Παιδιατρική | Τόμος 70 • Τεύχος 4 • Ιούλιος - Αύγουστος 2007

Pediatri July-Aug 07

09-07-07

17:07

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∞¡∞™∫O¶∏™∂π™ 257 Persistent vegetative state in children: terminology, aetiology, prognosis and ethical issues v D. Neubauer, S. Grosek, P. Hamilton, M. LoGiudice, D. Matthys, V. Molina, L. Nikolovski, E. Siebke, A. Tenore, F.P. Crawley

320 ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔ̤·˜ Ô‰fiÓÙ·˜ Û ÙÚ›· ‚Ú¤ÊË ∞. ∞Ó‰Ú¤Ô˘, ∞. ∫Ô‡ÙÏ·, ∂. ∑¢Á·Ú›‰Ô˘, ∞. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘

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Pediatri July-Aug 07

09-07-07

17:07

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Paediatriki Bimonthly Publication of the Greek Paediatric Society

Volume 70 ñ Number 4 ñ July-August 2007

President A. Constantopoulos

Contents

Editorial Board

EDITORIAL COMMENTARY

CASE REPORTS

Editor-in-Chief C. Stefanidis

253 The death of ethics Th. Pelegrinis

316 Coexistence of neuroblastoma and hereditary spherocytosis J.P. Panagiotou, G. Lekka, A. Garoufi, A. Stamoulakatou, E. Premetis, A. Constantopoulos

Members S. Andronikou P. Augoustides-Savvopoulou A. Vazeou-Gerasimidi G. Varlamis ∂. Galanakis L. Thomaidou M. Kanariou ∂. Katsarou-Pectasides A. Kattamis S. Kitsiou-Tzeli ∞. Papadopoulou N. Papadopoulos A. Siamopoulou-Mavridou M. Tsolia Manuscript Editing Greek Editing A. Vasilopoulou English Editing S. Nakou Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 1∞ Pierias St. GR - 144 51, Metamorfossi 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

REVIEW ARTICLES 257 Persistent vegetative state in children: terminology, aetiology, prognosis and ethical issues v D. Neubauer, S. Grosek, P. Hamilton, M. LoGiudice, D. Matthys, V. Molina, L. Nikolovski, E. Siebke, A. Tenore, F.P. Crawley 266 The increase of allergic conditions in recent years: epidemiology and causes A. Sofianou-Katsoulis 272 Breastfeeding: does it also protect against neoplasms?

D. Matthaios, E. Mantadakis, P. Laios, S. Kakolyris, A. Chatzimihail

320 Congenital nasal pyriform stenosis and single central upper maxillary incisor in three infants A. Andreou, A. Koutla, E. Zeugaridou, A. Sakellaropoulou 325 Blue Rubber Bleb Nevus Syndrome with concurrent neurological and skeletal involvement M. Tzoufi, P. Sihlimiri, I. Nakou, M. Argyropoulou, A. Siamopoulou-Mavridou PRACTICAL ISSUE

278 Contraindications to breastfeeding E. Hatzidaki, C. Giannakopoulou

330 Therapeutic management of childhood atopic dermatitis T. Kakourou

ORIGINAL ARTICLES

336 PAEDIATRIC NEWS IN BRIEF

285 Effect of a supportive program on breastfeeding A. Ntourntoufi, V. Cholevas, L. Kontou, M. Pavlou, S. Andronikou 293 Environmental factors possibly associated with the pathogenesis of diabetes mellitus type 1 (DM1) K. Karavanaki, E. Tsoka, C. Karayianni, V. Petrou, E. Pippidou, M. Brisimitzi, M. Mavrikiou, K. Kakleas, C. Dacou-Voutetakis 300 Waist circumference percentiles of children of Crete aged 3 to 16 years ∂. Linardakis, K. Vardavas, A. Kafatos 308 Hormones regulating the food intake and metabolism of preterm infants T. Siahanidou, I. Papassotiriou, M. Vounatsou, H. Militsi, H. Mandyla

E. Galanakis 338 NEWS FROM THE INTERNET N. Papadopoulos 340 CLINICAL QUIZ G. Dioudis, V. Georgopoulou, M. Manolaki, N. Myriokefalitakis 341 LETTERS TO THE EDITOR A. Andreou S. Petmezaki G.P. Chroussos, M. Karantza

Pediatri July-Aug 07

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™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

∂ȉÈÎÔ› ™˘ÓÙ¿ÎÙ˜

Section Editors

™Ù¤ÏÏ· ∞Ó‰ÚfiÓÈÎÔ˘, ¡ÂÔÁÓÔÏÔÁ›·, πˆ¿ÓÓÈÓ·

Stella Andronikou, Neonatology, Ioannina

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

Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki

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

Andriani Vazaiou-Gerasimidi, Endocrinology, Athens

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

George Varlamis, Cardiology, Thessaloniki

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, ∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·, ∏Ú¿ÎÏÂÈÔ

Emmanouil Galanakis, Ethics and Deontology, Heraklion

§ˆÚ¤ÙÙ· £ˆÌ·˚‰Ô˘, ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜, ∞ı‹Ó·

Loretta Thomaidou, Developmental Pediatrics, Athens

ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ÓÔÛÔÏÔÁ›·, ∞ı‹Ó·

Maria Kanariou, Immunology, Athens

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

Eustathia Katsarou-Pektasides, Neurology, Athens

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

Antonis Kattamis, Haematology - √ncology, Athens

™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, °ÂÓÂÙÈ΋, ∞ı‹Ó·

Sophia Kitsiou-Tzeli, Genetics, Athens

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

Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens

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

Nicos Papadopoulos, Allergology - Pneumonology, Athens

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

Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina

ª·Ú›˙· ∆ÛÔÏÈ¿, §ÔÈ̈ÍÈÔÏÔÁ›·, ∞ı‹Ó·

Marisa Tsolia, Infectious Diseases, Athens

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

Peter Hoyer, Essen, Germany

Ellis D. Avner, Milwaukee, USA

Jan Janda, Prague, Czech Republic

Swati Bhave, New Delhi, India

Jan Kimpen, Ultrecht, Netherlands

Alberto Bissot, Panama, Panama

Craig B. Langman, Chicago, USA

David Branski, Jerusalem, Israel

John Manis, Boston, USA

Francesco Chiarelli, Chieti, Italy

Manuel Moya, Alicante, Spain

Chok-Wan Chan, Hong Kong, China

Hugh O'Brodovich, Toronto, Canada

Denis Daneman, Toronto, Canada

Ross Petty, Vancouver, 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

Nick J. Spencer, Coventry, UK

Margaret C. Fisher, Philadelphia, USA

Alfred Tenore, Udine, Italy

Raif Geha, Boston, USA

Alkis Togias, Bethesda, USA

Adenike Grange, Lagos, Nigeria

Eva Tsalikian, Iowa City, USA

Judith G. Hall, Vancouver, Canada

Catherine Weil-Olivier, Paris, France

Patricia Hamilton, London, UK

Max Zach, Graz, Austria

Enver Hasanoglu, Ankara, Turkey

Johannes Zschocke, Heidelberg, Germany

Christer Holmberg, Helsinki, Finland

v

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Pediatri July-Aug 07

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EDITORIAL COMMENTARY

253

O ı¿Ó·ÙÔ˜ Ù˘ ËıÈ΋˜ £. ¶ÂÏÂÁÚ›Ó˘ ¶ÂÚ›ÏË„Ë: ∏ ËıÈ΋ Û‹ÌÂÚ· ‚Ú›ÛÎÂÙ·È Û ÙfiÛÔ ‚·ıÈ¿ ÎÚ›ÛË, ÒÛÙ ӷ ÌÔÚ› Ó· ˘ÔÛÙËÚȯı› fiÙÈ ‚Ú›ÛÎÂÙ·È ÚÔ ÙÔ˘ Ù¤ÏÔ˘˜ Ù˘. ™ÙËÓ ˘fiıÂÛË ·˘Ù‹ Û˘ÓËÁÔÚÔ‡Ó ÙÚÂȘ ΢ڛˆ˜ ÏfiÁÔÈ. ¶ÚÒÙÔÓ, Ë ·ÌÊÈÛ‚‹ÙËÛË Ù˘ ËıÈ΋˜ ÁÏÒÛÛ·˜, ÙÔ ÁÂÁÔÓfi˜ ÂȉÈÎfiÙÂÚ· fiÙÈ, Û‡Ìʈӷ Ì ÔÚÈṲ̂ÓÔ˘˜ ÊÈÏÔÛfiÊÔ˘˜, ı· ÌÔÚÔ‡Û·Ó Ó· ··ÏÂÈÊıÔ‡Ó ·fi ÙË ÁÏÒÛÛ· Ì·˜ ÔÈ ËıÈÎÔ› fiÚÔÈ, ¯ˆÚ›˜ Ó· ·ÏÏÔȈı› ÙÔ ÓfiËÌ· Ù˘. ¢Â‡ÙÂÚÔÓ, Ë ·ÏÌ·Ù҉˘ ÂͤÏÈÍË Ù˘ Ù¯ÓÔÏÔÁ›·˜ Ô˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ‚·ÛÈΤ˜ ¤ÓÓÔȘ Ù˘ ËıÈ΋˜ Ó· ÌÔÈ¿˙Ô˘Ó Ó· ÌËÓ ¤¯Ô˘Ó Û‹ÌÂÚ· ÏfiÁÔ ‡·Ú͢. ∆Ú›ÙÔÓ, Ë ·ÌÊÈÛ‚‹ÙËÛË ÙÔ˘ ÊÔÚ¤· Ù˘ ËıÈ΋˜ ˙ˆ‹˜, ‰ËÏ·‰‹ ÙÔ˘ ·˘ÙÔ‡ Ì·˜, ˆ˜ Ì›·˜ ÂÓÈ·›·˜ ˘fiÛÙ·Û˘ Ô˘ ηÙ¢ı‡ÓÂÈ ÙȘ ÛΤ„ÂȘ Î·È ÙȘ Ú¿ÍÂȘ Ì·˜. ∏ ·ÌÊÈÛ‚‹ÙËÛË Ù˘ ËıÈ΋˜ ÂÓÙ¿ÛÛÂÙ·È ÛÙÔ ÁÂÓÈÎfiÙÂÚÔ Ó‡̷ Ù˘ ·Ó·Ó¤ˆÛ˘ ÙÔ˘ ÔÏÈÙÈÛÌÔ‡ Ì·˜ ̤۷ ·fi ÙËÓ Î·Ù¿ÚÁËÛË ÔÚÈÛÌ¤ÓˆÓ ÌÔÚÊÒÓ ÙÔ˘ Î·È ÙËÓ ·ÓÙÈηٿÛÙ·Û‹ ÙÔ˘˜ Ì ¿ÏϘ ÌÔÚʤ˜, fiˆ˜ Û˘Ó¤‚Ë ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ Ì˘ıÔÏÔÁ›·˜ Ô˘ ·fi ¤Ó· ÛËÌÂ›Ô ÎÈ ¤ÂÈÙ· ¤·„ ӷ ·ÔÙÂÏ› ËÁ‹ ‰ËÌÈÔ˘ÚÁ›·˜, ¯ˆÚ›˜ Ó· ·Ó·ÎÔ› Ë ÂÍÂÏÈÎÙÈ΋ ÔÚ›· ÙÔ˘ ÔÏÈÙÈÛÌÔ‡ Ì·˜.

AÏÏËÏÔÁÚ·Ê›·: £ÂÔ‰fiÛ˘ ¶ÂÏÂÁÚ›Ó˘ tpelegr@phil.uoa.gr K·ıËÁËÙ‹˜ ºÈÏÔÛÔÊ›·˜ Î·È ∫ÔÛÌ‹ÙÔÚ·˜ Ù˘ ºÈÏÔÛÔÊÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

§¤ÍÂȘ ÎÏÂȉȿ: ∏ıÈ΋, ÔÏÈÙÈÛÌfi˜, ÁÏÒÛÛ·.

The death of ethics Th. Pelegrinis Abstract: Ethics today is in such a grave crisis, so that one may suppose that it is one step before the end.

There are three reasons to support this. First, the questioning of moral language and the fact that according to certain philosophers it is possible to omit moral terms from the language without any change of meaning. Second, the great advancement of technology, due to which basic moral concepts seem to be obsolete. Third, the questioning of the subject of moral life, i.e. the self as a condensed entity which directs our thoughts and actions. The questioning of Ethics is subject to the general attitude of renewing our culture through the rejection of certain forms of it and their substitution with other forms as it happened with mythology. Mythology at a certain time ceased to be a source of creativity without causing a negative effect upon our culture’s progress.

Correspondence: Theodosis Pelegrinis tpelegr@phil.uoa.gr Professor of Philosophy and Dean of the School of Philosophy, University of Athens, Greece

Key words: Ethics, culture, language.

∏ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ, Â›Ó·È ÁÂÁÔÓfi˜, ·ÔÙÂÏ› Ì›· Â›ÔÓË ‰È·‰Èηۛ·. ¢ÂÓ Â›Ó·È ÌfiÓÔ Ô „˘¯ÈÎfi˜ Î·È ÛˆÌ·ÙÈÎfi˜ ο̷ÙÔ˜, ÛÙÔÓ ÔÔ›Ô ˘Ô‚¿ÏÏÂÙ·È Ô ÂÈÛÙ‹ÌˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙ·ÔÎÚÈı› ÛÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ¤ÚÁÔ˘ ÙÔ˘, ·ÏÏ¿ Â›Ó·È ·ÎfiÌË Ë ·ÌÊÈÛ‚‹ÙËÛË Î·È ÔÈ ÚÔËÏ·ÎÈÛÌÔ› Î·È Ë Î·Ù·ÎÚ·˘Á‹ Î·È Ë ¯ÏÂ‡Ë Î·È ÔÈ ‰ÈÒÍÂȘ Ô˘ ˘Ê›ÛٷٷÈ, fiÔÙÂ Û˘Ì‚Â› ÔÈ ·fi„ÂȘ ÙÔ˘ Ó· ÍÂÂÚÓÔ‡Ó Ù· fiÚÈ· Ù˘ ηıÂÛÙË΢›·˜ ·ÓÙ›Ï˄˘ Ù˘ ÎÔÈÓˆÓ›·˜. ∆· ÚÔ‚Ï‹Ì·Ù·, ÂȉÈÎfiÙÂÚ·, Ô˘ ·ÓÙÈÌÂÙˆ›˙ÂÈ Ô ÂÈÛÙ‹ÌˆÓ Î·Ù¿ ÙËÓ ¿ÛÎËÛË ÙÔ˘ ÂÚ¢ÓËÙÈÎÔ‡ ¤ÚÁÔ˘ ÙÔ˘ Â›Ó·È ·ÊÂÓfi˜ ÌÂÓ ÂÛˆÙÂÚÈ΋˜ ٿ͈˜, ·ÊÂÙ¤ÚÔ˘ ‰Â Â͈ÙÂÚÈ΋˜ ʇÛˆ˜. ∂ÛˆÙÂÚÈ΋˜ ٿ͈˜ ÚÔ‚Ï‹Ì·Ù· ÂÓÓÔÒ Ù· ˙ËÙ‹Ì·Ù·, Ù· ÔÔ›· ÚÔ·ÙÔ˘Ó Î·Ù¿ ÙËÓ ÔÚ›· Ù˘ ÂÈÛÙËÌÔÓÈ΋˜ ¤Ú¢ӷ˜. ∆· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿, ÚÔ‰‹Ïˆ˜, Â›Ó·È Î·Ïԉ¯ԇÌÂÓ· ·fi ÙÔÓ ÂÈÛÙ‹ÌÔÓ·, ·ÊÔ‡, ÂÍ·ÈÙ›·˜ ÙÔ˘˜ ‰ÈηÈÔÏÔÁ›-

Ù·È Ë ·ÚÔ˘Û›· ÙÔ˘ Î·È ·fi ÙËÓ Â›Ï˘Û‹ ÙÔ˘˜ ηٷÍÈÒÓÂÙ·È. ∆· Â͈ÙÂÚÈ΋˜ ʇÛˆ˜ ÚÔ‚Ï‹Ì·Ù·, ÂÍ¿ÏÏÔ˘, ·Ú·¤ÌÔ˘Ó Û fiÏ· ÂΛӷ Ù· ÂÌfi‰È·, Ù· ÔÔ›· ÔÚıÒÓÔÓÙ·È ÌÚÔÛÙ¿ ÛÙÔ ¤ÚÁÔ ÙÔ˘ ÂÈÛÙ‹ÌÔÓ· ·fi ÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ·Ó Û˘Ì‚Â› ÔÈ ·fi„ÂȘ Ô˘ ‰È·Ù˘ÒÓÂÈ ·˘Ùfi˜ Ó· ÌË Û˘Ó¿‰Ô˘Ó ÚÔ˜ ÙȘ ıÚËÛ΢ÙÈΤ˜, ÙȘ ËıÈΤ˜ ηÈ, ÁÂÓÈÎÒ˜, ÙȘ ηıÈÂڈ̤Ó˜ ÂÔÈı‹ÛÂȘ ÙÔ˘ ÎfiÛÌÔ˘. ™Â ·ÓÙ›ıÂÛË ÚÔ˜ Ù· ÂÛˆÙÂÚÈ΋˜ ٿ͈˜ ÚÔ‚Ï‹Ì·Ù·, Ù· ÔÔ›· ¤¯ÂÈ ÙËÓ ‰˘Ó·ÙfiÙËÙ· Ó· ·Ï¤„ÂÈ Î·È, ÂӉ¯Ô̤ӈ˜, Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ, Ô ÂÈÛÙ‹ÌˆÓ Â›Ó·È ¤ÚÌ·ÈÔ ÙˆÓ Â͈ÙÂÚÈ΋˜ ʇÛˆ˜ ÚÔ‚ÏËÌ¿ÙˆÓ. ∆· ·Ú·‰Â›ÁÌ·Ù·, ÛÙ· ÔÔ›· ÔÈ ÂÈÛÙ‹ÌÔÓ˜ Ï‹ÚˆÛ·Ó ·ÎfiÌË Î·È Ì ÙËÓ ˙ˆ‹ ÙÔ˘˜ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·Ï‹ıÂȘ Ô˘ ‰È·Ù‡ˆÛ·Ó ·¤ÎÏÈÓ·Ó ·fi ÙȘ ÂÔÈı‹ÛÂȘ Ù˘ ÎÔÈÓˆÓ›·˜ ÛÙËÓ ÔÔ›· ·Ó‹Î·Ó, ‰ÂÓ Ï›Ô˘Ó. √ ∆˙ÔÚÓÙ¿ÓÔ ªÚÔ‡ÓÔ, ·˜ Ô‡ÌÂ, ηٷ‰ÈοÛÙËΠÛÙȘ

∂Ó·ÚÎÙ‹ÚÈ· ÔÌÈÏ›· ÛÙÔ 45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 25-27 M·˝Ô˘ 2007, ™ÈıˆÓ›· ÷ÏÎȉÈ΋˜

¶·È‰È·ÙÚÈ΋ 2007;70:253-256

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·254

254

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·Ú¯¤˜ ÙÔ˘ 17Ô˘ ·ÈÒÓ·, ÁÈ·Ù›, ÌÂٷ͇ ¿ÏψÓ, ˘ÔÛÙ‹ÚÈÍ fiÙÈ ÙÔ Û‡Ì·Ó Â›Ó·È ¿ÂÈÚÔ, Ì›· ¿Ô„Ë Ô˘ ‹Ù·Ó ÌÂÓ ·ÏËı‹˜, ·ÏÏ¿ ·ÓÙ›ıÂÙË ÚÔ˜ ÙË ¯ÚÈÛÙÈ·ÓÈ΋ ·Ú¿‰ÔÛË. ™‡Ìʈӷ Ì ÙËÓ ∞Á›· °Ú·Ê‹, ÂȉÈÎfiÙÂÚ·, Ô £Âfi˜ ¤ÊÙÈ·Í ÙÔÓ ÎfiÛÌÔ, ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ÔÔ›Ô˘ ÙÔÔı¤ÙËÛ ÙËÓ ÎÔÚˆÓ›‰· Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÙÔ˘, ÙÔÓ ¿ÓıÚˆÔ. ∞Ó, fï˜, ÙÔ Û‡Ì·Ó ›ӷÈ, fiˆ˜ ˘ÔÛÙ‹ÚÈÍÂ Ô ªÚÔ‡ÓÔ, ¿ÂÈÚÔ, ÙfiÙ ‰ÂÓ ˘¿Ú¯ÂÈ ÂÚÈʤÚÂÈ· Ô˘ Ó· ÙÔ ÎÏ›ÓÂÈ Ì¤Û· Ù˘, Î·È Ê˘ÛÈο, ‰ÂÓ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ Î¤ÓÙÚÔ, ÔfiÙÂ Ë ¯ÚÈÛÙÈ·ÓÈ΋ ›ÛÙË ÂÚ› Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÙÔ˘ ÎfiÛÌÔ˘ ·fi ÙÔÓ £Âfi, Ô ÔÔ›Ô˜ ÙÔÔı¤ÙËÛ ÙÔÓ ¿ÓıÚˆÔ ÛÙÔ Î¤ÓÙÚÔ ÙÔ˘ ÎfiÛÌÔ˘, ηı›ÛÙ·Ù·È ¤ˆÏË. √È ·ÓÙȉڿÛÂȘ, ‚¤‚·È·, Ô˘ ÂΉËÏÒıËÎ·Ó Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÂÁ›ÚÔÓÙ·È ÛÙȘ ̤Ú˜ Ì·˜, ÂÓ·ÓÙ›ÔÓ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ÁÈ· ÙȘ ·fi„ÂȘ ÙÔ˘˜ Ô˘ ‰ÂÓ Û˘Ó¿‰Ô˘Ó ÚÔ˜ ÙȘ ηıÈÂڈ̤Ó˜ ·ÓÙÈÏ‹„ÂȘ Î·È ÙȘ ·ÁȈ̤Ó˜ ·Í›Â˜ Ù˘ ÎÔÈÓˆÓ›·˜ ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙÔ ‰›Ô Ù˘ ıÚËÛΛ·˜, ·ÏÏ¿ ÂÂÎÙ›ÓÔÓÙ·È, Â›Û˘, Û ¿ÏÏÔ˘˜ ÙÔÌ›˜ ÙÔ˘ ÔÏÈÙÈÛÌÔ‡ Ì·˜, fiˆ˜ Ë ËıÈ΋, fiÔ˘ ı· ‹ıÂÏ· Ó· οӈ ÔÚÈṲ̂Ó˜ ÂÈÛËÌ¿ÓÛÂȘ, ÌÈ·˜ Î·È ·¢ı‡ÓÔÌ·È Û ·ÎÚÔ·Ù‹ÚÈÔ Î˘Ú›ˆ˜ È·ÙÚÒÓ, ÔÈ ÔÔ›ÔÈ ÓÈÒıÔ˘Ó ÙÔÓ Ì·ÌԇϷ Ù˘ ËıÈ΋˜ Ó· ÙÔ˘˜ ÂÚÈ̤ÓÂÈ ÛÙË ÁˆÓ›·, ¤ÙÔÈÌÔ˜ Ó· ÙÔ˘˜ ÂÈÙÂı›, ·Ó ÂȯÂÈÚ‹ÛÔ˘Ó Ó· ÍÂʇÁÔ˘Ó ·fi ÙȘ ·Ú·‰Â‰Ô̤Ó˜ ·Ú¯¤˜. £· ‹ıÂÏ· Ó· ·Ú·ÙËÚ‹Ûˆ fiÙÈ Ë ËıÈ΋ -¤Ó· ϤÁÌ· ηÓfiÓˆÓ Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙȘ Û¯¤ÛÂȘ ÌÂٷ͇ ÙˆÓ ·ÓıÚÒˆÓ ÛÙÔ˘˜ ÎfiÏÔ˘˜ Ù˘ ÎÔÈÓˆÓ›·˜- ‰ÂÓ Â›Ó·È Û˘Ó˘Ê·Ṳ̂ÓË Ì ÙË Ê‡ÛË ÙÔ˘ ·ÓıÚÒÔ˘, fiˆ˜ ›ӷÈ, ·˜ Ô‡ÌÂ, ÙÔ ¤ÓÛÙÈÎÙÔ Ù˘ ·˘ÙÔÛ˘ÓÙ‹ÚËÛ˘. √ ∞ÚÈÛÙÔÙ¤Ï˘ ϤÂÈ -Î·È ÓÔÌ›˙ˆ fiÙÈ ¤¯ÂÈ ‰›ÎÈÔ- fiÙÈ Ë ËıÈ΋ ·Ú¯›˙ÂÈ ·fi ÂΛ fiÔ˘ ÛÙ·Ì·Ù¿ÂÈ Ë ÊÈÏ›·. ªÂٷ͇ ÙˆÓ Ê›ÏˆÓ ‰ÂÓ Ù›ıÂÙ·È ÙÔ ˙‹ÙËÌ· ·Ó Ú¤ÂÈ ‹ ‰ÂÓ Ú¤ÂÈ Ó· οÓÂÈ Î¿ÙÈ Ô ¤Ó·˜ ·fi ÙÔ˘˜ ‰‡Ô ÁÈ· ÙÔÓ ¿ÏÏÔ ·˘ıfiÚÌËÙ· Î·È ¯ˆÚ›˜ Î·Ó¤Ó·Ó ÂÓ‰ÔÈ·ÛÌfi: Ô Ê›ÏÔ˜ Û οı ÂÚ›ÙˆÛË Ú¿ÙÙÂÈ ÂΛÓÔ Ô˘ ÙÔ˘ ˘·ÁÔÚ‡ÂÈ Ë Û¯¤ÛË Ù˘ ÊÈÏ›·˜ ÙÔ˘ Ì οÔÈÔÓ Û˘Ó¿ÓıÚˆfi ÙÔ˘, ¤ÛÙˆ Î·È ·Ó ͤÚÂÈ fiÙÈ Ë Ú¿ÍË ÙÔ˘ ·˘Ù‹ ·Ú·‚È¿˙ÂÈ Î¿ÔÈ· ıÂÌÂÏÈÒ‰Ë ËıÈ΋ ·Ú¯‹ Ù˘ ÎÔÈÓˆÓ›·˜ fiÔ˘ ˙ÂÈ. ŸÙ·Ó, ÁÈ· Ó· ·Ó·Ê¤Úˆ ÌÈ· ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÂÚ›ÙˆÛË ÊÈÏ›·˜, Ô §·›ÏÈÔ˜, ÌÚÔÛÙ¿ ÛÙÔ˘˜ ƒˆÌ·›Ô˘˜ ˘¿ÙÔ˘˜, ÔÈ ÔÔ›ÔÈ, ÌÂÙ¿ ÙËÓ Î·Ù·‰›ÎË ÙÔ˘ ∆È‚¤ÚÈÔ˘ °Ú¿Î¯Ô˘, ΢ÓËÁÔ‡Û·Ó fiÏÔ˘˜ fiÛÔÈ ‹Ù·Ó Ù˘ ÂÌÈÛÙÔÛ‡Ó˘ ÙÔ˘, ÚÒÙËÛ ÙÔÓ ÛÙÂÓfiÙÂÚÔ Ê›ÏÔ ÙÔ˘, °¿ÈÔ µÏfiÛÈÔ, ÙÈ ı· ÌÔÚÔ‡Û ӷ οÓÂÈ ÁÈ· ¯¿ÚË ÙÔ˘ °Ú¿Î¯Ô˘, ÂΛÓÔ˜ ÙÔ˘ ·¿ÓÙËÛÂ: “∆· ¿ÓÙ·”. “¶Ò˜ Ù· ¿ÓÙ·”, Û˘Ó¤¯ÈÛÂ Ô §·›ÏÈÔ˜, “‰ËÏ·‰‹ ÙÈ; ∞Ó ÛÔ˘ ¤‰ÈÓ ÂÓÙÔÏ‹ Ó· ‚¿ÏÂȘ ʈÙÈ¿ ÛÙÔ˘˜ Ó·Ô‡˜ Ì·˜, ı· ÙÔ ¤Î·Ó˜;”. “¶ÔÙ¤ ‰ÂÓ ı· ÌÔ˘ ¤‰ÈÓ ٤ÙÔÈ· ÂÓÙÔÏ‹”, ·ÔÎÚ›ıËÎÂ Ô µÏfiÛÈÔ˜. “∞Ó, fï˜, ÛÔ˘ ¤‰ÈÓ ٤ÙÔÈ· ÂÓÙÔÏ‹;”, Â¤ÌÂÈÓÂ Ô §·›ÏÈÔ˜. “£· ›¯· ˘·ÎÔ‡ÛÂÈ”, ·¿ÓÙËÛÂ Ô µÏfiÛÈÔ˜. ŸÙ·Ó Ë Û¯¤Paediatriki 2007;70:253-256

ÛË ÌÂٷ͇ ‰‡Ô ·ÓıÚÒˆÓ ‰ÂÓ ·ÁÁ›˙ÂÈ Ù· fiÚÈ· Ù˘ ÊÈÏ›·˜, fiÔ˘ Ô ¤Ó·˜ ‰›ÓÂÙ·È ÛÙÔÓ ¿ÏÏÔ ¯ˆÚ›˜ Ó· ˘ÔÏÔÁ›˙ÂÈ Ù›ÔÙÂ, Î·È Ù·˘Ùfi¯ÚÔÓ·, ¿Ó, Û ÂÚ›ÙˆÛË Ô˘ Ô ¤Ó·˜ ÎÏËı› Ó· Ú¿ÍÂÈ Î¿ÙÈ Û ۯ¤ÛË Ì ÙÔÓ ¿ÏÏÔ, ÂΛÓÔ˜ ‰ÈÂÚˆÙËı› ·Ó Ú¤ÂÈ Ó· ÙÔ Î¿ÓÂÈ ‹ fi¯È, ÙfiÙ Ì·›ÓÂÈ ÛÙËÓ ˙ˆ‹ ÙÔ˘ Ë ËıÈ΋. ∞Ó, ÏÔÈfiÓ, Ë ËıÈ΋ ‰ÂÓ Â›Ó·È Û˘Ó˘Ê·Ṳ̂ÓË Ì ÙË Ê‡ÛË Ì·˜, ÙfiÙ ÙÔ ÂÚÒÙËÌ· Â›Ó·È Ì‹ˆ˜ ı· ÌÔÚÔ‡Û·Ì ӷ ˙‹ÛÔ˘Ì ¯ˆÚ›˜ ÙËÓ ËıÈ΋. ∫·È fiÙ·Ó Ï¤ˆ “¯ˆÚ›˜ ÙËÓ ËıÈ΋”, ÂÓÓÔÒ ¯ˆÚ›˜ ·Ó·ÊÔÚ¿ Û ηÌÈ¿ ËıÈ΋ ·Ú¯‹ ‹ ·Í›·, Î·È fi¯È ¯ˆÚ›˜ ÙËÓ Ù¿‰Â ËıÈ΋ ·Ú¯‹ ·ÏÏ¿ Ì ÙË ‰Â›Ó· ËıÈ΋ ·Ú¯‹. °È· Ó· ÏÂÈÙÔ˘ÚÁ‹ÛÂÈ ÌÈ· ËıÈ΋ ·Ú¯‹, ¯ÚÂÈ¿˙ÂÙ·È ·ÛÊ·ÏÒ˜ ¯ÚfiÓÔ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÔÚ¤ÛÂÈ Ó· ·ÁȈı› ÛÙË Û˘Ó›‰ËÛË ÙˆÓ ÚÔÛÒˆÓ ÛÙ· ÔÔ›· ·¢ı‡ÓÂÙ·È, ÒÛÙ ӷ ‰ËÌÈÔ˘ÚÁËı› Û ·˘Ù¿ Ë ·›ÛıËÛË ÙÔ˘ ηı‹ÎÔÓÙÔ˜, fiÙÈ ‰ËÏ·‰‹ ÔÊ›ÏÔ˘Ó Ó· ÂÓ·ÚÌÔÓÈÛÙÔ‡Ó ÚÔ˜ ÙËÓ ·Ú¯‹ ·˘Ù‹. √È ÂÍÂÏ›ÍÂȘ, fï˜, ÛÙÔÓ ÙÔ̤· Ù˘ È·ÙÚÈ΋˜ ÂȉÈο, Ì¿ÏÈÛÙ·, ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜- ÙÚ¤¯Ô˘Ó Ì ÙfiÛË Ù·¯‡ÙËÙ·, ÒÛÙ ӷ Â›Ó·È ·‰‡Ó·ÙÔÓ Ó· Î·Ï˘ÊıÔ‡Ó ·fi ÙȘ ÂοÛÙÔÙ ˘ÊÈÛÙ¿ÌÂÓ˜ ËıÈΤ˜ ·Ú¯¤˜. ∂ÎÙfi˜ ÎÈ ·Ó ı¤ÏÔ˘Ì ÔÈ ÂÎÚfiÛˆÔÈ Ù˘ È·ÙÚÈ΋˜ Ó· ˙Ô˘Ó Û ÌÈ· ·ÙÌfiÛÊ·ÈÚ· ·ÎÔ‡ÛÈ·˜, ¤ÛÙˆ, ˘ÔÎÚÈÛ›·˜ - Ú¿ÁÌ·, ¿ÏψÛÙÂ, Ô˘ ¤¯ˆ ÙËÓ ÂÓÙ‡ˆÛË fiÙÈ Û˘Ì‚·›ÓÂÈ. °È·Ù› ÌÔÚ› ÌÂÓ Ô ÁÈ·ÙÚfi˜, Û‡Ìʈӷ Ì ÙÔÓ fiÚÎÔ ÙÔ˘ πÔÎÚ¿ÙË, ÛÙÔÓ ÔÔ›Ô ‰›‰ÂÈ ›ÛÙÈÓ, Ó· ÔÊ›ÏÂÈ Ó· ‰È‰¿ÛÎÂÈ Î·È Ó· ·ÛΛ ÙËÓ ÂÈÛÙ‹ÌË ÙÔ˘ “¿Ó¢ ÌÈÛıÔ‡ Î·È Í˘ÁÁÚ·Ê‹˜” ‹ Ó· ÌËÓ “Ù¤ÌÓÂÈ”, ·ÏÏ¿ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· Â›Ó·È ·‰È·ÓfiËÙÔ, Û‹ÌÂÚ·, ¤Ó·˜ ÁÈ·ÙÚfi˜ Ó· ÌËÓ ·Ì›‚ÂÙ·È Î·È Ó· ÌËÓ ·Ú¿ÁÂÈ Û˘ÁÁÚ·ÊÈÎfi ¤ÚÁÔ ‹ ÎÏ¿‰ÔÈ Ù˘ È·ÙÚÈ΋˜, fiˆ˜ Ô ¯ÂÈÚÔ˘ÚÁÈÎfi˜, Ô ÔÚıÔ‰ÈÎfi˜, Ô ÔÊı·ÏÌÔÏÔÁÈÎfi˜ Ó· ··ÈÙÔ‡Ó ·fi ÙÔÓ ÁÈ·ÙÚfi Ó· ÌËÓ “Ù¤ÌÓÂÈ”. ª‹ˆ˜, ÏÔÈfiÓ, Ë Ï‡ÛË ÁÈ· Ó· ÂÈÙÂÏ› ·ÚfiÛÎÔÙ· ηÈ, ηْ Â¤ÎÙ·ÛË, ÛˆÛÙ¿ ÙÔ ¤ÚÁÔ ÙÔ˘ Ô ÁÈ·ÙÚfi˜ ı· ‹Ù·Ó Ó· ηٷÚÁËı› Ë ËıÈ΋ - ¯ˆÚ›˜ Ó· ÙÔ ÂÓÓÔÒ ·˘Ùfi ÛÙÔ ÚÔÛ¯¤˜ ̤ÏÏÔÓ, ·ÏÏ¿ Û ‚¿ıÔ˜ ¯ÚfiÓÔ˘; ÿÛˆ˜, Ì¿ÏÈÛÙ·, ·Ú·Î¿ÌÙÔÓÙ·˜ ÛÙȘ ηıËÌÂÚÈÓ¤˜ ˘Ôı¤ÛÂȘ Ì·˜ ÙËÓ ËıÈ΋, Ë ˙ˆ‹ Ì·˜ Ó· ÁÈÓfiÙ·Ó ÈÔ ÂÏ΢ÛÙÈ΋. °È·Ù›, Â›Ó·È ·Ï‹ıÂÈ·, Ë ËıÈ΋ ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜ Ì·˜ Â›Ó·È ÂÓÔ¯ÏËÙÈ΋. ∏ ·ÚÂÙ‹, ·›ÊÓ˘, ÚÔ˜ ÙËÓ ·fiÎÙËÛË Ù˘ ÔÔ›·˜ ·‰È·Ï›Ùˆ˜ Ì·˜ ÚÔÙÚ¤ÂÈ Ë ËıÈ΋ Î·È ÙÔ Î·ı‹ÎÔÓ Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙÔ ÌfiÓÈÌÔ ·›ÙËÌ· Ù˘ ·fiÎÙËÛ˘ Ù˘ ·ÚÂÙ‹˜ ··ÈÙÔ‡Ó ·fi Ì·˜ Ó· ı˘ÛÈ¿˙Ô˘Ì οÙÈ ·fi ÙËÓ ˘Á›· Ì·˜ Î·È ÙËÓ Â˘Ù˘¯›· Ì·˜. ∂Ó›ÔÙÂ, Ì¿ÏÈÛÙ·, fiÙ·Ó, fiˆ˜ ϤÂÈ Ô ÔÈËÙ‹˜, Ú¤ÂÈ Ó· ԇ̠ÙÔ ÌÂÁ¿ÏÔ Ó·È ‹ ÙÔ ÌÂÁ¿ÏÔ fi¯È, ÂÓ‰¤¯ÂÙ·È Ë ·ÚÂÙ‹ Î·È ÙÔ Î·ı‹ÎÔÓ Ó· Ì·˜ ÚÔÙÚ¤„Ô˘Ó Ó· ‰È·ÎÈÓ‰˘Ó‡ÛÔ˘ÌÂ Î·È ÙË ˙ˆ‹ Ì·˜ ·ÎfiÌË. ∂›Ó·È ÛÙËÓ Ê‡ÛË Ì·˜ Ó· ı¤ÏÔ˘Ì ӷ ·ÔÏ·Ì‚¿ÓÔ˘Ì ÙË ˙ˆ‹, ÎÈ ·˘Ùfi, ‰˘ÛÙ˘¯Ò˜, ‰ÂÓ Û˘Ì‚·›ÓÂÈ, ÂÓ ÔÏÏÔ›˜, ÂÍ·ÈÙ›·˜ Ù˘ ËıÈ΋˜ Î·È ÙˆÓ ˘Ô¯ÚÂÒÛˆÓ

Pediatri July-Aug 07

09-07-07

17:08

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Ô˘ ·˘Ù‹ Ì·˜ ˘·ÁÔÚ‡ÂÈ. ¢ÂÓ Ì·˜ ·Ú¤ÛÂÈ Ó· Ì·˜ ϤÓ ÙÈ Ú¤ÂÈ Ó· οÓÔ˘ÌÂ, ÔfiÙ οÓÔÓÙ·˜ Ú¿ÁÌ·Ù· Ô˘ Ì·˜ ÂÈ‚¿ÏÏÔÓÙ·È, ·ÈÛı·ÓfiÌ·ÛÙ ‰˘ÛÊÔÚ›·. ªÔÚÔ‡ÌÂ, ‚¤‚·È·, Ó· ·ÁÓÔ‹ÛÔ˘Ì fi,ÙÈ Ì·˜ ϤÓ ˆ˜ ÔÊ›ÏÔ˘Ì ӷ οÓÔ˘ÌÂ. ∞ÏÏ¿, ÙfiÙÂ, ÓÈÒıÔ˘Ì ÂÎÙÂıÂÈ̤ÓÔÈ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ¿ÏÏÔ˘˜, ˘ÔʤÚÔÓÙ·˜ ¤ÙÛÈ ·fi ÙÔ ‚¿ÚÔ˜ Ù˘ ÂÓÔ¯‹˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·Ì·˘ÚÒÓÂÙ·È Ë ·fiÏ·˘ÛË Ô˘ ÂÈÌfiÓˆ˜ ˙ËÙ¿ÌÂ. ¶ÚÔ˜ ÙÈ, ÏÔÈfiÓ, Ë ‰È·Ù‹ÚËÛË Ù˘ ËıÈ΋˜, Ë ÔÔ›· ÌÔÚ› Ó· ϤÂÈ fiÙÈ Ì·˜ ˘Ô¯ÚÂÒÓÂÈ Ó· ˙ԇ̠̠¤Ó·Ó ÔÚÈṲ̂ÓÔ ÙÚfiÔ ÚÔÎÂÈ̤ÓÔ˘ Ó· Ù‡¯Ô˘Ì ÂÓfi˜ ηχÙÂÚÔ˘ ‚›Ô˘, ·ÏÏ¿ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· Ì·˜ ÚÔÛʤÚÂÈ ÙË ÌÈ˙¤ÚÈ·; ∫·È Ë ·ÔÚ›· ·˘Ù‹ Á›ÓÂÙ·È ÂÓÙÔÓfiÙÂÚË, Â¿Ó ÛÎÂÊÙԇ̠fiÙÈ Ë ËıÈ΋ ‰ÂÓ ËÁ¿˙ÂÈ ·fi ÙË Ê‡ÛË ÙˆÓ Ú·ÁÌ¿ÙˆÓ. ∞Ó, ȉ›ˆ˜, ›̷ÛÙ ˘Ô¯Úˆ̤ÓÔÈ Ó· Ú˘ıÌ›˙Ô˘Ì ÙË Û˘ÌÂÚÈÊÔÚ¿ Ì·˜ Û‡Ìʈӷ Ì ÙȘ ÂÈÙ·Á¤˜ Ù˘ ËıÈ΋˜, ‰ÂÓ Â›Ó·È ÁÈ·Ù› Ì·˜ ˘Ô‰ÂÈÎÓ‡ÂÙ·È ·˘Ùfi ·fi ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÙˆÓ Ú·ÁÌ¿ÙˆÓ ‹, fiˆ˜ ·Ó¤ÊÂÚ· ÚÔËÁÔ˘Ì¤Óˆ˜, ·fi ÙËÓ ·ÓıÚÒÈÓË Ê‡ÛË Ì·˜, ·ÏÏ¿ ÂÂȉ‹ ‚ÚÂı‹Î·Ì ÂÁÎψ‚ÈṲ̂ÓÔÈ Û ÌÈ· ÁÏÒÛÛ·, ÙËÓ ÔÔ›· ÂÌ›˜ ÂÈÓÔ‹Û·ÌÂ. √È ¿ÓıÚˆÔÈ, Û˘ÁÎÂÎÚÈ̤ӷ, ÁÈ· Ó· ÂÙ‡¯Ô˘Ó Ó· ÂÚÈÔÚ›ÛÔ˘Ó “ÙË ÛÙÚÔ‚ÈÏ›˙Ô˘Û· ÔÏ˘ÏÔÎfiÙËÙ· ÙÔ˘ ÎfiÛÌÔ˘ Û ¤Ó· ÛÎfiÈÌÔ Î·È ¯Ú‹ÛÈÌÔ Û¯‹Ì·”, fiˆ˜ ı· ¤ÏÂÁÂ Ô ¡›ÙÛÂ, ÁÈ· Ó· ÌÔÚ¤ÛÔ˘Ó, ‰ËÏ·‰‹, Ó· ‚¿ÏÔ˘Ó ÙË ¯·Ò‰Ë Ú·ÁÌ·ÙÈÎfiÙËÙ· Û ٿÍË ‰ËÌÈÔ‡ÚÁËÛ·Ó ÙȘ ϤÍÂȘ, ÒÛÙÂ, Ì ‚¿ÛË ·˘Ù¤˜, Ó· ηٷٿÛÛÔ˘Ó Ù· Ú¿ÁÌ·Ù· Û ηÙËÁÔڛ˜, ÒÛÙ ӷ Ù· ͯˆÚ›˙Ô˘Ó ÙÔ ¤Ó· ·fi ÙÔ ¿ÏÏÔ Î·È Ó· Â›Ó·È Û ı¤ÛË, ¤ÙÛÈ, Ó· ÂÈÎÔÈÓˆÓÔ‡Ó ÌÂٷ͇ ÙÔ˘˜. ∆Ô Î·Îfi Ì ÙÔ˘˜ ·ÓıÚÒÔ˘˜ Â›Ó·È fiÙÈ ·fi ¤Ó· ÛËÌÂ›Ô Î·È ÌÂÙ¿ ͤ¯·Û·Ó fiÙÈ ÔÈ Ï¤ÍÂȘ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ¤Ó·Ó ηı·Ú¿ ÏÂÈÙÔ˘ÚÁÈÎfi ÚfiÏÔ Î·È ›ÛÙ„·Ó ˆ˜ ·˘Ù¤˜ ϤÔÓ Â›Ó·È Ù· ›‰È· Ù· Ú¿ÁÌ·Ù·. ∂Ó ÙÔÈ·‡ÙË ÂÚÈÙÒÛÂÈ, ÔÈ Ï¤ÍÂȘ ÌÔÈ¿˙Ô˘Ó Ó· ÔÚıÒÓÔÓÙ·È ÌÚÔÛÙ¿ Ì·˜ Û·Ó Û˘Ì·Á›˜ fiÁÎÔÈ Ú·ÁÌ¿ÙˆÓ Ô˘ Â›Ó·È ·‰‡Ó·ÙÔÓ Ó· ÙÔ˘˜ ·Ú·Î¿Ì„ÂÈ Î·Ó›˜. ªÂ ·˘Ù‹ ÙËÓ ¤ÓÓÔÈ·, ‰ÒÛ·Ì ÛÙÔ “ηÏfi”, ÛÙÔ “ÛˆÛÙfi”, ÛÙÔ “‰›Î·ÈÔ”, ÛÙÔ “Ú¤ÂÈ” Î·È ÛÙȘ ¿ÏϘ ϤÍÂȘ Ô˘ Û˘ÁÎÚÔÙÔ‡Ó ÙËÓ ÁÏÒÛÛ· Ù˘ ËıÈ΋˜ ÔÓÙÔÏÔÁÈ΋ ˘fiÛÙ·ÛË ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ÙËÓ ÂÔ›ıËÛË fiÙÈ, ·Ó ÂȯÂÈÚ‹ÛÂÈ Ó· ÙȘ ·ˆı‹ÛÂÈ Î·Ó›˜, ı· Ê¿ÂÈ Ù· ÌÔ‡ÙÚ· ÙÔ˘, fiÙÈ, fiˆ˜ ϤÂÈ ¿ÏÈ Ô ¡›ÙÛÂ, ÛÎÔÓÙ¿ÊÙÔÓÙ·˜ ¿Óˆ ÙÔ˘˜ “ı· Û¿ÛÂÈ ÙÔ fi‰È ÙÔ˘ Ì¿ÏÏÔÓ ·Ú¿ ·˘Ù¤˜”. ∞fi Ù· ̤۷ ÙÔ˘ ÂÚ·Ṳ̂ÓÔ˘ ·ÈÒÓ· -ÂÓÓÔÒ ÙÔ˘ 20Ô‡ ·ÈÒÓ·-, fï˜, ˘‹ÚÍ·Ó ÊÈÏfiÛÔÊÔÈ Ô˘ Âȯ›ÚËÛ·Ó Ó· Ì·˜ ‚Á¿ÏÔ˘Ó ·fi ÙËÓ Ï¿ÓË ·˘Ù‹ ϤÁÔÓÙ·˜ fiÙÈ ÔÈ ËıÈΤ˜ ϤÍÂȘ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÍÂ¤Ú·ÛÙÔ˘˜ ÔÓÙÔÏÔÁÈÎÔ‡˜ fiÁÎÔ˘˜, ·ÏÏ¿ fiÙÈ ı· ÌÔÚÔ‡Û·Ì οÏÏÈÛÙ· Ó· ÌÂÙ·¯ÂÈÚÈÛÙԇ̠ÂÚÈÁڷʤ˜ ·fi ÙȘ Ôԛ˜ Ó· ·Ô˘ÛÈ¿˙Ô˘Ó ÔÈ ËıÈÎÔ› fiÚÔÈ Î·È Ó· ··ÏÏ·ÁÔ‡ÌÂ, ¤ÙÛÈ, ·fi ÙȘ ԯϋÛÂȘ Ô˘ Û˘ÓÂ-

¿ÁÂÙ·È Ë ËıÈ΋. ∞ÓÙ›, ÁÈ· ·Ú¿‰ÂÈÁÌ·, Ó· ÂÈ Î·Ó›˜ ÁÈ· οÔÈÔÓ fiÙÈ Â›Ó·È Î·Ïfi˜ ·Ù¤Ú·˜, ı· ÌÔÚÔ‡ÛÂ, ··Ï›ÊÔÓÙ·˜ ÙÔÓ ˙ËÌÈÔÁfiÓÔ ËıÈÎfi fiÚÔ “ηÏfi˜”, Ó· ·Ú·ÙËÚ‹ÛÂÈ fiÙÈ ÊÚÔÓÙ›˙ÂÈ ÁÈ· Ù· ·È‰È¿ ÙÔ˘ Ó· ÌËÓ ÂÈÓ¿ÓÂ, Ó· ÌÔÚʈıÔ‡Ó, Ó· ÓÈÒıÔ˘Ó ·ÛÊ¿ÏÂÈ·, Î.Ô.Î. √ ·ÂÁÎψ‚ÈÛÌfi˜ Ì·˜ ·fi ÙËÓ ËıÈ΋ ÁÏÒÛÛ· Î·È Ë ·ÂÏ¢ı¤ÚˆÛ‹ Ì·˜ ·fi ÙȘ ·ÚÂÓ¤ÚÁÂȤ˜ Ù˘ ¢ÓÔÔ‡ÓÙ·È ·fi ÙÔ Î·ÈÓÔ‡ÚÈÔ ÂÚÈ‚¿ÏÏÔÓ Ô˘ ‰È·ÌÔÚÊÒÓÂÙ·È ¯¿ÚË ÛÙËÓ ÂͤÏÈÍË Ù˘ ÂÈÛÙ‹Ì˘ Î·È Ù˘ Ù¯ÓÔÏÔÁ›·˜. ∫ÔÚ˘Ê·›· ۇ̂ÔÏ· ÙÔ˘ ËıÈÎÔ‡ ‚›Ô˘ Ì·˜ ˘ÔÓÔ̇ÔÓÙ·È Î·È ÌÔÈ¿˙Ô˘Ó Ó· ηٷÚÚ¤Ô˘Ó Î¿Ùˆ ·fi ÙÔ ‚¿ÚÔ˜ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ Î·È Ù¯ÓÔÏÔÁÈÎÒÓ ÂÍÂϛ͈Ó. §fiÁÔ˘ ¯¿ÚÈÓ, Ë ¤ÓÓÔÈ· Ù˘ ÌËÙ¤Ú·˜, Ì fiÏË ÙËÓ ËıÈ΋ ·‡Ú· Ô˘ Û¤ÚÓÂÈ Ì·˙› Ù˘, Î·È ÙÔ˘ ·ÁÓÒÛÙÔ˘ ÛÙÚ·ÙÈÒÙË, Ô˘ ÂÎÊÚ¿˙ÂÈ ÙÔ ·‰È·Ú·ÁÌ¿Ù¢ÙÔ ËıÈÎfi ¯Ú¤Ô˜ Ì·˜ ÚÔ˜ ÙËÓ ·ÙÚ›‰· Ì·˜, ÂÌÊ·Ó›˙ÔÓÙ·È Û·Ó Î·Ù¿ÏÔÈ· ÌÈ·˜ ¿ÏÏ˘ ÂÔ¯‹˜. §¤ÁÔÓÙ·˜ “ÌËÙ¤Ú·”, Û˘ÁÎÂÎÚÈ̤ӷ, ÂÓÓÔԇ̠ÙÔ Ï¿ÛÌ· ÂΛÓÔ Ô˘ ·Ú¿ÁÂÈ ˆ¿ÚÈ·, Û˘ÏÏ·Ì‚¿ÓÂÈ, ΢ÔÊÔÚ› ̤۷ ÙÔ˘ ÙÔ ¤Ì‚Ú˘Ô Î·È, ÙÂÏÈο, ÁÂÓÓ¿ÂÈ ÙÔ ·È‰›. ∞fi ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ ·˘Ù¤˜ Ù˘ ÌËÙ¤Ú·˜, ˆÛÙfiÛÔ, ÔÈ ÙÚÂȘ -Ë Û‡ÏÏË„Ë, Ë Î˘ÔÊÔÚ›· Î·È Ë Á¤ÓÓËÛË- ¤¯Ô˘Ó ‹‰Ë, ¯¿ÚË ÛÙËÓ ÂͤÏÈÍË Ù˘ ÂÈÛÙ‹Ì˘, ÌÂÙ·ÙÔÈÛÙ› ·fi ÙÔÓ ÂÛˆÙÂÚÈÎfi ÎfiÛÌÔ Ù˘ ÌËÙ¤Ú·˜ Û ¿ÏÏ· ÂÚÈ‚¿ÏÏÔÓÙ·. ¶Ú¿ÁÌ·ÙÈ, Û‹ÌÂÚ· Ë Û‡ÏÏË„Ë ÌÔÚ› Ó· ÂÈÙ¢¯ı› Û ‰ÔÎÈÌ·ÛÙÈÎfi ۈϋӷ, Ë Î˘ÔÊÔÚ›· Ó· Á›ÓÂÈ ÛÙË Ì‹ÙÚ· ÌÈ·˜ ¿ÏÏ˘ Á˘Ó·›Î·˜, Ù˘ ηÏÔ‡ÌÂÓ˘ ‰·ÓÂÈ΋˜ ÌËÙ¤Ú·˜, Î·È Ë Á¤ÓÓËÛË Ó· Û˘ÓÙÂÏÂÛÙ› ·fi ÙË ‰·ÓÂÈ΋ ÌËÙ¤Ú·. ø˜ ÚÔ˜ ÙËÓ ¿ÏÏË ÏÂÈÙÔ˘ÚÁ›· ‰Â, ÙËÓ ·Ú·ÁˆÁ‹ ˆ·Ú›ˆÓ, ÔÈÔ˜ ÌÔÚ› Ó· ·ÔÎÏ›ÛÂÈ fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ Ë ÂÈÛÙ‹ÌË ‰ÂÓ ı· ÌÔÚ› Ó· Ù· ‰ËÌÈÔ˘ÚÁ› Ì Ù¯ÓËÙfi ÙÚfiÔ; ∞Ó¿ÏÔÁÔ˜ Â›Ó·È Î·È Ô ÂÎÊ˘ÏÈÛÌfi˜ Ô˘ ¤¯ÂÈ ˘ÔÛÙ›, ÂÍ·ÈÙ›·˜ Ù˘ ÚÔfi‰Ô˘ Ù˘ ÂÈÛÙ‹Ì˘ Î·È Ù˘ Ù¯ÓÔÏÔÁ›·˜, Ë ¤ÓÓÔÈ· ÙÔ˘ ¿ÁÓˆÛÙÔ˘ ÛÙÚ·ÙÈÒÙË. ∞Ó, ‰ËÏ·‰‹, ÛÙÔ ·ÚÂÏıfiÓ ÌÔÚÔ‡Û·Ì ӷ ÌÈÏ¿Ì ÁÈ· ÙÔÓ ¿ÁÓˆÛÙÔ ÛÙÚ·ÙÈÒÙË Ô˘ ¤ÂÛ ÛÙÔ ‰›Ô Ù˘ Ì¿¯Ë˜, Û‹ÌÂÚ· ‰ÂÓ ‰ÈηÈÔ‡ÌÂı· Ó· ÙÔ Î¿ÓÔ˘ÌÂ, ÂÂȉ‹, ¯¿ÚË ÛÙËÓ ·Ó¿Ï˘ÛË ÙÔ˘ DN∞ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·Ó·Î·Ï˘Êı› Ë Ù·˘ÙfiÙËÙ· ÙÔ˘ οı ·ÓıÚÒÔ˘. ∞ÏÏ¿, ¤Ú· ·fi ÙËÓ ·ÌÊÈÛ‚‹ÙËÛË ÙˆÓ Û˘Ì‚fiÏˆÓ Ù˘ ËıÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ Ì·˜, Ù›ÓÂÈ Ó· ·Î˘Úˆı› ·ÎfiÌË Î·È Ô ›‰ÈÔ˜ Ô Â·˘Ùfi˜ Ì·˜, ÂΛÓÔ˜ Ô˘ ˘ÔÙ›ıÂÙ·È ˆ˜ Ú¿ÙÙÂÈ Î·È ¯ÚÂÒÓÂÙ·È ÙËÓ ËıÈ΋ ¢ı‡ÓË ÙˆÓ Ú¿ÍÂÒÓ Ì·˜. ¶Ô‡ ˘¿Ú¯ÂÈ, ·Ï‹ıÂÈ·, Ô Â·˘Ùfi˜ Ì·˜ Î·È ÙÈ Â›Ó·È ·˘Ùfi˜; √‡Ù ӷ ÙÔÓ ‰Ô‡ÌÂ, Ô‡Ù ӷ ÙÔÓ ·ÁÁ›ÍÔ˘ÌÂ, Ô‡Ù ӷ ÙÔÓ ·ÓÙÈÏËÊıԇ̠ηı’ ÔÈÔÓ‰‹ÔÙ ¿ÏÏÔ ÙÚfiÔ ÌÔÚÔ‡ÌÂ. ∞ÏÒ˜, ıˆÚԇ̠fiÙÈ ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Î¿Ô˘ ‚·ıÈ¿ ̤۷ Ì·˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈηÈÔÏÔÁ‹ÛÔ˘Ì ÙÔÓ ÔÚÁ·ÓˆÌ¤ÓÔ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÂÓÂÚÁÔ‡ÌÂ. ∫·È Ë ÈÔ ·Ï‹ ÂÓ¤ÚÁÂÈ¿ Ì·˜, ÙÔ ¶·È‰È·ÙÚÈ΋ 2007;70:253-256

Pediatri July-Aug 07

09-07-07

17:08

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Paediatriki 2007;70:253-256

·ÔÙÂÏÂ›Ù·È ·fi ¯ÈÏÈ¿‰Â˜ ·ÙÙ·Ú· Ô˘ Û˘ÁÎÚÔÙÔ‡ÓÙ·È Û ۇÓÔÏ·, Ù· ÔÔ›· Û˘ÌÂÚÈʤÚÔÓÙ·È ÙÔ Î·ı¤Ó· ÙÔ˘˜ ÎÔÈÙÒÓÙ·˜ Ò˜ ÂÓÂÚÁ› ÙÔ ‰ÈÏ·Ófi ÙÔ˘˜. ∂Ó ÙÔÈ·‡ÙË ÂÚÈÙÒÛÂÈ, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È Ó· ηٷʇÁÔ˘Ì ÛÙËÓ ˘fiıÂÛË ÙÔ˘ ·˘ÙÔ‡ Ì·˜ ˆ˜ ˘‡ı˘ÓÔ˘ ÁÈ· fi,ÙÈ Î¿ÓÔ˘ÌÂ. ¶ÚÔÊ·ÓÒ˜, Û ¤Ó· ÂÚÈ‚¿ÏÏÔÓ, fiÔ˘ ‰ÂÓ ı· ˘¿Ú¯Ô˘Ó ËıÈο ۇ̂ÔÏ·, fiÔ˘ ÔÈ ¿ÓıÚˆÔÈ ‰ÂÓ ı· ÌÂÙ·¯ÂÈÚ›˙ÔÓÙ·È ÙË ÁÏÒÛÛ· Ù˘ ËıÈ΋˜ Î·È ‰ÂÓ ı· ·¢ı‡ÓÔÓÙ·È Ô ¤Ó·˜ ÛÙÔÓ ¿ÏÏÔ Û·Ó Ó· ˘¿Ú¯ÂÈ ·fi ›Ûˆ οÔÈÔ˜ Ú˘ıÌÈÛÙ‹˜ ÁÈ· Ó· ·Ó·Ï¿‚ÂÈ ÙËÓ Â˘ı‡ÓË ÁÈ· fiÛ· Ú¿ÙÙÔ˘Ó, Ë ËıÈ΋ ÌÔÚÊ‹ ˙ˆ‹˜ ‰ÂÓ ı· ¤¯ÂÈ Î·ÌÈ¿ ı¤ÛË. ∞˘Ùfi, ‚¤‚·È·, Â’ Ô˘‰ÂÓ› ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ, Â¿Ó Î·È ÂÊfiÛÔÓ Î·Ù·ÚÁËı› Ë ËıÈ΋, ı· ÁÂÌ›ÛÂÈ Ô ÎfiÛÌÔ˜ ·fi ηÎÔÔÈÔ‡˜. √È ¿ÓıÚˆÔÈ ı· Û˘Ó¯›ÛÔ˘Ó Ó· οÓÔ˘Ó Ï›ÁÔ Ôχ Ù· ›‰È· Ú¿ÁÌ·Ù·. ∞ÏÒ˜, ‰ÂÓ ı· ¤¯Ô˘Ó Î·Ó¤Ó·Ó ÏfiÁÔ Ó· Ù· ·ÍÈÔÏÔÁÔ‡Ó ËıÈο fiˆ˜ οÓÔ˘Ó Ì¤¯ÚÈ ÙÒÚ·. ∞˜ ÛÎÂÊÙԇ̠ÌfiÓÔ ÙÔ‡ÙÔ: fiÙ·Ó ¤·„Â Ë Ì˘ıÔÏÔÁ›· Ó· ·ÔÙÂÏ› Û˘ÛÙ·ÙÈÎfi Ù˘ ˙ˆ‹˜ ÙˆÓ ·ÓıÚÒˆÓ, Ù· ‰¤ÓÙÚ·, ÔÈ ı¿Ï·ÛÛ˜, ÔÈ Ï›ÌÓ˜, Ù· ıËÚ›· Î·È fiÏ· Ù· ¿ÏÏ· fiÓÙ· ÁÈ· Ù· ÔÔ›· ÌÈÏÔ‡Û·Ó ÔÈ Ì‡ıÔÈ, ‰ÂÓ ÂÍ·Ê·Ó›ÛÙËηÓ. ™˘Ó¤¯ÈÛ·Ó Ó· ˘¿Ú¯Ô˘Ó fiˆ˜ Î·È ÚÈÓ - ··ÏÏ·Á̤ӷ ·ÏÒ˜ ·fi ÙÔ Ó¤ÊÔ˜ ÙˆÓ Ì˘ıÔÏÔÁÈÎÒÓ ÂÚÈÁÚ·ÊÒÓ. √È fiÔȘ ·Ó·ÊÔÚ¤˜ Ì·˜ Û‹ÌÂÚ· ÛÙÔ˘˜ ̇ıÔ˘˜ Á›ÓÔÓÙ·È, fi¯È, ‚¤‚·È· ÁÈ·Ù› ÙÔ˘˜ ÈÛÙ‡ԢÌÂ, ·ÏÏ¿ ÚÔ˜ Ù¤Ú„Ë Ì·˜. ¶ÔÈÔ˜ ͤÚÂÈ, ÏÔÈfiÓ, Ì‹ˆ˜ ¤ÙÛÈ -·Ó ÔÙ¤ Î·È ÂÊfiÛÔÓ Î·Ù·ÚÁËı› Ë ËıÈ΋- ‰ÂÓ ÁÏÈÙÒÛÔ˘Ó ‰È· ·ÓÙfi˜ ÔÈ ÁÈ·ÙÚÔ› ·fi ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁ› Û‹ÌÂÚ· Ë ËıÈ΋ Ì ÙȘ ˘Ô¯ÚÂÒÛÂȘ Ô˘ ÙÔ˘˜ ÂÈ‚¿ÏÏÂÈ, Î·È ÂÌ›˜, ·ÓÙ› ÁÈ· ÙË ÌÈ˙¤ÚÈ· Ô˘ Â‰Ò Î·È ·ÈÒÓ˜ Ì·˜ ÚÔÍÂÓ› Ë ËıÈ΋, ‰ÂÓ ‚ÈÒÓÔ˘Ì ϤÔÓ ÙËÓ ·fiÏ·˘ÛË, ÙËÓ ÔÔ›·, fiˆ˜ ·Ó¤ÊÂÚ· ·Ú·¿Óˆ, ·fi ÙË Ê‡ÛË Ì·˜ ÂÈ˙ËÙԇ̠ÛÙË ˙ˆ‹ Ì·˜.

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Persistent vegetative state in children: terminology, aetiology, prognosis and ethical issues v

D. Neubauer, S. Grosek, P. Hamilton, M. LoGiudice, D. Matthys, V. Molina, L. Nikolovski, E. Siebke, A. Tenore, F.P. Crawley Abstract: The vegetative state comprises a group of clinical features of profound brain damage, which appear to demonstrate that the patient is awake but not aware of internal or external environments. The term was introduced to replace others used in the past, such as prolonged coma or coma vigile. Children are in a special position because at certain ages there should be consideration not only of their severe disability or handicap but also of their potential to become conscious. Terminology and definitions that are now quite well delineated are described. The boundaries of the vegetative state are noted and its diagnosis and prognosis are discussed in detail. Finally, ethical considerations are discussed, with regard to the different stances taken in different countries. In the Appendix the results of a short survey of members of the Paediatric section of UEMS (European Union of Medical Specialists)/EAP are summarized on the various attitudes and ethical considerations on persistent vegetative state in children.

Ethics Working Group of the Paediatric Section of the UEMS/European Academy of Paediatrics (formerly CESP) Correspondence: Prof. David Neubauer, david.neubauer@mf.uni-lj.si Department of Child, Adolescent & Developmental Neurology University Children's Hospital, Ljubljana, Slovenia

Key words: End-of-life decisions, children, ethical considerations, euthanasia.

Introduction More than three decades have passed since Professor Bryan Jennett and Professor Fred Plum led the world in understanding the devastating condition of unconsciousness, termed the vegetative state (1). The vegetative state comprises a group of clinical features of profound brain damage that appear to demonstrate that the patient is awake but not aware of internal or external environments. The complexity of its clinical features means that considerable experience is needed to be confident of the diagnosis, and much supportive evidence from a multidisciplinary team experienced in the management of severe brain damage is needed (2). At present neurophysiological assessment and even functional neuroimaging can still play only a supportive rather than a diagnostic or a prognostic role. In spite of concerted attempts to establish clear terminology there is still a relative lack of understanding of the existing nomenclature.

Amongst the relatives of brain-damaged persons the term “vegetative” is especially disliked, mainly because of its association with the word “vegetable” (2,3). The term was introduced to replace others used in the past (some of which are still used, although not considered exact), such as prolonged coma or coma vigile (the patients by definition are not in coma), decerebrate dementia, parasomnia, akinetic mutism and apallic syndrome (still preferred and used by German speaking professionals) (2). Confidence in the

diagnosis can sometimes be questioned due to the existence of similar conditions, such as deefferentated state, locked-in syndrome (also coined by Plum and Posner), and especially the minimally conscious state at one end of the spectrum, with brain death at the other. The prognosis was best represented in the paper by the Multi-Society Task Force, which consisted of adult and paediatric neurologists and neurosurgeons, representing five major medical societies in the US (American Academy of Neurology, Child Neurology Society, American Neurology Association, American Association of Neurological Surgeons and the American Academy of Pediatrics) (4,5). Their tables, especially those on the probability of one-year outcomes, of adults and children respectively, are still generally accepted as a basis for decision-making by both medical and legal professionals (6). Finally, there is a huge bulk of literature on ethical issues, especially on reasons for allowing withdrawal of artificially provided hydration and nutrition (AHN), which is still a debated and controversial topic, with very diverse policies in different European countries (7,8). Children are in a special position because at certain ages there should be consideration not only of their severe disability or handicap but also of their potential to become conscious, particularly in the case of severely damaged newborn or preterm infants (9). The basic statements on decision-making in extreme situations have already been laid down by the Royal ¶·È‰È·ÙÚÈ΋ 2007;70:257-265

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College of Paediatrics (10) and by EAP/the Ethics Working Group (11) (Table 1), which are also used in the recommendations.

This paper is an attempt to deal with the terminological, aetiological, prognostic and ethical issues concerning persistent vegetative state and other borderline conditions of consciousness in children and adolescents.

Terminology and definitions Consciousness is a spontaneously occurring state of awareness of oneself and one’s environment and it has two dimensions, wakefulness and awareness (4,5,12).

Normal consciousness requires arousals, autonomous brain functions that activate mechanisms to induce the wakeful state, while awareness requires wakefulness (but not vice versa) (13). The disorders of consciousness in children include coma and vegetative state, while the term minimally conscious state (MCS) was introduced to better describe those children and adults who are emerging from a vegetative state, and thus represents a condition “of severely altered consciousness in which minimal but definite behavioural evidence of self or environmental awareness is demonstrated” (12). The diagnostic criteria include simple command following, gestural responses, intelligible verbalization and purposeful behaviour (appropriate smile/cry, vocalization, reaching for objects, touching/holding objects and pursuit eye movements) (14).

The term vegetative state can be described as a condition of complete unawareness of the self and the environment, accompanied by preserved sleep-wake cycles with either complete or partial preservation of hypothalamic and brain stem autonomic functions (4,5).

The multi-society task force also expressed the view that persistent vegetative state (PVS) was a diagnosis,

while permanent vegetative state was a prognosis.

The word persistent usually describes those children and adults who are vegetative for more than one, three or 12 months, according to the aetiology, while permanent describes those who remain vegetative for more than 12 months after traumatic brain injury or more than 3 months after non-traumatic (e.g. anoxicischaemic) brain injury. However, it is now generally agreed that it is preferable to describe the duration and aetiology of the vegetative state rather than to use the terms persistent/permanent (12). The definition of PVS in infants and children includes 10 clinical characteristics that are generally accepted as constituting an operational definition (Table 3). The term coma describes a state of deep, unarousable sustained pathologic unconsciousness with the eyes closed that results from dysfunction of the ascending reticular activating system either in the brainstem or in both cerebral hemispheres (12). Coma usually requires the period of unconsciousness to persist for at least one hour - to distinguish it from other states of transient unconsciousness. Patients in coma lack wakefulness and awareness (patients in vegetative state lack awareness but have retained wakefulness) while the depth of coma can be specified by assessment of brainstem reflexes, breathing pattern, change of pulse and/or respiratory rate to stimulation and stimulus induced non-specific movement (12,15). In comparison, brain death is a permanent absence of all brain functions, including those of the brain stem, and the guidelines for its diagnosis in infants and children are now well established (15). Finally, there are some conditions which should be clearly differentiated from those cited above. Newborn infants cannot be regarded as being in PVS. Even full-term, healthy newborn babies fulfill only five of nine psychological criteria for being conscious. They have perception, record sensory stimulation, can be

Table 1. Considerations on the decision to withhold or withdraw life-supporting treatment in extreme situations (11) 1. Circumstances where life and/or life-supporting treatment are judged as unbearable for the child without the prospect of recovery.

2. One must honestly try to find out the best interest of children.

3. Actual or potential physical or mental disability itself is not a reason to withhold or withdraw life-sustaining treatment.

4. All remedial causes for the child’s condition should be excluded.

5. Available evidence for diagnosis, prognosis and alternative therapy should have been thoroughly explored and discussed.

6. Serious doubts in regarding what is in the best interest of the child should favour supporting the life of the child.

7. Each decision must be made in partnership with the competent child (not relevant in persistent vegetative states), the parents/guardians, the family and the entire health care team.

8. Withholding or withdrawal of life-supporting measures must be coupled with maximal palliative care, including prevention of suffering from hunger, thirst or pain, considering cultural sensitive social and psychosocial support and reflecting religious belief.

9. Paediatricians reject intentional ending of life by administration of a lethal dosage of medication. Treatment to relief suffering that may shorten life as a side-effect is acceptable where the intention of medication is not to end the life of the child.

10.During and after the death bereavement and consulting support should be ensured.

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awakened, show emotions and interact socially. However, they have limited long-term memory and cannot speak, and they lack symbolic thinking and free will (9,16).

Aetiological problems and boundaries of persistent vegetative state in children Some of the major neurological conditions that every clinician must be aware of and be able to differentiate from a vegetative state are listed in Table 2. The majority of members of the American Child Neurology Society agreed that the most appropriate statement on childhood PVS is that it “can be diagnosed based on the appropriate clinical neurological examination for age, knowledge of the insult causing brain injury, and appropriate period of observation depending on the age of the patient and nature of the insult” (17).

The majority (70%) of child neurologists questioned believed that a diagnosis of PVS could reliably be made in children above two years of age, while before this age, especially below the age of two months, the diagnosis was thought by 16% of child neurologists to be feasible. Some practical and easy approaches can be used to better present the interconnections of different conditions and the boundaries of PVS (Table 4) (15).

Diagnosis and prognosis of PVS New polysomnographic techniques, which allow long-term monitoring and even ambulatory recordings in infants and small children, can contribute to the differentiation of sleep/wake stages and thus to assessing some of the higher cortical functions. Regarding the outcome it seems that somatosensory evoked responses are the most sensitive and reliable (15). Classical electroencephalography (EEG) may be supportive of the diagnosis but cannot be diagnostic per se and is still

far from being prognostic (2). New visual functional techniques and especially some of the techniques for cognitive functional assessment in infants and newborns (e.g. visual evoked potentials and cognitive evoked potentials) will in the future permit better understanding and will define the possibility of the infant for sudden focusing and even tracking of objects when possible emergence from the vegetative state is under question. However, the problem remains that there are no tests that can confirm whether the child has any “internal awareness” and whether there exist any abilities to react with others or have any meaningful response to the spoken word. Serial investigations of brain metabolic activity (e.g. measured by positron emission tomography - PET) may potentially be of great value in providing objective criteria confirming the clinical diagnosis of PVS, particularly in small children. However, the restricted availability of this technology, recent statements on the diagnosis of the vegetative state without the need for any radiological or laboratory investigations and the limitations of its interpretation in young children due to low rates of brain metabolic activity and blood flow, all limit its value as a practical diagnostic and/or prognostic tool (6,15). A study made 25 years ago showed very poor outcomes for children in vegetative state following coma as there were only 10 survivors (out of 17 in the series) and only one child became ambulant a year after the initial insult and was moderately mentally retarded (18). The same study also confirmed the notion that children who develop the vegetative state following coma have a poor prognosis, especially when there are early indicators such as decorticate or decerebrate responses, roving eye-movements and spontaneous blinking. More recent studies have shown that the survival rate of PVS children appears to be directly related to age, as the younger children,

Table 2. Definitions of persistent vegetative state in infants and children*

1. Wakefulness without awareness 2. Eyes-open unconsciousness 3. No “voluntary” action/behaviour 4. No “cognitive” response 5. No “voluntary” language 6. Inability to follow commands 7. Spontaneous eye movements but no sustained tracking 8. Intact brainstem reflexes and sleep/wake cycles 9. Spontaneous breathing, chewing and swallowing impaired 10. Bowel and bladder incontinence

Apply (%)

Supportive (%)

Necessary (%)

95 94 91 90 84 83 83 75 75 53

16 33 23 22 29 22 47 53 65 53

84 67 77 78 71 78 53 47 35 47

*Opinion of 250 Child Neurologists (members of American Child Neurology Society) in a study by Ashwal et al (ref. 17) as to which of the listed criteria would apply, be supportive or be necessary as a clinical characteristic for the constitution of the operational guideline of persistent vegetative state (PVS). The data reflect the general opinion that PVS in infants and children is defined as a loss of higher cortical functions rather than the existence of vegetative functions. ¶·È‰È·ÙÚÈ΋ 2007;70:257-265

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Table 3. Severe disturbances of consciousness and related conditions (adapted from 3,4,5) Condition

Self awareness

Pain & Sleep/wake Motor suffering cycling function

Respiratory function

Brain death Absent

No

Absent

Absent

Coma

Absent

No

Absent

PVS

Absent

No

Intact

No purposeful movements

Minimally conscious state Akinetic mutism

Present but Yes very limited

Intact

Limited

Yes

Intact

Locked-insyndrome

Present

Yes

Intact

Some purposeful movements Moderate limitation of movements Tetraplegia; pseudobulbar palsy;eye movements preserved

None; Spinal reflexes possible No purposeful movements

EEG

Outcome/ recovery

No cerebral No recovery electrical activity/silence Variably Polymorphic Evolves to recovery, depressed delat/theta PVS or death in 2-4 weeks Normal/mildy Polymorphic Depends on depressed theta/delta aetiology (acute traumatic/nontraumatic; degenerative/ metabolic; developmental/ chromosomal) Normal/mildy Polymorphic Recovery unkown, depressed theta/delta probably depends on aetiology (see above) Normal/mildly Slow Recovery unlikely depressed or limited Normal to variably depressed

Normal

Recovery unlikely; remain tetraplegic

EEG=electroencephalogram, PVS=persistent vegetative state

especially those below two months of age, tended to have much shorter survival than children above seven years (mean duration of survival 4.1 vs. 7.4 years respectively) (17). Regarding the aetiology, the longer duration of survival was found in the non-traumatic group of PVS children compared to the traumatic group (8.6 vs. 3.0 years respectively) and perinatal injuries are associated with much shorter survival than those due to developmental/chromosomal abnormalities (4.1 vs. 8.2 years respectively) (19). These findings suggest the possibility that relative sparing of brainstem and hypothalamic functions in the latter group in contrast to the perinatal-insult group (where these structures may be seriously injured) is essential for survival. More recent data suggest that the oneyear outcome is much better after a one month follow-up, compared with a follow-up of three and six months respectively (Table 5) (4-6). Some authorities believe that the estimates of long-term survival by the Task Force Report are too low and that many reported deaths could be the result of decisions to limit lifesustaining measures. There might be a difference between how long these patients could live and how long they do live, as the practice of limiting life-sustaining medical treatment once the vegetative state is declared permanent becomes more widely accepted Paediatriki 2007;70:257-265

(6,7). Finally, a recent paper by Ashwal (15) reports the following probabilities for recovery: 1. After 3 months, children in post-traumatic VS have a 56% chance of regaining consciousness, in contrast to only 3% of children with non-traumatic VS. Good or moderate recovery is expected in 32% of children.

2. After 6 months, children in post-traumatic VS have a 31% chance of recovering consciousness, in contrast to only 3% of children with non-traumatic VS. Good or moderate recovery can be expected in only 11%.

3. VS can thus be considered permanent 12 months after brain trauma or 3 months after nontraumatic brain injury in children. The chance of recovery after this period seems to be exceedingly rare (however, cases of good recovery are well documented even after 12 months of PVS) and is almost always associated with severe disability.

Ethical issues and decisions on withdrawal of artificially provided hydration and nutrition (AHN) When Chalmers wrote on the phenomenology of the conscious mind, he noted: “…when I close my

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Table 4. Stepwise approach in evaluation of the unconscious child as proposed by S. Ashwal (adapted from 11, 14) Is the patient conscious?

Evidence of sustained or reproducible purposeful response or external stimuli NO absent brainstem function and apnoea YES BRAIN DEATH

NO preserved sleep/wake cycle and eye opening to stimulus or spontaneously NO YES COMA VEGETATIVE STATE

YES preserved functional interactive communication and/or functional use of one or more obejcts NO* YES MINIMALLY vertical eye movements present CONSCIOUS and/or eye blinking STATE YES NO LOCKED-IN EMERGENCE SYNDROME FROM MCS†

* usually preserved: following simple commands and/or gestural or yes/no responses and/or intelligible verbalization and/or purposeful behaviours in response to environmental stimuli (not reflex activity) BUT not able to express preferences † patient has emerged from minimally conscious state (MCS) and may have: mild to severe disability or may become normal

eyes, the whole world disappears and when I open them again, the world appears again” and this is a simplified description of the assessment of consciousness (see Table 3). As Searle stated: “consciousness consists of inner, qualitative, subjective states and processes of sentience or awareness. Consciousness begins when we wake in the morning and continues until we fall asleep again, die, go into coma, or otherwise become ‘unconscious’” (16). However, things become further complicated when other philosophical aspects of consciousness are taken into account, and perhaps its most frequently discussed role involves awareness of the sensory world as well as the awareness of self (including feelings and thoughts) and voluntary control involved in self-regulation (20,21). When the medical professionals and the parents have finally become convinced that the child has reached a (permanent) vegetative state condition, the question of final outcome becomes important, while the ethical decisions should depend on the most reliable prognosis. It is rather impractical to separate discussion of the ethical and legal issues raised by decisions to limit life-prolonging measures for vegetative patients, as the law is largely concerned with ethical principles in particular situations, and doctors and ethicists seek the formal approval of the public or society (represented by the judiciary) for their decisions to limit or stop artificially provided hydration and nutrition (AHN) (22).

The appendix presents the variations regarding attitudes about PVS in children in different EU countries according to the results of a short survey on these issues among CESP/EAP members.

Despite the fact that there are guidelines to help physicians decide whether certain actions would be

ethical or not, they must also confront the obstacles of personal values, as well as professional, religious and cultural factors. The decision about withdrawing Table 5. The Multi-Society Task Force data (4,5) - conclusions about long-term prognosis are based on review of 754 cases published in the English language literature who were vegetative at one month after an acute insult and from whom one-year outcome was available. The present table includes only children with PVS ( Total: 151, with traumatic injury: 106). The age limit was not defined but most were probably under the age of 16 years One-year outcome of those in vegetative state at 1, 3 and 6 months respectively a) Vegetative state - children after head trauma (n = 106).

All figures in %.

Outcome At 1 month At 3 months At 6 months died 9 14 14 vegetative 29 30 54 conscious 62 56 32 (independent) (27) (32) (11) b) Vegetative state - children with non-traumatic causes (n = 45). All figures in %.

Outcome At 1 month At 3 months At 6 months died 22 3 0 vegetative 65 94 97 conscious 13 3 3 (independent) (6) (0) (0) Children did much better than adults (one-year outcome of those adults in vegetative state at one month: died after trauma 33% and dead due to non-traumatic causes 53%).

Also one-year outcome of children in vegetative state at one month revealed that 62%/13% regained consciousness in comparison to adults where these percentages were 52%/15% respectively. The highest independence rate was achieved in head injured children (27%), the lowest in nontraumatic adults (4%) (6). ¶·È‰È·ÙÚÈ΋ 2007;70:257-265

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AHN and other life-sustaining medical treatment is still associated with a great deal of controversy, especially in paediatric practice. Even when the team in the intensive care unit and the members of the family all agree that it is the right thing to do, there is still sufficient negative professional and public sentiment to make it worth pursuing a judicial order to support such an act (7). Finally, a list is provided of some of the recent examples of practical decision-making and conclusions about treatment regimes in severely ill patients, and especially of the decisions when to withhold or withdraw life-sustaining treatment in children. Recently the Ethics Task Force argued that the word “passive euthanasia” should not be used for withdrawing or withholding life-prolonging treatment that is not providing a benefit to the patient (23) (see also the arguments in the RCPCH document quoted above). However, there are also some rebuttals to this argument, as some believe that professionals should be allowed to employ this term in their discussions of policy and clinical practice (24). Regarding the challenges in end-of-life care in the intensive care units, the recommendation is that the patient must be assured a pain-free death. The patient must be given sufficient analgesia to alleviate pain and distress; if such analgesia hastens death, this “double-effect” should not detract from the primary aim of ensuring comfort (25). Some practical instructions on decision-making about withdrawal of life-sustaining treatment in children are given by Alderson and Nicholson (26). They suggest that the decisions should not be rushed, and should be based on all the evidence available. There should be frequent sharing of information and discussions between all the members of the team, and regular informing and listening to the family, taking into account the child’s interests. Treatment should be withdrawn in a certain sequence (for example, first withdrawal of experimental interventions, then withdrawal of mechanical ventilation, withdrawal of inotropic pressor agents, forgoing antibiotics, forgoing artificial nutrition, including nasogastric tube feeding and decrease of intravenous fluids. Apart from these actions, the physician has a duty to comfort and cherish the child, to prevent and relieve suffering (pain) and to inform and support the family. Once an end-of-life decision has been made, the primary aim is to relieve suffering; pain relief is essential even if it hastens death (allowing the principle of the double effect - that is, associated repression of respiration, if it relieves suffering, is acceptable). If a ventilator is to be switched off, the time should be decided in agreement with the parents and with careful preparation and support. The use of paralyzing agents Paediatriki 2007;70:257-265

should be carefully reconsidered. The care should also continue after the child’s death (10,26). Finally, some advice has been addressed to the family physicians, who are frequently in a position to integrate medical knowledge, individual values and cultural influences into end-of-life care, especially after the Patient SelfDetermination Act was written in response to the Cruzan case (27). This implementation is particularly useful in those cases where a self-decision to end one’s life has been expressed.

Conclusions Thirty years after the term “persistent vegetative state” was first coined by Jennett and Plum it remains the most commonly used term, despite many arguments (more or less substantial) that it should be changed. In addition to the term vegetative state, many authors would like to include aetiological cause and duration. The majority of child neurologists believe that wakefulness without awareness, unconsciousness with the eyes wide open, and absence of voluntary behaviour and language along with lack of cognitive response, are the landmarks of the definition of PVS in children (17). However, such a definition is difficult to be applied in those children who (due to immaturity or disease condition) already demonstrated some of these characteristics before appearance of PVS (9,16).

Concerning the aetiological borders, there are not too many problems regarding the distinction of PVS from other similar conditions (refer to Tables 2 and 3), although again in the young age-group they may be questionable and difficult to determine.

The Multi-Society Task Force on PVS presented data which gave approximate figures of the long-term (6 and 12 months respectively) outcome of those children who had been at least one month in PVS, due to either traumatic or non-traumatic causes (4,5). The common notion is that children in VS with traumatic brain injury have the best prognosis, as more than half will recover and another half of these will have at least a fair or even a good recovery (4,5,16).

Finally but definitely, the most important are the ethical issues related to PVS. The ethics of PVS management rests on some (un)resolved court cases in the recent past. Good clinical practice (28,30) requires a multidisciplinary team (consisting of at least a paediatric intensive care specialist, a child neurologist, a senior registered nurse working in paediatric intensive care unit and a child psychologist) who should first reach an absolute consensus between the members of the team. Thereafter, the team is allowed to sit down with the parents and other relatives to discuss with

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them the possibility of withdrawal of AHN in a child who is in PVS. However, there is still an ongoing debate with pro-life representatives about whether such an act is ever justified (“killing or letting die” (6)), regardless of the wishes of the parents. However, some authorities (see an excellent paper on a personal experience by Dr. Richard J. Lin (7)) recommend that: “even if the health-care team and the family of the patient feel it is the ‘right’ thing to do, there is still enough negative professional and public sentiment that it may be worthwhile for a family wishing to withdraw AHN for a loved one to pursue a judicial order supporting their wishes” (7).

Acknowledgements The Working Group acknowledges the particular input and support of Ronald Kurz and Francis Crawley in preparing the present publication, as well as the valuable comments of Janez Primozvicv.

References 1. Jennett B, Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1972;1: 734-737.

2. Andrews K. The vegetative state-clinical diagnosis.

Postgrad Med J 1999;75:321-324.

3. Giacino JT, Zasler ND. Outcome after severe traumatic brain injury: coma, the vegetative state, and the minimally responsive state. J Head Trauma Rehabil 1995;10:40-56.

4. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (first of two parts). N Engl J Med 1994;330:1499-1508.

5. The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (second of two parts). N Engl J Med 1994;330:1572-1579.

6. Jennett B. The vegetative state. Medical facts, ethical and legal dilemmas. Cambridge: Cambridge University Press; 2002.

7. Lin RJ. Withdrawing life-sustaining medical treatment - a physician's personal reflection. Ment Retard Dev Disabil Res Rev 2003;9:10-15.

8. Harris J. Consent and end of life decisions. J Med Ethics 2003;29:10-15.

9. Lagercrantz H. Should euthanasia be legal? An international survey of neonatal intensive care units staff.

Arch Dis Child Fetal Neonatal Ed 2004;89:F2.

10. Royal College of Paediatrics. Withholding or Withdrawing Life-Sustaining Treatment in Children: A Framework for Practice - 2nd edition, 2004: www.rcpch.ac.uk/publications/ recentpublications/witholding.pdf 11. Kurz R, Ethics Working Group of Confederation of the European Specialists of Paediatrics. Decision making in extreme situations involving children: withholding or withdrawal of life supporting treatment in paediatric care.

Statement of the ethics working group of the Confederation of the European Specialists of Paediatrics (CESP). Eur J Pediatr 2001;160:214-216.

12. Ashwal S. Medical aspects of the minimally conscious state in children. Brain Dev 2003;25:535-545.

13. Zeman A. Consciousness. Brain 2001;124:1263-1289.

14. Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, et al. The minimally conscious state: definition and diagnostic criteria. Neurology 2002;58:349-353.

15. Ashwal S. Pediatric vegetative state: epidemiological and clinical issues. NeuroRehabilitation 2004;19:349-360.

16. Searle JR. Consciousness. Annu Rev Neurosci 2000;23: 557-578.

17. Ashwal S, Bale JF, Coulter DL, Eiben R, Garg BP, Hill A, et al. The persistent vegetative state in children: Report of the Child Neurology Society Ethics Committee. Ann Neurol 1992;32:570-576.

18. Gillies JD, Seshia SS. Vegetative state following coma in childhood: evolution and outcome. Dev Med Child Neurol 1980;22:642-648.

19. Ashwal S, Eyman RK, Call TL. Life expectancy of children in a persistent vegetative state. Pediatr Neurol 1994;10:27-33.

20. Posner MI, Rothbart MK. Attention, self-regulation and consciousness. Philos Trans R Soc Lond B Biol Sci 1998;353:1915-1927.

21. Bownds MD. The biology of mind: origins and structures of mind, brain, and consciousness. Maryland: Fitzgerald Science Press, Bethesda;1999.

22. Orentlicher D. From the Office of the General Counsel.

The right to die after Cruzan. JAMA 1990;264:2444-2446.

23. Materstvedt LJ, Clark D, Ellershaw J, Forde R, Gravgaard AM, Muller-Busch HC, et al. Euthanasia and physicianassisted suicide: a view from an EACP Ethics Task Force.

Palliat Med 2003;17:97-101.

24. Garrard E, Wilkinson S. Passive euthanasia. J Med Ethics 2005;31:64-68.

25. Thompson BT, Cox PN, Antonelli M, Carlet JM, Cassell J, Hill NS, et al. Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: executive summary. Crit Care Med 2004;32:1781-1784.

26. Alderson P, Nicholson R. Deciding when to withhold or withdraw life-sustaining treatment for children. Bull Med Ethics 1997;127:13-20.

27. Crane MK, Wittink M, Doukas DJ. Respecting end-of-life treatment preferences. Am Fam Physician 2005;72:12631268.

28. Trontelj JV. European trends in bioethics: medical research on persons unable to consent. Suppl Clin Neurophysiol 2000;53:457-459.

29. Sauer PJ, Ethics Working Group, Confederation of European Specialists in Paediatrics. Ethical dilemmas in neonatology: recommendations of the Ethics Working Group of the CESP. Eur J Pediatr 2001;160:364-368.

30. Gill D, Ethics Working Group of the Confederation of European Specialists in Paediatrics. Ethical principles and operational guidelines for good clinical practice in paediatric research. Recommendations of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP). Eur J Pediatr 2004;163:53-57.

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Appendix A questionnaire (A) was sent to each of the 35 members and to the observer national delegates to the Paediatric Section of UEMS/European Academy of Paediatrics (formerly CESP). Replies were received from 22 countries and the results are tabulated (B).

A. Questionnaire: Bioethics Committees in Europe and dealing with persistent vegetative state (PVS) in children.

1. Is there a National Bioethics Comittee in your country?

yes

no

2. Are the interests of children always represented?

yes

no

3. Does your National Paediatric Society have an Ethics Committee ?

yes

no

4. Are there special guidelines on ethics in paediatric practice ?

yes

no

5. Do local hospitals and universities have ethics committees?

yes

no

6. Do you have a strict definition of PVS? If yes, please answer the following:

yes

no

6a. Do you use the definition below?

yes

no

7. Do you encounter the cases of PVS?

yes

no

8. Would you ever consider withdrawal of artificially provided hydration and nutrition (AHN) in PVS children?

If yes, please answer the following:

yes

no

yes

no

yes

no

yes

no

8a. Would you still consider that it may be worthwhile to pursue a judicial order to support such an act?

9. PVS patients do not require any technological support in order to maintain their vital functions and such patients cannot in any way be considered terminal patients, since their condition can be stable and enduring.

10. Do you think that the word “passive euthanasia” should not be used for the withdrawing or withholding of life-prolonging treatment which is not providing a benefit to the patient ?

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Austria Belgium Czech Republic Denmark Former Yugoslav Republic of Macedonia France Georgia Germany Greece Hungary Ireland Israel Italy Luxembourg Netherlands Norway Slovakia Slovenia Sweden Switzerland Turkey United Kingdom of Great Britain and Northern Ireland

Country

N N Y Y Y

Y Y N Y Y Y Y Y N Y Y Y Y Y Y Y N

Y Y Y Y Y

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y N

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

Y Y Y N Y

Y Y Y Y Y N Y Y N N Y Y Y N Y Y Y

N Y N Y Y

Y Y Y Y Y Y Y Y Y Y Y Y Y / Y Y Y

Y Y / Y Y

Y N N N N Y Y N Y Y Y N Y N Y Y Y

Y Y Y Y N

N Y Y N N N Y N N Y Y N Y N N N Y

N N N Y N

N Y Y / Y N N N N N N / Y N N / Y

/ N N N N

Y N Y / Y Y Y Y Y N N Y Y Y Y Y Y

Y Y Y Y N

Y Y Y Y Y Y Y Y Y N Y N Y N Y Y Y

Y Y Y Y Y

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Y N N Y N

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N Y Y Y Y N N N N Y N Y N Y N Y Y

Y N N N N

National Interests National Ethical University Strict Common Cases With Judicial PVS not Passive committee of children Paediatric EC guidelines EC definition of PVS drawal order terminal euthanasia paediatric PVS AHN should not be used

B. The tabulated results from the delegates of 22 countries within the Paediatric Section of UEMS/EAP (formerly CESP).

Y = yes; N= no; / = no answer

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∞. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: √È ÂӉ›ÍÂȘ Û¯ÂÙÈο Ì ÙËÓ ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È Ôχ ÈÛ¯˘Ú¤˜. ¶¤Ú· ·fi Ù· “ÎÏ·ÛÈο” ·ÙÔÈο ÓÔÛ‹Ì·Ù·, ˘¿Ú¯ÂÈ Î·È ¤Ó·˜ ÈηÓfi˜ ·ÚÈıÌfi˜ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ÂӉ¯Ô̤ӈ˜ ÂÈΛӉ˘ÓˆÓ ÁÈ· ÙË ˙ˆ‹, fiˆ˜ ÔÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜, Ô˘ ϤÔÓ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Ôχ Û˘¯Ó¿. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∏ ·Ó·˙‹ÙËÛË ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙËÓ ·Ó·ÛÎfiËÛË ¤ÁÈÓ ̤ۈ ÙÔ˘ Medline ηıÒ˜ Î·È Ì ÂͤٷÛË Î·ıÂÌ›·˜ ÂÎ ÙˆÓ ·Ó·ÊÔÚÒÓ ÙˆÓ Û¯ÂÙÈÎÒÓ ¿ÚıÚˆÓ. ∞ÔÙÂϤÛÌ·Ù·: ∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ‰È·ÈÛÙÒÓÂÙ·È ·fi ¤Ó·Ó ·ÚÈıÌfi ÌÂÏÂÙÒÓ Ô˘ ·ÂÈÎÔÓ›˙Ô˘Ó ÙËÓ ·˘Í·ÓfiÌÂÓË Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ‰È·‰Ô¯ÈÎÒÓ ÁÂÓÂÒÓ ¤Ó·ÓÙÈ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. π‰È·›ÙÂÚ· ÛÙ· ·È‰È¿ ηٷÁÚ¿ÊÔÓÙ·È ˘„ËÏ¿ Â›‰· ÂȉÈÎÒÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ ∂ (πgE), ¤Ó·ÓÙÈ ‰È·ÊfiÚˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ∏ ·ÏÏ·Á‹ ·˘Ù‹ Û˘Ó‰¤ÂÙ·È Û ÔÏϤ˜ ÌÂϤÙ˜ Ì ÙËÓ “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜” Î·È ÙË ÛÙÚÔÊ‹ ·fi ÙÔÓ ·Ú·‰ÔÛÈ·Îfi ·ÁÚÔÙÈÎfi ÙÚfiÔ ˙ˆ‹˜ Û ¤Ó· “‰˘ÙÈÎÔ‡ Ù‡Ô˘” ÌÔÓÙ¤ÏÔ ˙ˆ‹˜, Ô˘ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ¤ÎıÂÛ˘ Û ÌÈÎÚfi‚È· Î·È ÙȘ ·Ú·ÁfiÌÂÓ˜ ÂÓ‰ÔÙÔ͛Ә. ™Â ·ÓÔÛÈ·Îfi Â›‰Ô, ÛÙ· ·ÙÔÈο ¿ÙÔÌ· ÂÈÎÚ·Ù› Ë Ù‡Ô˘ 2 ·ÓÔÛÔÏÔÁÈ΋ ·ÓÙ›‰Ú·ÛË ÙˆÓ ‚ÔËıËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ∆. ™˘ÌÂÚ¿ÛÌ·Ù·: H ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Ê·›ÓÂÙ·È fiÙÈ ¿Ú¯ÈÛ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1960 Î·È Û˘Ó¯›ÛÙËΠÛÙȘ ÂfiÌÂÓ˜ ÁÂÓȤ˜. √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ˘„ËÏfiÙÂÚÔ˜ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜, ÂÓÒ Î·È ÔÈ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ô˘ ˘ÈÔıÂÙÔ‡Ó ÙÔÓ ‰˘ÙÈÎfi ÙÚfiÔ ˙ˆ‹˜ ·ÎÔÏÔ˘ıÔ‡Ó ·˘Ù‹ ÙËÓ Ù¿ÛË. √ ·ÓÔÛÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙËÓ “˘fiıÂÛË ˘ÁÈÂÈÓ‹˜” ¤¯ÂÈ Á›ÓÂÈ ·ÓÙÈΛÌÂÓÔ ÂÎÙÂٷ̤Ó˘ ¤Ú¢ӷ˜ ηٿ ÙËÓ ÙÂÏÂ˘Ù·›· 15ÂÙ›·. ∏ ÂȉËÌÈÔÏÔÁÈ΋ ‚¿ÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘, ˆÛÙfiÛÔ, ·ÏÏ¿ Î·È ÔÈ Èı·ÓÔ› ÙÚfiÔÈ ÚfiÏ˄˘ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ Â›Ó·È ÌÂÚÈο ·fi Ù· ·ÓÙÈΛÌÂÓ· Ù˘ Û‡Á¯ÚÔÓ˘ ¤Ú¢ӷ˜.

