Melander E, Ekdahl K, Jonsson G, Molstad S ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ∫. ∆ÛÔ˘Ì¿Î·˜
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Left atrial myxoma in a child presenting as an acute cerebral episode
A.N. Kourtesis, C.A. Paphitis, ∂. Latoufi, E. Dragogia, G. Briasoulis, V. Thanopoulos, M. Azariades
∫Ôhler’s disease. A rare condition in children
C. Tsoumakas, A. Papadopoulou, P. Miha-Georgiopoulou
LITERATURE ABSTRACTS
Adolescent suicide attempts. Risks and protectors
Borowsky I, Ireland M, Resuick M Greek translation: C. Tsoumakas
A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia
Russel ARB, Emmerson AJB, Wilkinson N, Chant T, Sweet DG, Halliday HL et al Greek translation: S. Fotopoulos
Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics
Melander E, Ekdahl K, Jonsson G, Molstad S Greek translation: C. Tsoumakas
H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ 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).
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Abstract: A large number of heterogeneous disorders may lead to thromboembolism of the cerebral vessels. In view of the high incidence of death rate or permanent neurological sequelae, early diagnosis and extensive laboratory investigations are essential. The identification of the causative mechanism may help in the therapeutic management during the acute phase, as well as in the prevention of further episodes.
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6. Youroukos S, Psychou F, Fryssiras S, Paikos P, Nicolaidou P. Idiopathic intracranial hypertension in children. J Child Neurol 2000;15:453-457.
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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-12-2001
HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-12-2001
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T.K. 115 27, ∞ı‹Ó· E-mail: sotel@hol.gr
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Thromboembolic episodes of the central nervous system (CNS) of diverse etiology in children. A challenge for the physician
S. Aronis - Vournas
Abstract: Thromboembolic episodes (TE) of the central nervous system is rare in childhood which, however, has been increasingly recognized during the last few years. They occur with a frequency of 1-3.3/100.000/year in the pediatric population, the incidence being higher in the neonatal period e.g. 1 case per 1000 births of full-term infants. The pathogenesis of TE in children and adolescents has been unclear due to lack of prospective studies. Nevertheless, extensive studies during the past 5 years tend to identify it as being a multifactorial disease. The most common underlying diseases predisposing to CNS thrombosis include congenital heart disease, perinatal asphyxia, malignancies, infections, sickle cell anaemia, vasculitis, nephrotic syndrome, homocysteinaemia, and vascular dysplasia. Probable triggering events are: trauma, major surgery, obesity, dehydration, medication such as corticosteroids, L-asparaginase, central catheters and others. The literature regarding the role of congenital (FV Leiden, FII 20210A, MTHFR, AT, PC, PS) or acquired prethrombotic disorders (Lpa, Lupus anticoagulant, ACA, anti-b2GP1) in the pathogenesis of CNS cerebral infarction is controversial. However recent studies indicate that homozygocity for MTHFR and FV Leiden is closely associated with CNS infarcts and may be used as
ıÚfiÌ‚ˆÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Û¿ÓÈÔ,
predictors for recurrence of CNS thrombosis. The antiphospholipid syndrome (APS) is strongly associated with arterial or venous thrombosis in various organs, including CNS. Myxoma of the right atrium, a rare condition, usually presents as an acute cerebral syndrome, due to cerebral embolism from thrombus developing around the tumor or from detached particles derived from the tumor. In contrast with the APS, the presence of Lupus anticoagulant (LA) during childhood is not usually associated with thrombosis. The LA is transient and is detected following a viral infection or administration of drugs. In summary, CNS thromboembolic episodes are a rare event during childhood and constitute a real challenge for the physician, due to their diverse aetiology. Besides a good clinical examination, sensitive imaging techniques must be used in order to visualize the location and extent of the thrombus. The necessity and type of therapeutic intervention depends on the underlying disease. Moreover, the presence of one or more congenital or acquired prethrombotic factors will define the duration of anticoagulant therapy.
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¶·È‰È·ÙÚÈ΋ 2002;65:4-8
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myxoma presenting as a cerebrovascular accident. Pediatr Neurol 1999;21:569-572.
