Παιδιατρική | Τόμος 69 • Τεύχος 2 • Μάρτιος - Απρίλιος 2006

Pediatr Mar-Apr 06

18-04-06

16:41

™ÂÏ›‰·3

¶·È‰È·ÙÚÈ΋ ∆fiÌÔ˜ 69 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2006 ¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ ª. ∫·Ó¿ÚÈÔ˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë A. K·ÙÙ¿Ì˘ Ã. ∫ÒÛÙ·ÏÔ˜ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ¶··‰ÔÔ‡ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ª. ∆ÛÔÏÈ¿ ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ º. ª·˘ÚÔÂȉ‹ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘

¶ÂÚȯfiÌÂÓ· ∂¶π∫∞πƒ∞ £∂ª∞∆∞ 77 ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ 78 ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ 83 ∞Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÎÔηÙË: Ù· Ó¤· ‰Â‰Ô̤ӷ °. ∆ÛfiÏ·˜ 90 ∂ÎÙ›ÌËÛË ÎÈÓ‰‡ÓˆÓ Î·È Û¯Â‰È·ÛÌfi˜ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ∫. ¢Ô‡ÚÔ˜, µ. ∆Û·ÁÚ‹˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘-∫·Ú·ı›Ô˘

∞¡∞™∫O¶∏™∂π™ EΉfiÙ˘ K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ∞ÚÙ¤ÌȉԘ 3 151 25 M·ÚÔ‡ÛÈ TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889

ISSN 0377-2551

97 ∏ ˘fiıÂÛË PANDAS (·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË): ̇ıÔ˜ ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ·; µ. ∆Û·ÁÚ‹˜, ∫. ¢Ô‡ÚÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘-∫·Ú·ı›Ô˘ 104 §ÈÛÙÂÚ›ˆÛË Î·Ù¿ ÙËÓ Î‡ËÛË ¶. ª¤ÍË-ªÔ˘ÚÓ¿, ¡. ªÔ˘ÚÓ¿˜ 110 ™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ. ∂ÈÙÒÛÂȘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi ™. ∞ÓÙˆÓÈ¿‰Ë˜ ∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ 118 ¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·: ∞fi„ÂȘ ÂÏÏ‹ÓˆÓ ·È‰È¿ÙÚˆÓ ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘

127 ¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË: ¢È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙÚfiÔÈ ÚÔÛ¤Ï΢Û˘ ∂. ª·ıÚ¤ÏÏÔ˘, ª. °È·ÓÓ·ÎÔ‡ÏÈ·, ¡. µÔ˘Ù˙Ô˘Ú¿Î˘, ¶. ∑‹Û˘, ∞.§. ª·Ù¿Ï·, §.™. ™˘ÓÙÒÛ˘

∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™ 134 ∞Ï·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Ì ʷÈÓfiÙ˘Ô Û˘Ó‰ÚfiÌÔ˘ Smith-Lemli-Opitz Î·È Meckel ∞. ∞Ó‰Ú¤Ô˘, µ. ¶··‚·ÛÈÏ›Ԣ, ∞. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘ 138 £·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘ 143 ™¿ÓÈ· ÂÌÊ¿ÓÈÛË ÔÈÎÔÁÂÓÔ‡˜ ÓfiÛÔ˘ Moyamoya Û ·ÛıÂÓ›˜ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜ ∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘, ¡. µ·ÛÈÏ¿ÎË, ™. ∞ÚÒÓË, H. Ikeda, ∞. ¶··‚·ÛÈÏ›Ԣ

¶ƒ∞∫∆π∫O £∂ª∞ 150 H ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿ ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘

160 ∫§π¡π∫√ ∫√Àπ∑

161 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ∏ÏÂÎÙÚÔÓÈΤ˜ ‰È¢ı‡ÓÛÂȘ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ ∫. ™ÙÂÊ·Ó›‰Ë˜

Pediatr Mar-Apr 06

18-04-06

16:41

™ÂÏ›‰·5

Paediatriki Volume 69 ñ Number 2 ñ March-April 2006 Bimonthly Publication of the Greek Paediatric Society President A. Constantopoulos Editorial Board Editor-in-Chief C. Stefanidis Members P. Avgoustidou-Savvopoulou H. Antonopoulou A. Vazeou-Gerasimidi G. Varlamis M. Kanariou ∂. Katsarou-Pectasides A. Kattamis Ch. Costalos N. Papadopoulos ∞. Papadopoulou A. Siamopoulou-Mavridou M. Tsolia Manuscript Editing Greek Editing F. Mavroidi English Editing S. Nakou Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 3 Artemidos str.

GR - 151 25, Maroussi Tel.: +30 210 87 78 810 Fax: +30 210 87 78 822 Owner Greek Paediatric Society© 92 Michalakopoulou str.

GR - 115 28, Athens Tel.: +30 210 7771 140 +30 210 7771 663 Fax: +30 210 7758 354 e-mail: hps@ath.forthnet.gr Annual Subscription All foreign countries: US $ 50

Contents CURRENT ISSUES 77 Measles outbreak A. Constantopoulos

127 Food advertisements targeted at children: nutritional information and appeal E. Bathrellou, M. Yannakoulia, N. Voutzourakis, P. Zisis, A.L. Matalas, L.S. Sidossis

78 National Vaccination Programme National Vaccination Committee

CASE REPORTS

83 Diphtheria, tetanus, acellular pertussis booster vaccination for adolescents: the new data G. Tsolas

134 Aplasia of the cerebellar vermis with Smith-Lemli-Opitz and Meckel syndrome phenotypes A. Andreou, V. Papavassiliou, A. Sakellaropoulou

90 Polio control after certification: evaluating the risks and planning public health policies K. Douros, B. Tsagris, P. Nikolaidou-Karpathiou

138 Lethal multiple pterygium syndrome H. Hatzissevastou-Loukidou, A. Georgountzou 143 Familial Moyamoya disease in two European children H. Bazigou-Fotopoulou, N. Vassilaki, S. Aroni, H. Ikeda, A. Papavassiliou

REVIEW ARTICLES 97 The PANDAS hypothesis (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection): reality or myth?

V. Tsagris, K. Douros, P. Nikolaidou-Karpathiou

PRACTICAL ISSUES 150 Haemoptysis in children M.N. Vassilopoulou, N. Myriokefalitakis

104 Listeriosis during pregnancy P. Mexi-Bourna, N. Bournas

160 CLINICAL QUIZ

110 Congenital and acquired heart diseases.

Implications for pregnancy, the fetus and the newborn infant S. Antoniadis

161 NEWS FROM THE INTERNET

ORIGINAL ARTICLES 118 Paediatric palliative care: perceptions of Greek pediatricians M. Bouri, D. Papadatou

European Pediatric Societies electronic addresses C. Stefanidis

Pediatr Mar-Apr 06

18-04-06

16:41

™ÂÏ›‰·7

™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏

EDITORIAL BOARD

¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘

Editor-in-Chief

∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·

Constantinos Stefanidis, Athens

À‡ı˘ÓÔÈ ™‡ÓÙ·Í˘ ∂ÍÂȉÈ·ۈÓ

Section Editors

∂ϤÓË ∞ÓÙˆÓÔÔ‡ÏÔ˘, ∞ı‹Ó· ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ - ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜

Eleni Antonopoulou, Athens Developmental and behavioral pediatrics

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, £ÂÛÛ·ÏÔÓ›ÎË KÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·

Persefoni Avgoustidou-Savopoulou, Thessaloniki Metabolic disorders

∞Ó‰ÚÈ·Ó‹ µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë, ∞ı‹Ó· ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·

Andriani Vazaiou-Gerasimidi, Athens Endocrinology

°ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘, £ÂÛÛ·ÏÔÓ›ÎË ∫·Ú‰ÈÔÏÔÁ›·

George Varlamis, Thessaloniki Cardiology

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó· ∞ÓÔÛÔÏÔÁ›·

Maria Kanariou, Athens Immunology

∂˘ÛÙ·ı›· ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë, ∞ı‹Ó· ¡Â˘ÚÔÏÔÁ›·

Eustathia Katsarou-Pektasidou, Athens Neurology

∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ı‹Ó· ∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·

Antonis Kattamis, Athens Haematology - √ncology

ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜, ∞ı‹Ó· ¡ÂÔÁÓÔÏÔÁ›·

Christos Kostalos, Athens Neonatology

∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, ∞ı‹Ó· °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ∏·ÙÔÏÔÁ›· - ¢È·ÙÚÔÊ‹

Alexandra Papadopoulou, Athens Gastroenterology - Hepatology - Nutrition

¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ı‹Ó· ∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶Ó¢ÌÔÓÔÏÔÁ›·

Nicos Papadopoulos, Athens Allergology - Pneumonology

∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, πˆ¿ÓÓÈÓ· ƒÂ˘Ì·ÙÔÏÔÁ›·

Antigoni Siamopoulou-Mavridou, Ioannina Rheumatology

ª·Ú›˙· ∆ÛÔÏÈ¿, ∞ı‹Ó· §ÔÈ̈ÍÈÔÏÔÁ›·

Marisa Tsolia, Athens Infectious Diseases

ª¤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board Alexis Arzimanoglou, Paris, France

Enver Hasanoglu, Ankara, Turkey

Ellis D. Avner, Milwaukee, USA

Christer Holmberg, Helsinki, Finland

Swati Bhave, New Delhi, India

Peter Hoyer, Essen, Germany

Alberto Bissot, Panama, Panama

Jan Janda, Prague, Czech Republic

David Branski, Jerusalem, Israel

Jan Kimpen, Ultrecht, Netherlands

Francesco Chiarelli, Chieti, Italy

John Manis, Boston, USA

Chok-Wan Chan, Hong Kong, China

Manuel Moya, Alicante, Spain

Denis Daneman, Toronto, Canada

Hugh O'Brodovich, Toronto, Canada

Jochen Ehrich, Hannover, Germany

Willem Proesmans, Leuven, Belgium

Demetrius Ellis, Pittsburgh, USA

Jose Ramet, Antwerp, Belgium

Yoshikatsu Eto, Tokyo, Japan

Alan Sinaiko, Minneapolis, USA

Richard N. Fine, Stony Brook, USA

Alfred Tenore, Udine, Italy

Margaret C. Fisher, Philadelphia, USA

Alkis Togias, Bethesda, USA

Raif Geha, Boston, USA

Eva Tsalikian, Iowa City, USA

Adenike Grange, Lagos, Nigeria

Catherine Weil-Olivier, Paris, France

Judith G. Hall, Vancouver, Canada

Johannes Zschocke, Heidelberg, Germany

Patricia Hamilton, London, UK

vii

Pediatr Mar-Apr 06

18-04-06

16:42

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√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜

∂¶π™∆∏ª√¡π∫∂™ ∂∫¢√™∂π™

∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜, Ô˘ ‰È·Ó¤ÌÂÙ·È ÛÙ· ̤ÏË Ù˘. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.

4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.

5. ∫ÏÈÓÈο ∫Ô˘›˙.

6. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.

7. ∂›Î·ÈÚ· ı¤Ì·Ù·.

8. £¤Ì·Ù· ÂÎ·›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜.

9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ.

10. ™‡ÓÙÔÌ· Ó¤·.

11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

14. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

Ó·È Â˘Ì¿‰·˜ us ( ‚‚ÚÔÁÎ·È M. a spp. ÈÛÙÔÚÔ‚ÂÂÊÚÔr/ËÌÂr ËÌ¢ ·fi

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜ Î·È ¿ÚıÚ· Ì Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·ÛÙ› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì Â›Î·ÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. E›Û˘, Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋

xv

·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È Ù˘ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (21x29,7 cm), Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜.

TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ΛÌÂÓÔ, ¢¯·ÚÈÛٛ˜ ηıÒ˜ Î·È ·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢, ‚È‚ÏÈÔÁÚ·Ê›·, ›Ó·Î˜, ÂÈÎfiÓ˜, Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ. K¿ı ¤Ó· ·fi Ù· ·Ú·¿Óˆ ÛÙÔȯ›· Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ Û ¯ˆÚÈÛÙfi ʇÏÏÔ Î·È ÔÈ ÛÂÏ›‰Â˜ Ó· ·ÚÈıÌÔ‡ÓÙ·È ‰È·‰Ô¯Èο ·Ú¯›˙ÔÓÙ·˜ Ì ÙË ÛÂÏ›‰· Ù›ÙÏÔ˘.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 1500-2500 ϤÍÂȘ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ. ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋. ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤ·/ˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙÔ˘˜. ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·.

¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ñ ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ ÛÂ: ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·16

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K¿Ùˆ ·fi ÙËÓ ÂÏÏËÓÈ΋ Î·È ÙËÓ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë ÛËÌÂÈÒÓÔÓÙ·È ÙÚÂȘ ¤ˆ˜ ¤ÓÙ ϤÍÂȘ ÎÏÂȉȿ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙÔ ıÂÌ·ÙÈÎfi ¢ÚÂÙ‹ÚÈÔ.

K›ÌÂÓÔ OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó: ÂÈÛ·ÁˆÁ‹, ÌÂıfi‰Ô˘˜, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘˙‹ÙËÛË. H ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ·Ó¿Ï˘Û˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. T· ·ÔÙÂϤÛÌ·Ù· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ۷ʋÓÂÈ· Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙËÓ ··Ú·›ÙËÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. H Û˘˙‹ÙËÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ.

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË, Ì ¤ÌÊ·ÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË.

T· ˘fiÏÔÈ· ı¤Ì·Ù· ¤¯Ô˘Ó ÂχıÂÚË ‰ÔÌ‹ ηٿ ÙËÓ ÎÚ›ÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÙÔ˘˜. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Î·È ÚÈÓ ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜.

Editors/ Uniform Requirements for Manuscripts Sub-mitted to Biomedical Journals, (http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)]. ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

T·ÎÙÈ΋ ¤Î‰ÔÛË ÂÚÈÔ‰ÈÎÔ‡: ∞ÓÙˆÓ›Ô˘ ¢, ª¿Ú· Ã, °È·ÓÓ¿ÙÔ˘ Ã. ∂Ì‚fiÏÈ·: Â›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÏÔÈ̈‰ÒÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙËÓ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ¶·È‰È·ÙÚÈ΋ 1999;59:272-279.

Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679. ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19. Èڛ˜ Û˘ÁÁڷʤ·: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜, ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·.

OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó:

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: 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. µπµ§π∞ ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors.

Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.

ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. ñ ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.

¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance.

In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p.

484-500.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal

¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂÚ·›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 1979.

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Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

IV. ™∆O ¢π∞¢π∫∆ÀO ÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi: Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm ªÔÓÔÁÚ·Ê›·: Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô Î·È ‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (15,5 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

OÈ ›Ó·Î˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚Ú·¯‡ Ù›ÙÏÔ Î·È ÂÂÍ‹ÁËÛË ÙˆÓ Û˘ÓÙÌ‹ÛÂˆÓ ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ™ÙÔ˘˜ ›Ó·Î˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È ÔÈ Î¿ıÂÙ˜ ÁÚ·Ì̤˜. ŸÏÔ ÙÔ ·ÂÈÎÔÓÈÛÙÈÎfi ˘ÏÈÎfi (Û¯‹Ì·Ù·, ‰È·ÁÚ¿ÌÌ·Ù·, ʈÙÔÁڷʛ˜, Î.Ï.) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÈÎfiÓ˜ Î·È ı· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜. ™ÙÔ ›Ûˆ ̤ÚÔ˜ ÙˆÓ ÂÈÎfiÓˆÓ Ú¤ÂÈ Ó· ÛËÌÂÈÒÓÂÙ·È Ì ÌÔχ‚È Ô ·ÚÈıÌfi˜ Ù˘ ÂÈÎfiÓ·˜ Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÚÒÙÔ˘ Û˘ÁÁڷʤ·, ηıÒ˜ Î·È ¤Ó· ‚¤ÏÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÙÔ ¿Óˆ ̤ÚÔ˜ Ù˘ ÂÈÎfiÓ·˜. ™ÙȘ ʈÙÔÁڷʛ˜ ·ÛıÂÓÒÓ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È Ë Ù·˘ÙfiÙËÙ¿ ÙÔ˘˜. OÈ ·ÛıÂÓ›˜ ‰ÂÓ Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÔÓÔÌ·ÛÙÈο.

πÛÙÔÛÂÏ›‰Â˜: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰ÈÛΤٷ ‹ CD, ηıÒ˜ Î·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ.

H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹.

T· ¤ÍÔ‰· ÙˆÓ ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı› ÂÓÙfi˜ ÂÍ·Ì‹ÓÔ˘, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ.

OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92, 115 28 Aı‹Ó·

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó· Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜.

2. ¢ÈÛΤٷ ‹ CD Ì fiÏÔ ÙÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ (ΛÌÂÓÔ, ›Ó·Î˜, ÂÈÎfiÓ˜).

3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.

4. ™ÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂÚÈÏ·Ì‚¿ÓÂÈ: ·.Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ ‚.fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· ‰.fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›·.

5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

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

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

8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢).

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

10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.

12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

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™À¡∆√ª√°ƒ∞ºπ∂™ o

A cal cm cm2 cm3 o C g h IU kg l m mg min mm mol n NS ‹ ª™ osm p SD SE sec U

angstrom ıÂÚÌ›‰· ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢‚ÈÎfi ÂηÙÔÛÙfi ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ ÁÚ·ÌÌ¿ÚÈÔ ÒÚ· ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ¯ÈÏÈfiÁÚ·ÌÌÔ Ï›ÙÚÔ Ì¤ÙÚÔ ¯ÈÏÈfiÁÚ·ÌÌÔ ÏÂÙfi ¯ÈÏÈÔÛÙfiÌÂÙÚÔ ÁÚ·ÌÌÔÌfiÚÈÔ ·ÚÈıÌfi˜ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Èı·ÓfiÙËÙ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ‰Â˘ÙÂÚfiÏÂÙÔ ÌÔÓ¿‰·

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (109) mega- (106) kilo- (103) hector- (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)

ABBREVIATIONS

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

angstrom calorie centimeter square centimeter cubic centimeter degree Celsius gram hour international unit kilogram liter meter milligram minute millimeter mole number not significant osmole probability standard deviation standard error second unit

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INSTRUCTIONS TO AUTHORS A. General Information The Greek Paediatric Society is the owner of “Paediatriki”, its official scientific journal, which is distributed to its members. Its objectives are the publication of paediatric scientific work and the continuing education of paediatricians. For this purpose, it publishes a variety of articles, and in particular: 1. Editorials (upon invitation by the Editorial Board).

2. Review articles.

3. Award-winning articles.

4. Original articles.

5. Clinical Quiz.

6. Round tables.

7. Current issues.

8. Issues of healthcare management and education.

9. Case reports.

10. News.

11. Brief reports.

12. Letters to the editor.

13. Abstracts.

14. Future congresses and events.

15. Book reviews.

The Editorial Board reserves the right to publish articles of special scientific interest and articles on current issues without observing submission order. In addition it publishes upon decision original papers presented at the Annual Paediatric Conference, presentations of special interest - in whole or in part, and letters - in whole or in part - referring to scientific articles published in the journal.

Regarding papers on current issues, the author’s request for immediate publication should be quoted on the first page. The Editorial Board reserves the right to accept such papers for immediate publication.

All manuscripts should not have been published previously, in whole or in part, and not be under consideration by another publication. Manuscripts should acknowledge any funding, sponsorship or other financial support. All clinical research should have been conducted following informed consent of participants or of their legal representatives according to the Declarations of Helsinki and Tokyo.

In addition, the US National Institute of Health guide for the care and use of laboratory animals (DHEW Publication, NIH, 80-23) should have been observed. Clinical trials should have been approved by the Ethics Committee of the Hospital.

Authors’ opinions and conclusions expressed in the published papers do not necessarily reflect those of the journal. The Greek Paediatric Society, the Editorial Board and the Publisher of the journal do not necessarily approve the content of the advertisements appearing in the journal.

The copyright of all published papers is held by “Paediatriki” and their reproduction in whole or in part is authorized only following written consent of the journal.

B. Manuscript Preparation “Paediatriki” suggests compliance with the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”, recently modified and published on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf The entire paper (including figure legends and tables)

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should be typed on one side of blank paper format A4 (21x29.7 cm), double line spacing and minimum indent 2.5 cm on both sides.

The paper should have the following structure: title page, short title, abstract in Greek and English, list of abbreviations, text, acknowledgements and quoting of grants, sponsorships or other financial support sources, references, tables, figures, figure legends. Each of these sections should be started on a new page. Pages should be numbered consecutively, beginning with the title page.

Text length shall be: ñ review articles 2000-3000 words; ñ original articles 1500-2500 words and case reports 1000-1500 words; ñ brief reports 1000-1500 words; ñ letters 250-500 words.

The title page should include: ñ the title (<14 words) and the short title (<5 words) of the article. No abbreviations are permitted in the title; ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of the paper. If there is no affiliation with a specific centre, the status of the author(s) should be cited (e.g., private paediatrician) and home address; ñ the complete address, e-mail and telephone number of the author to whom correspondence should be addressed.

Abstracts The abstract should summarize the objectives, methodology, main results and conclusions of the study. ñ It should contain at least 200 words, and not exceed 250 words. ñ It should consist of the following paragraphs: background, methods, results and conclusions.

The English abstract should cite at the beginning the title of the paper and the authors’ names in English. The content of the text should consist of the following paragraphs: background, methods, results and conclusions. The abstract in English should not differ in content from the corresponding Greek abstract.

Beneath the Greek and English abstracts, three to five key words in the respective language should be supplied, to be used in the thematic index.

Text Original articles include: introduction, methods, results and discussion. The introduction includes the latest research data on the subject and the main references and the objectives of the paper. The description of the methods should be precise and detailed so as to enable reproduction by other researchers. In addition, the statistical methods of analysis and evaluation of the results should be described. Results should be presented clearly, together with the appropriate statistical analysis. Discussion should cover the results ensuing from the research, their significance and possible associations with the observations of other researchers.

Case reports comprise a short introduction, case description and brief discussion, with emphasis on differential diagnosis.

The structure of all other articles is free, according to the judgment of the authors.

Thanks or acknowledgements (reference to grants, sponsorships or other sources of financial support) should be quoted at the end of the text, before references.

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Units of measures of laboratory analyses Laboratory analyses should be expressed in the Système International (SI) units and in the metric (Conventional) system in parentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf

II. BOOKS Chapter in book: 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.

Abbreviations All issues of the journal contain internationally established abbreviations. Complex or long terms often repeated in the text may be replaced by abbreviations explained by the authors in a list submitted with the paper. Abbreviations are reported in parentheses only in abstracts.

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

References The reference section contains all references numbered in the order in which they appear in the text. In the text, references are to be indicated by Arabic numerals in parentheses. References should be no more than: ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.

In listing references follow the recently modified standards of the International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Abbreviated names of journals should conform to the Cumulated Index Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style I. JOURNALS All authors are cited if they are six or less; if they are 7 or more, the first six are cited, followed by “et al”.

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

Supplement issue: 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.

No author: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.

Article type specification: 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.

Publication in a volume of proceedings: 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.

Doctoral dissertation: Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

IV. ON THE INTERNET Article in journal Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm Monograph Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html Websites Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/ Tables and Figures Three copies should be submitted (original plus 2 copies). Their width should either be equal to the width of one column (7.5 cm) or to the width of the page (15.5 cm).

Their maximum length, titles included, should not exceed 22 cm.

Tables are numbered with Arabic numerals in the order in which they appear in the text. They should have a short title and abbreviations should be listed at the bottom. Vertical lines in tables should be avoided.

All illustration material is considered as figures (graphs, pictures, etc.). They should be of excellent quality. Also, at the back of every picture, the number of the picture and the name of the first author should be noted in pencil, with an arrow showing the top of the picture. The identity of patients should not be recognizable from their pictures nor should their names be stated.

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C. Manuscript Submission and Publication All manuscripts should be accompanied by a floppy disk or CD, as well as by a letter, signed by all the authors, in which it is stated that the paper has not been published in part or in whole, or is not under consideration by another journal and that the authors accept its publication in “Paediatriki”. Any funding, sponsorship or other financial support should be acknowledged.

Once the manuscript has been accepted, the corrected version, rewritten according to the reviewers’ recommendations should be submitted to the Editorial Board accompanied by a floppy disk or CD, containing the paper in Word format, along with a covering letter specifying in detail the modifications or objections to the reviewers’ suggestions.

Delay in submission of the modified paper exceeding 30 days entails new submission.

Authors will be charged film and reprint expenses, paid upon dispatch of the first proof directly to the printer.

Manuscripts of papers which have not been approved for publication are not returned to the author. The accompanying figures and photographs can be returned upon request within six months.

Manuscripts submitted for review and publication in “Paediatriki” should be sent in three copies to the following address: Editorial Board, Greek Paediatric Society 92, Michalakopoulou Street, 115 28 Athens, Greece

Before submitting your paper, make sure it contains: 1. 3 copies of the text of the paper, printed according to instructions.

2. A floppy disk or CD with the entire material of the paper (text, tables, pictures).

3. A covering letter and a statement that the paper has not been previously published.

4. The title page (on a separate page), which includes: a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and telephone number; 5. English and Greek abstracts, with the following structure: background, methods, results and conclusions (double space, separate page) and keywords.

6. List of abbreviations (double space, separate page).

7. Text (double space, separate page).

8. Acknowledgements and reference to funding, sponsorships or other financial sources.

9. References (double space, separate page).

10. Tables (one per page) in three copies.

11. Figures with an arrow at the back showing the top, numbered, in two copies.

12. Figure titles (double space - on separate pages) in three copies.

ª·Ú›· ¶··Ê›ÏË °È· ÏËÚÔÊÔڛ˜: www.euran.com ªaria Papafili For information: www.euran.com

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ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ∫·ıËÁËÙ‹˜ ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∏ ÈÏ·Ú¿ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, Â›Ó·È ¤Ó· ÏÔÈÌ҉˜ ÓfiÛËÌ· Ì ÌÂÁ¿ÏË ÌÂÙ·‰ÔÙÈÎfiÙËÙ·. ∆Ô 95% ÙÔ˘ ÏËı˘ÛÌÔ‡ ÓÔÛÔ‡Û ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ, ÚÈÓ ·Ú¯›ÛÂÈ Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÁÈ· ÙËÓ ÈÏ·Ú¿ Î·È Î¿ı 5 ÂÚ›Ô˘ ¯ÚfiÓÈ· ÂÌÊ·ÓÈ˙fiÙ·Ó Î·È ÌÈ· ÂȉËÌ›· ÈÏ·Ú¿˜. ∏ ˘„ËÏfiÙÂÚË Â›ÙˆÛË ‹Ù·Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ 5-9 ¯ÚfiÓˆÓ Î·È ÂÓÂÊ¿ÓÈ˙ Âԯȷ΋ ηٷÓÔÌ‹ Ì ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¯ÂÈÌÒÓ· Î·È ÙËÓ ¿ÓÔÈÍË. ∆ËÓ ‰ÂηÂÙ›· ÙÔ˘ 1970 ¿Ú¯ÈÛÂ Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ÈÏ·Ú¿˜ Ì ̛· ‰fiÛË MMR, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜. ∆Ô 1987 ÚÔÛÂÙ¤ıË Î·È Ì›· ‰Â‡ÙÂÚË ‰fiÛË, ·Ú¯Èο, ÛÙËÓ ËÏÈΛ· ÙˆÓ 12 ¯ÚfiÓˆÓ Î·È ·ÚÁfiÙÂÚ·, ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-6 ¯ÚfiÓˆÓ. ¶·Ú¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙËÓ ÙÂÏÂ˘Ù·›· 25ÂÙ›· ·Ú·ÙËÚ‹ıËÎ·Ó 4 ÂȉË̛˜ ÛÙËÓ ∂ÏÏ¿‰· ÙÔ 1983, 1988, 1992 Î·È ÙÔ 1996. ∞fi ÙÔÓ ÂÚ·Ṳ̂ÓÔ ¡Ô¤Ì‚ÚÈÔ ÙÔ˘ 2005 ·Ú·ÙËÚÂ›Ù·È ÛÙË ¯ÒÚ· Ì·˜ ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ΢ڛˆ˜ ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰·, ȉȷ›ÙÂÚ· Û ηٷ˘ÏÈÛÌÔ‡˜ ·ı›ÁÁ·ÓˆÓ. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÍ·ÏÒıËΠÛÙË £ÂÛÛ·ÏÔÓ›ÎË, fiÔ˘ ÓfiÛËÛ ¤Ó·˜ ·È‰›·ÙÚÔ˜, Ì›· ÓÔÛËχÙÚÈ· Î·È Ì›· ÌËÙ¤Ú· ÓÔÛËÏ¢Ô̤ÓÔ˘ ·È‰ÈÔ‡ ÁÈ· ¿ÏÏË ÓfiÛÔ. ∆· ÂfiÌÂÓ· ÎÚÔ‡ÛÌ·Ù· ÂÌÊ·Ó›ÛıËÎ·Ó ÛÙËÓ ∂‡‚ÔÈ· Î·È ÙËÓ ∞ı‹Ó·. √È ËÏÈ˘ Ô˘ ÚÔÛ‚ϋıËÎ·Ó ‹Ù·Ó ΢ڛˆ˜ ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 4 ¯ÚfiÓˆÓ Î·È ÂÓ‹ÏÈΘ 20-30 ¯ÚfiÓˆÓ. ™Â ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ·Ó›ÛıËÎ·Ó ÎÚÔ‡ÛÌ·Ù· Î·È ÛÙȘ ¿ÏϘ ËÏÈ˘. ∏ ¤Í·ÚÛË ·˘Ù‹ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·ÊÔÚÔ‡Û ΢ڛˆ˜ ·ÓÂÌ‚ÔÏ›·ÛÙ· ·È‰È¿ ‹ ·È‰È¿ ÛÙ· ÔÔ›· ‰ÂÓ Â›¯Â ¯ÔÚËÁËı› ‰Â‡ÙÂÚË ‰fiÛË MMR. °È· Ó· ·ÔÊ¢¯ı› Ë ÂÚ·ÈÙ¤Úˆ ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘ÓÈÛÙÒÓÙ·È Ù· ÂÍ‹˜: 1. ¡· Á›ÓÂÈ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÚÂÊÒÓ Ì MMR ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ. ∏ ‰fiÛË ·˘Ù‹ ÛÙË Û˘Ó¤¯ÂÈ·, ı· ·ÁÓÔËı› Î·È ı· Á›ÓÔ˘Ó ·ÎfiÌË 2 ÂÈÚfiÛıÂÙ˜ ÂÓ¤ÛÂȘ MMR. 2. ŸÏ· Ù· ·È‰È¿ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÓÔÛ‹ÛÂÈ Î·È Â›Ó·È ·ÓÂÌ‚ÔÏ›·ÛÙ· ‹ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·Ûı› Ì ÌÈ· ‰fiÛË ÂÌ‚ÔÏ›Ô˘ MMR Û˘ÓÈÛÙ¿Ù·È Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË Ì›·˜ ·ÎfiÌË ‰fiÛ˘ ÂÌ‚ÔÏ›Ô˘ MMR. 3. ŸÛ· ·È‰È¿ ¤¯Ô˘Ó οÓÂÈ Ì›· ‰fiÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-15 ÌËÓÒÓ, ÂÈ‚¿ÏÏÂÙ·È Ë ‰Â‡ÙÂÚË ‰fiÛË Ó· Á›ÓÂÈ ¿ÌÂÛ·, ·ÚΛ Ó· ¤¯Ô˘Ó ÂÚ¿ÛÂÈ 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì‹Ó˜ ·fi ÙËÓ ÚÒÙË ‰fiÛË, ¯ˆÚ›˜ Ó· ÂÚÈ̤ÓÔ˘Ì ӷ Á›ÓÂÈ 4 ¯ÚfiÓˆÓ ÙÔ ·È‰›.

4. ∂Ó‹ÏÈΘ ̤¯ÚÈ 45 ¯ÚfiÓˆÓ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ÈÏ·Ú¿ ‹ Â›Ó·È ·ÓÂÌ‚ÔÏ›·ÛÙÔÈ ‹ Â›Ó·È ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ Ì ̛· ‰fiÛË ÂÌ‚ÔÏ›Ô˘ MMR Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Ì›·˜ ‰fiÛ˘ MMR. º˘ÛÈο, ·Ó ÂÌ‚ÔÏÈ·ÛıÔ‡Ó fiϘ ·˘Ù¤˜ ÔÈ ÔÌ¿‰Â˜, Ù· ÂÌ‚fiÏÈ· MMR ı· ÂÍ·ÓÙÏËıÔ‡Ó, ÁÈ’ ·˘Ùfi Û ÚÒÙË Ê¿ÛË, ı· Ú¤ÂÈ Ó· ‰Ôı› ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙȘ ·Ú·Î¿Ùˆ ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘: ·. ∆Ô È·ÙÚÔÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ‚. ∆Ô ÚÔÛˆÈÎfi ‚ÚÂÊÔÓËÈ·ÎÒÓ ÛÙ·ıÌÒÓ Á. ºÔÈÙËÙ¤˜ Î·È ÛÔ˘‰·ÛÙ¤˜ Ô˘ οÓÔ˘Ó ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ¿ÛÎËÛË ‰. √È ·ı›ÁÁ·ÓÔÈ Î·È ¿ÏϘ ÔÌ¿‰Â˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·Ûı› ηıfiÏÔ˘.

¶Úfi‰ÚÔ˜ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

£· Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ MMR ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚ˜ ·ÚÂÓ¤ÚÁÂȘ, ÂÎÙfi˜ fiÙ·Ó ¯ÔÚËÁÂ›Ù·È Û ÂÓ‹ÏÈΘ, ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ Â›ÌÔÓË ·ÚıÚ›Ùȉ·. ¶·Ú¿ Ù·‡Ù· ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ÂÚÈÙÒÛÂȘ ÂȉËÌ›·˜ ‹ ¤Í·ÚÛ˘ Ù˘ ÈÏ·Ú¿˜.

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∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ ¶Úfi‰ÚÔ˜, ∫·ıËÁËÙ‹˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ªÂ ÙËÓ ·fi 13.1.2006 Û¯ÂÙÈ΋ ÂÁ·ÎÏÈÔ ÙÔ˘ ÀÊ˘Ô˘ÚÁÔ‡ ÀÁ›·˜ Î. ∞ı·Ó¿ÛÈÔ˘ °È·ÓÓfiÔ˘ÏÔ˘ ÂÎÛ˘Á¯ÚÔÓ›˙ÂÙ·È ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ. ∏ ·fiÊ·ÛË ·˘Ù‹, Ô˘ ÂÏ‹ÊıË ÌÂÙ¿ ·fi Û¯ÂÙÈ΋ ÚÔÂÙÔÈÌ·Û›· Î·È ÂÈÛ‹ÁËÛË Ù˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ, ·ÔÙÂÏ› ÌÈ· Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜ ·Ú¤Ì‚·ÛË ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ ÛÙË ¯ÒÚ· Ì·˜. ∆Ô Ó¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ Â›Ó·È ϤÔÓ ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ÂÈÛÙËÌÔÓÈΤ˜ ÂÍÂÏ›ÍÂȘ Î·È ‚Ú›ÛÎÂÙ·È Û Ï‹ÚË ·ÓÙÈÛÙÔȯ›· Ì ٷ ÚÔÁÚ¿ÌÌ·Ù· ÙˆÓ ÚÔËÁÌ¤ÓˆÓ Û˘ÛÙËÌ¿ÙˆÓ ˘Á›·˜. ªÂ ÙÔ Ó¤Ô ¶ÚfiÁÚ·ÌÌ· ÙÔ Â›Â‰Ô Ù˘ ·Ú¯fiÌÂÓ˘ ˘ÁÂÈÔÓÔÌÈ΋˜ ÊÚÔÓÙ›‰·˜ ·Ó·‚·ıÌ›˙ÂÙ·È ÛËÌ·ÓÙÈο. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ù· ÂÌ‚fiÏÈ· ·ÔÙÂÏÔ‡Ó ¤Ó· ·fi Ù· ‰¤Î· ÌÂÁ·Ï‡ÙÂÚ· ÂÈÙ‡ÁÌ·Ù· ÛÙÔ ‰›Ô Ù˘ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ Î·È ·ÔÙÂÏÔ‡Ó ¤Ó· ÎÚ›ÛÈÌÔ Ì¤ÛÔ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡, ÙËÓ ¿ÛÎËÛË ÚÔÏËÙÈ΋˜ È·ÙÚÈ΋˜ Î·È ÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∏ ÂͤÏÈÍË Ù˘ ‚ÈÔ˚·ÙÚÈ΋˜ Ù¯ÓÔÏÔÁ›·˜ Â¤ÙÚ„ ÙËÓ ·Ó·Î¿Ï˘„Ë Î·È ·Ú·ÁˆÁ‹ “Ó¤·˜ ÁÂÓÈ¿˜” ÂÌ‚ÔÏ›ˆÓ Ô˘ ¤¯Ô˘Ó ¯·ÌËÏfi Â›Â‰Ô ·ÓÙȉڷÛÙÈÎfiÙËÙ·˜ Î·È ˘„ËÏ¿ Â›‰· ·ÛÊ¿ÏÂÈ·˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜. ÷ڷÎÙËÚÈÛÙÈο ·Ú·‰Â›ÁÌ·Ù· Ù˘ Ù¯ÓÔÏÔÁ›·˜ ·˘Ù‹˜ ·ÔÙÂÏÔ‡Ó ÙÔ ·Î˘ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÎÔηÙË, ÙÔ ÓÂÎÚfi ÂÓÈÛ¯˘Ì¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÔÏ˘ÔÌ˘ÂÏ›Ùȉ·˜, ÙÔ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ µ, Ù· Û˘˙¢Á̤ӷ ÂÌ‚fiÏÈ· ηٿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘ ‚, ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Î·È ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ Ù˘ Ó¢ÌÔÓ›·˜, Ù· ÔÏ˘‰‡Ó·Ì· / Û˘Ó‰˘·Ṳ̂ӷ ÂÌ‚fiÏÈ·, Ù· ÂÌ‚fiÏÈ· ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜, Ù˘ Ë·Ù›Ùȉ·˜ ∞ Î·È Ù· ÂÌ‚fiÏÈ· ηٿ Ù˘ ÁÚ›˘.

√ ÚfiÏÔ˜ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ªÂ ·Ï¿ ÏfiÁÈ·, Ô ÚfiÏÔ˜ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Â›Ó·È Ó· ‰ÈÂÁ›ÚÔ˘Ó ÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ì·˜ ÒÛÙ ӷ ·Ú·Á¿ÁÂÈ ·ÓÔÛȷ΋ ·¿ÓÙËÛË (.¯. ·ÓÙÈÛÒÌ·Ù·) Û ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜. ªÂ ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÌÂÏÏÔÓÙÈ΋ ÚÔÛÙ·Û›· (·ÓÔÛ›·) ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·˘ÙÔ‡˜ ·Ú¿¶·È‰È·ÙÚÈ΋ 2006;69:78-82

ÁÔÓÙ˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ù· ÂÌ‚fiÏÈ· ÂÚȤ¯Ô˘Ó ›ÙÂ Ê˘ÛÈο Û˘ÛÙ·ÙÈο - ÚÔ˚fiÓÙ· ÙˆÓ ÏÔÈÌÔÁfiÓˆÓ ·˘ÙÒÓ ·Ú·ÁfiÓÙˆÓ, ›Ù ÚÔ˚fiÓÙ· ‚ÈÔÙ¯ÓÔÏÔÁ›·˜ Ô˘ ÌÈÌÔ‡ÓÙ·È Ù· Ê˘ÛÈο Û˘ÛÙ·ÙÈο ÙÔ˘˜. ªÂÙ¿ ·fi ÂȉÈ΋ ÂÂÍÂÚÁ·Û›·, Ù· Ê˘ÛÈο ‹ ‚ÈÔÙ¯ÓÔÏÔÁÈο Û˘ÛÙ·ÙÈο Â›Ó·È ·Ó›Î·Ó· Ó· ÚÔηϤÛÔ˘Ó ÓfiÛËÛË, ÌÔÚÔ‡Ó, fï˜, Ó· ÚÔηϤÛÔ˘Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓÙÈۈ̿وÓ. √ ·ÓıÚÒÈÓÔ˜ ÔÚÁ·ÓÈÛÌfi˜, ¤¯ÔÓÙ·˜ ·Ú·Á¿ÁÂÈ Ù· ηٿÏÏËÏ· ·ÓÙÈÛÒÌ·Ù· ‰È·ÙËÚ› ¤Ó· ÔÏÔÛÙ¿ÛÈÔ Ì ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ÂÍÔ˘‰ÂÙÂÚÒÛÂÈ ÙÔÓ Ê˘ÛÈÎfi ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ·, ÁÈ· ÙÔÓ ÔÔ›Ô ¤¯ÂÈ ·Ú·Û΢·Ûı› ÙÔ ÂÌ‚fiÏÈÔ fiÙ·Ó ¤ÚıÂÈ Û Â·Ê‹ Ì·˙› ÙÔ˘. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Ó· ÙÔÓÈÛı› fiÙÈ Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ· ÛÙË ˙ˆ‹ ÙˆÓ ·ÓıÚÒˆÓ, ηıÒ˜ ¤ÙÛÈ ·Ó·Ù‡ÛÛÂÙ·È Ë ÚÔÛٷ٢ÙÈ΋ ·ÓÔÛ›·. ™ÙËÓ ËÏÈΛ· ÌÂٷ͇ 3 Î·È 12 ÌËÓÒÓ ÙÔ Â›Â‰Ô ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ·ÓȯÓ‡ÔÓÙ·È Â›Ó·È Î˘Ú›ˆ˜ ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘. ∞Ó ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ Ë ÌÂÙ·ÊÔÚ¿ ÚÔÛٷ٢ÙÈ΋˜ ·ÓÔÛ›·˜ ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ Â›Ó·È Â·Ú΋˜, ÙfiÙ ÂΛÓÔ Ì¤ÓÂÈ ·Î¿Ï˘ÙÔ Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘. ªÂ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ·fi ÙÔÓ 2Ô Ì‹Ó· Ù˘ ˙ˆ‹˜, ÙÔ ‚Ú¤ÊÔ˜ ·ÔÎÙ¿ ·ÚÎÂÙ¿ ÓˆÚ›˜ ˘„ËÏfi Â›Â‰Ô ÂÍÔ˘‰ÂÙÂÚÈÎÒÓ ·ÓÙÈۈ̿وÓ. ∆Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ¤¯ÂÈ ÂÎÛ˘Á¯ÚÔÓÈÛı› Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1.

∆È Ú¤ÂÈ Ó· ÚÔÛ¤¯Ô˘Ó ÔÈ ·È‰›·ÙÚÔÈ √È ·È‰›·ÙÚÔÈ Ú¤ÂÈ ‰È·ÚÎÒ˜ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙȘ ÓÂfiÙÂÚ˜ ÂÍÂÏ›ÍÂȘ ÛÙÔÓ ÙÔ̤· ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ñ ¶Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÛˆÛÙ¿ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ·Ó¿ÁÎË Ù‹ÚËÛ˘ ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ Î·È ÙËÓ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ñ ¶Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔ˘Ó Î·È Ó· ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡. ñ ¶Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÙȘ ·Ú¯¤˜ ÁÈ· Ù˘¯fiÓ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ηٿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ñ ¶Ú¤ÂÈ Ó· ÂϤÁ¯Ô˘Ó ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ.

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·79

79

∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ

¶›Ó·Î·˜ 1. ÕÙÔÌ· Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÛÔ‚·Ú¤˜ Ó¢ÌÔÓÈÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ

¶›Ó·Î·˜ 2. ¶·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ê˘Ì·ÙÈ΋ ÌfiÏ˘ÓÛË/Ê˘Ì·Ù›ˆÛË

ñ ÀÁÈ‹ ‚Ú¤ÊË, ÌÈÎÚ¿ ·È‰È¿ Î·È ÂÓ‹ÏÈΘ >60 ÂÙÒÓ ñ ÕÙÔÌ· ÌÂ Û˘ÁÁÂÓ›˜ ·ÓÙÈۈ̷ÙÈΤ˜ ·ÓÂ¿ÚÎÂȘ (΢ڛˆ˜ ¤ÏÏÂÈ„Ë Ù˘ IgG2) ñ ÕÙÔÌ· Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› Ì ÙÔÓ Èfi HIV ñ ÕÙÔÌ· Ì Â›ÎÙËÙË ·ÓÔÛÔηٷÛÙÔÏ‹, ÂÍ·ÈÙ›·˜ ÓÔÛ‹Ì·ÙÔ˜ ‹ ıÂÚ·›·˜ ‹ ¿ÏÏ˘ (ÂÎÙfi˜ ÙÔ˘ HIV) ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ñ ÕÙÔÌ· Ì ÌÂÈÔÓÂÎÙÈ΋ ÛÏËÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ ·ÛÏËÓ›· .¯. Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ, Ì ˘ÂÚÛÏËÓÈÛÌfi, Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ ÛÏ‹Ó· ñ ÕÙÔÌ· Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ñ ÕÙÔÌ· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ñ ÕÙÔÌ· Ì ¯ÚfiÓÈ· Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·. ñ ÕÙÔÌ· Ì ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ñ ÕÙÔÌ· Ì ‰È·Ê˘Á‹ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·fi Û˘ÁÁÂÓ›˜ ‹ Â›ÎÙËÙ˜ ·Èٛ˜

ñ ªÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ Ì ˘„ËÏfi ‹ ̤ÛÔ ‰Â›ÎÙË ÂÓ‰ËÌÈÎfiÙËÙ·˜. ñ ∫·Ù·˘ÏÈÛÌÔ› ·ı›ÁÁ·ÓˆÓ Î·È ¿ÏÏˆÓ ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô˘ ˙Ô˘Ó ÌÂ Û˘Óı‹Î˜ ÔÌ·‰È΋˜ ‰È·‚›ˆÛ˘. ñ ¶·È‰È¿ Ì Mantoux (-) ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ ¿ÙÔÌÔ ÌÂ Ê˘Ì·Ù›ˆÛË (ıÂÙÈο Ù‡ÂÏ·). ñ ¡ÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› Ì ÙÔÓ Èfi HIV (fi¯È ‚Ú¤ÊË Û˘Ìو̷ÙÈο ÁÈ· AIDS). ñ ¡ÂÔÁÓ¿, ÛÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ ÔÔ›ˆÓ, ˘¿Ú¯ÂÈ ¿ÙÔÌÔ ÌÂ Ê˘Ì·Ù›ˆÛË (ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Î·Ù¿ ÙË Á¤ÓÓËÛË).

∆È Ú¤ÂÈ Ó· ÚÔÛ¤¯Ô˘Ó ÔÈ ÁÔÓ›˜ ñ √È ÁÔÓ›˜ Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ. ñ ¡· Û˘ÓÂÚÁ¿˙ÔÓÙ·È Ì ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜ ÁÈ· ÙËÓ Ù‹ÚËÛË ÙÔ˘ ηٿÏÏËÏÔ˘ ÂÌ‚ÔÏÈ·ÛÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜. ñ ¡· ÌËÓ ·ÌÂÏÔ‡Ó ÙËÓ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ÙˆÓ ‰fiÛˆÓ. ñ ¡· ÚÔÛ¤¯Ô˘Ó ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ‚È‚ÏÈ·Ú›Ô˘ ˘Á›·˜ ·fi ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜. ∏ Ù‹ÚËÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ Â›Ó·È Ë ·Û›‰· ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.

∞ÓÙ› ÂÈÏfiÁÔ˘ ∆Ô Ó¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ Â›Ó·È ÌÈ· Ô˘ÛÈ·ÛÙÈ΋ Î·È ÂÓ ‰˘Ó¿ÌÂÈ ÂÍ·ÈÚÂÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·Ú¤Ì‚·ÛË ¢ËÌfiÛÈ·˜ ÀÁ›·˜. ¶·ÚfiÏ· ·˘Ù¿ Ë ÂÈÙ˘¯›· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÔÛÔÛÙfi Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙÔ˘ ÏËı˘ÛÌÔ‡. ∂›Ó·È ÁÂÁÔÓfi˜ fï˜, fiÙÈ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ‰ÂÓ Â›Ó·È ·ÎfiÌ· ÛÙ· ÂÈı˘ÌËÙ¿ Â›‰·. ∞·ÈÙÂ›Ù·È Û˘ÓÂÚÁ·Û›· ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁ›·˜, Ù˘ È·ÙÚÈ΋˜ ÎÔÈÓfiÙËÙ·˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· Ó· Êı¿ÛÔ˘Ì ÛÙ· ÂÈı˘ÌËÙ¿ Â›‰· ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ Ù˘ ¯ÒÚ·˜ Ì·˜ Î·È Ó· ÚÔÛÂÁÁ›ÛÔ˘Ì ÙÔÓ ÛÙfi¯Ô ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ ÁÈ· ÙËÓ ÂÍ¿ÏÂÈ„Ë Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÔÊ›ÏÂÙ·È Û ·ı‹ÛÂȘ ÁÈ· ÙȘ Ôԛ˜ ˘¿Ú¯Ô˘Ó ‰È·ı¤ÛÈÌ· ÂÌ‚fiÏÈ·.

¶›Ó·Î·˜ 3. ∂Ӊ›ÍÂȘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ Ë·Ù›Ùȉ·˜ ∞ Û ¯ÒÚ˜ Ì ¯·ÌËÏ‹ Î·È Ì¤ÛË ÂÓ‰ËÌÈÎfiÙËÙ· ñ ∆·ÍȉÈÒÙ˜ ñ ∂·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ñ ∂·ÁÁÂÏ̷ٛ˜ ‰È·Î›ÓËÛ˘ ÙÚÔÊ›ÌˆÓ ñ ¶ÚÔÛˆÈÎfi È‰Ú˘Ì¿ÙˆÓ ñ ∫ÏÂÈÛÙÔ› ÏËı˘ÛÌÔ›* ñ √ÌÔÊ˘ÏfiÊÈÏÔÈ - ∆ÔÍÈÎÔÌ·Ó›˜ ñ ÕÙÔÌ· Ì ¯ÚfiÓÈ· Ïԛ̈ÍË Ì ÙÔÓ Èfi Ù˘ ∏µ * µÏ. ˘ÔÛËÌ›ˆÛË ¶›Ó·Î· 4

¶›Ó·Î·˜ 4. ∂Ӊ›ÍÂȘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ ÁÚ›˘ ¶·ÚÔ˘Û›· ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‹ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·: ñ ÕÛıÌ· ‹ ¿ÏϘ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ñ ∫·Ú‰È·Î‹ ÓfiÛÔ˜ Ì ÛÔ‚·Ú¤˜ ηډÈÔ‰˘Ó·ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ñ ∞ÓÔÛÔηٷÛÙÔÏ‹ (ÂÍ·ÈÙ›·˜ ÓÔÛ‹Ì·ÙÔ˜ ‹ ıÂÚ·›·˜) ñ ¢ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜ (Î·È ¿ÏϘ ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂȘ) ñ ª·ÎÚÔ¯ÚfiÓÈ· Ï‹„Ë ·ÛÈÚ›Ó˘ ·fi ·È‰È¿ (.¯. ÓfiÛÔ˜ Kawasaki) ÁÈ· Ó· ÂÏ·ÙÙˆı› Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Û. Reye ÌÂÙ¿ ·fi ÁÚ›Ë ñ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ‹ ¿ÏÏÔ ¯ÚfiÓÈÔ ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ñ ÃÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ· ñ ∫ÏÂÈÛÙÔ› ÏËı˘ÛÌÔ›* ñ ∂·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ñ ∂·ÁÁÂÏ̷ٛ˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì Ô˘ÏÂÚÈο** ñ ÕÙÔÌ· ËÏÈΛ·˜ 60 ÂÙÒÓ Î·È ¿Óˆ * ¶ÚÔÛˆÈÎfi Î·È ÂÛˆÙÂÚÈÎÔ› ÛÔ˘‰·ÛÙ¤˜ Á˘ÌÓ·Û›ˆÓ Ï˘Î›ˆÓ, ÛÙÚ·ÙȈÙÈÎÒÓ Î·È ·ÛÙ˘ÓÔÌÈÎÒÓ Û¯ÔÏÒÓ, ÂȉÈÎÒÓ Û¯ÔÏ›ˆÓ ‹ Û¯ÔÏÒÓ, ÙÚfiÊÈÌÔÈ Î·È ÚÔÛˆÈÎfi È‰Ú˘Ì¿ÙˆÓ Î.¿. ** √ Èfi˜ Ù˘ ÁÚ›˘ ÙˆÓ Ô˘ÏÂÚÈÎÒÓ Î·ÓÔÓÈο ‰ÂÓ ÚÔηÏ› ÓfiÛËÛË ÛÙÔÓ ¿ÓıÚˆÔ. ∂›Ó·È ‰˘Ó·ÙfiÓ fï˜, Û ÂÚ›ÙˆÛË Û˘ÏÏԛ̈͢ Ì ÙÔÓ Èfi Ù˘ ÁÚ›˘ ÙˆÓ ·ÓıÚÒˆÓ Ó· ÚÔ·„ÂÈ ÌÂÙ·ÏÏ·Á̤ÓÔ˜ Èfi˜ Ô˘ Ó· ÚÔÛ‚¿ÏÏÂÈ Î·È ÙÔÓ ¿ÓıÚˆÔ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈÛÙ¿Ù·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ·ÙfiÌˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì Ô˘ÏÂÚÈο. ¶·È‰È·ÙÚÈ΋ 2006;69:78-82

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·80

80

°¤ÓÓËÛË

∏ÏÈΛ· ∂Ì‚fiÏÈÔ

∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ

Hep B1

1 ÌËÓfi˜

2 ÌËÓÒÓ

4 ÌËÓÒÓ

6 ÌËÓÒÓ

Hep B2 (1-2 ‰fiÛÂȘ)

12 ÌËÓÒÓ

15 ÌËÓÒÓ

18 ÌËÓÒÓ

24 ÌËÓÒÓ

4-6 ÂÙÒÓ

11-12 ÂÙÒÓ

13-18 ÂÙÒÓ

Hep B

∏·Ù›Ùȉ·˜ µ (∏ep µ)

¢ÈÊıÂÚ›Ùȉ·˜, ∆ÂÙ¿ÓÔ˘, ∫ÔηÙË (D∆aP)4

Hep B

Hep B

DTaP

DTaP

¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ IPV(IPV)6

IPV

IPV

AÈÌfiÊÈÏÔ˘ Ù‡Ô˘ µ7

Hib

Hib

MËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ C (MCC)8

MCC

MCC

¶Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ (PCV)9

PCV

PCV

Hep B DTaP

Hep B (fiϘ ÔÈ ‰fiÛÂȘ) DTaP

DTaP

IPV Hib

∆d5 (1 ‰fiÛË/10ÂÙ›·)

IPV

Hib MCC PCV (PPV)10

PCV

πÏ·Ú¿˜, ¶·ÚˆÙ›Ùȉ·˜, ∂Ú˘ıÚ¿˜ (MMR)11

MMR

AÓÂÌ¢ÏÔÁÈ¿˜ (Var)12

Var

º˘Ì·Ù›ˆÛ˘ (BCG)13

Mantoux

MMR Var Var (1 ‰fiÛË) (2 ‰fiÛÂȘ) Mantoux13·

Mantoux13‚

BCG ∏·Ù›Ùȉ·˜ A (Hep A)14 °Ú›˘ (πNFL)15

Hep A (2 ‰fiÛÂȘ) π¡FL (ÂÙËÛ›ˆ˜)

∂ÈÎfiÓ· 1. ÃÚÔÓԉȿÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜.

-------- ∆· ÂÌ‚fiÏÈ· οو ·fi ÙË ‰È·ÎÂÎÔÌ̤ÓË ÁÚ·ÌÌ‹ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÂÈÏÂÎÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi (‚Ϥ ÂÂÍËÁ‹ÛÂȘ Ù˘ ∂ÈÎfiÓ·˜ 1) ∂‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ™ÙËÓ ·Ú¤ÓıÂÛË ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ‰fiÛÂȘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ô˘ Á›ÓÔÓÙ·È Û’ ·˘Ùfi ÙÔ Â‡ÚÔ˜ ËÏÈÎÈÒÓ, fiÙ·Ó Â›Ó·È ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›·. ∆Ô Â‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌÔÓÔ‰‡Ó·Ì· ‹ ÔÏ˘‰‡Ó·Ì· (Û˘Ó‰˘·Ṳ̂ӷ) ÂÌ‚fiÏÈ· ‹/Î·È Û˘Ó‰˘·ÛÌfi˜ ÌÔÓÔ‰‡Ó·ÌˆÓ-Û˘Ó‰˘·Ṳ̂ӈÓ. ∂‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ fiÙ·Ó ·˘Ùfi˜ ‰ÂÓ ¤¯ÂÈ ÚÔËÁËı› ηٿ ÙÔ Û˘ÓÈÛÙÒÌÂÓÔ Û¯‹Ì· ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· Î·È ÙȘ ‰fiÛÂȘ (‚Ϥ ÂÂÍËÁ‹ÛÂȘ ¶ÈÓ¿ÎˆÓ 5 Î·È 6).

∂ÂÍËÁ‹ÛÂȘ ÛÙËÓ ∂ÈÎfiÓ· 1 1. HepB = ¡ÂÎÚfi ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ µ. ∏ 1Ë ‰fiÛË ÙÔ‡ HepB ¯ÔÚËÁÂ›Ù·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÌfiÓÔÓ fiÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊÔÚ¤·˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ (HBsAg) ‹ fiÙ·Ó Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊÔÚ¤·˜ ‹ fi¯È. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ·Ó·ÁηÛÙÈο Ë 1Ë ‰fiÛË ÙÔ˘ HepB ¯ÔÚËÁÂ›Ù·È ˆ˜ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ.

2. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë 1Ë ‰fiÛË ¯ÔÚËÁÂ›Ù·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÓÔÏÈο 4 ‰fiÛÂȘ ·ÓÙ› 3 ‰fiÛÂȘ (Ë 2Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· Î·È Ë 3Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2Ô˘ Ì‹Ó·). ∆Ô ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ 1˘ Î·È 2˘ ηıÒ˜ Î·È 2˘ Î·È 3˘ ‰fiÛ˘ Â›Ó·È 4 ‚‰ÔÌ¿‰Â˜. ∆Ô ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ ÚÔÙÂÏÂ˘Ù·›·˜ (3˘) Î·È ÙÂÏÂ˘Ù·›·˜ (4˘) ‰fiÛ˘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Â›Ó·È 8-16 ‚‰ÔÌ¿‰Â˜ Î·È ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 24 ‚‰ÔÌ¿‰ˆÓ (6 ÌËÓÒÓ). ¶ÚÔÛÔ¯‹! ™Â ÂÚ›ÙˆÛË Ô˘ ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ∏·Ù›ÙȉԘ µ ¯ÔÚËÁËı› ˆ˜ Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ, Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ fiÙÈ Ù· Û˘Ó‰˘·Ṳ̂ӷ ÂÌ‚fiÏÈ· ‰ÂÓ ¯ÔÚËÁÔ‡ÓÙ·È ÚÈÓ ·fi ÙËÓ 6Ë Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜. ∂Ô̤ӈ˜, ÙÔ ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· Ô˘ ÌÂÛÔÏ·‚› ·fi ÙË Á¤ÓÓËÛË, Ô˘ ¯ÔÚËÁÂ›Ù·È ÙÔ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Ù˘ ∏·Ù›Ùȉ·˜ µ, Â›Ó·È 6 ‚‰ÔÌ¿‰Â˜ ·ÓÙ› 1 Ì‹Ó·˜. ¶·Ú¿ÏÏËÏ· Ì ÙËÓ 1Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, Û fiÏ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ ÊÔÚ¤ˆÓ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ Î·È Ì¤Û· ÛÙȘ ÚÒÙ˜ 12 ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ¯ÔÚËÁÔ‡ÓÙ·È 0,5 ml ˘ÂÚ¿ÓÔÛ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ÁÈ· Ë·Ù›Ùȉ· µ. ∏ ¤ÓÂÛË Á›ÓÂÙ·È Û ‰È·ÊÔÚÂÙÈÎfi ̤ÚÔ˜ ·’ ·˘Ùfi Ô˘ ¤ÁÈÓ (‹ ı· Á›ÓÂÈ) ÙÔ ÂÌ‚fiÏÈÔ. ŸÏ· Ù· ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ·fi ÌËÙ¤Ú˜ ÊÔÚ›˜ Î·È ‹Ú·Ó ÙÔ ÂÌ‚fiÏÈÔ Î·È ÙËÓ ˘ÂÚ¿ÓÔÛË ·ÓÔÛÔÛÊ·ÈÚ›ÓË Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ÁÈ· ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ (HBsAg) Î·È ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈ-HBs) ÛÙËÓ ËÏÈΛ· ÙˆÓ 9 ¤ˆ˜ 15 ÌËÓÒÓ. ŸÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Â›Ó·È ‹ fi¯È ÊÔÚ¤·˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ ηٿ ÙÔÓ ÙÔÎÂÙfi Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ô‰ÂȯÙ› fiÙÈ ‰ÂÓ Â›Ó·È, ·fi ÙË 2Ë ‰fiÛË Î·È ¤Ú· ·ÎÔÏÔ˘ıÂ›Ù·È ÙÔ Û¯‹Ì· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ÈÛ¯‡ÂÈ ÁÈ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ‰ÂÓ Â›Ó·È ÊÔÚ›˜ ÙÔ˘ HbsAg, ‰ËÏ·‰‹ ·ÁÓÔÂ›Ù·È Ë 1Ë ‰fiÛË.

3. ŸÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ·ÚÓËÙÈ΋ ÁÈ· ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ, Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ 3 ‰fiÛÂȘ (‰‡Ô ·Ú¯ÈΤ˜ Ì ÌÂÛԉȿÛÙËÌ· 6-8 ‚‰ÔÌ¿‰ˆÓ Î·È ÌÈ· ÙÚ›ÙË Û ËÏÈΛ· 6-18 ÌËÓÒÓ Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· ·fi ÙË 2Ë ‰fiÛË 8-16 ‚‰ÔÌ¿‰Â˜ Î·È fi¯È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ). ¶·È‰È·ÙÚÈ΋ 2006;69:78-82

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·81

81

∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ

4. DTaP= ¡ÂÎÚfi ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘, ÎÔηÙË Ô˘ ÂÚȤ¯ÂÈ Ù· ÙÔÍÔÂȉ‹ (‹ ·Ó·ÙÔ͛Ә ‰ËÏ. ·ÙÔÍÈΤ˜ ÙÔ͛Ә) ÙÔ˘ ÎÔÚ˘ÓÔ‚·ÎÙËÚȉ›Ô˘ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È ÌfiÓÔ ·ÓÙÈÁfiÓ· Ù˘ µ. pertussis (fi¯È ÔÏfiÎÏËÚÔ ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi ÓÂÎÚfi, fiˆ˜ Ù· ·Ï·ÈfiÙÂÚ· “ÔÏÔ΢ÙÙ·ÚÈο” ÂÌ‚fiÏÈ·) ÁÈ’ ·˘Ùfi Î·È Î·ÏÂ›Ù·È “·Î˘ÙÙ·ÚÈÎfi” ηٿ ÙÔ˘ ÎÔηÙË (acellular perstussis ‹ ·P) ÂÌ‚fiÏÈÔ.

5. Td= ¡ÂÎÚfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ Ì ÌÈÎÚfiÙÂÚË ‰fiÛË ‰ÈÊıÂÚÈÙÈ΋˜ ·Ó·ÙÔ͛Ӣ. ™˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ Î·È ¿Óˆ (·Ó¿ 10ÂÙ›·) Î·È ·ÊÔ‡ ¤¯Ô˘Ó ÂÚ¿ÛÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 ¯ÚfiÓÈ· ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ DTaP. ∆Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 65 ÂÙÒÓ, fiˆ˜ ÚԂϤÂÙ·È ·fi ÙË Û¯ÂÙÈ΋ ˘ÁÂÈÔÓÔÌÈ΋ ‰È¿Ù·ÍË.

6. IPV= ∂Ó¤ÛÈÌÔ ÓÂÎÚfi ÂÓÈÛ¯˘Ì¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜.

7. Hib= ¡ÂÎÚfi Û˘˙¢Á̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘ Ù‡Ô˘ ‚. ∂¿Ó Ë ÚˆÙ½ÓË Û‡˙¢Í˘ Â›Ó·È Ë PRP - OMP (ÚˆÙÂ˚ÓÈÎfi Û‡ÌÏÂÁÌ· Ù˘ Â͈ÙÂÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘) ÙfiÙÂ Ë 3Ë ·fi ÙȘ 3 ·Ú¯ÈΤ˜ ‰fiÛÂȘ ÌÔÚ› Ó· ·Ú·ÏËÊı› Î·È ÙÔ Û¯‹Ì· Ó· Â›Ó·È (2Ô˜, 4Ô˜ Î·È 12Ô˜-15Ô˜ Ì‹Ó·˜).

8. MCC= ¡ÂÎÚfi, Û˘˙¢Á̤ÓÔ, ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÔÚÔÔÌ¿‰·˜ C. ™˘ÓÈÛÙ¿Ù·È Ë ¤Ó·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ËÏÈΛ· 2 ÌËÓÒÓ Î·È ·ÎÔÏÔ˘ıÂ›Ù·È Û¯‹Ì· 3 ‰fiÛÂˆÓ - ÔÈ 2 ÚÒÙ˜ ‰fiÛÂȘ Ì ÌÂÛԉȿÛÙËÌ· 2 ÌËÓÒÓ Î·È Â·Ó·ÏËÙÈ΋ ‰fiÛË Û ËÏÈΛ· 15-18 ÌËÓÒÓ. ™Â ÂÚ›ÙˆÛË ¤Ó·Ú͢ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ËÏÈΛ· >12 ÌËÓÒÓ, ·ÎÔÏÔ˘ıÂ›Ù·È Û¯‹Ì· 1 ‰fiÛ˘.

9. PCV= ¡ÂÎÚfi, Û˘˙¢Á̤ÓÔ, ÔÏ˘Û·Î¯·ÚȉÈÎfi, ÂÙ·‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ Ù˘ Ó¢ÌÔÓ›·˜ (Ó¢ÌÔÓÈfiÎÔÎÎÔ˘). ™˘ÓÈÛÙ¿Ù·È Û fiÏ· Ù· ·È‰È¿ ËÏÈΛ·˜ 2-23 ÌËÓÒÓ. ∏ ÙÂÏÂ˘Ù·›· ‰fiÛË (4Ë) Á›ÓÂÙ·È Û ËÏÈΛ· ≥12 ÌËÓÒÓ. ∆Ô ÂÌ‚fiÏÈÔ ÌÔÚ› Ó· Á›ÓÂÈ Î·È Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Î·È È‰È·›ÙÂÚ· Û ¿ÙÔÌ· Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (‚Ϥ ˘ÔÛËÌÂÈÒÛÂȘ 6,7 ÛÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙËÓ ‚ÚÂÊÈ΋ ËÏÈΛ·, ¶›Ó·Î˜ 5 Î·È 6). ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË, ÔÈ Â·Ó·ÏËÙÈΤ˜ ‰fiÛÂȘ ÌÔÚ› Ó· Á›ÓÔÓÙ·È Î·È Ì ÙÔ 23‰‡Ó·ÌÔ ÔÏ˘Û·Î¯·ÚȉÈÎfi ÌË Û˘˙¢Á̤ÓÔ ÂÌ‚fiÏÈÔ (PPV).

10. PPV= ¡ÂÎÚfi, ÌË Û˘˙¢Á̤ÓÔ, ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ (23‰‡Ó·ÌÔ) ηٿ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ Ù˘ Ó¢ÌÔÓ›·˜ (Ó¢ÌÔÓÈÔÎfiÎÎÔ˘). ™˘ÓÈÛÙ¿Ù·È ÁÈ· Â·Ó·ÏËÙÈΤ˜ ‰fiÛÂȘ Û ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÔ‚·Ú‹ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ Ïԛ̈ÍË (¶›Ó·Î·˜ 1).

11. MMR= ∑ˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÈÏ·Ú¿˜, ·ÚˆÙ›Ùȉ·˜, ÂÚ˘ıÚ¿˜. ÃÔÚËÁÂ›Ù·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-15 ÌËÓÒÓ. ™˘ÓÈÛÙ¿Ù·È 2Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-6 ÂÙÒÓ ·ÏÏ¿ Î·È Û ÔÔÈ·‰‹ÔÙ ¿ÏÏË ËÏÈΛ· ·Ó ÁÈ· οÔÈÔ ÏfiÁÔ ·Ú·ÏËÊı› Ë ‰fiÛË ·˘Ù‹ ÛÙËÓ ÚÔÙÂÈÓfiÌÂÓË ËÏÈΛ· ÙˆÓ 4-6 ÂÙÒÓ. √ ·È‰›·ÙÚÔ˜ Ú¤ÂÈ Ó· ÂϤÁ¯ÂÈ ·Ó ¤ÁÈÓ ‹ fi¯È Ë 2Ë ‰fiÛË ÛÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ı· Á›ÓÂÈ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÙÔ˘ Î¿Ï˘„˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ.

12. Var= ZˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. ™˘ÓÈÛÙ¿Ù·È Û fiÏ· Ù· ·È‰È¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-18 ÌËÓÒÓ Û ̛· ‰fiÛË (ηٿ ÚÔÙ›ÌËÛË ÌÂÙ¿ ÙÔ 15Ô Ì‹Ó·), ·ÏÏ¿ Î·È Û ÔÔÈ·‰‹ÔÙ ¿ÏÏË ËÏÈΛ· ÂÊfiÛÔÓ ÙÔ ¿ÙÔÌÔ ‰ÂÓ ¤¯ÂÈ ÓÔÛ‹ÛÂÈ. ∂¿Ó Á›ÓÂÈ Û ËÏÈΛ· ≥12 ÂÙÒÓ ÙfiÙ Ú¤ÂÈ Ó· Á›ÓÔ˘Ó 2 ‰fiÛÂȘ Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 48 ‚‰ÔÌ¿‰ˆÓ.

13. BCG= ∑ˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ê˘Ì·Ù›ˆÛ˘. ™‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù˜ Ô‰ËÁ›Â˜ Ù˘ ¢ÈÂıÓÔ‡˜ ŒÓˆÛ˘ ηٿ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Î·È Ù˘ ¶·ÁÎfiÛÌÈ·˜ √ÚÁ¿ÓˆÛ˘ ÀÁ›·˜(10), Ë ¯ÒÚ· Ì·˜ ‰ÂÓ ÏËÚÔ› ÙȘ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ·ÓÙÈÊ˘Ì·ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡, Ô ÔÔ›Ô˜ ÂÍ·ÎÔÏÔ˘ı› Ó· Á›ÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ. π‰È·›ÙÂÚË ¤ÌÊ·ÛË Ú¤ÂÈ Ó· ‰Ôı› ΢ڛˆ˜ ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙȘ ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2). ¶·Ú¿ÏÏËÏ·, Û˘ÓÈÛÙ¿Ù·È Ì·˙ÈÎfi˜ ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ÛÙȘ ËÏÈ˘ 1, 4-6 ÂÙÒÓ (ÚÈÓ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ì BCG, 13·) Î·È ÛÙ· ·ÓÂÌ‚ÔÏ›·ÛÙ· ·È‰È¿, ÛÙËÓ ËÏÈΛ· 11-12 ÂÙÒÓ (fiÙ·Ó Á›ÓÂÙ·È Ë ÂÎÙ›ÌËÛË Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÙÔ˘˜ Î¿Ï˘„˘, 13‚).

14. Hep A= ¡ÂÎÚfi (·‰Ú·ÓÔÔÈË̤ÓÔ) ÔÏÔ΢ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ ∞. ÃÔÚËÁÂ›Ù·È Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ· ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Û 2 ‰fiÛÂȘ, Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 6 ÌËÓÒÓ, Û ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ë·Ù›Ùȉ· ∞ (¶›Ó·Î·˜ 3).

15. INFL= ¡ÂÎÚfi (·‰Ú·ÓÔÔÈË̤ÓÔ) ÔÏÔ΢ÙÙ·ÚÈÎfi ‹ ·Î˘ÙÙ·ÚÈÎfi (ÙÌËÌ·ÙÈÎfi) ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÁÚ›˘ Ô˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÂÙËÛ›ˆ˜, Û 1 ‰fiÛË Î·È Û ËÏÈΛ· ¿Óˆ ·fi 6 Ì‹Ó˜. ∂Ӊ›ÎÓ˘Ù·È ÌfiÓÔ ÛÙ· ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Ó· ÓÔÛ‹ÛÔ˘Ó ÛÔ‚·Ú¿ ·fi ÁÚ›Ë (¶›Ó·Î·˜ 4). ¶·È‰È¿ οو ÙˆÓ 8 ÂÙÒÓ Ô˘ ı· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ı· ¿ÚÔ˘Ó 2 ‰fiÛÂȘ ÂÌ‚ÔÏ›Ô˘ (0,25 ml <3 ÂÙÒÓ Î·È 0,5 ml ≥3 ÂÙÒÓ) Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 4 ‚‰ÔÌ¿‰ˆÓ. ∂›Û˘, Û˘ÓÈÛÙ¿Ù·È ÂÙ‹ÛÈÔ˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ Î·È ÙˆÓ ·ÙfiÌˆÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘, ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜. ™Â ÂÚ›ÙˆÛË ·ÏÏ·Á‹˜ ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ Û˘ÓıËÎÒÓ (.¯. ÂȉËÌ›·, ·Ó‰ËÌ›·) ÔÈ Û˘ÛÙ¿ÛÂȘ ·ÏÏ¿˙Ô˘Ó.

ŸÏ· Ù· ·È‰È¿ Ú¤ÂÈ Ó· ÂÈÛΤÙÔÓÙ·È ÙÔÓ ÁÈ·ÙÚfi ÙÔ˘˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ (Ù¤ÏÔ˜ ‰ËÌÔÙÈÎÔ‡, ¤Ó·ÚÍË ÊÔ›ÙËÛ˘ ÛÙÔ Á˘ÌÓ¿ÛÈÔ), ÒÛÙ ӷ Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÙÔ˘˜ Î¿Ï˘„˘ Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÛÙËÓ ÂȉÈ΋ ÛÂÏ›‰· ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‚È‚ÏÈ·Ú›Ô˘ ˘Á›·˜.

∫¿ı ÛÔ‚·Ú‹ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ô˘ ÂÈÛËÌ·›ÓÂÈ Ô ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È ÛÙÔÓ ∂√º (Ó· Û˘ÌÏËÚÒÓÂÙ·È Ë Î›ÙÚÈÓË Î¿ÚÙ·). ™ÙÔ˘˜ ¶›Ó·Î˜ 5 Î·È 6 Û˘ÓÔ„›˙ÂÙ·È ÙÔ ¯ÚÔÓԉȿÁÚ·ÌÌ· ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· Ù· ·È‰È¿ Ô˘ ηı˘ÛÙ¤ÚËÛ·Ó Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó. ¶·È‰È·ÙÚÈ΋ 2006;69:78-82

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·82

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∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ

¶›Ó·Î·˜ 5. ¶ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ ËÏÈΛ·˜ ̤¯ÚÈ 6 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙË Û˘ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ËÏÈΛ· ∂Ì‚fiÏÈÔ

1Ë ‰fiÛË ËÌ/Ó›·

∏·Ù›Ùȉ·˜ µ (Hep B) ¢ÈÊıÂÚ›Ùȉ·˜, ∆ÂÙ¿ÓÔ˘, ∫ÔηÙË (D∆aP) ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ IPV3 ∞ÈÌfiÊÈÏÔ˘ Ù‡Ô˘ ‚ (Hib)4 ªËÓÈÁÁÈÙȉÔÎfiÎÎÔ˘ C (MCC)5 ¶Ó¢ÌÔÓÈoÎfiÎÎÔ˘ (7‰‡Ó·ÌÔ) (PCV)6 πÏ·Ú¿˜, ¶·ÚˆÙ›Ùȉ·˜, ∂Ú˘ıÚ¿˜ (MMR) ∞ÓÂÌ¢ÏÔÁÈ¿˜ (Var)9 º˘Ì·Ù›ˆÛ˘ (BCG)10 º˘Ì·ÙÈÓ·ÓÙ›‰Ú·ÛË11 (Mantoux) ∏·Ù›Ùȉ·˜ ∞ (Hep ∞) °Ú›˘ (INFL)

2Ë ‰fiÛË 3Ë ‰fiÛË 1Ë-2Ë ËÌ/Ó›· 2Ë-3Ë ËÌ/Ó›· ‰fiÛË1 ‰fiÛË1 4 ‚‰.

3 ÌËÓÒÓ 4 ‚‰.

4 ‚‰.

4Ë ‰fiÛË 3Ë-4Ë ËÌ/Ó›· ‰fiÛË1

5Ë ‰fiÛË 4Ë-5Ë ËÌ/Ó›· ‰fiÛË1

6 ÌËÓ.

6 ÌËÓ.2

4 ‚‰.

4 ‚‰.

4 ‚‰.

4 ‚‰.

4 ‚‰.

4 ‚‰.

4 ‚‰.

8 ‚‰.

8 ‚‰.

4 ‚‰.

4 ‚‰.

8 ‚‰.7

4 ‚‰.8

6 ÌËÓ.

4 ‚‰.12

¶›Ó·Î·˜ 6. ¶ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 7-18 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙËÓ Û˘ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ËÏÈΛ· ∂Ì‚fiÏÈÔ

∏·Ù›Ùȉ·˜ µ (Hep B) ¢ÈÊıÂÚ›Ùȉ·˜, ∆ÂÙ¿ÓÔ˘ (Td) ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ IPV ªËÓÈÁÁÈÙȉÔÎfiÎÎÔ˘ C (MCC) πÏ·Ú¿˜, ¶·ÚˆÙ›Ùȉ·˜, ∂Ú˘ıÚ¿˜ (MMR) ∞ÓÂÌ¢ÏÔÁÈ¿˜ (Var) ∏·Ù›Ùȉ·˜ ∞ (Hep ∞) °Ú›˘ (INFL)

1Ë ‰fiÛË ËÌ/Ó›·

2Ë ‰fiÛË 1Ë-2Ë ËÌ/Ó›· ‰fiÛË1

3Ë ‰fiÛË 2Ë-3Ë ËÌ/Ó›· ‰fiÛË1

4Ë ‰fiÛË 3Ë-4Ë ËÌ/Ó›· ‰fiÛË1

4 ‚‰.

4 ‚‰.

4 ‚‰.

3 ÌËÓ.

6 ÌËÓ.

4 ‚‰.

6 ÌËÓ.

6 ÌËÓ.

4 ‚‰.

4 ‚‰.

6 ÌËÓ.

ÀÔÛËÌÂÈÒÛÂȘ Î·È ÂÂÍËÁ‹ÛÂȘ ÙˆÓ ¶ÈÓ¿ÎˆÓ 5 Î·È 6 1. ÃÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ‰fiÛË.

2. ∏ 5Ë ‰fiÛË ÌÔÚ› Ó· ·Ú·ÏËÊı› fiÙ·Ó Ë 4Ë Á›ÓÂÈ ÌÂÙ¿ ÙÔ 4Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Û˘Ó¯›˙ÂÙ·È Ì Td (µÏ¤ ÂÂÍ‹ÁËÛË 5 ÛÙËÓ ∂ÈÎfiÓ· 1).

3. ÃÔÚËÁÔ‡ÓÙ·È 4 ‰fiÛÂȘ IPV. ∆Ô ÂÌ‚fiÏÈÔ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÁÈ· ¿ÙÔÌ· ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 18 ÂÙÒÓ.

4. °›ÓÂÙ·È Û 2 ‰fiÛÂȘ Û ¿ÙÔÌ· ≤12 ÌËÓÒÓ ‹ Û 1 ‰fiÛË ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿. ∂¿Ó Á›ÓÂÈ Î¿Ï˘„Ë ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ì 2 ‰fiÛÂȘ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 12 ÌËÓÒÓ ÙfiÙ Á›ÓÂÙ·È, ÌÂÙ¿ ÙÔ 1Ô ¤ÙÔ˜, Î·È Ì›· Â·Ó·ÏËÙÈ΋ ‰fiÛË. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘, Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 5 ÂÙÒÓ.

5. ∂¿Ó Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Û ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 12 ÌËÓÒÓ, ¯ÔÚËÁÂ›Ù·È Ì›· ÌfiÓÔ ‰fiÛË MCC. ∂¿Ó ÔÈ ÚÒÙ˜ 2 ‰fiÛÂȘ ¤ÁÈÓ·Ó Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 12 ÌËÓÒÓ Á›ÓÂÙ·È Ì›· 3Ë ‰fiÛË.

6, 7. ∂¿Ó Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 7 ÌËÓÒÓ ¯ÔÚËÁÔ‡ÓÙ·È 4 ‰fiÛÂȘ ÙÔ˘ PCV ηٿ ÙÔ Û¯‹Ì· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1 (Ë 4Ë ‰fiÛË Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÌËÓÒÓ). ∂¿Ó Ë ¤Ó·ÚÍË Á›ÓÂÈ ÌÂٷ͇ 12Ô˘ Î·È 23Ô˘ Ì‹Ó· ¯ÔÚËÁÔ‡ÓÙ·È 2 ‰fiÛÂȘ Ì ÌÂÛԉȿÛÙËÌ· 6-8 ‚‰ÔÌ¿‰Â˜. ∂¿Ó Ë ¤Ó·ÚÍË Á›ÓÂÈ ·fi ÙÔÓ 24Ô Ì‹Ó· Î·È ÌÂÙ¿, ÛÙ· ˘ÁÈ‹ ·È‰È¿ ¯ÔÚËÁÂ›Ù·È Ì›· ÌfiÓÔ ‰fiÛË. ™Ù· ·ÓÔÛÔηٷÛÙ·Ï̤ӷ Î·È Û ·˘Ù¿ Ô˘ ·Ó‹ÎÔ˘Ó ÁÂÓÈο ÛÙȘ ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ó¢ÌÔÓÈÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ (¶›Ó·Î·˜ 1) ¯ÔÚËÁÔ‡ÓÙ·È 2 ‰fiÛÂȘ Ì ÌÂÛԉȿÛÙËÌ· 6-8 ‚‰ÔÌ¿‰Â˜.

8. ∏ 2Ë ‰fiÛË ÙÔ˘ MMR Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-6 ÂÙÒÓ. ∂¿Ó fï˜, Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Û ·˘Ù‹ ÙËÓ ËÏÈΛ·, Ë 2Ë ‰fiÛË ÌÔÚ› Ó· Á›ÓÂÈ Û‡ÓÙÔÌ· Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 4 ‚‰ÔÌ¿‰Â˜.

9. ŸÙ·Ó Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Á›ÓÂÈ Û ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 12 ÂÙÒÓ Û˘ÓÈÛÙÒÓÙ·È 2 ‰fiÛÂȘ (‚Ϥ ÂÂÍ‹ÁËÛË 13 ÛÙËÓ ∂ÈÎfiÓ· 1).

10, 11. µÏ¤ ÂÂÍ‹ÁËÛË 14 ÛÙËÓ ∂ÈÎfiÓ· 1.

12. µÏ¤ ÂÂÍ‹ÁËÛË 16 ÛÙËÓ ∂ÈÎfiÓ· 1. ¶·È‰È·ÙÚÈ΋ 2006;69:78-82

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AÓ·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÎÔηÙË: Ù· Ó¤· ‰Â‰Ô̤ӷ °. ∆ÛfiÏ·˜

¶ÂÚ›ÏË„Ë: ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ηٷÁÚ¿ÊÂÙ·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË ÙfiÛÔ ÛÙȘ ∏.¶.∞. fiÛÔ Î·È Û ¿ÏϘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ÛÙȘ Ôԛ˜ ‰ÈÂÓÂÚÁÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ÓfiÛÔ˘ Â› ÛÂÈÚ¿ ÂÙÒÓ. ∫‡ÚÈ· ·ÈÙ›· Ù˘ ·‡ÍËÛ˘ ·˘Ù‹˜ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÓÔÛ›· ÙËÓ ÔÔ›· ·Ú¤¯ÂÈ ÙÔ ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚fiÏÈÔ Êı›ÓÂÈ Ì ÙÔÓ ¯ÚfiÓÔ. ∆Ô‡ÙÔ Ô‰‹ÁËÛ ÛÙË ÛÙ·‰È·Î‹ ÌÂÙ·‚ÔÏ‹ Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙÔ ÁÂÁÔÓfi˜ fiÙÈ, ¤ˆ˜ Û‹ÌÂÚ·, ··ÁÔÚ¢fiÙ·Ó Ë ¯Ú‹ÛË ÙÔ˘ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÌÂÙ¿ ÙÔÓ 7Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ΢ڛˆ˜ ÂÍ·ÈÙ›·˜ Ù˘ Û˘¯ÓfiÙÂÚ˘ ÂΉ‹ÏˆÛ˘ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ·˘Ù‹ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, ÔÈ Ôԛ˜ ›¯·Ó ·Ô‰Ôı› ÛÙÔ ÔÏÔ΢ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ÙÂÏÂ˘Ù·›· 15 ÂÚ›Ô˘ ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÌÂÙ·ÙfiÈÛË Ù˘ ¢·›ÛıËÙ˘ ËÏÈΛ·˜ ·fi ÙËÓ ·È‰È΋ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÂÓÒ ·Ú·Ì¤ÓÂÈ Â›ÓÔÛË Ë ÚÔ Ù˘ ÔÏÔÎÏ‹ÚˆÛ˘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‚ÚÂÊÈ΋ ËÏÈΛ· ÙˆÓ ÚÒÙˆÓ 6 ÌËÓÒÓ. ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ Â›ÓÔÛˆÓ ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô‰‹ÁËÛ ÛÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ‰Â‰Ô̤Ó˘ Ì¿ÏÈÛÙ· Î·È Ù˘ ÎÏÈÓÈ΋˜ Ù˘ ·Ù˘›·˜ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· Ó· ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜ Î·È Ó· ÌÂÙ·‰›‰ÂÙ·È Â˘ÎÔÏfiÙÂÚ· ÛÙ· ‚Ú¤ÊË. ∆· ·Ú·¿Óˆ, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ·ÛÊ¿ÏÂÈ· ÙÔ˘ ·Î˘ÙÙ·ÚÈÎÔ‡ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘, Ô‰‹ÁËÛ·Ó ÛÙËÓ ·Ú·Û΢‹, fiψ˜ ÚÔÛÊ¿Ùˆ˜, ‰‡Ô Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Tdap adult). ∆· ÂÌ‚fiÏÈ· ·˘Ù¿ Ê·›ÓÂÙ·È fiÙÈ Û‡ÓÙÔÌ· ı· ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó ÙÔ ¤ˆ˜ Û‹ÌÂÚ· ÂÊ·ÚÌÔ˙fiÌÂÓÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ ‰ÈÏfi ÂÌ‚fiÏÈÔ (ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜) Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td adult), ÒÛÙ ӷ ηٷÛÙ› ÂÊÈÎÙfi˜ Ô ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÂÓËÏ›ÎˆÓ Î·Ù¿ ÙÔ˘ ÎÔηÙË Ì ÛÎÔfi ÙËÓ ·ÔÊ˘Á‹ ÌÂÙ¿‰ÔÛ˘ Ù˘ Ïԛ̈͢ ·˘Ù‹˜ ÛÙȘ ϤÔÓ Â˘¿ÏˆÙ˜ ÔÌ¿‰Â˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ Î·È ÙËÓ ÙÂÏÈ΋ Ù˘ ÂÎÚ›˙ˆÛË ÛÙÔ ÎÔÓÙÈÓfi ̤ÏÏÔÓ.

∂ÈÌÂÏËÙ‹˜ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶. °. ¡ÔÛÔÎÔÌ›Ԣ ¡›Î·È·˜ ¶ÂÈÚ·È¿ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ AÏÏËÏÔÁÚ·Ê›·: °ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜ ¶¿ÚÓËıÔ˜ 32, ∆.∫.190 13, ™·ÚˆÓ›‰· ∞ÙÙÈ΋˜ E-mail: geotsol@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-09-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-12-2005

§¤ÍÂȘ ÎÏÂȉȿ: ∫ÔÎ·Ù˘, ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜, ·Î˘ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ, Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜-·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Ù‡Ô˘ ÂÓËÏ›ÎÔ˘.

