Παιδιατρική | Τόμος 71 • Τεύχος 5 • Σεπτέμβριος - Οκτώβριος 2008

Pediatri Sept-Oct 08

15-10-08

09:52

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ™. ∞Ó‰ÚÔÓ›ÎÔ˘ ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ °. µ·ÚÏ¿Ì˘ ∂. °·Ï·Ó¿Î˘ §. £ˆÌ·˝‰Ô˘ ª. ∫·Ó¿ÚÈÔ˘ A. K·ÙÙ¿Ì˘ ™. K›ÙÛÈÔ˘-∆˙¤ÏË ∞. ¶··‰ÔÔ‡ÏÔ˘ µ. ¶··Â˘·ÁÁ¤ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∂. ÷ÚÌ·Ó‰¿ÚË ÀÔ‚ÔÏ‹ ∂ÚÁ·ÛÈÒÓ e-mail: hps@ath.forthnet.gr √‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜: http://www.e-child.gr/Instructions_ to_Authors_GR.pdf ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ∫. ¶··¯Ú‹ÛÙÔ˘ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘ K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶ÈÂÚ›·˜ 1∞ 144 51 MÂÙ·ÌfiÚʈÛË TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889

ISSN 0377-2551

™ÂÏ›‰·1

¶·È‰È·ÙÚÈ΋ ∆fiÌÔ˜ 71 ñ ∆‡¯Ô˜ 5 ñ ™Â٤̂ÚÈÔ˜-√ÎÙÒ‚ÚÈÔ˜ 2008

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390 ¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ¡. ÷ÏÈ¿ÛÔ˜, ∞. µÏ¿¯Ô˜, ∞. ª¿Î˘

345 A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases X. Castellsagué, G. Trimis, D. Florakis

∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏

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403 ¶·È‰› Ì “ÏÂÈÙÔ˘ÚÁÈÎfi” ʇÛËÌ· N. ∞Ó·ÁÓˆÛÙ¿ÙÔ˘, π. °ÂÚÌ·Ó¿Î˘, ª. ∫·ÏÌ·ÓÙ‹

368 ™¯¤ÛË ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Ì ÂÈÏÂÁ̤Ó˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û 11¯ÚÔÓ· ·È‰È¿ ∞. ÃÚÈÛÙfi‰Ô˘ÏÔ˜, ∂. ¢Ô‡‰·, ¢. ∆Ô‡ÛÔ˘Ï˘, ™. ∆ÔÎ̷Λ‰Ë˜ 376 ™˘¯ÓfiÙËÙ· Î·È ÂȉËÌÈÔÏÔÁ›· Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ Ù˘ ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋˜ ∞ÙÙÈ΋˜. ∂›‰Ú·ÛË ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·È Ô ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ √. ºÈÏ›Ô˘, ª. ¢ÔÏÈ·Ó›ÙË, ∫. ∫·Ú·Ó¿ÛÈÔ˘, µ. ∆·ÛÈÔÔ‡ÏÔ˘, ª. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘, ™. ¶··‰¿ÎÔ˘-§·ÁÔÁÈ¿ÓÓË 383 ∏ıÈο ‰ÈÏ‹ÌÌ·Ù· ηٿ ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË: ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ‰È·ÎÚ·ÙÈÎÔ‡ ÂÚ¢ÓËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ EDIG ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË, ™. ÃÚÈÛÙÔÁÈÒÚÁÔ˜, µ. µ·ÛÈÏÔÔ‡ÏÔ˘, ∂˘Á. ™Ô˘Ì¿ÎË, °. ∫ÔÏ·˝Ù˘, µ. §¿ÁÁ·ÚË, ∫. ∫ˆÛÙ¿ÎÔ˘, µ. µÂÏÈÛÛ·Ú›Ô˘, ¡. ™ÙÚ›ÓÙ˙˘, ¢. ªfiÙÛ˘, ∂. ∫·Ó·‚¿Î˘, π. ∆ÛÈ¿ÓÙ˘, EDIG consortium

™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞ 404 ∞ÏÁfiÚÈıÌÔÈ, Û˘ÛÙ¿ÛÂȘ, ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Î·È ı¤ÛÂȘ 2008 E. °·Ï·Ó¿Î˘ ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ 407 ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ §. £ˆÌ·˝‰Ô˘ ¡∂∫ƒ√§√°π∞ 409 Victor A. McKusick Ã. ™. ª·ÚÙÛfiη˜ ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ 413 ™˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV A. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

Pediatri Sept-Oct 08

15-10-08

09:52

™ÂÏ›‰·3

Bimonthly Publication of the Greek Paediatric Society

Paediatriki

President A. Constantopoulos Editorial Board Editor-in-Chief C. Stefanidis Members S. Andronikou ª. ∞nthracopoulos P. Augoustides-Savvopoulou G. Varlamis ∂. Galanakis L. Thomaidou M. Kanariou A. Kattamis S. Kitsiou-Tzeli ∞. Papadopoulou V. Papaevagelou A. Siamopoulou-Mavridou A. Syrigou-Papavasiliou E. Charmandari Manuscript submission e-mail: hps@ath.forthnet.gr Instructions to authors: http://www.e-child.gr/paediatriki/ iae.pdf Manuscript Editing Greek Editing K. Papachristou 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 St. 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

Volume 71 ñ Number 5 ñ September-October 2008

Contents REVIEW ARTICLES

PRACTICAL ISSUE

331 Psychology of embryos, neonates and infants: current developmental research G. Kugiumutzakis

390 Diagnostic approach to lymphadenopathy in children N. Chaliasos, A. Vlahos, A. Makis

345 A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases X. Castellsagué, G. Trimis, D. Florakis

CASE REPORT

355 Phimosis and circumcision in children G. Sakellaris, I. Bouloukaki, A. Dimopoulou, G. Charissis

399 Thrombocytopenic purpura in a child with brucellosis: case report and literature review ∞. ªanola, ∞. ªakis, C. ∆saousi, ¡. Chaliasos, ∞. Siamopoulou-Mavridou

ORIGINAL ARTICLES

CLINICAL QUIZ

361 Adherence to the Mediterranean diet by children and adolescents in Greece N. Vidra, A-E. Farmaki, S. Koinaki, K. Belogianni, S. Sofrona, F. Magkanari, M. Kontogianni, M. Yannakoulia

403 “Innocent” heart murmur in a child N. Anagnostatou, I. Germanakis, M. Kalmanti PAEDIATRIC NEWS IN BRIEF

368 The relation of body mass index with selected behavioural parameters in 11 year-old children A. Christodoulos, H. Douda, D. Tousoulis, S. Tokmakidis

NEWS FROM THE INTERNET

376 The prevalence and epidemiology of obesity in children of southeastern Attica.

The modern lifestyle and the role of the primary care paediatrician O. Filippou, M. Dolianiti, K. ∫aranasiou, V. Tasiopoulou, M. Ziva-Petropoulou, S. Papadakou-Lagogianni 383Ethical dilemmas due to prenatal diagnostics: preliminary results of the multicentre research programme EDIG S. Kitsiou-Tzeli, S. Christogiorgos, V. Vassilopoulou, Eug. Soumaki, G. Kolaitis, V. Lagari, K. Kostakou, V. Velissariou, N. Strintzis, D. Botsis, E. Kanavakis, J. Tsiantis, EDIG consortium

404 Algorithms, Recommendations, Guidelines and Scientific Statements 2008 E. Galanakis

407 An algorithm for Developmental Surveillance and Screening L. Thomaidis OBITUARY 409 Victor A. McKusick Ch. Sp. Bartsokas LETTER TO THE EDITORIAL BOARD 413 Prescription of the HPV vaccine A. Constantopoulos

Pediatri Sept-Oct 08

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™ÂÏ›‰·5

™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‰ÚÔÓ›ÎÔ˘, ¡ÂÔÁÓÔÏÔÁ›·, πˆ¿ÓÓÈÓ·

Stella Andronikou, Neonatology, Ioannina

ªÈ¯·‹Ï ∞ÓıÚ·ÎfiÔ˘ÏÔ˜, ¶Ó¢ÌÔÓÔÏÔÁ›·, ¶¿ÙÚ·

Michael Anthracopoulos, Pneumonology, Patras

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

Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki

°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

∞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

µ·ÛÈÏÈ΋ ¶··Â˘·ÁÁ¤ÏÔ˘, §ÔÈ̈ÍÈÔÏÔÁ›·, ∞ı‹Ó·

Vassiliki Papaevagelou, Infectious Diseases, Athens

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

Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina

∞ÓÙÈÁfiÓË ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ, ¡Â˘ÚÔÏÔÁ›·, ∞ı‹Ó·

Antigone Syrigou-Papavasiliou, Neurology, Athens

∂˘·ÁÁÂÏ›· ÷ÚÌ·Ó‰¿ÚË, ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·, ∞ı‹Ó·

Evangelia Charmandari, Endocrinology, 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

Nikolai Shabalov, St. Petersburg, Russia

Richard N. Fine, Stony Brook, USA

Alan Sinaiko, Minneapolis, USA

Margaret C. Fisher, Philadelphia, USA

Nick J. Spencer, Coventry, UK

Raif Geha, Boston, USA

Alfred Tenore, Udine, Italy

Adenike Grange, Lagos, Nigeria

Alkis Togias, Bethesda, USA

Judith G. Hall, Vancouver, Canada

Eva Tsalikian, Iowa City, USA

Patricia Hamilton, London, UK

Catherine Weil-Olivier, Paris, France

Enver Hasanoglu, Ankara, Turkey

Max Zach, Graz, Austria

Christer Holmberg, Helsinki, Finland

Zheng-Yan Zhao, Hangzhou, China

Lewis B. Holmes, Boston, USA

Johannes Zschocke, Heidelberg, Germany

v

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REVIEW ARTICLE

331

æ˘¯ÔÏÔÁ›· ÂÌ‚Ú‡ˆÓ, ÓÂÔÁÓÒÓ Î·È ‚ÚÂÊÒÓ: Û‡Á¯ÚÔÓË ·Ó·Ù˘Íȷ΋ ¤Ú¢ӷ* °. ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘ ¶ÂÚ›ÏË„Ë: ™ÙÔ ·ÚfiÓ Î›ÌÂÓÔ ÂÚÈÁÚ¿ÊÔÓÙ·È Â˘Ú‹Ì·Ù· Ù˘ Û‡Á¯ÚÔÓ˘ ∞Ó·Ù˘Íȷ΋˜ æ˘¯ÔÏÔÁ›·˜ Û¯ÂÙÈο Ì ÙȘ ÈηÓfiÙËÙ˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ, ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ 21 Ì‹Ó˜ Ù˘ ˙ˆ‹˜ (ÂÁ΢ÌÔÛ‡ÓË Î·È ÚÒÙÔ ¤ÙÔ˜). √È ·Ó·ÙÚÔ¤˜ Ô˘ Â¤ÊÂÚ ÛÙȘ „˘¯ÔÏÔÁÈΤ˜ ıˆڛ˜ Ë ¤Ú¢ӷ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÓÔ˘ ‹Ù·Ó ÌÂÁ¿Ï˜, Ë ÚfiÔ‰Ô˜ Ù˘ ÁÓÒÛ˘ Û·Ê‹˜, Ù· ÛËÌ›· ÎÔÈÓÒÓ ÂӉȷÊÂÚfiÓÙˆÓ ÌÂٷ͇ ·È‰È¿ÙÚˆÓ Î·È ·Ó·Ù˘ÍÈ·ÎÒÓ „˘¯ÔÏfiÁˆÓ ÔÏÏ¿ Î·È Ô ‰ÈÂÈÛÙËÌÔÓÈÎfi˜ ‰È¿ÏÔÁÔ˜ ÂÎÎÚÂÌ›. §¤ÍÂȘ ÎÏÂȉȿ: æ˘¯ÔÏÔÁÈ΋ Á¤ÓÓËÛË, ‰È-˘ÔÎÂÈÌÂÓÈÎfi˜ ÓÔ˘˜, ¤Ì‚Ú˘·, ÓÂÔÁÓ¿, ‚Ú¤ÊË.

∆Ì‹Ì· ºÈÏÔÛÔÊÈÎÒÓ Î·È ∫ÔÈÓˆÓÈÎÒÓ ™Ô˘‰ÒÓ, ºÈÏÔÛÔÊÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: °È¿ÓÓ˘ ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘ gkugium@phl.uoc.gr ∆Ì‹Ì· ºÈÏÔÛÔÊÈÎÒÓ Î·È ∫ÔÈÓˆÓÈÎÒÓ ™Ô˘‰ÒÓ, ºÈÏÔÛÔÊÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, ¶·ÓÂÈÛÙËÌÈÔ‡ÔÏË, 74 100, ƒ¤ı˘ÌÓÔ, ∫Ú‹ÙË

Psychology of embryos, neonates and infants: current developmental research** G. Kugiumutzakis Abstract: The aim of this paper is to describe the current developmental psychological research findings on the abilities of human embryos, neonates and infants during pregnancy and first year. These research findings have led to many reversals of the psychological theories about the origin of the human mind, and provide clear progress of knowledge. Although the common points of interest of paediatricians and developmental psychologists are many, the relevant interdisciplinary dialogue has yet to begin.

Key words: Psychological birth, intersubjective mind, embryo, neonate, infant.

√ ÓÂÔÁÓÈÎfi˜ ÓÔ˘˜: ·Ï·ÈfiÙÂÚ· Î·È Û‹ÌÂÚ· ∆· Â˘Ú‹Ì·Ù· ÙˆÓ „˘¯ÔÏÔÁÈÎÒÓ ÂÚ¢ÓÒÓ Ù· ÙÂÏÂ˘Ù·›· 40 ¯ÚfiÓÈ· ¿ÏÏ·Í·Ó ÙȘ ·fi„ÂȘ ÙˆÓ ÂȉÈÎÒÓ ˆ˜ ÚÔ˜ ÙȘ ÈηÓfiÙËÙ˜ ÙˆÓ ÂÌ‚Ú‡ˆÓ, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ. Èڛ˜ Ó· ··ÍÈÒÓÂÙ·È Ë ÙÂÚ¿ÛÙÈ· ÚÔÛÊÔÚ¿ ÙˆÓ ÚˆÙÔfiÚˆÓ ÂÚ¢ÓËÙÒÓ (fiˆ˜ ÙÔ˘ Freud, ÙÔ˘ Piaget, ÙÔ˘ Vygotsky Î.¿.), Û‹ÌÂÚ· ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÔÈ ÂÚÈÁڷʤ˜ ÙÔ˘˜ ˘ÔÙ›ÌËÛ·Ó ÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÓÔ˘ (1,2,3,4,5,6). ™ÙÔÓ ¶›Ó·Î· 1, Û˘ÓÔ„›˙ÔÓÙ·È Û 10 ÛËÌ›· ÔÈ ÚÈ˙ÈΤ˜ ·Ó·ÙÚÔ¤˜ Ô˘ Â¤ÊÂÚ·Ó ÔÈ Û‡Á¯ÚÔÓ˜ ¤Ú¢Ó˜ ˆ˜ ÚÔ˜ ÙËÓ “·Ú¯È΋ ηٿÛÙ·ÛË” ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ÓÔ˘. ∞ÓÙÈÚÔÛˆ¢ÙÈο ÂÚ¢ÓËÙÈο Â˘Ú‹Ì·Ù· ¶·Ú·Î¿Ùˆ ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÚÈṲ̂ӷ ·ÓÙÈÚÔÛˆ¢ÙÈο Â˘Ú‹Ì·Ù· ·fi ÙË Û‡Á¯ÚÔÓË ‚ÚÂÊÈ΋ ¤Ú¢ӷ, ÂÓ‰ÂÈÎÙÈο Ù˘ ·Ó·ÙÚÔ‹˜. ∂Ó‰ÔÌ‹ÙÚÈ· „˘¯ÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Î·È ÌÂÙ·ÁÂÓÓËÙÈ΋ Û˘Ó¤¯ÂÈ· ™Ù· ¤Ì‚Ú˘· ·Ú·ÙËÚÔ‡ÓÙ·È ÔÚÁ·ÓˆÌ¤Ó˜ Û˘ÌÂÚÈÊÔÚ¤˜, fiˆ˜ È›ÏÈÛÌ· ‰·ÎÙ‡ÏÔ˘, Ïfi-

Department of Philosophy and Social Studies School of Philosophy, University of Crete Correspondence: Giannis Kugiumutzakis gkugium@phl.uoc.gr Department of Philosophy and Social Studies, School of Philosophy, University of Crete, 74 100 Rethymno, Crete

͢Áη˜, ÌÔÚÊ·ÛÌÔ› ÚÔÛÒÔ˘, ÎψÙÛȤ˜, ·Ó·‰›ψÛË, ·ÓÙ›‰Ú·ÛË Û Â͈ÙÂÚÈÎÔ‡˜ ÂÚÂıÈÛÌÔ‡˜ Î.¿. ∏ Á‡ÛË Î·È Ë ÔÛÌ‹ ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ Ô‰ËÁ› Ù· ¤Ì‚Ú˘· Ó· Ì¿ıÔ˘Ó ÙËÓ ÂȉÈ΋ Ì˘Úˆ‰È¿ ÙÔ˘ ÌËÙÚÈÎÔ‡ ÛÒÌ·ÙÔ˜ ηÈ, fiÙ·Ó ÁÂÓÓËıÔ‡Ó, Ó· ÙËÓ ÚÔÙÈÌÔ‡Ó ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÌÈ·˜ ͤÓ˘ Á˘Ó·›Î·˜. ∏ ›‰È· ÚÔÙ›ÌËÛË ÈÛ¯‡ÂÈ ˆ˜ ÚÔ˜ ÙË Á‡ÛË Î·È ÙËÓ ÔÛÌ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜, ÚÔÙÈÌ‹ÛÂȘ ÂÓ‰ÂÈÎÙÈΤ˜ ÙˆÓ ÂÌ‚Ú˘˚ÎÒÓ Û˘Ó-ÏÂÈÙÔ˘ÚÁÈÒÓ ·ÓÙ›Ï˄˘, Ì¿ıËÛ˘ Î·È ÌÓ‹Ì˘ (7,8). ™Â Û¯ÂÙÈο ÂÈÚ¿Ì·Ù·, Ô DeCasper Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ÂÍ¤Ù·Û·Ó ·Ó ÓÂÔÁÓ¿ ËÏÈΛ·˜ 3 ËÌÂÚÒÓ ÚÔÙÈÌÔ‡Ó Ó· ·ÎÔ‡Ó ÙË Ì·ÁÓËÙÔʈÓË̤ÓË ÊˆÓ‹ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘˜ Ó· ÙÔ˘˜ ϤÂÈ ¤Ó· ·Ú·Ì‡ıÈ ‹ ÙË Ì·ÁÓËÙÔʈÓË̤ÓË ÊˆÓ‹ ÌÈ·˜ ͤÓ˘ Á˘Ó·›Î·˜ Ó· ·ÊËÁÂ›Ù·È ÙÔ ›‰ÈÔ ·Ú·Ì‡ıÈ. ∂ͤٷ۷Ó, Â›Û˘, ·Ó Ù· ÓÂÔÁÓ¿ ÚÔÙÈÌÔ‡Ó Ó· ·ÎÔ‡Ó ¤Ó· ·Ú·Ì‡ıÈ Ô˘ Ë ÌËÙ¤Ú· ›¯Â ·ÊËÁËı› (ÚÔ˜ ÙËÓ ÎÔÈÏÈ¿ Ù˘!) ηıËÌÂÚÈÓ¿ ηٿ ÙȘ ÙÂÏÂ˘Ù·›Â˜ 6 ‚‰ÔÌ¿‰Â˜ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ (ÔÈÎÂ›Ô ·Ú·Ì‡ıÈ) ‹ ¤Ó· Ó¤Ô ·Ú·Ì‡ıÈ ¿ÏÈ ·fi ÙË ÊˆÓ‹ Ù˘ ÌËÙ¤Ú·˜ Î.Ï. µÚ¤ıËΠfiÙÈ ÓÂÔÁÓ¿ ·ÁÁÏfiÊˆÓˆÓ Î·È Á·ÏÏfiÊˆÓˆÓ ÌËÙ¤ÚˆÓ ı‹Ï·˙·Ó ÈÔ ÁÚ‹ÁÔÚ· (‹ ÈÔ ·ÚÁ¿, ·Ó¿ÏÔÁ· Ì ÙËÓ

* ∂Ó·ÚÎÙ‹ÚÈ· ÔÌÈÏ›· ÛÙÔ 46Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ∫¤Ú΢ڷ, 13-15 πÔ˘Ó›Ô˘ 2008. ** Opening speech at the 46th Panhellenic Congress of Paediatrics, Corfu, June 13-15, 2008.

¶·È‰È·ÙÚÈ΋ 2008;71:331-344

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°. ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘

¶›Ó·Î·˜ 1. ™‡ÓÔ„Ë ÙˆÓ ÚÈ˙ÈÎÒÓ ·Ó·ÙÚÔÒÓ Ô˘ Â¤ÊÂÚ·Ó ÔÈ Û‡Á¯ÚÔÓ˜ ·Ó·Ù˘ÍȷΤ˜ ¤Ú¢Ó˜ ˆ˜ ÚÔ˜ ÙËÓ “·Ú¯È΋ ηٿÛÙ·ÛË” ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ ÓÔ˘ ¡ÂÔÁÓÈÎfi˜ ÓÔ˘˜ ¶·Ï·ÈfiÙÂÚ˜ „˘¯ÔÏÔÁÈΤ˜ ıˆڛ˜ ™‡Á¯ÚÔÓ˜ „˘¯ÔÏÔÁÈΤ˜ ıˆڛ˜ 1 2 3 4 5

∞-ÎÔÈÓˆÓÈÎfi˜ ∞Û˘Ó›‰ËÙÔ˜ ÕÁÚ·ÊÔ˜ ¯¿ÚÙ˘ (tabula rasa) ∞ÓÙ·Ó·ÎÏ·ÛÙÈο ∞Û˘ÓÙfiÓÈÛÙ˜ ÌÂٷ͇ ÙÔ˘˜ ·ÈÛı‹ÛÂȘ

6 7

∞ÚÓËÙÈΤ˜ Û˘ÁÎÈÓ‹ÛÂȘ ∞Ô˘Û›· ·›ÛıËÛ˘ ÙÔ˘ 3‰È¿ÛÙ·ÙÔ˘ ¯ÒÚÔ˘, ÙÔ˘ ¯ÚfiÓÔ˘ Î·È Ù˘ ·ÈÙÈfiÙËÙ·˜ ªÂϤÙË ‚ÚÂÊÒÓ ˆ˜ ·ÙfiÌˆÓ ∏ ·Ó¿Ù˘ÍË ˆ˜ ÌÈ· ÌÔÓ·¯È΋ ‰ÈÂÚÁ·Û›·

8 9

10 ∆· ‚Ú¤ÊË Â›Ó·È “̈ڿ”

∫ÔÈÓˆÓÈÎfi˜ ∞Û˘Ó›‰ËÙÔ˜ Î·È Û˘ÓÂȉËÙfi˜ ŒÌÊ˘Ù˜ ÈηÓfiÙËÙ˜ ∞ÓÙ·Ó·ÎÏ·ÛÙÈο Î·È ÈηÓfiÙËÙ· ÂÌÚfiıÂÙ˘ ‰Ú¿Û˘ Î·È ÛΤ„˘ ™˘ÓÙÔÓÈṲ̂Ó˜ ÌÂٷ͇ ÙÔ˘˜ ·ÈÛı‹ÛÂȘ ∞ÓÙÈÏËÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ £ÂÙÈΤ˜ Î·È ·ÚÓËÙÈΤ˜ Û˘ÁÎÈÓ‹ÛÂȘ ¶·ÚÔ˘Û›· ·›ÛıËÛ˘ ÙÔ˘ 3‰È¿ÛÙ·ÙÔ˘ ¯ÒÚÔ˘, ÙÔ˘ ¯ÚfiÓÔ˘ Î·È Ù˘ ·ÈÙÈfiÙËÙ·˜ ªÂϤÙË ‚ÚÂÊÒÓ ˆ˜ ·ÙfiÌˆÓ Î·È ˆ˜ ÂÈÎÔÈÓˆÓÈ·ÎÒÓ Û˘ÓÙÚfiÊˆÓ ∞Ó¿Ù˘ÍË Û Ï·›ÛÈ· Û˘Ó-·Ó¿Ù˘Í˘. µÚ¤ÊÔ˜ Î·È ÁÔÓ¤·˜ ·˘ÙÔ-‰ÔÌÔ‡ÓÙ·È Î·È ÂÙÂÚÔ-‰ÔÌÔ‡ÓÙ·È, Û˘Ó-‰ÔÌÒÓÙ·˜ ÙËÓ ·Ó·Ù˘ÛÛfiÌÂÓË Û¯¤ÛË ÙÔ˘˜. ∆· ‚Ú¤ÊË ıˆÚÔ‡ÓÙ·È ˆ˜ ÎÔÈÓˆÓÈο ÚfiÛˆ· Ì ÓÔ˘, ¢·ÈÛıËۛ˜ Î·È Ì ÌÈ· ÌÔÓ·‰È΋ ȉÈÔÛ˘ÛÙ·Ûȷ΋ Î·È „˘¯ÔÏÔÁÈ΋ ·ÙÔÌÈÎfiÙËÙ·

ÂÈÚ·Ì·ÙÈ΋ Û˘Óı‹ÎË) ÁÈ· Ó· ·ÎÔ‡Ó ÙË Ì·ÁÓËÙÔʈÓË̤ÓË ÊˆÓ‹ Ù˘ ÌËÙ¤Ú·˜ ·Ú¿ Ù˘ ͤÓ˘ Á˘Ó·›Î·˜, ÁÈ· Ó· ·ÎÔ‡Ó ÙÔ ·Ï·Èfi ÔÈÎÂ›Ô ·Ú·Ì‡ıÈ ·Ú¿ ÙÔ Ó¤Ô ·Ú·Ì‡ıÈ, ÂÓÒ ‰ÂÓ ÚÔÙÈÌÔ‡Û·Ó ÙË ÊˆÓ‹ ÙÔ˘ ·Ù¤Ú· ·fi ÙË ÊˆÓ‹ ¿ÏÏˆÓ ·Ó‰ÚÒÓ (∂ÈÎfiÓ· 1). √È ÌÂϤÙ˜ ·˘Ù¤˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ·fi ÙÔÓ 7Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì‹Ó· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Û˘Ó-ÏÂÈÙÔ˘ÚÁÔ‡Ó Ë ·ÎÔ‹, Ë Ì¿ıËÛË Î·È Ë ÌÓ‹ÌË Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Ë ·ÎÔ˘ÛÙÈ΋ ÚÔÙ›ÌËÛË (9,10,6). ∏ Piontelli (11,12) ÌÂϤÙËÛ ÛÙÔ˘˜ ˘ÂÚ‹¯Ô˘˜ Ù· ÎÈÓËÙÈο ÚfiÙ˘· ‰›‰˘ÌˆÓ ÂÌ‚Ú‡ˆÓ, Ù· ÔÔ›·, ·ÊÔ‡ ÁÂÓÓ‹ıËηÓ, Û˘Ó¤¯ÈÛ ӷ Ù· ÌÂÏÂÙ¿ ̤¯ÚÈ Ù· 4 ¯ÚfiÓÈ· ÙÔ˘˜. ∆· ‰›‰˘Ì· ¤Ì‚Ú˘· ‰È·ÌÔÚÊÒÓÔ˘Ó Ì¤Û· ÛÙË Ì‹ÙÚ· ‰È·ÎÚÈÙ¿ ·ÙÔÌÈο ÎÈÓËÙÈο ÚfiÙ˘· ÁÚ‹ÁÔÚ˜ ‹ ·ÚÁ¤˜ ÎÈÓ‹ÛÂȘ ÙÔ˘ ÛÒÌ·ÙÔ˜ ‹ ÙˆÓ ÌÂÏÒÓ, ÎψÙÛȤ˜ Î.Ù.Ï. ∂ÈϤÔÓ, ÛÙË Ì‹ÙÚ· ‰È·ÌÔÚÊÒÓÔ˘Ó ÌÂٷ͇ ÙÔ˘˜ Û·Ê‹ ÚfiÙ˘· ·ÏÏËÏÂȉڷÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ (.¯. ÂÈıÂÙÈÎfiÙËÙ·, ÙÚ˘ÊÂÚfiÙËÙ·, ·ÔÌ¿ÎÚ˘ÓÛË, ¯·˝‰ÂÌ· ÎÂÊ·ÏÒÓ Î.¿.), Ù· ÔÔ›· ·Ú·ÙËÚÔ‡ÓÙ·È Î·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∫¿ÔÈ· ‰›‰˘Ì· ¤Ì‚Ú˘· ‰ÂÓ ·ÓÙȉÚÔ‡Ó ÛÙȘ ÎψÙÛȤ˜ ÙÔ˘ ‰›‰˘ÌÔ˘ Û˘ÓÙÚfiÊÔ˘ ÙÔ˘˜, ÔÚÈṲ̂ӷ ÌfiÏȘ ÓÈÒÛÔ˘Ó ÙÔ ¿ÁÁÈÁÌ· ÙÔ˘ ‰È‰‡ÌÔ˘ ÙÔ˘˜ ·ÔÛ‡ÚÔÓÙ·È Û·Ó Ó· Ù· ¯Ù‡ËÛ ËÏÂÎÙÚÈÎfi Ú‡̷ Î·È Î¿ÔÈ· ¿ÏÏ· „¿¯ÓÔ˘Ó ÙË ÛˆÌ·ÙÈ΋ Â·Ê‹, ›Ù ÁÈ· Ó· ·Ú¯›ÛÔ˘Ó ·ÌÔÈ‚·›Â˜ ÎψÙÛȤ˜ ›Ù ÁÈ· Ó· ·ÓÙȉڿÛÔ˘Ó ÊÈÏÈο Ì οÙÈ Û·Ó ¯¿‰È (Ì¿ÁÔ˘ÏÔ Ì ̿ÁÔ˘ÏÔ Â·Ê‹). ¶·Ú·‰Â›ÁÌ·ÙÔ˜ ¯¿ÚÈÓ, ÛÙË Ì‹ÙÚ·, ÔÈ ‰È˙˘ÁˆÙÈÎÔ› ‰›‰˘ÌÔÈ Alice Î·È Luca ‹Ù·Ó Ôχ ÊÈÏÈÎÔ› ÌÂٷ͇ ÙÔ˘˜ Î·È Ì¤Û· ·fi ÙȘ ¯ˆÚÈṲ̂Ó˜ ÌÂÌ‚Ú¿Ó˜ ÙÔ˘˜ ÙÔ‡˜ ¿ÚÂÛ ӷ ·ÁÁ›˙Ô˘Ó Ù· ÎÂÊ¿ÏÈ· ÙÔ˘˜. ∆Ô ·Á·Ë̤ÓÔ ÙÔ˘˜ ·ÈxÓ›‰È ÛÙÔ˘˜ 12 Ì‹Ó˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ó· ‚Ú›ÛÎÔÓÙ·È ·fi ÙȘ ‰‡Ô Ï¢ڤ˜ ÌÈ·˜ ÎÔ˘ÚÙ›Ó·˜ Î·È Ó· ÙÚ›‚Ô˘Ó Ù· ÎÂÊ¿ÏÈ· ÙÔ˘˜ (11). ∆· ·Ú·¿Óˆ Â˘Ú‹Ì·Ù·, Û ·ÓÙ›ıÂÛË Ì ÙȘ ·Paediatriki 2008;71:331-344

Ú·‰ÔÛȷΤ˜ ıˆڛ˜ Ù˘ ∞Ó·Ù˘Íȷ΋˜ æ˘¯ÔÏÔÁ›·˜, ‰Â›¯ÓÔ˘Ó fiÙÈ Ë „˘¯ÔÏÔÁÈ΋ Á¤ÓÓËÛË ÛÙÔ Â›‰Ô˜ Ì·˜ ·Ú¯›˙ÂÈ ÓˆÚ›ÙÂÚ· ·fi ÙË ‚ÈÔÏÔÁÈ΋ Á¤ÓÓËÛË. √ ÓÔ˘˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ ∆· ÓÂÔÁÓ¿, fiˆ˜ Î·È ÔÈ ÂÓ‹ÏÈΘ, Ï‹ÙÙÔ˘Ó ÁÚ‹ÁÔÚ· ÛÙ· Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÔÙÈο Î·È ·ÎÔ˘ÛÙÈο ÂÚÂı›ÛÌ·Ù· Î·È ·‡Ô˘Ó Ó· Ù· ÚÔÛ¤¯Ô˘Ó. ∆Ô ÂӉȷʤÚÔÓ ÙÔ˘˜ ͢Ó¿ ·Ì¤Ûˆ˜ ÛÙȘ ·Ú·ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÙÔ˘ ·Ï·ÈÔ‡ ÂÚÂı›ÛÌ·ÙÔ˜. ∫ÔÈÙ¿˙Ô˘Ó ‹ ·ÎÔ‡Ó ÂÈÏÂÎÙÈο Ù· Û‡ÓıÂÙ· ·Ú¿ Ù· ·Ï¿ ÂÚÂı›ÛÌ·Ù·. √È ·ÈÛı‹ÛÂȘ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Â›Ó·È ÏÂÈÙÔ˘ÚÁÈΤ˜ Î·È Û˘ÓÙÔÓÈṲ̂Ó˜ ÌÂٷ͇ ÙÔ˘˜. ∂›Ó·È, Â›Û˘, Û˘ÓÙÔÓÈṲ̂Ó˜ Ì ÙÔ ÎÈÓËÙÈÎfi Û‡ÛÙËÌ·. √È Û˘ÓÙÔÓÈÛÌÔ› ·˘ÙÔ› ·Ó·Ù‡ÛÛÔÓÙ·È Î·È ÂÎÏÂÙ‡ÓÔÓÙ·È ÛÙÔÓ ¯ÚfiÓÔ Î·È ‰Â›¯ÓÔ˘Ó fiÙÈ ÌÂٷ͇ ÙÔ˘˜ ÔÈ ·ÈÛı‹ÛÂȘ “ÌÈÏÔ‡Ó”

∂ÈÎfiÓ· 1. ¡ÂÔÁÓfi ËÏÈΛ·˜ 3 ËÌÂÚÒÓ, ·ÓÙ› Ó· ıËÏ¿˙ÂÈ ·ÚÁ¿ Î·È Ó· ·ÎÔ‡ÂÈ ÙË ÊˆÓ‹ ÌÈ·˜ ͤÓ˘ Á˘Ó·›Î·˜, ÚÔÙÈÌ¿ Ó· ıËÏ¿˙ÂÈ ÁÚ‹ÁÔÚ· ÁÈ· Ó· ·ÎÔ‡ÂÈ ÙËÓ ÔÈΛ·, ‹‰Ë ·fi ÙË Ì‹ÙÚ·, ʈӋ Ù˘ ÌËÙ¤Ú·˜ - Î·È ÔÈ 2 Ì·ÁÓËÙÔʈÓË̤Ó˜ ʈӤ˜ ϤÓ ÙÔ ›‰ÈÔ ·Ú·Ì‡ıÈ (10).

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æ˘¯ÔÏÔÁ›· ÂÌ‚Ú‡ˆÓ, ÓÂÔÁÓÒÓ Î·È ‚ÚÂÊÒÓ

ÌÈ· ÎÔÈÓ‹ “ÁÏÒÛÛ·” ‹ ÌÂٷʤÚÔ˘Ó Ë Ì›· ÛÙËÓ ¿ÏÏË ÏËÚÔÊÔÚ›· Û ÌÈ· “ÎÔÈÓ‹ ÁÏÒÛÛ·”. ™Â ¤Ó· ›ڷ̷ ‚¿˙Ô˘Ì (¯ˆÚ›˜ Ó· ÌÔÚÔ‡Ó Ó· ÙË ‰Ô˘Ó) ÌÈ· Û˘Ó‹ıË È›Ï· ÛÙÔ ÛÙfiÌ· ÌÈ·˜ ÔÌ¿‰·˜ ÓÂÔÁÓÒÓ ËÏÈΛ·˜ 1 ÌËÓfi˜ Î·È Ù· ·Ê‹ÓÔ˘Ì ӷ ÙË ıËÏ¿ÛÔ˘Ó ÁÈ· 1,5 ÏÂÙfi. ™Â ÌÈ· ¿ÏÏË ÔÌ¿‰· ÓÂÔÁÓÒÓ ›‰È·˜ ËÏÈΛ·˜ οÓÔ˘Ì ÙÔ ›‰ÈÔ, ·ÏÏ¿ ÙÒÚ· Ë È›Ï· ‰ÂÓ ¤¯ÂÈ Ï›· ÂÈÊ¿ÓÂÈ·. ªÂÙ¿ ÚÔ‚¿ÏÔ˘Ì ÛÙ· ‚Ú¤ÊË ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ 2 ʈÙÔÁڷʛ˜ ·fi ÙȘ È›Ï˜ Ô˘ ı‹Ï·Û·Ó ¯ˆÚ›˜ Ó· ÙȘ ¤¯Ô˘Ó ‰ÂÈ. ∆· ÓÂÔÁÓ¿ Ô˘ ı‹Ï·Û·Ó ÙË Û˘Ó‹ıË È›Ï· ÎÔÈÙ¿˙Ô˘Ó ÂÚÈÛÛfiÙÂÚÔ ÙË ÊˆÙÔÁÚ·Ê›· Ù˘ ·Ú¿ ÙË ÊˆÙÔÁÚ·Ê›· Ù˘ ¿ÏÏ˘ È›Ï·˜. ∆Ô ›‰ÈÔ ‚Ú¤ıËΠÁÈ· Ù· ÓÂÔÁÓ¿ Ô˘ ı‹Ï·Û·Ó ÙËÓ È›Ï· Ì ÙË ÌË Ï›· ÂÈÊ¿ÓÂÈ·. ∆Ô Â‡ÚËÌ· Ì·ÚÙ˘Ú› ÔÙÈÎÔ-ȉÈÔ‰ÂÎÙÈÎfi Û˘ÓÙÔÓÈÛÌfi. ™Â ÔÏÏ¿ ¿ÏÏ· ÂÈÚ¿Ì·Ù· ¤¯Ô˘Ó ‚ÚÂı› ¿ÏÏÔÈ Ù‡ÔÈ ‰È-·ÓÙÈÏËÙÈÎÒÓ Û˘ÓÙÔÓÈÛÌÒÓ (ÔÙÈÎÔ-·ÎÔ˘ÛÙÈÎfi˜, ÔÙÈÎÔ-·ÙÈÎfi˜ Î.Ï.). ∏ ÈηÓfiÙËÙ· ·˘Ù‹ Â›Ó·È Úԛη ÙÔ˘ ›‰Ô˘˜ Ì·˜ Î·È ÛÙ· Û¯ÂÙÈο ÂÈÚ¿Ì·Ù· Ù· ‚Ú¤ÊË, Î·È fi¯È ÔÈ ÊÈÏfiÛÔÊÔÈ, ¤Ï˘Û·Ó ÙÔ ·ÏÈfi Úfi‚ÏËÌ·-ÂÚÒÙËÌ· ÙÔ˘ Molyneux ÚÔ˜ ÙÔÓ Locke (4,13). ∆· ÓÂÔÁÓ¿ Î·È Ù· Ó·ڿ ‚Ú¤ÊË Ì ϛÁ˜ ‰ÔÎÈ̤˜ Ì·ı·›ÓÔ˘Ó Â‡ÎÔÏ· Ó· ¯ÂÈÚ›˙ÔÓÙ·È Î·Ù¿ ‚Ô‡ÏËÛË (Ì ÛÙÚÔÊ‹ Ù˘ ÎÂÊ·Ï‹˜ ‰ÂÍÈ¿ ‹ ·ÚÈÛÙÂÚ¿) .¯. ÌÈ· Û˘Û΢‹ Ô˘ ·Ó¿‚ÂÈ Î·È ÎÏ›ÓÂÈ Ù· ÊÒÙ·. ª·ı·›ÓÔ˘Ó Î·È Û˘ÏÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·Ú¯‹ “·ÈÙ›·-·ÔÙ¤ÏÂÛÌ·”. ŸÙ·Ó Ë ÚÔÛ¿ıÂÈ¿ ÙÔ˘˜ ÂÈÙ‡¯ÂÈ ÂÎÊÚ¿˙Ô˘Ó Â˘¯·Ú›ÛÙËÛË, ÂÓÒ fiÙ·Ó (Ì ÙÚÈÎ ÙÔ˘ ÂÈÚ·Ì·ÙÈÛÙ‹) ·ÔÙ‡¯Ô˘Ó Ó· ·Ó¿„Ô˘Ó/Ó· Û‚‹ÛÔ˘Ó Ù· ÊÒÙ·, ÂÎÊÚ¿˙Ô˘Ó ‰˘Û·Ú¤ÛÎÂÈ· ÁÈ· ÙË ÌË ÂȂ‚·›ˆÛË Ù˘ ÁÓˆÛÙÈ΋˜ ÙÔ˘˜ ÚÔÛ‰ÔΛ·˜ (14). ∆· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔÓ ÎfiÛÌÔ (ÚfiÛˆ·, ·ÓÙÈΛÌÂÓ·, ·ÔÛÙ¿ÛÂȘ Î.¿.) Î·È ÙÔ ÛÒÌ· ÙÔ˘˜ ̤۷ ÛÙÔÓ ÎfiÛÌÔ Û ÙÚÂȘ ‰È·ÛÙ¿ÛÂȘ. ∞Ó ˆı‹ÛÔ˘Ì Ì·ÏfiÓÈ· ÚÔ˜ ÙÔ ÚfiÛˆfi ÙÔ˘˜, Ù· ÓÂÔÁÓ¿ οÓÔ˘Ó ÎÈÓ‹ÛÂȘ ·ÔÊ˘Á‹˜ (‰È¿Ï·ÙÔ ¿ÓÔÈÁÌ· Ì·ÙÈÒÓ Î·È ÛÙfiÌ·ÙÔ˜, ΛÓËÛË Ù˘ ÎÂÊ·Ï‹˜ ÚÔ˜ Ù· ›Ûˆ, ÂÓÒ ÌÔÚ› Ó· ʤÚÔ˘Ó Ù· ¯¤ÚÈ· ÛÙÔ ÚfiÛˆÔ). ∆· ÌÂÁ·Ï‡ÙÂÚ· ‚Ú¤ÊË ·ÏÒ˜ ÎÈÓÔ‡Ó ‰ÂÍÈ¿ ‹ ·ÚÈÛÙÂÚ¿ ÙÔ ÎÂÊ¿ÏÈ Î·È Ù· Ì·ÏfiÓÈ· ʇÁÔ˘Ó ¯ˆÚ›˜ Ó· Á›ÓÂÈ Û‡ÁÎÚÔ˘ÛË. §fiÁˆ ¯ÒÚÔ˘, ‰ÂÓ ÂÚÈÁÚ¿ÊÔ˘Ì ÙÔ ›ڷ̷ ÙÔ˘ “ÔÙÈÎÔ‡ ÁÎÚÂÌÔ‡”, ÙÔ ÔÔ›Ô ‰Â›¯ÓÂÈ ÙËÓ ·ÓÙ›ÏË„Ë ÙÔ˘ ‚¿ıÔ˘˜ Î·È ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¤¯Ô˘Ó Ù· ‚Ú¤ÊË, Ù· ÔÔ›· ÌÔ˘ÛÔ˘ÏÔ‡Ó ¿Óˆ Û ÌÈ· Á˘¿ÏÈÓË ÂÈÊ¿ÓÂÈ· Î·È ÛÙ·Ì·ÙÔ‡Ó ÛÙÔ ÛËÌÂ›Ô fiÔ˘ ˘¿Ú¯ÂÈ ¤Ó·˜ ÔÈÔÓ› “ÔÙÈÎfi˜ ÁÎÚÂÌfi˜”, ·ÚfiÏÔ Ô˘ Ë ÌËÙ¤Ú· Ù· ·ÚÔÙÚ‡ÓÂÈ Ó· ÚÔ¯ˆÚ‹ÛÔ˘Ó (15). ™Â ÈÔ ÂÍÂÏÈÁ̤ӷ Û¯ÂÙÈο ÂÈÚ¿Ì·Ù· ÚÔÛÔÌÔ›ˆÛ˘, oÈ ÂÚ¢ÓËÙ¤˜ ÛÙ¤ÏÓÔ˘Ó ÙË ÛÎÈ¿ ÂÓfi˜ ·ÓÙÈÎÂÈ̤ÓÔ˘, ›Ù Û ÔÚ›· Û‡ÁÎÚÔ˘Û˘ Ì ÙÔ ÚfiÛˆÔ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ›Ù Û ¿ÏÏË ÔÚ›·. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË Ù· ‚Ú¤ÊË ·Ú·ÙËÚÔ‡Ó ·ÏÏ¿ ‰ÂÓ ·ÓÙȉÚÔ‡Ó, ÂÓÒ ÛÙËÓ

∂ÈÎfiÓ· 2. ¶Ôψ̤ÓÔ Êˆ˜ ¤ÊÙÂÈ ¿Óˆ Û ¤Ó· ÛÙÂÚÂfi ·ÓÙÈΛÌÂÓÔ, ÙÔ ÔÔ›Ô ÚÔ‚¿ÏÏÂÙ·È ˆ˜ ÌÈ· ÛÎÈ¿ / ‰˘ÓËÙÈÎfi ·ÓÙÈΛÌÂÓÔ Û ·fiÛÙ·ÛË Û‡ÏÏ˄˘ ·fi ÙÔ ‚Ú¤ÊÔ˜. ∆Ô ‚Ú¤ÊÔ˜, ÊÔÚÒÓÙ·˜ ÂȉÈο Á˘·ÏÈ¿, ‚ϤÂÈ ÙÔ ‰˘ÓËÙÈÎfi ˆ˜ Ú·ÁÌ·ÙÈÎfi 3‰È¿ÛÙ·ÙÔ ·ÓÙÈΛÌÂÓÔ Î·È ÚÔ¯ˆÚ› ÛÙË Û‡ÏÏË„‹ ÙÔ˘, ·ÏÏ¿ ÂÎÊÚ¿˙ÂÈ ¤ÎÏËÍË fiÙ·Ó ÙÔ ¯¤ÚÈ ÙÔ˘ ÂÚÓ¿ ̤۷ ·fi ÙÔ ·ÓÙÈΛÌÂÓÔ - ¤ÎÏËÍË ÛÙ· Ê˘ÛÈÎÒ˜ ·‰‡Ó·Ù· Û˘Ì‚¿ÓÙ· (16).

ÔÚ›· Û‡ÁÎÚÔ˘Û˘ οÓÔ˘Ó ÎÈÓ‹ÛÂȘ ·ÔÊ˘Á‹˜. ∏ ÈηÓfiÙËÙ· ·˘Ù‹ ÂÌÊ·Ó›˙ÂÙ·È Î·È Û ÓÂÔÁÓ¿ 2-3 ‚‰ÔÌ¿‰ˆÓ (16,17,14). ∆· ÓÂÔÁÓ¿ ηÈ, ÈÔ ¤ÓÙÔÓ·, Ù· ÌÂÁ·Ï‡ÙÂÚ· ‚Ú¤ÊË ÂÎÊÚ¿˙Ô˘Ó ¤ÎÏËÍË ÛÙ· Ê˘ÛÈÎÒ˜ ·‰‡Ó·Ù· Û˘Ì‚¿ÓÙ·, ‰ËÏ·‰‹ ¤ÎÏËÍË ÛÙÔ ÌË ·Ó·ÌÂÓfiÌÂÓÔ Ê˘ÛÈÎfi ÁÂÁÔÓfi˜. ∂ÎÊÚ¿˙Ô˘Ó ¤ÎÏËÍË Û ÂÈÚ¿Ì·Ù· fiÔ˘ ‚ϤÔ˘Ó ¤Ó· ÛÙÂÚÂfi ·ÓÙÈΛÌÂÓÔ Ó· ÛÙ¤ÎÂÙ·È ÌÂ Ì˘ÛÙËÚÈÒ‰Ë ÙÚfiÔ ÛÙÔÓ ·¤Ú·, ÂÓÒ ¤¯ÂÈ ·Ê·ÈÚÂı› ÙÔ ˘ÔÛÙ‹ÚÈÁÌ¿ ÙÔ˘, Û ÂÈÚ¿Ì·Ù· fiÔ˘ ‰‡Ô fiÌÔÈ· ÛÙÂÚ¿ ·ÓÙÈΛÌÂÓ· (ÙÔ ¤Ó· Â›Ó·È ÔÏfiÁÚ·ÌÌ· ÙÔ˘ ¿ÏÏÔ˘) ηٷϷ̂¿ÓÔ˘Ó Ì›· ı¤ÛË ÛÙÔÓ ¯ÒÚÔ Î·È Û ÂÈÚ¿Ì·Ù· fiÔ˘ ¤Ó· ·ÓÙÈΛÌÂÓÔ, ÂÓÒ ¤¯ÂÈ ÎÚ˘ÊÙ› ›Ûˆ ·fi ÌÈ· ÛÎËÓ‹, ÛÙË Û˘Ó¤¯ÂÈ·, fiÙ·Ó Ë ÛÎËÓ‹ ·ÓÔ›ÁÂÈ, ÙÔ ·ÓÙÈΛÌÂÓÔ ·Ô˘ÛÈ¿˙ÂÈ. ∫¿ˆ˜ ÁÓˆÚ›˙Ô˘Ó fiÙÈ ¤Ó· ÛÙÂÚÂfi ÛÒÌ· ‰ÂÓ ÛÙ¤ÎÂÙ·È ·fi ÌfiÓÔ ÙÔ˘ ÛÙÔÓ ·¤Ú·, ηٷϷ̂¿ÓÂÈ Ì›· ÌfiÓÔ ı¤ÛË ÛÙÔÓ ¯ÒÚÔ Î·È fiÙ·Ó ‰ÂÓ Ê·›ÓÂÙ·È ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ÂÍ·Ê·Ó›˙ÂÙ·È. ∞Ó ÙÔ ·ÓÙÈΛÌÂÓÔ ‰ÂÓ ‚Ú›ÛÎÂÙ·È Û ·fiÛÙ·ÛË Û‡ÏÏ˄˘, ÙfiÙ ٷ ‚Ú¤ÊË ÙÔ ‰Â›¯ÓÔ˘Ó Ì ÙÔ ¯¤ÚÈ, ÂÓÒ fiÙ·Ó ‚Ú›ÛÎÂÙ·È Û ·fiÛÙ·ÛË Û‡ÏÏ˄˘, ÙÔ Û˘ÏÏ·Ì‚¿ÓÔ˘Ó - ¤¯Ô˘Ó ·›ÛıËÛË Ù˘ ·fiÛÙ·Û˘ ÛÙÔÓ 3‰È¿ÛÙ·ÙÔ ¯ÒÚÔ. ™Â ¤Ó· ›ڷ̷ ÚÔÛÔÌÔ›ˆÛ˘ (∂ÈÎfiÓ· 2), Ôψ̤ÓÔ Êˆ˜ ¤ÊÙÂÈ ¿Óˆ Û ¤Ó· ÛÙÂÚÂfi ·ÓÙÈΛÌÂÓÔ, ÙÔ ÔÔ›Ô ÚÔ‚¿ÏÏÂÙ·È ˆ˜ ÌÈ· ÛÎÈ¿, ˆ˜ ¤Ó· ‰˘ÓËÙÈÎfi ·ÓÙÈΛÌÂÓÔ, ÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È Û ·fiÛÙ·ÛË Û‡ÏÏ˄˘ ·fi ÙÔ ‚Ú¤ÊÔ˜. ∆Ô ‚Ú¤ÊÔ˜, ÊÔÚÒÓÙ·˜ ÂȉÈο Á˘·ÏÈ¿, ‚ϤÂÈ ÙÔ ‰˘ÓËÙÈÎfi ˆ˜ Ú·ÁÌ·ÙÈÎfi 3‰È¿ÛÙ·ÙÔ ·ÓÙÈΛÌÂÓÔ Î·È ÚÔ¯ˆÚ› ÛÙË Û‡ÏÏË„‹ ÙÔ˘, ·ÏÏ¿ ÂÎÊÚ¿˙ÂÈ ¤ÎÏËÍË fiÙ·Ó ÙÔ ¯¤ÚÈ ÙÔ˘ ÂÚÓ¿ ̤۷ ·fi ÙÔ ·ÓÙÈΛÌÂÓÔ. ∫¿ˆ˜ ÁÓˆÚ›˙ÂÈ fiÙÈ ¤Ó· ÛÙÂÚÂfi ÛÒÌ· ‰ÂÓ Â›Ó·È ‰È·ÂÚ·Ùfi Î·È ÂÎÏ‹ÙÙÂÙ·È Ì ·˘Ùfi ÙÔ ÌË ·Ó·ÌÂÓfiÌÂÓÔ, Ê˘ÛÈÎÒ˜ ·‰‡Ó·ÙÔ Û˘Ì‚¿Ó (16,17,13,4). ¶·È‰È·ÙÚÈ΋ 2008;71:331-344

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14-10-08

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∆· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË ÂÎÊÚ¿˙Ô˘Ó, Â›Û˘, ¤ÎÏËÍË ÛÙ· Ì·ıËÌ·ÙÈÎÒ˜ ·‰‡Ó·Ù· Û˘Ì‚¿ÓÙ· ηÈ, ÂÈϤÔÓ, Ì ÙÔÓ ÙÚfiÔ ÙÔ˘˜ (.¯. ¤ÎÏËÍË, ·Ú·ÙÂٷ̤ÓÔ ÎÔ›Ù·ÁÌ· Î.¿.), ÚÔÛı¤ÙÔ˘Ó Î·È ·Ê·ÈÚÔ‡Ó Ì¤¯ÚÈ ÙÔ 3 ‹ ÙÔ 4. ™Ù· ÂÈÚ¿Ì·Ù· Ù˘ Wynn (18,19) ÙÔ 5ÌËÓÔ ‚Ú¤ÊÔ˜ ‚ϤÂÈ ÙÔ ¯¤ÚÈ ÌÈ·˜ ÂÚ¢ӋÙÚÈ·˜ Ó· ÎÚ·Ù¿ 1 ÎÔ‡ÎÏ· Î·È Ó· ÙËÓ ·Ê‹ÓÂÈ ÛÙËÓ ·ÓÔÈÎÙ‹ ÛÎËÓ‹ ÂÓfi˜ ÎÔ˘ÎÏÔı¤·ÙÚÔ˘. ªÂÙ¿, Ë ÎÔ˘ÚÙ›Ó· Ù˘ ÛÎËÓ‹˜ ÙÚ·‚ȤٷÈ. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔ ‚Ú¤ÊÔ˜ ‚ϤÂÈ ÙÔ ¯¤ÚÈ Ù˘ ÂÚ¢ӋÙÚÈ·˜ Ó· ‚¿˙ÂÈ ›Ûˆ ·fi ÙÔ Î¿Ï˘ÌÌ· Ù˘ ÎÔ˘ÚÙ›Ó·˜ 1 ‰Â‡ÙÂÚË ÎÔ‡ÎÏ·. µÏ¤ÂÈ Î·ı·Ú¿ ÙÔ ¯¤ÚÈ Ù˘ ÂÚ¢ӋÙÚÈ·˜ Ó· ·ÔÌ·ÎÚ‡ÓÂÙ·È ¿‰ÂÈÔ. ªÂÙ¿ ·ÓÔ›ÁÂÈ Ë ·˘Ï·›· Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È Â›Ù ÙÔ Ì·ıËÌ·ÙÈÎÒ˜ ÔÚıfi ·ÔÙ¤ÏÂÛÌ· (1+1=2 ÎÔ‡ÎϘ - Ù· ‚Ú¤ÊË ÎÔÈÙ¿˙Ô˘Ó ÙȘ 2 ÎÔ‡ÎϘ ¯ˆÚ›˜ ¤ÎÏËÍË) ›Ù ÙÔ Ì·ıËÌ·ÙÈÎÒ˜ ·‰‡Ó·ÙÔ ·ÔÙ¤ÏÂÛÌ· (1+1=1 ÎÔ‡ÎÏ·, Ë ‰Â‡ÙÂÚË Â›¯Â ·Ê·ÈÚÂı› ÎÚ˘Ê¿ ·fi ÙËÓ ÂÚ¢ӋÙÚÈ·). ∆· Ó·ڿ ‚Ú¤ÊË ÂÎÏ‹ÙÙÔÓÙ·È, Û·ÛÙ›˙Ô˘Ó, ·ÔÚÔ‡Ó, ·ÓÔ›ÁÔ˘Ó ÙÔ ÛÙfiÌ· ÛÙÔ 1+1=1 ‹ ÛÙËÓ ·Ú·ÏÏ·Á‹ 2+1=2, ·ÏÏ¿ Î·È ÛÙËÓ ·Ê·›ÚÂÛË 2-1=2 ‹ 3-1=3 - ¤ÎÏËÍË Ô˘ ÙË ‚ϤÔ˘Ì ÛÙÔ ÚfiÛˆfi ÙÔ˘˜, ÚÔ·ÙÂÈ ·fi ÌÂÙÚ‹ÛÂȘ ÙˆÓ ·ÏÏ·ÁÒÓ ÙÔ˘ ηډȷÎÔ‡ ÙÔ˘˜ ·ÏÌÔ‡ Î·È ·fi ÙÔÓ ·Ú·ÙÂٷ̤ÓÔ ¯ÚfiÓÔ Ô˘ Û·ÛÙÈṲ̂ӷ ÎÔÈÙ¿˙Ô˘Ó ÙÔ “Ï¿ıÔ˜”, ÙËÓ ·Ú·‚›·ÛË Ù˘ ‚ÚÂÊÈ΋˜ ÚÔÛ‰ÔΛ·˜ fiÙÈ 1+1 ‰ÂÓ Î¿ÓÂÈ Ô‡Ù 1 Ô‡Ù 3, ·ÏÏ¿ ·ÎÚÈ‚Ò˜ 2. ∆· ›‰È· Â˘Ú‹Ì·Ù· ˘‹ÚÍ·Ó Û ·Ú·ÏÏ·Á¤˜ ÙÔ˘ ·Ú¯ÈÎÔ‡ ÂÈÚ¿Ì·ÙÔ˜ Û ·ÓıÚÒÈÓ· ÓÂÔÁÓ¿ ËÏÈΛ·˜ 4 ËÌÂÚÒÓ, Ù· ÔÔ›· ‰È¤ÎÚÈÓ·Ó ÙȘ ‰ÈÛ‡ÏÏ·‚˜ ·fi ÙȘ ÙÚÈÛ‡ÏÏ·‚˜ ϤÍÂȘ (·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÔÙÈÎÒÓ Ì ·ÎÔ˘ÛÙÈο ÂÚÂı›ÛÌ·Ù·) Î·È Û Ó·ڿ ‚Ú¤ÊË Ô˘ ·Ó›¯ÓÂ˘Û·Ó ÙË ‰È·ÊÔÚ¿ 1/4 ˘ÁÚÔ‡ ·fi 3/4 ˘ÁÚÔ‡ Û ¤Ó· ‰Ô¯Â›Ô, ηÈ, ÙÔ ÈÔ ‰‡ÛÎÔÏÔ, fiÙ·Ó ¯ÚÂÈ¿ÛÙËΠӷ ·ÓȯÓ‡ÛÔ˘Ó ·ÚÈıÌÔ‡˜ ‰È-·ÈÛıËÙËÚȷο, ‰ËÏ·‰‹ Ó· ÚÔÛı¤ÛÔ˘Ó 1 ·ÓÙÈΛÌÂÓÔ Î·È 1 ‹¯Ô (20,21,22,23,4). °ÓˆÚ›˙·Ì ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980 fiÙÈ ÓÂÔÁÓ¿ ËÏÈΛ·˜ 2 ¤ˆ˜ 3 ËÌÂÚÒÓ Î·È ‚Ú¤ÊË Ì¤¯ÚÈ 8 ÌËÓÒÓ (25,26) ÌÔÚÔ‡Û·Ó Ó· ·ÓȯÓ‡ÛÔ˘Ó ‰È-·ÈÛıËÙËÚȷο ÌÈÎÚÔ‡˜ ·ÚÈıÌÔ‡˜, ‰ËÏ·‰‹ Ó· ·Ú·‚ϤÔ˘Ó ÙȘ ‰È·ÊÔÚ¤˜ ÔÙÈÎÒÓ Î·È ·ÎÔ˘ÛÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È Ó· ·ÓȯÓÂ‡Ô˘Ó ÙÔÓ ·ÚÈıÌfi ·˘ÙfiÓ Î·ı’ ·˘ÙfiÓ (·fi ÙÔ 1 ¤ˆ˜ ÙÔ 3). ™Ù· ÂÈÚ¿Ì·Ù·, ÔÈ ÂÚ¢ÓËÙ¤˜ ·ÚÔ˘Û›·˙·Ó 2 ʈÙÔÁڷʛ˜ Ô˘ ·Ó··ÚÈÛÙÔ‡Û·Ó .¯. 1 È›Ï· Î·È 3 ÎÔ˘‰Ô˘Ó›ÛÙÚ˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÚÔ˘Û›·Û˘, ·ÎÔ‡ÁÔÓÙ·Ó .¯. 3 ‹¯ÔÈ. ªÂÙ¿ ÙÔÓ ‹¯Ô, ‚Ú¤ÊË Î¿Ùˆ ÙˆÓ 8 ÌËÓÒÓ ÎÔ›Ù·˙·Ó ÂÚÈÛÛfiÙÂÚÔ ÙȘ 3 ÎÔ˘‰Ô˘Ó›ÛÙÚ˜ (ÔÙÈÎÔ-·ÎÔ˘ÛÙÈ΋ ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÚÈıÌÔ‡). ™ÙÔ ÂÚÁ·ÛÙ‹ÚÈfi Ì·˜ ÌÂÏÂÙ‹ıËΠ(23,4) Ë ·ÚÈıÌËÙÈ΋ ÈηÓfiÙËÙ· Û ‚Ú¤ÊË 5, 7 Î·È 9 ÌËÓÒÓ Î·È Ù¤ıËΠÙÔ ˙‹ÙËÌ· Ù˘ ·Ó¿Ù˘Í˘ Ù˘ ‚ÚÂÊÈ΋˜ ·ÚÈıÌËÙÈ΋˜ ÈηÓfiÙËÙ·˜ (∂ÈÎfiÓ· 3). µÚ¤ıËΠfiÙÈ Ù· ‚Ú¤ÊË ‰È·ÎÚ›ÓÔ˘Ó ÙÔ 1 ·fi ÙÔ 2 Î·È ·fi ÙÔ 3, ηıÒ˜ Paediatriki 2008;71:331-344

...Ù· Ú¿Á Ì·Ù ‰ÂÓ Ì · Ô˘ Ì ٠ÔÚ ›˜ Ó· ÚÔ‡Ó ÂÚ ÈÛ Ù· Ì ÙÚ‹Û ÛfiÙÂÚÔ ÂȘ

∂ÈÎfiÓ· 3. ∞Ó··Ú¿ÛÙ·ÛË Ù˘ ÂÈÚ·Ì·ÙÈ΋˜ Û˘Óı‹Î˘. 1 = Ù· ÌÂÁ¿ÊˆÓ·, 2 = Ù· ÚÔ‚·ÏÏfiÌÂÓ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· (108 x 80 ÂηÙ.), 3 = Ë Î¿ÌÂÚ·, Î·Ï˘Ì̤ÓË Ì ¤Ó· Ï¢Îfi ·Ó›, ÂÎÙfi˜ ·fi ÙÔÓ Ê·Îfi, 4 = ÙÔ ‚Ú¤ÊÔ˜, 5 = Ë ÌËÙ¤Ú·, 6 = Ô ÌÔÓfi‰ÚÔÌÔ˜ ηıÚ¤Ù˘ Ô˘ Â¤ÙÚÂ ÛÙËÓ ÂÚ¢ӋÙÚÈ· Ó· ‚ϤÂÈ Ì¤Û· ÛÙÔ ÂÈÚ·Ì·ÙÈÎfi ‰ˆÌ¿ÙÈÔ, 7 = ÚÔ‚ÔÏ›˜ ÙˆÓ “ÛÏ¿ÈÓÙ˜”, 8 = ·ÚÌfiÓÈÔ, 9 = Ì·ÁÓËÙfiʈÓÔ, 10 = ÂÚ¢ӋÙÚÈ·, 11 = ‚ÔËıÔ› Ù˘ ÂÚ¢ӋÙÚÈ·˜ (23).

Î·È ÙÔ 2 ·fi ÙÔ 3, ‰ËÏ·‰‹ Ù· ‚Ú¤ÊË ‚Ú‹Î·Ó ÙËÓ ·ÚÈıÌËÙÈ΋ ÛÙ·ıÂÚ¿ Ô˘ ‹Ù·Ó ÎÚ˘Ì̤ÓË ÛÙ· ÔÙÈο Î·È ÛÙ· ·ÎÔ˘ÛÙÈο ÂÚÂı›ÛÌ·Ù·. µÚ¤ıËÎÂ, Â›Û˘, fiÙÈ Ë ÈηÓfiÙËÙ· ·˘Ù‹ ·˘Í¿ÓÂÙ·È ·fi ÙÔ˘˜ 5 ¤ˆ˜ ÙÔ˘˜ 9 Ì‹Ó˜ - ·˘Í¿ÓÂÙ·È ÈÔ ÓˆÚ›˜ ÛÙ· ÎÔÚ›ÙÛÈ· ·fi fi,ÙÈ ÛÙ· ·ÁfiÚÈ·. ∆· ÎÔÚ›ÙÛÈ· “Ù· ‹Á·Ó ηχÙÂÚ·” ·fi Ù· ·ÁfiÚÈ·, Ù· ÔÔ›· ηٿ ÙÔÓ 9Ô Ì‹Ó· Î¿Ï˘„·Ó ÙË ‰È·ÊÔÚ¿ ·fi Ù· ÎÔÚ›ÙÛÈ·. ∆¤ÏÔ˜, ‚Ú¤ıËΠfiÙÈ Ù· fiÌÔÈ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· (1 Ì¿Ï· Î·È 3 Ì¿Ï˜) Î·È ÙÔ ÔÈÎÂ›Ô ÎÔÈÓˆÓÈÎfi ÂÚ¤ıÈÛÌ· ÙÔ˘ ÚÔÛÒÔ˘ Ù˘ ÌËÙ¤Ú·˜ ‰È¢ÎfiÏ˘Ó·Ó ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÚÈıÌÔ‡, ÂÓÒ ÙË ‰˘ÛÎfiÏ„·Ó Ù· ·ÓfiÌÔÈ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· (2 È›Ï˜ Î·È 3 Ì¿Ï˜) Î·È ÙÔ ÚfiÛˆÔ ÌÈ·˜ ͤÓ˘ Á˘Ó·›Î·˜ (23,4). √ ÎÔÈÓˆÓÈÎfi˜ ÓÔ˘˜ ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ °È· ÏfiÁÔ˘˜ ¯ÒÚÔ˘, ·fi ÙȘ ÂÈÚ·Ì·ÙÈΤ˜ ·ÏÏ¿ ΢ڛˆ˜ ·fi ÙȘ ÔÏϤ˜ Ó·ÙÔ˘Ú·ÏÈÛÙÈΤ˜, ‰È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜ ÌÈÎÚÔ-·Ó¿Ï˘Û˘ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, Ô˘ Ì·ÚÙ˘ÚÔ‡Ó ÙËÓ ¤ÌÊ˘ÙË ÎÔÈÓˆÓÈÎfiÙËÙ· ÙˆÓ ‚ÚÂÊÒÓ, ·Ó·Ê¤ÚÔ˘Ì ·Ú·Î¿Ùˆ ÌÂÚÈο ÌfiÓÔ Â˘Ú‹Ì·Ù· ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ 12 Ì‹Ó˜. ∏ ‰È¿ÎÚÈÛË ÙˆÓ Ê¿ÛÂˆÓ ·Ó¿Ù˘Í˘ ηٿ ÙÔ ÚÒÙÔ ¤ÙÔ˜, ̤۷ ÛÙȘ Ôԛ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Â˘Ú‹Ì·Ù·, ‚·Û›˙ÂÙ·È ÛÙË ıˆڛ· ÙÔ˘ Trevarthen (5,6,8) ÁÈ· ÙËÓ ¤ÌÊ˘ÙË Î·Ù·ÁˆÁ‹ Î·È ÙËÓ ÔÓÙÔÁÂÓÂÙÈ΋ ÔÚ›· ÙÔ˘ Û˘ÓÙÚÔÊÈÎÔ‡ ‹ ‰È˘ÔÎÂÈÌÂÓÈÎÔ‡ ÓÔ˘ ÙˆÓ ·ÓıÚÒˆÓ - Ì›· ·fi ÙȘ ϤÔÓ ÚÔˆıË̤Ó˜ „˘¯Ô-‚ÈÔÏÔÁÈΤ˜ ıˆڛ˜ Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡ ̤۷ ÛÙËÓ ÎÔ˘ÏÙÔ‡Ú· ·Ó·ÙÚÔÊ‹˜ ÙÔ˘ (27). √È ÚÒÙ˜ 4 ‚‰ÔÌ¿‰Â˜ (ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô˜) ™ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹, ·Ó·‰‡ÂÙ·È ÌÈ· ÈηÓfiÙËÙ· ¢·›ÛıËÙ˘ ·¿ÓÙËÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙËÓ ·ÚÔ˘Û›· Ù˘ ÌËÙ¤Ú·˜ Î·È ÌÈ· ÂÙÔÈÌfiÙËÙ· ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË

Pediatri Sept-Oct 08

14-10-08

13:26

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Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. ªÂ ÙȘ ÎÈÓ‹ÛÂȘ ÙÔ˘ ÛÒÌ·ÙÔ˜, ÙÔ˘ ÚÔÛÒÔ˘, ÙˆÓ ¯ÂÚÈÒÓ Î·È Ì ÙÔ ÎÏ¿Ì· ÙÔ˘, ÙÔ ÓÂÔÁÓfi ‰Â›¯ÓÂÈ ÙË ‰˘Û·Ú¤ÛÎÂÈ· ‹ ÙËÓ Î·Ù¿ÛÙ·ÛË ·Ó¿Á΢ ÙÔ˘. ∞Ô‰¤¯ÂÙ·È Â˘¯·Ú›ÛÙˆ˜ ÙÔ ÌËÙÚÈÎfi ¯¿‰È. ™ÙÚ¤ÊÂÈ ÙÔ ÎÂÊ¿ÏÈ ÙÔ˘ ÚÔ˜ ÙË ı¤ÛË Ô˘ ‚Ú›ÛÎÂÙ·È Ë ÌËÙ¤Ú· ÁÈ· Ó· Ì˘ÚÈÛÙ› ÙËÓ È‰È·›ÙÂÚË ÔÛÌ‹ Ù˘ Î·È ÁÈ· Ó· ·ÎÔ‡ÛÂÈ ÙËÓ È‰È·›ÙÂÚË ÔÈfiÙËÙ· Ù˘ ʈӋ˜ Ù˘. ¢ÂÓ ÂÈı˘Ì› ÌÈ· ÌË Â˘·›ÛıËÙË ‹ ÌÈ· ÌË Û˘ÌÔÓÂÙÈ΋ ÌËÙ¤Ú·, ÛÙËÓ ·ÚÔ˘Û›· Ù˘ ÔÔ›·˜ ·ÔÛ‡ÚÂÙ·È ·Ì˘ÓfiÌÂÓÔ, ·ÔʇÁÂÈ ÙË ‚ÏÂÌÌ·ÙÈ΋ Â·Ê‹ Ì·˙› Ù˘ ‹ ÎÏ·›ÂÈ. ¶ÚÔÛ·ÚÌfi˙ÂÈ ÙÔ ÛÒÌ· ÙÔ˘ ÁÈ· Ó· ·ÁηÏÈ·ÛÙ› ·fi ÙË ÌËÙ¤Ú·. ¢Â›¯ÓÂÈ ÌÈ· Ê˘ÛÈ΋ ÂȉÂÍÈfiÙËÙ· Ó· „¿ÍÂÈ, Ó· ‚ÚÂÈ Î·È Ó· ıËÏ¿ÛÂÈ ÙÔ ÛÙ‹ıÔ˜ Ù˘. ™‡ÓÙÔÌ·, Ô ıËÏ·ÛÌfi˜ ηı›ÛÙ·Ù·È ÌÈ· Û˘ÓÂÚÁ·ÙÈ΋ ‰È·‰Èηۛ·, fiÔ˘ ÔÈ ‰‡Ô Û‡ÓÙÚÔÊÔÈ fiÏÔ Î·È Î·Ï˘ÙÂÚÂ‡Ô˘Ó ÛÙËÓ Úfi‚ÏÂ„Ë ÙˆÓ Ú¿ÍÂˆÓ Î·È ÙˆÓ ÛÈÓÈ¿ÏˆÓ ÙÔ˘ ¿ÏÏÔ˘. ∏ ÔÌ·Ï‹ Î·È ·‰È¿Û·ÛÙË ‰È·‰Èηۛ· ÙÔ˘ Ê˘ÛÈÎÔ‡ (Î·È Û˘Ó‹ıˆ˜ ÙÔ˘ Ù¯ÓËÙÔ‡) ıËÏ·ÛÌÔ‡ Â›Ó·È ‰È·ÏÔÁÈ΋. ŸÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ ıËÏ¿˙ÂÈ, Ë ÌËÙ¤Ú· ÙÔ ÎÔÈÙ¿ Î·È ‰ÂÓ ÙÔ˘ ÌÈÏ¿ (Ë ÛÂÈÚ¿ ÙÔ˘). ŸÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ ÛÙ·Ì·Ù¿ Ó· ¿ÚÂÈ ·Ó¿Û·, ÙfiÙÂ Ë ÌËÙ¤Ú· ÙÔ‡ ÌÈÏ¿ ÙÚ˘ÊÂÚ¿ Î·È ·˘Ùfi ÙËÓ ÎÔÈÙ¿ ÛÙ· Ì¿ÙÈ· (Ë ÛÂÈÚ¿ Ù˘). ∞˘Ù‹ Ë ÂÓ·ÏÏ·Á‹ ÛÂÈÚ¿˜ (Ë ÛÂÈÚ¿ ÌÔ˘ - ·‡ÛË - Ë ÛÂÈÚ¿ ÛÔ˘) Â›Ó·È ‚·ÛÈÎfi ÛÙÔÈ¯Â›Ô ÙÔ˘ ‰È·ÏfiÁÔ˘ - ¤ÌÊ˘ÙË Úԛη, ÏÂÈÙÔ˘ÚÁ›· Î·È ÚÔÛ‰ÔΛ· ÙÔ˘ ÓÔ˘ ÙÔ˘ ›‰Ô˘˜ Ì·˜. ∆· ÓÂÔÁÓ¿ ·ÓÙȉÚÔ‡Ó ÚÔ˜ Ù· ÔÌÈÏÔ‡ÓÙ· ÚfiÛˆ· ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ ¿ÏÏˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ, ÚÔÙÈÌÔ‡Ó ÙËÓ ·ÓıÚÒÈÓË ÊˆÓ‹, ÙÔ ·ÓıÚÒÈÓÔ ÚfiÛˆÔ Î·È Ù· Û¯¤‰È· Ô˘ ÌÔÈ¿˙Ô˘Ó ÛÙÔ ÙÂÏÂ˘Ù·›Ô. ¢Â‡ÙÂÚÔ˜ Î·È ÙÚ›ÙÔ˜ Ì‹Ó·˜ (Ê¿ÛË Ù˘ ÚˆÙÔÁÂÓÔ‡˜ ‰È˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·˜) ™ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹, ·Ú·ÙËÚÂ›Ù·È ÌÈ· ·ÏÏ·Á‹ ÛÙË ÌÔÚÊ‹ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÌËÙ¤Ú·˜-‚Ú¤ÊÔ˘˜. ∆ÒÚ· Ù· ‚Ú¤ÊË ¤¯Ô˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ÚÔÛ‰Ô˘ ÁÈ· ÙÔ Ò˜ Ú¤ÂÈ Ó· Û˘ÌÂÚÈʤÚÂÙ·È Ë ÌËÙ¤Ú· ÒÛÙ ӷ Ù· ‚ÔËı‹ÛÂÈ Ó· ·Ó·Ù˘¯ıÔ‡Ó. ∏ ÌËÙ¤Ú·, ·fi ÙË ÌÂÚÈ¿ Ù˘, ÚÔÛ·ÚÌfi˙ÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ Ù˘ ÁÈ· Ó· ηχ„ÂÈ ÙȘ ÚÔÛ‰Ô˘ Î·È ÙȘ ·Ó¿ÁΘ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ù˘. √È Û˘Ó·ÏÏ·Á¤˜ ÙÔ˘˜ Â›Ó·È Î·ÓÔÓÈΤ˜, Ϙ Î·È ÙÔ ‚Ú¤ÊÔ˜ ‰È·ı¤ÙÂÈ ¤Ó· ·ÓÂÙ˘Á̤ÓÔ ÊˆÓËÙÈÎfi Û‡ÛÙËÌ·. √È ÛÙÔȯÂÈÒ‰ÂȘ ‚ÚÂÊÈΤ˜ ʈÓËÙÈΤ˜ ÂÎÊÔÚ¤˜ Ù·ÈÚÈ¿˙Ô˘Ó Ì ÙË ÌËÙÚÈ΋ ‰È·ÈÛıËÙÈ΋ ÔÌÈÏ›· (ª¢√), fiÔ˘ Ë ÌËÙ¤Ú·, Ì ÏfiÁÔ ·ÏÔ‡ÛÙÂÚÔ ÂΛÓÔ˘ Ô˘ ·¢ı‡ÓÂÙ·È Û ÂÓ‹ÏÈΘ, Â·Ó·Ï·Ì‚¿ÓÂÈ Û‡ÓÙÔ̘ ϤÍÂȘ, Û ›Û· ‰È·ÛÙ‹Ì·Ù·, Ì ··ÏÔ‡˜ ÙÚ·ÁÔ˘‰ÈÛÙÔ‡˜ ÙÔÓÈÛÌÔ‡˜ Î·È ‹ÚÂÌË ÊˆÓ‹ ÌÂÙÚ›Ô˘ ‡„Ô˘˜. ∏ ª¢√ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÌÂÁ·Ï‡ÙÂÚË ıÂÌÂÏÈÒ‰Ë Û˘¯ÓfiÙËÙ·, ÌÂÁ·Ï‡ÙÂÚË ÙÔÓÈ΋ ‰È·Î‡Ì·ÓÛË Î·È Û˘¯Ó¤˜ Â·Ó·Ï‹„ÂȘ Î·È ·‡ÛÂȘ. ∏ ‡ÚÂÛË Ù˘ ª¢√ Û ÌËÙ¤Ú˜ Ô˘ ÌÈÏÔ‡Ó ÙÔÓÈΤ˜ (∫ÈÓ¤˙˜, °È·ˆÓ¤˙˜) Î·È ÌË ÙÔÓÈΤ˜ ÁÏÒÛÛ˜ (∞ÁÁÏ›‰Â˜,

°ÂÚÌ·Ó›‰Â˜, πÙ·Ï›‰Â˜ Î.¿.) Î·È Û ÌËÙ¤Ú˜ ·fi 6 ‰È·ÊÔÚÂÙÈΤ˜ ÂıÓfiÙËÙ˜, Ì 6 ‰È·ÊÔÚÂÙÈΤ˜ ÎÔ˘ÏÙÔ‡Ú˜ Î·È ÁÏÒÛÛ˜, Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ÔÈÎÔ˘ÌÂÓÈÎfiÙËÙ·˜ Î·È Èı·Ófiٷٷ ˘¤Ú Ù˘ ¤ÌÊ˘Ù˘ ηٷÁˆÁ‹˜ Ù˘, ÂÂȉ‹ Ù· ‚Ú¤ÊË ÚÔÙÈÌÔ‡Ó ÙË ª¢√ ·fi ÙË ÌËÙÚÈ΋ ÔÌÈÏ›· Ô˘ ·¢ı‡ÓÂÙ·È Û ÂÓ‹ÏÈΘ. ∂ÈϤÔÓ, Ù· Έʿ ‚Ú¤ÊË ÚÔÙÈÌÔ‡Ó ÙË ÓÔËÌ·ÙÈ΋ ÁÏÒÛÛ· ÙˆÓ ÎˆÊÒÓ ÌËÙ¤ÚˆÓ Ô˘ ·¢ı‡ÓÂÙ·È Û Έʿ ‚Ú¤ÊË ·fi ÙË ÓÔËÌ·ÙÈ΋ ÁÏÒÛÛ· Ô˘ ÔÈ ÎˆÊ¤˜ ÌËÙ¤Ú˜ ·¢ı‡ÓÔ˘Ó Û ΈÊÔ‡˜ ÂÓ‹ÏÈΘ. ∆ÔÓ ›‰ÈÔ ‰È·ÈÛıËÙÈÎfi ÙÚfiÔ ÔÌÈÏ›·˜ ˘ÈÔıÂÙÔ‡Ó ·˘ıfiÚÌËÙ· ÔÈ ·Ù¤Ú˜, ÔÈ ÁÈ·ÁÈ¿‰Â˜, ÔÈ ·Ô‡‰Â˜ Î·È Ù· ·È‰È¿, ·ÎfiÌË Î·È Ù· Ó‹È· - ÌÈÏÔ‡Ó Ì ÙÔÓ ÙÚfiÔ Ô˘ ÚÔÛ‰ÔÎÔ‡Ó Ù· ‚Ú¤ÊË. ∞fi ÙË ÌÂÚÈ¿ ÙÔ˘, ÙÔ ‚Ú¤ÊÔ˜ Â›Ó·È ˆ˜ Â¿Ó Ó· ÚÔÛ·ı› Ó· “ÌÈÏ‹ÛÂÈ” (Ì ʈÓÔÔÈ‹ÛÂȘ, Ì ÂÎÊÚ¿ÛÂȘ ÙÔ˘ ÚÔÛÒÔ˘, Ì ¯ÂÈÚÔÓƠ̂˜, Ì ÛÙ¿ÛÂȘ Î·È ÎÈÓ‹ÛÂȘ ÙÔ˘ ÛÒÌ·ÙÔ˜) ÁÈ· Ó· ··ÓÙ‹ÛÂÈ ÛÙÔÓ ÌËÙÚÈÎfi ÏfiÁÔ. ™Â ·˘Ù¤˜ ÙȘ Û˘ÓÙÔÓÈṲ̂Ó˜ ÂÈÎÔÈÓˆÓȷΤ˜ ÛÙÈÁ̤˜ Ù˘ ‰˘¿‰·˜, Ë Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÂÚÓ¿ ·fi: ·) ÌÈ· Ê¿ÛË ÚÔÛ·Ó·ÙÔÏÈÛÌÔ‡ - ÛÙÚÔÊ‹ ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÚÔ˜ ÙÔ ÌËÙÚÈÎfi ÚfiÛˆÔ Î·È Û˘Ó¿ÓÙËÛË ÙˆÓ ‚ÚÂÊÈÎÒÓ Ì ٷ ÌËÙÚÈο Ì¿ÙÈ· ‚) ÌÈ· Ê¿ÛË ·Ó·ÁÓÒÚÈÛ˘ - .¯. Ë ·Ó·ÁÓÒÚÈÛË Ù˘ ÌËÙ¤Ú·˜ ÂÎÊÚ¿˙ÂÙ·È Ì ¤Ó· ‚ÚÂÊÈÎfi ¯·ÌfiÁÂÏÔ Á) ÌÈ· Ê¿ÛË ¤ÎÊÚ·Û˘ - ·‡ÍËÛË Ù˘ ‚ÚÂÊÈ΋˜ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, Ù˘ ʈÓÔÔ›ËÛ˘ Î·È ÙˆÓ ÎÈÓ‹ÛÂˆÓ ÙÔ˘ ÚÔÛÒÔ˘. ∞̤ۈ˜ ÌÂÙ¿, Ë ÌËÙ¤Ú· Û¯ÔÏÈ¿˙ÂÈ, Ϙ Î·È ··ÓÙ¿ ÛÙË ‚ÚÂÊÈ΋ ʈÓËÙÈ΋ ¤ÎÊÚ·ÛË, ˆ˜ Â¿Ó Ó· ‹Ù·Ó ÌÈ· ÈÛÙÔÚ›· Ô˘ Ù˘ ·ÊËÁ‹ıËΠÙÔ ‚Ú¤ÊÔ˜ Ù˘ ‰) ÌÈ· Ê¿ÛË ÔÏÔÎÏ‹ÚˆÛ˘ Ù˘ ÂÈÎÔÈÓˆÓ›·˜, Ë ÔÔ›· Ô‰ËÁ› Û ·fiÛ˘ÚÛË ÙÔ˘˜ ‰‡Ô Û˘ÓÙÚfiÊÔ˘˜ ‹ Û ¤Ó·ÚÍË Ó¤Ô˘ ÂÈÎÔÈÓˆÓÈ·ÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ªËÙ¤Ú· Î·È ‚Ú¤ÊÔ˜ ·ÔÚÚÔÊÔ‡ÓÙ·È ÛÙË ÌÂٷ͇ ÙÔ˘˜ ÂÈÎÔÈÓˆÓ›·, ·Ó·ÁÓˆÚ›˙Ô˘Ó ·ÏÏ‹ÏÔ˘˜ ˆ˜ ÚfiÛˆ·, ‰ËÏ·‰‹ ÂÈÎÚ·Ù› ÙÔ ÂÁÁÂÓ¤˜ ΛÓËÙÚÔ ÁÈ· Ù· ÚfiÛˆ· Î·È fi¯È ÙÔ ÂÁÁÂÓ¤˜ ΛÓËÙÚÔ ÁÈ· Ù· ·ÓÙÈΛÌÂÓ·. ∞Ó Î·Ù¿ ÙËÓ ÂÈÎÔÈÓˆÓ›· Ë ÌËÙ¤Ú· ·ÁÒÛÂÈ ÙÔ ÚfiÛˆfi Ù˘ Î·È ÚÔÛÔÈËı› fiÙÈ ‰ÂÓ ‰›ÓÂÈ ÛËÌ·Û›· ÛÙÔ ‚Ú¤ÊÔ˜ Ù˘, ·˘Ùfi οÓÂÈ fi,ÙÈ ÌÔÚ› ÁÈ· Ó· ÙËÓ Â·Ó·Ê¤ÚÂÈ ÛÙÔÓ ‰È¿ÏÔÁÔ. ∞Ó ÂÈÙ‡¯ÂÈ ¯·›ÚÂÙ·È. ∞Ó fi¯È, ÛÙË Ì·Ù·›ˆÛË ÙÔ˘ ÂÈÎÔÈÓˆÓÈ·ÎÔ‡ ÌÔÈÚ¿ÛÌ·ÙÔ˜ ÙÔ ‚Ú¤ÊÔ˜ Ï˘¿Ù·È Î·È ÎÏ·›ÂÈ. √È ÚÒÈ̘ ·˘Ù¤˜ ÚˆÙÔÛ˘ÓÔÌÈϛ˜ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÂÓ·ÏÏ·Á¤˜ ÛÂÈÚ¿˜, ÌÂ Û˘ÓÙÔÓÈÛÌfi ÛÂ Û˘ÁÎÂÎÚÈ̤ÓÔ Ú˘ıÌfi (·ÚÁfi adagio, ¤Ó·˜ ¯Ù‡Ô˜ οı 0,9 ‰Â˘ÙÂÚfiÏÂÙ·), fiÔ˘ Ô Î¿ı ۇÓÙÚÔÊÔ˜ ÚÔÛ¤¯ÂÈ ÛÙ· Ì¿ÙÈ· ÙÔÓ ¿ÏÏÔ (ÙÔ ‚Ú¤ÊÔ˜ ÎÔÈÙ¿ ÙÔ 90% ÙÔ˘ ¯ÚfiÓÔ˘ ÛÙ· ÌËÙÚÈο Ì¿ÙÈ·), ÙÔÓ ·Ê‹ÓÂÈ Ó· ÙÂÏÂÈÒÛÂÈ Î·È ÌÂÙ¿, Ì ÙË ÛÂÈÚ¿ ÙÔ˘, ‰Ú· ʈÓËÙÈο ‹ ÎÈÓËÙÈο. °È· ¤Ó· ‹ ‰‡Ô ‰Â˘ÙÂÚfiÏÂÙ· ÚÈÓ ‰Ú¿ÛÂÈ, ÙÔ ‚Ú¤ÊÔ˜ ÎÔÈÙ¿˙ÂÈ Ì·ÎÚÈ¿, ¶·È‰È·ÙÚÈ΋ 2008;71:331-344

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¿Óˆ Î·È ‰ÂÍÈ¿, Û·Ó ÙÔÓ ÂÓ‹ÏÈη Ô˘, ÚÈÓ ÌÈÏ‹ÛÂÈ, ÛΤÊÙÂÙ·È, ·ÔÛ‡ÚÔÓÙ·˜ ÙÔ ‚ϤÌÌ· ÙÔ˘ ·fi ÙÔ ‚ϤÌÌ· ÙÔ˘ Û˘ÓÔÌÈÏËÙ‹ ÙÔ˘. ∏ ˯ËÙÈ΋ ÂÎÊÔÚ¿ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (ʈÓÔÔ›ËÛË Ì ‹ÚÂÌ· ÁÔ˘ÚÁÔ˘Ú›ÛÌ·Ù· Î·È ÚÔÙÂٷ̤ӷ ¯Â›ÏË) ‰È·ÚΛ ÂÚ›Ô˘ 2 Ì 3 ‰Â˘ÙÂÚfiÏÂÙ· Î·È Û˘Óԉ‡ÂÙ·È ·fi ÛȈËÚ¤˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ¯ÂÈÏÈÒÓ Î·È ÚÔ‚ÔϤ˜ Ù˘ ÁÏÒÛÛ·˜ (ÚÔ-ÔÌÈÏ›·), ·fi ÂÎÊÚ·ÛÙÈΤ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ¯ÂÚÈÒÓ Î·È ÎÈÓ‹ÛÂȘ Ô˘ ı˘Ì›˙Ô˘Ó ¯·ÈÚÂÙÈÛÌfi (ÚˆÙÔ-Û‹Ì·Ù· ¯ÂÚÈÒÓ), ·fi ‚ÏÂÌÌ·ÙÈ΋ Â·Ê‹ Î·È ÌÂٷΛÓËÛË ÙÔ˘ ‚ϤÌÌ·ÙÔ˜ ·fi Ù· Ì¿ÙÈ· ÛÙÔ ÛÙfiÌ· Î·È ÛÙ· Ì·ÏÏÈ¿ Ù˘ ÌËÙ¤Ú·˜ ‹ Î·È “οÔ˘” ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ. ∫·Ù¿ ÙȘ ÚˆÙÔÛ˘ÓÔÌÈϛ˜, Ë ÌËÙ¤Ú· ·˘ıfiÚÌËÙ· ʤÚÂÈ ÙÔ Â›Â‰Ô ÙˆÓ Ì·ÙÈÒÓ Ù˘ ÛÙÔ ›‰ÈÔ Â›Â‰Ô Ì ÂΛÓÔ ÙˆÓ Ì·ÙÈÒÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜. ∆Ô ‚Ú¤ÊÔ˜ ‰ÂÓ ÂϤÁ¯ÂÈ ·ÎfiÌ· ÙȘ ÎÈÓ‹ÛÂȘ Û‡ÏÏ˄˘ Î·È ¯ÂÈÚÈÛÌÔ‡ ·ÓÙÈÎÂÈ̤ӈÓ, ·Ú·ÙËÚ›, fï˜, ÙË ÌËÙ¤Ú· fiÙ·Ó Ù· ¯ÂÈÚ›˙ÂÙ·È Î·È, fiÙ·Ó ÙÔ ›‰ÈÔ Î·Ù·Ê¤ÚÂÈ Î·È È¿ÛÂÈ ¤Ó· ·ÓÙÈΛÌÂÓÔ, ÙÔ ÂÍÂÚÂ˘Ó¿, ÙÔ ¯Ù˘¿, ÙÔ Ê¤ÚÓÂÈ ÛÙÔ ÛÙfiÌ· ÙÔ˘ Î·È Û˘¯Ó¿ ·˘ÙÔ-·ÔÚÚÔÊ¿Ù·È. ∞fi ÙÔÓ 4Ô ¤ˆ˜ ÙÔÓ 8Ô Ì‹Ó· (Ê¿ÛË ÙˆÓ ·ÈÁÓȉÈÒÓ) ™ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹, ·ÏÏ¿˙Ô˘Ó ÔÈ Î·ÓfiÓ˜ ÂÈÎÔÈÓˆÓ›·˜ ÌËÙ¤ÚˆÓ-‚ÚÂÊÒÓ. ∆· ‚Ú¤ÊË ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹ ·ÔÎÙÔ‡Ó ¤ÏÂÁ¯Ô ÙˆÓ ‚Ú·¯ÈfiÓˆÓ Î·È ÙÔ˘ Ï·ÈÌÔ‡, ÎÚ·ÙÔ‡Ó fiÚıÈÔ ÙÔ ÎÂÊ¿ÏÈ Î·È ÙÔ ÛÙÚ¤ÊÔ˘Ó ÁÈ· Ó· ·Ú·ÙËÚÔ‡Ó ÙÈ Û˘Ì‚·›ÓÂÈ Á‡Úˆ ÙÔ˘˜, Ô ‰Â ÎÈÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È ÔχÏ¢ÚÔ˜, ÈÔ ÂÈÙ‹‰ÂÈÔ˜ Î·È Û˘ÓÙÔÓ›˙ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÔÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆ÒÚ· Ù· ‚Ú¤ÊË ÂÈı˘ÌÔ‡Ó Ó· ·ÁÁ›˙Ô˘Ó, Ó· ÂÍÂÚ¢ÓÔ‡Ó, Ó· ¯·˚‰Â‡Ô˘Ó Î·È Ó· ·›˙Ô˘Ó Ì ÙÔ ÚfiÛˆÔ Î·È ÙÔ ÛÙfiÌ· Ù˘ ÌËÙ¤Ú·˜, fiÙ·Ó ·˘Ù‹ ÙÔ˘˜ ÌÈÏ›. ∞˘Ùfi ÙÔ ÚfiÛˆÔ Ì ÚfiÛˆÔ ·È¯Ó›‰È ¤¯ÂÈ ÌÈ· ÂÎÊÚ·ÛÙÈ΋ fi„Ë, Ë ÔÔ›· ·Ô˘ÛÈ¿˙ÂÈ fiÙ·Ó ÙÔ ‚Ú¤ÊÔ˜ ·ÁÁ›˙ÂÈ Î·È ÂÍÂÚÂ˘Ó¿ ¿„˘¯· ·ÓÙÈΛÌÂÓ·. ∏ ÌËÙ¤Ú·, Ì ÙË ÛÂÈÚ¿ Ù˘, Á›ÓÂÙ·È ÈÔ ˙ˆËÚ‹, ÂȂ‚·ÈˆÙÈ΋, ·È¯Óȉȿڷ Î·È ÚÔηÏ› ÂÚÈÛÛfiÙÂÚÔ ÙÔ ·È‰› Ù˘ Ó· ÂÌÏ·ÎÔ‡Ó Û ÂÈÎÔÈÓˆÓ›·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ Ú˘ıÌÈο ۈ̷ÙÈο ·È¯Ó›‰È·, ‚ÚÂÊÈο Î·È ÌË ‚ÚÂÊÈο ÙÚ·ÁÔ‡‰È·, ˙ˆËÚ‹ ΛÓËÛË ÙˆÓ ¿ÎÚˆÓ ÙÔ˘ Î.¿. - ·È¯Ó›‰È· Ô˘ ÚÔÛʤÚÔ˘Ó ÛÙÔ ÁÔÚÁ¿ ·Ó·Ù˘ÛÛfiÌÂÓÔ ‚Ú¤ÊÔ˜ ¿ÊıÔÓË ‰È¤ÁÂÚÛË, ȉȷ›ÙÂÚ· ÙÔ˘ ȉÈÔ‰ÂÎÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∞fi ÙËÓ ·›ÛıËÛË ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ¯ÈÔ‡ÌÔÚ ·Ó·‰‡ÔÓÙ·È Û˘ÌÂÚÈÊÔÚ¤˜ ÂÈÚ¿ÁÌ·ÙÔ˜ Î·È “ÔÓËÚÒÓ” ÂÎÊÚ¿ÛÂˆÓ Â˘¯·Ú›ÛÙËÛ˘. °‡Úˆ ÛÙÔ˘˜ 5 Ì‹Ó˜ ‹ Î·È ÓˆÚ›ÙÂÚ·, ÙÔ ‚Ú¤ÊÔ˜ ηٷʤÚÓÂÈ Ó· ·Ú·ÎÔÏÔ˘ı‹ÛÂÈ ·˘Ùfi Ô˘ ÙÔ˘ ‰Â›¯ÓÂÈ Ë ÌËÙ¤Ú· ÙÔ˘ ÛÙÔÓ ¯ÒÚÔ, Û˘ÏÏ·Ì‚¿ÓÔÓÙ·˜ ÙË ÓÔÂÚ‹ ÁÚ·ÌÌ‹ ·fi ÙÔ ‰¿ÎÙ˘ÏÔ Ù˘ ÌËÙ¤Ú·˜ ÛÙÔ ·ÓÙÈΛÌÂÓÔ-ÛÙfi¯Ô - ¤Ó· ηÏfi ·Ú¿‰ÂÈÁÌ· ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÂÈÎÔÈÓˆÓÈ·ÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ Ì ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÂÈÎÔÈÓˆÓÈ·ÎÒÓ ÎÈÓ‹ÛÂˆÓ Î·È ÚÔı¤ÛÂˆÓ ÙÔ˘ ¿ÏPaediatriki 2008;71:331-344