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Abstract: More than 100 years have passed since Little first suggested that cerebral palsy (CP) was associated with perinatal events; however, its etiology is still poorly understood. Recent research findings on the etiology of CP show that both antenatal and neonatal risk factors contribute to the development of severe neurologic impairment, including CP among very low birth weight (VLBW) infants. This article summarizes the recent research data concerning the etiology of CP in VLBW infants. Antenatal factors associated with increased risk for CP are genetic factors, short interpregnancy interval, intrauterine infections, placental abruption, vaginal bleeding, death of a co-twin in multiple pregnancy. In contrast, antenatal factors associated with decreased risk for CP are delivery without labor (elective cesarean section), delivery at specialized perinatal services, antenatal corticosteroids and preeclampsia. Neonatal factors associated with increased risk for CR are neonatal acidosis, sepsis, hypotension, respiratory distress syndrome, hypocapnia, chronic lung disease, pneumothorax and hypothyroxinemia. In conclusion, neurologic impairments among VLBW infants, including CP, are probably not caused by isolated risk factors, but rather by a complex interaction of many factors which act upon at different stages of development.
Division of Neonatology
General District Hospital “Alexandra”, Athens
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ηډȷÎfi˜ ı¿Ó·ÙÔ˜, Û‡Ó‰ÚÔÌÔ ·ÔÎÏÂÈÛÌÔ‡ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜ Î·È ·Ó¿Û·Û˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜.
Abstract: The Brugada syndrome is characterized by a right bundle branch block, ST segment elevation in the precordial leads V1 to V3, and episodes of syncope or sudden death caused by rapid polymorphic ventricular arrhythmias /ventricular fibrillation in patients with a structurally normal heart. It was first reported in 1992 by Brugada and Brugada. Since then, the number of cases indentified worldwide have increased, with more than 200 cases of Brugada syndrome reported up to date. The patients are mostly male and demonstrate their first arrhythmic event around the fourth decade. Nevertheless, the syndrome should also be considered as a cause of unexplained sudden cardiac death in children and even in infants. Systematic family studies have demonstrated an autosomal dominant inheritance pattern in many cases. Mutations in SCN5A, a gene encoding the cardiac sodium channel, have been detected in several patients. Pharmacological treatment with beta-adrenergic agents and anti-arrhythmic drugs does not protect effectively against recurrent arrhythmias. The implantation of a cardioverter-defibrillator constitutes the only effective therapy for the prevention of sudden death.
Key words: Brugada syndrome, sudden cardiac death, right bundle branch block - ST elevation syndrome.
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18. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3. A marker for sudden death in patients without demonstrable structural heart disease. Circulation 1998;97:457-460.
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Abstract: The thromboembolic episodes of the central nervous system (CNS) are quite rare in childhood and their pathophysiology still remains unknown mainly because of the restricted amount of available data. In our study, 48 children were included (28 boys, 20 girls), who presented with a CNS thromboembolic episode during the years 1990-1998. Their mean age was 6.3 years. The diagnosis was established using radiologic tests (CT scan, MRI scan, MR angiography etc). The episodes were classified as: ischemic infarcts (n=19), arterial thromboses (n=18) and cerebral venous sinus thromboses (n=11). An underlying disease was detected in 38.65% and a triggering event in 14.6% of the children. Twenty three out of 48 children (47.9%) had one or more thrombophilic disorders (inherited disorder: 8 children, acquired disorder: 18 children). The acquired disorders were, as a rule, temporary and related to the underlying disease. In general, one or more risk factors for thrombosis were detected in 68.75% of the children. Treatment was mainly conservative, except for a few selected cases. Thromboembolic episodes in children appear to be multifactorial. Our experience from the use of anticoagulant and/or thrombolytic therapy in our patient population - mainly in cases with cerebral venous sinus thrombosis - is generally favourable. Nevertheless, comparative studies are necessary
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Abstract: The aim of the study was to investigate the clinical significance of coagulasenegative staphylococcus (CONS) isolated from blood cultures (BC) of neonates receiving intensive care, and to evaluate the significance of the clinical and laboratory findings in distinguishing between sepsis and contamination. We reviewed the records of neonates hospitalized at the neonatal intensive care unit (NICU) from 1994 to 1999 who grew CONS from at least one BC. The clinical data and the results of all positive CONS BCs and the antibiotic sensitivity were recorded. An episode of isolation was considered to represent sepsis when the same CONS strain was isolated from two or more BCs. During the study period CONS was isolated from 269 BCs obtained from 184 neonates that corresponded to 200 episodes. Only 135/200 (68%) episodes could be classified either as sepsis (n=41) or contamination (n=94). The incidence of factors predisposing to sepsis and the numbers of neonates with increased CRP were significantly higher in the septic episodes. Clinical and/or laboratory evidence of sepsis were present in 90% of the septic episodes and in 51% of contamination ones. The sensitivity of the clinical and laboratory evidence of sepsis in discriminating between sepsis and contamination was 90%, the specificity 49%, the positive predictive value 43% and the negative predictive value 92%. In conclusion: a) only in 2/3 of the episodes in which CONS was isolated, the BCs could distinguish between sepsis and contamination b) of the episodes that could be