Diphtheria, tetanus and acellular pertussis booster vaccination for adolescents: ∆he new data G. Tsolas

Abstract: The number of cases of pertussis continue to increase in the US and other developed countries, despite high immunization coverage rates of infants and young children. As immunity from the primary childhood immunization series wanes, adolescents and adults become susceptible to infection. A large part of the reported increase is thought to be due to increasing physician recognition of pertussis as a cause of nonspecific, persistent cough in adolescents and adults. The spread of infection by adolescents and adults may also place more vulnerable patients, including babies and young infants, at greater risk. In summer 2005, the US Food and Drug Administration (FDA) approved two new combination tetanus, diphtheria, and acellular pertussis (Tdap) vaccines for booster immunization beyond the primary childhood immunization series. These products are intended to replace the current tetanus-diphtheria (Td) booster given at 11-12 years of age. This new Tdap product provides significant increases in pertussis antibody titers and appears to be well tolerated. It has the potential to provide considerable benefit, both in reducing the frequency of pertussis in adolescents and adults and in minimizing the spread of infection to younger high-risk patient populations.

Paediatric Clinic, “Aghios Panteleimon” General Hospital of Nikea, Piraeus, Greece Correspondence: Georgios Tsolas 32, Parnithos Str. 190 13, Saronida, Attica E-mail: geotsol@otenet.gr Date of submission: 02-09-2005 Date of approval: 14-12-2005

Key words: Pertussis, booster vaccination, acellular vaccine, combination tetanus, diphtheria, acellular pertussis vaccine.

¶·È‰È·ÙÚÈ΋ 2006;69:83-89

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84

°. ∆ÛfiÏ·˜

∂ÈÛ·ÁˆÁ‹ √ ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÎÔηÙË ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÍÈÔÛËÌ›ˆÙË ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙfiÛÔ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ ∞ÌÂÚÈ΋˜, fiÛÔ Î·È Û ¿ÏϘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ÛÙȘ Ôԛ˜ ÂÊ·ÚÌfi˙ÂÙ·È Ô ·ÓÙÈÎÔÎ΢ÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ÙˆÓ ÓË›ˆÓ Â‰Ò Î·È ·ÚÎÂÙ¤˜ ‰ÂηÂٛ˜. ∂ȉÈÎfiÙÂÚ· ÛÙȘ ∏.¶.∞, ÙÔ ¤ÙÔ˜ 2004, ‰ËÏÒıËÎ·Ó ÛÙÔ ∫¤ÓÙÚÔ ∂ϤÁ¯Ô˘ Î·È ¶ÚfiÏ˄˘ ¡ÔÛËÌ¿ÙˆÓ (CDC) 18.957 ÂÚÈÙÒÛÂȘ ÎÔηÙË, ·fi ÙȘ Ôԛ˜ ÔÈ 5.000 ·ÊÔÚÔ‡Û·Ó Û ÂÓËÏ›ÎÔ˘˜ (1-5). √ ·ÚÈıÌfi˜ ·˘Ùfi˜, Èı·Ófiٷٷ, ˘ÔÂÎÙÈÌ¿ ÙËÓ Ú·ÁÌ·ÙÈ΋ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÎÔηÙË, ‰Â‰Ô̤Ó˘ Ù˘ ÎÏÈÓÈ΋˜ ·Ù˘›·˜ Ù˘ Ïԛ̈͢ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ì ·ÔÙ¤ÏÂÛÌ· ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Ó· ÌË ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Î·È Ó· ÌË ‰ËÏÒÓÔÓÙ·È. ∞ÓÙ›ıÂÙ· ÛÙËÓ ∂˘ÚÒË, Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ·Ú·Ì¤ÓÂÈ È‰È·›ÙÂÚ· ˘„ËÏfi˜ Î·È ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ‰¤Î· ¯ÚfiÓÈ· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ (6). ∂Âȉ‹ Ë ·ÓÔÛ›· ÙËÓ ÔÔ›· ·Ú¤¯ÂÈ ÙÔ ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚fiÏÈÔ ÙÔ ÔÔ›Ô ‰ÈÂÓÂÚÁÂ›Ù·È ÛÙË ‚ÚÂÊÈ΋ Î·È ÓËȷ΋ ËÏÈΛ·, Êı›ÓÂÈ Ì ÙÔÓ ¯ÚfiÓÔ Î·È, ¤ˆ˜ Û‹ÌÂÚ· ÙÔ˘Ï¿¯ÈÛÙÔÓ, ··ÁÔÚ‡ÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·È È‰È·›ÙÂÚ· ÙÔ˘ ÔÏÔ΢ÙÙ·ÚÈÎÔ‡ ÌÂÙ¿ ÙÔÓ 7Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ê˘ÛÈ΋ ÓfiÛËÛË ·fi ÎÔηÙË ‰ÂÓ ÚÔÛʤÚÂÈ ÈÛfi‚È· ·ÓÔÛ›·, Ë ÂȉËÌÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÌÂÙ·‚ÏËı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ÙÂÏÂ˘Ù·›· 15 ÂÚ›Ô˘ ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÌÂÙ·ÙfiÈÛË Ù˘ ¢·›ÛıËÙ˘ ËÏÈΛ·˜ ·fi ÙËÓ ·È‰È΋ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÂÓÒ ·Ú·Ì¤ÓÂÈ Â›ÓÔÛË Ë ÓÂÔÁÓÈ΋ Î·È Ë ÚÔ Ù˘ ÔÏÔÎÏ‹ÚˆÛ˘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‚ÚÂÊÈ΋ ËÏÈΛ· ÙˆÓ ÚÒÙˆÓ 6 ÌËÓÒÓ (7-10). ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ Â›ÓÔÛˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙËÓ Â˘ÎÔÏ›· ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘ ·fi ÙÔ˘˜ ηٿ ηÓfiÓ· ·Ù‡ˆ˜ ¿Û¯ÔÓÙ˜ ÂÓËÏ›ÎÔ˘˜ ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Î·È ÌÈÎÚ¿ ‚Ú¤ÊË ·ÔÙÂÏ› ÙË ‚·ÛÈ΋, fi¯È fï˜ Î·È ÙË ÌÔÓ·‰È΋ ·ÈÙ›· Ù˘ ÂÎ Ó¤Ô˘ ·‡ÍËÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ (11). ŒÙÛÈ, Ê·›ÓÂÙ·È fiÙÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚfiÛÊ·ÙË ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË ¤¯ÂÈ ·›ÍÂÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ È·ÙÚÒÓ Ó· ˘ÔÙ‡ÔÓÙ·È ÙË Ïԛ̈ÍË, ·Ú¿ ÙËÓ ¿Ù˘Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Û ·ÓÙ›ıÂÛË Ì fi,ÙÈ Û˘Ó¤‚·ÈÓ ηٿ ÙÔ ÚfiÛÊ·ÙÔ ·ÚÂÏıfiÓ, ηٿ ÙÔ ÔÔ›Ô Ë ¶·È‰È·ÙÚÈ΋ 2006;69:83-89

ıÂÒÚËÛË ÙˆÓ ÂÚÈÛÛÔÙ¤ÚˆÓ È·ÙÚÒÓ ·ıÔÏfiÁˆÓ fiÙÈ Ô ÎÔÎ·Ù˘ ·ÔÙÂÏ› “·È‰È΋ ·Ûı¤ÓÂÈ·” Ô‰ËÁÔ‡Û Û ÛËÌ·ÓÙÈ΋ ˘ԉȿÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙȘ ËÏÈ˘ ¤Ú·Ó Ù˘ ·È‰È΋˜, ÛÙȘ Ôԛ˜ Ô ¿Ù˘Ô˜ ·Ú·ÙÂٷ̤ÓÔ˜ ‚‹¯·˜ ·ԉȉfiÙ·Ó Î·Ù¿ ηÓfiÓ· Û ‚ÚÔÁ¯›Ùȉ·, ÈÁÌÔÚ›Ùȉ· ‹ ¿ÛıÌ·. ™ÙËÓ Î·Ï‡ÙÂÚË ‰È¿ÁÓˆÛË Ì Â·ÎfiÏÔ˘ıÔ ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ïԛ̈͢ Û˘Ó¤‚·Ï Â›Û˘ Î·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ÎÔηÙË Ì ÙË ¯Ú‹ÛË Ù˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ (PCR). ∏ ÌÂÙ·‚ÔÏ‹ ·˘Ù‹ Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ ÙÔ˘ ÎÔηÙË ÂÌÂÚȤ¯ÂÈ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· Ù· ÓÂÔÁÓ¿ Î·È Ù· ÌÈÎÚ¿ ‚Ú¤ÊË ÛÙ· ÔÔ›· Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ Ïԛ̈͢ Â›Ó·È ıÔÚ˘‚҉˘ Î·È Ë Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ÂÈÏÔÎÒÓ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ȉȷ›ÙÂÚ· ·˘ÍË̤ÓË. ∞ÎfiÌË Ì¿ÏÈÛÙ· Î·È ÛÙȘ ÌÂÁ¿Ï˜ ËÏÈ˘, ÂÓ‰¤¯ÂÙ·È Ô ÎÔÎ·Ù˘ Ó· ÚÔ‚¿ÏÂÈ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ Ì ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÂÈÏÔΤ˜ (9,10). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 1,4-7,5% ÙˆÓ ÂÊ‹‚ˆÓ Î·È 3,5-5,7% ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ÎÔηÙË, ¯Ú‹˙Ô˘Ó ÓÔÛËÏ›·˜ (9,10). ∂Í¿ÏÏÔ˘, Û ÌÂϤÙË ÙÔ˘ 2004, ÔÈ Bisgard Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó fiÙÈ ÛÙÔ 75% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÎÔηÙË Û ‚Ú¤ÊË, Ë ËÁ‹ ÌÂÙ¿‰ÔÛ˘ ‹Ù·Ó ÂÓ‹ÏÈÎÔ ¿ÙÔÌÔ, Û˘Ó‹ıˆ˜ ÔÈ ÁÔÓ›˜, Ô ·Ô‡˜ ‹ Ë ÁÈ·ÁÈ¿ (12). ¶ÚÔÎÂÈ̤ÓÔ˘, ÏÔÈfiÓ, Ó· ·ÓÙÈÌÂÙˆÈÛı› ÔÚÈÛÙÈο ÙÔ Úfi‚ÏËÌ· ·˘Ùfi, ηٿ ÙÔ ‰›ÌËÓÔ ª·˝Ô˘-πÔ˘Ó›Ô˘ ÙÔ˘ 2005, Ë ∂ÈÙÚÔ‹ ∆ÚÔÊ›ÌˆÓ Î·È º·ÚÌ¿ÎˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ Ù˘ ∞ÌÂÚÈ΋˜ (Food and Drug AdministrationFDA), ÂÓ¤ÎÚÈÓ ‰È·‰Ô¯Èο ÙË ¯Ú‹ÛË ‰‡Ô Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË (Tdap) ÁÈ· ÙÔÓ ·Ó·ÌÓËÛÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËϛΈÓ. ∆· ‰‡Ô ·˘Ù¿ Ó¤· ÂÌ‚fiÏÈ· ÚÔÔÚ›˙ÔÓÙ·È Ó· ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó ÙÔ ·fi ÂÙÒÓ ÂÊ·ÚÌÔ˙fiÌÂÓÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ Î·È ·ÎÔÏÔ‡ıˆ˜ ·Ó¿ ‰ÂηÂÙ›·, ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td), ÁÓˆÛÙfi ÛÙË ¯ÒÚ· Ì·˜ Ì ÙËÓ ÔÓÔÌ·Û›· D.T.VAX adult (13). ∆· ‰‡Ô Ó¤· ÂÌ‚fiÏÈ·, Ù· ÔÔ›· ÌfiÏȘ ·Ú·Û΢¿ÛıËÎ·Ó ÛÙȘ ∏.¶.∞., Â›Ó·È ÙÔ Boostrix Ù˘ GlaxoSmithKline, ÙÔ ÔÔ›Ô ¤Ï·‚ ÙË Û¯ÂÙÈ΋ ¿‰ÂÈ· ÛÙȘ 3-5-2005 ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ·ÙfiÌˆÓ ËÏÈΛ·˜ 10-18 ÂÙÒÓ (14,15) Î·È ÙÔ Adacel Ù˘ Sanofi Pasteur, ÙÔ ÔÔ›Ô ¤Ï·‚ ¿‰ÂÈ· ΢ÎÏÔÊÔÚ›·˜ ·fi ÙÔ FDA ÛÙȘ 10-62005, ÚÔÎÂÈ̤ÓÔ˘ Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ·ÙfiÌˆÓ ËÏÈΛ·˜ 11-64 ÂÙÒÓ (16).

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·85

85

∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÔ˘ ÎÔηÙË

™˘ÛÙ·ÙÈο ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ∆· ‰‡Ô Ó¤· ÂÌ‚fiÏÈ· ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈÁÔÓÈ΋ ÙÔ˘˜ Û‡ÛÙ·ÛË. ™ÙÔÓ ¶›Ó·Î· 1 ·Ó·ÁÚ¿ÊÂÙ·È Ë ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ Û ÙÔÍ›ÓË ÙÔ˘ ÎÔηÙË (pertussis toxoidPT), ÓËÌ·ÙÔÂȉ‹ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË (filamentous hemagglutinin-FHA), ÂÚÙ·ÎÙ›ÓË (pertactinPRN), ‰ÈÊıÂÚÈÙÈ΋ ÙÔÍ›ÓË (diphtheria toxoid-D), ÙÂÙ·ÓÈ΋ ÙÔÍ›ÓË (tetanus toxoid-T) Î·È ¿ÏÏ· ·ÓÙÈÁÔÓÈο ÛÙÔȯ›·, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· fimbriae 2+3 (FIM) (14-16). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ù· ·Ú·¿Óˆ ·ÓÙÈÁfiÓ· ÂÚȤ¯ÔÓÙ·È ÛÙ· ÂÌ‚fiÏÈ· ·˘Ù¿ ÛÂ Û˘ÁÎÂÓÙÚÒÛÂȘ ÌÈÎÚfiÙÂÚ˜ ·fi Ù· ·ÓÙ›ÛÙÔȯ· ÂÌ‚fiÏÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÔÓ ‚·ÛÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Ô ÔÔ›Ô˜, ˆ˜ ÁÓˆÛÙfiÓ ÔÊ›ÏÂÈ Ó· ¤¯ÂÈ ÔÏÔÎÏËÚˆı› ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ. ™ËÌÂÈÒÓÂÙ·È, Â›Û˘, fiÙÈ ·ÌÊfiÙÂÚ· Ù· ÂÌ‚fiÏÈ· ÂÚȤ¯Ô˘Ó ·ÚÁ›ÏÈÔ. ™ÙÔÓ ¶›Ó·Î· 1 ·Ó·ÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈο Ë Û‡ÛÙ·ÛË ÙˆÓ ‰‡Ô Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ, ÂÓÒ ÛÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Û˘ÁÎÚÈÙÈο Ë Û‡ÛÙ·ÛË ÙÔ˘ ‹‰Ë ΢ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ÛÙË ¯ÒÚ· Ì·˜ ‰ÈÏÔ‡ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (DT VAX adult) Ù˘ Aventis Pasteur MSD ηıÒ˜ Î·È ÙÔ˘ ÙÚÈÏÔ‡ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘, ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË (Infanrix) Ù˘ GlaxoSmithKline, Ì ÙÔ ÔÔ›Ô ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Ù· ‚Ú¤ÊË Î·È Ù· ·È‰È¿ ËÏÈΛ·˜ ¤ˆ˜ 6 ÂÙÒÓ.

¢Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ ∏ ‰Ú·ÛÙÈÎfiÙËÙ· ÙÔ˘ Tdap (Boostrix) ÌÂÏÂÙ‹ıËΠ·fi ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· ÂÙ·ÈÚ›· Ì ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÌÈ·˜ ÔÏ˘ÎÂÓÙÚÈ΋˜, Ù˘¯·ÈÔÔÈË̤Ó˘ ÌÂϤÙ˘ ÛÙËÓ ÔÔ›· ÂÚÈÂÏ‹ÊıËÛ·Ó 2.516 ¤ÊË‚ÔÈ, ËÏÈΛ·˜ 10-18 ÂÙÒÓ, Î·È Û˘ÁÎÚ›¶›Ó·Î·˜ 1. ™‡ÛÙ·ÛË ÙˆÓ Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÂÊ‹‚ˆÓ Î·È ÂÓËÏ›ÎˆÓ ∞ÓÙÈÁfiÓÔ PT (mcg) FHA (mcg) PRN (mcg) FIM (mcg) D (Lf) T (Lf)

Boostrix

Adacel

8 8 2,5 0 2,5 5

2,5 5 3 5 2 5

¶›Ó·Î·˜ 2. ™‡ÛÙ·ÛË ÙÔ˘ ‰ÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ Î·È ÙÔ˘ ÙÚÈÏÔ‡ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘, ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Ô˘ Á›ÓÂÙ·È Û ‚Ú¤ÊË Î·È ·È‰È¿ ¤ˆ˜ 6 ÂÙÒÓ ∞ÓÙÈÁfiÓÔ PT (mcg) D (Lf) T (Lf) PT (mcg) FHA (mcg) PRN (mcg)

DT VAX adult

Infanrix

8 2 10 _ _ _

2,5 7-25 10 25 25 8

ıËΠ̠ÙÔ ·Ú·‰ÔÛÈ·Îfi ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td) (15). ¢È·ÈÛÙÒıËΠ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ Û ۯ¤ÛË Ì ٷ ÚÔ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Â›‰· Ù˘ ٿ͈˜ ÙÔ˘ 94,5% ÁÈ· ÙËÓ ÙÔÍ›ÓË ÙÔ˘ ÎÔηÙË (PT), 95,1% ÁÈ· ÙË ÓËÌ·ÙÔÂȉ‹ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË (FHA) Î·È 95,4% ÁÈ· ÙËÓ ÂÚÙ·ÎÙ›ÓË (PRN). ¢ÂÓ ‰È·ÈÛÙÒıËΠη̛· ‰È·ÊÔÚ¿ ÌÂٷ͇ Tdap Î·È Td fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ÁÈ· ÙÔÓ Ù¤Ù·ÓÔ Î·È ÙË ‰ÈÊıÂÚ›Ùȉ·. ∂ȉÈÎfiÙÂÚ·, ÈηÓÔÔÈËÙÈ΋ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÙÂÙ¿ÓÔ˘ ηٷÁÚ¿ÊËΠÛÙÔ 89,7% fiÛˆÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ Tdap Î·È ÛÙÔ 92,5% ÂÎÂ›ÓˆÓ Ô˘ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ Td. ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ Û¯ÂÙÈο Ì ÙË ‰ÈÊıÂÚ›Ùȉ· ‹Ù·Ó 90,6% Î·È 95,9%. ∆Ô 2004, ÔÈ Van Damme Î·È Burgess ‰ËÌÔÛ›Â˘Û·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ‰‡Ô ÌÂÏÂÙÒÓ Ô˘ ¤ÁÈÓ·Ó ÛÙÔ µ¤ÏÁÈÔ Î·È ÙËÓ ∞˘ÛÙÚ·Ï›· Î·È ·ÊÔÚÔ‡Û·Ó Û ÂÓËÏ›ÎÔ˘˜ ÔÈ ÔÔ›ÔÈ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap (17). ∆Ô 1/3 ÂÚ›Ô˘ ·fi Ù· 824 ¿ÙÔÌ· Ù· ÔÔ›· Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ‰ÂÓ Â›¯Â ·ÓȯÓ‡ÛÈÌÔ Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ PT Î·È Ù˘ PRN ηٿ ÙËÓ Â›ÛÔ‰Ô ÛÙË ÌÂϤÙË. ™Ù· ÌÈÛ¿ ¿ÙÔÌ· ¯ÔÚËÁ‹ıËΠTdap (Boostrix) Î·È ÛÙ· ˘fiÏÔÈ· Td ÌÂ Ù˘¯·›Ô ÙÚfiÔ. ŒÓ·Ó Ì‹Ó· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, 98,7% ÙˆÓ ·ÙfiÌˆÓ Ù˘ ÔÌ¿‰·˜ Tdap ›¯·Ó ÂÙ‡¯ÂÈ ÚÔÛٷ٢ÙÈÎfi Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ PT, FHA Î·È PRN. ∏ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ™˘ÁÎÂÎÚÈ̤ӷ, η٤ÛÙËÛ·Ó ÔÚÔıÂÙÈÎÔ› ¤Ó·ÓÙÈ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ ÙÔ 93% fiÛˆÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap Î·È ÙÔ 93,2% fiÛˆÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ ‰ÈÏfi Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td). ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÔÚÔıÂÙÈÎfiÙËÙ·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Ù¤Ù·ÓÔ ‹Ù·Ó 99,8% (Tdap) Î·È 99,5% (Td). ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Adacel ·ÍÈÔÏÔÁ‹ıËΠ·fi ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· ÂÙ·ÈÚ›· Û ¶·È‰È·ÙÚÈ΋ 2006;69:83-89

Pediatr Mar-Apr 06

18-04-06

16:42

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°. ∆ÛfiÏ·˜

749 ¿ÙÔÌ· ËÏÈΛ·˜ 12-54 ÂÙÒÓ, Û ÙÚÂȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ (16). Ÿˆ˜ ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ¤ÙÛÈ Î·È ÂÓ ÚÔÎÂÈ̤ӈ, ÔÈ ·ÛıÂÓ›˜ ¯ˆÚ›ÛıËÎ·Ó ÛÂ Ù˘¯·›Â˜ ÔÌ¿‰Â˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó Ì Tdap ‹ Td. O Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂÙÚ‹ıËΠ¤Ó·Ó Ì‹Ó· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∞fi Ù· 446 ¿ÙÔÌ· ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÙÔ ÂÌ‚fiÏÈÔ Tdap, Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ ‹Ù·Ó Û fiÏ· >0,1 IU/ml, ÙÔ ‰Â 84% ›¯·Ó Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ >0,1 IU/ml. ∆· Â›‰· ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ÎÔηÙË ‹Ù·Ó ÂÊ¿ÌÈÏÏ· ·˘ÙÒÓ Ô˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È ÌÂÙ¿ ·fi ÙȘ ÙÚÂȘ ‰fiÛÂȘ ÙÔ˘ ‚·ÛÈÎÔ‡ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙ· ‚Ú¤ÊË. ™ÙÔ Ù‡¯Ô˜ Ù˘ 22˘ πÔ˘Ó›Ô˘ 2005 ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ JAMA, ‰ËÌÔÛȇıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÚÔÔÙÈ΋˜, Ù˘¯·ÈÔÔÈË̤Ó˘, ‰ÈÏ‹˜Ù˘ÊÏ‹˜ ÌÂϤÙ˘ ÙˆÓ Pichichero Î·È Û˘Ó, ÛÙËÓ ÔÔ›· ÂȯÂÈÚ‹ıËΠۇÁÎÚÈÛË ÌÂٷ͇ ÙÔ˘ Tdap (Adacel) Î·È ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Td (18). ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 4.480 ¤ÊË‚ÔÈ Î·È ÂÓËÏ›ÎÔ˘˜ (11-64 ÂÙÒÓ) ·fi 39 ÂÚÈÔ¯¤˜ ÙˆÓ ∏.¶.∞. ∞ÌÊfiÙÂÚ· Ù· ÂÌ‚fiÏÈ· ¤Ù˘¯·Ó ÔÚÔÌÂÙ·ÙÚÔ‹ (‰ËÏ·‰‹ Û˘ÁΤÓÙÚˆÛË ·ÓÙÈÛˆÌ¿ÙˆÓ >0,1 IU/ml) Û ÔÛÔÛÙ¿ ·fi 94,1% ¤ˆ˜ 99,8% ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ· Î·È 99,8% ¤ˆ˜ 100% ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙÔÓ Ù¤Ù·ÓÔ. ™Ù· ¿ÙÔÌ· Ù· ÔÔ›· ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ Tdap ÂÈÙ‡¯ıËÎ·Ó Ù›ÙÏÔÈ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ¤ÓÙ ‚·ÛÈÎÒÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ÎÔηÙË, ÂÊ¿ÌÈÏÏÔÈ ·˘ÙÒÓ Ô˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È Î·Ù¿ ÙÔÓ ‚·ÛÈÎfi ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ Î·È ÔÈ ÔÔ›ÔÈ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÚÔÛٷ٢ÙÈÎÔ› ¤Ó·ÓÙÈ Ù˘ Ïԛ̈͢. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. √È Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ Tdap ·Ú¤¯ÂÈ Â·Ú΋ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ¤Ó·ÓÙÈ ÙfiÛÔ ÙÔ˘ ÎÔηÙË fiÛÔ Î·È ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ (18). ∆¤ÏÔ˜, ÔÈ Southern Î·È Û˘Ó. Û˘Ó¤ÎÚÈÓ·Ó ·ÌÊfiÙÂÚ· Ù· ÂÌ‚fiÏÈ· Tdap ·ÏÏ¿ Î·È ÙÔ Td Ì ¤Ó· ÂÈÚ·Ì·ÙÈÎfi ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜, ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Î·È ·‰Ú·ÓÔÔÈË̤ÓÔ˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (TdapIPV) Û 323 ÂÊ‹‚Ô˘˜ ÛÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ (19). ∆· Â›‰· Ù›ÙÏˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÂÙ¿ÓÔ˘ Î·È ‰ÈÊıÂÚ›Ùȉ·˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈÌ· Î·È ÛÙȘ 4 ÔÌ¿‰Â˜ ÙˆÓ ÂÌ‚ÔÏÈ·Ûı¤ÓÙˆÓ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙÔÓ Ì¤ÛÔ ÁˆÌÂÙÚÈÎfi Ù›ÙÏÔ ÙˆÓ ·ÓÙÈÎÔÎ΢ÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰È·ÈÛÙÒıËΠÙfiÛÔ Ì ٷ ‰‡Ô Tdap ÂÌ‚fiÏÈ· fiÛÔ Î·È Ì ÙÔ ÂÈÚ·Ì·ÙÈÎfi Tdap-IPV. ¢ÂÓ ‰È·ÈÛÙÒıËΠԢ¶·È‰È·ÙÚÈ΋ 2006;69:83-89

ÛÈ·ÛÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÌÂٷ͇ ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÔÌ¿‰ˆÓ. √È Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ù· ‰‡Ô Ó¤· Tdap ÂÌ‚fiÏÈ· Â›Ó·È ÂÊ¿ÌÈÏÏ· Î·È fiÙÈ Ë ÚÔÛı‹ÎË ÙÔ˘ ·Î˘ÙÙ·ÚÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÙÔ˘ ÎÔηÙË ÛÙÔ ‰ÈÏfi Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td) ‰ÂÓ ÂËÚ¤·Û ·ÚÓËÙÈο ÙËÓ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜.

∞ÓÙÂӉ›ÍÂȘ Î·È ÚÔÊ˘Ï¿ÍÂȘ ∏ ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Tdap ·ÓÙÂӉ›ÎÓ˘Ù·È Û ¿ÙÔÌ· Ì ÁÓˆÛÙ‹ ˘ÂÚ¢·ÈÛıËÛ›· Û οÔÈÔ ·fi Ù· Û˘ÛÙ·ÙÈο ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ‹ Ì ÈÛÙÔÚÈÎfi ÛÔ‚·Ú‹˜ ·ÓÙ›‰Ú·Û˘ Û ÔÔÈÔ‰‹ÔÙ ¿ÏÏÔ ·ÓÙÈÙÂÙ·ÓÈÎfi, ·ÓÙȉÈÊıÂÚÈÙȉÈÎfi, ·ÓÙÈÎÔÎ΢ÙÈÎfi ‹ ¿ÏÏÔ ÂÌ‚fiÏÈÔ Ì ·ÚfiÌÔÈ· Û‡ÓıÂÛË. ∞ÓÙÂӉ›ÎÓ˘Ù·È, Â›Û˘, Ë ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Û ¿ÙÔÌ· Ì ÈÛÙÔÚÈÎfi ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜, ÂÈÏË„›·˜, ÚÔ˚Ô‡Û·˜ Ó¢ÚÔÏÔÁÈ΋˜ ÓfiÛÔ˘, ηıÒ˜ Î·È fiÙ·Ó ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ÂÍÂÏÈÎÙÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ Ë ÔÔ›· ·Ô‰fiıËΠ۠·Ï·ÈfiÙÂÚÔ ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi (15-16). ∂Âȉ‹ ÙÔ ÒÌ· ÙÔ˘ ÊÈ·Ïȉ›Ô˘ Î·È ÛÙ· ‰‡Ô ÚÔ·Ó·ÊÂÚı¤ÓÙ· ÚÔ˚fiÓÙ· ÂÚȤ¯ÂÈ Ï¿ÛÙÈ¯Ô (latex), ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÎÏËı› ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË Û ¿ÙÔÌ· Ì ˘ÂÚ¢·ÈÛıËÛ›·. ™˘ÓÈÛٿٷÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Ó· ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌË ÂÈÓÂÊÚ›ÓË Î·È Ô ˘fiÏÔÈÔ˜ ·Ó·Áη›Ô˜ ÂÍÔÏÈÛÌfi˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛı› Ù˘¯fiÓ ·Ó·Ê˘Ï·ÎÙÈ΋ ·ÓÙ›‰Ú·ÛË Î·Ù¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Tdap (15-16). ∞ÎfiÌË, ‰ÂÓ Ú¤ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Ì Tdap ·ÛıÂÓ›˜ Ì ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ fiÛˆÓ ¿Û¯Ô˘Ó ·fi ıÚÔÌ‚Ô΢ÙÙÔÂÓ›·, ·ÈÌÔÚÚÔÊÈÏ›· ηıÒ˜ Î·È ·˘ÙÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, ÂÎÙfi˜ ‚‚·›ˆ˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÎÂ›ÓˆÓ Î·Ù¿ ÙȘ Ôԛ˜ Ù· ÔʤÏË ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Â›Ó·È Èı·Ófi Ó· ˘ÂÚÙÂÚÔ‡Ó ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÈÌÔÚÚ·Á›·˜ ηٿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∆· ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ¿ÙÔÌ· ÌÔÚÔ‡Ó Ó· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó, Ë ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË fï˜, ı· Â›Ó·È Èı·Ófiٷٷ ˘ԉ¤ÛÙÂÚË ÙÔ˘ ÚÔÛ‰ÔÎÒÌÂÓÔ˘. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È ÚÔ˜ ÙÔ ·ÚfiÓ Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì Tdap ÙˆÓ ÂÁ·ˆÓ Î·È ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ıËÏ¿˙Ô˘Ó, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯ÂÈ Â·ÚÎÒ˜ ÌÂÏÂÙËı› Ô‡ÙÂ Ë Èı·Ó‹ ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ ÙËÓ Î‡ËÛË, ·ÏÏ¿ Ô‡ÙÂ Î·È Ô ‚·ıÌfi˜ ¤ÎÎÚÈÛ‹˜ ÙÔ˘ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· (15,16).

Pediatr Mar-Apr 06

18-04-06

16:42

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87

∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÔ˘ ÎÔηÙË

∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ∆˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË ÂϤÁ¯Ô˘ ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÙÔ˘ Boostrix Ô˘ ÂÚȤϷ‚ 3.080 ÂÊ‹‚Ô˘˜ ÛÙȘ ∏.¶.∞. (15), ÔÈ ÌÈÛÔ› ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap Î·È ÔÈ ˘fiÏÔÈÔÈ Ì Td, η٤‰ÂÈÍ ÙËÓ ·Ô˘Û›· ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. √È Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚı›Û˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙÔ˘ Tdap ‹Ù·Ó ‹ÈÔ˜ fiÓÔ˜ (75,3%), ÙÔÈ΋ ÂÚ˘ıÚfiÙËÙ· (22,5%) Î·È Ô›‰ËÌ· (21,1%). ∞ӷʤÚıËÎ·Ó Â›Û˘ ˘ÚÂÙfi˜ (13,5%), ÎÂÊ·Ï·ÏÁ›· (43,1%), ÎfiˆÛË (37%) Î·È Á·ÛÙÚÂÓÙÂÚÈο Û˘ÌÙÒÌ·Ù· (26%). ªÂ ÂÍ·›ÚÂÛË ÙÔÓ fiÓÔ ÛÙÔ ÛËÌÂ›Ô ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô ÔÔ›Ô˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚÔ˜ Û ·˘ÙÔ‡˜ Ô˘ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ˘fiÏÔÈˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∞Ó¿ÏÔÁË ÌÂϤÙË Ë ÔÔ›· Û˘Ó¤ÎÚÈÓ ÙÔ Adacel Ì ÙÔ Td ÂÚȤϷ‚ 749 ÂÊ‹‚Ô˘˜ Î·È ÂÓËÏ›ÎÔ˘˜ (16). √È Û˘¯ÓfiÙÂÚ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙÔ˘ Tdap ‹Ù·Ó Ô ÙÔÈÎfi˜ fiÓÔ˜ (88,6%), Ë ÂÚ˘ıÚfiÙËÙ· (11,8%) Î·È ÙÔ Ô›‰ËÌ· (16,7%) ÛÙÔ ÛËÌÂ›Ô Ù˘ ¤ÓÂÛ˘ Î·È ·fi ÙȘ Û˘ÛÙËÌ·ÙÈΤ˜, Ë ÎÂÊ·Ï·ÏÁ›· (38,8%), Ë ÎfiˆÛË (20-30%), Ë Ó·˘Ù›· (14,7%), Ú›ÁÔ˜ ‹ ÊÚ›ÎÈ· (12,5%), ‰È¿ÚÚÔȘ (10%), ˘ÚÂÙfi˜ (9,4%), ‰ÈfiÁΈÛË ·ÚıÚÒÛÂˆÓ (9,1%) Î·È ¤ÌÂÙÔÈ (2,4%). √È ·Ú·¿Óˆ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ Ì ·˘Ù¤˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó Û fiÛÔ˘˜ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Td. ∞Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù· ‰È·ÈÛÙÒıËÎ·Ó Î·È ÛÙË ÌÂϤÙË ÙˆÓ Pichichero Î·È Û˘Ó (18) Ì ÙÔ Tdap Ó· ÚÔηÏ› Û ۯ¤ÛË Ì ÙÔ Td, Û˘¯ÓfiÙÂÚ· ÌfiÓÔ ÙÔÈÎfi fiÓÔ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (rate ratio) 1,10, 95% CI 1,04-1,16)) Î·È ˘ÚÂÙfi (rate ratio 1,85, 95% CI 1,13-3,02). ∞fi ÙË Û˘ÓÂÎÙ›ÌËÛË fiÏˆÓ ÙˆÓ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ Û˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ Â›Ó·È ·ÛʷϤ˜ Ì ÙÔ ÔÛÔÛÙfi ÙˆÓ ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Ó· ÌËÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 2%.

™˘Û΢·Û›· – Û˘ÓÙ‹ÚËÛË – ‰ÔÛÔÏÔÁ›· – ÙÚfiÔ˜ ¯ÔÚ‹ÁËÛ˘ – ÎfiÛÙÔ˜ ∆Ô ÂÌ‚fiÏÈÔ ∆dap ΢ÎÏÔÊÔÚ› ÛÙȘ ∏.¶.∞. Ì ÙȘ ÂÌÔÚÈΤ˜ ÔÓÔ̷ۛ˜ Boostrix Î·È Adacel, Û ÊÈ·Ï›‰È· ¤ÙÔÈÌÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÙˆÓ 0,5 ml. ∏ ÂÌÂÈÚ›· ·fi Ù· ÚÔËÁÔ‡ÌÂÓ· ·Ó¿ÏÔÁ· ÂÌ‚fiÏÈ· Û˘ÓËÁÔÚ› fiÙÈ ·ÚfiÌÔÈ· ı· Â›Ó·È Ë ÌÔÚÊ‹ Ë ÔÔ›· ı· ΢ÎÏÔÊÔÚ‹ÛÂÈ Î·È ÛÙË ¯ÒÚ· Ì·˜.

∆Ô ÂÌ‚fiÏÈÔ Ú¤ÂÈ Ó· ‰È·ÙËÚÂ›Ù·È ÛÙÔ „˘ÁÂ›Ô (2-8ÆC), ÂÓÒ ··ÁÔÚ‡ÂÙ·È Ë Î·Ù¿„˘ÍË. ∆Ô ÂÌ‚fiÏÈÔ ¯ÔÚËÁÂ›Ù·È ÂÓ‰ÔÌ˘˚ÎÒ˜, ηٿ ÚÔÙ›ÌËÛË ÛÙÔÓ ‰ÂÏÙÔÂȉ‹ Ì˘ (15,16). ∆Ô Tdap ı· ‰ÈÂÓÂÚÁÂ›Ù·È ˆ˜ ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÎÔηÙË ÛÙËÓ ËÏÈΛ· ÙˆÓ 11 ¤ˆ˜ 12 ÂÙÒÓ Î·È ·ÎÔÏÔ‡ıˆ˜ οı ‰¤Î· ¯ÚfiÓÈ·. ¶ÚԂϤÂÙ·È, Û˘ÓÂÒ˜, fiÙÈ ı· ·ÓÙÈηٷÛÙ‹ÛÂÈ ÙÔ ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td) ÙÔ ÔÔ›Ô ÂÊ·ÚÌfi˙ÂÙ·È ¤ˆ˜ Û‹ÌÂÚ· Ì ÙÔ ›‰ÈÔ ·ÎÚÈ‚Ò˜ ¯ÚÔÓԉȿÁÚ·ÌÌ·. ∞Í›˙ÂÈ, Ù¤ÏÔ˜, Ó· ·Ó·ÊÂÚı› fiÙÈ ÙÔ Tdap fiˆ˜ ¿ÏψÛÙÂ Î·È ÙÔ Td, ‰ÂÓ Â›Ó·È ÂÌ‚fiÏÈ· ηٿÏÏËÏ· ÁÈ· ÙÔÓ ‚·ÛÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ‚ÚÂÊÒÓ Î·È ÓË›ˆÓ (15,16,20). ∆Ô ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì Tdap Ê·›ÓÂÙ·È fiÙÈ ı· Â›Ó·È ÔÏÏ·Ï¿ÛÈÔ ÙÔ˘ Td. H ÙÈÌ‹ ÛÙȘ ∏.¶.∞. ÙÔ˘ Ó¤Ô˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÂÚ›Ô˘ 35 ¢ÚÒ ($ 44), fiÙ·Ó Ë ÙÈÌ‹ ÙÔ˘ Td (D.T. VAX adult) ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ÌfiÏȘ 1,5 ¢ÚÒ. ∆· ÙÂÏÂ˘Ù·›· ‰‡Ô ¯ÚfiÓÈ· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÌÂϤÙ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÔÈÎÔÓÔÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÂÓËÏ›ÎˆÓ Ì Tdap (21). ™Â ÌÂϤÙË ÙˆÓ Purdy Î·È Û˘Ó ÛÙȘ ∏.¶.∞. ‚Ú¤ıËΠfiÙÈ Ô ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ ÂÊ‹‚ˆÓ (10-19 ÂÙÒÓ) Ì Tdap ·ÓÙ› ÙÔ˘ Td, ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂΉ‹ÏˆÛË 0,4-1,8 ÂηÙÔÌÌ˘Ú›ˆÓ ÂÚÈÙÒÛÂˆÓ ÎÔηÙË Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÍÔÈÎÔÓfiÌËÛË 0,3 ¤ˆ˜ 1,8 ‰ÈÛÂηÙÔÌÌ˘Ú›ˆÓ ‰ÔÏ·Ú›ˆÓ ∏.¶.∞. Û ÌÈ· ‰ÂηÂÙ›· (22). ™Â ·ÚfiÌÔÈ· ÌÂϤÙË ÙˆÓ Iskedjian Î·È Û˘Ó ÛÙÔÓ ∫·Ó·‰¿ (23), ‚Ú¤ıËΠfiÙÈ ·Ú¿ ÙË ÌÈÎÚ‹ Û¯ÂÙÈο ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡, Ù· ÔÈÎÔÓÔÌÈο ÔʤÏË ·fi ÙËÓ ÚfiÏË„Ë ÂÚÈÙÒÛÂˆÓ ÎÔηÙË ı· Â›Ó·È ÔÏÏ·Ï¿ÛÈ·. √È Û˘ÁÁÚ·Ê›˜ ˘ÔÏÔÁ›˙Ô˘Ó fiÙÈ Û ۇÓÔÏÔ 144.000 ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 12 ÂÙÒÓ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ Ontario, Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ·˘ÙÒÓ Ì Tdap ı· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·ÔÙÚÔ‹ ÂΉ‹ÏˆÛ˘ 4.400 ÂÚÈÙÒÛÂˆÓ ÎÔηÙË Ì¤Û· Û ÌÈ· ‰ÂηÂÙ›· Î·È ÛÙËÓ ·ÔÊ˘Á‹ 50 ÂÈÛ·ÁˆÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ™ÙÔ Ù‡¯Ô˜ ª·˝Ô˘ 2005 ÙÔ˘ Pediatric Infectious Disease Journal, ÔÈ Caro Î·È Û˘Ó ÌÂϤÙËÛ·Ó ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Global Pertussis Initiative, ÙË Û¯¤ÛË ÎfiÛÙÔ˘˜-ÔʤÏÔ˘˜ Ë ÔÔ›· ı· ÚÔ·„ÂÈ ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ÂÊ‹‚ˆÓ ÙˆÓ ∏.¶.∞. (24). √È Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Î¿Ï˘„Ë Ì ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ ÙˆÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ 11 ¤ˆ˜ 18 ÂÙÒÓ Û ÔÛÔÛÙfi 80%, ı· Ô‰ËÁ‹ÛÂÈ Û ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË, ηıÒ˜ Î·È ¶·È‰È·ÙÚÈ΋ 2006;69:83-89

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·88

88

°. ∆ÛfiÏ·˜

ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û ·˘ÙfiÓ. ŒÙÛÈ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ı· Û˘Ì‚Ô‡Ó 68.000 ÏÈÁfiÙÂÚ· ÎÚÔ‡ÛÌ·Ù· ÎÔηÙË Î·È ı· ·ÔÊ¢¯ıÔ‡Ó 41 ÙÔ˘Ï¿¯ÈÛÙÔÓ ı¿Ó·ÙÔÈ Ì¤Û· Û ̛· ‰ÂηÂÙ›·. ∆ÔÓ πÔ‡ÏÈÔ 2005, ‰ËÌÔÛȇıËΠÛÙÔ ÂÚÈÔ‰ÈÎfi Pediatrics, Û¯ÂÙÈ΋ Ì ÙÔ ı¤Ì· ÌÂϤÙË ÙˆÓ Lee Î·È Û˘Ó, Ë ÔÔ›· ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙÔ CDC (25). √È ÂÚ¢ÓËÙ¤˜ ˘ÔÏÔÁ›˙Ô˘Ó fiÙÈ Ì ÙËÓ Î·ıȤڈÛË ÙÔ˘ ∆dap ı· ·˘ÍËı› ÌÂÓ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û˘ÁÎÚÈÓfiÌÂÓÔ Ì ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÙÔ˘ Td ηٿ ÙÔ˘Ï¿¯ÈÛÙÔÓ 50%, ‰È·ÈÛÙÒÓÔ˘Ó fï˜, fiÙÈ Ë Î¿Ï˘„Ë Û ÔÛÔÛÙfi 76% ÙˆÓ ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 11 ÂÙÒÓ Ì ÙÔ Tdap, ı· ÚÔÏ¿‚ÂÈ 30.800 ÂÚÈÙÒÛÂȘ ÎÔηÙË. ∆Ô ˘ÔÏÔÁÈ˙fiÌÂÓÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·Ó¤Ú¯ÂÙ·È ÛÙÔ ÔÛfi ÙˆÓ $ 1.100 ÁÈ· οı ÂÚ›ÙˆÛË ÎÔηÙË Ô˘ ÚÔÏ·Ì‚¿ÓÂÙ·È.

™ÙÚ·ÙËÁÈΤ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ú·Ó Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ™Â ÚfiÛÊ·ÙË Û˘Ó‰ڛ·ÛË ÙÔ˘ Global Pertussis Initiative (GPI) Û˘˙ËÙ‹ıËΠÙÔ ı¤Ì· Ù˘ ηχÙÂÚ˘ ‰˘Ó·Ù‹˜ ÛÙÚ·ÙËÁÈ΋˜ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ú·Ó Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ì ÛÙfi¯Ô ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÂÙ‹ÛÈ·˜ Â›ÙˆÛ˘ ÙÔ˘ ÎÔηÙË. √ Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÂÓËϛΈÓ, Ô ÔÔ›Ô˜ ı· Û˘Ó¤‚·Ï ÛËÌ·ÓÙÈο ÛÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Î·È Ù˘ Û˘Ó·ÎfiÏÔ˘ı˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÎÔηÙË ÛÙ· ÌÈÎÚ¿ ·ÓÂÌ‚ÔÏ›·ÛÙ· ‚Ú¤ÊË, Û˘Ó·ÓÙ¿ ÛÔ‚·Ú¤˜ ‰˘ÛÎÔϛ˜ ÏfiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ÎfiÛÙÔ˘˜ ·ÏÏ¿ Î·È Ù˘ ‰˘ÛÎÔÏ›·˜ Â›Ù¢Í˘ ˘„ËÏ‹˜ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘, Ë ÔÔ›· Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ÂÁ¯ÂÈÚ‹Ì·ÙÔ˜. Œ¯Ô˘Ó Â›Û˘ Û˘˙ËÙËı› ÙfiÛÔ Ô ÂÈÏÂÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ Ó¤ˆÓ ÌËÙ¤ÚˆÓ Î·È ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ, fiÛÔ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ Î·È Û¯ÔÏ›ˆÓ, Ú·ÎÙÈΤ˜ fï˜ ÔÈ Ôԛ˜ ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈ ı· ÂËÚ¿ÛÔ˘Ó È‰È·›ÙÂÚ· ÙË ÓÔÛËÚfiÙËÙ·. ∏ Ú·ÎÙÈ΋ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ (11-18 ÂÙÒÓ), ·Ú¿ ÙÔÓ Î›Ó‰˘ÓÔ ÌÂٷΛÓËÛ˘ Ù˘ ̤ÁÈÛÙ˘ Â›ÙˆÛ˘ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ¤Ó·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ‚ÚÂÊÒÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ‚‰ÔÌ¿‰ˆÓ (·ÓÙ› ÙÔ˘ 2Ô˘ ‹ 3Ô˘ Ì‹Ó·), Ê·›ÓÂÙ·È, ÛÙËÓ ·ÚÔ‡Û· ÙÔ˘Ï¿¯ÈÛÙÔÓ Ê¿ÛË, fiÙÈ ·ÔÙÂÏÔ‡Ó ÙȘ ϤÔÓ ÏÔÁÈΤ˜ Ú·ÎÙÈΤ˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ Ù˘ Â›ÙˆÛ˘ Ù˘ Ïԛ̈͢ Î·È Î˘Ú›ˆ˜ ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ÌÂÙ·‰ÔÛ‹˜ Ù˘ ÛÙȘ ϤÔÓ Â˘¿ÏˆÙ˜ ÔÌ¿‰Â˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ (26,27). ¶·È‰È·ÙÚÈ΋ 2006;69:83-89

™˘Ì¤Ú·ÛÌ· ∏ ™˘Ì‚Ô˘Ï¢ÙÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ ÙˆÓ ∏.¶.∞. (Advisory Committee on Immunization Practices) ÛÙË Û˘Ó‰ڛ·Û‹ Ù˘ ÛÙȘ 30 πÔ˘Ó›Ô˘ 2005, ·ÔÊ¿ÛÈÛ ÙËÓ Î·ıȤڈÛË ÙÔ˘ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ÙÔ Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ Tdap ·ÓÙ› ÙÔ˘ ¤ˆ˜ ÙÒÚ· ÂÊ·ÚÌÔ˙fiÌÂÓÔ˘ Td. To ÂÌ‚fiÏÈÔ ·˘Ùfi, Ë ·Ú·Û΢‹ ÙÔ˘ ÔÔ›Ô˘ η٤ÛÙË ÂÊÈÎÙ‹ ÌÂÙ¿ ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ÔÏÔ΢ÙÙ·ÚÈÎÔ‡ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ·Î˘ÙÙ·ÚÈÎfi, Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi, ·ÛʷϤ˜ Î·È ı· Ô‰ËÁ‹ÛÂÈ Èı·Ófiٷٷ, Û ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î·È ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ Î·È Û ·ÓÙ›ÛÙÔÈ¯Ô ÂÚÈÔÚÈÛÌfi Ù˘ ÌÂÙ¿‰ÔÛ‹˜ Ù˘ Û ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ΢ڛˆ˜ ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË. ∂›Ó·È Ôχ Èı·Ófi fiÙÈ ÙÔ ∆dap ı· ηıÈÂÚˆı› Û‡ÓÙÔÌ· Î·È ÛÙË ¯ÒÚ· Ì·˜, ·ÓÙÈηıÈÛÙÒÓÙ·˜ ÙÔ D.T. VAX adult. ∏ ÂÈÙ˘¯›·, fï˜, Ù˘ ÚÔÛ¿ıÂÈ·˜ ÂÚÈÔÚÈÛÌÔ‡ ÙÔ˘ ÎÔηÙË ÛÙȘ ÌÂÁ¿Ï˜ ËÏÈ˘, ··ÈÙ› ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ È·ÙÚÒÓ fiÏˆÓ ÙˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È fi¯È ÌfiÓÔ ÙˆÓ ·È‰È¿ÙÚˆÓ, ȉȷ›ÙÂÚ· ‰Â ÙˆÓ ·ıÔÏfiÁˆÓ ÂÓËÏ›ÎˆÓ ÛÙÔ ı¤Ì· ÙÔ˘ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÙË Û˘ÓÂȉËÙÔÔ›ËÛË ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ‰È·‰Èηۛ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È ÙÔ˘ Â·ÓÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·ÓıÚÒˆÓ ‰ÂÓ ÙÂÏÂÈÒÓÂÈ ÛÙËÓ ËÏÈΛ· ÙˆÓ 18 ÂÙÒÓ, ÔfiÙÂ Î·È ·‡Ô˘Ó Ô˘ÛÈ·ÛÙÈο Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ÙÔÓ ·È‰›·ÙÚÔ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Centers for Disease Control and Prevention. Notifiable diseases/ deaths in selected cities weekly information. MMWR Morb Mortal Wkly Rep 2004;53: 1213-1221.

2. Centers for Disease Control and Prevention. Pertussis United States 1997-2000. MMWR Morb Mortal Wkly Rep 2002;51:73-76.

3. Guris D, Strebel PM, Bardenheier B, Brennan M, Tachdjian R, Finch E et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 19901996. Clin Infect Dis 1999;28:1230-1237.

4. Centers for Disease Control and Prevention. Final: 2003 reports of notifiable diseases. MMWR Morb Mortal Wkly Rep 2004;53:687-696.

5. Tanaka M, Vitek CR, Pascual FB, Bisgard KM, Tate JE, Murphy TV. Trends in pertussis among infants in the United States, 1980-1999. JAMA 2003;290: 2968-2975.

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6. Celentano LP, Massari M, Paramatti D, Salmaso S, Tozzi AE; EUVAC-NET Group. Resurgence of pertussis in Europe. Pediatr Infect Dis J 2005;24(9): 761-765.

7. Rothstein E, Edwards K. Health burden of pertussis in adolescents and adults. Pediatr Infect Dis J 2005; 24 (5 Suppl):S44-S47 8. Davis JP. Clinical and economic effects of pertussis outbreaks. Pediatr Infect Dis J 2005;24 (6 Suppl): S109-S116.

9. Lee GM, Lett S, Schauer S, LeBaron C, Murphy TV, Rusinak D et al; Massachusetts Pertussis Study Group. Societal costs and morbidity of pertussis in adolescents and adults. Clin Infect Dis 2004;39: 1572-1580.

10. De Serres G, Shadmani R, Duval B, Boulianne N, Dery P, Douville Fradet M et al. Morbidity of pertussis in adolescents and adults. J Infect Dis 2000;182:174-179.

11. Schellekens J, von Konig CH, Gardner P. Pertussis sources of infection and routes of transmission in the vaccination era. Pediatr Infect Dis J 2005;24 (5 Suppl):S19-S24.

12. Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004;23:985-989.

13. Pichichero ME, Casey JR. Acellular pertussis vaccines for adolescents. Pediatr Infect Dis J 2005;24 (6 Suppl):S117-S126.

14. Chapman TM, Goa KL. Reduced-antigen combined diphtheria-tetanus-acellular pertussis vaccine (Boostrix). Drugs 2003;63:1407-1413.

15. Boostrix prescribing information. GlaxoSmith Kline, May 2005.

16. Adacel prescribing information. Sanofi Pasteur, June 2005.

17. Van Damme P, Burgess M. Immunogenicity of a combined diphtheria-tetanus-acellular pertussis vaccine in adults. Vaccine 2004;22:305-308.

18. Pichichero ME, Rennels MB, Edwards KM, Blatter MM, Marshall GS, Bologa M et al. Combined tetanus-diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. JAMA 2005;293:3003-3011.

19. Southern J, Andrews N, Burrage M, Miller E. Immunogenicity and reactogenicity of combined acellular pertussis/ tetanus/ low dose diphtheria vaccines given as a booster to UK teenagers. Vaccine 2005;23:3829-3835.

20. Humiston SG, Rosenthal SL. Challenges to vaccinating adolescents: vaccine implementation issues.

Pediatr Infect Dis J 2005;24 (6 Suppl):S134-S140.

21. Hay JW, Ward JI. Economic considerations for pertussis vaccination in adolescents. Pediatr Infect Dis J 2005;24 (6 Suppl):S127-S133.

22. Purdy KW, Hay JW, Botteman MF, et al. Evaluation of strategies for use of acellular pertussis vaccine in adolescents and adults: a cost-benefit analysis. Clin Infect Dis 2004;39:20-28.

23. Iskedjian M, Walker JH, Hemels ME. Economic evaluation of an extended acellular pertussis vaccine programme for adolescents in Ontario, Canada. Vaccine 2004;22:4215-4227.

24. Caro JJ, Getsios D, El-Hadi W, Payne K, O'Brien JA. Pertussis immunization of adolescents in the United States:an economic evaluation. Pediatr Infect Dis J 2005;24:S75-S82.

25. Lee GM, Lebaron C, Murphy TV, Lett S, Schauer S, Lieu TA. Pertussis in adolescents and adults: should we vaccinate? Pediatrics 2005;15:1675-1684.

26. Campins-Marti M, Cheng HK, Forsyth K, Guiso N, Halperin S, Huang LM et al; International Consensus Group on Pertussis Immunisation. Recommendations are needed for adolescent and adult pertussis immunization; rationale and strategies for consideration. Vaccine 2001;20:641-646.

27. 27. Plotkin S. The global pertussis initiative: process overview. Pediatr Infect Dis J 2005;24 (5 Suppl):S7-S9.

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CURRENT ISSUE

∂ÎÙ›ÌËÛË ÎÈÓ‰‡ÓˆÓ Î·È Û¯Â‰È·ÛÌfi˜ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÙÙÈÎfiÓ” AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¢Ô‡ÚÔ˜ ¡˘ÌÊÒÓ 7-9 ∆.∫. 111 46, ∞ı‹Ó· E-mail: costasdouros@freemail.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-03-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-03-2006

∫. ¢Ô‡ÚÔ˜, µ. ∆Û·ÁÚ‹˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘ - ∫·Ú·ı›Ô˘

¶ÂÚ›ÏË„Ë: ∞fi ÙÔ 1988, fiÙ·Ó Ë ¶·ÁÎfiÛÌÈ· ™˘Ó¤Ï¢ÛË ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (WHO) ·ÔÊ¿ÛÈÛ ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÈÔ‡ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ¤¯ÂÈ ÂÈÙ¢¯ı› ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÎÔ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡. √ WHO ¤¯ÂÈ ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙ¿ ÙȘ ÔÏÈÙÈΤ˜ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ı· ¯ÚÂÈ·ÛÙ› Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ÂÎÚ›˙ˆÛ˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ÚÔ¤Ú¯ÂÙ·È ·fi: ·) ÙË Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Î·È ‚) ÙËÓ ·Î·Ù¿ÏÏËÏË ¯Ú‹ÛË ÙˆÓ Ê˘Ï·ÛÛfiÌÂÓˆÓ ·ÔıÂÌ¿ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ. ™Â οı ̛· ·fi ÙȘ ‰‡Ô ·Ú·¿Óˆ ηÙËÁÔڛ˜ ˘¿Ú¯Ô˘Ó ÂÈ̤ÚÔ˘˜ ΛӉ˘ÓÔÈ Ô˘ Ë Ê‡ÛË ÙÔ˘˜ Â›Ó·È ϤÔÓ Û·Ê‹˜, ÂÓÒ Û ÂͤÏÈÍË ‚Ú›ÛÎÔÓÙ·È ÂÚ¢ÓËÙÈΤ˜ ÚÔÛ¿ıÂȘ ÁÈ· ÙoÓ ÏËÚ¤ÛÙÂÚÔ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘˜. ∏ ·ÎÚÈ‚‹˜ ÁÓÒÛË Ù˘ ʇÛ˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ·˘ÙÒÓ ÙˆÓ ÎÈÓ‰‡ÓˆÓ ¤¯ÂÈ È‰È·›ÙÂÚË ·Í›· ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÂÓfi˜ Ï·ÈÛ›Ô˘ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ı· ÂÊ·ÚÌÔÛıÔ‡Ó ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË. ¶¿ÓÙˆ˜, ÙÔ ÂÓ ÏfiÁˆ Ï·›ÛÈÔ ı· Ú¤ÂÈ Ó· ıˆÚËı› ˆ˜ ¤Ó· ‰˘Ó·ÌÈÎfi ÂÚÁ·ÏÂ›Ô Ô˘ ı· ··ÈÙ› Û˘Ó¯‹ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ì ÙËÓ ÂÓۈ̿وÛË ÏËÚÔÊÔÚÈÒÓ Ô˘ ı· ÚÔ·ÙÔ˘Ó ·fi Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜. À¿Ú¯Ô˘Ó Ù¤ÛÛÂÚȘ ¢Ú›˜ Î·È ·ÏÏËÏÔÛ˘Û¯ÂÙÈ˙fiÌÂÓ˜ ηÙËÁÔڛ˜ ÁÈ· ÙȘ Ôԛ˜ ı· Ú¤ÂÈ Ó· ۯ‰ȷÛıÔ‡Ó ÔÏÈÙÈΤ˜: ·) Ë ¿ÌÂÛË ·Ó›¯Ó¢ÛË Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÈÒÓ, ‚) ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È ÔÈ Ì˯·ÓÈÛÌÔ› ·ÓÙ›‰Ú·Û˘, Á) Ë Ê‡Ï·ÍË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÈÒÓ Î·È ‰) Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÚÔ˘Ù›Ó·˜ ÁÈ· ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·. ∏ ‰È·‰Èηۛ· ÙˆÓ ÙÂÏÈÎÒÓ ·ÔÊ¿ÛÂˆÓ ·Ó·Ì¤ÓÂÙ·È Ó· ·Ú¯›ÛÂÈ ÛÙÔ ÂÁÁ‡˜ ̤ÏÏÔÓ. §¤ÍÂȘ ÎÏÂȉȿ: ¶ÔÏÈÔÌ˘ÂÏ›ÙȘ, ÂÎÚ›˙ˆÛË, ‰ËÌfiÛÈ· ˘Á›·.

Polio control after certification: evaluating the risks and planning public health policies 3rd Pediatric Clinic, University of Athens, “Attikon” General University Hospital Correspondence: Konstantinos Douros 7-9 Nymfon Str. 111 46, Athens, Greece E-mail: costasdouros@freemail.gr Date of submission: 21-03-2005 Date of approval: 22-03-2006

K. Douros, B. Tsagris, P. Nikolaidou – Karpathiou

Abstract: Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, considerable progress has been made towards interrupting the transmission of wild poliovirus globally. As the achievement and certification of polio eradication draws near, WHO is evaluating potential postcertification policies. Since the year 2000, it has been realized that the risks of paralytic poliomyelitis in the post-certification era fall into two general categories: those due to the continued use of the oral poliovirus vaccine (OPV) and those due to future improper handling of wild polioviruses. The specific risks within each category have now been defined and further research is under way in order to be quantified properly. The knowledge of nature and magnitude of these risks is of outmost importance in constructing a framework for the evolution of public health policies for the post certification era.

However, this framework must be regarded as a dynamic tool, requiring regular updating as additional information on these risks becomes available. There are four broad (and interrelated) areas for which policies must be designed: detection and notification of circulating polioviruses, biocontainment, vaccine stockpiles and response mechanisms, and routine immunization against polioviruses. The process of final decisions is expected to begin at the near future.

Key words: Poliomyelitis, eradication, public health.

¶·È‰È·ÙÚÈ΋ 2006;69:90-96

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·91

91

ŒÏÂÁ¯Ô˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË

∂ÈÛ·ÁˆÁ‹ ∆Ô 1988, Ë 41Ë ¶·ÁÎfiÛÌÈ· ™˘Ó¤Ï¢ÛË ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (WHO) ·ÔÊ¿ÛÈÛ ÙËÓ ¤Ó·ÚÍË ÌÈ·˜ ·ÁÎfiÛÌÈ·˜ ÂÎÛÙÚ·Ù›·˜ Ì ÛÎÔfi ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ̤¯ÚÈ ÙÔ ¤ÙÔ˜ 2000 (1). ∏ ÚfiÔ‰Ô˜ Ô˘ ¤¯ÂÈ ÂÈÙ¢¯ı› ̤¯ÚÈ Û‹ÌÂÚ· Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÂÙ‹ÛÈ· Â›ÙˆÛË Ù˘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÂÏ·ÙÙÒıËΠ·fi 350.000 ÎÚÔ‡ÛÌ·Ù· ÙÔ 1988 Û ÌfiÏȘ 784 ÙÔ 2003, ÙÚÂȘ ‰Â ·fi ÙȘ ¶ÂÚÈʤÚÂȘ ÙÔ˘ WHO Î·È Û˘ÁÎÂÎÚÈ̤ӷ, Ë ¶ÂÚÈʤÚÂÈ· Ù˘ ∞ÌÂÚÈ΋˜ ÙÔ 1994, Ë ¶ÂÚÈʤÚÂÈ· ÙÔ˘ ¢˘ÙÈÎÔ‡ ∂ÈÚËÓÈÎÔ‡ ÙÔ 2000 Î·È Ë ¶ÂÚÈʤÚÂÈ· Ù˘ ∂˘ÚÒ˘ ÙÔ 2002, ÈÛÙÔÔÈ‹ıËÎ·Ó ÂχıÂÚ˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (2). ∏ ÂÎÚ›˙ˆÛË ·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ÔÏÔÎÏËÚˆı› ÙÔ 2000 Î·È Ô Ó¤Ô˜ ÛÙfi¯Ô˜ Ô˘ Ù¤ıËΠ‹Ù·Ó ÁÈ· ÙÔ 2005. ¢˘ÛÙ˘¯Ò˜, fï˜, ÙÔ 2005 ›¯·Ì 1.802 ηٷÁÂÁÚ·Ì̤ӷ ÎÚÔ‡ÛÌ·Ù· ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Ù· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÔÔ›· ‹Ù·Ó ÂÈÛ·ÁfiÌÂÓ· Û ¯ÒÚ˜ fiÔ˘ ›¯Â ‰È·ÎÔ› Ë ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡. ¶¿ÓÙˆ˜ Ô ¶√À ¤¯ÂÈ ÂÓÙ·ÙÈÎÔÔÈ‹ÛÂÈ ϤÔÓ ÙȘ ÚÔÛ¿ıÂȘ ÒÛÙ ӷ ıˆÚÂ›Ù·È Ôχ Èı·Ófi fiÙÈ Ë ‰È·ÎÔ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ ı· ÂÈÙ¢¯ı› Ù· ÚÔÛ¯‹ 2-3 ¯ÚfiÓÈ· (3). ∆Ë ‰È·ÎÔ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ı· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÙÚ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯ÚfiÓÈ· ÂÓÙ·ÙÈ΋˜ ÂÈÙ‹ÚËÛ˘, ÚÔÙÔ‡ ‰Ôı› Ë ÈÛÙÔÔ›ËÛË Ù˘ ÔÚÈÛÙÈ΋˜ ÂÎÚ›˙ˆÛ˘ Ù˘ ÓfiÛÔ˘ (4,5). ªÂ ‰Â‰Ô̤ÓÔ ÏÔÈfiÓ fiÙÈ Ë ÔÏÈÔÌ˘ÂÏ›Ùȉ· ı· Â›Ó·È ÙÔ ÚÒÙÔ ÏÔÈÌ҉˜ ÓfiÛËÌ· Ô˘ ı· ÂÎÚÈ˙ˆı› ÙÔÓ 21Ô ·ÈÒÓ·, Ë ÚÔÛÔ¯‹ Ù˘ ‰ÈÂıÓÔ‡˜ ÂÈÛÙËÌÔÓÈ΋˜ ÎÔÈÓfiÙËÙ·˜ ¤¯ÂÈ ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÛÙÚ¤ÊÂÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÛÙÚ·ÙËÁÈÎÒÓ Ô˘ ı· ··ÈÙËıÔ‡Ó ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡. ∏ ÂÌÂÈÚ›· Ô˘ ¤¯ÂÈ ·ÔÎÙËı› Û ·˘ÙfiÓ ÙÔÓ ÙÔ̤· ·fi ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ¢ÏÔÁÈ¿˜ Â›Ó·È ÔχÙÈÌË, ˆÛÙfiÛÔ, ‰ÂÓ Â·ÚΛ ·fi ÌfiÓË Ù˘ ÁÈ· Ó· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙ· Ôχ ÈÔ Û‡ÓıÂÙ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·Ó·Î‡ÙÔ˘Ó ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Î·È ¤¯Ô˘Ó Ó· οÓÔ˘Ó Ì ٷ ‰È·ÊÔÚÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙfiÙÂ Î·È ÙÒÚ·, ηıÒ˜ Î·È ÛÙȘ ÁˆÔÏÈÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÙˆÓ ÂÔ¯ÒÓ ÛÙȘ Ôԛ˜ ÔÈ ‰‡Ô ÂÎÛÙÚ·Ù›˜ ÂÎÚ›˙ˆÛ˘ ¤Ï·‚·Ó ¯ÒÚ·. ∏ ·Ú·Î¿Ùˆ Û˘˙‹ÙËÛË ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙËÓ ·ÚÔ˘Û›·ÛË ÙˆÓ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ ÂÏÏÔ¯Â‡Ô˘Ó Î·ıÒ˜ Î·È ÙÔ˘ Ï·ÈÛ›Ô˘ ̤۷ ÛÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÎÈÓÔ‡ÓÙ·È ÔÈ ÛÙÚ·ÙËÁÈΤ˜ ‰ËÌfiÛÈ·˜

˘Á›·˜ Ô˘ ı· ÂÊ·ÚÌÔÛıÔ‡Ó ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘.

∫›Ó‰˘ÓÔÈ Â·ÓÂÌÊ¿ÓÈÛ˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÏfiÁˆ Û˘Ó¯È˙fiÌÂÓ˘ ¯Ú‹Û˘ ÙÔ˘ OPV √È Î›Ó‰˘ÓÔÈ Â·ÓÂÌÊ¿ÓÈÛ˘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ÂÎÚ›˙ˆÛ˘ ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Û ·˘ÙÔ‡˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Î·È Û ·˘ÙÔ‡˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÌË ·ÛÊ·Ï‹ ʇϷÍË ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡. √ ϤÔÓ ÁÓˆÛÙfi˜ ·fi ÙËÓ ÚÒÙË Î·ÙËÁÔÚ›·, Â›Ó·È Ë ÚfiÎÏËÛË ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ·fi ÛÙÂϤ¯Ë ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (Vaccine ∞ssociated Paralytic Poliomyelitis - VAPP) Ô˘ ·¤ÎÙËÛ·Ó Ó¢ÚÔÙÔÍÈÎfiÙËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘˜ ÛÙÔ ¤ÓÙÂÚÔ ÙÔ˘ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ˘ ·ÙfiÌÔ˘. √È ÚÔÂÚ¯fiÌÂÓÔÈ ·fi ÙÔ OPV ÈÔ›, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ¿ÁÚÈÔ˘˜ ÈÔ‡˜, ‰ÂÓ Î˘ÎÏÔÊÔÚÔ‡Ó ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙËÓ ÎÔÈÓfiÙËÙ·. ∞Ó Î·È ¿Óˆ ·fi 30% ÙˆÓ ÂÌ‚ÔÏÈ·˙ÔÌ¤ÓˆÓ ı· ·Ô‚¿ÏÔ˘Ó ÛÙÂϤ¯Ë Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈ· ·‡ÍËÛË Ù˘ Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜, Ë VAPP ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi Ì›· ÂÚ›ÙˆÛË Û οı 750.000 ¤ˆ˜ 1 ÂηÙÔÌ̇ÚÈÔ ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙËÓ ÚÒÙË ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (6,7). ∏ Û˘¯ÓfiÙËÙ· ·˘Ù‹ Â›Ó·È ÛÙ·ıÂÚ‹ Û fiϘ ÙȘ ÂÚÈÔ¯¤˜ fiÔ˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÔ OPV, ¤¯ÂÈ ‰Â ÂÎÙÈÌËı› fiÙÈ 250-500 ÎÚÔ‡ÛÌ·Ù· VAPP Û˘Ì‚·›ÓÔ˘Ó ÂÙËÛ›ˆ˜ Û ·ÁÎfiÛÌÈ· Îϛ̷η. ¢Â‰Ô̤ӷ ·fi ÂÚÈÔ¯¤˜ fiÔ˘ ¤¯ÂÈ ÛÙ·Ì·Ù‹ÛÂÈ Ë Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÈÔ‡ ·ÏÏ¿ Û˘Ó¯›˙ÂÙ·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì OPV ‰Â›¯ÓÔ˘Ó ˆ˜ Ô Î›Ó‰˘ÓÔ˜ VAPP ·Ú·Ì¤ÓÂÈ ·ÌÂÙ¿‚ÏËÙÔ˜ (8). ŒÓ·˜ Û·ÓÈfiÙÂÚÔ˜ ΛӉ˘ÓÔ˜ Ô˘ ÚfiÛÊ·Ù· ¿Ú¯ÈÛ ӷ Á›ÓÂÙ·È Î·Ù·ÓÔËÙfi˜, ÚÔ·ÙÂÈ ÛÙËÓ ÂÚ›ÙˆÛË fiÔ˘, ̤ۈ Ù˘ ÙÚÔÔÔ›ËÛ˘ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡, ·˘Í¿ÓÂÙ·È ÂÎÙfi˜ ·fi ÙË Ó¢ÚÔÙÔÍÈÎfiÙËÙ· Î·È Ë ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ÙˆÓ ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘. √È ÈÔ› ·˘ÙÔ›, ÔÈ ÔÔ›ÔÈ, ·Ó Î·È ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ OPV, ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ù˘ ·Ú·ÙÂٷ̤Ó˘ ΢ÎÏÔÊÔÚ›·˜ (Circulating Vaccine - Derived Polioviruses, cVDPVs), ¤¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈο ¿ÁÚÈˆÓ ÈÒÓ Î·È Â›Ó·È ÈηÓÔ› Ó· ÚÔηϤÛÔ˘Ó ÂȉË̛˜. ¶ÚÔ·ÙÔ˘Ó ·fi ·Ó·Û˘Ó‰˘·ÛÌfi ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ì ÌË oÏÈÔ-ÂÓÙÂÚÔ˚Ô‡˜ (9). ™Â ÏËı˘ÛÌÈ·Îfi Â›‰Ô, fiÏ· Ù· ÎÚÔ‡ÛÌ·Ù· ·fi cVDPVs ¤¯Ô˘Ó ÂÌÊ·ÓÈÛı› Û ÂÚÈÔ¯¤˜ fiÔ˘ Ë ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡ ¶·È‰È·ÙÚÈ΋ 2006;69:90-96

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·92

92

∫. ¢Ô‡ÚÔ˜ Î·È Û˘Ó.

Ô‰‹ÁËÛ Û ÛÙ·‰È·Î‹ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÚÔ˘Ù›Ó·˜ Ì OPV. √È ÂȉË̛˜ Â›Ó·È ·ÚfiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÈÔ‡˜ Ô˘ ÂÈÛ¿ÁÔÓÙ·È ·fi ÂÓ‰ËÌÈΤ˜ Û ÌË ÂÓ‰ËÌÈΤ˜ ¯ÒÚ˜. ∆ÚÂȘ Ù¤ÙÔȘ ÂȉË̛˜ ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ̤¯ÚÈ ÛÙÈÁÌ‹˜. ∏ ÚÒÙË Î·Ù·ÁÚ¿ÊËΠÙÔ 2000 Û ¤Ó· ÓËÛ› Ù˘ ∫·Ú·˚‚È΋˜, ÙËÓ πÛ·ÓÈfiÏ·, fiÔ˘ 22 ·È‰È¿ ÓfiÛËÛ·Ó ·fi ·Ú·Ï˘ÙÈ΋ ÔÏÈÔÌ˘ÂÏ›Ùȉ· Û ÌÈ· ÂÚ›Ô‰Ô 12 ÌËÓÒÓ (10). ∆Ô ˘‡ı˘ÓÔ Û٤ϯԘ ‹Ù·Ó ¤Ó·˜ Ù‡Ô˘ 1 cVDPV. ∏ ‰Â‡ÙÂÚË ÛËÌÂÈÒıËΠÙÔ 2001 ÛÙȘ ºÈÏÈ›Ó˜, ‰È‹ÚÎÂÛ 4 Ì‹Ó˜, ÔÊÂÈÏfiÙ·Ó Â›Û˘ Û ¤Ó·Ó Ù‡Ô˘ 1 cVDPV Î·È ÚfiÛ‚·Ï 3 ·È‰È¿ (11). ∆Ô 2003 ÌÈ· ÙÚ›ÙË ·ÚfiÌÔÈ· ÌÈÎÚÔÂȉËÌ›· ÔÊÂÈÏfiÌÂÓË Û ¤Ó·Ó Ù‡Ô˘ 2 cVDPV ‰È·ÈÛÙÒıËΠÛÙË ª·‰·Á·ÛοÚË ·Ú·Ï‡ÔÓÙ·˜ 4 ·È‰È¿ Û ÌÈ· ÂÚ›Ô‰Ô ÂÓfi˜ Ì‹Ó· (12). ∫·È ÛÙȘ ÙÚÂȘ ÂÚÈÙÒÛÂȘ Ë ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̷̠˙ÈΤ˜ ÂÌ‚ÔÏÈ·ÛÙÈΤ˜ ÂÎÛÙÚ·Ù›˜ Ì OPV Î·È ‰È·ÎfiËΠÁÚ‹ÁÔÚ·. ∂ÈϤÔÓ, ·Ó·‰ÚÔÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ÁÔÓÈ‰ÈˆÌ¿ÙˆÓ ÈÒÓ ·fi ÙËÓ ∞›Á˘ÙÔ ¤‰ÂÈÍ·Ó fiÙÈ ¤Ó·˜ Ù‡Ô˘ 2 cVDPV ΢ÎÏÔÊÔÚÔ‡Û ÛÙË ¯ÒÚ· ·fi ÙÔ 1988 ¤ˆ˜ Î·È ÙÔ 1993, ¤¯ÔÓÙ·˜ ·Ú·Ï‡ÛÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 32 ·È‰È¿ (13). ∞Ó Î·È Ë ÓfiÛËÛË ·fi cVDPVs Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓ Ôχ ÈÔ Û¿ÓÈ· ·’ fi,ÙÈ Ì VAPP, Ë Â›ÙˆÛ‹ Ù˘ ÛÙÔ Ì¤ÏÏÔÓ ı· ÂÍ·ÚÙËı› ·fi ÙȘ ÂıÓÈΤ˜ Î·È ‰ÈÂıÓ›˜ ÔÏÈÙÈΤ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ı· ÂÈÎÚ·Ù‹ÛÔ˘Ó. ∞Ó ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Û˘Ó¯ÈÛÙ› Ë ¯Ú‹ÛË ÙÔ˘ OPV, Ì ¯·ÌËÏ‹ fï˜ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë, ı· ˘¿ÚÍÂÈ ˆ˜ ¿ÌÂÛË Û˘Ó¤ÂÈ·, ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÂȉËÌÈÒÓ ·fi cVDPVs. √ ÙÚ›ÙÔ˜ ‰˘ÓËÙÈÎfi˜ ΛӉ˘ÓÔ˜ ·fi ÙË Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Â›Ó·È Ë ÂӉ¯fiÌÂÓË ‰È·ÛÔÚ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓ ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ì ·˘ÍË̤ÓË Ó¢ÚÔÙÔÍÈÎfiÙËÙ· ÚÔÂÚ¯fiÌÂÓˆÓ ·fi ¿ÙÔÌ· Ì ·ÓÔÛÔÏÔÁÈ΋ ·ÓÂ¿ÚÎÂÈ· (immunodeficient long term excretors of Vaccine-Derived Polioviruses - iVDPVs). Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ô Èfi˜ ·ÂÎÎÚ›ÓÂÙ·È ÁÈ· 2-6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ì OPV. √È ·Ô‚·ÏÏfiÌÂÓÔÈ ÈÔ› ÌÔÚ› Ó· ÌÂÙ·‰ÔıÔ‡Ó Û ¿ÙÔÌ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜. ∞ÛıÂÓ›˜ Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜ ÌÔÚ› Ó· Á›ÓÔ˘Ó ¯ÚfiÓÈÔÈ ÊÔÚ›˜ Î·È Ó· ·Ô‚¿ÏÔ˘Ó ÁÈ· ÌÂÁ¿Ï· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÙÔÓ Èfi, Ô ÔÔ›Ô˜ Û˘¯Ó¿ ·ÔÎÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ¿ÁÚÈÔ˘ Ù‡Ô˘. £ÂˆÚËÙÈο, Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ ı· ÌÔÚÔ‡Û ӷ Â·ÓÂÈÛ·¯ı› Ô Èfi˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Î·È ÙË ¶·È‰È·ÙÚÈ΋ 2006;69:90-96

‰È·ÎÔ‹ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ. øÛÙfiÛÔ, Ù¤ÙÔÈÔÈ ¯ÚfiÓÈÔÈ ÊÔÚ›˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔÈ, Ì ÌfiÓÔ 19 ¿ÙÔÌ· Ó· ¤¯Ô˘Ó ·ÓȯÓ¢ı› Ù· ÙÂÏÂ˘Ù·›· 40 ¯ÚfiÓÈ· Ù˘ ¢Ú›·˜ ¯Ú‹Û˘ ÙÔ˘ OPV. ∞fi ÙÔ˘˜ 19, ÌfiÓÔ ÔÈ 2 ‚Ú›ÛÎÔÓÙ·È ÂÓ ˙ˆ‹. ∂ÈϤÔÓ, ‰ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› Ô‡Ù ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÌÂÙ¿‰ÔÛË Ô‡Ù ·Ó·Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ·ÂÎÎÚÈÓfiÌÂÓˆÓ ÈÒÓ Ì ¿ÏÏÔ˘˜ ÂÓÙÂÚÔ˚Ô‡˜. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ iVDPVs ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Û ¿ÙÔÌ· Ì ÛÔ‚·Ú¤˜ Û˘ÁÁÂÓ›˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·Ó Ù·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ ÁÈ· Ó· ÂÈ‚ÈÒÛÔ˘Ó. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙȘ ÌÂÓ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ù· ¿ÙÔÌ· ·˘Ù¿ ı· ‹Ù·Ó ·‰‡Ó·ÙÔ Ó· ÂÈ‚ÈÒÛÔ˘Ó ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙȘ ‰Â ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ·Ú·ÙËÚÂ›Ù·È ÌÈ· ÛÙ·‰È·Î‹ ·ÏÏ·Á‹ ÛÙËÓ ÔÏÈÙÈ΋ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ˘ÈÔı¤ÙËÛË ÙÔ˘ πPV, ·Ó·Ì¤ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ iVDPVs. ŒÙÛÈ, ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜ Ë ‰È·ÛÔÚ¿ ‰ÂÓ ıˆÚÂ›Ù·È fiÙÈ ı· ·ÔÙÂϤÛÂÈ Ú·ÁÌ·ÙÈÎfi Úfi‚ÏËÌ· (14).

∫›Ó‰˘ÓÔÈ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÌË ·ÛÊ·Ï‹ ʇϷÍË ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ ŒÓ·˜ ÔÚ·Ùfi˜ ΛӉ˘ÓÔ˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË, ·ÊÔÚ¿ ÛÙËÓ ·ÎÔ‡ÛÈ· ·ÂÏ¢ı¤ÚˆÛË ÛÙÂϯÒÓ ÈÒÓ ·fi ÌÔÓ¿‰Â˜ ·Ú·ÁˆÁ‹˜ ÂÌ‚ÔÏ›ˆÓ (IPV) ‹ ÂÚ¢ÓËÙÈο ÂÚÁ·ÛÙ‹ÚÈ·. ∆¤ÙÔÈ· ÂÚÈÛÙ·ÙÈο ¤¯Ô˘Ó Û˘Ì‚Â› ÂÏ¿¯ÈÛÙ˜ ÊÔÚ¤˜ ÛÙÔ ·ÚÂÏıfiÓ. ªfiÓÔ Ì›· ÂÚ›ÙˆÛË ·ÂÏ¢ı¤ÚˆÛ˘ ÈÔ‡ ·fi ÌÔÓ¿‰· ·Ú·ÁˆÁ‹˜ IPV Â›Ó·È ÁÓˆÛÙ‹ ̤¯ÚÈ Û‹ÌÂÚ·. ∆Ô ÂÂÈÛfi‰ÈÔ Û˘Ó¤‚Ë ÙÔ 1992, fiÙ·Ó ¤Ó· Û٤ϯԘ ·Ó·ÊÔÚ¿˜ ÈÔ‡ Ù‡Ô˘ 1 Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·ÔÌÔÓÒıËΠ·fi ¤Ó· ·È‰› Ì ‰È¿ÚÚÔÈ·. ∏ ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ ¤‰ÂÈÍ fiÙÈ Ô ·Ù¤Ú·˜ ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ˘¿ÏÏËÏÔ˜ ‚ÈÔÌ˯·Ó›·˜ ·Ú·ÁˆÁ‹˜ IPV. ∫ÚÔ‡ÛÌ·Ù· ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÔÊÂÈÏfiÌÂÓ· ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Û٤ϯԘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó (15). ¶ÂÚÈÙÒÛÂȘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÔÊÂÈÏfiÌÂÓ˘ Û ·ÎÔ‡ÛÈ· ·ÂÏ¢ı¤ÚˆÛË ÛÙÂϤ¯Ô˘˜ ·fi ÂÚ¢ÓËÙÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ, ‰ÂÓ ¤¯Ô˘Ó ÙÂÎÌËÚȈı› ̤¯ÚÈ Û‹ÌÂÚ·. ∂ÓÙÔ‡ÙÔȘ, ηٿ Ù· ¤ÙË 2002-2003, ¤Ó· ÂÚÁ·ÛÙËÚÈ·Îfi Û٤ϯԘ ¿ÁÚÈÔ˘ ÈÔ‡ Ù‡Ô˘ 2 ·ÔÌÔÓÒıËΠ·fi 9 Û˘ÓÔÏÈο ·È‰È¿ Ì ·Ú·Ï˘ÙÈ΋ ÔÏÈÔÌ˘ÂÏ›Ùȉ· ÛÙËÓ πÓ‰›·. ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ ˆ˜ ˘‡ı˘ÓÔ ÙÔ MEF-1, ¤Ó· Û˘ÓËıÈṲ̂ÓÔ Û٤ϯԘ ¿ÁÚÈÔ˘ ÈÔ‡ Ù‡Ô˘ 2, Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· Î·È ÛÙȘ

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·93

93

ŒÏÂÁ¯Ô˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË

ÌÔÓ¿‰Â˜ ·Ú·ÁˆÁ‹˜ IPV, Î·È ·Ú’ fiÏÔ Ô˘ Ô ÙÚfiÔ˜ Ù˘ ÌÂÙ¿‰ÔÛ‹˜ ÙÔ˘ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛı› ·ÎfiÌË, ˘¿Ú¯Ô˘Ó οÔÈ· ÛÙÔȯ›· Ô˘ ÂÓÔ¯ÔÔÈÔ‡Ó ÙË ÌfiÏ˘ÓÛË ·ÚÙ›‰ˆÓ √PV Ì ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Û٤ϯԘ (16). ∏ Û·ÓÈfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ıÈÛÙ¿ ‰‡ÛÎÔÏÔ ÙÔ ¤ÚÁÔ Ù˘ ÔÛÔÙÈÎÔÔ›ËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ Ì ÙËÓ ÔÔ›· ·˘Ù¿ ı· ··ÓÙÒÓÙ·È ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘. ¶·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ ·‡Ô˘Ó Ó· ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· ˘ÈÔı¤ÙËÛË ·fi fiϘ ÙȘ ¯ÒÚ˜ ÙˆÓ ·˘ÛÙËÚÒÓ Î·ÓfiÓˆÓ Ô˘ ¤¯Ô˘Ó ıÂÛÈÛÙ› ·fi ÙÔÓ WHO ÁÈ· ÙÔÓ ·ÛÊ·Ï‹ ¯ÂÈÚÈÛÌfi Î·È Ê‡Ï·ÍË ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ (17). ª¤¯ÚÈ, ¿ÓÙˆ˜, Î·È ÙÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2003, ÔÈ 194 ·fi ÙȘ 214 ¯ÒÚ˜ ÙÔ˘ WHO ›¯·Ó Û˘ÛÙ‹ÛÂÈ ÂıÓÈΤ˜ ÂÈÙÚÔ¤˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·ÓˆÙ¤Úˆ ηÓÔÓÈÛÌÒÓ. ∏ ‰È·‰Èηۛ· ÙÔ˘ ÂϤÁ¯Ô˘ Î·È Ù˘ ηٷÁÚ·Ê‹˜ ÙˆÓ ÂÚÁ·ÛÙËÚ›ˆÓ ¤¯ÂÈ ÔÏÔÎÏËÚˆı› Û 76 ¯ÒÚ˜, ÂÓÒ ¤¯ÂÈ ·Ú¯›ÛÂÈ Û ¿ÏϘ 81. ∏ ÚfiÔ‰Ô˜ Â›Ó·È ÛËÌ·ÓÙÈ΋ Î·È ‰ËÏÒÓÂÈ fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Ù˘ ÂÎÔ‡ÛÈ·˜ ·ÂÏ¢ı¤ÚˆÛ˘ ÙÔ˘ ÈÔ‡ Û˘Ó¯Ҙ ÌÂÈÒÓÂÙ·È (18). ∏ ÌÂÁ·Ï‡ÙÂÚË ˆÛÙfiÛÔ, ·ÂÈÏ‹ ÁÈ· ÙËÓ ÂÎ Ó¤Ô˘ ‰È·ÛÔÚ¿ ¿ÁÚÈˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡, Â›Ó·È Ë ÛÎfiÈÌË ·ÂÏ¢ı¤ÚˆÛ‹ ÙÔ˘ ·fi ¤Ó·Ó ¯ÒÚÔ Ê‡Ï·Í˘. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ ÁÓˆÛÙ¿ Ù¤ÙÔÈ· ÂÚÈÛÙ·ÙÈο. √ ÌÂÏÏÔÓÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÂÍ·ÚÙ¿Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙȘ ÂıÓÈΤ˜ Î·È ‰ÈÂıÓ›˜ ·ÔÊ¿ÛÂȘ Ô˘ ı· ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË. À¿Ú¯Ô˘Ó, ˆÛÙfiÛÔ, ÔÏÏÔ› ÏfiÁÔÈ Ô˘ ηıÈÛÙÔ‡Ó ·˘Ùfi ÙÔÓ Î›Ó‰˘ÓÔ fi¯È ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi. ¶ÚÒÙÔÓ, Ë Ïԛ̈ÍË ·fi Èfi ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ¤¯ÂÈ Ôχ ÌÈÎÚ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Û ۯ¤ÛË Ì ¿ÏÏÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ fiÏ· ‚ÈÔÙÚÔÌÔÎÚ·Ù›·˜ Î·È ÂÈϤÔÓ, Ë ÌÂÙ·ÊÔÚ¿ Î·È ‰È·ÛÔÚ¿ ÙÔ˘ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ ·Ú¯›ÛÂÈ ÂÎ Ó¤Ô˘ Ë ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘, Â›Ó·È È‰È·›ÙÂÚ· ‰‡ÛÎÔÏË. ¢Â‡ÙÂÚÔÓ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ·ÔÙÂϤÛÔ˘Ó Èı·ÓÔ‡˜ ÛÙfi¯Ô˘˜ ‚ÈÔÙÚÔÌÔÎÚ·ÙÒÓ, ¤¯Ô˘Ó ‹‰Ë ‰È·Ù˘ÒÛÂÈ ÙË ÚfiıÂÛ‹ ÙÔ˘˜ ÁÈ· Û˘Ó¤¯ÈÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì IPV ÒÛÙ ӷ ‰È·ÙËÚ‹ÛÔ˘Ó ÙËÓ ÏËı˘ÛÌȷ΋ ·ÓÔÛ›· Î·È ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ÂÎÚ›˙ˆÛ˘. ∆¤ÏÔ˜, Ô Î›Ó‰˘ÓÔ˜ ÂÎÔ‡ÛÈ·˜ Â·ÓÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÈÔ‡ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ, ·Ó Î·È ‰ÂÓ ÌÔÚ› Ó· ÌˉÂÓÈÛı› Ï‹Úˆ˜, ÌÔÚ› Ó· ÂÏ·ÙÙˆı› ÛËÌ·ÓÙÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÛÙËÚÒÓ Ì¤ÙÚˆÓ Ê‡Ï·Í˘ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ ÂӉ¯Ô̤ӈ˜ ·ÔÊ·ÛÈÛı› Ó· ‰È·ÙËÚËıÔ‡Ó (19).

