Paediatriki
Contents
REVIEW ARTICLES
243 Assessment of neurodevelopmental outcome of infants according to Bayley III scales
P. Karagianni, M. Kyriakidou, N. Nikolaidis
250 The safety of vaccines
A. Lykourinou-Karalexi
258 Management of low back pain in children and adolescents: a systemic approach
A. Konstantopoulou, D. Pasparakis
267 Guidelines for diagnosis and management of dyslipidemia in children and adolescents
A. Garoufi, P. Koukoutsakis
280 New International Neuroblastoma Risk Group Staging System for Children with Neuroblastoma
M. Baka, A. Kagia
286 Labial adhesions in childhood
L. Michala, A. Antsaklis, I. Mpiliatis
ORIGINAL ARTICLES
290 Experience and treatment results with the use of rituximab in children with no-malignant disease from Northern Greece
A. Tragiannidis, E. Farmaki, M. Trahana, N. Printza, M. Economou, Z. Pana, K. Kolios, A. Taparkou, Th. Papaeorgiou, I. Tsatra, E. Hadgipantelis, F. Papahristou, M. Athanasiou, F. Athanasiadou
299 Mannose Binding Lectin Polymorphisms and bacterial infections in children with acute lymphoblastic leukemia
Z.D. Pana, A. Tragiannidis, T. Papageorgiou, N. Vavatsi-Christaki, E. Roilides, F. Samarah,M. Arvanitidou-Vagiona, V. Tsotoulidou, F. Athanassiadou
307 Healthcare students with suboptimal protective immunity against vaccine preventable diseases
I.D. Pavlopoulou, G.L. Daikos, A. Tzivaras, A. Triantafyllidou, K. Tsoumakas, K. Theodoridou, K. Michail, M. Theodoridou
CASE REPORT
314 “Nutcracker” Syndrome: A Pediatric Case Presentation
A. Attilakos, E. Alexopoulou, A. Papapetrou, A. Fretzayas, P. Nicolaidou-Karpathiou, C. Liapis
CLINICAL QUIZ
318 4-year old boy with persistent cough and spontaneous pneumothorax
Ch. Koutsaftiki, J. Mammas, K. Kostari, G. Tapaki-Papadopoulou, A. Sakelaropoulos, E.Christianakis, Ch. Hlampoutaki, N. Miriokefalitakis
319 NEWS
NEWS FROM THE INTERNET
322 Obesity and Metabolic Syndrome in “Pediatriki”
C. Stefanidis, M. Garatzioti
LETTER TO THE EdITOR
326 Οbituary: Valassia Kiriakidou
S. Giouroukos
329 REVIEWERS OF MANUSCRIPTS INdEX, VOLUME 73
330 AUTHORS INdEX, VOLUME 73
332 KEY WORdS INdEX, VOLUME 73
Εμμανουήλ Γαλανάκης, Ηθική και Δεοντολογία,
Ηράκλειο
Μαρία Κανάριου, Ανοσολογία, Αθήνα
Αντώνης Καττάμης, Αιματολογία - Oγκολογία, Αθήνα Σοφία Κίτσιου-Τζέλη, Γενετική, Αθήνα
Αλεξάνδρα Παπαδοπούλου, Γαστρεντερολογία
Αντιγόνη Σιαμοπούλου-Μαυρίδου, Ρευματολογία,
Editor-in-Chief
Constantinos Stefanidis, Athens
Section Editors
Stella Andronikou, Neonatology, Ioannina
Michael Anthracopoulos, Pneumonology, Patras
Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki
George Varlamis, Cardiology, Thessaloniki
Emmanouil Galanakis, Ethics and Deontology, Heraklion
Loretta Thomaidou, Developmental Pediatrics, Athens
Maria Kanariou, Immunology, Athens
Antonis Kattamis, Haematology - Oncology, Athens
Sophia Kitsiou-Tzeli, Genetics, Athens
Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens
Vassiliki Papaevagelou, Infectious Diseases, Athens
Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina
Antigone Syrigou-Papavasiliou, Neurology, Athens
Evangelia Charmandari, Endocrinology, Athens
MeMbers of the InternatIonal edItorIal board
Alexis Arzimanoglou, Paris, France
Ellis D. Avner, Milwaukee, USA
Swati Bhave, New Delhi, India
Alberto Bissot, Panama, Panama
David Branski, Jerusalem, Israel
Francesco Chiarelli, Chieti, Italy
Chok-Wan Chan, Hong Kong, China
Denis Daneman, Toronto, Canada
Jochen Ehrich, Hannover, Germany
Demetrius Ellis, Pittsburgh, USA
Yoshikatsu Eto, Tokyo, Japan
Richard N. Fine, Stony Brook, USA
Margaret C. Fisher, Philadelphia, USA
Raif Geha, Boston, USA
Adenike Grange, Lagos, Nigeria
Judith G. Hall, Vancouver, Canada
Patricia Hamilton, London, UK
Enver Hasanoglu, Ankara, Turkey
Christer Holmberg, Helsinki, Finland
Lewis B. Holmes, Boston, USA
Peter Hoyer, Essen, Germany
Jan Janda, Prague, Czech Republic
Jan Kimpen, Ultrecht, Netherlands
Craig B. Langman, Chicago, USA
John Manis, Boston, USA
Manuel Moya, Alicante, Spain
Hugh O'Brodovich, Toronto, Canada
Ross Petty, Vancouver, Canada
Willem Proesmans, Leuven, Belgium
Jose Ramet, Antwerp, Belgium
Nikolai Shabalov, St. Petersburg, Russia
Alan Sinaiko, Minneapolis, USA
Nick J. Spencer, Coventry, UK
Alfred Tenore, Udine, Italy
Alkis Togias, Bethesda, USA
Eva Tsalikian, Iowa City, USA
Catherine Weil-Olivier, Paris, France
Max Zach, Graz, Austria
Zheng-Yan Zhao, Hangzhou, China
Johannes Zschocke, Heidelberg, Germany
Assessment of neurodevelopmental outcome of infants according to Bayley III scales
P. Karagianni1, M. Kyriakidou2, N. Nikolaidis1
Abstract: The Bayley III scale is an individually administered instrument that assesses the neurodevelopmental outcome of infants and young children aged from 1 to 42 months. The primary purpose of Bayley III is to identify children with developmental delay and to provide information for intervention planning. It consists of three administered scales: the Cognitive Scale, the Language Scale (Receptive and Expressive Communication), and the Motor Scale (Fine and Gross Motor). In addition, the Social-Emotional Scale and Adaptive Behaviour Questionnaire are completed by the parent or the primary caregiver. Bayley’s position on the structure and the process of infant development led to the creation of a unique type of assessment. The assessment of infants requires a unique set of procedures, different from those developed for testing older children or adults. The Bayley scales can be categorized as ‘power tests’. The role of play, the role of information processing and the role of the concept of numbers and counting in cognitive development are included and they are assessed in the cognitive scale of Bayley III testing. Assessment of both receptive and expressive language is important in the diagnosis of critical developmental delay and helpful in determining the aetiology of the delay. The fine and gross motor subtests include items that measure quality of movement, sensory integration, and perceptual-motor integration, as basic milestones of prehension and locomotion.
Key words: Infants, neurodevelopmental outcome, Bayley ΙΙΙ, motor scale, language scale, cognitive scale.
1 2nd NICU and Neonatology Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital 2 Department of Physiotherapy, Papageorgiou General Hospital, Thessaloniki
Correspondence: Paraskevi Karagianni karagpar@med.auth.gr
2nd NICU and Neonatology Department of Aristotle University of Thessaloniki, Papageorgiou General Hospital, Ring road, Nea Efkarpia, 54603, Thessaloniki
(Bayley Scale of Infant Development-BSID)
First-year Mental Scale, Bayley, 1933 (2), California
Preschool Mental Scale, Jaffa, 1934, California Infant
Scale of Motor Development, Bayley, 1936 (3)].
1. Bayley N. Manual for the Bayley Scales of Infant Development. San Antonio, TX: The Psychological Corporation; 1969.
2. Bayley N. The California First Year Mental Scale. Berkeley, CA: University of California Press; 1933.
3. Bayley N. The California Infant Scale of Motor development. Berkeley, CA: University of California Press; 1936.
4. Piaget J. The Origins of Intelligence in Children. New York. International Universities Press; 1952.
5. Bruner JS. Nature and Uses of Immaturity. Am Phychol, 1972;27(8):687-708.
6. Singer JL. The Child’s World of Make-Believe: Experimental Studies of Imaginative Play. New York: Academic Press; 1973.
7. Vygotsky LS. Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press; 1978.
8. Johnson JE. Relations of Divergent Thinking and Intelligence Test Scores With Social and Non-Social Make Believe Play of Preschool Children. Child Dev 1976;47:12001203.
9. Fenson L, Kagan J, Kearsley RB, Zelazo PR. The Developmental Progresssion of Manipulative Play in the First Two Years. Child Dev 1976;47:232-236.
10. Belsky J, Most RK. From Exploration to Play: A CrossSectional Study of Infant Free Play Behavior. Dev Psychol 1981;17(5):630-639.
11. Colombo J, Frick J. Recent Advances and Issues in the Study of Preverbal Intelligence. In: M. Anderson, editor. The Development of Intelligence Hove, England: Psychology Press; 1999. p. 43-71.
12. Bornstein MH, Sigman MD. Continuity in Mental Development from Infancy. Child Dev 1986;57:251-274.
13. Dougherty TM, Haith MM. Infant Expectations and Reaction Times as Predictors of Childhood Speed of Processing and IQ. Dev Psychol 1997;33(1):146-155.
14. Kail R. Speed of information Processing: Developmental
Change and Links to Intelligence. Journal of School Psychol 2000;38(1):51-61.
15. Schatz J, Kramer JH, Ablin A, Matthay KK. Processing Speed, Working Memory and IQ: A Developmental Model of Cognitive Deficits Following Cranial Radiation Therapy. Neuropsychol 2000;14(2):189-200.
16. Sigman M, Cohen S, Beckwith L, Parmelee AH. Infant Attention in Relation to Intellectual Abilities in Childhood. Dev. Psychol 1986; 22:788-792.
17. Fagan JF. Memory in the Infant. Journal of Experimental Child Psychol. 1970;9:217-226.
18. Fagan JF. New Evidence for the Prediction of Intelligence from Infancy. Infant Ment Health J 1982;3:219-228.
19. Berg CA, Sternberg RJ. Response to Novelty: Continuity Versus Discontinuity in the Developmental Course of Intelligence. In: Reese HW, editor. Advances in Child Development and Behavior Orlando, FL: Academic Press; 1985. p. 2-42
20. Rovee-Collier C. Learning and Memory in Infancy. In: Osofsky JD, editor. Handbook of Infant Development. 2nd ed., New York: John Wiley and Sons; 1987. p. 98-148.
21. Berthier NE, DeBlois S, Poirier CR, Novak MA, Clifton RK. Where is the ball? Two-and three-year-olds reason about unseen events. Dev Psychol 2000;36(3):394-401.
22. Aylward GP. Infant and Early Childhood Assessment. In: Tramontana MG, Hooper SR, editors. Assessment Issues in Child Neuropsychology. New York: Plenum Press; 1988. p. 225-248.
23. Dunst CJ. The Clinical Utility of Piagetian-Based Scales of Infant Development. Infant Ment Health J 1982;3:259-275.
24. Wynn K. Children’s Understanding of Counting. Cognition 1990;36:155-193.
25. Gelman R, Tucker MF. Further Investigations of the Young Child’s Conception of Number. Child Dev 1975;46: 167-175.
26. Silverman IW, Rose AP. Subitizing and Counting Skills in 3-year-olds. Dev Psychol 1980;16:539-540.
27. Lenneberg EH. On Explaining Language. Science 1969;164: 635-643.
28. Clifton RK, Rochat P, Robin DJ, Berthier DE. Multimodal Perception in the Control of Infant Reaching. J Exp Psychol 1994;20(4):876-886.
29. Litovsky RY, Ashmead DH. Development of binaural and spatial hearing in Infants and Children. In: Gilsky RH, Anderson TR, editors. Binaural and Spatial Hearing in Real and Virtual Environments. Hillsdale, NJ: Lawrence Erlbaum Associates 1997. p. 571-592.
30. Morrongiello BA. Infants’ Perception of Multiple-Group Auditory Patterns. Infant Behav Dev 1986;9:307-319.
31. Goldin-Meadow S, Seligman MEP, Gelman R. Language in the Two Year Old. Cognition 1976;4:189-202.
32. Chapman RS. Children’s Language Learning: An Interactionist Perspective. J Child Psychol Psyc 2000;41(1): 33-54.
33. Miller JF, Paul R. The Clinical Assessment of Language Comprehension. Baltimore: Paul H. Brooks; 1995.
34. Oller DK, Eilers RE, Neal AR, Schwartz HK. Precursors to Speech in Infancy: The Prediction of Speech and Language Disorders. J Commun Disord 1999;32:223-245.