Department of Neonatology Aristotelion University of Thessaloniki Department of Microbiology of Ippokration General Hospital, Thessaloniki
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1Russel ARB, Emmerson AJB, Wilkinson N, Chant T, Sweet DG, Halliday HL et al
A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia
Abstract: Eosinophilia is common in the neonatal period. However, its causes, mechanism and clinical significance are still unknown. Previous studies have reported that eosinophilia may be associated with numerous conditions (establishment of an anabolic state, drug reactions, response to foreign antigens, chronic lung disease, erythropoietin treatment and infections). The aim of this study was to evaluate the possible association of various conditions, especially infection, with eosinophilia and to clarify whether recognition of an increased eosinophil count is of any clinical significance in the management of hospitalized neonates. Fifty-six neonates with eosinophilia (AEC >700/mm3) and 55 control neonates matched for gestational age, birth weight and hospitalization days were included in the study. A significant difference between the two groups was found only in blood transfusions, Á-globulin treatment, specific antibiotic treatment and infectious disease. However, neonates who develop septic episodes are treated with specific antibiotics and Á-globulin and are more often transfused. Thus it can be speculated that the main relationship observed is that between eosinophilia and infection whereas the other associations may be secondary. The relative risk factor for infection when the AEC is >700/mm 3 is 1.58, with confidence interval 1.30;1.91. Eosinophilia seems to be a reliable indicator of sepsis while normal AEC does not exclude infection. The exact cause of eosinophilia in neonates remains unclear. However, sepsis seems to be associated with eosinophilia. Infection should be strongly considered in the evaluation of a neonate with eosinophilia.
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1Melander E, Ekdahl K, Jonsson G, Molstad S Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics Pediatr Infect Dis J 2000;19:1172-1177
Metastases in the central nervous system in children with neuroblastoma M. Baka, A. Pourtsidis, A. Stasinopoulou, M. Varvoutsi, D. Bouhoutsou, K. Paidousi, E. Kosmidi
Abstract: Neuroblastoma is the second in frequency malignant solid tumor among children. The majority of children affected by neuroblastoma (approximately 60%), present with distant metastases at the time of diagnosis. Common metastatic sites of neuroblastoma are the bones, bone marrow, liver and in infants the skin. With the use of aggressive chemotherapy, with or without autologous rescue, other metastatic sites have been identified during the recent years namely the CNS, the lungs and the ovaries. In order to study the occurrence of CNS metastases in children with neuroblastoma, we retrospectively reviewed the records of all patients diagnosed with neuroblastoma from 1/1980 to 12/2000 (a total of 102 children), and we describe 3 children with CNS metastases that were detected at the time of relapse. An attempt is also made to outline the possible pathophysiologic mechanisms of this metastatic pattern by reviewing the data reported in the literature.
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The effect of a nucleotide supplemented formula on the peptic system of preterm infants V. Skouteri1, C. Costalos1, S. Sevastiadou1, S. Gavrili1, K. Danelatou1, A. Voyiatzi2, C. Economidou2, V. Petrochilou2
Abstract: Studies in animals have shown that nucleotides (NT) have significant effects upon gastrointestinal growth and differentiation. πn the present study we investigated the hypothesis that an NT enriched formula might improve gastrointestinal absorptive function and enteral flora in preterm infants. A double blind randomized controlled trial was designed. Forty two premature infants with a mean gestational age of 32.6 weeks, were randomly assigned into two groups consisting of 21 infants each. The NT group received a standard term formula supplemented with NT, while the WNT group received a special preterm formula unsupplemented with NT. Ten days following the establishment of full enteral feeding, an oral DXylose test was performed. Stools were also collected for faecal fat concentration and culture. With regards to the absorptive capacity of the intestine, there was no significant difference in DXylose blood levels between the 2 groups. Faecal fat was significantly higher in the NT group. With regards to the faecal flora, the addition of NT to the formula was associated with: a) Increased colonization with bacteroides, bacillus bifidus and clostridium b) Decreased colonization with gram(-) bacteria, and staphylococcus sp. c) A significantly larger colony number of gram(-) bacteria, bacteroides and lactobacillus colonies were cultured d) A smaller number of E. coli , staphylococcus sp, bacillus bifidus and clostridium colonies were cultured. In conclusion, the use of an NT enriched standard term formula
1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·
¶. °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·
2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì·
¶. °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·
1 Department of Neonatal Medicine, “Alexandra” General Hospital, Athens
2 Department of Microbiology, “Alexandra” General Hospital, Athens
in preterm infants, as compared to the use of an usupplemented preterm formula, does not improve gastrointestinal absorptive capacity and does not lead to a stool flora that closely resembles that of breast fed infants. As the composition of the two formulae differed in several nutrients, it is difficult to draw definitive conclusion on the usefulness of NT in preterm nutrition. For this reason more studies are required.