∞Ó Î·È fiˆ˜ Ê·›ÓÂÙ·È ·fi Ù· ·Ú·¿Óˆ, ÌÔÚԇ̠ӷ οÓÔ˘Ì οÔȘ ÂÎÙÈÌ‹ÛÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Î·È ÛÙËÓ ÔÛÔÙÈÎÔÔ›ËÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ ÂÌÊ¿ÓÈÛ˘ ÎÚÔ˘ÛÌ¿ÙˆÓ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ÁÈ· ÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ, Â›Ó·È Ô˘ÛÈ҉˜ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ì fiÙÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ù· ‰Â‰Ô̤ӷ ı· ·ÏÏ¿ÍÔ˘Ó ÛËÌ·ÓÙÈο. √È ‰È·ÊÔÚÔÔÈ‹ÛÂȘ Ô˘ ı· ÚÔ·„Ô˘Ó ı· ÔÊ›ÏÔÓÙ·È ÛÙȘ ·ÔÊ¿ÛÂȘ Ô˘ ı· ÏËÊıÔ‡Ó Û¯ÂÙÈο Ì ÙË Ê‡Ï·ÍË ÙÔ˘ ÈÔ‡, ÙËÓ ÂÈÙ‹ÚËÛË Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÔÏÈÙÈ΋ Û ‰ÈÂıÓ¤˜ Â›‰Ô, ηıÒ˜ Î·È ÛÙÔÓ ‚·ıÌfi Ô˘ ÔÈ ·ÔÊ¿ÛÂȘ ·˘Ù¤˜ ı· ˘ÏÔÔÈËıÔ‡Ó Û ÂıÓÈÎfi Î·È ÙÔÈÎfi Â›‰Ô. ∂›Û˘, ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ı· ·›ÍÂÈ Ë ÂӉ¯fiÌÂÓË ·Ó¿Ù˘ÍË ÂÚÁ·Ï›ˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·ıÂÓfi˜ ·fi ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. °È· ·Ú¿‰ÂÈÁÌ·, Ë ·Ó·Î¿Ï˘„Ë ÂÓfi˜ ·ÓÙÈÈ˚ÎÔ‡ ·Ú¿ÁÔÓÙ· ‰Ú·ÛÙÈÎÔ‡ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ı· ¤Î·Ó ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÙËÓ ·ÓÙ›‰Ú·Û‹ Ì·˜ Û ÂÚ›ÙˆÛË Â·Ó·Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡. ™Â οı ÂÚ›ÙˆÛË ¿ÓÙˆ˜, Ë ÓÔÛËÚfiÙËÙ· ı· Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË Ì ÙÔ ÔÛÔÛÙfi Ù˘ ·ÓÔÛ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡. √È ÂÈ̤ÚÔ˘˜ ΛӉ˘ÓÔÈ Ô˘ ÛÎÈ·ÁÚ·Ê‹ıËηÓ, Û˘Óı¤ÙÔ˘Ó ¤Ó· ·Ú¯ÈÎfi Ï·›ÛÈÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Èı·ÓfiÙËÙ·˜ Â·ÓÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÈÔ‡ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË. ∞ÎfiÌË fï˜, ÎÈ ·Ó ηٷÛÙ› ‰˘Ó·Ù‹ Ë ·ÎÚÈ‚‹˜ ÔÛÔÙÈÎÔÔ›ËÛË ÙÔ˘ οı ÎÈÓ‰‡ÓÔ˘, ÙÔ ·Ú·¿Óˆ Ï·›ÛÈÔ ‰ÂÓ ı· ·ÔÙÂÏ› ·Ú¿ ¤Ó· ‰˘Ó·ÌÈÎfi ÌÔÓÙ¤ÏÔ, Ë ·Í›· ÙÔ˘ ÔÔ›Ô˘ ı· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Ù·ÎÙÈ΋ Î·È Û¯ÔÏ·ÛÙÈ΋ ÂÓË̤ڈۋ ÙÔ˘ Ì ٷ Ó¤· ‰Â‰Ô̤ӷ Ô˘ Û˘Ó¯Ҙ ı· ÚÔ·ÙÔ˘Ó (19).

¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ÛÙÔÓ Û¯Â‰È·ÛÌfi ÔÏÈÙÈÎÒÓ ÁÈ· ÙË ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÂÔ¯‹ ∆Ô Ï·›ÛÈÔ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ ÚԷӷʤÚıËΠı· ·ÔÙÂϤÛÂÈ ÙË ‚¿ÛË ÁÈ· ÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÛÙÔ˘˜ ÙÔÌ›˜ Ù˘ ÂÈÙ‹ÚËÛ˘, Ù˘ ʇϷ͢ ÙÔ˘ ÈÔ‡, ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ∞Ó Î·È Ë ·Ú·Î¿Ùˆ Û˘˙‹ÙËÛË ı· ·Ó·ÊÂÚı› ͯˆÚÈÛÙ¿ Û ηı¤Ó·Ó ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ÙÔÌ›˜, Ë ÔÏÈÙÈ΋ Ô˘ ı· ·ÔÊ·ÛÈÛı› ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÓÈ·›·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Î·Ó¤Ó·˜ ‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜. ∏ ÂÈÙ‹ÚËÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ̤¯ÚÈ ÙÒÚ· ÛÙËÚ›¯ıËΠÛÙËÓ ·Ó›¯Ó¢ÛË Ù˘ √Í›·˜ ÷Ϸڋ˜ ¶·Ú¿Ï˘Û˘ (√ö). ŒÙÛÈ, ÔÈ ˘ÁÂÈÔÓÔÌÈΤ˜ ¶·È‰È·ÙÚÈ΋ 2006;69:90-96

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·94

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∫. ¢Ô‡ÚÔ˜ Î·È Û˘Ó.

˘ËÚÂۛ˜ ÙˆÓ ¯ˆÚÒÓ ÛÙȘ Ôԛ˜ ÂÓ‰ËÌ› Ë ÓfiÛÔ˜, ηıÒ˜ Î·È ·˘ÙÒÓ Ô˘ ¤ˆ˜ ÚfiÛÊ·Ù· ‹Ù·Ó ÂÓ‰ËÌÈΤ˜, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔ˘Ó Î·È Ó· ‰ÈÂÚ¢ÓÔ‡Ó Ï‹Úˆ˜ fiÏ· Ù· ÂÚÈÛÙ·ÙÈο √ö. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ·ÎfiÌË Î·È Â› ·Ô˘Û›·˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, Ú¤ÂÈ Ó· ·ÓȯÓ‡ÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ÂÚÈÛÙ·ÙÈÎfi √ö ·Ó¿ 100.000 ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ÂÙÒÓ, ·Ó¿ ¤ÙÔ˜. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÂÈÙ‹ÚËÛ˘ ÛÙËÚ›˙ÂÙ·È ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·Ó·ÊÂÚÔÌ¤ÓˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ √ö Î·È ÛÙËÓ Â¿ÚÎÂÈ· Ù˘ ‰ÈÂÚ‡ÓËÛ˘ ÙÔ˘ ηıÂÓfi˜ ·fi ·˘Ù¿ (20). ¢ÂÓ ¤¯ÂÈ ·ÔÊ·ÛÈÛı› ·ÎfiÌË ·Ó ı· ‰È·ÙËÚËı› ÙÔ ›‰ÈÔ Û‡ÛÙËÌ· ÂÈÙ‹ÚËÛ˘ ‹ ı· ·ÓÙÈηٷÛÙ·ı› ·fi οÔÈÔ ¿ÏÏÔ. ∆Ô ‚¤‚·ÈÔ Â›Ó·È ¿ÓÙˆ˜, fiÙÈ Ë ÂÈÙ‹ÚËÛË ı· Ú¤ÂÈ Ó· Û˘Ó¯ÈÛı›, Èı·Ófiٷٷ ̤۷ ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ¢ÈÂıÓÒÓ ÀÁÂÈÔÓÔÌÈÎÒÓ ∫·ÓÔÓÈÛÌÒÓ ÙÔ˘ ¶√À (21), ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛı› Ë ÁÚ‹ÁÔÚË ·Ó›¯Ó¢ÛË Î·È ·¿ÓÙËÛË Û ÂÚ›ÙˆÛË Î˘ÎÏÔÊÔÚ›·˜ ÈÔ‡ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜. ∏ ʇϷÍË Î·È Ô ·ÛÊ·Ï‹˜ ¯ÂÈÚÈÛÌfi˜ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ (poliovirus containment) ÛÙË ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÂÔ¯‹, ·ÔÙÂÏ› ¤Ó· ·ÎfiÌ· ‰›Ô ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡. ™ËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ ÂÈÙ‡¯ıËΠÛÙÔÓ ÙÔ̤· ·˘Ùfi ÌÂÙ¿ ·fi ÙËÓ ¤Î‰ÔÛË ÙÔ˘ “¶·ÁÎfiÛÌÈÔ˘ ۯ‰›Ô˘ ‰Ú¿Û˘ ÁÈ· ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ʇϷÍË Î·È ¯ÂÈÚÈÛÌfi ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜” ·fi ÙÔÓ ¶√À, ÙÔ 1999 (17). ∆ÔÓ ›‰ÈÔ ¯ÚfiÓÔ Ë ¶·ÁÎfiÛÌÈ· ™˘Ó¤Ï¢ÛË ÙÔ˘ ¶√À οÏÂÛ fiÏ· Ù· ÎÚ¿ÙË Ì¤ÏË Ó· ·Ú¯›ÛÔ˘Ó ÙË ÛÙ·‰È·Î‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ì¤ÙÚˆÓ Ô˘ ÚԂϤÔÓÙ·Ó ÛÙÔ ·Ú·¿Óˆ Û¯¤‰ÈÔ (22). Ÿˆ˜ ÚԷӷʤÚıËÎÂ, ÔÏϤ˜ ¯ÒÚ˜ ¤¯Ô˘Ó ‹‰Ë ·Ú¯›ÛÂÈ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ۯ‰›Ô˘ ÂϤÁ¯ÔÓÙ·˜ Î·È Î·Ù·ÁÚ¿ÊÔÓÙ·˜ Ù· ÂÚÁ·ÛÙ‹ÚÈ· Ô˘ ¯ÂÈÚ›˙ÔÓÙ·È ¿ÁÚÈ· ÛÙÂϤ¯Ë ‹ ¯ÚËÛÈÌÔÔÈÔ‡Ó ˘ÏÈο ‰˘ÓËÙÈο ÌÔÏ˘Ṳ̂ӷ Ì ÙÔÓ Èfi. ∂ÓÙÔ‡ÙÔȘ, Ù· ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ê‡Ï·ÍË Î·È ÙÔÓ ¯ÂÈÚÈÛÌfi ÙÔ˘ ÈÔ‡ ·Ó·Ì¤ÓÂÙ·È Ó· Á›ÓÔ˘Ó ÈÔ ÔχÏÔη ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Î·È ı· ··ÈÙ‹ÛÔ˘Ó Â˘Ú›· ÔÌÔʈӛ· ÛÙÔ Â›Â‰Ô ·ÛÊ¿ÏÂÈ·˜ Ù˘ ʇϷ͢, fi¯È ÌfiÓÔ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡ ·ÏÏ¿ Î·È ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘. ∞ÎfiÌË, Ë ÚfiÛÊ·ÙË ÂÍ·ÎÚ›‚ˆÛË ÌÈÎÚÔ-ÂȉËÌÈÒÓ ·fi ΢ÎÏÔÊÔÚÔ‡ÓÙ· ÛÙÂϤ¯Ë ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (cVDPVs) ηıÈÛÙ¿ ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË Ó· ÏËÊı› ˘’ fi„ÈÓ ·˘Ùfi˜ Ô ÌÈÎÚfi˜ ·ÏÏ¿ ˘·ÚÎÙfi˜ ΛӉ˘ÓÔ˜, ηٿ ÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÁÈ· ÙË ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÂÔ¯‹ (10-13). ∏ ÂÎÚ›˙ˆÛË ÂÓfi˜ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· ‹Ù·Ó Û˘Ó˘Ê·Ṳ̂ÓË Ì¤¯ÚÈ ÚfiÛÊ·Ù· Ì ÙË ‰È·¶·È‰È·ÙÚÈ΋ 2006;69:90-96

ÎÔ‹ ÙˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ (23). øÛÙfiÛÔ, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi cVDPV Î·È ÙȘ Û¯ÂÙÈΤ˜ Ì ÙË ‚ÈÔÙÚÔÌÔÎÚ·Ù›· ·ÓËÛ˘¯›Â˜, ¤¯ÂÈ ·Ú¯›ÛÂÈ ÂÎ Ó¤Ô˘ ÌÈ· Û˘˙‹ÙËÛË ÛÙÔÓ ¯ÒÚÔ Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜, ÁÈ· ÙÔ Î·Ù¿ fiÛÔ Â›Ó·È Ú·ÁÌ·ÙÈο ÂÊÈÎÙ‹ Ë ‰È·ÎÔ‹ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·Ù¿ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÈΛÌÂÓË ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡ (24). ∫¿ÔÈÔÈ ÂÚ¢ÓËÙ¤˜ Ì¿ÏÈÛÙ·, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ı· Ú¤ÂÈ Ó· ··ÈÙÂ›Ù·È Ë ‰È·ÎÔ‹ ÙˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· Ó· ıˆڋÛÔ˘Ì fiÙÈ Ë ÂÎÚ›˙ˆÛË Â›Ó·È ÂÈÙ˘¯‹˜. ∆Ô 1998, ÚÈÓ ‰È·ÈÛÙˆı› ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·fi cVDPVs, ÌÈ· Û˘Ó¿ÓÙËÛË ÂȉÈÎÒÓ, Ô˘ ›¯Â Û˘ÁÎÏËı› ·fi ÙÔÓ ¶√À, ›¯Â ηٷϋÍÂÈ fiÙÈ Ë ‰È·ÎÔ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÚÔ˘Ù›Ó·˜ Ì OPV Â›Ó·È ÂȂ‚ÏË̤ÓË, ÂÓÒ ı· ÌÔÚÔ‡Û ӷ ÛÙ·Ì·Ù‹ÛÂÈ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì IPV ÂÊfiÛÔÓ ›Û¯˘·Ó ÔÈ ÂÍ‹˜ ÚÔ¸Ôı¤ÛÂȘ: 1) ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, 2) ·ÛÊ·Ï‹˜ ʇϷÍË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·ÔıÂÌ¿ÙˆÓ ÈÒÓ, 3) ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙˆÓ ÚÔÂÚ¯fiÌÂÓˆÓ ·fi ÙÔ ÂÌ‚fiÏÈÔ ÈÒÓ Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ OPV (25). ¶·Ú¿ Ù· ·ÓˆÙ¤Úˆ Û˘ÌÂÚ¿ÛÌ·Ù·, Ë ÂÌÊ¿ÓÈÛË Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÂÂÈÛÔ‰›ˆÓ cVDPVs Î·È Ô Êfi‚Ô˜ Ù˘ ‚ÈÔÙÚÔÌÔÎÚ·Ù›·˜ ¤¯Ô˘Ó ·Ó·ÁοÛÂÈ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È ÙÔ˘˜ ˘‡ı˘ÓÔ˘˜ ۯ‰ȷÛÌÔ‡ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ó· ·Ó·˙ËÙ‹ÛÔ˘Ó ¤Ó· Ó¤Ô Ï·›ÛÈÔ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙË Ê‡ÛË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ ‹Úı·Ó ÚfiÛÊ·Ù· ÛÙÔ ÚÔÛ΋ÓÈÔ. ŒÙÛÈ, ÙÔ 2001 ÙÔ ÛÒÌ· ÙˆÓ ÂȉÈÎÒÓ Ô˘ ÂÔÙ‡ÂÈ ÙËÓ ·ÁÎfiÛÌÈ· ÚÔÛ¿ıÂÈ· ÂÎÚ›˙ˆÛ˘ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ÚfiÛıÂÛ ˆ˜ ٤ٷÚÙË ÚÔ¸fiıÂÛË ÙËÓ ‡·ÚÍË ÈηÓÒÓ ·ÔıÂÌ¿ÙˆÓ ÂÌ‚ÔÏ›ˆÓ, ηıÒ˜ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· Â·ÚÎÔ‡˜ ·Ú·ÁˆÁ‹˜ OPV Û ÂÚ›ÙˆÛË ·Ó›¯Ó¢Û˘ ΢ÎÏÔÊÔÚ›·˜ ¿ÁÚÈÔ˘ ÈÔ‡ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË (26). ¶ÔÏÏ¿ ˙ËÙ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· Ì ·˘Ù‹ ÙËÓ ÚÔ¸fiıÂÛË ·Ú·Ì¤ÓÔ˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ ¿Ï˘Ù·, fiˆ˜ ÔÈÔ˜ Â›Ó·È Ô Î·Ù·ÏÏËÏfiÙÂÚÔ˜ Ù‡Ô˜ ÂÌ‚ÔÏ›Ô˘ (ÌÔÓÔ‰‡Ó·ÌÔ ‹ ÙÚȉ‡Ó·ÌÔ), ÔÈ· Â›Ó·È Ë ı¤ÛË ÙÔ˘ IPV, ÔÈÔ˜ ı· Â›Ó·È Ô ‰È·¯ÂÈÚÈÛÙ‹˜ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ, ηıÒ˜ Î·È ÔÈÔ ı· Â›Ó·È ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ Î·È Ò˜ ·˘Ùfi ı· Ú¤ÂÈ Ó· ÌÂÙ·‚¿ÏÏÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ ·ÓÔÛ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ (27). ¶·ÚfiÏÔ Ô˘ Â›Ó·È ϤÔÓ ÁÓˆÛÙfi fiÙÈ Ù· ÛÙÂϤ¯Ë cVDPVs ·ÔÙÂÏÔ‡Ó ¤Ó·Ó ˘·ÚÎÙfi ΛӉ˘ÓÔ ÁÈ· ÙËÓ ÚÔÛ¿ıÂÈ· ÂÎÚ›˙ˆÛ˘ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ‰ÂÓ ¤¯Ô˘Ó ۯ‰ȷÛı› ̤¯ÚÈ ·˘Ù‹

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·95

95

ŒÏÂÁ¯Ô˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË

ÙË ÛÙÈÁÌ‹ ηıÔÏÈο ·Ô‰ÂÎÙ¤˜ ÛÙÚ·ÙËÁÈΤ˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∏ ÂÍ¿ÏÂÈ„Ë ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·fi cVDPVs ı· ··ÈÙÔ‡Û ÙËÓ Ù·˘Ùfi¯ÚÔÓË ‰È·ÎÔ‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ OPV ·fi fiϘ ÙȘ ¯ÒÚ˜. ªÈ· Ù¤ÙÔÈ· ΛÓËÛË ı· ÌÔÚÔ‡Û ӷ Á›ÓÂÈ ÌfiÓÔ ÂÊfiÛÔÓ Ë Â˘·ÈÛıËÛ›· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÈÙ‹ÚËÛ˘ Î·È Ë ·ÓÔÛ›· ÙÔ˘ ÏËı˘ÛÌÔ‡ ›¯·Ó Êı¿ÛÂÈ Û Ôχ ˘„ËÏ¿ Â›‰· (Èı·Ófiٷٷ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ·ÁÎfiÛÌÈ·˜ ÂÎÚ›˙ˆÛ˘ Ù˘ ÓfiÛÔ˘). ∂Âȉ‹ ÔÏϤ˜ ¯ÒÚ˜ Â›Ó·È Èı·Ófi Ó· ÚÔÙÈÌ‹ÛÔ˘Ó Ó· ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó ÙÔ OPV Ì IPV, ·Ú¿ Ó· ÛÙ·Ì·Ù‹ÛÔ˘Ó ÂÓÙÂÏÒ˜ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, ı· ¯ÚÂÈ·Ûı› ÚÔÛÂÎÙÈÎfi˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ IPV. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÙ‹ÚËÛË, ı· Ú¤ÂÈ Ó· Â›Ó·È Û˘Ó¯‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÒÛÙ ӷ ‰È·ÛÊ·ÏÈÛı› fiÙÈ ÔÔÈ·‰‹ÔÙ ÂÚ›ÙˆÛË Â·Ó·Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡ ı· ·ÓȯÓ¢ı› ÁÚ‹ÁÔÚ· Î·È ı· ·ÓÙÈÌÂÙˆÈÛı› ˆ˜ Â›ÁÔ˘Û· ηٿÛÙ·ÛË ·fi ÙË ‰ÈÂıÓ‹ ÎÔÈÓfiÙËÙ·. ™˘ÓÔ„›˙ÔÓÙ·˜, ı· ÌÔÚÔ‡Û·Ì ӷ ԇ̠fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘, ÂÌ›ÙÂÈ Û ‰‡Ô ηÙËÁÔڛ˜: ·) Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Î·È ‚) Ï·Óı·Ṳ̂ÓÔÈ ‹ ÂÁÎÏËÌ·ÙÈÎÔ› ¯ÂÈÚÈÛÌÔ› ÙˆÓ Ê˘Ï·ÛÛÔÌ¤ÓˆÓ ·ÔıÂÌ¿ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ. ∏ ·Ú·¿Óˆ Û˘˙‹ÙËÛË ÂÈÎÂÓÙÚÒıËΠÛÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ fiÛˆÓ ‰Â‰ÔÌ¤ÓˆÓ ˘¿Ú¯Ô˘Ó ̤¯ÚÈ ·˘Ù‹ ÙË ÛÙÈÁÌ‹ Î·È ·ÊÔÚÔ‡Ó ÛÙÔÓ ÂÓ ÏfiÁˆ ΛӉ˘ÓÔ, ηıÒ˜ Î·È ÛÙÔ˘˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ Ù˘ ‰ÈÂıÓÔ‡˜ ÂÈÛÙËÌÔÓÈ΋˜ ÎÔÈÓfiÙËÙ·˜ ÁÈ· ÙÔÓ Û¯Â‰È·ÛÌfi ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ı· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ì Â¿ÚÎÂÈ· ÙÔ Úfi‚ÏËÌ·. ∏ ‰È·‰Èηۛ· Ï‹„˘ ÙˆÓ ÙÂÏÈÎÒÓ ·ÔÊ¿ÛÂˆÓ ·Ó·Ì¤ÓÂÙ·È Ó· ÂÈÙ·¯˘Óı› ÙÔ 2005 Î·È ı· ÂÍ·ÚÙËı› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙË Ì¤¯ÚÈ ÙfiÙ ÔÚ›· Ù˘ ‰È·‰Èηۛ·˜ ÂÎÚ›˙ˆÛ˘, ·ÏÏ¿ Î·È Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ô˘ ı· ¤¯Ô˘Ó ÚÔ·„ÂÈ ·fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ.

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∏ ˘fiıÂÛË PANDAS (·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË): ̇ıÔ˜ ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ·; µ. ∆Û·ÁÚ‹˜, ∫. ¢Ô‡ÚÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘ - ∫·Ú·ı›Ô˘

¶ÂÚ›ÏË„Ë: ∏ Û˘Û¯¤ÙÈÛË ‰È·ÊfiÚˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ‰È·Ù·Ú·¯ÒÓ, fiˆ˜ Ô ÚÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜, Ë ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ·ÓÙȉڷÛÙÈ΋ ·ÚıÚ›Ùȉ·, ÙÔ Ô˙҉˜ ÂÚ‡ıËÌ· Î·È Ë ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·, Ì ÚÔËÁËı›Û˜ ÛÙÚÂÙÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ, Â›Ó·È ÁÓˆÛÙ‹ Î·È Î·Ï¿ ÙÂÎÌËÚȈ̤ÓË Î·Ù¿ ÙÔ ·ÚÂÏıfiÓ. ∏ ÚfiÛÊ·ÙË ‰È‡ڢÓÛË ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙˆÓ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ì ÙËÓ ÚÔÛı‹ÎË ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·˘ÙÔ¿ÓÔÛˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û˘Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË (PANDAS), ¤¯ÂÈ ÚÔηϤÛÂÈ ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘ ÎÔÈÓÔ‡, ·ÏÏ¿ Î·È Ù˘ ·ÁÎfiÛÌÈ·˜ ÂÈÛÙËÌÔÓÈ΋˜ ÎÔÈÓfiÙËÙ·˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›·, ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∏ Èı·ÓfiÙËÙ· Û˘Û¯¤ÙÈÛ˘ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, fiˆ˜ Ë È‰ÂÔ„˘¯·Ó·ÁηÛÙÈ΋ ‰È·Ù·Ú·¯‹ Î·È Ù· ÙÈÎ, Ì ÚÔËÁËı›Û˜ ÛÙÚÂÙÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ ·Ú·Ì¤ÓÂÈ ÔˆÛ‰‹ÔÙ ˘fi ·ÌÊÈÛ‚‹ÙËÛË. ∏ ·Ó·ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ PANDAS ÂÍ·ÎÔÏÔ˘ı› Ó· ·Ú·Ì¤ÓÂÈ Ì›· ·Ó·fi‰ÂÈÎÙË ˘fiıÂÛË.

°’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô Ã·˚‰·Ú›Ô˘ “∞ÙÙÈÎfiÓ”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: µ·Û›ÏÂÈÔ˜ ∆Û·ÁÚ‹˜ ∞ÚÂÔfiψ˜ 30, ¢¿ÛÔ˜ ÷˚‰·Ú›Ô˘ ∆.∫. 124 62, ∞ı‹Ó· E-mail: billtsag@yahoo.com ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2005

§¤ÍÂȘ ÎÏÂȉȿ: PANDAS, ·˘ÙÔ¿ÓÔÛ˜, Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜, ÛÙÚÂÙfiÎÔÎÎÔ˜, ıÂÚ·›·.

The PANDAS hypothesis (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection): reality or myth?

V. Tsagris, ∫. Douros, P. Nikolaidou - Karpathiou

Abstract: Various inflammatory disorders have been shown to be associated with preceding streptococcal infections, including acute rheumatic fever, post-streptococcal reactive arthritis, erythema nodosum and post-streptococcal glomerulonephritis. The spectrum of post-streptococcal disease has been expanded with the addition of the paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). PANDAS are a recently described subgroup of childhood disorders, and there has been a great deal of public and physician interest in their pathophysiology, diagnosis and management. The likelihood that neuropsychiatric disorders such as obsessive-compulsive disorder (OCD) and tics are related to a preceding streptococcal infection is certainly controversial. The current literature is reviewed, culminating in the conclusion that PANDAS remains a yet-unproven assumption.

3rd Paediatric Clinic of the University of Athens “Attikon” University Hospital, Haidari, Athens Correspondence: Vassilios Tsagris 30 Areopoleos Str., Dasos Haidariou 124 62, Athens E-mail: billtsag@yahoo.com Date of submission: 17-09-2004 Date of approval: 21-09-2005

Key words: PANDAS, autoimmune, neuropsychiatric, streptococcal, treatment.

∂ÈÛ·ÁˆÁ‹ ∏ ȉÂÔ„˘¯·Ó·ÁηÛÙÈ΋ ‰È·Ù·Ú·¯‹ (πæ¢), ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÈÎ Î·È Ë ¯ÔÚ›· Sydenham (Sydenham’s chorea - SC) ·ÔÙÂÏÔ‡Ó Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·ԉȉfiÌÂÓ˜ Èı·Ófiٷٷ Û ‚Ï¿‚Ë ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∆Ô 1989, ÁÈ· ÚÒÙË ÊÔÚ¿, Ô Kiessling

·Ú·Ù‹ÚËÛ fiÙÈ Ë ¤Í·ÚÛË ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙËÓ ÎÔÈÓfiÙËÙ· Û˘Óԉ‡ÙËΠ·fi ‰ÂηÏ·ÛÈ·ÛÌfi ÙˆÓ ·Ú·ÔÌÒÓ ·È‰ÈÒÓ Û π·ÙÚÂ›Ô ¶·Ú·ÎÔÏÔ‡ıËÛ˘ ∫ÈÓËÙÈÎÒÓ ¢È·Ù·Ú·¯ÒÓ (1). ∆Ô 1998, Ì ÙËÓ ÂÚÈÁÚ·Ê‹ ÛÂÈÚ¿˜ 50 ·È‰ÈÒÓ, ÔÈ Swedo Î·È Û˘Ó ÚfiÙÂÈÓ·Ó ÙËÓ ˘fiıÂÛË fiÙÈ Ë πæ¢ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‹/Î·È Ù· ÙÈÎ ÌÔÚÔ‡Ó Ó· ÚÔÎÏËıÔ‡Ó ÛÙÔ Ï·›ÛÈÔ ¶·È‰È·ÙÚÈ΋ 2006;69:97-103

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µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

Ì›·˜ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ·˘ÙÔ¿ÓÔÛ˘ ‰ÈÂÚÁ·Û›·˜ (2). OÈ Û˘ÁÁÚ·Ê›˜ ÚfiÙÂÈÓ·Ó ÙÔ ·ÎÚˆÓ‡ÌÈÔ PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection - ¶·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË). ∏ πæ¢ ·Ó‹ÎÂÈ ÛÙȘ ·Á¯Ò‰ÂȘ ‰È·Ù·Ú·¯¤˜ Î·È ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 1-2% ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ¯ÚfiÓÈ· ‰È·Ù·Ú·¯‹ ÔÈΛÏ˘ ‚·Ú‡ÙËÙ·˜, ÌÂ Û˘¯Ó¤˜ ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, Ë ÔÔ›· Û ‚·ÚÈ¿ ÌÔÚÊ‹ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ·ÙfiÌÔ˘ ÁÈ· ÎÔÈÓˆÓÈ΋ ‹ ‰È·ÚÔÛˆÈ΋ ·ÏÏËÏÂ›‰Ú·ÛË. ∆Ô ¿ÙÔÌÔ Ì πæ¢ ·Áȉ‡ÂÙ·È Û ̛· ÛÂÈÚ¿ Â·Ó·ÏËÙÈÎÒÓ ÛΤ„ÂˆÓ (ȉÂÔÏË„›Â˜) Î·È Û˘ÌÂÚÈÊÔÚÒÓ („˘¯·Ó·ÁηÛÌÔ›). ™˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ‰È·Ù·Ú·¯¤˜ fiˆ˜ ÙÈÎ (30%), ηٿıÏÈ„Ë (26%), ‰È·Ù·Ú·¯‹ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ (¢∂¶À) (10%) Î·È ¿ÏϘ ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ (20%) (3). ∏ ıÂÚ·›· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÌÂÚÈÊÔÚÈ΋ „˘¯ÔıÂÚ·›· ‹/Î·È Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· Ì ÂÎÏÂÎÙÈÎÔ‡˜ ·Ó·ÛÙÔÏ›˜ Â·Ó·ÚfiÛÏ˄˘ ÛÂÚÔÙÔÓ›Ó˘ (SSRIs). √È ˘ÔÙÚÔ¤˜ Â›Ó·È Û˘¯Ó¤˜ ηٿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂÚ·›·˜, ˆÛÙfiÛÔ Ï‹Ú˘ ‡ÊÂÛË ÌÔÚ› Ó· ·Ú·ÙËÚËı› ηٿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÊ˂›·˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈÎÔÁÂÓÂȷΤ˜ ÌÂϤÙ˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó ÎÏËÚÔÓÔÌÈÎfiÙËÙ· Ì ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·ÎÙ‹Ú·, Ë ÌË ·ÔÌfiÓˆÛË ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÂÈηÛÈÒÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÔÈÎ›ÏˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∆· ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ·ÔÙÂÏÔ‡Ó Û·Û̈‰ÈΤ˜, ·ÎÔ‡ÛȘ, Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ Î·È ÛÙÂÚÂfiÙ˘˜ ÎÈÓ‹ÛÂȘ, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó Î¿ıÂ Ì˘˚΋ ÔÌ¿‰·. ∆·ÍÈÓÔÌÔ‡ÓÙ·È Û ÙÚÂȘ ηÙËÁÔڛ˜: ·) ·ÚÔ‰Èο ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹, Ì ηÏÔ‹ıË ÔÚ›· Î·È ‰È¿ÚÎÂÈ· ÌÈÎÚfiÙÂÚË ÙÔ˘ ¤ÙÔ˘˜, ‚) ¯ÚfiÓÈ· ÎÈÓËÙÈο ÙÈÎ Ô˘ ·Ú·Ì¤ÓÔ˘Ó Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜ Î·È Á) Û‡Ó‰ÚÔÌÔ Tourette (TS), ÙÔ ÔÔ›Ô - ÂÎÙfi˜ ·fi ÎÈÓËÙÈο - ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÊˆÓËÙÈο ÙÈÎ, Ù· ÔÔ›· ÂÓ›ÔÙ ·›ÚÓÔ˘Ó ÙË ÌÔÚÊ‹ Ù˘ ·ÏÈÏ·Ï›·˜, Ù˘ ˯ÔÏ·Ï›·˜ ‹ Î·È Ù˘ ÎÔÚÔÏ·Ï›·˜. ∆Ô TS Èı·Ófiٷٷ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·ÎÙ‹Ú·, Ì ÙÔ ˘‡ı˘ÓÔ ÁÔÓ›‰ÈÔ Ó· ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 18q22.1. ∫·ıÒ˜ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ÁÔÓȉȷ΋ ‚Ï¿‚Ë ÙÔ˘ TS ÌÔÚ› Ó· ÂÎÊÚ·ÛÙ› ÎÏÈÓÈο Î·È Ì ÙË ÌÔÚÊ‹ ÙˆÓ ·ÚÔ‰ÈÎÒÓ ‹ ¯ÚfiÓÈˆÓ ÎÈÓËÙÈÎÒÓ ÙÈÎ, ‰ÂÓ ·ÔÎÏ›ÂÙ·È ¶·È‰È·ÙÚÈ΋ 2006;69:97-103

ÙÂÏÈο ÔÈ ·Ú·¿Óˆ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ Ó· ·ÏÏËÏÂÈηχÙÔÓÙ·È. ™˘¯Ó¿, ̤ÚÔ˜ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ·ÔÙÂÏÔ‡Ó Ù· ȉÂÔ„˘¯·Ó·ÁηÛÙÈο Û˘ÌÙÒÌ·Ù· ηıÒ˜ Î·È Ë ¢∂¶À. ∏ SC ·ÔÙÂÏ› ÙË ÌÔÓ·‰È΋ Ó¢ÚÔÏÔÁÈ΋ ÂΉ‹ÏˆÛË ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡, ÌÂ Û˘Ó‹ıË ¯ÚfiÓÔ ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂٷ͇ 414 ÂÙÒÓ. ¶·ıÔÊ˘ÛÈÔÏÔÁÈο, ÔÈ ÂΉËÏÒÛÂȘ ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ ·fi ÙÔ ∫¡™ Èı·Ófiٷٷ ÂÚÌËÓ‡ÔÓÙ·È Ì¤Ûˆ Ù˘ ‰ÈÂÚÁ·Û›·˜ ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÌÈÌËÙÈÛÌÔ‡, Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ ηٿ ÙËÓ ÔÔ›· ·ÓÙÈÛÒÌ·Ù· ηٿ ۈ̷ÙÈÎÒÓ ÂÈÙfiˆÓ ÙÔ˘ ‚-·ÈÌÔÏ˘ÙÈÎÔ‡ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ ∞ (GABHS) ·ÓÙȉÚÔ‡Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ· Ì ÚˆÙÂ˚ÓÈÎÔ‡˜ ÂÈÙfiÔ˘˜ ȉ›ˆÓ ΢ÙÙ¿ÚˆÓ, ÚÔηÏÒÓÙ·˜ ÙËÓ ˘ÚÔ‰fiÙËÛË Ì›·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·˘ÙÔ¿ÓÔÛ˘ ‰ÈÂÚÁ·Û›·˜. ∂ȉÈÎfiÙÂÚ·, ·ÓÙÈÛÒÌ·Ù· ηٿ GABHS ·ÓÙȉÚÔ‡Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ· Ì ÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ΢ÙÙ¿ÚˆÓ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÚÔηÏÒÓÙ·˜ ÊÏÂÁÌÔÓ‹ Î·È Û˘Ó·ÎfiÏÔ˘ıË ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÈÓËÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ SC (4). ¢È·ÈÛÙÒıËÎÂ, Ì¿ÏÈÛÙ·, Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (Ù· ÔÔ›· ÔÓÔÌ¿ÛÙËÎ·Ó ·ÓÙÈÓÂ˘ÚˆÓÈο) Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ Î·È ¯ÚÔÓÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ∞ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜, fiÛÔ Î·È ÌÂϤÙ˜ Û ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi, ÂȂ‚·ÈÒÓÔ˘Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ SC. ∆Ô ¯ÚÔÓÈÎfi ‡ÚÔ˜ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÌÂÙ¿ ·fi ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË Î˘Ì·›ÓÂÙ·È ·fi Ï›Á˜ ‚‰ÔÌ¿‰Â˜ ¤ˆ˜ Î·È 9 Ì‹Ó˜. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯ÔÚ›·, ˘ÔÙÔÓ›· Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·¿ıÂÈ·, Ì ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ó· ÂÚÈÁÚ¿ÊÂÙ·È ¤ˆ˜ ÚÔԉ¢ÙÈ΋ ‹ - Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ - Î·È ıÔÚ˘‚҉˘. π‰ÂÔ„˘¯·Ó·ÁηÛÙÈο Û˘ÌÙÒÌ·Ù· ·Ú·ÙËÚÔ‡ÓÙ·È Û ÔÛÔÛÙfi ¤ˆ˜ Î·È 70% ·ÛıÂÓÒÓ Ì SC, Û˘¯Ó¿ ÚÔËÁÔ‡ÌÂÓ· Ù˘ ¯ÔÚ›·˜ ηٿ Ë̤Ú˜ ‹ Î·È Â‚‰ÔÌ¿‰Â˜. ⁄ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·Ú·ÙËÚÂ›Ù·È Û ‰È¿ÛÙËÌ· ÌËÓÒÓ ¤ˆ˜ Î·È 1-2 ÂÙÒÓ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÓÙËÚËÙÈο ̤ÙÚ· ÛÙȘ ‹Ș ÂÚÈÙÒÛÂȘ Î·È ¯ÔÚ‹ÁËÛË Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ‹ ·ÏÏÔÂÚȉfiÏ˘ ÛÙȘ ÛÔ‚·ÚfiÙÂÚ˜. §fiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډ›Ùȉ·˜, ÂÓÈÎÈÏ›ÓË ¯ÔÚËÁÂ›Ù·È ÚÔÊ˘Ï·ÎÙÈο ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛË. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ SC ˆ˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi Î·È ÎÏÈÓÈÎfi ÚfiÙ˘Ô, ÔÈ Swedo Î·È Û˘Ó ÚfiÙÂÈÓ·Ó ÙÔ PANDAS ˆ˜ Ì›· Û˘ÁÎÂÎÚÈ̤ÓË Î·È Û·ÊÒ˜ ηıÔÚÈ˙fiÌÂÓË ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·. ¶ÚfiÛÊ·Ù·, ÚÔÙ¿ıËÎÂ Ë ‰È‡ڢÓÛË ÙÔ˘

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·99

99

ÀfiıÂÛË PANDAS

Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ PANDAS, Ì ÙËÓ ÚÔÛı‹ÎË ÔÓÙÔÙ‹ÙˆÓ fiˆ˜ Ë Ó¢ÚÔÁÂÓ‹˜ ·ÓÔÚÂÍ›·, Ë ¢∂¶À, ÔÈ Ì˘ÔÎÏÔӛ˜, Ë ‰˘ÛÙÚÔÊÈ΋ ‰˘ÛÙÔÓ›·, ÔÈ ·ÚÔ͢ÛÌÈΤ˜ ‰˘ÛÎÈÓËۛ˜ Î·È Ë ÔÍ›· ‰È¿Û·ÚÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·.

ÚˆÓ, Û˘Û¯ÂÙ›˙ÔÓÙ·˜ Ì¿ÏÈÛÙ· ÙË ‚·Ú‡ÙËÙ· Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ì ÙȘ ÙÈ̤˜ ÙÔ˘ Ù›ÙÏÔ˘, ·ÔÙ˘Á¯¿ÓÔÓÙ·˜ ˆÛÙfiÛÔ Ó· ÙÂÎÌËÚÈÒÛÂÈ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ PANDAS ‹ ÙËÓ ·ÚÔ˘Û›· ıÂÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ Ì ÙÈÎ (6).

∏ ˘fiıÂÛË PANDAS

∆Ô ·ÓÔÛÔÏÔÁÈÎfi ˘fi‚·ıÚÔ ∏ ˘fiıÂÛË ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ·ıÔÁÂÓÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÙÔ˘ PANDAS ÂÓÈÛ¯‡ÂÙ·È ·fi Ì›· ÛÂÈÚ¿ ‰Â‰Ô̤ӈÓ: O µ ΢ÙÙ·ÚÈÎfi˜ ‰Â›ÎÙ˘ D8/17, Ô ÔÔ›Ô˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·Ú¯Èο ˆ˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Î·È Ù˘ SC, ·ÔÙÂÏ› ¤Ó· ·ÏÏÔ·ÓÙÈÁfiÓÔ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ Ì›·˜ ˘ÔÔÌ¿‰·˜ HLA-DR ıÂÙÈÎÒÓ µ ΢ÙÙ¿ÚˆÓ Ù˘ ÂÚÈÊÂÚÈ΋˜ ΢ÎÏÔÊÔÚ›·˜, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ·Ó·ÁÓˆÚÈÛÙ› ·fi ÌÔÓÔÎψÓÈο πgª ·ÓÙÈÛÒÌ·Ù·. ∏ Ù¯ÓÈ΋ ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÂÍÂÚÁ·Û›· ÙˆÓ µ ΢ÙÙ¿ÚˆÓ Ì ÙÔ ·Óٛۈ̷ Î·È Ì¤ÙÚËÛË ÙˆÓ ÛËÌ·ÛÌ¤ÓˆÓ µ ΢ÙÙ¿ÚˆÓ. ∆Ô ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÔÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÛËÌ·ÛÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi 11,8% (7).

O ‰Â›ÎÙ˘ D8/17 ÂÌÊ·Ó›˙ÂÈ ˘„ËÏ‹ ¢·ÈÛıËÛ›· (90%) ÁÈ· ÙÔÓ ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÓfiÛÔ˘. ™Â ·ÛıÂÓ›˜ Ì ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ‰È·ÈÛÙÒıËΠ¯·ÌËÏ‹ ¤ÎÊÚ·ÛË ÙÔ˘ ‰Â›ÎÙË, Û ·ÓÙȉȷÛÙÔÏ‹ Ì ÛÙÂÓÔ‡˜ Û˘ÁÁÂÓ›˜ ·ÛıÂÓÒÓ Ì ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, fiÔ˘ Ë ¤ÎÊÚ·ÛË ‹Ù·Ó ˘„ËÏ‹, ÂÓÈÛ¯‡ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ Èı·ÓfiÙËÙ· ‡·Ú͢ ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ˘fiıÂÛË ÂÚÁ·Û›·˜ ÙËÓ ÎÏÈÓÈ΋ ÔÌÔÈfiÙËÙ· ÌÂٷ͇ Ù˘ SC Î·È ÙˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÔÈ Murphy Î·È Û˘Ó ¤ÏÂÁÍ·Ó ÔÌ¿‰· 31 ·È‰ÈÒÓ Ì TS Î·È πæ¢, ‰È·ÈÛÙÒÓÔÓÙ·˜ ˘„ËÏ‹ ¢·ÈÛıËÛ›· ÙÔ˘ ‰Â›ÎÙË D8/17 ÁÈ· ÙÔ TS Î·È ÙËÓ Iæ¢ (100% Î·È 95%, ·ÓÙ›ÛÙÔȯ·) (8). ™Â ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË 27 ·È‰ÈÒÓ Ì PANDAS Î·È 9 ·È‰ÈÒÓ ÌÂ

∫·Ù¿ ÙÔ˘˜ Swedo Î·È Û˘Ó, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË ÙÔ˘ PANDAS ı· Ú¤ÂÈ Ó· ÏËÚÔ‡ÓÙ·È 5 ÎÚÈÙ‹ÚÈ· (¶›Ó·Î·˜ 1). ∏ ÙÂÎÌËÚ›ˆÛË Ù˘ Ïԛ̈͢ ·fi GABHS ·ÔÙÂÏ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô ‰È·ÁÓˆÛÙÈÎfi Ï›ıÔ Î·È ··ÈÙ› ηٿ‰ÂÈÍË ıÂÙÈ΋˜ ηÏÏȤÚÁÂÈ·˜ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹/Î·È ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ (ASTO, anti-DNase B). ∫·ıÒ˜ ÙÔ PANDAS Î·È Ë SC ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÎÏÈÓÈΤ˜ ÔÌÔÈfiÙËÙ˜ (Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·¿ıÂÈ·, ‰È·Ù·Ú·¯¤˜ ÚÔÛÔ¯‹˜, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ·‰ÂÍÈfiÙËÙ·, ¯ÔÚÂÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ¯ÂÚÈÒÓ Î·È ·ÒÏÂÈ· Ù˘ ÈηÓfiÙËÙ·˜ ÁÈ· ÏÂÙÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜), ÂÈÛËÌ·›ÓÂÙ·È Ë ·Ó¿ÁÎË ·ÓÙȉȷÛÙÔÏ‹˜ ÌÂٷ͇ Ù˘ Ú·ÁÌ·ÙÈ΋˜ ¯ÔÚ›·˜ Ù˘ SC Î·È ÙˆÓ ÌÂÌÔÓˆÌ¤ÓˆÓ “¯ÔÚÂÈfiÌÔÚʈӔ (choreiform) ÎÈÓ‹ÛÂˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ PANDAS (2). ∫·Ù¿ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÓÙÔÙ‹ÙˆÓ Û˘ÓÂÈÎÔ˘ÚÂ›Ù·È ·fi ÙËÓ ·Ô˘Û›· ‚·Ï‚ȉÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÔ PANDAS, Û ·ÓÙ›ıÂÛË Ì ÙËÓ SC, fiÔ˘ ··ÓÙÒÓÙ·È ÛÙÔ _ ÙˆÓ ÂÚÈÙÒÛˆÓ. ∆ËÓ ·Ú¯È΋ ÂÚÈÁÚ·Ê‹ ·ÎÔÏÔ‡ıËÛ ÚÔ‰ÚÔÌÈ΋ ÌÂϤÙË, ·fi ·ÓÂÍ¿ÚÙËÙË ÔÌ¿‰·, 12 ·ÛıÂÓÒÓ Ô˘ ıˆڋıËΠfiÙÈ ÏËÚÔ‡Ó Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ PANDAS (5). ∆˘ ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÚÔËÁ‹ıËΠÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ·, ÂÓÒ ·Ó·Ê¤ÚÂÙ·È ‡ÊÂÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ (πæ¢ Î·È ÙÈÎ) ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ηٿÏÏËÏ˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜. ™Â ÚfiÛÊ·ÙË Â›Û˘, ÚÔ‰ÚÔÌÈ΋, ÌÂϤÙË, Ô Cardona ÌÂϤÙËÛ ÔÌ¿‰· 150 ·È‰ÈÒÓ Ì ÙÈÎ, ‰È·ÈÛÙÒÓÔÓÙ·˜ ÛËÌ·ÓÙÈο ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù›ÙÏÔ˘ ASTO Û ۯ¤ÛË Ì ÔÌ¿‰· Ì·ÚÙ‡¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· PANDAS (ηٿ Swedo et al)

1. ¶·ÚÔ˘Û›· πæ¢ ‹/Î·È ÙÈÎ (ηٿ DSM πππ-R ‹ IV)* 2. ŒÓ·ÚÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÌÂٷ͇ 3 ÂÙÒÓ Î·È ·Ú¯‹˜ ÂÊ˂›·˜ 3. ∞ÈÊÓ›‰È· ¤Ó·ÚÍË Û˘ÌÙˆÌ¿ÙˆÓ ‹ ÔÚ›· ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ‰Ú·Ì·ÙÈΤ˜ ÂÍ¿ÚÛÂȘ. ∆· Û˘ÌÙÒÌ·Ù· ˘Ê›ÂÓÙ·È ÌÂٷ͇ ÙˆÓ ÂÍ¿ÚÛÂˆÓ Î·È ÂÓ›ÔÙ ÂÍ·Ê·Ó›˙ÔÓÙ·È ÙÂÏ›ˆ˜ 4. ™˘Û¯¤ÙÈÛË Ì Ïԛ̈ÍË ·fi GABHS: Ë ¤Í·ÚÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ú¤ÂÈ Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì Ïԛ̈ÍË ·fi GABHS (.¯. ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹/Î·È ·˘ÍË̤ÓÔÈ Ù›ÙÏÔÈ ·ÓÙÈۈ̿وÓ) (ηٿ ÚÔÙ›ÌËÛË Û 2 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ) 5. ¶·ıÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË (˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ¯ÔÚÂȷΤ˜ ÎÈÓ‹ÛÂȘ, ÙÈÎ) ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÍ¿ÚÛÂˆÓ * Diagnostic and Statistical Manual of Mental Disorders. 3rd revised/4th ed. American Psychiatry Association ¶·È‰È·ÙÚÈ΋ 2006;69:97-103

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·100

100

µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

SC, ‰È·ÈÛÙÒıËΠ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ Û ÔÛÔÛÙfi 85% Î·È 89%, ·ÓÙ›ÛÙÔȯ· (9), Ì ÌÂȈ̤ÓË ˆÛÙfiÛÔ ÂȉÈÎfiÙËÙ· Î·È ÁÈ· ÙȘ ‰‡Ô ÔÓÙfiÙËÙ˜. ∂›Ó·È, ÂÔ̤ӈ˜, ÚÔÊ·Ó¤˜ fiÙÈ Ë ¤ÎÊÚ·ÛË ÙÔ˘ ‰Â›ÎÙË D8/17 ÌfiÓË ‰ÂÓ ·ÚΛ ÁÈ· ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ ·È‰ÈÒÓ Ì PANDAS Î·È ·˘ÙÒÓ Ì TS Î·È πæ¢. ∂ÈϤÔÓ, Ë ¯ÚËÛÈÌfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ ·Ú·Ì¤ÓÂÈ ÂÚÈÔÚÈṲ̂ÓË, ηıÒ˜ ‰ÂÓ ‰È·Ù›ıÂÙ·È ·ÎfiÌË ÂÌÔÚÈο. ∞ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ÛıÂÓÒÓ Ì SC ¤¯Ô˘Ó ηٷ‰Â›ÍÂÈ ÙËÓ ‡·ÚÍË ‚Ï·‚ÒÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, ΢ڛˆ˜ Ì ÙË ÌÔÚÊ‹ ·‡ÍËÛ˘ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ÎÂÚÎÔÊfiÚÔ˘ ˘Ú‹Ó·, ÙÔ˘ ÎÂχÊÔ˘˜ Î·È Ù˘ ˆ¯Ú‹˜ ÛÊ·›Ú·˜. ™Â ÌÂϤÙË 34 ·È‰ÈÒÓ Ì PANDAS Î·È 82 Ì·ÚÙ‡ÚˆÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ Î·È ÛÙËÓ ÔÌ¿‰· PANDAS (10). ∏ ·‡ÍËÛË ·˘Ù‹ ·Ô‰fiıËΠ۠ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›·, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·˘ÙÔ¿ÓÔÛ˘ ·¿ÓÙËÛ˘ ÛÙËÓ ·Ú¯È΋ ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË. ∏ ÎÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÂÏÂÙÒÓ Ì·ÁÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ ·Ú·Ì¤ÓÂÈ ÂÚÈÔÚÈṲ̂ÓË, ηıÒ˜ Ë Ì¤ıÔ‰Ô˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂȈ̤ÓË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔ PANDAS Î·È ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘. £ÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË ∏ SC ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÔÚ›·, Ì ÙË Û˘Ìو̷ÙÔÏÔÁ›· Ó· ˘Ô¯ˆÚ› Û ÌÂÚÈΤ˜ ‚‰ÔÌ¿‰Â˜ ‹ Î·È Ì‹Ó˜. ∆Ô ·ÓÔÛÔÏÔÁÈÎfi ·ıÔÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ ·ÔÙ¤ÏÂÛ ÙÔ ¤ÚÂÈÛÌ· ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎÒÓ ıÂÚ·¢ÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ Û ·ÛıÂÓ›˜ Ì ¯ÚÔÓ›˙Ô˘Û· ÔÚ›·. ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ÂÓ‰ÔÊϤ‚È· Á-ÛÊ·ÈÚ›ÓË (IVIG) Î·È Ï·ÛÌ·Ê·›ÚÂÛË ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı›, Ì ·ÌÊÈÏÂÁfiÌÂÓ· ˆÛÙfiÛÔ ·ÔÙÂϤÛÌ·Ù·. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ SC ˆ˜ ÚfiÙ˘Ô, Ë ÔÌ¿‰· Ù˘ Swedo ‰ËÌÔÛ›Â˘Û ÙÔ 1999 ÌÂϤÙË 30 ·È‰ÈÒÓ Ì PANDAS, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì IVIG Î·È Ï·ÛÌ·Ê·›ÚÂÛË, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· ÂϤÁ¯ıËÎ·Ó ¤Ó·ÓÙÈ ÔÌ¿‰·˜ Ô˘ ¤Ï·‚ placebo IVIG (Ì ÙË ÌÔÚÊ‹ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡), fi¯È fï˜ Î·È placebo Ï·ÛÌ·Ê·›ÚÂÛ˘ (ÁÈ· ËıÈÎÔ‡˜ ÏfiÁÔ˘˜) (11). ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó ·ÚfiÌÔÈ·, "‚·ÚÈ¿" ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ì ‚¿ÛË ÂȉÈο ‰È·ÌÔÚʈ̤ÓË ÎÏÈÓÈ΋ Îϛ̷η ·ÍÈÔÏfiÁËÛ˘ Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜. ™Â ‰È¿ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜, ·Ó·Ê¤ÚÂÙ·È ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó IVIG ‹ Ï·ÛÌ·Ê·›ÚÂÛË, ¯ˆÚ›˜ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¶·È‰È·ÙÚÈ΋ 2006;69:97-103

ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó placebo. ™Â ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜, 80% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚·Ó IVIG ‹ ˘Ô‚Ï‹ıËÎ·Ó Û Ï·ÛÌ·Ê·›ÚÂÛË ·Ú¤ÌÂÈÓ Û ‡ÊÂÛË. ∫·ıÒ˜, ˆÛÙfiÛÔ, ÙÔ 50% ·˘ÙÒÓ Û˘Ó¤¯È˙ ӷ Ï·Ì‚¿ÓÂÈ ÙËÓ ·Ú¯È΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (SSRIs ‹ Ó¢ÚÔÏËÙÈο), Ù· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ·ÍÈÔÏÔÁËıÔ‡Ó. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi, ηıÒ˜ Î·È ÙÔ fiÙÈ Ë ¯ÔÚ‹ÁËÛË IVIG Î·È Ë Ï·ÛÌ·Ê·›ÚÂÛË ·Ú·Ì¤ÓÔ˘Ó Ì¤ıÔ‰ÔÈ ·ÚÂÌ‚·ÙÈΤ˜ Î·È ‰··ÓËÚ¤˜ Î·È Ì ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, Ô‰‹ÁËÛ Û ¤Î‰ÔÛË Ô‰ËÁ›·˜ ·fi ÙÔ ∞ÌÂÚÈηÓÈÎfi πÓÛÙÈÙÔ‡ÙÔ æ˘¯È΋˜ ÀÁ›·˜ (¡πª∏) ÁÈ· ·ÔÊ˘Á‹ ÙˆÓ ·Ú·¿Óˆ ÌÂıfi‰ˆÓ ̤¯ÚÈ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÌÂÁ·Ï‡ÙÂÚˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ·ÓÔÛÔÙÚÔÔÔÈËÙÈ΋˜ ·Ú¤Ì‚·Û˘. ¶ÚÔʇϷÍË ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÂÓÈÎÈÏ›Ó˘ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Â›Ó·È ÁÓˆÛÙ‹ Î·È ÙÂÎÌËÚȈ̤ÓË, ÂÓÒ ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ PANDAS ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË. ª›· ÈÏÔÙÈ΋ ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË ÂÚȤϷ‚ 37 ·È‰È¿ Ì PANDAS, ÛÙ· ÔÔ›· ÌÂÏÂÙ‹ıËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¯ÔÚ‹ÁËÛ˘ per os ÂÓÈÎÈÏ›Ó˘ ¤Ó·ÓÙÈ placebo (12). ∞Ó Î·È ÙÔ ÂӉȷʤÚÔÓ ÁÈ· ÙËÓ ¤Î‚·ÛË Ù˘ ÌÂϤÙ˘ ˘‹ÚÍ ·Ú¯Èο ˙ˆËÚfi, ηıÒ˜ ›¯Â ‹‰Ë ÂÎÊÚ·ÛÙ› Ë Èı·ÓfiÙËÙ· ·ıÚÔÈÛÙÈ΋˜ ‰Ú¿ÛË ÙˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙËÓ ÔÚ›· Î·È ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ PANDAS, Ù· ·ÔÙÂϤÛÌ·Ù¿ Ù˘ ‰ÂÓ Î·Ù¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ‹ ÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ∞ÓÙ›ıÂÙ·, ‰Â‰Ô̤ӷ ·fi ¿ÏÏË ÌÂϤÙË Î·Ù·‰ÂÈÎÓ‡Ô˘Ó ‚ÂÏÙ›ˆÛË ÙˆÓ ÂÍ¿ÚÛÂˆÓ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ·fi ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ (5). ∏ ÌÂϤÙË ·˘Ù‹ ¤¯ÂÈ ‰Â¯ı› ÎÚÈÙÈ΋ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Û¯Â‰È·ÛÌfi Ù˘, ηıÒ˜ ‰ÂÓ Â›Ó·È Ù˘ÊÏ‹ Î·È ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È placebo. ∫·ıÒ˜ ÙÔ Ê·ÈÓfiÌÂÓÔ placebo ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿ ÛÙÔ TS Î·È ÛÙËÓ πæ¢ Î·È Ë Ê˘ÛÈ΋ ÙÔ˘˜ ÔÚ›· ÙÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, ηı›ÛÙ·Ù·È Èı·Ó‹ Ë Ê·ÈÓÔÌÂÓÈ΋ ÂÈÙ˘¯›· ÔÔÈ·Û‰‹ÔÙ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙÔ ÛÙ¿‰ÈÔ ¤Í·ÚÛ˘ Ù˘ ÓfiÛÔ˘. ∏ ‰È‡ڢÓÛË ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ PANDAS ∂ÎÙfi˜ ·fi Ù· ÙÈÎ Î·È ÙËÓ πæ¢, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰È¿ÊÔÚ˜ ÔÓÙfiÙËÙ˜ ¤¯Ô˘Ó ÚÔÙ·ı› ˆ˜

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·101

101

ÀfiıÂÛË PANDAS

˘Ô„‹ÊȘ ÚÔ˜ ¤ÓÙ·ÍË ÛÙÔ ÎÏÈÓÈÎfi Ê¿ÛÌ· ÙÔ˘ PANDAS. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ÂÚÈÁÚ¿ÊÂÙ·È ÔÌ¿‰· 4 ·È‰ÈÒÓ ÛÙ· ÔÔ›· Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ Ó¢ÚÔÁÂÓÔ‡˜ ·ÓÔÚÂÍ›·˜ (¡∞), ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ PANDAS (13). ™Â 2 ·fi ·˘Ù¿ ‰È·ÈÛÙÒıËÎ·Ó Û˘ÌÙÒÌ·Ù· πæ¢, ÂÓÒ Ë ·ÚÂÏıÔ‡Û· ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË ÙÂÎÌËÚÈÒıËΠÛÙË ‚¿ÛË ·˘ÍËÌ¤ÓˆÓ Ù›ÙÏˆÓ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈۈ̿وÓ. ™˘Û¯¤ÙÈÛË ‰È·ÈÛÙÒıËΠÌÂٷ͇ ÂÂÈÛÔ‰›ˆÓ ·Ú·ÚÚÈÓÈÎÔÏ›Ùȉ·˜ Î·È ÂÍ¿ÚÛÂˆÓ Ù˘ Ó¢ÚÔÁÂÓÔ‡˜ ·ÓÔÚÂÍ›·˜, ÂÓÒ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Ì ¯ÔÚ‹ÁËÛË ·ÌÔ͢ÎÈÏÏ›Ó˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ô‰‹ÁËÛ Û ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ‡ÊÂÛË ÙˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ Û˘Ìو̿وÓ. ™ËÌ·ÓÙÈΤ˜ ÂÓÛÙ¿ÛÂȘ ÌÔÚÔ‡Ó Ó· ÂÎÊÚ·ÛÙÔ‡Ó fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ·ÚÂÏıÔ‡Û·˜ ÛÙÚÂÙÔÎÔÎÎÈ΋˜ Ïԛ̈͢ Î·È ÛÙËÓ ÂȯÂÈÚÔ‡ÌÂÓË Û˘Û¯¤ÙÈÛË Ù˘ Âȉ›ӈÛ˘ Ù˘ NA Ì ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù˘ Ïԛ̈͢, ·Ú¿ Ì ÙËÓ Î·ÎÔ˘¯›· Ô˘ Ë ÙÂÏÂ˘Ù·›· ·Ï¿ ÂÈʤÚÂÈ. øÛÙfiÛÔ, Ë ÌÂϤÙË Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ú¤¯ÂÈ ÚÔ‰ÚÔÌÈο ÛÙÔȯ›· Èηӿ Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙËÓ ‡·ÚÍË Ì›·˜ ˘ÔηÙËÁÔÚ›·˜ ¡∞ Ô˘ ı· ÌÔÚÔ‡Û ӷ Û˘ÌÂÚÈÏËÊı› ÛÙÔ Ê¿ÛÌ· ÙÔ˘ PANDAS. ªÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË Î·Ù¤‰ÂÈÍ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ D8/17 ‰Â›ÎÙË ÛÙÔ 81% ·ÛıÂÓÒÓ Ì NA Ù‡Ô˘ PANDAS, Û ۯ¤ÛË Ì ÔÛÔÛÙfi ÌfiÏȘ 12% Û ÔÌ¿‰· „˘¯È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ‰È·ÙÚÔÊÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·Ó Î·È ÂÚ·ÈÙ¤Úˆ ÎÚÈÙÈ΋ ı· ÌÔÚÔ‡Û ӷ ·ÛÎËı›, ηıÒ˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi ‰ÂÓ ÂÚÈÏ‹ÊıËΠÔÌ¿‰· PANDAS ¯ˆÚ›˜ ‰È·ÙÚÔÊÈΤ˜ ‰È·Ù·Ú·¯¤˜ (14). ∏ ÎÏÈÓÈ΋ Û˘Ó‡·ÚÍË Ù˘ ¢∂¶À Ì ÙËÓ πæ¢ Î·È Ù· ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿. ¶ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ˆÛÙfiÛÔ, ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ‡·ÚÍË ÌÔÚÊ‹˜ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ¢∂¶À, ¯ˆÚ›˜ ÛÙÔȯ›· πæ¢ ‹ ÙÈÎ, ˆ˜ ÙÌ‹Ì· ÙÔ˘ "·ÛÙÂÚÈÛÌÔ‡" ÙÔ˘ PANDAS, ηıÒ˜ Î·È ÙËÓ ‡·ÚÍË ıÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ·‡ÍËÛ˘ ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, Û ·ÛıÂÓ›˜ Ì ¢∂¶À (15,16).

∫ÚÈÙÈ΋ ıÂÒÚËÛË ∏ ¤ÎÊÚ·ÛË Ù˘ ˘fiıÂÛ˘ PANDAS ˘ÚÔ‰fiÙËÛ ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÂÚ¢ÓËÙÈÎÒÓ ÚÔÛ·ıÂÈÒÓ ÛÙÔÓ ¯ÒÚÔ ÙˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ

‰È·Ù·Ú·¯ÒÓ, ÙfiÛÔ Û ÎÏÈÓÈÎfi Â›Â‰Ô fiÛÔ Î·È Û Â›Â‰Ô ‚·ÛÈÎÒÓ ÂÈÛÙËÌÒÓ. øÛÙfiÛÔ, Ù· ·ÔÙÂϤÛÌ·Ù· Û˘¯Ó¿ ˘‹ÚÍ·Ó ·ÓÙÈÊ·ÙÈο. ™ÎÂÙÈÎÈÛÌfi ÚÔηÏ›, Â›Û˘, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ›‰È· ÙËÓ ÔÌ¿‰· Ù˘ Swedo, ÂÓÒ ÔÈ ·ÓÂÍ¿ÚÙËÙ˜ ÌÂϤÙ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÂÚÈÔÚÈṲ̂Ó˜ Û ·ÚÈıÌfi (5,6,15,17). ∏ ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË ÙˆÓ Kurlan Î·È Kaplan ·ÔÙÂÏ› ÙËÓ ÂÈÙÔÌ‹ ÙˆÓ ·ÓÙÈÚÚ‹ÛÂˆÓ Ô˘ ¤¯Ô˘Ó ÂÎÊÚ·ÛÙ› ̤¯ÚÈ Û‹ÌÂÚ·, Û¯ÂÙÈο Ì ÙËÓ ÙÂÎÌËÚ›ˆÛË Î·È, ÙÂÏÈο, ÙËÓ ‡·ÚÍË ÙÔ˘ PANDAS (18). ∏ ÎÚÈÙÈ΋ ÂÈÎÂÓÙÚÒÓÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·Û¿ÊÂÈ· ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ Ô˘ ¤¯Ô˘Ó ıÂÛÈÛÙ› (¶›Ó·Î·˜ 1). ™˘ÁÎÂÎÚÈ̤ӷ: ·) OÈ ÏfiÁÔÈ Ù˘ ÂÈÏÂÎÙÈ΋˜ ÚÔÛ‚ÔÏ‹˜ Û˘ÁÎÂÎÚÈ̤Ó˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ ·È‰ÈÒÓ ‰ÂÓ ÙÂÎÌËÚÈÒÓÔÓÙ·È Â·ÚÎÒ˜. ŒÙÛÈ, ·˘Ù‹ ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› ÛÙ· ÚfiÙ˘· ·Ú·ÔÌ‹˜ ‹ Î·È ÛÙËÓ ·˘ÍË̤ÓË ¤ÎıÂÛË ÛÙÔÓ GABHS ÛÙÔ Û¯ÔÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ™ÙÔÓ ·ÓÙ›ÏÔÁfi ÙÔ˘˜, ÔÈ Swedo Î·È Û˘Ó ÂÈηÏÔ‡ÓÙ·È ÌÂϤÙË ÙÔ˘ Fischetti, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· Ë ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÂÈÏÔÎÒÓ ÛÙË ÌÂÙÂÊË‚È΋ ËÏÈΛ· ·Ô‰›‰ÂÙ·È ÛÙËÓ ‡·ÚÍË "ÚÔÛٷ٢ÙÈÎÔ‡" Ù›ÙÏÔ˘ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÂÊ˂›·˜ (19,20). øÛÙfiÛÔ, Ë ÂÚÌËÓ›· ·˘Ù‹ ÌÔÚ› Ó· ıˆÚËı› ·‚¿ÛÈÌË, ηıÒ˜ Ë ÏÔÈÌÔÁfiÓÔ˜ ÈηÓfiÙËÙ· ÙÔ˘ GABHS ÂÍ·ÚÙ¿Ù·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ·fi ÙËÓ ÚˆÙ½ÓË ª ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÙˆÓ ÈÓȉ›ˆÓ ÙÔ˘, Ë Ù·˘ÙfiÙËÙ· Ù˘ ÔÔ›·˜ ηıÔÚ›˙ÂÈ Î·È ÙÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ (¿Óˆ ·fi 80) ÔÚÔÙ‡Ô˘˜ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ™ÙÂϤ¯Ë ÏÔ‡ÛÈ· Û ÚˆÙ½ÓË ª ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÔ¯‹ ÛÙË Ê·ÁÔ΢ÙÙ¿ÚˆÛË, ÂÓÒ ÛÙÂϤ¯Ë ÊÙˆ¯¿ Û ÚˆÙ½ÓË ª fi¯È. ∆Ô ª ÚˆÙÂ˚ÓÈÎfi ·ÓÙÈÁfiÓÔ ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÚÔÛٷ٢ÙÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ù· ÔÔ›· ˆÛÙfiÛÔ ÂÌÊ·Ó›˙Ô˘Ó ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ÌfiÓÔ ·ÓÙÈÁÔÓÈÎfi Ù‡Ô. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÔÈ ÛÙÚÂÙÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó Û ¤Ó· ÂÍ·ÈÚÂÙÈο ¢ڇ Ê¿ÛÌ· ÔÚÔÙ‡ˆÓ Î·È Î·ıÒ˜ ·ÎfiÌ· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë Ù·˘ÙfiÙËÙ· ·˘ÙÒÓ Ô˘ ÌÔÚ› Ó· ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ PANDAS, Ë ˘ÔÛÙ‹ÚÈÍË Ù˘ Â›Ù¢Í˘ ηıÔÏÈ΋˜ ·ÓÔÛ›·˜ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ ÔÚÔÙ‡ˆÓ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÌÔÈ¿˙ÂÈ ·Ú·ÎÈÓ‰˘ÓÂ˘Ì¤ÓË (21). ‚) O ÔÚÈÛÌfi˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ¯·Ú·ÎÙ‹Ú· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ˆ˜ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÚÔηÏ› Û‡Á¯˘ÛË, ηıÒ˜ - ÁÈ· ·Ú¿‰ÂÈÁÌ· - Ë ·ÚÔ˘Û›· ÙˆÓ ÙÈÎ ÌÔÚ› Ó· ÔÚÈÛÙ› ¶·È‰È·ÙÚÈ΋ 2006;69:97-103

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·102

102

µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.

ÌÔÓÔÛ‹Ì·ÓÙ· (·Ï¿ ˘¿Ú¯Ô˘Ó ‹ ‰ÂÓ ˘¿Ú¯Ô˘Ó). ∂›Û˘, ·ÌÊÈ‚Ôϛ˜ ÂÎÊÚ¿˙ÔÓÙ·È ÁÈ· ÙÔ ·Ó Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋, Ì ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, ÎÏÈÓÈ΋ ÔÚ›·, ÂÌÊ·Ó›˙ÂÈ ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔ PANDAS, ηıÒ˜ ·ÚfiÌÔÈ· ÔÚ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È ÔÈ Û˘Ì‚·ÙÈÎfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, fiˆ˜ Ù· ÌÂÌÔӈ̤ӷ ÙÈÎ ‹ Ë πæ¢. Á) ∏ Û˘Û¯¤ÙÈÛË Ù˘ ¤Í·ÚÛ˘ Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ì ÚÔËÁËı›۷ ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË ·ÔÙÂÏ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô ‰È·ÁÓˆÛÙÈÎfi Ï›ıÔ ÙÔ˘ PANDAS. øÛÙfiÛÔ, Ë Û˘Û¯¤ÙÈÛË ·˘Ù‹ ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÂȂ‚·Èˆı› Ì ÚÔ‰ÚÔÌÈΤ˜ ÌÂϤÙ˜. ∂ÈϤÔÓ, Ë ¤ÏÏÂÈ„Ë ÎÏÈÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ‰ËÌÈÔ˘ÚÁ› Û‡Á¯˘ÛË, ηıÒ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ÌÔÚ› Ó· ·ÓÙÈÚÔÛˆ‡ÂÈ ·ÏÔ‡˜ ÊÔÚ›˜, ÂÓÒ Î·È Ô ·˘ÍË̤ÓÔ˜ Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ·ÚΛ ÁÈ· ÙËÓ Î·Ù¿‰ÂÈÍË ÂÓÂÚÁÔ‡ Ïԛ̈͢. ∫·ıÒ˜ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·Ú·Ì¤ÓÂÈ ÂÍ·ÈÚÂÙÈο ÌÂÁ¿ÏË ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ë ÂȂ‚·›ˆÛË Ù˘ Ïԛ̈͢ ·ÎÔÏÔ˘ı› Ì›· ·Û·ÊÒ˜ ηıÔÚÈ˙fiÌÂÓË Î·È ¯·Ï·Ú‹ ÌÂıÔ‰ÔÏÔÁ›·, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÛÙÔ ÎÏÈÓÈÎfi Ê¿ÛÌ· ÙÔ˘ PANDAS ı· ÌÔÚÔ‡Û ‡ÎÔÏ· Ó· ÂÓÙ·¯ı› ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ. ¶·ÚfiÌÔÈ· "¯·Ï·Ú‹" ÌÂıÔ‰ÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË Â¤ÙÚ„ ÛÂ Û˘ÁÁÚ·Ê›˜ ηٿ ÙÔ ·ÚÂÏıfiÓ Ó· ÂÎÊÚ¿ÛÔ˘Ó ·Ó¿ÏÔÁ˜ ıˆڛ˜ Û¯ÂÙÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ÔÚʇڷ˜ Henoch-Schönlein ‹ Ù˘ ÓfiÛÔ˘ Kawasaki. ∏ ‰ËÌÈÔ˘ÚÁÔ‡ÌÂÓË Û‡Á¯˘ÛË Û¯ÂÙÈο Ì ÙÔÓ ÚfiÏÔ ÙÔ˘ GABHS ı· ÌÔÚÔ‡Û ӷ ¢ԉˆı› ÂÚ·ÈÙ¤Úˆ, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙËÓ Âȉ›ӈÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ·È‰È¿ Ì ÙÈÎ ‹ πæ¢ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ ÂÌ‡ÚÂÙË Ïԛ̈͢, ÏfiÁˆ Ù˘ ηÎÔ˘¯›·˜ Î·È ÙÔ˘ stress. ‰) ™ËÌ·ÓÙÈΤ˜ ·ÌÊÈ‚Ôϛ˜ ÂÁ›ÚÔÓÙ·È Û¯ÂÙÈο Ì ÙËÓ ÂȉÈÎfiÙËÙ· ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ ‰È·ÁÓˆÛÙÈÎÔ‡ ÎÚÈÙËÚ›Ô˘, Ù˘ ·ÚÔ˘Û›·˜ ‰ËÏ·‰‹ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·Ù¿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË. OÈ Swedo Î·È Û˘Ó ·ÓÙȉȷÛÙ¤ÏÏÔ˘Ó ÙËÓ Ù˘È΋, ıÔÚ˘‚Ò‰Ë Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ SC Î·È ÙȘ ȉÈfiÌÔÚʘ ÎÈÓËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ("¯ÔÚfi˜ ÙÔ˘ ∞Á›Ô˘ µ›ÙÔ˘"), Ì ÙȘ ‹Ș, "¯ÔÚÂÈfiÌÔÚʘ" ("Û·Ó ·›ÍÈÌÔ È¿ÓÔ˘") ‰È·Ù·Ú·¯¤˜ ÙÔ˘ PANDAS. ™˘¯Ó¿, ˆÛÙfiÛÔ, ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÌÔÚʤ˜ SC Ì ‹È· ‹ ¿Ù˘Ë Û˘Ìو̷ÙÔÏÔÁ›· (22). ∂ÈϤÔÓ, ηıÒ˜ Ë SC ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ÎÏÈÓÈÎfi Î·È ·ıÔÁÂÓÂÙÈÎfi ÌÔÓÙ¤ÏÔ ÁÈ· ÙÔ PANDAS Î·È ÔÈ ‰‡Ô ÔÓÙfiÙËÙ˜ ÌÔÈÚ¿˙ÔÓÙ·È ÎÔÈÓ¿ ·ÓÔÛÔÏÔÁÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·, Â›Ó·È ·ÌÊ›‚ÔÏÔ Î·Ù¿ fiÛÔÓ ¤Ó· ÙfiÛÔ ·Û·Ê¤˜ ÎÏÈÓÈÎfi ÎÚȶ·È‰È·ÙÚÈ΋ 2006;69:97-103

Ù‹ÚÈÔ Â·ÚΛ ÁÈ· Ó· ‰È·ÎÚ›ÓÂÈ ÙÔ PANDAS ·fi ÙȘ ¿Ù˘˜ ‹ ‹Ș ÌÔÚʤ˜ Ù˘ SC.

™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ‚¿ÛË Ù· ̤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛÈÂ˘Ì¤Ó· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÙÔ PANDAS ·Ú·Ì¤ÓÂÈ Ì›· ÂÍ·ÈÚÂÙÈο ÂӉȷʤÚÔ˘Û·, ·ÏÏ¿ ·ÎfiÌ· ·Ó·fi‰ÂÈÎÙË ˘fiıÂÛË. §fiÁˆ Ù˘ ·Û¿ÊÂÈ·˜ ÙˆÓ ÚÔÙÂÈÓfiÌÂÓˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ, ÛÙÔ ‰È·ÁÓˆÛÙÈÎfi Ê¿ÛÌ· ÙÔ˘ PANDAS ı· ÌÔÚÔ‡Û·Ó Û¯ÂÙÈο ‡ÎÔÏ· Ó· Ù·ÍÈÓÔÌËıÔ‡Ó ·È‰È¿ ÌÂ Û˘Ì‚·ÙÈÎfiÙÂÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ù· ·Ï¿ Î·È Î·ÏÔ‹ıË ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‹ Ë SC. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ηıÈÛÙ¿ ÙËÓ ‡·ÚÍË ÙÔ˘ PANDAS ·ÌÊ›‚ÔÏË. ∫·ıÒ˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ‹ ÚÔÊ˘Ï·ÎÙÈÎÒÓ Ì¤ÙÚˆÓ Ô˘ ¤¯Ô˘Ó ÚÔÙ·ı› ̤¯ÚÈ Û‹ÌÂÚ· ·ÌÊÈÛ‚ËÙÂ›Ù·È ÈÛ¯˘Ú¿, Ë ·Ó·ÌÔÓ‹ ·fi ÙÔÓ ·È‰›·ÙÚÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Â˘Ú‡ÙÂÚˆÓ Î·È ÌÂıÔ‰ÔÏÔÁÈο ÏËÚ¤ÛÙÂÚˆÓ ÌÂÏÂÙÒÓ ıˆÚÂ›Ù·È ÙfiÛÔ ·ÛÊ·Ï‹˜ fiÛÔ Î·È ÂȂ‚ÏË̤ÓË.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kiessling LS. Tic disorders associated with evidence of invasive group A beta hemolytic streptococcal disease. Dev Med Child Neurol 1989;31 (Suppl 59):S48.

2. Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998;155:264-271.

3. Snider LA, Swedo SE. Pediatric obsessive-compulsive disorder. JAMA 2000;284:3104-3106.

4. Husby G, van de Rijn I, Zabriskie JB, Abdin ZH, Williams RC Jr. Antibodies reacting with cytoplasm of subthalamic and caudate nuclei neurons in chorea and acute rheumatic fever. J Exp Med 1976;144:1094-1110.

5. Murphy ML, Pichichero ME. Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS).

Arch Pediatr Adolesc Med 2002;156:356-361.

6. Cardona F, Orefici G. Group A streptococcal infections and tic disorders in an Italian pediatric population. J Pediatr 2001;138:71-75.

7. Khanna AK, Buskirk DR, Williams RC Jr, Gibofsky A, Crow MK, Menon A et al. Presence of a non-HLA B cell antigen in rheumatic fever patients and their families as defined by a monoclonal antibody. J Clin Invest 1989;83:1710-1716.

8. Murphy TK, Goodman WK, Fudge MW, Williams RC Jr, Ayoub EM, Dalal M et al. B lymphocyte antigen D8/17: a peripheral marker for childhood-onset

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obsessive-compulsive disorder and Tourette’s syndrome? Am J Psychiatry 1997;154:402-407.

Swedo SE, Leonard HL, Mittleman BB, Allen AJ, Rapoport JL, Dow SP et al. Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry 1997;154:110-112.

Giedd JN, Rapoport JL, Garvey MA, Perlmutter S, Swedo SE. MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. Am J Psychiatry 2000;157: 281-283.

Perlmutter SJ, Leitman SF, Garvey MA, Hamburger S, Feldman E, Leonard HL et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 1999;354:1153-1158.

Garvey MA, Perlmutter SJ, Allen AJ, Hamburger S, Lougee L, Leonard HL et al. A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry 1999;45:1564-1571.

Sokol MS. Infection-triggered anorexia nervosa in children: clinical description of four cases. J Child Adolesc Psychopharmacol 2000;10:133-145.

Sokol MS, Ward PE, Tamiya H, Kondo DG, Houston D, Zabriskie JB. D8/17 expression on B lymphocytes in anorexia nervosa. Am J Psychiatry 2002;159: 1430-1432.

Waldrep DA. Two cases of ADHD following GABHS infection: a PANDAS subgroup? J Am Acad

Child Adolesc Psychiatry 2002;41:1273-1274.

16. Peterson BS, Leckman JF, Tucker D, Scahill L, Staib L, Zhang H et al. Preliminary findings of antistreptococcal antibody titers and basal ganglia volumes in tic, obsessive-compulsive, and attention deficit/hyperactivity disorders. Arch Gen Psychiatry 2000;57: 364-372.

17. Pavone P, Bianchini R, Parano E, Incorpora G, Rizzo R, Mazzone L et al. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatr Neurol 2004;30:107-110.

18. Kurlan R, Kaplan EL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity?

Practical considerations for the clinician. Pediatrics 2004;113:883-886.

19. Swedo SE, Leonard HL, Rapoport JL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction. Pediatrics 2004;113: 907-911.

20. Fischetti VA. The Streptococcus and the host. Present and future challenges. Adv Exp Med Biol 1997; 418:15-20.

21. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 2000;13:470511.

22. Aron AM, Freeman JM, Carter S. The natural history of Sydenham’s chorea. Review of the literature and long-term evaluation with emphasis on cardiac sequelae. Am J Med 1965;38:83-95.

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REVIEW ARTICLE

§ÈÛÙÂÚ›ˆÛË Î·Ù¿ ÙËÓ Î‡ËÛË 1 ∂ÈÌÂÏ‹ÙÚÈ· ∞’, °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÙÙÈÎfiÓ” 2 ∂ÈÌÂÏËÙ‹˜ ∞’, °’ ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÙÙÈÎfiÓ” AÏÏËÏÔÁÚ·Ê›·: ¶·Ó·ÁÈԇϷ ª¤ÍË-ªÔ˘ÚÓ¿, ™ÈÓÒ˘ 4, T.K. 145 72, ¢ÚÔÛÈ¿ E-mail: ymexi@hotmail.com ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-03-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-09-2005

¶. ª¤ÍË - ªÔ˘ÚÓ¿1, ¡. ªÔ˘ÚÓ¿˜2

¶ÂÚ›ÏË„Ë: ∏ ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ·fi Listeria monocytogenes Â›Ó·È ÌÈ· Û¿ÓÈ· ÓfiÛÔ˜ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜, Ô˘ ˆÛÙfiÛÔ ÂÌÊ·Ó›˙ÂÈ ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· Î·È ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·. ∏ ÌÂÙ¿‰ÔÛ‹ Ù˘ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ̤ۈ ÙˆÓ ÙÚÔÊÒÓ. ∂ÓÙÔ›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Û ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ Î·È ËÏÈÎȈ̤ӷ ¿ÙÔÌ·, ·ÏÏ¿ Î·È Î·Ù¿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô, ÚÔÛ‚¿ÏÏÔÓÙ·˜ ΢ڛˆ˜ Ù· ¤Ì‚Ú˘· Î·È Ù· ÓÂÔÁÓ¿. ¡fiÛËÛË Ù˘ ÂÁ·Ԣ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ Î·È ÙÔ˘ ‰Â˘Ù¤ÚÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘, Û˘Ó‹ıˆ˜, Ô‰ËÁ› Û ·Ô‚ÔÏ‹. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ÚÔηÏ› ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘, ÚfiˆÚÔ ÙÔÎÂÙfi, ıÓËÛÈÁÂÓ‹ ÓÂÔÁÓ¿ Î·È ÂÌÊ¿ÓÈÛË Ïԛ̈͢ ÛÙÔ ÓÂÔÁÓfi ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ™ÙÔ ÓÂÔÁÓfi Ë ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ÛË„·ÈÌ›·, Ó¢ÌÔÓ›· ‹ ÌËÓÈÁÁ›Ùȉ·. ∫·Ù¿ÏÏËÏË ıÂÚ·›· Ù˘ ÂÁ·Ԣ ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ ÙËÓ ÂΉ‹ÏˆÛË ·ıÔÏÔÁÈÎÒÓ ÛËÌ›ˆÓ ÛÙÔ ÓÂÔÁÓfi. ¶·ÚfiÙÈ Ë ÏÈÛÙ¤ÚÈ· Â›Ó·È Â˘·›ÛıËÙË Û fiÏ· Ù· ÎÔÈÓ¿ ·ÓÙÈ‚ÈÔÙÈο ÂÎÙfi˜ ·fi ÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜ ÙÚ›Ù˘ ÁÂÓÈ¿˜, Ë ıÂÚ·›· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÏÈÛÙÂÚ›ˆÛ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔ‚Ï‹Ì·Ù·. ∆Ô Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ Â›Ó·È Ë ·ÌÈÎÈÏÏ›ÓË, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ÓÂÔÁÓÈ΋˜ ÓfiÛÔ˘ Î·È Û ÌËÓÈÁÁ›Ùȉ· ·fi ÏÈÛÙ¤ÚÈ·. ¶ÚÔÊ˘Ï·ÎÙÈο ̤ÙÚ· ÁÈ· ÙË ‰È·¯Â›ÚÈÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÚÔÏËÙÈο ̤ÙÚ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ‰ÈÂıÓÒ˜ ÙË Û˘¯ÓfiÙËÙ· Ù˘ ÏÈÛÙÂÚ›ˆÛ˘. ∂‰Ò ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ë ‰È¿ÁÓˆÛË Î·È Ë ıÂÚ·›· Ù˘ ÓfiÛÔ˘, ηıÒ˜ Î·È ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù‹Ó. §¤ÍÂȘ ÎÏÂȉȿ: §ÈÛÙ¤ÚÈ· ÌÔÓÔ΢ÙÔÁfiÓÔ˜, ·ËÛË, ÓÂÔÁÓ¿.