§¤ÍÂȘ ÎÏÂȉȿ: ∂ȉËÌÈÔÏÔÁ›·, ·ÏÏÂÚÁ›·, ˘ÁÈÂÈÓ‹, ¢·ÈÛıËÙÔÔ›ËÛË.

The increase of allergic conditions in recent years: epidemiology and causes Barnet and Chase Farm Hospitals NHS Trust, London Southampton University Medical School, United Kingdom Correspondence: A. Sofianou-Katsoulis katsofkat@hotmail.com 6, Neofronos St. 161 21, Athens, Greece

A. Sofianou-Katsoulis Abstract Background: There is robust evidence of a rising prevalence of allergic conditions. In many countries the percentages of atopic manifestations have even doubled over a period of fifteen years. Apart from the “classical” atopic conditions, a number of potentially life threatening allergies are very commonly diagnosed, especially food allergies. This is a review of the relevant literature.

Methods: The literature search for this review was performed mainly on Medline. Following selection of the relevant papers, a manual search of their references was made.

Results: The rise in frequency of allergic conditions has not only been reported by patients and clinicians, but also documented by a number of studies that illustrate the increase in sensitivity to specific allergens between birth cohorts, and the presence of high levels of specific IgEs, particularly in younger populations.

This change in population sensitivities has been linked by many studies to the “hygiene hypothesis”, but also to the shift of many traditionally rural societies to a “westernized” life model, resulting in reduced microbial exposure. At the immunological level, atopic individuals exhibit the type 2 response of the helper T cells.

Conclusions: The increase in allergic conditions started probably after the 1960s, and seems to be maintained in subsequent birth cohorts. Their prevalence is higher in the developed countries, but developing countries adopting a “westernized” lifestyle follow this trend. The immunological mechanism described in the “hygiene hypothesis” has been investigated extensively in the past 15 years. The epidemiological basis of the increase in allergic conditions and prevention strategies are some of the current research topics.

Key words: Allergy, epidemiology, sensitization, hygiene.

Paediatriki 2007;70:266-271

Pediatri July-Aug 07

09-07-07

17:08

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267

∂ȉËÌÈÔÏÔÁ›· ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛˆÓ

∂ÈÛ·ÁˆÁ‹ ∏ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ú¤¯ÂÈ ÈÛ¯˘Ú¤˜ ÂӉ›ÍÂȘ ˆ˜ ÚÔ˜ ÙËÓ ·˘Í·ÓfiÌÂÓË Â›ÙˆÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛˆÓ. √È ÎÏ·ÛÈΤ˜ ·ÙÔÈΤ˜ ·ı‹ÛÂȘ, fiˆ˜ ÙÔ ¿ÛıÌ·, ÙÔ ¤Î˙ÂÌ·, Ë ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, ·ÏÏ¿ Î·È ÔÈ ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ Â›Ó·È Ôχ Û˘¯ÓfiÙÂÚ˜ Û ۯ¤ÛË Ì ÙÔ ·ÚÂÏıfiÓ, ÁÈ· ·Ú¿‰ÂÈÁÌ· Û·Ú¿ÓÙ· ¯ÚfiÓÈ· ÚÈÓ. ∏ ÁˆÁÚ·ÊÈ΋ Â›Û˘ ηٷÓÔÌ‹ Ù˘ Â›ÙˆÛ˘ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο Î·È ¤¯ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ Ë ·ÔÙ‡ˆÛ‹ Ù˘ ÛÙÔÓ ·ÁÎfiÛÌÈÔ ¯¿ÚÙË, ·fi ÙËÓ ÔÔ›· ÌÔÚÔ‡Ó Ó· ÚÔ·„Ô˘Ó ÛËÌ·ÓÙÈο Û˘ÌÂÚ¿ÛÌ·Ù·, ˆ˜ ÚÔ˜ ÙȘ ·Èٛ˜ Ù˘ ·Ú·ÙËÚÔ‡ÌÂÓ˘ ·‡ÍËÛ˘. √ ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ Â›Ó·È Ó· ·ÚÔ˘ÛÈ·ÛÙ› Ë ϤÔÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ·ÊÔÚ¿ ÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Î·È ÙȘ ·Èٛ˜ ¤Í·ÚÛ˘ ·˘ÙÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ·Ó·˙‹ÙËÛË ‚È‚ÏÈÔÁÚ·Ê›·˜ ÁÈ· ÙË Û˘ÁÁÚ·Ê‹ Ù˘ ·ÚÔ‡Û·˜ ·Ó·ÛÎfiËÛ˘ ¤ÁÈÓ Ì ¤Ú¢ӷ ÛÙË Medline ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙȘ ϤÍÂȘ ÎÏÂȉȿ “immediate hypersensitivity” OR “hypersensitivity, immediate” OR (“hypersensitivity”) OR “hypersensitivity” OR (“allergy and immunology”) OR (“allergy and immunology” OR Allergy) AND ((“disease outbreaks” [TIAB] NOT Medline[SB]) OR “disease outbreaks” [MeSH Terms] OR Epidemic[Text Word]) AND “humans” [MeSH Terms], Ì ·Ó·˙‹ÙËÛË Û¯ÂÙÈÎÒÓ ·Ó·ÛÎÔ‹ÛÂˆÓ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÙ›·˜. √È ·Ó·ÊÔÚ¤˜ ÙˆÓ ¿ÚıÚˆÓ Ô˘ ÎÚ›ıËÎ·Ó Î·Ù¿ÏÏËÏ· ÂÍÂÙ¿ÛıËÎ·Ó Ì›· ÚÔ˜ Ì›· Ì ÛÎÔfi Ó· ‚ÚÂıÔ‡Ó ËÁ¤˜ Ô˘ ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙȘ ËÏÂÎÙÚÔÓÈΤ˜ ‚¿ÛÂȘ ‰Â‰ÔÌ¤ÓˆÓ ‹ Ô˘ ›¯·Ó ‰ËÌÔÛÈ¢ı› ·ÚÎÂÙ¿ ·ÏÈ¿. ∂ȉËÌÈÔÏÔÁ›· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ∆· ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ·˘Ùfi Ô˘ Û‹ÌÂÚ· ·ÔηÏÂ›Ù·È “ÂȉËÌ›·” ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È Ô˘ÛÈ·ÛÙÈο. ¢ËÌÔÛȇÛÂȘ Ô˘ ÚˆÙÔ¤ÁÈÓ·Ó ÛÙ· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980 ·ÔÂÈÚ¿ıËÎ·Ó Ó· Û˘ÁÎÚ›ÓÔ˘Ó ÙËÓ ÙfiÙ Â›ÙˆÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Ì ·ÚfiÌÔÈ· ÛÙÔȯ›· ·fi ÚÔËÁÔ‡ÌÂÓ˜ ‰ÂηÂٛ˜. ¶ÔÏϤ˜ ÌÂϤÙ˜ Ù˘ ÂÔ¯‹˜ η٤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙȘ ·ÙÔÈΤ˜ ·ı‹ÛÂȘ, ȉȷ›ÙÂÚ· Û ¯ÒÚ˜ fiˆ˜ Ë ¢·Ó›· Î·È ÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ. √È Û˘ÁÁÚ·Ê›˜ ·¤‰ˆÛ·Ó ÙËÓ ·‡ÍËÛË ·˘Ù‹ ÛÙËÓ ÂÚÈ‚·ÏÏÔÓÙÈ΋ ÌfiÏ˘ÓÛË, ηıÒ˜ Î·È ÛÙËÓ ¤ÎıÂÛË ÛÙ· “ÔÈÎȷο” ·ÏÏÂÚÁÈÔÁfiÓ· (2). ∞Ó¿ÌÂÛ· ÛÙȘ ÌÂϤÙ˜ Ô˘ ηٷ‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛˆÓ, ȉȷ›ÙÂÚË ·Í›· ¤¯Ô˘Ó ·˘Ù¤˜ Ô˘ Û˘ÁÎÚ›ÓÔ˘Ó ÙËÓ Â›ÙˆÛ‹ ÙÔ˘˜ ·Ó¿ÌÂÛ· Û ‰˘Ô ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ ÛÙÔ ·ÚÂÏıfiÓ. ™Â Ì›· ·fi ·˘Ù¤˜, Ë ‰È¿ÁÓˆÛË ÙÔ˘

¿ÛıÌ·ÙÔ˜ ¤ÁÈÓ ‚¿ÛÂÈ ÙˆÓ ·Ó·ÊÂÚfiÌÂÓˆÓ Û˘Ìو̿وÓ, ·ÏÏ¿ Î·È ‚¿ÛÂÈ ‰ÔÎÈÌ·ÛÈÒÓ ÚfiÎÏËÛ˘. ∏ ÌÂϤÙË ·Ó·Ê¤ÚÂÈ ·‡ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙË µÚÂÙ·Ó›· ·fi 6 Û 12% ̤۷ Û 15 ¯ÚfiÓÈ·. ∆· ÔÛÔÛÙ¿ ·‡ÍËÛ˘ ‹Ù·Ó Â›Û˘ ÂÓÙ˘ˆÛȷο ÁÈ· ÙËÓ ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· (·fi 5 Û 16%) Î·È ÙËÓ ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· (·fi 9 Û 15%)(5). ∏ ¤ÎıÂÛË Û¯ÂÙÈο Ì ÙËÓ ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Û ·ÛıÂÓ›˜ Ì ·ÏÏÂÚÁÈο ÓÔÛ‹Ì·Ù·, Ë ÔÔ›· ÂΉfiıËΠ·fi ÙÔ µ·ÛÈÏÈÎfi ∫ÔϤÁÈÔ ÙˆÓ ¶·ıÔÏfiÁˆÓ ∞ÁÁÏ›·˜ ÙÔ 2004, ·Ó·Ê¤ÚÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο Ù· ÂÍ‹˜: Ù· Û˘¯ÓfiÙÂÚ· ·ÏÏÂÚÁÈο ÓÔÛ‹Ì·Ù· ¤¯Ô˘Ó ·˘ÍËı› ÛÙÔ ÙÚÈÏ¿ÛÈÔ Î·Ù¿ Ù· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· ÛÙË µÚÂÙ·Ó›·, ÂÓÒ ÂÚ›Ô˘ ÙÔ ¤Ó· ¤ÌÙÔ ÙÔ˘ ÏËı˘ÛÌÔ‡ ¤¯ÂÈ ·ÔÙ·Óı› Û οÔÈ· Ê¿ÛË Ù˘ ˙ˆ‹˜ ÙÔ˘ Û ÂȉÈÎfi, ÏfiÁˆ οÔÈ·˜ ·ÏÏÂÚÁÈ΋˜ ¿ıËÛ˘ (1,7,18). ∂›Ó·È ·Ï‹ıÂÈ· fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚ¢ÓÒÓ Ô˘ ηٷÁÚ¿ÊÔ˘Ó ·˘Ù‹ ÙËÓ ·‡ÍËÛË ‚·Û›˙ÔÓÙ·È Û ·ÔÙÂϤÛÌ·Ù· ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Î·È ÂÔ̤ӈ˜ Û ·Ó·ÊÂÚfiÌÂÓ· Û˘ÌÙÒÌ·Ù·, Ô˘ ÔˆÛ‰‹ÔÙ ÂÓ¤¯Ô˘Ó ˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·. øÛÙfiÛÔ, Û ÌÂÚÈΤ˜ ÌÂϤÙ˜ Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ‚·Û›˙ÔÓÙ·È ÛÙË Û‡ÁÎÚÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÂȉÈÎÒÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ IgE ÙÔ˘ ÔÚÔ‡ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ (4). ™Â Ì›· ·fi ·˘Ù¤˜ ÙȘ ÂÚÁ·Û›Â˜ ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÂȉÈÎÒÓ πgE Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Û ÙÚÂȘ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ Û ‰È¿ÛÙËÌ· 25 ÂÙÒÓ. ¢Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂÏ‹ÊıËÛ·Ó ·fi ÙÚÂȘ ÔÌ¿‰Â˜ ÂıÂÏÔÓÙÒÓ, Ì›· Û οı ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹. ŸÏÔÈ ÔÈ ÂıÂÏÔÓÙ¤˜ ¤¯Ô˘Ó ÙËÓ ›‰È· ËÏÈΛ· Û‹ÌÂÚ·, ÂÓÒ ÔÈ ÔÌ¿‰Â˜ ›¯·Ó ·ÚfiÌÔÈ· ‰ËÌÔÁÚ·ÊÈο Î·È Ê˘ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Â›‰· IgE Û Â·Ê‹ Ì ÙË Á‡ÚË ÙˆÓ ‰¤Ó‰ÚˆÓ Î·È ÙˆÓ ·ÁÚÒÓ, ηıÒ˜ Î·È ÙȘ Á¿Ù˜ (8). ∞fi Ù· ·Ú·¿Óˆ ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ‰ÂÓ ·˘Í¿ÓÂÙ·È ÌfiÓÔ ÛÙȘ ÓÂfiÙÂÚ˜ ÁÂÓȤ˜ ·ÏÏ¿ Î·È Û ·ÓıÚÒÔ˘˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, ÂÊfiÛÔÓ ÂÎÙ›ıÂÓÙ·È ÛÙÔÓ Û‡Á¯ÚÔÓÔ ÙÚfiÔ ˙ˆ‹˜, fiˆ˜ ı· ÂÚÈÁÚ·Ê› ·Ú·Î¿Ùˆ (¶›Ó·Î·˜ 1). ™¯ÂÙÈο Ì ٷ ·Ú·¿Óˆ Â›Ó·È Î·È Ù· Â˘Ú‹Ì·Ù· ÙˆÓ Linneberg Î·È Û˘Ó, Ô˘ Û˘Ó¤ÎÚÈÓ·Ó ÌÂÚÈΤ˜ ÁÂÓȤ˜ ˆ˜ ÚÔ˜ ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛ‹ ÙÔ˘˜ Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· (12). ™ËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ‚Ú¤ıËΠÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ›¯·Ó ÁÂÓÓËı› ÚÈÓ Î·È ÌÂÙ¿ ÙÔ 1960. ∆Ô ‰È¿ÁÚ·ÌÌ· ÛÙËÓ ∂ÈÎfiÓ· 1 ‰Â›¯ÓÂÈ fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ Êı›ÓÂÈ ÛÙȘ ·Ï·ÈfiÙÂÚ˜ ÁÂÓȤ˜. ∂›Ó·È ÂӉȷʤÚÔÓ, ˆÛÙfiÛÔ, Î·È Û¯ÂÙÈÎfi Ì ٷ Â˘Ú‹Ì·Ù· ÙˆÓ Law Î·È Û˘Ó. fiÙÈ ÌÂٷ͇ 1990-1998 ·ÎfiÌ· Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÁÂÓÈ¿ ·ÚÔ˘ÛÈ·˙fiÙ·Ó ÈÔ Â˘·ÈÛıËÙÔÔÈË̤ÓË (12). ÷ڷÎÙËÚÈÛÙÈο Û˘ÌÂÚ¿ÛÌ·Ù· Û¯ÂÙÈο Ì ÙȘ ‰È·ÊÔÚ¤˜ Â›ÙˆÛ˘ Ù˘ ·ÏÏÂÚÁ›·˜ ÌÂٷ͇ ÙˆÓ ÁÂÓÂÒÓ ¤‰ˆÛÂ Î·È Ë ·ÎfiÏÔ˘ıË ÌÂϤÙË. ™ÙË ÌÂϤÙË ·˘Ù‹ Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙË ºÈÏ·Ó‰›· ÂÍÂÙ¿ÛÙËÎ·Ó IgE Û ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ· Î·È Û ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ· ·fi ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ ÂıÂÏÔÓÙÒÓ Ô˘ ›¯·Ó ÁÂÓÓËı› ηٿ ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ 1920, 1940, 1960 Î·È 1990. ∏ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ‰È¿ÁÓˆÛ˘ ¿ÛıÌ·ÙÔ˜ ·fi È·ÙÚfi ‹Ù·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋. ∆· Â›‰· IgE ·ÚÔ˘Û›·˙·Ó ·‡ÍËÛË ÛÙȘ ÓÂfiÙÂÚ˜ ÁÂÓȤ˜, Ì ÛËÌ·ÓÙÈΤ˜

¶›Ó·Î·˜ 1. ∞Ó·ÏÔÁ›· ·Ó‰ÚÒÓ Ô˘ ‚Ú¤ıËÎ·Ó ıÂÙÈÎÔ› ÛÙÔ Phadiatop* ¤Ó·ÓÙÈ ÙÚÈÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ, Û ÙÚÂȘ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜. √È ÙÈ̤˜ Â›Ó·È % ÔÛÔÛÙ¿. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (8). ∆Ô χÇ Â›¯Â ÙÈÌ‹<0,001 ÁÈ· ÙÔ Phadiatop Î·È ÁÈ· ηı¤Ó· ·fi Ù· 3 ·ÏÏÂÚÁÈÔÁfiÓ· ŒÙÔ˜ 1975-6 1981-2 1996-8 M¤ÛË ·fiÏ˘ÙË ÂÙ‹ÛÈ· ·‡ÍËÛË ÂÈÔÏ·ÛÌÔ‡ (%)

Phadiatop

°Ú·Û›‰È

30 (26-34) 16 (13-19) 33 (29-37) 18 (14-21) 42 (37-46) 27 (23-31) 0,45 (0,17- 0,73) 0,53 (0,30- 0,77)

°‡ÚË ‰¤Ó‰ÚˆÓ

°¿Ù·

5,7 (3,8-8,0) 5,1 (3,3-7,3) 12,6 (9,9-15,8) 0,36 (0,19-0,53)

4,1 (2,6-6,2) 4,5 (2,9-6,6) 10,1 (7,6-13,1) 0,25 (0,13 -0,38)

*™Î‡·ÛÌ· 11 ÎÔÈÓÒÓ ÂÈÛÓÂfiÌÂÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ‰Â›ÎÙ˘ ·ÙÔ›·˜ ¶·È‰È·ÙÚÈ΋ 2007;70:266-271

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·268

268

∞. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË

45

∂ÈÔÏ·ÛÌfi˜ (%)

40 35

1990

30

1998

25 20 15 10 5 0 15-22 23-30 31-38 39-46 4754 55-62 63-70 70-77 ∏ÏÈΛ· (¤ÙË)

∂ÈÎfiÓ· 1. ∞ÏÏ·Á‹ ÛÙË Û˘¯ÓfiÙËÙ· ¢·ÈÛıËÙÔÔ›ËÛ˘ ηٿ ËÏÈÎȷ΋ ÔÌ¿‰· ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi ÌÂٷ͇ 1990-1998. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (15).

‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙ· ÂÚÈÛÛfiÙÂÚ· ˙‡ÁË ÁÂÓÂÒÓ, Û fi,ÙÈ ·ÊÔÚ¿ Ù· ·ÂÚÔ·ÏÏÂÚÁÈÔÁfiÓ·. ∞ÓÙ›ıÂÙ·, ÛÙ· ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙ· Â›‰· IgE ηٷÁÚ¿ÊËΠÌfiÓÔ ÌÂٷ͇ Ù˘ ÁÂÓÈ¿˜ ÙÔ˘ 1920 Î·È ÙÔ˘ 1990. ŒÓ· ·fi Ù· ÛËÌ·ÓÙÈο Â˘Ú‹Ì·Ù· ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ Â›Ó·È fiÙÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË Ù˘ ÁÂÓÈ¿˜ ÙÔ˘ 1940 ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ·˘Ù‹ ÙÔ˘ 1920. ∂›Ó·È Èı·Ófi ÔÈ Î·Î¤˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ ηٿ ÙÔÓ 2Ô ¶·ÁÎfiÛÌÈÔ ¶fiÏÂÌÔ Ó· ·Ó¤ÎÔ„·Ó ÚÔÛˆÚÈÓ¿ ÙËÓ ÂͤÏÈÍË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ (¶›Ó·Î·˜ 2) (9). ∂ÎÙfi˜ fï˜ ·fi ÙË Û˘¯ÓfiÙËÙ·, ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Î·È Ë Ê‡ÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Ô˘ ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔÓ ÏËı˘ÛÌfi. ∆ÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ·Ô‚Ô‡Ó ÂÈΛӉ˘Ó˜ ÁÈ· ÙË ˙ˆ‹, fiˆ˜ Ë ·ÏÏÂÚÁ›· ÛÙÔ˘˜ ÍËÚÔ‡˜ ηÚÔ‡˜, ·Ú·ÙËÚÔ‡ÓÙ·È ÈÔ Û˘¯Ó¿. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ‰È·ÙÚÔÊ‹ ÂÂÍÂÚÁ·ÛÌ¤ÓˆÓ ÙÚÔÊÒÓ Î·ıÒ˜ Î·È Ê·ÁËÙÒÓ ·fi ¯ÒÚ˜ Ù˘ ∞Û›·˜, fiÔ˘ Â›Ó·È Û˘¯ÓfiÙÂÚË Ë ¯Ú‹ÛË ÍËÚÒÓ Î·ÚÒÓ (1,17,18). ŒÓ· ·ÎfiÌË ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙȘ ̤Ú˜ Ì·˜ Â›Ó·È fiÙÈ Ù›ÓÔ˘Ó Ó· ¤¯Ô˘Ó ÔÏ˘Û˘ÛÙËÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ: ÔÏÏ¿ ·È‰È¿ Ì ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›·, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ˘ÔʤÚÔ˘Ó ·fi ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Î·È ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·, Ù¿ÛË Ô˘ ηٷÁÚ¿ÊÂÙ·È ÛÙËÓ ÙÚ›ÙË Ê¿ÛË Ù˘ ÔÏ˘ÎÂÓÙÚÈ΋˜ ÌÂϤÙ˘ ISAAC (International Study of Asthma and Allergies in Childhood) . ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ·Ú¿ÏÏËÏ· Ì ÙËÓ ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfiÙËÙ· ÛÙȘ ÂΉËÏÒÛÂȘ ÙˆÓ ·ÙÔÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ 3Ë Ê¿ÛË Ù˘ ÌÂϤÙ˘ ·Ú·ÙËÚÂ›Ù·È Î·È Ì›· ·ÏÏ·Á‹ ÛÙËÓ “ÎÏ·ÛÈ΋” ÛÂÈÚ¿ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ·Ó¿ ËÏÈΛ·. ∏ ÁÓˆÛÙ‹ ·ÏÏËÏÔ˘¯›· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·Ô‰›‰ÂÙ·È ·fi ÙÔÓ fiÚÔ “·ÙÔÈ΋ ·Ú¤Ï·ÛË”- atopic marching (1,18,20). ∞fi Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ISAAC, Û fiϘ Ù˘

Ê¿Û˘ ‰ÈÂÍ·ÁˆÁ‹˜ Ù˘, ÚÔ·ÙÂÈ fiÙÈ ÔÈ ¯ÒÚ˜ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·ÏÏÂÚÁÈÒÓ Â›Ó·È ÔÈ ÈÔ ·Ó·Ù˘Á̤Ó˜ ÔÈÎÔÓÔÌÈο Î·È ‚ÈÔÌ˯·ÓÈο, ÂÓÒ ·Ú¿ÏÏËÏ· ÔÈ ÏËı˘ÛÌÔ› ÙÔ˘˜ ÂӉ¯Ô̤ӈ˜ Ó· ¤¯Ô˘Ó ÔÌÔÈfiÙËÙ˜ Î·È Û ÁÂÓÂÙÈÎfi Â›Â‰Ô (∂ÈÎfiÓ· 2)(7, 20). ™ÙËÓ ∂ÏÏ¿‰·, ˆÛÙfiÛÔ, Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ Û¯ÂÙÈο ¯·ÌËÏ‹, ·Ó Î·È ·Ó·Ì¤ÓÔÓÙ·È ÓÂÒÙÂÚ· ÛÙÔȯ›· ·fi ÙËÓ ˘fi ÂͤÏÈÍË Â˘Úˆ·˚΋ ÌÂϤÙË Â›ÙˆÛ˘ Ù˘ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ∂uropreval. ™Â ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË, ÔÈ ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ Î·È Û˘Ó. ‰ËÌÔÛÈÂ‡Ô˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈ·˜ ÌÂϤÙ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ¶·ÙÚÒÓ. ∏ ηٷÁÚ·Ê‹ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Û ‰È¿ÊÔÚ˜ ¯ÚÔÓÈΤ˜ ÛÙÈÁ̤˜ Ù· ÙÂÏÂ˘Ù·›· 25 ¯ÚfiÓÈ· ÛÙËÓ ÂÚÈÔ¯‹ ‰Â›¯ÓÂÈ fiÙÈ Ù· ÔÛÔÛÙ¿ ¿ÛıÌ·ÙÔ˜ ·˘Í¿ÓÔ˘Ó, ·Ó Î·È Û ¯·ÌËÏfiÙÂÚÔ˘˜ Ú˘ıÌÔ‡˜ Û ۯ¤ÛË Ì ÙÔ ·ÚÂÏıfiÓ (21). ∞ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∆ËÓ ÙÂÏÂ˘Ù·›· 15ÂÙ›· ¤¯Ô˘Ó Á›ÓÂÈ ÔÏϤ˜ ÚÔÛ¿ıÂȘ Ó· ÂÚÌËÓ¢Ù› Ë ·Ú·ÙËÚÔ‡ÌÂÓË ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛˆÓ. Œ¯Ô˘Ó ‰È·Ù˘ˆı› ÔÈΛϘ “ıˆڛ˜” Î·È “˘Ôı¤ÛÂȘ”, Ô˘ Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Û˘ÌÏËÚÒÓÔ˘Ó Ë Ì›· ÙËÓ ¿ÏÏË. ∏ “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜” ‰È·Ù˘ÒıËΠÙÔ 1989 ·fi ÙÔÓ David Strachan. H ÌÂϤÙË ÙÔ˘ ¤‰ÂÈÍ fiÙÈ ÂÓ‰¤¯ÂÙ·È Ô ÏfiÁÔ˜ ÁÈ· ÙËÓ ·‡ÍËÛË ÙˆÓ ·ÙÔÈÎÒÓ ·ı‹ÛÂˆÓ Ó· Â›Ó·È Ë Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ, ·ÏÏ¿ Î·È Ë ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ ̤۷ ÛÙÔ Û›ÙÈ. ™˘ÁÎÂÎÚÈ̤ӷ, ÚԤ΢„ fiÙÈ Ë Â›ÙˆÛË Ù˘ ·ÏÏÂÚÁÈ΋˜ ÚÈÓ›Ùȉ·˜ Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·‰ÂÚÊÒÓ (3). ™·Ó Û˘Ó¤¯ÂÈ· Ù˘ ·Ú·¿Óˆ ˘fiıÂÛ˘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Ë ·ÏÏ·Á‹ ÛÙË ÌÈÎÚԂȷ΋ ¯ÏˆÚ›‰· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰ËÌÈÔ˘ÚÁ› ·ÏÏÂÚÁÈ΋ ÚԉȿıÂÛË, ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ηٷӿψÛ˘ ÌË ·ÛÙÂÚȈ̤ÓÔ˘ Á¿Ï·ÙÔ˜ Î·È ÏfiÁˆ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÙÚfiÔ˘ ‰È·ÙÚÔÊ‹˜ - ‰›·ÈÙ˜ ÔÏ˘ÂÂÍÂÚÁ·ÛÌ¤ÓˆÓ ÙÚÔÊÒÓ, Ùˆ¯¤˜ ÛÂ Ê˘ÙÈΤ˜ ›Ó˜. ™ÙË ‰È·Ù·Ú·¯‹ Â›Û˘ Ù˘ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Û˘Ì‚¿ÏÏÂÈ Ë ÌÂȈ̤ÓË ¤ÎıÂÛË Û ÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È Ù· ÚÔ˚fiÓÙ· ÙÔ˘˜, fiˆ˜ Â›Û˘ Î·È Ë Î·Ù¿¯ÚËÛË ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ (11). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, ÂÍÂÙ¿ÛÙËÎÂ Ô ÚfiÏÔ˜ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙË ‰È·ÙÚÔÊ‹, Ì ÛÎÔfi ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÙÔÈÎÒÓ ·ı‹ÛÂˆÓ (19). ∆· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È ÔÚȷο ˘¤Ú ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ ÚÔ‚ÈÔÙÈÎÒÓ Î·È ÔˆÛ‰‹ÔÙ ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ˜. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ‰ÂÓ ÈÛ¯‡ÂÈ Ô ÈÛ¯˘ÚÈÛÌfi˜ fiÙÈ ÔÈ Î·Î¤˜ Û˘Óı‹Î˜ ˘ÁÈÂÈÓ‹˜ ÚÔÛÙ·ÙÂ‡Ô˘Ó ¿ÓÙ· ·fi ÙËÓ ·Ó¿Ù˘ÍË ·ÙÔ›·˜. ∞ÓÙÈı¤Ùˆ˜, ÂÚÈÙÒÛÂȘ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë Ïԛ̈ÍË ·fi ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV), Úԉȷı¤ÙÔ˘Ó ÁÈ· ·Ó¿Ù˘ÍË ¿ÛıÌ·ÙÔ˜. ∏ ÈÔ ÛˆÛÙ‹ ‰È·Ù‡ˆÛË Â›Ó·È fiÙÈ Ô ·Ú·‰ÔÛÈ·Îfi˜ ·ÁÚÔÙÈÎfi˜ ÙÚfiÔ˜ ˙ˆ‹˜ ÚÔÛٷهÂÈ ·fi ÙËÓ ·Ó¿Ù˘ÍË ·ÙÔ›·˜. ™Â ¤Ó· “·ÁÚÔÙÈÎfi” ÂÚÈ‚¿ÏÏÔÓ, Ë ¤ÎıÂÛË Û Gram ·ÚÓËÙÈο ‚·ÎÙ‹ÚÈ· Ô‰ËÁ› ÛÙËÓ ¤ÎıÂÛË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ Û ‚·ÎÙËÚȷ΋ ÂÓ‰ÔÙÔÍ›ÓË. ∏

¶›Ó·Î·˜ 2. ∂ÈÔÏ·ÛÌfi˜ (%) -Ì 95% ‰È¿ÛÙËÌ· ‚‚·ÈfiÙËÙ·˜ - ¿ÛıÌ·ÙÔ˜, ·ÏÏÂÚÁ›·˜ ÛÙËÓ ÚˆÙ½ÓË Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰Ô˜ Î·È ·ÓȯÓ‡ÛÈÌˆÓ ÂȉÈÎÒÓ IgE Û ¿ÙÔÌ· Ô˘ ÂÎÚÔÛˆÔ‡Ó ÙȘ ÁÂÓȤ˜ ÙÔ˘ 1990, 1963-66, 1943-46 Î·È 1923-26. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (9) ∏ÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ÕÛıÌ· ÀÂÚ¢·ÈÛıËÛ›· ÛÙÔ Á¿Ï· ∂ȉÈΤ˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ πgE ÛÙÔ Á¿Ï· Paediatriki 2007;70:266-271

1990 7 ÂÙÒÓ, n=100

1963-67 27 ÂÙÒÓ, n=100

1943-46 47 ÂÙÒÓ, n=100

1923-26 67 ÂÙÒÓ, n=100

10 (4,9-17,7) 14 (7,9-22,4) 9 (4,2-16,4)

1 (0,03-5,5) 10 (4,9-17,6) 4,4 (1,2-10,8)

1 (0,03-5,5) 14 (8-22,6) 1 (0,03-5,5)

5 (1,6-11) 13 (7,1-21) 7,1 (2,9-14)

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·269

269

∂ȉËÌÈÔÏÔÁ›· ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛˆÓ

∂ÈÔÏ·ÛÌfi˜ ¿ÛıÌ·ÙÔ˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜

8,0% 3,4%

1,2%

∂ÈÔÏ·ÛÌfi˜ 3,6% ÂÎ˙¤Ì·ÙÔ˜ 1,3% ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜

1,3% ∂ÈÔÏ·ÛÌfi˜ ÚÈÓ›Ùȉ·˜ ÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ 12 Ì‹Ó˜

★

≥9%

◆

6-9%

●

3-6%

■

<3%

7,5%

∂ÈÎfiÓ· 2. ¶·ÁÎfiÛÌÈÔ˜ ¯¿ÚÙ˘ Ù˘ ηٷÓÔÌ‹˜ ÙÔ˘ ÂÙ‹ÛÈÔ˘ ÂÈÔÏ·ÛÌÔ‡ Û ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·fi ÙȘ ÙÚÂȘ ·ÙÔÈΤ˜ ·ı‹ÛÂȘ. ∫·Ù·ÁÚ¿ÊÂÙ·È Â›Û˘ Ë ·Ó·ÏÔÁ›· ÙˆÓ ·È‰ÈÒÓ Ì οÔÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi ÙȘ ÎÔÈÓ¤˜ ·ÙÔÈΤ˜ ·ı‹ÛÂȘ. ¢ËÌÔÛ›Â˘ÛË Î·ÙfiÈÓ ·‰Â›·˜ (7).

ÂÓ‰ÔÙÔÍ›ÓË ·˘Ù‹ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÂÈ‚›ˆÛË Î·È ˆÚ›Ì·ÓÛË ÙˆÓ ·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·ÛÙÈÎÒÓ ‰ÂÓ‰ÚÈÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ø˜ Û˘Ó¤ÂÈ· ÙˆÓ ·Ú·¿Óˆ, Ù· ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· ·Ó·Ù‡ÛÛÔ˘Ó ˘ԉԯ›˜ ∆LR (toll-like receptors) Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·Ó¿Ù˘ÍË ÌË ·ÏÏÂÚÁÈ΋˜ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ Ì ÙËÓ ·Ú·ÁˆÁ‹ ηٿÏÏËÏˆÓ Î˘Ù·ÚÔÎÈÓÒÓ (πL-12, INF-Á) Î·È ÙËÓ ÂÈÎÚ¿ÙËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Th1 (16). ¢ÂÓ ˘¿Ú¯ÂÈ ·ÌÊÈ‚ÔÏ›· Î·È ¤¯ÂÈ ·Ô‰Âȯı› Î·È ·fi Û¯ÂÙÈ΋ ÌÂϤÙË ÛÙË ¢·Ó›· fiÙÈ Ë ÌÂٷΛÓËÛË ÙˆÓ ÏËı˘ÛÌÒÓ ÛÙȘ ÌÂÁ¿Ï˜ fiÏÂȘ Ô‰ËÁ› ÛÙËÓ ·ÒÏÂÈ· Ù˘ “·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÔ¯‹˜” ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ·. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÁÈ·Ù› Ë ¤ÎıÂÛË ÙˆÓ ·ÓıÚÒˆÓ Û ·ÏÏÂÚÁÈÔÁfiÓ·, .¯. Á‡ÚË, Â›Ó·È Ôχ ÌÈÎÚfiÙÂÚË, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¯¿ÓÔ˘Ó ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ·ÓÔ¯‹ ÙÔ˘˜ Û ·˘Ù¿ Î·È Ó· ¢·ÈÛıËÙÔÔÈÔ‡ÓÙ·È. ™ÙËÓ ·ÓÔÛÔıÂÚ·›·, ·ÓÙÈı¤Ùˆ˜, Ë ·¢·ÈÛıËÙÔÔ›ËÛË ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·˘Í·ÓfiÌÂÓË ¤ÎıÂÛË Û οÔÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. ∞˘Ùfi˜ Â›Ó·È Ô ÏfiÁÔ˜ Ô˘ Ë Û˘ÁÎÂÎÚÈ̤ÓË ÌÂϤÙË ÔÓfiÌ·Û ÙËÓ ·Ú·¿Óˆ ‰È·‰Èηۛ· ·Ó¿Ù˘Í˘ ·ÏÏÂÚÁÈÒÓ ÏfiÁˆ ·ÛÙÈÎÔÔ›ËÛ˘, “·ÓÙ›ÛÙÚÔÊË ÂÚ›ÙˆÛË ·ÓÔÛÔıÂÚ·›·˜” (15). ∆Ô ·Ú¿‰ÂÈÁÌ· Ù˘ ÚÒËÓ ∞Ó·ÙÔÏÈ΋˜ °ÂÚÌ·Ó›·˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› Â›Û˘ ·fi ÔÏÏÔ‡˜ ÂÚ¢ÓËÙ¤˜. √ ÏfiÁÔ˜ Â›Ó·È fiÙÈ Ë Âӈ̤ÓË °ÂÚÌ·Ó›· ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ÁÂÓÂÙÈο ·ÚfiÌÔÈÔ˘˜ ÏËı˘ÛÌÔ‡˜, Ô˘ fï˜ ÂÎÙ¤ıËÎ·Ó Û ·ÏÏÂÚÁÈÔÁfiÓ· Û ‰È·ÊÔÚÂÙÈÎfi ‚·ıÌfi ÚÈÓ ·fi ÙËÓ ÂÓÔÔ›ËÛË. √ ‚·ıÌfi˜ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ Ô˘ ÂÎÙÈÌ‹ıËΠ·fi ‰ÂÚÌ·-

ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Ó˘ÁÌÔ‡ (skin prick tests) ‹Ù·Ó ¯·ÌËÏfiÙÂÚÔ˜ ÛÙËÓ ∞Ó·ÙÔÏÈ΋ Û ۇÁÎÚÈÛË Ì ÙË ¢˘ÙÈ΋ °ÂÚÌ·Ó›·. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, Ë Â›ÙˆÛË Ù˘ ·ÏÏÂÚÁÈ΋˜ ÚÈÓ›Ùȉ·˜, ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓË Û fiÏÂȘ Ù˘ ∞Ó·ÙÔÏÈ΋˜ °ÂÚÌ·Ó›·˜ ̤۷ Û ϛÁ· ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ÂÓÔÔ›ËÛË. ∞˘Ùfi Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È ÛÙÔÓ ÈÔ “‰˘ÙÈÎfi” ÙÚfiÔ ˙ˆ‹˜ Ô˘ ˘ÈÔıÂÙ‹ıËΠ(6). ªÂϤÙ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ÂηÂÙ›· ÙÔ˘ 1990 ˆÛÙfiÛÔ, ‰ÂÓ ‰Â›¯ÓÔ˘Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ Â›ÙˆÛË .¯. ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹ ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ‚¿ÛÂÈ ÙˆÓ ÙÈÌÒÓ IgE. ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ÚÔ¤Ú¯ÔÓÙ·È ·fi ÌÂϤÙ˜ ÛÙËÓ πÙ·Ï›·, ÙËÓ ∂Ï‚ÂÙ›· Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·. ∏ ÂÍ‹ÁËÛË Ô˘ ‰›ÓÂÙ·È Â›Ó·È fiÙÈ ÂӉ¯Ô̤ӈ˜ Ë ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ Ó· ¤¯ÂÈ ÊÙ¿ÛÂÈ Û ¤Ó· “Ï·Ùfi” (13,20, 22, 23). ™ÙÔ Î˘ÙÙ·ÚÈÎfi Â›‰Ô, Ë ˘fiıÂÛË “˘ÁÈÂÈÓ‹˜” ÌÔÚ› Ó· ÂÍËÁËı› ·fi ÙËÓ ·ÒÏÂÈ· Ù˘ ¯ÚfiÓÈ·˜ ÌÈÎÚԂȷ΋˜ ‰È¤ÁÂÚÛ˘ ÛÙ· ·ÙÙ·Ú· Ù˘ ÂÁÁÂÓÔ‡˜ ·ÓÔÛ›·˜, ̤ۈ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ TLR. OÈ toll-like receptors Â›Ó·È ˘ԉԯ›˜ (̤¯ÚÈ ÛÙÈÁÌ‹˜ ¤¯Ô˘Ó ·Ó·Î·Ï˘Êı› ÙÔ˘Ï¿¯ÈÛÙÔÓ 10) ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ‰ÂÓ‰ÚÈÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·ıÒ˜ Î·È ÙˆÓ ¡∫ (natural killer) ΢ÙÙ¿ÚˆÓ. √È ˘ԉԯ›˜ ·˘ÙÔ› ·ÏÏËÏÂȉÚÔ‡Ó Ì ‰È¿ÊÔÚ· ÙÌ‹Ì·Ù· ÙˆÓ ‚·ÎÙËÚ›ˆÓ Î·È ÙˆÓ ÈÒÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ·. ∞Ó¿ÏÔÁ· Ì ÙÔÓ Ù‡Ô ÙÔ˘ ˘Ô‰Ô¯¤· ·ÏÏ¿ Î·È ÙÔ ÙÌ‹Ì· ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Ô˘ ·ÚÔ˘ÛÈ¿¶·È‰È·ÙÚÈ΋ 2007;70:266-271

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·270

270

∞. ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË

˙ÂÙ·È ÚÔ·ÙÂÈ Î·È Ë ·Ó¿ÏÔÁË ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË, Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È. ∏ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ÊÔÚÙ›Ô˘ Û˘ÓÂ¿ÁÂÙ·È ÂÓ›Û¯˘ÛË Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ Ì¿ÏÏÔÓ ·¿ÓÙËÛ˘ ̤ۈ ÙˆÓ ‚ÔËıËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Th2, Ô˘ ¢ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ ÁÈ· ÙȘ ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ, ·Ú¿ Ù˘ ∆h1 ·¿ÓÙËÛ˘. √ Ì˯·ÓÈÛÌfi˜ Ì ÙÔÓ ÔÔ›Ô ÚÔ·ÙÂÈ ·˘Ù‹ Ë “·ÓÈÛÔÚÚÔ›·” ˘¤Ú Ù˘ ∆h2 ·¿ÓÙËÛ˘ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ›. ¶Èı·ÓfiÓ Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ˘ÂÚ·Ú·ÁˆÁ‹˜ ∆h2 ΢ÙÙ·ÚÔÎÈÓÒÓ ‹ ÌÂȈ̤Ó˘ ‰È¤ÁÂÚÛ˘ ÙˆÓ “Ú˘ıÌÈÛÙÈÎÒÓ” ∆ ΢ÙÙ¿ÚˆÓ (10). ∏ ·¿ÓÙËÛË Th2 Â›Ó·È Ô˘ÛÈ·ÛÙÈο ·ÏÏÂÚÁÈ΋ ·¿ÓÙËÛË ÙÔ˘ ·ÓÔÛÔÏÔÁÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û ¤Ó·Ó “·ıÒÔ ÂÈÛ‚ÔϤ·”, ÙÔ ·ÏÏÂÚÁÈÔÁfiÓÔ, Î·È Â›Ó·È ·ÚfiÌÔÈ· Ì ÙËÓ ·¿ÓÙËÛË Ô˘ ı· ›¯·Ì ÌÂÙ¿ ÙËÓ ÂÈÛ‚ÔÏ‹ ÂÓfi˜ ·Ú·Û›ÙÔ˘ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. ™ÙȘ ‰˘ÙÈΤ˜ ÎÔÈӈӛ˜ Ê·›ÓÂÙ·È fiÙÈ Ë ·¿ÓÙËÛË ·˘Ù‹ ÂÓÂÚÁÔÔÈÂ›Ù·È ·fi ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· Î·È ·˘Ùfi Û˘Ì‚·›ÓÂÈ, Èı·Ófiٷٷ, ÏfiÁˆ ¤ÏÏÂȄ˘ ÈηÓÔ‡ ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈÎÔ‡ ÊÔÚÙ›Ô˘ ·Ú·Û›ÙˆÓ ÛÙȘ Û˘Óı‹Î˜ ‚ÂÏÙȈ̤Ó˘ ˘ÁÈÂÈÓ‹˜. ∞˘Ùfi˜ Â›Ó·È Ô ÏfiÁÔ˜ Ô˘ Ù· ·Ú¿ÛÈÙ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·fi ÔÚÈṲ̂Ó˜ ÌÂϤÙ˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· ·Ó·ÛÙÚÔÊ‹˜ Ù˘ ·ÏÏÂÚÁÈ΋˜ ÚԉȿıÂÛ˘ ÔÚÈÛÌ¤ÓˆÓ ·ÙfiÌˆÓ (14). ™Â ¿ÏϘ ÌÂϤÙ˜, ¤Ó· Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ, ÙÔ ª.vaccae, ¯ÔÚËÁ‹ıËΠ۠ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ Ì ÙË ÌÔÚÊ‹ ·ÓÔÛÔıÂÚ·›·˜, ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ¤Í·ÚÛ˘ Ù˘ ·ÏÏÂÚÁÈ΋˜ ÚÈÓ›Ùȉ·˜ Û ÌÈ· ÚÔÛ¿ıÂÈ· ÂϤÁ¯Ô˘ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ (16). ∆· ·ÔÙÂϤÛÌ·Ù· ·˘ÙÒÓ ÙˆÓ ÂÚ¢ÓÒÓ Â›Ó·È Û Ôχ ÚÒÈÌÔ ÛÙ¿‰ÈÔ, fï˜ ‰È·Ê·›ÓÂÙ·È fiÙÈ ›Ûˆ˜ Ë ˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ Ó¤Â˜ ÛÙÚ·ÙËÁÈΤ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ·Ú·ÙËÚÔ‡ÌÂÓ˘ ·‡ÍËÛ˘ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛˆÓ.

™˘Ì¤Ú·ÛÌ· ∆· ÎÏ·ÛÈο ·ÏÏÂÚÁÈο ÓÔÛ‹Ì·Ù· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·‡ÍËÛË Ô˘ ηٷ‰ÂÈÎÓ‡ÂÙ·È ·fi ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ Ô˘ ‰ÈÂÍ¿ÁÔÓÙ·È Û ·ÁÎfiÛÌÈÔ Â›‰Ô. √È ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ÎÔÚ˘Ê‹ ÙˆÓ ·˘ÍËÙÈÎÒÓ Ù¿ÛˆÓ, ·ÏÏ¿ Î·È ÔÈ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ‰˘ÙÈÎfi ÌÔÓÙ¤ÏÔ ˙ˆ‹˜ ·ÎÔÏÔ˘ıÔ‡Ó Ì ÛËÌ·ÓÙÈο ÔÛÔÛÙ¿. ¢È·ÊÔÚ¤˜ ÛÙ· ÔÛÔÛÙ¿ ÂΉ‹ÏˆÛ˘ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÌfiÓÔ ÛÙ· ·È‰È¿ ·Ó¿ÌÂÛ· ÛÙȘ ‰ÂηÂٛ˜. ∞‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙËÓ ÂÔ¯‹ Ì·˜ ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔÓ ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi. ∆Ô ¿ÏÏÔ ÛËÌ·ÓÙÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙȘ ̤Ú˜ Ì·˜ Â›Ó·È Ë “ÔÏ˘Û˘ÛÙËÌ·ÙÈÎfiÙËÙ·” Ì ÙËÓ ÔÔ›· ÂΉËÏÒÓÔÓÙ·È. √È ·Èٛ˜ Ô˘ ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙȘ ̤Ú˜ Ì·˜ Â›Ó·È ·ÎfiÌ· ·ÓÙÈΛÌÂÓÔ ¤Ú¢ӷ˜. ∏ “˘fiıÂÛË ˘ÁÈÂÈÓ‹˜” ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ˆ˜ ÌÔÓÙ¤ÏÔ ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ ÌÂϤÙË ÙÔ˘˜ Û ÂȉËÌÈÔÏÔÁÈÎfi Î·È ·ÓÔÛÔÏÔÁÈÎfi Â›‰Ô, Ì ÂӉȷʤÚÔÓÙ· ·ÔÙÂϤÛÌ·Ù· ˆ˜ ÚÔ˜ ÙÔÓ ÚfiÏÔ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ, ÙˆÓ ‰È·ÊfiÚˆÓ ˘Ô‰Ô¯¤ˆÓ Î·È ÙÔ˘ ÌÈÎÚÔ‚È·ÎÔ‡ ÊÔÚÙ›Ô˘, ÛÙÔ ÔÔ›Ô ÂÎÙ›ıÂÓÙ·È ‰È¿ÊÔÚÔÈ ÏËı˘ÛÌÔ›. ∂›Ó·È ÛËÌ·ÓÙÈÎfi ÔÈ ·ÛıÂÓ›˜ Ì ·ÏÏÂÚÁ›Â˜ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·fi È·ÙÚÔ‡˜ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜, ÌÈ·˜ Î·È ÛÙȘ ̤Ú˜ Ì·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó‹ıˆ˜ ‚·Ú‡ÙÂÚ˜ ÂΉËÏÒÛÂȘ, Û Paediatriki 2007;70:266-271

ÔÏÏ¿ Û˘ÛÙ‹Ì·Ù·. ∂Ô̤ӈ˜, ¯ÚÂÈ¿˙ÔÓÙ·È ÚÔÛÂÎÙÈ΋ ‰ÈÂÚ‡ÓËÛË Î·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË.

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Quiz 1. À„ËÏfiÙÂÚÔ˜ ÂÙ‹ÛÈÔ˜ ÂÈÔÏ·ÛÌfi˜ Û ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÙÔÈΤ˜ ·ı‹ÛÂȘ Ù·˘Ùfi¯ÚÔÓ· Û˘Ó·ÓٿٷÈ: ·. ™Â ¯ÒÚ˜ Ù˘ ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋˜ ∞Û›·˜ ‚. ™ÙË ª. µÚÂÙ·Ó›· Á. ™Â ¯ÒÚ˜ Ù˘ ∫ÂÓÙÚÈ΋˜ ∂˘ÚÒ˘ ‰. ™ÙËÓ ∂ÏÏ¿‰· 2. ¶ÔÈ· ·fi ÙȘ ·Ú·Î¿Ùˆ ‰È·Ù˘ÒÛÂȘ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙËÓ “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜”; ·. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ÛÙȘ ̤Ú˜ Ì·˜ ÔÊ›ÏÂÙ·È ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÓıËÎÒÓ ˘ÁÈÂÈÓ‹˜ ÛÙÔ ÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ‚. ∏ Â›ÙˆÛË Ù˘ ·ÏÏÂÚÁÈ΋˜ ÚÈÓ›Ùȉ·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ Î·È Ù˘ ÛÂÈÚ¿˜ Á¤ÓÓËÛ˘ Á. ∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÒÓ ÔÊ›ÏÂÙ·È ÌÂٷ͇ ¿ÏÏˆÓ Û ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ Î·È ÎÏÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰. ∆Ô ·ÛÙÈÎÔÔÈË̤ÓÔ ÌÔÓÙ¤ÏÔ ˙ˆ‹˜ Î·È ‰È·ÙÚÔÊ‹˜ Û˘Ì‚¿ÏÏÂÈ Â›Û˘ ÛÙËÓ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ 3. ™ÙÔ ÎÏ·ÛÈÎfi ÌÔÓÙ¤ÏÔ “·ÙÔÈ΋˜ ·Ú¤Ï·Û˘” (atopic marching), Ë ·ÏÏËÏÔ˘¯›· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ·ÙÔÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È: ·. ∆ÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜-¤Î˙ÂÌ·-¿ÛıÌ·-·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· ‚. ŒÎ˙ÂÌ·-ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜-¿ÛıÌ·-·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· Á. ŒÎ˙ÂÌ·-¿ÛıÌ·-ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜-·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· ‰. ∞ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·-¤Î˙ÂÌ·-¿ÛıÌ·-ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜ 4. √È ·Ú·Î¿Ùˆ ΢ÙÙ·ÚÔΛÓ˜ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ Ù‡Ô˘ Th2 ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÎÒÓ ÂΉËÏÒÛˆÓ, ÂÎÙfi˜ ·fi ÙËÓ: ·. INF- Á ‚. IL-4 Á. IL-5 ‰. IL-13 5. ∞‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ·Ú·ÙËÚ›ٷÈ: ·. ™Â ¯ÒÚ˜ Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘ÈÔı¤ÙËÛ·Ó ÙÔ “‰˘ÙÈÎfi” ÌÔÓÙ¤ÏÔ ˙ˆ‹˜ ‚. ™Â ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ÈÔ ËÏÈÎȈ̤ÓÔ˘˜ Á. ™Â ·ÓıÚÒÔ˘˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Û ۇÁÎÚÈÛË Ì ÙȘ ÚÔ¯ˆÚË̤Ó˜ ËÏÈ˘ Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ÂηÂٛ˜ ‰. ™Â fiϘ ÙȘ ·Ú·¿Óˆ ÂÚÈÙÒÛÂȘ

√È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÛÙË ÛÂÏ›‰· 292 ¶·È‰È·ÙÚÈ΋ 2007;70:266-271

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1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏ˘ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜ - √ÁÎÔÏÔÁ›·˜, ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ 3 ∫ÏÈÓÈ΋ ¶·ıÔÏÔÁÈ΋˜ √ÁÎÔÏÔÁ›·˜, ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏ˘ AÏÏËÏÔÁÚ·Ê›·: ¶·Ó·ÁÈÒÙ˘ §¿ÈÔ˜ panoslaios@gmail.com ª·˘ÚÔÎÔÚ‰¿ÙÔ˘ 15 ∆.∫. 681 00, ∞ÏÂÍ·Ó‰ÚÔ‡ÔÏË

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ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜: ÚÔÛٷهÂÈ ÙÂÏÈο Î·È ·fi ÓÂÔϷۛ˜; ¢. ª·Ùı·›Ô˜3, ∂. ª·ÓÙ·‰¿Î˘2, ¶. §¿ÈÔ˜1, ™. ∫·ÎÔχÚ˘3, ∞. ÷Ù˙ËÌȯ·‹Ï1 ¶ÂÚ›ÏË„Ë: ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚȤ¯ÂÈ Ô˘Û›Â˜ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ‚Ú¤ÊÔ˜ ·fi ÏÔÈÌÒÍÂȘ Î·È ‚ÔËıÔ‡Ó ÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. ∂Âȉ‹ Ë √§§, Ë Û˘¯ÓfiÙÂÚË ÓÂÔÏ·Û›· ÛÙ· ·È‰È¿ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ηı˘ÛÙÂÚË̤ÓË ¤ÎıÂÛË Û ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ, ˘¿Ú¯ÂÈ Ë ¿Ô„Ë fiÙÈ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ı· ÌÔÚÔ‡Û ӷ ÌÂÙ·‚¿ÏÂÈ ÙËÓ Â›ÙˆÛ‹ Ù˘ ̤ۈ ÚÔʇϷ͢ ·fi ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÚ¢ӋÛÔ˘Ì ·Ó fiÓÙˆ˜ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ·ÛΛ ÚÔÛٷ٢ÙÈ΋ Â›‰Ú·ÛË ¤Ó·ÓÙÈ Ù˘ √§§, ·ÏÏ¿ Î·È ¿ÏÏˆÓ ÓÂÔÏ·ÛÈÒÓ Ù˘ ·È‰È΋˜ Î·È ÂÓ‹ÏÈ΢ ˙ˆ‹˜, ÚÔ‚‹Î·Ì Û ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙËÓ Medline ÌÂٷ͇ 1948-2006, ηıÒ˜ Î·È ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ÙÔ˘˜ ·Ó·ÊÔÚÒÓ. ∏ Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ Â›Ó·È ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ, ·ÚÎÂÙ¤˜ Ì ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ, ÂÓÒ Û ÔÏϤ˜ ‰ÂÓ ˘¿Ú¯ÂÈ Â·Ú΋˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘Ó˘¿Ú¯Ô˘Û˜ ÌÂÙ·‚ÏËÙ¤˜. ¢‡Ô ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂÙ··Ó·Ï‡ÛÂȘ ÙˆÓ ·Ú·¿Óˆ ÌÂÏÂÙÒÓ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ıËÏ¿˙Ô˘Ó ı· ÌÔÚÔ‡Û ÛÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË Ó· ÌÂÈÒÛÂÈ ÙÔÓ ·ÚÈıÌfi Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÔÍ›·˜ Ï¢¯·ÈÌ›·˜ ‹ ÏÂÌÊÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ ηٿ 5%, ÂÓÒ ıÂÙÈ΋ Â›‰Ú·ÛË ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ‚Ú¤ıËΠÌfiÓÔ ÁÈ· ÙÔÓ ÚÔÂÌÌËÓÔ·˘ÛÈ·Îfi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡. ™˘ÌÂÚ·ÛÌ·ÙÈο, ··ÈÙÔ‡ÓÙ·È Î·Ï‡ÙÂÚ· ۯ‰ȷṲ̂Ó˜, Ì·ÎÚÔ¯ÚfiÓȘ, ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÛÙÔ Ì¤ÏÏÔÓ, Ô˘ Ó· Ï·Ì‚¿ÓÔ˘Ó ˘fi„Ë ‰È¿ÊÔÚÔ˘˜ ÂÈ̤ÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÒÛÙ ӷ ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜ Ù˘¯fiÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË ÓÂÔÏ·ÛÈÒÓ. ∞Ó Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙȘ ÌÂϤÙ˜ ·˘Ù¤˜ Â›Ó·È ıÂÙÈο, ÔÈ ·È‰›·ÙÚÔÈ ·ÏÏ¿ Î·È Ë ÎÔÈÓˆÓ›· ÁÂÓÈÎfiÙÂÚ· ı· ¤¯Ô˘Ó ¤Ó· ·ÎfiÌ· Âȯ›ÚËÌ· ÁÈ· Ó· ÚÔˆı‹ÛÔ˘Ó ÂÓÂÚÁ¿ ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi.

§¤ÍÂȘ ÎÏÂȉȿ: ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ηÚΛÓÔ˜, ·ÓıÚÒÈÓÔ Á¿Ï·, Ï¢¯·ÈÌ›·, ·Ó·ÛÎfiËÛË.

1 Paediatric Department, Alexandroupoli University Hospital 2 Paediatric Haematology Oncology Department, Herakleion University Hospital 3 Internal Oncology Department, Alexandroupoli University Hospital Correspondence: Panagiotis Laios panoslaios@gmail.com 15, Mavrokordatou St. 681 00, Alexandroupoli, Greece

µreastfeeding: does it also protect against neoplasms?

D. Matthaios3, E. Mantadakis2, P.Laios1, S. Kakolyris3, A. Chatzimihail1 Abstract: Human milk contains substances that protect infants against infections and help the maturation of the immune system. Since acute lymphatic leukaemia (ALL), the most common paediatric neoplasm, has been related to delayed exposure to common infections, the opinion has been expressed that breastfeeding could modify its incidence by offering protection against these infections. In order to clarify whether breastfeeding is indeed protective against ALL and other forms of neoplasia in children and adults, a review was made of Medline-indexed papers published between 1948 and 2006, and their references. The vast majority of relevant studies were observational case-control studies, several of which concerned small numbers of patients, and many did not correct adequately for confounding variables.

Two published metanalyses of these studies suggest that increasing the number of women who breastfeed could at best decrease the incidence of acute leukaemia and lymphoma in children by 5%, while a protective role for adults was seen only for premenopausal breast cancer. In conclusion, better-planned long-term, prospective studies are required, with control for confounding variables, in order to define the role, if any, of breastfeeding in the development of malignancies. If these studies provide positive indications of a protective role, then paediatricians and society will have another reason for actively promoting breastfeeding.

Key words: Breastfeeding, cancer, human milk, leukaemia, review.

™˘ÓÙÔÌÔÁڷʛ˜ ALL HAMLET √§§ ∫¡™

Acute Lymphoblastic Leukemia Human Alpha-Lactalbumin Made LEthal to Tumor cells √Í›· §ÂÌÊÔ‚Ï·ÛÙÈ΋ §Â˘¯·ÈÌ›· ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ·

∂ÈÛ·ÁˆÁ‹ ∏ ¢ÓÔ˚΋ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·Paediatriki 2007;70:272-277

ÛÌÔ‡ ÛÙËÓ ÚfiÏË„Ë Ù˘ ÂÌÊ¿ÓÈÛ˘ ÓÔÛËÌ¿ÙˆÓ ÙfiÛÔ ÛÙË ‚ÚÂÊÈ΋ fiÛÔ Î·È ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¤¯ÂÈ ·Ô‰Âȯı› ·fi ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (1). O ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Â›Ó·È ·ԉ‰ÂÈÁ̤ÓÔ fiÙÈ ÚÔÛٷهÂÈ ·fi ÏÔÈÌÒÍÂȘ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, ˆÙ›Ùȉ˜, ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ¤Î˙ÂÌ·, ‰ÈÂÈÛ‰˘ÙÈΤ˜ ÏÔÈÌÒÍÂȘ (ÌÈÎÚÔ‚È·È̛˜,

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ÌËÓÈÁÁ›Ùȉ˜) Î·È Ô˘ÚÔÏÔÈÌÒÍÂȘ (2-10). ∆· ÓÂÔÁÓ¿ Ô˘ ıËÏ¿˙Ô˘Ó ÂÌÊ·Ó›˙Ô˘Ó Â›Û˘ ·˘ÍË̤ÓË ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË Û ÂÌ‚fiÏÈ· Î·È ÌÂÁ·Ï‡ÙÂÚÔ ı‡ÌÔ ·‰¤Ó· (11,12), ÂÓÒ Ù· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó ÁÈ· ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ·fi 6 Ì‹Ó˜ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË ıÓËÙfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ‰ÂÓ ıËÏ¿˙Ô˘Ó (13). ∆Ô ÌËÙÚÈÎfi Á¿Ï· ·Ú¤¯ÂÈ ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÏÔÈÌÒ͈Ó, ̤ۈ ÙˆÓ ·ÓÙÈۈ̿وÓ, ÏÈȉ›ˆÓ, ÁÏ˘ÎÔÚˆÙÂ˚ÓÒÓ Î·È ¿ÏÏˆÓ ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÚȤ¯ÂÈ (14-16). ¶·Ú¿ÏÏËÏ·, ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· ¤¯Ô˘Ó ‚ÚÂı› ÔÚÌfiÓ˜, ΢ÙÙ·ÚÔΛÓ˜ Î·È ¤Ó˙˘Ì· Ô˘ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎfi ÚfiÏÔ ÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (17). ™‡Ìʈӷ Ì ̛· ÌÂϤÙË, ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÚȤ¯ÂÈ Ï‹ıÔ˜ ·Ú·ÁfiÓÙˆÓ, ÔÏÏÔ› ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌ· Ù·˘ÙÔÔÈËı› Î·È ÔÈ ÔÔ›ÔÈ ‰ÚÔ˘Ó Û ÂÏ¿¯ÈÛÙ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Î·È Û˘¯Ó¿ Û˘ÓÂÚÁÈο (5). ∏ ‰ÈÂÚ‡ÓËÛË Ô˘ÛÈÒÓ, fiˆ˜ ÙÔ Û‡ÌÏÂÁÌ· HAMLET, Ô˘ ÚÔ·ÙÂÈ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ¤¯ÂÈ È‰ÈfiÙËÙ˜ ÂÈÏÂÎÙÈ΋˜ ηٷÛÙÚÔÊ‹˜ ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì¤Ûˆ Â·ÁˆÁ‹˜ Ù˘ ·fiÙˆÛ˘, ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ÌÂϤÙ˘ (18-20). ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÛÙËÓ ÚfiÏË„Ë ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Ë ·¯˘Û·ÚΛ· Î·È Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ÙfiÛÔ ÛÙ· ·È‰È¿ fiÛÔ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (1). ∆ÂÏÂ˘Ù·›·, Ô ÚfiÏÔ˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÛÙËÓ ÚfiÏË„Ë ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ ÓÂÔÏ·Û›·˜ ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ÌÂϤÙ˘. ™ÙËÓ ·ÚÔ‡Û· Û‡ÓÙÔÌË ·Ó·ÛÎfiËÛË ‰ÈÂÚ¢ÓÒÓÙ·È ÔÈ Èı·Ó¤˜ ÂȉڿÛÂȘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÚfiÏË„Ë ‰È·ÊfiÚˆÓ ÓÂÔÏ·ÛÈÒÓ ÙfiÛÔ ÛÙËÓ ·È‰È΋ fiÛÔ Î·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi, Ú·ÁÌ·ÙÔÔÈ‹ıËΠ·Ó·ÛÎfiËÛË ÌÂÏÂÙÒÓ Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙËÓ Medline ÌÂٷ͇ 1948-2006 Î·È ÙˆÓ ·Ó·ÊÔÚÒÓ ÙÔ˘˜. ™˘ÓÔÏÈο, ¤ÁÈÓ ·Ó·ÛÎfiËÛË 41 ÂÚÁ·ÛÈÒÓ Ô˘ Ú·ÁÌ·Ù‡ÔÓÙ·È ÙË Û¯¤ÛË ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È ÂÌÊ¿ÓÈÛ˘ ÓÂÔÏ·ÛÈÒÓ, ÔÈ 26 Û ·È‰È¿ Î·È ÔÈ 15 Û ÂÓ‹ÏÈΘ (21-60). √È ÂÚÁ·Û›Â˜ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Û ‰‡Ô ÌÂٷӷχÛÂȘ Ô˘ ÔÏÔÎÏËÚÒıËÎ·Ó ·fi ÙËÓ ›‰È· ÔÌ¿‰· ÂÚ¢ÓËÙÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ Bristol Î·È ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ St. George ÙÔ˘ §ÔÓ‰›ÓÔ˘ (61,62). ¶ÚÈÓ ·Ó·ÊÂÚıÔ‡ÌÂ, fï˜, ÛÙ· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ·˜ Û˘˙ËÙ‹ÛÔ˘Ì ÂÓ Ù¿¯ÂÈ ÙȘ ·fi„ÂȘ ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ √§§, Ù˘ Û˘¯ÓfiÙÂÚ˘ ·È‰È·ÙÚÈ΋˜ ÓÂÔÏ·Û›·˜.

∞ÈÙÈÔ·ıÔÁ¤ÓÂÛË ·È‰ÈÎÒÓ Ï¢¯·ÈÌÈÒÓ ∞Ó Î·È Ù· ·›ÙÈ· Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ ÌÂÏÂÙÔ‡ÓÙ·È ¿Óˆ ·fi ÌÈÛfi ·ÈÒÓ·, ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌ· ‰È¢ÎÚÈÓÈÛÙ›. ∂›Ó·È fï˜ ۷ʤ˜ fiÙÈ Ë ·È‰È΋ Ï¢-

¯·ÈÌ›· ·ÔÙÂÏ› ÔÏ˘·Ú·ÁÔÓÙÈ΋ ÓfiÛÔ. ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ·Ú¤¯Ô˘Ó ¤ÌÌÂÛ˜ ÂӉ›ÍÂȘ fiÙÈ Ë ÔÍ›· Ï¢¯·ÈÌ›· ÙˆÓ ·È‰ÈÒÓ ¤¯ÂÈ ÂÌ‚Ú˘˚΋ ÚԤϢÛË, ·ÚfiÏÔ Ô˘ Ì›· Ù¤ÙÔÈ· Û˘Û¯¤ÙÈÛË Â›Ó·È ÈÔ ÂÌÊ·Ó‹˜ ÁÈ· ÙËÓ ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· ÙˆÓ ‚ÚÂÊÒÓ ·Ú¿ ÁÈ· ÙËÓ √§§ ÙˆÓ ‚ÚÂÊÒÓ ‹ ÙˆÓ ·È‰ÈÒÓ. °ÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Down, ÙÔ Û‡Ó‰ÚÔÌÔ Bloom, Ë ·Ó·ÈÌ›· Fanconi, Ë ·Ù·Í›·-ÙËÏ·ÁÁÂÈÂÎÙ·Û›·, ·ÏÏ¿ Î·È Ë ¤ÎıÂÛË Û ÈÔÓ›˙Ô˘Û· ·ÎÙÈÓÔ‚ÔÏ›·, ·ÎfiÌ· Î·È Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹, ηıÒ˜ Î·È Ë ¯Ú‹ÛË ¯ËÌÈÎÒÓ, Ê·ÚÌ¿ÎˆÓ ‹ ¯ËÌÂÈÔıÂÚ·›·˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Â›ÙˆÛË ·È‰È΋˜ Ï¢¯·ÈÌ›·˜. ∂ÓÙÔ‡ÙÔȘ, ÙÔ ÔÛÔÛÙfi Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÁÓˆÛÙÔ‡˜ ηÚÎÈÓÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ ‹ ÎÏËÚÔÓÔÌÔ‡ÌÂÓ˜ ÁÂÓÂÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È <5% (63). ∏ Èı·Ó‹ Û˘Û¯¤ÙÈÛË ·È‰ÈÎÒÓ Ï¢¯·ÈÌÈÒÓ Ì ÏÔÈÌÒÍÂȘ Î·È ·ÛÙ˘ÊÈÏ›· ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ÌÂϤÙ˘ ÙÔ˘ Kinlen Â‰Ò Î·È ‰ÂηÂٛ˜ (64-67). ª¿ÏÈÛÙ·, ˘¿Ú¯ÂÈ Ë ¿Ô„Ë fiÙÈ Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ ·fi Ï¢¯·È̛˜ ÛÙ· ·È‰È¿ ηٿ ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ 1950 Î·È 1960 ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙËÓ πÙ·Ï›· Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÛˆÙÂÚÈ΋ ÌÂÙ·Ó¿ÛÙ¢ÛË ·fi ·ÁÚÔÙÈΤ˜ Û ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Ô˘ ÂÈÎÚ·ÙÔ‡Û ÙËÓ ÂÚ›Ô‰Ô ÂΛÓË (67). ∆· ‰Â‰Ô̤ӷ ÈÔÁÂÓÔ‡˜ ηÚÎÈÓÔÁ¤ÓÂÛ˘ Î·È Ï¢¯·ÈÌÈÔÁ¤ÓÂÛ˘ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Â›Ó·È ÔÏÏ¿ (68,69), ·ÏÏ¿ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙÔÓ ·È‰ÈÎfi ηÚΛÓÔ, Ì ÂÍ·›ÚÂÛË ÙÔ ÂÓ‰ËÌÈÎÔ‡ Ù‡Ô˘ ϤÌʈ̷ Burkitt Ô˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û˘¯Ófi ÛÙËÓ ∞ÊÚÈ΋ Î·È ·ԉ‰ÂÈÁ̤ӷ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ Èfi Epstein Barr (69), ·ÏÏ¿ Î·È ÙÔ Ë·ÙÔ΢ÙÙ·ÚÈÎfi ηÚΛӈ̷ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ µ (70). ∞ÈÙÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ˘¿Ú¯ÂÈ Î·È ÌÂٷ͇ ÙÔ˘ ÈÔ‡ Ù˘ Ë·Ù›Ùȉ·˜ C Î·È ÙˆÓ Û¿ÓÈˆÓ ÌË Hodgkin ÏÂÌÊˆÌ¿ÙˆÓ ÙÔ˘ ‹·ÙÔ˜ (71). √ ‚ÚÂÙ·Ófi˜ ·ÓÔÛÔÏfiÁÔ˜ Mel Greaves ‰È·Ù‡ˆÛ ÙËÓ ¿Ô„Ë fiÙÈ Ë ÎÔÈÓ‹ √§§ µ-΢ÙÙ·ÚÈ΋˜ ÚÔ¤Ï¢Û˘, Ë ÈÔ Û˘¯Ó‹ ÌÔÚÊ‹ Ï¢¯·ÈÌ›·˜ ÙˆÓ ·È‰ÈÒÓ, Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ì›·˜ ·ÓÒÌ·Ï˘ ‹ ηı˘ÛÙÂÚË̤Ó˘ ·¿ÓÙËÛ˘ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ Î·È fi¯È ·ÔÙ¤ÏÂÛÌ· Ï¢¯·ÈÌÈÔÁ¤ÓÂÛ˘ ·fi ¤Ó·Ó Û˘ÁÎÂÎÚÈ̤ÓÔ ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ·, Ô˘ Ô‡Ùˆ˜ ‹ ¿Ïψ˜ Ô˘‰¤ÔÙ ¤¯ÂÈ Ù·˘ÙÔÔÈËı› (63,72-74). ŒÓ· ·Ú¯ÈÎfi Ù˘¯·›Ô Û˘Ì‚¿Ó ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰È·›ÚÂÛ˘ ÙˆÓ Úfi‰ÚÔÌˆÓ µ ΢ÙÙ¿ÚˆÓ ÚÈÓ ‹ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ¤Ó· ‰Â‡ÙÂÚÔ Û˘Ì‚¿Ó ÛÙÔÓ ÌÂÙ·ÏÏ·Á̤ÓÔ ÎÏÒÓÔ, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ηı˘ÛÙÂÚË̤Ó˘ ‹ ˘ÂÚ‚ÔÏÈο ·ÓÒÌ·Ï˘ ·ÓoÛÔÏÔÁÈ΋˜ ‰È¤ÁÂÚÛ˘ ηٿ ÙËÓ Â͈̋ÙÚÈÔ ˙ˆ‹, ÌÂ Û˘ÓÂ·ÎfiÏÔ˘ıË ÂÌÊ¿ÓÈÛË Ï¢¯·ÈÌ›·˜. ∆Ô ÚfiÙ˘Ô Î·È Ë ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ ÙˆÓ ÌË ÂȉÈÎÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È Èı·Ófiٷٷ ÔÈ ¶·È‰È·ÙÚÈ΋ 2007;70:272-277

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·274

274

¢. ª·Ùı·›Ô˜ Î·È Û˘Ó.

ϤÔÓ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ï¢¯·ÈÌ›·˜. ¶Ú¿ÁÌ·ÙÈ, ÂȉËÌÈÔÏÔÁÈΤ˜ ¤Ú¢Ó˜ ‰È·›ÛÙˆÛ·Ó fiÙÈ ·È‰È¿ ̠Ϣ¯·ÈÌ›· ‰ÂÓ Â›¯·Ó ÂÎÙÂı› ηٿ ÙËÓ ÚÒÈÌË ‚ÚÂÊÈ΋ ËÏÈΛ· Û ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ Û ۯ¤ÛË Ì ÔÌ¿‰· ÂϤÁ¯Ô˘. ∏ ·˘ÍË̤ÓË Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ Û ÂÚÈÛÛfiÙÂÚÔ ·Ó·Ù˘Á̤Ó˜ ÎÔÈӈӛ˜ Û˘Ì‚·‰›˙ÂÈ Ì ÙË ıˆڛ· ·˘Ù‹ (63,72-74). ∏ Û˘ÏÏÔÁ‹ ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ Û οÚÙ˜ Guthrie Á›ÓÂÙ·È ·Ú·‰ÔÛȷο ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÎÏËÚÔÓÔÌÔ‡ÌÂÓˆÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, fiˆ˜ Ë Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·, ·ÏÏ¿ Û˘Ì‚¿ÏÏÂÈ Î·È ÛÙË ‰ÈÂÚ‡ÓËÛË ¿ÏÏˆÓ ÁÂÓÂÙÈÎÒÓ ·ÏÏ·ÁÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹. ∏ ÁÂÓÂÙÈ΋ Ù·˘ÙÔÔ›ËÛË Û ٤ÙÔȘ οÚÙ˜ Ù˘ ÎÚ˘ÙÈ΋˜ ÌÂÙ¿ÏÏ·Í˘ TEL-AML1, Ù˘ Û˘¯ÓfiÙÂÚ˘ Â›ÎÙËÙ˘ ÌÔÚȷ΋˜ ·ÓˆÌ·Ï›·˜ ·È‰ÈÒÓ Ì √§§, ÂÓÈÛ¯‡ÂÈ ÙËÓ ·Ú·¿Óˆ ıˆڛ· (72,75,76). ¶·ÚfiÏÔ Ô˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÎfiÌ· ·ÚÎÂÙ¿ ‰Â‰Ô̤ӷ, Â›Ó·È Ôχ Èı·Ófi fiÙÈ Ôχ ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ ʤÚÔ˘Ó ÙË ÌÂÙ¿ÏÏ·ÍË TEL-AML1 ·fi fiÛ· ÙÂÏÈο ı· ·Ó·Ù‡ÍÔ˘Ó ÎÔÈÓ‹ √§§, οÙÈ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Ë ÌÂÙ¿ÏÏ·ÍË ·˘Ù‹ ·fi ÌfiÓË Ù˘ ‰ÂÓ ·ÚΛ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ï¢¯·ÈÌ›·˜, ·ÏÏ¿ fiÙÈ ¤Ó· ‰Â‡ÙÂÚÔ ÁÂÁÔÓfi˜, Èı·ÓfiÓ Ë ·ÒÏÂÈ· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ÁÔÓȉ›Ô˘ TEL Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÎÔÈÓ‹˜ √§§ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (72). ∞Ó Ë ıˆڛ· ÙÔ˘ Greaves Â›Ó·È ÛˆÛÙ‹, ÙfiÙ ÔÙȉ‹ÔÙ ÚÔÛٷهÂÈ ÙÔ ·È‰› ·fi ÎÔÈÓ¤˜ ÏÔÈÌÒÍÂȘ ‹ ‚ÔËı¿ÂÈ ÙË ÛˆÛÙ‹ ˆÚ›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ı· ÌÔÚÔ‡Û ӷ ÌÂÈÒÛÂÈ ÙËÓ Â›ÙˆÛË Ù˘ Ï¢¯·ÈÌ›·˜, Ì›·˜ ÓfiÛÔ˘ Ô˘ ηٿ ÙÔÓ Greaves ÌÔÚ› Ó· ·ÔÙÂÏ› ÙÔ Ù›ÌËÌ· Ù˘ ÔÈÎÔÓÔÌÈ΋˜ ·Ó¿Ù˘Í˘ ÙˆÓ ·ÓıÚÒÈÓˆÓ ÎÔÈÓˆÓÈÒÓ (63,72-74). °È· ÙÔ˘˜ ·Ú·¿Óˆ ÏfiÁÔ˘˜ ÂÚÂ˘Ó¿Ù·È Ë ı¤ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÚfiÏË„Ë ÓÂÔÏ·ÛÈÒÓ ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ηıÒ˜ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÂÚȤ¯ÂÈ ÔÈΛÏÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜, ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ Î·È ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ·fi ÏÔÈÌÒÍÂȘ. ∂ȉÈÎfiÙÂÚ·, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËΠÛÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ÌËÙÚÈÎfi Á¿Ï· ÌÔÚ› Ó· ÌÂÈÒÛÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Î·È ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ηٿ ÙË ÓÂÔÁÓÈ΋ Î·È ÌÂÙ¤ÂÈÙ· ˙ˆ‹ ÙÔ˘ ·È‰ÈÔ‡, ̤ۈ ÌÂÙ·ÊÔÚ¿˜ ÌËÙÚÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ì·ÎÚÔÊ¿ÁˆÓ Î·È ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ô˘ ˘¿Ú¯Ô˘Ó ηٷگ‹Ó ÛÙÔ ÚˆÙfiÁ·Ï· Î·È ÌÂÙ¤ÂÈÙ· ÛÙÔ ÒÚÈÌÔ ÌËÙÚÈÎfi Á¿Ï·. ∞˜ ‰Ô‡Ì fï˜ ÂÚÈÏËÙÈο Ù· ˘¿Ú¯ÔÓÙ· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË ·È‰È΋˜ Ï¢¯·ÈÌ›·˜, ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚ· ÓÂÔÏ·ÛÈÒÓ Ù˘ ·È‰È΋˜ Î·È ÂÓ‹ÏÈ΢ ˙ˆ‹˜.

Paediatriki 2007;70:272-277

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔϷۛ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ¶ÚÈÓ ÙÔ 2006, ‰ËÌÔÛȇıËÎ·Ó Û˘ÓÔÏÈο 26 ÌÂϤÙ˜ Ô˘ Ú·ÁÌ·Ù‡ÔÓÙ·È ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÔÏ·ÛÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È Ô˘ ÂÚȤ¯Ô˘Ó ·Ó·ÏÔÁ›· Èı·ÓÔÙ‹ÙˆÓ (odds ratio) ÛÙË ÛÙ·ÙÈÛÙÈ΋ ÙÔ˘˜ ·Ó¿Ï˘ÛË (21-46). √È ÌÂϤÙ˜ ·˘Ù¤˜ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó Û ̛· ÌÂÙ··Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ ÙËÓ ›‰È· ¯ÚÔÓÈ¿, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰Ôı› ·¿ÓÙËÛË ÛÙÔ ÂÚÒÙËÌ· Ù˘ ÂӉ¯fiÌÂÓ˘ Â›‰Ú·Û˘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÓÂÔÏ·ÛÈÒÓ Î·Ù¿ ÙËÓ ·È‰È΋ ËÏÈΛ· (61). √È 24 ·fi ·˘Ù¤˜ ‹Ù·Ó ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ (observational, case-control studies) (21-23,25-28,30-46) Î·È ÌfiÏȘ ‰‡Ô ‹Ù·Ó ÌÂϤÙ˜ ÎÔfiÚÙ˘ (cohort studies) (24,29). ™ÙȘ 6 ÌÂÏÂÙ‹ıËÎÂ Ë Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙȘ Ï¢¯·È̛˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (21,27,33,35,37,42), ÛÙȘ 2 ÛÙȘ Ï¢¯·È̛˜ Î·È Ù· ÏÂÌÊÒÌ·Ù· Hodgkin (46) Î·È ÌË Hodgkin (43), ÛÙȘ 5 ÛÙËÓ √§§ ÌfiÓÔ (22,24,31,38, 45), ÛÙȘ 7 ÛÙȘ ·È‰ÈΤ˜ ÓÂÔϷۛ˜ ÁÂÓÈÎfiÙÂÚ· (13,25,28,34,36,39,44), ÂÓÒ Û Í¯ˆÚÈÛÙ¤˜ ÌÂϤÙ˜ ÂÍÂÙ¿ÛÙËÎ·Ó ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷ (30), ÔÈ ÓÂÔϷۛ˜ ÙÔ˘ ∫¡™ (27), ÔÈ fiÁÎÔÈ ·fi ·Ú¯¤ÁÔÓ· ÁÂÓÓËÙÈο ·ÙÙ·Ú· (26), ÔÈ Ó·ÓÈÎÔ› ÔÛÙÈÎÔ› fiÁÎÔÈ (32) Î·È ÙÔ Ï¤Ìʈ̷ Hodgkin (41). √È ÙÚÂȘ ÌÂÁ·Ï‡ÙÂÚ˜ Î·È ÛÙ·ÙÈÛÙÈο ÏËÚ¤ÛÙÂÚ˜ ÌÂϤÙ˜ ‹Ù·Ó ÂΛÓË ÙÔ˘ ·ÌÂÚÈηÓÈÎÔ‡ Children’s Cancer Group Ì >2.500 ·È‰È¿ Ì ηÚΛÓÔ (33), Ë ‚ÚÂÙ·ÓÈ΋ ÌÂϤÙË U∫ Childhood Cancer Ì >3.000 ·È‰È¿ Ì ηÚΛÓÔ (28) Î·È Ù¤ÏÔ˜ Ë ÌÂϤÙË Ù˘ √ÍÊfiډ˘ (Oxford Survey of Childhood Cancers) Ì >3.000 ·È‰È¿ Ì ηÚΛÓÔ (34). ™Â fiϘ ۯ‰fiÓ ÙȘ ÌÂϤÙ˜ ˘‹Ú¯Â ‰ÈfiÚıˆÛË ÁÈ· ÌÂÙ·‚ÏËÙ¤˜, fiˆ˜ Ë ÌËÙÚÈ΋ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ, ·ÏÏ¿ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·‚ÏËÙ¤˜ Ô˘ Èı·ÓfiÓ ÂËÚ¿˙Ô˘Ó ÙËÓ Â›ÙˆÛË Î·ÚΛÓÔ˘, fiˆ˜ Ë ÎÔÈÓˆÓÈ΋ Ù¿ÍË, Ë ‰È·ÌÔÓ‹, Ô ‚·ıÌfi˜ ·ÛÙÈÎÔÔ›ËÛ˘, Ë ÌËÙÚÈ΋ ÂÎ·›‰Â˘ÛË, ÙÔ ÂÈÛfi‰ËÌ·, ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (·ÚÈıÌfi˜ ·È‰ÈÒÓ) Î·È Ë ¤ÎıÂÛË Û ¯ËÌÈο, ηÓfi ‹ ·ÏÎÔfiÏ, Ô›ÎÈÏ Ôχ ·fi ÌÂϤÙË Û ÌÂϤÙË. ∂›Û˘, Ë Ì¤ıÔ‰Ô˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Ô›ÎÈÏ ÌÂٷ͇ ηْ ȉ›·Ó Û˘Ó¤ÓÙ¢Í˘ ÙˆÓ ÌËÙ¤ÚˆÓ Ì ÙÔÓ ÂÚ¢ÓËÙ‹ (25,28,29,31,34,35,39,43,44, 46), ÙËÏÂʈÓÈÎÒÓ Û˘ÓÂÓÙ‡ÍÂˆÓ Ì ÙÔÓ ÂÚ¢ÓËÙ‹ (30,41), ·Ó·ÛÎfiËÛ˘ È·ÙÚÈÎÒÓ ÈÛÙÔÚÈÎÒÓ (23,36), Î·È Û˘ÌÏ‹ÚˆÛ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Ô˘ Ù·¯˘‰ÚÔÌ‹ıËÎ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ (38,45). ∏ ÌÂÙ··Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ ·È‰È¿ Ô˘ ı‹Ï·Û·Ó ‰È¤ÙÚ¯·Ó ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó √§§ ηٿ 9% (95% fiÚÈ· ÂÌÈÛÙÔÛ‡Ó˘ 2-16%), ϤÌʈ̷ Hodgkin ηٿ 24% (95% fiÚÈ· ÂÌÈÛÙÔÛ‡Ó˘ 3-40%) Î·È Ó¢ÚÔ‚Ï¿Ûو̷ ηٿ 41% (95% fiÚÈ· ÂÌÈÛÙÔÛ‡Ó˘ 22-56%) Ì ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ÂÙÂÚÔÁ¤ÓÂÈ· ·Ó¿ÌÂÛ·

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·275

275

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔϷۛ˜

ÛÙȘ ÌÂϤÙ˜ (61). ŸÌˆ˜, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ù· ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙÔ Ï¤Ìʈ̷ Hodgkin Î·È ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ‰‡Ô ÌfiÓÔ ÌÂϤÙ˜ (41,30), οÙÈ Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Ë Û˘Û¯¤ÙÈÛË ·˘Ù‹ Ú¤ÂÈ Ó· ÂȂ‚·Èˆı› ÛÙÔ Ì¤ÏÏÔÓ Î·È ·fi ¿ÏϘ ÂÚÁ·Û›Â˜. ∫·Ì›· Â›‰Ú·ÛË ‰ÂÓ Ê¿ÓËΠӷ ¤¯ÂÈ Ô ıËÏ·ÛÌfi˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÔÍ›·˜ Ì˘ÂÏÔÁÂÓÔ‡˜ Ï¢¯·ÈÌ›·˜, ÓÂÔÏ·ÛÈÒÓ ÙÔ˘ ∫¡™, fiÁÎˆÓ ·fi ·Ú¯¤ÁÔÓ· ÁÂÓÓËÙÈο ·ÙÙ·Ú· Î·È ÔÛÙÈÎÒÓ ‹ ¿ÏÏˆÓ Û˘Ì·ÁÒÓ fiÁΈÓ. ∏ ÂÎÙ›ÌËÛË ÙˆÓ ‚ÚÂÙ·ÓÒÓ ÂÚ¢ÓËÙÒÓ ‹Ù·Ó fiÙÈ Ë ·‡ÍËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ‰ËÏ·‰‹ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ıËÏ¿˙Ô˘Ó ‹ ¿Ïψ˜ ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ·fi 50% Û 100% ı· ÌÔÚÔ‡Û ÛÙËÓ Î·Ï‡ÙÂÚË ÂÚ›ÙˆÛË Ó· ÌÂÈÒÛÂÈ ÙÔÓ ·ÚÈıÌfi Ó¤ˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÔÍ›·˜ Ï¢¯·ÈÌ›·˜ ‹ ÏÂÌÊÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ ηٿ 5% (61).

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔϷۛ˜ ÌÂÙ¿ ÙËÓ ÂÓËÏÈΛˆÛË H Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË ÓÂÔÏ·ÛÈÒÓ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ¤¯ÂÈ ÌÂÏÂÙËı› ·ÚÎÂÙ¿, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙË ‰ËÌÔÛ›Â˘ÛË ·ÚÎÂÙÒÓ ÌÂÏÂÙÒÓ Ô˘ Ú·ÁÌ·Ù‡ÔÓÙ·È ÙÔ ı¤Ì· (47-60,62). ∏ ÈÔ ÚfiÛÊ·ÙË ·fi ·˘Ù¤˜, ÁÓˆÛÙ‹ Î·È ˆ˜ ÌÂϤÙË Boyd Orr ·ÊÔÚ¿ 4.999 ¿ÙÔÌ· Ô˘ ¤Ï·‚·Ó ·Ú¯Èο ̤ÚÔ˜ ÛÙË ÌÂϤÙË Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô 1937-1939 Û ËÏÈΛ· 0-19 ÂÙÒÓ, ηٿ ÙË ‰È¿ÚÎÂÈ· ‰ËÏ·‰‹ Ù˘ ·È‰È΋˜ Î·È ÂÊË‚È΋˜ ËÏÈΛ·˜ (62). °È· 4.379 ·fi ·˘ÙÔ‡˜, ‰ËÏ·‰‹ ÙÔ 88% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ˘‹Ú¯·Ó ‰È·ı¤ÛÈÌ· ÛÙÔȯ›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·Ó¿Ù˘ÍË ÓÂÔÏ·ÛÈÒÓ ·fi ÙÔ 1948 ˆ˜ ÙÔ 2003. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ·Ó·ÏÔÁ›Â˜ ÎÈÓ‰‡ÓÔ˘ (hazard ratios), ÔÈ ÂÚ¢ÓËÙ¤˜ Ù˘ ÌÂϤÙ˘ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ÚÔÛٷ٢ÙÈ΋ Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ·Ó¿Ù˘ÍË Î·ÚΛÓÔ˘ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (·Ó·ÏÔÁ›· ÎÈÓ‰‡ÓÔ˘ 1,07, 95% fiÚÈ· ÂÌÈÛÙÔÛ‡Ó˘ 0,89-1,28). √È ÓÂÔϷۛ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·Ó Ô Î·ÚΛÓÔ˜ Ì·ÛÙÔ‡, ÚÔÛÙ¿ÙË, ÛÙÔÌ¿¯Ô˘ Î·È Ô ÔÚıÔÎÔÏÈÎfi˜ ηÚΛÓÔ˜ (62). ™ÙËÓ ›‰È· ‰ËÌÔÛ›Â˘ÛË, ÔÈ ÂÚ¢ÓËÙ¤˜ ÚÔ¤‚ËÛ·Ó Î·È Û ̛· ÌÂÙ··Ó¿Ï˘ÛË ÙˆÓ 14 ÚÔÁÂÓ¤ÛÙÂÚˆÓ ÌÂÏÂÙÒÓ Ô˘ ·Û¯ÔÏ‹ıËÎ·Ó Ì ÙÔ ı¤Ì· -Î·È ÔÈ Ôԛ˜ ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ‹Ù·Ó ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ- Î·È Î·Ù¤‰ÂÈÍ·Ó fiÙÈ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ÚÔÛٷهÂÈ ·fi ÙÔÓ ÚÔÂÌÌËÓÔ·˘ÛÈ·Îfi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ 0,88, 95% fiÚÈ· ÂÌÈÛÙÔÛ‡Ó˘ 0,79-0,98), ·ÏÏ¿ fi¯È ·fi ÙÔÓ ÌÂÙÂÌÌËÓÔ·˘ÛÈ·Îfi ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ‹ ¿ÏÏÔ˘˜ ηÚΛÓÔ˘˜ Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜ (62). ∞fi ÙȘ ÌÂϤÙ˜ Ô˘ Û˘ÌÂÚȤϷ‚Â Ë ÌÂÙ··Ó¿Ï˘ÛË ÙˆÓ Martin Î·È Û˘Ó. (62), ÔÈ ÂÙ¿ ÂÚÈÏ¿Ì‚·Ó·Ó ¿Óˆ ·fi 500 ·ÛıÂÓ›˜ Ì ηÚΛÓÔ (49-51,53,54,56,58) Ì ÌÂÁ·Ï‡ÙÂÚË ÙË ÌÂϤÙË ÙˆÓ Titus-Ernstoff Î·È Û˘Ó. Ô˘ ÂÚÈÏ¿Ì‚·Ó 4.008 ·ÛıÂÓ›˜ Ì ‰È¿ÊÔÚ˜ ÓÂÔϷۛ˜ (49). ™ÙÔÓ

·ÓÙ›Ô‰·, ÔÈ ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ ÙˆÓ Tokuhata Î·È Û˘Ó. Û ·ÔÁfiÓÔ˘˜ Á˘Ó·ÈÎÒÓ Ì ηÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ (52) Î·È ÙˆÓ Henderson Î·È Û˘Ó. Û¯ÂÙÈο Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÌÊ¿ÓÈÛË Î·ÚΛÓÔ˘ ÙˆÓ fiÚ¯ÂˆÓ Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ (59) ÂÚÈÏ¿Ì‚·Ó·Ó <80 ·ÛıÂÓ›˜ Î·È ÂÔ̤ӈ˜ ÂÏ¿¯ÈÛÙË ÛÙ·ÙÈÛÙÈ΋ ÈÛ¯‡. °ÂÓÈÎfiÙÂÚ·, Û¯ÔÏÈ¿˙ÔÓÙ·˜ Ù· ‰Â‰Ô̤ӷ ÙfiÛÔ ÁÈ· ÙȘ ·È‰È·ÙÚÈΤ˜ ÓÂÔϷۛ˜ fiÛÔ Î·È ÁÈ· ·˘Ù¤˜ ÙˆÓ ÂÓËϛΈÓ, Â›Ó·È Èı·Ófi Ù˘¯fiÓ Û¯ÂÙÈ΋ Ì›ˆÛË Ù˘ Â›ÙˆÛ˘ Û ۯ¤ÛË Ì ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· fi¯È ·˘ÙÔ‡ ηı’ ·˘ÙÔ‡ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ·ÏÏ¿ ÌÂÙ·‚ÏËÙÒÓ Ô˘ ‰ÂÓ ÂϤÁ¯ıËÎ·Ó ‹ Î·È ·ÔÙ¤ÏÂÛÌ· ÂÈÛ·ÁˆÁ‹˜ ÚÔηٷϋ„ÂˆÓ (bias) ˘¤Ú ÙÔ˘ ıËÏ·ÛÌÔ‡. ∞ÎfiÌ· fï˜ Î·È ·Ó Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Â›Ó·È fiÓÙˆ˜ ÚÔÛٷ٢ÙÈÎfi˜ ¤Ó·ÓÙÈ ÓÂÔÏ·ÛÈÒÓ, Ë ÚÔÛٷ٢ÙÈ΋ ÙÔ˘ Â›‰Ú·ÛË Â›Ó·È Ì¿ÏÏÔÓ ÌÈÎÚ‹ Î·È fi¯È ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÚfiÏ˄˘ ÙÔ˘ ηÚΛÓÔ˘.