35. Oller DK, Eilers RE. The Role of Audition in Infant Babbling. Child Dev 1988;59:441-449.
36. Poulson CL, Kymissis E, Reeve KF, Andreatos M, Reeve L. Generalized Vocal Imitation in Infants. J Exper Child Psychol 1991;51:267-269.
37. Nelson K. Structure and Strategy in Learning to Talk. Monographs of the Soc Res Child Devel 1973;38:(1-2 Serial No. 149).
38. Huttenlocher J, Smiley P, Charney R. Emergence of Action in the Child: Evidence from Verb Meanings. Psychol Rev1983;90(1):72-93.
39. Owens RE. Language Development: An Introduction. 5th ed. Boston: Allyn and Bacon; 2001.
40. Bloom P, Markson L. Capacities Underlying Word Learning. Trends Cogn Sci 1998;2(2):67-73.
41. Herchkowitz N. Neurological Bases of Behavioral Development in Infancy. Brain Dev 2000;22:411-416.
42. Acredolo L, Goodwyn S. Symbolic Gesturing in Normal Infants. Child Dev 1988;59:450-466.
43. Shore C, O’Connell B, Bates E. First Sentences in Language and Symbolic Play. Dev Psychol 1984;20(5):872-880.
44. Aslin RN, Salapatek P. Saccadic localization of visual targets by the very young human infant. Percept Psychophys 1975; 17(3):293-302.
45. Dayton GO, Jones MH. Analysis of characteristics of fixation reflexes in infants by use of direct current electrooculography. Neurology 1964;14(12):1152-1156.
46. Aslin RN. Devolopment of smooth pursuit in human infants. In: Fisher DF, Monty RA, Senders JW, editors. Eye movements: Cognition and visual perception. Hillsdale, NJ: Erlbaum 1981. p. 31-51.
47. Berk LE. Development through the lifespan. Boston: Ally and Bacon; 1998.
48. Bertenhal BI, Clifton RK. Perception and action. In: William D, editor. Handbook of child psychology. 5th ed. New York: John Wiley and Sons; 1998. p. 51-102.
49. Robin DJ, Berthier NE, Clifton RK. Infants’ Predictive Reaching for Moving Objects in the Dark. Dev Psychol 1996;32(5): 824-835.
50. Rochat P, Goubet N. Development of Sitting and Reaching in 5- to 6-month-old infants. Infant Behav Dev 1995;18: 53-68.
51. DeGangi GA, Berk RA, Valvano J. Test of Motor and Neurologiocal Functions in High Risk Infants: Preliminary Findings. Dev Behav Pediatr 1983;4:182-189.
52. Bly L. The Components of Normal Movement During the First Year of Life and Abnormal Motor Development. Monograph of the Neurodevelopmental Treatment Association. Birmingham, AL: Pittenger Associates, Pathway Press; 1983.
53. Konner MJ. Relations Among Infants and Juveniles in Comparative Perspective. Soc Sci Inform 1976;15:371-402.
54. Sutherland DH, Olshen R, Cooper L, Woo S. The Development of Mature Gait. Am J Bone Joint Surg 1980;62(3): 336-353.
55. Thelen E, Smith LB. A Dynamic Systems Approach to the Development of Cognition and Action. Cambridge, MA: The MIT Press; 1994.
56. Adolph KE. Learning in the Development of Infant Locomotion. Mon Soc Res Child Dev 1997;62 (3) Serial No. 251.
agielikourinou@hotmail.gr Καλλιρρόης 5-7, 185 39, Πειραιάς
Private Paediatrician
Correspondence: Angeliki Lykourinou –Karalexi agielikourinou@hotmail.gr 5-7, Kallirois St. 185 39, Piraeus, Greece
Key words: Vaccine safety, monitoring immunization safety. Ιδιώτης
The safety of vaccines
A. Lykourinou-Karalexi
Abstract: Vaccines constitute one of the greatest public health achievements of the last century. Αs immunization percentages have increased and more new vaccines are added to the childhood vaccination programme, vaccine-preventable diseases have become exceedingly rare and public attention has focussed on the safety of vaccines. The contemporary vaccination programmes demand a high degree of vaccine safety. As rare reactions, delayed reactions and reactions occurring within a specific subpopulation may not be detectable during preclinical evaluation, continued postlicensing surveillance of vaccine safety is crucial. For this purpose, many countries have set up specialized centres for the prospective evaluation of adverse events following vaccination. The programmes of these centres offer the opportunity for improving the understanding of the mechanisms and risk factors in cases of adverse reactions to vaccines. They make it possible to provide a convincing response to public concern about adverse events after vaccination; concern which is often reinforced by the media and by inaccurate information posed on the Internet. Finally the information gathered by such centres can be used for calculation and communication of the “risk / benefit ratio” of vaccines, indicating the real risks for idividuals and the community.
This review reports on the system of vaccine safety and the means with which it is ensured in the United States of America.
Επίμονο
Μηνιγγίτις
Παραλυτική
DDP
COSTART (Coding Symbols for a Thesaurus of Adverse
(12).
LLDBs
(National Childhood Vaccine Injury
(National Vaccine Compensation Program, VICP) (2,6,12,15,18,19,23).
Childhood Vaccine Injury Act Reporting and Compensation Tables).
(Clinical Immunization Safety Assessment Centers).
να χειρίζονται παρόμοιες περιπτώσεις. Επίσης, τα κέντρα
μπορούν να δηλώνονται κλινικά ζητήματα ασφάλειας των
(Immunization Safety Review Committee).
(National Institutes of Health,
(Institute of Medicine,
Bιβλιογραφία
1. Maldonado YA. Current Controversies in Vaccination. Vaccine Safety. JAMA; 2002;24:3155-58.
2. Chen KI. Safety of Vaccines. In Plotkin. SA, Orenstem WA (eds): Vaccines, Philadelphia, W.B. Saunders Co; 1999, p. 1144-1163.
3. Vaccine-preventable Diseases and Immunization Programme, WHO, MMWR; 51; 26: 573-574.
4. Report of the Committee on Infectious Diseases. Αmerican Academy of Pediatrics, Red Book 2000, 25th ed. 1η Eλληνική έκδοση. Eνεργητική και Παθητική Ανοσοποίηση, σελ. 1-80.
5. Chen RT, Rastogi SC, Mullen JP, Hayers SW, Cochi SL, Donlon JA, et al. The Vaccine Adverse Event Reporting System (VAERS), Vaccine 1994;12:542-550.
6. McPhillips H, Marcuse EK. Vaccine Safety. Curr-ProblPediatr 2001;31:91-121.
7. Chen RT. Vaccine risks: real, perceived and unknown. Vaccine 1999;17:41-46.
8. Παπαγρηγορίου-Θεοδωρίδου
1999;46:67-70.
9. Freed GL, Katz SL, Clark SJ. Safety of Vaccinations. Miss America, the Media, and Puplic Health. JAMA, 1996;23: 1869-1872.
10. Sauri MA. The Politics of Vaccine Production. Md-Med. 2005 Winter;6:19-22.
11. Ellenberg SS, Braun MM. Monitoring the Safety of Vaccines: assessing the risks. Drug Saf. 2002;25;145-152.
12. Center for Disease Control and Prevention. National Immunization Program. Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book, 9th Edition, Chapter 4, “Vaccine Safety”, p. 43-56, 2006 January: Webpage: www. cdc. gov. pink book.
13. Miller E, Goldacre M, Pugh S, Colville A, Farrington P, Flower A et al. Risk of aseptic meningitis after measles, mumps and rubella vaccine in UK children. The Lancet 1993;341:979-982.
14. Duclos P. Immunization Safety Priority Project, Department of Vaccine and Biologicals, Health Technology and Pharmaceuticals, WHO. A Global perspective on vaccine safety. Vaccine 2004;22:2059-2063.
15. Dittmann S. Communicable Disease and Immunisation Programmes, WHO, Regional Office for Europe, Copenhagen, Denmark. Vaccine safety: risk communication – a global perspective. Vaccine 2001;19:2446-2456.
16. Duclos P, Hofmann CA. On behalf of the Priority Project on Immunization Safety. Department of Vaccines and biologicals, Health Technology and Pharmaceuticals, WHO, Geneva, Switzerland. Immunization Safety. A Priority of the World Health Organization’s Department of Vaccines and Biologicals. Drug-Saf. 2001;24:1105-1112.
17. Rao MR, Blackwelder WC, Troendle JF, Naficy AB, Clemens JD. Sample size determination for phase II studies of new vaccines. Vaccine 2002;20:3364-3369.
18. Stiles GL. Wyeth Pharmaceutical’s perspective on vaccine production. Wyeth Pharmaceuticals, Collegeville, PA, USA. Md-Med 2005;6:22-23.
19. Chen RT, Hibbs B. Vaccine safety: current and future challenges. Pediatr Ann 1998;27:445-555.
20. Varricchio F, Iskander J, Destefano F, Ball R, Pless R, Braun MM et al. Understanding vaccine safety information from the Vaccine Adverse Event Reporting System. Pediatr. Infect Dis J, 2004;23:287-294.
21. Spier RE. Ethical aspects of vaccines and vaccination. Vaccine 1998;16:1788 -1794.
22. Iskander JK, Miller ER, Chen RT. The role of the Vaccine Advers Event Reporting System (VAERS) in Monitoring Vaccine Safety. Pediatric Annals 2004;33:599-605.
23. National Childhood Vaccine Injury Act 2006. Webpage: http://en.wikipedia.org /wiki/National_ Childhood_ Vaccine_Injury_Act.
24. Tozzi AE. Field evaluation of vaccine safety. Vaccine 2004;22:2091-2095.
25. Verstraeten T, DeStefano F, Chen RT, Miller E. Vaccine safety surveillance using large linked databases: opportunities, hazards and proposed guidelines. Expert Rev. Vaccines 2003;2:21-29.
26. Chen RT, DeStefano F, Davis RL, Jackson LA, Thompson RS et. al. The Vaccine Safety Datalink: immunization research in health maintenance organizations in the USA. Bull World Health Organ 2000;78:186-194.
27. Chen RT, Glasser JW, Rhodes PH, Davis RL et al. Vaccine Safety Datalink project: a new tool for improving vaccine safety monitoring in the United States-The Vaccine Safety Datalink Team. Pediatrics 1997;99:765-773.
28. Davis RL, Kolczak M, Lewis E, Nordin J et al. Active Surveillance of Vaccine Safety. A System to Detect Early Signs of Adverse Events. Epidemiology. Volume 2005;16: 336-341.
29. Davis RL, Marcuse E, Black S, Shinefield H et al. MMR2 immunization at 4 to 5 years and 10 to 12 years of age: a comparison of adverse clinical events after immunization in the Vaccine Safety Datalink project. The Vaccine Safety Datalink Team. Pediatrics 1997; 100:767-771.
30. Intussusception among recipients of rotavirus vaccine -
United States, 1998-1999. MMWR Morb Mortal Wkly Rep 1999;48:577-581.
31. Kohl KS, Bonhoeffer J, Chen R, Duclos P et al. Pharmacoepidemiology and Drug Safety 2003;12:335-340.
32. Zanoni G, Ferro A, Valsecchi M, Trdente G. The “Green Channel” of the Veneto region as a model for Vaccine safety monitoring in Italy. Vaccine 2005;23:2354-2358.
33. Zanoni G, Valsecchi NM, Gallo G, Tridente G. Prevention and monitoring of adverse events following immunization: the “Green Channel” of the Veneto Region in Italy. Vaccine 2003;22:194-201.
34. Rennels MB. The rotavirus vaccine story: a clinical investigator’s view. Pediatrics 2000;106:123-125.
35. McPhillips HA, Davis RL, Marcuse EK, Taylor JA. The rotavirus vaccine's withdrawal and physicians' trust in vaccine safety mechanisms. Arch Pediatr Adolesc Med 2001;155:1051-1056.
36. Murphy TV, Gargiullo PM, Massoudi MS, Nelson DB, Jumaan AO, Okoro CA et al; For the Rotavirus Intussusception Investigation Team. Intussusception among infants given an oral rotavirus vaccine. N. Engl J Med 2001; 344:564-572.
37. Rotavirus Vaccine for the Prevention of Rotavirus Gastroenteritis Among Children. MMWR, Morb Mortal Wkly Rep 1999;48:RR-2.
38. Rotavirus Vaccine for the Prevention of Rotavirus Gastroenteritis Among Children: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, Morb Mortal Wkly Rep 1999;48:RR-2.
39. Peter G, Myers MG. Intussusception, rotavirus, and oral vaccines: summary of a workshop. Pediatrics 2002;110:67. [Webpage]: www.pediatrics.org/cgi/content/full/110/6e67.
