Παιδιατρική | Τόμος 65 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2002

COVER Jan-FEB 02

14-05-03

10:54

™ÂÏ›‰·1

ISSN 0377-2551

¶AI¢IATPIKH

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TOMO™ 65

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TEYXO™ 1

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ETO™ 2002

π·ÓÔ˘¿ÚÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 1

∞ƒ£ƒO ™À¡∆∞•∏™ ∂ÁÎÂÊ·ÏÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È·

EDITORIAL 1

™.°. °ÈÔ˘ÚÔ‡ÎÔ˜

£ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) ‰È¿ÊÔÚ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙ· ·È‰È¿. ª›· ÚfiÎÏËÛË ÁÈ· ÙÔ ÁÈ·ÙÚfi

S. Youroukos 4

™. ∞ÚÒÓË-µÔ˘ÚÓ¿

REVIEW ARTICLES 9

π. ∫·Ï¤ÁÈ·˜, £. §È¿ÚÔ˘, ∑. ÷Ù˙ËÛÙ·Ì·Ù›Ô˘

™‡Ó‰ÚÔÌÔ Brugada

16

Brugada syndrome S. Maraka, A. Tsilimigaki

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ORIGINAL ARTICLES 23

£. ª¿ÓÙ˙ÈÔ˘, ∂. ¶Ï·ÙÔÎÔ‡ÎË, µ. ∫·Ú¿ÌÂÏ·˜, ∑. ∫·„ÈÌ¿ÏË, ∂. ∞‰·ÌÙ˙›ÎË, ∞. ∫Ô‚¿Ó˘, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜, ™. ∞ÚÒÓË

∫ÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘ ËÎÙ¿ÛË ·ÚÓËÙÈÎÔ‡ ·fi ÙȘ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ

Risk factors for cerebral palsy in extremely low birth weight infants J. Kaleyias, T. Liarou, Z. Hatzistamatiou

™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË

£ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿

Thromboembolic episodes of the central nervous system (CNS) of diverse etiology in children. A challenge for the physician S. Aronis-Vournas

∞¡∞™∫O¶∏™∂π™ ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÛÙ· ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ ÚfiˆÚ· ÓÂÔÁÓ¿

Cerebral thromboembolic episodes

Thromboembolic episodes of central nervous system in children T. Mantziou, H. Platokouki, V. Karambelas, Z. Kapsimali, E. Adamtziki, A. Kovanis, A. Scardoutsou, A. Constantopoulos, S. Aronis

32

Clinical evaluation of coagulase-negative staphylococcus in blood cultures of neonates

µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, Ã. ¡Ô‡ÙÛÈ·, ¶. ¶··Î˘ÚȷΛ‰Ô˘, ∂. ¢È·Ì·ÓÙ‹, ∫. ™·Ú·Ê›‰Ë˜, ª. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜

V. Drossou-Agakidou, H. Noutsia, P. Papakyriakidou, E. Diamanti, K. Sarafidis, M. Tsivitanidou, G. Kremenopoulos

∏ Û˘Ó¤¯ÂÈ· ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÛÙËÓ ÚÒÙË ÂÛˆÙÂÚÈ΋ ÛÂÏ›‰·

Continuation of table of contents inside title page

January - February 2002 . Volume 65 . No 1

JAN-FEB 2002 DONE

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10:53

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π·ÓÔ˘¿ÚÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 1

™˘Ó¤¯ÂÈ· ÂÚȯÔÌ¤ÓˆÓ ∏ˆÛÈÓÔÊÈÏ›· ÛÙ· ÓÔÛËÏ¢fiÌÂÓ· ÓÂÔÁÓ¿

Continuation of table of contents 40

ªÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Û ·È‰È¿ Ì Ó¢ÚÔ‚Ï¿Ûو̷

46

52

57

AWARD-WINNING ARTICLE

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞ 66

°. ª·ÓÈfi˜, π. ªÔÛ¯·Ó‰Ú¤·, Ã. ÷Ù˙‹˜, ∞. ∫·Ê¿ÙÔ˜

Chronic disease risk factors in primary school children of Crete following a six year health and nutrition education intervention program Y. Manios, I. Moschandrea, C. Hatzis, A. Kafatos

E¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ¶·ÚÔ‰ÈÎfi ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÙÂÛÛ¿ÚˆÓ ÂÚÈÙÒÛˆÓ

Clinical and laboratory investigation of associated myocardial-pericardial involvement in acute bronchiolitis M. Tsiligiri, M. Eboriadou, V. Aivazis, S. Alexiou, M. Diamandopoulou, G.S. Varlamis

ª. ∆ÛÈÏÈÁÁ›ÚË, ª. ∂ÌÔÚÈ¿‰Ô˘, µ. ∞˚‚¿˙˘, ™. ∞ÏÂ͛Ԣ, ª. ¢È·Ì·ÓÙÔÔ‡ÏÔ˘, °.™. µ·ÚÏ¿Ì˘

¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ ‰ËÌÔÙÈÎÔ‡ Ù˘ ∫Ú‹Ù˘ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÂÍ·ÂÙÔ‡˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜

The effect of a nucleotide supplemented formula on the peptic system of preterm infants V. Skouteri, C. Costalos, S. Sevastiadou, S. Gavrili, K. Danelatou, A. Voyiatzi, C. Economidou, V. Petrochilou

µ. ™ÎÔ˘Ù¤ÚË, Ã. ∫ÒÛÙ·ÏÔ˜, ™. ™Â‚·ÛÙÈ¿‰Ô˘, ™. °·‚Ú›ÏË, ∫. ¢·ÓÂÏ¿ÙÔ˘, ∞. µÔÁÈ·Ù˙‹, Ã. OÈÎÔÓÔÌ›‰Ô˘, µ. ¶ÂÙÚԯ›ÏÔ˘

∫ÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ÙÔ˘ ÂÚÈηډ›Ô˘ ÛÙËÓ ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·

Metastases in the central nervous system in children with neuroblastoma M. Baka, A. Pourtsidis, A. Stasinopoulou, M. Varvoutsi, D. Bouhoutsou, K. Paidousi, E. Kosmidi

ª. ª¿Î·, ∞. ¶Ô˘ÚÙÛ›‰Ë˜, ∞. ™Ù·ÛÈÓÔÔ‡ÏÔ˘, ª. µ·Ú‚Ô˘ÙÛ‹, ¢. ªÔ˘¯Ô‡ÙÛÔ˘, ∫. ¶·˚‰Ô‡ÛË, ∂. ∫ÔÛÌ›‰Ë

∏ Â›‰Ú·ÛË ÂÓfi˜ ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Ì ÓÔ˘ÎÏÂÔÙ›‰È· Á¿Ï·ÙÔ˜ ÛÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ

Eosinophilia in hospitalized neonates A. Manoura, E. Hatzidaki, E. Korakaki, M. Mitsaki, V. Valari, D. Mamoulakis, C. Giannakopoulou

∞. ª·ÓÔ˘Ú¿, ∂. ÷Ù˙ˉ¿ÎË, ∂. ∫ÔڷοÎË, ª. ªËÙÛ¿ÎË, µ. µ·Ï¿ÚË, ¢. ª·ÌÔ˘Ï¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

CASE REPORTS 77

Transient lupus anticoagulant in children: report of 4 cases

ª. OÈÎÔÓfiÌÔ˘, ∞. ∫Ô‡ÛË, π. ∆Û¿ÙÚ·, µ. °·Ú˘›‰Ô˘, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿

M. Economou, A. Koussi, I. Tsatra, V. Garipidou, M. Athanassiou-Metaxa

™˘Ó¯›˙ÔÓÙ·È

Continued

January - February 2002 . Volume 65 . No 1

JAN-FEB 2002 DONE

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™ÂÏ›‰·2

π·ÓÔ˘¿ÚÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2002 . ∆fiÌÔ˜ 65 . ∆‡¯Ô˜ 1

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

OÍ›· ÂÁÎÂÊ·ÏÈ΋ Û˘Ó‰ÚÔÌ‹ Û ·È‰› ˆ˜ ÂΉ‹ÏˆÛË Ì˘ÍÒÌ·ÙÔ˜ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘

Continuation of table of contents

81

∞. ∫Ô˘ÚÙ¤Û˘, Ã. ¶·Ê›Ù˘, ∂. §·ÙÔ‡ÊË, ∂. ¢Ú·ÁÒÁÈ·, °. ªÚÈ·ÛÔ‡Ï˘, µ. £·ÓfiÔ˘ÏÔ˜, ª. ∞˙·ÚÈ¿‰Ë˜

¡fiÛÔ˜ ÙÔ˘ Kohler. ™¿ÓÈ·, ·ÏÏ¿ ˘·ÚÎÙ‹ ÓfiÛÔ˜ ÛÙ· ·È‰È¿

A.N. Kourtesis, C.A. Paphitis, ∂. Latoufi, E. Dragogia, G. Briasoulis, V. Thanopoulos, M. Azariades 86

∫. ∆ÛÔ˘Ì¿Î·˜, ∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. ª›¯·-°ÂˆÚÁÈÔÔ‡ÏÔ˘

LITERATURE ABSTRACTS 8

Borowsky I, Ireland M, Resuick M ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ∫. ∆ÛÔ˘Ì¿Î·˜

ªÂϤÙË ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ‰ÈÂÁÂÚÙÈÎÔ‡ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ·Ú¿ÁÔÓÙ·, Û Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Ì Èı·Ó‹ ÛË„·ÈÌ›· Î·È Ô˘‰ÂÙÂÚÔÂÓ›·

Adolescent suicide attempts.

Risks and protectors Borowsky I, Ireland M, Resuick M Greek translation: C. Tsoumakas

39

A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia Russel ARB, Emmerson AJB, Wilkinson N, Chant T, Sweet DG, Halliday HL et al Greek translation: S. Fotopoulos

Russel ARB, Emmerson AJB, Wilkinson N, Chant T, Sweet DG, Halliday HL et al ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ™. ºˆÙfiÔ˘ÏÔ˜

∏ Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙ· ·È‰È¿ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÎÔÈÓfiÙËÙ·

∫Ôhler’s disease. A rare condition in children C. Tsoumakas, A. Papadopoulou, P. Miha-Georgiopoulou

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏¡ µπµ§πO°ƒ∞ºπ∞ ∞fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ·. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÚÔÛÙ·Û›·˜

Left atrial myxoma in a child presenting as an acute cerebral episode

45

Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics Melander E, Ekdahl K, Jonsson G, Molstad S Greek translation: C. Tsoumakas

Melander E, Ekdahl K, Jonsson G, Molstad S ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: ∫. ∆ÛÔ˘Ì¿Î·˜

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

xiii

Scheduled Medical Meetings

™˘ÓÙÔÌÔÁڷʛ˜

xvii

Abbreviations

January - February 2002 . Volume 65 . No 1

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·3

π·ÓÔ˘¿ÚÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈÔ˜ 2002

. ∆fiÌÔ˜

65

. ∆‡¯Ô˜

1

¢ÈÌËÓÈ·›· ¤Î‰ÔÛË E›ÛËÌÔ ¶ÂÚÈÔ‰ÈÎfi Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

Bimonthly Publication The Official Journal of the Hellenic Paediatric Society

EΉfiÙ˘ K. °ÚÈ‚¤·˜

Publisher K. Griveas

I‰ÈÔÎÙ‹Ù˘© EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó·È 115 28

Owner© Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28

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

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

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∫. ª·Ï·Î¿ ¢È¢ı˘ÓÙ‹˜ : ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹ M¤ÏË : ∂. ∞ÁÁÂÏ¿ÎË-°ÂˆÚÁ¿ÎË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ : °. µ·ÚÏ¿Ì˘ : ¶. ∫·ÊÚ›ÙÛ· : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ : £. ∆ÛÈÏÈÁÈ¿ÓÓ˘ : ∫. ∆ÛÔ˘Ì¿Î·˜ : ™. ºˆÙfiÔ˘ÏÔ˜ : A. ÷Ù˙‹˜

Scientific President Editor Members

ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘

Manuscript Editing

∂È̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ∑. ¶··‰ÔÔ‡ÏÔ˘-∫Ô˘ÏÔ˘Ì‹

English Editing Z. Papadopoulou-Couloumbis

∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 ∞ı‹Ó·È 115 28 ∆ËÏ: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

Correspondence Hellenic Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: 010-7771 140 / 010-7771 663, Fax: 010-7758 354

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10:53

™ÂÏ›‰·5

O‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ ™˘ÁÁÚ·Ê›˜ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊” Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Î·È È‰ÈÔÎÙËÛ›· Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜. Œ¯ÂÈ ˆ˜ ‚·ÛÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙËÓ ·ÔÙ‡ˆÛË ÙÔ˘ ·È‰È·ÙÚÈÎÔ‡ ¤ÚÁÔ˘ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙË Û˘Ó¯‹ È·ÙÚÈ΋ ÂÓË̤ڈÛË Î·È ÂÈÌfiÚʈÛË ÙˆÓ EÏÏ‹ÓˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: ¿ÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ EÈÛÙËÌÔÓÈ΋˜ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜), ·Ó·ÛÎÔ‹ÛÂȘ, Â›Î·ÈÚ· ı¤Ì·Ù·, ÂÍÂÏ›ÍÂȘ ÛÙËÓ π·ÙÚÈ΋ ∂ÈÛÙ‹ÌË, ÚˆÙfiÙ˘˜ ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ì ·È‰È·ÙÚÈÎfi ‹ È·ÙÚÔÎÔÈÓˆÓÈÎfi ÂÚȯfiÌÂÓÔ, ÁÂÓÈο ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ È·ÙÚÈ΋˜ ÂÎ·›‰Â˘Û˘ Î·È ˘Á›·˜, ‚Ú·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜, ÂÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ, ÂӉȷʤÚÔ˘Û˜ ÎÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ, ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ, ‚È‚ÏÈÔÎÚÈۛ˜, ÂÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË, ÂÚÈÏ‹„ÂȘ Ù˘ ÂÏÏËÓÈ΋˜ Î·È Í¤Ó˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ·Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘ÌÔÛ›ˆÓ Î·È Û˘Ó‰ڛˆÓ Û ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙËÓ ¶·È‰È·ÙÚÈ΋ Î·È ·Ó·ÊÔÚ¤˜ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜ Î·È Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ‚Ú·‚¢ı› ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÂÙ‹ÛÈÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ™˘Ó‰ڛԢ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜, Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. µ. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ OÈ ÂÚÁ·Û›Â˜ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÚÔ˜ ÎÚ›ÛË ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊” ·ÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó· ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÛÙËÓ ÔÔ›· ı· ‰ËÏÒÓÂÙ·È fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi Î·È fiÙÈ ÔÈ Û˘ÁÁÚ·Ê›˜ ÂÁÎÚ›ÓÔ˘Ó ÙË ‰ËÌÔÛ›Â˘Û‹ Ù˘ ÛÙÔ ÂÚÈÔ‰ÈÎfi “¶∞π¢π∞∆ƒπ∫◊”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÁÚ·Ù‹ ‰‹ÏˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ ¤ÁÈÓ·Ó ÌÂÙ¿ ·fi ÏËÚÔÊÔÚË̤ÓË Û˘Ó·›ÓÂÛË ÙˆÓ ÌÂÙ¯fiÓÙˆÓ ‹ ÙˆÓ ÓÔÌ›ÌˆÓ ÂÎÚÔÛÒˆÓ ÙÔ˘˜ Û‡Ìʈӷ Ì ÙȘ ‰È·ÎËÚ‡ÍÂȘ ÙÔ˘ EÏÛ›ÓÎÈ Î·È ÙÔ˘ TfiÎÈÔ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶∞π¢π∞∆ƒπ∫◊” Î·È Ë ÔÏÈ΋ ‹ ÌÂ-

ÚÈ΋ ·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∏ ¶∞π¢π∞∆ƒπ∫∏ ÚÔÙ›ÓÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÔÈ “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927934, http://jama.ama-assn.org/info/auinst_req.html.

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

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙËÓ EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word.doc ‹ MacWrite Î·È ÙÔ˘˜ ›Ó·Î˜, ·Ó Â›Ó·È ‰˘Ó·ÙfiÓ, Û ÚfiÁÚ·ÌÌ· Excel ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ Â·Ó˘Ô‚ÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘ÓÂ¿ÁÂÙ·È Ó¤· ˘Ô‚ÔÏ‹. °È· Ó· ÂÈÙ¢¯ı› Ë ¤ÁηÈÚË ‰ËÌÔÛ›Â˘ÛË Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È ··Ú·›ÙËÙÔ Ó· ÂÈÛÙÚ¤ÊÂÙ·È ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Ù˘ÔÁÚ·ÊÈÎfi ‰ÔΛÌÈÔ ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ̤۷ Û ‰‡Ô (2) Ë̤Ú˜.

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

T· ΛÌÂÓ· ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ÂÓ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË ‰ÂÓ ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·ÊÔ‡Ó, ÂÊfiÛÔÓ ˙ËÙËı›, Ù· Û¯‹Ì·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ô˘ Ù· Û˘Óԉ‡ԢÓ. °. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ TÔ Û‡ÓÔÏÔ Ù˘ ÂÚÁ·Û›·˜ (Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÈÓ¿ÎˆÓ Î·È ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÈÎfiÓˆÓ) Ú¤ÂÈ Ó· Â›Ó·È ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ A4 (22x28 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È Ê·Ú‰È¿ ÂÚÈıÒÚÈ· (2,5 cm) ÛÙȘ ‰‡Ô Ï¢ڤ˜.

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

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H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ· ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 15-25, ÁÈ· ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Û 12-15 ÛÂÏ›‰Â˜, ÁÈ· Ù· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 3-5 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜, ÂÓÒ ÁÈ· ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000 ϤÍÂȘ Î·È ÁÈ· ÙȘ ÂÈÛÙÔϤ˜ Û 250-300 ϤÍÂȘ. ™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ) ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ, - ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋, - ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·. ™Â ÂÚ›ÙˆÛË ¤ÏÏÂȄ˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ΤÓÙÚ·, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë È‰ÈfiÙËÙ· ÙÔ˘/ÙˆÓ Û˘ÁÁڷʤˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙˆÓ, - ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. ¢ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÂÏÏËÓÈÎfi.

T· ¿ÚıÚ· Û‡ÓÙ·Í˘ Î·È ÔÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ÌfiÓÔ ·ÁÁÏÈ΋ ÂÚ›ÏË„Ë.

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

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

OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÈÛ·ÁˆÁ‹, ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ Î·È ‚Ú·¯Â›· Û˘˙‹ÙËÛË. OÈ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û‡ÓÙÔÌË ÂÚÈÁÚ·Ê‹ Ù˘ ÂÚ›ÙˆÛ˘ ηÈ

vi

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

TÈ̤˜ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ OÈ ÙÈ̤˜ ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ ¢ÈÂıÓ¤˜ ™‡ÛÙËÌ· MÔÓ¿‰ˆÓ (SI Units) Î·È ÛÙÔ MÂÙÚÈÎfi (Conventional-™˘Ì‚·ÙÈÎfi) ™‡ÛÙËÌ· ̤۷ Û ·Ú¤ÓıÂÛË. ¶›Ó·Î˜ ÌÂÙ·ÙÚÔ‹˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔ JAMA 1986;255:2329-2339. ™˘ÓÙÔÌÔÁڷʛ˜ OÈ Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ¤¯Ô˘Ó ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜ ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ Â·Ó·Ï·Ì‚¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ Ô ÔÔ›Ô˜ ˘Ô‚¿ÏÏÂÙ·È Ì·˙› Ì ÙËÓ ÂÚÁ·Û›·. OÈ Û˘ÓÙÔÌÔÁڷʛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ·Ú¤ÓıÂÛË ÌfiÓÔ ÛÙȘ ÂÚÈÏ‹„ÂȘ.

BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ‰ÂÓ Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ, ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜, ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ, ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal Editors / Uniform Requirements for Manuscripts Submitted to Biomedical Journals (JAMA 1997;277:927-934), http://jama.amaassn.org/info/auinst_req.html. OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙÏˆÓ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Á›ÓÔÓÙ·È Ì ‚¿ÛË ÙÔ Cumulated Index Medicus (List of Journals Indexed in Index Medicus, http://www.nlm.nih.gov). ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶ÂÚÈÔ‰Èο AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ·Ó Â›Ó·È ÂÙ¿ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ÚÒÙÔÈ ¤ÍÈ Î·È ÚÔÛÙ›ıÂÙ·È “et al” ‹ “Î·È Û˘Ó”.

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

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™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜ ÂÚÈÔ‰ÈÎÔ‡: Flyvbjerg A. Role of growth hormone, insulin-like growth factors (IGFs) and IGF-binding proteins in the renal complications of diabetes. Kidney Int 1997;52 (60 Suppl):S12-S19.

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô+‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (8 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (16,8 cm). TÔ Ì¤ÁÈÛÙÔ Ì‹ÎÔ˜ ÙÔ˘˜, Ì·˙› Ì ÙÔ˘˜ Ù›ÙÏÔ˘˜, ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi 22 cm.

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

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

II. µÈ‚Ï›· ∫ÂÊ¿Ï·ÈÔ Û ‚È‚Ï›Ô: Clark AG, Barratt TM. Steroid-responsive nephrotic syndrome. In: Barratt TM, Arner ED, Harmon WE, editors. Pediatric Nephrology. 4th ed. Baltimore: Lippincott William Wilkins; 1999. p. 742. ™‡ÁÁÚ·ÌÌ· ‹ ÌÔÓÔÁÚ·Ê›·: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990. ¢ËÌÔÛ›Â˘ÛË Û ÙfiÌÔ Ú·ÎÙÈÎÒÓ: Bauer AW. The two definitions of bacterial resistance. In: Smith AJ, Rogers CA, eds. Proceedings of the Third International Congress of Chemotherapy; 1962 May 29-31; New York: International Society of Chemotherapy; 1963. p. 484-500.

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: - ÂÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ - ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜ - 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜ - ÛÂÏ›‰· Ù›ÙÏÔ˘ (¯ˆÚÈÛÙ‹ ÛÂÏ›‰·): ÂÚÈÏ·Ì‚¿ÓÂÈ - Ù›ÙÏÔ Î·È ‚Ú·¯‡ Ù›ÙÏÔ ÂÚÁ·Û›·˜ - fiÓÔÌ· Î·È ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜), ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤ÁÈÓÂ Ë ÂÚÁ·Û›· - fiÓÔÌ·, ‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ Û˘ÁÁڷʤ· ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· - ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ηٿÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ΛÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ¢¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢) - ‚È‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) - ›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó - ÂÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó - Ù›ÙÏÔÈ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.

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

Kaplan SJ. Post hospital home health care: the

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∞ƒ£ƒO ™À¡∆∞•∏™

Paediatriki 2002;65:1-3

EDITORIAL

∂ÁÎÂÊ·ÏÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ™. °. °ÈÔ˘ÚÔ‡ÎÔ˜

Cerebral thromboembolic episodes S. Youroukos

Abstract: A large number of heterogeneous disorders may lead to thromboembolism of the cerebral vessels. In view of the high incidence of death rate or permanent neurological sequelae, early diagnosis and extensive laboratory investigations are essential. The identification of

the causative mechanism may help in the therapeutic management during the acute phase, as well as in the prevention of further episodes.

Key words: thromboembolism, brain, stroke.

∞ÚÙËÚȷ΋ ·fiÊÚ·ÍË ∏ ·fiÊÚ·ÍË Ì›·˜ ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›·˜ Â›Ó·È ‰˘Ó·Ùfi Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÌ‚ÔÏ‹˜ ‹ ıÚfiÌ‚ˆÛ˘. ∞ÓÂÍ¿ÚÙËÙ· fï˜ ·fi ÙÔ ·›ÙÈÔ, Ë ·fiÊÚ·ÍË ·˘Ù‹ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ. ŸÙ·Ó Ë ·fiÊÚ·ÍË ·ÊÔÚ¿ Ì›· ·fi ÙȘ ÌÂÁ¿Ï˜ ÂÁÎÂÊ·ÏÈΤ˜ ·ÚÙËڛ˜, ÙÔ ¤ÌÊÚ·ÎÙÔ ·ÊÔÚ¿ ÙfiÛÔ ÛÙÔ ÊÏÔÈfi fiÛÔ Î·È ÛÙËÓ ˘ÔΛÌÂÓË Ï¢΋ Ô˘Û›· (1). ∏ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ¤¯ÂÈ Û¯¤ÛË Ì ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ÈÛ¯·ÈÌ›. ™˘Ó‹ıˆ˜, Ë ÚÔÛ‚ÔÏ‹ Ù˘ ÚfiÛıÈ·˜ ΢ÎÏÔÊÔÚ›·˜, ‰ËÏ·‰‹ ÎÏ¿‰ˆÓ Ù˘ ¤Ûˆ ηڈٛ‰·˜, ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÔÍ›· ËÌÈÏËÁ›·. ∏ Ì˘˚΋ ·‰˘Ó·Ì›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË ·Ú¯Èο, ÂÓÒ Û·ÛÙÈÎfiÙËÙ· Î·È ˘Ú·ÌȉÈο ÛËÌ›· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÚÁfiÙÂÚ·. O ‚·ıÌfi˜ Ù˘ ·ÔηٿÛÙ·Û˘ ÔÈΛÏÏÂÈ ÛËÌ·ÓÙÈο.

™ËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È ÙȘ ÚÒÙ˜ 2-3 ‚‰ÔÌ¿‰Â˜, ·ÏÏ¿ ‚Ú·‰Â›· ‚ÂÏÙ›ˆÛË Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ Û˘Ó¯›˙ÂÙ·È ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜ (2). ∞Ê·ÛÈÎÔ‡ Ù‡Ô˘ ‰È·Ù·Ú·¯¤˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È fiÙ·Ó ÚÔÛ‚ÏËı› Ô ÊÏÔÈfi˜ ÙÔ˘ ÂÈÎÚ·ÙÔ‡ÓÙÔ˜ ËÌÈÛÊ·ÈÚ›Ô˘. ∏ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ·fiÊڷ͢ Ù˘ ‚·ÛÈ΋˜ ·ÚÙËÚ›·˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ ÎÏ¿‰ˆÓ Ù˘ ÔÈΛÏÏÂÈ ÛËÌ·ÓÙÈο Î·È ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ¤ÎÙ·ÛË Î·È ÂÓÙfiÈÛË ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ‚Ï·‚ÒÓ (2). ™Â ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ, ÙÔ ·›ÙÈÔ Ù˘ ·ÚÙËÚȷ΋˜ ·fiÊڷ͢ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ (3). ∆· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· ·ÚÙËÚȷ΋˜ ·fiÊڷ͢ Â›Ó·È Ù· ·ÎfiÏÔ˘ı·: ∫·Ú‰È·Î¿ ·›ÙÈ·: OÈ Û˘ÁÁÂÓ›˜ ΢·ÓˆÙÈΤ˜ ηډÈÔ¿ıÂȘ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÂÁÎÂÊ·ÏÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÏfiÁˆ ·˘ÍË̤Ó˘ ÁÏÔÈfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ ·fi ÔÏ˘Î˘ı·ÈÌ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘ÔÍ›· ‹ Î·È ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›·. ŒÌ‚ÔÏ· ·fi Ù· ηډȷο ÙÔȯÒÌ·Ù· ÂÓ‰¤¯ÂÙ·È Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÎÔÏÈ΋ Ì·ÚÌ·Ú˘Á‹, ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, ‚·ÎÙËÚȷ΋ ÂÓ‰Ôηډ›Ùȉ· ‹ ηډȷο Ì˘ÍÒÌ·Ù·. ∆¤ÏÔ˜, ÂÌ‚ÔÏ‹ ·¤ÚÔ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÔÙÂÏ› ÂÈÏÔ΋ ηډȷ΋˜ ÂÂÌ‚¿Ûˆ˜ ‹ ηıÂÙËÚÈ·ÛÌÔ‡ ÙˆÓ ·ÁÁ›ˆÓ (2,4). ∞ÁÁ›·: ∞ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·ÔÙÂÏÔ‡Ó ˘fiÛÙڈ̷ ÁÈ· ÂÌÊ¿ÓÈÛË ·fiÊڷ͢. ∏ ÚÔԉ¢ÙÈ΋ ·ÔÊÚ·ÎÙÈ΋ ÓfiÛÔ˜ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

1st Pediatric Clinic of University of Athens “Agia Sophia” Children’s Hospital, Athens

∆· ÂÁÎÂÊ·ÏÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∆Ô ÁÂÁÔÓfi˜ fï˜ fiÙÈ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ı·Ó¿ÙˆÓ ‹ ÌfiÓÈÌˆÓ Ó¢ÚÔÏÔÁÈÎÒÓ Î·Ù·ÏÔ›ˆÓ ˘Ô‰ËÏÒÓÂÈ ÙË ÛËÌ·Û›· Ô˘ ¤¯ÂÈ Ë ·Ó·ÁÓÒÚÈÛË Î·È Ë ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∂›Ó·È Èı·Ófi fiÙÈ Ë ·Ú·ÙËÚÔ‡ÌÂÓË, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ·‡ÍËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÔÊ›ÏÂÙ·È ÛÙË ÛËÌÂÚÈÓ‹ ¢ÎÔÏ›· ·ÂÈÎfiÓÈÛ˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘.

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·ÁÁ›ˆÓ (ÓfiÛÔ˜ Moyamoya) Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ÂÁÎÂÊ·ÏÈο ¤ÌÊÚ·ÎÙ· ‹ ÚfiÛηÈÚ· ÈÛ¯·ÈÌÈο ÂÂÈÛfi‰È· (T.I.A. - Transient ischaemic attacks). ∞˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù·: ¶ÔÏÏ¿ ÓÔÛ‹Ì·Ù· Ù˘ ηÙËÁÔÚ›·˜ ·˘Ù‹˜ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÂÁÎÂÊ·ÏÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È·. ∆· Û˘ÓËı¤ÛÙÂÚ· Â›Ó·È Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıÂÌ·Ù҉˘ χÎÔ˜, Ë ÓfiÛÔ˜ Takayasu Î·È Ë Ô˙҉˘ ÔÏ˘·ÚÙËÚ›ÙȘ. ∞ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·: ∏ ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, Ë Ï¢¯·ÈÌ›·, Ë ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ Î·È Ë ÔÏ˘Î˘ı·ÈÌ›· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·ÔÙÂÏÔ‡Ó ·›ÙÈ· ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. O˘ÛÈ·ÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ê·›ÓÂÙ·È fiÙÈ ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÔÈ ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·ÈÌÔÛÙ·ÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ. OÈ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜ ‰‡Ó·ÓÙ·È Ó· Â›Ó·È ÎÏËÚÔÓÔÌÈΤ˜ ‹ Â›ÎÙËÙ˜. ∞ÓÂ¿ÚÎÂÈ· ÙˆÓ ÚˆÙÂ˚ÓÒÓ S Î·È C, Ù˘ ·ÓÙÈıÚÔÌ‚›Ó˘ πππ, ÙÔ˘ Ï·ÛÌÈÓÔÁfiÓÔ˘ Î·È ¤ÏÏÂÈÌÌ· ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ·Ú¿ÁÔÓÙÔ˜ V Leiden ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÁÎÂÊ·ÏÈο ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È·. ∂›Û˘, ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· fiˆ˜ ÙÔ ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ Î·È Ù· ·ÓÙÈηډÈÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ıÚÔÌ‚ÒÛÂȘ ·ÁÁ›ˆÓ (1,2). ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÚÙËÚȷΤ˜ ·ÔÊÚ¿ÍÂȘ ÛÙÔÓ ÂÁΤʷÏÔ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ô˘ Û˘¯Ó¿ Ô‰ËÁÔ‡Ó ÛÂ Û˘ÁÁÂÓ‹ ËÌÈÏËÁ›·, Ë ÔÔ›· ·Ó·ÁÓˆÚ›˙ÂÙ·È ÎÏÈÓÈο Û˘Ó‹ıˆ˜ ÌÂÙ¿ ÙÔÓ 4Ô Ì‹Ó· ˙ˆ‹˜. ªÂÚÈΤ˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ‹Íˆ˜. §ÔÈÌÒÍÂȘ: ∏ ÌÈÎÚԂȷ΋ ÌËÓÈÁÁ›ÙȘ, fiˆ˜ Î·È ÔÈ ÈÔÁÂÓ›˜ ÌËÓÈÁÁÔÂÁÎÂÊ·Ï›Ùȉ˜, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ıÚÔÌ‚ÒÛÂȘ ÊÏÔȈ‰ÒÓ ·ÚÙËÚÈÒÓ Î·È ÊÏ‚ÒÓ. ºÏÂÁÌÔÓ¤˜ Ù˘ ÙÚ·¯ËÏÈ΋˜ ÌÔ›Ú·˜ (.¯. ÂÚÈ·Ì˘Á‰·ÏÈο ·ÔÛÙ‹Ì·Ù·) Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ıÚfiÌ‚ˆÛË Ù˘ ηڈٛ‰·˜. ∫·ÎÒÛÂȘ, ·ÎÙÈÓÔ‚ÔÏ›·, ÙÔÍÈΤ˜ Ô˘Û›Â˜: Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ıÚÔÌ‚ÒÛÂȘ Ù˘ ¤Ûˆ ηڈٛ‰·˜, ÌÂÙ¿ ·fi οΈÛË Ù˘ ÂÚÈÔ¯‹˜ ÙˆÓ ·Ì˘Á‰·ÏÒÓ, Û ·È‰È¿ Ô˘ ¤ÊÙÔ˘Ó ¤¯ÔÓÙ·˜ ¤Ó· ÌÔχ‚È ÛÙÔ ÛÙfiÌ·. £ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔÎÏËıÔ‡Ó ÌÂÙ¿ ·fi ·ÎÙÈÓÔ‚fiÏËÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ηıÒ˜ Î·È ÌÂÙ¿ ·fi ¯Ú‹ÛË ÎÔη˝Ó˘ ‹ ÂÈÛÓÔ‹ ‰È·Ï˘ÙÒÓ (.¯. ·ÎÂÙfiÓ˘). ∂ÈÏË„›·: ¶·Ú·ÙÂٷ̤ÓË ÂÛÙȷ΋ ÂÈÏËÙÈ΋ ÎÚ›ÛË Û¿ÓÈ· ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ËÌÈÏËÁ›· (∏∏∂ syndrome - Hemiconvulsions, hemiplegia, epilepsy). ™ÙȘ ÂÚÈÙÒÛÂȘ, fï˜, ·˘Ù¤˜ Ê·›ÓÂÙ·È fiÙÈ ÙÔ ·›ÙÈÔ Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È ·ÁÁÂÈ·Îfi (5). ¢È¿ÊÔÚ· ÓÔÛ‹Ì·Ù·: ªÂ ·ÔÊÚ¿ÍÂȘ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ ¤¯Ô˘Ó Û˘Ó‰˘·ÛÙ› Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, Ë ÔÌÔ΢ÛÙÈÓ·ÈÌ›·, Ë ÓfiÛÔ˜ Kawasaki, Ë ÓfiÛÔ˜ Menkes, Ë ÌÈÙÔ¯ÔÓ‰Úȷ΋ ¿ıËÛË MELAS (Mitochondrial encephalopathy with lactic acidosis

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and stroke), ηıÒ˜ Î·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜, fiˆ˜ Ë ·ÓÂ¿ÚÎÂÈ· Ù˘ ÙÚ·ÓÛηڂ·Ì˘Ï¿Û˘. ∞ÚÙËÚȷΤ˜ ·ÔÊÚ¿ÍÂȘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ηٿ ÙË ‰È¿ÚÎÂÈ· ÎÚ›ÛÂˆÓ ÂÈÏÂÁ̤Ó˘ ËÌÈÎÚ·Ó›·˜. ∞Ó¿ÏÔÁ· ÚÔ‚Ï‹Ì·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û ۇӉÚÔÌ· Marfan Î·È Ehlers-Danlos (1-3). ºÏ‚È΋ ıÚfiÌ‚ˆÛË OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÁÎÂÊ·ÏÈ΋˜ ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ÂÓÙfiÈÛË Î·È ÙËÓ ¤ÎÙ·ÛË ÙˆÓ ‚Ï·‚ÒÓ, ηıÒ˜ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Î·È ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‚Ï¿‚˜ Ô˘ Â›Ó·È ·ÈÌÔÚÚ·ÁÈÎÔ‡ Ù‡Ô˘. O ·ÛıÂÓ‹˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÌÊ·Ó›˙ÂÈ ÎÂÊ·Ï·ÏÁ›·, ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘, ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ‰È·Ù·Ú·¯¤˜ Ù˘ fiÚ·Û˘, ËÌÈ·ÓÔ„›· ‹ ·Ê·Û›·. ™˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛ˘ Î·È Ô›‰ËÌ· ÙˆÓ ÔÙÈÎÒÓ ıËÏÒÓ (2).

OÈ ÂÁÎÂÊ·ÏÈΤ˜ ÊÏ‚ÈΤ˜ ıÚÔÌ‚ÒÛÂȘ ‰È·ÎÚ›ÓÔÓÙ·È Û ÛËÙÈΤ˜ Î·È ¿ÛËÙ˜. OÈ ÚÒÙ˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÈÎÚԂȷΤ˜ ÌËÓÈÁÁ›Ùȉ˜, ˆÙ›Ùȉ˜, Ì·ÛÙÔÂȉ›Ùȉ˜, ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ˜ ‹ ‰ÂÚÌ·ÙÈΤ˜ ÏÔÈÌÒÍÂȘ Ù˘ ÎÂÊ·Ï‹˜. OÈ ¿ÛËÙ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÔÊ›ÏÔÓÙ·È Û ‚·ÚÈ¿ ·Ê˘‰¿ÙˆÛË, ΢·ÓˆÙÈ΋ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ‰È·‚‹ÙË, ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ· ‹ ÓfiÛÔ Behcet-∞‰·Ì·ÓÙÈ¿‰Ë. ∞fi Ù· ·ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÔÈ ·ÈÌÔÏ˘ÙÈΤ˜ ·Ó·È̛˜, Ë ÔÍ›· Ï¢¯·ÈÌ›·, Ë ÔÏ˘Î˘ı·ÈÌ›·, Ë ıÚÔÌ‚Ô·ÙÙˆÛË, Ë ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂÈ΋ ‹ÍË, Ë ·ÓÂ¿ÚÎÂÈ· ÚˆÙ½Ó˘ C ‹ ·ÓÙÈıÚÔÌ‚›Ó˘ πππ Â›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ· ÂÓÔ¯ÔÔÈÔ‡ÌÂÓ˜. ºÏ‚ÈΤ˜ ıÚÔÌ‚ÒÛÂȘ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·Û·Ú·ÁÈÓ¿Û˘ (1,2). ∂ӉȷʤÚÔ˘Û· Â›Ó·È Ë ·Ó‡ÚÂÛË ıÚÔÌ‚ÒÛÂˆÓ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ Û ·È‰È¿ Ì “ȉÈÔ·ı‹” ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË. ™Â ÚfiÛÊ·ÙË ÂÏÏËÓÈ΋ ÌÂϤÙË 36 ·ÛıÂÓÒÓ ‚Ú¤ıËΠfiÙÈ ÔÈ 5 ›¯·Ó ıÚfiÌ‚ˆÛË ÊÏÂ‚Ò‰Ô˘˜ ÎfiÏÔ˘ (6). ∞ÂÈÎfiÓÈÛË πÛ¯·ÈÌÈÎÔ‡ Ù‡Ô˘ ‚Ï¿‚˜ Â›Ó·È Û˘Ó‹ıˆ˜ ‡ÎÔÏ· ·Ó·ÁÓˆÚ›ÛÈ̘ ÛÙËÓ ·ÂÈÎfiÓÈÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· (CTComputerized tomography) ‹ ·ÎfiÌË Î·Ï‡ÙÂÚ· Ì ÙÔÌÔÁÚ·Ê›· Ì·ÁÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ (ªRIMagnetic resonance imaging). ™ËÌ·ÓÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ‚Ô‹ıÂÈ· ÚÔÛʤÚÂÈ Ë ·ÂÈÎfiÓÈÛË ÙˆÓ ·ÚÙËÚÈÒÓ Î·È ÙˆÓ ÊÏ‚ÒÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (MRA-Magnetic resonance angiography). ∞Ó Î·È ÔÈ Ï·Ì‚·ÓfiÌÂÓ˜ Ì ÙË Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÂÈÎfiÓ˜ Â›Ó·È ·ÛÊ·ÏÒ˜ ˘ԉ¤ÛÙÂÚ˜ ÂÎÂ›ÓˆÓ Ù˘ ÎÏ·ÛÈ΋˜ ‹ Ù˘ „ËÊȷ΋˜ ·ÁÁÂÈÔÁÚ·Ê›·˜ (DSA-Digital subtraction angiography), ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÏÂÔÓ¤ÎÙËÌ·

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ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ì¤ıÔ‰Ô˜ ‰ÂÓ Â›Ó·È ·ÚÂÌ‚·ÙÈ΋ Î·È ‰ÂÓ ÂÎı¤ÙÂÈ ÙÔ ·È‰› Û ·ÎÙÈÓÔ‚ÔÏ›·.

ÓÂÚÁ·Û›· ÙÔ˘ ·È‰È¿ÙÚÔ˘ Ì ÂȉÈÎÔ‡˜ ÎÏÈÓÈÎÔ‡˜ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÔ‡˜ È·ÙÚÔ‡˜.

£ÂÚ·¢ÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ ∏ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Â›Ó·È Û˘Ìو̷ÙÈ΋. ∞ÓÙÈËÎÙÈο Ê¿Ú̷η ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÙfiÛÔ Û ·ÚÙËÚȷΤ˜ fiÛÔ Î·È Û ÊÏ‚ÈΤ˜ ıÚÔÌ‚ÒÛÂȘ. ™Â ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ, ȉȷ›ÙÂÚ· ÙȘ ÚÒÙ˜ ÒÚ˜ ·fi ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ıÚfiÌ‚ˆÛ˘, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¯ÚËÛÈÌÔÔÈËı› ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ (1,7).

O ΛӉ˘ÓÔ˜ fï˜ ÂÌÊ¿ÓÈÛ˘ ·ÈÌÔÚÚ·Á›·˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi Ë ıÚÔÌ‚ÔÏ˘ÙÈ΋ ıÂÚ·›· ‰ÂÓ Â›Ó·È ·fi fiÏÔ˘˜ ·Ô‰ÂÎÙ‹. ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ÌÂıfi‰Ô˘ ·˘Ù‹˜ Ú¤ÂÈ Ó· ÂȯÂÈÚÂ›Ù·È ·ÊÔ‡ Û˘ÓÂÎÙÈÌËıÔ‡Ó Ù· ÔʤÏË Î·È ÔÈ Î›Ó‰˘ÓÔÈ Î·È ÌfiÓÔ ·fi ÔÌ¿‰· È·ÙÚÒÓ Ô˘ ¤¯Ô˘Ó ·Ó¿ÏÔÁË ÂÌÂÈÚ›· Î·È ‰È·ı¤ÙÔ˘Ó ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÂÚÁ·ÛÙËÚȷ΋ ˘ÔÛÙ‹ÚÈÍË. °È· ÙËÓ ÚfiÏË„Ë Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚ· ·ÓÙÈËÎÙÈο Ê¿Ú̷η. OÈ Î›Ó‰˘ÓÔÈ ·fi Ì›· Ù¤ÙÔÈ· ¯ÔÚ‹ÁËÛË Ú¤ÂÈ ¿ÓÙÔÙ ӷ Û˘ÓÂÎÙÈÌÒÓÙ·È Ì ÙÔ ÚÔÛ‰ÔÎÒÌÂÓÔ fiÊÂÏÔ˜.

O ÎÏÈÓÈÎfi˜ È·ÙÚfi˜ ÔÊ›ÏÂÈ Ó· ·Ó·ÁÓˆÚ›ÛÂÈ ¤ÁηÈÚ· ÙËÓ ‡·ÚÍË ÂÁÎÂÊ·ÏÈÎÔ‡ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. ∞·Ú·›ÙËÙË Â›Ó·È Ë ¿ÌÂÛË Î·È Ï‹Ú˘ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Ô˘ ¤¯ÂÈ Û·Ó ÛÙfi¯Ô ÙËÓ ¿ÌÂÛË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË, fiÙ·Ó ·˘Ù‹ Â›Ó·È ‰˘Ó·Ù‹, ·ÏÏ¿ Î·È ÙËÓ ÚfiÏË„Ë Ù˘¯fiÓ Ó¤ˆÓ ÂÂÈÛÔ‰›ˆÓ. °È· ÙËÓ Â›Ù¢ÍË ·˘ÙÔ‡ ÙÔ˘ ÛÙfi¯Ô˘, Â›Ó·È ··Ú·›ÙËÙË Ë ÛÙÂÓ‹ Û˘-

µÈ‚ÏÈÔÁÚ·Ê›· 1. Edwards M, Hoffman H. Cerebral vascular disease in children and adolescents. Baltimore: Williams and Wilkins; 1989.

2. Brett EM. Vascular disorders of the nervous system. In: Brett EM, ed. Paediatric Neurology. 3rd ed. New York: Churchill Livingstone; 1997. p. 571-588.

3. Roach ES. Etiology of stroke in children. Sem Pediatr Neurol 2000;7:244-265.

4. Dusser A, Goutieres F, Aicardi J. Ischaemic strokes in children. J Child Neurol 1986;1:131-136.

5. Gastaut H, Poirier F, Payan H, Saloman G, Toga M, Vigouroux M. HHH syndrome: Hemiconvulsions, hemiplegia, epilepsy. Epilepsia 1960;1:418-447.

6. Youroukos S, Psychou F, Fryssiras S, Paikos P, Nicolaidou P. Idiopathic intracranial hypertension in children. J Child Neurol 2000;15:453-457.

7. Benamer H, Bone I. Cerebral venous thrombosis: anticoagulant or thrombolyic therapy? J Neurol Neurosurg Psychiat 2000;69:427-430.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-12-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ˆÙ‹Ú˘ °ÈÔ˘ÚÔ‡ÎÔ˜ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” T.K. 115 27, ∞ı‹Ó· E-mail: sotel@hol.gr

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∞ƒ£ƒO ™À¡∆∞•∏™

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EDITORIAL

£ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) ‰È¿ÊÔÚ˘ ·ÈÙÈÔÏÔÁ›·˜ ÛÙ· ·È‰È¿. ª›· ÚfiÎÏËÛË ÁÈ· ÙÔ ÁÈ·ÙÚfi ™. ∞ÚÒÓË - µÔ˘ÚÓ¿

Thromboembolic episodes of the central nervous system (CNS) of diverse etiology in children.

A challenge for the physician S. Aronis - Vournas

Abstract: Thromboembolic episodes (TE) of the central nervous system is rare in childhood which, however, has been increasingly recognized during the last few years. They occur with a frequency of 1-3.3/100.000/year in the pediatric population, the incidence being higher in the neonatal period e.g. 1 case per 1000 births of full-term infants. The pathogenesis of TE in children and adolescents has been unclear due to lack of prospective studies.

Nevertheless, extensive studies during the past 5 years tend to identify it as being a multifactorial disease. The most common underlying diseases predisposing to CNS thrombosis include congenital heart disease, perinatal asphyxia, malignancies, infections, sickle cell anaemia, vasculitis, nephrotic syndrome, homocysteinaemia, and vascular dysplasia. Probable triggering events are: trauma, major surgery, obesity, dehydration, medication such as corticosteroids, L-asparaginase, central catheters and others. The literature regarding the role of congenital (FV Leiden, FII 20210A, MTHFR, AT, PC, PS) or acquired prethrombotic disorders (Lpa, Lupus anticoagulant, ACA, anti-b2GP1) in the pathogenesis of CNS cerebral infarction is controversial. However recent studies indicate that homozygocity for MTHFR and FV Leiden is closely associated with CNS infarcts and may be used as

Key words: CNS infarct, antiphospholipid syndrome, myxoma, lupus anticoagulant.

∏ ıÚfiÌ‚ˆÛË ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È Û¿ÓÈÔ, ÏËÓ fï˜ ˘·ÚÎÙfi Ê·ÓfiÌÂÓÔ, Ô˘ ·Ó·ÁÓˆÚ›˙ÂÙ·È ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÏfiÁˆ Ù˘ ¢·ÈÛıËÙÔÔ›ËÛ˘ ÙˆÓ ÁÈ·ÙÚÒÓ. ∂ȉÈÎfiÙÂÚ·, Ù· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (£∂) ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ Û˘Ì‚·›ÓÔ˘Ó Û·ÓÈfiٷٷ, ÌÂ Û˘-

¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 1 ¤ˆ˜ 3,3 ·Ó¿ 100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·Ó¿ ¤ÙÔ˜ (1-2), ÂÓÒ Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË: Ì›· ÂÚ›ÙˆÛË ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ (3). ∏ ıÚfiÌ‚ˆÛË ÌÔÚ› Ó· ·ÊÔÚ¿ ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ÊÏ‚ÈÎfi Û‡ÛÙËÌ· (ÊϤ‚˜

ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘ - ∞ÈÌÔÚÚÔÊÈÏ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Hemostasis and Hemophilia Unit Chilldren’s Hospital “St. Sophia”, Athens

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predictors for recurrence of CNS thrombosis. The antiphospholipid syndrome (APS) is strongly associated with arterial or venous thrombosis in various organs, including CNS. Myxoma of the right atrium, a rare condition, usually presents as an acute cerebral syndrome, due to cerebral embolism from thrombus developing around the tumor or from detached particles derived from the tumor. In contrast with the APS, the presence of Lupus anticoagulant (LA) during childhood is not usually associated with thrombosis. The LA is transient and is detected following a viral infection or administration of drugs. In summary, CNS thromboembolic episodes are a rare event during childhood and constitute a real challenge for the physician, due to their diverse aetiology. Besides a good clinical examination, sensitive imaging techniques must be used in order to visualize the location and extent of the thrombus. The necessity and type of therapeutic intervention depends on the underlying disease. Moreover, the presence of one or more congenital or acquired prethrombotic factors will define the duration of anticoagulant therapy.

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™ÂÏ›‰·5

¶·È‰È·ÙÚÈ΋ 2002;65:4-8

Î·È ÊÏ‚҉ÂȘ ÎfiÏÔÈ) ‹ ÛÙȘ ÂÁÎÂÊ·ÏÈΤ˜ ·ÚÙËڛ˜. ∏ ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· Î·È ÔÈ ÎÏ¿‰ÔÈ Ù˘ ·ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ Û˘¯Ó‹ ÂÓÙfiÈÛË ÛÙ· ·È‰È¿. ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ £∂ ÛÙ· ·È‰È¿ Î·È Ù· Ó·ڿ ¿ÙÔÌ· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ª¤¯ÚÈ ÚfiÛÊ·Ù·, Ë ‚È‚ÏÈÔÁÚ·Ê›·, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· £∂ Ù˘ ÓÂÔÁÓÈ΋˜ ‹ ·È‰È΋˜ ËÏÈΛ·˜, ÂÚÈÔÚÈ˙fiÙ·Ó Û ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ ‹ ÌÈÎÚ¤˜ ÛÂÈÚ¤˜. ªfiÓÔ Ù· ÙÂÏÂ˘Ù·›· 5 ¯ÚfiÓÈ·, ÔÈ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·È‰ÈÒÓ ·Ú¯›˙Ô˘Ó Î·È ˘ÎÓÒÓÔ˘Ó, ÂÓÒ ÛÙ·‰È·Î¿ ‚ϤÔ˘Ó ÙÔ Êˆ˜ Ù˘ ‰ËÌÔÛÈfiÙËÙ·˜ Î·È ÛÙÔȯ›· ·fi Û˘ÁÎÂÓÙÚˆÙÈΤ˜ ÌÂϤÙ˜. ŒÙÛÈ, Á›ÓÂÙ·È fiÏÔ Î·È ÈÔ ¤Î‰ËÏÔ ˆ˜ Ù· £∂ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈÎfi Ê·ÈÓfiÌÂÓÔ. ¶ÂÚ›Ô˘ Ù· 3/4 ÙˆÓ ·È‰ÈÒÓ Ì ¤Ó· ÚÒÙÔ ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó·Ó ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚfiÌ‚ˆÛË (2). ¶ÈÔ Û˘¯Ó¿ ˘ÔΛÌÂÓ· ÓÔÛ‹Ì·Ù· ‹ ηٷÛÙ¿ÛÂȘ Ô˘ Úԉȷı¤ÙÔ˘Ó Û £∂ ÙÔ˘ ∫¡™ ›ӷÈ: Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·, ηÎÔ‹ıÂȘ, ÏÔÈÌÒÍÂȘ, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ·ÁÁÂÈ›Ùȉ˜, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ÔÌÔ΢ÛÙÈÓ·ÈÌ›· Î·È ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ (3). ¶Èı·Ó¿ ÂÎÏ˘ÙÈο ·›ÙÈ· ·ÔÙÂÏÔ‡Ó Ô ÙÚ·˘Ì·ÙÈÛÌfi˜, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, Ë ·¯˘Û·ÚΛ·, Ë ·Ê˘‰¿ÙˆÛË, Ë ıÂÚ·›· Ì ʿÚ̷η fiˆ˜ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, L·Û·Ú·ÁÈÓ¿ÛË, ÔÈ ÎÂÓÙÚÈÎÔ› ηıÂÙ‹Ú˜ Î·È ¿ÏÏ· (4). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÚfiÏÔ ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ‹ Â›ÎÙËÙˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ıÚfiÌ‚ˆÛ˘ ÙÔ˘ ∫¡™, Ë ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È ·ÓÙÈÊ·ÙÈ΋, ˆÛÙfiÛÔ ÚfiÛÊ·Ù· ‰Â‰Ô̤ӷ ·fi ÙË °ÂÚÌ·Ó›· ·Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ·ÚÔ˘Û›· Û˘ÁÁÂÓÒÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ ÙÔ˘ ·Ú¿ÁÔÓÙ· V (FV Leiden), Ù˘ ÚÔıÚÔÌ‚›Ó˘ (FII 20210A), ÙÔ˘ MTHFR, ·˘ÍË̤ӷ Â›‰· Lp(a) ηıÒ˜ Î·È ·ÓÂ¿ÚÎÂÈ· ÙˆÓ Ê˘ÛÈÎÒÓ ·Ó·ÛÙ·ÏÙÒÓ Ù˘ ‹Í˘, ∞∆, PC, PS, ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ÂΉ‹ÏˆÛË £∂ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ (5). ¶ÚÔ˜ ÙÔ‡ÙÔȘ, Û ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙËÓ ∞ÁÁÏ›· Ê·›ÓÂÙ·È ˆ˜ Ë ÔÌÔ˙˘ÁˆÙ›· ˆ˜ ÚÔ˜ ÙË ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ MTHFR Î·È Ë ·ÚÔ˘Û›· Ù˘ ÁÔÓȉȷ΋˜ ‰È·Ù·Ú·¯‹˜ FV Leiden ·ÔÙÂÏÔ‡Ó ÚÔÁÓˆÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ Â·Ó¿Ï˄˘ ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (6). ÀÔÙÚÔ‹ ıÚÔÌ‚ˆÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ÛÙÔ ∫¡™ ·Ó·Ê¤ÚÂÙ·È Û 39% Î·È ı¿Ó·ÙÔ˜ Û <10% ÙˆÓ ÂÚÈÙÒÛˆÓ. OÈ Mercuri Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ‡·ÚÍË ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÓfi˜ ÚÔıÚÔÌ‚ˆÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Û 42% ÙˆÓ ÓÂÔÁÓÒÓ Ì ÂÚÈÁÂÓÓËÙÈÎfi ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ (7). π‰È·›ÙÂÚ·, Ë ·ÚÔ˘Û›· ÙÔ˘ FV Leiden Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÂÓ‰ÔÎÔÈÏȷ΋˜ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ·fiÚÚÔÈ· ÂÁÎÂÊ·ÏÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ Î·È ÙË ÌÂÙ¤ÂÈÙ· ÂΉ‹ÏˆÛË ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ (8).

Paediatriki 2002;65:4-8

™Â ·˘Ùfi ÙÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” ‰ËÌÔÛȇÔÓÙ·È ÙÚ›· ¿ÚıÚ· Ì ‰È·ÊÔÚÂÙÈ΋ ıÂÌ·ÙÔÏÔÁ›· (9-11), Ô˘ fï˜ Û˘Ó‰¤ÔÓÙ·È Ì ÎÔÈÓ‹ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÙÔ˘ Ù‡Ô˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘. OÈ ª¿ÓÙ˙ÈÔ˘ Î·È Û˘Ó ·Ó·Ï‡Ô˘Ó ‰ÈÂÍÔ‰Èο Ù· ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ·fi ÙËÓ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË 48 ·È‰ÈÒÓ Ì £∂ ÙÔ˘ ∫¡™, Ù· ÔÔ›· ‰È·ÁÓÒÛÙËÎ·Ó Î·Ù¿ Ù· ¤ÙË 1990-1998 (9). ÀÔΛÌÂÓË ÓfiÛÔ ·ÚÔ˘Û›·˙ ÙÔ 38,7% ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ÙÔ 14,6%, ÂÓÒ ÙÔ 48% ÙˆÓ ·È‰ÈÒÓ Â›¯Â ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÚÔıÚÔÌ‚ˆÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (ÎÏËÚÔÓÔÌÈÎÔ‡˜ ‹ Â›ÎÙËÙÔ˘˜). ¶·Ú’ fiÙÈ Ô ¤ÏÂÁ¯Ô˜ ıÚÔÌ‚ÔÊÈÏ›·˜ ‰ÂÓ Á›ÓÔÓÙ·Ó Û˘ÛÙËÌ·ÙÈο ηٿ Ù· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ÌÂϤÙ˘, ÂÓÙÔ‡ÙÔȘ, ·‰È·ÌÊÈÛ‚‹ÙËÙ· ÔÈ Â›ÎÙËÙÔÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‹Ù·Ó ηٿ ηÓfiÓ· ·ÚÔ‰ÈÎÔ› Î·È Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ. ¶·Ú¿ ÙȘ ÁÓˆÛÙ¤˜ ·‰˘Ó·Ì›Â˜ Ì›·˜ ·Ó·‰ÚÔÌÈ΋˜ ÌÂϤÙ˘, ÛÙË ÌÂϤÙË ÙˆÓ ª¿ÓÙ˙ÈÔ˘ Î·È Û˘Ó ·Ó·‰ÂÈÎÓ‡ÂÙ·È Ë ÔÏ˘·Ú·ÁÔÓÙÈ΋ ʇÛË Ù˘ ıÚÔÌ‚ÔÂÌ‚ÔÏÈ΋˜ ÓfiÛÔ˘ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Û˘ÓÔÏÈο ÙÔ 68,8% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·˙ ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚfiÌ‚ˆÛË. OÈ Û˘ÁÁÚ·Ê›˜ ÙÔÓ›˙Ô˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ‰ÈÂÚ‡ÓËÛ˘ Ù˘ ıÚfiÌ‚ˆÛ˘ ÙÔ˘ ∫¡™ Ì MRI Î·È ·ÁÁÂÈÔÁÚ·Ê›·, ‰ÈfiÙÈ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‹ Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ¢·›ÛıËÙ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ÁÈ· ÙËÓ ·ÔÎ¿Ï˘„Ë ÙÔ˘ ıÚfiÌ‚Ô˘. ∂›Û˘, Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ÎÏËÚÔÓÔÌÈ΋ ‹ Â›ÎÙËÙË ıÚÔÌ‚ÔÊÈÏ›· ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ ÁÓˆÛÙÒÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (I, II, VII, VIII, XII, AT, PC, PS, Plg, tPA, PAI, FV Leiden, FII 20210A, MTHFR, Â›‰· ÔÌÔ΢ÛÙ½Ó˘, LA, ACA, Lp(a) anti-b2GP1) Ô˘ ÂÓ¤¯ÔÓÙ·È ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ıÚfiÌ‚ˆÛ˘. ∂ÊfiÛÔÓ ‰È·ÈÛÙÒÓÔÓÙ·È Û˘ÁÁÂÓ›˜ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ô ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û fiÏË ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È Ó· ‰›ÓÔÓÙ·È ÔÈ ‰¤Ô˘Û˜ Û˘Ì‚Ô˘Ï¢ÙÈΤ˜ ηÙ¢ı‡ÓÛÂȘ ÛÙÔ˘˜ ¤¯ÔÓÙ˜ ÙËÓ fiÔÈ· ‰È·Ù·Ú·¯‹ (ÚÔÏËÙÈο ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Û ÌÂÁ¿Ï· ¯ÂÈÚÔ˘ÚÁ›·, Ì·ÎÚÔ¯ÚfiÓÈ· ·ÎÈÓËÙÔÔ›ËÛË, ÂÁ΢ÌÔÛ‡ÓË). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ £∂ ÙÔ˘ ∫¡™, ÙfiÛÔ Ë ÌÂϤÙË ÙˆÓ ª¿ÓÙ˙ÈÔ˘ Î·È Û˘Ó fiÛÔÓ Î·È ¿ÏϘ ÚÔÁÂÓ¤ÛÙÂÚ˜ ‹ ÌÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ÌÂϤÙ˜, ˆ˜ ÌË ¤¯Ô˘Û˜ ÔÌ¿‰Â˜ Û‡ÁÎÚÈÛ˘, ‰ÂÓ ‰›ÓÔ˘Ó ·¿ÓÙËÛË ÛÙÔ Î·˘Ùfi ÂÚÒÙËÌ· Ù˘ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘: ÔÈÔ Ê¿ÚÌ·ÎÔ ÂÈϤÁÔ˘Ì (ıÚÔÌ‚ÔÏ˘ÙÈÎfi; ·ÓÙÈËÎÙÈÎfi;) Î·È ÁÈ· fiÛÔ ‰È¿ÛÙËÌ· ÙÔ ¯ÔÚËÁÔ‡ÌÂ; ¶¿ÓÙˆ˜, Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ¤Î‚·ÛË ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ Û ÔÚÈṲ̂ӷ ·È‰È¿ Â›Ó·È ‰˘ÛÔ›ˆÓ·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Î¿ÔÈ· ·fi ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ó¢ÚÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ·, ‰È¿ÊÔÚ˘ ‚·Ú‡ÙËÙ·˜ Î·È Î¿ÔÈ· ¿ÏÏ· Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜.

5

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·6

¶·È‰È·ÙÚÈ΋ 2002;65:4-8

∂Ӊ¯Ô̤ӈ˜, Ë Î·Ù·ÓfiËÛË Ù˘ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ·˜ Ù˘ £∂ ÓfiÛÔ˘ ÛÙ· ·È‰È¿ Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ Î·È ÙÔ Â›‰Ô˜ Ù˘ ¤ÁηÈÚ˘ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÚÔ˜ ·ÔÙÚÔ‹Ó ÙˆÓ ¿ÌÂÛˆÓ ‹ ·ÒÙÂÚˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÓfiÛÔ˘. ∆· ÂÁÎÂÊ·ÏÈο ¤ÌÊÚ·ÎÙ· ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ ·ÚÙËÚȷ΋˜ ıÚfiÌ‚ˆÛ˘ Û ¿ÙÔÌ· Ì ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· (∞ƒ∞) Ô˘ ÂΉËÏÒÓÂÙ·È Û Ó·ڤ˜ ËÏÈ˘. ∏ ÚÒÙË ÂÚÈÁÚ·Ê‹ ·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ χÎÔ˘ (Lupus anticoagulant, LA) ·Ó·Ê¤ÚÂÙ·È ÙÔ 1946. ∆Ô 1963 Û˘Û¯ÂÙ›ÛÙËÎÂ Ë ·ÚÔ˘Û›· LA Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ıÚfiÌ‚ˆÛ˘. ∆Ë ‰ÂηÂÙ›· ÙÔ˘ ‘80 ¿Ú¯ÈÛ·Ó Ó· ‰ËÌÔÛȇÔÓÙ·È ÔÈ ÚÒÙ˜ ÌÈÎÚ¤˜ ÛÂÈÚ¤˜ Î·È ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ Û˘Û¯¤ÙÈÛ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ú‰ÈÔÏÈ›Ó˘ (ACA) Ì Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ. ∆· ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· Â›Ó·È Ì›· ÌÂÁ¿ÏË ÂÙÂÚÔÁÂÓ‹˜ ÔÈÎÔÁ¤ÓÂÈ· ·ÓÔÛÔÛÊ·ÈÚÈÓÒÓ, Ù· ÔÔ›· - ·Ú¿ ÙÔ fiÓÔÌ¿ ÙÔ˘˜ - ‰ÂÓ ÚÔÛ‰¤ÓÔÓÙ·È ÛÙ· ʈÛÊÔÏÈ›‰È·, ·ÏÏ¿ ηÙ¢ı‡ÓÔÓÙ·È ÚÔ˜ ÚˆÙ½Ó˜ ÙÔ˘ Ï¿ÛÌ·ÙÔ˜, ÔÈ Ôԛ˜ ÚÔÛ‰¤ÓÔÓÙ·È Û ·ÚÓËÙÈο ÊÔÚÙÈṲ̂Ó˜ ÂÈÊ¿ÓÂȘ (ʈÛÊÔÏÈ›‰È·) (12). ªÂÚÈÎÔ› ·fi ÙÔ˘˜ ·ÓÙÈÁÔÓÈÎÔ‡˜ ÛÙfi¯Ô˘˜ ÙˆÓ ∞ƒ∞ Â›Ó·È Ë b2GP1, Ë ÚÔıÚÔÌ‚›ÓË, Ë ·ÓÂÍ›ÓË V, ÙÔ ˘„ËÏÔ‡ Î·È ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ ÎÈÓÈÓÔÁfiÓÔ, Ë ÂÓÂÚÁÔÔÈË̤ÓË PC Î·È Ë PS. ªÂÙ¿ ·fi Ì›· ‰È·‰ÚÔÌ‹ ÂÙÒÓ Ô˘ ÂÈÎÚ·ÙÔ‡Û ۇÁ¯˘ÛË ˆ˜ ÚÔ˜ ÙÔ ÙÈ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·ÓÙÈʈÛÊÔÏÈȉÈÎfi Û‡Ó‰ÚÔÌÔ (antiphospholipid syndrome, APS), ÙÔ 1998, ÛÙÔ 8Ô ¢ÈÂıÓ¤˜ Û˘ÌfiÛÈÔ APS ÛÙÔ Sapporo Ù˘ π·ˆÓ›·˜, ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ù· ÎÚÈÙ‹ÚÈ· Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ Û‡Ó‰ÚÔÌÔ (13). ∆· ÎÚÈÙ‹ÚÈ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ (ıÚÔÌ‚ÒÛÂȘ ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÊÏ‚ÒÓ, ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜, ÂÈÏÔΤ˜ Ù˘ ·ËÛ˘, Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜: ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ, ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·, ¯ÔÚ›·, ËÌÈÎÚ·Ó›·, ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, ÔÊı·ÏÌÈ΋ ÈÛ¯·ÈÌ›·) Î·È Ù· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· (ACA, APA, LA, antib2GP1). ŒÛÙˆ Î·È Ì›· ·ıÔÏÔÁÈ΋ ‰ÔÎÈÌ·Û›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ÛÙÔȯÂÈÔıÂÙÔ‡Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∆Ô˘Ó·ÓÙ›ÔÓ, Ë ·ÚÔ˘Û›· ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ÚÔıÚÔÌ‚›Ó˘, Ù˘ PC ‹ Ù˘ ·ÓÓÂ͛Ӣ V ·ÔÙÂÏÔ‡Ó ·ÛıÂÓ‹ ¤Ó‰ÂÈÍË ÙÔ˘ APS. ∆Ô Û‡Ó‰ÚÔÌÔ ‰È·ÎÚ›ÓÂÙ·È Û ÚˆÙÔ·ı¤˜, fiÙ·Ó ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ¿ÏÏÔ ·˘ÙÔ¿ÓÔÛÔ ÓfiÛËÌ· Î·È Û ‰Â˘ÙÂÚÔ·ı¤˜, fiÙ·Ó Û˘Ó˘¿Ú¯ÂÈ Ì SLE (Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıÚËÌ·ÙÒ‰Ë Ï‡ÎÔ) ‹ lupus-like ÓfiÛÔ. ∆Ô APS ·ÔÙÂÏ› ÙËÓ ϤÔÓ Û˘¯Ó‹ ·ÈÙ›· Â›ÎÙËÙ˘ ıÚÔÌ‚ÔÊÈÏ›·˜. ∞ÁÁÂȷΤ˜ ıÚÔÌ‚ÒÛÂȘ ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó Û οı ÙÌ‹Ì· Ù˘ ·ÚÙËÚȷ΋˜ ‹ ÊÏ‚È΋˜ ΢ÎÏÔÊÔÚ›·˜ ηÈ, ηٿ Û˘Ó¤ÂÈ·, οı fiÚÁ·ÓÔ ÌÔÚ› Ó· ÚÔÛ‚ÏËı›, ÁÈ’

6

Paediatriki 2002;65:4-8

·˘Ùfi Î·È ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ηχÙÔ˘Ó ¤Ó· ¢ڇ Ê¿ÛÌ·, ·Ó¿ÏÔÁ· Ì ÙÔ fiÚÁ·ÓÔ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È (12). ∆· ÂÂÈÛfi‰È· ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜ ÌÔÚ› Ó· Â›Ó·È ·ÚÔ‰Èο ‹ ÌfiÓÈÌ· Î·È Û˘¯Ó¿ ˘ÔÙÚÔÈ¿˙ÔÓÙ·. ∆· ÂÁÎÂÊ·ÏÈο ¤ÌÊÚ·ÎÙ· Û˘Ó‹ıˆ˜ Â›Ó·È ÌÂÙÚ›Ô˘ ÌÂÁ¤ıÔ˘˜ Î·È ·ÊÔÚÔ‡Ó Î·Ù’ ÂÍÔ¯‹Ó ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÌÂÁ¿ÏˆÓ Î·È ÌÈÎÚÒÓ ·ÁÁ›ˆÓ Ù˘ ̤Û˘ ÂÁηʷÏÈ΋˜ ·ÚÙËÚ›·˜ Î·È Ù˘ ηڈٛ‰·˜ (14). ∞ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· ¤¯Ô˘Ó ‚ÚÂı› Û ¿ÙÔÌ· Ì ÊÏ‚È΋ ıÚfiÌ‚ˆÛË ÛÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 5,2%-30%, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· ∞ƒ∞ Û ¿ÙÔÌ· ËÏÈΛ·˜ <50 ¯ÚfiÓˆÓ Ì ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· Î˘Ì·›ÓÂÙ·È ·fi 246% (15). µ¤‚·È·, Ë ·ÚÔ˘Û›· ·ÓÙÈʈÛÊÔÏÈȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¯ˆÚ›˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ‰ÂÓ Û˘ÓÈÛÙ¿ ∞ƒS. ™Â Ê˘ÛÈÔÏÔÁÈο Ó·ڿ ¿ÙÔÌ· ÂÚÈÁÚ¿ÊÔÓÙ·È ·ÓÙÈÛÒÌ·Ù· ηډÈÔÏÈ›Ó˘ Î·È Û·ÓÈfiÙÂÚ· ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ (LA) (12,15). ™Ù· ·È‰È¿, Ë ·ÚÔ˘Û›· ÙÔ˘ LA ‹ Î·È ÙˆÓ ACA Â›Ó·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ·ÚÔ‰È΋ Î·È ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È· (16). ∫·Ù¿ ηÓfiÓ·, Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÚÔËÁËı›۷ Ïԛ̈ÍË ‹ Ï‹„Ë Ê·Ú̿ΈÓ. ™ÙÔ ·ÚfiÓ Ù‡¯Ô˜, ÔÈ OÈÎÔÓfiÌÔ˘ Î·È Û˘Ó ÂÚÈÁÚ¿ÊÔ˘Ó Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ, ÛÙ· ÔÔ›· Ë ·Ú¿Ù·ÛË ÙÔ˘ Aƒ∆∆ ·Ô‰fiıËΠÛÙËÓ ·ÚÔ˘Û›· LA (10). ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ, Ù· ·È‰È¿ ‹Ù·Ó ·Û˘Ìو̷ÙÈο, ÙÔ LA ‹Ù·Ó ·ÚÔ‰ÈÎfi Î·È Ë ‰È·›ÛÙˆÛË ¤ÁÈÓ Û ÚÔÂÁ¯ÂÈÚËÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ù˘ ·ÈÌfiÛÙ·Û˘.

OÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌÂÚ·›ÓÔ˘Ó ˆ˜ Ë ·Ú¿Ù·ÛË ÙÔ˘ ∞ƒ∆∆ ‰ÂÓ ÔÊ›ÏÂÙ·È ¿ÓÙ· Û ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌfiÛÙ·Û˘ Ô˘ Û˘ÓÂ¿ÁÂÙ·È ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, ·ÏÏ¿ ÌÔÚ› Ó· Â›Ó·È Î·È ·ÔÙ¤ÏÂÛÌ· ·ÚÔ˘Û›·˜ LA, ÙÔ ÔÔ›Ô ÁÈ· Ó· ¯·Ú·ÎÙËÚÈÛı› ˆ˜ ·Î›Ó‰˘ÓÔ Î·È ·ÚÔ‰ÈÎfi Ú¤ÂÈ Ó· Â·ÓÂÏÂÁ¯ı›, ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ÚÔÛ‰ÈÔÚÈÛÌfi Î·È Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ÂÚÈÔ‰Èο, ÂÊfiÛÔÓ ·Ú·Ì¤ÓÂÈ. ™·ÓÈfiٷٷ, ·ÚÔ‰ÈÎfi LA ÌÔÚ› Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ Î·È ÌÂȈ̤ӷ Â›‰· ÚÔıÚÔÌ‚›Ó˘ (·Ú¿ÁÔÓÙ·˜ ππ) (17-18). ∞˘Ù‹ Ë ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· Èı·Ófiٷٷ ·ÓÙÈÚÔÛˆ‡ÂÈ ¤Ó·Ó ·ıÔÁÂÓÂÙÈÎfi Ì˯·ÓÈÛÌfi, ͯˆÚÈÛÙfi ·fi ÙÔ LA Û‡Ó‰ÚÔÌÔ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ıÚÔÌ‚ÔÊÈÏÈ΋ ÚԉȿıÂÛË. ∆¤ÏÔ˜, ÔÈ ∫Ô˘ÚÙ¤Û˘ Î·È Û˘Ó ÂÚÈÁÚ¿ÊÔ˘Ó ÛÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ÂӉȷʤÚÔ˘Û· ÂÚ›ÙˆÛË Ì˘ÍÒÌ·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Ô˘ ÚÔ¤‚·Ï ˆ˜ ÔÍ›· ÂÁÎÂÊ·ÏÈ΋ Û˘Ó‰ÚÔÌ‹, ÈÛ¯·ÈÌÈÎÔ‡ Ù‡Ô˘ (11). OÈ ÚˆÙÔ·ı›˜ fiÁÎÔÈ Ù˘ ηډȿ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔÈ Û fiϘ ÙȘ ÎÏÈÓÈΤ˜ ÔÌ¿‰Â˜. ™Â ÌÂÙ·ı·Ó¿ÙȘ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÛÂÈÚ¤˜ ·Ó·Ê¤ÚÂÙ·È Û˘¯ÓfiÙËÙ· 0,05%. ∆Ô 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÊÔÚ¿ ÛÂ Ì˘ÍÒÌ·Ù· ÙˆÓ ÎfiÏˆÓ,

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·7

¶·È‰È·ÙÚÈ΋ 2002;65:4-8

Ù· ÔÔ›· Û˘Ì‚·›ÓÔ˘Ó Î·Ù’ ÂÍÔ¯‹Ó ÌÂٷ͇ Ù˘ ÙÚ›Ù˘ Î·È ¤ÎÙ˘ ‰ÂηÂÙ›·˜ ˙ˆ‹˜, ÂÓÒ Â›Ó·È È‰È·›ÙÂÚ· Û¿ÓÈ· ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·. ∂ÓÙÔ‡ÙÔȘ, Ô͇ ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ ·ÔÙÂÏ› ÙË Û˘ÓËı¤ÛÙÂÚË ÂΉ‹ÏˆÛË Ì›·˜ ·Û˘Ó‹ıÔ˘˜ ÂÓ‰Ôηډȷ΋˜ Ì¿˙·˜ ÛÙ· ·È‰È¿, ÏfiÁˆ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌ‚ÔÏÈÛÌÔ‡ (1920). ∆Ô ¤Ì‚ÔÏÔ ÈÛÙ‡ÂÙ·È ˆ˜ ÚÔ¤Ú¯ÂÙ·È ·fi ıÚ·‡ÛÌ·Ù· ÙÔ˘ fiÁÎÔ˘ ‹ ·fi ıÚfiÌ‚Ô Ô˘ ·Ó·Ù‡ÛÛÂÙ·È ÛÙÔÓ fiÁÎÔ. ¶ÂÚ›Ô˘ ÙÔ 75% ÙˆÓ Ì˘ÍˆÌ¿ÙˆÓ ÂÓÙÔ›˙ÂÙ·È ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ˆÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜, ÙÔ 20% ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ‰ÂÍÈfi ÎfiÏÔ Î·È ÙÔ ˘fiÏÔÈÔ ·fi ‰È¿ÊÔÚ˜ ¿ÏϘ ı¤ÛÂȘ. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙˆÓ Ì˘ÍˆÌ¿ÙˆÓ ÙÔ˘ ÎfiÏÔ˘ Â›Ó·È Û˘¯Ó¿ ÌË ÂȉÈΤ˜, ˆÛÙfiÛÔ ·È‰È¿ Ì ̷͈̇ Û˘Ó‹ıˆ˜ ‰›ÓÔ˘Ó ÙÔ˘˜ ÂÍ‹˜ ÙÚÂȘ Ù‡Ô˘˜ ÂΉËÏÒÛˆÓ: ·) ·fiÊÚ·ÍË Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ ÌÂ Û˘Ó·ÎfiÏÔ˘ıË Ì›ˆÛË Ù˘ ηډȷ΋˜ ·ÚÔ¯‹˜ Î·È ÔÍ›· ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘, ‚) Û˘ÛÙËÌ·ÙÈÎfi ÂÌ‚ÔÏÈÛÌfi ÙÔ˘ ıÚfiÌ‚Ô˘ ‹ fiÁÎÔ˘. ™˘Ì‚·›ÓÂÈ ÛÙÔ 45% ÙˆÓ ·ÛıÂÓÒÓ Î·È Û¯Â‰fiÓ ÔÈ ÌÈÛÔ› ·fi ·˘ÙÔ‡˜ ·ÊÔÚÔ‡Ó ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ·ÁÁÂÈ·Îfi ‰›ÎÙ˘Ô, Á) ÁÂÓÈÎÂ˘Ì¤Ó· Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· (˘ÚÂÙfi˜, ηÎÔ˘¯›·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜, ıÚÔÌ‚Ô΢ÙÙ¿ÚˆÛË ‹ ıÚÔÌ‚ÔÂÓ›·) Ô˘ ·Ô‰›‰ÔÓÙ·È Û ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ·fi Ó¤ÎÚˆÛË ÙÔ˘ fiÁÎÔ˘ (19). ∆Ô Ì‡ÍˆÌ·, ·Ú’ fiÙÈ Û¿ÓÈÔ Û‡Ì‚·Ì·, Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË, ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ·È‰È¿ Ì Ó¢ÚÔÏÔÁÈο ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù·. ∏ ‰È¿ÁÓˆÛË ÚÔ¸Ôı¤ÙÂÈ Î·Ï‹ ÎÏÈÓÈ΋ ηډÈÔÏÔÁÈ΋ ÂͤٷÛË Î·È ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ˘ÂÚ˯ÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ·ÔÙÂÏ› ¿ÚÈÛÙÔ Ì¤ÛÔ, fi¯È ÌfiÓÔ ÁÈ· ÙË ‰È·›ÛÙˆÛË ÙÔ˘ Ì˘ÍÒÌ·ÙÔ˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜, ÙÔ˘ Û¯‹Ì·ÙÔ˜, ÙÔ˘ ÛËÌ›Ԣ Ù˘ ÚfiÛÊ˘Û˘ Î·È Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ fiÁÎÔ˘. O ηχÙÂÚÔ˜ ¯ÚfiÓÔ˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ê·›ÚÂÛ˘ ÙÔ˘ fiÁÎÔ˘ ·Ú·Ì¤ÓÂÈ ·Û·Ê‹˜. ÿÛˆ˜ Â›Ó·È ·ÛʷϤÛÙÂÚÔ Ó· ÂȯÂÈÚÂ›Ù·È ‰‡Ô ‚‰ÔÌ¿‰Â˜ ·fi ÙËÓ ÂÁηٿÛÙ·ÛË ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·ÔÙÂÏÔ‡Ó Û¿ÓÈÔ Û‡Ì‚·Ì·, Û ·ÓÙ›ıÂÛË Ì ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ Î·È Â›Ó·È Ú·ÁÌ·ÙÈο Ì›· ÚfiÎÏËÛË ÁÈ· ÙÔÓ È·ÙÚfi Ô˘ ηÏÂ›Ù·È Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ ‹ ÙËÓ Î·Ù¿ÛÙ·ÛË Ô˘ Û˘Ó‹ıˆ˜ Û˘Ó˘¿Ú¯ÂÈ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ÓfiÛÔ˜ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. ∂˘·›ÛıËÙ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó Â·ÎÚÈ‚Ò˜ ÙË ı¤ÛË, ÙËÓ ¤ÎÙ·ÛË Î·È ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘, ÂÓÒ Ô ÂÓ‰Âϯ‹˜ ¤ÏÂÁ¯Ô˜ ÎÏËÚÔÓÔÌÈÎÒÓ Î·È Â›ÎÙËÙˆÓ ·Ú·ÁfiÓÙˆÓ ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙËÓ Èı·ÓfiÙËÙ· Â·Ó¿Ï˄˘ ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ Î·È ÂӉ¯Ô̤ӈ˜ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ·ÓÙÈʈ-

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ÛÊÔÏÈȉÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·‚›·ÛÙ· ÛÙ· ·È‰È¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÙÔ LA ηٿ ηÓfiÓ· Â›Ó·È ·ÚÔ‰ÈÎfi Î·È ‰ÂÓ ÂÓ¤¯ÂÙ·È ÁÈ· ıÚÔÌ‚ÔÊÈÏÈ΋ ÚԉȿıÂÛË. ¶·Ú’ fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û˘ÛÛˆÚ‡ıËΠ·ÚÎÂÙ‹ ÁÓÒÛË ÁÈ· Ù· ÂÁÎÂÊ·ÏÈο ÂÂÈÛfi‰È· ÛÙ· ·È‰È¿, ÂÓÙÔ‡ÙÔȘ, Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ·Û·Ê‹˜. ¶ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ ÂӉ¯Ô̤ӈ˜ Ó· Ú›ÍÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ Êˆ˜ ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Î·È Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ Î·Ï‡ÙÂÚË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Rosendaal F. Thrombosis in the young: epidemiology and risk factors. A focus on venous thrombosis. Thromb Haemost 1977;78:1-6.

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9. ª¿ÓÙ˙ÈÔ˘ £, ¶Ï·ÙÔÎÔ‡ÎË ∂, ∫·Ú¿ÌÂÏ·˜ µ, ∫·„ÈÌ¿ÏË ∑, ∞‰·ÌÙ˙›ÎË ∂, ∫Ô‚¿Ó˘ ∞ Î·È Û˘Ó. £ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 2002;1:23-31.

10. OÈÎÔÓfiÌÔ˘ ª, ∫Ô‡ÛË ∞, ∆Û¿ÙÚ· π, °·Ú˘›‰Ô˘ µ, ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿ ª. ¶·ÚÔ‰ÈÎfi ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÙÂÛÛ¿ÚˆÓ ÂÚÈÙÒÛˆÓ. ¶·È‰È·ÙÚÈ΋ 2002;1:77-80.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-01-2002 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-01-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· ∞ÚÒÓË-µÔ˘ÚÓ¿ ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘ - ∞ÈÌÔÚÚÔÊÈÏ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∞fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ·. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÚÔÛÙ·Û›·˜1 ∆Ô 1997, Ë ·˘ÙÔÎÙÔÓ›· ‹Ù·Ó Ë ÙÚ›ÙË ÛÙË ÛÂÈÚ¿ ·ÈÙ›· ı·Ó¿ÙÔ˘ ÛÙȘ ËÏÈ˘ 10-19 ¯ÚfiÓˆÓ ÛÙȘ ∏¶∞. ∏ ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·˘ÙÔÎÙÔÓÈÒÓ ÙËÓ ÚÔËÁÔ‡ÌÂÓË ‰ÂηÂÙ›· ·Ú·ÙËÚ‹ıËΠ۠ÂÊ‹‚Ô˘˜ Ì·‡Ú˘ Ê˘Ï‹˜ Î·È ¿ÏÏˆÓ ÌÂÈÔÓÔًوÓ. ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ·Ó·ÁÓˆÚÈÛÙÔ‡Ó ÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ÚÔÛÙ·Û›·˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙȘ ·˘ÙÔÎÙÔӛ˜ Û ̷‡ÚÔ˘˜, ÈÛ·ÓfiʈÓÔ˘˜ Î·È Ï¢ÎÔ‡˜ ÂÊ‹‚Ô˘˜, ¿ÚÚÂÓ˜ Î·È ı‹ÏÂȘ. ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜: ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙÔȯ›· ·fi ÙËÓ ∂ıÓÈ΋ ¢È·¯ÚÔÓÈ΋ ªÂϤÙË ÀÁ›·˜ ÙˆÓ ∂Ê‹‚ˆÓ Ô˘ ¤ÁÈÓ ÙÔ 1995 Î·È 1996. ™Â ÂıÓÈÎfi Â›‰Ô, Û ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ‰Â›ÁÌ· 13110 Ì·ıËÙÒÓ, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó 2 Û˘ÓÂÓÙ‡ÍÂȘ ÛÙÔ Û›ÙÈ Ì ÌÂÛԉȷÛÙ‹Ì·Ù· 11 ÌËÓÒÓ Î·Ù¿ ̤ÛÔ fiÚÔ. ™ÙËÓ ÚÒÙË Û˘Ó¤ÓÙ¢ÍË ÂÍÂÙ¿ÛÙËÎ·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ ›¯·Ó Û¯¤ÛË Ì ÙÔÓ ›‰ÈÔ ÙÔÓ ÂÍÂÙ·˙fiÌÂÓÔ, ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙÔ ÎÔÈÓˆÓÈÎfi Â›‰Ô, ÔÈ ÔÔ›ÔÈ ÚÔ·Ó‹ÁÁÂÏÏ·Ó ‹ ÚÔÛٿ٢·Ó ÁÈ· ·fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜ ̤¯ÚÈ ÙË ‰Â‡ÙÂÚË Û˘Ó¤ÓÙ¢ÍË. ∞ÔÙÂϤÛÌ·Ù·: O ‰ÂÛÌfi˜ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·ÔÙÂÏÔ‡Û·Ó ·Ú¿ÁÔÓÙ˜ ÚÔÛÙ·Û›·˜ ÁÈ· ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ Î·È ÛÙ· ‰‡Ô ʇϷ ÁÈ· Ì·‡ÚÔ˘˜, πÛ·ÓfiʈÓÔ˘˜ Î·È Ï¢ÎÔ‡˜ Ì ۯÂÙÈÎfi ΛӉ˘ÓÔ 0,06-0,32. °È· ÙȘ ı‹ÏÂȘ, Ë Î·Ï‹ Û˘Ó·ÈÛıËÌ·ÙÈ΋ ηٿÛÙ·ÛË ‹Ù·Ó Â›Û˘ ·Ú¿ÁÔÓÙ·˜ ÚÔÛÙ·Û›·˜ ÁÈ· fiϘ ÙȘ ÔÌ¿‰Â˜ Û ÂıÓÈÎfi Â›‰Ô, ÂÓÒ ÁÈ· ÙÔ˘˜ ¿ÚÚÂÓ˜, Ë Ôχ ηϋ Û¯ÔÏÈ΋ Â›‰ÔÛË ‹Ù·Ó Â›Û˘ ¤Ó·˜ ÂÈÚfiÛıÂÙÔ˜ ÚÔÛٷ٢ÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ™ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÂÚÈÏ·Ì‚·ÓfiÙ·Ó Î·È Ë ÚÔËÁÔ‡ÌÂÓË ·fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜, ·fiÂÈÚ· ‚›·˜, ·Ú·‚·ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ¯Ú‹ÛË ÔÈÓÔÓ‡̷ÙÔ˜, ¯Ú‹ÛË Ì·ÚÈ¯Ô˘¿Ó·˜ Î·È ÚÔ‚Ï‹Ì·Ù· ÛÙÔ Û¯ÔÏ›Ô. ∂ÈÚfiÛıÂÙ·, ۈ̷ÙÈο ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜,

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·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓ›·˜ ʛψÓ, ¯Ú‹ÛË ¿ÏÏˆÓ ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÈÛÙÔÚÈÎfi ıÂÚ·›·˜ ÚÔ‚ÏËÌ¿ÙˆÓ „˘¯ÔÓÂ˘Ì·ÙÈ΋˜ ˘Á›·˜ ‹Ù·Ó ÚÔ¿ÁÁÂÏÔ˜ ÁÈ· ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓÈÒÓ Û ÎÔÚ›ÙÛÈ· πÛ·Ófiʈӷ, Ì·‡Ú˘ Î·È Ï¢΋˜ Ê˘Ï‹˜. ∏ ÔÏÔÊÔÚ›· ÛÙÔ Û¯ÔÏÂ›Ô Î·È Ë ¤ÏÍË ÁÈ· ÙÔ ›‰ÈÔ Ê‡ÏÔ ‹Ù·Ó ÚÔ¿ÁÁÂÏÔ˜ ·˘ÙÔÎÙÔÓÈÒÓ Û fiϘ ÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·ÁÔÚÈÒÓ. ∞fi ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ Èı·ÓÔÙ‹ÙˆÓ ÁÈ· ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓÈÒÓ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ÚԤ΢„ ˆ˜ Ë ·ÚÔ˘Û›· 3 ÚÔÛٷ٢ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ì›ˆÓ ÙÔÓ Î›Ó‰˘ÓÔ 70-85% ÁÈ· οı ÌÈ· ÔÌ¿‰· (ʇÏÔ˘, Ê˘ÏÂÙÈ΋ Î·È ÂıÓÈ΋ ÔÌ¿‰·). ™˘ÌÂÚ¿ÛÌ·Ù·: ™ÙÔ ‰Â›ÁÌ· Ô˘ ¤Ï·‚ ̤ÚÔ˜ ÛÙË ÌÂϤÙË ·fi Ì·‡ÚÔ˘˜, πÛ·ÓfiʈÓÔ˘˜ Î·È Ï¢ÎÔ‡˜ ÂÊ‹‚Ô˘˜, ÌÂÌÔӈ̤ÓÔÈ Î·È ·ÏÏËÏÔÂÍ·ÚÙÒÌÂÓÔÈ ·Ú¿ÁÔÓÙ˜ ÚÔÂÚ¯fiÌÂÓÔÈ ·fi ¤Ó· ÎÔÈÓˆÓÈÎfi ·ÓıÂÎÙÈÎfi ÈÛÙfi ÌÔÚÔ‡Û·Ó Ó· ÚԂϤ„Ô˘Ó ‹ Ó· ÙÔ˘˜ ÚÔÛٷ٤„Ô˘Ó ·fi ·fiÂÈÚ˜ ·˘ÙÔÎÙÔÓÈÒÓ. ∂ÈϤÔÓ, ÂÎÙfi˜ ·fi ÙË Ì›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘, Ë ÚÔ·ÁˆÁ‹ ·Ú·ÁfiÓÙˆÓ ÚÔÛÙ·Û›·˜ ı· ÌÔÚÔ‡Û ӷ ÚÔÛʤÚÂÈ Ô˘ÛÈ·ÛÙÈ΋ ‚Ô‹ıÂÈ· ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÚˆÙÔÁÂÓ‹ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ·ÔÙÚÔ‹ ÙˆÓ ·˘ÙÔÎÙÔÓÈÒÓ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜.

1 Borowsky I, Ireland M, Resuick M Adolescent suicide attempts. Risks and protectors Pediatrics 2001;107:485-493

∆ÛÔ˘Ì¿Î·˜ ∫ˆÓ/ÓÔ˜ ¶·È‰›·ÙÚÔ˜ - ¢È¢ı˘ÓÙ‹˜ ∂™À ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ - ∞ÙÙÈ΋˜

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·9

¶·È‰È·ÙÚÈ΋ 2002;65:9-15

∞¡∞™∫O¶∏™∏

Paediatriki 2002;65:9-15

REVIEW ARTICLE

¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÛÙ· ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ ÚfiˆÚ· ÓÂÔÁÓ¿ π. ∫·Ï¤ÁÈ·˜, £. §È¿ÚÔ˘, ∑. ÷Ù˙ËÛÙ·Ì·Ù›Ô˘

Risk factors for cerebral palsy in extremely low birth weight infants J. Kaleyias, T. Liarou, Z. Hatzistamatiou

¶ÂÚ›ÏË„Ë: Œ¯Ô˘Ó ÂÚ¿ÛÂÈ ÂÚÈÛÛfiÙÂÚ· ·fi 100 ¯ÚfiÓÈ· ·ÊfiÙÔ˘ Ô Little ÚÒÙÔ˜ ¤‰ÂÈÍ fiÙÈ Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (∂¶) Û˘Ó‰¤ÂÙ·È Ì ÂÚÈÁÂÓÓËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ¯ˆÚ›˜ Ó· ÌÔÚ› Ó· ηıÔÚ›ÛÂÈ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ÚfiÛÊ·ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ∂¶ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÚÔÁÂÓÓËÙÈÎÔ› ·ÏÏ¿ Î·È ÓÂÔÁÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù·, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Î·È Ù˘ ∂¶ ÙˆÓ ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓÒÓ (∂õ°¡). ∆Ô ¿ÚıÚÔ ·˘Ùfi ·Ó·ÛÎÔ› Ù· ÚfiÛÊ·Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ∂¶ ÙˆÓ ∂õ°¡. ¶ÚÔÁÂÓÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ Â›Ó·È ÙÔ ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷, ÙÔ Û‡ÓÙÔÌÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ ÙˆÓ Î˘‹ÛˆÓ, Ë ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË, Ë ·ÔÎfiÏÏËÛË ÙÔ˘ Ï·ÎÔ‡ÓÙ·, Ë ÎÔÏÈ΋ ·ÈÌÔÚÚ·Á›·, Ô ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÂÓfi˜ ·fi Ù· ΢‹Ì·Ù· Û Ôχ‰˘ÌË Î‡ËÛË. ∞ÓÙ›ıÂÙ·, ÚÔÁÂÓÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ Â›Ó·È Ë ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Î·ÈÛ·ÚÈ΋ ÙÔÌ‹, Ë Ì·›Â˘ÛË Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÁÈ· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù· ΤÓÙÚÔ, Ë ÚÔÁÂÓÓËÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂȉÒÓ Î·È Ë ÚÔÂÎÏ·Ì„›·. ¡ÂÔÁÓÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ Â›Ó·È Ë ÔͤˆÛË, Ë ÛË„·ÈÌ›·, Ë ˘fiÙ·ÛË, ÙÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, Ô Ó¢ÌÔıÒڷη˜, Ë ˘ÔηÓ›·, Ë ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ Î·È Ë ˘Ôı˘ÚÔÍÈÓ·ÈÌ›·. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ∂õ°¡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ∂¶, Èı·ÓÒ˜ ‰ÂÓ ÔÊ›ÏÔÓÙ·È Û ÌÂÌÔӈ̤ÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, ·ÏÏ¿ Ì¿ÏÏÔÓ Û ÔχÏÔΘ ·ÏÏËÏÂȉڿÛÂȘ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂȉÚÔ‡Ó Û ‰È·ÊÔÚÂÙÈο ÛÙ¿‰È· Ù˘ ·Ó¿Ù˘Í˘.

Abstract: More than 100 years have passed since Little first suggested that cerebral palsy (CP) was associated with perinatal events; however, its etiology is still poorly understood. Recent research findings on the etiology of CP show that both antenatal and neonatal risk factors contribute to the development of severe neurologic impairment, including CP among very low birth weight (VLBW) infants. This article summarizes the recent research data concerning the etiology of CP in VLBW infants. Antenatal factors associated with increased risk for CP are genetic factors, short interpregnancy interval, intrauterine infections, placental abruption, vaginal bleeding, death of a co-twin in multiple pregnancy. In contrast, antenatal factors associated with decreased risk for CP are delivery without labor (elective cesarean section), delivery at specialized perinatal services, antenatal corticosteroids and preeclampsia.

Neonatal factors associated with increased risk for CR are neonatal acidosis, sepsis, hypotension, respiratory distress syndrome, hypocapnia, chronic lung disease, pneumothorax and hypothyroxinemia. In conclusion, neurologic impairments among VLBW infants, including CP, are probably not caused by isolated risk factors, but rather by a complex interaction of many factors which act upon at different stages of development.

∆Ì‹Ì· ¡ÂÔÁÂÓÓ‹ÙˆÓ ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

Division of Neonatology General District Hospital “Alexandra”, Athens

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JAN-FEB 2002 DONE

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¶·È‰È·ÙÚÈ΋ 2002;65:9-15

§¤ÍÂȘ ÎÏÂȉȿ: ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ÚÔÁÂÓÓËÙÈÎÔ›, ÓÂÔÁÓÈÎÔ›.

™˘ÓÙÔÌÔÁڷʛ˜ ∂õ°¡ ∏∫ ™∫ ™∞¢ ö¡

∂Í·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ ∏ÏÈΛ· ·ËÛ˘ ™¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ™‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÃÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜

∂ÈÛ·ÁˆÁ‹ Œ¯Ô˘Ó ÂÚ¿ÛÂÈ ÂÚÈÛÛfiÙÂÚ· ·fi 100 ¯ÚfiÓÈ· ·ÊfiÙÔ˘ Ô Little (1) ÚÒÙÔ˜ ¤‰ÂÈÍ fiÙÈ Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (∂¶) Û˘Ó‰¤ÂÙ·È Ì ÂÚÈÁÂÓÓËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ¯ˆÚ›˜ Ó· ÌÔÚ› Ó· ηıÔÚ›ÛÂÈ ÙËÓ ·ÈÙÈÔÏÔÁ›· ÙÔ˘˜. ∏ ∂¶ ÔÚ›˙ÂÙ·È Û·Ó ¤Ó·˜ fiÚÔ˜ “ÔÌڤϷ” Ô˘ ηχÙÂÈ Ì›· ÔÌ¿‰· ÌË ÚÔԉ¢ÙÈÎÒÓ, ·ÏÏ¿ Û˘¯Ó¿ ÂÍÂÏÈÛÛfiÌÂÓˆÓ, Û˘Ó‰ÚfiÌˆÓ ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ·, Ô˘ ÔÊ›ÏÔÓÙ·È Û ‰Â˘ÙÂÚÔÁÂÓ‹ ‚Ï¿‚Ë ‹ ·ÓˆÌ·Ï›· ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÛÙ· ÚÒÈÌ· ÛÙ¿‰È· Ù˘ ·Ó¿Ù˘Í˘ (2). ∏ Ù¯ÓÔÏÔÁÈ΋ ÚfiÔ‰Ô˜ ηٿ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1980 Ô‰‹ÁËÛ ÛÙËÓ ÂÚ·ÈÙ¤Úˆ ÔÚÁ¿ÓˆÛË ÙˆÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ˙ÒÓÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Î·È ÙË Ì›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜, Ë ÔÔ›· fï˜ Û˘Óԉ¢fiÙ·Ó Ì ‰Ú·Ì·ÙÈ΋ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ∂¶ Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· (3). ∆· ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ (∂õ°¡-Extremely Low Birth Weight) ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ, ÙÔ˘Ï¿¯ÈÛÙÔÓ 70 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ (ÂȉÈο Ë Û·ÛÙÈ΋ ÌÔÚÊ‹ ∂¶) Û ۯ¤ÛË Ì ٷ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿ (4). ∏ Û·ÛÙÈ΋ ∂¶ ‹Ù·Ó Ë ‰Â‡ÙÂÚË ϤÔÓ Û˘¯Ó‹ ·ÈÙ›· ÛÔ‚·Ú‹˜ ÌÂÈÔÓÂÍ›·˜ ÛÙ· ∂õ°¡ ÛÙË ‰ÂηÂÙ›· ÙÔ˘ 1990 (5).

OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ∂¶ ‰È·ÎÚ›ÓÔÓÙ·È Û ÚÔÁÂÓÓËÙÈÎÔ‡˜, ÂÚÈÁÂÓÓËÙÈÎÔ‡˜ Î·È ·Ù·ÍÈÓfiÌËÙÔ˘˜ (2) (∂ÈÎfiÓ· 1). ™Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÔÈ ÂÚÈÁÂÓÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ (54%), ÂÓÒ ÔÈ ÚÔÁÂÓÓËÙÈÎÔ› ηχÙÔ˘Ó ÌfiÓÔ ÙÔ 8%, Û ·ÓÙ›ıÂÛË Ì ٷ ÙÂÏÂÈfiÌËÓ· fiÔ˘ Î·È ÔÈ ‰‡Ô ηÙËÁÔڛ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÂÚ›Ô˘ ÂÍ›ÛÔ˘ (ÚÔÁÂÓÓËÙÈÎÔ› 33% Î·È ÂÚÈÁÂÓÓËÙÈÎÔ› 28%). ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ Èı·Ó‹˜ Û˘Û¯¤ÙÈÛ˘ Ù˘ ¤Î‚·Û˘ ÙˆÓ ÂÍ·ÈÚÂÙÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓÒÓ Ì ÚÔÁÂÓÓËÙÈÎÔ‡˜ Î·È ÂÚÈÁÂÓÓËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ·ÍÈfiÏÔÁÔ˘ ·ÚÈıÌÔ‡ ÌÂÏÂÙÒÓ, ¯ˆÚ›˜ Ó· ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›. ∏ ÔÏ˘·Ú·ÁÔÓÙÈ΋ ʇÛË Ù˘ ∂¶ ηıÈÛÙ¿ ÙË ‰ÈÂÚ‡ÓËÛË ·˘Ù‹ ‰˘Û¯ÂÚ‹ (6). ¶ÚfiÛÊ·Ù˜ η-

10

Paediatriki 2002;65:9-15

Key words: cerebral palsy, extremely low birth weight infants, risk factors, antenatal, neonatal.

Ï¿ ۯ‰ȷṲ̂Ó˜ ÔÏ˘ÎÂÓÙÚÈΤ˜, ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ Ô˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ Î·ıÒ˜ Î·È ÌÂÙ·-·Ó·Ï‡ÛÂȘ ·˘ÙÒÓ, ··ÓÙÔ‡Ó Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÂÚˆÙËÌ¿ÙˆÓ, ÂÓÒ ¿ÏÏ· ·Ú·Ì¤ÓÔ˘Ó ·ÎfiÌ· ·Ó·¿ÓÙËÙ· ·ÊÔ‡ Ù· ·ÔÙÂϤÛÌ·Ù¿ ÙÔ˘˜ Â›Ó·È ·ÓÙÈÊ·ÙÈο. °È· ÙË Û˘Û¯¤ÙÈÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÌÂÏÂÙÒÓÙ·È Ì ÙËÓ ∂¶, ˘ÔÏÔÁ›˙ÂÙ·È Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (™∫ - odds ratio) ÌÈ·˜ Û·ÊÒ˜ ÔÏÔ¤Ó· Î·È ÂÚÈÛÛfiÙÂÚÔ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˘ ÛÙ·ÙÈÛÙÈ΋˜ ·Ú·Ì¤ÙÚÔ˘ ÛÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Î·È È‰›ˆ˜ ÛÙȘ ÌÂÙ·-·Ó·Ï‡ÛÂȘ (7). O ™∫ ÂÎÊÚ¿˙ÂÈ fiÛ˜ ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚË (™∫ >1) ‹ ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ (™∫ <1) Â›Ó·È Ë ˘fi ÌÂϤÙË ÓfiÛÔ˜ (.¯. ∂¶), fiÙ·Ó Ô ˘fi ÌÂϤÙË ·Ú¿ÁÔÓÙ·˜ Â›Ó·È ·ÚÒÓ, Û ۇÁÎÚÈÛË ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ fiÙ·Ó Ô ˘fi ÌÂϤÙË ·Ú¿ÁÔÓÙ·˜ Â›Ó·È ·ÒÓ (8). ∆Ô ¿ÚıÚÔ ·˘Ùfi ·Ó·ÛÎÔ› Ù· ÚfiÛÊ·Ù· Â˘Ú‹Ì·Ù· ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÈÚ·Ì·ÙÈÎÒÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ∂¶ ÙˆÓ ∂õ°¡. ∞. ¶ÚÔÁÂÓÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∏ Û˘Û¯¤ÙÈÛË Ù˘ ∂¶ Ì ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ÂÓÙ·ÙÈ΋˜ ÌÂϤÙ˘. ∆Ô 2% Ù˘ ∂¶ ıˆÚÂ›Ù·È Û‹ÌÂÚ· fiÙÈ ¤¯ÂÈ ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ (9,10). ™¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο, Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È ·ÊÔÚÔ‡Ó ÛÙËÓ ·Ù·ÍÈ΋ ÌÔÚÊ‹ Ù˘ ∂¶. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, Ë ·Ù·ÍÈ΋ ÌÔÚÊ‹ ηχÙÂÈ ÙÔ 5-10% Ù˘ ∂¶ Î·È ÔÈ ÌÈÛ¤˜ ÂÚÈÙÒÛÂȘ ·˘Ù‹˜ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Ì ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ¶ÚfiÛÊ·Ù· ¤¯Ô˘Ó ¯·ÚÙÔÁÚ·ÊËı› ÂÚÈÔ¯¤˜ ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ Ô˘ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È, fiˆ˜ ÛÙÔ ‚Ú·¯‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 9 (10) Î·È ÛÙÔ Ì·ÎÚ‡ ÛΤÏÔ˜ ÙÔ˘ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ 2 (9). ∂›Û˘, ÌÂÙ¿ÏÏ·ÍË Ô˘ ·ÊÔÚ¿ ÛÙÔ ıÚÔÌ‚ÔÊÈÏÈÎfi ·Ú¿ÁÔÓÙ· V Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÎÏËÚÔÓÔÌÈ΋ ÌÔÚÊ‹ ∂¶ (11,12). ∆Ô ÂÚÒÙËÌ· ‡·Ú͢ ÎÔÈÓÔ‡ ÁÂÓÂÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÚÔˆÚfiÙËÙ· Î·È ÙËÓ ∂¶ ·Ú·Ì¤ÓÂÈ ·Ó·¿ÓÙËÙÔ (13). ªËÙÚÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÚÈÓ ÙË Û‡ÏÏË„Ë Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ∂¶ Â›Ó·È ÙÔ Û‡ÓÙÔÌÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ ÙˆÓ Î˘‹ÛÂˆÓ (14) Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ Î˘‹ÛˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Î·È ÙˆÓ ·Ô‚ÔÏÒÓ (3). ∆Ô Û‡ÓÙÔÌÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ ÙˆÓ Î˘‹ÛÂˆÓ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ∂¶. OÈ Dinto-Martin Î·È Û˘Ó (14) ¤‰ÂÈÍ·Ó fiÙÈ Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ÌÂÛԉȿÛÙËÌ·ÙÔ˜ ÌÂٷ͇ ÙˆÓ Î˘‹ÛÂˆÓ ÛÙËÓ ÔÌ¿‰· ÙˆÓ

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·11

¶·È‰È·ÙÚÈ΋ 2002;65:9-15

Paediatriki 2002;65:9-15

ÓÂÔÁÓÒÓ Ì ∂¶ ‹Ù·Ó 16 Ì‹Ó˜, ¤Ó·ÓÙÈ 23 ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. µÈÔÏÔÁÈ΋ ÂÚÌËÓ›· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ ‰ÂÓ ¤¯ÂÈ ‰Ôı›. ¶¿ÓÙˆ˜, ÙÔ Û‡ÓÙÔÌÔ ÌÂÛԉȿÛÙËÌ·, ¯ˆÚ›˜ Ó· ÔÚ›˙ÂÙ·È Û·ÊÒ˜ ÔÈÔ Â›Ó·È ·˘Ùfi, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·‡ÍËÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Î·È Ù˘ ÓÔÛËÚfiÙËÙ·˜. ¶ÂÚÈÛÛfiÙÂÚ˜ ·fi 3 ΢‹ÛÂȘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ·˘Í¿ÓÂÙ·È Ô Î›Ó‰˘ÓÔ˜ ηٿ 4 ÊÔÚ¤˜ (™∫=4,3) (3). ¶·Ú¿ÁÔÓÙ˜ fiˆ˜ ÙÔ Â¿ÁÁÂÏÌ· Ù˘ ÌËÙ¤Ú·˜, Ë ÂÎ·›‰Â˘ÛË, Ë Ê˘Ï‹ ηıÒ˜ Î·È Ë ÔÈÎÔÁÂÓÂȷ΋ ηٿÛÙ·ÛË ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È (15,16). ∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÏÂÙÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË Û˘Û¯¤ÙÈÛË Ù˘ ‰È·ÙÚÔÊ‹˜ Ù˘ ÂÁ·Ԣ Ì ÙËÓ ∂¶ ÔÈΛÏÏÔ˘Ó. ŸÌˆ˜, ÛÙ·ıÂÚfi ‡ÚËÌ· Â›Ó·È Ë ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Î·Ù·Ó¿ÏˆÛ˘ „·ÚÈÒÓ ·fi ÙËÓ ¤ÁÎ˘Ô Î·È Ù˘ ∂¶ (17). ∏ Ôχ‰˘ÌË Î‡ËÛË ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÌÂϤÙ˜ Û ÏËı˘ÛÌÔ‡˜ Ù˘ ÎÔÈÓfiÙËÙ·˜ (18-20). H Û˘Û¯¤ÙÈÛË, fï˜, ·˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙËÓ Â›‰Ú·ÛË ÙÔ˘ ·Ú¿ÁÔÓÙ· Û‡Á¯˘Û˘ Ô˘ ·ÔÙÂÏ› Ë ÌÈÎÚfiÙÂÚË ∏∫ ÙˆÓ ‰È‰‡ÌˆÓ. ŸÙ·Ó ÏËÊı› ˘’ fi„ÈÓ Ë ∏∫, ÙfiÙÂ Ë ‰›‰˘ÌË Î‡ËÛË ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ∂¶ (™∫=1,2) (15,16,21,22). ∂ÓÒ, fï˜, Ë Ôχ‰˘ÌË Î‡ËÛË ‰ÂÓ Â›Ó·È ·fi ÌfiÓË Ù˘ ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶, Ô ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÙÔ˘ ÂÓfi˜ ΢‹Ì·ÙÔ˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ µ°. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, Ô ı¿Ó·ÙÔ˜ ÂÓfi˜ ·fi Ù· ΢‹Ì·Ù· ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·fi 7 ¤ˆ˜ 14 ÊÔÚ¤˜ ÁÈ· ∂¶ ÛÙÔ ÂÈ˙ÒÓ (18,19). O ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÂÓÂÚÁÔÔÈ› ÙÔ Ì˯·ÓÈÛÌfi Ù˘ ‹Í˘ Î·È Ô‰ËÁ› Û ÂÁÎÂÊ·ÏÈ΋ ıÚfiÌ‚ˆÛË ÙÔ˘ ÂÈ˙ÒÓÙÔ˜ ‰È‰‡ÌÔ˘ (23). ™‹ÌÂÚ·, ÔÈ Ôχ‰˘Ì˜

΢‹ÛÂȘ ¤¯Ô˘Ó ·˘ÍËı› ÏfiÁˆ ÙˆÓ Â͈ۈ̷ÙÈÎÒÓ ÁÔÓÈÌÔÔÈ‹ÛˆÓ. ∏ Û˘Û¯¤ÙÈÛË ÙˆÓ Â͈ۈ̷ÙÈÎÒÓ ÁÔÓÈÌÔÔÈ‹ÛÂˆÓ Ì ÙËÓ ∂¶ Â›Ó·È ¤ÌÌÂÛË, ÏfiÁˆ ÙˆÓ ·˘ÍËÌ¤ÓˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ·˘Ù‹ Û˘ÓÂ¿ÁÂÙ·È (ÚÔˆÚfiÙËÙ·, ÌÈÎÚfi ÁÈ· ÙËÓ ËÏÈΛ· ·ËÛ˘ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, Ôχ‰˘ÌË Î‡ËÛË) (24,25). ∞fi ÙȘ ÂÈÏÔΤ˜ Ù˘ ·ËÛ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÚÔˆÚfiÙËÙ·, Ë ÚÔÂÎÏ·Ì„›· Â›Ó·È Ë ÌÔÓ·‰È΋ Ô˘ ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ∂¶ Î·È Ì¿ÏÈÛÙ· ıˆÚÂ›Ù·È fiÙÈ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ (™∫=0,4) (13,15,16,26,27). °È· ÙËÓ ÂÚÌËÓ›· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ ·˘ÙÔ‡ ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚ˜ ·fi„ÂȘ, fiˆ˜ Ë ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ Ïԛ̈͢ Û ÛÔ‚·Ú‹ ÚÔÂÎÏ·Ì„›· ÛÙÔ 2Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ (28), fiÙÈ Ù· ∂õ°¡ ÌËÙ¤ÚˆÓ Ì ÚÔÂÎÏ·Ì„›· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ·ËÛ˘, ·ÊÔ‡ ÚfiÎÂÈÙ·È ÁÈ· ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ (29) ηÈ, Ù¤ÏÔ˜, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì Ó¢ÚÔÚÔÛÙ·Û›· ÙÔ˘ ıÂÈÈÎÔ‡ Ì·ÁÓËÛ›Ô˘ (MgSO4) Ô˘ ¯ÔÚËÁÂ›Ù·È ÛÙȘ ÌËÙ¤Ú˜ ·˘Ù¤˜ (28). ∞fi ÌÂϤÙ˜, fï˜, Ô˘ ·ÊÔÚÔ‡Ó ÚÔÂÎÏ·Ì„›· ¯ˆÚ›˜ ¯ÔÚ‹ÁËÛË Ì·ÁÓËÛ›Ô˘, ÂÍ·ÎÔÏÔ˘ı› Ó· ÚÔ·ÙÂÈ ÌÂȈ̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÁÈ· ∂¶ (30). ªÂϤÙ˜ Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙ›ÛÂÈ ÙË ¯ÔÚ‹ÁËÛË MgSO4 Ì ÙËÓ ∂¶ ηٷϋÁÔ˘Ó Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË (7-10 ÊÔÚ¤˜) ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶ (26,31). ∞fi ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·˘ÙÒÓ Ê¿ÓËΠfiÙÈ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈÎÔ› Û˘Á¯˘ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜. ŒÙÛÈ, ÈÔ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ Ô˘ ¤Ï·‚·Ó ˘’ fi„ÈÓ ·˘ÙÔ‡˜ ÙÔ˘˜ Û˘Á¯˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‰ÂÓ Î·Ù·Ï‹ÁÔ˘Ó Û ÙfiÛÔ ·ÈÛÈfi‰ÔÍ· ·ÔÙÂϤÛÌ·Ù· (™∫=0,5-0,8) (27). ∆Ô ıÂÈÈÎfi Ì·ÁÓ‹ÛÈÔ, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, ¤¯ÂÈ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË (32). ∞ӷ̤ÓÔÓÙ·È ·ÔÙÂϤÛÌ·Ù· ·fi ÌÂϤÙ˜ Ù˘¯·ÈÔÔÈË̤Ó˜ ÔÏ˘ÎÂÓÙÚÈΤ˜ ÁÈ· ÙËÓ Èı·Ó‹ Ó¢ÚÔÚÔÛٷ٢ÙÈ΋ ‰Ú¿ÛË ÙÔ˘ Ì·ÁÓËÛ›Ô˘ ÛÙÔÓ ·ÓıÚÒÈÓÔ ÂÁΤʷÏÔ (33).

60

¶ÚÔÁÂÓÓËÙÈÎÔ›

50

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40

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2 ¶ÚfiˆÚ· (1) Î·È ÙÂÏÂÈfiÌËÓ· (2)

∂ÈÎfiÓ· 1. ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË

11

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·12

¶·È‰È·ÙÚÈ΋ 2002;65:9-15

∏ ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ϤÔÓ ÛËÌ·ÓÙÈÎÔ‡˜ Î·È ÎÔÈÓ¿ ·Ô‰ÂÎÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÎÏÈÓÈΤ˜ ·ÏÏ¿ Î·È ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜. O ™∫ Â›Ó·È ÂÚ›Ô˘ ‰ÈÏ¿ÛÈÔ˜ Î·È Î˘Ì·›ÓÂÙ·È ·fi 1,5 ̤¯ÚÈ 3 ÊÔÚ¤˜ (16,27,34). £ÂˆÚÂ›Ù·È fiÙÈ Ë ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ÂÓÂÚÁÔÔÈ› ÙÔÓ Î·Ù·ÚÚ¿ÎÙË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Î·È Ô‰ËÁ› Û ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÙÂÏÈο Û ÂÁÎÂÊ·ÏÈΤ˜ ‚Ï¿‚˜ Ô˘ ÚÔηÏÔ‡Ó ∂¶ (35). ∏ Û˘Ó‡·ÚÍË ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ·˜ Î·È ÂÌ‚Ú˘˚΋˜ ·ÁÁÂÈ›Ùȉ·˜ (¯ÔÚÈÔÓÈÓÈÎÒÓ Î·È ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ) ÙÂÎÌËÚȈ̤Ó˘ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈο, ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈÎfiٷٷ ÙÔÓ ™∫ (̤¯ÚÈ Î·È 11 ÊÔÚ¤˜) ÁÈ· ÂÚÈÎÔÈÏȷ΋ Ï¢ÎÔ̷ϷΛ· Î·È ∂¶ (36). πÛ¯˘Úfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ıˆÚÂ›Ù·È Ë ¯ÚfiÓÈ· ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ· (·ÚÔ‡Û· ·ÚÎÂÙ¿ ÚÈÓ ·fi ÙË Ú‹ÍË ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ) (37). ™ËÌ·ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÚÔ·ÙÔ˘Ó ·fi ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜. ∏ ÂÓ‰ÔÂÚÈÙÔÓ·˚΋ ¤Á¯˘ÛË ‚·ÎÙËÚȉȷÎÒÓ ÂÓ‰ÔÙÔÍÈÓÒÓ Û ÓÂÔÁ¤ÓÓËÙ· ÂÈÚ·Ì·Ùfi˙ˆ· Û˘Û¯ÂÙ›ÛÙËΠ̠‚Ï¿‚Ë Ù˘ Ï¢΋˜ Ô˘Û›·˜ (38). ∏ ˘Ô‰fiÚÈ· ¤Á¯˘ÛË ÂÓ‰ÔÙÔÍÈÓÒÓ E. coli Û ÓÂÔÁ¤ÓÓËÙ· ÂÈÚ·Ì·Ùfi˙ˆ·, Û˘Û¯ÂÙ›ÛÙËΠ̠‚Ï¿‚Ë ÙÔ˘ ÊÏÔÈÔ‡ Î·È Ù˘ Ï¢΋˜ Ô˘Û›·˜ (39) Î·È Ë ÚÔÁÂÓÓËÙÈ΋ Ïԛ̈ÍË ÂÁ·ˆÓ ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÚÔηÏ› ‚Ï¿‚Ë Ù˘ Ï¢΋˜ Ô˘Û›·˜ ÛÙ· ÓÂÔÁ¤ÓÓËÙ· (40). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ Û ·ÌÓÈ·Îfi ˘ÁÚfi, ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ ηıÒ˜ Î·È ÂÚÈÊÂÚÈÎfi ·›Ì· ÓÂÔÁÓÒÓ ¤¯ÂÈ ‰Â›ÍÂÈ ÛÙ·ıÂÚ‹ Û˘Û¯¤ÙÈÛË Ì ‚Ï¿‚˜ Ù˘ Ï¢΋˜ Î·È Ê·È¿˜ Ô˘Û›·˜. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ·˘ÍË̤ӷ Â›‰· Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-6 (IL-6) ÛÙÔ ·ÌÓÈ·Îfi ˘ÁÚfi (41) Î·È ÛÙÔ ·›Ì· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ (42) ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÚÈÎÔÈÏȷ΋˜ Ï¢ÎÔ̷ϷΛ·˜ Î·È ∂¶. ¡ÂÔÁÓ¿ Ì ·˘ÍË̤ӷ Â›‰· IL-6 ÔÌÊ¿ÏÈÔ˘ ·›Ì·ÙÔ˜ ¤¯Ô˘Ó ‰ÈÏ¿ÛÈ· ÓÔÛËÚfiÙËÙ· (Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÂÚÈÎÔÈÏȷ΋˜ Ï¢ÎÔ̷ϷΛ·˜ Î·È Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜) Û ۯ¤ÛË Ì ·˘Ù¿ Ô˘ ›¯·Ó ¯·ÌËÏ¿ Â›‰· (43,44). ∞ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ¯ÚÒÛË ÂÁÎÂÊ¿ÏˆÓ ÓÂÔÁÓÒÓ Ì ∂¶ ¤‰ÂÈÍ 60-80% ıÂÙÈÎfiÙËÙ· ÛÙÔÓ ÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· fiÁÎÔ˘ (TNF-a), ¤Ó·ÓÙÈ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Ô˘ ›¯·Ó 020% (45,46). ∏ ÚÔÁÂÓÓËÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂȉÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› fi¯È ÌfiÓÔ Ì ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ Ó¢ÌfiÓˆÓ, ·ÏÏ¿ Î·È Ì ÙË Ì›ˆÛË Ù˘ ÓÂÔÁÓÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ (47), ηıÒ˜ Î·È Ì ÙË Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë Î·È ∂¶. ∏ ÚÔÁÂÓÓËÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂȉÒÓ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÚfiÎÏËÛË ÂÚÈÎÔÈÏȷ΋˜ Ï¢ÎÔ̷ϷΛ·˜ (48,49). ∏ ÚÔÁÂÓÓËÙÈ΋ ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂȉÒÓ ‰Ú· ÚÔÛٷ٢ÙÈο, ÌÂÈÒÓÔÓÙ·˜ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ (™∫=0,7) (48).

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Paediatriki 2002;65:9-15

∏ ÚÔÛÙ·Û›· Ô˘ ·Ú¤¯ÂÙ·È ·fi Ù· ÎÔÚÙÈÎÔÂȉ‹ ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ Â˘¿ÏˆÙÔ ÂÌ‚Ú˘˚Îfi ÂÁΤʷÏÔ, ·Ô‰›‰ÂÙ·È Û ˆÚ›Ì·ÓÛË ÙˆÓ ÔÏÈÁÔ‰ÂÓ‰ÚÔ΢ÙÙ¿ÚˆÓ (46), Û ¿ÌÂÛË ÚÔÛÙ·Û›· ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Û ‚ÂÏÙ›ˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ ·fi ˘ÔÍ·ÈÌ›·-ÈÛ¯·ÈÌ›· (50,51) ηÈ, Ù¤ÏÔ˜, Û ·Ó·ÛÙÔÏ‹ ÙÔ˘ ηٷÚÚ¿ÎÙË ÙˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ (35,52,53). ∆Ô Ï‹Ú˜ Û¯‹Ì· ÎÔÚÙÈÎÔÂȉÒÓ ˘ÂÚÙÂÚ› ¤Ó·ÓÙÈ ÙÔ˘ ·ÙÂÏÔ‡˜ Î·È ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·, ÂÚÈÎÔÈÏȷ΋ Ï¢ÎÔ̷ϷΛ· Î·È ˘‰ÚÔÎÂÊ¿ÏÔ˘, ¤Ó·ÓÙÈ ÙÔ˘ ·ÙÂÏÔ‡˜ Û¯‹Ì·ÙÔ˜ (49). ™ËÌÂÈÒÓÔÓÙ·È, fï˜, ÔÈ Èı·ÓÔ› ΛӉ˘ÓÔÈ ·fi ÔÏÏ·Ϥ˜ ‰fiÛÂȘ, fiˆ˜ Ë ·‡ÍËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Ïԛ̈͢ Û ·Ú·ÙÂٷ̤ÓË Ú‹ÍË ı˘Ï·Î›Ô˘, ¯ˆÚ›˜ ¢ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÛÙÔÓ ÂÁΤʷÏÔ (54) Î·È Ë Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È Î·Ù’ Â¤ÎÙ·ÛË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (55). µ. ¶ÂÚÈÁÂÓÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ I. ª·È¢ÙÈÎÔ› ∏ ·ÔÎfiÏÏËÛË ÙÔ˘ Ï·ÎÔ‡ÓÙ· Ô‰ËÁ› Û Ï·ÎÔ˘ÓÙȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È ÙÂÏÈο Û ˘ÔÍ›· Î·È ÔͤˆÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘. ∏ ·ÔÎfiÏÏËÛË ÙÔ˘ Ï·ÎÔ‡ÓÙ· ·ÔÙÂÏ› ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶ (™∫=1,6-2,5) (3,16,20,34). ∆Ô Â›‰Ô˜ ÙÔ˘ ÙÔÎÂÙÔ‡ ∂õ°¡ Î·È Ë Û˘Û¯¤ÙÈÛË ·˘ÙÔ‡ Ì ÙËÓ ∂¶ ‰›ÓÂÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Û Â›ÁÔ˘Û· ∫∆, ÂÓÒ Ë ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ∫∆ ıˆÚÂ›Ù·È fiÙÈ ·ÔÙÂÏ› ÙÔÓ ϤÔÓ ·ÛÊ·Ï‹ Î·È ÎÔÈÓ¿ ·Ô‰ÂÎÙfi ÙÚfiÔ Ì·›Â˘Û˘ Ù¤ÙÔÈˆÓ ÓÂÔÁÓÒÓ (3).

O ÛËÌ·ÓÙÈÎfiÙÂÚÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ì·›Â˘ÛË Î·È ÙËÓ ∂¶ Â›Ó·È Ô ÙfiÔ˜ Ì·›Â˘Û˘. O ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÙ·È, ¤ˆ˜ Î·È 6 ÊÔÚ¤˜, fiÙ·Ó Ë Ì·›Â˘ÛË ‰ÈÂÓÂÚÁÂ›Ù·È Û ÌË ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ÁÈ· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù· ΤÓÙÚÔ (34). ∆Ô ‰Â‰Ô̤ÓÔ ·˘Ùfi Û˘Ì›ÙÂÈ Ì ÙË ¯·ÌËÏfiÙÂÚË ıÓËÛÈÌfiÙËÙ· ÙˆÓ ∂õ°¡ Û ÙÚÈÙÔ‚¿ıÌÈ· ¡ÔÛÔÎÔÌ›·.

II. ¡ÂÔÁÓÈÎÔ› ∏ ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶ (™∫=2,5). ∏ ∞ÌÂÚÈοÓÈÎË ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· (56) ÔÚ›˙ÂÈ ˆ˜ ·ÛÊ˘Í›· ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙËÓ ÔÔ›· ·Ó¢ڛÛÎÔÓÙ·È Ù· οوıÈ ‚ÈÔ¯ËÌÈο Î·È ÎÏÈÓÈο Â˘Ú‹Ì·Ù·: ·) ™Ô‚·Ú‹ ÌÂÙ·‚ÔÏÈ΋ ‹ ÌÈÎÙ‹ ÔͤˆÛË Ì pH <7, Û ‰Â›ÁÌ· ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ Ï·Ì‚·ÓfiÌÂÓÔ˘ ·fi ÙÔÓ ÔÌÊ¿ÏÈÔ ÏÒÚÔ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ‚) ¶·Ú·ÌÔÓ‹ ÙÔ˘ Apgar score <3 ÁÈ· ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· >5 min. Á) ∫ÏÈÓÈΤ˜ Ó¢ÚÔÏÔÁÈΤ˜ ‚Ï¿‚˜ ÛÙËÓ ¿ÌÂÛË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (Û·ÛÌÔ›, ˘ÔÙÔÓ›·, ÎÒÌ· ‹ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·). ‰) ∂ÌÊ·Ó‹˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ¿ÏÏˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÛÙËÓ ¿ÌÂÛË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô.

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∆Ô ¯·ÌËÏfi Apgar score ÛÙ· 5 min Î·È ¤Ú·Ó ·˘ÙÒÓ Â›Ó·È ¤Ó·˜ Û·Ê‹˜ ÂÈ‚·Ú˘ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙËÓ ÚfiÎÏËÛË ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘. ∆Ô Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (™∞¢) ‰ÂÓ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ (™∫=1,3-2,1) (34,57). ∆· ÓÂÔÁÓ¿, fï˜, Ì ·Ó¿ÁÎË Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ (™∫=2,5-10,1) (15). O ΛӉ˘ÓÔ˜ ·˘Í¿ÓÂÙ·È fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂÈÏÔΤ˜ ÙÔ˘ ™∞¢ Î·È È‰›ˆ˜ ÛÙÔÓ Ó¢ÌÔıÒڷη (™∫=2,2-5). ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙ· ÓÂÔÁÓ¿ Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ù‡Ô˘ π ‰ÂÓ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ (™∫=0,4-1,1) (15,58). ∏ ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ (ö¡), ÂÈÏÔ΋ ÙÔ˘ ™∞¢, ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ (™∫=1,1-5,3) (15,59,60). ∂ÓÒ Ë Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË ‰ÂÍ·ÌÂı·˙fiÓ˘ ÌÂÈÒÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ö¡, ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ·˘Ù‹ ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ (61). π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ· ∂¶ ÛÙ· ÙÂÏÂÈfiÌËÓ· Î·È ÔÚȷο ÚÔÒÚ· ÓÂÔÁÓ¿ (™∫=5,2), ÂÓÒ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿ (<34 ‚‰ÔÌ¿‰ˆÓ) ‰ÂÓ ÈÛ¯‡ÂÈ ·˘Ùfi (™∫<1) (62). ª›· Èı·Ó‹ ÂÚÌËÓ›· ·˘ÙÔ‡ ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Â›Ó·È fiÙÈ Ù· ÚfiˆÚ· Ì ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ÓÂÔÁÓ¿ Û˘Ó‹ıˆ˜ ÁÂÓÓÈÔ‡ÓÙ·È ·fi ÌËÙ¤Ú˜ Ì ÚÔÂÎÏ·Ì„›· (63), Ë ÔÔ›· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ∂¶ (3,15,16,26,27). ∏ ÓÂÔÁÓÈ΋ ÛË„·ÈÌ›· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ∂¶ (™∫=2,2-4) (34,57). ∏ ÔͤˆÛË, Ë ˘ÔÁÏ˘Î·ÈÌ›· Î·È Ë ˘fiÙ·ÛË Û˘¯Ó¿ Û˘ÓÔ‰Â‡Ô˘Ó ÙË ÓÂÔÁÓÈ΋ ÛË„·ÈÌ›· Î·È Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË Û˘Û¯¤ÙÈÛË ·˘Ù‹˜ Ì ÙËÓ ∂¶. ™ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜ Ù· ∂õ°¡ ¤¯Ô˘Ó ¯·ÌËÏ¿ Â›‰· ı˘ÚÔ͛Ӣ Û ۯ¤ÛË Ì ٷ ÙÂÏÂÈfiÌËÓ·. ∏ ηٿÛÙ·ÛË ·˘Ù‹ ·Ó·Ê¤ÚÂÙ·È ˆ˜ ·ÚÔ‰È΋ ˘Ôı˘ÚÔÍÈÓ·ÈÌ›· (64). ¶·Ú¿ ÙÔ fiÙÈ ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ıÂÚ·›· ˘ÔηٿÛÙ·Û˘, ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ˘Ôı˘ÚÔÍÈÓ·ÈÌ›· ÌÔÚ› Ó· ÌËÓ Â›Ó·È Î·ÏÔ‹ı˘ Î·È Û ÌÂϤÙË Ì ∂õ¡ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ∂¶ (65). ∏ ı˘ÚÂÔÂȉÈ΋ ÔÚÌfiÓË ÚÔ¿ÁÂÈ ÙËÓ ˆÚ›Ì·ÓÛË ÙˆÓ ÔÏÈÁÔ‰ÂÓ‰ÚÈÙÒÓ, ÔÈ ÔÔ›ÔÈ Â›Ó·È ˘‡ı˘ÓÔÈ ÁÈ· ÙËÓ ·Ú·ÁˆÁ‹ Ù˘ Ì˘ÂÏ›Ó˘. ∂›Ó·È ÁÓˆÛÙ‹ Ë Û˘Û¯¤ÙÈÛË Ù˘ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜ ÏfiÁˆ ·ÈÌfiÏ˘Û˘ Î·È Ù˘ ·ıÂÙˆÛÈ΋˜ ∂¶ (66). ∏ ÎÏÈÓÈ΋ Û˘Ó‰ÚÔÌ‹, Ë ÔÔ›· Û‹ÌÂÚ· ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ·fi ¯ÔÏÂÚ˘ıÚ›ÓË, ‰ÂÓ ·ÊÔÚ¿ ϤÔÓ ÙfiÛÔ Û˘¯Ó¿ Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿, fiÛÔ Ù· ÚfiˆÚ·. ∆Ô ÂχıÂÚÔ ÎÏ¿ÛÌ· Ù˘ ¤ÌÌÂÛ˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ‰È¤Ú¯ÂÙ·È ÂχıÂÚ· ÙÔÓ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎfi ÊÚ·ÁÌfi Î·È Â›Ó·È ˘‡ı˘ÓÔ ÁÈ·

Paediatriki 2002;65:9-15

ÙËÓ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·. O ΛӉ˘ÓÔ˜ ÁÈ· ∂¶ Û ÓÂÔÁÓ¿ Ì ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ·˘Í¿ÓÂÙ·È ÙfiÛÔ, fiÛÔ ˘„ËÏfiÙÂÚ· Â›‰· ¯ÔÏÂÚ˘ıÚ›Ó˘ ¤¯Ô˘Ó (67). ÿÛˆ˜ Ù· Â›‰· Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ ‚·›ÓÔ˘Ó ·Ó¿ÏÔÁ· Ì ÙÔ ‚·ıÌfi Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ‹ Ë ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ηıÈÛÙ¿ ÙÔÓ ÂÁΤʷÏÔ Â˘¿ÏˆÙÔ ÛÙË Ó¢ÚÔÙÔÍÈ΋ ‰Ú¿ÛË Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘. ™˘ÌÂÚ¿ÛÌ·Ù· OÈ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙˆÓ EXB°N, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ∂¶, ‰ÂÓ ÔÊ›ÏÔÓÙ·È Û Í¯ˆÚÈÛÙÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ·ÏÏ¿ ·ÔÙÂÏÔ‡Ó ¤Ó· ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÔÈÎ›ÏˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ‰ÚÔ˘Ó Û ‰È·ÊÔÚÂÙÈÎfi ÛÙ¿‰ÈÔ Ù˘ ·Ó¿Ù˘Í˘. ™ÙÔ Ì¤ÏÏÔÓ ı· Ú¤ÂÈ Ó· ‰Ôı› ‚·Ú‡ÙËÙ· ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ Î·È ÛÙËÓ Î·Ù¿ ÙÔ ‰˘Ó·ÙfiÓ ÚfiÏË„Ë ·˘ÙÔ‡. ∂Âȉ‹ Ë ÚfiÏË„Ë Ù˘ ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ·˜ ‰ÂÓ Â›Ó·È Èı·Ó‹ ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ, ı· Ú¤ÂÈ Ó· ‰Ôı› ¤ÌÊ·ÛË ÛÙË Ì›ˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì Ó¢ÚÔÏÔÁÈ΋ ‚Ï¿‚Ë ·fi ÙËÓ ÏÂ˘Ú¿ ÙÔ˘ ÓÂÔÁÓÔ‡, fiˆ˜ Ë ÛË„·ÈÌ›· (68). ∆ÔÓ›˙ÂÙ·È fiÙÈ Û fiϘ ÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Ì ·˘Í·ÓfiÌÂÓÔ ·ÚÈıÌfi ˘ÁÈÒÓ ·È‰ÈÒÓ, ·ÏÏ¿ Û˘Á¯ÚfiÓˆ˜ Î·È ·‡ÍËÛË Ù˘ ÔÌ¿‰·˜ Ì ‚·Ú›· ÌÂÈÔÓÂÍ›·. ÃÚ¤Ô˜ ÙˆÓ ÊÔÚ¤ˆÓ ÀÁ›·˜ ·ÔÙÂÏ› Ë ‰ËÌÈÔ˘ÚÁ›· ˘Ô‰ÔÌ‹˜ ÁÈ· ÙËÓ ÔÈÎÔÓÔÌÈ΋ Î·È ÎÔÈÓˆÓÈ΋ ÂÓ›Û¯˘ÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Little WJ. On the influence of abnormal parturition, difficult labor, premature birth and asphyxia neonatorum on the mental and physical condition of the child especially in relation to deformities. Trans Obstet Soc Lond 1862;3:293344.

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3. Deidre J, Sellers S, MacKenzie JZ, Yadkin PL, Johnson AM. Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies.

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4. Cummins SK, Nelson KB, Gether JK. Cerebral palsy in four northern California counties, births 1983 through 1985. J Pediatr 1993;123:230-237.

5. O’ Stee TM, Dammann O. Antecedents of cerebral palsy in VLBW infants. Clin Perinatol 2000;27:285-300.

6. ¶ÂÙÚ›‰Ô˘ ∂. ªÂıÔ‰ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂȉËÌÈÔÏÔÁÈ΋ ıÂÒÚËÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘. ¶·È‰È·ÙÚÈο ÃÚÔÓÈο 1992;19:53-58.

7. Brand R, Kragt H. Importance of trends in the interpretation of an overall odds ratio in the meta-analysis of clinical trials.

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8. ∆ÚȯfiÔ˘ÏÔ˜ ¢. ∞Ó¿Ï˘ÛË ÔÈÔÙÈÎÒÓ ‰Â‰Ô̤ӈÓ. ™Â: ∆ÚȯfiÔ˘ÏÔ˜ ¢. π·ÙÚÈ΋ ™Ù·ÙÈÛÙÈ΋. 1Ë ¤Î‰ÔÛË. ∞ı‹Ó·: ¶·ÚÈÛÈ¿ÓÔ˜; 1975. ÛÂÏ. 78.

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Pediatrics 1998;102:315-322.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-05-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: πˆÛ‹Ê ∫·Ï¤ÁÈ·˜ Õıˆ 31 & øÚˆÔ‡, 242 24, ¶¿ÙÚ· E-mail: kaleyias@hotmail.com

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REVIEW ARTICLE

™‡Ó‰ÚÔÌÔ Brugada ™. ª¿Ú·Î·, ∞. ∆ÛÈÏÈÌÈÁοÎË

Brugada syndrome S. Maraka, A. Tsilimigaki

¶ÂÚ›ÏË„Ë: ∆Ô Û‡Ó‰ÚÔÌÔ Brugada ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÔÎÏÂÈÛÌfi ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜, ·Ó¿Û·ÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ST Î·È ÂÂÈÛfi‰È· Û˘ÁÎÔ‹˜ ‹ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÂÍ·ÈÙ›·˜ ÔχÌÔÚÊ˘ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ ‹ ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Û ·ÛıÂÓ›˜ ¯ˆÚ›˜ ˘ÔΛÌÂÓË Î·Ú‰È·Î‹ ÓfiÛÔ. ¶ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1992 ·fi ÙÔ˘˜ Brugada Î·È Brugada. ∞fi ÙfiÙÂ, Ô ·ÚÈıÌfi˜ ÙˆÓ Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ ·ÁÎÔÛÌ›ˆ˜ ¤¯ÂÈ ·˘ÍËı› Î·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 200 ÂÚÈÙÒÛÂȘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ̤¯ÚÈ Û‹ÌÂÚ·. OÈ ·ÛıÂÓ›˜ Â›Ó·È Î˘Ú›ˆ˜ ¿Ó‰Ú˜ Î·È ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·ÚÚ˘ıÌ›·˜ Û˘Ì‚·›ÓÂÈ ÂÚ›Ô˘ ÛÙËÓ Ù¤Ù·ÚÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. ¶·Ú’ fiÏ· ·˘Ù¿, ÙÔ Û‡Ó‰ÚÔÌÔ ı· Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È Î·È ˆ˜ ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿, ·ÎfiÌ· Î·È ÛÙ· ‚Ú¤ÊË. ∞˘ÙÔۈ̷ÙÈÎfi˜ ÂÈÎÚ·ÙÒÓ Ù‡Ô˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ¤¯ÂÈ ÙÂÎÌËÚȈı› Û ·ÚÎÂÙ¤˜ ÔÈÎÔÁ¤ÓÂȘ ·ÛıÂÓÒÓ. ™Â ·ÚÎÂÙÔ‡˜ ·ÛıÂÓ›˜ ¤¯Ô˘Ó ·Ó·ÁÓˆÚÈÛÙ› ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ SCN5A ÁÔÓ›‰ÈÔ, ˘‡ı˘ÓÔ ÁÈ· ÙÔ Î·Ó¿ÏÈ Na+ Ù˘ ηډȿ˜. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ Ì ʿÚ̷η, fiˆ˜ ÔÈ ‚-·Ó·ÛÙÔÏ›˜ Î·È Ù· ·ÓÙÈ·ÚÚ˘ıÌÈο, ‰ÂÓ ÚÔÛٷهÂÈ ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·ÚÚ˘ı̛˜. ∏ ÂÌʇÙ¢ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹ ·ÔÙÂÏ› ÙËÓ ÂÓ‰ÂÈÎÓ˘fiÌÂÓË Î·È ÙËÓ ϤÔÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÁÈ· ÙËÓ ÚfiÏË„Ë ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘.

Abstract: The Brugada syndrome is characterized by a right bundle branch block, ST segment elevation in the precordial leads V1 to V3, and episodes of syncope or sudden death caused by rapid polymorphic ventricular arrhythmias /ventricular fibrillation in patients with a structurally normal heart. It was first reported in 1992 by Brugada and Brugada. Since then, the number of cases indentified worldwide have increased, with more than 200 cases of Brugada syndrome reported up to date. The patients are mostly male and demonstrate their first arrhythmic event around the fourth decade. Nevertheless, the syndrome should also be considered as a cause of unexplained sudden cardiac death in children and even in infants. Systematic family studies have demonstrated an autosomal dominant inheritance pattern in many cases. Mutations in SCN5A, a gene encoding the cardiac sodium channel, have been detected in several patients. Pharmacological treatment with beta-adrenergic agents and anti-arrhythmic drugs does not protect effectively against recurrent arrhythmias. The implantation of a cardioverter-defibrillator constitutes the only effective therapy for the prevention of sudden death.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Brugada, ·ÈÊÓ›‰ÈÔ˜ ηډȷÎfi˜ ı¿Ó·ÙÔ˜, Û‡Ó‰ÚÔÌÔ ·ÔÎÏÂÈÛÌÔ‡ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜ Î·È ·Ó¿Û·Û˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜.

Key words: Brugada syndrome, sudden cardiac death, right bundle branch block - ST elevation syndrome.