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11. Tsujunaka T, Iijima S, Kido Y, Homma T, Ebisui C, Kan K et al. Role of nucleosides and nucleotide mixture in intestinal mucosal growth under total parenteral nutrition. Nutrition 1993;9:532-535.
12. Yu VYH. The role of dietary nucleotides in neonatal and infant nutrition. Singapore Med J 1998;39:145-150.
13. Nunez MC, Ayudarte MV, Morales D, Suarez MD, Gil A. Effect of dietary nucleotides on intestinal repair in rats with experimental chronic diarrhea. J Parenter Enteral Nutr 1990;14:598-604.
14. Brunsen O, Espinoza J, Araya M, Cruchet S, Gil A. Effect of dietary nucleotide supplementation on diarrhoeal
disease in infants. Acta Paediatr 1994;83:188-191.
15. Cosgrove M, Davies DP, Jenkins HR. Nucleotide supplementation and the growth of term small for gestational age infants. Arch Dis Child 1996;74:F122-F125.
16. Gil A, Pita ML, Martinez A, Molina JA, Sanchez-Medina F. Effects of dietary nucleotides in the plasma fatty acids in at term neonates. Hum Nutr Clin Nutr 1986;40:185-195.
17. Balmer SE, Hanvey LS, Wharton BA. Diet and faecal flora in the newborn: nucleotides. Arch Dis Child 1994;70:F137-F140.
18. Roy CC, Ste-Marie M, Chartrant RT, Weber A, Bard H, Doray B. Correction of the malabsorption of the preterm infant with a medium-chain triglyceride formula. J Pediatr 1975;86:446-450.
19. Auricchio S, Rubino A, Murset G. Intestinal glycosidase activities in the human embryo, fetus and newborn. Pediatrics 1965;35:944-954.
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21. Rubaltelli F, Biadaioli R, Pecile P, Nicoletti P. Intestinal flora in breast and bottle-fed infants. J Perinat Med 1998;186-191.
22. Leach JL, Baxter JH, Molitor BE, Ramstack MB, Masor ML. Total potentially available nucleosides of human milk by stage of lactation. Am J Clin Nutr 1995;61:1224-1230.
Abstract: The purpose of our study was the clinical and laboratory investigation of all children with acute bronchiolitis (AB) for possible associated cardiac involvement, such as myocarditis and pericarditis. One hundred and thirty three infants and small children aged 2-24 months, hospitalized for AB in the 4th Pediatric Department of Aristotelion University of Thessaloniki, AHEPA Hospital, during the period 1995-1998, were studied. The following investigations were performed on admission to the hospital: total clinical dyspnea score (0-12), oxygen haemoglobin saturation (SaO 2), full haematologic and biochemical examination and serology (1st sample) for respiratory viruses, mycoplasma, chlamydia and rickettsia (the second serology sample after 15-20 days), and total immunoglobulin E. The presence of cardiac disease was confirmed by chest radiography, electrocardiography and echocardiography. Based on clinical and laboratory findings, the patients were divided into two groups. Group A consisted of 120 children with the diagnosis of AB, and Group B of 13 children with the diagnosis of AB with cardiac involvement. The data of the two groups were compared statistically. Cardiac disease was found in 13 children (9.8%): myocarditis in 6 (4.5%), pericarditis in 5 (3.8%) and myopericarditis in 2 (1.5%). During the clinical evaluation the Group B patients had: a) higher whole clinical dyspnea score (p<0.001), b) lower SaO2, c) higher fever, lasting for more days, and d)
1 4th Pediatric Clinic of Aristotelion University of Thessaloniki
2 1st Pediatric Clinic of Aristotelion University of Thessaloniki
3 Microbiology Laboratory, Medical School of Aristotelion University of Thessaloniki (A.U.Th.)
4 Division of Forest and Natural Environment A.U.Th.
1. Erard LM. Acute bronchiolitis and pneumonia in infancy resulting from the RSV. In: Taussing LM, Laudan LI, eds. Pediatric Respiratory Medicine. St Louis Mosby Co; 1999. p. 580-595.
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12. Scott LP III, Gutelius MF, Parrott RH. Children with acute respiratory tract infections: An electrocardiographic survey. Am J Dis Child 1970;119:111-113.