40. Niu MT, Erwin DE, Braun MM. Data mining in the US Vaccine Adverse Event Reporting System (VAERS): early detection of intussusception and other events after rotavirus vaccination. Vaccine 2001;19:4627-4634.
41. Verstraeten T, Baughman AL, Cadwell B, Zanardi L, Haber P, Chen RT. Vaccine Adverse Event Reporting System Team. Enhancing vaccine safety surveillance: a capturerecapture analysis of intussusception after rotavirus vaccination. Am J Epidemiol 2001;154:1006-1012.
42. Immunization against Infectious Disease. Adverse Reactions “The Green Book” Chapter 8. 2006. p. 29-33. [Internet, Webpage] http:// www.dh.gov.uk.
43. Marshall GS, Gellin BG. Challenges to vaccine safety. Primary Care 2001;28:853-868, vii.
44. Fescharek R, Nicolay U, Arras-Reiter C. Plotkin S, Brown F, Horaud F, editors: Preclinical and Clinical Development of New Vaccines. Dev Biol Stand. Basel: Karger. Monitoring and Safety Assessment in Phase I to III Clinical Trials 1998;95:203-209.
45. Jacobson RM, Zabel KS, Poland GA. The challenge of vaccine safety [Review]. Semin Pediatr Infect Dis 2002;13: 215-220.
46. Duclos P. World Health Organization, Geneva, Switzerland. Response to current vaccine safety issues. [Editorial] Vaccines: Children and Practice 2000;3:26-27.
47. Cussler K. A 4R concept for the safety testing of immunobiologicals. Dev Biol Stand 1999;101:121-126.
48. Brown KR, Douglas RG Jr. New challenges in quality control and licensure. Regulation. Int J Technol Assess Health Care 1994;10:55-64.
49. Gardner P, Peter G. Recommended schedules for routine immunization of children and adults. Infect Dis Clin North Am 2001;15:1-8.
50. Jefferson T. The role of editorial peer review in the evaluation of vaccine safety. Vaccine 2004;22:2073-2075.
51. Clements CJ, Larsen G, Jodar L. Technologies that make administration of vaccines safer. Vaccine 2004;22:20542058.
52. Katz SL. Future vaccines and a global perspective. Lancet 1997;350:1767-1770.
53. Dellepiane N, Griffiths E, Milstien JB. New Challenges in assuring vaccine quality. Bulletin of the World Health Organization 2000;78:155-162.
54. Lawrence D, Frenkel, MD. Immunization Issues in the 21st Century, Part II. Pediatric Annals 2004;33:565-568.
55. Salmon DA, Moulton LH, Halsey NA. Enhancing public confidence in vaccines through independent oversight of postlicensure vaccine safety. Am J Public Health 2004;94: 947-950.
2nd Department of Orthopaedics, "P. & A. Kyriakou" Children’s Hospital, Athens
Correspondence: Anna Konstantopoulou annakonstant@gmail.com
2nd Department of Orthopaedics, "P. & A. Kyriakou" Children’s Hospital, Athens
Management of low back pain in children and adolescents: a systemic approach
A. Konstantopoulou, D. Pasparakis
Abstract: In the past, back pain in children was thought to be an infrequent symptom affecting 2% of the specific population group. It has been recently reported that the prevalence of low back pain is rising up to 24%-36%, with a higher incidence among adolescents older than 10 years. It was estimated, that in 84% of cases an underlying pathology could be identified, though according to recent studies a specific diagnosis is expected in only 21%-36% of cases. Common causes of back pain include non-specific pain, muscle strain, trauma, spondylolysis, herniated disk, scoliosis, and Scheuermann’s kyphosis. Less common causes include infections, tumors, leukaemia and other serious conditions providing an argument for an extensive diagnostic evaluation. “Benign” and “malignant” low back pain cannot be differentiated based on pathognomonic clinical signs and specific diagnostic tests. Warning features (red flags) include onset age less than 4 yr, persistent symptoms beyond 3-4 weeks, interference with function, persistent / worsening / night pain, weight loss, systemic symptoms, neurological features. Diagnosis can be established based on thorough clinical examination including history, a detailed profile of pain characteristics, scoliosis and abnormal neurological examination. X-ray examination is the initial diagnostic test of choice while bone scanning, magnetic resonance imaging or computed tomography may be also needed. Low back pain management is far more based on a systemic approach than on a specific diagnostic test. An algorithm for a stepwise evaluation of the disorder is described in order to reach a specific diagnosis with the minimum of diagnostic examinations, while not exposing young patients to unnecessary tests.
Key words: low back pain, children, approach, diagnosis
Scheuermann,
Sheuermann (0,4-8%).
Ewing (3,5% όλων των σαρκωμάτων
Ewing εντοπίζονται στη σπονδυλική
του χρόνου. Σύνδρομο διόγκωσης του πόνου (pain amplification syndrome)
1.
2.
(watchful waiting) (19).
(19,21). Εφόσον μετά από εξονυχιστικό κλινικό και εργαστηριακό
10. Iwamoto J, Abe H, Tsukimura Y, et al. Relationship between radiographic abnormalities of lumbar spine and incidence of low back pain in high school and college football players: a prospective study. Am J Sports Med. 2004;32:781-786.
11. Sward L, Hellstrom M, Jacobsson B, Nyman R, Peterson L. Disc degeneration and associated abnormalities of the spine in elite gymnasts: a magnetic resonance imaging study. Spine. 1991;16:437–443.
12. Hensinger RN. Back pain in children In: Bradford DS, Hensinger RN, eds. The Pediatric Spine. New York, NY: Thieme; 1985:41-60.
13. Bhatia N, Chow G, Timon S, Watts H. Diagnostic modalities for the evaluation of pediatric back pain. J Pediatr Orthop 2008: 28 (Nr 2):230-234.
14. Fribourg D, Delgado E. Occult spinal cord abnormalities in children referred for orthopaedic complaints. Am J Orthop. 2004;33:18-25.
15. Mackenzie WG, Sampath JS, Kruse RW, Sheir-Neiss GJ. Backpacks in children. Clin Orthop 2003:78.
16. Feldman DS, Hedden DM, Wright JG. The use of bone scan to investigate back pain in children and adolescents. J Pediatr Orthop 2000;20:790-5.
17. Roger E, Letts M. Sickle cell disease of the spine in children. Can J Surg 1999;42:289-92.
18. Selbst SM, Lavelle JM, Soyupak SK, Markowitz RI. Back pain in children who present to the emergency department Clin Pediatr 1999;38:401-6.
19. Bernstein R, Cozen H. evaluation of back pain in children and adolescents Am Fam Phys 2007:76:1669-1676.
20. Duggleby T, Kumar S. Epidemiology of juvenile low back pain: a review. Disabil Rehabil. 1997;19:505–512.
21. Feldman DS, Straight JJ, Badra MI, Mohaideen A, Madan SS. Evaluation of an algorithmic approach to pediatric back pain J Pediatr Orthop 2006: 26: 353-357.
22. David J. Evaluation of back pain in children Paediatr & Child Health 2007;18: 56-60.
Βιβλιογραφία
1. Αuerbach JD, Ahn J, Zgonis M, Reddy S, Ecker M, Flynn J. Streamlining the evaluation of low back pain in children Clin Orthop Rel Res 2008 : 466:1971-1977.
2. Turner PG, Hancock PG, Green JH, et al. Back pain in childhood. Spine. 1989; 14:812-814.
3. Νewcomer K, Sinaki M. Low back pain and its relationship to back strength and physical activity in children. Acta Paediatr 1996; 85:1433–1439.
4. Watson K, Papageorgiou A, Jones G, et al. Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child. 2003; 88:12-17.
5. Watson K, Papageorgiou A, Jones G, et al. Low back pain in schoolchildren: occurrence and characteristics. Pain. 2002;97:87-92.
6. Grantham V. Backache in boys: a new problem? Practitioner. 1977; 218:226-229.
7. Olsen TL, Anderson RL, Dearwater SR, et al. The epidemiology of low back pain in the adolescent. population. Am J Public Health. 1992; 82:606-609.
8. Bono CM. Low-back pain in athletes. J Bone Joint Surg Am 2004;86:382–396.
9. Balague F, Dutoit G, Waldburger M. Low back pain in school children: an epidemiological study. Scand J Rehabil Med. 1988;20: 175-179.
23. Ginsburg GM, Bassett GS. Back pain in children and adolescents: Evaluation and differential diagnosis J Am Acad Orth Surg 1997: 5: 67-78.
24. DeMicco R, Basic Evaluation Process for Back Pain in Children Spinal Column. Summer 2005. Cleveland Clinic Spine Institute Cleveland, OH.
25. Parisini P, Di Silvestre M, Greggi T, Miglietta A, Paderni S. Lumbar disc excision in children and adolescents. Spine 2001;26:1997-2000.
26. Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T. An epidemiologic study of MRI and low back pain in13-yearold children. Spine 2005; 30:798-806.
27. Slipman CW, Patel RK, Botwin K, Huston C, Zhang L,Lenrow D, et al. Epidemiology of spine tumors presenting to musculoskeletal physiatrists. Arch Phys Med Rehabil 2003; 84: 492-5.
28. Loh JK, Lin CK, Hwang YF, Hwang SL, Kwan AL, Howng SL. Primary spinal tumors in children. J Clin Neurosci 2005;12:246-8.
29. Nyska M, Constantini N, Cale-Benzoor M, Back Z, Kahn G, Mann G. Spondylolysis as a cause of low back pain in swimmers. Int J Sports Med 2000;21:375-9.
30. Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am 1997; 79: 364-8.
31. Grattan-Smith PJ, Ryan MM, Procopis PG. Persistent or
severe back pain and stiffness are ominous symptoms requiring prompt attention. J Paediatr Child Health 2000;36:208-12.
32. Villarejo-Ortega FJ, Torres Campa-Santamarina JM. [Lumber disc disease in adolescents]. Rev Neurol 2003; 36: 514–517.
33. Ring D, Johnston CE II, Wenger DR. Pyogenic infectious spondylitis in children: the convergence of discitis and vertebral osteomyelitis. J Pediatr Orthop 1995;15:652-60.
34. Leeson MC, Makley JT, Carter JR: Metastatic skeletal disease in the pediatric population. J Pediatr Orthop 1985;5:261-267.
35. Heinrich SD, Gallagher D, Warrior R,et al : The prognostic significance of the skeletal manifestations of acute
lymphoblastic leukemia of childhood. J Pediatr Orthop 1994;14:105-111.
36. Bentler WJ, Fredrickson BE, Murtland A, et al. The natural history of spondylolysis and spondylolisthesis: 45 year follow-up evaluation. Spine 2003; 28: 1027–1035.
37. Knoeller SM, Uhl M, Adler CP, Herget GW. Differential diagnosis of benign tumors and tumor-like lesions in the spine. Own cases and review of the literature. Neoplasma 2004;51:117-26.
38. Grubb MR, Currier BL, Pritchard DJ, et al: Primary Ewing’s sarcoma of the spine. Spine 1994;19:309-313.
39. Mirovsky Y, Jakim I, Halperin N, et al. Non-specific back pain in children and adolescents: a prospective study until maturity. J Pediatr Orthop 2002;11: 275-278.
2.
3.
1.
2.
5.
6.
7.
8.
(<110mg/dl)
(110-130mg/dl) 1.
