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COVER MAR-APR 2002

14-05-03

12:23

™ÂÏ›‰·1

ISSN 0377-2551

¶AI¢IATPIKH

TOMO™ 65

TEYXO™ 2

ETO™ 2002

ª¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 2

∞¡∞™∫O¶∏™∏ ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·

REVIEW ARTICLE 89

∞. °ÎÈfiη˜

A. Giokas

Bƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·ÛıÂÓÒÓ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ˆ˜ ÚÒÈÌÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›·

AWARD-WINNING ARTICLE 97

ª.π. ∏ÏÈÔÔ‡ÏÔ˘, °. ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜

ORIGINAL ARTICLES 108

™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË, ∂. °·Ï·Ó¿Î˘, £. ∆ÛÂÎÔ˘Ú¿, °. ∑·ÌÂÙ¿Î˘, ∂. ∫fiÎÔÚË

¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙ ¯ÚfiÓÈ·

∞septic meningitis in children from Crete S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori

113

∂. ÷Ù˙ˉ¿ÎË, ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔڷοÎË, ∂. ¶·Ú·Ûο΢, µ. µ·Ï¿ÚË, ª. ∫ÔÚÔÔ‡ÏË, ∂. °·Ï·Ó¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

™˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Î·È ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ Î·È ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∫·Ú‰›ÙÛ·˜

The cerebrospinal fluid ‚-glucuronidase activity in patients with bacterial meningitis as an early and sensitive predictor of response to treatment M. Eliopoulou, G.A. Syrogiannopoulos

Eƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ ∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ÛÙ· ·È‰È¿ Ù˘ ∫Ú‹Ù˘

Spondylodiscitis in childhood

Perinatal mortality in Crete over the last five years E. Hatzidaki, A. Manoura, E. Korakaki, E. Paraskakis, B. Balari, M. Koropouli, H. Galanakis, Ch. Giannakopoulou

118

Frequency of heterozygotes and detection of mutations for sickle-cell disease and b-thalassemia among high-school students of the prefecture of Karditsa

¢. ÷Ù˙ËÁˆÚÁ›Ô˘, ∂. ∫·Ó·‚¿Î˘, Ã. ∆Û¿ÓÙ·ÏË, J. Traeger-™˘ÓÔ‰ÈÓÔ‡, Ã. ¡Ù·ÓÙ¿Ì˘, ∂. ∫·ÓÙÂÚ¤-ªÂÎÈÒÙË, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿

D. Chatzigeorgiou, E. Kanavakis, C. Tsantali, J. Traeger-Synodinos, C. Dadamis, E. Kantere-Bekioti, M. Athanasiou-Metaxa

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

Continuation of table of contents inside title page

March - April 2002 . Volume 65 . No 2


MARCH-APRIL 2002

14-05-03

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™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ÂÚÈÔ¯‹˜ µ¿Ú˘ ∞ÙÙÈ΋˜

Continuation of table of contents

122

E. Marangaki, G. Galani, M. Yemeliari, C. Costalos, D. Papadopoulou, N. Faraklas

∂. ª·Ú·ÁοÎË, °. °·Ï¿ÓË, ª. °ÂÌÂÏÈ¿ÚË, Ã. ∫ÒÛÙ·ÏÔ˜, ¢. ¶··‰ÔÔ‡ÏÔ˘, ¡. º·Ú¿ÎÏ·˜

∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿

128

CASE REPORTS

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ 133

138

142

™˘Ó¯›˙ÔÓÙ·È

Kikuchi - Fujimoto disease: Case report G. Trimis, K. Athanasaki, A. Giannoulia-Karantana, X. Krikos

°. ∆Ú›Ì˘, ∫. ∞ı·Ó·Û¿ÎË, ∞. °È·ÓÓÔ‡ÏÈ·-∫·Ú·ÓÙ·Ó¿, •. ∫Ú›ÎÔ˜

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

Chronic midgut volvulus due to malrotation: Case report ∞. Michos, E. Orfanou, E. Papandreou, N. Baltogiannis, E. Roma-Giannikou, D. Keramidas

∞. M›¯Ô˜, ∂. OÚÊ·ÓÔ‡, ∂. ¶··Ó‰Ú¤Ô˘, ¡. ª·ÏÙÔÁÈ¿ÓÓ˘, ∂. ƒÒÌ·-°È·ÓÓ›ÎÔ˘, ¢. ∫ÂÚ·Ì›‰·˜

¡fiÛÔ˜ Kikuchi - Fujimoto: ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘

Neonatal withdrawal syndrome from narcotic and non-narcotic drugs. Report of two cases I. Kapetanakis, J. Kaleyias, M. Markouri, G. Alevizopoulos, G. Kourakis, ∂. Dellagrammaticas

π. ∫·ÂÙ·Ó¿Î˘, π. ∫·Ï¤ÁÈ·˜, ª. ª·ÚÎÔ‡ÚË, °. ∞Ï‚È˙fiÔ˘ÏÔ˜, °. ∫Ô˘Ú¿Î˘, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜

ÃÚfiÓÈ· Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ ÏfiÁˆ ·ÓˆÌ·Ï›·˜ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘: ¶ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜

Cholelithiasis in children A. Mitsika-Karanasou, H. Tziouvara, A. Kondylis, G. Tzortzatou, Z. Karakatsani

∞. ª‹ÙÛÈη-∫·Ú·Ó¿ÛÔ˘, Ã. ∆˙ÈÔ˘‚¿Ú·, ∞. ∫ÔÓ‰‡Ï˘, °. ∆˙ˆÚÙ˙¿ÙÔ˘, ∑. ∫·Ú·Î·ÙÛ¿ÓË

™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ·fi Ó·ÚΈÙÈΤ˜ Î·È ÌËÓ·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛˆÓ

Body fat indices of school-aged children of the Vari region in Attica

145

PEDIATRIC NEWS

Continued

March - April 2002 . Volume 65 . No 2


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™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏¡ µπµ§πO°ƒ∞ºπ∞ ¢È·ÊÔÚÂÙÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Û ÌÔÓÔ‡ÚËÓ· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë ÛÙÚÂÙfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ µ Ô˘ ÚÔηÏÔ‡Ó ÛË„·ÈÌ›· ‹ ÌfiÓÔ ·ÔÈÎÈÛÌfi

LITERATURE ABSTRACTS 107

Berner R, Csorba J, Brandis M ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™. ºˆÙfiÔ˘ÏÔ˜

∏ ·ÈÙÈÔÏÔÁ›· Î·È Ë ¤Î‚·ÛË Ù˘ Ó¢ÌÔÓ›·˜ Û ·È‰È¿ Ì ۇӉÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (AIDS) Ô˘ ÂÈÛ‹¯ıËÛ·Ó Û ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ (ª∂£) ·Ó·Ù˘ÛÛfiÌÂÓ˘ ¯ÒÚ·˜

Berner R, Csorba J, Brandis M Greek translation: S. Fotopoulos 117

Zar H, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: A. ÷Ù˙‹˜

¢È¿ÁÓˆÛË, ıÂÚ·›· Î·È ÓÔÛËÚfiÙËÙ· Û ·È‰È¿ Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (º¡∂)

The etiology and outcome of pneumonia in human immunodeficiency virus-infected children admitted to intensive care in a developing country Zar H, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et al Greek translation: A. Chatzis

121

Spray C, Debelle G, Murphy M ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: °. ∫·ÊÚ›ÙÛ·

£ÂÚ·›· ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ Û ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË

Different cytokine expression in cord blood mononuclear cells after stimulation with neonatal sepsis or colonizing strains of Streptococcus agalactiae

Current diagnosis, management and morbidity in paediatric inflammatory bowel disease Spray C, Debelle G, Murphy M Greek translation: G. Kafritsa

132

Wewer V, Andersen LP, Paerregaard A, Gernow A, Hansen JP, Matzen P et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: °. ∫·ÊÚ›ÙÛ·

Treatment of Helicobacter pylori in children with recurrent abdominal pain Wewer V, Andersen LP, Paerregaard A, Gernow A, Hansen JP, Matzen P et al Greek translation: G. Kafritsa

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xiii

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xvii

Abbreviations

March - April 2002 . Volume 65 .No 2


MARCH-APRIL 2002

14-05-03

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M¿ÚÙÈÔ˜ - ∞Ú›ÏÈÔ˜ 2002

.

∆fiÌÔ˜ 65

. ∆‡¯Ô˜

2

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

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

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

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

TËÏ.: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Tel.: 010-7771 140 / 010-7771 663, Fax: 010-7758 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: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

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

Greek Editing I. Karavranou

March-April 2002 .Volume 65 . No 2

πSSN 0377-2551 i


MARCH-APRIL 2002

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12:25

™ÂÏ›‰·5

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 ��Ô˚·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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MARCH-APRIL 2002

14-05-03

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

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

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

¶›Ó·Î˜ Î·È 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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Paediatriki 2002;65:89-96

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∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∞. °ÎÈfiη˜

Spondylodiscitis in childhood A. Giokas

¶ÂÚ›ÏË„Ë: ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙ· ·È‰È¿ Â›Ó·È Ì›· ·Û˘Ó‹ı˘ ÓfiÛÔ˜ Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û·Ó ÊÏÂÁÌÔÓ҉˘ ·ÏÏÔ›ˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Ì ÂÏ¿¯ÈÛÙË ‹ ηıfiÏÔ˘ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ∂ΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ì ÂÒ‰˘ÓË ‰˘Ûη̄›· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ·ÏÏ¿ Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È Î·È ·fi ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ϷÓı·Ṳ̂ÓË ‹ ηı˘ÛÙÂÚË̤ÓË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÌfiÓÔ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Î·È È‰È·›ÙÂÚ· Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Â›Ó·È ·ÎÚȂ›˜ Î·È Ù·¯Â›Â˜ ̤ıÔ‰ÔÈ Ô˘ ‰›‰Ô˘Ó ¯Ú‹ÛÈ̘ Î·È Î·ıÔÚÈÛÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÚÒÈÌË ‰È¿ÁÓˆÛË Î·È Èı·Ó‹ ÂÍ‹ÁËÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜. ∏ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÎÏÈÓÔÛÙ·ÙÈÛÌfi, ·ÓÙÈ‚›ˆÛË (IV Î·È per os) ÁÈ· 3-4 ‚‰ÔÌ¿‰Â˜ Î·È ·ÎÈÓËÙÔÔ›ËÛË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÁÈ· 2-3 Ì‹Ó˜. ∏ Ê˘ÛÈ΋ ÂͤÏÈÍË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Â›Ó·È Î·ÏÔ‹ı˘ Î·È Ë ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘.

Abstract: Intervertebral discitis is an uncommon disease in children and has been described as an inflammation of the disk-space. It is characterised by stenosis of the affected disk space with little or no evidence of adjacent vertebral involvement. The main clinical feature of discitis is painful stiffness of the spine, but it may be accompanied by other symptoms leading to misdiagnosis or delayed diagnosis and therapy. From the diagnostic procedures, only the bone scanning and especially the M.R.I. are accurate for the early establishment of the diagnosis, and give useful information concerning the clinical syndrome of discitis. Treatment requires bed rest and administration of antibiotics (IV and per os) for about 3-4 weeks, and stabilisation of the spine with back brace for 2-3 months. The natural course of discitis is benign, and the initial clinical picture correlates directly with the age of the child and the level of spine involvement.

§¤ÍÂȘ ÎÏÂȉȿ: ‰ÈÛΛÙȘ, ÛÔÓ‰˘Ï›ÙȘ, ÊÏÂÁÌÔÓ‹ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘.

Key words: discitis, spondylitis, spine infection.

∂ÈÛ·ÁˆÁ‹ ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Ì›· ÛËÙÈ΋ ‹ ¿ÛËÙË ÊÏÂÁÌÔÓ҉˘ ·ÏÏÔ›ˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰˘Ï›Ô˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Ì ÂÏ¿¯ÈÛÙË ‹ ηıfiÏÔ˘ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ∏ ÁÓÒÛË Ù˘ Ê˘ÛÈ΋˜ ÔÚ›·˜ Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË, ÂÂȉ‹ Ë ÔÏ˘ÌÔÚÊ›·

ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÓfiÛÔ˘ ÚÔηÏ› ‰È·ÁÓˆÛÙÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. Œ¯ÂÈ ‰Â ·Ó·ÁÓˆÚÈÛÙ› ˆ˜ ¿ıËÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÚÈÓ ÙÔ 1950 Î·È Èı·ÓfiÓ Ô Mayer Â›Ó·È Ô ÚÒÙÔ˜ Ô˘ ÂÚȤÁÚ·„Â Î·È ‰ËÌÔÛ›Â˘Û ÙËÓ ¿ıËÛË ·˘Ù‹ ÙÔ 1925 ÛÙÔ ÂÚÈÔ‰ÈÎfi Journal of Bone and Joint Surgery.

µ’ OÚıÔ·È‰È΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

B’ Orthopaedic Department Children’s Hospital “P. & A. Kyriakou”, Athens

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∏ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÔÊÂÈÏÔ̤ÓË Û ÛËÙÈ΋ ‹ ¿ÛËÙË ÊÏÂÁÌÔÓ‹ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì ‰È·ÊÔÚÂÙÈο ÔÓfiÌ·Ù·, fiˆ˜: 1) ηÏÔ‹ı˘ Ù‡Ô˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜ Ù˘ ™.™. (Smith 1933) (55), 2) ÔÍ›· ÊÏÂÁÌÔÓ҉˘ ·ÏÏÔ›ˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ (Ghormley 1940) (23), 3) ÔÍ›· ÔÛÙ½ÙȘ Ù˘ ™.™. (Bremner Î·È Neligan 1953) (5), 4) ÛÔÓ‰˘ÏÔ·ÚıÚ›ÙȘ (Saenger 1952) (52), 5) ηٷÛÙÚÔÊÈ΋ ·ÏÏÔ›ˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ (Mathews 1957) (39), 6) ÌË ÂȉÈ΋ ÛÔÓ‰˘Ï›ÙȘ (Dupont Î·È Anderson 1956) (14) Î·È 7) ‰ÈÛΛÙȘ (Menelaus 1964) (40). ™ÙËÓ ·È‰È΋ ËÏÈΛ·, Ë Û˘¯ÓfiÙËÙ· ÌÈ·˜ ÊÏÂÁÌÔÓ‹˜ Ù˘ ™.™. Â›Ó·È ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙȘ ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÔÛÙÒÓ Î·È ·ÚıÚÒÛÂˆÓ Î·È Û˘Ó‹ıˆ˜ fiÙ·Ó ÂÌÊ·Ó›˙ÂÙ·È Â›Ó·È ·›ÙÈÔ ·È‰È΋˜ ÔÛÊ˘·ÏÁ›·˜. ∂›Û˘, Ë ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙ· ·È‰È¿ Û·Ó›ˆ˜ Û˘Ó˘¿Ú¯ÂÈ Ì ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ¿ÏÏˆÓ ÔÛÙÒÓ ÙÔ˘ ÛÎÂÏÂÙÔ‡. H ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Û˘¯Ó‹ Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ, ·ÏÏ¿ ÌÔÚ› Ó· Û˘Ì‚Â› Û fiϘ ÙȘ ËÏÈ˘. ∏ ÚÔÛ‚ÔÏ‹ Û ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Â›Ó·È ÂÚ›Ô˘ ›ÛË. O Eismont Î·È Û˘Ó (1982) Î·È Ô Nade (1983) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÓÂÔÁÓÈ΋ ËÏÈΛ· ‰È·ÙÚ¤¯ÂÈ ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÚÔÛ‚ÔÏ‹˜ Ù˘ ™.™. (16,41). ∏ ÛË„·ÈÌ›· Â›Ó·È Û˘Ó‹ıˆ˜ Ë ÚÒÙË ‰È¿ÁÓˆÛË Ô˘ Á›ÓÂÙ·È, ÂÓÒ Ë ‰È¿ÁÓˆÛË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Â›Ó·È ·ÚÎÂÙ¿ ‰‡ÛÎÔÏË Î·È Î·ı˘ÛÙÂÚ› Ó· Á›ÓÂÈ ·ÚÎÂÙ¤˜ ‚‰ÔÌ¿‰Â˜. ∆Ô Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ Ù˘ ™.™. ·fi ‰ÈÛΛÙȉ· ηٿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜ Â›Ó·È ÚÒÙ· Ë ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÌÂÙ¿ Ë ıˆÚ·ÎÈ΋ Î·È ÈÔ Û¿ÓÈ· Ë ·˘¯ÂÓÈ΋. ∆Ô Û˘¯ÓfiÙÂÚÔ ‰Â, Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ Â›Ó·È ÙÔ ÌÂÛÔÛÔÓ‰‡ÏÈÔ ‰È¿ÛÙËÌ· O2-O3. ∏ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ ÛÙ· ·È‰È¿ Î˘Ì·›ÓÂÙ·È ·fi Ì›· ηÏÔ‹ıË, ·˘ÙÔ˚ÒÌÂÓË ÊÏÂÁÌÔÓ‹ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜, ·fi ÙËÓ ÔÔ›· ηӤӷ˜ ·ıÔÁfiÓÔ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ‰ÂÓ ¤¯ÂÈ ·ÔÌÔÓˆı›, ̤¯ÚÈ ÙËÓ ·ÚÔ˘Û›· ˘Ò‰Ô˘˜ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ÊÏÂÁÌÔÓ‹˜ Ì ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· „ÔÈÙÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ (33). ∞ÈÌ¿ÙˆÛË ÛÔÓ‰‡ÏÔ˘ - ‰›ÛÎÔ˘ O ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜ ¤¯ÂÈ ‰‡Ô ËÁ¤˜ ·ÈÌ¿ÙˆÛ˘: ·) Ù· ÂÚÈÔÛÙÈο ·ÁÁ›·, ‚) Ù· ·ÁÁ›· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÎÂÓÙÚÈ΋ ÌÔ›Ú· ÙÔ˘ ÛÔÓ‰‡ÏÔ˘. ∞˘Ù¿ ·Ú¯›˙Ô˘Ó Ó· ·ÙÚÔÊÔ‡Ó ·fi ÙÔ ÚÒÙÔ ¤ÙÔ˜ Î·È ÂÍ·Ê·Ó›˙ÔÓÙ·È Ï‹Úˆ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 10 ¯ÚfiÓˆÓ. ŒÙÛÈ ·Ú·Ì¤ÓÂÈ ÌfiÓÔ ÙÔ ÙÚȯÔÂȉ¤˜ ‰›ÎÙ˘Ô ÛÙÔÓ ÈÓÒ‰Ë ‰·ÎÙ‡ÏÈÔ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙÔ ÔÔ›Ô ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ

90

Paediatriki 2002;65:89-96

ÙÂÏÈΤ˜ ‰È·ÎÏ·‰ÒÛÂȘ ÙˆÓ ÂÚÈÔÛÙÈÎÒÓ ·ÁÁ›ˆÓ (17,69,71). ∂¿Ó Û˘Ì‚Â› Í·ÊÓÈο ·fiÙÔÌË ‰È·ÎÔ‹ Ù˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙfiÙÂ Ô ‰›ÛÎÔ˜ Ô‰ËÁÂ›Ù·È ÛÙËÓ È‰ÈÔ·ı‹ Ó¤ÎÚˆÛ‹ ÙÔ˘ Ô˘ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˆ˜ ·Û‚¤ÛÙˆÛË (57). ™ËÌÂÈÒÓÂÙ·È Â›Û˘ fiÙÈ Ô ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜ ¯¿ÓÂÈ Ï‹Úˆ˜ ÙËÓ ·ÈÌ¿ÙˆÛ‹ ÙÔ˘ ÂÚ›Ô˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 30 ¯ÚfiÓˆÓ (10). ¶·ıÔÁ¤ÓÂÈ· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ ∞. ∞ÈÌ·ÙÔÁÂÓ‹˜. ∏ ˘¿Ú¯Ô˘Û· ·ÈÌ¿ÙˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ ·Ú¤¯ÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÚÔÛ‚ÔÏ‹˜ ·˘ÙÔ‡ ·fi ÛËÙÈÎfi ¤Ì‚ÔÏÔ. O Schmorl (1959) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ‰ÈÛΛÙȘ Â›Ó·È ÚˆÙÔ·ı‹˜ ÊÏÂÁÌÔÓ‹ ÙÔ˘ ‰›ÛÎÔ˘ Î·È fi¯È ‰Â˘ÙÂÚÔ·ı‹˜ ·fi ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· ÙÔ˘ ÛÔÓ‰‡ÏÔ˘. ∞˘Ùfi ÂÍËÁÂ›Ù·È ·Ê’ ÂÓfi˜ ÌÂÓ ·fi ÙËÓ ÚÔηÏÔ‡ÌÂÓË ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜, ·Ê’ ÂÙ¤ÚÔ˘ ‰Â ·fi ÙËÓ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÂÈÊ˘ÛÈ·ÎÒÓ Ï·ÎÒÓ Î·È ÙˆÓ ‰‡Ô ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ (53). Ÿˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔ˘˜ Wiley Î·È Trueta (1959), ¤Ó·˜ ¿ÏÏÔ˜ Ì˯·ÓÈÛÌfi˜ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ Â›Ó·È Ë ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÚÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜ ÛÙË ÌÂÙ¿Ê˘ÛË ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ ÏËÛ›ÔÓ Ù˘ ÂÈÊ˘Ûȷ΋˜ Ͽη˜, ÙÔ ÔÔ›Ô ·ÓÙ› Ó· ηٷÛÙÚ¤„ÂÈ ÙÔÓ ÛfiÓ‰˘ÏÔ, Ú‹ÁÓ˘Ù·È ÛÙÔÓ ·Ú·Î›ÌÂÓÔ ‰›ÛÎÔ (69). O ·ıÔÁÂÓÂÙÈÎfi˜ ·˘Ùfi˜ Ì˯·ÓÈÛÌfi˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔÓ Ring Î·È Û˘Ó (1994, 1995), ηıÒ˜ Î·È ·fi ÙÔÓ Kwang Soon Song Î·È Û˘Ó (1997) ÌÂÙ¿ ·fi ÙË ÏÂÙÔÌÂÚ‹ ÌÂϤÙË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ (47,48,61). ∞fi ÙÔÓ Whalen Î·È Û˘Ó (1985) ÂÚÈÁÚ¿ÊÂÙ·È fiÙÈ Ë ‡·ÚÍË ·ÚÙËÚÈÔÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÛÙË ÌÂÙ¿Ê˘ÛË ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Ì ‚Ú·‰Â›· ·ÈÌ·ÙÈ΋ ÚÔ‹ ÌÂÈÒÓÂÈ ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ·fi Ù· Ï¢ÎÔ·ÙÙ·Ú·, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÚÔ-·ÔÛÙËÌ¿ÙˆÓ (71). ∂›Û˘, Ô Coventry Î·È Û˘Ó (1945) Î·È Ô Whalen Î·È Û˘Ó (1985) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ‰ÈÛΛÙȘ Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÓÒ Ë ÛÔÓ‰˘Ï›ÙȘ Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ‰ÈfiÙÈ Ô ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚË ·ÈÌ¿ÙˆÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô˘ Û˘Ó‹ıˆ˜ ÌÂÈÒÓÂÙ·È Î·È ÂÍ·Ê·Ó›˙ÂÙ·È fiÙ·Ó Û˘Ì‚Â› ÔÛÙÂÔÔ›ËÛË ÙÔ˘ Û˘˙¢ÎÙÈÎÔ‡ ¯fiÓ‰ÚÔ˘ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ (10,71). O Kwang Soon Song Î·È Û˘Ó (1997) ·Ó·Ê¤ÚÂÈ fiÙÈ Ë ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰ÈÛΛÙȘ ÚÔÛ‚¿ÏÏÂÈ ·Ú¯Èο ÙÔ ÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Î·È ÙÔ˘ ‰›ÛÎÔ˘ Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ô›ÛıÈÔ˘ ÙÌ‹Ì·ÙÔ˜. O ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰›ÛÎÔ˜ ηٷÛÙÚ¤ÊÂÙ·È ÂÂȉ‹ Ë ÊÏÂÁÌÔÓ҉˘ ‰È·‰Èηۛ· ¤¯ÂÈ ¯ÔÓ‰ÚÔÏ˘ÙÈ΋ ȉÈfiÙËÙ·, fiˆ˜ ·ÎÚÈ‚Ò˜ Î·È ÛÙËÓ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ· Î·È ÛËÙÈ΋ ·ÚıÚ›Ùȉ· ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ (61).


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·91

¶·È‰È·ÙÚÈ΋ 2002;65:89-96

B. ∂ÓÔÊı·ÏÌÈÛÌfi˜. ∂›Ó·È ¤Ó·˜ ¿ÏÏÔ˜ ÙÚfiÔ˜ ÚfiÎÏËÛ˘ ‰ÈÛΛÙȉ·˜ Ô˘ Û˘Ó‹ıˆ˜ Á›ÓÂÙ·È ÌÂÙ¿ ·fi ·Ú·Î¤ÓÙËÛË, ‰ÈÛÎÔÁÚ¿ÊËÌ·, ‰ÈÛÎÂÎÙÔÌ‹ Î·È Ì˘ÂÏÔÁÚ·Ê›·. ∆Ô ‰ÈÛÎÔÁÚ¿ÊËÌ· Î·È Ë ‰ÈÛÎÂÎÙÔÌ‹ Â›Ó·È ÂÂÌ‚¿ÛÂȘ Ô˘ Û˘Ó‹ıˆ˜ Á›ÓÔÓÙ·È Û ·È‰È¿ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜. µ·ÛÈο, Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ÌÂÛÔÛÔÓ‰˘Ï›Ô˘ ‰ÈÛΛÙȉ·˜ ‰ÂÓ Â›Ó·È ÍÂοı·ÚË. Œ¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÙÚ·˘Ì·ÙÈο ·›ÙÈ·, ÈÔ› Î·È ÌÈÎÚfi‚È·. ∏ ηÏÔ‹ı˘ ÔÚ›· ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ Ù˘ ÓfiÛÔ˘, Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi ÎÏÈÓÔÛÙ·ÙÈÛÌfi ÌfiÓÔ, Û˘ÓËÁÔÚ› ÁÈ· Ì›· ¯·ÌËÏ‹˜ ÙÔÍÈÎfiÙËÙ·˜ ÊÏÂÁÌÔÓ‹ ‹ ÁÈ· ¿ÛËÙË ÊÏÂÁÌÔÓ‹. ∫ÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙË ‰È·ÊÔÚÂÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ‰È·ÎÚ›ÓÂÙ·È Û 3 ÔÌ¿‰Â˜, ‰ËÏ·‰‹ ÙË ‚ÚÂÊÈ΋, ÙË ÓËȷ΋ Î·È ÙËÓ ·È‰È΋. ∏ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË ÛÙË ‚ÚÂÊÈ΋ Î·È ÓËȷ΋ ËÏÈΛ·, ÂÂȉ‹ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ Ù· ·È‰È¿ ‰ÂÓ Â›Ó·È Û˘ÓÂÚÁ¿ÛÈÌ· Î·È ‰ÂÓ ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ÏËÚÔÊÔڛ˜ ηٿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡. ∏ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ ÂÌÊ·Ó›˙ÂÙ·È Ì ÔÈΛϷ Û˘ÌÙÒÌ·Ù· ηÈ, ·Ó¿ÏÔÁ· Ì ÙÔ Î˘Ú›·Ú¯Ô Û‡Ìو̷ Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, Ù·ÍÈÓÔÌÂ›Ù·È ÛÙ· ·ÎfiÏÔ˘ı· Û‡Ó‰ÚÔÌ·: ∞. ™‡Ó‰ÚÔÌÔ ÂÒ‰˘ÓÔ˘ ÈÛ¯›Ô˘: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÌË ÂȉÈÎfi fiÓÔ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÈÛ¯›Ô˘ ‹ Û ÔÏfiÎÏËÚÔ ÙÔ ÛΤÏÔ˜, ¯ˆÚ›˜ Ó· Â›Ó·È ÂÓÙÔÈṲ̂ÓÔ˜ fiˆ˜ ÛÙË ‰ÈÛÎÔ΋ÏË. ∏ ÔÛÊ˘·ÏÁ›· ‰ÂÓ Â›Ó·È ¤ÓÙÔÓË Î·È Û˘Ó‹ıˆ˜ ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜. µ. ™‡Ó‰ÚÔÌÔ ÔÍ›·˜ ÎÔÈÏÈ¿˜: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ·ÓÔÚÂÍ›·, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ¤ÌÂÙÔ Ì¤¯ÚÈ Û˘Ìو̷ÙÔÏÔÁ›· ÂÈÏÂÔ‡, Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ Ô ·ÛıÂÓ‹˜ ¤¯ÂÈ Ô‰ËÁËı› ̤¯ÚÈ ÙË Ï··ÚÔÙÔÌ›·. ™˘Ó‹ıˆ˜, ÙË Û˘Ìو̷ÙÔÏÔÁ›· ·˘Ù‹ ‰›‰ÂÈ Ë ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ Ô˘ Û˘Ì‚·›ÓÂÈ ·fi ÙË £8 ¤ˆ˜ ÙËÓ O1 Ú›˙·. ∂›Û˘, Ë ËÏÈΛ· Ô˘ Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÔÓÙ·È Ù· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ Û ̛· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ· Î˘Ì·›ÓÂÙ·È ·fi Ù· 3 ¤ˆ˜ Ù· 8 ¤ÙË. °. ™‡Ó‰ÚÔÌÔ ÌËÓÈÁÁÈÙȉÈÎfi: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂÚÂıÈÛÌfi ÙˆÓ ÌËÓ›ÁÁˆÓ, fiˆ˜ ‰Â›¯ÓÂÈ Ë ·ÚÔ˘Û›· ÙˆÓ ÛËÌ›ˆÓ Kerning Î·È Brudzinski. ÀÂÚ˘ÚÂÍ›· Î·È ÎÏfiÓÔ˜ ›Ûˆ˜ Â›Ó·È ·ÚfiÓÙ· Û˘ÌÙÒÌ·Ù·, ηıÒ˜ Î·È Ë ÔÛÊ˘·ÏÁ›·, ·ÏÏ¿ fi¯È ¤ÓÙÔÓË. ¢. ™‡Ó‰ÚÔÌÔ Ú·¯È·ÏÁ›·˜: ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Û·Ê‹ fiÓÔ ÛÙË Oª™™ ‹ ÙË Ú¿¯Ë ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ¯ˆÏfiÙËÙ· Ì ÚÔԉ¢ÙÈ΋ ¿ÚÓËÛË ÁÈ· ‚¿‰ÈÛË Î·È ÛÙ¿ÛË Î·È ‰˘Ûη̄›· Ù˘ ™.™. ™˘Ó‹ıˆ˜, Ë Â˘ÂÚÂıÈÛÙfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì ٷ ˘¿Ú¯ÔÓÙ· ÁÂÓÈο Û˘ÌÙÒÌ·Ù·. ∫¿ı ΛÓËÛË Ù˘ ÏÂοÓ˘, ÙÔ˘ ÈÛ¯›Ô˘ Î·È ÙÔ˘

Paediatriki 2002;65:89-96

ÌËÚÔ‡ ÚÔηÏ› ‰˘ÛÊÔÚ›·. À¿Ú¯ÂÈ ‰˘Ûη̄›·, Ì˘˚Îfi˜ Û·ÛÌfi˜, ÙÔÈ΋ ¢·ÈÛıËÛ›· Î·È Â˘ıÂÈ·ÛÌfi˜ Ù˘ ™.™. ™˘Ó‹ıˆ˜ ÚÔηÏÂ›Ù·È fiÓÔ˜ ÌÂÙ¿ ·fi ›ÂÛË ÛÙËÓ ÚÔۂ‚ÏË̤ÓË ÂÚÈÔ¯‹ Ù˘ ™.™. ∂›Û˘, ¤Ó· ·ÚÎÂÙ¿ Û˘¯Ófi ÎÏÈÓÈÎfi ‡ÚËÌ· Â›Ó·È Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ÏfiÚ‰ˆÛË ‹ ÛÎÔÏ›ˆÛË Ô˘ ÚÔηÏ› ·ÓÒÌ·ÏË ÛÙ¿ÛË Î·È ı¤ÛË ÙÔ˘ ÎÔÚÌÔ‡, fiˆ˜ Â›Û˘ Î·È ÙÔ ıÂÙÈÎfi ÛËÌÂ›Ô laseque. ∂. ™‡Ó‰ÚÔÌÔ Â˘ÂÚ¤ıÈÛÙÔ˘ ·È‰ÈÔ‡: ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ¢ÂÚÂıÈÛÙfiÙËÙ· Î·È ·Û˘Ó‹ıË Û˘ÌÂÚÈÊÔÚ¿ Ì ¯·ÌËÏfi ˘ÚÂÙfi Î·È Î·ÎÔ˘¯›·. ¶ÚÔÛÂÎÙÈÎfiÙÂÚË ÂͤٷÛË ı· ·Ôηχ„ÂÈ ÙÔÈ΋ ¢·ÈÛıËÛ›· ÛÙË Oª™™ Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙ¿ÛË ÙÔ˘ ·È‰ÈÔ‡. ∏ Û˘ÓËı¤ÛÙÂÚË ‰Â, ËÏÈΛ· ÂΉ‹ÏˆÛ˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·˘ÙÒÓ Â›Ó·È Ì¤¯ÚÈ Ù· 3 ¯ÚfiÓÈ·. ™·Ó›ˆ˜ Ù· ·Ú¯Èο Û˘ÌÙÒÌ·Ù· Ô‰ËÁÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË ÊÏÂÁÌÔÓ‹˜ Ù˘ ™.™., ·ÏÏ¿ Ú¤ÂÈ Ó· Á›ÓÂÈ ¤ÏÂÁ¯Ô˜ ÁÈ’ ·˘Ù‹. ™˘Ó‹ıˆ˜ Ù· ·È‰È¿ Ì ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ· ÂÌÊ·Ó›˙Ô˘Ó Ó·˘Ù›· Î·È ¤ÌÂÙÔ, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ˘„ËÏfi˜ ˘ÚÂÙfi˜. ¢È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ ∞) ∞Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·. H ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Û˘Ó‹ıˆ˜ Â›Ó·È ·ÚÓËÙÈ΋ ÁÈ· Â˘Ú‹Ì·Ù· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜, fiˆ˜ Â›Ó·È Ë ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È ÔÈ ‹Ș ·ÏÏÔÈÒÛÂȘ Ù˘ ÂÈÊ˘Ûȷ΋˜ Ͽη˜ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘. ∏ ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ·fi ¤Ó· Ì‹Ó· (∂ÈÎfiÓ· 1 Î·È 5). µ) ∞ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, CRP, WIDAL, WRIGHT. ∂¿Ó ‰Â, ˘¿Ú¯Ô˘Ó Î·È ÛËÌ›· ÛË„·ÈÌ›·˜, ÙfiÙ ÂӉ›ÎÓ˘Ù·È Ó· Á›ÓÂÙ·È Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜, ηÏÏȤÚÁÂÈ· Ê¿Ú˘ÁÁÔ˜ Î·È Ô˘ÚÔηÏÏȤÚÁÂÈ·. ∂›Û˘, ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ Ó· Á›ÓÔÓÙ·È Î·ÏÏȤÚÁÂȘ ˘·Ú¯fiÓÙˆÓ ÙÚ·˘Ì¿ÙˆÓ. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙËÓ ÂͤٷÛË ÁÈ· ÙÔ ·ÓÙÈÁfiÓÔ HLA-B27, Ì ÛÎÔfi Ó· ·ÔÎÏÂÈÛÙ› Ë ·Á΢ÏÔÔÈËÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ·. °) ¢ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux. ¢) ™ÈÓıËÚÔÁÚ¿ÊËÌ·. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Ì 99mTc Â›Ó·È Ì›· ·ÎÚÈ‚‹˜ Î·È Ù·¯Â›· ̤ıÔ‰Ô˜ ÂÓÙÔÈÛÌÔ‡ ÌÈ·˜ ÊÏÂÁÌÔÓ‹˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Ê·›ÓÂÙ·È Ó· Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙ· ÌÈÎÚ¿ ·È‰È¿, ‰ÈfiÙÈ Ë ÂÓÙfiÈÛË Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ÂÂÍÂÚÁ·Û›·˜ ÛÙËÓ ËÏÈΛ· ·˘Ù‹ Â›Ó·È ·‰‡Ó·ÙË Ì ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË. ªÂÙ¿ ÙÔ ıÂÙÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ‰ËÏ·‰‹ Ì ÙËÓ ·ÚÔ˘Û›· “£ÂÚÌÔ‡ ÛËÌ›Ԣ” (Hot Spot), Û˘ÓÈÛÙ¿Ù·È Ë ÙÔÈ΋ ·ÂÈÎfiÓÈÛË Ì ̷ÁÓËÙÈ΋ ‹ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (∂ÈÎfiÓ· 2).

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™ÂÏ›‰·92

¶·È‰È·ÙÚÈ΋ 2002;65:89-96

Paediatriki 2002;65:89-96

∂ÈÎfiÓ· 1. ¶ÚÔÛıÔ›ÛıÈ· Î·È Ï·Á›· ·ÎÙÈÓÔÁÚ·Ê›· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Ì ÛÙ¤ÓˆÛË ÙÔ˘ £12-O1 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜. ∞Ó‹ÎÂÈ Û ÎÔÚ›ÙÛÈ 5 ÂÙÒÓ Ô˘ ·ÚÔ˘Û›·Û ·Ú¯Èο Û˘ÌÙÒÌ·Ù· ÔÍ›·˜ ÎÔÈÏ›·˜.

∂ÈÎfiÓ· 5. ¶ÚÔÛıÔ›ÛıÈ· Î·È Ï·Á›· ·ÎÙÈÓÔÁÚ·Ê›· ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Ì ÛÙ¤ÓˆÛË ÙÔ˘ O3-O4 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜.

∂) ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Â›Ó·È Ì›· ¯Ú‹ÛÈÌË ‰È·ÁÓˆÛÙÈ΋ ·ÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ ÁÈ· ÙËÓ ¤Ú¢ӷ ÛÔÓ‰˘ÏÈÎÒÓ ·ıÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛˆÓ. ∂›Ó·È ΢ڛˆ˜ ÔχÙÈÌË ÛÙË ‰È¢ÎÚ›ÓÈÛË Î·È ‰È¿ÁÓˆÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ˘˜ ÛÔÓ‰‡ÏÔ˘˜ ÌÂÙ¿ ·fi ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·˘ÙÒÓ ·ÏÏÔÈÒÛÂˆÓ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ. ∂›Û˘, Ô Û˘Ó‰˘·ÛÌfi˜ ·ÍÔÓÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Î·È Ì˘ÂÏÔÁÚ·Ê›·˜ ·Ú¤¯ÂÈ ÂÈÚfiÛıÂÙ˜ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘. ™∆) ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. ∂›Ó·È Ì›· Ó¤· ·ÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ Î·È È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ. ¢ÂÓ ÂÎ¤ÌÂÈ ·ÎÙÈÓÔ‚ÔÏ›· Î·È ·ÂÈÎÔÓ›˙ÂÈ Ù· ÚÒÈÌ· ÊÏÂÁÌÔÓÒ‰Ë ÛÙÔȯ›· ÙÔ˘ ‰›ÛÎÔ˘ Î·È ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ. ¢Â›¯ÓÂÈ ÙËÓ ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙËÓ ·Ú·Î›ÌÂÓË ÂÈÊ˘Ûȷ΋ Ͽη Î·È ÙȘ ·ÏÏÔÈÒÛÂȘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ∂›Û˘, ηٷÁÚ¿ÊÂÈ Î¿ı ‰È·ÊÔÚ¿ ÛÙÔ ÓˆÙÈ·›Ô ۈϋӷ Î·È ·Ú¤¯ÂÈ fi¯È ÌfiÓÔÓ ·Ó·ÙÔÌÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ™.™., ·ÏÏ¿ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ÛÙË ¯ËÌÈ΋ Û‡ÛÙ·ÛË ÙˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÈÛÙÒÓ (∂ÈÎfiÓ· 3 Î·È 4). ∑) ¶·Ú·Î¤ÓÙËÛË. ™˘Ó‹ıˆ˜ ‰ÂÓ ÂӉ›ÎÓ˘Ù·È Ó· Á›ÓÂÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÂÂȉ‹ Ô Î›Ó‰˘ÓÔ˜ ·fi ÙËÓ ·Ú·Î¤ÓÙËÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۯ¤ÛË Ì ÙËÓ Î·ÏÔ‹ıË ÔÚ›· Ù˘ ÓfiÛÔ˘. ∂›Û˘, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔÓ Spiegel Î·È Û˘Ó (1972) Î·È Wenger Î·È Û˘Ó (1978), Ì ÙËÓ ·Ú·Î¤ÓÙËÛË ‹ ÙËÓ ·ÓÔÈÎÙ‹ ‚ÈÔ„›· ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ‰›ÛÎÔ˘ ÌfiÓÔ ÛÙÔ 50% ÂÚ›Ô˘ ·Ó¢ڛÛÎÂÙ·È Ô ·ıÔÁfiÓÔ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ (58,68). ∏) µÈÔ„›·. ∏ ·ÓÔÈÎÙ‹ ‹ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ‰È¿ ‚Â-

ÏfiÓ˘ Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘ÓÈÛٿٷÈ, ‰ÈfiÙÈ ¤¯ÂÈ ÎÈÓ‰‡ÓÔ˘˜, ¤¯ÂÈ ·Ô‰Âȯı› ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ·ÓÂÈÙ˘¯‹˜ ÁÈ· ÙËÓ ·Ó·Î¿Ï˘„Ë ÙÔ˘ ·ıÔÁÂÓÂÙÈÎÔ‡ ·ÈÙ›Ô˘ Î·È ‰ÂÓ ÙËÓ ·Ô‰¤¯ÔÓÙ·È Â‡ÎÔÏ· ÔÈ ÁÔÓ›˜ Î·È ÔÈ ÌÈÎÚÔ› ·ÛıÂÓ›˜. ∏ ‚ÈÔ„›· ‰È¿ ‚ÂÏfiÓ˘ ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ ‰›ÛÎÔ˘ Û˘ÓÈÛÙ¿Ù·È ·fi ÙÔÓ Taylor (1985) Ó· Á›ÓÂÙ·È ÛÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÂÎÙÂٷ̤ÓË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ‰›ÛÎÔ˘ Î·È ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ÛÒÌ·ÙÔ˜ ÛÙËÓ ˘Ô„›· Ê˘Ì·ÙÈÒ‰Ô˘˜ ÛÔÓ‰˘Ï›Ùȉ·˜ ‹ Û ÂΛӘ ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹. ∂›Û˘, ÌÔÚ› Ó· ÎÚÈı› ··Ú·›ÙËÙË Ë ·ÓÔÈÎÙ‹ ‹ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ÌfiÓÔÓ ÂÊ’ fiÛÔÓ Ù›ıÂÙ·È ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· (63).

92

¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË 1) OÍ›· ÔÛÙÂÔÌ˘ÂÏ›ÙȘ ÛÔÓ‰‡ÏÔ˘. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi Ôͤ· ÁÂÓÈο Û˘ÌÙÒÌ·Ù· Ì ˘„ËÏfi ˘ÚÂÙfi, Ï¢ÎÔ΢ÙÙ¿ÚˆÛË, ·˘ÍË̤ÓË ∆∫∂ Î·È Ù·¯Â›· ÚÔԉ¢ÙÈ΋ ÔÛÙÈ΋ ηٷÛÙÚÔÊ‹. ∂›Û˘, ÙÔ Ôχ ıÂÚÌfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, Ë ·ÍÔÓÈ΋ Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ·ÚÎÂÙ¿ ‰È·ÊˆÙÈÛÙÈο ÛÙÔȯ›· Ù˘ ÚÔۂ‚ÏË̤Ó˘ ÂÚÈÔ¯‹˜. O Correa Î·È Û˘Ó (1993) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ÔÛÙÂÔÌ˘ÂÏ›ÙȘ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÂÙ·È Ì fiÓÔ ·Ó¿ÏÔÁ· Ù˘ ı¤Û˘ ÚÔÛ‚ÔÏ‹˜ ÛÙËÓ ·˘¯ÂÓÈ΋, ÙË ıˆÚ·ÎÈ΋ Î·È ÙËÓ ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ™™ (9). 2) º˘Ì·ÙÈ҉˘ ÛÔÓ‰˘ÏÈ΋ ÔÛÙÂÔÌ˘ÂÏ›ÙȘ. ™˘Ó‹ıˆ˜ Ë TBC Â›Ó·È ıˆÚ·ÎÈ΋, ÂÓÒ Ë ‰ÈÛΛÙȘ ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ Oª™™. ∏ ·ÚÓËÙÈ΋ Mantoux Î·È Ë Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·ÔÎÏÂ›Ô˘Ó ÙËÓ ‡·ÚÍ‹ Ù˘. ™ÙËÓ TBC ÛÔÓ‰˘Ï›Ùȉ·, Ë ÔÚ›· Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÚÔԉ¢ÙÈο ·ÚÁfi Ú˘ıÌfi Ì ÌÂÁ¿ÏË ÔÛÙÈ΋


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·93

¶·È‰È·ÙÚÈ΋ 2002;65:89-96

∂ÈÎfiÓ· 2. ™ÈÓıËÚÔÁÚ¿ÊËÌ· ÛÙÔ ÔÔ›Ô ·Ú·ÙËÚÂ›Ù·È Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÛÙÔ £12-O1 ÌÂÛÔÛÔÓ‰‡ÏÈÔ ‰È¿ÛÙËÌ· Û ÎÔÚ›ÙÛÈ 5 ÂÙÒÓ Ô˘ ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù· ÔÍ›·˜ ÎÔÈÏ›·˜, ·ÏÏ¿ Ë ÙÂÏÈ΋ ‰È¿ÁÓˆÛË ‹Ù·Ó ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·.

ηٷÛÙÚÔÊ‹ Î·È ÂÏ¿¯ÈÛÙË ·ÔηٿÛÙ·ÛË. ∂›Û˘, Û ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È ·Ú·ÛÔÓ‰˘ÏÈÎfi ·fiÛÙËÌ· Ô˘ ‡ÎÔÏ· ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·. 3) ∆˘ÊÈÎ��� Î·È ÌÂÏÈÙÔÎÔÎÎÈ΋ ÛÔÓ‰˘Ï›ÙȘ 4) ∞ÔÙÈÙ¿ÓˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘ 5) £ˆÚ·ÎÈ΋ Î·È ÔÛÊ˘˚΋ ÓfiÛÔ˜ ÙÔ˘ Scheuermann 6) TÚ·˘Ì·ÙÈ΋ ÛÔÓ‰˘Ï›ÙȘ 7) ŸÁÎÔÈ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ 8) ªËÓÈÁÁ›ÙȘ 9) ¡Â˘ÚÔÏÔÁÈ΋ ÓfiÛÔ˜ 10) ™ÎˆÏËÎÔÂȉ›ÙȘ 11) ¶˘ÂÏÔÓÂÊÚ›ÙȘ £ÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ 1) ∫ÏÈÓÔÛÙ·ÙÈÛÌfi˜. ∂Ê’ fiÛÔÓ ‰È·ÁÓˆÛı› ‰ÈÛΛÙȘ, Û˘ÓÈÛÙ¿Ù·È ¿ÌÂÛË Î·Ù¿ÎÏÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ̤¯ÚÈ Ó· ˘Ô¯ˆÚ‹ÛÂÈ Ô fiÓÔ˜, Ô Ì˘˚Îfi˜ Û·ÛÌfi˜ Î·È Ë ÙÔÈ΋ ¢·ÈÛıËÛ›·, Î·È ¤ˆ˜ fiÙÔ˘ Ë ∆∫∂, Ë Ï¢ÎÔ΢ÙÙ¿ÚˆÛË Î·È Ô ˘ÚÂÙfi˜ ·Ú¯›ÛÔ˘Ó Ó· ˘Ô¯ˆÚÔ‡Ó Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ‰Â›ÍÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÂȉÂÈÓˆı› Ë ÔÛÙÈ΋ ‰È¿‚ÚˆÛË. ∂ԇψÛË ‹ ›·ÛË ·fi ÙË ÓfiÛÔ ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ‡·ÚÍË ÌÂÚÈ΋˜ ÛÎÏ‹Ú˘ÓÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ÂÈÊ·ÓÂÈÒÓ. 2) ∞ÓÙÈ‚›ˆÛË. ∞Ú¯Èο, Â›Ó·È Û˘Ó‹ıˆ˜ ÂÌÂÈÚÈ΋ (ÎÂÊ·ÏÔÛÔÚ›ÓË + ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈο Ê¿Ú̷η) ÁÈ· 10 Ë̤Ú˜ (∂º) Î·È per os ̤¯ÚÈ Ó· ˘Ô¯ˆÚ‹ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· Î·È Ë ∆∫∂ ÂÈÛÙÚ¤„ÂÈ ÛÙ· Ê˘ÛÈÔÏÔÁÈο Â›‰· (Û˘Ó‹ıˆ˜ ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ· Î˘Ì·›ÓÂÙ·È ·fi 4 ¤ˆ˜ 6 ‚‰ÔÌ¿‰Â˜). ∂¿Ó fï˜ ·Ó·Î·Ï˘Êı› ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ÛÙËÓ ·ÈÌÔηÏÏȤÚÁÂÈ· Î·È ÛÙËÓ ·Ú·Î¤ÓÙËÛË, ÙfiÙ ¯ÔÚËÁÂ›Ù·È ÙÔ Î·-

Paediatriki 2002;65:89-96

∂ÈÎfiÓ· 3. O‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Ù˘ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. ¶·Ú·ÙËÚÂ›Ù·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ O3-O4 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È ÙÔ˘ O3 ÔÛÊ˘˚ÎÔ‡ ÛÔÓ‰‡ÏÔ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ 2,5 ÂÙÒÓ Ì ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ· Ô˘ ÂÌÊ¿ÓÈÛ ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ·‰˘Ó·Ì›·˜ Î·È ¿ÚÓËÛ˘ ‚¿‰ÈÛ˘.

Ù¿ÏÏËÏÔ ·ÓÙÈ‚ÈÔÙÈÎfi Û‡Ìʈӷ Ì ÙÔ ÙÂÛÙ Â˘·ÈÛıËÛ›·˜. ™ÙË ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·, ·Ú’ fiÙÈ ¤¯ÂÈ ÊÏÂÁÌÔÓÒ‰Ë ÚԤϢÛË, Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ıˆÚÂ›Ù·È ·ÌÊÈÛ‚ËÙ‹ÛÈÌË Î·È Û˘Ó‹ıˆ˜ Ë ÓfiÛÔ˜ Â›Ó·È ·˘ÙÔ˚ÒÌÂÓË Î·È ¤¯ÂÈ Î·Ï‹ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÎÈÓËÙÔÔ›ËÛË Ù˘ ™.™. Î·È ÙÔÓ ÎÏÈÓÔÛÙ·ÙÈÛÌfi. 3) ∫ˉÂÌfiÓ·˜. ∂Ê·ÚÌfi˙ÂÙ·È ÎˉÂÌfiÓ·˜ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚÈÔ¯‹ Ù˘ ÚÔۂ‚ÏË̤Ó˘ ™.™ ÁÈ· 23 Ì‹Ó˜. OÈ Scoles Î·È Quinn (1982) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÙÔÔı¤ÙËÛË Á‡„ÈÓÔ˘ ÎˉÂÌfiÓ· ÂÈÙ·¯‡ÓÂÈ ÙËÓ ›·ÛË Ù˘ ÓfiÛÔ˘ (54), ÂÓÒ Ô Taylor (1985) ÈÛÙ‡ÂÈ fiÙÈ Ë ¯Ú‹ÛË ÙÔ˘ Á‡„ÈÓÔ˘ ÎˉÂÌfiÓ· ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË fiÙ·Ó Ô ·ÛıÂÓ‹˜ ‰ÂÓ ·Ú·Ì¤ÓÂÈ ÎÏÈÓ‹Ú˘ ‹, ÂÓÒ ‚Ú›ÛÎÂÙ·È ÎÏÈÓ‹Ú˘, Ë ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȘ Â›Ó·È ¿Ú· Ôχ ÂÒ‰˘ÓË (63). ™˘Ó‹ıˆ˜ Û˘ÓÈÛÙ¿Ù·È ¤Ó·˜ Ô›ÛıÈÔ˜ ÎˉÂÌfiÓ·˜ Ù‡Ô˘ TaylorKnight Û ÌÂÁ¿Ï· ·È‰È¿, ¤ˆ˜ fiÙÔ˘ ·˘Ù¿ Á›ÓÔ˘Ó ·Û˘Ìو̷ÙÈο Ì ÙȘ Û˘Ó‹ıÂȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜. O ÎÏÈÓÔÛÙ·ÙÈÛÌfi˜ Î·È Ë ·ÎÈÓËÙÔÔ›ËÛË Ì ÎˉÂÌfiÓ·, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÈ Ô Richards Î·È Û˘Ó (1999), ¢ÓÔÔ‡Ó ÙËÓ ÂÔ˘ÏˆÙÈ΋ ‰È·‰Èηۛ· Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ‰›ÛÎÔ˘ (49). º˘ÛÈο, Ë ¯ÚÔÓÈfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·ıÔÚ›˙ÂÈ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÓÙÈ‚›ˆÛ˘ Î·È Ù˘ ·ÎÈÓËÙÔÔ›ËÛ˘. ™Â ÂÚ›ÙˆÛË ‰ËÌÈÔ˘ÚÁ›·˜ ·Ú·ÛÔÓ‰˘ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜, Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ˜ ÌfiÓÔ ÂÊ’ fiÛÔÓ Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË ÌÈÎÚԂȷ΋ ıÂÚ·›·. ∂›Û˘, Â¿Ó Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Â›Ó·È ·Ó·Áη›·, ÌfiÓÔ Ë ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ Â›Ó·È ·ÚÎÂÙ‹ (Joughin Î·È Û˘Ó, 1991). ∂¿Ó fï˜ Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ ηı·ÚÈÛÌfi˜ Â›Ó·È ÂÎÙÂٷ̤ÓÔ˜, ÙfiÙÂ Â›Ó·È ··Ú·›ÙËÙË Î·È Ë ÂÚÈÔÚÈṲ̂ÓË

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∂ÈÎfiÓ· 4. O‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ ÔÛÊ˘˚΋˜ ÌÔ›Ú·˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÛÙËÓ ÔÔ›· Ê·›ÓÂÙ·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ O3-O4 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Ì ‰ËÌÈÔ˘ÚÁ›· ÚÔÛÔÓ‰˘ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ 6 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¤ÓÙÔÓ˘ ÔÛÊ˘·ÏÁ›·˜.