15. Rakshi K, Couriel JM. Management of acute bronchiolitis. Arch Dis Child 1994;71:463-469.
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in clinical virology. Oxford: Blackwell; 1979.
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25. Puchkov GF, MinKovich BM. A case of respiratory syncytial infection in a child complicated by interstitial myocarditis with lethal outcome. Arch Pathol 1972;34:70-73.
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27. Meudiem S. Respiratory syncytial virus and heart block. Cause and effect. Austr NZ J Med 1991;15:55-57.
28. Menahem S. Respiratory syncytial virus and supraventricular tachycardia in an infant. Int J Cardiol 1991;32:249-251.
29. Agarwala BN, Ruschhaupt DE. Complete heart black from mycoplasma pneumoniae infection. Pediatr Cardiol 1991;12:233-236.
30. Grumbach IM, Heim A, Pring-Akerblom P, Vanhof S, Hein WJ, Muller G et al. Adenoviruses and enteroviruses as pathogens in myocarditis and dilated cardiomyopathy. Acta Cardiol 1999;54:83-88.
31. Conway HJ. Myocarditis with influenza B infection. J Pediatr Infect Dis 1997;16:629-630.
32. Donnerstein RL, Berg RA, Shehab Z, Ovadia M. Complex atrial tachycardias and respiratory syncytial virus infections in infants. J Pediatr 1994;125:23-28.
33. Torres F, Anquita M, Tejero I, Gimenez D, Franco M, Zayas R et al. Acute myocarditis with severe cardiac dysfunction in the pediatric population. The evolution and differential characteristics with respect to adult myocarditis. Rev Esp Cardiol 1995;48:660-665.
Chronic disease risk factors in primary school children of Crete following a six year health and nutrition education intervention program* Y. Manios, I. Moschandrea, C. Hatzis, A. Kafatos
Abstract: There is abundant evidence that the roots of chronic disease lie in childhood, during which time certain health related behaviors are established. The objective of the current study was to design, implement and assess the effectiveness of a health and nutrition education program undertaken in primary schools in Crete. The school-based intervention program was applied to all children registered in first grade in 1992 in two counties of Crete and had a total duration of six years. Children registered in a third county served as a control group. In order to assess the effectiveness of the intervention, a variety of biological and behavioral parameters were measured prior to and following completion of the intervention in a randomly selected school-based sample of 602 intervention group and 444 control group pupils. Our results showed that the biochemical indices generally improved significantly more in the intervention group, as compared to the controls, over the six-year period. Similarly, the changes observed in the anthropometric variables in the two groups were in favor of the intervention group. Total energy intake and consumption of total fat and saturated fat increased significantly less in the intervention group, as compared to the control, while time devoted to leisure time physical activity and cardiovascular run test performance increased significantly more in the intervention group. In conclusion, the positive changes in several of the chronic disease risk factors observed in the present
Department of Social Medicine
Preventive Medicine and Nutrition Clinic
University of Crete Medical School *1st Prize of Social Pediatrics 39th Panhellenic Pediatric Meeting,
study, underline the significant role of health education and nutrition programs in health promotion and prevention of chronic diseases, and encourage the implementation of such programs in all the schools of the country.
1. Kafatos A, Mamalakis G. Policies and programs in nutrition and physical fitness in Greece. Simopoulos AP, editor. Nutrition and Fitness in Health and Disease. World Rev Nutr Diet. Basel: Karger; 1993. p. 206-217.
2. Lionis C, Kafatos A, Vlachonikolis J, Vakaki M, Tzortzi M, Petraki A. The effects of a health education intervention
program among Cretan adolescents. Prev Med 1991;20:685-699.
3. Manios Y, Kafatos A, Mamalakis G. The effects of a health education intervention initiated at first grade over a 3 year period: physical activity and fitness indices. Health Educ Res 1998;13:593-606.
4. Manios Y, Moschandreas J, Hatzis C, Kafatos A. Evaluation of a health and nutrition intervention in primary school children of Crete over a three-year period. Prev Med 1999;2:149-159.
5. Williams C, Arnold C, Wynder E. Primary prevention of chronic disease beginning in childhood. The “Know Your Body” programme: Design of the study. Prev Med 1977;6:344-357.
6. Walter HJ, Wynder EL. The development, implementation, evaluation and future directions of a chronic disease prevention program for children: The “Know Your Body” study. Prev Med 1989;18:59-71.
7. Manios Y, Kafatos A, Markakis G. Physical activity of 6 year old children: Validation of two proxy reports. Pediatr Exerc Sci 1998;10:176-188.