και «υψηλά» επίπεδα για την apo B φαίνονται στον
πίνακα 3. Για την apo A1 σαν «χαμηλά» θεωρούνται επίπεδα < 120mg/dl και σαν «επιθυμητά» επίπεδα
>140mg/dl. Για την Lp(a) επίπεδα κάτω από 30mg/ dl θεωρούνται «φυσιολογικά», 30-100mg/dl «υψηλά» και >100mg/dl «πολύ υψηλά», ανεξάρτητα από
την ηλικία και το φύλο (1,3,6, 11,12). Τελευταία, για την εκτίμηση του κινδύνου καρδιαγγειακής νόσου
1. Οικογενής υπερχοληστερολαιμία (FH)
2. Οικογενής συνδυασμένη υπερλιπιδαιμία ( FCH)
3. Δυσβηταλιποπρωτεϊναιμία ή υπερλιποπρωτεϊναιμία τύπου ΙΙΙ
4. Πολυγονιδιακή υπερλιπιδαιμία
5. Οικογενής υποαλφαλιποπρωτεϊναιμία
6. Γενετική αύξηση της Lp(a)
7. Γενετική μετάλλαξη του νευροπεπτιδίου Υ
Β) Δευτεροπαθείς
1. Αυξημένο βάρος σώματος (ΒΜΙ > 85η Ε.Θ για την ηλικία και το φύλο)
2. Μεταβολικό σύνδρομο
3. Χαμηλό βάρος γέννησης για τη διάρκεια κύησης
4. Νευρογενής ανορεξία
5. Υποθυρεοειδισμός (κλινικός ή υποκλινικός)
6. Σακχαρώδης διαβήτης (τύπου 1 ή τύπου 2)
7. Νεφρική νόσος (χρόνια νεφρική νόσος, νεφρωσικό σύνδρομο)
8. Ηπατική νόσος (απόφραξη χοληφόρων, χολική κίρρωση, ενεργός ηπατίτιδα)
9. Συστηματικός ευρυθηματώδης λύκος
10. Σύνδρομο πολυκυστικών ωοθηκών
11. Μεταβολικά νοσήματα (π.χ. γλυκογονιάσεις, νόσος άθροισης εστέρων χοληστερόλης)
12. Μεταμοσχεύσεις οργάνων (π.χ. καρδιάς, νεφρού)
13. HIV λοίμωξη (υπό αγωγή, με αντιρετροϊκά φάρμακα)
14. Φάρμακα (π.χ. κορτικοστεροειδή, αναβολικά στεροειδή, αντιεπιληπτικά, ισοτρετινοΐνη, μερικά αντισυλληπτικά, β-αποκλειστές )
15. Κάπνισμα (ενεργητικό ή παθητικό)
16. Αυξημένη κατανάλωση αλκοολούχων ποτών
17. Απουσία φυσικής άσκησης
18. Διατροφή με αυξημένα ποσά κεκορεσμένου λίπους, trans λιπαρών οξέων και χοληστερόλης ή και απλών υδατανθράκων
19. Ειδικές δίαιτες π.χ. κετογόνες
HeFH
Α.
(Flow-Mediated Dilatation of brachial artery, FMD).
*Therapeutic Lifestyle Changes, From National Cholesterol Education Program ATP III, modified form, # Ηλικία
Βιβλιογραφία
1. Daniels SR, Greer FR, and the Committee on Nutrition. Lipid Screening and cardiovascular Health in Childhood. Pediatrics 2008; 122: 198-208.
2. Baumer JH, Shield JPH. Hypercholesterolaemia in children guidelines review. Arch Dis Child Educ Pract Ed 2009; 94:84-86.
3. Haney EM, Huffman LH, Bougatsos C, Freeman M, Steiner RD, Nelson HD. Screening and Treatment for Lipid Disorders in Children and Adolescents: Systemic Evidence Review for the US Preventive Services Task Force. Pediatrics 2007;120:e189-214.
4. American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood. Pediatrics 1998; 101:141-147.
5. National Cholesterol Education Program. Report of the expert panel on blood cholesterol levels in children and adolescents. Pediatrics 1992; 89 (3pt2):525-584.
6. Zappalla FR, Gidding SS. Lipid Management in children. Endocrinol Metab Clin N Am 2009; 38:171-183.
7. Kavey REW, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. J Pediatr 2003; 142:368-372.
8. Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and the early development of atherosclerosis. Bogalusa Heart Study. N Engl J Med 1998; 338(23):1650-1656.
9. McCrindle BW. Hyperlipidemia in children. Thrombosis Research 2006;118: 49-58.
10. Benlian P, Turquet A, Carrat F, Amsellem S, Sanchez L, Briffaut, et al. Diagnosing Scoring for Clinical Identification of Children With Heterozygous Familial Hypercholesterolemia. JPGN 2009;48:456-463.
11. McCrindle BW, Urbina E, Dennison BA, Jacobson MS, Steinberger J, Rocchini AP, et al. Drug Therapy of High –Risk Lipid Abnormalities in Children and Adolescents. Circulation 2007; 115: 1948-1967.
12. Schulpis K, Karikas GA. Serum cholesterol and triglyceride distribution in 7761 school-aged Greek children. Pediatrics 1998;101:861-864.
13. Eminoglu TF, Yenicesu I, Tumer L, Okur I, Dilsiz G, Hasanoglu A. Lipid apheresis applications in childhood: Experience in the University Hospital of Gazi. Transfusion and Apheresis Science 2008;39:235-240.
14. Yuan G, Wang J, Hegele RA. Heterozygous familial hypercholesterolemia: an under-recognized cause of early cardiovascular disease. CMAJ 2006;174(8):1124-1129.
15. Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol 2009;24:707-719.
16. Jarvisalo MJ, Jartti L, Nanto-Salonen K, Irjala K, Ronnemaa T, Hartiala JJ, et al. increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high –risk children. Circulation 2001;104:2943-2947.
17. Civiera F. International panel on management of familial hypercholesterolemia. Guidelines for the diagnosis and management of heterozygous familial hypercholesterolemia. Atherosclerosis 2004;173:55-68.
18. Davis V. Pediatric Lipid Disorders in Clinical Practice. eMedicine 2008.
19. Obarzanek E, Kimm SY, Barton BA, Van Horn LL, Kwiterovich PO jr, Simons-Morton DG, et al. Long –Term Safety and Efficacy of a Cholesterol-Lowering Diet in Children With Elevated Low Density Lipoprotein Cholesterol: Seven-Year Results of the Dietary Intervention Study in Children(DISC) Pediatrics 2001;107:256-264
20. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gilman MW, Lichtenstein AH, et al. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation 2005;112:2061-2075.
21. Olson RE. Is it wise to restrict fat in the diets of children? J Am Diet Assoc. 2000;100(1):28-32.
22. Jakulj L, Vissers MN, Rodenburg J, Wiegman A, Trip MD, Kastelein JJ. Plant stanols do not restore endothelial function in pre-pubertal children with familial hypercholesterolemia despite reduction of low-density lipoprotein cholesterol levels. J Pediatr 2006;148:495-500.
23. Tolfrey K, Jones AM, Campbell IG. The effect of aerobic exercise training on the lipid-lipoprotein profile of children and adolescents. Sports Med 2000;29:99-112.
24.
2009; 72:484-487.
25. Manlhiot C, Larsson P, Gurofsky RC, Smith RW, Fillingham C, Clarizia NA, et al. Spectrum and management of hypertriglyceridemia among children in clinical practice. Pediatrics 2009;123:458-465.
26. Rodenburg J, Vissers MN, Wiegman A, van Trotsenburg ASP, van der Graaf A, de Groot E, et al. Statin treatment in children with familial hypercholesterolemia: the younger, the better. Circulation 2007;116:664-668.
27. Stein EA. Statins and children. Whom do we treat and when? Circulation 2007;116:594-595.
28. Avis HJ, Vissers MN, Stein EA, Wijburg FA, Trip MD, Kastelein JJP, et al. A systematic review and metaanalysis of statin therapy in children with familial hypercholesterolemia. Arterioscler Thromb Vasc Biol 2007;27:1803-1810.
29. Belay B, Belamarick P, Tom-Revzon C. The use of statins in Pediatrics: Knowledge, base, limitations and future directions. Pediatrics 2007;119(2):370-379.
30. Wiegman A, Hutten BA, de Groot E, Rodenburg J, Bakker HD, Buller HR, et al. Efficacy and safety of statin therapy in children with familial hypercholesterolemia. A randomized controlled trial. JAMA 2004;292:331-337.
31. O’ Gorman CS, Higgins MF, O’ Nell MB. Systemic review and metaanalysis of statins for eterozygous familial hypercholesterolemia in children: Evaluation of cholesterol changes and side effects. Pediatr Cardiol 2009;30:482-489.
32. Clauss S, Wai KM, Kavey REW, Kuehl K. Ezetimibe treatment of pediatric patients with hypecholesterolemia. J Pediatr 2009;154:869-872.
1
Αλληλογραφία: Μαργαρίτα
margbaka@hotmail.com pedonca@aglaiakyriakou.gr
Ογκολογικό
1 Oncology Department, “Aglaia Kiriakou” Childrens’ Hospital
2 Gynecology Department, NIMTS Hospital
Correspondence: Margarita Baka margbaka@hotmail.com pedonca@aglaiakyriakou.gr Oncology Department, “Aglaia Kiriakou” Childrens’ Hospital
(Children’s Oncology Group -COG), η
(International Society Pediatric Oncology Europe Neuroblastoma Group- SIOPEN και German Pediatric Oncology and Hematology Group)
New
International Neuroblastoma Risk Group Staging System for Children with Neuroblastoma
M. Baka1, A. Kagia2
Abstract: Neuroblastoma is known for its differency concerning its clinical behaviour. Some tumors reduce or mature and some others appear to have a disease progress in spite of the aggressive therapy. The International Neuroblastoma Staging System (INSS) that has been used till now was developed in 1986, after an international consensus between researchers coming from different countries of the world. This system was based on surgical and pathologic criteria. In spite of the fact that many countries have accepted this staging system for children suffering from neuroblastoma there have been many difficulties that came up during its appliance. Since 1994 the protocol of SIOPEN (International Society Pediatric Oncology Europe Neuroblaestoma Group) classifies children with localized neuroblastoma in those having ressectable and those having unressectable tumor, no matter which the INSS stage is, taking under concern the presence or absence of surgical risk factors. A new staging system developed (INRG), aiming to stage the young neuroblastoma patients in risk groups before the beginning of the treatment. INRG is based on the imagings of the primary tumor before the beginning of the treatment and not on the extent of the surgical ressection. Research groups from different countries treating young neuroblastoma patients, such as North America and Australia (Children Oncology Group COG), Europe (International Society Pediatric Oncology Europe Neuroblastoma Group- SIOPEN and German Pediatric Oncology and Hematology Group) and Japan where gathered for the first time in 2004, so as to agree in the creation of a new staging system for the young neuroblastoma patients. The final results where based on the statistic analysis of 13 out of 35 possible risk factors that were studied in a sum up of 8.800 young neuroblastoma patients.
Key words: New, International Staging System, Neuroblastoma
EFS Event Free Survival
ENSG European Neuroblastoma Study Group
COG Children’s Oncology Group
INRG International Neuroblastoma Risk Group
INSS Iternational Neuroblastoma Staging System
LNESG1 Locoregional Neuroblastoma Study Group 1
LOH Loss Of Eterozygocity -Απώλεια της
MKΙ Mitotis Karyorrhexis Index -Δείκτης
SIOPEN International Society of Peadiatric Oncology-European Neuroblastoma
Το
(1)
(Iternational Neuroblastoma Staging
1)
3.
2)
1.
2.
3. Θωρακο-κοιλιακός όγκος, ατρακτοειδής περιαορτικός όγκος.
4.
3) Κοιλιά
1. Όγκος επινεφριδίου
2.
3.
4.
5.
6.
(Children’s Oncology Group
(International
Neuroblastoma
Children’s Oncology Group-COG 4235 European Neuroblastoma Study Group - ENSG 917
Pediatric Oncology and Hematology Group)
Children’s Oncology Group (COG), European Neuroblastoma Study Group (ENSG ),
(365
(5)
με στάδιο L2 και NMYC amplification (N) . 3. Όλα τα παιδιά < 18μηνών με στάδιο M με NMYC amplification (O) . 4. Όλα τα παιδιά ≥18μηνών με στάδιο M ανεξαρτήτως άλλων προγνωστικών παραγόντων (P) 5. Όλα τα παιδιά<18μηνών με στάδιο Ms χωρίς NMYC amplification αλλά με 11q LOH/ανωμαλίες (Q) . 6. Όλα τα παιδιά < 18μηνών με στάδιο Ms με NMYC
amplification (R). (EFS <50%)
Τελικά, στο νέο σύστημα
1. Brodeur GM. Neuroblastoma :.Biological insisights into aclinical enigma.Nat Rev Cancer. 2003 ;3:203-216
2 Brodeur GM, Seeger RC, Barrett A, Berthold F, Castleberry RP, D'Angio G, et al. Internatinal criteria for diagnosis,staging and response to treatment in patients with neuroblastoma.. J Clin Oncol 1988;6:1874-1881
3. Hero B, Simon T, Spitz R, Ernestus K, Gnekow AK, ScheelWalter HG, Schwabe D, Schilling FH, et al. Localized infants neuroblastomas often show spontaneous regression. Results of the prospective trials NB95-S AND NB97. J Clin Oncol 2008 ;26: 1504-1510
4. Cecchetto G, Mosseri V, De Bernardi B, Helardot P, Monclair T, Costa E, et al. Surgical risk factors in primary surgery for localized neuroblastoma: the LNESG1 study of the European International Society of Pediatric Oncology Neuroblastoma Group. J Clin Oncol 2005 ;23(33):8483-9.