∂ÈÛ·ÁˆÁ‹ ∏ ηډȷ΋ ·Ó·ÎÔ‹ ÂÍ·ÈÙ›·˜ ÎÔÈÏȷ΋˜ ·ÚÚ˘ıÌ›·˜ ·ÔÙÂÏ› ¤Ó· ‰Ú·Ì·ÙÈÎfi ÁÂÁÔÓfi˜ Ô˘

··ÈÙ› ÙËÓ Ï‹ÚË Î·È ÂÎÙÂÓ‹ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÂÓfi˜ ˘ÔΛÌÂÓÔ˘ ηډȷÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ ‹ Ì›·˜ ‰ÔÌÈ΋˜ ·ÓˆÌ·Ï›·˜

µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ µÂÓÈ˙¤ÏÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘

B’ Pediatric Clinic Venizelion Hospital, Heraklion, Crete

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¶·È‰È·ÙÚÈ΋ 2002;65:16-22

Ù˘ ηډȿ˜, fiˆ˜ Â›Ó·È ÔÈ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Î·È Ë Ì˘ÔηډÈÔ¿ıÂÈ·. ¶¿ÓÙˆ˜, ÛÙÔ 5-10% ÙˆÓ ÂÈ˙ÒÓÙˆÓ ‰ÂÓ ·Ó¢ڛÛÎÂÙ·È Î·Ì›· ·ÈÙ›· Î·È ÙÔ ÂÂÈÛfi‰ÈÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÚˆÙ·Ú¯È΋ ËÏÂÎÙÚÈ΋ ÓfiÛÔ˜ ‹ ȉÈÔ·ı‹˜ ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ (1,2). ∞˘Ù‹ Ë ‰È¿ÁÓˆÛË ˘Ô‰ËÏÒÓÂÈ fiÙÈ ÙÔ ·ÚÚ˘ıÌÈÔÁÂÓ¤˜ ˘fiÛÙڈ̷ Â›Ó·È Û˘ÁÁÂÓ¤˜ Î·È ·ÊÔÚ¿ ÙÔ ÂÚÂıÈÛÌ·Ù·ÁˆÁfi Û‡ÛÙËÌ· Ù˘ ηډȿ˜. ¶·Ú¿‰ÂÈÁÌ· ÚˆÙ·Ú¯È΋˜ ËÏÂÎÙÚÈ΋˜ ÓfiÛÔ˘ ·ÔÙÂÏ› ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ Ì·ÎÚÔ‡ QT ‰È·ÛÙ‹Ì·ÙÔ˜, ÛÙÔ ÔÔ›Ô ÌÂÙ·ÏÏ¿ÍÂȘ Û ÁÔÓ›‰È· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ‚·ÛÈΤ˜ ÚˆÙ½Ó˜ ÙˆÓ ‰È·‡ÏˆÓ Ó·ÙÚ›Ô˘ Î·È Î·Ï›Ô˘ Ù˘ ηډȿ˜ ‰È·ÊÔÚÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ‰È·‡ÏˆÓ ·˘ÙÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÌ‹Î˘ÓÛË ÙÔ˘ QT ‰È·ÛÙ‹Ì·ÙÔ˜ (3). ∆Ô 1992, ÔÈ Brugada Î·È Brugada ÂÚȤÁÚ·„·Ó 8 ·ÛıÂÓ›˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ 3 ·È‰ÈÒÓ, Ì ÂÂÈÛfi‰È· Û˘ÁÎÔ‹˜ ‹ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÂÍ·ÈÙ›·˜ ÔχÌÔÚÊ˘ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜ Î·È ·Ô˘Û›· ÔÔÈ·Û‰‹ÔÙ ‰ÔÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘. ∆Ô ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· (∏∫°) ηٿ ÙË ‰È¿ÚÎÂÈ· ÊÏÂÌ‚ÔÎÔÌ‚ÈÎÔ‡ Ú˘ıÌÔ‡ ¤‰ÂȯÓ ·ÔÎÏÂÈÛÌfi ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜ Î·È ·Ó¿Û·ÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ ST ÛÙȘ ‰ÂÍȤ˜ ÚÔοډȘ ··ÁˆÁ¤˜ V1, V2 Î·È V3, Ô˘ ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· ·Ô‰ÔıÔ‡Ó Û ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÈÛ¯·ÈÌ›· ‹ ‰ÔÌÈ΋ ηډȷ΋ ÓfiÛÔ. ∆Ô QT ‰È¿ÛÙËÌ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ™Â 4 ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ‡ÔÙÔ (4). ∞fi ÙÔ 1992, Ô ·ÚÈıÌfi˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È ·ÁÎÔÛÌ›ˆ˜ Ì ·˘Ù¿ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Í¿ÓÂÙ·È Û˘Ó¯Ҙ Î·È Ë ÓfiÛÔ˜ ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ Û‡Ó‰ÚÔÌÔ Brugada. ŸÏ˜ ÔÈ ‰ËÌÔÛȇÛÂȘ ÂȂ‚·ÈÒÓÔ˘Ó ÙÔÓ Î·ÎÔ‹ıË ¯·Ú·ÎÙ‹Ú· ·˘ÙÔ‡ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÚÔηÏ› ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ ·ÎfiÌ· Î·È Û ÚÔËÁÔ˘Ì¤Óˆ˜ ·Û˘Ìو̷ÙÈο ¿ÙÔÌ· (5). ¢ÂÓ Â›Ó·È ·ÎfiÌ· ۷ʤ˜ Â¿Ó ÙÔ Û‡Ó‰ÚÔÌÔ Brugada Î·È Ë È‰ÈÔ·ı‹˜ ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ ·ÔÙÂÏÔ‡Ó ÙËÓ ›‰È· ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ·. ™Â Ì›· ÌÂϤÙË ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó Ù· ∏∫° ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÛÙÔ 21% ÙˆÓ ·ÛıÂÓÒÓ Ì ȉÈÔ·ı‹ ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ (6). ∏ ÌË ‰È¿ÁÓˆÛË, fï˜, ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada Û ¤Ó·Ó Û˘Ìو̷ÙÈÎfi ·ÛıÂÓ‹ Î·È Ë ıÂÒÚËÛË fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ȉÈÔ·ı‹ ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹, Â›Ó·È È‰È·›ÙÂÚ· ÂÈ‚Ï·‚‹˜, ·ÊÔ‡ ÂÓ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÌË ÂϤÁ¯Ô˘ ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÁÈ· ÙËÓ ‡·ÚÍË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (7). ∆Ô ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Û˘ÓËÁÔÚ› ˘¤Ú Ù˘ ÎÏËÚÔÓÔÌÈ΋˜ ‚¿Û˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada Î·È Ì¿ÏÈÛÙ· Ì ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· Ù‡Ô ÌÂÙ·‚›‚·Û˘ ÛÙÔ 30% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛˆÓ, ÂÓÒ ÛÙÔ 20% Ô Ù‡Ô˜ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙÔ˜. ∆Ô ˘fiÏÔÈÔ 50% ·ÔÙÂÏ›

Paediatriki 2002;65:16-22

ÛÔÚ·‰ÈΤ˜ ÂÚÈÙÒÛÂȘ, Û˘ÓÈÛÙÒÓÙ·˜ “de novo” ÌÂÙ·ÏÏ¿ÍÂȘ (7,8). ªÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ SCN5A ÁÔÓ›‰ÈÔ, ˘‡ı˘ÓÔ ÁÈ· ÙÔ Î·Ó¿ÏÈ Na+ Ù˘ ηډȿ˜, ¤¯Ô˘Ó ·ÓȯÓ¢Ù› Û ·ÚÎÂÙ¤˜ ÔÈÎÔÁ¤ÓÂȘ. ™Â ÌÂϤÙË 52 ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Brugada, ‚Ú¤ıËÎ·Ó ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ SCN5A ÁÔÓ›‰ÈÔ ÌfiÓÔ ÛÙÔ 15% ÙˆÓ ÂÚÈÙÒÛˆÓ, ˘Ô‰ËÏÒÓÔÓÙ·˜ fiÙÈ ˘¿Ú¯ÂÈ ÁÂÓÂÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙÔ Û‡Ó‰ÚÔÌÔ (9). ∂ÂÎÙ›ÓÔÓÙ·˜ ÙÔÓ ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô Î·È ÙËÓ ·Ó¿Ï˘ÛË ÙÔ˘ DNA Û ̤ÏË ÔÈÎÔÁÂÓÂÈÒÓ ·ÛıÂÓÒÓ Ì ÌÂÙ¿ÏÏ·ÍË ÛÙÔ SCN5A ÁÔÓ›‰ÈÔ, ÙÂÎÌËÚÈÒıËÎÂ Ë ·ÙÂÏ‹˜ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ì ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË ÌfiÓÔ ÛÙÔ 12,5% Û ‰‡Ô ·fi ·˘Ù¤˜ ÙȘ ÔÈÎÔÁ¤ÓÂȘ (9). ∞Ó Î·È ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·ÚÚ˘ıÌ›·˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›Ô˘ ÙËÓ 4Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜, ÙÔ Û‡Ó‰ÚÔÌÔ Brugada Ú¤ÂÈ Ó· ıˆÚÂ›Ù·È ˆ˜ Ì›· ·ÈÙ›· ·ÓÂÍ‹ÁËÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ Î·È ÛÙ· ·È‰È¿, ·ÎfiÌ· Î·È ÛÙ· ‚Ú¤ÊË (10-12). ∂ȉËÌÈÔÏÔÁÈο ‰Â‰Ô̤ӷ ™Â Û˘ÁÎÂÓÙÚˆÙÈ΋ ÌÂϤÙË 163 ·ÛıÂÓÒÓ (3) Ô˘ ÏËÚÔ‡Û·Ó Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada, Ë ÂÈÎÚ¿ÙËÛË ÙˆÓ ·ÚÚ¤ÓˆÓ ‹Ù·Ó >90%, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ÂÈÎÚ¿ÙËÛË ÙˆÓ ıËϤˆÓ ·ÛıÂÓÒÓ ÛÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ Ì·ÎÚÔ‡ QT ‰È·ÛÙ‹Ì·ÙÔ˜. ∆Ô˘Ï¿¯ÈÛÙÔÓ ÙÔ 58% ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ·ÛÈ·ÙÈ΋˜ ηٷÁˆÁ‹˜. ∏ ̤ÛË ËÏÈΛ· ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·ÚÚ˘ıÌ›·˜ Î˘Ì·ÈÓfiÙ·Ó ·fi 22 ¤ˆ˜ 65 ¤ÙË. ∏ ηٷÓÔÌ‹ ÙˆÓ ËÏÈÎÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·˙ ·È¯Ì‹ ÂÚ›Ô˘ ÙËÓ 4Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜ Ì ‡ÚÔ˜ 2-77 ¤ÙË. ™ÙÔ 22% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ıÂÙÈÎfi ÁÈ· Û˘ÁÎÔ‹, ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ ‹ ·ÈÊÓ›‰ÈÔ Î·Ú‰È·Îfi ı¿Ó·ÙÔ. ™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜, ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ÂχıÂÚÔ (3). ∆· ȉÈfiÌÔÚÊ· ∏∫° ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› (1,3) Û ̛· ηÙËÁÔÚ›· ∆·˚Ï·Ó‰ÒÓ ·Ó‰ÚÒÓ, Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ηډȷ΋ ·Ó·ÎÔ‹ ÂÍ·ÈÙ›·˜ ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜. ∏ ÂÙ‹ÛÈ· ıÓËÙfiÙËÙ· Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ·ÛıÂÓÒÓ ˘ÔÏÔÁ›˙ÂÙ·È Û 26-38 ı·Ó¿ÙÔ˘˜ ·Ó¿ 100.000 ÏËı˘ÛÌfi. ™ÙË ÓÔÙÈÔ·Ó·ÙÔÏÈ΋ ∞Û›·, ÙÔ Û‡Ó‰ÚÔÌÔ Brugada ·ÔÙÂÏ› ÙË Û˘¯ÓfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ Û ӤԢ˜ ¿Ó‰Ú˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ™ÙÔ 40% ·˘ÙÒÓ ÙˆÓ ·ÛıÂÓÒÓ ˘¿Ú¯ÂÈ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ (1,3). ™ÙËÓ π·ˆÓ›·, ∏∫° Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÂÌÊ·Ó›˙ÂÈ ÙÔ 0,05% ÙÔ˘ ÏËı˘ÛÌÔ‡ (13). §›Á˜ ·Ó·ÊÔÚ¤˜ ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο Ì ÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÛÙËÓ ∂˘ÚÒË. Ÿˆ˜ Î·È Ì ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ Ì·ÎÚÔ‡ QT, Ë Â›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÂÎÙÈÌ¿Ù·È Û 20

17

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·18

¶·È‰È·ÙÚÈ΋ 2002;65:16-22

ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌfi (10). §›Á· ÛÙÔȯ›· ˘¿Ú¯Ô˘Ó, Â›Û˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ ÛÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi ÂÍ·ÈÙ›·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∆Ô Û‡Ó‰ÚÔÌÔ Brugada ÌÔÚ› Ó· ·ÔÙÂÏ› ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿ ·ÎfiÌ· Î·È Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜, fiÔ˘ ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ Û‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ (10-12). Œ¯ÂÈ ÂÚÈÁÚ·Ê› (10) Ë ·ÚÔ‰È΋ ÂÌÊ¿ÓÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÛÙÔ ∏∫° Û ¤Ó· ÎÔÚ›ÙÛÈ 14 ÌËÓÒÓ, ÛÙÔ ÔÔ›Ô ÌÂÙ¿ ÙËÓ ·Ó¿Ù·ÍË ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜, Ù¤ıËÎÂ Ë ˘Ô„›· ÁÈ· ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÙfiÛÔ Û ·˘Ù‹ ÙËÓ ·ÛıÂÓ‹ fiÛÔ Î·È Û ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ Ù˘. O ÊÏÂÌ‚ÔÎÔÌ‚ÈÎfi˜ Ú˘ıÌfi˜ Û ·˘Ùfi ÙÔ ÎÔÚ›ÙÛÈ ·ÔηٷÛÙ¿ıËΠÌÂÙ¿ ·fi ËÏÂÎÙÚÈ΋ ·Ó¿Ù·ÍË, ·ÏÏ¿ ÚÔÎÏ‹ıËΠÌfiÓÈÌË ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∆Ô QT ‰È¿ÛÙËÌ· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi, ÂÓÒ ·ÔÎÏ›ÛÙËÎÂ Ë ·ÚÔ˘Û›· ‰ÔÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘. ¢‡Ô ·‰ÂÏʤ˜ Ù˘ ·ÛıÂÓÔ‡˜ ¤ı·Ó·Ó Í·ÊÓÈο Û ËÏÈΛ· 2 ÌËÓÒÓ Î·È 3 ÂÙÒÓ. ŒÓ·˜ ·‰ÂÏÊfi˜ Ù˘ ÌËÙ¤Ú·˜ ¤ı·Ó ·ÈÊÓ›‰È· Û ËÏÈΛ· 14 ÌËÓÒÓ, fiˆ˜ Î·È ¤Ó· ·ÁfiÚÈ 12 ÌËÓÒÓ, ·È‰› Ù˘ ÂÙÂÚÔı·ÏÔ‡˜ ·‰ÂÏÊ‹˜ Ù˘ ÌËÙ¤Ú·˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÂȂ‚·ÈÒıËΠ·fi ÙËÓ ·Ó·ÁÓÒÚÈÛË ÌÂÙ¿ÏÏ·Í˘ ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ ηӷÏÈÔ‡ Na+ ÛÙÔ ÚÔۂ‚ÏË̤ÓÔ ·È‰›, ÛÙË ÌËÙ¤Ú· ÙÔ˘, ÛÙËÓ ÂÙÂÚÔı·Ï‹ ·‰ÂÏÊ‹ Ù˘ ÌËÙ¤Ú·˜ Î·È Û ¤Ó· ·Û˘Ìو̷ÙÈÎfi ÂÙ¿¯ÚÔÓÔ ·È‰› Ù˘ ÙÂÏÂ˘Ù·›·˜. O ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Û ·˘Ù‹ ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÚÔÎÏ‹ıËΠ·fi ¤Ó·Ó ·Û˘Ó‹ıË Ù‡Ô ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ì ÂÍ·ÈÚÂÙÈο ÛÔ‚·Ú‹ ÂΉ‹ÏˆÛË ÛÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ· (10). ¶ÂÚÈÁÚ¿ÊÂÙ·È, Â›Û˘, Ë ÂÚ›ÙˆÛË ÂÓfi˜ ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜ ËÏÈΛ·˜ 6 ÌËÓÒÓ ·fi ÙËÓ π·ˆÓ›· (12) Ì ¤Ó· ηÎÔ‹ıË Ù‡Ô ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada, ÙÔ ÔÔ›Ô ÂÌÊ¿ÓÈ˙Â Û˘¯Ó¿ ÂÂÈÛfi‰È· ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Î·È ·ÓıÈÛÙ¿ÌÂÓ˘ ÔχÌÔÚÊ˘ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜, ȉȷ›ÙÂÚ· ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ¶ÚÔÛÎÔÌ›ÛÙËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÂÂÈÛÔ‰›ˆÓ ΢¿ÓˆÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÎÏ¿Ì·ÙÔ˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ∏∫° 12 ··ÁˆÁÒÓ ·ÔÎ¿Ï˘„ ·Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ Ù‡Ô˘ “ıfiÏÔ˘” ÛÙȘ ··ÁˆÁ¤˜ V1 Î·È V2, ¯·Ú·ÎÙËÚÈÛÙÈÎfi J ·̷ ÛÙȘ ··ÁˆÁ¤˜ V3-V6 Î·È Ê˘ÛÈÔÏÔÁÈÎfi QTc ‰È¿ÛÙËÌ· (∂ÈÎfiÓ· 1 Î·È 2). ∆Ô ‚Ú¤ÊÔ˜ ‹Ù·Ó ÙÔ ¤Ó· ·fi ‰È˙˘ÁˆÙÈο ‰›‰˘Ì·, ·fi Ù· ÔÔ›· ÙÔ ÚÒÙÔ ¤ı·Ó ·ÓÂÍ‹ÁËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ Û ËÏÈΛ· 4 ÌËÓÒÓ. ∆· ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ∏∫° Î·È Ë ·Ô˘Û›· ‰ÔÌÈ΋˜ ηډȷ΋˜ ÓfiÛÔ˘ ¤ıÂÛ Û ·˘Ùfi ÙÔ ‚Ú¤ÊÔ˜ ÙË ‰È¿ÁÓˆÛË

18

Paediatriki 2002;65:16-22

ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada. ∆Ô ‚Ú¤ÊÔ˜ ·˘Ùfi ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹ Ì ηϿ ·ÔÙÂϤÛÌ·Ù·. ∞˘Ùfi ÙÔ ‚Ú¤ÊÔ˜ ·ÔÙÂÏ› ÙÔ ÓÂfiÙÂÚÔ ·ÛıÂÓ‹ Ì ۇӉÚÔÌÔ Brugada Ô˘ ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (12). ¢È¿ÁÓˆÛË - ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ∆· Ù˘Èο Â˘Ú‹Ì·Ù· ÛÙÔ ∏∫° ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ÔÎÏÂÈÛÌfi ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜ Ì ·Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ (≥0,1 mV) ÛÙȘ ‰ÂÍȤ˜ ÚÔοډȘ ··ÁˆÁ¤˜ V1, V2 Î·È V3 (1,3,4). ¶¿ÓÙˆ˜, ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ ·Ô˘ÛÈ¿˙ÂÈ ÙÔ Ù˘ÈÎfi ¢ڇ S ·̷ ÛÙȘ ·ÚÈÛÙÂÚ¤˜ ÚÔοډȘ ··ÁˆÁ¤˜, Û˘ÓËÁÔÚÒÓÙ·˜ fiÙÈ ‰ÂÓ ÚfiÎÂÈÙ·È ÁÈ· ·ÏËı‹ ·ÔÎÏÂÈÛÌfi ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜. ∏ ÚfiˆÚË ·fiÙÔÌË ·Ó‡„ˆÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ ÛÙȘ ‰ÂÍȤ˜ ÚÔοډȘ ··ÁˆÁ¤˜ (“J ·̷”) ÌÔÚ› Ó· ÌÈÌËı› ·ÔÎÏÂÈÛÌfi ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜. ™Â ÔÏÏÔ‡˜ ·ÛıÂÓ›˜ ·Ú·ÙËÚÂ›Ù·È Ù·˘Ùfi¯ÚÔÓ· ·ÚÈÛÙÂÚ‹ ·fiÎÏÈÛË ÙÔ˘ ¿ÍÔÓ· Ù˘ ηډȿ˜, ˆ˜ Â› ·ÚÈÛÙÂÚÔ‡ ÚfiÛıÈÔ˘ ËÌÈÛÎÂÏÈÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡. ∆Ô QTc Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi (3). Œ¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰‡Ô Ù‡ÔÈ ·Ó¿Û·Û˘ ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜: Ô Ù‡Ô˜ ıfiÏÔ˘, Ô˘ ıˆÚÂ›Ù·È Î·È Ô ÈÛ¯˘ÚfiÙÂÚÔ˜ ·ÚÚ˘ıÌÈÔÁÂÓ‹˜ ·Ú¿ÁÔÓÙ·˜ Î·È Ô Ù‡Ô˜ η̿ڷ˜ ‹ “Û¤ÏÏ·˜”. ™˘Ó‹ıˆ˜, Ë ·Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ Â›Ó·È Ù‡Ô˘ ıfiÏÔ˘, ·ÏÏ¿ ÌÂÙ¿ÙˆÛË Û هÔ Î·Ì¿Ú·˜ ‹ Û ÂÓÙÂÏÒ˜ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° Â›Ó·È Û˘¯Ó‹ (30%) (2,13). ŸÙ·Ó ·˘Í¿ÓÂÙ·È Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·, ¤¯ÂÈ ·Ó·ÊÂÚı› ÌÂÙ¿ÙˆÛË ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫°, ·ÏÏ¿ Û ÔÚÈṲ̂-

I

V1

II

V2

III

V3

aVR

V4

aVL

V5

aVF

V6

∂ÈÎfiÓ· 1. ∏∫° 12 ··ÁˆÁÒÓ ‚Ú¤ÊÔ˘˜ 6 ÌËÓÒÓ Ì ۇӉÚÔÌÔ Brugada. ∞Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ ıÔψً˜ ÌÔÚÊÔÏÔÁ›·˜ ÛÙȘ ··ÁˆÁ¤˜ V1 Î·È V2 Î·È Î˘Ú›·Ú¯Ô J ·̷ ÛÙȘ ··ÁˆÁ¤˜ V3-V6. (∆ÚÔÔÔÈË̤ÓÔ ·fi: J Cardiovasc Electrophysiol 2000;11:1278)

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·19

¶·È‰È·ÙÚÈ΋ 2002;65:16-22

∂ÈÎfiÓ· 2. ¶ÔχÌÔÚÊË ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, fiˆ˜ ηٷÁÚ¿ÊÙËΠ·fi ÙÔ Holter, ÛÙÔ ›‰ÈÔ ‚Ú¤ÊÔ˜. (∆ÚÔÔÔÈË̤ÓÔ ·fi: J Cardiovasc Electrophysiol 2000;11:1278)

Ó˜ ÂÚÈÙÒÛÂȘ Î·È Âȉ›ӈÛË ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ È‰ÈfiÌÔÚÊˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (3). ∞·ÈÙÂ›Ù·È Â·ÓÂÈÏËÌ̤ÓË ‹ Û˘Ó¯‹˜ ∏∫° ηٷÁÚ·Ê‹ (Holter) Î·È Â·ÓÂÈÏËÌ̤ӈ˜ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ·ÛÌ·Ï›Ó˘, ÊÏÂη˚Ó›‰Ë˜ ‹ ÚÔη˚Ó·Ì›‰Ë˜ οو ·fi Û˘Ó¯‹ ∏∫° ·Ú·ÎÔÏÔ‡ıËÛË, ÁÈ· ÙËÓ ·ÔÎ¿Ï˘„Ë ÙÔ˘ ·ÓÒÌ·ÏÔ˘ ∏∫° Û ·ÛıÂÓ›˜ Ì ·ÚÔ‰Èο Ê˘ÛÈÔÏÔÁÈÎfi ∏∫°, Û ̤ÏË ÔÈÎÔÁ¤ÓÂÈ·˜ ·ÛıÂÓÒÓ, ηıÒ˜ Î·È Û ÛȈËÏÔ‡˜ ÊÔÚ›˜ ÙÔ˘ ÁfiÓÔ˘ (1,2,5). ∞Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ Ù‡Ô˘ ıfiÏÔ˘ ¤¯ÂÈ, Â›Û˘, ·Ú·ÙËÚËı› Û ·ÛıÂÓ›˜ Ì ·ÚÚ˘ıÌÈÔÁfiÓÔ ‰ÂÍÈ¿ ÎÔÈÏ›·, ÛÙȘ ÓfiÛÔ˘˜ Chagas ‹ Steinert Î·È ÛÙÔ˘˜ fiÁÎÔ˘˜ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘. ∂›Û˘, ÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ÚfiˆÚ˘ Â·Ó·fiψÛ˘ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ÔÌÔÈfiÙËÙ˜ Ì ÙÔÓ Ù‡Ô Î·Ì¿Ú·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada (13). ™Â ÌÂϤÙË ÛÙËÓ ∂˘ÚÒË (13), Û 1000 ∏∫° Ô˘ ÂÈϤ¯ıËÎ·Ó Ù˘¯·›· Û ˘ÁÈ‹ ÏËı˘ÛÌfi Ì ‡ÚÔ˜ ËÏÈΛ·˜ 17-68 ¤ÙË, ‰È·ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· ·Ó¿Û·Û˘ ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ Ù‡Ô˘ η̿ڷ˜ (“Û¤ÏÏ·˜”) ÛÙÔ 6% ÙÔ˘ ÏËı˘ÛÌÔ‡ Î·È Ù‡Ô˘ ıfiÏÔ˘ ÛÙÔ 0,1%. ∏ ˘„ËÏ‹ Â›ÙˆÛË Û ˘ÁÈ‹ ÏËı˘ÛÌfi Ù˘ Ù˘È΋˜ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada, ı· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ, Â¿Ó ÈÛ¯‡ÂÈ, ÛËÌ·ÓÙÈο ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ∂˘ÚÒË, ÏfiÁˆ Ù˘ Û˘Ó·ÎfiÏÔ˘ı˘ ·‡ÍËÛ˘ ÛÙËÓ ÂÌʇÙ¢ÛË ·ÈÓȉˆÙÒÓ (13). ∞fi ÙÔ˘˜ 104 Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù˘ Û˘ÁÎÂÓÙÚˆÙÈ΋˜ ÌÂϤÙ˘ ÙˆÓ Alings Î·È Wilde (3), ÙÔ 73% ÂÌÊ¿ÓÈÛ ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ Î·È ÙÔ 27% Û˘ÁÎÔ‹. ™ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ 59 ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÙÔ ·ÓÒÌ·ÏÔ ∏∫° ·ÔηχÊıËΠηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘¯·›Ô˘ ∏∫° ‹ ηٿ ÙˆÓ ¤ÏÂÁ¯Ô ÙˆÓ ÌÂÏÒÓ ÔÈÎÔÁ¤ÓÂÈ·˜ ·ÛıÂÓÔ‡˜ Ô˘ ¤ı·Ó ·ÈÊÓ›‰È·. ™Â 17 ·fi ÙÔ˘˜ 21 ·ÛıÂÓ›˜ Ô˘ ¤ÁÈÓ ηٷÁÚ·Ê‹ Ù˘ ·ÚÚ˘ıÌ›·˜, ·˘Ù‹ ÂÌÊ·Ó›ÛÙËΠ۠ÂÚ›Ô‰Ô ËÚÂÌ›·˜ ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ™ÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ ÙˆÓ ·ÛıÂÓÒÓ, Ù· Â˘Ú‹Ì·Ù· ·fi ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜, ÙȘ ‚ÈÔ„›Â˜ Ì˘Ôηډ›Ô˘, ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È ÙËÓ ·ÁÁÂÈÔÁÚ·Ê›· ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∫·Ù¿ ÙËÓ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË ÚÔÎÏ‹ıËΠ·ÚÚ˘ıÌ›· ÛÙÔ 76% ÙˆÓ ·ÛıÂÓÒÓ, ÛÙÔ 86% ÙˆÓ ÔÔ›ˆÓ ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ Î·È Â›ÌÔÓË ÔχÌÔÚÊË ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· ÛÙÔ 14% (3). ™Â ÌÂϤÙË ÙˆÓ Brugada Î·È Brugada (5) Ô˘

Paediatriki 2002;65:16-22

·ÊÔÚÔ‡Û 25 ÔÈÎÔÁ¤ÓÂȘ ºÏ·Ì·Ó‰ÒÓ Ì ۇӉÚÔÌÔ Brugada, ·ÔÙÂÏÔ‡ÌÂÓ˜ ·fi 334 ̤ÏË Ì ‡ÚÔ˜ ËÏÈΛ·˜ 6 Ì‹Ó˜ ¤ˆ˜ 92 ¤ÙË, ÙÔ 15% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ¿ÓÈ˙ ·ÓÒÌ·ÏÔ ∏∫°, ÙÔ 50% ÙˆÓ ÔÔ›ˆÓ ÙÂÏÈο ·‚›ˆÛ ·ÈÊÓ›‰È· ÂÍ·ÈÙ›·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∞fi ÙÔ˘˜ 42 ı·Ó¿ÙÔ˘˜ Ô˘ ÛËÌÂÈÒıËÎ·Ó Û˘ÓÔÏÈο Û ·˘Ù¤˜ ÙȘ ÔÈÎÔÁ¤ÓÂȘ, ÙÔ 57% ·Ó·ÌÊ›‚ÔÏ· Û¯ÂÙÈ˙fiÙ·Ó Ì ÙÔ Û‡Ó‰ÚÔÌÔ (5). ¶·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ¶ÂÈÚ·Ì·ÙÈο Î·È ıˆÚËÙÈο ‰Â‰Ô̤ӷ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù· ȉȷ›ÙÂÚ· ∏∫° ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÔÈ ·ÚÚ˘ı̛˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÔÊ›ÏÔÓÙ·È ÛÙË ‰È·ÙÔȯˆÌ·ÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÛÙËÓ Â·Ó·fiψÛË ÛÙÔ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ (∂ÈÎfiÓ· 3). ∏ ÌÔÚÊÔÏÔÁ›· Ù˘ ηÌ‡Ï˘ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓÂÚÁ›·˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· 3 ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÚÂ˘Ì¿ÙˆÓ: ÙÔ˘ Ú‡̷ÙÔ˜ Na+ (INa), ÙÔ˘ Ú‡̷ÙÔ˜ K+ (Ito) Î·È ÙÔ˘ L-Ù‡Ô˘ Ú‡̷ÙÔ˜ Ca2+ (ICa). ªÂ›ˆÛË ÛÙÔ INa ‹ ÛÙÔ L-Ù‡Ô˘ ICa ‹ ·‡ÍËÛË ÛÙÔ Ito ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÙȘ ·ÏÏ·Á¤˜ ÛÙÔ ∏∫° Î·È ÙȘ ·ÚÚ˘ı̛˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Brugada (3).

O Ì˯·ÓÈÛÌfi˜ Ù˘ ¤Ó·Ú͢ Ù˘ ·ÚÚ˘ıÌ›·˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ Brugada Ê·›ÓÂÙ·È fiÙÈ ‰È·Ê¤ÚÂÈ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ Ì·ÎÚÔ‡ QT ‰È·ÛÙ‹Ì·ÙÔ˜ (LQTS). ™ÙÔ Û‡Ó‰ÚÔÌÔ Brugada, ÙÔ ‰È¿ÛÙËÌ· Û‡˙¢Í˘ Ù˘ ÚÒÙ˘ ¤ÎÙ·ÎÙ˘ ÎÔÈÏȷ΋˜ Û˘ÛÙÔÏ‹˜ ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ÊÏÂÌ‚ÔÎÔÌ‚È΋ Û˘ÛÙÔÏ‹ Â›Ó·È Û˘Ó‹ıˆ˜ ‚Ú·¯‡ (“ÙÔ R ¿Óˆ ÛÙÔ T” ‹ “ÛÙÔ ÙÂÏÈÎfi ÙÌ‹Ì· ÙÔ˘ T ·̷ÙÔ˜”) Î·È Ù· ÂÂÈÛfi‰È· ·ÚÚ˘ıÌ›·˜ ‰ÂÓ ÚÔËÁÔ‡ÓÙ·È ·fi ȉȷ›ÙÂÚ˜ ‰È‰˘Ì›Â˜. ∞fi Ì›· ¤ÎÙÔË ÎÔÈÏȷ΋ Û˘ÛÙÔÏ‹ ÍÂÎÈÓ¿ÂÈ Ë ·ÚÚ˘ıÌ›· Ì Ì˯·ÓÈÛÌfi Â·ÓÂÈÛfi‰Ô˘. ™ÙÔ LQTS, ÙÔ ‰È¿ÛÙËÌ· Û‡˙¢Í˘ Â›Ó·È Ì·ÎÚfi ÏfiÁˆ Ù˘ ÂÈÌ‹Î˘ÓÛ˘ ÙÔ˘ QT ‰È·ÛÙ‹Ì·ÙÔ˜ (3). ∏ ·˘ÍË̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ·Ú·Û˘Ì·ıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Ë ·Ó·ÛÙÔÏ‹ ÙÔ˘ Û˘Ì·ıËÙÈÎÔ‡ ÌÔÚ› Ó· ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÚÚ˘ıÌÈÔÁ¤ÓÂÛË, ÂÍËÁÒÓÙ·˜ ÙËÓ ÂÈÎÚ¿ÙËÛË ÙˆÓ ·ÚÚ˘ıÌÈÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (3,14). ªÔÚȷ΋ ‚¿ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ªÂ ‚¿ÛË ÙÔÓ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi Ì˯·ÓÈÛÌfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada, ÌÔÚ› Ó· ˘ÔÛÙËÚȯı› fiÙÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙ· ÁÔÓ›‰È· Ô˘ Â›Ó·È ˘‡ı˘Ó· ÁÈ· Ù· ηӿÏÈ· Na+, K+ ηÈ/‹ Ù· ηӿÏÈ· Ca2+, ÂÍËÁÔ‡Ó ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ·‚›‚·ÛË Ù˘ ÓfiÛÔ˘ (3,15,16). ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ ÌÔÚȷ΋˜ ‚¿Û˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÔÎ¿Ï˘„ fiÙÈ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ ÁÔÓ›‰ÈÔ SCN5A, Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 3p21-24 Î·È Îˆ‰ÈÎÔÔÈ› ‚·ÛÈΤ˜ ÚˆÙ½Ó˜ ÙˆÓ ‰È·‡ÏˆÓ Na+ ÙÔ˘ Û·ÚÎÂÈÏ‹Ì·ÙÔ˜, ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· Ù‡Ô ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ŒÙÛÈ Û¯Â‰È¿ÛÙËΠ¤Ó· ÌÔÚÈ·Îfi ÌÔÓÙ¤ÏÔ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ

19

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·20

¶·È‰È·ÙÚÈ΋ 2002;65:16-22

Paediatriki 2002;65:16-22

AP Endocardial

35mV

Epicardial

1mV ECG

100m ∂ÈÎfiÓ· 3. ¢È·ÊÔÚ¤˜ ÛÙË ÌÔÚÊÔÏÔÁ›· ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓÂÚÁ›·˜ ÌÂٷ͇ ÂÈηډ›Ô˘ Î·È ÂÓ‰Ôηډ›Ô˘ (¿Óˆ) Î·È ·ÓÙÈÛÙÔȯ›· Ì ÙÔ ∏∫° ÂÈÊ·Ó›·˜ (οو) ÛÙÔ Û‡Ó‰ÚÔÌÔ Brugada. ∏ ÂÎÛÂÛËÌ·Ṳ̂ÓË Ê¿ÛË 1 ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓÂÚÁ›·˜ ÙÔ˘ ÂÈηډ›Ô˘ (¿Óˆ ·ÚÈÛÙÂÚ¿) ÚÔÛ‰›‰ÂÈ ÛÙËÓ Î·Ì‡ÏË ÌÔÚÊÔÏÔÁ›· "·È¯Ì‹˜ Î·È Î‡Ì·ÙÔ˜" Î·È ·ÓÙÈÛÙÔȯ› ÛÙÔ Î‡Ì· J ÛÙÔ ∏∫° ÂÈÊ·Ó›·˜ (οو ·ÚÈÛÙÂÚ¿). ∏ ·ÒÏÂÈ· ÙÔ˘ ·̷ÙÔ˜ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓÂÚÁ›·˜ ÙÔ˘ ÂÈηډ›Ô˘ (¿Óˆ ‰ÂÍÈ¿) ‚Ú·¯‡ÓÂÈ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÂÓÂÚÁ›·˜ ÙÔ˘ ÂÈηډ›Ô˘, ÚÔηÏÒÓÙ·˜ ‰È·ÙÔȯˆÌ·ÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· Î·È ·Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ ÛÙÔ ∏∫° ÂÈÊ·Ó›·˜ (οو ‰ÂÍÈ¿). (∆ÚÔÔÔÈË̤ÓÔ ·fi: Circulation 1999;99:669)

·ÚÚ˘ıÌÈÔÁ¤ÓÂÛË (15,16). ∆Ô SCN5A ÁÔÓ›‰ÈÔ ÂÌϤÎÂÙ·È Î·È ÛÙÔ LQT3, fiÔ˘ fï˜ Ë ÌÂÙ¿ÏÏ·ÍË ÚÔηÏ› ÂÓÈÛ¯˘Ì¤ÓÔ ÂÈÛÂÚ¯fiÌÂÓÔ Ú‡̷ Ó·ÙÚ›Ô˘. Œ¯Ô˘Ó ηٷÁÚ·Ê› ‰È·ÊÔÚÂÙÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ SCN5A ÁÔÓ›‰ÈÔ, Û ·ÚÎÂÙ¤˜ ÔÈÎÔÁ¤ÓÂȘ Î·È ·ÛıÂÓ›˜ Ì ÈÛÙÔÚÈÎfi ÎÔÈÏȷ΋˜ Ì·ÚÌ·Ú˘Á‹˜ Î·È ·ÚÔ˘Û›· ÙˆÓ È‰È·›ÙÂÚˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÛÙÔ ∏∫° (1,3,15-17). OÈ ÌÂÙ·ÏÏ¿ÍÂȘ ·˘Ù¤˜ ‰È·ÊÔÚÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ‰È·‡ÏˆÓ Na+, ÚÔηÏÒÓÙ·˜ ÌÂȈ̤ÓÔ Ú‡̷ I¡a (15,16). À¿Ú¯Ô˘Ó ÛÙÔȯ›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Î·È ¿ÏÏ· ÁÔÓ›‰È· ÂÌϤÎÔÓÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ˘Ô‰ËÏÒÓÂÈ ÙË ÁÂÓÂÙÈ΋ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, fiˆ˜ Î·È Û ¿ÏÏ· ÎÏËÚÔÓÔÌÈο ηډȷο ÓÔÛ‹Ì·Ù· (9,15,16). ∏ ·Ó·ÁÓÒÚÈÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÈ· ÙÔ Î·Ó¿ÏÈ Na+ ÁÔÓȉ›Ô˘ Û ·Û˘Ìو̷ÙÈο ̤ÏË ÔÈÎÔÁ¤ÓÂÈ·˜ ·ÛıÂÓÒÓ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋, ·ÊÔ‡ ·ÊÔÚ¿ ÓfiÛÔ ÛÙËÓ ÔÔ›· Ë Î·Ú‰È·Î‹ ·Ó·ÎÔ‹ ·ÔÙÂÏ› Û˘¯Ó¿ ÙËÓ ÚÒÙË ÂΉ‹ÏˆÛË. ∞ÙÂÏ‹˜ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, fiÔ˘ ¤Ó·˜ ÁÔÓ¤·˜ ÌÔÚ› Ó· Â›Ó·È ÊÔÚ¤·˜ Ù˘ ÌÂÙ¿ÏÏ·Í˘ Î·È Ó· ÙË ÌÂٷʤÚÂÈ ÛÙ· ·È‰È¿ ÙÔ˘, ¯ˆÚ›˜ Ó· ÂÎÊÚ¿˙ÂÙ·È ÛÙÔÓ ›‰ÈÔ Ë ÓfiÛÔ˜, ‰È·ÈÛÙÒıËΠÛÙË ÌÂϤÙË Ù˘ Priori Î·È Û˘Ó. (10) Ô˘ ·ÊÔÚÔ‡Û ̛· ÔÈÎÔÁ¤ÓÂÈ· ÛÙËÓ ÔÔ›· 5 ·È‰È¿ ¤ı·Ó·Ó ¤ÂÈÙ· ·fi ·ÓÂÍ‹ÁËÙË Î·Ú‰È·Î‹ ·Ó·ÎÔ‹.

20

∞ÓÙÈÌÂÙÒÈÛË O ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ηÙ¢ı‡ÓÂÈ ÙÔÓ ·ÛıÂÓ‹ Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ Û ÁÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï‹, ÒÛÙ ӷ Á›ÓÂÙ·È ÂÊÈÎÙ‹ Ë ÚÔÛ˘Ìو̷ÙÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È Ó· ·Ú¯›˙ÂÈ ¤ÁηÈÚ· Ë Î·Ù¿ÏÏËÏË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. ¶ÚÔ˜ ÙÔ ·ÚfiÓ, ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔÛ‰ÈÔÚÈÛÙ› ÔÈÔ˜ ·Û˘Ìو̷ÙÈÎfi˜ ·ÛıÂÓ‹˜ ı· ·Ó·Ù‡ÍÂÈ Û˘ÌÙÒÌ·Ù· ÛÙÔ Ì¤ÏÏÔÓ. ™Â ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ, Ì¿ÏÈÛÙ·, Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ·ÔÙÂÏ› ÙËÓ ÚÒÙË Î·È ÙËÓ ÙÂÏÂ˘Ù·›· ÂΉ‹ÏˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™Â ÔÏ˘ÎÂÓÙÚÈ΋ ÌÂϤÙË ÙˆÓ Brugada Î·È Brugada (18) Ô˘ ·ÊÔÚÔ‡Û 41 Û˘Ìو̷ÙÈÎÔ‡˜ Î·È 22 ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË Î·Ù¿ ̤ÛÔ fiÚÔ ÁÈ· 32 Ì‹Ó˜, ‰È·ÈÛÙÒıËΠÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ÂÂÈÛfi‰ÈÔ ·ÚÚ˘ıÌ›·˜ ÛÙÔ 34% ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ, fiˆ˜ Î·È ÛÙÔ 27% ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ. ∏ ıÓËÙfiÙËÙ· ‹Ù·Ó Ôχ ˘„ËÏ‹ ÛÙËÓ ÔÌ¿‰· Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹, fiˆ˜ Ë ·ÌÈÔ‰·ÚfiÓË Î·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ (26%) Î·È ÛÙËÓ ÔÌ¿‰· Ô˘ ¤ÌÂÈÓ ¯ˆÚ›˜ ıÂÚ·›· (31%), ÂÓÒ ‰ÂÓ ÛËÌÂÈÒıËΠηӤӷ˜ ı¿Ó·ÙÔ˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ÂÌÊ˘Ù‡ÙËΠ·ÈÓȉˆÙ‹˜. OÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·ÚÚ˘ı̛˜ ÛÙÔ˘˜ ÙÂÏÂ˘Ù·›Ô˘˜ ·ÛıÂÓ›˜ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Î·Ù¿ÏÏËÏ· ·fi ÙË Û˘Û΢‹ (18). ™Â ÌÂϤÙË Ù˘ Priori Î·È Û˘Ó (9) Ô˘ ·ÊÔÚÔ‡Û 30 Û˘Ìو̷ÙÈÎÔ‡˜ Î·È 30 ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È ·Ú·ÎÔÏÔ‡ıËÛË Î·Ù¿ ̤ÛÔ fiÚÔ ÁÈ· 33 Ì‹Ó˜, ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ ÂÌÊ·Ó›ÛÙËΠÛÙÔ 16% ÙˆÓ Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ Î·È Û ηӤӷ ·fi ÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜. ∏ ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˘ ËÏÂÎÙÚÈ΋˜ ‰È¤ÁÂÚÛ˘ Î·È Ù˘ Ê·ÚÌ·ÎÔÏÔÁÈ΋˜ ÚfiÎÏËÛ˘ Ì ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ Î·Ó·ÏÈÒÓ Na+, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ·ÛıÂÓÒÓ Ì ˘„ËÏfi ΛӉ˘ÓÔ Î·È ÙËÓ ·ÔÎ¿Ï˘„Ë ÙˆÓ ÛȈËÏÒÓ ÊÔÚ¤ˆÓ ÙÔ˘ ÁfiÓÔ˘ ·ÓÙ›ÛÙÔȯ·, ‹Ù·Ó ¯·ÌËÏ‹ (9). ªÂ ‚¿ÛË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ËÏÂÎÙÚÈ΋ ‰È¤ÁÂÚÛË ‰ÂÓ Â›Ó·È ·ÍÈfiÈÛÙË ÚÔÁÓˆÛÙÈ΋ ‰ÔÎÈÌ·Û›·, ÚÔÙ›ÓÂÙ·È ¤Ó·˜ ·ÏÁfiÚÈıÌÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Brugada (9) (™¯‹Ì· 1). ™‡Ìʈӷ Ì ·˘ÙfiÓ ÙÔÓ ·ÏÁfiÚÈıÌÔ, ÛÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û˘ÁÎÔ‹, ηډȷ΋ ·Ó·ÎÔ‹ ‹ ηٷÁÚ·Ì̤ÓË ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›Ó·È ıÂÙÈÎfi ÁÈ· ÚfiˆÚÔ ·ÈÊÓ›‰ÈÔ Î·Ú‰È·Îfi ı¿Ó·ÙÔ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹. ™ÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÛÙÔ˘˜ ÛȈËÏÔ‡˜ ÊÔÚ›˜ ÙÔ˘ ÁfiÓÔ˘ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÌʇÙ¢ÛË ÌÈÎÚ‹˜ Û˘Û΢‹˜ Û˘Ó¯ԇ˜ ηٷÁÚ·Ê‹˜ ÙÔ˘ ηډȷÎÔ‡ Ú˘ıÌÔ‡ Î·È Ó· ÂÎ·È‰Â‡ÔÓÙ·È Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘˜

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·21

¶·È‰È·ÙÚÈ΋ 2002;65:16-22

Paediatriki 2002;65:16-22

∞ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Brugada

ñ ™˘Ìو̷ÙÈÎÔ› ·ÛıÂÓ›˜ (Û˘ÁÎÔ‹/ηډȷ΋ ·Ó·ÎÔ‹) ñ OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚfiˆÚÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘

ñ ∞Û˘Ìو̷ÙÈÎÔ› ·ÛıÂÓ›˜ ñ ∞ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ñ ™ÈˆËÏÔ› ÊÔÚ›˜ ÙÔ˘ ÁfiÓÔ˘

ñ ∂ÌʇÙ¢ÛË ÌÈÎÚ‹˜ Û˘Û΢‹˜ Û˘Ó¯ԇ˜ ηٷÁÚ·Ê‹˜ ηډȷÎÔ‡ Ú˘ıÌÔ‡ ñ ∂Î·›‰Â˘ÛË ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙËÓ Î·Ú‰ÈÔÓ¢ÌÔÓÈ΋ ·Ó¿ÓË„Ë Î·È ËÏÂÎÙÚÈ΋ ·Ó¿Ù·ÍË ¡·È ∂ÌʇÙ¢ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹

Ÿ¯È ∫·Ù·ÁÚ·Ì̤ÓË ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·

¶·Ú·ÎÔÏÔ‡ıËÛË ÎÏÈÓÈο

™¯‹Ì· 1. ∞ÏÁfiÚÈıÌÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Brugada. (∆ÚÔÔÔÈË̤ÓÔ ·fi: Circulation 2000;102:2514).

ÛÙËÓ Î·Ú‰ÈÔÓ¢ÌÔÓÈ΋ ·Ó¿ÓË„Ë Î·È ËÏÂÎÙÚÈ΋ ·Ó¿Ù·ÍË. ∞Ó Î·Ù·ÁÚ·Ê› ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›·, Á›ÓÂÙ·È ÂÌʇÙ¢ÛË ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹. ™ËÌ·ÓÙÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ ·˘ÙÔ‡ ÙÔ˘ ·ÏÁfiÚÈıÌÔ˘ ·ÔÙÂÏÔ‡Ó Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡ Î·È ÙÔ ÛËÌ·ÓÙÈÎfi ¿Á¯Ô˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ (9). ¢È·ÈÛÙÒÓÔÓÙ·È ‰È·ÊÔÚÂÙÈΤ˜ ·fi„ÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Â˘·ÈÛıËÛ›· Ù˘ ÚfiÎÏËÛ˘ Ì ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ Î·Ó·ÏÈÒÓ Na+, fiˆ˜ Ù· ·ÓÙÈ·ÚÚ˘ıÌÈο Ù˘ ÔÌ¿‰·˜ π∞ Î·È πC, ÙË ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˘ ËÏÂÎÙÚÈ΋˜ ‰È¤ÁÂÚÛ˘ Î·È ÙÔÓ ÙÚfiÔ ·ÓÙÈÌÂÙÒÈÛ˘ Î·È ÙËÓ ¤Î‚·ÛË ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ (2,7-9,18). OÈ Brugada Î·È Û˘Ó ÚÔÙ›ÓÔ˘Ó ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ Û fiÏÔ˘˜ ÙÔ˘˜ Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Î·È ÛÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜, Ô˘ ÌÂÙ¿ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ËÏÂÎÙÚÈ΋ ‰È¤ÁÂÚÛË ÚÔηÏÂ›Ù·È ·ÚÚ˘ıÌ›· (7,18). ™Â ÌÂϤÙË, Â›Û˘, ÙˆÓ Brugada Î·È Û˘Ó (2) ‰È·ÈÛÙÒıËΠfiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ˜ ·ÚÚ˘ı̛˜ Â›Ó·È Ô ›‰ÈÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÚÔÛˆÚÈÓ¿ Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° Î·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÌfiÓÈ̘ ∏∫° ‰È·Ù·Ú·¯¤˜ Î·È fiÙÈ Ë ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ·ÔÎÏÂÈÛÙ¤˜ ÙˆÓ Î·Ó·ÏÈÒÓ Na+ ·ÔηχÙÂÈ ÙÔ ·ıÔÏÔÁÈÎfi ∏∫° (2). ∏ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Ì ·ÌÈÔ‰·ÚfiÓË Î·È/‹ ‚·Ó·ÛÙÔÏ›˜ ‰ÂÓ ÚÔÛٷهÂÈ ·fi ÙÔÓ ·ÈÊÓ›‰ÈÔ Î·Ú‰È·Îfi ı¿Ó·ÙÔ. ª¿ÏÈÛÙ·, Ë ¯ÔÚ‹ÁËÛË ‚-·Ó·ÛÙÔϤˆÓ ·ÓÙÂӉ›ÎÓ˘Ù·È. ∏ ÎÈÓȉ›ÓË Î·Ù·ÛÙ¤ÏÏÂÈ ÙÔ Ú‡̷ K+ Î·È ÌÔÚ› Ó· ‰È·Ê˘Ï¿ÛÛÂÈ ÙËÓ ËÏÂÎÙÚÈ΋ ÔÌÔÈÔÁ¤ÓÂÈ· Ù˘ ηډȿ˜. ∏ ¯ÔÚ‹ÁËÛ‹ Ù˘ ·fi

ÙÔ ÛÙfiÌ· Û ·ÛıÂÓ›˜ Ì ÂÌÊ˘ÙÂ˘Ì¤ÓÔ ·ÈÓȉˆÙ‹ Ê¿ÓËΠӷ ÚÔÏ·Ì‚¿ÓÂÈ Ù· ÂÂÈÛfi‰È· ·ÚÚ˘ıÌ›·˜ Î·È ÂÔ̤ӈ˜ ÙȘ Û˘Ó¯›˜ ÂÎÊÔÚÙ›ÛÂȘ Ù˘ Û˘Û΢‹˜ (19). ∏ ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ ·ÔÙÂÏ› ÚÔ˜ ÙÔ ·ÚfiÓ ÙË ıÂÚ·›· ÂÎÏÔÁ‹˜, ·ÎfiÌ· Î·È ÁÈ· ÙÔ˘˜ ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ (1,3,7,9,14, 18,19). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÎÚ›ÓÂÙ·È ˆ˜ ÂÈÙ·ÎÙÈ΋ Ë ·Ó¿ÁÎË ÁÈ· Ï‹ÚË Î·È ÚÔÛÂÎÙÈ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ·ÛıÂÓÒÓ Ì ٷ Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Brugada ÛÙÔ ∏∫°, ηıÒ˜ Î·È Ë ·Ó¿ÁÎË ÁÈ· ¤ÏÂÁ¯Ô Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÂÈ˙ÒÓÙˆÓ ·fi ηډȷ΋ ·Ó·ÎÔ‹. OÈ ·ÛıÂÓ›˜ Ì ·ÔÎÏÂÈÛÌfi ÙÔ˘ ‰ÂÍÈÔ‡ ÛΤÏÔ˘˜, ·Ó¿Û·ÛË ÙÔ˘ ST ‰È·ÛÙ‹Ì·ÙÔ˜ ÛÙȘ V1,V2 Î·È V3 ··ÁˆÁ¤˜ Î·È ·Ô˘Û›· ‰ÔÌÈ΋˜ ÓfiÛÔ˘ Ù˘ ηډȿ˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ. ŒÓ· Ê˘ÛÈÔÏÔÁÈÎfi ∏∫° ‰ÂÓ Â›Ó·È Â·ÚΤ˜ ÁÈ· Ó· ·ÔÎÏ›ÛÂÈ ÙË ‰È¿ÁÓˆÛË. OÈ ·Û˘Ìو̷ÙÈÎÔ› ·ÛıÂÓ›˜ ˘ÔÛÙËÚ›˙ÂÙ·È fiÙÈ ¤¯Ô˘Ó ÙÔÓ ›‰ÈÔ Î›Ó‰˘ÓÔ ÁÈ· ÂÂÈÛfi‰È· ·ÚÚ˘ıÌ›·˜ Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ηډȷ΋˜ ·Ó·ÎÔ‹˜. ∞Ó Î·È ÔÈ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Brugada ÂÌÊ·Ó›˙Ô˘Ó Û˘Ó‹ıˆ˜ Û˘ÌÙÒÌ·Ù· ÂÚ›Ô˘ ÙËÓ 4Ë ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜, ÙÔ Û‡Ó‰ÚÔÌÔ ÌÔÚ› Ó· ¢ı‡ÓÂÙ·È ÁÈ· ·ÈÊÓ›‰ÈÔ Î·Ú‰È·Îfi ı¿Ó·ÙÔ Î·È ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ŸÏÔÈ ÔÈ ÂÚ¢ÓËÙ¤˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ë ÂÌʇÙ¢ÛË ·ÈÓȉˆÙ‹ ·ÔÙÂÏ› ÚÔ˜ ÙÔ ·ÚfiÓ ÙË ıÂÚ·›· ÂÎÏÔÁ‹˜. ∞·ÈÙÂ›Ù·È ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 10 ¯ÚfiÓÈ·, ÚÈÓ ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· Û¯ÂÙÈο Ì ÙË Ê˘ÛÈ΋ ÈÛÙÔÚ›·, ÙÔÓ Î›Ó‰˘ÓÔ ÁÈ·

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·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ Î·È ÙËÓ ·¿ÓÙËÛË ÛÙË ıÂÚ·›· ÙˆÓ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Brugada. ∏ ÂÚ·ÈÙ¤Úˆ ηٷÓfiËÛË Ù˘ ÌÔÚȷ΋˜ ‚¿Û˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ı· ÚÔÛʤÚÂÈ Ó¤Â˜ ÚÔÔÙÈΤ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó¿ÏÔÁ· Ì ÙÔ ÁÔÓfiÙ˘Ô ÙˆÓ ·ÛıÂÓÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Grace AA. Brugada syndrome. Lancet 1999;354:445-446.

2. Brugada R, Brugada J, Antzelevitch C, Kirsch GE, Potenza D, Towbin JA et al. Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation 2000;101:510-515.

3. Alings M, Wilde A. “Brugada” syndrome. Clinical data and suggested pathophysiological mechanism. Circulation 1999;99:666-673.

4. Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992;20:1391-1396.

5. Brugada P, Brugada R, Brugada J. Sudden death in patients and relatives with the syndrome of right bundle branch block, ST segment elevation in the precordial leads V1 to V3 and sudden death. Eur Heart J 2000;21:321-326.

6. Viskin S, Fish R, Eldar M, Zeltser D, Lesh MD, Glick A et al.

Prevalence of the Brugada sign in idiopathic ventricular fibrillation and healthy controls. Heart 2000;84:31-36.

7. Brugada P. Brugada syndrome: an electrocardiographic diagnosis not to be missed. Heart 2000;84:1-2.

8. Wilde AAM, Priori SG. Brugada syndrome and sudden death [letter]. Eur Heart J 2000;21:1483-1484.

9. Priori SG, Napolitano C, Gasparini M, Pappone C, Bella PD, Brignole M et al. Clinical and genetic heterogeneity of right bundle branch block and ST-segment elevation syndrome. A prospective evaluation of 52 families.

Circulation 2000;102:2509-2515.

10. Priori S, Napolitano C, Giordano U, Collisani G, Memmi M. Brugada syndrome and sudden cardiac death in children.

Lancet 2000;355:808-809.

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11. Erickson CC, Jones CS. Pediatric sudden cardiac death: What the pediatrician needs to know. Pediatr Ann 2000;29:509-518.

12. Suzuki H, Torigoe K, Numata O, Yazaki S. Infant case with a malignant form of Brugada syndrome. J Cardiovasc Electrophysiol 2000;11:1277-1280.

13. Hermida JS, Lemoine JL, Aoun FB, Jarry G, Rey JL, Quiret JC. Prevalence of the Brugada syndrome in an apparently healthy population. Am J Cardiol 2000;86:91-94.

14. Matsuo K, Kurita T, Inagaki M, Kakishita M, Aihara N, Shimizu W et al. The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome. Eur Heart J 1999;20:465-470.

15. Priori SG, Barhanin J, Hauer RNW, Haverkamp W, Jongsma HJ, Kleber AG et al. Genetic and molecular basis of cardiac arrhythmias: Impact on clinical management.

Parts I and II. Circulation 1999;99:518-528.

16. Priori SG, Barhanin J, Hauer RNW, Haverkamp W, Jongsma HJ, Kleber AG et al. Genetic and molecular basis of cardiac arrhythmias: Impact on clinical management.

Eur Heart J 1999;20:174-195.

17. Alshinawi C, Mannens M, Wilde A. Mutations in the human cardiac sodium channel gene (SCN5A) in patients with Brugada’s syndrome [abstract]. Eur Heart J 1998;19(Suppl):78.

18. Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3. A marker for sudden death in patients without demonstrable structural heart disease. Circulation 1998;97:457-460.

19. Belhassen B, Viskin S, Fish R, Glick A, Setbon I, Eldar M. Effects of electrophysiologic-guided therapy with Class IA antiarrhythmic drugs on the long-term outcome of patients with idiopathic ventricular fibrillation with or without the Brugada syndrome. J Cardiovasc Electrophysiol 1999;10:1301-1312.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 14-02-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 26-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞Ì·Ï›· ∆ÛÈÏÈÌÈÁοÎË ∏ÚÔ‰fiÙÔ˘ 214, ¡¤· ∞ÏÈηÚÓ·ÛÛfi˜ ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘, ∆.∫. 716 01

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ORIGINAL ARTICLE

£ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙ· ·È‰È¿ £. ª¿ÓÙ˙ÈÔ˘1, ∂. ¶Ï·ÙÔÎÔ‡ÎË2, µ. ∫·Ú¿ÌÂÏ·˜2, ∑. ∫·„ÈÌ¿ÏË2, ∂. ∞‰·ÌÙ˙›ÎË2, ∞. ∫Ô‚¿Ó˘3, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘4, ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1, ™. ∞ÚÒÓË2

Thromboembolic episodes of central nervous system in children T. Mantziou1, H. Platokouki2, V. Karambelas2, Z. Kapsimali2, E. Adamtziki2, A. Kovanis3, A. Scardoutsou4, A. Constantopoulos1, S. Aronis2

¶ÂÚ›ÏË„Ë: ∆· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (£∂) ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙÔ˘˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË ÏfiÁˆ ÙˆÓ ÂÚÈÔÚÈÛÌ¤ÓˆÓ ÌÂÏÂÙÒÓ. ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ÌÂÏÂÙ‹ıËÎ·Ó 48 ·È‰È¿ (28 ·ÁfiÚÈ·, 20 ÎÔÚ›ÙÛÈ·) Ô˘ ·ÚÔ˘Û›·Û·Ó £∂ ÙÔ˘ ∫¡™ ηٿ Ù· ¤ÙË 1990-1998, Ì ̤ÛË ËÏÈΛ· 6,3 ¯ÚfiÓÈ·. ∏ ‰È¿ÁÓˆÛË ÂÙ¤ıË Ì ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜ (·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·, Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· Î.¿.). ∆· £∂ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· (n=19), ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ (n=18) Î·È ıÚÔÌ‚ÒÛÂȘ ÙˆÓ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (n=11). ÀÔΛÌÂÓË ÓfiÛÔ ·ÚÔ˘Û›·˙ ÙÔ 38,65% Î·È ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ÙÔ 14,6% ÙˆÓ ·È‰ÈÒÓ. ∆· 23/48 ·È‰È¿ (47,9%) ·ÚÔ˘Û›·˙·Ó ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ıÚÔÌ‚ÔÊÈÏÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (8 ·È‰È¿ ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹, 18 Â›ÎÙËÙË ‰È·Ù·Ú·¯‹). OÈ Â›ÎÙËÙ˜ ‰È·Ù·Ú·¯¤˜ ‹Ù·Ó ηٿ ηÓfiÓ· ·ÚÔ‰ÈΤ˜ Î·È Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ. °ÂÓÈο, ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚfiÌ‚ˆÛË ·ÚÔ˘Û›·˙ ÙÔ 68,75% ÙˆÓ ·È‰ÈÒÓ. ∏ ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó ηٿ ηÓfiÓ· Û˘ÓÙËÚËÙÈ΋, Ì ÂÍ·›ÚÂÛË ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ. ∏ ıÚÔÌ‚ÔÂÌ‚ÔÏÈ΋ ÓfiÛÔ˜ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. ∏ ÂÌÂÈÚ›· ·fi ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈËÎÙÈ΋˜ ‹/Î·È ıÚÔÌ‚ÔÏ˘ÙÈ΋˜ ·ÁˆÁ‹˜ Û ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜, ΢ڛˆ˜ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Â›Ó·È Â˘Ô›ˆÓË. ∂ÓÙÔ‡ÙÔȘ,

Abstract: The thromboembolic episodes of the central nervous system (CNS) are quite rare in childhood and their pathophysiology still remains unknown mainly because of the restricted amount of available data. In our study, 48 children were included (28 boys, 20 girls), who presented with a CNS thromboembolic episode during the years 1990-1998. Their mean age was 6.3 years. The diagnosis was established using radiologic tests (CT scan, MRI scan, MR angiography etc). The episodes were classified as: ischemic infarcts (n=19), arterial thromboses (n=18) and cerebral venous sinus thromboses (n=11). An underlying disease was detected in 38.65% and a triggering event in 14.6% of the children. Twenty three out of 48 children (47.9%) had one or more thrombophilic disorders (inherited disorder: 8 children, acquired disorder: 18 children). The acquired disorders were, as a rule, temporary and related to the underlying disease. In general, one or more risk factors for thrombosis were detected in 68.75% of the children. Treatment was mainly conservative, except for a few selected cases. Thromboembolic episodes in children appear to be multifactorial.

Our experience from the use of anticoagulant and/or thrombolytic therapy in our patient population - mainly in cases with cerebral venous sinus thrombosis - is generally favourable.

Nevertheless, comparative studies are necessary

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘ Î·È ∞ÈÌÔÚÚÔÊÈÏ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ¡Â˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 4 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

1 1st Pediatric Dept. of Athens University Children’s Hospital “St. Sophia”, Athens 2 Hemostasis and Hemophilia Unit Children’s Hospital “St. Sophia”, Athens 3 Neurology Dept.

Children’s Hospital “St. Sophia”, Athens 4 2nd Pediatric Dept. of Athens University Children’s Hospital “Aglaia Kyriakou”, Athens

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¶·È‰È·ÙÚÈ΋ 2002;65:23-31

Paediatriki 2002;65:23-31

Â›Ó·È ·Ó·Áη›Â˜ Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ϤÔÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ıÂÚ·¢ÙÈ΋˜ Ú·ÎÙÈ΋˜.

in order to assess the most effective therapeutic approach.

§¤ÍÂȘ ÎÏÂȉȿ: ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ÙÔ˘ ∫¡™, ÈÛ¯·ÈÌÈ΋ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ∫¡™, ·È‰È¿.

Key words: thromboembolic episodes of the CNS in children, ischemic attacks in children, stroke in children.

™˘ÓÙÔÌÔÁڷʛ˜ £∂ ∫¡™ CT ªRI ªRA ã ö ∞PTT

AT III PC PS Plg ACA APCR LA FV Leiden FII 20210 A

£ÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Computed tomography (·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·) Magnetic resonance imaging (Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·) Magnetic resonance angiography (Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›·) ÃÚfiÓÔ˜ ıÚÔÌ‚›Ó˘ ÃÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘ Activated partial thromboplastin time (¯ÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘) ∞ÓÙÈıÚÔÌ‚›ÓË πππ Protein C (ÚˆÙ½ÓË C) Protein S (ÚˆÙ½ÓË S) Plasminogen (Ï·ÛÌÈÓÔÁfiÓÔ) Anticardiolipin antibodies (·ÓÙÈÛÒÌ·Ù· ηډÈÔÏÈ›Ó˘) Activated protein C resistance (·ÓÙ›ÛÙ·ÛË ÛÙËÓ ÂÓÂÚÁÔÔÈË̤ÓË ÚˆÙ½ÓË C) Lupus anticoagulant (·ÓÙÈËÎÙÈÎfi χÎÔ˘) Factor V Leiden (·Ú¿ÁÔÓÙ·˜ V Leiden) Factor ππ 20210 ∞ (·Ú¿ÁÔÓÙ·˜ ππ 20210 ∞)

∂ÈÛ·ÁˆÁ‹ ∏ ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™ Â›Ó·È ÛÔ‚·Úfi, ·ÏÏ¿ Û¿ÓÈÔ Û‡Ì‚·Ì· ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ (£∂) ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ ·Ó·Ê¤ÚÂÙ·È 1/100.000/¤ÙÔ˜ (1) ¤ˆ˜ 3,3/100.000/¤ÙÔ˜ (2). ∆· £∂ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ ‰È·Ê¤ÚÔ˘Ó ·fi ·˘Ù¿ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ˆ˜ ÚÔ˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ÙËÓ ·Ó·ÙÔÌÈ΋ ı¤ÛË Ù˘ ‚Ï¿‚˘ Î·È ÙËÓ ÎÏÈÓÈ΋ ÔÚ›·. OÈ ÈÔ Û˘¯ÓÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÛÙ· ·È‰È¿ ›ӷÈ: Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ·, ηÎÔ‹ıÂȘ, ÏÔÈÌÒÍÂȘ, ·Ê˘‰¿ÙˆÛË, ÙÚ·‡Ì·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ÔÚ›·, ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ú·ÙËÚÂ›Ù·È ˘Ô¯ÒÚËÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Î·È ·ÔηٿÛÙ·ÛË, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. ø˜ ÚÔ˜ ÙËÓ ÂÓÙfiÈÛË, Ë ıÚfiÌ‚ˆÛË ÌÔÚ› Ó· ·ÊÔÚ¿ ÛÙÔ ÂÁÎÂÊ·ÏÈÎfi ÊÏ‚ÈÎfi Û‡ÛÙËÌ· (ÊϤ‚˜ Î·È ÊÏ‚҉ÂȘ ÎfiÏÔÈ) ‹ ÛÙȘ ÂÁÎÂÊ·ÏÈΤ˜ ·ÚÙËڛ˜. ªÂ ‚¿ÛË ÙËÓ ·ÎÚÈ‚‹ ÂÓÙfiÈÛË ÙÔ˘ ıÚfiÌ‚Ô˘, ÔÈ ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ ‰È·ÎÚ›ÓÔÓÙ·È Û 3 ηÙËÁÔڛ˜: ·) ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË (·fiÊÚ·ÍË Ì›·˜ ÌÔÓ‹ÚÔ˘˜ ·ÚÙËÚ›·˜), ‚) ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·-

24

ÎÙÔ (arterial border zone infarct) Î·È Á) ÔÏ˘·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË (3). ∏ ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· Î·È ÔÈ ÎÏ¿‰ÔÈ Ù˘ ·ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ Û˘¯Ó‹ ÂÓÙfiÈÛË ÛÙ· ·È‰È¿ (4). ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ £∂ ÛÙ· ·È‰È¿ Î·È Ù· Ó·ڿ ¿ÙÔÌ· ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÈÌÔÛÙ·ÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, Û˘ÁÁÂÓ›˜ ‹ Â›ÎÙËÙ˜, ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Ó·ÓÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (5). øÛÙfiÛÔ, Ë ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ·ÊÔÚ¿ ÛÙË Û˘Ì‚ÔÏ‹ ÙˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È ÂÈϤÔÓ ·ÓÙÈÊ·ÙÈ΋. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞ӷχıËÎ·Ó Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ ·fi 48 ·È‰È¿, 28 ·ÁfiÚÈ· Î·È 20 ÎÔÚ›ÙÛÈ·, Ì ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎfi ÂÂÈÛfi‰ÈÔ ÙÔ˘ ∫¡™, Ô˘ ·Ú·¤ÌÊıËÎ·Ó ÛÙË ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·" ηٿ Ù· ¤ÙË 1990-1998. ∏ ËÏÈΛ· Î˘Ì·ÈÓfiÙ·Ó ·fi 8 Ë̤Ú˜ ¤ˆ˜ 14 ¯ÚfiÓÈ·, Ì ̤ÛË ËÏÈΛ· 6,3 ¯ÚfiÓÈ·. ∏ ‰È¿ÁÓˆÛË ÂÙ¤ıË Ì ̛· ‹ ÂÚÈÛÛfiÙÂÚ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜: ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT), Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI), Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (MRA), ·ÁÁÂÈÔÁÚ·Ê›·, „ËÊȷ΋ ·ÁÁÂÈÔÁÚ·Ê›·, ‰È·ÎÚ¿ÓÈÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·. ∂ÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ıÚÔÌ‚ÔÊÈÏ›·˜ ¤ÁÈÓ ÛÙËÓ ÔÍ›· Ê¿ÛË Î·È Ì·ÎÚÈ¿ ·fi ÙÔ ıÚÔÌ‚ˆÙÈÎfi ÂÂÈÛfi‰ÈÔ, ηٿ ÙËÓ ÔÔ›· ÂϤÁ¯ıËÎ·Ó ÔÈ ·Ú·Î¿Ùˆ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜: ¯ÚfiÓÔ˜ ıÚÔÌ‚›Ó˘ (ã), ¯ÚfiÓÔ˜ ÚÔıÚÔÌ‚›Ó˘ (ö), ¯ÚfiÓÔ˜ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ (APTT), ÈÓˆ‰ÔÁfiÓÔ, ·Ú¿ÁÔÓÙ·˜ ππ, VII, VIII, XII (ËÎÙÈÎÔÏÔÁÈ΋ ̤ıÔ‰Ô˜ Û ·˘ÙfiÌ·ÙÔ ·Ó·Ï˘Ù‹ [Combi, Organon, Technika ]), ·ÓÙÈıÚÔÌ‚›ÓË πππ (∞∆πππ), ÚˆÙ½ÓË C (PC), ÔÏÈ΋ ÚˆÙ½ÓË S (PS), Ï·ÛÌÈÓÔÁfiÓÔ (Plg) (̤ıÔ‰Ô˜ ¯ÚˆÌÔÁfiÓÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜ [Chromogenix]), ·ÓÙÈÛÒÌ·Ù· ηډÈÔÏÈ›Ó˘ (ACA) (Elisa) (Quanta Lite, Inova), APCR (activated protein C resistance), (ËÎÙÈÎÔÏÔÁÈ΋ ̤ıÔ‰Ô˜ [Chromogenix]), ¢-‰ÈÌÂÚ‹ (̤ıÔ‰Ô˜ ·ÓÔÛÔÎÚÔη‰ˆÛ˘ [Latex, Biopool]), ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ (LA) (Ì ÙÚÂȘ ‰È·ÊÔÚÂÙÈΤ˜ ËÎÙÈÎÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜: TTI, PNP [Stago], dRVVT [Akzo]), FV Leiden Î·È FII 20210 A Ì PCR Ù¯ÓÈΤ˜ [Vienna Lab Kit], Â›‰· ÔÌÔ΢ÛÙ½Ó˘ ÛÙÔ ·›Ì·.

∞ÔÙÂϤÛÌ·Ù· ∏ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ‹Ù·Ó ¿ÏÏÔÙ ¿ÏÏË, ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ıÚfiÌ‚Ô˘. ∂›ÎÔÛÈ Ù¤ÛÛÂÚ·

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·25

¶·È‰È·ÙÚÈ΋ 2002;65:23-31

Paediatriki 2002;65:23-31

·È‰È¿ ·ÚÔ˘Û›·Û·Ó ËÌÈ¿ÚÂÛË ‹ ÂÙÂÚfiÏ¢ÚË ·‰˘Ó·Ì›· Î·È ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ·. ¢Ò‰Âη ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÎÂÊ·Ï·ÏÁ›·, 9 ·È‰È¿ Û·ÛÌÔ‡˜, 6 Ï‹ı·ÚÁÔ, 6 ·Ê·ÛÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÂÓÒ 8 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ¿ÏÏ· Û˘ÌÙÒÌ·Ù·, fiˆ˜ ‰Èψ›·, ̇ÛË, ÙÚfiÌÔ, ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘, ¯ÔÚÂÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ, ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜, Û‡Á¯˘ÛË. 15/48 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó Û˘Ó‰˘·ÛÌfi ‰‡Ô ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ Û˘Ìو̿وÓ. ∏ ‰È¿ÁÓˆÛË Ù¤ıËΠ̛̠· ‹ ÂÚÈÛÛfiÙÂÚ˜ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT) ¤ÁÈÓ Û 43 ·È‰È¿ Î·È ·Ó¤‰ÂÈÍ ıÚfiÌ‚ˆÛË ÛÙ· 29, ÂÓÒ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ¤ÁÈÓ Û 30 ·È‰È¿ Î·È ‹Ù·Ó ıÂÙÈ΋ Û fiÏ·. ∏ Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ‹Ù·Ó ıÂÙÈ΋ ÛÙ· 8 ·fi Ù· 12 ·È‰È¿ ÛÙ· ÔÔ›· ¤ÁÈÓÂ, Ë „ËÊȷ΋ ·ÁÁÂÈÔÁÚ·Ê›· Û 6/7, Ë Û˘Ì‚·ÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· Û 3/4 Î·È ÙÔ ‰È·ÎÚ¿ÓÈÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Û 2/2 ·È‰È¿. ™Â 32/48 ·È‰È¿ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘. ™‡Ìʈӷ Ì ٷ Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ıÚfiÌ‚Ô˘, Ù· £∂ ÙÔ˘ ∫¡™ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· (arterial border infarcts): n=19 (39,5%), ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ (fiÙ·Ó ‹Ù·Ó ÂÌÊ·Ó‹˜ Ë ·fiÊÚ·ÍË Û˘ÁÎÂÎÚÈ̤Ó˘ ·ÚÙËÚ›·˜): n=18 (37,5%) Î·È Û ıÚÔÌ‚ÒÛÂȘ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘: n=11 (22,9%). ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿ Ì ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË, Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË ·ÔÙÂÏÔ‡ÛÂ Ë Ì¤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· (·ÚÈÛÙÂÚ‹ n=6, ‰ÂÍÈ¿ n=4), ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë Ô›ÛıÈ· ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· (·ÚÈÛÙÂÚ‹ n=5, ‰ÂÍÈ¿ n=2), ÂÓÒ ¤Ó· ·È‰› ›¯Â ·fiÊÚ·ÍË Ù˘ ‚·ÛÈ΋˜ ·ÚÙËÚ›·˜. ™ÙÔ˘˜ ÊÏ‚҉ÂȘ ÎfiÏÔ˘˜, Ô ıÚfiÌ‚Ô˜ ÂÎÙÂÈÓfi-

Ù·Ó Û ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi ¤Ó· Û 8/11 ·È‰È¿ (72,7%). ™˘ÁÎÂÎÚÈ̤ӷ, ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÂÁοÚÛÈÔ˘ ÎfiÏÔ˘ ‰È·ÈÛÙÒıËΠ۠8 ÂÚÈÙÒÛÂȘ, ÙÔ˘ Ô‚ÂÏÈ·›Ô˘ Û 6, ÙÔ˘ ¢ı¤Ô˜ ÎfiÏÔ˘ Û 3, ÙÔ˘ ÛÈÁÌÔÂȉԇ˜ Û 3, ÙÔ˘ ÛËÚ·ÁÁÒ‰Ô˘˜ Û ̛· ÂÚ›ÙˆÛË, Ù˘ ÊϤ‚·˜ ÙÔ˘ °·ÏËÓÔ‡ Û ̛·. ∂¤ÎÙ·ÛË ÙÔ˘ ıÚfiÌ‚Ô˘ ÛÙË ÛÊ·Á›Ùȉ· ÊϤ‚· ·ÚÔ˘Û›·Û·Ó 3 ·È‰È¿. ∂ÎÙÂٷ̤ÓË ıÚfiÌ‚ˆÛË ·ÚÔ˘Û›·Û·Ó Ù¤ÛÛÂÚ· ·È‰È¿ (8,3%). £ÚfiÌ‚ˆÛË Û ÔÏÏ·Ï¿ ÛËÌ›· ·Ú·ÙËÚ‹ıËΠ۠ÂÙ¿ ·È‰È¿ (14,6%). ™Â ‰‡Ô ·fi ·˘Ù¿, Ì¿ÏÈÛÙ·, ÙÔ £∂ ÙÔ˘ ∫¡™ ‹Ù·Ó ‰Â˘ÙÂÚÔ·ı¤˜ ·fi ıÚfiÌ‚ˆÛË Û ¿ÏÏÔ ÛËÌÂ›Ô ÙÔ˘ ÛÒÌ·ÙÔ˜: ¤Ó· ·È‰› Ì ϤÌʈ̷ Î·È Î·ıÂÙ‹Ú· Hickman ·ÚÔ˘Û›·Û ıÚfiÌ‚ˆÛË ÛÙÔ ‰ÂÍÈfi ÎfiÏÔ Î·È ·ÎÔÏÔ‡ıˆ˜ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ, ÂÓÒ ¤Ó· ‰Â‡ÙÂÚÔ ·È‰› ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· ·ÚÔ˘Û›·Û ıÚfiÌ‚ˆÛË ‰ÂÍÈÔ‡ ÎfiÏÔ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ Î·È ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË. ∏ ıÚfiÌ‚ˆÛË ‹Ù·Ó ˘ÔÙÚÔÈ¿˙Ô˘Û· Û 3 ·È‰È¿ (6,25%).

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ıÚÔÌ‚ÔÊÈÏ›· ‹Ù·Ó ÂÎÙÂٷ̤ÓÔ˜, ˆÛÙfiÛÔ fiÏ· Ù· ·È‰È¿ ‰ÂÓ ÂϤÁ¯ıËÎ·Ó Ì fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÛÙËÓ ÔÍ›· Ê¿ÛË, ‰ÈfiÙÈ Ô ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ıÚÔÌ‚ÔÊÈÏÈÎÒÓ ·Ú·ÁfiÓÙˆÓ APCR, FV Leiden Î·È FII 20210 A ¤ÁÈÓ ÂÊÈÎÙfi˜ Ù· ÙÂÏÂ˘Ù·›· ÌfiÏȘ ¯ÚfiÓÈ·. ™ÙËÓ ÔÍ›· Ê¿ÛË ÂϤÁ¯ıËÎ·Ó 38 ·È‰È¿, 7 ·È‰È¿ ÂϤÁ¯ıËÎ·Ó ÌfiÓÔ Î·Ù¿ ÙËÓ ‡ÊÂÛË (ÂÚÈÛÛfiÙÂÚÔ ·fi 10 Ë̤Ú˜ ·fi ÙÔ ÂÂÈÛfi‰ÈÔ), ÂÓÒ 23 ·È‰È¿ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙËÓ ÚfiÛÎÏËÛ‹ Ì·˜ ÁÈ· Â·Ó¤ÏÂÁ¯Ô Ì fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ¤ÙÔ˘˜ 1998, ‰ËÏ·‰‹ Ì‹Ó˜ ‹ Î·È ¯ÚfiÓÈ· (̤ÛÔ ‰È¿ÛÙËÌ· 4 ¯ÚfiÓÈ·) ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ (¶›Ó·Î·˜ 1).

¶›Ó·Î·˜ 1. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ıÚÔÌ‚ÔÊÈÏ›·˜ ¢ÔÎÈÌ·Û›· I FII FVII FVIII XII ATIII PC PS Plg APCR <2 FV Leiden FII 20210A LA (+) ACA (+) ÀÂÚoÌo΢ÛÙÂ˚Ó·ÈÌ›·

OÍ›· Ê¿ÛË n=38

∂·Ó¤ÏÂÁ¯Ô˜ n=30

4/24 0/4 2/8 5/16 0/3 4/37 4/36 3/30 2/20 3/15 2/8 0/8 1/17 3/15 2/13

1/27 2/26 0/25 1/18 0/9 0/30 0/30 1*/30 0/28 0/27 1/24 1/24 6/28 1/23 0/3

™‡ÓÔÏÔ n=48 % 5/40 2/31 2/32 6/30 0/12 4/46 4/45 4/41 2/36 3/34 3/32 1/32 6/34 4/28 2/15

12,5 6,5 6,25 20 0 8,7 8,9 9,8 5,6 8,8 9,4 3 17,6 14,3 13,3

* PS: 20% - ∫ÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹;

25

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·26

¶·È‰È·ÙÚÈ΋ 2002;65:23-31

™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ì ‰È·ÈÛو̤ÓË ‰È·Ù·Ú·¯‹, Û ۯ¤ÛË Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ù· ÔÔ›· ÂϤÁ¯ıËÎ·Ó ÁÈ· ÙÔÓ Î¿ı ÚÔıÚÔÌ‚ˆÙÈÎfi ·Ú¿ÁÔÓÙ· ÛÙËÓ ÔÍ›· Ê¿ÛË Î·È ÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÛÙ‹ÏË Ê·›ÓÂÙ·È Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ì ‰È·ÈÛو̤ÓË ‰È·Ù·Ú·¯‹ ÚÔ˜ ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ıËÎ·Ó ÁÈ· οı ÚÔıÚÔÌ‚ˆÙÈÎfi ·Ú¿ÁÔÓÙ·. ™˘ÓÔÏÈο 23/48 ·È‰È¿ (47,9%) ·ÚÔ˘Û›·Û·Ó Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜. ∞fi ·˘Ù¿, 18 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó Â›ÎÙËÙ˜ ‰È·Ù·Ú·¯¤˜ ÛÙËÓ ÔÍ›· Ê¿ÛË Î·È 8 ·È‰È¿ ÎÏËÚÔÓÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜. ™˘Ó‰˘·ÛÌfi˜ ÎÏËÚÔÓÔÌÈ΋˜ Î·È Â›ÎÙËÙ˘ ‰È·Ù·Ú·¯‹˜ ‰È·ÈÛÙÒıËΠ۠3 ·È‰È¿ (¶›Ó·Î·˜ 2).

OÈ ÎÏËÚÔÓÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‹Ù·Ó ÔÈ ÂÍ‹˜: ·ÓÂ¿ÚÎÂÈ· PS: 1/41 (2,4%), APCR ¯ˆÚ›˜ ÙË ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ÛÙÔÓ ·Ú¿ÁÔÓÙ· V: 1/34 (2,9%), FV Leiden: 3/32 (9,4%) (ÂÙÂÚÔ˙˘ÁÒÙ˜), FII 20210 A: 1/32 (3,1%) (ÂÙÂÚÔ˙˘ÁÒÙ˘) Î·È ÔÌÔ΢ÛÙÈÓ·ÈÌ›·: 2/15 (13,3%) (ÔÌÔ˙˘ÁÒÙ˜).