™˘ÌÂÚ¿ÛÌ·Ù· ™˘ÌÂÚ·ÛÌ·ÙÈο, Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ÂÎÙfi˜ ÙˆÓ Î·ıÈÂÚˆÌ¤ÓˆÓ ıÂÙÈÎÒÓ ÂȉڿÛÂÒÓ ÙÔ˘ ˆ˜ ÚÔ˜ ÙËÓ ÚfiÏË„Ë ‰È·ÊfiÚˆÓ ÓÔÛËÌ¿ÙˆÓ Î·È ÙË Ì›ˆÛË Ù˘ ‚ÚÂÊÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, Ê·›ÓÂÙ·È fiÙÈ ›Ûˆ˜ ÚÔÛٷهÂÈ Î·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·ÊfiÚˆÓ ÓÂÔÏ·ÛÈÒÓ, ΢ڛˆ˜ Ù˘ ·È‰È΋˜ Ï¢¯·ÈÌ›·˜ Î·È ÙÔ˘ ÚÔÂÌÌËÓÔ·˘ÛÈ·ÎÔ‡ ηÚΛÓÔ˘ ÙÔ˘ Ì·ÛÙÔ‡. ∏ ÂӉ¯fiÌÂÓË fï˜, ÚÔÛٷ٢ÙÈ΋ Â›‰Ú·Û‹ ÙÔ˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È ‹È· Î·È ‰ÂÓ ·Ó·‰ÂÈÎÓ‡ÂÙ·È Û fiϘ ÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜. √È ÙÂÏÂ˘Ù·›Â˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÌÂϤÙ˜ ·Ú·Ù‹ÚËÛ˘ ·ÛıÂÓÒÓ-Ì·ÚÙ‡ÚˆÓ, Ô˘ Û˘¯Ó¿ ‰ÂÓ ÂϤÁ¯Ô˘Ó Â·ÚÎÒ˜ ÁÈ· Û˘Ó˘¿Ú¯Ô˘Û˜ ÌÂÙ·‚ÏËÙ¤˜. ∂›Ó·È ۷ʤ˜ fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ ··ÈÙÔ‡ÓÙ·È Î·Ï‡ÙÂÚ· ۯ‰ȷṲ̂Ó˜, Ì·ÎÚÔ¯ÚfiÓȘ, ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Ô˘ Ó· Ï·Ì‚¿ÓÔ˘Ó ˘fi„Ë ‰È¿ÊÔÚÔ˘˜ Û˘Ó˘¿Ú¯ÔÓÙ˜ ·Ú¿ÁÔÓÙ˜ Î·È Ó· ‰›ÓÔ˘Ó ¤ÌÊ·ÛË ÛÙËÓ ¤Ó·ÚÍË, ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· Î·È ‰È¿ÚÎÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÒÛÙ ٷ Û˘ÌÂÚ¿ÛÌ·Ù· Ó· Â›Ó·È ϤÔÓ Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙ¿. ÕÏψÛÙÂ, Ë Î·ÚÎÈÓÔÁ¤ÓÂÛË Â›Ó·È ¤Ó· ÔÏ˘·Ú·ÁÔÓÙÈÎfi Î·È ÂÍ·ÈÚÂÙÈο ÔχÏÔÎÔ Ê·ÈÓfiÌÂÓÔ, ÙÔ˘ ÔÔ›Ô˘ ÙÔÓ Ì˯·ÓÈÛÌfi ÌfiÏȘ ÚfiÛÊ·Ù· ·Ú¯›˙Ô˘Ì ӷ ·Ó·Î·Ï‡ÙÔ˘ÌÂ. ∞Ó Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙȘ Ӥ˜, ηχÙÂÚ· ۯ‰ȷṲ̂Ó˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ·Í›· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ˆ˜ ÚÔ˜ ÙËÓ ÚfiÏË„Ë ÙÔ˘ ηÚΛÓÔ˘ Â›Ó·È ıÂÙÈο, ÔÈ ·È‰›·ÙÚÔÈ ·ÏÏ¿ Î·È Ë ÎÔÈÓˆÓ›· ÁÂÓÈÎfiÙÂÚ· ı· ¤¯Ô˘Ó ¤Ó· ·ÎfiÌ· Âȯ›ÚËÌ· ÁÈ· Ó· ÚÔˆı‹ÛÔ˘Ó ÂÓÂÚÁ¿ ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. µÈ‚ÏÈÔÁÚ·Ê›· 1. Department of Health and Human Services. HHS Blueprint for Action on Breastfeeding. Washington, DC: Office on Women’s Health; 2000 www.4woman.gov/Breastfeeding/bluprntbk2.pdf. ¶·È‰È·ÙÚÈ΋ 2007;70:272-277

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∞ÓÙÂӉ›ÍÂȘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ekibolos@med.uoc.gr, hritsa@yahoo.gr ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 71 305, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

∂. ÷Ù˙ˉ¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ¶ÂÚ›ÏË„Ë: ∆Ô ÌËÙÚÈÎfi Á¿Ï· ·ÔÙÂÏ› ÙËÓ È‰·ÓÈÎfiÙÂÚË ÙÚÔÊ‹ ÁÈ· Ù· ‚Ú¤ÊË. √ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË Î·È ÙË ÛÔ‚·ÚfiÙËÙ· ÔÏÏÒÓ ÏÔÈÌÒ͈Ó, fiˆ˜ ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ·, ÛË„·ÈÌ›·, Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ̤ÛË ˆÙ›Ùȉ·, Ô˘ÚÔÏԛ̈ÍË, Î·È fi„ÈÌË ÛË„·ÈÌ›·, Û ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ·ÏÏ¿ Î·È ÙË ‚ÚÂÊÈ΋ ıÓËÛÈÌfiÙËÙ·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌËÙ¤Ú·, ÂÚÈÔÚ›˙ÂÈ ÙËÓ ·ÒÏÂÈ· ·›Ì·ÙÔ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ‚ÔËı¿ÂÈ ÛÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ ·ÈÛıËÙÈ΋˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÔÈ ıËÏ¿˙Ô˘Û˜ ÌËÙ¤Ú˜ ¤¯Ô˘Ó ÌÂȈ̤ÓË Â›ÙˆÛË Î·Ù·ÁÌ¿ÙˆÓ ÙÔ˘ ÈÛ¯›Ô˘ Î·È ÔÛÙÂÔfiÚˆÛ˘ ηٿ ÙË ÌÂÙÂÌÌËÓÔ·˘Ûȷ΋ ÂÚ›Ô‰Ô Î·È ÌÈÎÚfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ ·Ó¿Ù˘Í˘ ηÚΛÓÔ˘ Ì·ÛÙÔ‡ Î·È ˆÔıËÎÒÓ. øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂȘ Ô˘ Ë ˘Á›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÚˆÙËÌ·ÙÈο Û¯ÂÙÈο Ì ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡. ∞ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÌËÙÚÈÎfi ıËÏ·ÛÌfi ·ÔÙÂÏ› ÙÔ Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜, fiÔ˘ Ë ¯ÔÚ‹ÁËÛË ÙÚÔÔÔÈË̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰·˜ Â›Ó·È ÂÊÈÎÙ‹ Î·È ‰È·ı¤ÛÈÌË, Ë ¯Ú‹ÛË Ú·‰ÈÔ˚ÛÔÙfiˆÓ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ‹ ıÂÚ·¢ÙÈÎÔ‡˜ ÛÎÔÔ‡˜ ÁÈ· fiÛÔ ‰È¿ÛÙËÌ· ·ÂÎÎÚ›ÓÂÙ·È ÙÔ Ú·‰ÈÔ˚ÛfiÙÔÔ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·, Ë ¯Ú‹ÛË Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ, ·ÓÙÈÌÂÙ·‚ÔÏÈÙÒÓ ‹ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È Ê·Ú̷΢ÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ ·fi ÙË ÌËÙ¤Ú· fiˆ˜ ÌÂÙÚÔÓȉ·˙fiÏË, ÎÏÈÓÙ·Ì˘Î›ÓË, ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË, οÔÈˆÓ ‚-·Ó·ÛÙÔϤˆÓ Î·È „˘¯ÔÙÚfiˆÓ. ∏ Ë·Ù›Ùȉ· µ ÂÊfiÛÔÓ ¯ÔÚËÁËı› ˘ÂÚ¿ÓÔÛË Á-ÛÊ·ÈÚ›ÓË, Î·È ÌÈ· ‰fiÛË ÂÌ‚ÔÏ›Ô˘, ‰ÂÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∏ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ‰ÂÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË, Â¿Ó Ë ÔÚÔÌÂÙ·ÙÚÔ‹ ‰ÂÓ Â›Ó·È ÚfiÛÊ·ÙË Î·È ÙÔ ÓÂÔÁÓfi Â›Ó·È ÙÂÏÂÈfiÌËÓÔ. ∂¿Ó Ë ÌËÙ¤Ú· ¤¯ÂÈ ÂÓÂÚÁfi Ê˘Ì·Ù›ˆÛË, ÙÔ ÓÂÔÁÓfi Ù˘ ·ÔÌ·ÎÚ‡ÓÂÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô Á¿Ï· Ù˘ ÌËÙ¤Ú·˜ ÌÔÚ› Ó· ¯ÔÚËÁÂ›Ù·È ÛÙÔ ÓÂÔÁÓfi ÂÎÙfi˜ Î·È Â¿Ó ˘¿Ú¯ÂÈ Ê˘Ì·ÙÈ҉˘ Ì·ÛÙ›Ùȉ·. §¤ÍÂȘ ÎÏÂȉȿ: ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ÔʤÏË, ·ÓÙÂӉ›ÍÂȘ.

Contraindications to breastfeeding Neonatology Department, University of Crete, Greece Correspondence: Christina Giannakopoulou ekibolos@med.uoc.gr, hritsa@yahoo.gr 37, Atlantidos St., 71 305, Herakleion, Crete, Greece

E. Hatzidaki, C. Giannakopoulou Abstract: Maternal breast milk is the ideal nutrient for infants. There is strong evidence that breastfeeding decreases the incidence and severity of a wide range of infectious diseases, including bacterial meningitis, bacteraemia, diarrhoea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection and late onset sepsis in preterm infants, as well as reducing infant mortality. Benefits for the mother include decreased postpartum bleeding, earlier return to pre-pregnancy weight, decreased risk of breast and ovarian cancer, and lowered risk of hip fractures and osteoporosis in the postmenopausal period. However, there are situations where maternal or neonatal health may be under threat as far as breastfeeding safety is concerned. Breastfeeding is contraindicated for mothers who are infected with human immunodeficiency virus in developed countries where formula preparation is safe, for mothers who are receiving diagnostic or therapeutic radioactive isotopes or who have been exposed to radioactive materials as long as radioactivity is present in their milk, and for mothers who are using narcotics or being administered antimetabolites, chemotherapeutic agents or certain other medications such as metronidazole, clindamycin, chloramphenicol, some beta-blocking agents and psychotropic drugs.

Hepatitis B is not a contraindication to breastfeeding when the infant has received hepatitis B immunoglobulin and the first dose of vaccine soon after birth. Cytomegalovirus infection is not a contraindication to breastfeeding if the conversion is not recent and the infant is full term. Separation of infants immediately after birth is appropriate if their mothers are suffering from active tuberculosis. The only contraindication to using breast milk is when the mother has tuberculosis mastitis.

Key words: Breastfeeding, benefits, contraindications.

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∂ÈÛ·ÁˆÁ‹ ∆Ô ÌËÙÚÈÎfi Á¿Ï· ·ÔÙÂÏ› ·Ó·ÌÊÈÛ‚‹ÙËÙ· ÙËÓ È‰·ÓÈÎfiÙÂÚË ÙÚÔÊ‹ ÁÈ· ÙÔ ‚Ú¤ÊÔ˜ Î·È ·fi ÙfiÙ Ô˘ ÙÔ Á¤ÓÔ˜ ÙˆÓ ·ÓıÚÒˆÓ ÂÌÊ·Ó›ÛÙËΠÛÙË ÁË ·ÔÙ¤ÏÂÛ ÙËÓ ·ÔÎÏÂÈÛÙÈ΋ ÙÚÔÊ‹ ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜. ¶ÂÚȤ¯ÂÈ fiÏ· Ù· ··Ú·›ÙËÙ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο Û ȉ·ÓÈ΋ ·Ó·ÏÔÁ›· ÁÈ· ÙË ÛˆÛÙ‹ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜. ∂›Ó·È ¤Ó· ‰˘Ó·ÌÈÎfi Î·È fi¯È ÛÙ·ÙÈÎfi ÚÔ˚fiÓ Ì Ï‹ıÔ˜ ΢ÙÙ¿ÚˆÓ, ·ÓÙÈۈ̿وÓ, ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ¿ÏÏˆÓ ÂÓÂÚÁÒÓ ‚ÈÔÏÔÁÈÎÒÓ ÛÙÔȯ›ˆÓ Ô˘ ‚ÔËıÔ‡Ó ÛÙËÓ ¿Ì˘Ó· Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Ó¤Ô˘ ÔÚÁ·ÓÈÛÌÔ‡ (1,2). √ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, Û‡Ìʈӷ Ì ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ·Ó·ÊÔÚ¤˜, Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÙË ‚ÚÂÊÈ΋ ıÓËÛÈÌfiÙËÙ· (3), ÙËÓ Â›ÙˆÛË Î·È ÙË ÛÔ‚·ÚfiÙËÙ· ÔÏÏÒÓ ÏÔÈÌÒÍÂˆÓ fiˆ˜ ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· (4), ÛË„·ÈÌ›· (5), Á·ÛÙÚÂÓÙÂÚ›Ùȉ· (6,7), ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (8-10), ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (11), ̤ÛË ˆÙ›Ùȉ· (12), Ô˘ÚÔÏԛ̈ÍË (13), Î·È fi„ÈÌË ÛË„·ÈÌ›·, Û ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (14). ∫¿ÔÈÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó·Ê¤ÚÔ˘Ó ÌÂȈ̤ÓË Â›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (15,16), ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ π Î·È ππ (17,18), ÙˆÓ ÏÂÌʈ̿وÓ, Ù˘ Ï¢¯·ÈÌ›·˜, Ù˘ ÓfiÛÔ˘ Hodgkin (19), Ù˘ ·¯˘Û·ÚΛ·˜ (20-22), Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ (23) Î·È ÙÔ˘ ¿ÛıÌ·ÙÔ˜ (24) Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ Ô˘ ı‹Ï·Û·Ó ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Û ۯ¤ÛË Ì ¿ÙÔÌ· Ô˘ ‰ÂÓ ı‹Ï·Û·Ó. Œ¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› fiÙÈ Ô ıËÏ·ÛÌfi˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÂÏ·ÊÚ¿ ˘ÂÚÔ¯‹ ÛÙËÓ Â›‰ÔÛË Û ‰ÔÎÈ̷ۛ˜ ÓÔËÙÈÎÔ‡ ÂÈ¤‰Ô˘ (25), ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÒ‰˘ÓˆÓ ‰È·‰ÈηÛÈÒÓ fiˆ˜ ·ÈÌÔÏË„›· ·fi ÙË Ù¤ÚÓ· ÙÔ˘ ÓÂÔÁÓÔ‡ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ·Ú¤¯ÂÈ ·Ó·ÏÁËÛ›· ÛÙÔ ÓÂÔÁÓfi (26). √ ıËÏ·ÛÌfi˜ ·Ú¤¯ÂÈ Â›Û˘, ÛËÌ·ÓÙÈο ÔʤÏË ÛÙË ÌËÙ¤Ú·. ¶ÂÚÈÔÚ›˙ÂÈ ÙËÓ ·ÒÏÂÈ· ·›Ì·ÙÔ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Î·È ‚ÔËı¿ÂÈ ÙË Ì‹ÙÚ· Ó· Â·Ó¤ÏıÂÈ ÁÚ‹ÁÔÚ· ÛÙËÓ ·Ú¯È΋ Ù˘ ÌÔÚÊ‹ (27). µÔËı¿ÂÈ ÛÙË ÁÚËÁÔÚfiÙÂÚË Î·Ù·Ó¿ÏˆÛË Ï›Ô˘˜ Î·È ÛÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ ·ÈÛıËÙÈ΋˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙÔ˘ ÛÙ‹ıÔ˘˜ (28), ÂÓÒ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÔÈ ıËÏ¿˙Ô˘Û˜ ÌËÙ¤Ú˜ ¤¯Ô˘Ó ηχÙÂÚË ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·, ÌÂȈ̤ÓË Â›ÙˆÛË Î·Ù·ÁÌ¿ÙˆÓ ÙÔ˘ ÈÛ¯›Ô˘ Î·È ÔÛÙÂÔfiÚˆÛ˘ ηٿ ÙË ÌÂÙÂÌÌËÓÔ·˘Ûȷ΋ ÂÚ›Ô‰Ô (29) Î·È ÌÈÎÚfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ ·Ó¿Ù˘Í˘ ηÚΛÓÔ˘ Ì·ÛÙÔ‡ Î·È ˆÔıËÎÒÓ (30). øÛÙfiÛÔ, ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂȘ Ô˘ Ë Ê˘ÛÈ΋ ηٿÛÙ·ÛË Î·È Ë ˘Á›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘, ‰ËÌÈÔ˘ÚÁÔ‡Ó Î¿ÔÈ· ÂÚˆÙËÌ·ÙÈο ÙfiÛÔ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÛÊ¿ÏÂÈ·, ·ÏÏ¿ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙÔ ‚Ú¤ÊÔ˜. ∆fiÙÂ, fiˆ˜ Â›Ó·È ÏÔÁÈÎfi, ··ÈÙÂ›Ù·È ÚÔÛÂÎÙÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ Ù˘¯fiÓ ·ÔÚÚ¤Ô˘Ó ·fi

ÙË ¯Ú‹ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, Û ۯ¤ÛË Ì ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ fiÊÂÏÔ˜. ™ÎÔfi˜ Ù˘ ·Ó·ÛÎfiËÛ˘ ·˘Ù‹˜ Â›Ó·È Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÔÈ ÙÚ¤¯Ô˘Û˜ ·ÓÙÈÏ‹„ÂȘ Û¯ÂÙÈο Ì ÙȘ Û˘¯ÓfiÙÂÚ˜ ·fi ÙȘ ·ÓÙÂӉ›ÍÂȘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡.

§ÔÈÌÒÍÂȘ Ù˘ ÌËÙ¤Ú·˜ §ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· Ù˘ ÌËÙ¤Ú·˜ Á›ÓÔÓÙ·È Ôχ Û˘¯Ó¿ ·Èٛ˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡ ÁÈ· ÙÔÓ ÂӉ¯fiÌÂÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙÔ ÓÂÔÁÓfi Î·È ÙÔ ‚Ú¤ÊÔ˜, Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙË Û˘Ó¤¯ÈÛË ÙÔ˘ ıËÏ·ÛÌÔ‡. ™Â ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, ÙÔ ÓÂÔÁÓfi ¤¯ÂÈ ‹‰Ë ÂÎÙÂı› ÛÙÔÓ ÏÔÈÌÒ‰Ë ·Ú¿ÁÔÓÙ·. ¢È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ηٿ ÙË Ê¿ÛË Ô˘ ·ÓÙÈÛÒÌ·Ù· Î·È ·ÓÔÛÔÚ˘ıÌÈÛÙÈΤ˜ Ô˘Û›Â˜ ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ‚Ú¤ÊÔ˜ ·fi ÙË Ïԛ̈ÍË ‹ ÂÚÈÔÚ›˙Ô˘Ó ÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘Ìو̿وÓ, Â¿Ó Ë Ïԛ̈ÍË ¤¯ÂÈ ‹‰Ë ÂÁηٷÛÙ·ı›, Ì¿ÏÏÔÓ ‰ÂÓ ˆÊÂÏ›. To ÎÔÈÓfi ÎÚ˘ÔÏfiÁËÌ· Â›Ó·È ·fi Ù· ηχÙÂÚ· ·Ú·‰Â›ÁÌ·Ù· ÓfiÛÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÔ›·˜ Â›Ó·È ÚÔÙÈÌfiÙÂÚË Ë Û˘Ó¤¯ÈÛË ÙÔ˘ ıËÏ·ÛÌÔ‡. §ÔÈÌÒÍÂȘ ÙÔ˘ Ô˘ÚÔÔÈÔÁÂÓÓËÙÈÎÔ‡ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ù˘ ÌËÙ¤Ú·˜ ‰ÂÓ ÂÎı¤ÙÔ˘Ó ÙÔ ‚Ú¤ÊÔ˜ Û ΛӉ˘ÓÔ, ÂÎÙfi˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ¤¯ÂÈ ÂÁηٷÛÙ·ı› ÛË„·ÈÌ›· (31,32). ™‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ √ Èfi˜ ·ÓȯÓ‡ÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÌÂÙ·‰›‰ÂÙ·È ÛÙÔ ÓÂÔÁÓfi Ì ÙÔÓ ıËÏ·ÛÌfi. ™ÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜, fiÔ˘ ˘¿Ú¯Ô˘Ó ‡ÎÔÏ· ‰È·ı¤ÛÈ̘ ËÁ¤˜ Ù¯ÓËÙ‹˜ ‰È·ÙÚÔÊ‹˜, Û˘ÓÈÛÙ¿Ù·È Ë ·ÔÊ˘Á‹ ÙÔ˘ ıËÏ·ÛÌÔ‡, ÂÓÒ ÁÈ· ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ÂÎÙÈÌ¿Ù·È Ô Î›Ó‰˘ÓÔ˜ Ô˘ ·ÔÚÚ¤ÂÈ ·fi ÙË Û›ÙÈÛË ·fi ¿ÏϘ ËÁ¤˜ Î·È Ì¿ÏÏÔÓ ÂÓı·ÚÚ‡ÓÔÓÙ·È ÔÈ ÌËÙ¤Ú˜, ÂÊfiÛÔÓ ‚¤‚·È· Ë Ê˘ÛÈ΋ ÙÔ˘˜ ηٿÛÙ·ÛË ÙÔ ÂÈÙÚ¤ÂÈ, Ó· ıËÏ¿ÛÔ˘Ó Ù· ‚Ú¤ÊË ÙÔ˘˜ (2,31,33). §Ô›ÌˆÍË ·fi ·Ú‚Ô˚fi µ19 ¢ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ ·fi ÙÔ ·ÓıÚÒÈÓÔ ÌËÙÚÈÎfi Á¿Ï·, ·Ó Î·È ¤¯ÂÈ ·ÓȯÓ¢Ù› Û Á¿Ï· ÔÓÙÈÎÔ‡. ¢ÂÓ ÚÔÙ›ÓÂÙ·È Ë ‰È·ÎÔ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (31). §Ô›ÌˆÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi √ Èfi˜ ·ÓȯÓ‡ÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ ‰È·Ï·ÎÔ˘ÓÙȷ΋ ÌÂÙ·ÊÔÚ¿ ÌËÙÚÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡, ÚÔÛٷهÂÈ Ù· ÙÂÏÂÈfiÌËÓ· ‚Ú¤ÊË ÔÚÔıÂÙÈÎÒÓ ÌËÙ¤ÚˆÓ. ªÂÙ¿ ÙË Á¤ÓÓËÛË, ¤ÎıÂÛË ÛÙÔÓ Èfi ‚ÚÂÊÒÓ Ô˘ ‰ÂÓ ‰È·ı¤ÙÔ˘Ó Ù· ÂȉÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡, fiˆ˜ ÚfiˆÚ· ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË ÔÚÔ·ÚÓËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂΉ‹ÏˆÛË ÛÔ‚·Ú‹˜ ÓfiÛÔ˘. £ËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ÔÚÔıÂÙÈÎÒÓ ÌËÙ¤ÚˆÓ ÌÔÚ› Ó· ÂΉËÏÒÛÔ˘Ó Û˘Ìو̷ÙÈ΋ ÓfiÛÔ, Â¿Ó Ë ÔÚÔÌÂÙ·ÙÚÔ‹ Á›ÓÂÈ Î·Ù¿ ¶·È‰È·ÙÚÈ΋ 2007;70:278-284

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·280

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∂. ÷Ù˙ˉ¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

ÙËÓ ÂÚ›Ô‰Ô Ù˘ Á·ÏÔ˘¯›·˜. ∏ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ‰ÂÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË, Â¿Ó Ë ÔÚÔÌÂÙ·ÙÚÔ‹ ‰ÂÓ ¤ÁÈÓ ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ Á·ÏÔ˘¯›·˜ Î·È ÙÔ ÓÂÔÁÓfi Â›Ó·È ÙÂÏÂÈfiÌËÓÔ. øÛÙfiÛÔ, ‰ÂÓ ÈÛ¯‡ÂÈ ÙÔ ›‰ÈÔ ÁÈ· Ù· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÚfiˆÚ· ÓÂÔÁÓ¿ ÔÚÔıÂÙÈÎÒÓ ÌËÙ¤ÚˆÓ. ∏ ·fiÊ·ÛË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÌÂÙ¿ ·fi ÚÔÛÂÎÙÈ΋ ÂÎÙ›ÌËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘, Û ۯ¤ÛË Ì ÙÔ fiÊÂÏÔ˜ ÁÈ· ÙÔ ÓÂÔÁÓfi ·fi ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Î·Ù¿„˘ÍË ‹ ·ÛÙÂÚ›ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÂÚÈÔÚ›˙ÂÈ ÛËÌ·ÓÙÈο ÙÔ È˚Îfi ÊÔÚÙ›Ô ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡ (2,31,34,35). §Ô›ÌˆÍË ·fi ÙÔÓ Èfi ÙÔ˘ ·ÏÔ‡ ¤ÚËÙ· ŒÓ· ˘ÁȤ˜ ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıËΠ·fi ÌËÙ¤Ú· Ì Ïԛ̈ÍË ·fi ÙÔÓ Èfi ÌÔÚ› Ó· ıËÏ¿ÛÂÈ, ÂÎÙfi˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ‚Ï¿‚Ë ÛÙÔÓ Ì·ÛÙfi Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ‚Ï¿‚Ë ÛÙÔÓ Ì·ÛÙfi, Ô ıËÏ·ÛÌfi˜ Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È Ì¤¯ÚÈ Ë ‚Ï¿‚Ë Ó· ÂÍ·Ê·ÓÈÛÙ› (2,31,32,34,36,37). §Ô›ÌˆÍË ·fi ÙÔÓ Èfi Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ ™ÙÔ ÌËÙÚÈÎfi Á¿Ï· ·ÓȯÓ‡ÔÓÙ·È ÙfiÛÔ ÙÔ DNA ÙÔ˘ ÈÔ‡, fiÛÔ Î·È ·ÓÙÈÛÒÌ·Ù· ÂÓ·ÓÙ›ÔÓ ÙÔ˘. ™ÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ Ô˘ Ë ÌËÙ¤Ú· ÂÌÊ·Ó›ÛÂÈ ÙË ÓfiÛÔ, Ô Î›Ó‰˘ÓÔ˜ ÌÂÙ¿‰ÔÛ˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙË ÛÙÂÓ‹ Â·Ê‹ Î·È Â›Ó·È ›‰ÈÔ˜ ÁÈ· ÙÔ ‚Ú¤ÊÔ˜ Ô˘ ıËÏ¿˙ÂÈ ·ÏÏ¿ Î·È ÁÈ· ·˘Ùfi Ô˘ ÛÈÙ›˙ÂÙ·È Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ∞ÔÌ·ÎÚ‡ÓÔ˘Ì ÏÔÈfiÓ ÙÔ ÓÂÔÁÓfi ÁÈ· fiÛÔ ‰È¿ÛÙËÌ· Ë ÌËÙ¤Ú· ÌÂÙ·‰›‰ÂÈ ÙË ÓfiÛÔ, ·Ó Î·È Ë ·ÔÌ¿ÎÚ˘ÓÛË ÌÔÚ› Ó· ÌËÓ ¤¯ÂÈ È‰È·›ÙÂÚÔ ÓfiËÌ·, ηıÒ˜ ÙÔ ÓÂÔÁÓfi ¤¯ÂÈ ÂÎÙÂı› ÛÙË ÓfiÛÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÔ‰ÚÔÌÈÎÔ‡ ÛÙ·‰›Ô˘. ∆Ô Á¿Ï· Ù˘ ÌËÙ¤Ú·˜ ÌÔÚ› Ó· ¯ÔÚËÁÂ›Ù·È ÛÙÔ ‚Ú¤ÊÔ˜, ÂÎÙfi˜ Â¿Ó ˘¿Ú¯Ô˘Ó ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÛÙÔÓ Ì·ÛÙfi. ∏ ÌËÙ¤Ú· ÌÔÚ› Ó· ıËÏ¿ÛÂÈ ÙÔ ÌˆÚfi Ù˘, fiÙ·Ó ‰ÂÓ ¤¯Ô˘Ó ÂÌÊ·ÓÈÛÙ› Ӥ˜ ‚Ï¿‚˜ ÁÈ· 72 ÒÚ˜, ÂÓÒ ÔÈ ˘¿Ú¯Ô˘Û˜ ¤¯Ô˘Ó ÂÊÂÏÎȉÔÔÈËı›, Û˘Ó‹ıˆ˜ 6 Ì 10 ̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÂÍ·Óı‹Ì·ÙÔ˜ (31,32). ∏·Ù›Ùȉ˜ ∏·Ù›Ùȉ· ∞. ªÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· ¤¯ÂÈ ·Ó·ÊÂÚı› Û ̛· ÂÚ›ÙˆÛË. øÛÙfiÛÔ, ‰ÂÓ Â›Ó·È ‚¤‚·ÈÔ fiÛÔ Û˘¯Ó¿ Ô Èfi˜ Ù˘ Ë·Ù›Ùȉ·˜ ∞ ÌÔÚ› Ó· ·ÔÌÔÓˆı› ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ ¤ÎıÂÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÛÙÔÓ Èfi Û˘Ó‹ıˆ˜ ¤¯ÂÈ ‹‰Ë ÚÔËÁËı› Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ÂȂ‚·›ˆÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙË ÌËÙ¤Ú·. ¢ÂÓ ˘¿Ú¯ÂÈ ÏfiÁÔ˜ ‰È·ÎÔ‹˜ ÙÔ˘ ıËÏ·ÛÌÔ‡. ™ÙË ÌËÙ¤Ú· Û˘ÓÈÛÙ¿Ù·È ÙÔ ÚÔÛÂÎÙÈÎfi χÛÈÌÔ ÙˆÓ ¯ÂÚÈÒÓ Î·È Ë ÛˆÛÙ‹ ˘ÁÈÂÈÓ‹, ÁÂÓÈÎfiÙÂÚ·, Î·È ÂÓı·ÚÚ‡ÓÂÙ·È Ó· ıËÏ¿ÛÂÈ ÙÔ ÓÂÔÁÓfi Ù˘ (31,32,34,37).

Paediatriki 2007;70:278-284

∏·Ù›Ùȉ· µ. √ Èfi˜ Ù˘ Ë·Ù›Ùȉ·˜ µ ÚÔηÏ› ÙË Û˘¯ÓfiÙÂÚË Î·È ÛÔ‚·ÚfiÙÂÚË ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË. ∆Ô ·ÓÙÈÁfiÓÔ ÙÔ˘ ÈÔ‡ ·ÓȯÓ‡ÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∆Ô È˚Îfi ÊÔÚÙ›Ô fï˜ Â›Ó·È ÌÈÎÚfi Î·È ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï·. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È ·ÔÊ˘Á‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂÊfiÛÔÓ ¤¯ÂÈ ÚÔËÁËı› Û˘Ó‰˘·Ṳ̂ÓË ÂÓÂÚÁËÙÈ΋ Î·È ·ıËÙÈ΋ ·ÓÔÛÔÔ›ËÛË Ì ˘ÂÚ¿ÓÔÛË Á-ÛÊ·ÈÚ›ÓË Î·È Ì›· ‰fiÛË ÂÌ‚ÔÏ›Ô˘ (31,32,34,37). ∏·Ù›Ùȉ· C. √ Èfi˜ Ù˘ Ë·Ù›Ùȉ·˜ C ÌÂÙ·‰›‰ÂÙ·È Ì ÙËÓ ·ÚÂÓÙÂÚÈ΋ Ô‰fi. ∏ ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ Ì ÙÔÓ ıËÏ·ÛÌfi ‰ÂÓ ¤¯ÂÈ ·Ô‰ÂȯÙ›. ∏ ı¤ÛË ÙÔ˘ Center for Disease Control and Prevention ÙˆÓ ∏¶∞ Â›Ó·È fiÙÈ Ë Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ C ‰ÂÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi, ÂÎÙfi˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ Û˘Ó˘¿Ú¯ÂÈ Ë·ÙÈ΋ ·ÓÂ¿ÚÎÂÈ·. øÛÙfiÛÔ ÈÛÙ‡ÂÙ·È fiÙÈ ıËϤ˜ Ì χÛË Û˘Ó¯›·˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹ ıËϤ˜ Ô˘ ·ÈÌÔÚÚ·ÁÔ‡Ó ÌÔÚ› Ó· ·˘Í‹ÛÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÌÂÙ¿‰ÔÛ˘ (31,32,34,35,37). ∞ÓÂÍ¿ÚÙËÙ· ·fi ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù˘ Ë·Ù›Ùȉ·˜ A, B, ‹ C, Ô ıˆÚËÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÌÂÙ¿‰ÔÛ˘ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· ı· Ú¤ÂÈ Ó· Û˘˙ËÙÂ›Ù·È Ì ÙÔ˘˜ ÁÔÓ›˜, ÔÈ ÔÔ›ÔÈ ı· Ú¤ÂÈ Ó· ·ÔÊ·Û›˙Ô˘Ó ÁÈ· ÙÔ Â›‰Ô˜ Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ (31). §Ô›ÌˆÍË ·fi ¯Ï·Ì‡‰È· ∂ȉÈΤ˜ πgA ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ¤¯Ô˘Ó ·ÓȯÓ¢Ù› ÛÙÔ ‡·Ú Î·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ¢ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ÂӉ¯fiÌÂÓË ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (31). §ÈÛÙÂÚ›ˆÛË ¢ÂÓ ˘¿Ú¯Ô˘Ó ·Ó·ÊÔÚ¤˜ Ô˘ Ó· ÂÓÔ¯ÔÔÈÔ‡Ó ÙÔ ÌËÙÚÈÎfi Á¿Ï· Û·Ó ËÁ‹ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÏÈÛÙ¤ÚÈ·˜. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ıˆÚÂ›Ù·È Î·Ù¿ÏÏËÏË ÙÚÔÊ‹ ÁÈ· ÙÔ ‚Ú¤ÊÔ˜ ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÁÈ· ÙË ıÂÚ·›· Ù˘ ÌËÙ¤Ú·˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÈÙÚ¤ÔÓÙ·È Î·Ù¿ ÙÔÓ ıËÏ·ÛÌfi (31). °ÔÓÔÎÎÔÎÈ΋ Ïԛ̈ÍË ¢ÂÓ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘ ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· (31). ™‡ÊÈÏË ¢ÂÓ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ÁÈ· ÂӉ¯fiÌÂÓË ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ Ì ÙÔÓ ıËÏ·ÛÌfi, ÂÎÙfi˜ ·Ó ˘¿Ú¯Ô˘Ó ÂÓÙÔÈṲ̂Ó˜ ‚Ï¿‚˜ ÛÙÔ Ì·ÛÙfi ‹ ÙË ıËÏ‹, ÔfiÙÂ Ô ıËÏ·ÛÌfi˜ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È, ̤¯ÚÈ Ë ÌËÙ¤Ú· Ó· ¿ÚÂÈ ıÂÚ·›· Î·È Ó· ˘Ô¯ˆÚ‹ÛÔ˘Ó ÔÈ ‚Ï¿‚˜ (31). ∆ÔÍÔÏ¿Û̈ÛË ªÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı›. √È ıËÏ¿˙Ô˘Û˜ ÌËÙ¤Ú˜

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·281

281

ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÓÂÔϷۛ˜

ÚÔÛʤÚÔ˘Ó ÛÙ· ÓÂÔÁÓ¿ ÙÔ˘˜ ÂȉÈο ·ÓÙÈÛÒÌ·Ù· Ì ÙÔ Á¿Ï· ÙÔ˘˜. ¢ÂÓ ˘¿Ú¯ÂÈ ÏÔÈfiÓ Î·Ì›· ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (31,37). º˘Ì·Ù›ˆÛË ™ÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ Ô˘ ˘¿Ú¯ÂÈ ÌfiÓÔ ıÂÙÈ΋ ‰ÂÚÌ·ÙÈ΋ ‰ÔÎÈÌ·Û›· Ê˘Ì·Ù›Ó˘, Ô ıËÏ·ÛÌfi˜ Û˘ÓÈÛÙ¿Ù·È ·ÓÂÈʇϷÎÙ·. ∂¿Ó Ë ÌËÙ¤Ú· ¤¯ÂÈ ÂÓÂÚÁ‹ ÓfiÛÔ, ÙÔ ÓÂÔÁÓfi ·ÔÌ·ÎÚ‡ÓÂÙ·È ·fi ÙË ÌËÙ¤Ú· ÙÔ˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∆Ô Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ‰ÂÓ ·ÔÌÔÓÒÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ ÌËÙ¤Ú· ÌÔÚ› Ó· ·Ê·ÈÚ› ÙÔ Á¿Ï· Ù˘ Ì ·ÓÙÏ›· Î·È Ó· ¯ÔÚËÁÂ›Ù·È ÛÙÔ ÓÂÔÁÓfi Ù˘ ·fi ¿ÏÏÔ ¿ÙÔÌÔ. ∏ ÌfiÓË ·ÓÙ¤Ó‰ÂÈÍË ¯ÔÚ‹ÁËÛ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Â›Ó·È Ë Ê˘Ì·ÙÈ҉˘ Ì·ÛÙ›Ùȉ· Ù˘ ÌËÙ¤Ú·˜. ™ÙËÓ ÂÈÏÔÁ‹ Ù˘ ·ÓÙÈÊ˘Ì·ÙÈ΋˜ ·ÁˆÁ‹˜ ÛÙË ÌËÙ¤Ú· Ï·Ì‚¿ÓÂÙ·È ˘fi„Ë Ë ÂӉ¯fiÌÂÓË ·¤ÎÎÚÈÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÔÈ ÂȉڿÛÂȘ ÛÙËÓ ˘Á›· ÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ·ÔÌ¿ÎÚ˘ÓÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÂÊ·ÚÌfi˙ÂÙ·È Ì¤¯ÚÈ Ó· ·Ô‰Âȯı› fiÙÈ Ë ÌËÙ¤Ú· ‰ÂÓ ÌÂÙ·‰›‰ÂÈ ÙË ÓfiÛÔ (31,32,35,37).

¡ÔÛ‹Ì·Ù· ÌÂÙ·‚ÔÏÈÛÌÔ‡ °·Ï·ÎÙÔ˙·ÈÌ›· ∏ Á·Ï·ÎÙÔ˙·ÈÌ›· Â›Ó·È ÌÈ· ÓfiÛÔ˜ Ô˘ ÔÊ›ÏÂÙ·È Û ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ galactose-1-phosphate uridyl transferase. ™ÙËÓ ÎÏ·ÛÈ΋ Ù˘ ÌÔÚÊ‹ Ë ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ Â›Ó·È Ï‹Ú˘ Î·È ÙÔ ÓÂÔÁÓfi ‰ÂÓ ÌÔÚ› Ó· ·Ó¯Ù› ÙËÓ ·ÚÔ˘Û›· Á·Ï·ÎÙfi˙˘ ÛÙË ‰›·ÈÙ¿ ÙÔ˘, ÂÔ̤ӈ˜ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ‰ÂÓ Â›Ó·È ·ÓÂÎÙfi˜ Î·È ‰ÂÓ ÂÈÙÚ¤ÂÙ·È. À¿Ú¯Ô˘Ó fï˜ Î·È ÌÔÚʤ˜ fiÔ˘ Ë ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ÂÓ˙‡ÌÔ˘ ‰ÂÓ Â›Ó·È Ï‹Ú˘ Î·È Î¿ÔÈ· ÔÛfiÙËÙ· Á·Ï·ÎÙfi˙˘ ÌÔÚ› Ó· Â›Ó·È ·ÓÂÎÙ‹ ·fi ÙÔ ÓÂÔÁÓfi, ÔfiÙÂ Î·È ÙÔ Á¿Ï· Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· Ó· ηχ„ÂÈ ÙÌ‹Ì· ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ÙÔ˘ ·Ó·ÁÎÒÓ (2,31,32,37). º·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ∏ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‰˘Û·ÓÂÍ›· ÛÙË Ê·ÈÓ˘Ï·Ï·Ó›ÓË. ∆Ô ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂÚȤ¯ÂÈ ÌÈÎÚ¿ ÔÛ¿ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘. ∏ ÚÔÛÊÔÚ¿ οÔÈˆÓ ÔÛÔÙ‹ÙˆÓ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ Î·È Ë ÚÔÛı‹ÎË ÂȉÈÎÔ‡ Á¿Ï·ÙÔ˜ ÂχıÂÚÔ˘ Û ʷÈÓ˘Ï·Ï·Ó›ÓË ˆ˜ Û˘ÌÏËڈ̷ÙÈ΋ ‰È·ÙÚÔÊ‹ Â›Ó·È Ë È‰·ÓÈÎfiÙÂÚË Ï‡ÛË (32,37). ¡fiÛÔ˜ Wilson ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ÌËÙ¤Ú· ¿Û¯ÂÈ ·fi ÓfiÛÔ ÙÔ˘ Wilson Ô˘ ÛÙË ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‚Ú›ÛÎÂÙ·È ˘fi ıÂÚ·›· Ì ÂÓÈÎÈÏÏ·Ì›ÓË, Ô ıËÏ·ÛÌfi˜ ‰ÂÓ ÂÈÙÚ¤ÂÙ·È. ∏ ÂÓÈÎÈÏÏ·Ì›ÓË ·ÂÎÎÚ›ÓÂÙ·È ·fi ÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È ÂÎÙfi˜ ·fi ÙÔÓ ¯·ÏÎfi, ‰ÂÛ̇ÂÈ ÙÔ Ì·ÁÓ‹ÛÈÔ Î·È ÙÔÓ Û›‰ËÚÔ (32).

™˘Ó‹ıÂȘ Ù˘ ıËÏ¿˙Ô˘Û·˜ ÌËÙ¤Ú·˜ ¢ÈÔÚıˆÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÙÔ˘ ÛÙ‹ıÔ˘˜ Ì ÛÈÏÈÎfiÓË ∞ÔÙÂÏ› ÌÈ· Û˘Ó‹ıË Ù·ÎÙÈ΋ ÛÙȘ ∏¶∞ fiÔ˘ ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 200.000 ÂÂÌ‚¿ÛÂȘ ÂÙËÛ›ˆ˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. √È ÂÚÈÛÛfiÙÂÚ˜ ·fi ·˘Ù¤˜ Â›Ó·È Û ¤Ê˂˜ Î·È Ó·ڤ˜ ÂÓ‹ÏÈΘ Á˘Ó·›Î˜. ™‡Ìʈӷ Ì ÙËÓ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ ‰ÂÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (38). øÛÙfiÛÔ, ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› ÂÚˆÙËÌ·ÙÈο, ηıÒ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Ô˘ Ó· ÙÂÎÌËÚÈÒÓÔ˘Ó ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (39). ¢È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ∏ ÌËÙ¤Ú· Ì ÙÔ Á¿Ï· Ù˘ ηχÙÂÈ ÙȘ ‰È·ÙÚÔÊÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ù˘, ·Ú¤¯ÔÓÙ¿˜ ÙÔ˘ fiÏ· Ù· ··Ú·›ÙËÙ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο, fiˆ˜ ÚˆÙ½Ó˜, Ï›Ë, ˘‰·Ù¿ÓıڷΘ, ‚Èٷ̛Ә, ȯÓÔÛÙÔȯ›· ÛÙË ÛˆÛÙ‹ ·Ó·ÏÔÁ›· ÁÈ· ÙËÓ ÔÌ·Ï‹ ÙÔ˘ ·Ó¿Ù˘ÍË. À¿Ú¯Ô˘Ó fï˜ ÂÚÈÙÒÛÂȘ ÌËÙ¤ÚˆÓ Ô˘ Ë ‰È·ÙÚÔÊ‹ ÙÔ˘˜ Â›Ó·È ÚÔÛ·ÚÌÔṲ̂ÓË, fi¯È Û‡Ìʈӷ Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘˜, ·ÏÏ¿ Û‡Ìʈӷ Ì ÔÏÈÙÈÛÌÈΤ˜ ‹ ÚÔÛˆÈΤ˜ ÂÔÈı‹ÛÂȘ. ÃÔÚÙÔÊ·Á›·, ·ÔÊ˘Á‹ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ, ˘ÔıÂÚÌȉÈ΋ ‰È·ÙÚÔÊ‹, Â›Ó·È ÌÂÚÈΤ˜ ·fi ·˘Ù¤˜ ÙȘ ηÙËÁÔڛ˜ ‰È·ÈÙËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. √È ÌËÙ¤Ú˜ ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙËÓ ÂӉ¯fiÌÂÓË ‰È·ÈÙËÙÈ΋ ·ÓÂ¿ÚÎÂÈ¿ ÙÔ˘˜ Î·È ÂÓı·ÚÚ‡ÓÔÓÙ·È Ó· ·›ÚÓÔ˘Ó Û˘ÌÏËÚÒÌ·Ù· ‰È·ÙÚÔÊ‹˜ Ì ÛÙfi¯Ô ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÏËÚ¤ÛÙÂÚ˘ ‰È·ÙÚÔÊÈ΋˜ Â¿ÚÎÂÈ·˜ ÛÙÔ ‚Ú¤ÊÔ˜ ÙÔ˘˜ (32,37). ∫¿ÓÈÛÌ· ∆Ô Î¿ÓÈÛÌ· Ù˘ ÌËÙ¤Ú·˜ ‰ÂÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙÔÓ ıËÏ·ÛÌfi, ˆÛÙfiÛÔ Ë ÌËÙ¤Ú· Ú¤ÂÈ Ó· ÂÓı·ÚÚ‡ÓÂÙ·È Ó· ÌËÓ Î·Ó›˙ÂÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡ Î·È Ó· ηٷ‚¿ÏÂÈ Î¿ı ‰˘Ó·Ù‹ ÚÔÛ¿ıÂÈ· Ó· ‰È·Îfi„ÂÈ ÙÔ Î¿ÓÈÛÌ· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ Û‡ÓÙÔÌ· (2,38). ∞ÏÎÔfiÏ √È ıËÏ¿˙Ô˘Û˜ ÌËÙ¤Ú˜ Ú¤ÂÈ Ó· ·ÔʇÁÔ˘Ó ÙË Ï‹„Ë ·ÏÎÔÔÏÔ‡¯ˆÓ ÔÙÒÓ, ÂÂȉ‹ ÙÔ ·ÏÎÔfiÏ Û˘ÁÎÂÓÙÚÒÓÂÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Î·È Ë ¯Ú‹ÛË ÙÔ˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜. ¶ÂÚÈÛÙ·Ûȷ΋ Ï‹„Ë ÂÓfi˜ ÌÈÎÚÔ‡ ·ÏÎÔÔÏÔ‡¯Ô˘ ÔÙÔ‡ Â›Ó·È ·Ô‰ÂÎÙ‹, ·ÏÏ¿ Ô ıËÏ·ÛÌfi˜ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È ÁÈ· 2 ÒÚ˜ ÌÂÙ¿ ·fi ÙË Ï‹„Ë ÙÔ˘ (2,40). ÃÚ‹ÛË Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ ∏ ¯Ú‹ÛË ·fi ÙË ÌËÙ¤Ú· Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ıËÏ·ÛÌfi (2). ¶·È‰È·ÙÚÈ΋ 2007;70:278-284

Pediatri July-Aug 07

09-07-07

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∂. ÷Ù˙ˉ¿ÎË, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

ŒÎıÂÛË ÛÂ Ê˘ÙÔÊ¿Ú̷η Î·È ·Ú·ÛÈÙÔÎÙfiÓ· ™Â ÂÚÈÙÒÛÂȘ ·Û˘Ó‹ıÈÛÙ· ˘„ËÏ‹˜ ÂÚÈ‚·ÏÏÔÓÙÈ΋˜ ÊfiÚÙÈÛ˘ ÔÈ ÌËÙ¤Ú˜ Â›Ó·È ‰˘ÓËÙÈο Û ΛӉ˘ÓÔ. ∫¿ı ÂÚ›ÙˆÛË ÌÂÏÂÙ¿Ù·È Ì ÚÔÛÔ¯‹ (32). ŒÎıÂÛË Û ‚·Ú¤· ̤ٷÏÏ· Œ¯ÂÈ ·Ó·ÊÂÚı› ¤ÎıÂÛË ‚ÚÂÊÒÓ Û ‚·Ú¤· ̤ٷÏÏ· fiˆ˜ ÌfiÏ˘‚‰Ô, ˘‰Ú¿ÚÁ˘ÚÔ, ·ÚÛÂÓÈÎfi, Î·È Î¿‰ÌÈÔ. ∏ ¤ÎıÂÛË ·˘Ù‹ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‰È·ı¤ÛÈÌË ·ÚÔ¯‹ ÓÂÚÔ‡ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÂÚÈÔ¯‹˜, ÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ·ÏÏ¿ Î·È ÙÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. øÛÙfiÛÔ Ë ¤ÎıÂÛË ÁÈ· Ù· ÓÂÔÁÓ¿ Ô˘ ÛÈÙ›˙ÔÓÙ·È Ì ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Û ۯ¤ÛË Ì ÙË Û›ÙÈÛË Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ·ÎfiÌ· Î·È Û ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ Ô˘ ˘¿Ú¯Ô˘Ó ˘„ËÏ¿ Â›‰· ÙÔ˘ ÌÂÙ¿ÏÏÔ˘ (32,37). ªfiÏ˘‚‰Ô˜: √ ÌfiÏ˘‚‰Ô˜ ‰È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ·, Î·È ·ÂÎÎÚ›ÓÂÙ·È Î·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∂¿Ó Ù· Â›‰· ÙÔ˘ ÌÔχ‚‰Ô˘ ÛÙË ÌËÙ¤Ú· Â›Ó·È ÌÈÎÚfiÙÂÚ· ÙˆÓ 40 Ìg/dl, Ô ıËÏ·ÛÌfi˜ ıˆÚÂ›Ù·È ·ÛÊ·Ï‹˜. ∏ ÁÂÓÈÎfiÙÂÚË ÛÙÚ·ÙËÁÈ΋ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ıËÏ·ÛÌfi ÛÙȘ ÂÚÈÙÒÛÂȘ ¤ÎıÂÛ˘ Û ‚·Ú¤· ̤ٷÏÏ· ÂÍ·ÚÙ¿Ù·È ¿ÌÂÛ· ·fi ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ÙË ‰˘Ó·ÙfiÙËÙ¿ Ù˘ Ó· ¯ÔÚËÁ‹ÛÂÈ ÛÙÔ ÓÂÔÁÓfi ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ Ë ÂÚÈ‚·ÏÏÔÓÙÈ΋ ÊfiÚÙÈÛË Â›Ó·È ÌÂÁ¿ÏË Î·È ÙÔ Ù¯ÓËÙ¿ ·Ú·Û΢·˙fiÌÂÓÔ Á¿Ï· ÂÎı¤ÙÂÈ ÙÔ ‚Ú¤ÊÔ˜ Û ÌÂÁ·Ï‡ÙÂÚ· ÔÛ¿ ÌÂÙ¿ÏÏÔ˘ Û ۯ¤ÛË Ì ÙÔ ÌËÙÚÈÎfi (32,37). À‰Ú¿ÚÁ˘ÚÔ˜: ŒÎıÂÛË Û ˘‰Ú¿ÚÁ˘ÚÔ ¤¯ÂÈ ·Ó·ÊÂÚı› Û ԉÔÓÙÈ·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È Ô‰ÔÓÙÈ¿ÙÚÔ˘˜, Î·È ÌÂÙ¿ ·fi ηٷӿψÛË ÌÔÏ˘ÛÌ¤ÓˆÓ ı·Ï·ÛÛÈÓÒÓ Î·È „·ÚÈÒÓ. ªÂϤÙ˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎ·Ó ÛÙ· ÓËÛÈ¿ ™Â¸¯¤ÏϘ Û ·È‰È¿ Ô˘ ÂÎÙ¤ıËÎ·Ó ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Ì¤Ù·ÏÏÔ ÌÂÙ¿ ·fi ηٷӿψÛË ÌÔÏ˘ÛÌ¤ÓˆÓ „·ÚÈÒÓ, ‰ÂÓ ‰È·ÈÛÙÒıËΠΛӉ˘ÓÔ˜ ·fi ÙËÓ ÂÈϤÔÓ ¤ÎıÂÛË Û ÌËÙÚÈÎfi Á¿Ï·. ∏ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ ÂͤÏÈÍË ÙˆÓ ·È‰ÈÒÓ Ô˘ ı‹Ï·˙·Ó ‹Ù·Ó ηχÙÂÚË Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ÛÈÙ›ÛÙËÎ·Ó Ì Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹ (32,37). ∫¿‰ÌÈÔ: ∆Ô Î¿‰ÌÈÔ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ‰È¤Ú¯ÂÙ·È ÙÔÓ Ï·ÎÔ‡ÓÙ·. ŒÎıÂÛË ¤¯ÂÈ ·Ó·ÊÂÚı› Û ‚ÈÔÌ˯·ÓÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û ‚·Ú›˜ ηÓÈÛÙ¤˜. ∆Ô ¤Ì‚Ú˘Ô ¤¯ÂÈ ‹‰Ë ÂÎÙÂı› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∏ ÌËÙ¤Ú· ı· Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÂÙ·È ÁÈ· ÙÔÓ ÂӉ¯fiÌÂÓÔ Î›Ó‰˘ÓÔ ·fi ÙË ¯ÔÚ‹ÁËÛË ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÛÙÔ ‚Ú¤ÊÔ˜ Ù˘ Û ۯ¤ÛË Ì ÙÔ fiÊÂÏÔ˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ. ªÂÚÈÎÔ› ÚÔÙ›ÓÔ˘Ó ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ÌÂÙ¿ÏÏÔ˘ ÛÙÔ ·›Ì· Ù˘ ıËÏ¿˙Ô˘Û·˜ fiÙ·Ó Ë ¤ÎıÂÛË Â›Ó·È ·Û˘Ó‹ıÈÛÙ· ÛËÌ·ÓÙÈ΋ (32,37). ƒ·‰ÈÔÓÔ˘ÎÏÂÔÙ›‰È·: ∏ ÂÚÈ‚·ÏÏÔÓÙÈ΋ ¤ÎıÂÛË Û ڷ‰ÈÔÓÔ˘ÎÏÂÔÙ›‰È· ¤¯ÂÈ ··Û¯ÔÏ‹ÛÂÈ Â› ‰ÂηÂٛ˜ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜. øÛÙfiÛÔ, ÚÔÛÂÎÙÈΤ˜ ÂÎÙÈÌ‹ÛÂȘ Paediatriki 2007;70:278-284

ηٿ ÙË ‰È¿ÚÎÂÈ· ˘ÚËÓÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ·ÔÎ¿Ï˘„·Ó, fiÙÈ Ù· Â›‰· ÙÔ˘ ÛÙÚÔÓÙ›Ô˘ (strontium 90) ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Â›Ó·È ÌÈÎÚfiÙÂÚ· ·fi ·˘Ù¿ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰·˜, ÛÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È ÛÙÔ ÓÂÚfi (32,37).

§‹„Ë Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ ·fi ÙË ÌËÙ¤Ú· ¶ÔÏϤ˜ ÌËÙ¤Ú˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ïԯ›·˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ‰È¿ÊÔÚ· Ê·Ú̷΢ÙÈο Û΢¿ÛÌ·Ù·. ∏ ÁÓÒÛË Ù˘ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋˜ Î·È Ù˘ ‚ÈԉȷıÂÛÈÌfiÙËÙ·˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙË ÌËÙ¤Ú· Î·È ÛÙÔ ÓÂÔÁÓfi, Î·È ÙˆÓ ÂӉ¯fiÌÂÓˆÓ ÂȉڿÛÂˆÓ ÛÙËÓ ˘Á›· ÙÔ˘˜, Â›Ó·È ÚˆÙÂ‡Ô˘Û·˜ ÛËÌ·Û›·˜. À¿Ú¯Ô˘Ó οÔȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ‰ÂÓ Â›Ó·È ·ÛÊ·Ï‹˜. °È· Ó· ÚÔÙ›ÓÔ˘Ì ÙË Û˘Ó¤¯ÈÛË ‹ ÙË ‰È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡, Â›Ó·È ··Ú·›ÙËÙÔ Ó· Û˘ÓÂÎÙÈÌ‹ÛÔ˘Ì ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ·Ó·ÁηÈfiÙËÙ· Ù˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙË ÌËÙ¤Ú·, Ë ‰˘Ó·ÙfiÙËÙ· ·ÓÙÈηٿÛÙ·Û‹˜ ÙÔ˘ Ì Û΢¿ÛÌ·Ù· Ô˘ ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Û ÌÈÎÚfiÙÂÚ˜ ÔÛfiÙËÙ˜ Î·È Ë Ú‡ıÌÈÛË ÙˆÓ ÌÂÛԉȷÛÙËÌ¿ÙˆÓ ¯ÔÚ‹ÁËÛ˘, ¤ÙÛÈ ÒÛÙÂ Ë Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛË ÛÙÔ Ï¿ÛÌ· Ó· ·¤¯ÂÈ ¯ÚÔÓÈο ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚÔ ·fi ÙËÓ ÒÚ· ÙˆÓ ÁÂ˘Ì¿ÙˆÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜. À¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ fiˆ˜, Ï‹„Ë ·Ó·ÈÛıËÛ›·˜ ‹ Ú·‰ÈÔÊ·ÚÌ¿ÎˆÓ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ÏfiÁÔ˘˜, ηٿ ÙȘ Ôԛ˜ ÌÔÚ› Ó· ‰È·ÎÔ› ÚÔÛˆÚÈÓ¿ Ô ıËÏ·ÛÌfi˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ë ÌËÙ¤Ú· Ó· ıËÏ¿˙ÂÈ ÙÔ ‚Ú¤ÊÔ˜ Ù˘ ¯ˆÚ›˜ Úfi‚ÏËÌ· (36,38,41). ™ËÌ·ÓÙÈ΋ Â›Û˘ ·Ú¿ÌÂÙÚÔ ·ÔÙÂÏ› Î·È Ë ËÏÈΛ· ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ıËÏ¿˙ÂÈ. ∆Ô ÓÂÔÁÓfi Î·È ÙÔ ÌÈÎÚfi ‚Ú¤ÊÔ˜ Â›Ó·È ÈÔ Â˘·›ÛıËÙÔ ·fi ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ‚Ú¤ÊÔ˜ ÂÍ·ÈÙ›·˜ Ù˘ ·ÓˆÚÈÌfiÙËÙ·˜ ÙfiÛÔ ÙˆÓ Ì˯·ÓÈÛÌÒÓ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙÔ ‹·Ú, fiÛÔ Î·È Ù˘ ÓÂÊÚÈ΋˜ ·¤ÎÎÚÈÛ˘ (41). ∏ ¯Ú‹ÛË ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·fi ÙË ÌËÙ¤Ú· Î·È Ë ¤ÎıÂÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Û ·ÓÙÈÓÂÔÏ·ÛÌ·ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÛÙË Ê¿ÛË Ô˘ Ë ·Ó¿Ù˘ÍË ÙˆÓ ÈÛÙÒÓ ÙÔ˘ Â›Ó·È Ù·¯‡Ù·ÙË Û›ÁÔ˘Ú· ÚÔ‚ÏËÌ·Ù›˙ÂÈ. ∞Ó Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ Ó· ÙÂÎÌËÚÈÒÓÔ˘Ó Î˘ÙÙ·ÚÈ΋ ‹ ÔÚÁ·ÓÈ΋ ‚Ï¿‚Ë, Ô ıËÏ·ÛÌfi˜ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ÌËÙ¤Ú· Â›Ó·È ˘fi ·ÁˆÁ‹ Ì ·ÓÙÈÌÂÙ·‚Ôϛ٘ ‹ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·ÓÙÂӉ›ÎÓ˘Ù·È. ∏ ¯Ú‹ÛË Ú·‰ÈÔ˚ÛÔÙfiˆÓ ÁÈ· ‰È·ÁÓˆÛÙÈÎÔ‡˜ ‹ ıÂÚ·¢ÙÈÎÔ‡˜ ÛÎÔÔ‡˜ ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ıËÏ·ÛÌfi ÁÈ· fiÛÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·ÂÎÎÚ›ÓÂÙ·È ÙÔ Ú·‰ÈÔ˚ÛfiÙÔÔ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· (2,38,41). ∏ ¯Ú‹ÛË Ù˘ ·ÛÈÚ›Ó˘ ·fi ÙË ıËÏ¿˙Ô˘Û· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÚÔÛÔ¯‹. ªÔÚ› Ó· ÚÔηϤÛÂÈ ‰È·Ù·Ú·¯‹ ÛÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË Î·È ÌÂÙ·‚ÔÏÈ΋ ÔͤˆÛË. ¶ÚÔÙ›ÓÂÙ·È ÛÙȘ ÌËÙ¤Ú˜ Ô˘ ıËÏ¿˙Ô˘Ó Ù· ÓÂÔÁÓ¿ ‹ Ù· Ôχ ÌÈÎÚ¿ ‚Ú¤ÊË ÙÔ˘˜ ηÈ

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·283

283

∞ÓÙÂӉ›ÍÂȘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

¯ÚÂÈ¿˙ÔÓÙ·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ·Ú¿ÁÔÓÙ˜, Ó· ·›ÚÓÔ˘Ó È‚Ô˘ÚÔ˘Ê¤ÓË ‹ Ó·ÚÔͤÓË (38,41,42). ∏ ¯Ú‹ÛË ‚-·Ó·ÛÙÔϤˆÓ ·fi ÙË ÌËÙ¤Ú· ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ˘fiÙ·ÛË, ‚Ú·‰˘Î·Ú‰›· Î·È Ù·¯‡ÓÔÈ· Û ÌÈÎÚ¿ ‚Ú¤ÊË. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ Ë ÛÔÙ·ÏfiÏË Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È, Ë ·ÙÂÓÔÏfiÏË Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ì ÚÔÛÔ¯‹Ø Ë Ï·‚ÂÙ·ÏfiÏË Î·È Ë ÚÔÚ·ÓÔÏfiÏË Â›Ó·È ÁÂÓÈο Û˘Ì‚·Ù¤˜ Ì ÙÔÓ ıËÏ·ÛÌfi Ì ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (38,41,42). ∏ ¯Ú‹ÛË ¯ÏˆÚ·ÌÊÂÓÈÎfiÏ˘ Ú¤ÂÈ Ó· ‰È·ÎfiÙÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÙÔÍÈÎfiÙËÙ·˜ ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ¶ÚÔÙ›ÓÂÙ·È ·Ó·ÌÔÓ‹ 24 ˆÚÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ‰fiÛË ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ıËÏ·ÛÌÔ‡. ∫·È ÁÈ· ÙË ¯Ú‹ÛË Ù˘ ÎÏÈÓÙ·Ì˘Î›Ó˘ ÚÔÙ›ÓÂÙ·È ·ÔÊ˘Á‹ ηٿ ÙÔÓ ıËÏ·ÛÌfi. ¶ÚÔÙ›ÓÂÙ·È ·Ó·ÌÔÓ‹ 24 ˆÚÒÓ ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ‰fiÛË ÚÈÓ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ıËÏ·ÛÌÔ‡. ∞Ó¿ÏÔÁË Ô‰ËÁ›· ·ÔÊ˘Á‹˜ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙË ÌÂÙÚÔÓȉ·˙fiÏË Ì ÚÔÙÂÈÓfiÌÂÓÔ ‰È¿ÛÙËÌ· ·ÔÊ˘Á‹˜ ÙȘ 12 Ì 24 ÒÚ˜ (42). ∞Ó ¤Ó· ‚Ú¤ÊÔ˜ ¤¯ÂÈ ¤ÏÏÂÈ„Ë G6PD, Ë ¯Ú‹ÛË ·fi ÙË ÌËÙ¤Ú· ÙÔ˘ Ó·ÏȉÈÍÈÎÔ‡ ÔͤԘ, ÓÈÙÚÔÊÔ˘Ú·ÓÙÔ˝Ó˘, Î·È ÛÔ˘ÏÊÔÓ·ÌȉÒÓ Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È (34). ∆· „˘¯ÔÙÚfi· Ê·Ú̷΢ÙÈο Û΢¿ÛÌ·Ù· ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï·. ∏ Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÌÔÚ› Ó· Â›Ó·È ¯·ÌËÏ‹ ·ÏÏ¿ Ô ¯ÚfiÓÔ˜ ËÌÈ˙ˆ‹˜ Â›Ó·È ÌÂÁ¿ÏÔ˜. ∏ ¯Ú‹ÛË ÙÔ˘˜ ·fi ÙË ıËÏ¿˙Ô˘Û· ÌËÙ¤Ú· ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ¿ÏÏÔÙ ¿ÏϘ Û˘Ó¤ÂȘ ÁÈ· ÙÔÓ ÂÁΤʷÏÔ ÙˆÓ ‚ÚÂÊÒÓ, Ô˘ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi ·Ó·Ù‡ÛÛÂÙ·È Ì ÁÚ‹ÁÔÚÔ˘˜ Ú˘ıÌÔ‡˜. ∏ ·fiÊ·ÛË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‹ fi¯È ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÌÂÙ¿ ·fi ÂÎÙÂÓ‹ Î·È ÏÂÙÔÌÂÚ‹ Û˘˙‹ÙËÛË ÌÂٷ͇ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ ÁÈ·ÙÚÔ‡ Î·È Ù˘ ÌËÙ¤Ú·˜, Û¯ÂÙÈο Ì ÙȘ ÂӉ¯fiÌÂÓ˜ Û˘Ó¤ÂȘ ÁÈ· ÙÔ ÓÂÔÁÓfi Û ۯ¤ÛË Ì ÙÔ fiÊÂÏÔ˜ ·fi ÙË ¯Ú‹ÛË ÙÔ˘. °ÂÓÈÎfiÙÂÚ·, ÔÈ Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÚÔÙ›ÓÔ˘Ó ÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ Û Ï‹ıÔ˜ Ù¤ÙÔÈˆÓ Û΢·ÛÌ¿ÙˆÓ (38,41). √È Î·Ù¿ÏÔÁÔÈ ÙˆÓ Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Û΢·ÛÌ¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ¿ÛÎËÛË Ù˘ È·ÙÚÈ΋˜ Â›Ó·È ÌÂÁ¿ÏÔÈ. ∫¿ı ÚÔÛ¿ıÂÈ· ·Ó·ÊÔÚ¿˜ Û ηıÂÌ›· Û˘ÁÎÂÎÚÈ̤ÓË Ê·Ú̷΢ÙÈ΋ Ô˘Û›·, ı· ··ÈÙÔ‡Û ÌÂÁ¿ÏË ¤ÎÙ·ÛË Î·È ı· ͤÊ¢Á ÂӉ¯Ô̤ӈ˜ ·fi ÙÔÓ ÛÎÔfi ·˘Ù‹˜ Ù˘ ·Ó·ÛÎfiËÛ˘. ∏ ¢·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ÎÏÈÓÈÎÔ‡, Ë ·Ó·˙‹ÙËÛË Û‡Á¯ÚÔÓˆÓ ÏËÚÔÊÔÚÈÒÓ ·fi ÙÔ ‰È·‰›ÎÙ˘Ô, ‹ ·fi ηٿ ÙÔ ‰˘Ó·ÙfiÓ ÈÔ ÚfiÛÊ·Ù˜ ·Ó·ÊÔÚ¤˜, Û¯ÂÙÈο Ì ÙË ‰˘Ó·ÙfiÙËÙ· ¯Ú‹Û˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ Ê·Ú̷΢ÙÈÎÔ‡ Û΢¿ÛÌ·ÙÔ˜, Ë Û˘ÓÂÎÙ›ÌËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÚԷӷʤÚıËÎ·Ó Î·È Ô Û‚·ÛÌfi˜ Ù˘ ˘Á›·˜ ÙfiÛÔ Ù˘ ÌËÙ¤Ú·˜ fiÛÔ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡ Ù˘, Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙË Ï‹„Ë

·ÔÊ¿ÛÂˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙË Û˘Ó¤¯ÈÛË ‹ ÙË ‰È·ÎÔ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (2,36,38,41). ™ÙȘ Û‡Á¯ÚÔÓ˜ ÎÔÈӈӛ˜ ¤¯Ô˘Ó Â¤ÏıÂÈ ÛËÌ·ÓÙÈΤ˜ ÙÚÔÔÔÈ‹ÛÂȘ ÛÙË ‰ÔÌ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ Á˘Ó·›Î· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ÙÚfiÔ ˙ˆ‹˜, Û˘ÌÌÂÙ¤¯ÂÈ ÂÓÂÚÁ¿ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ‚ÈÔÙÈÎÒÓ fiÚˆÓ, ·Ô˘ÛÈ¿˙ÂÈ ·ÚÎÂÙ¤˜ ÒÚ˜ ·fi ÙÔ Û›ÙÈ Î·È ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔÁ¤ÓÓËÙÔ˘ ·Ó·Ï·Ì‚¿ÓÂÈ Ôχ Û˘¯Ó¿ ÙÚ›ÙÔ ÚfiÛˆÔ. ∏ ¯ÚËÛÈÌÔÔ›ËÛË Ù˘ Ù¯ÓËÙ‹˜ ‰È·ÙÚÔÊ‹˜ Û˘¯Ó¿ ·ÔÙÂÏ› ÙËÓ Â‡ÎÔÏË Ï‡ÛË. ∆· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÁÈ· ÙË ÌËÙ¤Ú·, ÙÔ ÓÂÔÁÓfi, ÙÔ ‚Ú¤ÊÔ˜ Î·È ÙÔÓ ¿ÓıÚˆÔ ÁÂÓÈÎfiÙÂÚ·, Â›Ó·È ÔÏÏ¿ Î·È ÛËÌ·ÓÙÈο. √È ÂÚÈÙÒÛÂȘ Ô˘ Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ‰ÂÓ Â›Ó·È ·ÛÊ·Ï‹˜ ‰ÂÓ Â›Ó·È ÔÏϤ˜, ·ÏÏ¿ Ô Î¿ı ÎÏÈÓÈÎfi˜ Ô˘ ·Û¯ÔÏÂ›Ù·È Ì ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË Ú¤ÂÈ Ó· Â›Ó·È ÂÓ‹ÌÂÚÔ˜. ∆ËÓ ÙÂÏÈ΋ ·fiÊ·ÛË ı· ¿ÚÂÈ Ì·˙› Ì ÙÔ˘˜ ÁÔÓ›˜, ·ÊÔ‡ ÙÔ˘˜ ÂÎı¤ÛÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ·ÔÚÚ¤Ô˘Ó ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ ÁÈ· ÙÔ ÓÂÔÁÓfi ÙÔ˘˜, ¿ÓÙ· Ì ÁÓÒÌÔÓ· ÙÔÓ Û‚·ÛÌfi Ù˘ ˘Á›·˜ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡. ÃÚ¤Ô˜ ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜, ·ÏÏ¿ Î·È Ù˘ ÎÔÈÓˆÓ›·˜ ÁÂÓÈÎfiÙÂÚ·, Â›Ó·È Ë ÚÔ·ÁˆÁ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡. √ ÛÙfi¯Ô˜ ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ÁÈ· ÙÔ 2010 Â›Ó·È Ó· ÊÙ¿ÛÂÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ıËÏ¿˙Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÔ 75%, ÂÎÂ›ÓˆÓ Ô˘ ıËÏ¿˙Ô˘Ó ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 6 Ì‹Ó˜ ÙÔ 50%, ÂÓÒ ·˘ÙÒÓ Ô˘ ıËÏ¿˙Ô˘Ó ÁÈ· ¤Ó· ¯ÚfiÓÔ ÙÔ 25% (2).

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∂›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ∞. ¡ÙÔ˘ÚÓÙÔ‡ÊË1, µ. ÃÔϤ‚·˜3, §. ∫ÔÓÙÔ‡2, ª. ¶·‡ÏÔ˘1, ™. ∞Ó‰ÚÔÓ›ÎÔ˘1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (ª£) ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª·È¢ÙÈ΋ ∫ÏÈÓÈ΋ (ª∫) ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ (¶°¡π) ÂÎÙÈÌ‹ıËΠ·fi ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ˆ˜ Û¯ÂÙÈο ¯·ÌËÏ‹. ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1998 ÂÊ·ÚÌfiÛÙËΠÂÓÙ·ÙÈÎfi ÚfiÁÚ·ÌÌ· ÂÓ›Û¯˘Û˘ Î·È ÚÔÒıËÛ˘ ÙÔ˘ ª£. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËı› Ë Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ª£ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ¤ˆ˜ ÙÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1999 ÌÂÏÂÙ‹ıËÎ·Ó ÚÔ‰ÚÔÌÈο 878 ˙¢Á¿ÚÈ· (ÌËÙ¤Ú· – ÓÂÔÁÓfi), ˆ˜ ÚÔ˜ ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (ª£ ‹ Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹) Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÙËÓ ÂËÚ¿ÛÔ˘Ó. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂÎÙÈÌ‹ıËΠÌÂÙ¿ ·fi ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›·. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÁÎÚ›ıËÎ·Ó Ì ÂΛӷ ·ÚfiÌÔÈ·˜ ÚÔËÁÔ‡ÌÂÓ˘ ÌÂϤÙ˘, Ô˘ ›¯Â Á›ÓÂÈ ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË, ηٿ ÙÔ ¤ÙÔ˜ 1997. ∞ÔÙÂϤÛÌ·Ù·: ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫ (3Ë Ì 7Ë Ë̤ڷ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi) ·˘Í‹ıËΠÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ª£ ·fi 81,9% Û 87% (p<0,01) Î·È ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£ ·fi 38,6% Û 71% (p<0,001). ™ËÌ·ÓÙÈ΋ Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ Î·È ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ·Ú·ÙËÚ‹ıËΠÛÙ· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (µ°) ≥2,5 kg, ÛÙ· ÎÔÚ›ÙÛÈ·, ÛÙ· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi (º∆) Î·È ÛÙ· ÓÂÔÁÓ¿ ÙˆÓ ÌËÙ¤ÚˆÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Î·È Ì ÂÌÂÈÚ›· ª£ ·fi ÚÔËÁÔ‡ÌÂÓ· ·È‰È¿. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ª£ (Û˘ÓÔÏÈÎÔ‡ Î·È ·ÔÎÏÂÈÛÙÈÎÔ‡) ≥6 Ì‹Ó˜ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÂÁ·Ï‡ÙÂÚË (p<0,001) ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ıËÏ·ÛÌÔ‡ ηٿ ÙȘ ÚÒÙ˜ Ë̤Ú˜ ·fi ÙÔÓ ÙÔÎÂÙfi ‚ÔËı¿ÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£, Î·È ÛÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡.

1 ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, 2 ª·È¢ÙÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ 3 ∂ÚÁ·ÛÙ‹ÚÈÔ ÙÔ˘ ∆Ô̤· ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ.

AÏÏËÏÔÁÚ·Ê›·: ∞Á·ı‹ ¡ÙÔ˘ÚÓÙÔ‡ÊË dourdufi@otenet.gr ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ π·ÙÚÈ΋ ™¯ÔÏ‹ ∆Ô̤·˜ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ∆·¯. £˘Ú. 1186 ∆.∫. 451 10, πˆ¿ÓÓÈÓ·

§¤ÍÂȘ ÎÏÂȉȿ: ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, Ú·ÎÙÈΤ˜ ª£.

Effect of a supportive program on breastfeeding A. Ntourntoufi1, V. Cholevas3, L. Kontou2, M. Pavlou1, S. Andronikou1 Abstract Background: The rate of breastfeeding (BF) at discharge from the maternity ward at the University Hospital of Ioannina was estimated to be relatively low in a previous study. From January 1998, BF was actively supported for all neonates delivered at the maternity ward. The aim of the study was to evaluate the effect of a supportive program on the rate of initiation and duration of BF, at discharge from the maternity ward and during the first year of life.

Methods: From January to December 1999, 878 mother-infant couples were studied prospectively regarding the type of feeding of the infant (BF or bottle feeding) and the factors that could have an influence on it. The duration of BF was evaluated by telephone contact. The results of this study were compared to those of a previous similar study which was conducted before the intervention, during the year 1997.

Results: The rate of BF at discharge from the maternity ward (3rd to 7th day after delivery) increased after intervention from 81.9% to 87% for overall BF (p<0.01), and from 38.6% to 71% for exclusive BF (p<0.001). Significant increase of overall and exclusive BF after intervention was noticed in infants with birth weight ≥2.5kg, in girls, in infants born by normal vaginal delivery, in multiparous mothers and mothers of a more mature age. The duration of BF (overall and exclusive) ≥6 months was significantly higher after intervention (p<0.001).

Conclusion: BF policies applied constantly in the maternity ward seem to increase the overall and exclusive BF and the duration of BF ≥6 months.

1 Neonatal Intensive Care Unit 2 Maternity Clinic, University General Hospital of Ioannina 3 Child Health Department Laboratory, University of Ioannina Medical School Correspondence: Agathi Ntourntoufi dourdufi@otenet.gr University of Ioannina Medical School Child Health Department PO Box 1186 451 10, Ioannina, Greece

Key words: Breastfeeding rate, maternity ward routines.

¶·È‰È·ÙÚÈ΋ 2007;70:285-292

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·286

286

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∂ÈÛ·ÁˆÁ‹ ∂ÎÙÂٷ̤ÓË ¤Ú¢ӷ ‰Â›¯ÓÂÈ fiÙÈ ÔÈ Î·ıËÌÂÚÈÓ¤˜ Ú·ÎÙÈΤ˜ Ô˘ ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙȘ ª∫ ¤¯Ô˘Ó ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙËÓ ÂÁηٿÛÙ·ÛË Î·È ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ¤Î‚·ÛË ÙÔ˘ ª£ (1). ™ÙȘ ÛηӉÈÓ·‚ÈΤ˜ ¯ÒÚ˜, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ Â›Ó·È ÌÂÁ¿ÏË (>95%) Û ۇÁÎÚÈÛË Ì ÂΛÓË Û ¿ÏϘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ (24). ∞˘Ùfi Ê·›ÓÂÙ·È ˆ˜ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙȘ ·ÏÏ·Á¤˜ ÙˆÓ Ú·ÎÙÈÎÒÓ ÛÙȘ ª∫ (4). ¶ÔÏÏÔ› ·Ú¿ÁÔÓÙ˜ Ê·›ÓÂÙ·È ˆ˜ ÂËÚ¿˙Ô˘Ó ÙËÓ ¤Ó·ÚÍË Î·È ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ª£. √ÚÈṲ̂ÓÔÈ ·fi ·˘ÙÔ‡˜ ÌÔÚÔ‡Ó ‰˘ÓËÙÈο Ó· ÙÚÔÔÔÈËıÔ‡Ó, fiˆ˜ Ë ÊÚÔÓÙ›‰· ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡ Î·È ÛÙË ª∫ (4). ∏ Û˘¯ÓfiÙËÙ· ¤Ó·Ú͢ ÙÔ˘ ª£ ÛÙË ª∫ ÙÔ˘ ¶°¡π ›¯Â ÂÎÙÈÌËı› ηٿ ÙÔ ¤ÙÔ˜ 1997, Û ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË (ÌË ‰ËÌÔÛÈÂ˘Ì¤Ó· ÛÙÔȯ›·). ∞Ó Î·È Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ (Û˘ÓÔÏÈÎfi˜ ª£, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫ (3Ë Ì 7Ë Ì¤Ú· ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi) ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋ (81,9%), Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ‹Ù·Ó ¯·ÌËÏ‹ (38,6%). ∞fi ÙÔ ¤ÙÔ˜ 1998 Î·È ÌÂÙ¿ ¤ÁÈÓ ÚÔÛ¿ıÂÈ· ÂÓÙ·ÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ ÙˆÓ ÌËÙ¤ÚˆÓ, ÒÛÙ ӷ ηٷʤÚÔ˘Ó Ó· ıËÏ¿ÛÔ˘Ó ÙÔ ÓÂÔÁÓfi ÙÔ˘˜. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËıÔ‡Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÚÔÒıËÛ˘ Î·È ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ª£ Ô˘ ÂÊ·ÚÌfiÛÙËΠÛÙÔ ¶°¡π, Û˘ÁÎÚ›ÓÔÓÙ¿˜ Ù· Ì ÂΛӷ ÚÔËÁÔ‡ÌÂÓ˘ ÌÂϤÙ˘ Ô˘ ‰ÈÂÍ‹¯ıË Î·Ù¿ ÙÔ ¤ÙÔ˜ 1997, fiÔ˘ ‰ÂÓ ˘‹Ú¯Â Ù·ÎÙÈ΋ ÂȉÈ΋˜ ÔÏÈÙÈ΋˜ ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ª£. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆ÔÓ √ÎÙÒ‚ÚÈÔ ÙÔ˘ 1997, ¤Ó·˜ ÓÂÔÁÓÔÏfiÁÔ˜ Î·È ‰‡Ô Ì·›Â˜ ÙÔ˘ ¶°¡π ·Ú·ÎÔÏÔ‡ıËÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· ÂÎ·›‰Â˘Û˘ ÙÔ˘ ª£ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ŒÏÂÓ· µÂÓÈ˙¤ÏÔ˘. ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1998, Ô ª£ ˘ÔÛÙËÚ›¯ıËΠÂÓÙ·ÙÈο ÁÈ· fiÏ· Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ ¶°¡π. ∏ ·Ú¤Ì‚·ÛË ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ “¢¤Î· µËÌ¿ÙˆÓ ÁÈ· ∂ÈÙ˘¯‹ £ËÏ·ÛÌfi” (5). ŒÌÊ·ÛË ‰fiıËΠÛÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙÔ ÛÙ‹ıÔ˜ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘ ÂÓÙfi˜ ÌÈÛ‹˜ Ì ̛· ÒÚ· ·fi ÙÔÓ ÙÔÎÂÙfi, ÛÙË Û˘Ó¯‹ ·Ú·ÌÔÓ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ‰›Ï· ÛÙË ÌËÙ¤Ú· ÙÔ˘ (rooming in), ÛÙË ‚Ô‹ıÂÈ· ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈ· ÙË ÛˆÛÙ‹ ÙÔÔı¤ÙËÛË ÙÔ˘ ̈ÚÔ‡ ÙÔ˘˜ ÛÙÔ ÛÙ‹ıÔ˜, Î·È ÛÙËÓ Ú·ÎÙÈ΋ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÁÂÓÈο (Ô‰ËÁ›Â˜ ÚÔÊÔÚÈΤ˜ Î·È ÁÚ·Ù¤˜).

Paediatriki 2007;70:285-292

∏ ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓË ‚Ô‹ıÂÈ· Î·È Ë ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÌËÙ¤ÚˆÓ ÁÈÓfiÙ·Ó ·fi ÙÔ ÚÔÛˆÈÎfi Ù˘ ª∫ fiÛÔ Û˘¯Ó¿ ¯ÚÂÈ·˙fiÙ·Ó Ì¤¯ÚÈ ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡. ∂›Û˘, ÛÙ· Ï·›ÛÈ· ÙˆÓ Â͈ÙÂÚÈÎÒÓ È·ÙÚ›ˆÓ Ù˘ ¡ÂÔÁÓÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜, ÙËÚ‹ıËÎÂ Û˘Ì‚Ô˘Ï¢ÙÈÎfi È·ÙÚÂ›Ô ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ı‹Ï·˙·Ó, Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·Ó ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ¤ÁÈÓ ·Ó·‰ÚÔÌÈο ·Ó¿Ï˘ÛË 829 ÈÛÙÔÚÈÎÒÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÛÙË ª∫ ÙÔ˘ ¶°¡π ÌÂٷ͇ 1-1-97 Î·È 31-12-97, ÂÚ›Ô‰Ô Î·Ù¿ ÙËÓ ÔÔ›· ‰ÂÓ ˘‹Ú¯Â ÂȉÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ª£. ªÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ú¤Ì‚·Û˘, ÌÂÏÂÙ‹ıËÎ·Ó ÚÔÔÙÈο 878 ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ·fi 1-1-1999 ¤ˆ˜ 31-12-1999. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‹Ù·Ó ÙÂÏÂÈfiÌËÓ· Ì ËÏÈΛ· ·ËÛ˘ (∏∫) ≥37 ‚‰ÔÌ¿‰ˆÓ. ∫·Ù¿ ÙËÓ ÚÒÙË ÂÚ›Ô‰Ô (1997), 17 ‚Ú¤ÊË Â›¯·Ó ∏∫ 36 ‚‰ÔÌ¿‰ˆÓ, ¤Ó· ‹Ù·Ó 35 ‚‰ÔÌ¿‰ˆÓ Î·È 6 ·fi ·˘Ù¿ ›¯·Ó µ° <2,5 kg. ∫·Ù¿ ÙË ‰Â‡ÙÂÚË ÂÚ›Ô‰Ô (1999), 20 ‹Ù·Ó 36 ‚‰ÔÌ¿‰ˆÓ ∏∫ Î·È ¤Ó· 35 ‚‰ÔÌ¿‰ˆÓ. √ÎÙÒ ·fi ·˘Ù¿ ›¯·Ó µ° <2,5 kg. √ ¯ÚfiÓÔ˜ ·Ú·ÌÔÓ‹˜ ÛÙË ª∫ ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ›¯·Ó ÁÂÓÓ‹ÛÂÈ Ì º∆ ‹Ù·Ó 3 Ì 4 Ë̤Ú˜ Î·È ÂÎÂ›ÓˆÓ Ô˘ ›¯·Ó ÁÂÓÓ‹ÛÂÈ Ì ∫∆ 5 ¤ˆ˜ 7 Ë̤Ú˜. ŸÏ· Ù· ÓÂÔÁÓ¿ ÂÍÂÙ¿˙ÔÓÙ·Ó ·fi ÓÂÔÁÓÔÏfiÁÔ ÚÈÓ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫. °È· οı ÓÂÔÁÓfi ηٷÁÚ¿ÊËÎÂ Ô Ù‡Ô˜ Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘, ·ÔÎÏÂÈÛÙÈÎfi˜ ‹ ÌÈÎÙfi˜ (ª£ Î·È Û˘Ìϋڈ̷) ‹ Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹, ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘ ·fi ÙË ª∫. ∂›Û˘ ηٷÁÚ¿ÊËÎ·Ó ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚ› Ó· Û¯ÂÙ›˙ÔÓÙ·È Î·È Ó· ÂËÚ¿˙Ô˘Ó ÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ÓÂÔÁÓÒÓ, fiˆ˜ ÙÔ Ê‡ÏÔ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÙÔ µ° (<2,5 kg, 2,5 - 3,0 kg, >3,0 kg), Ô ÙÚfiÔ˜ Á¤ÓÓËÛ˘ (º∆, ∞∂, ∫∆), Ô ÙfiÎÔ˜ Ù˘ ÌËÙ¤Ú·˜ Î·È Ë ËÏÈΛ· Ù˘ (<20, 20-30, 31-40, >40 ÂÙÒÓ) Î·È ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, fiÔ˘ Ë Ù¿ÍË π ·Ó·Ê¤ÚÂÙ·È Û ·ÓÂȉ›Î¢ÙÔ˘˜ ÂÚÁ¿Ù˜, Ë Ù¿ÍË ππ Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÂÚÁ¿Ù˜ Î·È Ù¯ӛÙ˜, Ë Ù¿ÍË πππ Û ·fiÊÔÈÙÔ˘˜ ·ÓÒÙÂÚˆÓ Û¯ÔÏÒÓ Î·È Ë Ù¿ÍË IV Û ·fiÊÔÈÙÔ˘˜ ·ÓÂÈÛÙËÌ›Ô˘ (6). ŒÁÈÓ ۇÁÎÚÈÛË fiÏˆÓ ÙˆÓ ·Ú·¿Óˆ ·Ú·ÁfiÓÙˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË (1997) Î·È ÌÂÙ¿ ·fi ·˘Ù‹Ó (1999). ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÂÎÙÈÌ‹ıËÎÂ, ÌÂÙ¿ ·fi ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›· Ì ÙË ÌËÙ¤Ú·, 6 Î·È 12 Ì‹Ó˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÙÔ˘ ̈ÚÔ‡ Ù˘. √ÚÈÛÌÔ›: ∞ÔÎÏÂÈÛÙÈÎfi˜ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜: ÛËÌ·›ÓÂÈ fiÙÈ ÙÔ ÌˆÚfi ÛÈÙ›˙ÂÙ·È ÌfiÓÔ Ì ÌËÙÚÈÎfi Á¿Ï· ·fi ÙË ÌËÙ¤Ú· ÙÔ˘ ‹ Ì›· ÙÚÔÊfi, ‹ ÌËÙÚÈÎfi Á¿Ï· Ô˘ ¤¯ÂÈ Û˘ÏÏÂÁ›, Î·È Î·Ì›· ¿ÏÏË ÛÙÂÚ¿ ‹ ˘ÁÚ‹ ÙÚÔÊ‹. ™˘ÓÔÏÈÎfi˜ ıËÏ·ÛÌfi˜: ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË Û›ÙÈÛË ÙÔ˘ ̈ÚÔ‡ Ì ÌËÙÚÈÎfi Á¿Ï·, ›Ù ·ÔÎÏÂÈÛÙÈο ›Ù ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯ÔÚ‹ÁËÛË Û˘ÌÏËÚÒÌ·ÙÔ˜ ÙÚÔÔÔÈË̤ÓÔ˘ Á¿Ï·ÙÔ˜. ªÈÎÙ‹ ‰È·ÙÚÔÊ‹: Û›ÙÈÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ì ÌËÙÚÈÎfi Á¿Ï· ·ÏÏ¿ Î·È Û˘Ìϋڈ̷ Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï·. ∆¯ÓËÙ‹ ‰È·ÙÚÔÊ‹: Û›ÙÈÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ·ÔÎÏÂÈÛÙÈο Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ·ÁÂÏ¿‰Ô˜. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ∏ ÂÎÙ›ÌËÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ¤ÁÈÓ Ì ·Ó¿Ï˘ÛË ¯2. ™˘Û¯¤ÙÈÛË ¤ÁÈÓ ÁÈ· οı ÂÚ›Ô‰Ô ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ÁÈ· Ó· ÂÎÙÈÌËı› Ë Â›‰Ú·ÛË ÙˆÓ ‰È·ÊfiÚˆÓ ·Ú·Ì¤ÙÚˆÓ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ™˘Û¯¤ÙÈÛË ¤ÁÈÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ, ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, ÁÈ· Ó· ÂÎÙÈÌËı› Ë Â›‰Ú·ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÚÔÒıËÛ˘ ÙÔ˘ ıËÏ·ÛÌÔ‡ Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙÔÓ ª£.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÔÓÙ·È ÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·287

287

¶ÚÔÒıËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

Û¯ÂÙ›˙ÔÓÙ·È Ì ٷ ‚Ú¤ÊË Î·È Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ¤¯Ô˘Ó οÔÈ· Â›‰Ú·ÛË ÛÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙÔ˘˜ ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫, ÁÈ· ÙȘ ‰‡Ô ÂÚÈfi‰Ô˘˜ 1997 Î·È 1999. ∆Ô 1999, 87% ÙˆÓ ÓÂÔÁÓÒÓ ı‹Ï·˙·Ó ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫ Û˘ÁÎÚÈÙÈο Ì 81,9% ÙÔ 1997 (p<0,01). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÛÈÙ›˙ÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο Ì ÌËÙÚÈÎfi Á¿Ï· ‹Ù·Ó 71% Î·È 38,6% ·ÓÙ›ÛÙÔȯ· ÁÈ· Ù· ¤ÙË 1999 Î·È 1997 (p<0,001). ∏ ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È Î˘Ú›ˆ˜ Ë ·‡ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (¶›Ó·Î·˜ 1). º·›ÓÂÙ·È ˆ˜ Ë ·‡ÍËÛË ÙÔ˘ ª£ ÛÙ· ÎÔÚ›ÙÛÈ· ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£ (p<0,05 Î·È p<0,001, ·ÓÙ›ÛÙÔȯ·) Û˘ÁÎÚÈÙÈο Ì ٷ ·ÁfiÚÈ·, ηٿ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. ∆Ô µ° Ê·›ÓÂÙ·È Ó· ηıÔÚ›˙ÂÈ ÙÔÓ Ù‡Ô Û›ÙÈÛ˘ Î·È ·˘Ùfi˜ Ô ·Ú¿ÁÔÓÙ·˜ ·Ú·Ì¤ÓÂÈ ÛÙ·ıÂÚfi˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ. À¿Ú¯ÂÈ ÌÈ· ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ª£ Û ۯ¤ÛË Ì ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ µ° ·fi <2,5 kg ¤ˆ˜ >3 kg. ∆· ÓÂÔÁÓ¿ Ì µ° <2,5 kg ıËÏ¿˙Ô˘Ó ÏÈÁfiÙÂÚÔ ·fi ÂΛӷ Ì µ° >2,5 kg (p<0,05 ÚÈÓ Î·È p<0,01 ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË). ∆Ô ÌÈÎÚfiÙÂÚÔ µ° Ê·›ÓÂÙ·È ˆ˜ ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ª£ Î·È Î˘Ú›ˆ˜ ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£. ∆· ÓÂÔÁÓ¿ Ì µ° ≥2,5 kg ıËÏ¿˙Ô˘Ó Ì ÌÂÁ·Ï‡ÙÂÚË Û˘-

¯ÓfiÙËÙ· ·fi ÂΛӷ Ì ÌÈÎÚfiÙÂÚÔ µ°. ∆Ô ÚfiÁÚ·ÌÌ· ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ıËÏ·ÛÌÔ‡ ‚Ô‹ıËÛ ÛËÌ·ÓÙÈο ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ª£ ÌfiÓÔ ÛÙ· ÓÂÔÁÓ¿ Ì µ° ≥2,5 kg (p<0,05 Î·È p<0,001 ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi Î·È ·ÔÎÏÂÈÛÙÈÎfi ª£, ·ÓÙ›ÛÙÔȯ·) (¶›Ó·Î·˜ 1). √ ¶›Ó·Î·˜ 2 ‰Â›¯ÓÂÈ ÙÔ˘˜ ÌËÙÚÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫. ¶ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË, Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·Ó Ì º∆ Î·È ÂΛӷ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·Ó Ì ∫∆ ı‹Ï·˙·Ó Û ·ÚfiÌÔÈ· ÔÛÔÛÙ¿ (83,6% Î·È 84,5% ·ÓÙ›ÛÙÔȯ·), ÂÓÒ ÂΛӷ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·Ó Ì ∞∂ ı‹Ï·˙·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ (72,3%, p<0,01). ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ô Û˘ÓÔÏÈÎfi˜ ª£ ·˘Í‹ıËΠ۠88,6%, 91% Î·È 80,5% ·ÓÙ›ÛÙÔȯ· ÁÈ· Ù· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì º∆, ∞∂ Î·È ∫∆, ·ÓÙ›ÛÙÔȯ·. ∆· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ì ∫∆ Ê·›ÓÂÙ·È fiÙÈ ıËÏ¿˙Ô˘Ó ÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚÔ (p<0,05), Û ۯ¤ÛË Ì ÙȘ 2 ¿ÏϘ ÔÌ¿‰Â˜, ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. ∂›Û˘, Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ª£ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË Î·È ÛÙȘ 3 ÔÌ¿‰Â˜ ÙÔÎÂÙÔ‡ (p<0,001), ·Ó Î·È ÛÙËÓ ÔÌ¿‰· Ù˘ ∫∆ Ë Û˘¯ÓfiÙËÙ· ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ‹Ù·Ó ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙȘ ¿ÏϘ ‰‡Ô ÔÌ¿‰Â˜. ∏ ‡·ÚÍË ÚÔËÁÔ‡ÌÂÓÔ˘ ·È‰ÈÔ‡ Ù˘ ÌËÙ¤Ú·˜ Ô˘ ¤¯ÂÈ ıËÏ¿ÛÂÈ ÂËÚ¿˙ÂÈ ıÂÙÈο ÙÔÓ ª£. ∆Ô 1997, Ô ·ÚÈıÌfi˜ ÚÔËÁÔ‡ÌÂÓˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ‰ÂÓ Ê·›ÓÂÙ·È Ó· ›¯Â ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË

¶›Ó·Î·˜ 1. ™˘¯ÓfiÙËÙ· ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (ª£) (Û˘ÓÔÏÈÎfi˜, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) ηٿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ª∫, ÚÈÓ (1997) Î·È ÌÂÙ¿ (1999) ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ ÂÓ›Û¯˘ÛË ÙÔ˘ ª£ Î·È Û‡ÁÎÚÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ ÓÂÔÁÓfi (ʇÏÔ Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘) Î·È Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙÔÓ ÙÚfiÔ Û›ÙÈÛ˘ (ÂÓÙfi˜ οı ÂÚÈfi‰Ô˘ Î·È ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ) ∆ÚfiÔ˜ Û›ÙÈÛ˘

™˘ÓÔÏÈÎfi˜ ª£

∞ÚÈıÌfi˜ ÓÂÔÁÓÒÓ (%) ∞ÁfiÚÈ º‡ÏÔ ∫ÔÚ›ÙÛÈ µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (Kg)

<2,5 2,5-3 >3

™‡ÓÔÏÔ N 1997: 929 1999: 878 1997: 460 1999: 442 1997: 469 1999: 436 1997: 6 1999: 8 1997: 236 1999: 216 1997: 687 1999: 654

760 (81,9)** 764 (87,0)Á 371 (80,5) 374 (84,6) 389 (83,0)** 390 (89,4)· 3 (50,0)Á 4 (57,1)Â 183 (77,7)Á,* 185 (85,6)Â 574 (83,4)Á,* 576 (88,1)Â

∞ÔÎÏÂÈÛÙÈÎfi˜ ªÈÎÙfi˜ (ª£+ ª£ Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹) 359 (38,6)*** 623 (71,0) 187 (40,7)*** 277 (62,6)‚ 172 (36,7)** 327 (75,0)‚ 1 (16,7)‰ 1 (14,2)˙ 80 (34,2)‰,*** 148 (68,5)˙ 278 (40,5)‰,*** 442 (67,6)˙

401 (43,2) 141 (16,0) 184 (40,1) 97 (21,9) 217 (46,3) 63 (14,4) 2 (33,3) 3 (42,9) 103 (43,5) 37 (17,1) 296 (43,1) 134 (15,3)

∆¯ÓËÙ‹ ‰È·ÙÚÔÊ‹ 169 (18,0) 114(13,0) 89 (19,4) 68 (15,4) 80 (17,1) 46 (10,4) 3 (50,0) 4 (42,8) 53 (22,3) 31 (14,4) 113(16,6) 78 (11,9)

·,Á,‰

p<0,05, Â,˙ p<0,01 Î·È ‚ p<0,001: ∆È̤˜ p, ¯2, ÁÈ· ÙȘ ÔÌ¿‰Â˜ ‰È·ÊfiÚˆÓ ÙÚfiˆÓ Û›ÙÈÛ˘ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÓÂÔÁÓÒÓ, ÙÔ Ê‡ÏÔ Î·È ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÂÓÙfi˜ Ù˘ οı ÂÚÈfi‰Ô˘ Ù˘ ÌÂϤÙ˘. ·&‚ : ÛËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi (·) Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi (‚) ª£. Á&‰ : ÛËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ 3 ÔÌ¿‰ˆÓ ÙÔ˘ µ° ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË (1997) ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi (Á) Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi (‰) ª£ Â&˙ : ÛËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ 3 ÔÌ¿‰ˆÓ ÙÔ˘ µ° ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË (1999) ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi (Â) Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi (˙) ª£ * p<0,05, ** p<0,01, ***p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ Ù˘ ÌÂϤÙ˘ ÁÈ· ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ Û˘ÓÔÏÈÎfi Î·È ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£. ¶·È‰È·ÙÚÈ΋ 2007;70:285-292

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·288

288

∞. ¡ÙÔ˘ÚÓÙÔ‡ÊË Î·È Û˘Ó.