5. Cohn SL, Pearson AD, London WB, Monclair T, Ambros PF, Brodeur GM, et al. INRG Task Force.The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report.. J Clin Oncol 2009 ;27(2):289-97
6. London WB, Castleberry RP, Matthay KK, Look AT, Seeger RC, Shimada H, et al. Evidence for an age cutoff greater than 365 days to neuroblastoma risk group stratification in the Children’s Oncology Groyp. J Clin Oncol 2005;23:6459-6465
7. Bagatell R, Beck-Popovic M, London WB, Zhang Y, Pearson AD, Matthay KK, et al. International Neuroblastoma Risk Group.Significance of MYCN amplification in international neuroblastoma staging system stage 1 and 2 neuroblastoma:
a report from the International Neuroblastoma Risk Group database. J Clin Oncol 2009 ;27(3):365-70
8. De Bernardi B, Gerrard M, Boni L, Rubie H, Cañete A, Di Cataldo A, Castel V, et al..Excellent outcome with reduced treatment for infants with disseminated neuroblastoma without MYCN gene amplification. J Clin Oncol 2009;27(7):1034-40
9. Ambros PF, Ambros IM, Brodeur GM, Haber M, Khan J, Nakagawara A, et al.. International consensus for neuroblastoma molecular diagnostics: report from the International Neuroblastoma Risk Group (INRG) Biology Committee. Br J Cancer 2009;100(9) :1471-82
10. Beiske K, Burchill SA, Cheung IY, Hiyama E, Seeger RC, Cohn SL, et al. International neuroblastoma Risk Group Task Force.Consensus criteria for sensitive detection of minimal neuroblastoma cells in bone marrow, blood and stem cell preparations by immunocytology and QRT-PCR: recommendations by the International Neuroblastoma Risk Group Task Force. Br J Cancer 2009 ;100(10) : 1627-37
11. Matthay KK, Shulkin B, Ladenstein R, Michon J, Giammarile F, Lewington et al..Criteria for evaluation of disease extent by (123)I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force. Br J Cancer. 2010;102(9):1319-26
12. Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, et al. INRG Task Force.The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol 2009;27(2):298-303
1st Department of Obstetrics and Gynaecology, University of Athens
Correspondence: Lina Michala, linamichalas@hotmail.com
Aleksandra Hospital 6, Lampsakou Str. Athens
Labial adhesions in childhood
L.Michala, A. Antsaklis, I. Mpiliatis
Abstract: Labial fusion is a common gynaecological condition in childhood. Despite its benign nature it often distresses parents who worry that the genitalia of their daughter might not be normal. Labial adhesions are never present at birth and usually start forming once oestrogen levels drop 2-3 months after birth. The exact cause is unknown, however it is felt that inflammation leads to denudation of vulval skin, leading to the formation of adhesions between adjacent areas. Rarer causes of labial adhesions that lead to stronger fusion may be caused by skin conditions such as lichen sclerosus or infections such as genital herpes. The condition is usually asymptomatic, however adhesions can cause pain when stretched, such as when the child abducts her legs, and urinary symptoms, such as dribbling or change of urinary stream direction. Treatment is not always required, but when deemed necessary, it is best to start with conservative management using local oestrogen cream application. Surgical treatment should be restricted to symptomatic cases, where medical treatment has failed. Whichever the treatment modality, labial adhesions tend to recur and only permanently subside in early puberty when endogenous oestrogen levels rise. Labial adhesions are not linked to any long term gynaecological disease and parents should be reassured that their daughter’s future fertility and sexual life will not be affected.
Key words: Labial adhesions, adhesions between adjacent areas, genitalia, juvenile gynaecology
1. Leung AK, Robson WL, Tay-Uyboco J. The incidence of labial fusion in children. J Paediatr Child Health 1993; 29:235–6.
2. McCann J, Wells R, Simon M, Voris J. Genital findings in prepubertal girls selected for nonabuse: a descriptive study. Pediatrics 1990;86:428–39.
3. Breech LL, Laufer MR. Surgicel in the management of labial and clitoral hood adhesions in adolescents with lichen sclerosus. J Pediatr Adolesc Gynecol 2000;13:21–2.
4. Muram D. Labial adhesions in sexually abused children. JAMA 1988;259:352–3.
5. DeMarco BJ, Crandall RS, Hreshchyshyn MM. Labial agglutination secondary to a herpes simplex II infection. Am J Obstet Gynecol 1987;157:296–7.
6. Opipari AWJr. Management quandary. Labial agglutination in a teenager. J Pediatr Adolesc Gynecol 2003;16:61–2.
7. Leung AK, Robson WL. Labial fusion and asymptomatic bacteriuria. Eur J Pediatr 1993;152:250–1.
8. Muram D. Treatment of prepubertal girls with labial adhesions. J Pediatr Adolesc Gynecol 1999;12:67–70.
9. Norbeck JC, Ritchey MR, Bloom DA. Labial fusion causing upper urinary tract obstruction. Urology 1993;42:209–11.
10. Bacon JL. Prepubertal labial adhesions: evaluation of a referral population. Am J Obstet Gynecol 2002;187:327-331.
11. Schober J, Dulabon L, Martin-Alguacil N, Kow LM, Pfaff D. Significance of topical estrogens to labial fusion and vaginal introital integrity. J Pediatr Adolesc Gynecol 2006;19:337–9.
12. Leung AK, Robson WL, Kao CP, Liu EK, Fong JH. Treatment of labial fusion with topical estrogen therapy. Clin Pediatr (Phila) 2005;44:245–7.
13. Elmore JM, Baker LA, Snodgrass WT. Topical steroid therapy as an alternative to circumcision for phimosis in boys younger than 3 years. J Urol 2002;168:1746–7.
14. Myers JB, Sorensen CM, Wisner BP, Furness PD, III, Passamaneck M, Koyle MA. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol 2006;19:407–11.
15. Smith C, Smith DP. Office pediatric urologic procedures from a parental perspective. Urology 2000;55:272–6.
16. Kumetz LM, Quint EH, Fisseha S, Smith YR. Estrogen treatment success in recurrent and persistent labial agglutination. J Pediatr Adolesc Gynecol 2006;19:381–4.
17. Omar HA, Muram D, Schroeder B. Management of labial adhesions in prepubertal girls. J Pediatri Adolesc Gynecol 2000;13:183-6.
1 Β’ Παιδιατρική Κλινική
Α.Π.Θ, Νοσοκομείο
ΑΧΕΠΑ, Θεσσαλονίκη
2 Α’ Παιδιατρική Κλινική
Α.Π.Θ, Νοσοκομείο
Ιπποκράτειο, Θεσσαλονίκη
3 Γ’ Παιδιατρική Κλινική
Α.Π.Θ, Νοσοκομείο
Ιπποκράτειο, Θεσσαλονίκη
Αλληλογραφία:
Φ. Αθανασιάδου-Πιπεροπούλου atriagia@auth.gr atragian@hotmail.com
Στ. Κυριακίδη 1, 54636, Νοσοκομείο ΑΧΕΠΑ, Θεσσαλονίκη
1 2nd AUTH Pediatrics Department, AHEPA Hospital, Thessaloniki
2 1st AUTH Pediatrics Department, Ippokration Hospital, Thessaloniki
3 3rd AUTH Pediatrics Department, Ippokration Hospital
Correspondence:
F. Athanasiadou atriagia@auth.gr atragian@hotmail.com
AHEPA Hospital, 1, Kiriakidi str, 54636, Thessaloniki
Experience and treatment results with the use of rituximab in children with no-malignant disease from Northern Greece
A. Tragiannidis1, E. Farmaki2, M. Trahana2, N. Printza2, M. Economou2, Z. Pana1, K. Kolios3, A. Taparkou2, Th. Papaeorgiou1, I. Tsatra2, E. Hadgipantelis1, F. Papahristou2, M. Athanasiou2, F. Athanasiadou1
Abstract
Introduction: Rituximab is a chimeric monoclonal antibody against the CD 20 antigen, which is expressed on the surface of mature B lymphocytes. Its administration causes depletion followed up by regeneration of B lymphocytes in peripheral blood, while it is not accompanied by a decrease in immunoglobulins
1 Άρρεν 11.5 Σύνδρ. Evans** IVIG,
2 Θήλυ 17 Σύνδρ. Evans IVIG, Στεροειδή
MMF, AZA,
3 Άρρεν 5 NIA MTX, Humira, Enbrel, 12
Anakinra,
4 Άρρεν
5
6
7
8
9
MMF
AZA
1. Eisenberg R. Update on Rituximab. Ann Rheum Dis 2005;64 (Suppl 4):55-57.
2. Pescovitz MD. Rituximab, an anti-CD20 monoclonal antibody: history and mechanism of action. Am J Transplant 2006;6:859-866.
3. Kneitz C, Wilhelm M, Tony HP. Effective B cell depletion with rituximab in the treatment of autoimmune diseases. Immunobiology 2002;206:519-527.
4. Leget GA, Czuczman MS. Use of rituximab, the new FDAapproved antibody. Curr Opin Oncol. 1998;10:548-551.
5. Avivi I, Robinson S, Goldstone A. Clinical use of rituximab in haematological malignancies. Br J Cancer 2003;89:13891394.
6. Pinkerton R. Continuing challenges in childhood nonHodgkin's lymphoma. Br J Haematol. 2005;130:480-488.
7. Franchini M, Zaffanello M, Veneri D, Lippi G. Rituximab for the treatment of childhood chronic idiopathic thrombocytopenic purpura and hemophilia with inhibitors. Pediatr Blood Cancer 2007;49:6-10.
8. Lillicrap D. The role of immunomodulation in the management of Factor VIII Inhibitors.
9. Shenoy S, Kelly M, Grossman W, et al. Rituximab therapy in children with chronic refractory immuno cytopenia: Long term efficacy and immune function analysis. Blood 2003;102:1020 (abstract).
10. Bagga a, Sinha A, Moudgil A. Rituximab in patients with the steroid-resistant nephrotic syndrome. N Engl J Med 2007;356:2751-2752.
11. Norton A, Roberts I. Management of Evans syndrome. Br J Haematol. 2006;132:125-137.
12. Furst DE, Breedveld FC, Kalden JR, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2007. Ann Rheum Dis. 2007;66 (Suppl 3):2-22.
13. Stanhenko P, Nadler LM, Hardy R, Schlossman SF. Characterization of a human B lymphocyte-specific antigen. J Immunol 1980;125:1678-1685.
14. Ranchin B, Fargue S. New treatment strategies for proliferative lupus nephritis: keep children in mind! Lupus 2007;16:684-691.
15. Tarantino MD, Bolton-Maggs PH. Update on the management of immune thrombocytopenic purpura in children. Curr Opin Hematol. 2007;14:526-534.
16. Mantadakis E, Danilatou V, Stiakaki E, Kalmanti M. Rituximab for refractory Evans syndrome and other immune-mediated hematologic diseases. Am J Hematol. 2004;77:303-310.
17. Alvarado Y, Yao X, Jumper C, et al. Acquired hemophilia: a case report of 2 patients with acquired factor VIII inhibitor treated with rituximab plus a short course of steroid and review of the literature. Clin Appl Thromb Hemost. 2007; 13:443-448.
18. Franchini M. Rituximab in the treatment of adult acquired hemophilia A: a systematic review. Crit Rev Oncol Hematol. 2007;63:47-52.
19. Haffner D, Fischer DC. Nephrotic syndrome and rituximab: facts and perspectives. Pediatr Nephrol. 2009;24:14331438.
20. Parodi E, Nobili B, Perrotta S, et al. Rituximab in children with chronic refractory symptomatic immune thrombocytopenic purpura: Efficacy and safety of treatment. Int J Hematol 2006;84:48-53.
21. Arnold DM, Dentali F, Crowther MA, et al. Systematic review: efficacy and safety of Rituximab for adults with idiopathic thrombocytopenic purpura. Ann Intern Med 2007;146:25-33.
22. Wang J, Wiley JM, Luddy R, Greenberg J, Feuerstein MA, Bussel JB. Chronic immune thrombocytopenic purpura in children: assessment of Rituximab treatment. J Pediatr 2005;146:217-221.
23. Carcao M, St Louis J, Poon MC, et al. On behalf of the Inhibitor Subcommittee of the Association of Hemophilia Clinic Directors of Canada. Rituximab for congenital hemophiliacs with inhibitors: A Canadian experience. Haemophilia 2006;12:7-18.
24. Prytula A, Iijima K, Kamei K, et al. Rituximab in refractory nephrotic syndrome. Pediatr Nephrol 2010;25:461-468.
25. Guigonis V, Dallocchio A, Baudouin V, et al. Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases. Pediatr Nephrol 2008;23:1269-1279.
26. Macdermott EJ, Adams A, Lehman TJ. Systemic lupus erythematosus in children: current and emerging therapies. Lupus 2007;16:677-683.
27. Ramos-Casals M, Soto MJ, Cuadrado MJ, Khamashta MA. Rituximab in systemic lupus erythematosus: A systematic review of off-label use in 188 cases. Lupus. 2009;18:767-776.