Listeriosis during pregnancy 1 Registrar ∞, 3rd Paediatric Clinic, University of Athens, “Attikon” University Hospital, Athens 2 Registrar ∞, 3rd Obstetrics and Gynaecology Clinic, University of Athens, “Attikon” University Hospital, Athens Correspondence: Panagioula Mexi-Bourna, 4 Sinopis Str., 145 72, Drossia E-mail: ymexi@hotmail.com Date of submission: 23-03-2005 Date of approval: 12-09-2005

P. Mexi - Bourna1, N. Bournas2

Abstract: Listeriosis is an uncommon infection, caused by strains of the bacteria Listeria monocytogenes, with a severe clinical presentation, neurological sequelae and a high mortality rate.

Contaminated food is the usual source of infection. Listeriosis has a predilection for immunocompromised persons, the elderly, pregnant women, and especially fetuses and neonates.

Infection during the first and second trimester of pregnancy leads to miscarriage. Infection in late pregnancy may lead to intrauterine growth retardation, prematurity, stillbirth or death of the infant after birth. In newborn infants invasive disease is manifested as septicaemia, pneumonia and meningitis.

The treatment of listeriosis in the pregnant woman has resulted in successful in utero therapy of the fetus. Listeria monocytogenes strains are susceptible to nearly all common antibiotics but therapeutic success is impeded by the particular biological behaviour of these bacteria. High-dose ampicillin is the treatment of choice and gentamicin is added in the case of neonatal disease and meningitis. Surveillance of foodstuffs is the most effective strategy for prevention of the disease. Pregnant consumers should be widely and continually informed about recommendations on handling of food. The epidemiology, diagnosis, and management of Listeria infection in pregnancy are reviewed.

Key words: Listeriosis, pregnancy, infant.

∏ Listeria monocytogenes Â›Ó·È ¤Ó· ıÂÙÈÎfi ηٿ Gram ÂÓ‰Ô- Î·È ÂÍˆÎ˘ÙÙ¿ÚÈÔ ‚·ÎÙËÚ›‰ÈÔ. ∞ÔÙÂÏ› ÙÔÓ ÌfiÓÔ Ù‡Ô ÏÈÛÙ¤ÚÈ·˜ Ô˘ Â›Ó·È ·ıÔÁfiÓÔ˜ ÙfiÛÔ ÁÈ· Ù· ˙Ò· fiÛÔ Î·È ÁÈ· ÙÔÓ ¿ÓıÚˆÔ. ∏ ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË Û˘Óԉ‡ÂÙ·È ·fi ÌÂÁ¿ÏÔ Î›Ó‰˘ÓÔ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô Î·È ÛÔ‚·Ú‹ ¶·È‰È·ÙÚÈ΋ 2006;69:104-109

ÓÂÔÁÓÈ΋ ÓfiÛÔ (1). ∏ Listeria monocytogenes ÌÂÙ·‰›‰ÂÙ·È ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ΢ڛˆ˜ Ì ٷ ÙÚfiÊÈÌ· (2,3). ™ÙËÓ ·Ó·ÛÎfiËÛ‹ Ì·˜, ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ì ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ÁÈ· ÙËÓ Â›ÙˆÛË Ù˘ ÏÈÛÙ¤ÚÈ·˜ ΢ڛˆ˜ ÛÙËÓ Î‡ËÛË, ÙËÓ ·ıÔÁ¤ÓÂÈ·,

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§ÈÛÙÂÚ›ˆÛË Î·Ù¿ ÙËÓ Î‡ËÛË

ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛÙȘ ÂÁ·Ԣ˜, ÛÙ· ¤Ì‚Ú˘· Î·È Ù· ÓÂÔÁÓ¿, ηıÒ˜ Î·È ÙË ‰È¿ÁÓˆÛË, ÙË ıÂÚ·›· Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘. ∂›Û˘ ı· ·Ó·ÊÂÚıԇ̠۠ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÏÈÛÙÂÚ›ˆÛË ÛÙËÓ ∂ÏÏ¿‰·.

¤¯ÂÈ ·Ó·ÊÂÚı› Û ۯÂÙÈ΋ ÌÂϤÙË ·˘ÍË̤ÓË ÊÔÚ›· ÛÙÔÓ ÎfiÏÔ Á˘Ó·ÈÎÒÓ Ì ÈÛÙÔÚÈÎfi Â·ÓÂÈÏËÌÌ¤ÓˆÓ ·Ô‚ÔÏÒÓ, (20) ÁÂÁÔÓfi˜ fï˜, Ô˘ ‰ÂÓ ¤¯ÂÈ ÂȂ‚·Èˆı› Û ¿ÏÏË ÌÂϤÙË (21).

¶·ıÔÁ¤ÓÂÈ· ∂ȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ∏ Listeria monocytogenes Â›Ó·È ¤Ó· gram-ıÂÙÈÎfi ·Ó·ÂÚfi‚ÈÔ ÎÔÎÎÔ‚·ÎÙËÚ›‰ÈÔ. ªÔÚ› Ó· ·ÔÌÔÓˆı› ÛÙÔ ¯ÒÌ·, ÛÙËÓ ÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ, ÛÙÔ ÓÂÚfi, ÛÙ· ÎfiÚ·Ó·, ÛÙÔ Á¿Ï·, ηıÒ˜ Î·È ÛÙÔ˘˜ ÈÛÙÔ‡˜ ÔÏÏÒÓ ·ÛfiÓ‰˘ÏˆÓ Î·È ÛÔÓ‰˘ÏˆÙÒÓ ˙ÒˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓfiÌÂÓÔ˘ Î·È ÙÔ˘ ·ÓıÚÒÔ˘ (4,5). ∂ÈϤÔÓ, Ë Listeria monocytogenes ·ÔÈΛ˙ÂÈ Û˘¯Ó¿ Ù· ÙÚfiÊÈÌ·, ÌÂ Û˘¯ÓfiÙËÙ· ·fi 15-70% (6). T· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· ¤¯Ô˘Ó Û˘¯Ó¿ ÌÂÁ·Ï‡ÙÂÚÔ ÌÔÏ˘ÛÌ·ÙÈÎfi ÊÔÚÙ›Ô ·fi Ù· ¿ÏÏ· ÚÔ˚fiÓÙ· (7). ∏ Listeria ηٷÛÙÚ¤ÊÂÙ·È Ì ÙËÓ ·ÛÙÂÚ›ˆÛË Î·È ÙÔ Ì·Á›ÚÂÌ·. Œ¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È Û ıÂÚÌÔÎÚ·Û›· „˘Á›Ԣ. ∏ ÏÈÛÙÂÚ›ˆÛË, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÔÚ·‰Èο Î·È Ì ÌÔÚÊ‹ ÂȉËÌÈÒÓ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ. ªÂÁ¿Ï˜ ÂȉË̛˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÙȘ ‰˘Ô ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÛÙËÓ ∂˘ÚÒË Î·È ÙȘ ∏.¶.∞. (8-11). ∂Ó‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ÏÔÈÌÒÍÂȘ ÙfiÛÔ Û ÓÂÔÁÓ¿ fiÛÔ Î·È Û ÂÓ‹ÏÈΘ ¤¯Ô˘Ó Â›Û˘ ·Ó·ÊÂÚı› (12,13). ™Â ÂȉËÌ›· Ô˘ ÂÓ¤ÛÎË„Â Û ÓÂÔÁÓ¿ ÛÙËÓ ∫fiÛÙ· ƒ›Î·, Ë ÌÂÙ¿‰ÔÛË ÙÔ˘ ‚·ÎÙËÚȉ›Ô˘ ¤ÁÈÓ Ì ÙÔ Ï¿‰È Ô˘ ¯ÚËÛÈÌÔÔÈ›ÙÔ ÁÈ· ÙÔÓ Î·ı·ÚÈÛÌfi ÙˆÓ ÓÂÔÁÓÒÓ (14). ∏ ÌÂÙ¿‰ÔÛË Ù˘ ÏÈÛÙ¤ÚÈ·˜ ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ÓÂÔÁÓfi Á›ÓÂÙ·È ‹ ̤ۈ ÙÔ˘ Ï·ÎÔ‡ÓÙ· ‹ ·ÓÈfiÓÙˆ˜ ·fi ÙÔÓ ÁÂÓÓËÙÈÎfi ۈϋӷ ‹ Ù· ÎfiÚ·Ó· Ù˘ ÌËÙ¤Ú·˜ (15). Œ¯ÂÈ Â›Û˘ ÂÚÈÁÚ·Ê› ÂÚ›ÙˆÛË ÌÂÙ¿‰ÔÛ˘ Ù˘ ÏÈÛÙ¤ÚÈ·˜ Û ÓÂÔÁÓfi ̤ۈ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡Ø ·ÓÂΉÔÙÔÏÔÁÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÛÙ· ÛÎ˘Ï¿ÎÈ· ÙÔ˘ ÛÈÙÈÔ‡ ÙÔ˘˜ ÚÔοÏÂÛ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÈÛÙÂÚ›ˆÛË (16). ÕÙÔÌ· ˘ÁÈ‹ ÌÔÚ› Ó· Â›Ó·È ÊÔÚ›˜ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡, ·ÎfiÌ· Î·È ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Â›Ó·È ÔÈ ¤Á΢ÔÈ. ™ÙÔ 1-15% ÙÔ˘ ÏËı˘ÛÌÔ‡, Ë ÏÈÛÙ¤ÚÈ· ·ÔÌÔÓÒÓÂÙ·È ÛÙ· ÎfiÚ·Ó·. (17). √ ·ÔÈÎÈÛÌfi˜ Â›Ó·È ‚Ú·¯˘¯ÚfiÓÈÔ˜ Î·È ÙÔ ‚·ÎÙËÚ›‰ÈÔ ·˘ÙÔÂÚÈÔÚ›˙ÂÙ·È. √È ¤Á΢ÔÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·ÊÔÚÂÙÈ΋ ÊÔÚ›· ÛÙË ÏÈÛÙ¤ÚÈ· ·fi ÙÔÓ ˘fiÏÔÈÔ ÏËı˘ÛÌfi, ÙfiÛÔ ÛÙ· ÎfiÚ·Ó· (18) fiÛÔ Î·È ÛÙÔÓ ÎfiÏÔ Î·È ÙÔÓ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· (19). ∂ÓÙÔ‡ÙÔȘ,

∏ ÂΉ‹ÏˆÛË ÁÂÓÈÎÂ˘Ì¤Ó˘ ÓfiÛÔ˘ ·fi ÏÈÛÙ¤ÚÈ· Û ¤Ó· ¿ÙÔÌÔ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ Ù‡Ô ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Î·È ÙÔ ÌÔÏ˘ÛÌ·ÙÈÎfi ÊÔÚÙ›Ô Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ·ÏÏ¿ ΢ڛˆ˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ˘˜ ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÙÔ˘ ÍÂÓÈÛÙ‹. √È ÔÚfiÙ˘ÔÈ Ù˘ Listeria monocytogenes Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÁÂÓÈÎÂ˘Ì¤ÓË ÏÈÛÙÂÚ›ˆÛË Â›Ó·È ÔÈ 1/2a Î·È 4b (22). ∏ ÏÈÛÙÂÚ›ˆÛË ··ÓÙ¿Ù·È Î˘Ú›ˆ˜ Û ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ·, ÛÙȘ ÂÁ·Ԣ˜ Î·È Ù· ÓÂÔÁÓ¿ Ô˘ Â›Û˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜. ∏ ÏÈÛÙ¤ÚÈ· ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ÙÔ˘ ÍÂÓÈÛÙ‹ Û˘¯ÓfiÙÂÚ· ·fi ÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ. ¶ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙ· Ì·ÎÚÔÊ¿Á· ¯ˆÚ›˜ Ó· ηٷÛÙÚ¤ÊÂÈ ÙÔ Î‡ÙÙ·ÚÔ ÙÔ˘ ÍÂÓÈÛÙ‹ ÎÈ ¤ÙÛÈ ÌÂÙ·‰›‰ÂÙ·È Û ÁÂÈÙÔÓÈο ·ÙÙ·Ú· (6,23). ∏ Â›ÎÙËÙË ·ÓÔÛ›· Â›Ó·È ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ΢ÙÙ·ÚÈ΋ Î·È ÂÍ·ÚÙ¿Ù·È ·fi Ù· CD8 T-ÏÂÌÊÔ·ÙÙ·Ú· (24). ∏ ÏÈÛÙ¤ÚÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÎÏÂÎÙÈ΋ ÂÓÙfiÈÛË ÛÙÔ ¤ÓÙÂÚÔ, ÛÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ÛÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· (25). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ Ì¿ÏÈÛÙ·, Ë ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ˆ˜ ÌËÓÈÁÁ›Ùȉ· ‹ ÂÁÎÂÊ·Ï›Ùȉ· ‹ ÚÔÌ‚ÂÁÎÂÊ·Ï›Ùȉ· (Rhombencephalitis), Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÚÔ‚ÔÏ‹ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Î·È Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ (26).

§ÈÛÙÂÚ›ˆÛË ÛÙËÓ Î‡ËÛË ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘ ÛÙȘ ÂÁ·Ԣ˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ôχ ÂÏ·ÊÚ¿ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ “ÁÚÈ҉˘ Û˘Ó‰ÚÔÌ‹” Ì ˘ÚÂÙfi Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ Ì Á·ÛÙÚÂÓÙÂÚÈΤ˜ ÂÓԯϋÛÂȘ. ªÂÚÈΤ˜ ÊÔÚ¤˜ ·˘Ù¿ Ù· Û˘ÌÙÒÌ·Ù· ·Ô‰›‰ÔÓÙ·È ÂÛÊ·Ï̤ӷ Û ԢÚÔÏԛ̈ÍË (27). ∏ ¤ÁÎ˘Ô˜ ÌÔÚ› Ó· ÚÔÛ‚ÏËı› ·fi ÏÈÛÙ¤ÚÈ· Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∏ Ïԛ̈ÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ Î·È ‰Â˘Ù¤ÚÔ˘ ÙÚ›ÌËÓÔ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·Ô‚ÔÏ‹ (28). ¶ÚÔÛ‚ÔÏ‹ Ù˘ ÂÁ·Ԣ ÛÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÚfiˆÚÔ ÙÔÎÂÙfi, ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ¶·È‰È·ÙÚÈ΋ 2006;69:104-109

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¶. ª¤ÍË-ªÔ˘ÚÓ¿, ¡. ªÔ˘ÚÓ¿˜

¶›Ó·Î·˜. ª¤ÙÚ· ÚfiÏ˄˘ ÏÈÛÙÂÚ›ˆÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ∞. °ÂÓÈο ̤ÙÚ· 1. ¡· Ì·ÁÂÈÚ‡ÔÓÙ·È ÚÔÛÂÎÙÈο ÔÈ ˆÌ¤˜ ˙ˆÈΤ˜ ÙÚÔʤ˜ fiˆ˜ ÌÔÛ¯¿ÚÈ, Ô˘ÏÂÚÈο Î·È ¯ÔÈÚÈÓ¿.

2. ¡· ϤÓÔÓÙ·È Ù· ˆÌ¿ Ï·¯·ÓÈο ÚÈÓ ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜.

3. ¡· ·ÔʇÁÂÙ·È ÂÓÙÂÏÒ˜ ÙÔ ÌË ·ÛÙÂÚȈ̤ÓÔ Á¿Ï· Î·È Ù· ÙÚfiÊÈÌ· Ô˘ ÙÔ ÂÚȤ¯Ô˘Ó.

4. ¡· ϤÓÔÓÙ·È ÚÔÛÂÎÙÈο Ù· ¯¤ÚÈ·, Ù· Ì·¯·›ÚÈ· Î·È ÔÈ Û·Ó›‰Â˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ú·Û΢‹ ˆÌÒÓ ÙÚÔÊÒÓ.

5. ¡· ηٷӷÏÒÓÔÓÙ·È ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi Ù· ÂÚÈÛÛ‡̷ٷ ÙÚÔÊÒÓ Î·È Ù· ¤ÙÔÈÌ· ÙÚfiÊÈÌ· ·ÊÔ‡ ·ÓÔȯıÔ‡Ó. µ. ∂ȉÈο ̤ÙÚ· ÁÈ· ÚÔʇϷÍË ·fi ÙË ÏÈÛÙ¤ÚÈ· 1. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È ¤ÙÔÈÌ· ÚÔ˚fiÓÙ· ÎÚ¤·ÙÔ˜ (hot dogs, luncheon meats, ‹ deli meats) ÂÎÙfi˜ ÎÈ ·Ó ÙÔ Í·Ó·˙¤ÛÙ·Ì¿ ÙÔ˘˜ ÂÂÎÙ›ÓÂÙ·È Ì¤¯ÚÈ ÙÔ ‚Ú·ÛÌfi ‹ ÙÔ „‹ÛÈÌÔ.

2. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È Ì·Ï·Î¿ Ù˘ÚÈ¿ ÂÎÙfi˜ ÎÈ ·Ó ÛÙȘ ÂÙÈΤÙ˜ ÙÔ˘˜ Ê·›ÓÂÙ·È Î·ı·Ú¿ fiÙÈ ·Ú·Û΢¿˙ÔÓÙ·È ·fi ·ÛÙÂÚȈ̤ÓÔ Á¿Ï·.

3. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È Î·Ù„˘Á̤Ó˜ ·ÏÔÈʤ˜ ÎÚ¤·ÙÔ˜ (pâtés).

4. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È Î·Ù„˘Á̤ӷ ηÓÈÛÙ¿ ı·Ï·ÛÛÈÓ¿. √È ÎÔÓۤڂ˜ Î·È Ù· Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ÚÔ˚fiÓÙ· ÎÚ¤·ÙÔ˜ Î·È ı·Ï·ÛÛÈÓÒÓ ÌÔÚÔ‡Ó Ó· ηٷӷψıÔ‡Ó.

ÙÔ˘ ÂÌ‚Ú‡Ô˘, ıÓËÛÈÁÂÓ‹ ÓÂÔÁÓ¿ Î·È ÂÌÊ¿ÓÈÛË Ïԛ̈͢ ÛÙÔ ÓÂÔÁÓfi ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞Ó Ë ¤ÁÎ˘Ô˜ ·ÚÔ˘ÛÈ¿ÛÂÈ ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ· Ô˘ ÔÊ›ÏÂÙ·È Û ÏÈÛÙ¤ÚÈ· ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, Ë ıÂÚ·›· Ì ˘„ËϤ˜ ‰fiÛÂȘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ÂÓÒ ÙÔ ÓÂÔÁÓfi ı· ÁÂÓÓËı› ˘ÁȤ˜, ·ÓÙ›ıÂÙ· Ì fiÙÈ Û˘Ì‚·›ÓÂÈ Û ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ˜ (15). ∏ ÌÂϤÙË ‰‡Ô ·Ó·ÛÎÔ‹ÛÂˆÓ ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÂÚÈÛÙ·ÙÈÎÒÓ Î·Ï¿ ÙÂÎÌËÚÈˆÌ¤ÓˆÓ (∂. Mylonakis (17) Î·È Y. Siegman-Igra (29)), ·Ó·Ê¤ÚÔ˘Ó fiÙÈ fiÙ·Ó Ë ¤ÁÎ˘Ô˜ ÌÔÏ˘Óı› ·fi ÏÈÛÙ¤ÚÈ· ¤¯ÂÈ 20% ΛӉ˘ÓÔ ·Ô‚ÔÏ‹˜ ‹ ıÓËÛÈÁÂÓÔ‡˜ ÓÂÔÁÓÔ‡. ∆· ÓÂÔÁÓ¿ ÓÔÛÔ‡Ó Î·Ù¿ 56-68%. ∏ ıÓËÙfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ ·fi ÙËÓ ÓfiÛÔ Â›Ó·È 12%. ¡fiÛËÛË Ù˘ ÌËÙ¤Ú·˜ ¯ˆÚ›˜ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ··ÓÙ¿Ù·È Û ÔÛÔÛÙfi 10-25%. ™Â ÂÚ›ÙˆÛË Û˘Ó‡·Ú͢ ÏÈÛÙÂÚ›ˆÛ˘ Ì ·ÓÔÛÔηٷÛÙÔÏ‹ ÛÙËÓ Î‡ËÛË, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÌËÙ¤Ú·˜ ÂÈ‚·Ú‡ÓÂÙ·È. Œ¯ÂÈ ·Ó·ÊÂÚı› ÌËÓÈÁÁ›Ùȉ·, ÂÓ‰Ôηډ›Ùȉ· Î·È ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∞ÎfiÌË ¤¯Ô˘Ó ÂÚÈÁÚ¿ÊÂÈ ‰‡Ô ÂÚÈÛÙ·ÙÈο Ïԛ̈͢ ·fi ÏÈÛÙ¤ÚÈ· Ì ı¿Ó·ÙÔ Ù˘ ÌËÙ¤Ú·˜ Ô˘ ÂÌÊ¿ÓÈ˙ ·ÓÔÛÔηٷÛÙÔÏ‹ (30-33).

§ÈÛÙÂÚ›ˆÛË ÛÙÔ ÓÂÔÁÓfi ™Ù· ÓÂÔÁÓ¿ Ë ÏÈÛÙÂÚ›ˆÛË ÌÔÚ› Ó· ÂΉËψı› ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ (ÚÒÈÌË Ïԛ̈ÍË) ‹ ·ÚÁfiÙÂÚ· ÌÂÙ¿ ÙËÓ 5Ë Ë̤ڷ ˙ˆ‹˜ (fi„ÈÌË Ïԛ̈ÍË). ∫·Ù¿ ÙË ‰È·‰ÚÔÌ‹ Ù˘ ÚÒÈÌ˘ Ïԛ̈͢ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛı› ÎËÏȉԂϷÙȉ҉˜ ‹ Ê˘Û·ÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ·, ¶·È‰È·ÙÚÈ΋ 2006;69:104-109

Û˘Ó‹ıˆ˜ ÛÙÔ ıÒڷη Î·È Ù· ¿ÎÚ·, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË. ∂›Û˘ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ˘¿Ú¯ÂÈ ÂÚ˘ıËÌ·Ù҉˜ ‹ ÊÏ˘ÎÙ·ÈÓ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ Ô›ÛıÈÔ Ê¿Ú˘ÁÁ·. ∏ ÚÒÈÌË ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ˆ˜ Ó¢ÌÔÓ›· Î·È ÛË„·ÈÌ›· ·ÏÏ¿ Î·È ˆ˜ ÌËÓÈÁÁ›Ùȉ·. ∞ÎfiÌ· ÌÔÚ› Ó· ÂΉËψı› Ì ÎÔÎÎÈÒÌ·Ù· ÛÙÔ ‰¤ÚÌ·, ÙÔ ‹·Ú Î·È ¿ÏÏ· Û˘Ì·Á‹ fiÚÁ·Ó· ÙˆÓ ÓÂÔÁÓÒÓ Î·ıÒ˜ Î·È ÛÙÔÓ Ï·ÎÔ‡ÓÙ· (ÎÔÎÎȈ̿وÛË Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜, granulomatosis infantiseptica) (34). ∏ ÎÔÎÎȈ̷Ù҉˘ Ó¢ÌÔÓ›· ¤¯ÂÈ Ôχ ‚·ÚÈ¿ ÔÚ›· Î·È ÌÔÚ› Ó· ¯ÚÂÈ·Ûı› Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË (extracorporeal membrane oxygenation) (35). ∏ ̤ÛË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘ ÂÒ·Û˘ ÁÈ· ÙËÓ ÚÒÈÌË ÓfiÛÔ Â›Ó·È ÌÈ¿ÌÈÛË Ë̤ڷ ÂÓÒ ÁÈ· ÙËÓ fi„ÈÌË 14 Ë̤Ú˜. ∏ fi„ÈÌË Ïԛ̈ÍË ·fi ÏÈÛÙ¤ÚÈ· ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ê˘ÛÈÔÏÔÁÈο Î·È Ë ÌfiÏ˘ÓÛË Á›ÓÂÙ·È Î·Ù¿ ‹ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∞ÒÙÂÚ· Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·fi ÏÈÛÙ¤ÚÈ· ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ 12% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÈ‚ÈÒÓÔ˘Ó.

¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË Ïԛ̈͢ ·fi ÏÈÛÙ¤ÚÈ· ÛÙȘ ÂÁ·Ԣ˜ Î·È Ù· ÓÂÔÁÓ¿ Á›ÓÂÙ·È Ì ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ∏ ·Ó›¯Ó¢ÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Ì ÙËÓ ·ÓÙ›‰Ú·ÛË Ù˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ (PCR) ÌÔÚ› Ó· ÂÈÙ·¯‡ÓÂÈ ÙË ‰È¿ÁÓˆÛË (36). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÓ·ÓÙ›ÔÓ ÙˆÓ ·ÓÙÈÁfiÓˆÓ Ù˘ ÏÈÛÙ¤ÚÈ·˜, ÙfiÛÔ ÙˆÓ ÛˆÌ·ÙÈÎÒÓ √, fiÛÔ Î·È ÙˆÓ ‚ÏÂÊ·ÚȉÈÎÒÓ ∏, ‰ÂÓ ‰›ÓÂÈ ·ÍÈfiÈÛÙ· ·ÔÙÂϤÛÌ·Ù· ‰ÈfiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ

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ÔÏÏ¿ „¢‰Ò˜ ıÂÙÈο Î·È ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· (.¯. ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·Ûı› ÛÔ‚·Ú‹ Ïԛ̈ÍË Ì ·ÚÓËÙÈο ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÏÈÛÙ¤ÚÈ·) (37). ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ Î·È ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ÂͤٷÛË Ï·ÎÔ‡ÓÙˆÓ ·ÔηχÙÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜ (·ÔÛÙ‹Ì·Ù· Î·È ÌÈÎÚÔ·ÔÛÙ‹Ì·Ù·) (38).

£ÂÚ·›· ∏ ‰˘ÛÎÔÏ›· ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·›· Ù˘ ‰ÈÂÈÛ‰˘ÙÈ΋˜ ÏÈÛÙÂÚ›ˆÛ˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ ÂÓ‰Ô- Î·È ÂÍˆÎ˘ÙÙ¿ÚÈÔ ÙÚfiÔ ˙ˆ‹˜ Ù˘ L. monocytogenes Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Â›Ó·È ‰˘Ó·ÙfiÓ, ÂÓÒ ÙÔ ‚·ÎÙ‹ÚÈÔ ¤¯ÂÈ ÂÍ·Ê·ÓÈÛÙ› ·fi ÙÔÓ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ, Ó· ‰Ú· ·ÓÂÓfi¯ÏËÙ· ÂÓÙfi˜ ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÙÔ˘ ÍÂÓÈÛÙ‹ fiÔ˘ ‰ÂÓ Êı¿ÓÔ˘Ó Ù· ·ÓÙÈ‚ÈÔÙÈο. ¶·ÚfiÙÈ fiÏ· ۯ‰fiÓ Ù· ÛÙÂϤ¯Ë L. monocytogenes Ô˘ ·ÔÌÔÓÒÓÔÓÙ·È ·fi ηÏÏȤÚÁÂȘ ·ÛıÂÓÒÓ Î·È ÙÚÔÊ›ÌˆÓ Â›Ó·È Â˘·›ÛıËÙ· Û ÔÏÏ¿ ·ÓÙÈ‚ÈÔÙÈο, ÂÎÙfi˜ ·fi ÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜ 3˘ ÁÂÓÈ¿˜, ÛÙȘ Ôԛ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ê˘ÛÈ΋ ·ÓÔ¯‹, Î·È ÙË ÊˆÛÊÔÌ˘Î›ÓË, Ë Û˘¯ÓfiÙËÙ· ıÂÚ·›·˜ Â›Ó·È ÌfiÓÔÓ 70%. ∆Ô Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÏÈÛÙÂÚ›ˆÛ˘ Â›Ó·È ˘„ËϤ˜ ‰fiÛÂȘ ·ÌÈÎÈÏÏ›Ó˘. ∏ ÚÔÛı‹ÎË ÁÂÓÙ·ÌÈΛÓ˘ Ô˘ ¤¯ÂÈ Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË, Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ıÂÚ·›· ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ÂÁ·ˆÓ ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·. ∏ ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ú¤ÂÈ Ó· Â›Ó·È ‰˘Ô ¤ˆ˜ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜. ∆Ô Ê¿ÚÌ·ÎÔ ‰Â‡ÙÂÚ˘ ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÙÚÈÌÂıÔÚ›ÌË-ÎÔÙÚÈÌÔÍ·˙fiÏË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÌÈÎÈÏÏ›ÓË ‹ Î·È ÌfiÓË (39). √È ÓÂfiÙÂÚ˜ ÎÈÓÔÏfiÓ˜ Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ in vivo Î·È ÔÈ ÏÈÛÙ¤ÚȘ Â›Ó·È 100% ¢·›ÛıËÙ˜ ÛÙËÓ gemifloxacin. ∏ ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÙÚÔÔÔÈËÙÒÓ (immunomodulators) ·˘Í¿ÓÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ (39,40).

¶ÚfiÏË„Ë √È ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ÚfiÏË„Ë ·fi ÙË ÓfiÛÔ Î·Ù¢ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÔÓ ÙÚfiÔ ‰È·¯Â›ÚÈÛ˘ ÙˆÓ ÙÚÔʛ̈Ó, ÒÛÙ ÙÔ ÚÔ˚fiÓ Ô˘ Êı¿ÓÂÈ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË Ó· ÌËÓ ÂÚȤ¯ÂÈ Î·ıfiÏÔ˘ ·ıÔÁfiÓ· ÌÈÎÚfi‚È·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÂÁ·Ԣ˜ ¤¯Ô˘Ó ÚÔÙ·ı› ·fi ÙÔ ∫¤ÓÙÚÔ ∂ϤÁ-

¯Ô˘ §ÔÈÌÒÍÂˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ÁÂÓÈο Î·È ÂȉÈο ̤ÙÚ· ÁÈ· ÙË ÏÈÛÙ¤ÚÈ·, Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î·. ∂›Ó·È ·Ôχو˜ ··Ú·›ÙËÙÔ Ô Ì·ÈÂ˘Ù‹Ú·˜ Ó· ÏËÚÔÊÔÚ› ÙȘ ÂÁ·Ԣ˜ ÁÈ· Ù· ̤ÙÚ· ·˘Ù¿. ªÈ· ¿ÏÏË ËÁ‹ ÏËÚÔÊfiÚËÛ˘ ı· ÌÔÚÔ‡Û·Ó Ó· Â›Ó·È Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘. ¶ÚfiÏË„Ë Ù˘ ‰ÈÂÈÛ‰˘ÙÈ΋˜ ÓfiÛÔ˘ ·fi ÏÈÛÙ¤ÚÈ·, ÙfiÛÔ Û ·ÓıÚÒÔ˘˜ fiÛÔ Î·È Û ˙Ò·, ÌÔÚ› Ó· Á›ÓÂÈ Ì ÂÌ‚ÔÏÈ·ÛÌfi. ∞Ó Î·È ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È Û ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ, ÌÂϤÙ˜ ¤¯Ô˘Ó Ú·ÁÌ·ÙÔÔÈËı› Û ˙Ò· Î·È Û ·ÓıÚÒÔ˘˜ (41,42).

§ÈÛÙÂÚ›ˆÛË ÛÙËÓ ∂ÏÏ¿‰· ªËÓÈÁÁ›Ùȉ· ·fi ÏÈÛÙ¤ÚÈ· ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ÂÏÏËÓÈ΋ È·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ÙÔ 1967 (43). ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰Âη¤ÓÙ ÂÚÈÛÙ·ÙÈο ÂÚÈÁÂÓÓËÙÈ΋˜ Ïԛ̈͢ (44-47). ¢ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂȉËÌ›· ·fi ÏÈÛÙ¤ÚÈ· Ô‡Ù ÛÙË ‰ÈÂÈÛ‰˘ÙÈ΋ ÌÔÚÊ‹, Ô‡ÙÂ Û·Ó Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Û ·ÓıÚÒÔ˘˜ ÛÙËÓ ∂ÏÏ¿‰·. ™ËÌÂȈ٤ÔÓ fiÙÈ Ë ÏÈÛÙÂÚ›ˆÛË Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙ· ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ Ë ‰‹ÏˆÛË ÛÙÔ ∫¤ÓÙÚÔ ŒÏÂÁ¯Ô˘ §ÔÈÌÒÍÂˆÓ Â›Ó·È ˘Ô¯ÚˆÙÈ΋. ∂ȉË̛˜ ·fi ÏÈÛÙ¤ÚÈ· ÛÙ· ˙Ò· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û fiÏË ÙËÓ ËÂÈÚˆÙÈ΋ ∂ÏÏ¿‰· Î·È ÛÙ· ÓËÛÈ¿. ™˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ·ÈÁÔÚfi‚·Ù· Î·È È‰›ˆ˜ ÛÙ· ηÙÛ›ÎÈ· (48).

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™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ. ∂ÈÙÒÛÂȘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi ¶·È‰ÔηډÈÔÏfiÁÔ˜ – ∫·ıËÁËÙ‹˜ ∞ÓÒÙ·ÙÔ˘ ∆¯ÓÔÏÔÁÈÎÔ‡ ∂Î·È‰Â˘ÙÈÎÔ‡ π‰Ú‡Ì·ÙÔ˜ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ™Ù¤ÏÈÔ˜ ∞ÓÙˆÓÈ¿‰Ë˜ ∏Ú·ÎÏ›ÙÔ˘ 4, ∫ÔψӿÎÈ, ∆.∫. 106 73, ∞ı‹Ó· E -mail: prdrsant@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-05-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 30-09-2005

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¶ÂÚ›ÏË„Ë: ∆· ÂÈÙ‡ÁÌ·Ù· ÛÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ÂÂÌ‚·ÙÈ΋ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î˘Ú›ˆ˜ ηډÈÔ·ıÂÈÒÓ, ‰ËÌÈÔ‡ÚÁËÛ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÈ· ÚÔԉ¢ÙÈο ·˘Í·ÓfiÌÂÓË ÔÌ¿‰· Á˘Ó·ÈÎÒÓ Ì ηډÈÔ¿ıÂÈ·, ÔÈ Ôԛ˜ Êı¿ÓÔ˘Ó ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ·. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ë ÂÁ΢ÌÔÛ‡ÓË ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÛËÌ·ÓÙÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙË ˙ˆ‹ Ù˘ ÌËÙ¤Ú·˜ ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘. À¿Ú¯Ô˘Ó fï˜ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ Î›Ó‰˘ÓÔÈ Â›Ó·È ·˘ÍË̤ÓÔÈ ¤ˆ˜ Ôχ ·˘ÍË̤ÓÔÈ, Û ‚·ıÌfi Ô˘ Ó· ηıÈÛÙÔ‡Ó ÙË ÌËÙÚfiÙËÙ· ··ÁÔÚ¢ÙÈ΋. ∆· ÌÂÁ·Ï‡ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ù· ÔÔ›· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔ Î‡ËÌ· Â›Ó·È Ô ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, Ë ÚÔˆÚfiÙËÙ·, ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÔÈ ·ÈÌÔÚÚ·Á›Â˜, Ë ÙÂÚ·ÙÔÁ¤ÓÂÛË Î.Ï. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙË ÌËÙ¤Ú·, ÂÎÙfi˜ ·fi ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘, ÚÔηÏÔ‡ÓÙ·È ÔÏϤ˜ ÊÔÚ¤˜ ÛÔ‚·Ú¤˜ ¤ˆ˜ Ôχ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ·ÈÌÔ‰˘Ó·ÌÈ΋ Ù˘ ¿ıËÛ˘ ·fi ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÙÔÎÂÙÔ‡ (ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, ·ÚÚ˘ı̛˜ Î.Ï.). °È· ÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·˘ÙÒÓ Ì ÙÔ˘˜ ÌÈÎÚfiÙÂÚÔ˘˜ ‰˘Ó·ÙÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ÙfiÛÔ ÁÈ· ÙË ÌËÙ¤Ú· fiÛÔ Î·È ÁÈ· ÙÔ ¤Ì‚Ú˘Ô, Â›Ó·È ··Ú·›ÙËÙË Ë ¤ÁηÈÚË ÂÓË̤ڈÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È Ù˘ ›‰È·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÁÈ· Ù· Èı·Ó¿ ÚÔ‚Ï‹Ì·Ù·, Û οı ÂÚ›ÙˆÛË. ∂›Û˘, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Ë ÁÓÒÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, Ë ÂÎÙ›ÌËÛË Ù˘ ηډÈÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÚÈÓ ·fi ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·ıÒ˜ Î·È Ë Ï‹„Ë ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ÂÂÌ‚·ÙÈÎÒÓ ‹ ıÂÚ·¢ÙÈÎÒÓ Ì¤ÙÚˆÓ. ∆Ô ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ Ù˘ ÌËÙ¤Ú·˜ fiˆ˜ Î·È Ë ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ·‚›‚·ÛË ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ÛÔ‚·Ú¿ ˘’ fi„ÈÓ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÔÎÂÙfi, Û˘Ó‹ıˆ˜ ÚÔÙÈÌ¿Ù·È Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ Ì ÙË ‚Ô‹ıÂÈ· ÂÌ‚Ú˘Ô˘ÏΛ·˜. ™Â ÂÚÈÛÙ·ÙÈο Ì ۇӉÚÔÌÔ Marfan Î·È Î›Ó‰˘ÓÔ ·Ó¢ڇÛÌ·ÙÔ˜ ÛÙËÓ ·ÔÚÙ‹, fiˆ˜ Î·È ÛÙ· ÚÔ‚Ï‹Ì·Ù· ËÎÙÈÎfiÙËÙ·˜ ÛÙȘ ÌÂÙ·ÏÏÈΤ˜ ‚·Ï‚›‰Â˜ Î.Ï., ÚÔÙÈÌ¿Ù·È Ë Î·ÈÛ·ÚÈ΋ ÙÔÌ‹. ∏ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ë ÂÁ΢ÌÔÛ‡ÓË ÛÙË ÌËÙ¤Ú· Ì ηډÈÔ¿ıÂÈ· Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ı· Û˘Ì‚¿ÏÂÈ ÛÙË Ì›ˆÛË fiÏˆÓ ÙˆÓ Èı·ÓÒÓ ÎÈÓ‰‡ÓˆÓ Û ·fiÏ˘Ù· ·Ô‰ÂÎÙ¿ fiÚÈ·. §¤ÍÂȘ ÎÏÂȉȿ: ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ, ÂÁ΢ÌÔÛ‡ÓË.

Congenital and acquired heart diseases. Implications for pregnancy, the fetus and the newborn infant Paediatric cardiologist – Professor in the Technological Educational Institute of Athens Correspondence: 4, Herakleitou Str., 106 73, Athens E-mail: prdrsant@otenet.gr Date of submission: 17-05-2005 Date of approval: 30-09-2005

¶·È‰È·ÙÚÈ΋ 2006;69:110-117

S. Antoniadis

Abstract: Improvements in the diagnosis, intervention and surgical management of congenital heart disease (CHD) during recent years have led in increasing numbers of women with heart problems reaching childbearing age. In the majority of cases, pregnancy in women with cardiovascular does not cause serious problems to the mother or fetus, but there are cases in which maternity should be discouraged or prohibited.

The major problems for the fetus are fetal loss, prematurity, low birth weight and a variety of other problems such as haemorrhage, teratogenesis, etc. Apart from the increased mortality, pregnancy in a woman with cardiovascular disease may cause significant changes in the haemodynamics of the maternal circulation (heart failure, arrhythmia etc.) with need for intensive care by expert doctors and hospital staff.

For the optimal management in such cases, early counselling of the patient and those in her environment about the possible problems is very important. It is essential to know the history, to have a recent evaluation of the maternal cardiac functional status before pregnancy and to take appropriate medical or interventional treatment measures. The maternal life expectancy and the recurrence risk should be considered as factors of major importance. Normal vaginal delivery with forceps assistance is

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the birthing choice, except for cases with Marfan syndrome, the possibility of aortic aneurysm or coagulation problems in patients with artificial valves, when caesarian section is preferred.

A high level of knowledge of the problems that pregnancy may cause to mothers with cardiovascular disease will certainly minimize the possible dangers of pregnancy to acceptable levels.

Key words: Congenital and acquired heart diseases, pregnancy.

∂ÈÛ·ÁˆÁ‹ √È ÚfiÔ‰ÔÈ Ù˘ ·È‰È·ÙÚÈ΋˜ ηډÈÔÏÔÁ›·˜ Î·È Ù˘ ·È‰ÔηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ Ù· ÙÂÏÂ˘Ù·›· 25-30 ¯ÚfiÓÈ·, ›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ·ÏÏ¿ Î·È ÙËÓ ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ηډÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (1,2). ™‹ÌÂÚ· ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ Á˘Ó·ÈÎÒÓ, ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡ÌÏÔΘ ηډÈÔ¿ıÂȘ, Êı¿ÓÔ˘Ó Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· (3). ∏ ÛÂÍÔ˘·ÏÈ΋ Â·Ê‹ Ì ·ÔÙ¤ÏÂÛÌ· ÌÈ· ·ÓÂÈı‡ÌËÙË ‹ ÂÈı˘ÌËÙ‹ ÂÁ΢ÌÔÛ‡ÓË ·ÔÙÂÏ› ¿ÓÙ· ̤ÚÔ˜ Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜ (4). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÁÈ· ÙË ˙ˆ‹ Ù˘ ÌËÙ¤Ú·˜. ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ ÔÈ Î›Ó‰˘ÓÔÈ Â›Ó·È ·˘ÍË̤ÓÔÈ, ·ÏÏ¿ Î·È ¿ÏϘ Ô˘ ηıÈÛÙÔ‡Ó ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Û¯Â‰fiÓ ·ÓÂ›ÙÚÂÙË (5-7). ¢ÂÓ Ú¤ÂÈ ˆÛÙfiÛÔ, Ó· Ì·˜ ‰È·Ê‡ÁÂÈ fiÙÈ ÔÈ Î·Ú‰ÈÔ¿ıÂȘ ·ÎfiÌ· ÎÈ ·Ó ‰ÂÓ ·ÔÙÂϤÛÔ˘Ó ·ÈÙ›· ÌËÙÚÈÎÔ‡ ı·Ó¿ÙÔ˘, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ÂÈΛӉ˘Ó˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· ‹ ·ÚÚ˘ı̛˜ ÔÈ Ôԛ˜ ¯ÚÂÈ¿˙ÔÓÙ·È ¿ÌÂÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË (7). ∞fi fiÏ· Ù· ·Ú·¿Óˆ Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÛÔ ÌÂÁ¿ÏË ÛËÌ·Û›· ¤¯ÂÈ Ë ÂÓË̤ڈÛË fiÏˆÓ fiÛˆÓ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙÔÓ ÙÔÎÂÙfi Î·È ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô (8) (Ì·ÈÂ˘Ù‹Ú˜, ·È‰ÔηډÈÔÏfiÁÔÈ, ηډÈÔÏfiÁÔÈ, ·È‰›·ÙÚÔÈ, ÓÂÔÁÓÔÏfiÁÔÈ, ·Ó·ÈÛıËÛÈÔÏfiÁÔÈ, ÁÂÓÂÙÈÛÙ¤˜, Ì·›Â˜ Î.Ï.). ∏ ÁÓÒÛË ÙˆÓ ·ÏÏ·ÁÒÓ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, fiˆ˜ Î·È Ù˘ ‚·ÛÈ΋˜ ·Ó·ÙÔÌ›·˜ ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ Â›Ó·È Û¿ÓȘ, ·ÏÏ¿ Î·È ÔÈ Èı·ÓfiÙËÙ˜ ‚ÂÏÙ›ˆÛ˘ Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ Ê·Ú̷΢ÙÈο ‹ ·ÎfiÌ· Î·È ÂÂÌ‚·ÙÈο¯ÂÈÚÔ˘ÚÁÈο ÚÈÓ ‹ ηٿ ÙÔÓ ÙÔÎÂÙfi, ¤¯ÂÈ ÙÂÚ¿ÛÙÈ· ÛËÌ·Û›· (9,10). ∂›Û˘, Ôχ ÌÂÁ¿ÏË ÛËÌ·Û›· ¤¯ÂÈ Ë ¤ÁηÈÚË ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ‹ Î·È Ù˘ ›‰È·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÛÙËÓ ÚÔÂÊË‚È΋ ‹ ÂÊË‚È΋ ËÏÈΛ· ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ Î·È ÙÔÓ ·È‰›·ÙÚÔ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÌÈ·˜ Èı·Ó‹˜ ÂÁ΢ÌÔÛ‡Ó˘.

∏ ÂÓË̤ڈÛË ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ Î·Ù¿ÏÏËÏÔ ÁÈ· οı ÂÚ›ÙˆÛË ÙÚfiÔ ·ÓÙÈÛ‡ÏÏ˄˘, ÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ·ÏÏ¿ Î·È ÙË ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÛÙÔ ÓÂÔÁÓfi (11). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÙÔ ¤Ì‚Ú˘Ô ‰ÂÓ ÂËÚ¿˙ÂÙ·È, fï˜, Û ¤Ó· Ôχ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi, ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ Ù˘ ¿ıËÛ˘, ·Ú·ÙËÚÔ‡ÓÙ·È ·Ô‚ÔϤ˜ (20-25%), ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, Á¤ÓÓËÛË ÏÈÔ‚·ÚÒÓ Î·È ÚÔÒÚˆÓ ÂÌ‚Ú‡ˆÓ (ۯ‰fiÓ ÙÔ 100% ÛÙȘ ΢·ÓˆÙÈΤ˜ ÌËÙ¤Ú˜), Á¤ÓÓËÛË ÂÌ‚Ú‡Ô˘ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î.Ï. (7). ŸÏ· Ù· ·Ú·¿Óˆ ·Ó·Ï‡ÔÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ· ηٿ ηÙËÁÔÚ›· Î·È ÂÚ›ÙˆÛË. √È Û˘ÁÁÂÓ›˜ Î·È Ôχ Û·ÓÈfiÙÂÚ·, ÔÈ Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ, Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, Â›Ó·È ‰˘Ó·Ùfi ÁÈ· Ú·ÎÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó Û ÙÚÂȘ ηÙËÁÔڛ˜: ·) ·ı‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ‚) ·ı‹ÛÂȘ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘ Î·È Á) ·ı‹ÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ÏfiÁˆ Ù˘ ÔÚÌÔÓÈ΋˜ Â›‰Ú·Û˘ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, ·Ú·ÙËÚÔ‡ÓÙ·È: ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜, ·‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡ Î·È ÙÔ˘ ηٿ ÏÂÙfi fiÁÎÔ˘ ·›Ì·ÙÔ˜. √È ·˘Í‹ÛÂȘ ·˘Ù¤˜ Êı¿ÓÔ˘Ó ÛÙÔ Ì¤ÁÈÛÙÔ Î·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ Î·È ‰È·ÚÎÔ‡Ó Ì¤¯ÚÈ ÙÔÓ ÙÔÎÂÙfi. ∂›Û˘, ·Ú·ÙËÚÔ‡ÓÙ·È ÙÒÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ˘fiÙ·ÛË. ∏ ·ÈÌÔ‰˘Ó·ÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ‰È·ÚΛ ̤¯ÚÈ Î·È ‰‡Ô ‚‰ÔÌ¿‰Â˜ ÂÚ›Ô˘ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∏ ÏÂÙÔÌÂÚ‹˜ ÂÚÈÁÚ·Ê‹ Ù˘ ÁÈ· οı ·ÓˆÌ·Ï›· ‹ Û˘Ó‰˘·ÛÌÔ‡˜ ·ÓˆÌ·ÏÈÒÓ ‚Ú›ÛÎÂÙ·È ¤Ú· ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘ ¿ÚıÚÔ˘ ·˘ÙÔ‡ (5,12,13).

∞. ¶·ı‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 1. ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË ∏ ÚˆÙÔ·ı‹˜, Ë ‰Â˘ÙÂÚÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Î·È Î˘Ú›ˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Eisenmenger ·ÔÙÂÏÔ‡Ó ÙȘ ·ı‹ÛÂȘ Ì ÙÔÓ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·112

112

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˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ (·ÎfiÌ· Î·È fiÙ·Ó ÔÈ ȤÛÂȘ ÛÙÔ˘˜ Ó‡ÌÔÓ˜ Â›Ó·È 50% ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ). ∏ ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· ÁÈ· οı ÂÁ΢ÌÔÛ‡ÓË Î˘Ì·›ÓÂÙ·È ÛÙÔ 31%-50% (ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË 30%, ‰Â˘ÙÂÚÔ·ı‹˜ 50%, Û‡Ó‰ÚÔÌÔ Eisenmenger 36%), ¯ˆÚ›˜ Ó· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ ÓÂÔÁÓfi, ÔÈ ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ Â›Ó·È Û˘¯Ó¤˜, fiˆ˜ Î·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 30% ÙˆÓ Î˘‹ÛˆÓ. ∏ ÚÔˆÚfiÙËÙ· Â›Ó·È Â›Û˘ Û˘¯Ó‹, Ë ‰Â ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Êı¿ÓÂÈ ÙÔ 28%. ∏ ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ‚Ú›ÛÎÂÙ·È ÛÙÔ 13% (14-16). ªÂ Ù· ÔÛÔÛÙ¿ ·˘Ù¿ Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ¤ÁηÈÚË ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ Î·È Ù˘ ·ÛıÂÓÔ‡˜ ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ. ŸÙ·Ó Ë ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ·, Â›Ó·È ·fiÏ˘Ù· ··Ú·›ÙËÙÔ Ó· Ï·Ì‚¿ÓÔÓÙ·È Ù· ·ÛʷϤÛÙÂÚ· ηٿ ÂÚ›ÙˆÛË Ì¤ÙÚ· ·ÓÙÈÛ‡ÏÏ˄˘ ‹ Î·È ·ÎfiÌË Î·Ï‡ÙÂÚ· Ó· Á›ÓÂÙ·È ÛÂ Û˘ÓÂÓÓfiËÛË Ì ÙÔÓ Ì·ÈÂ˘Ù‹Ú· ÛÙ›ڈÛË, ·Ú’ fiÏÔ˘˜ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. ™Â ÂÚ›ÙˆÛË ÂÁ΢ÌÔÛ‡Ó˘ ı· Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿Ù·È ‰È·ÎÔ‹ ·ËÛ˘. ™ÙȘ ÌËÙ¤Ú˜ Ô˘ ·ÔÊ·Û›˙Ô˘Ó Û˘Ó¤¯ÈÛË Ù˘ ·ËÛ˘ Ú¤ÂÈ Ó· ÂÍËÁÔ‡ÓÙ·È ÔÈ Î›Ó‰˘ÓÔÈ (Ô ı¿Ó·ÙÔ˜ ·ÔÙÂÏ› Èı·ÓfiÙËÙ· ̤¯ÚÈ Î·È ‰‡Ô ¤ˆ˜ ¤ÍÈ Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi). ∂›Û˘, Â›Ó·È ··Ú·›ÙËÙË Ë ÂÈÛ·ÁˆÁ‹ Û ªÔÓ¿‰· ∫‡ËÛ˘ À„ËÏÔ‡ ∫ÈÓ‰‡ÓÔ˘ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ì Ô͢ÁfiÓÔ, ÓÈÙÚÈÎfi Ô͇, Ë·Ú›ÓË, ÚÔÛÙ·ÁÏ·‰›Ó˜ Î·È Èı·ÓÒ˜ ¿ÏÏ· ÓÂfiÙÂÚ· Ê¿Ú̷η, ·ÚfiÏÔ Ô˘ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· fiÏˆÓ Â›Ó·È ·ÌÊÈÛ‚ËÙ‹ÛÈÌË (17-21).

2. ª˘ÔηډÈÔ¿ıÂȘ ¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·: ∞ÔÙÂÏ› ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ì ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Ô˘ Êı¿ÓÂÈ ÙÔ 7% ÂÚ›Ô˘ Î·È ÌÂÁ¿Ï˜ Èı·ÓfiÙËÙ˜ ÂÈ‚¿Ú˘ÓÛ˘ Ù˘ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. √È ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ Â›Ó·È Û˘¯Ó¤˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È fiÛ· ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Î·È Î˘Ú›ˆ˜, Ó· ‰›ÓÂÙ·È ¤ÌÊ·ÛË ÛÙËÓ ¤ÁηÈÚË ÂÓË̤ڈÛË (22-24). ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·: ¶·ÚfiÏÔ Ô˘ Â›Ó·È Ë Û˘¯ÓfiÙÂÚË Ì˘ÔηډÈÔ¿ıÂÈ·, ÔÏϤ˜ ÊÔÚ¤˜ ΢ڛˆ˜ ÛÙ· ÂÚÈÛÙ·ÙÈο ¯ˆÚ›˜ ·ÚÂÌfi‰ÈÛË Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ë ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ ‹ ·ÎfiÌ· Î·È Ó· ÙÂı› Ì ÙËÓ Â˘Î·ÈÚ›· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ™ÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ˘¿Ú¯ÂÈ ·fiÊÚ·ÍË (ÌÂÁ¿ÏË ˘ÂÚÙÚÔÊ›·), ηڶ·È‰È·ÙÚÈ΋ 2006;69:110-117

‰È·Î‹ ·ÓÂ¿ÚÎÂÈ·, ·ÚÚ˘ı̛˜, ÔÈ ÂÈÙÒÛÂȘ Ù˘ ·ËÛ˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ôχ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Î·È ÁÈ’ ·˘Ùfi Ë ·ÔÊ˘Á‹ Ù˘ ·ÔÙÂÏ› ÙË ÛÔÊfiÙÂÚË ÂÈÏÔÁ‹. ™ÙȘ ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ ·fiÊÚ·ÍË ‹ ¿ÏϘ ÂÈ‚·Ú‡ÓÛÂȘ Ë ÂÁ΢ÌÔÛ‡ÓË Á›ÓÂÙ·È Î·Ï¿ ·ÓÂÎÙ‹, Ë ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Â›Ó·È Û¿ÓÈ· Î·È ÔÈ Î›Ó‰˘ÓÔÈ ÁÈ· ÙÔ ÓÂÔÁÓfi Û˘Ó›ÛÙ·ÓÙ·È Î˘Ú›ˆ˜ ÛÙÔ fiÙÈ ˘¿Ú¯ÂÈ 50% Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ÙËÓ ›‰È· ¿ıËÛË (25-29). ¶ÂÚÈÁÂÓÓËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·: ¶·ÚfiÏÔ Ô˘ Â›Ó·È Û¿ÓÈ·, ÂÚÈÁÚ¿ÊÂÙ·È ÏfiÁˆ Ù˘ Û¯¤Û˘ Ù˘ Ì ÙËÓ ÂÁ΢ÌÔÛ‡ÓË. ∂›Ó·È ÌÈ· ¿ıËÛË Ô˘ Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ·ÎfiÌ· ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜ (Èı·ÓÔÏÔÁÂ›Ù·È Ì˘Ôηډ›Ùȉ· ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÂÂÈÛfi‰È· ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ÚÈÓ ·fi ÙÔÓ ÙÔÎÂÙfi ηıÒ˜ Î·È ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ ¤ÓÙ ̋Ó˜. ∏ ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· ÊÙ¿ÓÂÈ ÙÔ 20%, ÂÓÒ ·ÚfiÏÔ Ô˘ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Â›Ó·È ·˘ÍË̤ÓË Î·ıÒ˜ Î·È ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÛÙÔ ÓÂÔÁÓfi. ∏ ηٿÛÙ·ÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Ë ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ Î.Ï., ÂÈÙÚ¤Ô˘Ó ÙËÓ ÚfiÁÓˆÛË Î·È ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÁÈ· ÂfiÌÂÓ˜ ÂÁ΢ÌÔÛ‡Ó˜ (2,5).

3. ™‡Ó‰ÚÔÌÔ Marfan ∞ÎfiÌ· Î·È fiÙ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÈÏÔΤ˜ Ë ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Êı¿ÓÂÈ ÙÔ 1%. ŸÙ·Ó ˘¿Ú¯Ô˘Ó, fiˆ˜ Ë ‰È¿Ù·ÛË Ù˘ Ú›˙·˜ Ù˘ ·ÔÚÙ‹˜ ‹ ·ÓÂ¿ÚÎÂÈ· Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜, ÙÔ Î·Îfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë Èı·ÓfiÙËÙ· ·Ó¢ڇÛÌ·ÙÔ˜, ·Ó‚¿˙Ô˘Ó ÙË ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Û Ôχ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿. ™Ù· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ Ë ÂÌ‚Ú˘˚΋ ıÓËÛÈÌfiÙËÙ· Êı¿ÓÂÈ ÙÔ 22%. ∞Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË Û˘ÓÈÛÙ¿Ù·È Û˘Ì‚Ô˘Ï‹ ÁÈ· ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ (26-28).

4. ™Ù¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ™Ù· ÂÚÈÛÙ·ÙÈο Ì ÌÈÎÚÔ‡ ‹ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ ÛÙÂÓÒÛÂȘ (ÎÏ›ÛË ›ÂÛ˘ <50 mm/hg) Ë ÂÁ΢ÌÔÛ‡ÓË Û˘Ó‹ıˆ˜ ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù·. £· Ú¤ÂÈ fï˜ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ fiÙÈ Ë ·Û˘Ìو̷ÙÈ΋ ÛÙ¤ÓˆÛË -Û˘Ó‹ıˆ˜ Û ¤‰·ÊÔ˜ ‰ÈÁÏÒ¯ÈÓÔ˜ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜- ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ Û˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù· ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ Ù˘ ÎÏ›Û˘ ›ÂÛ˘ ·fi ÙËÓ ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙÔ˘ ηٿ ÏÂÙfi fiÁÎÔ˘ Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ™Â ·ÛıÂÓ›˜ Ì ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÂÈ‚¿Ú˘ÓÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·113

113

™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ

Ì ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ (20%) fiˆ˜ ‰‡ÛÓÔÈ·, Ù·¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›·, ÚÔοډȷ ¿ÏÁË Î.Ï. ∏ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ Â›Ó·È Û˘¯Ó‹ ¿ıËÛË Î·È ÁÈ’ ·˘Ùfi Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÈ ÁÓˆÛÙfi fiÙÈ Û ÌÂÙÚ›Ô˘ ‹ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÛÙÂÓÒÛÂȘ, Ë ÂÁ΢ÌÔÛ‡ÓË ı· Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È Ì¤¯ÚÈ ÙËÓ ÂÂÌ‚·ÙÈ΋ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË. ∂¿Ó ·˘Ùfi ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi ·ÎfiÌ· Î·È ÛÙȘ ‰‡ÛÎÔϘ ÂÚÈÙÒÛÂȘ ·›ÚÓÔÓÙ·˜ ̤ÙÚ·, fiˆ˜ ÓÔÛËÏ›· Î·È ·ÔÊ˘Á‹ Ù˘ ·Ú·ÌÈÎÚ‹˜ ÎfiˆÛ˘ ηıÒ˜ Î·È Ë Èı·Ó‹ ¯ÔÚ‹ÁËÛË ‚ã ·Ó·ÛÙÔϤˆÓ Î.Ï., Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ë ÂÚ¿ÙˆÛË ÙÔ˘ ÙÔÎÂÙÔ‡. ªfiÓÔ Û Ôχ ‰‡ÛÎÔϘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Û˘˙ËÙËı› Ë ÂÂÌ‚·ÙÈ΋ ‰ÈfiÚıˆÛË ‹ ·ÎfiÌ· Î·È Ë ÙÔÔı¤ÙËÛË ‚·Ï‚›‰·˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ·ÚfiÏÔ Ô˘ Ô Î›Ó‰˘ÓÔ˜ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ Êı¿ÓÂÈ ÙÔ 30% (29-32).

5. ¶ÚÔ‚Ï‹Ì·Ù· ÛÙÂÊ·ÓÈ·›ˆÓ ∞Ó Î·È ÚÔ˜ ÙÔ ·ÚfiÓ ·Ú·ÙËÚÔ‡ÓÙ·È Û¿ÓÈ·, Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ ·ËÛ˘, Ê·›ÓÂÙ·È fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ ı· ·ÔÙÂϤÛÔ˘Ó ÂȉÈ΋ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (2).

6. ™‡ÌÏÔΘ ΢·ÓˆÙÈΤ˜ ηډÈÔ¿ıÂȘ ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ı‹ÛÂˆÓ ·˘ÙÒÓ ·Ó‹ÎÔ˘Ó Î˘·ÓˆÙÈΤ˜ ηډÈÔ¿ıÂȘ ÛÙȘ Ôԛ˜ ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜ (ηϋ ÂÍÈÛÔÚÚfiËÛË, ·ÌÊÈ‚Ôϛ˜ ÁÈ· ÙËÓ Â˘ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ Î.Ï.) ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ Î·Ì›· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ‹ ¤¯ÂÈ Á›ÓÂÈ ÌfiÓÔ ·ÚËÁÔÚËÙÈ΋ ·Ú¿Î·Ì„Ë (shunt). ∏ ·ÚÓËÙÈ΋ Â›‰Ú·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÔÊ›ÏÂÙ·È ÛÙËÓ Âȉ›ӈÛË Ù˘ ‰È·Ê˘Á‹˜ ·fi ‰ÂÍÈ¿ ÚÔ˜ ·ÚÈÛÙÂÚ¿, ÏfiÁˆ Ù˘ ÙÒÛ˘ ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ȤÛÂˆÓ Î·È Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ηٿ ÏÂÙfi fiÁÎÔ˘ ·›Ì·ÙÔ˜. ÃÚÂÈ¿˙ÂÙ·È ÌÂÁ¿ÏË ÚÔÛÔ¯‹ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË, ¤¯ÔÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ Û ÂÚÈÙÒÛÂȘ Ô˘ Ë Ô͢ÁfiÓˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ÌÈÎÚfiÙÂÚË ÙÔ˘ 85%, Ë Èı·ÓfiÙËÙ· Á¤ÓÓËÛ˘ ˙ˆÓÙ·ÓÔ‡ ÓÂÔÁÓÔ‡ ‰ÂÓ ÍÂÂÚÓ¿ÂÈ ÙÔ 12%, ÂÓÒ Û Ô͢ÁÔÓÒÛÂȘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ˘ 90% (οˆ˜ ‰‡ÛÎÔÏÔ) Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 90%. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ ¤Ì‚Ú˘Ô, Ô ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È Ë ÚÔˆÚfiÙËÙ· Â›Ó·È Ôχ Û˘¯Ó¿ ÚÔ‚Ï‹Ì·Ù·. ø˜ ÚÔ˜ ÙË ÌËÙ¤Ú·, ÛÙÔ 1/3 ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÔηÏÂ›Ù·È ·Ô‰ÈÔÚÁ¿ÓˆÛË Ù˘ ·ÈÌÔ‰˘Ó·ÌÈ΋˜ ÈÛÔÚÚÔ›·˜ (‚ÂÏÙÈÒÓÂÙ·È Ì ÙËÓ ·Ú·ÌÔÓ‹ ÛÙÔ ÎÚ‚¿ÙÈ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ), fï˜ Ô ı¿Ó·ÙÔ˜ Û˘Ó‹-

ıˆ˜ ·ÔʇÁÂÙ·È. ™ÙÔÓ ÙÔÎÂÙfi ÚÔÙÈÌ¿Ù·È Ë Î·ÈÛ·ÚÈ΋ ÙÔÌ‹ (33,34).

µ. ¶·ı‹ÛÂȘ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘ 1. ªÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË Ì ÂÂÌ‚¿ÛÂȘ Mustard ‹ Senning ªÔÏÔÓfiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÚÔÙÈÌ¿Ù·È Ë ·Ó·ÙÔÌÈ΋ ‰ÈfiÚıˆÛË, Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ÊÙ¿ÓÔ˘Ó Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ·ÓÙÈÌÂÙˆÈÛÙ› Ì ÙȘ ÂÂÌ‚¿ÛÂȘ Mustard ‹ Senning Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·Ó ·ÏÈfiÙÂÚ· (ÚÈÓ ·fi ÂÚ›Ô˘ 20-25 ¯ÚfiÓÈ·). ∞Ó Î·È Ë ¿ıËÛË Â›Ó·È ÛÔ‚·Ú‹ Î·È ÔÈ ÂÁ¯ÂÈÚ‹ÛÂȘ ‰‡ÛÎÔϘ, Ë ÂÁ΢ÌÔÛ‡ÓË Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ηϿ ·ÓÂÎÙ‹. √ ΛӉ˘ÓÔ˜ ·ÚÚ˘ıÌ›·˜, ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Î·È Âȉ›ӈÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Ù˘ ηډȿ˜ ÊÙ¿ÓÂÈ ÙÔ 14% (3,35).

2. ªÔÓ‹Ú˘ ÎÔÈÏ›·, ÌÂÙ¿ ·fi Â¤Ì‚·ÛË Ù‡Ô˘ Fontan ∆· ΢ÚÈfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ÛÙȘ ·ÛıÂÓ›˜ ·˘Ù¤˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙËÓ ·‰˘Ó·Ì›· Ù˘ ÎÔÈÏ›·˜ Ó· ·˘Í‹ÛÂÈ ÙËÓ Î·Ú‰È·Î‹ ·ÚÔ¯‹ Î·È ·fi ÙȘ Ôχ ÛÔ‚·Ú¤˜ Î·È ‰‡ÛÎÔÏ· ·ÓÙÈÌÂÙˆ›ÛÈ̘ ·ÚÚ˘ı̛˜. √ ΛӉ˘ÓÔ˜ ı·Ó¿ÙÔ˘ ‰ÂÓ Â›Ó·È ÌÂÁ¿ÏÔ˜, fï˜ Ë ·ÔÚ‡ıÌÈÛË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ (ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 1/3) ηıÒ˜ Î·È ÙÔ Ì¤ÏÏÔÓ, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÈÊ˘Ï¿ÍÂȘ ˆ˜ ÚÔ˜ ÙËÓ ·ÚÔ¯‹ ÚÔÁÂÓÓËÙÈÎÒÓ Û˘Ì‚Ô˘ÏÒÓ (ı· Ú¤ÂÈ Ì¿ÏÏÔÓ Ó· ·Ôı·ÚÚ‡ÓÂÙ·È Ë ÂÁ΢ÌÔÛ‡ÓË) (3,36).

3. ∆ÂÙÚ·ÏÔÁ›· Fallot Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ΢·ÓˆÙÈ΋ ηډÈÔ¿ıÂÈ·. ∏ ÂÈÙ˘¯‹˜ ‰ÈfiÚıˆÛ‹ Ù˘ Â›Ó·È ÂÊÈÎÙ‹ Â‰Ò Î·È ÔÏϤ˜ ‰ÂηÂٛ˜. ™Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ηϋ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ηٿÛÙ·ÛË ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù·. ™Â ·˘Ù¿ Ô˘ ˘¿Ú¯Ô˘Ó ·ÚÚ˘ı̛˜, ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‰È·Ê˘Á¤˜, ·ÓÂ¿ÚÎÂÈ· ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î.Ï., Ë ÛÔ‚·ÚfiÙËÙ· ÙˆÓ ÂÈÙÒÛÂˆÓ ·˘Í¿ÓÂÙ·È ‹ ÌÂÈÒÓÂÙ·È Î·Ù¿ ÂÚ›ÙˆÛË.

4. πÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ∂›Ó·È ÌÈ· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ. ™‹ÌÂÚ·, ÛÙË ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚfiÎÂÈÙ·È ÁÈ· ¯ÂÈÚÔ˘ÚÁÈο ‰ÈÔÚıˆÌ¤ÓË ÛÙ¤ÓˆÛË Ô˘ ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚ˜ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·114

114

™. ∞ÓÙˆÓÈ¿‰Ë˜

ÂÈÙÒÛÂȘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÂÎÙfi˜ Â¿Ó ˘¿Ú¯ÂÈ Â·Ó·ÛÙ¤ÓˆÛË ‹ ˘¤ÚÙ·ÛË Ô˘ ·Ú·Ì¤ÓÂÈ. ™Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰ÈÔÚıˆı›, Ë ·ÚÙËÚȷ΋ ›ÂÛË Ú˘ıÌ›˙ÂÙ·È ‰‡ÛÎÔÏ· ÏfiÁˆ ÙÔ˘ fiÙÈ Ë ÙÒÛË Ù˘ ›ÂÛ˘ ÛÙÔ ¿Óˆ ̤ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (ÚÈÓ ÙË ÛÙ¤ÓˆÛË) ÚÔηÏ› ÌÂÁ¿ÏË ÙÒÛË ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ∏ ÚÔˆÚfiÙËÙ· Î·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È Û¯ÂÙÈο Û˘¯Ó¤˜.

5. ™Ù¤ÓˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ √È ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÈÙÚÔÂȉ‹ ‚·Ï‚›‰· ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ‹ Â›Ó·È ÚÂ˘Ì·ÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (37). ∏ ÚÂ˘Ì·ÙÈ΋ ÓfiÛÔ˜ fï˜, Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ÛÙÔÓ ·ÓÂÙ˘Á̤ÓÔ ÎfiÛÌÔ. ™Â οı ÂÚ›ÙˆÛË, Ë ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ηıÒ˜ Î·È ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡, ÚÔηÏ› ¿ÓÔ‰Ô ÙˆÓ ȤÛÂˆÓ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ, Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·, ‰‡ÛÓÔÈ· Î·È Èı·ÓÒ˜ ·ÚÚ˘ıÌ›·. √È Î·Ù·ÛÙ¿ÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ·Ó¿·˘ÛË, ‰ÈÔ˘ÚËÙÈο, ‚-·Ó·ÛÙÔÏ›˜, Ë·Ú›ÓË (ΛӉ˘ÓÔ˜ ‰ËÌÈÔ˘ÚÁ›·˜ ıÚfiÌ‚ˆÓ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ). ™Â ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Û˘˙ËÙËı› ·ÎfiÌ· Î·È ‚·Ï‚ȉÔÏ·ÛÙÈ΋. ∂˘Ù˘¯Ò˜, Ë ¿ıËÛË ‰ÂÓ Â›Ó·È Ôχ Û˘¯Ó‹ Î·È Ì ÙËÓ ¤ÁηÈÚË Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÔÈ ‰˘ÛÎÔϛ˜ ·ÔÛÔ‚Ô‡ÓÙ·È. ª¤¯ÚÈ ÙÒÚ· ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÌËÙÚÈÎÔ› ı¿Ó·ÙÔÈ. ∏ ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜, ·Ó Î·È ‰ÂÓ ¤¯ÂÈ Û¯¤ÛË Ì ÙË ÛÙ¤ÓˆÛË, ·Ó·Ê¤ÚÂÙ·È Â‰Ò ÏfiÁˆ Ù˘ Û˘¯ÓfiÙËÙ¿˜ Ù˘, Ë ÔÔ›· ÔÏϤ˜ ÊÔÚ¤˜ ÔÊ›ÏÂÙ·È Û ˘ÂډȿÁÓˆÛË. ™Â οı ÂÚ›ÙˆÛË ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î‡ËÛË.

6. ªÂÙ·ÏÏÈΤ˜ ‚·Ï‚›‰Â˜ Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ÔÈ ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈ ÙÔÔıÂÙËı› ÌÂÙ·ÏÏÈ΋ ‚·Ï‚›‰· ·›ÚÓÔ˘Ó ·ÓÙÈËÎÙÈο. ŸÛÔÈ ¤¯Ô˘Ó ‚ÈÔÚÔÛıÂÙÈΤ˜ ‚·Ï‚›‰Â˜ Î·È ‚·Ï‚›‰Â˜ ·fi ÌÔۯ‡̷ٷ ‰ÂÓ ·›ÚÓÔ˘Ó ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Î·È ¤ÙÛÈ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù·. ∆Ô ‰›ÏËÌÌ· ÛÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٷÏÏËÏfiÙÂÚÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ·ÎfiÌ· Î·È ÛÙȘ ̤Ú˜ Ì·˜ ÚÔηÏ› ·ÓÙÈı¤ÛÂȘ, ÛÎÂÙÈÎÈÛÌfi Î·È ÚÔ‚ÏËÌ·ÙÈÛÌfi. ¶ÔÏÏ¿ ÂÍ·ÚÙÒÓÙ·È ·fi ÙË ı¤ÛË Î·È ÙÔ Â›‰Ô˜ Ù˘ ‚·Ï‚›‰·˜. ∏ Û˘Ó‹ıˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË ‚·ÚÊ·Ú›ÓË ÚÔηÏ› ‚Ï¿‚˜ ÛÙÔ ¤Ì‚Ú˘Ô, ΢ڛˆ˜ ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ, ÛÙË Ê¿ÛË Ù˘ ÔÚÁ·ÓÔÁ¤ÓÂÛ˘, ÂÓÒ Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ·ÈÌÔÚÚ·ÁÈÒÓ (ÂÁÎÂÊ·ÏÈ΋) Î·È ·˘ÙfiÌ·ÙˆÓ ·Ô‚ÔÏÒÓ. ∆Ô ¿Ï¶·È‰È·ÙÚÈ΋ 2006;69:110-117

ÏÔ Ê¿ÚÌ·ÎÔ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ·ÓÙÈËÎÙÈÎfi Â›Ó·È Ë Ë·Ú›ÓË, Ë ÔÔ›· ‰ÂÓ ÂÚÓ¿ÂÈ ÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù· ÛÙÔ ¤Ì‚Ú˘Ô, fï˜ Ë ·ÓÙÈËÎÙÈ΋ Ù˘ ‰Ú¿ÛË ‰ÂÓ Â›Ó·È Î·È ÙfiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋. ¶·ÚfiÏÔ Ô˘, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, ·ÎfiÌ· ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ˆ˜ ÚÔ˜ ÙÔ ·ÛʷϤÛÙÂÚÔ Û¯‹Ì·, Ê·›ÓÂÙ·È ˆ˜ ÔÈ ÁÓÒ̘ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙË ¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘ Û ‰fiÛË ÌÈÎÚfiÙÂÚË ‹ ›ÛË ÙˆÓ 5 mg. ™˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ·˘Ù‹˜ Ù˘ ‰fiÛ˘ Û fiÏË ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È Ë ÂÎÙ¤ÏÂÛË ÙÔ˘ ÙÔÎÂÙÔ‡ Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹, ÁÈ· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ·. ŒÓ· ¿ÏÏÔ Û¯‹Ì· Ô˘ ÚÔÙ›ÓÂÙ·È, Û˘ÓÈÛÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ë·Ú›Ó˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÛÈÚ›ÓË ÁÈ· ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, Ô‡Ùˆ˜ ÒÛÙ ӷ ÌÂȈıÔ‡Ó ÔÈ Î›Ó‰˘ÓÔÈ ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, ÂÓÒ ÁÈ· ÙȘ ÂfiÌÂÓ˜ ‚‰ÔÌ¿‰Â˜ ¿ÏÏÔÈ Û˘ÓÈÛÙÔ‡Ó Û˘Ó¤¯ÈÛË ·˘ÙÔ‡ ÙÔ˘ Û¯‹Ì·ÙÔ˜ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÙÔÎÂÙÔ‡ Î·È ¿ÏÏÔÈ ÚÔÙÈÌÔ‡Ó ÙË ¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘ ÂӉȿÌÂÛ·, ·fi ÙÔÓ ÙÚ›ÙÔ Ì‹Ó· ̤¯ÚÈ ÙËÓ 36Ë Â‚‰ÔÌ¿‰·. ŸÔÈÔ Û¯‹Ì· ÎÈ ·Ó ÚÔÙÈÌËı›, ı· Ú¤ÂÈ Ó· ÂÍËÁËı› ÛÙËÓ ¤ÁÎ˘Ô Î·È ÙÔ˘˜ ÔÈΛԢ˜ Ù˘ fiÙÈ ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ Ô˘ Êı¿ÓÂÈ Ì¤¯ÚÈ Î·È ÙÔ 10% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ (38-39).

°. ¶·ı‹ÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 1. ªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·, ·ÓÔȯÙfi˜ ·ÚÙËÚÈ·Îfi˜ fiÚÔ˜ ™ÙȘ ·ı‹ÛÂȘ Ì ‰È·Ê˘Á‹ ·fi ·ÚÈÛÙÂÚ¿ ÚÔ˜ Ù· ‰ÂÍÈ¿, fiÏ· ÂÍ·ÚÙÒÓÙ·È ·fi ÙȘ Ó¢ÌÔÓÈΤ˜ ȤÛÂȘ Î·È ·ÓÙÈÛÙ¿ÛÂȘ, ÙÔ ÔÛfi Ù˘ ‰È·Ê˘Á‹˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ‚Ï¿‚˘. ™‹ÌÂÚ· Ì ÙËÓ ÚÔÏËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Î·È ÙÔ˘˜ ·È‰ÔηډÈÔÏfiÁÔ˘˜, ÔÈ ·ı‹ÛÂȘ ·˘Ù¤˜, Ô˘ Â›Ó·È Î·È ÔÈ Û˘¯ÓfiÙÂÚ˜, ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ¤ÁηÈÚ· Î·È ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È. ŒÙÛÈ, ÔÈ ÌÂÁ¿Ï˜ ‰È·Ê˘Á¤˜ Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ·, Âȉ›ӈÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘ ‹ ·ÚÚ˘ı̛˜ ‰ÂÓ Â›Ó·È Û˘Ó‹ıÂȘ. ∂Í¿ÏÏÔ˘, ÔÈ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ì¿ÏÏÔÓ Â›Ó·È ÛˆÛÙfiÙÂÚÔ Ó· ÙÔÔıÂÙËıÔ‡Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ı‹ÛÂˆÓ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘. √È ÌÈÎÚ¤˜ ‰È·Ê˘Á¤˜ Û˘Ó‹ıˆ˜ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔÓ ÙÔÎÂÙfi Î·È ÙÔ ÌfiÓÔ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚›ˆÛ˘ ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ÂÓ‰Ôηډ›Ùȉ·˜. ¶·ÚfiÏÔ Ô˘ ÁÈ· ÙËÓ ÚÔʇϷÍË Ù˘ ÂÓ‰Ôηډ›Ùȉ·˜ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Î·È ·ÓÙÂӉ›ÍÂȘ ‹ ·ÎfiÌ· Î·È ·ÌÊÈÛ‚ËÙ‹ÛÂȘ, Ë ·ÛʷϤÛÙÂÚË Ú·ÎÙÈ΋ Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ÛÂ

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·115

115

™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ

fiϘ ÙȘ ÂÚÈÙÒÛÂȘ (Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜, ηÈÛ·ÚÈ΋ ÙÔÌ‹) Ù·ÎÙÈ΋ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È Î·È ·fi ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÔÌ¿‰Â˜. £· Ú¤ÂÈ ›Ûˆ˜ Ó· ·Ó·ÊÂÚı› fiÙÈ ·fi ÙȘ ÙÚÂȘ ·ı‹ÛÂȘ Ù˘ ηÙËÁÔÚ›·˜ ·˘Ù‹˜, Ë ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· Â›Ó·È ·˘Ù‹ Ô˘ ‰ËÌÈÔ˘ÚÁ› ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÎÏ‹ÍÂȘ. ªÔÏÔÓfiÙÈ Û‹ÌÂÚ· Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› Â›Ó·È Ôχ Ï›Á·, Û˘¯Ó¿ ¤Ó·˜ fi¯È Â˘Î·Ù·ÊÚfiÓËÙÔ˜ ·ÚÈıÌfi˜ ‚Ú›ÛÎÂÙ·È fiÙÈ ¤¯ÂÈ ‰È·Ê‡ÁÂÈ. ∆Ô Ôχ ‹ÈÔ Ê‡ÛËÌ· Ô˘ ÂÎÏ·Ì‚¿ÓÂÙ·È ˆ˜ ÏÂÈÙÔ˘ÚÁÈÎfi, Ë ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ·Ó¿Ù˘ÍË Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ú·Ï·Ó‹ÛÔ˘Ó ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ì ·ÔÙ¤ÏÂÛÌ· Ë ÚÒÙË ‰È¿ÁÓˆÛË Ó· Á›ÓÂÈ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, Ì ÙËÓ Â›Ù·ÛË ÙˆÓ Ê˘ÛËÌ¿ÙˆÓ (ʇÛËÌ· ÛÙËÓ Ó¢ÌÔÓÈ΋). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ·ÚÚ˘ı̛˜ ÏfiÁˆ Ù˘ ¯ÚfiÓÈ·˜ ÂÈ‚¿Ú˘ÓÛ˘ ÙˆÓ ‰ÂÍÈÒÓ Î·Ú‰È·ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ‹ Î·È ·Ú¿‰ÔÍË ÂÌ‚ÔÏ‹. √È Î›Ó‰˘ÓÔÈ Â›Ó·È ·˘ÍË̤ÓÔÈ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘.

2. ™Ù¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ ™ÙȘ ‹Ș ÛÙÂÓÒÛÂȘ Ì ÌÈÎÚ‹ ÎÏ›ÛË ›ÂÛ˘ fiˆ˜ Î·È ÛÙ· ÂÚÈÛÙ·ÙÈο Ô˘ Ë ¿ıËÛË ¤¯ÂÈ ·ÓÙÈÌÂÙˆÈÛÙ› Ì ‚·Ï‚ȉÔÏ·ÛÙÈ΋ Ì Ì·ÏfiÓÈ, ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î‡ËÛË. ∂Âȉ‹, fï˜, Ë ‚Ï¿‚Ë Â›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ÛÙËÓ ·È‰ÔηډÈÔÏÔÁ›·, Û¿ÓÈ· Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÂÚÈÛÙ·ÙÈο Ô˘ ¤¯Ô˘Ó ‰È·Ê‡ÁÂÈ ÏfiÁˆ ÙÔ˘ fiÙÈ ·ÎfiÌ· Î·È Û ‚·ÚȤ˜ ÌÔÚʤ˜, ÔÏϤ˜ ÊÔÚ¤˜ ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ó¤Ó· Û‡Ìو̷. ™Ù· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ Â›Ó·È ÔÚıfiÙÂÚÔ Ó· ·Ó·‚¿ÏÏÂÙ·È Ë ÂÁ΢ÌÔÛ‡ÓË Ì¤¯ÚÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË. ŸÔ˘ ·˘Ùfi ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi, ÌÔÚ› Ó· ÂȯÂÈÚËı› ÂÂÌ‚·ÙÈ΋ ‚·Ï‚ȉÔÏ·ÛÙÈ΋ ·ÎfiÌ· Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. √È ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÙÔÔıÂÙËıÔ‡Ó ÛÙËÓ Î·ÙËÁÔÚ›· ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÎÈÓ‰‡ÓÔ˘ (40-42).