100% 90%

™˘ÓÔÏÈÎfi˜ ª£

80%

∞ÔÎÏÂÈÛÙÈÎfi˜ ª£

70%

¶ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË

60%

¶ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË 50% ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË 40% 30% 20% 10% 0 1Ë Â‚‰ÔÌ¿‰·

1Ô˜ Ì‹Ó·˜

2Ô˜ Ì‹Ó·˜

3Ô˜ Ì‹Ó·˜

4-6 Ì‹Ó˜

>6 Ì‹Ó˜

∂ÈÎfiÓ· 1. ¶ÔÛÔÛÙfi ÙˆÓ ‚ÚÂÊÒÓ Ô˘ ıËÏ¿˙Ô˘Ó (·ÔÎÏÂÈÛÙÈÎfi˜ Î·È Û˘ÓÔÏÈÎfi˜ ª£) ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ ˙ˆ‹˜, ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. p<0,01 ·fi ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ˆ˜ ÙÔÓ 2Ô Ì‹Ó· ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ª£. p<0,001 ·fi ÙÔÓ 3Ô Ì‹Ó· Î·È ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó· ÁÈ· ÙÔ Û˘ÓÔÏÈÎfi ª£ Î·È ·fi ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ˆ˜ ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi ª£.

¶›Ó·Î·˜ 2. ¶·Ú¿ÁÔÓÙ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ÙË ÌËÙ¤Ú· (Ù‡Ô˜ ÙÔÎÂÙÔ‡, ·ÚÈıÌfi˜ ÙfiÎÔ˘ ÌËÙ¤Ú·˜, ËÏÈΛ· ÌËÙ¤Ú·˜) ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ (Û˘ÓÔÏÈÎfi˜, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) ηٿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ª∫, ÚÈÓ (1997) Î·È ÌÂÙ¿ (1999) ÙËÓ ·Ú¤Ì‚·ÛË, ÂÓÙfi˜ οı ÂÚÈfi‰Ô˘ Î·È ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ ∆ÚfiÔ˜ Û›ÙÈÛ˘

∆ÔÎÂÙfi˜ (%)

™˘ÓÔÏÈÎfi˜ ª£ º∆ ∞∂ ∫∆

∆fiÎÔ˜ ÌËÙ¤Ú·˜ (%)

I II III

∏ÏÈΛ· ÌËÙ¤Ú·˜ (¤ÙË)

<20 20-29 30-39 > 40

‚,Á,‰,˙

™‡ÓÔÏÔ N 1997: 709 1999: 647 1997: 148 1999: 67 1997: 71 1999: 164 1997: 468 1999: 414 1997: 346 1999: 346 1997: 115 1999: 118 1997: 31 1999: 18 1997: 633 1999: 473 1997: 252 1999: 375 1997: 11 1999: 12

593 (83,6)·,** 573 (88,6)‚ 107 (72,3)·,** 61 (91,0)‚ 60 (84,5)· 132 (80,5)‚ 396 (84,6) 350 (84,5)‰ 270 (78,0)*** 306 (88,4)‰ 94 (81,7)** 110 (93,2)‰ 29 (93,6)* 12 (66,6)Ë 526 (83,1) 402 (85,0)Ë 196 (77,8)*** 339 (90,4)Ë 8 (72,7) 7 (58,3)Ë

∞ÔÎÏÂÈÛÙÈÎfi˜ ªÈÎÙfi˜ (ª£+ ª£ Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹) 281 (39,6)Á,*** 441 (68,1) 53 (35,8)Á,*** 47 (70,2) 25 (35,2)Á,*** 105 (64,0) 166 (35,5)Â,*** 256 (61,8)˙ 136 (39,3)Â,*** 243 (70,2)˙ 57 (49,6)Â,** 84 (71,0)˙ 15 (48,4)* 10 (55,5)ı 242 (38,2)*** 316 (66,8)ı 98 (38,9)*** 258 (68,8)ı 4 (36,4) 5 (41,7)ı

312 (44,0) 132 (20,4) 54 (36,5) 14 (20,8) 35 (49,3) 27 (16,5) 230 (49,2) 94 (22,7) 134 (38,7) 63 (18,2) 37 (32,2) 26 (22,0) 14 (45,2) 2 (1,1) 284 (44,9) 86 (18,2) 98 (38,9) 81 (21,6) 4 (36,4) 2 (16,6)

∆¯ÓËÙ‹ ‰È·ÙÚÔÊ‹ 116(16,4) 74 (11,4) 41 (27,7) 6 (8,9) 11 (15,5) 32 (19,5) 89 (19,4) 64 (15,5) 80 (17,1) 40 (11,6) 21 (18,3) 8 (6,7) 2(6,5) 6 (33,3) 107 (16,9) 71 (15,0) 56 (22,2) 36 (9,6) 3 (27,3) 5 (41,6)

p<0,05, ·,Â,ı p<0,01 Î·È Ë p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ÁÈ· οı ·Ú¿ÁÔÓÙ· ηٿ ÙËÓ ›‰È· ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘ * p<0,05, **p<0,01, ***p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ, ÁÈ· ÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜.

Paediatriki 2007;70:285-292

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·289

289

¶ÚÔÒıËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡

¶›Ó·Î·˜ 3. ™˘¯ÓfiÙËÙ· ª£ (Û˘ÓÔÏÈÎfi˜, ·ÔÎÏÂÈÛÙÈÎfi˜ Î·È ÌÈÎÙfi˜) ηٿ ÙËÓ ¤ÍÔ‰Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ª∫, Û ۯ¤ÛË Ì ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô Î·Ù¿ ÙȘ ‰‡Ô ÂÚÈfi‰Ô˘˜ Ù˘ ÌÂϤÙ˘ ÚÈÓ (1997) Î·È ÌÂÙ¿ (1999) ÙËÓ ·Ú¤Ì‚·ÛË ∆ÚfiÔ˜ Û›ÙÈÛ˘

∆¿ÍË (N, %)

™˘ÓÔÏÈÎfi˜ ª£ I II III IV

™‡ÓÔÏÔ N 1997: 193 1999: 154 1997: 288 1999: 352 1997: 219 1999: 189 1997: 216 1999: 183

154 (79,8) 133 (86,4) 233 (80,9) 300 (85,2) 176 (80,4) 165 (87,3) 186 (86,1) 159 (86,9)

∞ÔÎÏÂÈÛÙÈÎfi˜ ªÈÎÙfi˜ (ª£+ ª£ Ù¯ÓËÙ‹ ‰È·ÙÚÔÊ‹) 72 (37,3)* 109 (70,8) 118 (41,0)* 219 (62,2) 81 (37,0)* 136 (72,0) 80 (37,0)* 115 (62,8)

82 (42,5) 24 (15,6) 115 (40,0) 81 (23,0) 95 (43,4) 29 (15,3) 106(49,1) 44 (24,0)

∆¯ÓËÙ‹ ‰È·ÙÚÔÊ‹ 39 (20,2) 21 (13,6) 55 (19,1) 52 (14,8) 43 (19,6) 24 (12,7) 30 (13,9) 24 (13,1)

*

p<0,001: ™ËÌ·ÓÙÈÎfiÙËÙ· ÌÂٷ͇ ÙˆÓ 2 ÂÚÈfi‰ˆÓ Ù˘ ÌÂϤÙ˘. ∆¿ÍË I: ·ÓÂȉ›Î¢ÙÔÈ ÂÚÁ¿Ù˜, ∆¿ÍË II: ÂȉÈÎÂ˘Ì¤ÓÔÈ ÂÚÁ¿Ù˜ Î·È Ù¯ӛÙ˜, ∆¿ÍË III: ·fiÊÔÈÙÔÈ ·ÓÒÙÂÚˆÓ Û¯ÔÏÒÓ, ∆¿ÍË IV: ·fiÊÔÈÙÔÈ ·ÓÂÈÛÙËÌ›Ô˘.

ÛÙÔÓ Û˘ÓÔÏÈÎfi ª£, ·ÏÏ¿ ·˘Í‹ıËΠÛËÌ·ÓÙÈο Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ (p<0,01). ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ê·›ÓÂÙ·È fiÙÈ fiÛÔ ·˘Í¿ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ¤¯Ô˘Ó ıËÏ¿ÛÂÈ, ·˘Í¿ÓÂÙ·È Ô Û˘ÓÔÏÈÎfi˜ Î·È Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ª£ (p<0,05). ∏ ·Ú¤Ì‚·ÛË ·‡ÍËÛ ÛËÌ·ÓÙÈο ÙÔÓ Û˘ÓÔÏÈÎfi ª£ ÛÙȘ ÌËÙ¤Ú˜ Ì 2 Î·È 3 ‹ ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ (p<0,001 Î·È p<0,01, ·ÓÙ›ÛÙÔȯ·). ∏ Â›‰Ú·ÛË ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ‹Ù·Ó ÈÔ ÛËÌ·ÓÙÈ΋ ÛÙȘ ÌËÙ¤Ú˜ Ì 1 Î·È 2 ·È‰È¿ (p<0,001) Î·È ÏÈÁfiÙÂÚÔ ÛËÌ·ÓÙÈ΋ Û ÂΛӘ Ì 3 ‹ ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ (p<0,01). ∏ ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙÔÓ ª£ ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ô ª£ (Û˘ÓÔÏÈÎfi˜ Î·È ·ÔÎÏÂÈÛÙÈÎfi˜) ·˘Í¿ÓÂÈ Ì ÙËÓ ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ (p<0,001). ªËÙ¤Ú˜ ËÏÈΛ·˜ >40 ÂÙÒÓ ıËÏ¿˙Ô˘Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Î·È ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. ∏ Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ‹Ù·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË ÛÙȘ ËÏÈ˘ 20-29 Î·È 30-39 ÂÙÒÓ (p<0,001). ∏ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ‰ÂÓ ÂËÚ¤·Û ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ Î·È ·˘Ùfi ‰ÂÓ ‰È¤ÊÂÚ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÂÚÈfi‰ˆÓ. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ∏ ‰È¿ÚÎÂÈ· ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÚÒÙË ÂÚ›Ô‰Ô ‰Â›¯ÓÂÈ ÌÈ· ÚÔԉ¢ÙÈ΋ ÂÏ¿ÙÙˆÛË ·fi 81,3% ÙËÓ 1Ë Â‚‰ÔÌ¿‰· ÛÙÔ 40% ÌÂٷ͇ ÙÔ˘ 4Ô˘ Î·È 6Ô˘ Ì‹Ó· Î·È ÛÙÔ 22,6% ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó·, ÂÓÒ Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ¤ÊÙÂÈ ·fi 39% ÛÙÔ 18,8% Î·È 9% ÛÙȘ ›‰È˜ ÂÚÈfi‰Ô˘˜. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ù· ÔÛÔÛÙ¿ Û˘ÓÔÏÈÎÔ‡ ª£ Â›Ó·È 84,4%, 64,9% Î·È 44,4% ÛÙÔ Ù¤ÏÔ˜ Ù˘ 1˘ ‚‰ÔÌ¿‰·˜, ηٿ ÙÔÓ 4Ô Ì 6Ô

Ì‹Ó· Î·È ÌÂÙ¿ ÙÔÓ 6Ô Ì‹Ó· ·ÓÙ›ÛÙÔȯ·, ÂÓÒ ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ 61,8%, 42,8% Î·È 29,1% (∂ÈÎfiÓ· 1). ∏ ·‡ÍËÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ª£ (Û˘ÓÔÏÈÎÔ‡ Î·È ·ÔÎÏÂÈÛÙÈÎÔ‡) ηٿ ≥6 Ì‹Ó˜ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,001) ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË.

™˘˙‹ÙËÛË ªÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ˘ÔÛÙ‹ÚÈ͢ Î·È ÂÓ›Û¯˘Û˘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÌÔÓ‹˜ ÙˆÓ ÌËÙ¤ÚˆÓ Î·È ÙˆÓ ÓÂÔÁÓÒÓ ÙÔ˘˜ ÛÙË ª∫ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ, ·Ú·ÙËÚ‹ıËΠÌÈ· ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ª£ ·fi 81,9% ÛÙÔ 87%, ·ÏÏ¿ ΢ڛˆ˜ ÌÈ· ·‡ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ Ô˘ ۯ‰fiÓ ‰ÈÏ·ÛÈ¿ÛÙËΠ·fi 38,6% ÙÔ 1997, ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË, ÛÙÔ 71% ÙÔ 1999 (¶›Ó·Î·˜ 1). ŒÙÛÈ, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ‰ÂÓ ¤·ÈÚÓ·Ó Î·ıfiÏÔ˘ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· ηٿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ª∫ ÂÏ·ÙÙÒıËΠۯ‰fiÓ ÛÙÔ ÌÈÛfi. ªÂÏÂÙÒÓÙ·˜ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ ÙÔ 1997, ‚Ú¤ıËΠfiÙÈ ÂÓÒ ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ÌËÙ¤ÚˆÓ Â›¯·Ó ÛÎÔfi Ó· ıËÏ¿ÛÔ˘Ó Î·È ÍÂΛӷÁ·Ó ª£, ÌfiÓÔ ÙÔ ¤Ó· ÙÚ›ÙÔ Û¯Â‰fiÓ ·˘ÙÒÓ, ηٿÊÂÚ·Ó Ó· ıËÏ¿ÛÔ˘Ó ·ÔÎÏÂÈÛÙÈο ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ª∫. º·›ÓÂÙ·È ˆ˜ Ë ·fiÊ·ÛË Ù˘ ÌËÙ¤Ú·˜ Ó· ıËÏ¿ÛÂÈ ·fi ÌfiÓË Ù˘ ‰ÂÓ Â·ÚΛ ÁÈ· Ó· ÂÙ‡¯ÂÈ Ô ÛÙfi¯Ô˜. °È· ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ª£ Â›Ó·È ·Ó·Áη›Â˜ ÛˆÛÙ¤˜ Ô‰ËÁ›Â˜ Î·È ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÌËÙ¤ÚˆÓ ·fi ÙÔ ÚÔÛˆÈÎfi ˘Á›·˜ Ù˘ ª∫ (ÓÂÔÁÓÔÏfiÁÔÈ, ·È‰›·ÙÚÔÈ, Ì·›Â˜, ÓÔÛËχÙÚȘ) (7). ™ÙȘ ÛηӉÈÓ·‚ÈΤ˜ ¯ÒÚ˜, Ë ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ª£ ÂÈÙ‡¯ıËΠÌÂÙ¿ ·fi ·Ú¤Ì‚·ÛË ÛÙȘ Ú·ÎÙÈΤ˜ ÙˆÓ ª∫ Î·È Î˘Ú›ˆ˜ ÙË ¶·È‰È·ÙÚÈ΋ 2007;70:285-292

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·290

290

∞. ¡ÙÔ˘ÚÓÙÔ‡ÊË Î·È Û˘Ó.

Û˘Ó¯‹ Â·Ê‹ ÌËÙ¤Ú·˜ - ÓÂÔÁÓÔ‡ Î·È ÙËÓ ·ÚÔ¯‹ ÚÔÛˆÈ΋˜ ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó˘ ‚Ô‹ıÂÈ·˜ Û οı ÌËÙ¤Ú· ÁÈ· ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ª£ (4). √ ÛÙfi¯Ô˜ Ù˘ ·Ú¤Ì‚·Û˘ ÁÈ· ÂÓ›Û¯˘ÛË ÙÔ˘ ª£ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó Ó· ·˘ÍËı› fi¯È ÌfiÓÔ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ Û˘ÓÔÏÈο ·ÏÏ¿ Î·È ÂΛÓË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ Ô˘ ‹Ù·Ó Ôχ ¯·ÌËÏ‹ Û ۯ¤ÛË Ì ¿ÏϘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ Î·È Î˘Ú›ˆ˜ ÙȘ ÛηӉÈÓ·‚ÈΤ˜ ¯ÒÚ˜ (2). ¶ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ (1) ¤‰ÂÈÍ·Ó fiÙÈ Ô ·ÔÎÏÂÈÛÙÈÎfi˜ ª£ ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ ›¯Â ÛËÌ·ÓÙÈ΋ Â›‰Ú·ÛË ÛÙË Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ŒÙÛÈ, Ë Â›Ù¢ÍË Ù˘ ÛËÌ·ÓÙÈ΋˜ ·‡ÍËÛ˘ ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ˙ˆ‹˜ Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi ÁÂÁÔÓfi˜ ÁÈ· ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ µ¢ ∂ÏÏ¿‰·˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë fiÙÈ ¿Óˆ ·fi ÙÔ 50% ÙˆÓ ÙÔÎÂÙÒÓ Á›ÓÔÓÙ·È ÛÙÔ ¶°¡π. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÚÔ¯‹ ‚Ô‹ıÂÈ·˜ ÛÙȘ ÌËÙ¤Ú˜ ηٿ ÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ï‡ÙÂÚË ÂÈÙ˘¯›· ÙÔ˘ ª£ ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜ ·Ó·Ê¤ÚÂÙ·È Î·È Û ¿ÏϘ ÌÂϤÙ˜ (8-10). ™ÙË ÌÂϤÙË ÙˆÓ Ahluwalia Î·È Û˘Ó. Û˘ÌÂÚ·›ÓÂÙ·È fiÙÈ “Ë ÛÙÚ·ÙËÁÈ΋ Ì ٷ ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È Ë ·ÚÔ¯‹ ‚Ô‹ıÂÈ·˜ Î·È Ë Î·ıÔ‰‹ÁËÛË Ô˘ ·Ú¤¯ÂÙ·È ÛÙȘ ÌËÙ¤Ú˜ Ï›ÁÔ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ÛÙÔ ÓÔÛÔÎÔÌ›Ԕ (11). √È Ú·ÎÙÈΤ˜ Ô‰ËÁ›Â˜ Ô˘ ‰›ÓÔÓÙ·È ÛÙȘ ÌËÙ¤Ú˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ÌÔÚ› Ó· ÙÔ˘˜ ÚÔÛʤÚÔ˘Ó ÙËÓ Î·Ù¿ÏÏËÏË ‚Ô‹ıÂÈ· ÁÈ· ÙÔÓ ÂÈÙ˘¯‹ ıËÏ·ÛÌfi ÙÔ˘ ̈ÚÔ‡ ÙÔ˘˜. ∏ ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ Î·È ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ Ì ÙËÓ ·Ú¤Ì‚·ÛË ÂÓ›Û¯˘Û˘ ÙÔ˘ ª£ ÛÙË ª∫ Û˘ÌʈÓ› Î·È Ì ¿ÏϘ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÙÈ Ë ÂÎ·›‰Â˘ÛË Î·È Ë ˘ÔÛÙ‹ÚÈÍË Û¯ÂÙ›˙ÔÓÙ·È Ì ·‡ÍËÛË Ù˘ ¤Ó·Ú͢ ÙÔ˘ ª£ (11-13). ªÈ· ÌÂϤÙË ·fi ÙËÓ ∆Ô˘ÚΛ· ¤‰ÂÈÍ ˘„ËÏfiÙÂÚË Û˘¯ÓfiÙËÙ· ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (14). ∂›Û˘, ÔÈ Kurinij Î·È Û˘Ó. ¤‰ÂÈÍ·Ó fiÙÈ Ë ÔÏÈÙÈ΋ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÂËÚ¿˙ÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ô˘ ¤¯ÂÈ ÌÈ· ÌËÙ¤Ú· Ó· ıËÏ¿ÛÂÈ ·ÔÎÏÂÈÛÙÈο ÙÔ ÌˆÚfi Ù˘ (15). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fiˆ˜ Î·È Û ¿ÏϘ ÌÂϤÙ˜ (16-18), Ù· ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ (<2,5 kg) ›¯·Ó ÏÈÁfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ıËÏ¿ÛÔ˘Ó (p<0,05) Û ۯ¤ÛË Ì ÂΛӷ ÌÂÁ·Ï‡ÙÂÚÔ˘ µ° (>2,5 kg). ∏ Û˘¯ÓfiÙËÙ· ª£ ‹Ù·Ó ÂÚ›Ô˘ 50% ÛÙ· <2,5 kg Î·È >80% ÛÙ· ÌÂÁ·Ï‡ÙÂÚÔ˘ µ° (>2,5 kg) ÓÂÔÁÓ¿. ∆Ô ÚfiÁÚ·ÌÌ· ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ª£ ‰ÂÓ ÂËÚ¤·Û ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ· ª£ ÙˆÓ ÓÂÔÁÓÒÓ Ì ¯·ÌËÏfi µ° (·‡ÍËÛË ·fi ÙÔ 50% ÛÙÔ 57,1%). ª›· ·fi ÙȘ Èı·Ó¤˜ ·Èٛ˜ Ù˘ ÌÈÎÚfiÙÂÚ˘ Û˘¯ÓfiÙËÙ·˜ ª£ ÛÙ· ÓÂÔÁÓ¿ Ì µ° <2,5 kg Â›Ó·È Ë Û¯ÂÙÈ΋ ·ÓˆÚÈÌfiÙËÙ¿ ÙÔ˘˜ (35-36 ‚‰ÔÌ¿‰Â˜) Û ۯ¤ÛË Ì Paediatriki 2007;70:285-292

Ù· ÌÂÁ·Ï‡ÙÂÚ· ÓÂÔÁÓ¿, ÌÂÁ·Ï‡ÙÂÚ˘ ∏∫ Î·È Â›Û˘ Ë ÌÂÁ·Ï‡ÙÂÚË ·‚‚·ÈfiÙËÙ· Ù˘ ÌËÙ¤Ú·˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â¿ÚÎÂÈ· ÙÔ˘ Á¿Ï·Ùfi˜ Ù˘, fiˆ˜ ·Ó·Ê¤ÚÔ˘Ó Î·È ÔÈ Barros Î·È Û˘Ó. (18). √È Rajan Î·È Û˘Ó. Â›Û˘ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ù· ÓÂÔÁÓ¿ Ì µ° >2,5 kg ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ıËÏ¿ÛÔ˘Ó ·ÔÎÏÂÈÛÙÈο ·’ fiÙÈ ÂΛӷ Ì µ° <2,5 kg (19). ∏ Â›‰Ú·ÛË ÙÔ˘ Ù‡Ô˘ ÙÔ˘ ÙÔÎÂÙÔ‡ ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ª£ ¤¯ÂÈ ·Ó·ÊÂÚı› Û ÔÏϤ˜ ÌÂϤÙ˜ (2022). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ∞∂ Î·È Ë ∫∆ Ê·›ÓÂÙ·È ˆ˜ ¤¯Ô˘Ó ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙÔÓ ª£. ∏ ·Ú¤Ì‚·ÛË ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ıËÏ·ÛÌÔ‡ ‚Ô‹ıËÛ ÙȘ ÌËÙ¤Ú˜ Ó· ÂÙ‡¯Ô˘Ó ÙÔÓ ª£ (p<0,01) ÌfiÓÔ ÛÙËÓ ÔÌ¿‰· ÂΛÓË Ô˘ Á¤ÓÓËÛ Ì ∞∂ Î·È fi¯È Ì ∫∆. ∏ ·‡ÍËÛË ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ª£ (p<0,05) ‹Ù·Ó ÏÈÁfiÙÂÚÔ ÛËÌ·ÓÙÈ΋ ÛÙ· ̈ڿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ∫∆, Û ۯ¤ÛË Ì ÂΛӷ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì º∆ ‹ ∞∂, ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË. ∏ ·‡ÍËÛË ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Î·È ÛÙȘ ÙÚÂȘ ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË (p<0,001). √È Victora Î·È Û˘Ó. Û‡ÁÎÚÈÓ·Ó ÙÔÓ ÙÚfiÔ Û›ÙÈÛ˘ Û ‚Ú¤ÊË Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì º∆ Î·È Ì ∫∆ (20). ™ÙË ÌÂϤÙË ÙÔ˘˜, Ô Ù‡Ô˜ ÙÔ˘ ÙÔÎÂÙÔ‡ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ª£, ÂÓÙÔ‡ÙÔȘ Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ª£ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ÛÙ· ̈ڿ Ô˘ ›¯·Ó ÁÂÓÓËı› Ì ∫∆. ∫·È Û ¿ÏϘ ÌÂϤÙ˜ ·Ó·Ê¤ÚÂÙ·È Â›‰Ú·ÛË ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÙÔÎÂÙÔ‡ ÛÙÔÓ ÙÚfiÔ Û›ÙÈÛ˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (21,22). ¶Èı·ÓfiÓ Ë ·ÈÙ›· Ù˘ ÌÈÎÚfiÙÂÚ˘ Û˘¯ÓfiÙËÙ·˜ ª£ ÛÙ· ‚Ú¤ÊË Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ì ∫∆ Â›Ó·È Ë Î·ı˘ÛÙÂÚË̤ÓË ÙÔÔı¤ÙËÛË ÙÔ˘ ̈ÚÔ‡ ÛÙÔ ÛÙ‹ıÔ˜ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘, Ô˘ ‰‡ÛÎÔÏ· ÂËÚ¿˙ÂÙ·È ·fi ·Ú¤Ì‚·ÛË. √ ÙfiÎÔ˜ Ù˘ ÌËÙ¤Ú·˜ ‹ Ô ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ª£, ·Ó Î·È Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ·˘Í·ÓfiÙ·Ó ·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ 1997. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Î·È ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ Î·È ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ (p<0,05). À¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£. ™Â Ì›· ÌÂϤÙË ·fi ÙÔ ¶ÂÚÔ‡, Ë ‡·ÚÍË Ó¤ˆÓ ·È‰ÈÒÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Û¯ÂÙÈ˙fiÙ·Ó ıÂÙÈο Ì ÙËÓ Â›ÙˆÛË ÙÔ˘ ª£ Î·È ÙË ‰È¿ÚÎÂÈ¿ ÙÔ˘ (23). ª›· ÌÂϤÙË ·fi ÙËÓ ∞ÁÁÏ›· ÙÔ 1990 ‰Â›¯ÓÂÈ fiÙÈ ÙÔ ÚÒÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ıËÏ¿˙ÂÈ Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Û ۯ¤ÛË Ì ÙÔ ‰Â‡ÙÂÚÔ Î·È Ù· ÂfiÌÂÓ· ·È‰È¿ (24). ™ÙË ÌÂϤÙË ÙˆÓ Victora Î·È Û˘Ó. ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ·È‰È¿ ÌËÙ¤ÚˆÓ Ô˘ ›¯·Ó ıËÏ¿ÛÂÈ ¤Ó· ÚÔËÁÔ‡ÌÂÓÔ ·È‰› ›¯·Ó ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ıËÏ¿ÛÔ˘Ó (20). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÔ ÚfiÁÚ·ÌÌ· ÂÓ›Û¯˘Û˘ ÙÔ˘ ıËÏ·ÛÌÔ‡

Pediatri July-Aug 07

09-07-07

17:08

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‹Ù·Ó ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÁÈ· ÙȘ ÌËÙ¤Ú˜ Ô˘ ›¯·Ó ÚÔËÁÔ‡ÌÂÓË ÂÌÂÈÚ›· ıËÏ·ÛÌÔ‡. ∏ ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙÔÓ ª£ ÚÈÓ ÙËÓ ·Ú¤Ì‚·ÛË. ªÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, ÙÔ 1999, Ù· ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ Ô ª£ ·˘Í¿ÓÂÈ ·Ú¿ÏÏËÏ· Ì ÙËÓ ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 40 ÂÙÒÓ. ™Â ÌËÙ¤Ú˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ (>40 ÂÙÒÓ), Ë ·Ú¤Ì‚·ÛË ‰ÂÓ ‰Â›¯ÓÂÈ Ó· ¤¯ÂÈ Î¿ÔÈ· Â›‰Ú·ÛË, ·Ó Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ ÌËÙ¤ÚˆÓ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜ ‹Ù·Ó Ôχ ÌÈÎÚfi˜. ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Î·È Û ¿ÏϘ ÌÂϤÙ˜ (21,23). ∏ ÌÈÎÚfiÙÂÚË ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ª£, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Û ÌÂϤÙË ·fi ÙË ¢·Ó›· (25), ·ÓÙ›ıÂÙ· Ì ¿ÏϘ ÌÂϤÙ˜ (24). √È ‰È·ÊÔÚ¤˜ ·˘Ù¤˜ ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È fi¯È ÛÙËÓ ËÏÈΛ· ·ÏÏ¿ Û ÂıÓÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ‰È·ÊÔÚ¤˜. ∏ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ‰ÂÓ ‰Â›¯ÓÂÈ Ó· ÂËÚ¿˙ÂÈ ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È Û ¿ÏϘ Â˘Úˆ·˚Τ˜ ÌÂϤÙ˜ (25,26). ™ÙȘ ‰˘ÙÈΤ˜ ‚ÈÔÌ˯·ÓÔÔÈË̤Ó˜ ¯ÒÚ˜, Â›Ó·È ÎÔÈÓfi Ê·ÈÓfiÌÂÓÔ ÌËÙ¤Ú˜ ˘„ËÏfiÙÂÚˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Ù¿ÍˆÓ, Ì ÌÂÁ·Ï‡ÙÂÚË ÌfiÚʈÛË, Ó· ıËÏ¿˙Ô˘Ó Û˘¯ÓfiÙÂÚ· Î·È ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙȘ Á˘Ó·›Î˜ ¯·ÌËÏfiÙÂÚˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ ÂÈ¤‰ˆÓ. ∆Ô ·ÓÙ›ıÂÙÔ ·Ú·ÙËÚÂ›Ù·È ÛÙȘ ÂÚÈÔ¯¤˜ ˘fi ·Ó¿Ù˘ÍË, fiÔ˘ ÔÈ ÌËÙ¤Ú˜ ¯·ÌËÏfiÙÂÚˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ ÛÙڈ̿وÓ, Ì ÌÈÎÚfiÙÂÚË ÌfiÚʈÛË, ıËÏ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ (21-23). ∞˘Ù‹ Ë ‰È·ÊÔÚ¿ ‰Â›¯ÓÂÈ fiÙÈ ÔÈ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰‡Ó·ÓÙ·È Ó· ÂËÚ¿ÛÔ˘Ó ÛËÌ·ÓÙÈο ÙÔÓ ª£ (27). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÒÓ Ù¿ÍˆÓ, ·Ó Î·È Ê·›ÓÂÙ·È fiÙÈ ÔÈ ÌËÙ¤Ú˜ Ì ÌÂÁ·Ï‡ÙÂÚË ÌfiÚʈÛË ÍÂÎÈÓÔ‡Ó Ó· ıËÏ¿˙Ô˘Ó Ì ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ·, ·ÏÏ¿ ÂΛӘ Ì ÌÈÎÚfiÙÂÚË ÌfiÚʈÛË ıËÏ¿˙Ô˘Ó ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∆Ô ÚfiÁÚ·ÌÌ· ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ª£ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË fi¯È ÌfiÓÔ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ¤Ó·Ú͢ ÙÔ˘ ª£ ·ÏÏ¿ Î·È Ù˘ ‰È¿ÚÎÂÈ¿˜ ÙÔ˘. ∫·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË, Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ª£ ‹Ù·Ó 64,9% Î·È ÙÔ˘ ·ÔÎÏÂÈÛÙÈÎÔ‡ ª£ ‹Ù·Ó 42,8% ÌÂٷ͇ ÙÔ˘ 4Ô˘ - 6Ô˘ Ì‹Ó·, Û˘¯ÓfiÙËÙ· Ô˘ ÏËÛÈ¿˙ÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘ “Healthy People” ÁÈ· ÙÔ 2000 (28). √ ·ÔÎÏÂÈÛÙÈÎfi˜ ıËÏ·ÛÌfi˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙËÓ ª∫ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ Ì·˜ ‹Ù·Ó ¯·ÌËÏfi˜ (38,6%) ÚÔ Ù˘ ·Ú¤Ì‚·Û˘, ÂÓÒ ÌÂÙ¿ ·fi ÙËÓ ˘ÔÛÙ‹ÚÈÍË Î·È ÙËÓ Î·ıÔ‰‹ÁËÛË ÙˆÓ ÌËÙ¤ÚˆÓ ·fi ÙÔ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi Ù˘ ª∫ ·fi ÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡ Î·È Î·Ù¿ ÙȘ ÚÒÙ˜ ̤Ú˜ ˙ˆ‹˜ ÂÈÙ‡¯ıËΠÌÈ· ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË (71%). ∏ ˘ÔÛÙ‹-

ÚÈÍË Î·È Ë ÂÓı¿ÚÚ˘ÓÛË ÙˆÓ ÌËÙ¤ÚˆÓ Ó· ıËÏ¿ÛÔ˘Ó ÛÙËÓ ÚÒÈÌË ÌÂÙ·ÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô Ê·›ÓÂÙ·È Î·ıÔÚÈÛÙÈ΋ ÁÈ· ÙËÓ ÂÁηٿÛÙ·ÛË Î·È ÂÔ̤ӈ˜ ÁÈ· ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡. ∆· “ÊÈÏÈο ÚÔ˜ Ù· ‚Ú¤ÊË” ÓÔÛÔÎÔÌ›· ¤¯Ô˘Ó Û·Ó ÛÙfi¯Ô ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ ÌËÙ¤ÚˆÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ ÙÔ˘˜ ÁÈ· ıËÏ·ÛÌfi ·ÔÎÏÂÈÛÙÈο Î·È ÁÈ· Ì·ÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (5,29). ∂ÈϤÔÓ, Ë Û˘Ó¯‹˜ Â·Ê‹ ÙˆÓ ÌËÙ¤ÚˆÓ Ì ¿ÙÔÌ· ÂȉÈο ÂÎ·È‰Â˘Ì¤Ó· ÛÙÔÓ ª£ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙË ‰È·Ù‹ÚËÛË ÙÔ˘ ª£.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Powers NG, Naylor AJ, Wester RA. Hospital policies: crucial to breastfeeding success. Semin Perinatol 1994;18:517-524.

2. Zetterstrom R. Breastfeeding and infant-mother interaction. Acta Paediatr 1999;88 (Suppl. 430):1-6.

3. Giovannini M, Banderali G, Agostoni C, Silano M, Radaelli G, Riva E. Epidemiology of breastfeeding in Italy. Acta Paediatr 1999;88 (Suppl 430):19-22.

4. Heiberg Endresen E, Helsing E. Changes in breastfeeding practices in Norwegian maternity wards: national surveys 1973, 1982 and 1991. Acta Paediatr 1995;84:719-724.

5. WHO/UNICEF. Protecting, promoting and supporting breastfeeding: the special role of maternity services. Joint WHO/ UNICEF statement. Geneva: WHO, 1989.

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7. Salariya EM, Easton PM, Carter JI. Duration of breastfeeding after early initiation and frequent feeding. Lancet 1978;2:1141-1143.

8. Pechlivani F, Vassilakou T, Sarafidou J, Zachou T, Anastasiou CA, Sidossis LS. Prevalence and determinants of exclusive breastfeeding during hospital stay in the area of Athens, Greece. Acta Paediatr 2005;94:928-934.

9. Jones DA, West RR. Lactation nurse increases duration of breast feeding. Arch Dis Child 1985;60:772-774.

10. Cunnigham WE, Segree W. Breast feeding promotion in an urban and a rural Jamaican hospital. Soc Sci Med 1990;30:341-348.

11. Ahluwalia IB, Tessaro I, Grummer-Strawn LM, MacGowan C, Benton-Davis S. Georgia’s breastfeeding promotion program for low-income women. Pediatrics 2000;105:E85.

12. Grossman LK, Harter C, Sachs L, Kay A. The effect of postpartum lactation counseling on the duration of breastfeeding in low-income women. Am J Dis Child 1990;144: 471-474.

13. Leff EW, Schriefer J, Hagan JF, DeMarco PA. Improving breastfeeding support: a community health improvement project. Jt Comm J Qual Improv 1995;21:521-529.

14. Neyzi O, Güleçyüz M, Dinçer Z, Olgun P, Kutluay T, Uzel N, et al. An educational intervention on promotion of breast feeding complemented by continuing support. Pediatr Perinat Epidemiol 1991;5:299-303.

15. Kurinij N, Shiono PH. Early formula supplementation of breast-feeding. Pediatrics 1991;88:745-750.

16. Kramer MS, Chalmers B, Hodnett ED, Serkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001;285:413-420. ¶·È‰È·ÙÚÈ΋ 2007;70:285-292

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17. Rogers IS, Emmett PM, Golding J. The incidence and duration of breast feeding. Early Hum Dev 1997;49:S46-S74.

18. Barros FC, Victora CG, Vaughan JP, Smith PG. Birth weight and duration of breast-feeding: are the beneficial effects of human milk being overestimated? Pediatrics 1986;78:656-661.

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20. Victora CG, Huttly SR, Barros FC Vaughan JP. Breast feeding duration in consecutive offspring: a prospective study from southern Brazil. Acta Paediatr 1992;81:12-14.

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25. Weile B, Rubin DH, Krasilnikoff PA, Kuo HS, Jekel JF. Infant feeding patterns during the first year of life in Denmark: factors associated with the discontinuation of breast-feeding. J Clin Epidemiol 1990;43:1305-1311.

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28. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. Washington, DC: Government Printing Office, 1990:379-80.

29. Philipp BL, Merewood A. The Baby-Friendly way: the best breastfeeding start. Pediatr Clin North Am 2004;51: 761-783.

™ˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ “∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙË Û‡Á¯ÚÔÓË ÂÔ¯‹: ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ Î·È ·ÈÙÈÔÏÔÁ›·” 1. À„ËÏfiÙÂÚÔ˜ ÂÙ‹ÛÈÔ˜ ÂÈÔÏ·ÛÌfi˜ Û ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ·ÙÔÈΤ˜ ·ı‹ÛÂȘ Ù·˘Ùfi¯ÚÔÓ· Û˘Ó·ÓٿٷÈ: ‚. ™ÙË ª. µÚÂÙ·Ó›· 2. ¶ÔÈ· ·fi ÙȘ ·Ú·Î¿Ùˆ ‰È·Ù˘ÒÛÂȘ ‰ÂÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙËÓ “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜”; Á. ∏ ·‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÒÓ ÔÊ›ÏÂÙ·È ÌÂٷ͇ ¿ÏÏˆÓ Û ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ Î·È ÎÏÈÌ·ÙÔÏÔÁÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ 3. ™ÙÔ ÎÏ·ÛÈÎfi ÌÔÓÙ¤ÏÔ “·ÙÔÈ΋˜ ·Ú¤Ï·Û˘” (atopic marching), Ë ·ÏÏËÏÔ˘¯›· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ·ÙÔÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È: ‚. ŒÎ˙ÂÌ·-ÙÚÔÊÈΤ˜ ·ÏÏÂÚÁ›Â˜-¿ÛıÌ·-·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· 4. √È ·Ú·Î¿Ùˆ ΢ÙÙ·ÚÔΛÓ˜ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙËÓ Ù‡Ô˘ Th2 ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ÏÏÂÚÁÈÎÒÓ ÂΉËÏÒÛˆÓ, ÂÎÙfi˜ ·fi ÙËÓ: ·. INF- Á 5. ∞‡ÍËÛË ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ ·Ú·ÙËÚ›ٷÈ: ‰. ™Â fiϘ ÙȘ ·Ú·¿Óˆ ÂÚÈÙÒÛÂȘ (Û ¯ÒÚ˜ Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ˘ÈÔı¤ÙËÛ·Ó ÙÔ “‰˘ÙÈÎfi” ÌÔÓÙ¤ÏÔ ˙ˆ‹˜, Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ÈÔ ËÏÈÎȈ̤ÓÔ˘˜, ηıÒ˜ Î·È Û ·ÓıÚÒÔ˘˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Û ۇÁÎÚÈÛË Ì ÙȘ ÚÔ¯ˆÚË̤Ó˜ ËÏÈ˘ Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ÂηÂٛ˜)

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ORIGINAL ARTICLE

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∏ Û˘Ì‚ÔÏ‹ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1 (™¢1) ∫. ∫·Ú·‚·Ó¿ÎË3, ∂. ∆Ûfiη2, Ã. ∫·Ú·ÁÈ¿ÓÓË3, µ. ¶¤ÙÚÔ˘1, ∂. ¶È›‰Ô˘2, ª. ªÚÈÛÈÌÈÙ˙‹2, ª. ª·˘ÚÈΛԢ2, ∫. ∫·ÎϤ·˜3, ∞. ¢¿ÎÔ˘-µÔ˘ÙÂÙ¿ÎË1 ¶ÂÚ›ÏË„Ë ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹Û·Ì 106 ·È‰È¿ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1 (™¢1) Ì ̤ÛË ËÏÈΛ· 11,73 ¤ÙË, ηıÒ˜ Î·È 150 Ì¿ÚÙ˘Ú˜ Ì ·ÓÙ›ÛÙÔÈ¯Ë ËÏÈΛ· Î·È Ê‡ÏÔ, Ì ÛÎÔfi Ó· ÂÎÙÈÌ‹ÛÔ˘Ì ÙËÓ Â›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1, ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË. √È ÁÔÓ›˜ Û˘ÌÏ‹ÚˆÛ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ·ÊÔÚÔ‡Û·Ó ÙËÓ ÂÎ·›‰Â˘ÛË Î·È ÙÔ Â¿ÁÁÂÏÌ¿ ÙÔ˘˜, ηıÒ˜ Î·È ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÙˆÓ ·È‰ÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÙÔÓ ıËÏ·ÛÌfi, ηıÒ˜ Î·È ÙË Û˘¯ÓfiÙËÙ· ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ. ∞ÔÙÂϤÛÌ·Ù·: ∆· ·È‰È¿ ÙˆÓ Î·ÙÒÙÂÚˆÓ ÎÔÈÓˆÓÈÎÒÓ Ù¿ÍÂˆÓ ÂÌÊ¿ÓÈ˙·Ó ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ™¢1, ·fi ÂΛӷ Ù˘ ̤Û˘ Î·È ·ÓÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ (OR = 0,16, 95% CI: (0,03, 0,80)). ∏ ÂΉ‹ÏˆÛË Î¿ı ·ÏÏÂÚÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ (OR=0,06; 95% CI: (0,01, 0,23)), ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË, ηıÒ˜ Î·È Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ (OR=0,45, 95% CI: (0,27, 0,77)) ‰ÚÔ‡Û·Ó ÚÔÛٷ٢ÙÈο ÛÙËÓ ÂΉ‹ÏˆÛË ™¢1. ∫·Ù¿ ÙËÓ ·Ó¿Ï˘ÛË Ù˘ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, Ë ÂΉ‹ÏˆÛË Û˘ÌÙˆÌ¿ÙˆÓ ·ÏÏÂÚÁ›·˜ (OR=0,10,95% CI: (0,03, 0,40)), Ë ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ (OR=0,11, 95% CI: (0,02, 0,50)), ȉȷ›ÙÂÚ· ηٿ Ù· ‰˘Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, ηıÒ˜ Î·È Ë ÚԤϢÛË ·fi ÙȘ ·ÓÒÙÂÚ˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ (OR=0,16, 95% CI: (0,03, 0,80)) ‰ÚÔ‡Û·Ó ÚÔÛٷ٢ÙÈο ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ™¢1. ™˘ÌÂÚ¿ÛÌ·Ù·: ™Ù· ·È‰È¿ Ì ™¢1 Ù˘ ÌÂϤÙ˘ Ì·˜, Ë ·ÚÔ˘Û›· ·ÏÏÂÚÁÈÎÒÓ ÂΉËÏÒÛˆÓ, Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ÔÈ Û˘¯Ó¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, ȉȷ›ÙÂÚ· ηٿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, ηıÒ˜ Î·È Ë ÚԤϢÛË ·fi ÙË ÌÂÛ·›· Î·È ÙËÓ ·ÓÒÙÂÚË ÎÔÈÓˆÓÈ΋ Ù¿ÍË ‰ÚÔ‡Û·Ó ÚÔÛٷ٢ÙÈο ÛÙËÓ ÂΉ‹ÏˆÛË ™¢1.

1 ∂Ó‰ÔÎÚÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” 2 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∞ıËÓÒÓ 3 ¢È·‚ËÙÔÏÔÁÈÎfi π·ÙÚ›Ô, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶&∞ ∫˘ÚÈ·ÎÔ‡” AÏÏËÏÔÁÚ·Ê›·: ∫˘Úȷ΋ ∫·Ú·‚·Ó¿ÎË kakarav2@yahoo.gr µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶&∞ ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

§¤ÍÂȘ ÎÏÂȉȿ: πÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì MMR, ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, ·ÏÏÂÚÁ›Â˜, ÎÔÈÓˆÓÈ΋ Ù¿ÍË, ·ıÔÁ¤ÓÂÈ· ™¢1.

∂nvironmental factors possibly associated with the pathogenesis of diabetes mellitus type 1 (DM1) K. Karavanaki3, E. Tsoka2, C. Karayianni3, V. Petrou1, E. Pippidou2, M. Brisimitzi2, M. Mavrikiou2, K. Kakleas3, C. Dacou-Voutetakis1 Abstract Methods: We studied 106 children with type 1 diabetes mellitus (DM1) with a median age of 11.73 years and 150 controls with similar age and sex distribution, with the aim to assess the potential associations between environmental factors and the development of DM1, stratified by social class. The parents completed questionnaires on their education and occupation and on their children’s personal history of breastfeeding, allergic symptoms and viral infections.

Results: Children of the lower classes had a higher risk of DM1 compared to children of the middle or upper social classes (OR = 0.16, 95% CI: (0.03, 0.80)). The occurrence of any assessed allergic symptoms (OR=0.06; 95% CI: (0.01, 0.23)), irrespectively of social class, as well as breastfeeding (OR=0.45, 95% CI: (0.27, 0.77)) were protective of DM1 presentation. According to the multiple logistic regression analysis, the presence of allergic symptoms (OR=0.10, 95% CI: (0.03,0.40)), the increased frequency of infections (OR=0.11, 95% CI: (0.02,0.50)), especially during the first 2 years of life and the origin from upper and middle social classes (OR=0.16, 95% CI: (0.03,0.80)), were protective of DM1 presentation.

Conclusion: In the children with DM1 of our study, the presence of allergic symptoms, breastfeeding, frequent viral infections and originating from a middle or upper social class had a protective effect on DM1 presentation.

1 Department of Endocrinology, First Department of Paediatrics of the University of Athens, “Aghia Sofia” Children’s Hospital 2 Second Department of Paediatrics, “Aghia Sofia” Children’s Hospital 3 Diabetic Clinic, Second Department of Paediatrics of the University of Athens, “P. & A. Kyriakou” Children’s Hospital Correspondence: Kyriaki Karavanaki, kakarav2@yahoo.gr 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital ∆hivon and Levadeias St., 115 27, Athens, Greece

Key words: Viral infections, MMR vaccination, breastfeeding, allergies, social class, DM1 pathogenesis.

¶·È‰È·ÙÚÈ΋ 2007;70:293-299

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·294

294

∫. ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó.

∂ÈÛ·ÁˆÁ‹ √ ۷ί·Ú҉˘ ‰È·‚‹Ù˘ Ù‡Ô˘ 1 (™¢1) ÔÊ›ÏÂÙ·È Û ·˘ÙÔ¿ÓÔÛË Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜ Û ÁÂÓÂÙÈο ÚԉȷÙÂıÂÈ̤ӷ ¿ÙÔÌ·. £ÂˆÚÂ›Ù·È fiÙÈ Ë ·˘ÙÔ¿ÓÔÛË ‰È·‰Èηۛ· Â¿ÁÂÙ·È ·fi ÔÚÈṲ̂ÓÔ˘˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ÌÈÎÚ‹ ‰È¿ÚÎÂÈ· ·ÔÎÏÂÈÛÙÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È Ë ÚÒÈÌË ¤ÎıÂÛË Û ÚˆÙ½Ó˜ Á¿Ï·ÎÙÔ˜ ·ÁÂÏ¿‰Ô˜ Î·È ‰ËÌËÙÚȷο ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (1), Ë ÌÂÁ¿ÏË ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ (2) Î·È ÙÔ ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô (3). √È ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÌÔÚ› Ó· ıˆÚËıÔ‡Ó ÂÈÙ·¯˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ·˘ÙÔ¿ÓÔÛ˘ ηٷÛÙÚÔÊ‹˜ ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ (4). ∞ÓÙ›ıÂÙ·, Û‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜ (hygiene hypothesis), Ë ÌÂȈ̤ÓË ¤ÎıÂÛË Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, ˆ˜ Û˘Ó¤ÂÈ· ÙˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ Û˘ÓıËÎÒÓ ‰È·‚›ˆÛ˘, Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÏÏÂÚÁÈÎÒÓ Î·È ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ (5). ∆ÂÏÂ˘Ù·›·, Û‡Ìʈӷ Ì ÙËÓ ˘fiıÂÛË Ù˘ ÂÈÙ¿¯˘ÓÛ˘ (accelerator hypothesis), Èı·ÓÔÏÔÁÂ›Ù·È Ë Û˘¯ÓfiÙÂÚË ¤Ó·ÚÍË ÙÔ˘ ™¢1 ‹ ™¢2 Û ¿ÙÔÌ· Ì ·˘ÍË̤ÓÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È ÔÈ ‰‡Ô ·˘Ù¤˜ ÌÔÚʤ˜ ‰È·‚‹ÙË ·Ô‰›‰ÔÓÙ·È Û ÂÓÈ·›· ‰È·Ù·Ú·¯‹ Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË (6). √ ÛÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ ÙÔÓ ÚfiÏÔ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÔÈ ÔÔ›ÔÈ Èı·ÓÒ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË Û˘ÌÂÚȤϷ‚ fiÏ· Ù· ·È‰È¿ ËÏÈΛ·˜ 3,5 -14,9 ÂÙÒÓ, ÛÙ· ÔÔ›· ‰È·ÁÓÒÛıËΠ™¢1 ÛÙËÓ ∂ÏÏ¿‰· ÙÔ 1992. ∏ ÂÈÎÔÈÓˆÓ›· Ì fiÏ· Ù· ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›· (ȉȈÙÈο ‹ ‰ËÌfiÛÈ·) Ù˘ ∂ÏÏ¿‰·˜ ¤ÁÈÓ Ì ÂÈÛÙÔϤ˜ Î·È Ì ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›·, ÙfiÛÔ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘, fiÛÔ Î·È ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ 12Ô˘ Ì‹Ó· Ù˘ ÌÂϤÙ˘. ∂ÈÚfiÛıÂÙ·, ÂÈÛÙÔϤ˜ ÂÛÙ¿ÏËÛ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ È·ÙÚÔ‡˜ Ì ÂÍÂȉ›Î¢ÛË ÛÙÔ ™¢, Û ÂÓ‰ÔÎÚÈÓÔÏfiÁÔ˘˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ·È‰È¿ Ì ™¢1 ÛÙËÓ ∂ÏÏ¿‰·, ηıÒ˜ Î·È Û fiÏÔ˘˜ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ (7). ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi ÂÓÙÔ›Û·Ì ÛÙËÓ ∂ÏÏ¿‰·, ηٿ ÙÔ ¤ÙÔ˜ 1992, 106 ·È‰È¿ Ì ÚfiÛÊ·ÙË ‰È¿ÁÓˆÛË ™¢1. √ ÏËı˘ÛÌfi˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÂÚÈÏ¿Ì‚·Ó 150 ·È‰È¿ Ì ·Ó¿ÏÔÁË ËÏÈΛ· Î·È Ê‡ÏÔ. ∆· ·È‰È¿ ·˘Ù¿ ÓÔÛËχıËÎ·Ó ÁÈ· ÚÔÛˆÚÈÓfi Úfi‚ÏËÌ· (΋ÏË, ÔÍ›· ÛΈÏËÎÔÂȉ›Ùȉ·, Ó¢ÌÔÓ›·, Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ÎÏ) Î·È ‰ÂÓ ¤·Û¯·Ó ·fi ¯ÚfiÓÈÔ ÓfiÛËÌ·. ∞fi ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÂÍ·ÈÚ¤ıËÎ·Ó ·È‰È¿ Ô˘ ÓÔÛËχÔÓÙ·Ó ÛÙȘ ·È‰È·ÙÚÈΤ˜ ÎÏÈÓÈΤ˜ ÏfiÁˆ ÎÚ›ÛÂˆÓ ¿ÛıÌ·ÙÔ˜ ‹ ¿ÏÏˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ, ‰ÈfiÙÈ ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ‡·ÚÍË ·ÏÏÂÚÁÈÒÓ ·ÓÙ·ÁˆÓ›˙ÂÙ·È ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ (8). √È ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ ·¿ÓÙËÛ·Ó ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. √È ÂÚˆÙ‹ÛÂȘ Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÂÙ¤ıËÛ·Ó ·fi ·È‰›·ÙÚÔ Ì ÂÍÂȉ›Î¢ÛË ÛÙÔ ™¢1 Î·È ÔÈ ··ÓÙ‹ÛÂȘ Û˘ÌÏËÚÒıËÎ·Ó ·fi ÙÔÓ ›‰ÈÔ ÛÙÔ ¤ÓÙ˘Ô ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘. ∂ȉÈÎfiÙÂÚ·, fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÈÛÙÔÚÈÎfi ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ, Ô È·ÙÚfi˜ ¤Ï·‚ ÙȘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔ Â›‰Ô˜, ÙÔÓ ·ÚÈıÌfi ‰fiÛÂˆÓ Î·È ÙËÓ ËÏÈΛ· ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ·fi ÙÔ ‚È‚ÏÈ¿ÚÈÔ ÀÁ›·˜ ÙˆÓ ·È‰ÈÒÓ.

Paediatriki 2007;70:293-299

∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÂÚÈÏ¿Ì‚·Ó ÙȘ ÂÍ‹˜ ÏËÚÔÊÔڛ˜: ·) ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο Î·È ÔÈÎÔÁÂÓÂȷο ¯·Ú·ÎÙËÚÈÛÙÈο (ËÏÈΛ· ÁÔÓ¤ˆÓ, ÌfiÚʈÛË, Â·ÁÁÂÏÌ·ÙÈ΋ Î·È ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, ·ÚÈıÌfi˜ ·‰ÂÚÊÒÓ), ‚) ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (‰È·‚‹Ù˘, ˘¤ÚÙ·ÛË, ηډȷÁÁÂȷΤ˜ Î·È ·ÓÔÛÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ), Á) ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi: 1. ™˘¯ÓfiÙËÙ· ÏÔÈÌÒ͈Ó, fiÔ˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó: ∞. §ÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· Ì ·ıÔÁÓˆÌÔÓÈ΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· (·ÓÂÌ¢ÏÔÁÈ¿) ‹ ÙÂÎÌËÚȈ̤ӷ Ì ·ÓÙÈۈ̷ÙÈÎfi ¤ÏÂÁ¯Ô, fiˆ˜ Ë Ïԛ̈ÍË ·fi ÈÔ‡˜ ÂÚ˘ıÚ¿˜, ·ÚˆÙ›Ùȉ·˜, Epstein Barr (EBV) Î·È Î˘ÙÙ·ÚÔÌÂÁ·ÏÔÈfi (CMV). µ. ∫ÔÈÓ¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, fiˆ˜ ÔÈ ÏÔÈÌÒÍÂȘ ·fi ÈÔ‡˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘ (9). √È ÈÔ› Ô˘ ıˆÚÔ‡ÓÙ·È ˆ˜ ÔÈ ÈÔ Èı·ÓÔ› ÁÈ· ÙËÓ ÚfiÎÏËÛË ÎÔÈÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Â›Ó·È ÔÈ ÚÈÓÔ˚Ô›, ÔÈ Rota-ÈÔ› Î·È ÔÈ ÈÔ› Ù˘ ÁÚ›˘ Î·È Ù˘ ·Ú·ÁÚ›˘, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ˘¿Ú¯ÂÈ ·ıËÙÈ΋ ·ÓÔÛÔÔ›ËÛË (9). ∞ÓÙ›ıÂÙ·, ÏÔÈÌÒÍÂȘ Ô˘ ÚÔÏ·Ì‚¿ÓÔÓÙ·È Ì ٷ ÂÌ‚fiÏÈ·, fiˆ˜ Ë ÈÏ·Ú¿, Ë ·ÚˆÙ›Ùȉ·, Ë ÂÚ˘ıÚ¿, Ë ·ÓÂÌ¢ÏÔÁÈ¿ Î·È Ô ÎÔÎ·Ù˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÌÔÏ˘ÛÌ·ÙÈΤ˜ Î·È ÌÂÙ·‰›‰ÔÓÙ·È Â‡ÎÔÏ· (8). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ Î·ıÔÚ›ÛÙËΠˆ˜ ÂÍ‹˜: ·Ô˘Û›· ÏÔÈÌÒ͈Ó: ≤ 2/¤ÙÔ˜, Û¿ÓȘ: 2-5/¤ÙÔ˜, Û˘¯Ó¤˜:> 5/¤ÙÔ˜.

2. ∆‡Ô˜ Î·È ËÏÈΛ· ·ÓÔÛÔÔ›ËÛ˘ Ì ˙ÒÓÙ˜ ÂÍ·ÛıÂÓË̤ÓÔ˘˜ ÈÔ‡˜, ‰ËÏ·‰‹ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ ÈÏ·Ú¿˜-ÂÚ˘ıÚ¿˜·ÚˆÙ›Ùȉ·˜ (MMR).

3. πÛÙÔÚÈÎfi ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ (Ù‡Ô˜ Î·È Û˘¯ÓfiÙËÙ· ÂÂÈÛÔ‰›ˆÓ). √ ·È‰›·ÙÚÔ˜ Ì ÂÍÂȉ›Î¢ÛË ÛÙÔ ™¢1 η٤ÁÚ·Ê ÙËÓ ·ÎÚÈ‚‹ ·¿ÓÙËÛË ÙÔ˘ ÁÔÓ¤· ÛÙȘ ÂÚˆÙ‹ÛÂȘ “¶·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ·È‰› Û·˜ ·ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ; ∂¿Ó Ó·È, ÂÚÈÁÚ¿„Ù ÙȘ. ¶fiÛÔ Û˘¯Ó¿ ÙȘ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È ·fi ÔÈ· ËÏÈΛ·; ÃÚÂÈ¿ÛıËΠÓÔÛËÏ›· Û ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi;”. ™ÙË Û˘Ó¤¯ÂÈ·, ÔÈ ·ÛıÂÓ›˜ ηٷٿ¯ıËÎ·Ó ÛÙȘ ‰È¿ÊÔÚ˜ ηÙËÁÔڛ˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ (¿ÛıÌ·, ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·, ÎÓ›‰ˆÛË, ·ÁÁÂÈÔÓÂ˘ÚˆÙÈÎfi Ô›‰ËÌ·, ÂÈÂÊ˘Î›Ùȉ·, ÚÈÓ›Ùȉ·, ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· Î·È Ê·Ú̷΢ÙÈ΋ ·ÏÏÂÚÁ›·) Ì ‚¿ÛË ÙȘ ··ÓÙ‹ÛÂȘ, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ·ÏÏÂÚÁÈÔÏfiÁÔ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ.

4. ™˘¯ÓfiÙËÙ· Î·È ‰È¿ÚÎÂÈ· ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡. ªÂıÔ‰ÔÏÔÁ›· ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· Î·È Û ¿ÏϘ ¯ÒÚ˜, Ë Â·ÁÁÂÏÌ·ÙÈ΋ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ‰È·ÈÚÂ›Ù·È Û ¤ÍÈ ÔÌ¿‰Â˜: Â·ÁÁÂÏÌ·ÙÈ΋ ··Û¯fiÏËÛË (I), ‰ÈÔÈÎËÙÈ΋ Î·È Ù¯ÓÈ΋ ··Û¯fiÏËÛË (II), ÂȉÈÎÂ˘Ì¤ÓË ··Û¯fiÏËÛË (III), ËÌÈ-ÂȉÈÎÂ˘Ì¤ÓË ¯ÂÈÚˆÓ·ÎÙÈ΋ ··Û¯fiÏËÛË (IV) Î·È ·ÓÂȉ›Î¢ÙË ¯ÂÈÚˆÓ·ÎÙÈ΋ ··Û¯fiÏËÛË (V) (10). ™ÙË ÌÂϤÙË Ì·˜, Ë ÂÎÙ›ÌËÛË Ù˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ ÙˆÓ ÁÔÓ¤ˆÓ ‚·Û›ÛÙËΠÛÙÔ ÌÔÚʈÙÈÎfi Î·È Â·ÁÁÂÏÌ·ÙÈÎfi Â›Â‰Ô Î·È ÙˆÓ ‰˘Ô ÁÔÓ¤ˆÓ Ù·˘Ùfi¯ÚÔÓ·. ™˘ÁÎÂÎÚÈ̤ӷ, Â¿Ó Î·È ÔÈ ‰˘Ô ÁÔÓ›˜ ›¯·Ó Ï¿‚ÂÈ ·ÓÒÙÂÚË ‹ ·ÓÒÙ·ÙË ÂÎ·›‰Â˘ÛË Î·È ·Ó‹Î·Ó ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ηÙËÁÔÚ›· I ‹ II, ÙfiÙÂ Ë ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ˆ˜ “∞ÓÒÙÂÚË”. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Î·È ÔÈ ‰˘Ô ÁÔÓ›˜ ‹Ù·Ó ̤¯ÚÈ ·fiÊÔÈÙÔÈ ÙÔ˘ §˘Î›Ԣ Î·È ·Ó‹Î·Ó ÛÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ηÙËÁÔÚ›· III, IV ‹ V, ÙfiÙÂ Ë ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ˆ˜ “∫·ÙÒÙÂÚË”. ∏ “ª¤ÛË” ÎÔÈÓˆÓÈ΋ Ù¿ÍË ÂÚÈÏ¿Ì‚·Ó fiϘ ÙȘ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· Stata 8. ∆· ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ·ÛıÂÓÒÓ Î·È Ì·ÚÙ‡ÚˆÓ Ì ÙË ‰ÔÎÈÌ·Û›· x2,

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·295

295

¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Î·È ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1

ÂÎÙfi˜ ·fi ÙËÓ ËÏÈΛ·, ÁÈ· ÙËÓ ÔÔ›· ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË·Ú·ÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· Mann-Whitney U Test. ∏ ÌÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ÂÚÈÂÏ¿Ì‚·Ó ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Û¯ÂÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ (Ôdds ratio) ÂÌÊ¿ÓÈÛ˘ ™¢1 ÁÈ· οı ÌÂÙ·‚ÏËÙ‹ ͯˆÚÈÛÙ¿. ™Â ‰Â‡ÙÂÚË Ê¿ÛË, ÔÈ ›‰È˜ Û˘Û¯ÂÙ›ÛÂȘ ÂÍÂÙ¿ÛıËÎ·Ó ÌÂÌÔӈ̤ӷ ÁÈ· ÙË ÌÂÛ·›·/·ÓÒÙÂÚË Î·È ÙËÓ Î·ÙÒÙÂÚË ÎÔÈÓˆÓÈ΋ Ù¿ÍË. ªÂ ÙËÓ ·Ó¿Ï˘ÛË Ù˘ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ÂÎÙÈÌ‹ıËÎÂ Ë ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ·ÓˆÙ¤ÚˆÓ ÌÔÓÔÌÂÙ·‚ÏËÙÒÓ ÛÙËÓ ÂΉ‹ÏˆÛË ™¢1, Î·È Â›Û˘ ‰È·ÈÛÙÒıËÎÂ Â¿Ó ·˘Ù‹ Ë Û˘Û¯¤ÙÈÛË ÙÚÔÔÔÈÔ‡Ù·Ó ·fi ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË.

∞ÔÙÂϤÛÌ·Ù· A. ∫·Ù·ÓÔÌ‹ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· ∏ ÌÂϤÙË ÂÚȤϷ‚ 106 ·È‰È¿ (55,7% ·ÁfiÚÈ· Î·È 44,3% ÎÔÚ›ÙÛÈ·) Ì ÚfiÛÊ·Ù· ‰È·ÁÓˆÛı¤ÓÙ· ™¢1 (Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜ ·fi ÙË ‰È¿ÁÓˆÛË) Î·È 150 Ì¿ÚÙ˘Ú˜ (55,3% ·ÁfiÚÈ· Î·È 44,7% ÎÔÚ›ÙÛÈ·), Ì ·Ó¿ÏÔÁË ËÏÈΛ· Î·È Ê‡ÏÔ. ∏ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ‰È·‚‹ÙË Î˘Ì·ÈÓfiÙ·Ó ·fi Ù· 3,5 ¤ˆ˜ Ù· 14,9 ¤ÙË (‰È¿ÌÂÛÔ˜ ÙÈÌ‹=11,7) Î·È ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ·fi ÙËÓ ËÏÈΛ· ÂͤٷÛ˘ ÙˆÓ Ì·ÚÙ‡ÚˆÓ.

B. ªÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ, Â·ÁÁÂÏÌ·ÙÈ΋ Î·È ÎÔÈÓˆÓÈ΋ Ù¿ÍË √È ·Ù¤Ú˜ ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ·fi ÂΛÓÔ˘˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ˆ˜ ÚÔ˜ ÙÔ ÌÔÚʈÙÈÎfi Â›‰Ô, ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ Î·È ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË. ∞ÓÙ›ıÂÙ·, ÔÈ ÌËÙ¤Ú˜ ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 ÂÌÊ¿ÓÈ˙·Ó ÈÔ Û˘¯Ó¿ ¯·ÌËÏfiÙÂÚÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô (‚·ÛÈ΋ Î·È ‰Â˘ÙÂÚÔ‚¿ıÌÈ· ÂÎ·›‰Â˘ÛË) (p<0,001), ·Û¯ÔÏÔ‡ÓÙ·Ó Û ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi Ì ٷ ÔÈÎȷο (75%) Î·È ·Ó‹Î·Ó ÛÙËÓ Î·ÙÒÙÂÚË ÎÔÈÓˆÓÈ΋ Ù¿ÍË Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi (92,1%), Û˘ÁÎÚÈÙÈο Ì ÂΛӘ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ·ÓÙ›ÛÙÔȯ· (ÔÈÎȷο: 57,7%, p=0,022, ÎÔÈÓˆÓÈ΋ Ù¿ÍË: 75,3%, p=0,001). √ ηıÔÚÈÛÌfi˜ Ù˘ ÔÈÎÔÁÂÓÂȷ΋˜ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ ‚·Û›ÛÙËΠÙfiÛÔ ÛÙËÓ ·ÙÚÈ΋, fiÛÔ Î·È ÛÙË ÌËÙÚÈ΋ ÎÔÈÓˆÓÈ΋ Ù¿ÍË. ¶·Ú·ÙËÚ‹ıËΠfiÙÈ Ë Û˘¯ÓfiÙËÙ· Ù˘ ηÙÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ ‹Ù·Ó ÔÚȷο ˘„ËÏfiÙÂÚË ÛÙ· ·È‰È¿ Ì ‰È·‚‹ÙË (46,2%),

Û˘ÁÎÚÈÓfiÌÂÓË Ì ÂΛÓË ÙˆÓ Ì·ÚÙ‡ÚˆÓ (34,9%) (p=0,07) (¶›Ó·Î·˜ 1). °. ªÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 Û˘ÁÎÚ›ıËΠ̠ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ˆ˜ ÚÔ˜ ÙÔ ÈÛÙÔÚÈÎfi ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÎÔÈÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì MMR Î·È ÙÔ ÈÛÙÔÚÈÎfi ·ÏÏÂÚÁÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ (¶›Ó·Î·˜ 2). ∂ÎÙÈÌ‹ıËΠÂ›Û˘ Ë ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ·Ú·¿Óˆ Û¯¤ÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ÙˆÓ ÁÔÓ¤ˆÓ. ∞fi ÙËÓ ÌÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ‰È·ÈÛÙÒÛ·Ì fiÙÈ ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ÂÌÊ·Ó›˙ÂÈ ÚÔÛٷ٢ÙÈ΋ Â›‰Ú·ÛË ¤Ó·ÓÙÈ ÙÔ˘ ™¢1 ·) ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 (¶›Ó·Î·˜ 2, OR = 0,45, p = 0,003), ‚) ÛÙ· ·È‰È¿ Ù˘ ̤Û˘ Î·È ·ÓÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ (OR=0,35, p=0,004), ·ÏÏ¿ fi¯È Û ÂΛӷ Ù˘ ηÙÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘. ∂ÈϤÔÓ, Ë ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ· ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Û¯ÂÙÈ˙fiÙ·Ó Ì ¯·ÌËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ™¢1 ÛÙË Û˘ÓÔÏÈ΋ ÔÌ¿‰· ·È‰ÈÒÓ Ì ™¢1 (¶›Ó·Î·˜ 2, OR=0,89, p=0,032), ·ÏÏ¿ fi¯È ÛÙȘ ÂÈ̤ÚÔ˘˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ. ¢È·ÈÛÙÒıËΠ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ·ÚÔ˘Û›·˜ ÏÔÈÌÒÍÂˆÓ Î·È ÙÔ˘ ™¢1 (¶›Ó·Î·˜ 2, OR=0,51, p=0,020). √ ÚÔÛٷ٢ÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ‰È·ÈÛÙÒıËΠÂ›Û˘ ÁÈ· Ù· ·È‰È¿ Ì ™¢1 Ù˘ ηÙÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ (OR=0,35, p=0,026), ·ÏÏ¿ fi¯È ÁÈ· ÂΛӷ Ù˘ ̤Û˘ Î·È ·ÓÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘. ∂ȉÈÎfiÙÂÚ·, ÔÈ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·Ó Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙËÓ ÂÌÊ¿ÓÈÛË ™¢1 Ô‡Ù ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 (¶›Ó·Î·˜ 2), Ô‡Ù ÛÙȘ ÂÈ̤ÚÔ˘˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ. ∞ÓÙ›ıÂÙ·, Ë ·ÚÔ˘Û›· ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ÂËÚ¤·˙ ÛËÌ·ÓÙÈο ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1 ·) ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ì ™¢1 (¶›Ó·Î·˜ 2, OR = 0,47, p=0,011) Î·È ‚) Û ÂΛӷ Ù˘ ηÙÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ (OR=0,30, p=0,014). ŸÛÔÓ ·ÊÔÚ¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ ÚÒÙ˘ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, ÔÈ ÏÔÈÌÒÍÂȘ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·Ó Î˘Ú›ˆ˜ ÛÙ· ‰˘Ô ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ (¶›Ó·Î·˜ 2, OR=0,33, p=0,005) ‹ Î·È ·ÚÁfiÙÂÚ· (OR=0,53, p=0,053), ‰ÚÔ‡Û·Ó ÚÔÛٷ٢ÙÈο ¤Ó·ÓÙÈ Ù˘ ÂΉ‹ÏˆÛ˘ ÙÔ˘ ™¢1.

¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË ·Ó¿ÏÔÁ· Ì ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ÙˆÓ ÁÔÓ¤ˆÓ ¶·ÙÚÈ΋ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¶·È‰È¿ Ì ‰È·‚‹ÙË ª¿ÚÙ˘Ú˜ N = 106 (%) N = 146 (%) ∫·ÙÒÙÂÚË ∞ÓÒÙÂÚË

49 (46,23) 57 (53,77) p-value = 0,211

56 (38,36) 90 (61,64) p-value = 0,001

∫ÔÈÓˆÓÈ΋ Ù¿ÍË ÙˆÓ ÁÔÓ¤ˆÓ ªËÙÚÈ΋ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¶·È‰È¿ Ì ‰È·‚‹ÙË ª¿ÚÙ˘Ú˜ N = 88 (%) N = 146 (%) 81 (92,05) 7 (7,95) p-value = 0,070

110 (75,34) 36 (24,66)

√ÈÎÔÁÂÓÂȷ΋ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¶·È‰È¿ Ì ‰È·‚‹ÙË ª¿ÚÙ˘Ú˜ N = 106 (%) N = 146 (%) 49 (46,23) 57 (53,77)*

51 (34,93) 95 (65,07)*

* ∏ ÔÈÎÔÁÂÓÂȷ΋ ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¤¯ÂÈ ÔÚÈÛı› Ì ÙÚ›· Â›‰· ‚·ÛÈ˙fiÌÂÓË ÛÙȘ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ ÙÔ˘ ·Ù¤Ú· Î·È Ù˘ ÌËÙ¤Ú·˜: ηÙÒÙÂÚË, ̤ÛË, ·ÓÒÙÂÚË. ∂‰Ò Ë Ì¤ÛË Î·È Ë ·ÓÒÙÂÚË ÎÔÈÓˆÓÈ΋ Ù¿ÍË Û˘ÁÎÚ›ÓÔÓÙ·È Ì ÙËÓ Î·ÙÒÙÂÚË ÎÔÈÓˆÓÈ΋ Ù¿ÍË ¶·È‰È·ÙÚÈ΋ 2007;70:293-299

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·296

296

∫. ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ªÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË: Ë Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ, ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì MMR ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1 N (ÂÚÈÙÒÛÂȘ / ¶·È‰È¿ Ì ̿ÚÙ˘Ú˜) ‰È·‚‹ÙË (%) ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ ¢È¿ÚÎÂÈ· ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ (Û ̋Ó˜)*

ª¿ÚÙ˘Ú˜ (%)

OR (95% CI)

p-value

103/150 96/140

53 (51,46) 0 (0, 8)

105 (70,00) 1 (0, 8)

0,45 (0,27, 0,77) 0,89 (0,79, 0,99)**

0,003 0,032

106/99

57 (53,77)

69 (69,70)

0,51 (0,28, 0,91)

0,020

106/99

49 (46,23) 8 (7,55)

64 (64,65) 5 (5,05)

0,47 (0,26, 0,85) 0,98 (0,29, 3,29)

0,011 0,973

¶ÂÚ›Ô‰Ô˜ Ù˘ ˙ˆ‹˜ Ì ÙËÓ ÚÒÙË ¤ÎıÂÛË ÛÙȘ ÏÔÈÌÒÍÂȘ ¶ÚÒÙ· 2 ¤ÙË ˙ˆ‹˜ 106/99 ∞ÚÁfiÙÂÚ·

17 (16,04) 48 (45,28)

28 (28,28) 49 (49,49)

0,33 (0,14, 0,75) 0,53 (0,27, 1,02)

0,005 0,053

™˘¯ÓfiÙËÙ· ÏÔÈÌÒÍÂˆÓ (2 ÊÔÚ¤˜ / ¤ÙÔ˜) ¤Ó·ÓÙÈ (< 2 ÊÔÚ¤˜/ ¤ÙÔ˜)

75/94

15 (20,00)

52 (55,32)

0,20 (0,10, 0,43)

<0,001

∂Ì‚ÔÏÈ·ÛÌfi˜ ∂Ì‚ÔÏÈ·ÛÌfi˜ Ì MMR ∏ÏÈΛ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì MMR*

106/97 51/92

51 (48,11) 1,5 (1,0, 4,0)

∞ÏÏÂÚÁÈΤ˜ ·ÓÙȉڿÛÂȘ ∞ÏÏÂÚÁ›Â˜

90/36

34 (37,38)

§ÔÈÌÒÍÂȘ §ÔÈÌÒÍÂȘ ∂›‰Ô˜ ÏÔÈÌÒÍÂˆÓ πÔÁÂÓ›˜ µ·ÎÙËÚȷΤ˜

92 (94,85) 0,05 (0,02, 0,16) <0,001 1.3 (1,2, 3,9) 1,59 (1,01, 2,50)** 0,046 33 (91,67)

0,06 (0,01, 0,23)

<0,001

* Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÔÈ ‰È¿ÌÂÛ˜ ÙÈ̤˜ Î·È Ù· ·ÓÙ›ÛÙÔȯ· ÂÓ‰ÔÙÂÙ·ÚÙËÌÔÚȷο ‡ÚË. ** OR ηٿ ÌÈ· ÌÔÓ¿‰· ·˘Í¿ÓÂÙ·È ÛÙËÓ “¤ÎıÂÛË”.

∏ Û˘Û¯¤ÙÈÛË ·˘Ù‹ ·Ú¤ÌÂÈÓ ÛËÌ·ÓÙÈ΋ ÁÈ· Ù· ·È‰È¿ Ì ™¢1 Ù˘ ηÙÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘, ·ÏÏ¿ fi¯È ÁÈ· ÂΛӷ Ù˘ ̤Û˘ Î·È ·ÓÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘. ∞Ó·ÊÔÚÈο Ì ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, Ë ·ÚÔ˘Û›· ‰˘Ô ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ÏÔÈÌÒ͈Ó/¤ÙÔ˜ Û¯ÂÙÈ˙fiÙ·Ó Ì ÌÈÎÚfiÙÂÚÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ™¢1, Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÏÈÁfiÙÂÚˆÓ ·fi ‰‡Ô ÏÔÈÌÒÍÂˆÓ ÙÔÓ ¯ÚfiÓÔ (¶›Ó·Î·˜ 2, OR=0,20, p<0,001). ∏ ·Ú·¿Óˆ Û˘Û¯¤ÙÈÛË ·Ú¤ÌÂÈÓ ÛËÌ·ÓÙÈ΋ Î·È ÛÙȘ ÂÈ̤ÚÔ˘˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì MMR Â›Û˘ ·ԉ›¯ıËΠfiÙÈ ‰Ú· ÚÔÛٷ٢ÙÈο ¤Ó·ÓÙÈ Ù˘ ÂΉ‹ÏˆÛ˘ ™¢1, ÙfiÛÔ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ (¶›Ó·Î·˜ 2, OR=0,05, p<0,001) fiÛÔ Î·È ÛÙȘ ÂÈ̤ÚÔ˘˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ. ∆· ·È‰È¿ Ì ™¢1 ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì MMR Û ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ (¶›Ó·Î·˜ 2, OR=1,59, p=0,046). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ ÛÙȘ ÂÈ̤ÚÔ˘˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ. ∏ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÁÂÓÈο ‰ÚÔ‡Û ÚÔÛٷ٢ÙÈο ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1 (OR=0,06, p<0,001)(¶›Ó·Î·˜ 2). ∏ Û˘Û¯¤ÙÈÛË ·˘Ù‹ ‰ÂÓ ‰È·ÊÔÚÔÔÈ‹ıËΠÛÙȘ ÂÈ̤ÚÔ˘˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ (ηÙÒÙÂÚË: OR=0,08, p=0,06, ·ÓÒÙÂÚË Î·È Ì¤ÛË Ù¿ÍË: OR=0,05, p<0,001).

Paediatriki 2007;70:293-299

¢. ∞Ó¿Ï˘ÛË ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ™ÙÔ ÌÔÓÙ¤ÏÔ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Û˘ÌÌÂÙ›¯·Ó ÔÈ ·ÎfiÏÔ˘ı˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó ÛËÌ·ÓÙÈο Ì ÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1 ηٿ ÙËÓ ÌÔÓÔ·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË (Û˘¯ÓfiÙËÙ· ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·È ÂÚ›Ô‰Ô˜ ˙ˆ‹˜ Ô˘ ¤ÁÈÓÂ Ë ÚÒÙË ¤ÎıÂÛË Û ·˘Ù¤˜, Û˘¯ÓfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì MMR, ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È ÎÔÈÓˆÓÈ΋ Ù¿ÍË) (¶›Ó·Î·˜ 3), Ì ÛÎÔfi Ó· ÌÂÏÂÙËı› Ë ·ÏÏËÏÂ›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1. ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ÂȂ‚·›ˆÛ ÙÔÓ ÚÔÛٷ٢ÙÈÎfi ÚfiÏÔ Ù˘ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1 (OR=0,10, 95% CI: (0,03, 0,40)). ∂›Û˘, Ë ·ÚÔ˘Û›· ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, ›Ù ηٿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜ (OR=0,08, 95% CI: (0,01, 0,93)), ›Ù ·ÚÁfiÙÂÚ· (OR=0,07, 95% CI: (0,07, 0,70)) ‰È·‰Ú·Ì·Ù›˙ÂÈ ÚÔÛٷ٢ÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1. ∂ÈÚfiÛıÂÙ·, Ë ÂΉ‹ÏˆÛË ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÏÔÈÌÒ͈Ó/¯ÚfiÓÔ Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ™¢1, Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÂΉ‹ÏˆÛË ÏÈÁfiÙÂÚˆÓ ·fi ‰‡Ô ÏÔÈÌÒÍÂˆÓ ÙÔÓ ¯ÚfiÓÔ (OR=0,11, 95% CI: (0,02, 0,50)). ∂›Û˘, Ù· ·È‰È¿ Ù˘ ηÙÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ™¢1, Û˘ÁÎÚÈÓfiÌÂÓ·

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·297

297

¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Î·È ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1

¶›Ó·Î·˜ 3. ∞Ó¿Ï˘ÛË Ù˘ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ˆ˜ ÚÔ˜ ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1

∞ÏÏÂÚÁÈΤ˜ ÂΉËÏÒÛÂȘ ¶ÂÚ›Ô‰Ô˜ Ù˘ ˙ˆ‹˜ ηٿ ÙËÓ ÚÒÙË ¤ÎıÂÛË ÛÙȘ ÏÔÈÌÒÍÂȘ ™˘¯ÓfiÙËÙ· ÏÔÈÌÒÍÂˆÓ ( 2 ÊÔÚ¤˜ / ¤ÙÔ˜ ¤Ó·ÓÙÈ < 2ÊÔÚ¤˜/¤ÙÔ˜) ∫ÔÈÓˆÓÈ΋ Ù¿ÍË (̤ÛË & ·ÓÒÙÂÚË ¤Ó·ÓÙÈ Î·ÙÒÙÂÚ˘)

Ì ÂΛӷ Ù˘ ̤Û˘ Î·È ·ÓÒÙÂÚ˘ ÎÔÈÓˆÓÈ΋˜ Ù¿Í˘ (OR = 0,16, 95% CI: (0,03, 0,80)). ™ÙËÓ ·Ó¿Ï˘ÛË Ù˘ ÔÏÏ·Ï‹˜ ÏÔÁÈÛÙÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘, Ë Â›‰Ú·ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì MMR ‰ÂÓ Û˘Ó¤‚·Ï·Ó ÛËÌ·ÓÙÈο ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢1.

™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÂÈ ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙÔÓ ÚfiÏÔ ÙˆÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ˙ÒÓÙ˜ ÂÍ·ÛıÂÓË̤ÓÔ˘˜ ÈÔ‡˜, ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Î·È Ù˘ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁÈÒÓ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1. ∞fi ÙÔ˘˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÔÚÈṲ̂ÓÔÈ ÈÔ› (Coxsackie, Echo, Rota, CMV, ∂Ú˘ıÚ¿˜ Î·È ¶·ÚˆÙ›Ùȉ·˜) ¤¯ÂÈ ıˆÚËı› fiÙÈ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ ™¢1 (11,12). ªÂÚÈΤ˜ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ·ÔÙÂÏÔ‡Ó Èı·ÓÔ‡˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ ‹ ÂÈÙ·¯˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ™¢1 (13,14). ∞ÓÙ›ıÂÙ·, Ë ˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜ (5) ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ÙÔ ˘„ËÏfi ‚ÈÔÙÈÎfi Â›Â‰Ô Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓË ¤ÎıÂÛË Û ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ Î·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ ·ÏÏÂÚÁÈÒÓ Î·È ·˘ÙÔ¿ÓÔÛˆÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∂›Û˘, Ë ıˆڛ· ·˘Ù‹ ˘ÔÛÙËÚ›˙ÂÈ ˆ˜ Ô ÌÂȈ̤ÓÔ˜ ·ÓÔÛÔÏÔÁÈÎfi˜ ÂÚÂıÈÛÌfi˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (ȉȷ›ÙÂÚ· ηٿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜), ÙÔ Î¿ÓÂÈ ÈÔ Â˘¿ÏˆÙÔ ÛÙË ÌÂÙ¤ÂÈÙ· ¤ÎıÂÛË ÛÙÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÁÂÁÔÓfi˜ Ô˘ ÂӉ¯Ô̤ӈ˜ ÂÈÛ‡‰ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ™¢1 Î·È ·ÏÏÂÚÁÈÒÓ (15,16). ¶Ú¿ÁÌ·ÙÈ, Ù· ·È‰È¿ Ì ‰È·‚‹ÙË Ù˘ ÌÂϤÙ˘ Ì·˜ ÂÌÊ¿ÓÈ˙·Ó ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÎÔÈÓ¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜, ȉȷ›ÙÂÚ· ηٿ Ù· ‰‡Ô ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜ Î·È ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ‹Ù·Ó ÈÔ ¤Î‰ËÏÔ ÛÙȘ ηÙÒÙÂÚ˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ. ¶ÔÈΛϷ ‰Â‰Ô̤ӷ ˘Ê›ÛÙ·ÓÙ·È ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È Ù˘ ÂΉ‹ÏˆÛ˘ ™¢1 ÛÙ· ·È‰È¿. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ (17,18) ıˆÚÔ‡Ó ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ì MMR ˆ˜ ÚÔÛٷ٢ÙÈÎfi ·Ú¿ÁÔÓÙ· ¤Ó·ÓÙÈ ÏÔÈÌÒÍÂˆÓ Ô˘ Èı·ÓfiÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂΉ‹Ïˆ-

¶ÚÒÙ· 2 ¤ÙË ˙ˆ‹˜ ∞ÚÁfiÙÂÚ·

OR

95% CI

p-value

0,10 0,08 0,07

(0,03, 0,40) (0,01, 0,93) (0,07, 0,70)

0,001 0,043 0,024

0,11

(0,02, 0,50)

0,004

0,16

(0,03, 0,80)

0,026

ÛË ™¢1. ™ÙË ÌÂϤÙË Ì·˜, ÛÙ· ·È‰È¿ Ì ‰È·‚‹ÙË ‰È·ÈÛÙÒıËΠÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì MMR Î·È ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· ÂÌ‚ÔÏÈ·ÛÌÔ‡, Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∆· ‰Â‰Ô̤ӷ ·˘Ù¿ Èı·ÓfiÓ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Ë ÌÂȈ̤ÓË ‹ Î·È Î·ı˘ÛÙÂÚË̤ÓË ‰È¤ÁÂÚÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Úԉȷı¤ÙÂÈ ÛÙËÓ ÂΉ‹ÏˆÛË ÙÔ˘ ™¢1 Î·È Û˘ÌʈÓÔ‡Ó Ì ÙËÓ ˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜ (5,19). ∏ Û¯¤ÛË ÌÂٷ͇ ·ÙÔ›·˜ Î·È ·˘ÙÔ·ÓÔÛ›·˜ Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓË. ∫·Ù¿ ÙËÓ ıˆڛ· ÙÔ˘ Th1/Th2 ·Ú·‰Â›ÁÌ·ÙÔ˜ (20,21), Ù· ∆2 ‚ÔËıËÙÈο ÏÂÌÊÔ·ÙÙ·Ú· (∆h2) ¢ԉÒÓÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ IgE ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, ̤ۈ Ù˘ ·ÂÏ¢ı¤ÚˆÛ˘ ΢ÙÙ·ÚÔÎÈÓÒÓ, ÂÓÒ Ù· ∆1 ‚ÔËıËÙÈο ÏÂÌÊÔ·ÙÙ·Ú· (Th1) ÙËÓ ÂÚÈÔÚ›˙Ô˘Ó Î·È ÚÔ¿ÁÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÔ·ÓfiÛˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Ô ™¢1 (22). ∫·Ù¿ Û˘Ó¤ÂÈ·, Û ÂÚÈÙÒÛÂȘ ·˘ÙÔ¿ÓÔÛˆÓ ·ı‹ÛˆÓ, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ∆h2 ·ÏÏÂÚÁÈÎÒÓ ·ı‹ÛÂˆÓ Â›Ó·È ÌÂȈ̤ÓË. ¶Ú¿ÁÌ·ÙÈ, ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ù· ·È‰È¿ Ì ™¢1 ÂÌÊ·Ó›˙Ô˘Ó ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂΉ‹ÏˆÛË ·ÙÔÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (8) Î·È Ù· ·È‰È¿ Ì ·ÙÔÈÎfi ¤Î˙ÂÌ· ¤¯Ô˘Ó ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÂΉ‹ÏˆÛË ™¢1, ÁÂÁÔÓfi˜ Ô˘ ‰Â›¯ÓÂÈ fiÙÈ Ô Ù‡Ô˜ ·˘Ùfi˜ Ù˘ ·ÙÔÈ΋˜ ·ÓÙ›‰Ú·Û˘ ›Ûˆ˜ ·Ú¤¯ÂÈ ÌÂÚÈ΋ ÚÔÛÙ·Û›· ¤Ó·ÓÙÈ ÙÔ˘ ™¢1 (23). ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÌʈÓÔ‡Ó Ì ÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜, ·ÊÔ‡ ‰È·ÈÛÙÒÛ·Ì ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ·ÏÏÂÚÁÈÒÓ Û ·È‰È¿ Ì ™¢1, Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∞ÓÙ›ıÂÙ·, ¿ÏϘ ÌÂϤÙ˜ (24) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ¿ÛıÌ·ÙÔ˜ ‹Ù·Ó ·˘ÍË̤ÓË Û ·È‰È¿ Ì ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ô ™¢1 Î·È Ë ÎÔÈÏÈÔοÎË, Û ۇÁÎÚÈÛË Ì ÂΛÓË ÛÙ· Ê˘ÛÈÔÏÔÁÈο ·È‰È¿. ™ÙȘ ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ ¿Óˆ ÛÙÔ ı¤Ì· Ù˘ Èı·Ó‹˜ Û˘Ó‡·Ú͢ ‹ fi¯È ·ÙÔ›·˜ Î·È ·˘ÙÔ·ÓÔÛ›·˜, ÔÈ Huang Î·È Û˘Ó. (25) ÚÔÙ›ÓÔ˘Ó ÙËÓ ÂÚÌËÓ›· fiÙÈ Ë ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË Ù‡Ô˘ Th2 ·Ú¯›˙ÂÈ ÓˆÚ›˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÚÔ¿ÁÔÓÙ·˜ ÙËÓ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÒÓ Î·È ÛÙ·Ì·Ù¿ Û οÔÈ· ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹. ∞ÓÙ›ıÂÙ·, Ë Th1 ·¿ÓÙËÛË Â›Ó·È Ì›· Ì·ÎÚ¿ ‰È·‰Èηۛ·, Ô˘ ‰È·ÚΛ ·fi Ì‹Ó˜ ¤ˆ˜ Î·È 10 ¯ÚfiÓÈ·, ˆ˜ ÙËÓ Ï‹ÚË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘ ÔÚÁ¿ÓÔ˘-ÛÙfi¯Ô˘ (fiˆ˜ Ù· ‚·ÙÙ·Ú· ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜). ŸÙ·Ó Ë ‰È·‰Èηۛ· ·˘Ù‹ ¶·È‰È·ÙÚÈ΋ 2007;70:293-299

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·298

298

∫. ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó.