28. Willems M, Haddad E, Niaudet P, et al; French PediatricOnset SLE Study Group. Rituximab therapy for childhoodonset systemic lupus erythematosus. J Pediatr. 2006;148: 623-627.
29. Podolskaya A, Stadermann M, Pilkington C, Marks SD, Tullus K. B cell depletion therapy for 19 patients with refractory systemic lupus erythematosus. Arch Dis Child. 2008;93:401-406.
30. Nwobi O, Abitbol CL, Chandar J, Seeherunvong W, Zilleruelo G. Rituximab therapy for juvenile-onset systemic lupus erythematosus. Pediatr Nephrol. 2008;23:413-419.
31. Kumar S, Benseler SM, Kirby-Allen M, Silverman ED. B-cell depletion for autoimmune thrombocytopenia and autoimmune hemolytic anemia in pediatric systemic lupus erythematosus. Pediatrics. 2009;123:e159-163.
32. Peters HP, van de Kar NC, Wetzels JF. Rituximab in minimal change nephropathy and focal segmental glomerulosclerosis: report of four cases and review of the literature. Neth J Med. 2008;66:408-415.
33. Gong Q, Ou Q, Ye S, et al. Importance of cellular icroenvironment and circulatory dynamics in B cell immunotherapy. J Immunol. 2005;174:817-826.
34. Salliot C, Dougados M, Gossec L. Risk of serious infections during rituximab, abatacept and anakinra treatments for rheumatoid arthritis: meta-analyses of randomised placebo-controlled trials. Ann Rheum Dis. 2009;68:25-32.
35. Rafailidis PI, Kakisi OK, Vardakas K, Falagas ME. Infectious complications of monoclonal antibodies used in cancer therapy: a systematic review of the evidence from randomized controlled trials. Cancer. 2007;109:2182-2189.
36. Venhuizen AC, HustinxWN, van Houte AJ, Veth G, van der Griend R. Three cases of Pneumocystis jirovecii pneumonia (PCP) during first line treatment with rituximab in combination with CHOP-14 for aggressive B-cell non-Hodgkin’s lymphoma. Eur J Haematol 2008;80:275-276.
37. Tam C, Seymour J, Brown M, et al. Early and late infectious consequences of adding rituximab to fludarabine and cyclophosphamide in patients with indolent lymphoid malignancies. Heamatologica 2005;90:700-702.
38. Lin PG, Hsiao LT, Poh S, et al. Higher fungal infection rate in elderly patients (more than 80 years old) suffering from diffuse large B cell lymphoma and treated with rituximab plus CHOP. Ann Hematol 2007;86:95-100.
Ζ.Δ.
Mannose Binding Lectin Polymorphisms and bacterial infections in children with acute lymphoblastic leukemia.
Z.D Pana1,2, A. Tragiannidis1, T. Papageorgiou1, N. Vavatsi- Christaki2, E. Roilides3, F. Samarah2, M. Arvanitidou Vagiona4, V. Tsotoulidou1, F. Athanassiadou1
Abstract
Introduction: The aim of this study was to determine the Mannose Binding Lectin (MBL) gene polymorphisms and to evaluate their possible association with the severity, frequency and duration of bacterial infections in pediatric patients with acute lymphoblastic leukemia (ALL).
Patients and methods: Material was 30 children with ALL. For each child data -concerning the number and duration of fever neutropenia episodes (FN), as well as the number and the microbiological spectrum of the laboratory documented infections- were registered. The polymorphisms of MBL gene for codons 54 and 57 was determined with Polymerase Chain Reaction (PCR) and with two restriction enzymes (BAN I, Mbo II). The sample was divided in two subgroups: in Α/Α (children with the normal gene) and in Α/Ο + Ο/Ο (children who carried the mutational allele MBL).
Results: 1. A significant difference was found between MBL genotype and number of bacterial infections (p=0,024). 2. A significant difference was documented between the number of FN episodes and the two MBL genotype subgroups (p=0,017). 3. A marginal significance was found between of the first FN episode and the MBL subgroups (p=0,054), as well as between the duration of fever neutropenia and the two subgroups (p=0,0092).
Conclusions: Our study support that the polymorphisms of MBL gene may constitute a genetic marker of bacterial infection susceptibility in pediatric patients with ALL and that the further evaluation of these polymorphisms will eventually establish their prognostic value in the infection’s risk stratification of these patients.
Key words: acute lymphoblastic leukemia, episodes of fever neutropenia, MBL polymorphism.
1. 2nd Pediatric Department, University Hospital of Thessaloniki “AHEPA”
2. Laboratory of Clinical Biochemistry, Aristotle Medical School of Thessaloniki
3. 3rd Pediatric Department, University Hospital of Thessaloniki “Hippokratio”
4. Laboratory of Hygiene, Aristotle University of Thessaloniki
Correspondence: F. Athanassiadou
email: fathanas@auth.gr
2nd University Pediatric Department
General Hospital “AHEPA” 1, St. Kyriakidi 54636, Thessaloniki
(Mannose Binding Lectin; MBL).
Recognition Receptors,
1.
3.
4.
5.
6.
8.
9.
QIAamp DNA Mini Kit QIAGEN.
(forward primer) 5 ’ -TAGGACAGAGGGCATGCTC - 3
και o Eo4 (reverse primer) 5’-CAGGCAGTTTCCTCTGGAAGG-3’
στατιστικό πακέτο “Statistical Package for the Social Science SPSS for Windows” (έκδοση 15.0, Chicago, IL).
Αποτελέσματα Από τα 30 παιδιά της μελέτης 20 (66.7%) ήταν αγόρια και 10 (33.3%) κορίτσια, ενώ η μέση ηλικία
κατά τη διάγνωση ήταν 4.33 (±2.04) χρόνια. Τα 29 παιδιά (96.7%) παρουσίαζαν ΟΛΛ Β κυτταρικής αρχής και ένα παιδί (3.3%) ΟΛΛ Τ κυτταρικής αρχής. Με βάση των ανοσοφαινότυπο 28 παιδιά (93.3%) παρουσίαζαν κοινή Β-ΟΛΛ, ένα
(BioLabs, New England)
MboII (BioLabs, New England).
Gram
Σταφυλόκοκκος (3,85%) 2. Χαλκοπράσινη Ψευδομονάδα (9,62%)
3. Εντερόκοκκος faecium (1,92%)
4. Πρασινίζων Στρεπτόκοκκος (1,92%)
(7,695)
4. Εντεροβακτήριο cloacae (5,7%)
5. Ψευδομονάδα fluroscens (1,92%)
6. Ακινετοβακτήριο baumanii (1,92%)
7. Κιτροβακτηρίδιο (1,92%)
8. Πρωτέας mirabilis (1,92%)
9. Προβιντένσια robustus (1,92%)
Pseudomonas aeruginosa (9,62%).
Πίνακας
EORTC (European Organization For Research and Treatment of Cancer)
1. Griffin TC, Buchanan GR. Hematologic predictors of bone marrow recovery in neutropenic patients hospitalized for fever: implications for discontinuation of antibiotics and early discharge from the hospital. J Pediatr 1992;121:28-33.
2. Jones GR, Konsler GK, Dunaway RP, Gold SH, Cooper HA, Wells RJ. Risk factors for recurrent fever after the discontinuation of empiric antibiotic therapy for fever and neutropenia in pediatric patients with a malignancy or hematologic condition. J Pediatr 1994; 124:703-708.
3. Baorto EP, Aquino VM, Mullen CA, Buchanan GR, DeBaun MR. Clinical parameters associated with low bacteremia risk in 1100 pediatric oncology patients with fever and neutropenia. Cancer 2001; 92:909-913.
4. risk prediction criteria for episodes of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 2002; 24:38-42.
5. Basu S, Fernandez I, Fisher S, Asselin BL, Lyman GH. Length of stay and mortality associated with febrile neutropenia among children with cancer. J Cin Oncol 2005; 23:7958-7966.
6. Bardi E, Jenei C, Kiss C. Polymorphism of angiotensin converting enzyme is associated with severe circulatory compromise in febrile neutropenic children with cancer. Pediatr Blood Cancer 2005;45:217-221.
7. Ezekowitz RA. Role of the mannose-binding lectin in innate immunity. J Infect Dis 2003; 187:335-339.
8. Drickdamer K, Weis W. Trimeric structure of a C-type mannose-binding protein. Structure 1994;40:1227-1240.
9. Palaniyar N, Nadesalingam J, Clark H, Shih MJ, Dodds AW, Reid KB. Nucleic acid is a novel ligand for innate, immune pattern recognition collectins surfactant proteins A and D and mannose-binding lectin. J Biol Chem 2004; 279: 3228-3236.
10. Schwaeble W, Dahl M, Thiel S, Stover C, Jensenius JC. The mannan-binding lectin-associated serine proteases (MASPs) and Map19: four components of the lectin pathway activation complex encoded by two genes. Immunobiol 2002;205: 455-466.
11. Takahashi M, Endo Y, Fujita T, Matsushita M. A truncated
form of mannose-binding lectin-associated serine protease (MASP)-2 expressed by alternative polyadenylation is a component of the lectin complement pathway. Int Immunol 1999; 11:859-863.
12. Tenner A, Robinson S, Ezekowitz R. Mannose-binding protein (MBP) enhances mononuclear phagocyte function via a receptor that contains the 126000 M(r) component of the C1q receptor. Immunity 1995;3:485-493.
13. Ogden CA, deCathelineau A, Hoffmann PR, Bratton D, Ghebrehiwet B, Fadok VA, et al. C1q and mannose binding lectin engagement of cell surface calreticulin and CD91 initiates macropinocytosis and uptake of apoptotic cells. J Exp Med 2001;194: 781-795.
14. Sastry K, Herman G, Day L, Deignan E, Bruns G, Morton CC, et al. The human mannose-binding protein gene. J Exp Med 1989; 170: 1175-1189.
15. Lipscombe R, Sumiya M, Summerfield J, Turner M. Distinct physicochemical characteristics of human mannose binding protein exprassed by individuals of differing genotype. Immunology 1995;85:660-667.
16. Cedzynski M, Szemraj J, Swierzko A. Mannan-binding lectin insufficiency in children with recurrent infections of the respiratory system. ClinExp Immunol 2004;136: 304-311.
17. Garred P, Pressler T, Madsen HO, Frederiksen B, Svejgaard A, Høiby N, et al. Association of mannose-binding lectin gene heterogeneity with severity of lung disease and survival in cystic fibrosis. J Clin Invest 1999;104 : 431-437.
18. Gabolde M, Guilloud-Bataille M, Feingold J, Besmond C. Association of variant alleles of mannose binding lectin with severity of pulmonary disease in cystic fibrosis: cohort study. BMJ 1999; 319: 1166-1167.
19. Davies J, Neth O, Alton E, Klein N, Turner M. Differential binding of mannose-binding lectin to respiratory pathogens in cystic fibrosis. Lancet 2000; 355:1885-1896.
20. Yarden J, Radojkovic D, De Boeck K, Macek M Jr, Zemkova D, Vavrova V, et al. Polymorphisms in the mannose binding lectin gene affect the cystic fibrosis pulmonary phenotype. J Med Genet 2004; 41:629-633.
21. Garred P, J JS, Quist L, Taaning E, Madsen HO. Association of mannose-binding lectin polymorphisms with sepsis and fatal outcome, in patients with systemic inflammatory response syndrome. J Infect Dis 2003 ;188: 1394-1403.
22. Fidler KJ, Wilson P, Davies JC, Turner MW, Peters MJ, Klein NJ. Increased incidence and severity of the systemic inflammatory response syndrome in patients deficient in mannose-binding lectin. Intensive Care Med 2004;30:14381445.
23. Saevarsdottir S, Oskarsson O, Aspelund T. Mannanbinding lectin as an adjunct to risk assessment for myocardial infarction in individuals with enhanced risk. J Exp Med 2005;201: 117-125.
24. Takahashi R, Tsutsumi A, Ohtani K, Muraki Y, Goto D, Matsumoto I, et al. Association of mannose binding lectin (MBL) gene polymorphism and serum MBL concentration with characteristics and progression of systemic lupus erythematosus. Ann Rheum Dis 2005;64: 311-314.
25. Seibold F, Konrad A, Flogerzi B, Seibold-Schmid B, Arni S, Jüliger S, Kun JF. Genetic variants of the mannan-binding lectin are associated with immune reactivity to mannans in Crohn's disease. Gastroenterology 2004;127:1076-1084.
26. Hibberd ML, Sumiya M, Summerfield JA, Booy R, Levin M. Association of variants of the gene for mannose-binding
lectin with susceptibility to meningococcal disease. Meningococcal Research Group. Lancet 1999;353:1049-1053.
27. Amoroso A, Berrino M, Boniotto M, Crovella S, Palomba E, Scarlatti G, et al. Polymorphism at codon 54 of mannosebinding protein gene infuences AIDS progression but not HIV infection in exposed children. AIDS 1999;13:863-864.