3. ∞ÚÚ˘ı̛˜ ∞ӷʤÚÔÓÙ·È Í¯ˆÚÈÛÙ¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ‡·ÚÍË Î¿ÔÈ·˜ ‚Ï¿‚˘ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÚÚ˘ıÌ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ¤ÁηÈÚ·. ™˘Ó‹ıˆ˜ ÔÈ ·ÛıÂÓ›˜ ‚Ú›ÛÎÔÓÙ·È Û ıÂÚ·›· ‹ ÂÊ·ÚÌfi˙ÂÙ·È Î¿ÔÈÔ ıÂÚ·¢ÙÈÎfi Û¯‹Ì· ·fi ÙËÓ ·Ú¯‹ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∏ ÂÈÏÔÁ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛÔ¯‹ ÏfiÁˆ Ù˘ Èı·Ó‹˜ ‚Ï·ÙÈ΋˜ Â›‰Ú·Û˘ ÛÙÔ ¤Ì‚Ú˘Ô. ŸÌˆ˜, ı· Ú¤ÂÈ ¿ÓÙ· Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Ë ‚Ï·ÙÈ΋ Â›‰Ú·ÛË Ù˘ ·ÚÚ˘ıÌ›·˜ ÙfiÛÔ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô

fiÛÔ Î·È ÁÈ· ÙË ÌËÙ¤Ú· (ÚfiÎÏËÛË ·ÈÌÔ‰˘Ó·ÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ıÚfiÌ‚ˆÓ Î.Ï.). º¿Ú̷η, fiˆ˜ Ë ‰ÈÁÔÍ›ÓË Î·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ ıˆÚÔ‡ÓÙ·È ·ÛÊ·Ï‹ ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ÂÌÂÈÚ›·˜ ·fi ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË. ÕÏÏ· fiˆ˜ Ë ÛÔÙ·ÏfiÏË, Ë ÏȉÔη˝ÓË, Ë ·‰ÂÓÔÛ›ÓË Î.Ï., ıˆÚÔ‡ÓÙ·È Â›Û˘ Û¯ÂÙÈο ·‚Ï·‚‹ ¯ˆÚ›˜ fï˜ Ó· ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÂÌÂÈÚ›· ÛÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË. ∆¤ÏÔ˜, Ë ËÏÂÎÙÚÈ΋ ηډȷ΋ ·Ó¿Ù·ÍË ıˆÚÂ›Ù·È ·ÛÊ·Ï‹˜ (43-44). ∂ȯÂÈÚ‹ıËΠ·Ú·¿Óˆ, Ë ·ÚÔ˘Û›·ÛË ÌÈ·˜ ÌÂÁ¿Ï˘ ÔÌ¿‰·˜ ηډÈÔÏÔÁÈÎÒÓ ·ı‹ÛÂˆÓ Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÏÈÁfiÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î‡ËÛË. ∏ ·Ó·ÊÔÚ¿ Û ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ΢ڛˆ˜ Û¿ÓÈˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ, ηıÒ˜ Î·È ÔÈ ÁÂÓÈÎfiÙÂÚ˜ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ÂÈÙÒÛÂȘ Ù˘ οı ‚Ï¿‚˘, ˘ÂÚ‚·›ÓÂÈ Ù· fiÚÈ· ·˘ÙÔ‡ ÙÔ˘ ¿ÚıÚÔ˘. Ÿˆ˜ Ê¿ÓËÎÂ, ÔÈ Î·Ú‰ÈÔ¿ıÂȘ, ΢ڛˆ˜ ÔÈ Û˘ÁÁÂÓ›˜ Î·È Û·ÓÈfiÙÂÚ· ÔÈ Â›ÎÙËÙ˜, ·Ϥ˜ ‹ Û‡ÌÏÔΘ, Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÈÙ›· ÛÙ¤ÚËÛ˘ Ù˘ ÔÏ˘fiıËÙ˘ ÌËÙÚfiÙËÙ·˜ ·fi ÙȘ ¿Û¯Ô˘Û˜ Á˘Ó·›Î˜. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ·ÎfiÌ· Î·È Û ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ê¿ÛË, ȉȷ›ÙÂÚ· Û‡ÌÏÔÎˆÓ ·ÓˆÌ·ÏÈÒÓ, ÔÈ Î›Ó‰˘ÓÔÈ ÌËÙÚÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ‰ÂÓ Â›Ó·È ··ÁÔÚ¢ÙÈÎÔ›. µ¤‚·È· ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÛÙ·ÙÈο fiˆ˜ ·˘Ù¿ Ì Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË, Ì˘ÔηډÈÔ¿ıÂÈ·, ‚·ÚÈ¿ ΢·ÓˆÙÈ΋ ηډÈÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ Marfan Î.Ï., Ô˘ Ë ÂÁ΢ÌÔÛ‡ÓË ı· Ú¤ÂÈ Ó· ·Ôı·ÚÚ‡ÓÂÙ·È (45-48). ∂ÎÙfi˜ fï˜ ·fi ÙË ıÓËÛÈÌfiÙËÙ·, ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È È‰È·›ÙÂÚ· ˘’ fi„ÈÓ Ë ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ Âȉ›ӈÛË Ù˘ ηٿÛÙ·Û˘ Ù˘ ÌËÙ¤Ú·˜, Ô˘ ¿ÏÏÔÙ ·Ó·Ù¿ÛÛÂÙ·È ÌÂÙ¿ ·fi ÔÏϤ˜ ÚÔÛ¿ıÂȘ ÌÂÁ¿Ï˘ ÔÌ¿‰·˜ ÂȉÈÎÒÓ ÁÈ·ÙÚÒÓ Î·È ¿ÏÏÔÙ ·Ê‹ÓÂÈ ÛÔ‚·Ú¿ ηٿÏÔÈ· Ô˘ ÌÂÏÏÔÓÙÈο ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÍ·ÈÚÂÙÈο ÂÈΛӉ˘Ó· ÚÔ‚Ï‹Ì·Ù· (49-50). ∂›Û˘, ı· Ú¤ÂÈ ¿ÓÙ· Ó· Ï·Ì‚¿ÓÔÓÙ·È Ôχ ÛÔ‚·Ú¿ ˘’ fi„ÈÓ Ù· ÌÂÁ¿Ï· ÔÛÔÛÙ¿ ÂÌ‚Ú˘˚΋˜ ıÓËÛÈÌfiÙËÙ·˜, ÚÔˆÚfiÙËÙ·˜, ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, ·ÈÌÔÚÚ·ÁÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô Î.Ï. (51-57). °È· Ó· ÂÏ·ÙÙˆıÔ‡Ó ÛÙÔ ¯·ÌËÏfiÙÂÚÔ ‰˘Ó·Ùfi ÔÛÔÛÙfi ÔÈ Î›Ó‰˘ÓÔÈ Ô˘ ·Ó·Ê¤ÚıËηÓ, ı· Ú¤ÂÈ Ó· ÙËÚÔ‡ÓÙ·È ·˘ÛÙËÚ¿, Ù· ·Ú·Î¿Ùˆ. ¶ÚÒÙ· ·’ fiÏ· Ó· ‰›‰ÂÙ·È Ôχ ÌÂÁ¿ÏË ÛËÌ·Û›· ÛÙËÓ ÂÓË̤ڈÛË. ¶Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÁηÈÚ· ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ, ÚÈÓ ·fi ÙËÓ ÂÊ˂›·, Î·È ÔˆÛ‰‹ÔÙ ÚÈÓ ·fi ÙËÓ ÂÁ΢ÌÔÛ‡ÓË (‹ ¤ÛÙˆ Î·È ÌÂÙ¿). °È· ÙËÓ ·ÎÚÈ‚‹ ÂÎÙ›ÌËÛË Ù˘ ηٿÛÙ·Û˘, Â›Ó·È ··Ú·›ÙËÙË Ë ÁÓÒÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÂӉȷÊÂÚÔÌ¤ÓˆÓ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117

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ÁÈ·ÙÚÒÓ: ·È‰›·ÙÚÔ˘, ·È‰ÔηډÈÔÏfiÁÔ˘, ·È‰ÔηډÈÔ¯ÂÈÚÔ˘ÚÁÔ‡, ηډÈÔÏfiÁÔ˘, Ì·ÈÂ˘Ù‹Ú·, ·Ó·ÈÛıËÛÈÔÏfiÁÔ˘ (58-60). ¶Ôχ ÛËÌ·ÓÙÈ΋ Â›Û˘, Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘ ηٿÛÙ·Û˘ Ù˘ ̤ÏÏÔ˘Û·˜ ÌËÙ¤Ú·˜ Ì ÎÏÈÓÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, ¤Á¯ÚˆÌÔ Doppler ‹ fiÔÈ· ¿ÏÏË ÂͤٷÛË ıˆÚÂ›Ù·È ÛÎfiÈÌË (.¯. 24ˆÚÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· - Holter). £· Ú¤ÂÈ ›Ûˆ˜ Ó· Û˘˙ËÙËıÔ‡Ó ÔÈ Èı·ÓfiÙËÙ˜ οÔÈÔ˘ ›‰Ô˘˜ Â¤Ì‚·Û˘ Ô˘ ı· ÌÔÚÔ‡Û ӷ ‚ÂÏÙÈÒÛÂÈ ÙËÓ ·Ó·ÙÔÌ›· Î·È Ó· ÌÂÈÒÛÂÈ ÙËÓ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ηډȷÎÔ‡ ¤ÚÁÔ˘. ∞ÎfiÌË, ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜, ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ‹ ¿ÏÏ· ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ Ë ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, ¤¯Ô˘Ó Â›Û˘ ÛËÌ·Û›·, ηıÒ˜ Î·È Ë Èı·ÓfiÙËÙ· ÎÏËÚÔÓÔÌÈ΋˜ ÌÂÙ·‚›‚·Û˘ ÛÙÔ ÓÂÔÁÓfi. ∏ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Î·È Ë ·Ó¿Ï˘ÛË ÙˆÓ Èı·ÓÔÙ‹ÙˆÓ ÌÂÙ·‚›‚·Û˘ Ù˘ ÓfiÛÔ˘ - Ô˘ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË ÌÔÚ› Ó· Â›Ó·È ˘„ËϤ˜, ¤ˆ˜ Î·È ‰¤Î· ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·’ fi,ÙÈ Û ˘ÁÈ›˜ ÁÔÓ›˜, ¤ˆ˜ Î·È Ôχ ˘„ËϤ˜ (Û‡Ó‰ÚÔÌÔ Marfan) - Û›ÁÔ˘Ú· ‚ÔËıÔ‡Ó. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·ÔÊ·Û›˙ÂÙ·È Ë ÂÁ΢ÌÔÛ‡ÓË ‹ Ë Û˘Ó¤¯ÈÛ‹ Ù˘, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂÈ· ÔÈ Î›Ó‰˘ÓÔÈ, Ë Èı·Ó‹ ÓÔÛËÏ›· Û ÌÔÓ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ηıÒ˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ ÙÔ ÓÂÔÁÓfi (61,62). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÔÎÂÙfi, Û˘Ó‹ıˆ˜ ÚÔÙÈÌ¿Ù·È Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ (ÌÈÎÚfiÙÂÚË ·ÒÏÂÈ· ·›Ì·ÙÔ˜, ÏÈÁfiÙÂÚÔ ·fiÙÔ̘ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ·ÏÏ·Á¤˜). ∏ ¯Ú‹ÛË ÂÌ‚Ú˘Ô˘ÏΛ·˜ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙȘ ÚÔÛ¿ıÂȘ ÂÍÒıËÛ˘ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔÓ ¯ÚfiÓÔ Ù˘ fiÏ˘ ‰È·‰Èηۛ·˜. ™Â ÂÚÈÛÙ·ÙÈο Ì ۇӉÚÔÌÔ Marfan, ÚÔ‚Ï‹Ì·Ù· Ú‡ıÌÈÛ˘ Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÌÂÙ·ÏÏÈΤ˜ ‚·Ï‚›‰Â˜, ·Ó‡ڢÛÌ· ·ÔÚÙ‹˜ Î·È Û οı ÂÚ›ÙˆÛË Ô˘ ı· ÎÚÈı› ·Ó·Áη›·, ÏfiÁˆ ȉȷ›ÙÂÚˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ, Ë Î·ÈÛ·ÚÈ΋ ÙÔÌ‹ ·ÔÙÂÏ› ÙË ÛˆÛÙ‹ χÛË. ∆¤ÏÔ˜, ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜ fiÙÈ ÔÈ ÌËÙ¤Ú˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 34 ¤ˆ˜ 7 ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ, ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ Ù˘ ¿ıËÛ˘ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ fiÏ˘ ‰È·‰Èηۛ·˜ ÂÁ΢ÌÔÛ‡Ó˘ ÙÔÎÂÙÔ‡ (63,64). °ÓˆÚ›˙ÔÓÙ·˜ Ì ‚‚·ÈfiÙËÙ· fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ ı· ·˘ÍËı› Ô ·ÚÈıÌfi˜ ÙˆÓ Á˘Ó·ÈÎÒÓ Ì ηډÈÔ¿ıÂȘ - Î·È Ì¿ÏÈÛÙ·, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, ȉȷ›ÙÂÚ· Û‡ÌÏÔΘ - Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ÙÔ fiÛÔ ÌÂÁ¿ÏË ÛËÌ·Û›· ¤¯Ô˘Ó fiÏ· ·˘Ù¿ Ô˘ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117

·Ó·Ê¤ÚıËÎ·Ó Ì ηٿ ÙÔ ‰˘Ó·Ùfi Û˘ÓÔÙÈÎfi Î·È ÂÚÈÏËÙÈÎfi ÙÚfiÔ (65,66).

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

ORIGINAL ARTICLE

¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·: ·fi„ÂȘ ∂ÏÏ‹ÓˆÓ ·È‰È¿ÙÚˆÓ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ, ∆Ì‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜

ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘

AÏÏËÏÔÁÚ·Ê›·: ¢·Ó¿Ë ¶··‰¿ÙÔ˘ ∫·ıËÁ‹ÙÚÈ· ∫ÏÈÓÈ΋˜ æ˘¯ÔÏÔÁ›·˜ ∆Ì‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘ 123, T.K. 115 27 ∞ı‹Ó· E-mail: dpap@cc.uoa.gr

¶ÂÚ›ÏË„Ë: ∏ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ·ÔÙÂÏ› ¤Ó·Ó ·Ó·Ù˘ÛÛfiÌÂÓÔ ÙÔ̤· Ù˘ ·È‰È·ÙÚÈ΋˜ Ô˘ ·ÊÔÚ¿ ÛÙËÓ ·ÚÔ¯‹ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋˜, „˘¯ÔÎÔÈÓˆÓÈ΋˜ Î·È ÓÂ˘Ì·ÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηٷÏËÎÙÈÎfi ÓfiÛËÌ· Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜, Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙÔ˘˜. ™ÎÔÔ› Ù˘ ·ÚÔ‡Û·˜ ÂÚÈÁÚ·ÊÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó: ·) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ ·È‰È¿ÙÚˆÓ Ô˘ ÊÚÔÓÙ›˙Ô˘Ó ·È‰È¿ Ì ηٷÏËÎÙÈο ÓÔÛ‹Ì·Ù·, Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Î·È ‚) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ô˘ ·Ú¤¯ÂÙ·È ÛÙ· ÙÌ‹Ì·Ù· fiÔ˘ ÂÚÁ¿˙ÔÓÙ·È. ∆· Â˘Ú‹Ì·Ù· ÂÂÛ‹Ì·Ó·Ó fiÙÈ Ë ÊÈÏÔÛÔÊ›· Î·È ÔÈ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Â·ÚÎÒ˜ ηٷÓÔËÙ¤˜ ·fi ÙÔ˘˜ ŒÏÏËÓ˜ ·È‰›·ÙÚÔ˘˜ ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÂÏÏÈ‹ Î·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ∏ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ·Ú·Ì¤ÓÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi È·ÙÚÔÎÂÓÙÚÈ΋, ÂÛÙÈ·Ṳ̂ÓË Î˘Ú›ˆ˜ ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Û˘Ìو̿وÓ, ÂÓÒ Ë „˘¯ÔÎÔÈÓˆÓÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ˘ÔÏ›ÂÙ·È ÛËÌ·ÓÙÈο. √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ·Ó·ÁÓÒÚÈÛ·Ó ÙȘ ÂÏÏÈ›˜ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ ÙÔ Î˘ÚÈfiÙÂÚÔ ÂÌfi‰ÈÔ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Î·È ÙfiÓÈÛ·Ó ÙËÓ ·Ó¿ÁÎË Î·Ù¿ÏÏËÏ˘ ηٿÚÙÈÛ‹˜ ÙÔ˘˜, fiÛÔ Î·È ÛÙÂϤ¯ˆÛ˘ ÙˆÓ ÙÌËÌ¿ÙˆÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Ì ÂÍÂȉÈÎÂ˘Ì¤ÓÔ È·ÙÚÔÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ηıÒ˜ Î·È Ì ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜. ∏ ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ·ÔÙÂÏ› ‚·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÛÙË ¯ÒÚ· Ì·˜, Ì ÛÎÔfi Ù˘ ÌÂÁÈÛÙÔÔ›ËÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ Ì ·ÂÈÏËÙÈο ÁÈ· ÙË ˙ˆ‹ ÓÔÛ‹Ì·Ù· Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2005

§¤ÍÂȘ ÎÏÂȉȿ: ∞Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·, ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ı¿Ó·ÙÔ˜, ·È‰È΋ ËÏÈΛ·.

Paediatric palliative care: perceptions of Greek pediatricians University of Athens, Faculty of Nursing Correspondence: Danai Papadatou Professor of Clinical Psychology University of Athens, Faculty of Nursing 123 Papadiamantopoulou St., 11527, Athens E-mail: dpap@cc.uoa.gr Date of submission: 21-09-2004 Date of approval: 22-07-2005

M. Bouri, D. Papadatou

Abstract: Paediatric palliative care, aimed at the provision of physical, psychosocial and spiritual care for children living with life-limiting diseases and their families, is recognised as an evolving field of paediatrics. In Greece, specialized palliative care services have not yet been developed, although certain elements of such care are being provided in oncology and intensive care settings. The aims of this descriptive study were: a) to investigate the extent of knowledge about paediatric palliative care of Greek paediatricians working in the above settings, and b) to determine their perceptions with regard to the effectiveness of provision of palliative care services in their respective units. The findings revealed that the philosophy and principles of paediatric palliative care have not been fully comprehended by Greek paediatricians, leading to inadequate and inefficient application of palliative care in clinical practice.

Their approach remains mainly medically centred, focusing on pain management and symptom control. According to their perceptions, psychosocial and spiritual support is inadequately offered to children and families in their work settings. The participants recognised their lack of knowledge as the major barrier to the application of palliative care. They identified the need for education and training for the effective provision of palliative care and for the staffing of their units with specialized medical, nursing staff and mental health professionals. In conclusion, education in paediatric palliative care is an essential prerequisite for the development of palliative care programmes for terminally ill children and their families in Greece.

Key words: Palliative care, terminal care, death, childhood.

¶·È‰È·ÙÚÈ΋ 2006;69:118-126

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¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·

∂ÈÛ·ÁˆÁ‹ √ fiÚÔ˜ “·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰·” (pediatric palliative care) ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·ÚÔ¯‹ ÔÚÁ·ÓˆÌ¤Ó˘ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋˜, „˘¯ÔÎÔÈÓˆÓÈ΋˜ Î·È ÓÂ˘Ì·ÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηٷÏËÎÙÈÎfi ÓfiÛËÌ· Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜, ·fi ‰ÈÂÈÛÙËÌÔÓÈ΋ ÔÌ¿‰· ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (1-5). £ÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ·ÔÙÂÏÔ‡Ó: ·) Ë ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·È‰ÈÔ‡ ·fi ÂӉ¯fiÌÂÓÔ fiÓÔ ‹ /Î·È ¿ÏÏ· Û˘ÌÙÒÌ·Ù·, ‚) Ë „˘¯ÔÎÔÈÓˆÓÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ Î·È È‰È·›ÙÂÚ· ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ˙ˆ‹˜ ÙÔ˘, Á) Ë „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡, ‰) Ë ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ·fi ‰ÈÂÈÛÙËÌÔÓÈ΋ ÔÌ¿‰· ÒÛÙ ӷ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÏËÚ¤ÛÙÂÚ· ÔÈ ÔχÏ¢Ú˜ ·Ó¿ÁΘ ·È‰ÈÔ‡ Î·È ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Â) Ë ÂÍÂȉÈÎÂ˘Ì¤ÓË Î·Ù¿ÚÙÈÛË ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ fiÛÔ Î·È Ë Û˘ÛÙËÌ·ÙÈ΋ „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍ‹ ÙÔ˘˜ (1-5, 7). ∏ ·Ó¿ÁÎË ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ Ì ÓfiÛËÌ· Ô˘ ‰ÂÓ ‰‡Ó·Ù·È Ó· ıÂÚ·¢ı› Ì ٷ ‰È·ı¤ÛÈÌ· ̤۷ -›Ù ÏfiÁˆ Ù˘ ʇÛ˘ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ›Ù ÏfiÁˆ ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ ·ÚÚÒÛÙÈ·˜- ·ÔÙ¤ÏÂÛ ÙÔ ·›ÙËÌ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ÂÍÂȉÈÎÂ˘Ì¤Ó˘ ·˘Ù‹˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηÚΛÓÔ, ∞πDS, ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, ÔÚÈṲ̂ӷ ÌÂÙ·‚ÔÏÈο Î·È Ó¢ÚÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ‹ ¿ÏϘ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ·Ûı¤ÓÂȘ (4,5,7,9-11). ¶ÚÒÙË Ë Ida Martinson ÙË ‰ÂηÂÙ›· ÙÔ˘ 1970 -Ì ¯ÚËÌ·ÙÔ‰fiÙËÛË ·fi ÙÔ ¡π∏ (National Institute of Health)- ÂÊ¿ÚÌÔÛ ÙȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ì ηÚΛÓÔ Ô˘ Â¤ÏÂÍ·Ó Ó· ÓÔÛËÏ¢ÙÔ‡Ó ÛÙÔ Û›ÙÈ ÙËÓ ÙÂÏÈ΋ ÂÚ›Ô‰Ô Ù˘ ˙ˆ‹˜ ÙÔ˘˜ (12). ŒÎÙÔÙ ÔÈ ÚˆÙÔ‚Ô˘Ï›Â˜ Î·È ÔÈ ‰Ô̤˜ ÁÈ· ÙËÓ ·ÚÔ¯‹ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ‰È·ÚÎÒ˜ ÏËı·›ÓÔ˘Ó Û fiÏÔÓ ÙÔÓ ÎfiÛÌÔ, Ì ÙËÓ ·Ó¿Ù˘ÍË ÂȉÈÎÒÓ ÍÂÓÒÓˆÓ ÁÈ· ·È‰È¿ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ·ÚÚÒÛÙÈ·˜ ÙÔ˘˜ (pediatric hospices), ˘ËÚÂÛÈÒÓ Î·Ù’ Ô›ÎÔÓ ÓÔÛËÏ›·˜ (pediatric home care programs) Î·È ÂȉÈÎÒÓ ÙÌËÌ¿ÙˆÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ (palliative care units) Û ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›·. ¶·Ú¿ÏÏËÏ·, ÚÔÛʤÚÔÓÙ·È

‹‰Ë ÌÂÙ·Ù˘¯È·Î¿ ÚÔÁÚ¿ÌÌ·Ù· Û ·È‰È¿ÙÚÔ˘˜ Î·È ¿ÏÏÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ Ô˘ ÂÈı˘ÌÔ‡Ó Ó· ÂȉÈ΢ÙÔ‡Ó ÛÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ¯ÒÚÔ (4,6,8,32). ™ÙËÓ ∂ÏÏ¿‰·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ˘ËÚÂۛ˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿, Ù˘¯¤˜ Ù˘ ÊÚÔÓÙ›‰·˜ ·˘Ù‹˜ ·Ú¤¯ÔÓÙ·È Î˘Ú›ˆ˜ Û ÔÁÎÔÏÔÁÈο ÙÌ‹Ì·Ù· Î·È ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ fiÔ˘ Î·È ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ·È‰È¿ Ì ηٷÏËÎÙÈο ÓÔÛ‹Ì·Ù· (13-14). ™ÎÔÔ› Ù˘ ·ÚÔ‡Û·˜ ÂÚÈÁÚ·ÊÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó ·) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÁÓÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó ·È‰›·ÙÚÔÈ Ô˘ ÊÚÔÓÙ›˙Ô˘Ó ·È‰È¿ Ì ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘˜ ·Ûı¤ÓÂȘ Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Î·È ‚) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ô˘ ·Ú¤¯ÂÙ·È ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÂÚÁ·Û›·˜ ÙÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÙ¿ ·fi ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›· ÙˆÓ ÂÚ¢ÓËÙÒÓ Ì ÙÔ˘˜ ¢È¢ı˘ÓÙ¤˜ ‰‡Ô √ÁÎÔÏÔÁÈÎÒÓ ∆ÌËÌ¿ÙˆÓ Î·È ÙÚÈÒÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ÙÚÈÒÓ ‰ËÌÔÛ›ˆÓ ¶·È‰È·ÙÚÈÎÒÓ ¡ÔÛÔÎÔÌ›ˆÓ Ù˘ ∞ı‹Ó·˜ Î·È ·ÊÔ‡ ÚÔËÁ‹ıËΠÂÓË̤ڈÛË Ù˘ È·ÙÚÈ΋˜ ÔÌ¿‰·˜ ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÌÂϤÙ˘, ÚÔÛÎÏ‹ıËÎ·Ó ÔÈ 39 ·È‰›·ÙÚÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·Ó ÛÙ· Û˘ÁÎÂÎÚÈ̤ӷ ÙÌ‹Ì·Ù· Ó· Û˘ÌÏËÚÒÛÔ˘Ó ·ÓÒÓ˘Ì· ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. ∆Ô ÔÛÔÛÙfi ··ÓÙËÙÈÎfiÙËÙ·˜ ‹Ù·Ó 82%. ∆Ô ‰Â›ÁÌ· ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 11 ·È‰È¿ÙÚÔ˘˜ ÔÁÎÔÏfiÁÔ˘˜-·ÈÌ·ÙÔÏfiÁÔ˘˜ Î·È 21 ·È‰È¿ÙÚÔ˘˜-ÂÓÙ·ÙÈÎÔÏfiÁÔ˘˜. ¶ÔÛÔÛÙfi 44% (14) ‹Ù·Ó Á˘Ó·›Î˜ Î·È 56% (18) ‹Ù·Ó ¿Ó‰Ú˜. OÈ ËÏÈ˘ ÙÔ˘˜ Î˘Ì·›ÓÔÓÙ·Ó ˆ˜ ÂÍ‹˜: 30-40 ÂÙÒÓ (22%), 41-50 ÂÙÒÓ (50%) Î·È ¿Óˆ ÙˆÓ 50 ÂÙÒÓ (28%). √È ÂÚÈÛÛfiÙÂÚÔÈ ‹Ù·Ó ·ÓÙÚÂ̤ÓÔÈ (84%) Î·È Â›¯·Ó ·È‰È¿ Û ÔÛÔÛÙfi 78%. √È È·ÙÚÔ› ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ›¯·Ó ÚÔ¸ËÚÂÛ›· ÛÙÔÓ ¯ÒÚÔ Ù˘ ˘Á›·˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ¿Óˆ ÙˆÓ 15 ÂÙÒÓ (62,5%). ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚÈÂÏ¿Ì‚·Ó ·ÓÔȯ٤˜ Î·È ÎÏÂÈÛÙ¤˜ ÂÚˆÙ‹ÛÂȘ Î·È ·ÔÙÂÏ›ÙÔ ·fi ‰‡Ô ̤ÚË. ™ÙÔ ÚÒÙÔ, “°ÂÓÈÎfi ̤ÚÔ˜”, ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÎÏ‹ıËÎ·Ó Ó· ‰ÒÛÔ˘Ó ¤Ó·Ó ÔÚÈÛÌfi Ù˘ ·È‰È·ÙÚÈ΋˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó fiÛÔ ÛËÌ·ÓÙÈ΋ ıˆÚÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ·ÚÚÒÛÙÈ·˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙËÓ Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂÒÓ ÙÔ˘˜ Ó· ÙËÓ ·Ú¤¯Ô˘Ó. ¶ÚÔÛÎÏ‹ıËÎ·Ó Â›Û˘, Ó· ·Ó·Ê¤ÚÔ˘Ó ÙȘ ·fi„ÂȘ ÙÔ˘˜ ¿Ó, Ì ÔÈÔ˘˜ ÙÚfiÔ˘˜ Î·È fiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈο, ÙÔ ÙÌ‹Ì· fiÔ˘ ÂÚÁ¿˙ÔÓÙ·È ÚÔÛʤÚÂÈ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ÛÙ· ·È‰È¿. ∆¤ÏÔ˜, η٤ÁÚ·„·Ó ÙȘ ‰˘ÛÎÔϛ˜ Ô˘ Û˘Ó·ÓÙÔ‡Ó ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÚfiÙÂÈÓ·Ó Ì¤ÙÚ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∆Ô “∂ȉÈÎfi ̤ÚÔ˜” ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ·ÔÙÂÏ›ÙÔ ·fi ¤ÓÙ ıÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ˘˜ ¤ÓÙ ‚·ÛÈÎÔ‡˜ ÙÔÌ›˜ ÁÓÒÛÂˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ ¶·È‰È·ÙÚÈ΋ 2006;69:118-126

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·120

120

ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘

Ô˘ Ú¤ÂÈ Ó· ‰È·ı¤ÙÔ˘Ó ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ Ô˘ ·Ú¤¯Ô˘Ó ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· (1-5): ·) ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Î·È ¿ÏÏˆÓ Û˘Ìو̿وÓ, ‚) ÙËÓ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, Á) ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ‰) ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÛÙ‹ÚÈ͢ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜ Ù˘, Î·È Â) ÙË ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›·. °È· οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú·¿Óˆ ÙÔÌ›˜, ÔÈ ·È‰›·ÙÚÔÈ ÎÏ‹ıËÎ·Ó Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙË ÛËÌ·Û›· Ô˘ ÙÔ˘ ·Ô‰›‰Ô˘Ó Î·È Î·ÙfiÈÓ Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙËÓ Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂˆÓ Ô˘ ‰È·ı¤ÙÔ˘Ó ÔÈ ›‰ÈÔÈ, ηıÒ˜ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÙÚ¤¯Ô˘Û·˜ Ú·ÎÙÈ΋˜ ÛÙ· ÙÌ‹Ì·Ù¿ ÙÔ˘˜. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÔÛÔÙÈΤ˜ Î·È ÔÈÔÙÈΤ˜ ÌÂıfi‰Ô˘˜. ÃÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS ÁÈ· Ù· ‰Â‰Ô̤ӷ Ô˘ ÚԤ΢„·Ó ·fi ÙȘ ÎÏÂÈÛÙ¤˜ ÂÚˆÙ‹ÛÂȘ, ÛÙȘ Ôԛ˜ Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ˘fi ÌÂϤÙË ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ Îϛ̷η Likert (0= ηıfiÏÔ˘ Î·È 5= ¿Ú· Ôχ). ™Ù· ‰Â‰Ô̤ӷ ÙˆÓ ·ÓÔȯÙÒÓ ÂÚˆÙ‹ÛÂˆÓ ÂÊ·ÚÌfiÛıËÎÂ Ë ·Ó¿Ï˘ÛË ÂÚȯÔ̤ÓÔ˘ (content analysis).

∞ÔÙÂϤÛÌ·Ù· ∆· ‰Â‰Ô̤ӷ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ¤ÍÈ ÂÓfiÙËÙ˜, Ë ÚÒÙË ·fi ÙȘ Ôԛ˜ ·ÊÔÚ¿ ÛÙȘ ÁÓÒÛÂȘ Î·È ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ·È‰È¿ÙÚˆÓ Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÂÚÁ·Û›·˜ ÙÔ˘˜, ÂÓÒ ÔÈ ÂfiÌÂÓ˜ ¤ÓÙ ÂÓfiÙËÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ¤ÓÙ ÙÔÌ›˜ ÁÓÒÛÂˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·Ú·¿Óˆ ˆ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙËÓ ·ÚÔ¯‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÊÚÔÓÙ›‰·˜. √ÚÈÛÌfi˜, ·Ó·ÁηÈfiÙËÙ· Î·È ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ (79%) fiÚÈÛ ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ˆ˜ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·È‰ÈÔ‡, Ì ¤ÌÊ·ÛË ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘. ªfiÓÔ ÙÔ 34,5% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó¤ÊÂÚ ÙËÓ ·Ú¿ÏÏËÏË „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡, ÂÓÒ Ë ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û˘ÌÂÚÈÏ‹ÊıËΠÌfiÏȘ Û ÔÛÔÛÙfi 17%. ∏ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ÔÚ›ÛıËΠ۠ÔÛÔÛÙfi 14% ˆ˜ ÂÍ·ÛÊ¿ÏÈÛË “ÔÈfiÙËÙ·˜ ˙ˆ‹˜”, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÔÈ ·Ú¿ÌÂÙÚÔÈ ·˘Ù‹˜ (¶›Ó·Î·˜ 1). ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ Ô Ï‹Ú˘ ÔÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ˆ˜ È·ÙÚÈ΋, „˘¯ÔÏÔÁÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ·Ô‰fiıËΠ·fi ¤Ó·Ó ÌfiÓÔ ·È‰›·ÙÚÔ. ¶·È‰È·ÙÚÈ΋ 2006;69:118-126

¶›Ó·Î·˜ 1. ∞fi„ÂȘ ÙˆÓ È·ÙÚÒÓ: √ÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ √ÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Î·È ÙˆÓ ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ æ˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ ™Ù‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ∂Í·ÛÊ¿ÏÈÛË ÔÈfiÙËÙ·˜ ˙ˆ‹˜ π·ÙÚÔÓÔÛËÏ¢ÙÈ΋ ÊÚÔÓÙ›‰· Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ & ÓÂ˘Ì·ÙÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜

% ÙˆÓ ··ÓÙ‹ÛÂˆÓ 79 34,5 17 14 3,5

∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ¯·Ú·ÎÙËÚ›ÛÙËΠˆ˜ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ (91%), ηıÒ˜ Î·È fiÙ·Ó ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏË ıÂÚ·¢ÙÈ΋ ‰˘Ó·ÙfiÙËÙ· ÁÈ· ÙÔ ·È‰› (87,5%). ™ËÌ·ÓÙÈÎfi Â›Û˘ ÔÛÔÛÙfi (90,6%) ·Ó·ÁÓˆÚ›˙ÂÈ ÙË ÛËÌ·Û›· Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ·fi ÙË ‰È¿ÁÓˆÛË ÂÓfi˜ ·ÂÈÏËÙÈÎÔ‡ ÁÈ· ÙË ˙ˆ‹ ÓÔÛ‹Ì·ÙÔ˜, ·Ú¿ÏÏËÏ· Ì ÙË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. √È ÂÚˆÙËı¤ÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙËÓ Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ˆ˜ “·ÚÎÂÙ‹” Û ÔÛÔÛÙfi 37,5%, ˆ˜ “Ôχ” ¤ˆ˜ “¿Ú· Ôχ” ÌÂÁ¿ÏË Û ÔÛÔÛÙfi 34,5% Î·È ˆ˜ “ÏÈÁÔÛÙ‹” ‹ “·Ó‡·ÚÎÙË” Û ÔÛÔÛÙfi 28%. ø˜ ËÁ¤˜ ÁÓÒÛ˘ Î·È ÂÓË̤ڈۋ˜ ÙÔ˘˜ ·Ó¤ÊÂÚ·Ó ÙȘ Û˘˙ËÙ‹ÛÂȘ ÌÂ Û˘Ó·‰¤ÏÊÔ˘˜ (44%), ÙËÓ È·ÙÚÈ΋ ÙÔ˘˜ ÂÎ·›‰Â˘ÛË (41%), ÛÂÌÈÓ¿ÚÈ· ‹ ‰È·Ï¤ÍÂȘ (34%), ÂÓÒ ÔÛÔÛÙfi 6% ·Ó¤ÊÂÚ fiÙÈ ‰ÂÓ Â›¯Â ÏËÚÔÊfiÚËÛË ·fi η̛· ËÁ‹. ∂ÓÒ ÔÈ ·È‰›·ÙÚÔÈ ·¿ÓÙËÛ·Ó fiÙÈ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ·Ú¤¯ÂÙ·È ÛÙ· ÙÌ‹Ì·Ù¿ ÙÔ˘˜ Û˘ÛÙËÌ·ÙÈο Û ÔÛÔÛÙfi 69% Î·È Â˘Î·ÈÚȷο Û ÔÛÔÛÙfi 31%, Ô ÂÚ·ÈÙ¤Úˆ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÙÈ ·ÎÚÈ‚Ò˜ ÚÔÛʤÚÂÙ·È ÛÙ· ·È‰È¿ ‰Â›¯ÓÂÈ ÙËÓ Î·Ù’ ÂÍÔ¯‹Ó ÂÈΤÓÙÚˆÛË ÛÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ Î·È ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·È‰ÈÔ‡. (¶›Ó·Î·˜ 2). ∏ „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Ì·˙› ÙÔ˘, ·Ó·Ê¤ÚıËΠÌfiÓÔ Û ÔÛÔÛÙfi 41%, ÂÓÒ ·ÎfiÌË Û·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚıËÎÂ Ë „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (14%). ∂ȉÈο “È·ÙÚ›· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘” ÁÈ· ÙËÓ ·ÚÔ¯‹ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ·Ó·Ê¤ÚıËÎ·Ó Û 3 ÂÚÈÙÒÛÂȘ. ∆· Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ· ÂÌfi‰È· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ·ÊÔÚÔ‡Û·Ó ÙËÓ ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È Â˘·ÈÛıËÙÔÔ›ËÛ˘ ÙÔ˘

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·121

121

¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·

¶›Ó·Î·˜ 2. ∆ÚfiÔÈ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜

¶›Ó·Î·˜ 3. ∂Ìfi‰È· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·È‰È·ÙÚÈ΋˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜

∂Ê·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜

∂Ìfi‰È· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜

ÃÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ ‹/ Î·È ¿ÏÏ˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ∂ÈÎÔÈÓˆÓ›· Ì ÙÔ ¿ÚÚˆÛÙÔ ·È‰› Î·È „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍ‹ ÙÔ˘ æ˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜

% ÙˆÓ ··ÓÙ‹ÛÂˆÓ 86 41 14

ÚÔÛˆÈÎÔ‡ (59%), ÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ ΢ڛˆ˜ „˘¯ÔÏfiÁÔ˘, ÎÔÈÓˆÓÈÎÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡ Î·È ÂȉÈÎÒÓ ÛÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·- (55,5%) Î·È ÙËÓ ¤ÏÏÂÈ„Ë ˘Ô‰ÔÌ‹˜ Û ¯ÒÚÔ˘˜ Î·È Î·Ù¿ÏÏËϘ ˘ËÚÂۛ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ηْ Ô›ÎÔÓ ÊÚÔÓÙ›‰·˜ (38%) (¶›Ó·Î·˜ 3). √È ÚÔÙ¿ÛÂȘ ÁÈ· ÙËÓ ˘¤Ú‚·ÛË ÙˆÓ ÂÌÔ‰›ˆÓ ·˘ÙÒÓ ÂÈÎÂÓÙÚÒıËÎ·Ó ÛÙËÓ ÚfiÛÏË„Ë ÚÔÛˆÈÎÔ‡ (67%), ÙËÓ ÂÎ·›‰Â˘ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ (48%) Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ ηٿÏÏËÏ˘ ˘Ô‰ÔÌ‹˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÂȉÈ΋˜ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜, ηْ Ô›ÎÔÓ ÓÔÛËÏ›·˜ Î·È ÂȉÈÎÒÓ ÙÌËÌ¿ÙˆÓ (44,5%). ∞ÓÙÈÌÂÙÒÈÛË fiÓÔ˘ Î·È ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ∆Ô Û‡ÓÔÏÔ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ·¿ÓÙËÛ fiÙÈ ıˆÚ› “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ ·È‰› Ô˘ ·ÂÈÏÂ›Ù·È Ë ˙ˆ‹ ÙÔ˘ ‹ Âı·›ÓÂÈ. ŸÌˆ˜, ÂÓÒ ‰ËÏÒÓÔ˘Ó fiÙÈ ÛÙÔ ÙÌ‹Ì· Ô˘ ÂÚÁ¿˙ÔÓÙ·È Ô fiÓÔ˜ ÙˆÓ ·È‰ÈÒÓ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È “Ôχ” ‹ “¿Ú· Ôχ” ·ÔÙÂÏÂÛÌ·ÙÈο Û ÔÛÔÛÙfi 81,5% Î·È Ù· ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Û ÔÛÔÛÙfi 72%, ·ÚfiÏ· ·˘Ù¿, ÛËÌ·ÓÙÈο ÔÛÔÛÙ¿ ÁÈ·ÙÚÒÓ ·ÍÈÔÏÔÁÔ‡Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ Û·ÊÒ˜ ÂÚÈÔÚÈṲ̂Ó˜, ȉȷ›ÙÂÚ· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ (53%), ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ fiÓÔ˘ (41%) Î·È ÏÈÁfiÙÂÚÔ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰‡ÛÓÔÈ·˜, ÙˆÓ Û·ÛÌÒÓ Î·ıÒ˜ Î·È ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ (¤ÌÂÙÔÈ, ·ÓÔÚÂÍ›·, ‰È¿ÚÚÔÈ·). ø˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÂÌfi‰ÈÔ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ·Ó·Ê¤ÚıËÎÂ Ë ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ ÂÎ·›‰Â˘Û˘ (63%) Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ (52%) ˘ÔÁÚ¿ÌÌÈÛ·Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· Û¯ÂÙÈ΋˜ ηٿÚÙÈÛ˘. √ÚÈṲ̂ÓÔÈ ·Ó·Ê¤ÚıËÎ·Ó Â›Û˘, ÛÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡, ÛÙËÓ ¤ÏÏÂÈ„Ë Î·Ù¿ÏÏËÏˆÓ ¯ÒÚˆÓ Î·È ˘Ô‰ÔÌ‹˜, ÂÓÒ ÁÈ· ÙÔ 26% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÌfi‰È· ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘.

ŒÏÏÂÈ„Ë ÁÓÒÛÂˆÓ / ¢·ÈÛıËÙÔÔ›ËÛ˘ ŒÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ ŒÏÏÂÈ„Ë ˘Ô‰ÔÌ‹˜-˘ËÚÂÛÈÒÓ ºfiÚÙÔ˜ ÂÚÁ·Û›·˜ ∞Ô˘Û›· ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ ¢ÂÓ ˘¿Ú¯Ô˘Ó ÂÌfi‰È·

% ÙˆÓ ··ÓÙ‹ÛÂˆÓ 59 55,5 38 26 18,5 15

∂ÈÎÔÈÓˆÓ›· Ì ÙÔ ¿ÚÚˆÛÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ √È ÂÚˆÙ‹ÛÂȘ ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ÙÚ›· ÛΤÏË, ÛÙÔ Î·ı¤Ó· ·fi Ù· ÔÔ›· ÂÍÂÙ¿˙ÔÓÙ·Ó ¯ˆÚÈÛÙ¿ Ë ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘: ·) ηٿ ÙË ‰È¿ÁÓˆÛË ÌÈ·˜ ·ÂÈÏËÙÈ΋˜ ÁÈ· ÙË ˙ˆ‹ ·Ûı¤ÓÂÈ·˜, ‚) ηٿ ÙËÓ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘ Î·È Á) ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÁÈ·ÙÚÒÓ (94%) ¯·Ú·ÎÙ‹ÚÈÛ ˆ˜ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ÙËÓ ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓÈÒÓ Î·È ÛÙȘ ÙÚÂȘ ·˘Ù¤˜ Ê¿ÛÂȘ. ™¯ÂÙÈο Ì ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡, ·˘Ù‹ ·ÍÈÔÏÔÁ‹ıËΠˆ˜ “Ôχ” ‹ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ηٿ ÙË Ê¿ÛË Ù˘ ‰È¿ÁÓˆÛ˘ Û ÔÛÔÛÙfi 66%, ηٿ ÙËÓ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘ Û ÔÛÔÛÙfi 50% Î·È ÌfiÓÔ 24% ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ. ∆ÔÓ›˙ÂÙ·È È‰È·›ÙÂÚ·, fiÙÈ Ë ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÎÚÈÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘, ·ÍÈÔÏÔÁ‹ıËΠˆ˜ “ηıfiÏÔ˘” ÛËÌ·ÓÙÈ΋ Û ÔÛÔÛÙfi 55%. √È ÂÚÈÛÛfiÙÂÚÔÈ ·È‰›·ÙÚÔÈ (62,5%) ÂÎÙ›ÌËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ ˆ˜ “ÔÏϤ˜” ‹ “¿Ú· ÔÏϤ˜”, ÂÓÒ ÌÂÁ¿ÏÔ Â›Û˘ ÔÛÔÛÙfi (72%) ¯·Ú·ÎÙ‹ÚÈÛ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ÙËÓ ÔÔ›· ÂÓËÌÂÚÒÓÔ˘Ó ÙÔ˘˜ ÁÔÓ›˜ ˆ˜ “Ôχ” ‹ “¿Ú· Ôχ” ÈηÓÔÔÈËÙÈ΋. ∞ÓÙÈı¤Ùˆ˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡, ÔÈ È·ÙÚÔ› ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ ÂÚÈÔÚÈṲ̂Ó˜ ‹ ·ÓÂ·ÚΛ˜ Û ÔÛÔÛÙfi 50% Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Ì·˙› ÙÔ˘ ˆ˜ ·ÓÂ·Ú΋ ‹ Ôχ ÂÚÈÔÚÈṲ̂ÓË Û ÔÛÔÛÙfi 63%. ø˜ ÂÌfi‰È· ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ ·Ó·ÁÓÒÚÈÛ·Ó ÙËÓ ¤ÏÏÂÈ„Ë ÁÓÒÛÂˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ ÂÈÎÔÈÓˆÓ›·˜ (34,5%), ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË ÙfiÛÔ ÙˆÓ ›‰ÈˆÓ fiÛÔ Î·È ÙˆÓ ÁÔÓÈÒÓ (27,5%), ÙËÓ ¤ÏÏÂÈ„Ë ¯ÚfiÓÔ˘ (27,5%) ηıÒ˜ Î·È ÙËÓ ÚÔ‚ÏËÌ·ÙÈ΋ Û˘ÓÂÚÁ·Û›· ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÌ¿‰·˜ Û¯ÂÙÈο Ì ÙËÓ ·ÚÔ¯‹ Î·È ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÏËÚÔÊfiÚËÛ˘ (24%). ™·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚıËÎ·Ó ˆ˜ ÂÌfi‰È·, Ë ¿ÚÓËÛË ÙˆÓ ÁÔÓÈÒÓ Ó· ·ԉ¯ıÔ‡Ó Î·È Ó· Û˘˙ËÙ‹ÛÔ˘Ó ÙËÓ ¶·È‰È·ÙÚÈ΋ 2006;69:118-126

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·122

122

ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘

ÛÔ‚·ÚfiÙËÙ· Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, ηıÒ˜ Î·È Ë ÎÚÈÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ı· ηıÈÛÙÔ‡Û ·‰‡Ó·ÙË ÙËÓ ÂÈÎÔÈÓˆÓ›· Ì·˙› ÙÔ˘. °È· ÔÛÔÛÙfi 14% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ë ÂÓË̤ڈÛË Á›ÓÂÙ·È ¯ˆÚ›˜ ηӤӷ ÂÌfi‰ÈÔ. √È Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ˜ ÚÔÙ¿ÛÂȘ ·ÊÔÚÔ‡Û·Ó ÙËÓ ÂÎ·›‰Â˘ÛË ÛÙȘ ‰ÂÍÈfiÙËÙ˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙÔ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ (41%), ÙËÓ ÔÚÁ¿ÓˆÛË Î·È Û˘ÓÂÚÁ·Û›· Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜ (34,5%), ÙË ‰ËÌÈÔ˘ÚÁ›· ÔÌ¿‰ˆÓ ÛÙ‹ÚÈ͢ ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ·ÏÏ¿ Î·È ÔÌ¿‰ˆÓ ÛÙ‹ÚÈ͢ ÁÈ· ÙÔ ÚÔÛˆÈÎfi (17%) Î·È ÙË ‰È¿ıÂÛË Î·Ù¿ÏÏËÏˆÓ ¯ÒÚˆÓ ÁÈ· ÂÓË̤ڈÛË (17%). ∏ıÈο ‰ÈÏ‹ÌÌ·Ù· Î·È Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ∆· Û˘¯ÓfiÙÂÚ· ËıÈο ‰ÈÏ‹ÌÌ·Ù· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ·) ÙËÓ ·fiÊ·ÛË Û¯ÂÙÈο Ì ÙË ÌÂÙ¿‚·ÛË ·fi ÙËÓ ÂÓÂÚÁfi ıÂÚ·¢ÙÈ΋ ÛÙËÓ ˘ÔÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹, ηıÒ˜ Î·È ÙÔ Â›‰Ô˜ ·˘Ù‹˜ (83%), ‚) ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÏËÚÔÊfiÚËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘ (47%) Î·È Á) ÙÔÓ ÚÔ‚ÏËÌ·ÙÈÛÌfi Û¯ÂÙÈο Ì ÙËÓ Â˘ı·Ó·Û›· (10%). √È ÂÚÈÛÛfiÙÂÚÔÈ È·ÙÚÔ› (76%) ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ Â›Ï˘ÛË ˙ËÙËÌ¿ÙˆÓ Ô˘ ·ÊÔÚÔ‡Ó ËıÈο ‰ÈÏ‹ÌÌ·Ù· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ˆ˜ ÂÏ¿¯ÈÛÙ˜ ‹ ·ÓÂ·ÚΛ˜. ¶ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ Û˘ÌÌÂÙ¯fiÓÙˆÓ ·Ó·ÁÓÒÚÈÛ·Ó ÂÌfi‰È· Î·È ¤Î·Ó·Ó ÚÔÙ¿ÛÂȘ ÁÈ· ÙËÓ Â›Ï˘Û‹ ÙÔ˘˜. ∏ Û˘˙‹ÙËÛË ÌÂٷ͇ Û˘Ó·‰¤ÏÊˆÓ ‹Ù·Ó Ô Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓÔ˜ ÙÚfiÔ˜ Â›Ï˘Û˘ ÙˆÓ ËıÈÎÒÓ ˙ËÙËÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·ÔÙÂÏÔ‡ÛÂ Î·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÂÌfi‰ÈÔ fiÙ·Ó ˘‹Ú¯·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ. ∏ ¤ÏÏÂÈ„Ë Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙÒÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙËÓ ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ·ÔÙÂÏÔ‡Û ÙÔ ‰Â‡ÙÂÚÔ ÛÂ Û˘¯ÓfiÙËÙ· ·Ó·ÊÂÚfiÌÂÓÔ ÂÌfi‰ÈÔ, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ÙËÓ ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ ÂÎ·›‰Â˘Û˘. ™·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚıËÎ·Ó ÔÈ ‰È·ÊÔÚÂÙÈΤ˜ ·fi„ÂȘ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ Î·È ÁÔÓÈÒÓ ˆ˜ ÚfiÛÎÔÌÌ· ÛÙËÓ Â›Ï˘ÛË ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Î·È ÙË Ï‹„Ë ·ÔÊ¿ÛˆÓ. æ˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ηٿ ÙËÓ ÔÚ›· Ù˘ ·ÚÚÒÛÙÈ·˜ Î·È ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜ √È ÂÚˆÙ‹ÛÂȘ ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ ÂÚÈÂÏ¿Ì‚·Ó·Ó ÙÚ›· ÛΤÏË ·ÍÈÔÏÔÁÒÓÙ·˜ ·ÓÙÈÛÙÔ›¯ˆ˜ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ·) ÛÙËÓ ÔÚ›· ¶·È‰È·ÙÚÈ΋ 2006;69:118-126

Ù˘ ÓfiÛÔ˘ ÙÔ˘ ·È‰ÈÔ‡, ‚) ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Î·È Á) ηٿ ÙÔ ¤ÓıÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ÏÂÈÔ„ËÊ›· (71%) ·ÍÈÔÏfiÁËÛ ˆ˜ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û fiÏ· Ù· ·ÓˆÙ¤Úˆ ÛÙ¿‰È·, ·Í›˙ÂÈ fï˜ Ó· ÛËÌÂȈı› fiÙÈ ¤ÛÙˆ Î·È ÏÈÁÔÛÙÔ› ·È‰›·ÙÚÔÈ ¯·Ú·ÎÙ‹ÚÈÛ·Ó ˆ˜ “ηıfiÏÔ˘” ÛËÌ·ÓÙÈΤ˜ ÙËÓ „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ÓfiÛÔ ÙÔ˘ (6%) Î·È ÙË ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜ Ù˘ (12,5%). ø˜ ·ÚÌÔ‰ÈfiÙÂÚÔÈ ÁÈ· ÙËÓ ·ÚÔ¯‹ ÛÙ‹ÚÈ͢ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ ÙÔ˘ ·È‰ÈÔ‡ ıˆڋıËÎ·Ó Ô „˘¯ÔÏfiÁÔ˜ ‹/ Î·È ÎÔÈÓˆÓÈÎfi˜ ÏÂÈÙÔ˘ÚÁfi˜ (97%), ÔÈ ÁÈ·ÙÚÔ› (87,5%), ÔÈ ÓÔÛËÏÂ˘Ù¤˜ (78%) Î·È ÔÈ Ê›ÏÔÈ Î·È Û˘ÁÁÂÓ›˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (69%). ¶·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ÙÔ Â‡ÚËÌ· fiÙÈ ÔÈ ·È‰›·ÙÚÔÈ ıˆÚÔ‡Ó ÏÈÁfiÙÂÚÔ ·ÚÌfi‰ÈÔ ÙÔÓ Â·˘Ùfi ÙÔ˘˜ Ó· ·Ú¤¯Ô˘Ó ÛÙ‹ÚÈÍË ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ (69%) Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙÔ˘ ¤ÓıÔ˘˜ (47%), ηٿ ÙËÓ ÔÔ›· Ô „˘¯ÔÏfiÁÔ˜, Ô ÎÔÈÓˆÓÈÎfi˜ ÏÂÈÙÔ˘ÚÁfi˜, ÔÈ Ê›ÏÔÈ Î·È Û˘ÁÁÂÓ›˜ ÎÚ›ÓÔÓÙ·È ˆ˜ ηٷÏÏËÏfiÙÂÚÔÈ ÁÈ· ÙËÓ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ™Â ÔÛÔÛÙfi 13% ·Ó·Ê¤ÚıËÎÂ Ô ·È‰Ô„˘¯›·ÙÚÔ˜ ˆ˜ ·ÚÌÔ‰ÈfiÙÂÚÔ˜ ÁÈ· ÙË ÛÙ‹ÚÈÍË ·È‰ÈÒÓ Î·È ÔÈÎÔÁÂÓÂÈÒÓ. √È ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ˆ˜ “·Ô‡Û˜” ‹ “Ï›Á˜” (48,5%), ÂÓÒ ÂÓÙ˘ˆÛȷο Ï›ÁÔÈ (19,5%) ·Ó¤ÊÂÚ·Ó “Ôχ” ‹ “¿Ú· Ôχ” ÌÂÁ¿ÏË Â¿ÚÎÂÈ· ÁÓÒÛˆÓ. √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ „˘¯ÔÎÔÈÓˆÓÈ΋˜ ÛÙ‹ÚÈ͢ Ô˘ ·Ú¤¯ÂÙ·È ÛÙ· ÙÌ‹Ì·Ù¿ ÙÔ˘˜, ÙfiÛÔ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ fiÛÔ Î·È Î·Ù¿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ˆ˜ “·ÓÂ·Ú΋” ‹ “ÂÚÈÔÚÈṲ̂ÓË” Û ÔÛÔÛÙfi 44% Î·È “̤ÙÚÈ·” Û ÔÛÔÛÙfi 34,5%. ŸÛÔÓ ·ÊÔÚ¿ ÙË ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂÙ¿ ÙÔ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡, Â›Ó·È ·ÔÎ·Ï˘ÙÈ΋ Ë ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· (90%) Ì ÙËÓ ÔÔ›· ·Ó·Ê¤ÚıËΠ·Ô˘Û›· ÛÙ‹ÚÈ͢ ‹ Ôχ ÂÚÈÔÚÈṲ̂ÓË ·ÚÔ¯‹ Ù˘. ø˜ ΢ÚÈfiÙÂÚ· ÂÌfi‰È· ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹, ·Ó·Ê¤ÚıËÎ·Ó Ë ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ -ȉȷ›ÙÂÚ· „˘¯ÔÏfiÁÔ˘ ‹/ Î·È ÎÔÈÓˆÓÈÎÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡(67%), Ë ·ÓÂ¿ÚÎÂÈ· ÁÓÒÛÂˆÓ (30%), Ë ¤ÏÏÂÈ„Ë ¯ÚfiÓÔ˘ (27%), ηٿÏÏËÏ˘ ˘Ô‰ÔÌ‹˜- Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ηْ Ô›ÎÔÓ ÊÚÔÓÙ›‰·˜(27%), ·ÏÏ¿ Î·È Ë ·ÓÂ·Ú΋˜ Û˘ÓÂÚÁ·Û›· ÙfiÛÔ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ fiÛÔ Î·È ·Ó¿ÌÂÛ· ÛÙ· ÙÌ‹Ì·Ù· Î·È ÙȘ ˘¿Ú¯Ô˘Û˜ „˘¯ÔÎÔÈÓˆÓÈΤ˜ ˘ËÚÂۛ˜ (23%). °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÌÔ‰›ˆÓ

Pediatr Mar-Apr 06

18-04-06

16:42

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¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·

·˘ÙÒÓ ÚÔÙ¿ıËÎ·Ó Î˘Ú›ˆ˜ Ë ÚfiÛÏË„Ë ÚÔÛˆÈÎÔ‡ Ì ¤ÌÊ·ÛË ÛÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ „˘¯È΋˜ ˘Á›·˜ (57%), Ë ÂÎ·›‰Â˘ÛË ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙˆÓ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (23%) Î·È Ë ‚ÂÏÙ›ˆÛË Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ (20%). ¢ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· ∏ ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· ·ÍÈÔÏÔÁ‹ıËΠˆ˜ “¿Ú· Ôχ” (56%) ‹ “Ôχ” (31%) ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜. øÛÙfiÛÔ, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› (75%) ·¿ÓÙËÛ·Ó fiÙÈ ÌfiÓÔ ÂÚÈÛÙ·Ûȷο ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙÔ Ï·›ÛÈÔ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜, ÂÓÒ Û ÔÛÔÛÙfi 16% ·Ó¤ÊÂÚ·Ó fiÙÈ ‰ÂÓ Â›¯·Ó ÔÙ¤ ·ÚfiÌÔÈ· ÂÌÂÈÚ›·. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ·fi Ù· ÙÚ›· ÓÔÛÔÎÔÌ›· Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ, ·È‰Ô„˘¯È·ÙÚÈ΋ ÔÌ¿‰· ˘‹Ú¯Â ÌfiÓÔ Û ¤Ó·. øÛÙfiÛÔ, Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘‹Ú¯Â ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›·, Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ ÂÎÙÈÌ‹ıËΠ΢ڛˆ˜ ˆ˜ “̤ÙÚÈ·” (37,5%) ‹ “ÌÈÎÚ‹” (22%). ŸÛÔÈ ÂÚˆÙËı¤ÓÙ˜ ›¯·Ó ÂÌÂÈÚ›· ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜, ˆ˜ ΢ÚÈfiÙÂÚ˜ ‰˘ÛÎÔϛ˜ ÂÂÛ‹Ì·Ó·Ó ÙËÓ ·ÓÂ·Ú΋ Û˘ÓÂÚÁ·Û›· Î·È ÂÈÎÔÈÓˆÓ›· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÈÎÔًوÓ, ÙËÓ ¤ÏÏÂÈ„Ë ¯ÚfiÓÔ˘ ÏfiÁˆ ÊfiÚÙÔ˘ ÂÚÁ·Û›·˜, ÙËÓ ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È ÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡. ∏ ·Ó·ÁηÈfiÙËÙ· Ù˘ ÚÔ·ÁˆÁ‹˜ Ù˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÈÎÔÙ‹ÙˆÓ ‹Ù·Ó Ë Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓË ÚfiÙ·ÛË ÁÈ· ÙËÓ ˘¤Ú‚·ÛË ÙˆÓ ·ÓˆÙ¤Úˆ ÂÌÔ‰›ˆÓ.

™˘˙‹ÙËÛË ∏ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ϤÔÓ ˆ˜ ·Ó·Ê·›ÚÂÙÔ ‰Èη›ˆÌ· ÙˆÓ ·È‰ÈÒÓ Ì ·ÂÈÏËÙÈο ÁÈ· ÙË ˙ˆ‹ ÓÔÛ‹Ì·Ù· Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (1-8). ∫È ÂÓÒ ÔÈ ÚˆÙÔ‚Ô˘Ï›Â˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ··Ú·›ÙËÙˆÓ ‰ÔÌÒÓ Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ Ù˘ ·Ú¯fiÌÂÓ˘ ÊÚÔÓÙ›‰·˜ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ·˘Ùfi ÏËı˘ÛÌfi ÏËı·›ÓÔ˘Ó ‰ÈÂıÓÒ˜ (4,6-8), ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÎfiÌ· ÔÚÁ·ÓˆÌ¤Ó˜ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ˘ËÚÂۛ˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿. ¶Ù˘¯¤˜ Ù˘ ÊÚÔÓÙ›‰·˜ ·˘Ù‹˜ ÚÔÛʤÚÔÓÙ·È Û ·È‰È·ÙÚÈο ÔÁÎÔÏÔÁÈο ÙÌ‹Ì·Ù· Î·È ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ fiÔ˘ ÓÔÛËχÔÓÙ·È ·È‰È¿ Ì ‰˘ÓËÙÈο ηٷÏËÎÙÈο ÓÔÛ‹Ì·Ù· (13-14). ™ÙË ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ÌÈ· ÚÒÙË ÚÔÛ¿ıÂÈ· ηٷÁÚ·Ê‹˜ ÙˆÓ ÁÓÒÛÂˆÓ Î·È ·fi„Â-

ˆÓ Ô˘ ¤¯Ô˘Ó ŒÏÏËÓ˜ ·È‰›·ÙÚÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Û √ÁÎÔÏÔÁÈο ∆Ì‹Ì·Ù· Î·È ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ·Ó·ÊÔÚÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ì ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘˜ ·Ûı¤ÓÂȘ. §fiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Û ÙÚ›· ÌÂÁ¿Ï· ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜, ıˆÚԇ̠fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ·¤¯Ô˘Ó Ôχ ·fi ÙËÓ ÂÏÏËÓÈ΋ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛÙÔ ı¤Ì· ·˘Ùfi.

H ·ÚÔ‡Û· ÂÚÁ·Û›· ¤‰ÂÈÍÂ: ·) ÙȘ ÂÏÏÈ›˜ ÁÓÒÛÂȘ ÙˆÓ ·È‰È¿ÙÚˆÓ Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·, ·ÚfiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ıˆÚÔ‡Ó Ôχ ÛËÌ·ÓÙÈ΋ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û ÂÚÈÙÒÛÂȘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ, Î·È ‚) ÙËÓ ÂÚÈÔÚÈṲ̂ÓË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ÙËÓ ÔÔ›· ·Ú¤¯ÂÙ·È Ë ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Û ÙÌ‹Ì·Ù· fiÔ˘ ÔÚÈṲ̂Ó˜ Ù˘¯¤˜ ·˘Ù‹˜ ÂÊ·ÚÌfi˙ÔÓÙ·È. ¶ÈÔ ·Ó·Ï˘ÙÈο, Ù· Â˘Ú‹Ì·Ù· ÂÂÛ‹Ì·Ó·Ó fiÙÈ Ë ÊÈÏÔÛÔÊ›· Î·È ÔÈ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Â·ÚÎÒ˜ ηٷÓÔËÙ¤˜ ·fi ÙÔ˘˜ ŒÏÏËÓ˜ ·È‰È¿ÙÚÔ˘˜. ∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÔÚ›˙ÂÈ ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ˆ˜ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡, Ì ¤ÌÊ·ÛË ÛÙËÓ ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹. ∏ ·Ó·ÊÔÚ¿ ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙfiÛÔ ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ fiÛÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, Ô˘ Â›Û˘ ·ÔÙÂÏÔ‡Ó ıÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ˘‹ÚÍ Ôχ ÂÚÈÔÚÈṲ̂ÓË. ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ Ô Ï‹Ú˘ ÔÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ˆ˜ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋, „˘¯ÔÏÔÁÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ·Ô‰fiıËΠ·fi ¤Ó·Ó ÌfiÓÔ ÂÚˆÙËı¤ÓÙ·. ∏ ÂÏÏÈ‹˜ ηٷÓfiËÛË Ù˘ ÊÈÏÔÛÔÊ›·˜ Î·È ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ¤¯ÂÈ Â›ÙˆÛË Î·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, fiÔ˘ ‰È·ÈÛÙÒÓÂÙ·È ÂÈΤÓÙÚˆÛË ÛÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ Î·È Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜, Ì ÙËÓ ·Ú¿ÏÏËÏË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Ôχ ÂÚÈÔÚÈṲ̂ӷ. ŸÌˆ˜, ·Ú¿ ÙËÓ ÂÛÙ›·ÛË ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ, Ë ÔÔ›· ÂÎÙÈÌ¿Ù·È Î·Ù¿ ηÓfiÓ· ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋, Ë ÏÂÈÔ„ËÊ›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó·Ê¤ÚÂÈ ÂÚÈÔÚÈṲ̂Ó˜ ÁÓÒÛÂȘ ÛÙÔÓ ÙÔ̤· ·˘Ùfi Î·È ÂÎÊÚ¿˙ÂÈ ÙËÓ ·Ó¿ÁÎË Î·Ù¿ÏÏËÏ˘ ηٿÚÙÈÛ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi, ·Ó Î·È ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙÔÓ ¶·È‰È·ÙÚÈ΋ 2006;69:118-126

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·124

124

ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘

˘„ËÏfi ‚·ıÌfi ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘Ìو̿وÓ, Û˘ÌʈÓ› Ì ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ Î·È ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û ·È‰È¿ Ô˘ Âı·›ÓÔ˘Ó, ·Ú·Ì¤ÓÂÈ ÂÏÏÈ‹˜ (3-4,9-11). ∏ ÂÓË̤ڈÛË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘ Â›Ó·È ¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›· ÌÈ· ‰‡ÛÎÔÏË ˘fiıÂÛË. ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ, Ë ÔÔ›· ·Ó·Ê¤ÚıËΠfiÙÈ ‰ÈÂÍ¿ÁÂÙ·È Î·Ù¿ ηÓfiÓ· ·ÔÙÂÏÂÛÌ·ÙÈο, ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÓË̤ڈÛ˘ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ ˆ˜ ȉȷ›ÙÂÚ· ·ÓÂ·ÚΛ˜. √È Û·ÊÒ˜ ÏÈÁfiÙÂÚ˜ ÁÓÒÛÂȘ Î·È ‰ÂÍÈfiÙËÙ˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙÔ ¿ÚÚˆÛÙÔ ·È‰›, Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÁÔÓ›˜, ·ÔÙÂÏ› ‡ÚËÌ· Ô˘ ·Í›˙ÂÈ Ó· ˘ÔÁÚ·ÌÌÈÛÙ›, Ì ‰Â‰Ô̤ÓË ÙËÓ ·È‰È·ÙÚÈ΋ ÂÍÂȉ›Î¢ÛË ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ. ∂›Ó·È Â›Û˘ ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚˆÙËı¤ÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ˆ˜ ÌË ÛËÌ·ÓÙÈ΋ ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡ Û ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Û¯ÂÙÈο Ì ÙËÓ ÎÚÈÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘, ‡ÚËÌ· Ô˘ ·ÓÙÈÊ¿ÛÎÂÈ Ï‹Úˆ˜ Ì ٷ Û‡Á¯ÚÔÓ· ‰Â‰Ô̤ӷ Ô˘ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó fiÙÈ ÙÔ ‚·ÚÈ¿ ¿ÚÚˆÛÙÔ ·È‰› ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘ Î·È Û˘¯Ó¿ ÂÎÊÚ¿˙ÂÈ ÙËÓ ·Ó¿ÁÎË Ó· Û˘˙ËÙ‹ÛÂÈ ÁÈ’ ·˘Ùfi (22,23). ÕÏψÛÙÂ, Û‡Ìʈӷ Ì ٷ ‰ÈηÈÒÌ·Ù· ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ, οı ·È‰› ¤¯ÂÈ ‰Èη›ˆÌ· Û˘ÌÌÂÙÔ¯‹˜ ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙËÓ ˆÚÈÌfiÙËÙ¿ ÙÔ˘ (4-5,24). ∏ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ ·È‰› ˆÛÙfiÛÔ, ‰È¤ÂÙ·È ·fi ÂÁÁÂÓ›˜ ‰˘ÛÎÔϛ˜ Î·È ÚÔÎÏ‹ÛÂȘ Ì ‰Â‰Ô̤ÓË ÙËÓ Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË ÙfiÛÔ ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜, fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙÔÓ ÂÈΛÌÂÓÔ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡ (15-17). ∏ ÛËÌ·ÓÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Ô˘ ‰È·ÈÛÙÒıËΠfiÛÔÓ ·ÊÔÚ¿ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ, ·ÔÙÂÏ› ÁÂÁÔÓfi˜ Ì ‰˘ÓËÙÈο ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙÔ ¤ÓıÔ˜ ÙˆÓ ÁÔÓÈÒÓ, ÙÔ ÔÔ›Ô Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂËÚ¿˙ÂÙ·È Î·È ·fi ÙȘ Û˘Óı‹Î˜ ̤۷ ÛÙȘ Ôԛ˜ Âı·›ÓÂÈ ÙÔ ·È‰› ÙÔ˘˜ (14,19-21). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‹Ù·Ó ¯·Ú·ÎÙËÚÈÛÙÈ΋ Î·È Ë ·Ô˘Û›· ÔÚÁ·ÓˆÌ¤Ó˘ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ÛÙ‹ÚÈ͢ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡, ‡ÚËÌ· Ô˘ ·Í›˙ÂÈ Ó· ˘ÔÁÚ·ÌÌÈÛı› Ì ‰Â‰Ô̤Ó˜ ÙȘ ¤Ú¢Ó˜ Ô˘ ÙÔÓ›˙Ô˘Ó fiÙÈ Ô ıÚ‹ÓÔ˜ ÙˆÓ ÁÔÓÈÒÓ Â›Ó·È ·Ú·ÙÂٷ̤ÓÔ˜ fiÛÔ Î·È È‰È·›ÙÂÚ· ÂÈÚÚÂ‹˜ Û ÂÚÈÏÔΤ˜ (18-20). ¶·È‰È·ÙÚÈ΋ 2006;69:118-126

√È Û˘¯ÓfiÙÂÚÔÈ ËıÈÎÔ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Ô˘ ·Ó·Ê¤ÚıËηÓ, Û˘ÌʈÓÔ‡Ó Ì ‰Â‰Ô̤ӷ ¿ÏÏˆÓ ÂÚ¢ÓÒÓ (4,25-26). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Â˘ı·Ó·Û›·, Ô˘ Û¿ÓÈ· ·Ó·Ê¤ÚıËΠˆ˜ ËıÈÎfi˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ‰ÂÓ ¤¯ÂÈ ı¤ÛË ÛÙÔ Ï·›ÛÈÔ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ηıÒ˜ ÔÈ ÚÔÛ¿ıÂȘ Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜ ÛÙÔ¯Â‡Ô˘Ó Ó· ηχ„Ô˘Ó ÛÊ·ÈÚÈο Î·È Ì ÙÔÓ Î·Ï‡ÙÂÚÔ ‰˘Ó·Ùfi ÙÚfiÔ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (5,7). √È ·Ó·ÊÂÚfiÌÂÓ˜ ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ ÌÂٷ͇ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ Î·È Ë ¤ÏÏÂÈ„Ë Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Û¯ÂÙÈο Ì ÙË ÊÚÔÓÙ›‰· ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÏÏËÏÔÛ˘Ó‰¤ÔÓÙ·È: ÈÛÙ‡ԢÌ fiÙÈ ·Ó ˘‹Ú¯Â ۷ʤ˜ Ï·›ÛÈÔ Û¯ÂÙÈο Ì ÙË ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÔÈ ‰ÈÂÓ¤ÍÂȘ ÛÙËÓ ÔÌ¿‰· Û¯ÂÙÈο Ì ËıÈο ˙ËÙ‹Ì·Ù· ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂȈıÔ‡Ó ‹ Î·È Ó· ·ÔÊ¢¯ıÔ‡Ó (25). ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ÙfiÓÈÛ ÙËÓ ÂÈÙ·ÎÙÈ΋ ·Ó¿ÁÎË ÚÔ·ÁˆÁ‹˜ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Î·È Û˘ÓÂÚÁ·Û›·˜ ÌÂٷ͇ ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· ÌÂٷ͇ ·È‰È¿ÙÚˆÓ, ÓÔÛËÏ¢ÙÒÓ Î·È ÂȉÈÎÒÓ Ù˘ „˘¯È΋˜ ˘Á›·˜ ·ÔÙÂÏ› ıÂÌÂÏÈÒ‰Ë ·Ú¯‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ÂÊfiÛÔÓ Û ·˘Ù‹ ‚·Û›˙ÂÙ·È Ë Î¿Ï˘„Ë ÙˆÓ ÔχÏÂ˘ÚˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ·ÏÏ¿ Î·È Ë ÛÙ‹ÚÈÍË ÙÔ˘ ÚÔÛˆÈÎÔ‡ (27). ∏ ·Ó¿ÁÎË ÛÙ·ıÂÚ‹˜ Î·È Û˘ÛÙËÌ·ÙÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ Ù˘ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋˜ ÔÌ¿‰·˜ Ì ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜, ̤ۈ ÚfiÛÏ˄˘ ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡ ‹ ̤ۈ Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ˘ÊÈÛÙ·Ì¤ÓˆÓ ‰ÔÌÒÓ, ·ÔÙ¤ÏÂÛ ¤Ó· ·fi Ù· ‚·ÛÈο ·ÈÙ‹Ì·Ù· ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ. ∏ ÛËÌ·ÓÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Ù˘ „˘¯ÔÎÔÈÓˆÓÈ΋˜ ÛÙ‹ÚÈ͢ Ô˘ ‰È·ÈÛÙÒıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ˘ÔÁÚ·ÌÌ›˙ÂÈ ÂÚ·ÈÙ¤Úˆ ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜. √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜, ÁÂÓÈο, ·Ó·ÁÓÒÚÈÛ·Ó ÙËÓ ·Ó¿ÁÎË ÙÔ˘˜ ÁÈ· ÂÎ·›‰Â˘ÛË Û¯ÂÙÈο Ì ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·, ηıÒ˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ·Ó¤ÊÂÚ·Ó ÙȘ ÂÚÈÔÚÈṲ̂Ó˜ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ ÙÔ Î˘ÚÈfiÙÂÚÔ ÂÌfi‰ÈÔ ÛÙËÓ ÔÏÔÎÏËڈ̤ÓË ·ÚÔ¯‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÊÚÔÓÙ›‰·˜, ÂÓÒ ÙÔ ·›ÙËÌ· ÁÈ· ÂÍÂȉÈÎÂ˘Ì¤ÓË Î·Ù¿ÚÙÈÛË ·ÔÙÂÏÔ‡Û ÙË Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓË ÚfiÙ·Û‹ ÙÔ˘˜. ∆Ô Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ‰Â‰Ô̤ӷ ·fi ¿ÏϘ ¤Ú¢Ó˜ fiÔ˘ ηٷÁÚ¿ÊÂÙ·È Ë ÂÏÏÈ‹˜ ÂÎ·›‰Â˘ÛË ÙˆÓ È·ÙÚÒÓ ÛÙËÓ ÊÚÔÓÙ›‰· ·È‰ÈÒÓ Û ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ (28-31).

Pediatr Mar-Apr 06

18-04-06

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ÕÏÏ· ÂÌfi‰È· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó Û˘¯Ó¿, ‹Ù·Ó Ë ·ÓÂ¿ÚÎÂÈ· ÚÔÛˆÈÎÔ‡ (Ì ¤ÌÊ·ÛË ÛÙÔ˘˜ ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜) Î·È Î·Ù¿ÏÏËÏ˘ ˘Ô‰ÔÌ‹˜ -·ÌÊfiÙÂÚ· Ú·ÁÌ·ÙÈο ‰Â‰Ô̤ӷ ÁÈ· Ù· ÂÏÏËÓÈο ÓÔÛÔÎÔÌ›·. ŒÓ·˜ ·fi ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È fiÙÈ ‰ÂÓ ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙÔ ‰Â›ÁÌ· Î·È ¿ÏÏÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ÏËÓ ÙˆÓ È·ÙÚÒÓ. ∂›Û˘ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó ÔÈ ÂÌÂÈڛ˜ Î·È ÔÈ ·fi„ÂȘ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ·ÏÏ¿ Î·È ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·. ∞ÎfiÌË, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ÂÍÂÙ¿ÛıËΠÏÂÙÔÌÂÚÒ˜ Ë Ú·ÎÙÈ΋ Û οı ‚·ÛÈ΋ ÂÓfiÙËÙ· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ (.¯. Ë ¯Ú‹ÛË ÙˆÓ Ô‰ËÁÈÒÓ ÙÔ˘ ¶.√.À. ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ (3)), ÂÓÒ ‰ÂÓ ·Ó·˙ËÙ‹ıËÎ·Ó Î·È Èı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ÙˆÓ ·È‰È¿ÙÚˆÓ ÔÁÎÔÏfiÁˆÓ Î·È ÙˆÓ ·È‰È¿ÙÚˆÓ Ù˘ ÂÓÙ·ÙÈ΋˜ ÌÔÓ¿‰·˜. ∂›Û˘, ı· ›¯Â ÂӉȷʤÚÔÓ Ó· ηٷÁÚ·Ê› ·Ó ˘‹ÚÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙȘ ·fi„ÂȘ ·È‰È¿ÙÚˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ‡·ÚÍË Ë ÌË ·È‰Ô„˘¯È·ÙÚÈ΋˜ ÔÌ¿‰·˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ηıÒ˜ Î·È fiÛÔ ·ÍÈÔÔÈ‹ıËÎ·Ó ÔÈ Û˘Ì‚Ô˘Ï¢ÙÈΤ˜- ‰È·Û˘Ó‰ÂÙÈΤ˜ ˘ËÚÂۛ˜ Ù˘ ÔÌ¿‰·˜ ·˘Ù‹˜ ÛÙÔ Ï·›ÛÈÔ Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ Ì ٷ ˘fi ÌÂϤÙË ÙÌ‹Ì·Ù·. ™ÙÔ Ï·›ÛÈÔ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ˆÛÙfiÛÔ, ÚfiıÂÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ ‹Ù·Ó Ó· ÂȯÂÈÚËı› ÌÈ· ÚÒÙË Î·Ù·ÁÚ·Ê‹ ÛÙÔȯ›ˆÓ Û¯ÂÙÈο Ì ÙËÓ ·ÚÔ¯‹ ·È‰È·ÙÚÈ΋˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ∂ÏÏ¿‰·. ∏ ÌÂϤÙË ·˘Ù‹ ˘¤‰ÂÈÍ ‚‹Ì·Ù· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÔ˘Ó ÁÈ· ÙËÓ ¿ÚÙÈ· Î·È Û‡ÌʈÓË Ì ÙȘ ‰ÈÂıÓ›˜ ·Ú¯¤˜ ·ÚÔ¯‹ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙË ‚·ÛÈ΋ È·ÙÚÈ΋ ÂÎ·›‰Â˘ÛË Ë ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ‰È‰¿ÛÎÂÙ·È Â‰Ò Î·È Ï›Á· ¯ÚfiÓÈ· ÌfiÓÔ Û ¤Ó· Ì¿ıËÌ· ÂÈÏÔÁ‹˜, ÔÈ ÁÈ·ÙÚÔ› ‰ÂÓ Â˘·ÈÛıËÙÔÔÈÔ‡ÓÙ·È Â·ÚÎÒ˜ Û¯ÂÙÈο Ì ÙËÓ ÔÏÔÎÏËڈ̤ÓË ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Âı·›ÓÔ˘Ó Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜, ı¤Ì· Ô˘ Â›Û˘ ‰ÂÓ ·Ó·Ù‡ÛÛÂÙ·È Ô‡Ù ÛÙËÓ ÂȉÈ΋ ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ. ŒÙÛÈ, ‰ÂÓ Î·ÏÏÈÂÚÁÂ›Ù·È ÌÈ· ÔÏÔÎÏËڈ̤ÓË È·ÙÚÈ΋ Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ ÚÔÛ¤ÁÁÈÛË, ÁÂÁÔÓfi˜ Ô˘ ηıÚÂÊÙ›˙ÂÙ·È Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË: ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ‰ÂÓ ÌfiÚÂÛ·Ó Ó· Û˘Ó‰˘¿ÛÔ˘Ó ÙËÓ È·ÙÚÈ΋ Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ ‰È¿ÛÙ·ÛË ÛÙÔ˘˜ ÔÚÈÛÌÔ‡˜ Ô˘ ¤‰ˆÛ·Ó ÁÈ· ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·. ∞Ó ‰ÂÓ ÂÓۈ̷وı› Ë ÊÈÏÔÛÔÊ›· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ È·ÙÚÈ΋ ÂÎ·›‰Â˘ÛË, Ë

ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÁÈ·ÙÚÒÓ ÛÙ· ·È‰È¿ Ô˘ Âı·›ÓÔ˘Ó ı· ·Ú·Ì›ÓÂÈ ‚ÈÔ˚·ÙÚÈο ÚÔÛ·Ó·ÙÔÏÈṲ̂ÓË Î·È ı· ÂÚÈÔÚ›˙ÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ. ∞Ó·ÁÓˆÚ›˙ÔÓÙ·˜ ÙËÓ ·Ó¿ÁÎË ÂÎ·›‰Â˘Û˘ ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, ÂȉÈο ÂÁ¯ÂÈÚ›‰È· Î·È ÂÎ·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· Û ÚÔÙ˘¯È·Îfi Î·È ÌÂÙ·Ù˘¯È·Îfi Â›Â‰Ô ¤¯Ô˘Ó ·Ú¯›ÛÂÈ Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ‰ÈÂıÓÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (6-7,30-32). ™ÙË ¯ÒÚ· Ì·˜, ‰ÈÂÈÛÙËÌÔÓÈο ÚÔÁÚ¿ÌÌ·Ù· ηٿÚÙÈÛ˘ Û¯ÂÙÈο Ì ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ ηıÒ˜ Î·È ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ÂÓı›, ÚÔÛʤÚÔÓÙ·È ·fi ÙÔ 1996 ·fi ÙË “ª¤ÚÈÌÓ·”, ÌÈ· ÂÈÛÙËÌÔÓÈ΋, ÌË ÎÂÚ‰ÔÛÎÔÈ΋ ÂÙ·ÈÚ›· ÁÈ· ÙË ÊÚÔÓÙ›‰· ·È‰ÈÒÓ Î·È ÔÈÎÔÁÂÓÂÈÒÓ ÛÙËÓ ·ÚÚÒÛÙÈ· Î·È ÙÔÓ ı¿Ó·ÙÔ (33). ¢˘ÛÙ˘¯Ò˜ fï˜, Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·Ù¿ÚÙÈÛ˘ ·fi ·È‰È¿ÙÚÔ˘˜ Â›Ó·È Ôχ ÂÚÈÔÚÈṲ̂ÓË Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÓÔÛËÏÂ˘Ù¤˜, „˘¯ÔÏfiÁÔ˘˜ Î·È ÎÔÈÓˆÓÈÎÔ‡˜ ÏÂÈÙÔ˘ÚÁÔ‡˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó. °È· Ó· ·Ó·Ù˘¯ı› Ë ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ¯ÚÂÈ¿˙ÂÙ·È ÎÔÈÓ‹ ÊÈÏÔÛÔÊ›· ¿Ú·, ‚·ÛÈ΋ ÂÎ·›‰Â˘ÛË ·ÏÏ¿ Î·È Û˘Ó¯È˙fiÌÂÓË Î·Ù¿ÚÙÈÛË, ηıÒ˜ Î·È ÛÙ‹ÚÈÍË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ô˘ ·Ó·Ï·Ì‚¿ÓÂÈ ·˘Ùfi ÙÔ ‰‡ÛÎÔÏÔ ¤ÚÁÔ, ·Ú¿ÏÏËÏ· Ì ÙËÓ ·Ó¿Ù˘ÍË Î·Ù¿ÏÏËÏˆÓ ‰ÔÌÒÓ Î·È ˘ËÚÂÛÈÒÓ Ô˘ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙȘ ÔχÏ¢Ú˜ ·Ó¿ÁΘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‚ÈÒÓÔ˘Ó ÌÈ· ·ÂÈÏËÙÈ΋ ·ÚÚÒÛÙÈ· Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ∏ ¢·ÈÛıËÙÔÔ›ËÛË Î·È Û˘ÛÙËÌ·ÙÈ΋ ÂÎ·›‰Â˘ÛË ÙˆÓ ÁÈ·ÙÚÒÓ ÛÙȘ ıÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ Ú¤ÂÈ Ó· ·ÔÙÂϤÛÂÈ ¤Ó· ·fi Ù· ÚÒÙ· ‚‹Ì·Ù· ÙÔ˘ ۯ‰ȷÛÌÔ‡ Î·È Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÛÙË ¯ÒÚ· Ì·˜, Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. International Work Group on Death, Dying and Bereavement. Palliative Care for Children: Position Statement. Death Studies 1993;17:277-280.

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15. ∞ÚÒÓË-µÔ˘ÚÓ¿ ™. ∏ ·ÓıÚÒÈÓË ÏÂ˘Ú¿ ÙÔ˘ ∞IDS. ªÈ· ¿ÓÙÔÙ Â›Î·ÈÚË, ÏËÓ fï˜ ·Ú·ÁÓˆÚÈṲ̂ÓË ¿Ô„Ë. ¢ÈÏ‹ÌÌ·Ù· Î·È ‰ÂÔÓÙÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·. ¶·È‰È·ÙÚÈ΋ 1995;58:145-152.

16. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË ™. √ ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÔÁÎÔÏfiÁÔ˘ ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡ Ì ηÚΛÓÔ. ¶·È‰È·ÙÚÈ΋ 2000; 63:121-128.

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19. ªÂÏÏ¿ÏË £¿ÏÂÈ·. √ ıÚ‹ÓÔ˜ ÙˆÓ ÁÔÓÈÒÓ ÌÂÙ¿ ÙË ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ∆Ì‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 2004.

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Alexandria, VA: National Hospice and Palliative Care Organization; 2003.

33. ª¤ÚÈÌÓ· - ∂Ù·ÈÚ›· ÁÈ· ÙË ºÚÔÓÙ›‰· ¶·È‰ÈÒÓ Î·È √ÈÎÔÁÂÓÂÈÒÓ ÛÙËÓ ∞ÚÚÒÛÙÈ· Î·È ÙÔ £¿Ó·ÙÔ. http://www.merimna.org.gr

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¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË: ‰È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙÚfiÔÈ ÚÔÛ¤Ï΢Û˘ ∂. ª·ıÚ¤ÏÏÔ˘, ª. °È·ÓÓ·ÎÔ‡ÏÈ·, ¡. µÔ˘Ù˙Ô˘Ú¿Î˘, ¶. ∑‹Û˘, ∞.§. ª·Ù¿Ï·, §.™. ™˘ÓÙÒÛ˘

¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ·Ó·Ï‡ÛÂÈ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Ô˘ ÚÔ-

‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË ˆ˜ ÚÔ˜ ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È Ù· ‰È·ÙÚÔÊÈο ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈο. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∫·Ù·ÁÚ¿ÊËÎ·Ó Û˘ÓÔÏÈο 968 ‰È·ÊËÌ›ÛÂȘ, Ô˘ ÚÔ‚Ï‹ıËÎ·Ó Û 51 ÒÚ˜ ·È‰È΋˜ ÙËÏÂÔÙÈ΋˜ ˙ÒÓ˘ 2 Û˘Ó¯fiÌÂÓˆÓ ™·‚‚·ÙÔ·ÚȷΈÓ, Î·È ·Ó·Ï‡ıËÎ·Ó ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ ÙÔ˘ ‰È·ÊËÌÈ˙fiÌÂÓÔ˘ ÚÔ˚fiÓÙÔ˜, ÙËÓ Î·ÙËÁÔÚ›· ÙÚÔʛ̈Ó, ηıÒ˜ Î·È ˆ˜ ÚÔ˜ Ù· Ù¯ÓÈο, ÛÎËÓÔıÂÙÈο Î·È ÛÂÓ·Úȷο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘˜. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô 53,7% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó Û ÙÚfiÊÈÌ·. √È ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‚Ú¤ıËΠӷ ¯ÚËÛÈÌÔÔÈÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi, Û ۯ¤ÛË Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó, ÛÙÔȯ›· Ô˘ ÙȘ ηıÈÛÙÔ‡Ó ÂÏ΢ÛÙÈΤ˜ ÛÙ· ·È‰È¿, fiˆ˜ ÂÚÈÛÛfiÙÂÚ· ηڤ ·Ó¿ ‰È·Ê‹ÌÈÛË (13,1±6,6 ¤Ó·ÓÙÈ 12±7,65, p=0,008), ÁÚËÁÔÚfiÙÂÚË ÂÓ·ÏÏ·Á‹ ÂÈÎfiÓˆÓ (0,67± 0,28 ηڤ/sec ¤Ó·ÓÙÈ 0,64± 0,29 ηڤ/sec, p=0,10), ¯·Ú·ÎÙ‹Ú˜ ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ (66,7% ¤Ó·ÓÙÈ 13,2%, ¯2=232,5, p<0,001) Î·È ıÂÌ·ÙÔÏÔÁ›· ·fi Ù· ÂӉȷʤÚÔÓÙ· ÙˆÓ ·È‰ÈÒÓ. √ ÈÔ ‰ËÌÔÊÈÏ‹˜ ÙÚfiÔ˜ ÚÔÒıËÛ˘ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ‹Ù·Ó Ë ÚÔ‚ÔÏ‹ ÙˆÓ ÔÚÁ·ÓÔÏËÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ (68,3%), Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÈÛ¯˘ÚÈÛÌÔ› ÁÈ· ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË (46,9%) Î·È Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ (40,6%). ∞Ó¿Ï˘ÛË ÙÔ˘ ›‰Ô˘˜ ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔÊ›ÌˆÓ ·Ó¤‰ÂÈÍ ٷ Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· ˆ˜ Ù· ÈÔ Û˘¯Ó¿ ‰È·ÊËÌÈ˙fiÌÂÓ· (31,7%). ∞ÎÔÏÔ˘ıÔ‡Û·Ó Ù· ˙·¯·ÚˆÙ¿ ÁÏ˘Î›ÛÌ·Ù· (21%) Î·È Ù· ÛÔÎÔÏ·ÙÔÂȉ‹ ÚÔ˚fiÓÙ· (11,5%). ∞fi ÙËÓ ·Ó¿Ï˘ÛË Ù˘ ‰È·ÙÚÔÊÈ΋˜ ÙÔ˘˜ ÔÈfiÙËÙ·˜ Ê¿ÓËΠˆ˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÚfiÎÂÈÙ·È ÁÈ· ÙÚfiÊÈÌ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˙¿¯·ÚË Î·È Ï›Ô˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·ÚÔ‡Û· ÌÂϤÙË Â›Ó·È Ë ÚÒÙË ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ηٷÁÚ¿ÊÂÈ ÛÙÔȯ›· ÁÈ· ÙÔ Â›‰Ô˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË. ¶ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ë Â›‰Ú·ÛË ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÛÙȘ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ·È‰ÈÒÓ.

∂ÚÁ·ÛÙ‹ÚÈÔ ¢È·ÙÚÔÊ‹˜ Î·È ∫ÏÈÓÈ΋˜ ¢È·ÈÙÔÏÔÁ›·˜, ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ – ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó·, ∂ÏÏ¿‰· AÏÏËÏÔÁÚ·Ê›·: §¿ÌÚÔ˜ ™˘ÓÙÒÛ˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ¢È·ÙÚÔÊ‹˜ Î·È ∫ÏÈÓÈ΋˜ ¢È·ÈÙÔÏÔÁ›·˜ ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜-¢È·ÙÚÔÊ‹˜ ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∂Ï. µÂÓÈ˙¤ÏÔ˘ 70, ∆.∫. 176 71 ∞ı‹Ó· E-mail: lsidossis@hua.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-04-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 10-02-2006

§¤ÍÂȘ ÎÏÂȉȿ: ¢È·ÊËÌ›ÛÂȘ, ÙÚfiÊÈÌ·, Ì¿ÚÎÂÙÈÓÁÎ, ‰È·ÙÚÔÊ‹, ·È‰È¿.

Food advertisements targeted at children: nutritional information and appeals E. Bathrellou, M. Yannakoulia, N. Voutzourakis, P. Zisis, A.L. Matalas, L.S. Sidossis

Abstract Background: The aim of the present study was to perform a content and appeal techniques’ analysis of

the television food advertisements targeted at children.

Methods: Nine hundred sixty eight advertisements were recorded during 51 hours of children’s

program on 2 consecutive weekends. Data on the type of the advertisement, the food category and appeals in the format and the scenario of the advertisements were collected.

Results: More than half (53.7%) of all advertisements were about food. Food advertisements were more likely than non-food advertisements to use techniques, which make them appealing to kids, such as more shots per ad (13.1±6.6 vs. 12±7.65, p=0.018), faster pace (0.67± 0.28 shots/sec vs. 0.64± 0.29 shots/sec, p=0.10), use of cartoon characters (66.7% vs. 13.2%, ¯2=232.5, p<0.001) and scenario inspired from children’s every day life. The most popular appeal method for food advertisements was promotion of the physical properties of the product (68.3%), followed by appeals for mood alteration (46.9%) and premium offers (40.6%). Analysis of the food categories advertised showed that almost one

Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece Correspondence: Labros S. Sidossis Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University 70, El. Venizelou Str. 176 71 Athens, Greece E-mail: lsidossis@hua.gr Date of submission: 01-04-2005 Date of approval: 10-02-2006

¶·È‰È·ÙÚÈ΋ 2006;69:127-133

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∂. ª·ıÚ¤ÏÏÔ˘ Î·È Û˘Ó.

third (31.7%) of the food advertisements were for dairy products. Other most advertised food categories were confectionary snacks (21%) and chocolate products (11.5%). Nutritional value analysis revealed that the majority of the foods advertised were high in sugar and fat.