ÏÔ˘. ¶ÚÈÓ ·fi ÙÔ˘˜ 6 Ì‹Ó˜, ÙÔ ‚Ú¤ÊÔ˜ ¤¯ÂÈ Î·Ù·ÎÙ‹ÛÂÈ ÙÂÏÂÙÔ˘ÚÁ›Â˜ ·È¯ÓȉÈÔ‡, ·ÔÏ·Ì‚¿ÓÂÈ ÂÌÂÈڛ˜ ÌÔ˘ÛÈ΋˜, ÙÚ·ÁÔ˘‰ÈÒÓ Î·È ·È¯ÓȉÈÒÓ ‰Ú¿Û˘, ¤¯ÂÈ Â›ÁÓˆÛË ÙÔ˘ ÚÔÛÒÔ˘ ÙÔ˘ ÛÙÔÓ Î·ıÚ¤ÙË - ¤¯ÂÈ ¤Ó·Ó “ηÙÔÙÚÈÎfi ·˘Ùfi” Ô˘ ÙÔÓ ÎÔÚÔ˚‰Â‡ÂÈ ‰È·ÛΉ¿˙ÔÓÙ·˜. ∆Ô ‚Ú¤ÊÔ˜ ÚÔ¯ˆÚ› Ì ÂÚËÊ¿ÓÈ· Û ·˘ÙÔÛ¯¤‰È˜ ·Ú·ÛÙ¿ÛÂȘ-‰ÒÚ· ÌÚÔÛÙ¿ ÛÙÔ˘˜ ¿ÏÏÔ˘˜, ÁÈ· ÙȘ Ôԛ˜ Â·ÈÓÂ›Ù·È Ì ·Ï·Ì¿ÎÈ·, ¯¿‰È· Î·È ÂÈʈӋ̷ٷ. √ Ú˘ıÌfi˜ ÙˆÓ ·È¯ÓȉÈÒÓ Â›Ó·È ˙ˆËÚfiÙÂÚÔ˜ Î·È Ù·¯‡ÙÂÚÔ˜ ·fi fi,ÙÈ ÚÈÓ, Ô ¯ÚfiÓÔ˜ Ô˘ ‰È·ÚÎÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ˜ Î·È Ë Û˘ÁÎÈÓËÛȷ΋ ÔÈÎÈÏ›· ÌÂÁ·Ï‡ÙÂÚË. ∆· ÌËÙÚÈο ÙÚ·ÁÔ‡‰È· Ô˘ ·¢ı‡ÓÔÓÙ·È ÛÙ· ‚Ú¤ÊË, ·Ú¿ ÙȘ ÁψÛÛÈΤ˜ Î·È ÔÏÈÙÈÛÌÈΤ˜ ‰È·ÊÔÚ¤˜, ¤¯Ô˘Ó ÎÔÈÓ‹ ÌÔÚÊ‹ (ÛÙÚÔÊ‹ ÙÂÛÛ¿ÚˆÓ ÁÚ·ÌÌÒÓ), ÎÔÈÓfi Ú˘ıÌfi (andante) Î·È ÎÔÈÓ¤˜ ÂÈÙ·¯‡ÓÛÂȘ Î·È ÂÈ‚Ú·‰‡ÓÛÂȘ ÛÙȘ ‰‡Ô ÙÂÏÂ˘Ù·›Â˜ ÁÚ·Ì̤˜. ∆· ÂÍÂÚ¢ÓËÙÈο ·È¯Ó›‰È· ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ì ٷ ÚfiÛˆ· ÚÔËÁÔ‡ÓÙ·È Î·È, ηٿ ÙÔÓ 5Ô Ì‹Ó·, Ô‰ËÁÔ‡Ó ÛÙ· ·È¯Ó›‰È· ÂÍÂÚ‡ÓËÛ˘ ÙˆÓ ·ÓÙÈÎÂÈ̤ӈÓ. ∆· ÙÂÏÂ˘Ù·›· Á›ÓÔÓÙ·È ÙÒÚ· ÌÈ· Á¤Ê˘Ú· ·ÏÏËÏÂ›‰Ú·Û˘ ·Ó¿ÌÂÛ· ÛÙË ÌËÙÚÈ΋ ÚfiıÂÛË ÁÈ· ÂÈÎÔÈÓˆÓ›· Î·È ÛÙË ‚ÚÂÊÈ΋ ÚfiıÂÛË ÁÈ· ÂÍÂÚ‡ÓËÛË. ŸÌˆ˜, ÙÔ ‚Ú¤ÊÔ˜ ‰‡ÛÎÔÏ· ı· ‰ÒÛÂÈ ¤Ó· ·ÓÙÈΛÌÂÓÔ ÛÙÔÓ Û‡ÓÙÚÔÊÔ Ô˘ ÙÔ˘ ÙÔ ˙ËÙ¿ Ù›ÓÔÓÙ¿˜ ÙÔ˘ ÙËÓ ·Ï¿ÌË. ∞fi ÙÔ˘˜ 6 ¤ˆ˜ ÙÔ˘˜ 8 Ì‹Ó˜, ÙÔ ‚Ú¤ÊÔ˜ ı· ‰Â¯Ù› ÙÔ ·ÓÙÈΛÌÂÓÔ Ô˘ ÙÔ˘ ÚÔÛʤÚÂÈ Ë ÌËÙ¤Ú·, ı· ÂÈÎÂÓÙÚÒÛÂÈ ¿Óˆ ÙÔ˘ ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘, ı· ÙÔ „¿ÍÂÈ Ì ٷ ¯¤ÚÈ· Î·È ÙÔ ÛÙfiÌ·, ı· ÙÔ ¯ÂÈÚÈÛÙ›, ı· ÙÔ ‰Â¯Ù› ˆ˜ ÌÂÛÔÏ·‚ËÙ‹ ÙˆÓ ÂÈÎÔÈÓˆÓÈ·ÎÒÓ ÚÔı¤ÛÂˆÓ Ù˘ ÌËÙ¤Ú·˜, Ë ÔÔ›· ÙÒÚ· ÁÓˆÚ›˙ÂÈ Î·È ÚÔÛʤÚÂÈ ÛÙÔ ‚Ú¤ÊÔ˜ Ù˘ Ù· ·È¯Ó›‰È· Ô˘ ÙÔ ›‰ÈÔ ÚÔÙÈÌ¿. °‡Úˆ ÛÙÔ˘˜ 7 Ì 8 Ì‹Ó˜, Ù· ·ÈÁÓ›‰È· “ÚfiÛˆÔ-·ÓÙÈΛÌÂÓÔ-ÚfiÛˆÔ” ·Ú¯›˙Ô˘Ó Ó· ·˘Í¿ÓÔÓÙ·È, ÚÔÂÙÔÈÌ¿˙ÔÓÙ·˜ ÌÈ· ·Ó·Ù˘Íȷ΋ ·ÏÏ·Á‹ Ô˘ ı· ¤ÚıÂÈ ÛÙËÓ ÂfiÌÂÓË Ê¿ÛË. ªÂÙ¿ ÙÔ˘˜ 6 Ì‹Ó˜, ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ϤÔÓ ÙÚfiÔ Ù· ‚Ú¤ÊË ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·Ó·ÊÔÚ¿ ÁÈ· Ó· ‰Ô˘Ó ·Ó ·˘Ùfi Ô˘ οÓÔ˘Ó ‹ ÛÎÔÂ‡Ô˘Ó Ó· οÓÔ˘Ó ÂÈ‚Ú·‚‡ÂÙ·È Î·È Î·Ù·ÍÈÒÓÂÙ·È Û˘Ó·ÈÛıËÌ·ÙÈο ·fi ÙË ÌËÙ¤Ú· ‹ ‰ÂÓ Î·Ù·ÍÈÒÓÂÙ·È - ‰ËÏ·‰‹, ÛÙÚ¤ÊÔ˘Ó ÙËÓ ÚÔÛÔ¯‹ ÙÔ˘˜ ÛÙÔ ÚfiÛˆÔ, ÛÙ· Ì¿ÙÈ· Î·È ÛÙ· ¯¤ÚÈ· Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘˜ ÁÈ· Ó· ÏËÚÔÊÔÚËıÔ‡Ó ·Ó ·˘Ùfi Ô˘ ¤Î·Ó·Ó ‹ ÚÔÙ›ıÂÓÙ·È Ó· οÓÔ˘Ó ÂȉÔÎÈÌ¿˙ÂÙ·È ·fi ÙË ÌËÙ¤Ú·. ∞fi ÙÔÓ 9Ô ¤ˆ˜ ÙÔÓ 12 Ì‹Ó· (Ê¿ÛË ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ‰È˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·˜) ™ÙËÓ ÂÚ›Ô‰Ô ·˘Ù‹, ·Ú·ÙËÚÂ›Ù·È ÌÈ· Ó¤· ÙÚÈ·‰È΋, Ï‹Úˆ˜ Û˘ÓÂÚÁ·ÙÈ΋ ÌÔÚÊ‹ ÂÈÎÔÈÓˆÓ›·˜: ÌËÙ¤Ú·-·ÓÙÈΛÌÂÓ·-‚Ú¤ÊÔ˜. ™ÙÔ˘˜ 9 Ì‹Ó˜, Á›ÓÂÙ·È ϤÔÓ ÚÔ˘Ù›Ó· ÙÔ “‰ÒÛÂ-¿Ú” ÙˆÓ ·ÓÙÈÎÂÈ̤ӈÓ. ∆Ô ‚Ú¤ÊÔ˜ ‰¤¯ÂÙ·È ÙÒÚ· Ù· ÚfiÛˆ· Ì ¤Ó· Ó¤Ô Î·È

Pediatri Sept-Oct 08

14-10-08

13:26

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æ˘¯ÔÏÔÁ›· ÂÌ‚Ú‡ˆÓ, ÓÂÔÁÓÒÓ Î·È ‚ÚÂÊÒÓ

Û·ÊÒ˜ ÈÔ ÂÎÔ‡ÛÈÔ ÙÚfiÔ - ·Ó·Ù‡ÛÛÂÈ ÌÈ· Ó¤· Â›ÁÓˆÛË ÙˆÓ Èı·ÓÔÙ‹ÙˆÓ Ù‹˜ ·fi ÎÔÈÓÔ‡ Ì ÙÔ˘˜ ¿ÏÏÔ˘˜ ÂÌÂÈÚ›·˜, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û‡ÓıÂÙ· ÚfiÙ˘· ÌÔÈÚ¿ÛÌ·ÙÔ˜ ÙÔ˘ ÂӉȷʤÚÔÓÙÔ˜. ∆ÒÚ· Ù· ‚Ú¤ÊË Â›Ó·È Èηӿ Ó· Û˘Ó‰˘¿ÛÔ˘Ó ·Ú·ÏÏ·Á¤˜ ÙˆÓ ÊˆÓÔÔÈ‹ÛÂˆÓ Ì ÙȘ ¯ÂÈÚÔÓƠ̂˜ (Ó· “ÊÙ¿ÛÂÈ” Î·È Ó· “‰Â›ÍÂÈ” οÙÈ), ÁÈ· Ó· ÌÂÙ·‰ÒÛÔ˘Ó Ì ·˘Ù‹Ó ÙËÓ “ÚˆÙÔÁÏÒÛÛ·” Û˘Ó·ÈÛı‹Ì·Ù·, ÂÈı˘Ì›Â˜ Î·È ÚÔı¤ÛÂȘ, ÊÙ¿ÓÔÓÙ·˜ ¤ÙÛÈ Û ÌÈ· Ú¿ÍË ÓÔ‹Ì·ÙÔ˜, Ë ÔÔ›· ʤÚÂÈ ·Ó·ÊÔÚÈÎfi ÊÔÚÙ›Ô. ∏ ÌËÙ¤Ú· ·ÓÙÈηıÈÛÙ¿ ÛÙÔÓ ÏfiÁÔ Ù˘ ÙȘ ÚÔÛÎÏ‹ÛÂȘ Î·È ÙȘ ÂÚˆÙ‹ÛÂȘ Ì ԉËÁ›Â˜ Î·È ÚÔÛÙ·ÎÙÈΤ˜, ÂÓÒ ·Ú¿ÏÏËÏ· ‰ÂÓ ˙ËÙ¿, ·ÏÏ¿ ÔÓÔÌ·Ù›˙ÂÈ Î·È ‰È‰¿ÛÎÂÈ ÙÔ ‚Ú¤ÊÔ˜, ÙÔ ÔÔ›Ô Â›Ó·È ÈηÓfi Ó· Ì¿ıÂÈ Î·È Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÙȘ Ô‰ËÁ›Â˜ Ù˘. ∏ ÌÓ‹ÌË ÁÈ· ÙÔ ÓfiËÌ· ÙˆÓ Ú·ÁÌ¿ÙˆÓ Á›ÓÂÙ·È Ôχ ÈÛ¯˘Ú‹ Î·È ÙÔ ‚Ú¤ÊÔ˜ ηٷÓÔ› fiÙÈ Ù· ·ÓÙÈΛÌÂÓ· ¤¯Ô˘Ó ÔÏϤ˜ ¯Ú‹ÛÂȘ, ‰È·ıÂÛÈÌfiÙËÙ· Î·È ÓfiËÌ· ÁÈ· ÙÔ˘˜ ¿ÏÏÔ˘˜, ¤¯Ô˘Ó ÙÚfiÔ˘˜ ¯ÂÈÚÈÛÌÔ‡ Ô˘ ÙÔ˘˜ Ì·ı·›ÓÂÈ ·Ú·ÙËÚÒÓÙ·˜ Ò˜ Ù· ¯ÂÈÚ›˙ÔÓÙ·È ÔÈ ¿ÏÏÔÈ. ¶ÚÔ˜ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘, Ù· ‚Ú¤ÊË ·Ú¯›˙Ô˘Ó Ó· ÂÚ·Ù¿ÓÂ Î·È Ó· ϤÓ ÌÂÚÈΤ˜ ϤÍÂȘ. ∆· ‚ÚÂÊÈο ΛÓËÙÚ· Û˘ÏÏ·Ì‚¿ÓÔ˘Ó ¿ÌÂÛ· Î·È ·ÓÙȉÚÔ‡Ó ¤ÓÙÔÓ· ÛÙȘ ÌËÙÚÈΤ˜ ÎÈÓ‹ÛÂȘ Î·È Û˘ÁÎÈÓ‹ÛÂȘ. ŒÙÛÈ, Ë ÌËÙ¤Ú·, η٤¯ÔÓÙ·˜ ÎÂÓÙÚÈ΋ ı¤ÛË ÛÙÔ ·ÓıÚÒÈÓÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜, Á›ÓÂÙ·È Û˘ÓÂÚÁfi˜ ÛÙË ‰È·‰Èηۛ· ·˘ÙÔÚ‡ıÌÈÛ˘ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ‚ÚÂÊÈÎÔ‡ ÂÁÎÂÊ¿ÏÔ˘. ∏ ·˘ÍË̤ÓË ÎÈÓËÙÈÎfiÙËÙ·, Ì·˙› Ì ÙËÓ Ù·¯Â›· ηٿÎÙËÛË Ù˘ ÔÌÈÏ›·˜, Ù˘ Ê·ÓÙ·Û›·˜, Ù˘ ÎÔÈÓ‹˜ ÔÏÈÙÈÛÌÈ΋˜ Â›ÁÓˆÛ˘, Ù˘ Û˘ÓÂÚÁ·ÙÈÎfiÙËÙ·˜ Î·È Ù˘ ÓfiËÛ˘, ʤÚÔ˘Ó, ÌÂÙ¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜, ÙÔÓ ‰È˘ÔÎÂÈÌÂÓÈÎfi ÓÔ˘ ÙˆÓ ‚ÚÂÊÒÓ Û ¤Ó· ¿ÏÏÔ Â›Â‰Ô “Û˘ÓÂÚÁ·ÙÈ΋˜ ÓÔËÌÔÛ‡Ó˘”, ‰ËψÙÈ΋˜ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Â›Ì·ÛÙ ÊÙÈ·Á̤ÓÔÈ Ó· ˙Ô‡ÌÂ Û˘ÓÂÚÁ·˙fiÌÂÓÔÈ, ̤۷ Û ÌÈ· ÎÔ˘ÏÙÔ‡Ú· fiÔ˘ ÌÔÈÚ·˙fiÌ·ÛÙ ٷ ÓÔ‹Ì·Ù¿ Ù˘. ∏ ÁÓˆÛÙÈ΋ ·Ó¿Ù˘ÍË Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ ÔÏÔÎÏËÚÒÓÂÙ·È Ì¤Û· ÛÙË ‰È·ÚÔÛˆÈ΋ ·Ó¿Ù˘ÍË. ∏ ‰˘Ó·ÌÈ΋ Ù˘ ·Ó¿Ù˘Í˘, Ì·˙› Ì ÙȘ ·ÚÔ‰ÈΤ˜ ·ÏÈÓ‰ÚÔÌ‹ÛÂȘ Û˘ÌÂÚÈÊÔÚÒÓ Î·È ÈηÓÔًوÓ, ·Ó·ÎÏÔ‡Ó Î˘Ú›ˆ˜ Ú˘ıÌ›ÛÂȘ Î·È ÌÂÙ·Û¯ËÌ·ÙÈÛÌÔ‡˜ ÛÙÔ ‰›Ô Ù˘ ¤ÌÊ˘Ù˘ ‰È˘ÔÎÂÈÌÂÓÈÎfiÙËÙ·˜ (1,2,5,6,28,29,30,31,32). ∞Ó¿‰˘ÛË Î·È ·Ó¿Ù˘ÍË ÙÔ˘ ‚ÚÂÊÈÎÔ‡ Ú˘ıÌÔ‡ À¿Ú¯Ô˘Ó ·ÎfiÌ· ÔÏÏ¿ Â˘Ú‹Ì·Ù· Ô˘ Ì·ÚÙ˘ÚÔ‡Ó ÙÔÓ ÂÍ·Ú¯‹˜ ÎÔÈÓˆÓÈÎfi ‚ÚÂÊÈÎfi ÓÔ˘ ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ 12 Ì‹Ó˜ Ù˘ ·Ó¿Ù˘Í˘. ∫Ï›ÓÔ˘Ì ÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ Ì ÌÈ· ÌÈÎÚ‹ ·Ó·ÊÔÚ¿ Û ‰‡Ô ÈηÓfiÙËÙ˜: ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ‚ÚÂÊÈÎÔ‡ Ú˘ıÌÔ‡ Î·È ÙËÓ ÈηÓfiÙËÙ· Ù˘ ÓÂÔÁÓÈ΋˜ Ì›ÌËÛ˘. ™ÙÔ ÂÚÁ·ÛÙ‹ÚÈfi Ì·˜ ÌÂÏÂÙ‹ıËΠ(33,4) Ë ·Ó¿Ù˘ÍË ÙÔ˘ ‚ÚÂÊÈÎÔ‡ Ú˘ıÌÔ‡ ·fi ÙÔÓ 2Ô ¤ˆ˜ ÙÔÓ 10Ô Ì‹Ó·, ÌÂ Û˘ÏÏÔÁ‹ ÙÔ˘ ÂÚ¢ÓËÙÈÎÔ‡ ˘ÏÈÎÔ‡ (Ì οÌÂÚ·) οı 15 Ë̤Ú˜ ÛÙ· Û›ÙÈ· ÙˆÓ ‚ÚÂÊÒÓ. ∏ ÌÈ-

ÎÚÔ-·Ó¿Ï˘ÛË, Ë Ê·ÛÌ·ÙÔÁÚ·ÊÈ΋ ·Ó¿Ï˘ÛË Î·È Ë ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ·Ó fiÙÈ: 1) Ù· ‚Ú¤ÊË ‰È·ı¤ÙÔ˘Ó ÂÁÁÂÓÒ˜ ‰ÈÎÔ‡˜ ÙÔ˘˜ Ú˘ıÌÔ‡˜, Ô˘ ÙÔ˘˜ ÂÎÊÚ¿˙Ô˘Ó ·˘ıfiÚÌËÙ· fiÙ·Ó Â›Ó·È ÌfiÓ· ÙÔ˘˜ Î·È ‰ÂÓ ·ÎÔ‡Ó ÌÔ˘ÛÈ΋ - Ú˘ıÌÈΤ˜ ʈÓÔÔÈ‹ÛÂȘ, Ú˘ıÌÈΤ˜ ¯ÂÈÚÔÓƠ̂˜, Ú˘ıÌÈΤ˜ ÎÈÓ‹ÛÂȘ ¯ÔÚÔ‡ Î·È Û˘Ó‰˘·ÛÌÔ‡˜ ·˘ÙÒÓ ÙˆÓ Ú˘ıÌÒÓ. ŸÙ·Ó Â›Ó·È ÌfiÓ· ÙÔ˘˜ ÂÈÎÚ·ÙÔ‡Ó ÔÈ Ú˘ıÌÈΤ˜ ¯ÂÈÚÔÓƠ̂˜.

2) fiÙ·Ó ·ÎÔ‡Ó ÌÔ˘ÛÈ΋, ·Ú¿ÁÔ˘Ó ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚ˜ Ú˘ıÌÈΤ˜ ÂÎÊÚ¿ÛÂȘ, ·Ú¿ fiÙ·Ó ‰ÂÓ ·ÎÔ‡Ó ÌÔ˘ÛÈ΋ (ÂÏÏËÓÈο ·È‰Èο ÙÚ·ÁÔ‡‰È·). ∆· ‚Ú¤ÊË Û˘ÓÙÔÓ›˙Ô˘Ó ÙÔ˘˜ Ú˘ıÌÔ‡˜ ÙÔ˘˜ Ì ÙÔ˘˜ Ú˘ıÌÔ‡˜ Ù˘ ÌÔ˘ÛÈ΋˜. ŸÙ·Ó ·ÎÔ‡Ó ÌÔ˘ÛÈ΋, ÔÈ ¯ÔÚ¢ÙÈΤ˜ ÎÈÓ‹ÛÂȘ Â›Ó·È ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚ˜, Ϙ Î·È Î¿ˆ˜ ÁÓˆÚ›˙Ô˘Ó Î·È Î¿ÓÔ˘Ó ·˘Ùfi Ô˘ ÚÔÛ‰Ôο Ë ÎÔ˘ÏÙÔ‡Ú· ÛÙÔ ¿ÎÔ˘ÛÌ· Ù˘ ÌÔ˘ÛÈ΋˜. ∏ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Ú˘ıÌÒÓ ·fi Ù· ‚Ú¤ÊË Î·Ù¿ ÙÔ ¿ÎÔ˘ÛÌ· Ù˘ ÌÔ˘ÛÈ΋˜ ‰ËÏÒÓÂÈ ÙËÓ ÈÛ¯‡ Ù˘ ÌÔ˘ÛÈ΋˜ ˆ˜ ÎÈÓËÙ‹ÚÈ·˜ ‰‡Ó·Ì˘ ÛÙËÓ ·ÓıÚÒÈÓË ˙ˆ‹ ·fi Ù· ÚÒÙ· Ù˘ ‚‹Ì·Ù·.

3) Ë ‰È¿ÚÎÂÈ· ÙˆÓ Ú˘ıÌÒÓ ·Ú¤ÌÂÈÓ ÛÙ·ıÂÚ‹ ·fi ÙÔÓ 2Ô ¤ˆ˜ ÙÔÓ 10Ô Ì‹Ó·, fiÙ·Ó Ù· ‚Ú¤ÊË ¿ÎÔ˘Á·Ó Î·È fiÙ·Ó ‰ÂÓ ¿ÎÔ˘Á·Ó ÌÔ˘ÛÈ΋: 3 ‰Â˘ÙÂÚfiÏÂÙ· ÛÙËÓ ·Ï‹ Î·È 6 ‰Â˘ÙÂÚfiÏÂÙ· ÛÙË Û‡ÓıÂÙË ÌÔÚÊ‹ Ú˘ıÌÒÓ.

4) fiÙ·Ó Â›Ó·È Ì ÙË ÌËÙ¤Ú· Î·È ·˘Ù‹ ·˘ıfiÚÌËÙ· ÙÔ˘˜ ÙÚ·ÁÔ˘‰¿, Ù· ‚Ú¤ÊË Û˘ÓÙÔÓ›˙Ô˘Ó ÙÔ˘˜ Ú˘ıÌÔ‡˜ ÙÔ˘˜ Ì ÙÔ˘˜ Ú˘ıÌÔ‡˜ ÙˆÓ ÙÚ·ÁÔ˘‰ÈÒÓ Ù˘ ÌËÙ¤Ú·˜. ∏ ʈӋ ÙˆÓ ÌËÙ¤ÚˆÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ ÙÔÔıÂÙÂ›Ù·È ÛÙË ÌÂÛ·›· ÔÎÙ¿‚· (C4), Ì Ôχ ÌÈÎÚ¤˜ ·ÏÏ·Á¤˜ ÚÔ˜ Ù· Â¿Óˆ ‹ ÚÔ˜ Ù· οو.

5) ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ·ÁÔ˘‰ÈÔ‡ Ù˘ ÌËÙ¤Ú·˜, ÙÔ ‚Ú¤ÊÔ˜ Û˘ÏÏ·Ì‚¿ÓÂÈ ÙȘ ÌÔ˘ÛÈΤ˜ ·ÏÏ·Á¤˜, ÚԂϤÂÈ ÙË Û˘Ó¤¯ÂÈ·, ·ÓÙȉڿ Û ηٿÏÏËÏ· ÌÔ˘ÛÈο ÛËÌ›· (·Ú¯‹ Î·È Ù¤ÏÔ˜ ÙˆÓ ÊÚ¿ÛˆÓ), ÂÓı·ÚÚ‡ÓÔÓÙ·˜ ¤ÙÛÈ ÙË ÌËÙ¤Ú· Û Â·Ó·Ï‹„ÂȘ ÙˆÓ ÊÚ¿ÛÂˆÓ ‹ Î·È ÔÏfiÎÏËÚˆÓ ÛÙÚÔÊÒÓ.

6) Ë ÌÔ˘ÛÈÎfiÙËÙ· Ù˘ ‰˘¿‰·˜ ·Ó·Ù‡ÛÛÂÙ·È Ì ÙÚfiÔ ‰È·ÏÔÁÈÎfi, ηıÒ˜ ÔÈ ‰‡Ô Û‡ÓÙÚÔÊÔÈ ·Ú¯›˙Ô˘Ó, Ô Î·ı¤Ó·˜ Ì ÙË ÛÂÈÚ¿ ÙÔ˘ (·˘Ùfi Ê·›ÓÂÙ·È Î·ı·Ú¿ ÛÙ· Ê·ÛÌ·ÙÔÁÚ·Ê‹Ì·Ù·), ‰ÚÒÓÙ·˜ Û ηٿÏÏËÏ· ÌÔ˘ÛÈο Î·È ¯ÚÔÓÈο ÛËÌ›· Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ ÙÚ·ÁÔ˘‰ÈÔ‡. ∆· ‚Ú¤ÊË Î·È ÔÈ ÌËÙ¤Ú˜ ‰ÂÓ Â›Ó·È ÌÔ˘ÛÈÎÔ›, ·ÏÏ¿ ¯ÚËÛÈÌÔÔÈÔ‡Ó ·˘ıfiÚÌËÙ· Î·È Ôχ ÓˆÚ›˜ ÙË ÌÔ˘ÛÈ΋ - Î·È ÂȉÈο ÙÔÓ Ú˘ıÌfi - ÁÈ· Ó· ÂÈÎÔÈÓˆÓ‹ÛÔ˘Ó. ∆· ‚Ú¤ÊË ‰ÂÓ ‹Ù·Ó ·ıËÙÈÎÔ› ·ÎÚÔ·Ù¤˜, ·ÏÏ¿ Û˘Ì̤ÙÔ¯ÔÈ ÛÙË ÌÔ˘ÛÈ΋ Ù˘ ÎÔ˘ÏÙÔ‡Ú·˜ ÙÔ˘˜. ∏ ÈηÓfiÙËÙ· ÙÔ˘ ‚Ú¤ÊÔ˘˜ ÁÈ· ·ÌÔÈ‚·›Ô Ú˘ıÌÈÎfi Û˘ÓÙÔÓÈÛÌfi Ì ÙËÓ ¿‰Ô˘Û· ÌËÙ¤Ú· Î·È Ì ÙË ÌÔ˘ÛÈ΋ Ô˘ ·ÎÔ‡ÓÂ Â›Ó·È Úԛη fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ›‰Ô˘˜ Ì·˜ Î·È fi¯È ÌÈ· ÁÂÓÂÙÈ΋ Úԛη ÔÏ›ÁˆÓ. ∆Ô ÍÂÙ‡ÏÈÁÌ· ÙˆÓ ÂÁÁÂÓÒÓ ÌÔ˘ÛÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ ÛÙȘ ÂÈ̤ÚÔ˘˜ ÔÈÎÔÁÂÓÂȷΤ˜ Î·È ÔÏÈÙÈÛÌÈΤ˜ Û˘Óı‹Î˜ ¶·È‰È·ÙÚÈ΋ 2008;71:331-344

Pediatri Sept-Oct 08

14-10-08

13:26

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ºˆÙÔÁÚ·Ê›· 1. √ ÂÚ¢ÓËÙ‹˜ ·ÓÔ›ÁÂÈ ÙÔ ÛÙfiÌ· ºˆÙÔÁÚ·Ê›· 2. √ ÂÚ¢ÓËÙ‹˜ ·ÓÔ›ÁÂÈ ÙÔ ºˆÙÔÁÚ·Ê›· 3. √ ÂÚ¢ÓËÙ‹˜ ·ÓÔ›ÁÂÈ ÙÔ ÛÙfiÌ· ÙÔ˘ ÁÈ· ÚÒÙË ÊÔÚ¿. ∆Ô ÂӉȷʤÚÔÓ ÙÔ˘ ÛÙfiÌ· ÙÔ˘ ÁÈ· ٤ٷÚÙË ÊÔÚ¿. ∆Ô ÓÂÔÁÓfi ÙÔÓ ÙÔ˘ ÁÈ· ¤ÌÙË ÊÔÚ¿. ∆Ô ÓÂÔÁÓfi ÙÔÓ ÌÈÌÂ›Ù·È Ì›· ÊÔÚ¿... ·Ú·ÙËÚ› ÚÔÛÂÎÙÈο. ÓÂÔÁÓÔ‡ Â›Ó·È ÂÌÊ·Ó¤˜ ÛÙÔ ÚfiÛˆfi ÙÔ˘. ∂ÈÎfiÓ· 4. ª›ÌËÛË ·ÓÔ›ÁÌ·ÙÔ˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·fi ÓÂÔÁÓfi ËÏÈΛ·˜ 20 ÏÂÙÒÓ, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. µÏ¤ ÙÔÓ ¯ÚfiÓÔ Û ÏÂÙ¿, ‰Â˘ÙÂÚfiÏÂÙ· Î·È ‰¤Î·Ù· ÙÔ˘ ‰Â˘ÙÂÚÔϤÙÔ˘ οو ·ÚÈÛÙÂÚ¿ Û οı ʈÙÔÁÚ·Ê›· (Kugiumutzakis, 1985).

Î·È ÔÈ Â˘Î·Èڛ˜ ÌÔ˘ÛÈÎÒÓ ÂÌÂÈÚÈÒÓ ı· ηıÔÚ›ÛÔ˘Ó ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜ Û οı ·È‰› (33,4). ∏ ÈηÓfiÙËÙ· Ù˘ ÓÂÔÁÓÈ΋˜ Ì›ÌËÛ˘ ∆Ë ‰ÂηÂÙ›· ÙÔ˘ 1970, ͤÛ·Û ÌÈ· ‰È·Ì¿¯Ë ·Ó Ù· ÓÂÔÁÓ¿ ηٿ ÙÔÓ 1Ô Ì‹Ó· (12Ë-30‹ Ë̤ڷ) ÌÈÌÔ‡ÓÙ·È (34) ‹ ‰ÂÓ ÌÈÌÔ‡ÓÙ·È. ™Â 4 ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, ÂÚ‡ÓËÛ· ÙË ÓÂÔÁÓÈ΋ Ì›ÌËÛË Û ÌÈ· Ì·È¢ÙÈ΋ ÎÏÈÓÈ΋, Ù· ÚÒÙ· 45 ÏÂÙ¿ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ™ÙËÓ ÂÈÚ·Ì·ÙÈ΋ Û˘Óı‹ÎË, ·ÚÔ˘Û›·˙· Û ÓÂÔÁÓ¿ ÔÙÈο ÚfiÙ˘· (ÚÔ‚ÔÏ‹ Ù˘ ÁÏÒÛÛ·˜, ¿ÓÔÈÁÌ· ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÎÏ›ÛÈÌÔ ÙˆÓ Ì·ÙÈÒÓ) Î·È ·ÎÔ˘ÛÙÈο ÚfiÙ˘· (ÙÔ˘˜ ‹¯Ô˘˜ ‘·’, ‘Ì’ Î·È ‘·ÁÎÔ‡’). √È ÌÈÎÚÔ-·Ó·Ï‡ÛÂȘ Î·È ÔÈ ÛÙ·ÙÈÛÙÈΤ˜ ·Ó·Ï‡ÛÂȘ ÙˆÓ ·ÓÙȉڿÛÂˆÓ 170 ÓÂÔÁÓÒÓ, ËÏÈΛ·˜ 10 ¤ˆ˜ 45 ÏÂÙÒÓ, η٤‰ÂÈÍ·Ó Ì›ÌËÛË ÙˆÓ ÔÙÈÎÒÓ ÚÔÙ‡ˆÓ Î·È ÙÔ˘ ʈӋÂÓÙÔ˜ ‘·’. ™ÙËÓ ∂ÈÎfiÓ· 4, Ê·›ÓÔÓÙ·È Ï›Á· ‰Â˘ÙÂÚfiÏÂÙ· ·fi ÙË ÌÈÎÚÔ-·Ó¿Ï˘ÛË Ù˘ Ì›ÌËÛ˘ ÂÓfi˜ ÓÂÔÁÓÔ‡, ÎÔÚÈÙÛÈÔ‡, ËÏÈΛ·˜ 20 ÏÂÙÒÓ, ÛÙÔ ÚfiÙ˘Ô ÙÔ˘ ·ÓÔ›ÁÌ·ÙÔ˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ (29,2,4). ™ÙË ‚¿ÛË ÙˆÓ ·Ú·¿Óˆ 4 Î·È ÛÙË Û˘Ó¤¯ÂÈ· ¿ÏÏˆÓ 10 ‰È·¯ÚÔÓÈÎÒÓ Ó·ÙÔ˘Ú·ÏÈÛÙÈÎÒÓ ÌÂÏÂÙÒÓ, Ô˘ ÂÎÔÓ‹Û·Ì ÌÂ Û˘ÓÂÚÁ¿Ù˜, Û¯ÂÙÈο Ì ÙËÓ ·Ó¿Ù˘ÍË Ù˘ Ì›ÌËÛ˘ Î·È ÙÔ Û˘ÁÎÈÓËÛÈ·Îfi Ù˘ Ï·›ÛÈÔ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ (‚Ï. ÏÂÙ. 4), ÚÔ¯ˆÚ‹Û·Ì ÛÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ÎÏ·ÛÈÎÔ‡ ÔÚÈÛÌÔ‡ Ù˘ Ì›ÌËÛ˘ (·Ó··Ú·ÁˆÁ‹ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ¿ÏÏÔ˘, Piaget) (35), ‰ÈfiÙÈ ‰ÂÓ ÂÚÈÁÚ¿ÊÂÈ Ì ·ÎÚ›‚ÂÈ·, ·ÓÙ›ıÂÙ· Û˘ÚÚÈÎÓÒÓÂÈ ·‰ÈηÈÔÏfiÁËÙ· ÙÔÓ ÏÔ‡ÙÔ ÙˆÓ Ê·ÈÓÔÌ¤ÓˆÓ Ù˘ ·ÓıÚÒÈÓ˘ Ì›ÌËÛ˘. ∞ÓÙÈηٷÛÙ‹Û·Ì ÙË Ï¤ÍË “·Ó··Ú·ÁˆÁ‹” Ì ÙË Ï¤ÍË “ÌÔ›Ú·ÛÌ·”. √Ú›Û·Ì ÙË Ì›ÌËÛË, ÙÔ˘Ï¿¯ÈÛÙÔÓ Î·Ù¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ˆ˜ ÙÔ ÌÔ›Ú·ÛÌ· Ï›ÁÔ Ôχ Ù˘ ›‰È·˜ Ú¿Í˘, ÙˆÓ ›‰ÈˆÓ Û˘ÁÎÈÓ‹ÛÂˆÓ (ÎÈÓ‹ÙÚˆÓ) Î·È ÙˆÓ ›‰ÈˆÓ ÚÔı¤ÛÂˆÓ ÂÈÎÔÈÓˆÓ›·˜ ·Ó¿ÌÂÛ· Û ‰‡Ô ˘ÔΛÌÂÓ· (36:176). ∆· ÙÂÏÂ˘Ù·›· 10 ¯ÚfiÓÈ·, ÔÈ Ó¢ÚÔÂÈÛÙ‹ÌÔÓ˜ ¿Ú¯ÈÛ·Ó Ó· ·ÓȯÓÂ‡Ô˘Ó Paediatriki 2008;71:331-344

ÛÙÔÓ ÂÁΤʷÏÔ ·ÓıÚÒˆÓ Î·È Èı‹ÎˆÓ (macaques) Ù· ÌÔÈÚ¿ÛÌ·Ù· Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î·Ù¿ ÙË Ì›ÌËÛË. ∞ÓȯÓÂ‡Ô˘Ó ÙÔ˘˜ ηıÚÂÙÈÎÔ‡˜ Ó¢ÚÒÓ˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó (ηÈ) ÛÙȘ ‰È·‰Èηۛ˜ Ù˘ Ì›ÌËÛ˘ Î·È ‰Ë Ù˘ ·ÓıÚÒÈÓ˘ ÓÂÔÁÓÈ΋˜ Ì›ÌËÛ˘ (37:77-82) - ·Ó Î·È ·fi ÌfiÓÔÈ ÙÔ˘˜ ÔÈ Î·ıÚÂÙÈÎÔ› Ó¢ÚÒÓ˜ ‰ÂÓ ÂÚÌËÓÂ‡Ô˘Ó ÙÔÓ ÏÔ‡ÙÔ ÙˆÓ ÌÈÌËÙÈÎÒÓ Ê·ÈÓÔ̤ӈÓ.

™ÙÔÓ ÎfiÌ‚Ô ÙˆÓ ÎÔÈÓÒÓ ÂӉȷÊÂÚfiÓÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ·Ó·Ù˘ÍÈ·ÎÒÓ „˘¯ÔÏfiÁˆÓ ∞Ó Î·È ˘¿Ú¯Ô˘Ó ÔÏϤ˜ ÂÚÈÔ¯¤˜ ¤Ú¢ӷ˜ ÎÔÈÓÔ‡ ÂӉȷʤÚÔÓÙÔ˜ ÁÈ· ·È‰›·ÙÚÔ˘˜ Î·È ·Ó·Ù˘ÍÈ·ÎÔ‡˜ „˘¯ÔÏfiÁÔ˘˜, ·Ú·Î¿Ùˆ ÂÚÈÁÚ¿ÊÔ˘Ì ÙËÓ ÙÚ¤¯Ô˘Û· ¤Ú¢ӷ ÙÚÈÒÓ ‰›ˆÓ, Ô˘ Ì·ÚÙ˘Ú› ÙȘ ÚÔÎÏ‹ÛÂȘ, Ù· ÎÂÓ¿ ÁÓÒÛ˘ Î·È ÙËÓ ·Ó¿ÁÎË ÁÈ· ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›·. ¢‡ÛÎÔϘ ÂÚ›Ô‰ÔÈ ∫·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜, ¤¯Ô˘Ó ‚ÚÂı› 8 “‰‡ÛÎÔϘ”, ÌÂÙ·‚·ÙÈΤ˜ ÂÚ›Ô‰ÔÈ Û˘ÁÎÈÓËÛȷ΋˜ ·ÛÙ¿ıÂÈ·˜, ÎÚ›Û˘ Î·È Û‡ÁÎÚÔ˘Û˘ ÛÙȘ Û¯¤ÛÂȘ ‚Ú¤ÊÔ˘˜-ÌËÙ¤Ú·˜. √È van de Rijt-Plooij & Plooij (38,39) ·Ú·Ù‹ÚËÛ·Ó ÙÔ Ê·ÈÓfiÌÂÓÔ ÙˆÓ “‰‡ÛÎÔψӔ ÂÚÈfi‰ˆÓ, ÚÒÙ· ÛÙȘ Û¯¤ÛÂȘ ÌËÙ¤ÚˆÓ-‚ÚÂÊÒÓ ¯ÈÌ·ÓÙ˙‹‰ˆÓ Î·È ÌÂÙ¿ ÛÙȘ Û¯¤ÛÂȘ ÌËÙ¤ÚˆÓ-‚ÚÂÊÒÓ ÙÔ˘ ›‰Ô˘˜ Ì·˜. ™ÙÔ˘˜ ¯ÈÌ·ÓÙ˙‹‰Â˜, Ë “‰˘ÛÎÔÏ›·” ÂÎÊÚ·˙fiÙ·Ó ·fi ÙËÓ ÂÈı˘Ì›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ó· ‚Ú›ÛÎÂÙ·È Û˘Ó¯Ҙ ÎÔÓÙ¿ ÛÙË ÌËÙ¤Ú· Î·È Ó· ÎÚ¤ÌÂÙ·È Û˘Ó¯Ҙ ·fi ÙÔ ÛÒÌ· Ù˘. ™ÙÔ Â›‰Ô˜ Ì·˜, ÔÈ “‰‡ÛÎÔϘ” ÂÚ›Ô‰ÔÈ ¤¯Ô˘Ó ‚ÚÂı› Û ÌÂϤÙ˜ ÛÙËÓ √ÏÏ·Ó‰›·, ÙËÓ πÛ·Ó›·, ÙȘ ∏¶∞, ÙË ™Ô˘Ë‰›· Î·È ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·. ∫·Ù¿ ÙȘ ÂÚÈfi‰Ô˘˜ ·˘Ù¤˜, ÛÙÔ ·ÓıÚÒÈÓÔ ‚Ú¤ÊÔ˜ ·Ú·ÙËÚÂ›Ù·È ·˘ÍË̤ÓÔ ÎÏ¿Ì·, ‰˘ÛÎÔϛ˜ ÛÙÔÓ ‡ÓÔ Î·È ÛÙÔÓ ıËÏ·ÛÌfi, ·˘ÍË̤ÓË ‰ÂÈÏ›·, ·˘ÍË̤ÓË Ù¿ÛË ÚÔÛÎfiÏÏËÛ˘ Î·È ÛˆÌ·ÙÈ΋˜ Â·Ê‹˜, ·˘ÍË̤ÓÔ˜ ÂÎÓ¢ÚÈÛÌfi˜, ·ÛÙ¿ıÂÈ· ÛÙË ‰È¿ıÂÛË Î·È ·˘ÍË̤ÓË

Pediatri Sept-Oct 08

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ºˆÙÔÁÚ·Ê›· 6. …ÙÚÂȘ ÊÔÚ¤˜.

·Ó¿ÁÎË ÁÈ· ÊÚÔÓÙ›‰·, Û˘ÓÙÚÔÊÈ¿ Î·È ·ÚËÁÔÚÈ¿. ∏ οı ÂÚ›Ô‰Ô˜ “‰˘ÛÎÔÏÈÒÓ” ıˆÚÂ›Ù·È fiÙÈ ·Ó·ÎÏ¿ ÎÚ›ÛÈ̘ ·ÏÏ·Á¤˜ Î·È ·Ó·‰ÈÔÚÁ·ÓÒÛÂȘ ÛÙÔÓ ‚ÚÂÊÈÎfi ÂÁΤʷÏÔ, ·ÏÏ¿ Î·È ÛÙÔÓ ÙÚfiÔ Ô˘ Ë ÌËÙ¤Ú· ¯ÂÈÚ›˙ÂÙ·È ÙȘ ·ÏÏ·Á¤˜ ·˘Ù¤˜. ∆· Ê·ÈÓfiÌÂÓ· ·˘Ù¿ Û˘Ì‚·›ÓÔ˘Ó ÚÈÓ ·fi Û·Ê‹ ‚ÚÂÊÈο ¿ÏÌ·Ù· ·ÓÂÍ·ÚÙËÛ›·˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ·fi ÙÔ˘˜ ÁÔÓ›˜. ¶Ôχ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ÙÚˆÙfiÙËÙ·, οÙÈ Û·Ó Ê·ÈÓÔÌÂÓÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ÛÙËÓ ·Ó¿Ù˘ÍË, Ì·˙› Ì ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ·, ‰ËÏ·‰‹ Û˘¯ÓfiÙÂÚ˜ ·ÚÚÒÛÙȘ ÙˆÓ ‚ÚÂÊÒÓ, ·ÚÚÒÛÙȘ ÔÔÈ·Û‰‹ÔÙ ·ÈÙÈÔÏÔÁ›·˜. À¿Ú¯ÂÈ ÂÎÓ¢ÚÈÛÌfi˜ Î·È ·fi ÙȘ ‰‡Ô Ï¢ڤ˜. √È ÁÔÓ›˜ Î·È Ù· ‚Ú¤ÊË Ú¤ÂÈ Ó· ‰È·Ú·ÁÌ·Ù¢ÙÔ‡Ó Í·Ó¿ ÙȘ Û˘Ó‹ıÂȘ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ·ÏÏËÏÂ›‰Ú·Û‹˜ ÙÔ˘˜, ηıÒ˜ ÔÈ ·ÏÏ·Á¤˜ ÛÙÔÓ ÂÁΤʷÏÔ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ¤¯Ô˘Ó ·ÏÏ¿ÍÂÈ Ù· ÂӉȷʤÚÔÓÙ· Î·È ÙȘ ÈηÓfiÙËÙ¤˜ ÙÔ˘, ·ÓÔ›ÁÔÓÙ·˜ Ó¤Ô˘˜ ‰ÚfiÌÔ˘˜ ÁÓˆÛÙÈ΋˜ ·Ó¿Ù˘Í˘, Ì¿ıËÛ˘ Î·È ÂÈÎÔÈÓˆÓ›·˜. √È “‰‡ÛÎÔϘ” ÂÚ›Ô‰ÔÈ ‹ ÂÚ›Ô‰ÔÈ “·ÏÈÓ‰ÚfiÌËÛ˘” ıˆÚÔ‡ÓÙ·È Û‹ÌÂÚ· ̤ÚÔ˜ Ù˘ ÔÌ·Ï‹˜ ·Ó¿Ù˘Í˘. ™Ù· ÌÂÛԉȷÛÙ‹Ì·Ù· ÌÂٷ͇ ÙˆÓ “‰‡ÛÎÔψӔ ÂÚÈfi‰ˆÓ ·Ú·ÙËÚÔ‡ÓÙ·È Ôχ “‡ÎÔϘ” ‚‰ÔÌ¿‰Â˜ (“sunny” weeks), fiÔ˘ ÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ Â›Ó·È “‰‡ÛÎÔÏÔ” ÛÙÔÓ Í‡ÓÈÔ, ÛÙÔÓ ‡ÓÔ Î·È ÛÙÔÓ ıËÏ·ÛÌfi, ·ÏÏ¿ ¯·ÚÔ‡ÌÂÓÔ, ÙÔÏÌËÚfi, Ì ÈÔ ÛÙ·ıÂÚ‹ ‰È¿ıÂÛË Î·È Ì ÏÈÁfiÙÂÚ˜ ·Ó¿ÁΘ ÊÚÔÓÙ›‰·˜, ·ÚËÁÔÚÈ¿˜ Î·È Û˘ÓÙÚÔÊÈ¿˜ - ‚‰ÔÌ¿‰Â˜ ηٿ ÙȘ Ôԛ˜ ·ÛΛ ÙȘ Ӥ˜ ÙÔ˘ ‰ÂÍÈfiÙËÙ˜. ™ÙËÓ ∂ÈÎfiÓ· 5 Ê·›ÓÔÓÙ·È ÔÈ 8 “‰‡ÛÎÔϘ” Î·È ÔÈ 8 “‡ÎÔϘ” ÂÚ›Ô‰ÔÈ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜. √È ·Ú·¿Óˆ “‰‡ÛÎÔϘ” ÂÚ›Ô‰ÔÈ ‰ÂÓ Ú¤ÂÈ Ó· Û˘Á¯¤ÔÓÙ·È Ì ÂÚÈÙÒÛÂȘ fiÔ˘ ÙÔ Ó·Úfi ‚Ú¤ÊÔ˜ ÓÔÛ› ‹ ÔÓ¿ÂÈ Î.Ï., ‰ËÏ·‰‹ Ì ÁÂÁÔÓfiÙ· Ù· ÔÔ›· ‰ËÌÈÔ˘ÚÁÔ‡Ó ·Ú·¿Óˆ ¿Á¯Ô˜, ÎÏ¿Ì·, ‰˘ÛÎÔϛ˜ ÛÙÔÓ ‡ÓÔ Î.¿. √‡Ù Ì ÙËÓ ÂÚ›ÙˆÛË Ù˘ χ˘ Î·È ÙÔ˘ ¿Á¯Ô˘˜ ÂÓfi˜ ÌÂÁ·Ï‡ÙÂÚÔ˘ ‚Ú¤ÊÔ˘˜ ÌÂÙ¿ ÙËÓ ÂÈÛÙÚÔÊ‹ Ù˘ ÌËÙ¤Ú·˜ ·fi ¤Ó·Ó Ô‰˘ÓËÚfi ·Ô¯ˆÚÈÛÌfi - ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ¿Á¯Ô˜ ·Ô¯ˆÚÈÛÌÔ‡ Î·È fi¯È ÁÈ· ¿Á¯Ô˜ ÏfiÁˆ Ù˘ “‰‡ÛÎÔÏ˘” ÂÚÈfi‰Ô˘. ∞Ó Ù· ·Ú·¿Óˆ Û˘Ì¤ÛÔ˘Ó ¯ÚÔÓÈο Ì οÔÈ· ·fi ÙȘ “‰‡ÛÎÔϘ” ÂÚÈfi‰Ô˘˜, ÙfiÙÂ Ô ‚ÚÂÊÈÎfi˜ ÂÎÓ¢ÚÈÛÌfi˜ Î·È ÔÈ Û˘ÁÎÚÔ‡ÛÂȘ ı· Â›Ó·È ÂÓÙÔÓfiÙÂÚ˜. ∏ ·˘ÍË̤-

ÓË ‚ÚÂÊÈ΋ ÓÔÛËÚfiÙËÙ· ηٿ ÙȘ 8 “‰‡ÛÎÔϘ” ÂÚÈfi‰Ô˘˜ Û›ÁÔ˘Ú· ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ˜ Î·È Î·Ù·ÓfiËÛ˘ (40,41,42). ¡ÂÔÁÓÈÎfi Î·È ‚ÚÂÊÈÎfi ÎÏ¿Ì· °ÂÓÈο ÛÙ· ıËÏ·ÛÙÈο Î·È ÂȉÈο ÛÙÔÓ ¿ÓıÚˆÔ, Ù· ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈ΋ Ì ÙË Á¤ÓÂÛË, ÙËÓ ·Ó¿Ù˘ÍË, ÙȘ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÂÓÙÔÈÛÌfi ÙˆÓ Ì˯·ÓÈÛÌÒÓ ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ Î·È ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÎÏ¿Ì·ÙÔ˜, ηıÒ˜ Î·È Ì ÙȘ Û¯ÂÙÈΤ˜ ÚÔ˜ ÙÔ ÎÏ¿Ì· ·ÓÙȉڿÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ, ‰ÂÓ ¤¯Ô˘Ó ̤¯ÚÈ Û‹ÌÂÚ· ‚ÚÂÈ ÈηÓÔÔÈËÙÈΤ˜ ··ÓÙ‹ÛÂȘ. ∂›Ó·È ¿Ú·Á ÙÔ ÎÏ¿Ì· ÌfiÓÔ ¤Ó·˜ ‰Â›ÎÙ˘ ›ӷ˜, ‰›„·˜, Ó‡ÛÙ·˜ Î.¿.; ∂›Ó·È ÌfiÓÔ ¤Ó· Û‡Ìو̷ ÎÏÈÓÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜, .¯. fiÓÔ˜ ˆ˜ Û‡Ìو̷ ÓfiÛÔ˘; ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ·Ó·Ù˘ÍÈ·Îfi ÛÈÓÈ¿ÏÔ, ‰ËÏ·‰‹ ÛËÌ·ÙÔ‰ÔÙ› ÌÈ· ÏÂÈÙÔ˘ÚÁ›· ÛÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÓÔ˘; ◊ Ì‹ˆ˜ Â›Ó·È Î·È Ù· 3 Ì·˙›; ŸÙ·Ó ÂÚ¢ÓËÙ¤˜ ·È‰›·ÙÚÔÈ Î·È ·Ó·Ù˘ÍÈ·ÎÔ› „˘¯ÔÏfiÁÔÈ (43) ıÂÒÚËÛ·Ó ÙÔ ÓÂÔÁÓÈÎfi Î·È ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· ˆ˜ ‰Â›ÎÙË Î·È ˆ˜ Û‡Ìو̷ ̤۷ ·fi ÌÈ· ·Ó·Ù˘Íȷ΋ ÚÔÔÙÈ΋, Ô‰ËÁ‹ıËÎ·Ó Ó· ÔÚ›ÛÔ˘Ó Û ˘ÁÈ‹ ‚Ú¤ÊË ÙÔÓ ‚ÚÂÊÈÎfi ÎÔÏÈÎfi, fi¯È ˆ˜ Á·ÛÙÚÂÓÙÂÚÈÎfi fiÓÔ, ·ÏÏ¿ ˆ˜ ÌÈ· ÂΉ‹ÏˆÛË ·ÙÔÌÈÎÒÓ ‰È·ÊÔÚÒÓ ÛÙÔ Ù·ÌÂڷ̤ÓÙÔ Î·È ÛÙË Û˘ÁÎÈÓËÛȷ΋ Ú‡ıÌÈÛË. ŒÙÛÈ, Ë Î‡ÚÈ· ÂÛÙ›· Ù˘ ¤Ú¢ӷ˜ Î·È Ë Î‡ÚÈ· ·ÈÙ›· ÙÔ˘ ÎÔÏÈÎÔ‡ ÌÂÙ·ÙÔ›ÛÙËΠ·fi ÙË Á·ÛÙÚÂÓÙÂÚÈ΋ ÂÚÈÔ¯‹ ÛÙÔ ∫¡™. ∞Ó Î·È Î¿ÔȘ ÔÚÁ·ÓÈΤ˜ ÓfiÛÔÈ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ¤Ó·Ó ÔÈÔÓ› ÎÔÏÈÎfi, ÔÈ ÓfiÛÔÈ ·˘Ù¤˜ Â›Ó·È ÏÈÁfiÙÂÚ˜ ·fi fiÛÔ ÔÈ ÂÚ¢ÓËÙ¤˜ ÚÔÛ‰ÔÎÔ‡Û·Ó. µ¤‚·È·, ÙÔ ·›ÓÈÁÌ· ÙÔ˘ ‚ÚÂÊÈÎÔ‡ ÎÔÏÈÎÔ‡ - ·Ú¿ Ù· ÂÚ¢ÓËÙÈο ‚‹Ì·Ù· - ·Ú·Ì¤ÓÂÈ ¿Ï˘ÙÔ (44,45,46). ™ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· ˘¿Ú¯Ô˘Ó ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÚfiÛˆ· - ÙÔ ‚Ú¤ÊÔ˜ Ô˘ ÎÏ·›ÂÈ Î·È Ô ÁÔÓ¤·˜ Ô˘ ÂÚÌËÓ‡ÂÈ ÙÔ ÎÏ¿Ì· Î·È ÌÂÙ¿ ‰Ú·. ∏ ÂÚÌËÓ›· ÙˆÓ ‹¯ˆÓ ÙÔ˘ ÎÏ¿Ì·ÙÔ˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÙÔÓÈÎfi ‡„Ô˜, ÙË ‰È¿ÚÎÂÈ·, ÙȘ ÂÎÚ‹ÍÂȘ Î·È ÙȘ ·‡ÛÂȘ ÌÂٷ͇ ÙˆÓ ‹¯ˆÓ, ÙȘ ÂÎÊÚ¿ÛÂȘ ÙÔ˘ ÚÔÛÒÔ˘, ÙȘ ÎÈÓ‹ÛÂȘ ÙˆÓ ¯ÂÚÈÒÓ Î·È ÙˆÓ Ô‰ÈÒÓ Î.¿. ŸÛÔ ˘„ËÏfiÙÂÚÔ ÙÔ ÙÔÓÈÎfi ‡„Ô˜ Î·È fiÛÔ ‰˘Ó·ÙfiÙÂÚÔ ÙÔ ÎÏ¿Ì· ÙfiÛÔ ÈÔ ¶·È‰È·ÙÚÈ΋ 2008;71:331-344

Pediatri Sept-Oct 08

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∂ÈÎfiÓ· 5. «¢‡ÛÎÔϘ» ÂÚ›Ô‰ÔÈ (Ì·‡Ú˜ ÛًϘ) Î·È «Â‡ÎÔϘ» ÂÚ›Ô‰ÔÈ (Ï¢Τ˜ ÛًϘ), Û ‚‰ÔÌ¿‰Â˜, ηٿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ (38,39).

ÁÚ‹ÁÔÚ· ÙÔ ÚÔÛ¤¯ÂÈ Î·È ·ÓÙȉڿ Ô ÁÔÓ¤·˜. ŸÌˆ˜, ÙÔ ÎÏ¿Ì· Û˘¯Ó¿ ÚÔηÏ› ÛÙÔÓ ÁÔÓ¤· Û˘Ó·ÈÛı‹Ì·Ù· ·ÔÙ˘¯›·˜, ¿Á¯Ô˘˜, Ì·Ù·›ˆÛ˘, ·ÎfiÌ· Î·È ÙËÓ È‰¤· fiÙÈ ÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ ÙÔÓ ·Á·¿. ŒÓ· ‚ÚÂÊÈÎfi ÎÏ¿Ì· Ôχ ˘„ËÏÔ‡ ÙÔÓÈÎÔ‡ ‡„Ô˘˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÎÓ¢ÚÈÛÌfi ÛÙË ÌËÙ¤Ú· ‹ ÙÔÓ ·Ù¤Ú· Î·È Ó· ÌËÓ ·ÓÙȉڿÛÔ˘Ó „‡¯Ú·ÈÌ·, ˘ÔÓÔ̇ÔÓÙ·˜ ÙË Û¯¤ÛË ÙÔ˘˜ Ì ÙÔ ‚Ú¤ÊÔ˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÙÔ ‚Ú¤ÊÔ˜ ÎÏ·›ÂÈ ÚÔÛ‰ÔÎÒÓÙ·˜ ·Ó·ÎÔ‡ÊÈÛË. ∆Ô ÓÂÔÁÓÈÎfi Î·È ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· Â›Ó·È ¤Ó·˜ ÙÚfiÔ˜ ÂÈÎÔÈÓˆÓ›·˜ ÙÔ˘ ·È‰ÈÔ‡ - ÌËÓ¿ Î·È ÚÔÛ‰Ôο ‚Ô‹ıÂÈ· (47,48,49,50,51). ∏ ÙÚ¤¯Ô˘Û· ¤Ú¢ӷ ‰Â›¯ÓÂÈ ÙÔÓ ÚfiÏÔ ÙÔ˘ ¿ÏÏÔ˘ (ÌËÙ¤Ú·, ·Ù¤Ú·˜ Î.¿), ·ÏÏ¿ Î·È ÙˆÓ “Ù¯ÓÈÎÒÓ” ÙÔ˘, ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÎÏ·›ÓÂ. ¡ÂÔÁÓ¿ ËÏÈΛ·˜ 4 ¤ˆ˜ 7 ˆÚÒÓ Ù· ÔÔ›· ¤ÎÏ·ÈÁ·Ó, ‰ÂÓ ËÚÂÌÔ‡Û·Ó Ì ÙË Û˘Ó¯‹ ·ÙÈ΋ Â·Ê‹, ·ÏÏ¿ Ì ÙËÓ ·Û˘Ó¯‹ ·ÙÈ΋ Â·Ê‹ - fi¯È Û˘Ó¯¤˜, ·ÏÏ¿ ·Û˘Ó¯¤˜ ¯¿‰È (52). ∂ÈϤÔÓ, ÙÔ ›‰ÈÔ ÙÔ ÓÂÔÁÓfi Ì ÙÔ ÎÏ¿Ì· ÙÔ˘ ÌÔÚ› Ó· ÂÎÊÚ¿ÛÂÈ Ì¤Ûˆ Ì›ÌËÛ˘ ‰È˘ÔÎÂÈÌÂÓÈ΋ Û˘Ì¿ıÂÈ· - ÓÂÔÁÓ¿ ËÏÈΛ·˜ 18 ¤ˆ˜ 34 ˆÚÒÓ ‰ÂÓ ÌÈÌÔ‡ÓÙ·È ÙÔ Ì·ÁÓËÙÔʈÓË̤ÓÔ ÎÏ¿Ì· ÙÔ˘˜, ·ÏÏ¿ ÙÔ Ì·ÁÓËÙÔʈÓË̤ÓÔ ÎÏ¿Ì· ¿ÏÏˆÓ ÓÂÔÁÓÒÓ. ∫Ï¿Ì· ÛÙÔ ÎÏ¿Ì· ÙÔ˘ ¿ÏÏÔ˘ Ì·ÚÙ˘Ú› Û˘ÁÎÈÓËÛȷ΋ ¢·ÈÛıËÛ›· Î·È ÂÓÛ˘Ó·›ÛıËÛË (53). ∂›Ó·È ۷ʤ˜ fiÙÈ Ì¤¯ÚÈ Ó· ÂÚ¢ӋÛÔ˘ÌÂ Î·È Ó· ηٷÓÔ‹ÛÔ˘Ì ÂÚÈÛÛfiÙÂÚÔ ÙÔ ÎÏ¿Ì·, Ô Û˘Ì‚Ô˘Ï¢ÙÈÎfi˜ Ì·˜ ÏfiÁÔ˜ ÚÔ˜ ÙÔ˘˜ ÂÍ·ÓÙÏË̤ÓÔ˘˜ ·fi ÙÔ ÓÂÔÁÓÈÎfi Î·È ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· ÁÔÓ›˜ ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÍ·ÈÚÂÙÈο ÚÔÛÂÎÙÈÎfi˜. ¡˘¯ÙÂÚÈÓfi ͇ÓËÌ· Ÿ,ÙÈ ÈÛ¯‡ÂÈ ÁÈ· ÙË ÁÓÒÛË Ì·˜ ·ÏÏ¿ Î·È ÙË Û˘Ì‚Ô˘Ï¢ÙÈ΋ Ì·˜ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ ˆ˜ ÚÔ˜ ÙÔ ÓÂÔÁÓÈÎfi Î·È ÙÔ ‚ÚÂÊÈÎfi ÎÏ¿Ì· ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔ Ó˘¯ÙÂÚÈÓfi ͇ÓËÌ· ÙˆÓ ‚ÚÂÊÒÓ, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ‹ Ó· ÌË Û˘Óԉ‡ÂÙ·È ·fi ÎÏ¿Ì·. ¶·Ú¿ ÙËÓ ÚfiÔ‰Ô ÛÙË Ê˘ÛÈÔÏÔÁ›· ÙˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ ‡ÓÔ˘-͇ÓÈÔ˘ ‹‰Ë ·fi ÙËÓ ÂÌ‚Ú˘˚΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (54,55), Ô ªÔÚʤ·˜ ‰ÂÓ ¤¯ÂÈ Paediatriki 2008;71:331-344

Á›ÓÂÈ fiÛÔ ı· ÂÈı˘ÌÔ‡Û·Ì ηٷÓÔËÙfi˜, ¤ÛÙˆ Î·È ·Ó ÓˆÚ›˜ Ô ¶Ï¿ÙˆÓ (56) Î·È ·ÚÁfiÙÂÚ· ÈÔ Û˘ÛÙËÌ·ÙÈο Ô Freud (57) ¿ÓÔÈÍ·Ó Ï›ÁÔ ÙËÓ ÎÂÚÎfiÔÚÙ· Ù˘ ÛÎÔÙÂÈÓ‹˜ ÙÔ˘ ÏÂ˘Ú¿˜ (58,59). ∏ Û˘˙‹ÙËÛË ·Ó Ù· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË ‰ÂÓ ÔÓÂÈÚ‡ÔÓÙ·È (60) ‹ ÔÓÂÈÚ‡ÔÓÙ·È (61) Û˘Ó¯›˙ÂÙ·È Î·È ÙÔ Úfi‚ÏËÌ· ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ͢Ó‹Ì·ÙÔ˜ ÙˆÓ ‚ÚÂÊÒÓ ·Ú·Ì¤ÓÂÈ ÂÓ ÔÏÏÔ›˜ ¿Ï˘ÙÔ. ∫¿ÔÈÔÈ ·Ô‰›‰Ô˘Ó ÙȘ ‰˘ÛÎÔϛ˜ ÙÔ˘ ‡ÓÔ˘ Î·È ÙÔ Ó˘¯ÙÂÚÈÓfi ͇ÓËÌ· ÙˆÓ ‚ÚÂÊÒÓ ÛÙ· ‚ÈÔÏÔÁÈο Î·È ÛÙ· „˘¯ÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‚ÚÂÊÒÓ, ¿ÏÏÔÈ ÛÙȘ ‰˘ÛÎÔϛ˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È ÙÔÓ ÙÔÎÂÙfi, ÔÚÈṲ̂ÓÔÈ ÛÙȘ Ú·ÎÙÈΤ˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÛÙȘ Û¯¤ÛÂȘ ÙÔ˘˜ Ì ٷ ‚Ú¤ÊË, ¿ÏÏÔÈ ÛÙË ‰È·‰Èηۛ· ıËÏ·ÛÌÔ‡-·ÔıËÏ·ÛÌÔ‡ Î·È Î¿ÔÈÔÈ ¿ÏÏÔÈ ÛÙÔ ¿Á¯Ô˜, ÛÙ· ÛÙÚÂÛÔÁfiÓ· ‚ÈÒÌ·Ù· Î·È ÛÙË ÌËÙÚÈ΋ ηٿıÏÈ„Ë ÚÈÓ Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ø˜ ÚÔ˜ ÙËÓ ·Ô˘Û›· ‹ ÙËÓ ·ÚÔ˘Û›· Û¯¤Û˘ ÌÂٷ͇ ÙÔ˘ Ó˘¯ÙÂÚÈÓÔ‡ ͢Ó‹Ì·ÙÔ˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, ¤¯ÂÈ ‚ÚÂı›: ·) ·Ô˘Û›· Û¯¤Û˘ Ì ÙËÓ ÎÔÈÓˆÓÈ΋ Ù¿ÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÙÔÓ ÚfiˆÚÔ ÙÔÎÂÙfi, ÙÔ Ê‡ÏÔ Î·È ÙË ÛÂÈÚ¿ Á¤ÓÓËÛ˘ ÙÔ˘ ‚Ú¤ÊÔ˘˜, Î·È ‚) ·ÚÔ˘Û›· Û¯¤Û˘ ÌÂ: 1. ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ - ·Ó ˘¿Ú¯ÂÈ ‚Ú¤ÊÔ˜ Ô˘ ͢Ó¿ ·Ú·¿Óˆ ·fi 4 ÊÔÚ¤˜ ÙË Ó‡¯Ù· οı ‚‰ÔÌ¿‰· Î·È ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ ·‰ÂÚÊfi ‹ ·‰ÂÚÊ‹, ·˘Ùfi˜ ‹ ·˘Ù‹ Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· ›¯Â ‹ Ó· ¤¯ÂÈ ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ 2. ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù· - Û˘¯Ó¿, ·ÏÏ¿ fi¯È ¿ÓÙ·, ¤¯Ô˘Ó ÚÔ‚Ï‹Ì·Ù· Ù· ÓÂÔÁÓ¿ Ô˘ ›¯·Ó ¯·ÌËϤ˜ ÙÈ̤˜ Apgar ÛÙÔ 1Ô Î·È ÛÙÔ 5Ô ÏÂÙfi ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ÚÔ‚Ï‹Ì·Ù· ·ÛÊ˘Í›·˜ Î.Ï.

3. ÙÔ ‚ÚÂÊÈÎfi Ù·ÌÂڷ̤ÓÙÔ Î·È ÙË Û˘ÌÂÚÈÊÔÚÈ΋ ÔÚÁ¿ÓˆÛË - Ù· ‚Ú¤ÊË Ì η΋ ‰È¿ıÂÛË, ÌÈÎÚfiÙÂÚË ÚÔÛ·ÚÌÔÛÙÈÎfiÙËÙ· Î·È Ú˘ıÌÈÎfiÙËÙ·, ηıÒ˜ Î·È Ì ‰˘ÛÎÔϛ˜ ÛÙËÓ ÚÔÛ¤ÁÁÈÛË/·fiÛ˘ÚÛË Â›¯·Ó ÂÚÈÛÛfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ ‡ÓÔ˘ 4. ÌËÙÚÈ΋ ηٿıÏÈ„Ë, ¿Á¯Ô˜, ÎÔÈÓˆÓÈ΋ ·ÔÌfiÓˆÛË Î·È ·ÛÙ·ı‹˜ ÌËÙÚÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ıËÏ·ÛÌÔ‡ ÙÔ˘ ‚Ú¤ÊÔ˘˜ (¿ÏÏÔÙ ÙÔ Ù·˝˙ÂÈ Î·È ¿ÏÏÔÙ ‰ÂÓ

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·341

341

æ˘¯ÔÏÔÁ›· ÂÌ‚Ú‡ˆÓ, ÓÂÔÁÓÒÓ Î·È ‚ÚÂÊÒÓ

ÙÔ Ù·˝˙ÂÈ ÙË Ó‡¯Ù·) - ÔÈ ÌËÙ¤Ú˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ¤¯Ô˘Ó ‚Ú¤ÊË Ì Ӣ¯ÙÂÚÈÓfi ͇ÓËÌ·. ∞‰È¢ÎÚ›ÓÈÛÙ˜ ·Ú·Ì¤ÓÔ˘Ó ÔÈ Û¯¤ÛÂȘ ÙˆÓ ‚ÚÂÊÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ‡ÓÔ˘ Ì ÙË Ì¤ıÔ‰Ô ıËÏ·ÛÌÔ‡ (Ê˘ÛÈÎfi˜ ‹ Ù¯ÓËÙfi˜ ıËÏ·ÛÌfi˜), ÙÔÓ ·ÔÁ·Ï·ÎÙÈÛÌfi/ ÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ Ï‹„˘ ÛÙÂÚ¿˜ ÙÚÔÊ‹˜ Î·È ÙȘ ÂıÓÈΤ˜ Î·È ÔÏÈÙÈÛÌÈΤ˜ ‰È·ÊÔÚ¤˜. ∏ ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ (.¯. diphenhydramine, trimeprazine tartate) ‰ÂÓ ·¤ÊÂÚ ٷ ·Ó·ÌÂÓfiÌÂÓ· ÛÙȘ ‰˘ÛÎÔϛ˜ ‡ÓÔ˘ ‚ÚÂÊÒÓ, ÓË›ˆÓ Î·È ·È‰ÈÒÓ Î·È ÔÈ Û˘ÌÂÚÈÊÔÚÈΤ˜ Î·È „˘¯Ô‰˘Ó·ÌÈΤ˜ ıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ›¯·Ó ̤ÙÚÈ· ·ÔÙÂϤÛÌ·Ù· (54,62,63,64,65). ™Â ÌÈ· ÚfiÛÊ·ÙË ¤Ú¢ӷ Ì ‚Ú¤ÊË 9 ÌËÓÒÓ (54), ‚Ú¤ıËΠfiÙÈ ÂÚÈÛÛfiÙÂÚÔ Ó˘¯ÙÂÚÈÓfi ͇ÓËÌ· ·Ú·ÙËÚÂ›Ù·È Û ÂΛӷ Ô˘ Â›Ó·È “‰‡ÛÎÔÏ·” ÛÙÔÓ Í‡ÓÈÔ ÙÔ˘˜, ¤¯Ô˘Ó ¤ÓÙÔÓË ·ÓÙ›‰Ú·ÛË ÛÙÔ ¿Á¯Ô˜ ·Ô¯ˆÚÈÛÌÔ‡ ·fi ÙË ÌËÙ¤Ú·, ÎÏ·›Ó ÂÚÈÛÛfiÙÂÚÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ë̤ڷ˜, ÎÔÈÌÔ‡ÓÙ·È Ì·˙› Ì ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Î·È ¤¯Ô˘Ó ÁÔÓ›˜ Ô˘ Ù· ‚¿˙Ô˘Ó ÙËÓ Ë̤ڷ Ó· ÎÔÈÌÔ‡ÓÙ·È “Û·ÛÙ¿” Î·È ÙË Ó‡¯Ù· Ù· ‚¿˙Ô˘Ó ÛÙËÓ ÎÔ‡ÓÈ· ÙÔ˘˜ ÎÔÈÌÈṲ̂ӷ. ∆Ô˘Ï¿¯ÈÛÙÔÓ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜, ÙÔ Ó˘¯ÙÂÚÈÓfi ͇ÓËÌ· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·Ú¿ÁˆÁÔ ·ÏÏËÏÂ›‰Ú·Û˘ ÂÓfi˜ Û˘Ó‰˘·ÛÌÔ‡ ‚ÚÂÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È ÁÔÓÈÎÒÓ Û˘ÌÂÚÈÊÔÚÒÓ Ì¿ÏÏÔÓ, ·Ú¿ ·ÔÙ¤ÏÂÛÌ· ÂÓfi˜ ÌfiÓÔ ÂÓ‰ÔÁÂÓÔ‡˜ ‹ Â͈ÁÂÓÔ‡˜ ·Ú¿ÁÔÓÙ·.

™˘˙‹ÙËÛË ∆· ·Ú·¿Óˆ ÙÚ›· ·Ú·‰Â›ÁÌ·Ù· ·fi ÙÔÓ ÎfiÌ‚Ô ÙˆÓ ÎÔÈÓÒÓ ÂӉȷÊÂÚfiÓÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ·Ó·Ù˘ÍÈ·ÎÒÓ „˘¯ÔÏfiÁˆÓ ‰Â›¯ÓÔ˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÁÈ· ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· Î·È ÁÈ· ¤Ó·ÚÍË ‹ Û˘Ó¤¯ÈÛË ÂÓfi˜ ‰È·ÏfiÁÔ˘ Ô˘ ÂÓ ÔÏÏÔ›˜ ÂÎÎÚÂÌ›. ∆· Â˘Ú‹Ì·Ù· ˆ˜ ÚÔ˜ ÙÔÓ ÓÔ˘ ÙˆÓ ÂÌ‚Ú‡ˆÓ, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ Ì¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜ Â›Ó·È Ôχ ÂÚÈÛÛfiÙÂÚ· ·fi fiÛ· ÂÚÈÁÚ¿ÊËÎ·Ó ·Ú·¿Óˆ. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ›¯·Ó Û˘Ó¤ÂȘ. ∞Ó¤ÙÚ„·Ó Î·È ·Ó·ÙÚ¤Ô˘Ó Û˘Ó¯Ҙ: ·) ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ˘ÔÙ›ÌËÛË Ô˘ ‹ıÂÏ ٷ ‚Ú¤ÊË ÙÔ˘ ·ÓıÚÒÔ˘ Ó· Â›Ó·È “̈ڿ”. ∆· 10 ÛËÌ›· Ù˘ ·Ó·ÙÚÔ‹˜ Ô˘ ÂÚÈÁÚ¿„·Ì ÛÙËÓ ·Ú¯‹ ÙÔ˘ ¿ÚıÚÔ˘ Â›Ó·È ÌÈ· ·‰Ú‹ ÂÚ›ÏË„Ë ÙˆÓ ¤ÓÙÔÓˆÓ Û˘˙ËÙ‹ÛÂˆÓ Ô˘ ÙÂÏÈο Ô‰‹ÁËÛ·Ó, ÂÚ› Ù· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1980, fiϘ ۯ‰fiÓ ÙȘ „˘¯ÔÏÔÁÈΤ˜ ıˆڛ˜ Ó· ·ÏÏ¿ÍÔ˘Ó ¿Ô„Ë ÁÈ· ÙËÓ Î·Ù·ÁˆÁ‹ Î·È ÙÔÓ ·Ú¯ÈÎfi ÂÍÔÏÈÛÌfi ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÓÔ˘.

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‚) ÙËÓ ÎÔÈÓˆÓÈ΋ ÚÔηٿÏË„Ë ÙÔ˘ “ËÏÈÎÈÛÌÔ‡” (ageism), Ë ÔÔ›·, ‚·ÛÈ˙fiÌÂÓË ÌfiÓÔ ÛÙÔ ÎÚÈÙ‹ÚÈÔ Ù˘ ËÏÈΛ·˜, ıˆÚÔ‡Û fiÙÈ fiÛÔ ÌÈÎÚfiÙÂÚË Â›Ó·È Ë ˙ˆ‹ ÙfiÛÔ ÈÔ ·ÓfiËÙË Î·È ·Ó¿ÍÈ· ‡·Ú͢ ›ӷÈ. √ “ËÏÈÎÈÛÌfi˜”, Ì·˙› Ì ¿ÏÏÔ˘˜ ÔÈÎÔÓÔÌÈÎÔ‡˜, ‰ËÌÔÁÚ·ÊÈÎÔ‡˜ Î·È ıÚËÛ΢ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ô‰‹ÁËÛ·Ó, Û ·Ï·ÈfiÙÂÚ˜ ÂÔ¯¤˜, Û ·›ÛÙÂ˘Ù· ÂÁÎÏ‹Ì·Ù· ÂÓ·ÓÙ›ÔÓ ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ - Ì·˙ÈΤ˜ ‚ÚÂÊÔÎÙÔӛ˜, ÂȉÈο ÙˆÓ ıËÏ˘ÎÒÓ, ‚¿Ú‚·ÚË Î·ÎÔÔ›ËÛË Î·È ·¿ÓıÚˆ˜ ıÂÛÌÔıÂÙË̤Ó˜ ÌÔÚʤ˜ ÂÁηٿÏÂȄ˘ (66)1. Á) ÙȘ ıÚËÛ΢ÙÈΤ˜ ÚÔηٷϋ„ÂȘ, Ô˘, ÂÎÏÔÁÈ·ÔÓÙ·˜ ÙËÓ ÔÚıfiÙËÙ· ÙÔ˘ fiÔÈÔ˘ ‰fiÁÌ·ÙÔ˜, ˘ÔÛÙ‹ÚÈ˙·Ó, fiˆ˜ Ô ∞˘ÁÔ˘ÛÙ›ÓÔ˜ (3), ÙÔÓ “·Ì·ÚÙˆÏfi ÂÁˆÎÂÓÙÚÈÛÌfi” ÙˆÓ ÂÌ‚Ú‡ˆÓ Î·È ÙˆÓ ÓÂÔÁÓÒÓ ‹, fiˆ˜ Ô ¢·‚›‰, ÙËÓ Î·Î‹, ·Ì·Úوϋ ʇÛË ÙÔ˘˜: “π‰Ô‡ Á·Ú ÂÓ ·ÓÔÌ›·È˜ Û˘ÓÂÏ‹ÊıËÓ Î·È ·Ó ·Ì·ÚÙ›·È˜ ÂΛÛÛËÛ¤ ÌÂ Ë Ì‹ÙËÚ ÌÔ˘” (67). ‰) ÙȘ Â› ̤ÚÔ˘˜ ÂÈÛÙËÌÔÓÈΤ˜ ÚÔηٷϋ„ÂȘ, fiˆ˜ .¯. ÙËÓ ¿Ô„Ë ÔÚÈÛÌ¤ÓˆÓ ·È‰È¿ÙÚˆÓ Î·È „˘¯ÔÏfiÁˆÓ fiÙÈ, ÏfiÁˆ ÙÔ˘ ÂÈ¤‰Ô˘ ˆÚ›Ì·ÓÛ˘ Ù˘ ÔÙÈ΋˜ Ô͇ÙËÙ·˜, Ù· ÓÂÔÁÓ¿ ‰ÂÓ ‚ϤÔ˘Ó - ÂÓÒ .¯. ÔÈ ¤Ú¢Ó˜ Ù˘ ÓÂÔÁÓÈ΋˜ Ì›ÌËÛ˘ Î·È ¿ÏÏˆÓ ÈηÓÔÙ‹ÙˆÓ Î·Ù·‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ˘¿Ú¯ÂÈ ÌÈ· ‚¤ÏÙÈÛÙË ·fiÛÙ·ÛË 20-23 ÂηÙÔÛÙÒÓ Ô˘ ηıÈÛÙ¿ Ù· ÓÂÔÁÓ¿ Èηӿ Ó· ‚ϤÔ˘Ó ·ÚÎÂÙ¿ ηı·Ú¿ Î·È ÁÈ’ ·˘Ùfi ·ÎÚÈ‚Ò˜ ÌÔÚÔ‡Ó Ó· ÌÈÌËıÔ‡Ó ·Ì¤Ûˆ˜ ÌfiÏȘ ÁÂÓÓËıÔ‡Ó (29). ∂›Ó·È Ë ·fiÛÙ·ÛË Ô˘ ¯ˆÚ›˙ÂÈ Ù· Ì¿ÙÈ· ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi Ù· Ì¿ÙÈ· Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙÔÓ Ê˘ÛÈÎfi ıËÏ·ÛÌfi. ªÈ· ÌÂÈÔÓfiÙËÙ· ·Ú¯·›ˆÓ πÓ‰ÒÓ Î·È ·Ú¯·›ˆÓ ∂ÏÏ‹ÓˆÓ ‰È·ÓÔËÙÒÓ (3,58) ‰ÂÓ ˘ÔÙ›ÌËÛ ÙÔÓ ÓÔ˘ ÙˆÓ ÂÌ‚Ú‡ˆÓ, ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ‚ÚÂÊÒÓ. Èڛ˜ ÂÚ¢ÓËÙÈ΋ Ì·ÚÙ˘Ú›·, Ì ÌÈ· ÂÎÓ¢ÚÈÛÙÈ΋ ‚‚·ÈfiÙËÙ·, Ô ∞ÚÈÛÙÔÙ¤Ï˘ ÛÙËÓ ¶ÔÈËÙÈ΋ ÙÔ˘ (68:1448b) ˘ÔÛÙ‹ÚÈÍ fiÙÈ Ô ¿ÓıÚˆÔ˜ ÂÁÁÂÓÒ˜ (ηٿ ʇÛÈÓ) ‰È·ı¤ÙÂÈ ÙȘ ÈηÓfiÙËÙ˜ Ù˘ Ì›ÌËÛ˘, ÙÔ˘ ·ÚÈıÌÔ‡, ÙÔ˘ Ú˘ıÌÔ‡ Î·È Ù˘ ÌÂψ‰›·˜ - ·˘Ù¿ ·ÎÚÈ‚Ò˜ ‰Â›¯ÓÔ˘Ó ÔÈ ÌÂϤÙ˜ Ô˘ ÂÚÈÁÚ¿„·Ì ·Ú·¿Óˆ. ∆fiÙ Ô˘ Ô Locke ıˆÚÔ‡Û ÙÔÓ ÓÂÔÁÓÈÎfi ÓÔ˘ tabula rasa Î·È Ô Rousseau ¤Ó· Ì¿ÙÛÔ ·ÓÙ·Ó·ÎÏ·ÛÙÈο, ÛÙËÓ ∫Ú‹ÙË ÙˆÓ Ì¤ÛˆÓ ÙÔ˘ 17Ô˘ ·ÈÒÓ·, Ô µÈÙÛ¤ÓÙ˙Ô˜ ∫ÔÚÓ¿ÚÔ˜ ÂÚȤÁÚ·Ê ¤Ó· ÓÂÔÁÓfi Ì ÚfiÛˆÔ Î·È ÓÔ˘, Ô ÔÔ›Ô˜ ÂÈÎÔÈÓˆÓ›, “‰Â›¯ÓÂÈ” Î·È “ÔÌÔÏÔÁ¿ Ù· ı¤ÏÂÈ” ÛÙË ÌËÙ¤Ú· ÙÔ˘ (69). ∏ ÙÚ¤¯Ô˘Û· ‚ÚÂÊÈ΋ ¤Ú¢ӷ ˘ÔÛÙËÚ›˙ÂÈ ÙË ı¤ÛË ÙÔ˘ ÔÈËÙ‹. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó Ì¤ÚÔ˜ ·fi ÙËÓ ¤ÌÊ˘ÙË Úԛη ÙÔ˘ ›‰Ô˘˜ Ì·˜. ™ÙË Á¤ÓÓËÛË, fï˜, ÔÈ „˘¯ÔÏÔÁÈΤ˜ ÈηÓfiÙËÙ˜ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ·Ó·Ù˘¯ı›

∫¿ÔȘ ·ÔÁڷʤ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙËÓ ·Ú¯·›· ª›ÏËÙÔ ÙÔ 220 .Ã. ˘‹Ú¯·Ó 118 ·ÁfiÚÈ· Î·È 28 ÎÔÚ›ÙÛÈ· Î·È Û οÔȘ Â˘Úˆ·˚Τ˜ fiÏÂȘ ÙÔ 801 Ì.Ã. ‚Ú¤ıËÎ·Ó 156 ·ÁfiÚÈ· Î·È 100 ÎÔÚ›ÙÛÈ· Î·È ÙÔ 1391 Ì.Ã. 172 ·ÁfiÚÈ· Î·È 100 ÎÔÚ›ÙÛÈ· (66). ∆Ș ·Ï·ÈfiÙÂÚ˜ ÂÔ¯¤˜, ÔÈ ‚ÚÂÊÔÎÙÔӛ˜ Á›ÓÔÓÙ·Ó .¯. Ì ÛÙÚ·ÁÁ·ÏÈÛÌfi, ÓÈÁÌfi, ¤ÎıÂÛË Û ÂȉÈÎÔ‡˜ “·Ôı¤Ù˜” (ÁÎÚÂÌÔ›, ÔÙ¿ÌÈ·, ˘fiÓÔÌÔÈ Î.¿.) Î·È Ì ı˘Û›Â˜ ÓÂÔÁÓÒÓ ˘fi ÙÔÓ ‹¯Ô Ù˘Ì¿ÓˆÓ ÁÈ· Ó· ÌËÓ ·ÎÔ‡ÁÔÓÙ·È ÔÈ ÎÚ·˘Á¤˜ ÙÔ˘˜ ·fi ÙË Ì¿Ó·. ∏ ηÎÔÌÂÙ·¯Â›ÚÈÛË ÁÈÓfiÙ·Ó .¯. Ì Û¿ÛÈÌÔ ÌÂÏÒÓ, ¢ÓÔ˘¯ÈÛÌfi ÙˆÓ ·ÚÛÂÓÈÎÒÓ Ì Îfi„ÈÌÔ ÙˆÓ fiÚ¯ÂˆÓ ¿Óˆ Û ÌÈ· Û·Ó›‰· ‹ Ì ÛÊ›ÍÈÌÔ ÙˆÓ fiÚ¯ÂˆÓ Û ÏÂοÓË Ì η˘Ùfi ÓÂÚfi ÁÈ· ÙË ÛÂÍÔ˘·ÏÈ΋ ÈηÓÔÔ›ËÛË ÙˆÓ ƒˆÌ·›ˆÓ ·Ó‰ÚÒÓ, Î.¿. À‹ÚÍ·Ó ıÂÛÌÔıÂÙË̤Ó˜ ÌÔÚʤ˜ ÂÁηٿÏÂȄ˘ – Ù· ÓÂÔÁÓ¿ ‰›‰ÔÓÙ·Ó fiÌËÚÔÈ ˆ˜ ÂÁÁ‡ËÛË ÁÈ· ¯Ú¤Ë, ÙÔ˘˜ ¯ÔÚËÁÔ‡Û·Ó fiÈÔ ‹ ·ÏÎÔfiÏ ÁÈ· Ó· ÌËÓ ÎÏ·›Ó Î.¿. ™ÙËÓ ÔÚ›· ÙÔ˘ ¯ÚfiÓÔ˘, Ù· ·Ú·¿Óˆ Ê·ÈÓfiÌÂÓ· ¤¯Ô˘Ó ηٿ Ôχ ÌÂȈı›, ·ÏÏ¿ ‰ÂÓ ¤¯Ô˘Ó ÂÍ·Ê·ÓÈÛı› – ÌfiÓÔ ÙÔ 374 Ì.Ã. ¿Ú¯ÈÛÂ Ô ÓfiÌÔ˜ Ó· ıˆÚ› ÙÔÓ ÊfiÓÔ ÙˆÓ ‚ÚÂÊÒÓ ˆ˜ ‰ÔÏÔÊÔÓ›·.

¶·È‰È·ÙÚÈ΋ 2008;71:331-344

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·342

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Ô‡ÙÂ Â›Ó·È Ï‹Úˆ˜ ÏÂÈÙÔ˘ÚÁÈΤ˜. ∏ Ï‹Ú˘ ¤ÎÊÚ·Û‹ ÙÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ˆÚ›Ì·ÓÛË Î·È ·fi ÙȘ Â·Ê¤˜ Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ. ŒÙÛÈ, ÔÈ „˘¯ÔÏÔÁÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ·Ó·Ù‡ÛÛÔÓÙ·È ·fi ÙËÓ ·ÌÔÈ‚·›· Ú‡ıÌÈÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤Û· ÛÙÔ ÛÒÌ· Î·È Ù· ·ÌÔÈ‚·›· ÌÔÈÚ¿ÛÌ·Ù· ÙˆÓ ÚÔÛÒˆÓ ̤۷ ÛÙÔ ÎÔÈÓfi ÙÔ˘˜ ÂÚÈ‚¿ÏÏÔÓ. ª¤Û· ÛÙ· ÌÔÈÚ¿ÛÌ·Ù· ·˘Ù¿ ı· ·Ó·‰˘ı›, ı· ·Ó·Ù˘¯ı› (‹ ı· ·ÁÒÛÂÈ) Ô ÓÔ˘˜ ÙÔ˘ οı ‚Ú¤ÊÔ˘˜, ÓË›Ô˘, ·È‰ÈÔ‡ ‹ ÂÊ‹‚Ô˘. ∞fi ÙËÓ ·Ú¯‹ Ù˘ ÔÓÙÔÁ¤ÓÂÛ˘, Ù· ÌÔÈÚ¿ÛÌ·Ù· ڿ͈Ó, ¯ÚfiÓÔ˘, ÎÈÓ‹ÙÚˆÓ, ÚÔı¤ÛˆÓ, ÚÔÛ‰ÔÎÈÒÓ, ȉÂÒÓ, ›ڷ˜, ÁÓÒÛ˘, Û˘ÁÎÈÓ‹ÛÂˆÓ Î.¿. ÚÔ¸Ôı¤ÙÔ˘Ó fiÙÈ Ô ÂÁΤʷÏÔ˜ οıÂ Û˘ÓÙÚfiÊÔ˘ ‰È·ı¤ÙÂÈ ·Ó··Ú·ÛÙ¿ÛÂȘ ·‰Ú¿ÓÂÈ·˜, ÙÔÔÁÚ·Ê›·˜, Û˘ÌÌÂÙÚ›·˜ Î·È ÔÏÈÎfiÙËÙ·˜ ÙÔ˘ ÛÒÌ·Ùfi˜ ÙÔ˘ ÂÓ ÛÙ¿ÛÂÈ Î·È ÂÓ ÎÈÓ‹ÛÂÈ, ·Ó··Ú¿ÛÙ·ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ ÙÔ˘ ¿ÏÏÔ˘ ÂÓ ÛÙ¿ÛÂÈ Î·È ÂÓ ÎÈÓ‹ÛÂÈ Î·È ·Ó··Ú¿ÛÙ·ÛË Ù˘ ÙÚ¤¯Ô˘Û·˜ ·ÏÏËÏÂ›‰Ú·Û‹˜ ÙÔ˘˜. ∆· ¤ÌÊ˘Ù· ΛÓËÙÚ· Û˘ÓÂÚÁ·Û›·˜ Ô˘ ‰È·ı¤ÙÂÈ ÙÔ Â›‰Ô˜ Ì·˜ ˘ËÚ¤ÙËÛ·Ó ÙËÓ ÂÈ‚›ˆÛË Î·È ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘ - ‹Ù·Ó ›Ûˆ˜ Ë ·Û›‰· ÛÙË Ì¿ÏÏÔÓ ÂÁÁÂÓ‹ ·˘ÙÔ- Î·È ÂÙÂÚÔ- ηٷÛÙÚÔÊÈÎfiÙËÙ¿ Ì·˜. ∂›Ó·È ·˘Ù¿ Ô˘ ¤Î·Ó·Ó ‰˘Ó·Ù‹ ÙË Û˘Ó‹¯ËÛË ÙÔ˘ „˘¯ÈÛÌÔ‡ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È Ù˘ ÌËÙ¤Ú·˜ - Û˘Ó‹¯ËÛË ÌÂٷ͇ Û‡ÛÙÔȯˆÓ ·ÓÙÈÏËÙÈÎÒÓ, ÎÈÓËÙÈÎÒÓ, ÁÓˆÛÙÈÎÒÓ Î·È Û˘ÁÎÈÓËÛÈ·ÎÒÓ ‰ÔÌÒÓ ‰‡Ô ·ÓıÚÒˆÓ, ·Ú¿ ÙË ‰È·ÊÔÚ¿ ËÏÈΛ·˜ ÙÔ˘˜. ∫¿ÔÈÔÈ ÔÓÔÌ¿˙Ô˘Ó ÙË Û˘Ó‹¯ËÛË, Î·È ÛˆÛÙ¿, ·ÌÔÈ‚·›· ·Á¿Ë. ™ÙËÓ ÍÂÚ‹ ÂÈÛÙËÌÔÓÈ΋ ÁÏÒÛÛ· ÔÓÔÌ¿˙ÂÙ·È ¤ÌÊ˘ÙË ‰È˘ÔÎÂÈÌÂÓÈÎfiÙËÙ· - ¤Ó·˜ ÚÔ‚ÏÂÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ (ÚÔ‚ÏÂÙÈΤ˜, ‰ËÏ·‰‹, ·Ó·ÌÂÓfiÌÂÓ˜ ÎÈÓËÙÈΤ˜ ÂÈÎfiÓ˜) ÙˆÓ ‰‡Ô Û˘ÓÙÚfiʈÓ, ÌÈ· ÈηÓfiÙËÙ· ÁÈ· ÂÈÎÔÈÓˆÓȷΤ˜ ÂÌÏÔΤ˜ Î·È ·ÂÌÏÔΤ˜, ¤Ó·˜ ÂÈÎÔÈÓˆÓÈ·Îfi˜ Ì˯·ÓÈÛÌfi˜ ÈÔ ÁÂÓÈÎfi˜ ·fi ÂΛÓÔÓ Ù˘ ÁÏÒÛÛ·˜, Ú˘ıÌÈÛÙ‹˜ Ù˘ ·ÓıÚÒÈÓ˘ „˘¯ÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘, Ô˘ ÚÔÈΛ˙ÂÈ Ù· ‚Ú¤ÊË Ì ÌÈ· ÂÁÁÂÓ‹ ÈηÓfiÙËÙ· ÁÈ· ·ÌÔÈ‚·›· ·Ó·ÁÓÒÚÈÛË Î·È ÂÈÎÔÈÓˆÓȷ΋ Û˘Ó·ÏÏ·Á‹, Ì ÌÈ· ¢·ÈÛıËÛ›· ÚÔ˜ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ÂÎÊÚ·ÛÙÈΤ˜ ÎÈÓ‹ÛÂȘ ÂÈÎÔÈÓˆÓ›·˜ Î·È Ì ÌÈ· ‰ÈÂÚÁ·Û›· ηٿ ÙËÓ ÔÔ›· Û˘Ì‚·›ÓÂÈ ¤Ó· ›‰Ô˜ “‰È·‚¿ÛÌ·ÙÔ˜” ÙÔ˘ ˘ÔÎÂÈÌÂÓÈÎÔ‡ ÎfiÛÌÔ˘ ÙÔ˘ ¿ÏÏÔ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· ÌÔ›Ú·ÛÌ· Ô˘ ˆı› ÙÔ˘˜ ·ÓıÚÒÔ˘˜ ÛÂ Û˘ÓÂÚÁ·Û›·, Û ¤Ó·Ó ÎfiÛÌÔ fiÔ˘ ÔÈ Ô˘Û›Â˜ ÙˆÓ ÚÔÛÒˆÓ Î·È ÙˆÓ Ê˘ÛÈÎÒÓ (¿„˘¯ˆÓ) ·ÓÙÈÎÂÈÌ¤ÓˆÓ Â›Ó·È Ôχ ‰È·ÊÔÚÂÙÈΤ˜. ªÔ›Ú·ÛÌ· ˘·ÚÎÙfi, Ô˘ ·ÓȯÓ‡ÂÙ·È ÂÚ¢ÓËÙÈο ÛÙË ‚ÈÔÏÔÁÈ΋-Ì˯·ÓÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÎÈÓ‹ÛˆÓ, ÛÙȘ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈΤ˜ ηٷÁڷʤ˜, ÛÙȘ Ó¢ÚÔ·ÂÈÎÔÓÈÛÙÈΤ˜ ηٷÁڷʤ˜, ÛÙȘ Ó¢ÚÔ¯ËÌÈΤ˜ ·ÓÙȉڿÛÂȘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (70,71) Î·È ÛÙ· Û¯ÂÙÈο „˘¯ÔÏÔÁÈο ÂÈÚ¿Ì·Ù·, Ù· ÔÔ›· ›¯·Ó ˆ˜ ˘ÔΛÌÂÓ· ‚Ú¤ÊË Î·È ÂÓ‹ÏÈΘ (4,6,8). ™ÙÔÓ ·Ó·Ù˘ÍÈ·Îfi ¯ÚfiÓÔ, Ë ‰È·ÊÔÚÔÔ›ËÛË Ù˘ ‰È˘ÔPaediatriki 2008;71:331-344

ÎÂÈÌÂÓÈÎfiÙËÙ·˜ ÛÙÔÓ ‚ÚÂÊÈÎfi ÂÁΤʷÏÔ ÂÚÌËÓ‡ÂÈ ÙȘ ·ÏÏ·Á¤˜ ÂÈÎÔÈÓˆÓ›·˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜, ÂȉÈο ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ∏ ÚˆÙfiÁÔÓË ·Ú¯‹ ÙÔ˘ ÌÔÈÚ¿ÛÌ·ÙÔ˜ Ê·›ÓÂÙ·È fiÙÈ ÚÔËÁÂ›Ù·È ÙˆÓ ·Ú¯ÒÓ Ù˘ ˉÔÓ‹˜-Ú·ÁÌ·ÙÈÎfiÙËÙ·˜ (Freud) Î·È Ù˘ ·ÊÔÌÔ›ˆÛ˘-Û˘ÌÌfiÚʈÛ˘ (Piaget). Èڛ˜ ÙÔ ÌÔ›Ú·ÛÌ· ‰ÂÓ ÁÂÓÓÈ¤Ù·È ˙ˆ‹, ‰ÂÓ ÓÔÂ›Ù·È ·Ó¿Ù˘ÍË, ‰ÂÓ ·ÚıÚÒÓÔÓÙ·È ÎÔÈӈӛ˜, ÏfiÁÔÈ, ÏÔÁÈΤ˜ Î·È Ì‡ıÔÈ, ‰ÂÓ ·Ó·‰‡ÔÓÙ·È Î›ÓËÙÚ· Î·È Û˘ÁÎÈÓ‹ÛÂȘ, ‰ÂÓ ˘Ê›ÛÙ·ÓÙ·È ıÂÛÌÔ› Î·È ÓÔ‹Ì·Ù·, ‰ÂÓ ‰ËÌÈÔ˘ÚÁÂ›Ù·È Ù¤¯ÓË Î·È ÂÈÛÙ‹ÌË. ∆Ô Í¯·Ṳ̂ÓÔ Ì¿ıËÌ· Ù˘ Û˘Ó¯ԇ˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÌÔÈÚ¿ÛÌ·ÙÔ˜ ÛÙË ˙ˆ‹ Ì¿˜ ÙÔ ‰›ÓÔ˘Ó Ù· “·ÊÂÏ‹” ‚Ú¤ÊË ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ¿ Ì·˜ Î·È ÛÙȘ ÂÈÚ·Ì·ÙÈΤ˜ Î·È Ó·ÙÔ˘Ú·ÏÈÛÙÈΤ˜ ÌÂϤÙ˜. ∞˘Ùfi ÙÔ ÔχÙÚÔÔ ÌÔ›Ú·ÛÌ· ηıÈÛÙ¿ ÙËÓ ·ÓıÚÒÈÓË ·Ó¿Ù˘ÍË ¤Ó· ¯ˆÚ›˜ ·Ó¿Û· ·È¯Ó›‰È Û˘Ó-·Ó¿Ù˘Í˘ ·È‰ÈÔ‡-ÛËÌ·ÓÙÈÎÔ‡ ¿ÏÏÔ˘: ∆Ô ¶·ÈÁÓ›‰È. µÈÔÏÔÁÈÎfi, ÎÔÈÓˆÓÈÎfi Î·È „˘¯ÔÏÔÁÈÎfi ·È¯Ó›‰È, Ô˘ fiÙ·Ó ‰ÂÓ ·›˙ÂÙ·È, ¤¯ÂÈ ÙÚ·˘Ì·ÙÈΤ˜ Û˘Ó¤ÂȘ ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ Î·È, ηْ Â¤ÎÙ·ÛË, Ù˘ ÎÔÈÓˆÓ›·˜ (1,2,3,4,5,6,7,29,30,31,70,71).