28. Chong WP, To YF, Ip WK, Yuen MF, Poon TP, Wong WH, et al. Mannose-binding lectin in chronic hepatitis B virus infection. Hepatology 2005;42:1037-1045.
29. Neth O, Hann I, Turner MW, Klein NJ. Deficiency of mannose-binding lectin and burden of infection in children with malignancy: a prospective study. Lancet 2001;358:614-618.
30. Frakking FN, van de Wetering MD, Brouwer N, Dolman KM,
Geissler J, Lemkes B, Caron HN, et al. The role of mannosebinding lectin (MBL) in paediatric oncology patients with febrile neutropenia. Eur J Cancer 2006;42:909-916.
31. Lausen B, Schmiegelow K, Andreassen B, Madsen HO, Garred P. Infections during induction therapy of childhood acute lymphoblastic leukemia--no association to mannosebinding lectin deficiency. Eur J Haematol 2006;76:481-487.
32. Schlapbach LJ, Aebi C, Otth M, Luethy AR, Leibundgut K, Hirt A, et al. Serum levels of mannose-binding lectin and the risk of fever in neutropenia pediatric cancer patients. Pediatr Blood Cancer 2007;49:11-16.
33. Sepkowitz K. Treatment of patients with hematologic neoplasma, fever and neutropenia. Clin Infect. Dis 2005;40: 253-256.
Λέξεις
Healthcare students with suboptimal protective immunity against vaccine preventable diseases
I. D. Pavlopoulou1, G. L. Daikos2, A. Tzivaras3, A. Triantafyllidou1, K. Tsoumakas1, K. Theodoridou4, K. Michail1, M. Theodoridou4
Abstract
Background: Healthcare students (HCS) are at risk of contracting and transmitting infectious diseases in the hospital setting. The aim of this study was to evaluate the vaccination history of HCS and their serologic immunity against vaccine-preventable diseases.
Methods: This prospective cohort study took place in a university children’s hospital in Athens, Greece. HCS were recruited during April through November 2007. Information obtained during personal interviews included demographic data and the history of varicella, measles, mumps, rubella and HAV or HBV infection. The vaccination history and documentation of disease were abstracted from medical records. Serum antibodies against the above-mentioned viral agents were determined by ELISA. HCS who were seronegative and those with immunization gaps were referred to local vaccination clinics, and compliance with recommendations was assessed 3 months later.
Results: A total of 187 HCS were recruited, 131 (70.1%) of whom provided complete documentation of vaccination history. Adequate immunity against diphtheria and tetanus was documented for 55 (37.2%) and 73 (49.3%) of the 148 participants, respectively, whereas age-appropriate vaccination against pertussis,
1 Paediatric Research Laboratory, Faculty of Nursing, University of Athens
2 First Internal Medicine University Clinic, Medical School, University of Athens
3 Department of Blood Donation, “Aghia Sophia” Children’s Hospital, Athens
4 First Paediatric Department, University of Athens, “Aghia Sophia” Children’s Hospital, Athens
Correspondence:
Ioanna D. Pavlopoulou idpavlop@yahoo.gr
Paediatric Research Laboratory, Faculty of Nursing, National & Kapodistrian University of Athens 55, Fidippidou St., 11527, Athens, Greece
diphtheria, tetanus, and poliomyelitis was noted for 138 (93.2%), 147 (99.3%), 147 (99.3%), and 147 (99.3%) students, respectively. Of 185 HCS, 171 (92.4%) were immune to varicella. Of 182 HCS, 179 (98.4%) were immune to measles, 163 (89.6%) were immune to mumps, and 176 (96.7%) were immune to rubella. Of 179 HCS, 151 (84.4%) were immune to HBV. Of 178 HCS, 26 (14.6%) were immune to HAV. Antibodies (≥10 IU/L) to HBsAg were detected for 151 (84.4%) of 179 HCS, and antibodies (≥10 IU/L) to HAV were detected for 26 (14.6%) of 178 HCS. Fewer than 30% of participants were in full compliance with recommended vaccinations.
Conclusions: Α proportion of HCS are susceptible to certain vaccine preventable diseases. Development of an appropriate vaccination strategy is required in order to decrease the transmission risk for HCS in the hospital setting.
Key words: Vaccine coverage, serologic immunity, healthcare students.
HCS healthcare students (replaced the term ‘medical and nursing students’)
SERION ELISA classic (Institut Virion/Serion GmbH). Τα IgG
του ιού της ηπατίτιδας Β μετρήθηκαν με τη μέθοδο AxSΥΜ AUSAB (Abbott Laboratories). Στους φοιτητές με θετικό αντίσωμα για το αντιγόνο επιφανείας (HΒs),
AxSΥΜ CORE, καθώς και του αντιγόνου επιφανείας
(HBsAg)
AxSYM HAV Ab 2.0 (Abbott Laboratories).
Αντίστοιχα, από τους 182 φοιτητές που ελέγχθηκαν, 179 (98,4%) βρέθηκαν οροθετικοί για ιλαρά, 163 (89,6%) οροθετικοί
0 103 99 (96,1) 4 (3,9)
1 7 4 (57,1) 3 (42,9)
2 16 2 (12,5) 14 (87,5)
52 47 (90,4)
εμβολίου ηπατίτιδας Α, 103 (57,9%) ήταν ανεμβολί-
4 (3,9%: 1 Έλληνα, 2 Αλβανούς και 1
από τους 103 μη εμβολιασμένους φοιτητές και σε 5 (9,6%) από 52 φοιτητές στους οποίους η εμβολιαστική κατάσταση ήταν άγνωστη. Κανείς
Βιβλιογραφία
1. Beltrami EM, Bolyard EA. Personnel health services. In: Jarvis WR, ed. Bennett & Brachman’s hospital infections. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 45-63.
2. Lane NG, Paul RI, Bracher DF, Stover BH. A survey of policies at children’s hospitals regarding immunity of healthcare workers: are physicians protected? Infect Contr Hosp Epidemiol 1997;18:400-404.
3. Rivera ME, Mason WH, Ross LA, Wright HT Jr. Nosocomial measles infection in a pediatric hospital during a community-wide epidemic. J Pediatr 1991;119:183-186.
4. Centers for Disease Control and Prevention. Immunization of healthcare workers. Recommendation of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997;46(No RR-18):1-42.
5. Centers for Disease Control and Prevention. Prevention of varicella. Update recommendations of the Advisory Committee on Immunization practices (ACIP). MMWR 1999;48(No RR-6):1-5.
6. Weber DJ, Rutala WA. Vaccines for healthcare workers. In: Plotkin SA, Orenstein WA, eds. Vaccines. 4th ed. Philadelphia: W.B. Saunders; 2004. p. 1511-1537.
7. Ruef C. Immunization for hospital staff. Curr Opin Infect Dis. 2004;17(4):335-339.
8. Brotherton JM, Bartlett MJ, Muscatello DJ, CampbellLloyd S, Stewart K, McAnulty JM. Do we practice what we preach? Health care worker screening and vaccination. Am J Infect Control 2003;31:144-150.
9. Breuer J. Varicella vaccination for healthcare workers. BMJ 2005; 330: 433-434.
10. Poland GA, Nichol KL. Medical students as sources of rubella and measles outbreaks. Arch Intern Med 1990; 150:44-46.
11. Sienko DG, Friedman C, McGee HB, Allen MJ, Simonsen WF, Wentworth BB, et al. A measles outbreak at university medical settings involving health care providers. Am J Public Health 1987;77:1222-1224.
12. Poland GA, Nichol KL. Medical schools and immunization policies: missed opportunities for disease prevention. Ann Intern Med 1990;113:628-630.
13. Rowan MS, Carter AO, Walker VJ. Immunization policies in Canadian medical schools. Can Med Assoc J 1994;151(7): 957-961.
14. Schmid K, Wallaschofski H, Drexler H. Student health policy of a German medical school-results of a cross sectional study concerning students’ immunity to vaccine preventable diseases. Int J Hygiene Environment Health 2004;207:595-600.
15. Baer G, Bonhoeffer J, Schaad UB. Seroprevalence and immunization history of selected vaccine preventable diseases in medical students. Vaccine 2005;23:2016-2020.
16. Ziegler E, Roth C, Wreghitt T. Prevalence of measles
susceptibility among health care workers in a UK hospital. Does the UK need to introduce a measles policy for its’ health care workers? Occup Med (Lond) 2003;53:398-402.
17. Asari S, Deguchi M, Tahara K, Taniike M, Toyokawa M, Nishi I, et al. Seroprevalence survey of measles, rubella, varicella, and mumps antibodies in health care workers and evaluation of a vaccination program in a tertiary care hospital in Japan. Am J Infect Control 2003;31:157-162.
18. Trevisan A, Morandin M, Frasson C, Paruzzolo P, Davanzo E, et al. Prevalence of childhood exanthematic disease antibodies in paramedical students: need of vaccination. Vaccine 2006;24:171-176.
19. Schoub BD, Johnson S, McAnerney JM, Borkon L. Susceptibility to poliomyelitis, measles, mumps and rubella in university students. South Afr Med J 1990;77(1):18-20.
20. Nichol KL. Medical students’ exposure and immunity to vaccine-preventable diseases. Arch Intern Med 1993; 153(16):1913-1916.
21. Wicker S, Allwinn R, Gottschalk R, Rabenau HF. Reliability of medical students’ vaccination histories for immunisable diseases. BMC Public Health 2008;8:121-128.
22. Kanra G, Yalčin SS, Kara A, Yourdakők K, Pehlivanli T. Varicella seroprevalence among Turkish medical students and the validity of disease history. Infect Contr Hosp Epidemiol 2003;24:795-796.
23. Torda AJ. Vaccination and screening of medical students: results of a student health initiative. MJA 2008;189:484-486.
24. Lionis C, Thireos E, Antonopoulou M, Rovithis E, Philalithis A, Trell E. Assessing university students’ health needs: lessons learnt from Crete, Greece. Eur J Public Health 2006;16(1):112.
25. Noula M, Raftopoulos V, Gesouli E, Tsaprounis T, Deltsidou A. Greek nursing students’ immunization coverage: Data from central continental Greece. Nurs Health Sci 2008;10: 169-174.
26. Bitsori M, Ntokos M, Kontarakis N, Sianava O, Ntouros T, Galanakis E. Vaccination coverage among adolescents in certain provinces of Greece. Acta Pediatr 2005;94(8):11221125.
27. Georgakopoulou T, Grylli C, Kalamara E, Katerelos P, Spala G, Panagiotopoulos T. Current measles outbreak in Greece. Euro Surveill 2006; 11(2):E060223.2.
28. Heiniger U, Baer G, Bonhoeffer J, Schaad UB. Reliability of varicella history in children and adolescents. Swiss Med Wkly 2005;135:252-255.
29. Sellick JA, Longbine D, Schifeling R, Mylotte JM. Screening hospital employees for measles immunity is more cost effective than blind immunization. Ann Intern Med 1992;116:982-984.
1
1 3rd Department of Pediatrics, «Attikon» University Hospital, Athens University Medical School
2 2nd Department of Radiology, «Attikon» University Hospital, Athens University Medical School
3 Department of Vascular Surgery, «Attikon» University Hospital, Athens University Medical School
Correspondence: Achilleas Attilakos attilakos@hotmail.com
3rd Department of Pediatrics, «Attikon» University Hospital, Athens University Medical School
«Nutcracker» Syndrome: A Pediatric Case Presentation
A. Attilakos1, E. Alexopoulou2, A. Papapetrou3, A. Fretzayas1, P. Nicolaidou-Karpathiou1, C. Liapis3
Abstract: Nutcracker syndrome is caused by the compression of the left renal vein between the superior mesenteric artery and the aorta (anterior syndrome), or rarely, between the aorta and the vertebral columns (posterior syndrome). The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank pain and macroscopic or microscopic, non-glomerular, hematuria. Also, in females, the syndrome may be manifested as “pelvic congestion syndrome”, characterized by symptoms of dysmenorrhea, lower abdominal pain, dysouria and pelvic, vulvar, gluteal or thigh varices. In males, nutcracker syndrome may appear as left varicocele or lower limb varices. Other manifestations of the syndrome include postural proteinouria and chronic fatigue syndrome. We present a case of a child with 2 episodes of macroscopic hematuria and flank pain, in which the diagnosis of nutcracker syndrome was proposed. Extensive laboratory evaluation excluded other causes of hematuria. Magnetic resonance imaging revealed the compression of the left renal vein between the superior mesenteric artery and the aorta. The child was treated conservatively, while macroscopic hematuria subsided gradually during a few days period. Nutcracker syndrome should be included in the differential diagnosis of a patient with macroscopic, non-glomerular, hematuria, especially when hematuria is combined with left flank pain.