ÚfiÛıÈ· ÛÔÓ‰˘ÏÔ‰ÂÛ›· (28). Ÿˆ˜ ˘ÔÛÙËÚ›˙Ô˘Ó Ô Spiegel Î·È Û˘Ó (1972) Î·È Ô Wenger Î·È Û˘Ó (1978), Â·ÓÂÓÂÚÁÔÔ›ËÛË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Ì ˘ÔÙÚÔ‹ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ Â›¯Â Á›ÓÂÈ ·ÎÈÓËÙÔÔ›ËÛË Ù˘ ™.™. (58,68). ∂·ÎfiÏÔ˘ı· ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ 1) ™Ù¤ÓˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜. ∏ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Û˘Ó‹ıˆ˜ ·Ú·Ì¤ÓÂÈ, ·ÏÏ¿ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÚÈ΋ ·ÔηٿÛÙ·ÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ‰›ÛÎÔ˘. OÈ Kwang Soon Song Î·È Û˘Ó (1997) ‚Ú‹Î·Ó ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Û ÚfiÛÊ·ÙË ·Ú·ÎÔÏÔ‡ıËÛË, ÂÓÒ Û ·ÛıÂÓ›˜ Ì ·Ú·ÎÔÏÔ‡ıËÛË ¤Ú·Ó Ù˘ ËÏÈΛ·˜ ÔÛÙÈ΋˜ ˆÚ›Ì·ÓÛ˘ ·Ú·ÙËÚ‹ıËÎÂ Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ (61). OÈ Ring Î·È Û˘Ó (1994, 1995) Î·È Wenger Î·È Û˘Ó (1978) ·Ú·Ù‹-

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ÚËÛ·Ó ‰È·ÊfiÚÔ˘ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ fi¯È Ï‹ÚË ·ÔηٿÛÙ·ÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ (47,48,58). ∏ ÛÙ¤ÓˆÛË Î·È, ÙÂÏÈο, Ë ·ÒÏÂÈ· ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÔÊ›ÏÂÙ·È ÛÙË ¯ÔÓ‰ÚÔÏ˘ÙÈ΋ ȉÈfiÙËÙ· ÙˆÓ ÊÏÂÁÌÔÓÒÓ ÛÙȘ ·ÓÒÚÈ̘ ÛÎÂÏÂÙÈο ·ÚıÚÒÛÂȘ, Úԉȷı¤ÙÔÓÙ·˜ Û ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔ›ËÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ ηÙÂÛÙÚ·Ì̤ÓÔ˘ ‰›ÛÎÔ˘. 2) ªÂÚÈ΋ ‹ Ï‹Ú˘ Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ªÂÚÈ΋ ‹ Ï‹Ú˘ Û˘ÓÔÛÙ¤ˆÛË ÌÂٷ͇ ‰‡Ô ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ ÌÔÚ› Ó· Û˘Ì‚Â› Î·È Â›Ó·È ¿ÌÂÛ· ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ÊÏÂÁÌÔÓ‹˜. 3) °ˆÓÈ҉˘ ·Ú·ÌfiÚʈÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜. ∆Ô‡ÙÔ Û˘Ì‚·›ÓÂÈ ÂÂȉ‹ Ë ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰ÈÛΛÙȘ ÚÔÛ‚¿ÏÏÂÈ ÙÔ ÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ‰›ÛÎÔ˘ Î·È ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ. 4) ™ÎÔÏ›ˆÛË Î·È Î‡ÊˆÛË. ∂›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ÁˆÓÈÒ‰Ô˘˜ ·Ú·ÌfiÚʈÛ˘ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È Ù˘ ÌÂÚÈ΋˜ ‹ Ï‹ÚÔ˘˜ Û˘ÓÔÛÙ¤ˆÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ. 5) ªÂÁ¤Óı˘ÛË ÛÔÓ‰‡ÏÔ˘ (Vertebra Magna). ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· Û˘ÌÌÂÙÚÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ÛÒÌ·ÙÔ˜, Ô˘ Ê·›ÓÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÚÔÛıÔ›ÛıÈ· ÚÔ‚ÔÏ‹. OÈ Smith Î·È Taylor (1967) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ˘ÂÚ·Ó¿Ù˘ÍË ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙËÓ ˘ÂÚ·ÈÌ›· Ù˘ ÂÚÈÔ¯‹˜, Û˘ÓÂ›· Ù˘ ÊÏÂÁÌÔÓ‹˜ (56). ∆· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ Ù· ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ‚ÚÂı› Ó· Â›Ó·È ·Û˘Ìو̷ÙÈο ÌÂÙ¿ ·fi ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ‰ÂÓ ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ıÂÚ·›·. ™˘ÌÂÚ¿ÛÌ·Ù· ™˘ÌÂÚ·ÛÌ·ÙÈο ÌÔÚ› Ó· ϯı› fiÙÈ Ë Ê˘ÛÈ΋ ÂͤÏÈÍË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ Â›Ó·È Î·ÏÔ‹ı˘ Î·È Ë ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘. O ˘„ËÏfi˜ ‚·ıÌfi˜ ˘Ô„›·˜ Î·È Ë ÁÓÒÛË Ù˘ ÓfiÛÔ˘ ıˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË Î·È ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∂›Û˘, Ê·›ÓÂÙ·È fiÙÈ ·fi fiϘ ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, Ë ¯Ú‹ÛË Ù˘ Ì·ÁÓËÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ Û˘Ì‚¿ÏÏÂÈ Î·ıÔÚÈÛÙÈο ÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË Ù˘ ÛÔÓ‰˘ÏÔ‰ÈÛΛÙȉ·˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. An AS, Vaccaro AR, Dolinskas CA, Cotler JM, Balderston RA, Bauerle WB. Differentiation between spinal tumors and infections with magnetic resonance imaging. Spine


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1991;16:334-338. 2. Atar D, Lehman WB, Grant AD. Discitis in children. Orthop Rev 1992;21:931-933. 3. Bomfiglio M, Lange TA, Kim YM. Pyogenic vertebral osteomyelitis: Disk space infection. Clin Orthop 1973;96:234-247. 4. Boston HC, Bianco AJ, Rhodes KH. Disk space infections in children. Orthop Clin N Am 1975;6:953-964. 5. Bremner AE, Neligan GA. Benign form of acute osteitis of the spine in young children. Br Med J 1953;1:856-860. 6. Brown R, Hussain M, McHugh, Novelli V, Jones D. Discitis in young children. J Bone Joint Surg (Br) 2001;83B:106111. 7. Bunnell WA. Back pain in children. Orthop Clin N Am 1982;13:587-604. 8. Choban S, Killian JT. Evaluation of acute gait abnormalities in preschool children. J Pediatr Orthop 1990;10:74-78. 9. Correa AG, Edwards MS, Baker CJ. Vertebral osteomyelitis in children. Pediatr Infect Dis J 1993;12:228-233. 10. Coventry MB, Ghormley RK, Kernoham LW. The intervertebral disc: Its microscopic anatomy and pathology. I: Anatomy, development, and physiology. J Bone Joint Surg 1945;27A:105-112. 11. Crawford AH, Kucharzyk DW, Ruda R, Smithermann HC Jr. Discitis in children. Clin Orthop 1991;266:70-79. 12. Cushing AH. Diskitis in children. Clin Infect Dis 1993;17:1-6. 13. Du Lac P, Panuel M, Devred P, Bollini G, Padovani J. MRI of disk space infection in infants and children: report of 12 cases. Pediatr Radiol 1990;20:175-178. 14. Dupont A, Andersen H. Non-specific pyogenic spondylitis in childhood. Acta Paediatr 1956;45:361-366. 15. Edgar MA. Back pain in childhood and adolenscence. Curr Orthop 1987;1:194-208. 16. Eismont FJ, Bohlman HH, Soni PL, Golderg VM, Freehafer AA. Vertebral osteomyelitis in infants. J Bone Joint Surg 1982;64B:32-35. 17. Ferguson WR. Some observations on the circulation in fetal and infant spines. J Bone Joint Surg [Am] 1950;32:640-648. 18. Forster A, Pothamann R, Winter K, Baumann-Rath CA. Magnetic resonance imaging in non-specific discitis. Pediatr Radiol 1987;17:162-163. 19. Fischer G. Discitis. In: Sheldon Kaplan, ed. Current therapy in paediatric infectious diseases. St Louis, Missouri; 1993. p. 105-109. 20. Fischer GW, Popich GA, Sullivan DE, Mayfield G, Mazat BA, Patterson PH. Diskitis: a prospective diagnostic analysis. Paediatrics 1978;62:543-548. 21. Gabriel KR, Crawford AH. Magnetic resonance imaging in a child who had clinical sign of discitis: report of a case. J Bone Joint Surg [Am] 1988;70:938-941. 22. Garrido E, Humphreys RP, Hendrick EB, Hoffman HJ. Lumbar disc disease in children. Neurosurgery 1978;2:22-26. 23. Ghormley RK, Bickel WH, Dickson DD. Study of acute infections lesions of intervertebral disks. Southern Med J 1940;33:347-353. 24. Giokas A, Pistevos G, Pasparakis D, Papandreou N.

Paediatriki 2002;65:89-96

25.

26.

27. 28.

29.

30.

31.

32. 33.

34. 35. 36. 37. 38. 39.

40.

41. 42.

43. 44.

45. 46.

Factors influence the diagnosis in inervertebral discitis in childhood. J Bone Joint Surg 1996;78B(Suppl II and III):151. Giokas A, Nezi M, Theodoropoulos B, Pistevos G. The childhood’s back pain and spine imaging. Pediatr Radiol 1998;28:381. Crawford AH, Kucharzykitherman DW, Ruda R, Smitherman HC Jr. Diskitis in children. Clin Orthop 1991;266:70-79. Jansen BRH, Hart W, Scchreuder O. Discitis in children. Acta Orthop Scand 1993;64:33-36. Joughin E, McDougall C, Parffit C, Yohg-Hing K, KirkaldyWillis WH. Causes and clinical management of vertebral osteomyelitis in Saskatchewan. Spine 1991;16:261-264. Hassler O. The human intevertebral disc: a microangiographical study on its vascular supply at various ages. Acta Orthop Scand 1970;40:765-772. Heller RM, Szalay EA, Green NE, Horev GD, Kirchner SD. Disc space infection in children: magnetic resonance imaging. Radiol Clin N Am 1988;26:207-209. Hensinger RN. Back pain in children. In: The Pediatric Spine. Bradford DS, Hensinger RN, editors. New York: Thieme; 1985. p. 41-60. Hensinger RN. Acute back pain in children. Instr Course Lect 1995;44:111-126. Holliday PO III, Davis CH Jr, Shaffner LS. Intervertebral disc space infection in a child presenting as a psoas abscess; case report. Neurosurgery 1980;7:395-397. Jansen BRH, Hart W, Scchreuder O. Discitis in children. Acta Orthop Scand 1993;64:33-36. King HA. Back pain in children. Pediatr Clin N Am 1984;31:1083-1095. King HA. Evaluating the child with back pain. Pediatr Clin N Am 1986;33:1489-1493. King HA, Tufel D. Prospective study of back pain in children. Orthop Trans 1986;10:9-10. Lascari AD, Graham MH, MacQueen JC. Intervertebral disk infection in children. J Pediatr 1967;70:751-757. Matthews SS, Wiltse LL, Karbelnig MJ. A destructive lesion involving the intervertebral disc in children. Clin Orthop 1957;9:162-167. Menelaus MB. Discitis: an inflammation affecting the intervertebral discs in children. J Bone Joint Surg [Br] 1964;46:16-23. Nade S. Acute haematogenous Ôsteomyelitis in infancy and childhood. J Bone Joint Surg Br 1983;65B:109-119. Norris S, Erlich MG, Mckusick K. Early diagnosis of disc space infection with 67Ga in an experimental model. Clin Orthop 1979;144:293-298. Ogden JA, Lister G. The pathology of neonatal osteomyelitis. Pediatrics 1975;55:474-478. Papanicolaou N, Wilkinson RH, Emans JB, Treves S, Micheli LJ. Bone scintigraphy and radiography in young athletes with low back pain. Am J Radiol 1985;145:10391044. Payne WK III, Ogilvie JW. Back pain in children and adolescents. Pediatr Clin N Am 1996;43:899-917. Ratcliffe JF. Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its

95


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47.

48.

49.

50.

51.

52. 53. 54. 55. 56.

57.

58.

59. 60.

61.

differentiation from childhood discitis: a microanteriographic investigation. Acta Radiol 1985;26:137-143. Ring D, Johnston CE II, Wenger DR. Pyogenic infectious spondylitis in children: the convergence of discitis and vertebral osteomyelitis. J Pediatr Orthop 1995;15:652-660. Ring D, Wenger DR. Magnetic resonance-imaging scans in discitis. Sequential studies in a child who needed operative drainage: a case report. J Bone Joint Surg [Am] 1994;76:596-601. Richards, SB, McCarthy ER, Akbarnia AB. Back pain in childhood and adolescence. AAOS Instructional Course Lectures 1999;48:525-542. Ryoppy S, Jaaskelainen J, Rapola J, Alberty A. Nonspecific diskitis in children. A nonmicrobial disease? Clin Orthop 1993;297:95-99. Rudert M, Tillman B. Lymph and blood supply of the human intervertebral disc; cadaver study of corrections to discitis. Acta Orthop Scand 1993;64:37-40. Saenger EL. Spondyloarthritis in children. Amer J Roentgen 1950;64:20-31. Schmorl G, Junghanns H. The Human Spine in Health and Disease. New York: Grune & Straton; 1959. p. 198-218. Scoles PV, Quinn TP. Intervertebral discitis in the children and adolescents. Clin Orthop 1982;162:31-36. Smith AD. A benign form of osteomyelitis of the spine. JAMA 1933;100:335-337. Smith RF, Taylor TKF. Inflammatory lesions of intervertebral discs in children. J Bone Joint Surg 1967;49A:1508-1520. Sonnabend DH, Taylor TKF, Chapman GK. Inervertebral disc calcification syndromes in children and adolescents. Spine 1982;6:535-537. Spiegel PG, Kengla K, Isaacson A, Wilson JC. Intervertebral disc space inflammation in children. J Bone Joint Surg [Am] 1972;52:284-296. Sponseller PD. Evaluating the child with back pain. Am Fam Physician 1996;54:1933-1941. Szalay EA, Green NE, Heller RM, Horev G, Kirchner SG. Magnetic resonance imaging in the diagnosis of childhood discitis. J Pediatr Orthop 1987;7:164-167. Song KS, Ogden JA, Ganey T, Guidera KJ. Contiguous

96

Paediatriki 2002;65:89-96

62.

63.

64.

65. 66. 67.

68.

69.

70.

71.

72.

discitis and osteomyelitis in children. J Pediatr Orthop 1997;17:470-477. Taylor JR, Scott JE, Cribb AM, Boswoorth TR. Human intervertebral disc acid glycosaminoglycans. J Anat 1992;180:137-141. Taylor KS. Diskitis in children. In: Bradford DS, Hensinger RN, editors. The pediatric Spine. New York: Thieme; 1985. p. 63-68. Tertti MO, Salminen JJ, Paajanen HE, Terho PH, Kormano MJ. Low back pain and disc degeneration in children: A control MR imaging study. Radiology 1991;180:503-507. Thomson GH. Back pain in children. J Bone Joint Surg 1993;75A:928-938. Turner PG, Hancock PG, Green JH, Galasko CSB. Back pain in children. Spine 1989;14:812-814. Ventura N, Gonzalez E, Terricabras L, Salvador A, Cabrera M. Intervertebral discitis in children: a review of 12 cases. Int Orthop 1996;20:32-34. Wenger DR, Bobechko WP, Gilday DL. The spectrum of intervertebral disc space infection in children. J Bone Joint Surg [Am] 1978;60:100-108. Wiley AM, Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg 1959;41B:796. Whalen JL, Fitzgerald RH Jr, Morrissy RT. A histological study of acute hematogenÔus osteomyelitis following physical injury in rabbits. J Bone Joint Surg 1988;70A:1383-1392. Whalen JL, Parke WW, Mazur JM, Stauffer ES. The intrinsic vasculature of developing vertebral end plates and its nutritive significance to the intervertebral discs. J Pediatr Orthop 1985;5:403-410. Yu L, Kasser JR, O’Rourke E, Kozakewich H. Chronic recurrent multifocal osteomyelitis association with vertebra plana. J Bone Joint Surg 1989;71A:105-112.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 13-11-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-02-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. °ÎÈfiη˜ ÷ÏÎˉfiÓÔ˜ 57-59, ∞ÌÂÏfiÎËÔÈ, ∆.∫. 115 27, ∞ı‹Ó·


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AWARD-WINNING ARTICLE

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·ÛıÂÓÒÓ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ˆ˜ ÚÒÈÌÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›·* ª. π. ∏ÏÈÔÔ‡ÏÔ˘, °. ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜

The cerebrospinal fluid ‚-glucuronidase activity in patients with bacterial meningitis as an early and sensitive predictor of response to treatment* M. Eliopoulou, G. A. Syrogiannopoulos

¶ÂÚ›ÏË„Ë: ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) ·˘Í¿ÓÂÙ·È ÛÙË ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·, ·ÏÏ¿ Ë ÔÚ›· Ù˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Â›Ó·È ¿ÁÓˆÛÙË. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Î·È Ë Û‡ÁÎÚÈÛ‹ Ù˘ Ì ¿ÏϘ ΢ÙÙ·ÚÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ∂¡À. H ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ô ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Ë Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ Î·È Ô ÏfiÁÔ˜ ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Û 34 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· (ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ÂÚÈfi‰Ô˘), Û 4 ÓÂÔÁÓÈΤ˜ ÌËÓÈÁÁ›Ùȉ˜, Û 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· Î·È Û 97 Ì¿ÚÙ˘Ú˜. OÈ ·ÛıÂÓ›˜ ›¯·Ó 1 ‹ 2 Â·Ó·ÏËÙÈΤ˜ ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ. ∂›Û˘, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÙÚ‹ıËΠ۠8 ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À. ¶ÚÈÓ ÙË ıÂÚ·›·, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û ·ÛıÂÓ›˜ ‚ÚÂÊÈ΋˜ ̤¯ÚÈ ÂÊË‚È΋˜ ËÏÈΛ·˜ ‹Ù·Ó 136 nmoles 4methylumbelliferone/ml/ÒÚ· (Ì ‰È·Î‡Ì·ÓÛË 44 ¤ˆ˜ 826), ÂÓÒ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ‹Ù·Ó 14 nmoles/ml/ÒÚ· (Ì ‰È·Î‡Ì·ÓÛË 7 ¤ˆ˜ 23) (p<0,000001). ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË Û ‰Â›ÁÌ·Ù· ∂¡À, Ù· ÔÔ›· ÂÏ‹ÊıËÛ·Ó ÌÂÙ¿ ¿ÚÔ‰Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ˆÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ŒÍÈ Ì¤¯ÚÈ 12 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ›¯Â ‹‰Ë ÌÂȈı›

Abstract: ‚-Glucuronidase activity is increased in the cerebrospinal fluid (CSF) in patients with bacterial meningitis, but its course during treatment is unknown. Our objective was to investigate the ‚glucuronidase activity during treatment and compare it to other CSF parameters. The ‚glucuronidase activity, cell number, protein concentration and CSF/blood glucose ratio were measured during treatment in 34 consecutive bacterial meningitis patients beyond the neonatal period, 4 neonatal meningitis patients, 2 patients with meningococcal sepsis and 97 controls. Patients had 1 or 2 follow-up lumbar punctures. Also, the activity was measured in 8 patients with pyelonephritis and CSF pleocytosis. Before treatment, the median ‚-glucuronidase activity in the patients with bacterial meningitis beyond the neonatal period was 136 nmoles 4 methylumbelliferone/ml/hour (range 44-826), while the CSF of the controls was 14 (7-23) (p<0.000001). In all patients with clinical improvement the activity was lower in the follow-up CSF samples. Six to 12 hours after initiation of treatment, the median activity was already reduced by 59%. The other CSF parameters showed a variability during the first 24 hours of treatment independently of the course of the disease. In a patient with pneumococcal meningitis, who showed aggravation of symptoms, the ‚-glucuronidase activity was increased by 89% 22 hours after starting therapy. Also, in neonatal meningitis the ‚-glucuronidase activity before treatment was increased, however

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ¶ÂÚÈÊÂÚÂÈ·Îfi ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·ÙÚÒÓ

Department of Pediatrics, University of Patras School of Medicine, General University Hospital, Patra

*∞’ ÈڤÌÂÈÔ Œ·ıÏÔ 39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2001

*1st “Choremio” Award 39th Panhellenic Pediatric Meeting, 2001

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ηٿ 59%. ∞ÓÙÈı¤Ùˆ˜, ÔÈ ˘fiÏÔÈÔÈ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ∂¡À ¤‰ÂÈ¯Ó·Ó ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÙÈÌÒÓ ÙÔ˘˜Î·Ù¿ ÙȘ ÚÒÙ˜ 24 ÒÚ˜ Ù˘ ıÂÚ·›·˜ Ô˘ ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ™Â ¤Ó·Ó ·ÛıÂÓ‹ Ì Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ· Î·È Âȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ 22 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ·˘Í‹ıËΠηٿ 89%. ™ÙË ÓÂÔÁÓÈ΋ ÌËÓÈÁÁ›Ùȉ·, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÚÈÓ ÙË ıÂÚ·›· ‹Ù·Ó ·˘ÍË̤ÓË, ·ÏÏ¿ Ë ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘ ··ÈÙ› ·Ú·ÙÂٷ̤ÓË ÂÚ›Ô‰Ô ÂÓ˙˘ÌÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÁÈ· ¤ÁηÈÚË Ú‡ıÌÈÛË Ù˘ ıÂÚ·›·˜. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ∂¡À Â›Ó·È ·ÍÈfiÈÛÙÔ˜ ‰Â›ÎÙ˘ ‚·ÎÙËÚȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ô˘ ÌÔÚ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ, ÓˆÚ›˜ ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›·.

monitoring of the course of illness required a protracted period of enzyme measurements. In conclusion, ‚-Glucuronidase activity in the CSF is a reliable indicator of bacterial meningitis, which can identify the response to treatment early in the course of illness.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ÚÔÁÂÓÓËÙÈÎÔ›, ÓÂÔÁÓÈÎÔ›.

Key words: bacterial meningitis, follow-up, ‚glucuronidase, lysosomal enzymes, meningococcal sepsis, neonatal meningitis.

™˘ÓÙÔÌÔÁڷʛ˜ ∂¡À

∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi

∂ÈÛ·ÁˆÁ‹ ∏ ·Ó¿Ù˘ÍË ·ÓÙ›ÛÙ·Û˘ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙȘ ‚Ï·Îٿ̘ Î·È ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Û˘Ó¯Ҙ ·˘Í¿ÓÂÈ (1-6), ·Ó Î·È Û˘Ó¯Ҙ ηÈÓÔ‡ÚÈ· ·ÓÙÈ‚ÈÔÙÈο Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÙË ıÂÚ·›· ÌÈÎÚÔ‚È·ÎÒÓ ÏÔÈÌÒ͈Ó. ∞fi ÙËÓ Î·Ù·ÁÂÁÚ·Ì̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÙˆÓ ÙÚÈÒÓ ÈÔ Û˘ÓËıÈÛÌ¤ÓˆÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, Neisseria meningitidis, Haemophilus influenzae Ù‡Ô˘ b Î·È Streptococcus pneumoniae, Ë ·ÓÙ›ÛÙ·ÛË ÛÙÔÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ Â›Ó·È Ë ÈÔ ÛËÌ·ÓÙÈ΋ ÛÙ· ÂÚÈÛÛfiÙÂÚ· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘ (7-12). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ηӤӷ˜ ·ÓÙÈÌÈÎÚÔ‚È·Îfi˜ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ıˆÚËı› Ì ‚‚·ÈfiÙËÙ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜, ÚÈÓ ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¢·ÈÛıËÛ›·˜ in vitro Î·È Ù˘ ¤Î‚·Û˘ Ù˘ ÓfiÛÔ˘. ¶ÚfiÛÊ·ÙË ÌÂϤÙË ¤‰ÂÈÍ ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÂÛÛ¿ÚˆÓ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÂ Ê˘ÁÔÎÂÓÙÚË̤ÓÔ, ÂχıÂÚÔ Î˘ÙÙ¿ÚˆÓ ∂¡À, ·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· (13). ∂ȉÈο ‚Ú¤ıËΠfiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÂÍ·ÛÊ·Ï›˙ÂÈ ·ÍÈfiÈÛÙÔ ‰È·¯ˆÚÈÛÌfi ÌÂٷ͇ ·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· Î·È Ì·ÚÙ‡ÚˆÓ (13). ∂Âȉ‹ Ë ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ·Ú·Ì¤ÓÂÈ Ì›· ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ Ïԛ̈ÍË, ÌÂÏÂÙ‹Û·Ì ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À

98

·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜, ÙË Û˘ÁÎÚ›Ó·Ì Ì ¿ÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ∂¡À Î·È ÙË Û˘Û¯ÂÙ›Û·Ì Ì ÙËÓ ÎÏÈÓÈ΋ ÔÚ›· Ù˘ ÓfiÛÔ˘. ∏ ÂÚÁ·Û›· ÛÎÔ‡ÂÈ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ·Ó Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÙÔ ∂¡À ·Ú·Ì¤ÓÂÈ ‹ fi¯È ‰Â›ÎÙ˘ Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜ Î·È Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹Û·Ì 38 ÂÚÈÙÒÛÂȘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Î·È 97 Ì¿ÚÙ˘Ú˜ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ·È‰È·ÙÚÈÎfi ÙÌ‹Ì· Ù˘ ∫ÏÈÓÈ΋˜ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1995 ¤ˆ˜ ÙÔÓ πÔ‡ÓÈÔ 2000. ∞fi ÙÔ˘˜ 38 ·ÛıÂÓ›˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, 34 ‹Ù·Ó ‚Ú¤ÊË, ·È‰È¿ Î·È ¤ÊË‚ÔÈ, Ì ‰È¿ÌÂÛË ËÏÈΛ· 3,6 ¤ÙË Î·È ‰È·Î‡Ì·ÓÛË 3,5 Ì‹Ó˜ ̤¯ÚÈ 14 ¤ÙË. ∏ ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ‰È·ÁÓÒÛÙËΠ̠ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ∂¡À Û 29 ÂÚÈÙÒÛÂȘ, Ì PCR ∂¡À Û 2 ÂÚÈÙÒÛÂȘ Î·È ÌÂ Û˘ÁÎÔÏÏËÙÈÓÔ·ÓÙ›‰Ú·ÛË Latex ∂¡À Û 3 ÂÚÈÙÒÛÂȘ. ¢¤Î· ÂÓÓ¤· ÂÚÈÛÙ·ÙÈο ÔÊ›ÏÔÓÙ·Ó Û N. meningitidis, 7 Û S. pneumoniae, 7 Û H. influenzae Î·È 1 Û Streptococcus ÔÌ¿‰·˜ D. E›ÎÔÛÈ ÔÎÙÒ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ıÂÚ·‡ÙËÎ·Ó Ì Ceftriaxone Î·È 6 ÌÂ Û˘Ó‰˘·ÛÌfi AmpicillinChloramphenicol. ™Â ¤Ó·Ó ·ÛıÂÓ‹, Ô˘ ·Ú¯Èο ıÂÚ·‡ÙËΠ̠Ceftriaxone, ÚÔÛÙ¤ıËΠÛÙȘ 24 ÒÚ˜ Ù˘ ıÂÚ·›·˜ Vancomycin. ∂ÈÚfiÛıÂÙ·, ÔÈ ·ÛıÂÓ›˜ ¤Ï·‚·Ó ‰ÂÍ·ÌÂı·˙fiÓË ÁÈ· 2 Ë̤Ú˜ (14). OÈ ˘fiÏÔÈÔÈ 4 ·ÛıÂÓ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ 7, 12, 17 Î·È 29 ËÌÂÚÒÓ, Ì ÂÈÏÂÁ̤ÓË ÔÚ›· ÓfiÛÔ˘, ȉȷ›ÙÂÚ· ÙˆÓ ÓÂÔÁÓÒÓ ÙˆÓ 12 Î·È 29 ËÌÂÚÒÓ. OÈ Î·ÏÏȤÚÁÂȘ ∂¡À ¤‰ÂÈÍ·Ó ∂. coli ÛÙ· ÓÂÔÁÓ¿ ÙˆÓ 7 ËÌÂÚÒÓ (ÂÚ›ÙˆÛË 1) Î·È ÙˆÓ 12 ËÌÂÚÒÓ (ÂÚ›ÙˆÛË 2) Î·È Streptococcus agalactiae, ÔÚfiÙ˘Ô˜ III, ÛÙÔ


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·99

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

Paediatriki 2002;65:97-107

ÓÂÔÁÓfi ÙˆÓ 17 ËÌÂÚÒÓ (ÂÚ›ÙˆÛË 3). ™ÙÔ 29 ËÌÂÚÒÓ ÓÂÔÁÓfi (ÂÚ›ÙˆÛË 4), Ë Î·ÏÏȤÚÁÂÈ· Î·È ÙÔ Latex ∂¡À ‹Ù·Ó ·ÚÓËÙÈο Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ‰È¿ÁÓˆÛË ‚·Û›ÛÙËΠÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À, ȉȷ›ÙÂÚ· ‰Â ÛÙËÓ Ôχ ˘„ËÏ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ë ÔÔ›· Â›Ó·È ‰È·ÁÓˆÛÙÈ΋ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (13). ∂ÈÚfiÛıÂÙ·, ÌÂÏÂÙ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ∂¡À ·fi 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›·, ¯ˆÚ›˜ ·Ú¯È΋ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À. ø˜ Ì¿ÚÙ˘Ú˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ· ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ∂¡À Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi 43 ÂÌ‡ÚÂÙÔ˘˜ ·ÛıÂÓ›˜, ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ∂¡À. ∏ ‰È¿ÌÂÛË ËÏÈΛ· ÙˆÓ Ì·ÚÙ‡ÚˆÓ ‹Ù·Ó 2 ¤ÙË, Ì ‰È·Î‡Ì·ÓÛË 1,1 Ì‹Ó˜ ¤ˆ˜ 15 ¯ÚfiÓÈ·. ∂ÈÚfiÛıÂÙ·, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘Ú˜, ÁÈ· ÙȘ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, 54 ÓÂÔÁÓ¿ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ∂¡À. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ Ì·ÚÙ‡ÚˆÓ-ÓÂÔÁÓÒÓ ‹Ù·Ó 16 Ë̤Ú˜, Ì ‰È·Î‡Ì·ÓÛË 1 ¤ˆ˜ 30 Ë̤Ú˜. ∞fi ÙȘ 34 ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁ›Ùȉ·˜ Û ·ÛıÂÓ›˜ ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÙˆÓ 3,5 ÌËÓÒÓ, 18 ›¯·Ó Ì›· Â·Ó·ÏËÙÈ΋ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Î·È ÔÈ ˘fiÏÔÈ˜ 16 ›¯·Ó ‰‡Ô Â·Ó·ÏËÙÈΤ˜ ·Ú·ÎÂÓÙ‹ÛÂȘ. ŒÓ· ̤ÚÔ˜ ÙÔ˘ ∂¡À ˘Ô‚¿ÏÏÔÓÙ·Ó ÛÂ Ê˘ÁÔΤÓÙÚËÛË Ì¤Û· Û 20 min Î·È ÙÔ ˘ÂÚΛÌÂÓÔ - ÂχıÂÚÔ Î˘ÙÙ¿ÚˆÓ - ˘ÁÚfi ·Ó·Ï˘fiÙ·Ó ¿ÌÂÛ· ‹ ·ÔıË΢fiÙ·Ó ÛÙÔ˘˜ -70ÔC ̤¯ÚÈ Ó· ·Ó·Ï˘ı›. ªÂÙÚ‹ÛÂȘ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙ· ·ÔıËÎÂ˘Ì¤Ó· ‰Â›ÁÌ·Ù· ∂¡À ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ú¤ÌÂÓ ÛÙ·ıÂÚ‹ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 6 Ì‹Ó˜. ∂›Û˘, ÌÂÏÂÙ‹ıËÎ·Ó 8 ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À. ∞fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜, Û 6 Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó ÙÔ ∂. coli, Û 1 Staphylococcus epidermidis Î·È Û 1 Klebsiella pneumoniae. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 42 Ë̤Ú˜, Ì ‰È·Î‡Ì·ÓÛË ·fi 11 Ë̤Ú˜ ¤ˆ˜ 3,5 Ì‹Ó˜. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›¯ıËΠÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙȘ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ Ô‡ÚˆÓ Î·È ÛÙÔ ÓÂÊÚÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· DMSA. OÈ Î·ÏÏȤÚÁÂȘ ∂¡À ‹Ù·Ó ·ÚÓËÙÈΤ˜. ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Î·È ÂÏ‹ÊıË Û˘ÁηٿıÂÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·ÛıÂÓÒÓ. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÙÚ‹ıËΠÂȘ ‰ÈÏÔ‡Ó, fiˆ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› (14). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ-

˙‡ÌÔ˘ ÂÎÊÚ¿ÛÙËΠ۠nmoles 4-methylumbelliferone/ml ∂¡À/ÒÚ·. ∆· ‰Â‰Ô̤ӷ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ‰È¿ÌÂÛË ÙÈÌ‹ Î·È ‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ. °È· ÙȘ Û˘ÁÎÚ›ÛÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ Wilcoxon test Î·È ÙÔ Mann-Whitney U test, fiˆ˜ ÂӉ›ÎÓ˘Ù·È. ™ÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Î·È Ù˘ Ë̤ڷ˜ ˙ˆ‹˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Spearman rank correlation. ∏ ÛËÌ·ÓÙÈÎfiÙËÙ· ÂÙ¤ıË ÛÙÔ 0,05.

∞ÔÙÂϤÛÌ·Ù· ªËÓÈÁÁ›Ùȉ· ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ˆ˜ ÙËÓ ÂÊ˂›· ∏ ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙȘ 34 ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁ›Ùȉ·˜, ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ‹Ù·Ó 139, Ì ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ·fi 44 ¤ˆ˜ 826. ™ÙÔ˘˜ Ì¿ÚÙ˘Ú˜, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ‹Ù·Ó 14, Ì ‰È·Î‡Ì·ÓÛË ·fi 7 ̤¯ÚÈ 23, u=22 (p<0,000001). ™ÙÔÓ ¶›Ó·Î· 1 ηٷÁÚ¿ÊÂÙ·È Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ë Û¯¤ÛË ÁÏ˘Îfi˙˘ ∂¡À ÚÔ˜ ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ Î·È Ë Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À 10 ·ÛıÂÓÒÓ, ÚÈÓ Î·È 6 ¤ˆ˜ 12 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÈÒıËΠ۠fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∏ ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂÈÒıËΠηٿ 59%, Ì ‰È·Î‡Ì·ÓÛË ·fi 4% ¤ˆ˜ 96%. ∏ ÌÈÎÚfiÙÂÚË Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰È·Î‡Ì·ÓÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ·Ú·ÙËÚ‹ıËΠ۠‰Â›ÁÌ·Ù· 2 ·ÛıÂÓÒÓ Ô˘ ÂÏ‹ÊıËÛ·Ó Î·È ÛÙȘ ‰‡Ô ÂÚÈÙÒÛÂȘ 9 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. O ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·ÔÌÔÓÒıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜ ‹Ù·Ó H. influenzae Î·È ¡. meningitidis. ™Ù· ÚˆÈÌfiÙÂÚ· ‰Â›ÁÌ·Ù· ∂¡À Ù˘ ÌÂϤÙ˘, Ô˘ ÂÏ‹ÊıËÛ·Ó ·fi 2 ·ÛıÂÓ›˜ Ì H. influenzae Î·È ¡. meningitidis ÙËÓ 6Ë Î·È 7Ë ÒÚ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ›¯Â ‹‰Ë ÌÂȈı› ηٿ 46% Î·È 41% ·ÓÙ›ÛÙÔȯ·. ™Â 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁ›Ùȉ· ·fi S. pneumoniae, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙËÓ 8Ë Î·È 12Ë ÒÚ· ıÂÚ·›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ›¯Â ÌÂȈı› ηٿ 49% Î·È 57% ·ÓÙ›ÛÙÔȯ·. ∞ÓÙ›ıÂÙ· Ì ÙË

¶›Ó·Î·˜ 1. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 10 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 6 ¤ˆ˜ 12 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ¶·Ú¿ÌÂÙÚÔ˜ ∂¡À ‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ ∫‡ÙÙ·Ú·/mm3 °Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ ¶ÚˆÙ½ÓË (mg/dl)

¶ÚÈÓ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

ªÂÙ¿ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

™ËÌ·ÓÙÈÎfiÙËÙ· p

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

216 (71-826) 6027 (100-18000) 0,32 (0,00-0,65) 141 (40-450)

87 (36-319) 9750 (120-3000) 0,35 (0,11-0,83) 165 (40-360)

0,005 0,169 0,114 0,508

↓ 10 ↑ 8, ↓ 2 ↑ 7, ↓ 3 ↓ 6, ↑ 4

* 5 N. meningitidis, 3 H. influenzae Ù‡Ô˜ b, 2 S. pneumoniae † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

99


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·100

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

Paediatriki 2002;65:97-107

·‡ÍËÛË 1874%). ™ÙÔÓ ¶›Ó·Î· 3 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ∂¡À 10 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÙ¿ ·fi 36 ¤ˆ˜ 50 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÈÒıËΠ۠fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÛÙÔ 6% ¤ˆ˜ 34% Ù˘ ·Ú¯È΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∫·Ù¿ ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ, ·Ó Î·È Ô ‰È¿ÌÂÛÔ˜ ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ ÙÔ˘ ∂¡À ÌÂÈÒıËΠÛÙÔ 28%, ·ÚÔ˘ÛÈ¿ÛÙËΠÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ·fi ÙÔ 5% ¤ˆ˜ ÙÔ 7017% Ù˘ ·Ú¯È΋˜ ÙÈÌ‹˜. ∆· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À ·fi 16 ·ÛıÂÓ›˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó 3 ¤ˆ˜ 8 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂÚ·›·˜ ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ¤‰ÂÈÍ·Ó ‚ÂÏÙ›ˆÛË Û¯Â‰fiÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∆Ô ™¯‹Ì· 1 ‰Â›¯ÓÂÈ ÙËÓ ÔÚ›· Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û 34 ·ÛıÂÓ›˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 8 ËÌÂÚÒÓ ıÂÚ·›·˜. ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· ™Â 2 ·ÛıÂÓ›˜ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›·, ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ‹Ù·Ó ·˘ÍË̤ÓË ÛÙ· 97 Î·È 62 ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó 2/mm3

‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÙˆÓ 10 ·ÛıÂÓÒÓ ·˘Í‹ıËΠÛÙÔ 161% ÙÔ˘ ·Ú¯ÈÎÔ‡ ·ÚÈıÌÔ‡ (̤ÁÈÛÙË ·‡ÍËÛË 373%). ∂›Û˘, Ô ·ÚÈıÌfi˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÎÔÏÔ‡ıËÛ ·Ú¿ÏÏËÏË ÔÚ›· (‰È¿ÌÂÛË ·‡ÍËÛË 166%, ̤ÁÈÛÙË ·‡ÍËÛË 376%). ™ÙÔÓ ¶›Ó·Î· 2 ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ›‰È˜ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ∂¡À ·fi 13 ·ÛıÂÓ›˜ Ô˘ ·¿ÓÙËÛ·Ó ÛÙË ıÂÚ·›·, 13 ¤ˆ˜ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÈÒıËÎÂ. ∏ ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ‹Ù·Ó ÛÙÔ 47% Ù˘ ·Ú¯È΋˜ ÙÈÌ‹˜, Ì ‰È·Î‡Ì·ÓÛË ·fi 28% ¤ˆ˜ 82%. ∏ ÌÂÁ·Ï‡ÙÂÚË Ì›ˆÛË ·Ú·ÙËÚ‹ıËΠ۠·ÛıÂÓ‹ Ì Ïԛ̈ÍË ·fi Streptococcus oÌ¿‰·˜ D Î·È Ë ÌÈÎÚfiÙÂÚË Û ·ÛıÂÓ‹ Ì S. pneumoniae, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙËÓ 16Ë Î·È 24Ë ÒÚ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ·ÓÙ›ÛÙÔȯ·. ∫·È ¿ÏÈ, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ∂¡À ‹Ù·Ó ·˘ÍË̤ÓË ÛÙÔ 188% ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÚÔ Ù˘ ıÂÚ·›·˜, Ì ·ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙË ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ (̤ÁÈÛÙË ·‡ÍËÛË 1405%). O ·ÚÈıÌfi˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÎÔÏÔ‡ıËÛÂ Î·È ¿ÏÈ ·Ú¿ÏÏËÏË ÔÚ›· Ì ·˘Ù‹ ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ (‰È¿ÌÂÛË ·‡ÍËÛË 180%, ̤ÁÈÛÙË

¶›Ó·Î·˜ 2. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È ·Ó·ÏÔÁ›· ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 13 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 13 ¤ˆ˜ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ¶·Ú¿ÌÂÙÚÔ˜ ∂¡À ‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ ∫‡ÙÙ·Ú·/mm3 °Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ ¶ÚˆÙ½ÓË (mg/dl)

¶ÚÈÓ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

ªÂÙ¿ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

™ËÌ·ÓÙÈÎfiÙËÙ· p

112 (57-750) 3620 (29-1700) 0,40 (0,00-0,62) 120 (25-752)

53 (25-303) 6800 (290-20500) 0,49 (0,29-1,09) 70 (8-160)

0,001 0,173 0,055 0,017

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ ↓ ↑ ↑ ↓

13 8, ↓ 5 8, ↓ 5 10, ↑ 3

* 8 N. meningitidis, 3 H. influenzae Ù‡Ô˜ b, 1 S. pneumoniae, 1 Streptococcus ÔÌ¿‰· D † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

¶›Ó·Î·˜ 3. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 10 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 36 ¤ˆ˜ 50 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ¶·Ú¿ÌÂÙÚÔ˜ ∂¡À ‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ ∫‡ÙÙ·Ú·/mm3 °Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ ¶ÚˆÙ½ÓË (mg/dl)

¶ÚÈÓ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

ªÂÙ¿ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

™ËÌ·ÓÙÈÎfiÙËÙ· p

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

138 (89-750) 2620 (56-10975) 0,22 (0,00-0,65) 197 (25-560)

31 (20-153) 725 (142-4930) 0,60 (0,32-0,70) 55 (35-180)

0,005 0,093 0,005 0,013

↓ 10 ↓ 7, ↑ 3 ↑ 10 ↓ 9, ↑ 1

*5 N. meningitidis, 4 H. influenzae Ù‡Ô˘ b, 1 S. pneumoniae † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

100


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·101

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

Paediatriki 2002;65:97-107

Û ·ÁˆÁ‹ Ì Ceftriaxone Î·È ‰ÂÍ·ÌÂı·˙fiÓË. OÈ Î·ÏÏȤÚÁÂȘ ∂¡À Î·È ·›Ì·ÙÔ˜ ·Ó¤‰ÂÈÍ·Ó S. pneumoniae, ÔÚÔÙ‡Ô˘ 14, Ì ÂÏ¿¯ÈÛÙË ·Ó·ÛÙ·ÏÙÈ΋ Û˘ÁΤÓÙÚˆÛË Ceftriaxone 0,032 Ìg/ml. ªÂÙ¿ ·fi 22 ÒÚ˜ ıÂÚ·›·˜, Ô ·ÛıÂ��‹˜ Û˘Ó¤¯ÈÛ ӷ ¤¯ÂÈ ˘„ËÏfi ˘ÚÂÙfi, ÂÓÒ ÂÈÚfiÛıÂÙ· ·ÚÔ˘Û›·Û ·˘Í·ÓfiÌÂÓË ˘ÓËÏ›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ·˘¯ÂÓÈ΋ ‰˘Ûη̄›·, ηÙÒÙÂÚÔ ÛËÌÂ›Ô Brudzinski Î·È ÛËÌÂ›Ô ÙÚ›Ô‰Ô˜. ∫·Ù¿ ÙÔ ¯ÚfiÓÔ ·˘Ùfi, ¤ÁÈÓ ‰Â‡ÙÂÚË ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË, Ô˘ ·Ó¤‰ÂÈÍ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·‡ÍËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘. §fiÁˆ Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÚÁ·ÛÙËÚȷ΋˜ Âȉ›ӈÛ˘ ÚÔÛÙ¤ıËΠVancomycin ÛÙÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì·. ∂›ÎÔÛÈ Ù¤ÛÛÂÚȘ ÒÚ˜ ·ÚÁfiÙÂÚ·, ÙfiÛÔ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· fiÛÔ Î·È Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, Û ÙÚ›ÙÔ ‰Â›ÁÌ·

Î·È 0, ·ÓÙ›ÛÙÔȯ·. ∂›Û˘, Ë Û˘ÁΤÓÙÚˆÛË Ù˘ ÚˆÙ½Ó˘ ‹Ù·Ó 10 mg/dl Î·È 22 mg/dl Î·È Ë Û¯¤ÛË ÁÏ˘Îfi˙Ë ∂¡À/ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ ‹Ù·Ó 0,57 Î·È 0,44 ·ÓÙ›ÛÙÔȯ·. ™ÙÔÓ ÚÒÙÔ ·ÛıÂÓ‹, ÛÙÔÓ ÔÔ›Ô ¤ÁÈÓ·Ó ‰‡Ô Â·Ó·ÏËÙÈΤ˜ ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ 24 Î·È 72 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ›¯Â ÂÏ·ÙÙˆı› ÛÙ· 77 Î·È 34, ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Â›¯Â ·˘ÍËı› ÛÙ· 156/mm3 Î·È 40/mm3 ·ÓÙ›ÛÙÔȯ·. ªËÓÈÁÁ›Ùȉ· ·fi Ó¢ÌÔÓÈfiÎÔÎÎÔ Ì ·ÓÂ·Ú΋ ·¿ÓÙËÛË ÛÙËÓ ·Ú¯È΋ ıÂÚ·›· ∞ÁfiÚÈ 2 ÂÙÒÓ, 12 ÒÚ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ·ÚÔ˘Û›·Û ˘„ËÏfi ˘ÚÂÙfi Ì ڛÁÔ˜, ÂÌÂÙfi, ˘ÓËÏ›·, Ù·¯‡ÓÔÈ· Î·È ÙÂÏÈ΋ ·˘¯ÂÓÈ΋ ‰˘Ûη̄›·, ¯ˆÚ›˜ ¿ÏÏ· ÂÈÚfiÛıÂÙ· ÌËÓÈÁÁÈο ÛËÌ›·. ¢È·ÁÓÒÛÙËΠÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· Î·È Ô ·ÛıÂÓ‹˜ ¿Ú¯È-

¶›Ó·Î·˜ 4. ¢Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 16 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·* ÚÈÓ Î·È 3 ¤ˆ˜ 8 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ ¶·Ú¿ÌÂÙÚÔ˜ ∂¡À ‚-°Ï˘ÎÔ˘ÚÔÓȉ¿Ûˆ ∫‡ÙÙ·Ú·/mm3 °Ï˘Îfi˙Ë ∂¡À/·›Ì·ÙÔ˜ ¶ÚˆÙ½ÓË (mg/dl)

¶ÚÈÓ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

ªÂÙ¿ ¢È¿ÌÂÛË (‰È·Î‡Ì·ÓÛË)

™ËÌ·ÓÙÈÎfiÙËÙ· p

∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ

134 (44-826) 4,26 (0,87-18,00) 0,33 (0,00-0,62) 217 (45-450)

18 (10-67) 0,08 (0,03-0,64) 0,71 (0,29-0,81) 35 (8-63)

0,0004 0,0004 0,0012 0,0009

↓ 16 ↓ 16 ↑ 15, ↓ 1 ↓ 15, ↑ 1

* 12 N. meningitidis, 2 S. pneumoniae, 1 H. influenzae, 1 Streptococcus ÔÌ¿‰·˜ D † nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

¢Ú·ÛÙËÚÈfiÙËÙ· Î·È ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ (%)

1908

494

2000

‚-°Ï˘ÎÔ˘ÚÔÓȉ¿ÛË 313 238

K‡ÙÙ·Ú·

150

100 (1) (1) (4) 50

(4)

(2)

(1) (2) (1) (2)(1) (4) (1)

(1)

(1)

0 0

10

20

(1)

(2)

30

40

(4)

(1)

(1)

50

(1) 60

70

(6)

(6)

(1)

96 120 144 168 192

XÚfiÓÔ˜ ·Ô ¤Ó·ÚÍË ıÂÚ·›·˜ (ÒÚ˜) ™¯‹Ì· 1. ¶ÔÛÔÛÙfi Ù˘ ÚÔ ıÂÚ·›·˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û 34 ·ÛıÂÓ›˜ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·, ηٿ ÙȘ ÚÒÙ˜ 8 Ë̤Ú˜ Ù˘ ıÂÚ·›·˜. ∂ÓÙfi˜ ·ÚÂÓı¤Ûˆ˜, Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î¿ı ÊÔÚ¿.

101


14-05-03

12:25

™ÂÏ›‰·102

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

Paediatriki 2002;65:97-107

∂¡À, ¤‰ÂÈÍ·Ó ÌÂÁ¿ÏË ‚ÂÏÙ›ˆÛË (™¯‹Ì· 2). ∏ Û˘ÁΤÓÙÚˆÛË Ù˘ Ceftriaxone ÛÙÔ ‰Â‡ÙÂÚÔ Î·È ÙÚ›ÙÔ ‰Â›ÁÌ· ∂¡À ‹Ù·Ó 12,5 Ìg/ml Î·È 30 Ìg/ml ·ÓÙ›ÛÙÔȯ·. ¡ÂÔÁÓÈ΋ ÌËÓÈÁÁ›Ùȉ· ™Ù· 54 ÓÂÔÁÓ¿-Ì¿ÚÙ˘Ú˜, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó 15, Ì ‰È·Î‡Ì·ÓÛË 5 ¤ˆ˜ 27. ™Ù· 4 ÓÂÔÁÓ¿ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, Ë ‰È¿ÌÂÛË ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ‹Ù·Ó 1105 Ì ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ·fi 369 ¤ˆ˜ 3988. ™Ù· ÓÂÔÁÓ¿ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ‰ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À Î·È Ù˘ Ë̤ڷ˜ ˙ˆ‹˜. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ·Ú·ÙËÚ‹ıËΠ·Ú¯Èο Ù·¯Â›· Ì›ˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À, Ë ÔÔ›· ·ÎÔÏÔ˘ıÔ‡Û ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ŸÌˆ˜, Ë ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÔÚ›· ‰È¤ÊÂÚ ԢÛÈ·ÛÙÈο ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ Î·È Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ··Ú·›ÙËÙ˜ Û˘¯Ó¤˜ ·ÏÏ·Á¤˜ Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Ì ·ÓÙÈ‚ÈÔÙÈο, ÒÛÙ ӷ

§Â‡ÎˆÌ· 240

0.2 0.0

200 20000

‚-°Ï˘ÎÔ˘ÚÔÓȉ¿ÛË

§Â‡ÎˆÌ· (mg/dl)

280

°Ï˘Îfi˙Ë

0.4

800 ‚-°Ï˘ÎÔ˘ÚÔÓȉ¿ÛË

15000

600 K‡ÙÙ·Ú·

10000

400

5000 200 100

AÚ. K˘ÙÙ¿ÚˆÓ/mm3

°Ï˘Îfi˙Ë ENY/·›Ì·

0.6

500

39 £ÂÚÌÔÎÚ·Û›· OC

MARCH-APRIL 2002

38 37 36 0

Ctr 100 mg/kg

1

2

+ Van 60 mg/kg

3

4

5

6

7

8

9

ŒÍÔ‰Ô˜ 12Ë Ì¤Ú·

™¯‹Ì· 2. £ÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ (nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·), ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È ÏfiÁÔ˜ ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û ·ÛıÂÓ‹ Ì ÌËÓÈÁÁ›Ùȉ· ·fi S.pneumoniae Î·È ·ÓÂ·Ú΋ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·Ú¯È΋ ıÂÚ·›·. [Ctr: ceftriaxone, Vnm: vancomycin]

102

·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ˘ÔÙÚÔ¤˜ Ù˘ ÓfiÛÔ˘ ‹ Â·Ó·ÌÔχÓÛÂȘ. ™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙËÓ 5Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘, fiÙ·Ó Ô ·ÛıÂÓ‹˜ ‰ÈÂÎÔÌ›ÛıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜, ‹Ù·Ó 1152 Î·È 529 ÛÙÔ ÎÔÈÏÈ·Îfi Î·È Ú·¯È·›Ô ∂¡À ·ÓÙ›ÛÙÔȯ· (Û¯¤ÛË ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÂÓ˙‡ÌÔ˘ ÛÙÔ ÎÔÈÏÈ·Îfi/Ú·¯È·›Ô ∂¡À 2,18). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·ÎÔÏÔ‡ıËÛ ηıÔ‰È΋ ÔÚ›· Î·È ÙËÓ 23Ë Ì¤Ú· ıÂÚ·›·˜ ÛÙÔ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ ‹Ù·Ó ÛÙÔ 86. ∆ËÓ Ë̤ڷ ·˘Ù‹ ·ÓÙÈηٷÛÙ¿ıËÎÂ Ë ‰ÂÍ·ÌÂÓ‹ Omaya, ·ÔÙ¤ÏÂÛÌ· Ù˘ ÔÔ›·˜ ‹Ù·Ó Ë Â·Ó·ÌfiÏ˘ÓÛË, Ë ÔÔ›· ÈÛÙÔÔÈ‹ıËΠ·fi ÙËÓ ·‡ÍËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û 154. ∆Ô ıÂÚ·¢ÙÈÎfi Û¯‹Ì· ¿ÏÏ·ÍÂ Î·È Ô ·ÛıÂÓ‹˜ ·Ó¿ÚÚˆÛ Ï‹Úˆ˜ (™¯‹Ì· 3∞). ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ô ·ÛıÂÓ‹˜ ‰ÈÂÎÔÌ›ÛıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ·fi ¿ÏÏÔ ÓÔÛÔÎÔÌÂ›Ô ÙËÓ 4Ë Ë̤ڷ Ù˘ ÓfiÛÔ˘. ∏ ·Ú¯Èο Ù·¯Â›· ÙÒÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ·ÎÔÏÔ˘ı‹ıËΠ·fi ˘ÔÙÚÔ¤˜ Ô˘ ÛËÌÂÈÒıËÎ·Ó ÙËÓ 23Ë Î·È ÙËÓ 58Ë Ë̤ڷ. ∏ ÌËÓÈÁÁÈ΋ ÊÏÂÁÌÔÓ‹ Ô˘ ÂÌÊ·Ó›ÛÙËΠÙËÓ 58Ë Ë̤ڷ ıÂÚ·›·˜, Èı·ÓfiÓ Ó· ‹Ù·Ó Â·Ó·ÌfiÏ˘ÓÛË Ì¤Ûˆ Ù˘ ‰ÂÍ·ÌÂÓ‹˜ Omaya, Ë ÔÔ›· ›¯Â ÙÔÔıÂÙËı›. OÈ Û˘Ó‰˘·ÛÌÔ› ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ¯ÔÚËÁ‹ıËηÓ, Ú˘ıÌ›ÛÙËÎ·Ó ‚¿ÛÂÈ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Ô˘ ÌÂÙÚÈfiÙ·Ó ÛÙÔ Ú·¯È·›Ô Î·È ÎÔÈÏÈ·Îfi ∂¡À (™¯‹Ì· 3µ). ∏ Û¯¤ÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ Î·È ÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ˘·Ú·¯ÓÔÂȉԇ˜ ¯ÒÚÔ˘ ÙË 10Ë, 13Ë, 15Ë, 17Ë, 20Ë, 23Ë, 41Ë, 59Ë, 64Ë Î·È 72Ë Ë̤ڷ ‹Ù·Ó 3,59, 4,00, 2,48, 1,36, 1,00, 1,55, 1,08, 1,10, 0,62 Î·È 0,96 ·ÓÙ›ÛÙÔȯ·. ™ÙËÓ ÙÚ›ÙË ÂÚ›ÙˆÛË, Ë Ù·¯Â›· ÙÒÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙȘ ÚÒÙ˜ 24 ÒÚ˜ ·ÎÔÏÔ˘ı‹ıËΠ·fi ¤Ó·Ó ·ÚÁfi Ú˘ıÌfi Ì›ˆÛ˘ ÙÔ˘ ÂÓ˙‡ÌÔ˘, ÙȘ ÂfiÌÂÓ˜ 4 Ë̤Ú˜ ıÂÚ·›·˜. ∆ËÓ 5Ë Ë̤ڷ ÚÔÛÙ¤ıËΠCefotaxime ÛÙËÓ ·Ú¯È΋ ·ÁˆÁ‹. ∆ËÓ 9Ë Ë̤ڷ, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË Ì¤ÙÚËÛË Î·È ÙÔ Û¯‹Ì· ·ÓÙÈ‚ÈÔÙÈÎÒÓ ¿ÏÏ·ÍÂ Î·È ¿ÏÈ. µ·ıÌÈ·›·, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â¤ÛÙÚ„ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Î·È Ë ıÂÚÌÔÎÚ·Û›· ¤ÂÛ οو ·fi ÙÔ˘˜ 37ÔC (™¯‹Ì· 3°). ™ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË, ÌÂÙ¿ ·fi Ì›· ·Ú¯Èο Ù·¯Â›· ÙÒÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ˘‹ÚÍ·Ó 2 ÚÔÊ·Ó›˜ ˘ÔÙÚÔ¤˜ Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜, ÙËÓ 5Ë Î·È 10Ë Ë̤ڷ ıÂÚ·›·˜, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ÚÒÈ̘ ·ÏÏ·Á¤˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ. ∏ ·‡ÍËÛË Ù˘ ıÂÚÌÔÎÚ·Û›·˜ ÙËÓ 36Ë Ë̤ڷ Û˘Ó¤ÂÛ ¯ÚÔÓÈο Ì ‰È·Ê˘Á‹ ∂¡À ·fi ÙË ‰ÂÍ·ÌÂÓ‹ Omaya Î·È ÙËÓ ·ÓÙÈηٿÛÙ·Û‹


™ÂÏ›‰·103

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

Paediatriki 2002;65:97-107

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0

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™¯‹Ì· 3. £ÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ (nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·), ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ ÛÙÔ ∂¡À Î·È ÏfiÁÔ˜ ÁÏ˘Îfi˙˘ ∂¡À/·›Ì·ÙÔ˜ Û 3 ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ (A, ° Î·È ¢), ηıÒ˜ Î·È ıÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘, ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Û ڷ¯È·›Ô Î·È ÎÔÈÏÈ·Îfi ∂¡À Û ÓÂÔÁÓfi Ì ÌËÓÈÁÁ›Ùȉ· (B). [Amk: amikacin, Amp: ampicillin, Azc: azactam, Cfp: cefepime, Ctr: ceftriaxone, Ctx: cefotaxime, Cfz: ceftazidime, Cpf: ciprofloxacin, Ntm: netromycin, Mrp: meropenem, Ppr: piperacilin, Rfm: rifampicin, Vnm: vancomycin]

103


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·104

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

Ù˘. ¢ÂÓ ‰È·ÈÛÙÒıËΠÌËÓÈÁÁÈ΋ ÊÏÂÁÌÔÓ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ·˘ÙÔ‡ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ (™¯‹Ì· 3¢). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ Î·Ù¿ ÙȘ Ë̤Ú˜ 13, 20, 33, 36, 39, 44 Î·È 49, fiÙ·Ó ¤ÁÈÓ·Ó ÌÂÙÚ‹ÛÂȘ Î·È Û ڷ¯È·›Ô ∂¡À ·fi ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂȘ, ‹Ù·Ó 98, 43, 40, 37, 36, 32 Î·È 28 ·ÓÙ›ÛÙÔȯ·. ∏ Û¯¤ÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡/Ú·¯È·›Ô˘ ∂¡À ‹Ù·Ó 0,66, 0,29, 0,95, 0,93, 0,90, 0,71 Î·È 0,97 ·ÓÙ›ÛÙÔȯ·. ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Â¤˙ËÛ·Ó. ∫ÔÈÏÈÔÂÚÈÙÔÓ·˚΋ ·ÚÔ¯¤Ù¢ÛË ÙÔÔıÂÙ‹ıËΠÛÙË ‰Â‡ÙÂÚË Î·È ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË. OÈ ÂÚÈÙÒÛÂȘ 1, 3 Î·È 4 ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË, ¯ˆÚ›˜ ηӤӷ Ó¢ÚÔÏÔÁÈÎfi ˘fiÏÂÈÌÌ·. ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, ÛÙËÓ ËÏÈΛ· ÙˆÓ 18 ÌËÓÒÓ, fiÙ·Ó ÂÍÂÙ¿ÛÙËΠÁÈ· ÙÂÏÂ˘Ù·›· ÊÔÚ¿, Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ‹Ù·Ó ÌÂٷ͇ 12 ¤ˆ˜ 14 ÌËÓÒÓ. ¶ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À ÔÊÂÈÏfiÌÂÓË Û ԢÚÔÏԛ̈ÍË ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó 43, Ì ‰È·Î‡Ì·ÓÛË ·fi 32 ¤ˆ˜ 53. ∞˘Ù‹ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ·’ fiÙÈ ÛÙ· ÓÂÔÁÓ¿-Ì¿ÚÙ˘Ú˜ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À (u=344, p=0,000008), ηıÒ˜ Â›Û˘ Î·È ·’ fiÙÈ ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ì ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÓÂÔÁÓÈ΋˜ (u=432, p=0,000005). ŸÌˆ˜, Ë ÂÓ˙˘ÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Û ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Â›Ó·È ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË Î·È ·fi ÂΛÓË ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ· (u=269, p=0,00002). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ·, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó 70/mm3, Ì ‰È·Î‡Ì·ÓÛË ·fi 13 ¤ˆ˜ 300/mm3, Ë ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ Û¯¤Û˘ Ù˘ ÁÏ˘Îfi˙˘ ∂¡À/ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ ‹Ù·Ó 0,54, Ì ‰È·Î‡Ì·ÓÛË 0,41 ¤ˆ˜ 0,70 Î·È Ë ‰È¿ÌÂÛË ÙÈÌ‹ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ÚˆÙ½Ó˘ ‹Ù·Ó 43, Ì ‰È·Î‡Ì·ÓÛË ·fi 35 mg/dl ¤ˆ˜ 70 mg/dl. ™˘˙‹ÙËÛË ∆· ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ ÂȂ‚·ÈÒÓÔ˘Ó ÚÔËÁÔ‡ÌÂÓË ‰ËÌÔÛ›Â˘ÛË, Ë ÔÔ›· ¤‰ÂȯÓ fiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Â›Ó·È ·˘ÍË̤ÓË ÛÙÔ ∂¡À ·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ÂÊ›¢ÛË ÙÈÌÒÓ ÌÂٷ͇ ·ÛıÂÓÒÓ Î·È Ì·ÚÙ‡ÚˆÓ (13). ∂ÈϤÔÓ, Ù· Â˘Ú‹Ì·Ù· ÂÂÎÙ›ÓÔ˘Ó ÙË ‰È·ÁÓˆÛÙÈ΋ ‰‡Ó·ÌË Ù˘ ÌÂıfi‰Ô˘ Î·È ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. º·›ÓÂÙ·È fiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Û ·ÛıÂÓ‹ ÓÂÔÁÓ¿ ÌÔÚ› Ó· Â›Ó·È ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚË ·fi fi,ÙÈ Û ÂÚÈÙÒÛÂȘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Û ·È‰È¿ Ì ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË Ù˘ ÓÂÔÁÓÈ΋˜. ∂›Û˘, ‚Ú¤ıË-