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47. Kirkland J. Crying and Babies. Helping families cope.

London: Croom Helm; 1985.

48. St James-Roberts I. Infant crying: normal development and persistent crying. In: St James-Roberts I, Harris G, Messer D, editors. Infant crying, feeding and sleeping. Development, problems and treatments. N.Y.: Harvester Wheatsheaf; 1993. p. 7-25.

49. St James-Roberts I. Explanations of persistent infant crying.

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50. Vaãrallyay G Jr. The melody of crying. Int J Pediatr Otorhinolaryngol 2007;71:1699-1708.

51. Wolke D. The treatment of problem crying behaviour. In: St James-Roberts I, Harris G, Messer D, editors. Infant crying, feeding and sleeping. Development, problems and treatments. N.Y.: Harvester Wheatsheaf ; 1993. p. 47-79.

52. Cecchini M, Lai C, Langher V. Communication and crying in newborns. Infant Behav Dev 2007;30: 655-665. ¶·È‰È·ÙÚÈ΋ 2008;71:331-344

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53. Martin GB, Clark RD. Distress crying in neonates: Species and peer specificity. Developmental Psychology 1982;18:3-9.

54. DeLeon CW, Karraker KH. Intrinsic and extrinsic factors associated with night waking in 9-month-old infants. Infant Behav Dev 2007;30:596-605.

55. Zaiwalla Z, Stein A. The physiology of sleep in infants and young children. In: St James-Roberts I, Harris G, Messer D, editors. Infant crying, feeding and sleeping. Development, problems and treatments. N.Y.: Harvester Wheatsheaf; 1993. p. 135-149.

56. ¶Ï¿ÙˆÓ. ¶ÔÏÈÙ›·. ∂ÈÛ·ÁˆÁ‹, ÂÚÌËÓ›· Î·È ÛËÌÂÈÒÛÂȘ. °ÂˆÚÁÔ‡Ï˘ ∫¢. ∞ı‹Ó·: ™È‰¤Ú˘; 1962; Û. 571-572.

57. Freud S. The Interpretation of Dreams. Harmondsworth: Penguin; 1976.

58. ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘ °. ∞ÓıÚÒÈÓË ·Ó¿Ù˘ÍË: ∆Ô ÎÏÔ˘‚› Î·È Ù· Ô˘ÏÈ¿. ™ÙÔ: ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘ °, Â. ¤Î‰. ∞Ó·Ù˘Íȷ΋ æ˘¯ÔÏÔÁ›·: ¶·ÚÂÏıfiÓ, ¶·ÚfiÓ Î·È ª¤ÏÏÔÓ. ∏Ú¿ÎÏÂÈÔ: ¶·ÓÂÈÛÙËÌȷΤ˜ ∂ΉfiÛÂȘ ∫Ú‹Ù˘; 1995. Û.

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65. Stevenson J. Sleep disturbance in children and its relationship to non-sleep behaviour problems. In: St James-Roberts I, Harris G, Messer D, editors. Infant crying, feeding and sleeping. Development, problems and treatments. N.Y.: Harvester Wheatsheaf; 1993. p. 174-193.

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68. ∞ÚÈÛÙÔÙ¤Ï˘. ¶ÂÚ› ¶ÔÈËÙÈ΋˜. ªÙÊ. ªÂÓ¿Ú‰Ô˜ ™, ÂÈÛ., ΛÌ. Î·È ÂÚÌ. ™˘ÎÔ˘ÙÚ‹˜ π. ∞ı‹Ó·: π¢ ∫ÔÏÏ¿ÚÔ˘; 1936.

69. ∫ÔÚÓ¿ÚÔ˜ µ. ∂ÚˆÙfiÎÚÈÙÔ˜. ∫ÚÈÙÈ΋ ¤Î‰ÔÛË, ÂÈÛ·ÁˆÁ‹, ÛËÌÂÈÒÛÂȘ: ∞ÏÂ͛Ԣ ™. ∞ı‹Ó·: ∂ÚÌ‹˜; 1980.

70. Braten S, editor. On Being Moved. From Mirror Neurons to Empathy. Amsterdam/Philadelphia: John Benjamins; 2007.

71. Trevarthen C, editor. Brain Circuits and Functions of the Mind. Essays in Honor of Roger Sperry. Cambridge: Cambridge University Press; 1990.

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A quadrivalent human papillomavirus (HPV) vaccine to prevent cervical cancer and other HPV related anogenital diseases X. Castellsagué1, G. Trimis2, D. Florakis2 Abstract: The quadrivalent (HPV types 6, 11, 16, 18) vaccine has been formulated to protect against the most common disease causing human papillomavirus (HPV) types and is expected to reduce substantially the morbidity, mortality, and cost burden of HPV infection. The quadrivalent vaccine has demonstrated high efficacy in women not exposed to HPV against anogenital cancers by preventing premalignant genital lesions (cervical, vulvar, vaginal), as well as genital warts, caused by HPV types 6, 11, 16 and 18. In adolescent males and females and young women, the quadrivalent HPV vaccine has been found to be immunogenic and safe, with a tolerability profile comparable to that of a placebo. Long-term follow up of young women has provided no evidence of diminished immunity through five years, as evidenced by high efficacy for prevention of persistent infection and disease caused by HPV 6, 11, 16 or 18.

Key words: HPV, quadrivalent vaccine, CIN 2/3, AIS, VIN 2/3, VaIN 2/3, genital warts.

Abbreviations AAHS: AIS: CIN: GMTs: HPV: VaIN: VIN: VLPs:

amorphous aluminium hydroxide sulphate adenocarcinoma in situ cervical intraepithelial neoplasia geometric mean titres human papillomavirus vaginal intraepithelial neoplasia vulvar intraepithelial neoplasia virus-like particles

Introduction Human papillomavirus (HPV) related morbidity and mortality from cytologic abnormalities of the cervix and surrounding genitalia and cervical cancer develop with high frequency.

Cervical cancer has been shown to be caused by HPV infection in over 99% of cases (1). Most sexually active women will become infected with HPV in their lifetime, and over 50% of girls will acquire HPV within 48 months of becoming sexually active (2). However, up to 80% and 90%, respectively, of the women infected in the first and second years will spontaneously become clear of the infection.

HPV-associated precancerous changes in the cervix may either resolve spontaneously or be identified through screening surveillance and treated, but in some cases (1-12%) progression to cervical cancer may occur (1-3). There are over 100 HPV types, with 30-40 types associated with anogenital disease. Approximately two thirds of these are considered “high-risk” for oncogenic progression while the remaining one third are considered “low-risk” (4). Approxi-

1 Unit of Infections and Cancer, Cancer Epidemiology Research Program (CERP), Institut Català d’Oncologia (ICO) CIBERESP, Hospitalet de Llobregat, Barcelona, Spain 2 Medical Department, Vaccine Unit (Sanofi Pasteur MSD), VIANEX S.A., Athens, Greece Correspondence: Xavier Castellsagué xcastellsague@iconcologia.net Unit of Infections and Cancer, Institut Català d’Oncologia (ICO) CIBERESP, Hospitalet de Llobregat, Barcelona, Spain

mately 500,000 women develop cervical cancer annually, resulting in an annual mortality of about 200,000 (1). Cervical cancer is the second most common cancer among young women in the 15-44 year age group in Europe, with estimated rates of 33,000 new cases, and 15,000 deaths per year (1,5). The low-risk HPV types are primarily associated with genital warts, but they may be associated rarely with anogenital and oral cancers (4). The morbidity associated with the low-risk HPV types results in physical and emotional discomfort, which, although treated by ablation or cryotherapy, is often followed by recurrence of lesions. Thus, there is a significant medical need to address HPV-related disease (3,4).

Immunization of women using a vaccine directed against the most common high-oncogenic risk HPV types (HPV 16 and 18) and most common low risk HPV types (HPV 6 and 11) represents a logical primary prevention strategy for reducing the occurrence of HPV related diseases. The purpose of this article is to review the clinical development, efficacy, immunogenicity and safety results of the recombinant quadrivalent HPV vaccine.

Rationale for development and composition of a quadrivalent HPV L1 VLP vaccine As is already known, most HPV-related disease can be attributed to HPV types 6, 11, 16, and 18.

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Table 1. Estimated annual number of clinical events caused by human papillomavirus (HPV) 6, 11, 16 and 18 in European* women Disease Cervical cancer CIN 2/3 CIN 1 Vulvar-vaginal cancer VIN 2/3 and VaIN 2/3 Genital warts

Cases/year in Europe HPV types 16, 18 HPV types 6, 11 ~ 25,000 ~ 112,000 ~ 200,000 ~ 1,900 ~ 24,000

~ 80,000 > 225,000

Estimated proportion of 6-, 11-, 16-, 18-related disease among HPV-related disease ~ 75% ~ 70% ~ 50% ~ 95% ~ 80% ~ 90%

*25 EU member states plus Iceland, Norway and Switzerland CIN 2/3: high grade cervical intraepithelial neoplasia CIN 1: low grade cervical intraepithelial neoplasia VIN 2/3: high grade vulvar intraepithelial neoplasia VaIN 2/3: high grade vaginal intraepithelial neoplasia

of nearly 90% of all anogenital warts in women and men and approximately 10% of low-grade cervical lesions. In Europe, HPV 16 and 18 are responsible for approximately 75% of cervical cancers, 70% of other HPV-positive genital cancers in women, and approximately 85% of HPV-positive anal cancers. In addition, HPV 16 and 18 are associated with approximately 25% of low-grade cervical lesions and 50% of high-grade cervical lesions. On the whole, 2/3 of HPV related anogenital diseases in females are attributed to HPV 6, 11, 16 and 18, while HPV 6 and 11 solely are responsible for half of these diseases; see Table 1 (1-12).

Immunization of women, therefore, with a prophylactic quadrivalent HPV vaccine targeting these common, major HPV types will result in substantial reduction in acquisition of HPV infection and the global burden of HPV-related disease (13). The quadrivalent vaccine is composed of a mixture of four types of virus-like particles (VLPs) derived from the major capsid protein L1 of HPV 6, 11, 16, and 18.

These type-specific L1 VLPs are generated in culture in the yeast Saccharomyces cerevisiae, using recombinant technology, and, after purification, are adsorbed onto the adjuvant amorphous aluminium hydroxyphosphate sulphate (AAHS). VLPs mimic the shell of the virus but they have no infectious content and genetic material; see Figure 1 (14,15). The quadrivalent vaccine is administered by intramuscular injection (0.5 mL injection volume containing 225 Ìg of aluminum adjuvant) in three doses over 6 months (day 1, month 2, and month 6). If an alternate vaccination schedule is necessary, the second dose should be administered at least one month after the first dose and the third dose should be administered at least 3 months after the second dose. All three doses should be given within a one-year period (16). Yeast-derived vaccines have been successfully employed to produce many other vaccines, including hepatitis B vaccine, Paediatriki 2008;71:345-354

and have been generally safe and well tolerated when administered to millions of children and adults worldwide (15).

The chemical composition of aluminium-containing adjuvants can have a significant effect on the ability of a given antigen to associate with the adjuvant and induce an immune response. Under physiological formulation conditions it was found that AAHS had the greatest capacity to bind HPV VLPs and that mice immunized with HPV 16 VLPs adsorbed onto AAHS generated substantially higher antibody titres than mice immunized with VLPs adsorbed onto aluminium hydroxide (AlOH) (17). For this reason, the final formulation of the quadrivalent HPV VLP vaccine contains HPV 16, 18, 6 and 11 VLPs adsorbed onto AAHS. There has been extensive clinical experience with AAHS, as it has been used in millions of administered doses of a hepatitis B vaccine (18).

Efficacy As summarized in Figure 2, the quadrivalent HPV vaccine clinical development programme is comprehensive and, to date, has involved the participation of more than 30,000 subjects in 33 countries.

Phase II and III studies, both conducted in women aged 15-26 years, had a follow up of five and four years, respectively (19-24). The duration of vaccine

Figure 1. Virus-like particles mimic the shell of the virus (A) but have no infectious content (B).

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Phase II proof-of-principle HPV 16 vaccine Women 16-23 years of age Phase II Women 16-23 years of age

Year-5 immune memory evaluation Duration of effectiveness registry study Nordic region

Phase III efficacy FUTURE 1&2 Women 15-26 years of age

Adolescent follow-up extension

Phase III adolescent immunogenicity, both genders, 9-15 years of age

Efficacy study in mid-adult women Male efficacy study

Jan 2003

Jan 2004

Jan 2005

Jan 2006

Jan 2007

Jan 2008

Jan 2009

Jan 2010

Approved in >60 countries, including US and EU Figure 2. Quadrivalent Human papillomavirus (HPV) vaccine clinical programme.

efficacy beyond the planned end of the primary efficacy trial is being extended in a subset of women enrolled in the Nordic region (15). A key aspect of the clinical efficacy studies of prophylactic HPV vaccines in women has been the utilization of high grade cervical intraepithelial neoplasia (CIN 2/3) as a surrogate marker for cervical cancer. CIN 2/3 is an obligate precursor for, and is closely temporally associated with the development of cervical cancer; it is a clinically im-

portant syndrome requiring treatment and its reduction implies a reduced risk of cervical cancer (25,26).

The combined data presented in this review are based on an analysis conducted at follow up at a mean of three years post-vaccination. These values differ slightly from the final combined analyses of the fouryear data, which have not yet been published. The primary analysis involved the per-protocol population, that is, subjects who had no serum antibodies to HPV

Table 2. Primary analysis of efficacy against human papillomavirus (HPV)16/18-related cervical intraepithelial neoplasia (CIN)2/3 adenocarcinoma-in-situ (AIS) (adapted from Ault KA - ref. 27) Vaccine (N=10,291) Per-protocol susceptible population HPV 16/18-related CIN2/3 or AIS By lesion type CIN2 CIN3 AIS

By HPV type HPV 16-related HPV 18-related

Placebo (N=10,292) Rate* N Cases

n

Cases

Rate*

Efficacy (95% CI)

8579

1

<0.1

8550

85

0.4

99% (93 to 100)

8579 8579 8579

0 1 0

0 <0.1 0

8550 8550 8550

56 51 7

0.3 0.2 <0.1

100% (93 to 100) 98% (89 to 100) 100% (31 to 100)

7455 7450

1 0

<0.1 0

7265 7381

73 18

0.4 0.1

99% (92 to 100) 100% (78 to 100)

†

Each woman counted only once in each applicable row. N=number randomised to group; n=number in specified population. *Cases per 100 person-years at risk. † Numbers with at least one follow-up visit post-dose 3: 8492 vaccine vs 8462 placebo for analysis of HPV16/18 endpoints; 7401 vs 7203 for analysis of HPV16 endpoints; 7381 vs 7314 for analysis of HPV18 endpoints. ¶·È‰È·ÙÚÈ΋ 2008;71:345-354

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Table 3. Vaccine efficacy in preventing high-grade vulval and vaginal lesions associated with human papillomavirus (HPV)16 or HPV18 and genital warts associated with HPV 6/11/16 and 18 (adapted from Joura EA, et al - ref. 28 and Barr E, et al - ref. 29) Vaccine (n=9087) Per-protocol susceptible population# HPV 16/18 related VIN2/3 or VaIN2/3 HPV 16-related VIN2/3 or VaIN2/3 HPV 18-related VIN2/3 or VaIN2/3 By lesion type HPV 16/18 related VIN2/3 HPV 16-related VIN2/3 HPV 18-related VIN2/3 HPV 16/18 related VaIN2/3 HPV 16-related VaIN2/3 HPV 18-related VaIN2/3 HPV 6/11/16/18 related genital warts

Placebo (n=9087) Rate* N

N

Cases

7811 6687 7450

0 0 0

0.00 0.00 0.00

7811 6687 7450 7811 6687 7450 7899

0 0 0 0 0 0 2

0.00 0.00 0.00 0.00 0.00 0.00 0.00

Efficacy (95% CI) Cases

Rate*

7785 6500 7381

15† 13 2

0.08 0.08 0.01

100% (72 to 100) 100% (68 to 100) 100% (-427 to 100)

7785 6500 7381 7785 6500 7381 7900

8 7 1 7 6 1 160

0.04 0.04 0.01 0.04 0.04 0.01 0.89

100% (42 to 100) 100% (33 to 100) 100% (<-999 to 100) 100% (31 to 100) 100% (18 to 100) 100% (<-999 to 100) 99% (95.4 to 99.9)

#

Includes individuals who were HPV DNA negative by PCR and seronegative to the relevant vaccine-HPV-type at enrolment, remained PCR negative to the same vaccine-HPV-type through 1 month after dose three, received three doses of vaccine or placebo within 1 year, and did not violate the protocol. Among those in the per-protocol population, the following had at least one follow-up visit after dose three: vaccine=7771 vs placebo=7742 for the analysis of HPV 16/18 endpoints; vaccine=6653 vs placebo=6465 for the analysis of HPV 16 endpoints; and vaccine=7413 vs placebo=7341 for the analysis of HPV 18 endpoints. *Cases per 100 person-years at risk † Of the 15 cases in the placebo group, seven were from protocol 013 and eight were from protocol 015.

6, 11, 16 or 18 at day 1, who had no HPV 6, 11, 16 or 18 DNA in their swabs at day 1 through month 7, and who had completed three vaccinations. Overall, on day 1, 73% of enrolled women tested negative for HPV types 6, 11, 16, 18 and 27% tested positive to at least one HPV type either by PCR and/or serology (27,28).

At the three-year follow up, the combined Phase II/Phase III per-protocol analysis demonstrated that prophylactic quadrivalent HPV vaccination was 99% efficacious against CIN 2/3 or adenocarcinoma in situ (AIS) related to HPV 16 and 18; see Table 2 (27). This analysis also showed that the quadrivalent vaccine prevented 100% of HPV 16- and HPV 18-related cases of high grade vulvar intraepithelial neoplasia (VIN 2/3) and high grade vaginal intraepithelial neoplasia (VaIN 2/3) and 99% of HPV 6, 11, 16, or 18-related cases of genital warts; see Table 3 (28,29). The quadrivalent vaccine was up to 100% effective in reducing the incidence of HPV 6/11/16/18-related disease in HPV-naïve women (i.e., seronegative and HPV DNA negative by PCR), as well as in women who had been previously exposed to at least one vaccine HPV type at enrollment, but had no ongoing HPV infection (i.e., seropositive but HPV DNA negative by PCR) (30).

Immunogenicity – Duration of Protection The immunoassay used in the trials of the quadrivalent vaccine is a competition assay measuring one neutralising antibody species only. VLPs are highly Paediatriki 2008;71:345-354

immunogenic and, in VLP-immunised individuals, the peak anti-VLP antibody responses are substantially greater (at least 1-3 logs) than those made at seroconversion in natural infections (31). What is the duration, however, of the protection induced by the vaccines? The data from the trials are very encouraging, with serum antibody levels falling from the peak levels achieved after the third immunization to a lower concentration that persists at the same level (at least 1020 times that of natural infection for HPV 16) for at least 60 months post-vaccination; see Figure 3 (31).

The quadrivalent vaccine was 100% efficacious in preven-ting HPV 6, 11, 16, or 18-related cases of CIN 2/3, VIN 2/3, VaIN 2/3 and genital warts at five year follow up (31). Antibody responses in women entering the quadrivalent Phase II study, who were already sero-positive and DNA-negative for vaccine-type HPV, had about twice the response as women who were naïve to the respective HPV types, suggesting an anamnestic response to infection (32). Results from a challenge study of 241 women, in which vaccinated women were given a booster dose five years after enrolment, showed rapid and enhanced antibody response after the fourth immunisation characteristic of an anamnestic response, so it is probable that quadrivalent vaccine will confer protection for a very long period and a booster dose may not be needed, as the vaccine induces good immune memory (31).

While the major part of the clinical development programme for quadrivalent vaccine was conducted

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Table 4. Human papillomavirus (HPV) quadrivalent vaccine-related injection site and systemic adverse events* Percentage of subjects HPV vaccine Group (n= 5088)

Aluminiumcontaining placebo group (n=3470)

Saline placebo group (n=320)

All placebo recipients (n=3790)

83.9 25.4 24.6 3.1

75.4 15.8 18.4 2.8

48.6 7.3 12.1 0.6

-

10.3 4.2 2.8

-

-

Injection site (occurring 1-5 days after vaccination) Pain Swelling Erythema Pruritus Systemic (occurring 1-15 days after vaccination) Fever Nausea Dizziness

8.6 4.1 2.6

* Vaccine-related adverse experiences include only those occurring at a frequency of ≥1% among recipients of quadrivalent vaccine and also at a greater frequency compared with placebo recipients.

Data from Gardasil, quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine. EPAR, 16-8-07. www.emea.europa.eu/humandocs/Humans/EPAR/gardasil/gardasil.htm

in female subjects aged 16-26 years, Phase III immunogenicity studies have also been performed in more than 6,000 female and male adolescents aged 915 years. The quadrivalent vaccine has been shown to be well tolerated and immunogenic in subjects aged 9-15 years. The results of the study showed that, by month 7, seroconversion rates were more than 99% for all four HPV types in each group (girls, boys and young women). By month 7, compared to young women, anti-HPV geometric mean titres (GMTs) in girls and boys, respectively, were 1.7 to 2.7-fold higher, thus permitting the bridging of efficacy data generated in young women to both girls and boys; see Figure 4 (24). Based on the strength of the clinical data from women aged 16-26 years and the even higher immunogenicity levels seen in male and female adolescents aged 9-15 years, bridging studies permitted the

conclusion that adolescents would also be protected from clinical disease after quadrivalent vaccine administration.

Cross protection The humoral immunity induced by the VLP vaccines appears to be predominantly type-specific, but there is considerable amino-acid sequence homology in L1 between closely related HPV types (27). This implies that there could be cross-neutralising epitopes. The first results from a supportive per protocol analysis of two large phase III studies (FUTURE I and FUTURE II, three-year follow up) show that the quadrivalent vaccine prevented 38% (95% CI; 6,60) of pre-cancerous cervical lesions (CIN 2/3, AIS) caused by ten other cancer-causing HPV types (31/ 33/35/39/45/51/52/56/58/59), in addition to the virus

Neutralising antibodies (HPV type 16)

GMT (mMU/ml) 10.000

Quadrivalent vaccine

1.000

n=79

100 n=8

Natural infection 10 0 Dose

7

12

18

24

30

Months

36

54

60 5 years

Figure 3. Geometric mean titres (GMTs) of neutralized antibodies (HPV type 16) after quadrivalent vaccine administration for up to 60 months, compared with those of natural infection (adapted from Olsson SE, et al - ref. 31). ¶·È‰È·ÙÚÈ΋ 2008;71:345-354

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HPV 6

GMT, log mMU/mL

1,000 100

100

10

10

1

** *

Vaccination

10,000

1

** *

Vaccination

1,000

HPV 16

1,000

HPV 18

100

100 10

HPV 11

1,000

10 ** *

Vaccination

7 12 18 24 30 36

1 54 60

** *

Vaccination

7 12 18 24 30 36

54 60

Time since vaccination day 1, months 9-15 years of age (protocol 018)

16-23 years of age (protocol 007)

Figure 4. Anti-human papillomavirus (HPV) geometric mean titres (GMTs) in adolescent and adult recipients of quadrivalent HPV types 6, 11, 16, and 18 vaccine. Bars indicate 95% CIs. (Adapted from Block SL, et al - ref. 24.)

types directly targeted by the vaccine (mean follow up of three years) (33). These ten additional virus types cause around 16% of cervical cancer in Europe and up to 22% of cervical cancer around the world (34).

Safety The combined quadrivalent HPV vaccine safety database indicates that the quadrivalent vaccine was generally well tolerated in both young women and adolescents, as assessed by using a vaccination-report card (VRC)-aided surveillance for 14 days following each vaccine injection. The most common vaccineand placebo-related systemic adverse experiences were fever (10.3% vs 8.6%), nausea (4.2% vs 4.1%), and dizziness (2.8% vs 2.6%), respectively. Adverse vaccine-related injection site experiences included pain, swelling, erythema and pruritus, all of which occurred at a somewhat higher frequency than in subjects receiving aluminum-containing placebo; see Table 4 (24,35). At the time of licensure, a total of 2,266 subjects became pregnant during clinical trials (vaccine = 1115, placebo = 1151). Of these pregnancies, the percentage of subjects experiencing an adverse outcome was similar in the vaccine and placebo groups. The rates of congenital abnormalities were comparable to those in the general population, with no difference between the quadrivalent HPV vaccine (15 cases) and the placebo group (16 cases). However, Paediatriki 2008;71:345-354

it is recommended that pregnancy be avoided during the course of vaccination (16).

The quadrivalent HPV vaccine is approved to be safe, and post licensure, as more than 30 million doses of quadrivalent vaccine have been distributed worldwide and no serious adverse events have been associated with the vaccine, according to the Adverse Report System of the Centers for Disease Control (CDC) and the European Medicine Agency (EMEA) (36).

Moreover, through the central Nordic registry, longterm efficacy and safety is continuing to be evaluated on a population basis in real time (15).

Ongoing studies with quadrivalent HPV vaccine An ongoing Phase III study is being conducted in mid-adult women, aged 24-45 years. This placebo controlled, triple-blind study is following a total of 2,800 subjects over a three-year period in order to evaluate the safety profile of the quadrivalent vaccine and its efficacy in preventing HPV type 6-, 11-, 16-, and 18-related infections and disease. The interim analysis showed that the quadrivalent vaccine was as safe in this group as it is in younger women and prevented 92% of combined HPV 6, 11, 16, or 18-related cases of CIN 2/3 or AIS, VIN 2/3 and VaIN 2/3 and genital warts after a follow up of 1.65 years. More extensive results will be available in the near future (37).

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An additional study in the Phase III clinical development programme for the quadrivalent HPV vaccine is aimed at evaluating the immunogenicity and tolerability of the vaccine, together with the clinical efficacy in preventing genital warts and anal cancer in men aged 16-23 years; results are expected towards the end of 2008 (15). Genital warts occur in both men and women who are sexually active, and a majority (85%) of anal cancer cases worldwide can be attributed to HPV infection (38). Thus, it is appropriate to investigate the potential impact and benefits of administering a quadrivalent HPV vaccine to males (39). This is particularly important in the light of the lack of success of other vaccination programmess that targeted females only, e.g. Measles, Mumps, Rubella vaccine (MMR) (40).

Cost-Effectiveness Studies Economic analyses using population-dynamic models of HPV infection, transmission, and disease for the US have demonstrated that universal vaccination of girls and women at the age of 12-24 years is cost-effective, compared with other currently accepted US health care practices, costing $4,666 per qualityadjusted life-year. This strategy was shown to yield substantially larger and more rapid health benefits than vaccinating girls at the age of 12 years only, without catch-up vaccination, and it was shown to be costeffective ($10,362 per quality-adjusted life-year), compared with a more limited female catch-up vaccination strategy for girls and women at the age of 1219 years (41). Similar results have been obtained from health-economic studies of quadrivalent vaccine conducted in other countries (42,43).

vaccine for clinical use and most of the health authorities of these countries have also issued recommendations and approved funding. In the USA only quadrivalent vaccine is licensed and the recommended age for vaccination of females is 11-12 years.

Catch-up vaccination is recommended for females aged 13-26 years who have not been previously vaccinated (46). Most European countries have introduced HPV vaccines as routine vaccination in females aged 12-15 years, and a number of them have adopted catch up programmes for older females of up to 26 years. Many health authorities and physicians stress the importance of genital warts prevention, as genital warts have an increasing incidence worldwide (47,48,49). On the other hand, screening recommendations (Pap test) are unlikely to change in the short term, and it will be important for vaccinated women to comply with the recommendations, given that the current vaccines are not expected to protect against some other infections that can lead to cervical cancer (50,51).

In summary, quadrivalent HPV vaccine is expected to reduce substantially the morbidity, mortality, and cost burden of HPV infection, as it has been demonstrated to be of high efficacy in HPV-naive women against cervical precancerous lesions, cervical cancer, vulvar and vaginal precancerous lesions, vulvar cancer and genital warts related to the four more common HPV types.

Xavier Castellsaqué is principal investigator of HPV vaccine clinical trials conducted in Spain

References Implementation Issues Genital HPV infections are acquired rapidly after initiation of sexual activity (44), and VLP vaccines are unlikely to induce regression of established lesions (20). Therefore, there is general agreement that vaccination of preadolescent or early adolescent girls, as well as older girls and women who have not yet become sexually active, would be the most cost-effective use of the vaccine. However, sexually active women may also benefit from vaccination. It is unlikely that these women have been exposed to more than 1 or 2 of the 4 vaccine types, so the quadrivalent vaccine could protect them against infections from the remaining types. In women with prevalent or breakthrough infections, the vaccine-induced neutralizing antibodies might also inhibit transmission of the virus to a new partner (45).

More than 100 countries, including the USA and the EU countries, have approved the quadrivalent

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28. Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet 2007;369:1693-1702.

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Quiz 1. Cervical cancer is the _______ most common cancer among women _______ in Europe. a. first / 45-74 years old b. second / 15-44 years old c. first / 15-44 years old d. second / 45-74 years old 2. Cervical cancer has been shown to be caused by HPV infection in over _______ of cases. a. 99% b. 89% c. 79% d. 69% 3. Over _______ of girls will acquire HPV within 48 months of becoming sexually active. a. 10% b. 30% c. 50% d. 70% 4. Up to _______ of HPV-associated precancerous changes might progress to cervical cancer. a. 3% b. 6% c. 12% d. 20% 5. HPV types 16 and 18 account for _______ of cervical cancer and HPV types 6 and 11 for _______ of genital warts in Europe. a. 60% / 50% b. 90% / 75% c. 50% / 90% d. 75% / 90% 6. Amorphous Aluminium Hydroxide Sulphate (AAHS): a. has the greatest capacity to bind HPV VLPs and generate substantially higher antibody titres than ALOH

b. has limited capacity to bind HPV VLPs and generate substantially lower antibody titres than ALOH c. has no clinical experience as it has not been used as an adjuvant in other licensed vaccines d. It is used as an adjuvant only in conjugated vaccines 7. The quadrivalent HPV vaccine has demonstrated high efficacy against the following 6, 11, 16, 18 HPV related diseases: a. cervical cancer, high grade cervical intraepithelial neoplasia b. cervical cancer, high grade cervical, vulvar and vaginal intraepithelial neoplasias c. cervical cancer, high grade cervical intraepithelial neoplasia and genital warts d. cervical cancer, high grade cervical, vulvar, vaginal intraepithelial neoplasias and genital warts 8. In 9-15 year old adolescents, the quadrivalent HPV vaccine has demonstrated: a. high efficacy against 6, 11, 16, 18 HPV related anogenital diseases b. low efficacy against 6, 11, 16, 18 HPV related anogenital diseases c. higher immunogenicity than in women 15-26 years old d. lower immunogenicity than in women 15-26 years old 9. The most effective practice to reduce cervical cancer worldwide is: a. systematic implementation of screening programmes (Pap test) in sexually active women b. routine HPV vaccination of women aged 12-26 years c. combined implementation of screening programs (Pap test) in sexually active women and routine vaccination in women aged 12-26 years d. there is no effective practice to reduce cervical cancer

The correct answers at page 416

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º›ÌˆÛË Î·È ÂÚÈÙÔÌ‹ ÛÙ· ·È‰È¿ °. ™·ÎÂÏÏ¿Ú˘, π. ªÔ˘ÏÔ˘Î¿ÎË, ∞. ¢ËÌÔÔ‡ÏÔ˘, °. ÷ڛÛ˘ ¶ÂÚ›ÏË„Ë: ∏ ÂÚÈÙÔÌ‹ ÛÙÔ˘˜ ¿Ó‰Ú˜ Â›Ó·È ÌÈ· ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È ·fi Ù· ·Ú¯·›· ¯ÚfiÓÈ·. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ˆÛÙfiÛÔ, ·ÔÙÂÏ› ı¤Ì· Û˘˙‹ÙËÛ˘ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÏϤ˜ ÂÂÌ‚¿ÛÂȘ ÂÚÈÙÔÌ‹˜ Á›ÓÔÓÙ·È ¿ÛÎÔ·. ∏ ÈÔ Û˘¯Ó‹ È·ÙÚÈ΋ ¤Ó‰ÂÈÍË ÁÈ· ÂÚÈÙÔÌ‹ Â›Ó·È Ë ·ıÔÏÔÁÈ΋ ʛ̈ÛË. ŸÌˆ˜, ÂÍ·ÎÔÏÔ˘ı› Ó· ˘¿Ú¯ÂÈ Û‡Á¯˘ÛË fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÎÚÈ‚‹ ¤ÓÓÔÈ· ÙÔ˘ fiÚÔ˘ ʛ̈ÛË, Ë ÔÔ›· ‰ÂÓ ‰È·¯ˆÚ›˙ÂÙ·È ¿ÓÙ· ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ʛ̈ÛË, Ô˘ ·ÔÙÂÏ› ̤ÚÔ˜ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ¤Ô˘˜. ∏ ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ù˘ ·ÎÚÔÔÛı›·˜ ı· Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÂÙ·È Û ‚Ï¿‚˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È Û ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜, fiˆ˜ Ù· ÙÔÈο ÛÙÂÚÔÂȉ‹, Ë Û˘ÌÊ˘ÛÈfiÏ˘ÛË Î·È Ë Ï·ÛÙÈ΋ Ù˘ ·ÎÚÔÔÛı›·˜. ∏ ηχÙÂÚË Î·Ù·ÓfiËÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ·ÎÚÔÔÛı›·˜ ·fi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ı· ÌÔÚÔ‡Û ӷ ·ÔÙÚ¤„ÂÈ ·ÚÎÂÙ¤˜ ·Ú·ÔÌ¤˜ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ù˘ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋˜.

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§¤ÍÂȘ ÎÏÂȉȿ: º›ÌˆÛË, ÂÚÈÙÔÌ‹, ·ÎÚÔÔÛı›·, ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜.

Phimosis and circumcision in children G. Sakellaris, I. Bouloukaki, A. Dimopoulou, G. Charissis Abstract: Male circumcision is a surgical technique that has been practiced since ancient times. However, there has been concern over the last few years that many operations for circumcision are performed unnecessarily. The most common medical indication for circumcision is pathological phimosis, but there is confusion about the interpretation of the term phimosis, as the pathological form is not always distinguished from physiological phimosis, which is a normal part of penile development. Surgical excision of the prepuce should be restricted to lesions that are unresponsive to alternative forms of treatment, such as topical steroid application, adhesiolysis and preputioplasty. Improved knowledge of foreskin development and disorders on the part of the paediatrician could reduce many referrals to the paediatric surgery outpatient department.

Department of Paediatric Surgery, University General Hospital of Heraklion, Medical School of the University of Crete Correspondence: Georgios Sakellaris gsakell@mycosmos.gr Department of Paediatric Surgery, University General Hospital of Heraklion, Medical School of the University of Crete

Key words: Phimosis, circumcision, prepuce, alternative treatments.

∂ÈÛ·ÁˆÁ‹ ∏ ·ÎÚÔÔÛı›· ·ÔÙÂÏ› Ê˘ÛÈÔÏÔÁÈÎfi ̤ÚÔ˜ ÙÔ˘ ¤Ô˘˜ Î·È Û¯ËÌ·Ù›˙ÂÈ ÙÔ ·Ó·ÙÔÌÈÎfi Î¿Ï˘ÌÌ· Ù˘ ‚·Ï¿ÓÔ˘. ∫¿ÔÈÔÈ Ï·Ô› ¤¯Ô˘Ó ηıÈÂÚÒÛÂÈ ÙËÓ ·Ê·›ÚÂÛË Ù˘ ·ÎÚÔÔÛı›·˜ ÙˆÓ ·È‰ÈÒÓ, ÁÈ· Ó· Û˘ÌÌÔÚʈıÔ‡Ó Ì ٷ ÎÔÈÓˆÓÈο ÙÔ˘˜ ÚfiÙ˘·, ÂÓÒ ¿ÏÏÔÈ ÙËÓ ·Ô‰¤¯ÔÓÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÚÔ˜ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ (1). √È ·Ú¯·›ÔÈ ŒÏÏËÓ˜ ıˆÚÔ‡Û·Ó ÙË ÌË ‡·ÚÍË ·ÎÚÔÔÛı›·˜ Ô˘ ηχÙÂÈ ÙË ‚¿Ï·ÓÔ ˆ˜ ÎÔÈÓˆÓÈο ··Ú¿‰ÂÎÙË Î·È ¿Û¯ËÌË (2). °È· ıÚËÛ΢ÙÈÎÔ‡˜ Î·È ÔÏÈÙÈÛÌÈÎÔ‡˜ ÏfiÁÔ˘˜, ηıÒ˜ Î·È ÏfiÁˆ ¤ÏÏÂȄ˘ ηٷÓfiËÛ˘ Ù˘ ‰ÔÌ‹˜, ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ·Ó¿Ù˘Í˘ Ù˘ ·ÎÚÔÔÛı›·˜, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ¤¯ÂÈ Á›ÓÂÈ ‰ËÌÔÊÈÏ‹˜ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ¯ÈÏÈÂٛ˜, ηıÈÛÙÒÓÙ·˜ ÙËÓ ·ÎÚÔÔÛı›· ‰˘ÛÊËÌÈÛÙÈ΋, ÂÈΛӉ˘ÓË Î·È ÌË ˘ÁÈ‹ ·Ó·ÙÔÌÈ΋ ‰ÔÌ‹ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜. ∏ ÈÔ Û˘¯Ó‹ È·ÙÚÈ΋ ¤Ó‰ÂÈÍË ÁÈ· ÂÚÈÙÔÌ‹

Â›Ó·È Ë ·ıÔÏÔÁÈ΋ ʛ̈ÛË. ŸÌˆ˜, ·ÎfiÌË Î·È Û‹ÌÂÚ· ÂÍ·ÎÔÏÔ˘ı› Ó· ˘¿Ú¯ÂÈ Û‡Á¯˘ÛË fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÎÚÈ‚‹ ¤ÓÓÔÈ· ÙÔ˘ fiÚÔ˘ ʛ̈ÛË, Ë ÔÔ›· ‰ÂÓ ‰È·¯ˆÚ›˙ÂÙ·È ¿ÓÙ· ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ʛ̈ÛË, Ô˘ ·ÔÙÂÏ› ̤ÚÔ˜ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ¤Ô˘˜. ¶·ÚfiÙÈ, ÏÔÈfiÓ, Û‹ÌÂÚ· ¤¯Ô˘Ó ‰È·Ù˘ˆı› ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙË ‰ÈÂÓ¤ÚÁÂÈ· Ù˘ ÂÚÈÙÔÌ‹˜, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÔ̤˜ ‚·Û›˙ÔÓÙ·È ÂÚÈÛÛfiÙÂÚÔ Û ıÚËÛ΢ÙÈÎÔ‡˜ ÏfiÁÔ˘˜ ·Ú¿ Û ÙÂÎÌËÚȈ̤Ó˜ È·ÙÚÈΤ˜ ÂӉ›ÍÂȘ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ë ‰È·Û·Ê‹ÓÈÛË ÙÔ˘ fiÚÔ˘ ʛ̈ÛË, Ô ‰È·¯ˆÚÈÛÌfi˜ ÙÔ˘ ·fi ÙË Ê˘ÛÈÔÏÔÁÈ΋ ʛ̈ÛË, Ë Â·Ó·ÍÈÔÏfiÁËÛË ÙˆÓ È·ÙÚÈÎÒÓ ÂӉ›ÍÂˆÓ Ù˘ ÂÚÈÙÔÌ‹˜, ηıÒ˜ Î·È Ë ·ÚÔ˘Û›·ÛË ÂÓ·ÏÏ·ÎÙÈÎÒÓ ÌÂıfi‰ˆÓ ÂÚÈÙÔÌ‹˜, Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë Ù· ‰Â‰Ô̤ӷ Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. ŸÌˆ˜, ÚÈÓ Á›ÓÂÈ ·Ó·ÛÎfiËÛË ÙˆÓ Û‡Á¯ÚÔÓˆÓ ·fi„ÂˆÓ ÁÈ· ÙËÓ ÂÚÈÙÔÌ‹, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Î·Ù·ÓÔËÙ‹ Ë Ê˘ÛÈÔÏÔÁÈ΋ ·Ó·ÙÔÌ›· Î·È ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÎÚÔÔÛı›·˜. ¶·È‰È·ÙÚÈ΋ 2008;71:355-360

Pediatri Sept-Oct 08

14-10-08

13:26

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356

°. ™·ÎÂÏÏ¿Ú˘ Î·È Û˘Ó.

º˘ÛÈÔÏÔÁÈ΋ ·Ó·ÙÔÌ›· Î·È ·Ó¿Ù˘ÍË ∏ ·ÎÚÔÔÛı›· ·ÔÙÂÏ› ¤Ó·Ó ÂÍÂȉÈÎÂ˘Ì¤ÓÔ, Û˘Ó‰ÂÙÈÎfi ‚ÏÂÓÓÔÁÔÓÔ‰ÂÚÌ·ÙÈÎfi ÈÛÙfi Ô˘ ÌÔÈ¿˙ÂÈ Ì ÂΛÓÔ ÙˆÓ ‚ÏÂÊ¿ÚˆÓ, ÙˆÓ ÌÈÎÚÒÓ ¯ÂÈϤˆÓ ÙÔ˘ ·È‰Ô›Ô˘ Î·È ÙÔ˘ ÚˆÎÙÔ‡. ∞ÔÙÂÏÂ›Ù·È ·fi ÙÔ Â͈ÙÂÚÈÎfi ÂÈı‹ÏÈÔ, Ô˘ ηχÙÂÈ ÙË ‚¿Ï·ÓÔ Î·È ÙÔ ÛÙfiÌÈÔ Ù˘ Ô˘Ú‹ıÚ·˜, Î·È ÙÔ ÂÛˆÙÂÚÈÎfi ÂÈı‹ÏÈÔ Î·È ÂÍ·ÛÊ·Ï›˙ÂÈ ÏÈÁfiÙÂÚÔ˘˜ Â͈ÙÂÚÈÎÔ‡˜ ÂÚÂıÈÛÌÔ‡˜ ‹ ÌÔχÓÛÂȘ (1). ∂›Û˘, Ë ·ÎÚÔÔÛı›· Û˘Ì‚¿ÏÏÂÈ ÛÙË Ï›·ÓÛË Ù˘ ‚·Ï¿ÓÔ˘ Î·È ÙË ‰È¢ÎfiÏ˘ÓÛË Ù˘ ÔÏ›ÛıËÛ‹˜ Ù˘ ηٿ ÙË ÛÂÍÔ˘·ÏÈ΋ Â·Ê‹. ∏ ÌÔÓ·‰È΋ Ù˘ Ó‡ڈÛË Û˘Ì‚¿ÏÏÂÈ ÛÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ˆ˜ ÂÚˆÙÔÁÂÓÔ‡˜ ˙ÒÓ˘. ∏ ·Ó¿Ù˘ÍË Ù˘ ·ÎÚÔÔÛı›·˜ Â›Ó·È ·ÙÂÏ‹˜ ÛÙ· ÓÂÔÁ¤ÓÓËÙ· ·ÁfiÚÈ·. ∆Ș ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ Û˘ÌʇÂÙ·È Û ‹ÈÔ ‚·ıÌfi Ì ÙË ‚¿Ï·ÓÔ, ˆÛÙfiÛÔ Ë Û‡ÌÊ˘ÛË ·˘Ù‹ Á›ÓÂÙ·È ÈÛ¯˘ÚfiÙÂÚË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜. ™Â ÂÚÈÛÙ·ÙÈο fiÔ˘ ¤ÁÈÓ ÂÚÈÙÔÌ‹ Û ·˘Ù‹ ÙËÓ ËÏÈΛ·, ‰ÂÓ ‚Ú¤ıËÎ·Ó ·ıÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÛÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ Î·È ÙÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ‰ÂÓ ıˆÚÂ›Ù·È Ê›ÌˆÛË Ì ÙËÓ ·ıÔÏÔÁÈ΋ ¤ÓÓÔÈ·, ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ·Ó·Ê¤ÚÂÙ·È ˆ˜ “Ê˘ÛÈÔÏÔÁÈ΋ ʛ̈ÛË” ‹ ·Ï¿ ˆ˜ “ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›·” (3). √ ‰È·¯ˆÚÈÛÌfi˜ ·fi ÙË ‚¿Ï·ÓÔ Î·È Ë ·Ó¿Û·ÛË Ù˘ ·ÎÚÔÔÛı›·˜ Û˘Ì‚·›ÓÂÈ Û ‰È¿ÊÔÚ˜ ËÏÈ˘. √È Û˘ÌʇÛÂȘ ‰È·¯ˆÚ›˙ÔÓÙ·È ·˘ÙfiÌ·Ù·, Û˘Ó‹ıˆ˜ ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ÂȉÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜. ∏ Ê˘ÛÈÔÏÔÁÈ΋ ʛ̈ÛË ÌÂÈÒÓÂÙ·È Ì ÙËÓ ËÏÈΛ·, fiˆ˜ Ê·›ÓÂÙ·È ·fi ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ (4). ™‡Ìʈӷ Ì ÙÔÓ Gairdner, Ë ¤ÏÍË Ù˘ ·ÎÚÔÔÛı›·˜ ÚÔ˜ Ù· ›Ûˆ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì¤¯ÚÈ ÙÔ 1Ô ¤ÙÔ˜ ÛÙÔ 50% ÙˆÓ ·ÁÔÚÈÒÓ, ¤ˆ˜ ÙÔ 2Ô ¤ÙÔ˜ ÛÙÔ 75% Î·È ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ ÛÙÔ 90% ÙˆÓ ·ÁÔÚÈÒÓ. ∏ ·Ó¿Ù˘ÍË Ù˘ ·ÎÚÔÔÛı›·˜ ÂÚÈÁÚ¿ÊËΠÂ›Û˘ ·fi ÙÔÓ Oster, Û‡Ìʈӷ Ì ÙÔÓ ÔÔ›Ô ‚Ú¤ıËΠfiÙÈ ÔÈ ÂÈÙÒÛÂȘ ÙˆÓ Û˘ÌʇÛÂˆÓ Ù˘ ·ÎÚÔÔÛı›·˜ ÌÂÈÒıËÎ·Ó ·fi 70% ÛÙËÓ ËÏÈΛ· ÙˆÓ 6-7 ÂÙÒÓ Û 5% ÛÙËÓ ËÏÈΛ· ÙˆÓ 16-17 ÂÙÒÓ. ¢ÂÓ ˘¿Ú¯ÂÈ, ÂÔ̤ӈ˜, ÚÔıÂÛÌ›· ÁÈ’ ·˘Ùfi Î·È Û ÌÈÎÚfi ÔÛÔÛÙfi ·ÁÔÚÈÒÓ Ë ·ÎÚÔÔÛı›· ‰ÂÓ ¤¯ÂÈ Î·Ù·Û·ÛÙ› Ï‹Úˆ˜ ̤¯ÚÈ ÙËÓ ÂÊ˂›·. ∂Ô̤ӈ˜, ÌÈ· ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›· Û ·È‰› ÚÈÓ ·fi ÙËÓ ÂÊ˂›· ‰ÂÓ ıˆÚÂ›Ù·È ÓfiÛÔ˜ Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ıÂÚ·›·. ºÚÔÓÙ›‰· Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·ÎÚÔÔÛı›·˜ ∏ Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÚÔÔÛı›· ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È È‰È·›ÙÂÚË ÊÚÔÓÙ›‰·, Ô‡Ù ÂÚ·ÈÙ¤Úˆ ηı·ÚÈfiÙËÙ· ·fi ¿ÏÏ· ÛËÌ›· ÙÔ˘ ÛÒÌ·ÙÔ˜ Û ·È‰È¿ ÌÈÎÚ‹˜ ËÏÈΛ·˜, Ô‡ÙÂ Î·È Â›Ó·È ··Ú·›ÙËÙË Ë ¤ÏÍË Ù˘. ∏ ¤ÏÍË ÚÔ˜ Ù· ›Ûˆ Ù˘ ·ÓÒÚÈÌ˘ ·ÎÚÔÔÛı›·˜ ı· Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ô˘Ï‹˜, ·ÈÌÔÚÚ·Á›·˜, ʛ̈Û˘ ‹ „˘¯ÔÏÔÁÈÎÔ‡ ÙÚ·‡Ì·ÙÔ˜ (1). ¶ÔÏϤ˜ ÊÔPaediatriki 2008;71:355-360

∂ÈÎfiÓ· 1. ºˆÙÔÁÚ·Ê›· ·È‰ÈÔ‡ Ì ÛÔ‚·Ú‹ ʛ̈ÛË. ¢ÂÓ ÌÔÚ› Ó· Á›ÓÂÈ ¤ÏÍË Ù˘ ·ÎÚÔÔÛı›·˜ ÚÔ˜ Ù· ›Ûˆ, ÒÛÙ ӷ Á›ÓÂÈ ÔÚ·Ù‹ Ë ‚¿Ï·ÓÔ˜.

Ú¤˜, ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ÌÈ· ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›· Û¯ÂÙ›˙ÂÙ·È Ì ‰ÈfiÁΈÛË ‰›ÎËÓ Ì·ÏÔÓÈÔ‡ (ballooning) ηٿ ÙËÓ Ô‡ÚËÛË. ∆Ô Ê·ÈÓfiÌÂÓÔ ·˘Ùfi Â›Ó·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓÔ Î·È ˘Ô¯ˆÚ› fiÙ·Ó Ë ·ÎÚÔÔÛı›· ÌÔÚ› Ó· ηٷÛ·ÛÙ› Ê˘ÛÈÔÏÔÁÈο. ™Â ·Ô˘Û›· ·ıÔÏÔÁÈ΋˜ ʛ̈Û˘, ÙÔ ballooning ‰ÂÓ Â›Ó·È ÂÓ‰ÂÈÎÙÈÎfi ·fiÊڷ͢ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ (3). ∏ ·Ú·ÁˆÁ‹ ÛÌ‹ÁÌ·ÙÔ˜ ·fi ÙËÓ ÂÛˆÙÂÚÈ΋ ÂÈÊ¿ÓÂÈ· Ù˘ ·ÎÚÔÔÛı›·˜, Ô˘ Û˘Ì‚¿ÏÏÂÈ ÛÙÔÓ ‰È·¯ˆÚÈÛÌfi Ù˘ ·ÎÚÔÔÛı›·˜ ·fi ÙË ‚¿Ï·ÓÔ, Î·È Ë ·Ô‚ÔÏ‹ ·˘ÙÔ‡ ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜ Û˘¯Ó¿ ÂÎÏ·Ì‚¿ÓÔÓÙ·È ÂÛÊ·Ï̤ӷ ˆ˜ Ïԛ̈ÍË. ∏ ¿ıÚÔÈÛË ÙÔ˘ ÛÌ‹ÁÌ·ÙÔ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·Ó¿Ù˘ÍË ÌÈ·˜ ÎÈÙÚÈÓˆ‹˜ ‰ÈfiÁΈÛ˘ ÛÙÔ ‰¤ÚÌ· Ù˘ ·ÎÚÔÔÛı›·˜, Ô˘ ÂÛÊ·Ï̤ӷ ÌÔÚ› Ó· ÂÎÏËÊı› ˆ˜ ÛÌËÁÌ·ÙÔÁfiÓÔ˜ ·ÛÙË ‹ ·ÎfiÌË Î·È ˆ˜ fiÁÎÔ˜. ªÂÙ¿ ÙËÓ ÂÊ˂›·, Ë ·ÎÚÔÔÛı›· Ú¤ÂÈ Ó· ¤ÏÎÂÙ·È Î·È Ó· ηı·Ú›˙ÂÙ·È, ÏfiÁˆ Ù˘ ÔÚÌÔÓÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙËÓ ÂÚÈÔ¯‹.

º›ÌˆÛË ∏ ʛ̈ÛË ÚÔηÏÂ›Ù·È ·fi ¤Ó· ÛÊÈÎÙfi ‰·ÎÙ‡ÏÈÔ ÈÓÒ‰Ô˘˜ ÈÛÙÔ‡ ÛÙËÓ ·ÎÚÔÔÛı›·, Ô˘ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ¤ÏÍË Ù˘ ·ÎÚÔÔÛı›·˜ ÚÔ˜ Ù· ›Ûˆ, ÒÛÙ ӷ Á›ÓÂÈ ÔÚ·Ù‹ Ë ‚¿Ï·ÓÔ˜ (∂ÈÎfiÓ· 1). ªÔÚ› Ó· ÚÔ·„ÂÈ ·fi ÚÔÛ¿ıÂȘ ‚›·È˘ ¤Ï͢ Ù˘ ·ÎÚÔÔÛı›·˜ ÚÔ˜ Ù· ›Ûˆ, Û˘ÓÂ›· Ï·Óı·Ṳ̂Ó˘ Û˘Ì‚Ô˘Ï‹˜, ·fi ˘ÔÙÚÔÈ¿˙Ô˘Û· ‚·Ï·Ó›Ùȉ· ‹ ·fi ·ÙÂÏ‹ ÂÚÈÙÔÌ‹. ∏ ηٿÛÙ·ÛË ·˘Ù‹ Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ ·fi ÙËÓ ÂÚ›ÙˆÛË Ù˘ ·‰˘Ó·Ì›·˜ ·Ó¿Û·Û˘ Ù˘ ·ÎÚÔÔÛı›·˜, Ë ÔÔ›· ·ÔÙÂÏ› Û˘Ó‹ıˆ˜ ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ‡ÚËÌ· Û ÔÏÏ¿ ·ÁfiÚÈ· (Ê˘ÛÈÔÏÔÁÈ΋ ʛ̈ÛË) (5). ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË, Ë ‹È· ÚÔ˜ Ù· ›Ûˆ ¤ÏÍË Ù˘ ·ÎÚÔÔÛı›·˜ Ô‰ËÁ› Û ·ÔÎ¿Ï˘„Ë Ù˘ ÎÔÚ˘Ê‹˜ Ù˘ ‚·Ï¿ÓÔ˘, fï˜ ÔÈ Û˘ÌʇÛÂȘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÍË. √È ‰‡Ô ηٷÛÙ¿ÛÂȘ ÔÏϤ˜

Pediatri Sept-Oct 08

14-10-08

13:26

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357

∏ ʛ̈ÛË Î·È Ë ÂÚÈÙÔÌ‹ ÛÙ· ·È‰È¿

¶›Ó·Î·˜ 1. ∞fiÏ˘Ù˜ ÂӉ›ÍÂȘ ÂÚÈÙÔÌ‹˜ ñ ¶·ıÔÏÔÁÈ΋ ʛ̈ÛË: ∏ ÌfiÓË ·fiÏ˘ÙË ¤Ó‰ÂÈÍË ÁÈ· ÂÚÈÙÔÌ‹ ıˆÚÂ›Ù·È Ë ‰ËÌÈÔ˘ÚÁ›· Ô˘ÏÒ‰Ô˘˜ ‰·ÎÙ˘Ï›Ô˘ ÛÙÔ ¿ÓÔÈÁÌ· Ù˘ ·ÎÚÔÔÛı›·˜, ηıÈÛÙÒÓÙ·˜ ÙË ÌË Î·Ù·ÛÒÌÂÓË. ¢ÂÓ Â›Ó·È Û˘ÓËıÈṲ̂ÓÔ ·›ÙÈÔ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ. ñ ÀÔÙÚÔÈ¿˙Ô˘Û· ‚·Ï·Ó›Ùȉ·/‚·Ï·ÓÔÔÛı›Ùȉ·. ñ ™·ÓÈfiÙÂÚ˜ ηٷÛÙ¿ÛÂȘ. ∂ÈÎfiÓ· 2. ∏ Ù¯ÓÈ΋ Ù˘ Ï·ÛÙÈ΋˜ Ù˘ ·ÎÚÔÔÛı›·˜.

ÊÔÚ¤˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ‰È·ÎÚÈıÔ‡Ó Î·È Ë Ê›ÌˆÛË ÌÔÚ› Ó· ‰È·ÁÓˆÛÙ› ÌfiÓÔ ·Ó·‰ÚÔÌÈο, ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ Î·ıfiÏÔ˘ ‚ÂÏÙ›ˆÛË ÛÙË ‰˘Ó·ÙfiÙËÙ· ¤Ï͢ Ù˘ fiÛı˘. ∏ ʛ̈ÛË ÂÌÔ‰›˙ÂÈ ÙËÓ ·ÚÔ¯¤Ù¢ÛË ÙÔ˘ ¯ÒÚÔ˘ ÌÂٷ͇ Ù˘ ·ÎÚÔÔÛı›·˜ Î·È Ù˘ ‚·Ï¿ÓÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙË Û˘ÛÛÒÚ¢ÛË Ô‡ÚˆÓ Î·È ÛÌ‹ÁÌ·ÙÔ˜. ∂·ÎfiÏÔ˘ıÔ Â›Ó·È ÌÈ· ‹È· ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹, Ô˘ ÂȉÂÈÓÒÓÂÈ ÙË Ê›ÌˆÛË. ∏ ‰ÈfiÁΈÛË ‰›ÎËÓ Ì·ÏÔÓÈÔ‡ Ù˘ ·ÎÚÔÔÛı›·˜ ηٿ ÙËÓ Ô‡ÚËÛË ·ÔÙÂÏ› ÛËÌÂ›Ô ·fiÊڷ͢ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ÛÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹. ™˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Â›Ó·È Ë ÌË Î·Ù·ÛÒÌÂÓË ·ÎÚÔÔÛı›·, Ô ÂÚÂıÈÛÌfi˜ ‹ Ë ·ÈÌÔÚÚ·Á›· ·fi ÙÔ ¿ÓÔÈÁÌ· Ù˘ ·ÎÚÔÔÛı›·˜, Ë ¯ÚfiÓÈ· Â›Û¯ÂÛË Ô‡ÚˆÓ, Ô˘ ÌÔÚ› Ó· ÂÈϷΛ Ì ‰Â˘ÙÂÚÔ·ı‹ ÂÓÔ‡ÚËÛË, ‹ ·ÔÊÚ·ÎÙÈο Ê·ÈÓfiÌÂÓ· ÛÙÔ ·ÓÒÙÂÚÔ Ô˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· (2). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë Â›ÙˆÛË Ù˘ ·ıÔÏÔÁÈ΋˜ ʛ̈Û˘ ÛÙ· ·ÁfiÚÈ· Â›Ó·È 0,4 ÂÚÈÙÒÛÂȘ/1000 ·ÁfiÚÈ· ÙÔÓ ¯ÚfiÓÔ ‹ fiÙÈ 0,6% ÙˆÓ ·ÁÔÚÈÒÓ ÚÔÛ‚¿ÏÏÔÓÙ·È Ì¤¯ÚÈ ÙÔ 15Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ ÙÔ˘˜. ∆Ô ÔÛÔÛÙfi, fï˜, ÙˆÓ ·ÁÔÚÈÒÓ Ô˘ ˘Ê›ÛÙ·Ù·È ÂÚÈÙÔÌ‹ ÛÙËÓ ∞ÁÁÏ›· Â›Ó·È 8 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÁÔÚÈÒÓ Ì ·ıÔÏÔÁÈ΋ ʛ̈ÛË (6).

£ÂÚ·›· Ù˘ ʛ̈Û˘ ∏ ʛ̈ÛË Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ıÂÚ·¢ÙÈο fiÙ·Ó Û˘Óԉ‡ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ·fiÊڷ͢ Ù˘ Ô˘ÚÔÊfiÚÔ˘ Ô‰Ô‡ ‹ Ïԛ̈ÍË. ∞Ó ¤Ó· ·È‰› ·ÊÂı› Ì ʛ̈ÛË, ı· ÂÌÊ·Ó›˙ÂÈ ¿ÏÁÔ˜ ηٿ ÙËÓ ÂÚˆÙÈ΋ Â·Ê‹ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ÏfiÁˆ ‚Ï¿‚˘ Ù˘ ·ÎÚÔÔÛı›·˜. ∫¿Ùˆ ·fi ÙËÓ ·ÎÚÔÔÛı›· ı· ÂÌÊ·ÓÈÛÙ› ‹È· ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ‹ ηÈ, ·Ó ·˘Ù‹ Ë ÊÏÂÁÌÔÓ‹ ÂÈÌ›ÓÂÈ ÁÈ· ‰ÂηÂٛ˜, Â›Ó·È ‰˘Ó·Ùfi Ó· Ô‰ËÁ‹ÛÂÈ Û ηÚΛӈ̷ Ï·ÎÒ‰Ô˘˜ ÂÈıËÏ›Ô˘ Ù˘ ‚·Ï¿ÓÔ˘ ·ÚÁfiÙÂÚ· ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∞fi ÙË ÛÙÈÁÌ‹ Ô˘ ı· Á›ÓÂÈ Ë ‰È¿ÁÓˆÛË Ù˘ ʛ̈Û˘, ÔÈ ıÂÚ·›˜ Ô˘ Â›Ó·È ‰È·ı¤ÛÈ̘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔÈο ÛÙÂÚÔÂȉ‹, Û˘ÌÊ˘ÛÈfiÏ˘ÛË, Ï·ÛÙÈ΋ Ù˘ ·ÎÚÔÔÛı›·˜ Î·È ÂÚÈÙÔÌ‹. √È ÂӉ›ÍÂȘ ÁÈ· ÙȘ ÂÓ·ÏÏ·ÎÙÈΤ˜ Ù˘ ÂÚÈÙÔÌ‹˜ ıÂÚ·›˜ Ù˘ ʛ̈Û˘ Â›Ó·È Ë ˘ÔÙÚÔÈ¿˙Ô˘Û· ‚·Ï·ÓÔÔÛı›Ùȉ·, ÔÈ Ô˘Ï¤˜ ÙÔ˘ ¯Â›ÏÔ˘˜ Ù˘ ·ÎÚÔÔÛı›·˜ (·fi ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· ‰È¿ÓÔÈ͢) Î·È Ù· ÙÔÈο

ÂÓԯϋ̷ٷ ·fi Û˘ÁΤÓÙÚˆÛË Î˘ÙÙ¿ÚˆÓ Ô˘ ·Ô›ÙÔ˘Ó. √È ÂÓ·ÏÏ·ÎÙÈΤ˜ ıÂÚ·›˜ ı· Ú¤ÂÈ Ó· ÚÔËÁÔ‡ÓÙ·È Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â¤Ì‚·Û˘ ÌfiÓÔ fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ ·fiÏ˘ÙË ¤Ó‰ÂÈÍË ¿ÌÂÛ˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ú¤Ì‚·Û˘ Î·È ‰ÂÓ ·ÔÙÂÏÔ‡Ó Î·ıÈÂڈ̤Ó˜ Ù·ÎÙÈΤ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ʛ̈Û˘. ∏ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ʛ̈Û˘ Ì ÙÔÈο ÛÙÂÚÔÂȉ‹ ˘ÔÛÙËÚ›˙ÂÙ·È ·fi ·ÚÎÂÙ¤˜ ÌÂϤÙ˜, Ì ÔÛÔÛÙfi ·ÔηٿÛÙ·Û˘ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (3). °›ÓÂÙ·È ÙÔÈ΋ ÂÊ·ÚÌÔÁ‹ ÛÙÂÚÔÂȉԇ˜ Îڤ̷˜ (0,05% betamethasone) ‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤ڷ, ÁÈ· Ì›·, ‰‡Ô ‹ Ù¤ÛÛÂÚȘ ‚‰ÔÌ¿‰Â˜, Ë ÔÔ›· Â›Ó·È ÌÈ· ·ÛÊ·Ï‹˜, ·Ï‹ Î·È ÊıËÓ‹ χÛË. °›ÓÂÙ·È ··Ï‹ ¤ÏÍË Ù˘ ·ÎÚÔÔÛı›·˜, ¯ˆÚ›˜ Ó· ÚÔÎÏËı› fiÓÔ˜, Î·È ÂÊ·ÚÌÔÁ‹ ÂÓfi˜ ÈηÓÔ‡ ¿¯Ô˘˜ ÛÙÚÒÌ·ÙÔ˜ Îڤ̷˜ ÛÙÔ ÈÔ ÛÙÂÓfi ̤ÚÔ˜ Ù˘ ·ÎÚÔÔÛı›·˜. ∞Ó ÌÂÙ¿ ·fi 3 Ì‹Ó˜ ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· Á›ÓÂÈ ¤ÏÍË Ù˘ ·ÎÚÔÔÛı›·˜, Ë ıÂÚ·›· ÛÙ·Ì·Ù¿ÂÈ. ™Â ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯Ô˘Ó ·Û‡ÌÌÂÙÚ˜ ‹ ÂÌÊ·Ó›˜ Û˘ÌʇÛÂȘ ÌÂٷ͇ Ù˘ ·ÎÚÔÔÛı›·˜ Î·È Ù˘ ‚·Ï¿ÓÔ˘, ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› Ë Û˘ÌÊ˘ÛÈfiÏ˘ÛË, ÌÈ· ·Ï‹ Â¤Ì‚·ÛË Ô˘ ÌÔÚ› Ó· Á›ÓÂÈ ˘fi ÙÔÈ΋ ·Ó·ÈÛıËÛ›· (7). ŸÌˆ˜, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ÚÔÛ¿ıÂÈ· ‰È¿ÓÔÈ͢ Ù˘ ·ÎÚÔÔÛı›·˜ Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ¤ÌÂÈÚÔ ¯ÂÈÚÔ˘ÚÁfi, ÁÈ· Ó· ·ÔʇÁÔ˘Ì ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ ÛÙÔ ¯Â›ÏÔ˜ Ù˘ ·ÎÚÔÔÛı›·˜, ÔÈ ÔÔ›ÔÈ ÌÔÚÔ‡Ó Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ô˘Ï‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ʛ̈ÛË. ªÈ· ¿ÏÏË ÂÓ·ÏÏ·ÎÙÈ΋ ̤ıÔ‰Ô˜ ıÂÚ·›·˜ Ù˘ ʛ̈Û˘, Ë Ï·ÛÙÈ΋ Ù˘ ·ÎÚÔÔÛı›·˜, ·ÔÙÂÏ› ÈÔ Â‡ÎÔÏË, ÁÚ‹ÁÔÚË Î·È ·ÛÊ·Ï‹ Â¤Ì‚·ÛË ·fi ÙËÓ ÂÚÈÙÔÌ‹ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÈÌ‹ÎË ÙÔÌ‹ ÙÔ˘ ÊÈ̈ÙÈÎÔ‡ ‰·ÎÙ˘Ï›Ô˘ Ì ÂÁοÚÛÈ· Û˘ÚÚ·Ê‹, ¯ˆÚ›˜ ·Ê·›ÚÂÛË ÈÛÙÔ‡ (∂ÈÎfiÓ· 2) (8). Œ¯Ô˘Ó ÚÔÙ·ı› ·ÚÎÂÙ¤˜ ÂÓ·ÏÏ·ÎÙÈΤ˜ ÂÂÌ‚¿ÛÂȘ, Ì ÏÈÁfiÙÂÚ˜ ÂÈÏÔΤ˜, Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÛÙË ‰È‡ڢÓÛË Ù˘ ·ÎÚÔÔÛı›·˜, ÒÛÙ ӷ ηٷÛ¿Ù·È ÈÔ Â‡ÎÔÏ· Î·È Ó· ¤¯ÂÈ Î·Ï‡ÙÂÚË ˘ÁÈÂÈÓ‹, ÂÓÒ ·Ú¿ÏÏËÏ· ‰È·ÙËÚÂ›Ù·È Ë Ê˘ÛÈÔÏÔÁÈ΋ ·ÈÛıËÙÈ΋ ÂÌÊ¿ÓÈÛË ÙÔ˘ ¤Ô˘˜. ªÂ ÙËÓ Ï·ÛÙÈ΋ Ù˘ ·ÎÚÔÔÛı›·˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ï‡ÙÂÚÔ ÏÂÈÙÔ˘ÚÁÈÎfi Î·È ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Î·È Ôχ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ÌÂÙÂÁ¯ÂÈÚËÙÈÎÒÓ ÂÈÏÔÎÒÓ, Û ۯ¤ÛË Ì ÙËÓ ÂÚÈÙÔÌ‹. ¶·È‰È·ÙÚÈ΋ 2008;71:355-360

Pediatri Sept-Oct 08

22-10-08

12:14

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358

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¶›Ó·Î·˜ 2. ¶ÏÂÔÓÂÎÙ‹Ì·Ù· Î·È ÌÂÈÔÓÂÎÙ‹Ì·Ù· Ù˘ ÂÚÈÙÔÌ‹˜ À¤Ú

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∫ÔÈÓˆÓÈÎÔ›/„˘¯ÔÏÔÁÈÎÔ› ÏfiÁÔÈ

∫ÔÈÓˆÓÈÎfi ÚfiÙ˘Ô ¶ÔÏÈÙÈÛÌÈÎÔ›/ıÚËÛ΢ÙÈÎÔ› ÏfiÁÔÈ

æ˘¯ÔÏÔÁÈÎfi ÙÚ·‡Ì· ™ÂÍÔ˘·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·

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∂Ï·Ùو̤ÓÔ˜ ΛӉ˘ÓÔ˜ ηÚΛÓÔ˘ ÙÔ˘ ¤Ô˘˜ ∂Ï·Ùو̤ÓÔ˜ ΛӉ˘ÓÔ˜ ηÚΛÓÔ˘ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Ù˘ Ì‹ÙÚ·˜ ∂Ï·Ùو̤ÓÔ˜ ΛӉ˘ÓÔ˜ Ô˘ÚÔÏԛ̈͢ ∂Ï·Ùو̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÌÂÙ¿‰ÔÛ˘ ÙˆÓ ÛÂÍÔ˘·ÏÈο ÌÂÙ·‰È‰fiÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ ∫·Ï‡ÙÂÚË ˘ÁÈÂÈÓ‹

∂ÈÏÔΤ˜: ∞ÈÌÔÚÚ·Á›· §Ô›ÌˆÍË ∆Ú·˘Ì·ÙÈÛÌfi˜ Ù˘ ‚·Ï¿ÓÔ˘ ¶ÂÚ›ÛÛÂÈ· ·ÎÚÔÔÛı›·˜ ™˘ÌʇÛÂȘ Ù˘ ‚·Ï¿ÓÔ˘

∂ÊfiÛÔÓ ·ÔÙ‡¯Ô˘Ó ÔÈ ÚÔËÁÔ‡ÌÂÓ˜ ̤ıÔ‰ÔÈ, ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Ë ÂÚÈÙÔÌ‹, Ë ÔÔ›·, fiˆ˜ οı Â¤Ì‚·ÛË, ıˆÚÂ›Ù·È ÙÚ·˘Ì·ÙÈ΋ ÁÈ· ÙÔ ·È‰›, ÂÓÒ Â›Ó·È ÌË ·Ó·ÛÙÚ¤„ÈÌË Î·È ı· Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÙÂÏÂ˘Ù·›· χÛË. √È ÂӉ›ÍÂȘ ÁÈ· ÂÚÈÙÔÌ‹, Û‡Ìʈӷ Ì ÙÔ The Royal College of Surgeons of England (9), Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∏ ÍËÚˆÙÈ΋ ·ÔÊÚ·ÎÙÈ΋ ‚·Ï·Ó›Ùȉ· ‰ÂÓ ıˆÚÂ›Ù·È ϤÔÓ ÌÔÚÊ‹ ʛ̈Û˘ Ô˘ ··ÈÙ› ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· (7). ªÂ ÙȘ ÓÂfiÙÂÚ˜ ıÂÚ·›˜ Ô˘ ÚԷӷʤÚıËηÓ, ÙÔ ÔÛÔÛÙfi Ù˘ ÂÚÈÙÔÌ‹˜ ÌÂÈÒÓÂÙ·È ·Ó·ÁηÛÙÈο (10).

™˘˙‹ÙËÛË Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ÔÏϤ˜ ÊÔÚ¤˜ Ë ÂÚÈÙÔÌ‹ Á›ÓÂÙ·È ¿ÛÎÔ·. ∏ ÂÚÈÙÔÌ‹ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔÓ fiÙ·Ó ˘¿Ú¯Ô˘Ó ·fiÏ˘Ù· Û·Ê‹ ÎÏÈÓÈο ‰Â‰Ô̤ӷ, ÂÂȉ‹ ÔÏϤ˜ ÊÔÚ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÔ‚·Ú¤˜ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ÂÈÏÔΤ˜, fiˆ˜ Û˘ÌʇÛÂȘ Ù˘ ‚·Ï¿ÓÔ˘, ÛÙ¤ÓˆÛË Ù˘ Ô˘Ú‹ıÚ·˜, Ô˘ÚËıÚÈÎfi Û˘Ú›ÁÁÈÔ, ·ÈÌÔÚÚ·Á›· ‹ Ïԛ̈ÍË, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ¯ÚÂÈ·ÛÙÔ‡Ó ¯ÂÈÚÔ˘ÚÁÈ΋ ıÂÚ·›· (11). ∆Ô ÔÛÔÛÙfi ÙˆÓ ÂÈÏÔÎÒÓ ÔÈΛÏÏÂÈ ·fi 0,06% ¤ˆ˜ 55% (12) Î·È ÔÏÏÔ› ÂÈÛÙ‹ÌÔÓ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ·‰ÈηÈÔÏfiÁËÙ˜ ÂÚÈÙÔ̤˜ ·ÔÙÂÏÔ‡Ó ÌÈ· ÌÔÚÊ‹ ηÎÔÔ›ËÛ˘ ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ÙÔ˘ ·Ê‹ÛÂÈ „˘¯ÔÏÔÁÈο ÙÚ·‡Ì·Ù·. ™‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ ÙÔ˘ 1999 (13), Ô˘ Â·Ó·‰È·Ù˘ÒıËÎ·Ó ÙÔ 2005 (14), Ë ÂÚÈÙÔÌ‹, ÂȉÈο fiÙ·Ó ÂÎÙÂÏÂ›Ù·È ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜, ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, ȉȷ›ÙÂÚ· Û ÓÂÔÁÓ¿ Ì ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ ‹ Ì ÁÓˆÛÙ‹ ·ÓˆÌ·Ï›· ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡, fiˆ˜ Ë Î˘ÛÙÂÔÔ˘ÚËÙËÚÈ΋ ·ÏÈÓ‰ÚfiÌËÛË (3), ¯ˆÚ›˜ fï˜ Ó· ÌÂÈÒÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘, ηıÒ˜ Î·È Ô ÌÂÏÏÔÓÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Î·ÚΛÓÔ˘ ÙÔ˘ ¤Ô˘˜ ‹ ÛÂÍÔ˘·ÏÈÎÒ˜ ÌÂÙ·‰È‰fiÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ŸÌˆ˜, Ù· ‰Â‰Ô̤ӷ ·˘Ù¿ ‰ÂÓ Â›Ó·È Â·Ú΋ ÁÈ· Ó· ηıÈÂÚÒÛÔ˘Ó ÙË ÓÂÔÁÓÈ΋ ÂÚÈÙÔÌ‹ ˆ˜ Â¤Ì‚·ÛË ÚÔ˘Ù›Ó·˜ Paediatriki 2008;71:355-360

(13,14,15). ∞ÓÙÈÎÚÔ˘fiÌÂÓ˜ ¿ÓÙˆ˜ Â›Ó·È Î·È ÔÈ ·fi„ÂȘ ÁÈ· ÙÔ ·Ó Ë Â¤Ì‚·ÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û fiÏ· Ù· ÓÂÔÁ¤ÓÓËÙ·. √È ÁÔÓ›˜ fiÏˆÓ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ ·ÁÔÚÈÒÓ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔ˘Ó ·ÎÚÈ‚‹ Î·È ·ÌÂÚfiÏËÙË ÂÓË̤ڈÛË, ηıÒ˜ Î·È Ó· ¤¯Ô˘Ó ÙËÓ Â˘Î·ÈÚ›· Ó· Û˘˙ËÙ‹ÛÔ˘Ó ÙËÓ ·fiÊ·Û‹ ÙÔ˘˜. ™ÙËÓ ∞ÁÁÏ›·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÙÔÌÒÓ ÌÂÈÒıËΠ·fi 35%, ÛÙȘ ·Ú¯¤˜ ÙÔ˘ 1930, ÛÙÔ 6,5% ÛÙ· ̤۷ ÙÔ˘ 1980. ¶·Ú’ fiÏ· ·˘Ù¿, fï˜, ıˆÚÂ›Ù·È fiÙÈ Ù· 2/3 ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ‹Ù·Ó ¿ÛÎÔ˜, ÂÊfiÛÔÓ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÔ̤˜ ¤ÁÈÓ·Ó Û ËÏÈΛ· οو ÙˆÓ 5 ÂÙÒÓ, fiÔ˘ Ë ·ıÔÏÔÁÈ΋ ʛ̈ÛË ıˆÚÂ›Ù·È Û¿ÓÈ· (16). °ÂÓÈÎfiÙÂÚ·, ˘¿Ú¯ÂÈ ÌÈ· Û‡Á¯˘ÛË fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ fiÚÔ Ê›ÌˆÛË Î·È ÔÏÏ¿ ·È‰È¿ ıˆÚÂ›Ù·È fiÙÈ ¤¯Ô˘Ó ·ıÔÏÔÁÈ΋ ʛ̈ÛË Î·È Ô‰ËÁÔ‡ÓÙ·È ¿ÛÎÔ· ÛÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô. ™¯ÂÙÈ΋ ÌÂϤÙË ‰Â›¯ÓÂÈ fiÙÈ ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ ¿Ô„Ë, ÌÂٷ͇ ·È‰È¿ÙÚˆÓ Î·È ¯ÂÈÚÔ˘ÚÁÒÓ, fiÛÔÓ ·ÊÔÚ¿ ÙȘ ÂӉ›ÍÂȘ ÁÈ· ÂÚÈÙÔÌ‹. √È ¯ÂÈÚÔ˘ÚÁÔ› ÚfiÙÂÈÓ·Ó ÂÚÈÛÛfiÙÂÚÔ ÙËÓ ÂÚÈÙÔÌ‹ ˆ˜ χÛË, Èı·Ófiٷٷ Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙÔÓ ·˘ÍË̤ÓÔ ·ÚÈıÌfi ¿ÛÎÔˆÓ ÂÚÈÙÔÌÒÓ (17). ™ÙË ™Î·Ó‰ÈÓ·‚›·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÚÈÙÔÌÒÓ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi 2% (16). ∏ ÂÚÈÙÔÌ‹, fï˜, ·Ú·Ì¤ÓÂÈ ·ÚÎÂÙ¿ ‰ËÌÔÊÈÏ‹˜ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ ∞ÌÂÚÈ΋˜, Ì ÔÛÔÛÙfi 60% (ÙÒÛË ·fi ÙÔ 80% ÙÔ 1970), ÂÓÒ ÙÔ 80% ÙˆÓ ∞ÌÂÚÈηÓÒÓ ·Ó‰ÚÒÓ ¤¯ÂÈ ˘ÔÛÙ› ÂÚÈÙÔÌ‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÁÂÁÔÓfi˜ Ô˘ ÂËÚ¿˙ÂÈ Î·Ù¿ ÚÔÛ¤ÁÁÈÛË 100 ÂηÙÔÌ̇ÚÈ· ÂÓ‹ÏÈΘ, Û ÔÈΛÏÔ ‚·ıÌfi (18). ∏ Â›‰Ú·ÛË Ù˘ ÂÚÈÙÔÌ‹˜ ÛÙËÓ ÂÚˆÙÈ΋ ¢¯·Ú›ÛÙËÛË Î·È ÙÔ˘ ¿ÓÙÚ· Î·È Ù˘ Á˘Ó·›Î·˜ ‰ÂÓ ¤¯ÂÈ Â·ÚÎÒ˜ ÌÂÏÂÙËı›. ªÂϤÙË ‚·ÛÈṲ̂ÓË Û ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Û ¿ÓÙÚ˜ ÌÂ Î·È ¯ˆÚ›˜ ÂÚÈÙÔÌ‹ ‰Â›¯ÓÂÈ fiÙÈ ˘¿Ú¯ÂÈ Ì›ˆÛË Ù˘ ¢¯·Ú›ÛÙËÛ˘ ·fi ÙÔÓ ·˘Ó·ÓÈÛÌfi Î·È ·fi ÙË ÛÂÍÔ˘·ÏÈ΋ Â·Ê‹, Èı·ÓÒ˜ ÏfiÁˆ ÂÈÏÔÎÒÓ ÙÔ˘ ¯ÂÈÚÔ˘ÚÁ›Ԣ Î·È ·ÒÏÂÈ·˜ ÙˆÓ Ó¢ÚÈÎÒÓ ·ÔÏ‹ÍÂˆÓ (19), ÂÓÒ Û ¿ÏϘ ÌÂϤÙ˜ Ù· ·ÔÙÂϤÛÌ·Ù· Â›Ó·È ÔÈΛϷ (20,21,22,23), ÁÂÁÔÓfi˜ Ô˘ ÙÔÓ›˙ÂÈ ÙË ÛËÌ·Û›· Ù˘ ÛˆÛÙ‹˜ ÂÓË̤ڈÛ˘ ÁÈ· Ù· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ÚÈÓ ·fi ÙËÓ Â¤Ì‚·ÛË. ™Â ¿ÏÏË ÌÂϤÙË Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Û Á˘Ó·›Î˜ ÔÈ

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∂ÈÎfiÓ· 3. ∞ÏÁfiÚÈıÌÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ʛ̈Û˘.

Ôԛ˜ ›¯·Ó ÂÌÂÈڛ˜ ÌÂ Û˘ÓÙÚfiÊÔ˘˜ Ô˘ ›¯·Ó ˘ÔÛÙ› ÂÚÈÙÔÌ‹ Î·È ÌÂ Û˘ÓÙÚfiÊÔ˘˜ ¯ˆÚ›˜ ÂÚÈÙÔÌ‹, Ê·›ÓÂÙ·È fiÙÈ ÔÈ Á˘Ó·›Î˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÚˆÙÈ΋ Û˘Ó‡ÚÂÛ‹ ÙÔ˘˜, ›¯·Ó ÚÔÙ›ÌËÛË ÛÙÔ ÌË ÂÚÈÙÂÙÌË̤ÓÔ ¤Ô˜, Û ۇÁÎÚÈÛË Ì ÙÔ ÂÚÈÙÂÙÌË̤ÓÔ (24). ∂ÎÙfi˜, fï˜, ·fi ÙȘ Ì·ÎÚÔÚfiıÂÛ̘ Û˘Ó¤ÂȘ ÛÙËÓ ÂÚˆÙÈ΋ ‰È¤ÁÂÚÛË, ¤¯Ô˘Ó ·Ó·ÊÂÚı› „˘¯ÔÏÔÁÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ÂÈÙÒÛÂȘ. ∏ ·ÒÏÂÈ· ÂÓfi˜ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÓıÚÒÈÓÔ˘ ÛÒÌ·ÙÔ˜ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ¿Á¯Ô˜, ηٿıÏÈ„Ë, ·ÏÏ·Á‹ ÛÙÔÓ ÙÚfiÔ ·ÓÙ›Ï˄˘ ÙÔ˘ ÛÒÌ·ÙÔ˜, ·›ÛıËÌ· ·ÎÚˆÙËÚÈ·ÛÌÔ‡, ·ÎfiÌË Î·È ÔÚÁ‹ ‹ ·ÈÛı‹Ì·Ù· ·˘ÙÔÎÙÔÓ›·˜ (18). ™ÙÔÓ ¶›Ó·Î· 2, Û˘ÓÔ„›˙ÔÓÙ·È Ù· ˘¤Ú Î·È Ù· ηٿ Ù˘ ÂÚÈÙÔÌ‹˜ ·fi È·ÙÚÈ΋˜ Î·È ÎÔÈÓˆÓÈÎÔ„˘¯ÔÏÔÁÈ΋˜ ÏÂ˘Ú¿˜. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔηٿÛÙ·ÛË Ù˘ ·ÎÚÔÔÛı›·˜ ÌÂÙ¿ ÙËÓ ÂÚÈÙÔÌ‹, ¤¯Ô˘Ó Á›ÓÂÈ ·ÚÎÂÙ¤˜ ÚÔ-

Û¿ıÂȘ ·fi ÙËÓ ·Ú¯·ÈfiÙËÙ· (2). √È ¯ÂÈÚÔ˘ÚÁÈΤ˜ ·˘Ù¤˜ ÂÂÌ‚¿ÛÂȘ ‰ÂÓ ¤¯Ô˘Ó ηıÈÂÚˆı›, ˘¿Ú¯Ô˘Ó Ï›Á˜ ÌÂϤÙ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È ‰ÂÓ ˘¿Ú¯ÂÈ Â·Ú΋˜ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ٤ÙÔÈÔ˘ ›‰Ô˘˜ ıÂÚ·›˜. ™˘ÓÔ„›˙ÔÓÙ·˜, Û‡Ìʈӷ Ì ÙÔ˘˜ Bréaud et al (25), ·Í›˙ÂÈ Ó· ı˘Ì¿Ù·È ηÓ›˜ ÙÔÓ ·Ú·¿Óˆ ·ÏÁfiÚÈıÌÔ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ʛ̈Û˘ (∂ÈÎfiÓ· 3).

∂›ÏÔÁÔ˜ °ÂÓÈο, Ù· ·È‰È¿ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ Ì ·ÎÚÔÔÛı›· Ô˘ ‰ÂÓ ÙÚ·‚È¤Ù·È ÚÔ˜ Ù· ›Ûˆ Î·È ¯ˆÚ›˜ ÎÏÈÓÈο Û˘ÌÙÒÌ·Ù· ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È Î·Ì›· ıÂÚ·›· Î·È ı· Ú¤ÂÈ ÌfiÓÔ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î¿ı ¤ÙÔ˜. ∏ Û·ÓÈfiÙËÙ· Ù˘ ʛ̈Û˘ ÚÈÓ ·fi ·˘Ù‹ ÙËÓ ËÏÈΛ· Ú¤ÂÈ Ó· ÂÈÛËÌ·Óı›, ·ÊÔ‡ ¶·È‰È·ÙÚÈ΋ 2008;71:355-360

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°. ™·ÎÂÏÏ¿Ú˘ Î·È Û˘Ó.

ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ¿ÛÎÔ˜ ÂÚÈÙÔ̤˜ ÂÎÙÂÏÔ‡ÓÙ·È Û ·˘Ù‹ ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰·. √È ÁÔÓ›˜ Ú¤ÂÈ Ó· ηıËÛ˘¯·ÛÙÔ‡Ó fiÙÈ Ë Î·Ù¿ÛÙ·ÛË ·˘Ù‹ ۯ‰fiÓ ¿ÓÙÔÙ ÂÚÓ¿ Ì ÙÔ ¯ÚfiÓÔ. ∂›Û˘, ‰ÂÓ ı· Ú¤ÂÈ Û η̛· ÂÚ›ÙˆÛË Ó· ÚÔÛ·ı‹ÛÔ˘Ó Ó· ¤ÏÍÔ˘Ó ‚›·È· ÚÔ˜ Ù· ›Ûˆ ÙËÓ ·ÎÚÔÔÛı›· ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. ∏ ηχÙÂÚË ÁÓÒÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ·ÎÚÔÔÛı›·˜ ·fi ÙÔÓ ÁÂÓÈÎfi È·ÙÚfi Î·È ÙÔÓ ·È‰›·ÙÚÔ ı· ÌÔÚÔ‡Û ӷ Ô‰ËÁ‹ÛÂÈ Û Ì›ˆÛË ÙˆÓ ·Ú·ÔÌÒÓ Ù¤ÙÔÈˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· Ù˘ ·È‰Ô¯ÂÈÚÔ˘ÚÁÈ΋˜. ∏ ∞ÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ·Ó·ÁÓˆÚ›˙ÂÈ fiÙÈ Ë ÂÚÈÙÔÌ‹ Û ÓÂÔÁ¤ÓÓËÙ· ¤¯ÂÈ ÎÈÓ‰‡ÓÔ˘˜ ·ÏÏ¿ Î·È ÔʤÏË Î·È fiÙÈ Ë ·fiÊ·ÛË ÁÈ· ÙËÓ ÂÎÙ¤ÏÂÛ‹ Ù˘ Ú¤ÂÈ Ó· Â›Ó·È ı¤Ì· ÂÈÏÔÁ‹˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ÙÔ˘ ÁÈ·ÙÚÔ‡ Ù˘. ∏ ÂÚÈÙÔÌ‹, ÏÔÈfiÓ, ‰ÂÓ ı· Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ۈÛÙfi ÙÚfiÔ, ÒÛÙ ӷ ·ÔʇÁÔ˘Ì ÙȘ ÂÈÏÔΤ˜ Ù˘ Â¤Ì‚·Û˘.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 (Suppl 1): 34-44.

2. Brandes SB, McAninch JW. Surgical methods of restoring the prepuce: a critical review. BJU Int 1999;83 (Suppl 1): 109-113.

3. Rickwood AM. Medical indications for circumcision. BJU Int 1999;83 (Suppl 1):45-51.

4. Hsieh TF, Chang CH, Chang SS. Foreskin development before adolescence in 2149 schoolboys. Int J Urol 2006;13: 968-970.

5. Dewan PA. Treating phimosis. Med J Aust 2003;178:148-150.

6. Shankar KR, Rickwood AM. The incidence of phimosis in boys. BJU Int 1999;84:101-102.

7. Huntley JS, Bourne MC, Munro FD, Wilson-Storey D. Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons. J R Soc Med 2003;96:449-451.

8. Cuckow PM, Rix G, Mouriquand PD. Preputial plasty: a good alternative to circumcision. J Pediatr Surg 1994;29: 561-563.

9. The Royal College of Surgeons of England. Statement on Male Circumcision, 6 March 2001. Webpage: http://www.rcseng.ac. uk/media/medianews/index.html#2001.

Paediatriki 2008;71:355-360

10. Quaba O, MacKinlay GA. Changing trends in a decade of circumcision in Scotland. J Pediatr Surg 2004;39:1037-1039.

11. Ceylan K, Burhan K, Yilmaz Y, Can S, Kus A, Mustafa G. Severe complications of circumcision: an analysis of 48 cases. J Ped Urol 2007;3: 32-35.

12. Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. B J Surg 2006;93:885-890.

13. American Academy of Pediatrics, Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103: 686-693.

14. American Academy of Pediatrics. AAP publications retired and reaffirmed. Pediatrics 2005;116:796.

15. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomized trials and observational studies. Arch Dis Child 2005;90:853-858.

16. Rickwood AM, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice. BMJ 2000;321:792-793.

17. Farshi Z, Atkinson KR, Squire R. A study of clinical opinion and practice regarding circumcision. Arch Dis Child 2000; 83:393-396.

18. Hammond T. A preliminary poll of men circumcised in infancy or childhood. BJU Int 1999;83 (Suppl 1):85-92.

19. DaiSik K, Myung-Geol P. The effect of male circumcision on sexuality. BJU Int 2007;99:619-622.

20. Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff MK. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? Urol Int 2005; 75:62-66.

21. Aydur E, Gungor S, Ceylan ST, Taiimaz L, Baser I. Effects of childhood circumcision age on adult male sexual functions.

Int J Impot Res 2007;19:424-431.

22. Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol 2002;167:2113-2116.

23. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P. Effects of circumcision on male sexual function: debunking a myth. J Urol 2002;167:2111-2112.

24. O’Hara K, O’Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999;83 (Suppl 1):79-84.

25. Bréaud J, Guys JM. Phimosis: medical treatment or circumcision? Arch Pediatr 2005;12:1424-1432.

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ORIGINAL ARTICLE

361

ÀÈÔı¤ÙËÛË Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜ ·fi ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÛÙËÓ ∂ÏÏ¿‰· ¡. µ›‰Ú·1, ∞-∂. º·ÚÌ¿ÎË1, ™. ∫Ô˚Ó¿ÎË1, ∫. ªÂÏÔÁÈ¿ÓÓË1, ™. ™ˆÊÚÔÓ¿2, º. ª·ÁηӿÚË2, ª. ∫ÔÓÙÔÁÈ¿ÓÓË1, ª. °È·ÓÓ·ÎÔ‡ÏÈ·1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙÔÓ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜ ·fi Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÛÙËÓ ∂ÏÏ¿‰·, Ì ¯Ú‹ÛË ÙÔ˘ ÔÈÔÙÈÎÔ‡ ‰Â›ÎÙË KIDMED, ηıÒ˜ Î·È ÙȘ Èı·Ó¤˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: √ ˘fi ÌÂϤÙË ÏËı˘ÛÌfi˜ ÂÚÈÂÏ¿Ì‚·Ó 1305 ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 3-18 ÂÙÒÓ. ∆Ô ‰Â›ÁÌ· ‹Ù·Ó ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ·, ηχÙÔÓÙ·˜ fiϘ ÙȘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜, ÂÎÙfi˜ ·fi Ù· ÓËÛÈ¿ ÙÔ˘ πÔÓ›Ô˘ Î·È ÙÔ˘ ∞ÈÁ·›Ô˘. ∞fi ÙÔ˘˜ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ¤ÊË‚Ô˘˜ Û˘ÏϤ¯ıËηÓ, ̤ۈ ÙËÏÂʈÓÈ΋˜ Û˘Ó¤ÓÙ¢Í˘, ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ, Ù· ·ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÙË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë, ÙÔÓ ‰Â›ÎÙË KIDMED, ÙË ÛˆÌ·ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ‰È·ÈÙËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô 10% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·ÚÔ˘Û›·˙ ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙË ‚·ıÌÔÏÔÁ›· ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ, ·ÏÏ¿ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·Ø ÔÈ ¤ÊË‚ÔÈ ÂÌÊ¿ÓÈ˙·Ó ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· Û ۯ¤ÛË Ì ٷ ·È‰È¿. ∆Ô ÔÛÔÛÙfi ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ¿ÙÔÌ· ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ‹ Ô ·Ù¤Ú·˜ ›¯Â ˘„ËÏfiÙÂÚÔ ÌÔÚʈÙÈÎfi Â›‰Ô. ∂›Û˘, Ë ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙË Û˘ÓÔÏÈ΋ ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡/ÂÊ‹‚Ô˘ Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô Ù˘ ÌËÙ¤Ú·˜, ÂÓÒ Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡/ÂÊ‹‚Ô˘ Î·È ÙȘ ηıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÌÂϤÙ˘ ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÌÈ· ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Ù¿ÛË ·ÔÌ¿ÎÚ˘ÓÛ˘ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ·fi Ù· ·Ú·‰ÔÛȷο ‰È·ÙÚÔÊÈο ÚfiÙ˘· ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ.

1 ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó· 2 ÿ‰Ú˘Ì· “∞ÚÈÛÙ›‰Ë˜ ¢·ÛηÏfiÔ˘ÏÔ˜”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ª·›ÚË °È·ÓÓ·ÎÔ‡ÏÈ· myiannak@hua.gr ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ Î·È ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∂Ï. µÂÓÈ˙¤ÏÔ˘ 70 176 71, ∫·ÏÏÈı¤·

§¤ÍÂȘ ÎÏÂȉȿ: ¢È·ÙÚÔÊ‹, ÌÂÛÔÁÂȷ΋ ‰›·ÈÙ·, ·È‰È¿, ¤ÊË‚ÔÈ.

Adherence to the Mediterranean diet in children and adolescents in Greece N. Vidra1, A-E. Farmaki1, S. Koinaki1, K. Belogianni1, S. Sofrona2, F. Magkanari2, M. Kontogianni1, M. Yannakoulia1 Abstract Background: The aim of this study was to evaluate the adherence to the Mediterranean dietary pattern among children and adolescents in Greece, based on the KIDMED index, and its association with sociodemographic parameters.

Methods: The sample consisted of 1,305 boys and girls, aged 3-18 years; it was representative of the Greek population in terms of age and gender, and covered all geographical areas apart from the Aegean and Ionian islands. Information on the subjects’ socio-demographic, dietary, anthropometric and physical activity characteristics were collected by telephone interview. For the participants aged 3-12 years, parents were asked to respond on behalf of their children.

Results: Of the total sample, 10% had a high KIDMED score, indicating optimal Mediterranean diet. No differences were observed between girls and boys with regards to the KIDMED score; however, adolescents reported lower values than younger children. The percentage of children and adolescents with high KIDMED score was statistically greater among individuals with a high parental educational level.

Multivariate analysis revealed that the KIDMED score was associated positively with physical activity and maternal educational level and negatively with age and sedentary activities.

Conclusion: The findings of this study indicate that Greek children and adolescents exhibit a low degree of adherence to the traditional Mediterranean dietary pattern.

1 Department of Nutrition – Dietetics, Harokopio University, Athens 2 “Aristidis Daskalopoulos” Foundation, Athens Correspondence: Mary Yannakoulia myiannak@hua.gr Department of Nutrition – Dietetics, Harokopio University 70, El. Venizelos St. 17671, Kallithea

Key words: Nutrition, Mediterranean diet, children, adolescents.

¶·È‰È·ÙÚÈ΋ 2008;71:361-367

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¡. µ›‰Ú· Î·È Û˘Ó.

™˘ÓÙÔÌÔÁڷʛ˜ cm: kcal: kg: KIDMED: m: min:

centimeter kilocalories kilogram Mediterranean diet quality index for children and adolescents meter minutes

∂ÈÛ·ÁˆÁ‹ √ fiÚÔ˜ “ÌÂÛÔÁÂȷ΋ ‰›·ÈÙ·” ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ·Ú·‰fiÛÂȘ Ù˘ ∫Ú‹Ù˘, Ù˘ ¡ÔÙ›Ô˘ πÙ·Ï›·˜ Î·È ¿ÏÏˆÓ ÌÂÛÔÁÂÈ·ÎÒÓ ¯ˆÚÒÓ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1960 (1,2). ∞Ô‰›‰ÂÙ·È ‰Â Û¯ËÌ·ÙÈο Ì ÙË ÌÔÚÊ‹ ˘Ú·Ì›‰·˜, Ù˘ ÔÔ›·˜ Ù· ‚·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο Â›Ó·È Ë Î·ıËÌÂÚÈÓ‹ ηٷӿψÛË ·‰ÚÒÓ ÂÂÍÂÚÁ·ÛÌ¤ÓˆÓ ‰ËÌËÙÚÈ·ÎÒÓ, ÊÚÔ‡ÙˆÓ, Ï·¯·ÓÈÎÒÓ, ÂÏ·ÈÔÏ¿‰Ô˘ Î·È Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ, Ë Î·Ù·Ó¿ÏˆÛË „·ÚÈÒÓ, Ô˘ÏÂÚÈÎÒÓ, ÔÛÚ›ˆÓ, ·‚ÁÒÓ Î·È ÁÏ˘ÎÈÛÌ¿ÙˆÓ 1-2 ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, Ë Î·Ù·Ó¿ÏˆÛË ÎfiÎÎÈÓÔ˘ ÎÚ¤·ÙÔ˜ 1-2 ÊÔÚ¤˜ ÙÔÓ Ì‹Ó·, ηıÒ˜ Â›Û˘ Î·È Ë Ì¤ÙÚÈ· ηٷӿψÛË ÎÚ·ÛÈÔ‡ (1-2 ÔÙ‹ÚÈ· ÙËÓ Ë̤ڷ, ΢ڛˆ˜ Ì·˙› Ì ÙÔ Ê·ÁËÙfi) (3). ¶Ï‹ıÔ˜ ÌÂÏÂÙÒÓ ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ Ù· ¢ÂÚÁÂÙÈο ıÚÂÙÈο Û˘ÛÙ·ÙÈο Ù· ÔÔ›· ÂÚȤ¯ÔÓÙ·È Û ·ÊıÔÓ›· ÛÙ· ÙÚfiÊÈÌ· Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜, fiˆ˜ Ù· ÌÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·, Ô ÏfiÁÔ˜ ÙˆÓ ··Ú·›ÙËÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ˆ6:ˆ3, ÔÈ ‰È·ÈÙËÙÈΤ˜ ›Ó˜, ÔÈ ‚Èٷ̛Ә ∂ Î·È C, Ù· ηÚÔÙÂÓÔÂȉ‹, ÙÔ ÛÂÏ‹ÓÈÔ, Ë ÁÏÔ˘Ù·ıÂÈfiÓË, Ë ÚÂÛ‚ÂÚ·ÙÚfiÏË, ‰È¿ÊÔÚ˜ ÔÏ˘Ê·ÈÓfiϘ, ÙÔ Ê˘ÏÏÈÎfi Ô͇ Î·È ÔÏÏ¿ ·ÎfiÌ· Ù· ÔÔ›· ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ÛÙ¿‰ÈÔ Ù˘ ‰ÈÂÚ‡ÓËÛ˘ (4). ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë ˘ÈÔı¤ÙËÛË ÂÓfi˜ ÌÂÛÔÁÂÈ·ÎÔ‡ ÚÔÙ‡Ô˘ ‰È·ÙÚÔÊ‹˜ Û¯ÂÙ›˙ÂÙ·È Ì ̷ÎÚÔ˙ˆ›· (5), ηıÒ˜ Î·È Ì ¯·ÌËÏ¿ Â›‰· ÂÌÊ¿ÓÈÛ˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘, ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ‚ÈÔ¯ËÌÈÎÒÓ ‰ÂÈÎÙÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÈÓÛÔ˘ÏÈÓÔ·ÓÙ›ÛÙ·ÛË, ÙË ÊÏÂÁÌÔÓ‹ Î·È ÙÔÓ Î·Ú‰ÈÔ·ÁÁÂÈ·Îfi ΛӉ˘ÓÔ (6-10). ŸÛÔÓ ·ÊÔÚ¿ Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ̤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯Ô˘Ó ‰È·ÌÔÚʈı› Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘ÛÙ¿ÛÂȘ ‚·ÛÈṲ̂Ó˜ Û ·˘Ùfi ÙÔ ÚfiÙ˘Ô ‰È·ÙÚÔÊ‹˜ Î·È ÚÔÛ·ÚÌÔṲ̂Ó˜ ÛÙȘ ȉȷ›ÙÂÚ˜ ·Ó¿ÁΘ ·˘Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜. §ÈÁÔÛÙ¤˜ Â›Ó·È Î·È ÔÈ ÌÂϤÙ˜ Û ·È‰ÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙ›ÛÂÈ Î¿ÔÈ· ·fi Ù· ‚·ÛÈο ıÚÂÙÈο Û˘ÛÙ·ÙÈο ‹ ÙÚfiÊÈÌ· Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜, fiˆ˜ Ë ˘„ËÏ‹ ÚfiÛÏË„Ë ÌÔÓÔ·ÎfiÚÂÛÙˆÓ Î·È Ë ¯·ÌËÏ‹ ÚfiÛÏË„Ë ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ, Ë Î·Ù·Ó¿ÏˆÛË ÊÚÔ‡ÙˆÓ, Ï·¯·ÓÈÎÒÓ, ÔÏÈ΋˜ ¿ÏÂÛ˘ ‰ËÌËÙÚÈ·ÎÒÓ Î·È ÔÛÚ›ˆÓ, Ì ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ Î·È ·¯˘Û·ÚΛ· (11-14). ™¯ÂÙÈο ÚfiÛÊ·Ù·, ÔÈ Serra-Majem Î·È Û˘Ó. ·Ó¤Ù˘Í·Ó ¤Ó·Ó ‰Â›ÎÙË ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜ (KIDMED) (15) Paediatriki 2008;71:361-367

Î·È ‚Ú‹Î·Ó fiÙÈ Ë ˘„ËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔÓ ‰Â›ÎÙË ·˘Ùfi, Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ Î·È ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ‰È·ÙÚÔÊÈÎÔ‡ ÚÔÙ‡Ô˘, Û¯ÂÙ›˙ÂÙ·È Ì ˘„ËÏfiÙÂÚË Â¿ÚÎÂÈ· ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ·È‰ÈÒÓ Î·È Ó·ÚÒÓ ÂÓËÏ›ÎˆÓ ËÏÈΛ·˜ 6-24 ÂÙÒÓ (16). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ‰ÈÂÚ¢ӋÛÂÈ ÙÔÓ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜ ·fi Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÛÙËÓ ∂ÏÏ¿‰·, Ì ‚¿ÛË ÙÔÓ ‰Â›ÎÙË KIDMED, ηıÒ˜ Î·È ÙȘ Èı·Ó¤˜ Û˘Û¯ÂÙ›ÛÂȘ Ì ÎÔÈÓˆÓÈÎÔ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ·¯˘Û·ÚΛ·.

ªÂıÔ‰ÔÏÔÁ›· ¶ÏËı˘ÛÌfi˜ ÌÂϤÙ˘ ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 1.305 ¿ÙÔÌ· ËÏÈΛ·˜ 3-18 ÂÙÒÓ (52% ÎÔÚ›ÙÛÈ·). ∆Ô ‰Â›ÁÌ· ‹Ù·Ó ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ÁÈ· ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ·, ηχÙÔÓÙ·˜ fiϘ ÙȘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜, ÂÎÙfi˜ ·fi Ù· ÓËÛÈ¿ ÙÔ˘ πÔÓ›Ô˘ Î·È ÙÔ˘ ∞ÈÁ·›Ô˘. ∏ ÂÈÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤ÁÈÓ Ì ¯Ú‹ÛË ÔÏ˘ÛÙ·‰È·Î‹˜, ÛÙڈ̷ÙÔÔÈË̤Ó˘, ·Ó·ÏÔÁÈ΋˜, Ù˘¯·›·˜ ‰ÂÈÁÌ·ÙÔÏË„›·˜: ÔÏ˘ÛÙ·‰È·Î‹˜ Î·È ÛÙڈ̷ÙÔÔÈË̤Ó˘ ·Ó¿ ÓÔÌfi Î·È ËÏÈÎȷ΋ ÔÌ¿‰· ·Ó·ÊÔÚ¿˜ (3-12 ÂÙÒÓ, 13-18 ÂÙÒÓ), ·Ó·ÏÔÁÈ΋˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ ÙˆÓ ·È‰ÈÒÓ 3-18 ÂÙÒÓ ·Ó¿ ÓÔÌfi (ÁÈ· ÙȘ ·ÛÙÈΤ˜ Î·È ÙȘ ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜), Ù˘¯·›·˜ ˆ˜ ÚÔ˜ ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ÓÔÈÎÔ΢ÚÈÔ‡ Û οı ÛÙÚÒÌ·, ηıÒ˜ Î·È ˆ˜ ÚÔ˜ ÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ·È‰ÈÔ‡ ·Ó·ÊÔÚ¿˜ ÂÓÙfi˜ ÙÔ˘ ÓÔÈÎÔ΢ÚÈÔ‡ (Ì ¯Ú‹ÛË ÁÂÓÓ‹ÙÚÈ·˜ Ù˘¯·›ˆÓ ·ÚÈıÌÒÓ). ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ª·˝Ô˘-πÔ˘Ï›Ô˘ 2007, ̤ۈ ÙËÏÂʈÓÈ΋˜ Û˘Ó¤ÓÙ¢Í˘, ‰È¿ÚÎÂÈ·˜ ÂÚ›Ô˘ 35 ÏÂÙÒÓ, ›Ù Ì ÙÔÓ ÁÔÓ¤· (‹ ÙÔÓ ˘‡ı˘ÓÔ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ·È‰ÈÔ‡), fiÛÔÓ ·ÊÔÚ¿ Ù· ·È‰È¿ ËÏÈΛ·˜ 3-12 ÂÙÒÓ, ›Ù Ì ÙÔÓ ›‰ÈÔ ÙÔÓ ¤ÊË‚Ô, ÁÈ· ¿ÙÔÌ· ÌÂÁ·Ï‡ÙÂÚ· ·fi 13 ÂÙÒÓ. ªÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ Ì ٷ ÔÔ›· ¤ÁÈÓ ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›·, 10.192 ‰ÂÓ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· Û˘ÌÌÂÙÔ¯‹˜ (¿ÙÂÎÓÔÈ, ·È‰È¿ Ô˘ ‰ÂÓ Ù·›ÚÈ·˙·Ó ˆ˜ ÚÔ˜ ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰·, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ··ÈÙÔ‡ÌÂÓË ÁˆÁÚ·ÊÈ΋ ÂÚÈÔ¯‹ Î.Ï.) Î·È 3.545 ·ÚÓ‹ıËÎ·Ó Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Û ÔÔÈÔ‰‹ÔÙ ÛÙ¿‰ÈÔ Ù˘ ÌÂϤÙ˘ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ·˘ÙÒÓ Ô˘ ·ÚÓ‹ıËÎ·Ó ÚÈÓ Ó· ‰ÈÂÚ¢ÓËı› ηٿ fiÛÔÓ ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÛÙË ÌÂϤÙË). ™˘ÓÔÏÈο, ¤Ï·‚·Ó ̤ÚÔ˜ 751 ·È‰È¿ Î·È 554 ¤ÊË‚ÔÈ. Ÿˆ˜ ÂÈÒıËÎÂ Î·È ·Ú·¿Óˆ, ÂÓÒ ÔÈ ¤ÊË‚ÔÈ ¤‰ˆÛ·Ó ÔÈ ›‰ÈÔÈ ÙȘ ˙ËÙÔ‡ÌÂÓ˜ ÏËÚÔÊÔڛ˜, ÛÙ· ·È‰È¿ ·˘Ùfi ¤ÁÈÓ ̤ۈ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. √È ÁÔÓ›˜ ‹ ÔÈ ÎˉÂÌfiÓ˜ ÌÔÚÔ‡Ó Ó· ‰ÒÛÔ˘Ó ·ÎÚȂ›˜ Î·È ·ÍÈfiÈÛÙ˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰›·ÈÙ·, ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Î·È Ù· ·ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Ó·ÚÒÓ ·È‰ÈÒÓ. ∞fi ÙËÓ ¿ÏÏË, Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜, Ù· ·È‰È¿ Ê·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ·Ó·Î·Ï¤ÛÔ˘Ó ÌfiÓ· ÙÔ˘˜ ÙË ‰È·ÈÙËÙÈ΋ ÙÔ˘˜ ÚfiÛÏË„Ë (19-23). ∞ÍÈÔÏfiÁËÛË ÎÔÈÓˆÓÈÎÔ-‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ, ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘, ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ¿ÏÏˆÓ Û˘ÓËıÂÈÒÓ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ √È ÂÚˆÙËı¤ÓÙ˜ ¤‰ˆÛ·Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ËÏÈΛ·, ÙËÓ ÂıÓÈÎfiÙËÙ·, ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ‡„Ô˜ ÙÔ˘˜ (Î·È ÔÈ ÁÔÓ›˜ ·ÓÙ›ÛÙÔȯ· ÁÈ· Ù· ·È‰È¿ ÙÔ˘˜), ÙËÓ ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË, ÙË ÌfiÚʈÛË Î·È ÙÔ Â¿ÁÁÂÏÌ· ÙˆÓ ÁÔÓ¤ˆÓ. ∞fi ÙÔ ·˘ÙÔ‰ËÏÔ‡ÌÂÓÔ ‚¿ÚÔ˜ Î·È ‡„Ô˜ ˘ÔÏÔÁ›ÛıËÎÂ Ô ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ [‚¿ÚÔ˜ ÚÔ˜ ‡„Ô˜2 (kg/m2)] Î·È ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·363

363

ªÂÛÔÁÂȷ΋ ‰›·ÈÙ· ÛÙË Ó·ڋ ËÏÈΛ·

¶›Ó·Î·˜ 1. KIDMED: ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ÔÈfiÙËÙ·˜ Ù˘ ‰›·ÈÙ·˜, Û‡Ìʈӷ Ì ÙȘ ·Ú¯¤˜ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰È·ÙÚÔÊ‹˜ µ·ıÌÔÏÔÁ›· +1 +1 +1 +1 +1 -1 +1 +1 +1 +1 +1 -1 +1 -1 +1 -1

∫·Ù·Ó·ÏÒÓÂȘ ¤Ó· ÊÚÔ‡ÙÔ ‹ ¯˘Ìfi ÊÚÔ‡ÙˆÓ Î¿ı Ë̤ڷ ∫·Ù·Ó·ÏÒÓÂȘ ¤Ó· ‰Â‡ÙÂÚÔ ÊÚÔ‡ÙÔ Î¿ı Ë̤ڷ ∫·Ù·Ó·ÏÒÓÂȘ Ï·¯·ÓÈο Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ ∫·Ù·Ó·ÏÒÓÂȘ Ï·¯·ÓÈο ÂÚÈÛÛfiÙÂÚÔ ·fi Ì›· ÊÔÚ¿ ÙËÓ Ë̤ڷ ∫·Ù·Ó·ÏÒÓÂȘ „¿ÚÈ Ù·ÎÙÈο (ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-3 ÊÔÚ¤˜/‚‰ÔÌ¿‰·) ∫·Ù·Ó·ÏÒÓÂȘ Úfi¯ÂÈÚÔ Ê·ÁËÙfi ÂÚÈÛÛfiÙÂÚÔ ·fi 1 ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰· ∫·Ù·Ó·ÏÒÓÂȘ fiÛÚÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 1 ÊÔÚ¿ ÙËÓ Â‚‰ÔÌ¿‰· ∫·Ù·Ó·ÏÒÓÂȘ „ˆÌ›, ˙˘Ì·ÚÈο ‹ Ú‡˙È Û¯Â‰fiÓ Î¿ı Ë̤ڷ (5 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·) °È· ÚˆÈÓfi Û˘Ó‹ıˆ˜ ÙÚˆ˜ ‰ËÌËÙÚȷο (Ù‡Ô˘ corn flakes) ‹ „ˆÌ› ‹ ÊÚ˘Á·ÓȤ˜ ‹ ·ÚÙÔÛ΢¿ÛÌ·Ù· ∫·Ù·Ó·ÏÒÓÂȘ ÍËÚÔ‡˜ ηÚÔ‡˜ Ù·ÎÙÈο (ÙÔ˘Ï¿¯ÈÛÙÔÓ 2-3/‚‰ÔÌ¿‰·) ∫·Ù·Ó·ÏÒÓÂȘ ÂÏ·ÈfiÏ·‰Ô (›Ù Û ۷Ͽٷ ›Ù Û ʷÁËÙfi) ™˘Ó‹ıˆ˜ ·Ú·Ï›ÂȘ ÙÔ ÚˆÈÓfi °È· ÚˆÈÓfi Û˘Ó‹ıˆ˜ ÙÚˆ˜ ‹ ›ÓÂȘ ¤Ó· Á·Ï·ÎÙÔÎÔÌÈÎfi ÚÔ˚fiÓ, fiˆ˜ Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Î.¿. °È· ÚˆÈÓfi Û˘Ó‹ıˆ˜ ÙÚˆ˜ ÁÏ˘Î¿ ∫·Ù·Ó·ÏÒÓÂȘ 3 ÌÂÚ›‰Â˜ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÙËÓ Ë̤ڷ (1 ÔÙ‹ÚÈ Á¿Ï· ‹ 1 ·ÂÏÏÔ ÁÈ·Ô‡ÚÙÈ ‹ 30 g Ù˘Ú›) ∫·Ù·Ó·ÏÒÓÂȘ ÁÏ˘Î¿ οı ̤ڷ

ηÙËÁÔÚÈÔÔÈ‹ıËÎ·Ó ˆ˜ ÂÏÏÈÔ‚·Ú›˜, Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜, ˘¤Ú‚·ÚÔÈ Î·È ·¯‡Û·ÚÎÔÈ, ‚¿ÛÂÈ ÙˆÓ ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙÔÓ ¢Â›ÎÙË ª¿˙· ™ÒÌ·ÙÔ˜ ÙÔ˘ International Obesity Task Force (17,18). ∏ ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ·ÍÈÔÏÔÁ‹ıËΠ̤ۈ (·) ÂÓfi˜ Û‡ÓÙÔÌÔ˘, ÌË ÔÛÔÙÈÎÔÔÈË̤ÓÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Û˘¯ÓfiÙËÙ·˜ ηٷӿψÛ˘ ÙÚÔʛ̈Ó, ÙÔ ÔÔ›Ô ÂÚÈÏ¿Ì‚·Ó ÙȘ ‚·ÛÈΤ˜ ÔÌ¿‰Â˜ Ù˘ ‰›·ÈÙ·˜ ÙˆÓ ·È‰ÈÒÓ, (‚) ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ KIDMED Î·È (Á) Ì›·˜ ·Ó¿ÎÏËÛ˘ Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘. ∆Ô KIDMED Â›Ó·È ¤Ó· Û‡ÓÙÔÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ 16 ÂÚˆÙ‹ÛˆÓ, ÙÔ ÔÔ›Ô ·ÍÈÔÏÔÁ› ÙÔÓ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ ÙÔ˘ ÌÂÛÔÁÂÈ·ÎÔ‡ ‰È·ÙÚÔÊÈÎÔ‡ ÚÔÙ‡Ô˘ (15). ™ÙËÚ›¯ıËΠÛÙȘ ‚·ÛÈΤ˜ ·Ú¯¤˜ ÙˆÓ ÌÂÛÔÁÂÈ·ÎÒÓ ‰È·ÈÙËÙÈÎÒÓ ÚÔÙ‡ˆÓ, ηıÒ˜ Î·È Û ¿ÏϘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù¤˜. °È· οı ÂÚÒÙËÛË, Ë ıÂÙÈ΋ ‰‹ÏˆÛË, fiÛÔÓ ·ÊÔÚ¿ ÙË ÌÂÛÔÁÂȷ΋ ‰›·ÈÙ·, ‚·ıÌÔÏÔÁÂ›Ù·È Ì +1 ‚·ıÌfi, ÂÓÒ Ë ·ÚÓËÙÈ΋ Ì -1 (¶›Ó·Î·˜ 1). ∏ Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ¤¯ÂÈ Â‡ÚÔ˜ ÙÈÌÒÓ ·fi 0 ¤ˆ˜ 12 Î·È Î·ÙËÁÔÚÈÔÔÈ‹ıËΠ۠3 Â›‰·: Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ≥8 ˘Ô‰ËÏÒÓÂÈ ‚¤ÏÙÈÛÙË ÌÂÛÔÁÂȷ΋ ‰›·ÈÙ·, 4-7 ··ÈÙÂ›Ù·È ‚ÂÏÙ›ˆÛË ÁÈ· Ó· ÚÔÛ·ÚÌÔÛÙ› Ë ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë ÛÙ· ÌÂÛÔÁÂȷο ‰È·ÈÙËÙÈο ÚfiÙ˘·, ≤3 ‰›·ÈÙ· ¯·ÌËÏ‹˜ ÔÈfiÙËÙ·˜. ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ ·Ó¿ÎÏËÛË Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ 24ÒÚÔ˘, ÔÈ ÂÚ¢ÓËÙ¤˜ ÂÎ·È‰Â‡ÙËÎ·Ó ·fi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÚÔÛˆÈÎfi, ÒÛÙ ӷ ηٷÁÚ¿„Ô˘Ó Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÏÂÙÔ̤ÚÂÈ· Î·È ·ÎÚ›‚ÂÈ· ÙÔ Â›‰Ô˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ô˘ ηٷӷÏÒıËΠ(ÏÈÔÂÚÈÂÎÙÈÎfiÙËÙ·, Ì¿Úη ÚÔ˚fiÓÙÔ˜, Û˘ÛÙ·ÙÈο Û‡ÓıÂÙˆÓ Ê·ÁËÙÒÓ Î.¿.), ηıÒ˜ ηÈ

ÙËÓ ÔÛfiÙËÙ· ‹ ÙÔÓ fiÁÎÔ ÙÔ˘ Ì ‚¿ÛË ÔÈÎȷΤ˜ ÌÂ˙Ô‡Ú˜ ‹ ¿ÏÏ· ·ÓÙÈΛÌÂÓ·, fiˆ˜ ¯¿Ú·Î˜ Î·È ÙÚ¿Ô˘Ï˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ‰Â‰Ô̤ӷ ·fi ÙËÓ ·Ó¿ÎÏËÛË Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘ ·Ó·Ï‡ıËÎ·Ó ˆ˜ ÚÔ˜ ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ̷ÎÚÔÎ·È ÌÈÎÚÔ-ıÚÂÙÈο Û˘ÛÙ·ÙÈο Ì ÙÔ ÏÔÁÈÛÌÈÎfi Nutritionist Pro, version 2.2 (Axxya Systems-Nutritionist Pro, Stafford, TX, USA). ∏ ‚¿ÛË ‰Â‰ÔÌ¤ÓˆÓ Û‡ÛÙ·Û˘ ÙÚÔÊ›ÌˆÓ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÏÔÁÈÛÌÈÎÔ‡, Ë ÔÔ›· ÛÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ˘˜ ¶›Ó·Î˜ ∞Ó¿Ï˘Û˘ ∆ÚÔÊ›ÌˆÓ ÙÔ˘ USDA (19), ÂÌÏÔ˘Ù›ÛÙËΠ̠·Ó·Ï‡ÛÂȘ ·Ú·‰ÔÛÈ·ÎÒÓ ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Î·È Û˘ÓÙ·ÁÒÓ (20,21), ηıÒ˜ Î·È Ì ÙȘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰È·ÙÚÔÊÈ΋ Û‡ÛÙ·ÛË Î¿ÔÈˆÓ Ù˘ÔÔÈËÌ¤ÓˆÓ ÙÚÔʛ̈Ó, fiˆ˜ ·˘Ù¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·Ó ÛÙȘ ÂÙÈΤÙ˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ ‹ ·Ú·¯ˆÚÔ‡ÓÙ·Ó ·fi ÙȘ ‚ÈÔÌ˯·Ó›Â˜ ÙÚÔʛ̈Ó. ∏ ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ·ÍÈÔÏÔÁ‹ıËΠ̠·Ó¿ÎÏËÛË ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ù˘ ÚÔËÁÔ‡ÌÂÓ˘ Ë̤ڷ˜ ηÈ, ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÙÔ˘ ¯ÚfiÓÔ˘ Ô˘ ÔÈ ÂıÂÏÔÓÙ¤˜ ‰·¿ÓËÛ·Ó Û ÂÚ¿ÙËÌ· (.¯. ‚fiÏÙ·, ·fi ÙÔ Û›ÙÈ ÛÙÔ Û¯ÔÏ›Ô/ÊÚÔÓÙÈÛÙ‹ÚÈÔ Î.Ï.), ·È¯Ó›‰È ‹ ¿ıÏËÛË Ì ʛÏÔ˘˜/Û˘ÌÌ·ıËÙ¤˜ (.¯. Ì¿ÛÎÂÙ, ‚fiÏÂ˚, Ô‰fiÛÊ·ÈÚÔ, ΢ÓËÁËÙfi, ÎÚ˘ÊÙfi, ÛÎÔÈÓ¿ÎÈ Î.Ï.), ÔÚÁ·ÓˆÌ¤ÓË ¿ıÏËÛË (.¯. Ì¿ÛÎÂÙ, ‚fiÏÂ˚, Ô‰fiÛÊ·ÈÚÔ, ÛÙ›‚Ô˜, ÂÓfiÚÁ·ÓË, Ì·Ï¤ÙÔ Î.Ï. Û ÔÌ¿‰· ‹ Û‡ÏÏÔÁÔ ‹ Á˘ÌÓ·ÛÙ‹ÚÈÔ Î.Ï.). ∂›Û˘, ηٷÁÚ¿ÊËÎÂ Ô ¯ÚfiÓÔ˜ Ô˘ ·ÊÈ¤ÚˆÛ·Ó ÙËÓ ÚÔËÁÔ‡ÌÂÓË Ë̤ڷ Û ÙËÏÂfiÚ·ÛË, ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹ ‹ ·È¯Ó›‰È Ù‡Ô˘ play station (ηıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜). ∆¤ÏÔ˜, ·ÍÈÔÏÔÁ‹ıËÎ·Ó Î·È ¿ÏϘ ·Ú¿ÌÂÙÚÔÈ Ù˘ ‰È·ÙÚÔÊÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÙÔ ·Ó ηٷӷÏÒÓÔ˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· Á‡̷ Ì ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ηıËÌÂÚÈÓ¿, ·Ó ‚ϤÔ˘Ó ÙËÏÂfiÚ·ÛË ÙËÓ ÒÚ· Ô˘ ÙÚÒÓÂ, ηıÒ˜ Î·È fiÛÔ Â˘¯·ÚÈÛÙË̤ÓÔÈ Â›Ó·È ÔÈ ›‰ÈÔÈ (‹ ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ·È‰ÈÒÓ) Ì ÙÔ ÛÒÌ· ÙÔ˘˜ Î·È ·Ó ¤¯Ô˘Ó οÓÂÈ ÛÙÔ ·ÚÂÏıfiÓ, ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘, ‰›·ÈÙ· ·‰˘Ó·Ù›ÛÌ·ÙÔ˜.

∞ÔÙÂϤÛÌ·Ù· ∆· ÂÚÈÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™Ù· ·È‰È¿ ËÏÈΛ·˜ 3-12 ÂÙÒÓ, ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ fiÛÔÓ ·ÊÔÚ¿ Ù· ‰ËÏÔ‡ÌÂÓ· ·fi ÙÔ˘˜ ÁÔÓ›˜ ۈ̷ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÙË ‰È·ÈÙËÙÈ΋ ÚfiÛÏË„Ë, ÙȘ Û˘Ó‹ıÂȘ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙË ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED. ∞ÓÙ›ıÂÙ·, ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ù· ·ÁfiÚÈ· ›¯·Ó, Û‡Ìʈӷ Ì ÙÔ ‡„Ô˜ Î·È ÙÔ ‚¿ÚÔ˜ Ô˘ ‰‹ÏˆÛ·Ó, ÛÙ·ÙÈÛÙÈο ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi ˘¤Ú‚·ÚÔ˘ Î·È ·¯˘Û·ÚΛ·˜ Û ۯ¤ÛË Ì ٷ ÎÔÚ›ÙÛÈ· (19,8% Î·È 3,7% ¤Ó·ÓÙÈ 8,7% Î·È 1,9%, ·ÓÙ›ÛÙÔȯ·, p<0,001), fiˆ˜ Â›Û˘ Î·È ˘„ËÏfiÙÂÚË ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (2095±823 kcal/Ë̤ڷ ¤Ó·ÓÙÈ 1534±557 kcal/Ë̤ڷ, p<0,001), ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ·ÊÈÂڈ̤ÓÔ ÛÙÔ ·È¯Ó›‰È (36±59 min/Ë̤ڷ ¤Ó·ÓÙÈ 17±40 min/Ë̤ڷ, p=0,001) Î·È ÛÙËÓ ÔÚÁ·ÓˆÌ¤ÓË ¿ÛÎËÛË (32±61 min/Ë̤ڷ ¤Ó·ÓÙÈ 17±44 min/Ë̤ڷ, p=0,001). ∂›Û˘, ÔÈ ¤ÊË‚ÔÈ, Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿, ›¯·Ó ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED (4,8±2,1 ¤Ó·ÓÙÈ 5,4±1,8, p<0,001), ·ÊÈ¤ÚˆÓ·Ó ÏÈÁfiÙÂÚÔ ¯ÚfiÓÔ ÛÙÔ ·È¯Ó›‰È (25±50 min/Ë̤ڷ ¤Ó·ÓÙÈ ¶·È‰È·ÙÚÈ΋ 2008;71:361-367

Pediatri Sept-Oct 08

22-10-08

12:15

™ÂÏ›‰·364

364

¡. µ›‰Ú· Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ∞ÓıÚˆÔÌÂÙÚÈο Î·È ‰È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó¿ ËÏÈÎȷ΋ ÔÌ¿‰· Î·È Ê‡ÏÔ ¶·È‰È¿ (3-12 ÂÙÒÓ) ∫ÔÚ›ÙÛÈ· µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (kg/m2) ∫·ÙËÁÔڛ˜ ˘¤Ú‚·ÚÔ˘ (%) À¤Ú‚·ÚÔÈ ¶·¯‡Û·ÚÎÔÈ ∂ÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (kcal/Ë̤ڷ) ¶ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (% ÂÓÂÚÁ. ÚfiÛÏ˄˘) ¶ÚfiÛÏË„Ë ÚˆÙÂ˚ÓÒÓ (% ÂÓÂÚÁ. ÚfiÛÏ˄˘) ¶ÚfiÛÏË„Ë ÏÈȉ›ˆÓ (% ÂÓÂÚÁ. ÚfiÛÏ˄˘) ∫ÔÚÂÛÌ¤ÓˆÓ ÏÈȉ›ˆÓ ªÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈȉ›ˆÓ ∫·ıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (min/Ë̤ڷ) ¶ÂÚ¿ÙËÌ· (min/Ë̤ڷ) ¶·È¯Ó›‰È Ì ʛÏÔ˘˜ (min/Ë̤ڷ) √ÚÁ·ÓˆÌ¤ÓË ¿ÛÎËÛË (min/Ë̤ڷ) KIDMED (0-12)

∞ÁfiÚÈ·

ŒÊË‚ÔÈ (13-18 ÂÙÒÓ) ∫ÔÚ›ÙÛÈ· ‰

∞ÁfiÚÈ·

31,0 ± 12,2 130 ± 20 17,9 ± 4,1

30,6 ± 12,7 128 ± 20 18,0 ± 3,6

55,8 ± 9,4 164 ± 7‰ 20,6 ± 3,0‰

65,3 ± 13,5‚,‰ 172 ± 11‚,‰ 21,9 ± 3,6‚,‰

18,0 13,1 1727 ± 555 42,8 ± 9,4 15,8 ± 4,1 42,3 ± 8,1 15,4 ± 4,2 18,5 ± 5,5 62 ± 58 25 ± 37 63 ± 83 18 ± 42 5,4 ± 1,7

18,5 12,8 1762 ± 568 42,9 ± 8,4 16,2 ± 3,7 41,8 ± 7,4 15,2 ± 3,5 18,4 ± 5,3 69 ± 61 26 ± 41 73 ± 84 14 ± 32 5,4 ± 1,9

8,7‰ 1,9‰ 1534 ± 557‰ 43,5 ± 10,6 15,8 ± 4,7 41,7 ± 8,8 14,2 ± 4,5 19,0 ± 5,8 86 ± 85 34 ± 39Á 17 ± 40‰ 17 ± 44 4,9 ± 2,1‰

19,8‚,‰ 3,7‚,‰ 2095 ± 823‚,‰ 42,2 ± 8,4 15,8 ± 4,1 43,0 ± 8,1 14,9 ± 3,8· 19,5 ± 5,5Á 92 ± 85‰ 31 ± 39 36 ± 59‚,‰ 32 ± 61‚,‰ 4,6 ± 2,0‰

·

p≤0,05 Û ۯ¤ÛË Ì ٷ ÎÔÚ›ÙÛÈ· Ù˘ ·ÓÙ›ÛÙÔȯ˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ p<0,001 Û ۯ¤ÛË Ì ٷ ÎÔÚ›ÙÛÈ· Ù˘ ·ÓÙ›ÛÙÔȯ˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ Á p≤0,05 Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· ÙÔ˘ ›‰ÈÔ˘ ʇÏÔ˘ Ù˘ ÌÈÎÚfiÙÂÚ˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ ‰ p<0,001 Û ۯ¤ÛË Ì ٷ ¿ÙÔÌ· ÙÔ˘ ›‰ÈÔ˘ ʇÏÔ˘ Ù˘ ÌÈÎÚfiÙÂÚ˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ ‚

68±54 min/Ë̤ڷ, p<0,001), ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ÛÙÔ ÂÚ¿ÙËÌ· (33±39 min/Ë̤ڷ ¤Ó·ÓÙÈ 26±39 min/Ë̤ڷ, p=0,001), ÛÙËÓ ÔÚÁ·ÓˆÌ¤ÓË ¿ÛÎËÛË (23±53 min/Ë̤ڷ ¤Ó·ÓÙÈ 16±38 min/Ë̤ڷ, p=0,01) Î·È ÛÙȘ ηıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (88±84 min/Ë̤ڷ ¤Ó·ÓÙÈ 66±60 min/Ë̤ڷ, p<0,001). ∂›Û˘, ÔÈ ¤ÊË‚ÔÈ Â›¯·Ó ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ˘¤Ú‚·ÚÔ˘ Î·È ·¯˘Û·ÚΛ·˜ Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ (p<0,001). ŸÙ·Ó ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÛÙË ÌÂϤÙË Î·ÙËÁÔÚÈÔÔÈ‹ıËηÓ, ·Ó¿ÏÔÁ· Ì ÙË ‚·ıÌÔÏÔÁ›· ÙÔ˘˜ ÛÙÔ KIDMED, Û ·˘ÙÔ‡˜ Ô˘ ›¯·Ó ¯·ÌËÏ‹, ÌÂÛ·›· Î·È ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›·, ÚԤ΢„ fiÙÈ ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›·, ‰ËÏ·‰‹ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ ÙˆÓ ‚·ÛÈÎÒÓ ·Ú¯ÒÓ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜, ›¯Â ÙÔ 10% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (11,3% ÙˆÓ ·È‰ÈÒÓ Î·È 8,3% ÙˆÓ ÂÊ‹‚ˆÓ, p<0,001). ∂›Û˘, ÙÔ ÔÛÔÛÙfi Ì ˘„ËÏfi KIDMED ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ¿ÙÔÌ· ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ›¯Â ·ÓÒÙÂÚË ‹ ·ÓÒÙ·ÙË ÂÎ·›‰Â˘ÛË, Û ۯ¤ÛË Ì ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ›¯Â Ï¿‚ÂÈ Ì¤¯ÚÈ Î·È ‰Â˘ÙÂÚÔ‚¿ıÌÈ· ÂÎ·›‰Â˘ÛË (14,3% Î·È 7,7% ·ÓÙ›ÛÙÔȯ·, p<0,001). ∞ÓÙ›ÛÙÔȯ·, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜, ·Ó¿ÏÔÁ· Ì ÙË ÌfiÚʈÛË ÙÔ˘ ·Ù¤Ú·, ‚Ú¤ıËÎ·Ó ÛÙ· ÔÛÔÛÙ¿ ÙˆÓ ·ÙfiÌˆÓ Ì ˘„ËÏfi KIDMED. √È ·Ú¿ÌÂÙÚÔÈ Ô˘ ‰˘ÓËÙÈο ÂËÚ¿˙Ô˘Ó ÙË ‚·ıÌÔÏÔÁ›· ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ KIDMED ·ÍÈÔÏÔÁ‹ıËÎ·Ó Û ÔÏ˘·Ú·ÁÔÓÙÈÎfi ˘fi‰ÂÈÁÌ· ·Ó¿Ï˘Û˘ ·ÏÈÓ‰ÚfiÌËÛ˘ Î·È ‚Ú¤ıËΠfiÙÈ, ηÙfiÈÓ ÂϤÁ¯Ô˘ Paediatriki 2008;71:361-367

ÁÈ· Èı·ÓÔ‡˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÙÔ ˘„ËÏfiÙÂÚÔ KIDMED Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙË Û˘ÓÔÏÈ΋ ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (‚=0,079, p=0,005) Î·È ÙÔ Â›Â‰Ô ÌfiÚʈÛ˘ Ù˘ ÌËÙ¤Ú·˜ (‚=0,097, p=0,003) Î·È ·ÚÓËÙÈο Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ (‚=0,115, p<0,001) Î·È ÙȘ ηıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (‚=0,134, p<0,001). ∂›Û˘, Ë ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED ÂÌÊ¿ÓÈÛ ÌÈ· Ù¿ÛË Ó· Û˘Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙÔ Â›Â‰Ô ÌfiÚʈÛ˘ ÙÔ˘ ·Ù¤Ú· (‚=0,057, p=0,075) Î·È ·ÚÓËÙÈο Ì ÙÔÓ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (‚=0,052, p=0,103).

™˘˙‹ÙËÛË √ ÂÈÔÏ·ÛÌfi˜ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ Î·È Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó 16,2% Î·È 8,6%, ·ÓÙ›ÛÙÔȯ·. ∆· ÔÛÔÛÙ¿ ·˘Ù¿ Â›Ó·È ÛÂ Û˘Ìʈӛ· Ì ٷ ·ÓÙ›ÛÙÔȯ· Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÁÈ· ·ÓÂÏÏ‹ÓÈ· ·ÓÙÈÚÔÛˆ¢ÙÈο ‰Â›ÁÌ·Ù· Î·È ‚·Û›˙ÔÓÙ·È ÙfiÛÔ Û ÌÂÙÚÔ‡ÌÂÓ˜ (22) fiÛÔ Î·È Û ·˘ÙÔ‰ËÏÔ‡ÌÂÓ˜ ÙÈ̤˜ (23). ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ, ÔÈ ·ÏÏ·Á¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰‡Ô ‰ÂηÂٛ˜ Û ‰È¿ÊÔÚÔ˘˜ ÏËı˘ÛÌÔ‡˜ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÈ· ÛÂÈÚ¿ ·fi ·ÏÏ·Á¤˜ Û ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ∂ȉÈÎfiÙÂÚ· ÁÈ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ë Î·Ù·Ó¿ÏˆÛË ÙÚÔÊ›ÌˆÓ ÂÎÙfi˜ ÛÈÙÈÔ‡, ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó, Ô ÂÚÈÔÚÈÛÌfi˜ ÛÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ Ì ·ÓÙ›ÎÙ˘Ô ÛÙËÓ ·Ú·Û΢‹ Î·È ÙËÓ Î·Ù·Ó¿ÏˆÛË ÙˆÓ ÁÂ˘Ì¿ÙˆÓ Î·È Ë ‡·ÚÍË fiÏÔ

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·365

365

ªÂÛÔÁÂȷ΋ ‰›·ÈÙ· ÛÙË Ó·ڋ ËÏÈΛ·

Î·È ÂÚÈÛÛfiÙÂÚˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÛÙȘ Ôԛ˜ Î·È ÔÈ ‰‡Ô ÁÔÓ›˜ ÂÚÁ¿˙ÔÓÙ·È ¤¯Ô˘Ó Û˘Ì‚¿ÏÂÈ È‰È·›ÙÂÚ· ÛÙËÓ ·ÏÏ·Á‹ Ù˘ ‰È·ÙÚÔÊÈ΋˜ ÙÔ˘˜ Û˘ÌÂÚÈÊÔÚ¿˜, ·ÏÏ¿ Î·È ÛÙÔÓ Ù‡Ô ÙˆÓ Î·Ù·Ó·ÏÔ‡ÌÂÓˆÓ ÙÚÔÊ›ÌˆÓ (24). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‰ÈÂÚ¢ӋıËÎÂ Ë ÔÈfiÙËÙ· Ù˘ ‰›·ÈÙ·˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ ÛÙËÓ ∂ÏÏ¿‰·, fiˆ˜ ·˘Ù‹ ·ÍÈÔÏÔÁÂ›Ù·È ·fi ÙÔÓ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜, ̤ۈ ÙÔ˘ ‰Â›ÎÙË KIDMED. √ ‰Â›ÎÙ˘ ·˘Ùfi˜ ‰ËÌÈÔ˘ÚÁ‹ıËΠÁÈ· Ó· ·ÍÈÔÏÔÁ‹ÛÂÈ ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ÂÓfi˜ ÏËı˘ÛÌÔ‡ 3.850 ·ÙfïÓ, ÈÛ·ÓÈ΋˜ ηٷÁˆÁ‹˜, ËÏÈΛ·˜ 2-24 ¯ÚÔÓÒÓ ÛÙË ÌÂϤÙË enKid (15). Ÿˆ˜ ·Ó·Ê¤ÚÔ˘Ó ÔÈ Û˘ÁÁÚ·Ê›˜, ÛÙÔÓ ‰Â›ÎÙË ·˘Ùfi ÚÔÛÙ›ıÂÓÙ·È ‚·ıÌÔ› fiÙ·Ó ·ÎÔÏÔ˘ıÂ›Ù·È ÌÈ· ÛÂÈÚ¿ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜, ÂÓÒ ·Ê·ÈÚÔ‡ÓÙ·È ‚·ıÌÔ› fiÙ·Ó ˘¿Ú¯Ô˘Ó ÈÔ “‰˘ÙÈÎÔÔÈË̤Ó˜” ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ, fiˆ˜ Û˘¯Ó‹ ηٷӿψÛË Úfi¯ÂÈÚÔ˘ Ê·ÁËÙÔ‡ Î·È ÁÏ˘ÎÒÓ Î·È ·Ú¿ÏÂÈ„Ë ÚˆÈÓÔ‡ (15,25). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Û‡Ìʈӷ Ì fiÛ· ‰‹ÏˆÛ·Ó ÔÈ ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ Î·È ÔÈ ¤ÊË‚ÔÈ, ÙÔ 10% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (11,3% ÙˆÓ ·È‰ÈÒÓ Î·È 8,3% ÙˆÓ ÂÊ‹‚ˆÓ) ›¯Â ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED, ‰ËÏ·‰‹ ·ÚÔ˘Û›·˙ ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ˘ÈÔı¤ÙËÛ˘ ÙÔ˘ ÚÔÙ‡Ô˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È È‰›·ÙÂÚ· ¯·ÌËÏfi, ȉȷ›ÙÂÚ· ·Ó Û˘ÁÎÚÈı› Ì ٷ ‰Â‰Ô̤ӷ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÈÛ·ÓÈ΋ ÌÂϤÙË, ÛÙËÓ ÔÔ›· ÙÔ 49,4% ÙÔ˘ ˘fi ÌÂϤÙË ÏËı˘ÛÌÔ‡ ·ÚÔ˘Û›·˙ ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· (15). º·›ÓÂÙ·È, ÂÔ̤ӈ˜, fiÙÈ Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÛÙËÓ ∂ÏÏ¿‰· ·ÎÔÏÔ˘ıÔ‡Ó ÏÈÁfiÙÂÚÔ Ù· ·Ú·‰ÔÛȷο Î·È ÂÚÈÛÛfiÙÂÚÔ Ù· ÈÔ “‰˘ÙÈÎÔ‡ Ù‡Ô˘” ‰È·ÙÚÔÊÈο ÚfiÙ˘·, fiˆ˜, ¿ÏψÛÙÂ, ˘Ô‰ÂÈÎÓ‡Ô˘Ó Î·È ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Û ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ·˘Ù‹˜ Ù˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ (14,26). ¢ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙË ‚·ıÌÔÏÔÁ›· ÙÔ˘ KIDMED ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ, ÁÂÁÔÓfi˜ Ô˘ Ê¿ÓËÎÂ Î·È ÛÙË ÌÂϤÙË ÙˆÓ Serra-Majem Î·È Û˘Ó. (15). ¶·Ú·ÙËÚ‹Û·ÌÂ, fï˜, ÌÈ· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚÔÔ›ËÛË Ù˘ ‚·ıÌÔÏÔÁ›·˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÌÂٷ͇ ÂÊ‹‚ˆÓ Î·È ·È‰ÈÒÓ, Ì ÙÔ˘˜ ÚÒÙÔ˘˜ Ó· ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›·. √È ·ÏÏ·Á¤˜ ÛÙË ‰È·ÈÙËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ë ˘ÈÔı¤ÙËÛË ÏÈÁfiÙÂÚÔ ÔÈÔÙÈÎÒÓ Û˘ÌÂÚÈÊÔÚÒÓ Ì ÙËÓ ¿ÚÔ‰Ô Ù˘ ËÏÈΛ·˜, ¤¯ÂÈ Ê·Ó› Î·È ·fi ‰Â‰Ô̤ӷ ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (27-29). ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ·Ó·ÊÂÚı› fiÙÈ ÔÈ ÁÔÓ›˜ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Â›‰Ú·ÛË ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ·È‰ÈÒÓ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜, Ì ·ÔÙ¤ÏÂÛÌ· ·˘Ù¿ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·Ï‡ÙÂÚË ÔÈfiÙËÙ· ‰È·ÙÚÔÊ‹˜ (27). ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÔÈ ¤ÊË‚ÔÈ, ÛÙÔ Ï·›ÛÈÔ Ù˘ ÚÔÛ¿ıÂÈ¿˜ ÙÔ˘˜ Ó· ·ÓÂÍ·ÚÙËÙÔÔÈËıÔ‡Ó, ÌÂٷ͇ ¿ÏψÓ, ÙÚÔÔÔÈÔ‡Ó ÙȘ ‰È·ÙÚÔÊÈΤ˜ ÙÔ˘˜ Û˘Ó‹ıÂȘ Î·È Ô‰ËÁÔ‡ÓÙ·È Û ÏÈÁfiÙÂÚÔ ÔÈÔÙÈΤ˜, ·ÏÏ¿ ÂÚÈÛÛfiÙÂÚÔ Ù·˘ÙÈṲ̂Ó˜ Ì ÙËÓ ËÏÈΛ·

ÙÔ˘˜, ÂÈÏÔÁ¤˜. °È· ·Ú¿‰ÂÈÁÌ·, ¤¯ÂÈ ‚ÚÂı› fiÙÈ ·Ú¯›˙Ô˘Ó Ó· ηٷӷÏÒÓÔ˘Ó ÂÚÈÛÛfiÙÂÚ· Á‡̷ٷ ÂÎÙfi˜ ÛÈÙÈÔ‡, ·Ú·Ï›Ô˘Ó Û˘¯ÓfiÙÂÚ· ÙÔ ÚˆÈÓfi Î·È Î·Ù·Ó·ÏÒÓÔ˘Ó ÏÈÁfiÙÂÚ· ÊÚÔ‡Ù· Î·È Ï·¯·ÓÈο (30,31). ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ì ˘„ËÏ‹ ‚·ıÌÔÏÔÁ›· ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ KIDMED ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ¿ÙÔÌ· ÙˆÓ ÔÔ›ˆÓ Ë ÌËÙ¤Ú· ‹ Ô ·Ù¤Ú·˜ ›¯Â ˘„ËÏfiÙÂÚÔ ÌÔÚʈÙÈÎfi Â›‰Ô. ™ÙÔ ÛËÌÂ›Ô ·˘Ùfi, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔ˘Ì fiÙÈ, Û‡Ìʈӷ Î·È Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ enKid, Ù· ·È‰È¿ Î·È ÔÈ Ó·ÚÔ› ÂÓ‹ÏÈΘ Ì ηÙÒÙÂÚÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Â›‰Ô, ·ÏÏ¿ Î·È ·˘Ù¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÌËÙ¤Ú˜ ›¯·Ó ¯·ÌËÏfiÙÂÚÔ Â›Â‰Ô ÂÎ·›‰Â˘Û˘, Î·Ù·Ó¿ÏˆÓ·Ó Û˘¯ÓfiÙÂÚ· ÁÏ˘Î¿ Î·È ·ÚÙÔÛ΢¿ÛÌ·Ù· Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛÔ˜, ÛÓ·Î ÏÔ‡ÛÈ· ›Ù Û ˙¿¯·ÚË Â›Ù Û ϛÔ˜ Î·È ÏÈÁfiÙÂÚ· Ï·¯·ÓÈο Î·È ‚Ú¤ıËΠӷ ¤¯Ô˘Ó ¯·ÌËÏfiÙÂÚË ‚·ıÌÔÏÔÁ›· ÛÙÔ KIDMED (16). ¶·ÚfiÌÔȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÛÙȘ ∏.¶.∞. (32), ÛÙË ºÈÓÏ·Ó‰›· (33) Î·È Û ¿ÏϘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ (34,35). ∂›Ó·È Èı·ÓfiÓ ÛÙȘ ‰˘ÙÈÎÔ‡ Ù‡Ô˘ ÎÔÈӈӛ˜ ÙÔ ¯·ÌËÏfi ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ Î·È ÙÔ ¯·ÌËÏfi Â›Â‰Ô ÂÎ·›‰Â˘Û˘ Ó· Û¯ÂÙ›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· Ì ÏÈÁfiÙÂÚÔ ÈÛÔÚÚÔË̤Ó˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ. ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÔÏ˘·Ú·ÁÔÓÙÈ΋˜ ·Ó¿Ï˘Û˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ‚·ıÌÔÏÔÁ›· ÛÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ KIDMED, Û˘ÓÂÒ˜ Î·È Ô ‚·ıÌfi˜ ˘ÈÔı¤ÙËÛ˘ Ù˘ ÌÂÛÔÁÂȷ΋˜ ‰›·ÈÙ·˜, Û¯ÂÙ›˙ÂÙ·È ıÂÙÈο Ì ÙË Û˘ÓÔÏÈ΋ ۈ̷ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô Ù˘ ÌËÙ¤Ú·˜ Î·È ·ÚÓËÙÈο Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙȘ ηıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ¢Â‰Ô̤ӷ ·fi ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ Ô˘ Â›Ó·È ÈÔ ‰Ú·ÛÙ‹ÚÈÔÈ Ù›ÓÔ˘Ó Ó· ˘ÈÔıÂÙÔ‡Ó Î·È Î·Ï‡ÙÂÚ˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ, ÂÓÒ, ·ÓÙ›ıÂÙ·, ÔÈ ÏÈÁfiÙÂÚÔ ÔÈÔÙÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ ÂÈÏÔÁ¤˜ Û˘Ì‚·‰›˙Ô˘Ó Ì ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ ·ÊÈÂڈ̤ÓÔ Û ηıÈÛÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (36). ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Ì¤Ûˆ ÙËÏÂʈÓÈ΋˜ Û˘Ó¤ÓÙ¢Í˘ ·ÔÙÂÏ› ÌÈ· Èı·Ó‹ ·‰˘Ó·Ì›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ·ÊÔ‡ ‰ÂÓ ¤ÁÈÓ·Ó ÌÂÙÚ‹ÛÂȘ ‚¿ÚÔ˘˜ Î·È ‡„Ô˘˜, Ô‡Ù ηٿ ÚfiÛˆÔ ·ÍÈÔÏfiÁËÛË Ù˘ ‰È·ÈÙËÙÈ΋˜ ÚfiÛÏ˄˘. £· Ú¤ÂÈ fï˜ Ó· ÛËÌÂȈı› fiÙÈ Ë ·˘Í·ÓfiÌÂÓË ·Ó¿ÁÎË Û˘ÏÏÔÁ‹˜ ‰È·ÙÚÔÊÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ ·fi ÌÂÁ¿Ï· ‰Â›ÁÌ·Ù· Ì ¤Ó·Ó ÔÈÎÔÓÔÌÈÎfi ÙÚfiÔ ¤¯ÂÈ ‰È¢ڇÓÂÈ ÙË ¯Ú‹ÛË ÙˆÓ ÙËÏÂʈÓÈÎÒÓ Û˘ÓÂÓÙ‡ÍÂˆÓ Û ·ÚÎÂÙ¤˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÂÊ‹‚ˆÓ (37), Î·È ÔÈ ÌÂϤÙ˜ ÂÁ΢ÚfiÙËÙ·˜ ¤¯Ô˘Ó ˘ÔÛÙËÚ›ÍÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÙˆÓ Û˘Ïϯı¤ÓÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ (38). ∂ÈϤÔÓ, Ë ‚È‚ÏÈÔÁÚ·Ê›· ˘Ô‰ÂÈÎÓ‡ÂÈ Û¯ÂÙÈο ÌÂÁ¿ÏË ÂÁ΢ÚfiÙËÙ· ÙÔ˘ ·˘ÙÔ‰ËÏÔ‡ÌÂÓÔ˘ ¶·È‰È·ÙÚÈ΋ 2008;71:361-367

Pediatri Sept-Oct 08

14-10-08

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ORIGINAL ARTICLE

™¯¤ÛË ÙÔ˘ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ Ì ÂÈÏÂÁ̤Ó˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û 11¯ÚÔÓ· ·È‰È¿ 1 ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ º˘ÛÈ΋˜ ∞ÁˆÁ‹˜ & ∞ıÏËÙÈÛÌÔ‡, ¢ËÌÔÎÚ›ÙÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £Ú¿Î˘ 2 ∞’ ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ™¿‚‚·˜ ∆ÔÎ̷Λ‰Ë˜ stokmaki@phyed.duth.gr ∆.∂.º.∞.∞. ∫ÔÌÔÙËÓ‹˜ ¢ËÌÔÎÚ›ÙÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £Ú¿Î˘ ¶·ÓÂÈÛÙËÌÈÔ‡ÔÏË 69100 ∫ÔÌÔÙËÓ‹

∞. ÃÚÈÛÙfi‰Ô˘ÏÔ˜1, ∂. ¢Ô‡‰·1, ¢. ∆Ô‡ÛÔ˘Ï˘2, ™. ∆ÔÎ̷Λ‰Ë˜1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ‰ÈÂÚ¢ӋÛÂÈ ÙË Û¯¤ÛË ÙÔ˘ ¢Â›ÎÙË ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) Ì ÂÈÏÂÁ̤Ó˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, Û ·È‰È¿ Ù˘ ™∆’ Ù¿Í˘ ÙÔ˘ ¢ËÌÔÙÈÎÔ‡. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∆Ô ‰Â›ÁÌ· ·ÔÙ¤ÏÂÛ·Ó 181 ·ÁfiÚÈ· Î·È 197 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 11,40±0,39 ÂÙÒÓ, ·fi ÙË µÔÚÂÈÔ·Ó·ÙÔÏÈ΋ ∞ÙÙÈ΋. ∞ÍÈÔÏÔÁ‹ıËÎ·Ó Ù· ·ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ, Ë ‰È·ÙÚÔÊ‹, Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (º¢) Î·È ÂÈÏÂÁ̤Ó˜ ·Ú¿ÌÂÙÚÔÈ Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘. ∏ ÂÎÙ›ÌËÛË ÙÔ˘ ˘ÂÚ‚ÔÏÈÎÔ‡ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È Ù˘ ·¯˘Û·ÚΛ·˜ ¤ÁÈÓ Ì ‚¿ÛË ‰ÈÂıÓ‹ ÎÚÈÙ‹ÚÈ·. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô 37,3% ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó ˘¤Ú‚·ÚÔ/·¯‡Û·ÚÎÔ (˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜: 28,6%, ·¯˘Û·ÚΛ·: 8,7%), ¯ˆÚ›˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (χ2=0,03, p=0,986). T· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· ·Ó¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (p=0,009 Î·È p=0,0001, ·ÓÙ›ÛÙÔȯ·) Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ Ï›Ô˘˜ (p=0,045 Î·È p=0,005, ·ÓÙ›ÛÙÔȯ·) Î·È ÚˆÙÂ˚ÓÒÓ (p=0,028 Î·È p=0,0001, ·ÓÙ›ÛÙÔȯ·) ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, Û ۯ¤ÛË Ì ٷ ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¢ª™. ∏ ÂÓÂÚÁÂȷ΋ ‰·¿ÓË ·fi º¢ ˘„ËÏ‹˜ ¤ÓÙ·Û˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ˘¤Ú‚·Ú· ·È‰È¿ (·ÁfiÚÈ·: p=0,05, ÎÔÚ›ÙÛÈ·: p=0,011), ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ‰È·ÈÛÙÒıËÎ·Ó ÂÈϤÔÓ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘ÓÔÏÈ΋ º¢ (p=0,024). ∆· ˘¤Ú‚·Ú· ·È‰È¿ ÛËÌ›ˆÛ·Ó ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ ÛÙËÓ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ Î·È ÙË Ì˘˚΋ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ (p≤0,001). ªÂ ‚¿ÛË ÙȘ ·Ó·Ï‡ÛÂȘ ÔÏÏ·Ï‹˜ ·ÏÈÓ‰ÚfiÌËÛ˘, Ë º¢ ÛÙ· ‰‡Ô ʇϷ (·ÁfiÚÈ·: ‚=-0,18, SE=0,01, p=0,05, ÎÔÚ›ÙÛÈ·: ‚=-0,17, SE=0,31, p=0,05) Î·È Ë ‰È·ÙÚÔÊÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ÛÙ· ÎÔÚ›ÙÛÈ· (‚=0,17, SE=0,04, p=0,05) ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ ·ÓÂÍ¿ÚÙËÙË Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ¢ª™. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ, ÂÈÛËÌ·›ÓÔÓÙ·˜ ÙËÓ ·Ó¿ÁÎË ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘, Ì ÛÙfi¯Ô ÙËÓ ·‡ÍËÛË Ù˘ º¢, ÙË ‚ÂÏÙ›ˆÛË Ù˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜ Î·È ÙËÓ ˘ÈÔı¤ÙËÛË ˘ÁÈÂÈÓÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÚÔÙ‡ˆÓ.

§¤ÍÂȘ ÎÏÂȉȿ: ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, ·È‰È΋ ·¯˘Û·ÚΛ·, Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, Ê˘ÛÈ΋ ηٿÛÙ·ÛË, Ì·ÎÚÔıÚÂÙÈο ÛÙÔȯ›·.

The relation of body mass index with selected behavioural parameters in 11 year-old children 1 Department of Sports and Exercise Science, Democritus University of Thrace, Greece 2 1st Cardiology Unit, Athens University Medical School, Greece Correspondence: Savvas Tokmakidis stokmaki@phyed.duth.gr Department of Physical Education and Sports Science Democritus University of Thrace 69100 Komotini, Greece

Paediatriki 2008;71:368-375

A. Christodoulos1, H. Douda1, D. Tousoulis2, S. Tokmakidis1 Abstract Background: The aim of this study was to investigate the possible relationship of body mass index (BMI) with selected behavioural parameters in 11 year-old Greek children.

Methods: The sample consisted of 181 boys and 197 girls, aged 11.40±0.39 years, from northeastern Attica, Greece. Data were collected on the children’s anthropometry, dietary patterns, physical activity (PA), and selected physical fitness components. The participants were classified into normal weight and overweight/obese according to international age- and gender-specific BMI cut-off points.

Results: The prevalence of overweight/obesity was 37.3% (overweight: 28.6%, obese: 8.7%), without a significant gender difference (χ2=0.03, p=0.986). Compared with their normal-weight peers, overweight boys and girls reported lower energy intake derived from carbohydrates (p=0.009 and p=0.0001, respectively) and a higher intake of fat (p=0.045 and p=0.005, respectively) and protein (p=0.028 and p=0.0001, respectively). Energy expenditure from vigorous PA was lower in overweight children (boys: p=0.05, girls: p=0.011), while for girls, statistically significant differences were also observed in total PA (p=0.024). Finally, the overweight children had lower cardiovascular fitness and abdominal endurance than their normal-weight peers (p≤0.001). In multiple regression analysis, PA for both genders (boys: ‚=-0.18, SE=0.01, p=0.05, girls: ‚=-0.17, SE=0.31, p=0.05) and dietary fat intake for girls (‚=0.17, SE=0.04, p=0.05) remained significantly and independently related to BMI. Conclusions: These findings confirm the rising prevalence of obesity in Greek children and suggest that

Pediatri Sept-Oct 08

14-10-08

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¶·¯˘Û·ÚΛ· Î·È ·Ú¿ÌÂÙÚÔÈ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿

future intervention strategies for counteracting and/or preventing obesity in children should aim primarily at promotion of physical activity, improvement of cardiorespiratory fitness and adoption of healthy dietary patterns.

Key words: Body mass index, childhood obesity, physical activity, physical fitness, macronutrients.

™˘ÓÙÔÌÔÁڷʛ˜ ¢∂: ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘ ¢ª™: ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ∂º¢∆∑: ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ÙÚfiÔ˘ ˙ˆ‹˜ ª∂∆: ÌÂÙ·‚ÔÏÈÎfi ÈÛÔ‰‡Ó·ÌÔ SE: Ù˘ÈÎfi ÛÊ¿ÏÌ· ∆∞: Ù˘È΋ ·fiÎÏÈÛË À¶/¶™: ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜/·¯˘Û·ÚΛ· º¢: Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·

∂ÈÛ·ÁˆÁ‹ ∏ ÂÍ¿ψÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô ·Ó·‰ÂÈÎÓ‡ÂÙ·È ˆ˜ ¤Ó· ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ·, ηıÒ˜ Ë ·˘ÍË̤ÓË Û˘ÛÛÒÚ¢ÛË ÛˆÌ·ÙÈÎÔ‡ Ï›Ô˘˜ ÛÙ· ·È‰È¿, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ˘„ËϤ˜ ÙÈ̤˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ‰˘ÛÌÂÓ¤˜ ÚÔÊ›Ï ÏÈȉ›ˆÓ Î·È ˘„ËϤ˜ ÙÈ̤˜ ÁÏ˘Îfi˙˘ Î·È ÈÓÛÔ˘Ï›Ó˘ ÛÙÔ ·›Ì· (1-3). ∂ÈϤÔÓ, Ë ·È‰È΋ ·¯˘Û·ÚΛ· Âȉڿ ‚Ï·ÙÈο ÛÙË ‰ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ·ÁÁ›ˆÓ Ì·ÎÚÔÚfiıÂÛÌ·, Û˘Ì‚¿ÏÏÔÓÙ·˜ ÛÙË ÌÂÏÏÔÓÙÈ΋ ÂÌÊ¿ÓÈÛË Î·Ú‰È·ÁÁÂÈ·ÎÒÓ Î·È ÌÂÙ·‚ÔÏÈÎÒÓ ·ı‹ÛˆÓ, fiˆ˜ ÌÂÙ·‚ÔÏÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ηڈÙȉÈ΋˜ ÓfiÛÔ˘, ‰È·‚‹ÙË Ù‡Ô˘ ππ Î·È ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (4-6). ∞ÚÎÂÙ¤˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙfiÛÔ Ë ·¯˘Û·ÚΛ· Î·È ÔÈ ÂÈÏÔΤ˜ Ù˘ (5-7) fiÛÔ Î·È ÔÈ Û˘ÌÂÚÈÊÔÚ¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù‹Ó (8,9) ¤¯Ô˘Ó ÙȘ Ú›˙˜ ÙÔ˘˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ù›ÓÔ˘Ó Ó· ÌÂٷʤÚÔÓÙ·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∆· ·È‰È¿ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÂÓ‹ÏÈΘ ÙÔ˘ ̤ÏÏÔÓÙÔ˜Ø Û˘ÓÂÒ˜ Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·‡ÍËÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ ı· Ú¤ÂÈ Ó· ·ÔÙÂϤÛÂÈ ÛËÌ·ÓÙÈ΋ ÚÔÙÂÚ·ÈfiÙËÙ· ÁÈ· ÙÔ˘˜ ÊÔÚ›˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘Á›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ó·Ù˘¯ıÔ‡Ó ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜ ÚfiÏ˄˘ Î·È ÚÒÈÌ˘ ·Ú¤Ì‚·Û˘. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ ÛÙËÓ ∂ÏÏ¿‰· ¤¯ÂÈ ˘ÂÚ‰ÈÏ·ÛÈ·ÛÙ› ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· (10). ∆· ‰Â‰Ô̤ӷ Ô˘ ·ÊÔÚÔ‡Ó ÙË Û¯¤ÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ Ì ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ›ӷÈ, ˆÛÙfiÛÔ, ÏÈÁÔÛÙ¿ Î·È Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ·ÓÙÈÎÚÔ˘fiÌÂÓ· (11-14). ∂ÈϤÔÓ, Ù· Û˘ÌÂÚ¿ÛÌ·Ù¿ ÙÔ˘˜ ‰ÂÓ Â›Ó·È ÁÂÓÈ·ÛÈÌ·, ηıÒ˜ Ë Û˘ÓÂÚÁÈ-

ÛÙÈ΋ Â›‰Ú·ÛË ÙˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ Û˘ÓÙÂÏÔ‡Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ Â›Ó·È Èı·ÓfiÓ Ó· ‰È·ÊÔÚÔÔÈÂ›Ù·È ·fi ÂÚÈÔ¯‹ Û ÂÚÈÔ¯‹. ¢Â‰Ô̤Ó˘ Ù˘ ·Ó¿Á΢ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ı¤Ì·ÙÔ˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÍÂÙ¿˙ÂÙ·È Ë Û¯¤ÛË Ù˘ ·¯˘Û·ÚΛ·˜ Ì ÙË ‰È·ÙÚÔÊ‹, ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (º¢) Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË Û ¤Ó· ‰Â›ÁÌ· Ì·ıËÙÒÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ¶ÂÚÈÔ¯‹ Î·È ÏËı˘ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ∏ ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠÙÔ Û¯ÔÏÈÎfi ¤ÙÔ˜ 2005-2006 (√ÎÙÒ‚ÚÈÔ˜ 2005 - π·ÓÔ˘¿ÚÈÔ˜ 2006) ÛÙË µÔÚÂÈÔ·Ó·ÙÔÏÈ΋ ∞ÙÙÈ΋, Ì ÙËÓ ¤ÁÎÚÈÛË ÙÔ˘ ¶·È‰·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘, Î·È ·ÔÙÂÏ› ÙÌ‹Ì· ¢ڇÙÂÚ˘ ¤Ú¢ӷ˜ Ì ÛÎÔfi ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ Ù˘ ·¯˘Û·ÚΛ·˜ Ì ÙÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜ Î·È ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÙˆÓ Ì·ıËÙÒÓ. °È· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ¤Ú¢ӷ˜ ÂÈϤ¯ıËηÓ, Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Ù˘¯·›ˆÓ ·ÚÈıÌÒÓ, 15 ·fi Ù· 25 ‰ËÌfiÛÈ· ‰ËÌÔÙÈο Û¯ÔÏ›· Ù˘ ÂÚÈÔ¯‹˜, ÛÙ· ÔÔ›· ÊÔÈÙÔ‡Û·Ó 393 Ì·ıËÙ¤˜ Ù˘ ™∆ã Ù¿Í˘ (205 ÎÔÚ›ÙÛÈ·, 188 ·ÁfiÚÈ·). ∆Ô ˘ÏÈÎfi Ù˘ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛ·Ó ÙÂÏÈο 378 Ì·ıËÙ¤˜ ËÏÈΛ·˜ 11,4±0,4 ÂÙÒÓ (197 ÎÔÚ›ÙÛÈ·, 181 ·ÁfiÚÈ·, ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ 96,2%), ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÔÔ›ˆÓ ˙ËÙ‹ıËΠ¤ÁÁÚ·ÊË ¿‰ÂÈ· ÙˆÓ ÁÔÓ¤ˆÓ, ηÙfiÈÓ ÏÂÙÔÌÂÚÔ‡˜ ÂÓË̤ڈۋ˜ ÙÔ˘˜ ̤ۈ ÂÈÛÙÔÏ‹˜. ∆· ‰Â‰Ô̤ӷ Û˘ÏϤ¯ıËÎ·Ó Î·Ù¿ ÙȘ ÚÒÙ˜ ÒÚ˜ ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ Û¯ÔÏÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Î·È ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Ì·ı‹Ì·ÙÔ˜ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜. ∞ÊÔ‡ ÚÔËÁÔ˘Ì¤Óˆ˜ ‰fiıËÎ·Ó ÔÈ ··Ú·›ÙËÙ˜ Ô‰ËÁ›Â˜ Î·È ‰È¢ÎÚÈÓ›ÛÂȘ ÁÈ· ÙÔÓ ÙÚfiÔ ‰ÈÂÍ·ÁˆÁ‹˜ ÙˆÓ ÌÂÙÚ‹ÛˆÓ, ÔÈ Ì·ıËÙ¤˜ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ˆ˜ ÚÔ˜ ÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙ˜, ÙË ‰È·ÙÚÔÊ‹, ÙË º¢ Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÂÎÙ¤ÏÂÛ˘ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ÔÈ Ì·ıËÙ¤˜ ·Ú·ÎÈÓÔ‡ÓÙ·Ó ·fi ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Ó· ηٷ‚¿ÏÔ˘Ó ÙÔ Ì¤ÁÈÛÙÔ ÙˆÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘˜. ∞ÓıÚˆÔÌÂÙÚÈÎÔ› ‰Â›ÎÙ˜ √È ÛˆÌ·ÙÔÌÂÙÚ‹ÛÂȘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Ì ÙÔ˘˜ Ì·ıËÙ¤˜ ÓÙ˘Ì¤ÓÔ˘˜ ÂÏ·ÊÚ¿ Î·È ¯ˆÚ›˜ ˘Ô‰‹Ì·Ù·. ∆Ô ‚¿ÚÔ˜ ÌÂÙÚ‹ıËΠ̠„ËÊȷ΋ ˙˘Á·ÚÈ¿ ·ÎÚȂ›·˜, Ì ÚÔÛ¤ÁÁÈÛË ±0,1 kg. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ̠ÙËÓ Ï¿ÙË ›ÛÈ· Î·È ·ÎÔ˘ÌÈṲ̂ÓË Û ·Ó·ÛÙËÌfiÌÂÙÚÔ ÙÔ›¯Ô˘, Ì ÚÔÛ¤ÁÁÈÛË ±0,5 cm. √ ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠˆ˜ ÙÔ ËÏ›ÎÔ ÙÔ˘ ‚¿ÚÔ˘˜ ‰È· ÙÔ˘ ‡„Ô˘˜ ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2). ªÂ ‚¿ÛË ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ·, ÔÈ ÙÈ̤˜ ÙÔ˘ ¢ª™ οı ·È‰ÈÔ‡ ÌÂÙ·ÙÚ¿ËÎ·Ó Û z-score Î·È ÂÎÙÈÌ‹ıËÎÂ Ë Û˘¯ÓfiÙËÙ· ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· ¶·È‰È·ÙÚÈ΋ 2008;71:368-375

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·370

370

∞. ÃÚÈÛÙfi‰Ô˘ÏÔ˜ Î·È Û˘Ó.

∞ÁfiÚÈ·

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∫ÔÚ›ÙÛÈ·

30

30

20

20

10

10

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-3,00 -2,00 -1,00 -0,00 1,00 2,00 ¢ª™ z-score

3,00

4,00

0

-3,00 -2,00 -1,00 -0,00 1,00 2,00 ¢ª™ z-score

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4,00

∂ÈÎfiÓ· 1. ∫·Ù·ÓÔÌ‹ ÙˆÓ z-scores ÙÔ˘ ¢ª™ ÛÙ· ‰‡Ô ʇϷ Û ۯ¤ÛË Ì ÙËÓ Î·Ì‡ÏË Î·ÓÔÓÈ΋˜ ηٷÓÔÌ‹˜.

Ù˘ ¢ÈÂıÓÔ‡˜ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ÁÈ· ÙËÓ ¶·¯˘Û·ÚΛ·, Ù· ÔÔ›· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙȘ ÙÈ̤˜ ·Ó·ÊÔÚ¿˜ ÙÔ˘ ¢ª™ ÂÓËϛΈÓ, ‰ËÏ·‰‹ Û 25.01≤¢ª™≥29.99 kg/m2 ÁÈ· ÙÔ ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È Û ¢ª™≥30.0 kg/m2 ÁÈ· ÙËÓ ·¯˘Û·ÚΛ· (15,16). ∞ÍÈÔÏfiÁËÛË ‰È·ÙÚÔÊ‹˜ ∏ ‰È·ÙÚÔÊ‹ ·ÍÈÔÏÔÁ‹ıËΠ̠¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ 24ˆÚ˘ ·Ó¿ÎÏËÛ˘ (17). √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÎÏ‹ıËÎ·Ó Ó· ηٷÁÚ¿„Ô˘Ó Ì ·ÎÚ›‚ÂÈ· ÙÔ Â›‰Ô˜ Î·È ÙËÓ ÔÛfiÙËÙ· fiÏˆÓ ÙˆÓ ÁÂ˘Ì¿ÙˆÓ, ˘ÁÚÒÓ Î·È Ù˘¯fiÓ Û˘ÌÏËÚˆÌ¿ÙˆÓ Ô˘ Î·Ù·Ó¿ÏˆÛ·Ó ÙËÓ ÚÔËÁÔ‡ÌÂÓË Ë̤ڷ, Ì ÙÔÓ fiÚÔ fiÙÈ ‹Ù·Ó ÌÈ· Û˘ÓËıÈṲ̂ÓË Ë̤ڷ. °È· ÙËÓ ·ÎÚÈ‚‹ ÂÎÙ›ÌËÛË ÙˆÓ ÔÛÔÙ‹ÙˆÓ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÌÈ·˜ ηÓÔÓÈ΋˜ ÌÂÚ›‰·˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ¤Á¯ÚˆÌ˜ ʈÙÔÁڷʛ˜ ÙÚÔʛ̈Ó. ªÂ ‚¿ÛË ÙÔ˘˜ “¶›Ó·Î˜ Û‡ÓıÂÛ˘ ÙÚÔÊ›ÌˆÓ Î·È ÂÏÏËÓÈÎÒÓ Ê·ÁËÙÒÓ” (18), ηıÒ˜ Î·È ÙȘ ÂÙÈΤÙ˜ Û˘Û΢·ÛÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ΢ÎÏÔÊÔÚÔ‡Ó ÛÙËÓ ÂÏÏËÓÈ΋ ·ÁÔÚ¿, ÂÎÙÈÌ‹ıËÎ·Ó Ë Û˘ÓÔÏÈ΋ ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (kcal/Ë̤ڷ) Î·È Ë ÚfiÛÏË„Ë Ì·ÎÚÔıÚÂÙÈÎÒÓ ÛÙÔȯ›ˆÓ ˆ˜ ÔÛÔÛÙfi Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜. ∂ÎÙ›ÌËÛË Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ∏ º¢ ·ÔÙÈÌ‹ıËΠ̠ÙÔ ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ º˘ÛÈ΋˜ ¢Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ∆ÚfiÔ˘ ∑ˆ‹˜ (∂º¢∆∑), ¤Ó· ·ÍÈfiÈÛÙÔ Î·È ¤Á΢ÚÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ∂ÏÏËÓÔ·›‰ˆÓ (19). √È Ì·ıËÙ¤˜ ÎÏ‹ıËÎ·Ó Ó· ηٷÁÚ¿„Ô˘Ó fiϘ ÙȘ º¢ ÛÙȘ Ôԛ˜ Û˘ÌÌÂÙ›¯·Ó ÛÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ Ù˘È΋˜ ‚‰ÔÌ¿‰·˜ ηÈ, ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÙȘ ÙÂÏÂ˘Ù·›Â˜ 7 Ë̤Ú˜. °È· fiϘ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÔÈ Ì·ıËÙ¤˜ ¤ÚÂ ӷ ‰ÒÛÔ˘Ó ·Ó·Ï˘ÙÈΤ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙË Û˘¯ÓfiÙËÙ· Î·È ÙË ‰È¿ÚÎÂÈ· Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘˜ Û ·˘Ù¤˜. ªÂ ‚¿ÛË Ù· ÛÙÔȯ›· ·˘Ù¿ Î·È ÙÔ ÂÓÂÚÁÂÈ·Îfi ÎfiÛÙÔ˜ οı ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Û ÌÂÙ·‚ÔÏÈο ÈÛÔ‰‡Ó·Ì· (ª∂∆) (20), ˘ÔÏÔÁ›ÛÙËÎÂ Ë ÂÓÂÚÁÂȷ΋ ‰·¿ÓË (Û MET-ÒÚ˜/‚‰ÔÌ¿‰·) ·fi ‰Ú·ÛÙËÚÈfiÙËÙ˜ ̤ÙÚÈ·˜ (3-5,9 ª∂∆) Î·È ˘„ËÏ‹˜ ¤ÓÙ·Û˘ (≥6 ª∂∆), ηıÒ˜ Î·È Ë Û˘ÓÔÏÈ΋ ‚‰ÔÌ·‰È·›· ÂÓÂÚÁÂȷ΋ ‰·¿ÓË. ŒÏÂÁ¯Ô˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ∏ Ê˘ÛÈ΋ ηٿÛÙ·ÛË ·ÍÈÔÏÔÁ‹ıËΠ̠ÙȘ ‰ÔÎÈ̷ۛ˜ ÙÔ˘ ·Ï›Ó‰ÚÔÌÔ˘ ÙÚÂ̷͛ÙÔ˜ 20 m (ηډÈÔ·Ó·Ó¢ÛÙÈ΋ Paediatriki 2008;71:368-375

·ÓÙÔ¯‹), ÙˆÓ ·Ó·‰ÈÏÒÛÂˆÓ ·fi ÙËÓ Î·Ù¿ÎÏÈÛË Û 30 sec (Ì˘˚΋ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡) Î·È Ù˘ ‰›ψÛ˘ ·fi ηıÈÛÙ‹ ı¤ÛË (Â˘Ï˘ÁÈÛ›·). √È ‰ÔÎÈ̷ۛ˜ ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙËÓ ∂˘Úˆ·˚΋ ¢¤ÛÌË ¢ÔÎÈÌ·ÛÈÒÓ EUROFIT, ÂÓÒ Ô ÙÚfiÔ˜ ‰ÈÂÍ·ÁˆÁ‹˜ ÙÔ˘˜ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ Û¯ÂÙÈÎfi ÂÁ¯ÂÈÚ›‰ÈÔ (21). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË °È· fiϘ ÙȘ ÛÙ·ÙÈÛÙÈΤ˜ ·Ó·Ï‡ÛÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· SPSS 13,0. √È Û˘Ó¯›˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ̤Û˜ ÙÈ̤˜ ± Ù˘È΋ ·fiÎÏÈÛË. √È Î·ÙËÁÔÚÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ÂÚÈÁÚ¿ÊÔÓÙ·È ˆ˜ Û¯ÂÙÈΤ˜ Û˘¯ÓfiÙËÙ˜. ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍÂÙ·ÛÙÔ‡Ó ÔÈ Èı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ ÛÙ· ÔÛÔÛÙ¿ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ ¤ÁÈÓ ¯Ú‹ÛË ÙÔ˘ ÙÂÛÙ χ2. ∏ ·Ó¿Ï˘ÛË Û˘Ó‰È·Î‡Ì·ÓÛ˘ Ì ڇıÌÈÛË ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ‰È·ÊÔÚÒÓ ÛÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙ˜, ÙË ‰È·ÙÚÔÊ‹, ÙË º¢ Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË, Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ Î·È ÙÔÓ ¢ª™. ™ÙË Û˘Ó¤¯ÂÈ· ÂÊ·ÚÌfiÛÙËÎ·Ó ·Ó·Ï‡ÛÂȘ ÔÏÏ·Ï‹˜ ÁÚ·ÌÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ͯˆÚÈÛÙ¿ ÁÈ· Ù· ‰‡Ô ʇϷ, ÁÈ· Ó· ÂÍÂÙ·ÛÙ› Ë ·ÓÂÍ¿ÚÙËÙË Â›‰Ú·ÛË Ù˘ º¢ Î·È ÙˆÓ ‰È·ÙÚÔÊÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ ÛÙÔÓ ¢ª™. ∆Ô Â›Â‰Ô ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËΠ۠p<0,05.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ÂÓÒ ÛÙËÓ ∂ÈÎfiÓ· 1 ·ÂÈÎÔÓ›˙ÂÙ·È Ë Î·Ù·ÓÔÌ‹ ÙÔ˘ z-score ÙÔ˘ ¢ª™ ÛÙ· ‰‡Ô ʇϷ, Û ۯ¤ÛË Ì ÙËÓ Î·Ì‡ÏË Î·ÓÔÓÈ΋˜ ηٷÓÔÌ‹˜. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ·ÁÔÚÈÒÓ Î·È ÎÔÚÈÙÛÈÒÓ ÛÙÔ ‡„Ô˜, ÙÔ ‚¿ÚÔ˜ ‹ ÙÔÓ ¢ª™. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, Ë Î‡ÚÈ· Â›‰Ú·ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· «Î·ÙËÁÔÚ›· ¢ª™» ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û fiÏÔ˘˜ ÙÔ˘˜ ÂÍÂÙ·˙fiÌÂÓÔ˘˜ ‰Â›ÎÙ˜. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÔÈ Ì¤ÛÔÈ fiÚÔÈ ÙÔ˘ ‡„Ô˘˜, ÙÔ˘ ‚¿ÚÔ˘˜ Î·È ÙÔ˘ ¢ª™ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔÈ ÛÙ· ˘¤Ú‚·Ú·/·¯‡Û·Úη ·È‰È¿, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·371

371

¶·¯˘Û·ÚΛ· Î·È ·Ú¿ÌÂÙÚÔÈ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿

¶›Ó·Î·˜ 1. ∞ÓıÚˆÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Û˘¯ÓfiÙËÙ· ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ ÛÙÔ ‰Â›ÁÌ· Ù˘ ¤Ú¢ӷ˜ ¶·Ú¿ÌÂÙÚÔÈ

∫·ÙËÁÔڛ˜ ¢ª™

⁄„Ô˜ (cm)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

µ¿ÚÔ˜ (kg)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

¢ª™ (kg/m2)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

¢ª™ (z-score)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

™˘¯ÓfiÙËÙ· À¶/¶™

ÀÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜, % (95% ¢∂) ¶·¯˘Û·ÚΛ·, % (95% ¢∂)

∫ÔÚ›ÙÛÈ·

∞ÁfiÚÈ·

n=197

n=181

150,28±7,15 153,00±6,64‡ F(1, 373)=8,18 39,45±6,41 56,61±9,52# F(1, 373)=272,11 17,36±1,81 24,11±3,03# F(1, 373)=429,65 -0,26±0,84 1,89±0,55# F(1, 373)=386,45 28,9 (22,6-35,2) 8,6 (4,7-12,5)

149,87±6,91 151,97±5,85* F(1, 373)= 4,44 39,89±6,43 55,28±7,41# F(1, 373)=198,01 17,69±1,79 23,89±2,80# F(1, 373)=328,71 0,17±0,87 2,15±0,47# F(1, 373)=293,45 28,2 (21,6-34,8) 8,8 (4,7-12,9)

¢ª™ = ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜, À¶/¶™ = ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜/·¯˘Û·ÚΛ·, ¢∂ = ‰È¿ÛÙËÌ· ÂÌÈÛÙÔÛ‡Ó˘. √È ÙÈ̤˜ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ˘˜ ·ÓıÚˆÔÌÂÙÚÈÎÔ‡˜ ‰Â›ÎÙ˜ ·ÊÔÚÔ‡Ó Ì¤ÛË ÙÈÌ‹±Ù˘È΋ ·fiÎÏÈÛË. ∆Ô ˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜ Î·È Ë ·¯˘Û·ÚΛ· ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ Û¯ÂÙÈΤ˜ Û˘¯ÓfiÙËÙ˜ (95% ¢∂). ∏ Ù·ÍÈÓfiÌËÛË ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ Ì ‚¿ÛË ÙȘ ‰ÈÂıÓ›˜ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ˘ÂÚ‚ÔÏÈÎÔ‡ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ 2-18 ÂÙÒÓ (15). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Î·ÙËÁÔÚÈÒÓ ÙÔ˘ ¢ª™ ÁÈ·: *p≤0,05, ‡p≤0,005, #p≤0,0001.

‚¿ÚÔ˘˜ (¶›Ó·Î·˜ 1). ªÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ô˘ Ù¤ıËÎ·Ó (15,16), 37,3% ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó ˘¤Ú‚·ÚÔÈ (˘ÂÚ‚ÔÏÈÎfi ‚¿ÚÔ˜: 28,6%, ·¯˘Û·ÚΛ·: 8,7%), ¯ˆÚ›˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ (χ2=0,03, df=2, p=0,986). ∆· ‰È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Ë º¢ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∏ ̤ÛË ËÌÂÚ‹ÛÈ· ıÂÚÌȉÈ΋ ÚfiÛÏË„Ë ‰ÂÓ ·ÚÔ˘Û›·Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ·È‰ÈÒÓ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ¢ª™ Î·È ˘¤Ú‚·ÚˆÓ/·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, Ì ÂÍ·›ÚÂÛË ÌÈ· ÔÚȷ΋ ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· ÛÙ· ·ÁfiÚÈ· (p=0,058). ™ËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ‚Ú¤ıËÎ·Ó ÛÙ· ÂÈ̤ÚÔ˘˜ Ì·ÎÚÔıÚÂÙÈο ÛÙÔȯ›·, Ì ٷ ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· Ó· ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ÚfiÛÏË„Ë ˘‰·Ù·ÓıÚ¿ÎˆÓ (p=0,009 Î·È p=0,0001, ·ÓÙ›ÛÙÔȯ·) Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ Ï›Ô˘˜ (p=0,045 Î·È p=0,005, ·ÓÙ›ÛÙÔȯ·) Î·È ÚˆÙÂ˚ÓÒÓ (p=0,028 Î·È p=0,0001, ·ÓÙ›ÛÙÔȯ·) ÛÙË ‰È·ÙÚÔÊ‹ ÙÔ˘˜, Û ۯ¤ÛË Ì ٷ ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¢ª™. ∏ ÂÓÂÚÁÂȷ΋ ‰·¿ÓË ·fi º¢ ˘„ËÏ‹˜ ¤ÓÙ·Û˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (p=0,05 Î·È p=0,011, ·ÓÙ›ÛÙÔȯ·), ÂÓÒ ÛÙ· ÎÔÚ›ÙÛÈ· ‰È·ÈÛÙÒıËÎ·Ó ÂÈϤÔÓ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘ÓÔÏÈ΋ ‚‰ÔÌ·‰È·›· ÂÓÂÚÁÂȷ΋ ‰·¿ÓË (p=0,024). ∆¤ÏÔ˜, Ù· ˘¤Ú‚·Ú· ·È‰È¿ ÛËÌ›ˆÛ·Ó ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ ÛÙËÓ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ Î·È ÙË Ì˘˚΋ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ (∂ÈÎfiÓ· 2·-‚), ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ Â˘Ï˘ÁÈÛ›· (∂ÈÎfiÓ· 2Á). ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ·Ó·Ï‡ÛÂˆÓ ÁÚ·ÌÌÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ ‚Ú¤ıËΠfiÙÈ ÛÙ· ÎÔÚ›ÙÛÈ· Ë Û˘-

ÓÔÏÈ΋ º¢ (p=0,017) Î·È Ë ‰È·ÙÚÔÊÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ (p=0,019) Û˘Ó¤‚·Ï·Ó ÛËÌ·ÓÙÈο Î·È ·ÓÂÍ¿ÚÙËÙ· Ë Î¿ı ̛· ·fi ÙËÓ ¿ÏÏË ÛÙËÓ Úfi‚ÏÂ„Ë ÙÔ˘ ¢ª™ (¶›Ó·Î·˜ 3). ™Ù· ·ÁfiÚÈ·, Ë Û˘ÓÔÏÈ΋ º¢ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Ú¿ÌÂÙÚÔ˜ ÙÔ˘ ¢ª™ (p=0,018), ÂÓÒ Ë Û˘Ì‚ÔÏ‹ Ù˘ ̤Û˘ ËÌÂÚ‹ÛÈ·˜ ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘ Î·È Ù˘ ÚfiÛÏ˄˘ Ï›Ô˘˜ ‹Ù·Ó ÔÚȷο ÛËÌ·ÓÙÈ΋ (p=0,067 Î·È p=0,089, ·ÓÙ›ÛÙÔȯ·). √È ÂÍÈÛÒÛÂȘ ·ÏÈÓ‰ÚfiÌËÛ˘ ÂÚÌ‹ÓÂ˘Û·Ó Î·È ÛÙ· ‰‡Ô ʇϷ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi Ù˘ ‰È·Î‡Ì·ÓÛ˘ ÙÔ˘ ¢ª™ (7%).

™˘˙‹ÙËÛË ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÍÂÙ¿ÛÙËÎÂ Ë Û¯¤ÛË ÙÔ˘ ¢ª™ Ì ÙË º¢, ÙË ‰È·ÙÚÔÊ‹ Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË Û 11¯ÚÔÓÔ˘˜ Ì·ıËÙ¤˜. ¢È·ÈÛÙÒıËΠ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ˘¤Ú‚·ÚˆÓ/·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ, Ù· ÔÔ›·, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜, ·ÚÔ˘Û›·Û·Ó ÌÂȈ̤ÓË º¢, ‰È·ÊÔÚÂÙÈο ‰È·ÙÚÔÊÈο ÚfiÙ˘· Î·È ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘. ∞fi ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, Ë º¢ ÛÙ· ‰‡Ô ʇϷ Î·È Ë ÚfiÛÏË„Ë Ï›Ô˘˜ ÛÙ· ÎÔÚ›ÙÛÈ· ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ ·ÓÂÍ¿ÚÙËÙË Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ¢ª™. ∆Ô 37,3% ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ›¯·Ó Úfi‚ÏËÌ· ‚¿ÚÔ˘˜. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ÂȂ‚·ÈÒÓÔ˘Ó Ù· ·ÓËÛ˘¯ËÙÈο ÔÛÔÛÙ¿ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ ÛÙË ¯ÒÚ· Ì·˜, Ù· ÔÔ›· ηٷÁÚ¿ÊÔÓÙ·È ÙfiÛÔ ÛÙ· ·ÛÙÈο ΤÓÙÚ·, fiÛÔ Î·È ÛÙËÓ ÂÏÏËÓÈ΋ ÂÚÈʤÚÂÈ· (13,14,22,23). ™Â Û‡ÁÎÚÈÛË Ì ¿ÏϘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, Ù· ÔÛÔÛÙ¿ ÙˆÓ ˘¤Ú‚·ÚˆÓ ¶·È‰È·ÙÚÈ΋ 2008;71:368-375

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·372

372

∞. ÃÚÈÛÙfi‰Ô˘ÏÔ˜ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ¢È·ÊÔÚ¤˜ ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È ˘¤Ú‚·ÚˆÓ/·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Û ۯ¤ÛË Ì ÙË ‰È·ÙÚÔÊ‹ Î·È ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ¶·Ú¿ÌÂÙÚÔÈ

∂ÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (kcal/Ë̤ڷ)

∂Ó¤ÚÁÂÈ· (%) ·fi: À‰·Ù¿ÓıڷΘ

∫·ÙËÁÔڛ˜ ¢ª™

∫ÔÚ›ÙÛÈ·

∞ÁfiÚÈ·

n=197

n=181

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

1682,89±477,15 1632,19±468,16 F(1, 354)=0,54

1575,14±467,97 1718,67±420,85 F(1, 354)=3,63

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

55,75±8,67 49,28±11,05# F(1, 354)= 16,95 19,03±4,18 22,42±5,64# F(1, 354)=14,70 25,23±6,41 28,31±7,15‡ F(1, 354)=7,99

53,15±9,86 48,73±13,72† F(1, 354)= 6,94 21,10±5,70 23,19±8,75* F(1, 354)=4,88 25,75±6,55 28,08±9,82* F(1, 354)=4,03

27,12±22,88 24,89±24,24 F(1, 373)=0,48 16,68±20,61 9,00±17,01† F(1, 373)=6,45 43,79±32,15 33,87±32,23* F(1, 373)=5,14

24,61±18,84 23,51±22,88 F(1, 373)=0,11 22,61±22,18 16,37±21,54* F(1, 373)=3,85 47,01±25,78 39,91±29,34 F(1, 373)=2,38

¶ÚˆÙ½Ó˜

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

§›Ë

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

∂ÓÂÚÁÂȷ΋ ‰·¿ÓË ·fi: ª¤ÙÚÈ· º¢ (ª∂∆-ÒÚ˜/‚‰ÔÌ¿‰·)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

ŒÓÙÔÓË º¢ (ª∂∆-ÒÚ˜/‚‰ÔÌ¿‰·)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

™˘ÓÔÏÈ΋ º¢ (ª∂∆-ÒÚ˜/‚‰ÔÌ¿‰·)

º˘ÛÈÔÏÔÁÈÎfi˜ ¢ª™ À¤Ú‚·Ú·/ ¶·¯‡Û·Úη

¢ª™ = ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜, º¢ = Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, MET = ÌÂÙ·‚ÔÏÈÎfi ÈÛÔ‰‡Ó·ÌÔ. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Î·ÙËÁÔÚÈÒÓ ÙÔ˘ ¢ª™ ÁÈ·: *p≤0,05, †p≤0,01, ‡p≤0,005, #p≤0,0001.

·È‰ÈÒÓ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ·¯˘Û·ÚΛ·˜) ÛÙÔ ·ÚfiÓ ‰Â›ÁÌ· ÂÌÊ·Ó›˙ÔÓÙ·È ˘„ËÏfiÙÂÚ· Û ۯ¤ÛË Ì ÙȘ ¯ÒÚ˜ Ù˘ µfiÚÂÈ·˜ ∂˘ÚÒ˘ (10,227,4%) Î·È ·ÚfiÌÔÈ· Ì ÂΛӷ ÙˆÓ ÌÂÛÔÁÂÈ·ÎÒÓ ¯ˆÚÒÓ (29,8-36,0%), Ì ÂÍ·›ÚÂÛË ÙËÓ ∆Ô˘ÚΛ· (14,0%) (1,24-26). ∏ ÈÛ¯˘Ú‹ ·ÓÙ›ÛÙÚÔÊË Û¯¤ÛË ÙÔ˘ ¢ª™ Ì ÙË º¢, Ë ÔÔ›· ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ Â›‰Ú·ÛË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, Â›Ó·È Û‡ÌʈÓË Ì ٷ Û˘ÌÂÚ¿ÛÌ·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÂÚ¢ÓÒÓ ÛÙË ¯ÒÚ· Ì·˜ (12) Î·È ·ÏÏÔ‡ (27), ÔÈ Ôԛ˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë º¢ ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. À¿Ú¯Ô˘Ó ˆÛÙfiÛÔ Î·È ¤Ú¢Ó˜ Ô˘ η٤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë º¢ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·¯˘Û·ÚΛ· (11,28). ∞ÓÙÈÎÚÔ˘fiÌÂÓ· Â›Ó·È Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÂÚ¢ÓÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÙË Û¯¤ÛË ÙÔ˘ ¢ª™ Ì ÙȘ ‰È·ÙÚÔÊÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ, Ë Î·Ù·Ó¿ÏˆÛË Ï›Ô˘˜ ·ÚÔ˘Û›·Û ·ÓÂÍ¿ÚÙËÙË ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔÓ ¢ª™ ÛÙ· ÎÔÚ›ÙÛÈ·, ÂÓÒ Ë ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë ‰ÂÓ Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·¯˘Û·ÚΛ·. ™Â ÌÈ· ÌÂϤÙË ÛÙȘ ∏¶∞ (29), ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÚÔÛÏ·Ì‚·ÓfiÌÂÓˆÓ ıÂÚÌ›‰ˆÓ Î·È Ë ÚfiÛÏË„Ë Ï›Ô˘˜ Î·È ˘‰·Ù·ÓıÚ¿ÎˆÓ ·ÔÙÂÏÔ‡Û·Ó ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÙÔ˘ ۈ̷ÙÈÎÔ‡ Ï›Ô˘˜ Û Paediatriki 2008;71:368-375

·È‰È¿ 11-12 ÂÙÒÓ. ∞ÚÎÂÙÔ› ÂÚ¢ÓËÙ¤˜, ˆÛÙfiÛÔ, ‰ÂÓ ÌfiÚÂÛ·Ó Ó· ‰È·ÈÛÙÒÛÔ˘Ó ·ÚfiÌÔȘ Û˘Û¯ÂÙ›ÛÂȘ (30,31). ™ÙË ¯ÒÚ· Ì·˜, ÌÂϤÙ˜ ÛÙËÓ ¶ÈÂÚ›· (12) Î·È ÙË ª·ÁÓËÛ›· (13) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë Î·È Ë Î·Ù·Ó¿ÏˆÛË Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ‰ÂÓ Û¯ÂÙ›ÛÙËÎ·Ó Ì ÙÔ ÛˆÌ·ÙÈÎfi Ï›Ô˜ ‹ ÙÔÓ ¢ª™. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÌÈ· ÚfiÛÊ·ÙË ¤Ú¢ӷ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ πˆ·ÓÓ›ÓˆÓ (14) η٤ÏËÍ Û ·ÓÙ›ıÂÙ· Û˘ÌÂÚ¿ÛÌ·Ù·. ∫ÔÈÓfi ‡ÚËÌ·, ˆÛÙfiÛÔ, ÛÙȘ ÙÚÂȘ ·˘Ù¤˜ ¶›Ó·Î·˜ 3. ∞ÔÙÂϤÛÌ·Ù· ·Ó¿Ï˘Û˘ ·ÏÈÓ‰ÚfiÌËÛ˘ ÁÈ· ÙÔÓ ¢ª™ Û ۯ¤ÛË Ì ÙËÓ ËÏÈΛ·, ÙȘ ‰È·ÙÚÔÊÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Î·È ÙË º¢ ¶·Ú¿ÌÂÙÚÔÈ ∏ÏÈΛ· (¤ÙË) ∂ÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (kcal/Ë̤ڷ) ∂Ó¤ÚÁÂÈ· ·fi Ï›Ë (%) ™˘ÓÔÏÈ΋ º¢ (ª∂∆-ÒÚ˜/‚‰ÔÌ¿‰·) R

∫ÔÚ›ÙÛÈ·

∞ÁfiÚÈ·

‚ (SE)

‚ (SE)

0,01 (0,94) 0,01 (0,00)

0,04 (0,60) 0,14 (0,00)

0,17 (0,04)* -0,17 (0,31)*

0,13 (0,04) -0,18 (0,01)*

0,257*

0,261*

¢ª™ = ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜, º¢ = Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, MET = ÌÂÙ·‚ÔÏÈÎfi ÈÛÔ‰‡Ó·ÌÔ, SE = Ù˘ÈÎfi ÛÊ¿ÏÌ·. * p≤0,05.

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·373

373

¶·¯˘Û·ÚΛ· Î·È ·Ú¿ÌÂÙÚÔÈ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿

ml/kg/min

·. ∫·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹ 39 37 35 33 31 29 27 25

# 33,00 #

30,25

28,34 26,35 ∫ÔÚ›ÙÛÈ·

∞ÁfiÚÈ·

‚. ª˘˚΋ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ ∫ÔÈÏÈ·ÎÔ› Û 30 ‰Â˘Ù.

29 27 25

#

23 21

# 22,47

21,88

20,11

19 18,75

17 15

¢›ψÛË Û cm

∫ÔÚ›ÙÛÈ· 28 26 24 22 20 18 16 14 12 10

∞ÁfiÚÈ· #

Á. ∂˘Ï˘ÁÈÛ›·

# 20,35

20,52 15,15

∫ÔÚ›ÙÛÈ· º˘ÛÈÔÏÔÁÈο

14,52

∞ÁfiÚÈ· À¤Ú‚·Ú·

∂ÈÎfiÓ· 2. ¢È·ÊÔÚ¤˜ ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î·È ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ÛÙËÓ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹, ÙË Ì˘˚΋ ·ÓÙÔ¯‹ ÎÔÚÌÔ‡ Î·È ÙËÓ Â˘Ï˘ÁÈÛ›·. √È ÙÈ̤˜ ·ÊÔÚÔ‡Ó Ì¤ÛË ÙÈÌ‹ ± Ù˘È΋ ·fiÎÏÈÛË. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Î·ÙËÁÔÚÈÒÓ ÙÔ˘ ¢ª™ ÁÈ·: # p≤0,001.

¤Ú¢Ó˜, fiˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Â›Ó·È Ë ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÙÔ˘ ¢ª™ Ì ÙË º¢ Î·È ÙËÓ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÙÔ¯‹. ∏ ·Û˘Ìʈӛ· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ÚԷӷʤÚıËÎ·Ó Â›Ó·È Èı·ÓfiÓ Ó· ÔÊ›ÏÂÙ·È Û ‰È·ÊÔÚ¤˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi Î·È ÙË ÌÂıÔ‰ÔÏÔÁ›· ÙÔ˘˜, ·ÏÏ¿ Î·È Û Èı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰ÈÂÚ¢ÓÒÌÂÓˆÓ ÏËı˘ÛÌÒÓ (28). ∏ ·ÍÈÔÏfiÁËÛË Ù˘ º¢ Î·È Ù˘ ‰È·ÙÚÔÊ‹˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ‰˘ÛÎÔϛ˜, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ¤ÏÏÂÈ„Ë Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙÒÓ ÂÚÁ·Ï›ˆÓ ηٷÁÚ·Ê‹˜, ηıÒ˜ Î·È Ë Ù¿ÛË ˘ÂÚÂÎÙ›ÌËÛ˘ Ù˘ º¢ Î·È ˘ÔÂÎÙ›ÌËÛ˘ Ù˘ ÂÓÂÚÁÂÈ·-

΋˜ ÚfiÛÏ˄˘. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ë ‰È·ÙÚÔÊÈ΋ ·ÍÈÔÏfiÁËÛË Ô˘ ÛÙËÚ›˙ÂÙ·È Û ·˘ÙÔ·Ó·ÊÂÚfiÌÂÓ· ‰Â‰Ô̤ӷ ˘fiÎÂÈÙ·È Û ÛÊ¿ÏÌ· ˘ÔÂÎÙ›ÌËÛ˘, ÙÔ ÔÔ›Ô Û’ ·˘Ù‹ ÙËÓ ËÏÈΛ· ÌÔÚ› Ó· ·Ó¤ÏıÂÈ ¤ˆ˜ ~1/3 Ù˘ Û˘ÓÔÏÈ΋˜ ËÌÂÚ‹ÛÈ·˜ ÂÓÂÚÁÂȷ΋˜ ÚfiÛÏ˄˘ (32) Î·È Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÛÙ· ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη ·È‰È¿, Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¢ª™ (33). §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙȘ ˘„ËϤ˜ ÙÈ̤˜ ÙÔ˘ ¢ª™ ÛÙÔ ·ÚfiÓ ‰Â›ÁÌ·, ı· ÌÔÚÔ‡Û ӷ ˘Ôı¤ÛÂÈ Î¿ÔÈÔ˜ fiÙÈ Ë Û˘ÓÔÏÈ΋ ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë ÙˆÓ ·È‰ÈÒÓ, fiˆ˜ ·˘Ù‹ ηٷÁÚ¿ÊËΠ̠ÙÔ ∂º¢∆∑, ‹Ù·Ó Èı·ÓÒ˜ ¯·ÌËÏfiÙÂÚË Û ۯ¤ÛË Ì ÙËÓ Ú·ÁÌ·ÙÈ΋. ∂Í¿ÏÏÔ˘, Ë ·¯˘Û·ÚΛ· Â›Ó·È ÙÔ Ì·ÎÚÔÚfiıÂÛÌÔ ·ÔÙ¤ÏÂÛÌ· ÂÓfi˜ ıÂÙÈÎÔ‡ ÂÓÂÚÁÂÈ·ÎÔ‡ ÈÛÔ˙˘Á›Ô˘, ÙÔ ÔÔ›Ô ÌÔÚ› ¿ÏÏÔÙ ӷ ÔÊ›ÏÂÙ·È Û ·˘ÍË̤ÓË ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë Î·È ¿ÏÏÔÙ Û ÌÂȈ̤ÓË ÂÓÂÚÁÂȷ΋ ‰·¿ÓË ‹ ÛÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ ·Ú·ÁfiÓÙˆÓ, Û ¤Ó· ÁÂÓÂÙÈο ηıÔÚÈṲ̂ÓÔ ˘fi‚·ıÚÔ. ∂ÈϤÔÓ, ÔÈ Û˘Ó¤ÂȘ ÌÈ·˜ ‰È·Ù·Ú·¯‹˜ Ù˘ ÂÓÂÚÁÂȷ΋˜ ÈÛÔÚÚÔ›·˜ ÛÙËÓ ÂͤÏÈÍË Ù˘ ·¯˘Û·ÚΛ·˜ ÌÔÚ› Ó· ÔÈΛÏÏÔ˘Ó ÛÙȘ ‰È¿ÊÔÚ˜ Ê¿ÛÂȘ Ù˘ ·Ó¿Ù˘Í˘, ηıÒ˜ Î·È ÌÂٷ͇ ‰È·ÊÔÚÂÙÈÎÒÓ ÏËı˘ÛÌÒÓ (34). ∆¤ÏÔ˜, ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ¿Ԅ˘ fiÙÈ Ë ÌÂÙ·‚ÔÏÈ΋ ·¿ÓÙËÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Û ÌÈ· ‰È·Ù·Ú·¯‹ Ù˘ ÂÓÂÚÁÂȷ΋˜ ÈÛÔÚÚÔ›·˜ ÂËÚ¿˙ÂÙ·È ÛËÌ·ÓÙÈο ·fi ÙÔÓ ÁÔÓfiÙ˘Ô Î¿ı ·ÙfiÌÔ˘ (35,36). ∂Ô̤ӈ˜, Ù· ¿ÙÔÌ· Ì ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË ÂӉ¯Ô̤ӈ˜ Ó· ÌËÓ Â›Ó·È Û ı¤ÛË Ó· ·ÓÙÈÛÙ·ıÌ›ÛÔ˘Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÙȘ ÂÚÈÔ‰ÈΤ˜ ‰È·Î˘Ì¿ÓÛÂȘ ÛÙËÓ ÂÓÂÚÁÂȷ΋ ‰·¿ÓË ‹ ÙËÓ ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë. ∏ ·Ú·ÙÂٷ̤ÓË ·‰˘Ó·Ì›· ·ÓÙÈÛÙ¿ıÌÈÛ˘ ÌÈ·˜ Ù¤ÙÔÈ·˜ ‰È·Ù·Ú·¯‹˜ ÛÙËÓ ÂÓÂÚÁÂȷ΋ ÈÛÔÚÚÔ›· Ì·ÎÚÔÚfiıÂÛÌ· ÂΉËÏÒÓÂÙ·È ˆ˜ ·‡ÍËÛË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ Ï›Ô˘˜ ÛÙÔ ÛÒÌ· (28). ∞Ó Î·È ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ÂÓÂÚÁÂȷ΋ ‰·¿ÓË ·fi º¢ ̤ÙÚÈ·˜ ¤ÓÙ·Û˘, Ù· ˘¤Ú‚·Ú· ·È‰È¿ ·Ó¤ÊÂÚ·Ó ÌÈÎÚfiÙÂÚË Û˘ÌÌÂÙÔ¯‹ Û º¢ ˘„ËÏ‹˜ ¤ÓÙ·Û˘. ™Â ·ÚÎÂÙ¤˜ ¤Ú¢Ó˜ ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ Û˘ÌÌÂÙ¤¯Ô˘Ó ÏÈÁfiÙÂÚÔ Û ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ ··ÈÙÔ‡Ó ·˘ÍË̤ÓË ÂÓÂÚÁÂȷ΋ ‰·¿ÓË Î·È Î·Ï‹ Ê˘ÛÈ΋ ηٿÛÙ·ÛË (13,37). ∂Ô̤ӈ˜, Ù· ÚÔÁÚ¿ÌÌ·Ù· ·Ú¤Ì‚·Û˘ Ô˘ ·¢ı‡ÓÔÓÙ·È Û ·È‰È¿ Ì ·˘ÍË̤ÓÔ ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ë ¤ÓÙ·ÛË ÙˆÓ ÔÔ›ˆÓ ı· Û˘Ì‚·‰›˙ÂÈ Ì ÙȘ ‰˘Ó·ÙfiÙËÙ¤˜ ÙÔ˘˜. ∏ ¢ÓÔ˚΋ Â›‰Ú·ÛË Ù˘ º¢ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ‰‡Ô Ì˯·ÓÈÛÌÔ‡˜: ·ÊÂÓfi˜ ¿ÌÂÛ·, Ì ÙËÓ ·‡ÍËÛË Ù˘ ÂÓÂÚÁÂȷ΋˜ ‰·¿Ó˘ Ô˘ ÚÔ·ÙÂÈ ·fi ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙËÓ ÂοÛÙÔÙ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÌÂÈÒÓÂÈ ÙËÓ Èı·ÓfiÙËÙ· ıÂÙÈÎÔ‡ ÂÓÂÚÁÂÈ·ÎÔ‡ ÈÛÔ˙˘Á›Ô˘ (38), ·ÊÂÙ¤ÚÔ˘ Ì·ÎÚÔÚfiıÂÛÌ·, ¯¿ÚË ÛÙËÓ ·‡ÍËÛË Ù˘ ¿ÏÈ˘ Ì¿˙·˜ ¶·È‰È·ÙÚÈ΋ 2008;71:368-375

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·374

374

∞. ÃÚÈÛÙfi‰Ô˘ÏÔ˜ Î·È Û˘Ó.

ÙÔ˘ ÛÒÌ·ÙÔ˜, ÙË Û˘Ó·ÎfiÏÔ˘ıË ·‡ÍËÛË ÙÔ˘ ‚·ÛÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Î·È ÙËÓ ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ÛÙËÓ ·Ú·ÁˆÁ‹ ÂÓ¤ÚÁÂÈ·˜ (39). ∞Ó·ÊÔÚÈο Ì ÙË Û¯¤ÛË ·¯˘Û·ÚΛ·˜ Î·È Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘, ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ˘¤Ú‚·Ú· ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÛÙȘ ‰ÔÎÈ̷ۛ˜ Ô˘ ··ÈÙÔ‡Û·Ó Î¿ıÂÙË ‹ ÔÚÈ˙fiÓÙÈ· ÌÂÙ·ÙfiÈÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, οÙÈ Ô˘ ·ÔÙÂÏ› ÎÔÈÓfi ‡ÚËÌ· ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (13,23,37). √È ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ÔÊ›ÏÔÓÙ·È ÚÔÊ·ÓÒ˜ ÛÙ· ·˘ÍË̤ӷ ÔÛÔÛÙ¿ Ï›Ô˘˜ ÛÙÔ ÛÒÌ· ÙÔ˘˜, Ô˘ ·ÔÙÂÏÔ‡Ó ¤Ó· ÂÈϤÔÓ ÊÔÚÙ›Ô ÛÙË ‰È¿ÚÎÂÈ· ÂÎÙ¤ÏÂÛ˘ ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ (40). £· Ú¤ÂÈ ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi Ó· ÙÔÓÈÛÙ› ȉȷ›ÙÂÚ· Ë ÛËÌ·Û›· Ù˘ ÌÂȈ̤Ó˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜, ηıÒ˜ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏ› ·ÓÂÍ¿ÚÙËÙÔ ÚԉȷıÂÛÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (41). ∏ Û¯¤ÛË ·˘Ù‹ ÂÚÌËÓ‡ÂÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ¯·ÌËÏ¿ Â›‰· ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÙÔ¯‹˜ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ÙËÓ ÂÚÈÔÚÈṲ̂ÓË ÈηÓfiÙËÙ· ÔÍ›‰ˆÛ˘ ÙˆÓ ÂÓ‰ÔÌ˘˚ÎÒÓ ÏÈ·ÚÒÓ ÔͤˆÓ (42), ÁÂÁÔÓfi˜ Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙËÓ Â›Û˘ ÂÚÈÔÚÈṲ̂ÓË ·ÓÔ¯‹ ÛÙ· Ï›Ë ÙˆÓ ÙÚÔÊÒÓ Î·È, ÙÂÏÈο, ÙËÓ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È Ï›Ô˘˜ (12). ∞˘Ùfi Û˘Ì‚·‰›˙ÂÈ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜: ·ÚfiÏÔ Ô˘ ÙÔ ÔÛÔÛÙfi Ï›Ô˘˜ ÛÙË ‰È·ÙÚÔÊ‹ ‹Ù·Ó ·ÚfiÌÔÈÔ ÁÈ· Ù· ˘¤Ú‚·Ú· ·ÁfiÚÈ· Î·È ÎÔÚ›ÙÛÈ· (~28%), ¯ˆÚ›˜ Ó· ˘ÂÚ‚·›ÓÂÈ ÙÔ Û˘ÓÈÛÙÒÌÂÓÔ fiÚÈÔ ÙÔ˘ 30% Ù˘ Û˘ÓÔÏÈ΋˜ ÂÓ¤ÚÁÂÈ·˜, Ë ‰È·ÙÚÔÊÈ΋ ÚfiÛÏË„Ë Ï›Ô˘˜ ·ÔÙ¤ÏÂÛ ÛËÌ·ÓÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ‰Â›ÎÙË ÙÔ˘ ¢ª™ ÌfiÓÔ ÛÙ· ÎÔÚ›ÙÛÈ·, ÂÍ·ÈÙ›·˜ ÂӉ¯Ô̤ӈ˜ Ù˘ ¯·ÌËÏfiÙÂÚ˘ ηډÈÔ·Ó·Ó¢ÛÙÈ΋˜ ÙÔ˘˜ ·ÓÙÔ¯‹˜ Û ۯ¤ÛË Ì ٷ ·ÁfiÚÈ·. √ ÔÌfi¯ÚÔÓÔ˜ ۯ‰ȷÛÌfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ ÁÈ· ·ÈÙÈÒ‰Ë Û¯¤ÛË Ù˘ º¢ Î·È Ù˘ ‰È·ÙÚÔÊ‹˜ Ì ÙËÓ ·¯˘Û·ÚΛ·. ŒÓ·˜ ¿ÏÏÔ˜ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ¤Ú¢ӷ˜ Â›Ó·È Ë ¤ÏÏÂÈ„Ë ÛÙÔȯ›ˆÓ ·Ó·ÊÔÚÈο Ì ÙÔ ÛÙ¿‰ÈÔ ˆÚ›Ì·ÓÛ˘ ÙˆÓ Ì·ıËÙÒÓ. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ‚ÈÔÏÔÁÈο ÛÙ¿‰È· ˆÚ›Ì·ÓÛ˘ ÂȉÚÔ‡Ó ÛÙËÓ ·¯˘Û·ÚΛ· Î·È Ì¿ÏÈÛÙ· Ì ‰È·ÊÔÚÂÙÈÎfi ÙÚfiÔ ÛÙ· ‰‡Ô ʇϷ. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÚÒÈÌË ˆÚ›Ì·ÓÛË ÛÙ· ÎÔÚ›ÙÛÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ¢ª™, ÂÓÒ ÛÙ· ·ÁfiÚÈ· Û¯ÂÙ›˙ÂÙ·È Ì ¯·ÌËϤ˜ ÙÈ̤˜ ÙÔ˘ ¢ª™ (43). ªÂ ‚¿ÛË ÙËÓ ËÏÈΛ· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ıˆÚԇ̠fiÙÈ fi ¤ÏÂÁ¯Ô˜ ˆ˜ ÚÔ˜ ÙÔ ÛÙ¿‰ÈÔ ‚ÈÔÏÔÁÈ΋˜ ˆÚ›Ì·ÓÛ˘ ÙˆÓ Ì·ıËÙÒÓ ı· ÂËÚ¤·˙ ÂӉ¯Ô̤ӈ˜ ÙȘ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ʇψÓ, ˆÛÙfiÛÔ Ù· ÔÛÔÛÙ¿ ˘ÂÚ‚ÔÏÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ·¯˘Û·ÚΛ·˜ ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‰ÂÓ ı· ÌÂÙ·‚¿ÏÏÔÓÙ·Ó ‰Ú·Ì·ÙÈο.

Paediatriki 2008;71:368-375

™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· Â˘Ú‹Ì·Ù· Ù˘ ¤Ú¢ӷ˜ ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ¯¿Ú·Í˘ ÙÂÎÌËÚÈˆÌ¤ÓˆÓ ÔÏÈÙÈÎÒÓ ˘Á›·˜ Î·È ÂÊ·ÚÌÔÁ‹˜ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÚfiÏ˄˘ Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜, Ô˘ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙȘ ·Ó¿ÁΘ ÙˆÓ ‰‡Ô Ê‡ÏˆÓ Î·È Ó· ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ ·‡ÍËÛË Ù˘ º¢, ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Î·È ÛÙËÓ ˘ÈÔı¤ÙËÛË ˘ÁÈÂÈÓÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÚÔÙ‡ˆÓ. ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ··ÈÙ› ·ÚÂÌ‚¿ÛÂȘ ¢Ú›·˜ Îϛ̷η˜ Î·È ÎÈÓËÙÔÔ›ËÛË fiÏˆÓ ÙˆÓ ÂÌÏÂÎfiÌÂÓˆÓ ÎÔÈÓˆÓÈÎÒÓ ‰ÔÌÒÓ (ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔÈ΋˜ ÎÔÈÓˆÓ›·˜, È·ÙÚÈ΋˜ ÎÔÈÓfiÙËÙ·˜, ÊÔÚ¤ˆÓ ˘Á›·˜), ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂȈı› Ë Û˘¯ÓfiÙËÙ· Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜ Î·È Ó· ÚÔÏËÊıÔ‡Ó ÔÈ ÂÈÏÔΤ˜ Ù˘ ÛÙË ÌÂÏÏÔÓÙÈ΋ ˘Á›· ÙˆÓ ÛËÌÂÚÈÓÒÓ ·È‰ÈÒÓ.

∂˘¯·ÚÈÛٛ˜ √È Û˘ÁÁÚ·Ê›˜ ıˆÚÔ‡Ó ˘Ô¯Ú¤ˆÛ‹ ÙÔ˘˜ Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ, ηıÒ˜ Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜.

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ORIGINAL ARTICLE

™˘¯ÓfiÙËÙ· Î·È ÂȉËÌÈÔÏÔÁ›· Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ Ù˘ ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋˜ ∞ÙÙÈ΋˜. ∂›‰Ú·ÛË ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ Î·È Ô ÚfiÏÔ˜ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÛÎÏËÈÂ›Ô µÔ‡Ï·˜” AÏÏËÏÔÁÚ·Ê›·: ŸÏÁ· ºÈÏ›Ô˘ filiolga@hotmail.com ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÛÎÏËÈÂ›Ô µÔ‡Ï·˜”

√. ºÈÏ›Ô˘, ª. ¢ÔÏÈ·Ó›ÙË, ∫. ∫·Ú·Ó¿ÛÈÔ˘, µ. ∆·ÛÈÔÔ‡ÏÔ˘, ª. ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘, ™. ¶··‰¿ÎÔ˘-§·ÁÔÁÈ¿ÓÓË ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó: 1) Ë Î·Ù·ÁÚ·Ê‹ Ù˘ Û˘¯ÓfiÙËÙ·˜ Î·È ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ Î·È ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÓÔÛÔÎÔÌ›Ԣ Ù˘ ¡ÔÙÈÔ·Ó·ÙÔÏÈ΋˜ ∞ÙÙÈ΋˜, 2) Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ÛËÌ·Û›·˜ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ·¯˘Û·ÚΛ·˜ Î·È 3) Ë ÂÎÙ›ÌËÛË ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ™ÙËÓ ÚÔÔÙÈ΋ ·˘Ù‹ ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 167 ·È‰È¿ (103 ·ÁfiÚÈ·), ËÏÈΛ·˜ 2-14 ÂÙÒÓ, Ì ¢ª™ ≥85Ë ∂£. ∫·Ù·ÁÚ·ÊfiÙ·Ó Ë ËÏÈΛ·, ÙÔ ‚¿ÚÔ˜ Î·È ÙÔ ‡„Ô˜ ÛÒÌ·ÙÔ˜ ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÁÔÓÈÒÓ Î·È ÙˆÓ ·‰ÂÏÊÒÓ ÙÔ˘˜, ηıÒ˜ Î·È o ÙÚfiÔ˜ ˙ˆ‹˜ ÙÔ˘˜ (‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ, Ê˘ÛÈ΋ ¿ÛÎËÛË, ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘). °È· Ù· ·È‰È¿ Ì ·˘ÍË̤ÓÔ ¢ª™ ηٷÁÚ¿ÊËΠ·Ó ›¯·Ó Á›ÓÂÈ Û˘ÛÙ¿ÛÂȘ ·fi ÙÔÓ ·È‰›·ÙÚÔ. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô 9,7% ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÈÛΤÊÙËΠٷ Â͈ÙÂÚÈο È·ÙÚ›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÌÈ·˜ ‰ÈÂÙ›·˜ ›¯Â ¢ª™ ≥85Ë ∂£ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘. ∆· ·È‰È¿ ËÏÈΛ·˜ 2-5 ÂÙÒÓ ¤ÙÂÈÓ·Ó Ó· Â›Ó·È Ë ÂÚÈÛÛfiÙÂÚÔ ·¯‡Û·ÚÎË ÔÌ¿‰·, ÂÓÒ ÛÙÔ 93,2% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÓÙÔ›ÛÙËΠÙÔ˘Ï¿¯ÈÛÙÔÓ ¿ÏÏÔ ¤Ó· ˘¤Ú‚·ÚÔ ¿ÙÔÌÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∏ ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË ¤ÙÔÈÌˆÓ ¯˘ÌÒÓ Î·È “chips”, Ë ¤ÏÏÂÈ„Ë Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È o ·˘ÍË̤ÓÔ˜ ¯ÚfiÓÔ˜ ÙËÏÂı¤·Û˘ ÂËÚ¤·Û·Ó ÛËÌ·ÓÙÈο ÙËÓ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜. √ ·È‰›·ÙÚÔ˜ ‰ÂÓ ÚÔÛ‰ÈfiÚÈÛ ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·˘ÍË̤ÓÔ˘ ¢ª™ ÛÙÔ 55,6% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÓÒ ÔÈ Ô‰ËÁ›Â˜ ·ÓÙÈÌÂÙÒÈÛ˘ ‹Ù·Ó Û˘¯Ó¿ ÁÂÓÈÎfiÏÔÁ˜ Î·È ·Û·Ê›˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ Û˘Ó¯‹˜ ÂÓË̤ڈÛË Î·È Ë ÚÒÈÌË ·Ú¤Ì‚·ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Â›Ó·È ··Ú·›ÙËÙ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙ·ÔÎÚÈıÔ‡Ó ÛÙÔÓ Ôχ Ô˘ÛÈ·ÛÙÈÎfi ÚfiÏÔ Ù˘ ÚfiÏ˄˘ Î·È ¤ÁηÈÚ˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ Ì·ÎÚÔ¯ÚfiÓÈˆÓ Û˘ÓÂÂÈÒÓ Ù˘ ·¯˘Û·ÚΛ·˜.

§¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰È΋ ·¯˘Û·ÚΛ·, ·ÓÙÈÌÂÙÒÈÛË ·¯˘Û·ÚΛ·˜, ·ÚÂÌ‚¿ÛÂȘ, Ô‰ËÁ›Â˜ ‰È·ÙÚÔÊ‹˜, ¢ª™.

The prevalence and epidemiology of obesity in children of southeastern Attica. The modern lifestyle and the role of the primary care paediatrician Department of Paediatrics, “Asklipeio Voulas” General Hospital

O. Filippou, M. Dolianiti, K. ∫aranasiou, V. Tasiopoulou, M. Ziva-Petropoulou, S. Papadakou-Lagogianni

Correspondence: Olga Filippou filiolga@hotmail.com Department of Paediatrics, “Asklipeio Voulas” General Hospital

Abstract

Paediatriki 2008;71:376-382

Background: The aims of this study were: 1) to provide epidemiological and demographic data on the prevalence of overweight and obese children from the outpatient clinic of a hospital in southeastern Attica, 2) to study possible correlations between obesity in these children and various parameters of the modern lifestyle, and 3) to evaluate the abilities of primary care paediatricians in the recognition and therapeutic intervention of childhood obesity.

Methods: The prospective study included 167 children (103 boys), aged 2-14 years, with Body Mass Index (BMI) ≥85th percentile for age and gender. Information was obtained regarding the age, body weight and height of the subjects and of their parents and siblings, and lifestyle parameters of the overweight patients (physical activity, dietary habits and TV watching hours). ∆he instructions that had been given by paediatricians concerning the increased BMI problem of the children were also recorded.

Results: During a two-year period, 9.7% of children attending for well child visits had a BMI ≥85th percentile. Obesity prevalence tended to be higher for children in the 2-5 years age group. Most of the overweight children (93.2%) had a familial form of obesity. A positive correlation was demonstrated between the children’s BMI and their consumption of commercial juices and chips, reduced physical activity and increased TV watching hours. The children’s paediatricians had failed to identify the obesity problem in 55.6% of all cases, while the instructions that had been given about its management were often generalized and unclear.

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·377

377

∂ȉËÌÈÔÏÔÁ›· Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ ÛÙËÓ ∞ÙÙÈ΋

Conclusions: As the role of primary care paediatricians in early recognition and prevention of the longterm sequelae of obesity is crucial, their awareness and provision of interventions are necessary, in order to face this problem from its beginning.

Key words: Childhood obesity, obesity management, interventions, dietary recommendations, Body Mass Index.

™˘ÓÙÔÌÔÁڷʛ˜ ¢ª™: ‰Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ∂£: ÂηÙÔÛÙÈ·›· ı¤ÛË ∂π: Â͈ÙÂÚÈο È·ÙÚ›·

∂ÈÛ·ÁˆÁ‹ ∆Ô 1997, Ô ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ ¯·Ú·ÎÙ‹ÚÈÛ ÙËÓ ·¯˘Û·ÚΛ· ˆ˜ ·ÁÎfiÛÌÈ· ÂȉËÌ›·. ∏ ÓfiÛÔ˜ ¤Ï·‚ ·˘Í·ÓfiÌÂÓ˜ ‰È·ÛÙ¿ÛÂȘ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›·, ȉȷ›ÙÂÚ· ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi, Î·È ·ÔÙÂÏ› ¤Ó· Úfi‚ÏËÌ·-ÚfiÎÏËÛË ÁÈ· ÙÔÓ Û‡Á¯ÚÔÓÔ ·È‰›·ÙÚÔ. ŒÙÛÈ, ÂÓÒ Ë ‰ÈÂıÓ‹˜ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ·ÁˆÓ›˙ÂÙ·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ó·Ù‡ÍÂÈ ÂÈÙ˘¯Â›˜ ÛÙÚ·ÙËÁÈΤ˜ ÚfiÏ˄˘ ·ÏÏ¿ Î·È ıÂÚ·›·˜ ·˘Ù‹˜ Ù˘ ÂȉËÌ›·˜, Ë ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛ‹ Ù˘ ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ·Ú·Ì¤ÓÂÈ ÙÔ ÎÚ›ÛÈÌÔ ·Ú¯ÈÎfi ‚‹Ì·. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·¯˘Û·ÚΛ·˜ Î·È ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ Î·È ‰ËÌÔÁÚ·ÊÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Ô˘ ÚÔÛ‹Ïı·Ó ÛÙ· ∂͈ÙÂÚÈο π·ÙÚ›· (∂π) ÙÔ˘ ÙÌ‹Ì·ÙÔ˜, Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Â›‰Ú·Û˘ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ Î·È ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙËÓ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚΛ·˜ ηÈ, Ù¤ÏÔ˜, Ë ÌÂϤÙË ÙÔ˘ ÚfiÏÔ˘ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ÀÏÈÎfi - ª¤ıÔ‰Ô˜ ∫·Ù¿ ÙË ‰ÈÂÙ›· ∞‡ÁÔ˘ÛÙÔ˜ 2005 - ™Â٤̂ÚÈÔ˜ 2007, 180 ·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì µªπ ≥85Ë ∂£ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ ÙÔ˘˜ (‰ËÏ·‰‹ ·¯‡Û·Úη ‹ ˘¤Ú‚·Ú·) ÚÔÛ‹Ïı·Ó ÛÙ· ∂π ÙÔ˘ ÙÌ‹Ì·ÙÔ˜. ∆ÂÏÈο, 167 ·fi ·˘Ù¿ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ·ÚÔ‡Û· ÚÔÔÙÈ΋ ÌÂϤÙË, ηÙfiÈÓ Û˘Ó·›ÓÂÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜. ∆· ÛÙÔȯ›· ·ÓÙÏ‹ıËÎ·Ó ·fi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏ‹ÚˆÓ·Ó ÔÈ ÁÈ·ÙÚÔ› Ù˘ ÎÏÈÓÈ΋˜ (¶›Ó·Î·˜ 1). ™ˆÌ·ÙÔÌÂÙÚÈο ‰Â‰Ô̤ӷ ∆Ô ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ ÌÂÙÚ‹ıËΠ̠˙˘Á·ÚÈ¿ Ù‡Ô˘ Seca ·ÎÚȂ›·˜ ±0,5 kg, Ì ٷ ·È‰È¿ ÓÙ˘Ì¤Ó· ÂÏ·ÊÚ¿. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ۠fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·, Ì ÙÔ ·Ó·ÛÙËÌfiÌÂÙÚÔ Ô˘ ‚Ú›ÛÎÂÙ·È ÂÓۈ̷و̤ÓÔ ÛÙË ˙˘Á·ÚÈ¿. √ ¢ª™ ˘ÔÏÔÁ›ÛÙËΠ·fi ÙË Û¯¤ÛË ‚¿ÚÔ˘˜ Û ÎÈÏ¿ ÚÔ˜ ÙÔ ‡„Ô˜ Û ̤ÙÚ· ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (kg/m2). ∆· fiÚÈ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ, ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ Î·ıÔÚ›ÛÙËÎ·Ó Ì ‚¿ÛË ÙȘ η-

Ì‡Ï˜ ¢ª™ ÙˆÓ ∂ÏÏ‹ÓˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ, ÂÓÒ ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ ¯ÚËÛÈÌÔÔÈ‹Û·Ì ٷ ‰ÈÂıÓÒ˜ ηıÔÚÈṲ̂ӷ fiÚÈ· (≤25, 25,1-29,9 Î·È ≥30 kg/m2, ·ÓÙ›ÛÙÔȯ·) (1,2). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË √È ÔÈÔÙÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ÙË Û¯ÂÙÈ΋ Û˘¯ÓfiÙËÙ·. °È· ÙË Û‡ÁÎÚÈÛË ·Ó·ÏÔÁÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙÔ˘ χ2 Î·È ÙÔ Fisher’s exact test. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÚfiÁÚ·ÌÌ· stata 8,0. √È ÙÈ̤˜ p Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Â›Ó·È ·ÌÊ›Ï¢Ú˜ Î·È Ë ÛÙ·ÙÈÛÙÈ΋ ÛËÌ·ÓÙÈÎfiÙËÙ· Ù¤ıËΠÛÙÔ 0.05. ¶›Ó·Î·˜ 1. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ ÌÂϤÙ˘ 1. ¢ËÌÔÁÚ·ÊÈο Î·È ÛˆÌ·ÙÔÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ, ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘˜ Î·È ÙˆÓ ·‰ÂÏÊÒÓ ÙÔ˘˜ (ËÏÈΛ·, ʇÏÔ, ‚¿ÚÔ˜ Î·È ‡„Ô˜ ÛÒÌ·ÙÔ˜).

2. ¢È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ: ∫·Ù·Ó¿ÏˆÛË ·Ó·„˘ÎÙÈÎÒÓ ‹/Î·È ¤ÙÔÈÌˆÓ ¯˘ÌÒÓ. ∫·Ù·Ó¿ÏˆÛË “snacks” (·Ù·Ù¿ÎÈ·, Á·Úȉ¿ÎÈ·, ÛÔÎÔÏ¿Ù˜, ÌÈÛÎfiÙ·). ∫·Ù·Ó¿ÏˆÛË ¤ÙÔÈÌˆÓ Ê·ÁËÙÒÓ ·fi ÂÛÙÈ·ÙfiÚÈ·, Ù·¯˘Ê·Á›· Î.Ï. ∏ Û˘¯ÓfiÙËÙ· ηٷÁÚ·ÊfiÙ·Ó ˆ˜ 0-1-2-3-4-5-6-7 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.

3. º˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·: ™˘ÛÙËÌ·ÙÈ΋ ÂÓ·Û¯fiÏËÛË Ì οÔÈÔ ¿ıÏËÌ·. ¶·È¯Ó›‰È ÛÙÔ Û¯ÔÏ›Ô, ÛÙÔÓ ‰ÚfiÌÔ ‹ ÛÙËÓ ·˘Ï‹ ÙÔ˘ ÛÈÙÈÔ‡. ¶ÂÚ¿ÙËÌ· ¤ˆ˜ ÙÔ Û¯ÔÏ›Ô/ ÙÔ ÊÚÔÓÙÈÛÙ‹ÚÈÔ/ ÙË ÛÙ¿ÛË ÏˆÊÔÚ›Ԣ. ∏ Û˘¯ÓfiÙËÙ· ηٷÁÚ·ÊfiÙ·Ó ˆ˜ 0-1-2-3-4-5-6-7 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·.

4. ¶·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘: ¶·ÚÔ˘Û›· Û˘Û΢‹˜ ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡. flÚ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂfiÚ·Û˘. ∏ Û˘¯ÓfiÙËÙ· ηٷÁÚ·ÊfiÙ·Ó ˆ˜ 0-1-2-3-4-5-6-7 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ÙËÓ Ë̤ڷ.

5. ∞Ó·ÁÓÒÚÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ·fi ÙÔÓ ·È‰›·ÙÚÔ Î·È ·ÚÔ¯‹ Ô‰ËÁÈÒÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ∞Ó Â›¯·Ó ‰Ôı› Ô‰ËÁ›Â˜, ·˘Ù¤˜ ·ÊÔÚÔ‡Û·Ó: ·. ¢È·ÈÙËÙÈΤ˜ Û˘ÛÙ¿ÛÂȘ ‚. √‰ËÁ›Â˜ ÁÈ· ·‡ÍËÛË Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Á. ¶·Ú·ÔÌ‹ ÁÈ· ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô (ÏÈȉÈfiÁÚ·ÌÌ· Î·È ÁÏ˘Îfi˙Ë Ó‹ÛÙˆ˜, ÙÚ·ÓÛ·ÌÈÓ¿Û˜ ÔÚÔ‡, ÔÚÌÔÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ¤ÏÂÁ¯Ô ÛȉËÚÔÂÓ›·˜) ‰. ¶·Ú·ÔÌ‹ Û ‰È·ÈÙÔÏfiÁÔ, ÂÓ‰ÔÎÚÈÓÔÏfiÁÔ, „˘¯ÔÏfiÁÔ Â. ¶·Ú·ÎÔÏÔ‡ıËÛË Î·È Â·ÓÂÎÙ›ÌËÛË ¶·È‰È·ÙÚÈ΋ 2008;71:376-382

Pediatri Sept-Oct 08

22-10-08

12:27

™ÂÏ›‰·378

378

√. ºÈÏ›Ô˘ Î·È Û˘Ó.

∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÈÛΤÊÙËÎ·Ó Ù· ∂π, 9,7% (180 ·È‰È¿) ›¯·Ó ¢ª™ ≥ 85Ë ∂£ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ (‰ËÏ·‰‹ ‹Ù·Ó ·¯‡Û·Úη ‹ ˘¤Ú‚·Ú·). ∞fi ·˘Ù¿ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË (167 ·È‰È¿), 103 (61,7%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 64 (38,3%) ÎÔÚ›ÙÛÈ·. ∏ ‰È¿ÌÂÛË ËÏÈΛ· ‹Ù·Ó 9,7 ¤ÙË (2-14 ÂÙÒÓ). ∆Ô 54,5% ÙˆÓ ·ÙfiÌˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, 57 ·ÁfiÚÈ· Î·È 34 ÎÔÚ›ÙÛÈ· ‹Ù·Ó ·¯‡Û·Úη (µªπ ≥95Ë ∂£). ªÂ ‰È·¯ˆÚÈÛÌfi ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙˆÓ ·¯‡Û·ÚΈÓ/˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ Û 3 ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ (2-5 ÂÙÒÓ, 6-10 ÂÙÒÓ Î·È 11-14 ÂÙÒÓ), ‰È·ÈÛÙÒıËΠfiÙÈ Ù· Ó‹È· ¤ÙÂÈÓ·Ó Ó· Â›Ó·È Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·¯‡Û·Úη, Û˘ÁÎÚÈÓfiÌÂÓ· Ì ٷ ˘fiÏÔÈ· ·È‰È¿. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ‹Ù·Ó 70,4% ÛÙËÓ ÔÌ¿‰· ÙˆÓ 2-5 ÂÙÒÓ, 53,2% ÛÙËÓ ÔÌ¿‰· ÙˆÓ 610 ÂÙÒÓ Î·È 49,2% ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜. ¢ÂÓ ‚Ú¤ıËΠ‰È·ÊÔÚ¿ ÛÙÔÓ ‚·ıÌfi Ù˘ ·¯˘Û·ÚΛ·˜ ·Ó¿ÌÂÛ· ÛÙ· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ·. ∏ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÂȂ‚·›ˆÛ ÙËÓ ÂÓ‰ÔÔÈÎÔÁÂÓÂȷ΋ ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘, ηıÒ˜ ÛÙÔ 93,2% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÓÙÔ›ÛÙËΠÙÔ˘Ï¿¯ÈÛÙÔÓ ¿ÏÏÔ ¤Ó· ˘¤Ú‚·ÚÔ ¿ÙÔÌÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∆Ô 37,8% ÙˆÓ ·Ù¤ÚˆÓ Î·È ÙÔ 36,1% ÙˆÓ ÌËÙ¤ÚˆÓ ÙˆÓ ·ÙfiÌˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ‹Ù·Ó ·¯‡Û·ÚÎÔÈ (¢ª™ ≥30), ÂÓÒ 1 ÛÙ· 4 ·¯‡Û·Úη ·È‰È¿ ›¯Â Î·È ÙÔ˘˜ ‰‡Ô ÁÔÓ›˜ ·¯‡Û·ÚÎÔ˘˜. ∞ÎfiÌ·, ·fi Ù· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ô˘ ›¯·Ó ·‰¤ÚÊÈ·, ‚Ú¤ıËΠfiÙÈ ÙÔ 40% ›¯Â ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ·‰ÂÚÊfi ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ. ∏ ‡·ÚÍË Î·È ¿ÏÏˆÓ ÌÂÏÒÓ Ì ·˘ÍË̤ÓÔ ¢ª™ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÂËÚ¤·˙ ÛËÌ·ÓÙÈο ÙÔÓ ‚·ıÌfi Ù˘ ·¯˘Û·ÚΛ·˜ ÙˆÓ ·È‰ÈÒÓ (p=0,006) (∂ÈÎfiÓ· 1). ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ, ÙÔ 59,3% ÙˆÓ ·È‰ÈÒÓ Î·Ù·Ó¿ÏˆÓ ¤ÙÔÈÌÔ˘˜ ¯˘ÌÔ‡˜ ≥3 ÊÔÚ¤˜/‚‰ÔÌ¿‰·, ÁÂÁÔÓfi˜ Ô˘ Û˘Ó‰¤ıËΠ̠ÙËÓ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ÙÔ˘˜ ‚¿ÚÔ˘˜ (p=0,028). OÈ ¤ÊË‚ÔÈ Î·Ù·Ó¿ÏˆÓ·Ó Û˘¯ÓfiÙÂÚ· ·ÂÚÈÔ‡¯· ÔÙ¿ Û˘ÁÎÚÈÙÈο Ì ٷ Ó‹È· Î·È Ù· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ (p=0,027), ÂÓÒ ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘ (2-5 ÂÙÒÓ) ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈο ·˘ÍË̤ÓË Î·Ù·Ó¿ÏˆÛË ÌÈÛÎfiÙˆÓ Î·È ‚Ô˘ÙËÌ¿ÙˆÓ, Û˘ÁÎÚÈÙÈο Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ (p=0,006). ∆Ô 34,1% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ηٷӿψÓ ¤ÙÔÈÌÔ Ê·ÁËÙfi >2 ÊÔÚ¤˜/‚‰ÔÌ¿‰·, ÂÓÒ ÙÔ 39,5% Ï¿Ì‚·Ó ˘„ËÏ‹˜ ıÂÚÌȉÈ΋˜ ·Í›·˜ “snacks” ≥3 ÊÔÚ¤˜/‚‰ÔÌ¿‰·. ∂›Û˘, Ë ·¯˘Û·ÚΛ· ‹Ù·Ó Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Û˘¯ÓfiÙÂÚË ÛÙ· ·È‰È¿ Ô˘ ¤ÙÚˆÁ·Ó “chips” Î·È Á·Úȉ¿ÎÈ· Û˘¯ÓfiÙÂÚ· ·fi 2 ÊÔÚ¤˜/‚‰ÔÌ¿‰· (p=0,045). ∏ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ·ÎÔÏÔ˘ıÔ‡Û ¤Ó· ηıÈÛÙÈÎfi ÚfiÙ˘Ô ‰È·‚›ˆÛ˘, Ì ·˘ÍË̤ÓË ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘ Î·È ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙÔ˘ Paediatriki 2008;71:376-382

70 60

p=0,002

50 40 30 20

46%

45% p=0,003 24%

p=0,033 28,8%

44,4% 25,3% p=0,006

10 0

¶·¯‡Û·Úη À¤Ú‚·Ú·

65,9%

¶·¯‡Û·ÚÎË ÌËÙ¤Ú·

6,9% ¶·¯‡Û·ÚÎÔ˜ ŒÓ·˜ ·¯‡Û·ÚÎÔ˜ ¢‡Ô ÁÔÓ›˜ ·Ù¤Ú·˜ ÁÔÓ¤·˜ ·¯‡Û·ÚÎÔÈ

∂ÈÎfiÓ· 1. ¢ª™ ·È‰ÈÒÓ Î·È ÔÈÎÔÁÂÓÂȷ΋ ÂÌÊ¿ÓÈÛË ·¯˘Û·ÚΛ·˜.

¯ÚfiÓÔ˘ ÛÙÔȯÂÈÒ‰Ô˘˜ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ∂ȉÈÎfiÙÂÚ·, ÙÔ 86,2% ·Ú·ÎÔÏÔ˘ıÔ‡Û ÙËÏÂfiÚ·ÛË >2 ÒÚ˜ ÙËÓ Ë̤ڷ, ÂÓÒ ÙÔ 41,8% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·Ú·ÎÔÏÔ˘ıÔ‡Û ÙËÏÂfiÚ·ÛË Î·ıËÌÂÚÈÓ¿ >4 ÒÚ˜. ∆Ô 46,7% ›¯Â Û˘Û΢‹ ÙËÏÂfiÚ·Û˘ ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘, Ú·ÎÙÈ΋ Ô˘ Û¯ÂÙ›ÛÙËΠ̠·˘ÍË̤Ó˜ ÒÚ˜ ηıËÌÂÚÈÓ‹˜ ÙËÏÂı¤·Û˘ (p=0,006). ∆· ÌÈÛ¿ ۯ‰fiÓ ·fi Ù· ·È‰È¿ Ù˘ ¤Ú¢ӷ˜ ‰ÂÓ ·ıÏÔ‡ÓÙ·Ó Î·ıfiÏÔ˘ Î·È ‰ÂÓ ÂÚ·ÙÔ‡Û·Ó Î·ıËÌÂÚÈÓ¿, ·ÎfiÌ· Î·È ÌÈÎÚ¤˜ ·ÔÛÙ¿ÛÂȘ fiˆ˜ Ë ‰È·‰ÚÔÌ‹ Û›ÙÈ-Û¯ÔÏÂ›Ô (48% Î·È 49,6% ·ÓÙ›ÛÙÔȯ·). ∆Ô ·È¯Ó›‰È ÛÙËÓ ·˘Ï‹ ›¯Â ÂÚÈÔÚÈÛÙ› Ôχ, ·ÊÔ‡ ۯ‰fiÓ 1 ÛÙ· 3 ·È‰È¿ (30,2%) ‰ÂÓ ¤·È˙ ηıfiÏÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‚‰ÔÌ¿‰·˜. ∏ ·Ô˘Û›· Ù˘ ηıËÌÂÚÈÓ‹˜ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È Û˘ÛÙËÌ·ÙÈ΋˜ ÂÓ·Û¯fiÏËÛ˘ Ì οÔÈÔ ¿ıÏËÌ· Û¯ÂÙ›ÛÙËΠÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο Ì ·˘ÍË̤ÓÔ ¢ª™ (p=0,017). ™Â fiÙÈ ·ÊÔÚ¿ ÛÙȘ Ô‰ËÁ›Â˜ Ô˘ ›¯·Ó ‰Ôı› ·fi ÙÔÓ ·È‰›·ÙÚÔ Ô˘ Ù· ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ, ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ·È‰È¿ (55,6%) ‰ÂÓ ¤Ï·‚·Ó η̛· Ô‰ËÁ›· Û¯ÂÙÈο Ì ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·˘ÍË̤ÓÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙÔ˘˜. √È ·È‰›·ÙÚÔÈ ¤‰ÈÓ·Ó Û˘¯ÓfiÙÂÚ· Ô‰ËÁ›Â˜ ÛÙ· Ó‹È· (64%), Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿ ËÏÈΛ·˜ 6-10 ÂÙÒÓ (48,7%) Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (31,1%) (p=0,012), ·ÔÙ¤ÏÂÛÌ· Ô˘ Èı·ÓfiÓ ÔÊ›ÏÂÙ·È Î·È ÛÙËÓ ÏËÌÌÂÏ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ ·È‰ÈÒÓ. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔÓ ¢ª™ ‰È·ÈÛÙÒıËΠfiÙÈ ÛÙÔ 33,8% ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ÛÙÔ 52,7% ÙˆÓ ·¯‡Û·ÚÎˆÓ ·È‰ÈÒÓ ¤ÁÈÓ·Ó Î¿ÔȘ Û˘ÛÙ¿ÛÂȘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ (p=0,016). ¶·ÚfiÌÔÈ·, ÔÈ ·¯‡Û·ÚÎÔÈ Ï¿Ì‚·Ó·Ó Û˘¯ÓfiÙÂÚ· Ô‰ËÁ›Â˜ Î·È ÛÙȘ ÂÈ̤ÚÔ˘˜ ÔÌ¿‰Â˜ Ô‰ËÁÈÒÓ (¶›Ó·Î·˜ 2). ∞fi Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó οÔȘ Ô‰ËÁ›Â˜, ÙÔ 91,7% ¤Ï·‚ ‰È·ÙÚÔÊÈΤ˜ Û˘ÛÙ¿ÛÂȘ, ÙÔ 59,7% Ô‰ËÁ›Â˜ ÁÈ· ·‡ÍËÛË Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ÙÔ 50% Ô‰ËÁ›Â˜ ÁÈ· ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Î·È ÌfiÓÔ 27,8% ÙˆÓ ·È‰ÈÒÓ ¤Ï·‚ ԉËÁ›Â˜ ÁÈ· Ì›ˆÛË ÙÔ˘ ËÌÂÚ‹ÛÈÔ˘ ¯ÚfiÓÔ˘ ÙËÏÂı¤·Û˘. ∞Í›˙ÂÈ Û ·˘Ùfi ÙÔ ÛËÌÂ›Ô Ó· ·Ó·ÊÂÚı› fiÙÈ ·ÎfiÌ·

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·379

379

∂ȉËÌÈÔÏÔÁ›· Ù˘ ·¯˘Û·ÚΛ·˜ Û ·È‰È¿ ÛÙËÓ ∞ÙÙÈ΋

¶›Ó·Î·˜ 2. ¢ª™ ·È‰ÈÒÓ Î·È ÔÌ¿‰Â˜ Ô‰ËÁÈÒÓ (Û‡ÓÔÏÔ ‰Â›ÁÌ·ÙÔ˜) √‰ËÁ›Â˜

¢ª™ (85Ë-94Ë ∂£)

¢ª™ ( ≥95Ë ∂£)

N

%

N

%

P

√‰ËÁ›Â˜

Ÿ¯È ¡·È

47 24

66,2 33,8

43 48

47,3 52,7

0,016

√‰ËÁ›Â˜ ‰È·ÙÚÔÊ‹˜

Ÿ¯È ¡·È

49 22

69,0 31,0

47 44

51,6 48,4

0,026

√‰ËÁ›Â˜ ÁÈ· ¿ÛÎËÛË

Ÿ¯È ¡·È

58 13

81,7 18,3

61 30

67,0 33,0

0,036

√‰ËÁ›Â˜ ÁÈ· ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô

Ÿ¯È ¡·È

63 8

88,7 11,3

63 28

69,2 30,8

0,003

√‰ËÁ›Â˜ ÁÈ· ÂÏ¿ÙÙˆÛË Ù˘ ÙËÏÂı¤·Û˘

Ÿ¯È ¡·È

67 4

94,4 5,6

75 16

82,4 17,6

0,022

Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ›¯·Ó Á›ÓÂÈ Î¿ÔȘ Û˘ÛÙ¿ÛÂȘ ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜, ·˘Ù¤˜ ‹Ù·Ó ÁÂÓÈÎfiÏÔÁ˜ Î·È ·Û·Ê›˜. ∂ȉÈÎfiÙÂÚ· ÁÈ· ÙË ‰È·ÙÚÔÊ‹, Ë ÚÔÙÚÔ‹ ‹Ù·Ó ·Ï¿ “ÙÚÒÙ ÏÈÁfiÙÂÚÔ”, ¯ˆÚ›˜ Û˘ÁÎÂÎÚÈ̤ÓË ·Ó·ÊÔÚ¿ ÛÙËÓ ·ÔÊ˘Á‹ ‹ ÛÙËÓ ÚÔÛı‹ÎË ÂȉÈÎÒÓ ÙÚÔÊ›ÌˆÓ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ. °È· ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË, ηӤӷ˜ ·È‰›·ÙÚÔ˜ ‰ÂÓ Â›¯Â ÚÔÙ›ÓÂÈ ÛÙÔÓ ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ ·ÛıÂÓ‹ ÙÔ˘ Û˘ÌÌÂÙÔ¯‹ Û οÔÈÔ ÔÚÁ·ÓˆÌ¤ÓÔ ¿ıÏËÌ·, Ô‡Ù ›¯Â ÂÈÛËÌ¿ÓÂÈ ÙËÓ ·Ó¿ÁÎË ÁÈ· ·‡ÍËÛË Ù˘ ηıËÌÂÚÈÓ‹˜ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ¿˜ ÙÔ˘, ÂÈϤÁÔÓÙ·˜, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ÙÔ ÂÚ¿ÙËÌ· ˆ˜ ÙÔ Û¯ÔÏÂ›Ô ‹ ÙÔ ·È¯Ó›‰È ÛÙËÓ ·˘Ï‹. √È Ô‰ËÁ›Â˜ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, fiÔ˘ ˘‹Ú¯·Ó, ·ÊÔÚÔ‡Û·Ó ·ÔÎÏÂÈÛÙÈο ÛÙÔ ÏÈȉÈfiÁÚ·ÌÌ·, ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó Û˘ÛÙ¿ÛÂȘ ÁÈ· ÚÔÛ‰ÈÔÚÈÛÌfi ÁÏ˘Îfi˙˘ Ó‹ÛÙˆ˜, ÔÚÌÔÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ηٿ ÂÚ›ÙˆÛË ‹ ‰ÈÂÚ‡ÓËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘¯fiÓ Û˘Ó˘¿Ú¯Ô˘Û·˜ ÛȉËÚÔÂÓ›·˜ (Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÛÙ· ·¯‡Û·Úη ·È‰È¿) (3,4). ∞ÎfiÌË, ηӤӷ ·È‰› ‰ÂÓ Â›¯Â Ï¿‚ÂÈ Ô‰ËÁ›· ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ ·ÚÈıÌfi ˆÚÒÓ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂfiÚ·Û˘ ÙËÓ Ë̤ڷ. ∆ÂÏÈο, ηӤӷ˜ ·È‰›·ÙÚÔ˜ ‰ÂÓ ·Ú¤ÂÌ„Â ÙÔÓ ˘¤Ú‚·ÚÔ ‹ ·¯‡Û·ÚÎÔ ·ÛıÂÓ‹ ÙÔ˘ ÁÈ· ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ‰È·ÈÙÔÏÔÁÈ΋ Û˘Ì‚Ô˘Ï‹, „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË, ·ÏÏ¿ Ô‡ÙÂ Î·È ÚfiÙÂÈÓ ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Î·È Â·ÓÂÎÙ›ÌËÛË.

™˘˙‹ÙËÛË ∏ Ú·Á‰·›· ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ Û ÂÚÈ‚·ÏÏÔÓÙÔÏÔÁÈΤ˜ ·ÏÏ·Á¤˜ Î·È fi¯È Û ÁÔÓȉȷΤ˜ ÌÂÙ·‚ÔϤ˜, Ô˘ ··ÈÙÔ‡Ó ÂηÙÔÓÙ¿‰Â˜ ¯ÚfiÓÈ·. ™‡Ìʈӷ Ì ÙȘ ÙÚ¤¯Ô˘Û˜ ÌÂϤÙ˜, ÂÚÈÛÛfiÙÂÚ· ·fi 1 ÛÙ· 5 ·È‰È¿ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ Â›Ó·È ˘¤Ú‚·Ú· ‹ ‰È·ÙÚ¤¯Ô˘Ó ΛӉ˘ÓÔ ·¯˘Û·ÚΛ·˜ (5). ∏ ÓfiÛÔ˜ Úԉȷı¤ÙÂÈ Î·Ù¿ 30% Û ·¯˘Û·ÚΛ· ÙˆÓ ÂÓËϛΈÓ,

ÂÓÒ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ fiÛÔ ÓˆÚ›ÙÂÚ· ÍÂÎÈÓ¿ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ÙfiÛÔ ÂÚÈÛÛfiÙÂÚ˜ ÂÈÏÔΤ˜ ÚÔηÏ› ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (6,7). √È ‰È·ÛÙ¿ÛÂȘ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Â›Ó·È ÙÂÚ¿ÛÙȘ, ÂÂȉ‹ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ· ·fi ·ı‹ÛÂȘ fiˆ˜ Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË, Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, ·ÏÏ¿ Î·È ÌÂÚÈΤ˜ ÌÔÚʤ˜ ηÚΛÓÔ˘ (8). ™ÙË ÌÂϤÙË Ì·˜ ‰È·ÈÛÙÒıËΠÛÔ‚·Ú‹ ·ÏÏ·Á‹ ÛÙȘ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ÛÙÔÓ ÙÚfiÔ ˙ˆ‹˜ Ù˘ Û‡Á¯ÚÔÓ˘ ÂÏÏËÓÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. √È ··ÈÙ‹ÛÂȘ Ù˘ Û‡Á¯ÚÔÓ˘ ˙ˆ‹˜ ·Ó·Áο˙Ô˘Ó ÙÔ˘˜ ÁÔÓ›˜ Ó· Ï›Ô˘Ó ·ÚÎÂÙ¤˜ ÒÚ˜ ·fi ÙÔ Û›ÙÈ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÌËÓ ˘¿Ú¯ÂÈ ¯ÚfiÓÔ˜ Î·È ‰˘Ó·ÙfiÙËÙ· ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ÔÚÁ¿ÓˆÛ˘ ÙÔ˘ ‰È·ÈÙÔÏÔÁ›Ô˘ ÙˆÓ ·È‰ÈÒÓ. ◊‰Ë ·fi ÙË ÓËȷ΋ ËÏÈΛ· ‰È·ÈÛÙÒÓÔÓÙ·È ˘„ËÏ¿ ÔÛÔÛÙ¿ ·¯˘Û·ÚΛ·˜. ∂ȉÈο ÛÙȘ ÌÈÎÚ¤˜ ËÏÈ˘, ·Ú·ÙËÚÂ›Ù·È ˘ÂÚηٷӿψÛË ÚÔ˚fiÓÙˆÓ ˘„ËÏ‹˜ ıÂÚÌȉÈ΋˜ ·Í›·˜ (ÌÈÛÎfiÙ·, ‚Ô˘Ù‹Ì·Ù·, ·Ù·Ù¿ÎÈ·), ÂÓÒ Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ηٷӷÏÒÓÔ˘Ó Ôχ Û˘¯Ó¿ Ù·¯‡ Ê·ÁËÙfi Ô˘ Â›Ó·È ÏÔ‡ÛÈÔ Û η΋˜ ÔÈfiÙËÙ·˜ Ï›Ë. ∆Ô ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ Î·È ·¯‡Û·ÚÎˆÓ ÓË›ˆÓ Ù˘ ÌÂϤÙ˘ Â›Ó·È ·ÓËÛ˘¯ËÙÈÎfi, ÁÈ·Ù› Ù· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· Á›ÓÔ˘Ó ·¯‡Û·ÚÎÔÈ ÂÓ‹ÏÈΘ (9). ∂ÈϤÔÓ, ÛÙ· Ó‹È· ‰ÂÓ ¤¯Ô˘Ó ‰È·ÌÔÚʈı› ·ÎfiÌ· ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È ¿Ú· Ë ¤ÁηÈÚË ·Ú¤Ì‚·ÛË Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· Â›Ó·È Î·È ÂÈÙ˘¯‹˜. ™¯ÂÙÈο Ì ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘, ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ 86,2% ‚ϤÂÈ ÙËÏÂfiÚ·ÛË ÂÚÈÛÛfiÙÂÚÔ ·fi 2 ÒÚ˜ ÙËÓ Ë̤ڷ, ÂÓÒ Ô Ì¤ÛÔ˜ ËÌÂÚ‹ÛÈÔ˜ ¯ÚfiÓÔ˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÊÙ¿ÓÂÈ ÙȘ 4,2 ÒÚ˜, ‰È¿ÛÙËÌ· ˘ÂÚ‰ÈÏ¿ÛÈÔ ÙÔ˘ ÚÔÙÂÈÓfiÌÂÓÔ˘ ·fi ÙËÓ AÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∞η‰ËÌ›· (10). ¡· ÛËÌÂȈı› fiÙÈ ÛÙË ÌÂϤÙË Ì·˜ ‰ÂÓ ¤¯Ô˘Ó ˘ÔÏÔÁÈÛÙ› ÔÈ ÒÚ˜ ··Û¯fiÏËÛ˘ Ì video ·È¯Ó›‰È· ‹ Ì ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹. ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ¶·È‰È·ÙÚÈ΋ 2008;71:376-382

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·380

380

√. ºÈÏ›Ô˘ Î·È Û˘Ó.

ηٷ‰Â›ÍÂÈ ÙË ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ‰È¿ÚÎÂÈ·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂfiÚ·Û˘ Î·È ÙÔ˘ ‚·ıÌÔ‡ ·¯˘Û·ÚΛ·˜ Û ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘ ·È‰ÈÒÓ (11,12,13). Œ¯ÂÈ ‚ÚÂı› fiÙÈ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 12-17 ÂÙÒÓ, οı ÂÈϤÔÓ ÒÚ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂfiÚ·Û˘ Ô‰ËÁ› Û 2% ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ·¯˘Û·ÚΛ·˜ (12). ∂ÈϤÔÓ, Û ÚfiÛÊ·ÙË ÌÂϤÙË ·Ú·ÎÔÏÔ‡ıËÛ˘ 976 ·È‰ÈÒÓ, ËÏÈΛ·˜ 3-15 ÂÙÒÓ, ‰È·ÈÛÙÒıËΠfiÙÈ ÙfiÛÔ Ë Û˘¯ÓfiÙËÙ· Ù˘ ·¯˘Û·ÚΛ·˜ fiÛÔ Î·È Ô ¢ª™ Û¯ÂÙ›˙ÔÓÙ·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο Ì ÙȘ ÒÚ˜ ‚‰ÔÌ·‰È·›·˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂfiÚ·Û˘ (14). ∏ ·˘ÍË̤ÓË ÙËÏÂı¤·ÛË ÚÔ¿ÁÂÈ ÙËÓ ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, ÌÂÈÒÓÔÓÙ·˜ ÙËÓ Î·Ù·Ó¿ÏˆÛË ÂÓ¤ÚÁÂÈ·˜ Î·È ·˘Í¿ÓÔÓÙ·˜ ÙËÓ ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ıÂÚÌ›‰ˆÓ, ›Ù ̤ۈ Ù˘ ηٷӿψÛ˘ “snacks” ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘ ›Ù ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ‰È·Ê‹ÌÈÛ˘ (15). ∞Ó·ÊÔÚÈο Ì ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ‰È·ÈÛÙÒıËΠfiÙÈ Û¯Â‰fiÓ Ù· ÌÈÛ¿ ·È‰È¿ ‰ÂÓ ·ÛÎÔ‡Ó Ô‡Ù ÙȘ ηıËÌÂÚÈÓ¤˜ ·Ϥ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ·ÊÔ‡ ‰ÂÓ ÂÚ·ÙÔ‡Ó Ô‡Ù ηٿ ÙË ‰È·‰ÚÔÌ‹ Û›ÙÈ-Û¯ÔÏ›Ô. ∏ ¢Ú›· ¯Ú‹ÛË ÙÔ˘ ·˘ÙÔÎÈÓ‹ÙÔ˘ ÛÙȘ ÌÂÙ·ÎÈÓ‹ÛÂȘ, Ë Î·ı‹ÏˆÛË ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË ÁÈ· ÔÏϤ˜ ÒÚ˜, Ë ·ÓÙÂÏ‹˜ ¤ÏÏÂÈ„Ë ¿ÛÎËÛ˘ Î·È Ë ·ıÔÏÔÁÈ΋ ‰È·ÙÚÔÊÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Ô‰ËÁÔ‡Ó ÙÂÏÈο Û ÂÚ›ÛÛÂÈ· ıÂÚÌ›‰ˆÓ Î·È ÛÙË Á¤ÓÂÛË ·¯˘Û·ÚΛ·˜. √ ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·˘Ù‹˜ Ù˘ ÂȉËÌ›·˜ Â›Ó·È Ë Û˘ÓÔÏÈ΋ Î·È ÛÙÔ¯Â˘Ì¤ÓË ÚÔÛ¤ÁÁÈÛË, ÌÂ Û˘Ó‰˘·ÛÌfi ‰›·ÈÙ·˜, ·˘ÍË̤Ó˘ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ·ÏÏ¿ Î·È ·ÏÏ·Á‹˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Û˘ÓËıÂÈÒÓ, ÙfiÛÔ ÙÔ˘ ·È‰ÈÔ‡ fiÛÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ (16). ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ, ‡ÎÔÏ· ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È Î·Ó›˜ fiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙÔ Â›Â‰Ô ÂÓfi˜ ÎÔÈÓÔ‡ ·È‰È·ÙÚÈÎÔ‡ È·ÙÚ›Ԣ Â›Ó·È ‰‡ÛÎÔÏË Î·È ¯ÚÔÓÔ‚fiÚ· ‰È·‰Èηۛ·. À¿Ú¯Ô˘Ó Ôχ Ï›Á˜ ¤Ú¢Ó˜ Û¯ÂÙÈο Ì ÙÔÓ ‚·ıÌfi ÛÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ÙÔ Úfi‚ÏËÌ· ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Î·È ÙÔ fiÛÔ ÂÈÙ˘¯‹˜ Â›Ó·È Ë ıÂÚ·›· Ô˘ ÚÔÙ›ÓÔ˘Ó. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÏÈÁfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·È‰›·ÙÚÔ˘˜ (ÌfiÏȘ 45,4%) ηٿÊÂÚ·Ó Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÙÔ Úfi‚ÏËÌ· ÙÔ˘ ·˘ÍË̤ÓÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘˜, fiÛÔ Ì¿ÏÏÔÓ Ó· οÓÔ˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘ÛÙ¿ÛÂȘ. √ ˘ÔÏÔÁÈÛÌfi˜ ÙÔ˘ ¢ª™ ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌ· ÚÔ˘Ù›Ó· ÛÙËÓ ·È‰È·ÙÚÈ΋ ÂͤٷÛË Î·È ÁÈ’ ·˘ÙfiÓ ÙÔ ÏfiÁÔ Ù· ¿ÙÔÌ· Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÎÛÂÛËÌ·Ṳ̂ÓÔ Úfi‚ÏËÌ· ‰È·Ï·Óı¿ÓÔ˘Ó ÙËÓ ÚÔÛÔ¯‹. ¶Èı·ÓÒ˜ ·˘Ù‹ Ó· Â›Ó·È Ë ÂÍ‹ÁËÛË ÁÈ· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 64% ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ ‰ÂÓ ¤Ï·‚ η̛· Ô‰ËÁ›· ·fi ÙÔÓ ·È‰›·ÙÚÔ Ô˘ Ù· ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ, Û ·ÓÙ›ıÂÛË Ì ÙÔ 52,7% ÙˆÓ ·¯‡Û·ÚÎˆÓ Ô˘ ¤Ï·‚ οÔȘ Ô‰ËÁ›Â˜. ¶Ú¤ÂÈ Ó· ÂÈÛËPaediatriki 2008;71:376-382

Ì·Óı› fiÙÈ ÙÔ ‰Â›ÁÌ· Ù˘ ÌÂϤÙ˘ ·ÊÔÚ¿ ¿ÙÔÌ· Ù· ÔÔ›· ηÙÔÈÎÔ‡Ó Û ÂÚÈÔ¯‹ ˘„ËÏÔ‡ ‚ÈÔÙÈÎÔ‡ ÂÈ¤‰Ô˘ Î·È ÙÔ Û‡ÓÔÏÔ ·˘ÙÒÓ ÚÔÛ¤Ú¯ÔÓÙ·Ó ÛÙ· ∂π Ù˘ ÎÏÈÓÈ΋˜ ‹ ÛÙ· ȉȈÙÈο ·È‰È·ÙÚÈο È·ÙÚ›· ÁÈ· Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ∏ ÂÙ‹ÛÈ· ÂÎÙ›ÌËÛË Î·È Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ¢ª™ Û fiÏ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ¤Ó· ··Ú·›ÙËÙÔ Î·È ·Ó·Áη›Ô ·Ú¯ÈÎfi ̤ÙÚÔ ÁÈ· ÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂΉ‹ÏˆÛ˘ Ù˘ ÓfiÛÔ˘. ¶·ÚfiÏÔ Ô˘ Ë AÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ (10), Ë ∞ÌÂÚÈηÓÈ΋ ∫·Ú‰ÈÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (16,17) Î·È Ë ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ (13) ¤¯Ô˘Ó ‰ÒÛÂÈ Û˘ÁÎÂÎÚÈ̤Ó˜ Î·È Û·Ê›˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ·¯˘Û·ÚΛ·˜, ηıÒ˜ Î·È ‰È·ÙÚÔÊÈΤ˜ ÚÔÙ¿ÛÂȘ ÁÈ· οı ËÏÈÎȷ΋ ÔÌ¿‰·, ηӤӷ˜ ·È‰›·ÙÚÔ˜ ÛÙË ÌÂϤÙË Ì·˜ ‰ÂÓ Ê¿ÓËΠӷ ÂÊ·ÚÌfi˙ÂÈ ÙȘ ‰ÈÂıÓ›˜ Û˘ÛÙ¿ÛÂȘ. ∆Ô 40,7% ÙˆÓ ·È‰È¿ÙÚˆÓ ¤‰ˆÛ οÔȘ Û˘Ì‚Ô˘Ï¤˜ ÁÈ· ·ÏÏ·Á¤˜ ÛÙÔÓ ÙÚfiÔ ‰È·ÙÚÔÊ‹˜, ÔÈ Ôԛ˜ fï˜ ‹Ù·Ó ·fiÚÈÛÙ˜ Î·È ÌË ÂȉÈΤ˜. ™Â ·Ó¿ÏÔÁ˜ ÌÂϤÙ˜, ·ÚÎÂÙ¿ ˘„ËÏ¿ ÔÛÔÛÙ¿ ·È‰È¿ÙÚˆÓ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ (Î˘Ì·›ÓÔÓÙ·È ·fi 67%75%) Û˘Ó¤ÛÙËÛ·Ó ÛÙÔ˘˜ ˘¤Ú‚·ÚÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘˜ ·ÒÏÂÈ· ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜, ÂÛÙÈ¿˙ÔÓÙ·˜ ȉȷ›ÙÂÚ· ÛÙÔÓ ÂÚÈÔÚÈÛÌfi ıÂÚÌȉÈ΋˜ ÚfiÛÏ˄˘, ̤ۈ ·ÔÊ˘Á‹˜ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ (18,19). ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Î¿ı ËÏÈÎȷ΋ ÔÌ¿‰· ¤¯ÂÈ ‰È·ÊÔÚÂÙÈΤ˜ ıÂÚÌȉÈΤ˜ ·Ó¿ÁΘ, ·ÏÏ¿ Î·È ‰È·ÊÔÚÂÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ ÁÈ· Ê˘ÛÈ΋ ¿ÛÎËÛË. ∏ Â›Ù¢ÍË ÈÛÔÚÚÔ›·˜ ÌÂٷ͇ ÚfiÛÏ˄˘ Î·È Î·Ù·Ó¿ÏˆÛ˘ ÂÓ¤ÚÁÂÈ·˜ Â›Ó·È ÔχÏÔÎË ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÂÂȉ‹ Â›Ó·È ··Ú·›ÙËÙË Ë Â·Ú΋˜ ÚfiÛÏË„Ë ÌÈÎÚÔ- Î·È Ì·ÎÚÔ- ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁÈ΋ ·‡ÍËÛË Î·È ·Ó¿Ù˘Í‹ ÙÔ˘˜ (16,20). ™Ùfi¯Ô˜ Â›Ó·È Ë ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Û˘ÓÔÏÈο ˘ÁÈÂÈÓÔ‡ ‰È·ÈÙÔÏÔÁ›Ô˘ Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÊÚÔ‡Ù·, Ï·¯·ÓÈο, ÙÚÔʤ˜ ¯·ÌËϤ˜ Û ÏÈ·Ú¿ Î·È ÚÔ˚fiÓÙ· ÔÏÈ΋˜ ¿ÏÂÛ˘, ¯ˆÚ›˜ Ó· ·ÔÎÏ›ÔÓÙ·È ÔÌ¿‰Â˜ ÙÚÔÊÒÓ. ¶·Ú¿ÏÏËÏ·, ÔÚÈṲ̂Ó˜ ÁÂÓÈΤ˜ ·ÏÏ¿ ÔÏϤ˜ ÊÔÚ¤˜ ¯Ú‹ÛÈ̘ Ú·ÎÙÈΤ˜, fiˆ˜ Ë Û˘ÛÙËÌ·ÙÈ΋ ηٷӿψÛË ÚˆÈÓÔ‡, ÔÈ ÛˆÛÙ¤˜ ÌÂÚ›‰Â˜ Ê·ÁËÙÔ‡, ÙÔ ÛÂÚ‚›ÚÈÛÌ· Ì fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Û˘ÁÎÂÓÙڈ̤ÓË ÛÙÔ ÙÚ·¤˙È, Ë ·ÔÊ˘Á‹ ¯ÔÚ‹ÁËÛ˘ ÙÚÔÊÒÓ ÁÈ· ·ÚËÁÔÚÈ¿ ‹ ÂÈ‚Ú¿‚¢ÛË, ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÙË ‚¿ÛË ÁÈ· ÛˆÛÙ¤˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ (20). ¶·ÚfiÏÔ Ô˘ Ë Û˘ÛÙËÌ·ÙÈ΋ ۈ̷ÙÈ΋ ¿ÛÎËÛË Î·È Ë ·˘ÍË̤ÓË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ¢ÓÔÔ‡Ó ÙËÓ ÚfiÏË„Ë, ·ÏÏ¿ Î·È ÙËÓ Î·Ù·ÔϤÌËÛË Ù˘ ·¯˘Û·ÚΛ·˜, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ηٷÁÚ¿ÊÂÙ·È fiÙÈ ÔÈ ·È‰›·ÙÚÔÈ Û˘¯Ó¿ ˘ÔÂÎÙÈÌÔ‡Ó ‹ ·Ú·‚ϤÔ˘Ó ÙË ÛËÌ·Û›· Ù˘ (21,22). ∂ȉÈÎfiÙÂÚ·, Û ÌÂϤÙË ÙˆÓ Harvey et al, ÌfiÓÔ 1 ÛÙÔ˘˜ 3 ·È‰›·ÙÚÔ˘˜ ¤‰ˆÛ ԉËÁ›Â˜ ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘

Pediatri Sept-Oct 08

22-10-08

12:30

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√‰ËÁ›Â˜ √‰ËÁ›Â˜ √‰ËÁ›Â˜ ÁÈ· √‰ËÁ›Â˜ ÁÈ· ‰È·ÙÚÔÊ‹˜ ÁÈ· Ê˘ÛÈ΋ ÂÚÁ·ÛÙËÚÈ·Îfi Ì›ˆÛË ¿ÛÎËÛË ¤ÏÂÁ¯Ô ÙËÏÂı¤·Û˘

∂ÈÎfiÓ· 2. ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ηٿ ÔÌ¿‰Â˜ Ô‰ËÁÈÒÓ (Û‡ÓÔÏÔ ‰Â›ÁÌ·ÙÔ˜).

ÛÙÔ˘˜ ·¯‡Û·ÚÎÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘, ÂÓÒ ·ÚfiÌÔÈ· ÔÈ Barlow et al ‰È·›ÛÙˆÛ·Ó fiÙÈ ÌfiÏȘ ÙÔ 42% ÙˆÓ ·È‰È¿ÙÚˆÓ Ù˘ ÌÂϤÙ˘ ÙÔ˘˜ Û˘Ó¤ÛÙËÛ ÙÚfiÔ˘˜ ÚÔÒıËÛ˘ Ù˘ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙ· ˘¤Ú‚·Ú· ·È‰È¿ (18,23). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ÌfiÓÔ ÙÔ 26,5% ÙˆÓ ·È‰È¿ÙÚˆÓ ¤‰ˆÛ ԉËÁ›Â˜ ÁÈ· ·‡ÍËÛË Ù˘ Ê˘ÛÈ΋˜ ¿ÛÎËÛ˘, ÌË ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·˜ ˆÛÙfiÛÔ Ì ۷ʋÓÂÈ· ÙÔ Â›‰Ô˜, ÙË ‰È¿ÚÎÂÈ· Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ Â›Ù¢͋˜ Ù˘. ∏ ·‡ÍËÛË Ù˘ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Û ηıËÌÂÚÈÓ‹ ‚¿ÛË Î·È Ë ÚÔÒıËÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ Û ÔÚÁ·ÓˆÌ¤Ó· ·ıÏ‹Ì·Ù·, ·Ó¿ÏÔÁ· Ì ٷ ÂӉȷʤÚÔÓÙ· Î·È ÙȘ ‰ÂÍÈfiÙËÙ¤˜ ÙÔ˘˜, Â›Ó·È ··Ú·›ÙËÙÔÈ ÙÚfiÔÈ ·Ú¤Ì‚·Û˘ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ·È‰È¿ÙÚÔ˘, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ Ì ÂÈÙ˘¯›· ÙÔ Úfi‚ÏËÌ· Ù˘ ·¯˘Û·ÚΛ·˜. ∆Ô 12,3% ÙˆÓ ·È‰È¿ÙÚˆÓ Û˘Ó¤ÛÙËÛ ÏÈÁfiÙÂÚ˜ ÒÚ˜ ηı‹ÏˆÛ˘ ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË, ÔÛÔÛÙfi Ô˘ ÛÙȘ ‰ÈÂıÓ›˜ ÌÂϤÙ˜ Î˘Ì·›ÓÂÙ·È ·ÎfiÌË ¯·ÌËÏfiÙÂÚ· (3%-5%) (18,23). ∏ ÙËÏÂfiÚ·ÛË, ÂÎÙfi˜ ·fi ÙË Û˘ÌÌÂÙÔ¯‹ Ù˘ ÛÙÔÓ Û‡Á¯ÚÔÓÔ Î·ıÈÛÙÈÎfi ÙÚfiÔ ˙ˆ‹˜, ·ÛΛ fiˆ˜ ÚԷӷʤÚıËÎÂ Î·È ÛËÌ·ÓÙÈÎfi ·ÚÓËÙÈÎfi ÚfiÏÔ Ì¤Ûˆ Ù˘ ‰È·Ê‹ÌÈÛ˘ ·Óı˘ÁÈÂÈÓÒÓ ÙÚÔÊÒÓ Î·È Û˘ÓËıÂÈÒÓ. °È’ ·˘ÙÔ‡˜ ÙÔ˘˜ ÏfiÁÔ˘˜, Ë Ô‰ËÁ›· ·fi ÙÔÓ ·È‰›·ÙÚÔ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, Û ÂÚÈÔÚÈṲ̂ÓÔ ¯ÚfiÓÔ, Â›Ó·È ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈ΋ (∂ÈÎfiÓ· 2). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·È‰È΋ ·¯˘Û·ÚΛ· ·ÔÙÂÏ› ¤Ó· ÔÏ˘·Ú·ÁÔÓÙÈÎfi Úfi‚ÏËÌ· Ì ÔÏϤ˜ Û˘ÓÈÛÙÒÛ˜, Ô˘ ¯Ú‹˙ÂÈ ·Ó¿ÏÔÁ˘ ÚÔÛ¤ÁÁÈÛ˘ (24,25). ∏ ·Ó·ÁηÈfiÙËÙ· ÁÈ· ÚfiÏË„Ë Â›Ó·È ÌÂÁ¿ÏË, ÂÊfiÛÔÓ ÔÈ ‰˘Ó·ÙfiÙËÙ˜ ıÂÚ·›·˜ ·Ú·Ì¤ÓÔ˘Ó Ì¤¯ÚÈ Û‹ÌÂÚ· ÂÚÈÔÚÈṲ̂Ó˜. √È ·È‰›·ÙÚÔÈ ¤¯Ô˘Ó ÙËÓ Â˘ı‡ÓË ·Ú¯Èο Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó Ù· ˘¤Ú‚·Ú· Î·È ·¯‡Û·Úη ·È‰È¿ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ó· ÙÔ˘˜ ·Ú¤¯Ô˘Ó ÙÂÎÌËÚȈ̤ÓË ·Ú¤Ì‚·ÛË. ¶·Ú¿ÏÏËÏ·, ηÏÔ‡ÓÙ·È Ó· ·›ÍÔ˘Ó Û˘Ì‚Ô˘Ï¢ÙÈÎfi ÚfiÏÔ ÙfiÛÔ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÁÈ· ÙË ‰È·ÌfiÚʈÛË ˘ÁÈÂÈÓÒÓ Û˘ÓËıÂÈÒÓ ‰È·ÙÚÔÊ‹˜ Î·È Ê˘-

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20. ∫·Ê¿ÙÔ˜ ∞. ¢È·ÙÚÔÊ‹ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÁÈ· ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ·Ó¿Ù˘Í˘ Î·È ÚfiÏË„Ë ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ. ¶·È‰È·ÙÚÈ΋ 2008;71:157-161.

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ORIGINAL ARTICLE

383

∏ıÈο ‰ÈÏ‹ÌÌ·Ù· ηٿ ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË: ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ‰È·ÎÚ·ÙÈÎÔ‡ ÂÚ¢ÓËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ EDIG ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË1, ™. ÃÚÈÛÙÔÁÈÒÚÁÔ˜2, µ. µ·ÛÈÏÔÔ‡ÏÔ˘2, ∂˘Á. ™Ô˘Ì¿ÎË2, °. ∫ÔÏ·˝Ù˘2, µ. §¿ÁÁ·ÚË2, ∫. ∫ˆÛÙ¿ÎÔ˘2, µ. µÂÏÈÛÛ·Ú›Ô˘3, ¡. ™ÙÚ›ÓÙ˙˘3, ¢. ªfiÙÛ˘4, ∂. ∫·Ó·‚¿Î˘1, π. ∆ÛÈ¿ÓÙ˘2, EDIG consortium* ¶ÂÚ›ÏË„Ë: °È· ÚÒÙË ÊÔÚ¿ ÛÂ Â˘Úˆ·˚Îfi Â›Â‰Ô ‰ÈÂÍ¿ÁÂÙ·È ‰È·ÎÚ·ÙÈ΋ ¤Ú¢ӷ ÌÂ Û˘ÓÙÔÓÈÛÙÈÎfi ΤÓÙÚÔ ÙÔ πÓÛÙÈÙÔ‡ÙÔ Freud Ù˘ ºÚ·ÓÎÊÔ‡ÚÙ˘, Ô˘ ÌÂÏÂÙ¿ Ù· ËıÈο ‰ÈÏ‹ÌÌ·Ù· ÌÂÙ¿ ·fi ÙË ‰È¿ÁÓˆÛË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô, ηıÒ˜ Î·È ÙȘ „˘¯ÔÏÔÁÈΤ˜ ÂÈÙÒÛÂȘ ÛÙȘ Á˘Ó·›Î˜ Î·È ÛÙÔ˘˜ Û˘ÓÙÚfiÊÔ˘˜ ÙÔ˘˜. ∏ Û˘ÏÏÔÁ‹ ÙÔ˘ ˘ÏÈÎÔ‡ Á›ÓÂÙ·È Ì¤Û· ·fi ‰‡Ô ˘ÔÌÂϤÙ˜: ·) ηٷÁÚ¿ÊÂÙ·È Ë ÂÌÂÈÚ›· ˙¢Á·ÚÈÒÓ Ô˘ ‰È¤Ú¯ÔÓÙ·È ·fi ÙË ‰È·‰Èηۛ· ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Î·È Û˘ÓÂÓÙ‡ÍÂȘ Î·È ‚) ηٷÁÚ¿ÊÔÓÙ·È ÔÈ ÙÚfiÔÈ ‰È·¯Â›ÚÈÛ˘ ÙˆÓ ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Î·È ÙˆÓ ÂÈÙÒÛÂÒÓ ÙÔ˘˜ ÛÙËÓ „˘¯È΋ ˘Á›· ÙˆÓ ·ÛıÂÓÒÓ, ̤۷ ·fi ÙË Û˘ÓÂÚÁ·Û›· Ì „˘¯ÔıÂÚ·Â˘Ù¤˜/„˘¯·Ó·Ï˘Ù¤˜ Î·È ÚÒËÓ ·ÛıÂÓ›˜ ÙÔ˘˜, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÙËÓ ÂÌÂÈÚ›· ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô. ∆· ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∞ı‹Ó·˜ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Á˘Ó·›Î˜ Î·È ¿Ó‰Ú˜ ‰È·¯ÂÈÚ›˙ÔÓÙ·È ÙÔ ÁÂÁÔÓfi˜ Ù˘ ·Ó·ÎÔ›ÓˆÛ˘ ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÂÎÊÚ¿˙ÔÓÙ·˜ ı˘Ìfi ÚÔ˜ ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙÔÓ £Âfi, ÚÔÛ·ıÒÓÙ·˜ Ó· ͯ¿ÛÔ˘Ó ÁÚ‹ÁÔÚ· ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜. √È Á˘Ó·›Î˜ ÂÈÛÚ¿ÙÙÔ˘Ó ˆ˜ Ó·ÚÎÈÛÛÈÛÙÈÎfi ÙÚ·‡Ì· ÙËÓ ‡·ÚÍË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÛÙÔ ¤Ì‚Ú˘Ô, ÂÓÒ ÚÔηÏÂ›Ù·È ¤ÓÙ·ÛË ÛÙÔ ˙¢Á¿ÚÈ. ∏ ‰È¿ÁÓˆÛË, ˆÛÙfiÛÔ, Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ ÚfiÏÔ ÛÙË Ï‹„Ë ·fiÊ·Û˘ Î·È ÛÙÔ˘˜ ÙÚfiÔ˘˜ ‰È·¯Â›ÚÈÛ‹˜ Ù˘. ™ÙȘ ÂÚÈÙÒÛÂȘ Ì ÙÚÈۈ̛· 21, Ë ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ Ê·›ÓÂÙ·È Â‡ÏÔÁË ·fiÊ·ÛË Î·È Ë ¤ÎÊÚ·ÛË ÓÙÚÔ‹˜ Î·È ÂÓÔ¯‹˜ Â›Ó·È ËÈfiÙÂÚË. ∏ „˘¯ÔıÂÚ·¢ÙÈ΋ ‚Ô‹ıÂÈ· ÌÔÚ› Ó· ‰È¢ÎÔχÓÂÈ ÙÔ ˙¢Á¿ÚÈ Ó· ·ÓÙÈÏËÊı› Ù· ËıÈο ‰ÈÏ‹ÌÌ·Ù· Î·È Ó· Ù· ‰È·Ú·ÁÌ·Ù¢Ù› Û ¤Ó· ÚÔÛˆÈÎfi Î·È ÔÏÈÙÈÛÌÈÎfi/ ıÚËÛ΢ÙÈÎfi Ï·›ÛÈÔ, ‰ÚÒÓÙ·˜ ÚÔÏËÙÈο ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂΉ‹ÏˆÛ˘ „˘¯Ô·ıÔÏÔÁ›·˜ ÛÙÔ Ì¤ÏÏÔÓ.

1 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ¶·È‰Ô„˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 3 ∆Ì‹Ì· °ÂÓÂÙÈ΋˜, ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ “ªËÙ¤Ú·” 4 µ’ ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, “∞ÚÂÙ·›ÂÈÔ” ¡ÔÛÔÎÔÌ›Ô, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË skitsiou@med.uoa.gr ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

§¤ÍÂȘ ÎÏÂȉȿ: ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, ‰È·‰Èηۛ· ·fiÊ·Û˘, ËıÈο ‰ÈÏ‹ÌÌ·Ù·, Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·ÓÙȉڿÛÂȘ.

Ethical dilemmas due to prenatal diagnostics: preliminary results of the multicentre research programme EDIG S. Kitsiou-Tzeli1, S. Christogiorgos2, V. Vassilopoulou2, Eug. Soumaki2, G. Kolaitis2, V. Lagari2, K. Kostakou2, V. Velissariou3, N. Strintzis3, D. Botsis4, E. Kanavakis1, J. Tsiantis2, EDIG consortium** Abstract: This multicentre study, conducted for the first time in Europe, with the coordination of the Sigmund-Freud Institute in Frankfurt, is investigating the ethical dilemmas arising from an abnormal diagnosis on prenatal testing, and its impact on the women and their partners. Data were derived from two substudies: a) Substudy A examines the behaviour of couples that have received positive prenatal diagnostic results and their dilemmas, as revealed through personal interviews and questionnaires; b) Substudy B describes the behaviour of couples receiving professional help from psychotherapists/psychoanalysts in order to deal with their ethical dilemmas and to accept therapeutic guidance to help them to handle the situation. Preliminary results obtained from the Athens research centres have shown that couples tend to express anger towards the medical personnel or God, and at the same time to use their own defenses to overcome the incident as soon as possible. The women are more likely to display narcissistic trauma, while the couples express a high degree of tension and frustration. The diagnosis appears to play an important role in decision making and coping. In cases of trisomy 21, termination of pregnancy is the usual decision, and expression of shame and guilt is milder. Psychotherapists can help the individuals to deal with their ethical dilemmas according to their personal culture or religion, in order to prevent any psychopathology in the future.

Key words: Prenatal diagnostics, decision making, ethical dilemmas, emotional reactions.

∂ÈÛ·ÁˆÁ‹ ¶ÚfiÔ‰ÔÈ ÛÙËÓ ¤Ú¢ӷ ÛÙÔÓ ÙÔ̤· Ù˘ ÁÂÓÂÙÈ΋˜ ÚÔηÏÔ‡Ó ËıÈο ‰ÈÏ‹ÌÌ·Ù· Ù· ÔÔ›· Á›ÓÔÓÙ·È ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ ·ÓÙÈ-

1 Laboratory of Medical Genetics, “Aghia Sophia” Children’s Hospital, University of Athens Medical School 2 Department of Child Psychiatry, “Aghia Sophia” Children’s Hospital, University of Athens Medical School 3 Department of Genetics, “Mitera” Maternity Clinic 4 2nd Department of Obstetrics and Gynaecology, “Areteio” Hospital, University of Athens Medical School Correspondence: Sophia Kitsiou-Tzeli skitsiou@med.uoa.gr Laboratory of Medical Genetics University of Athens

ΛÌÂÓÔ Û˘˙‹ÙËÛ˘ ÛÙȘ Û‡Á¯ÚÔÓ˜ ÎÔÈӈӛ˜. ∆· ËıÈο ‰ÈÏ‹ÌÌ·Ù· ·ÊÔÚÔ‡Ó Û ηٷÛÙ¿ÛÂȘ fiÔ˘ ÙÔ ¿ÙÔÌÔ ¤¯ÂÈ ÈÛ¯˘Ú‹ ËıÈ΋ ˘Ô¯Ú¤ˆÛË Ó· ÂÈϤÍÂÈ ·Ó¿ÌÂÛ· Û ‰‡Ô ÂÓ·ÏÏ·ÎÙÈÎÔ‡˜ ¶·È‰È·ÙÚÈ΋ 2008;71:383-389

Pediatri Sept-Oct 08

14-10-08

13:26

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ÙÚfiÔ˘˜ ‰Ú¿Û˘, ¯ˆÚ›˜ Ó· ÌÔÚ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Î·È ÙÔ˘˜ ‰‡Ô. ™‡Á¯ÚÔÓ˜ ̤ıÔ‰ÔÈ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ‰›ÓÔ˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔ˘˜ ÌÂÏÏÔÓÙÈÎÔ‡˜ ÁÔÓ›˜ Ó· ÁÓˆÚ›˙Ô˘Ó ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ̈ÚÔ‡ Ô˘ ı· ʤÚÔ˘Ó ÛÙÔÓ ÎfiÛÌÔ. ™ÙȘ ÂÚÈÙÒÛÂȘ ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÛÙÔ ¤Ì‚Ú˘Ô, ÔÈ Á˘Ó·›Î˜ Î·È ÔÈ Û‡ÓÙÚÔÊÔ› ÙÔ˘˜ Û˘¯Ó¿ ¤Ú¯ÔÓÙ·È ·ÓÙÈ̤وÔÈ Ì ËıÈο ‰ÈÏ‹ÌÌ·Ù· Û¯ÂÙÈο Ì ÙË ˙ˆ‹ Î·È ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·Á¤ÓÓËÙÔ˘ ·È‰ÈÔ‡. ∞Ó·‰‡ÔÓÙ·È ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈο Ì ÙÔ ‰Èη›ˆÌ· Ó· ÁÓˆÚ›˙ÂÈ Î·Ó›˜ ÙËÓ ‡·ÚÍË ·ÓˆÌ·Ï›·˜ ÛÙÔ ¤Ì‚Ú˘Ô Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘, ηıÒ˜ Î·È ÁÈ· ÙÔ ÔÈÔ˜ ·Ó·Ï·Ì‚¿ÓÂÈ ·˘Ù‹ ÙËÓ Â˘ı‡ÓË. ªÈ· ÛËÌ·ÓÙÈ΋ ÏÂ˘Ú¿ Ù˘ ‰È·‰Èηۛ·˜ ·fiÊ·Û˘ Â›Ó·È Ë Û‡ÁÎÚÔ˘ÛË ·Ó¿ÌÂÛ· ÛÙȘ ÚÔÛˆÈΤ˜ ·fi„ÂȘ ÙÔ˘ οı ·ÙfiÌÔ˘ Ô˘ ‰È¤Ú¯ÂÙ·È ·fi ÙË ‰È·‰Èηۛ· ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ÛÙȘ ·fi„ÂȘ Ô˘ ˘·ÁÔÚ‡ÂÈ ÙÔ ÂοÛÙÔÙ ÔÏÈÙÈÛÙÈÎfi Ï·›ÛÈÔ. §›Á˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ ÙÔ ı¤Ì· ÙˆÓ ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Ô˘ Ù›ıÂÓÙ·È ÏfiÁˆ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ Î·È ÁÂÓÂÙÈ΋˜ ‰È·ÁÓˆÛÙÈ΋˜ Ï·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ·ÙÔÌÈΤ˜ Î·È ÔÏÈÙÈÛÙÈΤ˜ ‰È·ÊÔÚ¤˜ (1,2,3,4,5,6, 7,8,9,10,11,12,13). ∆· ‰ÈÏ‹ÌÌ·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙÔÓ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô Û˘¯Ó¿ ·Ú·Ì¤ÓÔ˘Ó Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË, ·ÔÙÂÏÔ‡Ó ËÁ‹ ¿Á¯Ô˘˜ ÁÈ· ÙȘ Á˘Ó·›Î˜ Î·È ÙÔ˘˜ Û˘ÓÙÚfiÊÔ˘˜ ÙÔ˘˜, Ô‰ËÁÒÓÙ·˜ ÂÓ›ÔÙ ÛÙËÓ ÂΉ‹ÏˆÛË „˘¯Ô·ıÔÏÔÁ›·˜ Î·È Û ÚÔ‚Ï‹Ì·Ù· ÛÙȘ Û¯¤ÛÂȘ ÙˆÓ ˙¢Á·ÚÈÒÓ. ŒÚ¢Ó˜ Û¯ÂÙÈο Ì ÙË ‰È·‰Èηۛ· Ï‹„˘ ·fiÊ·Û˘ ÌÂÙ¿ ·fi ·ıÔÏÔÁÈÎfi ‡ÚËÌ· ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È ÁÈ· ÙȘ „˘¯ÔÏÔÁÈΤ˜ ·ÓÙȉڿÛÂȘ ÙˆÓ ÁÔÓ¤ˆÓ ÌÂÙ¿ ·fi ÙËÓ ·fiÊ·ÛË Ù˘ ‰È·ÎÔ‹˜ ‹ Ù˘ Û˘Ó¤¯ÈÛ˘ Ù˘ ·ËÛ˘ ·Ó·Ê¤ÚÔ˘Ó „˘¯ÔÏÔÁÈÎfi ÎÏÔÓÈÛÌfi ÙˆÓ ÌÂÏÏÔÓÙÈÎÒÓ ÁÔÓ¤ˆÓ, fiÙ·Ó ÙÔ˘˜ ·Ó·ÎÔÈÓÒÓÂÙ·È Ë ‰È¿ÁÓˆÛË (14) Î·È Û ·›ÛıËÌ· ·ÒÏÂÈ·˜ Ù˘ ÚÔÛ‰ÔÎÒÌÂÓ˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·ËÛ˘ (15). √È ÁÔÓ›˜ ‚Ú›ÛÎÔÓÙ·È ÛÙË ı¤ÛË Ó· Ú¤ÂÈ Ó· ¿ÚÔ˘Ó ‰‡ÛÎÔϘ ·ÔÊ¿ÛÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ¤Î‚·ÛË Ù˘ ·ËÛ˘, ‚ÈÒÓÔÓÙ·˜ Û˘Ó·ÈÛı‹Ì·Ù· ıÚ‹ÓÔ˘, Ì ı˘Ìfi, ·ÂÏÈÛ›·, ÂÓÔ¯‹ Î·È ·›ÛıËÌ· ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÂÌÊ·Ó›˙Ô˘Ó ‰˘ÛÎÔϛ˜ ‡ÓÔ˘ Î·È ‰È·ÙÚÔÊ‹˜ (16). ªÂÙ¿ ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ËÛ˘, ÔÈ Á˘Ó·›Î˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÙȉڿÛÂȘ ıÚ‹ÓÔ˘ Î·È ÌÂÁ¿Ï˘ „˘¯ÔÏÔÁÈ΋˜ ·Ó·ÛٿوÛ˘ ‚Ú·¯˘ÚfiıÂÛÌ· (4-6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ËÛ˘) (17,18). ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË Ù˘ ·Ó·ÛٿوÛ˘, ·Ó Î·È ÌÂÚÈΤ˜ Á˘Ó·›Î˜ Û˘Ó¯›˙Ô˘Ó Ó· ¤¯Ô˘Ó „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ‰‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ (19). √È ˘¿Ú¯Ô˘Û˜ ¤Ú¢Ó˜ ‰ÂÓ ¤¯Ô˘Ó ÌÂÏÂÙ‹ÛÂÈ Â·ÚÎÒ˜ ÙË Û¯¤ÛË ÌÂٷ͇ Ù˘ ËıÈ΋˜ Û‡ÁÎÚÔ˘Û˘ Û¯ÂÙÈο Ì ÙËÓ ·fiÊ·ÛË Î·È Ù˘ ÂΉ‹ÏˆÛ˘ „˘¯Ô·ıÔÏÔÁ›·˜ ·ÚÁfiÙÂÚ·. ∂›Û˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÚÎÂÙ‹ Paediatriki 2008;71:383-389

ÂÚ¢ÓËÙÈ΋ ÁÓÒÛË Û¯ÂÙÈο Ì ÙÔ Ò˜ ·ÔÊ·Û›˙Ô˘Ó ÔÈ Á˘Ó·›Î˜ ÌÂÙ¿ ·fi ÙË ‰È¿ÁÓˆÛË ÌÈ·˜ ·ÓˆÌ·Ï›·˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ÂÓÒ Ï›ÁË ÚÔÛÔ¯‹ ¤¯ÂÈ ‰Ôı› ÛÙȘ ·Ó¿ÁΘ ÙˆÓ ÁÔÓ¤ˆÓ, fiÙ·Ó Û˘Ó¯›˙ÂÙ·È Ë Î‡ËÛË ÌÂÙ¿ ·fi ·ıÔÏÔÁÈÎfi ‡ÚËÌ·, ηıÒ˜ Ë ÊÚÔÓÙ›‰· Û˘Ó‹ıˆ˜ ÂÛÙÈ¿˙ÂÙ·È ÛÙÔ ÌˆÚfi. ∏ ·ÚÔ‡Û· ¤Ú¢ӷ, Ë ÔÔ›· ·ÔÙÂÏ› Û˘Ó¤¯ÂÈ· Î·È ÌÂÚÈ΋ Â·Ó¿ÏË„Ë ‰‡Ô ÂÚ¢ÓÒÓ (10,20), ÛÙԯ‡ÂÈ Ó· ÌÂÏÂÙ‹ÛÂÈ ÙȘ ·Ú·¿Óˆ Ï¢ڤ˜ Î·È ÂȉÈÎfiÙÂÚ·: 1) Ó· ÌÂÏÂÙ‹ÛÂÈ ÙȘ ËıÈΤ˜ Û˘ÁÎÚÔ‡ÛÂȘ Î·È Ù· ‰ÈÏ‹ÌÌ·Ù· ÛÙÔ Ï·›ÛÈÔ Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ Î·È ÁÂÓÂÙÈ΋˜ ‰È·ÁÓˆÛÙÈ΋˜, 2) Ó· ·Ó·‰Â›ÍÂÈ ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË „˘¯Ô·ıÔÏÔÁ›·˜, 3) Ó· ‰È·ÌÔÚÊÒÛÂÈ Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË (Û˘Ì‚Ô˘Ï¢ÙÈ΋) ÙˆÓ ˙¢Á·ÚÈÒÓ, 4) Ó· Û˘Óı¤ÛÂÈ ÂȉÈΤ˜ ÁÓÒÛÂȘ ÛÙ· ı¤Ì·Ù· ËıÈ΋˜, ηıÒ˜ Î·È ÛÙ· ı¤Ì·Ù· ÙˆÓ „˘¯ÔÎÔÈÓˆÓÈÎÒÓ ÂÈÙÒÛÂˆÓ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÂÈÛÙËÌÔÓÈÎÔ‡˜ ¯ÒÚÔ˘˜ („˘¯È·ÙÚÈ΋, „˘¯·Ó¿Ï˘ÛË, È·ÙÚÈ΋, ÁÂÓÂÙÈ΋, ÊÈÏÔÛÔÊ›·), 5) Ó· ÂÌ‚·ı‡ÓÂÈ ÛÙÔÓ ÂÈÛÙËÌÔÓÈÎfi Î·È ‰ËÌfiÛÈÔ ‰È¿ÏÔÁÔ Û¯ÂÙÈο Ì ٷ ËıÈο ‰ÈÏ‹ÌÌ·Ù·, 6) Ó· ÌÂÙ·‰ÒÛÂÈ Ù· Â˘Ú‹Ì·Ù¿ Ù˘ ÛÙȘ ¯ÒÚ˜ Ù˘ ∂∂ Î·È ÙȘ ·ÓÙ›ÛÙÔȯ˜ ÂıÓÈΤ˜ ÂÈÙÚÔ¤˜ ËıÈ΋˜ Î·È 7) Ó· ÚÔÛʤÚÂÈ ÂÎ·›‰Â˘ÛË Î·È Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Û ÁÈ·ÙÚÔ‡˜ Î·È ÚÔÛˆÈÎfi ΤÓÙÚˆÓ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ ¤Ú¢ӷ ÍÂΛÓËÛ ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2005 Î·È ı· ÔÏÔÎÏËÚˆı› ÙÔÓ ™Â٤̂ÚÈÔ ÙÔ˘ 2008. ∏ Â›ÛËÌË ·ÚÔ˘Û›·ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ı· Á›ÓÂÈ ÛÂ Û˘Ó¤‰ÚÈÔ Ô˘ ı· ÔÚÁ·Óˆı› ÁÈ’ ·˘ÙfiÓ ÙÔ ÛÎÔfi ÛÙË ºÚ·ÓÎÊÔ‡ÚÙË Ì ÙË Ï‹ÍË ÙÔ˘ ÂÚ¢ÓËÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜.

ª¤ıÔ‰ÔÈ ÀÔÌÂϤÙË ∞ ªÂ ‚¿ÛË ÙÔ ÚˆÙfiÎÔÏÏÔ Ù˘ ¤Ú¢ӷ˜, ÙÔ ‰Â›ÁÌ· Ù˘ ˘ÔÌÂϤÙ˘ ∞ Û οıÂ Û˘ÌÌÂÙ¤¯Ô˘Û· ¯ÒÚ· ÂÚÈÏ·Ì‚¿ÓÂÈ 60 Á˘Ó·›Î˜/˙¢Á¿ÚÈ· Ô˘ ¤¯Ô˘Ó ˘Ô‚ÏËı› Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô (ÙÚÔÊÔ‚Ï¿ÛÙË, ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË, ˘ÂÚ˯ÔÁÚ¿ÊËÌ·), ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ 30 Ú¤ÂÈ Ó· ¤¯Ô˘Ó ·ÚÓËÙÈÎfi ‡ÚËÌ· (ÔÌ¿‰· ÂϤÁ¯Ô˘) Î·È ÔÈ ˘fiÏÔÈÔÈ 30 ·ıÔÏÔÁÈÎfi ‡ÚËÌ·. ∏ ¤Ó·ÚÍË Ù˘ ˘ÔÌÂϤÙ˘ ∞ ÚÔ¸Ôı¤ÙÂÈ ÙËÓ ¤ÁÎÚÈÛË ·fi ÙȘ ÂÈÙÚÔ¤˜ ËıÈ΋˜ ÙˆÓ Û˘ÓÂÚÁ·˙fiÌÂÓˆÓ Î¤ÓÙÚˆÓ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ ‰ÈÂÍ·ÁˆÁ‹ Ù˘ Á›ÓÂÙ·È Û ¤ÓÙ ʿÛÂȘ: 1) ÛÙË Ê¿ÛË ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, fiÔ˘ Ë Á˘Ó·›Î· ÚÔÛ¤Ú¯ÂÙ·È ÁÈ· Ó· ˘Ô‚ÏËı› Û ¤ÏÂÁ¯Ô, 2) ÛÙË Ê¿ÛË ·Ó·ÌÔÓ‹˜, Ì ̤ÁÈÛÙÔ ¯ÚfiÓÔ ÙÚÂȘ ÂÚ›Ô˘ ‚‰ÔÌ¿‰Â˜ (·ÔÙÂϤÛÌ·Ù· ·ÌÓÈÔ·Ú·Î¤ÓÙËÛ˘), 3) ÛÙË Ê¿ÛË ·fiÊ·Û˘, fiÔ˘ Ë Á˘Ó·›Î·/ÙÔ ˙¢Á¿ÚÈ Î·ÏÂ›Ù·È Ó· ·ÔÊ·Û›ÛÂÈ (Û ÂÚ›ÙˆÛË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜) Û Ôχ Û‡ÓÙÔÌË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ·, ÏfiÁˆ Ù˘

Pediatri Sept-Oct 08

14-10-08

13:26

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∏ıÈο ‰ÈÏ‹ÌÌ·Ù· ηٿ ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË

·Ó¿Á΢ ÁÈ· ÁÚ‹ÁÔÚË Ï‹„Ë ·fiÊ·Û˘ (‰‡Ô Ì ÙÚÂȘ ̤Ú˜), 4) ÛÙË Ê¿ÛË ÂÂÍÂÚÁ·Û›·˜, ‰ËÏ·‰‹ ÂÚ›Ô˘ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ·fi ÙË Ï‹„Ë ·fiÊ·Û˘ Î·È 5) ÛÙË Ê¿ÛË Â·ÓÂÎÙ›ÌËÛ˘, ÙÚÂȘ Ì‹Ó˜ ÌÂÙ¿ ·fi ÙË Á¤ÓÓËÛË ÙÔ˘ ̈ÚÔ‡ ‹ ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ËÌÂÚÔÌËÓ›· Á¤ÓÓËÛ˘ (Û ÂÚ›ÙˆÛË ‰È·ÎÔ‹˜ Ù˘ ·ËÛ˘). ∏ Û˘ÓÂÚÁ·Û›· Ì ÙÔ ˙¢Á¿ÚÈ ·Ú¯›˙ÂÈ Ì ÌÈ· ÚÒÙË Û˘Ó¿ÓÙËÛË Ù˘ Á˘Ó·›Î·˜/ÙÔ˘ ˙¢Á·ÚÈÔ‡ Ì ÙÔÓ ÁÂÓÂÙÈÛÙ‹ ‹ ÙÔÓ Á˘Ó·ÈÎÔÏfiÁÔ Î·È ÙÔÓ ÂÚ¢ÓËÙ‹-„˘¯ÔÏfiÁÔ. ∞ÊÔ‡ ÂÍ·ÛÊ·ÏÈÛÙ› Ë ÁÚ·Ù‹ Û˘Ó·›ÓÂÛË Ù˘ Á˘Ó·›Î·˜/ÙÔ˘ ˙¢Á·ÚÈÔ‡ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙËÓ ¤Ú¢ӷ, ¯ÔÚËÁÂ›Ù·È ÙÔ ‰ÈÂÚ¢ÓËÙÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Î·È ‰›ÓÂÙ·È ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ù˘ Ê¿Û˘ ·Ó·ÌÔÓ‹˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔ Û˘ÌÏËÚÒÛÔ˘Ó Î·È Ó· ÙÔ ÂÈÛÙÚ¤„Ô˘Ó Ù·¯˘‰ÚÔÌÈο. ŒÓ· ÙÚ›ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ·ÔÛÙ¤ÏÏÂÙ·È ÛÙË Ê¿ÛË ·fiÊ·Û˘. ∏ ›‰È· ‰È·‰Èηۛ· ·ÎÔÏÔ˘ıÂ›Ù·È ÛÙȘ ÂfiÌÂÓ˜ ‰‡Ô Ê¿ÛÂȘ (ÂÂÍÂÚÁ·Û›·˜ Î·È Â·ÓÂÎÙ›ÌËÛ˘). ™Â fiÏ· Ù· ˙¢Á¿ÚÈ· Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ¤Ú¢ӷ ‰›ÓÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ÁÈ· „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË, ÂÊfiÛÔÓ ÙÔ ˙ËÙ‹ÛÔ˘Ó. ∞Ú¯Èο ηٷÁÚ¿ÊÔÓÙ·È ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ˙ËÙÂ›Ù·È ·fi ÙȘ Á˘Ó·›Î˜ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ ‰ÈÂÚ¢ÓËÙÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ì ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙËÓ Â‚‰ÔÌ¿‰· ·ËÛ˘, ÁÈ· ÚÔËÁÔ‡ÌÂÓ˜ ÂÁ΢ÌÔÛ‡Ó˜ Î·È ÈÛÙÔÚÈÎfi ·Ô‚ÔÏÒÓ ‹/Î·È Ù¯ÓËÙÒÓ ‰È·ÎÔÒÓ, ÁÈ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û ÚÔËÁÔ‡ÌÂÓÔ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô, ÁÈ· È·ÙÚÈ΋ ıÂÚ·›· ÁÈ· Ó· ÂÈÙ¢¯ı› Ë ÂÁ΢ÌÔÛ‡ÓË Î·È ÁÈ· ÙÔÓ ÏfiÁÔ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô. ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â›Ó·È Ù· ÂÍ‹˜: ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ê¿Û˘ ·Ó·ÌÔÓ‹˜ √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÂÚˆÙÒÓÙ·È ÁÈ· Ù· ÂÍ‹˜: 1) fiÛÔ ·ÈÛÈfi‰ÔÍÔÈ Â›Ó·È ÁÈ· ÙÔ Ì¤ÏÏÔÓ ÙÔ˘˜ (Life Orientation Test (LOT-R) (22), 2) Ì ÔÈÔ˘˜ ÙÚfiÔ˘˜ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó „˘¯ÔÈÂÛÙÈο ÁÂÁÔÓfiÙ· ÛÙË ˙ˆ‹ ÙÔ˘˜ (COPE Inventory) (23), 3) ÔÈ· Â›Ó·È Ë Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÙÔ˘˜ ‰È¿ıÂÛË (Hospital Anxiety and Depression Scale (HADS) (24), 4) ÔȘ Â›Ó·È ÔÈ ·fi„ÂȘ ÙÔ˘˜ ÁÈ· ı¤Ì·Ù· ˘Á›·˜ Û¯ÂÙÈο Ì ÙËÓ ÂÁ΢ÌÔÛ‡ÓË (Fetal Health Locus of Control Scale (FHLC) (25), 5) Â¿Ó ¤¯Ô˘Ó ÌÈÏ‹ÛÂÈ Û οÔÈÔÓ ÁÈ· ÙÔ ÙÈ ı· ¤Î·Ó·Ó Û ÂÚ›ÙˆÛË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Î·È 6) Â¿Ó Â›¯·Ó Û˘Ó·ÈÛıËÌ·ÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ·fi ÙÔÓ/ÙË Û‡ÓÙÚÔÊÔ. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ê¿Û˘ ·fiÊ·Û˘ - Â› ·ÚÓËÙÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÂÓËÌÂÚÒıËηÓ

ÁÈ· ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÂϤÁ¯Ô˘ Î·È ÁÈ· ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÙÔ˘˜ ‰È¿ıÂÛË (Îϛ̷η HADS).

- Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ·Ú·¿Óˆ ÂÚˆÙ‹ÛÂȘ, ÂÓÒ ÚÔÛÙ›ıÂÓÙ·È Î·È ¿ÏϘ Û¯ÂÙÈο Ì ÙÔ ÔÈ· ·fiÊ·ÛË ÂÏ‹ÊıË Î·È Ò˜, ηıÒ˜ Î·È ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ Ô˘ ·›ÚÓÔ˘Ó ·ÔÊ¿ÛÂȘ (Decisional Conflict Scale (DCS) (26). ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ê¿Û˘ ÂÂÍÂÚÁ·Û›·˜ - Â› ·ÚÓËÙÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÚˆÙ‹ÛÂȘ ÁÈ·: 1) ÙȘ ÙÚ¤¯Ô˘Û˜ Û˘Óı‹Î˜ ˙ˆ‹˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, 2) ÙÔÓ ‚·ıÌfi ÈηÓÔÔ›ËÛ˘ ·fi ÙËÓ È·ÙÚÈ΋ ÊÚÔÓÙ›‰·, 3) ÙËÓ ˘ÔÛÙ‹ÚÈÍË ·fi ÙÔÓ/ÙË Û‡˙˘ÁÔ/Û‡ÓÙÚÔÊfi ÙÔ˘˜ (Berlin Social Suppport Scale (BSSS) (27), 4) ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÙÔ˘˜ ‰È¿ıÂÛË (Îϛ̷η HADS), 5) Ùo fiÛÔ ·ÈÛÈfi‰ÔÍÔÈ Â›Ó·È ÁÈ· ÙÔ Ì¤ÏÏÔÓ ÙÔ˘˜ (Îϛ̷η LOT-R) Î·È 6) ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÚÔÛˆÈÎfiÙËÙ¿˜ ÙÔ˘˜ (·fi Ê˘ÛÈÔÏÔÁÈΤ˜ ηٷıÏÈÙÈΤ˜ ·ÓÙȉڿÛÂȘ ̤¯ÚÈ ·ıÔÏÔÁÈΤ˜) (Depressive Experience Questionnaire (DEQ) (28).

- Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜: Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ·Ú·¿Óˆ ÂÚˆÙ‹ÛÂȘ, ÂÓÒ ÚÔÛÙ›ıÂÓÙ·È Î·È ¿ÏϘ Û¯ÂÙÈο Ì ٷ Û˘Ó·ÈÛı‹Ì·Ù¿ ÙÔ˘˜ ÁÈ· ÙËÓ ·fiÊ·ÛË Î·È Û¯ÂÙÈο Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤Ï·‚·Ó ˘fi„Ë ÛÙËÓ ·fiÊ·ÛË. ∂·Ó·¯ÔÚËÁÂ›Ù·È Ë Îϛ̷η DCS Î·È ÚÔÛÙ›ıÂÓÙ·È ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ‰˘ÛÎÔϛ˜ ÌÂÙ¿ ·fi „˘¯ÔÈÂÛÙÈο ÁÂÁÔÓfiÙ· (Impact of Event Scale (IES-R) (29). ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ê¿Û˘ Â·ÓÂÎÙ›ÌËÛ˘ - ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·¢ı‡ÓÂÙ·È Û Á˘Ó·›Î˜/Û˘ÓÙÚfiÊÔ˘˜ Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Ô˘ Û˘Ó¤¯ÈÛ·Ó ÙËÓ ÂÁ΢ÌÔÛ‡ÓË: ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÚˆÙ‹ÛÂȘ ÁÈ·: 1) ÙȘ ÙÚ¤¯Ô˘Û˜ Û˘Óı‹Î˜ ÛÙË ˙ˆ‹ ÙÔ˘˜, 2) ÙËÓ ‡·ÚÍË ˘ÔÛÙËÚÈÎÙÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, 3) ÙÔÓ ‚·ıÌfi ÈηÓÔÔ›ËÛ˘ ·fi ÙËÓ È·ÙÚÈ΋ ÊÚÔÓÙ›‰·, 4) ÙÔ ıÚ‹ÛÎÂ˘Ì¿ ÙÔ˘˜ Î·È ÙË ‰‡Ó·ÌË ÙˆÓ ıÚËÛ΢ÙÈÎÒÓ ÙÔ˘˜ ÂÔÈı‹ÛˆÓ, 5) ÙËÓ ¿Ô„‹ ÙÔ˘˜ ÁÈ· ÙËÓ ˘fiÛÙ·ÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È 6) ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÙÔ˘˜ ‰È¿ıÂÛË (Îϛ̷η HADS).

- ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·¢ı‡ÓÂÙ·È Û Á˘Ó·›Î˜/Û˘ÓÙÚfiÊÔ˘˜ Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Ô˘ ‰È¤ÎÔ„·Ó ÙËÓ ÂÁ΢ÌÔÛ‡ÓË: Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È ÔÈ ·Ú·¿Óˆ ÂÚˆÙ‹ÛÂȘ Î·È ÚÔÛÙ›ıÂÓÙ·È ¿ÏϘ ÁÈ·: 1) Ó¤· ÂÁ΢ÌÔÛ‡ÓË, 2) ‰˘ÛÎÔϛ˜ Û ۯ¤ÛË Ì ÙÔ ÁÂÁÔÓfi˜ Ù˘ ‰È·ÎÔ‹˜ (Îϛ̷η IES-R), 3) ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÙÔ˘˜ ‰È¿ıÂÛË (Îϛ̷η HADS) Î·È 4) fiÛÔ Û˘ÌʈÓÔ‡Ó Ì ‰ËÏÒÛÂȘ Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÙȘ ÛΤ„ÂȘ Î·È Ù· Û˘Ó·ÈÛı‹Ì·Ù· ·ÓıÚÒˆÓ Ô˘ ¤¯Ô˘Ó ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙËÓ ·ÒÏÂÈ· ÂÓfi˜ ·Á¤ÓÓËÙÔ˘ ̈ÚÔ‡ (Munich Grief Scale (MGS) (30).

- ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·¢ı‡ÓÂÙ·È Û Á˘Ó·›Î˜/Û˘ÓÙÚfiÊÔ˘˜ Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Ô˘ ¶·È‰È·ÙÚÈ΋ 2008;71:383-389

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·386

386

™. ∫›ÙÛÈÔ˘-∆˙¤ÏË Î·È Û˘Ó.

Û˘Ó¤¯ÈÛ·Ó ÙËÓ ÂÁ΢ÌÔÛ‡ÓË: ÔÈ ›‰È˜ ÂÚˆÙ‹ÛÂȘ Ì ÙȘ ÚÔ·Ó·ÊÂÚfiÌÂÓ˜, Ì ÂÍ·›ÚÂÛË ÙËÓ Îϛ̷η MGS. - ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·¢ı‡ÓÂÙ·È Û Á˘Ó·›Î˜/Û˘ÓÙÚfiÊÔ˘˜ Â› ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Ô˘ ›¯·Ó ·˘ÙfiÌ·ÙË ·Ô‚ÔÏ‹: ÔÈ ›‰È˜ ÂÚˆÙ‹ÛÂȘ Ì ÙȘ ÚÔ·Ó·ÊÂÚfiÌÂÓ˜, Ì ÂÍ·›ÚÂÛË ÙȘ ÂÚˆÙ‹ÛÂȘ ÁÈ· ÙËÓ ·fiÊ·ÛË.

™˘ÓÂÓÙ‡ÍÂȘ ™Â οı ʿÛË, ·Ú¿ÏÏËÏ· Ì ÙË ¯ÔÚ‹ÁËÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ, ‰ÈÂÍ¿ÁÂÙ·È Û˘Ó¤ÓÙ¢ÍË Ì ÙË Á˘Ó·›Î·/ÙÔ ˙¢Á¿ÚÈ. √È Û˘ÓÂÓÙ‡ÍÂȘ Â›Ó·È ËÌÈ-‰ÔÌË̤Ó˜ Î·È ÂÛÙÈ¿˙Ô˘Ó Î˘Ú›ˆ˜ ÛÙ· Û˘Ó·ÈÛı‹Ì·Ù· Ù˘ Á˘Ó·›Î·˜ Û¯ÂÙÈο Ì ÙÔÓ ¤ÏÂÁ¯Ô, ÛÙËÓ ÔÈfiÙËÙ· Ù˘ È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜, ÛÙËÓ ·ÓÙ›‰Ú·Û‹ Ù˘ ÛÙËÓ ·Ó·ÎÔ›ÓˆÛË Ù˘ ıÂÙÈ΋˜ ‰È¿ÁÓˆÛ˘, ÛÙË ‰È·‰Èηۛ· Ï‹„˘ ·fiÊ·Û˘ Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ. ∏ ·Ó¿Ï˘ÛË ÙˆÓ Û˘ÓÂÓÙ‡ÍÂˆÓ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÙË Ì¤ıÔ‰Ô ·Ó¿Ï˘Û˘ ·fi „˘¯ÔıÂÚ·Â˘Ù¤˜/„˘¯·Ó·Ï˘Ù¤˜ (expert validation) Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ۠ÚÔËÁÔ‡ÌÂÓË ¤Ú¢ӷ (21). ÀÔÌÂϤÙË µ ŒÓ· ÂÓËÌÂÚˆÙÈÎfi ÁÚ¿ÌÌ· ·ÔÛÙ¤ÏÏÂÙ·È Û „˘¯ÔıÂÚ·Â˘Ù¤˜/„˘¯·Ó·Ï˘Ù¤˜ ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ÂÙ·ÈÚÂÈÒÓ Î¿ıÂ Û˘ÌÌÂÙ¤¯Ô˘Û·˜ ¯ÒÚ·˜. ∂ÚˆÙÒÓÙ·È Î·Ù¿ fiÛÔ Â›¯·Ó Û ıÂÚ·›· ·ÛıÂÓ›˜ Ì ÙËÓ ÂÌÂÈÚ›· ıÂÙÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô Î·È Î·Ù¿ fiÛÔ ı· ÙÔ˘˜ ÂӉȤÊÂÚ ӷ Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙËÓ ¤Ú¢ӷ. ™Â fiÛÔ˘˜ ··ÓÙ‹ÛÔ˘Ó ıÂÙÈο, ·ÔÛÙ¤ÏÏÂÙ·È ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÁÈ· Ó· ‰ÒÛÔ˘Ó ÏËÚÔÊÔڛ˜ ÁÈ· ÚÒËÓ ıÂÚ·¢fiÌÂÓfi/‹ ÙÔ˘˜ Î·È ‰ÈÂÍ¿ÁÂÙ·È Û˘Ó¤ÓÙ¢ÍË Ì·˙› ÙÔ˘˜. °È· ‰ÂÔÓÙÔÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜, ˙ËÙÔ‡ÓÙ·È ÏËÚÔÊÔڛ˜ ÌfiÓÔ ÁÈ· ıÂÚ·¢fiÌÂÓÔ˘˜ Ô˘ ¤¯Ô˘Ó ÔÏÔÎÏËÚÒÛÂÈ ÙË ıÂÚ·›· ÙÔ˘˜. æ˘¯ÔÏfiÁÔ˜ ÂÈÎÔÈÓˆÓ› Ì ÙÔÓ ÚÒËÓ ıÂÚ·¢fiÌÂÓÔ, Ô ÔÔ›Ô˜ ¤¯ÂÈ ÂÓËÌÂÚˆı› Û¯ÂÙÈο ·fi ÙÔÓ ÚÒËÓ ıÂÚ·Â˘Ù‹ ÙÔ˘, ÁÈ· Ó· Ú·ÁÌ·ÙÔÔÈËı› Ë Û˘Ó¤ÓÙ¢ÍË. ™˘ÓÂÓÙ‡ÍÂȘ Ì „˘¯ÔıÂÚ·Â˘Ù¤˜/„˘¯·Ó·Ï˘Ù¤˜. √È Û˘ÓÂÓÙ‡ÍÂȘ Â›Ó·È ËÌÈ-‰ÔÌË̤Ó˜. √È ÂÚˆÙ‹ÛÂȘ ÂÛÙÈ¿˙Ô˘Ó ÛÙËÓ ÂÌÂÈÚ›· ÙˆÓ ·ÛıÂÓÒÓ ·fi ÙË ‰È·¯Â›ÚÈÛË ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Û¯ÂÙÈο Ì ÙË ‰È·‰Èηۛ· ·fiÊ·Û˘, ηıÒ˜ Î·È ÛÙȘ ‚Ú·¯˘ÚfiıÂÛ̘ Î·È Ì·ÎÚÔÚfiıÂÛ̘ Û˘Ó¤ÂȘ Ô˘ ›¯Â ÛÙÔ˘˜ ›‰ÈÔ˘˜ ·˘Ù‹ Ë ÂÌÂÈÚ›·. ™˘ÓÂÓÙ‡ÍÂȘ Ì ÚÒËÓ ıÂÚ·¢fiÌÂÓÔ˘˜. √È Û˘ÓÂÓÙ‡ÍÂȘ Â›Ó·È ËÌÈ-‰ÔÌË̤Ó˜. √È ÂÚˆÙ‹ÛÂȘ Â›Ó·È ›‰È˜ Ì ÙȘ ÚÔ·Ó·ÊÂÚfiÌÂÓ˜.

¶ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ∆· ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ·ÊÔÚÔ‡Ó ÛÙ· Paediatriki 2008;71:383-389

ÛÙÔȯ›· Ô˘ ¤¯ÂÈ ÛÙË ‰È¿ıÂÛ‹ Ù˘ Ë ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∞ı‹Ó·˜ ·fi ÙËÓ ˘ÔÌÂϤÙË ∞. ∞Ú¯Èο Û˘ÌÌÂÙ›¯·Ó 129 ¿ÙÔÌ· (100 Á˘Ó·›Î˜ Î·È 29 ¿Ó‰Ú˜). ∏ Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ Á˘Ó·ÈÎÒÓ ˘Ô‚Ï‹ıËΠ۠·ÌÓÈÔ·Ú·Î¤ÓÙËÛË, Ì ΢ÚÈfiÙÂÚÔ ÏfiÁÔ ÙËÓ ËÏÈΛ·. ªfiÓÔ 6 Á˘Ó·›Î˜ ˘Ô‚Ï‹ıËÎ·Ó Û ¤ÏÂÁ¯Ô ÙÚÔÊÔ‚Ï¿ÛÙ˘. ∏ ËÏÈΛ· ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ Î˘Ì·ÈÓfiÙ·Ó ·fi Ù· 23 ¤ˆ˜ Ù· 42 ¯ÚfiÓÈ· Î·È Ë Â‚‰ÔÌ¿‰· ·ËÛ˘ ·fi ÙË 12Ë ¤ˆ˜ ÙËÓ 22Ë Â‚‰ÔÌ¿‰·. ∂ÓÂÓ‹ÓÙ· ÙÚ›· ÙÔȘ ÂηÙfi (93%) ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ‹Ù·Ó ·ÓÙÚÂ̤ÓÔÈ Î·È ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ‹Ù·Ó ŒÏÏËÓ˜, ¯ÚÈÛÙÈ·ÓÔ› ÔÚıfi‰ÔÍÔÈ. ™Â ÔÛÔÛÙfi 47% ‹Ù·Ó ·ÓÒÙÂÚÔ˘ ÌÔÚʈÙÈÎÔ‡ ÂÈ¤‰Ô˘ Î·È 58% ÂÚÁ¿˙ÔÓÙ·Ó ˆ˜ ˘¿ÏÏËÏÔÈ (‰ËÌfiÛÈÔÈ Î·È È‰ÈˆÙÈÎÔ›). ∞fi ÙÔ˘˜ 129 Û˘ÌÌÂÙ¤¯ÔÓÙ˜, 79 Û˘Ó¤¯ÈÛ·Ó ÙË Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· ÛÙË Ê¿ÛË ·Ó·ÌÔÓ‹˜, 61 ÛÙË Ê¿ÛË ·fiÊ·Û˘, 42 ÛÙË Ê¿ÛË ÂÂÍÂÚÁ·Û›·˜ ηÈ, ¤ˆ˜ ÙÒÚ·, 27 ÛÙË Ê¿ÛË Â·ÓÂÎÙ›ÌËÛ˘. ™˘ÓÔÏÈο, Û 22 Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ‰È·ÁÓÒÛÙËΠοÔÈÔ ·ıÔÏÔÁÈÎfi ‡ÚËÌ·. ™˘ÁÎÂÎÚÈ̤ӷ, Ô ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„Â: 7 ÂÚÈÙÒÛÂȘ ÙÚÈۈ̛·˜ ·˘ÙÔۈ̷ÙÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ (3 Ì ÙÚÈۈ̛· 21, 3 Ì ÙÚÈۈ̛· 18, 1 Ì ÙÚÈۈ̛· 22), 8 ÂÚÈÙÒÛÂȘ ·Ó¢ÏÔÂȉ›·˜ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ÙÔ˘ ʇÏÔ˘ (4 Ì ÙÚÈÏfi x, 2 Ì ۇӉÚÔÌÔ Klinefelter, 1 Ì ۇӉÚÔÌÔ Turner, 1 Ì ÌÈÎÙ‹ ‰˘ÛÁÂÓÂÛ›· ÁÔÓ¿‰ˆÓ), 1 ÂÚ›ÙˆÛË Ì ‰ÈÏ‹ ¯ÚˆÌÔÛˆÌÈ΋ ·ÓˆÌ·Ï›· (ÙÚÈۈ̛· 21 Î·È Û‡Ó‰ÚÔÌÔ Turner), 3 ÂÚÈÙÒÛÂȘ Ì ‰È¿ÊÔÚ˜ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ (ÌÂÚÈ΋ ÌÔÓÔۈ̛· ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 15, ·Ó·ÛÙÚÔÊ‹ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 2, ˘ÂÚ¿ÚÈıÌÔ ¯ÚˆÌfiۈ̷-‰Â›ÎÙ˘), 1 ÂÚ›ÙˆÛË Ì ۇӉÚÔÌÔ Noonan Ì ÙË ÌÂÙ¿ÏÏ·ÍË c.922A>G ÛÙÔ ÂÍfiÓÈÔ 8 ÙÔ˘ ÁÔÓȉ›Ô˘ PTPN11, 1 ÂÌ‚Ú˘˚Îfi˜ ‡‰Úˆ·˜ Î·È 1 ÂÚ›ÙˆÛË Ì ˘‰ÚÔÎÂÊ·Ï›·. ™ÙȘ 15 ÂÚÈÙÒÛÂȘ ¤ÁÈÓ ‰È·ÎÔ‹ ·ËÛ˘, ÛÙȘ 6 Ë Î‡ËÛË Û˘Ó¯›ÛÙËΠ(3 ÂÚÈÙÒÛÂȘ Ì ÙÚÈÏfi x, 1 ÂÚ›ÙˆÛË Ì ۇӉÚÔÌÔ Turner, 1 ÂÚ›ÙˆÛË Ì ۇӉÚÔÌÔ Klinefelter Î·È 1 ÂÚ›ÙˆÛË Ì ‰˘ÛÁÂÓÂÛ›· ÁÔÓ¿‰ˆÓ), ÂÓÒ Û ̛· ÂÚ›ÙˆÛË ˘‹ÚÍ ·˘ÙfiÌ·ÙË ·Ô‚ÔÏ‹ (Û‡Ó‰ÚÔÌÔ Klinefelter). ∞fi ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Ì ıÂÙÈÎfi ‡ÚËÌ·, ÔÈ ÌÈÛÔ› Û˘Ó¤¯ÈÛ·Ó ÙË Û˘ÓÂÚÁ·Û›· ÙÔ˘˜ Ì ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰·. √È ÚÒÙ˜ ÔÈÔÙÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ Ô˘ ·ÔÚÚ¤Ô˘Ó ·fi ÙȘ Û˘ÓÂÓÙ‡ÍÂȘ Ì ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ Ì ıÂÙÈÎfi ‡ÚËÌ· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ Á˘Ó·›Î˜ ·ÈÛı¿ÓÔÓÙ·Ó fiÙÈ ‰ÂÓ ‹Ù·Ó ÈηӤ˜ Ó· ÁÂÓÓ‹ÛÔ˘Ó ¤Ó· ˘ÁȤ˜ ·È‰› ÂÂȉ‹ οÙÈ Û˘Ó¤‚·ÈÓ Ì ÙÔ ÛÒÌ· ÙÔ˘˜ (Ó·ÚÎÈÛÛÈÛÙÈÎfi ÙÚ·‡Ì·). ∂›Û˘ ‚›ˆÓ·Ó Û˘Ó·ÈÛı‹Ì·Ù· ¤ÓıÔ˘˜: ¿ÚÓËÛË, ·fiÁÓˆÛË, ı˘Ìfi ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, ÙËÓ ÂÈÛÙ‹ÌË Î·È ÙÔÓ £Âfi. ŸÙ·Ó Û˘Ó·ÓÙ‹Û·Ì ÙȘ Á˘Ó·›Î˜ ÛÙÔ ¯ÚÔÓÈÎfi ÛËÌÂ›Ô fiÔ˘ ÂÎÊÚ¿ÛÙËÎ·Ó Ù¤ÙÔÈ· Û˘Ó·ÈÛı‹Ì·Ù· (Ê¿ÛË ÂÂÍÂÚÁ·Û›·˜), Ë Û˘Ó¤¯ÈÛË Ù˘ Û˘ÓÂÚÁ·Û›·˜ Ì ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰·

Pediatri Sept-Oct 08

14-10-08

13:26

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∏ıÈο ‰ÈÏ‹ÌÌ·Ù· ηٿ ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË

¤ÁÈÓ ‰‡ÛÎÔÏË. ∫·Ó¤Ó·˜ ·fi ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ ÙË ‰˘Ó·ÙfiÙËÙ· Ô˘ ÙÔ˘ ‰fiıËΠÁÈ· „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË. ∏ ‰È¿ÁÓˆÛË Ê¿ÓËΠӷ ·›˙ÂÈ ÚfiÏÔ ÛÙËÓ ·fiÊ·ÛË Î·È ÛÙÔ˘˜ ÙÚfiÔ˘˜ ‰È·¯Â›ÚÈÛ‹˜ Ù˘. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ‰È·ÁÓÒÛÙËΠÙÚÈۈ̛· 21, Ë ·fiÊ·ÛË Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ‹Ù·Ó ÍÂοı·ÚË Î·È Û·Ê‹˜: ‰È·ÎÔ‹ Ù˘ ·ËÛ˘. ∆Ô ˙¢Á¿ÚÈ ‹Ù·Ó ÂÓ‹ÌÂÚÔ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Down, ηıÒ˜ Î·È ÁÈ· ÙÔ ÙÈ ·˘Ùfi Û˘ÓÂ¿ÁÂÙ·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÂÓfi˜ ·È‰ÈÔ‡. ∞fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÁÈ·ÙÚÒÓ, Ë Û‡ÛÙ·ÛË ‹Ù·Ó ÍÂοı·ÚË Î·È ‰ÂÓ ¿ÊËÓ ÂÚÈıÒÚÈ· ‰Â‡ÙÂÚˆÓ ÛΤ„ˆÓ: “Ú¤ÂÈ Ó· Á›ÓÂÈ ‰È·ÎÔ‹”. ∏ ·fiÊ·ÛË ÁÈ· ÙËÓ ¤Î‚·ÛË Ù˘ ·ËÛ˘ Ê¿ÓËΠӷ Â›Ó·È ·fiÏ˘Ù· ÍÂοı·ÚË ÙfiÛÔ ÛÙË Á˘Ó·›Î· fiÛÔ Î·È ÛÙÔÓ ¿Ó‰Ú·, ¯ˆÚ›˜ Ó· ·ÌÊÈÛ‚ËÙÂ›Ù·È Ë ¿Ô„Ë ÙÔ˘ ÂÓfi˜ ·fi ÙÔÓ ¿ÏÏÔ Û‡ÓÙÚÔÊÔ. ∞ÓÙ›ıÂÙ·, ÛÙȘ ÂÚÈÙÒÛÂȘ ¿ÏÏˆÓ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ (ÁÈ· ·Ú¿‰ÂÈÁÌ· Û‡Ó‰ÚÔÌÔ Turner Î·È Û‡Ó‰ÚÔÌÔ Klinefelter), ˘‹ÚÍ ۇÁÎÚÔ˘ÛË ÛÙÔ ˙¢Á¿ÚÈ ÁÈ· ÙË Ï‹„Ë Ù˘ ·fiÊ·Û˘ Î·È ‰˘ÛÎÔÏ›· ÛÙËÓ ·Ó¿ÏË„Ë Ù˘ ¢ı‡Ó˘ ÁÈ· ÙËÓ ·fiÊ·ÛË, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔηÏÂ›Ù·È ¤ÓÙ·ÛË ÌÂٷ͇ ÙÔ˘˜. ∫˘Ú›ˆ˜ Ë Á˘Ó·›Î· ‹Ù·Ó ·˘Ù‹ Ô˘ ÂÈÊÔÚÙÈ˙fiÙ·Ó Ì ÙÔÓ “ÙÂÏÂ˘Ù·›Ô ÏfiÁÔ”, ηıÒ˜, fiˆ˜ Û˘¯Ó¿ ÏÂÁfiÙ·Ó ·fi ÙÔÓ Û‡˙˘ÁÔ, “Ë Á˘Ó·›Î· ÌÔ˘ ÓÈÒıÂÈ Ì¤Û· Ù˘ ÙÔ ÌˆÚfi Î·È ·˘Ù‹ Ë ·fiÊ·ÛË ¤¯ÂÈ Ó· οÓÂÈ Ì ÙÔ ÛÒÌ· Ù˘”. ∂ÈϤÔÓ, Ë ·fiÊ·ÛË ÙÔ˘ ˙¢Á·ÚÈÔ‡ ÁÈ· ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ ÛÙËÓ ÂÚ›ÙˆÛË ÙÚÈۈ̛·˜ 21 ·ÚÔ˘ÛÈ¿ÛÙËΠӷ Â›Ó·È ·fiÏ˘Ù· ‰ÈηÈÔÏÔÁË̤ÓË Î·È ·Ó·ÌÂÓfiÌÂÓË ·fi ÙÔÓ ÂÚ›Á˘Úfi ÙÔ˘, οÙÈ Ô˘ Ê¿ÓËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ËÈfiÙÂÚË ¤ÎÊÚ·ÛË ÓÙÚÔ‹˜, ÂȉÈο ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ Á˘Ó·ÈÎÒÓ. ¶·Ú¿ÏÏËÏ·, Ë ÛÙ¿ÛË ÙÔ˘ ˙¢Á·ÚÈÔ‡ ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜, fiˆ˜ Î·È ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ‰ÈÂÍ¿ÁÔÓÙ˜ ÙË Û˘Ó¤ÓÙ¢ÍË, ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi ËÈfiÙÂÚË ¤ÎÊÚ·ÛË ı˘ÌÔ‡ Î·È ÔÚÁ‹˜, ÂȉÈÎfiÙÂÚ· ÌÂÙ¿ ·fi ÙË ‰È·ÎÔ‹ Ù˘ ·ËÛ˘. ∏ ÍÂοı·ÚË ÂÈÎfiÓ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÁÈ· ÙËÓ ·fiÊ·ÛË, ¤ÙÛÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ fiˆ˜ ÂÎÊÚ¿ÛÙËÎÂ, ‰È·ÊÔÚÔÔ›ËÛ ÔÈÔÙÈο ÙËÓ ¤ÎÊÚ·ÛË ÂÓÔ¯‹˜ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ Á˘Ó·›Î·˜ (Î·È ÙÔ˘ Û˘˙‡ÁÔ˘ Ù˘). ∏ ¤ÎÊÚ·ÛË ÂÓÔ¯‹˜ ‹Ù·Ó Û˘ÁÎ·Ï˘Ì̤ÓË Î·È ÂÚÈÔÚÈṲ̂ÓË, ηıÒ˜ Ë ·fiÊ·ÛË ‰ÈηÈÔÏÔÁ‹ıËΠÏ‹Úˆ˜ ·fi ÙË ‰È·ÁÓˆṲ̂ÓË ·ÓˆÌ·Ï›·. °ÂÓÈ΋, ˆÛÙfiÛÔ, ‹Ù·Ó Ë ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì ıÂÙÈÎfi ‡ÚËÌ· ‰ÂÓ ÂÎÊÚ¿ÛÙËΠ·ÓÔȯٿ οÔÈÔ ËıÈÎfi ‰›ÏËÌÌ·. ∏ ·fiÊ·ÛË Ù˘ Á˘Ó·›Î·˜ ‹ ÙÔ˘ ˙¢Á·ÚÈÔ‡ ÁÈ· ÙËÓ ¤Î‚·ÛË Ù˘ ·ËÛ˘ ·Ô‰fiıËΠηٿ ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÛÙȘ ÏËÚÔÊÔڛ˜ Î·È ÛÙË ÛÙ¿ÛË ÙˆÓ ÁÈ·ÙÚÒÓ, ÂȉÈÎfiÙÂÚ· ÙˆÓ Á˘Ó·ÈÎÔÏfiÁˆÓ, ÔÈ ÔÔ›ÔÈ ˘¤‰ÂÈÍ·Ó, Û‡Ìʈӷ Ì fiÛ· ·Ó·Ê¤ÚıËÎ·Ó ·fi ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜, ÙËÓ ·fiÊ·ÛË Ô˘ ¤ÚÂ ӷ ¿ÚÂÈ ÙÔ ˙¢Á¿ÚÈ: “‰ÂÓ Â›¯· ¿ÏÏË ÂÈÏÔÁ‹, ÙÔ ÌˆÚfi ‰ÂÓ ı· ˙Ô‡ÛÂ

¤ÙÛÈ ÎÈ ·ÏÏÈÒ˜ ‹ ı· ›¯Â Ôχ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ÌÔ˘ ÂÍ‹ÁËÛÂ Ô ÁÈ·ÙÚfi˜”.

™˘˙‹ÙËÛË ∏ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙË ‰È¿ÁÓˆÛË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÛÙÔÓ ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô Î·È Ë ‰È·¯Â›ÚÈÛ‹ ÙÔ˘˜ Â›Ó·È Ô Î‡ÚÈÔ˜ ÛÙfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜. ∏ ‰ÈÂıÓ‹˜ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ÂΉ‹ÏˆÛË Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ Û Á˘Ó·›Î˜ Ô˘ ‹Úı·Ó ·ÓÙÈ̤و˜ Ì ÙËÓ ·fiÊ·ÛË Ù˘ ‰È·ÎÔ‹˜ ‹ Ù˘ Û˘Ó¤¯ÈÛ˘ ÌÈ·˜ ·ËÛ˘ ÁÈ· ÁÂÓÂÙÈÎÔ‡˜ ÏfiÁÔ˘˜. √È ‰È·Ù·Ú·¯¤˜ ‰È¿ıÂÛ˘ Î·È ¿Á¯Ô˘˜ Â›Ó·È ÌÂÚÈΤ˜ ·fi ÙȘ „˘¯Ô·ıÔÏÔÁÈΤ˜ ÂΉËÏÒÛÂȘ Ô˘ ¤¯Ô˘Ó ηٷÁÚ·Ê› ˆ˜ ·ÓÙ›‰Ú·ÛË ·Ì¤Ûˆ˜ ‹ Î·È ¯ÚfiÓÈ· ÌÂÙ¿ ·fi ÙË ‰È·ÎÔ‹ ÌÈ·˜ ·ËÛ˘ ÏfiÁˆ ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô. ∆· ·Ú·¿Óˆ ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ ¤Ú¢ӷ˜ ·fi ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∞ı‹Ó·˜ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ Á˘Ó·›Î˜ Î·È ¿Ó‰Ú˜ ‰È·¯ÂÈÚ›ÛÙËÎ·Ó ÙÔ ÁÂÁÔÓfi˜ Ù˘ ·Ó·ÎÔ›ÓˆÛ˘ ÙÔ˘ ıÂÙÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÂÎÊÚ¿˙ÔÓÙ·˜ ı˘Ìfi ÚÔ˜ ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ Î·È ÙÔÓ £Âfi, ÚÔÛ·ıÒÓÙ·˜ Ó· ͯ¿ÛÔ˘Ó ÁÚ‹ÁÔÚ· ÙËÓ ÂÌÂÈÚ›· ÙÔ˘˜. ∏ ·ÓÙ›‰Ú·Û‹ ÙÔ˘˜ ı· ÌÔÚÔ‡Û ӷ Â›Ó·È ¤Ó·˜ ·fi ÙÔ˘˜ ÏfiÁÔ˘˜ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ¤Ó· ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ·ÓıÚÒˆÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ·Ú¯Èο ÛÙËÓ ¤Ú¢ӷ ·ÚÓ‹ıËÎ·Ó Ó· Û˘Ó¯›ÛÔ˘Ó Ì¤¯ÚÈ ÙÔ Ù¤ÏÔ˜. ™˘¯Ó¿, ÂȉÈÎfiÙÂÚ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ·fi ÙËÓ ·Ó·ÎÔ›ÓˆÛË, ÙÔ ˙¢Á¿ÚÈ ÚÔÛ¿ıËÛ ӷ ‚ÚÂÈ ÂÍËÁ‹ÛÂȘ ÁÈ· ÙÔ ÙÈ Û˘Ó¤‚Ë. √È Á˘Ó·›Î˜ ÂÈÛ¤Ú·Í·Ó ˆ˜ Ó·ÚÎÈÛÛÈÛÙÈÎfi ÙÚ·‡Ì· ÙËÓ ‡·ÚÍË ·ıÔÏÔÁÈÎÔ‡ Â˘Ú‹Ì·ÙÔ˜ ÛÙÔ ¤Ì‚Ú˘Ô, ηıÒ˜ Ê·ÓÙ¿ÛÙËÎ·Ó fiÙÈ ›Ûˆ˜ οÙÈ Û˘Ó¤‚·ÈÓ Ì ÙÔ ÛÒÌ· ÙÔ˘˜. ∞Ó·˙ËÙ‹ıËÎ·Ó Â˘ı‡Ó˜ ›Ù ¤ÌÌÂÛ· ›Ù ¿ÌÂÛ· ÛÙÔÓ/ÛÙË Û‡ÓÙÚÔÊÔ, ÙÔ ÔÔ›Ô Â¤ÊÂÚÂ, ηıÒ˜ ÂÚÓÔ‡ÛÂ Ô ¯ÚfiÓÔ˜, ¤ÓÙ·ÛË ÛÙÔ ˙¢Á¿ÚÈ. ¶›Ûˆ ·fi ÙȘ ÂÍËÁ‹ÛÂȘ Ô˘ ÚÔÛ¿ıËÛ·Ó Ó· ‰ÒÛÔ˘Ó ÎÚ˘‚fiÙ·Ó ÂÓÔ¯‹. ∏ ¢ı‡ÓË Ù˘ ·fiÊ·Û˘ ÌÂٷ٤ıËΠÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜. ∂Ó‰ÂÈÎÙÈÎfi ‹Ù·Ó fiÙÈ Î·Ó›˜ ·fi ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÁÔÓ›˜ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË Ô˘ ÙÔ˘ ÚÔÛʤÚıËÎÂ, ÁÂÁÔÓfi˜ Ô˘ ÂӉ¯Ô̤ӈ˜ Û˘Ó‰¤ÂÙ·È Ì ٷ ÚÔ·Ó·ÊÂÚfiÌÂÓ·. ∆· ÛÙÔȯ›· ·˘Ù¿ ·Ó¤‰ÂÈÍ·Ó ÙË ÛËÌ·Û›· Ù˘ ˘ÔÌÂϤÙ˘ µ ˆ˜ Û˘ÌÏËڈ̷ÙÈ΋˜ Ù˘ ˘ÔÌÂϤÙ˘ ∞. √È ÙÚfiÔÈ ‰È·¯Â›ÚÈÛ˘ Ù˘ ·fiÊ·Û˘, ˆÛÙfiÛÔ, Ê¿ÓËΠӷ ÂËÚ¿˙ÔÓÙ·È ·fi ÙË ‰È¿ÁÓˆÛË. ™ÙȘ ÂÚÈÙÒÛÂȘ ‰È¿ÁÓˆÛ˘ ÙÚÈۈ̛·˜ 21, Ë ·fiÊ·ÛË ‹Ù·Ó ÍÂοı·ÚË Î·È ‰ÈηÈÔÏÔÁË̤ÓË, ÙfiÛÔ ÛÙÔ ˙¢Á¿ÚÈ fiÛÔ Î·È ÛÙÔÓ ÂÚ›Á˘Úfi ÙÔ˘ Î·È ÛÙÔ˘˜ ÁÈ·ÙÚÔ‡˜. ∏ ¤ÎÊÚ·ÛË ÓÙÚÔ‹˜, fiˆ˜ Î·È ÂÓÔ¯‹˜, ‹Ù·Ó ËÈfiÙÂÚË. ™ÙÔ ˙¢Á¿ÚÈ ˘‹Ú¯Â Û‡ÌÓÔÈ· ˆ˜ ÚÔ˜ ÙËÓ ·fiÊ·ÛË. ¶·È‰È·ÙÚÈ΋ 2008;71:383-389

Pediatri Sept-Oct 08

14-10-08

13:26

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™. ∫›ÙÛÈÔ˘-∆˙¤ÏË Î·È Û˘Ó.

∏ ˘ÏÔÔ›ËÛË Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ Û˘Ó¿ÓÙËÛ ÔÏϤ˜ ‰˘ÛÎÔϛ˜, ÏfiÁˆ ÙˆÓ ËıÈÎÒÓ Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ıÂÌ¿ÙˆÓ Ô˘ ·Ó¤‰ÂÈÍÂ. ™Ù· Ï·›ÛÈ· Ù˘ ˘ÔÌÂϤÙ˘ ∞, Ë ÚÔÛ¤ÁÁÈÛË ÙˆÓ Á˘Ó·ÈÎÒÓ/˙¢Á·ÚÈÒÓ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ÚÔÁÂÓÓËÙÈÎfi ¤ÏÂÁ¯Ô ‹Ù·Ó ··ÈÙËÙÈ΋. √È Á˘Ó·›Î˜ ‚Ú›ÛÎÔÓÙ·Ó Û˘Ó‹ıˆ˜ Û ηٿÛÙ·ÛË ¿Á¯Ô˘˜ fiÙ·Ó ÚÔÛ¤Ú¯ÔÓÙ·Ó ÛÙÔ Î¤ÓÙÚÔ ÁÈ· ÙËÓ ÂͤٷÛË, ÂÓÒ ‰˘ÛÎÔϛ˜ ÚԤ΢„·Ó ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ Û˘ÓÂÚÁ·Û›·˜ Ì·˙› ÙÔ˘˜ ÛÙȘ ÂfiÌÂÓ˜ Ê¿ÛÂȘ Ù˘ ¤Ú¢ӷ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ fiÔ˘ ‰È·ÁÓÒÛÙËΠοÔÈ· ·ÓˆÌ·Ï›· ÛÙÔ ¤Ì‚Ú˘Ô. ∏ ·Ó·‰ÚÔÌÈ΋ Û˘ÏÏÔÁ‹ ‰Â‰ÔÌ¤ÓˆÓ ÛÙËÓ ˘ÔÌÂϤÙË µ Û˘Ó¿ÓÙËÛ ‰˘ÛÎÔϛ˜ ÛÙË Û˘Ó·›ÓÂÛË ÙˆÓ „˘¯·Ó·Ï˘ÙÒÓ/„˘¯ÔıÂÚ·¢ÙÒÓ Ó· ÂÈÎÔÈÓˆÓ‹ÛÔ˘Ó Ì ÚÒËÓ ıÂÚ·¢fiÌÂÓÔ‡˜ ÙÔ˘˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÛÙËÓ ¤Ú¢ӷ. ∏ Ù‹ÚËÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ·ÔÚÚ‹ÙÔ˘, Ë ‰È·Ê‡Ï·ÍË ÚÔÛˆÈÎÒÓ ‰Â‰Ô̤ӈÓ, Ë ‰ÂÔÓÙÔÏÔÁ›· Ù˘ ÎÏÈÓÈ΋˜ ÂÚÁ·Û›·˜ ‹Ù·Ó ÌÂÚÈΤ˜ ·fi ÙȘ ‰˘ÛÎÔϛ˜ ÛÙË ‰ÈÂÍ·ÁˆÁ‹ Ù˘ ÌÂϤÙ˘. ∏ ‰È·‰Èηۛ·, fiˆ˜ ÔÚÁ·ÓÒıËΠ·fi ÙËÓ ÂÚ¢ÓËÙÈ΋ ÔÌ¿‰· Ù˘ ∞ı‹Ó·˜, ÂÈÎÂÓÙÚÒıËΠÛÙËÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚË ˘¤Ú‚·ÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ. ∏ Âȉ›ˆÍË Ù˘ ÚÔÛˆÈ΋˜ Â·Ê‹˜ ÙÔ˘ ÂÚ¢ÓËÙ‹ Ì ÙË Á˘Ó·›Î· ‹ Ì ÙÔ ˙¢Á¿ÚÈ, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ÁÂÓÂÙÈÛÙ‹ ‹/Î·È ÙÔÓ Á˘Ó·ÈÎÔÏfiÁÔ, ÚfiÛˆ· Ô˘ Ë Á˘Ó·›Î· ÁÓˆÚ›˙ÂÈ Î·È ÂÌÈÛÙ‡ÂÙ·È, ‹Ù·Ó ÌÂÁ¿Ï˘ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÂÁηı›‰Ú˘ÛË Ù˘ ÌÂٷ͇ ÙÔ˘˜ Û¯¤Û˘, Ë ÔÔ›· ‹Ù·Ó ‚ÔËıËÙÈ΋ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ Ù˘ ÛÙȘ ÂfiÌÂÓ˜ Ê¿ÛÂȘ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Î·Ù·ÓfiËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ù˘ ÂÌÂÈÚ›·˜ ÙÔ˘ ÚÔÁÂÓÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, ‰ËÏ·‰‹ Ù˘ ËıÈ΋˜, „˘¯ÔÏÔÁÈ΋˜, ÔÏÈÙÈÛÌÈ΋˜ Î·È È·ÙÚÈ΋˜ ÏÂ˘Ú¿˜ Ù˘, Â›Ó·È ÛËÌ·ÓÙÈ΋. ™˘ÓÙÂÏ› ÙfiÛÔ ÛÙË ‰È·ÌfiÚʈÛË ÂÓfi˜ ËıÈÎÔ‡ Ï·ÈÛ›Ô˘ ÁÈ· ÙÔÓ ¯ÂÈÚÈÛÌfi ÙˆÓ fiÛˆÓ Û˘ÓÂ¿ÁÂÙ·È Ë Û‡Á¯ÚÔÓË ÁÂÓÂÙÈ΋ Î·È Ù¯ÓÔÏÔÁ›· fiÛÔ Î·È ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ ›‰Ô˘˜ ‚Ô‹ıÂÈ·˜ Ô˘ Â›Ó·È ÛÎfiÈÌÔ Ó· ·Ú¤¯ÂÙ·È Û Á˘Ó·›Î˜/˙¢Á¿ÚÈ· Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙË ‰È·‰Èηۛ· ·fiÊ·Û˘ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘ ·Á¤ÓÓËÙÔ˘ ̈ÚÔ‡. ∏ ·Ó¿‰ÂÈÍË ÙˆÓ ·Ú·¿Óˆ Ï¢ÚÒÓ ı· ÌÔÚÔ‡Û ӷ Ô‰ËÁ‹ÛÂÈ ÙȘ Á˘Ó·›Î˜/Ù· ˙¢Á¿ÚÈ· Ó· ηٷÓÔ‹ÛÔ˘Ó fiÙÈ Ë ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ‰ÈÏ‹ÌÌ·ÙÔ˜ Û˘ÓÙ›ıÂÙ·È ·fi ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ ÂÌϤÎÔÓÙ·È ÛÙËÓ Â›Ï˘Û‹ ÙÔ˘.

∆Ô ÂÚ¢ÓËÙÈÎfi ÚfiÁÚ·ÌÌ· EDIG ¯ÚËÌ·ÙÔ‰ÔÙÂ›Ù·È ·fi ÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË, ∞ÚÈıÌfi˜ Û˘Ì‚ÔÏ·›Ô˘: 016716-EDIG/ 08.12.05

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16. Hunfeld JA, Wladimiroff JW, Passchier J, Venema-Van Uden MV, Frets PG, Verhage F. Emotional reactions in women in late pregnancy (24 weeks or longer) following the ultrasound diagnosis of a severe or lethal fetal malformation. Prenat Diagn 1993;13:603-612.

17. Iles S, Gath D. Psychiatric outcome of termination of pregnancy for foetal abnormality. Psychol Med 1993;23:407-413.

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19. Salvesen KA, Oyen L, Schmidt N, Malt UF, Eik-Nes SH. Comparison of long-term psychological responses of women after pregnancy termination due to fetal anomalies and after perinatal loss. Ultrasound Obstet Gynecol 1997;9:80-85.

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* ™ÙÔ ÚfiÁÚ·ÌÌ· EDIG (Ethical Dilemmas due to Prenatal and Genetic Diagnostics) Û˘ÌÌÂÙ¤¯Ô˘Ó: 1) °ÂÚÌ·Ó›· (Sigmund Freud Institute, Û˘ÓÙÔÓÈÛÙÈÎfi ΤÓÙÚÔ Ù˘ ¤Ú¢ӷ˜, University of Kassel, University of Mainz, Eberhard Karls University of Tubingen), 2) πÛÚ·‹Ï (Hebrew University of Jerusalem), 3) ™Ô˘Ë‰›· (Linkoping University), 4) ª. µÚÂÙ·Ó›· (University of Cambridge), 5) πÙ·Ï›· (Universita Cattolica dea sacro cuora di Milano, Universita di Pavia) Î·È 6) ∂ÏÏ¿‰· (¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰Ô„˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ¶·ÓÂÈÛÙËÌȷ΋ æ˘¯È·ÙÚÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ¢ËÌÔÎÚ›ÙÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘). ™˘ÓÂÚÁ·˙fiÌÂÓ· ΤÓÙÚ·: ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”, µ’ °˘Ó·ÈÎÔÏÔÁÈ΋ Î·È ª·È¢ÙÈ΋ ∫ÏÈÓÈ΋, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, “∞ÚÂÙ·›ÂÈÔ” ¡ÔÛÔÎÔÌ›Ô, ∆Ì‹Ì· °ÂÓÂÙÈ΋˜ ÙÔ˘ ª·È¢ÙËÚ›Ô˘ “ªËÙ¤Ú·”. **The following centres are participating in the Ethical Dilemmas due to Prenatal and Genetic Diagnostics (EDIG) project: 1) Germany (Sigmund Freud Institute, coordination centre of the project, University of Kassel, University of Mainz, Eberhard Karls University of Tubingen), 2) Israel (Hebrew University of Jerusalem), 3) Sweden (Linkoping University), 4) United Kingdom (University of Cambridge), 5) Italy (Universita Cattolica dea sacro cuora di Milano; Universita di Pavia), and 6) Greece (Department of Child Psychiatry, University of Athens Medical School, “Aghia Sophia” Children’s Hospital; Department of Psychiatry, “Dimokritio” University of Thrace Medical School). Collaborating centres: Laboratory of Medical Genetics, University of Athens, “Aghia Sophia” Children’s Hospital; 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, “Areteio” Hospital; Department of Genetics, “Mitera” Maternity Clinic.

¶·È‰È·ÙÚÈ΋ 2008;71:383-389

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PRACTICAL ISSUE

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ AÏÏËÏÔÁÚ·Ê›·: ¡ÈÎfiÏ·Ô˜ ÷ÏÈ¿ÛÔ˜ nchalias@cc.uoi.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô πˆ·ÓÓ›ÓˆÓ

¡. ÷ÏÈ¿ÛÔ˜, ∞. µÏ¿¯Ô˜, ∞. ª¿Î˘ ¶ÂÚ›ÏË„Ë: ∏ ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Â›Ó·È Ôχ Û˘¯Ó‹ ÛÙ· ·È‰È¿. ∫·Ù¿ ηÓfiÓ·, Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÈÔÁÂÓÒÓ Î˘Ú›ˆ˜ ÏÔÈÌÒÍÂˆÓ Î·È ÏÈÁfiÙÂÚÔ ‚·ÎÙËÚÈ·ÎÒÓ ÏÔÈÌÒÍÂˆÓ ‹ ÏÔÈÌÒÍÂˆÓ ·fi Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ÂÓÒ ·ÎfiÌË ÈÔ Û¿ÓÈ· ÔÊ›ÏÂÙ·È Û ηÎÔ‹ıÂȘ ‹ ¿ÏÏ· ÓÔÛ‹Ì·Ù· ·ÓÔÛÔÏÔÁÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ ‹ Ê¿Ú̷η. ™‡Ìʈӷ Ì ÛÙ·ÙÈÛÙÈΤ˜, ÛÙÔ 25% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙȘ ÚˆÙÔ‚¿ıÌȘ ˘ËÚÂۛ˜ ˘Á›·˜ ÁÈ· ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ·˘Ù‹ Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓË. ∫·ÎÔ‹ıÂÈ· ·Ó¢ڛÛÎÂÙ·È Û ÏÈÁfiÙÂÚÔ ·fi 1% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ΢ڛˆ˜ Û ·È‰È¿ Û¯ÔÏÈ΋˜ Î·È ÂÊË‚È΋˜ ËÏÈΛ·˜. ™Â ÙÔÈ΋ ÂÓÙfiÈÛË, ȉȷ›ÙÂÚË ÚÔÛÔ¯‹ ··ÈÙÂ›Ù·È ÛÙÔ˘˜ ˘ÂÚÎÏ›‰ÈÔ˘˜ Î·È ÌÂÛÔıˆÚ¿ÎÈÔ˘˜ ÏÂÌÊ·‰¤Ó˜. ∏ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Á›ÓÂÙ·È Ì ÏÂÙÔÌÂÚ¤˜ ÈÛÙÔÚÈÎfi Î·È ÎÏÈÓÈ΋ ÂͤٷÛË, ÛÙ·‰È·Î‹ ¯Ú‹ÛË ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Î·È, ÙÂÏÈο, ·Ó ¯ÚÂÈ·ÛÙ›, Ì ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· Î·È ·Ó¿ÏÔÁË ıÂÚ·›·. π‰È·›ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰›‰ÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÌË ÏÂÌÊ·‰ÂÓÈΤ˜ Ì¿˙˜. ∏ ¯Ú‹ÛË ·ÏÁÔÚ›ıÌˆÓ Â›Ó·È ¯Ú‹ÛÈÌË ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ, ÚÈÓ ˙ËÙËı› Ë ‚Ô‹ıÂÈ· ·È‰Ô·ÈÌ·ÙÔÏfiÁÔ˘/ÔÁÎÔÏfiÁÔ˘. §¤ÍÂȘ ÎÏÂȉȿ: §ÂÌÊ·‰¤Ó˜, ‰ÈfiÁΈÛË, ·È‰È΋ ËÏÈΛ·.

Diagnostic approach to lymphadenopathy in children Department of Paediatrics, University Hospital of Ioannina Correspondence: N. Chaliasos nchalias@cc.uoi.gr Department of Paediatrics, University Hospital of Ioannina

N. Chaliasos, A. Vlahos, A. Makis Abstract: Lymph node enlargement is very common in children. Lymph node enlargement is caused mainly by infections, mostly viral, and less often bacterial or mycobacterial, while more rarely it is due to malignancies, immune diseases, or medication. Of all children presenting with lympadenopathy in the primary care setting, this is generalized in 25% of cases. Malignancy is identified in less than 1% of cases. Localized lympadenopathy merits special attention when the location is superclavicular or mediastinal. The diagnostic approach comprises detailed history, physical examination, targeted and stepwise use of laboratory tests, and eventually, when indicated, lymph node biopsy, in order to provide appropriate treatment. Special attention is needed to differentiate enlarged lymph nodes from other masses that are not of lymphatic origin. The use of appropriate algorithms is helpful to the paediatrician, before consultation with the paediatric haematologist/oncologist.

Key words: Lymph nodes, enlargement, childhood.

°ÂÓÈο ∏ ‰ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ ÛÙ· ·È‰È¿ Â›Ó·È Ôχ Û˘¯Ó‹. ™Â ˘ÁÈ‹ ·È‰È¿, Ë „ËÏ¿ÊËÛ‹ ÙÔ˘˜ Â›Ó·È Û˘ÓËıÈṲ̂ÓË, ÂÓÒ Û˘Ó·ÓÙÒÓÙ·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÛÙ· ÓÂÔÁÓ¿ (1). √È ÏÂÌÊ·‰¤Ó˜ ˘¿ÁÔÓÙ·È, Ì·˙› Ì ÙÔÓ ÛÏ‹Ó· Î·È ÙȘ ·¸¤ÚȘ ϿΘ, ÛÙ· ‰Â˘ÙÂÚÔÁÂÓ‹ ÏÂÌÊÈο fiÚÁ·Ó·. ¶ÚfiÎÂÈÙ·È ÁÈ· ÌÈÎÚ¤˜ ·ıÚÔ›ÛÂȘ ÏÂÌÊÈÎÔ‡ ÈÛÙÔ‡ Î·È ÏÂÈÙÔ˘ÚÁÔ‡Ó ˆ˜ Ê›ÏÙÚÔ ÛÙË ÏÂÌÊÈ΋ ΢ÎÏÔÊÔÚ›·. √ ·ÚÈıÌfi˜ ÙÔ˘˜ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ·Ó¤Ú¯ÂÙ·È Û 600 ¤ˆ˜ 1000. ∞Ó·ÙÔÌÈο ·ÔÙÂÏÔ‡ÓÙ·È ·fi ÙËÓ Î¿„·, ÙÔÓ ÂÚÈÊÂÚÈÎfi ÏÂÌÊÈÎfi ÎfiÏÔ, ÙÔÓ Â͈ÙÂÚÈÎfi ÊÏÔÈfi, ÙÔÓ ÂÓ Ùˆ ‚¿ıÂÈ ÊÏÔÈfi, ÙË Ì˘ÂÏÒ‰Ë ÌÔ›Ú· Î·È ÙÔ ‰ÈÎÙ˘ˆÙfi ÈÛÙfi (2). √È ÏÂÌÊ·‰¤Ó˜ ˘Ê›ÛÙ·ÓÙ·È ÌÂÙ·‚ÔÏ‹ ÙÔ˘ Û¯‹Ì·ÙÔ˜, ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘ ÂÛˆÙÂÚÈ΋˜ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘˜, ··ÓÙÒÓÙ·˜ Û ‰È¿ÊÔÚ· Â͈ÙÂÚÈο ·ÓÙÈÁÔÓÈο ÂÚÂı›ÛÌ·Ù· ‹ ÓÂÔÏ·ÛÌ·Paediatriki 2008;71:390-398

ÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜. ∏ ‰ÈfiÁΈÛË Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ›Ù ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÏÂÌÊ·‰¤Ó· -ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‹ ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ- ›Ù ‰È‹ıËÛ˘ ·fi ¿ÏÏ· ·ÙÙ·Ú·. ªÂÙ¿ ·fi ·ÓÙÈÁÔÓÈÎfi ÂÚÂıÈÛÌfi, Ù· ÏÂÌÊÔ·ÙÙ·Ú· ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Î·È ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È. ŸÙ·Ó ÙÔ ·ÓÙÈÁfiÓÔ ÂÍÔ˘‰ÂÙÂÚˆı›, Ë ·ÓˆÙ¤Úˆ ‰È·‰Èηۛ· ·‡ÂÈ Î·È Ô ·‰¤Ó·˜ Â·Ó¤Ú¯ÂÙ·È ÛÙÔ ÚÔËÁÔ‡ÌÂÓÔ Ì¤ÁÂıÔ˜. ∞Ó ÙÔ ·ÓÙÈÁfiÓÔ ·Ú·Ì›ÓÂÈ ¯ÚÔÓ›ˆ˜ (.¯. Û ÌÂÚÈΤ˜ ·Ú·ÛÈÙÒÛÂȘ), ÙfiÙÂ Ë ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ¯ÚÔÓ›˙ÂÈ. ∞ÓÂͤÏÂÁÎÙË ·‡ÍËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ¯ˆÚ›˜ ·ÓÙÈÁÔÓÈÎfi ÂÚÂıÈÛÌfi Û˘Ì‚·›ÓÂÈ Û ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈΤ˜ ÓfiÛÔ˘˜. ™ÙȘ ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ ˘¿Ú¯ÂÈ ‰È‹ıËÛË ·fi ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·, ÛÙȘ ıËÛ·˘ÚÈÛÌÒÛÂȘ Î·È ÙËÓ ÈÛÙÈÔ΢ÙÙ¿ÚˆÛË Û˘ÛÛÒÚ¢ÛË ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ Î·È ÛÙȘ ηÎÔ‹ıÂȘ ‰È‹ıËÛË ·fi ÎÏÒÓÔ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‹ ÌÂÙ·ÛÙ·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (3).

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·391

391

§ÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÛÙ· ·È‰È¿

∞Ó·ÙÔÌÈο, οı ÔÌ¿‰· ÏÂÌÊ·‰¤ÓˆÓ ‰¤¯ÂÙ·È ÙË Ï¤ÌÊÔ ·fi ÔÚÈṲ̂ӷ fiÚÁ·Ó· ‹ ÙÌ‹Ì·Ù· ÙÔ˘ ÛÒÌ·ÙÔ˜. ∏ ÁÓÒÛË ·˘Ù‹ ‚ÔËı¿ÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÏÂÌÊ·‰ÂÓÈÎÒÓ ‰ÈÔÁÎÒÛˆÓ. Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Û ˘ÁÈ‹ ·È‰È¿ ÔÈ ÏÂÌÊ·‰¤Ó˜ ‰ÂÓ „ËÏ·ÊÒÓÙ·È Û˘¯Ó¿ ÛÙË ÓÂÔÁÓÈ΋ Î·È ÚÒÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ÂÓÒ ÛÙȘ ˘fiÏÔÈ˜ ËÏÈ˘ ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·. √È ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ηٷϋÍÂÈ ÛÙËÓ ·‰Ú‹ ÂÎÙ›ÌËÛË fiÙÈ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜ Â›Ó·È ÁÈ· ÙÔ˘˜ ÙÚ·¯ËÏÈÎÔ‡˜ Î·È Ì·Û¯·ÏÈ·›Ô˘˜ <1 cm, ÁÈ· ÙÔ˘˜ ‚Ô˘‚ˆÓÈÎÔ‡˜ <1,5 cm Î·È ÁÈ· ÙÔ˘˜ ÂÈÙÚÔ¯›ÏÈÔ˘˜ <0,5 cm (4). √È ÏÂÌÊ·‰ÂÓÔ¿ıÂȘ ¯ˆÚ›˙ÔÓÙ·È Û ÁÂÓÈÎÂ˘Ì¤Ó˜ Î·È ÙÔÈΤ˜ (ÙÔÔÁÚ·ÊÈο) Î·È Û ÔÍ›˜ (̤¯ÚÈ 1 ‚‰ÔÌ¿‰·), ˘ÔÍ›˜ (1-3 ‚‰ÔÌ¿‰Â˜) Î·È ¯ÚfiÓȘ (>3 ‚‰ÔÌ¿‰Â˜), ·Ó¿ÏÔÁ· Ì ÙË ‰È¿ÚÎÂÈ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜. °ÂÓÈÎÂ˘Ì¤ÓË ıˆÚÂ›Ù·È Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· fiÙ·Ó ˘¿Ú¯ÂÈ ‰ÈfiÁΈÛË ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌË ÁÂÈÙÔÓÈÎÒÓ ÔÌ¿‰ˆÓ ÏÂÌÊ·‰¤ÓˆÓ, Ë ÔÔ›·, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, Û˘Óԉ‡ÂÙ·È Î·È ·fi ‰ÈfiÁΈÛË ÙÔ˘ ÛÏ‹Ó· ‹ Î·È ÙÔ˘ ‹·ÙÔ˜. ™Â ÌÈ· ÛÂÈÚ¿ 249 ·ÛıÂÓÒÓ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ˘ÁÂÈÔÓÔÌÈ΋ ÊÚÔÓÙ›‰·, ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·‰Ú‹ ηٷÓÔÌ‹ ÙˆÓ ÏÂÌÊ·‰ÂÓÔ·ıÂÈÒÓ Â›Ó·È 25% ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, 55% ÙÚ·¯ËÏÈ΋, 5% Ì·Û¯·ÏÈ·›·, 14% ‚Ô˘‚ˆÓÈ΋ Î·È 1% ˘ÂÚÎÏ›‰È· (5). ™Â ¿ÏÏË ÛÂÈÚ¿ ÏÂÌÊ·‰ÂÓÔ·ıÂÈÒÓ, ÌfiÓÔ ÙÔ 10% ¯ÚÂÈ¿ÛÙËΠ·Ú·ÔÌ‹ Û ÂȉÈÎfi (6). ™Â 126 ·È‰È¿ Ô˘ ·Ú·¤ÌÊıËÎ·Ó Û ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 3 ÂÙÒÓ Û ÂȉÈÎfi ΤÓÙÚÔ (ÔÁÎÔÏÔÁÈÎfi-·ÈÌ·ÙÔÏÔÁÈÎfi), ÚԤ΢„·Ó Ù· ÂÍ‹˜: 28 ›¯·Ó ‰ÈÔÁÎÒÛÂȘ Ô˘ ˘Ô‰‡ÔÓÙ·Ó ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· (ÏÂÌÊ·ÁÁÂÈÒÌ·Ù·, ‚Ú·Á¯È·Î¤˜ ·ÛÙÂȘ Î.Ï.), 23 ›¯·Ó ηÎÔ‹ıÂÈ· (Ì ÂÈÎÚ¿ÙËÛË ÙˆÓ ÏÂÌʈ̿وÓ), 75 ηÏÔ‹ıË ÓÔÛ‹Ì·Ù·, 6 Ê˘Ì·Ù›ˆÛË Î·È Ù· ˘fiÏÔÈ· ›¯·Ó ¿ÏÏ· ‹ ·‰È¿ÁÓˆÛÙ· ·›ÙÈ· (6). ™ÎÔfi˜ ÙÔ˘ ·ÚfiÓÙÔ˜ ¿ÚıÚÔ˘ Â›Ó·È Ó· ‰ÒÛÂÈ ÛÙÔÓ ·È‰›·ÙÚÔ Î·È ÙÔÓ ÁÂÓÈÎfi È·ÙÚfi ηٿ ÙÔ ‰˘Ó·ÙfiÓ Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Î·È Ó· ‰È¢ÎÔχÓÂÈ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ‰ÈÔÁÎˆÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ.

¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ∞. πÛÙÔÚÈÎfi ∆· ÛÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Ô˘ ı· ·Ó·˙ËÙËıÔ‡Ó Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: ‰È¿ÚÎÂÈ· ‰ÈfiÁΈÛ˘, ˘ÚÂÙfi˜, ÚfiÛÊ·ÙË ÓfiÛÔ˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó˘ÎÙÂÚÈÓÔ› ȉÚÒÙ˜, ÂӉ›ÍÂȘ Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘, ÓÂÔÏ·Û›·, ÛÂÍÔ˘·ÏÈÎfi ÈÛÙÔÚÈÎfi, Ù·Í›‰È·, ηٷӿψÛË ‡ÔÙÔ˘ Ê·ÁËÙÔ‡, ‡·ÚÍË Î·ÙÔÈΛ‰ÈˆÓ ‹ Â·ÁÁÂÏÌ·ÙÈ΋ ÂÓ·Û¯fiÏËÛË ÔÈÎÔÁ¤ÓÂÈ·˜ Ì ˙Ò·, ·ÏÏÂÚÁ›Â˜, Ï‹„Ë Ê·Ú̿ΈÓ. ∂ÈϤÔÓ, ÛËÌ·Û›· ¤¯ÂÈ ÙÔ ÈÛÙÔÚÈÎfi ÚfiÛÊ·ÙÔ˘ ÙÚ·˘Ì·ÙÈÛÌÔ‡, ÂÌ‚ÔÏÈ·ÛÌÔ‡, ¯ÂÈÚÔ˘ÚÁÈ΋˜ Â¤Ì‚·Û˘ Î·È Ô‰ÔÓÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ. ∏ ÂȉËÌÈÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË Â›Ó·È Ôχ ÛËÌ·-

ÓÙÈ΋, ÁÈ·Ù› ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÎıÂÛË ÌÔÚԇ̠ӷ Èı·ÓÔÏÔÁ‹ÛÔ˘Ì ÙÔ ·›ÙÈÔ. ∂ÈϤÔÓ, ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Ô˘ ‰ËÌÔÛȇÔÓÙ·È ·fi ÂÚ¢ÓËÙÈο ΤÓÙÚ· ·Ó¿ ÙÔÓ ÎfiÛÌÔ ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· ÔÛÔÛÙ¿ ·Ó¿ ·›ÙÈÔ ÔÈΛÏÏÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔÓ ÂÈÔÏ·ÛÌfi ‰È·ÊfiÚˆÓ ÓÔÛËÌ¿ÙˆÓ -΢ڛˆ˜ ÏÔÈÌÒ͈Ó- Ô˘ ÂÓ‰ËÌÔ‡Ó ÛÙËÓ ÂÚÈÔ¯‹ (7). µ. ∫ÏÈÓÈ΋ ÂͤٷÛË ∞·Ú·›ÙËÙÔ Â›Ó·È Ó· Á›ÓÂÙ·È Ï‹Ú˘ ÎÏÈÓÈ΋ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· Î·È Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È Ù· ÛËÌ›· ÂÓÙÔÈÛÌÔ‡ ÙˆÓ ‰ÈÔÁÎˆÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ, ÙÔ Ì¤ÁÂıÔ˜ Î·È Ë Û‡ÛÙ·ÛË ·˘ÙÒÓ, Ù˘¯fiÓ ‡·ÚÍË ıÂÚÌfiÙËÙ·˜ ‹ ÂÚÂıÈÛÌÔ‡ ÙÔ˘ ˘ÂÚΛÌÂÓÔ˘ ‰¤ÚÌ·ÙÔ˜, Èı·Ó‹ Û‡ÌÊ˘Û‹ ÙÔ˘˜ Ì ÙÔ˘˜ ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ Î·È Â˘·ÈÛıËÛ›· ‹ ÎÏ˘‰·ÛÌfi˜ ÛÙËÓ „ËÏ¿ÊËÛË. ∏ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÁÂÓÈÎÂ˘Ì¤ÓË ‹ ÙÔÈ΋, ηÈ, Â› ÙÔÈ΋˜, ˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË ‹ ÂÙÂÚfiÏ¢ÚË. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡, ÙËÓ ·Ó‡ÚÂÛË ÏÔÈÌÒ‰Ô˘˜ ÓÔÛ‹Ì·ÙÔ˜ ‹ ÂÛÙ›·˜ Î·È Ù· ¿ÏÏ· ÛÙÔȯ›· ÙÔ˘ ÈÛÙÔÚÈÎÔ‡. ¶Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛÂÎÙÈ΋ „ËÏ¿ÊËÛË ÁÈ· ‰ÈfiÁΈÛË ‹·ÙÔ˜-ÛÏ‹Ó·, ÂͤٷÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ Î·È ÚÈÓÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙˆÓ ·˘ÙÈÒÓ, ·Ó·˙‹ÙËÛË ÙÚ·˘Ì·ÙÈÛÌÒÓ ‹ ÂÚÂıÈÛÌÒÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ‹ ÛËÌ›Ԣ ÂÌ‚ÔÏÈ·ÛÌÔ‡ (BCG), ηıÒ˜ Â›Û˘ Î·È ·Ú·Ù‹ÚËÛË ÁÈ· Ôȉ‹Ì·Ù· (.¯. Û‡Ó‰ÚÔÌÔ ¿Óˆ ÎÔ›Ï˘). °. ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ∏ ÛÂÈÚ¿ ‰ÈÂÓ¤ÚÁÂÈ¿˜ ÙÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·È ÙËÓ ÂÌÂÈÚ›· ÙÔ˘ ·È‰È¿ÙÚÔ˘ Î·È ·‰Ú¿ ÂÚÈÏ·Ì‚¿ÓÂÈ: ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È Â›¯ÚÈÛÌ· ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, ∆∫∂, Mantoux, ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ÔÚÔÏÔÁÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È ‰ÂÚÌ·ÙÈÎfi ÙÂÛÙ ÁÈ· ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ÙÔ ¤Á¯ÚˆÌÔ Doppler ·ÁÁ›ˆÓ Â›Ó·È Â‡ÎÔϘ Î·È Ôχ ¯Ú‹ÛÈ̘ ÂÍÂÙ¿ÛÂȘ. ¶ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÏÂÌÊ·‰¤Ó·, ÙÔ Û¯‹Ì· ÙÔ˘ (·ÏÏ·Á‹ ·fi ˆÔÂȉ¤˜ Û ÛÊ·ÈÚÈÎfi), Ë ‰È·Ù‹ÚËÛË ‹ ÌË Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ÙÔ˘ Î·È Ë ·ÈÌ¿ÙˆÛ‹ ÙÔ˘. ™¿ÓÈ· ··ÈÙÔ‡ÓÙ·È Ì˘ÂÏfiÁÚ·ÌÌ·-ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·, ·ÍÔÓÈ΋ ‹ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, ‚ÈÔ„›· ‰È· ‚ÂÏfiÓ˘ ‹ ‚ÈÔ„›· ·‰¤Ó·. (§ÂÙÔÌÂÚ¤ÛÙÂÚË ÚÔÛ¤ÁÁÈÛË ÛÙÔ˘˜ ·Ú·ÙÈı¤ÌÂÓÔ˘˜ ·ÏÁfiÚÈıÌÔ˘˜.) ¢. ∫·Ù¿Ù·ÍË ÏÂÌÊ·‰ÂÓÔ·ıÂÈÒÓ ÙÔÔÁÚ·ÊÈο °ÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· – ∞›ÙÈ· §ÔÈÌÒÍÂȘ. ∆Ô Û˘ÓËı¤ÛÙÂÚÔ ÏÔÈÌ҉˜ ·›ÙÈÔ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿ Â›Ó·È ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ, fiˆ˜ Ë ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË, Ë ÂÚ˘ıÚ¿, Ë ·ÓÂÌ¢ÏÔÁÈ¿, Ë ÈÏ·Ú¿, ÔÈ ÏÔÈÌÒÍÂȘ ÙÔ˘ ¶·È‰È·ÙÚÈ΋ 2008;71:390-398

Paediatriki 2008;71:390-398

™ÙÚÂÙÔÎÔÎÎÈ΋ ·Ì˘Á‰·Ï›Ùȉ· §ÔÈÌÒÍÂȘ ·ÓÒÙ. ·Ó·Ó¢ÛÙÈÎÔ‡ √Í›· ÏÂÌÊ·‰ÂÓ›Ùȉ· §ÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË ∫·ÎÔ‹ıÂÈ· ¡. Kawasaki ªË ÏÂÌÊ·‰ÂÓÈΤ˜ Ì¿˙˜

º˘Ì·Ù›ˆÛË ™·ÚÎÔ›‰ˆÛË πÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜ ∫·ÎÔ‹ıÂÈ·

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°ÂÓÈ΋ ·›Ì·ÙÔ˜, ÌÈÎÚÔÛÎÔÈ΋ ÂÎÙ›ÌËÛË ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, LDH, Ô˘ÚÈÎfi, ·Û‚¤ÛÙÈÔ, ʈÛÊÔÚÈο U/S, Doppler ·ÁÁ›ˆÓ ∞ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, Èı·Ó‹ CT ‹ MRI ÂÚÈÔ¯‹ µÈÔ„›· ÏÂÌÊ·‰¤ÓˆÓ ‹/Î·È ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·

ÀÔ„›· ηÎÔ‹ıÂÈ·˜

ºÏÂÁÌÔÓ¤˜ ¯ÂÚÈÔ‡, Ì·Û¯¿Ï˘ ¡fiÛÔ˜ ·fi ·Ì˘¯‹ Á¿Ù·˜ ∂Ì‚ÔÏÈ·ÛÌfi˜ ·fi BCG ∫·ÎÔ‹ıÂÈ·

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ºÏÂÁÌÔÓ¤˜ Ô‰ÈÒÓ, ‚Ô˘‚ˆÓÈ΋˜ ¯ÒÚ·˜ ™‡ÊÈÏË ∞ÊÚÔ‰›ÛÈÔ ÏÂÌÊÔÎÔÎΛˆÌ· ·ÓÒÏ˘

µÔ˘‚ˆÓÈÎÔ›

∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¶Èı·Ó‹ ‚ÈÔ„›·, ÂÍ·›ÚÂÛË

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§¤Ìʈ̷ ÕÏϘ ηÎÔ‹ıÂȘ ªÂÛÂÓÙ¤ÚÈÔ˜ ·‰ÂÓ›Ùȉ·

∫ÔÈÏÈ·ÎÔ›

392

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∞‰¤Ó·˜ ÂÒ‰˘ÓÔ˜, ˘ÂÚΛÌÂÓË ÂÚ˘ıÚfiÙËÙ·, ıÂÚÌfiÙËÙ·, ÎÏ˘‰·ÛÌfi˜ ∞ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ‰È¿ÓÔÈÍË

∫·ÎÔ‹ıÂÈ· º˘Ì·Ù›ˆÛË

∆Ú·¯ËÏÈÎÔ›

¶·Ú·ÎÔÏÔ‡ıËÛË ÁÈ· 2-6 ‚‰ÔÌ¿‰Â˜

§ÔÈÌÒÍÂȘ ‰ÔÓÙÈÒÓÛÙfiÌ·ÙÔ˜ √Í›· ÏÂÌÊ·‰ÂÓ›Ùȉ· ∫·ÎÔ‹ıÂÈ· º˘Ì·Ù›ˆÛË

ÀÂÚÎÏ›‰ÈÔÈ

12:33

¶Èı·Ó‹ ÌÈÎÚԂȷ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·

§ÔÈÌÒÍÂȘ ÙÚȯˆÙÔ‡ ÎÂÊ·Ï‹˜ ∂Ú˘ıÚ¿ §ÔÈÌ҉˜ ÂÚ‡ıËÌ· ∫·ÎÔ‹ıÂÈ·

√Êı·ÏÌÔÏÔÁÈΤ˜ ÏÔÈÌÒÍÂȘ ¢ÂÚÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ¡fiÛÔ˜ ·fi ·Ì˘¯‹ Á¿Ù·˜

ÀÔÁÓ¿ıÈÔÈ

22-10-08

™˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· ÈÔÁÂÓÔ‡˜ Ïԛ̈͢

πÓÈ·ÎÔ›

¶ÚÔˆÙÈ·›ÔÈ

∫ÏÈÓÈ΋ ∂ͤٷÛË: ∂ÓÙÔÈÛÌfi˜ ÏÂÌÊ·‰¤ÓˆÓ, ̤ÁÂıÔ˜, Û‡ÛÙ·ÛË, ıÂÚÌfiÙËÙ·, ÂÚ‡ıËÌ·, ¢·ÈÛıËÛ›·, ÎÏ˘‰·ÛÌfi˜, ÙÚ·‡Ì·Ù·, ÊÏÂÁÌÔÓ¤˜

πÛÙÔÚÈÎfi: ∆Ú·˘Ì·ÙÈÛÌÔ›, ÊÏÂÁÌÔÓ¤˜, ˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó˘¯ÙÂÚÈÓÔ› ȉÚÒÙ˜, ‰È¿ÚÎÂÈ· Û˘Ìو̿وÓ, ÛÂÍÔ˘·ÏÈÎfi ÈÛÙÔÚÈÎfi, ÚfiÛÊ·ÙÔ Ù·Í›‰È

Pediatri Sept-Oct 08 ™ÂÏ›‰·392

¡. ÷ÏÈ¿ÛÔ˜ Î·È Û˘Ó.

Pediatri Sept-Oct 08

14-10-08

13:26

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¶›Ó·Î·˜ 1. πÔ›-·Ú¿ÛÈÙ· Î·È ÏÂÌÊ·‰ÂÓ›Ùȉ˜ πÔ›

¶›Ó·Î·˜ 2. ªÈÎÚԂȷο ·›ÙÈ· Î·È ÏÂÌÊ·‰ÂÓ›Ùȉ˜ ¶·Ú¿ÛÈÙ·

1. ∞‰ÂÓÔ˚Ô› 1. ∆ÔÍfiÏ·ÛÌ· 2. ƒÈÓÔ˚Ô› 2. ∆ÔÍfiηڷ 3. πÔ› Coxsackie 3. ∂ÏÔÓÔÛ›· 4. Parvovirus B19 5. πfi˜ ÈÏ·Ú¿˜ 6. πfi˜ ÂÚ˘ıÚ¿˜ 7. πfi˜ ·ÚˆÙ›Ùȉ·˜ 8. πfi˜ Ù˘ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ 9. ∂ÚËÙÔ˚Ô› πfi˜ Ebstein-Barr ∫˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ πfi˜ ·ÏÔ‡ ¤ÚËÙ· 1 Î·È 2 πfi˜ ·Ó¢Ì¢ÏÔÁÈ¿˜-¤ÚËÙ· ˙ˆÛÙ‹Ú· ∂ÚËÙÔ˚fi˜ 6, 7, 8

·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, HIV Î.¿. (¶›Ó·Î·˜ 1). ™ËÌÂȈ٤ÔÓ fiÙÈ Ù· ÂÌ‚fiÏÈ·, fiˆ˜ Ù˘ ÂÚ˘ıÚ¿˜, ηٿ ·ÚÈÔ ÏfiÁÔ, Ù˘ ÈÏ·Ú¿˜ Î·È Ù˘ ·ÚˆÙ›Ùȉ·˜, Â›Ó·È ‰˘Ó·ÙfiÓ Û Û¿ÓȘ ÂÚÈÙÒÛÂȘ Ó· ÚÔηϤÛÔ˘Ó ÁÂÓÈÎÂ˘Ì¤ÓË, ·ÏÏ¿ Î·È ÙÔÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·. ∞fi ÙÔ˘˜ ÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Û˘¯ÓfiÙÂÚÔÈ Â›Ó·È Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, Ô ∞ ·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ (ÛÙ· ÓÂÔÁÓ¿ Î·È ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË µ ·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜), Ë ÛË„·ÈÌ›·, Ë ‚ÚԢΤÏψÛË, Ë Û·ÏÌÔÓ¤ÏÏ· Î·È Ù· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (Ê˘Ì·Ù›ˆÛ˘-¿Ù˘·). ™Ù· ·È‰È¿, ÂÓ›ÔÙ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÔÈ ·Ú·ÛÈÙÈΤ˜ ÏÔÈÌÒÍÂȘ (ÙÔÍfiÏ·ÛÌ·, ÙÔÍfiηڷ, Ï·ÛÌÒ‰ÈÔ ÂÏÔÓÔÛ›·˜ Î.¿.) Î·È Û¿ÓÈ· ÔÈ Ì˘ÎËÙÈ¿ÛÂȘ, ΢ڛˆ˜ Û ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ (8). ∞ÓÔÛÔ‚ÈÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ - √ÚÔÓÔÛ›·. ªÂ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÌÔÚÔ‡Ó Ó· ÂΉËψıÔ‡Ó ÔÈ ÎÔÏÏ·ÁÔÓÒÛÂȘ ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ (Ó·ÓÈ΋ ȉÈÔ·ı‹˜ ·ÚıÚ›Ùȉ·, Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ Î.¿.) Î·È ÔÚÈṲ̂Ó˜ ·ÓÔÛÔ·ÓÂ¿ÚÎÂȘ (.¯. ¯ÚfiÓÈ· ÎÔÎÎȈ̷Ù҉˘ ÓfiÛÔ˜), ηıÒ˜ Î·È ÂÌ‡ÚÂÙ· ÂÚÈÔ‰Èο Û‡Ó‰ÚÔÌ· (.¯. Û‡Ó‰ÚÔÌÔ PFAFA Î·È ˘ÂÚÁ·ÌÌ·ÛÊ·ÈÚÈÓ·ÈÌ›· D) (9) (¶›Ó·Î·˜ 3). °ÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÌÔÏ˘ÙÈ΋˜ ·Ó·ÈÌ›·˜ Î·È ˘Ô¯ˆÚ› ·˘ÙfiÌ·Ù· (10). £ËÛ·˘ÚÈÛÌÒÛÂȘ. ¡fiÛÔÈ fiˆ˜ Gaucher Î·È ¡iemann-Pick ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È Î˘ÙÙ·ÚÔÂӛ˜, ·ÏÏ¿ ÂÌÊ·Ó›˙ÔÓÙ·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· (11). º¿Ú̷η. ™¿ÓÈ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ˆ˜ ·ÓÙ›‰Ú·ÛË Û ʿÚ̷η. ∏ ‰ÈfiÁΈÛË Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi ÎÓȉˆÙÈÎfi ÂÍ¿ÓıËÌ·, Û¿ÓÈ· ·fi ›ÎÙÂÚÔ Î·È ˘Ô¯ˆÚ› Ì ÙË

¡ÂÔÁÓ¿ ñ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ñ ÛÙÚÂÙfiÎÔÎÎÔ˜ ÔÌ¿‰·˜ µ µÚ¤ÊË Î·È Ó‹È· ñ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ñ ˘ÔÁfiÓÔ˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ ¶·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Î·È ¤ÊË‚ÔÈ ñ ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ñ ˘ÔÁfiÓÔ˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ ñ ·Ó·ÂÚfi‚È· ñ ˘ÂÚÛ›ÓÈ· ÂÓÙÂÚÔÎÔÏ›Ùȉ·˜ ñ ÊÚ·ÓÛÈÛ¤ÏÏ· Ù˘ ÙÔ˘Ï·Ú·ÈÌ›·˜ ñ Ì˘ÎÔ‚·ÎÙËÚ›‰È·

‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Û ٤ÛÛÂÚȘ ÂÚ›Ô˘ ‚‰ÔÌ¿‰Â˜. ∆· Ê¿Ú̷η Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Â›Ó·È Ë Ê·ÈÓ˘ÙÔ˝ÓË, Ë ÈÛÔÓÈ·˙›‰Ë, Ë ˘‰ÚÔÏ·˙›ÓË, Ë ·ÏÏÔÔ˘ÚÈÓfiÏË, Ë Î·ÙÔÚ›ÏË, Ë Î·Ú‚·Ì·˙Â›ÓË, ÔÈ ÎÂÊ·ÏÔÛÔÚ›Ó˜ Î.¿ (12,13). ∞ÈÌ·ÙÔÏÔÁÈΤ˜ ηÎÔ‹ıÂȘ. ªÂ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÂΉËÏÒÓÂÙ·È Î˘Ú›ˆ˜ Ë ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· Î·È ÏÈÁfiÙÂÚÔ ÔÈ ¿ÏϘ Ï¢¯·È̛˜ ‹ Ë ÈÛÙÈÔ΢ÙÙ¿ÚˆÛË. ∏ ‰ÈfiÁΈÛË Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢ÚË Î·È Û˘ÌÌÂÙÚÈ΋. ™Â ÔÍ›· ÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›·, Ë ‰ÈfiÁΈÛË Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙÔÓ ÙÚ¿¯ËÏÔ. ™Ù· ÏÂÌÊÒÌ·Ù·, Ë ÚÔÛ‚ÔÏ‹ ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ Â›Ó·È Î˘Ú›ˆ˜ ÌË Û˘ÌÌÂÙÚÈ΋ (14). ™˘Ì·Á›˜ fiÁÎÔÈ - ªÂÙ·ÛÙ¿ÛÂȘ. ∞fi ÙÔ˘˜ ÌÂÙ·ÛÙ·ÙÈÎÔ‡˜ fiÁÎÔ˘˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÏÂÌÊ·‰ÂÓÈΤ˜ ‰ÈÔÁÎÒÛÂȘ ÚÔηÏ› ΢ڛˆ˜ ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷. ∂›Ó·È ·Û‡ÌÌÂÙÚ˜, ‰È¿Û·ÚÙ˜ Î·È ÛÎÏËÚ¤˜ ‰ÈÔÁÎÒÛÂȘ (15). ¢ÂÚÌ·ÙÔ¿ıÂȘ. ¶·ı‹ÛÂȘ, fiˆ˜ ÙÔ ÂÈÌÔÏ˘Óı¤Ó ¤Î˙ÂÌ·, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË. ∆ÔÈ΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· – ∞›ÙÈ· πÓÈ·ÎÔ› ÏÂÌÊ·‰¤Ó˜. √È ÈÓÈ·ÎÔ› ÏÂÌÊ·‰¤Ó˜ Ê˘ÛÈÔÏÔÁÈο Â›Ó·È ·„ËÏ¿ÊËÙÔÈ. ¢ÈfiÁΈÛË ÈÓÈ·ÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ ÚÔηÏÔ‡Ó Û˘ÓËı¤ÛÙÂÚ· ÓÔÛ‹Ì·Ù· ¶›Ó·Î·˜ 3. ºÏÂÁÌÔÓÒ‰Ë ÌË ÏÔÈÌÔÁfiÓ· ·›ÙÈ· ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ 1. ƒÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›Ùȉ· 2. ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ı˘Ì·Ù҉˘ χÎÔ˜ 3. ¢ÂÚÌ·ÙÔÌ˘ÔÛ›Ùȉ· 4. ∞ÁÁÁÂÈ›Ùȉ˜ 5. ªÈÎÙ‹ ÓfiÛÔ˜ ÎÔÏÏ·ÁfiÓÔ˘ 6. ™·ÚÎÔ›‰ˆÛË 7. ¶ÂÚÈÔ‰Èο ÂÌ‡ÚÂÙ· ÓÔÛ‹Ì·Ù· 8. ¡fiÛÔ˜ Kikuchi-Fuzimoto 9. ¡fiÛÔ˜ Kimura ¶·È‰È·ÙÚÈ΋ 2008;71:390-398

Paediatriki 2008;71:390-398

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∞Ó Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ÏÔÈÌÒÍÂȘ Â›Ó·È ·ÚÓËÙÈÎfi˜ ‹ Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÂȉÂÈÓÒÓÂÙ·È ‹ ·Ú·Ì¤ÓÂÈ ÁÈ· >6 ‚‰ÔÌ¿‰Â˜

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™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ ¡Â·ÓÈ΋ ȉÈÔ·ı‹˜ ·ÚıÚ›Ùȉ· ™·ÚÎÔ›‰ˆÛË £ËÛ·˘ÚÈÛÌÒÛÂȘ √ÚÔÓÔÛ›· §ÂÌÊ·‰ÂÓÔ¿ıÂÈ· ·fi Ê¿Ú̷η

ÃÚfiÓÈ· Û˘ÌÙÒÌ·Ù·. ∂Ӊ›ÍÂȘ ÓfiÛÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ‹ ¯ÚfiÓÈ·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ηٿÛÙ·Û˘. ∂Í¿ÓıËÌ· ·ÁÁÂÈ›Ùȉ·˜, ·ÚıÚ›Ùȉ·, ÛËÌ·ÓÙÈ΋ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·. ÃÚ‹ÛË Ê·Ú̿ΈÓ.

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§ÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË, ÂÚ˘ıÚ¿, ·ÚˆÙ›Ùȉ·, ÈÏ·Ú¿, Ê˘Ì·Ù›ˆÛË, HIV

™˘ÌÙÒÌ·Ù· ÈÔÁÂÓÔ‡˜ Û˘Ó‰ÚÔÌ‹˜ ‹ Û˘ÛÙËÌ·ÙÈ΋˜ Ïԛ̈͢. §ÂÌÊ·‰¤Ó˜ Ì·Ï·ÎÔ›, Û˘¯Ó¿ ÂÒ‰˘ÓÔÈ, ¯ˆÚ›˜ Û‡ÌÊ˘ÛË Ì ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜. ∂Í¿ÓıËÌ·, Ê·Ú˘ÁÁ›Ùȉ·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·.

22-10-08

∞˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ηÎÔ‹ıÂÈ·˜ µÈÔ„›· ÏÂÌÊ·‰¤Ó·, ÔÛÙÂÔÌ˘ÂÏÈ΋ ‚ÈÔ„›·

∞ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó˘¯ÙÂÚÈÓÔ› ȉÚÒÙ˜, ÔÛÙÈο ¿ÏÁË ÀÂÚÎÏ›‰È· ÂÓÙfiÈÛË, ·ÓÒ‰˘ÓË ÚÔԉ¢ÙÈ΋ ‰ÈfiÁΈÛË, Û‡ÌÊ˘ÛË Ì ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜ ¶·ıÔÏÔÁÈ΋ ÁÂÓÈ΋ ·›Ì·ÙÔ˜ Î·È ÌÈÎÚÔÛÎfiËÛË, ·˘ÍË̤ÓÔ Ô˘ÚÈÎfi Ô͇ Î·È LDH. ¶·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη.

∫ÏÈÓÈ΋ ∂ͤٷÛË: ª¤ÁÂıÔ˜, Û‡ÛÙ·ÛË, ¢·ÈÛıËÛ›·, ıÂÚÌfiÙËÙ·, ÂÚ‡ıËÌ·, ÛËÌ›· ·fi ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·

πÛÙÔÚÈÎfi: ¶˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ó˘¯ÙÂÚÈÓÔ› ȉÚÒÙ˜, ÓfiÛÔ˜ ÎÔÏÏ·ÁfiÓÔ˘, ÓÂÔÏ·Û›·, ÛÂÍÔ˘·ÏÈÎfi ÈÛÙÔÚÈÎfi, Ù·Í›‰È·

Pediatri Sept-Oct 08 ™ÂÏ›‰·394

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Pediatri Sept-Oct 08

14-10-08

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ÙÔ˘ ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜, fiˆ˜ Â›Ó·È Ë ÛÌËÁÌ·ÙÔÚÚÔ˚΋ ‰ÂÚÌ·Ù›Ùȉ· (΢ڛˆ˜ ÛÙ· ‚Ú¤ÊË), Ë ÊıÂÈÚ›·ÛË, Ù· ÈÔÁÂÓ‹ ÓÔÛ‹Ì·Ù· (.¯. ÂÚ˘ıÚ¿, ÏÔÈÌ҉˜ ÂÚ‡ıËÌ·), Û¿ÓÈ· ηÎÔ‹ıÂÈ· ‹ ÙÔ ÙÚ·‡Ì· ÙÚȯˆÙÔ‡ Ù˘ ÎÂÊ·Ï‹˜. ¶ÚÔˆÙÈ·›ÔÈ ÏÂÌÊ·‰¤Ó˜. ™Â Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜ Â›Ó·È ·„ËÏ¿ÊËÙÔÈ. ¢ÈfiÁΈÛË Û˘Ì‚·›ÓÂÈ Û ÊÏÂÁÌÔÓ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Ù˘ ÎÚÔÙ·ÊÈ΋˜ ¯ÒÚ·˜, Û ÓfiÛÔ ·fi ·Ì˘¯‹ Á¿Ù·˜, Û ÊÏÂÁÌÔÓ‹ ÙÔ˘ ¤Íˆ ·ÎÔ˘ÛÙÈÎÔ‡ fiÚÔ˘ Î·È Û ÏÔÈÌÒÍÂȘ ÙˆÓ ÔÊı·ÏÌÒÓ (΢ڛˆ˜ ¯ÚfiÓȘ). ∞ӷʤÚÔÓÙ·È ÔÈ ÔÊı·ÏÌÈΤ˜ ÏÔÈÌÒÍÂȘ ·fi Chlamydia bedsonia (ÔÊı·ÏÌ··‰ÂÓÈÎfi Û‡Ó‰ÚÔÌÔ, Û‡Ó‰ÚÔÌÔ Parinaud), Û¿ÓÈ· ÙÚ¿¯ˆÌ· Î·È ÙÔ˘Ï·Ú·ÈÌ›·. √Êı·ÏÌÔ·‰ÂÓÈÎfi Û‡Ó‰ÚÔÌÔ ÚÔηÏÔ‡Ó Î·È ÔÈ ·‰ÂÓÔ˚Ô› 3 Î·È 8. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ‚Ú·Á¯È·Î‹ ·ÛÙË Î·È ÙË ‰ÈfiÁΈÛË ·ÚˆÙ›‰·˜ (8). ÀÔÁÓ¿ıÈÔÈ Î·È ˘ÔÁÏÒÛÛÈÔÈ ÏÂÌÊ·‰¤Ó˜. ™˘Ó‹ıˆ˜ ÔÊ›ÏÔÓÙ·È Û ÊÏÂÁÌÔÓ¤˜ ‰ÔÓÙÈÒÓ, Ù˘ ÁÏÒÛÛ·˜ Î·È ÙˆÓ ·ÚÂÈÒÓ. ™¿ÓÈ· Ë ‰ÈfiÁΈۋ ÙÔ˘˜ ÔÊ›ÏÂÙ·È Û ÈÔÁÂÓ‹ ·ÚˆÙ›Ùȉ· (ˆ˜ ÌfiÓË ÂΉ‹ÏˆÛË). ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ‚·ÙÚ¿¯ÈÔ (16). ÀÂÚÎÏ›‰ÈÔÈ ÏÂÌÊ·‰¤Ó˜. ∏ ‰ÈfiÁΈÛË ÙˆÓ ˘ÂÚÎÏ›‰ÈˆÓ ÏÂÌÊ·‰¤ÓˆÓ ··ÈÙ› ȉȷ›ÙÂÚË ÚÔÛÔ¯‹, ÁÈ·Ù› ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË Èı·ÓfiÙËÙ· Ó· ÔÊ›ÏÂÙ·È ÛÂ Ê˘Ì·Ù›ˆÛË ‹ ηÎÔ‹ıÂÈ·. ∞˘ÙÔ› Ù˘ ‰ÂÍÈ¿˜ ˘ÂÚÎÏ›‰È·˜ ¯ÒÚ·˜ (ÂÈÎÔÈÓˆÓ›· Ì ıˆÚ·ÎÈÎfi fiÚÔ) ÂËÚ¿˙ÔÓÙ·È ·fi ÓÔÛ‹Ì·Ù· ÌÂÛÔıˆÚ·Î›Ô˘ (.¯. Ê˘Ì·Ù›ˆÛË, ÏÂÌÊÒÌ·Ù·), ÂÓÒ Ù˘ ·ÚÈÛÙÂÚ‹˜ (ÂÈÎÔÈÓˆÓ›· Ì ÂÏ¿ÛÛÔÓ· ıˆÚ·ÎÈÎfi fiÚÔ) ‰ÈÔÁÎÒÓÔÓÙ·È Û ÓÔÛ‹Ì·Ù· Ù˘ ÎÔÈÏÈ¿˜ (.¯. ÏÂÌÊÒÌ·Ù·). ÕÏÏ· ·›ÙÈ· Â›Ó·È Û¿ÓÈ· (ÈÛÙÔÏ¿Û̈ÛË, ÎÔÎÎÈÔ˚‰Ô̇ΈÛË). ∞Ó ÔÈ ‰ÈÔÁΈ̤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ ‰ÂÓ Â›Ó·È ÙÌ‹Ì· (Û˘Ó¤¯ÂÈ·) ÙˆÓ Ï·Á›ˆÓ ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ, Ú¤ÂÈ ÔˆÛ‰‹ÔÙ ӷ ·ÔÎÏÂÈÛı› ÛÔ‚·Ú‹ ÓfiÛÔ˜ (15). ∆Ú·¯ËÏÈÎÔ› ÏÂÌÊ·‰¤Ó˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ˘˜ ÏÂÌÊ·‰¤Ó˜ Ô˘ ‰ÈÔÁÎÒÓÔÓÙ·È ÈÔ Û˘¯Ó¿ (55%) ·fi ÙÔ˘˜ ¿ÏÏÔ˘˜ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi. ∞Ó·ÙÔÌÈο ‰È·ÎÚ›ÓÔÓÙ·È ÛÙÔ˘˜ ·ÓÒÙÂÚÔ˘˜ ÂÓ Ùˆ ‚¿ıÂÈ, ÂÈÔÏ‹˜, Ô›ÛıÈÔ˘˜ ÙÚ·¯ËÏÈÎÔ‡˜ Î·È Î·ÙÒÙÂÚÔ˘˜ ÂÓ Ùˆ ‚¿ıÂÈ. ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Â›Ó·È ÏÔÈÌÒÍÂȘ (‚·ÎÙËÚȷΤ˜, ÈÔÁÂÓ›˜, Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ·Ú·ÛÈÙÈΤ˜) Î·È Û¿ÓÈ· ηÎÔ‹ıÂȘ Î·È ÈÛÙÈÔ΢ÙÙ¿ÚˆÛË ‹ ¿ÏÏ· ·›ÙÈ·, .¯. ÓfiÛÔ˜ Kawasaki (17). ∆· Û˘¯ÓfiÙÂÚ· ‚·ÎÙ‹ÚÈ· Â›Ó·È Ô ‚-·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ ÔÌ¿‰·˜ ∞ (ÛÙ· ÓÂÔÁÓ¿ Î·È ÌÈÎÚ¿ ‚Ú¤ÊË Ô ÛÙÚÂÙfiÎÔÎÎÔ˜ ÔÌ¿‰·˜ µ), Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜, Ô Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ Î·È Ù· ·Ó·ÂÚfi‚È·. ¶ÚÔηÏÔ‡Ó Â›Ù ÂÙÂÚfiÏ¢ÚË Â›Ù ·ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË. ∂›Ó·È ÂÒ‰˘ÓÔÈ, ‰˘Ó·ÙfiÓ Ó· ÎÏ˘‰¿˙Ô˘Ó Î·È Ó· ˘¿Ú¯ÂÈ ÂÚÂıÈÛÌfi˜ ÙÔ˘ ˘ÂÚΛÌÂÓÔ˘ ‰¤ÚÌ·ÙÔ˜.

√È ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ΢ڛˆ˜ ·Ó·Ó¢ÛÙÈÎÔ‡ (·‰ÂÓÔ˚Ô›, Coxsackie, ÂÚËÙÔ˚Ô›, RSV Î.¿.), ·ÏÏ¿ Î·È ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ ·fi EBV, CMV, HIV, ÈÏ·Ú¿, ÂÚ˘ıÚ¿, ·ÓÂÌ¢ÏÔÁÈ¿, Â›Ó·È Ù· ÈÔ Û˘¯Ó¿ ·›ÙÈ·. √È ·‰¤Ó˜ Â›Ó·È ·ÓÒ‰˘ÓÔÈ, ¢ΛÓËÙÔÈ Î·È ÂÓÙÔ›˙ÔÓÙ·È ·ÌÊÔÙÂÚfiÏ¢ڷ. ∏ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ·fi ∂µV Î·È ÂÚËÙÔ˚Ô‡˜ Â›Ó·È ÂÒ‰˘ÓË Î·È ‰˘Ó·ÙfiÓ Ó· Ï¿‚ÂÈ ÛËÌ·ÓÙÈΤ˜ ‰È·ÛÙ¿ÛÂȘ (18). ∏ Ê˘Ì·ÙÈ҉˘ ÙÚ·¯ËÏÈ΋ ·‰ÂÓ›Ùȉ· (Û¯ÂÙÈο Û¿ÓÈ· ÛÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜) Â›Ó·È ÂÙÂÚfiÏ¢ÚË ‹ ·ÌÊÔÙÂÚfiÏ¢ÚË. ™˘Óԉ‡ÂÙ·È Î·Ù¿ ηÓfiÓ· ·fi ıÂÙÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Î·È Mantoux. ∞Ó Ì›ÓÂÈ ¯ˆÚ›˜ ıÂÚ·›·, ‰˘Ó·ÙfiÓ Ó· Ô‰ËÁ‹ÛÂÈ ÛÂ Û˘Ú›ÁÁÈÔ ÚÔ˜ ÙÔ ˘ÂÚΛÌÂÓÔ ‰¤ÚÌ· (¯ÔÈÚ¿‰ˆÛË). ∏ Ê˘Ì·Ù›ˆÛË Â›Ó·È Û˘¯Ó‹ Î·È ‰È·‰Ú¿ÌÂÈ ‚·ÚÈ¿ Û ·È‰È¿ Ì HIV. ∏ ·‰ÂÓ›Ùȉ· ·fi ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· Â›Ó·È Û˘Ó‹ıˆ˜ ÂÙÂÚfiÏ¢ÚË (ÛÎÏËÚ›· ÛÙË ÁˆÓ›· Ù˘ οو ÁÓ¿ıÔ˘), ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ıÂÙÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Î·È Â›Ó·È ÈÔ Û˘¯Ó‹ Û ·È‰È¿ <4 ÂÙÒÓ (19). ∏ ÓfiÛÔ˜ ·fi ·Ì˘¯‹ Á¿Ù·˜ ÂΉËÏÒÓÂÙ·È ˆ˜ ÂȯÒÚÈ· ÏÂÌÊ·‰ÂÓ›Ùȉ· (ÙÚ·¯ËÏÈ΋ ‹ Ì·Û¯·ÏÈ·›·), ÔÊ›ÏÂÙ·È ÛÙÔ ÌÈÎÚfi‚ÈÔ Bardonella henselae, ¯ÚÔÓ›˙ÂÈ Î·È ‰˘Ó·ÙfiÓ Ó· Û˘Óԉ‡ÂÙ·È Î·È ·fi ÁÂÓÈο Û˘ÌÙÒÌ·Ù· (ηÎÔ˘¯›·, Ô˙҉˜ ÂÚ‡ıËÌ·, ˘ÚÂÙfi ·ÁÓÒÛÙÔ˘ ·ÈÙÈÔÏÔÁ›·˜ Î.¿.) (20). ∏ Â›ÎÙËÙË ÙÔÍÔÏ¿Û̈ÛË Â›Ó·È Û˘Ó‹ıˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË ÙÚ·¯ËÏÈ΋ ·‰ÂÓ›Ùȉ· Î·È ‰˘Ó·ÙfiÓ Ó· Û˘Óԉ‡ÂÙ·È ·fi Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù· (21). ∞fi ÙȘ ηÎÔ‹ıÂȘ, Û˘¯ÓfiÙÂÚ· ·›ÙÈ· Â›Ó·È Ë ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· ÌÂ Û˘ÌÌÂÙÚÈ΋ ·ÌÊÔÙÂÚfiÏ¢ÚË ÙÚ·¯ËÏÈ΋ ‰ÈfiÁΈÛË, Ù· ÏÂÌÊÒÌ·Ù· Ì ·Û‡ÌÌÂÙÚË ‰ÈfiÁΈÛË, ÙÔ Ó¢ÚÔ‚Ï¿Ûو̷, ÙÔ Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ Î·È Ë ÈÛÙÈÔ΢ÙÙ¿ÚˆÛË (22). ¢È¿ÊÔÚ· ¿ÏÏ· Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ·ÌÊÔÙÂÚfiÏ¢ÚË ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, fiˆ˜ Â›Ó·È Ë ÓfiÛÔ˜ Kawasaki (ÔÈ ·‰¤Ó˜ ‰ÂÓ ‰È·˘Ô‡ÓÙ·È), Ù· ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· (ȉÈÔ·ı‹˜ Ó·ÓÈ΋ ·ÚıÚ›Ùȉ·, Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, Î.¿), ÔÈ ıËÛ·˘ÚÈÛÌÒÛÂȘ (Û˘Óԉ‡ÔÓÙ·È Û¯Â‰fiÓ ¿ÓÙÔÙ ·fi Ë·ÙÔÛÏËÓÈ΋ ‰ÈfiÁΈÛË) Î·È Û¿ÓÈ· Ë Û·ÚÎÔ›‰ˆÛË (23). ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÙÚ·¯ËÏÈ΋˜ ‰ÈfiÁΈÛ˘ Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ÌË ÏÂÌÊ·‰ÂÓÈΤ˜ Ì¿˙˜ (24): ∫‡ÛÙË ı˘ÚÂÔÁψÛÛÈÎÔ‡ fiÚÔ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· Û˘ÁÁÂÓ‹ ‰È·Ì·ÚÙ›· ÛÙË Ì¤ÛË ÁÚ·ÌÌ‹ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ ÌÂٷ͇ ˘ÔÂȉԇ˜ ÔÛÙÔ‡ Î·È ÛÙ¤ÚÓÔ˘. ŸÙ·Ó ÊÏÂÁÌ·›ÓÂÈ ‰ÈÔÁÎÒÓÂÙ·È, ÌÂÙ·ÎÈÓÂ›Ù·È Ì ÙȘ ηٷÔÙÈΤ˜ ÎÈÓ‹ÛÂȘ ‹ ÙËÓ ¤ÍÔ‰Ô Ù˘ ÁÏÒÛÛ·˜. µÚ·Á¯È·Î‹ ·ÛÙË. µÚ›ÛÎÂÙ·È ÛÙÔ ¿Óˆ fiÚÈÔ ÙÔ˘ ÛÙÂÚÓÔÎÏÂȉÔÌ·ÛÙÔÂȉԇ˜, fiÙ·Ó ÊÏÂÁÌ·›ÓÂÈ ÂÌÊ·Ó›˙ÂÙ·È Û·Ó Ì¿˙· ‰È·Ì¤ÙÚÔ˘ 3-5 cm. ∫˘ÛÙÈÎfi ‡Áڈ̷. ∂ÓÙÔ›˙ÂÙ·È ÛÙÔ ÙÚ›ÁˆÓÔ ¿Óˆ ·fi ÙËÓ ÎÏ›‰·, Â›Ó·È ‰È¿Ê·ÓÔ Î·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ˘¿Ú¯ÂÈ ·fi ÙË Á¤ÓÓËÛË. ¶·È‰È·ÙÚÈ΋ 2008;71:390-398

Pediatri Sept-Oct 08

14-10-08

13:26

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396

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µ·ÙÚ¿¯ÈÔ. ∂ÌÊ·Ó›˙ÂÙ·È ÛÙÔ ¤‰·ÊÔ˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ÌÂÙ¿ ·fi ·fiÊÚ·ÍË ÙÔ˘ fiÚÔ˘ ÙˆÓ ˘ÔÁÏÒÛÛÈˆÓ ·‰¤ÓˆÓ. ∞È̿و̷ ÛÙÂÚÓÔÎÏÂȉÔÌ·ÛÙÔÂȉԇ˜ Ì˘fi˜. æËÏ·ÊÂ›Ù·È ˆ˜ Ì¿˙· ·Î›ÓËÙË ÌÂÙ¿ ÙË ‰Â‡ÙÂÚË Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜, ÂÓÒ ÂÍ·Ê·Ó›˙ÂÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÚÒÙÔ˘ ¤ÙÔ˘˜. ÀÂÚ¿ÚÈıÌË ÏÂ˘Ú¿. ™˘Ó‹ıˆ˜ Â›Ó·È ÛÎÏËÚ‹ ÛÙËÓ „ËÏ¿ÊËÛË Î·È ‰È·ÁÈÁÓÒÛÎÂÙ·È ·ÎÙÈÓÔÏÔÁÈο. ¶·ÚˆÙ›Ùȉ·. ªÂÚÈΤ˜ ÊÔÚ¤˜ Ú¤ÂÈ Ó· ‰È·ÊÔÚԉȷÁÓˆÛı›, ΢ڛˆ˜ fiÙ·Ó ˘ÔÙÚÔÈ¿˙ÂÈ ÂÙÂÚfiÏ¢ڷ. §ÂÌÊ·ÁÁ›ˆÌ·-∞ÈÌ·ÁÁ›ˆÌ·. ∞Ó¢ڛÛÎÔÓÙ·È ·fi ÙËÓ ÚÒÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Ì ̷Ϸ΋, ¢›ÂÛÙË Î·È ·ÓÒ‰˘ÓË ÙÚ·¯ËÏÈ΋ ‰ÈfiÁΈÛË. ª·Û¯·ÏÈ·›ÔÈ ÏÂÌÊ·‰¤Ó˜. ¢¤¯ÔÓÙ·È ÙË Ï¤ÌÊÔ ·fi Ù· ¿Óˆ ¿ÎÚ·, ÙÔ ıˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ·, ÙÔ ¿Óˆ Ï¿ÁÈÔ ÎÔÈÏÈ¿˜ Î·È Ì¤ÚÔ˜ ÙˆÓ Ì·ÛÙÒÓ. ¢ÈÔÁÎÒÓÔÓÙ·È, Û˘Ó‹ıˆ˜, Û ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ¿Óˆ ¿ÎÚˆÓ Î·È Ù˘ Ì·Û¯¿Ï˘, Û ÓfiÛÔ ·fi ·Ì˘¯‹ Á¿Ù·˜, Û ÂÌ‚ÔÏÈ·ÛÌfi Ì BCG Î·È ÛÙ· Ï·›ÛÈ· ηÎÔ‹ıÂÈ·˜ (25). µÔ˘‚ˆÓÈÎÔ› ÏÂÌÊ·‰¤Ó˜. ¢¤¯ÔÓÙ·È ÙË Ï¤ÌÊÔ ·fi ÙÔ fiÛ¯ÂÔ, ÙÔÓ ‚ÏÂÓÓÔÁfiÓÔ ·È‰Ô›Ô˘, ÙÔÓ ÎfiÏÔ, ÙÔ ‰¤ÚÌ· οو ÙÌ‹Ì·ÙÔ˜ Ù˘ ÎÔÈÏÈ¿˜, ÙÔ ÂÚ›ÓÂÔ, ÙÔ˘˜ ÁÏÔ˘ÙÔ‡˜ Î·È ÙÌ‹Ì· ÙÔ˘ ηÙÈfiÓÙÔ˜ ÎfiÏÔ˘ Î·È ÙÔÓ ÚˆÎÙfi. ¢ÈÔÁÎÒÓÔÓÙ·È Û ÊÏÂÁÌÔÓ¤˜ οو ¿ÎÚˆÓ, ‚Ô˘‚ˆÓÈ΋˜ ¯ÒÚ·˜, ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, Û ÓfiÛÔ ·fi ·Ì˘¯‹ Á¿Ù·˜, Û ·ÊÚÔ‰›ÛÈ· ÓÔÛ‹Ì·Ù· (.¯. ·ÊÚÔ‰›ÛÈÔ ÏÂÌÊÔÎÔÎΛˆÌ·), ÛÂ Ê˘Ì·Ù›ˆÛË Î·È Û ÙÚÔÈο ÓÔÛ‹Ì·Ù· (.¯. ÊÈÏ·Ú›·ÛË). ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ‚Ô˘‚ˆÓÔ΋ÏË, Ï›ˆÌ·, ·Ó‡ڢÛÌ· ‹ ¤ÎÙÔÔ fiÚ¯È (4,26). §ÂÌÊ·‰¤Ó˜ ÌÂÛÔıˆÚ·Î›Ô˘. ∫ÏÈÓÈο, ÔÈ ‰ÈÔÁΈ̤ÓÔÈ ÏÂÌÊ·‰¤Ó˜ ÌÂÛÔıˆÚ·Î›Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó Û˘ÌÙÒÌ·Ù· ·fi ›ÂÛË, fiˆ˜ ‚‹¯·, Û˘ÚÈÁÌfi, ‰˘ÛÊ·Á›·, Û‡Ó‰ÚÔÌÔ ¿Óˆ ÎÔ›Ï˘. ∫˘ÚÈfiÙÂÚ· ·›ÙÈ· Â›Ó·È Ë Ê˘Ì·Ù›ˆÛË (ÂÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË), Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, Ë Û·ÚÎÔ›‰ˆÛË (Û¿ÓÈ· ÛÙ· ·È‰È¿ ·ÌÊÔÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË Ì ·ÔÙÈÙ·ÓÒÛÂȘ), Ë ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË Î·È ÔÈ Î·ÎÔ‹ıÂȘ, ÂÓÒ ¿ÏÏ· ·›ÙÈ· Â›Ó·È Û¿ÓÈ· (.¯. ÈÛÙÔÏ¿Û̈ÛË). ∆Ô ‚ÚÔÁ¯ÈÎfi ηÚΛӈ̷ Â›Ó·È Û·ÓÈfiÙ·ÙÔ ÛÙ· ·È‰È¿. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ı‡ÌÔ˘ ·‰¤Ó· (̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ), ÙÔ Á·ÁÁÏÈÔÓ‡ڈ̷, ÙÔÓ ¤ÎÙÔÔ ı˘ÚÂÔÂȉ‹ (ÔÈÛıÔÛÙÂÚÓÈο), Ù· ÙÂÚ·ÙÒÌ·Ù· ‹ ÙËÓ Î·Ù·‰˘fiÌÂÓË ‚ÚÔÁ¯Ô΋ÏË (27). ∂Ó‰ÔÎÔÈÏÈ·ÎÔ› Î·È ÔÈÛıÔÂÚÈÙÔÓ·˚ÎÔ› ÏÂÌÊ·‰¤Ó˜. ¢¤¯ÔÓÙ·È Ï¤ÌÊÔ ·fi Ù· ÂÓ‰ÔÎÔÈÏȷο fiÚÁ·Ó· Î·È Ù· οو ¿ÎÚ·. ∏ ‰ÈfiÁΈۋ ÙÔ˘˜ ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ ÙÔÈο Û˘ÌÙÒÌ·Ù· (fiÓÔ, ‰˘ÛÎÔÈÏÈfiÙËÙ·, ·ÈÌ·ÙÔ˘Ú›·, ›ÎÙÂÚÔ, ·fiÊÚ·ÍË Î.Ï.). ™Â ÂÚÈÙÒÛÂȘ ÁÂÓÈÎÂ˘Ì¤Ó˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜, ÌÔÚ› Ó· ‰ÈÔÁΈıÔ‡Ó Î·È ·˘ÙÔ› Ì ·Ó¿ÏÔÁË Û˘Ìو̷ÙÔÏÔÁ›·. ™˘¯Ó‹ Â›Ó·È Ë ‰ÈfiÁΈۋ ÙÔ˘˜ Û Ïԛ̈ÍË ÙÔ˘ Paediatriki 2008;71:390-398

·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÌÂ Û˘ÓÔ‰fi ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ (ÔÍ›· ÌÂÛÂÓÙ¤ÚÈÔ˜ ÏÂÌÊ·‰ÂÓ›Ùȉ·). ∞›ÙÈ· ÙÔÈ΋˜ ‰ÈfiÁΈÛ˘ Â›Ó·È ÊÏÂÁÌÔÓ¤˜ ÙˆÓ ÂÓ‰ÔÎÔÈÏÈ·ÎÒÓ ÔÚÁ¿ÓˆÓ (.¯. ÛΈÏËÎÔÂȉ›Ùȉ·) ‹ ηÎÔ‹ıÂȘ. ∞Ó¿ÏÔÁ· Ì ÙËÓ ÂÚÈÔ¯‹ Ô˘ ˙ÂÈ ‹ ¤¯ÂÈ Ù·Íȉ¤„ÂÈ ÙÔ ·È‰› (΢ڛˆ˜ ¯ÒÚ˜ ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÎfiÛÌÔ˘), Ë Ê˘Ì·Ù›ˆÛË Â›Ó·È Û¿ÓÈÔ ·›ÙÈÔ Î·È ‰˘Ó·ÙfiÓ Ó· ˘Ô‰‡ÂÙ·È Î·È ÎÔÈÏȷ΋ Ì¿˙· (28). ∂. K·Ù¿Ù·ÍË ÏÂÌÊ·‰ÂÓÔ·ıÂÈÒÓ ¯ÚÔÓÔÏÔÁÈο ¢È·ÁÓˆÛÙÈÎfi ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ¯ÚÔÓÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË ·fi ÙËÓ Ë̤ڷ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ (29). √Í›· ÊÏÂÁÌÔÓ҉˘ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ™˘Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ·È‰› Ì ˘ÚÂÙfi Î·È ÂÙÂÚfiÏ¢ÚÔ ÏÂÌÊ·‰¤Ó· (‹ ÏÂÌÊ·‰¤Ó˜) ‰ÈÔÁΈ̤ÓÔ ·fi Ï›Á˜ ̤Ú˜, Ì ٿÛË Î·È ›Ûˆ˜ ÎÏ˘‰·ÛÌfi Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ÂÚÂıÈṲ̂ÓÔ ÙÔ ˘ÂÚΛÌÂÓÔ ‰¤ÚÌ·. ∆· ÈÔ Û˘ÓËıÈṲ̂ӷ ‚·ÎÙ‹ÚÈ· Â›Ó·È Ô ¯Ú˘Û›˙ˆÓ ÛÙ·Ê˘ÏfiÎÎÔÎÔ˜ Î·È Ô ∞ ·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜ (ÛÙ· ÓÂÔÁÓ¿ Î·È ÌÈÎÚ¿ ‚Ú¤ÊË µ ·ÈÌÔÏ˘ÙÈÎfi˜ ÛÙÚÂÙfiÎÔÎÎÔ˜). ÕÏÏ· ·›ÙÈ· Â›Ó·È Ù· ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È· (Û ·È‰È¿ ̤¯ÚÈ 4 ÂÙÒÓ), ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ (Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘) Î·È Û·ÓÈfiÙÂÚ· ¿ÏÏ· ·›ÙÈ· (ÙÔ˘Ï·Ú·ÈÌ›· Î.Ï.). √Í›· ·ÓÙȉڷÛÙÈ΋ ÏÂÌÊ·‰ÂÓ›Ùȉ·. ™˘ÓËıÈṲ̂ÓË Û ÏÔÈÌÒÍÂȘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‹ ÊÏÂÁÌÔÓ¤˜ Ù˘ ÎÂÊ·Ï‹˜ Î·È ÙÔ˘ ÙÚ·¯‹ÏÔ˘. √È ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ·fi ÈÓÊÏÔ˘¤ÓÙÛ· Î·È ·‰ÂÓÔ˚Ô‡˜ ÚÔηÏÔ‡Ó ·ÌÊÔÙÂÚfiÏ¢ÚË ÙÚ·¯ËÏÈ΋ ‰ÈfiÁΈÛË, ÂÓÒ ·fi ∂µV, CMV ‰˘Ó·ÙfiÓ Ó· Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓ›Ùȉ·. ÃÚfiÓÈ· ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ªÂ ÂÈÎfiÓ· ¯ÚfiÓÈ·˜ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÂÌÊ·Ó›˙ÔÓÙ·È ÎÔÎÎȈ̷ÙÒ‰ÂȘ ÓfiÛÔÈ (ÓfiÛÔ˜ ·fi ·Ì˘¯‹ Á¿Ù·˜, ¿Ù˘· Ì˘ÎÔ‚·ÎÙËÚ›‰È·, Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ê˘Ì·Ù›ˆÛ˘, Û·ÚÎÔ›‰ˆÛË), ÓÂÔϷۛ˜ (ϤÌʈ̷, Ï¢¯·ÈÌ›·, ÈÛÙÈÔ΢ÙÙ¿ÚˆÛË, Ó¢ÚÔ‚Ï¿Ûو̷, Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷), ÏÔÈÌÒÍÂȘ (EBV, CMV, HIV, ÙÔÍÔÏ¿Û̈ÛË, ÙÔ˘Ï·Ú·ÈÌ›·, ˘ÂÚÛ›ÓÈ·, ÈÛÙÈÔÏ¿Û̈ÛË, ÎÔÎÎȉÈÔ̇ΈÛË) Î·È ‰È¿ÊÔÚ· ¿ÏÏ· (·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·, ıËÛ·˘ÚÈÛÌÒÛÂȘ, ÓfiÛÔ˜ Kikuchi, ÂÌ‚ÔÏÈ·ÛÌfi˜, Ê¿Ú̷η). ™∆. µÈÔ„›· ÏÂÌÊ·‰¤Ó· ∏ ‚ÈÔ„›· Â›Ó·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ··Ú·›ÙËÙË ÁÈ· ÙËÓ ÙÂÏÈ΋ ‰È¿ÁÓˆÛË (30,31). ∏ ÂÈÏÔÁ‹ ÙÔ˘ ÚÔ˜ ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· ÂÍ·ÚÙ¿Ù·È ·fi ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ (¯ÂÈÚÔ˘ÚÁÈÎÔ‡˜, ·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎÔ‡˜ Î.Ï.) Î·È Û˘Ó‹ıˆ˜ ÂÈϤÁÂÙ·È ·˘Ùfi˜ Ô˘ ‰ÈÔÁÎÒıËΠÚfiÛÊ·Ù· Î·È Ô˘ Â›Ó·È ¯ÂÈÚÔ˘ÚÁÈο ÚÔÛÂÏ¿ÛÈÌÔ˜. √È ÂӉ›ÍÂȘ, fiˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙÔÓ ¶›Ó·Î· 4, Â›Ó·È ÔÈ ·ÎfiÏÔ˘ı˜: ̤ÁÂıÔ˜ ·‰¤Ó· >2 cm, ·‰¤Ó·˜ ·˘Í·ÓfiÌÂÓÔ˜ Û ̤ÁÂıÔ˜ >2 ‚‰ÔÌ¿‰Â˜, ÛÙ·ÛÈÌfiÙËÙ·

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·397

397

§ÂÌÊ·‰ÂÓÔ¿ıÂÈ· ÛÙ· ·È‰È¿

¶›Ó·Î·˜ 4. ∂Ӊ›ÍÂȘ ‚ÈÔ„›·˜ ÏÂÌÊ·‰¤Ó· 1. ª¤ÁÂıÔ˜ ·‰¤Ó· >2 cm 2. ∞‰¤Ó·˜ ·˘Í·ÓfiÌÂÓÔ˜ Û ̤ÁÂıÔ˜ >2 ‚‰ÔÌ¿‰Â˜ 3. ™Ù·ÛÈÌfiÙËÙ· ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿ ·fi 4-6 ‚‰ÔÌ¿‰Â˜ 4. ªË ·ÓÙ·fiÎÚÈÛË Û ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÌÂÙ¿ ·fi 2 ‚‰ÔÌ¿‰Â˜ 5. ªË Â¿ÓÔ‰Ô˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜ ÌÂÙ¿ ·fi 8-12 ‚‰ÔÌ¿‰Â˜ 6. ∞Ô˘Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ 7. ∞Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ·fi ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ıÒڷη 8. ¶·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη 9. ÀÂÚÎÏ›‰È· ÂÓÙfiÈÛË 10. ∂ÌÊ¿ÓÈÛË Ó¤ˆÓ ÏÂÌÊ·‰¤ÓˆÓ 11. “∂Ï·ÛÙÈ΋” Û‡ÛÙ·ÛË 12. ™˘Ó‡·ÚÍË Û˘ÛÙËÌ·ÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ (˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔÛÏËÓÈ΋ ‰ÈfiÁΈÛË) 13. ∞ÍÈÔÏfiÁËÛË ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Â˘ÚËÌ¿ÙˆÓ

ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿ 4-6 ‚‰ÔÌ¿‰Â˜, ÌË ˘Ô¯ÒÚËÛË ÌÂÙ¿ 8-12 ‚‰ÔÌ¿‰Â˜, ÌË ·ÓÙ·fiÎÚÈÛË Û ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÌÂÙ¿ 2 ‚‰ÔÌ¿‰Â˜, ·Ô˘Û›· Û˘ÛÙËÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ, ·Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ·fi ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ıÒڷη, ·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ˘ÂÚÎÏ›‰ÈÔ˜ ÂÓÙfiÈÛË, “ÂÏ·ÛÙÈ΋” Û‡ÛÙ·ÛË, Û˘Ó‡·ÚÍË Û˘ÛÙËÌ·ÙÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ (˘ÚÂÙfi˜, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ·ÚıÚ·ÏÁ›Â˜, Ë·ÙÔÛÏËÓÈ΋ ‰ÈfiÁΈÛË), ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ·‰¤ÓˆÓ. ™Â οı ÂÚ›ÙˆÛË, Á›ÓÂÙ·È ·ÍÈÔÏfiÁËÛË Ì›·˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ÂӉ›ÍˆÓ.

™˘Ì¤Ú·ÛÌ· ∏ ‰ÈfiÁΈÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙ· ·È‰È¿ Â›Ó·È Ôχ Û˘ÓËıÈṲ̂ÓË Î·È Î·Ù¿ ηÓfiÓ· ÔÊ›ÏÂÙ·È Û ÈÔÁÂÓ‹ ‹ ÌÈÎÚԂȷο ·›ÙÈ·. ∏ Ï‹„Ë ÛˆÛÙÔ‡ ÈÛÙÔÚÈÎÔ‡, Ë ÚÔÛÂÎÙÈ΋ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È Ë ÔÚıÔÏÔÁÈ΋ ¯Ú‹ÛË ÙˆÓ ·Ú·ÎÏÈÓÈÎÒÓ ÂÍÂÙ¿ÛˆÓ, fiˆ˜ Â›Ó·È Ô ·ÈÌ·ÙÔÏÔÁÈÎfi˜, ÔÚÔÏÔÁÈÎfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ‚ÈÔ„›·, ‚ÔËıÔ‡Ó ÛÙÔÓ ÂÓÙÔÈÛÌfi Î·È ÙËÓ fiÛÔ ‰˘Ó·ÙfiÓ Ù·¯‡ÙÂÚË ‰È¿ÁÓˆÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ™ÙÔȯ›· Ô˘ Ú¤ÂÈ Ó· ÚÔ‚ÏËÌ·Ù›ÛÔ˘Ó ÙÔÓ ·È‰›·ÙÚÔ Â›Ó·È: ·) ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÈÔÁÂÓ‹ ÂÈÎfiÓ·, ‚) ÂÙÂÚfiÏ¢ÚË ÂÛÙȷ΋ ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ· Ô˘ ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ÙÔÈο Â˘Ú‹Ì·Ù· ÊÏÂÁÌÔÓ‹˜ Ô˘ ¤¯ÂÈ ÙËÓ Ù¿ÛË Ó· ¯ÚÔÓ›ÛÂÈ, ȉȷ›ÙÂÚ· Û ·È‰È¿ Û¯ÔÏÈ΋˜ Î·È ÂÊË‚È΋˜ ËÏÈΛ·˜ Î·È Á) ˘ÂÚÎÏ›‰È· ÂÓÙfiÈÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Bamji M, Stone RK, Kaul A, Usmani G, Schachter FF, Wasserman E. Palpable lymph nodes in healthy newborns and infants. Pediatrics 1986;78:573-575.

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¡. ÷ÏÈ¿ÛÔ˜ Î·È Û˘Ó.

27. Grossman M, Shiramizu B. Evaluation of lymphadenopathy in children. Curr Opin Pediatr 1994;6:68-76.

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31. ∞Ó·ÁÓÒÛÙÔ˘-∫ÂÚ·Ì›‰· ∞, ∞ÓÙˆÓfiÔ˘ÏÔ˜ ª, ™Â˚Ù·Ó›‰Ë˜ µ, ÷˜ ™Ù. §ÂÌÊ·‰ÂÓÔ¿ıÂȘ Û ÂÓËÏ›ÎÔ˘˜ Î·È ·È‰È¿. π·ÙÚÈΤ˜ ∂ΉfiÛÂȘ “∑‹Ù·” 1996;136-137.

Quiz 1. ªÈÎÚfi ‚Ú¤ÊÔ˜ 40 ËÌÂÚÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ·fi ‚‰ÔÌ¿‰Ô˜ Î·È ˘ÚÂÙfi. ¶Èı·ÓfiÙÂÚÔ ·›ÙÈÔ, Ïԛ̈ÍË ·fi: ∞. Ó¢ÌÔÓÈfiÎÔÎÎÔ µ. ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ µ °. ·Ó·ÂÚfi‚È· ¢. EBV ∂. ÏÈÛÙ¤ÚÈ· 2. ªÈÎÚfi ‚Ú¤ÊÔ˜ 3 ÌËÓÒÓ ÚÔÛÎÔÌ›˙ÂÙ·È Ì ‰ÈfiÁΈÛË ÌÂÁ¤ıÔ˘˜ ÌÈÎÚÔ‡ Ì·ÓÙ·ÚÈÓÈÔ‡, Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙË ‰ÂÍÈ¿ ÙÚ·¯ËÏÈ΋ ¯ÒÚ·, Â›Ó·È Ì·Ï·Î‹ Î·È ÔÌÔÈfiÌÔÚÊ· ¢›ÂÛÙË, ¯ˆÚ›˜ ˘ÚÂÙfi ‹ ÙÔÈο ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ·. ∏ ÌËÙ¤Ú· ·Ú·Ù‹ÚËÛ ÙË ‰ÈfiÁΈÛË Ï›Á˜ Ë̤Ú˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: ∞. Ïԛ̈ÍË ·fi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ µ µ. Ïԛ̈ÍË ·fi EBV °. ‚Ú·Á¯È·Î‹ ·ÛÙË ¢. Ó¢ÚÔ‚Ï¿Ûو̷ ∂. ÏÂÌÊ·ÁÁ›ˆÌ· 3. ∫ÔÚ›ÙÛÈ 12 ÂÙÒÓ ÚÔÛ¤Ú¯ÂÙ·È Ì ˘Ú¤ÙÈÔ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ÚÔÛÎÔÌ›˙ÂÈ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Ì ÂÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ÌÂÛÔıˆÚ·Î›Ô˘. ¶ÚÒÙ˜ ‰È·ÁÓˆÛÙÈΤ˜ ÛΤ„ÂȘ: ∞. ‚ÚÔÁ¯ÈÎfi ηÚΛӈ̷ µ. Ê˘Ì·Ù›ˆÛË °. Û·ÚÎÔ›‰ˆÛË ¢. ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜ ∂. ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË 4. ∞ÁfiÚÈ 4 ÂÙÒÓ ·fi ·ÁÚÔÙÈ΋ ÂÚÈÔ¯‹ ÚÔÛÎÔÌ›˙ÂÙ·È Ì ˘ÚÂÙfi ·fi 10Ë̤ÚÔ˘ Î·È ‹È· ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ™ÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒÓÂÙ·È ˘„ËÏfi˜ ·ÚÈıÌfi˜ ˈÛÈÓÔÊ›ÏˆÓ (25.000/mm3). ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: ∞. Ïԛ̈ÍË ·fi EBV µ. Ïԛ̈ÍË ·fi ÙÔÍfiηڷ °. ÏÂ˚ÛÌ·Ó›·ÛË ¢. Ïԛ̈ÍË ·fi ¯ÈÓfiÎÔÎÎÔ ∂. ÓfiÛÔ˜ Kawasaki 5. ∂Ӊ›ÍÂȘ ÁÈ· ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· ·ÔÙÂÏÔ‡Ó ÔÈ ·Ú·Î¿Ùˆ: ∞. ̤ÁÂıÔ˜ ·‰¤Ó· >2 cm µ. ÛÙ·ÛÈÌfiÙËÙ· ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿ ·fi 4-6 ‚‰ÔÌ¿‰Â˜ °. ÌË ·ÓÙ·fiÎÚÈÛË Û ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÌÂÙ¿ ·fi 2 ‚‰ÔÌ¿‰Â˜ ¢. ÎÏ˘‰·ÛÌfi˜ ÛÙËÓ „ËÏ¿ÊËÛË ∂. ·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ™∆. ˘ÂÚÎÏ›‰È· ÂÓÙfiÈÛË

√È ÛˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÛÙË ÛÂÏ. 416 Paediatriki 2008;71:390-398

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CASE REPORT

399

£ÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Û ·È‰› Ì ‚ÚԢΤÏψÛË: ·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡ Î·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ∞. ª·ÓÒÏ·1, ∞. ª¿Î˘1, Ã. ∆Û·Ô‡ÛË2, ¡. ÷ÏÈ¿ÛÔ˜1, ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘1 ¶ÂÚ›ÏË„Ë: ∏ ‚ÚԢΤÏψÛË Â›Ó·È ÌÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ˙ˆÔ·ÓıÚˆÔÓfiÛÔ˜, Ô˘ ÂÓ‰ËÌ› Û ÔÚÈṲ̂Ó˜ ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜. ™Ù· ·È‰È¿ ÂΉËÏÒÓÂÙ·È Ì ·‚Ï˯ڿ Û˘ÌÙÒÌ·Ù·, fiˆ˜ ˘ÚÂÙfi˜, ηÎÔ˘¯›·, ·ÓÔÚÂÍ›·, ·ÚıÚ·ÏÁ›Â˜, Ì˘·ÏÁ›Â˜, ÛÏËÓÔÌÂÁ·Ï›· Î·È ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ∫·Ù¿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ ·Ó·Ê¤ÚÔÓÙ·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ·Ó·ÈÌ›·, ·ÈÌfiÏ˘ÛË, Ï¢ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· ‹ ·Ó΢ÙÙ·ÚÔÂÓ›·. ∏ ıÚÔÌ‚ÔÂÓ›· Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·, ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔΤ˜. ™¿ÓÈ·, ̤ۈ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, ÌÔÚ› Ó· ÚÔÎÏËı› ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›·, Ì ÛËÌ·ÓÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂÈÙÒÛÂȘ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË ıÚÔÌ‚ÔÂÓ›· Î·È ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÓfiÛËÛ˘ ·fi Brucella melitensis. ∏ ıÂÚ·›· Ì Á-ÛÊ·ÈÚ›ÓË, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ηٿÏÏËÏË ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙË ‚ÚԢΤÏÏ·, Ô‰‹ÁËÛ Û ÁÚ‹ÁÔÚË ·ÔηٿÛÙ·ÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜.

1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ 2 ∞ÈÌ·ÙÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ AÏÏËÏÔÁÚ·Ê›·: ∞ϤͷӉÚÔ˜ ª¿Î˘ amakis@cc.uoi.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ

§¤ÍÂȘ ÎÏÂȉȿ: £ÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ, ‚ÚԢΤÏψÛË.

Thrombocytopenic purpura in a child with brucellosis: case report and literature review ∞. ªanola1, ∞. ªakis1, C. ∆saousi2, ¡. Chaliasos1, ∞. Siamopoulou-Mavridou1 Abstract: Brucellosis is still endemic and continues to be a significant public health problem in many parts of Greece. It is a multisystemic disease with a broad spectrum of clinical manifestations, including haematological disorders, such as anaemia, pancytopenia, leucopenia and thrombocytopenia. Thrombocytopenia is usually moderate and attributed to bone marrow suppression or hypersplenism. Rarely, autoimmune stimulation can cause severe thrombocytopenia with clinically significant haemorrhagic manifestations. The case is presented of a girl with severe thrombocytopenic purpura as one of the presenting symptoms of Brucella melitensis infection. Treatment with intravenous immunoglobulin and the appropriate antimicrobial agents promptly resulted in the platelet counts returning to normal.

1 Department of Paediatrics, University Hospital of Ioannina 2 Haematology Laboratory, University Hospital of Ioannina Correspondence: Alexandros Makis amakis@cc.uoi.gr Department of Paediatrics, University Hospital of Ioannina

Key words: Thrombocytopenic purpura, brucellosis.

∂ÈÛ·ÁˆÁ‹ ∏ ‚ÚԢΤÏψÛË Â›Ó·È ÌÈ· ˙ˆÔ·ÓıÚˆÔÓfiÛÔ˜ Ô˘ ÂÓ‰ËÌ› ÛÙË µÔÚÂÈÔ‰˘ÙÈ΋ ∂ÏÏ¿‰· (1) Î·È ÔÊ›ÏÂÙ·È Û Gram ·ÚÓËÙÈο ‚·ÎÙËÚ›‰È· ÙÔ˘ Á¤ÓÔ˘˜ Brucellae. ∏ Brucella melitensis ÚÔηÏ› ÙËÓ ÈÔ ÛËÌ·ÓÙÈ΋ ÓfiÛËÛË ÛÙÔÓ ¿ÓıÚˆÔ (2,3). ™ÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi, Ë Ïԛ̈ÍË ÚÔηÏÂ›Ù·È ·fi ¿ÌÂÛË Â·Ê‹ Ì ٷ ÌÔÏ˘Ṳ̂ӷ ˙Ò· Î·È Ù· ˘ÁÚ¿ ÙÔ˘˜ Î·È ·fi ηٷӿψÛË ÌË ·ÛÙÂÚȈ̤ÓÔ˘ Á¿Ï·ÎÙÔ˜ ‹ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ (4). ∫·Ù¿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ ·Ó·Ê¤ÚÔÓÙ·È ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ·Ó·ÈÌ›·, ·ÈÌfiÏ˘ÛË, Ï¢ÎÔÂÓ›·, ıÚÔÌ‚ÔÂÓ›· ‹ ·Ó΢ÙÙ·ÚÔÂÓ›· (5). √È Î˘ÚÈfiÙÂÚÔÈ Ì˯·ÓÈÛÌÔ› ÚfiÎÏËÛ˘ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ Â›Ó·È Ë ¿ÌÂÛË ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, Ô ˘ÂÚÛÏËÓÈÛÌfi˜, Ë ·ÈÌÔÊ·ÁÔ΢ÙÙ¿ÚˆÛË Î·È Ë ÂÓÂÚÁÔÔ›ËÛË ·ÓÔ-

ÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ Ì ‰ËÌÈÔ˘ÚÁ›· ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ (1,6-11). ∏ ıÚÔÌ‚ÔÂÓ›· Ô˘ ‰È·ÈÛÙÒÓÂÙ·È ÛÙË ‚ÚԢΤÏψÛË Â›Ó·È Û˘Ó‹ıˆ˜ ‹È·, ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÈÏÔΤ˜ (1,5,6). ™¿ÓÈ·, ̤ۈ ·ÓÔÛÔÏÔÁÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, ÌÔÚ› Ó· ÚÔÎÏËı› ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· Ì ÛËÌ·ÓÙÈΤ˜ ÎÏÈÓÈΤ˜ ÂÈÙÒÛÂȘ. ∞ӷʤÚÂÙ·È fiÙÈ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ˆ˜ ÚÒÙË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘, ÌÂ Û˘Ó¤ÂÈ· Ë ·Ú¯È΋ ‰È¿ÁÓˆÛË Ó· Â›Ó·È Ë È‰ÈÔ·ı‹˜ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ (12). À¿Ú¯ÂÈ ÏËıÒÚ· ¿ÚıÚˆÓ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË ıÚÔÌ‚ÔÂÓ›·˜ ηٿ ÙËÓ ÂͤÏÈÍË Ù˘ ‚ÚԢΤÏψÛ˘ Û ÂÓ‹ÏÈΘ. ∞ÓÙ›ıÂÙ·, Ï›Á˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ·È‰È¿. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÎÔÚ›ÙÛÈ 5,5 ¯ÚÔÓÒÓ Ì ÂÎÛÂÛËÌ·Ṳ̂ÓË ıÚÔÌ‚ÔÂÓ›· ηٿ ÙË ÓfiÛËÛË ·fi ‚ÚԢΤÏÏ·. ¶·È‰È·ÙÚÈ΋ 2008;71:399-402

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·400

400

∞. ª·ÓÒÏ· Î·È Û˘Ó.

¶›Ó·Î·˜ 1. ∞ÈÌ·ÙÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ Î·Ù¿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘

§Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·, /mm3 ∞ÈÌ·ÙÔÎÚ›Ù˘, % ∞ÈÌÔÛÊ·ÈÚ›ÓË, g/dl ∞ÈÌÔÂÙ¿ÏÈ·, /mm3

3 Ë̤Ú˜ ÚÈÓ ÙËÓ ÂÈÛ·ÁˆÁ‹

∏̤ڷ ÂÈÛ·ÁˆÁ‹˜

3Ë Ë̤ڷ

10Ë Ë̤ڷ

6Ë Â‚‰ÔÌ¿‰·

10.800 36,8 12,5 3.000

7.510 33,3 11,4 1.000

15.790 37,6 12,6 218.000

7.210 36,6 12,1 503.000

9.950 38,8 12,9 315.000

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ 5,5 ÂÙÒÓ ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈÛ ˘ÚÂÙfi ¤ˆ˜ 38,5ÔC, ‰È¿ÚÎÂÈ·˜ ¤ÍÈ ËÌÂÚÒÓ, ΢ڛˆ˜ ÙȘ ·ÔÁÂ˘Ì·ÙÈÓ¤˜ ÒÚ˜. ø˜ Û˘ÓÔ‰fi Û‡Ìو̷ ·Ó·Ê¤ÚıËΠ¿ÏÁÔ˜ ÛÙË ‰ÂÍÈ¿ ˯ÂÔηÚÈ΋ ¿ÚıÚˆÛË Î·È ÛÙËÓ ¿ÚıÚˆÛË ÙÔ˘ ‰ÂÍÈÔ‡ ·ÁÎÒÓ·. ∏ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘ ÎÔÚÈÙÛÈÔ‡ ‰È·Ì¤ÓÂÈ ÛÙË £ÂÛÚˆÙ›· Î·È ·Û¯ÔÏÂ›Ù·È Ì ÙËÓ ÎÙËÓÔÙÚÔÊ›·. ∞ӷʤÚıËΠfiÙÈ ÙÔ ·È‰› ›¯Â ηٷӷÏÒÛÂÈ Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· Ô˘ ›¯·Ó ·Ú·Û΢·ÛÙ› ÚfiÛÊ·Ù· ·fi ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∆ÚÂȘ ̤Ú˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÂÍÂÙ¿ÛÙËΠ۠¿ÏÏÔ ÓÔÛÔÎÔÌ›Ô, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆıÔ‡Ó ·ÍÈfiÏÔÁ· Â˘Ú‹Ì·Ù· ·fi ÙȘ ·ÚıÚÒÛÂȘ ‹ ·fi Ù· ¿ÏÏ· Û˘ÛÙ‹Ì·Ù·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 7.200/mm3, ·ÈÌÔÂÙ¿ÏÈ· 180.000/mm3, ·ÈÌ·ÙÔÎÚ›Ù˘ 40%, ·ÈÌÔÛÊ·ÈÚ›ÓË 13,1 g/dl, ∆∫∂ 19 mm (1Ë ÒÚ·), CRP 10 mg/L, Monotest ·ÚÓËÙÈÎfi, AST 62 U/L, ‰ÔÎÈÌ·Û›· Û˘ÁÎfiÏÏËÛ˘ Wright ıÂÙÈ΋ (Ù›ÙÏÔ˜ 1/1280), Rose Bengal ·ÚÓËÙÈ΋. ªÂ ‚¿ÛË Ù· Û˘ÌÙÒÌ·Ù· Î·È ÙË ıÂÙÈ΋ Wright, ¤ÁÈÓ ¤Ó·ÚÍË ıÂÚ·›·˜ ÁÈ· ‚ÚԢΤÏψÛË. ÃÔÚËÁ‹ıËΠÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË (10 mg/kg/Ë̤ڷ) Î·È ÚÈÊ·ÌÈΛÓË (15 mg/kg/Ë̤ڷ) ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜. ∆ËÓ ÙÚ›ÙË Ë̤ڷ ·ÁˆÁ‹˜ ÂÌÊ·Ó›ÛÙËΠÁÂÓÈÎÂ˘Ì¤ÓÔ ÂÙ¯ÂÈ҉˜ ÂÍ¿ÓıËÌ· Î·È ‰È·ÈÛÙÒıËΠÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· 3.000/mm3, ÔfiÙ ÙÔ ·È‰› ·Ú·¤ÌÊıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ‰È·ÈÛÙÒıËΠıÂÚÌÔÎÚ·Û›· 38,8ÔC, ÁÂÓÈÎÂ˘Ì¤ÓÔ ÂÙ¯ÂÈ҉˜-ÔÚÊ˘ÚÈÎfi ÂÍ¿ÓıËÌ· Î·È Âί˘ÌÒÛÂȘ, ˘ÁÚ‹ ÔÚʇڷ ÛÙËÓ ˘ÂÚÒ· Î·È ·ÈÌÔÚÚ·Á›· ÛÙ· ԇϷ, ÂÓÒ Ô ÛÏ‹Ó·˜ Î·È ÙÔ ‹·Ú ‹Ù·Ó ÌfiÏȘ „ËÏ·ÊËÙ¿. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙȘ ·ÚıÚÒÛÂȘ, Ô‡Ù ·fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù·. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 7.510/mm3 (Ô˘‰ÂÙÂÚfiÊÈÏ· 45%, ÏÂÌÊÔ·ÙÙ·Ú· 52%, ÌÔÓÔ·ÙÙ·Ú· 3%), ·ÈÌÔÂÙ¿ÏÈ· 1.000/mm3, ·ÈÌÔÛÊ·ÈÚ›ÓË 12 g/dl, ∆∫∂ 15 mm (1Ë ÒÚ·), CRP 7 mg/L, AST 64 U/L, ALT 47 U/L, Á-GT 35 U/L, Ô˘Ú›· 20 mg/dl, ÎÚ·ÙÈÓ›ÓË 0,8 mg/dl, ÔÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË 0,7 mg/dl. ∏ ‰ÔÎÈÌ·Û›· Û˘ÁÎfiÏÏËÛ˘ Wright ‚Ú¤ıËΠıÂÙÈ΋ (Ù›ÙÏÔ˜ 1/1280), fiˆ˜ Â›Û˘ Î·È Ù· ÂȉÈο ·ÓÙÈÛÒÌ·Ù· IgM, IgA ¤Ó·ÓÙÈ Ù˘ Brucella melitensis. ∆· ÂȉÈο IgG ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈο. √È Î·ÏPaediatriki 2008;71:399-402

ÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ‹Ù·Ó ÛÙ›Ú˜. ∏ ¿ÌÂÛË Î·È ¤ÌÌÂÛË Coomb’s ‹Ù·Ó ·ÚÓËÙÈΤ˜. √ ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ IgG, IgM, IgA Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ C3 Î·È C4 ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ‹Ù·Ó ÂÓÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. ∆· ·ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù·, Ù· ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ‰ÈÏ‹˜ ¤ÏÈη˜ ÙÔ˘ DNA Î·È Ô ÚÂ˘Ì·ÙÔÂȉ‹˜ ·Ú¿ÁÔÓÙ·˜ ‹Ù·Ó ·ÚÓËÙÈο. √È ¯ÚfiÓÔÈ ‹Í˘ Î·È ÙÔ ÈÓˆ‰ÔÁfiÓÔ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›, Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο ·ÓÙÈÛÒÌ·Ù· ·ÚÓËÙÈÎfi˜, fiˆ˜ Â›Û˘ Î·È Ô ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜. §fiÁˆ ÙÔ˘ Ôχ ¯·ÌËÏÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ÙˆÓ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂΉËÏÒÛÂˆÓ ·fi ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, ¯ÔÚËÁ‹ıËΠÁ-ÛÊ·ÈÚ›ÓË (2 g/kg Û ‰‡Ô Ë̤Ú˜), Î·È ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Ì ·ÌÈηۛÓË ÂÓ‰ÔÊϤ‚È· (15 mg/kg/Ë̤ڷ ÁÈ· ÂÙ¿ Ë̤Ú˜), ÂÓÒ Û˘Ó¯›ÛÙËÎÂ Ë ÚÈÊ·ÌÈΛÓË ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜. ¢ÈÂÎfiË Ë ¯ÔÚ‹ÁËÛË ÙÚÈÌÂıÔÚ›Ì˘-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏ˘, ‰ÈfiÙÈ Ù¤ıËÎÂ Ë ˘Ô„›· ÚfiÎÏËÛ˘ Ù˘ ıÚÔÌ‚ÔÂÓ›·˜ ·fi ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Ê¿ÚÌ·ÎÔ (13). ¶·Ú·ÙËÚ‹ıËΠÛÙ·‰È·Î‹ ·‡ÍËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ¤ÓÙ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Ô ·ÚÈıÌfi˜ ÙÔ˘˜ ¤ÊÙ·Û ٷ 218.000/mm3. ™ÙË Ê¿ÛË ·˘Ù‹ ¤ÁÈÓ ‰ÔÎÈÌ·ÛÙÈ΋ Â·Ó¤Ó·ÚÍË Ù˘ ÙÚÈÌÂıÔÚ›Ì˘-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏ˘ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜, ¯ˆÚ›˜ Ó· ˘¿ÚÍÂÈ ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ∞ÓÙ›ıÂÙ·, Ë ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Û˘Ó¯›ÛÙËΠ̤¯ÚÈ Î·È Ù· 503.000/mm3. √ ˘ÚÂÙfi˜ ˘Ô¯ÒÚËÛ ÙË ‰Â‡ÙÂÚË Ë̤ڷ ÓÔÛËÏ›·˜, ÂÓÒ ‰ÂÓ ÂÌÊ·Ó›ÛÙËÎ·Ó Ó¤Â˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô, ‰fiıË ·ÁˆÁ‹ Ì ÚÈÊ·ÌÈΛÓË Î·È ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË ÁÈ· Û˘ÓÔÏÈο ¤ÍÈ Â‚‰ÔÌ¿‰Â˜. ∏ ·ÛıÂÓ‹˜ ¤Ï·‚ ÙËÓ ·ÁˆÁ‹ ¯ˆÚ›˜ ÚÔ‚Ï‹Ì·Ù· Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi˜ ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ: 315.000/mm3.

™˘˙‹ÙËÛË ∏ ıÚÔÌ‚ÔÂÓ›· ·ÔÙÂÏ› Ì›· ·fi ÙȘ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ‚ÚԢΤÏψÛ˘ ÛÙ· ·È‰È¿, Û ÔÛÔÛÙfi 5-40%. ™˘Ó‹ıˆ˜, Ë Ïԛ̈ÍË ·fi ‚ÚԢΤÏÏ· ÚÔηÏ›, Ì ÔÈΛÏÔ˘˜ Ì˯·ÓÈÛÌÔ‡˜, ‹È· ıÚÔÌ‚ÔÂÓ›·, ¯ˆÚ›˜ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ·ÈÌfiÛÙ·ÛË. ™·ÓÈfiÙÂÚ·, ·Ó·Ê¤ÚÂÙ·È ÌÂÁ¿ÏË ÙÒÛË

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·401

401

£ÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Û ·È‰› Ì ‚ÚԢΤÏψÛË

ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, ÂӉ¯Ô̤ӈ˜ ̤ۈ ·ÓÔÛÔÏÔÁÈÎÒÓ Ì˯·ÓÈÛÌÒÓ, ÂÈÎfiÓ· Ô˘ ÔÌÔÈ¿˙ÂÈ Ì ÙËÓ ¿ÓÔÛË ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ. ◊‰Ë ·fi ÙÔ 1964 ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ‚ÚԢΤÏψÛË Ô˘ ÂÌÊ¿ÓÈÛ·Ó ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ, Ô˘ ˘Ô¯ÒÚËÛ Ì ÙËÓ ·ÁˆÁ‹ (14). O Crosby Î·È Û˘Ó., ÙÔ 1984, ·Ó¤ÊÂÚ·Ó fiÙÈ Û 38 ·È‰È¿ Ì ‚ÚԢΤÏψÛË, 39,5% ›¯·Ó ıÚÔÌ‚ÔÂÓ›·, ÂÓÒ 26% ÂÌÊ¿ÓÈÛ·Ó ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ ·ÈÌÔÛÙ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ô˘ ·Ô‰fiıËÎ·Ó fi¯È ÌfiÓÔ ÛÙË ıÚÔÌ‚ÔÂÓ›·, ·ÏÏ¿ Î·È ÛÙȘ ¯·ÌËϤ˜ ÙÈ̤˜ ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÛÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ıÚÔÌ‚›Ó˘ (10). ™Â ÌÈ· ÛÂÈÚ¿ 115 ·È‰ÈÒÓ Ì ‚ÚԢΤÏψÛË ÛÙË ™·Ô˘‰È΋ ∞Ú·‚›·, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù¤ÛÛÂÚ· ·fi ·˘Ù¿ ·ÚÔ˘Û›·Û·Ó ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ. ∏ ηٿÏÏËÏË ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Ô‰‹ÁËÛ Û ÎÏÈÓÈ΋ ·ÔηٿÛÙ·ÛË (15). √ Benjamin, ÙÔ 1995, ÂÚȤÁÚ·„ ‰‡Ô ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ˘ÚÂÙfi, ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Î·È ·ÈÌÔÚÚ·Á›Â˜ ·fi ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜, Ô˘ ·ԉ›¯ÙËΠfiÙÈ ¤·Û¯·Ó ·fi ÌÂÏÈÙ·›Ô ˘ÚÂÙfi Î·È ·ÓÙ·ÔÎÚ›ıËÎ·Ó ¿ÌÂÛ· ÛÙËÓ ·ÓÙÈÌÈÎÚԂȷ΋ ıÂÚ·›· (16). ∏ ıÚÔÌ‚ÔÂÓ›· ·Ô‰fiıËΠ۠Èı·Ó‹ ÂÚÈÊÂÚÈ΋ ηٷÛÙÚÔÊ‹, ‰ÈfiÙÈ ‰È·ÈÛÙÒıËÎ·Ó ÌÂÁ¿Ï· ·ÈÌÔÂÙ¿ÏÈ· ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· Î·È ˘ÂÚÏ·Û›· ÙˆÓ ÌÂÁ·Î·Ú˘Ô΢ÙÙ¿ÚˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÂÈÎfiÓ· Ô˘ ÔÌÔÈ¿˙ÂÈ Ì ÙËÓ È‰ÈÔ·ı‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ. ™ÙË ¯ÒÚ· Ì·˜, ÙÔ 1998, ÔÈ ªÂÓ¤ÎÔ˜ Î·È Û˘Ó., ·fi ÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ πˆ·ÓÓ›ÓˆÓ, ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ì ‚ÚԢΤÏψÛË Ô˘ ›¯Â ˆ˜ ÚÒÙË ÂΉ‹ÏˆÛË ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Ì ÂÙ¤¯ÂȘ, ÂÈÛÙ¿ÍÂȘ, ÛÙÔÌ·ÙÈΤ˜ ·ÈÌÔÚÚ·Á›Â˜ Î·È ıÂÙÈο ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο ·ÓÙÈÛÒÌ·Ù·. ∞Ú¯Èο ·ÓÙÈÌÂÙˆ›ÛÙËΠˆ˜ ȉÈÔ·ı‹˜ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Î·È ˘‹ÚÍ ·ÔηٿÛÙ·ÛË Ù˘ ·ÈÌ·ÙÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜, ·ÏÏ¿ ÙÔ ·È‰› ÂÌÊ¿ÓÈÛ ·Ú·ÙÂÈÓfiÌÂÓÔ ÂÌ‡ÚÂÙÔ Î·È ÂÌ̤ÓÔ˘Û· Ë·ÙÔÌÂÁ·Ï›·, Ì ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÁÈ· Brucella melitensis, ÔfiÙ ıÂÚ·‡ÙËΠÂÈÙ˘¯Ò˜ Ì ÛÙÚÂÙÔÌ˘Î›ÓË Î·È ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË (17). ∆Ô 2000, ÔÈ Young Î·È Û˘Ó. ·Ó¤ÊÂÚ·Ó ¤ÊË‚Ô Ì ‚ÚԢΤÏψÛË Î·È ÔÚÊ˘ÚÈΤ˜ ‚Ï¿‚˜. ¶·Ú¿ ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ, ÌÂÙ·ÁÁ›ÛÂˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Î·È Î·Ù¿ÏÏËÏ˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜, Ô ·ÛıÂÓ‹˜ η٤ÏËÍ ÏfiÁˆ ÂÓ‰Ôηډȷ΋˜ Î·È ˘·Ú·¯ÓÔÂȉԇ˜ ·ÈÌÔÚÚ·Á›·˜, ·fiÙÔ΢ Ù˘ ÛÔ‚·Ú‹˜ ıÚÔÌ‚ÔÂÓ›·˜ (18). ∆ÔÓ ›‰ÈÔ ¯ÚfiÓÔ, ÔÈ Sevinc Î·È Û˘Ó., ηıÒ˜ Â›Û˘ Î·È ÔÈ Marom Î·È Û˘Ó., ÂÚȤÁÚ·„·Ó ¤Ó· ·ÁfiÚÈ 16 ÂÙÒÓ Î·È ¤Ó· ÎÔÚ›ÙÛÈ 4 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·, Ì ÚÒÙË Î·È ÌfiÓË ÂΉ‹ÏˆÛË ‚ÚԢΤÏψÛ˘ ÙË ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Ì ·ÈÌÔÚÚ·Á›Â˜ ·fi ÙÔ˘˜ ‚ÏÂÓÓÔÁfiÓÔ˘˜. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ·Ôηٷ-

ÛÙ¿ıËΠÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Î·È Î·Ù¿ÏÏËÏ˘ ·ÓÙÈ‚ÈÔÙÈ΋˜ ·ÁˆÁ‹˜ (19, 20). ™Â ÌÈ· ÌÂÁ¿ÏË ÛÂÈÚ¿ ·È‰ÈÒÓ Ì ‚ÚԢΤÏψÛË ÛÙÔ √Ì¿Ó, ‰È·ÈÛÙÒıËΠfiÙÈ ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓ›· ·ÚÔ˘ÛÈ·˙fiÙ·Ó Î˘Ú›ˆ˜ ÛÙ· ·È‰È¿ ÌÈÎÚ‹˜ ËÏÈΛ·˜, Ì ηϋ fï˜ ·ÓÙ·fiÎÚÈÛË ÛÙËÓ ·ÁˆÁ‹ Ì ÚÈÊ·ÌÈΛÓË Î·È ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË (21). √È Yaramis Î·È Û˘Ó. ÛÙËÓ ∆Ô˘ÚΛ·, ÙÔ 2001, ‰ËÌÔÛ›Â˘Û·Ó ÂÚ›ÙˆÛË ÂÊ‹‚Ô˘ Ì ÌÈÎÚÔ·ÁÁÂÈÔ·ıËÙÈ΋ ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›· Î·È ıÚÔÌ‚ÔÂÓ›· ÛÙ· Ï·›ÛÈ· ÔÍ›·˜ ‚ÚԢΤÏψÛ˘ Ô˘ ·ÓÙ·ÔÎÚ›ıËΠÏ‹Úˆ˜ ÛÙËÓ ·ÁˆÁ‹ Ì ÚÈÊ·ÌÈΛÓË Î·È ‰Ô͢΢ÎÏ›ÓË (22). √È ∆Û›Úη Î·È Û˘Ó., ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô “°. ÷Ù˙ËÎÒÛÙ·” ÙˆÓ πˆ·ÓÓ›ÓˆÓ, ÂÚȤÁÚ·„·Ó ·ÁfiÚÈ 11 ÂÙÒÓ Ì ·Ó·ÈÌ›·, Ï¢ÎÔÂÓ›· Î·È ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚÊ‡Ú·Ø ÂÓÒ ·Ú¯Èο Ë Î·Ù¿ÛÙ·ÛË ·ÓÙÈÌÂÙˆ›ÛÙËΠÂÈÙ˘¯Ò˜ Ì Á-ÛÊ·ÈÚ›ÓË, Ï›Á˜ Ë̤Ú˜ ·ÚÁfiÙÂÚ· ıÂÙÈÎÔÔÈ‹ıËÎÂ Ë Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ ÁÈ· Brucella melitensis Î·È ¯ÔÚËÁ‹ıËΠÂÈÙ˘¯Ò˜ ·ÁˆÁ‹ Ì ÁÂÓÙ·Ì˘Î›ÓË, ‰Ô͢΢ÎÏ›ÓË Î·È ÚÈÊ·ÌÈΛÓË (23). √È ∆ÛÔÏÈ¿ Î·È Û˘Ó., ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ 39 ·È‰È¿ Ô˘ ¤Ï·‚·Ó ‰È¿ÁÓˆÛË ‚ÚԢΤÏψÛ˘ Û ÂÚ›Ô‰Ô 15 ÂÙÒÓ ÛÙËÓ ∫ÂÓÙÚÈ΋ ∂ÏÏ¿‰·, ·Ó·Ê¤ÚÔ˘Ó ‰‡Ô ·È‰È¿ Ì ÛÔ‚·Ú‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Ô˘ ¤Ï·‚·Ó ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹, Ì ηϋ ¤Î‚·ÛË (24). ∆Ô 2004, ÔÈ Yalaz Î·È Û˘Ó. ÂÚȤÁÚ·„·Ó ·È‰› Ì ÌfiÓË ÂΉ‹ÏˆÛË ‚ÚԢΤÏψÛ˘ ÙË ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ. ∏ ·ÁˆÁ‹ Ì ‰Ô͢΢ÎÏ›ÓË Î·È ÚÈÊ·ÌÈΛÓË ·¤‰ˆÛ Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (25). Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÙȘ ·Ó·ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Â›Ó·È ··Ú·›ÙËÙÔ Ô ÎÏÈÓÈÎfi˜ ·È‰›·ÙÚÔ˜ Ó· ¤¯ÂÈ ¿ÓÙ· ˘fi„Ë ÙÔ˘ ÙË ‚ÚԢΤÏψÛË ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ıÚÔÌ‚ÔÂÓ›·˜, ȉȷ›ÙÂÚ· ÛÙȘ ÂÓ‰ËÌÈΤ˜ ÂÚÈÔ¯¤˜. ¶·È‰È¿ Ì ‰È·ÁÓˆÛı›۷, ·Ú¯Èο, ȉÈÔ·ı‹ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË ıÂÚ·›· ‹ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÚÂÙfi, ·ÚıÚ·ÏÁ›Â˜ ‹ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· ı· Ú¤ÂÈ Ó· ÂÚ¢ÓÒÓÙ·È Î·È ÁÈ· ‚ÚԢΤÏψÛË, ΢ڛˆ˜ fiÙ·Ó ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ηٷӿψÛ˘ ÌË ·ÛÙÂÚÈˆÌ¤ÓˆÓ Á·Ï·ÎÙÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ, ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‚ÚԢΤÏψÛ˘ ‹ ÚÔËÁËı¤Ó Ù·Í›‰È Û ¯ÒÚ˜ fiÔ˘ Ë ÓfiÛÔ˜ ·ÎfiÌ· ÂÓ‰ËÌ›. ∏ ·ıÔÁ¤ÓÂÛË Ù˘ ıÚÔÌ‚ÔÂÓ›·˜ ÛÙ· Ï·›ÛÈ· Ù˘ ‚ÚԢΤÏψÛ˘ ·ÔÙÂÏ› ·ÎfiÌË ·ÓÙÈΛÌÂÓÔ ¤Ú¢ӷ˜, ·ÏÏ¿ ÔÈ Èı·ÓfiÙÂÚÔÈ Ì˯·ÓÈÛÌÔ› Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ô ˘ÂÚÛÏËÓÈÛÌfi˜, Ë ·ÈÌÔÊ·ÁÔ΢ÙÙ¿ÚˆÛË, Ë Î·Ù·ÛÙÔÏ‹ ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Î·È ·ÓÔÛÔÏÔÁÈÎÔ› Ì˯·ÓÈÛÌÔ› ·Ú·ÁˆÁ‹˜ ·ÓÙÈ·ÈÌÔÂÙ·ÏÈ·ÎÒÓ ·ÓÙÈۈ̿وÓ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÚ›ÙˆÛ‹ Ì·˜, ˘‹Ú¯·Ó ÔÚÈṲ̂Ó˜ ȉȷÈÙÂÚfiÙËÙ˜ Ì ÙȘ Ôԛ˜ ‹Úı·Ì ·ÓÙÈ̤وÔÈ Î·È Ì·˜ ¤ıÂÛ·Ó ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜. ∏ ·ÛıÂÓ‹˜ Ì·˜ ÚÔÛ‹Ïı Ì ÂÍ·ÈÚÂÙÈο ¯·ÌËÏfi ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ Î·È ·ÈÌÔÚÚ·ÁÈΤ˜ ‚Ï¿‚˜ ·fi ÙÔ˘˜ ¶·È‰È·ÙÚÈ΋ 2008;71:399-402

Pediatri Sept-Oct 08

14-10-08

13:26

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∞. ª·ÓÒÏ· Î·È Û˘Ó.

‚ÏÂÓÓÔÁfiÓÔ˘˜. À‹Ú¯Â, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, ÛÔ‚·Úfi˜ ΛӉ˘ÓÔ˜ ÂÛˆÙÂÚÈ΋˜ ‹ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ·Ó·ÁηÈfiÙËÙ· ¿ÌÂÛ˘ ·Ú¤Ì‚·Û˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ¯ÔÚËÁ‹ıËΠÁ-ÛÊ·ÈÚ›ÓË Î·È ÂÓ‰ÔÊϤ‚È· ·ÁˆÁ‹ Ì ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Ë, Ì ٷ¯Â›· Î·È ÛËÌ·ÓÙÈ΋ ¿ÓÔ‰Ô ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ. ÕÏÏÔ ı¤Ì· ÚÔ˜ Û˘˙‹ÙËÛË Â›Ó·È Ë Èı·ÓfiÙËÙ· Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Ô˘ ‹‰Ë ÂÏ¿Ì‚·ÓÂ Ë ·ÛıÂÓ‹˜ ÛÙËÓ ÚfiÎÏËÛË Ù˘ ıÚÔÌ‚ÔÂÓ›·˜. ∏ ÚÈÊ·ÌÈΛÓË Â›Ó·È ¤Ó· Ê¿ÚÌ·ÎÔ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ıÚÔÌ‚ÔÂÓ›·, Ë ÔÔ›· fï˜ Â›Ó·È Û˘Ó‹ıˆ˜ ‹È· Î·È ÎÏÈÓÈο ÌË ÛËÌ·ÓÙÈ΋, ÂÓÒ Ë ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË ÂÓ›ÔÙ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÛÔ‚·Ú‹ ÙÒÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, Ì ÛËÌ·ÓÙÈΤ˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ (13). ø˜ ÂÎ ÙÔ‡ÙÔ˘, ·ÔÊ·Û›ÛÙËΠӷ ‰È·ÎÔ› ÌfiÓÔ Ë ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË. ¢Â‰Ô̤ÓÔ˘ fiÙÈ Ë ·ÛıÂÓ‹˜ ¤ÚÂ ӷ Û˘Ó¯›ÛÂÈ ‰ÈÏ‹ ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ Î·È ÌÂÙ¿ ÙËÓ ÔÍ›· Ê¿ÛË ÁÈ· Û˘ÓÔÏÈο ¤ÍÈ Â‚‰ÔÌ¿‰Â˜, ·ÔÊ·Û›ÛÙËΠӷ Û˘Ó¯ÈÛÙ› Ë ¯ÔÚ‹ÁËÛË Ù˘ ÚÈÊ·ÌÈΛÓ˘. ¶ÚÔ˜ ·ÔÎÏÂÈÛÌfi Ù˘ Èı·Ó‹˜ Ê·Ú̷΢ÙÈ΋˜ ıÚÔÌ‚ÔÂÓ›·˜ ·fi ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË, Î·È ·ÊÔ‡ ÛÙ·ıÂÚÔÔÈ‹ıËÎÂ Ë Î·Ù¿ÛÙ·ÛË Ù˘ ·ÛıÂÓÔ‡˜, ¤ÁÈÓ Â·Ó·¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÂÎÙ›ÌËÛË ÂÎ Ó¤Ô˘ Ù˘ ÂÈÎfiÓ·˜ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. ∏ ÛÙ·ıÂÚÔÔ›ËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ Ì¿˜ ·ÔÌ¿ÎÚ˘Ó ·fi ÙËÓ ·Ú¯È΋ ÛΤ„Ë Ù˘ Èı·Ó‹˜ Ê·Ú̷΢ÙÈ΋˜ ıÚÔÌ‚ÔÂÓ›·˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜ fiÔ˘ ÂÓ‰ËÌ› ·ÎfiÌË Ë ‚ÚԢΤÏψÛË, Ë ÓfiÛÔ˜ ·˘Ù‹ ı· Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, Û ÂÚÈÙÒÛÂȘ ȉÈÔ·ıÔ‡˜ ıÚÔÌ‚ÔÂÓÈ΋˜ ÔÚʇڷ˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ ı· Ú¤ÂÈ Ó· ÂÍ·ÙÔÌÈ·ÂÙ·È Û οı ·ÛıÂÓ‹, ÔˆÛ‰‹ÔÙ fï˜ Ë ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ ‹ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ‚ÔËı¿ ÛËÌ·ÓÙÈο, ÂÓÒ Ë ÙÂÏÈ΋ Î·È Î‡ÚÈ· Â›Ï˘Û‹ ÙÔ˘˜ Â¤Ú¯ÂÙ·È Ì ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Galanakis E, Bourantas KL, Leveidiotou S, Lapatsanis PD. Childhood brucellosis in North-Western Greece: a retrospective analysis. Eur J Pediatr 1996;155:1-6.

2. ÀÔung EJ. An overview of human brucellosis. Clin Infect Dis 1995;21:283-289.

3. Pappas G, Akritidis N, Bosilkovski M, Tsianos E. Brucellosis. N Engl J Med 2005;352:2325-2336.

4. ∞l-Eissa YA, Kambal AM, al-Nasser MN, al-Habib SA, alFawaz IM, al-Zamil FA. Childhood brucellosis: a study of 102 cases. Pediatr Infect Dis J 1990;9:74-79.

5. ª·˘ÚÔÎÒÛÙ· ª, °·Ï·Ó¿Î˘ ∂. ¡ÔÛËÚfiÙËÙ· Î·È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ‚ÚԢΤÏψÛ˘ ÛÙËÓ ∂ÏÏ¿‰·. ¶·È‰È·ÙÚÈ΋ 2006;69:37-44.

6. Shalev H, Abramson O, Levy J. Hematological manifestations of brucellosis in children. Pediatr Infect Dis J 1994; 13:543-545.

Paediatriki 2008;71:399-402

7. ∞l-Eissa Y, al-Nasser M. Haematological manifestations of childhood brucellosis. Infection 1993;21:23-26.

8. Galanakis E, Bourantas KL, Kefallinou A, Kakossimos G, Lapatsanis P. Haematological findings in childhood brucellosis. Paediatrics North Greece 1994;6:146-151.

9. Aysha MH, Shayib MA. Pancytopenia and other haematological findings in brucellosis. Scand J Haematol 1984; 36:335-338.

10. Crosby E, Llosa L, Miro Quesada M, Carrillo C, Gotuzzo E. Hematologic changes in brucellosis. J Infect Dis 1984;150: 419-424.

11. Pappas G, Kitsanou M, Christou L, Tsianos E. Immune thrombocytopenia attributed to brucellosis and other mechanisms of Brucella-induced thrombocytopenia. Am J Hematol 2004;75:139-141.

12. Yilmaz M, Tiryaki O, Namiduru M, Okan V, Oguz A, Buyukhatipoglu H, et al. Brucellosis-induced immune thrombocytopenia mimicking ITP: a report of seven cases.

Int J Lab Hematol. 2007;29:442-445.

13. Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med 2007;357:580-587.

14. ∆igano F, Larosa F. Brucellosis of hemorrhagic origin.

Clinical and pathogenic considerations. Riforma Med 1964;78:684-690.

15. Benjamin B, Annobil SH. Childhood brucellosis in southwestern Saudi Arabia: a 5-year experience. J Trop Pediatr 1992;38:167-172.

16. Benjamin B. Acute thrombocytopenic purpura in childhood brucellosis. Ann Trop Paediatr 1995;15:189-192.

17. Benecos P, Spingou T, Galanakis E, Lapatsanis PD. Thrombocytopenic purpura secondary to brucellosis. Eur J Pediatr 1998;157:698.

18. Young EJ, Tarry A, Genta RM, Ayden N, Gotuzzo E. Thrombocytopenic purpura associated with brucellosis: report of 2 cases and literature review. Clin Infect Dis 2000;31:904-909.

19. Sevinc A, Kutlu NO, Kuku I, Ozgen U, Aydogdu I, Soylu H. Severe epistaxis in brucellosis-induced isolated thrombocytopenia: a report of two cases. Clin Lab Haematol 2000;22:373-375.

20. Marom R, Miron D, Gabriel H, Horowitz Y. Thrombocytopenic purpura as sole manifestation of brucellosis in children. Harefuah 2000;139:278-279.

21. El-Amin EO, George L, Kutty NK, Sharma PP, Choithramani RS, Jhaveri VP, et al. Brucellosis in children of Dhofar Region, Oman. Saudi Med J 2001;22:610-615.

22. Yaramis A, Kervancioglu M, Yildirim I, Soker M, Derman O, Tas MA. Severe microangiopathic hemolytic anemia and thrombocytopenia in a child with Brucella infection.

Ann Hematol 2001;80:546-548.

23. Tsirka A, Markesinis I, Getsi V, Chaloulou S. Severe thrombocytopenic purpura due to brucellosis. Scand J Infect Dis 2002;34:535-536.

24. Tsolia M, Drakonaki S, Messaritaki A, Farmakakis T, Kostaki M, Tsapra H, et al. Clinical features, complications and treatment outcome of childhood brucellosis in central Greece. J Infect 2002;44:257-262.

25. Yalaz M, Arslan MT, Kurugöl Z. Thrombocytopenic purpura as only manifestation of brucellosis in a child. Turk J Pediatr 2004;46:265-267.

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™ÂÏ›‰·403

∫§π¡π∫√ ∫√Àπ∑

CLINICAL QUIZ

403

¶·È‰› Ì “ÏÂÈÙÔ˘ÚÁÈÎfi” ʇÛËÌ· N. ∞Ó·ÁÓˆÛÙ¿ÙÔ˘, π. °ÂÚÌ·Ó¿Î˘, ª. ∫·ÏÌ·ÓÙ‹

¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ

“Innocent” heart murmur in a child

AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ˘ °ÂÚÌ·Ó¿Î˘ germjohn@med.uoc.gr ¶·È‰ÔηډÈÔÏÔÁÈ΋ ªÔÓ¿‰·, ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °.¡. ∏Ú·ÎÏ›Ԣ, µÔ‡Ù˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

N. Anagnostatou, I. Germanakis, M. Kalmanti ∞ÁfiÚÈ ËÏÈΛ·˜ 3,5 ÂÙÒÓ ÚÔÛ‹Ïı ÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi Â͈ÙÂÚÈÎfi È·ÙÚÂ›Ô Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜, ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Ê˘Û‹Ì·ÙÔ˜. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ 2Ô Ù¤ÎÓÔ Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ì ·ÚÓËÙÈÎfi ηډÈÔÏÔÁÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ·Ó·Ê¤ÚÂÙ·È ÂχıÂÚË. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È Ë ÛˆÌ·ÙÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó ·fiÏ˘Ù· Û˘Ì‚·Ù‹ Ì ÙËÓ ËÏÈΛ· ÙÔ˘. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚıËÎ·Ó Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Û˘¯Ó‹ ¯Ú‹ÛË ‚ÚÔÁ¯Ô‰È·ÛÙ·ÏÙÈÎÒÓ ÁÈ· ‚ÚÔÁ¯fiÛ·ÛÌÔ, Ô˘ ÂÌÊ¿ÓÈ˙ ΢ڛˆ˜ ηٿ ÙË ‰È·‰ÚÔÌ‹ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∆Ô Î·Ú‰È·Îfi ʇÛËÌ· ›¯Â Á›ÓÂÈ ·ÓÙÈÏËÙfi ÁÈ· ÚÒÙË ÊÔÚ¿ Û ËÏÈΛ· 1 ¤ÙÔ˘˜ ·fi ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜ Î·È ıˆڋıËΠˆ˜ Û‡ÓËı˜ “ÏÂÈÙÔ˘ÚÁÈÎfi” ʇÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. §fiÁˆ ÂÌÌÔÓ‹˜ ÙÔ˘ Ê˘Û‹Ì·ÙÔ˜ Î·È Û˘ÓÔ‰Ô‡ ·ÓËÛ˘¯›·˜ ÙˆÓ ÁÔÓ¤ˆÓ, ¤ÁÈÓ ·Ú·ÔÌ‹ ÁÈ· ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ Â˘Ú‹Ì·ÙÔ˜. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ÙÔ ·È‰› ›¯Â Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÙ˘Ô ¯ˆÚ›˜ ‰˘ÛÌÔÚʛ˜, ηϋ ·Ó¿Ù˘ÍË, Ê˘ÛÈÔÏÔÁÈÎfi ·Ó·Ó¢ÛÙÈÎfi „Èı‡ÚÈÛÌ· ¯ˆÚ›˜ Ù·¯‡ÓÔÈ· ‹ ΢¿ÓˆÛË (Sat 98%), ÌfiÏȘ „ËÏ·ÊËÙfi ‹·Ú, „ËÏ·ÊËÙ¤˜ ÌËÚÈ·›Â˜ ¯ˆÚ›˜ ‰È·ÊÔÚ¿ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ¿Óˆ-οو ¿ÎÚˆÓ (BP = 98/75 mmHg). ¢ÂÓ ˘‹Ú¯Â „ËÏ·ÊËÙfi˜ ÚÔ›˙Ô˜ ÛÙËÓ „ËÏ¿ÊËÛË Ù˘ ÚÔοډȷ˜ ¯ÒÚ·˜ Î·È ÙÔ˘ ÛÊ·ÁÈÙȉÈÎÔ‡ ‚fiıÚÔ˘. ™ÙËÓ Î·Ú‰È·Î‹ ·ÎÚfi·ÛË Â›¯Â Ú˘ıÌÈ΋ ηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·. ŒÓ· ‹ÈÔ (2/6) Û˘ÛÙÔÏÈÎfi ʇÛËÌ·, Ì ¯·Ú·ÎÙ‹Ú· crescendo-decrescendo ÛÙË ÌÂÙ·‚ÔÏ‹ Ù˘ ¤ÓÙ·Û‹˜ ÙÔ˘ Ì ÙÔ ¯ÚfiÓÔ Î·È Ì¤ÁÈÛÙË ¤ÓÙ·ÛË ÛÙÔ 2Ô ÌÂÛÔχÚÈÔ ‰È¿ÛÙËÌ· ·ÚÈÛÙÂÚ¿ ·Ú·ÛÙÂÚÓÈο ‹Ù·Ó ·ÓÙÈÏËÙfi. √ ÚÒÙÔ˜ ηډȷÎfi˜ ÙfiÓÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ‰ÂÓ ˘‹Ú¯·Ó ¿ÏÏÔÈ ÚfiÛıÂÙÔÈ ‹¯ÔÈ, Ô ‰Â‡ÙÂÚÔ˜ ηډȷÎfi˜ ÙfiÓÔ˜ ÂÌÊ¿ÓÈ˙ ÛÙ·ıÂÚfi ‰È¯·ÛÌfi ÙfiÛÔ ÛÙËÓ ÂÈÛÓÔ‹ fiÛÔ Î·È ÛÙËÓ ÂÎÓÔ‹ (∂ÈÎfiÓ· 1). ™ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ηٷÁÚ¿ÊËÎ·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ ÊÏ‚ÔÎÔÌ‚ÈÎfi˜ Ú˘ıÌfi˜, ˘„ËÏ¿ Â¿ÚÌ·Ù· ÎÔÏÈ΋˜ ÂÎfiψÛ˘ (Ó¢ÌÔÓÈο p) Î·È ·ÙÂÏ‹˜ ‰ÂÍÈfi˜ ÛÎÂÏÈÎfi˜ ·ÔÎÏÂÈÛÌfi˜ ÎÔÈÏȷ΋˜ ÂÎfiψÛ˘ (∂ÈÎfiÓ· 2). ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ó¤‰ÂÈÍ ·˘ÍË̤ÓÔ Î·Ú‰ÈÔıˆÚ·ÎÈÎfi ‰Â›ÎÙË (0.61), ÚÔ‚ÔÏ‹ ÙÔ˘ ÙfiÍÔ˘ Ù˘ Ó¢ÌÔÓÈ΋˜ Î·È ·˘ÍË̤ÓË Ó¢ÌÔÓÈ΋ ·ÁÁ›ˆÛË (∂ÈÎfiÓ· 3).

Department of Pediatrics University Hospital of Heraklion, Crete

∂ÈÎfiÓ· 1. ºˆÓÔηډÈÔÁÚ¿ÊËÌ· ÙÔ˘ ·È‰ÈÔ‡, ηٷÁÚ·Ê‹ ÛÙÔ 2Ô ÌÂÛÔχÚÈÔ ‰È¿ÛÙËÌ· ·ÚÈÛÙÂÚ¿ ·Ú·ÛÙÂÚÓÈο (ÂÛÙ›· ·ÎÚfi·Û˘ Ó¢ÌÔÓÈ΋˜). ™Ù·ıÂÚfi˜ ‰È¯·ÛÌfi˜ ÙÔ˘ 2Ô˘ ÙfiÓÔ˘ (S2) (·ÚÈÛÙÂÚ¿) Î·È Û˘ÛÙÔÏÈÎfi ʇÛËÌ· ÌÈÎÚ‹˜ ¤ÓÙ·Û˘ ÌÂٷ͇ 1Ô˘ (S1) Î·È 2Ô˘ ÙfiÓÔ˘ (S2) (‰ÂÍÈ¿).

Correspondence: Ioannis Germanakis germjohn@med.uoc.gr Pediatric Cardiology Unit Dept of Pediatrics University Hospital Heraklion, Crete

∂ÈÎfiÓ· 2. ∏ÏÂÎÙÚÔηډÈÔÁÚ·ÊÈ΋ ηٷÁÚ·Ê‹ ‰ÂÍÈ¿˜ ÚÔοډȷ˜ ··ÁˆÁ‹˜ V1, Ì ·ÚÔ˘Û›· ˘„ËÏÒÓ Â·ÚÌ¿ÙˆÓ p ·ÎÔÏÔ˘ıÔ‡ÌÂÓˆÓ ·fi ·ÙÂÏ‹ ‰ÂÍÈfi ÛÎÂÏÈÎfi ·ÔÎÏÂÈÛÌfi (rsR).

∂ÈÎfiÓ· 3. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. ªÂÁ·ÏÔηډ›·, Ì ÚÔ‚ÔÏ‹ ÙÔ˘ ÙfiÍÔ˘ Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ (‚¤ÏÔ˜).

¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. §ÂÈÙÔ˘ÚÁÈÎfi ʇÛËÌ· 2. ¶Ó¢ÌÔÓÈ΋ ηډ›· ·fi ¯ÚfiÓÈ· ·ÔÊÚ·ÎÙÈ΋ ÓfiÛÔ ·ÂÚ·ÁˆÁÒÓ 3. ™Ù¤ÓˆÛË ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ 4. ªÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· ∏ ·¿ÓÙËÛË ÛÙË ÛÂÏ›‰· 411 ¶·È‰È·ÙÚÈ΋ 2008;71:403,411-412

Pediatri Sept-Oct 08

14-10-08

404

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

Department of Paediatrics, University of Crete Correspondence: Emmanouil Galanakis emmgalan@med.uoc.gr Department of Paediatrics, University of Crete

13:26

™ÂÏ›‰·404

™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞

∞ÏÁfiÚÈıÌÔÈ, Û˘ÛÙ¿ÛÂȘ, ηÙ¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Î·È ı¤ÛÂȘ 2008 ∂. °·Ï·Ó¿Î˘

Algorithms, Recommendations, Guidelines and Scientific Statements 2008 E. Galanakis

∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙËÓ ˘ÂÚ¢·ÈÛıËÛ›· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. √È Ú·ÁÌ·ÙÈΤ˜ ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜ ÌÂÙ¿ ÂÌ‚ÔÏÈ·ÛÌfi Â›Ó·È Û¿ÓȘ (ÂÚ›Ô˘ 1:50.000 ‰fiÛÂȘ ‰ÈÊıÂÚ›Ùȉ·˜ÙÂÙ¿ÓÔ˘-ÎÔηÙË ¤ˆ˜ 1:500.000-1:1.000.000 ÁÈ· Ù· ˘fiÏÔÈ· ÂÌ‚fiÏÈ·). øÛÙfiÛÔ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·ÁÓÔËıÔ‡Ó, ηıÒ˜ fiÏ· Ù· ·È‰È¿ ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Î·È Ì¿ÏÈÛÙ· Ì ·ÚÎÂÙ¤˜ ‰fiÛÂȘ ÂÌ‚ÔÏ›ˆÓ. ™ÙÔ Ù‡¯Ô˜ ™ÂÙÂÌ‚Ú›Ô˘ ÙÔ˘ Pediatrics (2008;122:e771-7), ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·fi ÙÔ Hypersensitivity Working Group of the Clinical Immunization Safety Assessment (CISA) Network, ∏¶∞, Û¯ÂÙÈΤ˜ Ô‰ËÁ›Â˜ Î·È ·ÏÁfiÚÈıÌÔ˜ Û¯ÂÙÈο Ì ٷ ÂÍ‹˜: ·) Ï‹„Ë ÈÛÙÔÚÈÎÔ‡ Î·È ÔÚıÔÏÔÁÈ΋ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·ÓÙȉڿÛÂˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ˆ˜ ·ÏÏÂÚÁÈΤ˜ ·fi ÙÔ˘˜ ÁÔÓ›˜, ‚) ÌÂıÔ‰ÔÏÔÁ›· ‰ÈÂÚ‡ÓËÛ˘ Î·È ÂȂ‚·›ˆÛ˘ Ù˘ ˘ÂÚ¢·ÈÛıËÛ›·˜, Á) ·fi ÔÈÔÓ Î·È Ô‡ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Ë ‰ÈÂÚ‡ÓËÛË/ÂȂ‚·›ˆÛË Î·È Ô Â·ÓÂÌ‚ÔÏÈ·ÛÌfi˜ Î·È Á) ÚÔ¸Ôı¤ÛÂȘ ÔÏÔÎÏ‹ÚˆÛ˘ ‹ fi¯È ÙÔ˘ Û¯‹Ì·ÙÔ˜ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ ‹ ÙÔ˘ ˘fiÏÔÈÔ˘ Û¯‹Ì·ÙÔ˜. ∂›Û˘, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È 3 Ú·ÁÌ·ÙÈΤ˜ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Î·È Û˘˙ËÙÂ›Ù·È Ô ¯ÂÈÚÈÛÌfi˜ ÙˆÓ ÂÚÈÙÒÛÂÒÓ ÙÔ˘˜. ∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÛÂÍÔ˘·ÏÈο ηÎÔÔÈËÌ¤ÓˆÓ ÂÊ‹‚ˆÓ. ∏ ÛÂÍÔ˘·ÏÈ΋ ηÎÔÔ›ËÛË, Ì ÙË ÌÂÁ¿ÏË Ù˘ ÔÈÎÈÏ›· fiÚˆÓ, ÌÔÚÊÒÓ Î·È ÛÔ‚·ÚfiÙËÙ·˜, ¤¯ÂÈ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ·fi fiϘ ÙȘ ¿ÏϘ ËÏÈÎȷΤ˜

Paediatriki 2008;71:404-406

ÔÌ¿‰Â˜. ™ÙÔ Ù‡¯Ô˜ ∞˘ÁÔ‡ÛÙÔ˘ ÙÔ˘ Pediatrics (2008;122:462-470), ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·fi ÙËÓ American Academy of Pediatrics (APA) Committee on Adolescence ÂȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÏÂÙÔÌÂÚ›˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÚÔÛ¤ÁÁÈÛË, ÙËÓ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ Î·È ÙËÓ ¤Ó·ÚÍË/ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ÙËÓ Â›ÁÔ˘Û· ·ÓÙÈÛ‡ÏÏË„Ë Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ. ∆ÔÓ›˙ÂÙ·È Ë ÛËÌ·Û›· Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Î·È Ù˘ Û˘˙‹ÙËÛ˘ ÙˆÓ ÁÈ·ÙÚÒÓ Ì ÙÔ˘˜ ÂÊ‹‚Ô˘˜, Ù˘ ηϋ˜ ÁÓÒÛ˘ ÙÔ˘ ÓÔÌÈÎÔ‡ Î·È ‰ÂÔÓÙÔÏÔÁÈÎÔ‡ Ï·ÈÛ›Ô˘ ¯ÂÈÚÈÛÌÔ‡ Ù¤ÙÔÈˆÓ ÂÚÈÙÒÛÂˆÓ Î·È Ù˘ ˘ÔÛÙ‹ÚÈ͢ ·fi ¿ÏϘ ÂȉÈÎfiÙËÙ˜ Î·È ÎÔÈÓˆÓÈÎÔ‡˜ ıÂÛÌÔ‡˜. √È ÚÔËÁÔ‡ÌÂÓ˜ Ô‰ËÁ›Â˜ ›Û¯˘·Ó ·fi ÙÔ 2001. ∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ ·ÓÙÈÌ ÙÒÈÛË Ù˘ ÂÁÎÂÊ·Ï›Ùȉ·˜. ™ÙÔ Ù‡¯Ô˜ ÙÔ˘ Clinical Infectious Diseases ∞˘ÁÔ‡ÛÙÔ˘ 2008 (CID 2008;47:203-27) ÂÎÙ›ıÂÓÙ·È Û 25 ÛÂÏ›‰Â˜ ÔÈ Î·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Ù˘ Infectious Diseases Society of America (IDSA) ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂÁÎÂÊ·Ï›Ùȉ·˜ ·fi ÈÔ‡˜, ‚·ÎÙ‹ÚÈ·, ̇ÎËÙ˜, ÚˆÙfi˙ˆ· Î·È ¤ÏÌÈÓı˜. √È Ô‰ËÁ›Â˜ Â›Ó·È ÎÔÈÓ¤˜ ÁÈ· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó fiÏÔ ÙÔ Ê¿ÛÌ· Ù˘ ÎÏÈÓÈ΋˜ ·˘Ù‹˜ ÔÓÙfiÙËÙ·˜, ·fi ÙËÓ ÂȉËÌÈÔÏÔÁ›·, ·Ó¿ÏÔÁ· Ì ÙË ÁˆÁÚ·Ê›· Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ¤ˆ˜ ÙȘ ÂΉËÏÒÛÂȘ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi ‹ ¿ÏÏ· Û˘ÛÙ‹Ì·Ù· Î·È ÙË ÛËÌ·Û›· ÙÔ˘˜, ÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ˘‡ı˘ÓÔ˘

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PAEDIATRIC NEWS IN BRIEF ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡ Î·È ÙË ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÂÓ Á¤ÓÂÈ Î·È ·Ó¿ÏÔÁ· Ì ÙÔ Èı·Ófi ·ıÔÁfiÓÔ, ÙËÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê›· Î·È ·ÂÈÎfiÓÈÛË (·fi ÙË CT ˆ˜ ÙÔ FDG-PET scanning), ηıÒ˜ Î·È ÙËÓ ·ÁˆÁ‹, ·ıÔÁfiÓÔ ÚÔ˜ ·ıÔÁfiÓÔ. ∏ ·Ó·ÛÎfiËÛË Û¯ÔÏÈ¿˙ÂÈ ÙËÓ ÙÂÎÌËÚ›ˆÛË ÙˆÓ Ô‰ËÁÈÒÓ Ì ‚¿ÛË ÙËÓ ˘¿Ú¯Ô˘Û· ÂÌÂÈÚ›· Î·È Â›Ó·È ‰È·ÓıÈṲ̂ÓË Ì ÏÂÙÔÌÂÚ›˜ ›Ó·Î˜ Î·È Û˘ÓÔÙÈ΋ ·ÚÔ˘Û›·ÛË ÙˆÓ ÈÔ Û˘¯ÓÒÓ Ù‡ˆÓ ÂÁÎÂÊ·Ï›Ùȉ·˜. ™˘ÛÙ¿ÛÂȘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ · ¯˘Û·ÚΛ·˜. ™ÙȘ ∏¶∞, ÙÔ ÔÛÔÛÙfi ÙˆÓ ˘¤Ú‚·ÚˆÓ ·È‰ÈÒÓ (ÈÛ¯‡ˆÓ ÔÚÈÛÌfi˜ CDC: µªπ >95Ë ∂£) ÂÎÙÈÌ¿Ù·È fiÙÈ ·Ó¤Ú¯ÂÙ·È Û 14%, 19% Î·È 17% ÁÈ· ÙȘ ËÏÈ˘ 2-5, 6-11 Î·È 1219 ÂÙÒÓ, ·ÓÙ›ÛÙÔȯ·. ∞Ó·ÁÓˆÚ›˙ÔÓÙ·˜ ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Î·È ÙËÓ ·ÓÂ¿ÚÎÂÈ· ÙˆÓ ¤ˆ˜ ÙÒÚ· Ô‰ËÁÈÒÓ, Ë American Medical Association (AMA) fiÚÈÛ ÔÌ¿‰· ÂȉÈÎÒÓ Ô˘ η٤ÏËÍ ÛÙȘ Û˘ÛÙ¿ÛÂȘ ÙÔ˘ Ù‡¯Ô˘˜ πÔ˘Ï›Ô˘ ÙÔ˘ American Family Physician (Am Fam Physician 2008;78:56-63) ÁÈ· ÙËÓ ÚÔÛ¤ÁÁÈÛË Î·È ÙËÓ ·ÁˆÁ‹ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ ·È‰ÈÔ‡. √È Û˘ÛÙ¿ÛÂȘ ·¢ı‡ÓÔÓÙ·È Û ÁÈ·ÙÚÔ‡˜ ÚˆÙÔ‚¿ıÌÈ·˜ ÂÚ›ı·Ï„˘ Î·È Û ¿ÏϘ ÎÏÈÓÈΤ˜ ÂȉÈÎfiÙËÙ˜, ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ Î·Ù¿ÏÏËÏË ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ÚÔÛ¤ÁÁÈÛË Î·È ·Ú·ÎÔÏÔ‡ıËÛË, ÏÂÙÔÌÂÚ›˜ Ô‰ËÁ›Â˜ ‰È·ÙÚÔÊ‹˜ (·Ó·„˘ÎÙÈο, ¯˘ÌÔ›, Ù·¯˘Á‡̷ٷ), Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛ˘ ÙËÏÂfiÚ·Û˘ ‹ ¿ÏÏ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Û ÔıfiÓË Î·È Î·Ù·Ï‹ÁÔ˘Ó Û 4 ‰È·‰Ô¯Èο ÛÙ¿‰È· ·ÁˆÁ‹˜ ÙÔ˘ ˘¤Ú‚·ÚÔ˘ ·È‰ÈÔ‡ Î·È ÂÊ‹‚Ô˘ ËÏÈΛ·˜ 2-19 ÂÙÒÓ. ∂ÈϤÔÓ, Ë AMA ÚÔÙ›ÓÂÈ ÎÔÈÓÔ‡˜ ÔÚÈÛÌÔ‡˜ ·¯˘Û·ÚΛ·˜ ÁÈ· ·È‰È¿ Î·È ÂÓ‹ÏÈΘ: ˘¤Ú‚·Ú· (BMI 85Ë - 95Ë ∂£), ·¯‡Û·Úη (BMI >95Ë ∂£) Î·È ÛÔ‚·Ú¿ ·¯‡Û·Úη (µªπ >99Ë ∂£).

405

£¤ÛÂȘ ÁÈ· ÙË Û˘Ó¯‹ ηْ Ô›ÎÔÓ Î·Ù·ÁÚ· Ê‹ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Û ·È‰È¿ Î·È ÂÊ‹ ‚Ô˘˜ , ·fi ÙËÓ American Heart Association (AHA): Atherosclerosis, Hypertension, and Obesity in Youth Committee, Hypertension; 2008;52:433-451. £¤ÛÂȘ ÁÈ· ÙËÓ ÚfiÏË„Ë Î·È ıÂÚ·›· ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ Î·È ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÛÙ· ·È‰È¿, ·fi ÙÔ Special Writing Group of the American Heart Association (AHA) Stroke Council and the Council on Cardiovascular Disease in the Young, Stroke 2008;39:2644-2691. ™ÙÚ·ÙËÁÈΤ˜ ÁÈ· ÙËÓ Â˘fi‰ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ÛÙÔ American Family Physician (Keister D, et al. Strategies for breastfeeding success. Am Fam Physician 2008;78:180,225232). ™ÙÔ ›‰ÈÔ Ù‡¯Ô˜ ‰ËÌÔÛȇÔÓÙ·È Ô‰ËÁ›Â˜ Ù˘ American Academy of Family Physicians Î·È ÁÈ· ÁÔÓ›˜ (Am Fam Physician 2008;78:233-234). ™˘ÛÙ¿ÛÂȘ ÁÈ· ÙËÓ ·ÓÂ¿ÚÎÂÈ· Ù˘ ‚ÈÙ·Ì› Ó˘ D Û ·È‰È¿, ·fi ÙË Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society, ∏¶∞, Pediatrics 2008;122: 398-417. ¢ÂοÏÔÁÔ˜ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ Ù˘ η΋˜ ¯Ú‹Û˘ Ù˘ ÁÂÓÂÙÈ΋˜ ¤Ú¢ӷ˜ ÛÙÔÓ ¿ÓıÚˆÔ , ·fi ÙÔ Center for Biomedical Ethics and Department of Pediatrics, Stanford University, Genome Biol 2008;9:404. ∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ Û˘ÓÙ·ÁÔÁÚ·Ê›·˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ÏÔÈÌÒÍÂȘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÂÚ›ı·Ï„Ë, ·fi ÙÔ ‚ÚÂÙ·ÓÈÎfi National Institute for Health and Clinical Excellence (NICE), BMJ 2008;337:a437.

∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ Âԯȷ΋ ÁÚ›Ë ÁÈ· ÙÔ 2008, ·fi ÙËÓ Advisory Committee on Immunization Practices (ACIP) ÙÔ˘ CDC ÛÙȘ ∏¶∞: MMWR Morb Mortal Wkly Rep 2008;57:1-60.

∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ ΢ÛÙÈ΋˜ ›ÓˆÛ˘ ·fi ÙÔ ÓÂÔÁÓfi ˆ˜ ÙÔÓ ÂÓ‹ÏÈη. Cystic Fibrosis Foundation Consensus Report, J Pediatr 2008;153:S4-S14.

∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ ÚÔʇ Ï·ÍË ¤Ó·ÓÙÈ Ù˘ ÂÓ‰Ôηډ›Ùȉ·˜, ·fi ÙȘ ∏¶∞ (American Heart Association, J Am Dent Assoc 2008;139:3S-24S) Î·È ÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ (National Institute for Health and Clinical Excellence [NICE], http://www.nice.org.uk/ nicemedia/pdf/CG64NICEguidance.pdf).

∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· Ù˘ ÚÈÓ›Ùȉ·˜, ·fi Ù· Joint Task Force on Practice; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology: J Allergy Clin Immunol 2008;122:S1-84. ¶·È‰È·ÙÚÈ΋ 2008;71:404-406

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™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞ √‰ËÁ›Â˜ ÁÈ· ÙËÓ ·fiÊÚ·ÍË ÙÔ˘ ·ÎÔ˘ÛÙÈÎÔ‡ fiÚÔ˘ ·fi ΢„ÂÏ›‰· , ·fi ÙËÓ American Academy of Otolaryngology - Head and Neck Surgery Foundation, Otolaryngol-Head Neck Surg 2008;139:S1-S21. √‰ËÁ›Â˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÏÈȉ›ˆÓ ÛÙ· ·È‰È¿, ·fi ÙËÓ American Academy of Pediatrics Committee on Nutrition, Pediatrics 2008;122: 198-208, ÁÈ· ÙËÓ ÎÏÈÓÈ΋, ÂÚÁ·ÛÙËÚȷ΋, ‰È·ÈÙËÙÈ΋ Î·È Ê·ÚÌ·ÎÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË. √È ÚÔËÁÔ‡ÌÂÓ˜ Ô‰ËÁ›Â˜ ›Û¯˘·Ó ·fi ÙÔ 1998. ∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· , ·fi ÙÔ ‚ÚÂÙ·ÓÈÎfi National Institute for Health and Clinical Excellence (NICE), BMJ 2008;337:a1095.

Paediatriki 2008;71:404-406

∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ ·ÁˆÁ‹ Ù˘ Ïԛ̈͢ ·fi ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ· ÓÂ¿ÚÎÂÈ·˜ HIV ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ·fi ÙËÓ International AIDS Society, JAMA 2008;300:555570. √È ÚÔËÁÔ‡ÌÂÓ˜ ›Û¯˘·Ó ·fi ÙÔ 2006. ¶ÚfiÛÊ·Ù˜ Ô‰ËÁ›Â˜ ÁÈ· ÙË Ïԛ̈ÍË ÛÙ· ·È‰È¿ ÛÙÔ Expert Rev Anti Infect Ther 2008;6:167-180 Î·È ÛԢˉÈΤ˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙËÓ Î‡ËÛË ÛÙÔ Scand J Infect Dis 2008;40:451-461. ∫·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ ÁÈ· ÙËÓ ·ÓÙÈÌ ÙÒÈÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ Û ·È‰È¿ Î·È Ó¤Ô˘˜ , ·fi ÙÔ Scottish Intercollegiate Guidelines Network (SIGN), Guideline Development Group, BMJ 208;336: 1367-1370.

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

NEWS FROM THE INTERNET

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∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

§. £ˆÌ·˝‰Ô˘

An algorithm for Developmental Surveillance and Screening

AÏÏËÏÔÁÚ·Ê›·: §ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘ developmental_health@yahoo.gr µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”

L. Thomaidis ∏ ÚÒÈÌË ·Ó›¯Ó¢ÛË ÙˆÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ÛˆÌ·ÙÈ΋, ÓÂ˘Ì·ÙÈ΋ Î·È „˘¯È΋ ˘Á›· ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ∂Í¿ÏÏÔ˘, ·ÔÙÂÏ› ¢ı‡ÓË ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, ÔÈ ÔÔ›ÔÈ ·Ú·ÎÔÏÔ˘ıÔ‡Ó Û˘ÛÙËÌ·ÙÈο ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·È‰ÈÒÓ. ∏ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ (AAP) ÚÔÙ›ÓÂÈ Û˘ÁÎÂÎÚÈ̤ÓÔ ·ÏÁfiÚÈıÌÔ Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ˆ˜ ÚfiÙ˘Ô ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·Ó¿Ù˘Í˘ ·È‰ÈÒÓ ·fi ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ.

µ’ Department of Pediatrics Children’s Hospital “P. & ∞. ∫iriakou” Correspondence: Loretta Thomaidis developmental_health@yahoo.gr µ’ Department of Pediatrics Children’s Hospital “P. & ∞. ∫iriakou”

1 Visit Complete

Pediatric Patient at Preventive Care Visit

Start

2 Schedule Early Return Visit

Perform Surveillance

Does Surveillance Demonstrate Risk?

Yes

Decision

No

5a

3

Action/ Process

6a Administer Screening Tool

7

No 5b 4 Is this a 9-, 18-, or 40-mo Visit?

Stop

Yes Are the Screening Tool Results Positive/ Concerning?

Yes

Make Referrals for: Developmental and Medical Evaluations and Early Developmental Intervention/ Early Childhood Services

6b

Administer Screening Tool

No

Yes Are the Screening Tool Results Positive/ Concerning?

No

Related Evaluation and Follow-up Visits

8 Schedule Next Routine Visit

Developmental and Medical Evaluations

Visit Complete

10 9 Visit Complete

Visit Complete

Schedule Early Return Visit

No

Is a Developmental Disorder Identified?

Yes

Identify as a Child With Special Health Care Needs Initiate Chronic Condition Management

Increasing Developmental Concern

∂ÈÎfiÓ· 1. ∞ÏÁfiÚÈıÌÔ˜ ÁÈ· ÙËÓ ÚÒÈÌË ·Ó›¯Ó¢ÛË ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ¶·È‰È·ÙÚÈ΋ 2008;71:407-408

Pediatri Sept-Oct 08

14-10-08

408

13:26

™ÂÏ›‰·408

¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ™˘ÓÈÛÙ¿Ù·È fiÙÈ ÚÔÏËÙÈÎfi˜, ·Ó·Ù˘ÍÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û fiÏ· Ù· Ê˘ÛÈÔÏÔÁÈο ·È‰È¿, ÛÙ· Ï·›ÛÈ· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Ù˘ ˘Á›·˜ ÙÔ˘˜ ·fi ÙÔÓ ·È‰›·ÙÚÔ. ∂ÈϤÔÓ, ÚÔÙ›ÓÂÙ·È fiÙÈ ÛÙȘ ËÏÈ˘ ÙˆÓ 9, 18 Î·È 30 ÌËÓÒÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÏËÙÈÎfi˜ ·Ó·Ù˘ÍÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÂȉÈÎÒÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ. ∏ ÚÒÈÌË ·Ó›¯Ó¢ÛË Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·Ù·Ú·¯‹˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ¤Á΢ÚË ·Ú·ÔÌ‹ ÁÈ· ·Ó·Ù˘Íȷ΋ ‰È¿ÁÓˆÛË Î·È ·Ó‡ÚÂÛË ÙˆÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÙËÓ ÚÔηÏ›. ∆· ·È‰È¿ ÛÙ· ÔÔ›· Á›ÓÂÙ·È ‰È¿ÁÓˆÛË ·Ó·Ù˘Íȷ΋˜ ‰È·Ù·Ú·¯‹˜ ÌÔÚÔ‡Ó Ó· ˆÊÂÏËıÔ‡Ó ·fi ÙËÓ ¤Á΢ÚË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Î·È ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ÁÈ· ÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·.

∏ ÈÛÙÔÛÂÏ›‰· Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ http://www.pediatrics.org/cgi/content/full/118/1/405 ™ÙËÓ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ˘¿Ú¯Ô˘Ó ·Ó·Ï˘ÙÈΤ˜ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÂÓۈ̿وÛË ÙÔ˘ ÚÔÏËÙÈÎÔ‡ ·Ó·Ù˘ÍÈ·ÎÔ‡ ÂϤÁ¯Ô˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú¿ÍË. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ô ·Ó·Ù˘ÍÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ÚÔÙ›ÓÂÙ·È ÛÙȘ Û˘ÁÎÂÎÚÈ̤Ó˜ ËÏÈ˘ ÙˆÓ 9, 18 Î·È 30 ÌËÓÒÓ Û fiÏ· Ù· Ê˘ÛÈÔÏÔÁÈο ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ı› Ô ·È‰›·ÙÚÔ˜. µÚ‹Î· ÙȘ ÏËÚÔÊÔڛ˜ ·˘Ù¤˜ ȉȷ›ÙÂÚ· ¯Ú‹ÛÈ̘ Î·È ÂÏ›˙ˆ fiÙÈ ı· Û·˜ ÂӉȷʤÚÔ˘Ó. ™ÙËÓ ÈÛÙÔÛÂÏ›‰· ·Ú¤¯ÂÙ·È Î·È Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.

∏ ÈÛÙÔÛÂÏ›‰· ·Ó·Ù˘Íȷ΋˜ ·È‰È·ÙÚÈ΋˜ ÛÙÔ ¢È·‰›ÎÙ˘Ô - http://www.dbpeds.org/ √È ÏËÚÔÊÔڛ˜ Ô˘ ·Ú¤¯ÂÈ ·˘Ù‹ Ë ÈÛÙÔÛÂÏ›‰· Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈ̘ ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ Ô˘ ÂӉȷʤÚÂÙ·È Ó· Û˘ÌÂÚÈÏ¿‚ÂÈ ÙÔÓ ÚÔÏËÙÈÎfi ·Ó·Ù˘ÍÈ·Îfi ¤ÏÂÁ¯Ô ÛÙË ‰È·‰Èηۛ· ‰È¿ÁÓˆÛ˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ı›. ∂‰Ò Ô ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ‚ÚÂÈ, ÌÂٷ͇ ¿ÏψÓ, ÂӉȷʤÚÔÓÙ· ¿ÚıÚ· ÔÚÁ·ÓˆÌ¤Ó· Û ıÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜, Ú·ÎÙÈο ÂÚÁ·Ï›· ÁÈ· ÙÔÓ ·Ó·Ù˘ÍÈ·Îfi ¤ÏÂÁ¯Ô, ÂÓËÌÂÚˆÙÈο Ê˘ÏÏ¿‰È· ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ı¤Ì·Ù· ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡, ηıÒ˜ Î·È ¯Ú‹ÛÈÌ· links.

Paediatriki 2008;71:407-408

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·409

¡∂∫ƒ√§√°π∞

OBITUARY

409

VICTOR A. McKUSICK (21 √ÎÙˆ‚Ú›Ô˘ 1921 – 22 πÔ˘Ï›Ô˘ 2008)

∏ ÂÈÛÙ‹ÌË ıÚËÓ› ÙÔÓ “·Ù¤Ú· Ù˘ È·ÙÚÈ΋˜ ÁÂÓÂÙÈ΋˜” ªÂÙ¿ ·fi Û‡ÓÙÔÌË Ì¿¯Ë Ì ÙÔÓ Î·ÚΛÓÔ, Ô Dr. Victor Almon McKusick ·‚›ˆÛÂ, Û ËÏÈΛ· 87 ÂÙÒÓ, ÛÙȘ 22 πÔ˘Ï›Ô˘ ÙÔ˘ 2008. √ Victor, Â›ÙÈÌÔ˜ ‰È‰¿ÎÙˆÚ ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ‹Ù·Ó ÁÓˆÛÙfi˜ ÛÙÔ˘˜ ŒÏÏËÓ˜ ·È‰È¿ÙÚÔ˘˜ ÙfiÛÔ ·fi ÙÔ “ÁÈÁ¿ÓÙÈÔ” ¤ÚÁÔ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ ÁÂÓÂÙÈ΋ fiÛÔ Î·È ·fi ÙȘ ÁÏ·Ê˘Ú¤˜ ·ÚÔ˘ÛÈ¿ÛÂȘ ÙÔ˘ ÛÙ· Û˘Ó¤‰ÚÈ·. √ Victor Î·È Ô ÌÔÓÔˆÔÁÂÓ‹˜ ‰›‰˘ÌÔ˜ ·‰ÂÏÊfi˜ ÙÔ˘ Vincent L. McKusick, LL.B., Ô ÔÔ›Ô˜ ›¯Â Á›ÓÂÈ ·Ú¯È‰ÈηÛÙ‹˜ ÛÙÔ ∞ÓÒÙ·ÙÔ ¢ÈηÛÙ‹ÚÈÔ Ù˘ ¶ÔÏÈÙ›·˜ Maine, ÁÂÓÓ‹ıËÎ·Ó ÛÙȘ 21 √ÎÙˆ‚Ú›Ô˘ 1921 Û ÌÈ· ÔÈÎÔÁ¤ÓÂÈ· ÌÂ Û˘ÓÔÏÈο 5 ·È‰È¿. √ ·Ù¤Ú·˜ ›¯Â ˘ËÚÂÙ‹ÛÂÈ ˆ˜ Á˘ÌÓ·Ûȿگ˘ ÛÙË ¶ÔÏÈÙ›· Vermont ÁÈ· 9 ¯ÚfiÓÈ·. ∏ ÌËÙ¤Ú· ÙÔ˘ ‹Ù·Ó ‰·ÛοϷ. ∏ ÔÈÎÔÁ¤ÓÂÈ· ¤˙ËÛ Û Á·Ï·ÎÙÔ·Ú·ÁˆÁfi ·ÁÚfiÎÙËÌ· ÛÙÔ Parkman Ù˘ ÔÏÈÙ›·˜ Maine.

TÔ Î·ÏÔη›ÚÈ ÙÔ˘ 1937, Ô Victor ·Ó¤Ù˘Í ‚·ÚÈ¿˜ ÌÔÚÊ‹˜ ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË, ÁÈ· ÙËÓ ÔÔ›· ÓÔÛËχıËΠ·Ú¯Èο Û ÓÔÛÔÎÔÌÂ›Ô ÛÙÔ Maine ÁÈ· Ì›· ‚‰ÔÌ¿‰· Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÁÈ· 10 ‚‰ÔÌ¿‰Â˜ ÛÙÔ Massachusetts General Hospital Ù˘ µÔÛÙÒÓ˘. ∆ÂÏÈο, ıÂÚ·‡ÙËΠ̠ÛÔ˘ÏÊ·ÓÈÏ·Ì›‰Ë, Ë ÔÔ›· ÌfiÏȘ ÙfiÙ ›¯Â ΢ÎÏÔÊÔÚ‹ÛÂÈ ÛÙȘ ∏¶∞. ŒÙÛÈ, ÂÓÒ Û¯Â‰›·˙ ӷ Á›ÓÂÈ ÈÂڈ̤ÓÔ˜, Ë Â·Ê‹ ÙÔ˘ Ì ÙÔ˘˜ ÁÈ·ÙÚÔ‡˜ ÙÔÓ ÂËÚ¤·ÛÂ Î·È ÛÔ‡‰·Û ȷÙÚÈ΋. ∆Ô 1940, ÌÂÙ¿ ÙȘ Á˘ÌÓ·ÛÙÈΤ˜ ÛÔ˘‰¤˜, Ô Victor ÂÓÂÁÚ¿ÊË ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Tufts ηÈ, ÌÂÙ¿ ÙÔ ÙÚ›ÙÔ ¤ÙÔ˜, ÂÓÂÁÚ¿ÊË ÛÙËÓ π·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ John Hopkins, ÛÙÔ ÔÔ›Ô ‰È·ÎÔÓÔ‡Û·Ó ÔÈ ÎÔÚ˘Ê·›ÔÈ Ù¤ÛÛÂÚȘ ηıËÁËÙ¤˜ William H. Welch, William Osler, Howard Atwood Kelly Î·È William Stewart Halsted. §fiÁˆ Ù˘ ÂÈÛÙÚ·Ù‡Ûˆ˜, ˘‹Ú¯·Ó ÔÏϤ˜ ÎÂÓ¤˜ ı¤ÛÂȘ ÛÙ· ¶·ÓÂÈÛÙ‹ÌÈ· Î·È ¤ÙÛÈ Ô Victor ‰ÂÓ ¯ÚÂÈ¿ÛıËΠӷ ÂÚ·ÙÒÛÂÈ ÚÒÙ· ÙȘ ÎÔÏÂÁȷΤ˜ ÛÔ˘‰¤˜. ™‡Ìʈӷ Ì ÙÔÓ McKusick, Ë ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ‹Ù·Ó ıÚËÛ΢fiÌÂÓË Î·È ·Ú·ÎÔÏÔ˘ıÔ‡Û ٷÎÙÈο ÙËÓ ÂÎÎÏËÛ›·. ∏ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ ‹Ù·Ó Â›Û˘ Ôχ ‰È·ÓÔÔ‡ÌÂÓË Î·È ·˘Ùfi ‰È¢ÎfiÏ˘Ó ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÚÔÛ¤ÁÁÈÛË ÛÙËÓ È·ÙÚÈ΋. ∂ÓÒ ÂÙÔÈÌ·˙fiÙ·Ó Ó· ÂÈÛÙÚ¤„ÂÈ ÛÙÔ Maine ÁÈ· Ó· ·Û΋ÛÂÈ ÁÂÓÈ΋ È·ÙÚÈ΋, ÂÂϤÁË ˆ˜ ÂȉÈ΢fiÌÂÓÔ˜ “William Osler” ÛÙËÓ ¶·ıÔÏÔÁ›·, ÔfiÙÂ Î·È ·Ú¤ÌÂÈÓ ÛÙÔ Johns Hopkins ̤¯ÚÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘. ∆Ș ÂfiÌÂÓ˜ ‰ÂηÂٛ˜, Ô

McKusick ‰È‹˘ı˘Ó ÙËÓ ∫ÏÈÓÈ΋ ÃÚfiÓÈˆÓ ¶·ı‹ÛÂˆÓ Î·È ÌÂٷ͇ 1957-1973 ÚÔ˝ÛÙ·ÙÔ Ù˘ Œ‰Ú·˜ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜, Ë ÔÔ›· ›¯Â ‰ËÌÈÔ˘ÚÁËı› ÚÔ˜ ÙÈÌ‹Ó ÙÔ˘. ∞fi ÙÔ 1973 ̤¯ÚÈ ÙÔ 1985 ‰Èˇı˘Ó ˆ˜ ∫·ıËÁËÙ‹˜-∞Ú¯›·ÙÚÔ˜ ÙÔ ¡ÔÛÔÎÔÌÂ›Ô Johns Hopkins Î·È ‹Ù·Ó Ô William Osler ηıËÁËÙ‹˜ Ù˘ ¶·ıÔÏÔÁ›·˜ Î·È ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ ∆Ì‹Ì·ÙÔ˜ ¶·ıÔÏÔÁ›·˜. ∞fi ÙÔ 1985 ̤¯ÚÈ ÙȘ ·Ú·ÌÔÓ¤˜ ÙÔ˘ ı·Ó¿ÙÔ˘ ÙÔ˘, Ô Victor ‰›‰·ÍÂ, ‰ÈÂÍ‹Á·Á ¤Ú¢Ó˜ Î·È ÂÍ¿ÛÎËÛ ȷÙÚÈ΋ ÛÙ· ∆Ì‹Ì·Ù· ¶·ıÔÏÔÁ›·˜ Î·È π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ Johns Hopkins. À‹ÚÍ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ‰‡Ô ÂÈÛÙËÌÔÓÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ, ÙˆÓ “Genomics” Î·È “Medicine”.

O McKusick Âͤ‰ˆÛ ÙÔ 1966 ÙËÓ ÚÒÙË ¤Î‰ÔÛË Î·Ù·ÏfiÁÔ˘ fiÏˆÓ ÙˆÓ ÙfiÙ ÁÓˆÛÙÒÓ ÁÔÓȉ›ˆÓ Î·È ÁÂÓÂÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÙÔ “Mendelian Inheritance in Man (MIª)”. ∏ ÙÂÏÈ΋ 12Ë ¤Î‰ÔÛË ÙÔ˘ ηٷÏfiÁÔ˘ ΢ÎÏÔÊfiÚËÛ ÙÔ 1998. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÙÔ ªπª ‰È·Ù›ıÂÙ·È ·fi ÙÔ 1987 ‰ˆÚÂ¿Ó ÛÙÔ ‰È·‰›ÎÙ˘Ô, ˆ˜ Online Mendelian Inheritance in Man (OMIM), Û˘Ó‰ÂfiÌÂÓÔ Ì ÙÔ ∂ıÓÈÎfi ∫¤ÓÙÚÔ µÈÔÙ¯ÓÔÏÔÁÈ΋˜ ¶ÏËÚÔÊÔÚ›·˜ (NCBI) Î·È ÙËÓ ∂ıÓÈ΋ π·ÙÚÈ΋ µÈ‚ÏÈÔı‹ÎË (NLM). O McKusick ‹Ù·Ó Â›Û˘ È‰Ú˘Ù‹˜ ÙÔ 1989 Î·È Úfi‰ÚÔ˜ ÙÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÙÔ˘ ∞ÓıÚÒÈÓÔ˘ °ÔÓȉÈÒÌ·ÙÔ˜ (Human Genome Organization - HUGO). ∞fi ÙÔ 1960 ηıȤڈÛ ÙÔ ÂÙ‹ÛÈÔ ‚Ú·¯‡ course π·ÙÚÈ΋˜ Î·È ¶ÂÈÚ·Ì·ÙÈ΋˜ °ÂÓÂÙÈ΋˜ ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ Jackson, ÛÙÔ Bar Harbor Ù˘ ¶ÔÏÈÙ›·˜ Maine Î·È ·fi ÙÔ 1987 ÙÔ ÂÙ‹ÛÈÔ Course π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ∫¤ÓÙÚÔ˘ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ Ù˘ Bologna, ÛÙÔ Bertinoro di Romagna ÛÙËÓ πÙ·Ï›·. √ Victor McKusick ›¯Â ¢ڇ Û˘ÁÁÚ·ÊÈÎfi ¤ÚÁÔ ÛÙËÓ πÛÙÔÚ›· Ù˘ π·ÙÚÈ΋˜, ÙË °ÂÓÂÙÈ΋ ηÈ, ȉȷ›ÙÂÚ·, ÙËÓ π·ÙÚÈ΋ °ÂÓÂÙÈ΋. π‰È·›ÙÂÚË ÌÓ›· Ú¤ÂÈ Ó· Á›ÓÂÈ ÛÙ· “Selected Papers Assembled with commentary” (1978), “Probable Assignment of the Duffy Blood Group Locus to Chromosome 1 in Man” (PNAS 61:949-955) Î·È “A Synopsis of Clinical Auscultation, Being a Treatise on Cardiovascular and Respiratory Sound, Intro-duced by a Historical Survey, Illustrated by Sound Spectrograms and Supplemented by a Comprehensive Bibliography”

ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛfiη˜ √ÌfiÙÈÌÔ˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜

¶·È‰È·ÙÚÈ΋ 2008;71:409-410

Pediatri Sept-Oct 08

410

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13:26

™ÂÏ›‰·410

¡∂∫ƒ√§√°π∞ (1956), Ù· ÔÔ›· Î·È Î·Ù¤ÛÙËÛ·Ó ÈÛÙÔÚÈ΋˜ ·Í›·˜. °È· ÙËÓ ÈÛÙÔÚ›· Ù˘ È·ÙÚÈ΋˜ ÁÂÓÂÙÈ΋˜ Û˘Ó¤ÁÚ·„ ÔÏÏ¿ ¿ÚıÚ· Î·È ÎÂÊ¿Ï·È· Û ‚È‚Ï›·: “Heritable Disorders of Connective Tissue” (¤ÓÙ ÂΉfiÛÂȘ 1956-1993), “Cardiovascular Sound in Health and Disease” (1958), “Medical Genetics” (ÙÚÂȘ ÂΉfiÛÂȘ 1958-1961), “Human Genetics” (‰‡Ô ÂΉfiÛÂȘ 1964 Î·È 1969), “On the X-Chromosome of Man” (1964), “Mendelian Inheritance in Man” (‰Ò‰Âη ÂΉfiÛÂȘ 1966-1998), “Medical Genetics Self-Instruction Guide” (1993), “Osler’s Textbook Revisited” (1967), “Genetics of Hand Malformations”, (1978), “Medical Genetic Studies of the Amish” (1978), “∞ Model of its Kind” (1989), “Osler’s Legacy” (1990), “A Century of Biomedical Science at Johns Hopkins” (1993). ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ‰È·‰Ú·Ì¿ÙÈÛ ÛÙËÓ ¤Ú¢ӷ ÁÈ· ÙÔ Â¿Ó Ô ∞‚Ú·¿Ì §›ÓÎÔÏÓ ¤·Û¯Â ·fi Û‡Ó‰ÚÔÌÔ Marfan. ™ÙÔÓ McKusick ·ÂÓÂÌ‹ıË ÙÔ ‚Ú·‚Â›Ô Albert Lasker ÁÈ· ∂ÈÙ˘¯›· ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË ÙÔ 1997. ∆Ô 2001 ¤Ï·‚ ÙÔ ∂ıÓÈÎfi ªÂÙ¿ÏÏÈÔ ∂ÈÛÙ‹Ì˘ ÙˆÓ ∏¶∞, ÂÓÒ ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Johns Hopkins ÙÔÓ ÂÙ›ÌËÛ ‰‡Ô ¯ÚfiÓÈ· ·ÚÁfiÙÂÚ·, ‰›ÓÔÓÙ·˜ ÙÔ fiÓÔÌ¿ ÙÔ˘ ÛÙÔ πÓÛÙÈÙÔ‡ÙÔ °ÂÓÂÙÈ΋˜ π·ÙÚÈ΋˜. ªÂٷ͇ Ù˘ ÏËıÒÚ·˜ ÙˆÓ ‰È·ÎÚ›ÛˆÓ, Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ô McKusick ·Ó·ÁÔÚ‡ıËΠÂ›ÙÈÌÔ˜ ‰È‰¿ÎÙˆÚ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÙÔ 2000. ¢Èη›ˆ˜ Ô Victor A. McKusick ›¯Â ıˆÚËı› ˆ˜ Ô ·Ù¤Ú·˜ Ù˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜. ªÂÁ¿ÏË ‹Ù·Ó Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ˆ˜ ÂÎ·È‰Â˘Ù‹ ÙˆÓ ÔÏ˘¿ÚÈıÌˆÓ research fellows Ô˘ ¤Ú·Û·Ó ·fi ÙÔ Johns Hopkins, ηıÒ˜ Î·È ·fi Ù· ÂÙ‹ÛÈ· Ì·ı‹Ì·Ù· (Delineation of Birth Defects) Ô˘ ÔÚÁ¿ÓˆÓ ÛÙË µ·ÏÙÈÌfiÚË, ÌÂ Û˘ÌÌÂÙÔ¯‹ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÈÛÙËÌfiÓˆÓ, ‹ ÛÙÔ Bar Harbor, Maine, ÁÈ· ÙËÓ ¶ÂÈÚ·Ì·ÙÈ΋ °ÂÓÂÙÈ΋ ‹ Â›Û˘ ÛÙËÓ πÙ·Ï›·. √ Û˘Ó¯Ҙ ·Ó·ÓÂÔ‡ÌÂÓÔ˜ ηٿÏÔÁÔ˜ ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ (Mendelian Inheritance in

Paediatriki 2008;71:409-410

Man) ·ÔÙ¤ÏÂÛ ÙÔ ··Ú·›ÙËÙÔ ÂÁÎfiÏÈÔ Û οı ÎÏÈÓÈÎfi ÁÂÓÂÙÈÛÙ‹. √ McKusick Û˘Ó¤‰ÂÛ ÙÔ fiÓÔÌ¿ ÙÔ˘ Ì 4-5 ÁÂÓÂÙÈο Û‡Ó‰ÚÔÌ·. ™ÙË Ì·ÎÚ¿ ÛÙ·‰ÈÔ‰ÚÔÌ›· ÙÔ˘ Û˘Ó¤‚·Ï ÚˆÙÔÔÚȷο ˆ˜ ηډÈÔÏfiÁÔ˜ ÌÂ Û˘ÁÁÚ¿ÌÌ·Ù· fiˆ˜ “The Heart Murmur” Î·È “Heritable Disorders of Connective Tissue”. ™ÙÔÓ ÙÔ̤· ·˘Ùfi ‰È¢ÎÚ›ÓÈÛ ٷ Û‡Ó‰ÚÔÌ· Marfan, Ehlers-Danlos Î.¿. ∂›¯Â ηٷÚÙ›ÛÂÈ ÌÈ· ÙÂÚ¿ÛÙÈ· Û˘ÏÏÔÁ‹ ‰È·Ê·ÓÂÈÒÓ ·fi fiÏÔ˘˜ ۯ‰fiÓ ÙÔ˘˜ ÁÂÓÂÙÈÛÙ¤˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ, Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤ÓÔ˜ ÌÂ Û˘¯Ó‹ ·ÏÏËÏÔÁÚ·Ê›·, ÂÓË̤ڈÛË, ηıÔ‰‹ÁËÛË Î·È ¤ÎÊÚ·ÛË ÂÈÏÈÎÚÈÓÔ‡˜ ÊÈÏ›·˜.

O McKusick ˘‹ÚÍ ‰Ú·ÛÙ‹ÚÈÔ˜ ÎÏÈÓÈÎfi˜ ÂÈÛً̈Ó, ÚˆÙÔfiÚÔ˜ ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ ÌÂٷ͇ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î·È ÓfiÛÔ˘. ∏ ‰ÈÂıÓ‹˜ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ÙÔÓ Ù›ÌËÛ Â·ÓÂÈÏËÌ̤ӈ˜ ˆ˜ ÙÔÓ ·Ù¤Ú·È‰Ú˘Ù‹ Ù˘ È·ÙÚÈ΋˜ ÁÂÓÂÙÈ΋˜ ˆ˜ Ó¤·˜ ÂȉÈÎfiÙËÙ·˜ Î·È ˆ˜ ˘¤ÚÔ¯Ô Ì¤ÓÙÔÚ· ÔÏÏÒÓ ÁÂÓÂÒÓ Î·ıËÁËÙÒÓ, Ó¤ˆÓ È·ÙÚÒÓ, ÂȉÈ΢ÔÌ¤ÓˆÓ Î·È ÊÔÈÙËÙÒÓ Ô˘ ÚÔÛÌÂÙÚÒÓÙ·È Û ¯ÈÏÈ¿‰Â˜. §¤ÁÂÙ·È fiÙÈ ¤¯ÂÈ ÂÎ·È‰Â‡ÛÂÈ 4.000 ÁÂÓÂÙÈÛÙ¤˜. ∂›¯Â ÙÈÌËı› Ì ÌÂÁ¿ÏÔ ·ÚÈıÌfi ‰ÈÂıÓÒÓ Î·È ÂıÓÈÎÒÓ ‰È·ÎÚ›ÛˆÓ, ‰È‰·ÎÙÔÚÈÒÓ honoris causa, Û ÌÈ· ÂÈÛÙËÌÔÓÈ΋ ηÚȤڷ Û˘Ó¯ԇ˜ ‰È¿ÚÎÂÈ·˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Johns Hopkins. ⁄„ÈÛÙ˜ ÙÈ̤˜ ‹Ù·Ó Ù· ‚Ú·‚›· Albert Lasker ÙÔ 1997 Î·È ÙÔ ∂ıÓÈÎfi ªÂÙ¿ÏÏÈÔ ∂ÈÛÙ‹Ì˘ ÙÔ 2001. Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ô McKusick ˘‹ÚÍÂ Ô È‰Ú˘Ù‹˜-Úfi‰ÚÔ˜ ÙÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ∞ÓıÚÒÈÓÔ˘ °ÔÓȉÈÒÌ·ÙÔ˜ (HUGO) Î·È Ì¤ÏÔ˜ Ù˘ ÂıÓÈ΋˜ ∞η‰ËÌ›·˜ ∂ÈÛÙËÌÒÓ ÙˆÓ ∏¶∞, ·fi ÙÔ 1973. ªÂ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ McKusick Ë ÂÈÛÙ‹ÌË ¤¯·Û ¤Ó·Ó “Á›Á·ÓÙ·”. ªÂ ÙÔÓ ı¿Ó·Ùfi ÙÔ˘ ÎÏ›ÓÂÈ ÙÔ ÎÂÊ¿Ï·ÈÔ Ù˘ ∫ÏÈÓÈ΋˜ °ÂÓÂÙÈ΋˜. ∂›ı ӷ ‚ÚÂı› ·ÓÙ¿ÍÈÔ˜ ‰È¿‰Ô¯fi˜ ÙÔ˘ ÛÙËÓ ∫ÏÈÓÈ΋ °ÔÓȉȈ̷ÙÈ΋, ÛÙË ‰ËÌÈÔ˘ÚÁ›· Ù˘ ÔÔ›·˜ Û˘ÓÂÙ¤ÏÂÛÂ Ô McKusick.

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·411

∫§π¡π∫√ ∫√Àπ∑

411

∞¶∞¡∆∏™∏ ¢È¿ÁÓˆÛË: ªÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·

∆Ô ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ·Ó¤‰ÂÈÍ ÙËÓ ·ÎÚÈ‚‹ ·Ó·ÙÔÌÈ΋ ÂÓÙfiÈÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÛÙÔ Ì¤ÛÔ ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (¤ÏÏÂÈÌÌ· ÙÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜) Î·È ÙȘ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ Û˘Ó¤ÂȤ˜ Ù˘ (‰È¿Ù·ÛË ‰ÂÍÈÔ‡ ÎfiÏÔ˘, ÎÔÈÏ›·˜, ·‡ÍËÛË ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ÛÙ· Ó¢ÌÔÓÈο ·ÁÁ›·) (∂ÈÎfiÓ· 4). ∞ÎÔÏÔ‡ıËÛ ÂÈÙ˘¯‹˜ ηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜, ηıÒ˜ ÙÔ ÌÂÁ¿ÏÔ Ì¤ÁÂıfi˜ Ù˘ (1) ‰ÂÓ Â¤ÙÚÂ ÙË Û‡ÁÎÏÂÈÛË Ì ÂȉÈ΋ Û˘Û΢‹ Ì ηıÂÙËÚÈ·ÛÌfi (2). ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊËΠ·ÓÙÈÚÔÛˆ‡ÂÈ ÌÈ· Ù˘È΋ ÂÚ›ÙˆÛË ÙÔ˘ ÙÚfiÔ˘ Ì ÙÔÓ ÔÔ›Ô ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·È ‰È·ÁÈÁÓÒÛÎÂÙ·È Ë ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∫·Ù¿ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹ ·ÓÙÈÚÔÛˆ‡ÂÈ ÌÈ· ¯Ú‹ÛÈÌË ÂÓ‰Ôηډȷ΋ Ô‰fi ·Ú¿Î·Ì„˘ Ù˘ Ó¢ÌÔÓÈ΋˜ ΢ÎÏÔÊÔÚ›·˜: Ô͢ÁÔӈ̤ÓÔ ·fi ÙÔÓ Ï·ÎÔ‡ÓÙ· ·›Ì· Êı¿ÓÂÈ ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ Î·È, ̤ۈ ÙÔ˘ ·ÓÔ›ÁÌ·ÙÔ˜ ÙÔ˘ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ·ˆı› ÙÔ ÏÂÙfi ÚˆÙÔÁÂÓ¤˜ ‰È¿ÊÚ·ÁÌ· (Ô˘ ηχÙÂÈ ÙÔ ‰Â˘ÙÂÚÔÁÂÓ¤˜) ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ, ηٷϋÁÔÓÙ·˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ (‰ÂÍÈÔ·ÚÈÛÙÂÚ‹ ‰È·Ê˘Á‹). ªÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Ë ·˘ÍË̤ÓË ›ÂÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ ˆı› ÙÔ ÚˆÙÔÁÂÓ¤˜ ‰È¿ÊÚ·ÁÌ· ¿Óˆ ÛÙÔ ‰Â˘ÙÂÚÔÁÂÓ¤˜, ÎÏ›ÓÔÓÙ·˜ ÙË ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·. ∂¿Ó Ë Û‡ÁÎÏÂÈÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È Ï‹Ú˘, ÙfiÙ ˘¿Ú¯ÂÈ ·Ó·ÙÔÌÈ΋ ÂÈÎÔÈÓˆÓ›· ÙˆÓ ‰‡Ô ÎfiÏˆÓ Î·È ·ÓÙ›ÛÙÚÔÊË ÚÔ‹ ·›Ì·ÙÔ˜ (·ÚÈÛÙÂÚÔ‰ÂÍÈ¿ ‰È·Ê˘Á‹). √ ·˘ÍË̤ÓÔ˜ fiÁÎÔ˜ Ô͢ÁÔӈ̤ÓÔ˘ ·›Ì·ÙÔ˜ Ô˘ ‰È¤Ú¯ÂÙ·È ÙÒÚ· ‰È·Ì¤ÛÔ˘ ÙˆÓ ‰ÂÍÈÒÓ Î·Ú‰È·ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· ÙË ‰È¿Ù·Û‹ ÙÔ˘˜, Ô˘ Á›ÓÂÙ·È ·ÓÙÈÏËÙ‹ ·ÎÙÈÓÔÏÔÁÈο ˆ˜ ηډÈÔÌÂÁ·Ï›·, Ì ÚÔ‚ÔÏ‹ ÙÔ˘ ÙfiÍÔ˘ Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ Î·È ·‡ÍËÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÁÁ›ˆÛ˘. ™ÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, ·ÓÙ›ÛÙÔȯ·, ηٷÁÚ¿ÊÔÓÙ·È ˘„ËÏ¿ ÎÔÏÈο Â¿ÚÌ·Ù· p (ÏfiÁˆ ‰È¿Ù·Û˘ ‰ÂÍÈÔ‡ ÎfiÏÔ˘) Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ËÏÂÎÙÚÈ΋ ÂÎfiψÛË Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (ÏfiÁˆ ‰È¿Ù·Û˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜). ∆Ô Ê‡ÛËÌ· Ù˘ ÌÂÛÔÎÔÏÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜, Û ·ÓÙ›ıÂÛË Ì ¿ÏϘ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, ‰ÂÓ ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ÛËÌÂ›Ô Ù˘ ·Ó·ÙÔÌÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÙˆÓ ÎfiÏˆÓ, ·ÏÏ¿ ·fi ÙËÓ ·˘ÍË̤ÓË ·ÈÌ·ÙÈ΋ ÚÔ‹ Ô˘ ‰È¤Ú¯ÂÙ·È ‰È·Ì¤ÛÔ˘ ÌÈ·˜ Ê˘ÛÈÔÏÔÁÈ΋˜ (ÌË ÛÙÂÓˆÙÈ΋˜)

RV LV RA

LA

∂ÈÎfiÓ· 4. ÀÂÚ˯ÔηډÈÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË Ì ·ÂÈÎfiÓÈÛË ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜, ˆ˜ ÂÚÈÔ¯‹ ·Ô˘Û›·˜ ÙÔ˘ ˯ÔÁÂÓÔ‡˜ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ (‚¤ÏÔ˜, ·ÚÈÛÙÂÚ¿) Î·È ·ÚÈÛÙÂÚÔ‰ÂÍÈ¿˜ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ ÛÙÔ ¤Á¯ÚˆÌÔ Doppler (‰ÂÍÈ¿).

Ó¢ÌÔÓÈ΋˜ ‚·Ï‚›‰·˜. ∏ ¤ÓÙ·ÛË ¤ÙÛÈ ÙÔ˘ Û˘ÛÙÔÏÈÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ Û˘Ó‹ıˆ˜ Â›Ó·È ‹È·, Ô ¯·Ú·ÎÙ‹Ú·˜ ÙÔ˘ ˆ˜ crescendo-decrescendo (‹ ÂÍÒıËÛ˘) Î·È Ë ı¤ÛË ‚¤ÏÙÈÛÙ˘ ·ÎÚfi·Û˘ Ë ÂÛÙ›· ·ÎÚfi·Û˘ Ù˘ Ó¢ÌÔÓÈ΋˜ ‚·Ï‚›‰·˜. ÷ڷÎÙËÚÈÛÙÈÎfi, fï˜, ‰È·ÊÔÚԉȷÁÓˆÛÙÈÎfi ·ÎÚÔ·ÛÙÈÎfi ‡ÚËÌ· Â›Ó·È Ë ·ÚÔ˘Û›· ÛÙ·ıÂÚÔ‡ ‰È¯·ÛÌÔ‡ ÙÔ˘ 2Ô˘ ÙfiÓÔ˘ Ô˘, ·Ó ·Ó·˙ËÙËı› Ì ÚÔÛÔ¯‹, ۯ‰fiÓ ¿ÓÙ· ı¤ÙÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ ÌÂÛÔÎÔÏÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ (3). º˘ÛÈÔÏÔÁÈο ˘¿Ú¯ÂÈ Î·ı˘ÛÙ¤ÚËÛË Û‡ÁÎÏÂÈÛ˘ Ù˘ Ó¢ÌÔÓÈ΋˜ ‚·Ï‚›‰·˜ ÌfiÓÔ Î·Ù¿ ÙËÓ ÂÈÛÓÔ‹, Ë ÔÔ›· Á›ÓÂÙ·È ·ÎÚÔ·ÛÙÈο ·ÓÙÈÏËÙ‹ ˆ˜ ÂÈÛÓ¢ÛÙÈÎfi˜ ‰È¯·ÛÌfi˜ ÙÔ˘ 2Ô˘ ÙfiÓÔ˘ (Ô˘ ÂÍ·Ê·Ó›˙ÂÙ·È ÛÙËÓ ÂÎÓÔ‹). ∏ ·˘ÍË̤ÓË fï˜ ·ÈÌ·ÙÈ΋ ÚÔ‹ ‰È·Ì¤ÛÔ˘ ÙˆÓ ‰ÂÍÈÒÓ ÎÔÈÏÔÙ‹ÙˆÓ Û ·ÚÔ˘Û›· ÌÂÛÔÎÔÏÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Ô‰ËÁ› Û ÛÙ·ıÂÚ‹ ηı˘ÛÙ¤ÚËÛË Û‡ÁÎÏÂÈÛ˘ Ù˘ Ó¢ÌÔÓÈ΋˜ ‚·Ï‚›‰·˜ Î·È Û ¢ڇ ‰È¯·ÛÌfi ÙÔ˘ 2Ô˘ ÙfiÓÔ˘. ∆Ô ·È‰› ‰ÂÓ Â›¯Â ÏÂÈÙÔ˘ÚÁÈÎfi ʇÛËÌ·, ηıÒ˜ ˘‹Ú¯Â ˘ÔΛÌÂÓË ÛÔ‚·Ú‹ Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·, Ì ¤Ó‰ÂÈÍË, Ì¿ÏÈÛÙ·, ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·ÔηٿÛÙ·Û˘. ∆Ô Ê‡ÛËÌ· Ù˘ ÌÂÛÔÎÔÏÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Û˘Á¯¤ÂÙ·È Û˘¯Ófiٷٷ Ì ÏÂÈÙÔ˘ÚÁÈÎfi ʇÛËÌ·, Ì ·ÔÙ¤ÏÂÛÌ· Ë ‰È¿ÁÓˆÛË Ó· Ù›ıÂÙ·È Î·ı˘ÛÙÂÚË̤ӷ Î·È Î¿ÔÙ Ôχ ·ÚÁ¿ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÌÂÙ¿ ÙËÓ ·Ó¿Ù˘ÍË ÌË ·Ó·ÛÙÚ¤„ÈÌ˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘ (4,5). ¶·È‰È·ÙÚÈ΋ 2008;71:403,411-412

Pediatri Sept-Oct 08

14-10-08

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∫§π¡π∫√ ∫√Àπ∑ ∆Ô ÏÂÈÙÔ˘ÚÁÈÎfi ʇÛËÌ· fï˜ ¤¯ÂÈ ÂÚÈÛÛfiÙÂÚÔ Â‡Ë¯Ô (ÌÔ˘ÛÈÎfi) ¿ÎÔ˘ÛÌ·, Â›Ó·È ‚Ú·¯Â›·˜ ‰È¿ÚÎÂÈ·˜ ÌÂÛÔÛ˘ÛÙÔÏÈÎfi, ·ÎÔ‡ÁÂÙ·È Î·Ï‡ÙÂÚ· ¯·ÌËÏfiÙÂÚ· ·ÚÈÛÙÂÚ¿ ·Ú·ÛÙÂÚÓÈο, ÂÓÒ ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ÛÙ·ıÂÚfi ‰È¯·ÛÌfi ÙÔ˘ 2Ô˘ ÙfiÓÔ˘. ∫·ıÒ˜ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ÂÌÊ·Ó›˙ÂÈ Û οÔÈ· ÂͤٷÛË ÏÂÈÙÔ˘ÚÁÈÎÔ‡ ¯·Ú·ÎÙ‹Ú· ʇÛËÌ·, Ë ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ·fi ÙÔ Û·ÓÈfiÙÂÚÔ Ê‡ÛËÌ· Ù˘ ÌÂÛÔÎÔÏÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Ô˘ ÂÚÈÁÚ¿„·ÌÂ Â›Ó·È ÛËÌ·ÓÙÈ΋. ∏ Ó¢ÌÔÓÈ΋ ηډ›·, ˆ˜ Û˘Ó¤ÂÈ· ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ‰ÂÓ Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∆Ô ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ÌÔÚ› Ó· ‰Â›¯ÓÂÈ ·ÓÙ›ÛÙÔȯ· Â˘Ú‹Ì·Ù· ‰ÂÍÈ¿˜ ÂÈ‚¿Ú˘ÓÛ˘, ÎÏÈÓÈο fï˜ ˘¿Ú¯ÂÈ ¤ÓÙÔÓÔ˜ 2Ô˜ ÙfiÓÔ˜ (Î·È fi¯È ‰È¯·ÛÌfi˜), ÂÓÒ ·ÎÙÈÓÔÏÔÁÈο ˘¿Ú¯ÂÈ Û˘¯Ó¿ Ì›ˆÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÁÁ›ˆÛ˘. ∏ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ Û˘Óԉ‡ÂÙ·È Â›Û˘ ·fi ʇÛËÌ· ÂÍÒıËÛ˘ (fiˆ˜ Ë ÌÂÛÔÎÔÏÈ΋), Ì ÂÓÙfiÈÛË fï˜ ‰ÂÍÈ¿ ·Ú·ÛÙÂÚÓÈο Î·È Â¤ÎÙ·ÛË ÛÙÔÓ ÙÚ¿¯ËÏÔ. ∏ ·ÚÔ˘Û›· Û˘ÛÙÔÏÈ΋˜ ÎÏ·ÁÁ‹˜ (ÎÏÈÎ) ‰È·Óԛ͈˜ Î·È Ë ·Ô˘Û›· ‰ÂÍÈ¿˜ ÂÈ‚¿Ú˘ÓÛ˘ ÛÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Â›Ó·È ÚfiÛıÂÙ· ‰È·ÊÔÚԉȷÁÓˆÛÙÈο ÎÏÈÓÈο ÛËÌ›·. ∏ ·ÚÔ˘Û›·ÛË ÙÔ˘ ÂÚÈÛÙ·ÙÈÎÔ‡ ·˘ÙÔ‡ ÙÔÓ›˙ÂÈ ÙË ÛËÌ·Û›· Ù˘ ÂÈÌÂÏÔ‡˜ ηډȷ΋˜ ·ÎÚfi·Û˘ ÁÈ· ÙË ÛˆÛÙ‹ ‰È¿ÎÚÈÛË Ù˘ ÏÂÈÔ„ËÊ›·˜ ÙˆÓ ·È‰ÈÒÓ Ì ·ıÒ· ÏÂÈÙÔ˘ÚÁÈο Ê˘Û‹Ì·Ù· ·fi Ù· Û¿ÓÈ· ÂÚÈÛÙ·ÙÈο Ô˘ ¯Ú‹˙Ô˘Ó ÂÚ·ÈÙ¤Úˆ ÂϤÁ¯Ô˘ (6). ∫·ıÒ˜ Ë ·Ú·ÔÌ‹ οı ·È‰ÈÔ‡ Ì ʇÛËÌ· ÁÈ· ˘ÂÚ˯ÔηډÈÔ-

Paediatriki 2008;71:403,411-412

ÁÚ¿ÊËÌ· ‰ÂÓ Â›Ó·È Ô‡Ù ÂÊÈÎÙ‹ Ô‡ÙÂ Î·È ÔÈÎÔÓÔÌÈο ·Ô‰ÂÎÙ‹ ÚÔÛ¤ÁÁÈÛË (7), ÌfiÓÔ Ë ÛˆÛÙ‹ ÂÎ·›‰Â˘ÛË ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ·È‰È¿ÙÚÔ˘ ÛÙËÓ Î·Ú‰È·Î‹ ·ÎÚfi·ÛË ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·Ó›¯Ó¢ÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Kharouf R, Luxenberg DM, Khalid O, Abdulla R. Atrial septal defect: spectrum of care. Pediatr Cardiol 2008;29:271-280.

2. Thanopoulos BD, Laskari CV, Tsaousis GS, Zarayelyan A, Vekiou A, Papadopoulos GS. Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results. J Am Coll Cardiol 1998; 31:1110-1116.

3. McCrindle BW, Shaffer KM, Kan JS, Zahka KG, Rowe SA, Kidd L. Cardinal clinical signs in the differen-tiation of heart murmurs in children. Arch Pediatr Adolesc Med 1996;150:169-174.

4. Gatzoulis MA, Freeman MA, Siu SC, Webb GD, Harris L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999;340:839-846.

5. Engelfriet P, Meijboom F, Boersma E, Tijssen J, Mulder B. Repaired and open atrial septal defects type II in adulthood: an epidemiological study of a large European cohort. Int J Cardiol 2008;126:379385.

6. Germanakis I, Dittrich S, Perakaki R, Kalmanti M. Digital phonocardiography as a screening tool for heart disease in childhood. Acta Paediatr 2008;97: 470-473.

7. Yi MS, Kimball TR, Tsevat J, Mrus JM, Kotagal UR. Evaluation of heart murmurs in children: costeffectiveness and practical implications. J Pediatr 2002; 141:504-511.

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413

™˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV ∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ, ªÂÙ¿ ÙËÓ ¤ÓÙ·ÍË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV ÛÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ, Ô √ÚÁ·ÓÈÛÌfi˜ ¶ÂÚ›ı·Ï„˘ ∞ÛÊ·ÏÈÛÌ¤ÓˆÓ ÙÔ˘ ¢ËÌÔÛ›Ô˘ (√¶∞¢), ÛÙȘ 08/02/2008 Ì ÙËÓ ˘’ ·ÚÈıÌ. 5124 ÂÁ·ÎÏÈfi ÙÔ˘, ··ÁÔÚ‡ÂÈ ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ó· Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó ÙÔ ÂÌ‚fiÏÈÔ HPV Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 15 ÂÙÒÓ. ∆Ô ¢.™. Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜, ÌfiÏȘ ÏËÚÔÊÔÚ‹ıËΠÙËÓ ÂÁ·ÎÏÈÔ ·˘Ù‹, ·ÓÙ¤‰Ú·Û ¤ÓÙÔÓ· ÚÔ˜ ÙÔ ∫∂™À (¤ÁÁÚ·ÊÔ 1). ªÂ ÙËÓ ˘’ ·ÚÈıÌ. 6 ·fiÊ·ÛË Ù˘ 215˘ ÔÏÔ̤ÏÂÈ·˜ ÙÔ˘ ∫∂™À ÛÙȘ 03-04-2008, Ë Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÂÂÙÚ¿Ë Î·È ÛÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÂÙÒÓ (¤ÁÁÚ·ÊÔ 2). ™ÙÔ ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Ù˘ ∫¤Ú΢ڷ˜ Û·˜ ·Ó·ÎÔ›ÓˆÛ· ÙËÓ ÈÔ ¿Óˆ ·fiÊ·ÛË. ¶·Ú¿ Ù·‡Ù·, ÌfiÏȘ ÚÔ¯ı¤˜ ÂÓËÌÂÚÒıËη ·fi Û˘Ó·‰¤ÏÊÔ˘˜ fiÙÈ Ù· Ê·Ú̷Λ· ‰ÂÓ ¯ÔÚËÁÔ‡Ó ÙÔ ÂÌ‚fiÏÈÔ, ÁÈ’ ·˘Ùfi ıˆÚԇ̠ÛÎfiÈÌÔ Ó· Û·˜ ÂÓËÌÂÚÒÛÔ˘ÌÂ. ¶·Ú¿ÏÏËÏ·, ÂÓËÌÂÚÒÛ·Ì ÙÔÓ √¶∞¢ Î·È ÙÔÓ ¶·ÓÂÏÏ‹ÓÈÔ º·Ú̷΢ÙÈÎfi ™‡ÏÏÔÁÔ. √ ¶Úfi‰ÚÔ˜ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ∫·ı. ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

ŒÁÁÚ·ÊÔ 1: ∂ÈÛÙÔÏ‹ ÙÔ˘ ¶ÚÔ¤‰ÚÔ˘ Ù˘ ∂.¶.∂. ÚÔ˜ ÙÔÓ ¶Úfi‰ÚÔ ÙÔ˘ ∫∂.™.À ¶ÚÔ˜ ÙÔÓ ¶Úfi‰ÚÔ ÙÔ˘ ∫∂™À ∫·ıËÁ. Î. ∫˘ÚÈ¿ÎÔ ™ÙÚÈÁÁ¿ÚË ª·Î‰ÔÓ›·˜ 8, 104 33, ∞ı‹Ó·

∫‡ÚÈ ¶Úfi‰ÚÂ, ∆Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ÌÂÙ¿ χ˘ ÙÔ˘ ‰È·›ÛÙˆÛ fiÙÈ Î˘ÎÏÔÊÔÚÔ‡Ó ¤ÁÁÚ·Ê· Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. √ ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ √¶∞¢ Î. ¡. º·ÚÌ¿Î˘, Ì ÙÔ ˘’ ·ÚÈıÌ. 5124 ¤ÁÁÚ·Êfi ÙÔ˘ Û¯ÂÙÈο Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV, ·Ó·Ê¤ÚÂÈ “°È· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 15 ¤ˆ˜ 18 ÂÙÒÓ ÙÔ ÂÌ‚fiÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ Á˘Ó·ÈÎÔÏfiÁÔ˘˜, ÁÂÓÈ΋˜ È·ÙÚÈ΋˜ Î·È ·ıÔÏfiÁÔ˘˜, ÂÎÙfi˜ Î·È Â¿Ó ÙÔ ∫∂™À ·ÔÊ·Û›ÛÂÈ ‰È·ÊÔÚÂÙÈο”. ¢È·Ì·ÚÙ˘ÚfiÌÂı· ¤ÓÙÔÓ· ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·È‰È¿ÙÚˆÓ, ÁÈ· ÙÔ˘˜ ÂÍ‹˜ ÏfiÁÔ˘˜: 1. ∆· ÂÌ‚fiÏÈ· Û fiϘ ÙȘ ËÏÈ˘ Ù· ¯ÂÈÚ›˙ÔÓÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ· ·ÔÎÏÂÈÛÙÈο Î·È ÌfiÓÔ ÔÈ ·È‰›·ÙÚÔÈ. √È Á˘Ó·ÈÎÔÏfiÁÔÈ, ÁÂÓÈÎÔ› È·ÙÚÔ› Î·È ·ıÔÏfiÁÔÈ Ë ÌfiÓË ÂÎ·›‰Â˘ÛË Ô˘ ¤¯Ô˘Ó ÁÈ· Ù· ÂÌ‚fiÏÈ· Â›Ó·È ·fi Ù· ÊÔÈÙËÙÈο ÙÔ˘˜ ¯ÚfiÓÈ·.

2. ∏ ÂıÓÈ΋ ÂÈÙÚÔ‹ ÂÌ‚ÔÏÈ·ÛÌÒÓ, ÛÙËÓ ÔÔ›· Û˘ÌÌÂÙ¤¯ˆ Û˘Ó¯Ҙ ·fi ÙÔ 1983 ̤¯ÚÈ Û‹ÌÂÚ·, ·ÔÙÂÏÂ›Ù·È ·fi 11 ̤ÏË Ô˘ Ù· 7 Â›Ó·È ·È‰›·ÙÚÔÈ Î·È Ù· ¿ÏÏ· 4 ̤ÏË, ÛÙÂϤ¯Ë ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ÙÔ˘ ∫∂∂§. √˘‰¤ÔÙÂ Û˘ÌÌÂÙ›¯·Ó Á˘Ó·ÈÎÔÏfiÁÔÈ, ÁÂÓÈÎÔ› È·ÙÚÔ› Î·È ·ıÔÏfiÁÔÈ.

3. √È ÁÈ·ÙÚÔ› ÌÂÙ¿ ÙËÓ ·ÔÊÔ›ÙËÛ‹ ÙÔ˘˜ ·fi ÙÔ ¶·Ó/ÌÈÔ ËÁ·›ÓÔ˘Ó ÛÙ· ·ÁÚÔÙÈο È·ÙÚ›· Î·È Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó Ù· ¿ÓÙ·. °È·Ù› ÙÒÚ· ·ÔÎÏ›ÔÓÙ·È ÔÈ ·È‰›·ÙÚÔÈ; ª‹ˆ˜ ¤·„·Ó Ó· Â›Ó·È ÁÈ·ÙÚÔ›; 4. √È ËÏÈ˘ 15-18 ÂÙÒÓ, Ô˘ Ô ÔÚÁ·ÓÈÛÌfi˜ Û˘Ó¯›˙ÂÈ Ó· ·˘Í¿ÓÂÙ·È, ˘¿ÁÔÓÙ·È ·ÁÎÔÛÌ›ˆ˜ ÛÙÔÓ ·È‰›·ÙÚÔ. ø˜ ¶Úfi‰ÚÔ˜ Ù˘ ¶·ÓÂ˘Úˆ·˚΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ Û¿˜ ÁÓˆÚ›˙ˆ fiÙÈ ÙfiÛÔ ÛÙËÓ ∂˘ÚÒË fiÛÔ Î·È ÛÙËÓ ∞ÌÂÚÈ΋ ÔÈ ËÏÈ˘ 15-18 ·Ó‹ÎÔ˘Ó ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ ·È‰›·ÙÚÔ. ¶·È‰È·ÙÚÈ΋ 2008;71:413-415

Pediatri Sept-Oct 08

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∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏ ¢È·Ì·ÚÙ˘ÚfiÌÂı· ¤ÓÙÔÓ· ÁÈ· ÙÔÓ ¿‰ÈÎÔ ·ÔÎÏÂÈÛÌfi ÙˆÓ ·È‰È¿ÙÚˆÓ ·fi ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ HPV Î·È Â˘ÂÏÈÛÙԇ̠ÛÙËÓ ·ÔηٿÛÙ·ÛË ·˘ÙÔ‡ ÙÔ˘ ‰ÈηÈÒÌ·Ùfi˜ Ì·˜, ÂΠ̤ÚÔ˘˜ Û·˜. ªÂ ÙÈÌ‹, ∫·ı. ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¶Úfi‰ÚÔ˜ ¶·ÓÂ˘Úˆ·˚΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ ∫ÔÈÓÔÔ›ËÛË: ÀÔ˘ÚÁfi ÀÁ›·˜ Î. ¢. ∞‚Ú·ÌfiÔ˘ÏÔ ÀÊ˘Ô˘ÚÁfi ÀÁ›·˜ Î. °. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ °ÂÓ. °Ú·ÌÌ. ÀÁ›·˜ Î. ∫·ÏÔÁÂÚfiÔ˘ÏÔ ¶Úfi‰ÚÔ ¶·ÓÂÏÏ‹ÓÈÔ˘ π·ÙÚÈÎÔ‡ ™˘ÏÏfiÁÔ˘ Î. ∂ÌÌ. ∫·ÏÔηÈÚÈÓfi ¢È¢ı˘ÓÙ‹ √¶∞¢ Î. ¡. º·ÚÌ¿ÎË

ŒÁÁÚ·ÊÔ 2: ∞fiÊ·ÛË ÙÔ˘ ∫∂.™.À. Û¯ÂÙÈο Ì ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV ∂§§∏¡π∫∏ ¢∏ª√∫ƒ∞∆π∞ ∫∂¡∆ƒπ∫√ ™Àªµ√À§π√ À°∂π∞™

∞ı‹Ó· 30.5.2008 ∞ÚÈıÌ. ∞fiÊ. 6 Ù˘ 215˘ √ÏÔÌ./3.4.2008

∞¶√º∞™∏ “™¯ÂÙÈÎÒ˜ Ì ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV” ªÂ ÙÔ ˘’ ·ÚÈıÌ. ÚˆÙ. oÈÎ.4832/6.2.2008 ¤ÁÁÚ·ÊÔ ÙÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ¶ÂÚ›ı·Ï„˘ ∞ÛÊ·ÏÈÛÌ¤ÓˆÓ ¢ËÌÔÛ›Ô˘ (√.¶.∞.¢.), ˙ËÙÔ‡ÓÙ·È ÏËÚÔÊÔڛ˜ ·fi ÙÔ ∫∂.™.À. Û¯ÂÙÈο Ì ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV, ·Ó·Ê¤ÚÔÓÙ·˜ Ù· ·ÎfiÏÔ˘ı·: ™ÙÔ ¡¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV), ÙÔ ÔÔ›Ô Û˘ÓÈÛÙ¿Ù·È Û ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 12-15 ÂÙÒÓ Î·È Û ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ 15 ¤ˆ˜ 26 ÂÙÒÓ Â¿Ó ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·Ûı› ÛÙË Û˘ÓÈÛÙÒÌÂÓË ËÏÈΛ· (¯ˆÚ›˜ Ó· ‰È·ÛÊ·Ï›˙ÂÙ·È Ë ÚÔʇϷ͋ ÙÔ˘˜ Â¿Ó ¤¯Ô˘Ó ÌÔÏ˘Óı› ·fi Ù‡Ô ÙÔ˘ ÈÔ‡ Ô˘ ÂÚȤ¯ÂÙ·È ÛÙÔ ÂÌ‚fiÏÈÔ, ȉȷ›ÙÂÚ· Â¿Ó ¤¯Ô˘Ó ·ÏÏ¿ÍÂÈ 3-4 ÛÂÍÔ˘·ÏÈÎÔ‡˜ Û˘ÓÙÚfiÊÔ˘˜). ¶ÚÔÎÂÈ̤ÓÔ˘ Ô √.¶.∞.¢. Ó· ‰ÒÛÂÈ Ô‰ËÁ›Â˜ ÛÙȘ ÀËÚÂۛ˜ ÙÔ˘, ˙ËÙ¿ Ó· ÙÔ˘ ÁÓˆÚ›ÛÂÈ ÙÔ ∫∂.™.À. ÔȘ ÂȉÈÎfiÙËÙ˜ È·ÙÚÒÓ ‰‡Ó·ÓÙ·È Ó· ÙÔ Û˘ÓÙ·ÁÔÁÚ·ÊÔ‡Ó Î·È ÂȉÈο ÁÈ· ÙȘ ËÏÈ˘ 12 ¤ˆ˜ Î·È 14 ÂÙÒÓ Î·È ÁÈ· ÙȘ ËÏÈ˘ 15 ¤ˆ˜ Î·È 18 ÂÙÒÓ. ∂ÈÚfiÛıÂÙ· ÁÓˆÛÙÔÔÈÂ›Ù·È fiÙÈ Ô √.¶.∞.¢., ÚÔÛˆÚÈÓ¿ Î·È ¤ˆ˜ fiÙÔ˘ ·ÔÊ·Û›ÛÂÈ ÙÔ ∫∂.™.À., Âͤ‰ˆÛ ÙȘ ÂÍ‹˜ Ô‰ËÁ›Â˜: °È· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ ·fi 12 ¤ˆ˜ 14 ÂÙÒÓ, ÙÔ ÂÓ ÏfiÁˆ ÂÌ‚fiÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂȉÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈ΋˜, °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈ΋˜ π·ÙÚÈ΋˜ Î·È ¶·ıÔÏÔÁ›·˜. °È· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ ·fi 15 ¤ˆ˜ Î·È 18 ÂÙÒÓ, ÙÔ ÂÌ‚fiÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂȉÈÎfiÙËÙ·˜ °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈ΋˜ π·ÙÚÈ΋˜ Î·È ¶·ıÔÏÔÁ›·˜. ∆¤ÏÔ˜, ÁÈ· ÎÔÚ›ÙÛÈ· Ô˘ ¤¯Ô˘Ó Û˘ÌÏËÚÒÛÂÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÂÙÒÓ, ÁÈ· ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ··ÈÙÂ›Ù·È ÂÈϤÔÓ Î·È È·ÙÚÈ΋ Áӈ̿Ù¢ÛË ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡ °˘Ó·ÈÎÔÏfiÁÔ˘ Ô˘ ı· ·Ó·Ê¤ÚÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÚÔÛ‚ÏËı› ·fi fiÏ· Ù· ÛÙÂϤ¯Ë ÙÔ˘ ÈÔ‡ Ô˘ ηχÙÂÈ ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Â͢·ÎÔ‡ÂÙ·È fiÙÈ Ë ·Ó·ÁÚ·Ê‹ ı· Á›ÓÂÙ·È ·fi È·ÙÚfi ÂȉÈÎfiÙËÙ·˜ °˘Ó·ÈÎÔÏÔÁ›·˜. ªÂ ÙË Ì ËÌÂÚÔÌËÓ›· 28.2.2008 ÂÈÛÙÔÏ‹ ÙÔ˘ ∫·ıËÁËÙÔ‡ Î. ∞Ó‰Ú¤· ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˘, ¶ÚÔ¤‰ÚÔ˘ Ù˘ ¶·ÓÂ˘Úˆ·˚΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜, Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ Î·È Ù˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ, ÁÓˆÛÙÔÔÈÔ‡ÓÙ·È ÛÙÔ ∫∂.™.À. ÔÈ ·fi„ÂȘ ÙÔ˘ ¢.™. Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ Û¯ÂÙÈÎÒ˜ Ì ÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ HPV ·fi È·ÙÚÔ‡˜ ÂȉÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈ΋˜. ∂›Û˘, Ì ÙÔ ˘’ ·ÚÈıÌ. ¶ÚˆÙ. 10755/21.2.2008 ¤ÁÁÚ·ÊÔ ÙÔ˘ π·ÙÚÈÎÔ‡ ™˘ÏÏfiÁÔ˘ §¿ÚÈÛ·˜ “√ Paediatriki 2008;71:413-415

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LETTER ∆√ ∆∏∂ ∂DITORIAL BOARD

415

π¶¶√∫ƒ∞∆∏™” ˙ËÙÂ›Ù·È ·fi ÙÔ ∫∂.™.À. Ó· Û˘ÌÂÚÈÏËÊıÔ‡Ó ÔÈ ¶·È‰›·ÙÚÔÈ ÛÙË Û˘ÓÙ·ÁÔÁÚ¿ÊËÛË Î·È ÂÎÙ¤ÏÂÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ Î·È ÛÙȘ ËÏÈ˘ 15-18 ÂÙÒÓ. ∫·ÙfiÈÓ ÙÔ‡ÙÔ˘, Ë ∂ÎÙÂÏÂÛÙÈ΋ ∂ÈÙÚÔ‹ ¤ıÂÛ ÙÔ ı¤Ì· ÚÔ˜ Û˘˙‹ÙËÛË ÛÙËÓ 215Ë ™˘Ó‰ڛ·ÛË Ù˘ √ÏÔ̤ÏÂÈ·˜ ÙÔ˘ ∫∂.™.À. (3.4.08), Ë ÔÔ›·, ÌÂÙ¿ ·fi ÌÂϤÙË Î·È ‰ÈÂÍÔ‰È΋ Û˘˙‹ÙËÛË, ·ÔÊ¿ÛÈÛ ÔÌfiʈӷ Ù· ÂÍ‹˜: ∆Ô ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) ‰‡Ó·Ù·È Ó· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂȉÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈ΋˜, °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈ΋˜ π·ÙÚÈ΋˜ Î·È ¶·ıÔÏÔÁ›·˜. °È· ÎÔÚ›ÙÛÈ· ËÏÈΛ·˜ ·fi 15 ¤ˆ˜ Î·È 18 ÂÙÒÓ, ÙÔ ÂÌ‚fiÏÈÔ ı· Û˘ÓÙ·ÁÔÁÚ·ÊÂ›Ù·È ·fi È·ÙÚÔ‡˜ ÂȉÈÎfiÙËÙ·˜ ¶·È‰È·ÙÚÈ΋˜, °˘Ó·ÈÎÔÏÔÁ›·˜, °ÂÓÈ΋˜ π·ÙÚÈ΋˜ Î·È ¶·ıÔÏÔÁ›·˜. ∆¤ÏÔ˜, ÁÈ· ÎÔÚ›ÙÛÈ· Ô˘ ¤¯Ô˘Ó Û˘ÌÏËÚÒÛÂÈ ÙËÓ ËÏÈΛ· ÙˆÓ 18 ÂÙÒÓ, ÁÈ· ÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘ ··ÈÙÂ›Ù·È ÂÈϤÔÓ Î·È È·ÙÚÈ΋ Áӈ̿Ù¢ÛË ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡ °˘Ó·ÈÎÔÏfiÁÔ˘ Ô˘ ı· ·Ó·Ê¤ÚÂÈ fiÙÈ ‰ÂÓ ¤¯ÂÈ ÚÔÛ‚ÏËı› ·fi fiÏ· Ù· ÛÙÂϤ¯Ë ÙÔ˘ ÈÔ‡ Ô˘ ηχÙÂÈ ÙÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÙˆÓ ·ÓıÚˆ›ÓˆÓ ıËÏˆÌ¿ÙˆÓ (HPV) Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ Â͢·ÎÔ‡ÂÙ·È fiÙÈ Ë ·Ó·ÁÚ·Ê‹ ı· Á›ÓÂÙ·È ·fi È·ÙÚfi ÂȉÈÎfiÙËÙ·˜ °˘Ó·ÈÎÔÏÔÁ›·˜.

∂ÛˆÙÂÚÈ΋ ¢È·ÓÔÌ‹ 1) °Ú·ÊÂ›Ô Î. ÀÔ˘ÚÁÔ‡ ÀÁ›·˜ Î·È ∫ÔÈÓ. ∞ÏÏËÏÂÁÁ‡Ë˜ 2) °Ú·ÊÂ›Ô Î. ÀÊ˘Ô˘ÚÁÔ‡ ÀÁ›·˜ 3) °Ú·ÊÂ›Ô Î. °ÂÓ. °Ú·ÌÌ·Ù¤· ÀÁ›·˜ 4) °Ú·ÊÂ›Ô Î·˜ °ÂÓ. ¢/ÓÙÚÈ·˜ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ 5) ¢/ÓÛË °Ú·ÌÌ·Ù›·˜ ∫∂.™.À. ∆Ì‹Ì· ∞ã (2)

°È· ÙÔ ∫∂.™.À. √ ¶Úfi‰ÚÔ˜ ∫˘ÚÈ¿ÎÔ˜ ™ÙÚÈÁÁ¿Ú˘

∞Ô‰¤ÎÙ˜ ÚÔ˜ ÂÓ¤ÚÁÂÈ· 1) ¢/ÓÛË ¢ËÌfiÛÈ·˜ ÀÁÈÂÈÓ‹˜ µÂÚ·Ó˙¤ÚÔ˘ 50 ∆.∫. 104 38, ∞£∏¡∞ 2) √ÚÁ·ÓÈÛÌfi˜ ¶ÂÚ›ı·Ï„˘ ∞ÛÊ·ÏÈÛÌ¤ÓˆÓ ÙÔ˘ ¢ËÌÔÛ›Ô˘ (√.¶.∞.¢.) ¢/ÓÛË ÀÁÂÈÔÓÔÌÈ΋˜ ¶ÂÚ›ı·Ï„˘ ∆Ì‹Ì· ∞ã ª·Î‰ÔÓ›·˜ 8 ∆.∫. 104 33, ∞£∏¡∞

¶·È‰È·ÙÚÈ΋ 2008;71:413-415

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416

Correct answers for the Quiz of the article “A quadrivalent HPV vaccine” 1. Cervical cancer is the second most common cancer among women 15-44 years old in Europe.

2. Cervical cancer has been shown to be caused by HPV infection in over 99% of cases.

3. Over 50% of girls will acquire HPV within 48 months of becoming sexually active.

4. Up to 12% of HPV-associated precancerous changes might progress to cervical cancer.

5. HPV types 16 and 18 account for 75% of cervical cancer and HPV types 6 and 11 for 90% of genital warts in Europe.

6. Amorphous Aluminium Hydroxide Sulphate (AAHS) has the greatest capacity to bind HPV VLPs and generate substantially higher antibody titres than ALOH. 7. The quadrivalent HPV vaccine has demonstrated high efficacy against the following 6,11,16,18 HPV related diseases: cervical cancer, high grade cervical, vulvar, vaginal intraepithelial neoplasias and genital warts.

8. In 9-15 year old adolescents, the quadrivalent HPV vaccine has demonstrated higher immunogenicity than in women 15-26 years old.

9. The most effective practice to reduce cervical cancer worldwide is combined implementation of screening programs (Pap test) in sexually active women and routine vaccination in women aged 12-26 years.

™ˆÛÙ¤˜ ··ÓÙ‹ÛÂȘ ÙÔ˘ Quiz ÁÈ· ÙÔ ¿ÚıÚÔ “¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·˜ ÛÙ· ·È‰È¿” 1. ªÈÎÚfi ‚Ú¤ÊÔ˜ 40 ËÌÂÚÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÚ·¯ËÏÈ΋ ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ·fi ‚‰ÔÌ¿‰Ô˜ Î·È ˘ÚÂÙfi. ¶Èı·ÓfiÙÂÚÔ ·›ÙÈÔ: Ïԛ̈ÍË ·fi ÛÙÚÂÙfiÎÔÎÎÔ ÔÌ¿‰·˜ µ.

2. ªÈÎÚfi ‚Ú¤ÊÔ˜ 3 ÌËÓÒÓ ÚÔÛÎÔÌ›˙ÂÙ·È Ì ‰ÈfiÁΈÛË ÌÂÁ¤ıÔ˘˜ ÌÈÎÚÔ‡ Ì·ÓÙ·ÚÈÓÈÔ‡, Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙË ‰ÂÍÈ¿ ÙÚ·¯ËÏÈ΋ ¯ÒÚ·, Â›Ó·È Ì·Ï·Î‹ Î·È ÔÌÔÈfiÌÔÚÊ· ¢›ÂÛÙË, ¯ˆÚ›˜ ˘ÚÂÙfi ‹ ÙÔÈο ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ·. ∏ ÌËÙ¤Ú· ·Ú·Ù‹ÚËÛ ÙË ‰ÈfiÁΈÛË Ï›Á˜ Ë̤Ú˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: ÏÂÌÊ·ÁÁ›ˆÌ·.

3. ∫ÔÚ›ÙÛÈ 12 ÂÙÒÓ ÚÔÛ¤Ú¯ÂÙ·È Ì ˘Ú¤ÙÈÔ, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ÚÔÛÎÔÌ›˙ÂÈ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Ì ÂÙÂÚfiÏ¢ÚË ‰ÈfiÁΈÛË ÌÂÛÔıˆÚ·Î›Ô˘. ¶ÚÒÙ˜ ‰È·ÁÓˆÛÙÈΤ˜ ÛΤ„ÂȘ: Ê˘Ì·Ù›ˆÛË.

4. ∞ÁfiÚÈ 4 ÂÙÒÓ ·fi ·ÁÚÔÙÈ΋ ÂÚÈÔ¯‹ ÚÔÛÎÔÌ›˙ÂÙ·È Ì ˘ÚÂÙfi ·fi 10Ë̤ÚÔ˘ Î·È ‹È· ÁÂÓÈÎÂ˘Ì¤ÓË ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·. ™ÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜ ‰È·ÈÛÙÒÓÂÙ·È ˘„ËÏfi˜ ·ÚÈıÌfi˜ ˈÛÈÓÔÊ›ÏˆÓ (25.000/mm3). ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: Ïԛ̈ÍË ·fi ÙÔÍfiηڷ.

5. ∂Ӊ›ÍÂȘ ÁÈ· ‚ÈÔ„›· ÏÂÌÊ·‰¤Ó· ·ÔÙÂÏÔ‡Ó ÔÈ ·Ú·Î¿Ùˆ: ̤ÁÂıÔ˜ ·‰¤Ó· >2 cm, ÛÙ·ÛÈÌfiÙËÙ· ÌÂÁ¤ıÔ˘˜ ÌÂÙ¿ ·fi 4-6 ‚‰ÔÌ¿‰Â˜, ÌË ·ÓÙ·fiÎÚÈÛË Û ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÌÂÙ¿ ·fi 2 ‚‰ÔÌ¿‰Â˜, ·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ˘ÂÚÎÏ›‰È· ÂÓÙfiÈÛË.

Paediatriki 2008;71:416

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¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

xv

18 √ÎÙˆ‚Ú›Ô˘ 2008

∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· “∂›Î·ÈÚ· ı¤Ì·Ù· Î·È ·ÓÙÈÁӈ̛˜ ÛÙËÓ ¶·È‰È·ÙÚÈ΋” •ÂÓÔ‰Ô¯Â›Ô “King George Palace” √ÚÁ¿ÓˆÛË: ∞ã ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ¶ÏËÚÔÊÔڛ˜: ∫∂°ª ∆Ô˘ÚÈÛÙÈΤ˜ & ™˘Ó‰ÚȷΤ˜ ∂ȯÂÈÚ‹ÛÂȘ, Congress World ∆ËÏ.: 210-7210052, 7210001 Fax: 210-7210051 E-mail: info@congressworld.gr Website: http://www.congressworld.gr

∞ı‹Ó·

18 √ÎÙˆ‚Ú›Ô˘ 2008

22o ™ÂÌÈÓ¿ÚÈÔ ∂›ÁÔ˘Û·˜ Î·È ∂ÓÙ·ÙÈ΋˜ ¶·È‰È·ÙÚÈ΋˜: ¡Â˘ÚÔÏÔÁÈο ¶ÚÔ‚Ï‹Ì·Ù· Î·È ∂ÓÙ·ÙÈ΋ £ÂÚ·›· ÛÙ· ¶·È‰È¿ ∞ÌÊÈı¤·ÙÚÔ °.¡. ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ¶ÏËÚÔÊÔڛ˜: Î. °. ™È‰¤Ú˘, Î. º. ¡ÈÎÔÏ¿Ô˘ ∆ËÏ.: 210-7798033 Fax: 210-7798357 E-mail: picupapadatosgr@yahoo.com

∞ı‹Ó·

23-26 √ÎÙˆ‚Ú›Ô˘ 2008

31st Congress of the Union of Middle-Eastern & Mediterranean Pediatric Societies Contact: Prof. Ahmed Sahloul Essoussi Tel.: +216.73.219494/221411 Fax: +216.73.224899 E-mail: sahloulessoussi@ms.tn

Tunis, Tunisia

24-28 √ÎÙˆ‚Ú›Ô˘ 2008

EAP 2008 - 2nd Congress of the European Academy of Paediatrics Contact: Daniela Morein-Bar Tel.: 41-229-080-488 Fax: 41-227-322-850 E-mail: paediatrics@kenes.com Website: www.kenes.com/paediatrics/index.asp

Nice, France

25-26 √ÎÙˆ‚Ú›Ô˘ 2008

1Ô ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ÙÔ˘ ∂Ê‹‚Ô˘ Àfi ÙËÓ ·ÈÁ›‰· Ù˘ π·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ Î·È ÙÔ˘ π·ÙÚÈÎÔ‡ ™˘ÏÏfiÁÔ˘ ª·ÁÓËÛ›·˜ Î·È ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ Î·È £ÂÛÛ·Ï›·˜ √ÚÁ¿ÓˆÛË: ∂Ù·ÈÚ›· ºÚÔÓÙ›‰·˜ ÀÁ›·˜ Î·È ∂Î·›‰Â˘Û˘ (∂ºÀ∫∂) & ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ (∂∂∫¶¶À) - ∂›ÛÔ‰Ô˜ ÂχıÂÚË ¶ÏËÚÔÊÔڛ˜: ∞Ó·ÛÙ·Û›· ∞Ó·ÛÙ·Û›Ô˘, ¶Úfi‰ÚÔ˜ ∂ºÀ∫∂ ∆ËÏ.: 6937676725 E-mail: anasgr@gmail.com

µfiÏÔ˜

5-7 ¡ÔÂÌ‚Ú›Ô˘ 2008

36th Meeting of the British Society for Paediatric Endocrinology and Diabetes ¶ÏËÚÔÊÔڛ˜: Shirine Borbor, Joanne Galer ∆ËÏ.: 01-454-642-210 Fax: 01-454-642-222 E-mail: conferences@endocrinology.org

Swansea, United Kingdom

Pediatri Sept-Oct 08

14-10-08

13:26

™ÂÏ›‰·420

xvi

13-14 ¡ÔÂÌ‚Ú›Ô˘ 2008

2nd National Conference: New Trends in Paediatric Asthma and Allergy ¶ÏËÚÔÊÔڛ˜: Amy Tranter ∆ËÏ.: 02-0-75-016-711 E-mail: amy.t@markallengroup.com

London, United Kingdom

17-19 ¡ÔÂÌ‚Ú›Ô˘ 2008

1st International Congress of UENPS (Union of European Neonatal and Perinatal Societies) Global Neonatology & Perinatology Contact: L. Zmuda Tel.: 39-0-680-693-320 Fax: 39-0-680-692-586 E-mail: uenps2008@emec-roma.com Website: www.uenps2008.eu/homepage.htm

Rome, Italy

28-30 ¡ÔÂÌ‚Ú›Ô˘ 2008

™‡Á¯ÚÔÓ˜ ∂ÍÂÏ›ÍÂȘ Î·È ¶ÚÔÔÙÈΤ˜ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ 2008 √ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈÎfi ∫ÔϤÁÈÔ ¶·È‰È¿ÙÚˆÓ ¶ÏËÚÔÊÔڛ˜: The Mastermind Group ∆ËÏ.: 210-6827405, 6839690 Fax: 210-6827409 E-mail: estasinou@tmg.gr Website: www.mastermind.gr

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3-5 ¢ÂÎÂÌ‚Ú›Ô˘ 2008

Primary Care Pediatrics ¶ÏËÚÔÊÔڛ˜: CME Office ∆ËÏ.: 617-384-8600 Fax: 617-384-8686 E-mail: hms-cme@hms.harvard.edu

Boston, MA, United States

13-14 ¢ÂÎÂÌ‚Ú›Ô˘ 2008

8Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰ÔÓ¢ÚÔÏÔÁÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô “Athens Imperial” √ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈ΋ ¶·È‰ÔÓ¢ÚÔÏÔÁÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: AC&C International TËÏ.: 210-6889100 Fax: 210-6844777 E-mail: Paidneuro-info@acnc.gr Website: www.paidneuro.gr

∞ı‹Ó·

15-16 ¢ÂÎÂÌ‚Ú›Ô˘ 2008

∂ÓÙ·ÙÈ΋ ∂Î·›‰Â˘ÛË: 11Ô˜ ∫‡ÎÏÔ˜ “¶·È‰ÔÂÓ‰ÔÎÚÈÓÔÏÔÁ›·” √ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈ΋ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋ ∂Ù·ÈÚ›· & ¶·ÓÂÏÏ‹ÓÈ· ŒÓˆÛË ∂Ó‰ÔÎÚÈÓÔÏfiÁˆÓ ∆ËÏ.: 210-7774370 Fax: 210-7701552 E-mail: info@endo.gr Website: www.endo.gr

∞ı‹Ó·

19 π·ÓÔ˘·Ú›Ô˘ 2009

19Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· Ì ı¤Ì·: ∂›Î·ÈÚ· £¤Ì·Ù· ÛÙËÓ ¶·È‰È·ÙÚÈ΋ •ÂÓÔ‰Ô¯Â›Ô “Makedonia Palace” √ÚÁ¿ÓˆÛË: º. ∞ı·Ó·ÛÈ¿‰Ô˘ ¶ÏËÚÔÊÔڛ˜: Global Events TËÏ.: 2310-247743, 4 Fax: 2310-247746 E-mail: info@globalevents.gr Website: www.globalevents.gr

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