ÔÏÔÎÏËÚˆı›, ÌÔÚ› Ó· ÂÓÂÚÁÔÔÈËı› Ë Th2 ·¿ÓÙËÛË Ô‰ËÁÒÓÙ·˜ Û ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÒÓ. √ ÚfiÏÔ˜ Ù˘ ¤Ó·Ú͢ Ï‹„˘ ͤÓ˘ ÙÚÔÊ‹˜ ·fi ÙÔ ‚Ú¤ÊÔ˜ ˆ˜ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ™¢1 ‹ ™¢2 ÛÙË ÌÂÙ¤ÂÈÙ· ˙ˆ‹ Â›Ó·È ·ÌÊÈÏÂÁfiÌÂÓÔ˜ (26). Œ¯ÂÈ ·Ô‰ÂȯÙ› fiÙÈ Ë ˘ÁÈÂÈÓ‹ Î·È Ë ËÌÈ-·ÔÛÙÂÈڈ̤ÓË ‰È·ÙÚÔÊ‹ ηٿ ÙËÓ ÚÒÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (27) ÙÚÔÔÔÈ› ÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ì ‚·ÎÙËÚ›‰È· Î·È ÚÔÛٷهÂÈ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ·ÏÏÂÚÁÈÒÓ Î·È ·˘ÙÔ·ÓÔÛ›·˜. ∞ÓÙ›ıÂÙ·, Ë ÚÒÈÌË ¤ÎıÂÛË ÛÙȘ ÚˆÙ½Ó˜ ÙÔ˘ Á¿Ï·ÙÔ˜ ·ÁÂÏ¿‰·˜ (1) Î·È ÛÙ· ‰ËÌËÙÚȷο, ηıÒ˜ Î·È ÙÔ ·˘ÍË̤ÓÔ ‚¿ÚÔ˜ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (6) ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ˆ˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ™¢1. ∂Ô̤ӈ˜, Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Â›Ó·È ‰˘Ó·Ùfi Ó· “ÂϤÁÍÔ˘Ì”, ̤ۈ Ù˘ ‰È·ÙÚÔÊÈ΋˜ ·Ú¤Ì‚·Û˘, ÙËÓ ·˘ÙÔ·ÓÔÛ›· ¤Ó·ÓÙÈ ÙˆÓ ‚-΢ÙÙ¿ÚˆÓ, Ì ÙÔÓ ·ÔÎÏÂÈÛÙÈÎfi Î·È ·Ú·ÙÂٷ̤ÓÔ ÌËÙÚÈÎfi ıËÏ·ÛÌfi (28). ∏ ÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ™¢1 ¤¯ÂÈ ·Ô‰Âȯı› Î·È ÛÙË ÌÂϤÙË Ì·˜ ÛÙ· ·È‰È¿ Ì ‰È·‚‹ÙË, Î·È È‰È·›ÙÂÚ· Û ÂΛӷ ÙˆÓ ·ÓÒÙÂÚˆÓ ÎÔÈÓˆÓÈÎÒÓ Ù¿ÍˆÓ. ø˜ ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ÌÂϤÙ˘ Ì·˜ ÌÔÚ› Ó· ıˆÚËı› fiÙÈ Ë ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ ÂÚȤϷ‚ ·È‰È¿ Ô˘ ÓÔÛËχıËÎ·Ó Ì Ô͇ ·È‰È·ÙÚÈÎfi Úfi‚ÏËÌ· (Á·ÛÙÚÂÓÙÂÚ›Ùȉ·). ŸÌˆ˜, ÈÛÙ‡ԢÌ fiÙÈ Ë ÂÈÏÔÁ‹ ·˘ÙÒÓ ÙˆÓ Ì·ÚÙ‡ÚˆÓ ‰ÂÓ ÂËÚ¤·Û ÙËÓ ·ÍÈÔÈÛÙ›· ÙÔ˘˜ ÛÙËÓ ·¿ÓÙËÛË ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ù˘ ÌÂϤÙ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ Û ̛· ÔÌ¿‰· ·È‰ÈÒÓ Ì ÚfiÛÊ·Ù· ‰È·ÁÓˆṲ̂ÓÔ ™¢1, Ë ·ÚÔ˘Û›· Û˘¯ÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ Î·Ù¿ Ù· 2 ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, Ô ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜, Ë ·ÚÔ˘Û›· ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ, ηıÒ˜ Î·È Ë ÚԤϢÛË ·fi ÙȘ ·ÓÒÙÂÚ˜ ÎÔÈÓˆÓÈΤ˜ Ù¿ÍÂȘ ‹Ù·Ó ·Ú¿ÁÔÓÙ˜ ÚÔÛٷ٢ÙÈÎÔ› ÛÙËÓ ÂÌÊ¿ÓÈÛË ™¢1. √È ÎÏÈÓÈΤ˜ ·˘Ù¤˜ ·Ú·ÙËÚ‹ÛÂȘ Ô‰ËÁÔ‡Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÎÔÈÓÔ› ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (fiˆ˜ ÌÂȈ̤ÓÔ˜ ·ÓÔÛÔÏÔÁÈÎfi˜ ÂÚÂıÈÛÌfi˜ ηٿ Ù· ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜) ÚÔ¿ÁÔ˘Ó ÙËÓ ÂΉ‹ÏˆÛË ·ÙÔ›·˜ Î·È ·˘ÙÔ·ÓÔÛ›·˜. ŸÌˆ˜, Â›Ó·È Èı·Ófi Ë ·ÏÏËÏÂ›‰Ú·ÛË ÌÂٷ͇ Ù˘ Th1 Î·È Th2 ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ Ó· ‰Ú· ÚÔÛٷ٢ÙÈο ÛÙËÓ ÂÌÊ¿ÓÈÛË ™¢1.

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ORIGINAL ARTICLE

∂ηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 3 ¤ˆ˜ 16 ÂÙÒÓ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ∆Ì‹Ì· π·ÙÚÈ΋˜, ∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜, ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: EÌÌ·ÓÔ˘‹Ï §ÈÓ·Ú‰¿Î˘ linman@med.uoc.gr ¢È·ÛÙ·‡ÚˆÛË µÔ‡Ù˜ – ™Ù·˘Ú¿ÎÈ· ∆.∫. 71 003, ∆.£. 2208 ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

∂. §ÈÓ·Ú‰¿Î˘, ∫. µ·Ú‰·‚¿˜, ∞. ∫·Ê¿ÙÔ˜ ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ô ˘ÔÏÔÁÈÛÌfi˜ ÂηÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ (∂£) Î·È Ë ‰ËÌÈÔ˘ÚÁ›· ηÌ˘ÏÒÓ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ (¶ª) ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ù˘ ∫Ú‹Ù˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 5.321 ·È‰È¿ - 2.643 ·ÁfiÚÈ· Î·È 2.678 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 2,516,5 ÂÙÒÓ, Î·È ‰ÈÂÓÂÚÁ‹ıËÎ·Ó 7.538 ÌÂÙÚ‹ÛÂȘ ¶ª. √È ÌÂÙÚ‹ÛÂȘ ·˘Ù¤˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÙ¿ ÌÂϤÙ˜ Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÌÂٷ͇ 1992-2005 Û ·ÓÙÈÚÔÛˆ¢ÙÈο ‰Â›ÁÌ·Ù· ·È‰ÈÒÓ, ·fi ÙËÓ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. OÈ ÂÍÔÌ·Ï˘Ṳ̂Ó˜ ∂£ Ù˘ ¶ª ˘ÔÏÔÁ›ÛÙËÎ·Ó Ì ÙË ¯Ú‹ÛË ÔÏ˘ˆÓ˘ÌÈÎÒÓ ÌÔÓ٤ψÓ, ÂÓÒ ¤ÁÈÓ ۇÁÎÚÈÛË Ù˘ ¶ª ÙˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ì ÌÂÙÚ‹ÛÂȘ ¿ÏÏˆÓ ‰ÈÂıÓÒÓ ÌÂÏÂÙÒÓ. ∞ÔÙÂϤÛÌ·Ù·: ∏ ¶ª ˘ÔÏÔÁ›ÛÙËΠ·Ó¿ ʇÏÔ Î·È ËÏÈΛ· ηıÒ˜ Î·È ÔÈ ÂÍÔÌ·Ï˘Ṳ̂Ó˜ ∂£: 5Ë, 10Ë, 25Ë, 50‹, 75Ë, 85Ë, 90‹ Î·È 95Ë. ™˘ÁÎÚÈÙÈο, ‚Ú¤ıËΠfiÙÈ Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ù˘ ∫Ú‹Ù˘ ¤¯Ô˘Ó, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ËÏÈ˘, ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ¶ª ·fi Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ù˘ ∫‡ÚÔ˘ Î·È ÙˆÓ ∏¶∞ (p<0,05), Î·È Û fiϘ ÙȘ ËÏÈ˘ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ˜ ̤Û˜ ÙÈ̤˜ ·fi Ù· ·È‰È¿ Ù˘ √ÏÏ·Ó‰›·˜, Ù˘ ª. µÚÂÙ·Ó›·˜, Ù˘ ∞˘ÛÙÚ·Ï›·˜ Î·È ÙÔ˘ ∫·Ó·‰¿. øÛÙfiÛÔ, ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο (p>0,05) ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ËÏÈ˘ ·fi Ù· ·È‰È¿ Ù˘ πÛ·Ó›·˜, ÂÓÒ Û fiϘ ÙȘ ËÏÈ˘ ›¯·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ¶ª (50‹ ∂£) ·fi Ù· ·È‰È¿ Ù˘ πÙ·Ï›·˜ (p<0,001). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË ÙˆÓ ∂£ Ù˘ ¶ª ·ÔÙÂÏ› ¯Ú‹ÛÈÌÔ Î·È ·ÍÈfiÈÛÙÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÁÔÓ›˜ Î·È ·È‰›·ÙÚÔ˘˜, ÂÓÒ Ë ¶ª ηٷ‰ÂÈÎÓ‡ÂÈ ÙÔ ÛÔ‚·Úfi Úfi‚ÏËÌ· Ù˘ ·È‰È΋˜ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ Ù˘ ∫Ú‹Ù˘.

§¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰È¿, ÂÚ›ÌÂÙÚÔ˜ ̤Û˘, ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ.

Waist circumference percentiles of children of Crete aged 3 to 16 years University of Crete, Faculty of Medicine Department of Social Medicine, Division of Preventive Medicine and Nutrition, Heraklion, Crete, Greece Correspondence: Emmanouil Linardakis linman@med.uoc.gr Voutes-Stavrakia Junction 71 003, PO Box.: 2208 Heraklion, Crete, Greece

E. Linardakis, K. Vardavas, A. Kafatos Abstract Background: The aim of this study was to estimate percentiles and growth curves of the waist circumference (WC) in children and adolescents of Crete, Greece.

Methods: WC measurements were recorded for 5,321 subjects, 2,643 boys and 2,678 girls, aged 2.5 to 16.5 years, on whom a total of 7,538 were made. These measurements were derived from seven studies conducted between 1992 and 2005, on representative samples of children and adolescents in Crete, by the Preventive Medicine and Nutrition Clinic of the University of Crete. Smoothed percentiles of WC were estimated using polynomial models. The WC distribution was compared with that reported in other countries.

Results: The age-sex specific descriptive characteristics and the smoothed percentiles of the 5th, 10th, 25th, 50th, 75th, 85th, 90th and 95th place were estimated. The mean WC of children and adolescents in this study in most age groups was found to be higher than that of children from Cyprus and the U.S (p<0.05) and higher in all age groups than that of children from the Netherlands, the U.K, Australia and Canada. The WC of the Cretan children did not differ significantly from that of Spanish children in most age groups but was lower (50th percentiles) in all age groups compared to Italian children (p<0.001).

Conclusions: WC percentiles can be a useful and reliable tool for use by parents and paediatricians. The use of WC percentiles confirms that childhood central obesity is a major health problem in Crete.

Key words: Children, waist circumference, central obesity, percentiles.

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301

∂ηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ·È‰ÈÒÓ

∂ÈÛ·ÁˆÁ‹ ∏ ¤Ó·ÚÍË Ù˘ ÂȉËÌÈ΋˜ ¤Í·ÚÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ ¯ÚÔÓÔÏÔÁÂ›Ù·È ·fi ÙȘ ·Ú¯¤˜ ÙÔ˘ 1960 ÁÈ· ÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ÙÔ˘ 1980 ÁÈ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (1,2). Œ¯Ô˘Ó ˆÛÙfiÛÔ ·Ó·Ù˘¯ı› ‰È¿ÊÔÚÔÈ ‰Â›ÎÙ˜ ̤ÙÚËÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ¯ÚËÛÈÌÔÔÈËı› ÙfiÛÔ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ fiÛÔ Î·È ÁÈ· ÙË ‰È·¯ÚÔÓÈ΋ Î·È ‰È·ÔÏÈÙÈÛÌÈ΋ Û‡ÁÎÚÈÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘. ¶ÔÏϤ˜ ÌÂϤÙ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ ÙÔÓ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ù˘ ̤ÙÚËÛ˘ Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ (¶ª) ˆ˜ ‰Â›ÎÙË ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ ÙfiÛÔ ÛÙÔÓ ÂÓ‹ÏÈÎÔ fiÛÔ Î·È ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi (3-11). ∏ ̤ÙÚËÛË Ù˘ ¶ª Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ·ÔÙÂÏ› ·ÍÈfiÈÛÙÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·Ù¿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ηډȷÁÁÂÈ·ÎÒÓ Î·È ¿ÏÏˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ (3-6). ∏ ¶ª ·È‰ÈÒÓ Î·È ÂÓËÏ›ÎˆÓ ·ÔÙÂÏ› Â›Û˘ Ì›· ·fi ÙȘ ¤ÓÙÂ Û˘ÓÈÛÙÒÛ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (6-11). ∏ ·˘ÍË̤ÓË ÂÓ·fiıÂÛË ÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ÓË ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ Î·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2. ∏ Û‡ÓıÂÛË Â›Û˘ ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ Ï›Ô˘˜ Û ÏÈ·Ú¿ Ôͤ· Â›Ó·È ‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Ó·ÓÙÈ ÙÔ˘ ÁÏÔ˘ÙÈ·›Ô˘ (5). ∏ ̤ÙÚËÛË Ù˘ ¶ª ˆ˜ ‰Â›ÎÙË ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜ Â›Ó·È ·Ï‹, Ë Èı·ÓfiÙËÙ· ÛÊ¿ÏÌ·ÙÔ˜ ÛÙË ‰È·‰Èηۛ· ̤ÙÚËÛ˘ ÌÈÎÚ‹ Î·È Ë Î·ıȤڈۋ Ù˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË Ê·›ÓÂÙ·È ÂȂ‚ÏË̤ÓË. ∏ ·ÚÔ‡Û· ÌÂϤÙË ÛÙԯ‡ÂÈ ÛÙÔ Ó· Ù·ÍÈÓÔÌ‹ÛÂÈ ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Û ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ (∂£), ÒÛÙ ӷ ˘¿Ú¯ÂÈ ¤Ó· ̤ÙÚÔ Û‡ÁÎÚÈÛ˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ ÂͤٷÛË, ηıÒ˜ Î·È ‚·ÛÈο ‰Â‰Ô̤ӷ Û‡ÁÎÚÈÛ˘ ÁÈ· ÌÂÏÏÔÓÙÈ΋ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂÈÔÏ·ÛÌÔ‡ Ù˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¶ÂÚÈÔ¯‹ ÌÂϤÙ˘ ∏ ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ Ô˘ Û˘ÌÌÂÙ›¯·Ó Û ÌÂϤÙ˜ Ù˘ ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ∏ ∫Ú‹ÙË ‰È·ÈÚÂ›Ù·È Û ٤ÛÛÂÚȘ ÓÔÌÔ‡˜, ÂÎÙ›ÓÂÙ·È Û 8.335 km2, Ì ÌfiÓÈÌÔ ÏËı˘ÛÌfi 594.368 ηÙÔ›ÎÔ˘˜ (·ÔÁÚ·Ê‹ 2001), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 142.880 ‹ 24% Â›Ó·È <19 ÂÙÒÓ. ∆Ô 42% ÙÔ˘ ÏËı˘ÛÌÔ‡ Â›Ó·È ·ÁÚÔÙÈÎfi˜, ÙÔ 46% ·ÛÙÈÎfi˜ Î·È ÙÔ 12% ËÌÈ·ÛÙÈÎfi˜. ¶ÏËı˘ÛÌfi˜ ÌÂϤÙ˘ °È· ÙË ÌÂϤÙË ÂÈϤ¯ıËÎ·Ó Î·È ÂÏ‹ÊıËÛ·Ó ·fi fiϘ ۯ‰fiÓ Ù˘ ÂÚÈÔ¯¤˜ Ù˘ ∫Ú‹Ù˘ (∂ÈÎfiÓ· 1) 5.321 ·È‰È¿ Î·È ¤ÊË‚ÔÈ - 2.643 ·ÁfiÚÈ· Î·È 2.678 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 2,5-16,5 ÂÙÒÓ, ÙˆÓ ÔÔ›ˆÓ ÌÂÙÚ‹ıËÎÂ Ë ¶ª. ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ

Û˘ÌÌÂÙ›¯·Ó Û ·ÓÙÈÚÔÛˆ¢ÙÈο ‰Â›ÁÌ·Ù· ·È‰ÈÎÒÓ Î·È ÂÊË‚ÈÎÒÓ ÏËı˘ÛÌÒÓ ÂÙ¿ ‰È·¯ÚÔÓÈÎÒÓ Î·È Û˘Á¯ÚÔÓÈÎÒÓ ÌÂÏÂÙÒÓ (¶›Ó·Î·˜ 1) Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ·fi ÙËÓ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜, Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. √È ÌÂϤÙ˜ ·˘Ù¤˜ Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÌÂٷ͇ ÙˆÓ ÂÙÒÓ 1992 Î·È 2005, ·ÊÔÚÔ‡Û·Ó ¶ÚÔÁÚ¿ÌÌ·Ù· ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ÁÈ· ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÚfiÏË„Ë ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘. ∏ ÂÈÏÔÁ‹ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ÂÙ¿ ÌÂϤÙ˜ ‹Ù·Ó Ù˘¯·›· ÔÏ˘ÛÙ·‰È·Î‹. ∞ÊÔ‡ ÂÈϤ¯ıËÎ·Ó Ù˘¯·›· ÔÈ ÂÚÈÔ¯¤˜ ÌÂϤÙ˘ (·ÛÙÈΤ˜, ËÌÈ·ÛÙÈΤ˜ Î·È ·ÁÚÔÙÈΤ˜) Î·È ÂÓ Û˘Ó¯›· Ù· Û¯ÔÏ›· ÙˆÓ ÂÚÈÔ¯ÒÓ, Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó fiÏ· Ù· ·È‰È¿ ÙˆÓ Û¯ÔÏ›ˆÓ. ¶ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ ˆÛÙfiÛÔ ·Ó·Ê¤ÚÔÓÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ÙˆÓ ÌÂÏÂÙÒÓ (12-20). ∂›Û˘, ÔÈ ÂÍÂÙ¿ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ·Ó ÛÙÔÓ ¯ÒÚÔ ÙˆÓ Û¯ÔÏ›ˆÓ ÙÔ˘˜ ηÙfiÈÓ ¤ÁÎÚÈÛ˘ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È ÙˆÓ ÂÍÂÙ¿ÛÂÒÓ ÙÔ˘˜ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜, ÂÓÒ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÚÔËÁ‹ıËΠÏÂÙÔÌÂÚ‹˜ ÂÓË̤ڈÛË Î·È ÂÓ˘fiÁÚ·ÊË Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ. ¶ÚÔËÁ‹ıËΠ·ÎfiÌË ¤ÁÎÚÈÛË ÙˆÓ ÌÂÏÂÙÒÓ ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ª¤ÙÚËÛË ¶ÂÚÈ̤ÙÚÔ˘ ª¤Û˘ ∏ ̤ÙÚËÛË Ù˘ ¶ª ¤ÁÈÓ ¯ˆÚ›˜ ÚÔ‡¯·, Û ÂηÙÔÛÙ¿, Ì Ï·ÛÙÈ΋ ÌÂÙÚÈ΋ Ù·ÈÓ›·, οوıÂÓ ÙÔ˘ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ ÛÙÔ Ì¤ÛÔ Ù˘ ·fiÛÙ·Û˘ ÌÂٷ͇ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘ ·ÎÚÔÏÔÊ›·˜ (∂ÈÎfiÓ· 2). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS 13.0. ™ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ∂£ Ù˘ ¶ª, ηıÒ˜ Î·È ÛÙË ÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ Î·Ì˘ÏÒÓ ÙÔ˘˜, ˘ÔÏÔÁ›ÛÙËÎ·Ó ÔÈ ËÏÈ˘ Û ‰È·ÛÙ‹Ì·Ù· ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ ·ÊÔÚ¿ ÙÔ ‰È¿ÛÙËÌ· ·fi 2,5 ¤ˆ˜ 3,4 ¤ÙË, ÙˆÓ 4 ÙÔ ‰È¿ÛÙËÌ· ·fi 3,5 ¤ˆ˜ 4,4 ¤ÙË, Î.Ô.Î. ¶ÔÏ˘ˆÓ˘ÌÈο ÌÔÓ٤Ϸ ÚÔÛ·ÚÌÔÁ‹˜ Áã ‚·ıÌÔ‡ (cubic models) (21,22) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· ÙËÓ ÂÍÔÌ¿Ï˘ÓÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·‰ÚÒÓ ∂£, Ù· ÔÔ›· ¤‰ˆÛ·Ó Û˘ÓÙÂÏÂÛÙ¤˜ ÚÔÛ·ÚÌÔÁ‹˜ (R2) ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÙÔ˘ 98%. ªÂ ÙË Ì¤ıÔ‰Ô ÂϤÁ¯Ô˘ Student ·ÏÔ‡ ‰Â›ÁÌ·ÙÔ˜ (One sample t test) ¤ÁÈÓ ۇÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ Ù˘ ¶ª ÙˆÓ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ì ÂΛӘ ¿ÏÏˆÓ ÂÚ¢ÓÒÓ (22-30), ÂÓÒ ·Ó··Ú·ÛÙ¿ıËÎ·Ó ÁÚ·ÊÈο ÔÈ 90¤˜ ∂£ ÙˆÓ ÌÂÏÂÙÒÓ ·˘ÙÒÓ (·fi ÙË ÌÂϤÙË ÙˆÓ Fredriks et al, 2005 (23) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ÙÈ̤˜ Ù˘ +2SD). ∏ ÂÈÏÔÁ‹ Ù˘ 90‹˜ ∂£ Ù˘ ¶ª ·ÊÔÚ¿ ÙË ¯Ú‹ÛË Ù˘ ˆ˜ fiÚÈÔ Î·ıÔÚÈÛÌÔ‡ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ - ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ.

¡. ÷ӛˆÓ ¡. ƒÂı‡ÌÓÔ˘ ¢È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜

™‡Á¯ÚÔÓ˜ ÌÂϤÙ˜

¡. ∏Ú·ÎÏ›Ԣ ¡. §·ÛÈı›Ô˘

∂ÈÎfiÓ· 1. ÿÚÙ˘ Ù˘ ∫Ú‹Ù˘. √È Î‡ÎÏÔÈ ‰Â›¯ÓÔ˘Ó ÙȘ ÂÚÈÔ¯¤˜ ·fi ÙȘ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·È Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ù˘ ÌÂϤÙ˘. ¶·È‰È·ÙÚÈ΋ 2007;70:300-307

Paediatriki 2007;70:300-307

™˘Á¯ÚÔÓÈ΋ ™˘Á¯ÚÔÓÈ΋ ™˘Á¯ÚÔÓÈ΋ ¢È·¯ÚÔÓÈ΋

¶ÚfiÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ (¢‹ÌÔ˜ ƒÔ‡‚·)

¶ÚfiÁÚ·ÌÌ· ÕıÏËÛ˘ Î·È ¢È·ÙÚÔÊ‹˜

¶ÚfiÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ (¶·È‰ÈÎÔ› ™Ù·ıÌÔ› ∏Ú·ÎÏ›Ԣ)

¶ÚfiÁÚ·ÌÌ· ∂Î·È‰Â˘ÙÈ΋˜ ¶·Ú¤Ì‚·Û˘

¶·È‰ÈÎÔ› ™Ù·ıÌÔ› ∏Ú·ÎÏ›Ԣ

™¯ÔÏ›· ¢‹ÌˆÓ ∏Ú·ÎÏ›Ԣ, ∆˘Ï›ÛÔ˘ Î·È ÃÂÚÛÔÓ‹ÛÔ˘

¡ËÈ·ÁˆÁ›Ô, ¢ËÌÔÙÈÎfi Î·È °˘ÌÓ¿ÛÈÔ ¢‹ÌÔ˘ ƒÔ‡‚· ∏Ú·ÎÏ›Ԣ

¢ËÌÔÙÈο ™¯ÔÏ›· ¢‹ÌÔ˘ ∞Á. ¡ÈÎÔÏ¿Ô˘

1Ë ÂͤÙ. - 2004/05 ¡ËÈ·ÁˆÁ›· fiÏˆÓ ÙˆÓ ¢‹ÌˆÓ Î·È ∫ÔÈÓÔÙ‹ÙˆÓ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ

2004

2003-04

2001

2000

4,0-7,0

2,5-6,1

2,8-16,5

4,0-15,3

8,1-13,8

10,0-16,5

9,2-16,5

13,6-16,5

10,2-13,1

7,6-9,9

864

73

382

92

173

215

373

292

408

241

621

∞fi ÙÔÓ ¡ÔÌfi §·ÛÈı›Ô˘ ÂÈϤ¯ıËÎÂ Î·È Û˘ÌÌÂÙ›¯Â ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÌfiÓÔ Î·Ù¿ ÙËÓ ÚÒÙË Ì¤ÙÚËÛË (1992-93) Î·È ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 109 ·ÁfiÚÈ· Î·È 111 ÎÔÚ›ÙÛÈ· * ™ÙȘ ‰È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜ ˘‹Ú¯·Ó ·È‰È¿ Ô˘ ÂÓÙ¿¯ıËÎ·Ó Û ·˘Ù¤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÂÍÂÙ¿ÛˆÓ

2.678

3.804

∫·Ê¿ÙÔ˜ Î·È Û˘Ó, 2005 [20]

∞‰ËÌÔÛ›Â˘Ù· ™ÙÔȯ›·

§ÈÓ·Ú‰¿Î˘ ª, 2005 [19]

ªÔÛ¯·Ó‰Ú¤· Î·È Û˘Ó, 2003 [18]

∞‰ËÌÔÛ›Â˘Ù· ™ÙÔȯ›·

¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ [17]

Moschandreas et al, 2003 [16]

Kafatos et al, 2005 [15]

Manios et al, 2002 [14]

Manios et al, 1999 [13]

∫·Ê¿ÙÔ˜ Î·È Û˘Ó, 1998 [12]

µÈ‚ÏÈÔÁÚ·Ê›·

302

†

*

833

45

426

99

175

258

430

322

409

233

574

ªÂÙÚ‹ÛÂȘ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ·

2.643

™˘Á¯ÚÔÓÈ΋

¶ÚfiÁÚ·ÌÌ· ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ (¢‹ÌÔ˜ ∞Á. ¡ÈÎÔÏ¿Ô˘)

-//-

2Ë ÂͤÙ. - 2000

°˘ÌÓ¿ÛÈ· - §‡ÎÂÈ· ¡ÔÌÒÓ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ

4Ë ÂͤÙ. - 2002 ¢ËÌÔÙÈο Î·È °˘ÌÓ¿ÛÈ· ¡ÔÌÒÓ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È §·ÛÈı›Ô˘

¢ËÌÔÙÈο ™¯ÔÏ›· ¡ÔÌÒÓ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ

3Ë ÂͤÙ. - 1998

1Ë ÂͤÙ. - 1999

¢ËÌÔÙÈο ™¯ÔÏ›· ¡ÔÌÒÓ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È Ã·Ó›ˆÓ

2Ë ÂͤÙ. - 1995

5,0-8,5

∏ÏÈΛ· (¤ÙË)

™‡ÓÔÏÔ ·È‰ÈÒÓ

¢È·¯ÚÔÓÈ΋

¶ÚfiÁÚ·ÌÌ· ∂Î·È‰Â˘ÙÈ΋˜ ¶·Ú¤Ì‚·Û˘

¢ËÌÔÙÈο ™¯ÔÏ›· ¡ÔÌÒÓ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘, ÷ӛˆÓ Î·È §·ÛÈı›Ô˘†

1Ë ÂͤÙ. - 1992

ÃÒÚÔ˜ ÌÂϤÙ˘

17:08

3.734

¢È·¯ÚÔÓÈ΋

¶ÚfiÁÚ·ÌÌ· ∂Î·È‰Â˘ÙÈ΋˜ ¶·Ú¤Ì‚·Û˘

ŒÙÔ˜ ∂ͤٷÛ˘

09-07-07

™‡ÓÔÏÔ ÌÂÙÚ‹ÛˆÓ

∂›‰Ô˜

ªÂϤÙË ¶ÚfiÁÚ·ÌÌ·

¶›Ó·Î·˜ 1. ™˘Á¯ÚÔÓÈΤ˜ Î·È ‰È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜ - ÚÔÁÚ¿ÌÌ·Ù· ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ÂηÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ 5.321 ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘, ËÏÈΛ·˜ 2,5 ¤ˆ˜ 16,5 ÂÙÒÓ, Ì 7.538 ÌÂÙÚ‹ÛÂȘ

Pediatri July-Aug 07 ™ÂÏ›‰·302

∂. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·303

303

∂ηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ·È‰ÈÒÓ

∂ÈÎfiÓ· 2. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ì¤ÙÚËÛ˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘.

∞ÔÙÂϤÛÌ·Ù· √È ·Ó¿ ËÏÈΛ· Î·È Ê‡ÏÔ Ì¤Û˜ ÙÈ̤˜ Î·È Ù˘ÈΤ˜ ·ÔÎÏ›ÛÂȘ Ù˘ ¶ª ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™ÙÔÓ ¶›Ó·Î· 3 ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ÂȉÈΤ˜ ·Ó¿ ʇÏÔ Î·È ËÏÈΛ· ÂÍÔÌ·Ï˘Ṳ̂Ó˜ ∂£ Ù˘ ¶ª. √È ∂£ ·ÊÔÚÔ‡Ó ÙËÓ 5Ë, 10Ë, 25Ë, 50‹, 75Ë, 85Ë, 90‹ Î·È 95Ë ∂£ Ì ÙË ÁÚ·ÊÈ΋ ÙÔ˘˜ ·ÂÈÎfiÓÈÛË Ó· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 3. ™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ·Ó¿ ʇÏÔ Î·È ËÏÈΛ· ̤Û˜ Î·È ‰È¿ÌÂÛ˜ ÙÈ̤˜ Ù˘ ¶ª, Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û ۇÁÎÚÈÛË Ì ÂΛӘ ÌÂÏÂÙÒÓ ¿ÏÏˆÓ ¯ˆÚÒÓ. Ÿˆ˜ Ê·›ÓÂÙ·È, Ù· ·È‰È¿ Ù˘ ∫Ú‹Ù˘ ¤¯Ô˘Ó ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ËÏÈ˘ ÛËÌ·ÓÙÈο (p<0,05) ˘„ËÏfiÙ¶›Ó·Î·˜ 2. ¶ÂÚ›ÌÂÙÚÔ˜ ̤Û˘ 7.538 ÌÂÙÚ‹ÛÂˆÓ 5.321 ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ∏ÏÈΛ· (¤ÙË)† 3 4 5 6 7 8 9 10 11 12 13 14 15 16 #

∞ÁfiÚÈ· ¡ ª¤ÛË ÙÈÌ‹ (∆∞)# 44 96 421 872 213 113 220 170 384 427 84 156 357 177

50,5 (3,9)* 54,0 (4,9) 55,1 (5,9) 56,3 (7,1) 56,8 (6,3) 59,7 (6,4) 62,6 (8,4) 68,1 (9,9) 71,4 (10,7) 71,6 (10,6) 72,5 (9,7) 76,9 (10,8) 78,2 (10,4) 81,8 (12,9)

∫ÔÚ›ÙÛÈ· ¡ ª¤ÛË ÙÈÌ‹ (∆∞) 33 99 389 834 181 108 213 173 414 417 113 192 457 181

52,2 (3,9) 52,8 (4,5) 54,7 (5,4) 55,1 (6,0) 55,1 (5,7) 59,9 (8,2) 61,7 (8,9) 66,2 (9,2) 68,6 (9,7) 69,2 (9,8) 69,5 (9,2) 71,8 (7,9) 71,8 (8,0) 72,7 (9,1)

∆∞: Ù˘È΋ ·fiÎÏÈÛË † ∏ ËÏÈΛ· ·ÊÔÚ¿ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜: Ù· 3 ¤ÙË ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·È‰È¿ ËÏÈΛ·˜ 2,5-3,4 ¯ÚfiÓˆÓ Î.Ô.Î. * √È ÙÈ̤˜ Â›Ó·È Û ÂηÙÔÛÙ¿ (cm)

™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ˘ÔÏÔÁ›ÛÙËÎ·Ó Î·È ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ∂£ Ù˘ ¶ª ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘. ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ù˘ ∫Ú‹Ù˘ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ·fi ÙȘ ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜, Ì ÂÍ·›ÚÂÛË ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ ·È‰È¿ Ù˘ πÙ·Ï›·˜. √È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÌÂϤÙ˜ ÙˆÓ ¯ˆÚÒÓ ∫‡ÚÔ˘, πÙ·Ï›·˜, πÛ·Ó›·˜, ª. µÚÂÙ·Ó›·˜, 110 ¶ÂÚ›ÌÂÙÚÔ˜ ª¤Û˘ (cm)

∆ÔÔı¤ÙËÛË ÛÙÔ ‡„Ô˜ ÙÔ˘ ÔÌÊ·ÏÔ‡

Ú˜ ̤Û˜ ÙÈ̤˜ ¶ª Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙÔȯ˘ ËÏÈΛ·˜ ·È‰È¿ Ù˘ ∫‡ÚÔ˘ Î·È ÙˆÓ ∏¶∞, ÂÓÒ Û fiϘ ÙȘ ËÏÈ˘ ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ˜ ̤Û˜ ÙÈ̤˜ ·fi Ù· ·È‰È¿ Ù˘ √ÏÏ·Ó‰›·˜, Ù˘ ª. µÚÂÙ·Ó›·˜, Ù˘ ∞˘ÛÙÚ·Ï›·˜ Î·È ÙÔ˘ ∫·Ó·‰¿. ∂›Û˘, ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ËÏÈ˘ ·fi Ù· ·È‰È¿ Ù˘ πÛ·Ó›·˜ (p>0,05), ÂÓÒ ¤¯Ô˘Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ ¶ª (50‹ ∂£) ·fi ÂΛӷ Ù˘ πÙ·Ï›·˜ (p<0,001). ∆¤ÏÔ˜, ÛÙËÓ ∂ÈÎfiÓ· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì¤Ûˆ ÁÚ·ÊÈÎÒÓ Ù· fiÚÈ· Ù˘ 90‹˜ ∂£ Ù˘ ¶ª ÁÈ· ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜ ¯ÒÚ˜. ∆· ·È‰È¿ Ù˘ πÙ·Ï›·˜ Ê·›ÓÔÓÙ·È Ó· ¤¯Ô˘Ó ÙËÓ ˘„ËÏfiÙÂÚË 90‹ ∂£ Î·È Ù· ·È‰È¿ Ù˘ ª. µÚÂÙ·Ó›·˜ ÙË ¯·ÌËÏfiÙÂÚË, ÂÓÒ ÂΛӷ Ù˘ ∫Ú‹Ù˘ ¤¯Ô˘Ó ۯ‰fiÓ ·ÚfiÌÔÈ· 90‹ ∂£ ÌfiÓÔ Ì ٷ ·È‰È¿ ÙˆÓ ∏¶∞.

95 90 85 75

·ÁfiÚÈ·

100 90 80

50 25 10 5

70 60 50 40

3

4

5

6

7

8 9 10 11 12 13 14 15 16 ∏ÏÈΛ· (¤ÙË)

100 ¶ÂÚ›ÌÂÙÚÔ˜ ª¤Û˘ (cm)

ªÂٷ͇ Ï¢ÚÈÎÔ‡ ÙfiÍÔ˘ Î·È Ï·ÁÔÓ›Ô˘

ÎÔÚ›ÙÛÈ·

90

95 90 85 75 50 25 10 5

80 70 60 50 40

3

4

5

6

7

8 9 10 11 12 13 14 15 16 ∏ÏÈΛ· (¤ÙË)

∂ÈÎfiÓ· 3. ∫·Ì‡Ï˜ ÂηÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ ÂÚÈ̤ÙÚÔ˘ ̤Û˘. ¶·È‰È·ÙÚÈ΋ 2007;70:300-307

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·304

304

∂. §ÈÓ·Ú‰¿Î˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 3. ∆È̤˜ ÂÍÔÌ·Ï˘ÛÌ¤ÓˆÓ ÂηÙÔÛÙÈ·›ˆÓ ı¤ÛÂˆÓ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ 7.538 ÌÂÙÚ‹ÛÂˆÓ 5.321 ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ ∏ÏÈΛ· (¤ÙË) ∞ÁfiÚÈ· 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ∫ÔÚ›ÙÛÈ· 3 4 5 6 7 8 9 10 11 12 13 14 15 16

5Ë

10Ë

25Ë

50‹

75Ë

85Ë

90‹

95Ë

45,4 46,3 47,3 48,6 50,0 51,5 53,2 54,9 56,8 58,8 60,9 63,0 65,2 67,4

46,8 47,6 48,6 49,8 51,3 52,8 54,6 56,5 58,5 60,6 62,8 65,1 67,5 69,9

49,0 49,8 50,8 52,2 53,8 55,6 57,5 59,6 61,8 64,1 66,3 68,5 70,7 72,7

51,3 52,0 53,2 54,8 56,8 59,1 61,6 64,2 66,8 69,4 71,9 74,1 76,1 77,8

53,1 54,3 56,2 58,6 61,5 64,7 68,1 71,6 75,0 78,2 81,1 83,6 85,5 86,8

55,3 56,9 59,0 61,8 64,9 68,3 71,9 75,7 79,4 83,0 86,4 89,4 92,1 94,2

56,3 58,5 61,2 64,3 67,7 71,3 75,1 79,0 82,9 86,6 90,2 93,6 96,6 99,1

59,1 62,1 65,3 68,6 72,2 75,8 79,5 83,3 87,1 90,9 94,6 98,4 102,0 105,6

46,3 46,3 46,6 47,3 48,4 49,8 51,3 53,0 54,8 56,5 58,2 59,8 61,1 62,2

47,4 47,4 47,7 48,5 49,7 51,3 53,0 54,9 56,8 58,6 60,3 61,7 62,8 63,4

49,8 49,8 49,9 50,7 52,1 53,9 56,0 58,2 60,4 62,5 64,3 65,6 66,4 66,4

52,2 52,2 52,9 54,3 56,2 58,4 60,7 63,2 65,5 67,5 69,2 70,3 70,7 70,7

55,2 55,3 56,4 58,3 60,8 63,7 66,8 69,8 72,6 74,9 76,5 77,2 76,8 75,1

55,7 57,1 59,2 61,8 64,8 68,0 71,2 74,3 77,0 79,2 80,7 81,4 81,0 79,5

56,7 58,5 61,0 64,0 67,3 70,7 74,2 77,4 80,2 82,5 84,1 84,7 84,2 82,5

60,5 62,2 64,8 67,8 71,3 75,0 78,6 82,1 85,2 87,8 89,6 90,5 90,3 88,7

√ÏÏ·Ó‰›·˜, ∞˘ÛÙÚ·Ï›·˜, ∫·Ó·‰¿ Î·È ∏¶∞ (22-29), Ô˘ ·ÊÔÚÔ‡Ó ÂÚÁ·Û›Â˜ ˘ÔÏÔÁÈÛÌÔ‡ ∂£ Ù˘ ¶ª, ·ÔÙÂÏÔ‡Ó Û˘Á¯ÚÔÓÈΤ˜ ÌÂϤÙ˜ Î·È ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› Û ‰È·ÛÙ‹Ì·Ù· ‰È¿ÚÎÂÈ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ ‰‡Ô ÂÙÒÓ. øÛÙfiÛÔ, Ë ·fi ÎÔÈÓÔ‡ ¯Ú‹ÛË ‰È·¯ÚÔÓÈÎÒÓ Î·È Û˘Á¯ÚÔÓÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ∂£ ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘ Ô˘ ηχÙÔ˘Ó Â›Û˘ ÌÂÁ·Ï‡ÙÂÚ· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ¤¯ÂÈ ‹‰Ë ÂÊ·ÚÌÔÛÙ› Û ∏¶∞ Î·È ª. µÚÂÙ·Ó›· (30,31). ∏ ¶ª Â›Ó·È ·Ï‹ Î·È Â‡ÎÔÏË ÛÙË Ì¤ÙÚËÛ‹ Ù˘ ·ÏÏ¿ Î·È ÌÂÁ¿Ï˘ ÛÔ˘‰·ÈfiÙËÙ·˜, ηıÒ˜ Â›Ó·È ‰Â›ÎÙ˘ ÎÂÓÙÚÈ΋˜ ·¯˘Û·ÚΛ·˜. √È Mamalakis Î·È Û˘Ó.

(5), ¤‰ÂÈÍ·Ó fiÙÈ Ë Û‡ÓıÂÛË Û ÏÈ·Ú¿ Ôͤ· ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ˘Ô‰fiÚÈÔ˘ Ï›Ô˘˜ Â›Ó·È ÛËÌ·ÓÙÈο ‰˘ÛÌÂÓ¤ÛÙÂÚË ÙÔ˘ ÁÏÔ˘ÙÈ·›Ô˘ (˘„ËÏfiÙÂÚ· Â›‰· ÎÔÚÂÛÌ¤ÓˆÓ Î·È trans ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ¯·ÌËÏfiÙÂÚ· ÌÔÓÔ·ÎfiÚÂÛÙˆÓ Î·È ÔÏ˘·ÎfiÚÂÛÙˆÓ) Î·È Û¯ÂÙ›˙ÂÙ·È Â›Û˘ ηχÙÂÚ· Ì ٷ ÏÈ›‰È· ÔÚÔ‡ ·›Ì·ÙÔ˜. ∂ÈϤÔÓ, Ë ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (611). √È Moreno Î·È Û˘Ó. (11), ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ¶ª ˆ˜ ‰Â›ÎÙ˘ ·¯˘Û·ÚΛ·˜ ·ÔÙÂÏ› Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ηχÙÂÚÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÙÔ˘ ÌÂÙ·Paediatriki 2007;70:300-307

‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ·fi fi,ÙÈ Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) ‹ ÙÔ ¿¯Ô˜ ÙˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ. °È· ÙËÓ ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ· Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ¢ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ Ë ¤ÏÏÂÈ„Ë ÛˆÌ·ÙÈ΋˜ ¿ÛÎËÛ˘, Ë Î·Î‹ ‰È·ÙÚÔÊ‹ Î·È ÙÔ stress, Ô˘ Ô‰ËÁÔ‡Ó Û ·ÔÚÚ‡ıÌÈÛË ÙÔ˘ ¿ÍÔÓ· ˘Ôı·Ï¿ÌÔ˘˘fiÊ˘Û˘-ÂÈÓÂÊÚȉ›ˆÓ (32). ∏ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘, ·‡ÍËÛË ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, Ì›ˆÛË Ù˘ HDL ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ·‡ÍËÛË ÙÔ˘ ۷ί¿ÚÔ˘. ™Ô˘‰·›Ô ÚfiÏÔ Â›Û˘ Ê·›ÓÂÙ·È ˆ˜ ¤¯ÂÈ Ë ÔÚÌÔÓÈ΋ ‰Ú¿ÛË Ù˘ ÏÂÙ›Ó˘, ηıÒ˜ ¤¯ÂÈ ‚ÚÂı› Û ·È‰È¿ Î·È ÂÓ‹ÏÈΘ Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ˘˜ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ˜ Î·È È‰È·›ÙÂÚ· Ì ÙËÓ ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· Ô˘ Ô‰ËÁ› Û ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2 (33-35). ™Â 1.209 ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Ù˘ ∫Ú‹Ù˘ ËÏÈΛ·˜ 3-18 ÂÙÒÓ (19), ‚Ú¤ıËÎ·Ó 48 ·È‰È¿ (3,9%) Ì ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚ˜ Û˘ÓÈÛÙÒÛ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ 62% ›¯·Ó ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ· (¶ª>90‹ ∂£). ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, ÙÔ 8,5% ‚Ú¤ıËΠ̠ÎÂÓÙÚÈ΋ ·¯˘Û·ÚΛ·, ÂÓÒ, Ì ‚¿ÛË ÙÔÓ ¢ª™ (fiÚÈ· International Obesity Task Force - IOTF)

†

55,6 58,1 58,8 62,1 65,4 66,1 67,0 66,4 68,1 69,5 68,5

52,2 52,8 54,7 55,1 55,1 59,9 61,7 66,2 68,6 69,2 69,5 71,8 71,8 72,7

49,7 51,2 52,1 53,3 54,8 56,5 58,2 59,9 61,8 63,9 66,1 68,2 70,3 72,3 49,2 50,6 51,3 52,5 54,0 55,7 57,3 59,0 60,6 62,4 64,1 65,6 66,8 67,9

0,038 <0,001 <0,001 <0,001 0,100 0,926 0,118 <0,001 <0,001 <0,001 0,020 <0,001 <0,001 <0,001 <0,001 0,001 <0,001 0,681 <0,001 0,150 0,099 <0,001 <0,001 <0,001 0,127 0,004 0,666 0,081

M.T.

<0,001 <0,001 <0,001 <0,001 0,011 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

0,200 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

p-value

0,160 0,236 0,119 0,275 <0,001 <0,001 <0,001 0,073 <0,001

54,9 0,372 56,6 0,001 59,0 0,234 61,4 0,611 64,1 0,03 64,9 <0,001 65,3 <0,001 67,3 0,011 66,8 <0,001 -

56,0 57,3 60,6 63,2 65,4 68,0 68,0 70,6 72,8 -

M.T. p-value

πÛ·Ó›· (25)

51,3 52,2 54,4 55,3 56,8 58,0 60,0 61,6 63,6 64,7 64,9 66,2

52,3 52,7 54,6 55,7 58,1 59,6 61,5 63,8 66,4 68,7 70,8 71,8

M.T.

<0,001 <0,001 0,107 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

<0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

p-value

ª. µÚÂÙ·Ó›·, 1990 (24)

55,6 57,3 59,1 61,0 62,3 64,6 66,8 68,2 69,8 -

55,9 58,1 60,2 61,3 64,6 66,6 69,4 71,3 73,2 -

0,235 0,001 <0,001 <0,001 <0,001 <0,001 0,002 <0,001 <0,001

0,041 0,011 <0,001 <0,001 <0,001 <0,001 0,004 <0,001 <0,001

M.T. p-value

∞˘ÛÙÚ·Ï›·, 1985 (26)

63,0 66,5 69,0 71,0 76,0 77,0 82,0 85,0 -

61,0 64,0 67,0 69,0 72,0 75,0 80,0 82,0 -

<0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

<0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

¢È¿ÌÂÛÔ˜ p-value

πÙ·Ï›· (30)

One sample Student test √È Ì¤Û˜ ÙÈ̤˜ ‰fiıËÎ·Ó ÌÂÙ¿ ·fi ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›·, ÂÓÒ ÔÈ ∂£ ‰ËÌÔÛȇÔÓÙ·È ÛÙÔ Obes. Res. 2001. * ∆È̤˜ ÙˆÓ Â˘Úˆ-·ÌÂÚÈηÓÒÓ. ##M.T.: ª¤ÛË ∆ÈÌ‹

49,3 51,2 53,1 55,0 56,9 58,8 60,7 62,5 64,4 66,3 68,2 70,1 72,0 73,9

49,2 51,3 53,3 55,4 57,5 59,6 61,7 63,7 65,8 67,9 70,0 72,1 74,1 76,2

¢È¿ÌÂÛÔ˜ p-value

√ÏÏ·Ó‰›·, 1996 (23)

60,9 62,5 64,8 65,9 68,3 67,9

63,3 65,8 66,5 69,7 72,5 73,6

<0,001 <0,001 <0,001 <0,001 <0,001 <0,001

<0,001 <0,001 <0,001 <0,001 <0,001 <0,001

M.T. p-value

∫·Ó·‰¿˜, 1981 (29)

17:08

0,014 <0,001 0,150 0,523 0,252 <0,001 <0,001 <0,001 <0,001 <0,001 <0,001

55,6 0,002 57,6 0,068 60,4 0,218 62,8 0,701 66,5 0,034 66,9 <0,001 69,1 <0,001 71,4 0,291 75,9 0,262 75,2 <0,001 78,7 0,002

50,5 54,0 55,1 56,3 56,8 59,7 62,6 68,1 71,4 71,6 72,5 76,9 78,2 81,8

M.T. p-value

M.T. ##

∏¶∞, 1988-94* (27)

09-07-07

#

∞ÁfiÚÈ· 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ∫ÔÚ›ÙÛÈ· 3 4 5 6 7 8 9 10 11 12 13 14 15 16

∏ÏÈΛ· (¤ÙË)

∫‡ÚÔ˜, 1999 † (22)

¶·ÚÔ‡Û· ÌÂϤÙË

¶›Ó·Î·˜ 4. ™‡ÁÎÚÈÛË Ì¤ÛˆÓ ÙÈÌÒÓ Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ·È‰ÈÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È ÌÂÏÂÙÒÓ ¿ÏÏˆÓ ¯ˆÚÒÓ

Pediatri July-Aug 07 ™ÂÏ›‰·305

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305

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3

4

5

6

7

8 9 10 11 12 13 14 15 16 ∏ÏÈΛ· (¤ÙË)

100 95 ÎÔÚ›ÙÛÈ· 90 85 80 75 70 65 60 55 50 3 4 5 6

πÙ·Ï›· ∏¶∞

¶ÂÚ›ÌÂÙÚÔ˜ ª¤Û˘ (cm)

∫Ú‹ÙË πÙ·Ï›· ∏¶∞ ∫‡ÚÔ˜

·ÁfiÚÈ·

¶ÂÚ›ÌÂÙÚÔ˜ ª¤Û˘ (cm)

100 95 90 85 80 75 70 65 60 55 50

√ÏÏ·Ó‰›· ∫Ú‹ÙË ∞˘ÛÙÚ·Ï›· ∞˘ÛÙÚ·Ï›· ∫‡ÚÔ˜ ∫·Ó·‰¿˜ ª. µÚÂÙ·Ó›· ª. µÚÂÙ·Ó›·

7

8 9 10 11 12 13 14 15 16 ∏ÏÈΛ· (¤ÙË)

∂ÈÎfiÓ· 4. ™¯ËÌ·ÙÈ΋ Û‡ÁÎÚÈÛË Î·Ì˘ÏÒÓ 90˘ ÂηÙÔÛÙÈ·›·˜ ı¤Û˘ ‹/Î·È +2SD Ù˘ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ·È‰ÈÒÓ ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ.

(2), ÙÔ ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‹Ù·Ó 9,9%. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ÔÊ›ÏÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ Ï›Ô˘˜ ÛÙÔ ÛÒÌ· (ÎÂÓÙÚÈο ‹ ÂÚÈÊÂÚÂȷο) Î·È ÛÙÔ fiÙÈ Ù· fiÚÈ· ÙÔ˘ IOTF ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·È‰È¿ ·fi ÙËÓ ∂ÏÏ¿‰· Î·È ÙËÓ ∫Ú‹ÙË. £· Ú¤ÂÈ, ÂÔ̤ӈ˜, ÛÙȘ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ, ÙË ÌÂÙ·‚ÔÏ‹ ÙˆÓ ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂÒÓ ÙÔ˘˜ ·ÏÏ¿ Î·È ÙÔÓ ˘ÔÏÔÁÈÛÌfi ∂£ Î·È ÙËÓ Î·Ù·Û΢‹ ηÌ˘ÏÒÓ ·Ó¿Ù˘Í˘, Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÎÔÈÓˆÓÈÎÔ›, ÔÏÈÙÈÛÌÈÎÔ›, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› Î·È ‚ÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ (1,36). ∞fi ÙË Û‡ÁÎÚÈÛË Ù˘ ¶ª ÙˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ Ì ·È‰È¿ ¿ÏÏˆÓ ¯ˆÚÒÓ Î·È ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ô Î·ıÔÚÈÛÌfi˜ ÙˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ ‰È¤ÊÂÚ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ·È‰È¿ Ù˘ ∫Ú‹Ù˘ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ¶ª Û ۇÁÎÚÈÛË Ì ·È‰È¿ ¿ÏÏˆÓ ¯ˆÚÒÓ, Ì ÌÔÓ·‰È΋ ÂÍ·›ÚÂÛË ÂΛӷ Ù˘ πÙ·Ï›·˜. ∞˘Ùfi ÙÂÎÌËÚÈÒÓÂÙ·È Î·È ·fi ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ù˘ ∫Ú‹Ù˘ Ô˘ Ì ‚¿ÛË ÙÔÓ ¢ª™ (fiÚÈ· IOTF) ·Ó¤Ú¯ÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙÔ 33,1% (19). ™ÙËÓ πÙ·Ï›·, ·ÓÙ›ÛÙÔȯ·, ÙÔ ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‚Ú¤ıËΠ˘„ËÏfiÙÂÚÔ, ÊÙ¿ÓÔÓÙ·˜ ÙÔ 36%, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡Ó Ô ∫·Ó·‰¿˜ Ì 30%, Ë πÛ·Ó›· Ì 27%, ÔÈ ∏¶∞ Ì 25,6% (ÙÔ 198894) Î·È Ë ª. µÚÂÙ·Ó›· Ì 20% (2). ¢˘ÛÙ˘¯Ò˜, Ë ¤ÏÏÂÈ„Ë ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ‰Â‰ÔÌ¤ÓˆÓ ∂£ Ù˘ ¶ª ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ·fi ¿ÏϘ ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜, ηıÈÛÙÔ‡Ó ·‰‡Ó·ÙË ÙË Û‡ÁÎÚÈÛË Ì ·È‰È¿ ¿ÏÏˆÓ ÂÚÈÔ¯ÒÓ. ∂ÈϤÔÓ, ÏfiÁˆ ¤Í·ÚÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ ηٿ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ‰ÂÓ ‰‡Ó·Ù·È Ó· ÂÏÂÁ¯ı› Ë ÏËı˘ÛÌȷ΋ Ù¿ÛË (secular trend) ÙÔ˘ ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ Û ۯ¤ÛË Ì ÙËÓ ¶ª. °È’ ·˘Ùfi Ô ˘ÔÏÔÁÈÛÌfi˜ ∂£ Ù˘ ¶ª ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ù˘ ∫Ú‹Ù˘, ¤¯ÂÈ È‰È·›ÙÂÚË ÛÔ˘‰·ÈfiÙËÙ·, ÒÛÙ ÌÂÏÏÔÓÙÈο Ó· ˘¿ÚÍÂÈ Ì¤ÙÚÔ Û‡ÁÎÚÈÛ˘ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ‰È·¯ÚÔÓÈÎÒÓ ·ÏÏ·ÁÒÓ.

Paediatriki 2007;70:300-307

°ÂÓÈο, Â›Ó·È ·Ó·Áη›· Ë ‰ÈÂÍ·ÁˆÁ‹ ÌÂϤÙ˘ Û ÂıÓÈÎfi Â›Â‰Ô Ì ÙË Ï‹„Ë ·ÓÙÈÚÔÛˆ¢ÙÈÎÔ‡ ÂıÓÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜ ·È‰ÈÒÓ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘ÔÏÔÁÈÛıÔ‡Ó Î·È Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ∂£ Î·È Î·Ì‡Ï˜ ¶ª. ¶·Ú¿ÏÏËÏ·, ÂÎÙfi˜ ·fi ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÂÈ¤‰Ô˘ ˘Á›·˜, ıÚ¤„˘ Î·È ·Ó¿Ù˘Í˘, ÔÈ ∂£ Ù˘ ¶ª ÌÔÚÔ‡Ó Ó· ÂÓۈ̷وıÔ‡Ó Î·È ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Î·Ì˘ÏÒÓ ·Ó¿Ù˘Í˘ ÙÔ˘ ‚È‚ÏÈ·Ú›Ô˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ, ÒÛÙ ӷ ·ÔÙÂÏÔ‡Ó ¤Ó· ÔÏÔÎÏËڈ̤ÓÔ Î·È Û‡Á¯ÚÔÓÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙÔÓ ¤ÏÏËÓ· ·È‰›·ÙÚÔ Î·È ÁÔÓÈfi.

XÚËÌ·ÙÔ‰fiÙËÛË ∏ ¯ÚËÌ·ÙÔ‰fiÙËÛË ÙˆÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ ∞ÁˆÁ‹˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ¤ÁÈÓ ·fi ÙË Friesland Hellas, Î·È ÂÎÂ›ÓˆÓ Ô˘ ·ÊÔÚÔ‡Û·Ó ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, ·fi ÙË °ÂÓÈ΋ °Ú·ÌÌ·Ù›· ∞ıÏËÙÈÛÌÔ‡, ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ, ÙÔ ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ÙȘ ‰ËÌÔÙÈΤ˜ ·˘ÙÔ‰ÈÔÈ΋ÛÂȘ ÙˆÓ ¢‹ÌˆÓ ∞Á. ¡ÈÎÔÏ¿Ô˘, ƒÔ‡‚·, ÃÂÚÛÔÓ‹ÛÔ˘, ∏Ú·ÎÏ›Ԣ Î·È Ã·Ó›ˆÓ, ηıÒ˜ Î·È ÙË ¡Ô̷گȷ΋ ∞˘ÙÔ‰ÈÔ›ÎËÛË Ã·Ó›ˆÓ.

∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÁÈ· ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÌÂϤÙ˘ ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜: ÃÚ‹ÛÙÔ Ã·Ù˙‹, ∂ÈÚ‹ÓË ª¿ÚηÙ˙Ë, πˆ¿ÓÓ· ªÔÛ¯·Ó‰Ú¤·, ªÈ¯¿ÏË ∫˘ÚȷοÎË, ™ÔÊ›· ºÏÔ˘Ú‹, ª·Ú›· ªÈÙÛÒÚË, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ºÚfiÛˆ ªÂÚ‚·Ó¿ÎË, Caroline Codrington, ∞ϛӷ ¶··‰¿ÎË, ∫·ÙÂÚ›Ó· ™·ÚÚ‹, ª˘ÚˆÓ›· §·ÓÙ˙Ô˘Ú¿ÎË Î·È ·fi ÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ÷ӛˆÓ ÙÔ˘˜ ¢ËÌ‹ÙÚË ∞ı·Ó·ÛfiÔ˘ÏÔ Î·È ∂˘·ÁÁÂÏ›· ª·ÏˆÌÂÓ¿ÎË. ∂›Û˘, ·ÔÙÂÏÂÛÌ·ÙÈο Û˘Ó¤‚·Ï·Ó ÙÔ π·ÙÚÔÎÔÈÓˆÓÈÎfi ∫¤ÓÙÚÔ Î·È Ë ¢È‡ı˘ÓÛË ¶ÚˆÙÔ‚¿ıÌÈ·˜ ∂Î·›‰Â˘Û˘ ÙÔ˘ ¡ÔÌÔ‡ ÷ӛˆÓ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Cole TJ. The secular trend in human physical growth: a biological view. Econ Hum Biol 2003;1:161-168.

2. Lobstein T, Baur L, Uauy R; IASO International Obesity Taskforce. Obesity in children and young people: a crisis in public health. Obes Rev 2004;1 (Suppl 5):4-104.

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3. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-toheight ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000;24:1453-1458.

4. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tato L. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res 2001;9:179-187.

5. Mamalakis G, Kafatos A, Manios Y, Kalogeropoulos N, Andrikopoulos N. Abdominal vs buttock adipose fat: relationships with children's serum lipid levels. Eur J Clin Nutr 2002; 56:1081-1086.

6. Hirschler V, Aranda C, Calcagno Mde L, Maccalini G, Jadzinsky M. Can waist circumference identify children with the metabolic syndrome? Arch Pediatr Adolesc Med 2005;159:740-744.

7. Cruz M, Goran M. The metabolic syndrome in children and adolescents. Curr Diab Rep 2004;453-462.

8. Jessup A, Harrell J. The Metabolic Syndrome: Look for It in Children and Adolescents, Too! Clin Diabetes 2005;23: 26-32.

9. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among U.S. adolescents, 1999-2000. Diabetes Care 2004;27:2438-2443.

10. Grundy S, Becker D, Clark LT, Cooper RS, Denke MA, Howard J, et al. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation 2002;106:3143-3420.

11. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 2002;91: 1307-1312.

12. ∫·Ê¿ÙÔ˜ ∞, ª·ÓÈfi˜ °, ÷Ù˙‹˜ Ã, ªÔÛ¯·Ó‰Ú¤· π, ª·ÏˆÌÂÓ¿ÎË ∂, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢, et al. ∞ÍÈÔÏfiÁËÛË ÚÔÁÚ¿ÌÌ·ÙÔ˜ “∞ÁˆÁ‹˜ ÀÁ›·˜” ÌÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 1998;61:483-497.

13. Manios Y, Moschandreas J, Hatzis C, Kafatos A. Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period.

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14. Manios Y, Moschandreas J, Hatzis C, Kafatos A. Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention program. Br J Nutr 2002;88:315-324.

15. Kafatos A, Codrington CA, Linardakis M. Obesity in childhood: The Greek experience. World Rev Nutr Diet 2005;94:27-35.

16. Moschandreas JA, Kafatos A. Calcium intake in relation to diet and health indicators in Cretan primary and high school pupils, Greece. Int J Vitam Nutr Res 2002;72: 264-277.

17. ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ - ŒÚÁÔ ™∂¶¶∂, “ ŒÎıÂÛË ¶·ÚÔ˘Û›·Û˘ ∆ˆÓ ∞ÔÙÂÏÂÛÌ¿ÙˆÓ ∆ˆÓ ¶ÂÈÚ·Ì·ÙÈÎÒÓ ¶ÚÔÁÚ·ÌÌ¿ÙˆÓ”, ∞ı‹Ó·, ∑¿ÂÈÔ ª¤Á·ÚÔ, 7-9 ºÂ‚ 2000.

18. ªÔÛ¯·Ó‰Ú¤· I, ÷Ù˙‹˜ X, ª·ÌÌ¿˜ I, ªÂÚÙÛÈ¿˜ °, §ÈÓ·Ú‰¿Î˘ ª, ∫˘Úȷο΢ ª, et al. ¢Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ Î·È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ·ÁÚÔÙÈ΋˜ ÔÚÂÈÓ‹˜ ÂÚÈÔ¯‹˜ Ù˘ ∫Ú‹Ù˘. ¶·È‰È·ÙÚÈ΋ 2003;66:264-277.

19. §ÈÓ·Ú‰¿Î˘ ª. ™˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó-

20.

21.

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23.

24.

25.

26.

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28.

29.

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31.

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34.

35.

36.

‰ÚfiÌÔ˘ Û ·È‰ÈÎfi, ÂÊË‚ÈÎfi Î·È ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi Ù˘ ∫Ú‹Ù˘ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜. [ªÂÙ·Ù˘¯È·Î‹ ÂÚÁ·Û›·]. ∏Ú¿ÎÏÂÈÔ: ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘; 2005, Webpage: http//:mph.med.uoc.gr/ dissertation_catalog.htms ∫·Ê¿ÙÔ˜ ∞, ÷Ù˙‹˜ Ã, §ÈÓ·Ú‰¿Î˘ ª, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢, §ÈÔÓ‹˜ Ã, ª·ÏˆÌÂÓ¿ÎË ∂, et al. ∞ıËÚÔÁfiÓÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÙÔ˘ ÓÔÌÔ‡ ÷ӛˆÓ. ¶·È‰È·ÙÚÈ΋ 2006;70:97-106. §ÈÓ·Ú‰¿Î˘ ª, ªÔÛ¯·Ó‰Ú¤· I, ∫·Ê¿ÙÔ˜ ∞. ∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ ‚ÚÂÊÈ΋˜ Î·È ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ù˘ ∫Ú‹Ù˘ Ô˘ ÚԤ΢„·Ó ·fi ‰È·¯ÚÔÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜. ¶·È‰È·ÙÚÈ΋ 2000;63:391-407.

Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Tafouna P, Kafatos A. Reference growth curves for cypriot children 6 to 17 years of age. Obes Res 2001;9:754-762.

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Moran O, Phillip M. Leptin: obesity, diabetes and other peripheral effects--a review. Pediatr Diabetes 2003;4:101-109.

Mendoza-Nunez VM, Garcia-Sanchez A, Sanchez-Rodriguez M, Galvan-Duarte RE, Fonseca-Yerena ME. Overweight, waist circumference, age, gender, and insulin resistance as risk factors for hyperleptinemia. Obes Res 2002;10: 253-259.

Johnson MS, Huang TT, Figueroa-Colon R, Dwyer JH, Goran MI. Influence of leptin on changes in body fat during growth in African American and white children. Obes Res 2001;9:593-598. ∫·Ê¿ÙÔ˜ ∞. ∫·Ì‡Ï˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜. ¶·È‰È·ÙÚÈ΋ 2007;70:70-74. ¶·È‰È·ÙÚÈ΋ 2007;70:300-307

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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

ORIGINAL ARTICLE

√ÚÌfiÓ˜ Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ fiÚÂÍË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Û ÚfiˆÚ· ÓÂÔÁÓ¿ 1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ, 2 µÈÔ¯ËÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” AÏÏËÏÔÁÚ·Ê›·: ∆¿ÓÈ· ™È·¯·Ó›‰Ô˘ neonat5@paidon-agiasofia.gr ªÔÓ¿‰· ¡ÂÔÁÓÒÓ, ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & §Â‚·‰Â›·˜ ∆.∫. 115 27, ∞ı‹Ó·

∆. ™È·¯·Ó›‰Ô˘1, π. ¶··ÛˆÙËÚ›Ô˘2, ª. µÔ˘Ó¿ÙÛÔ˘2, ∂. ªËÏ›ÙÛË2, ∂. ª¿Ó‰˘Ï·1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ ·Ó¿Ù˘ÍË Î·È ıÚ¤„Ë Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÌÂÙ¤ÂÈÙ· ˘Á›· ‹ ÂÌÊ¿ÓÈÛË ÓÔÛËÌ¿ÙˆÓ ÊıÔÚ¿˜. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜, Û ÚfiˆÚ· ÓÂÔÁÓ¿, ÙˆÓ ÂÈ¤‰ˆÓ ÔÚÌÔÓÒÓ Ô˘ ÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi, ·ÏÏ¿ Î·È Ë ·Ó·˙‹ÙËÛË Ù˘ ÌÂٷ͇ ÙÔ˘˜ Û¯¤Û˘, ηıÒ˜ Î·È Ù˘ Û˘Û¯¤ÙÈÛ‹˜ ÙÔ˘˜ Ì ÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∆· Â›‰· ÔÏÈÎÔ‡ ÂÙȉ›Ô˘ ÀÀ (ƒÀÀ), ƒÀÀ3-36, ÁÎÚÂÏ›Ó˘, ÈÓÛÔ˘Ï›Ó˘, ÏÂÙ›Ó˘ Î·È ·‰ÈÔÓÂÎÙ›Ó˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÛÙÔÓ ÔÚfi 62 ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ, ËÏÈΛ·˜ ·ËÛ˘ 32,0±2,1 ‚‰ÔÌ¿‰ˆÓ, Û ËÏÈΛ· 40±14 Ë̤Ú˜ ˙ˆ‹˜, ηıÒ˜ Î·È 15 ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘. ŸÏ· Ù· ÓÂÔÁÓ¿ ÛÈÙ›ÛÙËÎ·Ó Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï·. ∞ÔÙÂϤÛÌ·Ù·: ∆· Â›‰· ƒÀÀ, ƒÀÀ3-36 Î·È ÁÎÚÂÏ›Ó˘ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· ·fi Ù· ÙÂÏÂÈfiÌËÓ· (p<0,001 ÁÈ· fiϘ ÙȘ ‰È·ÊÔÚ¤˜), Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· (p<0,01), ÂÓÒ Ù· Â›‰· ÏÂÙ›Ó˘ Î·È ÈÓÛÔ˘Ï›Ó˘ ‰ÂÓ ‰È¤ÊÂÚ·Ó. øÛÙfiÛÔ, ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, Ù· Â›‰· Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ ‹Ù·Ó ˘„ËÏfiÙÂÚ· (p=0,02) Î·È Ù˘ ÈÓÛÔ˘Ï›Ó˘ ¤ÙÂÈÓ·Ó Ó· Â›Ó·È ˘„ËÏfiÙÂÚ· (p=0,07) ·fi ·˘Ù¿ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ. ∆· Â›‰· ƒÀÀ Î·È ƒÀÀ3-36 ÛÙÔÓ ÔÚfi ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó ıÂÙÈο Ì ٷ Â›‰· ÁÎÚÂÏ›Ó˘ (r=0,33, p=0,009 Î·È r=0,30, p=0,01, ·ÓÙ›ÛÙÔȯ·) Î·È ÈÓÛÔ˘Ï›Ó˘ (r=0,37, p=0,003 Î·È r=0,38, p=0,003, ·ÓÙ›ÛÙÔȯ·). ¢È·ÈÛÙÒıËΠ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚÔÒÚˆÓ Ì ÙÔ ƒÀÀ (r=-0,44, p<0,001), ÙÔ ƒÀÀ3-36 (r=-0,33, p=0,01) Î·È ÙËÓ ÈÓÛÔ˘Ï›ÓË (r=-0,43, p<0,01), ·ÏÏ¿ ıÂÙÈ΋ Ì ÙËÓ ·‰ÈÔÓÂÎÙ›ÓË (r=0,28, p=0,02). ∆· Â›‰· ÏÂÙ›Ó˘ Û˘Û¯ÂÙ›ÛÙËÎ·Ó ·ÚÓËÙÈο (r=-0,27, p<0,05) Î·È Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ ıÂÙÈο (r=0,26, p<0,05) Ì ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ªÂ ÙË Ì¤ıÔ‰Ô Ù˘ ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛ˘ ‰È·ÈÛÙÒıËΠfiÙÈ Ë ‰È·ÙÚÔÊ‹ Ì Á¿Ï· Ô˘ ÂÚÈ›¯Â LCPUFAs ÂËÚ¤·Û ıÂÙÈο Ù· Â›‰· Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ (‚=0,28, p=0,03). ™˘ÌÂÚ¿ÛÌ·Ù·: ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Ù· ÚfiˆÚ· ‚Ú¤ÊË ‰ÂÓ ÌÂÈÔÓÂÎÙÔ‡Ó ˆ˜ ÚÔ˜ ÙË Û‡ÓıÂÛË/¤ÎÎÚÈÛË ÙˆÓ ÔÚÌÔÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·‡ÍËÛË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi, ˆÛÙfiÛÔ Ô ‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ÔÚÌÔÓÒÓ ·˘ÙÒÓ ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË.

§¤ÍÂȘ ÎÏÂȉȿ: ¶ÂÙ›‰ÈÔ ÀÀ, ÁÎÚÂÏ›ÓË, ÏÂÙ›ÓË, ·‰ÈÔÓÂÎÙ›ÓË, ÓÂÔÁÓ¿.

Hormones regulating the food intake and metabolism of preterm infants 1 First Department of Paediatrics, University of Athens 2 Biochemistry Laboratory, “Aghia Sophia” Hospital, Athens, Greece

Correspondence: Tania Siahanidou neonat5@paidon-agiasofia.gr Neonatal Unit, First Department of Paediatrics, University of Athens “Aghia Sophia” Children’s Hospital Thivon & Levadias St 115 27, Athens, Greece

Paediatriki 2007;70:308-315

T. Siahanidou1, I. Papassotiriou2, M. Vounatsou2, H. Militsi2, H. Mandyla1 Abstract Background: Growth and nutrition in the neonatal period have been linked with health and disease in later life. The aim of this study was to determine in preterm infants the circulating levels of hormones implicated in the regulation of food intake and metabolism, and to examine their interrelation and correlations with anthropometric parameters and weight gain.

Methods: Serum levels of total peptide YY (PYY), PYY3-36, ghrelin, insulin, leptin and adiponectin were determined in 62 preterm infants (gestational age 32.0±2.1 weeks) at 40±14 days of life, and in 15 full term infants of a comparable postnatal age and gender. All the infants were formula fed.

Results: In the preterm infants, the levels of PYY, PYY3-36 and ghrelin were significantly higher than in the full term infants (p<0.001 for all), adiponectin levels were lower (p<0.01) and there was no difference in leptin and insulin levels between the two groups. However, after correction for body weight, serum adiponectin levels were significantly higher (p=0.02) and insulin levels tended to be higher (p=0.07) in preterm than in full term infants. In the preterm infants, serum PYY and PYY3-36 levels were positively correlated with serum ghrelin (r=0.33, p=0.009 and r=0.30, p=0.01, respectively) and insulin levels (r=0.37, p=0.003 and r=0.38, p=0.003, respectively). PYY, PYY3-36 and insulin levels correlated negatively (r=-0.44, p<0.001; r=-0.33, p=0.01 and r=-0.43, p<0.01, respectively), and adiponectin levels positively

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√ÚÌfiÓ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ fiÚÂÍË Î·È ÙoÓ ÌÂÙ·‚ÔÏÈÛÌfi

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(r=0.28, p=0.02), with the body weight, while leptin levels correlated negatively (r=-0.27, p<0.05) and adiponectin levels positively (r=0.26, p<0.05) with the growth rate. In multiple regression analysis, feeding with a formula containing LCPUFAs was an independent predictor of the serum adiponectin level (‚=0.28, p=0.03).

Conclusions: Preterm infants are not defective in the synthesis/secretion of the hormones implicated in the regulation of growth and metabolism; however the physiological role of these hormones needs to be further elucidated.

Key words: Peptide YY, ghrelin, leptin, adiponectin, neonates.

∂ÈÛ·ÁˆÁ‹ ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÓÂÔÁÓ¿ Ì ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó Î·Ú‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù· Î·È ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ (˘¤ÚÙ·ÛË, ˘ÂÚÏÈȉ·ÈÌ›·, ·ÓÙÔ¯‹ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 2) ηٿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (1). ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Î·È Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÓÔÛ‹Ì·Ù· ÊıÔÚ¿˜ ·ÚÁfiÙÂÚ·, ·ÓÂÍ·Úًو˜ ·Ó ÙÔ ‚¿ÚÔ˜ ÙÔ˘˜ ηٿ ÙË Á¤ÓÓËÛË ‹Ù·Ó ¯·ÌËÏfi ‹ ηÓÔÓÈÎfi ÁÈ· ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘ (2). ∂ÈϤÔÓ, Ë ‰È·ÙÚÔÊ‹, Ë ·Ó¿Ù˘ÍË Î·È Ë ıÚ¤„Ë Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÌÂÙ¤ÂÈÙ· ηϋ ÂͤÏÈÍË ‹ ÙËÓ ÂÌÊ¿ÓÈÛË ÓÔÛËÌ¿ÙˆÓ ÊıÔÚ¿˜ (3-5). ∞fi Ù· ÂÙ›‰È· Ô˘ ¤¯Ô˘Ó ̤¯ÚÈ Û‹ÌÂÚ· ·Ó·ÁÓˆÚÈÛı› fiÙÈ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔ ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜, ÙÔ ÂÙ›‰ÈÔ ÀÀ (ƒÀÀ) ÂÎÎÚ›ÓÂÙ·È Î˘Ú›ˆ˜ ·fi ÂÓ‰ÔÎÚÈÓÈο ·ÙÙ·Ú· ÙÔ˘ ÏÂÙÔ‡ Î·È ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ Î·È ÔÈ Î‡ÚÈÔÈ ÈÛfiÙ˘Ô› ÙÔ˘ Â›Ó·È ÙÔ ƒÀÀ1-36 Î·È ÙÔ ƒÀÀ3-36. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ƒÀÀ1-36 Û ÂÈÚ·Ì·Ùfi˙ˆ· ·ÛΛ ÔÚÂÍÈÔÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ ÙˆÓ À1 ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘ Î·È ·ÓÔÚÂÍÈÔÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ ÙˆÓ À2 ˘Ô‰Ô¯¤ˆÓ, ÂÓÒ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ƒÀÀ3-36 ¤¯ÂÈ ÌfiÓÔÓ ·ÓÔÚÂÍÈÔÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ ÙˆÓ À2 ˘Ô‰Ô¯¤ˆÓ Î·È ·Ó·ÛÙ¤ÏÏÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (6,7). ∏ ÁÎÚÂÏ›ÓË ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi ·ÙÙ·Ú· ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ·ÛΛ ÔÚÂÍÈÔÁfiÓÔ ‰Ú¿ÛË Ì¤Ûˆ ‰È¤ÁÂÚÛ˘ ÙˆÓ À1 ˘Ô‰Ô¯¤ˆÓ ÙÔ˘ ˘Ôı·Ï¿ÌÔ˘. ∏ ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛ‹ Ù˘ Û ÂÈÚ·Ì·Ùfi˙ˆ· Ô‰ËÁ› Û ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ̤ۈ ·‡ÍËÛ˘ Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÙÚÔÊ‹˜ ·ÏÏ¿ ηÈ, ÂӉ¯Ô̤ӈ˜, ̤ۈ ÂÏ¿ÙÙˆÛ˘ Ù˘ ÔÍ›‰ˆÛ˘ ÙÔ˘ Ï›Ô˘˜ Î·È Ì›ˆÛ˘ Ù˘ ηٷӿψÛ˘ ÂÓ¤ÚÁÂÈ·˜ (8). ∏ ÏÂÙ›ÓË ·Ú¿ÁÂÙ·È ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi ηÈ, ̤ۈ Ù˘ ÎÂÓÙÚÈ΋˜ ‰Ú¿Û˘ Ù˘ Û ·ÙÙ·Ú· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÂÚÈÔÚ›˙ÂÈ ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ·ÚÂÌ‚·›ÓÂÈ ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ÙË ÓÂÔÁÏ˘ÎÔÁ¤ÓÂÛË (9). ∆· Â›‰¿ Ù˘ ÛÙÔÓ ÔÚfi Â›Ó·È ·˘ÍË̤ӷ Û ¿ÙÔÌ·

Ì ·¯˘Û·ÚΛ· Î·È ÌÂÙ·‚ÔÏÈÎfi Û‡Ó‰ÚÔÌÔ, ÏfiÁˆ ·Ó¿Ù˘Í˘ ·ÓÙÔ¯‹˜. ∏ ÈÓÛÔ˘Ï›ÓË, ÂÎÙfi˜ ·fi ÙÔÓ ÁÓˆÛÙfi Ù˘ ÚfiÏÔ ÛÙËÓ ÔÌÔÈÔÛÙ·Û›· Ù˘ ÁÏ˘Îfi˙˘, ¤¯ÂÈ ÎÂÓÙÚÈ΋ ‰Ú¿ÛË, Û˘ÓÂÚÁÈ΋ Ì ·˘Ù‹ Ù˘ ÏÂÙ›Ó˘, ÛÙË Ú‡ıÌÈÛË Ù˘ ÚfiÛÏ˄˘ ÙÚÔÊ‹˜ Î·È ÛÙÔ ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜ (9). ∆¤ÏÔ˜, Ë ·‰ÈÔÓÂÎÙ›ÓË ·Ú¿ÁÂÙ·È ·fi ÙÔÓ ÏÈÒ‰Ë ÈÛÙfi Î·È ·˘Í¿ÓÂÈ ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ÚÔÛٷهÔÓÙ·˜ ·fi ÙËÓ ·Ó¿Ù˘ÍË ·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ (10). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó Ù· Â›‰· ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36, ÁÎÚÂÏ›Ó˘, ÈÓÛÔ˘Ï›Ó˘, ÏÂÙ›Ó˘ Î·È ·‰ÈÔÓÂÎÙ›Ó˘ ÛÙÔÓ ÔÚfi ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÂÚ› ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· ˙ˆ‹˜ ÙÔ˘˜ Î·È Ó· ·Ó·˙ËÙËı› Ë ÌÂٷ͇ ÙÔ˘˜ Û¯¤ÛË, ηıÒ˜ Î·È Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙˆÓ ·È‰ÈÒÓ, ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 62 ÚfiˆÚ· ÓÂÔÁÓ¿ (ÎÔÚ›ÙÛÈ·/·ÁfiÚÈ· 34/28), ËÏÈΛ·˜ ·ËÛ˘ 32,0±2,1 ‚‰ÔÌ¿‰ˆÓ Î·È ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ 1542±275 g, Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË ªÔÓ¿‰· Ì·˜. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó ÓÂÔÁÓ¿ Ô˘ 1) ‰ÂÓ ÂÌÊ¿ÓÈ˙·Ó Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜, 2) ‰ÂÓ Â›¯·Ó ÛËÌ·ÓÙÈ΋ ÓÔÛËÚfiÙËÙ· (ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ·‰›Ô˘ >1 ηٿ Volpe) ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘˜, 3) ‰ÂÓ ÂÌÊ¿ÓÈÛ·Ó Ïԛ̈ÍË Î·Ù¿ ÙȘ 10 ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÂÏÂ˘Ù·›Â˜ Ë̤Ú˜ ÓÔÛËÏ›·˜ Î·È 4) ÛÈÙ›ÛÙËÎ·Ó ·ÔÎÏÂÈÛÙÈο Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï·. ∏ ËÏÈΛ· ·ËÛ˘ ˘ÔÏÔÁ›ÛÙËΠ‚¿ÛÂÈ Ù˘ ÙÂÏÂ˘Ù·›·˜ ¤ÌÌËÓ˘ Ú‡Û˘, ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ Î·È Ù˘ ÎÏÈÓÈ΋˜ ÂͤٷÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. ø˜ ÏÈÔ‚·Ú‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘ ÔÚ›ÛÙËÎ·Ó Ù· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ <-2 SD ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ Î·È ÙÔ Ê‡ÏÔ. ∂Ù¿ ·fi Ù· 62 ÚfiˆÚ· ‹Ù·Ó ÏÈÔ‚·Ú‹ (11,3%). ŸÏ· Ù· ÓÂÔÁÓ¿ ÛÈÙ›ÛÙËÎ·Ó Ì ÙÔ ›‰ÈÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· (S-26, Wyeth Nutritional, Ireland). ∏ ÂÙ·ÈÚ›· ·Ú·ÁˆÁ‹˜ ÂÈÛ‹Á·Á ÛÙËÓ ·ÁÔÚ¿ Á¿Ï· Ì ÙËÓ ›‰È· ÂˆÓ˘Ì›·, ÙÔ ÔÔ›Ô ÂÚÈ›¯Â ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· Ôχ Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ (LCPUFAs), ·Ú·¯È‰ÔÓÈÎfi (97 mg/100g ÛÎfiÓ˘ Á¿Ï·ÎÙÔ˜) Î·È ÂÈÎÔÛȉ˘ÔÂÍ·ÓÔ˚Îfi ¶·È‰È·ÙÚÈ΋ 2007;70:308-315

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·310

310

∆. ™È·¯·Ó›‰Ô˘ Î·È Û˘Ó.

(56 mg/100 g ÛÎfiÓ˘ Á¿Ï·ÎÙÔ˜), fï˜ ‰ÂÓ ‰È¤ÊÂÚ ˆ˜ ÚÔ˜ ÙË ÏÔÈ‹ Û‡ÓıÂÛ‹ ÙÔ˘ ·fi ÙÔ ÚÔËÁÔ‡ÌÂÓÔ Á¿Ï·, Ô‡Ù ˆ˜ ÚÔ˜ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘ Û ıÂÚÌ›‰Â˜ (67 Kcal/100 ml Á¿Ï·ÎÙÔ˜). ∂ÓÓ¤· ·fi Ù· 62 ÚfiˆÚ· ÛÈÙ›ÛÙËÎ·Ó Ì ÙÔ Á¿Ï· Ô˘ ‹Ù·Ó ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì LCPUFAs. ∏ ËÏÈΛ· ·ËÛ˘, ÙÔ Ê‡ÏÔ Î·È Ù· ۈ̷ÙÔÌÂÙÚÈο ηٿ ÙË Á¤ÓÓËÛË ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ô˘ ÛÈÙ›ÛÙËÎ·Ó Ì Á¿Ï· Ô˘ ÂÚÈ›¯Â LCPUFAs ‰ÂÓ ‰È¤ÊÂÚ·Ó ·fi Ù· ·ÓÙ›ÛÙÔȯ· ÙˆÓ ˘ÔÏÔ›ˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∆· ÓÂÔÁÓ¿ ÛÈÙ›ÛÙËÎ·Ó ·Ú¯Èο Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ηıÂÙ‹Ú· Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì ı‹Ï·ÛÙÚÔ Î¿ı 3 ÒÚ˜. ŒÁÈÓ ηٷÁÚ·Ê‹ Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÔÛfiÙËÙ·˜ Á¿Ï·ÙÔ˜ Î·È ˘ÔÏÔÁ›ÛÙËÎÂ Ë ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ/∫g*/24ˆÚÔ Î·Ù¿ ÙËÓ ÙÂÏÂ˘Ù·›· ‚‰ÔÌ¿‰· ÚÈÓ ÙËÓ ¤ÍÔ‰Ô. ∆· ÓÂÔÁÓ¿ ˙˘Á›˙ÔÓÙ·Ó Î·ıËÌÂÚÈÓ¿ ÛÙËÓ ›‰È· ËÏÂÎÙÚÔÓÈ΋ ˙˘Á·ÚÈ¿. ∆Ô Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ÙÔ˘˜ ÌÂÙÚÈfiÙ·Ó ·Ó¿ ‚‰ÔÌ¿‰· ·fi ÙÔÓ ›‰ÈÔ ÂÚ¢ÓËÙ‹. ∂ÎÙÈÌ‹ıËÎÂ Ë ·fiÎÏÈÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ·fi ÙÔ Ì¤ÛÔ Ê˘ÛÈÔÏÔÁÈÎfi ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ (z-score) Ì ηٿÏÏËÏÔ ÚfiÁÚ·ÌÌ· (http://www.biomedcentral.com). YÔÏÔÁ›ÛÙËÎÂ Ô Ú˘ıÌfi˜ ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg*/24ˆÚÔ), ηıÒ˜ Î·È Ô ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (BMI). ∫·Ù¿ ÙËÓ Ë̤ڷ Ù˘ ÂÍfi‰Ô˘ ÙÔ˘˜ ·fi ÙÔ ÙÌ‹Ì· ÓÂÔÁÓÒÓ, Ù· ÓÂÔÁÓ¿ ˘Ô‚Ï‹ıËÎ·Ó Û ·ÈÌÔÏË„›· ÁÈ· ÙÔÓ Û˘Ó‹ıË ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÂÈϤÔÓ ÁÈ· ÙË Ì¤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36, ÁÎÚÂÏ›Ó˘, ÈÓÛÔ˘Ï›Ó˘, ÏÂÙ›Ó˘ Î·È ·‰ÈÔÓÂÎÙ›Ó˘ ÛÙÔÓ ÔÚfi. ∏ ̤ÛË ËÏÈΛ· ÙÔ˘˜ ηٿ ÙËÓ ·ÈÌÔÏË„›· ‹Ù·Ó 40±14 Ë̤Ú˜ ˙ˆ‹˜. ∏ ̤ÙÚËÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ Î·È ƒÀÀ3-36 ¤ÁÈÓ Ì RIA (Linco Research), fiˆ˜ Î·È Ù˘ ÁÎÚÂÏ›Ó˘ (Phoenix Pharmaceuticals) Î·È Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ (Linco Research). H ÏÂÙ›ÓË ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ELISA (Diagnostic Systems Laboratories, USA). ∏ ÂÏ¿¯ÈÛÙË ·ÓȯÓ‡ÛÈÌË Û˘ÁΤÓÙÚˆÛË Î·È Ô ÂÓ‰Ô- Î·È ‰È·- ·Ó·Ï˘ÙÈÎfi˜ Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ ÙˆÓ ¯ÚËÛÈÌÔÔÈËı¤ÓÙˆÓ ÂÌÔÚÈÎÒÓ Û˘Û΢·ÛÈÒÓ (kits) ‹Ù·Ó 10 pg/ml, 4,5% Î·È 6,5% ·ÓÙ›ÛÙÔȯ· ÁÈ· ÙÔ ÔÏÈÎfi PYY, 20 pg/ml, 7% Î·È 6,4% ·ÓÙ›ÛÙÔȯ· ÁÈ· ÙÔ PYY3-36, 12 pg/ml, 5,5% Î·È 2,1% ·ÓÙ›ÛÙÔȯ· ÁÈ· ÙË ÁÎÚÂÏ›ÓË, 1 Ìg/ml, 7% Î·È 6% ·ÓÙ›ÛÙÔȯ· ÁÈ· ÙËÓ ·‰ÈÔÓÂÎÙ›ÓË Î·È 0,05 Ìg/L, 3,2% Î·È 4% ·ÓÙ›ÛÙÔȯ· ÁÈ· ÙË ÏÂÙ›ÓË. ∏ ̤ÙÚËÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ Û ·˘ÙfiÌ·ÙÔ ·Ó·Ï˘Ù‹ (ASC:180, Bayer Diagnostics Corp.). °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÔÚÌÔÓÒÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ÔÌ¿‰· ·Ó·ÊÔÚ¿˜ 15 ˘ÁÈ‹ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ 3200±498 g, Ô˘ ›¯·Ó ·ÚfiÌÔÈ· ËÏÈΛ· (36±15 Ë̤Ú˜ ˙ˆ‹˜) Î·È Ê‡ÏÔ (ÎÔÚ›ÙÛÈ·/·ÁfiÚÈ· 9/6) Ì ٷ ÚfiˆÚ· Î·È ÛÈÙ›ÛÙËÎ·Ó ·fi ÙË Á¤ÓÓËÛË Ì ÙÔ ›‰ÈÔ ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· (S-26, Wyeth) ¯ˆÚ›˜ LCPUFAs. ∏ ÌÂϤÙË ÂÁÎÚ›ıËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ Î·È Ï‹ÊıËΠ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. ∆· ·ÔÙÂϤÛÌ·Ù· ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ̤ÛË ÙÈÌ‹±SD, Ì ÂÍ·›ÚÂÛË ÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙË ÏÂÙ›ÓË, ÙˆÓ ÔÔ›ˆÓ Ù· Â›‰· ÂÎÊÚ¿ÛÙËÎ·Ó ˆ˜ ‡ÚÔ˜ Î·È ‰È¿ÌÂÛË ÙÈÌ‹, ÏfiÁˆ ÌË Î·ÓÔÓÈ΋˜ ηٷÓÔÌ‹˜. ∏ ηٷÓÔÌ‹ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÔÏÈÎÔ‡ PYY, ÙÔ˘ PYY3-36 Î·È Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ ‹Ù·Ó ηÓÔÓÈ΋. °È· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÔÈ ‰ÔÎÈ̷ۛ˜ ttest Î·È Mann-Whitney U-test. ∏ ·Ó·˙‹ÙËÛË ÙˆÓ Û˘Û¯ÂÙ›ÛÂˆÓ ¤ÁÈÓ Ì ÌÂıfi‰Ô˘˜ ·Ï‹˜ Û˘Û¯¤ÙÈÛ˘ (correlation analysis), ·Ï‹˜ ÂÍ¿ÚÙËÛ˘ (regression analysis) Î·È ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛ˘ (multiple regression analysis). °È· ÙË ÌÂϤÙË ÙˆÓ Û˘Û¯ÂÙ›ÛÂˆÓ ¤ÁÈÓ ÏÔÁ·Ú›ıÌËÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÔÚÌÔÓÒÓ Ô˘ ‰ÂÓ Â›¯·Ó ηÓÔÓÈ΋ ηٷÓÔÌ‹.

Paediatriki 2007;70:308-315

∞ÔÙÂϤÛÌ·Ù· ∆· ۈ̷ÙÔÌÂÙÚÈο ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙË ªÔÓ¿‰· ¡ÂÔÁÓÒÓ, ηıÒ˜ Î·È ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ, Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ™Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, Ë ·fiÎÏÈÛË ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ ·fi ÙÔ Ì¤ÛÔ Ê˘ÛÈÔÏÔÁÈÎfi ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ (z-score) ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· ¡ÂÔÁÓÒÓ ‹Ù·Ó ·ÚÓËÙÈ΋ (-2,0±0,4). ∂›Û˘, ÙÔ ÈÛÔ˙‡ÁÈÔ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ ‹Ù·Ó ·ÚÓËÙÈÎfi, ‰ÈfiÙÈ Ë ‰È·ÊÔÚ¿ ÙÔ˘ z-score ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ·fi ÙÔ zscore ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· (¢z-score ‚¿ÚÔ˘˜) ‹Ù·Ó ·ÚÓËÙÈ΋ (-0,92±0,72, ¶›Ó·Î·˜ 1), ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ì ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ <-2 SD ηٿ ÙËÓ ¤ÍÔ‰Ô (63%) ¤Ó·ÓÙÈ ÌÈÎÚfiÙÂÚÔ˘ ÔÛÔÛÙÔ‡ ηٿ ÙË Á¤ÓÓËÛË (11,3%). ∏ ÔÛfiÙËÙ· ÙÔ˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓÔ˘ Á¿Ï·ÙÔ˜/∫g*/24ˆÚÔ ‰ÂÓ ‰È¤ÊÂÚÂ, Î·È ÂÔ̤ӈ˜ Ô‡Ù ÙÔ ÔÛfi ıÂÚÌ›‰ˆÓ/∫g*/24ˆÚÔ ÌÂٷ͇ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ (156±20 Î·È 155±27 Kcal/Kg/24ˆÚÔ, ·ÓÙ›ÛÙÔȯ·). ∆· Â›‰· ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36 Î·È ÁÎÚÂÏ›Ó˘, ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· ·fi Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿. ∆· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· Î·È ‰ÂÓ ‰È¤ÊÂÚ·Ó Ù· Â›‰· ÈÓÛÔ˘Ï›Ó˘ Î·È ÏÂÙ›Ó˘ ÌÂٷ͇ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ. øÛÙfiÛÔ, ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, Ù· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙ· ÚfiˆÚ· ·fi Ù· ÙÂÏÂÈfiÌËÓ·, ÂÓÒ Ë ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ Ù· Â›‰· ÈÓÛÔ˘Ï›Ó˘ ¤ÙÂÈÓ ӷ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,07) (¶›Ó·Î·˜ 2). ™Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, Ù· Â›‰· ƒÀÀ3-36 ·ÔÙÂÏÔ‡Û·Ó ÙÔ 48% ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ, ÔÛÔÛÙfi ·ÚfiÌÔÈÔ Ì ·˘Ùfi ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ (42%), Ë ‰Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ƒÀÀ Î·È ƒÀÀ3-36 ‹Ù·Ó ıÂÙÈ΋ (r=0,82, p<0,01). ∆· Â›‰· ƒÀÀ, ηıÒ˜ Î·È ƒÀÀ3-36, Û˘Û¯ÂÙ›ÛıËÎ·Ó ıÂÙÈο Ì ٷ Â›‰· ÁÎÚÂÏ›Ó˘ (r=0,33, p=0,009, ∂ÈÎfiÓ· 1∞, Î·È r=0,30, p=0,01, ·ÓÙ›ÛÙÔȯ·) Î·È ÈÓÛÔ˘Ï›Ó˘ (r=0,37, p=0,003, ∂ÈÎfiÓ· 1µ, Î·È r=0,38, p=0,003, ·ÓÙ›ÛÙÔȯ·). ¶›Ó·Î·˜ 1. ™ˆÌ·ÙÔÌÂÙÚÈΤ˜ ·Ú¿ÌÂÙÚÔÈ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ¶ÚfiˆÚ· ∆ÂÏÂÈfiÌËÓ· (n=62) (n=15) ∏ÏÈΛ· Â͈̋ÙÚÈ·˜ ˙ˆ‹˜ (Ë̤Ú˜) 40±14 µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (g) 2269±162** ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ (cm) 46,7±0,7** ¶ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ (cm) 33,2±1,0** ¢z-score ‚¿ÚÔ˘˜# -0,92±0,72**

36±15 3835±706 54,3±3,3 36,7±1,6 -0,15±0,63

# ¢È·ÊÔÚ¿ z-score ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ·fi ÙÔ z-score ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ηٿ ÙËÓ ·ÈÌÔÏË„›· **p≤0,01 Û˘ÁÎÚÈÙÈο Ì ٷ ÙÂÏÂÈfiÌËÓ·

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·311

311

√ÚÌfiÓ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ fiÚÂÍË Î·È ÙoÓ ÌÂÙ·‚ÔÏÈÛÌfi

1600

A

A 1400

¶ÂÙ›‰ÈÔ ÀÀ (pg/ml)

OÏÈÎfi ÂÙ›‰ÈÔ ÀÀ ÔÚÔ‡ (pg/ml)

1600

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°ÎÚÂÏ›ÓË ÔÚÔ‡ (pg/ml) 1600

2400

2600

2800

1,4

B

B

1,2

1400

log ÈÓÛÔ˘Ï›ÓË (mU/L)

OÏÈÎfi ÂÙ›‰ÈÔ ÀÀ ÔÚÔ‡ (pg/ml)

2200

B¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (g)

1200 1000 800

1,0 ,8 ,6 ,4 ,2

600

0,0 400 -,2

0,0

,2

,4

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Log ÈÓÛÔ˘Ï›ÓË ÔÚÔ‡ (mU/L)

2000

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2600

2800

B¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (g)

∂ÈÎfiÓ· 1. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÔÏÈÎÔ‡ ƒÀÀ ÔÚÔ‡ Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ∞) Ù· Â›‰· ÁÎÚÂÏ›Ó˘ (r=0,33, p=0,009, µ) Ù· Â›‰· ÈÓÛÔ˘Ï›Ó˘ (r=0,37, p=0,003).