OÈ Â›ÎÙËÙ˜ ‰È·Ù·Ú·¯¤˜ ‹Ù·Ó ÔÈ ÂÍ‹˜: ·˘ÍË̤ÓÔ ( ) ÈÓˆ‰ÔÁfiÓÔ: 4/24 (16,7%), FVII: 2/8 (25%), FVIII: 5/16 (31,25%), ·ÓÂ¿ÚÎÂÈ· ( )ATIII: 4/37 (10,8%), PC: 4/36 (11,1%), PS: 3/30 (10%), Plg: 2/20 (10%), LA ıÂÙÈο (+): 1/17 (5,9%) Î·È ∞CA (+): 3/15 (20%). ¢Âη٤ÛÛÂÚ· ·È‰È¿ ›¯·Ó ·ÚÔ‰ÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ·ԉ›¯ıËΠÛÙÔÓ Â·Ó¤ÏÂÁ¯Ô. ™Â 4 ·È‰È¿ ‰ÂÓ ‰È¢ÎÚÈÓ›ÛÙËÎÂ Ë Ê‡ÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ. ∞fi ·˘Ù¿, Ù· 3 η٤ÏËÍ·Ó Î·È ÙÔ Ù¤Ù·ÚÙÔ ‰ÂÓ Â·Ó‹Ïı ÁÈ· Â·ÓÂͤٷÛË. ŒÓ· ·È‰› ›¯Â ·˘ÍË̤ӷ Â›‰· ·Ú¿ÁÔÓÙ· VIII ÛÙËÓ ÔÍ›· Ê¿ÛË, ÙÔ ‰Â‡ÙÂÚÔ ·È‰› ›¯Â ·ÓÂ¿ÚÎÂÈ· ∞∆πππ, ƒC, Plg Î·È ·˘ÍË̤ÓÔ ÈÓˆ‰ÔÁfiÓÔ Î·È ÙÔ ÙÚ›ÙÔ ·ÓÂ¿ÚÎÂÈ· ∞∆πππ, ƒC Î·È ÂÙÂÚÔ˙˘ÁˆÙ›· FV Leiden. ∆Ô Ù¤Ù·ÚÙÔ ·È‰› ‹Ù·Ó ıÂÙÈÎfi ÁÈ· ∞CA IgG. ªfiÓÈÌË Â›ÎÙËÙË ‰È·Ù·Ú·¯‹ ‰ÂÓ ·ÚÔ˘Û›·Û ηӤӷ ·È‰›. ∫·Ù¿ ÙÔÓ Â·Ó¤ÏÂÁ¯Ô Ô˘ ‰ÈÂÓÂÚÁ‹ıËΠÛÙ· ¶›Ó·Î·˜ 2. ∫ÏËÚÔÓÔÌÈÎÔ› ‹ Â›ÎÙËÙÔÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™ ñ ™‡ÓÔÏÔ ‰È·Ù·Ú·¯ÒÓ: 23/48 ·È‰È¿ (48%) ñ ∫ÏËÚÔÓÔÌÈΤ˜ ‰È·Ù·Ú·¯¤˜: 8 ·È‰È¿ ∞ÓÂ¿ÚÎÂÈ· PS 1/41 (2,4%), APCR 1/34 (2,9%) FV Leiden 3/32 (9,4%), ·Ú·ÏÏ·Á‹ FII 1/32 (3,1%) OÌÔ΢ÛÙÈÓ·ÈÌ›· 2/15 (13,3%) ñ ∂›ÎÙËÙ˜ ‰È·Ù·Ú·¯¤˜: 18 ·È‰È¿ I 4/24 (16,7%), VII 2/8 (25%), VIII 5/16 (31,25%), ATIII 4/37 (10,8%), PC 4/36 (11,1%), PS 3/30 (10%) Plg 2/20 (10%), LA (+) 1/17 (5,9%), ACA (+) 3/15 (20%) ñ ™˘Ó‰˘·ÛÌfi˜ ÎÏËÚÔÓÔÌÈ΋˜ Î·È Â›ÎÙËÙ˘ ‰È·Ù·Ú·¯‹˜: 3 ·È‰È¿

26

Paediatriki 2002;65:23-31

·È‰È¿, ‰È·ÈÛÙÒıËÎ·Ó ÔÈ ÂÍ‹˜ ‰È·Ù·Ú·¯¤˜: ÈÓˆ‰ÔÁfiÓÔ: 1 (ϤÌʈ̷), FII: 2 (Ô ¤Ó·˜ ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· FII 20210 A), FVIII: 1 (O§§) Î·È ∞CA (+): 1 (ACA ‰ÂÓ Â›¯Â ÚÔÛ‰ÈÔÚÈÛÙ› ÛÙËÓ ÔÍ›· Ê¿ÛË). ∂›Û˘, Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ì ÙËÓ Ù¯ÓÈ΋ ∆∆π ‚Ú¤ıËΠLA (+) Û 6 ·È‰È¿, ÂÓÒ ÔÈ ÂȂ‚·ÈˆÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ PNP Î·È dRVVT ‹Ù·Ó ·ÚÓËÙÈΤ˜. ÀÔΛÌÂÓË ÓfiÛÔ˜ ‰È·ÈÛÙÒıËΠ۠19/48 ·È‰È¿ (38,6%): ηÎÔ‹ıÂÈ· Û 5, Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· 3, ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ 2, ÌËÓÈÁÁ›Ùȉ· 2, Ì·ÛÙÔÂȉ›Ùȉ· 2, ÛË„·ÈÌ›· 1, ·ÓÂÌ¢ÏÔÁÈ¿ 1, ÈÔÁÂÓ‹˜ Ïԛ̈ÍË 1, ·ÁÁÂȷ΋ ‰˘ÛÏ·Û›· 1 Î·È ÂÙÂÚÔ˙˘ÁˆÙ›· ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜ Û 1. ™˘ÁÎÂÎÚÈ̤ӷ, ˘ÔΛÌÂÓË ÓfiÛÔ ·ÚÔ˘Û›·˙·Ó 6/19 ·È‰È¿ Ì ÈÛ¯·ÈÌÈÎfi ¤ÌÊÚ·ÎÙÔ, 4/18 Ì ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË Î·È 9/11 Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ. ¶Èı·Ófi ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ·ÚÔ˘Û›·Û·Ó 7/48 ·È‰È¿ (14,6%): ÙÚ·˘Ì·ÙÈÛÌfi˜: 2, ηıÂÙ‹Ú·˜ ∏ickman: 2, ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË: 2, ·¯˘Û·ÚΛ·: 1, ıÂÚ·›· Ì L-asparaginase: 1, ·Ê˘‰¿ÙˆÛË: 1. ¢‡Ô ·È‰È¿ ›¯·Ó ‰‡Ô Èı·Ó¿ ÂÎÏ˘ÙÈο ·›ÙÈ·. °ÂÓÈο, ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚfiÌ‚ˆÛË, ‰ËÏ·‰‹ ˘ÔΛÌÂÓË ÓfiÛÔ ‹/Î·È ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ‹/Î·È ÚÔıÚÔÌ‚ˆÙÈÎfi ·Ú¿ÁÔÓÙ·, ·ÚÔ˘Û›·˙·Ó 33/48 ·È‰È¿ (68,75%), ÂÓÒ ÌfiÓÔ 15 ·È‰È¿ (31,25%) ‰ÂÓ Â›¯·Ó ηӤӷ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 3). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·›·, Ù· ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· Î·È ÔÈ ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ˆ˜ Â› ÙÔ Ï›ÛÙÔÓ Û˘ÓÙËÚËÙÈο (¶›Ó·Î·˜ 4). ¶¤ÓÙ ·È‰È¿ Ì ıÚfiÌ‚ˆÛË Û ÔÏÏ·Ï¿ ÛËÌ›· ‹ ˘ÔÙÚÔÈ¿˙Ô˘Û· ıÚfiÌ‚ˆÛË ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ‹/Î·È ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹. ™˘ÁÎÂÎÚÈ̤ӷ, ¤Ó· ·È‰› Ì ηÎÔ‹ıÂÈ· Î·È Î·ıÂÙ‹Ú· ∏ickman ›¯Â ıÚfiÌ‚ˆÛË ÛÙÔ ‰ÂÍÈfi ÎfiÏÔ Î·È ‰Â˘ÙÂÚÔ·ı¤˜ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ. ∆Ô ·È‰› ·˘Ùfi ¤Ï·‚ ıÚÔÌ‚fiÏ˘ÛË (rtPA), ·ÓÙÈËÎÙÈ΋ (Ë·Ú›ÓË, ‚·ÚÊ·Ú›ÓË) Î·È ·ÓÙÈ·ÈÌÔÂÙ·Ïȷ΋ (·ÛÈÚ›ÓË) ·ÁˆÁ‹. ∂›¯Â ηϋ ÎÏÈÓÈ΋ ¤Î‚·ÛË Ì ‰È·ÈÛو̤ÓË ·ÂÈÎÔÓÈÛÙÈο χÛË ÙÔ˘ ıÚfiÌ‚Ô˘. ¶·È‰› Ì ıÚfiÌ‚ˆÛË Û ÔÏÏ·Ï¿ ÛËÌ›· (ÂÚÈÊÂÚÈΤ˜ ·ÚÙËڛ˜ οو ¿ÎÚˆÓ, Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ Î·È ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ) ¤Ï·‚ ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ ¶›Ó·Î·˜ 3. ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚfiÌ‚ˆÛË Û ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™

ñ ÀÔΛÌÂÓË ÓfiÛÔ˜ ñ ∂ÎÏ˘ÙÈÎfi ·›ÙÈÔ ñ ¶ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ i) ÎÏËÚÔÓÔÌÈÎÔ› ii) Â›ÎÙËÙÔÈ ñ 1 ‹ ÂÚÈÛÛfiÙÂÚÔÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘

n=48

%

19/48 7/48 23/48 8/48 18/48

38,58 14,6 47,9

33/48

68,75

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·27

¶·È‰È·ÙÚÈ΋ 2002;65:23-31

Paediatriki 2002;65:23-31

¶›Ó·Î·˜ 4. ∂›‰Ô˜ ıÂÚ·¢ÙÈ΋˜ ·ÁˆÁ‹˜ Û ·È‰È¿ Ì ¤ÌÊÚ·ÎÙÔ, ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™ ‹ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ

ŒÌÊÚ·ÎÙ· (n=19) ∞ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË (n=18) £ÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ (n=11)

rtPA1

SH2

1

3 1 4

5

£ÂÚ·›· LMWH3 1 2

Warfarin4

ASA5

η̛·

3 1 5

4 6

13 10 5

1

·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˜ ÂÓÂÚÁÔÔÈËÙ‹˜ ÈÛÙÈÎÔ‡ Ï·ÛÌÈÓÔÁfiÓÔ˘ (recombinant tissue plasminogen activator) Ó·ÙÚÈÔ‡¯Ô˜ Ë·Ú›ÓË (sodium heparin) 3 ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË (low molecular weight heparin) 4 ‚·ÚÊ·Ú›ÓË 5 ·ÛÈÚ›ÓË (acetyl-salycilic acid) 2

(Ë·Ú›ÓË, ‚·ÚÊ·Ú›ÓË), ˆÛÙfiÛÔ ·ÚÁfiÙÂÚ· ‰È·ÈÛÙÒıËΠ˘ÔÏÂÈÌÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÎÈÓËÙÈ΋ ÛËÌÂÈÔÏÔÁ›·. ŒÓ· ·È‰› Ì ˘ÔÙÚÔÈ¿˙ÔÓ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ ÙÔ˘ ∫¡™ ¤Ï·‚ ÁÈ· ÙÔ ‰Â‡ÙÂÚÔ ÂÂÈÛfi‰ÈÔ ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Ë·Ú›ÓË (LMWH) Î·È ‚·ÚÊ·Ú›ÓË. ∂›¯Â ηϋ ÎÏÈÓÈ΋ ÔÚ›· Î·È Ï‡ÛË ÙÔ˘ ıÚfiÌ‚Ô˘. ¢‡Ô ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™ ¤Ï·‚·Ó Â›Û˘ ıÂÚ·›·. ™ÙÔ ÚÒÙÔ ¯ÔÚËÁ‹ıËÎ·Ó ÎÔ˘Ì·ÚÈÓÈο (¿ÁÓˆÛÙË ¤Î‚·ÛË) Î·È ÙÔ ‰Â‡ÙÂÚÔ Ô˘ ›¯Â ıÚfiÌ‚ˆÛË Û ÔÏÏ·Ï¿ ÛËÌ›· (‰ÂÍÈfi ÎfiÏÔ Î·È Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹), ¤Ï·‚ Ë·Ú›ÓË, ·ÏÏ¿ ÛÙË Û˘Ó¤¯ÂÈ· η٤ÏËÍÂ. ∞fi Ù· ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÙˆÓ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ, Ù· ¤ÍÈ ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ‹/Î·È ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, Ì ηϋ ÎÏÈÓÈ΋ ÔÚ›· Î·È ‰È·ÈÛو̤ÓË Ï‹ÚË Ï‡ÛË ÙÔ˘ ıÚfiÌ‚Ô˘ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi Â·Ó¤ÏÂÁ¯Ô. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ Ì·˜, ¤ÓÙ η٤ÏËÍ·Ó - Ù· 4 ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÚfiÌ‚ˆÛ˘ (ıÓËÙfiÙËÙ· 8,3%). ∞fi Ù· ˘fiÏÔÈ· ·È‰È¿, ÁÓˆÚ›˙Ô˘Ì ÙËÓ ÎÏÈÓÈ΋ ÔÚ›· Û ÙÚÈ¿ÓÙ· ¤Ó·. ∫·Ï‹ ÔÚ›· ›¯·Ó 13 ·È‰È¿ (41,9%), ÂÓÒ 18/31 (58%) ·ÚÔ˘Û›·Û·Ó ÂÈÏÔΤ˜: 15 ·È‰È¿ Ì ÈÛ¯·ÈÌÈÎfi ¤ÌÊÚ·ÎÙÔ ‹ ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË Â›¯·Ó ÎÈÓËÙÈΤ˜ ÂÈÏÔΤ˜ ‹/Î·È Û·ÛÌÔ‡˜, ÂÓÒ 3 ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·ÚÔ˘Û›·Û·Ó ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË. ∞ÂÈÎÔÓÈÛÙÈÎfi˜ Â·Ó¤ÏÂÁ¯Ô˜ ¤ÁÈÓ Û 22 ·È‰È¿ Î·È ‰È·ÈÛÙÒıËΠÏ‹Ú˘ χÛË ÙÔ˘ ıÚfiÌ‚Ô˘ Û 13 ·È‰È¿ (59%) (Ù· 6 ¤Ï·‚·Ó ·ÓÙÈËÎÙÈ΋ ‹/Î·È ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹), ÌÂÚÈ΋ χÛË Û 2 (9,1%) (Î·È Ù· ‰‡Ô ¤Ï·‚·Ó ıÂÚ·›·), ÂÓÒ 7 ·È‰È¿ - ÂÎ ÙˆÓ ÔÔ›ˆÓ ÌfiÓÔ ¤Ó· ¤Ï·‚ ıÂÚ·›· - ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ‚ÂÏÙ›ˆÛË (31,8%). ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, 6/11 ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ¤Ï·‚·Ó ıÂÚ·›· Î·È fiÏ· ·ÚÔ˘Û›·Û·Ó χÛË ÙÔ˘ ıÚfiÌ‚Ô˘ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi Â·Ó¤ÏÂÁ¯Ô. ∞fi Ù· ˘fiÏÔÈ· ¤ÓÙ ·È‰È¿ Ô˘ ‰ÂÓ ‹Ú·Ó ıÂÚ·›·, ÌfiÓÔ ¤Ó· ·ÚÔ˘Û›·Û χÛË

ÙÔ˘ ıÚfiÌ‚Ô˘, ÙÚ›· ·Ó¤Ù˘Í·Ó ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË, ÂÓÒ ÙÔ ¤ÌÙÔ ·È‰› ‰ÂÓ Â·Ó‹Ïı ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË Î·È Â›Ó·È ¿ÁÓˆÛÙË Ë ÎÏÈÓÈ΋ ÙÔ˘ ¤Î‚·ÛË. ™˘˙‹ÙËÛË ∆· ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· (£∂) ·ÔÙÂÏÔ‡Ó ˘·ÚÎÙfi Úfi‚ÏËÌ· ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·, ÌÔÏÔÓfiÙÈ Â›Ó·È ·ÚÎÂÙ¿ Û¿ÓÈ· [(Ë Û˘¯ÓfiÙËÙ· ·Ó·Ê¤ÚÂÙ·È 1/100.000/¤ÙÔ˜ ÙÔ 1997 (1) ¤ˆ˜ 3,3/100.000 ·Ó¿ ¤ÙÔ˜ ÙÔ 2000 (2)]. ∏ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ‰ÈÏ¿ÛÈÔ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ‰ÂηÂÙÈÒÓ) ·Ô‰›‰ÂÙ·È ÛÙÔ fiÙÈ ·È‰È¿ Ì ÛÔ‚·Ú¿ ÓÔÛ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ıÚÔÌ‚ÔÂÌ‚ÔÏÈο ÂÂÈÛfi‰È· fiˆ˜ ÔÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÔÈ Î·ÎÔ‹ıÂȘ, ¤¯Ô˘Ó Û‹ÌÂÚ· Ì·ÎÚ¿ ÂÈ‚›ˆÛË, ·ÓÙ›ıÂÙ· Ì ÙÔ ·ÚÂÏıfiÓ Ô˘ ·ÚÔ˘Û›·˙·Ó ·˘ÍË̤ÓË ıÓËÙfiÙËÙ· (2). ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ £∂ ÛÙ· ·È‰È¿ Î·È Ù· Ó·ڿ ¿ÙÔÌ· Â›Ó·È ¿ÁÓˆÛÙË, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÎÙÂٷ̤Ó˜ ÌÂϤÙ˜. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÈÌÔÛÙ·ÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, Û˘ÁÁÂÓ›˜ ‹ Â›ÎÙËÙ˜, ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ Ó·ÓÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (stroke) (5). ∂ÓÙÔ‡ÙÔȘ, Ë ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË Î·È ÂÈϤÔÓ ·ÓÙÈÊ·ÙÈ΋. ∆· £∂ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ ‰È·Ê¤ÚÔ˘Ó ·fi ·˘Ù¿ ÙˆÓ ÂÓËÏ›ÎˆÓ Û ÙÚ›· ÛËÌ›·: ÙËÓ ·Ó·ÙÔÌÈ΋ ı¤ÛË Ù˘ ‚Ï¿‚˘, ÙËÓ ‡·ÚÍË ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÙËÓ ÎÏÈÓÈ΋ ÔÚ›·. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÍ·ÚÙ¿Ù·È ·ÛÊ·ÏÒ˜ ·fi ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ ıÚfiÌ‚Ô˘ ÛÙÔ ∫¡™. ∆· Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· ÁÈ· Ù· ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· Î·È ÙȘ ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ Â›Ó·È ÔÍ›· ·‰˘Ó·Ì›· ‹ ËÌÈÏËÁ›·, ËÌÈ·ÈÛıËÛ›·, ‰È·Ù·Ú·¯‹ ÙÔ˘ ÏfiÁÔ˘, ·Ê·Û›·, ‰˘Û·ÚıÚ›·, ÂÏÏ›ÌÌ·Ù· ÔÙÈÎÔ‡ ‰›Ô˘, ‰È·Ù·Ú·¯‹ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘, ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ‹ ÂÛÙÈ·ÎÔ› Û·ÛÌÔ›, ·Ù·Í›· (4,6,7). ∆· ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÈ¤‰Ô˘ Û˘Ó›‰ËÛ˘

27

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·28

¶·È‰È·ÙÚÈ΋ 2002;65:23-31

Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Èı·Ófi Ó· ¤¯Ô˘Ó ·ÌÊÔÙÂÚfiÏ¢ÚË ‚Ï¿‚Ë (7). ŸÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÊÏ‚È΋ ıÚfiÌ‚ˆÛË, Ù· Û˘ÌÙÒÌ·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘Ó‹ıˆ˜ ÎÂÊ·Ï·ÏÁ›·, ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ‹ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜, ·Ú¿Ï˘ÛË ÎÚ·ÓÈ·ÎÒÓ Ó‡ڈÓ, „˘¯È·ÙÚÈο Û˘ÌÙÒÌ·Ù·, ‰È¿Ù·ÛË ÂÈÔÏ‹˜ ÊÏ‚ÒÓ ¿Óˆ ·fi ÙÔ ıÚÔÌ‚ˆÌ¤ÓÔ ÎfiÏÔ (ÎÂÊ·Ï‹ ª¤‰Ô˘Û·˜) (8). ™Ù· ÓÂÔÁÓ¿ Î·È Ù· ÌÈÎÚ¿ ‚Ú¤ÊË, Ù· £∂ ÂΉËÏÒÓÔÓÙ·È Û˘Ó‹ıˆ˜ Ì ·ÓÂÍ‹ÁËÙÔ˘˜ Û·ÛÌÔ‡˜ ‹ Ï‹ı·ÚÁÔ, ÂÓÒ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛËÌ›· ·˘ÍË̤Ó˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ›ÂÛ˘ (9,10). ∆· ·È‰È¿ Ù˘ ‰È΋˜ Ì·˜ ÌÂϤÙ˘ ·ÚÔ˘Û›·˙·Ó ÂÙÂÚfiÏ¢ÚË ·‰˘Ó·Ì›· ‹ ËÌÈ¿ÚÂÛË, ÎÂÊ·Ï·ÏÁ›·, Û·ÛÌÔ‡˜, Ï‹ı·ÚÁÔ, ·Ê·ÛÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÈÔ Û¿ÓÈ· ‰Èψ›·, ̇ÛË, ÙÚfiÌÔ, ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘, ¯ÔÚÂÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ, ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‹ Û‡Á¯˘ÛË. 15/48 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· Û˘ÌÙÒÌ·Ù·. ∏ ‰È¿ÁÓˆÛË ÙˆÓ £∂ ÙÔ˘ ∫¡™ Ù›ıÂÙ·È Ì ·ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂıfi‰Ô˘˜. ∏ ªRI ˘ÂÚ¤¯ÂÈ Ù˘ CT ÛÙËÓ ·ÂÈÎfiÓÈÛË Ù˘ ÂÓÙfiÈÛ˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ‚Ï¿‚˘ (4), ηıÒ˜ Î·È ÛÙÔÓ ¯·Ú·ÎÙËÚÈÛÌfi ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ (stroke) (7). OÈ ÔÏÏ·Ϥ˜ ÙÔ̤˜ ·˘Í¿ÓÔ˘Ó ÛËÌ·ÓÙÈο ÙËÓ Èı·ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ·ÓˆÌ·ÏÈÒÓ. ∏ ªRI ˘ÂÚ¤¯ÂÈ Î·È ÛÙË ‰È¿ÁÓˆÛË Ù˘ ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘ ÙÔ˘ ∫¡™ (8-11). ∏ CT Â›Ó·È Û˘¯Ó¿ ·ıÔÏÔÁÈ΋, fï˜ Ù· Â˘Ú‹Ì·Ù· ‰ÂÓ Â›Ó·È ÂȉÈο Î·È ÛÙÔ ÚÒÈÌÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∏ ªRI ·ÂÈÎÔÓ›˙ÂÈ ÙfiÛÔ ÙË ÚÔ‹, fiÛÔ Î·È ÙË ÛÙ¿ÛË ÙÔ˘ ·›Ì·ÙÔ˜ ÚˆÈÌfiÙÂÚ· ·fi ÙË CT. øÛÙfiÛÔ, Ë ·ÁÁÂÈÔÁÚ·Ê›· ·ÔÙÂÏ› ÙË Ì¤ıÔ‰Ô ÂÎÏÔÁ‹˜ (8). ÕÏÏÔÈ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô Û˘Ó‰˘·ÛÌfi˜ MRI Î·È MRA Ê·›ÓÂÙ·È Ó· Â›Ó·È Ë ÂͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÂÈÎfiÓÈÛË ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘ ÙÔ˘ ∫¡™ Î·È Ë Û˘Ì‚·ÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· Ú¤ÂÈ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È fiÙ·Ó ˘¿Ú¯ÂÈ ÎÏÈÓÈ΋ ˘Ô„›· Ì ·ÚÓËÙÈ΋ MRI (12). H „ËÊȷ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÏÂÔÓÂÎÙ› ¤Ó·ÓÙÈ Ù˘ ÎÏ·ÛÈ΋˜ ˆ˜ ÚÔ˜ ÙÔ ÎfiÛÙÔ˜, ÙËÓ Â˘ÎÔÏ›· ‰ÈÂÓ¤ÚÁÂÈ·˜ Î·È ÛÙÔ fiÙÈ Â›Ó·È ·Ó·›Ì·ÎÙË Ù¯ÓÈ΋ (8). ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, Ë CT ·Ó¤‰ÂÈÍ ıÚfiÌ‚ˆÛË Û 29/43 ·È‰È¿, ÂÓÒ Ë MRI ‹Ù·Ó ıÂÙÈ΋ Î·È ÛÙ· 30 ·È‰È¿ Ô˘ ˘Ô‚Ï‹ıËÎ·Ó Û ·˘Ù‹. ª·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›·, „ËÊȷ΋ ·ÁÁÂÈÔÁÚ·Ê›· Î·È ÎÏ·ÛÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ¤ÁÈÓ·Ó Û ÏÈÁfiÙÂÚ· ·È‰È¿. ™Ù· 32/48 ·È‰È¿ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ·ÂÈÎÔÓÈÛÙÈΤ˜ ̤ıÔ‰ÔÈ, ÁÂÁÔÓfi˜ Ô˘ ˘ÔÁÚ·ÌÌ›˙ÂÈ ÙË ‰˘ÛÎÔÏ›· ÂÓÙÔÈÛÌÔ‡ Ù˘ ‚Ï¿‚˘ Ì ̛· ÌfiÓÔ Ì¤ıÔ‰Ô, ηıÒ˜ Î·È ÙÔ fiÙÈ Î·Ì›· ·ÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ ‰ÂÓ Â›Ó·È È‰·ÓÈ΋ Î·È ÈηӋ ·fi ÌfiÓË Ù˘ Ó· ı¤ÛÂÈ ‹ Ó· ·ÔÎÏ›ÛÂÈ ÙË ‰È¿ÁÓˆÛË. ™Ù· ·È‰È¿ Ì ·ÚÙËÚȷ΋ ıÚfiÌ‚ˆÛË, Û˘¯ÓfiÙÂ-

28

Paediatriki 2002;65:23-31

ÚË ÂÓÙfiÈÛË ·ÔÙÂÏÔ‡ÛÂ Ë Ì¤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›·, ·ÎÔÏÔ˘ıÔ‡ÛÂ Ë Ô›ÛıÈ· ÂÁÎÂÊ·ÏÈ΋ Î·È Ù¤ÏÔ˜, Ë ‚·ÛÈ΋ ·ÚÙËÚ›·. ∆Ô Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, Û‡Ìʈӷ Ì ٷ ÔÔ›· Ë Ì¤ÛË ÂÁÎÂÊ·ÏÈ΋ ·ÚÙËÚ›· Î·È ÔÈ ÎÏ¿‰ÔÈ Ù˘ ıˆÚÔ‡ÓÙ·È ˆ˜ Ë ÈÔ Û˘¯Ó‹ ÂÓÙfiÈÛË (4). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÚfiÌ‚ˆÛË ÙÔ˘ ÊÏ‚ÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ıÚfiÌ‚ˆÛË Ì›·˜ ÌfiÓÔ ÊϤ‚·˜ Â›Ó·È ·Û˘Ó‹ıÈÛÙÔ Â‡ÚËÌ·. ™Ù· 2/3 ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ıÚfiÌ‚ˆÛË ·Ê‹ÓÂÈ ÂχıÂÚ˜ ÙȘ ÊÏÔÈ˚Τ˜ Î·È ÙȘ ÂÓ Ùˆ ‚¿ıÂÈ ÊϤ‚˜, ÂÓÒ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ·ÊÔÚ¿ Û ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi ¤Ó·Ó ÊÏ‚҉ÂȘ ÎfiÏÔ˘˜ (8,12), fiˆ˜ Î·È ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË. ∆· £∂ ÙÔ˘ ∫¡™ ÌÔÚ› Ó· Â›Ó·È È‰ÈÔ·ı‹ ‹ ‰Â˘ÙÂÚÔ·ı‹ (fiÙ·Ó ˘¿Ú¯ÂÈ ˘ÔΛÌÂÓË ÓfiÛÔ˜ ‹ Èı·Ófi ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ Ô˘ ‰Ú· ˆ˜ ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ıÚfiÌ‚Ô˘). ⁄·ÚÍË ÚԉȷıÂÛÈÎÔ‡ ·Ú¿ÁÔÓÙ· ·Ó·Ê¤ÚÂÙ·È ÛÙÔ 75% ÙˆÓ ·È‰ÈÒÓ Ì £∂ ÙÔ˘ ∫¡™ (2). ∆· ÈÔ Û˘¯Ó¿ ˘ÔΛÌÂÓ· ÓÔÛ‹Ì·Ù· Â›Ó·È ÔÈ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, Ë ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·, ÔÈ Î·ÎÔ‹ıÂȘ, ÔÈ ÏÔÈÌÒÍÂȘ, Ë ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ·ÁÁÂÈ›Ùȉ˜, ÙÔ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, Ë ÔÌÔ΢ÛÙÈÓ·ÈÌ›· Î·È ÔÈ ·ÁÁÂȷΤ˜ ‰˘ÛϷۛ˜ (3,4,8-10,13-19). ¶Èı·Ó¿ ÂÎÏ˘ÙÈο ·›ÙÈ· ·ÔÙÂÏÔ‡Ó Ô ÙÚ·˘Ì·ÙÈÛÌfi˜, Ë ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË, Ë ·¯˘Û·ÚΛ·, Ë ·Ê˘‰¿ÙˆÛË, Ë ıÂÚ·›· Ì ʿÚ̷η fiˆ˜ ÎÔÚÙÈÎÔÂȉ‹ ‹ L-asparaginase, Ô ÎÂÓÙÚÈÎfi˜ ηıÂÙ‹Ú·˜ (˘ÔÎÏÂȉ›Ô˘ ‹ ÛÊ·Á›Ùȉ·˜) Î·È ¿ÏÏ· (4,8,9,19). ∞fi Ù· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜, 19/48 (39,58%) ·ÚÔ˘Û›·˙·Ó ˘ÔΛÌÂÓË ÓfiÛÔ ·Ó¿ÏÔÁË Ì ·˘Ù¤˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ÂÓÒ Èı·Ófi ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ‰È·ÈÛÙÒıËΠ۠14,6% (7/48) ÙˆÓ ·È‰ÈÒÓ. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ·fi Ù· 11 ·È‰È¿ Ì £∂ ÙˆÓ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ, Ù· 9 ›¯·Ó ˘ÔΛÌÂÓË ÓfiÛÔ Î·È ¿ÏÏÔ ¤Ó· Èı·Ófi ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ, ‰ËÏ·‰‹ ÌfiÓÔ Û ̛· ÂÚ›ÙˆÛË ÙÔ £∂ ‹Ù·Ó ·˘ÙfiÌ·ÙÔ (1%). §›Á˜ ÌÂϤÙ˜ ¤¯Ô˘Ó Á›ÓÂÈ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ Û˘ÁÁÂÓÒÓ ‹ Â›ÎÙËÙˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙˆÓ £∂ ÙÔ˘ ∫¡™. ¢È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÈÌÔÛÙ·ÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡ ÂÓÔ¯ÔÔÈ‹ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ stroke (5). ™Â Ì›· ÌÂϤÙË 24 Ó·ÚÒÓ ·ÙfiÌˆÓ (ËÏÈΛ·˜ <45 ÂÙÒÓ) Ì ÈÛ¯·ÈÌÈÎfi ¤ÌÊÚ·ÎÙÔ, ‚Ú¤ıËΠÌfiÓÔ ¤Ó· Ì ·ıÔÏÔÁÈ΋ APCR ¯ˆÚ›˜ ÙË ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ·Ú¿ÁÔÓÙ· V, ÂÓÒ ÔÈ ˘fiÏÔÈÔÈ ·ÛıÂÓ›˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈο Â›‰· ATIII, PC, PS, Plg, Heparin cofactor II. OÈ Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ô ÚfiÏÔ˜ ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ ‹Íˆ˜ ÛÙ· ∞∂∂ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÂÚÈÔÚÈṲ̂ÓÔ˜ Î·È fiÙÈ ¤ÏÂÁ¯Ô˜

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·29

¶·È‰È·ÙÚÈ΋ 2002;65:23-31

Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ Û ·ÛıÂÓ›˜ Ì ÔÈÎÔÁÂÓÂÈ·Îfi ‹ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘ (5). ∞ÓÙ›ıÂÙ·, Û ̛· ÌÂϤÙË 32 ·È‰ÈÒÓ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÂÁÎÂÊ¿ÏÔ˘ (19), 20/32 ·È‰È¿ ›¯·Ó Ì›· ÎÏËÚÔÓÔÌÈ΋ ‰È·Ù·Ú·¯‹, ÂÓÒ 3/20 ·È‰È¿ ›¯·Ó Û˘Ó‰˘·ÛÌfi ÎÏËÚÔÓÔÌÈÎÔ‡ Î·È Â›ÎÙËÙÔ˘ ÚÔıÚÔÌ‚ˆÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. OÈ ÂÚ¢ÓËÙ¤˜ ‚Ú‹Î·Ó ˆ˜ ÙÔ 22% ÙˆÓ ·È‰ÈÒÓ Â›¯Â FV Leiden (R506Q mutation), 19% ·˘ÍË̤ӷ Â›‰· ( ) Lp(a), 19% ·ÓÂ¿ÚÎÂÈ· PC Î·È 3,1% ·ÓÂ¿ÚÎÂÈ· ATIII, ÂÓÒ ¤Ó·˜ ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ¯·ÌËÏ¿ Â›‰· FXII Î·È ¤Ó·˜ ¯·ÌËÏ¿ Â›‰· Plg. ¶·ıÔÏÔÁÈ΋ ∞PCR ¯ˆÚ›˜ ÙË ÁÓˆÛÙ‹ ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË Â›¯Â ÙÔ 6,25% ÙˆÓ ·È‰ÈÒÓ. ª¤ÓÂÈ Ó· ‰È¢ÎÚÈÓÈÛÙ› Ô Èı·Ófi˜ ÚfiÏÔ˜ Ó¤ˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔÓ FV (19). ™ÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë Û˘ÓÔÏÈ΋ Â›ÙˆÛË ÙˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û ·È‰È¿ Ì ·ÚÙËÚÈ·Îfi ÈÛ¯·ÈÌÈÎfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ Â›Ó·È 20%-50% Î·È Û ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ 33%-99% (20,21). ¶ÂÚÈÁÚ¿ÊËηÓ, Â›Û˘, ‰‡Ô ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ıÚfiÌ‚ˆÛË Î·È ·ÚÔ‰È΋ ÙÒÛË Ù˘ PC (22), ‡ÚËÌ· Û˘Ì‚·Ùfi Î·È Ì ٷ ‰Èο Ì·˜, ηı’ fiÙÈ ·ÚÔ‰È΋ ÙÒÛË ÙˆÓ PC Î·È PS ‹ Î·È ¿ÏÏˆÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‰È·ÈÛÙÒıËΠ۠ÈηÓfi ·ÚÈıÌfi ·È‰ÈÒÓ Î·Ù¿ ÙËÓ ÔÍ›· Ê¿ÛË. ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ 47,4% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ıËÎ·Ó ÛÙËÓ ÔÍ›· Ê¿ÛË ·ÚÔ˘Û›·Û Â›ÎÙËÙ˜ ‰È·Ù·Ú·¯¤˜, ÂÎ ÙˆÓ ÔÔ›ˆÓ ·ÚÔ‰ÈΤ˜ ‹Ù·Ó ¤Ó· ÔÛÔÛÙfi 77,8%. ™Â 4 ÂÚÈÙÒÛÂȘ (22,2%), Ë Ê‡ÛË Ù˘ ‰È·Ù·Ú·¯‹˜ ·Ú¤ÌÂÈÓ ·‰È¢ÎÚ›ÓÈÛÙË, ›Ù ÏfiÁˆ ÌË ÚÔÛ¤ÏÂ˘Û‹˜ ÙÔ˘˜ ÁÈ· Â·Ó¤ÏÂÁ¯Ô, ›Ù ‰ÈfiÙÈ Î·Ù¤ÏËÍ·Ó ·fi ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ. ¶¿ÓÙˆ˜, Ô Â·Ó¤ÏÂÁ¯Ô˜ ·¤‰ÂÈÍ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ˆ˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ‹Ù·Ó Â›ÎÙËÙ˜ Î·È Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙÔ ˘ÔΛÌÂÓÔ ÓfiÛËÌ·. O ·ıÔÁÂÓÂÙÈÎfi˜ ‹ ÌË ÚfiÏÔ˜ Ù˘ ÚÔÛˆÚÈÓ‹˜ ·ÓÂ¿ÚÎÂÈ·˜ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ·˘ÙÒÓ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ ıÚfiÌ‚Ô˘ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙÔ˜. ∏ Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ Û˘ÁÁÂÓÒÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜ ‰ÂÓ ‰È·Ê¤ÚÂÈ ‹ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi ÂΛÓË ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÂÎÙfi˜ ·fi ÙËÓ ÂÚ›ÙˆÛË Ù˘ ÔÌÔ΢ÛÙÈÓ·ÈÌ›·˜ (2/15 ·È‰È¿ [13,3%]). øÛÙfiÛÔ, Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ıËÎ·Ó ÁÈ· ÔÌÔ΢ÛÙÈÓ·ÈÌ›· ‹Ù·Ó ȉȷ›ÙÂÚ· ¯·ÌËÏfi˜ Î·È ÙÔ ·Ú·¿Óˆ ÔÛÔÛÙfi Â›Ó·È Ì¿ÏÏÔÓ Ù˘¯·›Ô. ¶¿ÓÙˆ˜, Ë ‡·ÚÍË ÎÏËÚÔÓÔÌÈÎÒÓ ÚÔıÚÔÌ‚ˆÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Úԉȷı¤ÙÂÈ ·fi ÌfiÓË Ù˘ ÛÙËÓ ·Ó¿Ù˘ÍË ıÚfiÌ‚ˆÛ˘ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·. °ÂÓÈο, ·Ó Û˘Ó˘ÔÏÔÁ›ÛÔ˘Ì ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ‰ËÏ·‰‹ ÙËÓ ˘ÔΛÌÂÓË ÓfiÛÔ ‹/Î·È ÙÔ ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ‹/Î·È ÙËÓ ‡·ÚÍË ÚÔıÚÔÌ‚ˆÙÈÎÔ‡

Paediatriki 2002;65:23-31

·Ú¿ÁÔÓÙ·, ÚÔ·ÙÂÈ ˆ˜ ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 68,75%, ÂÓÒ ÌfiÓÔ ÙÔ 31,25% ‰ÂÓ Â›¯Â ηӤӷ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ıÚfiÌ‚ˆÛË, ¿Ú· Ë È‰ÈÔ·ı‹˜ ıÚfiÌ‚ˆÛË Â›Ó·È Û·ÓÈfiÙÂÚË. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ȉÈÔ·ı‹ £∂ ÙÔ˘ ∫¡™ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ 25% ÙˆÓ ·È‰ÈÒÓ Ì ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· ‹ ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ (4). °È· ÙË ÊÏ‚È΋ ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™, ÙÔ ÔÛÔÛÙfi Î˘Ì·›ÓÂÙ·È ·fi 3% ̤¯ÚÈ 25% (8,12,19). ™Ù· ÓÂÔÁÓ¿, Ë Û˘¯ÓfiÙËÙ· ȉÈÔ·ıÔ‡˜ ÊÏ‚È΋˜ ıÚfiÌ‚ˆÛ˘ ÙÔ˘ ∫¡™ Î˘Ì·›ÓÂÙ·È ·fi 28,5% ¤ˆ˜ 40% (9,10). ∆Ô ı¤Ì· Ù˘ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· £∂ ÙÔ˘ ∫¡™ Ì ıÚÔÌ‚ÔÏ˘ÙÈο ‹/Î·È ·ÓÙÈËÎÙÈο Ê¿Ú̷η ·Ú·Ì¤ÓÂÈ ·ÓÔÈÎÙfi. ™Ù· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ì·˜, Ë Î¿ı ÂÚ›ÙˆÛË ·ÓÙÈÌÂÙˆ›ÛÙËΠͯˆÚÈÛÙ¿ Û˘Ó˘ÔÏÔÁ›˙ÔÓÙ·˜ fiÏ· Ù· ‰Â‰Ô̤ӷ. ™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜, ¿ÓÙˆ˜, Ù· ÈÛ¯·ÈÌÈο ¤ÌÊÚ·ÎÙ· Î·È ÔÈ ·ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Û˘ÓÙËÚËÙÈο, ÂÎÙfi˜ ·fi ¤ÓÙ ·È‰È¿ Ô˘ ·ÚÔ˘Û›·˙·Ó Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, ıÚfiÌ‚ˆÛË Û ÔÏÏ·Ï¿ ÛËÌ›· ‹ ˘ÔÙÚÔÈ¿˙Ô˘Û· ıÚfiÌ‚ˆÛË. ∞˜ ÛËÌÂȈı› fiÙÈ Ù· ¤ÍÈ ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ Ô˘ ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ‹/Î·È ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, ›¯·Ó fiÏ· ηϋ ÎÏÈÓÈ΋ ÔÚ›· Ì χÛË ÙÔ˘ ıÚfiÌ‚Ô˘ ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi Â·Ó¤ÏÂÁ¯Ô, Û ·ÓÙ›ıÂÛË Ì ·˘Ù¿ Ô˘ ‰ÂÓ ¤Ï·‚·Ó ıÂÚ·›·. ∏ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· ÚÔÙ›ÓÂÈ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ (·ÚÙËÚȷ΋ ·fiÊÚ·ÍË, ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ) ÂÊ·ÚÌÔÁ‹ ·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜ (Ë·Ú›ÓË Î·È ÎÔ˘Ì·ÚÈÓÈο) (23). °È· ÙË ıÚfiÌ‚ˆÛË ÙÔ˘ ÊÏ‚ÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ·ÓÙÈËÎÙÈ΋ ‹/Î·È ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ Û ÌÂÌÔӈ̤Ó˜ ÂÚÈÙÒÛÂȘ (8,12,14,15,24). ÕÌÂÛË ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ ÚÔÙ›ÓÂÙ·È Û ·È‰È¿ Ì Ô͇ ÂÁÎÂÊ·ÏÈÎfi ¤ÌÊÚ·ÎÙÔ (̤۷ Û 3 ÒÚ˜). ŸÌˆ˜, ÂÂȉ‹ Ï›Á· ·È‰È¿ ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÚÁ·ÓˆÌ¤ÓÔ ÎÏÈÓÈÎfi ∫¤ÓÙÚÔ ÙfiÛÔ ÓˆÚ›˜, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û˘¯Ó¿ (2,23). ∂›Û˘, ÚÔÙ›ÓÂÙ·È Ì·ÎÚfi¯ÚÔÓË ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Û ·È‰È¿ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ıÚfiÌ‚ˆÛË Î·È ÂÌ‚ÔÏ‹ (Û˘ÁÁÂÓ‹˜ ‹ Â›ÎÙËÙË Î·Ú‰ÈÔ¿ıÂÈ· ÁÈ· ·Ú¿‰ÂÈÁÌ·) (23). ÕÏÏÔÈ ıˆÚÔ‡Ó ÙË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË ÂÚÈÙÙ‹ - ÏfiÁˆ Ù˘ ηϋ˜ ÁÂÓÈο ÎÏÈÓÈ΋˜ ¤Î‚·Û˘ ÙˆÓ ·È‰ÈÒÓ - ‹/Î·È ÂÈΛӉ˘ÓË ÁÈ· ÚfiÎÏËÛË ÂÓ‰ÔÂÁÎÂÊ·ÏÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ (10,14). ∏ ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ ıˆÚÂ›Ù·È ˆ˜ Ô ·ÎÚÔÁˆÓÈ·›Ô˜ Ï›ıÔ˜ ÛÙË ıÂÚ·›· ÙÔ˘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ÂÈÏÂÁÌ¤ÓˆÓ ÂÚÈÙÒÛÂˆÓ ·ÛıÂÓÒÓ Ì Ô͇ ıÚÔÌ‚ˆÙÈÎfi stroke, Ì·˙È΋ Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ ‹ ÂÎÙÂٷ̤ÓË ÂÁÁ‡˜ ÂÓ Ùˆ ‚¿ıÂÈ ÊÏ‚È΋ ıÚfiÌ‚ˆÛË (25). ∂ÓÙÔ‡ÙÔȘ, ÔÈ ·fi„ÂȘ ‰È›ÛÙ·ÓÙ·È Î·È Ú¤ÂÈ Ó· Á›ÓÔ˘Ó ÔÚÁ·ÓˆÌ¤Ó˜ ÚÔÔÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· Ó· ηıÔÚÈÛÙÔ‡Ó ÙfiÛÔ ÔÈ Û·Ê›˜

29

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·30

¶·È‰È·ÙÚÈ΋ 2002;65:23-31

ÂӉ›ÍÂȘ Î·È ·ÓÙÂӉ›ÍÂȘ, fiÛÔ Î·È Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÁˆÁ‹˜ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÓËÙfiÙËÙ·, ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË ‹Ù·Ó 8,3% (4/5 ·È‰È¿ η٤ÏËÍ·Ó ÂÍ·ÈÙ›·˜ Ù˘ ıÚfiÌ‚ˆÛ˘). ∆· ÔÛÔÛÙ¿ ıÓËÙfiÙËÙ·˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ Î˘Ì·›ÓÔÓÙ·È ·fi 5% ¤ˆ˜ 80% (4), ÂÓÒ ÛÙ· ·È‰È¿ 10%50% (19). ™ÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ë ıÓËÙfiÙËÙ· ÙˆÓ £∂ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ ·Ó·Ê¤ÚÂÙ·È 10% (2), ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ 10% (26) ¤ˆ˜ 20% (2), ÂÓÒ Ó¢ÚÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ· ÌÂÙ¿ ÙËÓ ·Ô‰ÚÔÌ‹ Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó 2/3 ÙˆÓ ·È‰ÈÒÓ (2). ™Â Ì›· ÌÂϤÙË 36 ·È‰ÈÒÓ Ì ÈÛ¯·ÈÌÈÎfi ¤ÌÊÚ·ÎÙÔ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ - Ù· ÂÚÈÛÛfiÙÂÚ· ·ÚÔ˘Û›·Û·Ó ÔÍ›· ËÌÈÏËÁ›· - Ë ¤Î‚·ÛË ÛÙÔ 38,9% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‹Ù·Ó Ï‹Ú˘ ·ÔηٿÛÙ·ÛË, ÛÙÔ 44,4% ‹È· ˘ÔÏÂÈÌÌ·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Î·È ÛÙÔ 16,6% ̤ÙÚÈ· ‹ ÛÔ‚·Ú‹ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·. ∫·Ó¤Ó· ·È‰› ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‰ÂÓ Î·Ù¤ÏËÍ (4). ™Â ¿ÏÏË ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û Û ÓÂÔÁÓ¿ Î·È ·È‰È¿ Ì £∂ ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÌfiÓÔ ÙÔ 40% ÙˆÓ ÓÂÔÁÓÒÓ Â›¯Â ηϋ ÎÏÈÓÈ΋ ¤Î‚·ÛË, ÂÓÒ ÛÙ· ·È‰È¿ ÙÔ ÔÛÔÛÙfi ·Ó¤Ú¯ÂÙ·È ÛÙÔ 95% (9). ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, Ë ÎÏÈÓÈ΋ ÔÚ›· Â›Ó·È ÁÓˆÛÙ‹ ÛÙÔ 75% ÙˆÓ ·È‰ÈÒÓ. ¢ÂηÙÚ›· ·È‰È¿ (36,1%) ›¯·Ó ηϋ ÎÏÈÓÈ΋ ÔÚ›·, 18 (50%) ›¯·Ó ÂÈÏÔΤ˜, ÂÓÒ 5 ·È‰È¿ η٤ÏËÍ·Ó. ÕÁÓˆÛÙË ·Ú·Ì¤ÓÂÈ Ë ¤Î‚·ÛË Û 12 ·È‰È¿. ∞Ó Û˘Û¯ÂÙ›ÛÔ˘Ì ٷ Â˘Ú‹Ì·Ù· ÛÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi Â·Ó¤ÏÂÁ¯Ô Ì ÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ, ı· ‰Ô‡Ì fiÙÈ 8 ·fi Ù· 15 (53,3%) ·È‰È¿ Ì Ï‹ÚË ‹ ÌÂÚÈ΋ χÛË ÙÔ˘ ıÚfiÌ‚Ô˘ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈËÎÙÈ΋ ‹/Î·È ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹, ÂÓÒ ÌfiÓÔ ¤Ó· ·fi Ù· ÂÙ¿ ·È‰È¿ (14,2%) Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û ‚ÂÏÙ›ˆÛË, ›¯Â Ï¿‚ÂÈ ıÂÚ·›·. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ 6/11 ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ¤Ï·‚·Ó ıÚÔÌ‚ÔÏ˘ÙÈ΋ ‹/Î·È ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Î·È ·ÚÔ˘Û›·Û·Ó Ï‹ÚË Ï‡ÛË ÙÔ˘ ıÚfiÌ‚Ô˘. ∞fi Ù· ˘fiÏÔÈ· ·È‰È¿ Ô˘ ‰ÂÓ ‹Ú·Ó ıÂÚ·›·, Ù· 3 ·ÚÔ˘Û›·Û·Ó ÂÓ‰ÔÎÚ¿ÓÈ· ˘¤ÚÙ·ÛË ˆ˜ ÂÈÏÔ΋. µ¤‚·È·, ÙÔ ı¤Ì· Ù˘ ıÂÚ·¢ÙÈ΋˜ Ú·ÎÙÈ΋˜ ÁÈ· Ù· £∂ ÙÔ˘ ∫¡™ ÛÙ· ·È‰È¿ ·Ú·Ì¤ÓÂÈ ·ÓÔÈÎÙfi Î·È Â›Ó·È ··Ú·›ÙËÙ˜ Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi ıÂÚ·¢ÙÈÎÒÓ ÚˆÙÔÎfiÏψÓ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ Ë ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ ÓfiÛÔ˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ù· 2/3 ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·˙·Ó ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Úԉȷı¤ÙÔ˘Ó Û ıÚfiÌ‚ˆÛË, ÂÓÒ ÎÏËÚÔÓÔÌÈÎÔ› ‹ Â›ÎÙËÙÔÈ ıÚÔÌ‚ÔÊÈÏÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‰È·ÈÛÙÒıËηÓ

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ÛÙÔ 48% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂϤÁ¯ıËηÓ. OÈ ÎÏËÚÔÓÔÌÈÎÔ› ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Úԉȷı¤ÙÔ˘Ó ·fi ÌfiÓÔÈ ÙÔ˘˜ Û ıÚfiÌ‚ˆÛË ÙÔ˘ ∫¡™ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ·. OÈ Â›ÎÙËÙÔÈ ıÚÔÌ‚ÔÊÈÏÈÎÔ› ·Ú¿ÁÔÓÙ˜ Â›Ó·È Î·Ù¿ ηÓfiÓ· ·ÚÔ‰ÈÎÔ› Î·È ·fiÚÚÔÈ· Û˘Ó‹ıˆ˜ Ù˘ ˘ÔÎÂÈ̤Ó˘ ÓfiÛÔ˘.

OÈ ÚÔıÚÔÌ‚ˆÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÎÏËÚÔÓÔÌÈÎÔ› ‹ Â›ÎÙËÙÔÈ, Ê·›ÓÂÙ·È ˆ˜ ¤¯Ô˘Ó Û˘ÓÂÚÁÈÎfi Ì¿ÏÏÔÓ, ·Ú¿ ·ÈÙÈÔÏÔÁÈÎfi ÚfiÏÔ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘ ıÚfiÌ‚Ô˘. ∏ Û¯ÂÙÈο ÌÂÁ¿ÏË ıÓËÙfiÙËÙ· Î·È Ë ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ˘ÔÏÂÈÌÌ·ÙÈ΋˜ Ó¢ÚÔÏÔÁÈ΋˜ ÛËÌÂÈÔÏÔÁ›·˜ ÂÈ‚¿ÏÏÔ˘Ó Û˘ÁÎÚÈÙÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ϤÔÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ıÚÔÌ‚ˆÙÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ∏ ÂÌÂÈÚ›· ·fi Ù· ·È‰È¿ Ì ıÚfiÌ‚ˆÛË ÊÏ‚ˆ‰ÒÓ ÎfiÏˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ηٷ‰ÂÈÎÓ‡ÂÈ ˆ˜ Ë ıÚÔÌ‚ÔÏ˘ÙÈ΋ ·ÁˆÁ‹ ÂÈÙ˘Á¯¿ÓÂÈ ÁÚËÁÔÚfiÙÂÚË Î·È Ï‹ÚË Ï‡ÛË ÙÔ˘ ıÚfiÌ‚Ô˘, ÂÓÒ Ë ÌË ·Ú¤Ì‚·ÛË Û˘ÓÂ¿ÁÂÙ·È Î·Ù¿ ηÓfiÓ· ÂÈÏÔΤ˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Rosendaal F. Thrombosis in the young: epidemiology and risk factors. A focus on venous thrombosis. Thromb Haemost 1997;78:1-6.

2. de Veber G, Roach ES, Riela AR, Wiznitzer M. Stroke in children: recognition, treatment and future directions.

Semin Pediatr Neurol 2000;7:309-317.

3. Smith CH, Baumann R. Clinical features and magnetic resonance imaging in congenital and childhood stroke. J Child Neurol 1991;6:263-272.

4. Brower M, Rollins N, Roach ES. Basal ganglia and thalamic infarction in children. Cause and clinical features.

Arch Neurol 1996;53:1252-1256.

5. Tosetto A, Ruggeri M, Gastaman G, Rodeghiero F. Inherited abnormalities of blood coagulation in juvenile stroke. A case control study. Blood Coagul Fibrinolysis 1997;8:397-402.

6. Holt Larsen B, Soelberg Sorenses P, Marquardsen J. Transient ischemic attacks in young patients: a thromboembolic or migrainous manifestation? A 10 year follow up study of 46 patients. J Neurol Neurosurg Psychiatry 1990;53:1029-1033.

7. Norman D, Baker L. Cerebrovascular disease. Curr Opin Neurol Neurosurg 1991;4:837-842.

8. ∆ÚÈ·ÓٷʇÏÏÔ˘ ∞. ∫ÂÊ·Ï·ÏÁ›· Î·È ÊÏ‚È΋ ıÚfiÌ‚ˆÛË. ∫ÂÊ·Ï·ÏÁ›·. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ∫ÂÊ·Ï·ÏÁ›·˜. ∫·Ú·ÁˆÚÁ›Ô˘ ∫, ÷ÚÌÔ‡ÛË-¶Â˚fiÁÏÔ˘ ™, ÂΉfiÙ˜. ∞ı‹Ó·; 1998. ÛÂÏ. 319-341.

9. µ·rron T, Gusnard D, Zimmerman R, Clancy R. Cerebral venous thrombosis in neonates and children. Pediatr Neurol 1992;8:112-116.

10. Rivkin M, Anderson M, Kaye E. Neonatal idiopathic cerebral venous thrombosis: an unrecognized cause of transient seizures or lethargy. Ann Neurol 1992;32:51-56.

11. Adams R. Sickle cell disease and stroke. J Child Neurol 1995;10:15-76.

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12. Perkin GD. Cerebral venous thrombosis: developments in imaging and treatment. J Neurol Neurosurg Psychiatry 1995;59:1-3.

13. Burns A, Wilson E , Harber M, Brunton C, Sweny P. Cerebral venous sinus thrombosis in minimal change nephrotic syndrome. Nephrol Dial Transplant 1995;10:30-34.

14. Divekar A, Ali U, Ronghe M, Singh A, Dalvi R. Superior sagittal sinus thrombosis in a child with nephrotic syndrome. Pediatr Nephrol 1996;10:206-207.

15. Garcia RD, Baker A, Cunningham M, Weber A. Lateral sinus thrombosis associated with otitis media and mastoiditis in children. J Pediatr Infect Dis 1995;14:617-623.

16. Radhakrishnan K, Thacker AK, Maloo JC, el Mangoush MA. Sickle cell trait and stroke in the young adult. Postgrad Med J 1990;66:1078-1080.

17. Feldenzer J, Bueche M, Venes J, Gebarski S. Superior sagittal sinus thrombosis with infarction in sickle cell trait.

Stroke 1987;18:656-660.

18. Partington MD, Aronyk KE, Byrd SE. Sickle cell trait and stroke in children. Pediatr Neurosurg 1994;20:148-151.

19. Vielhaber H, Ehrenforth S, Koch H, Scharrer I, van der Werf N, Nowak-Gottl U. Cerebral venous sinus thrombosis in infancy and childhood: role of genetic and acquired risk factors of thrombophilia. Eur J Pediatr 1998;157:555-560.

20. Chan AK, de Veber G. Prothrombotic disorders and ischemic stroke in children. Semin Pediatr Neurol 2000;7:301-308.

21. µÔnduel M, Sciuccati G, Hepner M, Torres AF, Pieroni G, Frontroth Jr. Arch Neurol 1999;56:967-971.

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22. Dusser A, Boyer-Neumann C, Wolf M. Temporary protein C deficiency associated with cerebral arterial thrombosis in childhood. J Pediatr 1988;113:849-851.

23. Roach ES. Stroke in children. Curr Treat Options Neurol 2000;2:295-304.

24. Gonault-Heilmann M, Quetin P, Dreyfus M, Gandrille S, Emmerich J, Leroy-Matheron C, Guesnu M. Massive thrombosis of venous cerebral sinuses in a 2-year old boy with a combined inherited deficiency of Antithrombin III and Protein C. Thromb Haemost 1994;72:782-786.

25. Uttenreuther-Fischer M, Vetter B, Hellmann C, Otting U, Ziemer S, Hausdorf G, Gaedicke G, Kulozik A. Paediatric thromboembolism: the influence of non-genetic factors and the role of activated protein C resistance and protein C deficiency. Eur J Pediatr 1997;156:277-281.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-08-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 03-01-2002 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ™ÔÊ›· ∞ÚÒÓË ªÔÓ¿‰· ∞ÈÌfiÛÙ·Û˘-∞ÈÌÔÚÚÔÊÈÏ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

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ORIGINAL ARTICLE

∫ÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘ ËÎÙ¿ÛË ·ÚÓËÙÈÎÔ‡ ·fi ÙȘ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ ÓÂÔÁÓÒÓ µ. ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘, Ã. ¡Ô‡ÙÛÈ·, ¶. ¶··Î˘ÚȷΛ‰Ô˘, ∂. ¢È·Ì·ÓÙ‹, ∫. ™·Ú·Ê›‰Ë˜, ª. ∆ÛÈ‚ÈÙ·Ó›‰Ô˘, °. ∫ÚÂÌÂÓfiÔ˘ÏÔ˜

Clinical evaluation of coagulase-negative staphylococcus in blood cultures of neonates V. Drossou-Agakidou, H. Noutsia, P. Papakyriakidou, E. Diamanti, K. Sarafidis, M. Tsivitanidou, G. Kremenopoulos

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ó· ‰ÈÂÚ¢ÓËı› ·Ó ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ (∫∞) ÓÂÔÁÓÒÓ Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó ÛÙ·Ê˘ÏfiÎÔÎÎÔ ËÎÙ¿ÛË ·ÚÓËÙÈÎfi (™¶∞) Ï·Ì‚¿ÓÔÓÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ÌÂ Û˘Óı‹Î˜ Ô˘ Ó· ÂÈÙÚ¤Ô˘Ó ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ ÛË„·ÈÌ›·˜ Î·È ÂÈÌfiÏ˘ÓÛ˘, Î·È ·Ó Ë Û˘ÓÂÎÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË. ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο Ù· ÈÛÙÔÚÈο ÓÂÔÁÓÒÓ Ô˘ ·Ó¤Ù˘Í·Ó ™¶∞ ÛÙȘ ∫∞ ηٿ ÙËÓ ÂÍ·ÂÙ›· 1994-1999. ∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ÎÏÈÓÈο ÛÙÔȯ›·, ÔÈ Ù‡ÔÈ ™¶∞ Î·È Ë Â˘·ÈÛıËÛ›· ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘˜ ÛÙ· ·ÓÙÈÌÈÎÚԂȷο. ™·Ó Û‹„Ë ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó Ù· ÂÂÈÛfi‰È· ·ÔÌfiÓˆÛ˘ ÙÔ˘ ›‰ÈÔ˘ Ù‡Ô˘ Î·È ÛÙÂϤ¯Ô˘˜ ™¶∞ ·fi ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ∫∞. ™ÙÔ ‰È¿ÛÙËÌ· Ù˘ ÌÂϤÙ˘, ™¶∞ ·ÔÌÔÓÒıËΠ·fi 269 ∫∞ 184 ÓÂÔÁÓÒÓ. ™˘ÓÔÏÈο ηٷÁÚ¿ÊËÎ·Ó 200 ÂÂÈÛfi‰È· ·ÔÌfiÓˆÛ˘ ™¶∞, ·fi Ù· ÔÔ›· ÌfiÓÔ Ù· 135 (68%) ÌÔÚÔ‡Û·Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Û ۋ„Ë (n=41) ‹ ÂÈÌfiÏ˘ÓÛË (n=94). ∆· ÓÂÔÁÓ¿ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ˆ˜ ÚÔ˜ Ù· ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ù· ÚÔ‚Ï‹Ì·Ù·, ÙÔÓ ·ÚÈıÌfi Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÚԉȷıÂÛÈÎÒÓ ÁÈ· Ïԛ̈ÍË ·Ú·ÁfiÓÙˆÓ Î·È ·˘ÍË̤Ó˘ CRP ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· Û‹„˘. ∫ÏÈÓÈΤ˜ ‹/Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ ˘‹Ú¯·Ó ÛÙÔ 90% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Û‹„˘ Î·È ÛÙÔ 51% Ù˘ ÂÈÌfiÏ˘ÓÛ˘ Î·È Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜ ÁÈ· ‰È¿ÎÚÈÛË ÌÂٷ͇ ÛË„·ÈÌ›·˜ Î·È ÂÈÌfiÏ˘ÓÛ˘ ‹Ù·Ó 90%, Ë ÂȉÈÎfiÙËÙ· 49%, Ë ıÂÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (£¶∞) 43% Î·È Ë ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· (∞¶∞) 92%. ™˘ÌÂÚ·ÛÌ·ÙÈο: ·) ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË, ÌfiÓÔ ÛÙ· 2/3 ÙˆÓ

Abstract: The aim of the study was to investigate the clinical significance of coagulasenegative staphylococcus (CONS) isolated from blood cultures (BC) of neonates receiving intensive care, and to evaluate the significance of the clinical and laboratory findings in distinguishing between sepsis and contamination. We reviewed the records of neonates hospitalized at the neonatal intensive care unit (NICU) from 1994 to 1999 who grew CONS from at least one BC. The clinical data and the results of all positive CONS BCs and the antibiotic sensitivity were recorded.

An episode of isolation was considered to represent sepsis when the same CONS strain was isolated from two or more BCs. During the study period CONS was isolated from 269 BCs obtained from 184 neonates that corresponded to 200 episodes. Only 135/200 (68%) episodes could be classified either as sepsis (n=41) or contamination (n=94). The incidence of factors predisposing to sepsis and the numbers of neonates with increased CRP were significantly higher in the septic episodes. Clinical and/or laboratory evidence of sepsis were present in 90% of the septic episodes and in 51% of contamination ones. The sensitivity of the clinical and laboratory evidence of sepsis in discriminating between sepsis and contamination was 90%, the specificity 49%, the positive predictive value 43% and the negative predictive value 92%. In conclusion: a) only in 2/3 of the episodes in which CONS was isolated, the BCs could distinguish between sepsis and contamination b) of the episodes that could be

∞’ ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ πÔÎÚ¿ÙÂÈÔ˘ °¶¡ £ÂÛÛ·ÏÔӛ΢

Department of Neonatology Aristotelion University of Thessaloniki Department of Microbiology of Ippokration General Hospital, Thessaloniki

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¶·È‰È·ÙÚÈ΋ 2002;65:32-39

Paediatriki 2002;65:32-39

ÂÂÈÛÔ‰›ˆÓ ·ÔÌfiÓˆÛ˘ ™¶∞ ·fi ∫∞ ÓÂÔÁÓÒÓ, ÔÈ ∫∞ ¤¯Ô˘Ó ÏËÊı› Ì ÙÚfiÔ Ô˘ ‚ÔËı¿ ÛÙË ‰È¿ÎÚÈÛËÛ‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘, ‚) ·fi ÙȘ ·ÍÈÔÏÔÁ‹ÛÈ̘ ıÂÙÈΤ˜ ÁÈ· ™¶∞ ∫∞, ÌfiÓÔ ÙÔ 30% ·ÓÙÈηÙÔÙÚ›˙ÂÈ Ú·ÁÌ·ÙÈ΋ Û‹„Ë Î·È Á) Ë Û˘ÓÂÎÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Û‹„˘ ‰ÂÓ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È¿ÎÚÈÛ‹ Ù˘ ·fi ÙËÓ ÂÈÌfiÏ˘ÓÛË.

classified either as sepsis or contamination, only 30% represented sepsis and c) the simultaneous evaluation of clinical and laboratory evidence of sepsis does not contribute significantly in the differentiation between sepsis and contamination.

§¤ÍÂȘ ÎÏÂȉȿ: Û‹„Ë, ÂÈÌfiÏ˘ÓÛË, ÚfiˆÚ· ÓÂÔÁÓ¿.

Key words: sepsis, contamination, preterm neonates.

O ÛÙ·Ê˘ÏfiÎÔÎÎÔ˜ ËÎÙ¿ÛË ·ÚÓËÙÈÎfi˜ (™¶∞) ·ÔÙÂÏ› Û˘¯Ó‹ ·ÈÙ›· Û‹„˘ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÔÓÙ·È Û ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ÓÂÔÁÓÒÓ (ª∂£¡) (1-9) Î·È Û¯ÂÙ›˙ÂÙ·È Ì ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ÓÔÛËÏ›·˜ Î·È Ù˘ ¯Ú‹Û˘ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ (10,11). ∆·˘Ùfi¯ÚÔÓ·, fï˜, Â›Ó·È Î·È ÙÔ Û˘¯ÓfiÙÂÚÔ ÌÈÎÚfi‚ÈÔ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ¯ÏˆÚ›‰·˜ ÙÔ˘ ÓÂÔÁÓÔ‡ (12) Î·È ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙˆÓ ª∂£¡ (13). ŒÙÛÈ, Ë ·ÔÌfiÓˆÛ‹ ÙÔ˘ ·fi ÙȘ ∫∞ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù· ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ÌÂٷ͇ ·ÏËıÈÓ‹˜ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ Ô˘ Ô‰ËÁÔ‡Ó Û˘Ó‹ıˆ˜ Û ¿ÛÎÔË ¯Ú‹ÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ (14-16). °È· Ó· Á›ÓÂÈ ‰˘Ó·Ù‹ Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ·˘ÙÒÓ Î·Ù·ÛÙ¿ÛˆÓ, ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚ· ÎÏÈÓÈο Î·È ÌÈÎÚÔ‚ÈÔÏÔÁÈο ÎÚÈÙ‹ÚÈ· (3,14,15,17-21). ™Ù· ÌÈÎÚÔ‚ÈÔÏÔÁÈο ÎÚÈÙ‹ÚÈ· Û‹„˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·Ó¿Ù˘ÍË ÙÔ˘ ™¶∞ Û ·ÂÚfi‚Ș Î·È ·Ó·ÂÚfi‚Ș Û˘Óı‹Î˜ (3,14), Ë ·Ó¿Ù˘Í‹ ÙÔ˘ ÛÙȘ ÚÒÙ˜ 48 ÒÚ˜ Ù˘ ÂÒ·Û˘ (3,14,15) Î·È Ô ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ·ÔÈÎÈÒÓ (20,21). ∞ÓÙ›ıÂÙ·, Û·Ó ÂÈÌfiÏ˘ÓÛË ıˆÚÂ›Ù·È Ë ·ÔÌfiÓˆÛË ÂÚÈÛÛÔÙ¤ÚˆÓ ÙÔ˘ ÂÓfi˜ Û·ÚfiÊ˘ÙˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ ·fi ÙËÓ ›‰È· ∫∞, ·Ó¿Ù˘ÍË ™¶∞ Û ∫∞ Ô˘ Ï‹ÊıËΠ˘fi ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹ ÛÙËÓ ÔÔ›· Â›Ó·È Â˘·›ÛıËÙÔ ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Û٤ϯԘ, ηıÒ˜ Î·È Ë ·Ó¿Ù˘Í‹ ÙÔ˘ Û ̛· ÌfiÓÔ ∫∞ (3,18). øÛÙfiÛÔ, ÌÂϤÙ˜ fiÔ˘ Ë Ù˘ÔÔ›ËÛË ÙÔ˘ ™¶∞ ¤ÁÈÓ Ì ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜, ¤‰ÂÈÍ·Ó fiÙÈ Î·Ó¤Ó· ·fi Ù· ÚÔËÁÔ‡ÌÂÓ· ÎÚÈÙ‹ÚÈ· ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· ·ÍÈfiÈÛÙÔ ÁÈ· ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ (7,16,22-24). ŒÙÛÈ, ÈÔ ·ÍÈfiÈÛÙÔ ÎÚÈÙ‹ÚÈÔ ıˆÚÂ›Ù·È Ë ·ÔÌfiÓˆÛË ÙÔ˘ ›‰ÈÔ˘ Ù‡Ô˘ Î·È ÛÙÂϤ¯Ô˘˜ ™¶∞ ·fi ‰‡Ô ηÏÏȤÚÁÂȘ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Ù·˘Ùfi¯ÚÔÓ· ·fi ‰È·ÊÔÚÂÙÈΤ˜ ı¤ÛÂȘ (5,21,25). ¶ÔÏϤ˜ ÊÔÚ¤˜ ÛÙȘ ª∂£¡ ‰ÂÓ ÂÊ·ÚÌfi˙ÂÙ·È Ë Ù·ÎÙÈ΋ Ï‹„˘ ‰‡Ô ∫∞ Ù·˘Ùfi¯ÚÔÓ·, ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÚÈÔÚÈÛÌÔ‡ ÙˆÓ ÂÒ‰˘ÓˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ ÛÙ· ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ· ÓÂÔÁÓ¿, Ù· ÔÔ›· ÌÔÚ› Ó· ÂÈ‚·Ú‡ÓÔ˘Ó ÙËÓ Î·Ù¿ÛÙ·Û‹ ÙÔ˘˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ô ÓÂÔÁÓÔÏfiÁÔ˜ Â›Ó·È ˘Ô¯Úˆ̤ÓÔ˜ Ó· ÛÙËÚ›ÍÂÈ ÙË ‰È¿ÁÓˆÛË Ù˘ Û‹„˘ ÛÙË Û˘Ó‡·ÚÍË ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢. øÛÙfiÛÔ, ÌÂϤÙ˜ Û ÂÓ‹ÏÈΘ Î·È ÓÂÔÁÓ¿ ¤‰ˆÛ·Ó

·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· ·Ó·ÊÔÚÈο Ì ÙË Û¯¤ÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ Ì ÙËÓ ·ÚÔ˘Û›· Û‹„˘ ·fi ™¶∞ (3,10, 16,19,21,26,27). ∏ ·ÚÔ‡Û· ÌÂϤÙË ¤¯ÂÈ ÛÎÔfi Ó· ‰ÈÂÚ¢ӋÛÂÈ ·Ó ÔÈ ∫∞ ÓÂÔÁÓÒÓ Ô˘ ÓÔÛËχÔÓÙ·È Û ª∂£¡, ÔÈ Ôԛ˜ ·Ó·Ù‡ÛÛÔ˘Ó ™¶∞, Ï·Ì‚¿ÓÔÓÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ÌÂ Û˘Óı‹Î˜ Ô˘ ÂÈÙÚ¤Ô˘Ó ÙËÓ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘˜ ÁÈ· ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ ÛË„·ÈÌ›·˜ Î·È ÂÈÌfiÏ˘ÓÛ˘, Û ÙÈ ÔÛÔÛÙfi ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó Ú·ÁÌ·ÙÈ΋ ÛË„·ÈÌ›· Î·È ·Ó Ë Û˘ÓÂÎÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ïԛ̈͢ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË Ù˘ Û‹„˘ ·fi ™¶∞. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο Ù· ÈÛÙÔÚÈο ÓÂÔÁÓÒÓ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË ª∂£¡ ÙÔ˘ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢, Û ‰È¿ÛÙËÌ· 6 ¯ÚfiÓˆÓ (1994-1999), ·fi ÙȘ ∫∞ ÙˆÓ ÔÔ›ˆÓ ·ÔÌÔÓÒıËΠ™¶∞. ∫∞ Ï·Ì‚¿ÓÔÓÙ·Ó Û fiÏ· Ù· ÓÂÔÁÓ¿ Ì ÎÏÈÓÈΤ˜ ‹ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢, ·ÏÏ¿ Î·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ‡·ÚÍË ÂӉ›ÍÂˆÓ Ïԛ̈͢ Û fiÏ· Ù· ÓÂÔÂÈÛ·ÁfiÌÂÓ· ÓÂÔÁÓ¿, Û ÓÂÔÁÓ¿ Ì ÚÔËÁÔ‡ÌÂÓË ıÂÙÈ΋ ∫∞ ÁÈ· Â·Ó¤ÏÂÁ¯Ô, Î·È Û fiÏ· Ù· ÓÔÛËÏ¢fiÌÂÓ· ÓÂÔÁÓ¿ fiÙ·Ó ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ∆Ì‹Ì· ¿Óˆ ·fi ¤Ó· ÎÚÔ‡ÛÌ·Ù· ÛË„·ÈÌ›·˜ ·fi ÙÔ ›‰ÈÔ ÌÈÎÚfi‚ÈÔ. ∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ù· Û˘Ó˘¿Ú¯ÔÓÙ· ÚÔ‚Ï‹Ì·Ù·, ÔÈ ÚԉȷıÂÛÈÎÔ› ÁÈ· Ïԛ̈ÍË ·Ú¿ÁÔÓÙ˜, Ë ‡·ÚÍË ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢, Ë ¤Î‚·ÛË, Ù· ÛÙÂϤ¯Ë ÙÔ˘ ™¶∞ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ÙȘ ∫∞ Î·È Ë Â˘·ÈÛıËÛ›· ÙÔ˘˜ ÛÙ· ·ÓÙÈÌÈÎÚԂȷο. OÈ ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ Û‹„˘ ÂÚÈÏ¿Ì‚·Ó·Ó ÙȘ ·Ú·Î¿Ùˆ ÂΉËÏÒÛÂȘ: Âȉ›ӈÛË Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ÓÂÔÁÓÔ‡, ÓˆıÚfiÙËÙ·, ˘ÔÙÔÓ›·, ¿ÓÔȘ, ‚Ú·‰˘Î·Ú‰›·, η΋ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›·, ÂÌÊ¿ÓÈÛË ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ‹ Âȉ›ӈÛË ÚÔ¸¿Ú¯Ô˘Û·˜, ÌÂÙˆÚÈÛÌfi, ÂÌÂÙÔ‡˜ Î·È ·ıÔÏÔÁÈÎfi, Û fiÁÎÔ ‹ Û‡ÛÙ·ÛË, Á·ÛÙÚÈÎfi ˘fiÏÔÈÔ. OÈ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ ‹Ù·Ó Ù· ¯·ÌËÏ¿ Ô˘‰ÂÙÂÚfiÊÈÏ· (<1800/mm3), Ë ·‡ÍËÛË Ù˘ Û¯¤Û˘ ·ÒÚˆÓ/ÔÏÈο Ô˘‰ÂÙÂÚfiÊÈÏ· ¿Óˆ ·fi 0,25, Ë ıÚÔÌ‚ÔÂÓ›· (·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ <100000/mm3) Î·È Ë ·‡ÍËÛË Ù˘ CRP (>10 mg/L). OÈ ı¿Ó·ÙÔÈ Ô˘ Û˘Ó¤‚ËÛ·Ó Ì¤Û· Û 10 Ë̤Ú˜ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÛË„·ÈÌ›·˜ ıˆڋıËÎ·Ó fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· ‹ ¤ÌÌÂÛ· Ì ·˘Ù‹Ó.

