589 ∞ÈÙÈÔÏÔÁ›· 136 ∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ 424 ∞ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË 87,163 ∞ÏÏÂÚÁ›· ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰Ô˜ 219 ∞ÏÏÂÚÁÈÎfi ¿ÛıÌ· 330 ∞ÏÏÔÁÂÓ‹˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ 45 ∞ÌÈÁ‹˜ ·Ï·Û›· Ù˘ ÂÚ˘ıÚ¿˜ ÛÂÈÚ¿˜ 34 ∞Ó·ÈÌ›· Diamond-Blackfan 45 ∞Ó·ÈÌ›· Fanconi 45 ∞Ó··Ú·ÁˆÁ‹ 400 ∞Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· 159 ∞Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÚÔÌ‚ÔÔ›ËÛË 30 ∞Ó¿Ù˘ÍË 527 ∞Ó¿Ù˘ÍË ÏfiÁÔ˘ 370 ∞Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ 365 ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ 365 ∞Ó·Ù˘Íȷ΋ ‰È·ÁÓˆÛÙÈ΋ 376 ∞Ó·Ê˘Ï·Í›· 215 ∞Ó¢ڇÛÌ·Ù· ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ 420 ∞ÓËÛ˘¯ËÙÈο ÛËÌ›· ·Ó¿Ù˘Í˘ ÏfiÁÔ˘ 370 ∞ÓıÂÎÙÈÎfi ÛÙË ıÂÚ·›· ¿ÛıÌ· 336 ∞ÓÔÛÔηٷÛÙÔÏ‹ 39,272 ∞ÓÔÛÔÏÔÁÈ΋ ·fiÎÚÈÛË 237 ∞ÓÙÈ‚ÈÔÙÈο 223 ∞ÓÙÈ‚›ˆÛË 547 ∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η 460 ∞ÓÙÈı˘ÚÂÔÂȉÈο ·ÓÙÈÛÒÌ·Ù· 188 ∞ÓÙÈÌÂÙÒÈÛË 93,215,268,436 ∞ÓÙÈÙÂÙ·ÓÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ 610 ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· 177 ∞¤ÎÎÚÈÛË ·Û‚ÂÛÙ›Ô˘ 465 ∞Ï·Û›· 30 ∞Ï·ÛÙÈ΋ ·Ó·ÈÌ›· 39,45 ÕÓÔÈ· 551

∞ÒÏÂÈ· ·ÎÔ‹˜ 370 ∞ÚıÚ›Ùȉ· ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÂÓÙ¤ÚÔ˘ 233 ∞ÚÙËÚȷ΋ ›ÂÛË 448 ÕÛıÌ· 330,336 ∞Û˘Ìو̷ÙÈÎfi ÓÂÔÁÓfi 168 ·-ÙÔÎÔÊÂÚfiÏË 154 ∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· 223 ∞Ù˘¯‹Ì·Ù· 261,624 ∞˘ÍËÙÈ΋ ÔÚÌfiÓË 406 ∞˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ 527 ∞˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ 26 ∞˘ÙÔ¿ÓÔÛË 557 ∞˘ÙÔ¿ÓÔÛË ÓfiÛÔ˜ 229 ∞˘ÙÔ·Óٛۈ̷ 229 ∞˘ÙÔ‰Ú·ÛÙÈÎÔ› ÏÂÌÊÔ΢ÙÙ·ÚÈÎÔ› ÎÏÒÓÔÈ 229 ∞˘ÙÔÂ›ÁÓˆÛË 384 ∞˘ÙfiÌ·ÙË ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· 583 ∞Ê˘‰¿ÙˆÛË 4,49 µ ‚2-‰ÈÂÁ¤ÚÙ˜ Ì·ÎÚ¿˜ ‰Ú¿Û˘ µ·ıÌfi˜ ‰‡ÛÓÔÈ·˜ µ·Ï‚›‰Â˜ Ô˘Ú‹ıÚ·˜ µ·ÏÚÔ˚Îfi Ô͇ µ·Ú‡ ¿ÛıÌ· µÈÔÙÈÓȉ¿ÛË µÈÙ·Ì›ÓË C µÈÙ·Ì›ÓË ∞ µÈÙ·Ì›ÓË ∂ ‚-ηڈ٤ÓÈ· µÏ¿‚˜ ·fi ·Ù˘¯‹Ì·Ù· µÚÂÊÈ΋ ËÏÈΛ· µÚ¤ÊÔ˜ µÚÔÁ¯ÈÎfi ¿ÛıÌ· µÚÔÁ¯ÈÔÏ›Ùȉ· µÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈο µÚÔÁ¯Ô΋ÏË ° °ÂÓÓËÙÈÎfi Û‡ÛÙËÌ· °ÈÁ·ÓÙÈ·›· ·ÈÌÔÂÙ¿ÏÈ· °Ú·ÌÌÈ΋ IgA ÓfiÛÔ˜ ¢ ¢Â›ÎÙ˘ ‰È·ÌfiÏ˘ÓÛ˘ ¢ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ¢ÂÛÌÔÚÂÛÛ›ÓË ¢ËÏËÙËÚ›·ÛË ¢È¿ÁÓˆÛË ¢È·ÁÓˆÛÙÈ΋ ÂÓ‰ÔÛÎfiËÛË