Key words: Nutcracker syndrome, hematuria, child
ευρήματα. Ο
1. El-Sadr AR, Mina E. Anatomical and surgical aspects in the operative management of varicocele. Urol Cutaneous Rev. 1950; 54:257-262.
2. Chait A, Matasar KW, Fabian CE, Mellins HZ. Vascular impressions on the ureters. Am J Roentgenol Radium Ther Nucl Med. 1971; 111:729-749.
3. De Schepper A.: Nutcracker phenomenon of the left renal vein pathology. J Belg Rad 1972; 55: 507-511.
4. Jang YB, Kang KP, Lee S, Kim W, Kwak HS, Park SK. Posterior nutcracker phenomenon. Nephrol Dial Transplant. 2005; 20:2573-2574.
5. Ahmed K, Sampath R, Khan MS. Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg. 2006; 31:410-416.
6. Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006; 20:120-129.
7. Shin JI, Lee JS, Kim MJ. The prevalence, physical characteristics and diagnosis of nutcracker syndrome. Eur J Vasc Endovasc Surg. 2006; 32:335-336.
8. Scultetus AH, Villavicencio JL, Gillespie DL. The nutcracker syndrome: its role in the pelvic venous disorders. J Vasc Surg. 2001; 34:812-819.
9. Pan CG. Evaluation of gross hematuria. Pediatr Clin North Am. 2006; 53:401-412.
10. Στεφανίδης
2006; 69:75,78-79.
11. Wang L, Yi L, Yang L, Liu Z, Rao J, Liu L, Yang J. Diagnosis and surgical treatment of nutcracker syndrome: a singlecenter experience. Urology. 2009; 73:871-876.
12. Okada M, Tsuzuki K, Ito S. Diagnosis of the nutcracker phenomenon using two-dimensional ultrasonography. Clin Nephrol. 1998; 49:35–40.
13. Kim SH, Cho SW, Kim HD, Chung JW, Park JH, Han MC. Nutcracker syndrome: diagnosis with Doppler US. Radiology. 1996; 198:93-97.
14. Takebayashi S, Ueki T, Ikeda N, Fujikawa A. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 1999; 172:39-43.
15. Shin JI, Park JM, Lee JS, Kim MJ. Doppler ultrasonographic indices in diagnosing nutcracker syndrome in children. Pediatr Nephrol. 2007; 22:409-413.
16. Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 2007; 166:399-404.
17. Cheon JE, Kim WS, Kim IO, Kim SH, Yeon KM, Ha IS, Cheong HI, Choi Y. Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation of the left renal vein. Pediatr Radiol. 2006; 36:682-686.
18. Ragazzi M, Milani G, Edefonti A, Burdick L, Bianchetti MG, Fossali EF. Left renal vein entrapment: a frequent feature in children with postural proteinuria. Pediatr Nephrol. 2008; 23:1837-1839.
19. Shin JI, Park JM, Lee SM, Shin YH, Kim JH, Lee JS, Kim MJ. Factors affecting spontaneous resolution of hematuria in childhood nutcracker syndrome. Pediatr Nephrol. 2005; 20:609-613.
20. Shin JI, Park JM, Lee JS, Kim MJ. Morphologically improved nutcracker syndrome in an 11-year-old girl with hematuria. Pediatr Int. 2007; 49:677-679.
21. Wei SM, Chen ZD, Zhou M. Intravenous stent placement for treatment of the nutcracker syndrome. J Urol. 2003; 170:1934-1935.
1
3
1 1st Pediatrics Department, Penteli Childrens’ Hospital
2 Radiology Department, Penteli Childrens’ Hospital
3 Surgical Department, Penteli Childrens’ Hospital
4 C/T Department, Iaso Childrens’ Horpital.
Correspondence: Chrysa Κoutsaftaki kochrysa@yahoo.com
1st Pediatrics Department, Penteli Childrens’ Hospital
Χ. Κουτσαυτίκη1, Ι. Μαμμάς1, Α. Κώτσαρη1,
4–year old boy with persistent cough and spontaneous pneumothorax
Ch. Koutsaftiki1, J. Mammas1, K. Kostari1,G. Tapaki-Papadopoulou1, A. Sakelaropoulos2, E.Christianakis3, Ch. Hlampoutaki4, N. Miriokefalitakis1
Λευκά αιμοσφαίρια= 15.700/mm3 (Π= 51%, Λ= 39%, Μ= 8%, Η=2%), Αιμ= 342.000/mm3
13,9 g/dl,
15 mm Hg/1ηh, CRP=
2) Νεκρωτική πνευμονία
3) Πνευμονοβλάστωμα
4) Νευροβλάστωμα
5) Ραβδομυωσάρκωμα
1
2
Obesity and Metabolic Syndrome in “Pediatriki”
C. Stefanidis1, M. Garatzioti2
1 Department of Nephrology, “Aglaia Kyriakou” Children’s Hospital
2 1st Pediatric Clinic, “Agia Sofia” Children’s Hospital
Correspondence:
Κonstantinos Stefanidis stefanid@hol.gr Department of Nephrology, “Aglaia Kyriakou” Children’s Hospital Maria Garatzioti maria.garatzioti@gmail.com
1st Pediatric Clinic, “Agia Sofia” Children’s Hospital
2009; 72 (2): 139 -144] http://www.e-child.gr/sites/default/files/Pages%20139-144.pdf
Childhood obesity - A public health crisis across the European Union A.J. Nicholson, S. Del Torso, A. Hadjipanyidis,D.Van Esso [Παιδιατρική 2008; 71(2):92-95] http://www.e-child.gr/oldmagazines/Paediatriki_2008_71_p_92_95.pdf
Obesity prevalence in children aged 8-13 years according to IOTF cutoffs, CDC growth charts and Z-BMI scores
N. Mantzouranis, H. Douda, T. Pilianidis, S. Tokmakidis, [Παιδιατρική 2009; 72 (1): 41-45] http://www.e-child.gr/sites/default/files/pages%2041-45.pdf
Use of the new World Health Organization growth standards in the prevention of childhood overweight and obesity
M. Ponce-Rivera, D. Fuentes-Lugo, [Παιδιατρική 2008; 71(2):96-104] http://www.e-child.gr/oldmagazines/Paediatriki_2008_71_p_96_104.pdf
2009 72; (4): 274-282] http://www.e-child.gr/sites/default/files/Pages%20274-282%20from%20PAIDIATRIKH_%20JulAug%202009-4.pdf
2009 72; (4):283-292] http://www.e-child.gr/sites/default/files/Pages%20283-292from%20PAIDIATRIKH_%20Jul-Aug%20 2009-5.pdf
2009; 72 (1): 55-59]
http://www.e-child.gr/sites/default/files/pages%2055-59_0.pdf
http://www.e-child.gr/oldmagazines/Paediatriki_2007_70_p_300_307.pdf
70(3):205-216] http://www.e-child.gr/oldmagazines/Paediatriki_2007_70_p_205_216.pdf
71(5):331-415] http://www.e-child.gr/oldmagazines/Paediatriki_2008_71_p_376_382.pdf
2007; 70(1):24-36]
http://www.e-child.gr/oldmagazines/Paediatriki_%202007_70_p_24_36.pdf
2005; 68(6):433-439]
http://www.e-child.gr/oldmagazines/Pediatriki_2005_68_No6_P433_439.pdf
http://www.e-child.gr/oldmagazines/Paediatriki_2008_71_p_157_161.pdf
2009; 72(6):484-487] http://www.e-child.gr/sites/default/files/Paediatriki_2009_72_p_484_487.pdf
2006; 69(6): 468-477] http://www.e-child.gr/oldmagazines/Paediatriki_2006_69_p_468_477.pdf
2005; 68(1):45-52]
http://www.e-child.gr/oldmagazines/Paediatriki_2005_68_No1_P45_52.pdf
2006; 69(2):127-133]
http://www.e-child.gr/oldmagazines/Paediatriki_2006_69_P127_133.pdf
2008; 71(5):368-375] http://www.e-child.gr/oldmagazines/Paediatriki_2008_71_p_368_375.pdf
2009; 72 (6): 457-462] http://www.e-child.gr/sites/default/files/Paediatriki_2009_72_p_457_462.pdf
[Παιδιατρική 2007; 70(6):454-459] http://www.e-child.gr/oldmagazines/Paediatriki_2007_70_p_454_459.pdf
Οbituary: Valassia Kiriakidou
S. G. Giouroukos
(14).
1. Hasiotou M, Polyviou P, Strantzia CM, Pourtsidis A, Stinios I. Pleuropulmonary blastoma in the area of a previously diagnosed congenital lung cyst: report of two cases. Acta Radiol 2004;45:289-292.
2. Federici S, Domenichelli V, Tani G, Sciutti R, Burnelli R, Zanetti G, Domini R. Pleuropulmonary blastoma in congenital cystic adenomatoid malformation: report of a case. Eur J Pediatr Surg 2001;11:196-199.
3 Naffaa LN, Donnelly LF. Imaging findings in pleuropulmonary blastoma. Pediatr Radiol. 2005;35:387-391.
4. Priest JR, McDermott MB, Bhatia S, Watterson J, Manivel JC, Dehner LP. Pleuropulmonary blastoma: a clinicopathologic study of 50 cases. Cancer 1997; 80:147-161.
5. Barnard M, Bayani J, Grant R, Teshima I, Thorner P, Squire J. Use of multicolor karyotyping in genetic analysis of pleuropulmonary blastoma. Pediatr Dev Pathol 2000;3:479-486.
6 Wright JR. Pleuropulmonary blastoma: A case report documenting transition from type I (cystic) to type III (solid). Cancer 2000;88:2853-2858.
7 Hill DA, Sadeghi S, Schultz MZ, Burr JS, Dehner LP. Pleuropulmonary blastoma in an adult: an initial case report. Cancer 1999;85:2368-2374.
8 Pinarli FG, Oguz A, Ceyda K, Memis L, Aylar P. Type II pleuropulmonary blastoma responsive to multimodal therapy. Pediatr Hematol Oncol. 2005; 22:71-76.
9 The International Pleuropulmonary Blastoma Registry. Type I PPB Treatment Recommendations. Available at: www.ppbregistry.org/doctors/ treatment_I.asp Accessed October 8, 2006.
10. Vargas SO, Nose V, Fletcher JA, Perez- Atayde AR. Gains of chromosome 8 are confined to mesenchymal components in pleuropulmonary blastoma. Pediatr Dev Pathol 2001;4:434-445.
11 Miniati DN, Chintagumpala M, Langston C, Dishop MK, Olutoye OO, Nuchtern JG, Cass DL. Prenatal presentation and outcome of children with pleuropulmonary blastoma. J Pediatr Surg. 2006;41:66-71.
12 Surmont VF, van Klaveren RJ, Nowak PJ, Zondervan PE, Hoogsteden HC, van Meerbeeck JP. Unexpected response of a pulmonary blastoma on radiotherapy: a case report and review of the literature. Lung Cancer 2002;36:207-211.
13 Indolfi P, Casale F, Carli M, Bisogno G, Ninfo V, Cecchetto G, et al. Pleuropulmonary blastoma: management and prognosis of 11 cases. Cancer 2000; 89:1396-1401.
14 Granata C, Gambini C, Carlini C, Repetto P, Torre M, Mazzole C, et al. Eur J Pediatr Surg 2001; 11: 271-273.
Α
Αγακίδου Ε. 130
Αγγελάκου Β. 191
Αθανασιάδου - Πιπεροπούλου Φ. 159, 290, 299
Αθανασίου Μ. 290
Αλεξοπούλου Ε. 314
Αναγνωστάτου Ν. 150
Αναστασιάδου Ε. 55
Ανδρέου Α. 55, 147
Ανδρονίκου Σ. 167, 177
Αντσακλής Α. 286
Αρβανιτίδου - Βαγιωνά Μ. 39, 213, 299
Ασπρούδης Ι. 221
Αττιλάκος Α. 313184
Βαβάτση-Χριστάκη Ν. 299 Βαρλάμης Γ.
Βασιλόπουλος Α.
Βουτουφιανάκης Σ.
Γ
Γαλανάκης Ε.
Γαλανόπουλος Ν. 1, 13
Γαλλή – Τσινοπούλου Α. 39,
Μ.
ΕΥρΕΤΗριΟ
Μουσουράκης Σ.
Μπάκα Μ.
Μπιλιάκης Ι.
Μπουτζιούκα Β.
Ν
Νικολαϊδης
Ο
Οικονόμου Μ.
Π
Πανά
Παπαγεωργίου
Παπαντζίμας
17-21
2011 Pediatric Emergency Medicine: Sarasota, ΗΠΑ
An Evidence-Based Approach
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17-20
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E-mail: info@globalevents.gr
2011 the first Global Congress for Consensus in
Pediatrics and Child Health
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