104

Paediatriki 2002;65:97-107

ΠfiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÔÚ› Ó· Â›Ó·È ·˘ÍË̤ÓË ÛÙÔ ∂¡À ·ÎfiÌË Î·È ÚÈÓ Á›ÓÔ˘Ó ÂÌÊ·Ó›˜ ÔÈ ¿ÏϘ ÎÏ·ÛÈΤ˜ ÂÚÁ·ÛÙËÚȷΤ˜ ·Ú¿ÌÂÙÚÔÈ Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∞ÍÈÔÛËÌ›ˆÙË Â›Ó·È Ë ·Ú·Ù‹ÚËÛË fiÙÈ ˘¿Ú¯ÂÈ Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ÂÌÊ¿ÓÈÛË ÏÂÈÔ΢ÙÙ¿ÚˆÛ˘ ∂¡À, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ·ÚÎÂÙ¤˜ ÒÚ˜ ·ÚÁfiÙÂÚ·, Û ¯ÚfiÓÔ Î·Ù¿ ÙÔÓ ÔÔ›Ô, ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ¤¯ÂÈ ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÌÂÈÒÓÂÙ·È. ∏ ÛËÌ·ÓÙÈÎfiÙÂÚË ·Ú·Ù‹ÚËÛË Ù˘ ÌÂϤÙ˘ Â›Ó·È fiÙÈ Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Â›Ó·È ÚÒÈÌÔ˜ Î·È Â˘·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ Úfi‚Ï„˘ Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. º·›ÓÂÙ·È fiÙÈ Ì ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ì ·ÍÈÔÈÛÙ›· ÔÈ ·ÛıÂÓ›˜ Ô˘ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË ıÂÚ·›·, 13 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ì ·ÓÙÈ‚ÈÔÙÈο Î·È Èı·ÓfiÓ ·ÎfiÌ· ÓˆÚ›ÙÂÚ·. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒıËÎÂ Î·È ÛÙÔ˘˜ 10 ·ÛıÂÓ›˜ Ô˘ Â·ÓÂÎÙÈÌ‹ıËÎ·Ó 6 ¤ˆ˜ 12 ÒÚ˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ·ÏÏ¿ Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ı· Ú¤ÂÈ Ó· ·˘ÍËı›, ÁÈ· Ó· ÛÙ·ıÌÈÛÙ› Ë ·ÍÈÔÈÛÙ›· ÙˆÓ ÌÂÙÚ‹ÛˆÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÚԂϤÂÙ·È Ë ÎÏÈÓÈ΋ ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘ Û ÙfiÛÔ ÚÒÈÌÔ ¯ÚfiÓÔ. ∂›Ó·È Èı·Ófi fiÙÈ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ÂÚÈÛÙ·ÙÈο ·ÛıÂÓÒÓ Ô˘ ‰ÂÓ ı· ‰Â›ÍÔ˘Ó Ì›ˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÂÙ¿ ·fi 6 ¤ˆ˜ 12 ÒÚ˜ ıÂÚ·›·˜. ™Â ¤Ó·Ó ·ÛıÂÓ‹ Ì ÌËÓÈÁÁ›Ùȉ· ·fi ∏. Influenzae Ù‡Ô˘ b, Ô˘ ÌÂÏÂÙ‹ıËΠ9 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‹Ù·Ó ÌÂȈ̤ÓË ÌfiÓÔ Î·Ù¿ 4% ·fi ÙËÓ ·Ú¯È΋ ÙÈÌ‹. øÛÙfiÛÔ, ÛÙÔ˘˜ ÂÓ·ÔÌ›ӷÓÙ˜ 9 ·ÛıÂÓ›˜, Ë ÔÚ›· Ù˘ ÓfiÛÔ˘ ÌÔÚÔ‡Û ӷ ÚÔ‚ÏÂÊı› Ì ·ÍÈÔÈÛÙ›·. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ‰Â›¯ÓÂÈ fiÙÈ Û ·ÛıÂÓ›˜ ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜, ÌÂÙ¿ ÙËÓ ¿ÚÔ‰Ô 12ÒÚÔ˘ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ Ì ·ÓÙÈ‚ÈÔÙÈο, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À Â›Ó·È ·ÍÈfiÈÛÙÔ˜ ÚÔÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì·. ∞˘Ùfi Ê¿ÓËΠÔχ ηϿ ÛÙÔÓ ·ÛıÂÓ‹ Ì ÌËÓÈÁÁ›Ùȉ· ·fi S. pneumoniae, Ô ÔÔ›Ô˜ ÂÌÊ¿ÓÈÛ ÎÏÈÓÈ΋ Âȉ›ӈÛË Î·Ù¿ ÙȘ ÚÒÙ˜ 22 ÒÚ˜ ıÂÚ·›·˜, ÂÓÒ ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ‰ÈÏ·ÛÈ¿ÛÙËÎÂ. ∂›ÎÔÛÈ Ù¤ÛÛÂÚȘ ÒÚ˜ ÌÂÙ¿ ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, Ô ·ÛıÂÓ‹˜ ÎÏÈÓÈο ‚ÂÏÙÈÒıËÎÂ Î·È Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÌÂÈÒıËΠηٿ 24% ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÙÈÌ‹. ŸÌˆ˜, ‰ÂÓ Â›Ó·È Û·Ê¤˜ ÁÈ·Ù› ÙfiÛÔ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ·, fiÛÔ Î·È Ë ÙÈÌ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔÓ


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·105

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

·ÛıÂÓ‹ ¯ÂÈÚÔÙ¤Ú„·Ó ̤۷ ÛÙȘ ÚÒÙ˜ 22 ÒÚ˜ ıÂÚ·›·˜, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Û٤ϯԘ ÙÔ˘ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ ‹Ù·Ó ¢·›ÛıËÙÔ ÛÙËÓ Ceftriaxone Î·È Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ÛÙÔ ∂¡À ‹Ù·Ó ˘„ËÏ‹. ∞ÓÙ›ıÂÙ·, ÔÈ 3 ÎÏ·ÛÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙÔ˘ ∂¡À ÁÈ· ‰È¿ÁÓˆÛË Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ÁÏ˘Îfi˙Ë Î·È ÚˆÙ½ÓË, ¤‰ÂÈÍ·Ó Ì›· ·ÍÈÔÛËÌ›ˆÙË Â˘ÌÂÙ·‚ÏËÙfiÙËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 24 ˆÚÒÓ ıÂÚ·›·˜, Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ˆ˜ ÙȘ 49 ÒÚ˜ ÁÈ· ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·˘Í‹ıËΠÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 48 ˆÚÒÓ ıÂÚ·›·˜, ·ÎfiÌË Î·È ·Ó ÔÈ ·ÛıÂÓ›˜ ıÂÚ·‡ÙËÎ·Ó ÂÈÙ˘¯Ò˜. ∏ ‚ÂÏÙ›ˆÛË fiÏˆÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ÙÔ˘ ∂¡À Ô˘ ÌÂÏÂÙ‹ıËηÓ, ·Ú·ÙËÚ‹ıËΠ·fi ÙËÓ ÙÚ›ÙË Ë̤ڷ ıÂÚ·›·˜. ∂ÓÒ ÔÈ ÚÒÈ̘ ÌÂÙÚ‹ÛÂȘ Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Â›Ó·È ¯Ú‹ÛÈ̘ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË Ù˘ ·Ú¯È΋˜ ÌËÓÈÁÁÈ΋˜ ·¿ÓÙËÛ˘ ÛÙË ıÂÚ·›·, ÔÈ fi„È̘ ÌÂÙÚ‹ÛÂȘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ˘ÚÂÙÔ‡ ‹ ¿ÏÏˆÓ Û˘Ìو̿وÓ, Ù· ÔÔ›· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ·ÚÁfiÙÂÚ· ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ∆· ÛÙÔȯ›· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¯·ÌËÏ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ·ÔÎÏ›ÂÈ ÙËÓ ·ÚÔ˘Û›· ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜, ÂÓÒ Ó¤· ·‡ÍËÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ı· Ú¤ÂÈ Ó· ·Ô‰Ôı› Û ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘. ∏ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÁÈ· ÚÒÈÌË ÂÎÙ›ÌËÛË Ù˘ ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›·, Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË ÛÙȘ ÂÚÈÙÒÛÂȘ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ô˘ ··ÈÙ›ٷÈ, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÓˆÚÈÌfiÙËÙ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙË ÌÂȈ̤ÓË ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙÔ ∂¡À, Úԉȷı¤ÙÔ˘Ó Û ıÂÚ·¢ÙÈΤ˜ ·ÔÙ˘¯›Â˜ Î·È ÛÙËÓ ·Ó¿Ù˘ÍË ÌÈÎÚԂȷ΋˜ ·ÓÙ›ÛÙ·Û˘. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿„·ÌÂ, ÌÂÙÚ‹ÛÂȘ Ù˘ ‚ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÌÔÚÔ‡Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ˘ÔÙÚÔ¤˜ ‹ Â·Ó·ÏÔÈÌÒÍÂȘ ÓˆÚ›˜ ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ Î·È ¤ÙÛÈ ‰›ÓÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó·ÚÔÛ·ÚÌÔÁ‹˜ ÙˆÓ ¯ÔÚËÁÔ‡ÌÂÓˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ, ÚÈÓ ·ÎfiÌ· ÂÌÊ·ÓÈÛÙ› Ë ÎÏÈÓÈ΋ Âȉ›ӈÛË. ∏ ¯ÚËÛÈÌfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È ·ÎfiÌ· ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÓÂÔÁÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·, ÛÙ· ÔÔ›· Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ˜, fiˆ˜ ÛÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿„·ÌÂ. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË

Paediatriki 2002;65:97-107

‰È¿ÁÓˆÛË Ù˘ ÎÔÈÏÈ›Ùȉ·˜. ™¯¤ÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ∂¡À ÚÔ˜ ÙÔ Ú·¯È·›Ô ∂¡À ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1, ‰Â›¯ÓÂÈ ˘ÂÚÔ¯‹ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ÎÔÈÏÈÒÓ (ÂÚÈÙÒÛÂȘ 1 Î·È 2), ÂÓÒ Û¯¤ÛË ÌÈÎÚfiÙÂÚË ÙÔ˘ 1 ‰Â›¯ÓÂÈ ÂÈÎÚ¿ÙËÛË ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜ (ÂÚ›ÙˆÛË 4). ∏ ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ·ÛıÂÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ· ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ‰È·Ù·Ú·¯‹˜ Ù˘ ‰È·Î›ÓËÛ˘ ÙˆÓ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ (15-17), ·˘ÙfiÏ˘Û˘ ‹ ΢ÙÙ·ÚÈÎÔ‡ ı·Ó¿ÙÔ˘, Ô˘ ÚÔÎÏ‹ıËÎ·Ó ·fi ÙË ÊÏÂÁÌÔÓ‹. ŸÏ· ·˘Ù¿ Ù· ÁÂÁÔÓfiÙ· ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ̛· ‰È·ÚÚÔ‹ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘, Ì ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ÂÓ˙‡ÌˆÓ ·˘ÙÒÓ ÛÙÔ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ˘ÁÚfi. ∂Ó·ÏÏ·ÎÙÈο, Ë ˘„ËÏ‹ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤Ó˘ ‰È¿¯˘Û˘ ÙÔ˘ ÂÓ˙‡ÌÔ˘, ÏfiÁˆ ·˘ÍË̤Ó˘ ‰È·‚·ÙfiÙËÙ·˜ ÙÔ˘ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡. O Û˘Ó‰˘·ÛÌfi˜ ÂÓ˙˘ÌÈ΋˜ ‰È·ÚÚÔ‹˜ ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È ·˘ÍË̤Ó˘ ‰È·ÂÚ·ÙfiÙËÙ·˜ ÙˆÓ ÌËÓÈÁÁÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ÊÏÂÁÌÔÓ‹˜, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë Èı·ÓfiÙÂÚË ÂÍ‹ÁËÛË Ù˘ ˘„ËÏ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∆· ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ‰È·‰Èηۛ·˜ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÚÔηÏ› Ù·¯Â›· Ì›ˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÙÔ ∂¡À, Ë ÔÔ›· Â›Ó·È ‹‰Ë ÂÌÊ·Ó‹˜ 6 ÒÚ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ∞˘Ùfi ÙÔ Â‡ÚËÌ· ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë ·˘ÍË̤ÓË ÂÓ˙˘ÌÈ΋ ‰È·ÚÚÔ‹ ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È Ë ·˘ÍË̤ÓË ÂÓ˙˘ÌÈ΋ ‰È·‚·ÙfiÙËÙ· ÙÔ˘ ·ÈÌÔÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·Ú¯›˙Ô˘Ó Ó· ‚ÂÏÙÈÒÓÔÓÙ·È ÁÚ‹ÁÔÚ· ÌÂÙ¿ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ηٷÛÙÔÏ‹˜ Ù˘ ‰È·‰Èηۛ·˜ Ù˘ ÊÏÂÁÌÔÓ‹˜. ŸÌˆ˜, Ë ÂÈÛÙÚÔÊ‹ Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· ··ÈÙ› ·ÚÎÂÙ¤˜ Ë̤Ú˜ ıÂÚ·›·˜. ∞˘Ù‹ Ë ·Ú·Ù‹ÚËÛË ı· ÌÔÚÔ‡Û ӷ ÂÊ·ÚÌÔÛÙ› ÁÈ· ÙË ‰È¿ÁÓˆÛË ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ÛÙȘ Ôԛ˜ Ë Èı·ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ıÂÙÈ΋˜ ηÏÏȤÚÁÂÈ·˜ ∂¡À Â›Ó·È ¯·ÌËÏ‹ Î·È Ë Ù˘È΋ ÂÈÎfiÓ· ÙÔ˘ ∂¡À Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ. ŒÙÛÈ, Ӥ˜ ÚÔÔÙÈΤ˜ ÁÂÓÓÈÔ‡ÓÙ·È ·fi ·˘Ù‹ ÙË ÌÂϤÙË, ÔÈ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ Èı·ÓfiÙËÙ· fiÙÈ Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À ÌÔÚ› Ó· Â›Ó·È Â›Û˘ ¯Ú‹ÛÈÌË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·ÙÂÏÒ˜ ıÂÚ·Â˘Ì¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁ›Ùȉ·˜, ηıÒ˜ Â›Û˘ ·Ú·ÌËÓÈÁÁÈÎÒÓ ‰È·˘ËÌ¤ÓˆÓ ÂÛÙÈÒÓ, fiˆ˜ ÂÈÛÎÏËÚ›‰ÈÔ˘, ˘ÔÛÎÏËÚ›‰ÈÔ˘ ‹ ÂÁÎÂÊ·ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜, ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·˜, Ì·ÛÙÔÂȉ›Ùȉ·˜, ıÚÔÌ‚ÔÊÏ‚›Ùȉ·˜ Î·È ÎÚ·Óȷ΋˜ ÔÛÙÂÔÌ˘ÂÏ›Ùȉ·˜. ∞˘Ù¤˜ ÔÈ

105


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·106

¶·È‰È·ÙÚÈ΋ 2002;65:97-107

·fi„ÂȘ ‰ÈηÈÔÏÔÁÔ‡Ó ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ù˘ ���Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À Ù¤ÙÔÈˆÓ ·ÛıÂÓÒÓ. ŒÓ· ¿ÏÏÔ ÂÚÒÙËÌ· Ô˘ ·Ó·Ê‡ÂÙ·È ·fi Ù· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜, ÙÔ ÔÔ›Ô ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ˜, Â›Ó·È Ë Èı·ÓfiÙËÙ· Û˘ÌÌÂÙÔ¯‹˜ Ù˘ ·˘ÍË̤Ó˘ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜ Û˘ÁΤÓÙÚˆÛ˘ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙË ‰È·‰Èηۛ· Ù˘ ÌËÓÈÁÁÈ΋˜ ÊÏÂÁÌÔÓ‹˜. ∞Ó Î·È ÙÔ Î·Ù¿ÏÏËÏÔ pH ÙˆÓ ÂÓ˙‡ÌˆÓ ·˘ÙÒÓ Â›Ó·È ÎÔÓÙ¿ ÛÙÔ 4,0, ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÎÊÚ¿˙ÂÙ·È Î·È Û Ԣ‰¤ÙÂÚÔ pH. ∏ ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË Ì ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À, Ë ÔÔ›· ÔÊÂÈÏfiÙ·Ó Û Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÌÂٷ͇ ·˘Ù‹˜ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À Î·È ÂΛӢ ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ·. ∞Ó Î·È Î·Ì›· ÂÊ›¢ÛË ÙÈÌÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ÙˆÓ ·ÛıÂÓÒÓ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û ¤Ó·Ó ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ‹Ù·Ó ÂÓÙfi˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÔÚ›Ô˘ Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ·. ∏ ̤ÙÚÈ· ·‡ÍËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Û ·ÛıÂÓ›˜ Ì ˘ÂÏÔÓÂÊÚ›Ùȉ· Î·È ÏÂÈÔ΢ÙÙ¿ÚˆÛË ∂¡À ‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ˆ˜ ÌË ·Ó·ÌÂÓfiÌÂÓÔ Â‡ÚËÌ·, ÁÈ·Ù› Ê·›ÓÂÙ·È Ó· ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ‹ÈÔ˘ ‚·ıÌÔ‡ ÌËÓÈÁÁÈ΋ ÊÏÂÁÌÔÓ‹, Ô˘ ˘¿Ú¯ÂÈ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ. ∏ ·ÚÔ‡Û· ÌÂϤÙË ¤¯ÂÈ ÔÚÈṲ̂ÓÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜. ¶ÚÒÙÔÓ, Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Â›Ó·È ÌÈÎÚfi˜ Î·È Û˘ÓÂÒ˜, Ù· Û¯ÂÙÈο ÛÙÔȯ›· ı· Ú¤ÂÈ Ó· ıˆÚËıÔ‡Ó ˆ˜ ÚÔηٷÚÎÙÈο. ŸÌˆ˜, ÔÈ ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ‰Â›¯ÓÔ˘Ó fiÙÈ ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ··ÈÙ› ÂÌÂÈÚ›·, ÒÛÙ ӷ Á›ÓÔ˘Ó ¤ÁηÈÚ· ÔÈ Î·Ù¿ÏÏËϘ ·Ó·ÚÔÛ·ÚÌÔÁ¤˜ ÛÙË ıÂÚ·›·. ¢Â‡ÙÂÚÔÓ, Ë ·ÔÙ˘¯›· ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ Ó· ·ÔÌÔÓÒÓÂÈ ÌÈÎÚfi‚È· ÛÙ· ‰Â›ÁÌ·Ù· ∂¡À Ô˘ ÂÏ‹ÊıËÛ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ÙˆÓ ÓÂÔÁÓÒÓ Ì ÌËÓÈÁÁ›Ùȉ·, ‰ÂÓ Â¤ÙÚ„ ÙË Û˘Û¯¤ÙÈÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ì ÙËÓ ÔÚ›· Ù˘ ·ÔÛÙ›ڈÛ˘ ÙÔ˘ ∂¡À. ∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜, Û ¤Ó· ¢ڇ Ê¿ÛÌ· ÂÚÈÙÒÛÂˆÓ ÓÂÔÁÓÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈËıÔ‡Ó. ∆Ú›ÙÔÓ, ÂÂȉ‹ Ù· ‰Â‰Ô̤ӷ Û ·ÛıÂÓ›˜ ÂÎÙfi˜ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙËÓ ·Ú¯È΋ ıÂÚ·›· ÂÚÈÔÚ›˙ÔÓÙ·È Û ¤Ó· ÌfiÓÔ ÂÚÈÛÙ·ÙÈÎfi, ¯ÚÂÈ¿˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ ·fi ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì ·ÔÙ˘¯›· ÛÙË ıÂÚ·›·. ∏ ÚÔÛ‰ÔΛ· Â›Ó·È fiÙÈ Ì ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘

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‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ Î·È ÙËÓ ¤ÁηÈÚË ÂÊ·ÚÌÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ·ÁˆÁ‹˜, ı· Â¤ÏıÂÈ Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ‚-ÁÏ˘ÎÔ˘ÚÔÓȉ¿Û˘ ÛÙÔ ∂¡À Ì·˜ ÚÔÛʤÚÂÈ ¤Ó· ̤ÛÔ, fi¯È ÌfiÓÔ ÁÈ· ‰È¿ÁÓˆÛË Ù˘ ÌÈÎÚԂȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜, ·ÏÏ¿, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ÁÈ· ÚÒÈÌË Î·È ·ÍÈfiÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ı· ıÂÚ·¢ÙÔ‡Ó ·fi Ù· ¯ÔÚËÁÔ‡ÌÂÓ· ·ÓÙÈ‚ÈÔÙÈο Î·È ÂÎÂ›ÓˆÓ ÙˆÓ ÔÔ›ˆÓ Ë ·¿ÓÙËÛË ÛÙË ıÂÚ·›· Â›Ó·È ÌË ÈηÓÔÔÈËÙÈ΋ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÂӉ›ÎÓ˘Ù·È ¿ÌÂÛË ·ÏÏ·Á‹ ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Bryan CS, John JF Jr, Pai MS, Austin TL. Gentamicin vs cefotaxime for therapy of neonatal sepsis. Relationship to drug resistance. Am J Dis Child 1985;139:1086-1089. 2. Sirot DL, Goldstein FW, Soussy CJ, Courtieu AL, Husson MO, Lemozy J et al. Resistance to cefotaxime and seven other ‚-lactams in members of the family Enterobacteriaceae: a 3-year survey in France. Antimicrob Agents Chemother 1992;36:1677-1681. 3. Kunin CM. Resistance to antimicrobial drugs - a worldwide calamity. Ann Intern Med 1993;118:557-561. 4. Legakis NJ, Tzouvelekis LS, Tsakris A, Legakis JN, Vatopoulos AC. On the incidence of antibiotic resistance among aerobic Gram-negative rods isolated in Greek hospitals. J Hosp Infect 1993;24:233-237. 5. Chen DK, McGeer A, de Azavedo JC, Low DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 1999;341:233-239. 6. Barnett ED, Klein JO. The problem of resistant bacteria for the management of acute otitis media. In: Schreiber JR, Goldmann DA, eds. Antimicrobial resistance in pediatrics. The Pediatric Clinics of North America. Philadelphia: W.B. Saunders Co; 1995;42:509-517. 7. Fenoll A, Martin Bourgon C, Munoz R, Vicioso D, Casal J. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates causing systemic infections in Spain, 1979-1989. Rev Infect Dis 1991;13:56-60. 8. Friedland IR, Klugman KP. Antibiotic-resistant pneumococcal disease in South African children. Am J Dis Child 1992;146:920-923. 9. Appelbaum PC. Antimicrobial resistance in Streptococcus pneumoniae: an overview. Clin Infect Dis 1992;15:77-83. 10. Geslin P, Buu-Hoi A, Fremaux A, Acar JF. Antimicrobial resistance in Streptococcus pneumoniae: an epidemiological survey in France, 1970-1990. Clin Infect Dis 1992;15:95-98. 11. Syrogiannopoulos GA, Grivea IN, Beratis NG, Spiliopoulou AE, Fasola EL, Bajaksouzian S et al. Resistance patterns of Streptococcus pneumoniae from carriers attending day-care centers in Southwestern


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Greece. Clin Infect Dis 1997;25:188-194. 12. Syrogiannopoulos GA, Grivea IN, Katopodis GD, Geslin P, Jacobs MR, Beratis NG. Carriage of antibiotic-resistant Streptococcus pneumoniae in Greek infants and toddlers. Eur J Clin Microbiol Infect Dis 2000;19:288-293. 13. Beratis NG, Mavrommatis T, Hatiris I, Kavaliotis J, Tsagaropoulou-Stiga H, Syrogiannopoulos GA. Increased activity of lysosomal acid hydrolases in the cell-free cerebrospinal fluid of bacterial meningitis. Pediatr Res 1997;128:806-812. 14. Syrogiannopoulos GA, Lourida AN, Theodoridou MC, Pappas IG, Babilis GC, Economidis JJ et al. Dexamethasone therapy for bacterial meningitis in children: 2- versus 4-day regimen. J Infect Dis 1994;169:853-858. 15. Erickson AH, Blobel G. Early events in the biosynthesis of the lysosomal enzyme cathepsin D. J Biol Chem

1979;254:11771-11774. 16. Rosenfeld MG, Kreibich G, Popov D, Kato K, Sabatini DD. Biosynthesis of lysosomal hydrolyses: their synthesis in bound polysomes and the role of co- and post-translational processing in determining their subcellular distribution. J Cell Biol 1982;93:135-143. 17. Proia RL, Neufeld EF. Synthesis of ‚-hexosaminidase in cell-free translation and in intact fibroblasts: an insoluble precursor alpha chain in a rare form of Tay-Sachs disease. Proc Natl Acad Sci USA 1982;79:6360-6364.

¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· π. ∏ÏÈÔÔ‡ÏÔ˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ ∆.∫. 265 00, ƒ›Ô, ¶¿ÙÚ· E-mail: nic-bera@med.upatras.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¢È·ÊÔÚÂÙÈ΋ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Û ÌÔÓÔ‡ÚËÓ· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë ÛÙÚÂÙfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ µ Ô˘ ÚÔηÏÔ‡Ó ÛË„·ÈÌ›· ‹ ÌfiÓÔ ·ÔÈÎÈÛÌfi1 ™ÎÔfi˜: O ÛÙÚÂÙfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ µ (GBS) ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ·ÚÈÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜. ™Â ÌÂÚÈο ÓÂÔÁÓ¿, Ë ÛË„·ÈÌ›· ·fi ÙÔÓ GBS ÌÔÚ› Ó· ¤¯ÂÈ ‚·ÚÈ¿ ÔÚ›·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÙÔ˘ ÛË„·ÈÌÈÎÔ‡ shock, Ì ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜, ÂÓÒ ¿ÏÏ· ÓÂÔÁÓ¿ ·ÔÈΛ˙ÔÓÙ·È Ì ÙÔÓ GBS ¯ˆÚ›˜ Ó· ÂÌÊ·Ó›˙Ô˘Ó ÎÏÈÓÈο ÛËÌ›· ‚·ÎÙËÚȷ΋˜ Ïԛ̈͢. O ÏfiÁÔ˜ ÁÈ· ÙËÓ ·ÓٛʷÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È ÍÂοı·ÚÔ˜. ÀÏÈÎfi Î·È ÌÂıÔ‰ÔÏÔÁ›·: ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ó·˙ËÙ‹Û·Ì ӷ Û˘ÁÎÚ›ÓÔ˘Ì ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙ· ÌÔÓÔ‡ÚËÓ· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛ‹ ÙÔ˘˜, Ì ÛÙÂϤ¯Ë ÙÔ˘ GBS Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›·, ηıÒ˜ Â›Û˘ ·fi ÓÂÔÁÓ¿ Ô˘ ‹Ù·Ó ÌfiÓÔ ·ÔÈÎÈṲ̂ӷ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· Ïԛ̈͢. ∆· ÌÔÓÔ‡ÚËÓ· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Âˆ¿ÛıËηÓ, ›Ù Ì ‚·ÎÙËÚ›‰È· ‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂϯÒÓ Ô˘ ·‰Ú·ÓÔÔÈ‹ıËÎ·Ó Ì ıÂÚÌfiÙËÙ·, ›Ù Ì ÏÈÔÔÏ˘Û·Î¯·Ú›‰Â˜, ·ÓÙ›ÛÙÔȯ·. ªÂÙ¿ ·fi 6 Î·È 24 ÒÚ˜, Û˘ÓÂϤÁËÛ·Ó Ù· ·ÙÙ·Ú· Î·È ¤ÁÈÓ ·Ó¿Ï˘ÛË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ mRNA ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ì PCR. ∂›Û˘, Ù· ˘ÂÚΛÌÂÓ· ·ÙÙ·Ú· ÂϤÁ¯ıËÎ·Ó Ì ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô, ÁÈ· ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ IL-6 Î·È ÙÔ˘ TNF-·. ∞ÔÙÂϤÛÌ·Ù·: ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ IL-6 Î·È ÙÔ˘ TNF-· ‰È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· Â›‰· IL6 ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi Ù· ÛË„·ÈÌÈο ÓÂÔÁÓ¿, ·’ fiÙÈ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ·ÔÈÎÈṲ̂ӷ ÓÂÔÁÓ¿ ¯ˆÚ›˜ Ïԛ̈ÍË. ∂›Û˘, Ë ¤ÎÊÚ·ÛË ÙÔ˘ mRNA, ÙˆÓ IL-6, IL-1b Î·È IL-12p40, ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ÛË„·ÈÌÈο ÓÂÔÁÓ¿. ∆· ›‰È· ·ÔÙÂϤÛÌ·-

Ù·, Â›Û˘, ‰È·ÈÛÙÒıËÎ·Ó ÛÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË Ì ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ‰È·ÊÔÚÂÙÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ÚÔηÏÔ‡Ó Ù· ÛÙÂϤ¯Ë ÙÔ˘ GBS, ›Ù ˘fi ÙË ÌÔÚÊ‹ ÛË„·ÈÌ›·˜ ›Ù ˘fi ÙË ÌÔÚÊ‹ ÌfiÓÔ ÙÔ˘ ·ÔÈÎÈÛÌÔ‡, ›Ûˆ˜ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙȘ ÂȉÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÂοÛÙÔÙ ÛÙÂϯÒÓ. ∂¿Ó ηٷÛÙ› ‰˘Ó·Ùfi˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ È‰È·›ÙÂÚˆÓ ·˘ÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÌÔÚ› ̤ۈ ÌÔÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ Ó· ‰È·ÎÚÈıÔ‡Ó Ù· ÂÈΛӉ˘Ó· ·fi Ù· ·Î›Ó‰˘Ó· ÛÙÂϤ¯Ë. ∂ÈϤÔÓ, Ù· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜ ·fi GBS.

1 Berner R, Csorba J, Brandis M Different cytokine expression in cord blood mononuclear cells after stimulation with neonatal sepsis or colonizing strains of Streptococcus agalactiae Ped Res 2001;49:691-697

™‡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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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2002;65:108-112

ORIGINAL ARTICLE

∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ÛÙ· ·È‰È¿ Ù˘ ∫Ú‹Ù˘ ™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË, ∂. °·Ï·Ó¿Î˘, £. ∆ÛÂÎÔ˘Ú¿, °. ∑·ÌÂÙ¿Î˘, ∂. ∫fiÎÔÚË

∞septic meningitis in children from Crete S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori

¶ÂÚ›ÏË„Ë: ∏ ‰È¿ÎÚÈÛË Ù˘ ¿ÛËÙ˘ ·fi ÙË ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ· Â›Ó·È ‰‡ÛÎÔÏË Ì ‚¿ÛË ÌfiÓÔ Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ™ÙËÓ ∫Ú‹ÙË ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÎÚÈ‚‹˜ ηٷÁÚ·Ê‹ ÙˆÓ ·ÈÙ›ˆÓ Ù˘ ÌËÓÈÁÁ›Ùȉ·˜ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ·˘ÙÒÓ. ªÂÏÂÙ‹ıËÎ·Ó Ù· ÂȉËÌÈÔÏÔÁÈο, Ù· ÎÏÈÓÈο Î·È Ù· ÂÚÁ·ÛÙËÚȷο ¯·Ú·ÎÙËÚÈÛÙÈο 81 ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙÔ µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ηٿ ÙË ‰ÈÂÙ›· 1999-2000. ¢È·ÈÛÙÒıËΠÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ÙÔ Î·ÏÔη›ÚÈ Î·È ÙÔ ÊıÈÓfiˆÚÔ. ∆Ô 78% ÙˆÓ ·È‰ÈÒÓ ÓÔÛËχÙËΠηٿ ÙË ‰È¿ÚÎÂÈ· 2 Î˘Ì¿ÙˆÓ. ™Â 57 ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ηÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ıÂÙÈÎfi ÛÙÔ 33% ÙˆÓ ÂÚÈÙÒÛˆÓ. OÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍ�� ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜ ·ԉ›¯ÙËΠÛÙÔ 31% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ. ªÂ ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÎÔÚ¿ÓˆÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, ÙÔ 41% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÊÂÈÏfiÙ·Ó Û ÂÓÙÂÚÔ˚Ô‡˜. ∏ ¤Î‚·ÛË ‹Ù·Ó ηϋ Û fiÏ· Ù· ·È‰È¿. ∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· Â›Ó·È Û˘¯Ó‹ ÛÙËÓ ∫Ú‹ÙË Î·È ÂÌÊ·Ó›˙ÂÈ Âԯȷ΋ ηٷÓÔÌ‹. ¶Ôχ Û˘¯Ó¿ ÔÊ›ÏÂÙ·È Û ÂÓÙÂÚÔ˚Ô‡˜. ∏ ηÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Â›Ó·È ¯Ú‹ÛÈÌË, ·ÏÏ¿ ‰ÂÓ ˆÊÂÏ› ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘.

Abstract: The differential diagnosis between bacterial and aseptic meningitis is often difficult on clinical grounds alone. The exact epidemiologic patterns of aseptic meningitis in Crete has not been investigated yet. The present study included 81 children aged 30 days to 14 years, who were hospitalized from 1/1/1999 to 31/12/2000 in the Venizelio General Hospital of Heraklion for aseptic meningitis. We studied the epidemiological, clinical and laboratory characteristics of the children. A greater incidence of the disease was observed during the summer and fall months. Sixty-three children (78%) were hospitalized during 2 clusterings. Stool specimens were collected from 57 children and enteroviruses (∂Vs) were isolated from 19 (33%). Acute phase serology was positive for EVs in 31% of the investigated patients. Results from positive cultures and/or serology showed that 41% of the cases were due to EVs. The outcome was excellent in all patients. Enteroviral meningitis is frequent in Crete, it has a seasonal distribution and constitutes a major part of the total cases of aseptic meningitis. Culture of the virus is useful, but it is not diagnostically helpful during the acute phase of the disease.

§¤ÍÂȘ ÎÏÂȉȿ: ÈÔÁÂÓ‹˜ ÌËÓÈÁÁ›Ùȉ·, ÂÓÙÂÚÔ˚Ô›, ∫Ú‹ÙË.

Key words: viral meningitis, enteroviruses, Crete.

∂ÈÛ·ÁˆÁ‹ O fiÚÔ˜ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÙˆÓ ÌËÓ›ÁÁˆÓ, ÛÙÔ ÔÔ›Ô ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È ‚·ÎÙËÚȉȷÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) (1). ∏ ̤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË ÛÙȘ ∏¶∞ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ

4,4 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌfi. ™Â ÂÚÈfi‰Ô˘˜ Ì ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘, fï˜, Ë ÂÙ‹ÛÈ· Â›ÙˆÛË ÌÔÚ› Ó· ‰ÂηÏ·ÛÈ·ÛÙ› (2). ™‡Ìʈӷ Ì ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ, ÔÈ ÂÓÙÂÚÔ˚Ô›, Ì ÂÍ·›ÚÂÛË ÙÔ˘˜ ÈÔ‡˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, Â›Ó·È ˘‡ı˘ÓÔÈ ÁÈ· ÙÔ 80%-92% fiÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙ˘

∞’ & µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

1st & 2nd Pediatric Clinic Venizelion General Hospital of Heraklion, Crete

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ÌËÓÈÁÁ›Ùȉ·˜, ÛÙȘ Ôԛ˜ ·ÔÌÔÓÒÓÂÙ·È ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (1-8). ∞ÓÙÈÛÙÚfiʈ˜, Ë ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·fi ÙȘ ÛÔ‚·Ú¤˜ ÏÔÈÌÒÍÂȘ Ô˘ ÚÔηÏÔ‡Ó ÔÈ ÂÓÙÂÚÔ˚Ô› (1,8,9). ™Ù· ‡ÎÚ·Ù· Îϛ̷ٷ, Ë ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ηٿ ÙÔ˘˜ ηÏÔηÈÚÈÓÔ‡˜ Î·È ÙÔ˘˜ ÊıÈÓÔˆÚÈÓÔ‡˜ Ì‹Ó˜ (1,4,8-11). ∏ ÌÂÙ¿‰ÔÛË ÙˆÓ ÂÓÙÂÚÔ˚ÒÓ Á›ÓÂÙ·È Î˘Ú›ˆ˜ Ì ÙËÓ ÎÔÚ·ÓÔ-ÛÙÔÌ·ÙÈ΋ Ô‰fi Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Ì ÛÙ·ÁÔÓ›‰È· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, Ì ¯ÚfiÓÔ ÂÒ·Û˘ ·fi 1 Ë̤ڷ ¤ˆ˜ 3 ‚‰ÔÌ¿‰Â˜ (Û˘Ó‹ıˆ˜ 4-6 Ë̤Ú˜). ªÂÙ¿‰ÔÛË Ù˘ Ïԛ̈͢ ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È ÌÂÙ¿ ·fi ¤ÎıÂÛË Û ÓÂÚfi Ô˘ ¤¯ÂÈ ÌÔÏ˘Óı›, fiˆ˜ ÌÔÚ› Ó· Û˘Ì‚·›ÓÂÈ Û ÈÛ›Ó˜ (1,4,7-9). ∏ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· Â›Ó·È Û˘Ó‹ıˆ˜ ·˘ÙÔ˚ÒÌÂÓË ÓfiÛÔ˜ Ì ηϋ ÚfiÁÓˆÛË (1,4,8). ªÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÈÏÔΤ˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ηٿÏÔÈ· ÌÂÙ¿ ·fi Ïԛ̈ÍË ÙÔ˘ ∫¡™ ·fi ÂÓÙÂÚÔ˚Ô‡˜ ÂÌÊ·Ó›˙Ô˘Ó Ù· ÓÂÔÁÓ¿ Î·È Ù· ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ·È‰È¿ (1,4,5,9). ∏ ‰È¿ÎÚÈÛË Ù˘ Ïԛ̈͢ ÙÔ˘ ∫¡™ ·fi ÂÓÙÂÚÔ˚Ô‡˜, ·fi ÙË Ïԛ̈ÍË Ô˘ ÚÔηÏÂ›Ù·È ·fi Û˘Ó‹ıË ‚·ÎÙËÚ›‰È· Î·È ¿ÏÏÔ˘˜ ÈÔ‡˜, Â›Ó·È Û˘¯Ó¿ ‰‡ÛÎÔÏË Ì ‚¿ÛË ÌfiÓÔ Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ ‹ Ù· ·Ú¯Èο Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À (1,3,12,13). °È· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ·fi ÙË ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ·, Ë ·Ú·ÌÔÓ‹ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Ë ÂÌÂÈÚÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÂȉÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ Â›Ó·È Û˘¯Ó¿ ··Ú·›ÙËÙË (5,8). ™ÙËÓ ·Ó·‰ÚÔÌÈ΋ ·˘Ù‹ ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›·, Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, Ô˘ ÓÔÛËχÙËÎ·Ó Û ¤Ó· °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ÛÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ‰ÈÂÙ›·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË Û˘ÌÂÚȤϷ‚ 81 ·È‰È¿ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙȘ ‰‡Ô ¶·È‰È·ÙÚÈΤ˜ ∫ÏÈÓÈΤ˜ ÙÔ˘ µÂÓÈ˙¤ÏÂÈÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ·fi 1-1-1999 ¤ˆ˜ Î·È 31-12-2000. ∆ËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ÓÔÛËχÙËÎ·Ó 8 ·È‰È¿ Ì ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ·. ™Â fiÏ· Ù· ·È‰È¿ ¤ÁÈÓ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË (O¡¶) Î·È ÂÏ‹ÊıËÛ·Ó Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜. ø˜ ÎÚÈÙ‹ÚÈ· ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ıˆڋıËÎ·Ó Ë ·ÚÔ˘Û›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 15 Ï¢ÎÔ΢ÙÙ¿ÚˆÓ/mm3 ÛÙÔ ∂¡À, ÙÔ ·ÚÓËÙÈÎfi ¿ÌÂÛÔ ·Ú·Û··ÛÌ·, Ë ·ÚÓËÙÈ΋ ‰ÔÎÈÌ·Û›· ·Ó·˙‹ÙËÛ˘ ·ÓÙÈÁfiÓˆÓ ÁÈ· ‚·ÎÙËÚ›‰È· Î·È ÔÈ ÛÙ›Ú˜ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È ∂¡À (4,14). ∏ ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ÂÚȤϷ‚ Û 57 ÂÚÈÙÒÛÂȘ ηÏÏȤÚÁÂÈ· Î·È ·Ó·Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ ÛÙÔ ∂ÏÏËÓÈÎfi πÓÛÙÈÙÔ‡ÙÔ Pasteur, ÂÓÒ ÙÔ ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÂȂ‚·ÈÒıËΠ۠fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ì ÙËÓ ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ (polymerase chain reaction, PCR). ™Â 64 ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ˙ËÙ‹ıËΠ·Ó›¯Ó¢ÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙˆÓ ÂÓÙÂÚÔ˚ÒÓ ÛÙÔÓ ÔÚfi, ÙfiÛÔ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘, fiÛÔ Î·È

Paediatriki 2002;65:108-112

ηٿ ÙË Ê¿ÛË ·Ó¿ÚÚˆÛ˘ Ì ·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô (ELISA) ÛÙÔ ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ∞ÔÙÂϤÛÌ·Ù· ÂÓ‰ÂÈÎÙÈο ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚fi ıˆڋıËÎ·Ó Â›Ù ٷ ıÂÙÈο IgM ·ÓÙÈÛÒÌ·Ù· ›ÙÂ Ô ÙÂÙÚ·Ï·ÛÈ·ÛÌfi˜ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ IgG ÛÙ· ‰‡Ô ‰Â›ÁÌ·Ù· ÔÚÔ‡ Ô˘ ÂÏ‹ÊıËÛ·Ó Ì ‰È·ÊÔÚ¿ 14-21 ËÌÂÚÒÓ ÌÂٷ͇ ÙÔ˘˜. ™Â 54 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ ÂÊ·ÚÌfiÛÙËÎ·Ó Î·È ÔÈ ‰‡Ô ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜, Û 3 ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ÌfiÓÔ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜, ÂÓÒ Û 10 ÂÚÈÙÒÛÂȘ ÌfiÓÔ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. ™˘ÓÂÒ˜, ÂȉÈ΋ ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ (ηÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Î·È/‹ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜) ÂÊ·ÚÌfiÛÙËΠ۠67 ·fi ÙÔ˘˜ 81 ·ÛıÂÓ›˜ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, ÌÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο Ù· ÂȉËÌÈÔÏÔÁÈο, Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È Ë ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘.

∞ÔÙÂϤÛÌ·Ù· ∞fi Ù· 81 ·È‰È¿ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, Ù· 41 ‹Ù·Ó ·ÁfiÚÈ· (51%). ∆· ·È‰È¿ ›¯·Ó ËÏÈΛ· ·fi 30 Ë̤Ú˜ ¤ˆ˜ Î·È 14 ¤ÙË (ÂӉȿÌÂÛË ÙÈÌ‹ Ù· 5,4 ¤ÙË Î·È Ì¤ÛÔ˜ fiÚÔ˜ Ù· 5,8 ¤ÙË). 32 ·È‰È¿ ›¯·Ó ËÏÈΛ· 0-4 ÂÙÒÓ, 34 ËÏÈΛ· 5-9 ÂÙÒÓ Î·È 15 ËÏÈΛ· 10-14 ÂÙÒÓ (39%, 42% Î·È 19% ·ÓÙÈÛÙÔ›¯ˆ˜). ¶·Ú·ÙËÚ‹ıËΠ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ πÔ‡ÏÈÔ ¤ˆ˜ Î·È ÙÔ ¢ÂΤ̂ÚÈÔ (™¯‹Ì· 1). To 78% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÌÊ·Ó›ÛÙËΠ۠‰‡Ô ¢‰È¿ÎÚÈÙ· ·̷ٷ ·˘ÍË̤Ó˘ Â›ÙˆÛ˘, Ì οı ·̷ Ó· ·ÓÙÈÛÙÔȯ› ÛÙÔ˘˜ ηÏÔηÈÚÈÓÔ‡˜ Î·È ÊıÈÓÔˆÚÈÓÔ‡˜ Ì‹Ó˜ οı ¤ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Î·È ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi ‹Ù·Ó ÂÓ‰ÂÈÎÙÈο ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜, ·ÎÚÈ‚Ò˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ¯ÚÔÓÈÎÒÓ ·˘ÙÒÓ ÂÚÈfi‰ˆÓ (™¯‹Ì· 1). ™Â ‰‡Ô ÔÈÎÔÁ¤ÓÂȘ, ÚÔÛ‚Ï‹ıËÎ·Ó Û˘Á¯ÚfiÓˆ˜ 3 ·È‰È¿ ·fi οı ÔÈÎÔÁ¤ÓÂÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ·Ú·¿Óˆ Î˘Ì¿ÙˆÓ Î·È ·ÔÌÔÓÒıËΠ۠fiÏ· ÂÓÙÂÚÔ˚fi˜ ÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ. ™ÙÔ 85% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜, ÙÔ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ıÂÙÈÎfi ÁÈ· ÙÔ˘˜ ÈÔ‡˜ Echo. ∏ Ù·˘ÙÔÔ›ËÛË ÙÔ˘ ÔÚÔÙ‡Ô˘ ÙÔ˘ ÂÓÙÂÚÔ˚Ô‡ ·fi Ù· ÎfiÚ·Ó· ‰ÂÓ ‹Ù·Ó ÙÂÏÈο ÂÊÈÎÙ‹. ™Â 57 ·È‰È¿ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ¤ÁÈÓ ηÏÏȤÚÁÂÈ· Î·È ·Ó·Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ Î·È ·ÔÌÔÓÒıËΠÂÓÙÂÚÔ˚fi˜ Û 19 ÂÚÈÙÒÛÂȘ (33%). ∆Ô ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÂȂ‚·ÈÒıËΠ۠fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Ì PCR. ™Â 64 ·È‰È¿ ¤ÁÈÓ ÔÚÔÏÔÁÈ΋ ·Ó›¯Ó¢ÛË ÂÓÙÂÚÔ˚ÒÓ Û ‰‡Ô ‰Â›ÁÌ·Ù· ÔÚÔ‡, ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È Î·Ù¿ ÙËÓ ·Ó¿ÚÚˆÛË. O Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ‹Ù·Ó ÂÓ‰ÂÈÎÙÈÎfi˜ ÚfiÛÊ·Ù˘ Ïԛ̈͢ Û 20 ÂÚÈÙÒÛÂȘ (31%). ∞fi ÙȘ 54 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ô˘ ÂÊ·ÚÌfiÛÙËÎ·Ó Î·È Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Î·È ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Û 6 ÂÚÈÙÒÛÂȘ ÙÔ ·ÔÙ¤ÏÂÛÌ· ‹Ù·Ó ıÂÙÈÎfi Î·È Û 21 ‹Ù·Ó ·ÚÓËÙÈÎfi ηÈ

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™‡ÓÔÏÔ ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ¶·È‰È¿ Ì Î/· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ (+) ηÈ/‹ ÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜.

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™¯‹Ì· 1. ∂ԯȷ΋ ηٷÓÔÌ‹ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ηٿ ÙË ‰ÈÂÙ›· 1999-2000.

ÛÙȘ ‰‡Ô ·˘Ù¤˜ ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜. ™Â 13 ÂÚÈÙÒÛÂȘ Ì ·ÚÓËÙÈÎfi ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜, ·ÔÌÔÓÒıËΠ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÂÓÙÂÚÔ˚fi˜. ™Â 14 ÂÚÈÙÒÛÂȘ Ô˘ Ë Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈ΋, ˘‹ÚÍ ÔÚÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË ÚfiÛÊ·Ù˘ Ïԛ̈͢ ·fi ÂÓÙÂÚÔ˚Ô‡˜. ™˘ÓÂÒ˜, Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÎÔÚ·ÓÔηÏÏÈÂÚÁÂÈÒÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, ·fi ÙȘ 81 Û˘ÓÔÏÈο ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, Û 33 (41%) ·ÔÌÔÓÒıËΠÂÓÙÂÚÔ˚fi˜. ∞fi ÙȘ 67 ÂÚÈÙÒÛÂȘ Ô˘ ÂÊ·ÚÌfiÛÙËΠÂȉÈ΋ ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ (ÎÔÚ·ÓÔηÏÏȤÚÁÂÈ· ηÈ/‹ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜), Û 33 (49%) ÙÂÎÌËÚÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ·fi ÂÓÙÂÚÔ˚Ô‡˜. ∆Ô ·ÔÙ¤ÏÂÛÌ· ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙˆÓ ÎÔÚ¿ÓˆÓ ‰ÂÓ ‹Ù·Ó ‰È·ı¤ÛÈÌÔ ÚÈÓ ÙÔ 8Ô 24ˆÚÔ ÓÔÛËÏ›·˜, ÂÓÒ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚfi ¯ÚÂÈ¿˙ÔÓÙ·Ó Û˘Ó‹ıˆ˜ 3-8 Ë̤Ú˜. ∆· ·ÚÈ· ÎÏÈÓÈο ÛËÌ›· ηٿ ÙËÓ ÚÔۤϢÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÙÌ‹Ì· ∂ÂÈÁfiÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ ›¯·Ó ·Ú¯›ÛÂÈ 28,8 ± 11,8 ÒÚ˜ ÚÈÓ ÙËÓ ÚÔۤϢÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∆Ô ÂÍ¿ÓıËÌ· ‹Ù·Ó ·ÈÌÔÚÚ·ÁÈÎfi Û 5 ÂÚÈÙÒÛÂȘ Î·È ÎËÏȉԂϷÙȉ҉˜ Û ̛·. ™Â ¤Ó· ·È‰› ‰È·ÈÛÙÒıËΠÂÍ¿ÓıËÌ· ·ÓÂÌÔ‚ÏÔÁÈ¿˜ Û ·���Ô‰ÚÔÌ‹. ∫·Ó¤Ó· ·È‰› ‰ÂÓ ‹Ù·Ó Û Έ̷ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË Î·È Î·Ó¤Ó· ‰ÂÓ ¤Î·Ó Û·ÛÌÔ‡˜. ∆· Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙÔ˘ ∂¡À ÙˆÓ ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÂÎÂ›ÓˆÓ Ì ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ· Ô˘ ÓÔÛËχÙËÎ·Ó Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· Ù˘ ÌÂϤÙ˘, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙÔ 48% ÙˆÓ ÂÚÈÙÒ-

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ÛÂˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜ (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· >50%). ∂ÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·Ú·ÙËÚ‹ıËΠ۠36 ·fi ÙȘ 63 ÂÚÈÙÒÛÂȘ (57%) Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û ÏÈÁfiÙÂÚÔ ·fi 24 ÒÚ˜ ·fi ÙÔ ¯ÚfiÓÔ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ë O¡¶, ·ÏÏ¿ ÌfiÓÔ Û 3 ·fi ÙȘ 18 ÂÚÈÙÒÛÂȘ (17%) Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û ÂÚÈÛÛfiÙÂÚÔ ·fi 24 ÒÚ˜. ∞fi ÙȘ 81 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, Û 42 Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi˜. ∂Ô̤ӈ˜, Ë Â˘·ÈÛıËÛ›· Ù˘ ÂÈÎÚ¿ÙËÛ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ‹Ù·Ó 52%. ∞fi ÙȘ 8 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, ·ÏÏ¿ ›¯·Ó ‚·ÎÙËÚȉȷ΋, Û 7 Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‰ÂÓ ‹Ù·Ó ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi˜, ÂȉÈÎfiÙËÙ· 88%. ∂›Û˘, ·fi Ù· 43 ·È‰È¿ Ì ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi Ù‡Ô ÛÙÔ ∂¡À, Ù· 42 ›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· 98%. ∞fi Ù· 46 ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ÏÂÌÊÔ΢ÙÙ·ÚÈÎfi Ù‡Ô ÛÙÔ ∂¡À, Ù· 7 ‰ÂÓ Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ·, ·ÏÏ¿ ›¯·Ó ‚·ÎÙËÚȉȷ΋, ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· 15%. ∆· Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜, ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ÙÂÎÌËÚÈÒıËΠÏԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Ï‹ÊıËΠÂȉÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 3). §Â˘ÎÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· (Ï¢ÎÔ·ÙÙ·Ú· >15.000/mm3) ‰È·ÈÛÙÒıËΠÛÙÔ 28% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ Ì ̤ÛË ÙÈÌ‹ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ 11.850 ± 3.708/mm3 Î·È ÂӉȿÌÂÛË ÙÈÌ‹ 11.400/mm3. ∂ÈÎÚ¿ÙËÛË ÙˆÓ


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¶·È‰È·ÙÚÈ΋ 2002;65:108-112

Paediatriki 2002;65:108-112

ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ‰È·ÈÛÙÒıËΠÛÙÔ 81% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ‹Ù·Ó 64% ± 22%. ∏ ∆∫∂ ‹Ù·Ó >20 Û 47 ÂÚÈÙÒÛÂȘ (58%). ∞fi Ù· 47 ·˘Ù¿ ·È‰È¿, 31 ›¯·Ó ∆∫∂ 20-39 mm/h Î·È 16 ·È‰È¿ >40 mm/h. OÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ‹Ù·Ó ÛÙ›Ú˜ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¯ÚÂÈ¿ÛÙËΠӷ ‰Ôı› ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹, Ë ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ‹Ù·Ó 3-8 Ë̤Ú˜, ¤ˆ˜ fiÙÔ˘ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·. ∏ ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ηϋ Û fiÏ· Ù· ·È‰È¿ Î·È Î·Ù¿ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÂÈÏÔΤ˜ ‹ Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ·. ™˘˙‹ÙËÛË ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ˘Ô„›· ÈÔÁÂÓÔ‡˜ ÌËÓÈÁÁ›Ùȉ·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‹ıˆ˜ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ Ê·Ú̿ΈÓ, ¤ˆ˜ fiÙÔ˘ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·. ∂ÎÙfi˜ ·fi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ‚·ÎÙËÚȉȷÎÒÓ ·ÈÙ›ˆÓ, Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È ÂÎÙÂٷ̤ÓË. ∏ ·Ó‡ÚÂÛË ÙÔ˘ ·ÈÙ›Ô˘ ÊÙ¿ÓÂÈ ÌfiÓÔ ÛÙÔ 55%-70% ÙˆÓ ÂÚÈÙÒÛˆÓ, fiÔ˘ ÂÊ·ÚÌfi˙ÂÙ·È Ì›· ÛÙ·ıÂÚ‹ ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜ (1,4). ∏ ·ÔÌfiÓˆÛË ÙˆÓ ÂÓÙÂÚÔ˚ÒÓ ·fi ηÏÏȤÚÁÂÈ· ΢ÙÙ¿ÚˆÓ ¤¯ÂÈ Û¯ÂÙÈο ¯·ÌËÏ‹ ¢·ÈÛıËÛ›· (65%-75%) Î·È ··ÈÙÔ‡ÓÙ·È Î·Ù¿ ̤ÛÔ fiÚÔ 3-8 Ë̤Ú˜ ÁÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ· (5,6,8). ∏ Ù¯ÓÈ΋ Ù˘ ·Ó›¯Ó¢Û˘ ÙÔ˘ RNA ÙÔ˘ ÂÓÙÂÚÔ˚Ô‡ Ì PCR ıˆÚÂ›Ù·È Î·È ÈÔ ·ÛÊ·Ï‹˜ Î·È Ù·¯Â›· ‰È·ÁÓˆÛÙÈ΋ ̤ıÔ‰Ô˜, ‰›ÓÔÓÙ·˜ ·ÔÙ¤ÏÂÛÌ· ̤۷ Û ϛÁ˜ ÒÚ˜ (5,6,8,15). ¶›Ó·Î·˜ 1. ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ·È‰ÈÒÓ Ì ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ηٿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ

%

Ô

88 87 87 74 11 5 48

¶˘ÚÂÙfi˜ >38,5 ∫ÂÊ·Ï·ÏÁ›· Û ·È‰È¿ >2 ÂÙÒÓ ªËÓÈÁÁÈÙȉÈο ÛËÌ›· ŒÌÂÙÔÈ ∂Í¿ÓıËÌ· ¢È¿ÚÚÔÈ· ∂Ï·ÊÚÒ˜ ÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË

∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ÌÂÏÂÙËı› ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∫Ú‹Ù˘. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ÚÔ·ÙÂÈ fiÙÈ Ù· ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ Â›Ó·È ·ÚfiÌÔÈ· ·˘ÙÒÓ ÙˆÓ Â‡ÎÚ·ÙˆÓ ÎÏÈÌ¿ÙˆÓ, fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ ÙÔ Î·ÏÔη›ÚÈ Î·È ÙÔ ÊıÈÓfiˆÚÔ. ™ËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó Ô ·Ó·‰ÚÔÌÈÎfi˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ Î·È Ë ¤ÏÏÂÈ„Ë Ù·˘ÙÔÔ›ËÛ˘ ÙÔ˘ ÔÚÔÙ‡Ô˘ ÙÔ˘ ÂÓÙÂÚÔ˚Ô‡ ·fi Ù· ÎfiÚ·Ó·. ∫·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ ¤ÁÈÓ ÛÙÔ 70% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, ΢ڛˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÌËÓÒÓ ÙÔ˘ ηÏÔηÈÚÈÔ‡ Î·È ÙÔ˘ ÊıÈÓÔÒÚÔ˘, fiÙ·Ó ‹Ù·Ó ÂÌÊ·Ó›˜ ÔÈ Û˘ÛÛˆÚ‡ÛÂȘ ÎÚÔ˘ÛÌ¿ÙˆÓ. ∆Ô ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ηÏÏȤÚÁÂÈ·˜ ‰ÂÓ Â›¯Â Â›‰Ú·ÛË ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ, ·ÊÔ‡ ‰ÂÓ ‹Ù·Ó Û˘Ó‹ıˆ˜ ‰È·ı¤ÛÈÌÔ ÚÈÓ ÙÔ 8Ô 24ˆÚÔ ÓÔÛËÏ›·˜. ªÂ ÙÔ Û˘Ó‰˘·ÛÌfi ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ÎÔÚ·ÓÔηÏÏÈÂÚÁÂÈÒÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 41% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙËÓ ∫Ú‹ÙË ÔÊ›ÏÂÙ·È Û ÂÓÙÂÚÔ˚Ô‡˜. ∞fi ·˘Ù‹ ÙË ÌÂϤÙË ÚÔ·ÙÂÈ Â›Û˘ ÂÙ‹ÛÈ· Â›ÙˆÛË ÁÈ· ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ÛÙËÓ ∫Ú‹ÙË ÙÔ˘Ï¿¯ÈÛÙÔÓ 20 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌfi. ∏ Â›ÙˆÛË ·˘Ù‹ Â›Ó·È ·˘ÍË̤ÓË Ì ‚¿ÛË Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Î·È ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË (2). π‰È·›ÙÂÚÔ ‰È·ÁÓˆÛÙÈÎfi ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙÔ 48% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜. ∂ÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·Ú·ÙËÚ‹ıËΠÛÙÔ 57% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û ÏÈÁfiÙÂÚÔ ·fi 24 ÒÚ˜ ·fi ÙÔ ¯ÚfiÓÔ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ë O¡¶, fiˆ˜ Î·È ÛÙÔ 17% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ Û ÂÚÈÛÛfiÙÂÚÔ ·fi 24 ÒÚ˜. ∏ ¢·ÈÛıËÛ›· Î·È Ë ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ÂÈÎÚ¿ÙËÛ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ‹Ù·Ó ¯·ÌËÏ‹. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÚÁ·Û›·˜ Û˘ÌʈÓÔ‡Ó Ì ·ÚÎÂÙ¤˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, Û‡Ìʈӷ Ì ÙȘ Ôԛ˜, ÛÙË ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ Ë ÂÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·ÔÙÂÏ› ÂÚÈÛÛfiÙÂÚÔ ÙÔÓ Î·ÓfiÓ· ·fi fiÙÈ ÙËÓ ÂÍ·›ÚÂÛË Î·È Ì¿ÏÈÛÙ· ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È

¶›Ó·Î·˜ 2. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À Û ·È‰È¿ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ Î·È Û ·È‰È¿ Ì ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ÕÛËÙË ÌËÓÈÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ (n=33) ∂ӉȿÌÂÛË ÙÈÌ‹ ∂‡ÚÔ˜ §Â˘ÎÔ·ÙÙ·Ú·/mm3 ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (%) °Ï˘Îfi˙Ë (mg/dl) ¶ÚˆÙ½ÓË (mg/dl)

75 60 63 30

20-750 10-90 39-105 6-100

µ·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· (n=8) ∂ӉȿÌÂÛË ÙÈÌ‹ ∂‡ÚÔ˜ 53 65 74 40

20-4.600 49-93 50-128 18-230

111


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·112

¶·È‰È·ÙÚÈ΋ 2002;65:108-112

Paediatriki 2002;65:108-112

¶›Ó·Î·˜ 3. ∂˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À (ÂӉȿÌÂÛË ÙÈÌ‹, ‡ÚÔ˜) ÛÙ· ·È‰È¿ ÌÂ Î·È ¯ˆÚ›˜ ÙÂÎÌËÚȈ̤ÓË ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ ŒÏÂÁ¯Ô˜ ÁÈ· ÚfiÛÊ·ÙË Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ ∞ÔÙ¤ÏÂÛÌ·

n

£ÂÙÈÎfi ∞ÚÓËÙÈÎfi ¢ÂÓ ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ™‡ÓÔÏÔ

33 34 14 81

§Â˘ÎÔ·ÙÙ·Ú·/mm3

¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (%)

¶ÚˆÙ½ÓË (mg/dl)

°Ï˘Îfi˙Ë (mg/dl)

∂.∆. (‡ÚÔ˜)

∂.∆. (‡ÚÔ˜)

∂.∆. (‡ÚÔ˜)

∂.∆. (‡ÚÔ˜)

75 (20-750) 75 (15-1.000) 85 (15-510) 84 (15-1.000)

60 (10-90) 60 (0-90) 55 (0-96) 60 (0-96)

30 (6-100) 30 (6-170) 34 (10-130) 30 (6-170)

63 (39-105) 63 (47-87) 61 (38-81) 63 (38-105)

∂.∆.: ÂӉȿÌÂÛË ÙÈÌ‹

ÛÙȘ ÚÒÙ˜ 24 ÒÚ˜ Ù˘ ÓfiÛÔ˘ (13,14). ™˘ÓÂÒ˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‰ÂÓ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ·ÛʷϤ˜ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ¿ÛËÙ˘ ·fi ÙË ‚·ÎÙËÚȉȷ΋ ÌËÓÈÁÁ›Ùȉ·. ∂Ô̤ӈ˜, ηٿ ÙËÓ ÂÔ¯‹ Ô˘ ÂÌÊ·Ó›˙ÂÈ ¤Í·ÚÛË Ë ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜, ¤Ó·˜ ·ÛıÂÓ‹˜ Ì ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË ÛÙÔ ∂¡À ‰ÂÓ Â›Ó·È ·›ı·ÓÔ Ó· ¤¯ÂÈ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· (14). ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È Ë ‰È·›ÛÙˆÛË fiÙÈ ·ÚÎÂÙ¿ ·È‰È¿ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ ·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË Ù˘ ÚˆÙ½Ó˘ Î·È Ì›ˆÛË Ù˘ ÁÏ˘Îfi˙˘ ÛÙÔ ∂¡À, Â˘Ú‹Ì·Ù· ‰ËÏ·‰‹ Ô˘ ıˆÚÔ‡ÓÙ·È ˆ˜ ÂÓ‰ÂÈÎÙÈο ‚·ÎÙËÚȉȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜. ∏ ÙÂÏÈ΋, ÏÔÈfiÓ, ‰È¿ÎÚÈÛË Ù˘ ‚·ÎÙËÚȉȷ΋˜ ·fi ÙËÓ ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ‰ÂÓ ÌÔÚ› Ó· ÛÙËÚ›˙ÂÙ·È ·ÔÎÏÂÈÛÙÈο ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À, ·ÏÏ¿ ÂȉÈΤ˜ ‰È·ÁÓˆÛÙÈΤ˜ ̤ıÔ‰ÔÈ Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È. ∂›Û˘, Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ ÙÂÎÌËÚȈ̤ÓË ¿ÛËÙË ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜. ∏ ÌËÓÈÁÁ›Ùȉ· ·fi ÂÓÙÂÚÔ˚Ô‡˜ ·ÔÙÂÏ› ¤Ó· ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÎÏÈÓÈÎfi Û‡Ó‰ÚÔÌÔ ÌÂ Ù˘È΋ ·ÈÊÓ›‰È· ¤Ó·ÚÍË ÛÙ· ·È‰È¿. ∏ ·Ú·ÌÔÓ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù· ÚÒÙ· 24ˆÚ· Ù˘ ÓfiÛÔ˘, ¤ˆ˜ fiÙÔ˘ Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·, Â›Ó·È ··Ú·›ÙËÙË. ∏ ÂÊ·ÚÌÔÁ‹ Ì›·˜ ÌÂıfi‰Ô˘ Ô˘ ÂÈÙÚ¤ÂÈ Ù·¯Â›· ‰È¿ÁÓˆÛË, ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ¿ÛÎÔË ·Ú·ÌÔÓ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È ı· ‚ÂÏÙÈÒÛÂÈ ÙË ÊÚÔÓÙ›‰· ÙˆÓ ·È‰ÈÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Rotbart HA. Enteroviral infections of the central nervous system. Clin Infect Dis 1995;20:971-981. 2. Rice SK, Heinl RE, Thornton LL, Opal SM. Clinical characteristics, management strategies, and cost implications of a statewide outbreak of enterovirus meningitis. Clin Infect Dis 1995;20:931-937. 3. Norris CM, Danis PG, Gardner TD. Aseptic meningitis in the newborn and young infant. Am Fam Physician 1999;59:2761-2770. 4. Lipton JD, Schafermeyer RW. Central nervous system infections. The usual and the unusual. Emerg Med Clin

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North Am 1995;13:417-440. 5. Ramers C, Billman G, Hartin M, Ho S, Sawyer MH. Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. JAMA 2000;283:2680-2685. 6. Ahmed A, Brito F, Goto C, Hickey SM, Olsen KD, Trujillo M et al. Clinical utility of the polymerase chain reaction for diagnosis of enteroviral meningitis in infancy. J Pediatr 1997;131:393-397. 7. Rotbart HA. Viral meningitis. Sem Neurol 2000;20:277-292. 8. Sawyer MH. Enterovirus infections: diagnosis and treatment. Pediatr Infect Dis J 1999;18:1033-1040. 9. ∆ÛÔÏÈ¿ ª. §ÔÈÌÒÍÂȘ ·fi ÂÓÙÂÚÔ˚Ô‡˜. ™ÙÔ: ¢È·ÁÓˆÛÙÈο Î·È ıÂÚ·¢ÙÈο ÚÔ‚Ï‹Ì·Ù·. ªÂÙÂÎ·È‰Â˘ÙÈÎfi ™ÂÌÈÓ¿ÚÈÔ ¶·È‰È·ÙÚÈ΋˜ 2000; ∞ı‹Ó·: µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ; 2000. ÛÂÏ. 50-58. 10. Rotbart HA, McCracken GH Jr, Whitley RJ, Modlin JF, Cascino M, Shah S et al. Clinical significance of enteroviruses in serious summer febrile illnesses of children. Pediatr Infect Dis J 1999;18:869-874. 11. ÷ڛÛË ª, ªÔ˘ÁÈÔ˘ÎÏ‹˜ ¶, °·Ï·Ó¿Î˘ ∂, ª·˘Ú›‰Ë˜ ∞, ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑. ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ¿ÛËÙ˘ ÌËÓÈÁÁ›Ùȉ·˜ ·fi ÂÓÙÂÚÔ˚Ô‡˜ [¶ÂÚ›ÏË„Ë]. 38Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2000 16-18 πÔ˘Ó›Ô˘; ∫ˆ˜; 2000. ÛÂÏ. 72. 12. Michelow IC, Nicol M, Tiemessen C, Chezzi C, Pettifor JM. Value of cerebrospinal fluid leukocyte aggregation in distinguishing the causes of meningitis in children. Pediatr Infect Dis J 2000;19:66-72. 13. ¡›ÙÛ· ∞, §˘ÎÔÔ‡ÏÔ˘ §, µ¤ÚÌ˘ π, º·ÚÌ¿ÎË ∂, ¶··ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, •·˚‰¿Ú· ∞. ∂˘Ú‹Ì·Ù· ∂¡À ÛÙËÓ ¿ÛËÙË Û ۯ¤ÛË Ì ÙË ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· [¶ÂÚ›ÏË„Ë]. 39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 2001 1-3 πÔ˘Ó›Ô˘; ∫Ú‹ÙË; 2001. ÛÂÏ. 298. 14. Negrini B, Kelleher KJ, Wald ER. Cerebrospinal fluid findings in aseptic versus bacterial meningitis. Pediatrics 2000;105:316-319. 15. Hosoya M, Honzumi K, Sato M, Katayose M, Kato K, Suzuki H. Application of PCR for various neurotropic viruses on the diagnosis of viral meningitis. J Clin Virol 1998;11:117-124. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-09-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-01-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ì·Ï›· ∆ÛÈÏÈÌÈÁοÎË ∏ÚÔ‰fiÙÔ˘ 214, ¡¤· ∞ÏÈηÚÓ·ÛÛfi˜ ∆.∫. 716 01, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘


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ORIGINAL ARTICLE

¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙ ¯ÚfiÓÈ· ∂. ÷Ù˙ˉ¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ∂. ∫ÔڷοÎË1, ∂. ¶·Ú·Ûο΢1, µ. µ·Ï¿ÚË1, ª. ∫ÔÚÔÔ‡ÏË1, ∂. °·Ï·Ó¿Î˘2, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘1

Perinatal mortality in Crete over the last five years E. Hatzidaki1, A. Manoura1, E. Korakaki1, E. Paraskakis1, B. Balari1, M. Koropouli1, H. Galanakis2, Ch. Giannakopoulou1

¶ÂÚ›ÏË„Ë: ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ϤÔÓ ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙ˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÂÈ¤‰Ô˘ Ì·È¢ÙÈ΋˜ Î·È ÓÂÔÁÓÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Ì›·˜ ¯ÒÚ·˜. OÈ ‰È·Î˘Ì¿ÓÛÂȘ Ù˘ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ¯ˆÚÒÓ Â›Ó·È ÌÂÁ¿Ï˜, Ì ٿÛÂȘ Û˘Ó¯ԇ˜ Ì›ˆÛ˘ ‰ÈÂıÓÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ ¤ÙÔ˜ 2000 Î·È Ë Û‡ÁÎÚÈÛ‹ Ù˘ Ì ٷ ÛÙÔȯ›· ÙÔ˘ 1995 ÛÙÔ ÓËÛ› Ù˘ ∫Ú‹Ù˘. ∫·Ù·ÁÚ¿ÊËΠÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛˆÓ, ÙˆÓ ıÓËÛÈÁÂÓÒÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ, ÛÙÔ ÓËÛ› Ì·˜, Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ·fi 9,58ò Û 7,2ò. ∏ ÂÌÊ¿ÓÈÛË ÂÓfi˜ Û˘ÁÎÚ›ÛÈÌÔ˘, Ì ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÔÛÔÛÙÔ‡ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ηٷ‰ÂÈÎÓ‡ÂÈ ÙË ‚ÂÏÙ›ˆÛË Ô˘ ¤¯ÂÈ Â¤ÏıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· ÛÙÔ ÓËÛ› Ì·˜.

Abstract: Perinatal mortality rate is considered to be one of the most reliable indicators regarding the quality of antenatal and perinatal care, and, in general, the delivery of health services of any country. Although there are significant differences in perinatal mortality between countries, nevertheless, the tendency during the last years has been towards a decrease in its rate. The purpose of the present study was to examine the perinatal mortality rate in the year 2000 in the island of Crete and compare it with that of the year 1995. The total births, stillbirths and early neonatal deaths during the first post-natal week were recorded. The perinatal mortality rate over the last five years in our island has declined significantly; for the year 1995 it was 9.58ò, while for the year 2000 was 7.2ò. According to our findings, the perinatal mortality rate in Crete compares favorably with that of the majority of other European countries. This is indicative of the improvement that has occurred in the antenatal and perinatal care in our island over the last few years.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·, ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰·.

Key words: perinatal mortality, perinatal care.

™˘ÓÙÔÌÔÁڷʛ˜

∂ÈÛ·ÁˆÁ‹ ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ϤÔÓ ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙ˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÂÈ¤‰Ô˘ Ì·È¢ÙÈ΋˜ Î·È ÓÂÔÁÓÈ΋˜ ÊÚÔÓÙ›‰·˜

Î·È ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Ì›·˜ ¯ÒÚ·˜ (1,2). OÈ ‰È·Î˘Ì¿ÓÛÂȘ Ù˘ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ¯ˆÚÒÓ Â›Ó·È ÌÂÁ¿Ï˜, Ì ٿÛÂȘ Û˘Ó¯ԇ˜ Ì›ˆÛ˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÈÂıÓÒ˜ (3-7). ∏ ‚ÂÏÙ›ˆÛË Ô˘ Û˘ÓÙÂϤÛÙËΠٷ ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛ˘ ÓÂÔÁÓÒÓ Ì Ôχ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ˘‹ÚÍ ı·̷ÙÈ΋ Î·È ·ÔÙÂÏ› ¤Ó· ·fi Ù· ϤÔÓ ÛËÌ·ÓÙÈο ÂÈÙ‡ÁÌ·Ù· Ù˘ È·ÙÚÈ΋˜ ÙÔ˘ ÂÈÎÔÛÙÔ‡ ·ÈÒÓ· (8). ∏ ÚfiÔ‰Ô˜ ·˘Ù‹ ÔÊ›ÏÂÙ·È

1 ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

1 Department of Neonatology of the University of Crete 2 Department of General Pediatrics of the University of Crete

¶ÂÚÈÁ. ·ÛÊ˘Í›· ™˘Á. ·Ó/ϛ˜ ∂ÈÛÚ. ÌËÎ.

¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ∂ÈÛÚfiÊËÛË ÌËÎˆÓ›Ô˘

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¶·È‰È·ÙÚÈ΋ 2002;65:113-117

ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓfiËÛË Ù˘ ·ıÔÏÔÁ›·˜ ÙÔ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡, ÛÙȘ ÂÍÂÏ›ÍÂȘ Ù˘ Ì·È¢ÙÈ΋˜, ÛÙË ¯Ú‹ÛË ÚÔËÁ̤Ó˘ Ù¯ÓÔÏÔÁ›·˜ Î·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· Û‡Á¯ÚÔÓˆÓ ÓÂÔÁÓÔÏÔÁÈÎÒÓ ÌÔÓ¿‰ˆÓ Î·È ÂÚÈÁÂÓÓËÙÈÎÒÓ Î¤ÓÙÚˆÓ, ÛÙÂϯˆÌ¤ÓˆÓ Ì ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ Ì·ÈÂ˘Ù‹Ú˜ Î·È ÓÂÔÁÓÔÏfiÁÔ˘˜, ÈηÓÔ‡˜ Ó· ÊÚÔÓÙ›ÛÔ˘Ó ÙfiÛÔ ÙËÓ ¤ÁÎ˘Ô fiÛÔ Î·È ÙÔ ÓÂÔÁÓfi Ù˘ (6,9). O fiÚÔ˜ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ·Ó·Ê¤ÚÂÙ·È ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ı·Ó¿ÙˆÓ ·fi ÙËÓ 28Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ ̤¯ÚÈ ÙËÓ 7Ë Ë̤ڷ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ (1). ∏ ÂÈ‚›ˆÛË, fï˜, ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂÙ¿ ·fi ·ËÛË 25 ‚‰ÔÌ¿‰ˆÓ ‰ÂÓ Â›Ó·È ϤÔÓ Û¿ÓÈÔ ÁÂÁÔÓfi˜, ÂÓÒ ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÈ‚›ˆÛË ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂÙ¿ ·fi ·ËÛË 24 ‹ Î·È 23 ‚‰ÔÌ¿‰ˆÓ (8). ∫¿ı ¯ÒÚ·, Ì ‚¿ÛË ÙÔ Û‡ÓÙ·ÁÌ· Î·È ÙÔ˘˜ ÓfiÌÔ˘˜ Ù˘, ı¤ÙÂÈ Ù· ‰Èο Ù˘ fiÚÈ· ‚ȈÛÈÌfiÙËÙ·˜ Î·È ıÂÛÌÔıÂÙ› Ù· ‰Èο Ù˘ fiÚÈ· ηٷÁÚ·Ê‹˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÓÂÎÚ¿ ÛÙË ‰È΋ Ù˘ ÂÈÎÚ¿ÙÂÈ·. ∏ ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË YÁ›·˜ ÚÔÙ›ÓÂÈ ÙËÓ Î·Ù·ÁÚ·Ê‹ οı ÂÌ‚Ú‡Ô˘ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÙˆÓ 500 ÁÚ·ÌÌ·Ú›ˆÓ. ™Â ÔÏϤ˜ ·fi ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ ∞ÌÂÚÈ΋˜ οı ÓÂÔÁÓfi Ô˘ ÁÂÓÓÈ¤Ù·È ÓÂÎÚfi ÌÂÙ¿ ·fi ·ËÛË ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 20 ‚‰ÔÌ¿‰ˆÓ ηٷÁÚ¿ÊÂÙ·È Û·Ó ıÓËÛÈÁÂÓ¤˜, ÂÓÒ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙË °·ÏÏ›· οı ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜ Ô˘ ÂÈÛ˘Ì‚·›ÓÂÈ ÚÈÓ ÙËÓ 28Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È (10). ™‡Ìʈӷ Ì ÙËÓ ÈÛ¯‡Ô˘Û· ·fi ÙÔ 1976 ÓÔÌÔıÂÛ›· ÛÙË ¯ÒÚ· Ì·˜, ηٷÁÚ¿ÊÂÙ·È Û·Ó ÓÂÎÚfi οı ¤Ì‚Ú˘Ô Ô˘ ÁÂÓÓÈ¤Ù·È ÌÂÙ¿ ·fi ·ËÛË 180 ËÌÂÚÒÓ ‹ 25 ‚‰ÔÌ¿‰ˆÓ Î·È 5 ËÌÂÚÒÓ (11). ∞fi ·ÓÂÏÏ‹ÓÈ· ÌÂϤÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠÛÙË ¯ÒÚ· Ì·˜ ÙÔ 1983 ‚Ú¤ıËΠfiÙÈ Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 23,8ò, ‰ÈÏ¿ÛÈ· ‹ ·ÎfiÌ· Î·È ÙÚÈÏ¿ÛÈ· ·fi ‚ÔÚÂÈÔÂ˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÂÓÒ ·fi ·Ó¿ÏÔÁË ÌÂϤÙË ÙÔ 1998 ÚԤ΢„ fiÙÈ Â›¯Â ÌÂȈı› ÛËÌ·ÓÙÈο ÛÙÔ Â›Â‰Ô ÙÔ˘ 10,5ò (12,13). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ ¤ÙÔ˜ 2000 Î·È Ë Û‡ÁÎÚÈÛ‹ Ù˘ Ì ٷ ÛÙÔȯ›· ÙÔ˘ ¤ÙÔ˘˜ 1995 ÛÙÔ ÓËÛ› Ù˘ ∫Ú‹Ù˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ ∏ ∫Ú‹ÙË Â›Ó·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÓËÛ› Ù˘ ÂÏÏËÓÈ΋˜ ÂÈÎÚ¿ÙÂÈ·˜. ∂›Ó·È Ì›· ÎÏÂÈÛÙ‹ ÎÔÈÓfiÙËÙ· Ù˘ ÂÏÏËÓÈ΋˜ ÂÚÈʤÚÂÈ·˜, Ô˘ ÏfiÁˆ Ù˘ ÁˆÁÚ·ÊÈ΋˜ Ù˘ ı¤Û˘ Â›Ó·È ‰‡ÛÎÔÏË Ë ·Ó·˙‹ÙËÛË ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ÛÙÔ Î¤ÓÙÚÔ. ∆· ÓÂÔÁÓ¿ ÓÔÛËχÔÓÙ·È Û ‰‡Ô ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ NÂÔÁÓÒÓ, Ì›· ÛÙÔ ÎÚ·ÙÈÎfi Î·È Ì›· ÛÙÔ ·ÓÂÈÛÙËÌÈ·Îfi ÓÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, Ô˘ ¿Ú¯ÈÛ·Ó Ó· ÏÂÈÙÔ˘ÚÁÔ‡Ó ·fi ÙÔ 1987 Ë ÚÒÙË Î·È ·fi ÙÔ 1991 Ë ‰Â‡ÙÂÚË Î·È ¤¯Ô˘Ó ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈ-

114

Paediatriki 2002;65:113-117

ο ÙËÓ ÔÈfiÙËÙ· ·ÚÔ¯‹˜ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜. ™ÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ÙÔ˘ ÓËÛÈÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡Ó ¤ÍÈ È‰ÈˆÙÈΤ˜ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ Î·È ÂÙ¿ Ì·È¢ÙÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁ›·˜, ÂÓÒ Ë Ì·È¢ÙÈ΋ ÎÏÈÓÈ΋ Ô˘ ÏÂÈÙÔ˘ÚÁ› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔ ·ÓÂÈÛÙËÌÈ·Îfi ÓÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ·Ó·Ï·Ì‚¿ÓÂÈ ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ÙÔÎÂÙÒÓ Î·È ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÙÔÎÂÙÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ¤Ó· ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ ÙˆÓ ÙÔÎÂÙÒÓ ÛÙÔ ÓËÛ› ηχÙÂÙ·È ·fi ÂȉÈÎÂ˘Ì¤ÓÔ ÓÂÔÁÓÔÏfiÁÔ. ∫·Ù·ÁÚ¿„·Ì ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛˆÓ, Ù· ıÓËÛÈÁÂÓ‹ Î·È Ù· ÓÂÔÁÓ¿ Ô˘ ¤ı·Ó·Ó ÙȘ ÚÒÙ˜ 7 Ë̤Ú˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∫Ú‹Ù˘. ™ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Û˘ÌÂÚÈÏ¿‚·Ì ÓÂÔÁÓ¿ Ô˘ ¤ı·Ó·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Î·È Ù· ¤Ì‚Ú˘· Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÓÂÎÚ¿ Ì ËÏÈΛ· ·ËÛ˘ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 28 ‚‰ÔÌ¿‰ˆÓ ‹ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂÁ·Ï‡ÙÂÚÔ ‹ ›ÛÔ ÙˆÓ 500 ÁÚ·ÌÌ·Ú›ˆÓ. ∆· ÛÙÔȯ›· Ì·˜ ·ÓÙÏ‹ıËÎ·Ó ·fi Ù· ‚È‚Ï›· Ô˘ ÙËÚÔ‡ÓÙ·È ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ· Î·È ÛÙȘ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ.

∞ÔÙÂϤÛÌ·Ù· ∆Ô ¤ÙÔ˜ 2000 ÁÂÓÓ‹ıËÎ·Ó 6513 ÓÂÔÁÓ¿. ¢Âη¤ÓÙ ÓÂÔÁÓ¿ ¤ı·Ó·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛË (2,3ò), ÂÓÒ 32 ‹Ù·Ó ıÓËÛÈÁÂÓ‹ (4,9ò). ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ‚Ú¤ıËΠ7,2ò. ∫·Ù¿ ÙÔ ¤ÙÔ˜ 1995 ÁÂÓÓ‹ıËÎ·Ó 6114 ÓÂÔÁÓ¿. O ·ÚÈıÌfi˜ ÙˆÓ ı·Ó¿ÙˆÓ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó 20 ÓÂÔÁÓ¿ (3,27ò), ÂÓÒ Ù· ıÓËÛÈÁÂÓ‹ ‹Ù·Ó 39 (6,38ò). ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 9,58ò (™¯‹Ì· 1). ∆· ÓÂÔÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó ·Ó¿ÏÔÁ· Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ·ÊÔ‡ ¯ˆÚ›ÛÙËÎ·Ó ÛÙȘ ·Ú·Î¿Ùˆ ÔÌ¿‰Â˜: 5001000 g, 1001-1500 g, 1501-2000 g, 2001-2500 g Î·È >2500 g. ™¯ÂÙÈο Ì ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ıÓËÛÈÁÂÓÒÓ ·Ó¿ÏÔÁ· Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜, ˆ˜ ÔÛÔÛÙfi ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓËı¤ÓÙˆÓ Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÓÂÔÁÓÒÓ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË Û fiϘ ÙȘ ÔÌ¿‰Â˜ (™¯‹Ì· 2). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÙ›· ÙˆÓ ı·Ó¿ÙˆÓ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË

14 12 10 8 6 4 2 0

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000

9,58 7,2

6,38 4,9 3,27

£¿Ó·ÙÔÈ 1˘ ‚‰ÔÌ¿‰·˜

2,3

£ÓËÛÈÁÂÓ‹

¶ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·

™¯‹Ì· 1. £¿Ó·ÙÔÈ 1˘ ‚‰ÔÌ¿‰·˜ ˙ˆ‹˜, ıÓËÛÈÁÂÓ‹ Î·È ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ηٿ Ù· ¤ÙË 1995 Î·È 2000.


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·115

¶·È‰È·ÙÚÈ΋ 2002;65:113-117

Paediatriki 2002;65:113-117

60%

100% 80% 60% 40% 20% 0%

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000

69,2% 56%

50% 40%

47% 35% 26% 10% 10% 7%

30% 20%

24,3% 9,1%

7% 2,3% 0,2% 4,9% 0,1% 0,7%

500-1000 g 1001-1500 g 1501-2000 g 2001-2500 g

>2500 g

™¯‹Ì· 2. ∫·Ù·ÓÔÌ‹ (%) ÙˆÓ ıÓËÛÈÁÂÓÒÓ ·Ó¿ÏÔÁ· ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ ˆ˜ ÔÛÔÛÙfi ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓËı¤ÓÙˆÓ Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÓÂÔÁÓÒÓ Î·Ù¿ Ù· ¤ÙË 1995 Î·È 2000.

η��¿ ÙÔ 2000, ÛËÌÂÈÒıËΠÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ÛË„·ÈÌ›·˜, ÂÓÒ Ë ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· Î·È ÔÈ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÌÂÈÒıËÎ·Ó (™¯‹Ì· 3). ∞fi Ù· 6513 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÙÔ 2000, 695 ÚÔ‹Ïı·Ó ·fi ·ÏÏÔ‰·¤˜ ÔÈÎÔÁ¤ÓÂȘ, ÂÓÒ ÙÔ 1995 Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ ‹Ù·Ó 58 ÓÂÔÁÓ¿. ™˘˙‹ÙËÛË ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ·, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔ ÓËÛ› Ì·˜, ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ·fi 9,58ò ÙÔ 1995 Û 7,2ò ÙÔ 2000. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙÔ 1983 ÛÙËÓ ∂ÏÏ¿‰· ‹Ù·Ó 23,8ò, ÙÔ 1991 ÌÂÈÒıËΠ۠11,06ò ÁÈ· Ó· ÊÙ¿ÛÂÈ ÛÙÔ 9,1ò ÙÔ 1998 (12-14). ∞ÓÙ›ÛÙÔȯ·, Û ∂˘Úˆ·˚Τ˜ ¯ÒÚ˜ ÙÔ 1983 ‹Ù·Ó: ÛÙË ™ÎˆÙ›· 11,3ò, ÛÙËÓ ∞ÁÁÏ›· 10,8ò, ÛÙË °ÂÚÌ·Ó›· 9,6ò, ÛÙË ¡ÔÚ‚ËÁ›· 9,4ò Î·È ÛÙË ™Ô˘Ë‰›· 7,5ò. ∆Ô 1998 ‹Ù·Ó: ÛÙËÓ πÛ·Ó›· 7,3ò, ÛÙË ¢·Ó›· 7,1ò, ÛÙË ™ÎˆÙ›· Î·È ÙÔ µ¤ÏÁÈÔ 7ò, ÛÙËÓ OÏÏ·Ó‰›· 6ò, ÛÙË ¡ÔÚ‚ËÁ›· 5,7ò, ÛÙË ºÈÓÏ·Ó‰›· 4,7ò Î·È ÛÙË ™Ô˘Ë‰›· 4,1ò (13). ¶·Ú¿ ÙȘ ‰˘ÛÎÔϛ˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙË ‰È·ÎÚ·ÙÈ΋ Û‡ÁÎÚÈÛË, Ë ÂÌÊ¿ÓÈÛË ÂÓfi˜ Û˘ÁÎÚ›ÛÈÌÔ˘ Ì ÙȘ ÂÚÈÛÛfiÙÂÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ ÔÛÔÛÙÔ‡ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ηٷ‰ÂÈÎÓ‡ÂÈ ÙË ‚ÂÏÙ›ˆÛË Ô˘ ¤¯ÂÈ Â¤ÏıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· ÛÙÔ ÓËÛ› Ì·˜. ∏ Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ıÓËÛÈÁÂÓÒÓ ÓÂÔÁÓÒÓ ·fi 6,38ò ÙÔ 1995 Û 4,9ò ÙÔ 2000 ·ÓÙ·Ó·ÎÏ¿ ÙËÓ Î·Ï‡ÙÂÚË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÁ·ˆÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∏ Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ı·Ó¿ÙˆÓ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·fi 3,27ò Û 2,3ò ·Ô‰›‰ÂÙ·È ÛÙË ÏÂÈÙÔ˘ÚÁ›· Û‡Á¯ÚÔÓˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙÔ ÓËÛ›, ·ÏÏ¿ Î·È ÛÙË ÛˆÛÙfiÙÂÚË Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË Û˘ÓÂÚÁ·Û›· Ì·ÈÂ˘Ù‹ÚˆÓ-ÓÂÔÁÓÔÏfiÁˆÓ. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·, Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘, ÌÂÈÒıËΠÛËÌ·ÓÙÈο, fiˆ˜ Î·È Ë ÂÈÛÚfiÊËÛË ÌËÎˆÓ›Ô˘, ÁÂÁÔÓfi˜ Ô˘ ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› ÛÙËÓ Î·Ï‡ÙÂÚË Ì·È¢ÙÈ΋ ·-

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000

35% 20%

5%

10% 0%

¶ÚÔˆÚfiÙ˘

¶ÂÚÈÁ. ·ÛÊ˘Í›·

™Ë„·ÈÌ›·

™˘Á. ·Ó/ϛ˜

0%

∂ÈÛÚ. ÌËÎ.

5%

0%

ÕÁÓˆÛÙË

™¯‹Ì· 3. ∞›ÙÈ· ı·Ó¿ÙÔ˘ (%) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ 1˘ ‚‰ÔÌ¿‰·˜ ˙ˆ‹˜ ηٿ Ù· ¤ÙË 1995 Î·È 2000.

Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÈÙfiÎÔ˘ Î·È ÛÙËÓ ·ÚÔ˘Û›· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ·ÙfiÌÔ˘, ÈηÓÔ‡ Ó· οÓÂÈ ·Ó¿ÓË„Ë ÛÙÔ ÓÂÔÁÓfi Û ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÙÔÎÂÙÒÓ. ¶·Ú¿ÏÏËÏ·, ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ Î·È Ù˘ ÛË„·ÈÌ›·˜ Û·Ó ·ÈÙ›·˜ ı·Ó¿ÙÔ˘. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ ‰ÈÂÓÂÚÁ‹ıËΠȷÙÚÔ‰ÈηÛÙÈ΋ Ú·ÁÌ·ÙÔÁÓˆÌÔÛ‡ÓË, ÔfiÙÂ Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ·ÈÙ›·˜ ı·Ó¿ÙÔ˘ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ÎÏÈÓÈ΋ ¿Ô„Ë ÙÔ˘ ıÂÚ¿ÔÓÙ· Î·È ÌÔÚ› ÂӉ¯Ô̤ӈ˜ Ó· ÌËÓ Â›Ó·È ·ÎÚÈ‚‹˜. ∂‰Ò Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ·Ú·ÙËÚ‹ıËΠοÔÈ· ·Ú¤ÎÎÏÈÛË Û ۯ¤ÛË Ì ¿ÏϘ ÚÔËÁ̤Ó˜ ¯ÒÚ˜, fiÔ˘ Û·Ó Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ηٿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ (1,15,16). °È· Ó· ÂÈÙ¢¯ı› Ë ÛˆÛÙ‹ Û˘Û¯¤ÙÈÛË ·˘ÙÒÓ ÙˆÓ ı·Ó¿ÙˆÓ Ì ÙËÓ ÔÈfiÙËÙ· ·ÚÔ¯‹˜ ˘Á›·˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ·Ú¤Ì‚·Û˘, ı· Ú¤ÂÈ, ÂÎÙfi˜ ·fi ÙȘ Û˘Óı‹Î˜ ÓÔÛËÏ›·˜ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜, Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„Ë ÔÈ Û˘Óı‹Î˜ Ì ÙȘ Ôԛ˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ô ÙÔÎÂÙfi˜, ÔÈ Û˘Óı‹Î˜ ·Ó¿Ó˄˘ Î·È ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘ ÚÔÒÚÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, ·ÏÏ¿ Î·È Ë Â·Ú΋˜ ‹ fi¯È ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÚÔÂÙÔÈÌ·Û›· Ù˘ ÂÈÙfiÎÔ˘, Ë ¯ÔÚ‹ÁËÛË ‹ fi¯È ÎÔÚÙÈÎÔÂȉÒÓ ÛÙËÓ ¤ÁÎ˘Ô Ì ÛÙfi¯Ô ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ˆÚ›Ì·ÓÛ˘ ÙˆÓ Ó¢ÌfiÓˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ·ÏÏ¿ Î·È Ë ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂӉ¯fiÌÂÓ˘ ÚfiˆÚ˘ ڋ͢ ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ Ô˘ ÂÎÙfi˜ ·fi ÙËÓ ÚfiÎÏËÛË ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, Úԉȷı¤ÙÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÚÒÈÌˆÓ ÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒ͈Ó, ÂÈ‚·Ú‡ÓÔÓÙ·˜ ÛËÌ·ÓÙÈο ÙÔ ÌÈÎÚfi ÚfiˆÚÔ Î·È ·ÓÒÚÈÌÔ ÓÂÔÁÓfi (17-20). ∫‡ÚÈÔ˜ ÛÙfi¯Ô˜ fiÏˆÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ È·ÙÚÈ΋ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô Â›Ó·È Ë ·Ó·ÛÙÔÏ‹ ‹ ¤ÛÙˆ Î·È Ë Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡. £ÂˆÚÂ›Ù·È ˆ˜ ÂÈÙ·ÎÙÈ΋ ·Ó¿ÁÎË Ë ÛˆÛÙ‹ ÂÓË̤ڈÛË Î·È ·È‰Â›· ÙfiÛÔ ÙˆÓ ÂÁ·ˆÓ fiÛÔ Î·È ÙˆÓ ÊÔÚ¤ˆÓ ÚˆÙÔ‚¿ıÌÈ·˜ ˘Á›·˜ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ÂÈ‚·Ú˘ÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ·

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ÚfiˆÚÔ ÙÔÎÂÙfi, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ·Ó·˙‹ÙËÛË ÊÚÔÓÙ›‰·˜ Û ÂÚÈÁÂÓÓËÙÈο ΤÓÙÚ· Èηӿ Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÙfiÛÔ ÙËÓ ¤ÁÎ˘Ô fiÛÔ Î·È ÙÔ ÚfiˆÚÔ ÓÂÔÁÓfi Ù˘ (4,9). ™ËÌ·ÓÙÈ΋ Â›Û˘ ıˆÚÂ›Ù·È Ë ÛÙÂϤ¯ˆÛË ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ Ì ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi Î·È Û‡Á¯ÚÔÓÔ Ù¯ÓÔÏÔÁÈÎfi ÂÍÔÏÈÛÌfi, ηıÒ˜ Î·È Ë ÔÚÁ¿ÓˆÛË ‰ÈÎÙ‡Ô˘ ÌÂÙ·ÊÔÚ¿˜ ÓÂÔÁÓÒÓ ÛÙÂϯˆÌ¤ÓÔ˘ Ì ¤ÌÂÈÚÔ˘˜ ÓÂÔÁÓÔÏfiÁÔ˘˜ Î·È Ì ۇÁ¯ÚÔÓÔ Ù¯ÓÔÏÔÁÈÎfi ÂÍÔÏÈÛÌfi, ÛÙÔÈ¯Â›Ô Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÛÙÔ ÓËÛ› Ì·˜. ªÂ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ı· ÂÚÈÔÚÈÛÙ› ηٿ ÙÔ ‰˘Ó·ÙfiÓ Ë ÂÈ‚¿Ú˘ÓÛË Ô˘ ˘Ê›ÛÙ·Ù·È ÙÔ ÓÂÔÁÓfi, Î·È È‰È·›ÙÂÚ· ÙÔ ÌÈÎÚfi ÚfiˆÚÔ, ηٿ ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ¤¯ÂÈ Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· (17). ™ËÌ·ÓÙÈ΋ ·Ú·Ù‹ÚËÛË ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·fi Ù· 6513 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙËÓ ∫Ú‹ÙË, Ù· 695 (ÔÛÔÛÙfi 10,67%) ÚÔ¤Ú¯ÔÓÙ·È ·fi ·ÏÏÔ‰·¤˜ ÔÈÎÔÁ¤ÓÂȘ, ΢ڛˆ˜ ÔÈÎÔÓÔÌÈÎÔ‡˜ ÚfiÛÊ˘Á˜ Ô˘ ¤¯Ô˘Ó ¤ÚıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· ·Ó·˙‹ÙËÛË ÂÚÁ·Û›·˜ ΢ڛˆ˜ ·fi ÙËÓ ∞Ï‚·Ó›·, ÙË µÔ˘ÏÁ·Ú›· Î·È ·fi ¯ÒÚ˜ Ù˘ ÚÒËÓ ™Ô‚ÈÂÙÈ΋˜ ŒÓˆÛ˘. ªÂ ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 1995 Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ‹Ù·Ó ηٿ Ôχ ÌÈÎÚfiÙÂÚÔ˜, ÛËÌÂÈÒÓÂÙ·È Ì›· Û¯ÂÙÈ΋ Ì›ˆÛË ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ·fi ÂÏÏËÓÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ. ∞fi ·˘Ù‹ ÙËÓ ·Ú·Ù‹ÚËÛË ˘ÔÛËÌ·›ÓÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ ÙÔ Úfi‚ÏËÌ· Ù˘ Ì›ˆÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÛÙËÓ ÂÏÏËÓÈ΋ ÔÈÎÔÁ¤ÓÂÈ·. ∞˘ÙÔ› ÔÈ ¿ÓıÚˆÔÈ, Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ, ˙Ô˘Ó ÛÂ Û˘Óı‹Î˜ οو ·fi Ù· fiÚÈ· Ù˘ ·ÓıÚÒÈÓ˘ ·ÍÈÔÚ¤ÂÈ·˜ Î·È ‰ÂÓ ¤¯Ô˘Ó ηÓÂÓfi˜ ›‰Ô˘˜ ÂÚÈÁÂÓÓËÙÈ΋ ÊÚÔÓÙ›‰· ·fi ÙȘ ˘ËÚÂۛ˜ ˘Á›·˜. ∏ ÚÔÛ¤ÁÁÈÛ‹ ÙÔ˘˜ ·fi ÙËÓ ÎÔÈÓˆÓÈ΋ ÚfiÓÔÈ· Î·È Ë Î·ıÔ‰‹ÁËÛ‹ ÙÔ˘˜ ÁÈ· ·Ó·˙‹ÙËÛË ·ÚÔ¯‹˜ ÂÚÈÁÂÓÓËÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ·fi ÙȘ ˘ËÚÂۛ˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁ›·˜ ı· ÌÔÚÔ‡Û ‰˘ÓËÙÈο Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ Â›Ù¢ÍË ÙÔ˘ ÛÙfi¯Ô˘ Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙË ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ÌÂȈı› ÛËÌ·ÓÙÈο. ∏ Ì›ˆÛ‹ Ù˘ ·Ô‰›‰ÂÙ·È ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú¯fiÌÂÓˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ÛÙËÓ ¤ÁÎ˘Ô ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔÁÓfi Ù˘. À¿Ú¯Ô˘Ó fï˜ ·ÎfiÌ· ÂÚÈıÒÚÈ· ‚ÂÏÙ›ˆÛ˘. ™Ùfi¯Ô˜ Ì·˜ Â›Ó·È Ë ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú¯fiÌÂÓˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ·ÏÏ¿ Î·È Û Â›Â‰Ô ‚ÂÏÙ›ˆÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ. ∂ÎÙfi˜ ·fi ÙȘ ÚÔÛ¿ıÂȘ ÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡, Ô˘

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Û ÌÂÚÈΤ˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ıˆÚÂ›Ù·È fiÙÈ ÍÂÂÚÓÔ‡Ó ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Î·È ÙȘ ·ÓÙÔ¯¤˜ Ù˘ ·ÓıÚÒÈÓ˘ ʇÛ˘ ÙÔ˘˜, Â›Ó·È ¯Ú‹ÛÈÌË Î·È ÂÈÙ·ÎÙÈ΋ Ë ‚Ô‹ıÂÈ· Ù˘ ¶ÔÏÈÙ›·˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Guyer B, Hoyert DL, Martin JA, Ventura SJ, MacDorman MF, Strobino DM. Annual summary of vital statistics-1998. Pediatrics 1999;104:1229-1246. 2. Richardus JH, Graafmans WC, Verloove-Vanhorick SP, Mackenbach JP. The perinatal mortality rate as an indicator of quality of care in international comparisons. Med Care 1998;36:54-66. 3. Forssas E, Gissler M, Hemminki E. Declining perinatal mortality in Finland between 1987 and 1994: Contribution of different subgroups. Eur J Obstet Gynecol Reprod Biol 1998;80:177-181. 4. Centers for Disease Control and Prevention. Achievements in public health, 1900-1999: Healthier mothers and babies. MMWR Morb Mortal Wkly Rep 1999;48:849-858. 5. Pearn J. Recent advances. Pediatrics-I: Infancy and early childhood. BMJ 1997;314:801-805. 6. Guyer B, Freedman MA, Strobino DM, Sondik EJ. Annual summary of vital statistics: trends in the health of Americans during the 20th century. Pediatrics 2000;106:1307-1317. 7. Rutstein SO. Factors associated with trends in infant and child mortality in developing countries during the 1990s. Bull World Health Organ 2000;78:1256-1270. 8. Lorenz JM. Survival of the extremely preterm infant in North America in the 1990s. Clin Perinatol 2000;27:255-262. 9. Goldenberg RL, Rouse DJ. Prevention of premature birth. N Engl J Med 1998;339:313-320. 10. Sepkowitz S. International statistics-incomparable. Pediatrics 1993;92:637. 11. ¢›Î·ÈÔ ÙˆÓ ÏËÍÈ·Ú¯ÈÎÒÓ ڿ͈Ó. ¡fiÌÔ˜ 344/1976 ¿ÚıÚÔ 37 “ÂÚ› ÏËÍÈ·Ú¯ÈÎÒÓ ڿ͈Ӕ. 12. Tzoumaka-Bakoula C. The Greek national perinatal survey: I: Design, methodology, case ascertainment. Pediatr Perinatal Epidemiol 1987;1:43-55. 13. ∆˙Ô˘Ì¿Î·-ª·ÎԇϷ Ã, §ÂΤ· µ, ∫·‚‚·‰›· °, ª·ÎÚ‹ ∞, KÔ˘ÙÛÔ‚›ÙË ¶, ª·ÙÛ·ÓÈÒÙË ¡. ¶Ú·ÎÙÈο Ù˘ ∞η‰ËÌ›·˜ ∞ıËÓÒÓ- 20Ë ∞ÚÈÏ›Ô˘ 2000; 101-112. 14. Mantagos S. Neonatal-perinatal care in Greece. J Perinatol 1997;17:156-160. 15. Sowards KA. What is the leading cause of infant mortality? A note on the interpretation of official statistics. Am J Public Health 1999;89:1752-1754. 16. Linhart Y, Bashiri A, Maymon E, Shoham-Vardi I, Furman B, Vardi H et al. Congenital anomalies are an independent risk factor for neonatal morbidity and perinatal mortality in preterm birth. Eur J Obstet Gynecol Reprod Biol 2000;90:43-49. 17. 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. 18. National Institutes of Health Consensus Development


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Panel on the effect of corticosteroids for fetal maturation on perinatal outcomes. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995;273:413418. 19. Schaap AH, Wolf H, Bruinse HW, Smolders-De Haas H, Van Ertbruggen I, Treffers PE. Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants. Obstet Gynecol 2001;97:954-960.

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20. Ernest JM. Neonatal consequences of preterm PROM. Clin Obstet Gynecol 1998;41:827-831. HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-09-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-02-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: ekibolos@med.uoc.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∏ ·ÈÙÈÔÏÔÁ›· Î·È Ë ¤Î‚·ÛË Ù˘ Ó¢ÌÔÓ›·˜ Û ·È‰È¿ Ì ۇӉÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (AIDS) Ô˘ ÂÈÛ‹¯ıËÛ·Ó Û ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ (ª∂£) ·Ó·Ù˘ÛÛfiÌÂÓ˘ ¯ÒÚ·˜1 ™ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, ÔÏÏ¿ ·È‰È¿ Ì Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV) ¯ÚÂÈ¿˙ÔÓÙ·È ÓÔÛËÏ›· ÛÙË ª∂£, fï˜ Ï›Á· Â›Ó·È ÁÓˆÛÙ¿ ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ Ó¢ÌÔÓ›·˜ Î·È ÙËÓ Â›‰Ú·ÛË Ù˘ ÓÔÛËÏ›·˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙË ª∂£. ™ÎÔfi˜: ∏ Û‡ÁÎÚÈÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È Ù˘ ¤Î‚·Û˘ Ù˘ Ó¢ÌÔÓ›·˜ Û HIV-ÔÚÚÔıÂÙÈÎÔ‡˜ [HIV(+)] Î·È HIV-ÔÚÚÔ·ÚÓËÙÈÎÔ‡˜ [HIV(-)] ·ÛıÂÓ›˜. ™¯Â‰È·ÛÌfi˜: ¶ÚÔÔÙÈ΋ ÌÂϤÙË. ÃÒÚÔ˜: ¢‡Ô ª∂£ ·È‰ÈÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ ∫·ÈËÙ¿Ô˘Ó ÛÙË ÓfiÙÈ· ∞ÊÚÈ΋. ∞ÛıÂÓ›˜: ŸÏ· Ù· ·È‰È¿ Ô˘ ÂÈÛ‹¯ıËÛ·Ó Ì Ó¢ÌÔÓ›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 1998. ªÂÙÚ‹ÛÂȘ Î·È Î˘ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù·: °È· ÙË ÌÂϤÙË ¤ÁÈÓÂ Û˘ÏÏÔÁ‹ ÎÏÈÓÈÎÒÓ, ‰ËÌÔÁÚ·ÊÈÎÒÓ, ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È ·Ó·Ó¢ÛÙÈÎÒÓ ‰Â‰Ô̤ӈÓ, ηıÒ˜ Î·È Ï‹„Ë ·›Ì·ÙÔ˜ ÁÈ· ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ. ¶Ù‡ÂÏ· ‹ ‚ÚÔÁ¯Ô΢„ÂÏȉÈÎfi ¤ÎÏ˘Ì· (BAL) ÂϤÁ¯ÔÓÙ·Ó ÁÈ· Ó¢ÌÔÓÔ·ÛÙË carinii (PC) Î·È Á·ÛÙÚÈÎfi ˘ÁÚfi ÁÈ· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (ª∫). 76 ·È‰È¿, ·fi Ù· ÔÔ›· Ù· 21 (27,6%) HIV(+), Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, 15/21 (71,4%) HIV(+) ·È‰È¿ ›¯·Ó AIDS. §Ô›ÌˆÍË ·fi PC ‰È·ÈÛÙÒıËΠ۠8 HIV(+) ·È‰È¿ [8/15 (38%) ÙˆÓ ·È‰ÈÒÓ Ì AIDS] Î·È Û 1 HIV(-). ™Â 7/15 (47%) HIV(+) ·ÛıÂÓ›˜, ‹Ù·Ó ÙÔ ›‰ÈÔ ÙÔ AIDS Ô˘ ηıfiÚÈ˙ ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ÓfiÛËÛ˘. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÌÈÎÚÔ‚È·ÈÌ›·˜ (15,3%) ‹Ù·Ó ›‰È· ÛÙ· HIV(+) Î·È HIV(-) ·È‰È¿ (15,8% ¤Ó·ÓÙÈ 15,1%, p=0,94). O Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ Î·È Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ‹Ù·Ó Ù· Û˘¯ÓfiÙÂÚ· ÛÙÂϤ¯Ë Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ÛÙÔ ·›Ì·. ∞fi Ù· Ù‡ÂÏ· Î·È ÙÔ BAL ·ÔÌÔÓÒıËÎ·Ó Ù· ›‰È· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë Î·È ÈÔ›, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ Î·È ÙÔ˘ ªµ

Û 6 (8%) ÂÚÈÙÒÛÂȘ, ·ÓÂÍ¿ÚÙËÙ· Ù˘ HIV(+) ‹ (-) ηٿÛÙ·Û˘. ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ (ª∞) ÂÊ·ÚÌfiÛÙËΠ۠8/21 ·ÛıÂÓ›˜ (38%) HIV(+) Î·È Û 28/55 (51%) HIV(-), (p=0,32). ∏ ̤ÛË ‰È¿ÚÎÂÈ· Û Ë̤Ú˜ ÙÔ˘ ª∞ (3), Ù˘ ÓÔÛËÏ›·˜ ÛÙË ª∂£ (5) Î·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (11) ‰ÂÓ ‰È¤ÊÂÚ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∏ ÂÓ‰ÔÓÔÛÔÎÔÌÂȷ΋ ıÓËÙfiÙËÙ· ‹Ù·Ó ‰ÈÏ¿ÛÈ· ÛÙÔ˘˜ HIV(+) ·ÛıÂÓ›˜ [6/21 (28,6%)] ·fi ÙÔ˘˜ HIV(-) ·ÛıÂÓ›˜ [8/55 (14,5%)], [Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (RR) 1,96, (p=0,16). ™˘ÌÂÚ¿ÛÌ·Ù·: ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 1/4 ÙˆÓ ·È‰ÈÒÓ Ù˘ ÁˆÁÚ·ÊÈ΋˜ ÂÚÈÔ¯‹˜ Ù˘ ÌÂϤÙ˘ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ ÁÈ· Ó¢ÌÔÓ›·, Â›Ó·È HIV(+), Ì ٷ ÈÔ ÔÏÏ¿ Ó· ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Ì ÙËÓ Â›ÛÔ‰Ô ÛÙË ª∂£. ∏ Ïԛ̈ÍË ·fi PC Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÁÈ· AIDS. ∆· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› ·fi ÙÔÓ Èfi [HIV(+)] Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÙË ª∂£ ÁÈ· Ó¢ÌÔÓ›·, ›¯·Ó ¯ÂÈÚfiÙÂÚË ¤Î‚·ÛË ·fi fiÙÈ Ù· HIV(-) ·È‰È¿, Ë ‰È·ÊÔÚ¿ fï˜ ·˘Ù‹ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ.

1 Zar H, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et al The etiology and outcome of pneumonia in human immunodeficiency virus-infected children admitted to intensive care in a developing country Pediatr Crit Care Med 2001;2:108-112

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ORIGINAL ARTICLE

™˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Î·È ·Ó›¯Ó¢ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ Î·È ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ¢. ÷Ù˙ËÁˆÚÁ›Ô˘1, ∂. ∫·Ó·‚¿Î˘2, Ã. ∆Û¿ÓÙ·ÏË3, J. Traeger-™˘ÓÔ‰ÈÓÔ‡2, Ã. ¡Ù·ÓÙ¿Ì˘1, ∂. ∫·ÓÙÂÚ¤-ªÂÎÈÒÙË1, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿3

Frequency of heterozygotes and detection of mutations for sickle-cell disease and b-thalassemia among high-school students of the prefecture of Karditsa D. Chatzigeorgiou1, E. Kanavakis2, C. Tsantali3, J. Traeger-Synodinos2, C. Dadamis1, E. Kantere-Bekioti1, M. Athanasiou-Metaxa3

¶ÂÚ›ÏË„Ë: ∂ÍÂÙ¿ÛÙËÎ·Ó 1048 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 14-16 ÂÙÒÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ÊÔÚ¤ˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Î·È Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜. µÚ¤ıËÎ·Ó 99 Ì·ıËÙ¤˜ ÊÔÚ›˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ (ÔÛÔÛÙfi 9,45%) Î·È 24 Ì·ıËÙ¤˜ ÊÔÚ›˜ Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ (ÔÛÔÛÙfi 2,29%). ∏ ·Ó›¯Ó¢ÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Û 86 ·fi ÙÔ˘˜ 99 ÊÔÚ›˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤‰ÂÈÍ fiÙÈ Ë Û˘¯ÓfiÙËÙ· Î·È Ô Ù‡Ô˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù¿ ÛÙÔ ÁÂÓÈÎfi ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi Ì ÌÈÎÚ¤˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤‰ÂÈÍ fiÙÈ ÙÔ 80% ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÙȘ ÙÚÂȘ ·ÎfiÏÔ˘ı˜: IVSI 110(G-A) (41,86%), cd39(C-T) (26,74%), IVSI 1(G-A) (11,63%). ∆· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù· ı· ‚ÔËı‹ÛÔ˘Ó Û ÚÔÁÚ¿ÌÌ·Ù· ·Ó›¯Ó¢Û˘ ÙˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Î·È ÁÂÓÈο ÛÙo ۯ‰ȷÛÌfi ÚfiÏ˄˘ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

Abstract: A total of 1048 high-school students of the prefecture of Karditsa were investigated for the detection of heterozygotes for b-thalassemia and sickle-cell anemia. Ninety-nine students were found to be heterozygotes for b-thalassemia (9.45%), and 24 to be heterozygotes for sickle-cell anemia (2.29%). The investigation for the responsible genetic mutations in 86 of the 99 heterozygotes of b-thalassemia showed that the frequency and the type of the mutations are similar to those reported in the general Greek population with only minor differentiations. DNA analysis revealed that eighty per cent of the mutations concerned mainly the three following: IVSI 110 (GA) (41.86%), cd39(C-T) (26.74%), IVSI 1(G-A) (11.63%). These findings will be usefull for the screening programs to detect genetic mutations of b-thalassemia, the prenatal diagnosis and generally for the prevention policy of this disease.

§¤ÍÂȘ ÎÏÂȉȿ: ‚-ı·Ï·ÛÛ·ÈÌ›·, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÌÂÙ·ÏÏ¿ÍÂȘ.

Key words: b-thalassemia, sickle-cell disease, mutations.

∏ ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· ·ÔÙÂÏÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ÎÏËÚÔÓÔÌÈο ÓÔÛ‹Ì·Ù· ÁÈ· ÙÔÓ ÏËı˘ÛÌfi Ù˘ ∂ÏÏ¿‰·˜. ™Â ÔÚÈṲ̂Ó˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ fiˆ˜ Ë Ã·ÏÎȉÈ΋, Ë ª˘ÙÈÏ‹ÓË Î·È Ë ∫·Ú‰›ÙÛ·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì ÙÔ

ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∏ ·Ó·˙‹ÙËÛË ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÁÈ· Û˘ÁÁÂÓ›˜ ·ÈÌÔÏ˘ÙÈΤ˜ ·Ó·È̛˜ Î·È Ë ÂÓË̤ڈۋ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ Èı·ÓfiÙËÙ· ·fiÎÙËÛ˘ ·È‰ÈÔ‡ Ì ¤Ó· ·fi Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿ ‹ ÌÂ Û˘Ó‰˘·ÛÌfi ÙÔ˘˜, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ÚfiÏË„‹ ÙÔ˘˜.

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡Ô̷گȷÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∫·Ú‰›ÙÛ·˜ 2 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 3 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢

1 Pediatric Clinic, General Hospital of Karditsa 2 Laboratory of Medical Genetics, University of Athens 3 1st Pediatric Clinic, Ippokration Hospital of Thessaloniki

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∏ ÂÚÁ·Û›· ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÛÎÔfi ÙËÓ ÂÓË̤ڈÛË ÙˆÓ Ì·ıËÙÒÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ÁÈ· Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿, ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ Ì·ıËÙÒÓ ÔÈ ÔÔ›ÔÈ Â›Ó·È ÊÔÚ›˜ ÙˆÓ Û˘ÁÁÂÓÒÓ ·˘ÙÒÓ ·ÈÌÔÏ˘ÙÈÎÒÓ ·Ó·ÈÌÈÒÓ, ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Î·È ÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ Û¯ÂÙÈο Ì ÙËÓ Èı·ÓfiÙËÙ· ·fiÎÙËÛ˘ ·È‰ÈÔ‡ Ì ¤Ó· ·fi ·˘Ù¿ Ù· ÓÔÛ‹Ì·Ù·.

ÛÙfi 12,98%), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 41 (30,15%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 95 (69,85%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. ™Â 55 Ì·ıËÙ¤˜ (5,25%) Û˘ÛÙ‹ıËΠÂ·ÓÂͤٷÛË ÁÈ·Ù› ÂÌÊ¿ÓÈ˙·Ó ÂËÚ·Ṳ̂ÓÔ˘˜ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ‡˜ ‰Â›ÎÙ˜ MCV, MCH, MCHC ‹ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ‹ ÔÚȷΤ˜ ÙÈ̤˜ HbA2. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ¤ÁÈÓ Û 86 ·fi ÙÔ˘˜ 99 Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ ÁÈ· ÙË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· (¶›Ó·Î·˜ 1).

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

™˘˙‹ÙËÛË ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ Ù˘ ‚ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÛÙÔ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi Ù˘ ∂ÏÏ¿‰·˜ Â›Ó·È ÂÚ›Ô˘ 7,5% (2). ™ÙË ÌÂϤÙË Ì·˜, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Ì·ıËÙÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ‹Ù·Ó 9,45%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ (p=0,06). ™Â ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∫·Ú‰›ÙÛ·˜ ›¯Â ‚ÚÂı› 18,15% (3), 14,2% (4) Î·È 9,8% (5). ªÂϤÙË Û ·È‰È¿ Ù˘ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜ ¤‰ÂÈÍÂ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓȉ›Ô˘ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÛÙÔ ÓÔÌfi Ù˘ £ÂÛÛ·ÏÔӛ΢ 2,69%, ÛÙÔ ÓÔÌfi Ù˘ ¶ÈÂÚ›·˜ 5,97% Î·È ÛÙÔ ÓÔÌfi Ù˘ ÷ÏÎȉÈ΋˜ 8,4% (6). ª›· ¿ÏÏË ¤Ú¢ӷ Û ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ÛÙÚ·ÙÈÒÙ˜ ›¯Â ‰Â›ÍÂÈ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ 7,9% (7). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ ÛÙË ÌÂϤÙË Ì·˜ ‚Ú¤ıËΠ2,29%. ™Â ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ÛÙÔÓ ›‰ÈÔ ÓÔÌfi, Ë Û˘¯ÓfiÙËÙ· ‹Ù·Ó 2,04% (3), 1,4% (4) Î·È 2% (5). OÈ ‰È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜ ·ÊÂÓfi˜ ·ÊÔÚÔ‡Ó ÛÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ ÛÙȘ Ôԛ˜ ¤ÁÈÓ·Ó ÔÈ ·Ú·¿Óˆ ÌÂϤÙ˜, ·ÊÂÙ¤ÚÔ˘ ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈıÌfi ÂÍÂÙ·˙fiÌÂÓˆÓ Û οı ÂÚ›ÙˆÛË. ¢È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ

∂ϤÁ¯ıËÎ·Ó 1048 Ì·ıËÙ¤˜ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜, ËÏÈΛ·˜ 14-16 ÂÙÒÓ. ™Â οı Á˘ÌÓ¿ÛÈÔ ¤Ó·˜ ÁÈ·ÙÚfi˜ Ù˘ ÂÚ¢ÓËÙÈ΋˜ ÔÌ¿‰·˜ ¤‰ÈÓ ̛· ÔÌÈÏ›· Û fiÏÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Û¯ÂÙÈο Ì ÙË ÌÂÛÔÁÂȷ΋ Î·È ÙË ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÙÔÓ ÙÚfiÔ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ¿˜ ÙÔ˘˜ Î·È ÙȘ ÌÂıfi‰Ô˘˜ ÚfiÏ˄˘ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ. ™ÙÔ˘˜ Ì·ıËÙ¤˜ Ù˘ ‰Â‡ÙÂÚ˘ Ù¿Í˘ ÙÔ˘ °˘ÌÓ·Û›Ô˘ (µ’), ÔÈ ÔÔ›ÔÈ ¤ÊÂÚ·Ó ÂÓ˘fiÁÚ·ÊË ÙË Û˘ÁηٿıÂÛË ÙÔ˘ ÁÔÓ¤·-ÎˉÂÌfiÓ· ÙÔ˘˜, ÁÈÓfiÙ·Ó ·ÈÌÔÏË„›· ·fi ÓÔÛËχÙÚȘ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∫·Ú‰›ÙÛ·˜. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ̤ÙÚËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ MCV, MCH, MCHC, RDW Ì ·ÈÌ·ÙÔÏÔÁÈÎfi ·Ó·Ï˘Ù‹, ÌÂϤÙË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, ̤ÙÚËÛË Ù˘ ÊÂÚÚÈÙ›Ó˘ ÙÔ˘ ÔÚÔ‡, ËÏÂÎÙÚÔÊfiÚËÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û ٷÈӛ˜ ÔÍÂ˚΋˜ ΢ÙÙ·Ú›Ó˘ Î·È Ì¤ÙÚËÛË ÙˆÓ ·ÈÌÔÛÊ·ÈÚÈÓÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ (HbA, HbA2, HbF, HbS). ∫ÚÈÙ‹ÚÈÔ ÁÈ· ÙÔ ¯·Ú·ÎÙËÚÈÛÌfi ÂÓfi˜ Ì·ıËÙ‹ ˆ˜ ÂÙÂÚÔ˙˘ÁÒÙË Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ ‹Ù·Ó Ë ·Ó‡ÚÂÛË HbS Û ÔÛÔÛÙfi 35-40% Î·È Ë ıÂÙÈ΋ ‰ÔÎÈÌ·Û›· ‰ÚÂ¿ÓˆÛ˘. ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙÔ ¯·Ú·ÎÙËÚÈÛÌfi ÂÓfi˜ Ì·ıËÙ‹ ˆ˜ ÂÙÂÚÔ˙˘ÁÒÙË Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‹Ù·Ó ÔÈ ¯·ÌËÏÔ› ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ› ‰Â›ÎÙ˜ MCV Î·È MCH, Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚÊÔÏÔÁ›· ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (·ÓÈÛÔ΢ÙÙ¿ÚˆÛË, ÔÈÎÈÏÔ΢ÙÙ¿ÚˆÛË, ˘ԯڈ̛·, ÌÈÎÚÔ΢ÙÙ¿ÚˆÛË) ÛÙÔ Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÔÛÔÛÙfi HbA2 >3,5%. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ˘‡ı˘ÓˆÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤ÁÈÓ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ·fi Ï¢ÎÔ·ÙÙ·Ú· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ÂÍ·ÁˆÁ‹˜ Ì ¿Ï·˜. ∞ÎÔÏÔ‡ıËÛ ËÏÂÎÙÚÔÊfiÚËÛË Û Á¤ÏË Ì ÎÏ‹ÛË ·ԉȷٷÎÙÈÎÒÓ Ô˘ÛÈÒÓ (DCGE Denaturing Gradient Gel Electroforesis) Î·È ÁÈ· οı ÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË ¤ÁÈÓ ÂȂ‚·›ˆÛË Ì ÙË Ì¤ıÔ‰Ô ARMS (Amplification Refractory Mutation System) (1).

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ˘˜ 1048 Ì·ıËÙ¤˜ Ô˘ ÂϤÁ¯ıËηÓ, ‚Ú¤ıËÎ·Ó ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ 99 (9,45%) Î·È ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ 24 Ì·ıËÙ¤˜ (2,29%). ™È‰ËÚÔÂÓ›· (ÊÂÚÚÈÙ›ÓË <10 ng/ml) ›¯·Ó 136 Ì·ıËÙ¤˜ (ÔÛÔ-

¶›Ó·Î·˜ 1. ∆‡Ô˜ Î·È Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ˘˜ Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ªÂÙ¿ÏÏ·ÍË IVS-110 (G-A) cd39 (C-T) IVS 1 (G-A) 0IVSII - 745 (C-G) cd5/A cd6/A ‰‚Mac/A ‰‚Lepore/A IVSI 5/A IVSI 6 (T-C) IVSII 1 (G-A)

∞ÚÈıÌfi˜ Ì·ıËÙÒÓ

™˘¯ÓfiÙËÙ· (%)

36 23 10 6 2 2 2 2 1 1 1

41,86 26,74 11,63 6,98 2,33 2,33 2,33 2,33 1,16 1,16 1,16

119


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·120

¶·È‰È·ÙÚÈ΋ 2002;65:118-121

Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‚Ú¤ıËÎ·Ó Î·È Û ÂÚÈÔ¯¤˜ ÙÔ˘ ›‰ÈÔ˘ ÓÔÌÔ‡. ™ÙÔ ÓÔÌfi Ù˘ ∫·Ú‰›ÙÛ·˜, Û Á˘ÌÓ¿ÛÈ· ÔÚÂÈÓÒÓ ÂÚÈÔ¯ÒÓ fiˆ˜ ÙÔ˘ ªÔ˘˙·Î›Ô˘ Î·È ÙÔ˘ §ÂÔÓÙ·Ú›Ô˘, Ë Û˘¯ÓfiÙËÙ· ‹Ù·Ó 4,11% Î·È 0% ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Û Á˘ÌÓ¿ÛÈ· ‰ÈÓÒÓ ÂÚÈÔ¯ÒÓ, fiˆ˜ ÙÔ˘ ¶·Ï·Ì¿ Î·È Ù˘ fiÏ˘ Ù˘ ∫·Ú‰›ÙÛ·˜, ‹Ù·Ó ·ÓÙ›ÛÙÔȯ· 14,28% Î·È 11,39%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ›Ûˆ˜ Û¯ÂÙ›˙ÂÙ·È Î·È Ì ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·Ú·ÌÔÓ‹ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁfiÓÔ˘ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ·ÔÙÂÏ› ÂÍÂÏÈÎÙÈ΋ ÚÔÛ·ÚÌÔÁ‹ Ì ÛÎÔfi ÙËÓ ·˘ÍË̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÂÏÔÓÔÛ›· Ô˘ ÂÓ‰ËÌÔ‡Û ÛÙȘ ‰ÈÓ¤˜ ÂÚÈÔ¯¤˜ (5). ™È‰ËÚÔÂÓ›· ‚Ú¤ıËΠ۠136 Ì·ıËÙ¤˜ (ÔÛÔÛÙfi 12,98%), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 41 ‹Ù·Ó ·ÁfiÚÈ· (30,15%) Î·È 95 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (69,85%). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÛȉËÚÔÂÓ›·˜ ÛÙËÓ fiÏË Ù˘ ∫·Ú‰›ÙÛ·˜ ‹Ù·Ó 14,38% (·ÛÙÈÎfi˜ ÏËı˘ÛÌfi˜), ÂÓÒ Û ·ÁÚÔÙÈΤ˜ Î·È ËÌÈ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó 12,019%. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ Û˘ÌʈÓÔ‡Ó Ì ÌÂϤÙË ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰·, fiÔ˘ ‚Ú¤ıËΠÛȉËÚÔÂÓ›· Û ̷ıËÙ¤˜ ËÌÈ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÏËı˘ÛÌÒÓ Û ÔÛÔÛÙfi 20,8% Î·È Û ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Û ÔÛÔÛÙfi 8,4% (7). OÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ Â›Ó·È Èı·Ófi Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Ô˘ ·ÊÔÚÔ‡Ó ÔÈ ‰‡Ô ÌÂϤÙ˜. ™ÙÔ˘˜ Ì·ıËÙ¤˜ ·˘ÙÔ‡˜ Û˘ÛÙ‹ıËÎÂ Ë Ï‹„Ë Ûȉ‹ÚÔ˘ ÁÈ· 3 Ì‹Ó˜ Î·È Ë Â·ÓÂͤٷۋ ÙÔ˘˜. ∂·ÓÂͤٷÛË Û˘ÛÙ‹ıËÎÂ Î·È Û 55 Ì·ıËÙ¤˜ (5,25%) ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÂËÚ·Ṳ̂ÓÔ˘˜ ÙÔ˘˜ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ‡˜ ‰Â›ÎÙ˜ MCV, MCH, MCHC ‹ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‹ ÔÚȷΤ˜ ÙÈ̤˜ Ù˘ HbA2 ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÊÔÚ¤ˆÓ Ù˘ ·-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ‹ ÊÔÚ¤ˆÓ ÙÔ˘ ÛȈËÚÔ‡ ÁfiÓÔ˘ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘ HbA2 (8). ∏ ·Ó¿Ï˘ÛË ÙÔ˘ DNA Û 86 ·fi ÙÔ˘˜ 99 Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ¤‰ÂÈÍ fiÙÈ ÙÔ 80,23% ·ÊÔÚ¿ Û ÙÚÂȘ ΢ڛˆ˜ ÌÂÙ·ÏÏ¿ÍÂȘ: IVSI 110(G-A), cd39(C-T) Î·È IVSI 1(G-A). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ Â›Ó·È ·ÚfiÌÔÈ· Ì ÂΛӷ ÌÂϤÙ˘ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Ù˘ ∂ÏÏ¿‰·˜ (10), ÂÓÒ ‰È·Ê¤ÚÔ˘Ó ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ·ÚfiÌÔÈ·˜ ÌÂϤÙ˘ ÛÙÔ ÓÔÌfi Ù˘ ª·ÁÓËÛ›·˜ fiÔ˘ ÙÔ 67,8% ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ›¯·Ó ÙȘ ·ÎfiÏÔ˘ı˜ ÌÂÙ·ÏÏ¿ÍÂȘ: IVSI 110(G-A), IVSI 6(T-C), cd39(C-T), IVSI 1(GA) (11). H Û˘¯ÓfiÙËÙ· Ù˘ ÌÂÙ¿ÏÏ·Í˘ IVSI 110(G-A) ÛÙÔÓ ÏËı˘ÛÌfi ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó 41,86%, ·ÚfiÌÔÈ· Ì ÙË Û˘¯ÓfiÙËÙ· ÛÙÔ ÁÂÓÈÎfi ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi (42,55%) (10), ÂÓÒ ‰È¤ÊÂÚ ·fi ÂΛÓË ÛÙË ÌÂϤÙË ÙÔ˘ ÓÔÌÔ‡ ª·ÁÓËÛ›·˜, fiÔ˘ ‹Ù·Ó 20,8% (11). ∏ ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÙ¿ÏÏ·ÍË ÛÙÔÓ ÏË-

120

Paediatriki 2002;65:118-121

ı˘ÛÌfi Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë cd39(C-T), fiˆ˜ Î·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, Ì ÙË ‰È·ÊÔÚ¿ fiÙÈ ÛÙÔ ‰Â›ÁÌ· Ì·˜ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Ì ÙË ÌÂÙ¿ÏÏ·ÍË cd39(C-T) ‹Ù·Ó 26,74%, ÂÓÒ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ‹Ù·Ó 16,95%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ (p=0,09). ∏ ÌÂÙ¿ÏÏ·ÍË IVSI 1(G-A) ‹Ù·Ó ÙÚ›ÙË ÛÂ Û˘¯ÓfiÙËÙ· Ì ÔÛÔÛÙfi 11,63%, Ô˘ Ï›ÁÔ ‰È·Ê¤ÚÂÈ ·fi ÙÔ ÔÛÔÛÙfi ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (13,22%). ∆¤Ù·ÚÙË, ÛÂ Û˘¯ÓfiÙËÙ·, ÌÂÙ¿ÏÏ·ÍË ÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó Ë IVSII 745(C-G) Ì ÔÛÔÛÙfi 6,98%, ·Ó¿ÏÔÁÔ Ì ·˘Ùfi ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (6,9%). ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ· Ù˘ ÌÂÙ¿ÏÏ·Í˘ IVSI 6(T-C) ÛÙË ÌÂϤÙË Ì·˜ (1,16%), ÂÓÒ ÙfiÛÔ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÛÔ Î·È ÛÙË ÌÂϤÙË Ù˘ ª·ÁÓËÛ›·˜ ‹Ù·Ó ˘„ËÏfiÙÂÚË, 7,18% (p=0,05) Î·È 18,7% (p=0,003) ·ÓÙ›ÛÙÔȯ·. OÈ ‰È·ÊÔÚ¤˜ Ì ÙË ÌÂϤÙË ÛÙÔ ÓÔÌfi Ù˘ ª·ÁÓËÛ›·˜ ›Ûˆ˜ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈıÌfi ÙˆÓ ÂÍÂÙ·˙fiÌÂÓˆÓ Û οı ÌÂϤÙË, ηıÒ˜ Î·È Ì ÙË ‰È·ÊÔÚÂÙÈ΋ ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹, ·Ó Î·È ÚfiÎÂÈÙ·È ÁÈ· fiÌÔÚÔ˘˜ ÓfiÌÔ˘˜ Ù˘ £ÂÛÛ·Ï›·˜. §ÈÁfiÙÂÚÔ Û˘¯Ó¤˜ ÌÂÙ·ÏÏ¿ÍÂȘ Ô˘ ·ÓȯÓ‡ıËÎ·Ó ÛÙË ÌÂϤÙË Ì·˜ ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: cd 5(-CT) 2,33%, cd6(-A) 2,33%, ‰‚Mac/A 2,33%, ‰‚ Lepore/A 2,33%, IVSI 5(G-A) 1,16% Î·È IVSII 1(GA) 1,16%. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Î·È Ù˘ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ Û ̷ıËÙ¤˜ ÙˆÓ °˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ‚Ú¤ıËΠӷ Â›Ó·È 9,45% Î·È 2,29% ·ÓÙ›ÛÙÔȯ·, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È ·ÚfiÌÔÈ· Ì ·˘Ù‹ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi Ì ÌÈÎÚ¤˜ ÌfiÓÔ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ. ¶ÈÛÙ‡ԢÌ fiÙÈ Ù· Â˘Ú‹Ì·Ù¿ Ì·˜ ·˘Ù¿ ı· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ˘‡ı˘ÓˆÓ ÁÔÓȉȷÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Ù˘ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Î·È ÁÂÓÈÎfiÙÂÚ· ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ·˘ÙÔ‡. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙȘ ÓÔÛËχÙÚȘ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ∫·Ú‰›ÙÛ·˜ Î. ∞ıËÓ¿ ª·Ó·Û‹ Î·È ∂˘·ÁÁÂÏ›· ¶·¿, ÙȘ ·Ú·Û΢¿ÛÙÚȘ ÙÔ˘ ∞ÈÌ·ÙÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Ù˘ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌ›Ԣ £ÂÛÛ·ÏÔӛ΢ Î. µ·ÛÈÏÈ΋ ∞ÏÂÙÚ¿ Î·È ª¿Á‰· ∫ˆÙԇϷ, ηıÒ˜ Î·È ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÁÈ· ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘˜ ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kanavakis E, Traeger-Synodinos J, Vrettou C, Maragoudaki E, Tzetis M, Kattamis C. Prenatal diagnosis of the thalassemia syndromes by rapid DNA analytical methods. Mol Hum Reprod 1997;3:523-528.


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2. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. µ-MÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. ∞ÈÎ. ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘, ÂÈÌÂÏËÙ‹˜. ¶Ú·ÎÙÈ΋ ¶·È‰È·ÙÚÈ΋. £ÂÛÛ·ÏÔÓ›ÎË: University Studio Press; 1999. ÛÂÏ. 611-612. 3. ™¯›˙·˜ ¡, ∆¤ÁÔ˜ ∫, µÔ˘ÙÛ·‰¿Î˘ ∞, ∞Ú·Ì·Ù˙‹˜ °, ∞ÁÁÂÏÔÔ‡ÏÔ˘ ¶, ÃÚ˘Û·ÓıfiÔ˘ÏÔ˜ ∫ Î·È Û˘Ó. ™˘¯ÓfiÙ˘ Î·È Î·Ù·ÓÔÌ‹ ‚-ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ Î·È ·ıÔÏÔÁÈÎÒÓ ·ÈÌÔÛÊ·ÈÚÈÓÒÓ ÂȘ ÙÔÓ ∂ÏÏËÓÈÎfiÓ ¯ÒÚÔÓ. ŒÚ¢ӷ Â› 15550 ÓÂÔÛ˘ÏϤÎÙˆÓ. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛË ∂ÏÏËÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:197-209. 4. Stamatoyannopoylos G, Fessas Ph. ∆halassemia, glucose6-phosphate dehydrogenase deficiency, sickling and malaria endemicity in Greece. Brit Med J 1964;1:875-880. 5. Barnicot NA, Allison AC, Blumberg BS, Deliyannis G, Krimbas C, Ballas A. Haemoglobin types in Greek populations. Ann Hum Genet 1963;26:229-237. 6. ∫·ÙÚÈÔ‡-¡ÈÎÔϷοÎË ¢, ™ÎÏ·‚Ô‡ÓÔ˘-∆ÛÔ˘ÚÔ˘ÎÙÛfiÁÏÔ˘ ™, ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º, ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª, ∫·Û›ÌÔ˜ Ã. ¶ÏËı˘ÛÌÈ΋ ¤Ú¢ӷ ÙˆÓ ·ÈÌÔÛÊ·ÈÚÈÓÔ·ıÂÈÒÓ ÂȘ ·È‰È¿ Ù˘ µÔÚ›Ԣ ∂ÏÏ¿‰Ô˜. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛË ∂ÏÏËÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:237-246. 7. ∫·ÙÙ¿Ì˘ Ã, ªÂٷ͈ÙÔ‡-ª·˘ÚÔÌÌ¿ÙË ∞, ∫ÔÓȉ¿Ú˘ ∫, ∆Ô˘ÏÈ¿ÙÔ˜ ¡, ∫ˆÛÙ¿ÓÙ˙·˜ ¡, ª·ÙÛ·ÓÈÒÙ˘ ¡. ™˘¯ÓfiÙ˘ ÛȉËÚÔÂÓÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ÛÙ›ÁÌ·ÙÔ˜ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜ ÂȘ ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ÛÙÚ·ÙÈÒÙ·˜. π·ÙÚÈ΋ ∂ÈıÂÒÚËÛË ∂ÏÏËÓÈÎÒÓ ∂ÓfiÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:229-235. 8. ∫ÂÚ·Ìȉ¿-∫·˚Ó·‰¿ ª. ∏ Â›‰Ú·ÛË ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È ÙÔ˘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ ÛÙËÓ ÂÌÊ¿-

Paediatriki 2002;65:118-121

ÓÈÛË ÛȉËÚÔÂÓ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· [¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. £ÂÛÛ·ÏÔÓ›ÎË: ∞¶£ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋: 1996. 9. Tzetis M, Traeger-Synodinos J, Kanavakis E, MetaxotouMavromati A, Kattamis C. The molecular basis of normal HbA2 (type 2) ‚-Thalassemia in Greece. Hematol Pathol 1994;8:25-34. 10. Kattamis C, Hu H, Cheng G, Reese AL, Gonzalez-Redondo M, Kutlar A et al. Molecular characterization of ‚thalassaemia in 174 Greek patients with thalassaemia major. Brit J Haematol 1990;74:342-346. 11. Nissiotou J, Vrettou C, Taeger-Synodinos J, Tzetis M, Kanavakis E, Zeikos G et al. Distribution of ‚-thalassemia mutations in a district of central Greece (Magnesia). Hellenic Association of medical genetics, 1st Balkan meeting on human genetics; 1994 August 31-September 3; Thessaloniki, Greece. 1994. p. 111.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-05-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ËÌ‹ÙÚÈÔ˜ ÷Ù˙ËÁˆÚÁ›Ô˘ ª¿ÚÎÔ˘ ªfiÙÛ·ÚË 41, ∆.∫. 601 00, ∫·ÙÂÚ›ÓË E-mail: dimchatz@otenet.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ¢È¿ÁÓˆÛË, ıÂÚ·›· Î·È ÓÔÛËÚfiÙËÙ· Û ·È‰È¿ Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (º¡∂)1 ∂ÈÛ·ÁˆÁ‹: ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ÛÙÔ ·ÚÂÏıfiÓ ÙfiÓÈ˙·Ó ÙË ÌÂÁ¿ÏË Î·ı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË ·È‰ÈÒÓ Ì º¡∂. ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ηٿ fiÛÔ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÁÈ· ÙË º¡∂ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Ô‰‹ÁËÛ ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, ‚ÂÏÙ›ˆÛË Ù˘ ıÂÚ·›·˜ Î·È ÂÏ¿ÙÙˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 112 ·È‰È¿ Ì º¡∂ (64 Ì ÓfiÛÔ Crohn, 41 Ì ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ·, 7 Ì ·ÚÔÛ‰ÈfiÚÈÛÙË ÎÔÏ›Ùȉ·), Ô˘ ·Ú·¤ÌÊıËÎ·Ó Û °·ÛÙÚÂÓÙÂÚÔÏÔÁÈÎfi ∆Ì‹Ì· ·fi ÙÔ 1994 ¤ˆ˜ ÙÔ 1998, ÌÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο. ™Ù· ·È‰È¿ Ì ÓfiÛÔ Crohn, Ô ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ ̤¯ÚÈ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 47 ‚‰ÔÌ¿‰Â˜ (maximum 7 ¤ÙË). ™Ù· ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ‰È¿ÚÚÔÈ·, Ë ‰È¿ÁÓˆÛË Î·ı˘ÛÙ¤ÚËÛ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ (66 ¤Ó·ÓÙÈ 28 ‚‰ÔÌ¿‰ˆÓ, p=0,005). O ̤ÛÔ˜ ¯ÚfiÓÔ˜ ‰È¿ÁÓˆÛ˘ ÁÈ· Ù· ·È‰È¿ Ì ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ· ‹Ù·Ó 20 ‚‰ÔÌ¿‰Â˜ (maximum 3 ¤ÙË). ∂›Ó·È ÂӉȷʤÚÔÓ fiÙÈ Û ·È‰È¿ Ì ‚·ÚÈ¿ ÎÔÏ›Ùȉ· Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ ÌÂÙ¿ ·fi 5,5 ‚‰ÔÌ¿‰Â˜ Î·È 4 ·fi ·˘Ù¿ ¯ÚÂÈ¿ÛÙËÎ·Ó ¿ÌÂÛË ÎÔÏÂÎÙÔÌ‹. ∞ÚÎÂÙ¿ ·È‰È¿ Ì ÓfiÛÔ Crohn ›¯·Ó ˘Ô‚ÏËı› Û ÌË ·Ô‰ÂÎÙ¤˜ ıÂÚ·›˜, fiˆ˜ ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ‹ „˘¯ÔÊ·Ú̿ΈÓ. ¢¤Î· ÂÓÓ¤· (17%) ›¯·Ó ˘Ô‚ÏËı› Û ÂÓ‰ÔÛÎfiËÛË Û ÓÔÛÔÎÔÌ›· ÂÓËϛΈÓ. ∏ ˘ÔıÚ„›· ‹Ù·Ó ÙÔ ›‰ÈÔ Û˘¯Ó‹ Û ·È‰È¿ Ì Crohn Î·È Ì ÂÏ-

ÎÒ‰Ë ÎÔÏ›Ùȉ· (11%). ∫ÔÓÙfi ·Ó¿ÛÙËÌ· ›¯Â ÙÔ 19% ÙˆÓ ·È‰ÈÒÓ Ì Crohn Î·È ÙÔ 5% ·˘ÙÒÓ Ì ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ·. µÚ¤ıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙÔ˘ ‚·ıÌÔ‡ Ù˘ ‰˘ÛÙÚÔÊ›·˜ (p=0,004). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ηı˘ÛÙ¤ÚËÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È Ë ÌË ÛˆÛÙ‹ ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ·ÎfiÌË ÛËÌ·ÓÙÈο ÚÔ‚Ï‹Ì·Ù· ÁÈ· ÙË º¡∂ ÛÙËÓ ·È‰È΋ ËÏÈΛ·.

1 Spray C, Debelle G, Murphy M Current diagnosis, management and morbidity in paediatric inflammatory bowel disease Acta Paediatr 2001;90:400-405

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ· ¶·È‰›·ÙÚÔ˜-°·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

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Paediatriki 2002;65:122-127

ORIGINAL ARTICLE

¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ÂÚÈÔ¯‹˜ µ¿Ú˘ ∞ÙÙÈ΋˜ ∂. ª·Ú·ÁοÎË1, °. °·Ï¿ÓË1, ª. °ÂÌÂÏÈ¿ÚË1, Ã. ∫ÒÛÙ·ÏÔ˜2, ¢. ¶··‰ÔÔ‡ÏÔ˘1, ¡. º·Ú¿ÎÏ·˜1

Body fat indices of school-aged children of the Vari region in Attica ∂. ªarangaki1, G. Galani1, ª. Yemeliari1, C. Costalos2, D. Papadopoulou1, ¡. Faraklas1

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Ì·˜ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ÂÚÈÔ¯‹˜ µ¿Ú˘ ∞ÙÙÈ΋˜. °È· ÙË ÌÂϤÙË ¯ÚËÛÈÌÔÔÈ‹ıËΠ‰Â›ÁÌ· 635 ˘ÁÈÒÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 5-16 ÂÙÒÓ. ø˜ ‰Â›ÎÙ˜ ·Ó¿Ù˘Í˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î·È ÙÔ ‡„Ô˜, ·fi Ù· ÔÔ›· ˘ÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™). ™Â fiÛ· ·È‰È¿ ‹Ù·Ó ¿Óˆ ÙˆÓ 8 ÂÙÒÓ ˘ÔÏÔÁ›ÛÙËÎÂ Î·È Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (%) Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘. OÈ ÛˆÌ·ÙÔÌÂÙÚÈΤ˜ ÙÈ̤˜ Ù˘ ÌÂϤÙ˘ Ì·˜, ÙfiÛÔ ÁÈ· ÙÔ ¢ª™ fiÛÔ Î·È ÁÈ· ÙÔ Ï›Ô˜, Â›Ó·È ˘„ËÏfiÙÂÚ˜ Û ۇÁÎÚÈÛË Ì ٷ ‰ÈÂıÓ‹ ÚfiÙ˘·. ª¤ÁÈÛÙ˜ ÙÈ̤˜ Ï›Ô˘˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ ÁÈ· Ù· ·ÁfiÚÈ· Î·È ÙˆÓ 15 ÂÙÒÓ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ™‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ¤‰ÂÈÍ fiÙÈ Ù· ·ÁfiÚÈ· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ Ï›Ô˜ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ, ÂÓÒ ÌÂÙ¿ Ù· 10 ¤ÙË, Ë Û¯¤ÛË ·˘Ù‹ ·ÓÙÈÛÙÚ¤ÊÂÙ·È ˘¤Ú ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∏ ̤ÙÚËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ Â›Ó·È Â‡¯ÚËÛÙË, ÁÚ‹ÁÔÚË Î·È ÔÈÎÔÓÔÌÈ΋.

Abstract: Assessment of body composition provides important data on nutritional status and quality of growth in children. Limited data are available, however, on the body composition of human infants due to limitation of existing methods of measurement. The aim of the present study was to assess the growth of 635 healthy Greek children aged 5 to 16 years, from the Vari area of Attica Greece. Body mass index (BMI) was estimated in all children while body fat content was assessed by bioelectric impedance analysis in those children who were 8 to 16 years of age. From the present survey it is concluded that the mean BMI and the fat content in both sexes exceed US growth standards. Maximum fat accretion was noted at the age of 13 for boys and 15 for girls. Comparison of both sexes revealed that boys have more body fat up to the age of 10 years after which body fat content in girls exceeds that of boys. Bioelectric impedance analysis constitutes a useful, quick and economic method for estimating body fat content in children.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡ÓıÂÛË ÛÒÌ·ÙÔ˜, ۈ̷ÙÈÎfi Ï›Ô˜, ‚ÈÔËÏÂÎÙÚÈ΋ ·ÓÙ›ÛÙ·ÛË, ·È‰›.

Key words: body composition, body fat content, bioelectric impedance.

∏ ÂÎÙ›ÌËÛË Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ·Ú¤¯ÂÈ ÔχÙÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È·ÈÙËÙÈ΋ ηٿÛÙ·ÛË Î·È ÙËÓ ÔÈfiÙËÙ· ·Ó¿Ù˘Í˘ ÂÓfi˜ ·È‰ÈÔ‡. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Û‹ÌÂÚ· Ë ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÎÔÈÓˆÓÈÎfi ·ÏÏ¿ Î·È ˘ÁÂÈÔÓÔÌÈÎfi Úfi‚ÏËÌ· ÁÈ· Ù· ·È‰È¿ Ù˘ ¯ÒÚ·˜ Ì·˜, ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ·Ó¿ÁÎË ÁÈ· ÙË ¯ÚËÛÈÌÔÔ›ËÛË ·ÍÈfiÈÛÙˆÓ ÌÂıfi‰ˆÓ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ÔÚıÔÏÔÁÈο Ë ·¯˘Û·ÚΛ·. OÈ ÏËÚÔÊÔڛ˜ Ô˘ ¤¯Ô˘Ì ÁÈ· ÙË Û‡-

ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜ Î·È ·˘Ùfi ÁÈ·Ù› ‰ÂÓ ˘‹Ú¯·Ó ̤¯ÚÈ ÚfiÛÊ·Ù· ·Ϥ˜ Î·È ·ÍÈfiÈÛÙ˜ ̤ıÔ‰ÔÈ ÂÎÙ›ÌËÛ˘. ∏ ÈÔ ·Ï‹ ̤ıÔ‰Ô˜ ˘ÔÏÔÁÈÛÌÔ‡ ÙÔ˘ ÔÏÈÎÔ‡ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Á›ÓÂÙ·È Ì ̤ÙÚËÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ (1), Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙÔ˘ ‚Ú·¯›ÔÓ· (2) ‹ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) (3,4). OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜, ·Ó Î·È ·Ϥ˜, ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ·ÍÈfiÈÛÙ˜. ∏ ̤ÙÚËÛË Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ¿Ô„Ë fiÙÈ Ë ÔÛfiÙËÙ· ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜

1 ∫¤ÓÙÚÔ ÀÁ›·˜ µ¿Ú˘ 2 ¶° ¡ÔÛÔÎÔÌÂ›Ô ∞ÏÂÍ¿Ó‰Ú· ∞ıËÓÒÓ

1 Vari Health Center, Athens 2 Alexandra General Hospital, Athens

122


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·123

¶·È‰È·ÙÚÈ΋ 2002;65:122-127

·ÔÙÂÏ› ‰Â›ÎÙË Ù˘ ÔÏÈ΋˜ ÔÛfiÙËÙ·˜ ÙÔ˘ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, ηıÒ˜ Î·È ÛÙÔ Âȯ›ÚËÌ· fiÙÈ ÔÈ ı¤ÛÂȘ ·’ fiÔ˘ Á›ÓÂÙ·È Ë Ì¤ÙÚËÛË Â›Ó·È ·ÓÙÈÚÔÛˆ¢ÙÈΤ˜ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ fiÏÔ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. •¤ÚÔ˘ÌÂ, fï˜, Û‹ÌÂÚ· fiÙÈ Ù· ‰‡Ô ·˘Ù¿ ÂȯÂÈÚ‹Ì·Ù· ‰ÂÓ Â˘ÛÙ·ıÔ‡Ó (5,6). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹, Â›Û˘, ‰ÂÓ Â›Ó·È Ôχ ·ÓÙÈÎÂÈÌÂÓÈ΋, ·ÊÔ‡ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÌÂÈÚ›· - ‹ fi¯È - ÙÔ˘ ÂÍÂÙ·ÛÙ‹. ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ ¿ÏÈ Ì¤Ûˆ Ù˘ ̤ÙÚËÛ˘ Ù˘ ÂÚÈ̤ÙÚÔ˘ ÙÔ˘ ‚Ú·¯›ÔÓ· Î·È ÙÔ˘ ¢ª™ ·ÔÙÂÏ› ÌfiÓÔ ¤ÌÌÂÛË Ì¤ıfi‰Ô Î·È ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ¿Ô„Ë fiÙÈ Ë Û¯¤ÛË Ï›Ô˘˜/¿ÏÈˆÓ ÈÛÙÒÓ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ÛÙ·ıÂÚ‹, ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ Â˘ÛÙ·ı› (7). ∞fi ÙȘ ÌÂıfi‰Ô˘˜ ¿ÌÂÛ˘ ̤ÙÚËÛ˘ ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜, Ë ·Ï·ÈfiÙÂÚË Â›Ó·È ·˘Ù‹ Ô˘ ÛÙËÚ›˙ÂÙ·È Û ÂÎÙ›ÌËÛË Ù˘ ˘ÎÓfiÙËÙ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÌÂÙ¿ ·fi ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ·¤Ú· Î·È ÓÂÚfi (8). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ Â›Ó·È Ù¯ÓÈο ‰‡ÛÎÔÏË Î·È fi¯È ÙfiÛÔ ·ÎÚÈ‚‹˜, ÂȉÈο ÁÈ· ·È‰È¿. ¶ÈÔ ·ÎÚȂ›˜ ̤ıÔ‰ÔÈ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ·˘Ù¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó Ú·‰ÈÔ˚ÛfiÙÔ· (Ú·‰ÈÂÓÂÚÁfi ‡‰ˆÚ ‹ οÏÈÔ) (9-11), ηıÒ˜ Î·È ·˘Ù¤˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·È Û ÂÓÂÚÁÔÔ›ËÛË ÓÂÙÚÔÓ›ˆÓ (7). ∆Ô ˘„ËÏfi ÙÔ˘˜ ÎfiÛÙÔ˜ Î·È Ë ¤ÎıÂÛË Û ڷ‰ÈÂÓ¤ÚÁÂÈ· ηıÈÛÙÔ‡Ó ÙȘ ÌÂıfi‰Ô˘˜ ·˘Ù¤˜ ·Î·Ù¿ÏÏËϘ ÁÈ· ¢Ú›· ¯Ú‹ÛË Û ·È‰È¿. ¶ÈÔ ÚfiÛÊ·Ù· ΢ÎÏÔÊfiÚËÛ ̛· ¿ÏÏË Ì¤ıÔ‰Ô˜ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ̤ۈ ̤ÙÚËÛ˘ Ù˘ ËÏÂÎÙÚÈ΋˜ ·ÁˆÁÈÌfiÙËÙ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÌÂÙ¿ ·fi ÙÔÔı¤ÙËÛË ÙÔ˘ ÂÍÂÙ·˙fiÌÂÓÔ˘ Û ËÏÂÎÙÚÔÌ·ÁÓËÙÈο ‰›· (TABEC) (12). ∆· ÏÂÔÓÂÎÙ‹Ì·Ù· Ù˘ ÌÂıfi‰Ô˘ ·˘Ù‹˜ Â›Ó·È Ë ÌÂÁ¿ÏË ·ÎÚ›‚ÂÈ· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ·Ú¤¯ÂÈ Î·È Ë ·Ô˘Û›· ÔÔÈÔ˘‰‹ÔÙ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙÔ ·È‰›. ªÂÈÔÓ¤ÎÙËÌ· ·ÔÙÂÏ› ÙÔ ˘„ËÏfi ÎfiÛÙÔ˜ Î·È Ô ÌÂÁ¿ÏÔ˜ ¯ÚfiÓÔ˜ Ô˘ ··ÈÙÂ›Ù·È ÁÈ· οı ÂͤٷÛË. ª›· Ó¤· ̤ıÔ‰Ô˜ ÂÎÙ›ÌËÛ˘ Ù˘ Û‡ÓıÂÛ˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È Ì¤Ûˆ ̤ÙÚËÛ˘ Ù˘ ËÏÂÎÙÚÈ΋˜ ·ÓÙ›ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ÛÙËÚ›˙ÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂχıÂÚÔÈ Ï›Ô˘˜ ÈÛÙÔ› ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ËÏÂÎÙÚÔχÙ˜ Î·È ‡‰ˆÚ, ¿Ú· Î·È ÌÂÁ·Ï‡ÙÂÚË ·ÁˆÁÈÌfiÙËÙ· ·’ fiÙÈ Ô ÏÈ҉˘ ÈÛÙfi˜ Î·È Ù· ÔÛÙ¿. ∞˘Ù‹ Ë ‰È·ÊÔÚ¿ ÛÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ËÏÂÎÙÚÔχÙ˜ Î·È ÛÙËÓ ·ÁˆÁÈÌfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÈÛÙÒÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÔÛfiÙËÙ·˜ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ ÙÔ˘ ÛÒÌ·ÙÔ˜ Ì ‚¿ÛË ÙËÓ ËÏÂÎÙÚÈ΋ ÙÔ˘ ·ÁˆÁÈÌfiÙËÙ· (13). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ·ԉ›¯ıËΠÚ·ÎÙÈ΋, ¯Ú‹ÛÈÌË Î·È ·ÍÈfiÈÛÙË ÙfiÛÔ Û ÂÓ‹ÏÈΘ (14,15), fiÛÔ Î·È Û ·È‰È¿ (16-18). ∞˘Ù‹ ÙË Ì¤ıÔ‰Ô ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ Î·È ÂÌ›˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ÔÔ›· ›¯Â ÛÎÔfi Ó· ÂÎÙÈÌ‹ÛÂÈ ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘

Paediatriki 2002;65:122-127

ÂÚÈÔ¯‹˜ µ¿Ú˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÂÈ Û‡ÁÎÚÈÛË Ì ٷ ˘¿Ú¯ÔÓÙ· ‰ÈÂıÓ‹ ÚfiÙ˘· Î·È Ó· ÂÓÙÔÈÛÙ› ÙÔ ÔÛÔÛÙfi ·¯˘Û·ÚΛ·˜ Û ·˘ÙfiÓ ÙÔÓ ÏËı˘ÛÌfi. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó Û˘ÓÔÏÈο 635 ˘ÁÈ‹ ·È‰È¿ - 307 ·ÁfiÚÈ· Î·È 328 ÎÔÚ›ÙÛÈ· - ËÏÈΛ·˜ 5-16 ÂÙÒÓ. ŸÏ· Ù· ·È‰È¿ ‹Ù·Ó ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜. OÈ ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ÛÙÔ ∫¤ÓÙÚÔ ÀÁ›·˜ µ¿Ú˘ ÛÙËÓ ÂÚ›Ô‰Ô 1995-2000, ηٿ ÙË ‰È¿ÚÎÂÈ· Â›Û΄˘ ÙˆÓ ·È‰ÈÒÓ ÛÙÔ ·È‰È·ÙÚÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô ÛÙ· Ï·›ÛÈ· ÁÂÓÈ΋˜ ÂͤٷÛ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔ˘˜ ¯ÔÚËÁËı› ÈÛÙÔÔÈËÙÈÎfi ˘Á›·˜ ‹ Ó· ÙÔ˘˜ Á›ÓÂÈ ÂÌ‚ÔÏÈ·ÛÌfi˜. ŸÏ˜ ÔÈ ÌÂÙÚ‹ÛÂȘ ¤ÁÈÓ·Ó ·fi Ù· ›‰È· ¿ÙÔÌ· (∂ª, °° Î·È ª°). ∏ ‰È·‰Èηۛ· Ô˘ ·ÎÔÏÔ˘ı‹ıËΠ‹Ù·Ó Ë ÂÍ‹˜: ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, ÂÈϤ¯ıËÎ·Ó fiÛ· ·ÚÔ˘Û›·˙·Ó ·fiÎÏÈÛË Ì¤¯ÚÈ 3 ÙÔ Ôχ Ì‹Ó˜ ·fi ÙȘ ·Ú·¿Óˆ ËÏÈ˘. ∏ ÂͤٷÛË ÁÈÓfiÙ·Ó 2-3 ÒÚ˜ ÌÂÙ¿ ÙÔ ÙÂÏÂ˘Ù·›Ô Á‡̷, ÂÊ’ fiÛÔÓ ‰ÂÓ Â›¯Â ÚÔËÁËı› ۈ̷ÙÈ΋ ¿ÛÎËÛË ÁÈ· 12 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÒÚ˜, Ô‡Ù ϋ„Ë Î·Ê¤ ‹ ‰ÈÔ˘ÚËÙÈÎÒÓ Î·È Ë ÂÓ˘‰¿ÙˆÛ‹ ÙÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ¶ÚÈÓ ·fi ÙËÓ ÂͤٷÛË ÚÔËÁ‹ıËΠ̤ÙÚËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Ì ˙˘Á·ÚÈ¿ ‰¿ÊÔ˘˜ Ù‡Ô˘ Secca ·ÎÚ›‚ÂÈ·˜ ±100 gr, ÌÂÙ¿ ·fi ·Ê·›ÚÂÛË ÙˆÓ ÂÓ‰˘Ì¿ÙˆÓ Î·È ÙˆÓ ˘Ô‰ËÌ¿ÙˆÓ. ∆Ô ‡„Ô˜ ÂÎÙÈÌ‹ıËΠ̠·Ó·ÛÙËÌfiÌÂÙÚÔ ÙÔ›¯Ô˘. ™Â οı ·È‰› Á›ÓÔÓÙ·Ó ÙÚÂȘ ·ÏÏÂ¿ÏÏËϘ ÌÂÙÚ‹ÛÂȘ Î·È ÂÏ‹ÊıË Ô Ì¤ÛÔ˜ fiÚÔ˜. O ‰Â›ÎÙ˘ ۈ̷ÙÈ΋˜ Ì¿˙·˜ (¢™ª) ÂÎÙÈÌ‹ıËΠ̠‚¿ÛË ÙÔÓ Ù‡Ô ¢™ª=µ (kg)/⁄„Ô˜ (m)2. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ·Ó·Ï˘Ù‹˜ Ï›Ô˘˜ Ù˘ Maltron (Maltron Ltd Essex, England) Ô˘ ÛÙËÚ›˙ÂÙ·È ÛÙË Ì¤ıÔ‰Ô Ù˘ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜. ø˜ ÁÓˆÛÙfi, Ë ¿·¯Ë Ì¿˙· ÙÔ˘ ÛÒÌ·ÙÔ˜ ¤¯ÂÈ Ôχ ÌÂÁ·Ï‡ÙÂÚË ·ÁˆÁÈÌfiÙËÙ· ·fi ÙÔ Ï›Ô˜ ÏfiÁˆ ÌÂÁ·Ï‡ÙÂÚ˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ËÏÂÎÙÚÔχÙ˜. O ·Ó·Ï˘Ù‹˜ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ ÌÂÙÚ¿ÂÈ ÙË ÚÔ‹ ËÏÂÎÙÚÈÛÌÔ‡ fiˆ˜ ·˘Ùfi˜ ÂÚÓ¿ÂÈ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Ï›Ô˘˜, ÙˆÓ ¿·¯ˆÓ ÈÛÙÒÓ Î·È ÙÔ˘ ‡‰·ÙÔ˜. ŒÙÛÈ, ÙÔ Ì˯¿ÓËÌ· ‰ÈÔ¯ÂÙ‡ÂÈ ËÏÂÎÙÚÈÎfi Ú‡̷ ¯·ÌËÏ‹˜ Ù¿Û˘ (6v) ̤ۈ 4 ·ÈÛıËÙ‹ÚˆÓ Î·È Î·Ù·ÁÚ¿ÊÂÈ ÙȘ ËÏÂÎÙÚÈΤ˜ ‚ÈÔ·ÓÙÈÛÙ¿ÛÂȘ, ‰ËÏ·‰‹ ÙËÓ È‰ÈfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Ó· ÂÈ‚Ú·‰‡ÓÂÈ ÙÔÓ ËÏÂÎÙÚÈÛÌfi, ηıÒ˜ ·˘Ùfi˜ ‰È¤Ú¯ÂÙ·È Ì¤Ûˆ ‰È·ÊfiÚˆÓ ÈÛÙÒÓ Ì ‰È·ÊÔÚÂÙÈ΋ ·ÁˆÁÈÌfiÙËÙ· (Ï›Ô˜, ¿·¯ÔÈ ÈÛÙÔ›, ‡‰ˆÚ). ªÂÙ¿ ·fi ÂÈÛ·ÁˆÁ‹ ÙˆÓ ÛÙÔȯ›ˆÓ ʇÏÔ˘, ËÏÈΛ·˜, ‚¿ÚÔ˘˜ Î·È ‡„Ô˘˜, ÙÔ ·È‰› ÙÔÔıÂÙÂ›Ù·È Û ηٷÎÂÎÏÈ̤ÓË ‡ÙÈ· ı¤ÛË. ∆ÔÔıÂÙÔ‡ÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ· 2 ·ÈÛıËÙ‹Ú˜ ÛÙÔ ‰ÂÍ› ¯¤ÚÈ Î·È 2 ÛÙÔ ‰ÂÍ› fi‰È ÙÔ˘ ·È‰ÈÔ‡ Î·È ‰ÈÔ¯ÂÙ‡ÂÙ·È ËÏÂÎÙÚÈÎfi Ú‡̷ 1 mA Û˘¯ÓfiÙËÙ·˜ 50 KHz ̤ۈ 2 ËÏÂÎÙÚÈÎÒÓ ÛÙËÏÒÓ. ªÂÙ¿ ·fi ‰È¿ÛÙËÌ· ÌÈÎÚfiÙÂÚÔ ÙˆÓ 10 sec, Ë Û˘Û΢‹ Ì¿˜ ‰Â›¯ÓÂÈ ÛÙËÓ ÔıfiÓË ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (%). ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ ¤ÁÈÓ ÌfiÓÔ ÛÙ· ·È‰È¿ ÂΛӷ Ô˘ ›¯·Ó ËÏÈΛ· ¿Óˆ ÙˆÓ 8 ÂÙÒÓ, ·ÊÔ‡ ÙÔ Ì˯¿ÓËÌ· ·˘Ùfi ·‰˘Ó·Ù› Ó· ÌÂÙÚ‹ÛÂÈ ÙË Û‡ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ·È‰È¿ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜.

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¶·È‰È·ÙÚÈ΋ 2002;65:122-127

Paediatriki 2002;65:122-127

∞ÔÙ��ϤÛÌ·Ù· ∆· ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙÔ ÛˆÌ·ÙÈÎfi Ï›Ô˜ (%) Î·È ÙÔ ¢ª™ ÎÔÚÈÙÛÈÒÓ Î·È ·ÁÔÚÈÒÓ Ù˘ ÌÂϤÙ˘ ηٷÁÚ¿ÊÔÓÙ·È ÙfiÛÔ ÛÙÔ˘˜ ¶›Ó·Î˜ 1 Î·È 2 (̤ÛË ÙÈÌ‹ Î·È 1 ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË), fiÛÔ Î·È ÛÙ· ™¯‹Ì·Ù· 1, 2, 3, 4 (̤ÛË ÙÈÌ‹, 1 Î·È 2 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ). ™˘˙‹ÙËÛË ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡. ŒÙÛÈ, fi¯È ÌfiÓÔ Î¿ı ¯ÒÚ·, ·ÏÏ¿ ·ÎfiÌË Î·È ‰È·ÊÔÚÂÙÈΤ˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ ̤۷ ÛÙËÓ ›‰È· ¯ÒÚ· ¤¯Ô˘Ó ‰È·ÌÔÚÊÒÛÂÈ Ù· ‰Èο ÙÔ˘˜ ÚfiÙ˘· ·Ó¿Ù˘Í˘ Î·È ‰È·ÙËÚÔ‡Ó Î¿ÔȘ ȉȷÈÙÂÚfiÙËÙ˜ Û fi,ÙÈ ·ÊÔÚ¿ ÙÔ˘˜ Ú˘ıÌÔ‡˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ (19). ∞˘Ùfi˜ Â›Ó·È Ô ÏfiÁÔ˜ Ô˘ Ì·˜ ÒıËÛ ӷ ÌÂÏÂÙ‹ÛÔ˘Ì ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ì›·˜ Û˘ÁÎÂÎÚÈ̤Ó˘ ÂÚÈÔ¯‹˜ Ù˘ ∞ÙÙÈ΋˜ Ô˘ ·ÔÙÂÏÂ›Ù·È ÙfiÛÔ ·fi ·ÛÙÈÎfi, fiÛÔ Î·È ·fi ·ÁÚÔÙÈÎfi ÏËı˘ÛÌfi. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ‰È·ÛÙڈ̷ÙÈ΋˜ Ì·˜ ÌÂϤÙ˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô ¢™ª ÛÙ· ·È‰È¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚÔ˜ Û fiϘ ÙȘ ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ·, Û ۯ¤ÛË Ì ͤÓ˜ ÌÂϤÙ˜ (20-22), ÂÓÒ Â›Ó·È Û˘ÁÎÚ›ÛÈÌ· Ì ÂΛӷ ÌÂϤÙ˘ Ô˘ ¤ÁÈÓ Û ·È‰È¿ Ù˘ ™ËÙ›·˜ ∫Ú‹Ù˘ (23), ηıÒ˜ Î·È ·˘Ù‹˜ ·È‰ÈÒÓ Ù˘ ∫‡ÚÔ˘ (24) Ô˘ ¤ÁÈÓ ÚfiÛÊ·Ù·. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ ÛˆÌ·ÙÈÎfi Ï›Ô˜, ·˘Ùfi ·ÔÙÂÏ› ÙÔ ÈÔ Â˘ÌÂÙ¿‚ÏËÙÔ Û˘ÛÙ·ÙÈÎfi ÙÔ˘ ÛÒÌ·ÙÔ˜, ·ÊÔ‡ fi¯È ÌfiÓÔ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈο - ·‡ÍËÛË ‹ Ì›ˆÛË - ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ (25), ·ÏÏ¿ Î·È ÁÈ· Ì›· Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈΛ· ·Ú·ÙËÚÂ›Ù·È ‰È·ÊÔÚ¿ ̤¯ÚÈ Î·È 5 ÊÔÚ¤˜ ·fi ·È‰› Û ·È‰› (26). OÈ Ì¤Û˜ ÙÈ̤˜ Ï›Ô˘˜ Ù˘ ÌÂϤÙ˘ Ì·˜ Û ·È‰È¿ ËÏÈΛ·˜ 13-16 ÂÙÒÓ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›ÙÛÈ·, ‹Ù·Ó ˘„ËÏfiÙÂÚ˜ ·fi ·˘Ù¤˜ Ô˘

·Ó·Ê¤ÚÔÓÙ·È ÙfiÛÔ ·fi ÙËÓ Widowson ÛÙËÓ ∂˘ÚÒË (26), fiÛÔ Î·È ·fi ‰‡Ô ∞ÌÂÚÈηÓÈΤ˜ ÌÂϤÙ˜ (20,21). ª¤ÁÈÛÙ˜ ̤Û˜ ÙÈ̤˜ Ï›Ô˘˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ 13 ÂÙÒÓ ÁÈ· Ù· ·ÁfiÚÈ· Î·È 15 ÂÙÒÓ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ∞ÓÙ›ıÂÙ·, ÛÙË ÌÂϤÙË Ù˘ Widowson (26) ̤ÁÈÛÙË ÙÈÌ‹ ·Ú·ÙËÚ‹ıËΠÛÙ· ÌÂÓ ·ÁfiÚÈ· ÛÙ· 10 Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÙ· 16 ¤ÙË. ∫·Ù¿ ÙÔ˘˜ ∏asche et al (27) ̤ÁÈÛÙË ÙÈÌ‹ ·Ú·ÙËÚ‹ıËΠÁÈ· Ù· ·ÁfiÚÈ· ÛÙ· 11,5 Î·È ÁÈ· Ù· ÎÔÚ›ÙÛÈ· ÛÙ· 15,5 ¤ÙË. ∏ Û‡ÁÎÚÈÛË ·ÁÔÚÈÒÓ-ÎÔÚÈÙÛÈÒÓ ÛÙË ¶›Ó·Î·˜ 1. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (%) ∏ÏÈΛ· (¤ÙË)

ª¤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ∫ÔÚ›ÙÛÈ· ∞ÁfiÚÈ·

8 9 10 11 12 13 14 15 16

12 (5) 13 (9) 13 (9) 18 (10) 17 (10) 23 (13) 26 (12) 28 (8) 28 (8)

10 (8) 15 (12) 19 (12) 18 (12) 15 (10) 22 (13) 18 (10) 19 (10) 20 (12)

¶›Ó·Î·˜ 2. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ∏ÏÈΛ· (¤ÙË)

ª¤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË) ∫ÔÚ›ÙÛÈ· ∞ÁfiÚÈ·

5 6 7 8 9 10 11 12 13 14 15 16

16 (1,5) 17,5 (2,5) 17,0 (3) 17,5 (1,5) 18,0 (3) 17,5 (4) 19,0 (5) 19,0 (5) 22,5 (2,5) 22,5 (3) 22,5 (3) 22,0 (2)

17,5 (2) 17,0 (2) 18,0 (3) 18,0 (3) 19,0 (3) 21,0 (5) 21,0 (4) 20,0 (2,5) 22,5 (3) 22,5 (4) 24,0 (3,5) 24,5 (4)

60 50

§›Ô˜ %

40 30

MT (M¤ÛË TÈÌ‹)

20

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË)

10

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ)

0 -10 8

9

10

11

12 13 HÏÈΛ· (¤ÙË)

14

™¯‹Ì· 1. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (%) ÛÙ· ÎÔÚ›ÙÛÈ·.

124

15

16


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Paediatriki 2002;65:122-127

60 50 40

§›Ô˜ %

30 20 10 0 -10 -20 10

9

8

11

MT (M¤ÛË TÈÌ‹)

12

14

13

15

16

HÏÈΛ· (¤ÙË)

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË) 2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ) ™¯‹Ì· 2. ¶ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ (%) ÛÙ· ·ÁfiÚÈ·. 40 35 30

¢M™

25 MT (M¤ÛË TÈÌ‹) 20

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË)

15

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ)

10 5 0 5

6

7

8

9

10 11 HÏÈΛ· (¤ÙË)

12

13

14

15

16

™¯‹Ì· 4. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙ· ·ÁfiÚÈ·.

ÌÂϤÙË Ì·˜ ¤‰ÂÈÍ fiÙÈ ÂÓÒ ÁÈ· ÙȘ ËÏÈ˘ 9 Î·È 10 Ù· ·ÁfiÚÈ· ˘ÂÚÙÂÚÔ‡Ó ˆ˜ ÚÔ˜ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛÔ˜, ·fi Ù· 11 ¤ˆ˜ Ù· 16 ˘¿Ú¯ÂÈ Û·Ê‹˜ ˘ÂÚ›Û¯˘ÛË ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∞Ó¿ÏÔÁ· Â›Ó·È Î·È Ù·

·ÔÙÂϤÛÌ·Ù· Ù˘ Widowson (26). ∞ÓÙ›ıÂÙ·, ÔÈ Fomon Î·È Û˘Ó (21) ‚Ú‹Î·Ó fiÙÈ ÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ ÛÙ· ÎÔÚ›ÙÛÈ· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ·fi ·˘Ùfi ÙˆÓ ·ÁÔÚÈÒÓ ·fi Ù· 5 ¯ÚfiÓÈ· Î·È ¿Óˆ.

125


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¶·È‰È·ÙÚÈ΋ 2002;65:122-127

Paediatriki 2002;65:122-127

35

30

25

20

MT (M¤ÛË TÈÌ‹)

¢M™

MARCH-APRIL 2002

™A (1 ™Ù·ıÂÚ‹ AfiÎÏÈÛË) 2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂȘ)

15

10

5

0

5

6

7

8

9

10

11

12

13

14

15

16

HÏÈΛ· (¤ÙË) ™¯‹Ì· 3. ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ÛÙ· ÎÔÚ›ÙÛÈ·.

∏ ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ ËÏÂÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ԉ›¯ıËΠ‡¯ÚËÛÙË, ÁÚ‹ÁÔÚË Î·È ÔÈÎÔÓÔÌÈ΋. ªÔÚ› Ó· ÌËÓ ·Ú¤¯ÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÈÔ ÂÚ›ÏÔÎˆÓ ÌÂıfi‰ˆÓ, ˘ÂÚ¤¯ÂÈ fï˜ Û·ÊÒ˜ Ù˘ ÌÂıfi‰Ô˘ ̤ÙÚËÛ˘ Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ù˘¯‹˜, ·ÊÔ‡ Ù· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È ·ÓÙÈÎÂÈÌÂÓÈο Î·È ·Ó··Ú·ÁÒÁÈÌ· Î·È ‰ÂÓ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ÂÌÂÈÚ›· ‹ fi¯È ÙÔ˘ ¯ÂÈÚÈÛÙ‹ ÙÔ˘ Ì˯·Ó‹Ì·ÙÔ˜. ªÂÈÔÓ¤ÎÙËÌ· Ù˘ ÌÂıfi‰Ô˘ Â›Ó·È Ë ·‰˘Ó·Ì›· ÂÊ·ÚÌÔÁ‹˜ Ù˘ Û ÌÈÎÚ¿ ·È‰È¿, ‰ÈfiÙÈ ÌÈÎÚ¤˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ‡‰ˆÚ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙË Û¯¤ÛË Ï›Ô˘˜/¿ÏÈË ÛˆÌ·ÙÈ΋ Ì¿˙·. ŒÙÛÈ, ÏÔÈfiÓ, Ë Ù·¯¤ˆ˜ ÌÂÙ·‚·ÏÏfiÌÂÓË ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ‡‰ˆÚ Î·È Ù˘ ηٷÓÔÌ‹˜ Ù˘ ¿ÏÈ˘ ۈ̷ÙÈ΋˜ Ì¿˙·˜ ÌÂٷ͇ ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ ÛÙÔ ÌÈÎÚfi ·È‰› ηıÈÛÙ¿ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ÏÈÁfiÙÂÚÔ ·ÍÈfiÈÛÙË ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ (28). ∞˘Ùfi˜ Â›Ó·È Î·È Ô ÏfiÁÔ˜ Ô˘ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ϛÔ˜ ÌÂÙÚ‹ıËΠÌfiÓÔ Û ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 8 ÂÙÒÓ, ·ÊÔ‡ ·fi ·˘Ù‹ ÙËÓ ËÏÈΛ· Î·È ¿Óˆ ÙfiÛÔ Ô fiÁÎÔ˜ fiÛÔ Î·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ˘ÁÚÒÓ ÙÔ˘ ÛÒÌ·ÙÔ˜ ‰È·ÙËÚÔ‡ÓÙ·È ÛÙ·ıÂÚ¿ Î·È ÚÔÛÔÌÔÈ¿˙Ô˘Ó Ì ·˘Ù¿ ÙˆÓ ÂÓËÏ›ÎˆÓ (26). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ì ‚¿ÛË Ù· fiÛ· ·Ó·هͷÌ ÌÔÚԇ̠ӷ ԇ̠fiÙÈ: ·) Ù· ÂÏÏËÓfiÔ˘Ï· Ù˘

126

ÂÚÈÔ¯‹˜ µ¿Ú˘ Â›Ó·È Û·ÊÒ˜ ÈÔ ·¯‡Û·Úη Û ۯ¤ÛË Ì ͤӷ ÚfiÙ˘· Î·È ‚) Ë Ì¤ÙÚËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ Û ·È‰È¿ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÈ΋˜ ‚ÈÔ·ÓÙ›ÛÙ·Û˘ Â›Ó·È Â‡¯ÚËÛÙË, ÁÚ‹ÁÔÚË Î·È ÔÈÎÔÓÔÌÈ΋. µÈ‚ÏÈÔÁÚ·Ê›· 1. Falkner F. Growth monitoring: Fetus to the first two postnatal years. In: Brunser O, Carrazza F, Gracey M, Nichols B, Senterre J, editors. Clinical nutrition of the young child. New York: Raven Press; 1985. p. 23-48. 2. Owen GM. Measurement recording and assessement of skinfold thickness in childhood and adolescence: report of a small meeting. Am J Clin Nutr 1982;35:629-639. 3. Hammer LD, Kraemer HC, Wilson DM. Standarized percentile curves of body-mass index for children and adolescents. Am J Dis Child 1991;145:259-265. 4. Zerfas AJ, Shorr IJ, Neumann CG. Office assessment of nutritional status. Pediatr Clin N Am 1977;24:253-272. 5. Tanner JM. The measurement of body fat in man. Proc Nutr Soc 1959;18:148-153. 6. Parvizkova J. Total body fat and skinfold thickness in children. Metabolism 1961;10:794-799. 7. Klish WJ. Methods for measuring body composition in infants and children-The gold standard. In: Sehring DA, Sauls HS, editors. Body composition measurements in infants and children. Report of the 98th Ross Conference on Pediatric Research. Colombus Ohio: Ross Laboratories; 1989. p. 4-7.


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8. Behnke AR Jr, Feen BG, Welham WC. The specific gravity of healthy men. JAMA 1942;118:495-499. 9. Forbes GB. Methods for determining composition of the human body with a note of the effect of diet on body composition. Pediatrics 1962;29:477-494. 10. Garrow JS, Fletcher K, Halliday D. Body composition in severe infantile malnutrition. J Clin Invest 1965;44:417-425. 11. Reba RC, Cheek DB, Leitnaker FF. Body potassium and lean body mass. In: Check DB, editor. Human growth. Philadelphia: Lea and Febiger; 1968. p. 165-181. 12. de Buin NC, van Velthoven KAM, de Rodder M, Stijnen T, Juttmann RE, Degenhart HJ et al. Standards for total body fat and fat-free mass in infants. Arch Dis Child 1996;74:386399. 13. Hoffer EC, Meador CK, Simpson DC. Correlation of wholebody impedance with total body water volume. J Appl Physiol 1969;27:531-537. 14. Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am J Clin Nutr 1985;41:810-816. 15. Kushner RF, Schoeller DA. Estimation of total body water by bioelectrical impedance analysis. Am J Clin Nutr 1986;44:417-423. 16. Newman SL. Bioelectric impedance analysis in the determination of body composition of children. In: Klish WJ, Kretchmer N, editors. Body composition measurements in infants and children. Report of the ninetyeight Ross Conference on Pediatric Research. Colombus Ohio: Ross Laboratories; 1989. p. 8-13. 17. Barillas-Mury C, Vettorazzi C, Molina S, Pineda O. Experience with bioelectrical impedance in young children. In: Ellis KJ, Yasumura S, Morgan WD, eds. In vivo body composition studies. London: Institute of Physical Sciences in Medicine; 1987. p. 87-90. 18. DeLozier M, Gutin B, Wang J. Bioimpedance-derived estimates of body composition in 4-8 year olds [abstract]. Med Sci Sports Exerc 1988;20:S31. 19. Rooth G. Low birthweight revised. Lancet 1980;1:639-641. 20. Ten-State Nutrition Survey, 1968-1970. DHEW Publication

Paediatriki 2002;65:122-127

No [HSM] July 1972;72-8132. 21. Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body composition of reference children from birth to age 10 years. Am J Clin Nutr 1982;35:1169-1175. 22. Rolland-Cachera MF, Cole TJ, Sempe M, Ticher J, Rossignal C, Charraud A. Body mass index variations. Centiles from birth to 87 years. Eur J Clin Nutr 1991;45:13-21. 23. ªÈÙÛÒÚË ª, ¡Â¿Ú¯Ô˘ ∞, ∫·ÏÌ·Ù˙‹ µ, ª·Ï·ıÚ¿ÎË ª, ∫ÔÏ˘‰¿ÎË-™˘Úȉ¿ÎË ª, ƒÂÌÂÏ¿Î˘ µ Î·È Û˘Ó. AÓ¿Ù˘ÍË Î·È ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙËÓ Â·Ú¯Â›· ™ËÙ›·˜. ¶·È‰È·ÙÚÈ΋ 1995;58:326-335. 24. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›Ù˘ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ™È·ÌÔ˘Ó¿ÎË ª. ∏ ·¯˘Û·ÚΛ· Û ·È‰È¿ ËÏÈΛ·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚfiÓÈ·. ¶·È‰È·ÙÚÈ΋ 2000;63:137-144. 25. Falkner F. Monitoring growth. In: Nutritional needs and assessment of normal growth. Gracey M, Falkner F, editors. Nestle’ Nutrition, Vevey, New York: Raven Press; 1985. p. 123-137. 26. Widdowson EM. Growth and body composition in childhood. In: Clinical nutrition of the young child. Brunser O, Carrazza F, Gracey M, Nichols B, Senterre J, editors. New York: Raven Press; 1985. p. 1-14. 27. Haschke F. Body composition of adolescent males. Acta Paediatr Scand 1983;307[Suppl]:1-13. 28. Malina RM. Application of bioelectric impedance analysis to children and adolescents. In: Klish WJ, Kretchmer N, editors. Body composition measurements in infants and children. Report of the ninety-eight Ross conference on Pediatric Research. Colombus Ohio: Ross Laboratories; 1989. p. 14-19.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-09-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 05-02-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã. ∫ÒÛÙ·ÏÔ˜ ∞ÚÙ¤ÌȉԘ 130, ∆.∫. 175 62, ¶. º¿ÏËÚÔ

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¶·È‰È·ÙÚÈ΋ 2002;65:128-132

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Paediatriki 2002;65:128-132

ORIGINAL ARTICLE

∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿ ∞. ª‹ÙÛÈη - ∫·Ú·Ó¿ÛÔ˘, Ã. ∆˙ÈÔ˘‚¿Ú·, ∞. ∫ÔÓ‰‡Ï˘, °. ∆˙ˆÚÙ˙¿ÙÔ˘, ∑. ∫·Ú·Î·ÙÛ¿ÓË

Cholelithiasis in children A. Mitsika - Karanasou, H. Tziouvara, A. Kondylis, G. Tzortzatou, Z. Karakatsani

¶ÂÚ›ÏË„Ë: ∏ ¯ÔÏÔÏÈı›·ÛË ·Ú·Ì¤ÓÂÈ Û¿ÓÈÔ ÎÏÈÓÈÎfi Úfi‚ÏËÌ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ˆÛÙfiÛÔ Ë Û˘¯ÓfiÙËÙ· Î·È ÙÔ Ê¿ÛÌ· ÙˆÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ù˘ ÓfiÛÔ˘ Ê·›ÓÂÙ·È Ó· ·ÏÏ¿˙Ô˘Ó Î·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÂÈÚ›· Ì·˜ ·fi ÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË 9 ·È‰ÈÒÓ Ì ¯ÔÏÔÏÈı›·ÛË Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ Ô›ÎÈÏ·Ó: 4 ·fi Ù· 9 ·È‰È¿ ·ÚÔ˘Û›·˙·Ó Ù˘Èο Û˘ÌÙÒÌ·Ù· (fiÓÔ ÛÙÔ ‰ÂÍÈfi ¿��ˆ ÙÂÙ·ÚÙËÌfiÚÈÔ Ù˘ ÎÔÈÏ›·˜ ‹ ÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, Â̤ÙÔ˘˜ Î·È ‰˘Û·ÓÂÍ›· ÛÙË Ï‹„Ë ÏÈ·ÚÒÓ ÁÂ˘Ì¿ÙˆÓ), 2 ›¯·Ó ¿Ù˘˜ ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈÎfi Î·È 3 ‹Ù·Ó ·Û˘Ìو̷ÙÈο. ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ¤ÁÈÓ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ·Ó¢ڤıËÛ·Ó Û 7/9 ·È‰È¿. ÃÔÏÔ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ Û 4 ·È‰È¿, ÂÓÒ Ù· ˘fiÏÔÈ· 5 ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÁÈ· ̤ÛÔ ‰È¿ÛÙËÌ· 3,2 ¯ÚfiÓˆÓ Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Â›Ó·È ·Û˘Ìو̷ÙÈο. ∫·Ó¤Ó· ·fi Ù· ·È‰È¿ ‰ÂÓ ·ÚÔ˘Û›·Û ÂÈÏÔΤ˜.

Abstract: Cholelithiasis remains a rare clinical problem in childhood, although the frequency and spectrum of the risk factors concerning this entity seems to be changing during the past decades. We are describing our 5 year experience concerning the diagnosis, management and follow-up of 9 children with gallstones. The clinical presentation showed variability: of the 9 children, 4 presented with typical symptoms such as right upper quadrant or epigastric pain, nausea, vomiting and fat intolerance, 2 children had nonspecific abdominal symptoms and 3 were asymptomatic. The diagnosis of cholelithiasis was based on abdominal ultrasonography. Predisposing risk factors for gallstone formation were found in 7 of 9 children. Cholecystectomy was performed in 4 children, while the other 5 are under close observation for a mean period of 3.2 years, and remain asymptomatic. None of our patients developed complications.

§¤ÍÂȘ ÎÏÂȉȿ: ¯ÔÏÔÏÈı›·ÛË, ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹, ÌË ¯ÔÏÂÚ˘ıÚÈÓÈÎÔ› ¯ÔÏfiÏÈıÔÈ.

Key words: cholelithiasis, cholecystectomy, nonpigmented gallstones.

∂ÈÛ·ÁˆÁ‹ ∏ ¯ÔÏÔÏÈı›·ÛË Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ŒÙÛÈ, Û˘¯Ó¿ ‰È·Ê‡ÁÂÈ ˆ˜ Èı·Ó‹ ·ÈÙ›· ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. πÛÙÔÚÈο, Ë ÓfiÛÔ˜ Â›Ó·È Û˘Ó‰Â‰Â̤ÓË Ì ÙȘ ·ÈÌÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÙËÓ ÂÁ΢ÌÔÛ‡ÓË ÛÙËÓ ÂÊ˂›· (1-3). ∆Ș ÙÂÏÂ˘Ù·›Â˜ 3 ‰ÂηÂٛ˜, Ì ÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜, Ë ¯ÔÏÔÏÈı›·ÛË ‰È·ÁÈÁÓÒÛÎÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ·, ·ÎfiÌË Î·È Û ÔÌ¿‰Â˜ ·È‰ÈÒÓ Ô˘ ÚÔËÁÔ‡ÌÂÓ· ‰ÂÓ ‹Ù·Ó ÁÓˆÛÙfi fiÙÈ ‚Ú›ÛÎÔÓÙ·Ó Û ΛӉ˘ÓÔ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ (¶›Ó·Î·˜ 1). ∂›Û˘,

ÔÏϤ˜ ¯ÔÏÔÏÈıÈ¿ÛÂȘ, ÂÎÙfi˜ ·fi ·˘Ù¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È È‰ÈÔ·ı›˜. ∞fi ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ ÙÔ 80% ÂÚ›Ô˘ ÙˆÓ ¯ÔÏfiÏÈıˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ ÔÊ›ÏÂÙ·È Û ·ÈÌÔÏ˘ÙÈ΋ ‰È·Ù·Ú·¯‹ Î·È ÙÔ ˘fiÏÔÈÔ 20% Û¯ÂÙ›˙ÂÙ·È Ì ˘ÔÙÚÔÈ¿˙Ô˘Û· ·ÈÌfiÏ˘ÛË (46). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¯ÔÏfiÏÈıˆÓ ÛÙ· ·È‰È¿ ·ÔÙÂÏ› ıÂÚ·¢ÙÈÎfi ‰›ÏËÌÌ·. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ 10% ÙˆÓ ÂÓËÏ›ÎˆÓ ı· ¤¯Ô˘Ó ·Û˘Ìو̷ÙÈÎÔ‡˜ ¯ÔÏfiÏÈıÔ˘˜ ·Ó ˘Ô‚ÏËıÔ‡Ó Û ÂͤٷÛË ÚÔ˘Ù›Ó·˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ∞fi ·˘ÙÔ‡˜, ÌfiÓÔ

∞’ Î·È µ’ ¶·È‰È·ÙÚÈο ∆Ì‹Ì·Ù· °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘, ∞ı‹Ó·

1st and 2nd Pediatric Divisions Children’s General Hospital of Penteli, Athens

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MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·129

¶·È‰È·ÙÚÈ΋ 2002;65:128-132

¶›Ó·Î·˜ 1. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÌË ·ÈÌÔÏ˘ÙÈ΋˜ ¯ÔÏÔÏÈı›·Û˘ ñ OÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ñ ¶ÚÔˆÚfiÙËÙ·, ʈÙÔıÂÚ·›· ñ ¡fiÛÔ˜ ˘·ÏÔÂȉԇ˜ ÌÂÌ‚Ú¿Ó˘, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›· ñ ™˘ÛÙËÌ·ÙÈ΋ Ïԛ̈ÍË ‹ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ñ ∂ÎÙÔÌ‹ ÂÈÏÂÔ‡, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, Ó. Crohn, ÙÚ·‡Ì· ñ ∞ӈ̷ϛ˜ ¯ÔÏËÊfiÚˆÓ Î·È ¯ÔÏˉfi¯Ô˘ ·ÛÙˆ˜ ñ ∂Á΢ÌÔÛ‡ÓË, ·ÓÙÈÛ˘ÏÏËÙÈο per os ñ ¶·¯˘Û·ÚΛ· ñ ∆Ú·˘Ì·ÙÈÛÌÔ› Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ·Ú·ÙÂٷ̤ÓË ·ÎÈÓËÛ›· ñ ∞Ê˘‰¿ÙˆÛË, ¤ÌÂÙÔÈ, ¯ÔÚ‹ÁËÛË ÊÔ˘ÚÔÛÂÌ›‰Ë˜

10%-25% ı· ·Ó·Ù‡ÍÂÈ Û˘ÌÙÒÌ·Ù· Ô˘ Ó· ¯ÚÂÈ¿˙ÔÓÙ·È ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹ (7,8). ™Â ·ÓÙ›ıÂÛË, fï˜, Ì ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ù· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌË ÂȉÈΤ˜ ÂΉËÏÒÛÂȘ ·fi ÙËÓ ÎÔÈÏÈ¿ Î·È ‰ÂÓ ÌÔÚÔ‡Ó Ì ·ÎÚ›‚ÂÈ· Ó· ÂÚÈÁÚ¿„Ô˘Ó Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘˜. ∂Ì›˜ ÌÂÏÂÙ‹Û·Ì 9 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ¯ÔÏfiÏÈıÔ˘˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂͤٷÛË Î·È ·Ó·Ï‡Ô˘Ì ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, ÙËÓ ·ıÔÁ¤ÓÂÈ· Î·È ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ·fi ÙÔÓ ∞Ú›ÏÈÔ 1995 ¤ˆ˜ ÙÔÓ ∞Ú›ÏÈÔ 2001 ÓÔÛËχÙËÎ·Ó ÛÙȘ ·È‰È·ÙÚÈΤ˜ ÎÏÈÓÈΤ˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ 9 ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË. ¶·Ú·ÎÔÏÔ˘ı‹Û·Ì ٷ ·È‰È¿ ·˘Ù¿ Ì ÎÏÈÓÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ, ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ˘˜ ÁÔÓ›˜ ‹ Ù· ·È‰È¿ Î·È ˘ÂÚ˯ÔÁÚ·ÊÈο. ¶ÏËÚÔÊÔڛ˜ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ıÂÚ·›·˜ ηٷÁÚ¿ÊËÎ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. ∆· Û˘ÌÙÒÌ·Ù· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ˆ˜ Ù˘Èο, ¿Ù˘· ‹ ·fiÓÙ·. ∆· ·Û˘Ìو̷ÙÈο ·È‰È¿ ‰ÂÓ Â›¯·Ó ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈÎfi. ™Â ·˘Ù¿, ÔÈ ¯ÔÏfiÏÈıÔÈ ‰È·ÁÓÒÛÙËÎ·Ó Ù˘¯·›· Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Ô˘ ¤ÁÈÓ ÁÈ· ¿Û¯ÂÙ· ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ηٿ ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÌÂÙ¿ ·fi Ô˘ÚÔÏԛ̈ÍË. ∆· Û˘Ìو̷ÙÈο ·È‰È¿ ¯ˆÚ›ÛÙËÎ·Ó Û ·˘Ù¿ ÌÂ Ù˘Èο Û˘ÌÙÒÌ·Ù· ·fi Ù· ¯ÔÏËÊfiÚ·, fiˆ˜ fiÓÔ ÛÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ ‹ ÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, Â̤ÙÔ˘˜ Î·È ‰˘Û·ÓÂÍ›· ÛÙ· Ï›Ë Î·È Û ·˘Ù¿ Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi. ÃÔÏÔ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ ÛÙ· ·È‰È¿ ÌÂ Ù˘Èο Û˘ÌÙÒÌ·Ù·, ÂÓÒ Ù· ˘fiÏÔÈ· Ù¤ıËÎ·Ó Û ·Ú·ÎÔÏÔ‡ıËÛË. ™Ù· ¯ÂÈÚÔ˘ÚÁËı¤ÓÙ· ·È‰È¿ ÂÎÙÈÌ‹ıËÎ·Ó Ù· ¯ÂÈÚÔ˘ÚÁÈο Â˘Ú‹Ì·Ù· Î·È Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· Î·È ÛÙËÓ ÔÌ¿‰· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛËÌÂÈÒıËÎÂ Ë Ù˘¯fiÓ ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ ‹ ÂÈÏÔÎÒÓ.

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ˘˜ 9 ·ÛıÂÓ›˜ Ì ¯ÔÏÔÏÈı›·ÛË, 5 ‹Ù·Ó ·ÁfiÚÈ· Î·È 4 ÎÔÚ›ÙÛÈ·. ∏ ËÏÈΛ· ÙÔ˘˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 9 Ì‹Ó˜ ˆ˜ 15 ¯ÚfiÓÈ· (̤ÛË ËÏÈΛ· 11,5 ¯Úfi-

Paediatriki 2002;65:128-132

ÓÈ·). ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ¤ÁÈÓ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ∫·Ù¿ ÙË ‰È¿ÁÓˆÛË, ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙˆÓ ·È‰ÈÒÓ Ô›ÎÈÏ·Ó Â˘Ú¤ˆ˜. ÿÎÙÂÚÔ Î·È fiÓÔ ÛÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ ·ÚÔ˘Û›·˙ 1 ·È‰›, Â̤ÙÔ˘˜ Î·È fiÓÔ ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ 1, ‰˘Û·ÓÂÍ›· ÛÙȘ ÏÈ·Ú¤˜ ÙÚÔʤ˜ 1 Î·È ›ÎÙÂÚÔ 1. ∆Ô ÙÂÏÂ˘Ù·›Ô ·˘Ùfi ·È‰› ›¯Â ÓÔÛËÏ¢Ù› Ì ›ÎÙÂÚÔ Î·È ÚÔ ‰ÈÂÙ›·˜, ÔfiÙ ‰È·ÈÛÙÒıËΠÏ‹Ú˘ ¤ÏÏÂÈ„Ë G6PD, ÂÓÒ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ÕÙ˘· ÎÔÈÏȷο Û˘ÌÙÒÌ·Ù· ›¯·Ó 2 ·È‰È¿ Î·È 3 ‹Ù·Ó ·Û˘Ìو̷ÙÈο. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ·Ó¢ڤıËÛ·Ó Û 7/9 ·È‰È¿: 2 ·È‰È¿ Ì ÚÔˆÚfiÙËÙ· Î·È ·Ú·ÙÂٷ̤ÓË Ï‹„Ë ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ (2 Î·È 2ó Ì‹Ó˜), 1 Ì ÚÔˆÚfiÙËÙ· Î·È ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË, 1 Ì ۇӉÚÔÌÔ Gilbert, 1 Ì Ï‹ÚË ¤ÏÏÂÈ„Ë G6PD, 1 Ì ÂÙÂÚfi˙˘ÁÔ ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Û˘Ó‡·ÚÍË ÙÚÈÏ·ÛÈ·Ṳ̂ÓÔ˘ · ÁfiÓÔ˘ Î·È 1 ·È‰› ÌÂ Û˘Ó‰˘·ÛÌfi ÔÏÏÒÓ ·Ú·ÁfiÓÙˆÓ (ÚÔˆÚfiÙËÙ·, Ï‹ÚË ¤ÏÏÂÈ„Ë G6PD, Û‡Ó‰ÚÔÌÔ Gilbert). ™Â 2 ·È‰È¿ ‰ÂÓ ·Ó¢ڤıËÛ·Ó ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜. £ÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¯ÔÏÔÏÈı›·Û˘ ‰È·ÈÛÙÒıËΠ۠4 ·È‰È¿. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ·˘ÍË̤Ó˜ ÙÚ·ÓÛ·ÌÈÓ¿Û˜ (SGOT: 186 U/L, SGPT: 121 U/L) ·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ Û 1 ·È‰›, ÙÔ ÔÔ›Ô Â›¯Â ÔÚȷο ·˘ÍË̤ÓË Î·È ÙËÓ ¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË (ÔÏ. ¯ÔÏ.: 1,49 mg%, ·Ì.: 0,53 mg%). ™ÙÔ ·È‰› ·˘Ùfi, Ë ·Ê·ÈÚÂı›۷ ¯ÔÏˉfi¯Ô˜ ·ÛÙË Â›¯Â ÂӉ›ÍÂȘ ¯ÚfiÓÈ·˜ ¯ÔÏÔ΢ÛÙ›Ùȉ·˜. ª¤ÙÚÈ· ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· ¤ÌÌÂÛÔ˘ Ù‡Ô˘ ›¯·Ó Ù· ·È‰È¿ Ì ·ÈÌÔÏ˘ÙÈ΋ ‰È·Ù·Ú·¯‹ ‹ Û. Gilbert. ŸÏ· Ù· ·È‰È¿ ›¯·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ·Ì˘Ï¿Û˘, ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘, Á-GT, Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ∆∫∂. ÃÔÏÔ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ Û 4/9 ·È‰È¿, Û 3 ÌÂ Ù˘Èο Û˘ÌÙÒÌ·Ù· Î·È Û 1 ·Ú¯Èο ·Û˘Ìو̷ÙÈÎfi. ªÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô Î·È Ù· 4 ·È‰È¿ Â›Ó·È ÂχıÂÚ· Û˘Ìو̿وÓ. ∆· ˘fiÏÔÈ· 5 Â›Ó·È ˘fi ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· ¤Ó· ̤ÛÔ ‰È¿ÛÙËÌ· 3,2 ¯ÚfiÓˆÓ (6 Ì‹Ó˜ ˆ˜ 5 ¯ÚfiÓÈ·) Î·È ·Ú·Ì¤ÓÔ˘Ó ·Û˘Ìو̷ÙÈο. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ¤Ó· ·È‰› ËÏÈΛ·˜ 9 ¯ÚfiÓˆÓ ·ÚÔ˘Û›·Û ·˘ÙfiÌ·ÙË Ï‡ÛË ÙˆÓ ¯ÔÏfiÏÈıˆÓ. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¯ÔÏfiÏÈıÔÈ ÛÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ Â·ÓÂÎÙ›ÌËÛË Ô˘ ¤ÁÈÓ ÛÙÔ˘˜ 6 Ì‹Ó˜ ·fi ÙË ‰È¿ÁÓˆÛË. ∂›Û˘, ¤Ó· ·È‰›, ·Ú¯Èο ·Û˘Ìو̷ÙÈÎfi, ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù· ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ. ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·Û ÂÈÏÔΤ˜. ™˘˙‹ÙËÛË ∏ ¯ÔÏÔÏÈı›·ÛË ÂÚÈÁÚ¿ÊËΠÚÒÙË ÊÔÚ¿ Û ·È‰È·ÙÚÈÎfi ·ÛıÂÓ‹ ÚÈÓ 250 Î·È ϤÔÓ ¯ÚfiÓÈ·,

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14-05-03

12:25

™ÂÏ›‰·130

¶·È‰È·ÙÚÈ΋ 2002;65:128-132

fiÙ·Ó ÔÏÏ·ÏÔ› ¯ÔÏfiÏÈıÔÈ ·Ó¢ڤıËÛ·Ó ÛÙÔÓ ÎÔÈÓfi ¯ÔÏˉfi¯Ô fiÚÔ, ηٿ ÙËÓ ·˘ÙÔ„›· ÂÓfi˜ ·ÁÔÚÈÔ‡ 13 ¯ÚfiÓˆÓ (9). ∏ ¯ÔÏÔÏÈı›·ÛË ·Ú·Ì¤ÓÂÈ Ì›· ·Û˘Ó‹ı˘ ηٿÛÙ·ÛË ÛÙ· ·È‰È¿, ·Ó Î·È ÚfiÛÊ·Ù˜ ÛÂÈÚ¤˜ ÂȂ‚·ÈÒÓÔ˘Ó Ì›· ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ (4,10), Ë ÔÔ›· ı· ÌÔÚÔ‡Û ÌÂÚÈÎÒ˜ Ó· ÂÍËÁËı› ·fi ÙË Û˘¯Ó‹ ¯Ú‹ÛË ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜. ™Â ‰‡Ô ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜, ÛÙȘ Ôԛ˜ Ë ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ Ì ‚¿ÛË Ù· ·Ú¯Èο Û˘ÌÙÒÌ·Ù·, ¯ÔÏfiÏÈıÔÈ ·Ó¢ڤıËÛ·Ó Û ÔÛÔÛÙfi 0,13%-0,19% (11,12). ™Â ÙÂÏÂ˘Ù·›· ÌÂϤÙË 4.200 ·È‰ÈÒÓ, Ô˘ ¤Î·Ó·Ó ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÁÈ· ‰È¿ÊÔÚ· ·›ÙÈ·, ¯ÔÏfiÏÈıÔÈ ·ÔηχÊıËÎ·Ó Û ÔÛÔÛÙfi 1,9%, ‡ÚËÌ· ÙÔ ÔÔ›Ô ·Ô‰fiıËΠ·fi ÙÔ˘˜ ÌÂÏÂÙËÙ¤˜ ÛÙËÓ ÂÓÙfiÈÛË ÂÚÈÛÛfiÙÂÚˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ¯ÔÏfiÏÈıˆÓ ̤ۈ ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ (10). ∏ ¯ÔÏÔÏÈı›·ÛË ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Â›Ó·È Û˘Ó‰Â‰Â̤ÓË Ì ÎÏËÚÔÓÔÌÈΤ˜ ·ÈÌÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË Î·È ·ÓÂ¿ÚÎÂÈ· G6PD ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ‰Â˘ÙÂÚÔ·ıÒ˜ ·fi ÙË ¯ÚfiÓÈ· ·ÈÌfiÏ˘ÛË, Ë ÔÔ›· ÚÔηÏ› ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ¯ÔÏÂÚ˘ıÚ›Ó˘. ™Â ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜, ·˘ÙÔ› ÔÈ ·ÛıÂÓ›˜ ·ÔÙÂÏÔ‡Ó ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÚÈÙÒÛÂˆÓ (1,2). øÛÙfiÛÔ, ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÙÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó ¯ÔÏÔÏÈı›·ÛË ÏfiÁˆ ˘ÔΛÌÂÓ˘ ·ÈÌ·ÙÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ ·ÊÔÚ¿ ÙÔ 20%25% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5,10). ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, ‰‡Ô ·ÛıÂÓ›˜ (22,2%) ›¯·Ó ˘ÔΛÌÂÓË ·ÈÌÔÏ˘ÙÈ΋ ‰È·Ù·Ú·¯‹. ∆Ô Û‡Ó‰ÚÔÌÔ Gilbert, Ì›· ηÏÔ‹ı˘, Û˘¯Ó‹ ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Úԉȷı¤ÙÂÈ Û ۯËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ. ™˘ÁÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert Ì ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ G6PD ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ¯ÔÏÔÏÈı›·ÛË. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙÔ Û˘Ó‰˘·ÛÌfi Ù˘ ·˘ÍË̤Ó˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ·fi ÙË ¯ÚfiÓÈ· ·ÈÌfiÏ˘ÛË Î·È ÙË ÌÂȈ̤ÓË Ë·ÙÈ΋ Ù˘ Û‡Ó‰ÂÛË (13,14). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ¤Ó· ·È‰› ›¯Â Û‡Ó‰ÚÔÌÔ Gilbert Î·È ¤Ó· ¿ÏÏÔ Û˘Ó‡·ÚÍË Û˘Ó‰ÚfiÌÔ˘ Gilbert Ì Ï‹ÚË ¤ÏÏÂÈ„Ë G6PD. ∫·È Ù· ‰‡Ô ·È‰È¿ ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¯ÔÏÔÏÈı›·Û˘. µÚ¤ÊË Î·È ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Â›Ó·È Û ΛӉ˘ÓÔ ÁÈ· ·Ó¿Ù˘ÍË ¯ÔÏÔÏ›ıˆÓ (15). O ΛӉ˘ÓÔ˜ ·˘Ùfi˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó ÂÓ‰ÔÊϤ‚È· ‰È·ÙÚÔÊ‹ ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 30 Ë̤Ú˜, ¯ˆÚ›˜ Û˘Ìϋڈ̷ ‰È·ÙÚÔÊ‹˜ ·fi ÙÔ ÛÙfiÌ· (5,16). ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, Ë ¯ÔÏÈ΋ ÛÙ¿ÛË Î·È Ë Á·ÛÙÚÂÓÙÂÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Èı·ÓfiÓ Ó· ›ӷÈ

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ÔÈ ÚˆÙ·Ú¯ÈÎÔ› ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ ¯ÔÏÔÏÈı›·Û˘. ∏ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ÌÔÚ› Ó· ÂÌÔ‰›˙ÂÈ ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ¯ÔÏfiÏÈıˆÓ (5). ™˘ÓÈÛÙ¿Ù·È ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÁÈ· Èı·Ófi Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ ÁÈ· ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 10 ¯ÚfiÓˆÓ (17). ™Â ÔÚÈṲ̂ӷ ‚Ú¤ÊË ·Ó·Ê¤ÚÂÙ·È ·˘ÙfiÌ·ÙË Ï‡ÛË ÙˆÓ ¯ÔÏfiÏÈıˆÓ 2 ‚‰ÔÌ¿‰Â˜ ˆ˜ 6 Ì‹Ó˜ ·fi ÙË ‰È¿ÁÓˆÛË (18). ∞fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜, ‰‡Ô ›¯·Ó ÈÛÙÔÚÈÎfi ÚÔˆÚfiÙËÙ·˜ Ì ·Ú·ÙÂٷ̤ÓË Ï‹„Ë ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. ∏ ËÏÈΛ· ‰È¿ÁÓˆÛ˘ Ù˘ ¯ÔÏÔÏÈı›·Û˘ ‹Ù·Ó 3 Î·È 14 ¯ÚfiÓÈ· ·ÓÙ›ÛÙÔȯ·. ∫·È ÛÙ· ‰‡Ô ·È‰È¿ ‰ÂÓ Â›¯Â Á›ÓÂÈ ÚÔËÁÔ‡ÌÂÓ· ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ¡ÔÛ‹Ì·Ù· ÙÔ˘ ÂÈÏÂÔ‡ ‹ ÂÎÙÔÌ‹ ÙÔ˘ Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙË Ê˘ÛÈÔÏÔÁÈ΋ ΢ÎÏÔÊÔÚ›· ÙˆÓ ¯ÔÏÈÎÒÓ ·Ï¿ÙˆÓ, Úԉȷı¤ÙÔ˘Ó Û ۯËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ. ∂ÌϤÎÔÓÙ·È ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ë ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, Ë ÓfiÛÔ˜ Crohn, ÙÔ ÏÂÌÊ·ÁÁ›ˆÌ· ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È Ë ‚Ï¿‚Ë ÙÔ˘ ÂÈÏÂÔ‡ ·fi ·ÎÙÈÓÔ‚ÔÏ›· (18). ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ‰ÂÓ Â›¯Â ÓfiÛËÌ· ÙÔ˘ ÂÈÏÂÔ‡. ™Â ‰‡Ô ·ÛıÂÓ›˜ (22,2%) ‰ÂÓ ·Ó¢ڤıËÛ·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ Ó· Úԉȷı¤ÙÔ˘Ó ÛÙÔ Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ. ∆Ô ›‰ÈÔ ÔÛÔÛÙfi ·Ó·Ê¤ÚıËΠ·fi ÙÔ˘˜ Reif Î·È Û˘Ó (6), fiˆ˜ Î·È ·fi ÙÔ˘˜ Wesdorp Î·È Û˘Ó (10). OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ¯ÔÏÔÏÈı›·Û˘ ÛÙ· ·È‰È¿ ÔÈΛÏÔ˘Ó Â˘Ú¤ˆ˜ Î·È ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ËÏÈΛ· Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Û¯ËÌ·ÙÈÛÌfi ÙˆÓ ¯ÔÏfiÏÈıˆÓ. ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ù· ·È‰È¿ Û˘¯Ó¿ ¤¯Ô˘Ó ÌË ÂȉÈο ÎÔÈÏȷο ÂÓԯϋ̷ٷ Î·È ‰ÂÓ ÌÔÚÔ‡Ó Ì ·ÎÚ›‚ÂÈ· Ó· ÂÚÈÁÚ¿„Ô˘Ó Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘˜. ŒÙÛÈ, ÎÏ·ÛÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ fiÓÔ˜ ÛÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ ‹ ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, ¤ÌÂÙÔÈ Î·È ‰˘Û·ÓÂÍ›· ÛÙË Ï‹„Ë ÏÈ·ÚÔ‡ Á‡̷ÙÔ˜, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ. ∆· ÌÈÎÚfiÙÂÚ· ·È‰È¿, ΢ڛˆ˜ οو ÙˆÓ 5 ¯ÚfiÓˆÓ, ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó‹ıˆ˜ ÌË ÂȉÈο Û˘ÌÙÒÌ·Ù·. ∂˘ÂÚÂıÈÛÙfiÙËÙ·, ΢ڛˆ˜ ÌÂÙ¿ Ù· Á‡̷ٷ, ı· ÌÔÚÔ‡Û ӷ ˘Ô‰ËÏÒÓÂÈ Èı·Ó‹ ¯ÔÏÔÏÈı›·ÛË, ȉȷ›ÙÂÚ· Û ÚfiˆÚ· ‚Ú¤ÊË ‹ ‚Ú¤ÊË Ì ÈÛÙÔÚÈÎfi ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ‹ ÓÂÎÚˆÙÈ΋˜ ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ (6). ∂›Û˘, Û˘¯Ó¿ Ë ¯ÔÏÔÏÈı›·ÛË Â›Ó·È ·Û˘Ìو̷ÙÈ΋ Î·È ·ÔηχÙÂÙ·È Ù˘¯·›·, fiˆ˜ Ì ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ·fi Ô˘ÚÔÏԛ̈ÍË. ™ÙË ÌÂϤÙË Ì·˜, 3 ·È‰È¿ (33,3%) ‹Ù·Ó ·Û˘Ìو̷ÙÈο. O ›ÎÙÂÚÔ˜ ÌÔÚ› Ó· ¤¯ÂÈ Û¯¤ÛË Â›Ù Ì ·fiÊÚ·ÍË ÙÔ˘ ÎÔÈÓÔ‡ ¯ÔÏˉfi¯Ô˘ fiÚÔ˘ ‹ Ì ÊÏÂÁÌÔÓ‹ Ù˘ ¯ÔÏˉfi¯Ô˘ ·ÛÙ˘ ·fi ÙÔ˘˜ ¯ÔÏfiÏÈıÔ˘˜. ∏ ¯ÔÏˉԯÔÏÈı›·ÛË ÛÙ· ·È‰È¿ Ê·›ÓÂÙ·È Ó· Â›Ó·È Û¿ÓÈ·. ™ÙË ÛÂÈÚ¿ ÙˆÓ Reif Î·È Û˘Ó, Û ηӤӷ ·fi Ù· 50 ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË ‰ÂÓ ‚Ú¤ıËÎÂ


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¯ÔÏˉԯÔÏÈı›·ÛË (6). ¢‡Ô ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ›¯·Ó ›ÎÙÂÚÔ, ·ÏÏ¿ Î·È ÔÈ 2 ›¯·Ó ˘ÔΛÌÂÓË ·ÈÌÔÏ˘ÙÈ΋ ‰È·Ù·Ú·¯‹ ‹ ÓfiÛÔ Gilbert. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ¤¯ÂÈ ·˘Í‹ÛÂÈ ÛËÌ·ÓÙÈο ÙË ‰È·ÁÓˆÛÙÈ΋ Ì·˜ ·ÎÚ›‚ÂÈ· Î·È Â˘·ÈÛıËÛ›· ÛÙÔÓ ÂÓÙÔÈÛÌfi ÙˆÓ ¯ÔÏfiÏÈıˆÓ. ÕÏϘ ‰È·ÁÓˆÛÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ Ë ÂÓ‰ÔÛÎÔÈ΋ ·Ï›Ó‰ÚÔÌË ¯ÔÏ·ÁÁÂÈÔ·ÁÎÚ·ÙÔÁÚ·Ê›· (ERCP), ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È fiÙ·Ó Ù· ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ‰ÂÓ Â›Ó·È ÂÈÛÙÈο ‹ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ·ÓˆÌ·Ï›Â˜ ÙˆÓ ¯ÔÏËÊfiÚˆÓ Ô‰ÒÓ ‹ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘. OÈ ÂÈÏÔΤ˜ Ù˘ ¯ÔÏÔÏÈı›·Û˘ fiˆ˜ ¯ÔÏÔ΢ÛÙ›Ùȉ·, ¯ÔÏˉԯÔÏÈı›·ÛË, ¯ÔÏ·ÁÁÂÈ›Ùȉ·, ‰È¿ÙÚËÛË Î·È ·ÁÎÚ·ٛÙȉ·, ‰ÂÓ Â›Ó·È Û˘¯Ó¤˜ ÛÙ· ·È‰È¿. ™Â ÚfiÛÊ·ÙË ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË, ÂÈÏÔΤ˜ ·ÚÔ˘Û›·Û·Ó 6 ·fi Ù· 82 ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË. ∫·Ì›· fï˜ ·fi ·˘Ù¤˜ ÙȘ ÂÈÏÔΤ˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÌË ÂȉÈο ÎÔÈÏȷο Û˘ÌÙÒÌ·Ù· (19/82) ‹ ÛÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ (14/82) Ù˘ ÌÂϤÙ˘ (10). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÌfiÓÔ ¤Ó·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ¯ÔÏÔ΢ÛÙ›Ùȉ·. £ÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· ÙÔ˘˜ ¯ÔÏfiÏÈıÔ˘˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ÎÏ·ÛÈο Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë ¯ÔÏÂ΢ÛÙÂÎÙÔÌ‹. øÛÙfiÛÔ, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ‰ÂÓ Ê·›ÓÂÙ·È Ó· ‰›ÓÂÈ ¿ÓÙ· χÛË ÛÙËÓ ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ. ∫·Ù¿ ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, 10%-45% ÙˆÓ ¯ÂÈÚÔ˘ÚÁËı¤ÓÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘ÔÙÚÔ‹ ÙˆÓ ·Ú¯ÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ (10,19). ÃÔÏÂ΢ÛÙÂÎÙÔÌ‹ ¤ÁÈÓ Û 4 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜, ÔÈ ÔÔ›ÔÈ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Â›Ó·È ÂχıÂÚÔÈ Û˘Ìو̿وÓ. ∆· ·È‰È¿ Ì ¯ÔÏfiÏÈıÔ˘˜ Î·È ÌË ÂȉÈο ÎÔÈÏȷο Û˘ÌÙÒÌ·Ù· ·ÔÙÂÏÔ‡Ó ‰È·ÁÓˆÛÙÈÎfi Î·È ıÂÚ·¢ÙÈÎfi ‰›ÏËÌÌ·. ∆· Û˘ÌÙÒÌ·Ù· ÌÔÚ›, ·ÏÏ¿ ÌÔÚ› Î·È Ó· ÌËÓ ÔÊ›ÏÔÓÙ·È ÛÙË ¯ÔÏÔÏÈı›·ÛË. OÈ Brush Î·È Û˘Ó ·Ú·ÎÔÏÔ‡ıËÛ·Ó 41 Ù¤ÙÔÈ· ·È‰È¿, ·ÊÔ‡ Ù· ¤ıÂÛ·Ó Û ‰›·ÈÙ· ÊÙˆ¯‹ Û ϛÔ˜ Î·È ÏÔ‡ÛÈ· ÛÂ Ê˘ÙÈΤ˜ ›Ó˜, ÁÈ· Ó· ‰È·ÈÛÙÒÛÔ˘Ó ·Ó ÔÈ ·Û˘Ìو̷ÙÈÎÔ› ¯ÔÏfiÏÈıÔÈ ÌÔÚÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Û˘ÓÙËÚËÙÈο. ªÂÙ¿ ·fi ̤ÛÔ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛ˘ 21 ÌËÓÒÓ (3-41 Ì‹Ó˜), ÙÔ 82% ÙˆÓ ·È‰ÈÒÓ Â›¯Â Ï‹ÚË ‹ ÌÂÚÈ΋ ˘Ô¯ÒÚËÛË ÙˆÓ Û˘Ìو̿وÓ, ÂÓÒ ÔÛÔÛÙfi 18% ·Ú¤ÌÂÈÓÂ Û˘Ìو̷ÙÈÎfi Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠¯ÔÏÂ΢ÛÙÂÎÙÔÌ‹ (19). ∂›Û˘, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ Ì ·Û˘Ìو̷ÙÈ΋ ¯ÔÏÔÏÈı›·ÛË, ÌfiÓÔ 10%-25% ·Ó·Ù‡ÛÛÂÈ Û˘ÌÙÒÌ·Ù·, Ù· ÔÔ›· Û˘Ó‹ıˆ˜ ÂΉËÏÒÓÔÓÙ·È ÚÈÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÂÈÏÔÎÒÓ (8). ∞fi Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Ê·›ÓÂÙ·È ˆ˜ Ë Û˘ÓÙËÚËÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ Ì ÌË ÂȉÈ΋ ‹ ·Û˘Ìو̷ÙÈ΋ ÚÔ‚ÔÏ‹ Ù˘ ¯ÔÏÔÏÈı›·Û˘ Â›Ó·È ·Ô‰ÂÎÙ‹. ™ÙË ‰È΋ Ì·˜

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ÌÂϤÙË, ÌfiÓÔ ¤Ó· ·Ú¯Èο ·Û˘Ìو̷ÙÈÎfi ·È‰› ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù·, ¯ˆÚ›˜ ÂÈÏÔΤ˜ ηٿ ÙËÓ ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¯ÂÈÚÔ˘ÚÁ‹ıËÎÂ. ∫·Ù¿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜, Ë ¯ÔÏÔÏÈı›·ÛË ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Û ·˘ÍË̤ÓÔ ·ÚÈıÌfi ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ. ∏ ‰È¿ÁÓˆÛË ·˘Ù‹ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„Ë Î·Ù¿ ÙËÓ ÂÎÙ›ÌËÛË ·È‰ÈÒÓ Ì ÂΉËÏÒÛÂȘ ·fi ÙÔ ÂÙÈÎfi, ȉȷ›ÙÂÚ· ·Ó ˘¿Ú¯Ô˘Ó ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜. ∏ ·Ú¯‹ ·˘Ù‹ Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ·ÎfiÌË Î·È Û ‚Ú¤ÊË, ΢ڛˆ˜ Û ·˘Ù¿ Ì ÈÛÙÔÚÈÎfi ÚÔˆÚfiÙËÙ·˜ Î·È ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù·, Ù· ·È‰È¿ Ì ¯ÔÏfiÏÈıÔ˘˜ ÌÔÚÔ‡Ó Ó· ¯ˆÚÈÛÙÔ‡Ó Û 2 ÔÌ¿‰Â˜. ∞˘Ù¿ ÌÂ Ù˘Èο Û˘ÌÙÒÌ·Ù· ¯ÚÂÈ¿˙ÔÓÙ·È ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹. ∞Û˘Ìو̷ÙÈο ·È‰È¿ Î·È ·È‰È¿ Ì ¿Ù˘· Û˘ÌÙÒÌ·Ù· ÌÔÚÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Û˘ÓÙËÚËÙÈο. ∞˘Ù¿ Ù· ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘Ó¯‹ ·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· Ó· ·Ó·ÁÓˆÚÈÛÙ› ¤ÁηÈÚ· ÂӉ¯fiÌÂÓË ÂÌÊ¿ÓÈÛË Û˘Ìو̿وÓ, ÔfiÙÂ Î·È ı· ¯ÚÂÈ·ÛÙÔ‡Ó ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹. µÈ‚ÏÈÔÁÚ·Ê›· 1. Ariyan S, Shessel FS, Pickett LK. Cholecystitis and cholelithiasis masking as abdominal crisis in sickle cell disease. Pediatrics 1976;58:252-258. 2. Lan GE, Andrassy RJ, Mahour GH. A 30-year review of the management of gallbladder disease at a children’s hospital. Am J Surg 1983;49:411-413. 3. Andrassy RJ, Treadwell TA, Ratner IA, Buckley CJ. Gallbladder disease in children and adolescents. Am J Surg 1976;132:19-21. 4. Bailey VP, Robert H, Tracy FT, Sotelo-Avila CJ, Lewis E, Weber RT et al. Changing spectrum of cholelithiasis and cholecystitis in infants and children Am J Surg 1989;158:585-588. 5. Holcomb WG, Holcomb WG, III. Cholelithiasis in infants, children, and adolescents. Pediatr Rev 1990;11:268-276. 6. Reit C, Daniel G, Lebenthal E. Gallstones in children. AJDC 1991;145:105-108. 7. Hopper DK, Landis JR, Meilstrup JW, McCauslin AM, Sechtin GA. The prevalence of asymptomatic gallstones in the general population. Invest Radiol 1991;26:939-945. 8. McSherry CK, Ferstenberg H, Calhoun WF. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 1985;202:59-63. 9. Gibson J. An extraordinary large gallbladder and hydropic cystitis. Medical assays and observations. Philosoph Soc Edin 1737;2:352. 10. Wesdorp I, Bosman D, Graaff A, Arohson D, Blij VF, Taminiau J. Clinical presentations and predisposing factors of cholelithiasis and sludge in children. J Pediatr Gastroenterol Nutr 2000;31:411-417. 11. Palasciano G, Portincasa P, Vinciguerra V. Gallstone prevalence and gallbladder volume in children and adolescents: an epidemiological ultrasonography survey and relationship to body mass index. Am J Gastroenterol

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1989;84:1378-1382. 12. Gilger MA. Cholelithiasis and cholecystitis. In: Wyllie R, Hyams JS, eds. Pediatric Gastrointestinal Disease. W.B. Saunders Co; 1993. p. 931-940. 13. Giudice ME, Perrota S, Nobili B, Specchia C, Urzo G, Iolascon A. Coinheritance of Gilbert syndrome increases the risk for developing gallstones in patients with hereditary spherocytosis. Blood 1999;94:2259-2262. 14. Meloni T, Forteleoni G, Noja G, Dettori G, Sale MA, Melani GF. Increased prevalence of glucose-6 phosphate dehydrogenase deficiency in patients with cholelithiasis. Acta Haematol 1991;85:76-79. 15. King RD, Ginn-Paese EM, Lioyd VT, Hoffman J, Columbus HK. Parenteral nutrition with associated cholelithiasis: Another iatrogenic disease of infants and children. J Pediatr Surg 1987;22:593-596. 16. Pitt HA, King W, Mann LL. Increased risk of cholelithiasis with prolonged parenteral nutrition. Am J Surg

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1983;145:106-112. 17. Schweizer P, Lenz MP, Kirschner HJ. Pathogenesis and symptomatology of cholelithiasis in childhood. A prospective study. Dig Surg 2000;17:459-467. 18. Debray D, Pariente D, Gauthier F, Myara A, Bernard O. Cholelithiasis in infancy: A study of 40 cases. J Pediatr 1993;122:385-391. 19. Brush WS, Ein HS, Rocchi C, Kim CWP. The management of nonpigmented gallstones in children. J Pediatr Surg 2000;35:729-732.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 15-11-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-02-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ÁÁÂÏÈ΋ ª‹ÙÛÈη ¶›Ó‰Ô˘ 9-11, ∆∫. 152 35, µÚÈÏ‹ÛÛÈ·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· £ÂÚ·›· ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ Û ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË1 ™ÎÔfi˜: O ÚfiÏÔ˜ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚȉ›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ (H. pylori) ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ ·Ú·Ì¤ÓÂÈ ·Û·Ê‹˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› ·Ó Û ·È‰È¿ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË Î·È Ïԛ̈ÍË ·fi H. pylori Ù· Û˘ÌÙÒÌ·Ù· ÂÍ·Ê·Ó›˙ÔÓÙ·È ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 37 ·È‰È¿ ËÏÈΛ·˜ 4,9-14,5 ÂÙÒÓ (‰È¿ÌÂÛË ËÏÈΛ· 9,8 ¤ÙË) Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏȷο ¿ÏÁË Î·È Ïԛ̈ÍË ·fi H. pylori ·ÔÙ¤ÏÂÛ·Ó ÙÔ ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘. ∏ ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi H. pylori ¤ÁÈÓ Ì ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Î·È Î·ÏÏȤÚÁÂÈ·. ¢fiıËΠ·ÁˆÁ‹ ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H. pylori Î·È ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ·ÁˆÁ‹˜ ¤ÁÈÓ Â·Ó¿ÏË„Ë Ù˘ Á·ÛÙÚÔÛÎfiËÛ˘ Ì ϋ„Ë ‚ÈÔ„ÈÒÓ. ∏ ·ÚÔ˘Û›· ‹ fi¯È Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù·ÁÚ¿ÊËΠ3 Î·È 6 Ì‹Ó˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ıÂÚ·›·˜ ÂÎÚ›˙ˆÛ˘ Î·È ·Ú¿ÏÏËÏ· ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· H. pylori ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜. ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛ˘, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÂÓ‰ÔÛÎfiËÛ˘ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ ‰ÂÓ ÁÓˆÛÙÔÔÈ‹ıËÎ·Ó Û 23 ·ÛıÂÓ›˜, ÂÓÒ ¤ÁÈÓ·Ó ÁÓˆÛÙ¿ Û 14, Û‡Ìʈӷ Ì ÙËÓ ÂÈı˘Ì›· ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ. ∞ÔÙÂϤÛÌ·Ù·: ∆· ÔÛÔÛÙ¿ ÂÎÚ›˙ˆÛ˘ ‹Ù·Ó 81% (30/37) ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Î·È 74% (17/23) ÛÙËÓ Ù˘ÊÏ‹ ÔÌ¿‰·. ∆· IgG ·ÓÙÈÛÒÌ·Ù· ÌÂÈÒıËÎ·Ó ÛËÌ·ÓÙÈο ÛÙÔ˘˜ 3 Ì‹Ó˜ (p<0,03), ηıÒ˜ Â›Û˘ Î·È ÛÙÔ˘˜ 6 Ì‹Ó˜ (p<0,001) ÛÙ·

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·È‰È¿ Ì ÂÈÙ˘¯‹ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ ÌÂÈÒıËÎÂ Î·È ˘‹Ú¯Â ‚ÂÏÙ›ˆÛË Ù˘ ÁÂÓÈ΋ ηٿÛÙ·Û˘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (95%) 6 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ·ÁˆÁ‹. ¢ÂÓ ‚Ú¤ıËΠfï˜ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÎÚ›˙ˆÛ˘ ‹ fi¯È ÙÔ˘ H. pylori Î·È ÂÍ·Ê¿ÓÈÛ˘ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ, ›Ù ÛÙÔ˘˜ 3 Î·È 6 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (p=0,94 Î·È p=0,90), ›Ù ÛÙËÓ Ù˘ÊÏ‹ ÔÌ¿‰· (p=0,42 Î·È p=0,65). ™˘ÌÂÚ¿ÛÌ·Ù·: ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ‰ÂÓ ·Ô‰ÂÈÎÓ‡ÂÙ·È ·ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ Î·È H. pylori.