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ∞) ÔÏÈÎÔ‡ ƒÀÀ ÔÚÔ‡ (r=-0,44, p<0,001) Î·È µ) ÈÓÛÔ˘Ï›Ó˘ ÔÚÔ‡ (r=-0,43, p<0,01) Ì ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ.

¢È·ÈÛÙÒıËΠ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ƒÀÀ, ηıÒ˜ Î·È ƒÀÀ3-36, Ì ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=-0,44, p<0,001, ∂ÈÎfiÓ· 2∞, Î·È r=-0,33, p=0,01, ·ÓÙ›ÛÙÔȯ·) Î·È Ì ÙÔÓ µªπ (r=-0,46, p<0,001 Î·È r=-0,38, p<0,01, ·ÓÙ›ÛÙÔȯ·). ∂›Û˘, Ù· Â›‰· ÈÓÛÔ˘Ï›Ó˘ Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÚÓËÙÈο Ì ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ Úfiˆ-

ÚˆÓ ÓÂÔÁÓÒÓ (r=-0,43, p<0,01, ∂ÈÎfiÓ· 2µ) Î·È Ì ÙÔÓ µªπ (r=-0,52, p<0,01). ¢ÂÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÁÎÚÂÏ›Ó˘ Î·È ÏÂÙ›Ó˘ ÔÚÔ‡ Ì ÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·Ù¿ ÙË Á¤ÓÓËÛË ‹ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰·. ∆· Â›‰· ÏÂÙ›Ó˘ Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÚÓËÙÈο Ì ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘

¶›Ó·Î·˜ 2. ∂›‰· ÔÚÌÔÓÒÓ ÛÙÔÓ ÔÚfi ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘

√ÏÈÎfi ƒÀÀ (pg/ml) ƒÀÀ3-36 (pg/ml) °ÎÚÂÏ›ÓË (pg/ml) πÓÛÔ˘Ï›ÓË (mU/L) πÓÛÔ˘Ï›ÓË/Kg* (mU/L/∫g*) §ÂÙ›ÓË (Ìg/L) ∞‰ÈÔÓÂÎÙ›ÓË (Ìg/ml) ∞‰ÈÔÓÂÎÙ›ÓË/Kg*(Ìg/ml/Kg*)

¶ÚfiˆÚ· (n=62)

∆ÂÏÂÈfiÌËÓ· (n=15)

1126±215 544±157 721±98 0,7-22,2 (‰È¿ÌÂÛË 2,3) 0,3-9,7 (‰È¿ÌÂÛË 1,0) 0,1-15,6 (‰È¿ÌÂÛË 1,2) 40±15 18,0±6,8

825±234 350±114 602±93 0,5-10,6 (‰È¿ÌÂÛË 3,1) 0,1-3,4 (‰È¿ÌÂÛË 0,7) 0,1-9,7 (‰È¿ÌÂÛË 1,2) 53±16 14,1±4,8

p <0,001 <0,001 <0,001 >0,05 0,07 >0,05 <0,01 0,02 ¶·È‰È·ÙÚÈ΋ 2007;70:308-315

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·312

312

∆. ™È·¯·Ó›‰Ô˘ Î·È Û˘Ó.

Log ÏÂÙ›Ó˘ ÔÚÔ‡ (Ìg/L)

1,5 1,0 ,5 0,0 -, 5 -1,0 -1,5 0

3

6

9

12

15

18

21

24

27

30

∞‡ÍËÛË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ) ∂ÈÎfiÓ· 3. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÏÂÙ›Ó˘ ÔÚÔ‡ Ì ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=-0,27, p<0,05).

·‰ÈÔÓÂÎÙ›ÓË ÔÚÔ‡ ‡ (Ìg/ml)

100 ∞ 80 60 40 20 0 -3,0

-2,5

-2,0

-1,5

-1,0

-,5

z-score ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜

·‰ÈÔÓÂÎÙ›ÓË ÔÚÔ‡ ‡ (Ìg/ml)

100 µ 80 60 40 20 0 0

5

10

15

20

25

30

∞‡ÍËÛË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ) ∂ÈÎfiÓ· 4. ™˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ·‰ÈÔÓÂÎÙ›Ó˘ ÔÚÔ‡ Ì ∞) ÙÔ z-score ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=0,28, p=0,02) Î·È µ) ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ (r=0,26, p<0,05).

Paediatriki 2007;70:308-315

‚¿ÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=-0,27, p<0,05, ∂ÈÎfiÓ· 3). ¢È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ·‰ÈÔÓÂÎÙ›Ó˘ ÔÚÔ‡ Ì ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ (r=0,31, p<0,05), ÙÔ zscore ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· (r=0,28, p=0,02, ∂ÈÎfiÓ· 4∞) Î·È ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔ˘ ۈ̷ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ (r=0,26, p<0,05, ∂ÈÎfiÓ· 4µ). ªÂ ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï‹˜ ÂÍ¿ÚÙËÛ˘ ‰È·ÈÛÙÒıËΠfiÙÈ Ë Á¤ÓÓËÛË Ì ‚¿ÚÔ˜ <-2SD (ÏÈÔ‚·Ú‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘ ÓÂÔÁÓ¿) Î·È Ë ‡·ÚÍË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ <-2SD ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· (οو ·fi Ù· Ê˘ÛÈÔÏÔÁÈο fiÚÈ·) ÂËÚ¤·Û·Ó ·ÚÓËÙÈο Ù· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ (‚=-0,26, p<0,05 Î·È ‚=-0,25, p<0,05, ·ÓÙ›ÛÙÔȯ·), ÂÓÒ Ë ‰È·ÙÚÔÊ‹ Ì ÙÚÔÔÔÈË̤ÓÔ Á¿Ï· Ô˘ ÂÚÈ›¯Â LCPUFAs Ù· ÂËÚ¤·Û ıÂÙÈο (‚=0,28, p=0,02). ªÂ ÙË Ì¤ıÔ‰Ô Ù˘ ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛ˘ ‰È·ÈÛÙÒıËΠfiÙÈ Ë ‰È·ÙÚÔÊ‹ Ì Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì LCPUFAs, ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÁÈ· ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘ (ÏÈÔ‚·Ú‹ ÓÂÔÁÓ¿) Î·È Ô Ú˘ıÌfi˜ ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÓÂÍ¿ÚÙËÙ· Ì ٷ Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ (¶›Ó·Î·˜ 3). ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈÂÚ¢ÓËı› ÂÚ·ÈÙ¤Úˆ Ë Û˘Û¯¤ÙÈÛË Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ Ì ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ‚¿ÚÔ˘˜, ·Ó·˙ËÙ‹ıËÎ·Ó Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿. ∂ÎÙfi˜ Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ Î·È Ù˘ ÏÂÙ›Ó˘ (Ë ÔÔ›· ‹‰Ë ·Ó·Ê¤ÚıËΠfiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο Ì ÙËÓ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜), ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È ÙÔ Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Û˘Û¯ÂÙ›ÛıËÎ·Ó ·ÚÓËÙÈο (r=-0,27, p<0,05 Î·È r=-0,36, p=0,02, ·ÓÙ›ÛÙÔȯ·), ÂÓÒ Ë ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ Û˘Û¯ÂÙ›ÛıËΠıÂÙÈο Ì ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘˜ (r=0,53, p<0,001). ªÂ ÙË Ì¤ıÔ‰Ô Ù˘ ÔÏÏ·Ï‹˜ ÂÍ¿ÚÙËÛ˘ ‰È·ÈÛÙÒıËΠfiÙÈ Ë ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ Î·È Ù· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ‹Ù·Ó ÔÈ ÌfiÓÔÈ ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¤·Û·Ó ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ (¶›Ó·Î·˜ 4). ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ÔÚÌÔÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Ì ÙËÓ ÔÛfiÙËÙ· Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÙÚÔÊ‹˜ Î·È ÙÔ ÔÛfi ÙˆÓ ıÂÚÌ›‰ˆÓ.

™˘˙‹ÙËÛË ∏ ÌÂϤÙË ·˘Ù‹ ¤‰ÂÈÍ fiÙÈ Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, ÂÚ› ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· ˙ˆ‹˜ ÙÔ˘˜, ¤¯Ô˘Ó ˘„ËÏfiÙÂÚ· Â›‰· ÔÏÈÎÔ‡ ƒÀÀ, ƒÀÀ3-36 Î·È ÁÎÚÂÏ›Ó˘, Û˘ÁÎÚ›ÛÈÌ· Â›‰· ÈÓÛÔ˘Ï›Ó˘ Î·È ÏÂÙ›Ó˘, Î·È ¯·ÌËÏfiÙÂÚ· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ÔÚÔ‡ ·fi ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ·ÚfiÌÔÈ·˜ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘. ∆Ô ÔÏÈÎfi ƒÀÀ Ô˘ ΢ÎÏÔÊÔÚ› ÛÙÔÓ ÔÚfi ·ÔÙÂÏ›ٷÈ, ÂÚ›Ô˘ ηٿ ÙÔ ‹ÌÈÛ˘, ·fi ÙÔ ƒÀÀ3-36, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ (11). ∞’ fiÛÔ ÁÓˆÚ›˙Ô˘ÌÂ, ·˘Ù‹ ›ӷÈ

Pediatri July-Aug 07

09-07-07

17:08

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313

√ÚÌfiÓ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ fiÚÂÍË Î·È ÙoÓ ÌÂÙ·‚ÔÏÈÛÌfi

¶›Ó·Î·˜ 3. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó Ù· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ÔÚÔ‡ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (r2 ÙÔ˘ ÌÔÓÙ¤ÏÔ˘=0,25, p=0,006) ∞ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ µ¿ÚÔ˜ Á¤ÓÓËÛ˘ <-2 SD (ÏÈÔ‚·Ú‹ ÁÈ· ÙË ‰È¿ÚÎÂÈ· ·ËÛ˘) z-score ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ηٿ ÙËÓ ¤ÍÔ‰Ô ·fi ÙË ªÔÓ¿‰· ƒ˘ıÌfi˜ ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ) ™›ÙÈÛË Ì Á¿Ï· Ô˘ ÂÚÈ›¯Â LCPUFAs

‚

p

-0,28 -0,006 0,27 0,28

0,04 0,96 0,03 0,03

∂Í·ÚÙË̤ÓË ÌÂÙ·‚ÏËÙ‹: Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ÔÚÔ‡ ‚, Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘

Ë ÚÒÙË ÌÂϤÙË Î·Ù¿ ÙËÓ ÔÔ›· ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Û˘Á¯ÚfiÓˆ˜ ÛÙÔÓ ÔÚfi ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ·˘Ù¤˜ ÔÈ ÔÚÌfiÓ˜ Î·È ·Ó·˙ËÙ‹ıËÎÂ Ë ÌÂٷ͇ ÙÔ˘˜ Û¯¤ÛË, ηıÒ˜ Î·È Ë Û¯¤ÛË ÙÔ˘˜ Ì ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È Ì ·Ú·Ì¤ÙÚÔ˘˜ ·‡ÍËÛ˘. ∏ Û‡ÓıÂÛË ‹/Î·È ¤ÎÎÚÈÛË ÙÔ˘ ƒÀÀ (ÔÏÈÎÔ‡ Î·È ƒÀÀ3-36) Î·È Ù˘ ÁÎÚÂÏ›Ó˘ Ú˘ıÌ›˙ÔÓÙ·È ·fi ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ıÚÂÙÈο Û˘ÛÙ·ÙÈο (ÚˆÙ½ÓË, Ï›Ô˜, ˘‰·Ù¿ÓıڷΘ), ÙÔ ÔÛfi ıÂÚÌ›‰ˆÓ, ÙÔ ¯ÔÏÈÓÂÚÁÈÎfi Û‡ÛÙËÌ· (Ë ‰È¤ÁÂÚÛË ¯ÔÏÈÓÂÚÁÈÎÒÓ ÈÓÒÓ ÙÔ˘ Ó¢ÌÔÓÔÁ·ÛÙÚÈÎÔ‡ Ô‰ËÁ› Û ¤ÎÎÚÈÛË PYY Î·È ÁÎÚÂÏ›Ó˘), ÔÈ ÔÚÌfiÓ˜ (Á·ÛÙÚ›ÓË, ÈÓÛÔ˘Ï›ÓË, ¯ÔÏÔ΢ÛÙÔÎÈÓ›ÓË, Á·ÛÙÚÈÎfi ·Ó·ÛÙ·ÏÙÈÎfi ÂÙ›‰ÈÔ, ·˘ÍËÙÈ΋ ÔÚÌfiÓË, ۈ̷ÙÔÛÙ·Ù›ÓË, ÏÂÙ›ÓË, ÁÏ˘ÎÔÎÔÚÙÈÎÔÂȉ‹, Î.·.) Î·È ÔÈ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (IGF-1, TGF-·, ÂȉÂÚÌÈÎfi˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁˆÓ, Î.¿.) (12-14). ∏ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ƒÀÀ, ÁÎÚÂÏ›Ó˘ Î·È ÈÓÛÔ˘Ï›Ó˘ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Ù˘ ÌÂϤÙ˘ Ì·˜ ˘Ô‰ËÏÒÓÂÈ fiÙÈ ÂӉ¯Ô̤ӈ˜ ˘¿Ú¯ÂÈ ·ÏÏËÏÔÚÚ‡ıÌÈÛË Ù˘ ¤ÎÎÚÈÛ˘ ÙˆÓ ÂÙȉ›ˆÓ ·˘ÙÒÓ ‹ Ë ¤ÎÎÚÈÛ‹ ÙÔ˘˜ ˘fiÎÂÈÙ·È Û ÎÔÈÓ‹ Ú‡ıÌÈÛË. ∞Ó Î·È ÙÔ ·›ÙÈÔ Ô˘ ¢ı‡ÓÂÙ·È ÁÈ· Ù· ˘„ËÏfiÙÂÚ· Â›‰· ƒÀÀ Î·È ÁÎÚÂÏ›Ó˘ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹Û·Ì ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi, Â›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ Ù· ·˘ÍË̤ӷ Â›‰· ÁÎÚÂÏ›Ó˘ ÛÙÔÓ ÔÚfi ·ÔÙÂÏÔ‡Ó ÛÙ·ıÂÚfi ‡ÚËÌ· Û ηٷÛÙ¿ÛÂȘ Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ·ÚÓËÙÈÎfi ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜ ‹ ·ÒÏÂÈ· ‚¿ÚÔ˘˜, .¯. Ó¢ÚÔÁÂÓ‹˜ ·ÓÔÚÂÍ›·, η¯ÂÍ›· ÏfiÁˆ ηډÈÔ¿ıÂÈ·˜ ‹ ηÚΛÓÔ˘, Î.· (15,16). ÀÔ¶›Ó·Î·˜ 4. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ Ú˘ıÌfi ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚÔÒÚˆÓ (r2 ÙÔ˘ ÌÔÓÙ¤ÏÔ˘=0,48, p=0,001) ∞ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ µ¿ÚÔ˜ Á¤ÓÓËÛ˘ ª‹ÎÔ˜ ÛÒÌ·ÙÔ˜ ¶ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ/Kg/24ˆÚÔ ∂›‰· ÏÂÙ›Ó˘ ÔÚÔ‡ ∂›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ÔÚÔ‡

‚

p

0,08 -0,23 0,46 -0,11 0,30

0,56 0,12 0,003 0,41 0,03

∂Í·ÚÙË̤ÓË ÌÂÙ·‚ÏËÙ‹: ·‡ÍËÛË ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ (g/Kg/24ˆÚÔ) ‚, Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘

ÛÙËÚ›˙ÂÙ·È fiÙÈ Ë ÁÎÚÂÏ›ÓË ·˘Í¿ÓÂÙ·È ÛÙȘ ηٷÛÙ¿ÛÂȘ ·˘Ù¤˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Û΋ÛÂÈ ·ÓÙÈÛÙ·ıÌÈÛÙÈ΋ ‰Ú¿ÛË Ì¤Ûˆ Ù˘ ıÂÙÈ΋˜ Â›‰Ú·Û‹˜ Ù˘ ÛÙËÓ fiÚÂÍË Î·È ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡. Œ¯Ô˘Ó Â›Û˘ ·Ó·ÊÂÚı› ·˘ÍË̤ӷ Â›‰· ƒÀÀ Û ηٷÛÙ¿ÛÂȘ Ì ·ÚÓËÙÈÎfi ÈÛÔ˙‡ÁÈÔ ÂÓ¤ÚÁÂÈ·˜ Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·Ó Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Ï›ÁˆÓ ̤¯ÚÈ Û‹ÌÂÚ· ÌÂÏÂÙÒÓ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ· (15,17). ∞ÚÓËÙÈÎfi ÈÛÔ˙‡ÁÈÔ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ·Ú·ÙËÚ‹ıËΠÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Ù˘ ÌÂϤÙ˘ Ì·˜ Î·È ÂÈϤÔÓ, Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ƒÀÀ Î·È ÙÔ˘ ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ‹ ÙÔ˘ BMI ‹Ù·Ó ·ÚÓËÙÈ΋. ∏ ‰È·›ÛÙˆÛË fiÙÈ Ù· Â›‰· ÈÓÛÔ˘Ï›Ó˘ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹Û·Ì ¤ÙÂÈÓ·Ó Ó· Â›Ó·È ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ÈÓÛÔ˘Ï›Ó˘ Ì ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ÚfiˆÚˆÓ Î·È ÙËÓ ·Ô˘Û›· ¯·ÌËÏfiÙÂÚˆÓ ÂÈ¤‰ˆÓ ÏÂÙ›Ó˘ ÛÙ· ÚfiˆÚ· Û˘ÁÎÚÈÙÈο Ì ٷ ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, Â›Ó·È ÂӉ¯Ô̤ӈ˜ ÂÓ‰ÂÈÎÙÈ΋ ÂÓfi˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌÔ‡ Ô˘ ·ÊÔÚ¿ ÛÙË ÌÂÙ¤ÂÈÙ· ÂÌÊ¿ÓÈÛË ·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË Î·È ÙË ÏÂÙ›ÓË Û ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· ‹ Ì ¯·ÌËÏfi ‚¿ÚÔ˜ (2,18). ∆· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ Ù˘ ÌÂϤÙ˘ Ì·˜, ·Ó Î·È ¯·ÌËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ, ‹Ù·Ó ˘„ËÏfiÙÂÚ· ·fi ÂΛӷ ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË ÁÈ· ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜, ·ÏÏ¿ Î·È ·fi Ù· Â›‰· Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› Û ÌÂÁ¿Ï· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ (19). ∆· ˘„ËÏ¿ Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Î·È Ë ıÂÙÈ΋ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Û˘ÌʈÓÔ‡Ó Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÌÂÏÂÙÒÓ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ (19,20). ∂ÓÒ Û ÌÂÁ¿Ï· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ, fiÛÔ ÌÂÁ·Ï‡ÙÂÚÔ Â›Ó·È ÙÔ ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ Î·È Ë Ì¿˙· ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡, ÙfiÛÔ ¯·ÌËÏfiÙÂÚ· Â›Ó·È Ù· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ (10,21), ÙÔ‡ÙÔ ‰ÂÓ Û˘Ì‚·›ÓÂÈ Û ÓÂÔÁÓ¿, ‰ÈfiÙÈ ÂӉ¯Ô̤ӈ˜ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË ·Ó·Ù˘¯ı› ÔÈ Ì˯·ÓÈÛÌÔ› Ô˘ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ·Ú·ÁˆÁ‹ ·‰ÈÔÓÂÎÙ›Ó˘, ΢ڛˆ˜ ÏfiÁˆ ‰È·ÊÔÚÂÙÈ΋˜ Û‡ÓıÂÛ˘ Î·È Î·Ù·ÓÔÌ‹˜ ÙÔ˘ ÏÈÒ‰Ô˘˜ ÈÛÙÔ‡ .¯. ÌÈÎÚ¿-·ÓÒÚÈÌ· ÏÈÔ·ÙÙ·Ú·, ¶·È‰È·ÙÚÈ΋ 2007;70:308-315

Pediatri July-Aug 07

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17:08

™ÂÏ›‰·314

314

∆. ™È·¯·Ó›‰Ô˘ Î·È Û˘Ó.

‡·ÚÍË Ê·ÈÔ‡ Ï›Ô˘˜, ·ÚÔ˘Û›· Ï›Ô˘˜ ΢ڛˆ˜ ÛÙÔÓ ˘Ô‰fiÚÈÔ ÈÛÙfi Î·È fi¯È ÂÓ‰ÔÎÔÈÏȷο ÛÙ· ÓÂÔÁÓ¿, Û˘ÁÎÚÈÙÈο Ì ÌÂÁ¿Ï· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ (20). ∏ ÌÂϤÙË Ì·˜ ¤‰ÂÈÍ fiÙÈ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿, Ô Ú˘ıÌfi˜ ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ ·ÔÙÂÏ› ·Ú¿ÁÔÓÙ· Ô˘ ÂËÚ¿˙ÂÈ ıÂÙÈο Ù· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ (¶›Ó·Î·˜ 3). ∆Ô‡ÙÔ ÂӉ¯Ô̤ӈ˜ ÔÊ›ÏÂÙ·È Û ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, .¯. IGF-1, ·˘ÍËÙÈ΋ ÔÚÌfiÓË, Î.·., ÔÈ ÔÔ›ÔÈ ·ÊÂÓfi˜ ÂȉÚÔ‡Ó ıÂÙÈο ÛÙËÓ ·‡ÍËÛË Î·È ·ÊÂÙ¤ÚÔ˘ Â¿ÁÔ˘Ó ÙË Û‡ÓıÂÛË Ù˘ ·‰ÈÔÓÂÎÙ›Ó˘ (22). ∞ÏÏ¿ Î·È ·ÓÙ›ÛÙÚÔÊ·, Ë ·‰ÈÔÓÂÎÙ›ÓË ‚Ú¤ıËΠfiÙÈ ·ÔÙÂÏ› ·Ú¿ÁÔÓÙ· Ô˘ ÂËÚ¿˙ÂÈ ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ (¶›Ó·Î·˜ 4), ÂӉ¯Ô̤ӈ˜ Ì ¿ÌÂÛË ‰Ú¿ÛË ‹/Î·È ·˘Í¿ÓÔÓÙ·˜ ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÈÛÙÒÓ Û ÔÚÌfiÓ˜ Ô˘ ‰ÈÂÁ›ÚÔ˘Ó ÙËÓ ·‡ÍËÛË, .¯. ÈÓÛÔ˘Ï›ÓË Î·È IGF (23). ∞Ó Î·È Â›Ó·È ÌÈÎÚfi˜ Ô ·ÚÈıÌfi˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Ô˘ ÛÈÙ›ÛÙËÎ·Ó Ì Á¿Ï· Ô˘ ÂÚÈ›¯Â LCPUFAs, Ë ıÂÙÈ΋ Â›‰Ú·ÛË ÙˆÓ LCPUFAs ÛÙ· Â›‰· ·‰ÈÔÓÂÎÙ›Ó˘ ·ÔÙÂÏ›, ηٿ ÙË ÁÓÒÌË Ì·˜, ÛËÌ·ÓÙÈÎfi ‡ÚËÌ· Î·È ·Ó·Ê¤ÚÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙÔÓ ¿ÓıÚˆÔ. ª¤¯ÚÈ Û‹ÌÂÚ·, ÂÏ¿¯ÈÛÙ˜ ÌÂϤÙ˜, ÔÈ Ôԛ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÌfiÓÔ Û ÂÈÚ·Ì·Ùfi˙ˆ·, ¤‰ÂÈÍ·Ó fiÙÈ Ë ‰È·ÙÚÔÊ‹ Ô˘ ÂÚȤ¯ÂÈ LCPUFAs, Û˘ÁÎÂÎÚÈ̤ӷ ÂÈÎÔÛÈÂÓÙ·ÓÔ˚Îfi (20:5, n-3) Î·È ÂÈÎÔÛȉ˘ÔÂÍ·ÓÔ˚Îfi (22:6, n-3), ÚÔηÏ› ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ ·‰ÈÔÓÂÎÙ›Ó˘, Èı·Ófiٷٷ ̤ۈ ‰È¤ÁÂÚÛ˘ Ù˘ Û‡ÓıÂÛ˘ ‹/Î·È ¤ÎÎÚÈÛ‹˜ Ù˘ ·fi Ù· ÏÈÔ·ÙÙ·Ú· (24). ∂›Û˘, fiˆ˜ ηٷ‰Â›¯ıËΠ۠ÂÈÚ·Ì·Ùfi˙ˆ·, ‰›·ÈÙ· ÏÔ‡ÛÈ· Û LCPUFAs ηٿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ηٿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (3). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚ› Ó· ÂÚÌËÓ‡ÛÂÈ ÙËÓ ˆÊ¤ÏÈÌË ‰Ú¿ÛË ÙˆÓ LCPUFAs ηٿ Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ηıÒ˜ Î·È ÙË ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ·¯˘Û·ÚΛ·˜, ·ÓÙÔ¯‹˜ ÛÙËÓ ÈÓÛÔ˘Ï›ÓË, ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË Ù‡Ô˘ 2, ˘¤ÚÙ·Û˘ Î·È ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ηٿ ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ Û ·È‰È¿ Ô˘ ÛÈÙ›ÛÙËÎ·Ó Î·Ù¿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Ì ÌËÙÚÈÎfi Á¿Ï·, ÙÔ ÔÔ›Ô Â›Ó·È ÁÓˆÛÙfi fiÙÈ Â›Ó·È ÏÔ‡ÛÈÔ Û LCPUFAs (3). ÃÚÂÈ¿˙ÂÙ·È Ó· ‰ÈÂÚ¢ÓËı› ·Ó Ô ÂÌÏÔ˘ÙÈÛÌfi˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ Á¿Ï·ÙÔ˜ Ì LCPUFAs ÁÈ· ÙË ‰È·ÙÚÔÊ‹ ÚfiˆÚˆÓ ‹ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ Ô˘ ‰ÂÓ ıËÏ¿˙Ô˘Ó ı· ›¯Â ·ÚfiÌÔÈ· ¢ÂÚÁÂÙÈο ·ÔÙÂϤÛÌ·Ù·. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÔÚÌÔÓÒÓ Ô˘ ÌÂÏÂÙ‹Û·Ì Ì ÙËÓ ÔÛfiÙËÙ· Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÙÚÔÊ‹˜ Î·È ÙÔ ÔÛfi ÙˆÓ ıÂÚÌ›‰ˆÓ. ∂›Û˘, Ì ÂÍ·›ÚÂÛË ÙË ÏÂÙ›ÓË Î·È ÙËÓ ·‰ÈÔÓÂÎÙ›ÓË, ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ˘ÔÏÔ›ˆÓ ÔÚÌÔÓÒÓ Ì ÙÔÓ Ú˘ıÌfi ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ŸÌˆ˜, Ú¤ÂÈ Ó· ÏËÊı› ˘fi„Ë fiÙÈ ÔÈ Ì˯·ÓÈÛÌÔ› Ô˘ Ú˘ıÌ›˙Ô˘Ó ÙËÓ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ÙÔ ÈÛÔ˙‡ÁÈÔ ÛˆÌ·ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Â›Ó·È ÔχÏÔÎÔÈ Î·È fiÙÈ Ë ·ÏÏËÏÂ›‰Ú·ÛË ‰È·ÊfiPaediatriki 2007;70:308-315

ÚˆÓ ÔÚÌÔÓÒÓ Î·È ·Ú·ÁfiÓÙˆÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈÛÎÈ¿˙ÂÈ ÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÔÚÌÔÓÒÓ Ô˘ ÌÂÏÂÙ‹Û·ÌÂ Î·È Ù˘ ÔÛfiÙËÙ·˜ Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ÙÚÔÊ‹˜ ‹ ÙÔ˘ Ú˘ıÌÔ‡ ·‡ÍËÛ˘. ∂Í¿ÏÏÔ˘, Ô ‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ˘fi ÌÂϤÙË ÔÚÌÔÓÒÓ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ› ηÈ, fiˆ˜ ˘ÔÛÙËÚ›˙ÂÙ·È Û ¿ÏϘ ÌÂϤÙ˜ (25), ‰ÂÓ ·ÔÎÏ›ÂÙ·È Ó· Â›Ó·È ‰È·ÊÔÚÂÙÈÎfi˜ ‹ ÂÚÈÛÛfiÙÂÚÔ Û‡ÓıÂÙÔ˜ ·fi ·˘ÙfiÓ Ô˘ ̤¯ÚÈ Û‹ÌÂÚ· ÁÓˆÚ›˙Ô˘ÌÂ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ‰ÂÓ ÌÂÈÔÓÂÎÙÔ‡Ó Û˘ÁÎÚÈÙÈο Ì ٷ ÙÂÏÂÈfiÌËÓ· ˆ˜ ÚÔ˜ ÙË Û‡ÓıÂÛË/¤ÎÎÚÈÛË ÔÚÌÔÓÒÓ Ô˘ ıˆÚÂ›Ù·È fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·‡ÍËÛË Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi. ∞Ó Î·È Ô ‚ÈÔÏÔÁÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ ÔÚÌÔÓÒÓ ·˘ÙÒÓ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ ̤ÏÏÂÈ Ó· ‰È¢ÎÚÈÓÈÛÙ› ÂÚ·ÈÙ¤Úˆ, ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ÚÔ·ÙÔ˘Ó ÂӉ›ÍÂȘ fiÙÈ ÔÈ ‰È·Ù·Ú·¯¤˜ Ô˘ ‰È·ÈÛÙÒÓÔÓÙ·È Û ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÚfiˆÚ· ‹ Ì ¯·ÌËÏfi ‚¿ÚÔ˜ (1,2,18) ÂӉ¯Ô̤ӈ˜ ÍÂÎÈÓÔ‡Ó Ôχ ÓˆÚ›˜, ·fi ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·. ∏ ·‰ÈÔÓÂÎÙ›ÓË Ê·›ÓÂÙ·È fiÙÈ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·‡ÍËÛË.

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√ÚÌfiÓ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ fiÚÂÍË Î·È ÙoÓ ÌÂÙ·‚ÔÏÈÛÌfi

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20. Dunger D, Ong K. Abundance of adiponectin in the newborn. Clin Endocrinol 2004;61:416-417.

21. Stefan N, Bunt JC, Salbe AD, Funahashi T, Matsuzawa Y, Tataranni PA. Plasma adiponectin concentrations in children: relationships with obesity and insulinemia. J Clin Endocrinol Metab 2002;87:4652-4656.

22. Halleux CM, Takahashi M, Delporte ML, Detry R, Funahashi T, Matsuzawa Y, et al. Secretion of adiponectin and regulation of apM1 gene expression in human visceral adipose tissue. Biochem Biophys Res Commun 2001;288: 1102-1107.

23. Fu Y, Luo N, Klein RL, Garvey WT. Adiponectin promotes adipocyte differentiation, insulin sensitivity, and lipid accumulation. J Lipid Res 2005;46:1369-1379.

24. Flachs P, Mohamed-Ali V, Horakova O, Rossmeisl M, Hosseinzadeh-Attar MJ, Hensler M, et al. Polyunsaturated fatty acids of marine origin induce adiponectin in mice fed a high-fat diet. Diabetologia 2006;49:394-397.

25. Degen L, Oesch S, Casanova M, Graf S, Ketterer S, Drewe J, et al. Effect of peptide YY3-36 on food intake in humans.

Gastroenterology 2005;129:1430-1436.

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

CASE REPORT

™˘Ó‡·ÚÍË Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È ÎÏËÚÔÓÔÌÈ΋˜ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛ˘ 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ™¿ÚÙ˘ 2 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” 3 ∞ÈÌ·ÙÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ˘ ¶. ¶·Ó·ÁÈÒÙÔ˘ gpp@hospspa.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ™¿ÚÙ˘

π.¶. ¶·Ó·ÁÈÒÙÔ˘1, °. §¤Îη2, ∞. °·ÚÔ‡ÊË2, ∞. ™Ù·ÌÔ˘Ï·Î¿ÙÔ˘3, ∂. ¶ÚÂ̤Ù˘3, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜2 ¶ÂÚ›ÏË„Ë: ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ Û˘ÓÈÛÙ¿ ÙÔÓ Û˘¯ÓfiÙÂÚÔ Â͈ÎÚ·ÓÈ·Îfi Û˘Ì·Á‹ ηÎÔ‹ıË fiÁÎÔ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÂÎÚÔÛˆÒÓÙ·˜ ÙÔ 8-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙ· ·È‰È¿. ¶ÚÔ¤Ú¯ÂÙ·È ·fi Ù· ·ÙÙ·Ú· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ë ÚÔ‚ÔÏ‹ ÙÔ˘ ÔÈΛÏÏÂÈ ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ ÚˆÙÔ·ı‹ ÂÓÙfiÈÛË Î·È ÙÔ ÛÙ¿‰ÈÔ ÙÔ˘ fiÁÎÔ˘. ∏ ·Ó·ÈÌ›· ‰ÂÓ ·ÔÙÂÏ› Û‡ÓËı˜ ‡ÚËÌ· ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È Û ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·ÈÌÔÚÚ·Á›· ÙÔ˘ fiÁÎÔ˘ ‹ ·˘ÙÔ¿ÓÔÛË ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·. ∏ ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË Â›Ó·È ¤Ó· Û¯ÂÙÈο Û˘¯Ófi ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· Ù˘ Ï¢΋˜ Ê˘Ï‹˜, Ô˘ ÚÔ‚¿ÏÏÂÈ Ì ·Ó·ÈÌ›·, ›ÎÙÂÚÔ, ÛÏËÓÔÌÂÁ·Ï›·. ∏ ÙÚÈ¿‰· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û ¿ÏÏÔ˘˜ ·ÛıÂÓ›˜ ÂÎÊÚ¿˙ÂÙ·È Ï‹Úˆ˜ Î·È Û ¿ÏÏÔ˘˜ Ë ˘fiÓÔÈ· Î·È ‰È¿ÁÓˆÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ÚÔ·ÙÂÈ ÛÂ Ù˘¯·›Ô ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô. ªfiÓÔ ÙÔ 1/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰È·ÁÈÁÓÒÛÎÂÙ·È Î·Ù¿ ÙÔÓ 1Ô ¯ÚfiÓÔ ˙ˆ‹˜. ∏ ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ηÎÔËıÒÓ ÓÔÛËÌ¿ÙˆÓ. Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ Û˘Ó‡·Ú͢ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ, fiˆ˜ ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, Î·È ·ÎfiÌË ÏÈÁfiÙÂÚ˜ ÌÂ Û˘Ì·Á›˜ fiÁÎÔ˘˜. ™˘Ó‡·ÚÍË ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛ˘ Î·È Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ ÙÒÚ· ÂÚÈÁÚ·Ê›, fiˆ˜ ·˘Ùfi ÚÔ·ÙÂÈ ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ·Ó Î·È Ë Û˘¯ÓfiÙËÙ· ηıÂÌ›·˜ ·fi ÙȘ ‰‡Ô ηٷÛÙ¿ÛÂȘ ‰ÂÓ Â›Ó·È Î·È ÙfiÛÔ Û¿ÓÈ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È ı‹Ï˘ ‚Ú¤ÊÔ˜ 2,5 ÌËÓÒÓ Ì ·Ó·ÈÌ›· Î·È ÌfiÚʈ̷ ·ÚÈÛÙÂÚÔ‡ ÂÈÓÂÊÚȉ›Ô˘ Ô˘ ·ÓÙÈÛÙÔȯԇÛ Û Ó¢ÚÔ‚Ï¿Ûو̷. ∏ ·Ó·ÈÌ›· ‹Ù·Ó ÙÔ ÚÔ¤¯ÔÓ Û‡Ìو̷ Î·È ‰ÂÓ ÔÊÂÈÏfiÙ·Ó ÛÙÔ Ó¢ÚÔ‚Ï¿Ûو̷ ·ÏÏ¿ Û ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË Ô˘ ÎÏËÚÔÓÔÌ‹ıËΠ̠˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi ÁÔÓ›‰ÈÔ, fiˆ˜ ·ԉ›¯ıËΠ·fi ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘.

§¤ÍÂȘ ÎÏÂȉȿ: ¡Â˘ÚÔ‚Ï¿Ûو̷, ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË, ·Ó·ÈÌ›·, ‚Ú¤ÊÔ˜.

Coexistence of neuroblastoma and hereditary spherocytosis 1 Paediatric Department, Sparta Hospital 2 2nd Paediatric Department, University of Athens, “P. & A. Kyriakou” Children’s Hospital 3 Haematology Lab, “Aghia Sophia” Children’s Hospital Correspondence: John P. Panagiotou gpp@hospspa.gr Paediatric Clinic Sparta Hospital, Greece

J.P. Panagiotou1, G. Lekka2, A. Garoufi2, A. Stamoulakatou3, E. Premetis3, A. Constantopoulos2 Abstract: Neuroblastoma is the most common extracranial solid tumour of childhood, accounting for 810% of all childhood cancers. It originates from neural crest cells of the sympathetic nervous system and its clinical presentation depends on the primary tumour site and the extension of the disease. Anaemia is not a common feature of neuroblastoma, but when present it may be due to bone marrow metastasis, tumor haemorrhage or autoimmune haemolytic anaemia. Hereditary spherocytosis is a relatively common haematologic disease in Caucasian populations. Its cardinal symptoms are anaemia, jaundice, and splenomegaly, which may all be present, but some patients are asymptomatic and the disease is detected on routine examination. Only one third of cases are diagnosed during the first year of life. Hereditary spherocytosis is not associated with an increased risk of malignancies. Rarely, coexistence of spherocytosis with blood cancers, such as acute lymphoblastic leukaemia, has been reported and even less frequently with solid tumours. To the knowledge of the authors, coexistence of spherocytosis and neuroblastoma has never been described, even though neither condition is rare. The case is described of an infant girl, aged 2.5 months, who presented with anaemia as the primary symptom, and who had a mass in the left adrenal gland, found to be neuroblastoma. The cause of the anaemia was hereditary spherocytosis, transmitted as an autosomal recessive trait, as confirmed by the laboratory investigation of the infant and her parents.

Key words: Neuroblastoma, hereditary spherocytosis, anaemia, infant.

∂ÈÛ·ÁˆÁ‹ ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ ·Ó‹ÎÂÈ ÛÙ· ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· Î·È ÚÔ¤Ú¯ÂÙ·È ·fi Ù· ·ÙÙ·Ú· ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘ Â›Ó·È ÂÚ›Ô˘ 1:10.000 ·È‰È¿ Î·È ÂÎÚÔÛˆ› ÙÔ 8-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÒÓ ÓÔPaediatriki 2007;70:316-319

ÛËÌ¿ÙˆÓ ÛÙ· ·È‰È¿. ™˘Ó‹ıˆ˜ ·ÊÔÚ¿ ·È‰È¿ οو ÙˆÓ 5 ÂÙÒÓ (50% οو ÙˆÓ 2 ÂÙÒÓ, 1/3 οو ÙÔ˘ 1 ÂÙfi˜) Î·È ··ÓÙ¿Ù·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·ÁfiÚÈ·. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ, Ô fiÁÎÔ˜ ·Ú¯›˙ÂÈ Ó· Û¯ËÌ·Ù›˙ÂÙ·È ÂÓ‰ÔÌËÙÚ›ˆ˜ Î·È ÌÔÚ› Ó· ‰È·ÁÓˆÛı› Ì ÙÔ ÂÌ‚Ú˘˚Îfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ·.

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™ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ·ÔÙÂÏ› ÙÔÓ Û˘¯ÓfiÙÂÚÔ Û˘Ì·Á‹ fiÁÎÔ. ™Ù· 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÍÂÎÈÓ¿ÂÈ ·fi ÙËÓ ÎÔÈÏÈ¿ Î·È ÙÔ 65% ·˘ÙÒÓ ·fi Ù· ÂÈÓÂÊÚ›‰È·. ªÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ Û˘ÌÙÒÌ·Ù· Ô˘ ÌÔÈ¿˙Ô˘Ó Ì ÔÔÈ·‰‹ÔÙ ¿ÏÏË ÓfiÛÔ, fiˆ˜ ‰È¿ÚÚÔȘ, ·ÓÔÚÂÍ›·, ÔÛÙÈο ¿ÏÁË ‹ Ó· ‰È·ÁÓˆÛı› ÛÂ Ù˘¯·›Ô ÎÏÈÓÈÎfi ‹ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ∏ ·Ó·ÈÌ›· ‰ÂÓ Â›Ó·È Û˘¯Ó‹ ÂΉ‹ÏˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Î·È Û˘Ó‹ıˆ˜ ·ÎÔÏÔ˘ı› ÙË ¯ËÌÂÈÔıÂÚ·›· (1-4). ∏ ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË Â›Ó·È ¤Ó· Û¯ÂÙÈο Û˘¯Ófi ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· Ô˘ ÔÊ›ÏÂÙ·È Û ¤ÏÏÂÈÌÌ· ÙÔ˘ ÚˆÙÂ˚ÓÈÎÔ‡ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ‡ ÛÎÂÏÂÙÔ‡. ∆Ô ·ÔÙ¤ÏÂÛÌ· Ù˘ ‚Ï¿‚˘ ·˘Ù‹˜ Â›Ó·È Ù· ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· Ó· Ï·Ì‚¿ÓÔ˘Ó ÛÊ·ÈÚÈÎfi Û¯‹Ì·, Ó· Á›ÓÔÓÙ·È ‰‡ÛηÌÙ· (·˘ÍË̤ÓË Â˘ıÚ·˘ÛÙfiÙËÙ·) Î·È Ó· ηٷÛÙÚ¤ÊÔÓÙ·È Î·ıÒ˜ ‰È¤Ú¯ÔÓÙ·È ·fi Ù· ÙÚȯÔÂȉ‹ ·ÁÁ›· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ Î·È Î˘Ú›ˆ˜ ÙÔ˘ ÛÏ‹Ó·. ∏ Â›ÙˆÛ‹ Ù˘ ÛÙË µfiÚÂÈ· ∂˘ÚÒË Â›Ó·È Û¯Â‰fiÓ 1:2000. ∏ ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ÙÂı› ÛÙË ÓÂÔÁÓÈ΋, ÛÙË ‚ÚÂÊÈ΋ ‹ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ™ÙËÓ ÚÒÈÌË ‚ÚÂÊÈ΋ ËÏÈΛ· ÌÔÚ› Ó· ÚÔ‚¿ÏÂÈ Ì Ôχ ‚·Ú‡ Ê·ÈÓfiÙ˘Ô, ·ÎfiÌË Î·È Û ·ÛıÂÓ›˜ Ô˘ ·ÚÁfiÙÂÚ· ÂÌÊ·Ó›˙Ô˘Ó ‹Ș ‹ ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ ÌÔÚʤ˜ Ù˘ ÓfiÛÔ˘ (5-7). ¶ÂÚÈÁÚ¿ÊÂÙ·È ‚Ú¤ÊÔ˜ ı‹Ï˘ ËÏÈΛ·˜ 2,5 ÌËÓÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Î·È ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË, ‰‡Ô ÓÔÛÔÏÔÁÈΤ˜ ÔÓÙfiÙËÙ˜, Ë Û˘Ó‡·ÚÍË ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ̤¯ÚÈ Û‹ÌÂÚ· ÛÙËÓ ÂÏÏËÓÈ΋ ‹ ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ £‹Ï˘ ‚Ú¤ÊÔ˜ 2,5 ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÁÈ· ¤ÏÂÁ¯Ô ·Ó·ÈÌ›·˜. ∂›Ó·È ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Ê˘ÛÈÔÏÔÁÈ΋ ·ËÛË Î·È Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3390 g. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È ÂχıÂÚÔ. ™Â ËÏÈΛ· 1,5 ÌËÓÒÓ ÓÔÛËχıËΠÁÈ· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, fiÔ˘ Î·È ‰È·ÈÛÙÒıËΠ·Ó·ÈÌ›· (Hb:8,8gr/dl, ∏t:24,5% ), Ë ÔÔ›· ÌÂÙ¿ ·fi 15 Ë̤Ú˜ ÂȉÂÈÓÒıËΠ(Hb:7,4gr/dl, ∏t:20,5%) Î·È ÂÈÛ‹¯ıË ÁÈ· ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ˆ¯ÚfiÙËÙ· Î·È „ËÏ·ÊËÙfi ÌfiÚʈ̷ ÛÙÔ ·ÚÈÛÙÂÚfi ˘Ô¯fiÓ‰ÚÈÔ, ÛÎÏËÚ‹˜ Û‡ÛÙ·Û˘, ·ÓÒ‰˘ÓÔ, ÎÈÓËÙfi, Ô˘ ‰ÂÓ Ê·ÈÓfiÙ·Ó Ó· ÂÍÔÚÌ¿Ù·È ·fi ÙÔÓ ÛÏ‹Ó·. ∏ ÏÔÈ‹ ηٿ Û˘ÛÙ‹Ì·Ù· ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·Ó·ÈÌ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, Ì ‚¿ÛË Ù· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ‰ËÏ·‰‹ ·ÓÈÛÔ΢ÙÙ¿ÚˆÛË, ÌÈÎÚÔ΢ÙÙ¿ÚˆÛË, ÔÏ˘¯ÚˆÌ·ÙÔÊÈÏ›· Î·È ¤ÓÙÔÓË ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË, ÙËÓ ·‡ÍËÛË ÙˆÓ ¢∂∫ (¢∂∫:9,04%, ‰ÈÔÚıˆÌ¤Ó· ¢∂∫:5,97%), ÙË ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ¤ÌÌÂÛË ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· (1,7mg/dl) Î·È ÙȘ ·ÚÓËÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Coombs,

Ù·ÍÈÓÔÌ‹ıËΠÛÙËÓ ÔÌ¿‰· ÙˆÓ ÌË ¿ÓÔÛˆÓ ·ÈÌÔÏ˘ÙÈÎÒÓ ·Ó·ÈÌÈÒÓ, Ì Èı·ÓfiÙÂÚË ‰È¿ÁÓˆÛË ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË. ™ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Ô˘ ·ÎÔÏÔ‡ıËÛ (˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜, ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÎÔÈÏ›·˜, ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì ÛÂÛËÌ·Ṳ̂ÓË ÌÂÙ·-Ȉ‰Ô-‚ÂÓ˙˘Ï-ÁÔ˘·Óȉ›ÓË (MIµG)) ‰È·ÈÛÙÒıËΠÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÚfiÛıÈÔ˘ ·Ú·ÓÂÊÚÈÎÔ‡ ¯ÒÚÔ˘ ¢ÌÂÁ¤ı˘ ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÍÂÚÁ·Û›· ̤ÁÈÛÙ˘ ‰È·Ì¤ÙÚÔ˘ 6 cm, Ì ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Û˘Ì‚·Ù¿ Ì Ó¢ÚÔ‚Ï¿Ûو̷. ∞ÎÔÏÔ‡ıËÛ ÂÎÙÂٷ̤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˜ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Î·È ÛÙ·‰ÈÔÔ›ËÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ªÂ ÙÔÓ ·Ú·ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ÔÌ·ÎÚ˘Ṳ̂Ó˜ ÌÂÙ·ÛÙ¿ÛÂȘ. ∞ÎÔÏÔ‡ıËÛ Ï‹Ú˘ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘. ∏ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ¤ÎıÂÛË ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜, ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÔ‡ ÛÙ·‰›Ô˘ π, Î·È ÙÔ ‚Ú¤ÊÔ˜ ·Ú·¤ÌÊıËΠÛÙÔ √ÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË. ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ıÂÚ·›·˜ ‰ÈÂÓÂÚÁ‹ıËΠÏ‹Ú˘ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ ‚Ú¤ÊÔ˜ Î·È Û fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ™ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‰ÂÓ ‚Ú¤ıËΠη̛· ÔÛÔÙÈ΋ ‹ ÔÈÔÙÈ΋ ‰È·Ù·Ú·¯‹ ÙˆÓ ÚˆÙÂ˚ÓÒÓ. ™ÙË ‰ÔÎÈÌ·Û›· ÔÛ̈ÙÈ΋˜ ·ÓÙ›ÛÙ·Û˘ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Ì ‰È¿Ï˘Ì· NaCl 5 g/l ‰È·ÈÛÙÒıËΠχÛË ÛÙÔ 39% ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ÛÙÔ 8,5% ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·Ù¤Ú· (ÊÙ 0-5%), ÂÓÒ Û ‰È¿Ï˘Ì· NaCl 5,5 g/l ‰È·ÈÛÙÒıËΠχÛË ÛÙÔ 1,9% ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ÌËÙ¤Ú·˜ (ÊÙ 0%). ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÂϤÁ¯Ô˘ ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛ˘ Ì ۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ Ù‡Ô ÌÂÙ·‚›‚·Û˘.

™˘˙‹ÙËÛË ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ ·Ó‹ÎÂÈ ÛÙÔ˘˜ ηÎÔ‹ıÂȘ fiÁÎÔ˘˜ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ 8-10% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Î·ÎÔËıÒÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∂ȉÈÎfiÙÂÚ· fï˜, ÁÈ· ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ·ÔÙÂÏ› ÙÔÓ Û˘¯ÓfiÙÂÚÔ Û˘Ì·Á‹ fiÁÎÔ (2). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÔÈΛÏÏÂÈ ÛËÌ·ÓÙÈο Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÓÙfiÈÛË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ fiÁÎÔ˘. ™Â ÂÚ›Ô˘ 2/3 ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÎÔÈÏÈ¿ ÌÂ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË Ù· ÂÈÓÂÊÚ›‰È· Î·È ÎÏÈÓÈο ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ‰ÈfiÁΈÛË ÎÔÈÏ›·˜, Ë ÔÔ›· Û˘¯Ó¿ ·Ó·Î·Ï‡ÙÂÙ·È Ù˘¯·›· ·fi ÙÔ˘˜ ÁÔÓ›˜ ‹ Ì „ËÏ·ÊËÙ‹ Ì¿˙· Ô˘ ·ÔηχÙÂÙ·È ÛÂ Ù˘¯·›· ÎÏÈÓÈ΋ ÂͤٷÛË ·fi ÙÔÓ ·È‰›·ÙÚÔ. ™Â ÂÚ›ÙˆÛË Ô˘ ˘¿Ú¯Ô˘Ó ‰ÈËı‹ÛÂȘ Î·È ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ, Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÚÔ‚¿ÏÂÈ Ì ·Ó¿ÏÔÁË ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›·, fiˆ˜ ·Ó·ÈÌ›·, ·Ó ¤¯ÂÈ ¶·È‰È·ÙÚÈ΋ 2007;70:316-319

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·318

318

π.¶. ¶·Ó·ÁÈÒÙÔ˘ Î·È Û˘Ó.

‰ÈËıËı› Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ, Ë·ÙÔÌÂÁ·Ï›· Û ÂÓÙfiÈÛË Ù˘ ÓfiÛÔ˘ ÛÙÔ ‹·Ú, ÎÏ (1,4,8). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷ ·ÔηχÊıËÎÂ Ù˘¯·›· ηٿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ¤ÁÈÓ ÏfiÁˆ ·Ó·ÈÌ›·˜. ∞Ú¯Èο, ÙÔ „ËÏ·ÊËÙfi ÌfiÚʈ̷ Ô˘ ÂÓÙÔ›ÛıËΠÛÙËÓ ˘ÔÛÏËÓÈ΋ ÂÚÈÔ¯‹, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ˘¿Ú¯Ô˘Û· ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, ıˆڋıËÎÂ Û·Ó Èı·Ó‹ ÂÍˆÌ˘ÂÏÈ΋ ÂÛÙ›· ·ÈÌÔÔ›ËÛ˘. ™Â ·ÁfiÚÈ 9 ÂÙÒÓ Ì ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂÍˆÌ˘ÂÏÈ΋ ·ÈÌÔÔ›ËÛË, ˘Ô‰˘fiÌÂÓË Ì¿˙· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, Ë ÔÔ›· ·ÔηχÊıËΠÛÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÎÔÈÏ›·˜ Ô˘ ¤ÁÈÓ ÏfiÁˆ ÈÎÙ¤ÚÔ˘, ÂÓÒ Ë ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË Ù¤ıËΠ̠ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Î·È ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÌÔÚÊÒÌ·ÙÔ˜ (9). ™ÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË, Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Ì·˜ ÚÔÛ·Ó·ÙfiÏÈÛ·Ó ÚÔ˜ ÙËÓ Èı·Ó‹ ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ ÂÓÈÛ¯‡ıËΠ·fi ÙËÓ ·Ó‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ‚·ÓÈÏÌ·Ó‰ÂÏÈÎÔ‡ (VMA) Î·È ÔÌÔ‚·ÏÈÓÈÎÔ‡ ÔͤԘ (HVA) ÛÙ· Ô‡Ú· Î·È ÙÂÏÈο ÂȂ‚·ÈÒıËΠ̠ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘. °ÂÓÈο, ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Û˘Ì‚¿ÏÏÔ˘Ó Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Î·È ÔÈ ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜. ∞fi ÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜, ÛËÌ·ÓÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ·Í›· ¤¯Ô˘Ó Ù· ·˘ÍË̤ӷ Â›‰· ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ, VMA Î·È HVA, ÛÙ· Ô‡Ú· ÙˆÓ ·ÛıÂÓÒÓ, Ô˘ ‚Ú›ÛÎÔÓÙ·È ·˘ÍË̤ӷ Û ¿Óˆ ·fi 90% ÙˆÓ ÂÚÈÙÒÛˆÓ. ∞fi ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, Ë ÈÔ ÂȉÈ΋ ÂͤٷÛË Â›Ó·È ÙÔ ÔÏfiÛˆÌÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì MIBG, ·Ó Î·È ¿ÏϘ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ, fiˆ˜ Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È Ë ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ÚÔÛʤÚÔ˘Ó ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· (1). ∏ ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÌÂϤÙË ÈÛÙÈÎÒÓ ‰ÂÈÁÌ¿ÙˆÓ ÙÔ˘ fiÁÎÔ˘, ‹ ·fi ÙÔ Û˘Ó‰˘·ÛÌfi ‰È‹ıËÛ˘ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ VMA Î·È HVA (3). ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‰˘·ÛÌfi ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÂÍ·›ÚÂÛ˘, ¯ËÌÂÈÔıÂÚ·›·˜ Î·È ·ÎÙÈÓÔıÂÚ·›·˜. ™Â ÂÚÈÛÙ·ÙÈο Ì ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË (ÛÙ¿‰ÈÔ IV, ˘ÔÙÚÔ‹ ÓfiÛÔ˘) ÌÔÚ› Ó· ÂȯÂÈÚËı› ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË ·Ú¯¤ÁÔÓˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (1). ∏ ·Ó·ÈÌ›· Û ·È‰È¿ Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹ Î·È ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ηÎÔ‹ıË Î‡ÙÙ·Ú·, ÙË ¯ËÌÂÈÔıÂÚ·›· Î·È ·ÎÙÈÓÔıÂÚ·›· ‹/Î·È ÙËÓ ÔÍ›· ·ÒÏÂÈ· ·›Ì·ÙÔ˜. ∆· ÔÛÔÛÙ¿ ·Ó·ÈÌ›·˜ Â›Ó·È Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚ· ÛÙȘ ηÎÔ‹ıÂȘ Ì ‰È‹ıËÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (Ï¢¯·ÈÌ›·, ϤÌʈ̷, Ó¢ÚÔ‚Ï¿Ûو̷ ÛÙ·‰›Ô˘ 3-4), Û˘ÁÎÚÈÓfiÌÂÓ· Ì ¿ÏÏÔ˘˜ Ù‡Ô˘˜ ηÚΛÓÔ˘. ∏ ·Ó·ÈÌ›· Û fiϘ ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ›Paediatriki 2007;70:316-319

Ó·È Î·Ù¿ ηÓfiÓ· ÔÚıfi¯ÚˆÌË - ÔÚıÔ΢ÙÙ·ÚÈ΋, ÔÊÂÈÏfiÌÂÓË Û ·ÓÂ·Ú΋ ·Ú·ÁˆÁ‹ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ. ∏ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ô˘ Û˘Ó‰˘¿˙ÂÙ·È Ì ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· ··ÓÙ¿Ù·È Î˘Ú›ˆ˜ Û ÏÂÌÊÒÌ·Ù·, Î·È ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο ¿ÓÔÛÔ˘ Ù‡Ô˘ ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ (10). ∆Ô È‰È·›ÙÂÚÔ ÛÙÔÈ¯Â›Ô Ù˘ ÂÚ›ÙˆÛ˘ Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Â›Ó·È fiÙÈ Ë ·Ó·ÈÌ›· ‰ÂÓ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷, ·ÏÏ¿ ÔÊÂÈÏfiÙ·Ó Û ÌË ¿ÓÔÛÔ˘ Ù‡Ô˘ ·ÈÌfiÏ˘ÛË Î·È ÂȉÈÎfiÙÂÚ· ÛÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË, fiˆ˜ ÚԤ΢„ ·fi ÙÔÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô. ∏ ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË ·ÔÙÂÏ› ·ÈÌ·ÙÔÏÔÁÈÎfi ÓfiÛËÌ· Ô˘ ηٿ ηÓfiÓ· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ۈ̷ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi (~75%), Û·ÓÈfiÙÂÚ· Ì ۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ÁÔÓ›‰ÈÔ (~25%), ÂÓÒ ÌÈÎÚfi ÌfiÓÔ ÔÛÔÛÙfi ·ÊÔÚ¿ Ӥ˜ ÌÂÙ·ÏÏ¿ÍÂȘ. √Ê›ÏÂÙ·È Û ¤ÏÏÂÈÌÌ· ÙÔ˘ ÚˆÙÂ˚ÓÈÎÔ‡ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÔ‡ ÛÎÂÏÂÙÔ‡, Ô˘ ÌÔÚ› Ó· ·ÊÔÚ¿ ÔÛÔÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÛÂÎÙÚ›Ó˘, ·Á΢ڛÓ˘, ÚˆÙ½Ó˘ 3 ‹ ÚˆÙ½Ó˘ 4,2, Î·È Ô‰ËÁ› Û ÛÊ·ÈÚÈÎfi Û¯‹Ì· ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ (5). ∏ ÂÏ·Ùو̤ÓË Â˘Î·Ì„›· ÙˆÓ ÛÊ·ÈÚÔ΢ÙÙ·ÚÈÎÒÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ÚÔηÏ› ÙËÓ ÚfiˆÚË Î·Ù·ÛÙÚÔÊ‹ ÙÔ˘˜ ÛÙÔÓ ÛÏ‹Ó·. ∏ ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ ÔÈΛÏÏÂÈ ·fi ·Û˘Ìو̷ÙÈ΋ ¤ˆ˜ ‚·ÚÈ¿ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Ì ÛÏËÓÔÌÂÁ·Ï›· Î·È Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂȘ. ∏ ‰È¿ÁÓˆÛË Ù˘ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛ˘ Ù›ıÂÙ·È ·fi (5,6): 1) ÙËÓ ‡·ÚÍË ÛÙÔ Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÓ Û ÔÛÔÛÙfi ¿Óˆ ·fi 15-20%, 2) ÙË ‰ÔÎÈÌ·Û›· ÔÛ̈ÙÈ΋˜ ·ÓÙ›ÛÙ·Û˘ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ (¤ÎıÂÛË Û ˘fiÙÔÓÔ ‰È¿Ï˘Ì· NaCl Ô‰ËÁ› Û ٷ¯‡ÙÂÚË Ï‡ÛË ÙˆÓ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÓ), Î·È 3) ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÂÚ˘ıÚÒÓ (ËÏÂÎÙÚÔÊfiÚËÛË Á¤Ï˘ ÁÈ· Ù·˘ÙÔÔ›ËÛË Ù˘ ÂȉÈ΋˜ ÚˆÙÂ˚ÓÈ΋˜ ·ÓˆÌ·Ï›·˜). ªÂ ÙË ‰ÔÎÈÌ·Û›· ÔÛ̈ÙÈ΋˜ ·ÓÙ›ÛÙ·Û˘ ÂÚ˘ıÚÒÓ ÂȂ‚·ÈÒıËÎÂ Ë ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË ÛÙÔ ‚Ú¤ÊÔ˜ Î·È Ë ÂÙÂÚÔ˙˘ÁˆÙ›· ÛÙÔ˘˜ ÁÔÓ›˜. ¡· ÛËÌÂȈı› fiÙÈ ÙÔ ÁÂÁÔÓfi˜ Ù˘ ÌË Î·Ù·ÁÚ·Ê‹˜ ¢ÚËÌ¿ÙˆÓ ·fi ÙËÓ ·Ó¿Ï˘ÛË ÚˆÙÂ˚ÓÒÓ Ù˘ ÌÂÌ‚Ú¿Ó˘, fiˆ˜ Û˘Ó¤‚Ë ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ‰ÂÓ ·ÔÎÏ›ÂÈ ÙÔ ÓfiÛËÌ·, Î·È ÙfiÙÂ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·fi ÙË ‰ÔÎÈÌ·Û›· ÔÛ̈ÙÈ΋˜ ·ÓÙ›ÛÙ·Û˘ ÂÚ˘ıÚÒÓ Î·È ÙË ÌÔÚÊÔÏÔÁ›· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ Û ¿Û¯ÔÓÙ· Î·È ÁÔÓ›˜. ∏ Û˘Ó‡·ÚÍË ÛÊ·ÈÚÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ Î·È Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔ Û˘Ó‰˘·ÛÌfi, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ¿ÏÏÔ ·Ó¿ÏÔÁÔ ÂÚÈÛÙ·ÙÈÎfi ÛÙËÓ ÚÔÛÈÙ‹ Û ̷˜ ‰ÈÂıÓ‹ Î·È ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·. ∞ÎfiÌË, ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂÌÊ·Ó›˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ·ÈÌ·ÙÔÏÔÁÈ΋˜ ‹ ¿ÏÏ˘ ηÎÔ‹ıÂÈ·˜, ·ÊÔ‡ ¤¯Ô˘Ó ·Ó·ÊÂÚı›

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¡Â˘ÚÔ‚Ï¿Ûو̷ Î·È ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË

ÌÂÌÔӈ̤Ó˜ ÌfiÓÔ ÂÚÈÙÒÛÂȘ Û˘Ó‰˘·ÛÌÔ‡ Ù˘ .¯. Ì ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·, ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ‹ Ì ÔÏÏ·ÏÔ‡Ó Ì˘¤ÏˆÌ· (11). Œ¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› ÌÂÙ·ÙÚÔ‹ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Û ÛÊ·ÈÚÔ·ÙÙ·Ú·, ÌÂÙ¿ ·fi ÂÒ·ÛË Ì ηÎÔ‹ıË Î‡ÙÙ·Ú·, ÚÔÊ·ÓÒ˜ ·fi ÙËÓ Â›‰Ú·ÛË Ô˘ ¿ÛÎËÛ·Ó ¿Óˆ ÙÔ˘˜ Ù· ηÎÔ‹ıË Î‡ÙÙ·Ú·, ¯ˆÚ›˜ fï˜ Ó· ÌÔÚ› Ó· ·ÈÙÈÔÏÔÁËı› ·˘Ùfi ÙÔ Ê·ÈÓfiÌÂÓÔ (12). ∆¤ÏÔ˜, Û˘Ó‡·ÚÍË Û˘ÁÁÂÓÔ‡˜ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛ˘ Ì ηÏÔ‹ıÂȘ fiÁÎÔ˘˜, fiˆ˜ ·Ì·ÚÙÒÌ·Ù· ÛÏËÓfi˜, ÂÛٛ˜ ÂÍˆÌ˘ÂÏÈ΋˜ ·ÈÌÔÔ›ËÛ˘ Î·È Ì˘ÂÏÔÏ›ˆÌ·, ·Ó·Ê¤ÚÔÓÙ·È Û˘¯ÓfiÙÂÚ· (9). ¶Èı·ÓÒ˜, ÛÙÔ Ì¤ÏÏÔÓ, ÂÊfiÛÔÓ ˘¿ÚÍÔ˘Ó ¿ÏÏ· ·Ó¿ÏÔÁ· ÂÚÈÛÙ·ÙÈο, Ó· ‰È¢ÎÚÈÓÈÛı› ·Ó Ë Û˘Ó‡·ÚÍË ÙˆÓ ‰‡Ô ·˘ÙÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÓÔÛÔÏÔÁÈÎÒÓ ÔÓÙÔًوÓ, Ì›·˜ ·ÈÌ·ÙÔÏÔÁÈ΋˜ Î·È ÂÓfi˜ Û˘Ì·ÁÔ‡˜ fiÁÎÔ˘ (ÎÏËÚÔÓÔÌÈ΋ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË-Ó¢ÚÔ‚Ï¿Ûو̷), ‹Ù·Ó Ù˘¯·›· ‹ ·Ó ˘¿Ú¯ÂÈ Î¿ÔÈÔ˜ ÎÔÈÓfi˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜.

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¶·È‰È·ÙÚÈ΋ 2007;70:316-319

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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

CASE REPORT

™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔ̤·˜ Ô‰fiÓÙ·˜ Û ÙÚ›· ‚Ú¤ÊË ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂™À, °¶¡ “πÔÎÚ¿ÙÂÈÔ”, £ÂÛÛ·ÏÔÓ›ÎË AÏÏËÏÔÁÚ·Ê›·: ∞ϤͷӉÚÔ˜ ∞Ó‰Ú¤Ô˘ aalex@the.forthnet.gr ÃÂÈ̈ӛ‰Ô˘ 15, ∫·Ï·Ì·ÚÈ¿ T.K. 551 33, £ÂÛÛ·ÏÔÓ›ÎË

∞. ∞Ó‰Ú¤Ô˘, ∞. ∫Ô‡ÙÏ·, ∂. ∑¢Á·Ú›‰Ô˘, A. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘ ¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÙÚ›· ‚Ú¤ÊË ÌÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ·ÈÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ (™™∞∆) Î·È ÌÔÓ‹ÚË ÎÂÓÙÚÈÎfi ¿Óˆ ÙÔ̤· Ô‰fiÓÙ· (ª∫∞∆√). √ ª∫∞∆√ Û ÓÂÔÁÓ¿ Ì ™™AT ·ÔÙÂÏ› ¤Ó·Ó ηϿ ÙÂÎÌËÚȈ̤ÓÔ, Û¿ÓÈÔ Û˘Ó‰˘·ÛÌfi Ô˘ ÂÚÈÁÚ¿ÊËΠÂÎÙÂÓÒ˜ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980. ∏ ‰È¿ÁÓˆÛË Ù˘ ™™∞∆ Ù¤ıËΠÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ‚·ÛÈṲ̂ÓË ÛÙ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ù˘ ıÔÚ˘‚Ò‰Ô˘˜, Û˘Ú›ÙÙÔ˘Û·˜ ÚÈÓÈ΋˜ ·Ó·ÓÔ‹˜ Î·È Ù˘ ·‰˘Ó·Ì›·˜ ‰Èfi‰Ô˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8. ∏ ÂȂ‚·›ˆÛË ¤ÁÈÓ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘. ∏ ‡·ÚÍË ª∫∞∆√ ‰È·ÁÓÒÛıËΠ̠·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ ÛÙ· 2 ÂÚÈÛÙ·ÙÈο ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Î·È ÛÙÔ ¿ÏÏÔ ÎÏÈÓÈο, Û ËÏÈΛ· 10 ÌËÓÒÓ. ŒÓ· ÓÂÔÁÓfi ›¯Â ÔÏÏ·Ϥ˜ Ì›˙ÔÓ˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ˘fi ÌÔÚÊ‹ Û˘Ó‰ÚfiÌÔ˘ Ì ˘Ô-˘ÔÊ˘ÛÈÛÌfi, ·ÙÚËÛ›· ÚˆÎÙÔ‡, ÎÚ˘„ÔÚ¯›·, ÌÈÎÚfi ¤Ô˜, ıÔψً ˘ÂÚÒ· Î·È ÓÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜. ∆· ¿ÏÏ· ‰‡Ô ›¯·Ó ‹È· Û˘ÓÔ‰¿ ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ·ÚÔ‰È΋ ‰˘ÛÊ·Á›· Î·È Î·ı˘ÛÙ¤ÚËÛË ÛˆÌ·ÙÈ΋˜ ·Ó¿Ù˘Í˘. ™˘˙ËÙÂ›Ù·È Ë Û¯¤ÛË Ô˘ ¤¯Ô˘Ó ÔÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ Ì ÛÔ‚·Ú¤˜ ·ı‹ÛÂȘ, fiˆ˜ Ë ÔÏÔÚÔÛÂÁÎÂÊ·Ï›·, Ô ˘Ô-˘ÔÊ˘ÛÈÛÌfi˜ Î·È ÙÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ·. §¤ÍÂȘ ÎÏÂȉȿ: ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔًوÓ, Û˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜, ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔ̤·˜ Ô‰fiÓÙ·˜.

Congenital nasal pyriform stenosis and single central upper maxillary incisor in three infants Neonatology Department ¡∏π, Hippokration General Hospital, Thessaloniki, Greece Correspondence: Alexandros Andreou aalex@the.forthnet.gr 15, Chimonidou St, Kalamaria 551 33, Thessaloniki, Greece

A. Andreou, A. Koutla, E. Zeugaridou, A. Sakellaropoulou Abstract: Three neonates with congenital nasal pyriform stenosis (CNPS) and a single central maxillary incisor (SCMI) are described. SCMI in neonates with CNPS comprises a well documented but rare combination that was extensively described in the 1980s. The diagnosis of CNPS was made in infancy, based on the clinical findings of noisy, wheezing nasal breathing and the inability of passage of a rhinogastric tube size Fr 8. SCMI was diagnosed in infancy in two of the neonates by computer tomography (CT) scanning of upper maxilla, and in the third on the basis of clinical findings at the 10th month of age.

One neonate had associated multiple major congenital abnormalities in the form of a syndrome, with hypopituitarism, anal atresia, cryptorchidism, small penis, high arched palate and renal malformations.

The other two had mild coexisting problems, such as transient dysphagia and developmental retardation.

The relationship between CNPS and SCMI and severe abnormalities, such as holoprosencephaly, hypopituitarism and short stature are discussed.

Key words: Congenital nasal stenosis, congenital nasal pyriform stenosis, single central upper maxillary incisor.

∂ÈÛ·ÁˆÁ‹ √ ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔ̤·˜ Ô‰fiÓÙ·˜ (ª∫∞∆√) Û ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ (™™ƒ∫) ·ÔÙÂÏ› ¤Ó·Ó ηϿ ÙÂÎÌËÚȈ̤ÓÔ, Û¿ÓÈÔ Û˘Ó‰˘·ÛÌfi Ô˘ ÂÚÈÁÚ¿ÊËΠÂÎÙÂÓÒ˜ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980 (1). ∏ ™™ƒ∫ Û˘Óԉ¢fiÙ·Ó Ì ª∫∞∆√ Û ÔÛÔÛÙfi 60%-70% (2-4), ÂÓÒ Û ·ÛıÂÓ›˜ Ì ª∫∞∆√ Ë ·ÚÔ˘Û›· οÔÈ·˜ ÌÔÚÊ‹˜ ™™ƒ∫ Â›Ó·È ÛÙ·ıÂÚfi ‡ÚËÌ· (5). ªÂÌÔӈ̤ӷ ‹ ÛÂ Û˘Ó‰˘·ÛÌÔ‡˜, Ë ™™ƒ∫ Î·È Ô ª∫∞∆√ ÌÔÚ› Ó· Û˘Ó‰¤ÔÓÙ·È ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·, ÁÓˆÛÙ¿ Paediatriki 2007;70:320-324

Û‡Ó‰ÚÔÌ· Î·È ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‹ Ó· ··ÓÙÔ‡Ó Û ηٿ Ù· ¿ÏÏ· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· (6). ªÔÚ› Â›Û˘, Ó· ·ÔÙÂÏÔ‡Ó ÙȘ ÌÔÓ·‰ÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÏÔÚÔÛÂÁÎÂÊ·Ï›·˜, ˘Ô-˘ÔÊ˘ÛÈÛÌÔ‡ Î·È Î·ı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (6,7). ¶ÂÚÈÁÚ¿ÊÔ˘Ì ÙÚ›· ÓÂÔÁÓ¿ Ì ™™∞∆ Î·È ª∫∞∆√ ÁÈ· Ó· ÙÔÓÈÛı› Ë Û·ÓÈfiÙËÙ· Î·È Ë ÛËÌ·Û›· Ù˘ ‰È¿ÁÓˆÛ˘ ηٿ ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·.

¶ÂÚ›ÙˆÛË 1Ë ¡ÂÔÁÓfi, ·ÁfiÚÈ, ‰Â‡ÙÂÚÔ ·È‰› Ê·ÈÓÔÌÂÓÈο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ Ô˘ ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·321

321

™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔ̤·˜ Ô‰fiÓÙ·˜

ÙÔ˘˜, ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. °ÂÓÓ‹ıËΠ·fi 24¯ÚÔÓË ÌËÙ¤Ú· ÌÂÙ¿ ·fi ÔÌ·Ï‹ ÂÁ΢ÌÔÛ‡ÓË 39 ‚‰ÔÌ¿‰ˆÓ. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ·ÚÓËÙÈÎfi ÁÈ· ˘ÔÛÌ›·, ÌÔÓ‹ÚË ÎÂÓÙÚÈÎfi ÙÔ̤· Ô‰fiÓÙ·, ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÚÔÛÒÔ˘ ‹ ¿ÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜.

H ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 9 ÛÙÔ 1Ô Î·È 5Ô ÏÂÙfi. ∆Ô µ° ‹Ù·Ó 3700 g, ÙÔ ª™ 54 cm Î·È Ë ¶∫ 36 cm. ∏ Ê˘ÛÈ΋ ÂͤٷÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ¤‰ÂÈÍ 60 ·Ó·ÓÔ¤˜ ÛÙÔ ÏÂÙfi, ̤ÙÚȘ ÂÈÛÔÏΤ˜ ÌÂÛÔÏ¢ڛˆÓ Î·È ıÔÚ˘‚Ò‰Ë ÚÈÓÈ΋, ÂÈÛÓ¢ÛÙÈ΋ Î·È ÂÎÓ¢ÛÙÈ΋ ·Ó·ÓÔ‹. À‹Ú¯·Ó ·˘ÍË̤Ó˜ ÂÎÎÚ›ÛÂȘ Î·È ÛÙȘ ‰‡Ô ÚÈÓÈΤ˜ ÎÔÈÏfiÙËÙ˜ Î·È ·‰˘Ó·Ì›· ‰Èfi‰Ô˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ‰È·Ì¤ÛÔ˘ Î·È ÙˆÓ ‰‡Ô ÚÈÓÈÎÒÓ ÎÔÈÏÔًوÓ. ∏ ÂͤٷÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ¤‰ÂÈÍ ÛÙÂÓ‹, ıÔψً ˘ÂÚÒ·. √È fiÚ¯ÂȘ ‰ÂÓ ‹Ù·Ó „ËÏ·ÊËÙÔ› ÛÙÔ fiÛ¯ÂÔ, Ô‡Ù ÛÙÔ˘˜ ‚Ô˘‚ˆÓÈÎÔ‡˜ fiÚÔ˘˜. ∆Ô Ì¤ÁÂıÔ˜ ÙÔ˘ ¤Ô˘˜ ‹Ù·Ó 1,5 cm Î·È ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ ·fi ÙË 10Ë ∂ηÙÔÛÙÈ·›· £¤ÛË (∂£). À‹Ú¯Â ·ÙÚËÛ›· ÙÔ˘ ÚˆÎÙÔ‡. ∏ ÏÔÈ‹ Ê˘ÛÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. √ Û˘Ó‹ı˘ ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ‚ÂÏÙÈÒıËΠ̠ÙËÓ ÙÔÔı¤ÙËÛË ÂÓfi˜ ÛÙÔÌ·ÙÈÎÔ‡ ·ÂÚ·ÁˆÁÔ‡. ∆ËÓ 3Ë Ë̤ڷ ˙ˆ‹˜ ‰ÈÂÓÂÚÁ‹ıËΠÎÔÏÔÛÙÔÌ›·. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ¤‰ÂÈÍÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ÛÙÔ ·ÈÔÂȉ¤˜ ÙÚ‹Ì· Î·È ª∫∞∆√ (∂ÈÎfiÓ· 1). ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍ ˘ÔÏ·Û›· Ù˘ ˘fiÊ˘Û˘, ¯ˆÚ›˜ ÛÙÔȯ›· ÔÏÔÚÔÛÂÁÎÂÊ·Ï›·˜. √ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÎÔÈÏȷ΋˜ ¯ÒÚ·˜ ¤‰ÂÈÍ ‰ÈÏ·ÛÈ·ÛÌfi Ù˘ ÓÂÊÚÈ΋˜ ˘¤ÏÔ˘ ¿Ìʈ Î·È ¤Ó·Ó ÂÈÎÔ˘ÚÈÎfi ÛÏ‹Ó·, Ô˘ÚÈ·›· ÛÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜, Ô ·ÎÙÈÓÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ù· ÔÙÈο Î·È ·ÎÔ˘ÛÙÈο ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. √ ηڢfiÙ˘Ô˜ ‹Ù·Ó ¿ÚÚÂÓÔ˜, 46ÃÀ. ∏ ™™∞∆ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÙËÓ ÙÔÔı¤ÙËÛË ÚÈÓÈÎÒÓ ÛˆÏËÓ·Ú›ˆÓ ¿Ìʈ ÁÈ· 2 Ì‹Ó˜. ™ÙË ‰È¿ÚÎÂÈ· 2 ¯ÚfiÓˆÓ ·Ú·ÎÔÏÔ‡ıËÛ˘, ÙÔ µ™, ÙÔ ª™ Î·È Ë ¶∫ ·Ú¤ÌÂÓ·Ó Î¿Ùˆ ·fi ÙË 10Ë ∂£. √È fiÚ¯ÂȘ ›¯·Ó η٤ÏıÂÈ ÛÙÔÓ ‚Ô˘‚ˆÓÈÎfi fiÚÔ, ÂÓÒ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ ¤Ô˘˜ ·Ú¤ÌÂÈÓ οو ·fi ÙË 10Ë ∂£. ∏ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË Î·Ù¿ Denver ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ˘fiÊ˘Û˘ Û ËÏÈΛ· 2 ÂÙÒÓ ¤‰ÂÈÍ ·ÓÂ¿ÚÎÂÈ· Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (Â›‰· ÛÙ· 0 ÏÂÙ¿: 0,36 ng/ml, ÛÙ· 60 ÏÂÙ¿: 0,48 ng/ml, ÛÙ· 90 ÏÂÙ¿: 0,44 ng/ml, Î·È ÛÙ· 120 ÏÂÙ¿: 0,4 ng/ml), Ù˘ ı˘Ï·ÎÈÔÙÚfiÔ˘ (FSH: 0) Î·È Ù˘ ˆ¯ÚÈÓÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (LH: 0). ∂Ï·Ùو̤ӷ ‹Ù·Ó Î·È Ù· Â›‰· ÔÏÈ΋˜ ı˘-

∂ÈÎfiÓ· 1. ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ Î·È ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ÙÔ̤·˜ Ô‰fiÓÙ·˜ ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÛÙËÓ 1Ë ÂÚ›ÙˆÛË.

ÚÔ͛Ӣ (∆4: 2,78 mg/dl), ÔÏÈ΋˜ ÙÚÈ-Ȉ‰Ôı˘ÚÔÓ›Ó˘ (∆3: 51,6 ng/dl), ÂχıÂÚ˘ ∆4 (FT4: 0,51 ng/dl) Î·È ÂχıÂÚ˘ ∆3 (F∆3: 1,07 pg/dl). ∆· Â›‰· Ù˘ ÊÏÔÈÔÙÚfiÔ˘ (ACTH) Î·È ı˘ÚÂÔÙÚfiÔ˘ ÔÚÌfiÓ˘ (TSH), ηıÒ˜ Î·È Ù˘ ÎÔÚÙÈ˙fiÏ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο.

¶ÂÚ›ÙˆÛË 2Ë ¡ÂÔÁÓfi, ÎÔÚ›ÙÛÈ, ÙÚ›ÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Û ËÏÈΛ· 16 ËÌÂÚÒÓ, ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÛÙ¤ÓˆÛ˘ ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¿Ìʈ. ∏ ÌËÙ¤Ú·, 32 ÂÙÒÓ, ¤·Û¯Â ·fi ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ͽη˜ Î·È ‰ÂÓ Â›¯Â Û˘ÁÁ¤ÓÂÈ· Ì ÙÔÓ Î·ıfiÏ· ˘ÁÈ‹ ·Ù¤Ú·. ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. ∆Ô Ì·È¢ÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∏ ·ËÛË ÂÚ·ÙÒıËΠÙËÓ 37Ë Â‚‰ÔÌ¿‰·, Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÚÔËÁËı›۷˜. ∆Ô ÓÂÔÁÓfi ¤ÎÏ·„ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È Ï›Á˜ ÒÚ˜ ·ÚÁfiÙÂÚ· ÂÌÊ¿ÓÈÛ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ÂÈÛÓ¢ÛÙÈÎfi Û˘ÚÈÁÌfi. ∏ ÂÈÛ·ÁˆÁ‹ ÚÈÓÈÎÔ‡ ηıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 6 Û ·ÌÊfiÙÂÚ˜ ÙȘ ÚÈÓÈΤ˜ ÎÔÈÏfiÙËÙ˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹. §fiÁˆ Âȉ›ӈÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙÔ ÓÂÔÁÓfi ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ù· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó µ° 2890 g, ª™ 48 cm Î·È ¶∫ 33,5 cm. ∂ÈÛÎÔÈο, ÙÔ ¯ÚÒÌ· ‹Ù·Ó Úfi‰ÈÓÔ, ÔÈ ·Ó·ÓÔ¤˜ ‹Ù·Ó 70 ÙÔ ÏÂÙfi Î·È ˘‹Ú¯Â ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ. ∞ÎÚÔ·ÛÙÈο, ˘‹Ú¯Â ÂÈÛÓ¢ÛÙÈÎfi˜ Û˘ÚÈÁÌfi˜. ¢ÂÓ ‹Ù·Ó ‰˘Ó·Ù‹ Ë ‰›Ô‰Ô˜ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ‰È·Ì¤ÛÔ˘ ÙˆÓ ‰‡Ô ÚÈÓÈÎÒÓ ÎÔÈÏÔًوÓ. H ÂͤٷÛË ÙˆÓ ÏÔÈÒÓ Û˘ÛÙËÌ¿ÙˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∆ËÓ 6Ë Ë̤ڷ ˙ˆ‹˜, ÏfiÁˆ Âȉ›ӈÛ˘ ¶·È‰È·ÙÚÈ΋ 2007;70:320-324

Pediatri July-Aug 07

09-07-07

17:08

™ÂÏ›‰·322

322

∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.

Ϥ˜ Ì ÎËÚ›· ÌÂÁ¤ıÔ˘˜ Fr 7, 8 Î·È 9. §fiÁˆ ‰˘ÛÊ·Á›·˜, Ë Û›ÙÈÛË ÁÈÓfiÙ·Ó Ì ÚÈÓÔÁ·ÛÙÚÈÎfi ۈϋӷ ÁÈ· 8 Ë̤Ú˜. ™Â ËÏÈΛ· 1 ÌËÓfi˜ ÂÍ‹Ïı Ì µ™ 3240 g (3Ë-10Ë ∂£), ¶∫ 36 cm (50Ë-75Ë ∂£), Î·È ª™ 48 cm (10Ë ∂£). ™Â ËÏÈΛ· 3 ÌËÓÒÓ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ∆4, ∆3, ∆SH, ÎÔÚÙÈ˙fiÏË ÔÚÔ‡ Î·È ·˘ÍËÙÈ΋ ÔÚÌfiÓË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆Ô ·ÌÈÓfiÁÚ·ÌÌ· ÔÚÔ‡, Ô‡ÚˆÓ Î·È Ù· ÔÚÁ·ÓÈο Ôͤ· Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. √ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÎÔÈÏÈ¿˜ Î·È ÔÈ ˆÙÔ·ÎÔ˘ÛÙÈΤ˜ ÂÎÔÌ¤˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∏ ·ÍÔÓÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô Û ËÏÈΛ· 10,5 ÌËÓÒÓ ¤ÁÈÓ ·ÓÙÈÏËÙ‹, ÂÈÛÎÔÈο, Ë ‡·ÚÍË ª∫∞∆√. ™Â ËÏÈΛ· 25 ÌËÓÒÓ, ÙÔ µ™ ‹Ù·Ó 9700g (3Ë -10Ë ∂£), ÙÔ ª™ 76,5 cm (3Ë ∂£) Î·È Ë ¶∫ 46,5 cm (10Ë - 50Ë ∂£). ∏ „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ì ÙË ‰ÔÎÈÌ·Û›· Denver ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∂ÈÎfiÓ· 2. ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ÛÙË 2Ë ÂÚ›ÙˆÛË.

∂ÈÎfiÓ· 3. ™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ·ÈÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ Î·È ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ÙÔ̤·˜ Ô‰fiÓÙ·˜ ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÛÙËÓ 3Ë ÂÚ›ÙˆÛË.

Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ÙÔ ÓÂÔÁÓfi ‰È·ÛˆÏËÓÒıËÎÂ Î·È ÙÔÔıÂÙ‹ıËΠÛÂ Û˘Ó¯‹ ıÂÙÈ΋ ›ÂÛË ·ÂÚ·ÁˆÁÒÓ ÁÈ· 2 Ë̤Ú˜. √ Û˘Ó‹ı˘ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¤‰ÂÈÍ ÛÙ¤ÓˆÛË ÛÙÔ ·ÈÔÂȉ¤˜ ÙÚ‹Ì· ¿Ìʈ (∂ÈÎfiÓ· 2). ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ ÁÈ· ÙËÓ ‡·ÚÍË ª∫∞∆√ ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÁÈ· Ù¯ÓÈÎÔ‡˜ ÏfiÁÔ˘˜. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ ‰ÂÓ ÛÎÈ·ÁÚ¿ÊËÛ ¢ÎÚÈÓÒ˜ ÙȘ Ô‰ÔÓÙÈΤ˜ Ú›˙˜ Î·È ‰ÂÓ ‹Ù·Ó ‰È·ÁÓˆÛÙÈ΋ ÁÈ· ‡·ÚÍË ‹ ÌË ª∫∞∆√. ∏ ™™∞∆ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠‰È·ÛÙÔPaediatriki 2007;70:320-324

¶ÂÚ›ÙˆÛË 3Ë ¡ÂÔÁÓfi, ÎÔÚ›ÙÛÈ, 1Ô ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÙÔ 2Ô 24ˆÚÔ ˙ˆ‹˜, ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÌÂÁ¿Ï˘ ÛÙ¤ÓˆÛ˘ ÙˆÓ ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¿Ìʈ. ∏ ÌËÙ¤Ú·, 30 ÂÙÒÓ, Î·È Ô ·Ù¤Ú·˜, 37 ÂÙÒÓ, ‹Ù·Ó Ê·ÈÓÔÌÂÓÈο ˘ÁÈ›˜ Î·È ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. ¢ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ¿ÙÔÌ· ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. ∏ ·ËÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÂÚ·ÙÒıËΠÙËÓ 39Ë Â‚‰ÔÌ¿‰·, Ì ÛÈ··. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 9 ÛÙÔ 1Ô Î·È 5Ô ÏÂÙfi. ∆Ô ÓÂÔÁÓfi ÂÌÊ¿ÓÈÛ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ¤ÓÙÔÓË ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÂÈÛÓ¢ÛÙÈÎfi Û˘ÚÈÁÌfi Î·È Ì¤ÙÚȘ ÂÈÛÔÏΤ˜ ÌÂÛÔÏ¢ڛˆÓ. ŒÁÈÓ ·Ú¯Èο ÚÔÛ¿ıÂÈ· ÂÈÛfi‰Ô˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ·ÌÊÔÙÂÚfiÏ¢ڷ, Ë ÔÔ›· ·¤Ù˘¯Â. ÃÔÚËÁ‹ıËΠÔ͢ÁfiÓÔ Ì ̿Ûη ÁÈ· Ì›· Ë̤ڷ Î·È ÙË 2Ë Ë̤ڷ ˙ˆ‹˜ ÏfiÁˆ Âȉ›ӈÛ˘ Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ‰È·ÛˆÏËÓÒıËÎÂ Î·È ‰È·ÎÔÌ›ÛÙËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, Ù· ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ‹Ù·Ó µ° 3150 g (25Ë -50Ë ∂£), ¶∫ 34 cm (50Ë ∂£)Î·È ª™ 50 cm (50Ë -75Ë ∂£). ∏ ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ¤Íˆ ηÓıÒÓ ‹Ù·Ó 5,1 cm (3Ë ∂£), ÌÂٷ͇ ÙˆÓ ¤Ûˆ ηÓıÒÓ 1,7cm (3Ë ∂£) Î·È ÌÂٷ͇ ÙˆÓ ÎÔÚÒÓ 3,1 cm (<3Ë ∂£). ∏ ÂͤٷÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙÔ˘ ‰È·ÛˆÏËӈ̤ÓÔ˘ ÓÂÔÁÓÔ‡ ¤‰ÂÈÍ ÚÈÓÈ΋ Û˘ÌÊfiÚËÛË Î·È ¤ÎÎÚÈÌ· ¿Ìʈ. ∆· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∆Ô ÓÂÔÁÓfi Ù¤ıËΠ۠ÂÓ‰ÔÙÚ·¯Âȷ΋ ÂÊ·ÚÌÔÁ‹ Û˘Ó¯ԇ˜ ıÂÙÈ΋˜ ›ÂÛ˘ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ÁÈ· 6 Ë̤Ú˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÙÔÔıÂÙ‹ıËΠ·ÂÚ·ÁˆÁfi˜ ÁÈ· 3 Ë̤Ú˜. À‹Ú¯Â ‰˘Û¯¤ÚÂÈ· ÛÙË Û›ÙÈÛË Î·È ÙËÓ Î·Ù¿ÔÛË. √ Û˘Ó‹ı˘ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜

Pediatri July-Aug 07

09-07-07

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323

™˘ÁÁÂÓ‹˜ ÛÙ¤ÓˆÛË ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Î·È ÌÔÓ‹Ú˘ ÎÂÓÙÚÈÎfi˜ ¿Óˆ ÙÔ̤·˜ Ô‰fiÓÙ·˜

‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ηıÒ˜ Î·È Ô ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ηډȿ˜ Î·È ÙˆÓ ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ Î·È ÚÈÓÈÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ·ÔÎ¿Ï˘„ ™™∞∆ Î·È ‡·ÚÍË ª∫∞∆√ (∂ÈÎfiÓ· 3). ∆Ô Â‡ÚÔ˜ ÙˆÓ ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ ÛÙÔ ‡„Ô˜ ÙÔ˘ ·ÈÔÂȉԇ˜ ÎfiÏÔ˘ ‹Ù·Ó 3,6 mm Î·È 4,8 mm ·ÓÙ›ÛÙÔȯ· (º.∆.

13,4 mm). ∏ ‚˘ıÔÛÎfiËÛË Î·È Ù· ·ÎÔ˘ÛÙÈο ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∂Í‹Ïı Û ËÏÈΛ· ÂÓfi˜ ÌËÓfi˜ Ì ‹ÈÔ ÂÈÛÓ¢ÛÙÈÎfi Û˘ÚÈÁÌfi. ™Â ËÏÈΛ· ÙÚÈÒÓ ÌËÓÒÓ Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋.