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™ÂÏ›‰·34

¶·È‰È·ÙÚÈ΋ 2002;65:32-39

°È· ÙȘ ∫∞ ¤ÁÈÓ ÂÒ·ÛË ÛÙÔ ·˘ÙÔÌ·ÙÔÔÈË̤ÓÔ Û‡ÛÙËÌ· BACT/ALERT. OÈ ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ ‰›ÓÔ˘Ó ÔÙÈÎfi Î·È Ë¯ËÙÈÎfi Û‹Ì·, ÔfiÙ Á›ÓÔÓÙ·Ó Ó¤Â˜ ηÏÏȤÚÁÂȘ Û ·ÈÌ·ÙÔ‡¯Ô ¿Á·Ú. ∏ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ÌÈÎÚÔ‚›ˆÓ Î·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ ¢·ÈÛıËÛ›·˜ ÛÙ· ·ÓÙÈÌÈÎÚԂȷο ¤ÁÈÓ Ì ÙÔ Û‡ÛÙËÌ· Vitek. ™·Ó “›‰È·” ıˆڋıËÎ·Ó Ù· ÛÙÂϤ¯Ë ÙÔ˘ ›‰ÈÔ˘ Ù‡Ô˘ ™¶∞, Ô˘ ›¯·Ó ÙÔ ›‰ÈÔ ·ÎÚÈ‚Ò˜ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·. ∆· ÂÂÈÛfi‰È· ·ÔÌfiÓˆÛ˘ ™¶∞ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ÂÂÈÛfi‰È· Û‹„˘ Î·È ÂÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘ Ì ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ∫∞. ™·Ó ÂÂÈÛfi‰È· Û‹„˘ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ÂΛӷ ÛÙ· ÔÔ›· ·ÔÌÔÓÒıËΠÙÔ ›‰ÈÔ Û٤ϯԘ ÙÔ˘ ™¶∞ ·fi ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ∫∞ Ô˘ Ï‹ÊıËÎ·Ó Ù·˘Ùfi¯ÚÔÓ· ‹ ̤۷ ÛÙȘ ÂfiÌÂÓ˜ 2 Ë̤Ú˜. ™·Ó ÂÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘ ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ÂΛӷ ÛÙ· ÔÔ›· ·ÔÌÔÓÒıËΠ™¶∞ ·fi Ì›· ÌfiÓÔ ∫∞, ÂÓÒ Ë ‰Â‡ÙÂÚË, Ô˘ Ï‹ÊıËΠ›Ù ٷ˘Ùfi¯ÚÔÓ· ›Ù ̤۷ ÛÙȘ ÂfiÌÂÓ˜ 2 Ë̤Ú˜ ¯ˆÚ›˜ Ó· ÌÂÛÔÏ·‚‹ÛÂÈ ·ÏÏ·Á‹ Ù˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜, ‹Ù·Ó ·ÚÓËÙÈ΋ ‹ ·Ó¤Ù˘Í ‰È·ÊÔÚÂÙÈÎfi Ù‡Ô ‹ Û٤ϯԘ ™¶∞ ‹ ‰È·ÊÔÚÂÙÈÎfi ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi. ∂›Û˘, Û·Ó ÂÈÌfiÏ˘ÓÛË ¯·Ú·ÎÙËÚ›ÛÙËÎÂ Ë ·ÔÌfiÓˆÛË ™¶∞ ·fi ∫∞ Ô˘ Ï‹ÊıËΠ˘fi ·ÁˆÁ‹ fiÔ˘ ÙÔ Û٤ϯԘ ‹Ù·Ó ¢·›ÛıËÙÔ (10,16,22,28). ∆· ÂÂÈÛfi‰È· Ô˘ ‰ÂÓ ÏËÚÔ‡Û·Ó Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·, Û˘ÁÎÂÎÚÈ̤ӷ ÂΛӷ ÛÙ· ÔÔ›· Ï‹ÊıËΠ̛· ÌfiÓÔ ∫∞ ‹ ÌÂÛÔÏ¿‚ËÛ ·ÏÏ·Á‹ Ù˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ ÌÂٷ͇ Ù˘ Ï‹„˘ ÙˆÓ ‰‡Ô ∫∞, ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Ì ‚‚·ÈfiÙËÙ· Û η̛· ·fi ÙȘ ‰‡Ô ηÙËÁÔڛ˜ Î·È ·Ó·Ê¤ÚÔÓÙ·È Û·Ó ÌË Ù·ÍÈÓÔÌ‹ÛÈÌ· (21,29). ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË: ÀÔÏÔÁ›ÛÙËÎ·Ó ÔÈ Ì¤Û˜ ÙÈ̤˜, ÔÈ ÛÙ·ıÂÚ¤˜ ·ÔÎÏ›ÛÂȘ Î·È Ù· fiÚÈ· ÙˆÓ ÔÛÔÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ. ∏ Û‡ÁÎÚÈÛË ÙˆÓ ÔÈÔÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ¤ÁÈÓ Ì ÙÔ Fisher exact test Î·È ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ Ì ÙÔ student’s t test. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ·Í›·˜ ÙˆÓ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ˘ÔÏÔÁ›ÛÙËÎÂ Ë Â˘·ÈÛıËÛ›·, Ë ÂȉÈÎfiÙËÙ·, Ë £¶∞ Î·È Ë ∞¶∞.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔ ‰È¿ÛÙËÌ· Ù˘ ÌÂϤÙ˘, ™¶∞ ·ÔÌÔÓÒıËΠ·fi 269 ∫∞ Ô˘ ÂÏ‹ÊıËÛ·Ó ·fi 184 ÓÂÔÁÓ¿. OÈ Ù‡ÔÈ ™¶∞ Ô˘ ·ÔÌÔÓÒıËÎ·Ó ‹Ù·Ó ™. ÂȉÂÚÌ›‰·˜ (n=172), ™. ·ÈÌÔÏ˘ÙÈÎfi˜ (n=22), ™. hominis (n=20), ™. simulans (n=13), capitis (n=7), ™. warneri (n=6), ™. Û·ÚÔÊ˘ÙÈÎfi˜ (n=6), ™. cohnii (n=4), ÂÓÒ ‰ÂÓ Ù˘ÔÔÈ‹ıËÎ·Ó 19 ÛÙÂϤ¯Ë.

OÈ ıÂÙÈΤ˜ ÁÈ· ™¶∞ ∫∞ ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Û 200 ÂÂÈÛfi‰È· ·ÔÌfiÓˆÛ˘ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡, ·fi Ù· ÔÔ›· ÌfiÓÔ Ù· 135 (68%) ÏËÚÔ‡Û·Ó ÙȘ ÚÔ¸Ôı¤ÛÂȘ Ù·ÍÈÓfiÌËÛ˘ Ì ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· Ô˘ ηıÔÚ›Û·ÌÂ, ÂÓÒ Ù· ˘fiÏÔÈ· 65 ÂÂÈÛfi‰È· ‰ÂÓ ÌÔÚÔ‡Û·Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Ì ‚‚·ÈfiÙËÙ· Û ̛· ·fi ÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∞fi Ù· 135 ÂÂÈÛfi‰È· ·ÔÌfiÓˆÛ˘ Ô˘ ÌÔÚÔ‡Û·Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó, 41 (30%) ·ÓÙÈÛÙÔÈ¯Ô‡Û·Ó Û ·ÏËıÈÓ‹ Û‹„Ë Î·È 94 (70%) Û ÂÈÌfiÏ˘ÓÛË. ∏ Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ ¤‰ÂÈÍ fiÙÈ Ù· ÓÂÔÁÓ¿ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο

34

Paediatriki 2002;65:32-39

ˆ˜ ÚÔ˜ ÙÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÙËÓ ËÏÈΛ· ·ËÛ˘ Î·È ÙËÓ Î·Ù·ÓÔÌ‹ ÙÔ˘ ʇÏÔ˘. ∞fi Ù· ·ÚÈ· ÚÔ‚Ï‹Ì·Ù·, Ë ÚfiˆÚË Ú‹ÍË ÂÌ‚Ú˘˚ÎÒÓ ˘Ì¤ÓˆÓ, ÙÔ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È Ë ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›· ππ-IV ‚·ıÌÔ‡ ‹Ù·Ó Û˘¯ÓfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· Û‹„˘, ·ÏÏ¿ Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∞Ó·ÊÔÚÈο Ì ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÚԉȷıÂÛÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Ïԛ̈͢, ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÓÂÔÁÓÒÓ Ù˘ ÔÌ¿‰·˜ Û‹„˘ ›¯·Ó ÂÓ‰Ô·ÁÁÂÈ·ÎÔ‡˜ ηıÂÙ‹Ú˜, ‹Ù·Ó Û ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ Î·È ¯ÚÂÈ¿ÛÙËÎ·Ó Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi (¶›Ó·Î·˜ 1). ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ ÔÈ ‰‡Ô ÔÌ¿‰Â˜ ‰ÂÓ ‰È¤ÊÂÚ·Ó ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· ηٿ ÙËÓ ·ÈÌÔÏË„›· Ù˘ ıÂÙÈ΋˜ ÁÈ· ™¶∞ ∫∞, ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ Î·È ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ, ÂÓÒ Ë ÔÛÔÛÙÈ·›· ·Ó·ÏÔÁ›· ÙˆÓ ÓÂÔÁÓÒÓ Ì ·˘ÍË̤ÓË Û¯¤ÛË ·ÒÚˆÓ ÚÔ˜ ÔÏÈο ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (>0,25) Î·È Ì ·˘ÍË̤ÓË CRP ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ÛÙËÓ ÔÌ¿‰· ÂÂÈÛÔ‰›ˆÓ Û‹„˘ (¶›Ó·Î·˜ 2). ∞fi Ù· 184 ÓÂÔÁÓ¿ Ù˘ ÌÂϤÙ˘ η٤ÏËÍ·Ó Û˘ÓÔÏÈο 33 (18%), ·fi Ù· ÔÔ›· ÌfiÓÔ ÛÙÔ ¤Ó· Ë Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ (ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·) ›¯Â Û¯¤ÛË Ì ÂÈ̤ÓÔ˘Û· Û‹„Ë ·fi ™¶∞. ∏ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ÔÌ¿‰· Û‹„˘ ‹Ù·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË (¶›Ó·Î·˜ 2). ªËÓÈÁÁ›Ùȉ· Ì ·ÔÌfiÓˆÛË ÙÔ˘ ›‰ÈÔ˘ ÛÙÂϤ¯Ô˘˜ ™¶∞ ·fi ÙÔ ∂¡À ‚Ú¤ıËΠ۠2 ÓÂÔÁÓ¿, Ó¢ÌÔÓ›· ˘‹Ú¯Â Û 8, Û ‰‡Ô ·fi Ù· ÔÔ›· ·ÔÌÔÓÒıËΠ™¶∞ ·fi ÙÔ ‚ÚÔÁ¯ÈÎfi ˘ÁÚfi Î·È Û ¤Ó· ·fi ÙÔ ¿ÎÚÔ ÙÔ˘ ÙÚ·¯ÂÈÔۈϋӷ. ¢‡Ô ÓÂÔÁÓ¿ ›¯·Ó Û˘ÏÏÔÁ‹ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡, ·ÏÏ¿ ‰ÂÓ ·ÔÌÔÓÒıËΠ™¶∞ ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ÙÔ˘ Ï¢ÚÈÙÈÎÔ‡ ˘ÁÚÔ‡. ™Â 3 ÓÂÔÁÓ¿ Ô ™¶∞ ·ÔÌÔÓÒıËΠ·fi ·fiÛÙËÌ· ‰¤ÚÌ·ÙÔ˜. °È· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ·Í›·˜ ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ ÛÙË ‰È¿ÁÓˆÛË Ù˘ Û‹„˘ ·fi ™¶∞, ·Ó·Ï‡ıËÎ·Ó ÌfiÓÔ Ù· Â˘Ú‹Ì·Ù· ·fi Ù· 135 ÂÂÈÛfi‰È· ·ÔÌfiÓˆÛ˘ Ô˘ ÌÔÚÔ‡Û·Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Û ۋ„Ë ‹ ÂÈÌfiÏ˘ÓÛË. ∫ÏÈÓÈΤ˜ Ì·˙› Ì ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ ˘‹Ú¯·Ó ÛÙÔ 57% Î·È 14% ÙˆÓ ÓÂÔÁÓÒÓ Ì ۋ„Ë ‹ ÂÈÌfiÏ˘ÓÛË, ·ÓÙ›ÛÙÔȯ·, ÌfiÓÔ ÎÏÈÓÈΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ ˘‹Ú¯·Ó ÛÙÔ 22% Î·È 29%, ·ÓÙ›ÛÙÔȯ·, ÂÓÒ ÛÙÔ 11% Î·È 8% ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ, ·ÓÙ›ÛÙÔȯ·, ˘‹Ú¯·Ó ÌfiÓÔ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢. ™˘ÓÔÏÈο, ÎÏÈÓÈΤ˜ ‹/Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢ ˘‹Ú¯·Ó Û 37/41 (90%) ÂÂÈÛfi‰È· Û‹„˘ Î·È Û 48/94 (51%) ÂÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘. ªÂ ‚¿ÛË Ù· ÛÙÔȯ›· ÙÔ˘ ¶›Ó·Î· 3, Ë Â˘·ÈÛıËÛ›· ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ú·ÁÌ·ÙÈ΋˜ Û‹„˘ Û ÓÂÔÁÓ¿ Ì ·ÔÌfiÓˆÛË ™¶∞ ·fi ÙËÓ ∫∞ Â›Ó·È 90%, Ë ÂȉÈÎfiÙËÙ· 49%, Ë £¶∞ 43% Î·È Ë ∞¶∞ 92%.

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·35

¶·È‰È·ÙÚÈ΋ 2002;65:32-39

Paediatriki 2002;65:32-39

¶›Ó·Î·˜ 1. ¢ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È Î‡ÚÈ· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ·Ó¤Ù˘Í·Ó ÛÙ·Ê˘ÏfiÎÔÎÔ ËÎÙ¿ÛË ·ÚÓËÙÈÎfi (™¶∞) ÛÙȘ ·ÈÌÔηÏÏȤÚÁÂȘ

∞ÚÈıÌfi˜ ÂÂÈÛÔ‰›ˆÓ ∞ÚÈıÌfi˜ ÓÂÔÁÓÒÓ ∏ÏÈΛ· ·ËÛ˘ (‚‰., X±SD, fiÚÈ·) µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g, X±SD, fiÚÈ·)

∂ÂÈÛfi‰È· Û‹„˘

∂ÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘

41 40 31±5 (25-40) 1669±873 (740-3800) 22/18

94 86 32±4 (25-40) 1871±993 (585-4920) 37/49

ª.™. ª.™. ª.™.

65 58 33±4 (25-41) 1908±846 (720-5250) 42/16

13 (14) 9 (10) 7 (7) 37 (39) 14 (15)

ª.™. ª.™. ª.™. ª.™. ª.™.

3 (5) 3 (5) 7 (11) 27 (41) 4 (6)

13(14) 4 (4) 43 (46) 28 (30) 2 (2)

0,0003 0,007 0,0002 <0,0001 ª.™.

º‡ÏÔ (∞/∫) ¶ÚÔ‚Ï‹Ì·Ù· ñ ¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· [n,(%)] 4 (10) ñ ƒ∂À [n,(%)] 7 (17) ñ ∂Ó‰ÔÌ‹ÙÚÈ· ‰˘ÛÙÚÔÊ›· [n,(%)] 2 (5) ñ ™‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ [n,(%)] 23 (56) ñ ∂Ó‰Ô-ÂÚÈÎÔÈÏȷ΋ ·ÈÌÔÚÚ·Á›· ππÔ˘-IVÔ˘ ‚·ıÌÔ‡ [n,(%)] 9 (22) ¶ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ñ OÌÊ·ÏÈÎfi˜ ·ÚÙËÚ. ηıÂÙ‹Ú·˜ [n,(%)] 18 (44) ñ ÕÏÏÔÈ ÂÓ‰·ÁÁ. ηıÂÙ‹Ú˜ [n,(%)] 8 (20) ñ OÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ [n,(%)] 33 (80) ñ ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ [n,(%)] 31 (76) ñ £ˆÚ·ÎÈ΋ ·ÚÔ¯¤Ù¢ÛË [n,(%)] 3 (10)

p*

ªË Ù·ÍÈÓÔÌ‹ÛÈÌ· ÂÂÈÛfi‰È·

10 4 38 23 3

(15) (6) (58) (35) (5)

* ∆Ô p ·Ó·Ê¤ÚÂÙ·È ÛÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘

™˘˙‹ÙËÛË O ÚfiÏÔ˜ ÙÔ˘ ™¶∞ ÛÙËÓ ÚfiÎÏËÛË Û‹„˘ Û ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÔÓÙ·È Û ª∂£¡ ¿Ú¯ÈÛ ӷ ··Û¯ÔÏ› ·fi ÙË ‰ÂηÂÙ›· ÙÔ˘ ’80 (3,4,27,30-33). ŒÎÙÔÙÂ, ·Ó·Ê¤ÚıËΠ‚·ıÌÈ·›· ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ™¶∞ ·fi ÙȘ ∫∞ ÓÂÔÁÓÒÓ (1,2,33). ∏ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Û‹„˘ ·fi ¤Ó· ÌÈÎÚfi‚ÈÔ ÌÈÎÚ‹˜ ÏÔÈÌÔÁfiÓÔ˘ ‰‡Ó·Ì˘, fiˆ˜ Ô ™¶∞, ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ¿Û¯ÔÓÙ· ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÔÓÙ·È Û ª∂£¡ ˘¿Ú¯Ô˘Ó ÔÏÏÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ¢ÓÔÔ‡Ó ÙËÓ ·Ó¿Ù˘ÍË Ïԛ̈͢ (34,35). OÈ Û˘¯ÓfiÙÂÚÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ Â›Ó·È Ë ÚÔˆÚfiÙËÙ·, Ì ÙËÓ ·ÓˆÚÈÌfiÙËÙ· ÙˆÓ ·Ì˘ÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Ô˘ Û˘ÓÂ¿ÁÂÙ·È (2,36,37), Ë ‡·ÚÍË ÂÓ‰Ô·ÁÁÂÈ·ÎÒÓ Î·ıÂÙ‹ÚˆÓ (3,21,30,33, 38-40), Ë ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ (41) Î·È Ë ÂÊ·ÚÌÔÁ‹ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ (33,42). ™ÙË ÌÂϤÙË Ì·˜, ÔÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› ‹Ù·Ó ÛËÌ·ÓÙÈο Û˘¯ÓfiÙÂÚÔÈ ÛÙ· ÂÂÈÛfi‰È· Û‹„˘ Û˘ÁÎÚÈÙÈο Ì ٷ ÂÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ·ÓÙ·Ó·ÎÏ¿, Â›Û˘, ÙË ÌÂÁ·Ï‡ÙÂÚË ‚·Ú‡ÙËÙ· ÙˆÓ ÓÂÔÁÓÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙËÓ ÔÌ¿‰· Û‹„˘, Ë ÔÔ›· ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ Î·È ÙË ÌÂÁ·Ï‡ÙÂÚË ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ÔÌ¿‰· ·˘Ù‹, ·Ú’ fiÏÔ Ô˘ Ë ıÓËÙfiÙËÙ· Ù˘ Û‹„˘ ·fi ™¶∞ ‹Ù·Ó ÌÈÎÚ‹ (ÌfiÓÔ ¤Ó· ÓÂÔÁÓfi). ∏ Û·ÚÔÊ˘ÙÈ΋ ·ÚÔ˘Û›· ÙÔ˘ ™¶∞ ÛÙÔ ‰¤ÚÌ· ʤÚÓÂÈ ÙÔ ÓÂÔÁÓÔÏfiÁÔ ·ÓÙÈ̤وÔ Ì ÙÔ ‰›ÏËÌÌ· ·Ó Ë ·ÔÌfiÓˆÛ‹ ÙÔ˘ ·fi ÙËÓ ∫∞ ·ÓÙÈÚÔÛˆ‡ÂÈ Ú·ÁÌ·ÙÈ΋ Û‹„Ë ‹ ÔÊ›ÏÂÙ·È Û ÂÈÌfiÏ˘ÓÛË. ¶ÚˆÙ·Ú¯ÈÎfi ̤ÏËÌ· ÙÔ˘ ÓÂÔÁÓÔÏfiÁÔ˘ ÌÚÔÛÙ¿ Û ٤ÙÔÈÔ ‰›ÏËÌÌ· Â›Ó·È Ó· ÌËÓ ·Ú·Ì›ÓÂÈ ·‰È¿ÁÓˆÛÙË Î·È ÂÔ̤ӈ˜ ¯ˆÚ›˜ ıÂÚ·›·, Ô‡Ù ̛·

ÂÚ›ÙˆÛË ·ÏËıÈÓ‹˜ Û‹„˘. ¶·Ú¿ÏÏËÏ·, fï˜, Â›Ó·È ÛËÌ·ÓÙÈ΋ Ë ÂÏ·¯ÈÛÙÔÔ›ËÛË Ù˘ ¯Ú‹Û˘ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ ÛÙȘ ª∂£¡, Ë ÔÔ›· ÂÎÙfi˜ ·fi ÙËÓ ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÓÔÛËÏ›·˜ ÂÓ¤¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ (ÓÂÊÚÈ΋ ‚Ï¿‚Ë, Ì˘ÎËÙÈ·ÛÈΤ˜ ÏÔÈÌÒÍÂȘ) Î·È Ô‰ËÁ› ÛÙËÓ ·Ó¿Ù˘ÍË ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ ÌÈÎÚÔ‚›ˆÓ. ∞fi ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ fiÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È¿ÊÔÚ· ÎÚÈÙ‹ÚÈ·, ΢ڛˆ˜ ÌÈÎÚÔ‚ÈÔÏÔÁÈο, ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ™¶∞ ·fi ÙȘ ∫∞ ÂÓ‰ÔÓÔÛÔÎÔÌÂÈ·ÎÒÓ ·ÛıÂÓÒÓ Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÂÈÌfiÏ˘ÓÛË, ÔÈΛÏÏÂÈ ·fi 30% ̤¯ÚÈ 85% ·Ó¿ÏÔÁ· Ì ٷ ÎÚÈÙ‹ÚÈ· (3,20,21,30,43). ∞fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ 135 ÂÂÈÛÔ‰›ˆÓ fiÔ˘ ˘‹Ú¯Â ‰˘Ó·ÙfiÙËÙ· Ù·ÍÈÓfiÌËÛ˘, Ê·›ÓÂÙ·È fiÙÈ ÛÙÔ 68% ÂÚ›Ô˘ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ™¶∞ ÚfiÎÂÈÙ·È ÁÈ· ÂÈÌfiÏ˘ÓÛË. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È ·ÚÎÂÙ¿ ˘„ËÏfi, ÒÛÙ ӷ Ô‰ËÁ› Û ηٿ¯ÚËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ, ·Ó ‰ÂÓ ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Û˘ÁÎÂÎÚÈ̤ӷ ÎÚÈÙ‹ÚÈ· ‰È¿ÎÚÈÛ˘ ÌÂٷ͇ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘. OÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÌʈÓÔ‡Ó fiÙÈ ÙÔ Î·Ï‡ÙÂÚÔ ÎÚÈÙ‹ÚÈÔ Â›Ó·È Ë ·ÔÌfiÓˆÛË ÙÔ˘ ›‰ÈÔ˘ ÛÙÂϤ¯Ô˘˜ ÙÔ˘ ›‰ÈÔ˘ Ù‡Ô˘ ™¶∞ Û ‰‡Ô ∫∞ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Ù·˘Ùfi¯ÚÔÓ· ·fi ‰È·ÊÔÚÂÙÈο ÛËÌ›· (5,21,25). ∆· ·ÚÈ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ÚÔ·ÙÔ˘Ó Î·Ù¿ ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙÔ˘ ÎÚÈÙËÚ›Ô˘ ·˘ÙÔ‡ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙȘ ‰È·ı¤ÛÈ̘ ÌÂıfi‰Ô˘˜ Ù˘ÔÔ›ËÛ˘ ÙÔ˘ ™¶∞ Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Ù·ÎÙÈ΋˜ Ï‹„˘ ‰‡Ô ∫∞ Ù·˘Ùfi¯ÚÔÓ·. ™ÙË ÌÂϤÙË Ì·˜, Û·Ó “›‰È·” ıˆڋıËÎ·Ó Ù· ÛÙÂϤ¯Ë ™¶∞ Ô˘ ·Ó‹Î·Ó ÛÙÔÓ ›‰ÈÔ Ù‡Ô Î·È Â›¯·Ó ÙÔ

35

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·36

¶·È‰È·ÙÚÈ΋ 2002;65:32-39

Paediatriki 2002;65:32-39

¶›Ó·Î·˜ 2. ∏ÏÈΛ· ηٿ ÙË Û‹„Ë, ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Î·È ¤Î‚·ÛË ÓÂÔÁÓÒÓ ÛÙȘ 3 ÔÌ¿‰Â˜ ÂÂÈÛÔ‰›ˆÓ

∏ÏÈΛ· ÂÂÈÛÔ‰›Ô˘ (ËÌ., X±SD, fiÚÈ·) ∂ÂÈÛfi‰È· ÚÈÓ ÙËÓ 6Ë Ë̤ڷ ˙ˆ‹˜ (n) ∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ñ ∞ÚÈıÌfi˜ Ï¢ÎÒÓXmm-3 (X±SD, fiÚÈ·) ñ ∞ÈÌÔÂÙ¿ÏÈ· X103Xmm-3 (X±SD, fiÚÈ·) ñ ∞/O Ô˘‰ÂÙÂÚfiÊÈÏ· >0,25 [n,(%)]** ñ CRP >10 mg/l [n,(%)] ŒÎ‚·ÛË ñ £ÓËÛÈÌfiÙËÙ· [n,(%)] ñ £ÓËÙfiÙËÙ· Û‹„˘ ·fi ™¶∞ ñ ¢È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (ËÌ., X±SD, fiÚÈ·)

∂ÂÈÛfi‰È· Û‹„˘ (n=41)

∂ÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘ (n=94)

p*

ªË Ù·ÍÈÓÔÌ‹ÛÈÌ· ÂÂÈÛfi‰È· (n=65)

15±14 (1-83) 5

18±17 (1-127) 12

ª.™. ª.™.

12±12 (1-67) 22

12733±9660 (2200-46000) 151±130 (9-554) 19 (46) 29 (71)

16381±11432 (3000-69000) 186±124 (11-467) 2 (2) 41 (44)

ª.™.

13525±10050 (4000-47600) 214±124 (9-496) 11 (17) 23 (35)

12 (29) 1 53±36 (13-165)

11 (12) 0 43±27 (4-120)

ª.™. <0,001 0,0048 0,023 ª.™.

10 (15) 0 33±23 (2-101)

* ∆Ô p ·Ó·Ê¤ÚÂÙ·È ÛÙË Û‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ ** ∞/O: ¿ˆÚ· / ÔÏÈο

›‰ÈÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·. ∞Ó Î·È Ë ·ÍÈÔÈÛÙ›· ÙÔ˘ ·ÓÙÈ‚ÈÔÁÚ¿ÌÌ·ÙÔ˜ Ó· ·Ó·ÁÓˆÚ›˙ÂÈ “›‰È·” ÛÙÂϤ¯Ë ™¶∞ Î·È Î·Ù’ Â¤ÎÙ·ÛË Ó· ‰È¢ÎÚÈÓ›˙ÂÈ ÌÂٷ͇ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ ¤¯ÂÈ ·ÌÊÈÛ‚ËÙËı› ·fi ÔÚÈṲ̂ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ (3,7), ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÁÈ· ÙÔ ÛÎÔfi ·˘Ùfi. OÈ Khatib Î·È Û˘Ó (22), ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙË Ì¤ıÔ‰Ô ·ÔÌfiÓˆÛ˘ ÙˆÓ Ï·ÛÌȉ›ˆÓ, ‰È·›ÛÙˆÛ·Ó fiÙÈ ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ· ›¯Â Ôχ ˘„ËÏ‹ ¢·ÈÛıËÛ›· (100%) Î·È ÂȉÈÎfiÙËÙ· (84%) ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÁÂÓÂÙÈο Û˘ÁÁÂÓÒÓ ÛÙÂϯÒÓ. ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ· Â›Ó·È ·Ô‰ÂÎÙfi˜ ÙÚfiÔ˜ ·Ó·ÁÓÒÚÈÛ˘ ÙˆÓ ÛÙÂϯÒÓ ™¶∞, ȉȷ›ÙÂÚ· ·Ó ‰ÂÓ Â›Ó·È ‰È·ı¤ÛÈ̘ ¿ÏϘ ̤ıÔ‰ÔÈ, fiˆ˜ Ë ·ÔÌfiÓˆÛË ÙˆÓ Ï·ÛÌȉ›ˆÓ (23,24), Ë pulsed field gel electrophoresis (16,29) Î·È ¿ÏϘ ÌÔÚȷΤ˜ Ù¯ÓÈΤ˜ (7). ∏ Ï‹„Ë ‰‡Ô ∫∞ Ù·˘Ùfi¯ÚÔÓ· ·fi ‰È·ÊÔÚÂÙÈο ÛËÌ›· Â›Ó·È Ì›· ‰È·‰Èηۛ· Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ ‰ÂÓ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙ· ÓÂÔÁÓ¿. ∞˘Ùfi ·ÊÔÚ¿ ȉȷ›ÙÂÚ· Ù· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Ô˘ Â›Ó·È ÂÈ‚·Ú˘Ì¤Ó· Ì ÔÏÏ¿ ¿ÏÏ· ÚÔ‚Ï‹Ì·Ù· Î·È ·ÛÙ·ı‹, ÒÛÙ ӷ ·ÔʇÁÔÓÙ·È Û ·˘Ù¿ ÔÈ ÔÏÏÔ› ¯ÂÈÚÈÛÌÔ›, fiˆ˜ Â›Ó·È ÔÈ Â·ÓÂÈÏËÌ̤Ó˜ ÚÔÛ¿ıÂȘ ·ÈÌÔÏË„›·˜. ŒÙÛÈ, ÔÏϤ˜ ÊÔÚ¤˜ Ë ‰Â‡ÙÂÚË ∫∞ Ï·Ì‚¿ÓÂÙ·È ÌÂÙ¿ ·fi 2-3 Ë̤Ú˜, ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÔÔ›ˆÓ ÌÔÚ› Ó· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Ë ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹, ÁÂÁÔÓfi˜ Ô˘ ÂÚÈÔÚ›˙ÂÈ ÙË ‰È·ÁÓˆÛÙÈ΋ ·Í›· Ù˘ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ™¶∞ (21,29). ™ÙȘ ÂÚÈÙÒÛÂȘ ÌË Ù·˘Ùfi¯ÚÔÓ˘ Ï‹„˘ ∫∞, Ë ‰Â‡ÙÂÚË ∫∞ ÌÔÚ› Ó· ·ÍÈÔÏÔÁËı› ÌfiÓÔ Ì ÔÚÈṲ̂Ó˜ ÚÔ¸Ôı¤ÛÂȘ, fiˆ˜ ·˘Ù¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈ‹Û·ÌÂ Û·Ó ÎÚÈÙ‹ÚÈ· Ù·ÍÈÓfiÌËÛ˘ ÛÙË ÌÂϤÙË Ì·˜ (10,16,22). ªÂ ‚¿ÛË Ù· ÎÚÈÙ‹ÚÈ· ·˘Ù¿, ÌfiÓÔ 135/200 ÂÂÈÛfi‰È· ÌÔÚÔ‡Û·Ó Ó· Ù·ÍÈÓÔÌË-

36

ıÔ‡Ó. ¢ËÏ·‰‹, Ì ÙË ‰È·‰Èηۛ· Ô˘ ÙËÚÂ›Ù·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË, ÌfiÓÔ ÛÙÔ 68% ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÔÌfiÓˆÛ˘ ÙÔ˘ ™¶∞ Ë ∫∞ ÌÔÚ› Ó· ·ÍÈÔÏÔÁËı› Î·È Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘. ™ÙȘ ˘fiÏÔÈ˜ ÂÚÈÙÒÛÂȘ, Ë ·fiÊ·ÛË ÙÔ˘ ÓÂÔÁÓÔÏfiÁÔ˘ ÁÈ· Û˘Ó¤¯ÈÛË ‹ ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜ ¤ÚÂ ӷ ‚·ÛÈÛÙ› ÛÙ· ˘fiÏÔÈ· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·. ∂›Ó·È ÏÔÈfiÓ ÛËÌ·ÓÙÈÎfi Ó· ‰È¢ÎÚÈÓÈÛÙ› Ë Û¯¤ÛË ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ Ì ÙËÓ ‡·ÚÍË ·ÏËıÈÓ‹˜ Û‹„˘ ·fi ™¶∞. ªÂϤÙ˜ Û ·ÛıÂÓ›˜ ÌÔÓ¿‰ˆÓ ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÂÓ ÌfiÚÂÛ·Ó Ó· ÙÂÎÌËÚÈÒÛÔ˘Ó Ì›· ÛÙ·ıÂÚ‹ Û¯¤ÛË ÌÂٷ͇ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ Ïԛ̈͢ Î·È Ú·ÁÌ·ÙÈ΋˜ Û‹„˘ ·fi ™¶∞ (16,19,21,27). ª›· Ù¤ÙÔÈ· Û¯¤ÛË Â›Ó·È ·ÎfiÌË ÈÔ ‰‡ÛÎÔÏÔ Ó· ÙÂÎÌËÚȈı› ÛÙ· ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· Ù· ÎÏÈÓÈο ÛËÌ›· Ïԛ̈͢ Â›Ó·È ÌË ÂȉÈο Î·È ÌÔÚÔ‡Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Û ÔÏϤ˜ ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ, Ôχ ÎÔÈÓ¤˜ Û ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÔÓÙ·È Û ÙÌ‹Ì·Ù· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜, fiˆ˜ Â›Ó·È ÙÔ ™∞¢, Ë ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·, Ë ·Ú·ÌÔÓ‹ ·ÓÔÈÎÙÔ‡ ·ÚÙËÚÈ·ÎÔ‡ fiÚÔ˘, Î.¿. (20,21). ∂ÈϤÔÓ, ·ÓÙÈÎÚÔ˘fiÌÂÓ· Â›Ó·È Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·Í›· ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ïԛ̈͢ ÛÙË ‰È¿ÁÓˆÛË Ù˘ Û‹„˘ ·fi ™¶∞ (20,21,26). ¶ÚÔÛ·ıÒÓÙ·˜ ÏÔÈfiÓ Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ì ÙË Û˘Ì‚ÔÏ‹ ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ ÛÙËÓ ÂȂ‚·›ˆÛË ‹ ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Û‹„˘ ·fi ™¶∞, ·Ó·Ï‡Û·Ì ÙË Û˘Ó‡·ÚÍË ÎÏÈÓÈÎÒÓ ‹/Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ ÛÙ· 135 ÂÂÈÛfi‰È·, fiÔ˘ ˘‹Ú¯·Ó ÔÈ ÚÔ¸Ôı¤ÛÂȘ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ∫∞. ¢È·ÈÛÙÒÛ·Ì fiÙÈ Ù· ÂÂÈÛfi‰È· Û‹„˘ ÛÙË ÌÂÁ¿ÏË ÙÔ˘˜ ÏÂÈÔ„ËÊ›· Û˘Óԉ‡ÔÓÙ·Ó ·fi ÎÏÈÓÈΤ˜ ‹/Î·È ÂÚÁ·ÛÙËÚȷΤ˜

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·37

¶·È‰È·ÙÚÈ΋ 2002;65:32-39

Paediatriki 2002;65:32-39

¶›Ó·Î·˜ 3. ¢È·ÁÓˆÛÙÈ΋ ·Í›· ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ ÛÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ ·fi ™¶∞ ∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ

∂ÂÈÛfi‰È· Û‹„˘

∂ÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘

¡·È

37/41 (90%, ·ÏËıÒ˜ ıÂÙÈο) 4/41 (10%, „¢‰Ò˜ ·ÚÓËÙÈο)

48/94 (51%, „¢‰Ò˜ ıÂÙÈο) 46/94 (49%,·ÏËıÒ˜ ·ÚÓËÙÈο)

Ÿ¯È

ÂӉ›ÍÂȘ Ïԛ̈͢. øÛÙfiÛÔ, ÛÙÔ 10% ·fi ·˘Ù¿ ·Ô˘Û›·˙·Ó ÔÈ ÂӉ›ÍÂȘ Ïԛ̈͢, ÁÂÁÔÓfi˜ Ô˘ ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙËÓ ËÈfiÙÂÚË ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÔÚ›· Ù˘ Û‹„˘ ·fi ™¶∞ Û˘ÁÎÚÈÙÈο Ì ÂΛÓË ·fi ¿ÏÏÔ˘˜ ÈÔ ÙÔÍÈÎÔ‡˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (27,34,35). ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Â›Ó·È ÛËÌ·ÓÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙ· ÌÈÛ¿ ÂÚ›Ô˘ ÂÂÈÛfi‰È· ÂÈÌfiÏ˘ÓÛ˘ ˘‹Ú¯·Ó ÎÏÈÓÈο ‹/Î·È ÂÚÁ·ÛÙËÚȷο ÛËÌ›· Ïԛ̈͢. ∆Ô ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È ·Ó·ÌÂÓfiÌÂÓÔ, ÂÂȉ‹ Ë ·ÚÔ˘Û›· ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ ‡ÔÙˆÓ ÁÈ· Ïԛ̈ÍË ‹Ù·Ó Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ Ï‹„˘ ÙˆÓ ∫∞, ÂÓÒ fiˆ˜ Ê·›ÓÂÙ·È ·fi Ù· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÓÂÔÁÓÒÓ, ˘‹Ú¯·Ó Û ·˘Ù¿ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢, fiˆ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ·ÈÌÔÂÙ·Ï›ˆÓ, ·ÏÏ¿ Î·È Ù˘ CRP. OÈ ÂÚÈÔÚÈÛÌÔ› ·˘ÙÔ› ÌÂÈÒÓÔ˘Ó ÙËÓ ·Í›· ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ ÛÙË ‰È¿ÁÓˆÛË Ù˘ Û‹„˘ ·fi ™¶∞, fiˆ˜ ÂȂ‚·ÈÒıËΠ̠ÙÔ˘˜ ÛÙ·ÙÈÛÙÈÎÔ‡˜ ‰Â›ÎÙ˜ ÂÎÙ›ÌËÛ˘ Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ·Í›·˜. ∞fi ÙÔ˘˜ ‰Â›ÎÙ˜ ·˘ÙÔ‡˜ ȉȷ›ÙÂÚË ÎÏÈÓÈ΋ ÛËÌ·Û›· ¤¯Ô˘Ó Ë ıÂÙÈ΋ Î·È ·ÚÓËÙÈ΋ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘, ÁÈ·Ù› ‰Â›¯ÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ‡·Ú͢ ‹ ·Ô˘Û›·˜ ÓfiÛÔ˘, ·Ó Ë ·Ú¿ÌÂÙÚÔ˜ ‚ÚÂı› ıÂÙÈ΋ ‹ ·ÚÓËÙÈ΋, ·ÓÙ›ÛÙÔȯ·. ∞fi Ù· ÛÙÔȯ›· Ù˘ ÌÂϤÙ˘ Ì·˜ ÚԤ΢„ ̛· £¶∞ (43%) ÌÈÎÚfiÙÂÚË ·fi ÙËÓ Ù˘¯·›· Èı·ÓfiÙËÙ· Ú‹„˘ ÓÔÌ›ÛÌ·ÙÔ˜ (50%). ∏ ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË ·˘Ù‹˜ Ù˘ ¯·ÌËÏ‹˜ £¶∞ ‰Â›¯ÓÂÈ fiÙÈ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÌÈÛ¿ ÂÂÈÛfi‰È· fiÔ˘ Ë ·ÔÌfiÓˆÛË ÙÔ˘ ™¶∞ Û˘Óԉ‡ÂÙ·È ·fi ÎÏÈÓÈΤ˜ ‹/Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢, ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÈÌfiÏ˘ÓÛË. ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, Ë ∞¶∞ Â›Ó·È ·ÚÎÂÙ¿ ˘„ËÏ‹ (92%) Î·È ‰Â›¯ÓÂÈ fiÙÈ ÛÙ· ÂÂÈÛfi‰È· fiÔ˘ Ë ·ÔÌfiÓˆÛË ÙÔ˘ ™¶∞ ·fi ÙËÓ ∫∞ ‰ÂÓ Û˘Óԉ‡ÂÙ·È ·fi ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷΤ˜ ÂӉ›ÍÂȘ Ïԛ̈͢, Ë Èı·ÓfiÙËÙ· ‡·Ú͢ Û‹„˘ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 10%. ∆Ô ÔÛÔÛÙfi ·˘Ùfi ı· ÌÔÚÔ‡Û ӷ Á›ÓÂÈ ·Ô‰ÂÎÙfi, ·Ó ‰ÂÓ ÂÚfiÎÂÈÙÔ ÁÈ· ÙfiÛÔ ÛÔ‚·Ú‹ ÓfiÛÔ fiˆ˜ Ë ÓÂÔÁÓÈ΋ Û‹„Ë, Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ Î·Î‹ ÂͤÏÈÍË, ·Ó ‰ÂÓ ‰È·ÁÓˆÛÙ› Î·È ·ÊÂı› ¯ˆÚ›˜ ÙËÓ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË. ∂Ô̤ӈ˜, Ë ÎÏÈÓÈ΋ ÂÚÌËÓ›· ÙˆÓ ÛÙ·ÙÈÛÙÈÎÒÓ ·˘ÙÒÓ ‰ÂÈÎÙÒÓ Ô‰ËÁ› ÛÙÔ

Û˘Ì¤Ú·ÛÌ· fiÙÈ Ì ÙË ¯Ú‹ÛË ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Ïԛ̈͢ Û ÓÂÔÁÓ¿ Ô˘ ·Ó·Ù‡ÛÛÔ˘Ó ™¶∞ ·fi ÙȘ ∫∞, fi¯È ÌfiÓÔ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È Ë Î·Ù¿¯ÚËÛË ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ, ·ÏÏ¿ ÂÈϤÔÓ Â›Ó·È ‰˘Ó·ÙfiÓ ÔÚÈṲ̂ӷ ÂÂÈÛfi‰È· ·ÏËıÈÓ‹˜ Û‹„˘ Ó· ¯·Ú·ÎÙËÚÈÛÙÔ‡Ó ˆ˜ ÂÈÌfiÏ˘ÓÛË Î·È Ó· ·Ú·Ì›ÓÔ˘Ó ¯ˆÚ›˜ ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹. ™˘ÓÔÙÈο, Ù· Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ÔÈ ∫∞ ¤¯Ô˘Ó ÏËÊı› Ì ÙÚfiÔ Ô˘ ‚ÔËı¿ ÛÙË ‰È¿ÎÚÈÛË Û‹„˘ Î·È ÂÈÌfiÏ˘ÓÛ˘ ÌfiÓÔ ÛÙ· 2/3 ÙˆÓ ÂÂÈÛÔ‰›ˆÓ ·ÔÌfiÓˆÛ˘ ™¶∞ ·fi ∫∞ ÓÂÔÁÓÒÓ ª∂£¡. ∞fi ÙȘ ·ÍÈÔÏÔÁ‹ÛÈ̘ ıÂÙÈΤ˜ ÁÈ· ™¶∞ ∫∞, ÌfiÓÔ ÙÔ 30% ·ÓÙÈηÙÔÙÚ›˙ÂÈ Ú·ÁÌ·ÙÈ΋ Û‹„Ë, ÂÓÒ Ë Û˘ÓÂÎÙ›ÌËÛË ÙˆÓ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÂӉ›ÍÂˆÓ Û‹„˘ ‰ÂÓ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È¿ÎÚÈÛ‹ Ù˘ ·fi ÙËÓ ÂÈÌfiÏ˘ÓÛË. µÈ‚ÏÈÔÁÚ·Ê›· 1. Hervas JA, Alomar A, Salva F, Reina J, Benedi VJ. Neonatal sepsis and meningitis in Mallorca, Spain, 1977-1991. Clin Infect Dis 1993;16:719-724.

2. Rodriguez Cervilla J, Fraga JM, Garcia Riestra C, Fernandez Lorenzo JR, Martinez Soto I. Neonatal sepsis: epidemiologic indicators and relation to birth weight and length of hospitalization time. An Esp Pediatr 1998;48:401-408.

3. Kirchhoff LV, Sheagren JN. Epidemiology and clinical significance of blood cultures positive for coagulasenegative staphylococcus. Infect Control 1985:6:479-486.

4. Kumar SP, Delivoria-Papadopoulos M. Infections in newborn infants in a special care unit. A changing pattern of infection. Ann Clin Lab Sci 1985;15:351-356.

5. Neumeister B, Kastner S, Conrad S, Klotz G, Bartmann P. Characterization of coagulase-negative staphylococci causing nosocomial infections in preterm infants. Eur J Clin Microbiol Infect Dis 1995;4:856-863.

6. Patrick CC, Kaplan SL, Baker CJ, Parisi JT, Mason EO Jr. Persistent bacteremia due to coagulase-negative staphylococci in low birth weight neonates. Pediatrics 1989;84:977-985.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-06-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: µ·ÛÈÏÈ΋ ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ °ÏËÓÔ‡ 28, 543 52 £ÂÛÛ·ÏÔÓ›ÎË E-mail: agaki@med.auth.gr

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ªÂϤÙË ıÂÚ·¢ÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ‰ÈÂÁÂÚÙÈÎÔ‡ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ·Ú¿ÁÔÓÙ·, Û Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Ì Èı·Ó‹ ÛË„·ÈÌ›· Î·È Ô˘‰ÂÙÂÚÔÂÓ›·1 ™ÎÔfi˜: O ·ÚÈÔ˜ ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÚ¢ÓËı› Ë ·ÛÊ¿ÏÂÈ· ·fi ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ˘ ·ÓıÚÒÈÓÔ˘ ‰ÈÂÁÂÚÙÈÎÔ‡ ÙˆÓ ÎÔÎÎÈÔ΢ÙÙ¿ÚˆÓ ·Ú¿ÁÔÓÙ· (rhGCSF) ηٿ ÙË ıÂÚ·›· Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (µ°≤1500 gr) ÛË„·ÈÌÈÎÒÓ ÓÂÔÁÓÒÓ Ì ۯÂÙÈ΋ Ô˘‰ÂÙÂÚÔÂÓ›·, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ Âȉ›ӈÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, ÙË ıÚÔÌ‚ÔÂÓ›· Î·È ÙË ıÓËÙfiÙËÙ·. ¢Â˘ÙÂÚ‡ÔÓÙ˜ ÛÙfi¯ÔÈ ‹Ù·Ó Ë ÂÎÙ›ÌËÛË Ù˘ ‰È¿ÚÎÂÈ·˜ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ Î·È ¯Ú‹Û˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Û·Ó ‰Â›ÎÙ˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ·Ú¿ÁÔÓÙ·. ÀÏÈÎfi Î·È ÌÂıÔ‰ÔÏÔÁ›·: ¡ÂÔÁÓ¿ ËÏÈΛ·˜ ≤28 ËÌÂÚÒÓ Ô˘ ÓÔÛËχÔÓÙ·È Û ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ Ì µ° 5001500 g, ·fiÏ˘ÙÔ ·ÚÈıÌfi ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ≤5x109/L Î·È ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛË„·ÈÌ›·˜, ÂÂϤÁËÛ·Ó Ù˘¯·›· Ó· ¿ÚÔ˘Ó Â›Ù rhG-CSF (10 Ìg/kg/ËÌÂÚËÛ›ˆ˜) ÛÙ¿Á‰ËÓ ÂÓ‰ÔÊϤ‚È· (n=13), ›Ù placebo (n=15) ÁÈ· 15 ÙÔ ·ÓÒÙÂÚÔ Ë̤Ú˜, ·Ú¿ÏÏËÏ· Ì ÙËÓ ˘fiÏÔÈË ˘ÔÛÙËÚÈÎÙÈ΋ Î·È ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹. O ‰Â›ÎÙ˘ Ô͢ÁfiÓˆÛ˘, ÙÔ ÔÛÔÛÙfi ıÚÔÌ‚ÔÂÓ›·˜, ÔÈ ·Èٛ˜ ıÓËÙfiÙËÙ·˜, Ë ‰È¿ÚÎÂÈ· ·ÂÚÈÛÌÔ‡, ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜, ıÂÚ·›·˜ Ì ·ÓÙÈ‚ÈÔÙÈο Î·È Ë ·ÔηٿÛÙ·ÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ÌÂÏÂÙËı¤ÓÙˆÓ ÓÂÔÁÓÒÓ. ∞ÔÙÂϤÛÌ·Ù·: ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ Ì ÙÔÓ rhGCSF ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙˆÓ ·ÚÂÓÂÚÁÂÈÒÓ Î·È ÙÔ˘ ‰Â›ÎÙË Ô͢ÁfiÓˆÛ˘, Ë ‰Â ·Ú·ÙËÚËı›۷ ıÚÔÌ‚ÔÂÓ›· ‰ÂÓ ·Ô‰fiıËΠÛÙË ¯Ú‹ÛË ÙÔ˘ ‰ÈÂÁÂÚÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ™ÙȘ ËÏÈ˘ ÙˆÓ 6 Î·È 12 ÌËÓÒÓ ‰È·ÈÛÙÒıËÎ·Ó ÏÈÁfiÙÂÚÔÈ ı¿Ó·ÙÔÈ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ηٿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Â›¯·Ó ¿ÚÂÈ rhG-CSF (1/13 √ 7/15; p<0,038). ¢È·ÈÛÙÒıËΠ̛· Ù¿ÛË, Ë ÔÔ›· fï˜ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, ÚÔ˜ Ì›ˆÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ·ÂÚÈÛÌÔ‡ Ù˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ Î·È Ù˘ ¯Ú‹Û˘ ÙˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ÓÂÔÁÓÒÓ Ô˘

‹Ú·Ó rhG-CSF. ¶·Ú·ÙËÚ‹ıËΠ̛· ÛËÌ·ÓÙÈο Ù·¯‡ÙÂÚË ·‡ÍËÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙ· ÓÂÔÁÓ¿ Ô˘ ‹Ú·Ó rhG-CSF (p<0,001). ™˘ÌÂÚ¿ÛÌ·Ù·: ™ÙËÓ ·ÚÔ‡Û· ÌÈÎÚ‹ Ù˘¯·ÈÔÔÈË̤ÓË ÂÏÂÁ¯fiÌÂÓË ÌÂϤÙË Ì ÂÈÏÂÁ̤ÓË ÔÌ¿‰· ÓÂÔÁÓÒÓ, Ë ıÂÚ·›· Ì rhG-CSF ·‡ÍËÛ Ôχ ÁÚ‹ÁÔÚ· ÙÔÓ ·fiÏ˘ÙÔ ·ÚÈıÌfi ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÚÂÓ¤ÚÁÂȘ Ô˘ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ıÂÚ·¢ÙÈ΋ ¯ÔÚ‹ÁËÛË ÙÔ˘ ·Ú¿ÁÔÓÙ·. ∏ ıÓËÙfiÙËÙ· ÛÙȘ ËÏÈ˘ ÙˆÓ 6 Î·È 12 ÌËÓÒÓ ‹Ù·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ηٿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô ÙÔ‡˜ ¯ÔÚËÁ‹ıËΠrhG-CSF. ª›· ÌÂÁ·Ï‡ÙÂÚË ÌÂϤÙË, ÛÙËÓ ÔÔ›· ı· ÂÎÙÈÌËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ rhG-CSF Û ›‰È· ÔÌ¿‰· ÓÂÔÁÓÒÓ, Â›Ó·È ·fiÏ˘Ù· ‰ÈηÈÔÏÔÁË̤ÓË.

1

Russel ARB, Emmerson AJB, Wilkinson N, Chant T, Sweet DG, Halliday HL et al A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia Arch Dis Child Fetal Neonatal 2001;84:F172-F176

™‡ÚÔ˜ ºˆÙfiÔ˘ÏÔ˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜ ¢È‰¿ÎÙˆÚ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ∞Ó·ÏËÚˆÙ‹˜ ¢È¢ı˘ÓÙ‹˜ µ’ ª∂¡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”

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ORIGINAL ARTICLE

∏ˆÛÈÓÔÊÈÏ›· ÛÙ· ÓÔÛËÏ¢fiÌÂÓ· ÓÂÔÁÓ¿ ∞. ª·ÓÔ˘Ú¿, ∂. ÷Ù˙ˉ¿ÎË, ∂. ∫ÔڷοÎË, ª. ªËÙÛ¿ÎË, µ. µ·Ï¿ÚË, ¢. ª·ÌÔ˘Ï¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Eosinophilia in hospitalized neonates A. Manoura, E. Hatzidaki, E. Korakaki, M. Mitsaki, V. Valari, D. Mamoulakis, C. Giannakopoulou

¶ÂÚ›ÏË„Ë: ∏ ˈÛÈÓÔÊÈÏ›· Â›Ó·È ¤Ó· Û˘¯Ófi ‡ÚËÌ· ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. øÛÙfiÛÔ, Ô Ì˯·ÓÈÛÌfi˜, Ù· ·›ÙÈ· Î·È Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· Ù˘ ‰ÂÓ ¤¯Ô˘Ó ‰È¢ÎÚÈÓÈÛÙ›. ∏ ˈÛÈÓÔÊÈÏ›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È Î·Ù·ÛÙ¿ÛÂȘ (ÙË Ê¿ÛË Ù·¯Â›·˜ ·Ó¿Ù˘Í˘ ÙˆÓ ÚÔÒÚˆÓ, ÙË ¯ÚfiÓÈ· ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ, ‰È¿ÊÔÚ· Â͈ÁÂÓ‹ ·ÓÙÈÁfiÓ· Î·È Ê¿Ú̷η, ÙË ıÂÚ·›· Ì ÂÚ˘ıÚÔÔÈËÙ›ÓË, ÙȘ ÏÔÈÌÒÍÂȘ). ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘Û¯¤ÙÈÛ˘ Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Ì ‰È¿ÊÔÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È È‰È·›ÙÂÚ· Ì ÙȘ ÏÔÈÌÒÍÂȘ Î·È Ë ÂÎÙ›ÌËÛË Ù˘ ÎÏÈÓÈ΋˜ ÛËÌ·Û›·˜ Ù˘ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÔÛËÏ¢fiÌÂÓÔ˘ ÓÂÔÁÓÔ‡. ªÂÏÂÙ‹ıËÎ·Ó 56 ÓÂÔÁÓ¿ Ì ˈÛÈÓÔÊÈÏ›· (>700/mm3) Î·È 55 ÓÂÔÁÓ¿ ¯ˆÚ›˜ ˈÛÈÓÔÊÈÏ›·, ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜, ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Î·È ‰È¿ÚÎÂÈ·˜ ·Ú·ÌÔÓ‹˜ ÛÙË ª∂¡. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‚Ú¤ıËΠÌfiÓÔ ÁÈ· ÙȘ ÌÂÙ·ÁÁ›ÛÂȘ, ÙË ¯ÔÚ‹ÁËÛË ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Á-ÛÊ·ÈÚ›Ó˘ Î·È ÙȘ ÏÔÈÌÒÍÂȘ. øÛÙfiÛÔ, ÛÙ· ÓÂÔÁÓ¿ Ì Ïԛ̈ÍË ¯ÔÚËÁÔ‡ÓÙ·È ·ÓÙÈ‚ÈÔÙÈο Î·È Á-ÛÊ·ÈÚ›ÓË Î·È ÌÂÙ·ÁÁ›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ·. ŒÙÛÈ, ÌÔÚ› Ó· ˘ÔÙÂı› fiÙÈ Ë Î‡ÚÈ· Û˘Û¯¤ÙÈÛË Â›Ó·È ·˘Ù‹ ÌÂٷ͇ Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Î·È ÙˆÓ ÏÔÈÌÒ͈Ó, ÂÓÒ ÔÈ ¿ÏϘ Û˘Û¯ÂÙ›ÛÂȘ ÌÔÚÔ‡Ó Ó· ıˆÚËıÔ‡Ó ‰Â˘ÙÂÚÔÁÂÓ›˜. O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ Ïԛ̈͢ Û ÓÂÔÁÓ¿ Ì ·fiÏ˘ÙÔ ·ÚÈıÌfi ˈÛÈÓÔÊ›ÏˆÓ >700/mm3 Â›Ó·È 1,58 Ì fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 1,30;1,91. ™˘ÓÂÒ˜, Ë ‰È·›ÛÙˆÛË ËˆÛÈÓÔÊÈÏ›·˜ Â›Ó·È Û·Ê‹˜ ‰Â›ÎÙ˘ Ïԛ̈͢ ¯ˆÚ›˜, ˆÛÙfiÛÔ, Ë ·Ô˘Û›· Ù˘ Ó· ÙËÓ ·ÔÎÏ›ÂÈ. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ˈÛÈÓÔÊÈÏ›·˜ ·Ú·Ì¤ÓÂÈ ·Û·Ê‹˜. øÛÙfiÛÔ, Ë Ïԛ̈ÍË Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ¤Ó·Ó ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· ·‡ÍËÛ˘ ÙˆÓ ËˆÛÈÓÔʛψÓ. ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Û ¤Ó· ÓÂÔÁÓfi Ú¤ÂÈ Î·Ù’ ·Ú¯¿˜ Ó· ÛÙÚ¤ÊÂÙ·È ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ Ïԛ̈͢.

Abstract: Eosinophilia is common in the neonatal period. However, its causes, mechanism and clinical significance are still unknown.

Previous studies have reported that eosinophilia may be associated with numerous conditions (establishment of an anabolic state, drug reactions, response to foreign antigens, chronic lung disease, erythropoietin treatment and infections). The aim of this study was to evaluate the possible association of various conditions, especially infection, with eosinophilia and to clarify whether recognition of an increased eosinophil count is of any clinical significance in the management of hospitalized neonates. Fifty-six neonates with eosinophilia (AEC >700/mm3) and 55 control neonates matched for gestational age, birth weight and hospitalization days were included in the study. A significant difference between the two groups was found only in blood transfusions, Á-globulin treatment, specific antibiotic treatment and infectious disease.

However, neonates who develop septic episodes are treated with specific antibiotics and Á-globulin and are more often transfused. Thus it can be speculated that the main relationship observed is that between eosinophilia and infection whereas the other associations may be secondary. The relative risk factor for infection when the AEC is >700/mm3 is 1.58, with confidence interval 1.30;1.91. Eosinophilia seems to be a reliable indicator of sepsis while normal AEC does not exclude infection. The exact cause of eosinophilia in neonates remains unclear. However, sepsis seems to be associated with eosinophilia.

Infection should be strongly considered in the evaluation of a neonate with eosinophilia.

¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

Department of Neonatology of University of Crete

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10:53

™ÂÏ›‰·41

¶·È‰È·ÙÚÈ΋ 2002;65:40-45

Paediatriki 2002;65:40-45

§¤ÍÂȘ ÎÏÂȉȿ: ˈÛÈÓÔÊÈÏ›·, ÓÂÔÁÓÈ΋ ËÏÈΛ·, Ïԛ̈ÍË.

Key words: eosinophilia, neonatal period, sepsis.

∂ÈÛ·ÁˆÁ‹ ∏ ˈÛÈÓÔÊÈÏ›· Â›Ó·È ¤Ó· Û˘¯Ófi ‡ÚËÌ· ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 13% ¤ˆ˜ 76% (1). øÛÙfiÛÔ, Ô Ì˯·ÓÈÛÌfi˜, Ù· ·›ÙÈ· Î·È Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· Ù˘ ˈÛÈÓÔÊÈÏ›·˜ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›. ™Â ·Ï·ÈfiÙÂÚ˜ ÂÚÁ·Û›Â˜, Ë ËˆÛÈÓÔÊÈÏ›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ Î·È Î·Ù·ÛÙ¿ÛÂȘ, fiˆ˜ Â›Ó·È Ë Ê¿ÛË Ù·¯Â›·˜ ·Ó¿Ù˘Í˘ ÙˆÓ ÚÔÒÚˆÓ, ÔÚÈṲ̂ӷ Ê¿Ú̷η, Ë ¯ÚfiÓÈ· ·Ó·Ó¢ÛÙÈ΋ ÓfiÛÔ˜, ‰È¿ÊÔÚ· Â͈ÁÂÓ‹ ·ÓÙÈÁfiÓ· Î·È Ë ıÂÚ·›· Ì ÂÚ˘ıÚÔÔÈËÙ›ÓË (2-7). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÏÔÈÌÒÍÂȘ, ÔÈ ·Ó·ÊÔÚ¤˜ Â›Ó·È ·ÓÙÈÊ·ÙÈΤ˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÙfiÛÔ ·‡ÍËÛË fiÛÔ Î·È Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜, Û·Ó ·ÓÙ›‰Ú·ÛË ÛÙȘ ÏÔÈÌÒÍÂȘ ÙˆÓ ÓÂÔÁÓÒÓ (1,8-11).

O ÛÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ó· ‰ÈÂÚ¢ÓËı› Ë Èı·Ó‹ Û˘Û¯¤ÙÈÛË ‰È·ÊfiÚˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ ÏÔÈÌÒÍÂˆÓ - Ì ÙËÓ ËˆÛÈÓÔÊÈÏ›· Î·È Ó· ‰È¢ÎÚÈÓÈÛÙ› Â¿Ó Ë ‰È·›ÛÙˆÛË Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ¤¯ÂÈ Î¿ÔÈ· ÎÏÈÓÈ΋ ÛËÌ·Û›· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÓÂÔÁÓÒÓ.

ηıÒ˜ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∂ÍÂÙ¿ÛÂȘ ÁÂÓÈ΋˜ ·›Ì·ÙÔ˜ ›¯·Ó Á›ÓÂÈ Û fiÏ· Ù· ÓÂÔÁÓ¿ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, ‰‡Ô Ì ÙÚÂȘ ÊÔÚ¤˜ ÙËÓ Â‚‰ÔÌ¿‰·, ηٿ ÙȘ ÒÚ˜ 08:30 ¤ˆ˜ 09:30. ÃÚËÛÈÌÔÔÈ‹ıËΠ·˘ÙfiÌ·ÙÔ˜ ·Ó·Ï˘Ù‹˜ ÁÈ· ÙË Ì¤ÙÚËÛË ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ÂÓÒ Ô Î·ıÔÚÈÛÌfi˜ ÙÔ˘ Ù‡Ô˘ ¤ÁÈÓ ·fi ÌÈÎÚÔ‚ÈÔÏfiÁÔ, Ì ÂͤٷÛË Û ÌÈÎÚÔÛÎfiÈÔ Ù˘ Â›ÛÙÚˆÛ˘ ·›Ì·ÙÔ˜ Û ϷοÎÈ, ÌÂÙ¿ ·fi ¯ÚÒÛË May-Grunwald-Giemsa. ∏ ˈÛÈÓÔÊÈÏ›· ÔÚ›ÛÙËÎÂ Û·Ó ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ˈÛÈÓÔÊ›ÏˆÓ >700/mm3 (1). ∞Ó¿ÏÔÁ· Ì ÙË Ì¤ÁÈÛÙË ÙÈÌ‹ ÙÔ˘ ·fiÏ˘ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ (∞∞∏), Ë ËˆÛÈÓÔÊÈÏ›· ¯·Ú·ÎÙËÚ›ÛÙËΠ‹È· (700≤∞∞∏<1000), ̤ÙÚÈ· (1000≤∞∞∏<1500) Î·È ÛÔ‚·Ú‹ (∞∞∏≥1500) (1). ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ¤ÁÈÓ Ì ÙȘ ‰ÔÎÈ̷ۛ˜ Kruskal-Wallis, Mood’s median test Î·È JohnckheereTerpstra test (J-T test), ηıÒ˜ Î·È Ì ÙÔÓ ÌË ·Ú·ÌÂÙÚÈÎfi Û˘ÓÙÂÏÂÛÙ‹ Û˘Û¯¤ÙÈÛ˘ Spearman. O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ˘ÔÏÔÁ›ÛÙËΠ̠ÙË ‰ÔÎÈÌ·Û›· x2 (›Ó·Î˜ 2x2, Mantel-Haenszel, ‰ÈfiÚıˆÛË Î·Ù¿ Yates).

ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜ ∞fi ÙÔÓ ∞‡ÁÔ˘ÛÙÔ 1998 ¤ˆ˜ Î·È ÙÔ ª¿ÚÙÈÔ 1999, ÂÈÛ‹¯ıËÛ·Ó ÛÙË ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ 213 ÓÂÔÁÓ¿. ∞Ó·ÛÎÔ‹ıËÎ·Ó ÔÈ ÁÂÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ ·›Ì·ÙÔ˜ ÚÔ˘Ù›Ó·˜ ÙˆÓ ÓÂÔÁÓÒÓ ·˘ÙÒÓ Î·È ‚Ú¤ıËÎ·Ó 56 ÓÂÔÁÓ¿ Ì ˈÛÈÓÔÊÈÏ›· (>700/mm3) ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ 30 ÚÒÙˆÓ ËÌÂÚÒÓ ˙ˆ‹˜. ∆· ÓÂÔÁÓ¿ ·˘Ù¿ ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÌÂϤÙ˘. °È· οı ÓÂÔÁÓfi Ì ˈÛÈÓÔÊÈÏ›· ·Ó·˙ËÙ‹ıËΠ¤Ó· ÓÂÔÁÓfi-Ì¿ÚÙ˘Ú·˜, ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ ·ËÛ˘, ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ Î·È ‰È·ÛÙ‹Ì·ÙÔ˜ ÓÔÛËÏ›·˜ Ì ·fiÎÏÈÛË 7 ËÌÂÚÒÓ. °È· ¤Ó· ÏÈÔ‚·Ú¤˜ ÓÂÔÁÓfi ‰ÂÓ ‚Ú¤ıËΠ·ÓÙ›ÛÙÔȯԘ Ì¿ÚÙ˘Ú·˜. ™¯ËÌ·Ù›ÛÙËÎÂ, ¤ÙÛÈ, Ë ÔÌ¿‰· ÂϤÁ¯Ô˘ Ì 55 ÓÂÔÁÓ¿. ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∞Ó·ÛÎÔ‹ıËÎ·Ó Ù· È·ÙÚÈο ÈÛÙÔÚÈο ·˘ÙÒÓ ÙˆÓ 111 ÓÂÔÁÓÒÓ Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÔ ÈÛÙÔÚÈÎfi Ù˘ ÌËÙ¤Ú·˜, ÙË Á¤ÓÓËÛË Î·È Ù· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù·, ¶›Ó·Î·˜ 1. ÷ڷÎÙËÚÈÛÙÈο ÙˆÓ ÓÂÔÁÓÒÓ Ù˘ ÌÂϤÙ˘ (̤ÛË ÙÈÌ‹ ± SD) ¡ÂÔÁÓ¿ ¡ÂÔÁÓ¿ Ì ˈÛÈÓÔÊÈÏ›· ¯ˆÚ›˜ ˈÛÈÓÔÊÈÏ›· ñ µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (gr) 2181 ± 757 ñ ∏ÏÈΛ· ·ËÛ˘ (‚‰ÔÌ¿‰Â˜) 35,1 ± 3,4 ñ ¢È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ (Ë̤Ú˜) 27 ± 14,2

2234 ± 720 35,2 ± 3,6 22,5 ± 13,6

∞ÔÙÂϤÛÌ·Ù· ªÂ ‚¿ÛË Ù· ÛÙÔȯ›· Ù˘ ÌÂϤÙ˘ ‰È·ÈÛÙÒıËΠfiÙÈ Ë ËˆÛÈÓÔÊÈÏ›· Â›Ó·È Û˘¯Ófi ‡ÚËÌ· ÛÙ· ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÔÓÙ·È ÛÙÔ ÙÌ‹Ì· Ì·˜ (26,29%). ∏ ‚·Ú‡ÙËÙ· Î·È Ë ‰È¿ÚÎÂÈ· Ù˘ ˈÛÈÓÔÊÈÏ›·˜ ÛÙ· ÚfiˆÚ· Î·È Ù· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ∞fi ÙȘ ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‚Ú¤ıËΠÌfiÓÔ ÛÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜, ÙË ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘, ÙË ıÂÚ·›· ÌÂ Û˘ÁÎÂÎÚÈ̤ӷ ·ÓÙÈ‚ÈÔÙÈο Î·È ÙȘ ÏÔÈÌÒÍÂȘ (¶›Ó·Î·˜ 3). ∏ ̤ÛË ÙÈÌ‹ ÙˆÓ ËˆÛÈÓÔʛψÓ, Ë Ì¤ÁÈÛÙË Î·È Ë ÂÏ¿¯ÈÛÙË ÙÈÌ‹ Î·È ÙÔ 95% fiÚÈÔ ·ÍÈÔÈÛÙ›·˜ (95% CI) Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 4. ∞fi Ù· 111 ÓÂÔÁÓ¿ Ô˘ ÌÂÏÂÙ‹ıËηÓ, Ù· 46 ·ÚÔ˘Û›·Û·Ó Ïԛ̈ÍË. ∆· 22 ÓÂÔÁÓ¿ ›¯·Ó Ïԛ̈ÍË ÙÂÎÌËÚȈ̤ÓË Ì ıÂÙÈΤ˜ ηÏÏȤÚÁÂȘ Î·È Ù· 24 Èı·Ó‹ Ïԛ̈ÍË. ∞fi Ù· ÓÂÔÁÓ¿ ·˘Ù¿, Ù· 40 ·ÚÔ˘Û›·˙·Ó ˈÛÈÓÔÊÈÏ›·. ∏ ̤ÛË ÙÈÌ‹ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ Î·È ÙÔ 95% fiÚÈÔ ·ÍÈÔÈÛÙ›·˜ (95% CI) ÛÙ· ÓÂÔÁÓ¿ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË, Èı·Ó‹ Ïԛ̈ÍË Î·È ¯ˆÚ›˜ Ïԛ̈ÍË, Ê·›ÓÔÓÙ·È ÛÙÔ ™¯‹Ì· 1. ∫·Ó¤Ó· ·fi Ù· 22 ÓÂÔÁÓ¿ Ì ÙÂÎÌËÚȈ̤ÓË Ïԛ̈ÍË ‰ÂÓ Â›¯Â ·fiÏ˘ÙÔ ·ÚÈıÌfi ˈÛÈÓÔÊ›ÏˆÓ (∞∞∏) οو ·fi 700/mm3, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ™¯‹Ì· 1. ªÂ ‚¿ÛË ÙËÓ ·Ú·Ù‹ÚËÛË ·˘Ù‹, ÂÎÙÈÌ‹ıËÎÂ Ë ·ÍÈÔÈÛÙ›· ÙÔ˘ ∞∞∏ ˆ˜ ‰Â›ÎÙË Ïԛ̈͢ (¶›Ó·Î·˜ 5). ∏ ÂȉÈÎfiÙËÙ¿ ÙÔ˘ ‚Ú¤ıËΠ73,2%, Ë Â˘·ÈÛıËÛ›· 100%, Ë ıÂÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ·Í›· 100% Î·È Ë ·ÚÓËÙÈ΋ ‰È·ÁÓˆÛÙÈ΋ ·Í›· 55%. O Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ Ïԛ̈͢ Û ÓÂÔÁÓ¿ Ì ∞∞∏ >700/mm3

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10:53

™ÂÏ›‰·42

¶·È‰È·ÙÚÈ΋ 2002;65:40-45

Paediatriki 2002;65:40-45

¶›Ó·Î·˜ 2. µ·Ú‡ÙËÙ· Î·È ‰È¿ÚÎÂÈ· Ù˘ ˈÛÈÓÔÊÈÏ›·˜ ÛÙ· ÙÂÏÂÈfiÌËÓ· Î·È ÚfiˆÚ· ÓÂÔÁÓ¿ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ¶ÚfiˆÚ·

∞ÚÈıÌfi˜ ÓÂÔÁÓÒÓ ∆ÂÏÂÈfiÌËÓ·

™‡ÓÔÏÔ

¢È¿ÚÎÂÈ· ˈÛÈÓÔÊÈÏ›·˜ (Ë̤Ú˜) ª¤ÛË ÙÈÌ‹ ± SD

6 9 20

8 6 7

14 15 27

10,86 ± 4,35 14,47 ± 7,74 29,7 ± 18,04

◊È· ˈÛÈÓÔÊÈÏ›· ª¤ÙÚÈ· ˈÛÈÓÔÊÈÏ›· ™Ô‚·Ú‹ ˈÛÈÓÔÊÈÏ›·

¶›Ó·Î·˜ 3. OÈ ·Ú¿ÌÂÙÚÔÈ ÁÈ· ÙȘ Ôԛ˜ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ Ì ˈÛÈÓÔÊÈÏ›· Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ ∫ÂÊ·ÏÔÛÔÚ›Ó˜ -πÌÈÂÓ¤ÌË

°-ÛÊ·ÈÚ›ÓË

ªÂÙ¿ÁÁÈÛË

28 9 0,0000

16 6 0,0009

13 3 0,0000

¡ÂÔÁÓ¿ Ì ˈÛÈÓÔÊÈÏ›· (n=56) ª¿ÚÙ˘Ú˜ (n=55) P

§Ô›ÌˆÍË ¶Èı·Ó‹ ∆ÂÎÌËÚȈ̤ÓË 18 6

22 0,0000

¶›Ó·Î·˜ 4. ª¤ÛË ÙÈÌ‹ (ª∆) Î·È ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· (™™), ÂÏ¿¯ÈÛÙË Î·È Ì¤ÁÈÛÙË ÙÈÌ‹ ηıÒ˜ Î·È 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ (CI) Ù˘ ·fiÏ˘Ù˘ ÙÈÌ‹˜ ˈÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ÙˆÓ ÓÂÔÁÓÒÓ, ·Ó¿ÏÔÁ· Ì ÙËÓ ‡·ÚÍË ‹ fi¯È ÙÔ˘ ·Ú¿ÁÔÓÙ· Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ¶·Ú¿ÌÂÙÚÔ˜ ñÃÔÚ‹ÁËÛË ·ÓÙÈ‚›ˆÛ˘ Ÿ¯È ¡·È ñÃÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ Ÿ¯È ¡·È ñªÂÙ¿ÁÁÈÛË Ÿ¯È ¡·È ñ⁄·ÚÍË Ïԛ̈͢ Ÿ¯È ¡·È ¶Èı·Ó‹

ª∆ ± ™™

∂Ï¿¯ÈÛÙË ÙÈÌ‹

ª¤ÁÈÛÙË ÙÈÌ‹

95% CI

P

819 ± 99 2049 ± 220

20 90

3700 5000

1212;2285 1602;2495

0,0000

1065 ± 117 2917 ± 284

20 100

5000 4700

831;1299 1425;2608

0,0009

1918 ± 107 2469 ± 319

20 280

5000 4700

805;1231 1794;3144

0,0000

679 ± 103 2172 ± 243 1951 ± 259

20 1100 100

3600 4400 5000

472;887 1665;2679 1413;2488

0,0000

Â›Ó·È 1,58 Ì fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 1,30;1,91. ™˘ÓÂÒ˜, Ë ‰È·›ÛÙˆÛË ËˆÛÈÓÔÊÈÏ›·˜ Â›Ó·È Û·Ê‹˜ ‰Â›ÎÙ˘ Ïԛ̈͢ ¯ˆÚ›˜, ˆÛÙfiÛÔ, Ë ·Ô˘Û›· Ù˘ Ó· ÙËÓ ·ÔÎÏ›ÂÈ. ∏ ˈÛÈÓÔÊÈÏ›· ÂÌÊ·Ó›ÛÙËΠÙËÓ Ë̤ڷ 10,2±0,8 (̤ÛË ÙÈÌ‹±ÛÙ·ıÂÚfi ÛÊ¿ÏÌ·), Ù¤ÛÛÂÚȘ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ Ïԛ̈͢ (6,65±0,85 Ë̤ڷ ˙ˆ‹˜). ªfiÓÔ Û 5 ÓÂÔÁÓ¿ Ë ËˆÛÈÓÔÊÈÏ›· ·ÚÔ˘ÛÈ¿ÛÙËΠÚÈÓ ÙËÓ Ë̤ڷ ÂÌÊ¿ÓÈÛ˘ Ù˘ Ïԛ̈͢. ™·Ó Ë̤ڷ ÂÌÊ¿ÓÈÛ˘ Ù˘ Ïԛ̈͢ ıˆڋıËÎÂ Ë Ë̤ڷ fiÔ˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÂÚÁ·ÛÙËÚȷο ‹ ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÂÓ‰ÂÈÎÙÈο Ïԛ̈͢, fiˆ˜ Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÂÂÈÛfi‰È· ¿ÓÔÈ·˜, ·ÛÙ·ı‹˜ ıÂÚÌÔÎÚ·Û›· ÛÒÌ·ÙÔ˜, Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜. ∞fi Ù· ÓÂÔÁÓ¿ Ì Ïԛ̈ÍË, Ù· 4 ›¯·Ó ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·. OÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙȘ ÂÚÈÙÒÛÂȘ ÙÂÎÌËÚȈ̤Ó˘ Ïԛ̈͢ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 6. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜ ‚Ú¤-

42

ıËΠÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜. øÛÙfiÛÔ, Ù· ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ Ô˘ ÌÂÙ·ÁÁ›ÛÙËÎ·Ó Â›¯·Ó Ïԛ̈ÍË (83,3%) (¶›Ó·Î·˜ 7). ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p~0,009), ηıÒ˜ Â›Û˘ Î·È Ë ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·›· Ì ÔÚÈṲ̂ӷ ·ÓÙÈ‚ÈÔÙÈο (ÎÂÊ·ÏÔÛÔÚ›Ó˜-ÈÌÈÂÓ¤ÌË) (p~0,0000). øÛÙfiÛÔ, ÙÔ Â›‰Ô˜ ÙÔ˘ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ (ÎÂÊÔÙ·Í›ÌË, ÎÂÊÙ·˙ȉ›ÌË, ÈÌÈÂÓ¤ÌË Î·È Û˘Ó‰˘·ÛÌÔ›) ‰ÂÓ ÂËÚ¤·Û ÙÔÓ ·fiÏ˘ÙÔ ·ÚÈıÌfi ˈÛÈÓÔÊ›ÏˆÓ (™¯‹Ì· 2). ∂›Û˘, Ë ¯ÔÚ‹ÁËÛË ¿ÏÏˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ (·ÌÈÎÈÏÏ›Ó˘, ·ÌÈÓÔÁÏ˘ÎÔÛȉÒÓ, ‚·ÓÎÔÌ˘Î›Ó˘) ‰ÂÓ ‰È¤ÊÂÚ Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ™Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ‰È·ÈÛÙÒıËΠ̛· ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Î·È Ù˘ Ë̤ڷ˜ Â·Ó·fiÎÙËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ (rho=0,3288, p=0,0000). ™Â ¤Ó· ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ¿ÏÏˆÓ ·Ú·Ì¤ÙÚˆÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ, ‰ÂÓ

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·43

¶·È‰È·ÙÚÈ΋ 2002;65:40-45

4000

Paediatriki 2002;65:40-45

¶›Ó·Î·˜ 5. ∆·ÍÈÓfiÌËÛË ÙˆÓ ÓÂÔÁÓÒÓ ·Ó¿ÏÔÁ· Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÙÔ˘ ·›Ì·ÙÔ˜ (>700 mm3 ‹ ≤700 mm3) Î·È Ù˘ ‡·Ú͢ ‹ fi¯È ÙÂÎÌËÚȈ̤Ó˘ Ïԛ̈͢ ÛÙÔ ÓÂÔÁÓfi

∞∞∏-99%CI

3000

∞ÚÈıÌfi˜ ˈÛÈÓÔʛψÓ

2000

≤700 >700 ™‡ÓÔÏÔ

⁄·ÚÍË Ïԛ̈͢ Ÿ¯È ¡·È ™‡ÓÔÏÔ 47 18 65

0 22 22

47 40 87

Mantel-Haenszel x2=30,7, p=0,00, Yates corrected x2=28,4, p=0,000, RR=2,17, 95% CI (1,43;3,07)

1000

0 N1=65

N2=22

N3=24

™¯‹Ì· 1. ª¤ÛË ÙÈÌ‹ Î·È 99% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ (∞∞∏-99% CI) ÛÙÔ ·›Ì· ÓÂÔÁÓÒÓ ¯ˆÚ›˜ Ïԛ̈ÍË (¡1=65) (·ÚÈÛÙÂÚ¿), Ì ÂȂ‚·ÈˆÌ¤ÓË Ïԛ̈ÍË (¡2=22) (ÛÙÔ Î¤ÓÙÚÔ) Î·È Ì Èı·Ó‹ Ïԛ̈ÍË (¡3=24) (‰ÂÍÈ¿).

‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (¶›Ó·Î·˜ 8). ™˘˙‹ÙËÛË ™Â ·˘Ù‹ ÙËÓ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ‰È·ÈÛÙÒıËΠ̛· ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Ïԛ̈͢ Î·È Ù˘ ˈÛÈÓÔÊÈÏ›·˜, ‡ÚËÌ· Ô˘ Û˘ÌʈÓ› Ì ÙȘ ÈÔ ÚfiÛÊ·Ù· ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ (1,9,10,12). ∏ ˈÛÈÓÔÊÈÏ›· Ê·›ÓÂÙ·È Ó· Â›Ó·È ¤Ó·˜ Û¯ÂÙÈο ÂȉÈÎfi˜ ‰Â›ÎÙ˘ Ïԛ̈͢. ¶·Ú’ fiÏÔ Ô˘ ‰ÂÓ Â›Ó·È ÚÒÈÌÔ˜ ‰Â›ÎÙ˘, ·ÊÔ‡ ÂÌÊ·Ó›˙ÂÙ·È Ï›Á˜ ̤Ú˜ ÌÂÙ¿ ÙËÓ ÂΉ‹ÏˆÛË Ù˘ Ïԛ̈͢, ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË Î·È Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÛÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ˈÛÈÓÔÊÈÏ›· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙË Ïԛ̈ÍË ·fi Candida, ·fi gram-·ÚÓËÙÈο ÌÈÎÚfi‚È· Î·È Ì ÙË ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· (1,9,10). ™ÙËÓ ÂÚÁ·Û›· Ì·˜, ηӤӷ ÓÂÔÁÓfi ‰ÂÓ ¤·Û¯Â ·fi Ì˘ÎËÙÈ·ÛÈ΋ Ïԛ̈ÍË, ÂÓÒ Ù· 4 ÓÂÔÁÓ¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ›¯·Ó Î·È ËˆÛÈÓÔÊÈÏ›·. ¢ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Ì οÔÈÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Â›‰Ô˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡. ª›· ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ‰È·ÈÛÙÒıËÎÂ, Â›Û˘, ·Ó¿ÌÂÛ· Û ÔÚÈṲ̂ӷ ·ÓÙÈ‚ÈÔÙÈο, ÛÙË ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ Î·È ÛÙȘ ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜. øÛÙfiÛÔ, Ë Á-ÛÊ·ÈÚ›ÓË Î·È Ù· ·ÓÙÈ‚ÈÔÙÈο ·˘Ù¿ ¯ÔÚËÁÔ‡ÓÙ·È ÛÙ· ÓÂÔÁÓ¿ Ì Ïԛ̈ÍË, Ù· ÔÔ›· Î·È ÌÂÙ·ÁÁ›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ·. ªÔÚԇ̠ÏÔÈfiÓ Ó· ıˆڋÛÔ˘Ì fiÙÈ Ë Î‡ÚÈ· Û˘Û¯¤ÙÈÛË Â›Ó·È ÌÂٷ͇ Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Î·È Ù˘ Ïԛ̈͢, ÂÓÒ ÔÈ ¿ÏϘ Û˘Û¯ÂÙ›ÛÂȘ Â›Ó·È ‰Â˘ÙÂÚÔÁÂÓ›˜. ∂ÎÙfi˜ ·fi ÙË Ïԛ̈ÍË, Ô ÌfiÓÔ˜ ¿ÏÏÔ˜ ·Ú¿ÁÔÓÙ·˜ Ô˘ ‚Ú¤ıËΠӷ Û¯ÂÙ›˙ÂÙ·È Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi

¶›Ó·Î·˜ 6. OÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙȘ ÂÚÈÙÒÛÂȘ ÙÂÎÌËÚȈ̤Ó˘ Ïԛ̈͢ ¡ÂÔÁÓ¿ Ì (+) ηÏÏȤÚÁÂȘ Staph. Aureus Staph. Epidermidis Group B Streptococcus E. coli P. aeruginosa Enterobacter cloaca Klebsiella pneumoniae

22 2 9 2 4 2 1 2

¶›Ó·Î·˜ 7. ∆·ÍÈÓfiÌËÛË ÙˆÓ ÓÂÔÁÓÒÓ Ù˘ ÌÂϤÙ˘ ·Ó¿ÏÔÁ· Ì ÙË ¯ÔÚ‹ÁËÛË ·›Ì·ÙÔ˜ Î·È ÙËÓ ‡·ÚÍË Ïԛ̈͢ §o›ÌˆÍË

ªÂÙ¿ÁÁÈÛË Ÿ¯È (n=93) ¡·È (n=18)

ñ Ÿ¯È ñ ¶Èı·Ó‹ ‹ ÙÂÎÌËÚȈ̤ÓË ∆ÂÎÌËÚȈ̤ÓË ¶Èı·Ó‹

62 (66,6%) 31 (33,3%) 15 16

3 (16,6%) 15 (83,3%) 7 8

Ì ÙËÓ ËˆÛÈÓÔÊÈÏ›·, Â›Ó·È Ë ¤Ó·ÚÍË ·‡ÍËÛ˘ ‚¿ÚÔ˘˜ ÛÙ· ÚfiˆÚ· ÓÂÔÁÓ¿. ∞Ó¿ÏÔÁË Û˘Û¯¤ÙÈÛË Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Ì ÙË ‚ÂÏÙ›ˆÛË ÛÙË ıÚ¤„Ë ·Ó·Ê¤ÚÂÙ·È Î·È Û ̛· ·Ï·ÈfiÙÂÚË ÂÚÁ·Û›· (2). ∏ ˈÛÈÓÔÊÈÏ›· ¤¯ÂÈ ·Ô‰Ôı› Û ÂȉÈ΋ ·ÓÙ›‰Ú·ÛË ˘ÂÚ¢·ÈÛıËÛ›·˜ Û ʿÚ̷η (ÎÂÊÙÚÈ·ÍfiÓË, L-tryptophan) Û ‰‡Ô ÌÂϤÙ˜ (3,4). ™ÙË ÌÂϤÙË Ì·˜, Ë ¯ÔÚ‹ÁËÛË ÔÚÈÛÌ¤ÓˆÓ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‰È¤ÊÂÚ Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. øÛÙfiÛÔ, ‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Ì ¤Ó· Û˘ÁÎÂÎÚÈ̤Óo ›‰Ô˜ ·ÓÙÈ‚ÈÔÙÈÎÔ‡, ÒÛÙ ӷ ıˆÚËı› ·˘Ùfi Û·Ó Èı·Ófi ·›ÙÈÔ Ì¤Ûˆ ·ÓÙ›‰Ú·Û˘ ˘ÂÚ¢·ÈÛıËÛ›·˜. ¢ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Ì ÙË ¯ÔÚ‹ÁËÛË ÂÚ˘ıÚÔÔÈËÙ›Ó˘, ·ÌÈÎÈÏÏ›Ó˘, ÓÂÙÈÏÌ˘Û›Ó˘, ÙËÓ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹, ÙË ¯ÔÚ‹ÁËÛË ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÙËÓ ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË, Û ·ÓÙ›ıÂÛË Ì ¿ÏϘ ÂÚÁ·Û›Â˜ (7-9,13,14).

43

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·44

¶·È‰È·ÙÚÈ΋ 2002;65:40-45

(+---) A (------+-------------) C (-------+--------------) S (-------+--) P (----------+------------------------) CP (----+-----) SP --------+---------+---------+-------1200 2400 3600 AAH ™¯‹Ì· 2. ª¤ÛË ÙÈÌ‹ Î·È 95% fiÚÈ· ·ÍÈÔÈÛÙ›·˜ ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ (∞∞∏) ÛÙÔ ÂÚÈÊÂÚÈÎfi ·›Ì· ÛÙ· ÓÂÔÁÓ¿, ÛÙ· ÔÔ›· ‰ÂÓ ¯ÔÚËÁ‹ıËÎ·Ó ÎÂÊ·ÏÔÛÔÚ›Ó˜-ÈÌÈÂÓ¤ÌË (∞) Î·È ÂÎÂ›ÓˆÓ ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÎÂÊÔÙ·Í›ÌË (C), ÎÂÊÙ·˙ȉ›ÌË (S), ÈÌÈÂÓ¤ÌË (P) Î·È Û˘Ó‰˘·ÛÌÔ› (CP, SP).

O Ì˯·ÓÈÛÌfi˜ Ù˘ ˈÛÈÓÔÊÈÏ›·˜ ÛÙ· ÓÂÔÁÓ¿ Â›Ó·È ·Û·Ê‹˜. ∏ ÂÌÊ¿ÓÈÛË ËˆÛÈÓÔÊÈÏ›·˜ ¤¯ÂÈ ·Ô‰Ôı› Û ΢ÙÙ·ÚÈ΋ ·ÓÙ›‰Ú·ÛË Û Â͈ÁÂÓ‹ ·ÓÙÈÁfiÓ·, ÛÙ· ÔÔ›· Ù· ÓÂÔÁÓ¿ ÂÎÙ›ıÂÓÙ·È Ì¤Ûˆ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ ۈϋӷ Î·È ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‰¤ÓÙÚÔ˘ (4). øÛÙfiÛÔ, ÛÙË ÌÂϤÙË Ì·˜, fiˆ˜ Î·È Û ÔÚÈṲ̂Ó˜ ·Ï·ÈfiÙÂÚ˜ ÂÚÁ·Û›Â˜, Ë ¤ÎıÂÛË Û ‰È¿ÊÔÚ· ·ÓÙÈÁfiÓ· (ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹, ‰È¿ÊÔÚ· Ê¿Ú̷η, ÙÚ·¯ÂÈÔۈϋÓ˜) ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙËÓ ËˆÛÈÓÔÊÈÏ›· (2,7,9). ŒÓ·˜ Èı·Ófi˜ Ì˯·ÓÈÛÌfi˜ ˈÛÈÓÔÊÈÏ›·˜ Û ÓÂÔÁÓ¿ Ì ÛË„·ÈÌ›· Â›Ó·È Ë ·ÓÙ›‰Ú·ÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ Û ΢ÙÔΛÓ˜ Ô˘ ÂÎχÔÓÙ·È Î·Ù¿ ÙË ÏÔÈÌÒ‰Ë ‰ÈÂÚÁ·Û›·. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ù· ˈÛÈÓfiÊÈÏ· ·Ú¿ÁÔÓÙ·È ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ·fi ·Ú¯¤ÁÔÓ· ÔÏ˘‰‡Ó·Ì· ÌËÙÚÈο ·ÙÙ·Ú·. ∏ ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ Ú˘ıÌ›˙ÂÙ·È ·fi ÙËÓ IL-3, ÙËÓ IL-5 Î·È ÙÔÓ GM-CSF (1,12,15). ™ÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, Ù· ˈÛÈÓfiÊÈÏ· ˆÚÈÌ¿˙Ô˘Ó Û 3-6 Ë̤Ú˜ (1,15). ŒÙÛÈ ÌÔÚ› Ó· ÂÍËÁËı› Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Û ۯ¤ÛË Ì ÙËÓ Ë̤ڷ ÂΉ‹ÏˆÛ˘ Ù˘ Ïԛ̈͢, Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ÂÚÁ·Û›· Ì·˜. ∏ ·Ú·ÁˆÁ‹ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÂÛÛ¿ÚˆÓ ‰È¿ÎÚÈÙˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ: Ù˘ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, Ù˘ ·ÏÏËÏÂ›‰Ú·Û˘ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ Ì ٷ ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÚÔÛÎfiÏÏËÛË Î·È ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ ËˆÛÈÓÔʛψÓ, ÙË ¯ËÌÂÈÔÙ·Í›· Ô˘ ηÙ¢ı‡ÓÂÈ Ù· ˈÛÈÓfiÊÈÏ· ÚÔ˜ Ì›· Û˘ÁÎÂÎÚÈ̤ÓË ÂÛÙ›· ηÈ, Ù¤ÏÔ˜, ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Î·È ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ (1,15). ¶ÚfiÛÊ·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰‡Ô ¯ËÌÂÈÔΛÓ˜, Ë ËˆÙ·Í›ÓË -1 Î·È -2, Ô˘ Â›Ó·È Û¯ÂÙÈο ÂȉÈΤ˜ ¯ËÌÂÈÔÙ·ÎÙÈΤ˜ Ô˘Û›Â˜ ÁÈ· Ù· ˈÛÈÓfiÊÈÏ· (1,15). OÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ Ô˘ÛÈÒÓ ·˘ÙÒÓ ÛÙÔÓ ÔÚfi ·›Ì·ÙÔ˜ ·fi ÙÔÓ ÔÌÊ¿ÏÈÔ ÏÒÚÔ Î·È ·fi ÚfiˆÚ· Î·È ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ‚ÚÂı› ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ˜ ·fi ·˘Ù¤˜ ÙˆÓ ÂÓËÏ›ÎˆÓ (1). ∏ Û¯ÂÙÈ΋ ·ÓÂ¿ÚÎÂÈ· Ù˘ ¯ËÌÂÈÔÙ·-

44

Paediatriki 2002;65:40-45

¶›Ó·Î·˜ 8. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ Ì ˈÛÈÓÔÊÈÏ›· (ÔÌ¿‰· ÂϤÁ¯Ô˘) Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ (ªann-Whitney U test) ¶·Ú¿ÁÔÓÙ˜

∫·ÈÛ·ÚÈ΋ ÙÔÌ‹ ∞Ó¿ÓË„Ë ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜ ∂ÈÊ·Ó. ·Ú¿ÁÔÓÙ·˜ ¶ÚfiˆÚË Ú‹ÍË ı˘Ï·Î›Ô˘ ¶·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ ∂Ú˘ıÚÔÔÈËÙ›ÓË ºÚ¤ÛÎÔ Î·Ù„˘Á̤ÓÔ Ï¿ÛÌ· OÌÊ·ÏÈÎfi˜ ηıÂÙ‹Ú·˜ ∞ÌÈÎÈÏÏ›ÓË-ÓÂÙÚÔÌ˘Û›ÓË ¶ÚÔÂÎÏ·Ì„›· ÕÚÚÂÓ Ê‡ÏÔ

OÌ¿‰· ÂϤÁ¯Ô˘ (n=56)

OÌ¿‰· Ì·ÚÙ‡ÚˆÓ (n=55)

37 25 34 19 11 41 7 6 24 54 5 36

39 30 31 11 13 37 5 3 27 50 3 33

Í›·˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÓÂÔÁÓ¿, Èı·Ó¿ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘Ù¤˜ ÙȘ ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ. ∞˘Ù¤˜ ÔÈ ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ, Â›Û˘, Û˘Ì‚¿ÏÏÔ˘Ó Èı·ÓfiÓ ÛÙËÓ ËˆÛÈÓÔÊÈÏ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ÓÂÔÁÓ¿, ·ÊÔ‡ Ë ¯ËÌÂÈÔÙ·Í›· ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÚÔ˜ Ì›· ÂÛÙ›· Â›Ó·È ·ÓÂ·Ú΋˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙËÓ ·Ó·‰ÚÔÌÈ΋ ·˘Ù‹ ÌÂϤÙË, Ë ËˆÛÈÓÔÊÈÏ›· ‹Ù·Ó ¤Ó· Û¯ÂÙÈο Û˘¯Ófi ‡ÚËÌ·, ÙfiÛÔ ÛÙ· ÚfiˆÚ· fiÛÔ Î·È ÛÙ· ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜. ∏ Ïԛ̈ÍË ‚Ú¤ıËΠfiÙÈ Û¯ÂÙ›˙ÂÙ·È Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙËÓ ËˆÛÈÓÔÊÈÏ›·. ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ ˈÛÈÓÔÊÈÏ›·˜ Û ¤Ó· ÓÂÔÁÓfi Ú¤ÂÈ, Û‡Ìʈӷ Ì ٷ ÛÙÔȯ›· Ì·˜, Ó· ÛÙÚ¤ÊÂÙ·È Î·Ù’ ·Ú¯¿˜ ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ Ïԛ̈͢, ÚÈÓ ÙÔ Â‡ÚËÌ· ·˘Ùfi ·Ô‰Ôı› Û ¿ÏÏ· ηÏÔ‹ıË ·›ÙÈ·. ∏ ηٷÓfiËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ ·Ó¿Ù˘Í˘ ˈÛÈÓÔÊÈÏ›·˜ ÛÙË ÓÂÔÁÓÈ΋ ÛË„·ÈÌ›· ·Ú·Ì¤ÓÂÈ ·ÓÙÈΛÌÂÓÔ ÌÂϤÙ˘ Î·È ¤Ú¢ӷ˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Sullivan S, Calhoun DA. Eosinophilia in the neonatal intensive care unit. Clin Perinatol 2000;27:603-622.

2. Gibson EL, Vaucher Y, Corrigan JJ. Eosinophilia in premature infants: relationship to weight gain. J Pediatr 1979;95:99-101.

3. Hatch DL, Garona JE, Goldman LR, Walker KO. Persistent eosinophilia in an infant with probable intrauterine exposure to L-tryptophan-containing supplements.

Pediatrics 1991;88:810-813.

4. Van-Reempts PJ, Van-Overmeire B, Mahieu LM, Vanacker KJ. Clinical experience with ceftriaxone treatment in the neonate. Chemotherapy 1995;41:316-322.

5. Aranda JV, Portuguez-Malavasi A, Collinge JM, Germanson T, Outerbridge EW. Epidemiology of adverse drug reactions in the newborn. Dev Pharmacol Ther

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1982;5:173-184.

6. Yamamoto C, Kojima T, Hattori K, Nogi S, Imamura H, Tsubura A et al. Eosinophilia in premature infants: correlation with chronic lung disease. Acta Paediatr 1996;85:1232-1235.

7. Ehara A, Takeda Y, Kida T, Mizukami S, Hagisawa M, Yamada Y. Time-course changes of eosinophil counts in premature infants: no effects of medical manipulation, except erythropoietin treatment, on eosinophilia. Pediatr Int 2000;42:58-60.

8. Bhat AM, Scanlon JW. The pattern of eosinophilia in premature infants. J Pediatr 1981;98:612-616.

9. Patel L, Garvey B, Arnon S, Roberts IA. Eosinophilia in newborn infants. Acta Paediatr 1994;83:797-801.

10. Wolach B, Bogger-Goren S, Whyte R. Perinatal hematological profile of newborn infants with candida antenatal infections. Biol Neonate 1991;59:5-12.

11. Weinberg AG, Rosenfeld CR, Manroe BL, Browne R. Neonatal blood cell count in health and disease. II. Values for lymphocytes, monocytes and eosinophils. J Pediatr 1985;106:462-466.

12. Calhoun DA, Sullivan SE, Lunoe M, Du Y, Christensen RD. Granulocyte-macrophage colony-stimulating factor and interleukin-5 concentrations in premature neonates with eosinophilia. J Perinatol 2000;20:166-171.

13. Fayon M, Babin JP. Hypereosinophilia in premature newborn infants. Pediatrics 1988;43:667-672.

14. Lawrence R Jr, Church JA, Richards W, Lipsey AI. Eosinophilia in the hospitalized neonate. Ann Allergy 1980;44:349-352.

15. Rothenberg ME. Eosinophilia. N Engl J Med 1998;338:1592-1600.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-03-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 25-09-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, 713 05, ∏Ú¿ÎÏÂÈÔ

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ∏ Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎˆÓ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙ· ·È‰È¿ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ ÎÔÈÓfiÙËÙ·1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ - Û ÏËı˘ÛÌÈ·Îfi Â›Â‰Ô - Ù˘ ηٷӿψÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ·È‰È¿ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ·Ó¿Ù˘Í˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰Ô˜: ™Â 20 ÁÂÈÙÔÓÈÎÔ‡˜ ‰‹ÌÔ˘˜ Ù˘ ÂÚÈÔ¯‹˜ ª·lmohus ηٷÁÚ¿ÊËÎ·Ó ÔÈ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ËÏÈΛ·˜ 06 ¯ÚfiÓˆÓ, ÛÙȘ Ôԛ˜ ·ÔÌÔÓÒıËÎ·Ó Û ηÏÏȤÚÁÂȘ ÚÈÓÔÊ¿Ú˘ÁÁ· ·ÓıÂÎÙÈο ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϤ¯Ë Ó¢ÌÔÓÈfiÎÔÎÎÔ˘. ∫·Ù·ÁÚ¿ÊËΠÂ›Û˘ - fiÔ˘ ‹Ù·Ó ‰˘Ó·Ùfi - Î·È Ô ÔÏÈÎfi˜ ·ÚÈıÌfi˜ ÙˆÓ Î·ÏÏÈÂÚÁÂÈÒÓ ÚÈÓÔÊ¿Ú˘ÁÁ· Ì ·Ó¿Ù˘ÍË Ó¢ÌÔÓÈfiÎÔÎÎÔ˘. ∞ӷχıËÎ·Ó fiϘ ÔÈ Û˘ÓÙ·Á¤˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÁÈ· ·È‰È¿ Ù˘ ›‰È·˜ ËÏÈΛ·˜ ÛÙÔ˘˜ ›‰ÈÔ˘˜ ‰‹ÌÔ˘˜. ™˘Û¯ÂÙ›ÛÙËÎÂ, Ù¤ÏÔ˜, Ë Î·Ù·Ó¿ÏˆÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ë Û˘¯ÓfiÙËÙ· ·Ó‡ÚÂÛ˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ Û ÏËı˘ÛÌÈ·Îfi Â›‰Ô. ∞ÔÙÂϤÛÌ·Ù·: ∏ ·Ó·ÏÔÁ›· ·Ó‡ÚÂÛ˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ (ÌÂٷ͇ fiÏˆÓ ÙˆÓ ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘) Û ηÏÏȤÚÁÂȘ ÚÈÓÔÊ¿Ú˘ÁÁ·, Î˘Ì·ÈÓfiÙ·Ó ·fi 0% ¤ˆ˜ 49,5%. ∏ ηٷӿψÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ·fi ·È‰È¿ Î˘Ì·ÈÓfiÙ·Ó ·fi 8,5 ¤ˆ˜ 19,7 ηıÔÚÈṲ̂Ó˜ ËÌÂÚ‹ÛȘ ‰fiÛÂȘ ·Ó¿ 1000 ·È‰È¿ ÙËÓ Ë̤ڷ. OÈ ‰‹ÌÔÈ ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ë Û˘ÓÔÏÈ΋ ηٷӿψÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ‹Ù·Ó Ë ÌÂÁ·Ï‡ÙÂÚË Â›¯·Ó Î·È ÙË Û˘¯ÓfiÙÂÚË Î·Ù·Ó¿ÏˆÛË Ì·ÎÚÔÏ›‰ˆÓ Î·È Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ. À‹Ú¯Â ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ηٷӿψÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ù˘ ·Ó·ÏÔÁ›·˜

·Ó‡ÚÂÛ˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ (Û˘ÓÙÂÏÂÛÙ‹˜ Û˘Û¯¤ÙÈÛ˘ 0,96, p=0,002). OÈ Û˘ÓÙÂÏÂÛÙ¤˜ Û˘Û¯¤ÙÈÛ˘ ÁÈ· ÙËÓ ÙÚÈÌÂıÔÚ›ÌË-ÛÔ˘ÏÊ·ÌÂıÔÍ·˙fiÏË, ·ÌÔÍÈÎÈÏÏ›ÓË, Ì·ÎÚÔÏ›‰Â˜ Î·È ÎÂÊ·ÏÔÛÔÚ›Ó˜ ‹Ù·Ó ÛËÌ·ÓÙÈÎÔ› (Â›Â‰Ô 0,001). ¢ÂÓ ˘‹Ú¯Â Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ ¯Ú‹Û˘ ÂÓÈÎÈÏÏ›Ó˘ V Î·È ·Ó‡ÚÂÛ˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘. ™˘ÌÂÚ¿ÛÌ·Ù·: À¿Ú¯ÂÈ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Û˘¯ÓfiÙËÙ·˜ ·Ó‡ÚÂÛ˘ ·ÓıÂÎÙÈÎÒÓ ÛÙËÓ ÂÓÈÎÈÏÏ›ÓË ÛÙÂϯÒÓ Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ Î·È Ù˘ ηٷӿψÛ˘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙ· ·È‰È¿ Û ÏËı˘ÛÌÈ·Îfi Â›‰Ô.

1 Melander E, Ekdahl K, Jonsson G, Molstad S Frequency of penicillin-resistant pneumococci in children is correlated to community utilization of antibiotics Pediatr Infect Dis J 2000;19:1172-1177

∆ÛÔ˘Ì¿Î·˜ ∫ˆÓ/ÓÔ˜ ¶·È‰›·ÙÚÔ˜ - ¢È¢ı˘ÓÙ‹˜ ∂™À ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆ - ∞ÙÙÈ΋˜

45

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¶·È‰È·ÙÚÈ΋ 2002;65:46-51

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2002;65:46-51

ORIGINAL ARTICLE

ªÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Û ·È‰È¿ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ª. ª¿Î·, ∞. ¶Ô˘ÚÙÛ›‰Ë˜, ∞. ™Ù·ÛÈÓÔÔ‡ÏÔ˘, ª. µ·Ú‚Ô˘ÙÛ‹, ¢. ªÔ˘¯Ô‡ÙÛÔ˘, ∫. ¶·˚‰Ô‡ÛË, ∂. ∫ÔÛÌ›‰Ë

Metastases in the central nervous system in children with neuroblastoma M. Baka, A. Pourtsidis, A. Stasinopoulou, M. Varvoutsi, D. Bouhoutsou, K. Paidousi, E. Kosmidi

¶ÂÚ›ÏË„Ë: ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ Â›Ó·È Ô ‰Â‡ÙÂÚÔ˜ ÛÂ Û˘¯ÓfiÙËÙ· Û˘Ì·Á‹˜ ηÎÔ‹ı˘ fiÁÎÔ˜ ÛÙ· ·È‰È¿. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ (~60%) ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ‰È¿Û·ÚÙ˜ ÌÂÙ·ÛÙ¿ÛÂȘ. ™˘Ó‹ıÂȘ ı¤ÛÂȘ ÌÂÙ·ÛÙ¿ÛÂˆÓ ÛÙ· ·È‰È¿ Â›Ó·È Ù· ÔÛÙ¿, Ô Ì˘ÂÏfi˜ ÙˆÓ ÔÛÙÒÓ, ÙÔ ‹·Ú Î·È ÙÔ ‰¤ÚÌ· (ÛÙ· ‚Ú¤ÊË). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ì ÙË ¯Ú‹ÛË ÂÈıÂÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Ì ‹ ¯ˆÚ›˜ ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡, ·Ú·ÙËÚÔ‡ÓÙ·È ÌÂÙ·ÛÙ¿ÛÂȘ Î·È Û ¿ÏϘ ı¤ÛÂȘ, fiˆ˜ ÛÙÔ ∫¡™, ÛÙÔ˘˜ Ó‡ÌÔÓ˜ Î·È ÛÙȘ ˆÔı‹Î˜. ªÂ ÛÎÔfi Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ì ٷ ·È‰È¿ Ì ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ∫¡™, ÌÂÏÂÙ‹Û·Ì ·Ó·‰ÚÔÌÈο Ù· ÈÛÙÔÚÈο fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Ô˘ ÓÔÛËχıËÎ·Ó ÛÙÔ ÙÌ‹Ì· Ì·˜ ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1980 ¤ˆ˜ ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2000 (Û˘ÓÔÏÈο 102 ·È‰È¿) Î·È ÂÚÈÁÚ¿ÊÔ˘Ì 3 ÂÚÈÙÒÛÂȘ Ì ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ∫¡™ ηٿ ÙËÓ ˘ÔÙÚÔ‹. ∂›Û˘, Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ ÂÚÌËÓ›· ÙˆÓ ÌÂÙ·ÛÙ¿ÛÂˆÓ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ∫¡™ Ì ‚¿ÛË Ù· ‰Â‰Ô̤ӷ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

Abstract: Neuroblastoma is the second in frequency malignant solid tumor among children.

The majority of children affected by neuroblastoma (approximately 60%), present with distant metastases at the time of diagnosis.

Common metastatic sites of neuroblastoma are the bones, bone marrow, liver and in infants the skin. With the use of aggressive chemotherapy, with or without autologous rescue, other metastatic sites have been identified during the recent years namely the CNS, the lungs and the ovaries. In order to study the occurrence of CNS metastases in children with neuroblastoma, we retrospectively reviewed the records of all patients diagnosed with neuroblastoma from 1/1980 to 12/2000 (a total of 102 children), and we describe 3 children with CNS metastases that were detected at the time of relapse. An attempt is also made to outline the possible pathophysiologic mechanisms of this metastatic pattern by reviewing the data reported in the literature.

§¤ÍÂȘ ÎÏÂȉȿ: Ó¢ÚÔ‚Ï¿Ûو̷, ÌÂÙ·ÛÙ¿ÛÂȘ, ∫¡™.

Key words: neuroblastoma, metastases, CNS.

™˘ÓÙÔÌÔÁڷʛ˜ NB À/° À/∫ À/∆ ª/∆ ã ∫¡™ CÀ DOXO

¡Â˘ÚÔ‚Ï¿Ûو̷ ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ÀÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÃËÌÂÈÔıÂÚ·›· ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ∫˘ÎÏÔʈÛÊ·Ì›‰Ë ∞‰ÚÈ·Ì˘Û›ÓË

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

46

DTIC PL CPL VP16 VCR VMA Oª™™ O¡¶ ∂¡À MIBG

¢·Î·Ú‚·˙›ÓË ™ÈÛÏ·Ù›ÓË ∫·Ú‚ÔÏ·Ù›ÓË ∂ÙÔÔÛ›‰Ë µÈÓÎÚÈÛÙ›ÓË µ·ÓÈÏÔÌ·Ó‰ÂÏÈÎfi Ô͇ OÛÊ˘˚΋ ÌÔ›Ú· ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ OÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË ∂ÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ªÂÙ·-πˆ‰Ô‚ÂÓ˙ÈÏÔÁÔ˘·Óȉ›ÓË

Oncology Division “Aghia Sophia” Children’s Hospital, Athens

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∂ÈÛ·ÁˆÁ‹ ∆Ô Ó¢ÚÔ‚Ï¿Ûو̷ (¡µ) ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ Â͈ÎÚ·ÓÈ·Îfi Û˘Ì·Á‹ ηÎÔ‹ıË fiÁÎÔ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (1) Î·È ÛÙÔ 60% ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ‰È¿Û·ÚÙ˜ ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙË ‰È¿ÁÓˆÛË. ∫·Ù¿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜, Ë ÂÓÙfiÈÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜ Â›Ó·È ÎÔÈÏȷ΋ ÛÙÔ 65% ÙˆÓ ÂÚÈÙÒÛˆÓ, ıˆÚ·ÎÈ΋ ÛÙÔ 19%, Û ¿ÏϘ ı¤ÛÂȘ ÛÙÔ 15%, ÂÓÒ ÙÔ 1% ÂÚ›Ô˘ Â›Ó·È ·ÁÓÒÛÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ÂÓÙfiÈÛ˘ (2). ∆Ô ¡µ ÌÂı›ÛÙ·Ù·È Û˘Ó‹ıˆ˜ ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ, ÛÙ· ÔÛÙ¿, ÛÙÔ ‹·Ú (3) Î·È ÛÙÔ ‰¤ÚÌ· ÛÙ· ‚Ú¤ÊË (4). ∏ ÂÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË ÙˆÓ ·È‰ÈÒÓ >1 ¤ÙÔ˘˜ Ì ‰È¿Û·ÚÙÔ Ó¢ÚÔ‚Ï¿Ûو̷, ·ÎfiÌË Î·È Ì ÙË ¯Ú‹ÛË ÂÈıÂÙÈÎÒÓ ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Î·È ·˘ÙfiÏÔÁ˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ·Ó¤Ú¯ÂÙ·È ÂÚ›Ô˘ ÛÙÔ 30% (5,6). ªÂ ÙË ¯Ú‹ÛË ÙˆÓ ÂÈıÂÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ ¯ËÌÂÈÔıÂÚ·›·˜ Î·È ÙËÓ ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡, ·˘Í¿ÓÂÙ·È Û˘Ó¯Ҙ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ Î·È Û¿ÓȘ ı¤ÛÂȘ ÌÂÙ·ÛÙ¿ÛˆÓ, fiˆ˜ Â›Ó·È ÙÔ ∫¡™ (7-12), Ô ÔÊı·ÏÌÈÎfi˜ ‚ÔÏ‚fi˜ (13), ÔÈ Ó‡ÌÔÓ˜ (3) Î·È ÔÈ ˆÔı‹Î˜ (14). ªÂ ÛÎÔfi Ó· ‰È¢ÎÚÈÓ›ÛÔ˘Ì ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ¡µ Î·È ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ∫¡™, ÌÂÏÂÙ‹Û·Ì ·Ó·‰ÚÔÌÈο Ù· ÈÛÙÔÚÈο ÙÔ˘˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ ÙÔ˘ 1980 ̤¯ÚÈ Î·È ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2000 ÓÔÛËχıËÎ·Ó ÛÙÔ OÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” Û˘ÓÔÏÈο 102 ·È‰È¿ Ì ¡µ. ∆· 38 ‹Ù·Ó <1 ¤ÙÔ˘˜ Î·È Ù· 64 >1 ¤ÙÔ˘˜. ∞fi ·˘Ù¿, Ù· 46 ·È‰È¿ ›¯·Ó ÂÓÙÔÈṲ̂ÓÔ Ó¢ÚÔ‚Ï¿Ûو̷ ÛÙ·‰›Ô˘ π ‹ ππ ‹ πππ Î·È Ù· 56 ÌÂÙ·ÛÙ·ÙÈÎfi Ó¢ÚÔ‚Ï¿Ûو̷ (51 ·È‰È¿ ›¯·Ó ÛÙ·‰›Ô˘ IV Î·È 5 ›¯·Ó ÛÙ·‰›Ô˘ 4S). ∞fi ÙËÓ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÙˆÓ ÈÛÙÔÚÈÎÒÓ ÚԤ΢„ fiÙÈ Î·Ó¤Ó· ·fi Ù· ·È‰È¿ ·˘Ù¿ ‰ÂÓ Â›¯Â ÛÙË ‰È¿ÁÓˆÛË ‹ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ¯ËÌÂÈÔıÂÚ·›·˜ (ã) Û˘Ìو̷ÙÔÏÔÁ›· Ô˘ Ó· Ô‰ËÁ› Û Èı·Ó‹ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ∫¡™ ÛÙË ÓfiÛÔ. ™Â 3/102 ·È‰È¿, fï˜, Ë ˘ÔÙÚÔ‹, ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ·Ú¯È΋˜ ã, ÂÌÊ·Ó›ÛÙËΠÛÙÔ ∫¡™ ‹ ˆ˜ ÌÂÌÔӈ̤ÓË ˘ÔÙÚÔ‹ ∫¡™ (2/3) ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÈ΋ ˘ÔÙÚÔ‹ Î·È ÁÂÓÈÎÂ˘Ì¤Ó˜ ÌÂÙ·ÛÙ¿ÛÂȘ (1/3). £· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÛÙË Û˘Ó¤¯ÂÈ· ÔÈ ÙÚÂȘ ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ Î·È Ë ÙÂÏÈ΋ ¤Î‚·Û‹ ÙÔ˘˜. £· Û˘˙ËÙËıÔ‡Ó ÔÈ Èı·ÓÔ› ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Ô˘ ÂÌϤÎÔÓÙ·È ÛÙË ÌÂÙ¿ÛÙ·ÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ∫¡™, Ì ‚¿ÛË Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ. ¶ÂÚ›ÙˆÛË 1Ë ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ Ô˘ ÙÔÓ 10Ô Ì‹Ó· ÙÔ˘ 1984 ÂÈÛ‹¯ıË ÛÙÔ OÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” Ì ˆ¯ÚfiÙËÙ· Î·È fiÓÔ ÛÙ· ÔÛÙ¿. ∆Ô ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÂχıÂÚÔ. ™‡Ìʈӷ Ì ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ›¯Â ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜: Hb 9,3 g/dl, Hct 27%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 7,8x103/Ìl Ì ه-

Paediatriki 2002;65:46-51

Ô o˘‰ÂÙÂÚfiÊÈÏ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 50%, ÏÂÌÊÔ·ÙÙ·Ú· 45%, ÌÔÓÔ‡ÚËÓ· 3%, ˈÛÈÓfiÊÈÏ· 2% Î·È ·ÈÌÔÂÙ¿ÏÈ· 158x103/Ìl. ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙÔ ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ¤‰ÂÈÍ·Ó: Ô˘Ú›· 25 mg/dl, ÎÚ·ÙÈÓ›ÓË 0,6 mg/dl, ·Û‚¤ÛÙÈÔ 9,6 mg/dl, ÊÒÛÊÔÚÔ˜ 3,7 mg/dl, οÏÈÔ 3,7 meq/L, Ó¿ÙÚÈÔ 138 meq/L, ¯ÏÒÚÈÔ 100 meq/L, ÙÚ·ÓÛ·ÌÈÓ¿Û˜ ÔÍ·ÏÔÍÂ˚΋ 25 U/L Î·È ˘ÚÔÛÙ·Ê˘ÏÈ΋ 14 U/L, Á-GT 121 U/L, VMA Ô‡ÚˆÓ 50 Ìg/mg ÎÚ·ÙÈÓ›Ó˘. ∞fi ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ÔÛÙÒÓ ·Ó¢ڤıËÛ·Ó Ï˘ÙÈΤ˜ ÂÛٛ˜ ÛÙÔ ÌËÚÈ·›Ô Î·È ·fi ÙË ‚ÈÔ„›· ÙÔ˘ ÔÛÙÔ‡ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÌÂÙ·ÛÙ·ÙÈÎÔ‡ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜. ∞ÎÔÏÔ‡ıËÛ ÔÏfiÛˆÌÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Ì Á-camera Ì Tc 99m Ô˘ ¤‰ÂÈÍ ·˘ÍË̤ÓË Î·ı‹ÏˆÛË Û ÔÏÏ·Ϥ˜ ı¤ÛÂȘ ÛÙ· ÔÛÙ¿. ™ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ÔÛÙÒÓ ‚Ú¤ıËÎ·Ó Í¤Ó· ÚÔ˜ ÙÔ Ì˘ÂÏfi ·ÙÙ·Ú· ηٿ ÔÌ¿‰Â˜ Ù˘Èο ‰È‹ıËÛ˘ ·fi ¡µ. ™ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Ù˘ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ıÒÚ·ÎÔ˜ ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ù‹ Ë ÂÓÙfiÈÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜. ªÂ Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙ·‰›Ô˘ IV ·ÁÓÒÛÙÔ˘ ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜. ÕÚ¯ÈÛ ·Ì¤Ûˆ˜ ã Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ΢ÎÏÔʈÛÊ·Ì›‰Ë (CÀ), ·‰ÚÈ·Ì˘Î›ÓË (DOXO), ‰·Î·Ú‚·˙›ÓË (DTIC) ÂÓ·ÏÏ¿Í Ì ÛÈÛÏ·Ù›ÓË (PL), ÂÙÔÔÛ›‰Ë (VP16). ÀÔ‚Ï‹ıËÎÂ Û˘ÓÔÏÈο Û 2 ¯ÚfiÓÈ· ıÂÚ·›·˜ ¤ˆ˜ ÙÔÓ OÎÙÒ‚ÚÈÔ ÙÔ˘ 1986. ∫·Ù¿ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ã ¢ڤıË ·ÔÙÈٷӈ̤ÓË ÂÛÙ›· ¿Óˆ ·fi ÙÔÓ ·ÚÈÛÙÂÚfi ÓÂÊÚfi, ÂÓÒ Ô ˘fiÏÔÈÔ˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ Î·È ÙÔ ·È‰› Ù¤ıËΠ˘fi ·Ú·ÎÔÏÔ‡ıËÛË. ¢‡Ô Ì‹Ó˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ã, ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1986, ÚÔÛ‹Ïı ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ Ì ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜ Î·È ÛÙËÓ ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· (À/∆) ÂÁÎÂÊ¿ÏÔ˘ ·Ú·ÙËÚ‹ıËΠÌÔÓ‹Ú˘ ÂÛÙ›· ·˘ÍË̤Ó˘ ˘ÎÓfiÙËÙ·˜ ÛÙË ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹ ·ÚÈÛÙÂÚ¿. ∏ ÂÛÙ›· ÂÚÈ‚·ÏÏfiÙ·Ó ·fi ÔȉËÌ·ÙÒ‰Ë ¿Ïˆ. ∞fi ÙÔÓ ˘fiÏÔÈÔ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ÂÓÙÔ›ÛÙËÎ·Ó ÛËÌ›· ˘ÔÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘. ÕÚ¯ÈÛ ã Û‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ “8 in 1” ÁÈ· fiÁÎÔ˘˜ ÂÁÎÂÊ¿ÏÔ˘. ∏ ıÂÚ·›· ·˘Ù‹ Ì 8 Ê¿Ú̷η ¯ÔÚËÁÂ›Ù·È ÌÂÙ¿ ·fi ηٿÏÏËÏË ÂÓ˘‰¿ÙˆÛË Û ‰È¿ÛÙËÌ· 12 ˆÚÒÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË, ‚ÈÓÎÚÈÛÙ›ÓË, ÏÔÌÔ˘ÛÙ›ÓË, ÚÔηڂ·˙›ÓË, ˘‰ÚÔ͢Ԣڛ·, ÛÈÛÏ·Ù›ÓË, ΢ÎÏÔʈÛÊ·Ì›‰Ë, ηڂÔÍÈÌ›‰Ë. ∏ ÌÂÙ·ÛÙ·ÙÈ΋ ÂÛÙ›· ·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ Ì›ˆÛË Î·È ÛÙȘ 7/7/1987 ·Ê·ÈÚ¤ıËÎÂ Ë ˘ÔÏÂÈfiÌÂÓË Ì¿˙· ‰È·ÛÙ¿ÛÂˆÓ 5x4,5x3,5 cm ·fi ÙËÓ ·ÚÈÛÙÂÚ‹ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹. πÛÙÔÏÔÁÈο ÂȂ‚·ÈÒıËΠfiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· ÌÂÙ·ÛÙ·ÙÈ΋ ÂÛÙ›· Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔ ·È‰› Ù¤ıËΠ˘fi ·Ú·ÎÔÏÔ‡ıËÛË ¯ˆÚ›˜ ÂÈÚfiÛıÂÙË ıÂÚ·›·. ™ÙȘ 19/11/1987 ÙÔ ·È‰› ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ÌÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ Î·È Ì À/∆ ÂÁÎÂÊ¿ÏÔ˘ ÂÓÙÔ›ÛÙËΠ˘¤Ú˘ÎÓË ÂÛÙ›· Ô˘ ÚÔÛÊ˘fiÙ·Ó ÛÙÔ ‰Ú¤·ÓÔ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÂÓÙÔÈ˙fiÙ·Ó ÛÙËÓ ·ÓÒÙÂÚË ÌÔ›Ú· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ‚ÚÂÁÌ·ÙÈÎÔ‡ ÏÔ‚Ô‡. ◊Ù·Ó ÂÌÊ·Ó¤˜ fiÙÈ ÂÚfiÎÂÈÙÔ ÁÈ· Ó¤· ÌÂÙ·ÛÙ·ÙÈ΋ ÂÛÙ›· ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ∫¡™. ∆Ô ·È‰› η٤ÏËÍ ϛÁ˜ Ë̤Ú˜ ÌÂÙ¿ ÙË ‰Â‡ÙÂÚË ˘ÔÙÚÔ‹ Ì ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË. ¶ÂÚ›ÙˆÛË 2Ë ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 2 ÂÙÒÓ Ô˘ ÛÙȘ 3/12/1991 ÂÈÛ‹¯ıË ÛÙÔ OÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. &

47

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·48

¶·È‰È·ÙÚÈ΋ 2002;65:46-51

∞. ∫˘ÚÈ·ÎÔ‡”, Ì ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ·fi 15Ë̤ÚÔ˘, ·ÓÔÚÂÍ›·, ·ÒÏÂÈ· ‚¿ÚÔ˘˜ Î·È ·ÓËÛ˘¯›·. ™ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ÙÔ ·È‰› ‹Ù·Ó ˆ¯Úfi Î·È ˘‹Ú¯Â Ì¿˙· „ËÏ·ÊËÙ‹, ÌË Û·ÊÒ˜ ·ÊÔÚÈ˙fiÌÂÓË, ÛÙÔ ‰ÂÍÈfi ˘Ô¯fiÓ‰ÚÈÔ Ì Â¤ÎÙ·ÛË ÚÔ˜ ÙÔ ÂÈÁ¿ÛÙÚÈÔ Î·È ÂÏ·ÊÚ‡ Â›ÊÏ‚Ô. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ›¯Â ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜: Hb 7,8 g/dl, Hct 26,2%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 11,0x103/Ìl Ì هÔ Ô˘‰ÂÙÂÚfiÊÈÏ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 63%, ÏÂÌÊÔ·ÙÙ·Ú· 26%, ÌÔÓÔ‡ÚËÓ· 7%, ˈÛÈÓfiÊÈÏ· 4% Î·È ·ÈÌÔÂÙ¿ÏÈ· 526x103/Ìl. ∞fi ÙÔ ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô: ۿί·ÚÔ 88 mg/dl, Ô˘Ú›· 13 mg/dl, ÎÚ·ÙÈÓ›ÓË 0,6 mg/dl, ·Û‚¤ÛÙÈÔ 9,0 mg/dl, ʈÛÊfiÚÔ˜ 3,7 mg/dl, οÏÈÔ 4,6 meq/L, Ó¿ÙÚÈÔ 138 meq/L, ¯ÏÒÚÈÔ 99 meq/L, ÙÚ·ÓÛ·ÌÈÓ¿Û˜ ÔÍ·ÏÔÍÂ˚΋ 23 U/L Î·È ˘ÚÔÛÙ·Ê˘ÏÈ΋ 7 U/L, Á-GT 11 U/L, ¯ÔÏÂÚ˘ıÚ›ÓË 0,6 mg/dl, VMA Ô‡ÚˆÓ 71 Ìg/mg ÎÚ·ÙÈÓ›Ó˘. ∞fi ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ (À/∫) ¤‰ÂÈÍ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÈÁ·ÛÙÚ›Ô˘ ˘ÂÚ˯ÔÁÂÓ‹ Ì¿˙· ‰È·ÛÙ¿ÛÂˆÓ 9,8x7,1 cm Ì ·ÔÙÈÙ·ÓÒÛÂȘ ηٿ ÙfiÔ˘˜. ™ÙËÓ À/∆ ÎÔÈÏ›·˜ ‚Ú¤ıËΠ̿˙· ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›Ô˘ Ì Â¤ÎÙ·ÛË ÚÔ˜ ÙÔÓ ·Ú·ÛÔÓ‰˘ÏÈÎfi ¯ÒÚÔ Î·È ‡·ÚÍË ·ÔÙÈÙ·ÓÒÛˆÓ. ∂›Û˘, ‰È·ÈÛÙÒıËΠ‰ÈfiÁΈÛË ·Ú·ÔÚÙÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ. ™ÙÔ ÔÏfiÛˆÌÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì I-123 MIBG ·Ú·ÙËÚ‹ıËΠηı‹ÏˆÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÌfiÓÔ ÛÙË ı¤ÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜, ÂÓÒ ‹Ù·Ó ·ÚÓËÙÈÎfi ÁÈ· ÌÂÙ·ÛÙ·ÙÈΤ˜ ÂÓÙÔ›ÛÂȘ, fiˆ˜ Î·È ÙÔ ÔÏfiÛˆÌÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Ì Á-camera Ì Tc 99m. ™ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ‰ÂÓ ‚Ú¤ıËÎ·Ó Í¤Ó· ÚÔ˜ ÙÔ Ì˘ÂÏfi ·ÙÙ·Ú·. ªÂ Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‰ÂÍÈÔ‡ ÂÈÓÂÊÚȉ›Ô˘ ÛÙ·‰›Ô˘ πππ Î·È ¿Ú¯ÈÛ ã, Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ‚ÈÓÎÚÈÛÙ›ÓË (VCR), ΢ÎÏÔʈÛÊ·Ì›‰Ë (CÀ), ·‰ÚÈ·Ì˘Î›ÓË (DOXO), ÂÓ·ÏÏ¿Í Ì ÛÈÛÏ·Ù›ÓË (PL), ÂÙÔÔÛ›‰Ë (VP16). ∆Ô ·È‰› ›¯Â ÈηÓÔÔÈËÙÈ΋ ·¿ÓÙËÛË ÛÙË Ã£ Î·È ÛÙȘ 27/7/1992 (ÌÂÙ¿ ·fi 8 Û¯‹Ì·Ù· ıÂÚ·›·˜) ¤ÁÈÓ ̷ÎÚÔÛÎÔÈο Ï‹Ú˘ ÂÍ·›ÚÂÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜ Î·È ÈÛÙÔÏÔÁÈο ÂȂ‚·ÈÒıËÎÂ Ë ‰È¿ÁÓˆÛË ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜. ™˘ÌÏ‹ÚˆÛ ÙË Ã£ Ì 4 ›‰È· Ì ٷ ·Ú¯Èο Û¯‹Ì·Ù· ã ̤¯ÚÈ 13/10/1992. ªÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ã, ·ÎÔÏÔ‡ıËÛ Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ Î·È ÙÔ ·È‰› ‹Ù·Ó Û Ï‹ÚË ‡ÊÂÛË Î·È Ù¤ıËΠ˘fi ·Ú·ÎÔÏÔ‡ıËÛË. ™ÙȘ 24/12/1992 ÙÔ ·È‰› ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ˘ÚÂÙfi 39oC Î·È ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜. ŒÁÈÓ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË (O¡¶) Î·È Î˘ÙÙ·ÚÔÏÔÁÈ΋ ÌÂϤÙË ÙÔ˘ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ (∂¡À) Ô˘ ‹Ù·Ó ·ÚÓËÙÈ΋. ™ÙËÓ À/∆ ÂÁÎÂÊ¿ÏÔ˘ ‚Ú¤ıËΠÛÙË ‰ÂÍÈ¿ ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ· ÂÛÙ›· Ì ÂÚÈÔ¯¤˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ˘fi˘ÎÓË ¿Ïˆ ¤ÚÈÍ ·˘Ù‹˜ (∂ÈÎfiÓ· 1). O ˘fiÏÔÈÔ˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ·È‰ÈÔ‡ ÁÈ· ÙÔÈ΋ ‹ ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÚÔ‹ ·¤‚Ë ·ÚÓËÙÈÎfi˜. ∂·Ó·ÚÔÛ‰ÈÔÚ›ÛÙËΠÙÔ VMA Ô‡ÚˆÓ Ô˘ ‹Ù·Ó ·˘ÍË̤ÓÔ (70 Ìg/mg ÎÚ·ÙÈÓ›Ó˘). ªÂ Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ, Ë ·Ó¢ÚÂı›۷ ÂÛÙ›· ÛÙÔÓ ÂÁΤʷÏÔ ·Ô‰fiıËΠ۠ÌÂÌÔӈ̤ÓË ˘ÔÙÚÔ‹ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ∫¡™ Î·È ÙÔ ·È‰› ¿Ú¯ÈÛ ÂÎ Ó¤Ô˘ ã ÛÙȘ 31/12/1992. ∏ ã ÂÚÈÂÏ¿Ì‚·Ó Â·Ó·Ï·Ì‚·ÓfiÌÂÓÔ˘˜ ·ÎÏÔ˘˜ ηڂÔÏ·Ù›Ó˘ (CPL) Î·È ÂÙÔÔÛ›‰Ë˜ (VP16). ™ÙȘ 29/3/1993, ÛÙËÓ À/∆ ÂÁÎÂÊ¿ÏÔ˘ ‰È·ÈÛÙÒıËΠÛÌ›ÎÚ˘ÓÛË Ù˘ Ì¿˙·˜ ÛÙË ‰ÂÍÈ¿ ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹ Î·È ÙÔ À/° ÎÔÈÏ›·˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ Â›Ó·È ·ÚÓËÙÈÎfi ÁÈ· ˘ÔÙÚÔ‹ Ù˘ ÓfiÛÔ˘. ¶ÚÔÁÚ·ÌÌ·Ù›ÛÙËΠ·Ê·›ÚÂÛË Ù˘ ˘ÔÏÂÈfiÌÂÓ˘

48

Paediatriki 2002;65:46-51

∂ÈÎfiÓ· 1. À/∆ ÂÁÎÂÊ¿ÏÔ˘ (ÂÚ›ÙˆÛË 2Ë). ∂ÛÙ›· Ì ÂÚÈÔ¯¤˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ Î·È ˘fi˘ÎÓË ¿Ïˆ ¤ÚÈÍ ·˘Ù‹˜ ÛÙË ‰ÂÍÈ¿ ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ·.

Ì¿˙·˜ ÛÙÔÓ ÂÁΤʷÏÔ ÛÙȘ 29/4/1993, Ô˘ ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÏfiÁˆ ÂÈÏÔÎÒÓ Î·Ù¿ ÙË ÁÂÓÈ΋ ·Ó·ÈÛıËÛ›·. ™ÙȘ 10/6/1993, ÛÙËÓ À/∆ ÂÁÎÂÊ¿ÏÔ˘ ‰È·ÈÛÙÒıËΠÂÈϤÔÓ Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÌÂÙ·ÛÙ·ÙÈ΋˜ ÂÛÙ›·˜ Î·È ‰ÂÓ ıˆڋıËΠϤÔÓ ÛÎfiÈÌË Ë ·Ê·›ÚÂÛ‹ Ù˘, ·ÏÏ¿ Û˘Ó¤¯ÈÛ ÙË Ã£ ÙÔ˘. ™ÙȘ 12/6/1993 ÙÔ ·È‰› ·ÚÔ˘Û›·ÛÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ ÙÔÓÈÎÔÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ Î·È Û˘Á¯ÚfiÓˆ˜ Û À/° ÎÔÈÏ›·˜ ‰È·ÈÛÙÒıËΠ‡·ÚÍË ·Ú·ÔÚÙÈ΋˜ Ì¿˙·˜ ‰È·ÛÙ¿ÛÂˆÓ 0,9x4,7x1,9 cm. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔ ·È‰› ·ÚÔ˘Û›·Û Âȉ›ӈÛË, ¿Ú¯ÈÛ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·ÁˆÁ‹ Î·È Î·Ù¤ÏËÍ ÛÙȘ 6/9/1993 Ì ‰È¿Û·ÚÙË ÓfiÛÔ. ¶ÂÚ›ÙˆÛË 3Ë ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 27 ÌËÓÒÓ Ô˘ ÛÙȘ 2/10/1996 ÂÈÛ‹¯ıË ÛÙÔ OÁÎÔÏÔÁÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” ÏfiÁˆ ‰ÈfiÁΈÛ˘ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ·ÚÂÈ¿ ·fi 20Ë̤ÚÔ˘. ∆Ô ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ÂχıÂÚÔ. ∞ÓÙÈÎÂÈÌÂÓÈο ˘‹Ú¯Â ˆ¯ÚfiÙËÙ· Î·È ‰ÈfiÁΈÛË ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ·ÚÂÈ¿˜ Î·È Ù›ÔÙ· ÙÔ ÂÈÚfiÛıÂÙÔ. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÛÙË ÁÂÓÈ΋ ·›Ì·ÙÔ˜: Hb 8,8 g/dl, Hct 27%, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 9,0x103/Ìl Ì هÔ Ô˘‰ÂÙÂÚfiÊÈÏ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 23%, ÏÂÌÊÔ·ÙÙ·Ú· 60%, ÌÔÓÔ‡ÚËÓ· 9%, ˈÛÈÓfiÊÈÏ· 6% Î·È ·ÈÌÔÂÙ¿ÏÈ· 131x103/Ìl. ∞fi ÙÔ ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô: ۿί·ÚÔ 84 mg/dl, Ô˘Ú›· 23 mg/dl, ÎÚ·ÙÈÓ›ÓË 0,5 mg/dl, ·Û‚¤ÛÙÈÔ 10,7 mg/dl, ÊÒÛÊÔÚÔ˜ 5,7 mg/dl, Ì·ÁÓ‹ÛÈÔ 1,9 mg/dl, οÏÈÔ 5,1 meq/L,

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·49

¶·È‰È·ÙÚÈ΋ 2002;65:46-51

Ó¿ÙÚÈÔ 142 meq/L, ¯ÏÒÚÈÔ 108 meq/L, ÙÚ·ÓÛ·ÌÈÓ¿Û˜ ÔÍ·ÏÔÍÂ˚΋ 29 U/L Î·È ˘ÚÔÛÙ·Ê˘ÏÈ΋ 5 U/L, Á-GT 4 U/L, ¯ÔÏÂÚ˘ıÚ›ÓË 0,3 mg/dl, VMA Ô‡ÚˆÓ 95 Ìg/mg ÎÚ·ÙÈÓ›Ó˘ Î·È ÊÂÚÚÈÙ›ÓË ÔÚÔ‡ 92 Ìg/dl. ™ÙË ª/∆ ÛÏ·Á¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘ ‚Ú¤ıËÎÂ Û˘Ì·ÁÔ‡˜ ˘Ê‹˜ ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÍÂÚÁ·Û›· ÛÙËÓ ·ÚÈÛÙÂÚ‹ ˙˘ÁˆÌ·ÙÈ΋ ÂÚÈÔ¯‹ ÚÔÛı›ˆ˜ Î·È ¿Óˆ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘, Ô˘ ηٷϿ̂·Ó ۯ‰fiÓ Ï‹Úˆ˜ ÙÔ ·ÚÈÛÙÂÚfi ÈÁÌfiÚÂÈÔ ¿ÓÙÚÔ. ∂›Û˘, ‚Ú¤ıËΠÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ϤÙ˘ÓÛË ¤ˆ˜ ‰È·ÎÔ‹ Ù˘ Û˘Ó¯›·˜ ÙÔ˘ ˙˘ÁˆÌ·ÙÈÎÔ‡ ÔÛÙÔ‡ ÛÙÔ ¤‰·ÊÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÔÊı·ÏÌÈÎÔ‡ ÎfiÁ¯Ô˘ Ì ÌÈÎÚ‹ Â› Ù· ÂÓÙfi˜ ÚÔ¤ÙÂÈ· Ù˘ ÂÍÂÚÁ·Û›·˜. ∏ Ì¿˙· ÚÔÛÂÏ¿Ì‚·Ó ۯÂÙÈο ÔÌÔÈÔÁÂÓÒ˜ ÙËÓ ·Ú·Ì·ÁÓËÙÈ΋ Ô˘Û›·. ∞fi Ù· ÂÁÎÂÊ·ÏÈο ËÌÈÛÊ·›ÚÈ· ‰ÂÓ ·Ú·ÙËÚ‹ıËΠٛÔÙ· ÙÔ ·ıÔÏÔÁÈÎfi. ™ÙËÓ À/∆ ÎÔÈÏ›·˜ ‚Ú¤ıËΠ̿˙· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ‰È·ÛÙ¿ÛÂˆÓ 4x3x1,7 cm ÛÙÔÓ ÚÔÛÔÓ‰˘ÏÈÎfi ¯ÒÚÔ Î·È ‰ÂÍÈ¿ ·Ú·ÛÔÓ‰˘ÏÈο ÛÙÔ ‡„Ô˜ £12-O1 ¯ˆÚ›˜ ·ÔÙÈÙ·ÓÒÛÂȘ, Ì Â¤ÎÙ·ÛË ÂÓÙfi˜ ÙÔ˘ ÛÔÓ‰˘ÏÈÎÔ‡ ۈϋӷ ÛÙÔÓ ÂÈÛÎÏËÚ›‰ÈÔ ¯ÒÚÔ ‰ÂÍÈ¿. ¢ÂÓ ‚Ú¤ıËÎ·Ó Û˘ÓÔ‰Ô› ÏÂÌÊ·‰¤Ó˜. ∆· ÏÔÈ¿ ÂÓ‰ÔÎÔÈÏȷο fiÚÁ·Ó· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ À/∆ ıÒÚ·ÎÔ˜ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ™ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÂÈÓÂÊÚȉ›ˆÓ Ì I-123 MIBG ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ·ÚÈÛÙÂÚ¿˜ ¿Óˆ ÁÓ¿ıÔ˘ Î·È ÛÙÔ Û‡ÛÙÔÈ¯Ô ÈÁÌfiÚÂÈÔ, ÛÙËÓ Î·ÙÒÙÂÚË ıˆÚ·ÎÈ΋ Î·È ·ÓÒÙÂÚË ÔÛÊ˘˚΋ ÌÔ›Ú· Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘, ÛÙ· ÌËÚÈ·›· ÔÛÙ¿, ÛÙȘ ÎӋ̘, ÛÙ· ‚Ú·¯ÈfiÓÈ· Î·È ÛÙ· ÔÛÙ¿ Ù˘ ÏÂοÓ˘ ¿Ìʈ. ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· ¤‰ÂÈÍ ‰È‹ıËÛË ·fi ͤӷ ÚÔ˜ ÙÔ Ì˘ÂÏfi ·ÙÙ·Ú·. ªÂ Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË ·Ú·ÛÔÓ‰˘ÏÈÎÔ‡ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙ·‰›Ô˘ IV Ì ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙ· ÔÛÙ¿ Î·È ÛÙÔ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. ™ÙȘ 3/10/1996 ¿Ú¯ÈÛ ã Ì ‚ÈÓÎÚÈÛÙ›ÓË (VCR), ΢ÎÏÔʈÛÊ·Ì›‰Ë (CÀ), ·‰ÚÈ·Ì˘Î›ÓË (DOXO), ÂÓ·ÏÏ¿Í Ì ÛÈÛÏ·Ù›ÓË (PL), ÂÙÔÔÛ›‰Ë (VP16). ªÂÙ¿ ·fi 6 ·ÎÏÔ˘˜ ã ÙÔ ª¿ÚÙÈÔ ÙÔ˘ 1997, Û Â·Ó¤ÏÂÁ¯Ô ÙˆÓ ÌÂÙ·ÛÙ¿ÛÂˆÓ Ì ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÂÈÓÂÊÚȉ›ˆÓ Î·È À/∆ ÛÏ·Á¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘, ›¯Â Ï‹ÚË ‡ÊÂÛË ÙˆÓ ÌÂÙ·ÛÙ¿ÛˆÓ. ™ÙËÓ À/∆ ÎÔÈÏ›·˜ ‰ÂÓ ·Ó·ÁÓˆÚ›ÛÙËΠ˘ÔÏÂÈÌÌ·ÙÈ΋ Ì¿˙·, ÂÎÙfi˜ ·fi ·‰Ú‹ ·ÔÙÈÙ¿ÓˆÛË ÛÙÔ ÂÈÓÂÊÚ›‰ÈÔ. ∏ ·ÓÙ·fiÎÚÈÛË ÛÙË Ã£ ‹Ù·Ó ¿ÚÈÛÙË Î·È ‰ÂÓ ıˆڋıËΠÛÎfiÈÌÔ Ó· Á›ÓÂÈ ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË ÁÈ· ·Ê·›ÚÂÛË Ù˘ ÚˆÙÔ·ıÔ‡˜ ÂÛÙ›·˜. ∆Ô ·È‰› Û˘Ó¤¯ÈÛ ÙËÓ ›‰È· ã ¤ˆ˜ ÙȘ 4/8/1997. ªÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ã ¤ÁÈÓ Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙË ÓfiÛÔ Î·È ÙÔ ·È‰› ‹Ù·Ó Û Ï‹ÚË ‡ÊÂÛË Î·È Û˘Ó¤¯ÈÛ ÌfiÓÔ Ì ·Ú·ÎÔÏÔ‡ıËÛË ·Ó¿ Ì‹Ó·. ¶¤ÓÙ ̋Ó˜ ÌÂÙ¿, ÛÙȘ 28/1/1998, ÙÔ ·È‰› ÚÔÛÎÔÌ›ÛÙËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, Û˘Ìو̷ÙÔÏÔÁ›· ›ÂÛ˘ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ Î·È ÎÂÊ·Ï·ÏÁ›·. ŒÁÈÓ Â·Ó¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ¤ÎÙ·ÛË Ù˘ ÓfiÛÔ˘ Î·È ÛÙËÓ À/∆ ÎÔÈÏ›·˜ ‚Ú¤ıËΠ̿˙· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ·Ú·ÔÚÙÈο ÚÔÛÔÓ‰˘ÏÈο Ì ‰È·ÛÙ¿ÛÂȘ 5x4x2 cm ÛÙÔ ‡„Ô˜ O4-O5, ÂÓÒ Û ÁÂÓfiÌÂÓË ª/∆ ÂÁÎÂÊ¿ÏÔ˘ ·ÂÈÎÔÓ›ÛÙËΠ¢ÌÂÁ¤ı˘ ÛÊ·ÈÚÔÂȉ‹˜ ÂÍÂÚÁ·Û›· ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ· Ì ̤ÁÈÛÙË ‰È¿ÌÂÙÚÔ 5 cm, Û·ÊÒ˜ ÔÌ·Ïfi ÂÚ›ÁÚ·ÌÌ·, ‰ÂÓ ÂÚÈ‚·ÏÏfiÙ·Ó ·fi Ô›‰ËÌ· Î·È ‰ÂÓ ·ÚÔ˘Û›·˙ ·ıÔÏÔÁÈ΋ Û˘ÁΤÓÙÚˆÛË ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ·Ú·Ì·ÁÓËÙÈ΋˜ Ô˘Û›·˜ (∂ÈÎfiÓ· 2). ™ÙË ‰ÂÍÈ¿ ÈÓȷ΋ ¯ÒÚ· ·ÂÈÎÔÓ›ÛÙËΠÔÛÙÈ΋ ·ÏÏÔ›ˆÛË, Ô˘ Û˘Óԉ¢fiÙ·Ó ·fi ÂÓ‰ÔÎÚ·Óȷ΋ Ì¿˙· Ì·Ï·ÎÒÓ ÌÔ-

Paediatriki 2002;65:46-51

∂ÈÎfiÓ· 2. ª/∆ ÂÁÎÂÊ¿ÏÔ˘ (ÂÚ›ÙˆÛË 3Ë). ∂˘ÌÂÁ¤ı˘ ÛÊ·ÈÚÔÂȉ‹˜ ÂÍÂÚÁ·Û›· ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ¯ÒÚ· Ì ̤ÁÈÛÙË ‰È¿ÌÂÙÚÔ 5 cm Î·È Û·ÊÒ˜ ÔÌ·Ïfi ÂÚ›ÁÚ·ÌÌ·. ¢ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ·ıÔÏÔÁÈ΋ Û˘ÁΤÓÙÚˆÛË ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·Ú·Ì·ÁÓËÙÈ΋˜ Ô˘Û›·˜ ÂÓ‰ÔÊÏ‚›ˆ˜.

Ú›ˆÓ. ∏ ÂÓ ÏfiÁˆ Ì¿˙· ›¯Â ‰È·ÛÙ¿ÛÂȘ 2,5x0,3 cm Î·È ·ÚÔ˘Û›·˙ ÔÌÔÈÔÁÂÓ‹ ÛÎÈ·ÁÚ¿ÊËÛË, ‰ÂÓ Û˘Óԉ¢fiÙ·Ó ·fi Ô›‰ËÌ· Î·È ÚÔηÏÔ‡Û ÂÏ·ÊÚ¿ Û˘Ì›ÂÛË ÙÔ˘ ÈÓÈ·ÎÔ‡ ÏÔ‚Ô‡. ∆Ô VMA Ô‡ÚˆÓ ‹Ù·Ó ·˘ÍË̤ÓÔ, ÂÓÒ ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ‹Ù·Ó ·ÚÓËÙÈÎfi ÁÈ· ‰È‹ıËÛË ·fi ͤӷ ·ÙÙ·Ú·. ™ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÂÈÓÂÊÚȉ›ˆÓ Ì MIBG I-123 ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ú·‰ÈÔÊ·ÚÌ¿ÎÔ˘ ÛÙËÓ ÈÓȷ΋ ¯ÒÚ· ‰ÂÍÈ¿, ÛÙÔÓ ˘ÂÚÎÏ›‰ÈÔ ¯ÒÚÔ ‰ÂÍÈ¿, ÛÙÔ Î·ÙÒÙÂÚÔ ÙÌ‹Ì· ÙˆÓ ÌËÚÈ·›ˆÓ ¿Ìʈ, ÛÙËÓ Oª™™, ÛÙÔ ‰ÂÍÈfi Ï·ÁfiÓÈÔ Î·È ÛÙÔ Î·ÙÒÙÂÚÔ ÙÌ‹Ì· Ù˘ ·ÚÈÛÙÂÚ¿˜ ÈÂÚÔÏ·ÁÔÓ›Ô˘ ¿ÚıÚˆÛ˘. ∂ÚfiÎÂÈÙÔ, ÂÔ̤ӈ˜, ÁÈ· ˘ÔÙÚÔ‹ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜, ÙfiÛÔ ÙÔÈ΋ fiÛÔ Î·È ÁÂÓÈÎÂ˘Ì¤ÓË, Ì ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙ· ÔÛÙ¿ Î·È ÛÙÔÓ ÂÁΤʷÏÔ. ÕÚ¯ÈÛ ã ÛÙȘ 30/1/1998 Ì ηڂÔÏ·Ù›ÓË (CPL)/ÂÙÔÔÛ›‰Ë (VP16) Î·È Û˘Á¯ÚfiÓˆ˜ ‰ÂÍ·ÌÂı·˙fiÓË, ÏfiÁˆ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ›ÂÛ˘ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ¢ÂÓ Â›¯Â ÈηÓÔÔÈËÙÈ΋ ·¿ÓÙËÛË Ô‡ÙÂ Î·È ÛÙÔ Û˘Ó‰˘·ÛÌfi ÈʈÛÊ·Ì›‰Ë˜/ÂÙÔÔÛ›‰Ë˜ Î·È ÏfiÁˆ Âȉ›ӈÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙȘ 25/9/1998 ¯ÔÚËÁ‹ıËΠ˘„ËÏ‹ ‰fiÛË Î˘ÎÏÔʈÛÊ·Ì›‰Ë˜/ÂÙÔÔÛ›‰Ë˜. ¶·Ú¿ ÙË Ï›·Ó ÂÈıÂÙÈ΋ ã, ·ÚÔ˘Û›·Û Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘ Î·È ·fi ÙÔ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 1998 ¿Ú¯ÈÛ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·ÁˆÁ‹. ∫·Ù¤ÏËÍ ÛÙȘ 13/1/1999.

49

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·50

¶·È‰È·ÙÚÈ΋ 2002;65:46-51

™˘˙‹ÙËÛË ∞fi ÙËÓ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÙˆÓ ÈÛÙÔÚÈÎÒÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ÙÌ‹Ì·Ùfi˜ Ì·˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷, ‰È·ÈÛÙÒÛ·Ì fiÙÈ ÌfiÓÔ 3/102 (~3%) ·ÚÔ˘Û›·Û·Ó ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔÓ ÂÁΤʷÏÔ Û 2, 2 Î·È 5 Ì‹Ó˜ ·ÓÙ›ÛÙÔȯ·, ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ã. ∏ ˘ÔÙÚÔ‹ ‹Ù·Ó ÌÂÌÔӈ̤ÓË ÛÙÔÓ ÂÁΤʷÏÔ ÛÙ· 2 ·fi Ù· 3 ·È‰È¿ Î·È ÁÂÓÈÎÂ˘Ì¤ÓË ÛÙÔ 3Ô ·È‰›. ∫·È ÛÙ· ÙÚ›· ·˘Ù¿ ·È‰È¿ Ë ‰È¿ÁÓˆÛË ¤ÁÈÓ ÌÂÙ¿ ÙÔ 1984 Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ۯÂÙÈο ÂÈıÂÙÈο ÚˆÙfiÎÔÏÏ· ã, ¯ˆÚ›˜ fï˜ ·˘ÙfiÏÔÁË ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ¶·Ú¿ ÙËÓ ·¿ÓÙËÛË ÛÙË Ã£ ·Ú¯Èο ÛÙ· 2 ·fi Ù· 3 ·È‰È¿ Î·È ·Ú¿ ÙËÓ Ï‹ÚË ÂÍ·›ÚÂÛË Ù˘ ÌÂÙ·ÛÙ·ÙÈ΋˜ ÂÛÙ›·˜ ÛÙÔ ¤Ó· ·È‰› Î·È ÙËÓ ·Ú¯È΋ Â›Ù¢ÍË ‡ÊÂÛ˘ Î·È Ù· ÙÚ›· ·È‰È¿ ÙÂÏÈο η٤ÏËÍ·Ó Ì ‰È¿Û·ÚÙË ÓfiÛÔ ÛÙÔ˘˜ 11, 9 Î·È 12 Ì‹Ó˜ ·ÓÙ›ÛÙÔȯ· ·fi ÙË ‰È¿ÁÓˆÛË Ù˘ ˘ÔÙÚÔ‹˜. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔÒÓ ÛÙÔ ∫¡™ Û ·È‰È¿ Ì ¡µ >1 ¤ÙÔ˘˜ Î˘Ì·›ÓÂÙ·È ·fi 5 ¤ˆ˜ 16,2% (7,12). ™ÙÔ ‰ÈÎfi Ì·˜ ˘ÏÈÎfi Ù· 3/64 (~4,5%) ·È‰È¿ >1 ¤ÙÔ˘˜ ·ÚÔ˘Û›·Û·Ó ÓfiÛÔ ÛÙÔ ∫¡™. ∞fi ÙË ÌÂϤÙË Ì·˜, Â›Û˘, ÂȂ‚·ÈÒÓÂÙ·È Ë Î·Î‹ ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, ·ÎfiÌË Î·È Ì ÙË ¯Ú‹ÛË ÂÈıÂÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Ã£ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÛÈÛÏ·Ù›ÓË, ÈʈÛÊ·Ì›‰Ë ‹ ˘„ËÏ‹ ‰fiÛË Î˘ÎÏÔʈÛÊ·Ì›‰Ë˜. °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ, ›Ûˆ˜ Â›Ó·È ··Ú·›ÙËÙ˜ Û˘Ó‰˘·Ṳ̂Ó˜ ıÂÚ·›˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÂÈıÂÙÈο Û¯‹Ì·Ù· ã ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ÌÂÙ·ÛÙ·ÙÈ΋˜ ÂÛÙ›·˜ ÛÙÔÓ ÂÁΤʷÏÔ Î·È ·ÎÙÈÓÔıÂÚ·›· ÛÙÔÓ ÂÁΤʷÏÔ Î·È ÙÔÓ ÓÂ˘Ú¿ÍÔÓ· (7). ¢ÂÓ Â›Ó·È Û·Ê¤˜ Â¿Ó Ë ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ·È‰ÈÒÓ Ì ¡µ Î·È ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ∫¡™ ÔÊ›ÏÂÙ·È ÛÙË ¯Ú‹ÛË ÂÈıÂÙÈÎÒÓ ÚˆÙÔÎfiÏÏˆÓ Ã£, Ì ‹ ¯ˆÚ›˜ ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ‹ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ¯Ú‹Û˘ ÈÔ Â˘·›ÛıËÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÌÂÙ·ÛÙ¿ÛÂˆÓ ÛÙÔ ∫¡™. ∂›Ó·È Û ÂͤÏÈÍË ÌÂϤÙË Ô˘ ÂϤÁ¯ÂÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ÛÙ·‰›Ô˘ IV ·ÎÙÈÓÔÏÔÁÈο Î·È Ì ΢ÙÙ·ÚÔÏÔÁÈ΋ ∂¡À ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ã Î·È Î¿ı 6 Ì‹Ó˜ ÛÙË Û˘Ó¤¯ÂÈ·, Ì ÙËÓ ÂÏ›‰· Ó· ‰È¢ÎÚÈÓÈÛÙ› Ë Ê˘ÛÈ΋ ÈÛÙÔÚ›· ÙˆÓ ÌÂÙ·ÛÙ¿ÛÂˆÓ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ∫¡™ (7). O ¤ÏÂÁ¯Ô˜ ÁÈ· ÌÂÙ·ÛÙ¿ÛÂȘ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ∫¡™ Â›Ó·È Î·Ïfi Ó· Á›ÓÂÙ·È Ì ª/∆ ηı’ fiÛÔÓ ÔÈ ÏÂÙÔÌËÓÈÁÁÈΤ˜ ÌÂÙ·ÛÙ¿ÛÂȘ ·ÂÈÎÔÓ›˙ÔÓÙ·È Î·Ï‡ÙÂÚ· Ì ª/∆ Û ۯ¤ÛË Ì ÙËÓ À/∆ Î·È ÂÈϤÔÓ, Ô ¤ÏÂÁ¯Ô˜ Ù˘ ‚¿Û˘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ˘ ÚfiÛıÈÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ‚fiıÚÔ˘, Ô˘ Û˘Ó‹ıˆ˜ ‰ÈËıÔ‡ÓÙ·È ·fi ÌÂÙ·ÛÙ¿ÛÂȘ, Á›ÓÂÙ·È Î·Ï‡ÙÂÚ· Ì ª/∆, ÂÓÒ Ô ÓˆÙÈ·›Ô˜ Ì˘ÂÏfi˜ ÂϤÁ¯ÂÙ·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο Ì ª/∆ (9). ∂›Ó·È, Â›Û˘, ··Ú·›ÙËÙÔ˜ Ô ¤ÏÂÁ¯Ô˜ ÌÂ

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΢ÙÙ·ÚÔÏÔÁÈ΋ ∂¡À Â› ˘Ô„›·˜ ‰È‹ıËÛ˘ ÙÔ˘ ∫¡™ (7,8,12). ∆¤ÏÔ˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙˆÓ ÌÂÙ·ÛÙ¿ÛÂˆÓ ÛÙÔ ∫¡™ Û ·È‰È¿ Ì ¡µ Â›Ó·È Û·Ê¤˜, ÙfiÛÔ ·fi ÙÔ ‰ÈÎfi Ì·˜ ˘ÏÈÎfi fiÛÔ Î·È ·fi ÙË Û¯ÂÙÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·, fiÙÈ ‰ÂÓ ·ÊÔÚÔ‡Ó Â¤ÎÙ·ÛË Ù˘ ÓfiÛÔ˘ ·fi ·Ú·Î›ÌÂÓÔ˘˜ ÈÛÙÔ‡˜, fiˆ˜ Â›Ó·È Ù· ÔÛÙ¿ ÙÔ˘ ÎÚ·Ó›Ô˘ ‹ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ‹ Ë ÛÎÏËÚ¿ Ì‹ÓÈÁÁ·. OÈ ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ∫¡™ Á›ÓÔÓÙ·È ‹ ·ÈÌ·ÙÔÁÂÓÒ˜ ‹ ̤ۈ ÙÔ˘ ∂¡À ÛÙÔ ÓˆÙÈ·›Ô Ì˘ÂÏfi (12). ∞˘Ùfi ÂȂ‚·ÈÒÓÂÙ·È Î·È ·fi ·˘ÙÔ„›Â˜ ÓÂÔÁÓÒÓ Ì Ó¢ÚÔ‚Ï¿Ûو̷ ÛÙ·‰›Ô˘ IV Ô˘ ÁÂÓÓ‹ıËÎ·Ó ÓÂÎÚ¿ Î·È Â›¯·Ó ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔÓ ÂÁΤʷÏÔ Î·È ÙÔ ÓˆÙÈ·›Ô Ì˘ÂÏfi ¯ˆÚ›˜ ‰È‹ıËÛË ÙˆÓ ÌËÓ›ÁÁˆÓ ‹ ÙˆÓ ÔÛÙÒÓ ÙÔ˘ ÎÚ·Ó›Ô˘ (15). ∂›Û˘, Û‡Ìʈӷ Ì ÙËÓ ÂÌÂÈÚ›· ÙˆÓ Kellie Î·È Û˘Ó (7), ·Ú¿ ÙÔ fiÙÈ Ô ÙÚfiÔ˜ Ù˘ ÂÈÛfi‰Ô˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ∫¡™ Û ·ÛıÂÓ›˜ Ì ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ÓÂ˘Ú¿ÍÔÓ· ‰ÂÓ ÌÔÚ› Ó· ηıÔÚÈÛÙ› Â·ÎÚÈ‚Ò˜, Èı·ÓfiÓ Ù· ·ÙÙ·Ú· ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‰ÈËıÔ‡Ó ÙÔ ∫¡™ Ì ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔÚ¿ ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÓÂÚÁÔ‡ ÓfiÛÔ˘ Î·È ›Ûˆ˜ ·Ú·Ì¤ÓÔ˘Ó ·ÓÂÓÂÚÁ¿ ÁÈ· Ì‹Ó˜ ‹ ¯ÚfiÓÈ·, ·ÏÏ¿ ‰È·ÙËÚÔ‡Ó ÙËÓ ÈηÓfiÙËÙ¿ ÙÔ˘˜ Ó· ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Î·È Ó· ÌÂı›ÛÙ·ÓÙ·È (7,16). ∏ ˘fiıÂÛË ·˘Ù‹ ÂÓÈÛ¯‡ÂÙ·È Î·È ·fi ÙË ÁÓÒÛË Ì·˜ fiÙÈ ÏfiÁˆ ÙÔ˘ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡ ÙÔ ∫¡™ ·ÔÙÂÏ› ¿‰˘ÙÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ù· ηÎÔ‹ıË Î‡ÙÙ·Ú· Ô˘ ηٷʇÁÔ˘Ó ÂΛ Ó· ÌËÓ ÂÍÔÓÙÒÓÔÓÙ·È ÂÂȉ‹ Ù· ¯ËÌÂÈÔıÂÚ·¢ÙÈο Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ‰ÂÓ Êı¿ÓÔ˘Ó Î·ıfiÏÔ˘ ÛÙÔ ∫¡™. ŒÙÛÈ ÌÔÚÔ‡Ó Ó· ÂÍËÁËıÔ‡Ó Î·È ÔÈ ·Ú·ÙËÚËı›Û˜ ˘ÔÙÚÔ¤˜ ·Ú¯Èο ÌfiÓÔ ÛÙÔ ∫¡™ fiˆ˜ ÛÙ· 2 ·fi Ù· 3 ·È‰È¿ Ì·˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·ÎÔÏÔ˘ı› ÚfiÔ‰Ô˜ ÓfiÛÔ˘ Î·È Î·ıÔÏÈ΋ ‰È·ÛÔÚ¿ (7,12,17). ∂›Û˘, ÙÔ ∂¡À Ê·›ÓÂÙ·È Ó· Â›Ó·È ÛËÌ·ÓÙÈ΋ Ô‰fi˜ ‰È·ÛÔÚ¿˜ ΢ÙÙ¿ÚˆÓ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ÛÙÔ ÓÂ˘Ú¿ÍÔÓ·, fiˆ˜ Ê·›ÓÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ‰È¿¯˘Ù˘ ÌËÓÈÁÁÈ΋˜ ‰È‹ıËÛ˘ Î·È ÙȘ ÔÏÏ·Ϥ˜ ˘·Ú·¯ÓÔÂȉ›˜ ÌÂÙ·ÛÙ¿ÛÂȘ ‹ ·fi ÙËÓ ·ÚÔ˘Û›· ÔÌ¿‰ˆÓ ΢ÙÙ¿ÚˆÓ ÛÙÔ ∂¡À (7-9,12). ¶·Ú¿ ÙȘ ·Ú·¿Óˆ ˘Ôı¤ÛÂȘ, Ù· ÚˆÙfiÎÔÏÏ· ıÂÚ·›·˜ ÙÔ˘ Ó¢ÚÔ‚Ï·ÛÙÒÌ·ÙÔ˜ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÚÔÊ˘Ï·ÎÙÈ΋ ıÂÚ·›· ÙÔ˘ ∫¡™, fiˆ˜ ÂΛӷ ÙˆÓ Ï¢¯·ÈÌÈÒÓ ÛÙ· ·È‰È¿ Î·È ›Ûˆ˜ ̤ÓÂÈ Ó· ··ÓÙËı› Ë ·Ó·ÁηÈfiÙËÙ· ÁÈ· ÙË ¯Ú‹ÛË Ù¤ÙÔÈ·˜ ıÂÚ·›·˜. ™˘Ì¤Ú·ÛÌ· OÈ ÌÂÙ·ÛÙ¿ÛÂȘ ÛÙÔ ∫¡™ ÛÙ· ·È‰È¿ Ì ¡µ ‰ÂÓ Â›Ó·È Û˘¯Ó¤˜, ·Ú·ÙËÚÔ‡ÓÙ·È fï˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û ·˘Í·ÓfiÌÂÓË Û˘¯ÓfiÙËÙ·. ∂›Ó·È ··Ú·›ÙËÙÔ, Ì ÙËÓ ·Ú·ÌÈÎÚ‹ ¤Ó‰ÂÈÍË Û˘ÌÙˆÌ¿ÙˆÓ Ô˘ Èı·ÓfiÓ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ ∫¡™, fiˆ˜ ÎÂÊ·Ï·ÏÁ›· Ì ‹ ¯ˆÚ›˜ Â̤ÙÔ˘˜, ·ÛÙ¿ıÂÈ· ‚¿‰ÈÛ˘, Û·ÛÌÔ›, fiÓÔÈ ÛÙË ÛÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË

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Ô˘ ‰ÂÓ ·Ô‰›‰ÔÓÙ·È Û ¿ÏÏË ·ÈÙ›·, Ó· Á›ÓÂÙ·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ª/∆ ÌÂ Î·È ¯ˆÚ›˜ ÛÎÈ·ÁÚ·ÊÈÎfi ˘ÏÈÎfi Î·È Î˘ÙÙ·ÚÔÏÔÁÈ΋ ∂¡À (12,16). ¶Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ı› ¿ÌÂÛË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÔÙÚÔ‹˜ Ì ¯ËÌÂÈÔıÂÚ·¢ÙÈο Ê¿Ú̷η Ô˘ ‰È·ÂÚÓÔ‡Ó ÙÔÓ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎfi ÊÚ·ÁÌfi, ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ÌÂÙ·ÛÙ·ÙÈ΋˜ ÂÛÙ›·˜ fiÔ˘ ·˘Ùfi Â›Ó·È ÂÊÈÎÙfi ηÈ, Â¿Ó ÂӉ›ÎÓ˘Ù·È, ·ÎÙÈÓÔıÂÚ·›· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÓÂ˘Ú¿ÍÔÓ·. ¶·Ú¿ ÙË ¯Ú‹ÛË fï˜ ·ÎfiÌË Î·È Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÌÂıfi‰ˆÓ ıÂÚ·›·˜, Ë ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Â›Ó·È ‚·Ú‡Ù·ÙË (12). µÈ‚ÏÈÔÁÚ·Ê›· 1. Miller RW, Young JL Jr, Novakovic B. Childhood cancer.

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5. Ladenstein R, Philip T, Lasset C, Hartmann O, Garaventa A, Pinkerton R et al. Multivariate analysis of risk factors in stage 4 neuroblastoma patients over the age of one year treated with megatherapy and stem-cell transplantation: a report from the European Bone Marrow Transplantation Solid Tumor Registry. J Clin Oncol 1998;16:953-965.

6. Dini S, Lamino E, Garavento A, Rogers D, Dallorso S, Viscoli C et al. Multivariate therapy and unpurged autologous bone marrow transplantation for poor prognosis neuroblastoma. J Clin Oncol 1991;9:962-969.

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9. Palasis S, Morris J, Egelhoff J. Central nervous system relapse following bone marrow transplantation in stage IV neuroblastoma. Pediatr Hematol Oncol 1999;16:443-452.

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11. Astigarraga I, Lajarreta R, Navajas A, Fernanotez-Teijeiro A, Imaz I, Bezanila JL. Secondary central nervous system metastases in children with neuroblastoma. Med Pediatr Oncol 1996;27:529-533.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-07-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-10-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ª·ÚÁ·Ú›Ù· ª¿Î· ∫ÏÂÔ‚Ô‡Ï˘ 28, ∑ˆÁÚ¿ÊÔ˘, 157 73

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ORIGINAL ARTICLE

∏ Â›‰Ú·ÛË ÂÓfi˜ ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Ì ÓÔ˘ÎÏÂÔÙ›‰È· Á¿Ï·ÙÔ˜ ÛÙÔ ÂÙÈÎfi Û‡ÛÙËÌ· ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ µ. ™ÎÔ˘Ù¤ÚË1, Ã. ∫ÒÛÙ·ÏÔ˜1, ™. ™Â‚·ÛÙÈ¿‰Ô˘1, ™. °·‚Ú›ÏË1, ∫. ¢·ÓÂÏ¿ÙÔ˘1, ∞. µÔÁÈ·Ù˙‹2, Ã. OÈÎÔÓÔÌ›‰Ô˘2, µ. ¶ÂÙÚԯ›ÏÔ˘2

The effect of a nucleotide supplemented formula on the peptic system of preterm infants V. Skouteri1, C. Costalos1, S. Sevastiadou1, S. Gavrili1, K. Danelatou1, A. Voyiatzi2, C. Economidou2, V. Petrochilou2

¶ÂÚ›ÏË„Ë: ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ·Ó fiÙÈ Ù· ÓÔ˘ÎÏÂÔÙ›‰È· (¡∆) ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÈÂÚ¢ӋıËÎÂ Ë ˘fiıÂÛË fiÙÈ ¤Ó· Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆ ›Ûˆ˜ ÚÔ¿ÁÂÈ ÙËÓ ·ÔÚÚÔÊËÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÂÙÈÎÔ‡ ηıÒ˜ Î·È ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ÚÔ˜ ÙÔ Â˘ÓÔ˚ÎfiÙÂÚÔ. ªÂÏÂÙ‹ıËÎ·Ó 42 ÚfiˆÚ· ÓÂÔÁÓ¿, Ù· ÔÔ›· ÌÂ Ù˘¯·›· ÂÈÏÔÁ‹ ¯ˆÚ›ÛÙËÎ·Ó Û 2 ÔÌ¿‰Â˜. ∏ ÔÌ¿‰· ¡∆ ¤Ï·‚ Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆, ÂÓÒ Ë ÔÌ¿‰· á∆ (Ì¿ÚÙ˘Ú˜) ¤Ï·‚ Á¿Ï· ÂȉÈÎfi ÁÈ· ÚfiˆÚ·, ÌË ÂÌÏÔ˘ÙÈṲ̂ÓÔ fï˜ Ì ¡∆. ¢¤Î· Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ï‹ÚÔ˘˜ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ ¤ÁÈÓ ‰ÔÎÈÌ·Û›· D͢Ïfi˙˘, ÂÎÙ›ÌËÛË ÙÔ˘ ·Ô‚·ÏÏfiÌÂÓÔ˘ Ï›Ô˘˜ ÛÙ· ÎfiÚ·Ó·, ηıÒ˜ Î·È ÂÎÙ›ÌËÛË Ù˘ ÂÓÙÂÚÈ΋˜ ¯ÏˆÚ›‰·˜. ™Â fiÙÈ ·ÊÔÚ¿ ÙËÓ ·ÔÚÚÔÊËÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÂÙÈÎÔ‡ ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ Ù· Â›‰· ͢Ïfi˙˘ ·›Ì·ÙÔ˜, ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ∏ ÔÛfiÙËÙ· ÙÔ˘ Ï›Ô˘˜ ÛÙ· ÎfiÚ·Ó· ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· ¡∆. ™Â fiÙÈ ·ÊÔÚ¿ ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·, Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· á∆, ÛÙËÓ ÔÌ¿‰· ¡∆ ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ÂÍ‹˜: ·) ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ ·ÔÈΛÛÙËÎ·Ó Ì ‚·ÎÙËÚÈÔÂȉ‹, ‰Èۯȉ¤˜ ‚·ÎÙËÚ›‰ÈÔ Î·È ÎψÛÙËÚ›‰È·, ‚) ÏÈÁfiÙÂÚ· ÓÂÔÁÓ¿ ·ÔÈΛÛÙËÎ·Ó Ì gram(-) ‚·ÎÙËÚ›‰È· Î·È ÛÙ·Ê˘ÏfiÎÔÎÎÔ, Á) ·Ó·Ù‡¯ıËΠÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ·ÔÈÎÈÒÓ gram(-) ‚·ÎÙËÚȉ›ˆÓ, ‚·ÎÙËÚÔÂȉÒÓ Î·È Á·Ï·ÎÙÔ‚¿ÎÈÏÔ˘ Î·È ‰) ·Ó·Ù‡¯ıËΠÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ·ÔÈÎÈÒÓ ÎÔÏÔ‚·ÎÙËÚȉ›Ô˘, ÛÙ·Ê˘ÏfiÎÔÎÎÔ˘, ‰Èۯȉԇ˜ ‚¿ÎÈÏÔ˘ Î·È ÎψÛÙËÚȉ›Ô˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ¯ÔÚ‹ÁËÛË Á¿Ï·ÙÔ˜ ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Ì ¡∆ Û ÚfiˆÚ·

Abstract: Studies in animals have shown that nucleotides (NT) have significant effects upon gastrointestinal growth and differentiation. πn the present study we investigated the hypothesis that an NT enriched formula might improve gastrointestinal absorptive function and enteral flora in preterm infants. A double blind randomized controlled trial was designed. Forty two premature infants with a mean gestational age of 32.6 weeks, were randomly assigned into two groups consisting of 21 infants each. The NT group received a standard term formula supplemented with NT, while the WNT group received a special preterm formula unsupplemented with NT. Ten days following the establishment of full enteral feeding, an oral DXylose test was performed. Stools were also collected for faecal fat concentration and culture.

With regards to the absorptive capacity of the intestine, there was no significant difference in DXylose blood levels between the 2 groups. Faecal fat was significantly higher in the NT group. With regards to the faecal flora, the addition of NT to the formula was associated with: a) Increased colonization with bacteroides, bacillus bifidus and clostridium b) Decreased colonization with gram(-) bacteria, and staphylococcus sp. c) A significantly larger colony number of gram(-) bacteria, bacteroides and lactobacillus colonies were cultured d) A smaller number of E. coli, staphylococcus sp, bacillus bifidus and clostridium colonies were cultured. In conclusion, the use of an NT enriched standard term formula

1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ¶. °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó· 2 ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∆Ì‹Ì· ¶. °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

1 Department of Neonatal Medicine, “Alexandra” General Hospital, Athens 2 Department of Microbiology, “Alexandra” General Hospital, Athens

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ÓÂÔÁÓ¿, Û ۇÁÎÚÈÛË Ì Á¿Ï· ÂȉÈÎfi ÁÈ· ÚfiˆÚ· ÌË ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆, ‰ÂÓ ·‡ÍËÛ ÙËÓ ·ÔÚÚÔÊËÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Ô‡ÙÂ Û˘Ó¤‚·Ï ÛÙÔ Ó· ηٷÛÙ‹ÛÂÈ ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ·Ó¿ÏÔÁË Ì ·˘Ù‹ ÓÂÔÁÓÒÓ Ô˘ ·›ÚÓÔ˘Ó ÌËÙÚÈÎfi Á¿Ï·. §fiÁˆ, fï˜, Ù˘ ‰È·ÊÔÚÂÙÈ΋˜ Û‡ÛÙ·Û˘ ÙˆÓ ‰‡Ô Á·Ï¿ÙˆÓ, ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰Ôı› ÔÚÈÛÙÈ΋ ·¿ÓÙËÛË ÁÈ· ÙË ¯ÚËÛÈÌfiÙËÙ· ‹ ÌË ÙˆÓ ¡∆ ÛÙË ‰È·ÙÚÔÊ‹ ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. ∞·ÈÙÔ‡ÓÙ·È ÁÈ’ ·˘Ùfi ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜.

in preterm infants, as compared to the use of an usupplemented preterm formula, does not improve gastrointestinal absorptive capacity and does not lead to a stool flora that closely resembles that of breast fed infants. As the composition of the two formulae differed in several nutrients, it is difficult to draw definitive conclusion on the usefulness of NT in preterm nutrition. For this reason more studies are required.

§¤ÍÂȘ ÎÏÂȉȿ: ÓÂÔÁÓfi, ÚfiˆÚÔ, ÓÔ˘ÎÏÂÔÙ›‰È·, ÂÙÈÎfi.

Key words: neonate, preterm, nucleotides, intestine.

™˘ÓÙÔÌÔÁڷʛ˜

ÚÔ˜ ÙÔ ‚¿ÚÔ˜, ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· ·ËÛ˘ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ø˜ ÚÔ˜ ÙË Û›ÙÈÛË, ·ÎÔÏÔ˘ı‹ıËΠÙÔ ÂÍ‹˜ ÚˆÙfiÎÔÏÏÔ: ∞Ó Ù· ‚Ú¤ÊË ·‰˘Ó·ÙÔ‡Û·Ó Ó· Ï¿‚Ô˘Ó ÂÓÙÂÚÈ΋ Û›ÙÈÛË, ¯ÔÚËÁÔ‡ÓÙ·Ó ·Ú¯Èο ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹. ŸÙ·Ó ‰È·ÈÛÙÒıËΠfiÙÈ ‹Ù·Ó Û ı¤ÛË Ó· ÛÈÙÈÛÙÔ‡Ó, ‰›ÓÔÓÙ·Ó ÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì¤Ûˆ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú· Û ÔÛfiÙËÙ· 20 ml/kg/24ˆÚÔ. ∏ ËÌÂÚ‹ÛÈ· ÔÛfiÙËÙ· Á¿Ï·ÙÔ˜ ·˘Í·ÓfiÙ·Ó ÚÔԉ¢ÙÈο ηٿ 10-20 ml/kg ËÌÂÚËÛ›ˆ˜, ̤¯ÚÈ ÙË Ì¤ÁÈÛÙË ÔÛfiÙËÙ· ÙˆÓ 150-180 ml/kg ÙËÓ Ë̤ڷ. ¶·Ú¿ÏÏËÏ·, ÌÂȈÓfiÙ·Ó ·Ó¿ÏÔÁ· Ë ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹, ̤¯ÚÈ ÙËÓ ÔÚÈÛÙÈ΋ ‰È·ÎÔ‹ Ù˘. ¢¤Î· Ë̤Ú˜ ÌÂÙ¿ ÙËÓ Ï‹ÚË ÂÓÙÂÚÈ΋ Û›ÙÈÛË, ¤ÁÈÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ‰ÔÎÈÌ·Û›· D-͢Ïfi˙˘, ÂÎÙÈÌ‹ıËÎÂ Ë ÔÛfiÙËÙ· ÙÔ˘ Ï›Ô˘˜ Î·È Ë ÌÈÎÚԂȷ΋ ¯ÏˆÚ›‰· ÙˆÓ ÎÔÚ¿ÓˆÓ. °È· ÙË ‰ÔÎÈÌ·Û›· Ù˘ D-͢Ïfi˙˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙˆÓ Roe Î·È Rice (5,6). ∏ ÂÎÙ›ÌËÛË ÙÔ˘ Ï›Ô˘˜ ÙˆÓ ÎÔÚ¿ÓˆÓ ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ Phuapradit Î·È Û˘Ó (7). °È· ÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ, Ë Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤ÁÈÓ Û ·ÔÛÙÂÈڈ̤ÓÔ ‰Ô¯Â›Ô Î·È Ô Û˘ÓÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ ÚÔÂÙÔÈÌ·Û›· Î·È Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˜ ·fi Ì›· ÒÚ·. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ıÚÂÙÈο ˘ÏÈο, ηٿÏÏËÏ· ÁÈ· ηÏÏȤÚÁÂÈ· Î·È ·Ó›¯Ó¢ÛË ÙfiÛÔ ·ÂÚfi‚ÈˆÓ fiÛÔ Î·È ·Ó·ÂÚfi‚ÈˆÓ ÌÈÎÚÔ‚›ˆÓ. ¢È·ÊÔÚÂÙÈΤ˜ ÌÔÚÊÔÏÔÁÈο ·ÔÈ˘ Ô˘ ·Ó·Ù‡¯ıËÎ·Ó ÛÙ· ‰È¿ÊÔÚ· ˘ÏÈο ÌÂÙÚ‹ıËÎ·Ó Î·È ÔÏÏ·Ï·ÛÈ¿ÛÙËÎ·Ó x108, ÒÛÙÂ Ô ·ÚÈıÌfi˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÈÎÚÔ‚›ˆÓ Ó· ÂÎÊÚ·ÛÙ› ·Ó¿ ÁÚ·ÌÌ¿ÚÈÔ ÎÔÚ¿ÓˆÓ. °È· ÙËÓ Ù·˘ÙÔÔ›ËÛË ÙˆÓ ‰È·ÊfiÚˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÂȉÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌÔÚÊÔÏÔÁ›· ÙˆÓ ·ÔÈÎÈÒÓ, Ë gram ¯ÚÒÛË Î·È Ë ‚ÈÔ¯ËÌÈ΋ ÙÔ˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ·. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÙÔ Student’s t test.

¡∆ á∆ °∂™ ¢µ

¡Ô˘ÎÏÂÔÙ›‰È· Èڛ˜ ÓÔ˘ÎÏÂÔÙ›‰È· °·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· ¢Èۯȉ‹˜ ‚¿ÎÈÏÔ˜

∆· ¡∆ Â›Ó·È ‚ÈÔÏÔÁÈο ÂÓÂÚÁ¤˜, ÌË ÚˆÙÂ˚ÓÈΤ˜, ·˙ˆÙÔ‡¯Â˜ Ô˘Û›Â˜ Ô˘ ˘¿Ú¯Ô˘Ó ÛÙÔ ·ÓıÚÒÈÓÔ Á¿Ï· ηıÒ˜ Î·È ÛÙÔ Á¿Ï· ¿ÏÏˆÓ ÂȉÒÓ. ∆· ¡∆ Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘˜ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Û ÔÏϤ˜ ‚ÈÔÏÔÁÈΤ˜ ‰È·‰Èηۛ˜, ‰ÈfiÙÈ ·ÔÙÂÏÔ‡Ó Ù· ‰ÔÌÈο Û˘ÛÙ·ÙÈο ÙˆÓ ÓÔ˘ÎÏÂ˚ÓÈÎÒÓ ÔͤˆÓ (RNA Î·È DNA) (1). ∆Ô ÌËÙÚÈÎfi Á¿Ï· ÂÚȤ¯ÂÈ Ôχ ˘„ËÏfiÙÂÚ· Â›‰· ¡∆ Û ۇÁÎÚÈÛË Ì ٷ ÙÚÔÔÔÈË̤ӷ Á¿Ï·Ù· (ηٿ ¤ÍÈ ÊÔÚ¤˜). ∆· ¡∆ Ô˘ ÂÚȤ¯ÂÈ ÙÔ ÌËÙÚÈÎfi Á¿Ï· ıˆÚÔ‡ÓÙ·È ÛËÌ·ÓÙÈο ÁÈ· ÙËÓ ·‡ÍËÛË Î·È ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ °∂™ (2,3). ªÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ¤‰ÂÈÍ·Ó fiÙÈ Ù· ¡∆ ÚÔ¿ÁÔ˘Ó ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ‰Èۯȉԇ˜ ‚·ÎÙËÚȉ›Ô˘ (¢µ) ÛÙÔ °∂™. ∂ÓÙÔ‡ÙÔȘ, ÂÏ¿¯ÈÛÙ˜ ÌÂϤÙ˜ ˘¿Ú¯Ô˘Ó Û¯ÂÙÈο Ì ÙË ‰Ú¿ÛË ÙˆÓ ¡∆ ÛÙÔ °∂™ ÓÂÔÁÓÒÓ (4). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËÓ ·ÔÚÚÔÊËÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰· ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ ÌÂÙ¿ ·fi Û›ÙÈÛË Ì Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 42 ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ̤ÛË ËÏÈΛ· ·ËÛ˘ 32,6 ‚‰ÔÌ¿‰Â˜ Î·È Ì¤ÛÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1720 g. ªÂ Ù˘¯·›· ÂÈÏÔÁ‹, Ù· ÓÂÔÁÓ¿ ¯ˆÚ›ÛÙËÎ·Ó Û 2 ÔÌ¿‰Â˜ ·ÔÙÂÏÔ‡ÌÂÓ˜ ·fi 21 ÓÂÔÁÓ¿ Ë Î¿ı ̛·. ∏ Ì›· ÔÌ¿‰· ¤Ï·‚ Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆ Î·È Ë ¿ÏÏË ¤Ï·‚ Á¿Ï· ÂȉÈÎfi ÁÈ· ÚfiˆÚ· ÓÂÔÁÓ¿, ÌË ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆ (ÔÌ¿‰· á∆) (¶›Ó·Î·˜ 1). ŸÏ· Ù· ÓÂÔÁÓ¿ ÁÂÓÓ‹ıËÎ·Ó ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ “∞ÏÂÍ¿Ó‰Ú·”. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ ˙ËÙ‹ıËÎÂ Ë ¤ÁÁÚ·ÊË Û˘Ó·›ÓÂÛË ÙˆÓ ÁÔÓ¤ˆÓ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÌÂÏÂÙ‹ıËηÓ. ∞ÔÎÏ›ÛÙËÎ·Ó ·fi ÙË ÌÂϤÙË ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÂÙÈÎÔ‡ ‹ ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ηıÒ˜ Î·È ·˘Ù¿ Ô˘ ›¯·Ó Ï¿‚ÂÈ ·ÓÙÈ‚ÈÔÙÈο. ¢ÂÓ ˘‹Ú¯·Ó ‰È·ÊÔÚ¤˜ ˆ˜

∞ÔÙÂϤÛÌ·Ù· ¢ÂÓ ˘‹Ú¯Â ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÎÂÓÒÛˆÓ, ÙËÓ ·ÓÔ¯‹ ÙÔ˘ Á¿Ï·ÙÔ˜, ÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘ Î·È ÙÔ ¯ÚfiÓÔ ¤Ó·Ú͢ ·ÔÎÏÂÈÛÙÈ΋˜ ÂÓÙÂÚÈ΋˜ Û›ÙÈÛ˘. ∆· ̤۷ Â›‰· ÙÔ˘ Ï›Ô˘˜ ÛÙ· ÎfiÚ·Ó· ‹Ù·Ó ˘„ËÏfiÙÂÚ· ÛÙËÓ ÔÌ¿‰· ¡∆ (80,0% ¤Ó·ÓÙÈ 65,8%). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹

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¶·È‰È·ÙÚÈ΋ 2002;65:52-56

Paediatriki 2002;65:52-56

¶›Ó·Î·˜ 1. ™‡ÛÙ·ÛË Á·Ï¿ÙˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÙË ÌÂϤÙË ·Ó¿ Ï›ÙÚÔ ¤ÙÔÈÌÔ˘ Á¿Ï·ÙÔ˜ £ÚÂÙÈο ÛÙÔȯ›· ¶ÚˆÙ½Ó˜ (g) ™¯¤ÛË Î·˙½Ó˘/ÔÚÔÁ¿Ï·ÙÔ˜ À‰·Ù¿ÓıڷΘ (g) §·ÎÙfi˙Ë (%) ª·ÏÙÔ‰ÂÍÙÚ›Ó˜ (%) §›Ô˜ (g) §È›‰È· Ì¤ÛˆÓ ·Ï‡ÛÂˆÓ (%) ∂Ó¤ÚÁÂÈ· (kcal) NÔ˘ÎÏÂÔÙ›‰È· (mg) ™›‰ËÚÔ˜ (mg)

°¿Ï· á∆ 23,2 22/78 85,8 64,5 35,5 41,6 38 800 5 1,5

°¿Ï· ¡∆ 15 40/60 72 100 0 36 3,5 672 29,5 1,2

‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,01) (¶›Ó·Î·˜ 2). ∆· ̤۷ Â›‰· Ù˘ D-͢Ïfi˙˘ ‹Ù·Ó 21,5 mg/dL ÁÈ· ÙËÓ ÔÌ¿‰· ¡∆ Î·È 23,7 mg/dL ÁÈ· ÙËÓ ÔÌ¿‰· á∆. H ‰È·ÊÔÚ¿ ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,1) (¶›Ó·Î·˜ 2). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·, ·Ú·ÙËÚ‹ıËÎ·Ó Ù· ÂÍ‹˜: ™ÙËÓ ÔÌ¿‰· ¡∆: ·) ·Ó·Ù‡¯ıËΠÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜ ̤ÛÔ˜ ·ÚÈıÌfi˜ ·ÔÈÎÈÒÓ, gram(-) ‚·ÎÙËÚȉ›ˆÓ, ‚·ÎÙËÚÔÂȉÒÓ Î·È Á·Ï·ÎÙÔ‚¿ÎÈÏˆÓ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· á∆ (p<0,001), ‚) ·Ó·Ù‡¯ıËΠÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚÔ˜ ·ÚÈıÌfi˜ ÎÔÏÔ‚·ÎÙËÚȉ›ˆÓ, ÛÙ·Ê˘ÏfiÎÔÎΈÓ, ‰Èۯȉԇ˜ ‚¿ÎÈÏÔ˘ Î·È ÎψÛÙËÚȉ›ˆÓ (p<0,01, p<0,001, p<0,001, p<0,01, ·ÓÙ›ÛÙÔȯ·) Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· á∆ (¶›Ó·Î·˜ 3), Á) ÂÚÈÛÛfiÙÂÚ· ÓÂÔÁÓ¿ ·ÔÈΛÛÙËÎ·Ó Ì ‚·ÎÙËÚÔÂȉ‹, ‰Èۯȉ¤˜ ‚·ÎÙËÚ›‰ÈÔ Î·È ÎψÛÙËÚ›‰È· (p<0,001, p<0,005, p<0,005, ·ÓÙ›ÛÙÔȯ·), ‰) ÏÈÁfiÙÂÚ· ÓÂÔÁÓ¿ ·ÔÈΛÛÙËÎ·Ó Ì gram(-) ‚·ÎÙËÚ›‰È·, ÏËÓ ÙÔ˘ ÎÔÏÔ‚·ÎÙËÚȉ›Ô˘ Î·È Ì ÛÙ·Ê˘ÏfiÎÔÎÎÔ (p<0,05, p<0,001, ·ÓÙ›ÛÙÔȯ·) (¶›Ó·Î·˜ 4). ™˘˙‹ÙËÛË ∆Ô ÂÓÙÂÚÈÎfi ÂÈı‹ÏÈÔ ·ÔÙÂÏ› Ù·¯¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÈÛÙfi, Ô˘ ··ÈÙ› ÏËÓ ÙˆÓ ¿ÏÏˆÓ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ¡∆. ∞Ó Î·È Ù· ¡∆ ÚÔÛʤÚÔÓÙ·È Û ·ÊıÔÓ›· Ì ÙËÓ ÙÚÔÊ‹ Î·È Û˘ÓÙ›ıÂÓÙ·È, Â›Û˘, ÂÓ‰ÔÁÂÓÒ˜ ˘fi ÔÚÈṲ̂Ó˜ fï˜ Û˘Óı‹Î˜, fiˆ˜ ÌÂȈ̤ÓË ÚfiÛÏË„Ë ÙÚÔÊ‹˜, ¯ÚfiÓȘ ·ı‹ÛÂȘ, Ù·¯Â›· ·Ó¿Ù˘ÍË, ·ÓÒÚÈÌÔÈ ÌÂÙ·‚ÔÏÈÎÔ› Ì˯·ÓÈÛÌÔ›, Â›Ó·È ‰˘Ó·ÙfiÓ Ù· ÂÓ‰ÔÁÂÓÒ˜ ·Ú·ÁfiÌÂÓ· ¡∆ Ó· ÌËÓ Â·ÚÎÔ‡Ó ÁÈ· ÙËÓ Î¿Ï˘„Ë ÙˆÓ ·Ó·ÁÎÒÓ Î·È Ó· ÂÌÊ·ÓÈÛÙ› ·ÓÂ¿ÚÎÂÈ· (1). ™ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Â›Ó·È È‰È·›ÙÂÚ· ·˘ÍË̤Ó˜ ÔÈ ·Ó¿ÁΘ Û Â͈ÁÂÓ‹ ¯ÔÚ‹ÁËÛË ¡∆ Û ÓÂÔÁÓ¿ Ì ÂÓ‰ÔÌ‹ÙÚÈ· ‰˘ÛÙÚÔÊ›·, Û ÚfiˆÚ· ÓÂÔÁÓ¿ Ì ·ÓÂ·Ú΋ ÚfiÛÏË„Ë ÙÚÔÊ‹˜ Î·È ·ÓÂ·ÚΛ˜ ÌÂÙ·‚ÔÏÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, ηıÒ˜ Î·È Û ‚·Ú¤ˆ˜ ¿Û¯ÔÓÙ·. ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, Ë Â͈ÁÂÓ‹˜

54

¶›Ó·Î·˜ 2. ∂›‰· D-͢Ïfi˙˘ ·›Ì·ÙÔ˜ Î·È ·¤ÎÎÚÈÛË Ï›Ô˘˜ ÛÙ· ÎfiÚ·Ó· - ̤Û˜ ÙÈ̤˜ Î·È (SD)

D-•˘Ïfi˙Ë (mg/dL) §›Ô˜ (%)

°¿Ï· ÌÂ ¡∆

°¿Ï· á∆

p

21,5 (10,1) 80 (7,3)

23,7 (12,6) 65,8 (8,2)

<0,1 <0,01

¯ÔÚ‹ÁËÛË ¡∆ ÂÈο˙ÂÙ·È fiÙÈ ¤¯ÂÈ Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ‰È·ÊÔÚÔÔ›ËÛË ÙÔ˘ °∂™ (8,9).

OÈ Uauy Î·È Û˘Ó (10) ‚Ú‹Î·Ó ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· DNA Î·È ÌÂÁ·Ï‡ÙÂÚÔ ‡„Ô˜ Ï·¯ÓÒÓ Î·È ÂÈ¤‰ˆÓ ‰È۷ί·Úȉ·ÛÒÓ ÛÙÔÓ ÂÓÙÂÚÈÎfi ‚ÏÂÓÓÔÁfiÓÔ ıËÏ·˙fiÓÙˆÓ ÔÓÙÈÎÒÓ Ô˘ ÙÚ¿ÊËÎ·Ó Ì Á¿Ï· ÂÌÏÔ˘ÙÈṲ̂ÓÔ Ì ¡∆, ÂÓÒ Û ¿ÏÏ· ÂÈÚ¿Ì·Ù· Û ÔÓÙÈÎÔ‡˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÔÚËÁ‹ıËÎ·Ó ¡∆ ·ÚÂÓÙÂÚÈο, ‚Ú¤ıËΠ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ ÙˆÓ ÂÓÙÂÚÈÎÒÓ ÎÚ˘ÙÒÓ (11). ∞ÓÙ›ıÂÙ·, Ô Yu (12) ‰È·ÊˆÓ› Ì ٷ ·Ú·¿Óˆ ÙÔÓ›˙ÔÓÙ·˜ Ù· ÂÍ‹˜: ·) ™Ù· ÂÈÚ¿Ì·Ù· Ô˘ ¤‰ÂÈÍ·Ó Â˘ÓÔ˚΋ ‰Ú¿ÛË ÙˆÓ ¡∆, Ë Û‡ÁÎÚÈÛË ¤ÁÈÓ Ì ¯ÚËÛÈÌÔÔ›ËÛË ‰‡Ô ‰È·ÈÙËÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ ¤Ó· ÂÚÈ›¯Â ¡∆ ÂÓÒ ÙÔ ¿ÏÏÔ ‹Ù·Ó ÙÂÏ›ˆ˜ ÂχıÂÚÔ ¡∆. ¶Ú·ÎÙÈο, Ù¤ÙÔÈ· ‰›·ÈÙ· ‰ÂÓ ˘¿Ú¯ÂÈ, ·ÊÔ‡ fiÏ· Ù· Á¿Ï·Ù· ÂÚȤ¯Ô˘Ó ¤ÛÙˆ Î·È ÌÈÎÚ‹ ÔÛfiÙËÙ· ¡∆. ‚) ∏ ÙÚÔÊÈ΋ ‰Ú¿ÛË ÙˆÓ ¡∆ ·Ú·ÙËÚ‹ıËΠÌfiÓÔ ÛÙÔ ·ÓÒÙÂÚÔ ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È fi¯È ÛÙÔ Ì¤ÛÔ ‹ ÛÙÔ Î·ÙÒÙÂÚÔ. Á) ∆· Â›‰· ÛÔ˘ÎÚ¿Û˘ Î·È Ï·ÎÙ¿Û˘ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ¡∆ ‹Ù·Ó ÌÂÓ ˘„ËÏfiÙÂÚ· ÛÙÔ Ì¤ÛÔ ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ·ÏÏ¿ ¯·ÌËÏfiÙÂÚ· ÛÙÔ ¿Óˆ ÙÌ‹Ì· ÙÔ˘ ÂÓÙ¤ÚÔ˘. ‰) ™ÙËÓ ÔÌ¿‰· ÙˆÓ ÂÈÚ·Ì·Ùfi˙ˆˆÓ Ô˘ ‹Ú·Ó ¡∆, ÙÔ Û˘ÓÔÏÈÎfi ̤ÁÂıÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ‰ÂÓ ·˘Í‹ıËΠ۠ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ÕÏÏË ÌÂϤÙË, Â›Û˘, Û ÔÓÙÈÎÔ‡˜ Ì ¯ÚfiÓÈ· ‰È¿ÚÚÔÈ· ¤‰ÂÈÍ fiÙÈ Ë ÚÔÛı‹ÎË ¡∆ ÛÙË ‰›·ÈÙ¿ ÙÔ˘˜ ‚Ô‹ıËÛ Û ٷ¯‡ÙÂÚË ·Ó¿Ï·ÛË ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ (13). ¶Ôχ Ï›Á˜ ÌÂϤÙ˜ ¤¯Ô˘Ó Á›ÓÂÈ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙˆÓ ¡∆ ÛÙÔ °∂™ ‚ÚÂÊÒÓ. ™Â ÌÈ· ÌÂϤÙË ·fi Ì›· ÂÚÈÔ¯‹ Ù˘ ÃÈÏ‹˜ Ì Ôχ ˘„ËÏ‹ Û˘¯ÓfiÙËÙ· Á·ÛÙÚÂÓÙÂÚ›ÙȉˆÓ, ‚Ú¤ÊË ¯·ÌËÏ‹˜ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋˜ ηٿÛÙ·Û˘ ÂÌÊ¿ÓÈÛ·Ó ÏÈÁfiÙÂÚ· ÂÂÈÛfi‰È· ‰È·ÚÚÔÈÒÓ ÌÂÙ¿ ÙË Ï‹„Ë ¡∆ Û ۇÁÎÚÈÛË Ì ̿ÚÙ˘Ú˜ (14). OÈ Cosgrove Î·È Û˘Ó (15) ¯ÔÚ‹ÁËÛ·Ó, Â›Û˘, ¡∆ Û ÓÂÔÁÓ¿ Ì ÂÓ‰ÔÌ‹ÙÚÈ· ‰˘ÛÙÚÔÊ›· Î·È ‰È·›ÛÙˆÛ·Ó Ù·¯‡ÙÂÚË ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘ÍË. OÈ Gill Î·È Û˘Ó (16) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ÚÔÛı‹ÎË ¡∆ Û ‚ÚÂÊÈ΋ ÙÚÔÊ‹ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔÛÔÌÔÈ¿˙ÂÈ Ë ÌÈÎÚԂȷ΋ ¯ÏˆÚ›‰· ÙˆÓ ÎÔÚ¿ÓˆÓ Ì ÂΛÓË ‚ÚÂÊÒÓ ÙÚÂÊfiÌÂÓˆÓ Ì ÌËÙÚÈÎfi Á¿Ï·, ‰ËÏ·‰‹ Ì ˘ÂÚ›Û¯˘ÛË ÙÔ˘ ¢µ. ∆Ô ‚·ÎÙËÚ›‰ÈÔ ·˘Ùfi Â›Ó·È È‰È·›ÙÂÚ· ˆÊ¤ÏÈÌÔ ‰ÈfiÙÈ ÌÂÈÒÓÂÈ ÙÔ pH ÙÔ˘ ÂÓÙÂÚÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ̤ۈ Ù˘ ˘‰ÚÔÏ˘ÙÈ΋˜ ÙÔ˘ ‰Ú¿Û˘ ÛÙ· ‰È¿ÊÔÚ· ۿί·Ú·. ∆Ô ¯·ÌËÏfi pH ÂÌÔ‰›˙ÂÈ ÙËÓ ·Ó¿Ù˘ÍË

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·55

¶·È‰È·ÙÚÈ΋ 2002;65:52-56

Paediatriki 2002;65:52-56

¶›Ó·Î·˜ 3. ∂ÓÙÂÚÈ΋ ¯ÏˆÚ›‰· - ª¤ÛÔ˜ fiÚÔ˜ ·ÔÈÎÈÒÓ (SD) (log10/g ÎÔÚ¿ÓˆÓ) ∂›‰Ô˜ ÌÈÎÚÔ‚›Ô˘

OÌ¿‰· ¡∆

∫ÔÏÔ‚·ÎÙËÚ›‰ÈÔ 9,55 (0,12) ÕÏÏ· gram(-) 8,0 (0,62) ∂ÓÙÂÚfiÎÔÎÎÔ˜ 9,1 (0,5) ™Ù·Ê˘ÏfiÎÔÎÎÔ˜ 7,0 (0,1) µ·ÎÙËÚÈÔÂȉ‹ 9,5 (0,1) ¢Èۯȉ¤˜ ‚·ÎÙËÚ›‰ÈÔ 9,46 (0,08) ∫ψÛÙËÚ›‰È· 8,14(0,24) °·Ï·ÎÙÔ‚¿ÎÈÏÔÈ 8,65 (0,14) ª‡ÎËÙ˜ 4,3 (0,26)

OÌ¿‰· X¡∆

p

9,7 (0,06) 7,4 (0,18) 9,17 (0,06) 7,3 (0,18) 9,1 (0,25) 9,7 (0,05) 8,32(0,2) 8,25 (0,13) 4,3 (0,04)

<0,01 <0,001 <0,5 <0,001 <0,001 <0,001 <0,01 <0,001 <0,5

·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ÛÙÔ ¤ÓÙÂÚÔ. ™Â ÈÔ ÚfiÛÊ·ÙË ÌÂϤÙË, ÔÈ Balmer Î·È Û˘Ó (17) ‰ÂÓ ÂȂ‚·›ˆÛ·Ó Ù· Â˘Ú‹Ì·Ù· ÙˆÓ Gill Î·È Û˘Ó Û¯ÂÙÈο Ì ÙÔ ¢µ. ∞fi ÙȘ ·Ú·¿Óˆ ÌÂϤÙ˜ Ê·›ÓÂÙ·È fiÙÈ Ë ‰Ú¿ÛË ÙˆÓ ¡∆ Â›Ó·È ˆÊ¤ÏÈÌË Î˘Ú›ˆ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· ‹ ‚Ú¤ÊË Ô˘ ¿Û¯Ô˘Ó ·fi ¯ÚfiÓÈ· ‰È¿ÚÚÔÈ· ‹ ¯ÚfiÓÈ· ‰˘ÛÙÚÔÊ›·. ™Â ˘ÁÈ‹ ÂÈÚ·Ì·Ùfi˙ˆ· ˘¿Ú¯Ô˘Ó οÔÈ· ‰Â‰Ô̤ӷ, ÂÓÒ Û ˘ÁÈ‹ ÚfiˆÚ· ÓÂÔÁÓ¿ Ù· ‰Â‰Ô̤ӷ Â›Ó·È ÏÈÁfiÙÂÚ· (17). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ì·˜ Ù›ÓÔ˘Ó Ó· ÂÓÈÛ¯‡ÛÔ˘Ó ·˘Ù‹ ÙËÓ ¿Ô„Ë. ™Ù· ˘ÁÈ‹ ÚfiˆÚ· ÓÂÔÁÓ¿ Ô˘ ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÛÙËÓ ¤Ú¢ӷ, Ë ¯Ú‹ÛË ¡∆ fi¯È ÌfiÓÔ ‰ÂÓ ‚ÂÏÙ›ˆÛ ÙËÓ ·ÔÚÚÔÊËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘, ·ÏÏ¿ ·ÓÙ›ıÂÙ· ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÌÂÁ·Ï‡ÙÂÚË ·Ô‚ÔÏ‹ Ï›Ô˘˜ ÛÙ· ÎfiÚ·Ó· Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Á¿Ï· á∆ ÂÚȤ¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÔÛfiÙËÙ· ÏÈȉ›ˆÓ. ÿÛˆ˜ ·˘Ùfi Ó· ÔÊ›ÏÂÙ·È ÛÙË ‰È·ÊÔÚÂÙÈ΋ Û‡ÓıÂÛË ÙˆÓ ‰‡Ô Á·Ï¿ÙˆÓ Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ÏÈȉ›ˆÓ ÛÙÔ Á¿Ï· á∆ Â›Ó·È ˘fi ÌÔÚÊ‹ ÏÈȉ›ˆÓ Ì¤ÛˆÓ ·Ï‡ÛˆÓ, Ù· ÔÔ›· Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·ÔÚÚÔÊÒÓÙ·È Î·Ï‡ÙÂÚ· ·fi Ù· Ì·ÎÚ¿˜ ·Ï‡ÛÔ˘ (18). ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·. ∏ ·ÚÔ˘Û›· ¡∆ fi¯È ÌfiÓÔ ‰ÂÓ Û˘Ó¤‚·Ï ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ¢µ, ·ÏÏ¿ Ô‰‹ÁËÛ Û ¯·ÌËÏfiÙÂÚÔ ·ÔÈÎÈÛÌfi Ì ÙÔ ‚·ÎÙËÚ›‰ÈÔ ·˘Ùfi, ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Á¿Ï· Ì ¡∆ ÂÚȤ¯ÂÈ ·ÔÎÏÂÈÛÙÈο Ï·ÎÙfi˙Ë, Ë ÔÔ›· ¢ÓÔ› ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ‰Èۯȉԇ˜ ‚·ÎÙËÚȉ›Ô˘ (19) Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ Á¿Ï· á∆ ¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ۛ‰ËÚÔ, Û ۯ¤ÛË Ì ÙÔ Á¿Ï· ¡∆, Ô˘ ÂÌÔ‰›˙ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ¢µ (20). µ¤‚·È·, ÙÂÏÂ˘Ù·›Â˜ ¤Ú¢Ó˜ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Î·È Ë Ì·ÏÙfi˙Ë Ô˘ ÂÚȤ¯ÂÈ ÙÔ Á¿Ï· á∆, ¢ÓÔ› Î·È ·˘Ù‹ ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ¢µ (21). ŒÙÛÈ, ÌÈ· ·ÈÙ›· ÁÈ· ÙËÓ ¤ÏÏÂÈ„Ë Â˘ÓÔ˚ÎÒÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ·fi ÙË ¯Ú‹ÛË ¡∆ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ›Ûˆ˜ Ó· Â›Ó·È Ë ϤÔÓ Î·Ù¿ÏÏËÏË Û‡ÓıÂÛË ÙÔ˘ Á¿Ï·ÙÔ˜ á∆ Û ϛË Î·È ˘‰·Ù¿ÓıڷΘ Û ۇÁÎÚÈÛË Ì ÙÔ Á¿Ï· Ì ¡∆, Ô˘ ˘ÂÚÎ¿Ï˘„Â Ù˘¯fiÓ ÔʤÏË ÙˆÓ ¡∆. ªÈ· ¿ÏÏË ·ÈÙ›·

¶›Ó·Î·˜ 4. ¶ÔÛÔÛÙfi ·ÔÈÎÈÛÌÔ‡ ÓÂÔÁÓÒÓ (%) Ì ÌÈÎÚfi‚È· ∂›‰Ô˜ ÌÈÎÚÔ‚›Ô˘ ∫ÔÏÔ‚·ÎÙËÚ›‰ÈÔ ÕÏÏ· gram(-) ∂ÓÙÂÚfiÎÔÎÎÔ˜ ™Ù·Ê˘ÏfiÎÔÎÎÔ˜ µ·ÎÙËÚÈÔÂȉ‹ ¢Èۯȉ¤˜ ‚·ÎÙËÚ›‰ÈÔ ∫ψÛÙËÚ›‰ÈÔ °·Ï·ÎÙÔ‚¿ÎÈÏÔ˜ ª‡ÎËÙ˜

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Èı·ÓÒ˜ Ó· Â›Ó·È Ë ÔÛfiÙËÙ· ÙˆÓ ¡∆ ÛÙÔ ˘fi ÌÂϤÙË Á¿Ï·. ∏ ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ Á¿Ï·ÙÔ˜ Û ¡∆ ‹Ù·Ó ÌÂÓ Ì¤Û· ÛÙ· fiÚÈ· Ù˘ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜, ·ÏÏ¿ ‹Ù·Ó ˘„ËÏfiÙÂÚË ·fi ÙË Ì¤ÛË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ÒÚÈÌÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜. ∆Ô ÌËÙÚÈÎfi Á¿Ï· ‰ÂÓ ¤¯ÂÈ ÛÙ·ıÂÚ‹ Û‡ÛÙ·ÛË Û ¡∆. ŒÙÛÈ, ÂÓÒ ÙÔ ‡·Ú Î·È ÙÔ ÚÒÈÌÔ Á¿Ï· ÂÚȤ¯Ô˘Ó ˘„ËÏ¿ Â›‰· ¡∆, ·˘Ù¿ ¤ÊÙÔ˘Ó Î·Ù¿ 50% ̤۷ ÛÙȘ ÂfiÌÂÓ˜ ‰‡Ô ‚‰ÔÌ¿‰Â˜ (22). ∞˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ Ë ÂÚÈÂÎÙÈÎfiÙËÙ· ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÙÔ˜ Û ¡∆ ÚÔÛ·ÚÌfi˙ÂÙ·È Û˘Ó¯Ҙ Û‡Ìʈӷ Ì ÙȘ ·Ó¿ÁΘ ÙÔ˘ ‚Ú¤ÊÔ˘˜. ∂Ӊ¯Ô̤ӈ˜, Ë ÛÙ·ıÂÚ‹ Û‡ÛÙ·ÛË Î·È Ù· Û¯ÂÙÈο ˘„ËÏ¿ Â›‰· ¡∆ ÛÙÔ ˘fi ÌÂϤÙË Á¿Ï· Ó· ÌËÓ Â›Ó·È Ù· ÂӉ‰ÂÈÁ̤ӷ. ªÈ· ¿ÏÏË Èı·Ó‹ ÂÍ‹ÁËÛË ÁÈ· ÙËÓ ¤ÏÏÂÈ„Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ¡∆ ›Ûˆ˜ Ó· Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¯ÔÚËÁ‹ıËÎ·Ó ÁÈ· ÌÈÎÚfi ‰È¿ÛÙËÌ· (ÂÚ›Ô˘ 25 Ë̤Ú˜), ¯ÚfiÓÔ˜ ÌÈÎÚfi˜ ÁÈ· Ó· Ê·Ó› Ë Â˘ÓÔ˚΋ ÙÔ˘˜ ‰Ú¿ÛË. ™˘ÌÂÚ·ÛÌ·ÙÈο, Û ۇÁÎÚÈÛË Ì Á¿Ï· ÂȉÈÎfi ÁÈ· ÚfiˆÚ· ÓÂÔÁÓ¿, Ë ¯ÔÚ‹ÁËÛË ·ÏÔ‡ Á¿Ï·ÙÔ˜ ÂÌÏÔ˘ÙÈṲ̂ÓÔ˘ Ì ¡∆ Û ÚfiˆÚ· ˘ÁÈ‹ ÓÂÔÁÓ¿ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Â˘ÓÔ˚΋ Â›‰Ú·ÛË ÛÙËÓ ·ÔÚÚÔÊËÙÈ΋ ÈηÓfiÙËÙ· ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô‡ÙÂ Î·È ÛÙËÓ ÂÓÙÂÚÈ΋ ¯ÏˆÚ›‰·. §fiÁˆ Ù˘ ‰È·ÊÔÚÂÙÈ΋˜, fï˜, Û‡ÛÙ·Û˘ ÙˆÓ ‰‡Ô Á·Ï¿ÙˆÓ, Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÍ·¯ıÔ‡Ó ·ÛÊ·Ï‹ Û˘ÌÂÚ¿ÛÌ·Ù· ˆ˜ ÚÔ˜ ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÂÌÏÔ˘ÙÈÛÌÔ‡ ÙÔ˘ Á¿Ï·ÙÔ˜ Ì ¡∆. ∞·ÈÙÔ‡ÓÙ·È ÁÈ’ ·˘Ùfi ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜, ÒÛÙ ӷ ‰È·Ï¢ηÓı› Ô ÚfiÏÔ˜ ÙˆÓ ¡∆ ÛÙË ‰È·ÙÚÔÊ‹ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ. µÈ‚ÏÈÔÁÚ·Ê›· 1. Carver JD. Dietary nucleotides: effects on the immune and gastrointestinal systems. Acta Paediatr Suppl 1999;430:83-88.

2. Carver JD, Walker WA. The role of nucleotides in human nutrition. Nutritional Biochemistry 1995;6:58-72.

3. Uauy R. Dietary nucleotides and requirements in early life. In: Lebenthal E, editor. Textbook of Gastroenterology and Nutrition in Infancy. 2nd ed. New

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5. Roe JH, Rice EW. A photometric method for the determination of free pentoses in animal tissues. J Biol Chem 1947;173:507-512.

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7. Phuapradit P, Narang A, Mendonca P, Harris DA, Baum JD. The steatocrit: a simple method for estimating stool fat content in newborn infants. Arch Dis Child 1981;56:725-727.

8. Cosgrove M. Nucleotides. Nutrition 1998;14:748-751.

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ORIGINAL ARTICLE

∫ÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Î·È ÙÔ˘ ÂÚÈηډ›Ô˘ ÛÙËÓ ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ª. ∆ÛÈÏÈÁÁ›ÚË1, ª. ∂ÌÔÚÈ¿‰Ô˘1, µ. ∞˚‚¿˙˘2, ™. ∞ÏÂ͛Ԣ3, ª. ¢È·Ì·ÓÙÔÔ‡ÏÔ˘4, °.™. µ·ÚÏ¿Ì˘1

Clinical and laboratory investigation of associated myocardial-pericardial involvement in acute bronchiolitis M. Tsiligiri1, M. Eboriadou1, V. Aivazis2, S. Alexiou3, M. Diamandopoulou4, G.S. Varlamis1

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë ÎÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· (OB) ÁÈ· ÂӉ¯fiÌÂÓË Û˘Ó‡·ÚÍË Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ¯‹˜ (∫™), fiˆ˜ Ì˘Ôηډ›Ùȉ· Î·È ÂÚÈηډ›Ùȉ·. ªÂÏÂÙ‹ıËÎ·Ó 133 ‚Ú¤ÊË Î·È Ó‹È· ËÏÈΛ·˜ 2-24 ÌËÓÒÓ, Ù· ÔÔ›· ÓÔÛËχıËÎ·Ó ÛÙË ¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ∞¶£ ¡ÔÛÔÎÔÌ›Ԣ ∞Ã∂¶∞ Ì Oµ ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1995-1998. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈÓfiÙ·Ó ÂÎÙ›ÌËÛË ÙÔ˘ ÔÏÈÎÔ‡ ÎÏÈÓÈÎÔ‡ ‰Â›ÎÙË ‚·Ú‡ÙËÙ·˜ ‰‡ÛÓÔÈ·˜ (012), ̤ÙÚËÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ, Ï‹Ú˘ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ï‹„Ë ÚÒÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÔÚÔ‡ ÁÈ· ·Ó·Ó¢ÛÙÈÎÔ‡˜ ÈÔ‡˜, Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È·, ÚÈΤÙÛȘ (‰Â‡ÙÂÚÔ ‰Â›ÁÌ· ·›Ì·ÙÔ˜ Ï·Ì‚¿ÓÔÓÙ·Ó Û 15 Ë̤Ú˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ) Î·È ÔÏÈ΋ ·ÓÔÛÔÛÊ·ÈÚ›ÓË ∂. ∏ ‰È¿ÁÓˆÛË Ù˘ ∫™ ÂȂ‚·ÈÒıËΠ̠·ÎÙÈÓÔÁÚ·Ê›· ηډȿ˜, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Î·È ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈ΋ ÌÂϤÙË. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, ÔÈ ·ÛıÂÓ›˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜. ∏ ÔÌ¿‰· ∞ ÂÚȤϷ‚ 120 ·È‰È¿, ÛÙ· ÔÔ›· ‰È·ÁÓÒÛÙËΠÌfiÓÔÓ Oµ Î·È Ë ÔÌ¿‰· µ ÂÚȤϷ‚ 13 ·È‰È¿, ÛÙ· ÔÔ›· ‰È·ÁÓÒÛÙËΠOµ Î·È ∫™. ∆· ‰Â‰Ô̤ӷ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÛÙ·ÙÈÛÙÈο. ¢È·ÈÛÙÒıËΠ∫™ Û 13 ·È‰È¿ (9,8%) ηÈ, ·Ó·Ï˘ÙÈÎfiÙÂÚ·, Ì˘Ôηډ›Ùȉ· Û 6 (4,5%), ÂÚÈηډ›Ùȉ· Û 5 (3,8%) Î·È Ì˘ÔÂÚÈηډ›Ùȉ· Û 2 (1,5%). ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË, Ù· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ ›¯·Ó: ·) ÌÂÁ·Ï‡ÙÂÚÔ ÔÏÈÎfi ÎÏÈÓÈÎfi ‰Â›ÎÙË ‚·Ú‡ÙËÙ·˜ ‰‡ÛÓÔÈ·˜ (p<0,001), ‚) ¯·ÌËÏfiÙÂÚÔ ÎÔÚÂÛÌfi

Abstract: The purpose of our study was the clinical and laboratory investigation of all children with acute bronchiolitis (AB) for possible associated cardiac involvement, such as myocarditis and pericarditis. One hundred and thirty three infants and small children aged 2-24 months, hospitalized for AB in the 4th Pediatric Department of Aristotelion University of Thessaloniki, AHEPA Hospital, during the period 1995-1998, were studied. The following investigations were performed on admission to the hospital: total clinical dyspnea score (0-12), oxygen haemoglobin saturation (SaO2), full haematologic and biochemical examination and serology (1st sample) for respiratory viruses, mycoplasma, chlamydia and rickettsia (the second serology sample after 15-20 days), and total immunoglobulin E. The presence of cardiac disease was confirmed by chest radiography, electrocardiography and echocardiography.

Based on clinical and laboratory findings, the patients were divided into two groups. Group A consisted of 120 children with the diagnosis of AB, and Group B of 13 children with the diagnosis of AB with cardiac involvement. The data of the two groups were compared statistically. Cardiac disease was found in 13 children (9.8%): myocarditis in 6 (4.5%), pericarditis in 5 (3.8%) and myopericarditis in 2 (1.5%). During the clinical evaluation the Group B patients had: a) higher whole clinical dyspnea score (p<0.001), b) lower SaO2, c) higher fever, lasting for more days, and d)

1 ¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£.

2 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£.

3 ∂ÚÁ·ÛÙ‹ÚÈÔ ªÈÎÚÔ‚ÈÔÏÔÁ›·˜ ÙÔ˘ π·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ∞.¶.£.

4 ∆Ì‹Ì· ¢·ÛÔÏÔÁ›·˜ Î·È º˘ÛÈÎÔ‡ ¶ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ∞.¶.£.

1 4th Pediatric Clinic of Aristotelion University of Thessaloniki 2 1st Pediatric Clinic of Aristotelion University of Thessaloniki 3 Microbiology Laboratory, Medical School of Aristotelion University of Thessaloniki (A.U.Th.) 4 Division of Forest and Natural Environment A.U.Th.

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·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ, Á) ˘„ËÏfiÙÂÚÔ ˘ÚÂÙfi Î·È ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜, ‰) Ë·ÙÔÌÂÁ·Ï›· Î·È Â) ηٿ ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ÛËÌÂÈÒıËΠ۠ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË, ·‡ÍËÛË Ù˘ ÎÚ·ٛÓ˘-ʈÛÊÔÎÈÓ¿Û˘, Ù˘ Á·Ï·ÎÙÈ΋˜ ‰Â¸‰ÚÔÁÂÓ¿Û˘, ηıÒ˜ Î·È ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·¤‚Ë ıÂÙÈÎfi˜ Û 53 ·È‰È¿ (39,7%), ÌÂ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ÙÔÓ Èfi ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ Û 35 (26,3%). ™˘ÌÂÚ·›ÓÂÙ·È fiÙÈ Û ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ Oµ Ì ÔÏÈÎfi ÎÏÈÓÈÎfi ‰Â›ÎÙË ‚·Ú‡ÙËÙ·˜ ‰‡ÛÓÔÈ·˜ >10, Û˘Ó˘¿Ú¯ÂÈ Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ∫™. °È’ ·˘Ùfi Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÙ· ·È‰È¿ ·˘Ù¿ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Î·È ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·.

hepatomegaly. On laboratory investigation, higher levels of neutrophils, CPK, LDH, AST and ALT were found. Serology examination was positive in 53 children (39.7%) with more frequent viral causal agent the RSV in 35 patients (26.3%). It is concluded that in severe cases of acute bronchiolitis that demonstrate a total clinical dyspnea score >10, a relatively high frequency of cardiac involvement may coexist, and therefore electrocardiogram and echocardiogram should be performed in these children.

§¤ÍÂȘ ÎÏÂȉȿ: ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, RSV ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, Ì˘Ôηډ›Ùȉ·, ÂÚÈηډ›Ùȉ·.

Key words: acute bronchiolitis, RSV bronchiolitis, myocarditis, pericarditis.

™˘ÓÙÔÌÔÁڷʛ˜

¶ÚÒÙÔÈ ÔÈ Henderson Î·È Û˘Ó (11) ÌÂϤÙËÛ·Ó ÙËÓ Oµ Ì ¤ÌÊ·ÛË ÛÙȘ ηډȷΤ˜ ÂÈÏÔΤ˜ Î·È ·ÚÁfiÙÂÚ· ÔÈ Scott Î·È Û˘Ó (12) ÂÚȤÁÚ·„·Ó ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ Û ÔÛÔÛÙfi 2% Û ·È‰È¿ Ô˘ ÓÔÛËχıËÎ·Ó Ì Oµ. ¶ÚfiÛÊ·Ù·, ·fi ÙÔ˘˜ Thomas Î·È Û˘Ó (8) ÂÚÈÁÚ¿ÊËÎ·Ó ‰‡Ô ÂÚÈÙÒÛÂȘ ‚ÚÂÊÒÓ Ì Oµ Î·È ∫™. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ Ì·˜ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Û˘¯ÓfiÙËÙ·˜ Èı·Ó‹˜ Û˘Ó‡·Ú͢ ∫™ Û ‚Ú¤ÊË Î·È Ó‹È· Ì Oµ, Ë Û˘Û¯¤ÙÈÛË ÙÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· Ù˘ Oµ Ì ÙËÓ ·Ó¿Ù˘ÍË Ì˘Ôηډ›Ùȉ·˜ Î·È ÂÚÈηډ›Ùȉ·˜, Ë ‰ÈÂÚ‡ÓËÛË ÁÈ· Èı·Ó¿ ÚÒÈÌ· ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ÂÓ‰ÂÈÎÙÈο ∫™ ÛÙËÓ Oµ Î·È Ë ÂÎÙ›ÌËÛË ·Ú·ÌÔÓ‹˜ ‹ fi¯È ηډȷÎÒÓ ‚Ï·‚ÒÓ Î·È ÂӉ¯fiÌÂÓ˘ ·ÒÙÂÚ˘ ·Ó¿Ù˘Í˘ ηډȷÎÒÓ ÂÈÏÔÎÒÓ. ∞’ fiÛÔ Â›Ì·ÛÙ Û ı¤ÛË Ó· ÁÓˆÚ›˙Ô˘ÌÂ, Ë ¤Ú¢ӷ ·˘Ù‹ Â›Ó·È ÚˆÙfiÙ˘Ë ÛÙÔÓ ÂÏÏËÓÈÎfi ¯ÒÚÔ.

∫™ Oµ RSV ∏∫° ECHO LVEF ∆∫∂ CRP LDH AST ALT CPK ∞µ

∫·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹ OÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· πfi˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ ∏ÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ÀÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ∫Ï¿ÛÌ· ÂÍÒıËÛ˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ∆·¯‡ÙËÙ· ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË °·Ï·ÎÙÈ΋ ‰Â¸‰ÚÔÁÂÓ¿ÛË ∞Û·ÚÙÈ΋ ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿ÛË ∞Ï·Ó›ÓË ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿ÛË ∫Ú·ٛÓË-ºˆÛÊÔÎÈÓ¿ÛË Acute bronchiolitis

∂ÈÛ·ÁˆÁ‹ ∏ ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· (Oµ) Â›Ó·È Û˘¯Ó‹ ÓfiÛÔ˜ Ù˘ ‚ÚÂÊÈ΋˜ Î·È ÚÒÙ˘ ÓËȷ΋˜ ËÏÈΛ·˜. ¶ÔÛÔÛÙfi 10% ÂÌÊ·Ó›˙ÂÈ ÙË ÓfiÛÔ Î·Ù¿ ÙÔ ÚÒÙÔ ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ ÙÔ˘ (1), ÂÓÒ ÁÈ· ÙÔ 0,1-1,5% Ë ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Â›Ó·È ··Ú·›ÙËÙË (2). ∏ ıÓËÙfiÙËÙ· ·Ó¤Ú¯ÂÙ·È ÛÙÔ 0,5-1% ÂÚ›Ô˘ (3,4), ·ÏÏ¿ ÁÈ· Ù· ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÙÔ ÔÛÔÛÙfi Î˘Ì·›ÓÂÙ·È ·fi 15-37% (3). OÊ›ÏÂÙ·È Û Ïԛ̈ÍË ·fi ÏÂÈ¿‰· ÈÒÓ, ÌÂ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ÙÔÓ Èfi ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÁÎ˘Ù›Ô˘ (RSV) (5,6). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÓÔÛËÏ›·˜ ÙÔ˘˜, Ù· ·È‰È¿ Ì Oµ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÂÈÏÔΤ˜, fiˆ˜: ·) ¿ÓÔȘ, ÁÈ· ÙȘ Ôԛ˜ ›Ûˆ˜ ¯ÚÂÈ·ÛÙ› Ó· ÌÂÙ·ÊÂÚıÔ‡Ó Û ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ·Ú·ÎÔÏÔ‡ıËÛ˘, ‚) ·˘ÙfiÌ·ÙÔ Ó¢ÌÔıÒڷη (7), Á) ÂÓ‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ‹ ‰Â˘ÙÂÚÔ·ı›˜ ÏÔÈÌÒÍÂȘ, Ô˘ ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ Û ‚·ÎÙËÚ›‰È· fiˆ˜ Ô Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ Î·È Ô ·ÈÌfiÊÈÏÔ˜ Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ (8), ‰) ˘ÔÙÚÔ¤˜ Û˘Ú›ÙÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô (9,10) ηÈ, Ù¤ÏÔ˜, Â) Â͈Ó¢ÌÔÓÈΤ˜ ÂΉËÏÒÛÂȘ, fiˆ˜ Ì˘Ôηډ›Ùȉ· Î·È ÂÚÈηډ›Ùȉ· (8).

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ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÌÂϤÙË Ì·˜ ÂÚȤϷ‚ 133 ‚Ú¤ÊË Î·È Ó‹È·, 94 ·ÁfiÚÈ· (70,6%) Î·È 39 ÎÔÚ›ÙÛÈ· (29,4%) ËÏÈΛ·˜ 2 ¤ˆ˜ 24 ÌËÓÒÓ (̤ÛË ËÏÈΛ· 6,67 ± 4,7 Ì‹Ó˜), Ô˘ ÓÔÛËχıËÎ·Ó ÛÙË ¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÙÔ˘ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 1995-1998 Ì Oµ. ∆· ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ÙˆÓ ·ÛıÂÓÒÓ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (13). ∞fi ÙË ÌÂϤÙË ·ÔÎÏ›ÛÙËÎ·Ó ·È‰È¿ ÌÂ Û˘ÁÁÂÓ‹ ‹ ¿ÏÏË Î·Ú‰ÈÔ¿ıÂÈ· ‹ Ó¢ÌÔÓÔ¿ıÂÈ·, ÚfiˆÚ· Ì ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›·, Ì ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ì ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· Î·È ‚Ú¤ÊË Ì ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο ÓÔÛ‹Ì·Ù·. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ÎÏÈÓÈ΋ ÁÈÓfiÙ·Ó ÂÎÙ›ÌËÛË ÙÔ˘ ÔÏÈÎÔ‡ ÎÏÈÓÈÎÔ‡ ‰Â›ÎÙË (score) Û‡Ìʈӷ Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ (5,14) Î·È Î·Ù·ÁÚ¿ÊÔÓÙ·Ó ÁÈ· ÙÔ

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¶›Ó·Î·˜ 1. ∫ÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ÎÚÈÙ‹ÚÈ· ÂÈÏÔÁ‹˜ ·ÛıÂÓÒÓ Ì ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· [ÃÚ˘Û·ÓıfiÔ˘ÏÔ˜ Î·È Û˘Ó (13)] ñ ∏ÏÈΛ· ·ÛıÂÓÔ‡˜: 2-24 ÌËÓÒÓ ñ πÛÙÔÚÈÎfi: ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ÂÎÓ¢ÛÙÈ΋˜ Û˘Ú›ÙÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ ñ ∞ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ ÌÈÌÔ‡ÓÙ·È ÙËÓ Oµ ñ AÎÙÈÓÔÁÚ·Ê›· ıÒڷη. ∂ÈÎfiÓ· ˘ÂÚ·ÂÚÈÛÌÔ‡ ‹ ·ÙÂÏÂÎÙ·ÛÈΤ˜ ÂÚÈÔ¯¤˜ ‹ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈΤ˜ ÂÛٛ˜ ñ ∞ÎÚfi·ÛË Ó¢ÌfiÓˆÓ: ¶·Ú¿Ù·ÛË ÂÎÓ¢ÛÙÈ΋˜ Ê¿Û˘, ‰È¿Û·ÚÙÔÈ ÏÂÙÔ› ˘ÁÚÔ› ÚfiÁ¯ÔÈ, ÂÏ¿ÙÙˆÛË ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜ οı ·È‰› Ë ·Ó·Ó¢ÛÙÈ΋ Î·È Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·, Ô ‚·ıÌfi˜ Ù˘ ÂÎÓ¢ÛÙÈ΋˜ Û˘Ú›ÙÙÔ˘Û·˜ ·Ó·ÓÔ‹˜ (wheezing) Î·È Ë ¯Ú‹ÛË ÂÈÎÔ˘ÚÈÎÒÓ Ì˘ÒÓ, Ô˘ ‚·ıÌÔÏÔÁÔ‡ÓÙ·Ó ·fi 0-3 Û‡Ìʈӷ Ì ÙÔÓ ¶›Ó·Î· 2. O ÔÏÈÎfi˜ ÎÏÈÓÈÎfi˜ ‰Â›ÎÙ˘ ‚Ú¤ıËΠ·fi ÙÔ ¿ıÚÔÈÛÌ· ÙˆÓ ÂÈ̤ÚÔ˘˜ ÙÈÌÒÓ ÙˆÓ ˆ˜ ¿Óˆ ÙÂÛÛ¿ÚˆÓ ·Ú·Ì¤ÙÚˆÓ. ªÂ ·ÏÌÈ΋ Ô͢ÌÂÙÚ›· ÁÈÓfiÙ·Ó Ì¤ÙÚËÛË ÙÔ˘ ÎÔÚÂÛÌÔ‡ Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ ‹ Ô͢·ÈÌÔÛÊ·ÈÚ›Ó˘ SaO2, Û ËÚÂÌ›· ÁÈ· 2 ÏÂÙ¿. ø˜ Ê˘ÛÈÔÏÔÁÈ΋ ıˆڋıËÎÂ Ë ÙÈÌ‹ SaO2 ≥95 (15). ∆ÈÌ‹ SaO2 ÌÂٷ͇ 93-94% ıˆڋıËΠˆ˜ ÔÚȷο Ê˘ÛÈÔÏÔÁÈ΋ ‹ ˆ˜ ÂÏ·ÊÚ¿ ˘ÔÍ·ÈÌ›· (¶›Ó·Î·˜ 3). ∏ ÂÎÙ›ÌËÛË ·˘Ù‹ Â·Ó·Ï·Ì‚·ÓfiÙ·Ó Î¿ı ̤ڷ, ÁÈ· ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙË ‰È·›ÛÙˆÛË Ù˘ Û˘ÓÔÏÈ΋˜ ‚ÂÏÙ›ˆÛ˘ ÚÈÓ ·fi ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜. ªÂÙÚ‹ÛÂȘ Ù˘ PaO2 Î·È Ù˘ PaCO2 ¤ÁÈÓ·Ó Î·Ù’ ÂÈÏÔÁ‹ Û 7 ·ÛıÂÓ›˜ Ì ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È score ‰‡ÛÓÔÈ·˜ ≥8.

O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·ÓÂ: ª¤ÙÚËÛË Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, Ï¢ÎÔ΢ÙÙ·ÚÈÎfi Ù‡Ô, Hb, Hct, TKE, CRP, IgE, ALT, AST, CPK, LDH Î·È Ï‹„Ë ‰‡Ô ‰ÂÈÁÌ¿ÙˆÓ ÔÚÔ‡ Ì ÌÂÛԉȿÛÙËÌ· 15 ËÌÂÚÒÓ ÁÈ· ·Ó·Ó¢ÛÙÈÎÔ‡˜ ÈÔ‡˜, Ì˘ÎfiÏ·ÛÌ·, ¯Ï·Ì‡‰È· Î·È ÚÈΤÙÛȘ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜.

O ·ÓˆÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÛÙÔ ªÈÎÚÔ‚ÈÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ Ù˘ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢ Ì ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ·Ó·Ï˘Ù‹ (coulter). ∏ ̤ÙÚËÛË ¤ÁÈÓ ۇÌʈӷ Ì ÙȘ ÎÏ·ÛÈΤ˜ ÌÂıfi‰Ô˘˜. ∏ˆÛÈÓÔÊÈÏ›· ıˆڋıËΠfiÙ·Ó Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ˈÛÈÓÔÊ›ÏˆÓ ‹Ù·Ó >400/mm3 Î·È ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË fiÙ·Ó Ô ·fiÏ˘ÙÔ˜ ·ÚÈıÌfi˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ‹Ù·Ó >5.600/mm3. ∏ ̤ÙÚËÛË ÙÔ˘ ÔÛÔÙÈÎÔ‡ ÚÔÛ‰ÈÔÚÈÛÌÔ‡ Ù˘ ÔÏÈ΋˜ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ∂ (IgE) ¤ÁÈÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ¡ÂÊÂÏÔÌÂÙÚ›·˜ (16). ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ¤ÁÈÓ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ. ÃÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ·ÓÙ›‰Ú·ÛË Û‡Ó‰ÂÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ (CFT). °È· ÙËÓ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ÈÔ‡ Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ ∞ Î·È µ, Ù˘ ·Ú·˚ÓÊÏÔ˘¤ÓÙ˙·˜ 1 Î·È 3, ÙÔ˘ RSV, ÙˆÓ ·‰ÂÓÔ˚ÒÓ, ηıÒ˜ Î·È ÁÈ· ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜, Ù· ¯Ï·Ì‡‰È· Î·È ÙȘ ÚÈΤÙÛȘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·ÓÙÈÁfiÓ· ÙˆÓ Ô›ÎˆÓ Hoechst Î·È Serion Û ٛÙÏÔ˘˜ ηıÔÚÈṲ̂ÓÔ˘˜ ·fi ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· ÂÙ·ÈÚ›·. ™˘Ìϋڈ̷ Î·È ·ÈÌÔÏ˘Û›ÓË (Bio-Merieux) ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û ٛÙÏÔ, Ô ÔÔ›Ô˜ ÚÔÛ‰ÈÔ-

Paediatriki 2002;65:57-65

Ú›ÛÙËΠÌÂÙ¿ ·fi ‰È·ÛÙ·˘ÚˆÙ‹ ÙÈÙÏÔÔ›ËÛË (Chess-board titration). ∏ ÂͤٷÛË Ù˘ Û‡Ó‰ÂÛ˘ ÙÔ˘ Û˘ÌÏËÚÒÌ·ÙÔ˜ ¤ÁÈÓ Û ÌÈÎÚÔϿΘ ηٿ ÙÔ˘˜ Grist Î·È Û˘Ó (17). ™Â οı ÂͤٷÛË ÂÚÈÂÏ‹ÊıËÛ·Ó, ˆ˜ Ì¿ÚÙ˘Ú˜ ıÂÙÈÎÔ›, ÔÚÔ› ÁÓˆÛÙÔ‡ Ù›ÙÏÔ˘. OÈ ÔÚÔ› ÂÍÂÙ¿ÛÙËÎ·Ó ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ ·ÓÙÈÁfiÓˆÓ Û ·Ú·ÈÒÛÂȘ 1:8 Î·È 1:16 Û ¤Ó· ·Ú¯ÈÎfi screening test. OÈ ıÂÙÈÎÔ› ÔÚÔ›, ¤Ó·ÓÙÈ ÂÓfi˜ ·fi Ù· ·ÓÙÈÁfiÓ· ÛÙËÓ ·Ú·›ˆÛË 1:16 (50% ·ÈÌfiÏ˘ÛË), ÂÍÂÙ¿ÛÙËÎ·Ó Û ˘„ËÏfiÙÂÚ˜ ‰È·‰Ô¯ÈΤ˜ ·Ú·ÈÒÛÂȘ ÁÈ· ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ·ÓÙÈÁfiÓÔ. ∆· ˙‡ÁË ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÔÚÔ‡ ÂÍÂÙ¿ÛÙËÎ·Ó ·Ú¿ÏÏËÏ·. ∆· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ ÔÚÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË ‹Ù·Ó Ë ÙÂÙÚ·Ï¿ÛÈ· ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Û ‰‡Ô ‰Â›ÁÌ·Ù· ÔÚÔ‡ Ô˘ Ï‹ÊıËÎ·Ó ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘ Î·È ÛÙË Ê¿ÛË ·Ô‰ÚÔÌ‹˜ ‹ ÌfiÓÈÌÔ˜ ˘„ËÏfi˜ Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ≥1:64 Î·È ÛÙ· ‰‡Ô ‰Â›ÁÌ·Ù· ÔÚÔ‡. ∫·Ú‰È·Î‹ Û˘ÌÌÂÙÔ¯‹ ıˆڋıËΠfiÙÈ Â›¯·Ó ÔÈ ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ÏËÚÔ‡Û·Ó Ù· ·Ú·Î¿Ùˆ ÎÚÈÙ‹ÚÈ·: ª˘Ôηډ›Ùȉ·: 1) ·ÈÊÓ›‰È· ÂÌÊ¿ÓÈÛË Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜ Ì ˘ÚÂÙfi Î·È ÌÂ/‹ ¯ˆÚ›˜ ·ÚÚ˘ıÌ›·, 2) ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·: ¯·ÌËÏ¿ ‰˘Ó·ÌÈο Û fiϘ ÙȘ ··ÁˆÁ¤˜, ȉ›ˆ˜ ÙˆÓ ÚÔÎ¿Ú‰ÈˆÓ ÎÔÈÏÈ·ÎÒÓ Û˘ÌÏÂÁÌ¿ÙˆÓ, ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Q-T, ÙÒÛË Î·È Û¿ÓÈ· ·Ó‡„ˆÛË ÙÔ˘ S-T, ȉ›ˆ˜ ÛÙȘ ··ÁˆÁ¤˜ π, AVL Î·È V4-V6, 3) ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·: ÂÏ·Ùو̤ÓË ÎÈÓËÙÈÎfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ¯·ÌËÏ‹ ·ÚÔ¯‹ Ù˘ ÌÈÙÚÔÂȉԇ˜ Î·È Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜, ¯·ÌËÏfi ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, 4) ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·: ÌÂÁ·ÏÔηډ›· Ì ‹ ¯ˆÚ›˜ ÛËÌ›· Ó¢ÌÔÓÈ΋˜ ÛÙ¿Û˘ Î·È Ó¢ÌÔÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜. ¶ÂÚÈηډ›Ùȉ·: 1) ηÎÔ˘¯›·, ˘ÚÂÙfi˜, ‰‡ÛÓÔÈ· Î·È ıˆÚ·ÎÈÎfi˜ fiÓÔ˜ Ô˘ ÂȉÂÈÓÒÓÂÙ·È Ì ÙËÓ ·ÏÏ·Á‹ Ù˘ ı¤Û˘, ÙȘ ·Ó·Ó¢ÛÙÈΤ˜ ÎÈÓ‹ÛÂȘ Î·È ÙÔ ‚‹¯·, 2) ‰È·›ÛÙˆÛË ¯·ÌËÏ‹˜ ¤ÓÙ·Û˘ ÙˆÓ Î·Ú‰È·ÎÒÓ ‹¯ˆÓ Î·È Û˘¯Ó¿ ‹¯Ô˜ ÂÚÈηډȷ΋˜ ÙÚÈ‚‹˜, ÛÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, 3) ÌÂÁ·ÏÔηډ›· Î·È ÊÏ‚È΋ Û˘ÌÊfiÚËÛË ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ηډȿ˜, 4) ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·: ·Ú¯Èο ·Ó‡„ˆÛË ÙÔ˘ S-T, ‡ÛÙÂÚ· ·ÔÏ¿Ù˘ÓÛË ÙÔ˘ ∆ ÌÂ Ê˘ÛÈÔÏÔÁÈο S-T, ηÙfiÈÓ ·Ó·ÛÙÚÔÊ‹ ÙÔ˘ ∆ Î·È Ù¤ÏÔ˜, ·ÔηٿÛÙ·ÛË, 5) ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· (·ıÔÁÓˆÌÔÓÈÎfi): fiÙ·Ó ˘¿Ú¯ÂÈ ÌÈÎÚ‹ ÔÛfiÙËÙ· ÂÚÈηډȷÎÔ‡ ˘ÁÚÔ‡ ÂÌÊ·Ó›˙ÂÙ·È ÂÈÎfiÓ· “˘ÁÚÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜” ÌÂٷ͇ Ô›ÛıÈÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÂÈηډ›Ô˘. ŸÙ·Ó fï˜ Ë ÔÛfiÙËÙ· ˘ÁÚÔ‡ Â›Ó·È ÌÂÁ¿ÏË, ÂÌÊ·Ó›˙ÂÙ·È ÂÈÎfiÓ· “˘ÁÚÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜” ÌÂٷ͇ Ô›ÛıÈÔ˘ Î·È ÚfiÛıÈÔ˘ ÙÔȯÒÌ·ÙÔ˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÂÈηډ›Ô˘. ™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ¤ÁÈÓ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ô ÔÔ›Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ÎÏÈÓÈ΋ ÂͤٷÛË, ·ÎÙÈÓÔÁÚ·Ê›· ηډȿ˜, ∏∫° Î·È ECHO ηډȿ˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ηډȿ˜ ¤ÁÈÓ Û fiÚıÈ· ı¤ÛË Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÂÎÙÈÌ‹ıËÎÂ Ô Î·Ú‰ÈÔıˆÚ·ÎÈÎfi˜ ‰Â›ÎÙ˘, Ô ÔÔ›Ô˜ ıˆڋıËΠ·ıÔÏÔÁÈÎfi˜ Û ÙÈ̤˜ ≥0,6.

O ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙÔ ¶·È‰ÔηډÈÔÏÔÁÈÎfi ¢È·ÁÓˆÛÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ Ù˘ ¢’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞ÚÈÛÙÔÙ¤ÏÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·ÏÔӛ΢. ÃÚËÛÈÌÔÔÈ‹ıËΠ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊÔ˜ ÙÔ˘ Ô›ÎÔ˘ “Kontron” Ù‡Ô˘ Sigma 44, Ì ¤Á¯ÚˆÌÔ Doppler, Ì ÎÂÊ·Ï‹

59

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·60

¶·È‰È·ÙÚÈ΋ 2002;65:57-65

Paediatriki 2002;65:57-65

¶›Ó·Î·˜ 2. OÏÈÎfi˜ ÎÏÈÓÈÎfi˜ ‰Â›ÎÙ˘ (score) ÂÎÙ›ÌËÛ˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜* µ·ıÌÔÏÔÁ›·

∞.™./min**

∫.™./min***

0 1 2

≤30 31-45 46-60

≤120 121-140 141-160

3

>60

>160

∂ÎÓ¢ÛÙÈ΋ Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹

ÃÚ‹ÛË ÂÈÎÔ˘ÚÈÎÒÓ Ì˘ÒÓ

ñ Ÿ¯È ñ ™ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÎÓÔ‹˜ ñ AÎÔ˘ÛÙ‹: ¯ˆÚ›˜ ÛÙËıÔÛÎfiÈÔ ÛÙËÓ ÂÈÛÓÔ‹ Ì ÛÙËıÔÛÎfiÈÔ ÛÙËÓ ÂÎÓÔ‹ ñ ∞ÎÔ˘ÛÙ‹ Û˘Ó¯Ҙ ¯ˆÚ›˜ ÛÙËıÔÛÎfiÈÔ

ñ Ÿ¯È ñ ∂Ï·ÊÚ¿ ñ ª¤ÙÚÈ· ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ıÒڷη ñ ™Ô‚·Ú‹ ÌÂ Û˘ÌÌÂÙÔ¯‹ ÛÊ·Á‹˜, ÛÙ¤ÚÓÔ˘, ÌÂÛÔÏ¢ڛˆÓ Î·È ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ

* ◊È· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·: 0-4, ª¤ÙÚÈ· ‚ÚÔÁ¯ÈÔÏ›Ùȉ·: 5-7, ™Ô‚·Ú‹ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·: ≥8 ** ∞.™.: ∞Ó·Ó¢ÛÙÈ΋ Û˘¯ÓfiÙËÙ· *** ∫.™.: ∫·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· ¶›Ó·Î·˜ 3. ∆·ÍÈÓfiÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ÔÍ›·˜ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·˜ Ì ‚¿ÛË ÙÔÓ ÎÏÈÓÈÎfi ‰Â›ÎÙË Î·È ÙÔ SaO2 ÷ڷÎÙËÚÈÛÌfi˜ ◊È· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ª¤ÙÚÈ· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· ™Ô‚·Ú‹ ‚ÚÔÁ¯ÈÔÏ›Ùȉ·

∫ÏÈÓÈÎfi˜ ‰Â›ÎÙ˘

SaO2 (%)

PaO2 mmHg

0-4 5-7 ≥8

≥95 93-94 <93

85-90 80-84 <80

(ÌÔÚÊÔÙÚÔ¤·) ÙˆÓ 5 ª∏z ÁÈ· fiÏÔ˘˜ ÙÔ˘˜ ÂÍÂÙ·˙fiÌÂÓÔ˘˜. ∫·Ù¿ ÙËÓ ÂͤٷÛË, ÛÙ· ÌË Û˘ÓÂÚÁ¿ÛÈÌ· ·È‰È¿ ÚÔËÁ‹ıËΠ·ÁˆÁ‹ Ì ÚÔÌÂı·˙›ÓË 0,3 mg/kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ÂÊ’ ¿·Í ·fi ÙÔ ÛÙfiÌ·. ŒÁÈÓ Ï‹Ú˘ ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈ΋ ÌÂϤÙË (M-mode, 2 ‰È·ÛÙ¿ÛˆÓ, Doppler ÛÊ˘ÁÌÈÎfi, Û˘Ó¯¤˜ Î·È ¤Á¯ÚˆÌÔ) ÚÔ˜ ·ÔÎÏÂÈÛÌfi ‹ ÂȂ‚·›ˆÛË ÚÔ¸¿Ú¯Ô˘Û·˜ Û˘ÁÁÂÓÔ‡˜ ‹ Â›ÎÙËÙ˘ ηډÈÔ¿ıÂÈ·˜. °È· ÙÔ ÛÎÔfi Ù˘ ÌÂϤÙ˘ Ì·˜ ÌÂÙÚ‹ıËηÓ, ÌÂ Û˘Ó‰˘·ÛÌfi M-mode Î·È ‰‡Ô ‰È·ÛÙ¿ÛÂˆÓ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·, ÔÈ ·Ú¿ÌÂÙÚÔÈ: Û˘ÛÙÔÏÈ΋ ‰È¿ÌÂÙÚÔ˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, ‰È·ÛÙÔÏÈ΋ ‰È¿ÌÂÙÚÔ˜ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ·Ú·ÛÙÂÚÓÈ΋ ı¤ÛË Î·Ù¿ ÙÔ ‚Ú·¯‡ ¿ÍÔÓ·. ∂ÈϤ¯ıËÎÂ Ë ÂÁοÚÛÈ· ÙÔÌ‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ 1 ¤ˆ˜ 1,5 cm οو ·fi ÙË ÌÈÙÚÔÂȉ‹ ‚·Ï‚›‰·, Û‡Ìʈӷ Ì ÙȘ ÎÏ·ÛÈο ·Ô‰ÂÎÙ¤˜ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ (18).

OÈ ÁÔÓ›˜ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÂÓ‹ÌÂÚÔÈ ÁÈ· ÙÔ ÛÎÔfi Ù˘ ÌÂϤÙ˘ Î·È ·Ôχو˜ Û‡ÌʈÓÔÈ. ∂Í·ÈÚ¤Û·Ì ÙÂÏ›ˆ˜ ·fi ÙË ÌÂϤÙË Ì·˜ 3 ·È‰È¿, ÙˆÓ ÔÔ›ˆÓ ÔÈ ÁÔÓ›˜ ‰ÂÓ ÂÈı˘ÌÔ‡Û·Ó Ó· Û˘ÓÂÚÁ·ÛÙÔ‡Ó. ªÂ ‚¿ÛË Ù· ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, ÔÈ ·ÛıÂÓ›˜ Ù·ÍÈÓÔÌ‹ıËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜. ∏ ÔÌ¿‰· ∞ ÂÚȤϷ‚ 120 ‚Ú¤ÊË Î·È Ó‹È·, 85 ·ÁfiÚÈ· Î·È 35 ÎÔÚ›ÙÛÈ·, Ù· ÔÔ›· ›¯·Ó ÌfiÓÔ Oµ Î·È Ë ÔÌ¿‰· µ ÂÚȤϷ‚ 13 ‚Ú¤ÊË Î·È Ó‹È·, 9 ·ÁfiÚÈ· Î·È 4 ÎÔÚ›ÙÛÈ·, Ù· ÔÔ›· ›¯·Ó Oµ Î·È ∫™ (Ì˘Ôηډ›Ùȉ· ηÈ/‹ ÂÚÈηډ›Ùȉ·). ªÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙËÓ ÎÏÈÓÈ΋, Ô ÚÒÙÔ˜ Â·Ó¤ÏÂÁ¯Ô˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÙË 15Ë Ë̤ڷ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘˜ ‹ Î·È ÓˆÚ›ÙÂÚ·, ·Ó¿ÏÔÁ· Ì ٷ ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÚÔ˘Û›·˙·Ó Î·È ÂÚÈÂÏ¿Ì‚·Ó ÎÏÈÓÈ΋ ÂͤٷÛË, ηٷÁÚ·Ê‹ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·Ó,

60

∏∫°, ECHO ηډȿ˜ Î·È ·ÈÌÔÏË„›· ÁÈ· 2Ô ‰Â›ÁÌ· ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È Ô ‰Â‡ÙÂÚÔ˜ Â·Ó¤ÏÂÁ¯Ô˜, ÙËÓ 60‹ Ë̤ڷ ·fi ÙËÓ Â›ÛÔ‰Ô ÛÙËÓ ÎÏÈÓÈ΋ Û fiÏÔ˘˜ ¿ÏÈ ÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÂÚÈÂÏ¿Ì‚·Ó ∏∫° Î·È ECHO ηډȿ˜. ∆· Â˘Ú‹Ì·Ù· ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ Û˘ÁÎÚ›ıËÎ·Ó ÌÂٷ͇ ÙÔ˘˜. ™˘ÁÎÚ›ıËÎ·Ó ÔÈ Ì¤Û˜ ÙÈ̤˜ ÙˆÓ ÌÂÙ·‚ÏËÙÒÓ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ t-test ÁÈ· Ó· ÂÏÂÁ¯ı› Ë ˘fiıÂÛË ÈÛfiÙËÙ·˜ ‹ ·ÓÈÛfiÙËÙ·˜ ÙˆÓ Ì¤ÛˆÓ, Û ÛÙ¿ıÌË ÛËÌ·ÓÙÈÎfiÙËÙ·˜ p=0,05. ∏ ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›·, Ë ÔÔ›· ÂÚÈÂÏ¿Ì‚·Ó ÂηÙÔÛÙÈ·›Â˜ ·Ó·ÏÔÁ›Â˜, ̤ÛË ÙÈÌ‹, ·fiÎÏÈÛË Î·È Â‡ÚÔ˜ ηٷÓÔÌ‹˜ ÙÈÌÒÓ, fiÔ˘ ‹Ù·Ó ·Ó·Áη›Ô, ¤ÁÈÓ Ì ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹. OÈ ÙÈ̤˜ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÂÙ·‚ÏËÙÒÓ Î·Ù·¯ˆÚ‹ıËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ· Excell (Excell for Windows 95) Î·È ÔÈ ˘ÔÏÔÁÈÛÌÔ›, Ù· Û¯‹Ì·Ù·, ηıÒ˜ Î·È Ë ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ·Ó Ì ÙË ¯Ú‹ÛË ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ·Î¤ÙÔ˘ SPSS ver. 7.0. °È· ÙËÓ ·Ó¿Ï˘ÛË ÔÈÔÙÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ x2 Ì ‰ÈfiÚıˆÛË Î·Ù¿ Yates (19,20), ÂÓÒ ÁÈ· Ù· ÔÛÔÙÈο ‰Â‰Ô̤ӷ ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ unpaired-test. ∏ ÙÈÌ‹ p ˘ÔÏÔÁÈ˙fiÙ·Ó ·fi ÂȉÈÎfi ›Ó·Î·: p<0,05=‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋, p<0,01=‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο ·ÚÎÂÙ¿ ÛËÌ·ÓÙÈ΋, p<0,001=‰È·ÊÔÚ¿ ÛÙ·ÙÈÛÙÈο Ôχ ÛËÌ·ÓÙÈ΋.

∞ÔÙÂϤÛÌ·Ù· ∞fi Ù· ÏËı˘ÛÌȷο ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ÚÔ·ÙÂÈ fiÙÈ Ë Ì¤ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ µ (6,12 ± 4,6 Ì‹Ó˜) ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·fi Ù˘ ÔÌ¿‰·˜ ∞ (7,23 ± 6,8 Ì‹Ó˜). ∏ ‰È·ÊÔÚ¿ ‰ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,437). ªÂ ‹ ¯ˆÚ›˜ ∫™, Ë Oµ ‹Ù·Ó Û˘¯ÓfiÙÂÚË ÛÙ· ·ÁfiÚÈ· ·Ú¿ ÛÙ· ÎÔÚ›ÙÛÈ· (Û¯¤ÛË ∞:∫ = 2,4:1). ∫ÏÈÓÈ΋ ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÛıÂÓÒÓ Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 4, ÔÈ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ µ ·ÚÔ˘Û›·Û·Ó ÌÂÁ·Ï‡ÙÂÚË ·Ó·Ó¢ÛÙÈ΋ Û˘¯ÓfiÙËÙ· Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (p<0,021). ∏ ηډȷ΋ Û˘¯ÓfiÙËÙ·, Â›Û˘, ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ (p<0,001).

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·61

¶·È‰È·ÙÚÈ΋ 2002;65:57-65

Paediatriki 2002;65:57-65

¶›Ó·Î·˜ 4. ∫ÏÈÓÈο Â˘Ú‹Ì·Ù· Î·È ‚·ıÌÔÏÔÁ›· ÂÎÙ›ÌËÛ˘ ‚·Ú‡ÙËÙ·˜ ÙˆÓ ·ÛıÂÓÒÓ ∫ÏÈÓÈο Â˘Ú‹Ì·Ù·-∂ÎÙ›ÌËÛË ‚·Ú‡ÙËÙ·˜ ∞Ó·Ó. Û˘¯ÓfiÙËÙ·/min (M ± SD) K·Ú‰. Û˘¯ÓfiÙËÙ·/min (M ± SD) Score (‚·ıÌÔ›) (M ± SD) KÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ (M) ◊·Ú-„ËÏ·ÊËÙfi ≥2 cm (¡ Î·È % ·Ó·ÏÔÁ.) ¶˘ÚÂÙfi˜ ≥38ÔC (N Î·È % ·Ó·ÏÔÁ.)

∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ‰È·ÈÛÙÒıËÎÂ Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ Û fiÏ· Ù· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ Î·È Û 110/120 Ù˘ ÔÌ¿‰·˜ ∞ Î·È Ë ‰È·ÊÔÚ¿ ‰ÂÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋. ∂ÈÛÔÏΤ˜ ÌÂÛÔÏ¢ڛˆÓ ‰È·ÛÙËÌ¿ÙˆÓ ‹ ÂÈÁ·ÛÙÚ›Ô˘ ·ÚÔ˘Û›·Û·Ó 95 ·È‰È¿ (79%) ·fi Ù· 120 Ù˘ ÔÌ¿‰·˜ ∞ Î·È 11 (84,6%) ·fi Ù· 13 Ù˘ ÔÌ¿‰·˜ µ, fiÔ˘ ÛËÌÂÈÒıËÎ·Ó Î·È ÂÈÛÔÏΤ˜ ÛÊ·Á‹˜ ÏfiÁˆ Ù˘ ÂÈ‚·ÚË̤Ó˘ ηٿÛÙ·Û‹˜ ÙÔ˘˜. ∆Ô ÔÏÈÎfi ÎÏÈÓÈÎfi score ÂÎÙ›ÌËÛ˘ ‚·Ú‡ÙËÙ·˜ ‰‡ÛÓÔÈ·˜ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÛÙË µ ÔÌ¿‰· Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (p<0,01) (¶›Ó·Î·˜ 4). O ÎÔÚÂÛÌfi˜ ·ÈÌÔÛÊ·ÈÚ›Ó˘ Û Ô͢ÁfiÓÔ ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ ‹Ù·Ó ¯·ÌËÏfiÙÂÚÔ˜ ·fi ·˘ÙfiÓ Ù˘ ÔÌ¿‰·˜ ∞. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠ‹·Ú „ËÏ·ÊËÙfi >2 cm οو ·fi ÙÔ Ï¢ÚÈÎfi ÙfiÍÔ Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ Î·È ˘‹ÚÍ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p=0,002). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛËÌÂÈÒıËΠÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ Î·È ˆ˜ ÚÔ˜ ÙÔÓ ˘ÚÂÙfi (p<0,05).

EÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞ Î·È µ, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·ÚÈıÌfi Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Î·È Ù˘ ∆∫∂. ™ËÌÂÈÒıËΠfï˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË, Ë ÔÔ›· ·Ú·ÙËÚ‹ıËΠ۠ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÛÙ· ·È‰È¿ Ù˘ µ ÔÌ¿‰·˜ (p<0,005). ªÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ‚Ú¤ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ µ fiÔ˘ Ë AST ›¯Â ̤ÛË ÙÈÌ‹ 280,2 U/L, ÂÓÒ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ Ë Ì¤ÛË ÙÈÌ‹ ‹Ù·Ó 24,2 U/L Î·È Ë ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,02), ηıÒ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‹Ù·Ó Ë ‰È·ÊÔÚ¿ (p<0,04) Î·È ˆ˜ ÚÔ˜ ÙËÓ ALT, Ë ÔÔ›· ÛÙ· ·È‰È¿ Ù˘ µ ÔÌ¿‰·˜ ‚Ú¤ıËΠ̠̤ÛË ÙÈÌ‹ 132,1 U/L, ÂÓÒ ÛÙ˘ ÔÌ¿‰·˜ ∞ Ì ̤ÛË ÙÈÌ‹ 35,3 U/L. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ (p=0,012) ‚Ú¤ıËÎÂ Î·È ˆ˜ ÚÔ˜ ÙËÓ LDH, Ë ÔÔ›· ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ µ ÔÌ¿‰·˜ ‹Ù·Ó ˘„Ë-

OÌ¿‰· ∞

OÌ¿‰· µ

48,4 ± 1,1 136,1 ± 1,6 6,8 ± 0,7 93,6 23 (19,1) 50 (41,6)

56,5 ± 3,6 152,5 ± 3,7 10,4± 0,5 90,8 8 (61,5) 8 (61,5)

ÏfiÙÂÚË (̤ÛË ÙÈÌ‹ 720,2 u/L), Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ∞ (̤ÛË ÙÈÌ‹ 210,4 u/L). ∏ ̤ÛË ÙÈÌ‹ Ù˘ CPK ‹Ù·Ó 287,3 Î·È 52,9 ·ÓÙ›ÛÙÔȯ· ÛÙȘ ÔÌ¿‰Â˜ µ Î·È ∞ Î·È ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ (p=0,027). ∏ ÔÏÈ΋ IgE ‚Ú¤ıËΠ·ıÔÏÔÁÈ΋ Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi 34,2% ÛÙËÓ ÔÌ¿‰· ∞, ÂÓÒ ÛÙËÓ µ ÔÌ¿‰· ÙÔ ÔÛÔÛÙfi ·Ó¤Ú¯ÂÙ·È Û 15,4%. ∞fi ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Ù· ·ÔÙÂϤÛÌ·Ù· Ê·›ÓÔÓÙ·È Î·Ù¿ ÔÌ¿‰Â˜ ÛÙÔÓ ¶›Ó·Î· 5. O ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‚Ú¤ıËΠ۠53/133 ·ÛıÂÓ›˜ (ÔÛÔÛÙfi 39,7%). O RSV ‹Ù·Ó ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Oµ Û ÔÛÔÛÙfi 26,6%. ¢Â‡ÙÂÚÔ˜, ηٿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜, ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‚Ú¤ıËÎÂ Ô Èfi˜ Ù˘ ·Ú·˚ÓÊÏÔ˘¤ÓÙ˙·˜ 3 (ÔÛÔÛÙfi 3,7%) Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÔÈ ·‰ÂÓÔ˚Ô› Î·È ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Ì ›‰ÈÔ ÔÛÔÛÙfi (3%). O Èfi˜ Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ ∞ ‚Ú¤ıËΠ۠ÔÛÔÛÙfi 2,2% Î·È Ù¤ÏÔ˜ Ù· ¯Ï·Ì‡‰È· Û ÔÛÔÛÙfi 1,5%. ¢ÂÓ ‚Ú¤ıËΠÏԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ ·Ú·˚ÓÊÏÔ˘¤ÓÙ˙·˜ 1, ÈÓÊÏÔ˘¤ÓÙ˙·˜ µ, coxsackie A Î·È µ Î·È coxiella burnetti. OÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ· Oµ Î·È ∫™ ‚Ú¤ıËÎ·Ó Î·Ù¿ ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜: Ô RSV Ì ÔÛÔÛÙfi 2,3%, ÔÈ ·‰ÂÓÔ˚Ô› Î·È ÙÔ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ Ì ›‰ÈÔ ÔÛÔÛÙfi (7,6%). ™ÙÔ πÛÙfiÁÚ·ÌÌ· Ù˘ ∂ÈÎfiÓ·˜ 1 ·ÚÈÛÙ¿ÓÂÙ·È Ë Âԯȷ΋ ηٷÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜, fiÔ˘ ·Ú·ÙËÚÂ›Ù·È ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ηٿ ÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜, ÂÓÒ ÛÙËÓ ∂ÈÎfiÓ· 2 Ê·›ÓÂÙ·È Ë Û˘Û¯¤ÙÈÛË ∫™ Û ·È‰È¿ Ì Oµ Ì ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·, fiÔ˘ ‚Ú¤ıËÎ·Ó 3 ·È‰È¿ Ì RSV (ÂÎ ÙˆÓ ÔÔ›ˆÓ ÙÔ 1 ›¯Â ÂÚÈηډ›Ùȉ· Î·È Ù· 2 Ì˘Ôηډ›Ùȉ·), 1 Ì ·‰ÂÓÔ˚fi (ÂÚÈηډ›Ùȉ·) Î·È 1 ÌÂ Ì˘ÎfiÏ·ÛÌ· (Ì˘ÔÂÚÈηډ›Ùȉ·). ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜: ∫·Ù¿ ÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ·Ú·ÙËÚ‹ıËΠÌÂÁ·ÏÔηډ›· Û 11 (84,6%) ·fi Ù· 13 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ Î·È Û ηӤӷ ·È‰› Ù˘ ÔÌ¿‰·˜ ∞. ∞fi ÙÔÓ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ·Ú·ÙËÚ‹ıËÎ·Ó Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ Ì˘Ôηډ›Ùȉ· Û 6 ·È‰È¿ (4,5%), Ì ÂÚÈηډ›Ùȉ· Û 3 (2,2%) Î·È ÌÂ Ì˘ÔÂÚÈηډ›Ùȉ· Û 2 (1,5%). ªÂ ÙËÓ ˘ÂÚ˯ÔηډÈÔÁÚ·Ê›· ·Ú·ÙËÚ‹ıËÎÂ Ì˘Ôηډ›Ùȉ· Û 6 ·È‰È¿ (4,5%), ÂÚÈηډ›Ùȉ· Û 5 (3,8%) Î·È Ì˘ÔÂÚÈηډ›Ùȉ· Û 2 (1,5%). ∆Ô ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘

61

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¶›Ó·Î·˜ 5. ∞ÔÙÂϤÛÌ·Ù· ·fi ÙÔÓ ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ ∞ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜

RSV ∞‰ÂÓÔ˚Ô› ¶·Ú·˚ÓÊÏÔ˘¤ÓÙ˙· 1 ¶·Ú·˚ÓÊÏÔ˘¤ÓÙ˙· 3 πÓÊÏÔ˘¤ÓÙ˙· ∞ πÓÊÏÔ˘¤ÓÙ˙· µ Coxsackie A Coxsackie B ª˘ÎfiÏ·ÛÌ· Ó¢ÌÔÓ›·˜ ÃϷ̇‰È· Ó¢ÌÔÓ›·˜ Coxiella Burneti ™‡ÓÔÏÔ

OÌ¿‰· ∞ ∞ÚÈıÌfi˜ ¶ÔÛÔÛÙfi ·ÛıÂÓÒÓ % 120 32 3 0 5 3 0 0 0 3 2 0 48

26,6 2,5 4,1 2,5

2,5 1,6 39,8

·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (LVEF) ÛÙ· ·È‰È¿ ÌÂ Ì˘Ôηډ›Ùȉ· Î·È Ì˘ÔÂÚÈηډ›Ùȉ· ‚Ú¤ıËΠ¯·ÌËÏfi (¶›Ó·Î·˜ 6). ∫·Ù¿ ÙÔÓ ÚÒÙÔ Â·Ó¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓÂ, ηӤӷ ·È‰› Ù˘ ÔÌ¿‰·˜ ∞ ‰ÂÓ ·ÚÔ˘Û›·Û ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ Î·È ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ ηٿ ÙÔÓ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô, ÛËÌÂÈÒıËÎ·Ó Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ Ì˘Ôηډ›Ùȉ· Û 4 ·fi Ù· 6, ÂÚÈηډ›Ùȉ· Û 2 ·fi Ù· 5 Î·È Ì˘ÔÂÚÈηډ›Ùȉ· Î·È ÛÙ· 2 ·È‰È¿. ∆· ›‰È· ·ÎÚÈ‚Ò˜ Â˘Ú‹Ì·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙÔÓ ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô (¶›Ó·Î·˜ 7). ™Ù· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ, ÛÙ· ÔÔ›· ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛË, ÛËÌÂÈÒıËÎÂ Î·È ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛ˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ 45% ·fi ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô. ∫·Ù¿ ÙÔÓ ‰Â‡ÙÂÚÔ Â·Ó¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ Ì·˜, ÙÔ ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ·ÚÔ˘Û›·Û ·‡ÍËÛË ÛÙ· ·È‰È¿ Ì Oµ Î·È ∫™ 58%, ÂÎÙfi˜ ·fi 3 ·È‰È¿. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 7, ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ˘¿Ú¯Ô˘Ó Â˘Ú‹Ì·Ù· Ì˘Ôηډ›Ùȉ·˜ Û 2 Î·È Ì˘ÔÂÚÈηډ›Ùȉ·˜ Û 1 ·È‰›. ŒÁÈÓÂ Î·È ÙÚ›ÙÔ˜ Â·Ó¤ÏÂÁ¯Ô˜ ÛÙ· ÙÚ›· ·Ú·¿Óˆ ·È‰È¿, ÙÔÓ ¤ÌÙÔ Ì‹Ó· ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ Î·È ·Ú·ÙËÚ‹ıËΠÏ‹Ú˘ ·ÔηٿÛÙ·ÛË ÙˆÓ ÎÏÈÓÈÎÒÓ, ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎÒÓ Î·È ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ™˘˙‹ÙËÛË ∏ Ì˘Ôηډ›Ùȉ· Î·È Ë ÂÚÈηډ›Ùȉ· Â›Ó·È ‰‡Ô ȉȷ›ÙÂÚ· ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Û ·È‰È¿ Ì Oµ. ∏ ÚÒÙË ·Ú·Ù‹ÚËÛË ·fi ·˘Ù‹ ÙË ÌÂϤÙË ‹Ù·Ó fiÙÈ Ë ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ Oµ, Ì ‹ ¯ˆÚ›˜ ∫™, ‚Ú¤ıËΠÛÙ· ·ÁfiÚÈ· ËÏÈΛ·˜ <6 ÌËÓÒÓ. ∆· ·ÔÙÂϤÛÌ·Ù· Û˘ÌʈÓÔ‡Ó Ì ÂΛӷ ÚÔËÁÔ‡ÌÂÓˆÓ Û˘ÁÁڷʤˆÓ (3). ∏ Û˘Û¯¤ÙÈÛË Ù˘ ËÏÈΛ·˜ ÙˆÓ ·ÛıÂÓÒÓ Ì·˜ Ì ÙÔ Ê‡ÏÔ, Ì·˜ Ô‰ËÁÔ‡Ó ÛÙËÓ

62

OÌ¿‰· µ ∞ÚÈıÌfi˜ ¶ÔÛÔÛÙfi ·ÛıÂÓÒÓ % 13 3 1 0 0 0 0 0 0 1 0 0 5

23 7,6

7,6

38,2

OÌ¿‰· ∞+B ∞ÚÈıÌfi˜ ¶ÔÛÔÛÙfi ·ÛıÂÓÒÓ % 133 35 4 0 5 3 0 0 0 4 2 0 53

26,3 3 3,7 2,2

3 1,5 39,7

·Ú·Ù‹ÚËÛË fiÙÈ Ë ÌÈÎÚ‹ ËÏÈΛ· (οو ÙˆÓ 6 ÌËÓÒÓ) Î·È ÙÔ Ê‡ÏÔ (·ÁfiÚÈ·), ·ÔÙÂÏÔ‡Ó ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ‚·Ú‡ÙÂÚË ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Oµ. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ˘ÚÂÙfi ›¯Â ÙÔ 46,1% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ÙÔ 61,5% Ù˘ ÔÌ¿‰·˜ µ, ‰ËÏÒÓÂÈ fiÙÈ Î·È Ô ˘ÚÂÙfi˜ ÌÔÚ› Ó· ·ÔÙÂÏ› ÂÈ‚·Ú˘ÓÙÈÎfi ÛÙÔÈ¯Â›Ô ÁÈ· ∫™ Û ·È‰È¿ Ì Oµ. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ‰ÈÂÚ‡ÓËÛË, Ù·¯‡ÓÔÈ· (>60 ·Ó·ÓÔ¤˜/1 min) Î·È Ù·¯˘Î·Ú‰›· (>180 ÛʇÍÂȘ/1 min) ÛËÌÂÈÒıËÎ·Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞, ηıÒ˜ Ô ÂÎÓ¢ÛÙÈÎfi˜ Û˘ÚÈÁÌfi˜ Î·È Ë ¯Ú‹ÛË ÂÈÎÔ˘ÚÈÎÒÓ Ì˘ÒÓ. ∆Ô ÔÏÈÎfi ÎÏÈÓÈÎfi score ‚Ú¤ıËΠÌÂÁ·Ï‡ÙÂÚÔ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ µ Î·È Ë ÙÈÌ‹ SaO2 ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ. ™Â ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÛËÌÂÈÒıËÎÂ Ë „ËÏ¿ÊËÛË ‹·ÙÔ˜ (>2 cm οو ·fi ÙÔ Ï¢ÚÈÎfi ÙfiÍÔ) ÛÙËÓ ÔÌ¿‰· µ. ¶·ÚfiÌÔÈ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ·Ó·Ê¤ÚÔ˘Ó ÔÈ ∆homas Î·È Û˘Ó Û ‰‡Ô ÂÚÈÙÒÛÂȘ Oµ Ì ·ÚÚ˘ıÌ›· (8). ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ·ÈÌ·ÙÔÏÔÁÈÎfi Î·È ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ Ì ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÛË, ηıÒ˜ Î·È Ù˘ AST, ALT, LDH, CPK ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ (ÌÂ Ì˘Ôηډ›Ùȉ· Î·È Ì˘ÔÂÚÈηډ›Ùȉ·). ¶·ÚfiÌÔÈ· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ›¯·Ó ÔÈ Gowrishankar Î·È Û˘Ó (21).

O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·¤‚Ë ıÂÙÈÎfi˜ Û 53/133 ·È‰È¿ (39,7%) Ô˘ ÓÔÛËχıËÎ·Ó ÛÙËÓ ∫ÏÈÓÈ΋ Ì·˜ Ì Oµ. ™Â ¿ÏϘ ÌÂϤÙ˜, ÙÔ ÔÛÔÛÙfi Î˘Ì·›ÓÂÙ·È Â˘Ú¤ˆ˜ ·fi 14-74% (13,26). ™Â ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ô RSV ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· (14,22). ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ›¯·ÌÂ Î·È ÛÙË ‰È΋ Ì·˜ ÌÂϤÙË. ∞fi ÙÔ˘˜ ηډÈÔÙÚfiÔ˘˜ ÈÔ‡˜, ΢ڛˆ˜ ÔÈ ÂÓÙÂÚÔ˚Ô› ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ∫™. ¶ÚÒÙÔÈ ÔÈ Silver ηÈ

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35 24

30 25 20

21

∞

18

17

15

µ 12

10 9 6

6

5

4

1

2

2

0 ¡

¢

π

º

ª

∞

ª

∞

∂ÈÎfiÓ· 1. ∂ԯȷ΋ ηٷÓÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È µ.

RSV ·‰ÂÓÔ˚fi Ì˘ÎfiÏ·ÛÌ· ˘fiÏÔÈÔ

6 5

2 1

4 1

3 2

3

4 1

1 1

0 ÂÚÈηډ.

Ì˘Ôηډ.

Ì˘ÔÂÚÈÎ.

∂ÈÎfiÓ· 2. ™˘Û¯¤ÙÈÛË Î·Ú‰È·Î‹˜ Û˘ÌÌÂÙÔ¯‹˜ ÛÙËÓ ÔÍ›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· Ì ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·.

Û˘Ó (23) ·Ó¤ÊÂÚ·Ó ˆ˜ ÔÈ ·Ó·Ó¢ÛÙÈÎÔ› ÈÔ› ¢ı‡ÓÔÓÙ·È ÁÈ· Â›ÎÙËÙË Î·Ú‰È·Î‹ ÓfiÛÔ. ∞ÚÁfiÙÂÚ·, ·fi ÙÔÓ Adams (24) ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Ì˘ÔÂÚÈηډ›Ùȉ·˜ Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 6 ÂÙÒÓ ÌÂÙ¿ ·fi Ïԛ̈ÍË Ì ÙÔÓ Èfi Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ µ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, ·fi ÙÔÓ Hilleman (10), ·Ó·Ê¤ÚÂÙ·È Î·Ú‰È·Î‹ ÚÔÛ‚ÔÏ‹ ·fi ÙÔÓ RSV. OÈ Puchkov Î·È Û˘Ó (25) ·Ó·Ê¤ÚÔ˘Ó ÂÚ›ÙˆÛË Ì˘Ôηډ›Ùȉ·˜ ·fi ÙÔÓ RSV, ηıÒ˜ Î·È ÔÈ Gilesman Î·È Û˘Ó (26). ¶ÚfiÛÊ·Ù· ·fi ÙÔ˘˜ Thomas Î·È Û˘Ó (8) ÂÚÈÁÚ¿ÊËΠOµ Î·È ∫™ Û 2 ‚Ú¤ÊË ÌÂÙ¿ ·fi Ïԛ̈ÍË Ì ÙÔÓ RSV. OÈ Gouton Î·È Û˘Ó (22) Û ̛· ÌÂϤÙË Ô˘ ¤Î·Ó·Ó ‚Ú‹Î·Ó ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Û 37% ÙˆÓ ·È‰ÈÒÓ ÌÂ Ì˘Ôηډ›Ùȉ·, ·fi Ù· ÔÔ›· 73% ‹Ù·Ó ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜. ™ÙË ‰È΋ Ì·˜ ÌÂϤÙË, ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙ· ·È‰È¿ Ì Oµ Î·È ∫™

‚Ú¤ıËΠ۠5 ·È‰È¿ (38,2%). ¢ÂÓ ˘¿Ú¯Ô˘Ó ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘Û¯¤ÙÈÛË ∫™ Û ·È‰È¿ Ì Oµ ·Ó·ÊÔÚÈο Ì ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ·, ·Ú¿ ÌfiÓÔ ÂÚÈÁÚ·Ê‹ ÂÏ¿¯ÈÛÙˆÓ ÂÚÈÙÒÛÂˆÓ (22,27-30). ™ÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‰È·ÈÛÙÒıËΠÌÂÁ·ÏÔηډ›· Û 11 ·fi Ù· 13 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ Î·È Û ηӤӷ ·È‰› Ù˘ ÔÌ¿‰·˜ ∞. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ‰È·ÁÓˆÛÙÈ΋ Ù˘ ·Í›· ·Ó¤Ú¯ÂÙ·È ÛÙÔ 84,6% ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ∫™ Û ·È‰È¿ Ì Oµ. ªÂ ÙÔÓ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ·Ú·ÙËÚ‹ıËÎ·Ó Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ ÌÂ Ì˘Ôηډ›Ùȉ· Û 6 ·È‰È¿, Ì ÂÚÈηډ›Ùȉ· Û 3 Î·È ÌÂ Ì˘ÔÂÚÈηډ›Ùȉ· Û 2. ™˘ÓÂÒ˜, Ë ‰È·ÁÓˆÛÙÈ΋ ÙÔ˘ ·Í›· ·Ó¤Ú¯ÂÙ·È ÌfiÏȘ ÛÙÔ 60%. ∆Ô ECHO ‹Ù·Ó ‰È·ÁÓˆÛÙÈÎfi ÛÙȘ 13/13 ÂÚÈÙÒÛÂȘ ·ÛıÂÓÒÓ Ì·˜ Ì ∫™. ø˜ ÚÔ˜ ÙËÓ ÂÚÈηډ›Ùȉ· ÂȂ‚·ÈÒÓÂÙ·È Î·È Ì ÙË ‰È΋ Ì·˜ ÌÂϤÙË Ë ‰ÈÂıÓÒ˜ ·Ú·‰ÂÎÙ‹ ·fiÏ˘ÙË ‰È·ÁÓˆÛÙÈ΋ ·Í›· Ù˘ ˘ÂÚ˯ÔηډÈÔÁÚ·Ê›·˜ (EÈÎfiÓ· 3). ø˜ ÚÔ˜ ÙË Ì˘Ôηډ›Ùȉ· fï˜, Ô ÌÈÎÚfi˜ ·ÚÈıÌfi˜ ÙˆÓ ·Û¯fiÓÙˆÓ Î·È Ë ÌÂıÔ‰ÔÏÔÁ›· Ù˘ ÌÂϤÙ˘ Ì·˜ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ÙËÓ ÂÍ·ÁˆÁ‹ ·ÚfiÌÔÈÔ˘ Û˘ÌÂÚ¿ÛÌ·ÙÔ˜ (EÈÎfiÓ· 3). ¶ÚÒÙÔÈ ÔÈ Henderson Î·È Û˘Ó (11) ÌÂϤÙËÛ·Ó ·È‰È¿ Ì Oµ Ì ¤ÌÊ·ÛË ÛÙȘ ηډȷΤ˜ ÂÈÏÔΤ˜ Î·È ·ÚÁfiÙÂÚ· ÔÈ Scott Î·È Û˘Ó (12). ¶ÚfiÛÊ·Ù· ·Ó·Ê¤ÚÂÙ·È ·fi ÙÔ˘˜ Thomas Î·È Û˘Ó (8) ·ÂÈÎÔÓÈÛÙÈÎfi˜ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û 2 ‚Ú¤ÊË Ô˘ ÓÔÛËχıËÎ·Ó Ì Oµ Î·È ∫™. ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô, Ù· Â˘Ú‹Ì·Ù· ‹Ù·Ó ÈηÓÔÔÈËÙÈο. ¢¤Î· ·È‰È¿ ›¯·Ó Ï‹ÚË ·ÔηٿÛÙ·ÛË Î·È ÌfiÓÔ 3 (2,2%) ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ¤¯Ô˘Ó Â˘Ú‹Ì·Ù· ηډȷ΋˜ ÚÔÛ‚ÔÏ‹˜ Î·È ·Ó·Ï˘ÙÈÎfiÙÂÚ·, Ì˘Ôηډ›Ùȉ· 1 Î·È Ì˘ÔÂÚÈηډ›Ùȉ· 2 ·È‰È¿, ÂÓÒ ÙÔ

63

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¶›Ó·Î·˜ 6. ¢È·Î‡Ì·ÓÛË Î·È Ì¤ÛË ÙÈÌ‹ ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (LVEF) ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ ∞ Î·È µ ∫Ï¿ÛÌ· ÂÍÒıËÛ˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (LVEF) ªÈÎÚfiÙÂÚË ÙÈÌ‹ (%) ªÂÁ·Ï‡ÙÂÚË ÙÈÌ‹ (%) ª¤ÛË ÙÈÌ‹ (%) OÌ¿‰· ·ÛıÂÓÒÓ ∞ OÌ¿‰· ·ÛıÂÓÒÓ µ

58,64 22,18

73,14 36,22

63,32 30,14

¶›Ó·Î·˜ 7. ∂˘Ú‹Ì·Ù· ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈο Î·È ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈο ηٿ ÙÔÓ 1Ô, 2Ô Î·È 3Ô Â·Ó¤ÏÂÁ¯Ô OÌ¿‰·˜ ·ÛıÂÓÒÓ ∞ + µ (∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ 133) 1Ô˜ Â·Ó¤ÏÂÁ¯Ô˜ 2Ô˜ Â·Ó¤ÏÂÁ¯Ô˜ 3Ô˜ Â·Ó¤ÏÂÁ¯Ô˜ 15Ë Ë̤ڷ 60Ë Ë̤ڷ 5Ô˜ Ì‹Ó·˜ ª˘Ôηډ›Ùȉ· (∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ) ¶ÂÚÈηډ›Ùȉ· (∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ) ª˘ÔÂÚÈηډ›Ùȉ· (∞ÚÈıÌfi˜ ·ÛıÂÓÒÓ)

4 2 2

∂ÈÎfiÓ· 3. ∞ (¿Óˆ). ∂ÎÛÂÛËÌ·Ṳ̂ÓË ‰È¿Ù·ÛË Î·È ·ıÔÏÔÁÈÎÔ› ‰Â›ÎÙ˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∞ÁfiÚÈ ËÏÈΛ·˜ 4 ÌËÓÒÓ Ù˘ ÌÂϤÙ˘ Ì·˜ Ô˘ ÂÌÊ¿ÓÈÛÂ Ì˘Ôηډ›Ùȉ· ÌÂÙ¿ ·fi ‚ÚÔÁ¯ÈÔÏ›Ùȉ·, Ë ÔÔ›· ‰ÂÓ ÂÍÂÏ›¯ıËΠ۠‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. µ (οو). ¶ÂÚÈηډȷ΋ Û˘ÏÏÔÁ‹ Û ·ÁfiÚÈ ËÏÈΛ·˜ 23 ÌËÓÒÓ Ù˘ ÌÂϤÙ˘ Ì·˜.

64

2 1

-

ÎÏ¿ÛÌ· ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ‰ÂÓ ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Û˘ÁÎÚÈÙÈο Ì ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ¤ÏÂÁ¯Ô. ™ÙÔÓ ÙÚ›ÙÔ Â·Ó¤ÏÂÁ¯Ô, 5 Ì‹Ó˜ ·ÚÁfiÙÂÚ·, ·Ú·ÙËÚ‹ıËΠÏ‹Ú˘ ·ÔηٿÛÙ·ÛË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ. ∆· Â˘Ú‹Ì·Ù¿ Ì·˜ Û˘ÌʈÓÔ‡Ó Ì ٷ Â˘Ú‹Ì·Ù· ÚÔËÁÔ‡ÌÂÓˆÓ ÂÚ¢ÓËÙÒÓ (31-33). ∞ÛıÂÓ›˜ ÌÂ Ì˘Ôηډ›Ùȉ·, Â¿Ó ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÂÍÒıËÛ˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Û ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (10,35). ∞Ó Î·È ‰ÂÓ ÂÌ›ÙÔ˘Ó ÛÙÔÓ Î›Ó‰˘ÓÔ ·˘Ùfi, Û˘Ó¯›˙ÂÙ·È Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚfiÌÂÓˆÓ ‰ÈÎÒÓ Ì·˜ ·ÛıÂÓÒÓ Û ·Ú·È¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·. ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ Û˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· Û˘Ó‡·Ú͢ ηډȷ΋˜ ÚÔÛ‚ÔÏ‹˜ (9,8%) Û ·È‰È¿ Ì Oµ Î·È fiÙÈ ÔÈ ›‰ÈÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È Î·È ÁÈ· ∫™. ¢ÂÓ ˘¿Ú¯Ô˘Ó Â·Ú΋ ÛÙÔȯ›· ÁÈ· Ó· ÛÙËÚ›ÍÔ˘Ì ÙËÓ ˘fiıÂÛË fiÙÈ ÔÈ ·Ó·Ó¢ÛÙÈÎÔ› ÈÔ› ÚÔÛ‚¿ÏÏÔ˘Ó ¿ÌÂÛ· ÙÔ Ì˘ÔοډÈÔ. µÈÔ„›· Ì˘Ôηډ›Ô˘ ‰ÂÓ ¤ÁÈÓ Û ηӤӷ ·È‰› Î·È ‰ÂÓ ÎÚ›ıËΠ‰ÂÔÓÙÔÏÔÁÈο ÛÎfiÈÌË. ∏ ·‰˘Ó·Ì›· Ì·˜ Ó· ηÏÏÈÂÚÁ‹ÛÔ˘Ì ÙÔ˘˜ ·Ó·Ó¢ÛÙÈÎÔ‡˜ ÈÔ‡˜ ‹ Ó· ÙÔ˘˜ ·ÓȯÓ‡ÛÔ˘Ì Ì ÙË Ì¤ıÔ‰Ô Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ ‰ÂÓ Ì·˜ Â¤ÙÚ„ ӷ ÂȂ‚·ÈÒÛÔ˘ÌÂ Î·È Ì ÙȘ ÌÂıfi‰Ô˘˜ ·˘Ù¤˜ Ù· Â˘Ú‹Ì·Ù¿ Ì·˜. ¶ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ÂȂ‚·Èˆı› Î·È Ó· ηٷÓÔËı› Ë ·ıÔÁ¤ÓÂÈ· Ù˘ Ì˘Ôηډ›Ùȉ·˜ Î·È Ù˘ ÂÚÈηډ›Ùȉ·˜ ·fi ·Ó·Ó¢ÛÙÈÎÔ‡˜ ÈÔ‡˜ ÛÙ· ·È‰È¿. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙËÓ Î˘Ú›· ∞ÚÂÙ‹ ÛÙÔÁÏÔ˘-ª·Î¤‰Ô˘, ∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ·, ˘‡ı˘ÓË ÙÔ˘ ªÈÎÚÔ‚ÈÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Ù˘ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞.¶.£. ÁÈ· ÙËÓ

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¿ÌÂÛË Û˘Ì‚ÔÏ‹ Ù˘, ÙȘ Ù¯ÓÔÏfiÁÔ˘˜ ÙÔ˘ ªÈÎÚÔ‚ÈÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘, ηıÒ˜ Î·È ÙËÓ Ù¯ÓÔÏfiÁÔ ÙÔ˘ ÀÂÚ˯ÔηډÈÔÁÚ·ÊÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Ù˘ ¢’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∞.¶.£.

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33. Torres F, Anquita M, Tejero I, Gimenez D, Franco M, Zayas R et al. Acute myocarditis with severe cardiac dysfunction in the pediatric population. The evolution and differential characteristics with respect to adult myocarditis. Rev Esp Cardiol 1995;48:660-665.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 11-07-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘ µ·Û. ŸÏÁ·˜ 85, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË

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Paediatriki 2002;65:66-76

AWARD-WINNING ARTICLE

¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ Û ·È‰È¿ ‰ËÌÔÙÈÎÔ‡ Ù˘ ∫Ú‹Ù˘ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÂÍ·ÂÙÔ‡˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜* °. ª·ÓÈfi˜, π. ªÔÛ¯·Ó‰Ú¤·, Ã. ÷Ù˙‹˜, ∞. ∫·Ê¿ÙÔ˜

Chronic disease risk factors in primary school children of Crete following a six year health and nutrition education intervention program* Y. Manios, I. Moschandrea, C. Hatzis, A. Kafatos

¶ÂÚ›ÏË„Ë: ¶ÔÏÏ¿ ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÈ Ú›˙˜ ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ηٿ ÙËÓ ÔÔ›· ·ÔÎÙÒÓÙ·È Û˘ÌÂÚÈÊÔÚ¤˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘Á›·. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ô Û¯Â‰È·ÛÌfi˜, Ë ÂÊ·ÚÌÔÁ‹ Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÂÓfi˜ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÁÈ· ÙËÓ ˘Á›· Î·È ÙË ‰È·ÙÚÔÊ‹ Û ·È‰È¿ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ù˘ ∫Ú‹Ù˘. ∆Ô ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘ ÂÊ·ÚÌfiÛÙËΠ۠fiÏ· Ù· ·È‰È¿ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ÚÒÙË ‰ËÌÔÙÈÎÔ‡ Û ‰‡Ô ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘ ÙÔ 1992 Î·È Â›¯Â Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· ¤ÍÈ ÂÙÒÓ, ÂÓÒ Ù· ·È‰È¿ Ô˘ ÁÚ¿ÊÙËÎ·Ó Û ¤Ó· ÙÚ›ÙÔ ÓÔÌfi ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. °È· Ó· ·ÍÈÔÏÔÁËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ú¤Ì‚·Û˘, ÌÂÙÚ‹ıËÎ·Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ‚ÈÔÏÔÁÈΤ˜ ·Ú¿ÌÂÙÚÔÈ Î·È ·Ú¿ÌÂÙÚÔÈ Û˘ÌÂÚÈÊÔÚ¿˜ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Î·È ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÂÍ·ÂÙÔ‡˜ ·Ú¤Ì‚·Û˘ ÛÂ Ù˘¯·›· ÂÈÏÂÁ̤ÓÔ ‰Â›ÁÌ· 602 Ì·ıËÙÒÓ ·fi ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È 444 Ì·ıËÙÒÓ ·fi ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. OÈ ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÁÂÓÈο ‚ÂÏÙÈÒıËÎ·Ó ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ ηٿ ÙËÓ ÂÍ·ÂÙ›·. OÌÔ›ˆ˜, ÔÈ ·ÏÏ·Á¤˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ¢ÓÔÔ‡Û·Ó ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘. ∏ Û˘ÓÔÏÈ΋ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È Ë Î·Ù·Ó¿ÏˆÛË Ï›Ô˘˜ Î·È ÎÔÚÂṲ̂ÓÔ˘ Ï›Ô˘˜ ·˘Í‹ıËΠÛËÌ·ÓÙÈο ÏÈÁfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. O ¯ÚfiÓÔ˜ Ô˘ ·ÊÈÂÚÒıËΠÛÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, ηıÒ˜ Î·È ÔÈ ÂȉfiÛÂȘ

Abstract: There is abundant evidence that the roots of chronic disease lie in childhood, during which time certain health related behaviors are established. The objective of the current study was to design, implement and assess the effectiveness of a health and nutrition education program undertaken in primary schools in Crete. The school-based intervention program was applied to all children registered in first grade in 1992 in two counties of Crete and had a total duration of six years. Children registered in a third county served as a control group. In order to assess the effectiveness of the intervention, a variety of biological and behavioral parameters were measured prior to and following completion of the intervention in a randomly selected school-based sample of 602 intervention group and 444 control group pupils. Our results showed that the biochemical indices generally improved significantly more in the intervention group, as compared to the controls, over the six-year period.

Similarly, the changes observed in the anthropometric variables in the two groups were in favor of the intervention group. Total energy intake and consumption of total fat and saturated fat increased significantly less in the intervention group, as compared to the control, while time devoted to leisure time physical activity and cardiovascular run test performance increased significantly more in the intervention group. In conclusion, the positive changes in several of the chronic disease risk factors observed in the present

∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ ∫ÏÈÓÈ΋ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ ∆Ì‹Ì· π·ÙÚÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ *µÚ·‚Â›Ô ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ 39Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2001

Department of Social Medicine Preventive Medicine and Nutrition Clinic University of Crete Medical School *1st Prize of Social Pediatrics 39th Panhellenic Pediatric Meeting, 2001

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ÛÙȘ ‰ÔÎÈ̷ۛ˜ ·ÓÙÔ¯‹˜ ·˘Í‹ıËÎ·Ó ÛËÌ·ÓÙÈο ÂÚÈÛÛfiÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ıÂÙÈΤ˜ ·ÏÏ·Á¤˜ Û ÔÏÏÔ‡˜ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ, ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙÔÓ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ Ô˘ ÌÔÚÔ‡Ó Ó· ‰È·‰Ú·Ì·Ù›ÛÔ˘Ó ÚÔÁÚ¿ÌÌ·Ù· ·ÁˆÁ‹˜ ˘Á›·˜ Î·È ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ Î·È ÂÓı·ÚÚ‡ÓÔ˘Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù¤ÙÔÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÛÙ· Û¯ÔÏ›· fiÏ˘ Ù˘ ÂÈÎÚ¿ÙÂÈ·˜.

study, underline the significant role of health education and nutrition programs in health promotion and prevention of chronic diseases, and encourage the implementation of such programs in all the schools of the country.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÁˆÁ‹ ˘Á›·˜, ·È‰È¿, ¯ÔÏËÛÙÂÚfiÏË, ·¯˘Û·ÚΛ·, ıÚÂÙÈο Û˘ÛÙ·ÙÈο, ‰›·ÈÙ·, ¿ÛÎËÛË, Ê˘ÛÈ΋ ηٿÛÙ·ÛË.

Key words: health education, children, cholesterol, obesity, nutrients, diet, exercise, fitness.

™˘ÓÙÔÌÔÁڷʛ˜

ÚÒÙˆÓ ¯ÚfiÓˆÓ Ù˘ ·Ú¤Ì‚·Û˘ ¤¯Ô˘Ó ‹‰Ë ‰ËÌÔÛÈ¢ı› ÛÙËÓ ∂ÏÏ¿‰· Î·È ÛÙÔ Â͈ÙÂÚÈÎfi (3,4). ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜, ¤ÍÈ ¯ÚfiÓÈ· ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÙ‹ÛÈ·˜ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›·.

¢ª™ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ USDA United States Department of Agriculture MUFA Monounsaturated fatty acids (ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·) PUFA Polyunsaturated fatty acids (¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ·) SFA Saturated fatty acids (∫ÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ·)

∂ÈÛ·ÁˆÁ‹ ∏ ·ÁˆÁ‹ ˘Á›·˜ Î·È ‰È·ÙÚÔÊ‹˜ ÛÙËÓ ∂ÏÏ¿‰· ÚfiÛÊ·Ù· ÌfiÓÔ ¤¯ÂÈ ·Ú¯›ÛÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È ÛÔ‚·Ú¿ ˆ˜ Ë ÌfiÓË Ï‡ÛË ÁÈ· ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ÂÏ¿ÙÙˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÙÔ˘ ÂÏÏËÓÈÎÔ‡ ÏËı˘ÛÌÔ‡. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi Î·È ·Ú¿ Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÌÂÚÈÎÒÓ ÚˆÙÔ‚Ô˘ÏÈÒÓ ÌÈÎÚ‹˜ Îϛ̷η˜ (1,2), ‰ÂÓ ˘¿Ú¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÛÙËÓ ∂ÏÏ¿‰· ÂıÓÈ΋ ÔÏÈÙÈ΋ ÁÈ· ÙËÓ ·ÁˆÁ‹ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· ˆ˜ ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙˆÓ ·Ó·ÌÂÓfiÌÂÓˆÓ ·˘ÍËÌ¤ÓˆÓ ‰ÂÈÎÙÒÓ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ·fi ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. O ∆Ô̤·˜ ∫ÔÈÓˆÓÈ΋˜ π·ÙÚÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÍÂΛÓËÛ ¤Ó· ÂÎ·È‰Â˘ÙÈÎfi ÚfiÁÚ·ÌÌ· ÁÈ· ÙËÓ ˘Á›·, ÙË ‰È·ÙÚÔÊ‹ Î·È ÙËÓ ¿ıÏËÛË ÙÔ 1992. ∆Ô ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘, ÙÔ ÔÔ›Ô Â›¯Â ÚÔ‚ÏÂfiÌÂÓË ‰È¿ÚÎÂÈ· ¤ÍÈ ¤ÙË, ÍÂΛÓËÛÂ Î·È ·Ó·Ù‡¯ıËΠÁÈ· Ó· ηÏÏÈÂÚÁ‹ÛÂÈ Î·Ï¤˜ Û˘Ó‹ıÂȘ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ˘Á›·, ÙË ‰È·ÙÚÔÊ‹ Î·È ÁÂÓÈο ÙÔÓ ÙÚfiÔ ˙ˆ‹˜ ÛÙ· ·È‰È¿, Ì ·ÒÙÂÚÔ ÛÙfi¯Ô ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ÙËÓ ÂÏ·¯ÈÛÙÔÔ›ËÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·. ∆Ô ÚfiÁÚ·ÌÌ· ·˘Ùfi Â›Ó·È Ì›· ·fi ÙȘ ϤÔÓ Ì·ÎÚÔÚfiıÂÛ̘ ÚÔÛ¿ıÂȘ ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· ÙË Ï‹„Ë Â·ÚÎÒÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÁÈ· ÙËÓ ˘Á›· Ô˘ ÂÊ·ÚÌfiÛÙËΠÛÙ· ‰ËÌÔÙÈο Û¯ÔÏ›·. O ۯ‰ȷÛÌfi˜, Ë ÂÊ·ÚÌÔÁ‹ Î·È Ù· ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÙÚÈÒÓ

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆Ô ÚfiÁÚ·ÌÌ· ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜ ÍÂΛÓËÛ ÙÔ ™Â٤̂ÚÈÔ ÙÔ˘ 1992 Ì ÙËÓ ¤ÁÎÚÈÛË ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ¶·È‰Â›·˜. ∏ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 4171 ·È‰ÈÒÓ Ô˘ ÁÚ¿ÊÙËÎ·Ó ÛÙËÓ ÚÒÙË Ù¿ÍË ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Û¯ÔÏ›Ԣ Û ‰‡Ô ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘ ÙÔ ™Â٤̂ÚÈÔ ÙÔ˘ 1992, ÂÓÒ ÙÔ Û‡ÓÔÏÔ ÙˆÓ 1510 ·È‰ÈÒÓ Ô˘ ÁÚ¿ÊÙËÎ·Ó Û ¤Ó· ÙÚ›ÙÔ ÓÔÌfi ·ÔÙ¤ÏÂÛ ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ŒÓ· Ù˘¯·›Ô ‰Â›ÁÌ· ·fi 24 Û¯ÔÏ›· (602 Ì·ıËÙ¤˜) ÂÈϤ¯ıËΠÛÙÔ˘˜ ÓÔÌÔ‡˜ ·Ú¤Ì‚·Û˘ ∏Ú·ÎÏ›Ԣ Î·È ƒÂı‡ÌÓÔ˘ ÁÈ· Ó· ·ÍÈÔÏÔÁËı› Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜. ¶·ÚÔÌÔ›ˆ˜, 16 Ù˘¯·ÈÔÔÈË̤ӷ Û¯ÔÏ›· (444 Ì·ıËÙ¤˜) ÂÈϤ¯ıËÎ·Ó ÛÙÔ ÓÔÌfi ÷ӛˆÓ Î·È ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. °È· Ó· ˘¿Ú¯ÂÈ ·ÓÙÈÛÙÔȯ›· ÛÙË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ ÙÔ˘ ÏËı˘ÛÌÔ‡, ÙÔ 49,8% ·˘ÙÒÓ ÙˆÓ Ì·ıËÙÒÓ ÚÔ‹Ïı ·fi ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ (fiÏÂȘ Ì ÏËı˘ÛÌfi ¿Óˆ ÙˆÓ 4000 ηÙԛΈÓ) Î·È ÙÔ 50,2% ÚÔ‹Ïı ·fi ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ (¯ˆÚÈ¿ Ì ÏËı˘ÛÌfi οو ÙˆÓ 4000 ηÙԛΈÓ). µ¿ÛÂÈ ÙˆÓ ÛÙÔȯ›ˆÓ Ù˘ ∂ıÓÈ΋˜ ™Ù·ÙÈÛÙÈ΋˜ ÀËÚÂÛ›·˜ (·ÔÁÚ·Ê‹ 1991) ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÏËı˘ÛÌÒÓ ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÓÔÌÒÓ ÙÔ˘ ÓËÛÈÔ‡ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÎ·›‰Â˘ÛË, ÙÔ ÂÈÛfi‰ËÌ·, Ù· ÔÛÔÛÙ¿ ·ÓÂÚÁ›·˜ Î·È ÙËÓ ËÏÈÎȷ΋ ηٷÓÔÌ‹. ∞ÓÙ›ıÂÙ·, ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ Û fiϘ ÙȘ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂٷ͇ ÙˆÓ ·ÛÙÈÎÒÓ Î·È ÙