Παιδιατρική | Τόμος 65 • Τεύχος 2 • Μάρτιος - Απρίλιος 2002 by E-chlld

∞¡∞™∫O¶∏™∏ ∏ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

∞. °ÎÈﬁÎ·˜

Bƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ ∏ ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·ÛıÂÓÒÓ

ÌÂ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ˆ˜ ÚÒÈÌÔ˜

ÚÔÁÓˆÛÙÈÎﬁ˜ ‰Â›ÎÙË˜ ·ÓÙ·ﬁÎÚÈÛË˜

ÛÙË ıÂÚ·Â›·

ª.π. ∏ÏÈÔÔ‡ÏÔ˘, °. ™˘ÚÔÁÈ·ÓÓﬁÔ˘ÏÔ˜

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

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

¶ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌﬁÙËÙ· ÛÙËÓ ∫Ú‹ÙË

Ù· ÙÂÏÂ˘Ù·›· ¤ÓÙÂ ¯ÚﬁÓÈ·

∂. Ã·Ù˙Ë‰¿ÎË, ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔÚ·Î¿ÎË, ∂. ¶·Ú·ÛÎ¿ÎË˜, µ. µ·Ï¿ÚË, ª. ∫ÔÚÔÔ‡ÏË, ∂. °·Ï·Ó¿ÎË˜, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

™˘¯ÓﬁÙËÙ· ÊÔÚ¤ˆÓ Î·È ·Ó›¯ÓÂ˘ÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ Î·È ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÛÂ Ì·ıËÙ¤˜ ÙÔ˘ ¡ÔÌÔ‡ ∫·Ú‰›ÙÛ·˜

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

REVIEW ARTICLE

Spondylodiscitis in childhood

A. Giokas

AWARD-WINNING ARTICLE

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

ORIGINAL ARTICLES

∞septic meningitis in children from Crete

S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori

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

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

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

Continuation of table of contents inside title page

¢Â›ÎÙÂ˜ ·¯˘Û·ÚÎ›·˜ ·È‰ÈÒÓ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜

ÙË˜ ÂÚÈÔ¯‹˜ µ¿ÚË˜ ∞ÙÙÈÎ‹˜

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

∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿

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

∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™

™‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛË˜ ·ﬁ Ó·ÚÎˆÙÈÎ¤˜ Î·È ÌË-

Ó·ÚÎˆÙÈÎ¤˜ Ô˘Û›Â˜ ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô.

¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ

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

ÃÚﬁÓÈ· Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘

ÏﬁÁˆ ·ÓˆÌ·Ï›·˜ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛË˜ ÙÔ˘

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

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

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

of table of contents

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

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

Cholelithiasis in children

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

CASE REPORTS

Neonatal withdrawal syndrome from narcotic and non-narcotic drugs. Report of two cases

I. Kapetanakis, J. Kaleyias, M. Markouri, G. Alevizopoulos, G. Kourakis, ∂. Dellagrammaticas

Chronic midgut volvulus due to malrotation: Case report

∞. Michos, E. Orfanou, E. Papandreou, N. Baltogiannis, E. Roma-Giannikou, D. Keramidas

Kikuchi - Fujimoto disease: Case report

G. Trimis, K. Athanasaki, A. Giannoulia-Karantana, X. Krikos

ÂÚÈÂ¯ÔÌ¤ÓˆÓContinuation of table of contents

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏¡ µπµ§πO°ƒ∞ºπ∞

¢È·ÊÔÚÂÙÈÎ‹ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ

ÛÂ ÌÔÓÔ‡ÚËÓ· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·ﬁ ‰È¤ÁÂÚÛË ÌÂ ÛÙÂÏ¤¯Ë ÛÙÚÂÙﬁÎÔÎÎÔ˘

ÔÌ¿‰·˜ µ Ô˘ ÚÔÎ·ÏÔ‡Ó ÛË„·ÈÌ›· ‹ ÌﬁÓÔ ·ÔÈÎÈÛÌﬁ

Berner R, Csorba J, Brandis M

∞ﬁ‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: ™. ºˆÙﬁÔ˘ÏÔ˜

∏ ·ÈÙÈÔÏÔÁ›· Î·È Ë ¤Î‚·ÛË ÙË˜ ÓÂ˘ÌÔÓ›·˜

ÛÂ ·È‰È¿ ÌÂ Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜

·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (AIDS) Ô˘ ÂÈÛ‹¯ıËÛ·Ó

ÛÂ ÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜ (ª∂£)

·Ó·Ù˘ÛÛﬁÌÂÓË˜ ¯ÒÚ·˜

Zar H, Apolles P, Argent A, Klein M, Burgess J, Hanslo D et al

∞ﬁ‰ÔÛË ÛÙ· ∂ÏÏËÓÈÎ¿: A. Ã·Ù˙‹˜

¢È¿ÁÓˆÛË, ıÂÚ·Â›· Î·È ÓÔÛËÚﬁÙËÙ· ÛÂ ·È‰È¿

ÌÂ ÊÏÂÁÌÔÓÒ‰Ë ÓﬁÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (º¡∂)

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

£ÂÚ·Â›· ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚÈ‰›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡

ÛÂ ·È‰È¿ ÌÂ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏÈ·Î¿ ¿ÏÁË

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

LITERATURE ABSTRACTS

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

Berner R, Csorba J, Brandis M

Greek translation: S. Fotopoulos

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

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

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

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M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ : °. µ·ÚÏ¿ÌË˜ : ¶. ∫·ÊÚ›ÙÛ· : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ : £. ∆ÛÈÏÈÁÈ¿ÓÓË˜ : ∫. ∆ÛÔ˘Ì¿Î·˜ : ™. ºˆÙfiÔ˘ÏÔ˜ : A. Ã·Ù˙‹˜

ºÈÏÔÏÔÁÈÎ‹ EÈÌ¤ÏÂÈ·

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I. K·Ú·‚Ú¿ÓÔ˘

∂ÈÌ¤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ

∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

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™˘ÓÙÔÓÈÛÙ‹˜ ∂Î‰ﬁÛÂˆ˜ E¶I™THMONIKE™EK¢O™EI™E.¶.E. ¶. ∆Û·Ï‰¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ

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EÈ‰ÈÎÂ˘ﬁÌÂÓÔÈ, ºÔÈÙËÙ¤˜:14,67

πSSN 0377-2551

Bimonthly Publication

The Official Journal of the Hellenic Paediatric Society

Publisher

K. Griveas

Owner©

Hellenic Paediatric Society

Michalakopoulou 92

Athens 115 28

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

Scientific Editorial Board

President : K. Malaka

Editor : Z. Papadopoulou-Couloumbis

Members : E. Agelaki-Georgaki

: F. Athanassiadou-Piperopoulou

: M. Anthrakopoulos

: G. Varlamis

: P. Kafritsa

: A. Konstadopoulos

: Th. Tsiligiannis

: K. Tsoumakas

: S. Fotopoulos

: ∞. Hatzis

Manuscript Editing

Greek Editing I. Karavranou

English Editing Z. Papadopoulou-Couloumbis

Correspondence

Hellenic Paediatric Society

Michalakopoulou 92

Athens 115 28

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

Publishing Coordinator

SCIENTIFICPUBLICATIONSLtd

P. Tsaldari 3, Marousi 151 22

Tel.: 010-61 41 360-5 Fax: 010-61 41 366

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H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙÈ˜ ·Ó·ÛÎÔ‹ÛÂÈ˜ ÛÂ

15-25, ÁÈ· ÙÈ˜ ÂÚÂ˘ÓËÙÈÎ¤˜ ÂÚÁ·Û›Â˜ ÛÂ 12-15 ÛÂÏ›‰Â˜, ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙÈ˜ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜

ÂÚÈÙÒÛÂÈ˜ ÛÂ 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊËÌ¤ÓÂ˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙÈ˜ ‚Ú·¯Â›Â˜ ‰ËÌÔÛÈÂ‡ÛÂÈ˜ ÛÂ 1000 Ï¤ÍÂÈ˜ Î·È ÁÈ· ÙÈ˜ ÂÈÛÙÔÏ¤˜ ÛÂ 250-300 Ï¤ÍÂÈ˜.

™ÂÏ›‰· Ù›ÙÏÔ˘

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ÔÓÔÌ·ÛÙÈÎ‹, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi Î¤ÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈÎ‹, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›Ùˆ-

ÛË ¤ÏÏÂÈ„Ë˜ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈÌ¤Ó· Î¤ÓÙÚ·,

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ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰ÈÂ‡ı˘ÓÛË Î·È ÙÔ ÙËÏ¤ÊˆÓÔ ÙÔ˘ Û˘Á-

ÁÚ·Ê¤· ÌÂ ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

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ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙﬁ-

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·ÔÙÂÏ¤ÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜. ¢ÂÓ

Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÈ˜ 250 Ï¤ÍÂÈ˜. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈÎ¿ Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔ-

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·ﬁ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎﬁ.

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ÛÂÈ˜ ¤¯Ô˘Ó ÌﬁÓÔ ·ÁÁÏÈÎ‹ ÂÚ›ÏË„Ë.

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ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂÈ˜ ¤ˆ˜ ¤ÓÙÂ Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ Ô˘ ı·

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Ù¿ ÏÂÙÔÌÂÚ‹˜ ÒÛÙÂ Ó· ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹

ÙÔ˘˜ ·ﬁ ¿ÏÏÔ˘˜ ÂÚÂ˘ÓËÙ¤˜. T· ∞ÔÙÂÏ¤ÛÌ·Ù· Ú¤ÂÈ

Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÌÂ Û·Ê‹ÓÂÈ· Î·È Ó· Û˘ÓÔ‰Â‡ÔÓÙ·È ·ﬁ ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈÎ‹ ·Ó¿Ï˘ÛË. H ™˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘

¿ÏÏˆÓ ÂÚÂ˘ÓËÙÒÓ.

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

ÂÏÂ‡ıÂÚË ‰ÔÌ‹ Î·Ù¿

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

‚È‚ÏÈÔÁÚ·ÊÈÎ¤˜ ·Ú·ÔÌ¤˜.

TÈÌ¤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈÌ¤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎﬁ (Conventional-™˘Ì‚·ÙÈÎﬁ) ™‡ÛÙËÌ· Ì¤Û· ÛÂ ·Ú¤ÓıÂÛË. ¶›Ó·ÎÂ˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339.

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

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

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÚÔ‰È·ÁÚ·Ê¤˜ ÙË˜ International Committee of Medical Journal Editors / Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂÈ˜ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È ÌÂ ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov).

¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ

I. ¶ÂÚÈÔ‰ÈÎ¿ AÓ ÔÈ Û˘ÁÁÚ·ÊÂ›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ﬁÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛﬁÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

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

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

™˘ÌÏËÚˆÌ·ÙÈÎﬁ ÙÂ‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡:

Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

ÃˆÚ›˜ Û˘ÁÁÚ·Ê¤·:

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

¶ÚÔÛ‰ÈÔÚÈÛÌﬁ˜ Ù‡Ô˘ ¿ÚıÚÔ˘:

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

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

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

J Am Soc Nephrol 1991;2:562.

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

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

II. µÈ‚Ï›·

∫ÂÊ¿Ï·ÈÔ ÛÂ ‚È‚Ï›Ô:

Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742.

™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·:

Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.

¢ËÌÔÛ›Â˘ÛË ÛÂ ÙﬁÌÔ Ú·ÎÙÈÎÒÓ:

Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.

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

Kaplan SJ. Post hospital home health care: the

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

¶›Ó·ÎÂ˜ Î·È EÈÎﬁÓÂ˜

AÔÛÙ¤ÏÏÔÓÙ·È ÂÈ˜ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ÊˆÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ ÌÂ ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ ÌÂ ÙÔ Ï¿ÙÔ˜ fiÏË˜ ÙË˜ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› ÌÂ ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm. OÈ ›Ó·ÎÂ˜ ·ÚÈıÌÔ‡ÓÙ·È ÌÂ ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ ÌÂ

ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ÎÂ›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ Ì¤ÚÔ˜. ™ÙÔ˘˜ ›Ó·ÎÂ˜ Ú¤ÂÈ Ó· ·ÔÊÂ‡ÁÔÓÙ·È ÔÈ Î¿ıÂÙÂ˜ ÁÚ·ÌÌ¤˜.

ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ÊˆÙÔÁÚ·Ê›Â˜, ÎÏ.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓÂ˜. £·

Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙË˜ ÔÈﬁÙËÙ·˜ ÌÂ ÌÔÚÊ‹ ÊˆÙÔÁÚ·-

ÊÈÒÓ ‹ Î·È ÚˆÙÔÙ‡ˆÓ. ™ÙÔ ›Ûˆ Ì¤ÚÔ˜ ÙˆÓ ÂÈÎﬁÓˆÓ

Ó· ÛËÌÂÈÒÓÂÙ·È ÌÂ ÌÔÏ‡‚È Ô ·ÚÈıÌfi˜ ÙË˜ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁÚ·Ê¤·, Î·ıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ Ì¤ÚÔ˜ ÙË˜ ÂÈÎfiÓ·˜. ™ÙÈ˜

·ÔÛÙÂ›ÏÂÙÂ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚Â‚·ÈˆıÂ›ÙÂ

- ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ - ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚË˜ ‰ËÌÔÛ›Â˘ÛË˜ ÙË˜ ÂÚÁ·Û›·˜ - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈÌ¤ÓÔ˘ ÙË˜ 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˘ÁÁÚ·Ê¤ˆÓ (ÔÏÔÁÚ¿Êˆ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ Î¤ÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰ÈÂ‡ı˘ÓÛË Î·È ÙËÏ¤ÊˆÓÔ Û˘ÁÁÚ·Ê¤· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·

- ÂÚ›ÏË„Ë ÂÏÏËÓÈÎ‹-·ÁÁÏÈÎ‹, Ï¤ÍÂÈ˜ ÎÏÂÈ‰È¿ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- Î·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- ÎÂ›ÌÂÓÔ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- Â˘¯·ÚÈÛÙ›Â˜ ‹ ·Ó·ÁÓˆÚ›ÛÂÈ˜ (·Ó·ÊÔÚ¿ ÛÂ ÂÈ‰ÔÙ‹ÛÂÈ˜¯ÔÚËÁ›Â˜ ‹ ¿ÏÏÂ˜ ËÁ¤˜ ˘ÔÛÙ‹ÚÈÍË˜)

- ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏﬁ ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·)

- ›Ó·ÎÂ˜ (Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó - ÂÈÎﬁÓÂ˜, ÌÂ ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ Ì¤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌËÌ¤ÓÂ˜, ÂÈ˜ ÙÚÈÏÔ‡Ó

- Ù›ÙÏÔÈ ÂÈÎﬁÓˆÓ (‰ÈÏﬁ ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ ÛÂ ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÈ˜ ÙÚÈÏÔ‡Ó.

∞. °ÎÈﬁÎ·˜

Spondylodiscitis in childhood

A. Giokas

¶ÂÚ›ÏË„Ë: ∏ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ˜ ÛÙ· ·È‰È¿ Â›Ó·È Ì›· ·Û˘Ó‹ıË˜ ÓfiÛÔ˜ Î·È ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› Û·Ó ÊÏÂÁÌÔÓÒ‰Ë˜ ·ÏÏÔ›ˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÌÂ ÂÏ¿¯ÈÛÙË ‹ Î·ıfiÏÔ˘ ÚÔÛ‚ÔÏ‹ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ∂Î‰ËÏÒÓÂÙ·È Î˘Ú›ˆ˜ ÌÂ ÂÒ‰˘ÓË

ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ·ÏÏ¿ Û˘Ó‹ıˆ˜ Û˘ÓÔ‰Â‡ÂÙ·È Î·È

¿ÏÏ· Û˘ÌÙÒÌ·Ù· Ù·

ÌÔÚÂ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÂ Ï·Óı·ÛÌ¤ÓË ‹ Î·ı˘ÛÙÂÚËÌ¤ÓË ‰È¿ÁÓˆÛË Î·È ıÂÚ·Â›·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÌfiÓÔ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ·

Î·È È‰È·›ÙÂÚ· Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· Â›Ó·È ·ÎÚÈ‚Â›˜ Î·È Ù·¯Â›Â˜ Ì¤ıÔ‰ÔÈ Ô˘ ‰›‰Ô˘Ó ¯Ú‹ÛÈÌÂ˜ Î·È

Î·ıÔÚÈÛÙÈÎ¤˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÚÒÈÌË ‰È¿ÁÓˆÛË

Î·È Èı·Ó‹ ÂÍ‹ÁËÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡ Û˘Ó‰ÚﬁÌÔ˘ ÙË˜ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜. ∏ ıÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÎÏÈÓÔÛÙ·ÙÈÛÌﬁ, ·ÓÙÈ‚›ˆÛË (IV Î·È per os) ÁÈ· 3-4 Â‚‰ÔÌ¿‰Â˜ Î·È ·ÎÈÓËÙÔÔ›ËÛË ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÁÈ· 2-3 Ì‹ÓÂ˜. ∏ Ê˘ÛÈÎ‹ ÂÍ¤ÏÈÍË ÙË˜

ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜ Â›Ó·È Î·ÏÔ‹ıË˜ Î·È Ë ·Ú¯ÈÎ‹

ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·ﬁ ÙËÓ ËÏÈÎ›· ÙÔ˘

·È‰ÈÔ‡ Î·È ÙÔ Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ‰ÈÛÎ›ÙÈ˜, ÛÔÓ‰˘Ï›ÙÈ˜, ÊÏÂÁÌÔÓ‹ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜.

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. Key words: discitis, spondylitis, spine infection.

µ’ OÚıÔ·È‰ÈÎ‹ ∫ÏÈÓÈÎ‹

¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Journal of Bone and Joint Surgery.

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

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

∂) ∞ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·. ∏ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›·

Â›Ó·È Ì›· ¯Ú‹ÛÈÌË ‰È·ÁÓˆÛÙÈÎ‹ ·ÂÈÎÔÓÈÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ ÁÈ· ÙËÓ ¤ÚÂ˘Ó· ÛÔÓ‰˘ÏÈÎÒÓ ·ıÔÏÔÁÈÎÒÓ

Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ˘˜ ÛÔÓ‰‡ÏÔ˘˜ ÌÂÙ¿ ·ﬁ

ÙËÓ ·ÓÂ‡ÚÂÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ·˘ÙÒÓ ·ÏÏÔÈÒÛÂˆÓ ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Î·È ÙÔ ÛÈÓıËÚÔÁÚ¿-

ÊËÌ· ÔÛÙÒÓ. ∂›ÛË˜, Ô Û˘Ó‰˘·ÛÌﬁ˜ ·ÍÔÓÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ Î·È Ì˘ÂÏÔÁÚ·Ê›·˜ ·Ú¤¯ÂÈ ÂÈÚﬁÛıÂÙÂ˜ ¯Ú‹ÛÈÌÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙË ‰È·ÁÓˆÛÙÈÎ‹

ÂÎÙ›ÌËÛË ÙË˜ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘.

™∆) ª·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·. ∂›Ó·È Ì›· Ó¤· ·ÂÈ-

ÎÔÓÈÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ Î·È È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈÎ‹

ÛÙËÓ Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ. ¢ÂÓ ÂÎ¤ÌÂÈ ·ÎÙÈÓÔ‚ÔÏ›· Î·È ·ÂÈÎÔÓ›˙ÂÈ Ù· ÚÒÈÌ· ÊÏÂÁ-

ÌÔÓÒ‰Ë ÛÙÔÈ¯Â›· ÙÔ˘ ‰›ÛÎÔ˘ Î·È ·Ú·ÛÔÓ‰˘ÏÈ-

ÎÒÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ. ¢Â›¯ÓÂÈ ÙËÓ ¤ÎÙ·ÛË ÙË˜ ‚Ï¿-

‚Ë˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘, ÙËÓ ·Ú·ÎÂ›ÌÂ-

ÓË ÂÈÊ˘ÛÈ·Î‹ Ï¿Î· Î·È ÙÈ˜ ·ÏÏÔÈÒÛÂÈ˜ ÙˆÓ

ÛÔÓ‰‡ÏˆÓ. ∂›ÛË˜, Î·Ù·ÁÚ¿ÊÂÈ Î¿ıÂ ‰È·ÊÔÚ¿

ÛÙÔ ÓˆÙÈ·›Ô ÛˆÏ‹Ó· Î·È ·Ú¤¯ÂÈ ﬁ¯È ÌﬁÓÔÓ ·Ó·ÙÔ-

ÌÈÎ‹ ·ÂÈÎﬁÓÈÛË ÙË˜ ™.™., ·ÏÏ¿ Â›Ó·È ·ÔÙÂÏÂÛÌ·-

ÙÈÎ‹ Î·È ÛÙË ¯ËÌÈÎ‹ Û‡ÛÙ·ÛË ÙˆÓ ÚÔÛ‚Â‚ÏËÌ¤-

ÓˆÓ ÈÛÙÒÓ (∂ÈÎfiÓ· 3 Î·È 4). ∑) ¶·Ú·Î¤ÓÙËÛË. ™˘Ó‹ıˆ˜ ‰ÂÓ ÂÓ‰Â›ÎÓ˘Ù·È Ó· Á›ÓÂÙ·È ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜, ÂÂÈ‰‹ Ô Î›Ó‰˘ÓÔ˜ ·fi ÙËÓ ·Ú·Î¤ÓÙËÛË Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÂ Û¯¤ÛË ÌÂ ÙËÓ Î·ÏÔ‹ıË ÔÚÂ›· ÙË˜ ÓfiÛÔ˘. ∂›ÛË˜, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ÙÔÓ Spiegel Î·È Û˘Ó (1972) Î·È Wenger Î·È Û˘Ó (1978), ÌÂ ÙËÓ ·Ú·Î¤ÓÙËÛË ‹ ÙËÓ ·ÓÔÈÎÙ‹ ‚ÈÔ„›· ÙÔ˘ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ ‰›ÛÎÔ˘ ÌfiÓÔ ÛÙÔ 50% ÂÚ›Ô˘ ·ÓÂ˘Ú›ÛÎÂÙ·È Ô ·ıÔÁfiÓÔ˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ (58,68). ∏) µÈÔ„›·. ∏ ·ÓÔÈÎÙ‹ ‹ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ‰È¿ ‚Â-

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

ÏfiÓË˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È, ‰ÈfiÙÈ ¤¯ÂÈ ÎÈÓ‰‡ÓÔ˘˜, ¤¯ÂÈ ·Ô‰ÂÈ¯ıÂ› ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ·ÓÂÈÙ˘¯‹˜ ÁÈ· ÙËÓ ·Ó·Î¿Ï˘„Ë ÙÔ˘ ·ıÔÁÂÓÂÙÈÎÔ‡ ·ÈÙ›Ô˘ Î·È ‰ÂÓ ÙËÓ ·Ô‰¤¯ÔÓÙ·È Â‡ÎÔÏ· ÔÈ ÁÔÓÂ›˜ Î·È ÔÈ ÌÈÎÚÔ› ·ÛıÂÓÂ›˜. ∏ ‚ÈÔ„›· ‰È¿ ‚ÂÏfiÓË˜ ÙÔ˘ ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ ‰›ÛÎÔ˘ Û˘ÓÈÛÙ¿Ù·È ·fi ÙÔÓ Taylor (1985) Ó· Á›ÓÂÙ·È ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÂÎÂ›ÓÂ˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÂÎÙÂÙ·Ì¤ÓË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ‰›ÛÎÔ˘ Î·È ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ÛÒÌ·ÙÔ˜ ÛÙËÓ ˘Ô„›· Ê˘Ì·ÙÈÒ‰Ô˘˜ ÛÔÓ‰˘Ï›ÙÈ‰·˜ ‹ ÛÂ ÂÎÂ›ÓÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË

Û˘ÓÙËÚËÙÈÎ‹ ·ÁˆÁ‹. ∂›ÛË˜, ÌÔÚÂ› Ó· ÎÚÈıÂ› ··Ú·›ÙËÙË Ë ·ÓÔÈÎÙ‹ ‹ ÎÏÂÈÛÙ‹ ‚ÈÔ„›· ÌﬁÓÔÓ ÂÊ’

fiÛÔÓ Ù›ıÂÙ·È ‰È·ÁÓˆÛÙÈÎfi Úfi‚ÏËÌ· (63).

¢È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË 1) OÍÂ›· ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜ ÛÔÓ‰‡ÏÔ˘. Ã·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÔÍ¤· ÁÂÓÈÎ¿ Û˘ÌÙÒÌ·Ù· ÌÂ ˘„ËÏfi ˘ÚÂÙfi, ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË, ·˘ÍËÌ¤ÓË ∆∫∂ Î·È Ù·¯Â›· ÚÔÔ‰Â˘ÙÈÎ‹ ÔÛÙÈÎ‹ Î·Ù·ÛÙÚÔÊ‹. ∂›ÛË˜, ÙÔ ÔÏ‡ ıÂÚÌfi ÛÈÓıËÚÔÁÚ¿ÊËÌ·, Ë ·ÍÔÓÈÎ‹ Î·È Ë Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ·ÚÎÂÙ¿ ‰È·ÊˆÙÈÛÙÈÎ¿ ÛÙÔÈ¯Â›· ÙË˜ ÚÔÛ‚Â‚ÏËÌ¤ÓË˜ ÂÚÈÔ¯‹˜.

O Correa Î·È Û˘Ó (1993) ˘ÔÛÙËÚ›˙ÂÈ ﬁÙÈ Ë ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜ ÙÔ˘ ÛÔÓ‰‡ÏÔ˘ Û˘Ó‹ıˆ˜ ÂÎ‰ËÏÒÓÂÙ·È ÌÂ ﬁÓÔ ·Ó¿ÏÔÁ· ÙË˜ ı¤ÛË˜ ÚÔÛ‚ÔÏ‹˜ ÛÙËÓ ·˘¯ÂÓÈÎ‹, ÙË ıˆÚ·ÎÈÎ‹ Î·È ÙËÓ ÔÛÊ˘˚Î‹ ÌÔ›Ú· ÙË˜ ™™ (9). 2) º˘Ì·ÙÈÒ‰Ë˜ ÛÔÓ‰˘ÏÈÎ‹ ÔÛÙÂÔÌ˘ÂÏ›ÙÈ˜. ™˘Ó‹ıˆ˜ Ë TBC Â›Ó·È ıˆÚ·ÎÈÎ‹, ÂÓÒ Ë ‰ÈÛÎ›ÙÈ˜ ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ Oª™™. ∏ ·ÚÓËÙÈÎ‹ Mantoux Î·È Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·ÔÎÏÂ›Ô˘Ó

ÙËÓ ‡·ÚÍ‹ ÙË˜. ™ÙËÓ TBC ÛÔÓ‰˘Ï›ÙÈ‰·, Ë ÔÚÂ›· ÙË˜ ÓfiÛÔ˘ ¤¯ÂÈ ÚÔÔ‰Â˘ÙÈÎ¿ ·ÚÁfi Ú˘ıÌfi ÌÂ ÌÂÁ¿ÏË ÔÛÙÈÎ‹

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

Î·Ù·ÛÙÚÔÊ‹ Î·È ÂÏ¿¯ÈÛÙË ·ÔÎ·Ù¿ÛÙ·ÛË. ∂›ÛË˜, ÛÂ ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È ·Ú·ÛÔÓ‰˘ÏÈÎfi ·fiÛÙËÌ· Ô˘ Â‡ÎÔÏ· ‰È·ÁÈÁÓÒÛÎÂÙ·È ÌÂ ·ÍÔÓÈÎ‹ ‹ Ì·ÁÓËÙÈÎ‹ ÙÔÌÔÁÚ·Ê›·.

3) ∆˘ÊÈÎ‹ Î·È ÌÂÏÈÙÔÎÔÎÎÈÎ‹ ÛÔÓ‰˘Ï›ÙÈ˜

4) ∞ÔÙÈÙ¿ÓˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰›ÛÎÔ˘

5) £ˆÚ·ÎÈÎ‹ Î·È ÔÛÊ˘˚Î‹ ÓﬁÛÔ˜ ÙÔ˘ Scheuermann

6) TÚ·˘Ì·ÙÈÎ‹ ÛÔÓ‰˘Ï›ÙÈ˜

7) ŸÁÎÔÈ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ 8) ªËÓÈÁÁ›ÙÈ˜

9) ¡Â˘ÚÔÏÔÁÈÎ‹ ÓﬁÛÔ˜

10) ™ÎˆÏËÎÔÂÈ‰›ÙÈ˜ 11) ¶˘ÂÏÔÓÂÊÚ›ÙÈ˜

£ÂÚ·Â˘ÙÈÎ‹ ·ÁˆÁ‹

1) ∫ÏÈÓÔÛÙ·ÙÈÛÌfi˜. ∂Ê’ fiÛÔÓ ‰È·ÁÓˆÛıÂ› ‰ÈÛÎ›ÙÈ˜, Û˘ÓÈÛÙ¿Ù·È ¿ÌÂÛË Î·Ù¿ÎÏÈÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì¤¯ÚÈ Ó· ˘Ô¯ˆÚ‹ÛÂÈ Ô fiÓÔ˜, Ô Ì˘˚Îfi˜ Û·ÛÌfi˜ Î·È Ë ÙÔÈÎ‹ Â˘·ÈÛıËÛ›·, Î·È ¤ˆ˜ fiÙÔ˘ Ë ∆∫∂, Ë ÏÂ˘ÎÔÎ˘ÙÙ¿ÚˆÛË Î·È Ô ˘ÚÂÙfi˜ ·Ú¯›ÛÔ˘Ó Ó· ˘Ô¯ˆÚÔ‡Ó Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ‰Â›ÍÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÂÈ‰ÂÈÓˆıÂ› Ë ÔÛÙÈÎ‹ ‰È¿‚ÚˆÛË. ∂Ô‡ÏˆÛË ‹ ›·ÛË ·fi ÙË ÓfiÛÔ ÂÈ‚Â‚·ÈÒÓÂÙ·È ·fi ÙËÓ ‡·ÚÍË ÌÂÚÈÎ‹˜ ÛÎÏ‹Ú˘ÓÛË˜ ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ ÛÔÓ‰˘ÏÈÎÒÓ ÂÈÊ·ÓÂÈÒÓ.

2) ∞ÓÙÈ‚›ˆÛË. ∞Ú¯ÈÎ¿, Â›Ó·È Û˘Ó‹ıˆ˜ ÂÌÂÈÚÈÎ‹ (ÎÂÊ·ÏÔÛÔÚ›ÓË + ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈÎ¿ Ê¿ÚÌ·Î·) ÁÈ· 10 ËÌ¤ÚÂ˜ (∂º) Î·È per os Ì¤¯ÚÈ Ó· ˘Ô¯ˆÚ‹ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù· Î·È Ë ∆∫∂ ÂÈÛÙÚ¤„ÂÈ ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ Â›Â‰· (Û˘Ó‹ıˆ˜ ·˘Ùfi ÙÔ ‰È¿ÛÙËÌ· Î˘Ì·›ÓÂÙ·È ·fi 4 ¤ˆ˜ 6 Â‚‰ÔÌ¿‰Â˜). ∂¿Ó fiÌˆ˜ ·Ó·Î·Ï˘ÊıÂ› ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ÛÙËÓ ·ÈÌÔÎ·ÏÏÈ¤ÚÁÂÈ· Î·È ÛÙËÓ ·Ú·Î¤ÓÙËÛË, ÙfiÙÂ ¯ÔÚËÁÂ›Ù·È ÙÔ Î·-

∂ÈÎﬁÓ· 3. O‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ÙË˜ ÔÛÊ˘˚Î‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜. ¶·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 ÌÂ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰· Ô˘ ÂÌÊ¿ÓÈÛÂ ÎÏÈÓÈÎ¿ Û˘ÌÙÒÌ·Ù· ·‰˘Ó·Ì›·˜ Î·È ¿ÚÓËÛË˜ ‚¿‰ÈÛË˜.

·ÓÙÈ‚ÈÔÙÈÎfi Û‡ÌÊˆÓ· ÌÂ ÙÔ ÙÂÛÙ Â˘·ÈÛıËÛ›·˜. ™ÙË ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·, ·Ú’ fiÙÈ ¤¯ÂÈ ÊÏÂÁÌÔÓÒ‰Ë ÚÔ¤ÏÂ˘ÛË, Ë ¯Ú‹ÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ıÂˆÚÂ›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 ÙË˜ ™.™. Î·È ÙÔÓ ÎÏÈÓÔÛÙ·ÙÈÛÌfi. 3) ∫Ë‰ÂÌfiÓ·˜. ∂Ê·ÚÌfi˙ÂÙ·È ÎË‰ÂÌfiÓ·˜ ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ÂÚÈÔ¯‹ ÙË˜ ÚÔÛ‚Â‚ÏËÌ¤ÓË˜ ™.™ ÁÈ· 23 Ì‹ÓÂ˜. OÈ Scoles Î·È Quinn (1982) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ÙÔÔı¤ÙËÛË Á‡„ÈÓÔ˘ ÎË‰ÂÌfiÓ· ÂÈÙ·¯‡ÓÂÈ

ÙËÓ ›·ÛË ÙË˜ ÓfiÛÔ˘ (54), ÂÓÒ Ô Taylor (1985) ÈÛÙÂ‡ÂÈ fiÙÈ Ë ¯Ú‹ÛË ÙÔ˘ Á‡„ÈÓÔ˘ ÎË‰ÂÌfiÓ· ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙË fiÙ·Ó Ô ·ÛıÂÓ‹˜ ‰ÂÓ ·Ú·Ì¤ÓÂÈ ÎÏÈÓ‹ÚË˜ ‹, ÂÓÒ ‚Ú›ÛÎÂÙ·È ÎÏÈÓ‹ÚË˜, Ë ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ˜ Â›Ó·È ¿Ú· ÔÏ‡ ÂÒ‰˘ÓË (63). ™˘Ó‹ıˆ˜ Û˘ÓÈÛÙ¿Ù·È ¤Ó·˜ Ô›ÛıÈÔ˜ ÎË‰ÂÌfiÓ·˜ Ù‡Ô˘ TaylorKnight ÛÂ ÌÂÁ¿Ï· ·È‰È¿, ¤ˆ˜ fiÙÔ˘ ·˘Ù¿ Á›ÓÔ˘Ó ·Û˘ÌÙˆÌ·ÙÈÎ¿ ÌÂ ÙÈ˜ Û˘Ó‹ıÂÈ˜ ‰Ú·ÛÙËÚÈfiÙËÙÂ˜. O ÎÏÈÓÔÛÙ·ÙÈÛÌfi˜ Î·È Ë ·ÎÈÓËÙÔÔ›ËÛË ÌÂ ÎË‰ÂÌfiÓ·, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÈ Ô Richards Î·È Û˘Ó (1999), Â˘ÓÔÔ‡Ó ÙËÓ ÂÔ˘ÏˆÙÈÎ‹ ‰È·‰ÈÎ·Û›· ÙË˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ ‰›ÛÎÔ˘ (49). º˘ÛÈÎ¿, Ë ¯ÚÔÓÈfiÙËÙ·

ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·ıÔÚ›˙ÂÈ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ·ÓÙÈ‚›ˆÛË˜ Î·È ÙË˜ ·ÎÈÓËÙÔÔ›ËÛË˜.

™Â ÂÚ›ÙˆÛË ‰ËÌÈÔ˘ÚÁ›·˜ ·Ú·ÛÔÓ‰˘ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜, Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ Î·ı·ÚÈÛÌfi˜ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ˜ ÌfiÓÔ ÂÊ’ fiÛÔÓ Ô ÌÈÎÚfi˜ ·ÛıÂÓ‹˜ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË ÌÈÎÚÔ‚È·Î‹ ıÂÚ·Â›·. ∂›ÛË˜, Â¿Ó Ë ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË Â›Ó·È ·Ó·ÁÎ·›·, ÌfiÓÔ Ë ·ÚÔ¯¤ÙÂ˘ÛË ÙÔ˘ ·ÔÛÙ‹Ì·ÙÔ˜ Â›Ó·È ·ÚÎÂÙ‹ (Joughin Î·È Û˘Ó, 1991). ∂¿Ó fiÌˆ˜ Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜ Î·ı·ÚÈÛÌfi˜ Â›Ó·È ÂÎÙÂÙ·Ì¤ÓÔ˜, ÙfiÙÂ Â›Ó·È ··Ú·›ÙËÙË Î·È Ë ÂÚÈÔÚÈÛÌ¤ÓË

∂ÈÎﬁÓ· 4. O‚ÂÏÈ·›· ÙÔÌ‹ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ ÔÛÊ˘˚-

Î‹˜ ÌÔ›Ú·˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÛÙËÓ ÔÔ›· Ê·›ÓÂÙ·È

ÚÔÛ‚ÔÏ‹ ÙÔ˘ O3-O4 ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÌÂ ‰ËÌÈÔ˘ÚÁ›· ÚÔÛÔÓ‰˘ÏÈÎÔ‡ ·ÔÛÙ‹Ì·ÙÔ˜. ¶ÚﬁÎÂÈÙ·È ÁÈ· ·ÁﬁÚÈ 6 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¤ÓÙÔÓË˜ 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 ÙË˜ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜ ÌÂ ˘ÔÙÚÔ‹ ÙˆÓ Û˘-

ÌÙˆÌ¿ÙˆÓ Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ ÛÂ ·ÛıÂÓÂ›˜ Ô˘ ‰ÂÓ Â›¯Â Á›ÓÂÈ ·ÎÈÓËÙÔÔ›ËÛË ÙË˜ ™.™. (58,68).

∂·ÎﬁÏÔ˘ı· ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜ 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¿ ÔÚÈÛÌ¤ÓÂ˜ ÊÔÚ¤˜ ¤¯ÂÈ ·Ú·ÙËÚËıÂ› ÌÂÚÈÎ‹ ·ÔÎ·Ù¿ÛÙ·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˜ ÛÂ ÚﬁÛÊ·ÙË ·Ú·ÎÔÏÔ‡ıËÛË, ÂÓÒ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ ·Ú·ÎÔÏÔ‡ıËÛË ¤Ú·Ó ÙË˜ ËÏÈÎ›·˜ ÔÛÙÈÎ‹˜ ˆÚ›Ì·ÓÛË˜ ·Ú·ÙËÚ‹ıËÎÂ Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ (61). OÈ Ring Î·È Û˘Ó (1994, 1995) Î·È Wenger Î·È Û˘Ó (1978) ·Ú·Ù‹-

ÚËÛ·Ó ‰È·ÊﬁÚÔ˘ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜, ·ÏÏ¿ ﬁ¯È Ï‹ÚË ·ÔÎ·Ù¿ÛÙ·ÛË ÙÔ˘ ‡„Ô˘˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ (47,48,58).

∏ ÛÙ¤ÓˆÛË Î·È, ÙÂÏÈÎ¿, Ë ·ÒÏÂÈ· ÙÔ˘ ‡„Ô˘˜

ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ÔÊÂ›ÏÂÙ·È ÛÙË

¯ÔÓ‰ÚÔÏ˘ÙÈÎ‹ È‰ÈﬁÙËÙ· ÙˆÓ ÊÏÂÁÌÔÓÒÓ ÛÙÈ˜ ·ÓÒÚÈÌÂ˜ ÛÎÂÏÂÙÈÎ¿ ·ÚıÚÒÛÂÈ˜, ÚÔ‰È·ı¤ÙÔÓÙ·˜ ÛÂ

ÚÔÔ‰Â˘ÙÈÎ‹ ÔÛÙÂÔÔ›ËÛË ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ‰È·Ì¤ÛÔ˘ ÙÔ˘ Î·ÙÂÛÙÚ·ÌÌ¤ÓÔ˘ ‰›ÛÎÔ˘.

2) ªÂÚÈÎ‹ ‹ Ï‹ÚË˜ Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ªÂÚÈÎ‹ ‹ Ï‹ÚË˜ Û˘ÓÔÛÙ¤ˆÛË ÌÂÙ·Í‡ ‰‡Ô ·Ú·ÎÂ›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ ÌÔÚÂ› Ó· Û˘Ì‚Â› Î·È

Â›Ó·È ¿ÌÂÛ· ÂÍ·ÚÙÒÌÂÓË ·fi ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜ ÊÏÂÁÌÔÓ‹˜. 3) °ˆÓÈÒ‰Ë˜ ·Ú·ÌfiÚÊˆÛË ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜. ∆Ô‡ÙÔ Û˘Ì‚·›ÓÂÈ ÂÂÈ‰‹ Ë ÌÂÛÔÛÔÓ‰‡ÏÈÔ˜ ‰ÈÛÎ›ÙÈ˜ ÚÔÛ‚¿ÏÏÂÈ ÙÔ ÚfiÛıÈÔ ÙÌ‹Ì· ÙÔ˘ ‰›ÛÎÔ˘ Î·È ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ. 4) ™ÎÔÏ›ˆÛË Î·È Î‡ÊˆÛË. ∂›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÁˆÓÈÒ‰Ô˘˜ ·Ú·ÌfiÚÊˆÛË˜ ÙÔ˘ ÌÂÛÔÛÔÓ‰‡ÏÈÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Î·È ÙË˜ ÌÂÚÈÎ‹˜ ‹ Ï‹ÚÔ˘˜ Û˘ÓÔÛÙ¤ˆÛË˜ ÙˆÓ ·Ú·ÎÂ›ÌÂÓˆÓ ÛÔÓ‰‡ÏˆÓ.

5) ªÂÁ¤Óı˘ÛË ÛÔÓ‰‡ÏÔ˘ (Vertebra Magna).

¶ÚﬁÎÂÈÙ·È ÁÈ· Ì›· Û˘ÌÌÂÙÚÈÎ‹ ·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‹ ÔÊÂ›ÏÂÙ·È ÛÙËÓ ˘ÂÚ·ÈÌ›· ÙË˜ ÂÚÈÔ¯‹˜, Û˘ÓÂÂ›· ÙË˜ ÊÏÂÁÌÔÓ‹˜ (56).

∆· ÂÚÈÛÛﬁÙÂÚ· ·ﬁ ·˘Ù¿ Ù· ·ÎÙÈÓÔÁÚ·ÊÈÎ¿ Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ‚ÚÂıÂ› Ó· Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎ¿

ÌÂÙ¿ ·ﬁ ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎﬁ ‰È¿ÛÙËÌ· ·Ú·ÎÔÏÔ‡ıËÛË˜ Î·È ‰ÂÓ ··ÈÙÂ›Ù·È È‰È·›ÙÂÚË ıÂÚ·Â›·.

™˘ÌÂÚ¿ÛÌ·Ù·

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿ ÌÔÚÂ› Ó· ÏÂ¯ıÂ› ﬁÙÈ Ë Ê˘ÛÈÎ‹ ÂÍ¤ÏÈÍË ÙË˜ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜ Â›Ó·È Î·ÏÔ‹ıË˜ Î·È Ë ·Ú¯ÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ·

·fi ÙËÓ ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ Â›Â‰Ô ÚÔÛ‚ÔÏ‹˜ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜. O ˘„ËÏfi˜ ‚·ıÌfi˜ ˘Ô„›·˜ Î·È Ë ÁÓÒÛË ÙË˜ ÓfiÛÔ˘ ıÂˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙÔÈ ·Ú¿ÁÔÓÙÂ˜ ÛÙË ‰È·ÁÓˆÛÙÈÎ‹ ÂÎÙ›ÌËÛË Î·È ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ∂›ÛË˜, Ê·›ÓÂÙ·È fiÙÈ ·fi

ﬁÏÂ˜ ÙÈ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜, Ë ¯Ú‹ÛË ÙË˜ Ì·ÁÓËÙÈÎ‹˜ ÙÔÌÔÁÚ·Ê›·˜ Û˘Ì‚¿ÏÏÂÈ Î·ıÔÚÈÛÙÈÎ¿ ÛÙËÓ ÚÒÈÌË ‰È¿ÁÓˆÛË ÙË˜ ÛÔÓ‰˘ÏÔ‰ÈÛÎ›ÙÈ‰·˜.

1. An AS, Vaccaro AR, Dolinskas CA, Cotler JM, Balderston RA, Bauerle WB. Differentiation between spinal tumors and infections with magnetic resonance imaging. Spine

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.

Factors influence the diagnosis in inervertebral discitis in childhood. J Bone Joint Surg 1996;78B(Suppl II and III):151.

25. Giokas A, Nezi M, Theodoropoulos B, Pistevos G. The childhood’s back pain and spine imaging. Pediatr Radiol 1998;28:381.

26. Crawford AH, Kucharzykitherman DW, Ruda R, Smitherman HC Jr. Diskitis in children. Clin Orthop 1991;266:70-79.

27. Jansen BRH, Hart W, Scchreuder O. Discitis in children. Acta Orthop Scand 1993;64:33-36.

28. 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.

29. Hassler O. The human intevertebral disc: a microangiographical study on its vascular supply at various ages. Acta Orthop Scand 1970;40:765-772.

30. 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.

31. Hensinger RN. Back pain in children. In: The Pediatric Spine. Bradford DS, Hensinger RN, editors. New York: Thieme; 1985. p. 41-60.

32. Hensinger RN. Acute back pain in children. Instr Course Lect 1995;44:111-126.

33. 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.

34. Jansen BRH, Hart W, Scchreuder O. Discitis in children. Acta Orthop Scand 1993;64:33-36.

35. King HA. Back pain in children. Pediatr Clin N Am 1984;31:1083-1095.

36. King HA. Evaluating the child with back pain. Pediatr Clin N Am 1986;33:1489-1493.

37. King HA, Tufel D. Prospective study of back pain in children. Orthop Trans 1986;10:9-10.

38. Lascari AD, Graham MH, MacQueen JC. Intervertebral disk infection in children. J Pediatr 1967;70:751-757.

39. Matthews SS, Wiltse LL, Karbelnig MJ. A destructive lesion involving the intervertebral disc in children. Clin Orthop 1957;9:162-167.

40. Menelaus MB. Discitis: an inflammation affecting the intervertebral discs in children. J Bone Joint Surg [Br] 1964;46:16-23.

41. Nade S. Acute haematogenous Ôsteomyelitis in infancy and childhood. J Bone Joint Surg Br 1983;65B:109-119.

42. Norris S, Erlich MG, Mckusick K. Early diagnosis of disc space infection with 67Ga in an experimental model. Clin Orthop 1979;144:293-298.

43. Ogden JA, Lister G. The pathology of neonatal osteomyelitis. Pediatrics 1975;55:474-478.

44. 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.

45. Payne WK III, Ogilvie JW. Back pain in children and adolescents. Pediatr Clin N Am 1996;43:899-917.

46. Ratcliffe JF. Anatomic basis for the pathogenesis and radiologic features of vertebral osteomyelitis and its

differentiation from childhood discitis: a microanteriographic investigation. Acta Radiol 1985;26:137-143.

47. 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.

48. 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.

49. Richards, SB, McCarthy ER, Akbarnia AB. Back pain in childhood and adolescence. AAOS Instructional Course Lectures 1999;48:525-542.

50. Ryoppy S, Jaaskelainen J, Rapola J, Alberty A. Nonspecific diskitis in children. A nonmicrobial disease? Clin Orthop 1993;297:95-99.

51. 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.

52. Saenger EL. Spondyloarthritis in children. Amer J Roentgen 1950;64:20-31.

53. Schmorl G, Junghanns H. The Human Spine in Health and Disease. New York: Grune & Straton; 1959. p. 198-218.

54. Scoles PV, Quinn TP. Intervertebral discitis in the children and adolescents. Clin Orthop 1982;162:31-36.

55. Smith AD. A benign form of osteomyelitis of the spine. JAMA 1933;100:335-337.

56. Smith RF, Taylor TKF. Inflammatory lesions of intervertebral discs in children. J Bone Joint Surg 1967;49A:1508-1520.

57. Sonnabend DH, Taylor TKF, Chapman GK. Inervertebral disc calcification syndromes in children and adolescents. Spine 1982;6:535-537.

58. Spiegel PG, Kengla K, Isaacson A, Wilson JC. Intervertebral disc space inflammation in children. J Bone Joint Surg [Am] 1972;52:284-296.

59. Sponseller PD. Evaluating the child with back pain. Am Fam Physician 1996;54:1933-1941.

60. 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.

61. Song KS, Ogden JA, Ganey T, Guidera KJ. Contiguous

discitis and osteomyelitis in children. J Pediatr Orthop 1997;17:470-477.

62. Taylor JR, Scott JE, Cribb AM, Boswoorth TR. Human intervertebral disc acid glycosaminoglycans. J Anat 1992;180:137-141.

63. Taylor KS. Diskitis in children. In: Bradford DS, Hensinger RN, editors. The pediatric Spine. New York: Thieme; 1985. p. 63-68.

64. 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.

65. Thomson GH. Back pain in children. J Bone Joint Surg 1993;75A:928-938.

66. Turner PG, Hancock PG, Green JH, Galasko CSB. Back pain in children. Spine 1989;14:812-814.

67. 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.

68. Wenger DR, Bobechko WP, Gilday DL. The spectrum of intervertebral disc space infection in children. J Bone Joint Surg [Am] 1978;60:100-108.

69. Wiley AM, Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg 1959;41B:796.

70. 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.

71. 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.

72. 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›· ¤ÁÎÚÈÛË˜: 06-02-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. °ÎÈﬁÎ·˜

Ã·ÏÎË‰ﬁÓÔ˜ 57-59, ∞ÌÂÏﬁÎËÔÈ, ∆.∫. 115 27, ∞ı‹Ó·

ARTICLE

ıÂÚ·Â›·*

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· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚﬁ (∂¡À) ·˘Í¿ÓÂÙ·È ÛÙË ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰·, ·ÏÏ¿ Ë ÔÚÂ›· ÙË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ Â›Ó·È ¿ÁÓˆÛÙË.

™ÎÔﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Ì¤ÙÚËÛË ÙË˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ Î·È Ë Û‡ÁÎÚÈÛ‹ ÙË˜ ÌÂ ¿ÏÏÂ˜

Î˘ÙÙ·ÚÈÎ¤˜ Î·È ‚ÈÔ¯ËÌÈÎ¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ∂¡À.

H ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, Ô ·ÚÈıÌﬁ˜ Î˘ÙÙ¿ÚˆÓ, Ë Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ Î·È Ô

ÏﬁÁÔ˜ ÁÏ˘Îﬁ˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÌÂÙÚ‹ıËÎ·Ó Î·Ù¿ ÙË

‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜ ÛÂ 34 ·ÛıÂÓÂ›˜ ÌÂ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰· (ÂÎÙﬁ˜ ÓÂÔÁÓÈÎ‹˜ ÂÚÈﬁ‰Ô˘), ÛÂ

4 ÓÂÔÁÓÈÎ¤˜ ÌËÓÈÁÁ›ÙÈ‰Â˜, ÛÂ 2 ·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÛË„·ÈÌ›· Î·È ÛÂ 97 Ì¿ÚÙ˘ÚÂ˜. OÈ

·ÛıÂÓÂ›˜ Â›¯·Ó 1 ‹ 2 Â·Ó·ÏËÙÈÎ¤˜ ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂÈ˜. ∂›ÛË˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÌÂÙÚ‹ıËÎÂ ÛÂ 8 ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÏÔÓÂÊÚ›ÙÈ‰· Î·È ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ∂¡À. ¶ÚÈÓ ÙË ıÂÚ·Â›·, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ‚ÚÂÊÈÎ‹˜ Ì¤¯ÚÈ ÂÊË‚ÈÎ‹˜ ËÏÈÎ›·˜ ‹Ù·Ó 136 nmoles 4methylumbelliferone/ml/ÒÚ· (ÌÂ ‰È·Î‡Ì·ÓÛË 44 ¤ˆ˜ 826), ÂÓÒ ÛÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜ ‹Ù·Ó 14 nmoles/ml/ÒÚ· (ÌÂ ‰È·Î‡Ì·ÓÛË 7 ¤ˆ˜ 23) (p<0,000001). ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÎÏÈÓÈÎ‹ ‚ÂÏÙ›ˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÂ ‰Â›ÁÌ·Ù· ∂¡À, Ù· ÔÔ›· ÂÏ‹ÊıËÛ·Ó ÌÂÙ¿ ¿ÚÔ‰Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ˆÚÒÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. ŒÍÈ Ì¤¯ÚÈ 12 ÒÚÂ˜ ÌÂÙ¿

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹

39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎﬁ ™˘Ó¤‰ÚÈÔ, 2001

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

Department of Pediatrics, University of Patras School of Medicine, General University Hospital, Patra *1st “Choremio” Award 39th Panhellenic Pediatric Meeting, 2001

Î·Ù¿ 59%. ∞ÓÙÈı¤Ùˆ˜, ÔÈ ˘ﬁÏÔÈÔÈ ·Ú¿ÌÂÙÚÔÈ

ÙÔ˘ ∂¡À ¤‰ÂÈ¯Ó·Ó ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÙÈÌÒÓ

ÙÔ˘˜Î·Ù¿ ÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ÙË˜ ıÂÚ·Â›·˜ Ô˘

‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·ﬁ ÙËÓ ÔÚÂ›· ÙË˜ ÓﬁÛÔ˘. ™Â

¤Ó·Ó ·ÛıÂÓ‹ ÌÂ ÓÂ˘ÌÔÓÈÔÎÔÎÎÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰· Î·È

ÂÈ‰Â›ÓˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ 22 ÒÚÂ˜ ÌÂÙ¿

ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Ë ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜

‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ·˘Í‹ıËÎÂ Î·Ù¿ 89%. ™ÙË ÓÂÔ-

ÁÓÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·, Ë ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘-

ÚÔÓÈ‰¿ÛË˜ ÚÈÓ ÙË ıÂÚ·Â›· ‹Ù·Ó ·˘ÍËÌ¤ÓË, ·ÏÏ¿

Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÔÚÂ›·˜ ÙË˜ ÓﬁÛÔ˘ ··ÈÙÂ›

·Ú·ÙÂÙ·Ì¤ÓË ÂÚ›Ô‰Ô ÂÓ˙˘ÌÈÎÒÓ ÌÂÙÚ‹ÛÂˆÓ ÁÈ·

¤ÁÎ·ÈÚË Ú‡ıÌÈÛË ÙË˜ ıÂÚ·Â›·˜. ∏ ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÙÔ˘ ∂¡À Â›Ó·È ·ÍÈﬁÈ-

ÛÙÔ˜ ‰Â›ÎÙË˜ ‚·ÎÙËÚÈ·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ô˘ ÌÔ-

ÚÂ› Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ, ÓˆÚ›˜ ÛÙËÓ ÔÚÂ›· ÙË˜ ÓﬁÛÔ˘, ÙËÓ ·ÓÙ·ﬁÎÚÈÛË ÛÙË ıÂÚ·Â›·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÁÎÂÊ·ÏÈÎ‹ ·Ú¿Ï˘ÛË, ÂÍ·ÈÚÂÙÈÎ¿ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛË˜ ÓÂÔÁÓ¿, ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, ÚÔÁÂÓÓËÙÈÎÔ›, ÓÂÔÁÓÈÎÔ›.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

∂¡À∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚﬁ

∂ÈÛ·ÁˆÁ‹

∏ ·Ó¿Ù˘ÍË ·ÓÙ›ÛÙ·ÛË˜ ÙˆÓ ÌÈÎÚÔ‚›ˆÓ ÛÙÈ˜ ‚-

Ï·ÎÙ¿ÌÂ˜ Î·È ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·-

Ú¿ÁÔÓÙÂ˜ Û˘ÓÂ¯Ò˜ ·˘Í¿ÓÂÈ (1-6), ·Ó Î·È Û˘ÓÂ¯Ò˜

Î·ÈÓÔ‡ÚÈ· ·ÓÙÈ‚ÈÔÙÈÎ¿ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÙË ıÂÚ·-

Â›· ÌÈÎÚÔ‚È·ÎÒÓ ÏÔÈÌÒÍÂˆÓ. ∞ﬁ ÙËÓ Î·Ù·ÁÂ-

ÁÚ·ÌÌ¤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙ· ·ÓÙÈ‚ÈÔÙÈÎ¿ ÙˆÓ ÙÚÈÒÓ

ÈÔ Û˘ÓËıÈÛÌ¤ÓˆÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ·Ú·ÁﬁÓÙˆÓ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, Neisseria meningitidis, Haemophilus influenzae Ù‡Ô˘ b Î·È Streptococcus pneumoniae, Ë ·ÓÙ›ÛÙ·ÛË ÛÙÔÓ ÓÂ˘ÌÔÓÈﬁÎÔÎÎÔ

Â›Ó·È Ë ÈÔ ÛËÌ·ÓÙÈÎ‹ ÛÙ· ÂÚÈÛÛfiÙÂÚ· Ì¤ÚË ÙÔ˘ ÎfiÛÌÔ˘ (7-12). °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Î·Ó¤Ó·˜ ·ÓÙÈÌÈ-

ÎÚÔ‚È·Îfi˜ ·Ú¿ÁÔÓÙ·˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ıÂˆÚËıÂ› ÌÂ ‚Â‚·ÈfiÙËÙ· ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜, ÚÈÓ ·fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ Â˘·ÈÛıËÛ›·˜ in vitro Î·È ÙË˜ ¤Î‚·ÛË˜ ÙË˜ ÓfiÛÔ˘. ¶ÚfiÛÊ·ÙË ÌÂÏ¤ÙË ¤‰ÂÈÍÂ ·˘ÍËÌ¤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÂÛÛ¿ÚˆÓ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÂ Ê˘ÁÔ-

ÎÂÓÙÚËÌ¤ÓÔ, ÂÏÂ‡ıÂÚÔ Î˘ÙÙ¿ÚˆÓ ∂¡À, ·ÛıÂÓÒÓ

ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· (13). ∂È‰ÈÎ¿ ‚Ú¤ıËÎÂ

ﬁÙÈ Ë ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÂÍ·-

ÛÊ·Ï›˙ÂÈ ·ÍÈﬁÈÛÙÔ ‰È·¯ˆÚÈÛÌﬁ ÌÂÙ·Í‡ ·ÛıÂÓÒÓ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· Î·È Ì·ÚÙ‡ÚˆÓ (13).

∂ÂÈ‰‹ Ë ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ·Ú·Ì¤ÓÂÈ

·ÂÈÏËÙÈÎ‹ ÁÈ· ÙË ˙ˆ‹ ÏÔ›ÌˆÍË, ÌÂÏÂÙ‹Û·ÌÂ ÙË

ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÔ

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.

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

ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜, ÙË Û˘ÁÎÚ›Ó·ÌÂ ÌÂ ¿ÏÏÂ˜ ÂÚÁ·ÛÙËÚÈ·Î¤˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ∂¡À Î·È ÙË Û˘Û¯ÂÙ›Û·ÌÂ ÌÂ ÙËÓ ÎÏÈÓÈÎ‹ ÔÚÂ›· ÙË˜ ÓfiÛÔ˘. ∏ ÂÚÁ·Û›· ÛÎÔÂ‡ÂÈ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ·Ó Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÛÙÔ ∂¡À ·Ú·Ì¤ÓÂÈ ‹ fi¯È ‰Â›ÎÙË˜ ÙË˜ ÌËÓÈÁÁÈÎ‹˜ ÊÏÂÁÌÔÓ‹˜ Î·È ÙË˜ ·ÓÙ·fiÎÚÈÛË˜ ÛÙË ıÂÚ·Â›·.

ÀÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ

ªÂÏÂÙ‹Û·ÌÂ 38 ÂÚÈÙÒÛÂÈ˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È 97 Ì¿ÚÙ˘ÚÂ˜ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ·È‰È·ÙÚÈÎfi ÙÌ‹Ì· ÙË˜ ∫ÏÈÓÈÎ‹˜ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1995 ¤ˆ˜ ÙÔÓ πÔ‡ÓÈÔ 2000. ∞fi ÙÔ˘˜ 38 ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰·, 34 ‹Ù·Ó ‚Ú¤ÊË, ·È‰È¿ Î·È ¤ÊË‚ÔÈ, ÌÂ ‰È¿ÌÂÛË ËÏÈÎ›· 3,6 ¤ÙË Î·È ‰È·Î‡Ì·ÓÛË 3,5 Ì‹ÓÂ˜ Ì¤¯ÚÈ 14 ¤ÙË. ∏ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ‰È·ÁÓÒÛÙËÎÂ ÌÂ ıÂÙÈÎ‹ Î·ÏÏÈ¤ÚÁÂÈ· ∂¡À ÛÂ 29 ÂÚÈÙÒÛÂÈ˜, ÌÂ PCR ∂¡À ÛÂ 2 ÂÚÈÙÒÛÂÈ˜ Î·È ÌÂ Û˘ÁÎÔÏÏËÙÈÓÔ·ÓÙ›‰Ú·ÛË Latex ∂¡À ÛÂ 3 ÂÚÈÙÒÛÂÈ˜. ¢¤Î· ÂÓÓ¤· ÂÚÈÛÙ·ÙÈÎ¿ ÔÊÂ›ÏÔÓÙ·Ó ÛÂ N. meningitidis, 7 ÛÂ S. pneumoniae, 7 ÛÂ H. influenzae Î·È 1 ÛÂ Streptococcus ÔÌ¿‰·˜ D. E›ÎÔÛÈ ÔÎÙÒ ·fi ÙÔ˘˜ ·ÛıÂÓÂ›˜ ıÂÚ·Â‡ÙËÎ·Ó ÌÂ Ceftriaxone Î·È 6 ÌÂ Û˘Ó‰˘·ÛÌfi AmpicillinChloramphenicol. ™Â ¤Ó·Ó ·ÛıÂÓ‹, Ô˘ ·Ú¯ÈÎ¿ ıÂÚ·Â‡ÙËÎÂ ÌÂ Ceftriaxone, ÚÔÛÙ¤ıËÎÂ ÛÙÈ˜ 24 ÒÚÂ˜ ÙË˜ ıÂÚ·Â›·˜ Vancomycin. ∂ÈÚfiÛıÂÙ·, ÔÈ ·ÛıÂÓÂ›˜ ¤Ï·‚·Ó ‰ÂÍ·ÌÂı·˙fiÓË ÁÈ· 2 ËÌ¤ÚÂ˜ (14). OÈ ˘fiÏÔÈÔÈ 4 ·ÛıÂÓÂ›˜ ‹Ù·Ó ÓÂÔÁÓ¿ 7, 12, 17 Î·È 29 ËÌÂÚÒÓ, ÌÂ ÂÈÏÂÁÌ¤ÓË ÔÚÂ›· ÓfiÛÔ˘, È‰È·›ÙÂÚ· ÙˆÓ ÓÂÔÁÓÒÓ ÙˆÓ 12 Î·È 29 ËÌÂÚÒÓ. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ∂¡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

ÓÂÔÁÓﬁ ÙˆÓ 17 ËÌÂÚÒÓ (ÂÚ›ÙˆÛË 3). ™ÙÔ 29 ËÌÂÚÒÓ ÓÂÔÁÓﬁ

(ÂÚ›ÙˆÛË 4), Ë Î·ÏÏÈ¤ÚÁÂÈ· Î·È ÙÔ Latex ∂¡À ‹Ù·Ó ·ÚÓËÙÈÎ¿

Î·È ÁÈ· ÙÔ ÏﬁÁÔ ·˘Ùﬁ Ë ‰È¿ÁÓˆÛË ‚·Û›ÛÙËÎÂ ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘

∂¡À, È‰È·›ÙÂÚ· ‰Â ÛÙËÓ ÔÏ‡ ˘„ËÏ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜

‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, Ë ÔÔ›· Â›Ó·È ‰È·ÁÓˆÛÙÈÎ‹ ÌÈÎÚÔ‚È·Î‹˜

ÌËÓÈÁÁ›ÙÈ‰·˜ (13).

∂ÈÚﬁÛıÂÙ·, ÌÂÏÂÙ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ∂¡À ·ﬁ 2 ·ÛıÂÓÂ›˜

ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÛË„·ÈÌ›·, ¯ˆÚ›˜ ·Ú¯ÈÎ‹ ÏÂÈÔÎ˘ÙÙ¿Úˆ-

ÛË ∂¡À.

ø˜ Ì¿ÚÙ˘ÚÂ˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÌËÓÈÁÁ›ÙÈ‰· ÂÎÙﬁ˜ ÓÂÔÁÓÈÎ‹˜

ËÏÈÎ›·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰Â›ÁÌ·Ù· ∂¡À Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó

·ﬁ 43 ÂÌ‡ÚÂÙÔ˘˜ ·ÛıÂÓÂ›˜, ¯ˆÚ›˜ ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ÛÙÔ

∂¡À. ∏ ‰È¿ÌÂÛË ËÏÈÎ›· ÙˆÓ Ì·ÚÙ‡ÚˆÓ ‹Ù·Ó 2 ¤ÙË, ÌÂ ‰È·Î‡Ì·ÓÛË 1,1 Ì‹ÓÂ˜ ¤ˆ˜ 15 ¯ÚﬁÓÈ·. ∂ÈÚﬁÛıÂÙ·, ¯ÚËÛÈÌÔÔÈ‹-

ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘ÚÂ˜, ÁÈ· ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÓÂÔÁÓÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜, 54 ÓÂÔÁÓ¿ ¯ˆÚ›˜ ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ÛÙÔ ∂¡À. ∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ Ì·ÚÙ‡ÚˆÓ-ÓÂÔÁÓÒÓ ‹Ù·Ó 16 ËÌ¤ÚÂ˜, ÌÂ ‰È·Î‡Ì·ÓÛË 1 ¤ˆ˜ 30 ËÌ¤ÚÂ˜.

∞fi ÙÈ˜ 34 ÂÚÈÙÒÛÂÈ˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÙˆÓ 3,5 ÌËÓÒÓ, 18 Â›¯·Ó Ì›· Â·Ó·ÏËÙÈÎ‹ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË Î·È ÔÈ ˘fiÏÔÈÂ˜ 16 Â›¯·Ó ‰‡Ô Â·Ó·ÏËÙÈÎ¤˜ ·Ú·ÎÂÓÙ‹ÛÂÈ˜. ŒÓ· Ì¤ÚÔ˜ ÙÔ˘ ∂¡À ˘Ô‚¿ÏÏÔÓÙ·Ó ÛÂ Ê˘ÁÔÎ¤ÓÙÚËÛË Ì¤Û· ÛÂ 20 min Î·È ÙÔ ˘ÂÚÎÂ›ÌÂÓÔ - ÂÏÂ‡ıÂÚÔ Î˘ÙÙ¿ÚˆÓ - ˘ÁÚfi ·Ó·Ï˘fiÙ·Ó ¿ÌÂÛ· ‹ ·ÔıËÎÂ˘fiÙ·Ó ÛÙÔ˘˜ -70ÔC Ì¤¯ÚÈ Ó· ·Ó·Ï˘ıÂ›. ªÂÙÚ‹ÛÂÈ˜ ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜

‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙ· ·ÔıËÎÂ˘Ì¤Ó· ‰Â›ÁÌ·Ù· ∂¡À ¤‰ÂÈÍ·Ó

ﬁÙÈ Ë ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ· ·Ú¤ÌÂÓÂ ÛÙ·ıÂÚ‹ ÁÈ· ÂÚÈÛ-

ÛﬁÙÂÚÔ˘˜ ·ﬁ 6 Ì‹ÓÂ˜.

∂›ÛË˜, ÌÂÏÂÙ‹ıËÎ·Ó 8 ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÏÔÓÂÊÚ›ÙÈ‰· Î·È

ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ∂¡À. ∞fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜, ÛÂ 6 Ô ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó ÙÔ ∂. coli, ÛÂ 1 Staphylococcus epidermidis Î·È ÛÂ 1 Klebsiella pneumoniae. ∏ Ì¤ÛË ËÏÈÎ›· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 42 ËÌ¤ÚÂ˜, ÌÂ ‰È·Î‡Ì·ÓÛË ·fi 11 ËÌ¤ÚÂ˜ ¤ˆ˜ 3,5 Ì‹ÓÂ˜. ∏ ‰È¿ÁÓˆÛË ÛÙËÚ›¯ıËÎÂ ÛÙËÓ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·, ÛÙÈ˜ ıÂÙÈÎ¤˜ Î·ÏÏÈ¤ÚÁÂÈÂ˜ Ô‡ÚˆÓ Î·È ÛÙÔ ÓÂÊÚÈÎfi ÛÈÓıËÚÔÁÚ¿ÊËÌ· DMSA. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ∂¡À ‹Ù·Ó ·ÚÓËÙÈÎ¤˜.

∏ ÌÂÏ¤ÙË ÂÁÎÚ›ıËÎÂ ·ﬁ ÙËÓ ∂ÈÙÚÔ‹ ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ Î·È ÂÏ‹ÊıË Û˘ÁÎ·Ù¿ıÂÛË ·ﬁ ÙÔ˘˜ ÁÔÓÂ›˜ ÙˆÓ ·ÛıÂÓÒÓ.

∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÌÂÙÚ‹ıËÎÂ ÂÈ˜ ‰ÈÏÔ‡Ó, fiˆ˜ ¤¯ÂÈ ÂÚÈÁÚ·ÊÂ› (14). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ-

˙‡ÌÔ˘ ÂÎÊÚ¿ÛÙËÎÂ ÛÂ nmoles 4-methylumbelliferone/ml

∂¡À/ÒÚ·. ∆· ‰Â‰ÔÌ¤Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ‰È¿ÌÂÛË ÙÈÌ‹ Î·È

‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ. °È· ÙÈ˜ Û˘ÁÎÚ›ÛÂÈ˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó

ÙÔ Wilcoxon test Î·È ÙÔ Mann-Whitney U test, ﬁˆ˜ ÂÓ‰Â›ÎÓ˘Ù·È.

™ÙË Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ Î·È

ÙË˜ ËÌ¤Ú·˜ ˙ˆ‹˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Spearman rank correlation. ∏ ÛËÌ·ÓÙÈÎﬁÙËÙ· ÂÙ¤ıË ÛÙÔ 0,05.

∞ÔÙÂÏ¤ÛÌ·Ù· ªËÓÈÁÁ›ÙÈ‰· ·ﬁ ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ˆ˜ ÙËÓ ÂÊË‚Â›·

∏ ‰È¿ÌÂÛË ÙÈÌ‹ ÙË˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘-

ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÈ˜ 34 ÂÚÈÙÒÛÂÈ˜ ÌËÓÈÁÁ›ÙÈ‰·˜, ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ‹Ù·Ó 139, ÌÂ ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ·fi 44 ¤ˆ˜ 826. ™ÙÔ˘˜ Ì¿ÚÙ˘ÚÂ˜, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ‹Ù·Ó 14, ÌÂ ‰È·Î‡Ì·ÓÛË ·fi 7 Ì¤¯ÚÈ 23, u=22 (p<0,000001).

™ÙÔÓ ¶›Ó·Î· 1 Î·Ù·ÁÚ¿ÊÂÙ·È Ë ‰Ú·ÛÙËÚÈﬁÙËÙ·

ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ë Û¯¤ÛË ÁÏ˘Îfi˙Ë˜ ∂¡À ÚÔ˜ ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ Î·È Ë Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À 10 ·ÛıÂÓÒÓ, ÚÈÓ Î·È 6 ¤ˆ˜ 12 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÌÂÈÒıËÎÂ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜. ∏ ‰È¿ÌÂÛË ÙÈÌ‹ ÙË˜ ÂÓ˙˘ÌÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂÈÒıËÎÂ Î·Ù¿ 59%, ÌÂ ‰È·Î‡Ì·ÓÛË ·fi 4% ¤ˆ˜ 96%. ∏ ÌÈ-

ÎÚfiÙÂÚË Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ‰È·Î‡Ì·ÓÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ·Ú·ÙËÚ‹ıËÎÂ ÛÂ ‰Â›ÁÌ·Ù· 2 ·ÛıÂÓÒÓ Ô˘ ÂÏ‹ÊıËÛ·Ó Î·È ÛÙÈ˜ ‰‡Ô ÂÚÈÙÒÛÂÈ˜ 9 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. O ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ·ÔÌÔÓÒıËÎÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜ ‹Ù·Ó H. influenzae Î·È ¡. meningitidis ™Ù· ÚˆÈÌfiÙÂÚ· ‰Â›ÁÌ·Ù· ∂¡À ÙË˜ ÌÂÏ¤ÙË˜, Ô˘ ÂÏ‹ÊıËÛ·Ó ·fi 2 ·ÛıÂÓÂ›˜ ÌÂ H. influenzae Î·È ¡. meningitidis ÙËÓ 6Ë Î·È 7Ë ÒÚ· ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ Â›¯Â ‹‰Ë ÌÂÈˆıÂ› Î·Ù¿ 46% Î·È 41% ·ÓÙ›ÛÙÔÈ¯·. ™Â 2 ·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁ›ÙÈ‰· ·fi S. pneumoniae, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙËÓ 8Ë Î·È 12Ë ÒÚ· ıÂÚ·Â›·˜, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›¯Â ÌÂÈˆıÂ› Î·Ù¿ 49% Î·È 57% ·ÓÙ›ÛÙÔÈ¯·. ∞ÓÙ›ıÂÙ· ÌÂ ÙË

¶›Ó·Î·˜ 1. ¢Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ, Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÛÂ 10 ·ÛıÂÓÂ›˜ ÌÂ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰·* ÚÈÓ Î·È 6 ¤ˆ˜ 12 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜

¶·Ú¿ÌÂÙÚÔ˜¶ÚÈÓªÂÙ¿™ËÌ·ÓÙÈÎﬁÙËÙ·∞ÚÈıÌﬁ˜ ∂¡À¢È¿ÌÂÛË ¢È¿ÌÂÛËp·ÛıÂÓÒÓ (‰È·Î‡Ì·ÓÛË)(‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓÈ‰¿ÛË†216 (71-826)87 (36-319)0,005 ↓ 10

∫‡ÙÙ·Ú·/mm3 6027 (100-18000)9750 (120-3000)0,169 ↑ 8, ↓ 2

°Ï˘Îﬁ˙Ë ∂¡À/·›Ì·ÙÔ˜0,32 (0,00-0,65)0,35 (0,11-0,83)0,114 ↑ 7, ↓ 3

¶ÚˆÙÂ˝ÓË (mg/dl)141 (40-450)165 (40-360)0,508 ↓ 6, ↑ 4

* 5 N. meningitidis, 3 H. influenzae Ù‡Ô˜ b, 2 S. pneumoniae

† nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, Ë ‰È¿ÌÂ-

ÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÙˆÓ

10 ·ÛıÂÓÒÓ ·˘Í‹ıËÎÂ ÛÙÔ 161% ÙÔ˘ ·Ú¯ÈÎÔ‡

·ÚÈıÌÔ‡ (Ì¤ÁÈÛÙË ·‡ÍËÛË 373%). ∂›ÛË˜, Ô

·ÚÈıÌﬁ˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÎÔÏÔ‡ıËÛÂ

·Ú¿ÏÏËÏË ÔÚÂ›· (‰È¿ÌÂÛË ·‡ÍËÛË 166%, Ì¤ÁÈ-

ÛÙË ·‡ÍËÛË 376%).

™ÙÔÓ ¶›Ó·Î· 2 Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ ›‰ÈÂ˜ ·Ú¿-

ÌÂÙÚÔÈ ÙÔ˘ ∂¡À ·ﬁ 13 ·ÛıÂÓÂ›˜ Ô˘ ·¿ÓÙËÛ·Ó

ÛÙË ıÂÚ·Â›·, 13 ¤ˆ˜ 24 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË

ÙË˜ ·ÁˆÁ‹˜. ™Â ﬁÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜, Ë ‰Ú·ÛÙË-

ÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÌÂÈÒıËÎÂ. ∏ ‰È¿-

ÌÂÛË ‰Ú·ÛÙËÚÈﬁÙËÙ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ

·˘ÙÒÓ ‹Ù·Ó ÛÙÔ 47% ÙË˜ ·Ú¯ÈÎ‹˜ ÙÈÌ‹˜, ÌÂ ‰È·Î‡-

Ì·ÓÛË ·ﬁ 28% ¤ˆ˜ 82%. ∏ ÌÂÁ·Ï‡ÙÂÚË ÌÂ›ˆÛË

·Ú·ÙËÚ‹ıËÎÂ ÛÂ ·ÛıÂÓ‹ ÌÂ ÏÔ›ÌˆÍË ·ﬁ

Streptococcus oÌ¿‰·˜ D Î·È Ë ÌÈÎÚﬁÙÂÚË ÛÂ

·ÛıÂÓ‹ ÌÂ S. pneumoniae, Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÙËÓ

16Ë Î·È 24Ë ÒÚ· ·ﬁ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ·ÓÙ›ÛÙÔÈ¯·. ∫·È ¿ÏÈ, Ë ‰È¿ÌÂÛË ÙÈÌ‹ ÙÔ˘ ·ÚÈıÌÔ‡

ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ∂¡À ‹Ù·Ó ·˘ÍËÌ¤ÓË ÛÙÔ 188%

ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÚÔ ÙË˜ ıÂÚ·Â›·˜, ÌÂ Î‡ÚÈÔ ¯·Ú·-

ÎÙËÚÈÛÙÈÎﬁ ÙË ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ÌÂÙ·Í‡

ÙˆÓ ·ÛıÂÓÒÓ (Ì¤ÁÈÛÙË ·‡ÍËÛË 1405%). O ·ÚÈı-

Ìﬁ˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ·ÎÔÏÔ‡ıËÛÂ Î·È ¿-

ÏÈ ·Ú¿ÏÏËÏË ÔÚÂ›· ÌÂ ·˘Ù‹ ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡

ÙˆÓ Î˘ÙÙ¿ÚˆÓ (‰È¿ÌÂÛË ·‡ÍËÛË 180%, Ì¤ÁÈÛÙË

·‡ÍËÛË 1874%).

™ÙÔÓ ¶›Ó·Î· 3 Î·Ù·ÁÚ¿ÊÔÓÙ·È ÔÈ ·Ú¿ÌÂÙÚÔÈ

ÙÔ˘ ∂¡À 10 ·ÛıÂÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ÌÂÙ¿ ·ﬁ 36 ¤ˆ˜ 50 ÒÚÂ˜ ·ﬁ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜. ∏

‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÌÂÈÒıËÎÂ ÛÂ fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÛÙÔ 6% ¤ˆ˜ 34% ÙË˜ ·Ú¯ÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∫·Ù¿ ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ, ·Ó Î·È Ô ‰È¿ÌÂÛÔ˜ ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ∂¡À ÌÂÈÒıËÎÂ ÛÙÔ 28%, ·ÚÔ˘ÛÈ¿ÛÙËÎÂ ÌÂÁ¿ÏË ‰È·Î‡Ì·ÓÛË ÙˆÓ ÙÈÌÒÓ Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ·fi ÙÔ 5% ¤ˆ˜ ÙÔ 7017% ÙË˜ ·Ú¯ÈÎ‹˜ ÙÈÌ‹˜.

∆· Â˘Ú‹Ì·Ù· ÙÔ˘ ∂¡À ·ﬁ 16 ·ÛıÂÓÂ›˜ Ô˘

ÌÂÏÂÙ‹ıËÎ·Ó 3 ¤ˆ˜ 8 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ·ÓÙÈ‚ÈÔÙÈÎ‹˜ ıÂÚ·Â›·˜ Î·Ù·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. OÈ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ¤‰ÂÈÍ·Ó

‚ÂÏÙ›ˆÛË Û¯Â‰ﬁÓ ÛÂ ﬁÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓÂ›˜.

∆Ô ™¯‹Ì· 1 ‰Â›¯ÓÂÈ ÙËÓ ÔÚÂ›· ÙË˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÂ 34 ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰·, Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÒÙˆÓ 8 ËÌÂÚÒÓ ıÂÚ·Â›·˜.

ªËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÛË„·ÈÌ›· ™Â 2 ·ÛıÂÓÂ›˜ ÌÂ ÌËÓÈÁÁÈÙÈ‰ÔÎÔÎÎÈÎ‹ ÛË„·ÈÌ›·, ¯ˆÚ›˜ ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ∂¡À, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, ‹Ù·Ó ·˘ÍËÌ¤ÓË ÛÙ· 97 Î·È 62 ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ‹Ù·Ó 2/mm3

¶›Ó·Î·˜ 2. ¢Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ, Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À Î·È ·Ó·ÏÔÁ›· ÁÏ˘Îfi˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÛÂ 13 ·ÛıÂÓÂ›˜ ÌÂ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰·* ÚÈÓ Î·È 13 ¤ˆ˜ 24 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜

¶·Ú¿ÌÂÙÚÔ˜¶ÚÈÓªÂÙ¿™ËÌ·ÓÙÈÎﬁÙËÙ·∞ÚÈıÌﬁ˜ ∂¡À¢È¿ÌÂÛË ¢È¿ÌÂÛËp·ÛıÂÓÒÓ (‰È·Î‡Ì·ÓÛË)(‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓÈ‰¿ÛË†112 (57-750)53 (25-303)0,001 ↓ 13

∫‡ÙÙ·Ú·/mm3 3620 (29-1700)6800 (290-20500)0,173 ↑ 8, ↓ 5

°Ï˘Îﬁ˙Ë ∂¡À/·›Ì·ÙÔ˜0,40 (0,00-0,62)0,49 (0,29-1,09)0,055 ↑ 8, ↓ 5

¶ÚˆÙÂ˝ÓË (mg/dl)120 (25-752)70 (8-160)0,017 ↓ 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· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ, Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÛÂ 10 ·ÛıÂÓÂ›˜ ÌÂ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰·* ÚÈÓ Î·È 36 ¤ˆ˜ 50 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜

¶·Ú¿ÌÂÙÚÔ˜¶ÚÈÓªÂÙ¿™ËÌ·ÓÙÈÎﬁÙËÙ·∞ÚÈıÌﬁ˜ ∂¡À¢È¿ÌÂÛË ¢È¿ÌÂÛËp·ÛıÂÓÒÓ (‰È·Î‡Ì·ÓÛË)(‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓÈ‰¿ÛË†138 (89-750)31 (20-153)0,005 ↓ 10

∫‡ÙÙ·Ú·/mm3 2620 (56-10975)725 (142-4930)0,093 ↓ 7, ↑ 3

°Ï˘Îﬁ˙Ë ∂¡À/·›Ì·ÙÔ˜0,22 (0,00-0,65)0,60 (0,32-0,70)0,005 ↑ 10

¶ÚˆÙÂ˝ÓË (mg/dl)197 (25-560)55 (35-180)0,013 ↓ 9, ↑ 1

*5 N. meningitidis, 4 H. influenzae Ù‡Ô˘ b, 1 S. pneumoniae

† nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·

Î·È 0, ·ÓÙ›ÛÙÔÈ¯·. ∂›ÛË˜, Ë Û˘ÁÎ¤ÓÙÚˆÛË ÙË˜

ÚˆÙÂ˝ÓË˜ ‹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›ÛÙÔÈ¯·. ™ÙÔÓ ÚÒÙÔ ·ÛıÂÓ‹, ÛÙÔÓ ÔÔ›Ô ¤ÁÈÓ·Ó

‰‡Ô Â·Ó·ÏËÙÈÎ¤˜ ÔÛÊ˘ÔÓˆÙÈ·›Â˜ ·Ú·ÎÂÓÙ‹ÛÂÈ˜

24 Î·È 72 ÒÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜, Ë

ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ· Â›¯Â ÂÏ·ÙÙˆıÂ› ÛÙ· 77 Î·È

34, ÂÓÒ Ô ·ÚÈıÌﬁ˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Â›¯Â ·˘ÍËıÂ› ÛÙ·

156/mm3 Î·È 40/mm3 ·ÓÙ›ÛÙÔÈ¯·.

ªËÓÈÁÁ›ÙÈ‰· ·ﬁ ÓÂ˘ÌÔÓÈﬁÎÔÎÎÔ ÌÂ ·ÓÂ·ÚÎ‹ ·¿ÓÙËÛË ÛÙËÓ ·Ú¯ÈÎ‹ ıÂÚ·Â›·

∞ÁfiÚÈ 2 ÂÙÒÓ, 12 ÒÚÂ˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ·ÚÔ˘Û›·ÛÂ ˘„ËÏfi ˘ÚÂÙfi ÌÂ Ú›ÁÔ˜, ÂÌÂÙfi, ˘ÓËÏ›·, Ù·¯‡ÓÔÈ· Î·È ÙÂÏÈÎ‹ ·˘¯ÂÓÈÎ‹ ‰˘ÛÎ·Ì„›·, ¯ˆÚ›˜ ¿ÏÏ· ÂÈÚfiÛıÂÙ· ÌËÓÈÁÁÈÎ¿ ÛËÌÂ›·. ¢È·ÁÓÒÛÙËÎÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· Î·È Ô ·ÛıÂÓ‹˜ ¿Ú¯È-

ÛÂ ·ÁˆÁ‹ ÌÂ Ceftriaxone Î·È ‰ÂÍ·ÌÂı·˙ﬁÓË. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ∂¡À Î·È ·›Ì·ÙÔ˜ ·Ó¤‰ÂÈÍ·Ó S. pneumoniae, ÔÚÔÙ‡Ô˘ 14, ÌÂ ÂÏ¿¯ÈÛÙË ·Ó·ÛÙ·ÏÙÈÎ‹ Û˘ÁÎ¤ÓÙÚˆÛË Ceftriaxone 0,032 Ìg/ml. ªÂÙ¿ ·ﬁ 22 ÒÚÂ˜ ıÂÚ·Â›·˜, Ô ·ÛıÂÓ‹˜ Û˘Ó¤¯ÈÛÂ Ó·

¤¯ÂÈ ˘„ËÏfi ˘ÚÂÙfi, ÂÓÒ ÂÈÚfiÛıÂÙ· ·ÚÔ˘Û›·ÛÂ

·˘Í·ÓﬁÌÂÓË ˘ÓËÏ›·, Â˘ÂÚÂıÈÛÙﬁÙËÙ·, ·˘¯ÂÓÈÎ‹

‰˘ÛÎ·Ì„›·, Î·ÙÒÙÂÚÔ ÛËÌÂ›Ô Brudzinski Î·È ÛËÌÂ›Ô ÙÚ›Ô‰Ô˜. ∫·Ù¿ ÙÔ ¯ÚﬁÓÔ ·˘Ùﬁ, ¤ÁÈÓÂ ‰Â‡ÙÂÚË

ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË, Ô˘ ·Ó¤‰ÂÈÍÂ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·‡ÍËÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ‚ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜. §fiÁˆ ÙË˜ ÎÏÈÓÈÎ‹˜ Î·È ÂÚÁ·ÛÙËÚÈ·Î‹˜ ÂÈ‰Â›ÓˆÛË˜ ÚÔÛÙ¤ıËÎÂ Vancomycin ÛÙÔ ıÂÚ·Â˘ÙÈÎfi Û¯‹Ì·. ∂›ÎÔÛÈ Ù¤ÛÛÂÚÈ˜ ÒÚÂ˜ ·ÚÁfiÙÂÚ·, ÙfiÛÔ Ë ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· fiÛÔ Î·È Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ÛÂ ÙÚ›ÙÔ ‰Â›ÁÌ· ¶·È‰È·ÙÚÈÎ‹ 2002;65:97-107 Paediatriki 2002;65:97-107

¶›Ó·Î·˜ 4. ¢Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ·ÚÈıÌfi˜ Î˘ÙÙ¿ÚˆÓ, Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À Î·È Û¯¤ÛË ÁÏ˘Îfi˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÛÂ 16 ·ÛıÂÓÂ›˜ ÌÂ

ÚÈÓ Î·È 3 ¤ˆ˜ 8 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·Â›·˜ ¶·Ú¿ÌÂÙÚÔ˜¶ÚÈÓªÂÙ¿™ËÌ·ÓÙÈÎﬁÙËÙ·∞ÚÈıÌﬁ˜ ∂¡À¢È¿ÌÂÛË ¢È¿ÌÂÛËp·ÛıÂÓÒÓ (‰È·Î‡Ì·ÓÛË)(‰È·Î‡Ì·ÓÛË)

‚-°Ï˘ÎÔ˘ÚÔÓÈ‰¿ÛË†134 (44-826)18 (10-67)0,0004 ↓ 16

∫‡ÙÙ·Ú·/mm3 4,26 (0,87-18,00)0,08 (0,03-0,64)0,0004 ↓ 16

°Ï˘Îﬁ˙Ë ∂¡À/·›Ì·ÙÔ˜0,33 (0,00-0,62)0,71 (0,29-0,81)0,0012 ↑ 15, ↓ 1

¶ÚˆÙÂ˝ÓË (mg/dl)217 (45-450)35 (8-63)0,0009 ↓ 15, ↑ 1

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

‚-°Ï˘ÎÔ˘ÚÔÓÈ‰¿ÛË

K‡ÙÙ·Ú·

∂¡À, ¤‰ÂÈÍ·Ó ÌÂÁ¿ÏË ‚ÂÏÙ›ˆÛË (™¯‹Ì· 2). ∏ Û˘-

ÁÎ¤ÓÙÚˆÛË ÙË˜ Ceftriaxone ÛÙÔ ‰Â‡ÙÂÚÔ Î·È ÙÚ›ÙÔ

‰Â›ÁÌ· ∂¡À ‹Ù·Ó 12,5 Ìg/ml Î·È 30 Ìg/ml ·ÓÙ›-

ÛÙÔÈ¯·.

¡ÂÔÁÓÈÎ‹ ÌËÓÈÁÁ›ÙÈ‰·

™Ù· 54 ÓÂÔÁÓ¿-Ì¿ÚÙ˘ÚÂ˜, Ë ‰È¿ÌÂÛË ‰Ú·ÛÙË-

ÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ‹Ù·Ó 15, ÌÂ ‰È·-

Î‡Ì·ÓÛË 5 ¤ˆ˜ 27. ™Ù· 4 ÓÂÔÁÓ¿ ÌÂ ÌÈÎÚÔ‚È·Î‹

ÌËÓÈÁÁ›ÙÈ‰·, Ë ‰È¿ÌÂÛË ÂÓ˙˘ÌÈÎ‹ ‰Ú·ÛÙËÚÈﬁÙËÙ·

‹Ù·Ó 1105 ÌÂ ‰È·Î‡Ì·ÓÛË ÙÈÌÒÓ ·ﬁ 369 ¤ˆ˜ 3988. ™Ù· ÓÂÔÁÓ¿ ¯ˆÚ›˜ ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ‰ÂÓ

˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜

ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÔ ∂¡À Î·È ÙË˜ ËÌ¤Ú·˜ ˙ˆ‹˜.

™Â

ﬁÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ÓÂÔÁÓÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ-

‰·˜ ·Ú·ÙËÚ‹ıËÎÂ ·Ú¯ÈÎ¿ Ù·¯Â›· ÌÂ›ˆÛË ÙË˜

‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÔ

∂¡À, Ë ÔÔ›· ·ÎÔÏÔ˘ıÔ‡ÛÂ ÙËÓ ¤Ó·ÚÍË ÙË˜ ıÂÚ·-

Â›·˜. ŸÌˆ˜, Ë ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÔÚÂ›· ‰È¤ÊÂÚÂ

Ô˘ÛÈ·ÛÙÈÎ¿ ÌÂÙ·Í‡ ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÛÂ ÔÚÈÛÌ¤ÓÂ˜

ÂÚÈÙÒÛÂÈ˜ ‹Ù·Ó ··Ú·›ÙËÙÂ˜ Û˘¯Ó¤˜ ·ÏÏ·Á¤˜

ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ ÌÂ ·ÓÙÈ‚ÈÔÙÈÎ¿, ÒÛÙÂ Ó·

·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ˘ÔÙÚÔ¤˜ ÙË˜ ÓfiÛÔ˘ ‹ Â·Ó·ÌÔÏ‡ÓÛÂÈ˜. ™ÙËÓ ÚÒÙË ÂÚ›ÙˆÛË, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÙËÓ 5Ë ËÌ¤Ú· ÙË˜ 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›ÛÙÔÈ¯· (Û¯¤ÛË ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÂÓ˙‡ÌÔ˘ ÛÙÔ

ÎÔÈÏÈ·Îfi/Ú·¯È·›Ô ∂¡À 2,18). ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ·ÎÔÏÔ‡ıËÛÂ Î·ıÔ‰ÈÎ‹ ÔÚÂ›· Î·È ÙËÓ 23Ë Ì¤Ú· ıÂÚ·Â›·˜ ÛÙÔ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ ‹Ù·Ó ÛÙÔ 86. ∆ËÓ ËÌ¤Ú· ·˘Ù‹ ·ÓÙÈÎ·Ù·ÛÙ¿ıËÎÂ Ë ‰ÂÍ·ÌÂÓ‹ Omaya, ·ÔÙ¤ÏÂÛÌ· ÙË˜ ÔÔ›·˜ ‹Ù·Ó Ë Â·Ó·ÌfiÏ˘ÓÛË, Ë ÔÔ›· ÈÛÙÔÔÈ‹ıËÎÂ ·fi ÙËÓ ·‡ÍËÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜

ÛÂ 154. ∆Ô ıÂÚ·Â˘ÙÈÎﬁ Û¯‹Ì· ¿ÏÏ·ÍÂ Î·È Ô ·ÛıÂÓ‹˜ ·Ó¿ÚÚˆÛÂ Ï‹Úˆ˜ (™¯‹Ì· 3∞).

™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË, Ô ·ÛıÂÓ‹˜ ‰ÈÂÎÔÌ›ÛıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ·ﬁ ¿ÏÏÔ ÓÔÛÔÎÔÌÂ›Ô

ÙËÓ 4Ë ËÌ¤Ú· ÙË˜ ÓﬁÛÔ˘. ∏ ·Ú¯ÈÎ¿ Ù·¯Â›· ÙÒÛË

ÙË˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ·ÎÔÏÔ˘ı‹ıËÎÂ ·ﬁ ˘ÔÙÚÔ¤˜

ÙËÓ 23Ë Î·È ÙËÓ 58Ë ËÌ¤Ú·. ∏ ÌËÓÈÁÁÈÎ‹ ÊÏÂÁÌÔÓ‹ Ô˘ ÂÌÊ·Ó›ÛÙËÎÂ ÙËÓ 58Ë ËÌ¤Ú· ıÂÚ·Â›·˜, Èı·ÓﬁÓ Ó· ‹Ù·Ó Â·Ó·ÌﬁÏ˘ÓÛË Ì¤Ûˆ ÙË˜ ‰ÂÍ·ÌÂÓ‹˜

Omaya, Ë ÔÔ›· Â›¯Â ÙÔÔıÂÙËıÂ›. OÈ Û˘Ó‰˘·ÛÌÔ› ·ÓÙÈ‚ÈÔÙÈÎÒÓ Ô˘ ¯ÔÚËÁ‹ıËÎ·Ó, Ú˘ıÌ›ÛÙËÎ·Ó ‚¿ÛÂÈ ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ Ô˘ ÌÂÙÚÈfiÙ·Ó ÛÙÔ Ú·¯È·›Ô Î·È ÎÔÈÏÈ·Îfi ∂¡À (™¯‹Ì· 3µ). ∏ Û¯¤ÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÙÔ˘ ∂¡À ÙˆÓ ÎÔÈÏÈÒÓ Î·È ÙÔ˘ ÔÛÊ˘˚ÎÔ‡ ˘·Ú·¯ÓÔÂÈ‰Ô‡˜ ¯ÒÚÔ˘ ÙË 10Ë, 13Ë, 15Ë, 17Ë, 20Ë, 23Ë, 41Ë, 59Ë, 64Ë Î·È 72Ë ËÌ¤Ú· ‹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›ÛÙÔÈ¯·.

™ÙËÓ ÙÚ›ÙË ÂÚ›ÙˆÛË, Ë Ù·¯Â›· ÙÒÛË ÙË˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ·ÎÔÏÔ˘ı‹ıËÎÂ ·fi ¤Ó·Ó ·ÚÁfi Ú˘ıÌfi ÌÂ›ˆÛË˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘, ÙÈ˜ ÂfiÌÂÓÂ˜ 4 ËÌ¤ÚÂ˜ ıÂÚ·Â›·˜. ∆ËÓ 5Ë ËÌ¤Ú· ÚÔÛÙ¤ıËÎÂ Cefotaxime ÛÙËÓ ·Ú¯ÈÎ‹ ·ÁˆÁ‹. ∆ËÓ 9Ë ËÌ¤Ú·, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ‹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¤ÛÙÚÂ„Â ÛÙ· Ê˘ÛÈÔÏÔÁÈÎ¿ fiÚÈ· Î·È Ë ıÂÚÌÔÎÚ·Û›· ¤ÂÛÂ Î¿Ùˆ ·fi ÙÔ˘˜ 37ÔC (™¯‹Ì· 3°).

2. £ÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ (nmol 4-methylumbelliferone/ml ∂¡À/ÒÚ·), ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À Î·È ÏfiÁÔ˜

ÁÏ˘Îﬁ˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÛÂ ·ÛıÂÓ‹ ÌÂ ÌËÓÈÁÁ›ÙÈ‰· ·ﬁ

S.pneumoniae Î·È ·ÓÂ·ÚÎ‹ ·ÓÙ·ﬁÎÚÈÛË ÛÙËÓ ·Ú¯ÈÎ‹ ıÂÚ·Â›·.

[Ctr: ceftriaxone, Vnm: vancomycin]

™ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË, ÌÂÙ¿ ·ﬁ Ì›· ·Ú¯ÈÎ¿ Ù·¯Â›· ÙÒÛË ÙË˜ ÂÓ˙˘ÌÈÎ‹˜ ‰Ú·ÛÙËÚÈﬁÙËÙ·˜, ˘‹ÚÍ·Ó 2 ÚÔÊ·ÓÂ›˜ ˘ÔÙÚÔ¤˜ ÙË˜ ÌËÓÈÁÁÈÎ‹˜

ÊÏÂÁÌÔÓ‹˜, ÙËÓ 5Ë Î·È 10Ë ËÌ¤Ú· ıÂÚ·Â›·˜, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÌÂ ÚÒÈÌÂ˜ ·ÏÏ·Á¤˜ ÙˆÓ ·ÓÙÈ-

102030405060708090100

ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ (nmol

∂¡À/ÒÚ·), ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Û˘ÁÎ¤ÓÙÚˆÛË ÚˆÙÂ˝ÓË˜ ÛÙÔ ∂¡À Î·È ÏfiÁÔ˜ ÁÏ˘Îfi˙Ë˜ ∂¡À/·›Ì·ÙÔ˜ ÛÂ 3 ÂÚÈÙÒÛÂÈ˜ ÓÂÔÁÓÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ (A, ° Î·È ¢), Î·ıÒ˜ Î·È ıÂÚÌÔÎÚ·Û›·, ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜, ·ÚÈıÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÂ Ú·¯È·›Ô Î·È ÎÔÈÏÈ·Îfi ∂¡À ÛÂ ÓÂÔÁÓfi ÌÂ ÌËÓÈÁÁ›ÙÈ‰· (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]

·ﬁ„ÂÈ˜ ‰ÈÎ·ÈÔÏÔÁÔ‡Ó ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË ÙË˜

‰Ú·ÛÙËÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÔ

∂¡À Ù¤ÙÔÈˆÓ ·ÛıÂÓÒÓ. ŒÓ· ¿ÏÏÔ ÂÚÒÙËÌ· Ô˘

·Ó·Ê‡ÂÙ·È ·ﬁ Ù· Â˘Ú‹Ì·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜, ÙÔ ÔÔ›Ô ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ¤ÚÂ˘Ó·˜, Â›Ó·È Ë Èı·-

ÓﬁÙËÙ· Û˘ÌÌÂÙÔ¯‹˜ ÙË˜ ·˘ÍËÌ¤ÓË˜ ÂÍˆÎ˘ÙÙ¿ÚÈ·˜

Û˘ÁÎ¤ÓÙÚˆÛË˜ Ï˘ÔÛˆÌÈÎÒÓ ÂÓ˙‡ÌˆÓ ÛÙË ‰È·‰ÈÎ·-

Û›· ÙË˜ ÌËÓÈÁÁÈÎ‹˜ ÊÏÂÁÌÔÓ‹˜. ∞Ó Î·È ÙÔ Î·Ù¿Ï-

ÏËÏÔ pH ÙˆÓ ÂÓ˙‡ÌˆÓ ·˘ÙÒÓ Â›Ó·È ÎÔÓÙ¿ ÛÙÔ 4,0, ‰Ú·ÛÙËÚÈﬁÙËÙ· ÂÎÊÚ¿˙ÂÙ·È Î·È ÛÂ Ô˘‰¤ÙÂÚÔ pH. ∏ ‰È¿ÌÂÛË ‰Ú·ÛÙËÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÂ ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ÌÂ ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË

∂¡À, Ë ÔÔ›· ÔÊÂÈÏﬁÙ·Ó ÛÂ ÏÔ›ÌˆÍË ÙÔ˘ Î·ÙÒÙÂÚÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ‚Ú¤ıËÎÂ ﬁÙÈ ‹Ù·Ó ÌÂÙ·Í‡ ·˘-

Ù‹˜ ÙˆÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ∂¡À Î·È

ÂÎÂ›ÓË˜ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰·.

∞Ó Î·È Î·Ì›· ÂÊ›Â˘ÛË ÙÈÌÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ

ÌÂÙ·Í‡ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘ÂÏÔ-

ÓÂÊÚ›ÙÈ‰· Î·È ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ∂¡À, Ë ‰Ú·ÛÙË-

ÚÈﬁÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÂ ¤Ó·Ó ·ﬁ

ÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ‹Ù·Ó

ÂÓÙﬁ˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÔÚ›Ô˘ ÙË˜ ÂÓ˙˘ÌÈÎ‹˜ ‰Ú·-

ÛÙËÚÈﬁÙËÙ·˜ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ˘˜ ·ÛıÂÓÂ›˜ ÌÂ ˘ÂÏÔÓÂÊÚ›ÙÈ‰·. ∏ Ì¤ÙÚÈ· ·‡ÍËÛË ÙË˜ ‰Ú·ÛÙË-

ÚÈﬁÙËÙ·˜ ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÂ ·ÛıÂÓÂ›˜ ÌÂ

˘ÂÏÔÓÂÊÚ›ÙÈ‰· Î·È ÏÂÈÔÎ˘ÙÙ¿ÚˆÛË ∂¡À ‰ÂÓ

ÌÔÚÂ› Ó· ıÂˆÚËıÂ› ˆ˜ ÌË ·Ó·ÌÂÓﬁÌÂÓÔ Â‡ÚËÌ·, ÁÈ·Ù› Ê·›ÓÂÙ·È Ó· ·ÓÙ·Ó·ÎÏ¿ ÙËÓ ‹ÈÔ˘ ‚·ıÌÔ‡

ÌËÓÈÁÁÈÎ‹ ÊÏÂÁÌÔÓ‹, Ô˘ ˘¿Ú¯ÂÈ ÛÂ ·˘Ù¤˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜.

∏ ·ÚÔ‡Û· ÌÂÏ¤ÙË ¤¯ÂÈ ÔÚÈÛÌ¤ÓÔ˘˜ ÂÚÈÔÚÈ-

ÛÌÔ‡˜. ¶ÚÒÙÔÓ, Ô ·ÚÈıÌﬁ˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂÔ-

ÁÓÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Â›Ó·È ÌÈÎÚﬁ˜

Î·È Û˘ÓÂÒ˜, Ù· Û¯ÂÙÈÎ¿ ÛÙÔÈ¯Â›· ı· Ú¤ÂÈ Ó· ıÂ-

ˆÚËıÔ‡Ó ˆ˜ ÚÔÎ·Ù·ÚÎÙÈÎ¿. ŸÌˆ˜, ÔÈ ÂÚÈÙÒ-

ÛÂÈ˜ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ‰Â›¯ÓÔ˘Ó ﬁÙÈ ˘¿Ú¯ÂÈ ÌÂ-

Á¿ÏË ÔÈÎÈÏÔÌÔÚÊ›· ÛÙËÓ ÔÚÂ›· ÙË˜ ÓﬁÛÔ˘ ÛÙ·

ÓÂÔÁÓ¿ Ô˘ ··ÈÙÂ› ÂÌÂÈÚ›·, ÒÛÙÂ Ó· Á›ÓÔ˘Ó

¤ÁÎ·ÈÚ· ÔÈ Î·Ù¿ÏÏËÏÂ˜ ·Ó·ÚÔÛ·ÚÌÔÁ¤˜ ÛÙË ıÂ-

Ú·Â›·. ¢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· ÙË˜ ıÂÚ·Â›·˜ ÙˆÓ

ÓÂÔÁÓÒÓ ÌÂ ÌËÓÈÁÁ›ÙÈ‰·, ‰ÂÓ Â¤ÙÚÂ„Â ÙË Û˘Û¯¤ÙÈÛË ÙË˜ ÂÓ˙˘ÌÈÎ‹˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÌÂ ÙËÓ ÔÚÂ›· ÙË˜ ·ÔÛÙÂ›ÚˆÛË˜ ÙÔ˘ ∂¡À. ∂›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÂÚÈÛÛfiÙÂÚÂ˜ ÌÂÏ¤ÙÂ˜, ÛÂ ¤Ó· Â˘Ú‡ Ê¿ÛÌ· ÂÚÈ-

ÙÒÛÂˆÓ ÓÂÔÁÓÈÎ‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜, ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈËıÔ‡Ó. ∆Ú›ÙÔÓ, ÂÂÈ‰‹ Ù· ‰Â‰ÔÌ¤Ó·

‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ Î·È ÙËÓ ¤ÁÎ·ÈÚË ÂÊ·ÚÌÔÁ‹ ÙË˜ Î·Ù¿ÏÏËÏË˜ ·ÁˆÁ‹˜, ı· Â¤ÏıÂÈ ÌÂ›ˆÛË ÙË˜ Û˘¯ÓﬁÙËÙ·˜ ÙˆÓ ÓÂ˘ÚÔÏÔÁÈÎÒÓ ÂÈÏÔÎÒÓ ÛÙÔ˘˜

·ÛıÂÓÂ›˜ ·˘ÙÔ‡˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ‰Ú·ÛÙËÚÈfiÙËÙ· ÙË˜ ‚-ÁÏ˘ÎÔ˘ÚÔÓÈ‰¿ÛË˜ ÛÙÔ ∂¡À Ì·˜ ÚÔÛÊ¤ÚÂÈ ¤Ó· Ì¤ÛÔ, fi¯È ÌfiÓÔ ÁÈ· ‰È¿ÁÓˆÛË ÙË˜ ÌÈÎÚÔ‚È·Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜, ·ÏÏ¿, ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ, ÁÈ· ÚÒÈÌË Î·È ·ÍÈfiÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂÙ·Í‡ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ı· ıÂÚ·Â˘ÙÔ‡Ó ·fi Ù· ¯ÔÚËÁÔ‡ÌÂÓ· ·ÓÙÈ‚ÈÔÙÈÎ¿ Î·È ÂÎÂ›ÓˆÓ ÙˆÓ ÔÔ›ˆÓ Ë ·¿ÓÙËÛË ÛÙË ıÂÚ·Â›· Â›Ó·È ÌË ÈÎ·ÓÔÔÈËÙÈÎ‹ Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÂÓ‰Â›ÎÓ˘Ù·È ¿ÌÂÛË ·ÏÏ·Á‹ ÙÔ˘ ıÂÚ·Â˘ÙÈ-

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

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.

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·Ú›· π. ∏ÏÈÔÔ‡ÏÔ˘

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ¶·ÙÚÒÓ

∆.∫. 265 00, ƒ›Ô, ¶¿ÙÚ· E-mail: nic-bera@med.upatras.gr

™ÎÔfi˜: O ÛÙÚÂÙfiÎÔÎÎÔ˜ ÙË˜ ÔÌ¿‰·˜ µ (GBS) ·ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ Î‡ÚÈÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ ÙË˜

ÓÂÔÁÓÈÎ‹˜ ÛË„·ÈÌ›·˜. ™Â ÌÂÚÈÎ¿ ÓÂÔÁÓ¿, Ë ÛË„·ÈÌ›· ·ﬁ ÙÔÓ

GBS ÌÔÚÂ› Ó· ¤¯ÂÈ ‚·ÚÈ¿ ÔÚÂ›·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ ÙÔ˘

ÛË„·ÈÌÈÎÔ‡ shock, ÌÂ ˘„ËÏfi ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜, ÂÓÒ ¿ÏÏ·

ÓÂÔÁÓ¿ ·ÔÈÎ›˙ÔÓÙ·È ÌÂ ÙÔÓ GBS ¯ˆÚ›˜ Ó· ÂÌÊ·Ó›˙Ô˘Ó ÎÏÈÓÈÎ¿

ÛËÌÂ›· ‚·ÎÙËÚÈ·Î‹˜ ÏÔ›ÌˆÍË˜. O ÏﬁÁÔ˜ ÁÈ· ÙËÓ ·ÓÙ›Ê·ÛË ·˘-

Ù‹ ‰ÂÓ Â›Ó·È ÍÂÎ¿ı·ÚÔ˜.

ÀÏÈÎﬁ Î·È ÌÂıÔ‰ÔÏÔÁ›·: ™ÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·Ó·˙ËÙ‹Û·ÌÂ

Ó· Û˘ÁÎÚ›ÓÔ˘ÌÂ ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙ· ÌÔÓÔ‡ÚËÓ· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛ‹ ÙÔ˘˜, ÌÂ ÛÙÂÏ¤¯Ë ÙÔ˘ GBS Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ÓÂÔÁÓ¿ ÌÂ ÛË„·ÈÌ›·, Î·ıÒ˜ Â›ÛË˜ ·fi ÓÂÔÁÓ¿ Ô˘ ‹Ù·Ó ÌfiÓÔ ·ÔÈÎÈÛÌ¤Ó· ¯ˆÚ›˜

Û˘ÌÙÒÌ·Ù· ÏÔ›ÌˆÍË˜. ∆· ÌÔÓÔ‡ÚËÓ· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ Âˆ¿ÛıËÎ·Ó, Â›ÙÂ ÌÂ ‚·ÎÙËÚ›‰È· ‰È·ÊÔÚÂÙÈÎÒÓ ÛÙÂÏÂ¯ÒÓ Ô˘ ·‰Ú·ÓÔÔÈ‹ıËÎ·Ó ÌÂ ıÂÚÌfiÙËÙ·, Â›ÙÂ ÌÂ ÏÈÔÔÏ˘Û·Î¯·Ú›‰Â˜, ·ÓÙ›ÛÙÔÈ¯·. ªÂÙ¿ ·fi 6 Î·È 24 ÒÚÂ˜, Û˘ÓÂÏ¤ÁËÛ·Ó Ù· Î‡ÙÙ·Ú· Î·È ¤ÁÈÓÂ ·Ó¿Ï˘ÛË ÙË˜ ¤ÎÊÚ·ÛË˜ ÙÔ˘ mRNA ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÌÂ PCR. ∂›ÛË˜, Ù· ˘ÂÚÎÂ›ÌÂÓ· Î‡ÙÙ·Ú· ÂÏ¤Á¯ıËÎ·Ó ÌÂ ·ÓÔÛÔÂÓ˙˘ÌÈÎ‹ Ì¤ıÔ‰Ô, ÁÈ· ÙÔÓ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙË˜ IL-6 Î·È ÙÔ˘ TNF-·. ∞ÔÙÂÏ¤ÛÌ·Ù·: ™˘ÁÎÚ›ÓÔÓÙ·˜ ÙÈ˜ Û˘ÁÎÂÓÙÚÒÛÂÈ˜ ÙË˜ IL-6 Î·È ÙÔ˘ TNF-· ‰È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏfiÙÂÚ· Â›Â‰· IL6 ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË ÌÂ ÛÙÂÏ¤¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi Ù·

ÛË„·ÈÌÈÎ¿ ÓÂÔÁÓ¿, ·’ ﬁÙÈ ÌÂÙ¿ ·ﬁ ‰È¤ÁÂÚÛË ÌÂ ÛÙÂÏ¤¯Ë

IL-6, IL-1b Î·È IL-12p40, ‹Ù·Ó ÛËÌ·ÓÙÈÎ¿ ˘„ËÏﬁÙÂÚË

·ﬁ ‰È¤ÁÂÚÛË ÌÂ ÏÈÔÔÏ˘Û·Î¯·Ú›ÙÂ˜.

∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ‰È·ÊÔÚÂÙÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎfiÓ· Ô˘ ÚÔÎ·ÏÔ‡Ó Ù· ÛÙÂÏ¤¯Ë ÙÔ˘ GBS, Â›ÙÂ ˘fi ÙË ÌÔÚÊ‹ ÛË„·ÈÌ›·˜ Â›ÙÂ ˘fi ÙË ÌÔÚÊ‹ ÌfiÓÔ ÙÔ˘ ·ÔÈÎÈÛÌÔ‡, ›Ûˆ˜ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙÈ˜ ÂÈ‰ÈÎ¤˜ È‰ÈfiÙËÙÂ˜ ÙˆÓ ÂÎ¿ÛÙÔÙÂ ÛÙÂÏÂ¯ÒÓ. ∂¿Ó Î·Ù·ÛÙÂ› ‰˘Ó·Ùfi˜ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ È‰È·›ÙÂÚˆÓ ·˘ÙÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ÌÔÚÂ› Ì¤Ûˆ ÌÔÚÈ·ÎÒÓ ÌÂıfi‰ˆÓ Ó· ‰È·ÎÚÈıÔ‡Ó Ù· ÂÈÎ›Ó‰˘Ó· ·fi Ù· ·Î›Ó‰˘Ó· ÛÙÂÏ¤¯Ë. ∂ÈÏ¤ÔÓ, Ù· Â˘Ú‹Ì·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙÔ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙË˜ ÓÂÔÁÓÈÎ‹˜ ÛË„·ÈÌ›·˜ ·fi GBS

1Berner 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

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞ORIGINAL ARTICLE

∏ ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰· ÛÙ· ·È‰È¿ ÙË˜ ∫Ú‹ÙË˜

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

∞septic meningitis in children from Crete

S. Maraka, A. Tsilimigaki, E. Galanakis, T. Tsekoura, G. Zambetakis, E. Kokori

¶ÂÚ›ÏË„Ë: ∏ ‰È¿ÎÚÈÛË ÙË˜ ¿ÛËÙË˜ ·ﬁ ÙË ‚·-

ÎÙËÚÈ‰È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· Â›Ó·È ‰‡ÛÎÔÏË ÌÂ ‚¿ÛË Ìﬁ-

ÓÔ Ù· ÎÏÈÓÈÎ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿. ™ÙËÓ ∫Ú‹ÙË ‰ÂÓ

¤¯ÂÈ Á›ÓÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÎÚÈ‚‹˜ Î·Ù·ÁÚ·Ê‹ ÙˆÓ

·ÈÙ›ˆÓ ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Î·È ÙË˜ Û˘¯ÓﬁÙËÙ·˜ ·˘-

ÙÒÓ. ªÂÏÂÙ‹ıËÎ·Ó Ù· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿, Ù· ÎÏÈÓÈÎ¿

Î·È Ù· ÂÚÁ·ÛÙËÚÈ·Î¿ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ 81 ·È‰ÈÒÓ

ÌÂ ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰· Ô˘ ÓÔÛËÏÂ‡ÙËÎ·Ó ÛÙÔ µÂ-

ÓÈ˙¤ÏÂÈÔ °ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘ Î·Ù¿ ÙË

‰ÈÂÙ›· 1999-2000. ¢È·ÈÛÙÒıËÎÂ ÌÂÁ·Ï‡ÙÂÚË Â›-

ÙˆÛË ÙË˜ ÓﬁÛÔ˘ ÙÔ Î·ÏÔÎ·›ÚÈ Î·È ÙÔ ÊıÈÓﬁˆÚÔ.

∆Ô 78% ÙˆÓ ·È‰ÈÒÓ ÓÔÛËÏÂ‡ÙËÎÂ Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· 2 Î˘Ì¿ÙˆÓ. ™Â 57 ÂÚÈÙÒÛÂÈ˜ ¤ÁÈÓÂ Î·ÏÏÈ¤Ú-

ÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ· ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÙÔ ·ÔÙ¤ÏÂÛÌ·

‹Ù·Ó ıÂÙÈÎﬁ ÛÙÔ 33% ÙˆÓ ÂÚÈÙÒÛÂˆÓ. OÚÔÏÔÁÈ-

Î‹ ¤Ó‰ÂÈÍË ÚﬁÛÊ·ÙË˜ ÏÔ›ÌˆÍË˜ ·ﬁ ÂÓÙÂÚÔ˚Ô‡˜

·Ô‰Â›¯ÙËÎÂ ÛÙÔ 31% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ. ªÂ ‚¿ÛË Ù·

·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÎÔÚ¿ÓˆÓ Î·È

ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘, ÙÔ 41% ÙˆÓ ÂÚÈÙÒÛÂ-

ˆÓ ÔÊÂÈÏﬁÙ·Ó ÛÂ ÂÓÙÂÚÔ˚Ô‡˜. ∏ ¤Î‚·ÛË ‹Ù·Ó Î·Ï‹

ÛÂ ﬁÏ· Ù· ·È‰È¿. ∏ ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰· Â›Ó·È Û˘-

¯Ó‹ ÛÙËÓ ∫Ú‹ÙË Î·È ÂÌÊ·Ó›˙ÂÈ ÂÔ¯È·Î‹ Î·Ù·ÓÔÌ‹.

¶ÔÏ‡ Û˘¯Ó¿ ÔÊÂ›ÏÂÙ·È ÛÂ ÂÓÙÂÚÔ˚Ô‡˜. ∏ Î·ÏÏÈ¤Ú-

ÁÂÈ· ÎÔÚ¿ÓˆÓ Â›Ó·È ¯Ú‹ÛÈÌË, ·ÏÏ¿ ‰ÂÓ ˆÊÂÏÂ›

ÛÙËÓ ÔÍÂ›· Ê¿ÛË ÙË˜ ÓﬁÛÔ˘.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÈÔÁÂÓ‹˜ ÌËÓÈÁÁ›ÙÈ‰·, ÂÓÙÂÚÔ˚Ô›, ∫Ú‹ÙË.

Û‡Ó‰ÚÔÌÔ ÙË˜

ÙˆÓ ÌËÓ›ÁÁˆÓ,

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.

Key words: viral meningitis, enteroviruses, Crete.

‚·ÎÙËÚÈ‰È·ÎÔ› ·Ú¿ÁÔÓÙÂ˜ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) (1). ∏ Ì¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË ÛÙÈ˜ ∏¶∞ ˘ÔÏÔÁ›˙ÂÙ·È ÛÂ 4,4 ÂÚÈÙÒÛÂÈ˜ ·Ó¿ 100.000 ÏËı˘ÛÌfi. ™Â ÂÚÈfi‰Ô˘˜ ÌÂ ¤Í·ÚÛË ÙË˜ ÓfiÛÔ˘, fiÌˆ˜, Ë ÂÙ‹ÛÈ· Â›ÙˆÛË ÌÔÚÂ› Ó· ‰ÂÎ·Ï·ÛÈ·ÛÙÂ› (2). ™‡ÌÊˆÓ· ÌÂ

∞’ & µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹

µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

‰Â‰ÔÌ¤Ó·, ÔÈ ÂÓÙÂÚÔ˚Ô›, ÌÂ ÂÍ·›ÚÂÛË ÙÔ˘˜ ÈÔ‡˜ ÙË˜ ÔÏÈÔÌ˘ÂÏ›ÙÈ‰·˜, Â›Ó·È ˘Â‡ı˘ÓÔÈ ÁÈ· ÙÔ 80%-92% ﬁÏˆÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙË˜

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

ÛÙÈ˜ ‰‡Ô ·˘Ù¤˜ ‰È·ÁÓˆÛÙÈÎ¤˜ ‰ÔÎÈÌ·Û›Â˜. ™Â 13

ÂÚÈÙÒÛÂÈ˜ ÌÂ ·ÚÓËÙÈÎﬁ ÔÚÔÏÔÁÈÎﬁ ¤ÏÂÁ¯Ô ÁÈ·

ÂÓÙÂÚÔ˚Ô‡˜, ·ÔÌÔÓÒıËÎÂ ·ﬁ ÙËÓ Î·ÏÏÈ¤ÚÁÂÈ·

ÎÔÚ¿ÓˆÓ ÂÓÙÂÚÔ˚ﬁ˜. ™Â 14 ÂÚÈÙÒÛÂÈ˜ Ô˘ Ë

Î·ÏÏÈ¤ÚÁÂÈ· ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈÎ‹, ˘‹ÚÍÂ

ÔÚÔÏÔÁÈÎ‹ ¤Ó‰ÂÈÍË ÚﬁÛÊ·ÙË˜ ÏÔ›ÌˆÍË˜ ·ﬁ

ÂÓÙÂÚÔ˚Ô‡˜. ™˘ÓÂÒ˜, ÌÂ ‚¿ÛË Ù· ·ÔÙÂÏ¤ÛÌ·Ù·

ÙˆÓ ÎÔÚ·ÓÔÎ·ÏÏÈÂÚÁÂÈÒÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡

ÂÏ¤Á¯Ô˘, ·ﬁ ÙÈ˜ 81 Û˘ÓÔÏÈÎ¿ ÂÚÈÙÒÛÂÈ˜ ¿ÛË-

ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜, ÛÂ 33 (41%) ·ÔÌÔÓÒıËÎÂ ÂÓÙÂÚÔ˚fi˜. ∞fi ÙÈ˜ 67 ÂÚÈÙÒÛÂÈ˜ Ô˘ ÂÊ·ÚÌfi-

ÛÙËÎÂ ÂÈ‰ÈÎ‹ ‰È·ÁÓˆÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ (ÎÔÚ·ÓÔÎ·Ï-

ÏÈ¤ÚÁÂÈ· Î·È/‹ ÔÚÔÏÔÁÈÎﬁ˜ ¤ÏÂÁ¯Ô˜), ÛÂ 33 (49%)

ÙÂÎÌËÚÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË ÙË˜ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ·ﬁ ÂÓÙÂÚÔ˚Ô‡˜. ∆Ô ·ÔÙ¤ÏÂÛÌ· ·ﬁ ÙËÓ Î·Ï-

ÏÈ¤ÚÁÂÈ· ÙˆÓ ÎÔÚ¿ÓˆÓ ‰ÂÓ ‹Ù·Ó ‰È·ı¤ÛÈÌÔ ÚÈÓ

ÙÔ 8Ô 24ˆÚÔ ÓÔÛËÏÂ›·˜, ÂÓÒ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈ-

ÛÌﬁ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔÓ ÔÚﬁ ¯ÚÂÈ¿-

˙ÔÓÙ·Ó Û˘Ó‹ıˆ˜ 3-8 ËÌ¤ÚÂ˜.

∆· Î‡ÚÈ· ÎÏÈÓÈÎ¿ ÛËÌÂ›· Î·Ù¿ ÙËÓ ÚÔÛ¤ÏÂ˘ÛË

ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÙÌ‹Ì· ∂ÂÈÁﬁÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ

ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1.

∆· Û˘ÌÙÒÌ·Ù· ÙË˜ ÓﬁÛÔ˘ Â›¯·Ó ·Ú¯›ÛÂÈ 28,8 ± 11,8 ÒÚÂ˜ ÚÈÓ ÙËÓ ÚÔÛ¤ÏÂ˘ÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÔ

ÓÔÛÔÎÔÌÂ›Ô. ∆Ô ÂÍ¿ÓıËÌ· ‹Ù·Ó ·ÈÌÔÚÚ·ÁÈÎﬁ ÛÂ 5 ÂÚÈÙÒÛÂÈ˜ Î·È ÎËÏÈ‰Ô‚Ï·ÙÈ‰Ò‰Â˜ ÛÂ Ì›·. ™Â ¤Ó·

·È‰› ‰È·ÈÛÙÒıËÎÂ ÂÍ¿ÓıËÌ· ·ÓÂÌÔ‚ÏÔÁÈ¿˜ ÛÂ ·Ô‰ÚÔÌ‹. ∫·Ó¤Ó· ·È‰› ‰ÂÓ ‹Ù·Ó ÛÂ ÎˆÌ·ÙÒ‰Ë

¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜, 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‹ıËÎÂ ÛÂ 36 ·fi ÙÈ˜ 63 ÂÚÈÙÒÛÂÈ˜ (57%) ÌÂ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÛÂ ÏÈÁfiÙÂÚÔ ·fi 24 ÒÚÂ˜ ·fi ÙÔ ¯ÚfiÓÔ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ë O¡¶, ·ÏÏ¿ ÌfiÓÔ ÛÂ 3 ·fi ÙÈ˜ 18 ÂÚÈÙÒÛÂÈ˜ (17%) ÌÂ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÛÂ ÂÚÈÛÛfiÙÂÚÔ ·fi 24 ÒÚÂ˜. ∞fi ÙÈ˜ 81 ÂÚÈÙÒÛÂÈ˜

·È‰ÈÒÓ ÌÂ ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰·, ÛÂ 42 Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎfi˜. ∂ÔÌ¤Óˆ˜, Ë Â˘·ÈÛıËÛ›· ÙË˜ ÂÈÎÚ¿ÙËÛË˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ‹Ù·Ó 52%. ∞fi ÙÈ˜ 8 ÂÚÈÙÒÛÂÈ˜ ·È‰ÈÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰·, ·ÏÏ¿ Â›¯·Ó ‚·ÎÙËÚÈ‰È·Î‹, ÛÂ 7 Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‰ÂÓ ‹Ù·Ó ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎfi˜, ÂÈ‰ÈÎfiÙËÙ· 88%. ∂›ÛË˜, ·fi Ù· 43 ·È‰È¿ ÌÂ ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎfi Ù‡Ô ÛÙÔ ∂¡À, Ù· 42 Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰·, ıÂÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· 98%. ∞fi Ù· 46 ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ÏÂÌÊÔÎ˘ÙÙ·ÚÈÎfi Ù‡Ô ÛÙÔ ∂¡À, Ù· 7 ‰ÂÓ Â›¯·Ó ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰·, ·ÏÏ¿ Â›¯·Ó ‚·ÎÙËÚÈ‰È·Î‹, ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· 15%. ∆· Â˘Ú‹Ì·Ù· ·fi ÙÔ ∂¡À ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂÙ·Í‡ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ÙÂÎÌËÚÈˆÌ¤ÓË ÏÔ›ÌˆÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜, ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ÙÂÎÌËÚÈÒıËÎÂ ÏÔ›ÌˆÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ Ï‹ÊıËÎÂ ÂÈ‰ÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 3).

§Â˘ÎÔÎ˘ÙÙ¿ÚˆÛË ÛÙÔ ÂÚÈÊÂÚÈÎﬁ ·›Ì· (ÏÂ˘ÎÔÎ‡ÙÙ·Ú· >15.000/mm3) ‰È·ÈÛÙÒıËÎÂ ÛÙÔ 28% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÌÂ Ì¤ÛË

Î·Ù¿ ÙÔ ‰È¿ÛÙËÌ· ÙË˜ ÌÂÏ¤ÙË˜, ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙÔ 48% ÙˆÓ ÂÚÈÙÒ-

ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ‰È·ÈÛÙÒıËÎÂ ÛÙÔ 81% ÙˆÓ

ÂÚÈÙÒÛÂˆÓ. ∏ Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ÂÚÈÊÂÚÈÎﬁ ·›Ì· ‹Ù·Ó 64% ± 22%. ∏ ∆∫∂ ‹Ù·Ó >20 ÛÂ 47 ÂÚÈÙÒÛÂÈ˜ (58%).

∞ﬁ Ù· 47 ·˘Ù¿ ·È‰È¿, 31 Â›¯·Ó ∆∫∂ 20-39 mm/h

Î·È 16 ·È‰È¿ >40 mm/h. OÈ Î·ÏÏÈ¤ÚÁÂÈÂ˜ ·›Ì·ÙÔ˜

‹Ù·Ó ÛÙÂ›ÚÂ˜ ÛÂ ﬁÏÂ˜ ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ ¿ÛËÙË˜ ÌË-

ÓÈÁÁ›ÙÈ‰·˜.

™ÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ ¯ÚÂÈ¿ÛÙËÎÂ Ó· ‰ÔıÂ›

·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹, Ë ‰È¿ÚÎÂÈ· ÙË˜ ıÂÚ·Â›·˜

‹Ù·Ó 3-8 ËÌ¤ÚÂ˜, ¤ˆ˜ ﬁÙÔ˘ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ

Î·ÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·. ∏ ¤Î‚·ÛË ÙË˜ Óﬁ-

ÛÔ˘ ‹Ù·Ó Î·Ï‹ ÛÂ ﬁÏ· Ù· ·È‰È¿ Î·È Î·Ù¿ ÙËÓ ·-

Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó

ÂÈÏÔÎ¤˜ ‹ ÓÂ˘ÚÔÏÔÁÈÎ¿ Î·Ù¿ÏÔÈ·.

™˘˙‹ÙËÛË

∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÒÓ ÌÂ ˘Ô„›· ÈÔÁÂ-

ÓÔ‡˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‹ıˆ˜ ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ Ê·ÚÌ¿ÎˆÓ, ¤ˆ˜ fiÙÔ˘ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ó· Â›Ó·È ‰È·ı¤ÛÈÌ·. ∂ÎÙfi˜ ·fi ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ‚·ÎÙËÚÈ‰È·ÎÒÓ ·ÈÙ›ˆÓ, Ë ‰È·ÁÓˆÛÙÈÎ‹ ÚÔÛ¤Ï·ÛË ÙË˜ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È ÂÎÙÂÙ·Ì¤ÓË. ∏

·ÓÂ‡ÚÂÛË ÙÔ˘ ·ÈÙ›Ô˘ ÊÙ¿ÓÂÈ ÌﬁÓÔ ÛÙÔ 55%-70%

ÙˆÓ ÂÚÈÙÒÛÂˆÓ, ﬁÔ˘ ÂÊ·ÚÌﬁ˙ÂÙ·È Ì›· ÛÙ·ıÂÚ‹

‰È·ÁÓˆÛÙÈÎ‹ Ì¤ıÔ‰Ô˜ (1,4). ∏ ·ÔÌﬁÓˆÛË ÙˆÓ

ÂÓÙÂÚÔ˚ÒÓ ·ﬁ Î·ÏÏÈ¤ÚÁÂÈ· Î˘ÙÙ¿ÚˆÓ ¤¯ÂÈ Û¯ÂÙÈÎ¿

¯·ÌËÏ‹ Â˘·ÈÛıËÛ›· (65%-75%) Î·È ··ÈÙÔ‡ÓÙ·È Î·Ù¿ Ì¤ÛÔ ﬁÚÔ 3-8 ËÌ¤ÚÂ˜ ÁÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ· (5,6,8). ∏ ÙÂ¯ÓÈÎ‹ ÙË˜ ·Ó›¯ÓÂ˘ÛË˜ ÙÔ˘ RNA ÙÔ˘ ÂÓÙÂÚÔ˚Ô‡ ÌÂ PCR ıÂˆÚÂ›Ù·È Î·È ÈÔ ·ÛÊ·Ï‹˜ Î·È Ù·¯Â›· ‰È·ÁÓˆÛÙÈÎ‹ Ì¤ıÔ‰Ô˜, ‰›ÓÔÓÙ·˜ ·ÔÙ¤ÏÂÛÌ· Ì¤Û· ÛÂ Ï›ÁÂ˜ ÒÚÂ˜ (5,6,8,15).

¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎ‹ ÂÈÎﬁÓ· ÙˆÓ ·È‰ÈÒÓ ÌÂ ¿ÛËÙË ÌËÓÈÁÁ›-

ÙÈ‰· Î·Ù¿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô

∫ÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜%

¶˘ÚÂÙﬁ˜ >38,5Ô 88

∫ÂÊ·Ï·ÏÁ›· ÛÂ ·È‰È¿ >2 ÂÙÒÓ87

ªËÓÈÁÁÈÙÈ‰ÈÎ¿ ÛËÌÂ›·87

ŒÌÂÙÔÈ74

∂Í¿ÓıËÌ·11

¢È¿ÚÚÔÈ·5

∂Ï·ÊÚÒ˜ ÂËÚÂ·ÛÌ¤ÓË ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË48

∏ ÂÈ‰ËÌÈÔÏÔÁ›· ÙË˜ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ‰ÂÓ

¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ÌÂÏÂÙËıÂ› ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ∫Ú‹ÙË˜. ∞ﬁ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ·˘Ù‹˜ ÚÔÎ‡ÙÂÈ ﬁÙÈ Ù· ÂÈ‰ËÌÈÔÏÔÁÈÎ¿ ‰Â‰ÔÌ¤Ó· Â›Ó·È

·ÚﬁÌÔÈ· ·˘ÙÒÓ ÙˆÓ Â‡ÎÚ·ÙˆÓ ÎÏÈÌ¿ÙˆÓ, ﬁÔ˘

·Ú·ÙËÚÂ›Ù·È ¤Í·ÚÛË ÙË˜ ÓﬁÛÔ˘ ÙÔ Î·ÏÔÎ·›ÚÈ Î·È

ÙÔ ÊıÈÓfiˆÚÔ. ™ËÌ·ÓÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙË˜ ÌÂÏ¤ÙË˜

·ÔÙ¤ÏÂÛ·Ó Ô ·Ó·‰ÚÔÌÈÎﬁ˜ ¯·Ú·ÎÙ‹Ú·˜ ÙË˜ Î·È Ë

¤ÏÏÂÈ„Ë Ù·˘ÙÔÔ›ËÛË˜ ÙÔ˘ ÔÚÔÙ‡Ô˘ ÙÔ˘ ÂÓÙÂÚÔ˚Ô‡ ·ﬁ Ù· ÎﬁÚ·Ó·. ∫·ÏÏÈ¤ÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÁÈ·

ÂÓÙÂÚÔ˚Ô‡˜ ¤ÁÈÓÂ ÛÙÔ 70% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛË-

ÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜, Î˘Ú›ˆ˜ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ

ÌËÓÒÓ ÙÔ˘ Î·ÏÔÎ·ÈÚÈÔ‡ Î·È ÙÔ˘ ÊıÈÓÔÒÚÔ˘, ﬁÙ·Ó

‹Ù·Ó ÂÌÊ·ÓÂ›˜ ÔÈ Û˘ÛÛˆÚÂ‡ÛÂÈ˜ ÎÚÔ˘ÛÌ¿ÙˆÓ. ∆Ô

ıÂÙÈÎﬁ ·ÔÙ¤ÏÂÛÌ· ÙË˜ Î·ÏÏÈ¤ÚÁÂÈ·˜ ‰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 ÓÔÛËÏÂ›·˜. ªÂ ÙÔ Û˘Ó‰˘·ÛÌﬁ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ

ÎÔÚ·ÓÔÎ·ÏÏÈÂÚÁÂÈÒÓ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 41% ÙÔ˘ Û˘ÓﬁÏÔ˘ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ÛÙËÓ ∫Ú‹ÙË ÔÊÂ›ÏÂÙ·È ÛÂ ÂÓÙÂÚÔ˚Ô‡˜. ∞ﬁ ·˘Ù‹ ÙË ÌÂÏ¤ÙË ÚÔÎ‡ÙÂÈ

ÂÙ‹ÛÈ· Â›ÙˆÛË ÁÈ· ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰·

∫Ú‹ÙË ÙÔ˘Ï¿¯ÈÛÙÔÓ 20 ÂÚÈÙÒÛÂÈ˜ ·Ó¿

100.000 ÏËı˘ÛÌﬁ. ∏ Â›ÙˆÛË ·˘Ù‹ Â›Ó·È ·˘ÍËÌ¤ÓË ÌÂ ‚¿ÛË Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎ¿ ‰Â‰ÔÌ¤Ó· Î·È ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚÂ‡ÓËÛË (2).

π‰È·›ÙÂÚÔ ‰È·ÁÓˆÛÙÈÎfi ÂÓ‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙÔ 48% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‹Ù·Ó ÔÏ˘ÌÔÚÊÔ˘ÚËÓÈÎfi˜. ∂ÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·Ú·ÙËÚ‹ıËÎÂ ÛÙÔ 57% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÛÂ ÏÈÁfiÙÂÚÔ ·fi 24 ÒÚÂ˜ ·fi ÙÔ ¯ÚfiÓÔ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ë O¡¶, fiˆ˜ Î·È ÛÙÔ 17% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÌÂ ¤Ó·ÚÍË ÙË˜ ÓfiÛÔ˘ ÛÂ ÂÚÈÛÛfiÙÂÚÔ

·ﬁ 24 ÒÚÂ˜. ∏ Â˘·ÈÛıËÛ›· Î·È Ë ·ÚÓËÙÈÎ‹ ÚÔÁÓˆÛÙÈÎ‹ ·Í›· ÙË˜ ÂÈÎÚ¿ÙËÛË˜ ÙˆÓ ÏÂÌÊÔÎ˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙË˜ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ‹Ù·Ó ¯·ÌËÏ‹. ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÂÚÁ·Û›·˜ Û˘ÌÊˆÓÔ‡Ó ÌÂ ·ÚÎÂÙ¤˜ ÂÈ‰ËÌÈÔÏÔÁÈÎ¤˜ ÌÂÏ¤ÙÂ˜, Û‡ÌÊˆÓ· ÌÂ ÙÈ˜ ÔÔ›Â˜, ÛÙË ÌËÓÈÁÁ›ÙÈ‰·

·fi ÂÓÙÂÚÔ˚Ô‡˜ Ë ÂÈÎÚ¿ÙËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙÔ ∂¡À ·ÔÙÂÏÂ› 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 ÛÂ ·È‰È¿ ÌÂ ÙÂÎÌËÚÈˆÌ¤ÓË ÏÔ›ÌˆÍË ·fi ÂÓÙÂÚÔ˚Ô‡˜ Î·È ÛÂ ·È‰È¿ ÌÂ ‚·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ÕÛËÙË ÌËÓÈÁ›ÙÈ‰·µ·ÎÙËÚÈ·Î‹ ÌËÓÈÁÁ›ÙÈ‰· ·fi ÂÓÙÂÚÔ˚Ô‡˜ (n=33)(n=8)

∂Ó‰È¿ÌÂÛË ÙÈÌ‹∂‡ÚÔ˜∂Ó‰È¿ÌÂÛË ÙÈÌ‹∂‡ÚÔ˜

§Â˘ÎÔÎ‡ÙÙ·Ú·/mm3 7520-7505320-4.600

¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (%)6010-906549-93

°Ï˘Îﬁ˙Ë (mg/dl)6339-1057450-128

¶ÚˆÙÂ˝ÓË (mg/dl)306-1004018-230

ÂÓÙÂÚÔ˚Ô‡˜

ŒÏÂÁ¯Ô˜ ÁÈ·n§Â˘ÎÔÎ‡ÙÙ·Ú·/mm3 ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·¶ÚˆÙÂ˝ÓË °Ï˘Îﬁ˙Ë

ÚﬁÛÊ·ÙË ÏÔ›ÌˆÍË (%)(mg/dl)(mg/dl)

·ﬁ ÂÓÙÂÚÔ˚Ô‡˜

∞ÔÙ¤ÏÂÛÌ·

∂.∆. (Â‡ÚÔ˜)∂.∆. (Â‡ÚÔ˜)∂.∆. (Â‡ÚÔ˜)∂.∆. (Â‡ÚÔ˜)

£ÂÙÈÎﬁ 3375 (20-750)60 (10-90)30 (6-100)63 (39-105)

∞ÚÓËÙÈÎﬁ 3475 (15-1.000)60 (0-90)30 (6-170)63 (47-87)

¢ÂÓ ¤ÁÈÓÂ ¤ÏÂÁ¯Ô˜1485 (15-510)55 (0-96)34 (10-130)61 (38-81)

™‡ÓÔÏÔ8184 (15-1.000)60 (0-96)30 (6-170)63 (38-105)

∂.∆.: ÂÓ‰È¿ÌÂÛË ÙÈÌ‹

ÛÙÈ˜ ÚÒÙÂ˜ 24 ÒÚÂ˜ ÙË˜ ÓﬁÛÔ˘ (13,14). ™˘ÓÂÒ˜, Ô Ù‡Ô˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À ‰ÂÓ ÌÔÚÂ› Ó·

¯ÚËÛÈÌÔÔÈËıÂ› ˆ˜ ·ÛÊ·Ï¤˜ ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙË ‰È·ÊÔÚÈÎ‹ ‰È¿ÁÓˆÛË ÙË˜ ¿ÛËÙË˜ ·ﬁ ÙË ‚·ÎÙËÚÈ‰È·Î‹ ÌËÓÈÁÁ›ÙÈ‰·. ∂ÔÌ¤Óˆ˜, Î·Ù¿ ÙËÓ ÂÔ¯‹ Ô˘

ÂÌÊ·Ó›˙ÂÈ ¤Í·ÚÛË Ë ÌËÓÈÁÁ›ÙÈ‰· ·ﬁ ÂÓÙÂÚÔ˚Ô‡˜, ¤Ó·˜ ·ÛıÂÓ‹˜ ÌÂ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË ÛÙÔ ∂¡À ‰ÂÓ Â›Ó·È ·›ı·ÓÔ Ó· ¤¯ÂÈ ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰· (14).

∂Ó‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È Ë ‰È·›ÛÙˆÛË ﬁÙÈ

·È‰È¿ ÌÂ ÙÂÎÌËÚÈˆÌ¤ÓË ÏÔ›ÌˆÍË ·ﬁ

ÂÓÙÂÚÔ˚Ô‡˜ ·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË ÙË˜ ÚˆÙÂ˝ÓË˜

Î·È ÌÂ›ˆÛË ÙË˜ ÁÏ˘Îﬁ˙Ë˜ ÛÙÔ ∂¡À, Â˘Ú‹Ì·Ù· ‰ËÏ·‰‹ Ô˘ ıÂˆÚÔ‡ÓÙ·È ˆ˜ ÂÓ‰ÂÈÎÙÈÎ¿ ‚·ÎÙËÚÈ‰È·-

Î‹˜ ÌËÓÈÁÁ›ÙÈ‰·˜. ∏ ÙÂÏÈÎ‹, ÏÔÈﬁÓ, ‰È¿ÎÚÈÛË ÙË˜ ‚·ÎÙËÚÈ‰È·Î‹˜ ·ﬁ ÙËÓ ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ‰· ‰ÂÓ

ÌÔÚÂ› Ó· ÛÙËÚ›˙ÂÙ·È ·ÔÎÏÂÈÛÙÈÎ¿ ÛÙ· Â˘Ú‹Ì·Ù·

ÙÔ˘ ∂¡À, ·ÏÏ¿ ÂÈ‰ÈÎ¤˜ ‰È·ÁÓˆÛÙÈÎ¤˜ Ì¤ıÔ‰ÔÈ Ú¤-

ÂÈ Ó· ÂÊ·ÚÌﬁ˙ÔÓÙ·È. ∂›ÛË˜, Ù· Â˘Ú‹Ì·Ù· ·ﬁ ÙÔ

∂¡À ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈÎ¿ ÌÂÙ·Í‡ ÙˆÓ ·ÛıÂ-

ÓÒÓ ÌÂ Î·È ¯ˆÚ›˜ ÙÂÎÌËÚÈˆÌ¤ÓË ¿ÛËÙË ÌËÓÈÁÁ›ÙÈ-

‰· ·ﬁ ÂÓÙÂÚÔ˚Ô‡˜.

∏ ÌËÓÈÁÁ›ÙÈ‰· ·ﬁ ÂÓÙÂÚÔ˚Ô‡˜ ·ÔÙÂÏÂ› ¤Ó· ‚Ú·-

¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÎÏÈÓÈÎﬁ Û‡Ó‰ÚÔÌÔ ÌÂ Ù˘ÈÎ‹ ·ÈÊÓ›-

‰È· ¤Ó·ÚÍË ÛÙ· ·È‰È¿. ∏ ·Ú·ÌÔÓ‹ ÙÔ˘ ·È‰ÈÔ‡

ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ Ù· ÚÒÙ· 24ˆÚ· ÙË˜

ÓﬁÛÔ˘, ¤ˆ˜ ﬁÙÔ˘ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙˆÓ Î·ÏÏÈÂÚÁÂÈ-

ÒÓ 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 ÓÔÛÔÎÔÌÂ›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.

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. §ÔÈÌÒÍÂÈ˜ ·ﬁ ÂÓÙÂÚÔ˚Ô‡˜. ™ÙÔ: ¢È·ÁÓˆÛÙÈÎ¿ Î·È ıÂÚ·Â˘ÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù·. ªÂÙÂÎ·È‰Â˘ÙÈÎﬁ ™ÂÌÈÓ¿ÚÈÔ ¶·È‰È·ÙÚÈÎ‹˜ 2000; ∞ı‹Ó·: µ’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¶·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. Ã·Ú›ÛË ª, ªÔ˘ÁÈÔ˘ÎÏ‹˜ ¶, °·Ï·Ó¿ÎË˜ ∂, ª·˘Ú›‰Ë˜ ∞, ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ ∑. ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ¿ÛËÙË˜ ÌËÓÈÁÁ›ÙÈ‰·˜ ·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Ë˜ π, º·ÚÌ¿ÎË ∂, ¶··ı·Ó·Û›Ô˘-∫ÏÒÓÙ˙· ¢, •·˚‰¿Ú· ∞. ∂˘Ú‹Ì·Ù· ∂¡À ÛÙËÓ ¿ÛËÙË ÛÂ Û¯¤ÛË ÌÂ ÙË ÌÈÎÚÔ‚È·Î‹ ÌËÓÈÁÁ›ÙÈ‰· [¶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. ¶·È‰È·ÙÚÈÎ‹ 2002;65:108-112 Paediatriki 2002;65:108-112

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

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 19-09-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 18-01-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ì·Ï›· ∆ÛÈÏÈÌÈÁÎ¿ÎË ∏ÚÔ‰ﬁÙÔ˘ 214, ¡¤· ∞ÏÈÎ·ÚÓ·ÛÛﬁ˜

∆.∫. 716 01, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

¶ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌﬁÙËÙ· ÛÙËÓ ∫Ú‹ÙË Ù·

∂. Ã·Ù˙Ë‰¿ÎË1, ∞. ª·ÓÔ˘Ú¿1, ∂. ∫ÔÚ·Î¿ÎË1, ∂. ¶·Ú·ÛÎ¿ÎË˜1, µ. µ·Ï¿ÚË1, ª. ∫ÔÚÔÔ‡ÏË1, ∂. °·Ï·Ó¿ÎË˜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 ∂ƒ∂À¡∏∆π∫∏

¶ÂÚ›ÏË„Ë: ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· ·ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ Ï¤ÔÓ ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙÂ˜

ÂÎÙ›ÌËÛË˜ ÙÔ˘ ÂÈ¤‰Ô˘ Ì·ÈÂ˘ÙÈÎ‹˜ Î·È ÓÂÔÁÓÈÎ‹˜ ÊÚÔÓÙ›‰·˜ Î·È ÁÂÓÈÎﬁÙÂÚ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜ Ì›·˜ ¯ÒÚ·˜. OÈ ‰È·Î˘Ì¿ÓÛÂÈ˜ ÙË˜ ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊﬁÚˆÓ ¯ˆÚÒÓ Â›Ó·È ÌÂÁ¿ÏÂ˜, ÌÂ Ù¿ÛÂÈ˜ Û˘ÓÂ¯Ô‡˜

ÌÂ›ˆÛË˜ ‰ÈÂıÓÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚﬁÓÈ·. ™ÎÔﬁ˜

ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙË˜

ÂÚÈÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌﬁÙËÙ·˜ ÙÔ ¤ÙÔ˜ 2000 Î·È Ë

Û‡ÁÎÚÈÛ‹ ÙË˜ ÌÂ Ù· ÛÙÔÈ¯Â›· ÙÔ˘ 1995 ÛÙÔ ÓËÛ› ÙË˜ ∫Ú‹ÙË˜. ∫·Ù·ÁÚ¿ÊËÎÂ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ, ÙˆÓ ıÓËÛÈÁÂÓÒÓ Î·È ÙˆÓ ı·Ó¿ÙˆÓ ÙË˜ ÚÒÙË˜ Â‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞fi Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ Ê·›ÓÂÙ·È fiÙÈ, ÛÙÔ ÓËÛ› Ì·˜, Ë ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈÎ‹ ÌÂ›ˆÛË ·fi 9,58ò

ÛÂ 7,2ò. ∏ ÂÌÊ¿ÓÈÛË ÂÓﬁ˜ Û˘ÁÎÚ›ÛÈÌÔ˘, ÌÂ ÙÈ˜

ÂÚÈÛÛfiÙÂÚÂ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜, ÔÛÔÛÙÔ‡ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ Î·Ù·‰ÂÈÎÓ‡ÂÈ ÙË ‚ÂÏÙ›ˆÛË Ô˘ ¤¯ÂÈ Â¤ÏıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ

ÂÚÈÁÂÓÓËÙÈÎ‹ ÊÚÔÓÙ›‰· ÛÙÔ ÓËÛ› Ì·˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌﬁÙËÙ·, ÂÚÈÁÂÓÓËÙÈÎ‹ ÊÚÔÓÙ›‰·.

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

¶ÂÚÈÁ. ·ÛÊ˘Í›·¶ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· ™˘Á. ·Ó/Ï›Â˜™˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ∂ÈÛÚ. ÌËÎ.∂ÈÛÚﬁÊËÛË ÌËÎˆÓ›Ô˘

∂ÈÛ·ÁˆÁ‹

∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· ·ÔÙÂÏÂ› ¤Ó·Ó ·fi ÙÔ˘˜ Ï¤ÔÓ ·ÍÈfiÈÛÙÔ˘˜ ‰Â›ÎÙÂ˜ ÂÎÙ›ÌËÛË˜ ÙÔ˘ ÂÈ¤‰Ô˘ Ì·ÈÂ˘ÙÈÎ‹˜ Î·È ÓÂÔÁÓÈÎ‹˜ ÊÚÔÓÙ›‰·˜

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.

Key words: perinatal mortality, perinatal care.

Î·È ÁÂÓÈÎfiÙÂÚ· ÙˆÓ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜ Ì›·˜ ¯ÒÚ·˜ (1,2). OÈ ‰È·Î˘Ì¿ÓÛÂÈ˜ ÙË˜ ÌÂÙ·Í‡ ÙˆÓ ‰È·ÊfiÚˆÓ ¯ˆÚÒÓ Â›Ó·È ÌÂÁ¿ÏÂ˜, ÌÂ Ù¿ÛÂÈ˜ Û˘ÓÂ¯Ô‡˜ ÌÂ›ˆÛË˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰ÈÂıÓÒ˜ (3-7). ∏ ‚ÂÏÙ›ˆÛË Ô˘ Û˘ÓÙÂÏ¤ÛÙËÎÂ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙ· ÔÛÔÛÙ¿ ÂÈ‚›ˆÛË˜ ÓÂÔÁÓÒÓ ÌÂ ÔÏ‡ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ˘‹ÚÍÂ ıÂ·Ì·ÙÈÎ‹ Î·È ·ÔÙÂÏÂ› ¤Ó· ·fi Ù· Ï¤ÔÓ ÛËÌ·ÓÙÈÎ¿ ÂÈÙÂ‡ÁÌ·Ù· ÙË˜ È·ÙÚÈÎ‹˜ ÙÔ˘ ÂÈÎÔÛÙÔ‡ ·ÈÒÓ· (8). ∏ ÚfiÔ‰Ô˜ ·˘Ù‹ ÔÊÂ›ÏÂÙ·È

1 Department of Neonatology of the University of Crete

2 Department of General Pediatrics of the University of Crete

¶·È‰È·ÙÚÈÎ‹

ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÓﬁËÛË ÙË˜ ·ıÔÏÔÁ›·˜ ÙÔ˘

ÚﬁˆÚÔ˘ ÓÂÔÁÓÔ‡, ÛÙÈ˜ ÂÍÂÏ›ÍÂÈ˜ ÙË˜ Ì·ÈÂ˘ÙÈÎ‹˜, ÛÙË ¯Ú‹ÛË ÚÔËÁÌ¤ÓË˜ ÙÂ¯ÓÔÏÔÁ›·˜ Î·È ÛÙË ‰ËÌÈ-

Ô˘ÚÁ›· Û‡Á¯ÚÔÓˆÓ ÓÂÔÁÓÔÏÔÁÈÎÒÓ ÌÔÓ¿‰ˆÓ Î·È

ÂÚÈÁÂÓÓËÙÈÎÒÓ Î¤ÓÙÚˆÓ, ÛÙÂÏÂ¯ˆÌ¤ÓˆÓ ÌÂ ÂÍÂÈ‰È-

ÎÂ˘Ì¤ÓÔ˘˜ Ì·ÈÂ˘Ù‹ÚÂ˜ Î·È ÓÂÔÁÓÔÏﬁÁÔ˘˜, ÈÎ·-

ÓÔ‡˜ Ó· ÊÚÔÓÙ›ÛÔ˘Ó ÙﬁÛÔ ÙËÓ ¤ÁÎ˘Ô ﬁÛÔ Î·È ÙÔ

ÓÂÔÁÓﬁ ÙË˜ (6,9).

O ﬁÚÔ˜ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌﬁÙËÙ· ·Ó·Ê¤ÚÂÙ·È

ÛÙÔÓ ·ÚÈıÌﬁ ÙˆÓ ı·Ó¿ÙˆÓ ·ﬁ ÙËÓ 28Ë Â‚‰ÔÌ¿‰·

ÙË˜ Î‡ËÛË˜ Ì¤¯ÚÈ ÙËÓ 7Ë ËÌ¤Ú· ÌÂÙ¿ ÙË Á¤ÓÓËÛË,

·Ó¿ 1000 ÁÂÓÓ‹ÛÂÈ˜ (1). ∏ ÂÈ‚›ˆÛË, ﬁÌˆ˜, ÓÂÔÁÓÒÓ

Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂÙ¿ ·ﬁ Î‡ËÛË 25 Â‚‰ÔÌ¿‰ˆÓ

‰ÂÓ Â›Ó·È Ï¤ÔÓ Û¿ÓÈÔ ÁÂÁÔÓﬁ˜, ÂÓÒ ¤¯ÂÈ ·Ó·ÊÂÚ-

ıÂ› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÈ‚›ˆÛË ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹-

ıËÎ·Ó ÌÂÙ¿ ·ﬁ Î‡ËÛË 24 ‹ Î·È 23 Â‚‰ÔÌ¿‰ˆÓ (8).

∫¿ıÂ ¯ÒÚ·, ÌÂ ‚¿ÛË ÙÔ Û‡ÓÙ·ÁÌ· Î·È ÙÔ˘˜ ÓﬁÌÔ˘˜

ÙË˜, ı¤ÙÂÈ Ù· ‰ÈÎ¿ ÙË˜ ﬁÚÈ· ‚ÈˆÛÈÌﬁÙËÙ·˜ Î·È ıÂ-

ÛÌÔıÂÙÂ› Ù· ‰ÈÎ¿ ÙË˜ ﬁÚÈ· Î·Ù·ÁÚ·Ê‹˜ ÙˆÓ ÂÌ-

‚Ú‡ˆÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÓÂÎÚ¿ ÛÙË ‰ÈÎ‹ ÙË˜ ÂÈÎÚ¿-

ÙÂÈ·. ∏ ¶·ÁÎﬁÛÌÈ· OÚÁ¿ÓˆÛË YÁÂ›·˜ ÚÔÙÂ›ÓÂÈ ÙËÓ Î·Ù·ÁÚ·Ê‹ Î¿ıÂ ÂÌ‚Ú‡Ô˘ ÌÂ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÙˆÓ 500 ÁÚ·ÌÌ·Ú›ˆÓ. ™Â ÔÏÏ¤˜ ·ﬁ ÙÈ˜

∏ÓˆÌ¤ÓÂ˜ ¶ÔÏÈÙÂ›Â˜ ÙË˜ ∞ÌÂÚÈÎ‹˜ Î¿ıÂ ÓÂÔÁÓﬁ Ô˘

ÁÂÓÓÈ¤Ù·È ÓÂÎÚﬁ ÌÂÙ¿ ·ﬁ Î‡ËÛË ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 20 Â‚‰ÔÌ¿‰ˆÓ Î·Ù·ÁÚ¿ÊÂÙ·È Û·Ó ıÓËÛÈÁÂÓ¤˜, ÂÓÒ

Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÛÙË °·ÏÏ›· Î¿ıÂ ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·-

ÙÔ˜ Ô˘ ÂÈÛ˘Ì‚·›ÓÂÈ ÚÈÓ ÙËÓ 28Ë Â‚‰ÔÌ¿‰· ÙË˜

Î‡ËÛË˜ ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È (10). ™‡ÌÊˆÓ· ÌÂ ÙËÓ

ÈÛ¯‡Ô˘Û· ·ﬁ ÙÔ 1976 ÓÔÌÔıÂÛ›· ÛÙË ¯ÒÚ· Ì·˜, Î·Ù·ÁÚ¿ÊÂÙ·È Û·Ó ÓÂÎÚﬁ Î¿ıÂ ¤Ì‚Ú˘Ô Ô˘ ÁÂÓÓÈ¤-

Ù·È ÌÂÙ¿ ·ﬁ Î‡ËÛË 180 ËÌÂÚÒÓ ‹ 25 Â‚‰ÔÌ¿‰ˆÓ

Î·È 5 ËÌÂÚÒÓ (11).

∞ﬁ ·ÓÂÏÏ‹ÓÈ· ÌÂÏ¤ÙË Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎÂ ÛÙË

¯ÒÚ· Ì·˜ ÙÔ 1983 ‚Ú¤ıËÎÂ ﬁÙÈ Ë ÂÚÈÁÂÓÓËÙÈÎ‹

ıÓËÛÈÌﬁÙËÙ· ‹Ù·Ó 23,8ò, ‰ÈÏ¿ÛÈ· ‹ ·ÎﬁÌ· Î·È

ÙÚÈÏ¿ÛÈ· ·fi ‚ÔÚÂÈÔÂ˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜, ÂÓÒ ·fi ·Ó¿ÏÔÁË ÌÂÏ¤ÙË ÙÔ 1998 ÚÔ¤Î˘„Â fiÙÈ Â›¯Â

ÌÂÈˆıÂ› ÛËÌ·ÓÙÈÎ¿ ÛÙÔ Â›Â‰Ô ÙÔ˘ 10,5ò (12,13).

™ÎÔﬁ˜ ÙË˜ ·ÚÔ‡Û·˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë Î·Ù·-

ÁÚ·Ê‹ ÙË˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌﬁÙËÙ·˜ ÙÔ ¤ÙÔ˜

2000 Î·È Ë Û‡ÁÎÚÈÛ‹ ÙË˜ ÌÂ Ù· ÛÙÔÈ¯Â›· ÙÔ˘ ¤ÙÔ˘˜

1995 ÛÙÔ ÓËÛ› ÙË˜ ∫Ú‹ÙË˜.

ÀÏÈÎﬁ Î·È Ì¤ıÔ‰Ô˜

∏ ∫Ú‹ÙË Â›Ó·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÓËÛ› ÙË˜ ÂÏÏËÓÈÎ‹˜ ÂÈÎÚ¿ÙÂÈ·˜. ∂›Ó·È Ì›· ÎÏÂÈÛÙ‹ ÎÔÈÓﬁÙËÙ· ÙË˜ ÂÏÏËÓÈÎ‹˜ ÂÚÈÊ¤ÚÂÈ·˜, Ô˘ ÏﬁÁˆ ÙË˜ ÁÂˆÁÚ·ÊÈÎ‹˜ ÙË˜ ı¤ÛË˜ Â›Ó·È ‰‡ÛÎÔÏË Ë ·Ó·˙‹ÙËÛË ÊÚÔÓÙ›‰·˜ ˘ÁÂ›·˜ ÛÙÔ Î¤ÓÙÚÔ.

ÙËÓ ÔÈﬁÙËÙ· ·ÚÔ¯‹˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ÊÚÔÓÙ›‰·˜. ™ÙËÓ Â˘Ú‡ÙÂÚË ÂÚÈÔ¯‹ ÙÔ˘ ÓËÛÈÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡Ó ¤ÍÈ È‰ÈˆÙÈÎ¤˜ Ì·È-

Â˘ÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜ Î·È ÂÙ¿ Ì·ÈÂ˘ÙÈÎ¤˜ ÎÏÈÓÈÎ¤˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁÂ›·˜, ÂÓÒ Ë Ì·ÈÂ˘ÙÈÎ‹ ÎÏÈÓÈÎ‹ Ô˘ ÏÂÈÙÔ˘ÚÁÂ› Ù·

ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔ ·ÓÂÈÛÙËÌÈ·Îfi ÓÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏÂ›Ô˘ ·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 Ì¤ÚÔ˜ ÙˆÓ ÙÔÎÂÙÒÓ ÛÙÔ ÓËÛ› Î·Ï‡ÙÂÙ·È ·fi

ÂÈ‰ÈÎÂ˘Ì¤ÓÔ ÓÂÔÁÓÔÏﬁÁÔ.

∫·Ù·ÁÚ¿„·ÌÂ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ, Ù· ıÓËÛÈÁÂÓ‹ Î·È Ù· ÓÂÔÁÓ¿ Ô˘ ¤ı·Ó·Ó ÙÈ˜ ÚÒÙÂ˜ 7 ËÌ¤ÚÂ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÛÙËÓ ÂÚÈÔ¯‹ ÙË˜ ∫Ú‹ÙË˜. ™ÙÔÓ ˘ÔÏÔÁÈÛÌﬁ ÙË˜ ÂÚÈ-

ÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌﬁÙËÙ·˜ Û˘ÌÂÚÈÏ¿‚·ÌÂ ÓÂÔÁÓ¿ Ô˘ ¤ı·-

Ó·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Î·È Ù· ¤Ì‚Ú˘·

Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÓÂÎÚ¿ ÌÂ ËÏÈÎ›· Î‡ËÛË˜ ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 28

Â‚‰ÔÌ¿‰ˆÓ ‹ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜ ÌÂÁ·Ï‡ÙÂÚÔ ‹ ›ÛÔ ÙˆÓ 500 ÁÚ·ÌÌ·Ú›ˆÓ. ∆· ÛÙÔÈ¯Â›· Ì·˜ ·ÓÙÏ‹ıËÎ·Ó ·ﬁ Ù· ‚È‚Ï›· Ô˘

ÙËÚÔ‡ÓÙ·È ÛÙ· Ì·ÈÂ˘Ù‹ÚÈ· Î·È ÛÙÈ˜ ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ.

∆Ô ¤ÙÔ˜ 2000 ÁÂÓÓ‹ıËÎ·Ó 6513 ÓÂÔÁÓ¿. ¢ÂÎ·¤ÓÙÂ ÓÂÔÁÓ¿ ¤ı·Ó·Ó ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Á¤ÓÓËÛË (2,3ò), ÂÓÒ 32 ‹Ù·Ó ıÓËÛÈÁÂÓ‹ (4,9ò). ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· ‚Ú¤ıËÎÂ 7,2ò. ∫·Ù¿ ÙÔ ¤ÙÔ˜ 1995 ÁÂÓÓ‹ıËÎ·Ó 6114 ÓÂÔÁÓ¿. O ·ÚÈıÌfi˜ ÙˆÓ ı·Ó¿ÙˆÓ ÙË˜ ÚÒÙË˜ Â‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‹Ù·Ó 20 ÓÂÔÁÓ¿ (3,27ò), ÂÓÒ Ù· ıÓËÛÈÁÂÓ‹ ‹Ù·Ó 39 (6,38ò). ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó 9,58ò (™¯‹Ì· 1). ∆· ÓÂÔÁÓ¿ ÌÂÏÂÙ‹ıËÎ·Ó ·Ó¿ÏÔÁ· ÌÂ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛË˜, ·ÊÔ‡ ¯ˆÚ›ÛÙËÎ·Ó ÛÙÈ˜ ·Ú·Î¿Ùˆ ÔÌ¿‰Â˜: 5001000 g, 1001-1500 g, 1501-2000 g, 2001-2500 g Î·È >2500 g. ™¯ÂÙÈÎ¿ ÌÂ ÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ıÓËÛÈÁÂÓÒÓ ·Ó¿ÏÔÁ· ÌÂ ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜, ˆ˜ ÔÛÔÛÙfi ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓËı¤ÓÙˆÓ ÛÂ ·˘Ù‹ ÙËÓ ÔÌ¿‰·

ÓÂÔÁÓÒÓ ·Ú·ÙËÚ‹ıËÎÂ ÌÂ›ˆÛË ÛÂ ﬁÏÂ˜ ÙÈ˜

ÔÌ¿‰Â˜ (™¯‹Ì· 2). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÙ›· ÙˆÓ ı·Ó¿ÙˆÓ ÙË˜ ÚÒÙË˜ Â‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË

1995 ∫ƒ∏∆∏ 2000

∫ƒ∏∆∏ 1995 ∫ƒ∏∆∏ 2000

™¯‹Ì· 2. ∫·Ù·ÓÔÌ‹ (%) ÙˆÓ ıÓËÛÈÁÂÓÒÓ ·Ó¿ÏÔÁ· ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ ˆ˜

ÙÔ˘ Û˘ÓﬁÏÔ˘ ÙˆÓ ÁÂÓÓËı¤ÓÙˆÓ ÛÂ ·˘Ù‹ ÙËÓ ÔÌ¿‰· ÓÂÔÁÓÒÓ Î·Ù¿ Ù· ¤ÙË 1995 Î·È 2000.

Î·Ù¿ ÙÔ 2000, ÛËÌÂÈÒıËÎÂ ÌÈÎÚ‹ ·‡ÍËÛË ÙË˜ ÛË„·ÈÌ›·˜, ÂÓÒ Ë ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›· Î·È ÔÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ ÌÂÈÒıËÎ·Ó (™¯‹Ì· 3). ∞fi Ù· 6513 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÙÔ 2000, 695 ÚÔ‹Ïı·Ó ·fi ·ÏÏÔ‰·¤˜ ÔÈÎÔÁ¤ÓÂÈÂ˜, ÂÓÒ ÙÔ 1995 Ô ·ÓÙ›ÛÙÔÈ¯Ô˜ ·ÚÈıÌfi˜ ‹Ù·Ó 58 ÓÂÔÁÓ¿.

™˘˙‹ÙËÛË

∏

ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌﬁÙËÙ·, Ù· ÙÂÏÂ˘Ù·›·

¯ÚﬁÓÈ· ÛÙÔ ÓËÛ› Ì·˜, ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈÎ‹

Ú·ÎÔÏÔ‡ıËÛË ÙË˜ ÂÈÙﬁÎÔ˘ Î·È ÛÙËÓ ·ÚÔ˘Û›·

ÂÍÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ ·ÙfiÌÔ˘, ÈÎ·ÓÔ‡ Ó· Î¿ÓÂÈ ·Ó¿ÓË„Ë ÛÙÔ ÓÂÔÁÓfi ÛÂ ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÙÔÎÂÙÒÓ. ¶·-

Ú¿ÏÏËÏ·, ·Ú·ÙËÚ‹ıËÎÂ ·‡ÍËÛË ÙË˜ Û˘¯ÓﬁÙËÙ·˜

ÙË˜ ÚÔˆÚﬁÙËÙ·˜ Î·È ÙË˜ ÛË„·ÈÌ›·˜ Û·Ó ·ÈÙ›·˜

™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ ‰ÈÂÓÂÚÁ‹ıËÎÂ È·ÙÚÔ‰ÈÎ·ÛÙÈÎ‹ Ú·ÁÌ·ÙÔÁÓˆÌÔÛ‡ÓË, ÔﬁÙÂ Î·È Ô ÚÔÛ‰ÈÔÚÈÛÌﬁ˜ ÙË˜ ·ÈÙ›·˜

ÛÂ Û¯¤ÛË ÌÂ ¿ÏÏÂ˜ ÚÔËÁÌ¤ÓÂ˜

ÁÓˆÛÙfi fiÙÈ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÙÔ 1983

ÌÂ›ˆÛË ·ﬁ 9,58ò ÙÔ 1995 ÛÂ 7,2ò ÙÔ 2000. ∂›Ó·È

ÛÙËÓ ∂ÏÏ¿‰· ‹Ù·Ó 23,8ò, ÙÔ 1991 ÌÂÈÒıËÎÂ ÛÂ 11,06ò ÁÈ· Ó· ÊÙ¿ÛÂÈ ÛÙÔ 9,1ò ÙÔ 1998 (12-14). ∞ÓÙ›ÛÙÔÈ¯·, ÛÂ ∂˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜ 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¿ ÙÈ˜ ‰˘ÛÎÔÏ›Â˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙË ‰È·ÎÚ·ÙÈÎ‹ Û‡ÁÎÚÈÛË, Ë ÂÌÊ¿ÓÈÛË ÂÓfi˜ Û˘ÁÎÚ›ÛÈÌÔ˘ ÌÂ ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ Â˘Úˆ·˚Î¤˜ ¯ÒÚÂ˜ ÔÛÔÛÙÔ‡ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌfiÙËÙ·˜ Î·Ù·‰ÂÈÎÓ‡ÂÈ ÙË ‚ÂÏÙ›ˆÛË Ô˘ ¤¯ÂÈ Â¤ÏıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ ÊÚÔÓÙ›‰· ÛÙÔ ÓËÛ› Ì·˜. ∏ ÌÂ›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ıÓËÛÈÁÂÓÒÓ ÓÂÔÁÓÒÓ ·fi 6,38ò ÙÔ 1995 ÛÂ 4,9ò ÙÔ 2000 ·ÓÙ·Ó·ÎÏ¿ ÙËÓ Î·Ï‡ÙÂÚË ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÁÎ‡ˆÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ Î˘‹ÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∏ ÌÂ›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ı·Ó¿ÙˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜ ÚÒÙË˜ Â‚‰ÔÌ¿‰·˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·fi 3,27ò ÛÂ 2,3ò ·Ô‰›‰ÂÙ·È ÛÙË ÏÂÈÙÔ˘ÚÁ›· Û‡Á¯ÚÔÓˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙÔ ÓËÛ›, ·ÏÏ¿ Î·È ÛÙË ÛˆÛÙfiÙÂÚË Ì·ÈÂ˘ÙÈÎ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË Û˘ÓÂÚÁ·Û›· Ì·ÈÂ˘Ù‹ÚˆÓ-ÓÂÔÁÓÔÏfiÁˆÓ. ∏ ÂÚÈÁÂÓÓËÙÈÎ‹ ·ÛÊ˘Í›·, Û·Ó ·ÈÙ›· ı·Ó¿ÙÔ˘, ÌÂÈÒıËÎÂ ÛËÌ·ÓÙÈÎ¿, fiˆ˜ Î·È Ë ÂÈÛÚfiÊËÛË ÌËÎˆÓ›Ô˘, ÁÂÁÔÓfi˜ Ô˘ ı· ÌÔÚÔ‡ÛÂ Ó· ·Ô‰ÔıÂ› ÛÙËÓ Î·Ï‡ÙÂÚË Ì·ÈÂ˘ÙÈÎ‹ ·-

ﬁÔ˘ Û·Ó Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ Î·Ù¿ ÙËÓ Â-

ÂÚ›Ô‰Ô ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜ (1,15,16). °È· Ó· ÂÈÙÂ˘¯ıÂ› Ë ÛˆÛÙ‹ Û˘Û¯¤ÙÈÛË ·˘ÙÒÓ ÙˆÓ ı·Ó¿ÙˆÓ ÌÂ ÙËÓ ÔÈﬁÙËÙ· ·ÚÔ¯‹˜ ˘ÁÂ›·˜ Î·È

ÛÙË Û˘Ó¤¯ÂÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó Î·ÙÂ˘ı˘ÓÙ‹ÚÈÂ˜

ÁÚ·ÌÌ¤˜ ·Ú¤Ì‚·ÛË˜, ı· Ú¤ÂÈ, ÂÎÙﬁ˜ ·ﬁ ÙÈ˜

Û˘Óı‹ÎÂ˜ ÓÔÛËÏÂ›·˜ ÛÙË Û˘ÁÎÂÎÚÈÌ¤ÓË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜, Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘’ fi„Ë ÔÈ Û˘Óı‹ÎÂ˜ ÌÂ ÙÈ˜ ÔÔ›Â˜ ‰ÈÂÓÂÚÁ‹ıËÎÂ Ô ÙÔÎÂÙfi˜, ÔÈ Û˘Óı‹ÎÂ˜ ·Ó¿ÓË„Ë˜ Î·È ÌÂÙ·ÊÔÚ¿˜ ÙÔ˘ ÚÔÒÚÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ, ·ÏÏ¿ Î·È Ë Â·ÚÎ‹˜ ‹ fi¯È ·Ú·ÎÔÏÔ‡ıËÛË Î·È

ÚÔÂÙÔÈÌ·Û›· ÙË˜ ÂÈÙfiÎÔ˘, Ë ¯ÔÚ‹ÁËÛË ‹ fi¯È ÎÔÚÙÈÎÔÂÈ‰ÒÓ ÛÙËÓ ¤ÁÎ˘Ô ÌÂ ÛÙfi¯Ô ÙËÓ ÂÈÙ¿¯˘ÓÛË

ÙË˜ ˆÚ›Ì·ÓÛË˜ ÙˆÓ ÓÂ˘ÌﬁÓˆÓ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È

ÙË ÌÂ›ˆÛË ÙË˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, ·ÏÏ¿ Î·È Ë ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙË˜ ÂÓ‰Â¯fiÌÂÓË˜ ÚfiˆÚË˜ Ú‹ÍË˜ ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ Ô˘ ÂÎÙfi˜ ·fi

ÙËÓ ÚﬁÎÏËÛË ÚﬁˆÚÔ˘ ÙÔÎÂÙÔ‡, ÚÔ‰È·ı¤ÙÂÈ

ÛÙËÓ ·Ó¿Ù˘ÍË ÚÒÈÌˆÓ ÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒÍÂˆÓ, ÂÈ‚·Ú‡ÓÔÓÙ·˜ ÛËÌ·ÓÙÈÎ¿ ÙÔ ÌÈÎÚﬁ ÚﬁˆÚÔ Î·È

·ÓÒÚÈÌÔ ÓÂÔÁÓfi (17-20). ∫‡ÚÈÔ˜ ÛÙfi¯Ô˜ fiÏˆÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È ÌÂ ÙËÓ ÂÚÈÁÂÓÓËÙÈÎ‹ È·ÙÚÈÎ‹ ÛÂ ·ÁÎfiÛÌÈÔ Â›Â‰Ô Â›Ó·È Ë ·Ó·ÛÙÔÏ‹ ‹ ¤ÛÙˆ Î·È Ë Î·ı˘ÛÙ¤ÚËÛË ÙÔ˘

ÚﬁˆÚÔ ÙÔÎÂÙﬁ, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ Î˘‹ÛÂˆÓ

˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ÙËÓ ·Ó·˙‹ÙËÛË ÊÚÔÓÙ›‰·˜

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ÙfiÛÔ ÙËÓ ¤ÁÎ˘Ô fiÛÔ Î·È ÙÔ ÚfiˆÚÔ ÓÂÔÁÓfi ÙË˜

(4,9). ™ËÌ·ÓÙÈÎ‹ Â›ÛË˜ ıÂˆÚÂ›Ù·È Ë ÛÙÂÏ¤¯ˆÛË

ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜ ¡ÂÔÁÓÒÓ ÌÂ

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ÌÂÙ·ÊÔÚ¿˜ ÓÂÔÁÓÒÓ ÛÙÂÏÂ¯ˆÌ¤ÓÔ˘ ÌÂ ¤ÌÂÈÚÔ˘˜

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ÏÈÛÌﬁ, ÛÙÔÈ¯Â›Ô Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ·

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Î·Ù¿ ÙÔ ‰˘Ó·ÙﬁÓ Ë ÂÈ‚¿Ú˘ÓÛË Ô˘ ˘Ê›ÛÙ·Ù·È ÙÔ

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ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈÎ‹˜ ¡ÔÛËÏÂ›·˜

¡ÂÔÁÓÒÓ, Ô˘ ﬁˆ˜ Â›Ó·È ÁÓˆÛÙﬁ ¤¯ÂÈ Û¯ÂÙÈÛÙÂ›

ÌÂ ·˘ÍËÌ¤ÓË ÓÔÛËÚﬁÙËÙ· Î·È ıÓËÛÈÌﬁÙËÙ· (17).

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ﬁÙÈ ·ﬁ Ù· 6513 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙËÓ

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ÚﬁÛÊ˘ÁÂ˜ Ô˘ ¤¯Ô˘Ó ¤ÚıÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚﬁÓÈ·

ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· ·Ó·˙‹ÙËÛË ÂÚÁ·Û›·˜ Î˘Ú›ˆ˜ ·ﬁ ÙËÓ ∞Ï‚·Ó›·, ÙË µÔ˘ÏÁ·Ú›· Î·È ·ﬁ ¯ÒÚÂ˜

ÙË˜ ÚÒËÓ ™Ô‚ÈÂÙÈÎ‹˜ ŒÓˆÛË˜. ªÂ ‚¿ÛË ÙÔ ÁÂÁÔ-

Ófi˜ fiÙÈ ÙÔ 1995 Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ‹Ù·Ó Î·Ù¿ ÔÏ‡

ÌÈÎÚﬁÙÂÚÔ˜, ÛËÌÂÈÒÓÂÙ·È Ì›· Û¯ÂÙÈÎ‹ ÌÂ›ˆÛË ÛÙÔÓ

·ÚÈıÌﬁ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ·ﬁ ÂÏÏËÓÈ-

Î¤˜ ÔÈÎÔÁ¤ÓÂÈÂ˜. ∞ﬁ ·˘Ù‹ ÙËÓ ·Ú·Ù‹ÚËÛË ˘Ô-

ÛËÌ·›ÓÂÙ·È ÁÈ· ¿ÏÏË Ì›· ÊÔÚ¿ ÙÔ Úﬁ‚ÏËÌ· ÙË˜

ÌÂ›ˆÛË˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÛÙËÓ ÂÏÏËÓÈ-

Î‹ ÔÈÎÔÁ¤ÓÂÈ·. ∞˘ÙÔ› ÔÈ ¿ÓıÚˆÔÈ, ÛÂ ·ÚÎÂÙ¤˜ Â-

ÚÈÙÒÛÂÈ˜, ˙Ô˘Ó ÛÂ Û˘Óı‹ÎÂ˜ Î¿Ùˆ ·ﬁ Ù· ﬁÚÈ·

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ÓÈÎ‹ ÚﬁÓÔÈ· Î·È Ë Î·ıÔ‰‹ÁËÛ‹ ÙÔ˘˜ ÁÈ· ·Ó·˙‹ÙË-

ÛË ·ÚÔ¯‹˜ ÂÚÈÁÂÓÓËÙÈÎ‹˜ ÊÚÔÓÙ›‰·˜ ·ﬁ ÙÈ˜

˘ËÚÂÛ›Â˜ ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁÂ›·˜ ı·

ÌÔÚÔ‡ÛÂ ‰˘ÓËÙÈÎ¿ Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ Â›ÙÂ˘ÍË

ÙÔ˘ ÛÙﬁ¯Ô˘ Ì·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ÌÂ›ˆÛË ÙË˜ ÂÚÈ-

ÁÂÓÓËÙÈÎ‹˜ ıÓËÛÈÌﬁÙËÙ·˜. ™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÂÚÈÁÂÓÓËÙÈÎ‹ ıÓËÛÈÌﬁÙË-

Ù· ÛÙË ∫Ú‹ÙË Ù· ÙÂÏÂ˘Ù·›· ¯ÚﬁÓÈ· ¤¯ÂÈ ÌÂÈˆıÂ›

ÛËÌ·ÓÙÈÎ¿. ∏ ÌÂ›ˆÛ‹ ÙË˜ ·Ô‰›‰ÂÙ·È ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ·ÚÂ¯ﬁÌÂÓˆÓ ˘ËÚÂÛÈÒÓ ˘ÁÂ›·˜ ÛÙËÓ

¤ÁÎ˘Ô ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔÁÓﬁ ÙË˜. À¿Ú¯Ô˘Ó

µÈ‚ÏÈÔÁÚ·Ê›·

Paediatriki 2002;65:113-117

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 Ú¿ÍÂˆÓ. ¡ﬁÌÔ˜ 344/1976 ¿ÚıÚÔ 37 “ÂÚ› ÏËÍÈ·Ú¯ÈÎÒÓ Ú¿ÍÂˆÓ”.

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·ÎÔ‡Ï· Ã, §ÂÎ¤· µ, ∫·‚‚·‰›· °, ª·ÎÚ‹ ∞, KÔ˘ÙÛÔ‚›ÙË ¶, ª·ÙÛ·ÓÈÒÙË ¡. ¶Ú·ÎÙÈÎ¿ ÙË˜ ∞Î·‰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 ¶·È‰È·ÙÚÈÎ‹ 2002;65:113-117

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.

20. Ernest JM. Neonatal consequences of preterm PROM. Clin Obstet Gynecol 1998;41:827-831.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-09-2001

HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 21-02-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘

∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ ∫Ú‹ÙË˜

E-mail: ekibolos@med.uoc.gr

™ÙÈ˜ ·Ó·Ù˘ÛÛﬁÌÂÓÂ˜ ¯ÒÚÂ˜, ÔÏÏ¿ ·È‰È¿ ÌÂ ÏÔ›ÌˆÍË ·ﬁ

ÙÔÓ Èﬁ ÙË˜ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (HIV) ¯ÚÂÈ¿˙ÔÓÙ·È ÓÔ-

ÛËÏÂ›· ÛÙË ª∂£, ﬁÌˆ˜ Ï›Á· Â›Ó·È ÁÓˆÛÙ¿ ·Ó·ÊÔÚÈÎ¿ ÌÂ ÙËÓ

·ÈÙÈÔÏÔÁ›· ÙË˜ ÓÂ˘ÌÔÓ›·˜ Î·È ÙËÓ Â›‰Ú·ÛË ÙË˜ ÓÔÛËÏÂ›·˜

ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙË ª∂£.

™ÎÔﬁ˜: ∏ Û‡ÁÎÚÈÛË ÙË˜ ·ÈÙÈÔÏÔÁ›·˜ Î·È ÙË˜ ¤Î‚·ÛË˜ ÙË˜

ÓÂ˘ÌÔÓ›·˜ ÛÂ HIV-ÔÚÚÔıÂÙÈÎÔ‡˜ [HIV(+)] Î·È HIV-ÔÚÚÔ·Ú-

ÓËÙÈÎÔ‡˜ [HIV(-)] ·ÛıÂÓÂ›˜.

™¯Â‰È·ÛÌﬁ˜: ¶ÚÔÔÙÈÎ‹ ÌÂÏ¤ÙË.

ÃÒÚÔ˜: ¢‡Ô ª∂£ ·È‰ÈÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ ∫·ÈËÙ¿-

Ô˘Ó ÛÙË ÓﬁÙÈ· ∞ÊÚÈÎ‹.

∞ÛıÂÓÂ›˜: ŸÏ· Ù· ·È‰È¿ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÌÂ ÓÂ˘ÌÔÓ›· Î·Ù¿

ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ 1998.

ªÂÙÚ‹ÛÂÈ˜ Î·È Î˘ÚÈﬁÙÂÚ· ·ÔÙÂÏ¤ÛÌ·Ù·: °È· ÙË ÌÂÏ¤ÙË ¤ÁÈ-

ÓÂ Û˘ÏÏÔÁ‹ ÎÏÈÓÈÎÒÓ, ‰ËÌÔÁÚ·ÊÈÎÒÓ, ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È

·Ó·ÓÂ˘ÛÙÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ, Î·ıÒ˜ Î·È Ï‹„Ë ·›Ì·ÙÔ˜ ÁÈ· ÂÚÁ·ÛÙËÚÈ·Î¤˜ ÂÍÂÙ¿ÛÂÈ˜. ¶Ù‡ÂÏ· ‹ ‚ÚÔÁ¯ÔÎ˘„ÂÏÈ‰ÈÎfi ¤ÎÏ˘Ì· (BAL) ÂÏ¤Á¯ÔÓÙ·Ó ÁÈ· ÓÂ˘ÌÔÓÔÎ‡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 ÌÂÏ¤ÙË. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, 15/21 (71,4%) HIV(+) ·È‰È¿ Â›¯·Ó AIDS. §Ô›ÌˆÍË ·fi PC ‰È·ÈÛÙÒıËÎÂ ÛÂ 8 HIV(+) ·È‰È¿ [8/15 (38%) ÙˆÓ ·È‰ÈÒÓ ÌÂ AIDS] Î·È ÛÂ 1 HIV(-). ™Â 7/15 (47%) HIV(+) ·ÛıÂÓÂ›˜, ‹Ù·Ó ÙÔ ›‰ÈÔ ÙÔ AIDS Ô˘ Î·ıfiÚÈ˙Â ÙË ÛÔ‚·ÚfiÙËÙ· ÙË˜ ÓfiÛËÛË˜. ∏ Û˘¯ÓfiÙËÙ· ÙË˜ 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 ÓÂ˘ÌÔÓÈfiÎÔÎÎÔ˜ Î·È Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ‹Ù·Ó Ù· Û˘¯ÓfiÙÂÚ· ÛÙÂÏ¤¯Ë Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ÛÙÔ ·›Ì·. ∞fi Ù· Ù‡ÂÏ· Î·È ÙÔ BAL ·ÔÌÔÓÒıËÎ·Ó Ù· ›‰È· ÌÈÎÚÔ‚È·Î¿ ÛÙÂÏ¤¯Ë Î·È ÈÔ›, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓÔ˘ Î·È ÙÔ˘ ªµ

ÛÂ 6 (8%) ÂÚÈÙÒÛÂÈ˜, ·ÓÂÍ¿ÚÙËÙ· ÙË˜ HIV(+) ‹ (-) Î·Ù¿ÛÙ·ÛË˜. ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ (ª∞) ÂÊ·ÚÌfiÛÙËÎÂ ÛÂ 8/21 ·ÛıÂÓÂ›˜ (38%) HIV(+) Î·È ÛÂ 28/55 (51%) HIV(-), (p=0,32). ∏

Ì¤ÛË ‰È¿ÚÎÂÈ· ÛÂ ËÌ¤ÚÂ˜ ÙÔ˘ ª∞ (3), ÙË˜ ÓÔÛËÏÂ›·˜ ÛÙË ª∂£ (5) Î·È ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (11) ‰ÂÓ ‰È¤ÊÂÚÂ ÛÙÈ˜ ‰‡Ô ÔÌ¿‰Â˜. ∏ ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·Î‹ ıÓËÙfiÙËÙ· ‹Ù·Ó ‰ÈÏ¿ÛÈ· ÛÙÔ˘˜ HIV(+) ·ÛıÂÓÂ›˜ [6/21 (28,6%)] ·fi ÙÔ˘˜ HIV(-) ·ÛıÂÓÂ›˜ [8/55 (14,5%)], [Û¯ÂÙÈÎfi˜ Î›Ó‰˘ÓÔ˜ (RR) 1,96, (p=0,16). ™˘ÌÂÚ¿ÛÌ·Ù·: ¶ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 1/4 ÙˆÓ ·È‰ÈÒÓ ÙË˜ ÁÂˆÁÚ·ÊÈÎ‹˜ ÂÚÈÔ¯‹˜ ÙË˜ ÌÂÏ¤ÙË˜ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙË ª∂£ ÁÈ· ÓÂ˘ÌÔÓ›·, Â›Ó·È HIV(+), ÌÂ Ù· ÈÔ ÔÏÏ¿ Ó· ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ÌÂ ÙËÓ Â›ÛÔ‰Ô ÛÙË ª∂£. ∏ ÏÔ›ÌˆÍË ·fi PC Â›Ó·È ÂÓ‰ÂÈÎÙÈÎ‹ ÁÈ· AIDS. ∆· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘ÓıÂ› ·fi ÙÔÓ Èfi [HIV(+)] Î·È ÂÈÛ¿ÁÔÓÙ·È ÛÙË ª∂£ ÁÈ· ÓÂ˘ÌÔÓ›·, Â›¯·Ó ¯ÂÈÚfiÙÂÚË ¤Î‚·ÛË ·fi fiÙÈ Ù· HIV(-) ·È‰È¿, Ë ‰È·ÊÔÚ¿ fiÌˆ˜ ·˘Ù‹ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈÎ¿ ÛËÌ·ÓÙÈÎ‹ ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ

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1Zar 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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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 ∂ƒ∂À¡∏∆π∫∏

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14-16 ÂÙÒÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜

ÁÈ· ÙËÓ ·ÓÂ‡ÚÂÛË ÊÔÚ¤ˆÓ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ Î·È ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜.

µÚ¤ıËÎ·Ó 99 Ì·ıËÙ¤˜ ÊÔÚÂ›˜ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ (ÔÛÔÛÙﬁ 9,45%) Î·È 24 Ì·ıËÙ¤˜ ÊÔÚÂ›˜ ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ (ÔÛÔÛÙﬁ 2,29%). ∏ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÔÓÈ‰È·ÎÒÓ

ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÂ 86 ·ﬁ ÙÔ˘˜ 99 ÊÔÚÂ›˜ ÙË˜ ‚-ÌÂ-

ÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ¤‰ÂÈÍÂ ﬁÙÈ Ë Û˘¯ÓﬁÙËÙ· Î·È Ô

Ù‡Ô˜ ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È ·ÚﬁÌÔÈ· ÌÂ ·˘Ù¿

ÛÙÔ ÁÂÓÈÎfi ∂ÏÏËÓÈÎfi ÏËı˘ÛÌfi ÌÂ ÌÈÎÚ¤˜ ‰È·ÊÔ-

ÚÔÔÈ‹ÛÂÈ˜. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤‰ÂÈÍÂ ﬁÙÈ ÙÔ

80% ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ·ÊÔÚÔ‡Û·Ó Î˘Ú›ˆ˜ ÙÈ˜

ÙÚÂÈ˜ ·ÎﬁÏÔ˘ıÂ˜: 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 ÛÂ ÚÔÁÚ¿Ì-

Ì·Ù· ·Ó›¯ÓÂ˘ÛË˜ ÙˆÓ ÁÔÓÈ‰È·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ

ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜, ÛÙËÓ ÚÔÁÂÓÓËÙÈÎ‹

‰È¿ÁÓˆÛË Î·È ÁÂÓÈÎ¿ ÛÙo Û¯Â‰È·ÛÌﬁ ÚﬁÏË„Ë˜ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ‚-ı·Ï·ÛÛ·ÈÌ›·, ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›·, ÌÂÙ·ÏÏ¿ÍÂÈ˜.

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 (G→A) (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.

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

1 ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ °ÂÓÈÎÔ‡ ¡ÔÌ·Ú¯È·ÎÔ‡ ¡ÔÛÔÎÔÌÂ›Ô˘ ∫·Ú‰›ÙÛ·˜

1 Pediatric Clinic, General Hospital of Karditsa

2 Laboratory of Medical Genetics, University of Athens

3 1st Pediatric Clinic, Ippokration Hospital of Thessaloniki

∏ ÂÚÁ·Û›· ·˘Ù‹ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ ÌÂ ÛÎÔﬁ ÙËÓ ÂÓËÌ¤ÚˆÛË ÙˆÓ Ì·ıËÙÒÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘

ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ÁÈ· Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿, ÙËÓ ·ÓÂ‡-

ÚÂÛË ÙˆÓ Ì·ıËÙÒÓ ÔÈ ÔÔ›ÔÈ Â›Ó·È ÊÔÚÂ›˜ ÙˆÓ Û˘Á-

ÁÂÓÒÓ ·˘ÙÒÓ ·ÈÌÔÏ˘ÙÈÎÒÓ ·Ó·ÈÌÈÒÓ, ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Î·È

ÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ Û¯ÂÙÈÎ¿ ÌÂ ÙËÓ Èı·ÓfiÙËÙ· ·fiÎÙËÛË˜ ·È‰ÈÔ‡ ÌÂ ¤Ó· ·fi ·˘Ù¿ Ù· ÓÔÛ‹Ì·Ù·.

ÀÏÈÎﬁ Î·È Ì¤ıÔ‰ÔÈ

∂Ï¤Á¯ıËÎ·Ó 1048 Ì·ıËÙ¤˜ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡

∫·Ú‰›ÙÛ·˜, ËÏÈÎ›·˜ 14-16 ÂÙÒÓ. ™Â Î¿ıÂ Á˘ÌÓ¿ÛÈÔ ¤Ó·˜ ÁÈ·ÙÚﬁ˜ ÙË˜ ÂÚÂ˘ÓËÙÈÎ‹˜ ÔÌ¿‰·˜ ¤‰ÈÓÂ Ì›· ÔÌÈÏ›· ÛÂ ﬁÏÔ˘˜

ÙÔ˘˜ Ì·ıËÙ¤˜ Û¯ÂÙÈÎ¿ ÌÂ ÙË ÌÂÛÔÁÂÈ·Î‹ Î·È ÙË ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹ ·Ó·ÈÌ›·, ÙÔÓ ÙÚﬁÔ ÙË˜ ÎÏËÚÔÓÔÌÈÎﬁÙËÙ¿˜ ÙÔ˘˜ Î·È

ÙÈ˜ ÌÂıfi‰Ô˘˜ ÚfiÏË„Ë˜ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ. ™ÙÔ˘˜ Ì·ıËÙ¤˜ ÙË˜ ‰Â‡ÙÂÚË˜ Ù¿ÍË˜ ÙÔ˘ °˘ÌÓ·Û›Ô˘ (µ’), ÔÈ ÔÔ›ÔÈ ¤ÊÂÚ·Ó ÂÓ˘fiÁÚ·ÊË ÙË Û˘ÁÎ·Ù¿ıÂÛË ÙÔ˘ ÁÔÓ¤·-ÎË‰ÂÌfiÓ·

ÙÔ˘˜, ÁÈÓﬁÙ·Ó ·ÈÌÔÏË„›· ·ﬁ ÓÔÛËÏÂ‡ÙÚÈÂ˜ ÙÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ ∫·Ú‰›ÙÛ·˜.

O ÂÚÁ·ÛÙËÚÈ·Îﬁ˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·ÓÂ Ì¤ÙÚËÛË ÙÔ˘

·ÚÈıÌÔ‡ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÙˆÓ ÏÂ˘ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ MCV, MCH, MCHC, RDW ÌÂ ·ÈÌ·ÙÔÏÔÁÈÎﬁ ·Ó·Ï˘Ù‹, ÌÂÏ¤ÙË ÙË˜ ÌÔÚÊÔÏÔÁ›·˜ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÂ

Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Ì¤ÙÚËÛË ÙË˜ ÊÂÚÚÈÙ›ÓË˜ ÙÔ˘ ÔÚÔ‡, ËÏÂÎÙÚÔÊﬁÚËÛË ·ÈÌÔÛÊ·ÈÚ›ÓË˜ ÛÂ Ù·ÈÓ›Â˜ ÔÍÂ˚Î‹˜ Î˘ÙÙ·Ú›ÓË˜ 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 ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ ‹Ù·Ó Ë ·ÓÂ‡ÚÂÛË HbS ÛÂ ÔÛÔÛÙfi 35-40% Î·È Ë ıÂÙÈÎ‹ ‰ÔÎÈÌ·Û›· ‰ÚÂ¿ÓˆÛË˜. ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙÔ ¯·Ú·ÎÙËÚÈÛÌfi ÂÓfi˜ Ì·ıËÙ‹ ˆ˜ ÂÙÂÚÔ˙˘ÁÒÙË ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ‹Ù·Ó ÔÈ ¯·ÌËÏÔ› ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎÔ› ‰Â›ÎÙÂ˜ MCV Î·È MCH, Ë ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÌÔÚÊÔÏÔÁ›· ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (·ÓÈÛÔÎ˘ÙÙ¿ÚˆÛË, ÔÈÎÈÏÔÎ˘ÙÙ¿ÚˆÛË, ˘Ô¯ÚˆÌ›·, ÌÈÎÚÔÎ˘ÙÙ¿ÚˆÛË) ÛÙÔ Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Î·È ÔÛÔÛÙfi HbA2 >3,5%. °È· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÂÓÂÙÈÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ˘˜ ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ¤ÁÈÓÂ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ·fi ÏÂ˘ÎÔÎ‡ÙÙ·Ú· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ÂÍ·ÁˆÁ‹˜ ÌÂ ¿Ï·˜. ∞ÎÔÏÔ‡ıËÛÂ ËÏÂÎÙÚÔÊfiÚËÛË ÛÂ Á¤ÏË ÌÂ ÎÏ‹ÛË ·Ô‰È·Ù·ÎÙÈÎÒÓ Ô˘ÛÈÒÓ (DCGE Denaturing Gradient Gel Electroforesis) Î·È ÁÈ· Î¿ıÂ ÎÔÈÓ‹ ÌÂÙ¿ÏÏ·ÍË ¤ÁÈÓÂ ÂÈ‚Â‚·›ˆÛË ÌÂ ÙË Ì¤ıÔ‰Ô ARMS (Amplification Refractory Mutation System) (1).

∞ÔÙÂÏ¤ÛÌ·Ù·

∞ﬁ ÙÔ˘˜ 1048 Ì·ıËÙ¤˜ Ô˘ ÂÏ¤Á¯ıËÎ·Ó, ‚Ú¤ıËÎ·Ó ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ 99 (9,45%) Î·È ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ 24 Ì·ıËÙ¤˜ (2,29%). ™È‰ËÚÔÂÓ›· (ÊÂÚÚÈÙ›ÓË <10 ng/ml) Â›¯·Ó 136 Ì·ıËÙ¤˜ (ÔÛÔ-

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‹ıËÎÂ Â·ÓÂÍ¤Ù·ÛË ÁÈ·Ù› ÂÌÊ¿ÓÈ˙·Ó ÂËÚÂ·ÛÌ¤ÓÔ˘˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ‰Â›ÎÙÂ˜ MCV, MCH, MCHC ‹ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ ÂÚ˘ıÚÔÎ˘ÙÙ¿ÚˆÓ ‹ ÔÚÈ·Î¤˜ ÙÈÌ¤˜ HbA2. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÔÓÈ‰È·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ¤ÁÈÓÂ

ÛÂ 86 ·ﬁ ÙÔ˘˜ 99 Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÁÈ· ÙË

‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· (¶›Ó·Î·˜ 1).

™˘˙‹ÙËÛË

∏ Û˘¯ÓﬁÙËÙ· ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓÈ‰›Ô˘ ÙË˜ ‚-

ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÛÙÔ Û˘ÓÔÏÈÎﬁ ÏËı˘ÛÌﬁ ÙË˜

∂ÏÏ¿‰·˜ Â›Ó·È ÂÚ›Ô˘ 7,5% (2). ™ÙË ÌÂÏ¤ÙË Ì·˜, Ë

Û˘¯ÓﬁÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ Ì·ıËÙÒÓ ÌÂ ‚-ÌÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›· ‹Ù·Ó 9,45%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ

ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹ (p=0,06). ™Â ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜, Ë Û˘¯ÓﬁÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÛÙËÓ

ÂÚÈÔ¯‹ ÙË˜ ∫·Ú‰›ÙÛ·˜ Â›¯Â ‚ÚÂıÂ› 18,15% (3), 14,2% (4) Î·È 9,8% (5). ªÂÏ¤ÙË ÛÂ ·È‰È¿ ÙË˜ µÔÚÂ›Ô˘ ∂ÏÏ¿‰Ô˜ ¤‰ÂÈÍÂ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁÔÓÈ‰›Ô˘ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÛÙÔ ÓÔÌfi ÙË˜ £ÂÛÛ·ÏÔÓ›ÎË˜ 2,69%, ÛÙÔ ÓÔÌfi ÙË˜ ¶ÈÂÚ›·˜ 5,97% Î·È ÛÙÔ ÓÔÌfi ÙË˜ Ã·ÏÎÈ‰ÈÎ‹˜ 8,4% (6). ª›· ¿ÏÏË ¤ÚÂ˘Ó· ÛÂ ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ÛÙÚ·ÙÈÒÙÂ˜ Â›¯Â ‰Â›ÍÂÈ Û˘¯ÓfiÙËÙ· ÊÔÚ¤ˆÓ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ 7,9% (7). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ ÛÙË ÌÂÏ¤ÙË Ì·˜ ‚Ú¤ıËÎÂ 2,29%. ™Â

ÚÔËÁÔ‡ÌÂÓÂ˜ ÌÂÏ¤ÙÂ˜ 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 ÛÙÈ˜ ·Ú·¿Óˆ ÌÂÏ¤ÙÂ˜ ·ÊÂÓﬁ˜ ·ÊÔÚÔ‡Ó

ÛÙÈ˜ ‰È·ÊÔÚÂÙÈÎ¤˜ ÁÂˆÁÚ·ÊÈÎ¤˜ ÂÚÈÔ¯¤˜ ÛÙÈ˜ ÔÔ›Â˜ ¤ÁÈÓ·Ó ÔÈ ·Ú·¿Óˆ ÌÂÏ¤ÙÂ˜, ·ÊÂÙ¤ÚÔ˘

ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈıÌfi ÂÍÂÙ·˙fiÌÂÓˆÓ ÛÂ Î¿ıÂ

ÂÚ›ÙˆÛË.

¢È·ÊÔÚ¤˜ ÛÙË Û˘¯ÓﬁÙËÙ· ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ

¶›Ó·Î·˜ 1. ∆‡Ô˜ Î·È Û˘¯ÓﬁÙËÙ· ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ˘˜

Ì·ıËÙ¤˜ ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜

ªÂÙ¿ÏÏ·ÍË∞ÚÈıÌﬁ˜ Ì·ıËÙÒÓ™˘¯ÓﬁÙËÙ· (%)

IVS-110 (G-→A)3641,86

cd39 (C-→T)2326,74

IVS 1 (G-→A)1011,63

0IVSII - 745 (C-→G)66,98

cd5/A22,33 cd6/A22,33 ‰‚Mac/A22,33 ‰‚Lepore/A22,33

IVSI 5/A11,16

IVSI 6 (T-→C)11,16

IVSII 1 (G-→A)11,16

¶·È‰È·ÙÚÈÎ‹ 2002;65:118-121 Paediatriki 2002;65:118-121

ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ‚Ú¤ıËÎ·Ó Î·È ÛÂ Â-

ÚÈÔ¯¤˜ ÙÔ˘ ›‰ÈÔ˘ ÓÔÌÔ‡. ™ÙÔ ÓÔÌﬁ ÙË˜ ∫·Ú‰›ÙÛ·˜, ÛÂ 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›ÛÙÔÈ¯·, ÂÓÒ ÛÂ Á˘ÌÓ¿ÛÈ· Â‰ÈÓÒÓ Â-

ÚÈÔ¯ÒÓ, ﬁˆ˜ ÙÔ˘ ¶·Ï·Ì¿ Î·È ÙË˜ ﬁÏË˜ ÙË˜ ∫·Ú-

‰›ÙÛ·˜, ‹Ù·Ó ·ÓÙ›ÛÙÔÈ¯· 14,28% Î·È 11,39%. ∏ ‰È·-

ÊÔÚ¿ ·˘Ù‹ ›Ûˆ˜ Û¯ÂÙ›˙ÂÙ·È Î·È ÌÂ ÙÔ ÁÂÁÔÓﬁ˜ ﬁÙÈ Ë

·Ú·ÌÔÓ‹ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÁﬁÓÔ˘ ÙË˜ ‚-ÌÂÛÔÁÂÈ-

·Î‹˜ ·Ó·ÈÌ›·˜ ·ÔÙÂÏÂ› ÂÍÂÏÈÎÙÈÎ‹ ÚÔÛ·ÚÌÔÁ‹

ÌÂ ÛÎÔﬁ ÙËÓ ·˘ÍËÌ¤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÂÏÔÓÔÛ›·

Ô˘ ÂÓ‰ËÌÔ‡ÛÂ ÛÙÈ˜ Â‰ÈÓ¤˜ ÂÚÈÔ¯¤˜ (5).

™È‰ËÚÔÂÓ›· ‚Ú¤ıËÎÂ ÛÂ 136 Ì·ıËÙ¤˜ (ÔÛÔ-

ÛÙfi 12,98%), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 41 ‹Ù·Ó ·ÁfiÚÈ·

(30,15%) Î·È 95 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (69,85%). ∏ Û˘¯Óﬁ-

ÙËÙ· ÙË˜ ÛÈ‰ËÚÔÂÓ›·˜ ÛÙËÓ ﬁÏË ÙË˜ ∫·Ú‰›ÙÛ·˜

‹Ù·Ó 14,38% (·ÛÙÈÎﬁ˜ ÏËı˘ÛÌﬁ˜), ÂÓÒ ÛÂ ·ÁÚÔÙÈ-

Î¤˜ Î·È ËÌÈ·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ‹Ù·Ó 12,019%. ∆· Â˘-

Ú‹Ì·Ù· ·˘Ù¿ ‰ÂÓ Û˘ÌÊˆÓÔ‡Ó ÌÂ ÌÂÏ¤ÙË ÛÙË µﬁ-

ÚÂÈ· ∂ÏÏ¿‰·, ﬁÔ˘ ‚Ú¤ıËÎÂ ÛÈ‰ËÚÔÂÓ›· ÛÂ Ì·-

ıËÙ¤˜ ËÌÈ·ÛÙÈÎÒÓ Î·È ·ÁÚÔÙÈÎÒÓ ÏËı˘ÛÌÒÓ ÛÂ

ÔÛÔÛÙﬁ 20,8% Î·È ÛÂ ·ÛÙÈÎ¤˜ ÂÚÈÔ¯¤˜ ÛÂ ÔÛÔ-

ÛÙﬁ 8,4% (7). OÈ ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ Â›Ó·È Èı·Óﬁ Ó·

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÈ˜ ‰È·ÊÔÚÂÙÈÎ¤˜ ËÏÈÎÈ·Î¤˜ ÔÌ¿‰Â˜

Ô˘ ·ÊÔÚÔ‡Ó ÔÈ ‰‡Ô ÌÂÏ¤ÙÂ˜. ™ÙÔ˘˜ Ì·ıËÙ¤˜ ·˘ÙÔ‡˜ Û˘ÛÙ‹ıËÎÂ Ë Ï‹„Ë ÛÈ‰‹ÚÔ˘ ÁÈ· 3 Ì‹ÓÂ˜ Î·È Ë

Â·ÓÂÍ¤Ù·Û‹ ÙÔ˘˜. ∂·ÓÂÍ¤Ù·ÛË Û˘ÛÙ‹ıËÎÂ Î·È

ÛÂ 55 Ì·ıËÙ¤˜ (5,25%) ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÂËÚÂ·ÛÌ¤ÓÔ˘˜ ÙÔ˘˜ ÂÚ˘ıÚÔÎ˘ÙÙ·ÚÈÎÔ‡˜ ‰Â›ÎÙÂ˜ MCV, MCH, MCHC ‹ ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙˆÓ

ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‹ ÔÚÈ·Î¤˜ ÙÈÌ¤˜ ÙË˜ HbA2

ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌﬁ ÊÔÚ¤ˆÓ ÙË˜ ·-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ‹ ÊÔÚ¤ˆÓ ÙÔ˘ ÛÈˆËÚÔ‡ ÁﬁÓÔ˘ ÙË˜ ‚-ÌÂ-

ÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎ¤˜ ÙÈÌ¤˜ ÙË˜

HbA2 (8).

∏ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ÛÂ 86 ·ﬁ ÙÔ˘˜ 99 Ì·ıË-

Ù¤˜ ÂÙÂÚÔ˙˘ÁÒÙÂ˜ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜

¤‰ÂÈÍÂ ﬁÙÈ ÙÔ 80,23% ·ÊÔÚ¿ ÛÂ ÙÚÂÈ˜ Î˘Ú›ˆ˜ ÌÂ-

Ù·ÏÏ¿ÍÂÈ˜: IVSI 110(G-→A), cd39(C-→T) Î·È IVSI

1(G-→A). ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ·˘Ù¿ Â›Ó·È ·ÚﬁÌÔÈ·

ÌÂ ÂÎÂ›Ó· ÌÂÏ¤ÙË˜ ÛÙÔ ÁÂÓÈÎﬁ ÏËı˘ÛÌﬁ ÙË˜ ∂ÏÏ¿-

‰·˜ (10), ÂÓÒ ‰È·Ê¤ÚÔ˘Ó ·ﬁ Ù· ·ÔÙÂÏ¤ÛÌ·Ù·

·ÚﬁÌÔÈ·˜ ÌÂÏ¤ÙË˜ ÛÙÔ ÓÔÌﬁ ÙË˜ ª·ÁÓËÛ›·˜

ﬁÔ˘ ÙÔ 67,8% ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ‚-ÌÂÛÔÁÂÈ·Î‹˜

·Ó·ÈÌ›·˜ Â›¯·Ó ÙÈ˜ ·ÎﬁÏÔ˘ıÂ˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜: IVSI 110(G-→A), IVSI 6(T-→C), cd39(C-→T), IVSI 1(G→A) (11).

H Û˘¯ÓﬁÙËÙ· ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ IVSI 110(G-→A)

ÛÙÔÓ ÏËı˘ÛÌfi ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ‹Ù·Ó 41,86%, ·ÚfiÌÔÈ· ÌÂ ÙË Û˘¯ÓfiÙËÙ· ÛÙÔ ÁÂÓÈÎfi ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi (42,55%) (10), ÂÓÒ ‰È¤ÊÂÚÂ ·fi ÂÎÂ›ÓË ÛÙË ÌÂÏ¤ÙË ÙÔ˘ ÓÔÌÔ‡ ª·ÁÓËÛ›·˜, fiÔ˘ ‹Ù·Ó 20,8% (11).

∏ ‰Â‡ÙÂÚË ÛÂ Û˘¯ÓﬁÙËÙ· ÌÂÙ¿ÏÏ·ÍË ÛÙÔÓ ÏË-

ı˘ÛÌfi ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ‹Ù·Ó Ë cd39(C-→T), fiˆ˜ Î·È ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ÌÂ ÙË ‰È·ÊÔÚ¿ fiÙÈ ÛÙÔ

‰Â›ÁÌ· Ì·˜ ÙÔ ÔÛÔÛÙﬁ ÙˆÓ ÂÙÂÚÔ˙˘ÁˆÙÒÓ ÌÂ ÙË

ÌÂÙ¿ÏÏ·ÍË cd39(C-→T) ‹Ù·Ó 26,74%, ÂÓÒ ÛÙÔ ÁÂ-

ÓÈÎﬁ ÏËı˘ÛÌﬁ ‹Ù·Ó 16,95%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ

Â›Ó·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎ‹ (p=0,09).

∏ ÌÂÙ¿ÏÏ·ÍË IVSI 1(G-→A) ‹Ù·Ó ÙÚ›ÙË ÛÂ Û˘-

¯ÓﬁÙËÙ· ÌÂ 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 ÌÂÏ¤ÙË Ì·˜ ‹Ù·Ó Ë IVSII 745(C-→G) ÌÂ ÔÛÔÛÙfi 6,98%, ·Ó¿ÏÔÁÔ ÌÂ ·˘Ùfi ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi (6,9%).

∂Ó‰È·Ê¤ÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ¯·ÌËÏ‹ Û˘¯ÓfiÙËÙ· ÙË˜ ÌÂÙ¿ÏÏ·ÍË˜ IVSI 6(T-→C) ÛÙË ÌÂÏ¤ÙË Ì·˜ (1,16%), ÂÓÒ ÙfiÛÔ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÛÔ Î·È ÛÙË ÌÂÏ¤ÙË ÙË˜ ª·ÁÓËÛ›·˜ ‹Ù·Ó ˘„ËÏfiÙÂÚË, 7,18% (p=0,05) Î·È 18,7% (p=0,003) ·ÓÙ›ÛÙÔÈ¯·. OÈ ‰È·ÊÔÚ¤˜ ÌÂ ÙË ÌÂÏ¤ÙË ÛÙÔ ÓÔÌfi ÙË˜ ª·ÁÓËÛ›·˜ ›Ûˆ˜ Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ ‰È·ÊÔÚÂÙÈÎfi ·ÚÈıÌfi ÙˆÓ ÂÍÂÙ·˙fiÌÂÓˆÓ ÛÂ Î¿ıÂ ÌÂÏ¤ÙË, Î·ıÒ˜ Î·È ÌÂ ÙË ‰È·ÊÔÚÂÙÈÎ‹ ÁÂˆÁÚ·ÊÈÎ‹ ÂÚÈÔ¯‹, ·Ó Î·È

ÁÈ· ﬁÌÔÚÔ˘˜ ÓﬁÌÔ˘˜ ÙË˜ £ÂÛÛ·Ï›·˜.

§ÈÁﬁÙÂÚÔ Û˘¯Ó¤˜ ÌÂÙ·ÏÏ¿ÍÂÈ˜ Ô˘ ·ÓÈ¯ÓÂ‡ıËÎ·Ó ÛÙË ÌÂÏ¤ÙË Ì·˜ ‹Ù·Ó ÔÈ ·ÎﬁÏÔ˘ıÂ˜: 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(G→A) 1,16%.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÊÔÚ¤ˆÓ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ Î·È ÙË˜ ‰ÚÂ·ÓÔÎ˘ÙÙ·ÚÈÎ‹˜ ·Ó·ÈÌ›·˜ ÛÂ Ì·ıËÙ¤˜ ÙˆÓ °˘ÌÓ·Û›ˆÓ ÙÔ˘ ÓÔÌÔ‡ ∫·Ú‰›ÙÛ·˜ ‚Ú¤ıËÎÂ Ó· Â›Ó·È 9,45% Î·È 2,29% ·ÓÙ›ÛÙÔÈ¯·, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÔÓÈ‰È·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ Â›Ó·È ·ÚfiÌÔÈ· ÌÂ ·˘Ù‹ ÛÙÔ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÌÂ ÌÈÎÚ¤˜ ÌfiÓÔ ‰È·ÊÔÚÔÔÈ‹ÛÂÈ˜. ¶ÈÛÙÂ‡Ô˘ÌÂ fiÙÈ Ù· Â˘Ú‹Ì·Ù¿ Ì·˜ ·˘Ù¿ ı· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·Ó›¯ÓÂ˘ÛË ÙˆÓ ˘Â‡ı˘ÓˆÓ

ÁÔÓÈ‰È·ÎÒÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙË˜ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜, ÛÙËÓ ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË Î·È ÁÂÓÈÎﬁÙÂÚ· ÛÙËÓ ÚﬁÏË„Ë ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ·˘ÙÔ‡.

∂˘¯·ÚÈÛÙ›Â˜

∂˘¯·ÚÈÛÙÔ‡ÌÂ ÙÈ˜ ÓÔÛËÏÂ‡ÙÚÈÂ˜ ÙÔ˘ ÓÔÛÔÎÔÌÂ›Ô˘ ∫·Ú‰›ÙÛ·˜ Î. ∞ıËÓ¿ ª·Ó·Û‹ Î·È ∂˘·ÁÁÂÏ›· ¶·¿, ÙÈ˜ ·Ú·ÛÎÂ˘¿ÛÙÚÈÂ˜ ÙÔ˘ ∞ÈÌ·ÙÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ ÙË˜ ∞’ ¶·È‰È·ÙÚÈÎ‹˜ ∫ÏÈÓÈÎ‹˜ ÙÔ˘ πÔÎÚ¿ÙÂÈÔ˘ ¡ÔÛÔÎÔÌÂ›Ô˘ £ÂÛÛ·ÏÔÓ›ÎË˜ Î. µ·ÛÈÏÈÎ‹ ∞ÏÂÙÚ¿ Î·È ª¿Á‰· ∫ˆÙÔ‡Ï·, Î·ıÒ˜ Î·È ÙËÓ ·Ú·ÛÎÂ˘¿ÛÙÚÈ· ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈÎ‹˜ °ÂÓÂÙÈÎ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÁÈ· ÙË ‚Ô‹ıÂÈ¿ ÙÔ˘˜ ÛÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙË˜ 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.

2. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. µ-MÂÛÔÁÂÈ·Î‹ ·Ó·ÈÌ›·. ∞ÈÎ. ª·Ï·Î¿-∑·ÊÂÈÚ›Ô˘, ÂÈÌÂÏËÙ‹˜. ¶Ú·ÎÙÈÎ‹ ¶·È‰È·ÙÚÈÎ‹. £ÂÛÛ·-

ÏÔÓ›ÎË: University Studio Press; 1999. ÛÂÏ. 611-612.

3. ™¯›˙·˜ ¡, ∆¤ÁÔ˜ ∫, µÔ˘ÙÛ·‰¿ÎË˜ ∞, ∞Ú·Ì·Ù˙‹˜ °, ∞ÁÁÂ-

ÏÔÔ‡ÏÔ˘ ¶, ÃÚ˘Û·ÓıﬁÔ˘ÏÔ˜ ∫ Î·È Û˘Ó. ™˘¯ÓﬁÙË˜ Î·È

Î·Ù·ÓÔÌ‹ ‚-ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ Î·È ·ıÔÏÔÁÈÎÒÓ ·ÈÌÔÛÊ·ÈÚÈÓÒÓ ÂÈ˜ ÙÔÓ ∂ÏÏËÓÈÎﬁÓ ¯ÒÚÔÓ. ŒÚÂ˘Ó· Â› 15550 ÓÂÔÛ˘ÏÏ¤ÎÙˆÓ. π·ÙÚÈÎ‹ ∂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‡-¡ÈÎÔÏ·Î¿ÎË ¢, ™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˘ÛÌÈÎ‹ ¤ÚÂ˘Ó· ÙˆÓ ·ÈÌÔÛÊ·ÈÚÈÓÔ·ıÂÈÒÓ ÂÈ˜ ·È‰È¿ ÙË˜ µÔÚÂ›Ô˘ ∂ÏÏ¿‰Ô˜. π·ÙÚÈÎ‹ ∂ÈıÂÒÚËÛË

∂ÏÏËÓÈÎÒÓ ∂ÓﬁÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:237-246.

7. ∫·ÙÙ¿ÌË˜ Ã, ªÂÙ·ÍˆÙÔ‡-ª·˘ÚÔÌÌ¿ÙË ∞, ∫ÔÓÈ‰¿ÚË˜ ∫, ∆Ô˘ÏÈ¿ÙÔ˜ ¡, ∫ˆÛÙ¿ÓÙ˙·˜ ¡, ª·ÙÛ·ÓÈÒÙË˜ ¡. ™˘¯ÓﬁÙË˜

ÛÈ‰ËÚÔÂÓÈÎ‹˜ ·Ó·ÈÌ›·˜ Î·È ÛÙ›ÁÌ·ÙÔ˜ ÌÂÛÔÁÂÈ·Î‹˜ ·Ó·ÈÌ›·˜ ÂÈ˜ ÓÂÔÛ‡ÏÏÂÎÙÔ˘˜ ÛÙÚ·ÙÈÒÙ·˜. π·ÙÚÈÎ‹ ∂ÈıÂÒÚËÛË

∂ÏÏËÓÈÎÒÓ ∂ÓﬁÏˆÓ ¢˘Ó¿ÌÂˆÓ 1977;11:229-235.

8. ∫ÂÚ·ÌÈ‰¿-∫·˚Ó·‰¿ ª. ∏ Â›‰Ú·ÛË ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓË-

ıÂÈÒÓ Î·È ÙÔ˘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰Ô˘ ÛÙËÓ ÂÌÊ¿-

¢È¿ÁÓˆÛË,

∂ÈÛ·ÁˆÁ‹: ∞ÚÎÂÙ¤˜ ÌÂÏ¤ÙÂ˜ ÛÙÔ ·ÚÂÏıﬁÓ ÙﬁÓÈ˙·Ó ÙË ÌÂÁ¿-

ÏË Î·ı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË ·È‰ÈÒÓ ÌÂ º¡∂.

™ÎÔﬁ˜: ™ÎÔﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ë ‰ÈÂÚÂ‡ÓËÛË ÙÔ˘ Î·Ù¿

ﬁÛÔ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÁÈ· ÙË º¡∂ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

Ô‰‹ÁËÛÂ ÛÙËÓ ¤ÁÎ·ÈÚË ‰È¿ÁÓˆÛË, ‚ÂÏÙ›ˆÛË ÙË˜ ıÂÚ·Â›·˜

Î·È ÂÏ¿ÙÙˆÛË ÙË˜ ÓÔÛËÚﬁÙËÙ·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 112 ·È‰È¿ ÌÂ º¡∂ (64 ÌÂ ÓfiÛÔ Crohn, 41 ÌÂ ÂÏÎÒ‰Ë ÎÔÏ›ÙÈ‰·, 7 ÌÂ ·ÚÔÛ‰ÈfiÚÈÛÙË ÎÔÏ›ÙÈ‰·), Ô˘ ·Ú·¤ÌÊıËÎ·Ó ÛÂ °·ÛÙÚÂÓÙÂÚÔÏÔÁÈÎfi ∆Ì‹Ì· ·fi ÙÔ 1994 ¤ˆ˜ ÙÔ 1998, ÌÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈÎ¿. ™Ù· ·È‰È¿ ÌÂ ÓfiÛÔ Crohn, Ô ‰È¿ÌÂÛÔ˜ ¯ÚfiÓÔ˜ Ì¤¯ÚÈ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó 47 Â‚‰ÔÌ¿‰Â˜ (maximum 7 ¤ÙË). ™Ù· ·È‰È¿ Ô˘ ‰ÂÓ Â›¯·Ó ‰È¿ÚÚÔÈ·, Ë ‰È¿ÁÓˆÛË Î·ı˘ÛÙ¤ÚËÛÂ ·ÎfiÌË ÂÚÈÛÛfiÙÂÚÔ (66 ¤Ó·ÓÙÈ 28 Â‚‰ÔÌ¿‰ˆÓ, p=0,005). O Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ‰È¿ÁÓˆÛË˜ ÁÈ· Ù· ·È‰È¿ ÌÂ ÂÏÎÒ‰Ë ÎÔÏ›ÙÈ‰· ‹Ù·Ó 20 Â‚‰ÔÌ¿‰Â˜ (maximum 3 ¤ÙË). ∂›Ó·È ÂÓ‰È·Ê¤ÚÔÓ fiÙÈ ÛÂ ·È‰È¿ ÌÂ ‚·ÚÈ¿ ÎÔÏ›ÙÈ‰· Ë ‰È¿ÁÓˆÛË ¤ÁÈÓÂ ÌÂÙ¿ ·fi 5,5 Â‚‰ÔÌ¿‰Â˜ Î·È 4 ·fi ·˘Ù¿ ¯ÚÂÈ¿ÛÙËÎ·Ó ¿ÌÂÛË ÎÔÏÂÎÙÔÌ‹. ∞ÚÎÂÙ¿ ·È‰È¿ ÌÂ ÓfiÛÔ Crohn Â›¯·Ó ˘Ô‚ÏËıÂ› ÛÂ ÌË ·Ô‰ÂÎÙ¤˜ ıÂÚ·Â›Â˜,

ÓÈÛË ÛÈ‰ËÚÔÂÓ›·˜ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· [¢È‰·ÎÙÔÚÈÎ‹ ‰È·ÙÚÈ‚‹]. £ÂÛÛ·ÏÔÓ›ÎË: ∞¶£ ∞’ ¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹: 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

¤ÁÎÚÈÛË˜: 11-12-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¢ËÌ‹ÙÚÈÔ˜ Ã·Ù˙ËÁÂˆÚÁ›Ô˘ ª¿ÚÎÔ˘ ªﬁÙÛ·ÚË 41, ∆.∫. 601 00, ∫·ÙÂÚ›ÓË E-mail: dimchatz@otenet.gr

ÎÒ‰Ë ÎÔÏ›ÙÈ‰· (11%). ∫ÔÓÙﬁ ·Ó¿ÛÙËÌ· Â›¯Â ÙÔ 19% ÙˆÓ ·È‰ÈÒÓ ÌÂ Crohn Î·È ÙÔ 5% ·˘ÙÒÓ ÌÂ ÂÏÎÒ‰Ë ÎÔÏ›ÙÈ‰·. µÚ¤ıËÎÂ ÛËÌ·ÓÙÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÙË˜ ‰È¿ÚÎÂÈ·˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙÔ˘ ‚·ıÌÔ‡ ÙË˜ ‰˘ÛÙÚÔÊ›·˜ (p=0,004).

™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Î·ı˘ÛÙ¤ÚËÛË ÙË˜ ‰È¿ÁÓˆÛË˜ Î·È Ë ÌË ÛˆÛÙ‹ ‰ÈÂÚÂ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ·ÎﬁÌË ÛËÌ·ÓÙÈÎ¿ ÚÔ‚Ï‹Ì·Ù· ÁÈ· ÙË º¡∂ ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·

1Spray C, Debelle G, Murphy M Current diagnosis, management and morbidity in paediatric inflammatory bowel disease

Acta Paediatr 2001;90:400-405

π. ∫·ÊÚ›ÙÛ·

∂ƒ∂À¡∏∆π∫∏

∂. ª·Ú·ÁÎ¿ÎË1, °. °·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˜ ÙË˜ ÂÚÁ·Û›·˜ Ì·˜ ‹Ù·Ó Ë

ÂÎÙ›ÌËÛË ÙË˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ ·È‰ÈÒÓ Û¯Ô-

ÏÈÎ‹˜ ËÏÈÎ›·˜ ÙË˜ ÂÚÈÔ¯‹˜ µ¿ÚË˜ ∞ÙÙÈÎ‹˜. °È· ÙË

ÌÂÏ¤ÙË ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ ‰Â›ÁÌ· 635 ˘ÁÈÒÓ ·È-

‰ÈÒÓ ËÏÈÎ›·˜ 5-16 ÂÙÒÓ. ø˜ ‰Â›ÎÙÂ˜ ·Ó¿Ù˘ÍË˜

¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î·È ÙÔ

‡„Ô˜, ·ﬁ Ù· ÔÔ›· ˘ÔÏÔÁ›ÛÙËÎÂ Ô ‰Â›ÎÙË˜ Ì¿-

˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™). ™Â ﬁÛ· ·È‰È¿ ‹Ù·Ó ¿Óˆ ÙˆÓ

8 ÂÙÒÓ ˘ÔÏÔÁ›ÛÙËÎÂ Î·È Ë ÂÚÈÂÎÙÈÎﬁÙËÙ· ÙÔ˘

ÛÒÌ·ÙÔ˜ ÛÂ Ï›Ô˜ (%) ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜ ËÏÂÎÙÚÈÎ‹˜ ‚ÈÔ·ÓÙ›ÛÙ·ÛË˜. OÈ ÛˆÌ·ÙÔÌÂÙÚÈÎ¤˜ ÙÈÌ¤˜ ÙË˜

ÌÂÏ¤ÙË˜ Ì·˜, ÙﬁÛÔ ÁÈ· ÙÔ ¢ª™ ﬁÛÔ Î·È ÁÈ· ÙÔ Ï›-

Ô˜, Â›Ó·È ˘„ËÏﬁÙÂÚÂ˜ ÛÂ Û‡ÁÎÚÈÛË ÌÂ Ù· ‰ÈÂıÓ‹

ÚﬁÙ˘·. ª¤ÁÈÛÙÂ˜ ÙÈÌ¤˜ Ï›Ô˘˜ ·Ú·ÙËÚ‹ıËÎ·Ó

ÛÙËÓ ËÏÈÎ›· ÙˆÓ 13 ÂÙÒÓ ÁÈ· Ù· ·ÁﬁÚÈ· Î·È ÙˆÓ 15

ÂÙÒÓ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ™‡ÁÎÚÈÛË ÙˆÓ ‰‡Ô Ê‡ÏˆÓ

¤‰ÂÈÍÂ fiÙÈ Ù· ·ÁfiÚÈ· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ Ï›Ô˜ Ì¤-

¯ÚÈ ÙËÓ ËÏÈÎ›· ÙˆÓ 10 ÂÙÒÓ, ÂÓÒ ÌÂÙ¿ Ù· 10 ¤ÙË, Ë

Û¯¤ÛË ·˘Ù‹ ·ÓÙÈÛÙÚ¤ÊÂÙ·È ˘¤Ú ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∏

Ì¤ÙÚËÛË ÙÔ˘ ÛˆÌ·ÙÈÎÔ‡ Ï›Ô˘˜ ÌÂ ÙË Ì¤ıÔ‰Ô ÙË˜

ËÏÂÎÙÚÈÎ‹˜ ‚ÈÔ·ÓÙ›ÛÙ·ÛË˜ Â›Ó·È Â‡¯ÚËÛÙË, ÁÚ‹ÁÔ-

ÚË Î·È ÔÈÎÔÓÔÌÈÎ‹.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û‡ÓıÂÛË ÛÒÌ·ÙÔ˜, ÛˆÌ·ÙÈÎﬁ Ï›-

Ô˜, ‚ÈÔËÏÂÎÙÚÈÎ‹ ·ÓÙ›ÛÙ·ÛË, ·È‰›.

ÂÎÙ›ÌËÛË ÙË˜ Û‡ÓıÂÛË˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ·Ú¤-

ÔÏ‡ÙÈÌÂ˜

ÁÈ·

‰È·ÈÙËÙÈÎ‹ Î·Ù¿ÛÙ·ÛË Î·È ÙËÓ ÔÈfiÙËÙ· ·Ó¿Ù˘ÍË˜ ÂÓfi˜ ·È‰ÈÔ‡. ¢Â‰ÔÌ¤ÓÔ˘ fiÙÈ Û‹ÌÂÚ· Ë ·¯˘Û·ÚÎ›· ·ÔÙÂÏÂ› ÛËÌ·ÓÙÈÎfi ÎÔÈÓˆÓÈÎfi ·ÏÏ¿ Î·È ˘ÁÂÈÔÓÔÌÈÎfi Úfi‚ÏËÌ· ÁÈ· Ù·

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.

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

¤¯Ô˘ÌÂ ÁÈ· ÙË Û‡ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È ÂÚÈÔÚÈÛÌ¤ÓÂ˜ Î·È ·˘Ùfi ÁÈ·Ù› ‰ÂÓ ˘‹Ú¯·Ó Ì¤¯ÚÈ ÚfiÛÊ·Ù· ·Ï¤˜ Î·È ·ÍÈfiÈÛÙÂ˜ Ì¤ıÔ‰ÔÈ ÂÎÙ›ÌËÛË˜. ∏ ÈÔ ·Ï‹ Ì¤ıÔ‰Ô˜ ˘ÔÏÔÁÈÛÌÔ‡ ÙÔ˘ ÔÏÈÎÔ‡ Ï›Ô˘˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Á›ÓÂÙ·È ÌÂ Ì¤ÙÚËÛË ÙË˜ ‰ÂÚÌ·ÙÈÎ‹˜ Ù˘¯‹˜ (1), ÙË˜ ÂÚÈÌ¤ÙÚÔ˘ ÙÔ˘ ‚Ú·¯›ÔÓ· (2) ‹ ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) (3,4). OÈ Ì¤ıÔ‰ÔÈ ·˘Ù¤˜, ·Ó Î·È ·Ï¤˜, ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ·ÍÈfiÈÛÙÂ˜. ∏ Ì¤ÙÚËÛË ÙË˜ ‰ÂÚÌ·ÙÈÎ‹˜ Ù˘¯‹˜ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ¿Ô„Ë fiÙÈ Ë ÔÛfiÙËÙ· ÙÔ˘ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜

1 ∫¤ÓÙÚÔ ÀÁÂ›·˜ µ¿ÚË˜

2 ¶° ¡ÔÛÔÎÔÌÂ›Ô ∞ÏÂÍ¿Ó‰Ú· ∞ıËÓÒÓ

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

∞ÔÙÂÏ¤ÛÌ·Ù· ∆· ·ÔÙÂÏ¤ÛÌ·Ù· ÁÈ· ÙÔ ÛˆÌ·ÙÈÎﬁ Ï›Ô˜ (%)

Î·È ÙÔ ¢ª™ ÎÔÚÈÙÛÈÒÓ Î·È ·ÁÔÚÈÒÓ ÙË˜ ÌÂÏ¤ÙË˜ Î·-

Ù·ÁÚ¿ÊÔÓÙ·È ÙﬁÛÔ ÛÙÔ˘˜ ¶›Ó·ÎÂ˜ 1 Î·È 2 (Ì¤ÛË ÙÈ-

Ì‹ Î·È 1 ÛÙ·ıÂÚ‹ ·ﬁÎÏÈÛË), ﬁÛÔ Î·È ÛÙ· ™¯‹Ì·Ù·

1, 2, 3, 4 (Ì¤ÛË ÙÈÌ‹, 1 Î·È 2 ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂÈ˜).

™˘˙‹ÙËÛË

∂›Ó·È ÁÓˆÛÙﬁ ﬁÙÈ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› Î·È Â-

ÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙÂ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿-

Ù˘ÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡. ŒÙÛÈ, ﬁ¯È ÌﬁÓÔ

Î¿ıÂ ¯ÒÚ·, ·ÏÏ¿ ·ÎﬁÌË Î·È ‰È·ÊÔÚÂÙÈÎ¤˜ ÁÂˆ-

ÁÚ·ÊÈÎ¤˜ ÂÚÈÔ¯¤˜ Ì¤Û· ÛÙËÓ ›‰È· ¯ÒÚ· ¤¯Ô˘Ó

‰È·ÌÔÚÊÒÛÂÈ Ù· ‰ÈÎ¿ ÙÔ˘˜ ÚﬁÙ˘· ·Ó¿Ù˘ÍË˜

Î·È ‰È·ÙËÚÔ‡Ó Î¿ÔÈÂ˜ È‰È·ÈÙÂÚﬁÙËÙÂ˜ ÛÂ ﬁ,ÙÈ ·ÊÔ-

Ú¿ ÙÔ˘˜ Ú˘ıÌÔ‡˜ ÛˆÌ·ÙÈÎ‹˜ ·Ó¿Ù˘ÍË˜ (19). ∞˘-

Ùﬁ˜ Â›Ó·È Ô ÏﬁÁÔ˜ Ô˘ Ì·˜ ÒıËÛÂ Ó· ÌÂÏÂÙ‹ÛÔ˘ÌÂ

ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Ì›·˜ Û˘-

ÁÎÂÎÚÈÌ¤ÓË˜ ÂÚÈÔ¯‹˜ ÙË˜ ∞ÙÙÈÎ‹˜ Ô˘ ·ÔÙÂÏÂ›-

Ù·È ÙfiÛÔ ·fi ·ÛÙÈÎfi, fiÛÔ Î·È ·fi ·ÁÚÔÙÈÎfi ÏËı˘ÛÌfi.

‰Â›¯ÓÔ˘Ó ﬁÙÈ Ô ¢™ª ÛÙ· ·È‰È¿ ÙË˜ ·ÚÔ‡-

ÂÎ·ÙÔ-

ÛÙÈ·›Â˜ ı¤ÛÂÈ˜, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È ÛÙ· ÎÔÚ›-

ÙÛÈ·, ÛÂ Û¯¤ÛË ÌÂ Í¤ÓÂ˜ ÌÂÏ¤ÙÂ˜ (20-22), ÂÓÒ Â›Ó·È

Û˘ÁÎÚ›ÛÈÌ· ÌÂ ÂÎÂ›Ó· ÌÂÏ¤ÙË˜ Ô˘ ¤ÁÈÓÂ ÛÂ ·È‰È¿

ÙË˜ ™ËÙÂ›·˜ ∫Ú‹ÙË˜ (23), Î·ıÒ˜ Î·È ·˘Ù‹˜ ·È‰ÈÒÓ

ÙË˜ ∫‡ÚÔ˘ (24) Ô˘ ¤ÁÈÓÂ ÚﬁÛÊ·Ù·.

™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔ ÛˆÌ·ÙÈÎfi Ï›Ô˜, ·˘Ùfi ·ÔÙÂ-

ÏÂ› ÙÔ ÈÔ Â˘ÌÂÙ¿‚ÏËÙÔ Û˘ÛÙ·ÙÈÎﬁ ÙÔ˘ ÛÒÌ·ÙÔ˜,

·ÊÔ‡ ﬁ¯È ÌﬁÓÔ ÌÂÙ·‚¿ÏÏÂÙ·È ‰È·¯ÚÔÓÈÎ¿ - ·‡ÍËÛË

‹ ÌÂ›ˆÛË - ·Ó¿ÏÔÁ· ÌÂ ÙËÓ ËÏÈÎ›· ÙÔ˘ ·È‰ÈÔ‡ (25),

·ÏÏ¿ Î·È ÁÈ· Ì›· Û˘ÁÎÂÎÚÈÌ¤ÓË ËÏÈÎ›· ·Ú·ÙËÚÂ›Ù·È

‰È·ÊÔÚ¿ Ì¤¯ÚÈ Î·È 5 ÊÔÚ¤˜ ·ﬁ ·È‰› ÛÂ ·È‰› (26).

OÈ Ì¤ÛÂ˜ ÙÈÌ¤˜ Ï›Ô˘˜ ÙË˜ ÌÂÏ¤ÙË˜ Ì·˜ ÛÂ ·È-

‰È¿ ËÏÈÎ›·˜ 13-16 ÂÙÒÓ, ÙfiÛÔ ÛÙ· ·ÁfiÚÈ· fiÛÔ Î·È

ÛÙ· ÎÔÚ›ÙÛÈ·, ‹Ù·Ó ˘„ËÏﬁÙÂÚÂ˜ ·ﬁ ·˘Ù¤˜ Ô˘

·Ó·Ê¤ÚÔÓÙ·È ÙfiÛÔ ·fi ÙËÓ Widowson ÛÙËÓ ∂˘ÚÒË (26), fiÛÔ Î·È ·fi ‰‡Ô ∞ÌÂÚÈÎ·ÓÈÎ¤˜ ÌÂÏ¤ÙÂ˜ (20,21). ª¤ÁÈÛÙÂ˜ Ì¤ÛÂ˜ ÙÈÌ¤˜ Ï›Ô˘˜ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ËÏÈÎ›· ÙˆÓ 13 ÂÙÒÓ ÁÈ· Ù· ·ÁfiÚÈ· Î·È 15 ÂÙÒÓ ÁÈ· Ù· ÎÔÚ›ÙÛÈ·. ∞ÓÙ›ıÂÙ·, ÛÙË ÌÂÏ¤ÙË ÙË˜ Widowson (26) Ì¤ÁÈÛÙË ÙÈÌ‹ ·Ú·ÙËÚ‹ıËÎÂ ÛÙ·

ÌÂÓ ·ÁﬁÚÈ· ÛÙ· 10 Î·È ÛÙ· ÎÔÚ›ÙÛÈ· ÛÙ· 16 ¤ÙË. ∫·Ù¿ ÙÔ˘˜ ∏asche et al (27) Ì¤ÁÈÛÙË ÙÈÌ‹ ·Ú·ÙËÚ‹ıËÎÂ ÁÈ· 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˜ ÛÂ Ï›Ô˜ (%) ª¤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·ﬁÎÏÈÛË)

∏ÏÈÎ›· (¤ÙË)∫ÔÚ›ÙÛÈ·∞ÁﬁÚÈ·

8 12 (5)10 (8)

9 13 (9)15 (12)

10 13 (9)19 (12)

11 18 (10)18 (12) 12 17 (10)15 (10) 13 23 (13)22 (13) 14 26 (12)18 (10) 15 28 (8)19 (10) 16 28 (8)20 (12)

¶›Ó·Î·˜ 2. ¢Â›ÎÙË˜ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™)

ª¤ÛË ÙÈÌ‹ (ÛÙ·ıÂÚ‹ ·ﬁÎÏÈÛË)

∏ÏÈÎ›· (¤ÙË)∫ÔÚ›ÙÛÈ·∞ÁﬁÚÈ·

5 16 (1,5)17,5 (2) 6 17,5 (2,5)17,0 (2) 7 17,0 (3)18,0 (3) 8 17,5 (1,5)18,0 (3) 9 18,0 (3)19,0 (3) 1017,5 (4)21,0 (5) 1119,0 (5)21,0 (4) 1219,0 (5)20,0 (2,5) 1322,5 (2,5)22,5 (3) 1422,5 (3)22,5 (4) 1522,5 (3)24,0 (3,5) 1622,0 (2)24,5 (4)

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂÈ˜)

MT (M¤ÛË TÈÌ‹)

™A (1 ™Ù·ıÂÚ‹ AﬁÎÏÈÛË)

(¤ÙË) ™¯‹Ì· 2. ¶ÂÚÈÂÎÙÈÎﬁÙËÙ· ÙÔ˘ ÛÒÌ·ÙÔ˜ ÛÂ Ï›Ô˜ (%) ÛÙ· ·ÁﬁÚÈ·.

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂÈ˜)

MT (M¤ÛË TÈÌ‹)

™A (1 ™Ù·ıÂÚ‹ AﬁÎÏÈÛË)

2 ™A (2 ™Ù·ıÂÚ¤˜ AÔÎÏ›ÛÂÈ˜)

HÏÈÎ›· (¤ÙË)

ÌÂÏ¤ÙË Ì·˜ ¤‰ÂÈÍÂ fiÙÈ ÂÓÒ ÁÈ· ÙÈ˜ ËÏÈÎ›Â˜ 9 Î·È 10 Ù· ·ÁfiÚÈ· ˘ÂÚÙÂÚÔ‡Ó ˆ˜ ÚÔ˜ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· ÛÂ Ï›Ô˜, ·fi Ù· 11 ¤ˆ˜ Ù· 16 ˘¿Ú¯ÂÈ Û·Ê‹˜ ˘ÂÚ›Û¯˘ÛË ÙˆÓ ÎÔÚÈÙÛÈÒÓ. ∞Ó¿ÏÔÁ·

HÏÈÎ›·

(M¤ÛË TÈÌ‹)

™A (2 ™Ù·ıÂÚ¤˜

∏ ¯ÚËÛÈÌÔÔ›ËÛË ÙË˜ ËÏÂÎÙÚÈÎ‹˜ ‚ÈÔ·ÓÙ›ÛÙ·-

ÛË˜ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙË˜ ÂÚÈÂÎÙÈÎﬁÙËÙ·˜ ÙÔ˘ ÛÒ-

Ì·ÙÔ˜ ÛÂ Ï›Ô˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË ·Ô‰Â›¯ıË-

ÎÂ Â‡¯ÚËÛÙË, ÁÚ‹ÁÔÚË Î·È ÔÈÎÔÓÔÌÈÎ‹. ªÔÚÂ› Ó·

ÌËÓ ·Ú¤¯ÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÈÔ ÂÚ›ÏÔÎˆÓ ÌÂıﬁ-

‰ˆÓ, ˘ÂÚ¤¯ÂÈ ﬁÌˆ˜ Û·ÊÒ˜ ÙË˜ ÌÂıﬁ‰Ô˘ Ì¤ÙÚË-

ÛË˜ ÙË˜ ‰ÂÚÌ·ÙÈÎ‹˜ Ù˘¯‹˜, ·ÊÔ‡ Ù· ·ÔÙÂÏ¤-

ÛÌ·Ù· Â›Ó·È ·ÓÙÈÎÂÈÌÂÓÈÎ¿ Î·È ·Ó··Ú·ÁÒÁÈÌ· Î·È

‰ÂÓ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ÂÌÂÈÚ›· ‹ fi¯È ÙÔ˘ ¯ÂÈÚÈÛÙ‹ ÙÔ˘ ÌË¯·Ó‹Ì·ÙÔ˜. ªÂÈÔÓ¤ÎÙËÌ· ÙË˜ ÌÂıfi‰Ô˘

Â›Ó·È Ë ·‰˘Ó·Ì›· ÂÊ·ÚÌÔÁ‹˜ ÙË˜ ÛÂ ÌÈÎÚ¿ ·È‰È¿, ‰ÈﬁÙÈ ÌÈÎÚ¤˜ ÌÂÙ·‚ÔÏ¤˜ ÛÙËÓ ÂÚÈÂÎÙÈÎﬁÙËÙ· ÙÔ˘

ÛÒÌ·ÙÔ˜ ÛÂ ‡‰ˆÚ ÂËÚÂ¿˙ÂÈ ÛËÌ·ÓÙÈÎ¿ ÙË Û¯¤ÛË

Ï›Ô˘˜/¿ÏÈË ÛˆÌ·ÙÈÎ‹ Ì¿˙·. ŒÙÛÈ, ÏÔÈﬁÓ, Ë Ù·-

¯¤ˆ˜ ÌÂÙ·‚·ÏÏﬁÌÂÓË ÂÚÈÂÎÙÈÎﬁÙËÙ· ÙÔ˘ ÛÒÌ·-

ÙÔ˜ ÛÂ ‡‰ˆÚ Î·È ÙË˜ Î·Ù·ÓÔÌ‹˜ ÙË˜ ¿ÏÈË˜ ÛˆÌ·-

ÙÈÎ‹˜ Ì¿˙·˜ ÌÂÙ·Í‡ ÎÔÚÌÔ‡ Î·È ¿ÎÚˆÓ ÛÙÔ ÌÈÎÚﬁ

·È‰› Î·ıÈÛÙ¿ ÙË Ì¤ıÔ‰Ô ·˘Ù‹ ÏÈÁﬁÙÂÚÔ ·ÍÈﬁÈÛÙË

ÛÙÈ˜ ÌÈÎÚ¤˜ ËÏÈÎ›Â˜ (28). ∞˘Ùﬁ˜ Â›Ó·È Î·È Ô ÏﬁÁÔ˜

Ô˘ ÛÙËÓ ·ÚÔ‡Û· ÌÂÏ¤ÙË Ë ÂÚÈÂÎÙÈÎﬁÙËÙ· ÙÔ˘

ÛÒÌ·ÙÔ˜ ÛÂ Ï›Ô˜ ÌÂÙÚ‹ıËÎÂ ÌﬁÓÔ ÛÂ ·È‰È¿ ËÏÈ-

Î›·˜ ¿Óˆ ÙˆÓ 8 ÂÙÒÓ, ·ÊÔ‡ ·ﬁ ·˘Ù‹ ÙËÓ ËÏÈÎ›·

Î·È ¿Óˆ ÙfiÛÔ Ô fiÁÎÔ˜ fiÛÔ Î·È Ë Î·Ù·ÓÔÌ‹ ÙˆÓ

ÙÔ˘ ÛÒÌ·ÙÔ˜ ‰È·ÙËÚÔ‡ÓÙ·È ÛÙ·ıÂÚ¿ Î·È ÚÔÛÔÌÔÈ¿˙Ô˘Ó ÌÂ ·˘Ù¿ ÙˆÓ ÂÓËÏ›ÎˆÓ (26).

µ¿ÚË˜ Â›Ó·È Û·ÊÒ˜ ÈÔ ·¯‡Û·ÚÎ· ÛÂ Û¯¤ÛË ÌÂ Í¤Ó·

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.

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

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-™˘ÚÈ‰¿ÎË ª, ƒÂÌÂÏ¿ÎË˜ µ Î·È Û˘Ó. AÓ¿Ù˘ÍË Î·È ‰È·ÈÙËÙÈÎ¤˜ Û˘Ó‹ıÂÈÂ˜ ·È‰ÈÒÓ Û¯ÔÏÈÎ‹˜ ËÏÈÎ›·˜ ÛÙËÓ Â·Ú¯Â›· ™ËÙÂ›·˜. ¶·È‰È·ÙÚÈÎ‹ 1995;58:326-335.

24. ∫Ô˘Ú›‰Ë˜ °, ∆ÔÚÓ·Ú›ÙË˜ ª, ∫Ô˘Ú›‰Ë˜ Ã, ™¿‚‚· ™, Ã·Ù˙ËÁÂˆÚÁ›Ô˘ Ã, ™È·ÌÔ˘Ó¿ÎË ª. ∏ ·¯˘Û·ÚÎ›· ÛÂ ·È‰È¿ ËÏÈÎ›·˜ 11-12 ÂÙÒÓ ÛÙËÓ ∫‡ÚÔ. ™ËÌ·ÓÙÈÎ‹ ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· 8 ¯ÚﬁÓÈ·. ¶·È‰È·ÙÚÈÎ‹ 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›· ¤ÁÎÚÈÛË˜: 05-02-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: Ã. ∫ÒÛÙ·ÏÔ˜

∞ÚÙ¤ÌÈ‰Ô˜ 130, ∆.∫. 175 62, ¶. º¿ÏËÚÔ

∂ƒ∂À¡∏∆π∫∏

∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿

∞. ª‹ÙÛÈÎ· - ∫·Ú·Ó¿ÛÔ˘, Ã. ∆˙ÈÔ˘‚¿Ú·, ∞. ∫ÔÓ‰‡ÏË˜, °. ∆˙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‰ÈÎ‹ ËÏÈÎ›·, ˆÛÙfiÛÔ Ë

Û˘¯ÓﬁÙËÙ· Î·È ÙÔ Ê¿ÛÌ· ÙˆÓ ÚÔ‰È·ıÂÛÈÎÒÓ ·-

Ú·ÁﬁÓÙˆÓ ÙË˜ ÓﬁÛÔ˘ Ê·›ÓÂÙ·È Ó· ·ÏÏ¿˙Ô˘Ó Î·Ù¿

ÙÈ˜ ÙÂÏÂ˘Ù·›Â˜ ‰ÂÎ·ÂÙ›Â˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÌÂÈ-

Ú›· Ì·˜ ·ﬁ ÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË Î·È ·Ú·-

ÎÔÏÔ‡ıËÛË 9 ·È‰ÈÒÓ ÌÂ ¯ÔÏÔÏÈı›·ÛË Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·. OÈ ÎÏÈÓÈÎ¤˜ ÂÎ‰ËÏÒÛÂÈ˜ ÙˆÓ

·È‰ÈÒÓ Ô›ÎÈÏ·Ó: 4 ·fi Ù· 9 ·È‰È¿ ·ÚÔ˘Û›·˙·Ó Ù˘ÈÎ¿ Û˘ÌÙÒÌ·Ù· (fiÓÔ ÛÙÔ ‰ÂÍÈfi ¿Óˆ ÙÂÙ·ÚÙË-

ÌﬁÚÈÔ ÙË˜ ÎÔÈÏ›·˜ ‹ ÙÔ ÂÈÁ¿ÛÙÚÈÔ, Ó·˘Ù›·, ÂÌ¤ÙÔ˘˜ Î·È ‰˘Û·ÓÂÍ›· ÛÙË Ï‹„Ë ÏÈ·ÚÒÓ ÁÂ˘Ì¿ÙˆÓ),

2 Â›¯·Ó ¿Ù˘Â˜ ÂÎ‰ËÏÒÛÂÈ˜ ·ﬁ ÙÔ ÂÙÈÎﬁ Î·È 3

‹Ù·Ó ·Û˘ÌÙˆÌ·ÙÈÎ¿. ∏ ‰È¿ÁÓˆÛË ÙË˜ ÓﬁÛÔ˘ ¤ÁÈ-

ÓÂ ÌÂ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜. ¶ÚÔ‰È·ıÂÛÈÎÔ›

·Ú¿ÁÔÓÙÂ˜ ÁÈ· Û¯ËÌ·ÙÈÛÌﬁ ¯ÔÏﬁÏÈıˆÓ ·ÓÂ˘Ú¤-

ıËÛ·Ó ÛÂ 7/9 ·È‰È¿. ÃÔÏÔÎ˘ÛÙÂÎÙÔÌ‹ ¤ÁÈÓÂ ÛÂ 4

·È‰È¿, ÂÓÒ Ù· ˘ﬁÏÔÈ· 5 ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÁÈ·

Ì¤ÛÔ ‰È¿ÛÙËÌ· 3,2 ¯ÚﬁÓˆÓ Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó·

Â›Ó·È ·Û˘ÌÙˆÌ·ÙÈÎ¿. ∫·Ó¤Ó· ·ﬁ Ù· ·È‰È¿ ‰ÂÓ

·ÚÔ˘Û›·ÛÂ ÂÈÏÔÎ¤˜.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ¯ÔÏÔÏÈı›·ÛË, ¯ÔÏÔÎ˘ÛÙÂÎÙÔÌ‹, ÌË

¯ÔÏÂÚ˘ıÚÈÓÈÎÔ› ¯ÔÏﬁÏÈıÔÈ.

∂ÈÛ·ÁˆÁ‹ ∏ ¯ÔÏÔÏÈı›·ÛË Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›·. ŒÙÛÈ, Û˘¯Ó¿ ‰È·ÊÂ‡ÁÂÈ ˆ˜ Èı·Ó‹ ·ÈÙ›· ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. πÛÙÔÚÈÎ¿, Ë ÓﬁÛÔ˜ Â›Ó·È Û˘Ó‰Â‰ÂÌ¤ÓË

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.

Key words: cholelithiasis, cholecystectomy, nonpigmented gallstones.

ÌÂ ÙÈ˜ ·ÈÌÔÏ˘ÙÈÎ¤˜ ‰È·Ù·Ú·¯¤˜ Î·È ÙËÓ ÂÁÎ˘ÌÔÛ‡ÓË ÛÙËÓ ÂÊË‚Â›· (1-3). ∆È˜ ÙÂÏÂ˘Ù·›Â˜ 3 ‰ÂÎ·ÂÙ›Â˜, ÌÂ ÙËÓ Â˘ÚÂ›· ¯Ú‹ÛË ÙÔ˘ ˘ÂÚË¯ÔÁÚ·Ê‹Ì·ÙÔ˜, Ë ¯ÔÏÔÏÈı›·ÛË ‰È·ÁÈÁÓÒÛÎÂÙ·È ÌÂ ·˘ÍËÌ¤ÓË Û˘¯ÓfiÙËÙ·, ·ÎfiÌË Î·È ÛÂ ÔÌ¿‰Â˜ ·È‰ÈÒÓ Ô˘ ÚÔËÁÔ‡ÌÂÓ· ‰ÂÓ ‹Ù·Ó ÁÓˆÛÙfi fiÙÈ ‚Ú›ÛÎÔÓÙ·Ó ÛÂ Î›Ó‰˘ÓÔ ÁÈ· Û¯ËÌ·ÙÈÛÌfi ¯ÔÏfiÏÈıˆÓ (¶›Ó·Î·˜ 1). ∂›ÛË˜, ÔÏÏ¤˜ ¯ÔÏÔÏÈıÈ¿ÛÂÈ˜, ÂÎÙfi˜ ·fi ·˘Ù¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ ÙÔ˘˜ ·Ú¿ÁÔÓÙÂ˜ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È È‰ÈÔ·ıÂ›˜. ∞fi ÚfiÛÊ·ÙÂ˜ ÌÂÏ¤ÙÂ˜ Ê·›ÓÂÙ·È fiÙÈ ÙÔ 80% ÂÚ›Ô˘ ÙˆÓ ¯ÔÏfiÏÈıˆÓ ÛÙ· ·È‰È¿ ‰ÂÓ ÔÊÂ›ÏÂÙ·È ÛÂ ·ÈÌÔÏ˘ÙÈÎ‹ ‰È·Ù·Ú·¯‹ Î·È ÙÔ ˘fiÏÔÈÔ 20% Û¯ÂÙ›˙ÂÙ·È ÌÂ ˘ÔÙÚÔÈ¿˙Ô˘Û· ·ÈÌfiÏ˘ÛË (46). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ¯ÔÏfiÏÈıˆÓ ÛÙ· ·È‰È¿ ·ÔÙÂÏÂ› ıÂÚ·Â˘ÙÈÎfi ‰›ÏËÌÌ·. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ 10% ÙˆÓ ÂÓËÏ›ÎˆÓ ı· ¤¯Ô˘Ó ·Û˘ÌÙˆÌ·ÙÈÎÔ‡˜

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

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

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›· ¤ÁÎÚÈÛË˜: 06-02-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ÁÁÂÏÈÎ‹ ª‹ÙÛÈÎ·

¶›Ó‰Ô˘ 9-11, ∆∫. 152 35, µÚÈÏ‹ÛÛÈ·

™ÎÔfi˜: O ÚfiÏÔ˜ ÙÔ˘ ÂÏÈÎÔ‚·ÎÙËÚÈ‰›Ô˘ ÙÔ˘ ˘ÏˆÚÔ‡ (H. pylori) ÛÙËÓ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ˘ÔÙÚÔÈ·˙fiÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·Ï-

ÁÒÓ ·Ú·Ì¤ÓÂÈ ·Û·Ê‹˜. ™ÎÔﬁ˜ ÙË˜ ÌÂÏ¤ÙË˜ ‹Ù·Ó Ó· ‰ÈÂ-

ÚÂ˘ÓËıÂ› ·Ó ÛÂ ·È‰È¿ ÌÂ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏÈ·Î¿ ¿ÏÁË Î·È

ÏÔ›ÌˆÍË ·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¿ ËÏÈÎ›·˜ 4,9-14,5 ÂÙÒÓ (‰È¿ÌÂÛË

ËÏÈÎ›· 9,8 ¤ÙË) ÌÂ ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÎÔÈÏÈ·Î¿ ¿ÏÁË Î·È ÏÔ›ÌˆÍË ·fi H. pylori ·ÔÙ¤ÏÂÛ·Ó ÙÔ ˘ÏÈÎfi ÙË˜ ÌÂÏ¤ÙË˜. ∏ ‰È¿ÁÓˆÛË ÙË˜ ÏÔ›ÌˆÍË˜ ·fi H. pylori ¤ÁÈÓÂ ÌÂ ÈÛÙÔÏÔÁÈÎ‹ ÂÍ¤Ù·ÛË Î·È Î·ÏÏÈ¤ÚÁÂÈ·. ¢fiıËÎÂ ·ÁˆÁ‹ ÁÈ· ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ H.

pylori Î·È ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ·ÁˆÁ‹˜ ¤ÁÈÓÂ Â·Ó¿-

ÏË„Ë ÙË˜ Á·ÛÙÚÔÛÎﬁËÛË˜ ÌÂ Ï‹„Ë ‚ÈÔ„ÈÒÓ. ∏ ·ÚÔ˘Û›· ‹

fi¯È Û˘ÌÙˆÌ¿ÙˆÓ Î·Ù·ÁÚ¿ÊËÎÂ 3 Î·È 6 Ì‹ÓÂ˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙË˜ ıÂÚ·Â›·˜ ÂÎÚ›˙ˆÛË˜ Î·È ·Ú¿ÏÏËÏ· ¤ÁÈÓÂ ¤ÏÂÁ¯Ô˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÁÈ· H. pylori ÛÙÔÓ ÔÚfi ÙÔ˘ ·›Ì·ÙÔ˜. ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ·Ú·ÎÔÏÔ‡ıËÛË˜, Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÂÓ‰ÔÛÎfiËÛË˜ Î·È ÙÔ˘ ÔÚÔÏÔÁÈÎÔ‡ ÂÏ¤Á¯Ô˘ ‰ÂÓ ÁÓˆÛÙÔÔÈ‹ıËÎ·Ó ÛÂ 23 ·ÛıÂÓÂ›˜, ÂÓÒ ¤ÁÈÓ·Ó ÁÓˆÛÙ¿ ÛÂ 14, Û‡ÌÊˆÓ· ÌÂ ÙËÓ ÂÈı˘Ì›· ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ. ∞ÔÙÂÏ¤ÛÌ·Ù·: ∆· ÔÛÔÛÙ¿ ÂÎÚ›˙ˆÛË˜ ‹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·ÓÙÈÎ¿ ÛÙÔ˘˜ 3 Ì‹ÓÂ˜ (p<0,03), Î·ıÒ˜ Â›ÛË˜ Î·È ÛÙÔ˘˜ 6 Ì‹ÓÂ˜ (p<0,001) ÛÙ· ·È‰È¿ ÌÂ ÂÈÙ˘¯‹ ÂÎÚ›˙ˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ ÌÂÈÒıËÎÂ Î·È ˘‹Ú¯Â ‚ÂÏÙ›ˆÛË ÙË˜ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (95%) 6 Ì‹ÓÂ˜ ÌÂÙ¿ ÙËÓ ·ÁˆÁ‹. ¢ÂÓ ‚Ú¤ıËÎÂ fiÌˆ˜ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ÂÎÚ›˙ˆÛË˜ ‹ fi¯È ÙÔ˘ H. pylori Î·È ÂÍ·Ê¿ÓÈÛË˜ ÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ, Â›ÙÂ ÛÙÔ˘˜ 3 Î·È 6 Ì‹ÓÂ˜ ·Ú·ÎÔÏÔ‡ıËÛË˜ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (p=0,94 Î·È p=0,90), Â›ÙÂ ÛÙËÓ Ù˘ÊÏ‹ ÔÌ¿‰· (p=0,42 Î·È p=0,65).

™˘ÌÂÚ¿ÛÌ·Ù·: ™‡ÌÊˆÓ· ÌÂ Ù· ·ÔÙÂÏ¤ÛÌ·Ù· ÙË˜ ÌÂÏ¤ÙË˜ ‰ÂÓ ·Ô‰ÂÈÎÓ‡ÂÙ·È ·ÈÙÈÔÏÔÁÈÎ‹ Û˘Û¯¤ÙÈÛË ÌÂÙ·Í‡ ˘ÔÙÚÔÈ·˙ﬁÓÙˆÓ ÎÔÈÏÈ·ÎÒÓ ·ÏÁÒÓ Î·È H. pylori

1Wewer 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

∂¡¢π∞º∂ƒOÀ™∞

™‡Ó‰ÚÔÌÔ

ÛÙ¤ÚËÛË˜ ·ﬁ Ó·ÚÎˆÙÈÎ¤˜ Î·È ÌË-Ó·ÚÎˆÙÈÎ¤˜ Ô˘Û›Â˜

ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ

π. ∫·ÂÙ·Ó¿ÎË˜1, π. ∫·Ï¤ÁÈ·˜1, ª. ª·ÚÎÔ‡ÚË1, °. ∞ÏÂ‚È˙ﬁÔ˘ÏÔ˜2, °. ∫Ô˘Ú¿ÎË˜1, ∏. ¢ÂÏÏ·ÁÚ·ÌÌ¿ÙÈÎ·˜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

Î‡ËÛË˜ ÌÔÚÂ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Û‡Ó‰ÚÔÌÔ ÛÙ¤ÚËÛË˜ (™™) ÛÙË ÓÂÔÁÓÈÎ‹ ÂÚ›Ô‰Ô ÏfiÁˆ ·ÈÊÓ›‰È·˜ ‰È·ÎÔ‹˜ ÙË˜ ÂıÈÛÙÈÎ‹˜ Ô˘Û›·˜ Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. OÈ Ô˘Û›Â˜ Ô˘ ÌÔÚÂ› Ó· ÚÔÎ·Ï¤ÛÔ˘Ó ™™ ÛÙÔ ÓÂÔÁÓfi Â›Ó·È ·˘Ù¤˜ Ô˘ ÚÔÎ·ÏÔ‡Ó ÂÍ¿ÚÙËÛË ÛÂ ÂÓ‹ÏÈÎÂ˜, fiˆ˜ Ù· ÔÈÔÂÈ‰‹ (ËÚˆ›ÓË, ÌÂı·‰fiÓË, ÌÔÚÊ›ÓË), Ù· ‚·Ú‚ÈÙÔ˘ÚÈÎ¿, ÙÔ ·ÏÎÔfiÏ Î·È ÔÈ ‚ÂÓ˙Ô‰È·˙Â›ÓÂ˜. OÈ ÂÎ‰ËÏÒÛÂÈ˜ ÙÔ˘ ™™ Â›Ó·È ÔÈÎ›ÏÂ˜ Î·È ·ÓÂÍ¿ÚÙËÙÂ˜ ÙË˜ Ô˘Û›·˜ Î·È Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·‰˘Ó·Ì›· ‡ÓÔ˘, Â˘ÂÚÂıÈÛÙfiÙËÙ·, ÙÚfiÌÔ, ˘ÂÚ·ÓÙÈ‰Ú·ÛÙÈÎfiÙËÙ·, ‰È¿ÚÚÔÈ·, ·Ó·ÓÂ˘ÛÙÈÎ‹ ‰˘Û¯¤ÚÂÈ·, ¿ÓÔÈ·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·Ó·ÓÂ˘ÛÙÈÎ‹ ·ÏÎ¿ÏˆÛË

Î·È ‰·ÎÚ‡ÚÚÔÈ·. ∏ ÌË ÂÈ‰ÈÎ‹ ÎÏÈÓÈÎ‹ ÂÈÎﬁÓ· ÙÔ˘ ™™ Î·ıÈÛÙ¿ ÙË ‰È¿ÁÓˆÛ‹ ÙÔ˘ ‰˘Û¯ÂÚ‹. º·ÚÌ·ÎÂ˘ÙÈÎ‹

·Ú¤Ì‚·ÛË ··ÈÙÂ›Ù·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÛÔ‚·ÚÒÓ

ÂÎ‰ËÏÒÛÂˆÓ. ∆· Ê¿ÚÌ·Î· 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ÙÒÛÂÈ˜ ™™ ÛÙË ÓÂÔÁÓÈÎ‹ ËÏÈÎ›· ·fi Ó·ÚÎˆÙÈÎ¤˜ (ÌÂı·‰fiÓË) Î·È ÌË-Ó·ÚÎˆÙÈÎ¤˜ (‚ÂÓ˙Ô‰È·˙Â›ÓË) Ô˘Û›Â˜ Ô˘ Â›¯·Ó ·ÚfiÌÔÈ· ÎÏÈÓÈÎ‹ ÂÈÎfiÓ·. ∆Ô Î‡ÚÈÔ Û‡ÌÙˆÌ· ‹Ù·Ó Ë ÚÒÈÌË ¤Ó·ÚÍË Û·ÛÌÒÓ. ∏ ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ· Î·Ù¿¯ÚËÛË˜ Ê·ÚÌ¿ÎˆÓ ÛÙË ¯ÒÚ· Ì·˜ Ô‰ËÁÂ› ÛÂ ·˘Í·ÓfiÌÂÓÔ ·ÚÈıÌfi ÓÂÔÁÓÒÓ Ô˘ ¤¯Ô˘Ó ÂÎÙÂıÂ› ÛÂ ·˘Ù¿ ÂÓ‰ÔÌËÙÚ›ˆ˜. ∏ ÚfiÏË„Ë, Ë ıÂÚ·Â›· Î·È Ë ÊÚÔÓÙ›‰· ·˘ÙÒÓ ÙˆÓ ÓÂÔÁÓÒÓ ÂÈ‚¿ÏÏÂÈ ÙË ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· ÙË˜ ÔÏÈÙÂ›·˜, ÙˆÓ

1 ∆Ì‹Ì· ¡ÂÔÁÂÓÓ‹ÙˆÓ

2 Forensic Medicine and Toxicology Lab, University of Athens ¶ÂÚ›ÏË„Ë: ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó ÂıÈÛÙÂ› ÛÙË ¯Ú‹ÛË ‰È·ÊﬁÚˆÓ Ô˘ÛÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙË˜

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 Neonatal Intensive Care Unit

2nd Pediatric Clinic, University of Athens

ËÌ¤Ú· (Â‡ÚÔ˜ ·ﬁ 1Ë ¤ˆ˜ 14Ë ËÌ¤Ú· ˙ˆ‹˜) (7). ∆Ô

ÓÂÔÁÓﬁ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÌÂ ™™ ·ﬁ ÌË-Ó·ÚÎˆÙÈ-

Î¤˜ Ô˘Û›Â˜ ÂÎ‰‹ÏˆÛÂ ÙÔ ™™ ÙËÓ 3Ë ËÌ¤Ú· ˙ˆ‹˜.

ÕÏÏÂ˜ ˘ÓˆÙÈÎ¤˜ Ô˘Û›Â˜ ÂÎ‰ËÏÒÓÔ˘Ó Û˘ÌÙÒÌ·-

Ù· ™™ ·ÎfiÌ· ·ÚÁfiÙÂÚ·, fiˆ˜ Ë ‰È·˙Â¿ÌË ÙË 12Ë

ËÌ¤Ú· Î·È Ë ¯ÏˆÚ·‰È·˙ÂÔÍ›‰Ë ÙËÓ 21Ë ËÌ¤Ú· ˙ˆ‹˜ (12,13).

∆Ô Â˘Ú‡ Ê¿ÛÌ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÎ‰ËÏÒÛÂˆÓ ÙÔ˘

™™ Ê·›ÓÂÙ·È ·ﬁ ÙËÓ ÎÏ›Ì·Î· ‚·ıÌÔÏﬁÁËÛË˜ Î·Ù¿

Finnegan (14) (¶›Ó·Î·˜ 1). ∆· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ

Ô˘ Â›Ó·È ÛÂ ÚﬁÁÚ·ÌÌ· ·ÂÍ¿ÚÙËÛË˜ ÌÂ ÌÂı·-

‰ﬁÓË ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ µ° ÛÂ Û¯¤ÛË ÌÂ ·˘Ù¿ ÙˆÓ

ÌËÙ¤ÚˆÓ Ô˘ Â›Ó·È ¯Ú‹ÛÙÂ˜ ËÚˆ›ÓË˜, ·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 ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› (1). §›ÁÂ˜ ÌÂÏ¤ÙÂ˜ ¤¯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¿ ÌÂ ™™ ·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›·˙Â ‰È·Ù·Ú·¯¤˜ ÙË˜ Û˘ÌÂÚÈÊÔ-

Ú¿˜ (‰È¿Û·ÛË ÙË˜ ÚÔÛÔ¯‹˜, ÂÈıÂÙÈÎﬁÙËÙ·), ÙÔ 20% Â›¯Â Ì¤ÙÚÈ·/ÛËÌ·ÓÙÈÎ‹ „˘¯ÔÎÈÓËÙÈÎ‹ Î·ı˘ÛÙ¤-

ÚËÛË ÏfiÁˆ ÛÙ¤ÚËÛË˜ ÊÚÔÓÙ›‰·˜, Î·È ÙÔ 43% Â›¯Â ·ÔÌ·ÎÚ˘ÓıÂ› ·fi ÙË ÌËÙ¤Ú· ÙÔ˘˜ ÌÂÙ¿ ·fi ‰È-

Î·ÛÙÈÎ‹ ·ﬁÊ·ÛË. ∆· ‰‡Ô ÓÂÔÁÓ¿ Ô˘ ÂÚÈÁÚ¿-

ÊÔÓÙ·È ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÛÂ ËÏÈÎ›· 2 ÂÙÒÓ Î·È ‰ÂÓ

¶›Ó·Î·˜ 1. ∫ÏÈÓÈÎ‹ ‚·ıÌÔÏﬁÁËÛË Î·Ù¿ Finnegan

·ÚÔ˘Û›·˙·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ‹ ÛÙËÓ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË. ∏ ·Ú¯ÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™™ Â›Ó·È ˘ÔÛÙËÚÈÎÙÈÎ‹. ∏ ·ﬁÊ·ÛË ÁÈ· ıÂÚ·Â˘ÙÈÎ‹

·Ú¤Ì‚·ÛË ÂÍ·ÚÙ¿Ù·È ·ﬁ ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ Û˘Ó‰ÚﬁÌÔ˘ Î·È ÛÂ ·˘Ù‹ ‚ÔËı¿ Ë ¯ÚËÛÈÌÔÔ›ËÛË ÙË˜

ÎÏ›Ì·Î·˜ Finnegan.

∏ ·fiÊ·ÛË ÁÈ· Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ ÂÍ·ÙÔÌÈÎÂ‡ÂÙ·È Î·È ÛÙËÚ›˙ÂÙ·È ÛÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ™™. ∆Ô ™™ ÌÔÚÂ› Ó· Â›Ó·È ı·Ó·ÙËÊfiÚÔ. ¶·Ú’ fiÏ· ·˘Ù¿, Ë ÛÙ¤ÚËÛË Â›Ó·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ‰È·‰ÈÎ·Û›·. ∆Ô

fiÊÂÏÔ˜ ÙË˜ ıÂÚ·Â˘ÙÈÎ‹˜ ·ÁˆÁ‹˜ Â›Ó·È Ë ‚Ú·¯˘¯ÚfiÓÈ· ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ. ¢ÂÓ ¤¯ÂÈ, fiÌˆ˜, ·ÎfiÌ· ‰ÈÂ˘ÎÚÈÓÈÛÙÂ› ·Ó Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÓÔÛËÚfiÙËÙ· ·fi ÛÙ¤ÚËÛË ÌÂÈÒÓÂÙ·È ÌÂ Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹ (10,15).

¡ÂÔÁÓ¿ ÌÂ ÙÂÎÌËÚÈˆÌ¤ÓË ¤ÎıÂÛË ÛÂ Ô˘Û›Â˜ ÂÓ‰ÔÌËÙÚ›ˆ˜ ¯ˆÚ›˜ Û˘ÌÙÒÌ·Ù· ‰ÂÓ ¯Ú‹˙Ô˘Ó Ê·ÚÌ·ÎÂ˘ÙÈÎ‹˜ ·ÁˆÁ‹˜. OÈ ÂÓ‰Â›ÍÂÈ˜ ÁÈ· ·ÁˆÁ‹ Â›Ó·È ÔÈ Û·ÛÌÔ›, Ë ·ÓÂ·ÚÎ‹˜ Û›ÙÈÛË, ÔÈ ‰È¿ÚÚÔÈÂ˜, ÔÈ ¤ÌÂÙÔÈ Ô˘ Ô‰ËÁÔ‡Ó ÛÂ ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È

Ë ·‰˘Ó·Ì›· ‡ÓÔ˘ Î·È Ô ˘ÚÂÙfi˜ (1,10,14). ∏ ‚·ıÌÔÏfiÁËÛË Î·Ù¿ Finnegan ÌÂÁ·Ï‡ÙÂÚË ·fi 8 ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ÛÔ‚·ÚÔ‡ ™™ Î·È ·Ó¿ÁÎË˜ ÁÈ· Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÁˆÁ‹. ∞Ó ÙÂÏÈÎ¿ ÎÚÈıÂ› ÛÎfiÈÌË Ë Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·ÓÙÈÌÂÙÒÈÛË, ÙfiÙÂ ÚÔÙÈÌ¿Ù·È Ê¿ÚÌ·ÎÔ ·fi ÙËÓ ›‰È· Î·ÙËÁÔÚ›·

ÙË ÛÙ¤ÚËÛË. ∂ÁÎÂÎÚÈÌ¤Ó· Ê¿ÚÌ·Î·

∂‡ÚËÌ·µ·ıÌﬁ˜¶ÂÚ›ÙˆÛË 1¶ÂÚ›ÙˆÛË 2

OÍ‡ ÎÏ¿Ì·2+

™˘ÓÂ¯¤˜ ÔÍ‡ ÎÏ¿Ì·3

⁄ÓÔ˜ <1 ÒÚ· ÌÂÙ¿ ·ﬁ Û›ÙÈÛË4

⁄ÓÔ˜ <2 ÒÚÂ˜ ÌÂÙ¿ ·ﬁ Û›ÙÈÛË3

⁄ÓÔ˜ <3 ÒÚÂ˜ ÌÂÙ¿ ·ﬁ Û›ÙÈÛË2

∞ÓÙ·Ó·ÎÏ·ÛÙÈÎﬁ Moro ++2

∞ÓÙ·Ó·ÎÏ·ÛÙÈÎﬁ Moro +++3

∂Ï·ÊÚﬁ˜ ÙÚﬁÌÔ˜ ÛÙ· ÂÚÂı›ÛÌ·Ù·2

∂Ï·ÊÚ¤˜ ÙÚÔÌÒ‰ÂÈ˜ ÎÈÓ‹ÛÂÈ˜ ÛÙËÓ ·Ó¿·˘ÛË3+

∆ÚÔÌÒ‰ÂÈ˜ ÎÈÓ‹ÛÂÈ˜ ÛÙËÓ ·Ó¿·˘ÛË4+

ÀÂÚÙÔÓ›·2++ ™·ÛÌÔ›5++

£ËÏ·ÛÌﬁ˜ ÁÚÔıÈ¿˜ ¿ÌÊˆ1

¶Ùˆ¯‹ Û›ÙÈÛË2

∞Ó·ÁˆÁ¤˜2

ŒÌÂÙÔÈ3

¢È¿ÚÚÔÈ· +2

¢È¿ÚÚÔÈ· ++3

™˘¯Ó¿ ¯·ÛÌÔ˘ÚËÙ¿1

¶ÙÂÚÓ›ÛÌ·Ù·1

£ÔÚ˘‚Ò‰Ë˜ ·Ó·ÓÔ‹1

∂Ê›‰ÚˆÛË1

£ÂÚÌÔÎÚ·Û›· >38ÔC2

∆·¯‡ÓÔÈ· (>60 ·Ó·ÓÔ¤˜/min)1+

∆·¯‡ÓÔÈ· Î·È ÂÈÛÔÏÎ‹2

∂Î‰ÔÚ¿ Ì‡ÙË˜ / ÁÔÓ¿ÙˆÓ1

Â›Ó·È Ë ‚ÂÓ˙Ô‰È·˙Â›ÓË ÁÈ· ÙÔ ·ÏÎÔfiÏ Î·È Ë ÌÂı·‰fiÓË ÁÈ· Ù· ÔÈÔ‡¯·. ∂›Ó·È ÁÓˆÛÙfi, fiÌˆ˜, fiÙÈ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Î·È ¿ÏÏ· Ê¿ÚÌ·Î·, fiˆ˜ ÙÔ Ï¿‚‰·ÓÔ, Ë ¿Ó˘‰ÚÔ˜ ÌÔÚÊ›ÓË, Ë ÎÏÔÓÈ‰›ÓË, Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË, Ë ¯ÏˆÚÔÚÔÌ·˙›ÓË Î·È Ë ‰È·˙Â¿ÌË. ∏ ‚ÂÏÙ›ˆÛË ÙË˜ ‚·ıÌÔÏfiÁËÛË˜ Î·Ù¿ Fineggan ‚ÔËı¿ÂÈ ÛÙËÓ ·fiÊ·ÛË ÁÈ· ÙË ÌÂ›ˆÛË ÙË˜ ¯ÔÚËÁÔ‡ÌÂÓË˜ ‰fiÛË˜. ∆· ÎÚÈÙ‹ÚÈ· Â·ÚÎÔ‡˜ ·ÁˆÁ‹˜ Â›Ó·È

Ë Ê˘ÛÈÔÏÔÁÈÎ‹ ıÂÚÌÔÎÚ·Û›·, Ë ‰˘Ó·ÙﬁÙËÙ· ÙÔ˘

ÓÂÔÁÓÔ‡ Ó· ÎÔÈÌ¿Ù·È ÌÂÙ·Í‡ ÙˆÓ ÁÂ˘Ì¿ÙˆÓ, Ë ÌÂ›ˆÛË ÙÔ˘ ÎÏ¿Ì·ÙÔ˜ Î·È Ë ·‡ÍËÛË ÙÔ˘ ‚¿ÚÔ˘˜.

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, ÙÔ ™™ ÛÂ ÓÂÔÁ¤ÓÓËÙ· ÙÔÍÈÎÔ-

Ì·ÓÒÓ ÌËÙ¤ÚˆÓ, Ô˘ Û‹ÌÂÚ· Â›Ó·È Û¯ÂÙÈÎ¿ Û¿ÓÈÔ

Ê·ÈÓﬁÌÂÓÔ, ı· ·ÔÙÂÏ¤ÛÂÈ ÌÂÏÏÔÓÙÈÎ¿ ÛÔ‚·Úﬁ

Úfi‚ÏËÌ· ÛÙËÓ ÂÏÏËÓÈÎ‹ ÎÔÈÓˆÓ›·, ÏfiÁˆ ÌË ÂÏÂÁ¯fiÌÂÓË˜ ÂÍ¿ÏˆÛË˜ ÙˆÓ Ó·ÚÎˆÙÈÎÒÓ ÛÙË ÓÂÔÏ·›· Ì·˜. ∂ÈÛËÌ·›ÓÂÙ·È fiÙÈ ÙÔ ™™ ÂÎ‰ËÏÒÓÂÙ·È ·ÎfiÌ·

Î·È ÛÂ ÓÂÔÁÓ¿ Ô˘ ·›ÚÓÔ˘Ó ÌË-Ó·ÚÎˆÙÈÎ¤˜ Ô˘Û›Â˜, ﬁˆ˜ ·Á¯ÔÏ˘ÙÈÎ¿ Î·È ·ÓÙÈÎ·Ù·ıÏÈÙÈÎ¿ Ê¿Ú-

Ì·Î·. ∏ ÚﬁÏË„Ë, Ë ıÂÚ·Â›· Î·È Ë ÓÔÛËÏÂ›· ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ ™™ ÂÈ‚¿ÏÏÔ˘Ó ÙË ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· ÙË˜ ¶ÔÏÈÙÂ›·˜, ÙˆÓ ÎÔÈÓˆÓÈÎÒÓ ÊÔÚ¤ˆÓ, Î·ıÒ˜ Î·È ÙÔ˘ È·ÙÚÈÎÔ‡ Î·È ÓÔÛËÏÂ˘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‡ÁÎ· ª, ªÔ‡Ú· ™ Î·È Û˘Ó. ÃÚ‹ÛÙÂ˜ ËÚˆ›ÓË˜ Î·È ÂÊËÌÂÚ›·. π·ÙÚÈÎﬁ µ‹Ì· 2001;74:18-21.

3. ¶··ıˆÌ¿ ∂, Ã·Ù˙ËÛÙ·Ì·Ù›Ô˘ ∑, OÈÎÔÓÔÌ›‰Ô˘ O, Ã·Ú·Ï¿ÌÔ˘˜ ∞, ¡ÈÎÔÏﬁÔ˘ÏÔ˜ ¢. ¡ÂÔÁ¤ÓÓËÙ· ÌËÙ¤ÚˆÓ ¯ÚËÛÙÒÓ Ó·ÚÎˆÙÈÎÒÓ Ô˘ÛÈÒÓ. ¶Ú·ÎÙÈÎ¿ 9Ô˘ ¶·ÓÂÏÏ‹ÓÈÔ˘ ™˘ÓÂ‰Ú›Ô˘ ∫ÔÈÓˆÓÈÎ‹˜ π·ÙÚÈÎ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ ÀÁÂ›·˜ 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.

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›· ¤ÁÎÚÈÛË˜: 18-01-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆÛ‹Ê ∫·Ï¤ÁÈ·˜

Õıˆ 31 Î·È øÚˆÔ‡, ¶¿ÙÚ· E-mail: kaleyias@hotmail.com

∂¡¢π∞º∂ƒOÀ™∞

REPORT

Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ ÏﬁÁˆ ·ÓˆÌ·Ï›·˜

Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘: ¶ÂÚ›ÙˆÛË ·ÛıÂÓÔ‡˜

∞. M›¯Ô˜1, ∂. OÚÊ·ÓÔ‡1, ∂. ¶··Ó‰Ú¤Ô˘2, ¡. ª·ÏÙÔÁÈ¿ÓÓË˜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‹ÏˆÛË˜ ÙÔ˘ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ÚÔ‰È·ı¤ÙÂÈ ÛÂ Û˘ÛÙÚÔÊ‹

ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, Ë ÔÔ›· ÂÎ‰ËÏÒÓÂÙ·È Û¿ÓÈ· ÌÂ-

ÙË ‚ÚÂÊÈÎ‹ ËÏÈÎ›·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë

·È‰ÈÔ‡ 5 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ¯ÚﬁÓÈ·˜ ‰È¿ÚÚÔÈ·˜, ÂÚÈÔ‰ÈÎÔ‡ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜ Î·È ÂÌ¤ÙˆÓ. ∆Ô ·È‰› Â›¯Â ÓÔÛËÏÂ˘ÙÂ› ÛÂ ‰È¿ÊÔÚ· ÓÔÛÔÎÔÌÂ›· ¯ˆÚ›˜ Ó· ÙÂıÂ› Û·Ê‹˜ ‰È¿ÁÓˆÛË. ™Â Ê¿ÛË ˘ÔÙÚÔ‹˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‰È·ÁÓÒÛÙËÎÂ ÌÂ ·ÂÈÎÔÓÈ-

ÛÙÈÎ‹ Ì¤ıÔ‰Ô Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ Î·È ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛË˜ ÙÔ˘ Ì¤ÛÔ˘ ÂÓÙ¤-

∆· Â˘Ú‹Ì·Ù· ÂÈ‚Â‚·ÈÒıËÎ·Ó Î·È Î·Ù¿ ÙË ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË ﬁÔ˘ ¤ÁÈÓÂ Î·È ·ÓÙÈÌÂÙÒÈ-

ÛË. ™˘˙ËÙÔ‡ÓÙ·È Ë ÎÏÈÓÈÎ‹ ÚÔ‚ÔÏ‹ Î·È ÔÈ Ì¤ıÔ‰ÔÈ

‰È¿ÁÓˆÛË˜ ÙË˜ ¯ÚﬁÓÈ·˜ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÌÂÛÂÓÙÂ-

Ú›Ô˘, ÂÓÒ ÙÔÓ›˙ÂÙ·È ﬁÙÈ ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙÚÔÊ‹˜ ÙÔ˘

Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ı· Ú¤ÂÈ Ó· ·ÔÎÏÂ›ÔÓÙ·È ÛÂ ·È-

‰È¿ ÌÂ ¯ÚﬁÓÈ· Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ·ﬁ ÙÔ Á·ÛÙÚÂ-

ÓÙÂÚÈÎﬁ Û‡ÛÙËÌ·.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: Û˘ÛÙÚÔÊ‹ ÌÂÛÂÓÙÂÚ›Ô˘, ·ÓˆÌ·Ï›·

ÛÙÚÔÊ‹˜ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘, ¯ÚﬁÓÈ· ¿Ù˘· ÎÔÈÏÈ·Î¿

Û˘ÌÙÒÌ·Ù·, ·È‰ÈÎ‹ ËÏÈÎ›·.

∂ÈÛ·ÁˆÁ‹ H ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛË˜ ÙÔ˘ Ì¤-

ÛÔ˘ ÂÓÙ¤ÚÔ˘ (∞™∫ª∂) (malrotation) ÌÔÚÂ› Ó·

ÚÔÎ·Ï¤ÛÂÈ Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘. ∏ Û˘-

ÌÙˆÌ·ÙÔÏÔÁ›· Â›Ó·È Û˘Ó‹ıˆ˜ ÔÍÂ›· Î·Ù¿ ÙË ‰È¿Ú-

ÎÂÈ· ÙË˜ ÓÂÔÁÓÈÎ‹˜ Î·È ‚ÚÂÊÈÎ‹˜ ËÏÈÎ›·˜, ÂÓÒ ÛÙÈ˜

ÌÂÁ·Ï‡ÙÂÚÂ˜ ËÏÈÎ›Â˜ ÌÔÚÂ› Ó· Â›Ó·È ‰È·ÏÂ›Ô˘Û· Î·È ·Ì‚Ï˘¯Ú‹, ÌÂ ·ÔÙ¤ÏÂÛÌ· Ë ‰È¿ÁÓˆÛË Û˘¯Ó¿ Ó· ‰È·Ï·Óı¿ÓÂÈ (1). ¶ÂÚÈÁÚ¿ÊÂÙ·È

·È‰ÈÔ‡ 5 ÂÙÒÓ ÌÂ Û˘ÌÙÒÌ·Ù·

ÂÚÈÔ‰ÈÎÔ‡

‰È¿ÚÚÔÈ-

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.

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

Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘ ÛÂ ¤‰·ÊÔ˜ ·ÓÒÌ·ÏË˜ ÛÙÚÔÊ‹˜ Î·È Î·ı‹ÏˆÛË˜ ÙÔ˘ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

∞ÁﬁÚÈ ËÏÈÎ›·˜ 5 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜

ÏfiÁˆ ÂÌ¤ÙˆÓ, ‰È¿ÚÚÔÈ·˜ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È Î¿ÙÈ ·ıÔÏÔÁÈÎfi ¤ˆ˜ ÙËÓ ËÏÈÎ›· ÙˆÓ 2 ÂÙÒÓ, ÂÓÒ ÙÔ ·È‰› ÚÔÛÏ¿Ì‚·ÓÂ Ê˘ÛÈÔÏÔÁÈÎ¿ ‚¿ÚÔ˜,

ÂÌ¤ÙˆÓ, ÌÂ Â·ÓÂÈÏËÌÌ¤ÓÂ˜ ÂÈÛ·ÁˆÁ¤˜ ÛÂ ÓÔÛÔÎÔÌÂ›·. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ‰È·ÁÓÒÛıËÎÂ

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

2 µ’ ¶·È‰Ô¯ÂÈÚÔ˘ÚÁÈÎ‹ ∫ÏÈÓÈÎ‹ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”

1 1st Pediatric Clinic, University of Athens

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

‡„Ô˜ Î·È ·ÚÔ˘Û›·˙Â Ê˘ÛÈÔÏÔÁÈÎ‹ „˘¯ÔÎÈÓËÙÈÎ‹ ÂÍ¤ÏÈÍË. ªÂÙ¿ ÙÔ 2Ô ¤ÙÔ˜ ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÔ‰ÈÎ¿ ÂÂÈÛﬁ‰È· ‰È·ÚÚÔ˚ÎÒÓ ÎÂÓÒÛÂˆÓ ÎÈÙÚÈÓˆÒÓ ÌÂ

‚Ï¤ÓÓË (ÂÚ›Ô˘ 4-5/24ˆÚÔ) Ô˘ ‰È·ÚÎÔ‡Û·Ó ÂÚ›Ô˘ Ì›· Â‚‰ÔÌ¿‰·, Â·Ó·Ï·Ì‚¿ÓÔÓÙ·Ó Î¿ıÂ 2-3 Ì‹ÓÂ˜ Î·È Û˘ÓÔ‰Â‡ÔÓÙ·Ó ·fi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ‚ÔÚ‚ÔÚ˘ÁÌÔ‡˜ Î·È ÂÌ¤ÙÔ˘˜. ∆· ÂÂÈÛfi‰È· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó ÌÂ ‰È·ÈÙËÙÈÎ¤˜ Ô‰ËÁ›Â˜, ‰È·ÎÔ‹ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ, ·ÓÙÈ‰È·ÚÚÔ˚Î¿ Ê¿ÚÌ·Î·, ·ÓÙÈÌÈÎÚÔ‚È·Î‹ ·ÁˆÁ‹ Î·È ˘Ô¯ˆÚÔ‡Û·Ó. ∆Ô ·È‰› Â›¯Â ÂÈÛ·¯ıÂ› ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÍ¿ÌËÓÔ 3 ÊÔÚ¤˜ ÛÂ ÂÚÈÊÂÚÂÈ·Î¿ ÓÔÛÔÎÔÌÂ›·, fiÔ˘ Ô ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÂ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜ (3 ÊÔÚ¤˜), ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ (3 ÊÔÚ¤˜), ‰È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÌÂ ‚¿ÚÈÔ (2 ÊÔÚ¤˜) ‰ÂÓ ¤‰ÂÈÍ·Ó Î¿ÙÈ ·ıÔÏÔÁÈÎfi.

∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜, ·fi ÙËÓ ÂÈÛÎfiËÛË ¤‰ÈÓÂ ÙËÓ ÂÓÙ‡ˆÛË ¿Û¯ÔÓÙÔ˜ Î·È ‰˘ÛÙÚÔÊÈÎÔ‡ ·È‰ÈÔ‡ (·Ó·ÊÂÚfiÙ·Ó ·ÒÏÂÈ·

‚¿ÚÔ˘˜ 2 kg Î·Ù¿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ). ∆· ÛˆÌ·ÙÔÌÂÙÚÈÎ¿ ÙÔ˘ ¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ‹Ù·Ó: B.™.: 17 kg (10-25Ë ∂.£.), ‡„Ô˜: 119 cm (>97Ë ∂.£.), ÂÓÒ ·ﬁ

ÙËÓ ÎÏÈÓÈÎ‹ ÂÍ¤Ù·ÛË ‰ÂÓ ‚Ú¤ıËÎÂ Î¿ÙÈ ·ıÔÏÔÁÈÎﬁ.

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

ÌÂÛÂÓÙÂÚ›Ô˘.

∂ÈÎfiÓ· 2. ∞. ¢È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÌÂ ‚¿ÚÈÔ: ÂÈÎfiÓ· ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘ ÛÂ Û¯‹Ì· ·ÓÂÛÙÚ·ÌÌ¤ÓÔ˘ ∂ Î·È ·ÙÂÏ‹˜ ·fiÊÚ·ÍË ÛÙÔ ‡„Ô˜ ÙË˜ Ó‹ÛÙÈ‰·˜. µ. µ·ÚÈÔ‡¯Ô˜ ˘ÔÎÏ˘ÛÌfi˜: ÎÂÓÙÚÈÎ‹ ı¤ÛË ·ÓÈfiÓÙÔ˜ ÎfiÏÔ˘ Î·È Ù˘ÊÏÔ‡, Û˘Ì‚·Ù‹

ÌÂ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘.

™˘˙‹ÙËÛË

∏ Ê˘ÛÈÔÏÔÁÈÎ‹ ÛÙÚÔÊ‹ ÙÔ˘ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙËÓ ÂÌ‚Ú˘˚Î‹ ËÏÈÎ›· ÍÂÎÈÓ¿ÂÈ ÙËÓ 3Ë Î·È ÔÏÔÎÏËÚÒÓÂÙ·È ÙË 14Ë Â‚‰ÔÌ¿‰·, Á›ÓÂÙ·È ‰Â ÌÂ ÊÔÚ¿ ·ÓÙ›ÛÙÚÔÊË ·ﬁ ÙÔ˘˜ ‰Â›ÎÙÂ˜ ÙÔ˘ ÚÔÏÔÁÈÔ‡ ÛÙÈ˜

270Ô ÌÂ ¿ÍÔÓ· ÛÙÚÔÊ‹˜ ÙËÓ ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ ·ÚÙËÚ›·. ∏ ·Ó·ÛÙÔÏ‹ ÙË˜ ÛÙÚÔÊ‹˜ (non rotation) ‹ Ë ‰È·ÎÔ‹ ÙË˜ ÛÂ Î¿ÔÈÔ ·fi Ù· ÂÓ‰È¿ÌÂÛ· ÛÙ¿‰È· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ ¤ÓÙÂÚÔ Ó· ÎÚ¤ÌÂÙ·È ·fi Û¯ÂÙÈÎ¿ ÛÙÂÓfi Ì›Û¯Ô Î·È Ó· Â›Ó·È ÂÈÚÚÂ¤˜ ÛÂ Û˘ÛÙÚÔÊ‹ (volvulus), ÂÓÒ Ù˘¯¤˜ ÙÔ˘ ÂÚÈÙÔÓ·›Ô˘

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ÂÚÈÂÏ¿Ì‚·ÓÂ ÁÂÓÈÎ‹ ·›Ì·ÙÔ˜, ‚ÈÔ¯ËÌÈÎ¤˜ ÂÍÂÙ¿ÛÂÈ˜, ·ÓÔÛÔÛÊ·ÈÚ›ÓÂ˜, RAST test ÁÈ· ÙÚÔÊÈÎ¿ ·ÓÙÈÁfiÓ·, ·ÓÙÈÁÏÔÈ·‰ÈÓÈÎ¿ ·ÓÙÈÛÒÌ·Ù·, ‰ÔÎÈÌ·Û›· ÊfiÚÙÈÛË˜ ÌÂ Ï·ÎÙfi˙Ë, ‰ÔÎÈÌ·Û›· Í˘Ïfi˙Ë˜, ıÚ˘„›ÓË ÎÔÚ¿ÓˆÓ, ‰ÔÎÈÌ·Û›· È‰ÚÒÙ· Î·È pHÌÂÙÚ›·, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∂ÂÈ‰‹ ÛÙÔ ·È‰› Â›¯Â Á›ÓÂÈ ÚfiÛÊ·Ù· ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÂÙÈÎÔ‡ ¯ˆÚ›˜ ·ıÔÏÔÁÈÎ¿ Â˘Ú‹Ì·Ù·, ıÂˆÚ‹ıËÎÂ ÛÎfiÈÌÔ ÏfiÁˆ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È ÙË˜ Û˘ÌÙˆÌ·ÙÔÏÔÁ›·˜ Ó· ÚÔËÁËıÂ› ÂÓ‰ÔÛÎÔÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙÂ› Ë È‰ÈÔ·ı‹˜ ÊÏÂÁÌÔÓÒ‰Ë˜ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ™ÙË Á·ÛÙÚÔÛÎfiËÛË ‰È·ÈÛÙÒıËÎÂ Á·ÛÙÚ›ÙÈ˜ ·fi H. Pylori, ÂÓÒ Ë ÎÔÏÔÓÔÛÎfiËÛË ¤‰ÂÈÍÂ Ì¤ÙÚÈ· ÊÏÂÁÌÔÓ‹ ÛÙÔ ÔÚıfi ÌÂ Èı·Ó‹ ·ÏÏÂÚÁÈÎ‹ Û˘ÌÌÂÙÔ¯‹. ÃÔÚËÁ‹ıËÎÂ ·ÁˆÁ‹ ÂÎÚ›˙ˆÛË˜ ÁÈ· ÙÔ H. Pylori Î·È Û˘ÛÙ‹ıËÎÂ Â·Ó¿ÏË„Ë ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ Â› ˘ÔÙÚÔ‹˜. ∆Ô ·È‰› ¤ÌÂÈÓÂ ÂÏÂ‡ıÂÚÔ Û˘ÌÙˆÌ¿ÙˆÓ ÁÈ· 6 Ì‹ÓÂ˜ Î·È ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ·˘Í‹ıËÎÂ Î·Ù¿ 3 kg. ™ÙË Û˘Ó¤¯ÂÈ·, fiÌˆ˜, ·ÚÔ˘Û›·ÛÂ ¿ÏÈ ‰È·ÚÚÔ˚Î¤˜ ÎÂÓÒÛÂÈ˜, ¤ÓÙÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È ÂÌ¤ÙÔ˘˜. ™ÙË ‰È¿ÚÎÂÈ· Ù¤ÙÔÈÔ˘ ÔÍ¤Ô˜ ÂÂÈÛÔ‰›Ô˘ ¤ÁÈÓÂ ÂÂÈÁfiÓÙˆ˜ ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜, ÙÔ ÔÔ›Ô ¤‰ÂÈÍÂ ÂÈÎfiÓ· Û˘ÛÙÚÔÊ‹˜ ÌÂÛÂÓÙÂÚ›Ô˘ ÌÂ ÂÏÈÎÔÂÈ‰‹ ÔÚÂ›· ÙˆÓ ·ÁÁÂ›ˆÓ (∂ÈÎfiÓ· 1). ™ÙË ‰È¿‚·ÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÌÂ ‚¿ÚÈÔ ‚Ú¤ıËÎÂ ·fiÊÚ·ÍË ÛÙÔ ‡„Ô˜ ÙË˜ Ó‹ÛÙÈ‰·˜ (∂ÈÎfiÓ· 2), Ô ‰Â ‚·ÚÈÔ‡¯Ô˜ ˘ÔÎÏ˘ÛÌfi˜ ¤‰ÂÈÍÂ ·ÓÒÌ·ÏË ı¤ÛË ÙÔ˘ Ù˘ÊÏÔ‡, ÂÈÎfiÓÂ˜ Û˘Ì‚·Ù¤˜ ÌÂ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ÛÂ Ê¿ÛË Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ¯ÂÈÚÔ˘ÚÁÈÎ‹ Â¤Ì‚·ÛË ¤ÁÈÓÂ ·Ú¯ÈÎ¿ Ï··ÚÔÛÎÔÈÎ¿, fiÔ˘ ÂÈ‚Â‚·ÈÒıËÎÂ Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÙÔ ÔÔ›Ô ·ÚÔ˘Û›·˙Â Ù¤ÛÛÂÚÈ˜ (4) ÛÙÚÔÊ¤˜ Î·Ù¿ ÙË ÊÔÚ¿ ÙˆÓ ‰ÂÈÎÙÒÓ ÙÔ˘ ÚÔÏÔÁÈÔ‡. ∞ÎÔÏÔ‡ıËÛÂ Ï··ÚÔÙÔÌ›·, ·Ó¿Ù·ÍË ÙË˜ Û˘ÛÙÚÔÊ‹˜ (∂ÈÎfiÓ· 3), ‰È·ÙÔÌ‹ ÙˆÓ ÂÚÈÙÔÓ·˚ÎÒÓ Ù˘¯ÒÓ Ô˘ ÂÚÈ¤‚·ÏÏ·Ó ÙÔ Ù˘ÊÏfi Î·È ÙË Ó‹ÛÙÈ‰· Î·È ·ÂÏÂ˘ı¤ÚˆÛË ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∆Ô ·È‰› ÂÍ‹ÏıÂ ÛÂ Î·Ï‹ ÁÂÓÈÎ‹ Î·Ù¿ÛÙ·ÛË Î·È ¤¯ÂÈ ·Ú·ÌÂ›ÓÂÈ ÂÏÂ‡ıÂÚÔ Û˘ÌÙˆÌ¿ÙˆÓ Â› ¤Ó· ÂÚ›Ô˘ ¤ÙÔ˜.

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

(Ù·ÈÓ›Â˜ ÙÔ˘ Ladd) Â›Ó·È ‰˘Ó·ÙﬁÓ Ó· È¤˙Ô˘Ó ÙÔ

‰ˆ‰ÂÎ·‰¿ÎÙ˘ÏÔ ÌÂ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÚÈÎ‹ ‹ ÔÏÈÎ‹ ·ﬁÊÚ·ÍË (1). ∏ ·ÓˆÌ·Ï›· ÛÙÚÔÊ‹˜ ÌÔÚÂ› Ó·

Û˘Ó˘¿Ú¯ÂÈ Î·È ÌÂ ¿ÏÏÂ˜ Û˘ÁÁÂÓÂ›˜ ·ÓˆÌ·Ï›Â˜

ÙÔ˘ ÂÙÈÎÔ‡ ÛÂ ÔÛÔÛÙﬁ 30%-62%, ﬁˆ˜ Ë ÔÌ-

Ê·ÏÔÎ‹ÏË, Ë Á·ÛÙÚﬁÛ¯ÈÛË, ·ÙÚËÛ›Â˜ ‹ ÛÙÂÓÒÛÂÈ˜

ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙÔ ÂÎÎﬁÏˆÌ· Meckel, Ë ÓﬁÛÔ˜ Hirschsprung, Ë ÔÏÈÎ‹ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á-

¯ÓˆÓ, ÔÈ Î‡ÛÙÂÈ˜ ÙÔ˘ ÌÂÛÂÓÙÂÚ›Ô˘, ÔÈ ·ÓˆÌ·Ï›Â˜

‰È¿Ï·ÛË˜ ÙË˜ ¯ÔÏË‰fi¯Ô˘ Î‡ÛÙË˜ Î·È ÙˆÓ ¯ÔÏËÊfiÚˆÓ (1,2). ™ÙÈ˜ ÂÚÈÛÛfiÙÂÚÂ˜ ÂÚÈÙÒÛÂÈ˜, Û˘ÌÙˆÌ·ÙÔÏÔÁ›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙË ÓÂÔÁÓÈÎ‹ (65%) ‹ ‚ÚÂÊÈÎ‹ (21%) ËÏÈÎ›·, ÂÓÒ ÛÂ ÌÈÎÚfiÙÂÚÔ

ÔÛÔÛÙﬁ ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· (14%) (1,3). ™ÙË ÓÂÔÁÓÈÎ‹ Î·È ‚ÚÂÊÈÎ‹ ËÏÈÎ›· ÚÔ‚¿ÏÏÂÈ Û˘Ó‹ıˆ˜

ÌÂ ıÔÚ˘‚Ò‰Ë Û˘ÌÙˆÌ·ÙÔÏÔÁ›· Î·È ÂÈÎfiÓ· ÔÍÂ›·˜ ÎÔÈÏ›·˜ (¯ÔÏÒ‰ÂÈ˜ ¤ÌÂÙÔÈ, ·›Ì· ·fi ÙÔ ÔÚıfi, ÂÈÎfiÓ· shock). ∞ÓÙ›ıÂÙ·, ÛÂ ÌÂÁ·Ï‡ÙÂÚË ËÏÈÎ›· Ù·

Û˘ÌÙÒÌ·Ù· ÌÔÚÂ› Ó· Â›Ó·È ·Ì‚Ï˘¯Ú¿ ‹ ‰È·ÏÂ›-

ÔÓÙ· (chronic midgut volvulus), o ·ÂÈÎÔÓÈÛÙÈÎﬁ˜

¤ÏÂÁ¯Ô˜ Ó· ÌËÓ Â›Ó·È ‰È·ÁÓˆÛÙÈÎfi˜ Î·È Ô ¤ÏÂÁ¯Ô˜ Ó· Î·ÙÂ˘ı‡ÓÂÙ·È ÛÂ ¿ÏÏ· ·›ÙÈ·, fiˆ˜ ÊÏÂÁÌÔÓÒ‰ÂÈ˜ ÓfiÛÔ˘˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÙÚÔÊÈÎ‹ ·ÏÏÂÚÁ›·, ÓÔÛ‹Ì·Ù· Ô˘ ÚÔÎ·ÏÔ‡Ó ‰˘Û·ÔÚÚfiÊËÛË ‹ ·ÎfiÌË Ù· Û˘ÌÙÒÌ·Ù· Ó· ıÂˆÚÔ‡ÓÙ·È „˘¯ÔÁÂÓ‹ (4,5). ªÔÚÂ› ·ÎfiÌË Ó· ÌËÓ ˘¿Ú¯ÂÈ Î·Ó¤Ó· Û‡ÌÙˆÌ· Î·È Ë ‰È¿ÁÓˆÛË Ó· Â›Ó·È Ù˘¯·›Ô Â‡ÚËÌ·. ™Â ¯ÚfiÓÈÂ˜ ÂÚÈÙÒÛÂÈ˜, Ù· Î‡ÚÈ· Û˘ÌÙÒÌ·Ù· Â›Ó·È ÙÔ ÂÚÈÔ‰ÈÎfi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, Ë ‰È·ÏÂ›Ô˘Û· ‰È¿ÚÚÔÈ·, ÔÈ ¤ÌÂÙÔÈ (¯ÔÏÒ‰ÂÈ˜ ‹ ÌË), Ë ‰˘Û·ÔÚÚfiÊËÛË ÌÂ ·ÒÏÂÈ· ‹ ÌË ÚfiÛÏË„Ë ÈÎ·ÓÔÔÈËÙÈÎÔ‡ ‚¿ÚÔ˘˜, ·ÓÔÚÂÍ›·, Ó·˘Ù›· ÌÂÙ¿ Ù· ÁÂ‡Ì·Ù· (1,3,4). ∆Ô ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ·Ô‰›‰ÂÙ·È ÛÙËÓ ÂÚÈÔ‰ÈÎ‹ ÈÛ¯·ÈÌ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ÂÓÒ Ë ‰È¿ÚÚÔÈ· ÛÙÔ ¯ÚfiÓÈÔ Ô›‰ËÌ· ÙˆÓ ÏÂÌÊ·ÁÁÂ›ˆÓ Î·È ÙÔ˘ ‚ÏÂÓÓÔ-

ÁﬁÓÔ˘ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙËÓ ·ÒÏÂÈ·

Ô˘ÛÈÒÓ (1,2).

ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘, Ô˘ ÌÔÚÂ› fiÌˆ˜ Ó· ÌËÓ Â›Ó·È ¿ÓÙ· ‰È·ÁÓˆÛÙÈÎ¿, ÂÈ‰ÈÎ¿ ÛÂ ÂÚÈfi‰Ô˘˜ ËÚÂÌ›·˜. ™Â Ê¿ÛË Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (volvulus), ÛÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÎÔÈÏ›·˜, ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ÂÈÎfiÓ· ‰ÈÏ‹˜ Ê˘Û·Ï›‰·˜ (double-bubble sign) ÌÂ ˘‰Ú·ÂÚÈÎ¿ Â›Â‰·, ÏfiÁˆ ÙË˜ ‰È¿Ù·ÛË˜ ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙË˜ 1Ë˜ ÌÔ›Ú·˜ ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘, Î·ıÒ˜ Î·È ·Ô˘Û›· ·¤Ú· ÛÙÔ ÂÚÈÊÂÚÈÎfi ¤ÓÙÂÚÔ, Â˘Ú‹Ì·Ù· Ô˘ ‰ÂÓ ··ÓÙÒÓÙ·È fiÌˆ˜ Û˘¯Ó¿ (1,6). ∆Ô ˘ÂÚË¯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË ÌÂ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ı¤ÛË˜ ÙˆÓ ÌÂÛÂÓÙ¤ÚÈˆÓ ·ÁÁÂ›ˆÓ. º˘ÛÈÔÏÔÁÈÎ¿, Ë ¿Óˆ ÌÂÛÂÓÙ¤ÚÈÔ˜ ÊÏ¤‚· (∞ªº) ‚Ú›ÛÎÂÙ·È ‰ÂÍÈ¿ ÙË˜ ¿Óˆ ÌÂÛÂÓÙÂÚ›Ô˘ ·ÚÙËÚ›·˜ (∞ª∞) (6,7). ∞Ó Ë ∞ªº ‚ÚÂıÂ› ·ÚÈÛÙÂÚ¿ ‹ ÌÚÔÛÙ¿ ÙË˜ ∞ª∞, ·ÔÙÂÏÂ› ¤Ó‰ÂÈÍË ÁÈ· ·ÓÒÌ·ÏË ÂÚÈÛÙÚÔÊ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (∂ÈÎfiÓ· 1), Â‡ÚËÌ· Ô˘ ÌÔÚÂ› Ó· ¯ÚËÛÈÌÔÔÈËıÂ› ·ÎfiÌË Î·È ÁÈ· ÚÔÁÂÓÓËÙÈÎ‹ ‰È¿ÁÓˆÛË (8). ∞ÎfiÌË, ÛÂ ÂÚÈÙÒÛÂÈ˜ Û˘ÛÙÚÔÊ‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÌÔÚÂ› Ó· ˘¿Ú¯ÂÈ ÌÔÚÊÔÏÔÁ›· ÛÙÚÔ‚›ÏÔ˘ (whirlpool sign) ‹ ÂÏ·ÙËÚ›Ô˘ (corkscrew sign) (1,5,6).

∏ ‰È¿‚·ÛË ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ÌÂ ‚¿ÚÈÔ ·ÔÙÂÏÂ› ÙËÓ ÂÍ¤Ù·ÛË ÂÎÏÔÁ‹˜ Ô˘ ‚ÔËı¿ÂÈ ÙË ‰È¿ÁÓˆÛË ÛÂ

ÛËÌ·ÓÙÈÎﬁ ÔÛÔÛÙﬁ ·ÛıÂÓÒÓ (42%-94%) (3,9). ∏

Ê˘ÛÈÔÏÔÁÈÎ‹ ı¤ÛË ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ ÙÔ˘ Treitz Â›Ó·È

·ÚÈÛÙÂÚ¿ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜, ÛÙÔ ‡„Ô˜ ÙÔ˘

Á·ÛÙÚÈÎÔ‡ ¿ÓÙÚÔ˘, ÂÓÒ ÛÂ ÂÚÈÙÒÛÂÈ˜ ∞¶ª∂ ‚Ú›ÛÎÂÙ·È ‰ÂÍÈ¿ ÙË˜ ÛÔÓ‰˘ÏÈÎ‹˜ ÛÙ‹ÏË˜ ÌÚÔÛÙ¿ ·fi ÙÔ ‚ÔÏ‚fi ÙÔ˘ ‰ˆ‰ÂÎ·‰·ÎÙ‡ÏÔ˘. O ˘ÔÎÏ˘ÛÌfi˜ ÌÂ ‚¿ÚÈÔ ÌÔÚÂ› Ó· ‚ÔËı‹ÛÂÈ ÂÈÏ¤ÔÓ (23%-34%) ÛÂ ·ÌÊ›‚ÔÏÂ˜ ÂÚÈÙÒÛÂÈ˜ ÌÂ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙË˜ ı¤ÛË˜ ÙÔ˘ Ù˘ÊÏÔ‡, ÙÔ ÔÔ›Ô

Ê˘ÛÈÔÏÔÁÈÎ¿ ‚Ú›ÛÎÂÙ·È ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ ‚fiıÚÔ, ÂÓÒ ÛÂ ÂÚÈÙÒÛÂÈ˜ ∞¶ª∂ ‚Ú›ÛÎÂÙ·È ÛÂ ˘„ËÏfiÙÂÚË ı¤ÛË, ÛÙË ‰ÂÍÈ¿ ¿Óˆ ÎÔÈÏ›· ‹ ÌÔÚÂ› Ó· Â›Ó·È ÎÈÓËÙfi (3,6,9). O ¤ÏÂÁ¯Ô˜ ÌÂ ·ÍÔÓÈÎ‹ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜ ‰ÂÓ ¤¯ÂÈ ·ÍÈÔÏÔÁËıÂ› Â·ÚÎÒ˜ ÁÈ· ÙË ‚Ô‹ıÂÈ· Ô˘ ÌÔÚÂ› Ó· ÚÔÛÊ¤ÚÂÈ ÛÙË ‰È¿ÁÓˆÛË (5).

™Â ÂÚÈÙÒÛÂÈ˜ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ÁÓˆÛÙÈÎﬁ

·ÔÙ¤ÏÂÛÌ·, ÌÔÚÂ› Ó· ··ÈÙËıÂ› Â·Ó¿ÏË„Ë ÙÔ˘

·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂÏ¤Á¯Ô˘ ÛÂ Ê¿ÛË ÔÍÂ›·˜ Û˘ÌÙˆ-

Ì·ÙÔÏÔÁ›·˜, ﬁˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜

Ì·˜, ‹ ·ÎﬁÌË Î·È ‰ÈÂÚÂ‡ÓËÛË ÌÂ Ï··ÚÔÛÎﬁËÛË

Ô˘ ÛÂ ·Ï¤˜ ÂÚÈÙÒÛÂÈ˜ ÌÔÚÂ› Ó· Â›Ó·È ‰È·-

ÁÓˆÛÙÈÎ‹ Î·È ıÂÚ·Â˘ÙÈÎ‹ (10).

∆Ô ÂÚÈÛÙ·ÙÈÎﬁ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ· Ó· ÙÔÓÈÛÙÂ›

ÙÔ ÁÂÁÔÓﬁ˜ ﬁÙÈ Ë Û˘ÛÙÚÔÊ‹ ÙÔ˘ Ì¤ÛÔ˘ ÂÓÙ¤ÚÔ˘

ÏﬁÁˆ Û˘ÁÁÂÓÔ‡˜ ·ÓÒÌ·ÏË˜ ÛÙÚÔÊ‹˜ ÌÔÚÂ› Ó·

¤¯ÂÈ Î·È ¯ÚﬁÓÈ· ‹ Ï·Óı¿ÓÔ˘Û· ÔÚÂ›· Î·È ÛÂ ÂÚÈÙÒÛÂÈ˜ ÌÂ ‰È·ÏÂ›ÔÓÙ·

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 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›· ¤ÁÎÚÈÛË˜: 21-12-2001

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ı·Ó¿ÛÈÔ˜ °. ª›¯Ô˜

¶·ÓﬁÚÌÔ˘ 26-28, ∞ÌÂÏﬁÎËÔÈ

∆.∫. 115 23, ∞ı‹Ó· E-mail: athanmic@yahoo.com

∂¡¢π∞º∂ƒOÀ™∞

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

°. ∆Ú›ÌË˜, ∫. ∞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‡

ËÏÈÎ›·˜ 10 ÂÙÒÓ ÌÂ ·Ú·ÙÂÈÓﬁÌÂÓÔ ˘ÚÂÙﬁ Î·È ÂÈ-

Ì¤ÓÔ˘Û· ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, Ù· ÔÔ›· ·Ô-

Ù¤ÏÂÛ·Ó ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÓﬁÛÔ˘ Kicuchi. ∏ ‰È¿ÁÓˆ-

ÛË Ù¤ıËÎÂ ÌÂÙ¿ ‚ÈÔ„›· ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ ÏÂÌÊ·‰¤Ó·, ﬁÔ˘ ·ÓÈ¯ÓÂ‡ıËÎÂ Ë ¯·Ú·ÎÙËÚÈÛÙÈÎ‹ ÈÛÙÈÔ-

Î˘ÙÙ·ÚÈÎ‹ ÓÂÎÚˆÙÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰· ÌÂ ·ÚÂÌ‚Ô-

Ï‹ ÂÚÈÔ¯ÒÓ ˘ÁÈÔ‡˜ ÈÛÙÔ‡. OÈ ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ ˘Ô¯ÒÚËÛ·Ó ·˘ÙfiÌ·Ù· ÂÓÙfi˜ ÙÚÈÒÓ ÌËÓÒÓ.

§¤ÍÂÈ˜ ÎÏÂÈ‰È¿: ÓﬁÛÔ˜ Kicuchi, ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, ÈÛÙÈÔÎ˘ÙÙ·ÚÈÎ‹ ÓÂÎÚˆÙÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·.

∂ÈÛ·ÁˆÁ‹ ∏ ÈÛÙÈÔÎ˘ÙÙ·ÚÈÎ‹ ÓÂÎÚˆÙÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·,

ÁÓˆÛÙ‹ ˆ˜ ÓﬁÛÔ˜ Kikuchi - Fujimoto, Â›Ó·È ÏÂÌÊ·-

‰ÂÓÔ¿ıÂÈ· Ô˘ ÂÚÈÁÚ¿ÊËÎÂ ·Ú¯ÈÎ¿ ÙÔ 1972

ÛÙËÓ π·ˆÓ›· ·ﬁ ÙÔÓ Kikuchi Î·È ÙÔÓ Fujimoto (1).

TËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· ·Ó·Ê¤ÚÔÓÙ·È ÛÔÚ·‰ÈÎ¤˜

ÂÚÈÙÒÛÂÈ˜ ·fi fiÏÔ ÙÔÓ ÎfiÛÌÔ, ·Ó Î·È ·Ú·Ì¤ÓÂÈ

Û˘¯ÓﬁÙÂÚË ÛÙËÓ ∞Û›·. ¶ÚÔÛ‚¿ÏÏÂÈ Î˘Ú›ˆ˜ Á˘Ó·›-

ÎÂ˜ ÌÂ Ì¤ÛË ËÏÈÎ›· Ù· 30 ¯ÚﬁÓÈ·, ÂÓÒ Â›Ó·È È‰È·ÈÙ¤-

Úˆ˜ Û¿ÓÈ· ÛÙËÓ ·È‰ÈÎ‹ ËÏÈÎ›· (2). ¶ÚÔ‚¿ÏÏÂÈ

Û˘Ó‹ıˆ˜ ÌÂ ˘ÚÂÙﬁ Î·È ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, ·ÓÒ‰˘ÓË ‹ ÂÒ‰˘ÓË. Œ¯Ô˘Ó ·Ó·ÊÂÚıÂ›, Â›ÛË˜, ¤ÌÂÙÔÈ, ‰È¿ÚÚÔÈ·, Ì˘·ÏÁ›Â˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ÂÍ¿ÓıËÌ· (3). ∆· ÌÔÓ·‰ÈÎ¿ ·ıÔÏÔÁÈÎ¿ ÂÚÁ·ÛÙËÚÈ·Î¿ Â˘Ú‹Ì·Ù· Â›Ó·È ÔÈ ÌÂÙÚ›ˆ˜ ·˘ÍËÌ¤ÓÔÈ ‰Â›ÎÙÂ˜ ÊÏÂÁÌÔÓ‹˜ Î·È, ÂÓ›ÔÙÂ, Ë ÏÂ˘ÎÔÂÓ›·.

∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌÂÙ¿ ‚ÈÔ„›· ÚÔÛ‚Â‚ÏËÌ¤ÓÔ˘ ÏÂÌÊ·‰¤Ó· ÌÂ ·Ó›¯ÓÂ˘ÛË ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÓ, Î·Ù¿ ÙﬁÔ˘˜ Ó¤ÎÚˆÛË ¯ˆÚ›˜ ·ÔÛÙËÌ·ÙÔÔ›ËÛË Î·È

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.

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

ıÔ˘˜ ÏÂÌÊÒÌ·ÙÔ˜.

∏ ÓfiÛÔ˜ ¤¯ÂÈ Î·ÏÔ‹ıË ÔÚÂ›· Î·È ·˘ÙÔ˚¿Ù·È ÛÂ 4-6 Ì‹ÓÂ˜. ÀÔÙÚÔÈ¿˙ÂÈ ÛÂ ÔÛÔÛÙfi 3%, ÂÓÒ Û¿ÓÈ· Â›Ó·È Ë ÚÒÙË ÂÎ‰‹ÏˆÛË ™˘ÛÙËÌ·ÙÈÎÔ‡ ∂Ú˘ıËÌ·ÙÒ‰Ô˘˜ §‡ÎÔ˘ (™∂§) (4). ∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË, ·Ó Î·È Èı·ÓÔÏÔÁÂ›Ù·È ˘ÂÚ¿ÓÔÛË ·ÓÙ›‰Ú·ÛË ÛÂ ÏÔÈÌÒ‰Ë ·Ú¿ÁÔÓÙ· fiˆ˜ Ô Èfi˜ Epstein-µarr (5).

¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈÎ›·˜ 10 ÂÙÒÓ ÌÂ ·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi Î·È ÂÈÌ¤ÓÔ˘Û· ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰·, Û˘ÌÙÒÌ·Ù· Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÂÎ‰ËÏÒÛÂÈ˜ ÙË˜ ÓfiÛÔ˘ Kikuchi.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛË˜

∫ÔÚ›ÙÛÈ ËÏÈÎ›·˜ 10 ÂÙÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈÎ‹ Ì·˜ ÌÂ ˘ÚÂÙfi ¤ˆ˜ 40ÔC Î·È ·ÌÊÔÙÂÚfiÏÂ˘ÚË, ·ÓÒ‰˘ÓË ÙÚ·¯ËÏÈÎ‹ ÏÂÌÊ·‰ÂÓ›ÙÈ‰· ·fi 6ËÌ¤ÚÔ˘. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÔÓÙ·È ÂÏÂ‡ıÂÚ·.

·ÛıÂÓ‹˜ ‹Ù·Ó ÛÂ ¿ÚÈÛÙË

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

¯·Ú·ÎÙËÚÈÛÙÈÎ¿ ·ÔÛÙËÌ¿ÙÈ·. ∏ ‚ÈÔ„›· ÌÂ ÏÂÙ‹

ÌÔÚÂ› 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ÙˆÌ·ÙÈÎ¿ ÌÔ-

ÚÂ› Ó· ÚÔ¤Ú¯ÂÙ·È ·ﬁ ·ıÔÏÔÁÈÎ‹ ÂÚÈÔ¯‹ (3,9).

∏ ÔÚÂ›· ÙË˜ ÓﬁÛÔ˘ Â›Ó·È Û˘Ó‹ıˆ˜ Î·ÏÔ‹ıË˜, Î·ıÒ˜ Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Î·È Ô ˘ÚÂÙﬁ˜ ˘Ô¯ˆ-

ÚÔ‡Ó ÙÔ ·ÚÁﬁÙÂÚÔ ÛÂ 4-6 Ì‹ÓÂ˜. £ÂˆÚÂ›Ù·È ·˘ÙÔ˚-

ÒÌÂÓË ÓﬁÛÔ˜, Î·ıÒ˜ Ô˘‰ÂÌ›· Ê·ÚÌ·ÎÂ˘ÙÈÎ‹ ·Áˆ-

Á‹ Ê·›ÓÂÙ·È Ó· ·ÚÂÌ‚·›ÓÂÈ ÛÙËÓ ÔÚÂ›· ÙË˜. ∫·Ù¿ Î·ÈÚÔ‡˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËıÂ› Ù· ÎÔÚÙÈÎÔÂÈ‰‹, ¯ˆÚ›˜ Ó· ÂÈ‚Â‚·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˘ÔÎ·Ú‰›Ô˘ (11). Ã·Ú·ÎÙËÚÈÛÙÈÎﬁ Â›Ó·È ﬁÙÈ ¤¯Ô˘Ó

·Ú·ÙËÚËıÂ› ˘ÔÙÚÔ¤˜ ÛÂ ÔÛÔÛÙﬁ Ô˘ Î˘Ì·›-

ÓÂÙ·È ·ﬁ 2%-4% (12). ™¿ÓÈ· ¤¯Ô˘Ó Î·Ù·ÁÚ·ÊÂ›

ÂÚÈÙÒÛÂÈ˜ ·ÛıÂÓÒÓ Ô˘ ÂÎ‰‹ÏˆÛ·Ó ™∂§ ÛÂ Â‡-

ÏÔÁÔ ¯ÚÔÓÈÎﬁ ‰È¿ÛÙËÌ· ·Ê’ ﬁÙÔ˘ Â›¯·Ó ÚÔÛ‚ÏË-

ıÂ› ·ﬁ ÓﬁÛÔ Kikuchi (4,13).

∏ ·ÈÙÈÔÏÔÁ›· ÙË˜ ÓﬁÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË.

ﬁÙÈ Î¿ÔÈÔ˜ ·Ú¿ÁÔÓÙ·˜, Â›ÙÂ Ê˘ÛÈÎﬁ˜ Â›-

ÙÂ ¯ËÌÈÎﬁ˜ Â›ÙÂ ÏÔÈÌÒ‰Ë˜, Ô˘ Â›Ó·È Î·È ÙÔ Èı·Óﬁ-

ÙÂÚÔ, ‰ÈÂÁÂ›ÚÂÈ Ù· ∆ ÏÂÌÊÔÎ‡ÙÙ·Ú·, ÌÂ ·ÔÙ¤ÏÂ-

ÛÌ· Ó· ÚÔÎ·ÏÂ›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˘ÛÛÒÚÂ˘ÛË ÈÛÙÈÔÎ˘ÙÙ¿ÚˆÓ.

¶Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘Ó‡·ÚÍË ·˘ÙÔ¿ÓÔÛÔ˘ ˘Ô-

ÛÙÚÒÌ·ÙÔ˜, Ô˘ ÂÍËÁÂ› Î·È ÙËÓ ÂÍ¤ÏÈÍË ÔÚÈÛÌ¤ÓˆÓ

ÂÚÈÙÒÛÂˆÓ ÛÂ ™∂§. ™Â ÌÂÚÈÎÔ‡˜ ·ÛıÂÓÂ›˜ ÌÂ Óﬁ-

ÛÔ Kikuchi ¤¯ÂÈ ‰È·ÈÛÙˆıÂ› ¯ÚﬁÓÈ· ÂÓÂÚÁﬁ˜ ÏÔ›-

ÌˆÍË ·ﬁ Èﬁ Epstein-Barr (5) ‹ HTLV1 (10).

™˘ÌÂÚ·ÛÌ·ÙÈÎ¿, Ë ÛˆÛÙ‹ Î·È ¤ÁÎ·ÈÚË ‰È¿ÁÓˆ-

ÛË ·˘Ù‹˜ ÙË˜ Û¿ÓÈ·˜ ÔÓÙﬁÙËÙ·˜ Â›Ó·È È‰È·›ÙÂÚË˜

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 ÌÂ

ÙËÓ ˘ﬁÓÔÈ· Î·ÎÔ‹ıÔ˘˜ ÏÂÌÊÒÌ·ÙÔ˜ (14). ∏ Â˘·È-

ÛıËÙÔÔ›ËÛË ÙÔ˘ ·ıÔÏÔÁÔ·Ó·ÙﬁÌÔ˘ ·ﬁ ÙÔÓ

·È‰›·ÙÚÔ ÛÙÈ˜ ÂÚÈÙÒÛÂÈ˜ Ô˘ Ù›ıÂÙ·È ˘ﬁÓÔÈ· ‡·ÚÍË˜ ÓﬁÛÔ˘ Kikuchi ‚ÔËı¿ÂÈ ÛÙËÓ Â‰Ú·›ˆÛË ÙË˜ ‰È¿ÁÓˆÛË˜.

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.

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.

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HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛË˜: 11-01-2002

¢ÈÂ‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÈÒÚÁÔ˜ ∆Ú›ÌË˜

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1. ™ÙÔ ∫¤ÓÙÚÔ ÀÁÂ›·˜ ∆‹ÓÔ˘ ÁÈ·ÙÚÔ‡˜ ÂÈ‰ÈÎﬁÙËÙ·˜ ·È‰È·ÙÚÈÎ‹˜, ÌÈÎÚÔ‚ÈÔÏÔÁ›·˜.

2. ™ÙÔ ∫¤ÓÙÚÔ ÀÁÂ›·˜ £‹Ú·˜ ÁÈ·ÙÚÔ‡˜ ÂÈ‰ÈÎÔÙ‹ÙˆÓ °ÂÓÈÎ‹˜ π·ÙÚÈÎ‹˜ ‹ ¶·ıÔÏÔÁ›·˜, ·È‰È·ÙÚÈÎ‹˜, ÔÚıÔÂ‰ÈÎ‹˜ ‹ ¯ÂÈÚÔ˘ÚÁÈÎ‹˜

3. ™ÙÔ °ÂÓÈÎﬁ ¡ÔÛÔÎÔÌÂ›Ô ™‡ÚÔ˘ ÁÈ·ÙÚÔ‡˜ ÂÈ‰ÈÎÔÙ‹ÙˆÓ ·È‰È·ÙÚÈÎ‹˜.

OÈ ÂÓ‰È·ÊÂÚﬁÌÂÓÔÈ ÌÔÚÔ‡Ó Ó· ÂÁÁÚ·ÊÔ‡Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÂÈÎÔ˘ÚÈÎÒÓ ÁÈ·ÙÚÒÓ Ô˘ ÙËÚÂ›Ù·È ÛÙË ¢ÈÂ‡ı˘ÓÛË ¡ÔÌÈÎÒÓ ¶ÚÔÛÒˆÓ ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ (∞ÚÈÛÙÔÙ¤ÏÔ˘˜ 17, ∞ı‹Ó· 101 87, ÙËÏ.: 0105232821/123) Î·È Ó· ˙ËÙ‹ÛÔ˘Ó ÙË ı¤ÛË ÛÙËÓ ÔÔ›· ı¤ÏÔ˘Ó Ó· ÂÚÁ·ÛÙÔ‡Ó Î·È ÙÔ ¯ÚÔÓÈÎﬁ ‰È¿ÛÙËÌ· ÛÙÔ ÔÔ›Ô ı¤ÏÔ˘Ó Ó· ··Û¯ÔÏËıÔ‡Ó.

¢ÈÎ·ÈÔ‡¯ÔÈ ÂÁÁÚ·Ê‹˜ Â›Ó·È ÂÈ‰ÈÎÂ˘Ì¤ÓÔÈ ÁÈ·ÙÚÔ›,

¶ÚÔÎÂÈÌ¤ÓÔ˘ Ó· ÂÁÁÚ·ÊÔ‡Ó ÛÙÔÓ Î·Ù¿ÏÔÁÔ ÔÈ

ÂÈ‰ÈÎﬁÙËÙ·.

¿ÓÂÚÁÔÈ ÁÈ·ÙÚÔ› Ô˘ Â›Ó·È ÂÁÁÂÁÚ·ÌÌ¤ÓÔÈ ÛÙÔÓ O∞∂¢ ÚÔËÁÔ‡ÓÙ·È ¤Ó·ÓÙÈ ·˘ÙÒÓ Ô˘

∏ Û‡Ì‚·ÛË ÂÚÁ·Û›·˜ Â›Ó·È ÔÚÈÛÌ¤ÓÔ˘ ¯ÚﬁÓÔ˘ ÌÂ

ÛÙÔÓ È‰ÈˆÙÈÎﬁ ÙÔÌ¤·.

Î·È ·ÔÎÏÂÈÛÙÈÎ‹˜ ··Û¯ﬁÏËÛË˜ Î·È ·Ô‰Ô¯¤˜ ÂÈ‰ÈÎÂ˘Ì¤ÓÔ˘ ÁÈ·ÙÚÔ‡

˘ËÚÂÛ›·˜ Ï·Ì‚¿ÓÂÙ·È ˘ﬁ„Ë ÛÙÈ˜ ÎÚ›ÛÂÈ˜ ÁÈ· ÂÈÏÔÁ‹ ÁÈ·ÙÚÒÓ ÎÏ¿‰Ô˘ ∂™À.

OÈ ÂÓ‰È·ÊÂÚfiÌÂÓÔÈ ÁÈ· ÂÚÈÛÛfiÙÂÚÂ˜ ÏÂÙÔÌ¤ÚÂÈÂ˜ ÌÔÚÔ‡Ó Ó· ÂÈÎÔÈÓˆÓ‹ÛÔ˘Ó ÌÂ ÙËÓ ·ÚÌfi‰È· ¢ÈÂ‡ı˘ÓÛË ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›·˜ ‹ Ó· ·Â˘ı‡ÓÔ˘Ó ÁÚ·Ù¿ ÂÚˆÙ‹Ì·Ù· ÛÙ· ÁÚ·ÊÂ›· ÙÔ˘ ∞ ¶Â™À ¡. ∞ÈÁ·›Ô˘

Fax: 02810-96639 & ∆ËÏ.: 02810-96630

E-mail: apesykyk@otenet.gr

™Â ÌÂÚÈÎ¿ ÓËÛÈ¿ Â›Ó·È ‰˘Ó·ÙﬁÓ Ó· ÚÔÛÊ¤ÚÔÓÙ·È ·ﬁ ÙÔ˘˜ ÙÔÈÎÔ‡˜ ¢ËÌ¿Ú¯Ô˘˜ ÂÍ˘ËÚÂÙ‹ÛÂÈ˜ ÁÈ· ÙË ‰È·ÌÔÓ‹ ÙˆÓ ÁÈ·ÙÚÒÓ.

∂ÈÏ¤ÔÓ, ·Ó·ÎÔÈÓÒÓÂÙ·È fiÙÈ: ™Ù· ÓËÛÈ¿ ÙˆÓ ∫˘ÎÏ¿‰ˆÓ Î·È ÛÂ ı¤ÛÂÈ˜ Î·È ÂÈ‰ÈÎfiÙËÙÂ˜ ·ÓÙ›ÛÙÔÈ¯Â˜ ÌÂ ÙˆÓ ÂÈÎÔ˘ÚÈÎÒÓ ÁÈ·ÙÚÒÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÛ·ÛıÔ‡Ó ÁÈ·ÙÚÔ› ÙÔ˘ ∂™À ÔÔÈ·Û‰‹ÔÙÂ ‚·ıÌ›‰·˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ¤ÍÈ Ì‹ÓÂ˜ Ì¤¯ÚÈ ‰‡Ô ¯ÚfiÓÈ·. ™ÙÈ˜ ·ÔÛ¿ÛÂÈ˜ ·˘Ù¤˜ ÈÛ¯‡Ô˘Ó Ù· ·ÎfiÏÔ˘ı· Î›ÓËÙÚ·:

1. ∫·Ù·‚ÔÏ‹ ÚÔÛ·‡ÍËÛË˜ 50% Â› ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÈÛıÔ‡ (Ó. 2071, ·Ú. 75, ·Ú. 3)

2. ™Â

2920/2001):

µ. ªÂ ÙËÓ ˘’ ·ÚÈıÌ. 1933/27-10-99 Ù. µ’ º∂∫, ·ÚÈıÌ. ∞Ú. ∞π·/9879/99 ·ﬁÊ·ÛË ÙÔ˘ ÀÔ˘ÚÁÂ›Ô˘ ÀÁÂ›-

ÂÈ‰ÈÎÔÙ‹ÙˆÓ Î·È fi¯È ÌfiÓÔ fiÙÈ:

1. ∂›Ó·È ˘Ô¯ÚÂˆÙÈÎ‹ Ë ·Ó·ÊÔÚ¿ ÁÂÓÓ‹ÛÂˆ˜ ·È‰ÈÔ‡ ÌÂ ÁÓ·ıÔÚÔÛˆÈÎ¤˜ ·ÓˆÌ·Ï›Â˜ (Î˘Ú›ˆ˜ ˘ÂÚˆÈÔÛ¯ÈÛÙ›Â˜ Î·È ¯ÂÈÏÂÔÛ¯ÈÛÙ›Â˜) ÛÙÔ ÂÈ‰ÈÎﬁ Î¤ÓÙÚÔ. ∆ËÏ./Fax: 010-746 7165.

2. À¿Ú¯ÂÈ Ë ‰˘Ó·ÙﬁÙËÙ· ıÂÚ·Â˘ÙÈÎÒÓ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ ·ﬁ ÙË˜ ÁÂÓÓ‹ÛÂˆ˜ ÙÔ˘ ·È‰ÈÔ‡ Ì¤¯ÚÈ ÙËÓ ÂÓËÏÈÎ›ˆÛ‹ ÙÔ˘.

∏ ÔÌ¿‰· Ô˘ ·Ú·ÎÔÏÔ˘ıÂ› 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 ¡ÔÛËÏÂ‡ÙÚÈ·.

°È· ÔÔÈ·‰‹ÔÙÂ ÂÈÛÙËÌÔÓÈÎ‹ ÂÓËÌ¤ÚˆÛ‹ Û·˜ ·Ú·Î·ÏÔ‡ÌÂ Ó· ÂÈÎÔÈÓˆÓÂ›ÙÂ ÌÂ ÙÔ ÂÈ‰ÈÎﬁ Î¤ÓÙÚÔ ÛÙÔ ÙËÏ.:/fax: 010-746 7165. °. ÃÚÈÛÙﬁÔ˘ÏÔ˜

¢/ÓÙ‹˜ ø.ƒ.§. ÙÌ‹Ì·ÙÔ˜

°. ∏ ∂ÏÏËÓÈÎ‹ ¶·È‰ÔÓÂ˘ÌÔÓÔÏÔÁÈÎ‹

¤¯ÂÈ Î·Ù·ÛÎÂ˘¿ÛÂÈ ÈÛÙÔÛÂÏ›‰· ÛÙÔ ‰È·‰›ÎÙ˘Ô ÌÂ ÂÓ‰È·Ê¤ÚÔ˘ÛÂ˜ ÏËÚÔÊÔÚ›Â˜ ÁÈ· ÙÔÓ ŒÏÏËÓ· ¶·È‰›·ÙÚÔ. ∏ ‰ÈÂ‡ı˘ÓÛË Â›Ó·È: www.gprs.org.gr

¢. π∞∆ƒO∆∂∫ ∆· ª¤ÏË ÙË˜ ∂ÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜

“¶∞π¢π∞∆ƒπ∫∏”, ·Ú·Î·ÏÔ‡Ó ÙÔ˘˜ Û˘ÁÁÚ·ÊÂ›˜ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÙÈ˜ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔ˘Ó ÚÔ˜ ‰ËÌÔÛ›Â˘ÛË Î·È ·ÓÙ›ÛÙÔÈ¯Â˜ ·Ó·ÊÔÚ¤˜ ·ﬁ ÙËÓ ∂ÏÏËÓÈÎ‹ µÈ‚ÏÈÔÁÚ·Ê›·.

¶ÏËÚÔÊÔÚ›Â˜: π∞∆ƒO∆∂∫

www.mednet.gr/iatrotek

∂Î Ì¤ÚÔ˘˜ ÙË˜ ∂ÈÛÙËÌÔÓÈÎ‹˜ ™˘ÓÙ·ÎÙÈÎ‹˜ ∂ÈÙÚÔ‹˜

∫·ıËÁ‹ÙÚÈ· ∑ˆ‹ ¶··‰ÔÔ‡ÏÔ˘ - ∫Ô˘ÏÔ˘Ì‹

21-24 ª·ÚÙ›Ô˘ 2002

29Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ πˆ¿ÓÓÈÓ· ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ Î·È ªÂÙ·‚ÔÏÈÛÌÔ‡

•ÂÓÔ‰Ô¯Â›Ô Du Lac

∆ËÏ.: 010-77.74.370

23-24 ª·ÚÙ›Ô˘ 2002 6Ë ∂ÈÛÙËÌÔÓÈÎ‹ ™˘Ó¿ÓÙËÛË ¶·È‰È¿ÙÚˆÓ ∫ÔÌÔÙËÓ‹

∞Ó·ÙÔÏÈÎ‹˜ ª·ÎÂ‰ÔÓ›·˜ & £Ú¿ÎË˜

¶·È‰È·ÙÚÈÎ‹ ∫ÏÈÓÈÎ‹ ¢ËÌÔÎÚ›ÙÂÈÔ˘

¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿ÎË˜

¶ÏËÚÔÊÔÚ›Â˜: Minerva Fairs and Congresses

∆ËÏ.: 010-32.17.456, 32.17.474

Fax: 010-32.20.595

E-mail: minerva@medianet.gr

19-21 ∞ÚÈÏ›Ô˘ 2002

20-21 ∞ÚÈÏ›Ô˘ 2002 10Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ

∆ËÏ.: 010-62.31.541

Fax: 010-80.18.122

21-24 ∞ÚÈÏ›Ô˘ 2002

26-28 ∞ÚÈÏ›Ô˘ 2002

VIII International Congress on Cannes, France 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

1st Mediterranean CongressLimassol, Cyprus of Neurology

¶ÏËÚÔÊÔÚ›Â˜: Demos Antoniou

∆ËÏ.: 357-5-749919

Fax: 357-5-749744

E-mail: info@medneuro2002.com

4-7 ª·˝Ô˘ 2002

5-8 ª·˝Ô˘ 2002

21-25 ª·˝Ô˘ 2002

23-25 ª·˝Ô˘ 2002

24-27 ª·˝Ô˘ 2002

American Pediatric Society: Baltimore, MD U.S.A. Pediatric Societies Joint Meeting

Baltimore Convention Center

Fax: 011-281-419-0082

Web site: http://www.pas-meeting.org

4th European Congress Paris, France 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

28Ô ¶·ÓÂÏÏ‹ÓÈÔ

ª·È¿Ó‰ÚÔ˘ 23, 115 28 ∞ı‹Ó·

∆ËÏ.: 010 - 72 11 845

Fax: 010 - 72 15 082

E-mail: iea@mednet.gr

14Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ

¶ÏËÚÔÊÔÚ›Â˜: FORUM International Congress Organizers

∆ËÏ.: 0310 - 257 128 & 0310 - 243 588

Fax: 0310 - 231 849

E-mail: forup@otenet.gr

International Research Society ∞ı‹Ó· of Spinal Deformities Meeting

Tel.: 010-5534 256 & 010-7562 256-7

E-mail: grivas@dias.itel.gr

25-26 ª·˝Ô˘ 2002 11Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ

¶ÏËÚÔÊÔÚ›Â˜: Î. ¶Ú›ÊÙË˜ °. ¡. ¶·›‰ˆÓ ¶ÂÓÙ¤ÏË˜

∆ËÏ.: 010 - 80 36 484

Fax: 010 - 61 31 173

E-mail: kpriftis@otenet.gr

13-15 πÔ˘Ó›Ô˘ 200213th Annual Congress of the Ljubljana, Slovenia

E-mail: ivan.vidmar@kclj.si xiv ¶PO™EXH ™YNE¢PIA

European Society of Pediatric and Neonatal Intensive Care (ESPNIC)

Tel./Fax: ++ 386 (0) 1 430 17 14

™˘ÓÙÔÌÔÁÚ·Ê›Â˜

AIDS

AMP, ADP, ATP

ATPase cal

CSF ‹ ENY

CNS ‹ ∫¡™ cm

CoA cmÑ cm2

cAMP ÆC

CRP DNA

ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA

ESR ‹ ∆∫∂ EDTA

g Hct

HLA

Ig ICU ‹ ª∂£

i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol

ªW ‹ MB MCH

MCV mRNA m min n N

NS ‹ ª™

Ôsm % PCR pH

PCO2 PO2 p

ABBREVIATIONS

EÏÏËÓÈÎÔ› ﬁÚÔÈ

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙË˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

ÌÔÓÔ-, ‰È-, ÙÚÈÊˆÛÊÔÚÈÎ‹ ·‰ÂÓÔÛ›ÓË

ÙÚÈÊˆÛÊ·Ù¿ÛË ÙË˜ ·‰ÂÓÔÛ›ÓË˜

ıÂÚÌ›‰·

ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚﬁ

ÎÂÓÙÚÈÎﬁ ÓÂ˘ÚÈÎﬁ Û‡ÛÙËÌ·

ÂÎ·ÙÔÛÙﬁ

Û˘Ó¤Ó˙˘ÌÔ ∞

Î˘‚ÈÎﬁ ÂÎ·ÙÔÛÙﬁ

ÙÂÙÚ·ÁˆÓÈÎﬁ ÂÎ·ÙÔÛÙﬁ

Î˘ÎÏÈÎﬁ AMP

‚·ıÌﬁ˜ KÂÏÛ›Ô˘

C-·ÓÙÈ‰ÚÒÛ· ÚˆÙÂ˝ÓË

‰ÂÔÍ˘ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎﬁ ÔÍ‡ ËÏÂÎÙÚÔÎ·Ú‰ÈÔÁÚ¿ÊËÌ·

ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤ÙË˜ ·ÓÔÛÔÚÔÛÚﬁÊËÛË˜

ÚÔÛ‰ÈÔÚÈÛÌﬁ˜

Ù·¯‡ÙËÙ· Î·ıÈ˙‹ÛÂˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓÔ‰È·ÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îﬁ ÔÍ‡

ÁÚ·ÌÌ¿ÚÈo

·ÈÌ·ÙÔÎÚ›ÙË˜ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁﬁÓÔ ÈÛÙÔÛ˘Ì‚·ÙﬁÙËÙ·˜

·ÓÔÛÔÛÊ·ÈÚ›ÓË

ÌÔÓ¿‰· ÂÓÙ·ÙÈÎ‹˜ ıÂÚ·Â›·˜

‰ÈÂıÓ‹˜ ÌÔÓ¿‰·

ÂÓ‰ÔÌ˘˚Î¿ ÂÓ‰ÔÂÚÈÙÔÓ·˚Î¿ ÂÓ‰ÔÊÏ¤‚È·

Ï›ÙÚÔ(·)

ÏÔÁ¿ÚÈıÌÔ˜

ÁÚ·ÌÌÔÌﬁÚÈÔ

ÌÔÚÈ·Îﬁ ‚¿ÚÔ˜

Ì¤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ

Ì¤ÛÔ˜ ﬁÁÎÔ˜ ÂÚ˘ıÚÒÓ

·ÁÁÂÏÈÔÊﬁÚÔ˜ RNA

Ì¤ÙÚÔ

ÏÂÙﬁ ·ÚÈıÌﬁ˜ ÓÂ˘ÙÒÓÈÔ

ÌË ÛËÌ·ÓÙÈÎﬁ

ÔÛÌÒÏÈÔ

Â› ÙÔÈ˜ ÂÎ·Ùﬁ

·Ï˘ÛÈ‰ˆÙ‹

AÁÁÏÈÎÔ› ﬁÚÔÈ acquiredimmunodeficiency 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

AÁÁÏÈÎÔ› ﬁÚÔÈ

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

U ™˘Ó‰˘·˙ﬁÌÂÓ· ÚÔı¤Ì·Ù·

tera- (1012) giga- (109) mega-(106) kilo- (103) hecto(102) deca (101) deci (10-1) centi- (10-2) milli(10-3) micro (10-6) nano (10-9) pico (10-12) femto (10-15) atto (10-18) ·ﬁ ÙÔ ÛÙﬁÌ·

ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎﬁ ÔÍ‡ Û‡Ó‰ÚÔÌÔ

‰Â˘ÙÂÚﬁÏÂÙÔ

˘Ô‰ﬁÚÈ·

ÛÙ·ıÂÚ‹ ·ﬁÎÏÈÛË

ÛÙ·ıÂÚﬁ ÛÊ¿ÏÌ·

ÌÔÓ¿‰·

Combining prefixes

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