™˘˙‹ÙËÛË ∏ ‡·ÚÍË ª∫∞∆√ ·Ó·Ê¤ÚıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1958 ·fi ÙÔÓ Scott (8). H Û‡Ó‰ÂÛË ÙÔ˘ ª∫∞∆√ Ì ÙË ™™ƒ∫ ·Ó·ÁÓˆÚ›ÛıËΠ·fi ÙÔ˘˜ Arlis Î·È Û˘Ó. ÙÔ 1992 (5,9). À¿Ú¯Ô˘Ó ÙÚÂȘ Ù‡ÔÈ ™™ƒ∫ ·Ó¿ÏÔÁ· Ì ÙËÓ ·Ó·ÙÔÌÈ΋ ı¤ÛË Ù˘ ÛÙ¤ÓˆÛ˘ Î·È fiÏÔÈ ÙÔ˘˜ ÌÔÚ› Ó· Û˘Ó‰˘¿˙ÔÓÙ·È Ì ª∫∞∆√. ∂›Ó·È Ë ·ÙÚËÛ›· ÙˆÓ Ô›ÛıÈˆÓ ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ, Ë ÌÂÛÔÚÈÓÈ΋ ÛÙ¤ÓˆÛË Î·È Ë ÚfiÛÊ·Ù· ·Ó·ÁÓˆÚÈÛı›۷ ÛÙ¤ÓˆÛË ÙÔ˘ ·ÈÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ (1). ∆Ô ·ÈÔÂȉ¤˜ ÙÚ‹Ì· Â›Ó·È ÙÔ ÛÙÂÓfiÙÂÚÔ ÔÛÙ¤ÈÓÔ ÙÌ‹Ì· Ù˘ ÚÈÓÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ‹Ù·Ó Ë ·ÈÙ›· ™™ƒ∫ Î·È ÛÙȘ ÙÚÂȘ ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊËηÓ. ∏ ÛÙ¤ÓˆÛ‹ ÙÔ˘ ıˆÚÂ›Ù·È fiÙÈ ÔÊ›ÏÂÙ·È Û ˘ÂÚ·Ó¿Ù˘ÍË Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ηٿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË (5). ∫Ï·ÛÈο, Ë ·‰˘Ó·Ì›· ‰Èfi‰Ô˘ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· ÌÂÁ¤ıÔ˘˜ Fr 8 ı¤ÙÂÈ ÙËÓ ˘Ô„›· ÁÈ· ÔÛÙ¤ÈÓË ÚÈÓÈ΋ ·fiÊÚ·ÍË, fiˆ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È. ∏ ™™∞∆ ıˆÚÂ›Ù·È ·Û˘Ó‹ı˘ ·ÈÙ›· ÚÈÓÈ΋˜ ·fiÊڷ͢ ÛÙ· ÓÂÔÁÓ¿ Î·È ÛÙ· ·È‰È¿, Èı·ÓfiÓ fï˜, Ó· Â›Ó·È ÈÔ Û˘¯Ó‹ (3) Î·È ÚÔηÏ› fiÌÔÈ· ÎÏÈÓÈο ÛËÌ›· Ì ÙËÓ ·ÙÚËÛ›· ÙˆÓ ÚÈÓÈÎÒÓ ¯Ô·ÓÒÓ (10). ∏ ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙÔÓ ‚·ıÌfi Ù˘ ·fiÊڷ͢ Î·È ÂΉËÏÒÓÂÙ·È Ì ÚÈÓÈ΋ Û˘ÌÊfiÚËÛË, Û˘ÚÈÁÌfi, ΢ÎÏÈο ÂÂÈÛfi‰È· ΢¿ÓˆÛ˘ Î·È ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ηٷÛÙ¿ÛÂȘ. ∏ ‡·ÚÍË ª∫∞∆√ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ·ÓÙÈÏËÙ‹ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ÌÂÙ¿ ÙËÓ ·Ó·ÙÔÏ‹ ÙˆÓ ÓÂÔÁÈÏÒÓ Ô‰fiÓÙˆÓ, fiˆ˜ Ë 2Ë ÂÚ›ÙˆÛË. ∏ ˘fiÓÔÈ· ‡·Ú͢ ª∫∞∆√ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Ù›ıÂÙ·È fiÙ·Ó ˘¿Ú¯ÂÈ ™™ƒ∫ Î·È Ë ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘, fiˆ˜ Û˘Ó¤‚Ë ÛÙËÓ 1Ë Î·È 3Ë ÂÚ›ÙˆÛË. ™ÙË 2Ë ÂÚ›ÙˆÛË ÏfiÁˆ Ù¯ÓÈÎÔ‡ Έχ̷ÙÔ˜ ‰ÂÓ ¤ÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ Î·È Ë ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ¿Óˆ ÁÓ¿ıÔ˘ ‰ÂÓ ‹Ù·Ó ‰È·ÁÓˆÛÙÈ΋ ÏfiÁˆ Î·È Ù˘ ÌË Î·Ï‹˜ ·Û‚ÂÛÙÔÔ›ËÛ˘ ÙˆÓ Ô‰fiÓÙˆÓ Û ·˘Ù‹ ÙËÓ ËÏÈΛ·. ∏ ™™ƒ∫ Î·È Ô ª∫∞∆√ ÌÂÌÔӈ̤ӷ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi ¤¯Ô˘Ó ·Ó·ÊÂÚı› Û·Ó ÌÂÌÔӈ̤ӷ Â˘Ú‹Ì·-

Ù· Û ʷÈÓÔÌÂÓÈο ˘ÁÈ›˜ ·ÛıÂÓ›˜. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Û˘Ó‰¤ÔÓÙ·È Ì ¿ÏϘ Û˘ÁÁÂÓ›˜ Î·È ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‹ ÁÓˆÛÙ¿ Û‡Ó‰ÚÔÌ· (6). °È· ÙÔÓ ¤ÏÂÁ¯Ô Û˘ÓÔ‰ÒÓ ·ÓˆÌ·ÏÈÒÓ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ¯ÚˆÌÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË, ¤ÏÂÁ¯Ô˜ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ˘fiÊ˘Û˘, ÔÚÌÔÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ¤ÏÂÁ¯Ô˜ ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÒÓ. ∏ ™™ƒ∫ Â›Ó·È Û˘¯Ófi Î·È Î·Ù¿ ÔÚÈṲ̂ÓÔ˘˜ (5) ÛÙ·ıÂÚfi ‡ÚËÌ· Û ª∫∞∆√ (2,3,5,9). ∏ ™™∞∆ ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Û˘Óԉ‡ÂÙ·È ·fi ª∫∞∆√ Û ÔÛÔÛÙfi 60%-70% (2,4). ∫·ıÒ˜ Ë ™™ƒ∫ ‰È·ÁÈÁÓÒÛÎÂÙ·È Î˘Ú›ˆ˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·, ÌÔÚ› Ó· ıˆÚËı› ˆ˜ ÛÙÔÈ¯Â›Ô ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ ª∫∞∆√, ÚÈÓ ÙËÓ ·Ó·ÙÔÏ‹ ÙˆÓ ÓÂÔÁÈÏÒÓ Ô‰fiÓÙˆÓ. ™Â οı ÓÂÔÁÓfi Ì ˘Ô„›· ™™ƒ∫ ı· Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÚÔÛÒÔ˘, ·fi ÙËÓ ˘ÂÚÒ· ̤¯ÚÈ ÙË ÌÂÛfiÙËÙ· ÙÔ˘ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ (10,11) ÁÈ· ‰È¿ÁÓˆÛË Î·È ÂÓÙÔÈÛÌfi Ù˘ ÚÈÓÈ΋˜ ·fiÊڷ͢ Î·È ÙÔ˘ ª∫∞∆√. ∆Ô ÎÔÓÙfi ·Ó¿ÛÙËÌ· Â›Ó·È ¤Ó· ·fi Ù· ÚÒÙ· Â˘Ú‹Ì·Ù· Ô˘ Û˘Ó‰˘¿ÛÙËÎ·Ó Ì ™™ƒ∫ Î·È ª∫∞∆√ (2,5,9). ∏ 1Ë Î·È 2Ë ÂÚ›ÙˆÛË ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Î·È ‰˘ÛÙÚÔÊ›·. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È Ë ·ÓÂ¿ÚÎÂÈ· Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘. ∞fi Ù· ‰‡Ô ÂÚÈÛÙ·ÙÈο Ì·˜ Ì ÎÔÓÙfi ·Ó¿ÛÙËÌ·, Ô ¤Ó·˜ ·ÛıÂÓ‹˜ ›¯Â ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È ˘Ô-˘ÔÊ˘ÛÈÛÌfi. ∏ ™™∞∆ Î·È Ô ª∫∞∆√ ·ÔÙÂÏÔ‡Ó ·ÓˆÌ·Ï›Â˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜ Î·È ÌÔÚ› ·fi ÌfiÓ˜ ÙÔ˘˜ Ó· Â›Ó·È ÔÈ ÌÔÓ·‰ÈΤ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÔÏÔÚÔÛÂÁÎÂÊ·Ï›·˜ (7). ªÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ Ì ÔÏÔÚÔÛÂÁÎÂÊ·Ï›· ÌÔÚ› Ó· ¤¯ÂÈ Ê˘ÛÈÔÏÔÁÈÎfi ÚÔÛˆÂ›Ô ‹ ‹Ș, ÂÏ¿¯ÈÛÙ˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ ™™ƒ∫, ª∫∞∆√, ˘ÔÛÌ›· Î·È ˘ÔÙËÏÔÚÈÛÌfi (7). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ™™∞∆ Î·È ™ª∞∆√ ÌÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó Ì ˘ÔÙËÏÔÚÈÛÌfi, Â›ÌÔÓË ÚÈÓÈ΋ Û˘ÌÊfiÚËÛË, ‰˘ÛÎÔϛ˜ ÛÙË Û›ÙÈÛË, fiˆ˜ ÛÙË 2Ë Î·È 3Ë ÂÚ›ÙˆÛË, ‹ Ì ÌÈÎÚfi ¤Ô˜ Î·È ÎÚ˘„ÔÚ¯›·, fiˆ˜ ÛÙËÓ 1Ë ÂÚ›ÙˆÛË (6). √ ÚÒÙÔ˜ ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·˙ Â›Û˘ ·ÙÚËÛ›· ÙÔ˘ ÚˆÎÙÔ‡ Î·È ÓÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜. √ Û˘Ó‰˘·ÛÌfi˜ ·˘ÙÒÓ ÙˆÓ ·ÓˆÌ·ÏÈÒÓ ¤¯ÂÈ Û¿ÓÈ· ·Ó·ÊÂÚı› ÛÙÔ Û‡Ó‰ÚÔÌÔ VACTREL (6). √ ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ Â›¯Â Ù· ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù· ·˘ÙÔ‡ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, fï˜, ÙÔ Û‡ÓÔÏÔ ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Èı·ÓÔÏÔÁ› ÙËÓ ‡·ÚÍË Û˘Ó‰ÚfiÌÔ˘. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ™™∞∆ ‚·Û›˙ÂÙ·È ÛÙË ÛÔ‚·ÚfiÙËÙ· ÙˆÓ Û˘Ìو̿وÓ. ÕÌÂÛË ‰È·ÛˆÏ‹ÓˆÛË Ù˘ ÙÚ·¯Â›·˜ Î·È ·ÂÚÈÛÌfi˜ ··ÈÙÂ›Ù·È Û˘¯Ó¿ ÙȘ ÚÒÙ˜ Ë̤Ú˜ ˙ˆ‹˜, ηıÒ˜ Ù· ÓÂÔÁÓ¿ ·Ó·Ó¤Ô˘Ó ˘Ô¯ÚˆÙÈο ·fi ÙË Ì‡ÙË. ™Â ‰‡Ô ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì·˜ ¶·È‰È·ÙÚÈ΋ 2007;70:320-324

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∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.

¯ÚÂÈ¿ÛıËΠ·Ú¯Èο ‰È·ÛˆÏ‹ÓˆÛË Ù˘ ÙÚ·¯Â›·˜ ÁÈ· ·ÂÚÈÛÌfi. ∆ÔÈ΋ ıÂÚ·›· Î·È ÚÈÓÈÎÔ› ηıÂÙ‹Ú˜ ÂÊ·ÚÌfi˙ÔÓÙ·È Û ‹Ș ÂÚÈÙÒÛÂȘ (3,12). ∫·È ÔÈ ÙÚÂȘ ÂÚÈÙÒÛÂȘ Ì·˜ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Û˘ÓÙËÚËÙÈο Ì ÙÔÔı¤ÙËÛË ÚÈÓÈÎÒÓ Î·ıÂÙ‹ÚˆÓ Î·È ·ÂÚ·ÁˆÁÒÓ. ÃÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÂÊ·ÚÌfi˙ÂÙ·È Û ·ÛıÂÓ›˜ Ì ¿ÓÔÈ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, Â·ÓÂÈÏËÌ̤Ó˜ ‰È·ÛˆÏËÓÒÛÂȘ, ·ÔÙ˘¯›· ·ÔۈϋӈÛ˘, ‰˘ÛÎÔÏ›· Û›ÙÈÛ˘ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ΢¿ÓˆÛË, ÌË ·ÓÙ·fiÎÚÈÛË ÛÙË ¯ÔÚ‹ÁËÛË Û˘Ó¯ԇ˜ ıÂÙÈ΋˜ ›ÂÛ˘ ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜ Î·È fiÙ·Ó ˘¿Ú¯ÂÈ ·ÔÙ˘¯›· Ù˘ Û˘ÓÙËÚËÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÁÈ· ¿Óˆ ·fi 10-15 Ë̤Ú˜ (3). ∆¤ÏÔ˜, Â›Ó·È ‰˘Ó·Ù‹ Î·È ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Û ËÏÈΛ· ·ËÛ˘ 18-22 ‚‰ÔÌ¿‰ˆÓ (13).

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BÈ‚ÏÈÔÁÚ·Ê›· 1. Brown OE, Myer CM 3rd, Manning SC. Congenital nasal pyriform aperture stenosis. Laryngoscope 1989;99:86-91.

2. Lo FS, Lee ÀJ, Lin SP, Shen EY, Huang JK, Lee KS. Solitary maxillary central incisor and congenital nasal pyriform aperture stenosis. Eur J Pediatr 1998;157:39-44.

3. Van Den Abbeele T, Triglia JM, Francois M, Narcy P. Congenital nasal pyriform aperture stenosis: diagnosis and management of 20 cases. Ann Otol Rhinol Laryngol 2001;110:70-75.

4. Huang J∫, Cheng SJ, Lin JC, Sheu CY. Congenital nasal

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pyriform aperture stenosis and single central maxillary incisor: CT and MRI findings. Clin Imaging 1998;22:393-397.

Hall R∫, Bankier ∞, Aldred ªJ, Kan K, Lucas JO, Perks AG. Solitary median maxillary central incisor, short stature, choanal atresia/ midnasal stenosis (SMMCI) syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:651-662.

Nanni L, Ming JE, Du À, Hall RK, Aldred M, Bankier A, et al. SHH mutation is associated with solitary median maxillary central incisor: a study of 13 patients and review of the literature. Am J Med Genet 2001;102:1-10.

Hattori H, Okuno T, Momoi T, Kataoka K, Mikawa H, Shiota K. Single central maxillary incisor and holoprosencephaly. Am J Med Genet 1987;28:483-487.

Scott DC. Absence of upper central incisor. Brit Dent J 1958;104:247-248.

Arlis H, Ward RF. Congenital nasal pyriform aperture stenosis. Isolated abnormality vs developmental field defect. Arch Otolaryngol Head Neck Surg 1992;118:989-991.

Royal SA, Hedlund GL, Wiatrak µJ. Single central maxillary incisor with nasal pyriform aperture stenosis-CT diagnosis prior to tooth eruption. Pediatr Radiol 1999;29:357-359.

Huang JK, Cheng SJ, Yang CC, Yun CH, Shih SL. Congenital nasal pyriform aperture stenosis and single central maxillary incisor: preoperative evaluation with three-dimensional computed tomography. J Formos Med Assoc 2004;103:37-40.

Lee JJ, Bent JP, Ward RF. Congenital nasal pyriform aperture stenosis: non-surgical management and long-term analysis. Int J Pediatr Otorhinolaryngol 2001;60:167-171.

Hall R. Solitary median maxillary central incisor (SMMCI) syndrome. Orphanet J Rare Dis 2006;1:12.

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CASE REPORT

325

™‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus Ì ۇÁ¯ÚÔÓË ÚÔÛ‚ÔÏ‹ Ó¢ÚÈÎÔ‡ Î·È ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ª. ∆˙Ô‡ÊË1, ¶. ™È¯ÏÈÌ›ÚË1, π. ¡¿ÎÔ˘1, ª. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘2, ∞. ™È·ÌÔÔ‡ÏÔ˘ - ª·˘Ú›‰Ô˘1 ¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus (BRBN) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÊÏ‚ÈΤ˜ ‰˘ÛϷۛ˜, Ô˘ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÙÔ ‰¤ÚÌ· Î·È ÙoÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ. ¶ÈÔ Û¿ÓÈ· Â›Ó·È Ë ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ó¢ÚÈÎÔ‡ Î·È ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi Â›Ó·È Û¿ÓÈÔ, ·ÊÔ‡ ¤ˆ˜ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÏÈÁfiÙÂÚ˜ ·fi 200 ÂÚÈÙÒÛÂȘ. ∆· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‰È·ÈÛÙÒÓÔÓÙ·È ÛÙË Á¤ÓÓËÛË Î·È ÂȉÂÈÓÒÓÔÓÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÒÌ·ÙÔ˜, ÚÔηÏÒÓÙ·˜ ·ÈÛıËÙÈο ΢ڛˆ˜ ÚÔ‚Ï‹Ì·Ù·, ÂÓÒ Ù· ·ÓÙ›ÛÙÔȯ· ÚÔ‚Ï‹Ì·Ù· ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ ÌÔÚÔ‡Ó Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ∞Ó ·ÈÌÔÚÚ·Á‹ÛÔ˘Ó, ÚÔηÏÔ‡Ó ¯ÚfiÓÈ· ·Ó·ÈÌ›·, ‹ ÌÔÚ› Ó· ¤¯Ô˘Ó ÂÈÏÔΤ˜, fiˆ˜ Ú‹ÍË, Û˘ÛÙÚÔÊ‹ ÂÓÙ¤ÚÔ˘ Î·È ÂÁÎÔÏ·ÛÌfi. ∂›Û˘, ÌÔÚ› Ó· ÚÔÛ‚ÏËıÔ‡Ó Î·È ¿ÏÏ· fiÚÁ·Ó·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 13 ÂÙÒÓ, Ì ۇӉÚÔÌÔ BRBN, Ì ÔÏϤ˜ ÓÔÛËÏ›˜, ÙÔ˘ ÔÔ›Ô˘ Ë ·Ú·ÎÔÏÔ‡ıËÛË ÍÂΛÓËÛ ·fi ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ÔÏÏ·Ϥ˜ ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ ‚ÏÂÓÓÔÁfiÓˆÓ, ÂÓÒ ÔÈ ·ÓÙ›ÛÙÔȯ˜ ‰˘ÛϷۛ˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ ÂΉËÏÒıËÎ·Ó Ì ¯ÚfiÓÈ· ·Ó·ÈÌ›· Î·È ÂÈÏÂÔÂÈÏÂ˚Îfi ÂÁÎÔÏ·ÛÌfi. ∞ÍÈÔÛËÌ›ˆÙË Â›Ó·È Ë ÂÎÙÂٷ̤ÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ì ·ÈÌ·ÁÁ›ˆÌ· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÈÓÈ·Îfi ÏÔ‚fi, Ô˘ ›¯Â ÚÔηϤÛÂÈ ˆ˜ ÂÈÏÔ΋ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ Î·È Ì ·ÈÌ·ÁÁÂÈÒÌ·Ù· ·Ú·ÛÔÓ‰˘ÏÈο, Ù· ÔÔ›· Ȥ˙Ô˘Ó ÙÔÓ ÓˆÙÈ·›Ô Ì˘ÂÏfi. √ ·ÛıÂÓ‹˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓıÂÎÙÈΤ˜, Û‡ÓıÂÙ˜ ÂÛÙȷΤ˜ Î·È ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ¿Û¯ÂÈ ·fi ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË. ∆¤ÏÔ˜, ·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘, ÂÌÊ·Ó›˙ÂÈ ÔÏÏ·Ϥ˜ ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. ™ÙË ‰È·ı¤ÛÈÌË ‚È‚ÏÈÔÁÚ·Ê›·, ·˘Ù‹ Â›Ó·È Ë ÚÒÙË ÂÚ›ÙˆÛË Ù·˘Ùfi¯ÚÔÓ˘ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ Ó¢ÚÈÎÔ‡ Î·È ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ 2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ AÏÏËÏÔÁÚ·Ê›·: ªÂÚfiË ∆˙Ô‡ÊË mtzoufi@uoi.gr ∆Ô̤·˜ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ πˆ·ÓÓ›ÓˆÓ, ∆.£. 1186 ∆.∫. 45110, πˆ¿ÓÓÈÓ·

§¤ÍÂȘ ÎÏÂȉȿ: BRBNS, Ó¢ÚÈÎfi Û‡ÛÙËÌ·, ÂÚÂÈÛÙÈÎfi Û‡ÛÙËÌ·.

Blue Rubber Bleb Nevus Syndrome with concurrent neurological and skeletal involvement M. Tzoufi1, P. Sihlimiri1, I. Nakou1, M. Argyropoulou2, A. Siamopoulou - Mavridou1 Abstract: The blue rubber bleb nevus syndrome (BRBNS) consists of venous malformations affecting the skin and gastrointestinal tract. It is less common for the nervous and the skeletal systems to be involved.

This syndrome is rare, as descriptions of less than 200 cases have been published. The skin haemangiomata are present at birth and deteriorate as the body grows, causing mainly cosmetic problems. Haemangiomata of the gastrointestinal tract may appear later in life and can bleed, causing chronic anaemia, or present with complications such as rupture, intestinal torsion and intussusception.

Other organs may also be involved. The case of a 13 year-old boy with BRBNS is described, who was monitored since birth, and had multiple hospitalizations. He presented with multiple nevi of the skin and mucous membranes, and gastrointestinal tract lesions, which caused anaemia and ileoileic intussusception. This boy’s nervous system was significantly affected, with a haemangioma of the left occipital lobe, which caused a stroke, and multiple paravertebral haemangiomata causing pressure symptoms. He suffers from complex partial and generalized epileptic seizures and cerebral palsy. Multiple skeletal anomalies have also been present from birth. This is the first case of BRBNS in the available literature describing concurrent neurological and skeletal involvement.

1 Paediatric Department, University General Hospital of Ioannina, Ioannina 2 Radiology Department, University General Hospital of Ioannina, Ioannina Correspondence: Meropi Tzoufi mtzoufi@uoi.gr Department of Child Health University of Ioannina, Medical School, PO Box: 1186 GR 45110, Ioannina, Greece

Key words: BRBNS, nervous system, skeletal involvement.

∂ÈÛ·ÁˆÁ‹ ∆Ô Blue Rubber Bleb Nevus ™‡Ó‰ÚÔÌÔ (BRBN) Â›Ó·È ÌÈ· Û¿ÓÈ· ÔÓÙfiÙËÙ·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ. √ G. Gascoven ÛËÌ›ˆÛ ÚÒÙÔ˜ ÙË Û¯¤ÛË ÙˆÓ

ÊÏ‚ÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È Ù˘ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ·, ÙÔ 1860 (1). ™¯Â‰fiÓ ¤Ó·Ó ·ÈÒÓ· ·ÚÁfiÙÂÚ·, ÙÔ 1958, Ô William Bennet Bean, ÔÓfiÌ·Û ٷ ¯·Ú·ÎÙËÚÈÛÙÈο ·ÁÁ›· “Blue rubber bleb nevus”, ÂÍ·ÈÙ›·˜ ÙÔ˘ ¯ÚÒÌ·ÙÔ˜, Ù˘ ˘Ê‹˜ Î·È ÙÔ˘ Û¯‹Ì·Ùfi˜ ÙÔ˘˜ (2). ¶·È‰È·ÙÚÈ΋ 2007;70:325-329

Pediatri July-Aug 07

09-07-07

17:09

™ÂÏ›‰·326

326

ª. ∆˙Ô‡ÊË Î·È Û˘Ó.

°È’ ·˘Ùfi ÙÔÓ ÏfiÁÔ, ÙÔ BRBNS ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È ˆ˜ Û‡Ó‰ÚÔÌÔ Bean’s.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ‰ÂηÙÚÈ¿¯ÚÔÓÔ˘ ·ÁÔÚÈÔ‡, ÙÔ ÔÔ›Ô ÁÂÓÓ‹ıËΠ·fi ÙÂÙ·ÚÙÔÙfiÎÔ ÌËÙ¤Ú·, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ÙÂÏÂÈfiÌËÓÔ Î·È Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3.500 g. ∆Ô 6Ô ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ¿Û¯ÂÈ ·fi Ó¢ÚÔ˚ӈ̿وÛË Ù‡Ô˘ 1, ÂÓÒ Ù· ˘fiÏÔÈ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ˘ÁÈ‹. ∞̤ۈ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÓÔÛËχÙËΠÛÙË ÓÂÔÁÓÈ΋ ÌÔÓ¿‰· ÂÍ·ÈÙ›·˜ ÂÚÈÁÂÓÓËÙÈ΋˜ ·ÛÊ˘Í›·˜ Î·È Ïԛ̈͢. ™ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËηÓ: ·) ÔÏÏ·Ï¿ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ‰¤ÚÌ·ÙÔ˜ (¿Óˆ ‚ϤʷÚÔ, ÙÂÚ‡ÁÈÔ ÙÔ˘ ·˘ÙÈÔ‡, οو ÁÓ¿ıÔÈ, ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ·, Ï¿ÙË), ηıÒ˜ Î·È ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÛÙ· ԇϷ Î·È ÙÔ ‚ÏÂÓÓÔÁfiÓo ÙˆÓ ¯ÂÈϤˆÓ, ‚) ÔÏÏ·Ϥ˜ ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ (ÛÎÔÏ›ˆÛË, ıÒڷη˜ ˘Ô‰ËÌ·ÙÔÔÈÒÓ, Û˘ÁÁÂÓ¤˜ ÂÍ¿ÚıÚËÌ· ·ÚÈÛÙÂÚÔ‡ ÈÛ¯›Ô˘, ηٿÁÌ·Ù· ‰ÂÍÈÔ‡ Î·È ·ÚÈÛÙÂÚÔ‡ ÈÛ¯›Ô˘, ÂÍ¿ÚıÚËÌ· Î·È ÛÙȘ ‰‡Ô ηٿ ÁfiÓ˘ ·ÚıÚÒÛÂȘ Î·È ·ÌÊÔÙÂÚfiÏ¢ÚË Ú·È‚Ô˚ÔÔ‰›·), Á) ‚·Ï·ÓÈÎfi˜ ˘ÔÛ·‰›· Î·È ÎÚ˘„ÔÚ¯›· ¿Ìʈ, ‰) ÎÈÓËÙÈΤ˜ Î·È ·ÈÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙ· οو ¿ÎÚ· (·Ô˘Û›· ·ÓÙ›‰Ú·Û˘ ÛÙÔÓ fiÓÔ, ÙÔ ˙ÂÛÙfi Î·È ÙÔ ÎÚ‡Ô), ·ÎÚ¿ÙÂÈ· Ô‡ÚˆÓ Î·È ·Ô˘Û›· ÎÔÈÏÈ·ÎÒÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ (∂ÈÎfiÓ˜ 1,2). ™Â ËÏÈΛ· ‰‡Ô ÌËÓÒÓ, ÛÙÔÓ ÂÓ‰ÔÛÎÔÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‰È·ÈÛÙÒıËÎ·Ó ÔÏÏ·Ï¿ ·ÈÌ·ÁÁÂÈÒÌ·Ù· Û fiÏÔ ÙÔ Ì‹ÎÔ˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ Î·È ¤ÙÛÈ ¤ÁÈÓÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ BRBNS. √ ÏÔÈfi˜ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ·) ·ÈÌ·ÁÁ›ˆÌ· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÈÓÈ·Îfi ÏÔ‚fi, ÌÂÁ¤ıÔ˘˜ 2 cm, ‚) ·ÈÌ·ÁÁ›ˆÌ· Û Â·Ê‹ Ì ÙÔÓ ‰ÂÍÈfi ÓÂÊÚfi, Ô˘ ÂÂÎÙÂÈÓfiÙ·Ó ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË, Á) ÙÂÚ¿ÛÙÈÔ ·ÈÌ·ÁÁ›ˆÌ· ÛÙËÓ ÔÈÛıÔÂÚÈÙÔÓ·˚΋ ¯ÒÚ· Û Â·Ê‹ Ì ÙÔ ‰ÂÍÈfi ÂÈÓÂÊÚ›‰ÈÔ, ‰) ˘ÔÏ·ÛÙÈÎfi-‰˘ÛÏ·ÛÙÈÎfi ÓÂÊÚfi Î·È Â) Ó¢ÚÔÁÂÓ‹ ·ÛÙË ˘ÔÙÔÓÈÎÔ‡ Ù‡Ô˘. ™Â ËÏÈΛ· 2 ÌËÓÒÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Ì ÌÂÚÈ΋ ÂÎÙÔÌ‹ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜, ÙÔ ÔÔ›Ô ÂÚ¯fiÙ·Ó Û Â·Ê‹ Ì ÙÔ ‰ÂÍÈfi ÂÈÓÂÊÚ›‰ÈÔ. ™ÙËÓ ›‰È· ËÏÈΛ·, ηٿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎÂ Û˘ÁÁÂÓ‹˜ ·Ú·ÏËÁ›·. ™Â ËÏÈΛ· 3 ÂÙÒÓ, Ë ÂÎÙ›ÌËÛË Ù˘ ÓÔËÙÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜ Ì ÂȉÈο ·Ó·Ù˘Íȷο ÙÂÛÙ (Denver ππ Î·È Early Language Milestone) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ™Â ËÏÈΛ· 4 ÂÙÒÓ, ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Ì ÛÔ‚·Ú¤˜ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û ËÌÈ-Έ̷ÙÒ‰Ë Î·Ù¿ÛÙ·ÛË, ÛÙËÓ ÔÔ›· ·Ú¤ÌÂÈÓ ÁÈ· ÙÚ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ 24ˆÚ·. ∆fiÙ ·ÚÔ˘Û›·ÛÂ Î·È Â·ÓÂÈÏËÌ̤ӷ ÂÂÈÛfi‰È· ÂÛÙÈ·ÎÒÓ Û·ÛÌÒÓ Ì ‰Â˘ÙÂÚÔPaediatriki 2007;70:325-329

∂ÈÎfiÓ· 1. √ ·ÛıÂÓ‹˜.

∂ÈÎfiÓ· 2. ¢ÂÚÌ·ÙÈΤ˜ Î·È ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜.

·ı‹ ÁÂӛ΢ÛË (‰È¿ÚÎÂÈ·˜ ≤30 min). AÂÈÎÔÓÈÛÙÈο, ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘, ‰È·ÈÛÙÒıËΠÂÈÌ‹Î˘ ˘fi˘ÎÓË ÂÚÈÔ¯‹, ÛÙÔÓ ÌÂÙˆÈ·›Ô, ‚ÚÂÁÌ·ÙÈÎfi Î·È ÈÓÈ·Îfi ÏÔ‚fi, Ì Â·Û‚ÂÛÙÒÛÂȘ. ™ÙÔ Ï·›ÛÈÔ Ù˘ Ù·ÎÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÌÂÙ¿ ·fi ‰‡Ô Ì‹Ó˜, ‰È·ÈÛÙÒıËΠËÌÈÏËÁ›· ‰ÂÍÈÔ‡ ¿Óˆ ¿ÎÚÔ˘, ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹ ÔÌÈÏ›·˜, ‹È· ¤ÎÙˆÛË Ù˘ ÓÔËÌÔÛ‡Ó˘ Î·È ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜. ∂ÈϤÔÓ, 6 Ì‹Ó˜ ·ÚÁfiÙÂÚ·, ·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈο, Ôχ Û˘¯Ó¤˜, Û‡ÓıÂÙ˜ ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ (>10-15 ËÌÂÚËÛ›ˆ˜) ÌÈÎÚ‹˜ ‰È¿ÚÎÂÈ·˜ Î·È Û·ÓÈfiÙÂÚ· ÁÂÓÈÎÂ˘Ì¤Ó˜, ÌÂÁ¿Ï˘ ‰È¿ÚÎÂÈ·˜ (status epilepticus). ∞ÓÙÈÌÂÙˆ›ÛıËΠ̠ÔÏÏ·Ï‹ Î·È ÌÂÙ·‚·ÏÏfiÌÂÓË ·ÓÙÈÛ·Û̈‰È΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Ì ÌÂÚÈ΋ ÂÈÙ˘¯›· (Ú‡ıÌÈÛË Î·Ù¿ 75%). ™Â ËÏÈΛ· 6,5 ÂÙÒÓ, ·ÚÔ˘Û›·ÛÂ Û˘ÌÙÒÌ·Ù· ÂÓÙÂÚÈ΋˜ ·fiÊڷ͢. ∆¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘

Pediatri July-Aug 07

09-07-07

17:09

™ÂÏ›‰·327

327

™‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus

ÂÈÏÂÔÂÈÏÂ˚ÎÔ‡ ÂÁÎÔÏ·ÛÌÔ‡, Ô ÔÔ›Ô˜ ÔÊÂÈÏfiÙ·Ó Û ÌÂÁ¿ÏÔ ·ÈÌ·ÁÁ›ˆÌ· ÛÙËÓ ÂÚÈÔ¯‹ Î·È ÙÔ ÔÔ›Ô ·Ê·ÈÚ¤ıËΠ¯ÂÈÚÔ˘ÚÁÈο. ∂ÈϤÔÓ, ÂÂȉ‹ Û˘Ó¤¯È˙ ӷ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¤˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ¤ÁÈÓ ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRI), ÛÙËÓ ÔÔ›· ‰È·ÈÛÙÒıËΠÂÎÙÂٷ̤ÓË ‚Ï¿‚Ë Ì·ÎÚÔ΢ÛÙÈ΋˜ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ, Ë ÔÔ›· ÚÔηÏÔ‡Û ¤ÏÍË Ù˘ Û‡ÛÙÔȯ˘ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜, ÚÔÊ·ÓÒ˜ ·fiÙÔÎÔ˜ ÙÔ˘ ıÚÔÌ‚ˆÙÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, Ô˘ ›¯Â ˘ÔÛÙ› ÛÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ . ™Â ËÏÈΛ· 12 ÂÙÒÓ, ‰È·ÈÛÙÒıËΠÁÈ· ÚÒÙË ÊÔÚ¿ „ËÏ·ÊËÙ‹ ÂÒ‰˘ÓË Ì¿˙· ÛÙÔÓ ·˘¯¤Ó·. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜ ·ÔÎ¿Ï˘„ ¤Ó· ÌÂÁ¿ÏÔ Î·È ·ÚÎÂÙ¿ ÌÈÎÚfiÙÂÚ· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÛÙËÓ ·˘¯ÂÓÈ΋ ÂÚÈÔ¯‹ (∂ÈÎfiÓ· 3), ÂÓÒ Ë Â·Ó·ÏËÙÈ΋ MRI ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó ¯ˆÚ›˜ Ô˘ÛÈ·ÛÙÈ΋ ÌÂÙ·‚ÔÏ‹. ™Â ËÏÈΛ· 13 ÂÙÒÓ, ÂÂȉ‹ Û˘Ó¤¯È˙ ӷ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¤˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ÚÔԉ¢ÙÈο ÂȉÂÈÓÔ‡ÌÂÓ˜, ¤ÁÈÓÂ Î·È ‰Â‡ÙÂÚË Â·Ó·ÏËÙÈ΋ MRI ÂÁÎÂÊ¿ÏÔ˘, fiÔ˘ ‰È·ÈÛÙÒıËÎ·Ó ÔÈ ›‰È˜ ‚Ï¿‚˜ Ù˘ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ (∂ÈÎfiÓ· 4), ηıÒ˜ Î·È ‹È· ·ÙÚÔÊ›· ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛΤÏÔ˘˜ Î·È ÙÔ˘ ·ÓÙ›ÛÙÔÈ¯Ô˘ ËÌÈÛÊ·ÈÚ›Ô˘ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ Ì·ÎÚfi¯ÚÔÓ˘ ·Ú·ÎÔÏÔ‡ıËÛ‹˜ ÙÔ˘, ÂÈÛ‹¯ıË ÔÏϤ˜ ÊÔÚ¤˜ Û ÓÔÛÔÎÔÌÂ›Ô ÂÍ·ÈÙ›·˜ ÛÔ‚·ÚÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÔÈ Ôԛ˜ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ·ÔÙÂÏÂÛÌ·ÙÈο. √È ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ, Û˘Ó¯›˙Ô˘Ó Ó· ‰Â›¯ÓÔ˘Ó ÛÙ·ıÂÚ‹ Î·È ÂÌ̤ÓÔ˘Û· ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·, ηıÒ˜ Î·È ÛÙ·ıÂÚ‹ ÌÈÎÚÔÛÎÔÈ΋ ·Ô‚ÔÏ‹ ·›Ì·ÙÔ˜ ÛÙ· ÎfiÚ·Ó·. ÃÚÂÈ¿ÛÙËΠӷ ÌÂÙ·ÁÁÈÛÙ› 3 ÊÔÚ¤˜ Î·È Û˘Ó¯›˙ÂÙ·È Ë ¯ÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘ Î·È Ë Û˘ÌÏËڈ̷ÙÈ΋ ‰È·ÙÚÔÊ‹. ∆¤ÏÔ˜, ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ì ٷÎÙÈÎfi ÎÏÈÓÈÎfi Î·È ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô.

™˘˙‹ÙËÛË To µRBNS ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÁÁÂȷΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ¿ÏÏˆÓ ÔÚÁ¿ÓˆÓ. ∂›Ó·È ÌÈ· Û¿ÓÈ· ÔÓÙfiÙËÙ·, ·ÊÔ‡ ·fi ÙËÓ ·Ú¯È΋ ÂÚÈÁÚ·Ê‹ ÙÔ˘ ÙÔ 1958 (2), ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÏÈÁfiÙÂÚ˜ ·fi 200 ÂÚÈÙÒÛÂȘ, ΢ڛˆ˜ ۠ϢÎÔ‡˜ Î·È π¿ˆÓ˜, ÂÓÒ ÌfiÓÔÓ ÙÚÂȘ ·ÛıÂÓ›˜ ·Ó‹ÎÔ˘Ó ÛÙË Ì·‡ÚË Ê˘Ï‹. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰È·ÈÛÙÒÓÔÓÙ·È Î·Ù¿ ÙË Á¤ÓÓËÛË ‹ ÛÙ· ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, ÂÓÒ Û˘¯Ó¿ ÔÈ ‚Ï¿‚˜ Â›Ó·È ·ÚÔ‡Û˜ Î·È ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ˙ˆ‹. ∂Ï¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ ‰È·ÁÓÒÛÙËÎ·Ó ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (3). ∆Ô Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÂÙ·È Î·È ÛÙ· ‰‡Ô ʇϷ. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È ÛÔÚ·‰ÈΤ˜, ·Ó

∂ÈÎfiÓ· 3. MRI ·˘¯ÂÓÈ΋˜ ÌÔ›Ú·˜: ·ÈÌ·ÁÁÂÈÒÌ·Ù· ·˘¯ÂÓÈ΋˜ ÂÚÈÔ¯‹˜.

∂ÈÎfiÓ· 4. MRI ÂÁÎÂÊ¿ÏÔ˘: ÂÎÙÂٷ̤ÓË ‚Ï¿‚Ë Ì·ÎÚÔ΢ÛÙÈ΋˜ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ.

Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Î¿ÔȘ Ô˘ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Ì ÙÔÓ ·˘Ùoۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÔÊÂÈÏfiÌÂÓ˜ Û ÁÔÓ›‰ÈÔ Ô˘ ‰ڿ˙ÂÙ·È ¶·È‰È·ÙÚÈ΋ 2007;70:325-329

Pediatri July-Aug 07

09-07-07

17:09

™ÂÏ›‰·328

328

ª. ∆˙Ô‡ÊË Î·È Û˘Ó.

ÛÙÔ 9p ¯ÚˆÌfiۈ̷ (4). ¡ÂfiÙÂÚ· ‰Â‰Ô̤ӷ ‰›ÓÔ˘Ó ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔÓ ÙÚfiÔ ÁÂÓÂÙÈ΋˜ ÌÂÙ·‚›‚·Û˘ ·˘ÙÒÓ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ (5). ∆· Â˘Ú‹Ì·Ù· ÛÙÔ BRBNS ‰È·ÎÚ›ÓÔÓÙ·È Û ‰ÂÚÌ·ÙÈΤ˜ Î·È Â͈‰ÂÚÌ·ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. √È ‰ÂÚÌ·ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È Û˘Ó‹ıˆ˜ ÔÏÏ·Ϥ˜ Î·È ‰È·Ê¤ÚÔ˘Ó Û ̤ÁÂıÔ˜, ·fi Ï›Á· ¯ÈÏÈÔÛÙ¿ ̤¯ÚÈ ·ÚÎÂÙ¿ ÂηÙÔÛÙ¿ Û ‰È¿ÌÂÙÚÔ. ªÔÚ› Ó· Â›Ó·È Â˘·›ÛıËÙ˜ ÛÙËÓ „ËÏ¿ÊËÛË Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ˘ÂÚȉڈۛ·. ™·ÓÈfiٷٷ ·ÈÌÔÚÚ·ÁÔ‡Ó, ÂÎÙfi˜ ·Ó ÙÚ·˘Ì·ÙÈÛÙÔ‡Ó. ªÂ ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜ ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·ÛÈÒÓ . º·›ÓÂÙ·È fiÙÈ ÙÔ BRBNS ÂȉÂÈÓÒÓÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÌfiÓÔ Û·ÓÈfiٷٷ ‚ÂÏÙÈÒÓÂÙ·È, ÂÓÒ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È ÂÚÈÙÒÛÂȘ Â·ÓÂÌÊ¿ÓÈÛ˘ ÙˆÓ “·ÈÌ·ÁÂȈ̿وӔ ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË (3). Œ¯Ô˘Ó ·Ó·ÊÂÚı› ÙÚÂȘ Ù‡ÔÈ ·ÁÁÂÈ·ÎÒÓ ‰ÂÚÌ·ÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ: ·) Ê˘Û·Ï›‰Â˜ ÌÏÂ, ÂÏ·ÛÙÈΤ˜, ÁÂÌ¿Ù˜ Ì ·›Ì· (blue rubber bleb), Ì Ï›· ‹ Ú˘ÙȉˆÌ¤ÓË ÂÈÊ¿ÓÂÈ·, Ô˘ ˘Ô¯ˆÚÔ‡Ó Î·È Í·Ó·ÁÂÌ›˙Ô˘Ó ÁÚ‹ÁÔÚ·, fiÙ·Ó ·ÛÎËı› ›ÂÛË, ‚) ÌÂÁ¿Ï˜ ‰‡ÛÌÔÚʘ ÊÏ‚ÈΤ˜ ·ÓˆÌ·Ï›Â˜, Ô˘ ÌÔÚ› Ó· ȤÛÔ˘Ó ˙ˆÙÈο fiÚÁ·Ó· Î·È Á) ÌÏ ·ÓÒ̷Ϙ Ì¿˙˜. ∞Ó Î·È ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÔÔ˘‰‹ÔÙÂ, ÂÓÙÔ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙ· ¿Óˆ ¿ÎÚ·, ÙÔÓ ÎÔÚÌfi Î·È ÙÔ ÂÚ›ÓÂÔ. ∞ÈÌ·ÁÁÂÈÒÌ·Ù· ÛÙ· οو ¿ÎÚ· Â›Ó·È ·Û˘Ó‹ıÈÛÙ· ηÈ, fiÙ·Ó ˘¿Ú¯Ô˘Ó, Û˘Óԉ‡ÔÓÙ·È ·fi ·ÍÈÔÛËÌ›ˆÙ˜ ‰È·Ù·Ú·¯¤˜ (6). ∆· “·ÈÌ·ÁÁÂÈÒÌ·Ù·” ÛÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ (·fi ÙÔ ÛÙfiÌ· ˆ˜ ÙÔ ÔÚıfi, ÌÂ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË ÛÙÔ ÏÂÙfi ¤ÓÙÂÚÔ) ‰È·ÈÛÙÒÓÔÓÙ·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì BRBNS. øÛÙfiÛÔ, Ù· “·ÈÌ·ÁÁÂÈÒÌ·Ù·” ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· (ÂÊ˂›· ‹ Î·È ·ÚÁfiÙÂÚ·) Î·È fi¯È ·fi ÙË Á¤ÓÓËÛË, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ ‚Ï¿‚˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ™Â ·ÓÙ›ıÂÛË Ì ÙȘ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜, ÔÈ ÊÏ‚ÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ ·ÈÌÔÚÚ·ÁÔ‡Ó Û˘¯Ó¿. ªÔÚ› Ó· ˘ÔÛÙÔ‡Ó Ú‹ÍË ·˘ÙfiÌ·Ù· Î·È Ó· ÚÔηϤÛÔ˘Ó ÔÍ›· ÛÔ‚·Ú‹ ·ÈÌÔÚÚ·Á›· Î·È ı¿Ó·ÙÔ. ™˘Ó‹ıˆ˜ fï˜, Ë ·ÈÌÔÚÚ·Á›· Â›Ó·È ·ÚÁ‹, ÌÈÎÚ‹ Î·È ¯ÚfiÓÈ·, ¤¯ÔÓÙ·˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·. ∂Ó›ÔÙÂ, ÔÈ ÊÏ‚ÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡, ¢ı‡ÓÔÓÙ·È ÁÈ· ÂÈÏÔΤ˜ fiˆ˜ ÂÈÏÂfi, Û˘ÛÙÚÔÊ‹ ‹ ÂÁÎÔÏ·ÛÌfi (7). √ ·ÛıÂÓ‹˜ Ì·˜ ·ÔÙÂÏ› ·ÓÙÈÚÔÛˆ¢ÙÈ΋ ÂÚ›ÙˆÛË, ·ÊÔ‡ ·ÚÔ˘ÛÈ¿˙ÂÈ Ù˘ÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· Ì ıÂÙÈ΋ ªayer ÎÔÚ¿ÓˆÓ Î·È ÂÂÈÛfi‰ÈÔ ÂÁÎÔÏ·ÛÌÔ‡. √È ÔÚıÔ‰ÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘ÚÙÒÛÂȘ ÙˆÓ ÔÛÙÒÓ, ·ıÔÏÔÁÈο ηٿÁÌ·Ù·, ·ÚıÚÈΤ˜ ‚Ï¿‚˜ Î·È ˘ÂÚ·Ó¿Ù˘ÍË Paediatriki 2007;70:325-329

ÙˆÓ ÔÛÙÒÓ (6,8). √È ÔÛÙÈΤ˜ ‚Ï¿‚˜ ÚÔ·ÙÔ˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÛÎÔ‡ÌÂÓ˘ ›ÂÛ˘ ·fi ÙȘ ·Ú·Î›ÌÂÓ˜ ÊÏ‚ÈΤ˜ ‚Ï¿‚˜. µÏ¿‚˜ ÛÙËÓ ·Ú·Î›ÌÂÓË ÙˆÓ ÛÔÓ‰‡ÏˆÓ ÂÚÈÔ¯‹ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ›ÂÛË ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË Î·È Î·ı›˙ËÛË ÙˆÓ ÛÔÓ‰‡ÏˆÓ, ÂÓÒ Â›Ó·È Èı·Ófi Ó· ÂÎÙ›ÓÔÓÙ·È ÛÙ· ÌÂÛÔÛÔÓ‰‡ÏÈ· ‰È·ÛÙ‹Ì·Ù·, ÂËÚ¿˙ÔÓÙ·˜ ÙËÓ ÎÈÓËÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÈÛıËÙÈÎfiÙËÙ·. √ ·ÛıÂÓ‹˜ Ì·˜ ·ÚÔ˘Û›·˙ ·ıÔÏÔÁÈο ηٿÁÌ·Ù· ·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘, ·ÚıÚÈΤ˜ ‚Ï¿‚˜ (Û˘ÁÁÂÓ‹ ‰˘ÛÏ·Û›· ÈÛ¯›Ô˘) Î·È ›ÂÛË ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË, ÌÂ Û˘ÓÔ‰fi ·Ú·ÏËÁ›·. ™ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ˘¿Ú¯Ô˘Ó ¿ÏÏ· 14 ÂÚÈÛÙ·ÙÈο Ì ÙÔ Û‡Ó‰ÚÔÌÔ Î·È Û˘ÓÔ‰¤˜ ÔÚıo‰ÈΤ˜ ·ÓˆÌ·Ï›Â˜ (6,8). ÷ڷÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙÔ ‹·Ú, ÙÔÓ ÛÏ‹Ó·, ÙÔ ÂÚÈÙfiÓ·ÈÔ, ÙÔ˘˜ Ó‡ÌÔÓ˜, ÙËÓ ÙÚ·¯Â›·, ÙÔ˘˜ ÛÎÂÏÂÙÈÎÔ‡˜ ̇˜, Ù· Ì¿ÙÈ·, ÙË ¯ÔÏˉfi¯Ô ·ÛÙË, ÙÔ ¤Ô˜, ÙȘ ·ÚˆÙ›‰Â˜ Î·È ÙÔ ∫ÂÓÙÚÈÎfi ¡Â˘ÚÈÎfi ™‡ÛÙËÌ· (∫¡™) (3,7,8). ∞Ó Î·È ·ÚÎÂÙÔ› ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ÔÚÈṲ̂Ó˜ ·fi ÙȘ ‰È·ÁÓÒÛÂȘ ‰ÂÓ ‹Ù·Ó Û·Ê›˜. H ÚÒÙË ÙÂÎÌËÚȈ̤ÓË ÂÚÈÁÚ·Ê‹ ¤ÁÈÓ ÙÔ 1978 ·fi ÙÔ˘˜ Waybright et al (9), Û ·ÛıÂÓ‹ Ô˘ ·ÚÔ˘Û›·˙ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È Ó¢ÚÔÏÔÁÈο ÛËÌ›·, ÂÍ·ÈÙ›·˜ ıÚÔÌ‚ÒÛˆ˜ Ù˘ ÊϤ‚·˜ ÙÔ˘ °·ÏËÓÔ‡, ÂÓÒ Î·È ÔÏÏ¿ ¿ÏÏ· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ‹Ù·Ó Â›Û˘ ıÚÔÌ‚ˆÌ¤Ó·. ∆· ÂÛÙȷο Ó¢ÚÔÏÔÁÈο ÛËÌ›· Ê·›ÓÂÙ·È fiÙÈ ÔÊ›ÏÔÓÙ·È Û ıÚfiÌ‚ˆÛË ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·ÛÈÒÓ. √È ‰˘ÛϷۛ˜ ·˘Ù¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ıÚfiÌ‚ˆÛË ÏfiÁˆ ¯·ÌËÏ‹˜ ÚÔ‹˜ ·›Ì·ÙÔ˜, fiˆ˜ ·Ô‰ÂÈÎÓ‡ÂÙ·È ·fi ÙËÓ ÂÓ·fiıÂÛË ·ÈÌÔÛȉËÚ›Ó˘ ÛÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓÙ˜ ÈÛÙÔ‡˜ Î·È ÙËÓ ·Û‚ÂÛÙÔÔ›ËÛ‹ ÙÔ˘˜. ∂ÎÙfi˜ ·fi ÙȘ ÊÏ‚ÈΤ˜ ‰˘ÛϷۛ˜, Û ·ÛıÂÓ›˜ Ì BRBNS ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÔÓ‰˘ÏÈο ·ÈÌ·ÁÁÂÈÒÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó ›ÂÛË ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË, ÁÈÁ·ÓÙÈ·›Ô ÊÏ‚ÈÎfi ·ÁÁ›ˆÌ·, ¿ÓÔÈ· Û¯ÂÙÈ˙fiÌÂÓË Ì ÙË ¯ÚfiÓÈ· ÂÓ‰·ÁÁÂȷ΋ ‰È·ÛÔÚ¿ ıÚfiÌ‚ˆÓ, ÔÏÏ·Ï¿ ÂÁÎÂÊ·ÏÈο ·ÁÁÂȷο ¤ÌÊÚ·ÎÙ·, ηıÒ˜ Î·È ·ÚÙËÚÈÔÊÏ‚҉˜ Û˘Ú›ÁÁÈÔ (10). √È ·Ú·ÎÏÈÓÈΤ˜ ̤ıÔ‰ÔÈ Ô˘ ¯ÚËÛÈÌÂ‡Ô˘Ó ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ BRBNS Â›Ó·È ÂÍÂÙ¿ÛÂȘ ·›Ì·ÙÔ˜, ÁÂÓÈ΋ Ô‡ÚˆÓ (ÁÈ· ‡·ÚÍË ·ÈÌ·ÙÔ˘Ú›·˜), Mayer ÎÔÚ¿ÓˆÓ, ÂÓ‰ÔÛÎÔÈΤ˜ ̤ıÔ‰ÔÈ Î·È MRI ÂÁÎÂÊ¿ÏÔ˘, Ë ÔÔ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÂÏÂ˘Ù·›· ÁÈ· ÙËÓ ·Ó‡ÚÂÛË ·Û˘Ìو̷ÙÈÎÒÓ ·Û¯fiÓÙˆÓ, ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ (11). ∞ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·›· ÁÈ· ÙÔ˘˜ ¿Û¯ÔÓÙ˜ ·fi BRBNS ‰ÂÓ ˘¿Ú¯ÂÈ. ∏ ·Ó·ÈÌ›· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË Ûȉ‹ÚÔ˘ Î·È Ì ÌÂÙ·ÁÁ›ÛÂȘ. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ì¤ÁÂıÔ˜, ÙÔÓ ·ÚÈıÌfi, ÙËÓ ÂÓÙfiÈÛË Î·È Ù· Û˘ÌÙÒÌ·Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜. √È ÂÊ·ÚÌÔṲ̂Ó˜ ̤ıÔ‰ÔÈ ÁÈ· ıÂÚ·›·

Pediatri July-Aug 07

09-07-07

17:09

™ÂÏ›‰·329

329

™‡Ó‰ÚÔÌÔ Blue Rubber Bleb Nevus

Â›Ó·È ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÌÂÌÔÓˆÌ¤ÓˆÓ ‚Ï·‚ÒÓ, ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÎÙÔÌ‹ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‹ ÂȉÈΤ˜ ÂÓ‰ÔÛÎÔÈΤ˜ ıÂÚ·›˜ Ì Laser. √È ÔÚıÔ‰ÈΤ˜ ·ÓˆÌ·Ï›Â˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ‰ÈÔÚıˆÙÈΤ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ. ∞Ó ÔÈ ‚Ï¿‚˜ ÚÔηÏÔ‡Ó ÁÈÁ·ÓÙÈÛÌfi, Ô ·ÎÚˆÙËÚÈ·ÛÌfi˜ Â›Ó·È Èı·ÓfiÙÂÚ· Ë Î·Ï‡ÙÂÚË ıÂÚ·›· (6). ∏ ÚfiÁÓˆÛË ÔÈΛÏÂÈ Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÂÛˆÙÂÚÈÎÒÓ ÔÚÁ¿ÓˆÓ, ÂÓÒ Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™, fiÙ·Ó ˘¿Ú¯ÂÈ, Ô‰ËÁ› Û ̛· ¯ÚfiÓÈ·, ‚Ú·‰¤ˆ˜ ÂȉÂÈÓÔ‡ÌÂÓË ÔÚ›·, ÏfiÁˆ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ (11,12). √ ·ÛıÂÓ‹˜ Ô˘ ÂÚÈÁÚ¿„·Ì ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ, ÁÈ·Ù› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ÌfiÓÔ ‰‡Ô ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™, Ì ÚÒÙÔ Û‡Ìو̷ ÙËÓ ÂÌÊ¿ÓÈÛË ÂÛÙÈ·ÎÒÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÛÙË ÓÂÔÁÓÈ΋ Î·È ‚ÚÂÊÈ΋ ËÏÈΛ·, Ì ηϋ ‹ ÌÂÚÈ΋ ·ÓÙ·fiÎÚÈÛË ÛÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Î·È ·Ó·Ù˘Íȷ΋ ÂÈ‚Ú¿‰˘ÓÛË (11,12). ∂›Û˘, ÚÔ¯ˆÚÒÓÙ·˜ Û ·Ó·ÛÎfiËÛË Ù˘ ‰È·ı¤ÛÈÌ˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏË Î·Ù·ÁÂÁÚ·Ì̤ÓË ÂÚ›ÙˆÛË ·È‰ÈÔ‡ Ì BRBN Û‡Ó‰ÚÔÌÔ, Ì ٷ˘Ùfi¯ÚÔÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™, ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ Î·È ÙÔ˘ ÂÚÂÈÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

BÈ‚ÏÈÔÁÚ·Ê›· 1. Gascoyen CG. Case of nevus involving the parotid gland and causing death frouffocation: nevi of viscera. Trans Path Soc Lond 1860;11:267.

2. Bean WB. Blue rubber bleb naevi of the skin and gastrointestinal tract. In: Thomas CC, editor. Vascular spiders and related lesions of the skin. Spring-field, IL: Charles Thomas, 1958:178-185.

3. ¡ahmWK, Moise S, Eichenfield LF, Paller AS, Nathanson L, Malicki D, et al. Venous malformations in blue rubber bleb nevus syndrome: variable onset of presentation. J Am Acad Dermatol. 2004;50 (Suppl 5):S101-106.

4. Gallione CJ, Pasyk KA, Boon LM, Lennon F, Johnson DW, Helmbold EA et al. A gene for familial venous malformations maps to chromosome 9 in a second large kindred. J Med Genet 1995;32:197-199.

5. Chen DH, Lipe HP, Qin Z, Bird TD. Cerebral cavernous malformation: novel mutation in a Chinese family an evidence for heterogeneity. J Neurol Sci 2002;196:91-96.

6. ªcCarthy JC, Goldberg MJ, Zimbler S. Orthopaedic dysfunction in blue rubber-bleb nevus syndrome. J Bone Joint Surg Am 1982;64:280-283.

7. Dobru D, Seuchea N, Dorin M, Careianu V. Blue rubber bleb nevus syndrome: case report and literature review.

Rom J Gastroenterol 2004;13:237-240.

8. Kassarjian A, Fishman SJ, Fox VL, Burrows PE. Imaging characteristics of blue rubber bleb nevus syndrome. Am J Roentgenol 2003;181:1041-1048.

9. Waybright EA, Selhorst JB, Rosenblum WI, Suter CG. Blue rubber bleb nevus syndrome with CNS involvement and thrombosis of a vein of galen malformation. Ann Neurol 1978;3:464-467.

10. Carvalho S, Barbosa V, Santos N, Machado E. Blue rubber-bleb nevus syndrome: report of a familiar case with a dural arteriovenous fistula. Am J Neuroradiol 2003;24: 1916-1918.

11. Kim SJ. Blue rubber bleb nevus syndrome with central nervous system involvement. Pediatric Neurol 2000;22: 410-412.

12. Eiris-Punal J, Picon-Cotos M, Viso-Lorenzo A, CastroGago M. Epileptic disorder as the first neurologic manifestation of blue rubber bleb nevus syndrome. J Child Neurol 2002;17:219-222.

¶·È‰È·ÙÚÈ΋ 2007;70:325-329

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¶ƒ∞∫∆π∫√ £∂ª∞

PRACTICAL ISSUE

∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· ÛÙ· ·È‰È¿ - ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

∆. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘ - ∫¿ÎÔ˘ÚÔ˘

AÏÏËÏÔÁÚ·Ê›·: ∆¿ÏÈ· ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘ kakst@otenet.gr ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘, ∆.∫. 115 27, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë: ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· (∞¢) ‰ÂÓ ÛÙËÚ›˙ÂÙ·È ÌfiÓÔ ÛÙË ÁÓÒÛË, ·ÏÏ¿ Î·È ÛÙËÓ Ù¤¯ÓË ÙÔ˘ ¯ÂÈÚÈÛÌÔ‡ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ‰¤ÚÌ·ÙÔ˜. ª›· ·fi ÙȘ ÛÔ˘‰·ÈfiÙÂÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ Ì ∞¢ Â›Ó·È Ë ÂÎ·›‰Â˘ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, fiÛÔÓ ·ÊÔÚ¿ ÙË Ê‡ÛË Î·È ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÙËÓ ·ÔÊ˘Á‹ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÙË ÛˆÛÙ‹ ÂÓ˘‰¿ÙˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙËÓ ÂȉÈ΋ ıÂÚ·›·. ∏ Û˘˙‹ÙËÛË Ì ÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙÔÓ ÙÚfiÔ ‰Ú¿Û˘, ÙË Ì¤ıÔ‰Ô ÂÊ·ÚÌÔÁ‹˜ Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ÙÔÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ï‡ÙÂÚË Û˘ÌÌfiÚʈÛË Î·È ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÓfiÛÔ˘. ∏ ‰È·Ù‹ÚËÛË ·Î¤Ú·ÈÔ˘ ÂȉÂÚÌȉÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ∞¢, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÍËÚÔ‰ÂÚÌ›· ÂÈÙÚ¤ÂÈ ÙËÓ Â›ÛÔ‰Ô ÂÚÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙÔ ‰¤ÚÌ· Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÊÏÂÁÌÔÓ‹˜ Î·È ÙËÓ ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘. ∆· ÙÔÈο ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ·ÔÙÂÏÔ‡Ó ıÂÚ·›· ÚÒÙ˘ ÁÚ·ÌÌ‹˜. ŸÙ·Ó ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛˆÛÙ¿, ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ë Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜, Ù·¯˘Ê˘Ï·Í›·˜ Î·È ÂÌÊ¿ÓÈÛ˘ ¿ÏÏˆÓ ÙÔÈÎÒÓ Î·È Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÚÂÓÂÚÁÂÈÒÓ. √È ÙÔÈÎÔ› ·Ó·ÛÙÔÏ›˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘ ÂӉ›ÎÓ˘ÓÙ·È ÁÈ· ·È‰È¿ Ì ̤ÙÚÈ· ‹ ÛÔ‚·Ú‹ ∞¢. ™Â ÛÔ‚·Ú‹ ¤Í·ÚÛË Ù˘ ∞¢ Û˘ÓÈÛÙÒÓÙ·È ÙÔÈο ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È fiÙ·Ó ˘¿ÚÍÂÈ ‚ÂÏÙ›ˆÛË ÂÊ·ÚÌfi˙ÂÙ·È ÙÔÈÎfi˜ ·Ó·ÛÙÔϤ·˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘ ̯ÚÈ ÙËÓ Ï‹ÚË ‡ÊÂÛË ÙˆÓ Û˘Ìو̿وÓ. ™Â ÂÚ›ÙˆÛË ˘ÔÙÚÔ‹˜ ÂÊ·ÚÌfi˙ÂÙ·È ¿ÌÂÛ· ÙÔÈÎfi˜ ·Ó·ÛÙÔϤ·˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘. ŒÙÛÈ, Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙȘ Ê¿ÛÂȘ ¤ÓÙÔÓ˘ ¤Í·ÚÛ˘ Ù˘ ∞¢. ∆· ·ÓÙÈ˚ÛÙ·ÌÈÓÈο ¯ÔÚËÁÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈο ÁÈ· ÙËÓ ·ÓÙÈÎÓËÛÌÒ‰Ë Î·È ËÚÂÌÈÛÙÈ΋ ÙÔ˘˜ ‰Ú¿ÛË. ∏ ¯Ú‹ÛË ÙÔÈÎÔ‡ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ ¤¯ÂÈ ÛÙfi¯Ô ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎÔ‡ ÊÔÚÙ›Ô˘ ‹ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢.

§¤ÍÂȘ ÎÏÂȉȿ: ∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·, ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ÙÔÈÎÔ› ·Ó·ÛÙÔÏ›˜ ηÏÛÈÓ¢ڛÓ˘, ·ÓÙÈ˚ÛÙ·ÌÈÓÈο, ·ÓÙÈ‚ÈÔÙÈο.

Therapeutic management of childhood atopic dermatitis First Paediatric Department of the University of Athens, Greece Correspondence: Talia Kakourou kakst@otenet.gr First Department of Paediatrics of the University of Athens “Aghia Sofia” Children’s Hospital Thivon & Papadiamantopoulou St. 115 27, Athens, Greece

T. Kakourou Abstract: The management of children with Atopic Dermatitis (AD) is as much based on knowledge, as it is an art form. One of the most important aspects in the management of AD is education of the patient and his/her family regarding the nature and course of the disease, the avoidance of trigger factors, the proper hydration of the skin and the specific treatment. Explanation and discussion with the patient and the parents about the mode of action, the methods of application and the safety of topical preparations may achieve higher compliance and better control of the disease. The maintenance of an intact skin barrier is particularly important because xerosis allows the entry of antigens, which causes irritation of the skin and disease exacerbations. Topical corticosteroids (TCS) are first-line treatment for AD and when used properly, they minimize the possibility of rebound, tachyphylaxis, as well as topical and systemic side effects. Topical Calcineurin Inhibitors (TCI) are reserved for children with moderate and severe AD providing effective long-term disease control. It is suggested that a major flare should be managed with TCS and, when the inflammation subsides, TCI should be applied until the skin becomes clear. If the first sign reoccurs, TCI therapy should be restarted. Antihistamines are used for their sedative and antipruritic action and anti-infectious agents are used in order to reduce the staphylococcal burden or to treat an infection.

Key words: Atopic dermatitis, corticosteroids, topical calcineurin inhibitors, antihistamines, antibiotics.

∂ÈÛ·ÁˆÁ‹ ∏ Â›ÙˆÛË Ù˘ ·ÙÔÈ΋˜ ‰ÂÚÌ·Ù›Ùȉ·˜ (∞¢) Û ·È‰È¿ ÛÙËÓ ∂˘ÚÒË Â›Ó·È ÂÚ›Ô˘ 15% (1). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ È·ÙÚÈÎÒÓ ÂÈÛΤ„ÂˆÓ ÁÈ· ∞¢ Û ·È‰Ô‰ÂÚÌ·ÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô Î·Ù¿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜ Â›Ó·È 25,2% (ÚÔÛˆÈ΋ ÂÌÂÈÚ›·). ∂›Û˘, ÁÈ·ÙÚÔ› ¿ÏÏˆÓ ÂȉÈÎÔÙ‹Paediatriki 2007;70:330-335

ÙˆÓ, fiˆ˜ ·È‰›·ÙÚÔÈ, ‰ÂÚÌ·ÙÔÏfiÁÔÈ, ·ÏÏÂÚÁÈÔÏfiÁÔÈ, ÂÍÂÙ¿˙Ô˘Ó Î·ıËÌÂÚÈÓ¿ ·È‰È¿ Ì ∞¢ Î·È ¤ÙÛÈ ÂӉȷʤÚÔÓÙ·È ÁÈ· ÙË ÓfiÛÔ (2). ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞¢, fiˆ˜ Î·È Î¿ı ‰ÂÚÌ·ÙÔÏÔÁÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜, ‰ÂÓ ÛÙËÚ›˙ÂÙ·È ÌfiÓÔ ÛÙË ÁÓÒÛË ·ÏÏ¿ ÂÍ›ÛÔ˘ Î·È ÛÙËÓ Ù¤¯ÓË ÙÔ˘ ¯ÂÈÚÈÛÌÔ‡ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ‰¤ÚÌ·ÙÔ˜. ŒÙÛÈ, ÛÙËÓ ·ÚÔ‡Û·

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∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· – ıÂÚ·›·

ÂÈÛ‹ÁËÛË, Ë Û˘ÁÁڷʤ·˜ ‰ÂÓ ı· ·ÚÔ˘ÛÈ¿ÛÂÈ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ∞¢, ·ÏÏ¿ ÙȘ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ‰È΋ Ù˘ “Ù¤¯ÓË”, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ∂Î·›‰Â˘ÛË ª›· ·fi ÙȘ ÛÔ˘‰·ÈfiÙÂÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ Ì ∞¢ Â›Ó·È Ë ÂÎ·›‰Â˘ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, fiÛÔÓ ·ÊÔÚ¿ ÙË Ê‡ÛË Î·È ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÙËÓ ·ÔÊ˘Á‹ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ÙË ÛˆÛÙ‹ ÂÓ˘‰¿ÙˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙËÓ ÂȉÈ΋ ıÂÚ·›·. ŒÙÛÈ, ÛÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ‰›ÓÂÙ·È fiÛÔ˜ ¯ÚfiÓÔ˜ ¯ÚÂÈ¿˙ÂÙ·È ÁÈ· Ó· ηٷÓÔ‹ÛÔ˘Ó ÔÈ ÁÔÓ›˜ Î·È ÙÔ ·È‰› fiÙÈ Ë ÚԉȿıÂÛË ÁÈ· ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· ‚Ú›ÛÎÂÙ·È ÛÙ· ÁÔÓ›‰È¿ Ì·˜, fiÙÈ Ë ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·Ô ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, fiÙÈ ÔÈΛÏÔÈ ·Ú¿ÁÔÓÙ˜ (.¯. ·Î·Ù¿ÏÏËÏÔ ÓÙ‡ÛÈÌÔ, ÌÈÎÚfi‚È·, „˘¯ÔÏÔÁÈÎfi ÛÙÚ˜) Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ¤Ó·ÚÍË Î·È ÔÚ›· Ù˘ ÓfiÛÔ˘ Î·È fiÙÈ ÙÂÏÈο ¢ÂÏÈÛÙԇ̠fiÙÈ ÙÔ ·È‰› ÌÂÁ·ÏÒÓÔÓÙ·˜ ı· ··ÏÏ·Á› ·fi ÙÔ Úfi‚ÏËÌ¿ ÙÔ˘. ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÔÈ ÁÔÓ›˜ Ó· ÌËÓ ·ÈÛı¿ÓÔÓÙ·È ¤ÓÔ¯ÔÈ, ÂÂȉ‹ ÙÔ ·È‰› ÙÔ˘˜ ¿Û¯ÂÈ ·fi ∞¢. ¶ÚÔÏËÙÈο ̤ÙÚ· ∆o ˙ÂÛÙfi ÓÂÚfi ÚÔηÏ› ˘ÂÚ·ÈÌ›· Î·È ÂȉÂÈÓÒÓÂÈ ÙÔ ¤Î˙ÂÌ·, ÁÈ’ ·˘Ùfi ÙÔ ÓÂÚfi ÙÔ˘ Ì¿ÓÈÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ¯ÏÈ·Úfi (33-34oC). ∂›Û˘, ÙÔ ÎÔÈÓfi Û·Ô‡ÓÈ ÂȉÂÈÓÒÓÂÈ ÙÔ ‹‰Ë ÍËÚfi ‰¤ÚÌ· ÙÔ˘ ·ÙÔÈÎÔ‡ ·È‰ÈÔ‡, ÁÈ’ ·˘Ùfi Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˘ÔηٿÛÙ·ÙÔ Û·Ô˘ÓÈÔ‡ ‹ ÂȉÈÎfi Ï¿‰È (bath oil) ÛÙÔ ÓÂÚfi ÙÔ˘ Ì¿ÓÈÔ˘. ∆Ô ‰¤ÚÌ· ı· Ú¤ÂÈ Ó· ÛÎÔ˘›˙ÂÙ·È Ù·ÌÔÓ·ÚÈÛÙ¿ Î·È fi¯È Ì ÙÚ›„ÈÌÔ, ÙÔ Ì¿ÓÈÔ ÙÔ˘ ·È‰ÈÔ‡ Ó· Â›Ó·È Î·ıËÌÂÚÈÓfi Î·È ÔÈ Ì·Ï·ÎÙÈΤ˜ Ô˘Û›Â˜ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È ÙfiÛÔ Û˘¯Ó¿, ÒÛÙ ÙÔ ‰¤ÚÌ· ÙÔ˘ ·È‰ÈÔ‡ Ó· ‰È·ÙËÚÂ›Ù·È “‚ÂÏÔ‡‰ÈÓÔ”. ∂›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È Û ӈfi ‰¤ÚÌ·, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ Ì¿ÓÈÔ, ÁÈ· ηχÙÂÚÔ ·ÔÙ¤ÏÂÛÌ·. √È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂȉÂÚÌȉÈÎÔ‡ ÊÚ·ÁÌÔ‡ ÙÔ˘ ·ÙÔÈÎÔ‡ ‰¤ÚÌ·ÙÔ˜ ÂÈÙÚ¤Ô˘Ó ÙË ‰È·‰ÂÚÌÈ΋ ·ÒÏÂÈ· ÓÂÚÔ‡ Ô˘ Ô‰ËÁ› Û ÍËÚfiÙËÙ· ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ·Ú¿ÏÏËÏ· fï˜ ÂÈÙÚ¤Ô˘Ó Î·È ÙËÓ Â›ÛÔ‰Ô ÂÚÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ ·Ô ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÛÙÔ ‰¤ÚÌ· Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÊÏÂÁÌÔÓ‹˜. ∂Ô̤ӈ˜, Ë ‰ÈfiÚıˆÛË ÙÔ˘ ÂȉÂÚÌȉÈÎÔ‡ ÊÚ·ÁÌÔ‡ ·ÔÙÂÏ› ‚·ÛÈÎfi ̤ÙÚÔ ÚfiÏ˄˘ ÙÔ˘ ÂÎ˙¤Ì·ÙÔ˜ (∂ÈÎfiÓ· 1). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÁÈ· ÛˆÛÙ‹ ÂÓ˘‰¿ÙˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ÂÓfi˜ ÌÈÎÚÔ‡ ·È‰ÈÔ‡ ··ÈÙÔ‡ÓÙ·È 150-200 g Ì·Ï·ÎÙÈ΋˜ Ô˘Û›·˜ ‚‰ÔÌ·‰È·›ˆ˜, ÂÓÒ ÁÈ· ÂÓ‹ÏÈη 500 g. ¢˘ÛÙ˘¯Ò˜, Ù· ˘ÔηٿÛٷٷ Û·Ô˘ÓÈÔ‡ Î·È Ù· Ì·Ï·ÎÙÈο Û΢¿ÛÌ·Ù· ‰ÂÓ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È ·fi Ù· Ù·Ì›· Î·È Â›Ó·È ·ÚÎÂÙ¿ ‰··ÓËÚ¿. ŒÙÛÈ,

ÚÔÙ›ÓÂÙ·È Ó· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡ÓÙ·È 2-3 ˘ÔηٿÛٷٷ Û·Ô˘ÓÈÔ‡, bath oils Î·È Ì·Ï·ÎÙÈΤ˜ Îڤ̘/ ·ÏÔÈʤ˜, ÒÛÙ ÔÈ ÁÔÓ›˜ Î·È ÙÔ ·È‰› Ó· ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÈϤÍÔ˘Ó ÙÔ ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi, ÎÔÛÌËÙÈο ·Ô‰ÂÎÙfi Î·È ÔÈÎÔÓÔÌÈο Û‡ÌÊÔÚÔ Û¯‹Ì· ÂÚÈÔ›ËÛ˘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ∆· Ó‡¯È· Ú¤ÂÈ Ó· Îfi‚ÔÓÙ·È Û˘¯Ó¿, Ù· ÚÔ‡¯· Ó· Â›Ó·È ‚·Ì‚·ÎÂÚ¿, ¯·Ï·Ú¿ Î·È ¿ÓÂÙ· Î·È Ù· ÎÏÈÓÔÛÎÂ¿ÛÌ·Ù· Ó· Â›Ó·È Â›Û˘ ‚·Ì‚·ÎÂÚ¿ Î·È Ó· ϤÓÔÓÙ·È Û ıÂÚÌÔÎÚ·Û›· >55ÔC ·Ó¿ ‚‰ÔÌ¿‰·. ¡· ÚÔÙÈÌÔ‡ÓÙ·È ·ÔÚÚ˘·ÓÙÈο Û ˘ÁÚ‹ ÌÔÚÊ‹ Î·È Ó· ·ÔʇÁÂÙ·È ÙÔ Ì·Ï·ÎÙÈÎfi, ÁÈ·Ù› ·Ú·Ì¤ÓÂÈ ÛÙȘ ›Ó˜ ÙˆÓ ÚÔ‡¯ˆÓ Î·È ÌÔÚ› Ó· ÂÚÂı›ÛÂÈ ÙÔ ‰¤ÚÌ·. ∏ ¤ÎıÂÛË Û ÔÈÎȷ΋ ÛÎfiÓË, Á‡ÚË, ÙÚ›¯ˆÌ· ˙ÒˆÓ Î·È Î·Ófi Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È. ŒÙÛÈ, ÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·ÙÔÈÎÔ‡ ·È‰ÈÔ‡ Ú¤ÂÈ Ó· Â›Ó·È ÏÈÙfi ¯ˆÚ›˜ ÌÈÎÚÔ·ÓÙÈΛÌÂÓ· Ô˘ ‰ÂÓ ϤÓÔÓÙ·È ‹ ¯·ÏÈ¿ Ì ·¯‡ ¤ÏÔ˜. ∆Ô ¿ÙˆÌ· Ú¤ÂÈ Ó· ÛÎÔ˘›˙ÂÙ·È Ì ËÏÂÎÙÚÈ΋ ÛÎÔ‡· ηıËÌÂÚÈÓ¿ Î·È Ù· ¤ÈÏ· Ó· ÍÂÛÎÔÓ›˙ÔÓÙ·È Ì ‚ÚÂÁÌÂÓÔ ·Ó› ‰‡Ô ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, Ù· ·È¯Ó›‰È· Ó· ϤÓÔÓÙ·È Î¿ı 10 Ë̤Ú˜, ÂÓÒ Ù· ÏÔ˘ÏÔ‡‰È· ÛÙÔÓ ÂÛˆÙÂÚÈÎfi ¯ÒÚÔ ÙÔ˘ ÛÈÙÈÔ‡ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ·ÔʇÁÔÓÙ·È, fiˆ˜ Î·È Ë Â·Ê‹ Ì ÙÚȯˆÙ¿ ηÙÔÈΛ‰È· ˙Ò·, Ì ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ ÙÔ ÙÂÏÂ˘Ù·›Ô ‰ÂÓ ÂËÚ¿˙ÂÈ Û˘Ó·ÈÛıËÌ·ÙÈο ÙÔ ·È‰›. ∏ ıÂÚÌÔÎÚ·Û›· ÛÙÔ Û›ÙÈ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÔ˘˜ 18ÔC, ÂÓÒ ı· Ú¤ÂÈ Ó· ˘¿Ú¯ÂÈ Ì¤ÙÚÈ· ˘ÁÚ·Û›·. ∆Ô ÙÂÏÂ˘Ù·›Ô ÂÍ·ÛÊ·Ï›˙ÂÙ·È Â¿Ó ˘¿Ú¯ÂÈ ÌÒÏ Ì ÓÂÚfi ÛÙÔ ‰ˆÌ¿ÙÈÔ. √ ÌËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Û˘ÓÈÛÙ¿Ù·È ÙÔ˘Ï¿¯ÈÛÙÔ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ, Ì ÙȘ ÛÙÂÚ¤˜ ÙÚÔʤ˜ Ó· ÂÈÛ¿ÁÔÓÙ·È ÚÔԉ¢ÙÈο ·Ô ÙÔÓ 7Ô Ì‹Ó· (Ì›· ηÈÓÔ‡ÚÁÈ· ÙÚÔÊ‹ ·Ó¿ ‚‰ÔÌ¿‰·), ÒÛÙ ӷ Á›ÓÂÙ·È ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Ù˘¯fiÓ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜. ∂ÎÙfi˜ ·fi Ù· Û˘ÓÙËÚËÙÈο Î·È ÙȘ ¯ÚˆÛÙÈΤ˜ Ô˘ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È, Ù· ·È‰È¿ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂχıÂÚÔ ‰È·ÈÙÔÏfiÁÈÔ. ¢È·ÈÙËÙÈÎÔ› ¯ÂÈÚÈÛÌÔ› ‹/Î·È ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÂӉ›ÎÓ˘ÓÙ·È fiÙ·Ó ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ı¤ÙÂÈ ÈÛ¯˘Ú¤˜ ˘Ô„›Â˜ ÁÈ· ·ÏÏÂÚÁ›· ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ÙÚÔÊ‹ ‹ fiÙ·Ó ÙÔ ¤Î˙ÂÌ· ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. ∆Ô ÂÌ‚fiÏÈÔ Ù˘ ÈÏ·Ú¿˜ Â›Ó·È ·ÛʷϤ˜ Û ÂÚÈÙÒÛÂȘ ·ÏÏÂÚÁ›·˜ ÛÙÔ ·˘Áfi (3).

£ÂÚ·›· ∆ÔÈο ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ √È ÁÔÓ›˜ ‰È‰¿ÛÎÔÓÙ·È fiÙÈ ·) ÛÙË ‰ÂÚÌ·ÙÔÏÔÁ›· ÈÛ¯‡ÂÈ ÙÔ ·Í›ˆÌ· “˘ÁÚfi ÛÙÔ ˘ÁÚfi Î·È ÍËÚfi ÛÙÔ ÍËÚfi” Î·È fiÙÈ ‚) Ë Ï¤ÍË ¤Î˙ÂÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ Ú‹Ì· ˙¤ˆ (‚Ú¿˙ˆ). ∂Ô̤ӈ˜ ÂÎ˙ÂÌ·ÙÈΤ˜ ‚Ï¿‚˜ Ô˘ Â›Ó·È ˘ÁÚ¤˜ Î·È ÔÚÔÚÚÔÔ‡Ó ÌÔÚ› Ó· ˘Ô‰ËÏÒÓÔ˘Ó ·Ï¿ ¤Î˙ÂÌ· ÛÙËÓ ÔÍ›· ÙÔ˘ Ê¿ÛË, ·ÏÏ¿ Î·È ÂΉ‹ÏˆÛË Ïԛ̈͢. ŒÙÛÈ, ¶·È‰È·ÙÚÈ΋ 2007;70:330-335

Pediatri July-Aug 07

09-07-07

17:09

™ÂÏ›‰·332

332

∆. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘

∞) √È ‚Ï¿‚˜ Ô˘ Â›Ó·È ˘ÁÚ¤˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ·Ú¯Èο Ì ÂÈı¤Ì·Ù· ‹ „ÂηÛÌÔ‡˜ Ì NaCl 0,9%, ̤¯ÚȘ fiÙÔ˘ ÙÔ ‰¤ÚÌ· ÛÙ·Ì·Ù‹ÛÂÈ Ó· ÔÚÔÚÚÔ›. ∞˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È Û 1-3 24ˆÚ·. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÊ·ÚÌfi˙ÂÙ·È ÙÔÈÎfi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ¤˜ (‹È·˜ ÈÛ¯‡Ô˜ Û ÚfiÛˆÔ Î·È ÁÂÓÓËÙÈο fiÚÁ·Ó· ÁÈ· ‚Ú¤ÊË ¤ˆ˜ ¤ÍÈ ÌËÓÒÓ, ̤ÙÚÈ·˜ ÈÛ¯‡Ô˜ ÁÈ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿) Û ۯ‹Ì· ÚÔԉ¢ÙÈ΋˜ Ì›ˆÛ˘. °È· ·Ú¿‰ÂÈÁÌ·, ÂÊ·ÚÌfi˙ÂÙ·È ˘‰ÚÔÎÔÚÙÈ˙fiÓË 1% ÙÚÂȘ ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ (Úˆ› - ÌÂÛË̤ÚÈ - ‚Ú¿‰˘) ̤¯ÚÈ Ó· ˘¿ÚÍÂÈ ‚ÂÏÙ›ˆÛË (ÏÈÁfiÙÂÚÔ ÂÚ‡ıËÌ· Î·È ÎÓËÛÌfi˜), .¯. ÁÈ· 3 Ë̤Ú˜. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÊ·ÚÌfi˙ÂÙ·È ‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ (Úˆ›-‚Ú¿‰˘) ÁÈ· 3 Ë̤Ú˜, Î·È Ì›· ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜ (Úˆ›) ÁÈ· ¿ÏϘ 3 Ë̤Ú˜. ∞ÎfiÌË Î·È Û‹ÌÂÚ·, Ì ÙËÓ Î·ÈÓÔ‡ÚÁÈ· ÁÂÓÈ¿ ÙˆÓ ÙÔÈÎÒÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ (.¯. fluticasone propionate, mometasone furoate) Ô˘ ¤¯Ô˘Ó Ì·ÎÚ‡ ¯ÚfiÓÔ ‰Ú¿Û˘ (·ÚΛ Ë Â¿ÏÂÈ„Ë Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ) Î·È ÏÈÁfiÙÂÚ˜ ·ÚÂÓ¤ÚÁÂȘ (ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·ıËÌÂÚÈÓ¿ ÁÈ· ¤Ó·Ó Ì‹Ó· Ì ·ÛÊ¿ÏÂÈ·) (4,5), Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ ÙÔ Û¯‹Ì· ÚÔԉ¢ÙÈ΋˜ Ì›ˆÛ˘ (‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ .¯. 5 Ë̤Ú˜, Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì›· ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜ ÁÈ· 5 Ë̤Ú˜). ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÔÈ ÁÔÓ›˜ Ó· ηٷÓÔÔ‡Ó ÙË ‰È·ÊÔÚ¿ ¯Ú‹Û˘ Ì·Ï·ÎÙÈÎÔ‡ Û΢¿ÛÌ·ÙÔ˜ Î·È ÛˆÛÙ‹˜ ¯Ú‹Û˘ ÙÔÈÎÔ‡ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉԇ˜. ™ËÌÂÈÒÓÂÙ·È fiÙÈ fiÙ·Ó ÙÔ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ¤˜ ÂÊ·ÚÌfi˙ÂÙ·È Ì›· ÊÔÚ¿ ËÌÂÚËÛ›ˆ˜, Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ë ÂÊ·ÚÌÔÁ‹ Ó· Á›ÓÂÙ·È ÙÔ Úˆ› Î·È fi¯È ÙÔ ‚Ú¿‰˘ ÁÈ· Ó· ÂÏ·¯ÈÛÙÔÔÈÂ›Ù·È Ë Èı·ÓfiÙËÙ· ηٷÛÙÔÏ‹˜ ÙÔ˘ ¿ÍÔÓ· ˘Ôı¿Ï·ÌÔ˜- ˘fiÊ˘ÛË- ÂÈÓÂÊÚ›‰È·. ∏ ‰È·Ï›Ô˘Û· ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÂÏ·¯ÈÛÙÔÔÈ› ÙËÓ Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜, Ù·¯˘Ê˘Ï·Í›·˜ (·ÓÔ¯‹˜ ÛÙ· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹) Î·È ÙËÓ ÂÌÊ¿ÓÈÛË ¿ÏÏˆÓ ÙÔÈÎÒÓ Î·È Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÚÂÓÂÚÁÂÈÒÓ. ™‡Ìʈӷ Ì ÙËÓ ÂÌÂÈÚ›· ÌÔ˘, Ë ¯Ú‹ÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡ ÛÙÔ ¤Î˙ÂÌ· Ô˘ Â›Ó·È ˘ÁÚfi, ÂÏ·ÙÙÒÓÂÈ ÙÔÓ ¯ÚfiÓÔ ¯ÔÚ‹ÁËÛ˘ ÙÔÈÎÔ‡ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉԇ˜. ∞Ú¯Èο Û˘ÓÈÛÙÔ‡Û·Ì ·oÛÙ·Á̤ÓÔ ÓÂÚfi ·ÓÙ› ÁÈ· Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi Ì ÙÔ ·ÈÙÈÔÏÔÁÈÎfi fiÙÈ ÙÔ ·Ï·ÙÔ‡¯Ô ‰È¿Ï˘Ì· ı· ÂÚ¤ıÈ˙ ÙÔ ¿Û¯ÔÓ ‰¤ÚÌ·, fï˜ ‰È·ÈÛÙÒıËΠfiÙÈ ¤¯ÂÈ ·ÎÚÈ‚Ò˜ Ù· ·ÓÙ›ıÂÙ· ·ÔÙÂϤÛÌ·Ù·. ∆ÔÈο ·ÓÙÈ‚ÈÔÙÈο / ·ÓÙÈ‚ÈÔÙÈο Ì ÙË Û˘ÛÙËÌ·ÙÈ΋ Ô‰fi µ) ∂¿Ó ÔÈ ÂÎ˙ÂÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Î·È Â›Ó·È ˘ÁÚ¤˜ ÌÂÙ¿ ·Ô 5 Ë̤Ú˜ „ÂηÛÌÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi Î·È ÙÔ ·È‰› ηٿ Ù· ¿ÏÏ· Â›Ó·È Î·Ï¿, ÙfiÙ ÚÔÛÙ›ıÂÙ·È ÙÔÈÎfi ·ÓÙÈ‚ÈÔÙÈÎfi Ì ÛÙfi¯Ô Ó· ÂÏ·ÙÙˆı› ÙÔ ÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ÊÔÚÙ›Ô ‹ Ó· ·ÓÙÈÌÂÙˆÈÛı› Èı·Ó‹ Ïԛ̈ÍË (6). ŸÙ·Ó ÔÈ ‚Ï¿‚˜ ÛÙ·Ì·Ù‹ÛÔ˘Ó Ó· ÔÚÔÚÚÔÔ‡Ó, Ú¿ÁÌ· Ô˘ ÂÈÙ˘Á¯¿ÓÂPaediatriki 2007;70:330-335

∂ÈÎfiÓ· 1. •ËÚÔ‰ÂÚÌ›· Û ÎÔÚ›ÙÛÈ Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·.

∂ÈÎfiÓ· 2. ∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Û ‚Ú¤ÊÔ˜. √È ‚Ï¿‚˜ Â›Ó·È ÍËÚ¤˜.

∂ÈÎfiÓ· 3. √È ÂÎ˙ÂÌ·ÙÈΤ˜ ‚Ï¿‚˜ Â›Ó·È ˘ÁÚ¤˜ ηٷ ÙfiÔ˘˜ ÌÂÙ¿ ·Ô 5‹ÌÂÚË ·ÁˆÁ‹ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi ÔfiÙ ı· ÚÔÛÙÂı› ·ÓÙÈ‚›ˆÛË ÙÔÈο.

Pediatri July-Aug 07

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∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· – ıÂÚ·›·

Ù·È Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·Ô 2-3 Ë̤Ú˜ ÙÔÈ΋˜ ·ÓÙÈ‚ÈÔÙÈ΋˜ ıÂÚ·›·˜, Û˘ÓÈÛÙ¿Ù·È Îڤ̷ ÙÔÈÎÔ‡ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉԇ˜/ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Û ۯ‹Ì· ÚÔԉ¢ÙÈ΋˜ Ì›ˆÛ˘. °) ∂·Ó ÔÈ ÂÎ˙ÂÌ·ÙÈΤ˜ ‚Ï¿‚˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Â›Ó·È ˘ÁÚ¤˜ ÌÂÙ¿ ·Ô 5 Ë̤Ú˜ ÙÔÈ΋˜ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ ‹ Â¿Ó ÙÔ ¤ÎÎÚÈÌ· Â›Ó·È ÔÚÔ˘Ò‰Â˜, ˘¿Ú¯Ô˘Ó ÊÏ˘ÎÙ·ÈÓ›‰È· ‹ ¿ÏÏ· Û˘ÌÙÒÌ·Ù·, ¯ÔÚËÁÂ›Ù·È ·ÓÙÈ‚ÈÔÙÈÎfi ·Ô ÙÔ ÛÙfiÌ· ‹, Ôχ Û¿ÓÈ·, ÂÓ‰ÔÊÏ‚›ˆ˜ (∂ÈÎfiÓ˜ 2-6).

∂ÈÎfiÓ· 4. ∞ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Û ·È‰› Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. √È ‚Ï¿‚˜ ¯·Ú·ÎÙËÚÈÛÙÈο ÂÓÙÔ›˙ÔÓÙ·È ÛÙȘ ¤Ûˆ ÂÈÊ¿ÓÂȘ ÙˆÓ ¿ÎÚˆÓ Î·È ÙÔÓ ÎÔÚÌfi.

∂ÈÎfiÓ· 5. §ÂȯËÓÔÔÈË̤Ó˜ ÂÎ˙ÂÌ·ÙÈΤ˜ ‚Ï¿‚˜ Û ¤ÊË‚Ô.

∂ÈÎfiÓ· 6. ŒÎ˙ÂÌ· ÛÙȘ ¤Ûˆ ÂÈÊ¿ÓÂȘ ÙˆÓ ‰·ÎÙ‡ÏˆÓ (‰˘ÛȉڈÛÈÎfi) Ì ÔÚÔ˘Ò‰Â˜ ¤ÎÎÚÈÌ· ·fi 10Ë̤ÚÔ˘, ·Ú¿ ÙËÓ ÙÔÈ΋ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹. £· ‰Ôı› ·ÓÙÈÛÙ·Ê˘ÏÔÎÔÎÎÈÎfi ·fi ÙÔ ÛÙfiÌ·.

∆ÔÈÎÔ› ·Ó·ÛÙÔÏ›˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘ ™ÙËÓ ÂÚ›ÙˆÛË Û˘¯ÓÒÓ ˘ÔÙÚÔÒÓ ‹ ÂÎÙÂÙ·Ì¤ÓˆÓ Î·È Â›ÌÔÓˆÓ ÂÎ˙ÂÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ Ô˘ Ú·ÎÙÈο ÂÎÊÚ¿˙ÔÓÙ·È Ì ÂÊ·ÚÌÔÁ‹ ÙÔÈÎÒÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ >10 ̤Ú˜/ Ì‹Ó· ÛÙÔ ÚfiÛˆÔ Î·È >15 ̤Ú˜/ Ì‹Ó· ÛÙÔ ÛÒÌ· ‹/Î·È ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉԇ˜ >15gr/Ì‹Ó· Û ‚Ú¤ÊÔ˜ Î·È >30gr/Ì‹Ó· Û ÌÂÁ·Ï‡ÙÂÚÔ ·È‰›, ÙfiÙ ÚÔÛÙ›ıÂÙ·È Î·È ÙÔÈÎfi˜ ·Ó·ÛÙÔϤ·˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘ (tacrolimus, pimecrolimus) (3) . ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÙÔ tacrolimus ΢ÎÏÔÊÔÚ› ˆ˜ ·ÏÔÈÊ‹ Î·È ÙÔ pimecrolimus Ì ÙË ÌÔÚÊ‹ Îڤ̷˜. ∏ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ‰Ú¿ÛË ÙÔ˘ tacrolimus 0,1% Â›Ó·È ·ÚfiÌÔÈ· Ì ÂΛÓË ÂÓfi˜ ̤ÙÚÈ·˜ ÈÛ¯‡Ô˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉԇ˜, ÂÓÒ ÙÔ pimecrolimus 1% Â›Ó·È ËÈfiÙÂÚÔ (7-9). ∏ ÂÁÎÂÎÚÈ̤ÓË ËÏÈΛ· ¯ÔÚ‹ÁËÛ˘ ·Ó·ÛÙÔϤ· Ù˘ ηÏÛÈÓ¢ڛÓ˘ Û ·È‰È¿ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ ‰‡Ô ÂÙÒÓ. ∂¿Ó ¤Ó· ·È‰› ÏËÚ› Ù· ÎÚÈÙ‹ÚÈ· ¯Ú‹Û˘ ÙÔÈÎÔ‡ ·Ó·ÛÙÔϤ· ηÏÛÈÓ¢ڛÓ˘, ÙfiÙ ÛÙË Ê¿ÛË Ô˘ ÙÔ ÙÔÈÎfi ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ¤˜ ¯ÔÚËÁÂ›Ù·È ÌfiÓÔ ÙÔ Úˆ›, Ô ·Ó·ÛÙÔϤ·˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘ ÂÊ·ÚÌfi˙ÂÙ·È ÙÔ ‚Ú¿‰˘ Î·È fiÙ·Ó Á›ÓÂÈ ‰È·ÎÔ‹ ÙÔ˘ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉԇ˜, ÙfiÙ ÂÊ·ÚÌfi˙ÂÙ·È Úˆ›- ‚Ú¿‰˘ ̤¯ÚÈ Ï‹ÚÔ˘˜ ˘Ô¯ÒÚËÛ˘ ÙˆÓ Û˘Ìو̿وÓ. ™Â ¤Ó·ÚÍË ˘ÔÙÚÔ‹˜ (‹ÈÔ ÂÚ‡ıËÌ·, ÎÓËÛÌfi˜) ÂÊ·ÚÌfi˙ÂÙ·È ÙÔÈÎfi˜ ·Ó·ÛÙÔϤ·˜ ηÏÛÈÓ¢ڛÓ˘, ‰‡Ô ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜ Î·È Á›ÓÂÙ·È ·fiÙÔÌË ‰È·ÎÔ‹ fiÙ·Ó ˘Ô¯ˆÚ‹ÛÔ˘Ó Ù· Û˘ÌÙÒÌ·Ù·. ŸÙ·Ó ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ηÏÛÈÓ¢ڛÓ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ¤ÁηÈÚ·, ÌÂÈÒÓÔ˘Ó ÙË ‚·Ú‡ÙËÙ·, ÂÈÌË·ÓÔ˘Ó ÙÔÓ ¯ÚfiÓÔ ÌÂٷ͇ ÙˆÓ ÂÍ¿ÚÛÂˆÓ Î·È ‚ÂÏÙÈÒÓÔ˘Ó Û˘ÓÔÏÈο ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÓfiÛÔ˘. ŒÙÛÈ, Ë ¯Ú‹ÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙȘ Ê¿ÛÂȘ ¤ÓÙÔÓ˘ ¤Í·ÚÛ˘ ÙÔ˘ ÂÎ˙¤Ì·ÙÔ˜. ªÂϤÙ˜ Ì pimecrolimus Û ‚Ú¤ÊË ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ, fiÙ·Ó ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ, ÌÔÚ› Ó· ·ÔÙÚ¤„ÂÈ ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘ ÁÈ· ‰È¿ÛÙËÌ· ̤¯ÚÈ Î·È 12 Ì‹Ó˜ (10). ∞ÓÙÈ˚ÛÙ·ÌÈÓÈο ∞ÓÙÈ˚ÛÙ·ÌÈÓÈο ¯ÔÚËÁÔ‡ÓÙ·È Û˘ÛÙËÌ·ÙÈο ÁÈ· ÙËÓ ·ÓÙÈÎÓËÛÌÒ‰Ë Î·È ËÚÂÌÈÛÙÈ΋ ÙÔ˘˜ ‰Ú¿ÛË. ŒÙÛÈ, ¶·È‰È·ÙÚÈ΋ 2007;70:330-335

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∆. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘-∫¿ÎÔ˘ÚÔ˘

ÚÔÙÈÌÒÓÙ·È Ù· ÚÒÙ˘ ÁÂÓÈ¿˜ ·ÓÙÈ˚ÛÙ·ÌÈÓÈο Ô˘ ÏËÚÔ‡Ó ÙȘ ·ÓˆÙ¤Úˆ ȉÈfiÙËÙ˜. √˘‰¤ÔÙ fï˜ ÂÊ·ÚÌfi˙ÔÓÙ·È ÙÔÈο, ÁÈ·Ù› ¢·ÈÛıËÙÔÔÈÔ‡Ó ÙÔ ‰¤ÚÌ· (3). ∂˘Ú¤ˆ˜ Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È Ë ˘‰ÚÔ͢˙›ÓË. ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ô Ì¤ÛÔ˜ ¯ÚfiÓÔ˜ ˘Ô‰ÈÏ·ÛÈ·ÛÌÔ‡ Ù˘ ˘‰ÚÔ͢˙›Ó˘ ÛÙ· ·È‰È¿ Â›Ó·È 7,1±2,3 ÒÚ˜ Ì ‡ÚÔ˜ 4 ÒÚ˜ ÛÙ· ‚Ú¤ÊË ËÏÈΛ·˜ 12 ÌËÓÒÓ Î·È 11 ÒÚ˜ ÛÙ· ·È‰È¿ 14 ¯ÚÔÓÒÓ (11). ŒÙÛÈ, ÛÙ· ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ë ˘‰ÚÔ͢˙›ÓË ¯ÔÚËÁÂ›Ù·È 3 ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜, ÒÛÙ ӷ ÂÈÙ˘Á¯¿ÓÔÓÙ·È ÛÙ·ıÂÚ¿ ıÂÚ·¢ÙÈο Â›‰· ÛÙÔ ·›Ì·. ÃÔÚËÁÂ›Ù·È ·Ú¯Èο ¯·ÌËÏ‹ ‰fiÛË ˘‰ÚÔ͢˙›Ó˘ (1mg/kg/24ˆÚÔ) Î·È ÔÈ ÁÔÓ›˜ ÌÔÚ› ÚÔԉ¢ÙÈο Ó· ‰ÈÏ·ÛÈ¿ÛÔ˘Ó ‹ Î·È Ó· ÙÚÈÏ·ÛÈ¿ÛÔ˘Ó ÙËÓ 24ˆÚË ‰fiÛË ¯ˆÚ›˜ Ó· ˙ËÙ‹ÛÔ˘Ó ÙË Û˘Ó‰ÚÔÌ‹ ÙÔ˘ ÁÈ·ÙÚÔ‡ ÙÔ˘˜. ∂¿Ó ÙÔ ·È‰› ÂÍ·ÎÔÏÔ˘ı› Î·È ¤¯ÂÈ ÎÓËÛÌfi Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ·˘Í¿ÓÔ˘Ó Î·È ÙȘ ÙÚÂȘ ‰fiÛÂȘ, ÂÓÒ Â¿Ó ¤¯ÂÈ ÎÓËÛÌfi ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›Ô‰Ô Ù˘ Ë̤ڷ˜, ÁÈ· ·Ú¿‰ÂÈÁÌ· ÙÔ ‚Ú¿‰˘, ÙfiÙ ·˘Í¿ÓÔ˘Ó ÙË ‚Ú·‰ÈÓ‹ ‰fiÛË ÌfiÓÔ. ∏ ˘‰ÚÔ͢˙›ÓË ¯ÔÚËÁÂ›Ù·È ÁÈ· ¤ÓÙ Ë̤Ú˜ ÂÈϤÔÓ, ÌÂÙ¿ ÙËÓ ˘Ô¯ÒÚËÛË ÙÔ˘ ÎÓËÛÌÔ‡. ªÂ ÙÔ ·ÓˆÙ¤Úˆ Û¯‹Ì· ıÂÚ·›·˜, Ë ‰fiÛË Ù˘ ˘‰ÚÔ͢˙›Ó˘ fi¯È ÌfiÓÔ ÂÍ·ÙÔÌÈ·ÂÙ·È ·ÏÏ¿ ‰È·Ê¤ÚÂÈ ÛÙÔ ›‰ÈÔ ÙÔ ·È‰› οı ÊÔÚ¿, ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ˘ÔÙÚÔ‹˜. ∂ÈϤÔÓ, Ë ‰È·Ï›Ô˘Û· ¯ÔÚ‹ÁËÛË ·ÓÙÈ˚ÛÙ·ÌÈÓÈÎÔ‡ ÂÏ·ÙÙÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· Ù·¯˘Ê˘Ï·Í›·˜ Î·È ¿ÏÏˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÚÂÓÂÚÁÂÈÒÓ.

∂ÈÎfiÓ· 7. ¶ÔÏÏ·Ϥ˜ ‚Ï¿‚˜ ÌÔÏ˘ÛÌ·ÙÈ΋˜ ÙÂÚÌ›ÓıÔ˘ Û ·È‰› Ì ÍËÚÔ‰ÂÚÌ›·- ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ·.

∞ÓÙÈ-ÈÈ΋ ·ÁˆÁ‹ √È ·ÛıÂÓ›˜ Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Â›Ó·È ÂÈÚÚÂ›˜ Û ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (·Ïfi˜ ¤Ú˘, ÌÔÏ˘ÛÌ·ÙÈ΋ Ù¤ÚÌÈÓıÔ˜, Ì˘ÚÌËÁÎȤ˜) (∂ÈÎfiÓ˜ 7-9). √È ÁÔÓ›˜ Ú¤ÂÈ Ó· Â›Ó·È Â˘·ÈÛıËÙÔÔÈË̤ÓÔÈ Î·È Ó· ÂÈÛΤÙÔÓÙ·È ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜ ÌfiÏȘ ·ÓÙÈÏËÊıÔ‡Ó ÔÈ·‰‹ÔÙ ·Û˘Ó‹ıË ‰ÂÚÌ·ÙÈ΋ ‚Ï¿‚Ë (12). ™˘ÛÙËÌ·ÙÈ΋ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ·ÁˆÁ‹ ∏ Û˘ÛÙËÌ·ÙÈ΋ ·ÓÙÈÊÏÂÁÌÔÓ҉˘ ·ÁˆÁ‹ (.¯. ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ¤˜, ΢ÎÏÔÛÔÚ›ÓË, ·˙·ıÈÔÚ›ÓË) ÂÚÈÔÚ›˙ÂÙ·È Û Â›ÌÔÓ˜, ÛÔ‚·Ú¤˜ Î·È ·ÓıÂÎÙÈΤ˜ ÛÙËÓ ÙÔÈ΋ ·ÁˆÁ‹ ÂÚÈÙÒÛÂȘ ·ÙÔÈÎÔ‡ ÂÎ˙¤Ì·ÙÔ˜ (3,13). ™ÙË ¯ÒÚ· Ì·˜, Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ Ì ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· ¤¯Ô˘Ó ‹È· ‹ ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ ÓfiÛÔ. ∞˘Ùfi Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È ÛÙȘ ÎÏÈÌ·ÙÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ÙÔÓ ÙÚfiÔ ‰È·‚›ˆÛ˘ Î·È ÙË ‰È·ÙÚÔÊ‹ (ÌÂÛÔÁÂȷ΋ ‰›·ÈÙ·).

™˘Ì¤Ú·ÛÌ· ∏ ·ÙÔÈ΋ ‰ÂÚÌ·Ù›Ùȉ· Â›Ó·È ¯ÚfiÓÈ· ÓfiÛÔ˜ Ô˘ Paediatriki 2007;70:330-335

∂ÈÎfiÓ· 8. µÏ¿‚˜ ·ÏÔ‡ ¤ÚËÙ·.

∂ÈÎfiÓ· 9. √̷Ϥ˜ Ì˘ÚÌËÁÎȤ˜.

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¯·Ú·ÎÙËÚ›˙ÂÙ·È ·Ô ÂÍ¿ÚÛÂȘ Î·È ˘Ê¤ÛÂȘ. ∂›Ó·È ÂÔ̤ӈ˜ ÛËÌ·ÓÙÈÎfi ÙÔ ·È‰› Î·È Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ Ó· ÂÎ·È‰Â˘ıÔ‡Ó ÒÛÙ ӷ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙË ÓfiÛÔ ÌfiÓÔÈ ÙÔ˘˜, Ó· ˙ËÙÔ‡Ó ¿ÌÂÛ· È·ÙÚÈ΋ ‚Ô‹ıÂÈ· fiÙ·Ó ¤¯Ô˘Ó Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó Î¿ÙÈ ·Û‡ÓËı˜, Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Û ٷÎÙÈο ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ·Ô ÂȉÈÎfi Î·È Î˘Ú›ˆ˜ Ó· ¤¯Ô˘Ó ¿ÌÂÛË ÚfiÛ‚·ÛË ÛÙÔÓ ·È‰›·ÙÚÔ ÙÔ˘˜, fiÔÙÂ Î·È fiÙ·Ó ÙÔ ÎÚ›ÓÔ˘Ó ··Ú·›ÙËÙÔ.

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µÈ‚ÏÈÔÁÚ·Ê›· 1. Schultz Larsen F, Diepgen T, Svensson A. The occurrence of atopic dermatitis in north Europe: an international questionnaire study. J Am Acad Dermatol 1996;34:760-764.

2. Barbarot S, Beauchet A, Zaid S, Lacour JP, Groupe de Recherche Clinique en Dermatologie Pédiatrique. The management of atopic dermatitis in children by dermatologists, paediatricians, general practitioners and allergologists: a national survey on practice patterns. Ann Dermatol Venereol 2005;132:283-295.

3. Darsow U, Lubbe J, Taieb A. Seidenari S, Wollenberg A, Calza AM, et al. Position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol 2005;19: 286-295.

4. Friedlander SF, Hebert AA, Allen DB, Fluticasone Pediatrics Safety Study Group. Safety of fluticasone propionate cream 0.05% for the treatment of severe and extensive atopic dermatitis in children as young as 3 months. J Am Acad Dermatol 2002;46:387-393.

5. Lebwohl M. A comparison of once-daily application of

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mometasone furoate 0.1% cream compared with twicedaily hydrocortisone valerate 0.2% cream in pediatric atopic dermatitis patients who failed to respond to hydrocortisone: mometasone furoate study group. Int J Dermatol 1999;38:604-606.

Lever R, Hadley K, Downey D, Mackie R. Staphylococcal colonization in atopic dermatitis and the effect of topical mupirocin therapy. Br J Dermatol 1988;119:189-198.

Abramovits W. Atopic dermatitis. J Am Acad Dermatol 2005;53 (1 Suppl):S86-93.

Paller A, Eichenfield LF, Leung DY, Stewart D, Appell M. A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001;44 (1 Suppl):S47-S57.

Eichenfield LF, Lucky AW, Boguniewicz M, Langley RG, Cherill R, Marshall K. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol 2002;46:495-504.

Kapp A, Papp K, Bingham A, Folster-Holst R, Ortonne JP, Potter PC, et al. Long-term management of atopic dermatitis in infants with topical pimecrolimus, a nonsteroid antiinflammatory drug. J Allergy Clin Immunol 2002;110: 277-284.

Simons FE, Simons KJ, Becker AB, Haydey RP. Pharmacokinetics and antipruritic effects of hydroxyzine in children with atopic dermatitis. J Pediatr 1984;104:123-127.

Wollenberg A, Wetzel S, Burgdorf WH, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol 2003;112:667-674.

Dohil MA, Eichenfield LF. A treatment approach for atopic dermatitis. Pediatr Ann 2005;34:201-210.

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AÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘ egalanak@med.uoc.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘

∏ıÈο ˙ËÙ‹Ì·Ù· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ È·ÙÚÈ΋ ™ÙÔ ·ÚfiÓ Ù‡¯Ô˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ÊÈÏÔÍÂÓÔ‡ÓÙ·È Ë ÂÓ·ÚÎÙ‹ÚÈ· ÔÌÈÏ›· ÛÙÔ ÊÂÙÈÓfi 45Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ (£ÂÔ‰fiÛ˘ ¶ÂÏÂÁÚ›Ó˘. √ ı¿Ó·ÙÔ˜ Ù˘ ËıÈ΋˜) Î·È Ë ·Ó·ÛÎfiËÛË ÙˆÓ Neubauer Î·È Û˘Ó. (Ethics Working Group, UEMS/European Academy of Paediatrics) ÁÈ· ËıÈο ˙ËÙ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ·È‰ÈÔ‡ Û ÎÒÌ·. ∆· ËıÈο ˙ËÙ‹Ì·Ù· ÛÙËÓ ·È‰È·ÙÚÈ΋ Î·È ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ È·ÙÚÈ΋ Â›Ó·È ÔÏÏ¿ Î·È ·Î·ÓıÒ‰Ë. ¶Ôχ ÚfiÛÊ·Ù· ÛËÌÂÈÒıËÎ·Ó ¤ÓÙÔÓ˜ ·ÓÙÈ·Ú·ı¤ÛÂȘ ÁÈ· ˙ËÙ‹Ì·Ù· ‰È·ÎÔ‹˜ Ù˘ ·ËÛ˘ ÛÙȘ ∏¶∞ Î·È ÛÙËÓ ∂ÏÏ¿‰·. ™ÙȘ ∏¶∞, ÙÔ ∞ÓÒÙ·ÙÔ ¢ÈηÛÙ‹ÚÈÔ (Supreme Court, 18 ∞ÚÈÏ›Ô˘ 2007) ÁÓˆÌÔ‰fiÙËÛ (ÏÂÈÔ„ËÊ›· 5 ÚÔ˜ 4) ηٿ Ù˘ ‰È·ÎÔ‹˜ Ù˘ ÚÔ¯ˆÚË̤Ó˘ ·ËÛ˘, ·ÎfiÌË ÎÈ ·Ó Û˘ÓÙÚ¤¯Ô˘Ó È·ÙÚÈΤ˜ ÂӉ›ÍÂȘ (Ì ÂÍ·›ÚÂÛË ÙËÓ ·ÂÈÏ‹ ÁÈ· ÙË ˙ˆ‹ Ù˘ ÂÁ·Ԣ). H È·ÙÚÈ΋ ·ÓÙ›‰Ú·ÛË ˘‹ÚÍ ¿ÌÂÛË, ÙÔ ∞ÌÂÚÈηÓÈÎfi ∫ÔϤÁÈÔ ª·ÈÂ˘Ù‹ÚˆÓ Î·È °˘Ó·ÈÎÔÏfiÁˆÓ ¯·Ú·ÎÙ‹ÚÈÛ ÙËÓ ·fiÊ·ÛË “ÂÔÓ›‰ÈÛÙË Î·È ·‰È·ÓfiËÙË” Î·È ÙÔ New Engl J Med ÊÈÏÔͤÓËÛ 4 ΛÌÂÓ· ÛÙȘ ÊÂȉˆÏ¤˜ ÛÂÏ›‰Â˜ ÙÔ˘ (24 ª·˝Ô˘ 2007;356:2195, 2125, 2128, 2201) Ì ‰ËÎÙÈΤ˜ ÂÎÊÚ¿ÛÂȘ ÁÈ· ÓÔÌÈÎÔ‡˜ Î·È ‰ÈηÛÙÈÎÔ‡˜ Ô˘ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú·ÎÙÈ΋ Î·È “·ÛÎÔ‡Ó È·ÙÚÈ΋ ¯ˆÚ›˜ ¿‰ÂÈ· ¿ÛÎËÛ˘”. ™ÙËÓ ∂ÏÏ¿‰·, Ë ∂ıÓÈ΋ ∂ÈÙÚÔ‹ µÈÔËıÈ΋˜ ‰È·Ù‡ˆÛ (29 ª·ÚÙ›Ô˘ 2007, Ì ÌÂÈÔ„ËÊ›· ÂÓfi˜ ̤ÏÔ˘˜) ηÙ¢ı‡ÓÛÂȘ ÁÈ· ˙ËÙ‹Ì·Ù· ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ (www.bioethics.gr). ∂ÎÊÚ¿ÛÂȘ fiˆ˜ “Ë ∂ÈÙÚÔ‹ ıˆÚ› ‰ÈηÈÔÏÔÁË̤ÓË ÙËÓ ÂÈÏÔÁ‹ ÂÌ‚Ú‡Ô˘, ˆ˜ ÁÂÓÈ΋ ‰˘Ó·ÙfiÙËÙ· ÙˆÓ ˘Ô„ËÊ›ˆÓ ÁÔÓ¤ˆÓ…”, Î·È “Ë ·Ô‰Ô¯‹ Ù˘ Á¤ÓÓËÛ˘ ·È‰ÈÒÓ Ì ÛÔ‚·Ú¤˜ ‚Ï¿‚˜ ÛÙËÓ ˘Á›· ÙÔ˘˜, fiÛÔ Î·È ·Ó ı· ÌÔÚÔ‡Û ӷ ‰ÈηÈÔÏÔÁËı› Û ÂÓÙÂÏÒ˜ ·ÎÚ·›Â˜ ÂÚÈÙÒÛÂȘ…, ηٿ ηÓfiÓ· ÂϤÁ¯ÂÙ·È ËıÈο” ÂÈÎÚ›ıËÎ·Ó ·fi ÙËÓ ∂ÎÎÏËÛ›· (16 ª·˝Ô˘ 2007, www.ecclesia.gr/ greek/holysynod): “Ë ∂ÎÎÏËÛ›· Ì·˜ ηٷ‰Èο˙ÂÈ ·˘ÙfiÓ ÙÔÓ ÎÚ˘ÙÔ-Ú·ÙÛÈÛÌfi, ÙÈÌ¿ ÙÔ ·Á·ıfi Ù˘ ˙ˆ‹˜ ˆ˜ ÈÂÚfi Ì˘ÛÙ‹ÚÈÔ ·ÎfiÌË Î·È Ì¤Û· ·fi ·Ó·Ëڛ˜, ·Ù¤ÏÂȘ ‹ ÛÔ‚·Paediatriki 2007;70:336-337

Ú¤˜ ·Ûı¤ÓÂȘ…” Î·È “Ô fiÓÔ˜ ÁÂÓÓ¿ ÙËÓ ·Á¿Ë Î·È fi¯È Ë Î·ÏÔ¤Ú·ÛË ÙÔ˘ ¢ÁÔÓÈÎÔ‡ ۯ‰ȷÛÌÔ‡”. ∞ÓÙÈ·Ú·ı¤ÛÂȘ Û ˙ËÙ‹Ì·Ù· È·ÙÚÈ΋˜ ËıÈ΋˜ ÛËÌÂÈÒÓÔÓÙ·È Î·È Û ¿ÏϘ ¯ÒÚ˜, Î·È Â›Ó·È Â˘ÚfiÛ‰ÂÎÙ˜ Î·È ÁfiÓÈ̘. ∞˘Ùfi Ô˘ ͯˆÚ›˙ÂÈ ÛÙËÓ ÂÏÏËÓÈ΋ ÂÚ›ÙˆÛË Â›Ó·È Ë ÛȈ‹ ÙˆÓ ÂÏÏ‹ÓˆÓ È·ÙÚÒÓ. ∆· ηϿ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ∏ ·ÙÔ›· ¤¯ÂÈ ·˘ÍËı› ÙÂÏÂ˘Ù·›· ÛÙȘ ‰˘ÙÈΤ˜ ÎÔÈӈӛ˜, ·ÏÏ¿ ÙÔ ÁÈ·Ù› ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙÔ. ªÈ· ÂÚÌËÓ¢ÙÈ΋ ˘fiıÂÛË, ÁÓˆÛÙ‹ ˆ˜ “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜” (hygiene hypothesis) ÚÂۂ‡ÂÈ fiÙÈ Ë ÚÒÈÌË ¤ÎıÂÛË Û ÏÔÈÌÒÍÂȘ (fiˆ˜ Ë·Ù›Ùȉ· ∞, ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ˘ÏˆÚÔ‡, ÙÔÍfiÏ·ÛÌ·, ¤ÏÌÈÓı˜) Âȉڿ ¢ÂÚÁÂÙÈο ÛÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ·ÔÙÚ¤ÔÓÙ·˜ ÙËÓ ÂÌÊ¿ÓÈÛË ·ÙÔ›·˜ - ¿Ú· Ù· ·È‰È¿ ¯ˆÚ›˜ ÔÏϤ˜ ÏÔÈÌÒÍÂȘ ı· Â›Ó·È ÈÔ ·ÙÔÈο. ¶ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙË °ÂÚÌ·Ó›· (J Epidemiol Community Health 2007;61:638) Ì 3347 ·È‰È¿ ¤‰ÂÈÍ fiÙÈ fiÛÔ ÈÔ Û˘¯Ófi˜ Ô ·ÔÈÎÈÛÌfi˜ Ì Helicobacter pylori, ÙfiÛÔ ÏÈÁfiÙÂÚÔ Û˘¯Ófi ÙÔ ¤Î˙ÂÌ· (OR=0,31, p=0,006). √ÌÔ›ˆ˜, ÂÚÁ·Û›· ·fi ÙȘ ∏¶∞ (Arch Intern Med 2007;167:821) Ì 7663 ÂÓ‹ÏÈΘ η٤ÏËÍ fiÙÈ fiÛÔ ÈÔ Û˘¯Ófi˜ Ô ·ÔÈÎÈÛÌfi˜ Ì cagA(+) ÛÙÂϤ¯Ë H pylori, ÙfiÛÔ ÏÈÁfiÙÂÚÔ Û˘¯Ófi ÙÔ ¿ÛıÌ· (ȉȷ›ÙÂÚ· ÚÈÓ Ù· 15 ¤ÙË ˙ˆ‹˜, OR=0,63, 95% CI 0,43-0,93), Ë ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, Ù· ·ÏÏÂÚÁÈο Û˘ÌÙÒÌ·Ù· Î·È Ë ‰ÂÚÌ·ÙÈ΋ ¢·ÈÛıËÙÔÔ›ËÛË Û Á‡ÚË Î·È Ì‡ÎËÙ˜. ∞ӷʤÚÂÙ·È ÏÔÈfiÓ fiÙÈ o ¯ÚfiÓÈÔ˜ ÂÚÂıÈÛÌfi˜ ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡ ·fi ÙÔ H. pylori ÂÓ‰¤¯ÂÙ·È Ó· ¢ԉÒÓÂÈ ÙËÓ ˆÚ›Ì·ÓÛË Ù˘ ·ÓÔÛ›·˜. ∏ Ïԛ̈ÍË H. pylori Û˘Ó‹ıˆ˜ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙËÓ ÚÒÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ Î·È ¤¯ÂÈ ÌÂȈı› ÛÙȘ ‚ÈÔÌ˯·ÓÈΤ˜ ¯ÒÚ˜. ™Â ÌÈ· ÌÈÎÚfiÙÂÚ˘ Îϛ̷η˜ ÌÂϤÙË ·fi ÙËÓ ∆Ô˘ÚΛ· (J Trop Ped 2007; ˘fi ‰ËÌÔÛ›Â˘ÛË) ‰ÂÓ ÂȂ‚·ÈÒıËΠ·˘Ù‹ Ë Û¯¤ÛË. ∏ Ôχ ÂӉȷʤÚÔ˘Û· “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜” Û˘˙ËÙÂ›Ù·È ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980, ¿ÏÏÔÙ ÂÚÈÛÛfiÙÂÚÔ Î·È ¿ÏÏÔÙ ÏÈÁfiÙÂÚÔ, ˆÛÙfiÛÔ ·Ú·Ì¤ÓÂÈ ˘fiıÂÛË. ¶ÂÚÈÛÛfiÙÂÚ· ÁÈ· ÙËÓ “˘fiıÂÛË Ù˘ ˘ÁÈÂÈÓ‹˜” ÛÙÔ ·ÚfiÓ Ù‡¯Ô˜ Ù˘

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PAEDIATRIC NEWS IN BRIEF ¶·È‰È·ÙÚÈ΋˜, ÛÙËÓ ·Ó·ÛÎfiËÛË ™ÔÊÈ·ÓÔ‡-∫·ÙÛÔ‡ÏË Î·È ÛÙË ÌÂϤÙË ∫·Ú·‚·Ó¿ÎË Î·È Û˘Ó, fiÔ˘ ÔÈ Û˘¯Ó¤˜ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÛÙ· ‰˘Ô ÚÒÙ· ¤ÙË ˙ˆ‹˜ ʤÚÔÓÙ·È Ó· ‰ÚÔ˘Ó ÚÔÛٷ٢ÙÈο ÛÙËÓ ÂΉ‹ÏˆÛË Û·Î¯·ÚÒ‰Ë ‰È·‚‹ÙË Ù‡Ô˘ 1. √È ‰˘Ô fi„ÂȘ Ù˘ ËÏÈÔÚÔÛÙ·Û›·˜ ∏ ˘ÂÚÈ҉˘ ·ÎÙÈÓÔ‚ÔÏ›· Â›Ó·È Î·ÚÎÈÓÔÁfiÓÔ˜ Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ Â›Ó·È ÂÈΛӉ˘ÓË ÁÈ· fiÏÔ˘˜ - Ôχ ÂÚÈÛÛfiÙÂÚÔ ÁÈ· Ù· ÌÈÎÚ¿ ·È‰È¿. ∞fi ÙËÓ ¿ÏÏË fï˜, Ë ËÏȷ΋ ·ÎÙÈÓÔ‚ÔÏ›· ¢ԉÒÓÂÈ ÙË Û‡ÓıÂÛË Ù˘ ‚ÈÙ·Ì›Ó˘ D Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ·ÔÊ˘Á‹ Ù˘ ¤ÎıÂÛ˘ Ê·›ÓÂÙ·È Ó· ÌËÓ Â›Ó·È ¿Û¯ÂÙË Ì ÙËÓ ÚfiÛÊ·ÙË Â·ÓÂÌÊ¿ÓÈÛË Ù˘ Ú·¯›Ùȉ·˜ ·ÎfiÌË Î·È Û ËÏÈfiÏÔ˘ÛÙ˜ ¯ÒÚ˜ (Am Fam Physician 2006;74:619: “Ë Ú·¯›Ùȉ· ‰ÂÓ Â›Ó·È ÓfiÛÔ˜ ÙÔ˘ ·ÚÂÏıfiÓÙÔ˜”, Î·È J Clin Invest 2006 116:2062: “Ë ÓÂÎÚ·Ó¿ÛÙ·ÛË Ù˘ ·ÓÂ¿ÚÎÂÈ·˜ ‚ÈÙ·Ì›Ó˘ D Î·È Ù˘ Ú·¯›Ùȉ·˜”). ∆Ô Úfi‚ÏËÌ· Ì ÙÔÓ ‹ÏÈÔ Â›Ó·È fiÙÈ ÙÔ ·ÛʷϤ˜ fiÚÈÔ ¤ÎıÂÛ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ (Med J Aust 2006;185:268). ∞fi ÙËÓ ·ÓÂÈÛÙËÌȷ΋ ·È‰È·ÙÚÈ΋ ÎÏÈÓÈ΋ ÙÔ˘ ∏Ú·ÎÏ›Ԣ ¤Ú·Û·Ó ÙË ÊÂÙÈÓ‹ ¿ÓÔÈÍË 3 ‚Ú¤ÊË Ì ڷ¯›Ùȉ· - fiÏ· ‰È¤ÌÂÓ·Ó ÛÙË ÓfiÙÈ· ∫Ú‹ÙË, fiÔ˘ Ë ËÏÈÔÊ¿ÓÂÈ· Â›Ó·È ·˘ÙÔÓfiËÙË. ŸÏ˜ ÔÈ ¤ÁÎ˘Â˜ ÎÈ fiÏ· Ù· ‚Ú¤ÊË (Î·È Ì¿ÏÈÛÙ· Ù· ÌÂÏ·¯ÚÈÓ¿ ¿ÙÔÌ·) Ô˘ ‰ÂÓ ÂÎÙ›ıÂÓÙ·È ÛÙÔÓ ‹ÏÈÔ Ê·›ÓÂÙ·È fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘ÌÏËڈ̷ÙÈ΋ ‚ÈÙ·Ì›ÓË D. º˘Ì·Ù›ˆÛË Î·È ˘ÂÚ·ÙÏ·ÓÙÈΤ˜ Ù‹ÛÂȘ ™ÙȘ 29 ª·˝Ô˘ 2007, ¿Ó‰Ú·˜ 32 ÂÙÒÓ Ì ÂÍ·ÈÚÂÙÈο ·ÓıÂÎÙÈ΋ Ê˘Ì·Ù›ˆÛË (extensively drugresistant tuberculosis, XDR TB) Ù¤ıËΠ۠ηڷÓÙ›Ó· ÛÙȘ ∏¶∞ Ì ÓÔÛËÏ›· ˘fi ÊÚÔ‡ÚËÛË (CNN, BBC Î·È in.gr 30 ª·˝Ô˘ 2007, ‰ÂÏÙ›· Ù‡Ô˘ CDC 2 Î·È 8 πÔ˘Ó›Ô˘ 2007). ◊Ù·Ó Ë ÚÒÙË ÊÔÚ¿ ÌÂÙ¿ ·fi 44 ¤ÙË Ô˘ ÂÊ·ÚÌfiÛıËΠ٤ÙÔÈ· ηڷÓÙ›Ó· ÛÙȘ ∏¶∞, Ë ÚÔËÁÔ‡ÌÂÓË ‹Ù·Ó ÙÔ 1963 Î·È ·ÊÔÚÔ‡Û ÎÚÔ‡ÛÌ· ¢ÏÔÁÈ¿˜. √ ·ÛıÂÓ‹˜ ›¯Â Ù·Íȉ¤„ÂÈ Ôχ ÚfiÛÊ·Ù· Û ∂˘ÚÒË (Î·È ∂ÏÏ¿‰·, 14-21 ª·˝Ô˘) Ì ‰‡Ô ˘ÂÚ·ÙÏ·ÓÙÈΤ˜ Ù‹ÛÂȘ: ∞ÙÏ¿ÓÙ·-¶·Ú›ÛÈ Î·È ¶Ú¿Á·-ªfiÓÙÚÂ·Ï (12 Î·È 24 ª·˝Ô˘). ∏ ÌÔÏ˘ÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘ ıˆڋıËΠ¯·ÌËÏ‹, ˆÛÙfiÛÔ ÙÔ CDC Û˘Ó¤ÛÙËÛ ¤ÏÂÁ¯Ô ÁÈ· Ù· ÏËÚÒÌ·Ù· ÙˆÓ ·ÂÚÔÛηÊÒÓ Î·È ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ Û˘ÓÂÈ‚¿Ù˜ (Î·È Ì¿ÏÈÛÙ· fiÛÔ˘˜ οıÔÓÙ·Ó ÛÙËÓ ›‰È· ÛÂÈÚ¿ ‹ ‰‡Ô ÛÂÈÚ¤˜ ÌÚÔÛÙ¿ Î·È ‰˘Ô ÛÂÈÚ¤˜ ›Ûˆ). ∏ Û‡ÛÙ·ÛË ·ÊÔÚÔ‡Û ÙȘ ˘ÂÚ·ÙÏ·ÓÙÈΤ˜ Î·È fi¯È ÙȘ Â˘Úˆ·˚Τ˜ Ù‹ÛÂȘ ÏfiÁˆ ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ¯ÚfiÓÔ˘ ¤ÎıÂÛ˘. ∞fi ÙÔ˘˜ 274 Ôϛ٘ ∏¶∞ ÂÓÙÔ›ÛıËÎ·Ó ÁÚ‹ÁÔÚ· ÔÈ 255. ∞fi ÙȘ 25 ª·˝Ô˘ ÙÔ ı¤Ì· Û˘ÓÙfiÓÈÛÂ Ë ¶·-

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ÁÎfiÛÌÈ· √ÚÁ¿ÓˆÛË ÀÁ›·˜. ∂ÓËÌÂÚÒıËÎ·Ó ÔÈ ¯ÒÚ˜ Ì Ôϛ٘-Û˘ÓÂÈ‚¿Ù˜ Î·È ÔÈ ¯ÒÚ˜ ·fi fiÔ˘ ¤Ú·ÛÂ Ô ·ÛıÂÓ‹˜. ™ÙËÓ ∂˘ÚÒË ÂΉfiıËΠԉËÁ›· ÎÔÈÓ‹˜ ÔÏÈÙÈ΋˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ Î·È ÛÙËÓ ∂ÏÏ¿‰· Ù¤ıËΠ۠ÂÊ·ÚÌÔÁ‹ ÙÔ Û¯¤‰ÈÔ “¶ÂÚÛ¤·˜”. ŒÓ·˜ ŒÏÏËÓ·˜ Û˘ÓÂÈ‚¿Ù˘ ÛÙËÓ Ù‹ÛË ∞ÙÏ¿ÓÙ·¶·Ú›ÛÈ ‚Ú¤ıËÎÂ Î·È ÂϤÁ¯ıËÎÂ. ™ÙȘ ∏¶∞, Ë XDR ∆µ ¤¯ÂÈ ‰È·ÁÓˆÛı› Û 49 ·ÓıÚÒÔ˘˜ ·fi ÙÔ 1993 ¤ˆ˜ ÙÔ 2006, ·ÏÏ¿ Â›Ó·È Ôχ ÈÔ Û˘¯Ó‹ (Î·È Û˘Ó‹ıˆ˜ ı·Ó·ÙËÊfiÚ·) Û ¿ÏϘ ¯ÒÚ˜. ∏ ·ÓÙÈÌÂÙÒÈÛË Î¿ı ÎÚÔ‡ÛÌ·ÙÔ˜ ÛÙȘ ∏¶∞ ÎÔÛÙ›˙ÂÈ ÂÚ› Ù· $500.000 (ú400.000). À¿Ú¯ÂÈ Ï‡ÛÛ· ÛÙËÓ ∂ÏÏ¿‰·; Ÿ¯È Û¿ÓÈ· ¯ÚÂÈ¿˙ÂÙ·È Ó· ‰ÒÛÔ˘Ì ԉËÁ›Â˜ ÁÈ· ·È‰È¿ Ì ‰‹ÁÌ·Ù· (‹ Èı·Ó¿ ‰‹ÁÌ·Ù· ‹ ¿ÏÏË Â·Ê‹) ·fi Û΢ÏÈ¿ ‹ (Û·ÓÈfiÙÂÚ·) ·ÏÂÔ‡‰Â˜, Ó˘¯ÙÂÚ›‰Â˜ ‹ ¿ÏÏ· ¿ÁÚÈ· ˙Ò·. ∏ χÛÛ· Â›Ó·È ÙÔ ÏÔÈÌ҉˜ ÓfiÛËÌ· Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ıÓËÙfiÙËÙ· (100%), ‰ÂÓ ¤¯ÂÈ ıÂÚ·›·, Î·È Ë ÌÔÈÚ·›· ηٿÏËÍË Â›Ó·È ı¤Ì· ËÌÂÚÒÓ ÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ (Ë ÌÔÓ·‰È΋ ÂÍ·›ÚÂÛË, Û 15ÂÙ¤˜ ÎÔÚ›ÙÛÈ, ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ New Engl J Med 2005;352:2508). ∂›Ó·È ÁÓˆÛÙ‹ Ë ·Í›· Ù˘ ÚÔʇϷ͢ (ÂÚÈÔ›ËÛË ÙÚ·‡Ì·ÙÔ˜, ÂȉÈ΋ ·ÓÔÛÔÛÊ·ÈÚ›ÓË, ÂÌ‚fiÏÈÔ) ÌÂÙ¿ ÙËÓ ¤ÎıÂÛË Î·È ÚÈÓ ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ. ŸÌˆ˜, Ë Ï‡ÛÛ· ÛÙÔÓ ¿ÓıÚˆÔ Â›Ó·È Ôχ Û¿ÓÈ· ηÈ, ·fi ÙËÓ ¿ÏÏË, ÙÔ ·Ó·ÌÓËÛÙÈÎfi Â›Ó·È Û˘¯Ó¿ ·Û·Ê¤˜ ‹ ÙÔ ÛÎ˘Ï› Â›Ó·È ·‰¤ÛÔÙÔ Î·È ‰ÂÓ ÌÔÚ› Ó· ·Ú·ÎÔÏÔ˘ıËı›. ¢˘Ô ÚfiÛÊ·Ù· ÎÚÔ‡ÛÌ·Ù· ÛÙȘ ∏¶∞ (MMWR 2007;56:361) ·ÊÔÚÔ‡Û·Ó ·ÁfiÚÈ 11 ÂÙÒÓ Ì ‰‹ÁÌ· ·fi ÛÎ˘Ï› ÚÔ 2ÂÙ›·˜ Î·È ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 10 ÂÙÒÓ Ì ‰‹ÁÌ· ·fi Ó˘¯ÙÂÚ›‰· ÚÔ 3Ì‹ÓÔ˘. ∆· ·È‰È¿ ‰ÂÓ Â›¯·Ó ¿ÚÂÈ ÚÔÊ˘Ï·ÎÙÈ΋ ·ÁˆÁ‹ Î·È Î·Ù¤ÏËÍ·Ó, ÌÔÏÔÓfiÙÈ ·ÓÙÈÌÂÙˆ›ÛıËÎ·Ó Ì ÙËÓ ÈÔ ÂÓÙ·ÙÈ΋ Î·È ÙÂÎÌËÚȈ̤ÓË ·ÁˆÁ‹. ™ÙȘ ∏¶∞ ·Ó·Ê¤ÚÔÓÙ·È 3 ÂÚ›Ô˘ ÎÚÔ‡ÛÌ·Ù· ÂÙËÛ›ˆ˜. À¿Ú¯ÂÈ Ï‡ÛÛ· ÛÙËÓ ∂ÏÏ¿‰·; ∏ ¿ÌÂÛË ‰‹ÏˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Â›Ó·È (ıˆÚËÙÈÎÒ˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ) ˘Ô¯ÚˆÙÈ΋ ÛÙË ¯ÒÚ· Ì·˜ Î·È Ì ÙËÓ ÙÚ·ÁÈ΋ ÙÔ˘˜ ηٿÏËÍË, ‰ÂÓ ı· ÂÚÓÔ‡Û·Ó ··Ú·Ù‹ÚËÙ·. ∞fi ÌÈ· ÂÈÛÎfiËÛË ÙˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ‰ÂÏÙ›ˆÓ Ù˘ ∂™À∂, Ù˘ PubMed Î·È Ù˘ iatrotek on-line ÚÔ·ÙÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ·ÓıÚÒÈÓÔ ÎÚÔ‡ÛÌ· ÛÙËÓ ∂ÏÏ¿‰· ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1970. øÛÙfiÛÔ, ÛÙË ‰ÂηÂÙ›· 1951-1960 ›¯·Ó ·Ó·ÊÂÚı› 53 ı·Ó·ÙËÊfiÚ· ·ÓıÚÒÈÓ· ÎÚÔ‡ÛÌ·Ù· (Parassitologia 1988;30:93).

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¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜, ∞ÏÏÂÚÁÈÔÏfiÁÔ˜

AÏÏËÏÔÁÚ·Ê›·: ¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜ npg@allergy.gr

πÛÙÔÛÂÏ›‰Â˜ ÁÈ· ÌÔ˘ÛÈ΋ ÁÈ· ·È‰È¿ ∏ ÌÔ˘ÛÈ΋ ·ÔÙÂÏ› ·Ó·ÌÊ›‚ÔÏ· ·Ó·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ Ù˘ Û˘ÓÔÏÈ΋˜ ÌÔÚʈÙÈ΋˜ ÂÎ·›‰Â˘Û˘ ÙˆÓ ·È‰ÈÒÓ ·fi ÙËÓ ‚ÚÂÊÈ΋ ÙÔ˘˜ ÎÈfiÏ·˜ ËÏÈΛ·. ¶ÔÏϤ˜ ÂÈÛÙËÌÔÓÈΤ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ηٷϋÍÂÈ ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÌÔ˘ÛÈ΋ „˘¯·ÁˆÁ›· ÙˆÓ ·È‰ÈÒÓ Û˘Ì‚¿ÏÏÂÈ ÛÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ¯·Ú·ÎÙ‹Ú· ÙÔ˘˜ ηıÒ˜ Î·È ÛÙÔÓ ÌÂÙ¤ÂÈÙ· Â·ÁÁÂÏÌ·ÙÈÎfi ÙÔ˘˜ ÚÔÛ·Ó·ÙÔÏÈÛÌfi, fiÙ·Ó ·˘Ù‹ ·ÔÎÙ¿ Ù·ÎÙÈÎfi Î·È ÔÚÁ·ÓˆÌ¤ÓÔ ¯·Ú·ÎÙ‹Ú·. ∞Ó¿ÌÂÛ· Û ̛· ÏËıÒÚ· ‰˘Ó·ÙÔًوÓ, ÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÛʤÚÂÈ Î·È ÂΛÓË Ù˘ ÌÔ˘ÛÈ΋˜ ÂÎ·›‰Â˘Û˘, ÚÔÛÂÏ·ÔÓÙ·˜ ÙËÓ ÚÔÛÔ¯‹ fi¯È ÌfiÓÔ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ, ·ÏÏ¿ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ‹ Î·È ÙˆÓ ‰·ÛοψÓ.

ªÔ˘ÛÈ΋ ÂÎ·›‰Â˘ÛË ÁÈ· ·È‰È¿ - http://www.music4kids.com/meyc/ Music Education for Young Children, a resource for teachers and parents, Â›Ó·È Ô Ù›ÙÏÔ˜ Ù˘ ÚÒÙ˘ ÈÛÙÔÛÂÏ›‰·˜ Ô˘ Ì ȉȷ›ÙÂÚË Â˘ÎÔÏ›· ÌÔÚ› Ó· ‚ÚÂÈ Î¿ÔÈÔ˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô. ∞Ï‹, Ì ÏÈÙ¿ ·È‰Èο Û¯¤‰È· Ó· ÎÔÛÌÔ‡Ó ÙÔÓ “¯ÒÚÔ” Ù˘, Ë ÛÂÏ›‰· ·˘Ù‹ Â͢ËÚÂÙ› Ì ϷΈÓÈÎfi ÙÚfiÔ ÙÔÓ ÏfiÁÔ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘. ª›· ÛÙ‹ÏË ·ÚÈÛÙÂÚ¿ Ô‰ËÁ› ÙÔÓ ÂÈÛΤÙË ÛÙ· η›ÚÈ· links Ù˘, ñ Books, Periodicals, Catalogs ñ Music Curricula ñ Songs and Music Games ñ Teaching Ideas ñ Musical Development ñ Music and the Brain ñ Professional Organizations ÂÓÒ ˘¿Ú¯Ô˘Ó ÂÚ·ÈÙ¤Úˆ ÏÂÈÙÔ˘ÚÁ›Â˜ fiˆ˜ ‰˘Ó·ÙfiÙËÙ· register Û Discussion Forum, ÛÙÔ ÔÔ›Ô Ô ÂοÛÙÔÙ ÁÔÓ¤·˜ ‹ ‰¿ÛηÏÔ˜ ÌÔÚ› Ó· ·ÓÙ·ÏÏ¿ÍÂÈ È‰¤Â˜ Î·È Ó· ·Ó·Ù‡ÍÂÈ ‰È¿ÏÔÁÔ Û¯ÂÙÈο Ì ÙÔ ı¤Ì·.

ªÔ˘ÛÈ΋ Û‡ÓıÂÛË - http://www.creatingmusic.com/ A˘Ù‹ Ë ÈÛÙÔÛÂÏ›‰· ·Ó·Ê¤ÚÂÙ·È ÂÚÈÛÛfiÙÂÚÔ Û ·È‰È¿ Ô˘ ‹‰Ë ¤¯Ô˘Ó ÂÈÛ¯ˆÚ‹ÛÂÈ Ì ÙÔÓ ¤Ó· ‹ Ì ÙÔÓ ¿ÏÏÔ ÙÚfiÔ ÛÙÔÓ ¯ÒÚÔ Ù˘ ÌÔ˘ÛÈ΋˜ ÂÎ·›‰Â˘Û˘. ¶ÂÚÈÛÛfiÙÂÚÔ ÂÍÂȉÈÎÂ˘Ì¤ÓË ÏÔÈfiÓ ·ÏÏ¿ ¯ˆÚ›˜ Ó· ·ÔÎÏ›ÂÈ ÙÔÓ ÂÈÚ·Ì·ÙÈÛÌfi ÙˆÓ ·È‰ÈÒÓ ÛÙË ÌÔ˘ÛÈ΋ Û‡ÓıÂÛË, Ë ÈÛÙÔÛÂÏ›‰· ·Ú¤¯ÂÈ ¤Ó· on line ‰ËÌÈÔ˘ÚÁÈÎfi ÌÔ˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ·È‰È¿ fiÏˆÓ ÙˆÓ ËÏÈÎÈÒÓ. ªÔÚÔ‡Ó Ó· Û˘Óı¤ÛÔ˘Ó, Ó· Û¯ËÌ·Ù›ÛÔ˘Ó ÌÔ˘ÛÈο puzzles ·ÏÏ¿ Î·È Ó· ·Û¯ÔÏËıÔ‡Ó Ì ·È‰Èο ·È¯Ó›‰È·. |

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∫Ï·ÛÈ΋ ÌÔ˘ÛÈ΋ ÁÈ· ·È‰È¿ - http://www.classicsforkids.com/ ∏ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ÂÈÛ¿ÁÂÈ Ì ¢¯¿ÚÈÛÙÔ ÙÚfiÔ Ù· ·È‰È¿ ÛÙÔÓ ¯ÒÚÔ ÂÓfi˜ ˘„ËÏÔ‡ Î·È È‰È·›ÙÂÚÔ˘ ›‰Ô˘˜ ÌÔ˘ÛÈ΋˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ÎÏ·ÛÈ΋ ÌÔ˘ÛÈ΋. ∆Ô ÏÔ‡ÛÈÔ ÂÚȯfiÌÂÓÔ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ¤ÓÙÔÓ· ¯ÚÒÌ·Ù· Î·È ÁÚ·ÊÈο, ÂÓÒ Ôχ ‡ÎÔÏ· ·Ó·Î·Ï‡ÙÂÈ Î·Ó›˜ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ì›· ÈÛÙÔÛÂÏ›‰· Ì ÔÏϤ˜ Ú·ÎÙÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ Î·È ÏÈÁfiÙÂÚ˜ ıˆÚËÙÈΤ˜ ·Ó·Ï‡ÛÂȘ. ∆· ·È‰È¿ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·ÎÔ‡ÛÔ˘Ó ‰ˆÚÂ¿Ó ÎÏ·ÛÈ΋ ÌÔ˘ÛÈ΋, Ë ÔÔ›· ·Ó·‚·ıÌ›˙ÂÙ·È Û ‚‰ÔÌ·‰È·›· ‚¿ÛË. ∆· ‚‹Ì·Ù· ÁÈ· ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Â›Ó·È ·Ï¿, ÂÓÒ ·ÎÔÏÔ˘ıÔ‡Ó Quiz Ì ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÙÔÓ ÂοÛÙÔÙ ÎÏ·ÛÈÎfi Û˘Óı¤ÙË. ∂Ê·ÚÌÔÁ¤˜ fiˆ˜ ÌÔ˘ÛÈÎfi ÏÂÍÈÎfi, ·ÎÚfi·ÛË ÁÈ· Ôχ ÌÈÎÚ¿ ·È‰È¿, ηıÒ˜ Î·È ÏÔ‡ÛÈ· ·Ú¯Â›· Ì ‚ÈÔÁÚ·ÊÈο ÛÙÔȯ›· ÙˆÓ Û˘ÓıÂÙÒÓ, events Î·È ·È¯Ó›‰È· Â›Ó·È ÌÂÚÈο ÌfiÓÔ ·fi Ù· ÂÚȯfiÌÂÓ· ÙÔ˘.

Children’s music - http://www.childrensmusic.org/ ∏ ÛÂÏ›‰· ¤¯ÂÈ Û·Ê‹ ‰È·¯ˆÚÈÛÙÈο fiÚÈ· Ù˘ ıÂÌ·ÙÔÏÔÁ›·˜ Ù˘, Ì ÙÔÌ›˜ Ô˘ ·¢ı‡ÓÔÓÙ·È ÛÙÔ˘˜ ÁÔÓ›˜, ÛÙ· ·È‰È¿, ÛÙÔ˘˜ ‰·ÛοÏÔ˘˜, ηıÒ˜ Î·È ·Ú¯Â›Ô Ì ÏËıÒÚ· ÌÔ˘ÛÈÎÒÓ ÂÎÙÂÏÂÛÙÒÓ. ∏ ÈÛÙÔÛÂÏ›‰· ·Ú¤¯ÂÈ ÚfiÛ‚·ÛË Î·È ÛÙ· Children's Music Web Awards 2007, ‚Ú·‚›· Ô˘ ÂÈϤÁÔÓÙ·È Î·È ·ÔÓ¤ÌÔÓÙ·È ·ÔÎÏÂÈÛÙÈο ·fi Ù· ·È‰È¿. ∞ӷʤÚÔÓÙ·È ·ÎfiÌË ‰Ú·ÛÙËÚÈfiÙËÙ˜ Û¯ÂÙÈΤ˜ Ì ÊÈÏ·ÓıÚˆÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ Ë ‰ÈÔÚÁ¿ÓˆÛË ÎÔÓÛ¤ÚÙˆÓ Û ·È‰Èο ÓÔÛÔÎÔÌ›·. µ·ÛÈ΋ Âȉ›ˆÍË ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ·˘ÙÔ‡ ¯ÒÚÔ˘ Â›Ó·È Ë Ì‡ËÛË ÙˆÓ ·È‰ÈÒÓ ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ Ú·‰ÈÔÊÒÓÔ˘, ÛÙÔÓ ÔÔ›Ô ÂÈÛ¤Ú¯ÔÓÙ·È Â‡ÎÔÏ· Ì ÙËÓ ¤Ó·ÚÍË Ì›·˜ ·Ï‹˜ ÂÊ·ÚÌÔÁ‹˜.

¶·È‰È·ÙÚÈ΋ 2007;70:338-339

Pediatri July-Aug 07

09-07-07

17:09

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340

∫§π¡π∫√ ∫√Àπ∑

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ 2 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘

°. ¡ÙÈÔ‡‰Ë˜1, µ. °ÂˆÚÁÔÔ‡ÏÔ˘1, ¡. ª·ÓˆÏ¿ÎË2, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘1

AÏÏËÏÔÁÚ·Ê›·: µ·ÛÈÏÈ΋ °ÂˆÚÁÔÔ‡ÏÔ˘ villy_pedi@yahoo.gr ∞ÈÏÈ·ÓÔ‡ 29 ∆.∫. 112 54, ∫¿Ùˆ ¶·Ù‹ÛÈ· ∞ı‹Ó·

µÚ¤ÊÔ˜ ı‹Ï˘, ËÏÈΛ·˜ 3 ÌËÓÒÓ, ·ÚÔ˘Û›·Û ÂȉÂÈÓÔ‡ÌÂÓË ˆ¯ÚfiÙËÙ· Î·È ·ÓÔÚÂÍ›· ·fi 15Ë̤ÚÔ˘ Î·È ÌÂÙˆÚÈÛÌfi ÎÔÈÏ›·˜ ·fi 7Ë̤ÚÔ˘. ∆Ô ·ÙÔÌÈÎfi Î·È ÙÔ ÎÏËÚÔÓÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÔÓÙ·È ÂχıÂÚ·. ∆· ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙÔ˘ ΢‹Ì·ÙÔ˜ ·Ó·Ê¤ÚÔÓÙ·È ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ۈ̷ÙÈ΋ ·‡ÍËÛË Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠÎÔÈÏȷ΋ Ì¿˙· ÛÎÏËÚ‹˜ Û‡ÛÙ·Û˘, Ô˘ ηٷϿ̂·Ó ÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ Î·È ÂÂÎÙÂÈÓfiÙ·Ó ÛÙÔ ÂÈÁ¿ÛÙÚÈÔ. ∞fi Ù· ÏÔÈ¿ Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ÚԤ΢„ οÙÈ ·ıÔÏÔÁÈÎfi. ∏ ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ÁÏ˘Îfi˙Ë, Ô˘Ú›·, ÎÚ·ÙÈÓ›ÓË, SGOT, SGPT, ÁGT, ALP, LDH, ËÏÂÎÙÚÔχÙ˜, pH) ‰ÂÓ ¤‰ÂÈÍ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¤‰ÂÈÍ ÌfiÚʈ̷ ÂÙÂÚÔÁÂÓÔ‡˜ ˯ԉÔÌ‹˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ 10 cm, Ì ‰È¿Û·ÚÙ˜ ÌÈÎÚÔ·ÔÙÈÙ·ÓÒÛÂȘ, Ô˘ ·ÚÂÎÙfiÈ˙ ÙÔÓ ·ÚÈÛÙÂÚfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜, ÙÔÓ ÛÙfiÌ·¯Ô ηÈ, ÚÔ˜ Ù· ›Ûˆ, ÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊϤ‚· Î·È ÙËÓ ·ÔÚÙ‹. √ ‰ÂÍÈfi˜ ÏÔ‚fi˜ ÙÔ˘ ‹·ÙÔ˜ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ˜ ηٿ 3,5 cm, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ˘Ê‹, ÂÓÒ Ô ·ÚÈÛÙÂÚfi˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ·ÂÈÎÔÓÈÛÙ›. ∆· ˘fiÏÔÈ· ÂÓ‰ÔÎÔÈÏȷο fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. √ ¤ÏÂÁ¯Ô˜ ËÎÙÈÎfiÙËÙ·˜, Ë ÁÂÓÈ΋ Ô‡ÚˆÓ Î·È Ë

·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. √ ˘fiÏÔÈÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ¤‰ÂÈÍ ·ıÔÏÔÁÈο ÛÙÔȯ›· (·-ÂÌ‚Ú˘˚΋ ÚˆÙ½ÓË, ÊÂÚÚÈÙ›ÓË, ¿ÌÂÛÔ˜-¤ÌÌÂÛÔ˜ Coombs, VMA Î·È HVA Ô‡ÚˆÓ 24ÒÚÔ˘). ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· ¤‰ÂÈÍ ÂÈÎfiÓ· ·ÓÙ›‰Ú·Û˘ Ì˘ÂÏÔ‡ ÛÂ Û˘ÛÙËÌ·ÙÈ΋ ‹ ¯ÚfiÓÈ· ÓfiÛÔ ÂÍˆÌ˘ÂÏÈ΋˜ ÂÓÙfiÈÛ˘. ∆Ô ·È‰› ˘Ô‚Ï‹ıËΠ۠CT ÎÔÈÏ›·˜, fiÔ˘ ‰È·ÈÛÙÒıËΠÂÙÂÚÔÁÂÓ‹˜ Ì¿˙· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜ (ÙÌ‹Ì· ππ), ‰È·ÛÙ¿ÛÂˆÓ 10Ã10,5Ã6 cm, Ì ·ÔÙÈÙ·ÓÒÛÂȘ, Û·Ê‹ fiÚÈ·, ¤ÓÙÔÓË ÂÚÈÊÂÚÈ΋ ÚfiÛÏË„Ë ÛÎÈ·ÁÚ·ÊÈÎÔ‡ Î·È ÎÂÓÙÚÈΤ˜ Ù‹ÍÂȘ (∂ÈÎfiÓ· 1). ∏ Ì¿˙· ÚÔηÏÔ‡Û ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ· ÛÙÔÓ ÛÏ‹Ó· Î·È ÙÔÓ ·ÚÈÛÙÂÚfi ÓÂÊÚfi, ¯ˆÚ›˜ Ó· Ù· ‰ÈËı›. ∆· ˘fiÏÔÈ· fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∞ÎÔÏÔ‡ıËÛ·Ó ÂÚ¢ÓËÙÈ΋ Ï··ÚÔÙÔÌ›·, ‚ÈÔ„›· ‹·ÙÔ˜, ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Î·È ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜.

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. ™ËÚ·ÁÁ҉˜ ·ÈÌ·ÁÁ›ˆÌ· 2. ∏·ÙÔ‚Ï¿Ûو̷ 3. ªÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿Úو̷ 4. ™‡Ó‰ÚÔÌÔ Kasabach-Merritt 5. µÚÂÊÈÎfi Ë·ÙÈÎfi ·ÈÌ·ÁÁÂÈÔÂÓ‰ÔıËÏ›ˆÌ· (µ∏∞)

∂ÈÎfiÓ· 1. ÀÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ‡ÛÙÂÚ· ·fi ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡. ∂ÙÂÚÔÁÂÓ‹˜ Ì¿˙· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÏÔ‚fi ÙÔ˘ ‹·ÙÔ˜, Ì ·ÔÙÈÙ·ÓÒÛÂȘ Î·È Û·Ê‹ fiÚÈ·.

∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 344 Paediatriki 2007;70:340,344

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09-07-07

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¶ÚÔ˜ ÙËÓ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ™¯ÂÙÈο Ì ÙËÓ ÂÈÛ‹ÁËÛË Ù˘ ∂ÏÏËÓÈ΋˜ ¡ÂÔÁÓÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚfiÏË„Ë ÓfiÛÔ˘ ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi ∞ÍÈfiÙÈÌ ·ÚÈ ¢È¢ı˘ÓÙ¿, ™Â ÚfiÛÊ·ÙÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ‰ËÌÔÛȇıËÎ·Ó Û˘ÛÙ¿ÛÂȘ Ù˘ ∂ÏÏËÓÈ΋˜ ¡ÂÔÁÓÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ (∂¡∂) (Â› ÚÔ‰ڛ·˜ Î. ª. •¿ÓıÔ˘) ÁÈ· ¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÓfiÛÔ˘ ·fi ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV) (1). ∆Ô ¿ÚıÚÔ ·˘Ùfi Â›Ó·È Ô˘ÛÈ·ÛÙÈο ÌÈ· ·ÎÚÈ‚‹˜ ÌÂÙ¿ÊÚ·ÛË Û˘ÛÙ¿ÛÂˆÓ Ô˘ ÚÔÙ›ÓÔ˘Ó ÂÙ·ÈÚ›˜ ¿ÏÏˆÓ ÎÚ·ÙÒÓ ÁÈ· ÙȘ ¯ÒÚ˜ ÙÔ˘˜. ∞˘Ùfi Â›Ó·È Î·ıfiÏ· ÛÎfiÈÌÔ ·fi ÙË ÛÙÈÁÌ‹ Ô˘ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ ÁÈ· ÙÔ ·Ú·¿Óˆ ı¤Ì· ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ. ∆Ô ÌfiÓÔ ÛËÌÂ›Ô Ô˘ ÌÔÚ› Ó· ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ· Â›Ó·È ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ RSV, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙÔ ¿ÚıÚÔ. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ: “ÛÙËÓ ∂ÏÏ¿‰· (Ô RSV) ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂٷ͇ ¡ÔÂÌ‚Ú›Ô˘ Î·È ª·ÚÙ›Ô˘” (1). ŸÌˆ˜, Ô˘ıÂÓ¿ ÛÙÔ Î›ÌÂÓÔ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÂÏÏËÓÈ΋ ÌÂϤÙË Â›Ù οÔÈÔ ¿ÏÏÔ ÛÙÔÈ¯Â›Ô ·fi ÙÔ ÔÔ›Ô Ó· ÚÔ·ÙÂÈ ·˘Ùfi ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ RSV ÛÙËÓ ∂ÏÏ¿‰·. ¶·Ú·ı¤Ùˆ ‰‡Ô ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ ·fi ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ·Ó·ÊÂÚfiÌÂÓÔ ·fi ÙËÓ ∂¡∂ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Â›Ó·È ÂÛÊ·Ï̤ÓÔ: 1. ¶·ÓÂÏÏ‹ÓÈ· ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË, ‰ËÌÔÛÈÂ˘Ì¤ÓË ÙÔ 2002, Ô˘ ‰ÂÓ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ ¿ÚıÚÔ Ù˘ ∂¡∂ ‰Â›¯ÓÂÈ fiÙÈ Ë Ïԛ̈ÍË ·fi RSV Â›Ó·È ÈÔ Û˘¯Ó‹ ÙÔÓ ∞Ú›ÏÈÔ ·fi ÙÔÓ ¡Ô¤Ì‚ÚÈÔ Î·È ÙÔÓ ¢ÂΤ̂ÚÈÔ Î·È ÂÍ›ÛÔ˘ Û˘¯Ó‹ Ì ÙÔÓ π·ÓÔ˘¿ÚÈÔ. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÔÛÔÛÙfi 7,9-11,3% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÛËÌÂÈÒÓÔÓÙ·È ÙÔÓ ∞Ú›ÏÈÔ Î·È 0,3-4,6% ÙÔÓ ª¿ÈÔ (2), ÂÓÒ ÙÔÓ ¡Ô¤Ì‚ÚÈÔ ÛËÌÂÈÒÓÔÓÙ·È 1,9% Î·È ÙÔÓ ¢ÂΤ̂ÚÈÔ 9,8% (2). ™Ù· ÙÂÏÂ˘Ù·›· 10 ¯ÚfiÓÈ· ÓÔÛËχıËÎ·Ó ÛÙËÓ ª∂¡¡, fiÔ˘ ÚÔ˝ÛÙ·Ì·È, 47 ‚Ú¤ÊË Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· (ÛÙË ÏÂÈÔÓfiÙËÙ· ·fi RSV) Î·È Ë Êı›ÓÔ˘Û· ·ÚÈıÌËÙÈ΋ ηٷÓÔÌ‹ ÙÔ˘˜ ·Ó¿ Ì‹Ó· ‹Ù·Ó: ∞Ú›ÏÈÔ˜ 12, ºÂ‚ÚÔ˘¿ÚÈÔ˜ 11, ª¿ÚÙÈÔ˜ 8, π·ÓÔ˘¿ÚÈÔ˜ 6, ª¿ÈÔ˜ 5, πÔ‡ÓÈÔ˜ 2 Î·È ·fi ¤Ó· ÙÔ˘˜ Ì‹Ó˜ √ÎÙÒ‚ÚÈÔ, ¡Ô¤Ì‚ÚÈÔ Î·È ¢ÂΤ̂ÚÈÔ. ¶·ÚfiÙÈ Ô ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ·˘ÙÒÓ ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Î·È Ë ÂÈÏÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ·ÛÊ·ÏÒÓ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ, ÂÓÙÔ‡ÙÔȘ ·Ú¤¯ÂÙ·È Ì›· ¤Ó‰ÂÈÍË ÁÈ· ÙÔ˘˜ Ì‹Ó˜ ηٿ ÙÔ˘˜ ÔÔ›Ô˘˜ ÛËÌÂÈÒÓÔÓÙ·È ‚·ÚȤ˜ ÏÔÈÌÒÍÂȘ ·fi RSV Ô˘ ¯Ú‹˙Ô˘Ó ÓÔÛËÏ›·˜ ÛÙË ª∂¡¡. ŸÏ· Ù· ‚Ú¤ÊË ¯ÚÂÈ¿ÛÙËÎ·Ó Ô͢ÁfiÓÔ Î·È 26 ·fi Ù· 47 ¯ÚÂÈ¿ÛıËÎ·Ó Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜. ∞fi Ù· ·Ú·¿Óˆ Á›ÓÂÙ·È Û·Ê¤˜ fiÙÈ Ë ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ RSV, ÙËÓ ÔÔ›· ·Ó·Ê¤ÚÂÈ Ë ∂¡∂, ‰ÂÓ ÈÛ¯‡ÂÈ ÁÈ· Ù· ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ Ù˘ ∂ÏÏ¿‰·˜. ∫·Ù¿ ÙÔ˘˜ Ì‹Ó˜ ∞Ú›ÏÈÔ Î·È ª¿ÈÔ Î·Ù·ÁÚ¿ÊÔÓÙ·È ·ÚÎÂÙ¿ ÂÚÈÛÙ·ÙÈο, ÂÚÈÛÛfiÙÂÚ· ·fi fi,ÙÈ ÙÔÓ ¡Ô¤Ì‚ÚÈÔ Î·È ÙÔÓ ¢ÂΤ̂ÚÈÔ. √ÚÈṲ̂ӷ Ù·Ì›·, ‚·ÛÈ˙fiÌÂÓ· ÛÙËÓ ·ÙÂÎÌËÚ›ˆÙË Ô‰ËÁ›· Ù˘ ∂¡∂ fiÙÈ Ô RSV ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ∂ÏÏ¿‰· ηٿ ÙÔ˘˜ Ì‹Ó˜ ÌÂٷ͇ ¡ÔÂÌ‚Ú›Ô˘ Î·È ª·ÚÙ›Ô˘, ·ÚÓÔ‡ÓÙ·È Ó· ¯ÔÚËÁ‹ÛÔ˘Ó Synagis ÙÔÓ ∞Ú›ÏÈÔ Î·È ÙÔÓ ª¿ÈÔ Ì fi,ÙÈ ·˘Ùfi Û˘ÓÂ¿ÁÂÙ·È ÁÈ· ÙËÓ ˘Á›· ÓÂÔÁÓÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. £· ·Ú·Î·ÏÔ‡Û· fiÏÔ˘˜ ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Î·È Ù· Ù·Ì›· Ó· Ï¿‚Ô˘Ó ˘fi„Ë Ù· ÛÙÔȯ›· ·˘Ù¿. ∂›Û˘, Ì ·ÊÔÚÌ‹ ÙÔ Úfi‚ÏËÌ· ·˘Ùfi ı· ‹Ù·Ó ÛÎfiÈÌÔ ÔÈ Û˘ÛÙ¿ÛÂȘ ÙˆÓ ∂Ù·ÈÚÂÈÒÓ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ó· ‚·Û›˙ÔÓÙ·È Û ÙÂÎÌËÚȈ̤Ó˜ ·fi„ÂȘ ÔÌ¿‰·˜ ÂȉÈÎÒÓ. ªÂ ÂÎÙ›ÌËÛË ∞. ∞Ó‰Ú¤Ô˘ ¢È¢ı˘ÓÙ‹˜ ¡ÂÔÁÓÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ∂™À πÔÎÚ¿ÙÂÈÔ °¡£

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∂ÏÏËÓÈ΋ ¡ÂÔÁÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (EÈ̤ÏÂÈ· ™. ¶ÂÙÌÂ˙¿ÎË). ∂ÈÛ‹ÁËÛË ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚfiÏË„Ë ÓfiÛÔ˘ ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV). ¶·È‰È·ÙÚÈ΋ 2006;69:69-71.

2. Constantopoulos AG, Kafetzis DA, Syrogiannopoulos GA, Roilides EJ, Malaka-Zafiriou EE, Sbyrakis SS, et al. Burden of respiratory syncytial viral infections on pediatric hospitals: a two-year prospective epidemiological study. Eur J Clin Microbiol Infect Dis 2002;21:102-107.

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¶ÚÔ˜ ÙËÓ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ∞ÍÈfiÙÈÌ ·ÚÈ ¢È¢ı˘ÓÙ¿, ™¯ÂÙÈο Ì ÙËÓ ÂÈÛÙÔÏ‹ ÙÔ˘ ΢ڛԢ ∞Ó‰Ú¤Ô˘, Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙȘ Û˘ÛÙ¿ÛÂȘ Ù˘ ∂ÏÏËÓÈ΋˜ ¡ÂÔÁÓÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ (∂¡∂) ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Synagis (1), ı· ‹ıÂÏ· Ó· ··ÓÙ‹Ûˆ Ù· ÂÍ‹˜: 1. √ÚıÒ˜ ÙÔÓ›˙ÂÙ·È ÛÙËÓ ÂÈÛÙÔÏ‹ fiÙÈ ÔÈ Û˘ÛÙ¿ÛÂȘ ËÁ¿˙Ô˘Ó ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, ÁÂÁÔÓfi˜ Ô˘ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ¿ÚıÚÔ˘. ∫‡ÚÈ· ËÁ‹ ·ÔÙÂÏÔ‡Ó ÔÈ Û˘ÛÙ¿ÛÂȘ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ (2), ÛÙËÓ ÔÔ›· Î·È ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ¿ÏÏˆÓ ¯ˆÚÒÓ.

2. √ÚıÒ˜ Â›Û˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô˜ Û˘¯ÓfiÙÂÚ˘ Â›ÙˆÛ˘ Ù˘ Ïԛ̈͢ ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV) ‰È·Ê¤ÚÂÈ ·fi ¯ÒÚ· Û ¯ÒÚ·. ∆Ô ÛÙÔÈ¯Â›Ô ·˘Ùfi ÂÏ‹ÊıË ˘fi„Ë Î·È ¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›· ÛÙËÓ ∂ÏÏ¿‰· Â›Ó·È ‰È·ÊÔÚÂÙÈÎfi (3), fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙȘ Û˘ÛÙ¿ÛÂȘ (1). ∂›Û˘, Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ ·Ó·Ê¤ÚıËÎ·Ó ÂÎÙÂÓÒ˜ ÛÙËÓ ÔÌÈÏ›· ÌÔ˘ ÛÙÔ ™˘ÌfiÛÈÔ ÙÔ˘ 1Ô˘ ™˘Ó‰ڛԢ Ù˘ ∂¡∂ (∞Ú›ÏÈÔ˜ 2006).

3. ªÂÙ¿ ·fi Û˘ÏÏÔÁ‹ ÛÙÔȯ›ˆÓ ·fi ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¡ÂÔÁÓÒÓ ‰È·ÈÛÙÒıËΠfiÙÈ ÂÚÈÛÙ·ÙÈο Ì ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ·fi RSV ηٷÁÚ¿ÊËÎ·Ó Î·È ÙÔÓ ª¿ÈÔ. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·Ó·ÎÔÈÓÒıËÎ·Ó ÛÙÔ 44Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ (∞Ó·ÙÔÏ›ÙÔ˘ º. Î·È Û˘Ó. Î·È °È·ÓÓ¿ÎË ¶. Î·È Û˘Ó.).

4. ∆Ô Ó¤Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂¡∂ Ì ٷ ‰Â‰Ô̤ӷ ·˘Ù¿ ¤Î·Ó ÂÈÛ‹ÁËÛË ÚÔ˜ ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ Î·È ∫ÔÈÓˆÓÈ΋˜ ∞ÏÏËÏÂÁÁ‡Ë˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Á›ÓÂÈ ·Ô‰ÂÎÙ‹ Ë ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Synagis Î·È Î·Ù¿ ÙÔÓ ∞Ú›ÏÈÔ, ÒÛÙ ӷ Î·Ï˘ÊıÔ‡Ó Ù· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÓÂÔÁÓ¿ Î·È ÙÔÓ ª¿ÈÔ.

5. ŒÁÈÓ ÂÓË̤ڈÛË ÙˆÓ ∆·Ì›ˆÓ Î·È ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ÂÈϤÔÓ ÎfiÛÙÔ˘˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ Synagis Î·È ÙÔÓ ∞Ú›ÏÈÔ.

6. Œ¯ÂÈ ÂÙÔÈÌ·Ûı› ΛÌÂÓÔ Ì ·Ó¿ÏÔÁÔ ÂÚȯfiÌÂÓÔ ÁÈ· ηٷ¯ÒÚÈÛË ÛÙËÓ ÈÛÙÔÛÂÏ›‰· Ù˘ ∂¡∂.

7. ∂ÈÛ˘Ó¿ÙÔÓÙ·È ·ÓÙ›ÁÚ·Ê· Ù˘ ÂÈÛ‹ÁËÛ˘ ÚÔ˜ ÙÔÓ ÀÔ˘ÚÁfi ÀÁ›·˜ Î·È ∫ÔÈÓˆÓÈ΋˜ ∞ÏÏËÏÂÁÁ‡Ë˜ ηıÒ˜ Î·È ÙÔ˘ ÎÂÈ̤ÓÔ˘ ÁÈ· ÙËÓ Î·Ù·¯ÒÚÈÛË ÛÙËÓ ÈÛÙÔÛÂÏ›‰· Ù˘ ∂¡∂. ∂˘¯·ÚÈÛÙԇ̠Ôχ ÙÔÓ Î‡ÚÈÔ ∞Ó‰Ú¤Ô˘ ÁÈ· Ù· Û¯fiÏÈ¿ ÙÔ˘ Î·È ÁÈ· ÙËÓ Â˘Î·ÈÚ›· Ô˘ Ì·˜ ÚÔÛ¤ÊÂÚ ӷ ·Ó·ÊÂÚıԇ̠ÛÙȘ ÂÓ¤ÚÁÂȘ Ù˘ ∂¡∂ ÁÈ· ÙÔ ı¤Ì· ·˘Ùfi. ªÂ ÂÎÙ›ÌËÛË Î·È Û˘Ó·‰ÂÏÊÈÎÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜, ™ÔÊ›· ¶ÂÙÌÂ˙¿ÎË ¶·È‰›·ÙÚÔ˜ ¡ÂÔÁÓÔÏfiÁÔ˜ ¢È¢ı‡ÓÙÚÈ· ª∂¡¡ “ªËÙ¤Ú·”

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∂ÏÏËÓÈ΋ ¡ÂÔÁÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (EÈ̤ÏÂÈ· ™. ¶ÂÙÌÂ˙¿ÎË). ∂ÈÛ‹ÁËÛË ÁÈ· ¯ÔÚ‹ÁËÛË Synagis ÁÈ· ÚfiÏË„Ë ÓfiÛÔ˘ ·fi ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV). ¶·È‰È·ÙÚÈ΋ 2006;69:69-71.

2. American Academy of Pediatrics Committee on Infectious Diseases and Committee of Fetus and Newborn.

Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. Pediatrics 1998;102:1211-1216.

3. Constantopoulos AG, Kafetzis DA, Syrogiannopoulos GA, Roilides EJ, Malaka-Zafiriou EE, Sbyrakis SS, et al. Burden of respiratory syncytial viral infections on pediatric hospitals: a two-year prospective epidemiological study.

Eur J Clin Microbiol Infect Dis 2002;21:102-107.

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∞Á·ËÙÔ› ·ÚÈÔÈ, ∂›Ì·ÛÙ ÛÙËÓ Â˘¯¿ÚÈÛÙË ı¤ÛË Ó· Û·˜ ÂÓËÌÂÚÒÛÔ˘Ì fiÙÈ ÙÔ ∫¤ÓÙÚÔ ¶ÚfiÏ˄˘ Î·È ÀÁ›·˜ ÙˆÓ ∂Ê‹‚ˆÓ (∫∂.¶.À.∂.-“º›ÏÔÈ ∂Ê‹‚ˆÓ”) Ù˘ ∞ã ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, Û˘ÌÏ‹ÚˆÛ ‰‡Ô ¯ÚfiÓÈ· ÂÈÙ˘¯Ô‡˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ·ÓÔ‰È΋ ÔÚ›· ÙÔ˘ ÚÒÙÔ˘ ∫¤ÓÙÚÔ˘ ÁÈ· ÂÊ‹‚Ô˘˜ Û˘Ó¯›˙ÂÙ·È, ÌÂÙÚÒÓÙ·˜ ̤¯ÚÈ Û‹ÌÂÚ· 600 ÂÊ‹‚Ô˘˜ Î·È ÔÏÏÔ‡˜ ÁÔÓ›˜ Ô˘ ¤Ï·‚·Ó ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· Î·È ÛÙ‹ÚÈÍË Û ı¤Ì·Ù· Ô˘ ÙÔ˘˜ ··Û¯ÔÏÔ‡Û·Ó. ∆Ô ∫∂.¶.À.∂. ‰¤¯ÂÙ·È ÂÊ‹‚Ô˘˜ 11-18 ÂÙÒÓ Î·È ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜, Û ÒÚ˜ Û˘Ì‚·Ù¤˜ Ì ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜ Î·È ÔÈ ˘ËÚÂۛ˜ Ô˘ ·Ú¤¯ÔÓÙ·È Â›Ó·È: 1. ™˘Ì‚Ô˘Ï¢ÙÈ΋ Î·È ÚÔÏËÙÈ΋ ·ÁˆÁ‹ ˘Á›·˜, 2. ¢È·ÁÓˆÛÙÈ΋ Î·È ıÂÚ·¢ÙÈ΋ ‚Ô‹ıÂÈ· Û ÂÊ‹‚Ô˘˜ Ì ÔÚÁ·ÓÈο ‹ „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, 3. ∂ÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ÙȘ ȉȷÈÙÂÚfiÙËÙ˜ ÙˆÓ ÂÊ‹‚ˆÓ. √È ·Ó¿ÁΘ ÙˆÓ ÂÊ‹‚ˆÓ ηχÙÔÓÙ·È ·fi Ù· ·Ú·Î¿Ùˆ ÂȉÈο ÙÌ‹Ì·Ù· : ñ ∞ÁˆÁ‹˜ ÀÁ›·˜ ñ ¢È·ÙÚÔÊ‹˜-ÕÛÎËÛ˘ ñ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ ñ °˘Ó·ÈÎÔÏÔÁ›·˜ ñ ¢ÂÚÌ·ÙÔÏÔÁ›·˜ ñ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ ñ ¡Â˘ÚÔÏÔÁ›·˜ ñ æ˘¯È·ÙÚÈ΋˜ ñ æ˘¯ÔÏÔÁÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ (·ÙÔÌÈ΋ ˘ÔÛÙ‹ÚÈÍË ‹ ÔÌ¿‰· ÂÊ‹‚ˆÓ) ÎÏ. ¶·Ú¿ÏÏËÏ· ˘¿Ú¯ÂÈ Û˘ÓÂÚÁ·Û›· Î·È Ì ¿ÏϘ ÂȉÈÎfiÙËÙ˜, ·Ó¿ÏÔÁ· Ì ÙȘ ·Ó¿ÁΘ ÙˆÓ ÂÊ‹‚ˆÓ. ∏ ÂÊ˂›· Â›Ó·È ÌÈ· ËÏÈΛ· Ì ÔÏϤ˜ ‰˘ÛÎÔϛ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰È·ÚÔÛˆÈÎÒÓ Û¯¤ÛˆÓ. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ÂÈÏÔÁ‹ ÙˆÓ ÂȉÈÎÒÓ ÙÔ˘ ∫¤ÓÙÚÔ˘ Ì·˜, Ì ÎÚÈÙ‹ÚÈÔ ÙËÓ Î·Ù¿ÏÏËÏË ÁÓÒÛË Î·È ÂÌÂÈÚ›· ηıÒ˜ Î·È Ë Ù‹ÚËÛË ·fiÏ˘Ù˘ ¯Â̇ıÂÈ·˜ ·fi ÏÂ˘Ú¿˜ ÙÔ˘˜, ‚ÔËı¿ÂÈ ÛÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ È·ÙÚÔ‡-ÂÊ‹‚Ô˘. ™ÙÔ ∫∂.¶.À.∂. ηٿ ÙËÓ ÚÒÙË Â›ÛÎÂ„Ë ÙÔ˘ ÂÊ‹‚Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ô ‚·ÛÈÎfi˜ ÔÚÁ·ÓÈÎfi˜ ¤ÏÂÁ¯Ô˜ ηıÒ˜ Î·È Û˘˙‹ÙËÛË Ô˘ ·ÊÔÚ¿ ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË Î·È Û˘ÌÂÚÈÊÔÚ¿, ÚÔÛʤÚÔÓÙ¿˜ ÙÔ˘ ¤ÙÛÈ Ù· ηٿÏÏËÏ· ÂÊfi‰È· ÁÈ· ÛˆÛÙ¤˜ ÂÈÏÔÁ¤˜ Î·È ·ÔÊ¿ÛÂȘ Ô˘ ı· ηıÔÚ›ÛÔ˘Ó ÙËÓ ÔÚ›· ÙÔ˘ ÚÔ˜ ÙËÓ ÂÓËÏÈΛˆÛË. °È· ÏËÚÔÊÔڛ˜ Î·È Ú·ÓÙ‚ԇ ÔÈ ¤ÊË‚ÔÈ ‹ Î·È ÔÈ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ ÌÔÚÔ‡Ó Ó· ηÏÔ‡Ó ÛÙÔ 210 746 74 54 ηıËÌÂÚÈÓ¿ 10.00-14.30 ‹ ÛÙÔ 210 746 74 52 15.00-17.00. ªÂ ÙÈÌ‹, √ ¢È¢ı˘ÓÙ‹˜ °ÂÒÚÁÈÔ˜ ¶. ÃÚÔ‡ÛÔ˜ ∫·ıËÁËÙ‹˜-¢È¢ı˘ÓÙ‹˜ ∞ã ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

∏ ∂ÈÛÙËÌÔÓÈ΋ À‡ı˘ÓË ∫·Ú¿ÓÙ˙· ª·Ú›· ¶·È‰›·ÙÚÔ˜-∂Ó‰ÔÎÚÈÓÔÏfiÁÔ˜

¶·È‰È·ÙÚÈ΋ 2007;70:341-343

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CLINICAL QUIZ

∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏ ∏ ‰È¿ÁÓˆÛË ‹Ù·Ó ‚ÚÂÊÈÎfi Ë·ÙÈÎfi ·ÈÌ·ÁÁÂÈÔÂÓ‰ÔıËÏ›ˆÌ· (µ∏∞). √È Ë·ÙÈÎÔ› fiÁÎÔÈ ÛÙ· ·È‰È¿ Â›Ó·È Û¿ÓÈÔÈ (2-3% ÙˆÓ fiÁΈÓ) (1). ∆Ô µ∏∞ Â›Ó·È Ô ÙÚ›ÙÔ˜ ÈÔ Û˘¯Ófi˜ fiÁÎÔ˜ ‹·ÙÔ˜ ÛÙ· ·È‰È¿ (12%) Î·È Ô ÈÔ Û˘¯Ófi˜ ηÏÔ‹ı˘ ·ÁÁÂÈ·Îfi˜ fiÁÎÔ˜ ‹·ÙÔ˜ ÛÙ· ‚Ú¤ÊË, Ô ÔÔ›Ô˜ fï˜ ÌÔÚ› Ó· ÂÍ·ÏÏ·Á› Û ۿÚΈ̷ (2,3). √È ÂÚÈÛÛfiÙÂÚÔÈ fiÁÎÔÈ ·˘Í¿ÓÔ˘Ó Û ̤ÁÂıÔ˜ ηٿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ Î·È Û˘Ó‹ıˆ˜ ˘ÔÛÙÚ¤ÊÔ˘Ó Ì¤¯ÚÈ ÙÔ ‰Â‡ÙÂÚÔ (3,4). ∏ ‚Ï¿‚Ë ÌÔÚ› Ó· Â›Ó·È ÌÔÓ‹Ú˘ ‹ ÔÏ˘ÂÛÙȷ΋ (5). √ ÌÔÓ‹Ú˘ fiÁÎÔ˜ Â›Ó·È Û·ÊÒ˜ ÂÚÈÁÂÁÚ·Ì̤ÓÔ˜, ¯ˆÚ›˜ ο„·, Ì ‰È¿ÌÂÙÚÔ 0,2 ¤ˆ˜ 15 cm (6). Œ¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ‰‡Ô Ù‡ÔÈ µ∏∞. ™ÙÔÓ Ù‡Ô π, ÙÔ ÌfiÚʈ̷ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘¯Ó¿ ·ÔÙÈÙ·ÓÒÛÂȘ, Ì ÔÏÏ·Ï¿ ÌÈÎÚ¿ ·ÁÁ›· Ì ·ÓÒÚÈÌ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· Î·È Û¯ÈÛÌÔÂȉ›˜ ¯ÒÚÔ˘˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÁÎψ‚›˙ÔÓÙ·È ¯ÔÏËÊfiÚ· ·ÁÁ›·. ™ÙÔÓ Ù‡Ô ππ, Ù· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ÌÔÚÊÒÌ·ÙÔ˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ·‰È·ÊÔÚÔÔ›ËÙ·, ¯ˆÚ›˜ ÛÙÚÒÌ· ¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ (7,8). ∆Ô µ∏∞ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó Ù‡Ô˘ π. √ fiÁÎÔ˜ ÌÔÚ› Ó· Â›Ó·È ·Û˘Ìو̷ÙÈÎfi˜, Û˘¯Ó¿ fï˜ ÚÔ‚¿ÏÏÂÈ Ì Ë·ÙÔÌÂÁ·Ï›·, ÌÂÙˆÚÈÛÌfi ÎÔÈÏ›·˜ ‹ „ËÏ·ÊËÙ‹ Ì¿˙·. ªÔÚ› Ó· ˘¿Ú¯Ô˘Ó ÂÎÙÂٷ̤Ó˜ ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ÂÈÎÔÈӈӛ˜, ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ·˘ÍË̤Ó˜ ÂÚÈÊÂÚÈΤ˜ ·ÓÙÈÛÙ¿ÛÂȘ Î·È Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· Ì ˘„ËÏ‹ ·ÚÔ¯‹, ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈ΋ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Î·È ıÚÔÌ‚Ô΢ÙÙ·ÚÔÂÓ›·, ÏfiÁˆ ηٷÛÙÚÔÊ‹˜ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ ÂÓÙfi˜ ÙÔ˘ fiÁÎÔ˘. ™ÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û˘Ó˘¿Ú¯ÂÈ ÂȉÂÚÌȉÈÎfi ·ÈÌ·ÁÁ›ˆÌ·. ªÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ›ÎÙÂÚÔ˜, ÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜, ÂÓÙÂÚÈ΋ ·fiÊÚ·ÍË, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ·ÈÌÔÂÚÈÙfiÓ·ÈÔ Î·È shock, ÏfiÁˆ ڋ͢ ÙÔ˘ fiÁÎÔ˘ (5,8,9). ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙ· Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ÛÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË. ™Â ÂÚÈÙÒÛÂȘ µ∏∞ Ì ·ÚÙËÚÈÔÊÏ‚҉ÂȘ ÂÈÎÔÈӈӛ˜, Ù· ‰È·ÙÂٷ̤ӷ ·ÁÁ›· Ì ·˘ÍË̤ÓË ÚÔ‹ ·›Ì·ÙÔ˜ ‰›ÓÔ˘Ó Ù˘È΋ ÂÈÎfiÓ· ÛÙÔ Doppler. ªÂ ÙËÓ CT Î·È ÙËÓ MRI ÎÔÈÏ›·˜ ηıÔÚ›˙ÔÓÙ·È Ù· ·ÎÚÈ‚‹ ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ Ì¿˙·˜, ÙÔ Ì¤ÁÂıÔ˜, Ë ÔÌÔÈÔÁ¤ÓÂÈ· ‹ Ë ÂÙÂÚÔÁ¤ÓÂÈ· ·˘Ù‹˜, Ë ‡·ÚÍË ·ÈÌÔÚÚ·ÁÈÒÓ, ÓÂÎÚÒÛˆÓ, ÈÓÒÛÂˆÓ ‹ ·ÔÙÈÙ·ÓÒÛÂˆÓ Î·È Ë ‰È‹ıËÛË ‹ Ë ·ÚÂÎÙfiÈÛË ·Ú·Î›ÌÂÓˆÓ ÔÚÁ¿ÓˆÓ (4,5). ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Á›ÓÂÈ ·fi ÙÔ ÛËÚ·ÁÁ҉˜ ·ÈÌ·ÁÁ›ˆÌ·, ÙÔ Ë·ÙÔ‚Ï¿Ûو̷ Î·È ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿Úو̷. ∆Ô ÚÒÙÔ ··ÓÙ¿Ù·È Paediatriki 2007;70:340,344

Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Î·È ÛÙÔ ÛÒÌ· Û˘Ó˘¿Ú¯Ô˘Ó Î·È ¿ÏÏ· ·ÈÌ·ÁÁÂÈÒÌ·Ù·, ÂÓÒ ÙÔ ‰Â‡ÙÂÚÔ Â›Ó·È Î·ÎÔ‹ı˘ fiÁÎÔ˜, Ô˘ ··ÓÙ¿Ù·È Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 5 ÂÙÒÓ. ∆¤ÏÔ˜, ÙÔ ÌÂÛÂÁ¯˘Ì·ÙÈÎfi ·Ì¿Úو̷ Â›Ó·È Î˘ÛÙÈ΋˜ ˘Ê‹˜ Î·È ÚÔ‚¿ÏÏÂÈ Ì ˘ÚÂÙfi, ÌÂÙˆÚÈÛÌfi, Â̤ÙÔ˘˜ Î·È ‰˘ÛÎÔÈÏÈfiÙËÙ· (4). ™Â ·È‰È¿ Ì ·Û˘Ìو̷ÙÈÎfi µ∏∞ ‰ÂÓ ··ÈÙÂ›Ù·È ıÂÚ·›·, ÂÓÒ, fiÙ·Ó ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù·, Ë ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Î·È ·-ÈÓÙÂÚÊÂÚfiÓ˘. ™Â ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ·ÔÙ˘Á¯¿ÓÂÈ Ë Û˘ÓÙËÚËÙÈ΋ ·ÁˆÁ‹, ÚÔÙ›ÓÂÙ·È ÂÌ‚ÔÏÈÛÌfi˜ ‹ ·ÔϛӈÛË Ù˘ Ë·ÙÈ΋˜ ·ÚÙËÚ›·˜. √È ÌÔÓ‹ÚÂȘ Û˘Ìو̷ÙÈÎÔ› fiÁÎÔÈ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË, fiˆ˜ ¤ÁÈÓ ÛÙÔ ‚Ú¤ÊÔ˜ Ô˘ ÂÚÈÁÚ¿„·ÌÂ, Û ÂȉÈÎfi ΤÓÙÚÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÔÈ ˘fiÏÔÈ˜ ̤ıÔ‰ÔÈ ·ÔÙ‡¯Ô˘Ó, Û˘ÓÈÛÙ¿Ù·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (5,9).

µÈ‚ÏÈÔÁÚ·Ê›· 1. Parker BR. The hepatobiliary system. In: Silverman FN, Kuhn JP, eds. Caffey’s pediatric x-ray diagnosis: an integrating imaging approach. 9th ed. St. Louis, Mo: Mosby; 1993. 915-969.

2. Mortelé KJ, Vanzieleghem B, Mortelé B, Benoit Y, Ros PR. Solitary hepatic infantile hemangioendothelioma: dynamic gadolinium-enhanced MR imaging findings. Eur Radiol 2002;12:862-865.

3. Sty JR, Wells RG, Starshak RJ, Gregg DC. The hepatobiliary system. In: Sty JR, Wells RG, Starshak RJ, Gregg DC (eds). Diagnostic imaging of infants and children. Gaithersburg, Md: Aspen Publishers;1992.

247-293.

4. Rajendran VR, Manoj B. Giant infantile hemangioendothelioma liver in a two month old baby with a normal identical twin- a case report. Calicut Med J 2004;2:E6.

5. Konus √L, Ozdemir H, Onal B, Isik S. Infantile hepatic hemangioendothelioma: findings in the liver with spectral and color Doppler Sonography. Gazi Med J 1999;10:156-160.

6. Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK. CT and MR imaging of benign hepatic and biliary tumors. Radiographics 1999;19:431-451.

7. Dehner LP, Ishak KG. Vascular tumors of the liver in infants and children. A study of 30 cases and review of the literature. Arch Pathol 1971;92:101-111.

8. Zenge JP, Fenton L, Lovell MA, Grover TR. Case report: infantile hemangioendothelioma. Curr Opin Pediatr 2002;14:99-102.

9. Swischuk LE. Abnormalities of the liver. In: Swischuk LE, eds. Imaging of the newborn, infant, and young child. 4th ed. Baltimore: Md: Williams & Wilkins; 1997. 501-521.

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24-25 ∞˘ÁÔ‡ÛÙÔ˘ 2007

3Ô ¢ÈÂıÓ¤˜ ™˘Ó¤‰ÚÈÔ ¡ÔÛËÏ¢ÙÒÓ ¶·È‰È·ÙÚÈ΋˜ ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ AC&C International Tel.: 210 6889100 Fax: 210 6844777 E-mail: pn2007@acnc.gr Website: www.pediatricnursing2007.com

∞ı‹Ó·

25-30 ∞˘ÁÔ‡ÛÙÔ˘ 2007

25th International Congress of Pediatrics ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: ∞C&C International Tel.: 210 68 89 100 Fax: 210 68 44 777 E-mail: icp2007@acnc.gr Website: www.icp2007.gr

∞ı‹Ó·

31 ∞˘ÁÔ‡ÛÙÔ˘ 4 ™ÂÙÂÌ‚Ú›Ô˘ 2007

14th Congress of the International Pediatric Nephrology Association Blaguss Congress Bureau Tel.: +36 1 374 7030, Fax: +36 1 312 1582 E-mail: info@blaguss-congress.hu Website: www.blaguss-congress.hu

µÔ˘‰·¤ÛÙË, √˘ÁÁ·Ú›·

5-6 ™ÂÙÂÌ‚Ú›Ô˘ 2007

3rd International Multi-disciplinary symposium on Congenital Malformations in Fetus and Child Contact: Dr Liana Beni-Adani Tel.: 972 524 262 057 Fax: 972 36 973 451 E-mail: lianabenia@gmail.com

Jerusalem, Israel

9-12 ™ÂÙÂÌ‚Ú›Ô˘ 2007

2nd World Congress of the World Federation of Associations of Pediatric Surgeons Contact: General Secretariat, Uniline Exhibitions S.A, Av. Cfirdoba 632, 11th floor, (C1054AAS) Buenos Aires, Argentina Tel.: 541 143 225 707 E-mail : pedsurg2007@uniline.com.ar

Buenos Aires, Argentina

9-13 ™ÂÙÂÌ‚Ú›Ô˘ 2007

8th World Congress of Perinatal Medicine Contact: MCA Events - Roberto Caflisch Tel.: 39 0 234 934 404 Fax: 39 0 234 934 397 E-mail: caflisch@mcaevents.org

Florence, Italy

13-14 ™ÂÙÂÌ‚Ú›Ô˘ 2007

European Society for Social Pediatrics and Child Health Annual Meeting Contact: Dr. Stella Tsitoura Dept of Social Pediatrics Aglaia Kyriakou Children's Hospital 18, Mesogeion Avenue Athens, Greece E-mail: socmed@otenet.gr Website: www.essop.org

Trieste, Italy

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14-16 ™ÂÙÂÌ‚Ú›Ô˘ 2007

European Society for Paediatric Haematology & Immunology 2007 Athens Hilton ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress S.A 15, Mesogion Avenue, 115 26 Athens, Greece ∆ËÏ.: 210 74 99 372 / 304 / 300 Fax: 210 77 13 795 E-mail: congress@triaenatours.gr Website: www.esphi2007-athens.gr

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21 - 23 ™ÂÙÂÌ‚Ú›Ô˘ 2007

™ÂÌÈÓ¿ÚÈÔ ∂ÍÂȉÈÎÂ˘Ì¤Ó˘ ÀÔÛÙ‹ÚÈ͢ Ù˘ ∑ˆ‹˜ ÛÙ· ¶·È‰È¿ (APLS) ∆Ì‹Ì· π·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ¶ÏËÚÔÊÔڛ˜: ª.∂.£.¶. ¶·.°.¡.∏. ∆ËÏ.: 2810 392447 Fax: 2810 392652 ∂-mail: julietaperezg@hotmail.com

∏Ú¿ÎÏÂÈÔ, ∫Ú‹Ù˘

21-23 ™ÂÙÂÌ‚Ú›Ô˘ 2007

2Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ∂ÏÏËÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ Aldemar Olympian Village Resort ¶ÏËÚÔÊÔڛ˜: FIRSTEVENT ∆ËÏ.: 210 8228950 Fax: 210 8228901 E-mail: info@firstevent.gr

™Î·Êȉȿ ∏Ï›·˜

21-23 ™ÂÙÂÌ‚Ú›Ô˘ 2007

3rd ESH-EHA Conference on Focus on Paediatric Haematology and Oncology Contact: Conference Secretariat: European School of Haematology (ESH), Centre Hayem, Hôpital Saint-Louis, 1, av. Claude Vellefaux Cedex 10, 75475 Paris Tel.: 33 142 066 540 Fax: 33 142 060 587 E-mail: ghyslaine_lebougault@paris7.jussieu.fr

Sestri Levante, Italy

26-29 ™ÂÙÂÌ‚Ú›Ô˘ 2007

The 7th Congress of the European Pediatric Neurology Society Contact: Flap Tour Tel.: 90-3-124-540-000 Fax: 90-3-124-540-001 E-mail: epns2007@flaptour.com.tr Website: www.epns2007.org

Kuçadasi, Turkey

18-22 √ÎÙˆ‚Ú›Ô˘ 2007

19th International Congress of Pediatrics Contact: Dr GhR Walizadeh, Dr A Habibolahi Tel.: 982 166 428 998 Fax: 982 166 923 054 E-mail: pedcong@tums.ac.ir

Tehran, Iran