Conclusions: The present study sets the framework for further thinking and research concerning the relationship of food advertisements and dietary habits in children.

Key words: Advertisements, food, marketing, nutrition, children.

∂ÈÛ·ÁˆÁ‹ √ ÚfiÏÔ˜ Ù˘ ÙËÏÂı¤·Û˘ ˆ˜ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ·¯˘Û·ÚΛ·˜ Î·È ˘ÈÔı¤ÙËÛ˘ ÌË ˘ÁÈÂÈÓÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÂÈÏÔÁÒÓ ÛÙ· ·È‰È¿ ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÔÏÏÒÓ ÂÚ¢ÓËÙÈÎÒÓ ÌÂÏÂÙÒÓ. ∏ ÙËÏÂı¤·ÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (1-4), ÂËÚ¿˙ÔÓÙ·˜ fi¯È ÌfiÓÔ ÙȘ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ, ·ÏÏ¿ Î·È ÙȘ Û˘Ó‹ıÂȘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ø˜ ÚÔ˜ ÙËÓ ÚÒÙË ·Ú¿ÌÂÙÚÔ, Ë ÙËÏÂı¤·ÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› ÙfiÛÔ Ì ·˘ÍË̤ÓË ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (4,5), fiÛÔ Î·È Î·Ù·Ó¿ÏˆÛË, ÚÔÙ›ÌËÛË ‹ ·fiÚÚÈ„Ë Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ (6-9). ŒÓ·˜ ·fi ÙÔ˘˜ ÈÛ¯˘ÚfiÙÂÚÔ˘˜ ÙÚfiÔ˘˜ ÂÈÚÚÔ‹˜ Ù˘ ÙËÏÂı¤·Û˘ ÛÙȘ ÙÚÔÊÈΤ˜ ÂÈÏÔÁ¤˜ ÙˆÓ ·È‰ÈÒÓ ıˆÚÂ›Ù·È Ë ‰È·Ê‹ÌÈÛË. ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ·ÔÙÂÏÔ‡Ó ÁÈ· ÙË ‚ÈÔÌ˯·Ó›· ÙÚÔÊ›ÌˆÓ ÌÈ· ÛËÌ·ÓÙÈ΋ ÔÌ¿‰·-ÛÙfi¯Ô, ÂÍ·ÈÙ›·˜ Ù˘ ÂÈÚÚÔ‹˜ Ô˘ ·ÛÎÔ‡Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, Ù˘ ·ÁÔÚ·ÛÙÈ΋˜ ÙÔ˘˜ ‰‡Ó·Ì˘ Î·È Ù˘ ÌÂÏÏÔÓÙÈ΋˜ ÙÔ˘˜ ȉÈfiÙËÙ·˜ ˆ˜ ηٷӷψ٤˜ (10). ªÂϤÙ˜ ÛÙÔ ı¤Ì· Ù˘ Â›‰Ú·Û˘ Ù˘ ‰È·Ê‹ÌÈÛ˘ ÛÙËÓ Â·ÎfiÏÔ˘ıË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¤ÎıÂÛË Û ÌÈ· ‰È·Ê‹ÌÈÛË ÙÚÔÊ›ÌÔ˘ ·˘Í¿ÓÂÈ ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘ (11-13) Î·È ÙÔ ·›ÙËÌ· ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ÁÈ· ·ÁÔÚ¿ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ (14,15). ∆Ô ÛËÌ·ÓÙÈÎfi ÂÚÒÙËÌ· Ô˘ ÚÔ·ÙÂÈ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ ·ÊÔÚ¿ ÛÙËÓ ÔÈfiÙËÙ· ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÚÔ˚fiÓÙˆÓ. ŒÚ¢Ó˜ Û¯ÂÙÈο Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÛÙËÓ ·È‰È΋ ˙ÒÓË Î·Ù·Ï‹ÁÔ˘Ó ˆ˜ ·˘Ù¿ Â›Ó·È Î˘Ú›ˆ˜ ÚÔ˚fiÓÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˙¿¯·ÚË Î·È ÏÈ›‰È· Î·È ‰ÂÓ ÏËÚÔ‡Ó ÙȘ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ (16-20). ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó, Â›Û˘, Ù· ÁÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ·¢ı‡ÓÔÓÙ·È ÛÙ· ·È‰È¿ (‰È¿ÚÎÂÈ·, Û˘¯ÓfiÙËÙ·, ̤ıÔ‰ÔÈ ÚÔÛ¤Ï΢Û˘). ∆Ô ÔÛÔÛÙfi ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·È‰È΋˜ ˙ÒÓ˘ Â›Ó·È Î·Ù¿ ̤ÛÔÓ ¶·È‰È·ÙÚÈ΋ 2006;69:127-133

fiÚÔ 57% (‡ÚÔ˜ 35%-71%) (7) Î·È Ê·›ÓÂÙ·È Ó· ÚÔ‚¿ÏÏÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ ÙË ‰È·ÛΤ‰·ÛË Û ۯ¤ÛË Ì ÙÔ ÚÔ˚fiÓ, ·Ú¿ ÙË ıÚÂÙÈ΋ ÙÔ˘ ·Í›· (11,18). ™ÙËÓ ∂ÏÏ¿‰· Ì›· ÌfiÓÔ ÌÂϤÙË ¤¯ÂÈ ‰ÈÂÚ¢ӋÛÂÈ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÛÙËÓ ·È‰È΋ ˙ÒÓË, ÛÙÔ Ï·›ÛÈÔ ÌÈ·˜ ‰È·ÎÚ·ÙÈ΋˜ ¤Ú¢ӷ˜ Ô˘ ÂÚÈÏ¿Ì‚·Ó ‰¤Î· Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÙËÓ ∞˘ÛÙÚ·Ï›· Î·È ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ (21). ™ÙË ÌÂϤÙË ·˘Ù‹, ηٷÁÚ¿ÊËÎ·Ó 22,5 ÒÚ˜ ·È‰È΋˜ ˙ÒÓ˘ ™·‚‚·ÙÔ·ÚÈ·ÎÔ˘ ·fi ¤Ó· ȉȈÙÈÎfi ηӿÏÈ. ∆Ô 60% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·, Î·È ·fi ·˘Ù¤˜ ۯ‰fiÓ ÔÈ ÌÈÛ¤˜ (45,7%) ‹Ù·Ó ÁÈ· ÁÏ˘Î›ÛÌ·Ù·, ‰›ÓÔÓÙ·˜ ÛÙË ¯ÒÚ· Ì·˜ ÙËÓ ÚÒÙË ı¤ÛË ÌÂٷ͇ ÙˆÓ ˘ÔÏÔ›ˆÓ ¯ˆÚÒÓ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ·˘ÙÒÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ. øÛÙfiÛÔ, ‰ÂÓ Û˘ÏϤ¯ıËÎ·Ó ÛÙÔȯ›· ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÔÈ ‰È·ÊËÌ›ÛÂȘ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ‹Ù·Ó Ó· ·Ó·Ï‡ÛÂÈ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ˙ÒÓ˘ ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ ÙˆÓ ÙÚÔʛ̈Ó, ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó, ÙfiÛÔ Û Â›Â‰Ô ıÂÌ·ÙÔÏÔÁ›·˜ Î·È ÛÎËÓÔıÂÛ›·˜ fiÛÔ Î·È Û Â›Â‰Ô Ù¯ÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ‰È·Ê‹ÌÈÛ˘, Î·È Ó· Ù· Û˘ÁÎÚ›ÓÂÈ Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ∫·Ù·ÁÚ·Ê‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ √È ‰È·ÊËÌ›ÛÂȘ Ù˘ ·È‰È΋˜ ˙ÒÓ˘ ÙÚÈÒÓ (3) ÂÏÏËÓÈÎÒÓ È‰ÈˆÙÈÎÒÓ Î·Ó·ÏÈÒÓ Î·È ÂÓfi˜ (1) ÎÚ·ÙÈÎÔ‡ ηٷÁÚ¿ÊËÎ·Ó Û ‚ÈÓÙÂÔηۤÙ˜ ÁÈ· 2 Û˘Ó¯fiÌÂÓ· ™·‚‚·ÙÔ·Úȷη ÙÔÓ ∞Ú›ÏÈÔ ÙÔ˘ 2002. ∆Ô ™·‚‚·ÙÔ·ÚÈ·ÎÔ ÂÈϤ¯ıËÎÂ, ‰ÈfiÙÈ ıˆÚÂ›Ù·È ÂÚ›Ô‰Ô˜ ˘„ËÏ‹˜ ÙËÏÂı¤·Û˘ ÁÈ· Ù· ·È‰È¿. ∏ ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ˙ÒÓ˘ ‹Ù·Ó ·fi 2,5 ¤ˆ˜ 5,5 ÒÚ˜, ·Ó¿ÏÔÁ· Ì ÙÔ Î·Ó¿ÏÈ. ∫·ÙËÁÔÚÈÔÔ›ËÛË ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Î·È ·Ó¿Ï˘ÛË ÂÚȯÔ̤ÓÔ˘ °È· οı ‰È·Ê‹ÌÈÛË Ô˘ ÚÔ‚Ï‹ıËÎÂ Û˘ÏϤ¯ıËÎ·Ó Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó Ù· ·Ú·Î¿Ùˆ ÛÙÔȯ›·:

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¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË

1. ∆‡Ô˜ Ù˘ ‰È·Ê‹ÌÈÛ˘. ∂ÍÂÙ¿ÛÙËΠ·Ó Ë ‰È·Ê‹ÌÈÛË ·ÊÔÚÔ‡Û ÙÚfiÊÈÌÔ ‹ ÌË ÙÚfiÊÈÌÔ.

2. ∂›‰Ô˜ ÙÚÔÊ›ÌÔ˘. ∫·Ù·ÁÚ¿ÊËÎÂ Ë Î·ÙËÁÔÚ›· ÛÙËÓ ÔÔ›· ·Ó‹Î ÙÔ ÙÚfiÊÈÌÔ [Á·Ï·ÎÙÔÎÔÌÈο (Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, ·ÁˆÙfi), ÛÔÎÔÏ¿Ù· Î·È ÛÔÎÔÏ·ÙÔÁÎÔÊÚ¤Ù˜, ¯˘ÌÔ› Î·È ·Ó·„˘ÎÙÈο, ÛÓ·Î Ù‡Ô˘ Á·Úȉ¿ÎÈ·, ÙÛ›¯Ï˜ Î·È ˙·¯·ÚˆÙ¿, ‰ËÌËÙÚȷο ÚˆÈÓÔ‡, ·ÚÙÔÔÈ‹Ì·Ù· Î·È ÎÚÔ˘·Û¿Ó, ¤ÙÔÈÌÔ Î·È ÁÚ‹ÁÔÚÔ Ê·ÁËÙfi (Ê·ÛÙ ÊÔ˘ÓÙ), ¿ÏÏÔ Â›‰Ô˜].

3. ¢È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÙÚÔÊ›ÌÔ˘. ∂ÍÂÙ¿ÛÙËÎÂ Â¿Ó ÙÔ ÙÚfiÊÈÌÔ: ·) ‹Ù·Ó light (ÂÚÈ›¯Â ηٿ 30% ÏÈÁfiÙÂÚ˜ ıÂÚÌ›‰Â˜ Û ۯ¤ÛË Ì ÙÔ Û˘Ì‚·ÙÈÎfi ÙÚfiÊÈÌÔ), ‚) Ì ˘„ËÏfi ÔÛÔÛÙfi ÏÈȉ›ˆÓ (ÂÚÈ›¯Â ÂÚÈÛÛfiÙÂÚÔ ·fi 30 ÁÚ. Ï›Ô˘˜/100 ÁÚ. ÙÚÔÊ›ÌÔ˘), Á) Ì ÚfiÛıÂÙË ˙¿¯·ÚË Î·È ‰) ÂÌÏÔ˘ÙÈṲ̂ÓÔ, fiˆ˜ ÚԤ΢Ù ·fi ÙË ‰È·ÙÚÔÊÈ΋ Û‹Ì·ÓÛË ÙˆÓ ÚÔ˚fiÓÙˆÓ ‹ ÙÔ˘˜ ›Ó·Î˜ Û˘Óı¤Ûˆ˜ ÙÚÔʛ̈Ó.

4. ∆¯ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰È·Ê‹ÌÈÛ˘. ∂ÎÙÈÌ‹ıËÎ·Ó Ë Û˘¯ÓfiÙËÙ·, Ë ‰È¿ÚÎÂÈ·, Ù· Ï¿Ó· (ηڤ) Î·È Ô Ú˘ıÌfi˜ ÙˆÓ Ï¿ÓˆÓ (Ï¿Ó· ÚÔ˜ ÙË ‰È¿ÚÎÂÈ·) Ù˘ ‰È·Ê‹ÌÈÛ˘. ∆· ‰‡Ô ÙÂÏÂ˘Ù·›· ¯·Ú·ÎÙËÚÈÛÙÈο ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ÂÓ·ÏÏ·Á‹ Î·È ÙÔÓ Ú˘ıÌfi ÂÓ·ÏÏ·Á‹˜ ÙˆÓ ÂÈÎfiÓˆÓ, ‰ËÏ·‰‹ ÙˆÓ ÔÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Ù˘ ‰È·Ê‹ÌÈÛ˘, Î·È ·ÔÙÂÏÔ‡Ó ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ÁÂÓÈÎfiÙÂÚÔ˘ Ú˘ıÌÔ‡ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ (22).

5. ÷ڷÎÙ‹Ú˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È. ∂ÍÂÙ¿ÛÙËΠ·Ó ÔÈ ¯·Ú·ÎÙ‹Ú˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·Ó ‹Ù·Ó Ú·ÁÌ·ÙÈÎÔ› ‹ ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ·Ó ‹Ù·Ó ·È‰È¿ ‹ ÂÓ‹ÏÈΘ, ηıÒ˜ Î·È ÙÔ Ê‡ÏÔ ÙÔ˘˜.

6. £ÂÌ·ÙÔÏÔÁ›·. ∂ÎÙÈÌ‹ıËÎÂ Ô ÙÔ̤·˜ Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜, ·fi ÙÔÓ ÔÔ›Ô ÂÌÓ‡ÛÙËÎÂ Ë ‰È·Ê‹ÌÈÛË ‹ ÛÙÔÓ ÔÔ›Ô ·Ó·ÊÂÚfiÙ·Ó (ÁÈ· ·Ú¿‰ÂÈÁÌ· ÔÈÎÔÁÂÓÂÈ·Îfi, Â·ÁÁÂÏÌ·ÙÈÎfi, Û¯ÔÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ, Ê›ÏÔÈ, ·ıÏËÙÈÛÌfi˜, ‡·ÈıÚÔ˜).

7. ª¤ıÔ‰ÔÈ ÚÔÒıËÛ˘. ∂ÍÂÙ¿ÛÙËΠ·Ó ÛÙË ‰È·Ê‹ÌÈÛË ÂÚȤ¯ÔÓÙ·Ó ÔÈ ·Ú·Î¿Ùˆ ̤ıÔ‰ÔÈ ÚÔÒıËÛ˘: ·) ™¯ÂÙÈΤ˜ Ì ÙÔ ÚÔ˚fiÓ (ÌfiÓÔ ÁÈ· ÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·): ·Ó·ÊÔÚ¿ ÛÙ· ÔÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο (.¯. Û¯‹Ì·, Á‡ÛË, ¯ÚÒÌ·, ̤ÁÂıÔ˜ Î.Ï.) ‹ ÛÙ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο. ‚) ™¯ÂÙÈΤ˜ Ì ÔÈÎÔÓÔÌÈο ÔʤÏË: ·Ó·ÊÔÚ¿ Û ·ÛÊ¿ÏÂÈ· / ÂÁÁ‡ËÛË, ·Í›· ÙÔ˘ ÚÔ˚fiÓÙÔ˜, ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ Î·È Û˘ÌÌÂÙÔ¯‹ Û ‰È·ÁˆÓÈÛÌÔ‡˜ Ì ÙËÓ ·ÁÔÚ¿ ÙÔ˘ ÚÔ˚fiÓÙÔ˜. Á) ™¯ÂÙÈΤ˜ Ì ¿ÏÏ· ÔʤÏË Ô˘ ÂÈηÏ›ٷÈ: ÈÛ¯˘ÚÈÛÌÔ› fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ‚ÔËı¿ ÙÔÓ Î·Ù·Ó·ÏˆÙ‹ Ó·: i. Ù·˘ÙÈÛÙ› Ì ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÎÔÈÓˆÓÈÎfi Û‡ÓÔÏÔ, Ó· Á›ÓÂÈ ÈÔ ·Ô‰ÂÎÙfi˜ ‹ Â›ÎÂÓÙÚÔ Ù˘ ·Ú¤·˜, ii. ‚ÂÏÙÈÒÛÂÈ ÙËÓ ˘Á›· ‹ ÙËÓ ÔÌÔÚÊÈ¿ ÙÔ˘, iii. ‚ÂÏÙÈÒÛÂÈ ÙË ‰È¿ıÂÛ‹ ÙÔ˘, Ó· ¿ÚÂÈ ÂÓ¤ÚÁÂÈ· Î·È ‰‡Ó·ÌË, Ó· ˙‹ÛÂÈ ÂÚÈ¤ÙÂÈ· Î·È ‰Ú¿ÛË, iv. Á›ÓÂÈ ÂÈÙ˘¯Ë̤ÓÔ˜ Î·È Ó· ·ÔÎÙ‹ÛÂÈ Î‡ÚÔ˜, Ó· ‚ÚÂÈ Ï‡ÛÂȘ Û ÚÔ‚Ï‹Ì·Ù·.

∞ÔÙÂϤÛÌ·Ù· ™˘ÓÔÏÈο ·ÍÈÔÏÔÁ‹ıËÎ·Ó 968 ‰È·ÊËÌ›ÛÂȘ, ÔÈ Ôԛ˜ ÚÔ‚Ï‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· 51

ˆÚÒÓ ·È‰È΋˜ ˙ÒÓ˘. ªÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ηٷÁÚ¿ÊËηÓ, 53,7% ·ÊÔÚÔ‡Û·Ó Û ÙÚfiÊÈÌ·. √ Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ‰È·ÊËÌ›ÛÂˆÓ ·Ó¿ ÒÚ· ‹Ù·Ó 10,2 ÁÈ· Ù· ÙÚfiÊÈÌ· Î·È 8,8 ÁÈ· Ù· ÌË ÙÚfiÊÈÌ·. ∞fi ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ‚Ú¤ıËΠfiÙÈ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔÊ›ÌˆÓ (20,2±7,4 sec Î·È 21,1±14,1 sec ·ÓÙ›ÛÙÔȯ·, p=0,268). ¶ÂÚ·ÈÙ¤Úˆ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ù¯ÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ¤‰ÂÈÍ fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Û ۇÁÎÚÈÛË Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ÂÚÈ›¯·Ó ÂÚÈÛÛfiÙÂÚ· ηڤ ·Ó¿ ‰È·Ê‹ÌÈÛË (13,3±6,5 ηڤ/‰È·Ê‹ÌÈÛË Î·È 12±7,7 ηڤ/‰È·Ê‹ÌÈÛË ·ÓÙÈÛÙÔ›¯ˆ˜, p=0,008) Î·È Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ Ú˘ıÌfi, fiˆ˜ ·ÍÈÔÏÔÁÂ›Ù·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î·Ú¤ ·Ó¿ sec (0,67±0,28 ηڤ/sec Î·È 0,64±0,29 ηڤ/sec ·ÓÙ›ÛÙÔȯ·, p=0,10). ∞fi ÙËÓ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ô˘ ·ÊÔÚÔ‡Û·Ó Ù· ÛÎËÓÔıÂÙÈο ÛÙÔȯ›· ÙˆÓ ‰È·ÊË̛ۈÓ, ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·˘ÙÒÓ Î·È ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ (ÙÚfiÊÈÌÔ - ÌË ÙÚfiÊÈÌÔ). ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÙÔ 66,7% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ¯·Ú·ÎÙ‹Ú˜ ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ, ›Ù ·ÔÎÏÂÈÛÙÈο ›Ù ÛÂ Û˘Ó‰˘·ÛÌfi Ì Ú·ÁÌ·ÙÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ‹Ù·Ó 13,2% (x2=232,5, p<0,001). ™ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÂÌÊ·Ó›˙ÔÓÙ·Ó ·È‰È¿ Û ÔÛÔÛÙfi 83%, ÂÓÒ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ Û ÔÛÔÛÙfi 63% (x2=35,3, p<0,001). ∂›Û˘, ÙÔ 42,3% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÂÚÈ›¯·Ó ˙Ò· ÛÙÔ˘˜ ·ÚÔ˘ÛÈ·˙fiÌÂÓÔ˘˜ ¯·Ú·ÎÙ‹Ú˜ ÙÔ˘˜ Û ۇÁÎÚÈÛË Ì ÙÔ 13% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÌË ÙÚÔÊ›ÌˆÓ (x2=78,9, p<0,001). ™˘Û¯¤ÙÈÛË, Â›Û˘, ‚Ú¤ıËΠÌÂٷ͇ ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ Î·È ÙÔ˘ ÙÚfiÔ˘ ÚÔÒıËÛ‹˜ ÙÔ˘ ÛÙÔ˘˜ Èı·ÓÔ‡˜ ·ÁÔÚ·ÛÙ¤˜. ªÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÔÈ ÙÚÂȘ ÈÔ Û˘¯Ó¿ ÂÌÊ·ÓÈ˙fiÌÂÓÔÈ ÙÚfiÔÈ ÚÔÒıËÛ˘ ‹Ù·Ó Ù· ÔÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο (68,3%), Ë ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË (46,9%) Î·È Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ (40,6%). ∞ÓÙ›ıÂÙ·, ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ÔÈ ‰ËÌÔÊÈϤÛÙÂÚÔÈ ÙÚfiÔÈ ÚÔÒıËÛ˘ ‹Ù·Ó Ë ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË (47,2%), Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ (38,9%) Î·È Ô ÈÛ¯˘ÚÈÛÌfi˜ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ı· ‚ÔËı‹ÛÂÈ ÙÔÓ ·ÁÔÚ·ÛÙ‹ Ó· ÂÈÙ‡¯ÂÈ Î¿ÔÈÔ ÛÎÔfi (38,7%). ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ ÌÂıfi‰ˆÓ ÚÔÒıËÛ˘ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔʛ̈Ó. ¶·È‰È·ÙÚÈ΋ 2006;69:127-133

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·130

130

∂. ª·ıÚ¤ÏÏÔ˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ™˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ ÌÂıfi‰ˆÓ ÚÔÒıËÛ˘ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔʛ̈Ó

√ÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο £ÚÂÙÈο Û˘ÛÙ·ÙÈο πÛ¯˘ÚÈÛÌÔ› ∞ÛÊ¿ÏÂÈ·-ÂÁÁ‡ËÛË ¢ÒÚ· √ÈÎÔÓÔÌÈο ΛÓËÙÚ· ∫ÔÈÓˆÓÈ΋ ÚÔÛÊÔÚ¿ ¢È¿ıÂÛË ÀÁ›· √ÌÔÚÊÈ¿ ∂Ó¤ÚÁÂÈ· ¶ÂÚÈ¤ÙÂÈ· ∂ÈÙ˘¯›· §‡ÛÂȘ ¶·Ú¤·

¢È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó

¢È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó

68,6 19,7 27,7 8,5 40,6 0 3,8 46,9 21,7 0,4 21,9 12,1 14,0 1,2 22,8

2,5 0,9 28,5 7,2 38,9 14,4 15,7 47,2 13,5 17,5 13,3 8,6 38,7 12,8 30,4

∆Ô ÂÚÈ‚¿ÏÏÔÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚÈÛÛfiÙÂÚÔ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‹Ù·Ó ÙÔ “ÊÈÏÈÎfi” (30,6%), ÂÓÒ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ÙÔ “ÔÈÎÔÁÂÓÂÈ·Îfi” (14,6%). ∞fi ÙËÓ ¿ÏÏË, ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÛÙȘ Ôԛ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠۯÔÏÈÎfi, ·ıÏËÙÈÎfi, ÊÈÏÈÎfi, ˘·›ıÚÈÔ Î·È Â͈Á‹ÈÓÔ ÂÚÈ‚¿ÏÏÔÓ, Ë ÏÂÈÔ„ËÊ›· ‹Ù·Ó ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ (71,7%, 73,1%, 80,7%, 84,5%, 90%, ·ÓÙÈÛÙÔ›¯ˆ˜). ∞ÓÙÈı¤Ùˆ˜, ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÔÈÎÔÁÂÓÂÈ·Îfi, ÂÚˆÙÈÎfi Î·È Â·ÁÁÂÏÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ‹Ù·Ó ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ (56,5%, 69,4%, 78,3%, ·ÓÙÈÛÙÔ›¯ˆ˜). ∆¤ÏÔ˜, ÙÔ 54,1% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÌË ÙÚÔʛ̈Ó

‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó Î·Ó¤Ó· ·fi Ù· ı¤Ì·Ù· Ô˘ ÂϤÁ¯ıËηÓ. ø˜ ÚÔ˜ Ù· ÂÈϤÔÓ ÛÂÓ·Úȷο ÛÙÔȯ›·, Ë Ê·ÓÙ·Û›· ÂÌÊ·Ó›ÛÙËΠÛÙÔ 57,9% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ ¯ÈÔ‡ÌÔÚ Û ÔÛÔÛÙfi 26,7%. ¶·ÚfiÏÔ Ô˘ Ë ‚›· ˘‹Ú¯Â ÌfiÓÔ ÛÙÔ 2,9% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔʛ̈Ó, ÂÓÙÔ‡ÙÔȘ, ÙÔ 68,2% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ÙË ¯ÚËÛÈÌÔÔ›ËÛ·Ó ‹Ù·Ó ‰È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ¿ÏÏ· ‰‡Ô ÛÂÓ·Úȷο ÛÙÔȯ›·, fiÔ˘ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ Ù· ¯ÚËÛÈÌÔÔ›ËÛ·Ó ·ÊÔÚÔ‡Ó ÙÚfiÊÈÌ· (70,2% ÁÈ· ÙÔ ¯ÈÔ‡ÌÔÚ, 82,2% ÁÈ· ÙË Ê·ÓÙ·Û›·). ∆Ô 70,8% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÌË ÙÚÔÊ›ÌˆÓ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó Î·Ó¤Ó· ·fi ·˘Ù¿ Ù· ÛÙÔȯ›·.

°·Ï·ÎÙÔÎÔÌÈο

31,7

Ã˘ÌÔ›-∞Ó·„˘ÎÙÈο

5,8

™ÔÎÔÏ·ÙÔÂȉ‹

11,8

¶·Ù·Ù¿ÎÈ· & Û˘Ó·Ê‹

11

∆Û›¯Ï˜-∫·Ú·Ì¤Ï˜

21

∞ÚÙÔÔÈ‹Ì·Ù·-∫ÚÔ˘·Û¿Ó

4

¢ËÌËÙÚȷο ÚˆÈÓÔ‡

2,7

º·ÛÙ ÊÔ˘ÓÙ

6,7

ÕÏÏ·

5,6 0

5

10

15

20 ¶ÔÛÔÛÙfi (%)

25

30

35

∂ÈÎfiÓ· 1. ™˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙÚÔÊ›ÌˆÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·. ¶·È‰È·ÙÚÈ΋ 2006;69:127-133

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·131

131

¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË

™ÙËÓ ∂ÈÎfiÓ· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙÚÔÊ›ÌˆÓ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·. ∆· ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· ‹Ù·Ó Ù· ÈÔ Û˘¯Ó¿ ‰È·ÊËÌÈ˙fiÌÂÓ· ‰È·ÙÚÔÊÈο ÚÔ˚fiÓÙ·, ηχÙÔÓÙ·˜ ÙÔ 31,7% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔʛ̈Ó. ∞ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÙÛ›¯Ï˜ Î·È ÔÈ Î·Ú·Ì¤Ï˜ (21%), ÔÈ ÛÔÎÔÏ¿Ù˜ Î·È Ù· Û¯ÂÙÈο ÚÔ˚fiÓÙ· (11,5%), Î·È Ù· ·Ù·Ù¿ÎÈ· Î·È Ù· Û˘Ó·Ê‹ ÛÓ·Î (11%). ∞Ó¿Ï˘ÛË Ù˘ ‰È·ÙÚÔÊÈ΋˜ ÔÈfiÙËÙ·˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ‰È·ÊËÌ›˙ÔÓÙ·Ó ¤‰ÂÈÍ fiÙÈ 37,3% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó ÚÔ˚fiÓÙ· Ì ÔÛÔÛÙfi Ï›Ô˘˜ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 30%. ∂›Û˘, 63,8% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó ÚÔ˚fiÓÙ· Ì ÚfiÛıÂÙË ˙¿¯·ÚË, ÂÓÒ 10,4% ÙÚfiÊÈÌ·, ÛÙ· ÔÔ›· ¤¯ÂÈ Á›ÓÂÈ ÚÔÛı‹ÎË ‚ÈÙ·ÌÈÓÒÓ ‹/Î·È ·ÓfiÚÁ·ÓˆÓ ÛÙÔȯ›ˆÓ. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔʛ̈Ó. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, Ë ·Ó¿Ï˘ÛË Ù˘ ‰È·Î‡Ì·ÓÛ˘ ¤‰ÂÈÍ fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ Ì ÙË ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ‹Ù·Ó ÂΛӘ Ô˘ ·ÊÔÚÔ‡Û·Ó Ù· ˙·¯·ÚˆÙ¿ ÁÏ˘Î›ÛÌ·Ù· (14,8±5,5 sec), ÂÓÒ ·˘Ù¤˜ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‹Ù·Ó ÁÈ· Ù· ÚÔ˚fiÓÙ· Ù‡Ô˘ fast food (25,5±1 sec). ∏ ̤ÛË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ˙·¯·ÚˆÙÒÓ ÁÏ˘ÎÈÛÌ¿ÙˆÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÈÎÚfiÙÂÚË ·fi ·˘Ù‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ, fiˆ˜ ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ (21,4±7, sec, p<0,001), ÙˆÓ ¯˘ÌÒÓ Î·È ÙˆÓ ·Ó·„˘ÎÙÈÎÒÓ (22,3±4,6 sec, p<0,001), Ù˘ ÛÔÎÔÏ¿Ù·˜ Î·È ÙˆÓ Û˘Ó·ÊÒÓ ÚÔ˚fiÓÙˆÓ (21,7±6,6 sec, p<0,001), ÙˆÓ ÛÓ·Î Ù‡Ô˘ “·Ù·Ù¿ÎÈ·-Á·Úȉ¿ÎÈ·” (22,7±8,9 sec, p<0,001), ÙˆÓ ‰ËÌËÙÚÈ·ÎÒÓ ÚˆÈÓÔ‡ (21,4±4,4 sec, p<0,001) Î·È ÙˆÓ ÚÔ˚fiÓÙˆÓ Ù‡Ô˘ fast food (25,5±1 sec, p<0,016). ∆¤ÏÔ˜, Ô Ú˘ıÌfi˜ ÙˆÓ Ï¿ÓˆÓ (ηڤ/sec) ‰È¤ÊÂÚ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ (F=21,132, p<0,001), Ì ‡ÚÔ˜ ÙÈÌÒÓ ·fi 0,42±0,15 ¤ˆ˜ 0,88±0,1 ηڤ/sec, fiÔ˘ Ë ÌÈÎÚfiÙÂÚË ÙÈÌ‹ ·ÓÙÈÛÙÔȯ› ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÁÈ· Ù· ·ÚÙÔÔÈ‹Ì·Ù· Î·È ÎÚÔ˘·Û¿Ó Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÁÈ· Ù· ‰ËÌËÙÚȷο ÚˆÈÓÔ‡.

™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ÌÂϤÙË Â›Ó·È Ë ÚÒÙË ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ηٷÁÚ¿ÊÂÈ ÛÙÔȯ›· ÁÈ· ÙÔ Â›‰Ô˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË. ™Â Û˘Ìʈӛ· Ì ٷ ·ÔÙÂϤ-

ÛÌ·Ù· ·ÓÙ›ÛÙÔȯˆÓ ÌÂÏÂÙÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (7,21), Ë ·ÚÔ‡Û· ÌÂϤÙË ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÌÈÛ¤˜ ‰È·ÊËÌ›ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È Û˘ÓÔÏÈο ÛÙËÓ ·È‰È΋ ˙ÒÓË. ∆· ÛÎËÓÔıÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ·¢ı‡ÓÔÓÙ·È ÛÙ· ·È‰È¿ ‹Ù·Ó Ù¤ÙÔÈ· Ô˘ Ó· ÙȘ ηıÈÛÙÔ‡Ó ÂÏ΢ÛÙÈΤ˜ Û ·˘Ù¿. √È ÌÈÛ¤˜ ÂÚ›Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ÙÚÂȘ ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·’ fi,ÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó, Î·È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÌÈÛ¤˜, Ê·ÓÙ·Û›·. ∆Ô ›‰ÈÔ Ê·›ÓÂÙ·È Ó· Â͢ËÚÂÙÔ‡Ó Ë Û˘ÌÌÂÙÔ¯‹ ·È‰ÈÒÓ Î·È Ë ¯Ú‹ÛË ˙ÒˆÓ ÛÙÔ˘˜ ·ÚÔ˘ÛÈ·˙fiÌÂÓÔ˘˜ ¯·Ú·ÎÙ‹Ú˜. ∞Ó¿Ï˘ÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ ∞ÌÂÚÈ΋˜ Î·È ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· ¤‰ÂÈÍ fiÙÈ ÂȉÈο ÔÈ ¯·Ú·ÎÙ‹Ú˜ ˙ÒˆÓ ˆ˜ ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È· ÂÌÊ·Ó›˙ÔÓÙ·È Û¯Â‰fiÓ Û fiϘ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ (19). Ÿˆ˜ Â›Ó·È ÏÔÁÈο ·Ó·ÌÂÓfiÌÂÓÔ, Ë ıÂÌ·ÙÔÏÔÁ›· ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ‚Ú¤ıËΠӷ ·ÓÙÏÂ›Ù·È ·fi ÙÔ Î·ıËÌÂÚÈÓfi ÂÚÈ‚¿ÏÏÔÓ Î·È Ù· ÂӉȷʤÚÔÓÙ· ÙˆÓ ·È‰ÈÒÓ, Ì ΢ڛ·Ú¯Ô ı¤Ì· ÙÔ˘˜ Ê›ÏÔ˘˜. ∫·È ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ηٷÁÚ¿ÊÔ˘Ó fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË, Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙˆÓ ÌË ÙÚÔʛ̈Ó, ¯ÚËÛÈÌÔÔÈÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ÏÔ΋ ÈÛÙÔÚ›·˜ Î·È ¯ÈÔ‡ÌÔÚ (18), ·ÏÏ¿ Î·È ÌÔ˘ÛÈ΋ Î·È ÊÚ¿ÛÂȘ ˆ˜ ηٷÎÏ›‰· (19). ªÂٷ͇ ÙˆÓ ÙÚfiˆÓ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· Ó· ηٷÛÙÔ‡Ó ÈÔ ÂÓÙ˘ˆÛȷΤ˜ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÛÙ· ·È‰È¿, ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ‚›·. √È Rajecki Î·È Û˘ÓÂÚÁ¿Ù˜ (23) η٤ÁÚ·„·Ó ÙË ‚›· ˆ˜ Ôχ ‰ËÌÔÊÈÏ‹ ıÂÌ·ÙÔÏÔÁ›· ÙˆÓ ·È‰ÈÎÒÓ ‰È·ÊËÌ›ÛÂˆÓ (62%), οÙÈ Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ∏ ÌÂÁ¿ÏË ·˘Ù‹ ‰È·ÊÔÚ¿ ÌÔÚ› ›Ûˆ˜ Ó· ·Ô‰Ôı› Î·È ÛÙÔÓ ‰È·ÊÔÚÂÙÈÎfi ÔÚÈÛÌfi Ù˘ ‚›·˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÌÂÏÂÙÒÓ. √È ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ηڤ ·Ó¿ ‰È·Ê‹ÌÈÛË Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙˆÓ ÌË ÙÚÔÊ›ÌˆÓ Î·È ÌÂÁ·Ï‡ÙÂÚÔ Ú˘ıÌfi Ï¿ÓˆÓ (ηڤ/sec). ∏ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ ¤ÎıÂÛË ÛÙ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· ÙˆÓ Ì¤ÛˆÓ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ Î·È ÙË ‰È¿ÚÎÂÈ· ÚÔÛÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ·Ó·Ê¤ÚÂÈ fiÙÈ fiÛÔ ÈÔ ÁÚ‹ÁÔÚÔ˜ Ô Ú˘ıÌfi˜ ÂÓ·ÏÏ·Á‹˜ ÙˆÓ ÂÈÎfiÓˆÓ, ÙfiÛÔ ÈÔ Ôχ Ù· ·È‰È¿ ÚÔÛËÏÒÓÔÓÙ·È ÛÙÔ ÔÙÈÎfi ÂÚ¤ıÈÛÌ·, ÁÈ’ ·˘Ùfi Î·È ˘ÈÔıÂÙÂ›Ù·È ÂȉÈο ·fi Ù· ȉȈÙÈο ÙËÏÂÔÙÈο ÚÔÁÚ¿ÌÌ·Ù· (24). À¿Ú¯ÂÈ, fï˜, ¤Ó· ÛËÌÂ›Ô ¿Óˆ ·fi ÙÔ ÔÔ›Ô Ë ÚÔÛÔ¯‹ ÌÂÈÒÓÂÙ·È, ‰ÈfiÙÈ Ô Ú˘ıÌfi˜ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ÙÔÓ Ú˘ıÌfi ÂÂÍÂÚÁ·Û›·˜ Ù˘ ÏËÚÔÊÔÚ›·˜ ¶·È‰È·ÙÚÈ΋ 2006;69:127-133

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·132

132

∂. ª·ıÚ¤ÏÏÔ˘ Î·È Û˘Ó.

·fi ÙÔÓ ı·ً (25). ™Â ·˘Ùfi Û˘Ó˘ÔÏÔÁ›˙ÂÙ·È Î·È ÙÔ fiÙÈ ÌfiÏȘ ÛÙËÓ ËÏÈΛ· ÙˆÓ Ô¯ÙÒ ÂÙÒÓ, fiˆ˜ Ê·›ÓÂÙ·È ·fi ¤Ú¢Ó˜ Û¯ÂÙÈο Ì ÙË ÁÓˆÛȷ΋ ·Ó¿Ù˘ÍË, Ù· ·È‰È¿ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙËÓ ÚfiıÂÛË ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ó· Ô˘Ï‹ÛÔ˘Ó ¤Ó· ÚÔ˚fiÓ, ÂÓÒ ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ ‰Ò‰Âη ÂÙÒÓ ‰ÂÓ ·Ó·Ì¤ÓÂÙ·È Ó· ÌÔÚÔ‡Ó ·˘ıfiÚÌËÙ·, ¯ˆÚ›˜ ‰ËÏ·‰‹ οÔÈ· Â͈ÙÂÚÈ΋ ÂÓ›Û¯˘ÛË, Ó· ·Ú¿ÁÔ˘Ó ÛΤ„ÂȘ Ô˘ ı· ·ÍÈÔÏÔÁÔ‡Ó ÂÔÈÎÔ‰ÔÌËÙÈο ÙȘ ‰È·ÊËÌ›ÛÂȘ (26). ∂ÈϤÔÓ, Ù· ·È‰È¿ ‰ÂÓ ÌÔÚÔ‡Ó ¿ÓÙ· Ó· ηٷÓÔ‹ÛÔ˘Ó Ù· Ù¯ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È Ë ÚÔÛÔ¯‹ ÙÔ˘˜ ÛÙÔ ÏÂÎÙÈÎfi ÂÚȯfiÌÂÓÔ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÔÚ› Ó· ·ÔÛ·Ûı› ·fi ·ÏÏ·Á¤˜ ÛÙ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· (27). §·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ fiϘ ·˘Ù¤˜ ÙȘ ·Ú·ÙËÚ‹ÛÂȘ, ÌÔÚԇ̠ӷ Ô‰ËÁËıԇ̠ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ¯Ú‹ÛË ÂÚÈÛÛfiÙÂÚˆÓ Î·È ÁÚËÁÔÚfiÙÂÚˆÓ ÂÓ·ÏÏ·ÁÒÓ ÂÈÎfiÓˆÓ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÙȘ ηıÈÛÙÔ‡Ó ÈÔ ÂÏ΢ÛÙÈΤ˜ Î·È ›Ûˆ˜ ·ÔÚÔÛ·Ó·ÙÔÏÈÛÙÈΤ˜. ∆¯ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, fiˆ˜ Ô ·ÚÈıÌfi˜ Î·È Ô Ú˘ıÌfi˜ ÙˆÓ Î·Ú¤, ‰ÂÓ ¤¯Ô˘Ó Í·Ó·ÌÂÏÂÙËı› ˆ˜ ÚÔ˜ ÙÔ Â¿Ó ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔÊ›ÌˆÓ Î·È Ë Âͤٷۋ ÙÔ˘˜ ·ÔÙÂÏ› ÚˆÙÔÙ˘›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ™¯ÂÙÈο Ì ÙȘ ÌÂıfi‰Ô˘˜ ÚÔÒıËÛ˘, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ‰ËÌÔÊÈϤÛÙÂÚÔÈ ÙÚfiÔÈ ‹Ù·Ó Ë ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË Ô˘ ˘fiÛ¯ÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜ Î·È Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ. °È· ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÂȉÈÎfiÙÂÚ·, Ô ÂÚÈÛÛfiÙÂÚÔ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˜ ÙÚfiÔ˜ ÚÔÒıËÛ˘ ‹Ù·Ó Ë ÚÔ‚ÔÏ‹ ÙˆÓ ÔÚÁ·ÓÔÏËÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ÙÚÔÊ›ÌÔ˘. ∞˘Ùfi Ê·›ÓÂÙ·È Ó· Û˘Ì‚·›ÓÂÈ, ‰ÈfiÙÈ Ù· ÔÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÊÔÚÔ‡Ó È‰ÈfiÙËÙ˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ô˘ ÌÔÚÔ‡Ó Â‡ÎÔÏ· Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÛÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ̤ۈ ÂÈÎfiÓˆÓ. ªÂ ·˘Ùfi ÙÔÓ ÙÚfiÔ, fï˜, Ë ·Í›· Î·È ·Ô‰Ô¯‹ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ÂËÚ¿˙ÔÓÙ·È ÛËÌ·ÓÙÈο ·fi ÙȘ ÔÚÁ·ÓÔÏËÙÈΤ˜ ÙÔ˘ ȉÈfiÙËÙ˜, ·Ô‰˘Ó·ÌÒÓÔÓÙ·˜ ¤ÙÛÈ ÙË ıÚÂÙÈ΋ ·Í›· ÙÔ˘ ÙÚÔÊ›ÌÔ˘. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÔÈÎÔÓÔÌÈο ΛÓËÙÚ·. ∞˘Ùfi ›Ûˆ˜ ÔÊ›ÏÂÙ·È ÛÙËÓ ··ÁfiÚ¢ÛË Ô˘ ˘¿Ú¯ÂÈ ·fi ÙÔÓ ¢ÈÂıÓ‹ ∫Ò‰Èη ¢È·ÊËÌÈÛÙÈ΋˜ ¶Ú¿Í˘ Î·È ·ÊÔÚ¿ fiϘ ÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ·¢ı‡ÓÔÓÙ·È Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 14 ÂÙÒÓ, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÔÔ›Ô˘ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë ÙÈÌ‹ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ‹ ÔÈÎÔÓÔÌÈÎÔ› ÈÛ¯˘ÚÈÛÌÔ› Ô˘ Ó· ‰ËÏÒÓÔ˘Ó fiÙÈ ÙÔ ÚÔ˚fiÓ ÌÔÚ› Ó· ·ÁÔÚ·ÛÙ› ·fi οı ÓÔÈÎÔ΢ÚÈfi (21). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Â›‰Ô˜ ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔʛ̈Ó, Ù· ÂÚÈÛÛfiÙÂÚÔ ‰È·ÊËÌÈ˙fiÌÂÓ· ¶·È‰È·ÙÚÈ΋ 2006;69:127-133

ÚÔ˚fiÓÙ· ‹Ù·Ó Ù· Á·Ï·ÎÙÔÎÔÌÈο (¤Ó· ÙÚ›ÙÔ ÙˆÓ Û˘ÓÔÏÈο ‰È·ÊËÌÈ˙ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÔÈ ÙÛ›¯Ï˜ Î·È Î·Ú·Ì¤Ï˜. ∆Ô Â‡ÚËÌ· ·˘Ùfi ¤Ú¯ÂÙ·È ·Ú¯ÈÎÒ˜ Û ·ÓÙ›ıÂÛË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ·fi ÙË ÌÂϤÙË ÙÔ˘ ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ ¢ÈÂıÓ‹˜ ∫·Ù·Ó·ÏˆÙÒÓ (Consumers International) (21), fiÔ˘ ÙÔ ÚÒÙÔ ‰È·ÊËÌÈ˙fiÌÂÓÔ ÚÔ˚fiÓ ÛÙË ¯ÒÚ· Ì·˜ ‹Ù·Ó Ù· ÁÏ˘Î›ÛÌ·Ù·, ηχÙÔÓÙ·˜ ۯ‰fiÓ ÙȘ ÌÈÛ¤˜ ‰È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó. ø˜ ÁÏ˘Î›ÛÌ·Ù·, fï˜, ıˆÚÔ‡ÓÙ·Ó Ù· ÛÔÎÔÏ·ÙÔÂȉ‹ Î·È Ù· ˙·¯·ÚˆÙ¿. √fiÙÂ, ÙÔ ÔÛÔÛÙfi ·˘Ùfi Ú¤ÂÈ Ó· Û˘ÁÎÚÈı› Ì ÙÔ ¿ıÚÔÈÛÌ· Ù˘ ηÙËÁÔÚ›·˜ “ÙÛ›¯Ï˜-ηڷ̤Ϙ” Î·È Ù˘ ηÙËÁÔÚ›·˜ “ÛÔÎÔÏ¿Ù· Î·È ÛÔÎÔÏ·ÙÔÂȉ‹ ÛӷΔ ·fi ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ù· ÁÏ˘Î›ÛÌ·Ù· ‰È·ÊËÌ›˙ÔÓÙ·Ó Û ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ‰È·ÊË̛ۈÓ, ÍÂÂÚÓÒÓÙ·˜ Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·. ∆· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, ¿ÓÙˆ˜, ÛÙËÓ ¤Ú¢ӷ ÙÔ˘ 1996 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·Ó ÂÚ›Ô˘ Ù¤ÛÛÂÚȘ ÊÔÚ¤˜ ÏÈÁfiÙÂÚÔ ·’ fi,ÙÈ ÛÙËÓ ·ÚÔ‡Û·. ™Â οı ÂÚ›ÙˆÛË, Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ¤Ú¯ÔÓÙ·È Û ·ÓÙ›ıÂÛË Î·È Ì ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, fiÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÙÔ ÈÔ ‰È·ÊËÌÈ˙fiÌÂÓÔ ÙÚfiÊÈÌÔ Â›Ó·È Ù· ‰ËÌËÙÚȷο ÚˆÈÓÔ‡ (7,14,17,18,28). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ›Ûˆ˜ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ‰ËÌËÙÚȷο ¤¯Ô˘Ó ÌÂÈ ÛÙË ‰›·ÈÙ· ÙˆÓ ÌÈÎÚÒÓ Î·Ù·Ó·ÏˆÙÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜ ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ø˜ ÚÔ˜ ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÚÔ˚fiÓÙˆÓ, Ù· ‰‡Ô ÙÚ›Ù· ÂÚ›Ô˘ ÂÚÈ›¯·Ó ÚfiÛıÂÙË ˙¿¯·ÚË Î·È ÂÚ›Ô˘ ÙÔ ¤Ó· ÙÚ›ÙÔ ‹Ù·Ó ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ϛÔ˜, fiˆ˜ ¿ÏψÛÙ ¤¯ÂÈ ‚ÚÂı› Î·È Û ·ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜ ÛÙÔ Â͈ÙÂÚÈÎfi (16,17,20). √È ‰È·ÊËÌ›ÛÂȘ ÙˆÓ ÛÓ·Î Ù‡Ô˘ fast food, ·ÚfiÏÔ Ô˘ ‰ÂÓ ·Ó‹ÎÔ˘Ó ÛÙ· ÈÔ ‰È·ÊËÌÈ˙fiÌÂÓ· ÚÔ˚fiÓÙ·, Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ·. ∏ ‰ÈÂıÓ‹˜ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÈ fiÙÈ Ë ÔÛÔÛÙÈ·›· Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ “‡ÎÔÏÔ˘ Ê·ÁËÙÔ‡” ÛÙ· ‰È·ÊËÌÈ˙fiÌÂÓ· ÙÚfiÊÈÌ· ¤¯ÂÈ ·˘ÍËı› Ú·Á‰·›· ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· (18,28). À‹Ú¯Â, Â›Û˘, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÙÚÔʛ̈Ó, Ù· ÔÔ›· ‹Ù·Ó ÂÌÏÔ˘ÙÈṲ̂ӷ Ì ‚Èٷ̛Ә ‹/Î·È ·ÓfiÚÁ·Ó· ÛÙÔȯ›·, ÁÈ· Ù· ÔÔ›· Ë ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ Ê·›ÓÂÙ·È Ó· οÓÂÈ ÏfiÁÔ. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ, fï˜, ÔÛÔÛÙfi ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û ÙÚfiÊÈÌ· ÏÔ‡ÛÈ· Û ıÂÚÌ›‰Â˜ Î·È Ì ÌÈÎÚ‹ ıÚÂÙÈ΋ ·Í›·. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ‰È·ÊËÌ›ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË ·ÊÔÚÔ‡Ó Û ÙÚfiÊÈÌ·, Ë ÔÈfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘ÌʈÓ› Ì ÙȘ ÁÂÓÈΤ˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÈÛÔÚÚÔË̤ÓË ‰È·ÙÚÔÊ‹. ∆Ô Â‡ÚËÌ·

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·˘Ùfi ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÌÂÏÂÙÒÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·Ê‹ÌÈÛ˘ ÛÙË ‰È·ÈÙËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ, ηıÈÛÙ¿ ·Ó·Áη›· ÙË ÓÔÌÔıÂÙÈ΋ Ú‡ıÌÈÛË ÙˆÓ ıÂÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·Ê‹ÌÈÛË. ¶ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· ÙË Û¯¤ÛË ‰fiÛ˘-·ÔÙÂϤÛÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ¤ÎıÂÛË ÛÙË ‰È·Ê‹ÌÈÛË, ηıÒ˜ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÂÓ›Û¯˘Û˘ Ù˘ ¿Ì˘Ó·˜ ÙˆÓ ·È‰ÈÒÓ ·¤Ó·ÓÙÈ ÛÙ· ÌËӇ̷ٷ ÙˆÓ ‰È·ÊË̛ۈÓ.

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CASE REPORT

∞Ï·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Ì ʷÈÓfiÙ˘Ô Û˘Ó‰ÚfiÌÔ˘ Smith-Lemli-Opitz Î·È Meckel ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À, πÔÎÚ¿ÙÂÈÔ °.¶.¡., £ÂÛÛ·ÏÔÓ›ÎË

∞. ∞Ó‰Ú¤Ô˘, µ. ¶··‚·ÛÈÏ›Ԣ, ∞. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘

AÏÏËÏÔÁÚ·Ê›·: µ¿Ûˆ ¶··‚·ÛÈÏ›Ԣ ÃÚ˘ÛÔÛÙfiÌÔ˘ ™Ì‡ÚÓ˘ 6-8, ∆ÚÈ·Ó‰Ú›·, T.K. 553 37, £ÂÛÛ·ÏÔÓ›ÎË

¶ÂÚ›ÏË„Ë: ∆Ô 1987 ÔÈ Casamassima et al ÂÚȤÁÚ·„·Ó ¤Ó· Ó¤Ô Û‡Ó‰ÚÔÌÔ Ì ÂΉËÏÒÛÂȘ Ô˘ ı˘Ì›˙Ô˘Ó Ù· Û‡Ó‰ÚÔÌ· Smith-Lemli-Opitz (ÛSLO) Î·È Meckel (ÛM), ÌÂ Û˘Ó‡·ÚÍË ·ÚÂÁÎÂÊ·ÏȉÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ¤Ó· ‚Ú¤ÊÔ˜ ¿ÚÚÂÓ, Ô˘ Ù·ÈÚÈ¿˙ÂÈ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚȤÁÚ·„·Ó ÔÈ Casamassima et al. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Î·È Ê·ÈÓfiÙ˘Ô ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛSLO Ù‡Ô˘ ππ, ¯ˆÚ›˜ ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÛSLO.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘ 08-09-2005

§¤ÍÂȘ ÎÏÂȉȿ: ÀÔÏ·Û›· ÛÎÒÏËη, Û‡Ó‰ÚÔÌÔ SLO, Û‡Ó‰ÚÔÌÔ Meckel.

Aplasia of the cerebellar vermis with Smith-Lemli-Opitz and Meckel syndrome phenotypes Department of Neonatology, NHS, Ippokrateion Hospital, Thessaloniki Correspondence: Vasso Papavassiliou Chryssostomou Smyrnis 6-8 553 37, Thessaloniki Date of submission: 03-09-2004 Date of approval: 08-09-2005

A. Andreou, V. Papavassiliou, A. Sakellaropoulou

Abstract: In 1987 Casamassima and colleagues described a new syndrome, with an appearance resembling the Smith-Lemli-Opitz syndrome (SLOs) and the Meckel syndrome (Ms), associated with the presence of cerebellar deficit. The case is described of a male infant which matches the clinical appearance of this syndrome. The infant had hypoplasia of the cerebellar vermis and phenotype of the SLOs type II, but without the biochemical abnormalities of SLOs. Key words: Vermis hypoplasia, SLO syndrome, Meckel syndrome.

™˘ÓÙÔÌÔÁڷʛ˜ ™‡Ó‰ÚÔÌÔ Smith-Lemli-Opitz: ÛSLO ™‡Ó‰ÚÔÌÔ Meckel: ÛM

∂ÈÛ·ÁˆÁ‹ ∏ Û˘Ó‡·ÚÍË ·Ï·Û›·˜/˘ÔÏ·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Û˘Ó‰ÚfiÌˆÓ SLO Î·È Meckel ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1987 ·fi ÙÔ˘˜ Casamassima Î·È Û˘Ó (1) Û ÙÚ›· ·‰¤ÏÊÈ·, Ô˘ ÂÌÊ¿ÓÈ˙·Ó ·ÓˆÌ·Ï›Â˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ fiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ›¯·Ó ÂÚÈÁÚ·Ê› ÛÙÔ Û‡Ó‰ÚÔÌÔ Joubert. √ Casamassima ıÂÒÚËÛ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ó¤Ô Û‡Ó‰ÚÔÌÔ, ÌÈ· ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË ‰È·Ù·Ú·¯‹. ™ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ıˆڋıËΠfiÙÈ ·Ó‹ÎÔ˘Ó ‰‡Ô ·‰ÂÏʤ˜ Ì ʷÈÓfiÙ˘Ô ÛSLO Î·È ÛM Î·È Û˘ÓÔ‰fi ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, Ë·ÙÈ΋ ›ÓˆÛË Î·È ÓÂÊÚÈΤ˜ ·ÛÙÂȘ, Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ÙÔ 1986 ·fi ÙÔ˘˜ Thomson Î·È Baraitser (2), ηıÒ˜ Î·È ‰‡Ô ¶·È‰È·ÙÚÈ΋ 2006;69:134-137

·‰¤ÏÊÈ· Ì ʷÈÓfiÙ˘Ô ÛM Î·È Û˘ÓÔ‰¤˜ ÓÂÊÚÈΤ˜ Î·È Ë·ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ηıÒ˜ Î·È ‰È·Ì·Úٛ˜ ÙÔ˘ ∫¡™ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ÙÔ 1974 ·fi ÙÔ˘˜ Hunter Î·È Û˘Ó (3). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓÂÔÁÓfi Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ó¤Ô˘ ·˘ÙÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÁÈ· ÙË Û·ÓÈfiÙËÙ¿ ÙÔ˘.

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÔ‡ ¶ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÓfi, ·ÁfiÚÈ, ÚÒÙÔ ·È‰› Ê·ÈÓÔÌÂÓÈο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘, ÏfiÁˆ ÚÔˆÚfiÙËÙ·˜, ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÔÏÏ·ÏÒÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ∏ ÌËÙ¤Ú·, 39 ÂÙÒÓ Î·È Ô ·Ù¤Ú·˜, 47 ÂÙÒÓ, ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ, ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓ˜ ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ ‹ ÂÎÙÚÒÛÂȘ. ∏ Û‡ÏÏË„Ë ¤ÁÈÓ Ì ÛÂÚÌ·Ù¤Á¯˘ÛË. ∆o ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‹Ù·Ó

Pediatr Mar-Apr 06

18-04-06

16:42

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135

∞Ï·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜

Ê˘ÛÈÔÏÔÁÈÎfi Î·È Ë ¯ÚˆÌ·ÙÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ ¤‰ÂÈÍ ηڢfiÙ˘Ô 46ÃY. ∏ ·ËÛË ÂÂÏ¿ÎÂÈ ·fi ˘‰Ú¿ÌÓÈÔ Î·È ÚfiˆÚ˜ Û˘Û¿ÛÂȘ, Ô˘ ¿Ú¯ÈÛ·Ó ÙËÓ 35Ë Â‚‰ÔÌ¿‰· ·ËÛ˘. ÃÔÚËÁ‹ıËΠ̛· ‰fiÛË ÎÔÚÙÈÎÔÂȉÒÓ Î·È Ë Î‡ËÛË ÂÚ·ÙÒıËΠÙËÓ 36Ë Â‚‰ÔÌ¿‰·, Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹, ÏfiÁˆ ÙÔ˘ ˘‰Ú·ÌÓ›Ô˘ Î·È ÔχÙÈÌ˘ ·ËÛ˘. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠ΢·ÓˆÙÈÎfi Ì ¿ÚÚ˘ıÌË ·Ó·ÓÔ‹. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 2 ÛÙÔ 1Ô ÏÂÙfi Î·È 4 ÛÙÔ 5Ô Î·È 20fi ÏÂÙfi. ŒÁÈÓ ·Ó·˙ˆÔÁfiÓËÛË Ì ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË Î·È ¯ÔÚ‹ÁËÛË Ô͢ÁfiÓÔ˘ ÛÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡ Î·È ÌÂÙ·ÊÔÚ¿ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, fiÔ˘ Ù¤ıËΠ·Ì¤Ûˆ˜ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, ÏfiÁˆ ‚·ÚÈ¿˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ µ™ ‹Ù·Ó 2430 ÁÚ.

(25Ë-50Ë ÂηÙÔÛÙÈ·›· ı¤ÛË), ÙÔ ª™ 51 ÂÎ. (>90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË), Î·È Ë ¶∫ 31 ÂÎ. (2550‹ ÂηÙÔÛÙÈ·›· ı¤ÛË). ∆Ô ÚÔÛˆÂ›Ô ‹Ù·Ó ȉȿ˙ÔÓ, Ì ·ÓÂÛÙÚ·Ì̤ÓÔ˘˜ ÚÒıˆÓ˜, ¢Ú›· ‚¿ÛË ÚÈÓfi˜, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹ ÊÔÚ¿ Î·È ·˘ÍË̤ÓÔ Ì‹ÎÔ˜ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ·˘ÍË̤ÓË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ¤Íˆ ηÓıÒÓ, ÌÈÎÚÔÁÓ·ı›·, ˘ÂÚˆÔÛ¯ÈÛÙ›·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ Î·È ÌÂÁ¿ÏË ÚfiÛıÈ· ËÁ‹ ÙÔ˘ ÎÚ·Ó›Ô˘ (∂ÈÎfiÓ· 1). ™Ù· ¿ÎÚ· ˘‹Ú¯Â Ì›· ¯ÂÈÚÔÌ·ÓÙÈ΋ ÁÚ·ÌÌ‹, ¤Íˆ ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ, ·ÌÊÔÙÂÚfiÏ¢ÚË Û˘Ó‰·ÎÙ˘Ï›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ÙÚ›ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ, Î·È ·˘ÍË̤ÓÔ Ì‹ÎÔ˜ οو ¿ÎÚˆÓ (18,5 ÂÎ.) Î·È ·Ï¿Ì˘ (∂ÈÎfiÓ· 3). ∆· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· ‹Ù·Ó ·ÌÊ›‚ÔÏ·, Ì ÌÈÎÚfi ̤ÁÂıÔ˜ ¤Ô˘˜, ‰Èۯȉ¤˜ fiÛ¯ÂÔ, ·„ËÏ¿ÊËÙÔ˘˜ fiÚ¯ÂȘ, ‰ÂÍÈ¿ ‚Ô˘‚ˆÓÔ΋ÏË Î·È ‚¿Ï·ÓÔ-Â˚Îfi ˘ÔÛ·-

∂ÈÎfiÓ· 1. π‰È¿˙ÔÓ ÚÔÛˆÂ›Ô ÙÔ˘ ÓÂÔÁÓÔ‡, Ì ·ÓÂÛÙÚ·Ì̤ÓÔ˘˜ ÚÒıˆÓ˜, ¢Ú›· ‚¿ÛË ÚÈÓfi˜, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹ ÊÔÚ¿ Î·È ·˘ÍË̤ÓÔ Ì‹ÎÔ˜ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ·˘ÍË̤ÓË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ¤Íˆ ηÓıÒÓ, ÌÈÎÚÔÁÓ·ı›· Î·È ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ.

‰›· (∂ÈÎfiÓ· 2). ∏ Ó¢ÚÔÌ˘˚΋ ÂͤٷÛË ¤‰ÂÈÍ ÂÏ·Ùو̤ÓÔ Ì˘˚Îfi ÙfiÓÔ, ̤ÙÚÈ· ·ÓÙ›‰Ú·ÛË ÛÙ· ÂÚÂı›ÛÌ·Ù· Î·È ÂÍ·ÛıÂÓË̤ӷ ·Ú¯¤ÁÔÓ· Î·È ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ›¯Â ıÔÏÂÚfiÙËÙ˜ Î·È ÂÚÈÔ¯¤˜ ˘Ô·ÂÚÈÛÌÔ‡ ÛÙÔÓ Ì¤ÛÔ Î·È ÛÙÔÓ Î¿Ùˆ ÏÔ‚fi ÙÔ˘ ‰ÂÍÈÔ‡ Ó‡ÌÔÓ·. √ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÎÔÈÏÈ¿˜ Î·È ÙˆÓ ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ¤‰ÂÈÍ ¢Ú›· ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì ÂÊ›¢ÛË Ù˘ ·ÔÚÙ‹˜ Â› ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ¢ڇ ·ÓÔȯÙfi ·ÚÙËÚÈ·Îfi fiÚÔ Ì ÛËÌÂ›Ô ¤ÎÊ˘Û˘ ÌÂٷ͇ Ù˘ ·ÚÈÛÙÂÚ‹˜ ηڈٛ‰·˜ Î·È Ù˘ ·ÚÈÛÙÂÚ‹˜ ˘ÔÎÏÂȉ›Ô˘. √ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆ËÓ 17Ë Ë̤ڷ ˙ˆ‹˜, Ë ˘ÂÚË‚È΋ ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ·Ó¤Ù˘Í Hafnia alvei, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠‰ÈÏ‹ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹. √ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Ô˘ ÚÔÁÚ·ÌÌ·Ù›ÛıËΠ‰ÂÓ ¤ÁÈÓ ‰˘Ó·ÙfiÓ Ó· Ú·ÁÌ·ÙÔÔÈËı› ÏfiÁˆ Âȉ›ӈÛ˘ Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ Î·È ı·Ó¿ÙÔ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. √ ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÙÈÌÒÓ Ù˘ 7-‰Â¸‰ÚÔ-¯ÔÏËÛÙÂÚfiÏ˘, ‰ÂÛÌÔÛÙÂÚfiÏ˘, Ï·ıÔÛÙÂÚfiÏ˘, ¯ÔÏÂÛÙ·ÓfiÏ˘, Ï·ÓÔÛÙÂÚfiÏ˘, 8(9)-¯ÔÏÂÛÙÂÓfiÏ˘ Î·È Ù˘ 8-‰Â¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ ·›Ì·ÙÔ˜, ¤ÁÈÓ ÛÙÔ Institute of Child Health and Great Ormond Street Hospital for Children, University College London Î·È ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. √ ηڢfiÙ˘Ô˜ ·fi ÙÔ ·›Ì· ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó 46ÃÀ. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„ ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ÂÈÎÔÈÓˆÓ›· ·Ó¿ÌÂÛ· ÛÙË 4Ë ÎÔÈÏ›· Î·È ÛÙË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (∂ÈÎfiÓ· 4). ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¤ıÂÛ·Ó ÙË

∂ÈÎfiÓ· 2. ªÈÎÚfi ̤ÁÂıÔ˜ ¤Ô˘˜, ‚¿Ï·ÓÔ-Â˚Îfi˜ ˘ÔÛ·‰›·˜ Î·È ·ÓÒÌ·ÏÔ fiÛ¯ÂÔ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈ΋ 2006;69:134-137

Pediatr Mar-Apr 06

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136

∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.

∂ÈÎfiÓ· 4. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘: ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ÂÈÎÔÈÓˆÓ›· ·Ó¿ÌÂÛ· ÛÙË 4Ë ÎÔÈÏ›· Î·È ÛÙË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∂ÈÎfiÓ· 3. ŒÍˆ ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ Î·È ·ÌÊÔÙÂÚfiÏ¢ÚË Û˘Ó‰·ÎÙ˘Ï›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ÙÚ›ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ.

‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ˘ÔÏ·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÏÈÓÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ SLO Ù‡Ô˘ ππ. √ÎÙÒ ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ÙÔÓÈΤ˜ Û˘Û¿ÛÂȘ ÙˆÓ ¿ÎÚˆÓ Î·È ÙÔ˘ ÎÔÚÌÔ‡, ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›· Î·È ÂÍ·Ûı¤ÓÈÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ. ∏ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ·ÚÔ˘Û›·Û·Ó Û˘Ó¯‹ Âȉ›ӈÛË Î·È ÙË 19Ë Ë̤ڷ ˙ˆ‹˜ ÙÔ ÓÂÔÁÓfi ·‚›ˆÛ ·fi ‚·ÚÈ¿ ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·. √È ÁÔÓ›˜ ·ÚÓ‹ıËÎ·Ó ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÓÂÎÚÔÙÔÌ‹˜.

™˘˙‹ÙËÛË ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ì·˜ ›¯Â ÔÏÏ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙÔ˘ Û SLO Ù‡Ô˘ ππ (4,5), Î·È ÌÂÚÈο ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙÔ˘ Û Meckel (6,7). ∞ÂÈÎÔÓÈÛÙÈο, ›¯Â ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜. ∆· ·ÚÈ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ‰È¿ÁÓˆÛË ÛSLO Ù‡Ô˘ ππ ‹Ù·Ó Ë Û˘Ó‰·ÎÙ˘Ï›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ÙÚ›ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ, Ô ˘ÔÛ·‰›·˜ Î·È Ô „¢‰ÔÂÚÌ·ÊÚÔ‰ÈÙÈÛÌfi˜ ÙÔ˘ ¿ÚÚÂÓÔ˜ (4). ∆· ¿ÏÏ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÙfiÛÔ ÛÙÔ Û SLO fiÛÔ Î·È ÛÙÔ ÛM ÂÎÙfi˜ ·fi ÙËÓ ˘ÂÚˆÔÛ¯ÈÛÙ›·, Ô˘ ‰ÂÓ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ ÛSLO, ·ÏÏ¿ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Ûª (7). ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ÛSLO Ù›ıÂÙ·È Û‹ÌÂÚ· Ì ÙËÓ ·Ó‡ÚÂÛË ÂÏ·ÙÙˆÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ 7-‰Â¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· ÙˆÓ ·ÛıÂÓÒÓ (8). ∏ ÌË ·Ó‡ÚÂÛË ·˘ÙÒÓ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ·¤ÎÏÂÈÛ ÙÔ ÛSLO ÛÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi. ™ÙÔ ÛM, ÙÔ ÈÔ Û˘¯Ófi ‡ÚËÌ· Â›Ó·È Ë ˘ÔÏ·Û›· ÙˆÓ ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙÔ˘ ¿ÚÚ¶·È‰È·ÙÚÈ΋ 2006;69:134-137

ÓÔ˜ Î·È Ë ÎÚ˘„ÔÚ¯›·, ¯ˆÚ›˜ ·ÌÊ›‚ÔÏ· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·, ÂÓÒ Ë Û˘Ó‰·ÎÙ˘Ï›· Â›Ó·È Û¿ÓÈ·. ÕÏÏ· Û˘¯Ó¿ Â˘Ú‹Ì·Ù· Â›Ó·È Ë ÈÓȷ΋ ÂÁÎÂÊ·ÏÔ΋ÏË, ÔÈ ‰˘ÛÏ·ÛÙÈÎÔ›, ΢ÛÙÈÎÔ› ÓÂÊÚÔ›, Ë ÌÈÎÚÔÊı·ÏÌ›·, Ë ˘ÂÚˆÔÛ¯ÈÛÙ›·, ÔÈ ·ÓˆÌ·Ï›Â˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ fiˆ˜ ˘ÔÏ·Û›· ‹ ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÁÂÓÂÛ›· ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÙÂϤ¯Ô˘˜, ÌÂÁ¿Ï˜ ·ÓˆÌ·Ï›Â˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (6). ∆· ·ÚÈ· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÛÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi ‰ÂÓ Ù·ÈÚÈ¿˙Ô˘Ó Ì ÙÔ Ûª. ™Â ‰È¿ÚÎÂÈ· ÙˆÓ 18 ÂÙÒÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÓÂÔÁÓÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ¤¯Ô˘Ì ‰ÂÈ, Ì·˙› Ì ÙÔ ·ÚfiÓ, 3 ÂÚÈÛÙ·ÙÈο Ì ʷÈÓfiÙ˘Ô ÛSLO. ∆Ô ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi, ÓÔÛËχÙËΠÙËÓ ÂÔ¯‹ Ô˘ ‰ÂÓ ‹Ù·Ó ·ÎfiÌ· ÁÓˆÛÙ¤˜ ÔÈ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ‰È·ÁÓÒÛıËΠˆ˜ ÛSLO Ì ‚¿ÛË Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο (9). ∆Ô ‰Â‡ÙÂÚÔ ÂÚÈÛÙ·ÙÈÎfi, ÓÔÛËχÙËΠÈÔ ÚfiÛÊ·Ù· Î·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÛSLO Ù¤ıËΠ̠·Ó‡ÚÂÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (10). ∆Ô ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi, ÙÔ ÙÚ›ÙÔ, ›¯Â Ê·ÈÓfiÙ˘Ô ÛSLO Ù‡Ô˘ ππ ¯ˆÚ›˜ ÙȘ ‰È·ÁÓˆÛÙÈΤ˜ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÛSLO. ∏ Û˘Ó‡·ÚÍË ˘ÔÏ·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ô˘ ··ÓÙÔ‡Ó Î·È ÛÙÔ Ûª, Û˘ÓËÁÔÚÔ‡Ó ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚȤÁÚ·„·Ó ÔÈ Casamassima Î·È Û˘Ó (1). ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ıˆÚÂ›Ù·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔ. À¿Ú¯Ô˘Ó ÌfiÓÔ ÙÚÂȘ ‰ËÌÔÛȇÛÂȘ ·fi ÙËÓ ÚÔÛÈÙ‹ Û ÂÌ¿˜ ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, fiÔ˘ ÂÚÈÁÚ¿ÊÔÓÙ·È 7 ÂÚÈÛÙ·ÙÈο (1, 2, 3, √ªπª: 213010). ¶ÚÈÓ ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÛSLO ÁÈÓfiÙ·Ó ÌfiÓÔ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÛSLO ÙËÓ ÂÔ¯‹ ÂΛÓË ˘ÔÏÔÁÈ˙fiÙ·Ó Û 1:10000-1:40000 ˙ÒÓÙ·

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ÓÂÔÁÓ¿ (5) Î·È ‹Ù·Ó Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙË Û˘¯ÓfiÙËÙ· Ô˘ ÚԤ΢„ fiÙ·Ó Ë ‰È¿ÁÓˆÛË Ù¤ıËΠ̠‚¿ÛË Ù· ‚ÈÔ¯ËÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Î·È ˘ÔÏÔÁ›ÛÙËΠ۠1:60000-1:100000 ˙ÒÓÙ· ÓÂÔÁÓ¿ (11). ∏ ÌÂÁ¿ÏË ·˘Ù‹ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· Èı·Ófiٷٷ ÔÊ›ÏÂÙ·È Û ˘ÂډȿÁÓˆÛË ÙÔ˘ ÛSLO ÛÙËÓ ÂÚ›Ô‰Ô ÚÈÓ ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È Èı·ÓfiÓ ÔÚÈṲ̂ӷ ·fi Ù· ÂÚÈÛÙ·ÙÈο Ù˘ ÂÚÈfi‰Ô˘ ÂΛӢ, ȉȷ›ÙÂÚ· ·˘Ù¿ Ô˘ ›¯·Ó ·Ï·Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜, Ó· ·Ó‹Î·Ó ÛÙÔ ÚÔ·Ó·ÊÂÚfiÌÂÓÔ Û‡Ó‰ÚÔÌÔ. ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ·ÔÙÂÏ› Ì›· ͯˆÚÈÛÙ‹ ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ·ÓÂÍ¿ÚÙËÙË ·fi Ù· Û‡Ó‰ÚÔÌ· SLO Î·È Meckel. ∏ ‰È·ÊÔÚÂÙÈ΋ Ê·ÈÓÔÙ˘È΋ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û 3 ·È‰È¿ Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜, fiÔ˘ Ù· ‰‡Ô ÂÌÊ¿ÓÈ˙·Ó ¯·Ú·ÎÙËÚÈÛÙÈο ÛSLO Î·È ÙÔ ¤Ó· ¯·Ú·ÎÙËÚÈÛÙÈο Ûª, ıˆڋıËΠfiÙÈ ÔÊ›ÏÂÙ·È Û ÏÂÈÔÙÚÔÈ΋ ‰Ú¿ÛË ÙÔ˘ ›‰ÈÔ˘ ÌÂÙ·ÏÏ·Á̤ÓÔ˘ ÁÔÓȉ›Ô˘ (1). ∆Ô Û‡Ó‰ÚÔÌÔ Ê·›ÓÂÙ·È fiÙÈ ÎÏËÚÔÓÔÌÂ›Ù·È Î·Ù¿ ÙÔÓ ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈÌÌ·ÙÈÎfi ÙÚfiÔ (1). ¶ÚÔÁÂÓÓËÙÈ΋, ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Î·È ıˆÚÂ›Ù·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡ÛÎÔÏË, ÏfiÁˆ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ·ÁÂÓÂÛ›·˜ ÙÔ˘ ÛÎÒÏËη, ȉȷ›ÙÂÚ· Ù˘ ÙÌËÌ·ÙÈ΋˜ (12).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Casamassima AC, Mamunes P, Gladstone IM Jr, Solomon S, Moncure C. A new syndrome with features of the Smith-Lemli-Opitz and Meckel-Gruber syndromes in a sibship with cerebellar defects. Am J Med Genet 1987;26:321-336.

2. Thompson E, Baraitser M. An autosomal recessive mental retardation syndrome with hepatic fibrosis and renal cysts. Am J Med Genet 1986 May;24: 151-158.

3. Hunter AG, Rothman SJ, Hwang WS, Deckelbaum RJ. Hepatic fibrosis, polycystic kidney, colobomata and encephalopathy in siblings. Clin. Genet 1974; 6:82-89.

4. Cunniff C, Kratz LE, Moser A, Natowicz MR, Kelley RI. Clinical and biochemical spectrum of patients with RSH/Smith-Lemli-Opitz syndrome and abnormal cholesterol metabolism. Am J Med Genet 1997; 68:263-269.

5. Kelley RI, Hennekam RC. The Smith-Lemli-Opitz syndrome. J Med Genet 2000;37:321-335.

6. Paavola P, Salonen R, Baumer A, Schinzel A, Boyd PA, Gould S et al. Clinical and genetic heterogeneity in Meckel syndrome. Hum Genet 1997;101:88-92.

7. Lowry RB. Editorial comment: Variability in the Smith-Lemli-Opitz syndrome: overlap with the Meckel Syndrome. Am J Med Genet 1983;14: 429-433.

8. Tint GS, Irons M, Elias ER, Batta AK, Frieden R, Chen TS et al. Defective cholesterol biosynthesis associated with the Smith-Lemli-Opitz syndrome. N Engl J Med 1994;330:107-113.

9. ∞Ó‰Ú¤Ô˘ ∞, ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂, °ÂˆÚÁ›Ô˘ π, ™È·Î·‚¤Ï·˜ ∫. ¶ÂÚÈÁÚ·Ê‹ ÓÂÔÁÓÔ‡ Ì ۇӉÚÔÌÔ Smith-Lemli-Opitz. ¶·È‰È·ÙÚÈ΋ 1990; 53:303-307.

10. ∞Ó‰Ú¤Ô˘ ∞, °Ô˘‰ÂÛ›‰Ô˘ ª, ¶··‚·ÛÈÏ›Ԣ µ, ™·Ú·ÓÙ¿ÚË Ã. µÈÔ¯ËÌÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ Smith-Lemli-Opitz. ¶·È‰È·ÙÚÈ΋ 2002;65:447-451.

11. Ryan AK, Bartlett K, Clayton P, Eaton S, Mills L, Donnai D et al. Smith-Lemli-Opitz syndrome: a variable clinical and biochemical phenotype. J Med Genet 1998;35:558-565.

12. Zalel Y, Seidman DS, Brand N, Lipitz S, Achiron R. The development of the fetal vermis: an in utero sonographic evaluation. Ultrasound Obstet Gynaecol 2002;19:136-139.

¶·È‰È·ÙÚÈ΋ 2006;69:134-137

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£·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ °ÂÓÈÎfi ¶ÂÚÈÊÂÚÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “πÔÎÚ¿ÙÂÈÔ”, £ÂÛÛ·ÏÔÓ›ÎË

AÏÏËÏÔÁÚ·Ê›·: Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °.¶.¡. “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-12-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2005

Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘

¶ÂÚ›ÏË„Ë: ∆Ô ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· (Lethal Multiple Pterygium Syndrome, LMPS) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÌ‚Ú˘˚Îfi ı¿Ó·ÙÔ, ·fi ÂÌ‚Ú˘˚Îfi ‡‰Úˆ· ηÈ/‹ ΢ÛÙÈÎfi ‡Áڈ̷ Î·È ·fi ÙËÓ ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ÙÂÚ˘Á›ˆÓ ‹ ‰ÂÚÌ·ÙÈÎÒÓ ÎÚËÌÓÒÓ ‰›ÎËÓ ÙÂÚ˘Á›Ô˘ Û ÌÂÁ¿Ï˜ ·ÚıÚÒÛÂȘ Û ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÚÈÔ¯¤˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, Ô˘ ¿ÓÙ· Û˘Óԉ‡ÔÓÙ·È ·fi Û˘Û¿ÛÂȘ ÙˆÓ ·ÚıÚÒÛˆÓ. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ‹ Ã-Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú·. ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ù‹ ÛÙȘ ΢‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ·fi ÙËÓ 14Ë-16Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ ÁÈ· ÙË ‰È·›ÛÙˆÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·Ó·ÙÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Î·È Ù˘ ÂͤÏÈÍ‹˜ ÙÔ˘˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ì›· ÔÈÎÔÁ¤ÓÂÈ· Ù˘ ÔÔ›·˜ ÙÔ 1Ô ¿ÚÚÂÓ Ù¤ÎÓÔ Â›¯Â ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·. °›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Ô˘ ‰fiıËΠÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, ÛÙ· ·‰¤ÏÊÈ· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÚfiÛÊ·Ù·, ÛÙ· ˘ÁÈ‹ ·‰¤ÏÊÈ· ÙÔ˘ ÂÊË‚È΋˜ ËÏÈΛ·˜. §¤ÍÂȘ ÎÏÂȉȿ: £·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·, ÂÌ‚Ú˘˚Îfi Ô›‰ËÌ·, ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË.

Lethal multiple pterygium syndrome 1st Paediatric Clinic, Aristotle University, “Ippokration” General Hospital, Thessaloniki Correspondence: H. Hatzissevastou-Loukidou Laboratory of Cytogenetics 1st Paediatric Clinic, Aristotle University, “Ippokration” General Hospital, Thessaloniki 49 Konstantinoupoleos Str., 546 42, Thessaloniki Date of submission: 17-12-2004 Date of approval: 22-07-2005

H. Hatzissevastou - Loukidou, ∞. Georgountzou

Abstract: Lethal multiple pterygium syndrome (LMPS) is characterized by hydrops fetalis, and intrauterine death, where the fetus has multiple pterygia or wing-like webs of skin across joints, which are always associated with joint contractures. The inheritance is either autosomal or X-linked recessive.

In high risk pregnancies prenatal diagnosis is possible by ultrasound examination at 14 to 16 weeks’ gestation, which relies on identification of the characteristic fetal anatomical abnormalities and their evolution. A family is reported whose first male child was affected with fatal LMPS. Genetic counselling was provided to his parents, his parents’ siblings and recently to his adolescent siblings.

Key words: Lethal multiple pterygium syndrome, prenatal diagnosis, hydrops fetalis, genetic counselling.

™˘ÓÙÔÌÔÁڷʛ˜ LMPS £·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· ∞FP ·-ÂÌ‚Ú˘˚΋ ÚˆÙ½ÓË

∂ÈÛ·ÁˆÁ‹ ∆Ô ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· (LMPS) Â›Ó·È ÌÈ· Ôχ Û¿ÓÈ· ηٿÛÙ·ÛË (1,2) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÚÔÁÂÓÓËÙÈο ·fi ‡‰Úˆ·, ΢ÛÙÈο ˘ÁÚÒÌ·Ù·, ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· ÛÙȘ ÌÂÁ¿Ï˜ ·ÚıÚÒÛÂȘ Î·È ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ ÛÙÔ ‚ã ‹ ÓˆÚ›˜ ÛÙÔ Áã ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ (3,4). ¶ÂÚÈÏ·Ì‚¿ÓÂÈ Â›Û˘ ‰˘ÛÌÔÚʛ˜ ÙÔ˘ ÚÔÛÒÔ˘, ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ¶·È‰È·ÙÚÈ΋ 2006;69:138-142

˘ÔÏ·Û›· ÙˆÓ Ó¢ÌfiÓˆÓ Î·È Ù˘ ηډȿ˜. ™ÙȘ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÚÔÛÒÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ˘ÂÚÙÂÏÔÚÈÛÌfi˜, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹˜ ÊÔÚ¿ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, Ï·ÙÈ¿ ·Ó·ÛËΈ̤ÓË Ì‡ÙË, ÌÈÎÚÔÁÓ·ı›·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ Î·È Û¯ÈÛÙ›· ˘ÂÚÒ·˜. √È ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘Ó‹ıˆ˜ ˘ÔÏ·Û›· Ù˘ ˆÌÔÏ¿Ù˘, Ù˘ ˘¤ÏÔ˘ Î·È ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ, ·ÔÏ·Ù˘Ṳ̂Ó˜ ‹ ˘ÔÏ·ÛÙÈΤ˜ Ï¢ڤ˜, ‰˘ÛÏ·Û›· Î·È Û˘ÓÙ‹ÍÂȘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ™Â ‰ËÌÔÛȇÛÂȘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÔÚ·‰Èο ‰È¿ÊÔÚ˜ ¿ÏϘ ·ÓˆÌ·Ï›Â˜ fiˆ˜, ÛÎÔÏ›ˆÛË, ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ÏÂÙfi ‰È¿ÊÚ·ÁÌ·, ·ÌÊ›‚ÔÏ· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·, ·ÓÒÌ·ÏË ‹ ·ÙÂÏ‹˜ ÂÚÈÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á¯ÓˆÓ, ·ÙÚËÛ›· ÙÔ˘ ÎfiÏÔ˘, Ó¢ÚÔ·ıÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘

Pediatr Mar-Apr 06

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139

£·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·

ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, ˘‰ÚÔÓ¤ÊÚˆÛË Î·È ‚Ú·¯‡˜ ÔÌÊ¿ÏÈÔ˜ ÏÒÚÔ˜. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ‹ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (1,4-6). √È ∏all Î·È Û˘Ó (1984) Âȯ›ÚËÛ·Ó ÌÈ· ‰È·›ÚÂÛË Û ÙÚÂȘ ÔÌ¿‰Â˜ Ì ‚¿ÛË ÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ‰˘ÛÙÚÔÊ›·˜, ÙÔÓ ¯ÚfiÓÔ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ·˘¯ÂÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ Î·È ÙËÓ ·ÚÔ˘Û›· ‹ ·Ô˘Û›· ÔÛÙÈÎÒÓ Û˘Óً͈Ó. ™‡Ìʈӷ ÏÔÈfiÓ Ì ·˘Ù‹ ÙË ‰È·›ÚÂÛË ‰È·ÎÚ›ÓÔÓÙ·È ÙÚÂȘ Ù‡ÔÈ: o ÚÒÙÔ˜ ¯ˆÚ›˜ ÔÛÙÈΤ˜ Û˘ÓÙ‹ÍÂȘ, Ô ‰Â‡ÙÂÚÔ˜ Ì ۇÓÙËÍË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È Ô ÙÚ›ÙÔ˜ Ì ÔÛÙÈΤ˜ Û˘ÓÙ‹ÍÂȘ, ÂÎÙfi˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ (7). √È de Die-Smulders Î·È Û˘Ó (1990) ·Ó·ÛÎfiËÛ·Ó ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›· 36 ÂÚÈÙÒÛÂȘ ÙÔ˘ LMPS Î·È ÙÔ ‰È·›ÚÂÛ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜: “ÚÒÈÌÔ LPMS”, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ ÛÙÔ 2Ô ‹ 3Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È ·ÚÔ˘Û›· ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· ‹/ Î·È Î˘ÛÙÈÎÔ‡ ˘ÁÚÒÌ·ÙÔ˜, “fi„ÈÌÔ LMPS” ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ÂÈ‚›ˆÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ̤¯ÚÈ ÙÔ 3Ô ÙÚ›ÌËÓÔ Î·È ·Ô˘Û›· ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· Î·È Ù¤ÏÔ˜ ÙÔÓ “ÊÈÓÏ·Ó‰ÈÎfi Ù‡Ô”, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ÂÌ‚Ú˘˚Îfi ‡‰Úˆ· ·fi ÙËÓ 15Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘, ·fi ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ Î·Ù¿ ̤ÛÔÓ fiÚÔ ÙËÓ 29Ë Â‚‰ÔÌ¿‰· Î·È ·fi ÂȉÈο Ó¢ÚÔ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· (8). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÌÈ· ÔÈÎÔÁ¤ÓÂÈ· Ù˘ ÔÔ›·˜ ÙÔ 1o ¿ÚÚÂÓ Ù¤ÎÓÔ Â›¯Â ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·. °›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Ô˘ ‰fiıËΠÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, ÛÙ· ·‰¤ÏÊÈ· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÚfiÛÊ·Ù· ÛÙ· ˘ÁÈ‹ ·‰¤ÏÊÈ· ÙÔ˘ ÂÊË‚È΋˜ ËÏÈΛ·˜. ∏ ÂÚ›ÙˆÛË Â›Ó·È Ë ÚÒÙË Ô˘ ‰ËÌÔÛȇÂÙ·È ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∑¢Á¿ÚÈ Ó·ÚÒÓ ∂ÏÏ‹ÓˆÓ ÚÔÛ‹Ïı ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1988 ÁÈ· ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË, ÂÂȉ‹ Ë ÌËÙ¤Ú· ‹Ù·Ó ¤ÁÎ˘Ô˜ Û ‰Â‡ÙÂÚË Î‡ËÛË, ‚ÚÈÛÎfiÙ·Ó ÛÙË 10Ë Â‚‰ÔÌ¿‰· Î·È Â›¯Â ÈÛÙÔÚÈÎfi ÂÓfi˜ ıÓËÛÈÁÂÓÔ‡˜ ‰˘ÛÌÔÚÊÈÎÔ‡ ÓÂÔÁÓÔ‡ ÚÔ ‰ÈÂÙ›·˜, ÙÔ˘ ÔÔ›Ô˘ ÚÔÛÂÎfiÌÈÛ·Ó ÊˆÙÔÁڷʛ˜ (∂ÈÎfiÓ˜ 1,2,3). ∆Ô ÈÛÙÔÚÈÎfi Ù˘ ÚÒÙ˘ ·ËÛ˘ ›¯Â ˆ˜ ÂÍ‹˜: ÔÈ ÁÔÓ›˜ ‹Ù·Ó ˘ÁÈ›˜, ‰ÂÓ ‹Ù·Ó Û˘ÁÁÂÓ›˜ ÌÂٷ͇ ÙÔ˘˜ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙÔ˘˜ ÙfiÙÂ, ‹Ù·Ó ÂχıÂÚÔ. √ ·Ù¤Ú·˜ ‹Ù·Ó 29 Î·È Ë ÌËÙ¤Ú· 26 ÂÙÒÓ (∂ÈÎfiÓ˜ 4, III(1) Î·È III(5)) ·ÓÙ›ÛÙÔȯ·. ∞fi ÙȘ ·Ú¯¤˜ ÙÔ˘ ‚ã ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘ ·-

∂ÈÎfiÓ· 1. º·›ÓÂÙ·È Ë ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙÔ˘ ·˘ÙÈÔ‡, ÔÈÛıÔ-ÌÈÎÚÔÁÓ·ı›·, Ë ·Ó·ÛËΈ̤ÓË Ì‡ÙË, Ù· ÙÂÚ‡ÁÈ· ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛˆÓ.

Ú·ÙËÚ‹ıËΠÔÏ˘¿ÌÓÈÔ. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚ ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ù˘. ŒÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È Ù· Â˘Ú‹Ì·Ù· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó “·Û·Ê‹”. ¢ÈÂÓÂÚÁ‹ıËΠ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË Î·È Ô ¯ÚˆÌÔÛˆÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì G-banding ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô ¿ÚÚÂÓÔ˜ (46, ÃÀ). ∏ ·ËÛË Û˘Ó¯›ÛÙËÎÂ Î·È ÌÂÙ¿ ·fi ·˘ÙfiÌ·ÙË Ú‹ÍË ÙˆÓ ˘Ì¤ÓˆÓ ÁÂÓÓ‹ıËΠ¤Ó· ÙÂÏÂÈfiÌËÓÔ ıÓËÛÈÁÂÓ¤˜ ¿ÚÚÂÓ ‰˘ÛÌÔÚÊÈÎfi ÓÂÔÁÓfi (EÈÎfiÓ· 4, πV(3)). ∆Ô ·ÌÓÈ·Îfi ˘ÁÚfi ‹Ù·Ó ίڈṲ̂ÓÔ. ¢ÂÓ ¤ÁÈÓ ÓÂÎÚÔ„›·. ∞fi ÙȘ ʈÙÔÁڷʛ˜ Ê¿ÓËΠfiÙÈ ÙÔ ÓÂÔÁÓfi ›¯Â ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·, ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· Û ο̄Ë, Û˘ÌÌÂÙÚÈο ÙÂÚ‡ÁÈ· ÙˆÓ ·ÁÎÒÓˆÓ Î·È ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛˆÓ, ηÌÙÔ‰·ÎÙ˘Ï›· ¯ÂÈÚÒÓ, ¤Ûˆ ÛÙÚÔÊ‹ ÙˆÓ ÂÏÌ¿ÙˆÓ, ‰È¿Ù·ÛË Ù˘ ÎÔÈÏ›·˜, ÌÂÁ¿ÏË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ıËÏÒÓ, ‚Ú·¯‡ Ï·ÈÌfi, ÂÌÊ·ÓÒ˜ ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ, ˘ÂÚÙÂÏÔÚÈÛÌfi, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹ ÊÔÚ¿ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ·ÓÔȯÙfi ÛÙfiÌ·, ÔÈÛıÔ-ÌÈÎÚÔÁÓ·ı›·, Ï·ÙÈ¿ ·Ó·ÛËΈ̤ÓË Ì‡ÙË, ¢ÌÂÁ¤ıË 2Ô Î·È 3Ô ‰¿ÎÙ˘ÏÔ Ô‰ÈÒÓ, ÌÂÁ¿ÏË ·fiÛÙ·ÛË ÌÂٷ͇ 1Ô˘ Î·È 2Ô˘ ‰·ÎÙ‡ÏÔ˘ ÙÔ˘ Ô‰ÈÔ‡, ¿‰ÂÈÔ ¶·È‰È·ÙÚÈ΋ 2006;69:138-142

Pediatr Mar-Apr 06

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Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘

∂ÈÎfiÓ· 2. º·›ÓÂÙ·È Ë ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹˜ ÊÔÚ¿ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ÙÔ ·ÓÔȯÙfi ÛÙfiÌ·, Ë Ï·ÙÈ¿ ·Ó·ÛËΈ̤ÓË Ì‡ÙË, Ô Â˘ÌÂÁ¤ı˘ 2Ô˜ ‰¿ÎÙ˘ÏÔ˜, ÎÂÓfi fiÛ¯ÂÔ, Ù· ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· Û ο̄Ë, Ë ¤Ûˆ ÛÙÚÔÊ‹ ÙˆÓ ÂÏÌ¿ÙˆÓ.

∂ÈÎfiÓ· 3. º·›ÓÂÙ·È ÙÔ ÙÂÚ‡ÁÈÔ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ·ÁÎÒÓ·, Ê˘Û·Ï›‰· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÒÌÔ ÂÓ‰ÂÈÎÙÈ΋ ÙÔ˘ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ Ôȉ‹Ì·ÙÔ˜.

™˘˙‹ÙËÛË fiÛ¯ÂÔ. ∞fi ÙÔ ÈÛÙÔÚÈÎfi Ù˘ ·ËÛ˘ ·ÏÏ¿ Î·È ·fi Ù· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ ÓÂÔÁÓfi ÏËÚÔ‡Û ٷ ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ LMPS. √È ÁÔÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙËÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ÙÔÓ Î›Ó‰˘ÓÔ Â·Ó¿Ï˄˘ ÛÙÔ˘˜ ·ÔÁfiÓÔ˘˜ ÙÔ˘˜. ∆Ô˘˜ Û˘ÛÙ‹ıËΠ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·ÚÔ‡Û·˜ 2˘ ·ÏÏ¿ Î·È Î¿ı ÌÂÏÏÔÓÙÈ΋˜ ·ËÛ˘ ÌÂ Û˘¯Ó¿ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· Î·È ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ∞FP ÛÙÔÓ ÔÚfi Ù˘ ÌËÙ¤Ú·˜. ∞fi ÙË ‰Â‡ÙÂÚË Î‡ËÛË ÁÂÓÓ‹ıËΠ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ, 16 ÂÙÒÓ Û‹ÌÂÚ· (EÈÎfiÓ· 4, IV(4)). ∞ÎÔÏÔ‡ıËÛÂ Î·È ÙÚ›ÙË ÂÁ΢ÌÔÛ‡ÓË, ÙËÓ ÔÔ›· ·Ú·ÎÔÏÔ‡ıËÛ·Ó Û‡Ìʈӷ Ì ÙȘ ›‰È˜ Ô‰ËÁ›Â˜ Î·È ÁÂÓÓ‹ıËΠ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 12 ÂÙÒÓ Û‹ÌÂÚ· (EÈÎfiÓ· 4, IV(5)). ∞ӷʤÚÂÙ·È Î·È Ì›· ٤ٷÚÙË Î‡ËÛË (EÈÎfiÓ· 4, πV(6)) ÙËÓ ÔÔ›· ‰È¤ÎÔ„·Ó ËıÂÏË̤ӷ (¤ÎÙÚˆÛË), ÏfiÁˆ Êfi‚Ô˘ Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÂӉ¯fiÌÂÓË Â·ÓÂÌÊ¿ÓÈÛË ÙÔ˘ LMPS. ¶ÚfiÛÊ·Ù· ÔÈ ÁÔÓ›˜ Â·Ó‹Ïı·Ó ˙ËÙÒÓÙ·˜ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Û¯ÂÙÈο Ì ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ ÙÔ˘˜ ÂÊË‚È΋˜ ËÏÈΛ·˜. ¶·È‰È·ÙÚÈ΋ 2006;69:138-142

∫·ıÒ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ô ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜, ÔÈ Froster Î·È Û˘Ó (1997), ÚÔÙ›ÓÔ˘Ó ÁÈ· ÙËÓ ·ÎÚÈ‚‹ ‰È¿ÁÓˆÛ‹ ÙÔ˘ Î·È ·ÎÔÏÔ‡ıˆ˜, ÁÈ· ÙË ÛˆÛÙ‹ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ÙˆÓ ÁÔÓ¤ˆÓ, ÙÔ˘˜ ·Ú·Î¿Ùˆ ¯ÂÈÚÈÛÌÔ‡˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi: ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ıÓËÛÈÁÂÓÔ‡˜ ÓÂÔÁÓÔ‡, ·ÎÙÈÓÔÁڷʛ˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÙÔ˘, ÓÂÎÚÔ„›· ÁÈ· ¤ÏÂÁ¯Ô ‡·Ú͢ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ Î·È ÁÈ· ¤ÏÂÁ¯Ô ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™ÙȘ ÂÚÈÙÒÛÂȘ Ì ‚·ÚÈ¿ ·˘ÙfiÏ˘ÛË Û˘ÓÈÛÙ¿Ù·È ‚ÈÔ„›· Ì˘fi˜ ÁÈ· Ù·˘ÙÔÔ›ËÛË Ù˘ ÂÎʇÏÈÛ˘ ÙˆÓ Ì˘ÒÓ, Ó¢ÚÔ˚ÛÙÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÌÂÁ¿ÏˆÓ ‚Ï·‚ÒÓ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ηٷÁÚ·Ê‹ ÙˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ì Ôχ ηϋ ʈÙÔÁÚ¿ÊËÛË ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È Û‡ÁÎÚÈÛË Ì ¿ÏϘ ·ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ Î·È Ù¤ÏÔ˜ ηڢfiÙ˘Ô (4,8). ∆Ô ÓÂÔÁÓfi ÛÙȘ ʈÙÔÁڷʛ˜ ·ÚÔ˘Û›·˙ ٷ Ù˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ LMPS, Û˘ÁÎÂÎÚÈ̤ӷ: ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·, Û˘ÌÌÂÙÚÈο ÙÂÚ‡ÁÈ· ÌÂÁ¿ÏˆÓ ·ÚıÚÒÛÂˆÓ Û ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·141

141

£·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·

I 1

8

II 2

18

9

23

III 1

2 3

4

5

6

7

8

7

8

9

+ IV

1

2

3

4

5

6

9

10 11

∂ÈÎfiÓ· 4. √ÈÎÔÁÂÓÂÈ·Îfi ‰¤Ó‰ÚÔ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜: IV(3): ÙÔ ÓÂÔÁÓfi Ì LMPS III(1) Î·È III(5): ·Ù¤Ú·˜ Î·È ÌËÙ¤Ú· ÙÔ˘ ÓÂÔÁÓÔ‡, ·ÓÙ›ÛÙÔȯ· III(6) Î·È III(7): ·‰ÂÏÊ‹ Î·È ·‰ÂÏÊfi˜ Ù˘ ÌËÙ¤Ú·˜, ·ÓÙ›ÛÙÔȯ· III(2): ·‰ÂÏÊfi˜ ÙÔ˘ ·Ù¤Ú· IV(4): ˘ÁÈ‹˜ ·‰ÂÏÊfi˜ Î·È IV(5): ˘ÁÈ‹˜ ·‰ÂÏÊ‹ ÙÔ˘ ÓÂÔÁÓÔ‡, 16 Î·È 12 ÂÙÒÓ Û‹ÌÂÚ·, ·ÓÙ›ÛÙÔȯ· πV(7) Î·È πV (8): ˘ÁÈ‹ ·È‰È¿ ÙÔ˘ ·‰ÂÏÊÔ‡ Ù˘ ÌËÙ¤Ú·˜ IV(9), IV(10), IV(11): ˘ÁÈ‹ ·È‰È¿ Ù˘ ·‰ÂÏÊ‹˜ Ù˘ ÌËÙ¤Ú·˜ IV(1), IV(2): ˘ÁÈ‹ ·È‰È¿ ÙÔ˘ ·‰ÂÏÊÔ‡ ÙÔ˘ ·Ù¤Ú·.

ÂÚÈÔ¯¤˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (·ÁÎÒÓ˜ Î·È ÈÛ¯›·), Î¿Ì„Ë ÙˆÓ ·ÚıÚÒÛˆÓ, ÌÔÚÊÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÚÔÛÒÔ˘ (∂ÈÎfiÓ˜ 1-3), Â˘Ú‹Ì·Ù· Ù· ÔÔ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ, ÙËÓ ·Ó·ÊÂÚfiÌÂÓË ·fi ÙË ÌËÙ¤Ú· ÌÂȈ̤ÓË ÂÓ‰ÔÌ‹ÙÚÈ· ÎÈÓËÙÈÎfiÙËÙ·, ÙËÓ ·ÚÔ˘Û›· ÔÏ˘¿ÌÓÈÔ˘ Î·È ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘o, Û˘Ó¤‚·Ï·Ó ÛÙË ‰È¿ÁÓˆÛË Î·È ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ Û˘Ó‰ÚfiÌˆÓ Ô˘ Û˘Óԉ‡ÔÓÙ·È Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· (9). ∏ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¿ÁÓˆÛÙË. ø˜ Èı·ÓÔ› Ì˯·ÓÈÛÌÔ› ·Ó·Ê¤ÚÔÓÙ·È Ë ÚˆÙÔ·ı‹˜ ·Ï·Û›· ÙˆÓ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ (9,10), ÔÈ ‰È·Ù·Ú·¯¤˜ ÛÙË Û‡ÓıÂÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘, Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ ıÂÚÌÔÏËÍ›·˜ (heat shock proteins) (11), Ô Û˘Ó‰˘·ÛÌfi˜ ÂÌ‚Ú˘˚΋˜ ·ÎÈÓËÛ›·˜ ‹ ˘ÔÎÈÓËÛ›·˜ (fetal akinesia deformation sequence (FADS)) Î·È Ù˘ ·ÚÔ˘Û›·˜ ÂÌ‚Ú˘˚ÎÔ‡ Ôȉ‹Ì·ÙÔ˜, Ô˘ ÔÊ›ÏÂÙ·È Û ·fiÊÚ·ÍË ÙˆÓ ÛÊ·ÁÈÙȉÈÎÒÓ ÏÂÌÊ·ÁÁ›ˆÓ (jugular lymphatic obstruction sequence (JLOS)) (10). ∞Ó Î·È ‰ÂÓ ¤¯ÂÈ Ù·˘ÙÔÔÈËı› ÌÈ· ÂȉÈ΋ ÁÔÓȉȷ΋ ‚Ï¿‚Ë, Ê·›ÓÂÙ·È fiÙÈ Ùo Û‡Ó‰ÚÔÌÔ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú· ‹ Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ Ã-Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· (1,4-6). ∞Ó·ÛÎfiËÛË 27 ÔÈÎÔÁÂÓÂÈÒÓ ‰Â›¯ÓÂÈ ÌÈ· Û¯¤ÛË ·ÚÚ¤ÓˆÓ/ı‹Ï· 1.3:1 (12). √È Meyer Î·È Û˘Ó (1999) ·Ó·ÛÎÔÒ-

ÓÙ·˜ ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‚Ú‹Î·Ó ¤ÍÈ ÔÈÎÔÁ¤ÓÂȘ Ì ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ¿Û¯ÔÓÙ· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ (6). ∏ ‰È¿ÎÚÈÛË ÙÔ˘ ÙÚfiÔ˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ··ÈÙ› ·Ó¿Ï˘ÛË ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ‰¤Ó‰ÚÔ˘, ÂÂȉ‹ ‰ÂÓ ˘¿Ú¯Ô˘Ó οÔÈ· Û˘ÁÎÂÎÚÈ̤ӷ ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ Ó· ‰È·ÎÚ›ÓÔ˘Ó ÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ™ÙËÓ ·ÚÔ‡Û· ÔÈÎÔÁ¤ÓÂÈ· ‰ÂÓ ˘‹Ú¯Â Û˘ÁÁ¤ÓÂÈ· ÙˆÓ ÁÔÓ¤ˆÓ, Ô ·Ù¤Ú·˜ ÚÔÂÚ¯fiÙ·Ó ·fi ÌÈ· ÔÏ˘ÌÂÏ‹ ÔÈÎÔÁ¤ÓÂÈ·, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ¿ÚÚÂÓ ÎÈ ¤ÙÛÈ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ·ÔÎÏÂÈÛı›, Ô‡ÙÂ Ë ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË, Ô‡ÙÂ Ë Ã-Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ù‹ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ÙÔ ÔÔ›Ô ·ÔηχÙÂÈ ÙÔ ÔÏ˘¿ÌÓÈÔ, ÙÔ ÂÌ‚Ú˘˚Îfi Ô›‰ËÌ· (‡‰Úˆ· ‹/Î·È Î˘ÛÙÈÎfi ‡Áڈ̷), ÙËÓ ÂÏ·Ùو̤ÓË ÂÓ‰ÔÌ‹ÙÚÈ· ÎÈÓËÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÚÔ˘Û›· ·ıÔÏÔÁÈÎÒÓ ÛˆÌ·ÙÈÎÒÓ ·Ó·ÏÔÁÈÒÓ, ȉȷ›ÙÂÚ· ηٿ ÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ªÂ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÚÔ˘Ù›Ó·˜ Â›Ó·È ·›ı·ÓÔ Ó· ‰È·ÁÓˆÛÙ› Ë ·ÚÔ˘Û›· ÙˆÓ ÙÂÚ˘Á›ˆÓ (13). ªÂ ÙËÓ ÂͤÏÈÍË Ù˘ ‰È·ÎÚÈÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ ˘ÂÚ‹¯ˆÓ, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰È·ÈÛÙˆıÔ˘Ó Ù· ÙÂÚ‡ÁÈ· Î·È Ë ÂÏ·Ùو̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ì ‰È·ÎÔÏÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ·. ∞ӷʤÚÂÙ·È Ì¿ÏÈÛÙ· ·fi ÙÔ˘˜ Sciarrone Î·È Û˘Ó (1998) Û¯ÂÙÈο ÚÒÈÌË ÛÙË 19Ë Â‚‰ÔÌ¿‰· ·ËÛ˘ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÙÂÚ˘Á›ˆÓ ÛÙȘ ÌÂÁ¿Ï˜ ¶·È‰È·ÙÚÈ΋ 2006;69:138-142

Pediatr Mar-Apr 06

18-04-06

16:42

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Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘

·ÚıÚÒÛÂȘ (1). Œ¯Ô˘Ó ·Ó·ÊÂÚı› ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û ¤Ì‚Ú˘Ô 13 ‚‰ÔÌ¿‰ˆÓ (΢ÛÙÈÎfi ‡Áڈ̷, ·Ú·ÌÔÚÊÒÛÂȘ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ, ·ÓˆÌ·Ï›Â˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È ˘ÂÚÙÂÏÔÚÈÛÌfi˜). ªÂ ‚¿ÛË ·˘Ù¿ Â›Ó·È Èı·Ófi Ë ·Ó¿Ù˘ÍË ÙˆÓ ÙÂÚ˘Á›ˆÓ Ó· ·Ú¯›˙ÂÈ ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ¯ˆÚ›˜ fï˜ Ó· Â›Ó·È ÁÓˆÛÙfi ·Ó ·˘Ùfi ÈÛ¯‡ÂÈ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Î·È ·Ó fiÏ· Ù· ÙÂÚ‡ÁÈ· ·Ó·Ù‡ÛÛÔÓÙ·È Î·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô (1). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙËÓ ·Ú·¿Óˆ ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·, Ô Î·Ú˘fiÙ˘Ô˜ Â›Ó·È ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ™ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Û˘Ì‚¿ÏÏÂÈ Î·È Ë ÂÎÙ›ÌËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ∞FP ÙÔ˘ ÔÚÔ‡ Ù˘ ÂÁ·Ԣ. √È ÁÔÓ›˜ ÙÔ˘ ˘fi Û˘˙‹ÙËÛË ÓÂÔÁÓÔ‡ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ Â·Ó¿Ï˄˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û οı ÌÂÏÏÔÓÙÈÎfi ·fiÁÔÓfi ÙÔ˘˜ ‚¿ÛÂÈ ÙÔ˘ ‰È·ÊÔÚÂÙÈÎÔ‡ ÙÚfiÔ˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ô ÔÔ›Ô˜ ›ӷÈ: 25% ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ù˘ ·˘ÙÔۈ̷ÙÈ΋˜ ˘ÔÏÂÈfiÌÂÓ˘ Î·È 50% ÁÈ· Ù· ·ÁfiÚÈ· ÛÙË Ê˘ÏÔÛ‡Ó‰ÂÙË. ∂›Û˘ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Ì ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È Ì ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ ∞FP ÙÔ˘ ÔÚÔ‡ Ù˘ ÂÁ·Ԣ ÛÙȘ ·Ú¯¤˜ ÙÔ˘ ‚ã ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘. ∞ÍÈÔÔÈÒÓÙ·˜ ·˘Ù¤˜ ÙȘ ÏËÚÔÊÔڛ˜ ·¤ÎÙËÛ·Ó ‰‡Ô ·È‰È¿ Î·È ¤¯Ô˘Ó Û‹ÌÂÚ· ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ Î·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ÎÔÚ›ÙÛÈ, 16 Î·È 12 ÂÙÒÓ ·ÓÙ›ÛÙÔȯ·. ªÂÙ¿ ·fi ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ë ·‰ÂÏÊ‹ Ù˘ ÌËÙ¤Ú·˜ ·¤ÎÙËÛ ÙÚ›· ˘ÁÈ‹ ·È‰È¿, ¤Ó· ÎÔÚ›ÙÛÈ Î·È ‰‡Ô ·ÁfiÚÈ·, ËÏÈΛ·˜ 12, 8 Î·È 6 ÂÙÒÓ ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 4, IV(9),IV(10),IV(11)), ÂÓÒ Ô ·‰ÂÏÊfi˜ Ù˘ ÌËÙ¤Ú·˜ ·¤ÎÙËÛ ‰‡Ô ˘ÁÈ‹ ·ÁfiÚÈ·, ËÏÈΛ·˜ 7 Î·È 5 ÂÙÒÓ, (∂ÈÎfiÓ· 4, VI(7) Î·È VI(8)) ·ÓÙ›ÛÙÔȯ·. ∆¤ÏÔ˜ Ô ·‰ÂÏÊfi˜ ÙÔ˘ ·Ù¤Ú· ̤¯ÚÈ Û‹ÌÂÚ· ¤¯ÂÈ ·ÔÎÙ‹ÛÂÈ ‰‡Ô ˘ÁÈ‹ ·È‰È¿, ¤Ó· ÎÔÚ›ÙÛÈ Î·È ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ 8 Î·È 5 ÂÙÒÓ ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 4,VI (1),VI(2)). ™¯ÂÙÈο Ì ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙˆÓ ‰‡Ô ˘ÁÈÒÓ ·È‰ÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ô ÁÈo˜ ÙÔ˘˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÂÎÙfi˜ ÎÈÓ‰‡ÓÔ˘ Ó· ·ÔÎÙ‹ÛÂÈ ÌÂÏÏÔÓÙÈÎÔ‡˜ ·ıÔÏÔÁÈÎÔ‡˜ ·ÔÁfiÓÔ˘˜, Ì ÔÔÈÔÓ‰‹ÔÙ ·fi ÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË Ã-Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ‰ÂÓ ÌÔÚ› Ó· Â›Ó·È ÊÔÚ¤·˜, ÂÓÒ Ì ÙËÓ ˘ÔÏÂÈfiÌÂÓË ·˘ÙÔۈ̷ÙÈ΋, ·ÎfiÌ· ÎÈ ·Ó Â›Ó·È ÊÔÚ¤·˜, Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ·ÌÂÏËÙ¤Ô˜, ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∏ ÎfiÚË ÙÔ˘˜ fï˜, ÌÔÚ› Ó· Â›Ó·È ÊÔÚ¤·˜ Ì ÙÔÓ ¤Ó· ‹ ÙÔÓ ¿ÏÏÔ Ù‡Ô ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ªÂ ÙËÓ ˘ÔÏÂÈfiÌÂÓË, ·Ó ¶·È‰È·ÙÚÈ΋ 2006;69:138-142

Â›Ó·È ÊÔÚ¤·˜, Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ·ÌÂÏËÙ¤Ô˜, fiˆ˜ Î·È ÁÈ· ÙÔÓ ·‰ÂÏÊfi Ù˘. ªÂ ÙË Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ· fï˜, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ Ó· ·ÔÎÙ‹ÛÂÈ ·ıÔÏÔÁÈÎfi ·fiÁÔÓÔ, Ì Èı·ÓfiÙËÙ· ¤ˆ˜ 50%. ø˜ ÂÎ ÙÔ‡ÙÔ˘ Û˘ÛÙ‹ıËΠÛÙËÓ ÎfiÚË, Û ÂӉ¯fiÌÂÓË ÌÂÏÏÔÓÙÈ΋ ÂÁ΢ÌÔÛ‡ÓË, ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ¤ÏÂÁ¯Ô˜ Ù˘ ∞FP ÙÔ˘ ÔÚÔ‡ Ù˘ ·fi ÙȘ ·Ú¯¤˜ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Sciarrone A, Verdiglione P, Botta G, Franceschini P, Todros T. Prenatal diagnosis of lethal multiple pterygium syndrome in mid- pregnancy [Letter to the Editor]. Ultrasound Obstet Gynecol 1998;12:218-219.

2. Tolmie JL, Patrick A, Yates JR. A Lethal multiple pterygium syndrome with apparent X- linked recessive inheritance. Am J Med Genet 1987;27:913-919.

3. Brink DS, Luisiri A, Grange DK. Case report: lethal multiple pterygium syndrome. Pediatric Pathol Mol Med 2003;22:461-470.

4. Froster UG, Stallmach T, Wisser J, Hebisch G, Robbiani MB, Huch R et al. Lethal multiple pterygium syndrome: suggestion for a consistent pathological workup and review of reported cases [Brief clinical report]. Am J Med Genet 1997;68:82-85.

5. Martin NJ, Hill JB, Cooper DH, O'Brien GD, Masel JP. Lethal multiple pterygium syndrome: three consecutive cases in one family. Am J Med Genet 1986; 24:295-304.

6. Meyer-Cohen J, Dillon A, Pai GS, Conradi S. Lethal multiple pterygium syndrome in four male fetuses in a family: evidence for an X-linked recessive subtype? [Letter to the Editor]. Am J Med Genet 1999; 82:97-99.

7. Hall JG. The lethal multiple pterygium syndromes.

Am J Med Genet 1984;17:803-807.

8. de Die-Smulders CE, Schrander-Stumpel CT, Fryns JP. The lethal multiple pterygium syndrome: A nosological approach. Genet Couns 1990;1:13-23.

9. Spearritt DJ, Tannenberg AE, Payton DJ. Lethal multiple pterygium syndrome: report of a case with neurogical anomalies. Am J Med Genet 1993;47:45-49.

10. Gericke GS. Fragile collagen and the lethal multiple pterygium syndrome: does heat stress play a role?

Am J Med Genet 1991;38:630-631.

11. Moerman P, Fryns JP. The fetal akinesia deformation sequence: A fetopathological approach. Genet Couns 1990;1:25-33.

12. Online Mendelian Inheritance in Man, OMIM John Hopkins University, Baltimore, MD, MIM Number: 253290, 1/19/99. World Wide Web URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db= OMIM 13. Lockwood C, Irons M, Troiani J, Kawada C, Chaudhury A, Cetrulo C. The prenatal diagnosis of lethal multiple pterygium syndrome: A heritable cause of recurrent abortion. Am J Obstet Gynecol 1998;159: 474-476.

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

CASE REPORT

143

™¿ÓÈ· ÂÌÊ¿ÓÈÛË ÔÈÎÔÁÂÓÔ‡˜ ÓfiÛÔ˘ Moyamoya Û ·ÛıÂÓ›˜ Ù˘ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜ ∂. ª·˙›ÁÔ˘ - ºˆÙÔÔ‡ÏÔ˘1, ¡. µ·ÛÈÏ¿ÎË1, ™. ∞ÚÒÓË2, H. Ikeda3, ∞. ¶··‚·ÛÈÏ›Ԣ1

¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ ªÔyamoya (MM) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÙ¤ÓˆÛË ‹ ·fiÊÚ·ÍË ÙˆÓ Î‡ÚÈˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ. ªÔÏÔÓfiÙÈ Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ¿ÁÓˆÛÙË, ˘¿Ú¯Ô˘Ó ÛÔ‚·Ú¤˜ ÂӉ›ÍÂȘ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÔÏ˘·Ú·ÁÔÓÙÈÎfi ÓfiÛËÌ·. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰‡Ô ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÔ‡˜ ÌÔÚÊ‹˜ ªª Û ¿ÙÔÌ· Â˘Úˆ·˚΋˜ ηٷÁˆÁ‹˜, ÁÈ· Ó· ÙÔÓ›ÛÔ˘Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ Û¿ÓÈ·˜ ·˘Ù‹˜ ÓfiÛÔ˘ Î·È Û ¿ÙÔÌ· Ù˘ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜, ÏËÓ Ù˘ ·ÛÈ·ÙÈ΋˜, ηıÒ˜ Î·È ÙËÓ ·ÚÔ˘Û›· ÎÏËÚÔÓÔÌÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘. ™ÙËÓ ÚÒÙË ·ÛıÂÓ‹, Ô˘ Â›Ó·È ∂ÏÏËÓ›‰·, ‰È·ÈÛÙÒıËÎ·Ó ÂÈϤÔÓ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜. ¶·ÚfiÌÔȘ ‰È·Ù·Ú·¯¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ë ÌËÙ¤Ú· Ù˘, Ô˘ Â›Û˘ ¿Û¯ÂÈ ·fi ÓfiÛÔ ªª, ηıÒ˜ Î·È ¿ÙÔÌ· Ù˘ ÌËÙÚÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. √ ‰Â‡ÙÂÚÔ˜ ·ÛıÂÓ‹˜, ¤Ó· ·ÁfiÚÈ ·fi ÙË ™ÎˆÙ›·, ·ÔÙÂÏ› ÌÔÓ·‰È΋ ÂÚ›ÙˆÛË, ηıfiÛÔÓ Ë ÓfiÛÔ˜ ªª ¤¯ÂÈ ÚÔÛ‚¿ÏÏÂÈ ¤ÓÙ ¿ÙÔÌ· Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜ Ù˘ ÌËÙÚÈ΋˜ ÙÔ˘ ÔÈÎÔÁ¤ÓÂÈ·˜. §¤ÍÂȘ ÎÏÂȉȿ: √ÈÎÔÁÂÓ‹˜ Moyamoya, ·È‰È¿, η˘Î¿ÛÈ· Ê˘Ï‹.

1 ¡Â˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ 2 ∆Ì‹Ì· ∞ÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” 3 Kohnan Hospital, Department of Neurosurgery, Sendai Japan AÏÏËÏÔÁÚ·Ê›·: ∂ϤÓË ºˆÙÔÔ‡ÏÔ˘ §Â˘ÎˆÛ›·˜ 1, ¶. ¶ÂÓÙ¤ÏË T.K. 15236 ∞ı‹Ó· E-mail: fotopoul@hol.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-12-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-10-2005

Familial Moyamoya disease in two European children H. Bazigou - Fotopoulou1, N. Vassilaki1, S. Aroni2, H. Ikeda3, A. Papavassiliou1

Abstract: Moyamoya disease (MMD) is characterised by stenosis or occlusion of the main cerebral arteries detected on cerebral angiography. Although the aetiology is still unknown, there is extensive evidence that MMD may follow a multifactorial pattern of inheritance. Two cases are presented of familial MMD in children of European descent, in order to emphasize the occurrence of this rare disease in not only Oriental but also other races, and to stress the hereditary factors in its pathogenesis.

The first patient, a Greek girl, has additional coagulation disorders. Her mother, who also suffers from MMD, and various other members of her family, have similar coagulation disorders. The second patient, a Scottish boy, represents a unique case of familial MMD, as five members of three consecutive generations of his maternal family also suffer from MMD. Key words: Familial Moyamoya, children, Caucasian race.

∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ ªª ÂÚÈÁÚ¿ÊËΠÚÒÙË ÊÔÚ¿ ÛÙËÓ π·ˆÓ›· ÙÔ 1956 ·fi ÙÔ˘˜ Takenchi Î·È Shimizu ˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË ˘ÔÏ·Û›· ÙˆÓ Î·ÚˆÙ›‰ˆÓ (1). ∆Ô 1969 ÔÈ Suzuki Î·È Takaku ÂÈÛ‹Á·Á·Ó ÙÔÓ fiÚÔ Moyamoya ·fi ÙËÓ ·ÁÁÂÈÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘, Ô˘ ÛÙ· π·ˆÓÈο ÛËÌ·›ÓÂÈ “Û‡ÓÓÂÊÔ Î·ÓÔ‡” (2). ª¤¯ÚÈ ÙËÓ ÂÔ¯‹ ÂΛÓË, ÂÈÎÚ·ÙÔ‡ÛÂ Ë ¿Ô„Ë fiÙÈ Ë ÓfiÛÔ˜ ·ÊÔÚÔ‡Û ·ÔÎÏÂÈÛÙÈο ÙËÓ ·ÛÈ·ÙÈ΋ Ê˘Ï‹ (3). ŒÎÙÔÙ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ Î·È ÛÙËÓ Î·˘Î¿ÛÈ· Ê˘Ï‹, Ì ۷ÊÒ˜ fï˜ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· (4). ™ÙË ÓfiÛÔ ªª

1 Neurology Clinic, General Children’s Hospital of Penteli 2 Department of Haemorragic Dispositions, “Aghia Sofia” Children’s Hospital 3 Kohnan Hospital, Department of Neurosurgery, Sendai Japan Correspondence: Heleni Fotopoulou 1 Lefkosias Str., P. Penteli 15236 Athens E-mail: fotopoul@hol.gr Date of submission: 03-12-2004 Date of approval: 21-10-2005

·Ú·ÙËÚÂ›Ù·È ‰˘ÛÏ·Û›· ÙÔ˘ ¤Ûˆ ¯ÈÙÒÓ· ÙˆÓ ¿ˆ ÙÌËÌ¿ÙˆÓ ÙˆÓ ¤Ûˆ ηڈٛ‰ˆÓ Î·È ÙˆÓ ÂÁÁ‡˜ ÙÌËÌ¿ÙˆÓ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Ô˘ Ô‰ËÁ› Û ÛÙ¤ÓˆÛË ‹ ·fiÊÚ·Í‹ ÙÔ˘˜ Ì ÚÔԉ¢ÙÈ΋ ÂÌÊ¿ÓÈÛË ·Ú¿Ï¢Ú˘ ΢ÎÏÔÊÔÚ›·˜. ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ∏ ÔÈÎÔÁÂÓ‹˜ ÂÌÊ¿ÓÈÛ‹ Ù˘, Û ÔÛÔÛÙfi 7-10%, Ë ÂÈÎÚ¿ÙËÛ‹ Ù˘ ÛÙËÓ ·ÛÈ·ÙÈ΋ Ê˘Ï‹ Î·È Ù· ÂÓı·ÚÚ˘ÓÙÈο Â˘Ú‹Ì·Ù· ·fi ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÌÔÚÊÒÓ, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë ÂÓfi˜ ÁÂÓÂÙÈÎÔ‡ ηٿ ‚¿ÛË ÓÔÛ‹Ì·ÙÔ˜ (3, 4-6). ∏ ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ ‰‡Ô ÂÙÒÓ, ·ÏÏ¿ Î·È Û ÂÓ‹ÏÈΘ. ™ÙËÓ ·È‰È΋ ËÏÈΛ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¶·È‰È·ÙÚÈ΋ 2006;69:143-149

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∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ Î·È Û˘Ó.

Û·ÛÌÔ‡˜ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÈÛ¯·ÈÌÈο ÂÂÈÛfi‰È·, ÂÓÒ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ ·fi ˘·Ú·¯ÓÔÂȉ›˜ ·ÈÌÔÚÚ·Á›Â˜. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰‡Ô ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÔ‡˜ ÓfiÛÔ˘ ªª Û ‰‡Ô Î·È ÙÚÂȘ ÁÂÓ¤˜ ·ÓÙ›ÛÙÔȯ·. ∏ ÚÒÙË ÂÚ›ÙˆÛË Ô˘ ·ÊÔÚ¿ ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 11 ÌËÓÒÓ, ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜, ıˆÚÂ›Ù·È ·Û˘Ó‹ı˘ ÏfiÁˆ ÙÔ˘ Ó·ÚÔ‡ Ù˘ ËÏÈΛ·˜ Ù˘ Î·È ÙˆÓ Û˘ÓÔ‰ÒÓ ‰È·Ù·Ú·¯ÒÓ ‹Íˆ˜ ÛÙËÓ ›‰È· ηıÒ˜ Î·È Û ÚÒÙÔ˘ Î·È ‰Â˘Ù¤ÚÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ›˜ Ù˘. ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË Ô˘ ·ÊÔÚ¿ ·ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ, ÛΈÙÛ¤˙È΢ ηٷÁˆÁ‹˜, Â›Ó·È Ë ÌÔÓ·‰È΋ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ì ¤ÓÙ ¿Û¯ÔÓÙ· ¿ÙÔÌ· Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜.

¶ÂÚ›ÙˆÛË π ¶ÚfiÎÂÈÙ·È ÁÈ· ı‹Ï˘ ËÏÈΛ·˜ 11 ÌËÓÒÓ, ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜, Ô˘ ÚÔÛÎÔÌ›ÛıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ÁÈ· ‰ÈÂÚ‡ÓËÛË ‰ÂÍÈ¿˜ ËÌÈÏËÁ›·˜ Ô˘ ÂÁηٷÛÙ¿ıËΠ·Ì¤Ûˆ˜ ÌÂÙ¿ ·fi ÔÌfiÏ¢ÚÔ˘˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ‰È¿ÚÎÂÈ·˜ Ï›ÁˆÓ ‰Â˘ÙÂÚÔϤÙˆÓ. ∂›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·fi ÁÔÓ›˜ Ô˘ ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. √ ÙÔÎÂÙfi˜ ¤ÁÈÓ Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹, ÂÂȉ‹ Ë ÌËÙ¤Ú·, Ô˘ ¤·Û¯Â Î·È ·˘Ù‹ ·fi ÓfiÛÔ ªª, ·ÚÔ˘Û›·Û ˘¤ÚÙ·ÛË ÛÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∏ ÓfiÛÔ˜ ÛÙË ÌËÙ¤Ú· Ù˘ ·ÛıÂÓÔ‡˜ ‰È·ÁÓÒÛÙËΠ۠ËÏÈΛ· 9ó ÂÙÒÓ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ¯ÂÈÚÔ˘ÚÁÈο Ì ÂÈÙ˘¯›· ÛÙËÓ ËÏÈΛ· ·˘Ù‹ (¶›Ó·Î·˜ 1). ∏ ·ÛıÂÓ‹˜ Û ËÏÈΛ· 9 ÌËÓÒÓ ·ÚÔ˘Û›·Û ÁÈ· ÚÒÙË ÊÔÚ¿ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜ ‰È¿ÚÎÂÈ·˜ ‰Â˘ÙÂÚÔϤÙˆÓ. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (ªRI) Î·È ÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°) Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ÂÂÈÛfi‰ÈÔ ·˘Ùfi ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ŒÎÙÔÙÂ, Ë ·ÛıÂÓ‹˜ ‚ÚÈÛÎfiÙ·Ó Û ÛÙÂÓ‹ È·ÙÚÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 11 ÌËÓÒÓ. ™ÙËÓ ËÏÈΛ· ·˘Ù‹ ·ÚÔ˘Û›·ÛÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ, ·ÚfiÌÔÈÔ Ì ÙÔ ÚÒÙÔ Î·È ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ™ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ‰ÂÍÈ¿ ËÌÈÏËÁ›· Ì ȉȷ›ÙÂÚË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ¿Óˆ ¿ÎÚÔ˘. ∏ ˘fiÏÔÈË Ê˘ÛÈ΋ ÂͤٷÛË ‹Ù·Ó ¯ˆÚ›˜ Â˘Ú‹Ì·Ù·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓÂ, ‰È·ÈÛÙÒıËÎ·Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ÙfiÛÔ ÛÙËÓ ›‰È· fiÛÔ Î·È Û ̤ÏË Ù˘ ÌËÙÚÈ΋˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (¶›Ó·Î·˜ 2). ™˘ÁÎÂÎÚÈ̤ӷ: ·) Ë ¶·È‰È·ÙÚÈ΋ 2006;69:143-149

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1 ¶›Ó·Î·˜ 1. ∆Ô ÁÂÓ·ÏÔÁÈÎfi ‰¤ÓÙÚÔ Ù˘ ÚÒÙ˘ ·ÛıÂÓÔ‡˜ (ÌËÙ¤Ú· ÚÔ˜ ÎfiÚË) º‡ÏÔ

∏ÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘

1. ∞ÛıÂÓ‹˜ 2. ªËÙ¤Ú· ·ÛıÂÓÔ‡˜

9 ÌËÓÒÓ 9ó ÂÙÒÓ

·ÛıÂÓ‹˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ FV Leiden Î·È FII 20210∞, ‚) Ë ÌËÙ¤Ú· Ù˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙȘ ·Ú·¿Óˆ ÌÂÙ·ÏÏ¿ÍÂȘ ηıÒ˜ Î·È ÁÈ· ÙÔ ÁÔÓ›‰ÈÔ MTHFR, Á) Ë ·‰ÂÏÊ‹ Ù˘ ÌËÙ¤Ú·˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙÔ ÁÔÓ›‰ÈÔ FV Leiden Î·È ‰) Ë ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ MTHFR Î·È FII 20210A. ∆o ∏∂° ¤‰ÂÈÍ ‚Ú·‰¤· ·̷ٷ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ Ì ‰È¿Û·ÛË Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ‰ÔÌ‹˜ ÙÔ˘ ‡ÓÔ˘ Î·È ·Ô˘Û›· ·ÚÔ͢ÛÌÈÎÒÓ ÂÎÊÔÚÙ›ÛˆÓ. ∏ ªRI ÂÁÎÂÊ¿ÏÔ˘, Ô˘ ¤ÁÈÓ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ËÌÈÏËÁ›·˜, ¤‰ÂÈÍ ¤ÌÊÚ·ÎÙ· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎÚÔÙ·ÊÈÎfi Î·È ‚ÚÂÁÌ·ÙÈÎfi ÏÔ‚fi, ηıÒ˜ Î·È ÛÙÔÓ ‰ÂÍÈfi ÈÓÈ·Îfi Î·È ÎÚÔÙ·ÊÈÎfi ÏÔ‚fi. ∞ÎÔÏÔ‡ıËÛ ̷ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRA), Ë ÔÔ›· ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Î·È ¤‰ÂÈÍ ÛÙ¤ÓˆÛË Ù˘ ˘ÂÚÎÏÈÓÔÂȉԇ˜ ÌÔ›Ú·˜ Ù˘ ‰ÂÍÈ¿˜ ¤Ûˆ ηڈٛ‰·˜, ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË Ù˘ ˘ÂÚÎÏÈÓÔÂȉԇ˜ ÌÔ›Ú·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ¤Ûˆ ηڈٛ‰·˜ Î·È Ù˘ ·Ú¯‹˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, ηıÒ˜ Î·È ÛËÌ·ÓÙÈ΋ ˘ÂÚÙÚÔÊ›· ÙˆÓ Ê·ÎÔÚ·‚‰ˆÙÒÓ ·ÚÙËÚÈÒÓ. √È MRI ÂÁÎÂÊ¿ÏÔ˘ Ù˘ ÌËÙÚÈ΋˜ ÁÈ·ÁÈ¿˜ Î·È ÌËÙÚÈ΋˜ ·‰ÂÏÊ‹˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Ì Ë·Ú›ÓË ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Û ‰fiÛË 75 U/Kgr Î·È ·ÛÈÚ›ÓË Û ‰fiÛË 50 mgr/24ˆÚÔ, Â·Ú΋ ÂÓ˘‰¿ÙˆÛË Î·È ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Ì ηڂ·Ì·˙Â›ÓË. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜

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™¿ÓÈ· ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Moyamoya

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¶›Ó·Î·˜ 2. ¢È·Ù·Ú·¯¤˜ ‹Íˆ˜ Ù˘ ÚÒÙ˘ ·ÛıÂÓÔ‡˜ Î·È ÙˆÓ Û˘ÁÁÂÓÒÓ Ù˘ 1. ∞ÛıÂÓ‹˜: ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ F.V. Leiden Î·È FII 20210∞ 2. ªËÙ¤Ú· ·ÛıÂÓÔ‡˜: ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· F.V. Leiden, FII 20210A Î·È MTHFR 3. ªËÙÚÈ΋ ·‰ÂÚÊ‹: F.V. Leiden 4. ªËÙÚÈ΋ ÁÈ·ÁÈ¿: MTHFR Î·È FII 20210A

·ÚÔ˘Û›·˙Â Û˘Ó¯‹ ‚ÂÏÙ›ˆÛË. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô Û˘ÛÙ‹ıËÎÂ Û˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜ ÁÈ· ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜ ̤¯ÚÈ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘, ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Î·È ¤Ó·ÚÍË Ê˘ÛÈÔıÂÚ·›·˜. ∏ ·ÛıÂÓ‹˜ ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ ¤ÓÙ ̋Ó˜ ·ÚÔ˘Û›·Û ÔÌ·Ï‹ ÔÚ›·, fiÛÔÓ ·ÊÔÚ¿ ÙË ÓfiÛÔ Ù˘ Î·È ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ Ù˘ ÂͤÏÈÍË. ™Â ËÏÈΛ· 16 ÌËÓÒÓ Î·È ÂÓÒ ÓÔÛËÏ¢fiÙ·Ó Û ΤÓÙÚÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ÁÈ· ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ Ù˘, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ·ÈÊÓȉ›ˆ˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ·ÚÈÛÙÂÚ¿, Ì Â·ÎfiÏÔ˘ıË ÔÌfiÏ¢ÚË ËÌÈÏËÁ›· Î·È ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ÚÔÊÔÚÈÎfi ÏfiÁÔ. ∏ MRI ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍÂ Ó¤Ô ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹ (∂ÈÎfiÓ˜ 1,2), ÂÓÒ Ë ÙÔÌÔÁÚ·Ê›· Ì ÂÎÔÌ‹ ÔÛÈÙÚÔÓ›ˆÓ (ƒ∂∆ positron emission tomography) ¤‰ÂÈÍ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ Î·È ÛÙË ‰ÂÍÈ¿ ‚ÚÂÁÌ·ÙÔ˚Óȷ΋ ÂÚÈÔ¯‹. ¢Âη¤ÓÙ Ë̤Ú˜ ÌÂÙ¿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÂÈÛfi‰ÈÔ, ¤ÁÈÓ ·Ó·ÛÙfïÛË ÎÏ¿‰ˆÓ ÙˆÓ ¤Ûˆ Î·È ¤Íˆ ηڈٛ‰ˆÓ. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ˘‹ÚÍ ÔÌ·Ï‹ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÙË Û‡ÛÙ·ÛË Ó· ·Ú¯›ÛÂÈ Ê˘ÛÈÔıÂÚ·›·, ÂÚÁÔıÂÚ·›· Î·È ÏÔÁÔıÂÚ·›·. ∏ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ ηٿ ÙËÓ ¤ÍÔ‰Ô Û˘Ó›ÛÙ·ÙÔ Û ·ÛÈÚ›ÓË, ηڂ·Ì·˙Â›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË. ∏ MRI ÂÁÎÂÊ¿ÏÔ˘, ÔÎÙÒ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, ¤‰ÂÈÍ ÙËÓ ·ÚÔ˘Û›· ·Ï·ÈÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔÎÚÔÙ·ÊÔ‚ÚÂÁÌ·ÙÈ-

∂ÈÎfiÓ˜ 1,2. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ù˘ ÚÒÙ˘ ·ÛıÂÓÔ‡˜, Ë ÔÔ›· ‰Â›¯ÓÂÈ ¤ÌÊÚ·ÎÙ· ÛÙÔ˘˜ ÎÚÔÙ·ÊÈÎÔ‡˜ ÏÔ‚Ô‡˜, ÛÙÔÓ ‚ÚÂÁÌ·ÙÈÎfi ÏÔ‚fi ·ÚÈÛÙÂÚ¿ Î·È ÛÙÔÓ ÈÓÈ·Îfi ÏÔ‚fi ‰ÂÍÈ¿.

΋ ÂÚÈÔ¯‹ Î·È ‰È¿Û·ÚÙ˜ ÂÛٛ˜ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛ˘. ∆·˘Ùfi¯ÚÔÓË MRA ÂÁÎÂÊ¿ÏÔ˘ ·ÂÎ¿Ï˘„ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÙÔ˘ ˘ÂÚÎÏÈÓÔÂȉԇ˜ ÙÌ‹Ì·ÙÔ˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ ¤Ûˆ ηڈٛ‰ˆÓ, ·ÂÈÎfiÓÈÛË ÙˆÓ ÚÔÛı›ˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Î·È Ù˘ ·ÚÈÛÙÂÚ‹˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜, ·Ó·ÛÙfïÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ ‰ÂÍÈ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Ì ÎÏ¿‰Ô Ù˘ ‰ÂÍÈ¿˜ ¤Íˆ ηڈٛ‰·˜ Î·È ·Ó¿Ù˘ÍË ÓÂfiÏ·ÛÙˆÓ ·ÁÁ›ˆÓ. ¶·È‰È·ÙÚÈ΋ 2006;69:143-149

Pediatr Mar-Apr 06

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∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ Î·È Û˘Ó.

¢ÂηÔÎÙÒ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, Ë ·ÛıÂÓ‹˜ Û ËÏÈΛ· 3ó ÂÙÒÓ, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÛÙÔÓ ÎÈÓËÙÈÎfi ÙÔ̤· ·ÏÏ¿ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ ÚÔÊÔÚÈÎÔ‡ ÏfiÁÔ˘. ∏ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ Û˘Ó¯›˙ÂÙ·È Ì ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ 100 mg ËÌÂÚËÛ›ˆ˜ Î·È Î·Ú‚·Ì·˙Â›Ó˘. ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË Ù˘ ·ÛıÂÓÔ‡˜ Î·È ÙˆÓ ÛÙÂÓÒÓ Û˘ÁÁÂÓÒÓ Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ Î¤ÓÙÚÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡, ‰ÂÓ ¤‰ÂÈÍ ·ÓˆÌ·Ï›Â˜ ÛÙ· ÁÔÓ›‰È· CHL1, IL5AR, ILOC51185 Î·È ITRP1 ÛÙÔ ¯ÚˆÌfiۈ̷ 3p26. ∏ ·Ó¿Ï˘ÛË fï˜, ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Î·È À ÁÔÓfiÙ˘Ô˘ ¤‰ÂÈÍ fiÙÈ Ù· ÚÔۂ‚ÏË̤ӷ ¿ÙÔÌ· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ›¯·Ó ÙËÓ ›‰È· ·ÏÏËÏÔ˘¯›· ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ª∆3 Ù˘ ·Á·Ï˘ D Ì ȿˆÓ˜ ·ÛıÂÓ›˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ÌÔÚÊ‹˜. ¢È·ÈÛÙÒıËΠÂ›Û˘, ·ÓÙÈηٿÛÙ·ÛË Ì›·˜ ÌfiÓÔ ‚¿Û˘ ÛÙËÓ ÂÚÈÔ¯‹ CRS263 (A→G), ‡ÚËÌ· ÙÔ ÔÔ›Ô Â›Ó·È Û¿ÓÈÔ ÛÙ· ¿ÙÔÌ· Ù˘ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜ Ì ÓfiÛÔ ªª.

¶ÂÚ›ÙˆÛË πI ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ, ÛΈÙÛ¤˙È΢ ηٷÁˆÁ‹˜, ÙÔ ÔÔ›Ô Î·Ù¿ ÙȘ ηÏÔηÈÚÈÓ¤˜ ÙÔ˘ ‰È·ÎÔ¤˜ ÛÙËÓ ∂ÏÏ¿‰·, Ï›Á˜ ÒÚ˜ ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ, Ì ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜ 42ÆC, ·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ ·‰˘Ó·Ì›· ÛÙÔ ·ÚÈÛÙÂÚfi ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ. ∂›Ó·È ÙÔ ÙÚ›ÙÔ Ù¤ÎÓÔ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ì ÂχıÂÚÔ ÂÚÈÁÂÓÓËÙÈÎfi Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi. √È ÁÔÓ›˜ ‰ÂÓ ¤¯Ô˘Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. ∞fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ·‰ÂÏÊ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜, Ë ÌËÙÚÈ΋ ·‰ÂÏÊ‹ Î·È Ë ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ ¿Û¯Ô˘Ó ·fi Û˘Ìو̷ÙÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ªª, ÂÓÒ Ë ÌËÙ¤Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ·Û˘Ìو̷ÙÈ΋ ÌÔÚÊ‹ (¶›Ó·Î·˜ 3). ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ηٿ ÙËÓ Â›ÛÔ‰Ô, ¤‰ÂÈÍ ·ÚÈÛÙÂÚ‹ ËÌÈÏËÁ›· Ì ÌÂÁ·Ï‡ÙÂÚË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ¿Óˆ ¿ÎÚÔ˘ ηıÒ˜ Î·È ¿ÚÂÛË ÙÔ˘ ÔÌfiÏ¢ÚÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. ∏ ˘fiÏÔÈË ÎÏÈÓÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ªRI ÂÁÎÂÊ¿ÏÔ˘ ·Ó¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ÈÛ¯·ÈÌ›· ÛÙÔ ‰›Ô ‰È·ÓÔÌ‹˜ Ù˘ ‰ÂÍÈ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Î·È ÛÙÔ Û‡ÛÙÔÈ¯Ô Ê·ÎÔÂȉ‹ Î·È ÎÂÚÎÔÊfiÚÔ ˘Ú‹Ó· Ì ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ÓfiÛÔ˘ ªª (∂ÈÎfiÓ· 3). ∏ MRA ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË. ∞fi ÙÔÓ ˘fiÏÔÈÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Û˘¶·È‰È·ÙÚÈ΋ 2006;69:143-149

¶›Ó·Î·˜ 3. °ÂÓ·ÏÔÁÈÎfi ‰¤Ó‰ÚÔ Ù˘ ‰Â‡ÙÂÚ˘ ÂÚ›ÙˆÛ˘ ∞Ú. 1 - ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ (52 ÂÙÒÓ) ∞Ú. 2 - ÌËÙÚÈ΋ ·‰ÂÏÊ‹ (19 ÂÙÒÓ) ∞Ú. 3 - ÌËÙ¤Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜ (·Û˘Ìو̷ÙÈ΋, 38 ÂÙÒÓ) ∞Ú. 4 - ·ÛıÂÓ‹˜ ∞Ú. 5 - ·‰ÂÏÊ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ (6 ÂÙÒÓ)

ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ Î·È ÙÔ˘ ÂϤÁ¯Ô˘ ıÚÔÌ‚ÔÊÈÏ›·˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠοÙÈ ÙÔ ·ıÔÏÔÁÈÎfi, ÙfiÛÔ ÛÙÔÓ ·ÛıÂÓ‹ fiÛÔ Î·È ÛÙË ÌËÙ¤Ú· ÙÔ˘. √ ·ÛıÂÓ‹˜ ÂÓ˘‰·ÙÒıËÎÂ Î·È Ù¤ıËΠ۠·ÁˆÁ‹ Ì ʷÈÓ˘ÓÙÔ˝ÓË Î·È ·ÛÈÚ›ÓË (60 mg ËÌÂÚËÛ›ˆ˜, 3 mg/kg/24ˆÚÔ). ∆Ô ∏∂° ¤‰ÂÈÍ ÁÂÓÈÎÂ˘Ì¤ÓË ÂÌÊ¿ÓÈÛË ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ Ì ÂÈÎÚ¿ÙËÛ‹ ÙÔ˘˜ ÛÙÔ ‰ÂÍÈfi ËÌÈÛÊ·›ÚÈÔ. ªÂÙ¿ ·fi ÓÔÛËÏ›· ÔÎÙÒ ËÌÂÚÒÓ Î·È ÚÔԉ¢ÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ÙÔ˘ ÂÈÎfiÓ·˜, Ô ·ÛıÂÓ‹˜ ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· Ó· ÌÂÙ·‚› ÛÙËÓ È‰È·›ÙÂÚË ·ÙÚ›‰· ÙÔ˘ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÔηٿÛÙ·ÛË Î·È ‰ÈÂÚ‡ÓËÛË. ∞fi ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÛÙË ÌËÙ¤Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜, ¤¯ÂÈ Á›ÓÂÈ ÁÓˆÛÙfi fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰È·Ù·Ú·¯¤˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi D¡∞ (C0tRNALys ÂÓ‰ÔÁÂÓ‹ 9 bp ¤ÏÏÂÈ„Ë) ‡ÚËÌ· ·Û‡ÓËı˜ ÛÙÔ˘˜ ∫·˘Î¿ÛÈÔ˘˜ (7). ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙˆÓ ˘ÔÏÔ›ˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û˘Ó¯›˙ÂÙ·È.

™˘˙‹ÙËÛË °È·Ù› Ë ÓfiÛÔ˜ Moyamoya (MM) ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔ˘˜ ∞ÛÈ¿Ù˜ Î·È fi¯È ÙfiÛÔ Û˘¯Ó¿ ÛÙÔ˘˜ ∫·˘Î¿ÛÈÔ˘˜; ∏ ¯Ú‹ÛË ÌË ÂÂÌ‚·ÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ, fiˆ˜ Â›Ó·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) Î·È Ë Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (MRA), Ô‰‹ÁËÛ Û ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ó¤ˆÓ ÛÔÚ·‰ÈÎÒÓ, ÔÈÎÔÁÂÓÒÓ, ·ÏÏ¿ Î·È ·Û˘Ìو̷ÙÈÎÒÓ ÌÔÚÊÒÓ Ù˘ ÓfiÛÔ˘ Î·È ¿ÓÔÈÍ ÙÔÓ

Pediatr Mar-Apr 06

18-04-06

16:42

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™¿ÓÈ· ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Moyamoya

∂ÈÎfiÓ· 3. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ·ÛıÂÓÔ‡˜, Ë ÔÔ›· ‰Â›¯ÓÂÈ ÂÎÙÂٷ̤ÓÔ ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÎÚÔÙ·ÊÔ‚ÚÂÁÌ·ÙÔ˚Óȷ΋ ÂÚÈÔ¯‹ Ì ˘ÔÊÏÔÈÒ‰Ë ·ÙÚÔÊ›· ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹.

‰ÚfiÌÔ, Ì·˙› Ì ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË, ÁÈ· Ó· ··ÓÙËı› ÛÙÔ Ì¤ÏÏÔÓ ÙÔ ·Ú·¿Óˆ ÂÚÒÙËÌ· (8). MoÏÔÓfiÙÈ Ë ÓfiÛÔ˜ ÂÈÎÚ·Ù› ÌÂٷ͇ ÙˆÓ π·ÒÓˆÓ, Ӥ˜ ÂÚÈÙÒÛÂȘ ·Ó·ÎÔÈÓÒÓÔÓÙ·È Û˘Ó¯Ҙ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Î·È ÌÂٷ͇ ÙˆÓ ∫·˘Î¿ÛȈÓ. ¶ÂÓ‹ÓÙ· ÙÔȘ ÂηÙfi (50%) ÙˆÓ Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ ÂÓÙÔ›˙ÔÓÙ·È ÂÎÙfi˜ ÙˆÓ È·ˆÓÈÎÒÓ Û˘ÓfiÚˆÓ (9). ∆ÚÈ·ÎfiÛȘ ÂÚ›Ô˘ ÂÚÈÙÒÛÂȘ ‚‚·ÈˆÌ¤Ó˘ ‹ Èı·Ó‹˜ ÓfiÛÔ˘ Moyamoya ·Ó·Ê¤ÚÔÓÙ·È Û fiϘ ÙȘ ÂıÓÈÎfiÙËÙ˜ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ ∞ÌÂÚÈ΋˜ Î·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 6000 ·ÁÎÔÛÌ›ˆ˜ (10). √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ MM Â›Ó·È ÛÔÚ·‰ÈΤ˜ Î·È ÌfiÓÔ 7-10% Â›Ó·È ÔÈÎÔÁÂÓ›˜, ÛÙȘ Ôԛ˜ ÚÔÛ‚¿ÏÏÔÓÙ·È Û˘Ó‹ıˆ˜ ‰‡Ô ¿ÙÔÌ· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∏ ÓfiÛÔ˜ ÛÙȘ ÔÈÎÔÁÂÓ›˜ ÌÔÚʤ˜, ÂÌÊ·Ó›˙ÂÙ·È Û ÔÛÔÛÙfi 70% ÌÂٷ͇ ·‰ÂÏÊÒÓ Î·È Û 24% ÌÂٷ͇ ÁÔÓ¤ˆÓ Î·È Ù¤ÎÓˆÓ (8). √È ‰‡Ô ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ Ì·˜ Û η˘Î¿ÛÈÔ˘˜ ·ÛıÂÓ›˜ ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· Ù˘ ÓfiÛÔ˘ Î·È Û ¿ÏϘ Ê˘Ï¤˜ ÏËÓ Ù˘ ·ÛÈ·ÙÈ΋˜ Î·È ÂÓÈÛ¯‡Ô˘Ó ÙÔÓ ÎÏËÚÔÓÔÌÈÎfi Ù˘ ¯·Ú·ÎÙ‹Ú·. ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛ‹ Ì·˜, Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜, ·ÏÏ¿ Â›Ó·È ÌÔÓ·‰È΋ ÛÙÔ fiÙÈ, Ù· ¤ÓÙ ÚÔۂ‚ÏË̤ӷ ¿ÙÔÌ· ·ÔÙÂÏÔ‡Ó ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÙfiÌˆÓ Ì ÙË ÓfiÛÔ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (7,14). ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·-

̤ÓÂÈ ·ÎfiÌË ¿ÁÓˆÛÙË ·Ú¿ ÙȘ ·ÍÈfiÏÔÁ˜ ¤Ú¢Ó˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂȉËÌÈÔÏÔÁ›·, ÙË Û˘Ìو̷ÙÔÏÔÁ›·, ÙË Ó¢ÚÔ·ÂÈÎfiÓÈÛË Î·È ÙËÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ Ù˘ ÂÈÎfiÓ·. √ ÎÏËÚÔÓÔÌÈÎfi˜ ‹ Â›ÎÙËÙÔ˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰È¢ÎÚÈÓÈÛÙ›. ∏ ıˆڛ· Ô˘ ÂÓÔ¯ÔÔÈÔ‡Û Èı·Ó‹ Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı› ·fi ·Ó¿ÏÔÁ˜ ÌÂϤÙ˜ (8). ∏ Û˘Ó¯‹˜ ·‡ÍËÛË ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÌÔÚÊÒÓ, Ë Û˘Ó‡·ÚÍ‹ ÙÔ˘˜ Ì ¿ÏÏ· ÎÏËÚÔÓÔÌÈο ÓÔÛ‹Ì·Ù· fiˆ˜ Â›Ó·È Ë Ó¢ÚÔ˚ӈ̿وÛË Ù‡Ô˘ 1, Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÙÔ Û‡Ó‰ÚÔÌÔ Down, ηıÒ˜ Î·È Ë ˘ÂÚÔ¯‹ Ù˘ ÓfiÛÔ˘ ÛÙÔÓ È·ˆÓÈÎfi Ï·fi, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Èı·ÓfiÓ Ó· ÂÌϤÎÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘ Ì ÔÏ˘·Ú·ÁÔÓÙÈÎfi ÙÚfiÔ (11,12). ¶ÚfiÛÊ·ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË Û ÔÈÎÔÁÂÓ‹ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ η٤‰ÂÈÍ ÙËÓ ‡·ÚÍË ÁÔÓȉ›Ô˘ ÛÙÔ ¯ÚˆÌfiۈ̷ 3p24.2-26 (8). ™Â ¿ÏÏË ·ÚfiÌÔÈ· ÌÂϤÙË, ‰È·ÈÛÙÒıËΠfiÙÈ ˘¿Ú¯ÂÈ Èı·Ó‹ Û˘Û¯¤ÙÈÛË Ù˘ ÓfiÛÔ˘ Ì ÔÚÈṲ̂ӷ ·ÏÏËÏfiÌÔÚÊ· ÁÔÓ›‰È· ÙˆÓ ·ÓıÚÒÈÓˆÓ Ï¢ÎÔ΢ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ (HLA) ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· 6 Î·È 17 (6). ™ÙËÓ ÚÒÙË Ì·˜ ÂÚ›ÙˆÛË, Ë ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ ‰È·Ù·Ú·¯¤˜ ·ÚfiÌÔȘ Ì ÂΛӘ ÛÙÔ˘˜ È¿ˆÓ˜ ·ÛıÂÓ›˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Î·È À ÁÔÓfiÙ˘Ô, ÂÓÒ ÛÙÔ ¯ÚˆÌfiۈ̷ 3p26 ‰ÂÓ ·ÂÎ¿Ï˘„ ·ÓˆÌ·Ï›Â˜ ÛÙÔ˘˜ ÁfiÓÔ˘˜ ¶·È‰È·ÙÚÈ΋ 2006;69:143-149

Pediatr Mar-Apr 06

18-04-06

16:42

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148

∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ Î·È Û˘Ó.

CHL1, IL5AR, LOC51185 Î·È ITRP1, ·ÏÏ¿ ‰È·ÈÛÙÒıËΠ·ÓÙÈηٿÛÙ·ÛË Ì›·˜ ÌfiÓÔ ‚¿Û˘ ÛÙËÓ ÂÚÈÔ¯‹ CRS263(A→G), ‡ÚËÌ· Û¿ÓÈÔ ÛÙËÓ Î·˘Î¿ÛÈ· Ê˘Ï‹. ∏ ÂÚ›ÙˆÛË ·˘Ù‹ Â›Ó·È Ë ‰Â‡ÙÂÚË ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ∂ÏÏ¿‰· (13). ∆· Â˘Ú‹Ì·Ù· Ù˘ ÌÔÚȷ΋˜ ·Ó¿Ï˘Û˘ ÛÙȘ ‰‡Ô ÂÏÏËÓÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ Â›Ó·È ‰È·ÊÔÚÂÙÈο. ™ÙËÓ ÚÒÙË, ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÛÙË ı¤ÛË D3A ÛÙÔ ¯ÚˆÌfiۈ̷ 3p24.2-26, ÌÂȈ̤Ó˘ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·˜. ™ÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË Ù¤ÙÔÈ· Û˘Û¯¤ÙÈÛË ‰ÂÓ ‚Ú¤ıËÎÂ. ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛ‹ Ì·˜, ÛÙË ÛΈÙÛ¤˙ÈÎË ÔÈÎÔÁ¤ÓÂÈ·, Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÌËÙ¤Ú·˜ ¤‰ÂÈÍ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂÓ‰ÔÁÂÓ¤˜ 9-bp ¤ÏÏÂÈÌÌ· ÛÙÔ COIIRNA, οÙÈ Ô˘ ̤¯ÚÈ ÚfiÛÊ·Ù· ·ÔÙÂÏÔ‡Û ÂȉÈÎfi ‡ÚËÌ· ÛÙÔÓ ·ÛÈ·ÙÈÎfi ÏËı˘ÛÌfi. √ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ˘ÔÏÔ›ˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È Û ÂͤÏÈÍË. ∆· ÎÔÈÓ¿ ̤¯ÚÈ ÙÒÚ· Â˘Ú‹Ì·Ù· ·fi ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÛÙÔ˘˜ ‰‡Ô ·ÛıÂÓ›˜ Ì·˜, Ù· ÔÔ›· Â›Ó·È ·ÚfiÌÔÈ· Ì ÂΛӷ ÙˆÓ π·ÒÓˆÓ, ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ˘fiıÂÛË Èı·Ó‹˜ ÎÔÈÓ‹˜ ÁÔÓȉȷ΋˜ ‰È·Ù·Ú·¯‹˜ Ë ÔÔ›·, fï˜, Â›Ó·È Û¿ÓÈ· ÛÙËÓ Î·˘Î¿ÛÈ· Ê˘Ï‹. ∏ ‰È¿ÁÓˆÛË ÛÙÔ Ì¤ÏÏÔÓ ÂÚÈÛÛÔÙ¤ÚˆÓ ·ÛıÂÓÒÓ Î·È Ë Û˘ÓÂÚÁ·Û›· ÂÈÛÙËÌfiÓˆÓ Û ‰ÈÂıÓ¤˜ Â›‰Ô, ı· Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È·Ï‡ηÓÛË Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ Û¿ÓÈ·˜, ·ÏÏ¿ Î·È ÙfiÛÔ ÂӉȷʤÚÔ˘Û·˜ ·˘Ù‹˜ ÓfiÛÔ˘. ∏ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û Ó·ڿ Î·È ÂÓ‹ÏÈη ¿ÙÔÌ· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ˘fiıÂÛË fiÙÈ Î·È ÔÈ ‰‡Ô Ù‡ÔÈ Ù˘ MM Èı·Ófiٷٷ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔÓ ›‰ÈÔ ÁÂÓÂÙÈÎfi ·Ú¿ÁÔÓÙ· (4). ∏ ÔÚ›· Î·È Ë ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÚÒÙˆÓ Û˘Ìو̿وÓ. ™Â ·È‰È¿ οو ÙˆÓ 4 ÂÙÒÓ, Ë ÓfiÛÔ˜ Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· Î·È Ì ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË, ηıfiÛÔÓ Û˘Óԉ‡ÂÙ·È Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·fi ˘ÔÙÚÔ‹ ÈÛ¯·ÈÌÈÎÒÓ ‹ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ, ·fi ÌfiÓÈÌ· Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· Î·È ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË (8). ™‡Ìʈӷ Ì ٷ ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ, Ë ÚÒÈÌË ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 9 ÌËÓÒÓ, Ë Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ Î·È Ë ·ÚÔ˘Û›· Ó¢ÚÔÏÔÁÈÎÒÓ Î·Ù·ÏÔ›ˆÓ ÛÙËÓ ÚÒÙË ·ÛıÂÓ‹, ÙËÓ Î·Ù·Ù¿ÛÛÔ˘Ó ÛÙ· Û¯ÂÙÈÎÒ˜ Û¿ÓÈ· ÂÚÈÛÙ·ÙÈο. ∏ ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ ‹Íˆ˜ ÛÙËÓ ÚÒÙË ÔÈÎÔÁ¤ÓÂÈ· ·ÔÙÂÏ› Â›Û˘, ȉȷ›ÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ MM ÌÂ Û˘ÓÔ‰¤˜ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜, ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ ÛÙÔÓ ·Ûı¶·È‰È·ÙÚÈ΋ 2006;69:143-149

Ó‹ (1,15). ∂Í fiÛˆÓ ÁÓˆÚ›˙Ô˘ÌÂ, Ë ÂÚ›ÙˆÛ‹ Ì·˜ Â›Ó·È Ë ÌÔÓ·‰È΋ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ ÛÙËÓ ÔÔ›· ·Ó·Ê¤ÚÔÓÙ·È ÔÏÏ·Ϥ˜ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜ (FV-Leiden, MTHFR Î·È FII 20210A ÌÂÙ·ÏÏ¿ÍÂȘ) Ô˘ ·ÊÔÚÔ‡Ó Î·È ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜. ∆Ô ÂÚÒÙËÌ· Ô˘ Ú¤ÂÈ Ó· ··ÓÙËı› ÛÙÔ Ì¤ÏÏÔÓ Â›Ó·È ·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ‹Íˆ˜ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ‹ ·ÔÙÂÏÔ‡Ó Ù˘¯·›Ô ÁÂÁÔÓfi˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ‰‡Ô ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ: ·) ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ ÂÈÊ˘Ï·ÎÙÈ΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙ· Ôχ Ó·ڿ ¿ÙÔÌ·, ‚) ÙÂÎÌËÚÈÒÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘ Î·È Û ¿ÏϘ Ê˘Ï¤˜, ÏËÓ Ù˘ ·ÛÈ·ÙÈ΋˜ Î·È Á) ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ‡·ÚÍË ÁÂÓÂÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘. ¶ÔÏ˘ÎÂÓÙÚÈΤ˜ ÎÏÈÓÈΤ˜ ÁÂÓÂÙÈΤ˜ ÌÂϤÙ˜ ·ÔÙÂÏÔ‡Ó ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÁÈ· ÙËÓ Î·Ù¿Ù·ÍË Ù˘ ÓfiÛÔ˘ ÛÙ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù·. ∏ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ Ù˘ ‹Íˆ˜ Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ªª ÙÔÓ›˙Ô˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÂÚ·ÈÙ¤Úˆ ÌÂÏÂÙÒÓ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛÙ› Ô Èı·Ófi˜ ÙÔ˘˜ ÚfiÏÔ˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Akgun D, Yilmaz S, Senbil N, Aslan B, Gurer Y. Moyamoya syndrome with protein S deficiency. Eur J Paediatr Neurol 2000;4:185-188.

2. Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969;20:288-299.

3. Gosalakkal JA. Moyamoya disease: A Review. Neurol India 2002;50:6-10.

4. Shetty-Alva N, Alva S. Familial moyamoya disease in Caucasians. Pediatr Neurol 2000;23:445-447.

5. Houkin H, Tanaka N, Takahashi A, Kamiyama H, Abe H, Kajii N. Familial occurrence of moyamoya disease. Magnetic resonance angiography as a screening test for high-risk subjects. Childs Nerv Syst 1994;10:421-425.

6. Inoue T, Ikezaki K, Sasazuki T, Matsushima T, Fukui M. Linkage analysis of moyamoya disease on chromosome 6. J Child Neurol 2000;15:179-182.

7. Muir K, Tolmie J, Stephenson J, Petty R, Bone I. Moyamoya in Three Generations of a Scottish Family: Association with a Mitochondrial DNA Polymorphism Typical of Asian Population. Ann Neurol 1999;9 (Suppl):481.

8. Ikeda H, Sasaki T, Yoshimoto T, Fukui M, Arinami T. Mapping of a familial moyamoya disease gene to chromosome 3p24.2-p26. Am J Hum Genet 1999;64(2):533-537.

9. Caldarelli M, Di Rocco C, Gaglini P. Surgical treat-

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10. Ikezaki K. Rational Approach to Treatment of Moyamoya Disease in Childhood. J Child Neurol 2000; 15:350-356.

11. Sencer S, Poyanli A, Kiris T, Sencer A, Minareci O. Recent experience with Moyamoya disease in Turkey. Eur Radiol 2000;10:569-572.

12. Aydin K, Okuyaz C, Gucuyener K, Serdaroglu A, Akpek S. Moyamoya Disease Presented with migrainelike headache in a 4-year old girl. J Child Neurol 2003;18:361-363.

13. Zafeiriou DI, Ikeda H, Anastasiou A, Vargiami E, Vougiouklis N, Katzos G et al. Familial Moyamoya disease in a Greek family. Brain Dev 2003;25:288-290.

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15. Tsuda H, Hattori S, Nishioka S, Matsushima T, Ikezaki K, Fukui M et al. Thrombophilia found in patients with moyamoya disease. Clin Neurol Neurosurg 1997;99 (Suppl 2):S229-233.

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¶ÂÚ›ÏË„Ë: ∏ ·ÈÌfiÙ˘ÛË ·ÔÙÂÏ› Û¿ÓÈ· ÂΉ‹ÏˆÛË Î·Ù¿ ÙËÓ ·È‰È΋ ËÏÈΛ·. ∞Ú¯Èο Ú¤ÂÈ Ó· ÂȂ‚·Èˆı› fiÙÈ ÚfiÎÂÈÙ·È Ú¿ÁÌ·ÙÈ ÁÈ· ·ÈÌfiÙ˘ÛË Î·È fi¯È ÁÈ· ·ÈÌ·Ù¤ÌÂÛË ‹ Â›ÛÙ·ÍË. ∏ ·ÈÌfiÙ˘ÛË Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÛÔ‚·Ú‹˜ ÓfiÛÔ˘, Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ÌÔÈÚ·›· Â¿Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛÙ› ηٿÏÏËÏ·. ∏ oÍ›· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÔÙÂÏ› ÙÔ Û˘ÓËı¤ÛÙÂÚÔ ·›ÙÈÔ. ÕÏÏ· Û˘¯Ó¿ ·›ÙÈ· Â›Ó·È Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, Ë ÂÓÙÔÈṲ̂ÓË ‚Ï¿‚Ë ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È Ù· ηډÈÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÂÓÒ ·ÚÎÂÙ¿ Û·ÓÈfiÙÂÚ· Â›Ó·È Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ‹ Ù· Ó¢ÌÔÓÔÓÂÊÚÈο Û‡Ó‰ÚÔÌ·, ÛÙ· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture, Ë ÎÔÎÎȈ̿وÛË Wegener, Ë ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ· Î·È Ë ·Ó·Ê˘Ï·ÎÙÔÂȉ‹˜ ÔÚʇڷ. √ ¤ÏÂÁ¯Ô˜ Ì ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Â›Ó·È ÂȂ‚ÏË̤ÓÔ˜, ·Ó Î·È ÛÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÌfiÙ˘ÛË, ·˘Ù‹ ı· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È Ë ÂÎÙ¤ÏÂÛË ‚ÚÔÁ¯ÔÛÎfiËÛ˘ Ì ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË, ÚÔÛʤÚÔ˘Ó È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ·ÈÌfiÙ˘Û˘. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÈÌfiÙ˘ÛË ˘Ô¯ˆÚ› ·˘ÙfiÌ·Ù· ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ˘ÔΛÌÂÓË ·ÈÙÈÔÏÔÁ›· Î·È ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ì·˙È΋˜ ·ÈÌfiÙ˘Û˘ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË Ì ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ, ÙËÓ ÂÌ‚ÔÏ‹ ÙÔ˘ ˘‡ı˘ÓÔ˘ ·ÁÁ›Ԣ Î·È ÙËÓ Ó¢ÌÔÓÂÎÙÔÌ‹. §¤ÍÂȘ ÎÏÂȉȿ: ∞ÈÌfiÙ˘ÛË, ÏÔÈÌÒÍÂȘ ·Ó·Ó¢ÛÙÈÎÔ‡, ·È‰È΋ ËÏÈΛ·.

Haemoptysis in children 1 Paediatrician, ICU, Resident Penteli Children’s Hospital, Athens 2 Director, 1st Paediatric Clinic, Penteli Children’s Hospital, Athens Correspondence: Vassilopoulou Maria, 3, Kifissou Str., 152 34, Chalandri, Greece Date of submission: 20-04-2005 Date of approval: 10-02-2006

M.N. Vassilopoulou1, N. Myriokefalitakis2

Abstract: Haemoptysis is rare during childhood. In its management it is first important to distinguish between haemoptysis and haematemesis or epistaxis. Haemoptysis may indicate the presence of severe disease, which could be fatal if not treated appropriately. ∞cute lower respiratory tract infection is the most common cause. Other common causes are cystic fibrosis, localised airway lesions and heart disease. More rare causes include idiopathic pulmonary haemosiderosis and the pulmonary-renal syndromes, which include systemic lupus erythematosus, Goodpasture’s syndrome, Wegener’s granulomatosis, microscopic polyangiitis and Henoch-Schonlein purpura. A plain chest radiograph is mandatory, although one third of children with haemoptysis have a normal chest radiograph. Thorax computed tomography and bronchoalveolar lavage are of great assistance in the investigation. In the majority of children the haemoptysis resolves spontaneously, without the need for invasive measures.

The treatment of the child with haemoptysis depends on the underlying aetiology and on the extent of the bleeding. Bronchoscopy with a rigid bronchoscope, embolization of the suspected vessel and surgical resection of the affected lung segment might be required in case of massive bleeding.

Key words: Haemoptysis, respiratory tract infections, childhood.

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∞ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù· AÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈο ·ÓÙÈÛÒÌ·Ù· ∞nti-ds DNA AÓÙÈÛÒÌ·Ù· ηٿ Ù˘ ‰ÈÏ‹˜ ·Ï‡ÛÔ˘ ÙÔ˘ DNA Anti-GBM AÓÙÈÛÒÌ·Ù· ηٿ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159

∞ƒ∆∆ GPS HSP π¶∞ ªƒ MRI ƒ∆

ÃÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÈÛÙÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ ™‡Ó‰ÚÔÌÔ Goodpasture ¶ÔÚʇڷ Henoch-Schonlein π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ªÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁ›Ùȉ· M·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÃÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·151

151

∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿

SLE/™∂§ SIDS ∆∫∂ WG

™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ ™‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ ∆·¯‡ÙËÙ· ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ∫ÔÎÎȈ̿وÛË Wegener

∂ÈÛ·ÁˆÁ‹ ø˜ ·ÈÌfiÙ˘ÛË ÔÚ›˙ÂÙ·È Ë ·Ô‚ÔÏ‹ ·›Ì·ÙÔ˜ Ì ÙÔÓ ‚‹¯· ‹ Ë ·ÚÔ˘Û›· ·›Ì·ÙÔ˜ ÛÙ· Ù‡ÂÏ·. ™˘Ó‹ıˆ˜ Ë ·ÈÌfiÙ˘ÛË Â›Ó·È ‹È·˜ ‚·Ú‡ÙËÙ·˜ Î·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË, Û¿ÓÈ· fï˜ Ë ·ÈÌÔÚÚ·Á›· ÌÔÚ› Ó· Â›Ó·È Ì·˙È΋ (>8 ml/Kg/24ˆÚÔ) Î·È Ó· ·ÂÈÏ‹ÛÂÈ ÙË ˙ˆ‹ (1). ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÛÙËÓ ·ÁÁ›ˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ÔÈ Ó¢ÌÔÓÈΤ˜ ·ÚÙËڛ˜ (Ó¢ÌÔÓÈ΋ ΢ÎÏÔÊÔÚ›·) Î·È ÔÈ ‚ÚÔÁ¯ÈΤ˜ ·ÚÙËڛ˜ (Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·). ŸÙ·Ó Ë ·ÈÌÔÚÚ·Á›· ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ Ó¢ÌÔÓÈΤ˜ ·ÚÙËڛ˜ (Û‡ÛÙËÌ· ¯·ÌËÏÒÓ ȤÛˆÓ), Ë ·ÈÌfiÙ˘ÛË Â›Ó·È Û˘Ó‹ıˆ˜ ÌÈÎÚÔ‡ fiÁÎÔ˘, ÂÓÒ fiÙ·Ó ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ ‚ÚÔÁ¯ÈΤ˜ (Û‡ÛÙËÌ· ˘„ËÏÒÓ ȤÛˆÓ), Ù›ÓÂÈ Ó· Â›Ó·È Ì·˙È΋ (2). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·ÈÌfiÙ˘Û˘ ÛÙÔÓ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ì ·ÎÚ›‚ÂÈ·, ·ÊÔ‡ Ù· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ Û·ÓÈfiٷٷ ÚÔÛ¤Ú¯ÔÓÙ·È Ì ÚÔÂÍ¿Ú¯ÔÓ Û‡Ìو̷ ÙËÓ ·ÈÌfiÙ˘ÛË, ηıÒ˜ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ηٷ›ÓÔ˘Ó Ù· Ù‡ÂÏ¿ ÙÔ˘˜ (1).

¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÈÌfiÙ˘Û˘ Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘ ÛÙ· ·È‰È¿ ™˘Ó‹ıË ñ ∂ÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ñ §Ô›ÌˆÍË - ∆Ú·¯ÂÈÔ‚ÚÔÁ¯›Ùȉ· - ¶Ó¢ÌÔÓ›· (ÌÈÎÚԂȷ΋ - Ì˘ÎËÙÈ·ÛÈ΋ Ê˘Ì·ÙÈ҉˘ - ·Ú·ÛÈÙÈ΋) - ¶Ó¢ÌÔÓÈÎfi ·fiÛÙËÌ· ñ µÚÔÁ¯ÂÎÙ·Û›· (ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, ‰˘ÛÎÈÓËÛ›· ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·,·fiÙÔÎË Ïԛ̈͢ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡) ∞Û˘Ó‹ıË ·ÏÏ¿ fi¯È Û¿ÓÈ· ñ ∆Ú·‡Ì· ñ ¶·ı‹ÛÂȘ Ù˘ ηډȿ˜ - ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· (·fiÊÚ·ÍË ÙˆÓ ·ÚÈÛÙÂÚÒÓ ÎÔÈÏÔًوÓ) - ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË - ¶Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ ™¿ÓÈ· ñ ŸÁÎÔÈ - ªÂÙ·ÛÙ·ÙÈÎfi ÓÂfiÏ·ÛÌ· - ∞‰¤ÓˆÌ· ‚ÚfiÁ¯ˆÓ - ∫·ÚÎÈÓÔÂȉ¤˜ ñ ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙˆÓ Ó¢ÌfiÓˆÓ ¶Ó¢ÌÔÓÈ΋ ·ÚÙËÚÈÔÊÏ‚҉˘ ‰˘ÛÏ·Û›·, ‚ÚÔÁ¯ÔÁÂÓ‹˜ ·ÛÙË, Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì·, ·ÈÌ·ÁÁ›ˆÌ· ñ ∞ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË ¢Â˘ÙÂÚÔ·ı‹˜ Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿

™˘ÓÔÙÈο, ÔÈ Î·Ù·ÛÙ¿ÛÂȘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ·ÈÌfiÙ˘Û˘ ÛÙ· ·È‰È¿, ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆·ÍÈÓÔÌÔ‡ÓÙ·È Ì ÎÚÈÙ‹ÚÈÔ ÙË Û˘¯ÓfiÙËÙ· Ì ÙËÓ ÔÔ›· ·˘Ù¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È (3).

∂Í·ÈÚÂÙÈÎÒ˜ Û¿ÓÈ· ñ π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ñ ∞ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ñ ∞ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· ηٿ ÙˆÓ ·ÁÁ›ˆÓ Ó¢ÌfiÓˆÓ Î·È ÓÂÊÚÒÓ - ™‡Ó‰ÚÔÌÔ Goodpasture - ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ - ∫ÔÎÎȈ̿وÛË Wegener - MÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂi›Ùȉ· - ¶ÔÚʇڷ Henoch-Schonlein ñ ∞ÈÌfiÙ˘ÛË “ηٿ Ê·ÓÙ·Û›·Ó”

™˘Ó‹ıË ·›ÙÈ· ∏ ÔÍ›· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ·ÈÌfiÙ˘Û˘ ‹È·˜ ‚·Ú‡ÙËÙ·˜ (¤ˆ˜ Î·È 40% ÙˆÓ ÂÚÈÙÒÛˆÓ) (1). ∏ ¯ÚfiÓÈ· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ȉ›ˆ˜ fiÙ·Ó ·˘Ù‹ Û˘Ó‰˘¿˙ÂÙ·È Ì ‚ÚÔÁ¯ÂÎٷۛ˜, ÂΉËÏÒÓÂÙ·È Û˘¯Ó¿ ˆ˜ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ (4). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ‚ÚÔÁ¯ÂÎÙ·Û›·˜ ÛÙÔÓ ·ÓÂÙ˘Á̤ÓÔ ÎfiÛÌÔ Â›Ó·È Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜. ¶ÂÚ›Ô˘ 5%

ÙˆÓ ·ÛıÂÓÒÓ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ì·˙È΋ ·ÈÌfiÙ˘ÛË. ÕÏÏ· Û·ÓÈfiÙÂÚ· ·›ÙÈ· ‚ÚÔÁ¯ÂÎÙ·Û›·˜ Â›Ó·È ÏÔÈÌÒÍÂȘ, fiˆ˜ Ô ÎÔÎ·Ù˘, Ë ÈÏ·Ú¿, Ë Ê˘Ì·Ù›ˆÛË, ‰È¿ÊÔÚ· Û‡Ó‰ÚÔÌ· ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, Ë ¤ÏÏÂÈ„Ë Ù˘ ·1-·ÓÙÈıÚ˘„›Ó˘ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ‰˘ÛÎÈÓËÛ›·˜ ÙÔ˘ ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘. ∏ ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓÈ΋ Ê˘Ì·Ù›ˆÛË ·ÔÙÂÏ› ·›ÙÈÔ ·ÈÌfiÙ˘Û˘ Û ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1% (2).