8. Committee of Experts on Sports Research. EUROFIT. Rome: Edigraf Editoriale Grafica; 1988.
9. Walter HJ, Hofman A, Connelly PA, Barrett LT, Kost KL. Primary prevention of chronic disease in childhood: Changes in risk factors after one year of intervention. Am J Epidemiol 1985;122:772-781.
10. Walter HJ, Hofman A, Vaughan RD, Wynder EL. Modification of risk factors for coronary heart disease: fiveyear results of the school-based intervention trial. N Engl J Med 1988;318:1093-1100.
11. Arbeit ML, Johnson CC, Mott SD, Harsha DW, Nicklas TA, Webber LS et al. The Heart smart cardiovascular school health promotion: Behavior correlates of risk factor change. Prev Med 1992;21:18-32.
12. Tell G, Vellar O. Noncommunical disease risk factor intervention in Norwegian adolescents: The Oslo youth study. In: Hetzel B, Berenson G, editors. Cardiovascular risk factors in childhood: Epidemiology and Prevention. Amsterdam: Elsevier; 1987. p. 203-217.
13. The Writing Group for the DISC Collaborative Research Group. Efficacy and Safety of Lowering dietary intake of fat and cholesterol in children with elevated low-density lipoprotein cholesterol. JAMA 1995;273:1429-1435.
14. Lytle LA, Stone EJ, Nichaman MZ, Perry CL, Montgomery DH, Nicklas TA et al. Changes in nutrient intakes of elementary school children following a school-based intervention: Results from the CATCH study. Prev Med 1996;25:465-477.
15. McKenzie TL, Nader PR, Stikmiller PK, Yang M, Stone EJ, Perry CL et al. School physical education: Effect of a child and adolescent trial for cardiovascular health. Prev Med 1996;25:423-431.
16. Mamalakis G, Kafatos A. Prevalence of obesity in Greece. Int J Obesity 1996;20:488-492.
17. Resnicow K, Orlandi MA, Vaccaro D, Wynder E. Implementation of a pilot school-site cholesterol reduction intervention. J School Health 1989;59:74-78.
Senn K et al. Family-based cardiovascular risk reduction education among Mexican- and Anglo- Americans. Fam Community Health 1992;15:57-74.
19. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. A child and adolescent trial for cardiovascular health (CATCH). JAMA 1996;275:768-776.
20. Webber LS, Osganian SK, Feldman HA, Wu M, McKenzie TL, Nichaman M et al. Cardiovascular risk factors among children after a 2ó - year intervention - The CATCH study. Prev Med 1996;25:432-441.
21. Lauer RM, Lee J, Clarke WR. Factors affecting the relationship between childhood and adult cholesterol levels: The Muscatine study. Pediatrics 1988;82:309-318.
22. Berenson GS, Epstein FH. Conference on blood lipids in children: Optimal levels for early prevention of coronary artery disease. Prev Med 1983;12:741-797.
23. Bush PJ, Zuckerman AE, Taggart VS, Theiss PK, Peleg EO, Smith SA. Cardiovascular risk factor prevention in black school children: the ”Know Your Body” evaluation project. Prev Med 1989;16:215-227.
24. Resnicow K, Cohn L, Reinhardt J, Cross D, Futterman R, Kirschner E et al. A three-year evaluation of the ”Know Your Body” program in inner-city schoolchildren. Health Educ Q 1992;19:463-480.
25. Tamir D, Feurstein A, Brunner S, Halfon S, Reshef A, Palti H. Primary prevention of cardiovascular disease in childhood: Changes in serum total cholesterol, high density lipoprotein and body mass index after 2 years of intervention in Jerusalem schoolchildren age 7-9 years. Prev Med 1990;19:22-30.
26. Perry CL, Bishop DB, Taylor G, Murray DM, Mays RW,
Dudovitz BS et al. Changing fruit and vegetable consumption among children: The 5-a-day power plus program in St. Paul, Minnesota. Am J Public Health 1998;88:603-609.
27. Nader PR, Sellers DE, Johnson CC, Perry CL, Stone EJ, Cook KC et al. The effect of an adult participation in a school-based family intervention to improve children’s diet and physical activity: The child and adolescent trial for cardiovascular health. Prev Med 1996;25:455-464.
28. Donnelly JE, Jacobsen DJ, Whatley JE, Hill JO, Swift LL, Cherrington A et al. Nutrition and physical activity program to attenuate obesity and promote physical and metabolic fitness in elementary school children. Obesity Research 1996;4:229-243.
29. Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: The Cardiovascular Health in Children (CHIC) study. J Pediatr 1996;128:797-805.
30. Smolak L, Levine MP, Schermer F. A controlled evaluation of an elementary school primary prevention program for eating problems. J Psychosom Res 1998;44:339-353.
31. Contento IR, Manning AD, Shannon B. Research perspective on school-based nutrition education. J Nutr Educ 1992;24:247-260. ¶·È‰È·ÙÚÈ΋ 2002;65:66-76
Abstract: The lupus anticoagulant (LA) is an acquired inhibitor of blood coagulation. The presence of LA in children is usually transitory and benign, commonly induced by infection or drugs. We report 4 cases of asymptomatic APTT prolongation associated with the development of LA. In 3 cases LA was linked to repeated respiratory infections treated with antibiotics and was identified at screening before adenotonsillectomy. In the 4th case the presence of LA was detected during laboratory investigation due to a family history of hemophilia. In all cases laboratory findings were normalized within a period of a few months.
4. Roubey RA. Autoantibodies to phospholipid-binding plasma proteins: a new view of lupus anticoagulants and other antiphospholipid autoantibodies. Blood 1994;84:2854-2867.
5. Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med 1990;112:682-698.
6. Molta C, Meyer O, Dosquet C, Montes de Oca M, Babron MC, Danon F et al. Childhood onset SLE: antiphosphlipid autoantibodies in 37 patients and their first degree relatives. Pediatrics 1993;92:849-853.
7. Seaman DE, Londino AV, Kwoh CK, Medsger TA, Manzi S. Antiphospholipid autoantibodies in pediatric SLE. Pediatrics 1995;96:1040-1045.
2002;65:77-80
8. Montes de Oca MA, Babron MC, Bletry O, Broyer M, Courtecuisse V, Fontaine JL et al. Thrombosis in systemic lupus erythematosus: a French collaboration study. Arch Dis Child 1991;66:713-717.
9. Gattorno M, Buocompagni A, Molinari AC, Barbano GC, Morreale G, Stalla F et al. Antiphospholipid autoantibodies in paediatric SLE, juvenile chronic arthritis and overlap syndromes: SLE patients with both lupus anticoagulants and high-titre anticardiolipin antibodies are at risk for clinical manifestations related to the antiphospholipid syndrome. Br J Rheumatol 1995;34:873-881.
10. Manco J, Nuss R. Lupus anticoagulant in children with thrombosis. Am J Hematol 1995;48:240.
11. Von Scheven E, Athreya BH, Rose CD, Goldsmith DP, Morton L. Clinical characteristics of antiphospholipid antibody syndrome in children. J Pediatr 1996; 129:339-345.
12. Manco-Johnson MJ. Antiphospholipid antibodies in children. Semin Thromb Hemost 1998;24:591-598.
13. Manco J, Nuss R, Key N, Moertel C, Jacobson L, Meech S et al. Lupus anticoagulant and protein S deficiency in children with postvaricella purpura fulminans or thrombosis. J Pediatr 1996;128:319-323.
14. Lee MT, Nardi MA, Hadzi N, Kerpatkin M. Transient hemorrhagic diathesis associated with an inhibitor of prothrombin with lupus anticoagulant in a 1ó year old girl: report of a case and review of literature. Am J Hematol 1996;51:307-314.
associated with hemorrhage rather than thrombosis: the hemorrhagic lupus anticoagulant syndrome. J Pediatr 1997;130:998-1000.
16. Amiral J, Aronis S, Adamtziki E, Garoufi A, Karpathios T. Association of lupus anticoagulant with transient antibodies to prothrombin in a patient with hypoprothrombinemia. Thromb Research 1997;86:73-78.
17. Singh AK, Rao KP, Kizer J, Lazarchick J. Lupus anticoagulants in children. Ann Clin Lab Sci 1988; 18:384-387.
19. Currimboy Z. Transitory anticoagulants in healthy children. Am J Pediatr Hematol Oncol 1984;6:210-212.
20. Echaniz-Laguna A, Thiriaux A, Ruolt-Olivesi I, Marescaux C, Hirsch E. Lupus anticoagulant induced by the combination of valproate and lamotrigine. Epilepsia 1999;40:1661-1663.