1 Wewer V, Andersen LP, Paerregaard A, Gernow A, Hansen JP, Matzen P et al Treatment of Helicobacter pylori in children with recurrent abdominal pain Helicobacter 2001;6:244-248

°ÈÒÙ· π. ∫·ÊÚ›ÙÛ· ¶·È‰›·ÙÚÔ˜-°·ÛÙÚÂÓÙÂÚÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ


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CASE REPORT

™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ·fi Ó·ÚΈÙÈΤ˜ Î·È ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ π. ∫·ÂÙ·Ó¿Î˘1, π. ∫·Ï¤ÁÈ·˜1, ª. ª·ÚÎÔ‡ÚË1, °. ∞Ï‚È˙fiÔ˘ÏÔ˜2, °. ∫Ô˘Ú¿Î˘1, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈη˜1

Neonatal withdrawal syndrome from narcotic and non-narcotic drugs. Report of two cases I. Kapetanakis1, J. Kaleyias1, M. Markouri1, G. Alevizopoulos2, G. Kourakis1, ∂. Dellagrammaticas1

¶ÂÚ›ÏË„Ë: ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó ÂıÈÛÙ› ÛÙË ¯Ú‹ÛË ‰È·ÊfiÚˆÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ (™™) ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô ÏfiÁˆ ·ÈÊÓ›‰È·˜ ‰È·ÎÔ‹˜ Ù˘ ÂıÈÛÙÈ΋˜ Ô˘Û›·˜ Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. OÈ Ô˘Û›Â˜ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ™™ ÛÙÔ ÓÂÔÁÓfi Â›Ó·È ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡Ó ÂÍ¿ÚÙËÛË Û ÂÓ‹ÏÈΘ, fiˆ˜ Ù· ÔÈÔÂȉ‹ (ËÚˆ›ÓË, ÌÂı·‰fiÓË, ÌÔÚÊ›ÓË), Ù· ‚·Ú‚ÈÙÔ˘ÚÈο, ÙÔ ·ÏÎÔfiÏ Î·È ÔÈ ‚ÂÓ˙ԉȷ˙Â›Ó˜. OÈ ÂΉËÏÒÛÂȘ ÙÔ˘ ™™ Â›Ó·È ÔÈΛϘ Î·È ·ÓÂÍ¿ÚÙËÙ˜ Ù˘ Ô˘Û›·˜ Î·È Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·‰˘Ó·Ì›· ‡ÓÔ˘, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÙÚfiÌÔ, ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ·, ‰È¿ÚÚÔÈ·, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ¿ÓÔÈ·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·Ó·Ó¢ÛÙÈ΋ ·ÏοψÛË Î·È ‰·ÎÚ‡ÚÚÔÈ·. ∏ ÌË ÂȉÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ™™ ηıÈÛÙ¿ ÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘ ‰˘Û¯ÂÚ‹. º·Ú̷΢ÙÈ΋ ·Ú¤Ì‚·ÛË ··ÈÙÂ›Ù·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÛÔ‚·ÚÒÓ ÂΉËÏÒÛˆÓ. ∆· Ê¿Ú̷η Ô˘ Û˘¯ÓfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Ó·È Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, ÙÔ ·ÚËÁÔÚÈÎfi Ï¿‚‰·ÓÔ, Ë ¯ÏˆÚÔÚÔÌ·˙›ÓË Î·È Ë ‰È·˙Â¿ÌË. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÙÒÛÂȘ ™™ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ·fi Ó·ÚΈÙÈΤ˜ (ÌÂı·‰fiÓË) Î·È ÌË-Ó·ÚΈÙÈΤ˜ (‚ÂÓ˙ԉȷ˙Â›ÓË) Ô˘Û›Â˜ Ô˘ ›¯·Ó ·ÚfiÌÔÈ· ÎÏÈÓÈ΋ ÂÈÎfiÓ·. ∆Ô Î‡ÚÈÔ Û‡Ìو̷ ‹Ù·Ó Ë ÚÒÈÌË ¤Ó·ÚÍË Û·ÛÌÒÓ. ∏ ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ· ηٿ¯ÚËÛ˘ Ê·ÚÌ¿ÎˆÓ ÛÙË ¯ÒÚ· Ì·˜ Ô‰ËÁ› Û ·˘Í·ÓfiÌÂÓÔ ·ÚÈıÌfi ÓÂÔÁÓÒÓ Ô˘ ¤¯Ô˘Ó ÂÎÙÂı› Û ·˘Ù¿ ÂÓ‰ÔÌËÙÚ›ˆ˜. ∏ ÚfiÏË„Ë, Ë ıÂÚ·›· Î·È Ë ÊÚÔÓÙ›‰· ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ ÂÈ‚¿ÏÏÂÈ ÙË ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· Ù˘ ÔÏÈÙ›·˜, ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÊÔÚ¤ˆÓ, ÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÙÔ˘ ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡.

Abstract: A group of symptoms referred to as neonatal withdrawal syndrome (NWS) may occur in infants born to mothers addicted to certain drugs, as a result of sudden discontinuation of the drug supply. The classes of drugs that cause NWS are those that produce addiction in adults, such as opiates (heroin, methadone, morphine), barbiturates, alcohol and benzodiazepines. Many of the manifestations of NWS occur regardless of the drug type and include wakefulness, irritability, tremors, hyperactivity, diarrhea, respiratory distress, apnoeic attacks, weight loss, respiratory alkalosis and lacrimation (WITHDRAWAL). The fact that these symptoms are nonspecific makes the identification of NWS difficult, unless it is specifically looked for. Pharmacologic intervention may be required to control severe signs and symptoms. The most common drugs used to modify withdrawal symptoms are phenobarbital, paregoric, chloropromazine, and diazepam. We report two neonates with NWS from narcotic (methadone) and non-narcotic (benzodiazepamine) drugs which had similar clinical presentation. Early onset seizures was the presenting symptom. The increasing incidence of drug abuse in Greece leads to a growing number of children with intrauterine drug exposure. The prevention, therapy, and care of these neonates demands the close cooperation of the state, social welfare services, midwives, and the medical and nursing personnel.

1 ∆Ì‹Ì· ¡ÂÔÁÂÓÓ‹ÙˆÓ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÔ‰ÈηÛÙÈ΋˜ Î·È ∆ÔÍÈÎÔÏÔÁ›·˜ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ

1 Neonatal Intensive Care Unit 2nd Pediatric Clinic, University of Athens 2 Forensic Medicine and Toxicology Lab, University of Athens

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§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÌÂı·‰fiÓË, ‚ÂÓ˙ԉȷ˙Â›Ó˜.

Key words: neonatal withdrawal syndrome, methadone, benzodiazepine.

™˘ÓÙÔÌÔÁڷʛ˜

∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ (∫∆) ÏfiÁˆ ÚfiˆÚ˘ ¤Ó·Ú͢ ˆ‰›ÓˆÓ Î·È ÚÔËÁËı›۷˜ ∫∆ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (µ°) 1350 g (50Ë ∂£), Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (ª™) 40 cm (50Ë ∂£) Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ (¶∫) 27,5 cm (50Ë ∂£). ∏ ÌËÙ¤Ú· ‹Ù·Ó 39 ÂÙÒÓ, ·Ó‡·ÓÙÚË, ÙÂÙ·ÚÙ¤ÁÎ˘Ô˜ Î·È ‰Â˘ÙÂÚfiÙÔÎÔ˜ Î·È Â›¯Â Û˘ÛÙËÌ·ÙÈ΋ Ì·È¢ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, Ë ÌËÙ¤Ú· ‹Ù·Ó ˘fi ÔÏÏ·Ï‹ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, ÏfiÁˆ ηٷıÏÈÙÈ΋˜ „‡¯ˆÛ˘ Ô˘ ›¯Â ‰È·ÁÓˆÛÙ› ÚÈÓ ÙËÓ Î‡ËÛË (ÏÔÚ·˙Â¿ÌË, Ï‚ÔÚÔÌ·˙›ÓË, ‰È·˙Â¿ÌË, ÎÏÔÌÈÚ·Ì›ÓË Î·È ¯ÏˆÚÔÚÔÌ·˙›ÓË). ∆Ô Apgar score ÙÔ ÚÒÙÔ ÏÂÙfi ‹Ù·Ó 5 Î·È ÙÔ ¤ÌÙÔ 7. ∞̤ۈ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ÙÔ ÓÂÔÁ¤ÓÓËÙÔ ·ÚÔ˘Û›·Û ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ÁÈ· ÙËÓ ÔÔ›· ‰È·ÛˆÏËÓÒıËÎÂ Î·È ¯ÔÚËÁ‹ıËΠ·Ú¿ÏÏËÏ· ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Î·È ·Ú¤ÌÂÈÓ ‰È·ÛˆÏËӈ̤ÓÔ ÁÈ· 48 ÒÚ˜. ∆Ô ÓÂÔÁÓfi ·fi ÙËÓ 3Ë Ë̤ڷ ˙ˆ‹˜ ·ÚÔ˘Û›·Û ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÂÚÙÔÓ›· Î·È ÙËÓ 8Ë Ë̤ڷ ˙ˆ‹˜ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÔfiÙÂ Î·È ÌÂٷʤÚıËΠÛÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ (ª∂¡) ÓÂÔÁÓÒÓ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó Û ̤ÙÚÈ· ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ì ¤ÓÙÔÓ˜ ·ÁÁÂÈÔÎÈÓËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ıÂÚÌÔÎÚ·Û›· 36,7ÔC, ·Ó·ÓÔ¤˜ 40/min, ÛʇÍÂȘ 135/min Î·È Î·ıÔÏÈ΋ ˘ÂÚÙÔÓ›·. ¶·ÚÔ˘Û›·˙ Â›ÌÔÓÔ˘˜, ·ÓıÂÎÙÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÔÔ›ˆÓ ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ·ÓÙÈÛ·Û̈‰ÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ê·ÈÓ˘ÓÙÔ˝ÓË Î·È ‰È·˙Â¿ÌË). ∏ ÔÏ˘Ê·Ú̷΢ÙÈ΋ ·ÓÙÈηٷıÏÈÙÈ΋ ·ÁˆÁ‹ Ù˘ ÌËÙ¤Ú·˜ ¤ıÂÛ ÈÛ¯˘Ú¿ ÙËÓ ˘Ô„›· ÙÔ˘ ™™, ·Ú¿ÏÏËÏ· fï˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ô ··Ú·›ÙËÙÔ˜ ¤ÏÂÁ¯Ô˜ Î·È ·ÔÎÏ›ÛÙËÎ·Ó ¿ÏÏ· ·›ÙÈ· Û·ÛÌÒÓ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (Ïԛ̈ÍË, ˘ÔÁÏ˘Î·ÈÌ›·, ˘·Û‚ÂÛÙÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· Î·È ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·). ∂›Û˘, ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· Â›‰· ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ¤·ÈÚÓÂ Ë ÌËÙ¤Ú· ÛÙÔ Ï¿ÛÌ· ÙÔ˘ ÓÂÔÁÓÔ‡: ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο 40 ng/ml (ıÂÚ·¢ÙÈο Â›‰· 121-150 ng/ml) Î·È ‰È·˙Â¿ÌË 482 ng/ml (ıÂÚ·¢ÙÈο Â›‰· 86-595 ng/ml). ∆· ·ÓȯÓ‡ÛÈÌ· Â›‰· ÙˆÓ ÙÚÈ΢ÎÏÈÎÒÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ Î·È Ù· ˘„ËÏ¿ Â›‰· Ù˘ ‰È·˙Â¿Ì˘ (Ù· ÔÔ›· fï˜ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÌÂÙ¿ ÙË ıÂÚ·¢ÙÈ΋ ¯ÔÚ‹ÁËÛË ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û·ÛÌÒÓ) ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Û˘ÓËÁÔÚÔ‡Û·Ó ÁÈ· ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ Îϛ̷η ηٿ Finnegan, ÙÔ ÓÂÔÁÓfi ›¯Â 11 ‚·ıÌÔ‡˜ [ÙÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ (4)+ ˘ÂÚÙÔÓ›· (2)+ Û·ÛÌÔ› (5)] ηÈ, ÂÔ̤ӈ˜, ÂÚfiÎÂÈÙÔ ÁÈ· ÛÔ‚·Úfi ™™ Ô˘ ¤¯ÚË˙ ʷÚ̷΢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘. ÃÔÚËÁ‹ıËΠʷÈÓÔ‚·Ú‚ÈÙ¿ÏË Û ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ (5 mg/kg/∏, ™Ù.). ∆· ÂÂÈÛfi‰È· Û·ÛÌÒÓ Û˘Ó¯›ÛÙËÎ·Ó Î·È ÙȘ ÂfiÌÂÓ˜ 48 ÒÚ˜, ·ÏÏ¿ ·Ú·ÈfiÙÂÚ· Î·È ‹Ù·Ó ÈÔ Û‡ÓÙÔÌ˘ ‰È¿ÚÎÂÈ·˜, ÂÓÒ ‹Ù·Ó ·ÎfiÌ· ¢ÂÚ¤ıÈÛÙÔ, ÙÚÔÌ҉˜ Î·È ˘ÂÚÙÔÓÈÎfi (‚·ıÌÔÏÔÁ›· ηٿ Finnegan 6). ∆Ë 13Ë Ë̤ڷ ˙ˆ‹˜, Ù· Â›‰· Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ‹Ù·Ó 44 ng/ml, ÂÓÒ Ù· Â›‰· ÙˆÓ ÙÚÈ΢ÎÏÈÎÒÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ

™™

™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛ˘

∂ÈÛ·ÁˆÁ‹ ∏ ÂÓ‰ÔÌ‹ÙÚÈ· ¤ÎıÂÛË Û ӷÚΈÙÈΤ˜ Î·È ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ Ô‰ËÁ› Û ÙÔÍÈ΋ ¤ÎıÂÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È Û ۇӉÚÔÌÔ ÛÙ¤ÚËÛ˘ (™™) ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (1). ∏ ÂÍ¿ÚÙËÛË ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙË ¯ÒÚ· Ì·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∞fi ÚfiÛÊ·ÙË ÌÂϤÙË ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ¯ÚËÛÙÒÓ ËÚˆ›Ó˘ Ô˘ ‰È·ÎÔÌ›˙ÔÓÙ·È ÛÙ· ¡ÔÛÔÎÔÌ›· ÏfiÁˆ ˘ÂÚ‚ÔÏÈ΋˜ ‰fiÛ˘, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· (77% ÙˆÓ ¯ÚËÛÙÒÓ ‹Ù·Ó ÌÂٷ͇ 15-30 ÂÙÒÓ) (2). ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂÍ¿ÚÙËÛ˘ ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜, ÚÔÁÚ¿ÌÌ·Ù· ·ÂÍ¿ÚÙËÛ˘ Ì ÌÂı·‰fiÓË ‹‰Ë ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙË ¯ÒÚ· Ì·˜ Î·È ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ Â›Ó·È ÂÓÙ·Á̤Ó˜ Û ·˘Ù¿ (3). OÈ Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ™™, ·ÏÏ¿ ÙÂÏÂ˘Ù·›· ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈ ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ (1). ¡·ÚΈÙÈΤ˜ Ô˘Û›Â˜ Ô˘ ÚÔηÏÔ‡Ó ™™ Â›Ó·È Ë ÌÔÚÊ›ÓË, Ë ËÚˆ›ÓË Î·È Ë ÌÂı·‰fiÓË, ÂÓÒ ÌË-Ó·ÚΈÙÈΤ˜ Â›Ó·È Ù· ‚·Ú‚ÈÙÔ˘ÚÈο, ÔÈ ‚ÂÓ˙ԉȷ˙Â›Ó˜, Ù· ÙÚÈ΢ÎÏÈο ·ÓÙÈηٷıÏÈÙÈο, ÔÈ Ê·ÈÓÔıÂÈ·˙›Ó˜, ÙÔ Ï›ıÈÔ, ÙÔ ·ÏÎÔfiÏ Î·È ¿ÏϘ. ∆· Û˘ÌÙÒÌ·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙ¤ÚËÛ˘ Â›Ó·È ·˘Ù¿ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È Ì ٷ ·Ú¯Èο Ù˘ ·ÁÁÏÈ΋˜ Ϥ͢ WITHDRAWAL (wakefulness, irritability, tremors, hyperactivity, diarrhea, respiratory distress, apnoeic attacks, weight loss, respiratory alkalosis, lacrimation) (4). ∆· Û˘ÌÙÒÌ·Ù· Â›Ó·È ÌË ÂȉÈο Î·È ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Â›‰Ô˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. OÈ Û·ÛÌÔ› Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Î·Ù¿ ÙË ‰È·‰ÚÔÌ‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ÌÔÚ› fï˜ Ó· ·ÔÙÂÏÔ‡Ó Î·È ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ÂÚÈÛÙ·ÙÈο ™™ ·fi οı ηÙËÁÔÚ›· (Ó·ÚΈÙÈο Î·È ÌË-Ó·ÚΈÙÈο) ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔÓÈÛÙ› fiÙÈ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ·ÚfiÌÔÈ· Î·È fiÙÈ Ë ÎÏÈÓÈ΋ Â·ÁÚ‡ÓËÛË Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ™‹ÌÂÚ·, ÙÔ ™™ Û ÓÂÔÁ¤ÓÓËÙ· ‰ÂÓ Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ófi, ÌÂÏÏÔÓÙÈο fï˜ Â›Ó·È Èı·Ófi Ó· ·ÔÙÂϤÛÂÈ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆÓ›·, ÏfiÁˆ Ù˘ ÂÍ¿ψÛ˘ ÙˆÓ Ó·ÚΈÙÈÎÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÂÚ›ÙˆÛË ÚÒÙË: ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ¶ÚfiˆÚÔ ¿ÚÚÂÓ ÓÂÔÁÓfi, ËÏÈΛ·˜ ·ËÛ˘ (∏∫) 29 ‚‰ÔÌ¿‰ˆÓ, ÂÈÛ‹¯ıË ÛÙÔ ∆Ì‹Ì· ÙËÓ 8Ë Ë̤ڷ ˙ˆ‹˜ ÏfiÁˆ Û·ÛÌÒÓ.

134


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·135

¶·È‰È·ÙÚÈ΋ 2002;65:133-137

‹Ù·Ó ÛÙ·ıÂÚ¿ (39 ng/ml) Î·È Ù˘ ‰È·˙Â¿Ì˘ Û ÙˆÙÈ΋ ÔÚ›· (247 ng/ml). ∆ËÓ 24Ë Ë̤ڷ ˙ˆ‹˜, Ù· Â›‰· ÙˆÓ ÙÚÈ΢ÎÏÈÎÒÓ ·ÓÙÈηٷıÏÈÙÈÎÒÓ Î·È Ù˘ ‰È·˙Â¿Ì˘ ›¯·Ó ÌˉÂÓÈÛÙ› Î·È Ù˘ Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ‹Ù·Ó Û ÙˆÙÈ΋ ÔÚ›·. ∆ËÓ 28Ë Ë̤ڷ ˙ˆ‹˜, ‰È·ÎfiËÎÂ Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ù· Â›‰· Ù˘ ÔÔ›·˜ ‹Ù·Ó ˘ÔıÂÚ·¢ÙÈο Î·È ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ·Û˘Ìو̷ÙÈÎfi. ∆Ô ÓÂÔÁÓfi ÂÍ‹Ïı ÙËÓ 60Ë Ë̤ڷ ˙ˆ‹˜ Î·È Û ËÏÈΛ· 2 ÂÙÒÓ Â›¯Â Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. ¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË: ™™ ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ (ÌÂı·‰fiÓË) ¡ÂÔÁÓfi ·ÁfiÚÈ, ∏∫ 37 ‚‰ÔÌ¿‰ˆÓ, ÏÈÔ‚·Ú¤˜ [µ° 2180 g (10Ë ∂£), ¶∫ 29,5 cm (5Ë ∂£)] ÂÈÛ‹¯ıË ÛÙÔ ÙÌ‹Ì· ÏfiÁˆ Û·ÛÌÒÓ Û ËÏÈΛ· 24 ˆÚÒÓ. ∏ ÌËÙ¤Ú· ‹Ù·Ó 28 ÂÙÒÓ, ‰Â˘ÙÂÚ¤ÁÎ˘Ô˜, ‰Â˘ÙÂÚfiÙÔÎÔ˜ Î·È ·ÎÔÏÔ˘ıÔ‡Û ÚfiÁÚ·ÌÌ· ·ÂÍ¿ÚÙËÛ˘ ·fi ËÚˆ›ÓË Ì ÌÂı·‰fiÓË. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠ̠∫∆ ÏfiÁˆ ·ÈÌÔÚÚ·Á›·˜ ÙÔ˘ Ï·ÎÔ‡ÓÙ·. ∆Ô Apgar score ÛÙÔ ÚÒÙÔ ÏÂÙfi ‹Ù·Ó 9. ∏ ÌËÙ¤Ú· ‹Ù·Ó ¯ÚfiÓÈÔ˜ ÊÔÚ¤·˜ Ë·Ù›Ùȉ·˜ C Î·È ¯Ú‹ÛÙ˘ ËÚˆ›Ó˘ ̤¯ÚÈ ÙÔÓ 4Ô Ì‹Ó· ·ËÛ˘, Ë ÔÔ›· ·ÎÔÏÔ‡ıˆ˜ ÂÓÙ¿¯ıËΠ۠ÚfiÁÚ·ÌÌ· ·ÂÍ¿ÚÙËÛ˘ Ì ÌÂı·‰fiÓË. ™ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ÂÏ¿Ì‚·Ó ÂÚÈÛÙ·Ûȷο Î·È ‰È·˙Â¿ÌË. O ·Ù¤Ú·˜ ‹Ù·Ó Â›Û˘ ¯ÚfiÓÈÔ˜ ÊÔÚ¤·˜ Ë·Ù›Ùȉ·˜ Î·È ¯Ú‹ÛÙ˘ ËÚˆ›Ó˘. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ·È‰› ËÏÈΛ·˜ 14 ÂÙÒÓ ‹Ù·Ó ˘ÁȤ˜. ∆Ô ÓÂÔÁÓfi ÙËÓ 3Ë ÒÚ· ˙ˆ‹˜ ·ÚÔ˘Û›·Û ÙÚfiÌÔ Î·È ÙË 12Ë ÒÚ· Û·ÛÌÔ‡˜ (ÎÏÔÓÈΤ˜ Û˘Û¿ÛÂȘ ¿ÎÚˆÓ, ηٷÔÙÈΤ˜ ÎÈÓ‹ÛÂȘ Î·È Û˘Û¿ÛÂȘ ‚ÏÂÊ¿ÚˆÓ). ∆· ÂÂÈÛfi‰È· Û·ÛÌÒÓ ‹Ù·Ó ·Ú¯Èο ·Ú·È¿, ÛÙ·‰È·Î¿ ‡ÎÓˆÛ·Ó Î·È ÙÂÏÈο ¤ÁÈÓ·Ó Û˘Ó¯‹. ÃÔÚËÁ‹ıËΠÂÓ‰ÔÊϤ‚È· ‰È·˙Â¿ÌË (0,1 mg/kg, 6 ‰fiÛÂȘ). §fiÁˆ ÂÌÌÔÓ‹˜ ÙˆÓ Û·ÛÌÒÓ, ÙÔ ÓÂÔÁÓfi ‰È·ÎÔÌ›ÛÙËΠÛÙÔ ÙÌ‹Ì· ¡ÂÔÁÂÓÓ‹ÙˆÓ. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ‹Ù·Ó Û ̤ÙÚÈ· ÎÏÈÓÈ΋ ηٿÛÙ·ÛË, Ì ¯ÚÒÌ· ‰¤ÚÌ·ÙÔ˜ ÚÔ‰·Ïfi, ıÂÚÌÔÎÚ·Û›· 36,6ÔC, Ù·¯‡ÓÔÈ· (80 ·Ó·ÓÔ¤˜/min), ÛʇÍÂȘ 150/min, ˘„›Û˘¯ÓÔ ÎÏ¿Ì· Î·È ‹Ù·Ó ¢ÂÚ¤ıÈÛÙÔ Ì ÙÚfiÌÔ ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚˆÓ Î·È ·˘ÍË̤ÓÔ Ì˘˚Îfi ÙÚfiÌÔ. ∆Ô ÈÛÙÔÚÈÎfi Ï‹„˘ ÌÂı·‰fiÓ˘ ·fi ÙË ÌËÙ¤Ú· ¤ıÂÛ ÈÛ¯˘Ú¿ ÙËÓ ˘Ô„›· ™™ ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ (ÌÂı·‰fiÓË). O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠÁÈ· ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ ·ÈÙ›ˆÓ Û·ÛÌÒÓ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (Ïԛ̈ÍË, ˘ÔÁÏ˘Î·ÈÌ›·, ˘·Û‚ÂÛÙÈ·ÈÌ›·, ˘ÔÌ·ÁÓËÛÈ·ÈÌ›·, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· Î·È ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ™Ù· Ô‡Ú· ÙÔ˘ ÓÂÔÁÓÔ‡ ·ÓȯÓ‡ıËΠÌÂı·‰fiÓË, fiˆ˜ Î·È ÛÙ· Ô‡Ú· Ù˘ ÌËÙ¤Ú·˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™ Ù¤ıËΠ̠‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∏ ÎÏÈÓÈ΋ ‚·ıÌÔÏÔÁ›· ηٿ Finnegan ‹Ù·Ó 15 [Ô͇ ÎÏ¿Ì· (2)+ ÂÏ·ÊÚ¤˜ ÙÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ ÛÙËÓ ·Ó¿·˘ÛË (3)+ ˘ÂÚÙÔÓ›· (2)+ Û·ÛÌÔ› (5)+ ‰È¿ÚÚÔȘ (2)+ Ù·¯‡ÓÔÈ· (1)]. ªÂ ‚¿ÛË ÙË ‚·ıÌÔÏÔÁ›· ·˘Ù‹, ÂÚfiÎÂÈÙÔ ÁÈ· ÛÔ‚·Úfi ™™ Ô˘ ¤¯ÚË˙ ʷÚ̷΢ÙÈ΋˜ ·Ú¤Ì‚·Û˘. ÃÔÚËÁ‹ıËΠʷÈÓÔ‚·Ú‚ÈÙ¿ÏË Û ‰fiÛË Û˘ÓÙ‹ÚËÛ˘ (5 mg/kg/∏, ™Ù). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛÙ·‰È·Î¿ ‚ÂÏÙÈÒıËÎÂ, fiˆ˜ Î·È Ë ‚·ıÌÔÏfiÁËÛË Î·Ù¿ Finnegan. ∆Ë 13Ë Ë̤ڷ ˙ˆ‹˜, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÛÈÙÈ˙fiÙ·Ó Ì ÌÈÌÂÚfi, ·Ó¤ÎÙËÛ ÙÔ µ°, ÂÓÒ ÔÈ ·Ú¯Èο ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ ·ÔηٷÛÙ¿ıËηÓ. ¶·Ú¤ÌÂÈÓ ‹ÈÔ˜ ÙÚfiÌÔ˜ ¿ÎÚˆÓ Î·È ˘ÂÚÙÔÓ›· (Finnegan 4). ∏ ÂÏ¿ÙÙˆÛË Ù˘ ‚·ıÌÔÏfiÁËÛ˘ Ô‰‹ÁËÛ Û ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘, Ë ÔÔ›· ‰È·ÎfiËΠÙËÓ 24Ë Ë̤ڷ. ∆Ô ÓÂ-

Paediatriki 2002;65:133-137

ÔÁÓfi ÂÍ‹Ïı Û ËÏÈΛ· 27 ËÌÂÚÒÓ Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ÂͤÏÈÍË ÛÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ Î·È 3 ÌËÓÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋.

™˘˙‹ÙËÛË ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÙÔ ıÂÙÈÎfi ÈÛÙÔÚÈÎfi Ï‹„˘ Ô˘ÛÈÒÓ ·fi ÙȘ ÌËÙ¤Ú˜ ÙÔ˘˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∏ ÚÒÙË ÂÚ›ÙˆÛË ·ÊÔÚÔ‡Û ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Î·È Ë ‰Â‡ÙÂÚË ·fi Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ™™ ÔÈΛÏÏÂÈ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÒÚ· Î·È ÙË ‰fiÛË Ù˘ ÙÂÏÂ˘Ù·›·˜ ¯ÔÚ‹ÁËÛ˘ Ô˘ ‹ÚÂ Ë ¤ÁÎ˘Ô˜, ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ Ô˘Û›·˜ ÛÙË ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔÁÓfi, ÙÔ Ú˘ıÌfi ·¤ÎÎÚÈÛ˘ Ù˘ Ô˘Û›·˜, ·ÏÏ¿ Î·È ·fi ¿ÏÏÔ˘˜ ·‰È¢ÎÚ›ÓÈÛÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ (1). °ÂÓÈο, Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ™™ ·fi ÔÈÔ‡¯· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ¢ÂÚÂıÈÛÙfiÙËÙ· ÙÔ˘ ∫¡™ Î·È ·fi Û˘ÌÙÒÌ·Ù· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ ¢ÂÚÂıÈÛÙfiÙËÙ· ÙÔ˘ ∫¡™ Û˘Óԉ‡ÂÙ·È ·fi Û·ÛÌÔ‡˜ (2% ̤¯ÚÈ 11%) (5) Î·È ·ıÔÏÔÁÈÎfi ∏∂° (40%) (6). OÈ Û·ÛÌÔ› Û˘ÓÔ‰Â‡Ô˘Ó Î·È ÙÔ ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜, fiˆ˜ Ù· ‚·Ú‚ÈÙÔ˘ÚÈο (7), Ù· ˘ÓˆÙÈο-·Á¯ÔÏ˘ÙÈο (8) Î·È ÙÔ ·ÏÎÔfiÏ (9). O ¯ÚfiÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ¤ÚËÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ¯ÚfiÓÔ Ï‹„˘ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰fiÛ˘ Ù˘ Ô˘Û›·˜ Î·È ·fi ÙÔ ÌÂÙ·‚ÔÏÈÛÌfi Î·È ÙËÓ ·¤ÎÎÚÈÛË Ù˘ Ô˘Û›·˜ Î·È ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘. ∞Ó ÌÂٷ͇ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰fiÛ˘ Î·È ÙÔ˘ ÙÔÎÂÙÔ‡ ÌÂÛÔÏ·‚‹ÛÂÈ ‰È¿ÛÙËÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ‚‰ÔÌ¿‰·, ÙfiÙÂ Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ™™ ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο. ∞Ó fï˜ Ë ÙÂÏÂ˘Ù·›· ‰fiÛË Â›Ó·È 24 ÒÚ˜ ÚÈÓ ÙÔÓ ÙÔÎÂÙfi, ÙfiÙ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì¤Û· ÛÙ· ÚÒÙ· 24ˆÚ· ˙ˆ‹˜. ∏ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™™ ·fi ÔÈÔ‡¯·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ÌÂı·‰fiÓ˘, Â›Ó·È Û˘Ó‹ıˆ˜ ÙȘ ÚÒÙ˜ 48-72 ÒÚ˜ ˙ˆ‹˜, ·ÏÏ¿ ÌÔÚ› Ó· ÊÙ¿ÛÂÈ Î·È ÙȘ 4 ‚‰ÔÌ¿‰Â˜ (10). ∏ fi„ÈÌË ÂÌÊ¿ÓÈÛË ÙÔ˘ ™™ ·fi ÌÂı·‰fiÓË ¤¯ÂÈ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ·ÚfiÌÔÈ· Ì ÙËÓ ÚÒÈÌË Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚Ô˘ÏÈÌ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ™ÙÔ ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ë ÙÂÏÂ˘Ù·›· ‰fiÛË ÌÂı·‰fiÓ˘ ‹Ù·Ó 36 ÒÚ˜ ÚÈÓ ÙÔÓ ÙÔÎÂÙfi Î·È ÙÔ ™™ ÂΉËÏÒıËΠÙÔ ÚÒÙÔ 24ˆÚÔ ˙ˆ‹˜. OÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ‰fiÛË Ù˘ ÌÂı·‰fiÓ˘ ÛÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ÙfiÛÔ ˘„ËÏfiÙÂÚ˜ Â›Ó·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔ ÓÂÔÁÓfi (1,5,10,11). °È· ·˘Ùfi ÙÔ ÏfiÁÔ, Û‹ÌÂÚ· ÚÔÙ›ÓÂÙ·È Ë ÛÙ·‰È·Î‹ Ì›ˆÛË Ù˘ ‰fiÛ˘ Ù˘ ÌÂı·‰fiÓ˘ (<20 mg/Ë̤ڷ) ÛÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ÒÛÙ ӷ ÌÂÈÒÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ™™ (1,11). ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ™™ ·fi ·Á¯ÔÏ˘ÙÈο-˘ÓˆÙÈο Ê¿Ú̷η Â›Ó·È ‰˘ÛÎÔÏfiÙÂÚË, ÁÈ·Ù› ÂÌÊ·Ó›˙ÂÙ·È ÙËÓ 4Ë ¤ˆ˜ 7Ë

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¶·È‰È·ÙÚÈ΋ 2002;65:133-137

Ë̤ڷ (‡ÚÔ˜ ·fi 1Ë ¤ˆ˜ 14Ë Ë̤ڷ ˙ˆ‹˜) (7). ∆Ô ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Ì ™™ ·fi ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜ ÂΉ‹ÏˆÛ ÙÔ ™™ ÙËÓ 3Ë Ë̤ڷ ˙ˆ‹˜. ÕÏϘ ˘ÓˆÙÈΤ˜ Ô˘Û›Â˜ ÂΉËÏÒÓÔ˘Ó Û˘ÌÙÒÌ·Ù· ™™ ·ÎfiÌ· ·ÚÁfiÙÂÚ·, fiˆ˜ Ë ‰È·˙Â¿ÌË ÙË 12Ë Ë̤ڷ Î·È Ë ¯ÏˆÚ·‰È·˙ÂÔÍ›‰Ë ÙËÓ 21Ë Ë̤ڷ ˙ˆ‹˜ (12,13). ∆Ô Â˘Ú‡ Ê¿ÛÌ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÙÔ˘ ™™ Ê·›ÓÂÙ·È ·fi ÙËÓ Îϛ̷η ‚·ıÌÔÏfiÁËÛ˘ ηٿ Finnegan (14) (¶›Ó·Î·˜ 1). ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ Â›Ó·È Û ÚfiÁÚ·ÌÌ· ·ÂÍ¿ÚÙËÛ˘ Ì ÌÂı·‰fiÓË ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ µ° Û ۯ¤ÛË Ì ·˘Ù¿ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ Â›Ó·È ¯Ú‹ÛÙ˜ ËÚˆ›Ó˘, ·ÏÏ¿ ¤¯Ô˘Ó Û˘¯ÓfiÙÂÚ· ÌÈÎÚÔÎÂÊ·Ï›·, fiˆ˜ Î·È ÙÔ ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È (10,14). ∏ Ì·ÎÚÔ¯ÚfiÓÈ· ÓÔÛËÚfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› (1). §›Á˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ Ù· ÓÂÔÁÓ¿ ·˘Ù¿ ÌÂÙ¿ Ù· ÚÒÙ· ¤ÙË ˙ˆ‹˜. OÈ Ofofsson Î·È Û˘Ó (15) ·Ú·ÎÔÏÔ‡ıËÛ·Ó 72 ÓÂÔÁÓ¿ Ì ™™ ·fi ÌÂı·‰fiÓË ÁÈ· ‰È¿ÛÙËÌ· ·fi 1 ¤ˆ˜ 10 ¤ÙË Î·È Î·Ù¤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ 50% ·ÚÔ˘Û›·˙ ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (‰È¿Û·ÛË Ù˘ ÚÔÛÔ¯‹˜, ÂÈıÂÙÈÎfiÙËÙ·), ÙÔ 20% ›¯Â ̤ÙÚÈ·/ÛËÌ·ÓÙÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ÏfiÁˆ ÛÙ¤ÚËÛ˘ ÊÚÔÓÙ›‰·˜, Î·È ÙÔ 43% ›¯Â ·ÔÌ·ÎÚ˘Óı› ·fi ÙË ÌËÙ¤Ú· ÙÔ˘˜ ÌÂÙ¿ ·fi ‰ÈηÛÙÈ΋ ·fiÊ·ÛË. ∆· ‰‡Ô ÓÂÔÁÓ¿ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û ËÏÈΛ· 2 ÂÙÒÓ Î·È ‰ÂÓ

Paediatriki 2002;65:133-137

·ÚÔ˘Û›·˙·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ‹ ÛÙËÓ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. ∏ ·Ú¯È΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÓÂÔÁÓÒÓ Ì ™™ Â›Ó·È ˘ÔÛÙËÚÈÎÙÈ΋. ∏ ·fiÊ·ÛË ÁÈ· ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È Û ·˘Ù‹ ‚ÔËı¿ Ë ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ Îϛ̷η˜ Finnegan. ∏ ·fiÊ·ÛË ÁÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÂÍ·ÙÔÌÈ·ÂÙ·È Î·È ÛÙËÚ›˙ÂÙ·È ÛÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ™™. ∆Ô ™™ ÌÔÚ› Ó· Â›Ó·È ı·Ó·ÙËÊfiÚÔ. ¶·Ú’ fiÏ· ·˘Ù¿, Ë ÛÙ¤ÚËÛË Â›Ó·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ‰È·‰Èηۛ·. ∆Ô fiÊÂÏÔ˜ Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È Ë ‚Ú·¯˘¯ÚfiÓÈ· ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘Ìو̿وÓ. ¢ÂÓ ¤¯ÂÈ, fï˜, ·ÎfiÌ· ‰È¢ÎÚÈÓÈÛÙ› ·Ó Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÓÔÛËÚfiÙËÙ· ·fi ÛÙ¤ÚËÛË ÌÂÈÒÓÂÙ·È Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹ (10,15). ¡ÂÔÁÓ¿ Ì ÙÂÎÌËÚȈ̤ÓË ¤ÎıÂÛË ÛÂ Ô˘Û›Â˜ ÂÓ‰ÔÌËÙÚ›ˆ˜ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‰ÂÓ ¯Ú‹˙Ô˘Ó Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. OÈ ÂӉ›ÍÂȘ ÁÈ· ·ÁˆÁ‹ Â›Ó·È ÔÈ Û·ÛÌÔ›, Ë ·ÓÂ·Ú΋˜ Û›ÙÈÛË, ÔÈ ‰È¿ÚÚÔȘ, ÔÈ ¤ÌÂÙÔÈ Ô˘ Ô‰ËÁÔ‡Ó Û ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ·Ê˘‰¿ÙˆÛË, Ë ·‰˘Ó·Ì›· ‡ÓÔ˘ Î·È Ô ˘ÚÂÙfi˜ (1,10,14). ∏ ‚·ıÌÔÏfiÁËÛË Î·Ù¿ Finnegan ÌÂÁ·Ï‡ÙÂÚË ·fi 8 ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÛÔ‚·ÚÔ‡ ™™ Î·È ·Ó¿Á΢ ÁÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. ∞Ó ÙÂÏÈο ÎÚÈı› ÛÎfiÈÌË Ë Ê·Ú̷΢ÙÈ΋ ·��ÙÈÌÂÙÒÈÛË, ÙfiÙ ÚÔÙÈÌ¿Ù·È Ê¿ÚÌ·ÎÔ ·fi ÙËÓ ›‰È· ηÙËÁÔÚ›· Ô˘ ÚÔοÏÂÛ ÙË ÛÙ¤ÚËÛË. ∂ÁÎÂÎÚÈ̤ӷ Ê¿Ú̷η

¶›Ó·Î·˜ 1. ∫ÏÈÓÈ΋ ‚·ıÌÔÏfiÁËÛË Î·Ù¿ Finnegan ∂‡ÚËÌ· O͇ ÎÏ¿Ì· ™˘Ó¯¤˜ Ô͇ ÎÏ¿Ì· ⁄ÓÔ˜ <1 ÒÚ· ÌÂÙ¿ ·fi Û›ÙÈÛË ⁄ÓÔ˜ <2 ÒÚ˜ ÌÂÙ¿ ·fi Û›ÙÈÛË ⁄ÓÔ˜ <3 ÒÚ˜ ÌÂÙ¿ ·fi Û›ÙÈÛË ∞ÓÙ·Ó·ÎÏ·ÛÙÈÎfi Moro ++ ∞ÓÙ·Ó·ÎÏ·ÛÙÈÎfi Moro +++ ∂Ï·ÊÚfi˜ ÙÚfiÌÔ˜ ÛÙ· ÂÚÂı›ÛÌ·Ù· ∂Ï·ÊÚ¤˜ ÙÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ ÛÙËÓ ·Ó¿·˘ÛË ∆ÚÔÌÒ‰ÂȘ ÎÈÓ‹ÛÂȘ ÛÙËÓ ·Ó¿·˘ÛË ÀÂÚÙÔÓ›· ™·ÛÌÔ› £ËÏ·ÛÌfi˜ ÁÚÔıÈ¿˜ ¿Ìʈ ¶Ùˆ¯‹ Û›ÙÈÛË ∞Ó·ÁˆÁ¤˜ ŒÌÂÙÔÈ ¢È¿ÚÚÔÈ· + ¢È¿ÚÚÔÈ· ++ ™˘¯Ó¿ ¯·ÛÌÔ˘ÚËÙ¿ ¶ÙÂÚÓ›ÛÌ·Ù· £ÔÚ˘‚҉˘ ·Ó·ÓÔ‹ ∂Ê›‰ÚˆÛË £ÂÚÌÔÎÚ·Û›· >38ÔC ∆·¯‡ÓÔÈ· (>60 ·Ó·ÓÔ¤˜/min) ∆·¯‡ÓÔÈ· Î·È ÂÈÛÔÏ΋ ∂ΉÔÚ¿ ̇Ù˘ / ÁÔÓ¿ÙˆÓ

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Â›Ó·È Ë ‚ÂÓ˙ԉȷ˙Â›ÓË ÁÈ· ÙÔ ·ÏÎÔfiÏ Î·È Ë ÌÂı·‰fiÓË ÁÈ· Ù· ÔÈÔ‡¯·. ∂›Ó·È ÁÓˆÛÙfi, fï˜, fiÙÈ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ¿ÏÏ· Ê¿Ú̷η, fiˆ˜ ÙÔ Ï¿‚‰·ÓÔ, Ë ¿Ó˘‰ÚÔ˜ ÌÔÚÊ›ÓË, Ë ÎÏÔÓȉ›ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ë ¯ÏˆÚÔÚÔÌ·˙›ÓË Î·È Ë ‰È·˙Â¿ÌË. ∏ ‚ÂÏÙ›ˆÛË Ù˘ ‚·ıÌÔÏfiÁËÛ˘ ηٿ Fineggan ‚ÔËı¿ÂÈ ÛÙËÓ ·fiÊ·ÛË ÁÈ· ÙË Ì›ˆÛË Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ‰fiÛ˘. ∆· ÎÚÈÙ‹ÚÈ· Â·ÚÎÔ‡˜ ·ÁˆÁ‹˜ Â›Ó·È Ë Ê˘ÛÈÔÏÔÁÈ΋ ıÂÚÌÔÎÚ·Û›·, Ë ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ÓÂÔÁÓÔ‡ Ó· ÎÔÈÌ¿Ù·È ÌÂٷ͇ ÙˆÓ ÁÂ˘Ì¿ÙˆÓ, Ë Ì›ˆÛË ÙÔ˘ ÎÏ¿Ì·ÙÔ˜ Î·È Ë ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ ™™ Û ÓÂÔÁ¤ÓÓËÙ· ÙÔÍÈÎÔÌ·ÓÒÓ ÌËÙ¤ÚˆÓ, Ô˘ Û‹ÌÂÚ· Â›Ó·È Û¯ÂÙÈο Û¿ÓÈÔ Ê·ÈÓfiÌÂÓÔ, ı· ·ÔÙÂϤÛÂÈ ÌÂÏÏÔÓÙÈο ÛÔ‚·Úfi Úfi‚ÏËÌ· ÛÙËÓ ÂÏÏËÓÈ΋ ÎÔÈÓˆÓ›·, ÏfiÁˆ ÌË ÂÏÂÁ¯fiÌÂÓ˘ ÂÍ¿ψÛ˘ ÙˆÓ Ó·ÚΈÙÈÎÒÓ ÛÙË ÓÂÔÏ·›· Ì·˜. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ ÙÔ ™™ ÂΉËÏÒÓÂÙ·È ·ÎfiÌ· Î·È Û ÓÂÔÁÓ¿ Ô˘ ·›ÚÓÔ˘Ó ÌË-Ó·ÚΈÙÈΤ˜ Ô˘Û›Â˜, fiˆ˜ ·Á¯ÔÏ˘ÙÈο Î·È ·ÓÙÈηٷıÏÈÙÈο Ê¿Ú̷η. ∏ ÚfiÏË„Ë, Ë ıÂÚ·›· Î·È Ë ÓÔÛËÏ›· ÙˆÓ ÓÂÔÁÓÒÓ Ì ™™ ÂÈ‚¿ÏÏÔ˘Ó ÙË ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· Ù˘ ¶ÔÏÈÙ›·˜, ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÊÔÚ¤ˆÓ, ηıÒ˜ Î·È ÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÓÔÛËÏ¢ÙÈÎÔ‡ ÚÔÛˆÈÎÔ‡. µÈ‚ÏÈÔÁÚ·Ê›· 1. American Academy of Pediatrics. Policy Statement. Neonatal drug withdrawal. Pediatrics 1998;101:1079-1088. 2. ¢Ú›ÙÛ·˜ ¶, ∆ÛÂÚ¤ ¶, °Î›Î· ª, ™Ù·Ì·ÙfiÔ˘ÏÔ˜ ∏, ª·Ì·ÏÔ‡Áη ª, ªÔ‡Ú· ™ Î·È Û˘Ó. ÃÚ‹ÛÙ˜ ËÚˆ›Ó˘ Î·È ÂÊËÌÂÚ›·. π·ÙÚÈÎfi µ‹Ì· 2001;74:18-21. 3. ¶··ıˆÌ¿ ∂, ÷Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑, OÈÎÔÓÔÌ›‰Ô˘ O, ÷ڷϿÌÔ˘˜ ∞, ¡ÈÎÔÏfiÔ˘ÏÔ˜ ¢. ¡ÂÔÁ¤ÓÓËÙ· ÌËÙ¤ÚˆÓ ¯ÚËÛÙÒÓ Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ. ¶Ú·ÎÙÈο 9Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ™˘Ó‰ڛԢ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÀÁ›·˜ 1997:30. 4. Rylance G. Neonatal pharmacology. In: Roberton NRC, editor. Textbook of Neonatology. 2nd ed. New York: Churchill Livingstone; 1992. p. 1208-1209. 5. Herzlinger RA, Kandal SR, Vaughan HG. Neonatal seizures associated with narcotic withdrawal. J Pediatr 1971;91:638-641.

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6. Van Baar AI, Fleury P, Soepatmi S, Ultee CA, Wesselman PJ. Neonatal behavior after drug dependent pregnancy. Arch Dis Child 1989;64:235-240. 7. Bleyer WA, Marshall RE. Barbiturate withdrawal syndrome in passively addicted infants. JAMA 1972;221:185-186. 8. Prenner BM. Neonatal withdrawal syndrome associated with hydroxyzine hydrochloride. Am J Dis Child 1977;131:529-530. 9. Pierog S, Chandavasu O, Wexler I. Withdrawal syndrome in infants with the fetal alcohol syndrome. J Pediatr 1977;90:529-530. 10. Zelson C, Rubio E, Wassermann E. Neonatal narcotic addiction: 10 year observation. Pediatrics 1971;48:178-179. 11. Doberczak TM, Kandall SR, Friedmann P. Relations between maternal methadone dosage, maternal-neonatal methadone levels, and neonatal withdrawal. Obstet Gynecol 1993;81:936-940. 12. Rementeria JL, Bhatt K. Withdrawal symptoms in neonates from intrauterine exposure to diazepam. J Pediatr 1977;90:123-126. 13. Athinarayanan P, Pierog SH, Nigam SK, Glass L. Chlodiazepoxide withdrawal syndrome in the neonate. Am J Obstet Gynecol 1976;124:212-213. 14. Finnegan LP. Neonatal abstinence. In: Nelson NM, editors. Current therapy in neonatal-perinatal medicine. Toronto, Ontario: BC Decker, Inc; 1985. p. 262-270. 15. Olofsson M, Beckley W, Adersen GE, Friss-Hansen B. Investigation of 89 children born by drug-dependent mothers. II. Follow-up 1-10 years after birth. Acta Pediatr Scand 1983;72:407-410.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 04-10-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-01-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆÛ‹Ê ∫·Ï¤ÁÈ·˜ Õıˆ 31 Î·È øÚˆÔ‡, ¶¿ÙÚ· E-mail: kaleyias@hotmail.com

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CASE REPORT

ÃÚfiÓÈ· Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ ÏfiÁˆ ·ÓˆÌ·Ï›·˜ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘: ¶ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜ ∞. M›¯Ô˜1, ∂. OÚÊ·ÓÔ‡1, ∂. ¶··Ó‰Ú¤Ô˘2, ¡. ª·ÏÙÔÁÈ¿ÓÓ˘2, ∂. ƒÒÌ· - °È·ÓÓ›ÎÔ˘1, ¢. ∫ÂÚ·Ì›‰·˜2

Chronic midgut volvulus due to malrotation: Case report ∞. Michos1, E. Orfanou1, E. Papandreou2, N. Baltogiannis2, E. Roma - Giannikou1, D. Keramidas2

¶ÂÚ›ÏË„Ë: ∏ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ Úԉȷı¤ÙÂÈ ÛÂ Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È Û¿ÓÈ· ÌÂÙ¿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ 5 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¯ÚfiÓÈ·˜ ‰È¿ÚÚÔÈ·˜, ÂÚÈÔ‰ÈÎÔ‡ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È Â̤وÓ. ∆Ô ·È‰› ›¯Â ÓÔÛËÏ¢Ù› Û ‰È¿ÊÔÚ· ÓÔÛÔÎÔÌ›· ¯ˆÚ›˜ Ó· ÙÂı› Û·Ê‹˜ ‰È¿ÁÓˆÛË. ™Â Ê¿ÛË ˘ÔÙÚÔ‹˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰È·ÁÓÒÛÙËΠ̠·ÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘. ∆· Â˘Ú‹Ì·Ù· ÂȂ‚·ÈÒıËÎ·Ó Î·È Î·Ù¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË fiÔ˘ ¤ÁÈÓÂ Î·È ·ÓÙÈÌÂÙÒÈÛË. ™˘˙ËÙÔ‡ÓÙ·È Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Î·È ÔÈ Ì¤ıÔ‰ÔÈ ‰È¿ÁÓˆÛ˘ Ù˘ ¯ÚfiÓÈ·˜ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÂÓÒ ÙÔÓ›˙ÂÙ·È fiÙÈ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙÚÔÊ‹˜ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ı· Ú¤ÂÈ Ó· ·ÔÎÏ›ÔÓÙ·È Û ·È‰È¿ Ì ¯ÚfiÓÈ· Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·.

Abstract: Midgut malrotation and abnormal fixation predisposes to midgut volvulus which is rarely symptomatic after infancy. This is a case report of a 5 year old boy, who presented with symptoms of chronic diarrhea, periodic abdominal pain and vomiting. He had been hospitalized in several hospitals without a definitive diagnosis. During · relapsing episode, chronic volvulus with midgut malrotation was identified using radiographic and sonographic studies. The findings were further confirmed during surgical exploration at which time the anomaly was corrected. The clinical presentation as well as the diagnostic approach of chronic volvulus are discussed. It is emphasized that midgut malrotation must be included in the differential diagnosis in children with chronic, undiagnosed gastrointestinal complaints.

§¤ÍÂȘ ÎÏÂȉȿ: Û˘ÛÙÚÔÊ‹ ÌÂÛÂÓÙÂÚ›Ô˘, ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘, ¯ÚfiÓÈ· ¿Ù˘· ÎÔÈÏȷο Û˘ÌÙÒÌ·Ù·, ·È‰È΋ ËÏÈΛ·.

Key words: volvulus, midgut malrotation, chronic abdominal symptoms, childhood.

∂ÈÛ·ÁˆÁ‹ H ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ (∞™∫ª∂) (malrotation) ÌÔÚ› Ó· ÚÔηϤÛÂÈ Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘. ∏ Û˘Ìو̷ÙÔÏÔÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ ÔÍ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÂÔÁÓÈ΋˜ Î·È ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜, ÂÓÒ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ ÌÔÚ› Ó· Â›Ó·È ‰È·Ï›Ô˘Û· Î·È ·Ì‚Ï˘¯Ú‹, Ì ·ÔÙ¤ÏÂÛÌ· Ë ‰È¿ÁÓˆÛË Û˘¯Ó¿ Ó· ‰È·Ï·Óı¿ÓÂÈ (1). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·È‰ÈÔ‡ 5 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¯ÚfiÓÈ·˜ ‰È¿ÚÚÔÈ·˜, ÂÚÈÔ‰ÈÎÔ‡ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È Â̤وÓ, ÌÂ

Â·ÓÂÈÏËÌ̤Ó˜ ÂÈÛ·ÁˆÁ¤˜ Û ÓÔÛÔÎÔÌ›·. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ‰È·ÁÓÒÛıËÎÂ Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Û ¤‰·ÊÔ˜ ·ÓÒÌ·Ï˘ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛ˘ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘.