∞ÈÙÈÔÏÔÁ›·

¶·È‰È·ÙÚÈ΋ 2006;69:150-159

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·152

152

ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘

∏ ¯ÚfiÓÈ· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÔÚ› Â›Û˘ Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ¤Ó· ͤÓÔ ÛÒÌ· Ô˘ ¤¯ÂÈ ÂÈÛÚÔÊËı› ¯ˆÚ›˜ ·˘Ùfi Ó· ¤¯ÂÈ Á›ÓÂÈ ·ÓÙÈÏËÙfi. ∞Ó Î·È Ë ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ȉ›ˆ˜ Û ·ÁfiÚÈ· 1-3 ÂÙÒÓ, ·ÈÌfiÙ˘ÛË ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È È‰È·›ÙÂÚ· Û˘¯Ó¿, ·ÎfiÌË Î·È Ì ÙËÓ ÂÈÛÚfiÊËÛË Ô͇·È¯ÌˆÓ ·ÓÙÈÎÂÈ̤ӈÓ, fiˆ˜ Â›Ó·È ÔÈ ÈÓ¤˙˜, ÔÈ Î·ÚÊ›ÙÛ˜ Î.¿. ∏ ·ÈÌÔÚÚ·Á›· Û˘Ì‚·›ÓÂÈ Û˘Ó‹ıˆ˜ ηٿ ÙËÓ ·Ê·›ÚÂÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘, ÙÔ ÔÔ›Ô ¤¯ÂÈ ·Ú·Ì›ÓÂÈ ÛÙÔÓ Ó‡ÌÔÓ· ÁÈ· ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÒÛÙ ӷ ÂÈϷΛ Ì Ïԛ̈ÍË (3). ∞Û˘Ó‹ıË ·ÏÏ¿ fi¯È Û¿ÓÈ· ·›ÙÈ· √ ¿ÌÂÛÔ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ıÒڷη ÏfiÁˆ ÙÚÔ¯·›Ô˘ ·Ù˘¯‹Ì·ÙÔ˜ ‹ ·fi ¿ÏÏÔ ·›ÙÈÔ, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ıÏ¿ÛË ÙÔ˘ Ó‡ÌÔÓ· Î·È ÂÓ›ÔÙ Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›·. ™Â ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ‚ÚÂÊÒÓ Ô˘ η٤ÏËÍ·Ó ÏfiÁˆ Û˘Ó‰ÚfiÌÔ˘ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ (SIDS), ‰È·ÈÛÙÒıËΠ̠ÙË ÓÂÎÚÔ„›· ‡·ÚÍË ·›Ì·ÙÔ˜ ›Ù ÛÙÔ ÛÙfiÌ· ›Ù ÛÙÔ˘˜ Ó‡ÌÔÓ˜ (5). º·›ÓÂÙ·È fiÙÈ Ë ·ÛÊ˘Í›· - ›ÙÂ Ù˘¯·›·, ›Ù ÛÙ· Ï·›ÛÈ· ·È‰È΋˜ ηÎÔÔ›ËÛ˘ - ·ÔÙÂÏ› ¤Ó· ·fi Ù· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· ÙÚ·˘Ì·ÙÈ΋˜ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿. ™ËÌ·ÓÙÈ΋ ·ÈÙ›· ·ÈÌfiÙ˘Û˘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë ˘¤ÚÙ·ÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ ‹ Ù˘ Ó¢ÌÔÓÈ΋˜ ÊϤ‚·˜ ÏfiÁˆ Â›ÎÙËÙ˘ ‹ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ (.¯. ÛÙ¤ÓˆÛË ÌÈÙÚÔÂȉԇ˜) (4). ™·ÓÈfiÙÂÚ·, Ë Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÙÔ ÚÒÙÔ Û‡Ìو̷ Û ¤Ó· ·È‰› Ì ȉÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË. ∂›Û˘, ·ÈÌfiÙ˘ÛË ÌÔÚ› Ó· ·Ú·ÙËÚËı› ÏfiÁˆ Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜ Û ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÛÔ‚·Úfi ˘ÔΛÌÂÓÔ ÓfiÛËÌ· (ηډÈÔ¿ıÂÈ·, ‰È·Ù·Ú·¯¤˜ Ù˘ ‹Í˘, ηÎÔ‹ıÂÈ· ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ÈÛÙÔ‡ Û ·ÁˆÁ‹ Ì ¯ËÌÂÈÔıÂÚ·›·, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·) ‹ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (ηıÂÙ‹Ú· ÎÂÓÙÚÈ΋˜ ÊϤ‚·˜, ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (6). ™¿ÓÈ· ·›ÙÈ· ªÂٷ͇ ÙˆÓ Û¿ÓÈˆÓ ·ÈÙ›ˆÓ Ù· ÔÔ›· ÔÊ›ÏÂÈ Ó· ‰ÈÂÚ¢ӋÛÂÈ Î·Ó›˜ ˆ˜ Èı·Ófi ·›ÙÈÔ ·ÈÌfiÙ˘Û˘ Â›Ó·È ÔÈ fiÁÎÔÈ. ™˘Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ÌÂÙ·ÛÙ·ÙÈο ÓÂÔÏ¿ÛÌ·Ù· - ÓÂÊÚÔ‚Ï¿Ûو̷, ÔÛÙÂÔÂȉ¤˜ Û¿ÚΈ̷, Ë·ÙÔ‚Ï¿Ûو̷ Î·È Û·ÓÈfiÙÂÚ· ÁÈ· ÚˆÙÔ·ı‹, fiˆ˜ ÙÔ ‚ÚÔÁ¯ÈÎfi ηÚÎÈÓÔÂȉ¤˜ Û‡Ó‰ÚÔÌÔ ‹ ÙÔ Ó¢ÌÔÓÈÎfi

¶·È‰È·ÙÚÈ΋ 2006;69:150-159

·‰¤ÓˆÌ· (1). ∞ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. ∏ Û˘¯ÓfiÙËÙ· ·ÈÌfiÙ˘Û˘ Ô˘ ÔÊ›ÏÂÙ·È Û οÔÈÔ fiÁÎÔ Î˘Ì·›ÓÂÙ·È ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·fi 2,6%-6% (4). ∂›Û˘, Â›Ó·È ‰˘Ó·Ùfi Ó· ÂΉËψıÔ‡Ó Ì ·ÈÌfiÙ˘ÛË ÔÚÈṲ̂Ó˜ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ηٿ ÙË ‰È¿Ï·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ, fiˆ˜ ÔÈ ‚ÚÔÁ¯ÔÁÂÓ›˜ ·ÛÙÂȘ (7), ÙÔ Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì·, ÔÈ ÔÏÏ·Ϥ˜ ·ÚÙËÚÈÔ-ÊÏ‚҉ÂȘ ÂÈÎÔÈӈӛ˜, ÔÈ Ôԛ˜ ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Rendu-OslerWeber) (8) Î·È Ë ·ÈÌ·ÁÁÂȈ̿وÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ÙÚȯÔÂȉÒÓ (9). ¢È¿¯˘ÙË Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ 5% ÙˆÓ ·ÓÔÛÔηÙÂÛÙ·ÏÌ¤ÓˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (10) ηٿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÚÒÈÌ˘ ÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋˜ ÂÚÈfi‰Ô˘ (11). √ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·˘Ù‹˜ Ù˘ ÂÈÏÔ΋˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛı›. √È ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó‹ıˆ˜ ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ì ˘ÔÍ·ÈÌ›· Î·È Û·ÓÈfiÙÂÚ· ·ÈÌfiÙ˘ÛË. ¶Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ· ·È‰È¿ ÏfiÁˆ ÚˆÙÔ·ıÔ‡˜ ·ÈÌ·ÙÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ Â›Ó·È ÙÂÏ›ˆ˜ ·Û˘Ó‹ı˘. ∂Í·ÈÚÂÙÈο Û¿ÓÈ· ·›ÙÈ· ™·ÓÈfiÙÂÚ·, Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ· ·È‰È¿ ·Ú·ÙËÚÂ›Ù·È ÛÙ· Ï·›ÛÈ· Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÛȉ‹ÚˆÛ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈ΋ Û˘Ó‰ÚÔÌ‹, Ë ÂÈÎfiÓ· Ù˘ ÔÔ›·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚‹¯·, ‰‡ÛÓÔÈ·, ·ÈÌfiÙ˘ÛË, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· Î·È ‰È¿¯˘Ù˜ ‰ÈËı‹ÛÂȘ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚÂȘ ·ÓÂÍ¿ÚÙËÙ˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜: 1) ÙËÓ È‰ÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË, 2) ÙËÓ ·ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È 3) ÙËÓ ·ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· ηٿ ÙˆÓ ·ÁÁ›ˆÓ Ó¢ÌfiÓˆÓ Î·È ÓÂÊÚÒÓ ÛÙ· Ï·›ÛÈ· ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜. π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË Ÿˆ˜ ÚԷӷʤÚıËÎÂ, Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ·ÔÙÂÏ› Û¿ÓÈ· ηٿÛÙ·ÛË, ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜, ÛÙËÓ ÔÔ›· Ë ·ıÔÏÔÁ›· ÂÚÈÔÚ›˙ÂÙ·È ÛÙÔ˘˜ Ó‡ÌÔÓ˜ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ÓÂÊÚÈ΋ ‹ Û˘ÛÙËÌ·ÙÈ΋ Û˘ÌÌÂÙÔ¯‹. ∏ ÂÙ‹ÛÈ· Â›ÙˆÛ‹ Ù˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 0,241,23 ÂÚÈÙÒÛÂˆÓ ·Ó¿ ¤Ó· ÂηÙÔÌ̇ÚÈÔ ·È‰È¿ (12). ∏ π¶∞, ̤¯ÚÈ ÚfiÙÈÓÔ˜, ÈÛÙ¢fiÙ·Ó fiÙÈ ¤¯ÂÈ Ôχ η΋ ÚfiÁÓˆÛË, Ê·›ÓÂÙ·È fï˜, fiÙÈ Ë

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·153

153

∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿

ÚfiÁÓˆÛ‹ Ù˘ ÙÂÏÂ˘Ù·›· ¤¯ÂÈ ‚ÂÏÙȈı› ¯¿ÚË ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ (13,14). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔ¤˜ ·ÈÌfiÙ˘Û˘, Ì ¤Ó·ÚÍË ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û ËÏÈΛ· <6 ÂÙÒÓ Î·È ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ·Ó·ÈÌ›·. ∏ ‚·Ú‡ÙËÙ· Ù˘ ·ÈÌfiÙ˘Û˘ Î˘Ì·›ÓÂÙ·È ·fi ·ÈÌÔÚÚ·Á›· ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹, ¤ˆ˜ ‰È·Ï›Ô˘Û· ·Ô‚ÔÏ‹ ·ÈÌ·ÙËÚÒÓ Ù˘¤ÏˆÓ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÎÚ›ÛˆÓ, ÔÈ Ôԛ˜ ‰È·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ 2-4 Ë̤Ú˜, ÔÈ ·ÛıÂÓ›˜ ÂÓ‰¤¯ÂÙ·È Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÚÂÙfi, ‰‡ÛÓÔÈ·, ˘ÔÍ›· Î·È ÂÈÎfiÓ· ¯ÚfiÓÈ·˜ ÎfiˆÛ˘, ÂÓÒ Â›Ó·È ÂχıÂÚÔÈ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ· ÌÂÛԉȷÛÙ‹Ì·Ù· ÙˆÓ ˘ÔÙÚÔÒÓ. ∏ ·Ó¿ÚÚˆÛË ÌÔÚ› Ó· Â›Ó·È ÂÎÏËÎÙÈο Ù·¯Â›· Î·È Ï‹Ú˘, ÂÎÙfi˜ ‚¤‚·È· ·fi ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÍ·ÈÙ›·˜ Ù˘ ÛȉËÚÔÂÓÈ΋˜ ·Ó·ÈÌ›·˜ Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ¤¯ÂÈ Î·È ·Ó·ÏfiÁˆ˜ Ì ÙÔÓ ‚·ıÌfi Ù˘. ™Ù· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, ÛÙ· ÔÔ›· Â›Ó·È ‰˘Ó·Ù‹ Ë ÂÎÙ¤ÏÂÛË ‰ÔÎÈÌ·ÛÈÒÓ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ù· Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·Ù¿ Ì Ó¢ÌÔÓÔ¿ıÂÈ· ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘. ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙËÓ ·Ó‡ÚÂÛË ÛȉËÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ ÛÙȘ ‚ÚÔÁ¯ÈΤ˜ ‹ Á·ÛÙÚÈΤ˜ ÂÎÎÚ›ÛÂȘ 3-14 Ë̤Ú˜ ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ ÎÚ›Û˘ Î·È ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ÏÔÈÒÓ ·ÈÙ›ˆÓ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô Û¿ÓÈ·, ··ÈÙ› ‚ÈÔ„›· Ó‡ÌÔÓ·. πηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË Ú‰ÓÈ˙ÔÏfiÓ˘ ‹ ÒÛÂˆÓ ÌÂı˘Ï-Ú‰ÓÈ˙ÔÏfiÓ˘, ˘‰ÚÔ͢¯ÏˆÚÔΛÓ˘, ΢ÙÙ·ÚÔÙÔÍÈÎÒÓ ÌfiÓˆÓ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì Ú‰ÓÈ˙ÔÏfiÓË (3,13-15). ™Â ·ÛıÂÓ›˜ Ô˘ ·Ó·ÚÚÒÓÔ˘Ó ·fi π¶∞, Ë Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÌÔÚ› Ó· Â›Ó·È ·Ôχو˜ Ê˘ÛÈÔÏÔÁÈ΋, ÂÊfiÛÔÓ ‰ÂÓ ·ÚÔ˘ÛÈ·ÛÙ› ˘ÔÙÚÔ‹ Ù˘ ·ÈÌÔÚÚ·Á›·˜. ™Â ÚfiÛÊ·ÙË Û¯ÂÙÈο ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È ÂÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË Ô˘ Êı¿ÓÂÈ ÙÔ 86% (13), Û ·ÓÙȉȷÛÙÔÏ‹ Ì ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó Ù˘ Ù¿Í˘ ÙÔ˘ 50-60% (3). ¶ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ˘ÂÚ¢·ÈÛıËÛ›· ÛÙÔ Á¿Ï· Ù˘ ·ÁÂÏ¿‰·˜ (™. Heiner) ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ÛÙËÓ ÔÔ›· ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ Ù˘È΋ ÂÈÎfiÓ· Ù˘ π¶∞, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯ÚfiÓÈ· ÚÈÓ›Ùȉ·, ˘ÔÙÚÔÈ¿˙Ô˘Û· ̤ÛË ˆÙ›Ùȉ·, Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi, ηı˘ÛÙ¤ÚËÛË Ù˘ ·‡ÍËÛ˘ Î·È ·ÚÔ˘-

Û›· ÛÙÔÓ ÔÚfi ·ÓÙÈÛˆÌ¿ÙˆÓ IgG ¤Ó·ÓÙÈ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÎÙÔ˜ (milk precipitins). Œ¯ÂÈ Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË ·fi ÙËÓ π¶∞. ∞ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· ηٿ ÙˆÓ ·ÁÁ›ˆÓ Ó¢ÌfiÓˆÓ Î·È ÓÂÊÚÒÓ (Ó¢ÌÔÓÔÓÂÊÚÈο Û‡Ó‰ÚÔÌ·) ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture, Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ (™∂§), Ë ÎÔÎÎȈ̿وÛË Wegener, Ë ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ· Î·È Ë ·Ó·Ê˘Ï·ÎÙÈ΋ ÔÚʇڷ (¶›Ó·Î·˜ 2). ™ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture Î·È ÛÙÔÓ ™∂§ ·Ú·ÙËÚÂ›Ù·È ‰È¿¯˘ÙË Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ· Ï·›ÛÈ· Ó¢ÌÔÓÈ΋˜ ·ÁÁÂÈ›Ùȉ·˜, ÂÓÒ ÛÙËÓ ÎÔÎÎȈ̿وÛË Wegener Î·È ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ· Ë ·ÈÌÔÚÚ·Á›· ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ÛËÏ·ÈÒ‰ÂȘ ‚Ï¿‚˜. ∆· “ÌË ÂȉÈο Ó¢ÌÔÓÔ-ÓÂÊÚÈο” Û‡Ó‰ÚÔÌ·, ·ÊÔÚÔ‡Ó ·È‰È¿ Ì ÓÂÊÚÔ¿ıÂÈ·, ÛÙ· Ï·›ÛÈ· Ù˘ ÔÔ›·˜ ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÛ‚ÏËıÔ‡Ó Î·È ÔÈ Ó‡ÌÔÓ˜ (‚Ï. Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·, ÂÌ‚ÔÏ‹ ‹ Ïԛ̈ÍË Û ·È‰› Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ) (17). ™‡Ó‰ÚÔÌÔ Goodpasture: ∆Ô Û‡Ó‰ÚÔÌÔ Goodpasture Â›Ó·È ¤Ó· ·˘ÙÔ¿ÓÔÛÔ ÓfiÛËÌ· ÙÔ ÔÔ›Ô ÔÊ›ÏÂÙ·È ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ. ¶ÚÔÛ‚¿ÏÏÔÓÙ·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ÔÈ ÓÂÊÚÔ› Î·È ÔÈ Ó‡ÌÔÓ˜. √È ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· Î·È Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›·. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ÛÙÔÓ ÔÚfi ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜ ÙˆÓ ÓÂÊÚÒÓ, ÂÓÒ Û¿ÓÈ· Â›Ó·È ·Ó·Áη›· Ë ‚ÈÔ„›· ÙÔ˘ ÓÂÊÚÔ‡ ‹ ÙÔ˘ Ó‡ÌÔÓ·. ∞Ó Î·È Â›Ó·È Û˘ÓËı¤ÛÙÂÚÔ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture ¤¯ÂÈ ·Ú·ÙËÚËı› ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· Î·È ÛÙ· ·È‰È¿, ÌÂ Ù˘Èο ÎÏÈÓÈο Î·È ·ÓÔÛÔÏÔÁÈο Â˘Ú‹Ì·Ù· (18). ∏ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯Ú‹ÛË Ï·ÛÌ·Ê·›ÚÂÛ˘ Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ. ∏ ·ÓÙ·fiÎÚÈÛË, ÂÊfiÛÔÓ Ë ıÂÚ·›· ·Ú¯›˙ÂÈ ÛÙËÓ ·Ú¯È΋ Ê¿ÛË Ù˘ ÓfiÛÔ˘, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Î·Ï‹, ·Ó Î·È ˘¿Ú¯Ô˘Ó Ï›Á˜ ·Ó·ÊÔÚ¤˜ Û¯ÂÙÈο Ì ÙËÓ ¤Î‚·Û‹ Ù˘ ÛÙ· ·È‰È¿. ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜: ∆Ô 8% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ Â›Ó·È ·È‰È¿ ‹ ¤ÊË‚ÔÈ, ÂÓÒ ÙÔ 90% ·˘ÙÒÓ Â›Ó·È ÎÔÚ›ÙÛÈ·. ∏ ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ù· 11 ¤ÙË (19). √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙ· ·È‰È¿ Â›Ó·È ·ÚfiÌÔȘ Ì ·˘Ù¤˜ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ¶·È‰È·ÙÚÈ΋ 2006;69:150-159

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·154

154

ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘

¶›Ó·Î·˜ 2. ÷ڷÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙˆÓ Ó¢ÌÔÓÔ-ÓÂÊÚÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ (3) ™‡Ó‰ÚÔÌÔ ™˘ÛÙËÌ·ÙÈÎfi˜ ∫ÔÎÎȈ̿وÛË ªÈÎÚÔÛÎÔÈ΋ ¶ÔÚʇڷ Goodpasture ∂Ú˘ıËÌ·Ù҉˘ Wegener ¶ÔÏ˘·ÁÁ›ÈÙȉ· Henoch-Schonlein §‡ÎÔ˜ ¶Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ++++ ™ÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ++++ ™˘ÌÌÂÙÔ¯‹ ·ÓÒÙÂÚÔ˘ 0 ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ· 0/+ ∞ÚıÚ·ÏÁ›· 0 ∆∫∂ 0/+ ™˘ÌÌÂÙÔ¯‹ ÂÙÈÎÔ‡ 0 £ÂÙÈÎÔÔ›ËÛË Anti-GBM, ÔÚÔÏÔÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ p-ANCA (Û¿ÓÈ·) ∞ÓÙÈÌÂÙÒÈÛË

∫/™ ∫/∆ ¶Ï·ÛÌ·Ê·›ÚÂÛË

+/++ +++/++++ +/++

+++ ++++ ++++

+++ ++++ ++

+ ++++ 0

++++ ++++ ++++ 0 ∞¡∞, Anti-ds DNA, p-ANCA (Û¿ÓÈ·) ∫/™ ∫/∆

+++ +++ ++++ 0 c-ANCA, p-ANCA (Û¿ÓÈ·)

+++ +++ ++++ 0 p-ANCA, c-ANCA

++++ ++++ + ++++ IgA+ IgM+

∫/™ ∫/∆

∫/™ ∫/∆;

∫/™

Anti-GBM: ∞ÓÙÈÛÒÌ·Ù· ηٿ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜, ∞¡∞: ∞ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù·, ds DNA: ¢ÈÏ‹˜ ¤ÏÈη˜ DNA, ANCA: ∞ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈο ·ÓÙÈÛÒÌ·Ù·, ∫/™: ∫ÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹, ∫/∆: ∫˘ÙÙ·ÚÔÙÔÍÈο

¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÂÌ‡ÚÂÙÔ˘, ·ÚıÚ›Ùȉ·˜, ÂÍ·Óı‹Ì·ÙÔ˜ Î·È ÓÂÊÚÔ¿ıÂÈ·˜. ∏ Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ Ï¢ڛÙȉ·. ¢È¿¯˘ÙË Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›· ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÙÔ 6% ÙˆÓ ·È‰ÈÒÓ Ì ™∂§ (19,20). ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ∞¡∞ Î·È anti-ds DNA ÛÙÔÓ ÔÚfi. ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÌË-ÛÙÂÚÈÓÔÂȉÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ ‹ ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ. ™Â ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜, fiˆ˜ Â›Ó·È Ë Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›·, ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÒÛÂȘ ÌÂı˘ÏÔÚÂÓ‰È˙ÔÏfiÓ˘ Î·È Î˘ÎÏÔʈÛÊ·Ì›‰Ë˜, ÂÓÒ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ‚ÔËı¿ Ë Ï·ÛÌ·Ê·›ÚÂÛË. ∏ ÚfiÁÓˆÛË ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ‹Ù·Ó η΋ (21,22). ∫ÔÎÎȈ̿وÛË Wegener Î·È ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ·: ¶ÚfiÎÂÈÙ·È ÁÈ· ۯ‰fiÓ Ù·˘ÙfiÛË̘ ηٷÛÙ¿ÛÂȘ, ÔÈ Ôԛ˜ ‰È·ÎÚ›ÓÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜ Ì ÌfiÓÔ ÎÚÈÙ‹ÚÈÔ ÙË ıÂÙÈÎÔÔ›ËÛË ‹ ÌË ÂȉÈÎÒÓ ÔÚÔÏÔÁÈÎÒÓ ÂÍÂÙ¿ÛˆÓ. ™ÙË ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁ›Ùȉ· (MP) ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔÓ ÔÚfi Ù· p-ANCA Î·È Ù· c-ANCA ·ÓÙÈÛÒÌ·Ù·, ÂÓÒ ÛÙËÓ ÎÔÎÎȈ̿وÛË Wegener ·Ó¢ڛÛÎÔÓÙ·È Û˘Ó‹ıˆ˜ ÌfiÓÔ Ù· cANCA. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ·˘Ù‹ Ù˘ Ó¢ÌÔÓÈ΋˜ ÎÔÎÎȈ̿وÛ˘, Ì ‰ËÌÈÔ˘ÚÁ›· ÛËÏ·›ˆÓ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜, ‚Ï¿‚˜ ÙˆÓ ·ÓˆÙ¤¶·È‰È·ÙÚÈ΋ 2006;69:150-159

ÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È Û˘ÓÔ‰¤˜ ‚Ï¿‚˜ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ ÓÂÊÚÒÓ. ∞ÈÌfiÙ˘ÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÏfiÁˆ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙȘ ÛËÏ·ÈÒ‰ÂȘ ‚Ï¿‚˜ (17) Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·fi 5% ¤ˆ˜ 45% (22). ∏ ·ÁˆÁ‹ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ Î·È Î˘ÎÏÔʈÛÊ·Ì›‰Ë˜. √È ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÌÊ·Ó›˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ÂÈÏÔΤ˜ fiˆ˜ ˘ÔÁψÙÙȉÈ΋ ÛÙ¤ÓˆÛË Î·È ÚÈÓÈ΋ ‰˘ÛÌÔÚÊ›· - Û ۯ¤ÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ (23). ∞Ó·Ê˘Ï·ÎÙÔÂȉ‹˜ ÔÚʇڷ (ÔÚʇڷ HenochSchonlein): ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ù˘ÈÎfi ÂÍ¿ÓıËÌ· ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È Û˘ÌÙÒÌ·Ù· ÛÙȘ ·ÚıÚÒÛÂȘ. √È ÂΉËÏÒÛÂȘ ·˘Ù¤˜ Û˘Ó‹ıˆ˜ ˘Ê›ÂÓÙ·È ·˘ÙfiÌ·Ù· ‹ Û ·¿ÓÙËÛË ıÂÚ·›·˜ Ì ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ·Ó¿ÁÎË. ¶ÂÚÈÛÙ·Ûȷο, Ë ÓfiÛÔ˜ Â›Ó·È ÈÔ ÛÔ‚·Ú‹, Ì ÓÂÊÚÈ΋ Û˘ÌÌÂÙÔ¯‹, ÂÓÒ Û Ôχ Û¿ÓȘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ÂΉËψı› ‰È¿¯˘ÙË Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›·. ™ÔÚ·‰Èο, ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ·Ó·Ê˘Ï·ÎÙÔÂȉ‹ ÔÚʇڷ Î·È Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· Î·È ·ÚfiÏÔ Ô˘ Ù· ·È‰È¿ ·˘Ù¿ ‹Ù·Ó Û Ôχ ÛÔ‚·Ú‹ ηٿÛÙ·ÛË, Ë ¤Î‚·Û‹ ÙÔ˘˜ ‹Ù·Ó Ôχ ηϋ ÌÂÙ¿ ÙË ıÂÚ·›· Ì ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ ‹ ΢ÙÙ·ÚÔÙÔÍÈο Ê¿Ú̷η (16,24).

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·155

155

∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿

“∫·Ù¿ Ê·ÓÙ·Û›·Ó” ·ÈÌfiÙ˘ÛË ¶ÚfiÎÂÈÙ·È ÁÈ· ηٿÛÙ·ÛË Ë ÔÔ›· ·ÊÔÚ¿ ÂÊ‹‚Ô˘˜, ·ÛÙ·ı›˜ Û˘Ó·ÈÛıËÌ·ÙÈο. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÂÓËÏ›ÎÔ˘˜ Ì ÌÈ· ÌÔÚÊ‹ Û˘Ó‰ÚfiÌÔ˘ Munchausen, ÙÔ ÔÔ›Ô ÂΉ‹ÏˆÛ·Ó ˆ˜ “·ÈÌfiÙ˘ÛË”. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿, ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ˜ ·Ó·ÊÔÚ¤˜. ÷ڷÎÙËÚÈÛÙÈο ·Ú·Ù›ıÂÙ·È ÙÔ ÂÚÈÛÙ·ÙÈÎfi ÂÓfi˜ 12¯ÚÔÓÔ˘ ÎÔÚÈÙÛÈÔ‡ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠ·Ú¯Èο Ì ÈÛÙÔÚÈÎfi ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ·ÈÌ·Ù¤ÌÂÛ˘ Î·È ·ÚÁfiÙÂÚ· Ì ·ÈÌfiÙ˘ÛË, ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÔÔ›·˜ ˘Ô‚Ï‹ıËΠ۠Ï‹ıÔ˜ ÂÍÂÙ¿ÛˆÓ. ∆ÂÏÈο ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÛıÂÓ‹˜ “‰¿ÁΈÓ” Ù· ¯Â›ÏË Ù˘ Î·È ¤‚·˙ ٷ ‰¿¯Ù˘Ï¿ Ù˘ ÛÙ· ÚÔ˘ıÔ‡ÓÈ· Ù˘ (25).

¶ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ‰È¢ÎÚÈÓÈÛÙ› ·fi ÙËÓ ·Ú¯‹ fiÙÈ ÚfiÎÂÈÙ·È Ú¿ÁÌ·ÙÈ ÁÈ· ·ÈÌfiÙ˘ÛË Î·È fi¯È ÁÈ· ·ÈÌ·Ù¤ÌÂÛË ‹ ÁÈ· ·fi¯ÚÂÌ„Ë ·›Ì·ÙÔ˜ ÏfiÁˆ Â›ÛÙ·Í˘. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ Â›ÛÙ·Í˘ ÙÔ ·›Ì· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· (.¯. ÚÈÓÔÚÚ·Á›·, ÊÏÂÁÌÔÓ‹ ·Ú›ÛıÌÈˆÓ ·Ì˘Á‰·ÏÒÓ ‹ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ, Ô˘Ï›Ùȉ·, ÂÍÂÏÎÒÛÂȘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜). °È· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Â›Ó·È ··Ú·›ÙËÙË Ë ÚÔÛÂÎÙÈ΋ ÂÈÛÎfiËÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙÔ˘ ÚfiÛıÈÔ˘ Î·È Ô›ÛıÈÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ·ÈÌ·Ù¤ÌÂÛ˘ ÙÔ ·Ô‚·ÏÏfiÌÂÓÔ ·›Ì· ¤¯ÂÈ ‚·ı‡ ÎfiÎÎÈÓÔ ‹ ηʤ ¯ÚÒÌ·, fiÍÈÓÔ pH Î·È ÂӉ¯Ô̤ӈ˜ ÂÚȤ¯ÂÈ ˘ÔÏ›ÌÌ·Ù· ÙÚÔÊ‹˜, ÂÓÒ ·fi ÙÔ ÈÛÙÔÚÈÎfi Û˘Ó‹ıˆ˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÚÔËÁ‹ıËΠӷ˘Ù›·. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ·ÈÌfiÙ˘Û˘ ÙÔ ·›Ì· ¤¯ÂÈ ˙ˆËÚfi ÂÚ˘ıÚfi ¯ÚÒÌ·, ·ÏηÏÈÎfi pH Î·È ÌÔÚ› Ó· Â›Ó·È ·Ó·ÌÈÁ̤ÓÔ Ì ۛÂÏÔ. ∂Í¿ÏÏÔ˘, Ë ·ÈÌfiÙ˘ÛË Û˘Óԉ‡ÂÙ·È ·fi ‚‹¯· Î·È ÂÓ›ÔÙ ÌÔÚ› Ó· ·ÎÔ˘ÛÙ› ‹¯Ô˜ Û·Ó ÎÂÏ¿Ú˘ÛÌ· (¶›Ó·Î·˜ 3) (26). ∂ÊfiÛÔÓ ·Ô‰ÂȯÙ› fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·ÈÌfiÙ˘ÛË Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘, ÙÔ ÂfiÌÂÓÔ

‚‹Ì· Â›Ó·È Ë Ï‹„Ë ÈÛÙÔÚÈÎÔ‡. ™ÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Ô˘ ÂӉȷʤÚÔ˘Ó Â›Ó·È Ë ·ÚÔ˘Û›· ˘ÚÂÙÔ‡, Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ù· ÂÂÈÛfi‰È· ÂÈΛÌÂÓ˘ ÓÈÁÌÔÓ‹˜, Ù˘¯fiÓ ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, Ô ÚfiÛÊ·ÙÔ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜, Ù· Ù·Í›‰È·, Ë ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ (·ÛÈÚ›ÓË, ·ÓÙÈËÎÙÈο, ÚÔ˘Ï-ıÂÈԢڷΛÏË) Î·È Ë ¯Ú‹ÛË ÎÔη˝Ó˘ ‹ ηÓÔ‡. £· ·Ó·˙ËÙËıÔ‡Ó Â›Û˘ ÛÙÔȯ›· Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ¯ÚfiÓÈÔ Ó¢ÌÔÓÈÎfi ÓfiÛËÌ·, fiˆ˜ Ë ‡·ÚÍË ¯ÚfiÓÈÔ˘ ·Ú·ÁˆÁÈÎÔ‡ ‚‹¯· ‹ Û˘ÚÈÁÌÔ‡ ‹ ÔÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ Ó¢ÌÔӛ˜. ∏ ‡·ÚÍË ˘ÚÂÙÔ‡ Ì ‚‹¯· Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÔÍ›·˜ Ïԛ̈͢ ÙÔ˘ ηو٤ÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ë ‡·ÚÍË ıˆÚ·ÎÈÎÔ‡ ¿ÏÁÔ˘˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ›Ù ÙÚ·˘Ì·ÙÈÛÌÔ‡, ›Ù ÔÍ›·˜ Ïԛ̈͢, ›Ù Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ÈÛÙÔÚÈÎfi ÚfiÛÊ·Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â¤Ì‚·Û˘, fiÓÔ˜ ηٿ ÙË Á·ÛÙÚÔÎÓËÌ›·, ·Ú·ÙÂٷ̤ÓË ·ÎÈÓËÛ›· (2). ∏ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ·ÈÌfiÙ˘Û˘ Ì ÙËÓ ¤ÌÌËÓÔ Ú‡ÛË ÛÙȘ ¤Ê˂˜, ı¤ÙÂÈ ÙËÓ ˘Ô„›· Ù˘ ηٷ̋ÓÈ·˜ ·ÈÌfiÙ˘Û˘ ÏfiÁˆ ÂÓ‰ÔıˆÚ·ÎÈ΋˜ ÂÓ‰ÔÌËÙÚ›ˆÛ˘ (2). ∏ ‡·ÚÍË Ù¤ÏÔ˜ ·ÈÌ·ÙÔ˘Ú›·˜, ı· ı¤ÛÂÈ ÙÔ ÂӉ¯fiÌÂÓÔ ÌÈ·˜ Ó¢ÌÔÓÔ-ÓÂÊÚÈ΋˜ ·ÁÁÂÈ›Ùȉ·˜ (3). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ÚÔÛ¤ÁÁÈÛË, ÂÊfiÛÔÓ ÚfiÎÂÈÙ·È ÁÈ· Ì·˙È΋, ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ·ÈÌfiÙ˘ÛË, ·˘Ù‹ ı· Ú¤ÂÈ ·Ú¯Èο Ó· ÂÛÙÈ·ÛÙ› ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ‚·ÙfiÙËÙ·˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ù˘ Â·ÚÎÔ‡˜ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Ù˘ Â·ÚÎÔ‡˜ ΢ÎÏÔÊÔÚ›·˜. ∂ÊfiÛÔÓ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÂÂÈÛfi‰ÈÔ ·ÈÌfiÙ˘Û˘ ÌÈÎÚ‹˜ ‚·Ú‡ÙËÙ·˜, ¿ÌÂÛ· ÌÔÚ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Ë ÏÂÙÔÌÂÚ‹˜ Ê˘ÛÈ΋ ÂͤٷÛË, Ì ÙËÓ ÔÔ›· ı· ·Ó·˙ËÙËıÔ‡Ó Ë ‡·ÚÍË ˘ÚÂÙÔ‡, ÂÈÛÎÔÈο Ë ‡·ÚÍË ÏËÎÙÚÔ‰·ÎÙ˘Ï›·˜, ÂÓ‰ÂÈÎÙÈ΋ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ·ÚÙËÚÈÔÊÏÂ‚Ò‰Ô˘˜ ‰˘ÛÏ·Û›·˜ ‹ ΢·ÓˆÙÈ΋˜ ηډÈÔ¿ıÂÈ·˜, ˆ¯ÚfiÙËÙ·˜, ÂÓ‰ÂÈÎÙÈ΋ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ‹ Ù˘ ¯ÚÔÓÈfiÙËÙ·˜ Ù˘ ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘, Âί˘ÌÒÛÂˆÓ ‹ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÛÙÔÓ ıÒڷη Î·È ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ‹ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜

¶›Ó·Î·˜ 3. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·ÈÌfiÙ˘Û˘ - ·ÈÌ·Ù¤ÌÂÛ˘ (26)

∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ πÛÙÔÚÈÎfi ∞fi¯ÚÂÌ„Ë p∏ ·fi¯ÚÂ̄˘ ªÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ·fi¯ÚÂ̄˘

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¶ÚÔËÁÂ›Ù·È ‚‹¯·˜ ¶Ó¢ÌÔÓÔ¿ıÂÈ· ∞ÊÚ҉˘ ∑ˆËÚfi ÂÚ˘ıÚfi ¯ÚÒÌ· ∞ÏηÏÈÎfi ª·ÎÚÔÊ¿Á· Î·È Ô˘‰ÂÙÂÚfiÊÈÏ·

¶ÚÔËÁÂ›Ù·È Ó·˘Ù›·, Ù¿ÛË ÁÈ· ¤ÌÂÙÔ ¡fiÛÔ˜ ÛÙÔÌ¿¯Ô˘-‹·ÙÔ˜ ø˜ ÎfiÎÎÔÈ Î·Ê¤ ∫·Ê¤ ÛÎÔ‡ÚÔ ¯ÚÒÌ· ŸÍÈÓÔ ∆ÚÔÊ‹ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·156

156

ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘

Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ·ÚÙËÚÈÔÊÏÂ‚Ò‰Ô˘˜ ‰˘ÛÏ·Û›·˜. ÕÏÏ· ÛÙÔȯ›· ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË Ô˘ ÂӉȷʤÚÔ˘Ó, Â›Ó·È Ë ÂÓÙÔÈṲ̂ÓË Ì›ˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜, Ë ¿ÓÈÛË ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ‰‡Ô ËÌÈıˆÚ·Î›ˆÓ ÌÂ Û˘ÓÔ‰fi ÌÂȈ̤ÓË Â›ÛÔ‰Ô ·¤Ú·, fiˆ˜ Â› ÂÈÛÚfiÊËÛ˘ ͤÓÔ˘ ÛÒÌ·ÙÔ˜, Ô ÂÓÙÔÈṲ̂ÓÔ˜ Û˘ÚÈÁÌfi˜ Û ÂÓ‰Ô‚ÚÔÁ¯ÈΤ˜ ‚Ï¿‚˜ Î·È Û ͤӷ ÛÒÌ·Ù·, ÔÈ ÏÂÙÔ› ˘ÁÚÔ› ÚfiÁ¯ÔÈ Û Ó¢ÌÔÓ›· ‹ ÓÔÛ‹Ì·Ù· ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È Ù¤ÏÔ˜, Ë ‡·ÚÍË Î·Ù¿ ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ Ê˘Û‹Ì·ÙÔ˜ ÂÓ‰ÂÈÎÙÈÎÔ‡ ÛÙ¤ÓˆÛ˘ Ù˘ ÌÈÙÚÔÂȉԇ˜ ‹ Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜. ∆¤ÏÔ˜, ı· ÂÏÂÁ¯ı› Ë ·ÚÔ˘Û›· Ù˘¯fiÓ ‰ÈÔÁÎˆÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙÔÓ ÙÚ¿¯ËÏÔ, ÛÙÔ˘˜ ˘ÂÚÎÏ›‰ÈÔ˘˜ Î·È ÛÙÔ˘˜ Ì·Û¯·ÏÈ·›Ô˘˜ ‚fiıÚÔ˘˜. ¢˘ÛÙ˘¯Ò˜, fï˜, Ô‡Ù ÙÔ ÈÛÙÔÚÈÎfi Ô‡ÙÂ Ë Ê˘ÛÈ΋ ÂͤٷÛË, Â›Ó·È Èı·Ófi Ó· ı¤ÛÔ˘Ó ÙËÓ ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË, ÂÎÙfi˜ ‚¤‚·È· ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ fiÔ˘ Ë ·ÈÌfiÙ˘ÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û ·È‰› Ì ‹‰Ë ÁÓˆÛÙfi ÈÛÙÔÚÈÎfi ÈÓÔ΢ÛÙÈ΋˜ ÓfiÛÔ˘ ‹ ¿ÏÏÔ˘ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›·. ™Â fiϘ ۯ‰fiÓ ÙȘ ¿ÏϘ ÂÚÈÙÒÛÂȘ ı· ¯ÚÂÈ·ÛÙ› ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜. √ ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÂÍ‹˜: ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, ƒ∆, ƒ∆∆, ηÏÏȤÚÁÂÈ· Ù˘¤ÏˆÓ ÁÈ· ‚·ÎÙ‹ÚÈ·, ̇ÎËÙ˜ Î·È Ì˘ÎÔ‚·ÎÙËÚ›‰È· (ÛÙ· ·È‰È¿ ÌÈÎÚ‹˜ ËÏÈΛ·˜ Ù· ‰Â›ÁÌ·Ù· Ù˘¤ÏˆÓ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ÏËÊıÔ‡Ó Ì ÚÈÓÔÙÚ·¯Âȷ΋ ·Ó·ÚÚfiÊËÛË), ÁÂÓÈ΋ Ô‡ÚˆÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ·ÈÌ·ÙÔ˘Ú›·˜- ΢ÏÈÓ‰ÚÔ˘Ú›·˜, Ô˘Ú›· Î·È ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË Mantoux. ∏ Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰ÂÓ ·ÔÙÂÏ› ÂÁÁ‡ËÛË Ù˘ Â͈Ó¢ÌÔÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ·ÈÌfiÙ˘Û˘, ηıÒ˜ Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 30% ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÌfiÙ˘ÛË (1). ∂ÊfiÛÔÓ ˘¿Ú¯Ô˘Ó Â˘Ú‹Ì·Ù·, ·˘Ù¿ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÙÂÏÂÎٷۛ˜ ‹ ΢„ÂÏȉÈΤ˜ ‹ ‰È¿ÌÂÛ˜ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ. ÕÏÏ· ÛÙÔȯ›· Ô˘ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Â›Ó·È Ë ·ÚÔ˘Û›· ·Ú·˘Ï·›·˜ ·‰ÂÓÔ¿ıÂÈ·˜, Ô˙ȉ›Ô˘ ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·, ηډÈÔÌÂÁ·Ï›·˜ Î·È ·˘ÍË̤Ó˘ ·ÁÁ›ˆÛ˘ ÙˆÓ ¿Óˆ Ó¢ÌÔÓÈÎÒÓ ÏÔ‚ÒÓ. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ˘Ô„›· ÂÈÛÚfiÊËÛ˘ ͤÓÔ˘ ÛÒÌ·ÙÔ˜, ··ÈÙÂ›Ù·È Û˘ÁÎÚÈÙÈ΋ ÂͤٷÛË ÙˆÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ Û ‰‡Ô Ê¿ÛÂȘ Ù˘ ·Ó·ÓÔ‹˜. ∞Ó·ÏfiÁˆ˜ ÙˆÓ ÂӉ›ÍÂˆÓ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË, ı· ··ÈÙËı› ÂȉÈÎfiÙ¶·È‰È·ÙÚÈ΋ 2006;69:150-159

ÚÔ˜ ¤ÏÂÁ¯Ô˜: ‰ÔÎÈÌ·Û›· ȉÚÒÙ· (˘Ô„›· ÈÓÔ΢ÛÙÈ΋˜ ÓfiÛÔ˘), πgE ÔÚÔ‡ Î·È È˙ËÌ·Ù›Ó˜ ¤Ó·ÓÙÈ ∞spergillus fumigatus (˘Ô„›· ·ÛÂÚÁ›ÏψÛ˘), ˈÛÈÓfiÊÈÏ· Î·È IgE ÔÚÔ‡ (·˘ÍË̤Ó˜ ÙÈ̤˜ Û ·Ú·Û›ÙˆÛË), ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ÔÚÔ‡ (˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜), ÂͤٷÛË ‰ÂÈÁÌ¿ÙˆÓ Á·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÛȉËÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ Î·È ÁÈ· ηÏÏȤÚÁÂÈ· (1). ∂ÊfiÛÔÓ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¤¯ÂÈ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ë ÂͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË, Â›Ó·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (1). ∏ ÂÓ‰ÔÊϤ‚È· ¯Ú‹ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ·ÁÁÂÈ·ÎÒÓ ‰ÔÌÒÓ ÎÈ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË ÛÙËÓ ÂÚ›ÙˆÛË ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ. ∂ͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÂÈÎfiÓÈÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Â›Ó·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. ∏ ªRI ˘ÂÚ¤¯ÂÈ ÛÙËÓ ·ÂÈÎfiÓÈÛË ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ηıÒ˜ Â›Û˘ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È ÙˆÓ ˘ÏÒÓ, ÂÓÒ ‰ÂÓ ‰›ÓÂÈ È‰È·›ÙÂÚ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ÂÓ‰ÂÈÎÙÈο Ó¢ÌÔÓÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋, ηıÒ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ô ÚÔ·Ó·ÊÂÚfiÌÂÓÔ˜ ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰ÂÓ Î·Ù¢ı‡ÓÂÈ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ‰È¿ÁÓˆÛË (2), ÙÔ ÂfiÌÂÓÔ ‚‹Ì· ηıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜, Â›Ó·È Ë ÂÎÙ¤ÏÂÛË ‚ÚÔÁ¯ÔÛÎfiËÛ˘ Ì ‡ηÌÙÔ ÈÓÔÙÈÎfi ‚ÚÔÁ¯ÔÛÎfiÈÔ. ∆Ô ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â›Ù ÁÈ· ÙËÓ ·Ê·›ÚÂÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ›Ù ÛÙËÓ ÂÚ›ÙˆÛË Ì·˙È΋˜ ·ÈÌÔÚÚ·Á›·˜, ÔfiÙ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‰È·ÙËÚËı› ·Î¤Ú·ÈË Ë ‚·ÙfiÙËÙ· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Î·È Ù·˘Ùfi¯ÚÔÓ· Ó· Á›ÓÔÓÙ·È ·Ó·ÚÚÔÊ‹ÛÂȘ. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ·ÈÌÔÚÚ·Á›·, Ì ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÓÙÔÈÛÙ› Ì ۯÂÙÈ΋ ·ÎÚ›‚ÂÈ· Ë ı¤ÛË Ù˘. ŸÙ·Ó, fï˜, Ë ·ÈÌÔÚÚ·Á›· ¤¯ÂÈ ‹‰Ë ÛÙ·Ì·Ù‹ÛÂÈ Î·È Î·Ù¿ ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË ‰ÂÓ ·Ó¢ڛÛÎÂÙ·È Î¿ÔÈÔ ÂÌÊ·Ó¤˜ ·›ÙÈÔ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÙfiÙ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË (bronchoalveolar lavage-BAL), ÒÛÙ ӷ ÂÏÂÁ¯ı› Ë Ù˘¯fiÓ ·ÚÔ˘Û›· Û ·˘Ùfi Ì·ÎÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ Ì ·ÈÌÔÛȉËÚ›ÓË (“ÛȉËÚÔÊ¿ÁˆÓ”). ∏ ·ÚÔ˘Û›· ÙÔ˘˜ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÚÔËÁËı›۷˜ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜. ∞fi Ï›Á˜ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Ô˘ ˘¿Ú¯Ô˘Ó, Ê·›ÓÂÙ·È fiÙÈ Ù· ÛȉËÚÔÊ¿Á· ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È ·Ú¿

Pediatr Mar-Apr 06

18-04-06

16:42

™ÂÏ›‰·157

157

∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿

∞ÈÌfiÙ˘ÛË Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘

ªÂ ÂӉ›ÍÂȘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ ∞/· ıÒÚ·ÎÔ˜ ·ıÔÏÔÁÈ΋

CT £ÒÚ·ÎÔ˜

Èڛ˜ ÂӉ›ÍÂȘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ ∞/· ıÒÚ·ÎÔ˜ Ê˘ÛÈÔÏÔÁÈ΋ µÚÔÁ¯ÔÛÎfiËÛË

Ê˘ÛÈÔÏÔÁÈ΋

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¶·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·

Èڛ˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·

∂ȉÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·Ó·ÏfiÁˆ˜ ÙˆÓ ÂӉ›ÍÂˆÓ ∫·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË µ¶∂ ·fi 3Ë-14Ë Ë̤ڷ (--) ÁÈ· ÛȉËÚÔÊ¿Á·

µ¶∂ ·fi 3Ë-14Ë Ë̤ڷ (+) ÁÈ· ÛȉËÚÔÊ¿Á·

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∂› ˘ÔÙÚÔ‹˜ Â·Ó¤ÏÂÁ¯Ô˜

µ¶∂ >14Ë Ë̤ڷ ÌÂÙ¿ ·ÈÌÔÚÚ·Á›·

∫·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË

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¶Èı·Ó‹ ηډÈÔÏÔÁÈ΋ ÓfiÛÔ˜

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∂ÍÂÙ¿ÛÂȘ ÁÈ· ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË

∂ÍÂÙ¿ÛÂȘ ÁÈ· Ó¢ÌÔÓÔÓÂÊÚÈÎfi Û‡Ó‰ÚÔÌÔ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔÏÔÁ›·˜ Èڛ˜ Â˘Ú‹Ì·Ù· π¶∞

∂ÈÎfiÓ· 1. ¶ÚÔÛ¤ÁÁÈÛË ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘. π∫¡= πÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, µ¶∂= µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË, π¶∞= π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË, ∞/·= ∞ÎÙÈÓÔÁÚ·Ê›·, CT= AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·

50 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÔÍ›· ·ÈÌÔÚÚ·Á›· Î·È ·Ú·Ì¤ÓÔ˘Ó ¤ˆ˜ Î·È 5-6 Ë̤Ú˜ ÌÂÙ¿ (ηÙ' ¿ÏÏÔ˘˜ ̤¯ÚÈ 10 Ë̤Ú˜), ÂÓÒ ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È Î·Ù¿ ÙË 15Ë Ë̤ڷ ÌÂÙ¿ ÙËÓ Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· (27). ∂ÊfiÛÔÓ Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, Ë ‚ÚÔÁ¯ÔÛÎfiËÛË Î·È Ë ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË (Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÌÂٷ͇ 3˘-14˘ Ë̤ڷ˜ ÌÂÙ¿ ÙËÓ ·ÈÌÔÚÚ·Á›·) ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Â›Ó·È ÛÎfiÈÌÔ Ó· ·Ó·Ì¤ÓÂÙ·È ÙÔ Ó¤Ô ÂÂÈÛfi‰ÈÔ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ÂÊfiÛÔÓ ÂΉËψı›, Ó· ‰ÈÂÚ¢ÓËı› Ì ·ÚfiÌÔÈÔ ÙÚfiÔ. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ (BAL ıÂÙÈÎfi), ÂÓÒ Ì ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË ‰ÂÓ ÂÓÙÔ›˙ÂÙ·È ‚Ï¿‚Ë ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜

Î·È ÙÔ ·È‰› ‰ÂÓ ¤¯ÂÈ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ‹ ‚ÚÔÁ¯ÂÎٷۛ˜ ·fi ¿ÏÏ· ·›ÙÈ·, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Ï‹Ú˘ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜. ∂¿Ó Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο, ÙfiÙ ı· Á›ÓÂÈ ‰ÈÂÚ‡ÓËÛË ÁÈ· Èı·Ó‹ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ÛÙ· Ï·›ÛÈ· ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ¤ÏÂÁ¯Ô Ì ∞¡∞, anti-ds DNA, anti-GBM, c-ANCA, p-ANCA. √ ¤ÏÂÁ¯Ô˜ ·˘Ùfi˜ ‚¤‚·È· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔËÁËı›, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÁÓˆÛÙfi ÈÛÙÔÚÈÎfi Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘ ‹ ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ¿ÏÏ· ÛÙÔȯ›·, fiˆ˜ ÂÍ¿ÓıËÌ·, ·ÈÌ·ÙÔ˘Ú›· ‹ ΢ÏÈÓ‰ÚÔ˘Ú›·. ∂ÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ˘¤Ú ÌÈ·˜ Û˘ÛÙËÌ·ÙÈ΋˜ ¿ıËÛ˘, ÙfiÙ ÙÔ ·›ÙÈÔ Ù˘ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159

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ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘

Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Èı·ÓfiÓ Ó· Â›Ó·È Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË, Ù˘ ÔÔ›·˜ Ú·ÎÙÈο Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÂÍ ·ÔÎÏÂÈÛÌÔ‡. ™Â ·È‰È¿ Ì π¶∞, Û·Ó›ˆ˜ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ ‚ÈÔ„›· Ó‡ÌÔÓ·. ∂˘Ú‹Ì·Ù· ·fi ÙË ‚ÈÔ„›· Ù· ÔÔ›· Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú π¶∞, Â›Ó·È Ë ·ÚÔ˘Û›· ÔÏÏÒÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÂÓÙfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙfi, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ·ÈÌÔÚÚ·Á›·, Î·È Ë ·Ô˘Û›· ÛÙÔȯ›ˆÓ ·ÁÁÂÈ›Ùȉ·˜. ∂¿Ó Ë ‚ÈÔ„›· Ú·ÁÌ·ÙÔÔÈËı› ÌÂÙ¿ ¿ÚÔ‰Ô Î¿ÔÈˆÓ ËÌÂÚÒÓ ·fi ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ ·ÈÌÔÚÚ·Á›·˜, ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· ı· Â›Ó·È Ë ·ÚÔ˘Û›· Ì·ÎÚÔÊ¿ÁˆÓ Ì ·ÈÌÔÛȉËÚ›ÓË ÛÙȘ ΢„ÂÏ›‰Â˜ Î·È ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙfi. ∆¤ÏÔ˜, Â› ˘Ô„›·˜ Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜ ÂӉ›ÎÓ˘Ù·È Û˘Ó‹ıˆ˜ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÂÚÈÛÌÔ‡-·ÈÌ¿ÙˆÛ˘.

∞ÓÙÈÌÂÙÒÈÛË ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ‰‡Ô ·Ú¿ÁÔÓÙ˜: 1) ÙËÓ ˘ÔΛÌÂÓË ·ÈÙÈÔÏÔÁ›· Î·È 2) ÙËÓ ¤ÎÙ·ÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜. ŸÙ·Ó Ë ˘ÔΛÌÂÓË ·ÈÙÈÔÏÔÁ›· Â›Ó·È ÁÓˆÛÙ‹, Ï·Ì‚¿ÓÔÓÙ·È Ù· ηٿÏÏËÏ· ıÂÚ·¢ÙÈο ̤ÙÚ·. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ, Ë ·ÈÌfiÙ˘ÛË ˘Ô¯ˆÚ› ·˘ÙfiÌ·Ù·, ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË. ∂ÊfiÛÔÓ ÚfiÎÂÈÙ·È ÁÈ· Ì·˙È΋ ·ÈÌfiÙ˘ÛË, ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹, ı· Ú¤ÂÈ ¿ÌÂÛ· Ó· ÏËÊıÔ‡Ó Ì¤ÙÚ· Â›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛ˘, Ù· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ¯ÔÚ‹ÁËÛË √2, ÙËÓ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ‹ ÙË ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Î·È ÙÔÓ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, fiÔ˘ ¯ÚÂÈ¿˙ÂÙ·È, Ì ۇÁ¯ÚÔÓÔ ¤ÏÂÁ¯Ô ÙˆÓ ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜. ∞ÊÔ‡ ÂÍ·ÛÊ·ÏÈÛÙ› Ë ‚·ÙfiÙËÙ· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡, Á›ÓÂÙ·È ÚÔÛÂÎÙÈο ·Ó·ÚÚfiÊËÛË ÒÛÙ ӷ ·ÔÊ¢¯ı› Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ı· ‹Ù·Ó ¯Ú‹ÛÈÌË Ë ÂÎÙ¤ÏÂÛË ‚ÚÔÁ¯ÔÛÎfiËÛ˘ Ì ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ, ÒÛÙ ӷ ÂÓÙÔÈÛÙ› ÙÔ ÛËÌÂ›Ô Ù˘ ·ÈÌÔÚÚ·Á›·˜, Ó· ‰È·ÙËÚËı› ·ÓÔÈÎÙfi˜ Ô ·ÂÚ·ÁˆÁfi˜ Î·È Ù·˘Ùfi¯ÚÔÓ· Ó· Á›ÓÔÓÙ·È χÛÂȘ Ì ·ÁˆÌ¤ÓÔ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi. ¶ÂÚÈÛÙ·Ûȷο ÁÈ· Ó· ÛÙ·Ì·Ù‹ÛÂÈ Ë ·ÈÌÔÚÚ·Á›·, ··ÈÙÂ›Ù·È ÂÓ‰ÔÛÎÔÈο ÂÈˆÌ·ÙÈÛÌfi˜ Ì ÙË ¯Ú‹ÛË Î·ıÂÙ‹Ú· Ì ·ÂÚÔı¿Ï·ÌÔ (28). ∂¿Ó ·Ú¿ Ù· ·Ú·¿Óˆ ̤ÙÚ· Ë ·ÈÌÔÚÚ·Á›· Û˘Ó¯›˙ÂÙ·È, ÙÔ ÂfiÌÂÓÔ ‚‹Ì· Â›Ó·È Ë ÂÌ‚ÔÏ‹ ÙÔ˘ ˘‡ı˘ÓÔ˘ ·ÁÁ›Ԣ. ¶ÚÈÓ Á›ÓÂÈ ÂÌ‚ÔÏ‹, Â›Ó·È ÂȂ‚ÏË̤ÓÔ˜ Ô ¤ÏÂÁ¯Ô˜ Ì ÂÎÏÂÎÙÈ΋ ‚ÚÔÁ¯È΋ ·ÚÙËÚÈÔÁÚ·Ê›·, ηıÒ˜ Ë ÂÌ‚ÔÏ‹ ÙˆÓ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159

‚ÚÔÁ¯ÈÎÒÓ ·ÚÙËÚÈÒÓ ·ÓÙÂӉ›ÎÓ˘Ù·È fiÙ·Ó ·fi ·˘Ù¤˜ ÂÎʇÔÓÙ·È ·ÚÙËڛ˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ (1). ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Â›Ó·È ‰˘Ó·Ùfi Ó· ÛÙ·Ì·Ù‹ÛÂÈ ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ·ÓÙ¤Ó‰ÂÈÍË ÛÙËÓ ÂÌ‚ÔÏ‹ ÙÔ˘ ˘‡ı˘ÓÔ˘ ·ÁÁ›Ԣ, ÙÔ ÂfiÌÂÓÔ ‚‹Ì· Â›Ó·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÎÙÔÌ‹ ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ‹ ÏÔ‚Ô‡. ∏ Ó¢ÌÔÓÂÎÙÔÌ‹ ·ÔÙÂÏ› ÙË ıÂÚ·›· ÂÎÏÔÁ‹˜ ÁÈ· ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· Ì·˙È΋˜ ·ÈÌfiÙ˘Û˘.

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2. Bidwell JL, Pachner RW. Hemoptysis: Diagnosis and management. Am Fam Physician 2005;72:1253-1260.

3. Godfrey S. Pulmonary hemorrhage/hemoptysis in children. Pediatr Pulmonol 2004;37:476-484.

4. Coss-Bu JA, Sachdeva RC, Bricker JT, Harrison GM, Jefferson LS. Hemoptysis: a 10-year retrospective study. Pediatrics 1997;100:7.

5. Southall DP, Plunkett MC, Banks MW, Falkov AF, Samuels MP. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics 1997;100:735-760.

6. Evans DA, Wilmott RW. Pulmonary embolism in children. Pediatr Clin North Am 1994;41:569-584.

7. Nusair S, Salameh-Giryes S, Springer C, Izhar U. Congenital bronchial cyst with recurrent submassive hemoptysis. J Thorac Cardiovasc Surg 2003;125: 972-973.

8. Swanson KL, Prakash UB, Stanson AW. Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997. Mayo Clinic Proc 1999;74:671-680.

9. Abrahams NA, Colby TV, Pearl RH, Chipps BE, Juris AL, Leslie KO. Pulmonary hemangiomas of infancy and childhood: report of 2 cases and review of the literature. Ped Dev Pathol 2002;5:283-292.

10. Ben-Abraham R, Paret G, Cohen R, Szold O, Cindalli G, Toren A et al. Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children. Chest 2003;124:660-664.

11. Heggen J, West C, Olson E, Olson T, Teague G, Fortenberry J et al. Diffuse alveolar hemorrhage in pediatric hematopoietic cell transplant patients. Pediatrics 2002;109:965-971.

12. Dearborn DG. Pulmonary Hemosiderosis. In Behrman RE, Kliegman RM, Janson HB, editors.

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13. Saeed MM, Woo MS, MacLaughlin EF, Margetis MF, Keens TG. Prognosis in pediatric idiopathic pulmonary hemosiderosis. Chest 1999;116:721-725.

14. Le Clainche L, Le Bourgeois M, Fauroux B, Forenza N, Dommergues JP, Desbois JC et al. Long-term

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outcome of idiopathic pulmonary hemosiderosis in children. Medicine (Baltimore) 2000;79:318-326.

Kiper N, Gocmen A, Ozcelik U, Dilber E, Anadol D. Long-term course of patients with idiopathic pulmonary hemosiderosis (1979-1994): prolonged survival with low-dose corticosteroid therapy. Pediatr Pulmonol 1999;27:180-184.

Vats KR, Vats A, Kim Y, Dassenko D, Sinaiko AR. Henoch-Schonlein purpura and pulmonary hemorrhage: a report and literature review. Pediatr Nephrol 1999;13:530-534. von Vigier RO, Trummler SA, Laux-End R, Sauvain MJ, Truttmann AC, Bianchetti MG. Pulmonary renal syndrome in childhood: a report of twenty-one cases and a review of the literature. Pediatr Pulmonol 2000;29:382-388.

Martini A, Binda S, Mariani G, Scotta MS, Ruberto G. Goopasture’s syndrome in a child: natural history and effect of treatment. Acta Paediatr Scand 1981;70:435-439.

Font J, Cervera R, Espinosa G, Pallares L, RamosCasals M, Jimenez S, Garcia-Carrasco M. Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SEL characteristics in adults.

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20. Miller RW, Salcedo JR, Fink RJ, Murphy TM, Magilavy DB. Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus. J Pediatr 1986;108:576-579.

21. Badsha H, Edwards C. Intravenous pulses of methylprednisolone for systemic lupus erythematosus. Semin Arthritis Rheum 2003;32:370-377.

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Monogr Pathol 1993;36:195-218.

23. Belostotsky VM, Shah V, Dillon MJ. Clinical features in 17 paediatric patients with Wegener granulomatosis. Pediatr Nephrol 2002;17:754-761.

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26. Corder R. Hemoptysis. Emerg Med Clin North Am 2003;21:421-435.

27. Epstein CE, Elidemir √, Colasurdo GN, Fan LL. Time course of hemosiderin production by alveolar macrophages in a murine model. Chest 2001;120: 2013-2020.

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¶·È‰È·ÙÚÈ΋ 2006;69:150-159

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¡ÂÔÁ¤ÓÓËÙÔ ·ÁfiÚÈ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 4.900 ÁÚ·ÌÌ¿ÚÈ· Ô˘ ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÎÂÊ·ÏÔ-˘ÂÏÈ΋˜ ‰˘Û·Ó·ÏÔÁ›·˜, ÂÌÊ¿ÓÈÛ ÛÔ‚·Ú‹ ˘ÔÁÏ˘Î·ÈÌ›· ̤۷ ÛÙȘ ÚÒÙ˜ ÒÚ˜ ˙ˆ‹˜ (ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ 18 mg%), ÁÈ· ÙËÓ ÔÔ›· ··ÈÙ‹ıËÎÂ Ë ¯ÔÚ‹ÁËÛË 12 mg/kg/min ÁÏ˘Îfi˙˘, ÂÓ‰ÔÊÏ‚›ˆ˜, Û ‰È¿Ï˘Ì· 10%. ∏ ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó Â›Û˘ ¯·ÌËÏ‹ Î·È ··ÈÙ‹ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ÓÙÔ·Ì›Ó˘ ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË, Û ÔÛfiÙËÙ· 10 Ìg/kg. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¤‰ÂÈÍ Ë·ÙÔÌÂÁ·Ï›· Î·È ÓÂÊÚÔÌÂÁ·Ï›·, ÂÓÒ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ (∂ÈÎfiÓ· 1), ¤‰ÂÈÍ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ¢ÂÓ ˘‹Ú¯Â ÛÙË ÌËÙ¤Ú· ÈÛÙÔÚÈÎfi ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ηٿ ÙË Ê¿ÛË Ù˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ ¤‰ÂÈÍ ·˘ÍË̤ӷ Â›‰· ÈÓÛÔ˘Ï›Ó˘ (9,1 mU/l) Î·È C ÂÙȉ›Ô˘ (401 mU/l), ¯·ÌËÏ¿ Â›‰· ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ‚ ˘‰ÚÔ͢‚Ô˘Ù˘ÚÈÎÔ‡ Î·È Ê˘ÛÈÔÏÔÁÈο Â›‰· ÎÔÚÙÈ˙fiÏ˘ Î·È ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘. ¶·Ú¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÁÏ˘Îfi˙˘, Ù· Â›‰· Ù˘

ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· Â›Ó·È Û¯ÂÙÈο ¯·ÌËÏ¿ (35 mg%) Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¯ÔÚËÁ‹ıËΠ·Ú¯Èο ÁÏ˘Î·ÁfiÓË ÂÓ‰ÔÊÏ‚›ˆ˜, ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË (1 mg/kg/h) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÔÎÙÚÂÔÙ›‰ÈÔ (10 Ìg/kg/Ë̤ڷ). °È· ÙË ıÂÚ·›· Ù˘ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÙÔ‡ ‰fiıËΠÚÔÚ·ÓÔÏfiÓË. ªÂ ÙË ıÂÚ·›· ·˘Ù‹ ¤‰ÂÈÍ ı·̷ÙÈ΋ ‚ÂÏÙ›ˆÛË Î·È Ì›ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ Û ÁÏ˘Îfi˙Ë. •ÂΛÓËÛ Á‡̷ٷ Á¿Ï·ÎÙÔ˜ Ô˘ Ù· ·Ó¤¯ıËΠÈηÓÔÔÈËÙÈο. ŒÁÈÓ ÚÔԉ¢ÙÈ΋ ‰È·ÎÔ‹ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 21 ËÌÂÚÒÓ, ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ Û˘Ìو̿وÓ. ∂Í‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÙËÓ ËÏÈΛ· ÙˆÓ 4 ‚‰ÔÌ¿‰ˆÓ ˘fi ıÂÚ·›· Ì ÚÔÚ·ÓÔÏfiÓË. ∂·Ó·ÏËÙÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 3 ÌËÓÒÓ ¤‰ÂÈÍ Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ηډȿ˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ηÌ‡ÏË ÊfiÚÙÈÛ˘ Ù˘ ÌËÙ¤Ú·˜ Ì ÁÏ˘Îfi˙Ë ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ¶ÔÈ· Â›Ó·È Ë Èı·Ó‹ ‰È¿ÁÓˆÛË;

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 164 ¶·È‰È·ÙÚÈ΋ 2006;69:160, 164

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¢È¢ı˘ÓÙ‹˜ ¡ÂÊÚÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”

∏ÏÂÎÙÚÔÓÈΤ˜ ‰È¢ı‡ÓÛÂȘ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ √ÌÔÛÔÓ‰›· ∂˘Úˆ·›ˆÓ ∂ȉÈÎÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ - http://www.cesp-eap.org

AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ E-mail: stefanid@hol.gr

H √ÌÔÛÔÓ‰›· ∂˘Úˆ·›ˆÓ ∂ȉÈÎÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ (Confederation of European Specialists in Paediatrics, CESP) Â›Ó·È Ô ÎÏ¿‰Ô˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ π·ÙÚÈÎÒÓ ∂ȉÈÎÔÙ‹ÙˆÓ (European Union of Medical Specialties, UEMS) ÙˆÓ ÎÚ·ÙÒÓ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ Û˘ÌÂÚÈÏËÊı› ÛÙËÓ ÔÓÔÌ·Û›· Ù˘ CESP Î·È Ô Ù›ÙÏÔ˜ ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ (European Academy of Paediatrics), ÁÈ· Ó· ¯·Ú·ÎÙËÚÈÛı› Î·È Ô ·Î·‰ËÌ·˚Îfi˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ ∂Ù·ÈÚ›·˜. ™ÙÔÓ ÚfiÛÊ·Ù· ۯ‰ȷṲ̂ÓÔ ‰ÈÎÙ˘·Îfi ÙfiÔ Ù˘ CESP ÌÔÚ›Ù ӷ ‚Ú›Ù ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ∂Ù·ÈÚ›·˜. ªÂٷ͇ ÙˆÓ ÛÙfi¯ˆÓ Â›Ó·È Î·È Ë ÂÍ·ÛÊ¿ÏÈÛË ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÂÎ·›‰Â˘Û˘ ÛÙËÓ ·È‰È·ÙÚÈ΋ ÛÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘. ∂›Û˘ ȉȷ›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ·ÏÏËÏÂÁÁ‡Ë ÌÂٷ͇ ÙˆÓ Â˘Úˆ·›ˆÓ ·È‰È¿ÙÚˆÓ Î·È Ë ÂÓۈ̿وÛË ÙˆÓ ¶·È‰È·ÙÚÈÎÒÓ ÀÔÂȉÈÎÔًوÓ. H √ÌÔÛÔÓ‰›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÔÌ¿‰Â˜ ÂÚÁ·Û›·˜ ÁÈ· ÚˆÙÔ‚¿ıÌÈ·, ‰Â˘ÙÂÚÔ‚¿ıÌÈ· Î·È ÙÚÈÙÔ‚¿ıÌÈ· ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· Î·È Â›Ó·È Û ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ŒÓˆÛË ∂ıÓÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ (UNEPSA) Î·È Ì ÙȘ ∂˘Úˆ·˚Τ˜ ∂Ù·ÈÚ›˜ ÀÔÂȉÈÎÔًوÓ.

ŒÓˆÛË ∂ıÓÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ - http://www.unepsa.org ∏ ŒÓˆÛË ∂ıÓÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ (Union of National European Paediatric Societies and Associations, UNEPSA) ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Â˘Úˆ·˚ÎÔ‡ ÛÒÌ·ÙÔ˜ ·È‰È¿ÙÚˆÓ ·fi fiÏË ÙËÓ ∂˘ÚÒË Î·È ‰›‰ÂÈ È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÙËÓ ÂÓۈ̿وÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Ù˘ ∫ÂÓÙÚÈ΋˜ Î·È ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘. ™ÙËÓ ÈÛÙÔÛÂÏ›‰· ı· ‚Ú›Ù ÔÏϤ˜ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜. ∏ UNEPSA Û˘ÓÂÚÁ¿˙ÂÙ·È Ì ÙËÓ √ÌÔÛÔÓ‰›· ∂˘Úˆ·›ˆÓ ∂ȉÈÎÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ (CESP) Û ÎÔÈÓÔ‡˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜. ™Â Ì›· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË Ù˘ ∂Ù·ÈÚ›·˜ ηٷÁÚ¿ÊÔÓÙ·È Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ∂˘ÚÒË: Katz ª, Rubino ∞, Collier J, Rosen J, Ehrich JHH, Demography of Pediatric Primary Care in Europe: Delivery of Care and Training. Pediatrics 2002;109:788-796. http://pediatrics.aappublications.org/cgi/content/full/109/5/788

∂˘Úˆ·˚΋ ∞η‰ËÌ›· ∞ÏÏÂÚÁÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ - http://www.EAACI.net ∏ ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ∞ÏÏÂÚÁÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ (European Academy of Allergology and Clinical Immunology, EAACI) ‰ËÌÈÔ˘ÚÁ‹ıËΠ·fi ÙË Û˘ÓÂÚÁ·Û›· 39 ∂˘Úˆ·˚ÎÒÓ ∂ıÓÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ Î·È ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi 3.500 ·Î·‰ËÌ·˚ÎÒÓ, ÂÚ¢ÓËÙÒÓ Î·È ÎÏÈÓÈÎÒÓ È·ÙÚÒÓ. π‰Ú‡ıËΠÙÔ ¶·È‰È·ÙÚÈ΋ 2006;69:161-163

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∆Ì‹Ì·, 1956 Î·È ÔÚÁ·ÓÒÓÂÈ Î¿ı ¯ÚfiÓÔ ¤Ó· ÙÂÙÚ·‹ÌÂÚÔ Û˘Ó¤‰ÚÈÔ. √ ·È‰È·ÙÚÈÎfi˜ Ù˘ ÙÔ̤·˜¡ÂÊÚÔÏÔÁÈÎfi Â›Ó·È È‰È·›Ù¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ Ú· ‰Ú·ÛÙ‹ÚÈÔ˜ Î·È ÔÚÁ·ÓÒÓÂÈ Î¿ı ¯ÚfiÓÔ ™˘Ó¤‰ÚÈÔ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ ÛÙËÓ ∂˘ÚÒË. “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ E-mail: stefanid@hol.gr

∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ http://www.eurospe.org ∏ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ (European Organisation for Paediatric Endocrinology, ESPE) Â›Ó·È ¤Ó·˜ ‰ÈÂıÓ‹˜ ÔÚÁ·ÓÈÛÌfi˜ Ì ÂηÙÔÓÙ¿‰Â˜ ̤ÏË ·fi 45 ¯ÒÚ˜. ªÂ ÂȉÈ΋ ¤ÌÊ·ÛË ÛÙËÓ ÂÎ·›‰Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·. π‰Ú‡ıËΠÙÔ 1962 Î·È ÔÚÁ·ÓÒÓÂÈ Î¿ı ¯ÚfiÓÔ Û˘Ó¤‰ÚÈÔ.

∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ¡ÂÊÚÔÏÔÁ›·˜ - http://espn.uwcm.ac.uk √ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¡ÂÊÚÔÏÔÁ›·˜ (European Society for Paediatric Nephrology, ESPN) ÂÚȤ¯ÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ∂Ù·ÈÚ›·˜. ªÔÚ› Ó· ‚Ú›Ù ÂÚÈÏ‹„ÂȘ ·fi ·Ó·ÎÔÈÓÒÛÂȘ ÛÂ Û˘Ó¤‰ÚÈ· Î·È ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜. π‰È·›ÙÂÚ· ¯Ú‹ÛÈ̘ Â›Ó·È ÔÈ ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜ Ù˘ ∂˘Úˆ·˚΋˜ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ∂͈ÓÂÊÚÈ΋˜ ∫¿ı·ÚÛ˘ (European Paediatric Dialysis Working Group): http://espn.uwcm.ac.uk/eppdwg.htm ™Â Ì›· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË Ù˘ ∂Ù·ÈÚ›·˜ ηٷÁÚ¿ÊÔÓÙ·È Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· Ù˘ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ÙˆÓ ·È‰ÈÒÓ Ì ÓÂÊÚÔ¿ıÂȘ ÛÙËÓ ∂˘ÚÒË.

Ehrich JH, El Gendi AA, Drukker A, Janda J, Stefanidis C, Verrier-Jones K, Collier J, Katz M. Demography of paediatric renal care in Europe: organization and delivery. Nephrol Dial Transplant.

2005;20(2):297-305. http://ndt.oxfordjournals.org/cgi/reprint/20/2/297.pdf

∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ¡ÂÔÁÓÔÏÔÁ›·˜ Î·È ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ - http://www.espnic.org/ ∏ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ¡ÂÔÁÓÔÏÔÁ›·˜ Î·È ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ (European Society of Paediatric neonatal and Intensive Care, ESPNIC) ÂÚÈÏ·Ì‚¿ÓÂÈ ¤Ó·Ó È·ÙÚÈÎfi ÎÏ¿‰Ô Î·È ¤Ó·Ó ÁÈ· ÓÔÛËÏÂ˘Ù¤˜, Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›·. ∞ÔÙÂÏÂ›Ù·È ·fi 800 ̤ÏË ·fi 30 Â˘Úˆ·˚Τ˜ ¯ÒÚ˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯Ô˘Ó ÔÈ ÏËÚÔÊÔڛ˜ ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ·˘ÙÔ‡ ÙfiÔ˘ Û¯ÂÙÈο Ì ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ Î·È ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜.

¶·È‰È·ÙÚÈ΋ 2006;69:161-163

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PRINTO - http://www.printo.it/pediatric-rheumatology/ ∏ PRINTO Â›Ó·È ¤Ó· ÌË ÎÂÚ‰ÔÛÎÔÈÎfi ‰ÈÂıÓ¤˜ ‰›ÎÙ˘Ô, Ì ÛÙfi¯Ô Ó· ÂÓı·ÚÚ‡ÓÂÈ, Ó· ‰È¢ÎÔχÓÂÈ Î·È Ó· Û˘ÓÙÔÓ›˙ÂÈ ÙË ‰ÈÂÍ·ÁˆÁ‹ ÌÂÏÂÙÒÓ Ô˘ ·ÍÈÔÏÔÁÔ‡Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· Ê·Ú̷΢ÙÈÎÒÓ ıÂÚ·¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ, ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÙËÓ ¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ Ì ÚÂ˘Ì·ÙÈο ÓÔÛ‹Ì·Ù·. ∏ PRINTO ·ÔÙÂÏÂ›Ù·È ·fi ·Î·‰ËÌ·˚ο ‹/Î·È ÎÏÈÓÈο ΤÓÙÚ· Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙËÓ ¤Ú¢ӷ Î·È ÙËÓ ÎÏÈÓÈ΋ ÂÚ›ı·Ï„Ë ·È‰ÈÒÓ Ì ÚÂ˘Ì·ÙÈο ÓÔÛ‹Ì·Ù·. ∞˘Ùfi˜ Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Û˘ÓÂÚÁ·Û›·˜ ÌÂٷ͇ Ù˘ ¢ÈÂıÓÔ‡˜ √ÚÁ¿ÓˆÛ˘ ªÂÏÂÙÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ƒÂ˘Ì·ÙÔÏÔÁ›· (PRINTO) Î·È Ù˘ ¶·È‰È·ÙÚÈ΋˜ ƒÂ˘Ì·ÙÔÏÔÁÈ΋˜ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ (Paediatric Rheumatology European Society, PR∂S: http://www.pres.org.uk). ªÔÚ›Ù ӷ ‚Ú›Ù Ôχ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Î·È ÛÙ· ∂ÏÏËÓÈο. ∆Ô ÚÒÙÔ ÙÌ‹Ì·, ÛÙԯ‡ÂÈ Ó· ÂÓËÌÂÚÒÛÂÈ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· Ù· ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÈÔ ÛËÌ·ÓÙÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ ÚÂ˘Ì·ÙÔÏÔÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∆Ô ‰Â‡ÙÂÚÔ ÙÌ‹Ì· ‰›ÓÂÈ ÙȘ ‰È¢ı‡ÓÛÂȘ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ÚÂ˘Ì·ÙÔÏÔÁÈÎÒÓ Î¤ÓÙÚˆÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ È·ÙÚÔ› Â›Ó·È Ì¤ÏË Ù˘ PRINTO ‹/Î·È Ù˘ PRES. ∆Ô ÙÚ›ÙÔ ÙÌ‹Ì· ‰›ÓÂÈ ÙȘ ‰È¢ı‡ÓÛÂȘ ÙˆÓ Û˘ÏÏfiÁˆÓ Ô˘ ÚÔÛʤÚÔ˘Ó ‚Ô‹ıÂÈ· ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ÚÂ˘Ì·ÙÔ·ıÒÓ ·È‰ÈÒÓ.

ª·Ú›· ¶··Ê›ÏË °È· ÏËÚÔÊÔڛ˜: www.euran.com ªaria Papafili For information: www.euran.com

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CLINICAL QUIZ ∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏

∏ ‰È¿ÁÓˆÛË Â›Ó·È ·ÚÔ‰ÈÎfi˜ ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ Ì ̷ÎÚÔۈ̛· Î·È ˘ÂÚÙÚÔÊÈ΋ ·ÔÊÚ·ÎÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ∏ ¿ıËÛË ·˘Ù‹ ·Ú·ÙËÚÂ›Ù·È Û ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, Û ·Û˘Ì‚·ÙfiÙËÙ· Rh, Û ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ηıÒ˜ Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Beckwith. √ ·ÚÔ‰ÈÎfi˜ ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ ‰È·ÚΛ ·fi ÌÂÚÈΤ˜ Ë̤Ú˜ ̤¯ÚÈ Î·È Ì‹Ó˜. ∞ÓÙ›ıÂÙ·, Ô ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ Ô˘ Û˘Óԉ‡ÂÈ Ù· ÓÂÔÁ¤ÓÓËÙ· ‰È·‚ËÙÈ΋˜ ÌËÙ¤Ú·˜, ‰È·ÚΛ

ÌfiÏȘ Ï›Á˜ ÒÚ˜. ∆Ô Û‡Ó‰ÚÔÌÔ Beckwith ÂÎÙfi˜ ·fi ˘ÔÁÏ˘Î·ÈÌ›·, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÍÒÌÊ·ÏÔ, Ì·ÎÚÔÁψÛÛ›·, ÔÚÁ·ÓÔÌÂÁ·Ï›·, ÁÈÁ·ÓÙÈÛÌfi Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ¯ÚˆÌfiۈ̷ 11p 15.4. ™Â ·ÓÙ›ıÂÛË Ì ÙË ÌfiÓÈÌË ÌÔÚÊ‹ ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌÔ‡ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ÌÂÙ¿ÏÏ·ÍË 5 ÁÔÓȉ›ˆÓ (Ì ΢ÚÈfiÙÂÚ˜ ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ SUR1 Î·È ∫πR6.2), ÛÙËÓ ·ÚÔ‰È΋ ÌÔÚÊ‹, ‰ÂÓ ¤¯Ô˘Ó ‚ÚÂı› ¯ÚˆÌÔÛˆÌȷΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ÙÔ ·›ÙÈÔ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Nold JL, Georgieff MK. Infants of diabetic mothers [Review]. Pediatr Clin North Am. 2004 Jun; 51(3):619-637.

2. Breitweser JA, Meyer RA, Sperling MA, Tsang RC, Kaplan S. Cardiac septal hypertrophy in

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hyperinsulinemic infants. Part II. J Pediatr 1980; 96:535-539.

3. Gutgesell HP, Speer ME, Rosenberg HS. Characterization of the cardiomyopathy in infants of diabetic mothers. Circulation 1980;61:441-450.

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xxv

26-29 ∞ÚÈÏ›Ô˘ 2006

XVIIth Annual Congress of the European ∞ı‹Ó· Society for Paediatric Urology •ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔڛ˜: Erasmus Conferences Tours & Travel S.A. ∆ËÏ.: 210 7257 693 Fax: 210 7257 532 E-mail: info@espu2006.com Website: www.espu2006.com

1-6 ª·˝Ô˘ 2006

Paediatric Update Conference ¶ÏËÚÔÊÔڛ˜: Brenda Rau ∆ËÏ.: 416 813 8122 Fax: 416 813 5230 E-mail: brenda.rau@sickkids.ca

Toronto, Canada

3-5 ª·˝Ô˘ 2006

24th Annual Meeting of the European Society for Paediatric Infectious Diseases - ESPID ¶ÏËÚÔÊÔڛ˜: Kenes International / ESPID 2006 ∆ËÏ.: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: espid@kenes.com Website: www.kenes.com/espid/index2006.asp

Basel, Switzerland

9-13 ª·˝Ô˘ 2006

32Ô ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ¢ÈÔÚÁ¿ÓˆÛË: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: 210 7211 845, 7243 161, 7215 082 ∂-mail: vpapag@nednet.gr

∞ı‹Ó·

12-14 ª·˝Ô˘ 2006

36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰Ô‰ÔÓÙÈÎfi ™˘Ó¤‰ÚÈÔ ™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ £ÂÛÛ·Ï›·˜ ¶ÏËÚÔÊÔڛ˜: η §›˙· ¶··ÁÈ·ÓÓÔ‡ÏË ∆ËÏ: 210 7461 019, 7461 219 E-mail: hspd@enternet.gr Website: www.hspd.gr

µfiÏÔ˜

13-14 ª·˝Ô˘ 2006

15Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ ∞ÌÊÈı¤·ÙÚÔ ∂∫∫º∂ “¢ËÌfiÎÚÈÙÔ˜” ¢ÈÔÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· °.¡. ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ ¶ÏËÚÔÊÔڛ˜: Triaena Tours ∆ËÏ.: 210 7499 304 Fax: 210 7705 752 E-mail: congress@triaenatours.gr

∞ı‹Ó·

23 ª·˝Ô˘ 2006

Teach-In/Medical Update - Paediatrics ¶ÏËÚÔÊÔڛ˜: The Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ Christina Pottinger ∆ËÏ.: 44 0 1 312 257 324 Fax: 44 0 1 312 203 939 E-mail: c.pottinger@rcpe.ac.uk

Edinburgh, Scotland, UK

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24-27 ª·˝Ô˘ 2006

41st Annual Meeting of the Association for Basel, European Paediatric Cardiology (AEPC) Switzerland ¶ÏËÚÔÊÔڛ˜: Dr. Ingrid Oberhänsli-Weiss Ph.D, AEPC Secretary-general, 31 Route de Florissant, CH-1206 Geneva Switzerland TËÏ.: 41 22 347 10 56 / 43 1 370 81 75 Fax: 41 22 347 10 56 E-mail: secr@aepc.org / ingrid.oberhaensli@bluewin.ch

9-11 πÔ˘Ó›Ô˘ 2006

44o ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: C&C International SA Conventions & Congresses ¶·Ú·‰Â›ÛÔ˘ 16, 151 25 ∞ı‹Ó· ∆ËÏ.: 210 6889 100 Fax: 210 6844 777 E-mail: registrations@cnc.gr Website: www.pediatric2006.gr

ƒfi‰Ô˜, Rodos Palace

10-14 πÔ˘Ó›Ô˘ 2006

XXV Congress of the European Academy of Allergology and Clinical Immunology ¶ÏËÚÔÊÔڛ˜: Congrex Sweden ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: eaaci2006@congrex.se Website: www.congrex.com/eaaci2006

Vienna, Austria

30 πÔ˘Ó›Ô˘-3 πÔ˘Ï›Ô˘ 2006 45th Annual Meeting of the European Society for Paediatric Endocrinology ¶ÏËÚÔÊÔڛ˜: Congrex Sweden AB ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: espe2006@congrex.se Website: www.espe2006.org

Rotterdam, The Netherlands

8-11 πÔ˘Ï›Ô˘ 2006

7th International Congress on Pediatric Pulmonology ¶ÏËÚÔÊÔڛ˜: Annie Bidart, MD ∆ËÏ.: +33 0 497 038 597 Fax: +33 0 497 038 598 E-mail: cipp@cipp-meeting.com Website: www.cipp-meeting.com

Montreal, Canada

7-10 √ÎÙˆ‚Ú›Ô˘ 2006

40th Meeting of the European Society of Paediatric Nephrology ¶ÏËÚÔÊÔڛ˜: E.DI.PO. s.r.l.Via della Libertà, 103 - 90143 Palermo ∆ËÏ.: ++39 091 340255 Fax: ++39 091 340440 E-mail: edi.po@tiscali.it Website: www.espn2006.org/

Palermo, Italy