21. Muntean W, Peted W. Lupus anticoagulant after measles. Eur J Pediatr 1980;134:135-138.
Abstract: The case of an 11 year old girl is presented, who suffered an acute cerebral ischaemic episode due to embolism from an atrial myxoma. The patient, who suffered the episode while dancing, was admitted to the hospital with signs of left hemiplegia, facial palsy and impairment of vision of the right eye. The initial evaluation on admission, which included computerized tomography (CT) of the brain and echocardiography, revealed a small localized area of reduced density at the region of the left internal capsule of the brain, a picture consistent with an old ischaemic lesion, as well as the presence of a left atrial tumor which protruded through the mitral valve into the left ventricle during diastole. A repeat CT scan, 12 hours later, showed a new ischaemic area at the region of the right internal capsule, a picture consistent with the clinical findings of capsular hemiplegia. Nine days after admission, there was significant improvement of the neurological condition of the patient, and allowed the safe surgical removal of the atrial tumor using cardiopulmonary bypass. The tumor consisted of a friable and villous myxoma 4x4 cm in size, originating from the posterior surface of the left atrium above the mitral valve. The patient made an uneventful recovery and was discharged 12 days later. The presence of atrial myxoma is rare during childhood and often has a stormy initial presentation.
Peripheral General Children’s Hospital “Agia Sophia”, Athens
1. Nadas AS, Ellison RC. Cardiac tumors in infancy. Am J Cardiol 1968;21:363-367.
2. Mc Allister HA Jr, Fenoglio JJ Jr. Tumors of the cardiovascular system. In: Hartman WH, Cowan WR, editors. Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology; 1978. p. 432-441.
3. Ha JW, Rim SJ, Chang BC, Chung N, Cho SY. A mitral valve myxoma prolapsing into the left ventricular outflow tract. Clin Cardiol 2001;24:570-573.
4. Pfammatter JP, Iff T, Schupbach P. Imitation of chronic recurrent inflammatory illness by cardiac myxoma. Eur J Pediatr 1996;155:637-639.
5. Salehian O, Demers C, Patel A. Atrial myxoma presenting as isolated unilateral blindness: a case report and review of the literature. Can J Cardiol 2001;17:898-900.
6. Bickford BJ, Egan M, Bryce AG. Surgical treatment of tumors of the heart: a report of two cases. Br J Surg 1956;43:514-517.
7. Dennis MA, Appareti K, Manco-Johnson ML, Clewell W, Wiggins J. The echocardiographic diagnosis of multiple fetal cardiac tumors. J Ultrasound Med 1985;4:327-331.
9. Ota T, Okumura S, Matsuba K, Yamasita M, Ushimaru K. A case of surgically treated left atrial myxoma early after cerebral embolism. Kyobu Geka 1996;49:1094-1096.
10. Waller DA, Ettles DF, Saunders NR, Williams G. Recurrent cardiac myxoma: The surgical implications of two distinct groups of patients. Thorac Cardiovasc Surg 1989;37:226-230.
11. Kigawa I, Fukuda S, Marat D, Tanaka J, Ikeda S, Okiyama M et al. A case of familial cardiac myxoma. Kyobu Geka 1996;49:323-326.
12. Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore) 2001;80:159-172.
Abstract: Kohler’s disease is a rare disease of the tarsal navicular bone that is characterized by pain and swelling of the affected area, and Ôn radiographic examination, by flattening and sclerosis of the affected bone. It occurs more frequently in boys and there is evidence that it is due to mechanical factors due to compression of the bone before its ossification. Frequently it is associated with abnormal ossification. We describe the case of a 6 year old boy with Kohler’s disease.
3. Karp M. Kohler’s disease of the tarsal scaphoid. J Bone Joint Surg 1937;19:84.
4. Waugh W. The ossification and vascularization of the tarsal navicular and their relation to Kohler’s disease. J Bone Joint Surg 1958;40-B:765.
5. Behrman RE, Kliegman RM, Arvin AM. The foot and toes: osteochondroses. In: Nelson Textbook of Pediatrics. 15th Ed. Philadelphia: WB Saunders Co; 1996. p. 1922.
6. Morrissy RT, Weinstein SL. Osteochondroses. In: Lovell and Winter’s Pediatric Orthopaedics. 4th Ed. LippincottRaven Publishers; 1996. p. 1101.
8. Speed K. Kohler’s disease of the tarsal scaphoid bone. Trans Amer Surg Ass 1927;45:179.
9. Williams GA, Cowell HR. Kohler’s disease of the tarsal navicular. Clin Orthop 1981;158:53.
10. Scaglietti O, Stringa G, Mizzau M. Plus-variant of the astragalus and subnormal scaphoid space, two important findings in ∫ohler’s scaphoid necrosis. Acta Orthop Scand 1962;32:500.
11. England SP. Evaluation and management of pediatric foot deformities. In: The Pediatric Clinics of North America. Common Orthopedic Problems II. 1996;43:1104.
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