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 µ’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

1 1st Pediatric Clinic, University of Athens 2 2nd Pediatric Surgical Clinic Children’s Hospital of “St. Sophia”, Athens

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¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÏfiÁˆ Â̤وÓ, ‰È¿ÚÚÔÈ·˜ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Î¿ÙÈ ·ıÔÏÔÁÈÎfi ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ ÙÔ ·È‰› ÚÔÛÏ¿Ì‚·ÓÂ Ê˘ÛÈÔÏÔÁÈο ‚¿ÚÔ˜,


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‡„Ô˜ Î·È ·ÚÔ˘Û›·˙Â Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË. ªÂÙ¿ ÙÔ 2Ô ¤ÙÔ˜ ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÔ‰Èο ÂÂÈÛfi‰È· ‰È·ÚÚÔ˚ÎÒÓ ÎÂÓÒÛÂˆÓ ÎÈÙÚÈÓˆÒÓ Ì ‚ϤÓÓË (ÂÚ›Ô˘ 4-5/24ˆÚÔ) Ô˘ ‰È·ÚÎÔ‡Û·Ó ÂÚ›Ô˘ Ì›· ‚‰ÔÌ¿‰·, Â·Ó·Ï·Ì‚¿ÓÔÓÙ·Ó Î¿ı 2-3 Ì‹Ó˜ Î·È Û˘Óԉ‡ÔÓÙ·Ó ·fi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ‚ÔÚ‚ÔÚ˘ÁÌÔ‡˜ Î·È Â̤ÙÔ˘˜. ∆· ÂÂÈÛfi‰È· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Ì ‰È·ÈÙËÙÈΤ˜ Ô‰ËÁ›Â˜, ‰È·ÎÔ‹ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, ·ÓÙȉȷÚÚÔ˚ο Ê¿Ú̷η, ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ Î·È ˘Ô¯ˆÚÔ‡Û·Ó. ∆Ô ·È‰› ›¯Â ÂÈÛ·¯ı› ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ 3 ÊÔÚ¤˜ Û ÂÚÈÊÂÚÂȷο ÓÔÛÔÎÔÌ›·, fiÔ˘ Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜ (3 ÊÔÚ¤˜), ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ (3 ÊÔÚ¤˜), ‰È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ (2 ÊÔÚ¤˜) ‰ÂÓ ¤‰ÂÈÍ·Ó Î¿ÙÈ ·ıÔÏÔÁÈÎfi. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜, ·fi ÙËÓ ÂÈÛÎfiËÛË ¤‰ÈÓ ÙËÓ ÂÓÙ‡ˆÛË ¿Û¯ÔÓÙÔ˜ Î·È ‰˘ÛÙÚÔÊÈÎÔ‡ ·È‰ÈÔ‡ (·Ó·ÊÂÚfiÙ·Ó ·ÒÏÂÈ· ‚¿ÚÔ˘˜ 2 kg ηٿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ). ∆· ۈ̷ÙÔÌÂÙÚÈο ÙÔ˘ ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó: B.™.: 17 kg (10-25Ë ∂.£.), ‡„Ô˜: 119 cm (>97Ë ∂.£.), ÂÓÒ ·fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ ‚Ú¤ıËΠοÙÈ ·ıÔÏÔÁÈÎfi. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ, ·ÓÔÛÔÛÊ·ÈÚ›Ó˜, RAST test ÁÈ· ÙÚÔÊÈο ·ÓÙÈÁfiÓ·, ·ÓÙÈÁÏÔÈ·‰ÈÓÈο ·ÓÙÈÛÒÌ·Ù·, ‰ÔÎÈÌ·Û›· ÊfiÚÙÈÛ˘ Ì ϷÎÙfi˙Ë, ‰ÔÎÈÌ·Û›· ͢Ïfi˙˘, ıÚ˘„›ÓË ÎÔÚ¿ÓˆÓ, ‰ÔÎÈÌ·Û›· ȉÚÒÙ· Î·È pHÌÂÙÚ›·, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∂Âȉ‹ ÛÙÔ ·È‰› ›¯Â Á›ÓÂÈ ÚfiÛÊ·Ù· ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÙÈÎÔ‡ ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ıˆڋıËΠÛÎfiÈÌÔ ÏfiÁˆ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ó· ÚÔËÁËı› ÂÓ‰ÔÛÎÔÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› Ë È‰ÈÔ·ı‹˜ ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ™ÙË Á·ÛÙÚÔÛÎfiËÛË ‰È·ÈÛÙÒıËΠÁ·ÛÙÚ›ÙȘ ·fi H. Pylori, ÂÓÒ Ë ÎÔÏÔÓÔÛÎfiËÛË ¤‰ÂÈÍ ̤ÙÚÈ· ÊÏÂÁÌÔÓ‹ ÛÙÔ ÔÚıfi Ì Èı·Ó‹ ·ÏÏÂÚÁÈ΋ Û˘ÌÌÂÙÔ¯‹. ÃÔÚËÁ‹ıËΠ·ÁˆÁ‹ ÂÎÚ›˙ˆÛ˘ ÁÈ· ÙÔ H. Pylori Î·È Û˘ÛÙ‹ıËΠÂ·Ó¿ÏË„Ë ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Â› ˘ÔÙÚÔ‹˜. ∆Ô ·È‰› ¤ÌÂÈÓ ÂχıÂÚÔ Û˘ÌÙˆÌ¿ÙˆÓ ÁÈ· 6 Ì‹Ó˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·˘Í‹ıËΠηٿ 3 kg. ™ÙË Û˘Ó¤¯ÂÈ·, fï˜, ·ÚÔ˘Û›·Û ¿ÏÈ ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ, ¤ÓÙÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È Â̤ÙÔ˘˜. ™ÙË ‰È¿ÚÎÂÈ· Ù¤ÙÔÈÔ˘ ÔͤԘ ÂÂÈÛÔ‰›Ô˘ ¤ÁÈÓ ÂÂÈÁfiÓÙˆ˜ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜, ÙÔ ÔÔ›Ô ¤‰ÂÈÍ ÂÈÎfiÓ· Û˘ÛÙÚÔÊ‹˜ ÌÂÛÂÓÙÂÚ›Ô˘ Ì ÂÏÈÎÔÂȉ‹ ÔÚ›· ÙˆÓ ·ÁÁ›ˆÓ (∂ÈÎfiÓ· 1). ™ÙË ‰È¿‚·ÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ ‚Ú¤ıËΠ·fiÊÚ·ÍË ÛÙÔ ‡„Ô˜ Ù˘ Ó‹ÛÙȉ·˜ (∂ÈÎfiÓ· 2), Ô ‰Â ‚·ÚÈÔ‡¯Ô˜ ˘ÔÎÏ˘ÛÌfi˜ ¤‰ÂÈÍ ·ÓÒÌ·ÏË ı¤ÛË ÙÔ˘ Ù˘ÊÏÔ‡, ÂÈÎfiÓ˜ Û˘Ì‚·Ù¤˜ Ì ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Û ʿÛË Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ¤ÁÈÓ ·Ú¯Èο Ï··ÚÔÛÎÔÈο, fiÔ˘ ÂÈ-

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∂ÈÎfiÓ· 1. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜: ∞. º·›ÓÂÙ·È ·Ó·ÛÙÚÔÊ‹ Ù˘ ı¤Û˘ ÙˆÓ ÌÂÛÂÓÙ¤ÚÈˆÓ ·ÁÁ›ˆÓ Û˘Ì‚·Ù‹ Ì ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. µ. ∆Ô ¤ÓÙÂÚÔ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÈÎfiÓ· ÛÙÚÔ‚›ÏÔ˘ (whirlpool sign) ÏfiÁˆ Ù˘ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘.

∂ÈÎfiÓ· 2. ∞. ¢È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ: ÂÈÎfiÓ· ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ Û ۯ‹Ì· ·ÓÂÛÙÚ·Ì̤ÓÔ˘ ∂ Î·È ·ÙÂÏ‹˜ ·fiÊÚ·ÍË ÛÙÔ ‡„Ô˜ Ù˘ Ó‹ÛÙȉ·˜. µ. µ·ÚÈÔ‡¯Ô˜ ˘ÔÎÏ˘ÛÌfi˜: ÎÂÓÙÚÈ΋ ı¤ÛË ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘ Î·È Ù˘ÊÏÔ‡, Û˘Ì‚·Ù‹ Ì ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘.

‚‚·ÈÒıËÎÂ Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÙÔ ÔÔ›Ô ·ÚÔ˘Û›·˙ ٤ÛÛÂÚȘ (4) ÛÙÚÔʤ˜ ηٿ ÙË ÊÔÚ¿ ÙˆÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÚÔÏÔÁÈÔ‡. ∞ÎÔÏÔ‡ıËÛ Ϸ·ÚÔÙÔÌ›·, ·Ó¿Ù·ÍË Ù˘ Û˘ÛÙÚÔÊ‹˜ (∂ÈÎfiÓ· 3), ‰È·ÙÔÌ‹ ÙˆÓ ÂÚÈÙÔÓ·˚ÎÒÓ Ù˘¯ÒÓ Ô˘ ÂÚȤ‚·ÏÏ·Ó ÙÔ Ù˘ÊÏfi Î·È ÙË Ó‹ÛÙȉ· Î·È ·ÂÏ¢ı¤ÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∆Ô ·È‰› ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ¤¯ÂÈ ·Ú·Ì›ÓÂÈ ÂχıÂÚÔ Û˘ÌÙˆÌ¿ÙˆÓ Â› ¤Ó· ÂÚ›Ô˘ ¤ÙÔ˜. ™˘˙‹ÙËÛË ∏ Ê˘ÛÈÔÏÔÁÈ΋ ÛÙÚÔÊ‹ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙËÓ ÂÌ‚Ú˘˚΋ ËÏÈΛ· ÍÂÎÈÓ¿ÂÈ ÙËÓ 3Ë Î·È ÔÏÔÎÏËÚÒÓÂÙ·È ÙË 14Ë Â‚‰ÔÌ¿‰·, Á›ÓÂÙ·È ‰Â Ì ÊÔÚ¿ ·ÓÙ›ÛÙÚÔÊË ·fi ÙÔ˘˜ ‰Â›ÎÙ˜ ÙÔ˘ ÚÔÏÔÁÈÔ‡ ÛÙȘ 270Ô Ì ¿ÍÔÓ· ÛÙÚÔÊ‹˜ ÙËÓ ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ ·ÚÙËÚ›·. ∏ ·Ó·ÛÙÔÏ‹ Ù˘ ÛÙÚÔÊ‹˜ (non rotation) ‹ Ë ‰È·ÎÔ‹ Ù˘ Û οÔÈÔ ·fi Ù· ÂӉȿÌÂÛ· ÛÙ¿‰È· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ ¤ÓÙÂÚÔ Ó· ÎÚ¤ÌÂÙ·È ·fi Û¯ÂÙÈο ÛÙÂÓfi Ì›Û¯Ô Î·È Ó· Â›Ó·È ÂÈÚÚÂ¤˜ ÛÂ Û˘ÛÙÚÔÊ‹ (volvulus), ÂÓÒ Ù˘¯¤˜ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘

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∂ÈÎfiÓ· 3. ∞. ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÂÈÎfiÓ·: ‰È·ÎÚ›ÓÂÙ·È Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È ‰È¿Ù·ÛË ÙˆÓ ·ÈÌÔÊfiÚˆÓ ·ÁÁ›ˆÓ ÏfiÁˆ ÛÙ¿Û˘. µ. ªÂÙÂÁ¯ÂÈÚËÙÈ΋ ÂÈÎfiÓ·: ¤¯ÂÈ Á›ÓÂÈ ·Ó¿Ù·ÍË ·fi ÙË Û˘ÛÙÚÔÊ‹.

(Ù·Èӛ˜ ÙÔ˘ Ladd) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Ȥ˙Ô˘Ó ÙÔ ‰ˆ‰Âη‰¿ÎÙ˘ÏÔ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÚÈ΋ ‹ ÔÏÈ΋ ·fiÊÚ·ÍË (1). ∏ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ÌÔÚ› Ó· Û˘Ó˘¿Ú¯ÂÈ Î·È Ì ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÂÙÈÎÔ‡ Û ÔÛÔÛÙfi 30%-62%, fiˆ˜ Ë ÔÌÊ·ÏÔ΋ÏË, Ë Á·ÛÙÚfiÛ¯ÈÛË, ·ÙÚËۛ˜ ‹ ÛÙÂÓÒÛÂȘ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙÔ ÂÎÎfiÏˆÌ· Meckel, Ë ÓfiÛÔ˜ Hirschsprung, Ë ÔÏÈ΋ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á¯ÓˆÓ, ÔÈ Î‡ÛÙÂȘ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÔÈ ·ÓˆÌ·Ï›Â˜ ‰È¿Ï·Û˘ Ù˘ ¯ÔÏˉfi¯Ô˘ ·ÛÙ˘ Î·È ÙˆÓ ¯ÔÏËÊfiÚˆÓ (1,2). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Û˘Ìو̷ÙÔÏÔÁ›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ÓÂÔÁÓÈ΋ (65%) ‹ ‚ÚÂÊÈ΋ (21%) ËÏÈΛ·, ÂÓÒ Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· (14%) (1,3). ™ÙË ÓÂÔÁÓÈ΋ Î·È ‚ÚÂÊÈ΋ ËÏÈΛ· ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ Ì ıÔÚ˘‚Ò‰Ë Û˘Ìو̷ÙÔÏÔÁ›· Î·È ÂÈÎfiÓ· ÔÍ›·˜ ÎÔÈÏ›·˜ (¯ÔÏÒ‰ÂȘ ¤ÌÂÙÔÈ, ·›Ì· ·fi ÙÔ ÔÚıfi, ÂÈÎfiÓ· shock). ∞ÓÙ›ıÂÙ·, Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Ù· Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· Â›Ó·È ·Ì‚Ï˘¯Ú¿ ‹ ‰È·Ï›ÔÓÙ· (chronic midgut volvulus), o ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ó· ÌËÓ Â›Ó·È ‰È·ÁÓˆÛÙÈÎfi˜ Î·È Ô ¤ÏÂÁ¯Ô˜ Ó· ηÙ¢ı‡ÓÂÙ·È Û ¿ÏÏ· ·›ÙÈ·, fiˆ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔ˘˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·, ÓÔÛ‹Ì·Ù· Ô˘ ÚÔηÏÔ‡Ó ‰˘Û·ÔÚÚfiÊËÛË ‹ ·ÎfiÌË Ù· Û˘ÌÙÒÌ·Ù· Ó· ıˆÚÔ‡ÓÙ·È „˘¯ÔÁÂÓ‹ (4,5). ªÔÚ› ·ÎfiÌË Ó· ÌËÓ ˘¿Ú¯ÂÈ Î·Ó¤Ó· Û‡Ìو̷ Î·È Ë ‰È¿ÁÓˆÛË Ó· Â›Ó·È Ù˘¯·›Ô ‡ÚËÌ·. ™Â ¯ÚfiÓȘ ÂÚÈÙÒÛÂȘ, Ù· ·ÚÈ· Û˘ÌÙÒÌ·Ù· Â›Ó·È ÙÔ ÂÚÈÔ‰ÈÎfi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, Ë ‰È·Ï›Ô˘Û· ‰È¿ÚÚÔÈ·, ÔÈ ¤ÌÂÙÔÈ (¯ÔÏÒ‰ÂȘ ‹ ÌË), Ë ‰˘Û·ÔÚÚfiÊËÛË Ì ·ÒÏÂÈ· ‹ ÌË ÚfiÛÏË„Ë ÈηÓÔÔÈËÙÈÎÔ‡ ‚¿ÚÔ˘˜, ·ÓÔÚÂÍ›·, Ó·˘Ù›· ÌÂÙ¿ Ù· Á‡̷ٷ (1,3,4). ∆Ô ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ·Ô‰›‰ÂÙ·È ÛÙËÓ ÂÚÈÔ‰È΋ ÈÛ¯·ÈÌ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÂÓÒ Ë ‰È¿ÚÚÔÈ· ÛÙÔ ¯ÚfiÓÈÔ Ô›‰ËÌ· ÙˆÓ ÏÂÌÊ·ÁÁ›ˆÓ Î·È ÙÔ˘ ‚ÏÂÓÓÔ-

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ÁfiÓÔ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙËÓ ·ÒÏÂÈ· ˆÛ̈ÙÈο ‰Ú·ÛÙÈÎÒÓ Ô˘ÛÈÒÓ (1,2). ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘, Ô˘ ÌÔÚ› fï˜ Ó· ÌËÓ Â›Ó·È ¿ÓÙ· ‰È·ÁÓˆÛÙÈο, ÂȉÈο Û ÂÚÈfi‰Ô˘˜ ËÚÂÌ›·˜. ™Â Ê¿ÛË Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (volvulus), ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜, ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ÂÈÎfiÓ· ‰ÈÏ‹˜ Ê˘Û·Ï›‰·˜ (double-bubble sign) Ì ˘‰Ú·ÂÚÈο Â›‰·, ÏfiÁˆ Ù˘ ‰È¿Ù·Û˘ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È Ù˘ 1˘ ÌÔ›Ú·˜ ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘, ηıÒ˜ Î·È ·Ô˘Û›· ·¤Ú· ÛÙÔ ÂÚÈÊÂÚÈÎfi ¤ÓÙÂÚÔ, Â˘Ú‹Ì·Ù· Ô˘ ‰ÂÓ ··ÓÙÒÓÙ·È fï˜ Û˘¯Ó¿ (1,6). ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ı¤Û˘ ÙˆÓ ÌÂÛÂÓÙ¤ÚÈˆÓ ·ÁÁ›ˆÓ. º˘ÛÈÔÏÔÁÈο, Ë ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ˜ ÊϤ‚· (∞ªº) ‚Ú›ÛÎÂÙ·È ‰ÂÍÈ¿ Ù˘ ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜ (∞ª∞) (6,7). ∞Ó Ë ∞ªº ‚ÚÂı› ·ÚÈÛÙÂÚ¿ ‹ ÌÚÔÛÙ¿ Ù˘ ∞ª∞, ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÁÈ· ·ÓÒÌ·ÏË ÂÚÈÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (∂ÈÎfiÓ· 1), ‡ÚËÌ· Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ·ÎfiÌË Î·È ÁÈ· ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË (8). ∞ÎfiÌË, Û ÂÚÈÙÒÛÂȘ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ÌÔÚÊÔÏÔÁ›· ÛÙÚÔ‚›ÏÔ˘ (whirlpool sign) ‹ ÂÏ·ÙËÚ›Ô˘ (corkscrew sign) (1,5,6). ∏ ‰È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ Ì ‚¿ÚÈÔ ·ÔÙÂÏ› ÙËÓ ÂͤٷÛË ÂÎÏÔÁ‹˜ Ô˘ ‚ÔËı¿ÂÈ ÙË ‰È¿ÁÓˆÛË Û ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ (42%-94%) (3,9). ∏ Ê˘ÛÈÔÏÔÁÈ΋ ı¤ÛË ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ ÙÔ˘ Treitz Â›Ó·È ·ÚÈÛÙÂÚ¿ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÛÙÔ ‡„Ô˜ ÙÔ˘ Á·ÛÙÚÈÎÔ‡ ¿ÓÙÚÔ˘, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ∞¶ª∂ ‚Ú›ÛÎÂÙ·È ‰ÂÍÈ¿ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÌÚÔÛÙ¿ ·fi ÙÔ ‚ÔÏ‚fi ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘. O ˘ÔÎÏ˘ÛÌfi˜ Ì ‚¿ÚÈÔ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÈϤÔÓ (23%-34%) Û ·ÌÊ›‚ÔϘ ÂÚÈÙÒÛÂȘ Ì ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Ù˘ ı¤Û˘ ÙÔ˘ Ù˘ÊÏÔ‡, ÙÔ ÔÔ›Ô


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Ê˘ÛÈÔÏÔÁÈο ‚Ú›ÛÎÂÙ·È ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ∞¶ª∂ ‚Ú›ÛÎÂÙ·È Û ˘„ËÏfiÙÂÚË ı¤ÛË, ÛÙË ‰ÂÍÈ¿ ¿Óˆ ÎÔÈÏ›· ‹ ÌÔÚ› Ó· Â›Ó·È ÎÈÓËÙfi (3,6,9). O ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ ‰ÂÓ ¤¯ÂÈ ·ÍÈÔÏÔÁËı› Â·ÚÎÒ˜ ÁÈ· ÙË ‚Ô‹ıÂÈ· Ô˘ ÌÔÚ› Ó· ÚÔÛʤÚÂÈ ÛÙË ‰È¿ÁÓˆÛË (5). ™Â ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÁÓˆÛÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÌÔÚ› Ó· ··ÈÙËı› Â·Ó¿ÏË„Ë ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Û ʿÛË ÔÍ›·˜ Û˘Ìو̷ÙÔÏÔÁ›·˜, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì·˜, ‹ ·ÎfiÌË Î·È ‰ÈÂÚ‡ÓËÛË Ì Ϸ·ÚÔÛÎfiËÛË Ô˘ Û ·Ϥ˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Â›Ó·È ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ (10). ∆Ô ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ· Ó· ÙÔÓÈÛÙ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ ̤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ÏfiÁˆ Û˘ÁÁÂÓÔ‡˜ ·ÓÒÌ·Ï˘ ÛÙÚÔÊ‹˜ ÌÔÚ› Ó· ¤¯ÂÈ Î·È ¯ÚfiÓÈ· ‹ Ï·Óı¿ÓÔ˘Û· ÔÚ›· Î·È Û ÂÚÈÙÒÛÂȘ Ì ‰È·Ï›ÔÓÙ· Û˘ÌÙÒÌ·Ù· ¤¯ÂÈ ÛËÌ·Û›· Ó· ÙÂı› ¤ÁηÈÚ· Ë ‰È¿ÁÓˆÛË ÒÛÙ ӷ Á›ÓÂÈ ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Warner µW. Malrotation. In: Oldham KT, Colombani PM, Foglia RP, editors. Surgery of infants and children: Scientific Principles and practice. Philadelphia: LippincottRaven Publishers; 1997. p. 1229-1240. 2. Brandt ML, Pokomy WJ, Mc Gill CW, Harberg FJ. Late presentations of midgut malrotation in children. Am J Surg 1985;150:767-771. 3. Powell DM, Othersen HB, Smith CD. Malrotation of the intestines in children: The effect of age on presentation

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and therapy. J Pediatr Surg 1989;24:777-780. 4. Kullendorff CM, Mikaelsson C, Ivancev K. Malrotation in children with symptoms of gastrointestinal allergy and psychosomatic abdominal pain. Acta Pediatr Scand 1985;74:296-299. 5. Walsh DS, Crombleholme TM. Superior mesenteric venous thrombosis in malrotation with chronic volvulus. J Pediatr Surg 2000;35:753-755. 6. Berdon WE. The diagnosis of malrotation and volvulus in the older child and adult: a trap for radiologists. Pediatr Radiol 1995;25:101-103. 7. Dufour D, Delaet MH, Dassonville M, Cadranel S, Perlmutter N. Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol 1992;22:21-23. 8. ÀÔÔ SJ, Park KW, Cho SY, Sim JS, Hhan KS. Definitive diagnosis of intestinal volvulus in utero. Ultrasound Obstet Gynecol 1999;13:200-203. 9. Prasil P, Flageole H, Shaw KS, Nguyen LT, Youssef S, Laberge JM. Should malrotation in children be treated differently according to age? J Pediatr Surg 2000;35:756-758. 10. Gross E, Chen MK, Lobe TE. Laparoscopic evaluation and treatment of intestinal malrotation in infants. Surg Endosc 1996;10:936-937.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ı·Ó¿ÛÈÔ˜ °. ª›¯Ô˜ ¶·ÓfiÚÌÔ˘ 26-28, ∞ÌÂÏfiÎËÔÈ ∆.∫. 115 23, ∞ı‹Ó· E-mail: athanmic@yahoo.com

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CASE REPORT

¡fiÛÔ˜ Kikuchi - Fujimoto: ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ °. ∆Ú›Ì˘, ∫. ∞ı·Ó·Û¿ÎË, ∞. °È·ÓÓÔ‡ÏÈ· - ∫·Ú·ÓÙ·Ó¿, •. ∫Ú›ÎÔ˜

Kikuchi - Fujimoto disease: Case report G. Trimis, K. Athanasaki, A. Giannoulia - Karantana, X. Krikos

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 10 ÂÙÒÓ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi Î·È ÂÈ̤ÓÔ˘Û· ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, Ù· ÔÔ›· ·ÔÙ¤ÏÂÛ·Ó ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Kicuchi. ∏ ‰È¿ÁÓˆÛË Ù¤ıËΠÌÂÙ¿ ‚ÈÔ„›· ÚÔۂ‚ÏË̤ÓÔ˘ ÏÂÌÊ·‰¤Ó·, fiÔ˘ ·ÓȯÓ‡ıËÎÂ Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· Ì ·ÚÂÌ‚ÔÏ‹ ÂÚÈÔ¯ÒÓ ˘ÁÈÔ‡˜ ÈÛÙÔ‡. OÈ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ ˘Ô¯ÒÚËÛ·Ó ·˘ÙfiÌ·Ù· ÂÓÙfi˜ ÙÚÈÒÓ ÌËÓÒÓ.

Abstract: A case of a 10 year old girl is described who presented with prolonged fever and persistent cervical lymphadenitis, which were found to be manifestations of Kikuchi’s disease. The diagnosis was based on a lymph node biopsy that showed the characteristic histiocytic necrotic lymphadenitis with interjection of areas with healthy tissue. The manifestations of the disease resolved spontaneously in 3 months.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ Kicuchi, ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·.

Key words: Kikuchi’s disease, cervical lymphadenitis, histiocytic necrotic lymphadenitis.

∂ÈÛ·ÁˆÁ‹ ∏ ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ÁÓˆÛÙ‹ ˆ˜ ÓfiÛÔ˜ Kikuchi - Fujimoto, Â›Ó·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Ô˘ ÂÚÈÁÚ¿ÊËΠ·Ú¯Èο ÙÔ 1972 ÛÙËÓ π·ˆÓ›· ·fi ÙÔÓ Kikuchi Î·È ÙÔÓ Fujimoto (1). TËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· ·Ó·Ê¤ÚÔÓÙ·È ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ ·fi fiÏÔ ÙÔÓ ÎfiÛÌÔ, ·Ó Î·È ·Ú·Ì¤ÓÂÈ Û˘¯ÓfiÙÂÚË ÛÙËÓ ∞Û›·. ¶ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ Á˘Ó·›Î˜ Ì ̤ÛË ËÏÈΛ· Ù· 30 ¯ÚfiÓÈ·, ÂÓÒ Â›Ó·È È‰È·ÈÙ¤Úˆ˜ Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· (2). ¶ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜ Ì ˘ÚÂÙfi Î·È ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, ·ÓÒ‰˘ÓË ‹ ÂÒ‰˘ÓË. Œ¯Ô˘Ó ·Ó·ÊÂÚı›, Â›Û˘, ¤ÌÂÙÔÈ, ‰È¿ÚÚÔÈ·, Ì˘·ÏÁ›Â˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ÂÍ¿ÓıËÌ· (3). ∆· ÌÔÓ·‰Èο ·ıÔÏÔÁÈο ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Â›Ó·È ÔÈ ÌÂÙÚ›ˆ˜ ·˘ÍË̤ÓÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ηÈ, ÂÓ›ÔÙÂ, Ë Ï¢ÎÔÂÓ›·. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂÙ¿ ‚ÈÔ„›· ÚÔۂ‚ÏË̤ÓÔ˘ ÏÂÌÊ·‰¤Ó· Ì ·Ó›¯Ó¢ÛË ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ, ηٿ ÙfiÔ˘˜ Ó¤ÎÚˆÛË ¯ˆÚ›˜ ·ÔÛÙËÌ·ÙÔÔ›ËÛË Î·È ·ÚÂÌ‚ÔÏ‹ ÂÚÈÔ¯ÒÓ ˘ÁÈÔ‡˜ ÈÛÙÔ‡. ∆· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û˘¯Ó¿ Û˘Á¯¤ÔÓÙ·È Ì ·˘Ù¿ ÙÔ˘ ηÎÔ‹-

ıÔ˘˜ ÏÂÌÊÒÌ·ÙÔ˜. ∏ ÓfiÛÔ˜ ¤¯ÂÈ Î·ÏÔ‹ıË ÔÚ›· Î·È ·˘ÙÔ˚¿Ù·È Û 4-6 Ì‹Ó˜. ÀÔÙÚÔÈ¿˙ÂÈ Û ÔÛÔÛÙfi 3%, ÂÓÒ Û¿ÓÈ· Â›Ó·È Ë ÚÒÙË ÂΉ‹ÏˆÛË ™˘ÛÙËÌ·ÙÈÎÔ‡ ∂Ú˘ıËÌ·ÙÒ‰Ô˘˜ §‡ÎÔ˘ (™∂§) (4). ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, ·Ó Î·È Èı·ÓÔÏÔÁÂ›Ù·È ˘ÂÚ¿ÓÔÛË ·ÓÙ›‰Ú·ÛË Û ÏÔÈÌÒ‰Ë ·Ú¿ÁÔÓÙ· fiˆ˜ Ô Èfi˜ Epstein-µarr (5). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 10 ÂÙÒÓ Ì ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi Î·È ÂÈ̤ÓÔ˘Û· ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·, Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Kikuchi.

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, Aı‹Ó·

1st Pediatric Clinic of University of Athens “St. Sophia” Children’s Hospital, Athens

142

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 10 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Ì ˘ÚÂÙfi ¤ˆ˜ 40ÔC Î·È ·ÌÊÔÙÂÚfiÏ¢ÚË, ·ÓÒ‰˘ÓË ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· ·fi 6Ë̤ÚÔ˘. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÔÓÙ·È ÂχıÂÚ·. ∏ ·ÛıÂÓ‹˜ ‹Ù·Ó Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÔÌ¿‰· ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ÌÂÁ¤ıÔ˘˜ 3x3 cm,


MARCH-APRIL 2002

14-05-03

12:25

™ÂÏ›‰·143

¶·È‰È·ÙÚÈ΋ 2002;65:142-144

ÔÈ ÔÔ›ÔÈ ‹Ù·Ó ˘fiÛÎÏËÚÔÈ, ¢ΛÓËÙÔÈ, ·ÓÒ‰˘ÓÔÈ, ÌË Û˘ÌÊ˘fiÌÂÓÔÈ Ì ÙÔ ˘ÂÚΛÌÂÓÔ ‰¤ÚÌ· Î·È ¯ˆÚ›˜ ÛËÌ›· ÊÏÂÁÌÔÓ‹˜. ∏ ÂÓÙfiÈÛ‹ ÙÔ˘˜ ‹Ù·Ó fiÈÛıÂÓ ÙÔ˘ ÛÙÂÚÓÔÎÏÂȉÔÌ·ÛÙÔÂȉԇ˜ Ì˘fi˜ ‰ÂÍÈ¿ Î·È ÛÙËÓ ÚfiÛıÈ· ¿Óˆ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· ·ÚÈÛÙÂÚ¿. ∆Ô ‹·Ú Î·È Ô ÛÏ‹Ó·˜ ‹Ù·Ó ·„ËÏ¿ÊËÙ·, ÂÓÒ ‰ÂÓ ·Ó¢ڤıËÛ·Ó ÏÂÌÊ·‰¤Ó˜. ∞fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ÚԤ΢„ οÙÈ ·ıÔÏÔÁÈÎfi. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: Ht: 37,3%, Hb: 12,1 gr/dl, WBC: 10400/Ìl (¶/ 66% §/26% ª/6%), PLT: 502000/Ìl, TKE: 90 mm, CRP: 113 mg/L, SGOT: 10 IU/L, SGPT: 11 IU/L, ÁGT: 12 IU/L, ALP: 112 IU/L, LDH: 240 IU/L, Cu: 227 Ìg/dl, ÊÂÚÚÈÙ›ÓË: 211 ng/ml, ÏÔÈfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜: ÎÊ, ÁÂÓÈ΋ Ô‡ÚˆÓ: ÎÊ, ·ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ (·ÓÔÛÔÛÊ·ÈÚ›Ó˜, C3, C4, ANA, anti-DNA): ÎÊ, ·ÓÙÈÛÒÌ·Ù· ÔÚÔ‡ ¤Ó·ÓÙÈ HSV1, HSV2, HSV6, EBV, CMV, HIV, Coxsackie, Parvo, Yersinia, µartonella, ÙÔÍÔÏ¿ÛÌ·ÙÔ˜, ‚ÚԢΤÏÏ·˜, ÚÈÎÂÙÛÈÒÓ: ·ÚÓËÙÈο, Mantoux: (-), VMA Ô‡ÚˆÓ 24ÒÚÔ˘: ÎÊ. ŒÁÈÓÂ, Â›Û˘, ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, U/S ÎÔÈÏ›·˜, ‚˘ıÔÛÎfiËÛË Î·È Û¯ÈÛÌÔÂȉ‹˜ Ï˘¯Ó›·, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆıÔ‡Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞fi ÙÔ U/S ÙÚ·¯‹ÏÔ˘ ‰È·ÈÛÙÒıËΠfiÙÈ ÔÈ ÏÂÌÊ·‰¤Ó˜ ‹Ù·Ó ÛÙÚÔÁÁ˘ÏÔ›, Û˘Ì·Á›˜, ¯ˆÚ›˜ ‰È·Ù·Ú·¯‹ Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ Î·È Ù˘ ·ÈÌ·ÙÒÛÂÒ˜ ÙÔ˘˜. ∆Ô ·È‰› ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠‰È¿ÊÔÚ· Û¯‹Ì·Ù· ÂÓ‰ÔÊϤ‚È·˜ ¯ÔÚ‹ÁËÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜ Â› 20‹ÌÂÚÔ, ¯ˆÚ›˜ ‡ÊÂÛË ÙÔ˘ ˘ÚÂÙÔ‡ ‹ ˘Ô¯ÒÚËÛË Ù˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜. ∏ ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ·È‰ÈÔ‡ ·Ú¤ÌÂÓ Ôχ ηϋ, ÂÓÒ ‰ÂÓ ÂÌÊ¿ÓÈÛ ¿ÏÏ· Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·. EÓ fi„ÂÈ ‰È·ÁÓˆÛÙÈÎÔ‡ ·‰ÈÂÍfi‰Ô˘, ‰ÈÂÓÂÚÁ‹ıËΠ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· Ù˘ ¿Û¯Ô˘Û·˜ ÂÚÈÔ¯‹˜, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ¤ÁÈÓÂ Ì˘ÂÏfiÁÚ·ÌÌ· Î·È ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·. O Ì˘ÂÏfi˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÓÒ ·fi ÙË ‚ÈÔ„›· ÙÔ˘ ÏÂÌÊ·‰¤Ó· ‰È·ÈÛÙÒıËÎ·Ó ·ÏÏÔÈÒÛÂȘ Ô˘ ÚÔÛÏ¿Ì‚·Ó·Ó ηٿ ı¤ÛÂȘ ¯·Ú·ÎÙ‹Ú˜ ÈÛÙÈÔ΢ÙÙ·ÚÈ΋˜ ÓÂÎÚˆÙÈ΋˜ ÌË ·ÔÛÙËÌ·ÙÈ΋˜ ÏÂÌÊ·‰ÂÓ›Ùȉ·˜. ∏ ÂÚÈÁÚ·ÊfiÌÂÓË ÈÛÙÔÏÔÁÈ΋ ÂÈÎfiÓ· ‹Ù·Ó Û˘Ì‚·Ù‹ Ì ÙËÓ ·Ú·ÙËÚÔ‡ÌÂÓË Û ÏÂÌÊ·‰ÂÓ›Ùȉ· Ù‡Ô˘ Kikuchi-Fujimoto, ÂÊ’ fiÛÔÓ Â›¯Â ·ÔÎÏÂÈÛÙ› ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ÙÔ ÂӉ¯fiÌÂÓÔ ˘ÔÛÙÚÒÌ·ÙÔ˜ ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜ (™∂§). ∏ ηÏÏȤÚÁÂÈ· ÙÔ˘ ˘ÏÈÎÔ‡ ÁÈ· ÎÔÈÓ¿, ·Ó·ÂÚfi‚È· ÌÈÎÚfi‚È·, ̇ÎËÙ˜ Î·È Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·¤‚Ë ·ÚÓËÙÈ΋. ªÂ ‚¿ÛË ÙË ‚ÈÔ„›·, Ë ÔÔ›· ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Kikuchi, ‰È·ÎfiËÎÂ Ë Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹. O ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛ ·˘ÙfiÌ·Ù· 3 Ë̤Ú˜ ·ÚÁfiÙÂÚ·. ∆Ô ·È‰› ÂÍ‹ÏıÂ Î·È Ù¤ıËΠ۠ٷÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ∏ ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ˘Ô¯ÒÚËÛ ÚÔԉ¢ÙÈο ÂÓÙfi˜ 3 ÌËÓÒÓ.

Paediatriki 2002;65:142-144

™˘˙‹ÙËÛË ªÔÏÔÓfiÙÈ Ë ÈÛÙÈÔ΢ÙÙ·ÚÈ΋ ÓÂÎÚˆÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ· ‹ ÓfiÛÔ˜ Kikuchi ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÚÔ 30ÂÙ›·˜, Ï›Á˜ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È ·fi ÙË ÓfiÛÔ Â›Ó·È 30 ÂÙÒÓ, Ì ‡ÚÔ˜ ·fi 11 ˆ˜ 75 ¤ÙË. ∏ ·Ó·ÏÔÁ›· ·ÚÚ¤ÓˆÓ-ıËϤˆÓ Â›Ó·È 1:4 (2). ∏ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ ¯ÒÚ˜ Ù˘ ∞Û›·˜, ·Ó Î·È ÛÔÚ·‰Èο ÎÚÔ‡ÛÌ·Ù· ηٷÁÚ¿ÊÔÓÙ·È Û fiÏÔ ÙÔÓ ÎfiÛÌÔ. ∂›Ó·È Èı·Ófi Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Ó· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ Î·È Ó· ‰È·Ê‡ÁÂÈ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ ÏfiÁˆ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ÓfiÛÔ˜ Â›Ó·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË Î·È ÚÔηÏ› ·ÓËÛ˘¯›· ÛÙÔ ıÂÚ¿ÔÓÙ· È·ÙÚfi ÌfiÓÔ fiÙ·Ó ·˘Ù‹ ·Ú·Ù›ÓÂÙ·È. OÈ ÈÔ Û˘¯Ó¤˜ ÂΉËÏÒÛÂȘ Â›Ó·È Ô ·Ú·ÙÂٷ̤ÓÔ˜ ˘ÚÂÙfi˜ Î·È Ë ·ÓÒ‰˘ÓË ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·. ªÂÚÈΤ˜ ÊÔÚ¤˜, Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÂÓÙÔ›˙ÂÙ·È ÛÙÔ˘˜ ‚Ô˘‚ˆÓÈÎÔ‡˜, ÙÔ˘˜ ÌÂÛÔıˆÚ·ÎÈÎÔ‡˜ ‹ ÙÔ˘˜ ÌÂÛÂÓÙ¤ÚÈÔ˘˜ ÏÂÌÊ·‰¤Ó˜, ÂÓÒ ÌÔÚ› Ó· Â›Ó·È Î·È ÁÂÓÈÎÂ˘Ì¤ÓË, Û˘Óԉ¢fiÌÂÓË ·fi Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. OÈ ·ÛıÂÓ›˜ ÌÔÚ› ·ÎfiÌ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó·˘Ù›·, Â̤ÙÔ˘˜, Ú›ÁÔ˜, ÛÙÔÌ·ÙÈο ¤ÏÎË, Ì˘·ÏÁ›Â˜, ·ÚıÚ·ÏÁ›Â˜, Ó˘¯ÙÂÚÈÓ¤˜ ÂÊȉÚÒÛÂȘ Î·È ‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ ÂÚ‡ıËÌ· ÚÔÛÒÔ˘, ÎËÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ· Î·È ÔÌÊÔ‡˜, fï˜ Ë ÁÂÓÈ΋ ÙÔ˘˜ ηٿÛÙ·ÛË ·Ú·Ì¤ÓÂÈ Î·Ï‹ (3,6). ∏ Û˘Ìو̷ÙÔÏÔÁ›· ·˘Ù‹ Ô‰ËÁ› ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë Û ¤Ó· Â˘Ú‡Ù·ÙÔ Ê¿ÛÌ· ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÏÂÌÊ·‰ÂÓ›Ùȉ· ÏÔÈÌÒ‰Ô˘˜ ·ÈÙÈÔÏÔÁ›·˜, ÓÔÛ‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ ‹ ηÎfiËı˜ ϤÌʈ̷. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ Â›Ó·È ‚ÔËıËÙÈÎfi˜, ·ÊÔ‡ Ù· ÌfiÓ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È ÔÈ ·˘ÍË̤ÓÔÈ ‰Â›ÎÙ˜ ÊÏÂÁÌÔÓ‹˜ ÛÙÔÓ ÔÚfi (∆∫∂, CRP, LDH, ¯·ÏÎfi˜, ÊÂÚÚÈÙ›ÓË) Î·È ÂÓ›ÔÙ ̛· ‹È· Ï¢ÎÔÂÓ›· (7). ∏ ÂÈÌÔÓ‹ Ù˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜, ·Ú¿ ÙË Û˘Ó‹ıˆ˜ ¯ÔÚËÁÔ‡ÌÂÓË ·ÁˆÁ‹ Ì ·ÓÙÈ‚ÈÔÙÈο, ηıÈÛÙ¿ ·Ó·Áη›· ÙË ‚ÈÔ„›· ÚÔۂ‚ÏË̤ÓÔ˘ ÏÂÌÊ·‰¤Ó·, Ë ÔÔ›· Î·È ı¤ÙÂÈ ÙË ‰È¿ÁÓˆÛË. O ÚÔۂ‚ÏË̤ÓÔ˜ ÏÂÌÊ·‰¤Ó·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì·ÎÚÔÛÎÔÈο ÂÎÙÂٷ̤Ó˜ ÓÂÎÚÒÛÂȘ, ÂÓÒ ÂӉȿÌÂÛ· ·ÚÂÌ‚¿ÏÏÔÓÙ·È ˘ÁÈ›˜ ÂÚÈÔ¯¤˜. ∫·Ù¿ ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒÓÂÙ·È Û˘ÛÛÒÚ¢ÛË Î·Ù¿ ÙfiÔ˘˜ ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ÚÔηÏ› ηڢÔÚÚËÍ›· Î·È Ó¤ÎÚˆÛË, ΢ڛˆ˜ ÛÙËÓ ·Ú·ÊÏÔÈÒ‰Ë ÂÚÈÔ¯‹ ÙÔ˘ ·‰¤Ó·. ÷ڷÎÙËÚÈÛÙÈ΋ Â›Ó·È Ë ·Ô˘Û›· ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ÛÙȘ ÂÛٛ˜ Ó¤ÎÚˆÛ˘ (8). ∏ ÈÛÙÔÏÔÁÈ΋ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Î˘Ú›ˆ˜ ·fi ÙÔ Î·ÎfiËı˜ ϤÌʈ̷, ÁÈ· ÙË ‰È¿ÎÚÈÛË ÙÔ˘ ÔÔ›Ô˘ ··ÈÙÂ›Ù·È ÌÂÁ¿ÏË ÂÌÂÈÚ›· ·fi ÙÔÓ ·ıÔÏÔÁÔ·Ó·ÙfiÌÔ, ÙÔ ™∂§, ÁÈ· ÙÔÓ ÔÔ›Ô Û˘ÓÂÎÙÈÌÒÓÙ·È Ù· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, Î·È ÙË ÓfiÛÔ ÂÍ’ ÔÓ‡¯ˆÓ Á·Ï‹˜, fiÔ˘ ·Ú·ÙËÚÔ‡ÓÙ·È Ù·

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¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÛÙËÌ¿ÙÈ·. ∏ ‚ÈÔ„›· Ì ÏÂÙ‹ ‚ÂÏfiÓË ÌÔÚ› Ó· ı¤ÛÂÈ ÙË ‰È¿ÁÓˆÛË ÛÙÔ 50% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Î·È ·˘Ùfi ÂÍ·ÚÙ¿Ù·È ·fi ÙË Ï‹„Ë ÙÔ˘ ˘ÏÈÎÔ‡, ÙÔ ÔÔ›Ô Û˘Ìو̷ÙÈο ÌÔÚ› Ó· ÚÔ¤Ú¯ÂÙ·È ·fi ·ıÔÏÔÁÈ΋ ÂÚÈÔ¯‹ (3,9). ∏ ÔÚ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ηÏÔ‹ı˘, ηıÒ˜ Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Ô ˘ÚÂÙfi˜ ˘Ô¯ˆÚÔ‡Ó ÙÔ ·ÚÁfiÙÂÚÔ Û 4-6 Ì‹Ó˜. £ÂˆÚÂ›Ù·È ·˘ÙÔ˚ÒÌÂÓË ÓfiÛÔ˜, ηıÒ˜ Ô˘‰ÂÌ›· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ê·›ÓÂÙ·È Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙËÓ ÔÚ›· Ù˘. ∫·Ù¿ ηÈÚÔ‡˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› Ù· ÎÔÚÙÈÎÔÂȉ‹, ¯ˆÚ›˜ Ó· ÂȂ‚·ÈÒÓÂÙ·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ (10). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÌfiÓÔ Ì›· ı·Ó·ÙËÊfiÚÔ˜ ÂÚ›ÙˆÛË, ÏfiÁˆ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ (11). ÷ڷÎÙËÚÈÛÙÈÎfi Â›Ó·È fiÙÈ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ˘ÔÙÚÔ¤˜ Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 2%-4% (12). ™¿ÓÈ· ¤¯Ô˘Ó ηٷÁÚ·Ê› ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ô˘ ÂΉ‹ÏˆÛ·Ó ™∂§ Û ‡ÏÔÁÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·Ê’ fiÙÔ˘ ›¯·Ó ÚÔÛ‚ÏËı› ·fi ÓfiÛÔ Kikuchi (4,13). ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. º·›ÓÂÙ·È fiÙÈ Î¿ÔÈÔ˜ ·Ú¿ÁÔÓÙ·˜, ›ÙÂ Ê˘ÛÈÎfi˜ ›Ù ¯ËÌÈÎfi˜ ›Ù ÏÔÈÌ҉˘, Ô˘ Â›Ó·È Î·È ÙÔ Èı·ÓfiÙÂÚÔ, ‰ÈÂÁ›ÚÂÈ Ù· ∆ ÏÂÌÊÔ·ÙÙ·Ú·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔηÏÂ›Ù·È ·Ô‰fiÌËÛË Î˘ÙÙ¿ÚˆÓ Î·È Ó¤ÎÚˆÛË ÛÙËÓ ·Ú·ÊÏÔÈÒ‰Ë ÂÚÈÔ¯‹ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Î·È Â·ÎfiÏÔ˘ıË Û˘ÛÛÒÚ¢ÛË ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ. ¶Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘Ó‡·ÚÍË ·˘ÙÔ¿ÓÔÛÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜, Ô˘ ÂÍËÁ› Î·È ÙËÓ ÂͤÏÈÍË ÔÚÈÛÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ Û ™∂§. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÓfiÛÔ Kikuchi ¤¯ÂÈ ‰È·ÈÛÙˆı› ¯ÚfiÓÈ· ÂÓÂÚÁfi˜ Ïԛ̈ÍË ·fi Èfi Epstein-Barr (5) ‹ HTLV1 (10). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ÛˆÛÙ‹ Î·È ¤ÁηÈÚË ‰È¿ÁÓˆÛË ·˘Ù‹˜ Ù˘ Û¿ÓÈ·˜ ÔÓÙfiÙËÙ·˜ Â›Ó·È È‰È·›ÙÂÚ˘ ÛËÌ·Û›·˜, ·ÊÔ‡ ·ÔÙÚ¤ÂÈ ·fi ÙË ‰ÈÂÓ¤ÚÁÂÈ· ·ÓÒÊÂÏˆÓ ÂÂÌ‚·ÙÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È ÙË ¯ÔÚ‹ÁËÛË ÙÔÍÈÎÒÓ ·Ó·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ıÂÚ·ÂÈÒÓ Ì ÙËÓ ˘fiÓÔÈ· ηÎÔ‹ıÔ˘˜ ÏÂÌÊÒÌ·ÙÔ˜ (14). ∏ ¢·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ·ıÔÏÔÁÔ·Ó·ÙfiÌÔ˘ ·fi ÙÔÓ ·È‰›·ÙÚÔ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ù›ıÂÙ·È ˘fiÓÔÈ· ‡·Ú͢ ÓfiÛÔ˘ Kikuchi ‚ÔËı¿ÂÈ ÛÙËÓ Â‰Ú·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Kikuchi M. Lymphadenitis showing focal reticulum cell hyperplasia with nuclear debris and phagocytosis: a clinicopathological study. Acta Hematol Jpn 1972;7:261-267.

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2. Dorfman RF, Berry G. Kikuchi’s histiocytic necrotizing lymphadenitis: an analysis of 108 cases with emphasis on the differential diagnosis. Semin Diagn Pathol 1988;5:329-345. 3. Tsang W, Chan J, Ng CS. Kikuchi’s lymphadenitis: A morphologic analysis of 75 cases with special reference to unusual features. Am J Surg Pathol 1994;18:219-231. 4. Chen YH, Lan JL. Kikuchi’s disease in systemic lupus erythematosus: clinical features and literature review. J Microbiol Immunol Infect 1998;31:187-192. 5. Hudnall SD. Kikuchi-Fujimoto disease. Is Epstein-Barr virus the culprit? Am J Clin Pathol 2000;113:761-764. 6. Rakic L, Arrese JE, Thiry A, Pierard GE. Kikuchi-Fujimoto lymphadenitis with cutaneous involvement. J Eur Acad Dermatol Venereol 1999;13:118-122. 7. Sierra ML, Vegas E, Blanco-Gonzalez JE, Gonzalez A, Martinez P, Calero MA. Kikuchi’s disease with multisystemic involvement and adverse reaction to drugs. Pediatrics 1999;104:24. 8. Thongsuksai P, Kayasut K. Histiocytic necrotizing lymphadenitis (Kikuchi’s disease): clinicopathologic characteristics of 23 cases and literature review. J Med Assoc Thai 1999;82:812-818. 9. Viguer JM, Jimenez-Heffernan JA, Perez P, Lopez-Ferrer P, Gonzalez-Peramato P, Vicandi B. Fine-needle aspiration cytology of Kikuchi’s lymphadenitis: A report of ten cases. Diagn Cytopathol 2001;25:220-224. 10. Bataille V, Harland CC, Behrens J, Cook MG, Holden CA. Kikuchi’s disease (histiocytic necrotizing lymphadenitis) in association with HTLV1. Br J Dermatol 1997;136:610-612. 11. Chan JKC, Wong KC, Ng CS. A fatal case of multicentric Kikuchi’s histiocytic necrotizing lymphadenitis. Cancer 1989;63:1856-1862. 12. Blewitt RW, Kumar SN, Abraham JS. Reccurrence of Kikuchi’s lymphadenitis after 12 years. J Clin Pathol 2000;53:157-158. 13. Litwin MD, Kirkham B, Henderson DR, Milazzo SC. Histiocytic necrotizing lymphadenitis in systemic lupus erythematosus. Ann Rheum Dis 1992;51:805-807. 14. Chamulak GA, Brynes RK, Nathwani BN. Kikuchi-Fujimoto disease mimicking malignant lymphoma. Am J Surg Pathol 1990;14:514-523.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-10-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-01-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›Ì˘ ∏Ï›· ∑ÂÚ‚Ô‡ 72, ∆.∫. 111 44, ¶·Ù‹ÛÈ·


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µ. ªÂ ÙËÓ ˘’ ·ÚÈıÌ. 1933/27-10-99 Ù. µ’ º∂∫, ·ÚÈıÌ. ∞Ú. ∞π·/9879/99 ·fiÊ·ÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ¶ÚfiÓÔÈ·˜ ȉڇıËÎÂ Î·È ÏÂÈÙÔ˘ÚÁ› ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ÂȉÈÎfi ΤÓÙÚÔ ·ÓÙÈÌÂÙÒÈÛ˘ Û˘ÁÁÂÓÒÓ ÁÓ·ıÔÚÔÛˆÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ. °ÓˆÛÙÔÔÈÂ›Ù·È ÛÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ ÙˆÓ Û¯ÂÙÈÎÒÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È fi¯È ÌfiÓÔ fiÙÈ: 1. ∂›Ó·È ˘Ô¯ÚˆÙÈ΋ Ë ·Ó·ÊÔÚ¿ ÁÂÓÓ‹Ûˆ˜ ·È‰ÈÔ‡ Ì ÁÓ·ıÔÚÔÛˆÈΤ˜ ·ÓˆÌ·Ï›Â˜ (΢ڛˆ˜ ˘ÂÚˆÈÔÛ¯ÈÛٛ˜ Î·È ¯ÂÈÏÂÔÛ¯ÈÛٛ˜) ÛÙÔ ÂȉÈÎfi ΤÓÙÚÔ. ∆ËÏ./Fax: 010-746 7165. 2. À¿Ú¯ÂÈ Ë ‰˘Ó·ÙfiÙËÙ· ıÂÚ·¢ÙÈÎÒÓ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ·fi Ù˘ ÁÂÓÓ‹Ûˆ˜ ÙÔ˘ ·È‰ÈÔ‡ ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛ‹ ÙÔ˘. ∏ ÔÌ¿‰· Ô˘ ·Ú·ÎÔÏÔ˘ı› Î·È ·ÓÙÈÌÂÙˆ›˙ÂÈ Ù· ·È‰È¿ ·ÔÙÂÏÂ›Ù·È ·fi ¶·È‰›·ÙÚÔ, °ÂÓÂÙÈÛÙ‹, æ˘¯ÔÏfiÁÔ, ÃÂÈÚÔ˘ÚÁfi øÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏfiÁÔ, ∞ÎÔÔÏfiÁÔ, ∂Ó‰ÔÛÎfiÔ, ¶Ï·ÛÙÈÎfi ÃÂÈÚÔ˘ÚÁfi, O‰ÔÓÙ›·ÙÚÔ, OÚıÔ‰ÔÓÙÈÎfi, °Ó·ıÔ¯ÂÈÚÔ˘ÚÁfi, ∫ÔÈÓˆÓÈÎfi §ÂÈÙÔ˘ÚÁfi Î·È ¡ÔÛËχÙÚÈ·. °È· ÔÔÈ·‰‹ÔÙ ÂÈÛÙËÌÔÓÈ΋ ÂÓË̤ڈۋ Û·˜ ·Ú·Î·Ïԇ̠ӷ ÂÈÎÔÈÓˆÓ›Ù Ì ÙÔ ÂȉÈÎfi ΤÓÙÚÔ ÛÙÔ ÙËÏ.:/fax: 010-746 7165.

°. ÃÚÈÛÙfiÔ˘ÏÔ˜ ¢/ÓÙ‹˜ ø.ƒ.§. ÙÌ‹Ì·ÙÔ˜

°. ∏ ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¤¯ÂÈ Î·Ù·Û΢¿ÛÂÈ ÈÛÙÔÛÂÏ›‰· ÛÙÔ ‰È·‰›ÎÙ˘Ô Ì ÂӉȷʤÚÔ˘Û˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔÓ ŒÏÏËÓ· ¶·È‰›·ÙÚÔ. ∏ ‰È‡ı˘ÓÛË Â›Ó·È: www.gprs.org.gr

¢. π∞∆ƒO∆∂∫ ∆· ª¤ÏË Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫∏”, ·Ú·Î·ÏÔ‡Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙȘ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔ˘Ó ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË Î·È ·ÓÙ›ÛÙÔȯ˜ ·Ó·ÊÔÚ¤˜ ·fi ÙËÓ ∂ÏÏËÓÈ΋ µÈ‚ÏÈÔÁÚ·Ê›·. ¶ÏËÚÔÊÔڛ˜: π∞∆ƒO∆∂∫ www.mednet.gr/iatrotek

∂Π̤ÚÔ˘˜ Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ∫·ıËÁ‹ÙÚÈ· ∑ˆ‹ ¶··‰ÔÔ‡ÏÔ˘ - ∫Ô˘ÏÔ˘Ì‹

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¶PO™EXH ™YNE¢PIA

21-24 ª·ÚÙ›Ô˘ 2002

29Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ Î·È ªÂÙ·‚ÔÏÈÛÌÔ‡ •ÂÓÔ‰Ô¯Â›Ô Du Lac ∆ËÏ.: 010-77.74.370

πˆ¿ÓÓÈÓ·

23-24 ª·ÚÙ›Ô˘ 2002

6Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ¶·È‰È¿ÙÚˆÓ ∞Ó·ÙÔÏÈ΋˜ ª·Î‰ÔÓ›·˜ & £Ú¿Î˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¢ËÌÔÎÚ›ÙÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘ ¶ÏËÚÔÊÔڛ˜: Minerva Fairs and Congresses ∆ËÏ.: 010-32.17.456, 32.17.474 Fax: 010-32.20.595 E-mail: minerva@medianet.gr

∫ÔÌÔÙËÓ‹

19-21 ∞ÚÈÏ›Ô˘ 2002

8Ô ∂ÈÛÙËÌÔÓÈÎfi ™˘Ó¤‰ÚÈÔ ºÔÈÙËÙÒÓ π·ÙÚÈ΋˜ ∂ÏÏ¿‰Ô˜ ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ ∆ËÏ.: 06510-97.719

πˆ¿ÓÓÈÓ·

20 ∞ÚÈÏ›Ô˘ 2002

3Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ ™˘ÌfiÛÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ °·ÛÙÚÂÓÙÂÚÔÏÔÁ›·˜, ∏·ÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜ “™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÁÈ· Û˘Ó‹ıË ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·È‰È·ÙÚÈ΋ Á·ÛÙÚÂÓÙÂÚÔÏÔÁ›·”

∞ı‹Ó· ¶ÔÏÂÌÈÎfi ªÔ˘Û›Ô

20-21 ∞ÚÈÏ›Ô˘ 2002

10Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ªÂϤÙ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ OÛÙÒÓ ∆ËÏ.: 010-62.31.541 Fax: 010-80.18.122

ª‡ÎÔÓÔ˜

21-24 ∞ÚÈÏ›Ô˘ 2002

VIII International Congress on Immunorehabilitation “Allergy, Immunology and Global Network” Congress Secretariat Tel.: (++7-095) 336-5000 Fax: (++7-095) 336-5000 E-mail: acicis@ibch.ru Web site: http://www.isir.ru

Cannes, France

26-28 ∞ÚÈÏ›Ô˘ 2002

1st Mediterranean Congress of Neurology ¶ÏËÚÔÊÔڛ˜: Demos Antoniou ∆ËÏ.: 357-5-749919 Fax: 357-5-749744 E-mail: info@medneuro2002.com

Limassol, Cyprus

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4-7 ª·˝Ô˘ 2002

American Pediatric Society: Pediatric Societies Joint Meeting Baltimore Convention Center Fax: 011-281-419-0082 Web site: http://www.pas-meeting.org

Baltimore, MD U.S.A.

5-8 ª·˝Ô˘ 2002

4th European Congress of Chemotherapy and Infection Congress Secretariat: Congrex Sweden AB Attn: ECC-4, P.O. Box 5619 SE-114 86 Stockholm, Sweden Tel.: +46 8 459 66 00 Fax: +46 8 661 91 25 Web site: www.congrex.se/ecc-4

Paris, France

21-25 ª·˝Ô˘ 2002

28Ô ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ °Ú·ÌÌ·Ù›· π·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ∞ıËÓÒÓ ª·È¿Ó‰ÚÔ˘ 23, 115 28 ∞ı‹Ó· ∆ËÏ.: 010 - 72 11 845 Fax: 010 - 72 15 082 E-mail: iea@mednet.gr

∞ı‹Ó·

23-25 ª·˝Ô˘ 2002

14Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ¶ÏËÚÔÊÔڛ˜: FORUM International Congress Organizers ∆ËÏ.: 0310 - 257 128 & 0310 - 243 588 Fax: 0310 - 231 849 E-mail: forup@otenet.gr

£ÂÛÛ·ÏÔÓ›ÎË

24-27 ª·˝Ô˘ 2002

International Research Society of Spinal Deformities Meeting Tel.: 010-5534 256 & 010-7562 256-7 E-mail: grivas@dias.itel.gr

∞ı‹Ó·

25-26 ª·˝Ô˘ 2002

11Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ ¶ÏËÚÔÊÔڛ˜: Î. ¶Ú›ÊÙ˘ °. ¡. ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ ∆ËÏ.: 010 - 80 36 484 Fax: 010 - 61 31 173 E-mail: kpriftis@otenet.gr

∞ı‹Ó·

13-15 πÔ˘Ó›Ô˘ 2002

13th Annual Congress of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Tel./Fax: ++ 386 (0) 1 430 17 14 E-mail: ivan.vidmar@kclj.si

Ljubljana, Slovenia

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™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

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

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

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

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

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™˘ÓÙÔÌÔÁڷʛ˜

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

p.o. RIA RNA RDS sec s.c. ‹ À.¢. SD SE U

™˘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

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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 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002