342 59 395 488 336 488 154 65 65 154 410 504 351,618 330 351 351 101

400 76 557

132 132 14 319,624 211 290

641


¶·È‰È·ÙÚÈ΋ 2001;64:641-644

Paediatriki 2001;64:641-644

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË 115 ¢È·Èı˘ÏÈ΋ ÙÔÏÔ˘·Ì›‰Ë 181 ¢È·ÈÙËÙÈο ÂÏÏ›ÌÌ·Ù· 237 ¢È·Ï˘ÙÔ› ˘ԉԯ›˜ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 2 481 ¢È·ÛÙ·˘ÚÔ‡ÌÂÓË ÓÂÊÚÈ΋ ÂÎÙÔ›· 514 ¢È·Ù·Ú·¯¤˜ ·Ó¿Ù˘Í˘ 406 ¢È·Ù·Ú·¯¤˜ ÏfiÁÔ˘ 370 ¢È·Ù·Ú·¯¤˜ Ì¿ıËÛ˘ 387 ¢È·Ù·Ú·¯¤˜ ‡ÓÔ˘ 551 ¢ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì Á¿Ï· ·ÁÂÏ¿‰Ô˜ 219 ¢‡ÛÎÔÏÔ ¿ÛıÌ· 336 ¢˘ÛÏÂÍ›· 387,391 ∂ ŒÁη˘Ì· ∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ∂ÁÎÏËÌ·ÙÈÎfiÙËÙ· ∂ȉÈ΋ IgE ÁÈ· ÚˆÙ½Ó˜ ÙÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰Ô˜ ∂ȉÈ΋ ıÓËÛÈÌfiÙËÙ· ∂ηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ŒÎ˙ÂÌ· ∂ÎÛÙÚÔÊ‹ ·ÛÙˆ˜ ∂ÎÙ›ÌËÛË ∂ÎÙfi˜ ÂϤÁ¯Ô˘ Û˘ÌÂÚÈÊÔÚ¿ ŒÏÏÂÈ„Ë ÛÂÏËÓ›Ô˘ ŒÏÏÂÈ„Ë Û˘ÌÏËÚÒÌ·ÙÔ˜ ∂Ì‚Ú˘˚΋ ˘‰ÚÔÓ¤ÊÚˆÛË ŒÓ·˜ ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ¯ÚfiÓÔ˜ ∂Ó‰ËÌÈ΋ ‚ÚÔÁ¯Ô΋ÏË ∂Ó‰˘Ó¿ÌˆÛË ∂ÓÛ˘Ó·›ÛıËÛË ∂ÓÙÔÌÔ·ˆıËÙÈÎfi ∂Ó˘‰¿ÙˆÛË ŒÍÔ‰Ô˜ ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ∂͈ÓÂÊÚÈ΋ οı·ÚÛË ∂·ÓÂÈÏËÌ̤Ó˜ ÌËÓÈÁÁ›Ùȉ˜ ∂ÂÌ‚·ÙÈ΋ ÂÓ‰ÔÛÎfiËÛË ∂È‚›ˆÛË ∂ȉËÌÈÔÏÔÁ›· ∂ÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (Ê˘ÛÈÎfi˜, Û˘ÓıÂÙÈÎfi˜) ∂Ô¯È΋ ηٷÓÔÌ‹ ∂ÚÁÔÓÔÌ›· ∂ÚËÙÔÂȉ‹˜ ‰ÂÚÌ·Ù›ÙȘ ∂Ú˘ıÚÔÔÈËÙ›ÓË ∂Ê˂›· ∂ÊË‚È΋ ËÏÈΛ· ∏ ∏ÏÂÎÙÚÔÌ·ÁÓËÙÈ΋ ·ÎÙÈÓÔ‚ÔÏ›· ∏ÏÈÔÊ¿ÓÂÈ·

642

499 85 410 219 573 55 223 395 268 410 101 81 241 312 101 410 384 181 4 618 472 81 290 285 610 145 465 430 557 504 395,436,493 430

535 465

£ £ÂÚ·›·

247,285,304, 347,400,547 £ÂÚ·›· ÂÓ˘‰¿ÙˆÛ˘ ·fi ÙÔ ÛÙfiÌ· 49 £ÚÔÌ‚ÔÂÓ›· 30 £˘ÚÂÔÂȉ›ÙȘ 188 £ˆÚ·ÎÈÎfi˜ fiÓÔ˜ 115 π π‰ÈÔ·ı‹˜ ˘ÂÚ·Û‚ÂÛÙÈÔ˘Ú›· ÿÎÙÂÚÔ˜ πÓÔ΢ÛÙÈ΋ πÓÙÂÚÏ¢ΛÓË 2 πÓÙÂÚÏ¢ΛÓË 6 πfi˜ Epstein-Barr πÛÔ¤Ó˙˘Ì· Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ πÛÙÈ΋ ‚Ï¿‚Ë πÒ‰ÈÔ πˆ‰ÔÂÓ›·

255 208,293 308 481 481 172 87 229 101 101

∫ ∫·ıÔ‰ËÁÔ‡ÌÂÓË Ï‹„Ë ·fiÊ·Û˘ ∫·ı˘ÛÙÂÚË̤ÓË Ïԛ̈ÍË ∫·ÎÔÔ›ËÛË ·È‰ÈÒÓ ∫·ÎÒÛÂȘ ∫·Ì‡ÏË ·Ô‰¤ÛÌ¢Û˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û O2 ∫¿Ì„Ë ¤Ô˘˜ ∫·Ú‰È·ÁÁÂÈ·ÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ∫·Ù·ÏËÍ›· ∫·Ù¿¯ÚËÛË Ô˘ÛÈÒÓ ∫ÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹ ·ÈÌÔÂÙ·Ï›ˆÓ ∫ÔÈÏÈ·Îfi ÛÙfiÌÈÔ Ô˘Ú‹ıÚ·˜ ∫ÔÈÓˆÓÈΤ˜ Û¯¤ÛÂȘ ·È‰ÈÒÓ ∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∫ÔÓÙfi ·Ó¿ÛÙËÌ· ∫ÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û O2 ∫ÔÚÙÈÎÔÂÍ·ÚÙÒÌÂÓÔ ¿ÛıÌ· ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ∫Ú·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË ÛÙ· ·È‰È¿ ∫ÚÂÌ¿ÌÂÓÔ˜ ÛÏ‹Ó·˜ ∫Ú›ÛÈÌË ÂÚ›Ô‰Ô˜ Ì¿ıËÛ˘ ∫Ú˘„ÔÚ¯›· ∫‡ÛÙÂȘ ∫‡ÛÙÂȘ ÂÍ·ÚÙËÌ¿ÙˆÓ Ì‹ÙÚ·˜ ∫˘ÛÙÈ΋ ›ÓˆÛË

355 312 595 499 410 76 312 125 535 406 355 336 59 268 72 365 93 607 607 65

§ §·ÌÈÓ›ÓË ·2 §·Óı¿ÓÔ˘Û· Ì·ÛÙÔÂȉ›Ùȉ· §··ÚÔÛÎfiËÛË §·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›Ùȉ· §ÈÔÚˆÙ½ÓË (·)

508 177 607 59 55

410 136 125 493


¶·È‰È·ÙÚÈ΋ 2001;64:641-644

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Paediatriki 2001;64:641-644

136 535 172 272,361

ª ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ªÂÁ·Î·Ú˘Ô·ÙÙ·ÚÔ ª¤ıÔ‰ÔÈ ·ÔηٿÛÙ·Û˘ ·È‰ÈÒÓ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ ªÂϤÙË ‡ÓÔ˘ ªÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ªÂÙ·ÌfiÛ¯ÂÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ªÂÙ·ÌfiÛ¯Â˘ÛË ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ªËÓÈÁÁÈÙȉÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ªfiÏ˘‚‰Ô˜ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ªÔÚȷ΋ ‚ÈÔÏÔÁ›· ªÂÎÏÔÌÂı·˙fiÓË ª˘˚΋ ‰˘ÛÙÚÔÊ›· ª˘ÍÔȉËÌ·ÙÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜ ª˘ÔηډÈÔ¿ıÂȘ

276 81 208,300 319 565 290 59 508 101 424

¡ ¡¤· ÔÈÎÈÏ›· ÓfiÛÔ˘ Creutzfeldt-Jakob disease ¡Â·ÓÈ΋ ·Á΢ÏÔÔÈËÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ· ¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ·ÚıÚ›Ùȉ· ¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ·ʈÛË ¡Â·ÓÈ΋ ÛÔÓ‰˘ÏÔ·ÚıÚÔ¿ıÂÈ· ¡Â·ÓÈ΋ „ˆÚÈ·ÛÈ΋ ·ÚıÚ›Ùȉ· ¡ÂÔÁÓ¿ ¡ÂÔÁÓfi ¡ÂÔÁÓÈ΋ Ë·Ù›Ùȉ· ¡Â˘ÚÔ·Ó·ÙÔÌ›· ¡Â˘ÚÔ·ÂÈÎfiÓÈÛË ¡Â˘ÚÔ‚ÈÔÏÔÁ›· ¡Â˘ÚÔÁ¤ÓÂÛË ¡Â˘ÚÔÁÂÓ‹˜ ·ÛÙË ¡Â˘ÚÔηډÈÔÁÂÓ‹˜ Û˘ÁÎÔ‹ ¡Â˘ÚÔÏÔÁÈÎfi˜ ÎÚÂÙÈÓÈÛÌfi˜ ¡Â˘ÚÔÊ˘ÛÈÔÏÔÁ›· ¡ÂÊÚÔÏÈı›·ÛË ¡ÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ¡ÔËÌÔÛ‡ÓË ¡ÔÛÔÎÔÌÂȷ΋ Ïԛ̈ÍË ¡ÔÛÔÎÔÌÂȷ΋ Ó¢ÌÔÓ›· ¡fiÛÔ˜ Creutzfeldt-Jakob ¡fiÛÔ˜ Kawasaki ¡fiÛÔ˜ Scheuermann ¡˘¯ÙÂÚÈÓ‹ ÂÓÔ‡ÚËÛË

518 233 237 604 233 233 573,589 618 293 387 387 387 527 395 424 101 387 255 247 384 565 547 518 172,420 604 14

391 30 376 551 285 26

O O‰Ô› ÁψÛÛÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ O‰ÔÓÙÈÎfi˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ OÈÎȷο ·Ù˘¯‹Ì·Ù· OÈÛÙÚÔÁfiÓ· OÏÈ΋ ·ÓÙÈÔÍÂȉˆÙÈ΋ ÈηÓfiÙ˘ OÏÈ΋ ıÓËÛÈÌfiÙËÙ· OÌÊ·ÏÈÎfi ·›Ì· OÍ›· ‰È¿ÚÚÔÈ· OÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· OÍ›· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· O͢·ÈÌÔÛÊ·ÈÚ›ÓË OÚÈÛÌfi˜ OÛÙÂÔ¿ıÂÈ· ·fi ÚÔÛÙ·ÁÏ·Ó‰›ÓË OÛÊ˘·ÏÁ›· OÊı·ÏÌÔÏÔÁÈÎfi ÓfiÛËÌ·

370 304 261 400 154 573 276 4,49 136 472 355 211 163 604 315

¶ ¶·È‰› 136,319, ¶·È‰È¿ 181,188,223,595 ¶·È‰È¿ Ì ÂȉÈΤ˜ ·Ó¿ÁΘ 125 ¶·È‰È·ÙÚÈ΋ ·ÈÌ·ÙÔÏÔÁ›·-ÔÁÎÔÏÔÁ›· 280 ¶·È‰È΋ 557 ¶·È‰È΋ ËÏÈΛ· 34,39,400,430,436, 448,607,610,624 ¶·È‰È΋ Ï¢¯·ÈÌ›· 535 ¶·È‰È΋ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· 202 ¶·È‰ÈÎfi ¿ÛıÌ· 211,330,342,347 ¶·È‰ÈÎfi ÙÚ·‡Ì· 268 ¶·ÏÌÈÎfi Ô͇ÌÂÙÚÔ 355 ¶·Ú·ÔÌ‹ ÛÙÔÓ ÔÊı·ÏÌ›·ÙÚÔ 315 ¶¿ÚÂÛË ÚÔÛˆÈÎÔ‡ 177 ¶·ÚÔ‰È΋ ·‡ÍËÛË Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ 87 ¶¤ÌÊÈÁ· 557 ¶ÂÚÈÙÔÓ·˚΋ οı·ÚÛË 472 ¶ËÏ›ÎÔ ·Û‚ÂÛÙ›Ô˘ ÚÔ˜ ÎÚ·ÙÈÓ›ÓË Ô‡ÚˆÓ 465 ¶ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ 493 ¶Ó¢ÌÔÓÂÎÙÔÌ‹ 361 ¶Ó¢ÌÔÓ›· 481 ¶Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· 85 ¶ÔÏÈÙÈ΋ 300 ¶ÔÌÊÔÏ˘Á҉˘ 557 ¶ÚÔ·ÁˆÁ‹ 300 ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË 197,241,615 ¶ÚÔÁÂÓÓËÙÈ΋ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· 197 ¶ÚÔÁÂÓÓËÙÈ΋ ·Ú¤Ì‚·ÛË 241 ¶ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ 565 ¶ÚÔÏËÙÈ΋ ·ÁˆÁ‹ 410 ¶ÚfiÏË„Ë 261,285,304,624 ¶ÚÔÛÙ·ÁÏ·Ó‰›ÓË 163 ¶ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· 132

643


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Paediatriki 2001;64:641-644

308 202

™ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ 188 ™ÂÈÚËÓÔÌÂÏ›· 615 ™ÂÍÔ˘·ÏÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 410 ™·ÛÌÔ› 181 ™Ï‹Ó·˜ 72 ™ÔÁÁ҉˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· 518 ™ÔÁÁ҉˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ÙˆÓ ‚ÔÔÂȉÒÓ 518 ™Ù·Ê˘ÏfiÎÔÎÎÔ˜ 499 ™ÙÂÚÔÂȉ‹ 351 ™ÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ 420 ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ó‡ÌÔÓ· 361 ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ 395 ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ 417,424 ™˘ÁÁÂÓ›˜ Ô˘‰ÂÙÂÚÔÂӛ˜ 26 ™˘ÁÁÂÓ‹˜ ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË ·ÚÈÛÙÂÚ¿ 159 ™˘ÁÁÂÓ‹˜ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÛË 504 ™˘ÁÁÂÓ‹˜ Û‡ÊÈÏË 168 ™˘ÁÁÂÓ‹˜ ˘ÂÚÏ·Û›· ÂÈÓÂÊÚȉ›ˆÓ 514 ™˘ÁÁÂÓ‹˜ ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜ 101 ™˘ÁÎÔ‹ 424 ™˘ÏÏÔÁÈ΋ ·ÓÔÛ›· 136 ™˘ÌÂÚÈÊÔÚ¿ ÂÈΛӉ˘ÓË ÁÈ· ÙËÓ ˘Á›· 410 ™˘Ó·ÈÛı‹Ì·Ù· 384 ™˘Ó·ÙÔÁ¤ÓÂÛË 527 ™‡Ó‰ÚÔÌ· Ì˘ÂÏÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ 45 ™‡Ó‰ÚÔÌÔ Long QT 424 ™‡Ó‰ÚÔÌÔ Marfan 424 ™‡Ó‰ÚÔÌÔ Reiter 233 ™‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ 145 ™‡Ó‰ÚÔÌÔ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ 391 ™‡Ó‰ÚÔÌÔ ÚԉȤÁÂÚÛ˘ 424 ™‡Ó‰ÚÔÌÔ ÙÔÍÈ΋˜ ηٷÏËÍ›·˜ 499 ™‡Ó‰ÚÔÌÔ ˘ÂÚ¢·ÈÛıËÛ›·˜ 460 ™˘Û΢‹ ·Ê‡ÓÈÛ˘ 14 ™¯¤ÛË ÂÌÈÛÙÔÛ‡Ó˘ Ì ÙÔÓ ¤ÊË‚Ô 410 ∆ ∆·¯‡ÙËÙ· ·Ó¿Ù˘Í˘ ∆¤Ù·ÓÔ˜ ∆ËÏÂı¤·ÛË ∆ËÏÂ˚·ÙÚÈ΋ ∆ÔÍÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ∆ÔÈο ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ∆Ú·˘Ì·ÙÈÛÌÔ› ∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ∆ÚÔ¯·›Ô

406 610 595 417 181 59 436 261 624

À À‰ÚÔÓ¤ÊÚˆÛË

514

644

À‰ÚԯψÚÔıÂÈ·˙›‰Ë ÀÂÚ·ÓÙÈÁfiÓ· ÀÂÚ·Û‚ÂÛÙÈÔ˘Ú›· À¤Ú˯ÔÈ ÀÂÚÎÈÓËÙÈÎfiÙËÙ· À¤ÚÙ·ÛË ÀÂÚʈÛÊ·Ù·Û·ÈÌ›· ÀÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· À¤Ú¯ÚËÛË ÀÂÚˆÈÔÛ¯ÈÛٛ˜ ÀÔ·ÂÚÈÛÌfi˜ ÀÔ·ÏÏÂÚÁÈÔÁÔÓÈÎfi Á¿Ï· Ì ˘‰ÚÔÏ˘Ì¤ÓË ÚˆÙ½ÓË ÀÔÂȉÈÎfiÙËÙ· ÀÔıÚ„›· ÚˆÙÂ˚ÓÈ΋˜ ÂÓ¤ÚÁÂÈ·˜ ÀÔÍ›· ÀÔÛ·‰›·˜ ÀÔÛÙ‹ÚÈÍË ÀÔÙÚÔÈ¿˙Ô˘Û˜ Ó¢ÌÔӛ˜ ⁄„Ô˜

255 223 465 241 391 448 87 208 436 441 551 219 280 237 355 312,395 300 361 406

º º·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ºÏÂÁÌÔÓ¤˜ ºÏÔÈ҉˘ ˘ÂÚfiÛÙˆÛË º˘Ì·Ù›ˆÛË

154 400 163 132

à ÃÂÈÏÂÈÔÛ¯ÈÛٛ˜ ÃÂÈÏÂÔÁÓ·ıÔ¸ÂÚˆÈÔÛ¯ÈÛٛ˜ ÃÔÏfiÛÙ·ÛË “ÃÚ˘Û‹ ÒÚ·” ÃÚ˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜

441 441 293 268 223

æ 梉¿ÚÁ˘ÚÔ˜ 梉ÔıÚÔÌ‚ÔÂÓ›· æËÏfi ·Ó¿ÛÙËÌ· æ˘¯ÔÎÔÈÓˆÓÈ΋ ‰ÈÂÚ‡ÓËÛË

65 76 406 410

ø ˆ-3 ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·

237


¶PO™EXH ™YNE¢PIA

3-4 ¡ÔÂÌ‚Ú›Ô˘ 2001

ªÂÙÂÎ·È‰Â˘ÙÈÎfi ™ÂÌÈÓ¿ÚÈÔ ¶·È‰È·ÙÚÈ΋˜ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ £¤·ÙÚÔ ∫ÔÏÂÁ›Ô˘ ∞ıËÓÒÓ

∞ı‹Ó·

10 ¡ÔÂÌ‚Ú›Ô˘ 2001

6Ô ¶·ÓÂÏÏ‹ÓÈÔ ∂ÈÛÙËÌÔÓÈÎfi ™˘ÌfiÛÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ∂ÊË‚È΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ £¤Ì·: “∂Ó‰ÔÎÚÈÓÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ÂÊ‹‚Ô˘” •ÂÓÔ‰Ô¯Â›Ô “Holiday Inn”

∞ı‹Ó·

10 ¡ÔÂÌ‚Ú›Ô˘ 2001

14Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ “¡ÂÒÙÂÚ· ‰Â‰Ô̤ӷ ÛÙË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· ∞ÈÌ·ÙÔÏÔÁÈÎÒÓ - OÁÎÔÏÔÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜” ¶ÏËÚÔÊÔڛ˜: ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜/OÁÎÔÏÔÁ›·˜ ∆ËÏ.: 7467 303-6 & 7792 200 Fax: 7792 200

∞ı‹Ó·

17 ¡ÔÂÌ‚Ú›Ô˘ 2001

22Ë ∂ÓËÌÂÚˆÙÈ΋ ¶·È‰È·ÙÚÈ΋ ∏ÌÂÚ›‰· ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. •ÂÓÔ‰Ô¯Â›Ô “∫·„‹˜”

£ÂÛÛ·ÏÔÓ›ÎË

22-25 ¡ÔÂÌ‚Ú›Ô˘ 2001

7th Mediterranean Epilepsy Conference ¶ÏËÚÔÊÔڛ˜: C&C International S.A. (Î. ¡. ∆ۿΈӷ˜) ∆ËÏ.: 68.89.217 Fax: 68.44.777 •ÂÓÔ‰Ô¯Â›Ô “Holiday Inn”

∞ı‹Ó·

xiii


¶PO™EXH ™YNE¢PIA

23-24 ¡ÔÂÌ‚Ú›Ô˘ 2001

2nd European Conference 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

Kent, United Kingdom

15 ¢ÂÎÂÌ‚Ú›Ô˘ 2001

∏ÌÂÚ›‰· ¶ÂÚÈÁÂÓÓËÙÈ΋˜ π·ÙÚÈ΋˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ¶ÂÈÚ·È¿ ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶ÂÚÈÁÂÓÓËÙÈ΋˜ π·ÙÚÈ΋˜ ¶ÏËÚÔÊÔڛ˜: ¢Ú. ¶. ¶·Ó·ÁfiÔ˘ÏÔ˜ ∆ËÏ.: (01) 4123 552 Fax: (01) 4128 535

∞ı‹Ó·

9-10 ºÂ‚ÚÔ˘·Ú›Ô˘ 2002

3Ë ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∏ÌÂÚ›‰· ¶¿ÙÚ· ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ¶·ÙÚÒÓ £¤Ì·: “§ÔÈÌÒÍÂȘ Î·È ·ÏÏÂÚÁÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜” ¶ÏËÚÔÊÔڛ˜: ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜-TYPORAMA ∆ËÏ.: (061) 999 544, 999 612 Fax: (061) 994 533

xiv


™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

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

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

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º. L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

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

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

xvii


™˘ÓÙÔÌÔÁڷʛ˜ p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE U

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

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9

6

3

2

1

-1

-2

-3

-6

-9

-12

-15

-18

xviii

EÏÏËÓÈÎÔ› fiÚÔÈ

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

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

Παιδιατρική | Τόμος 64 • Τεύχος 6 • Νοέμβριος - Δεκέμβριος 2001  

Τριμηνιαία έκδοση της Ελληνικής Παιδιατρικής Εταιρείας

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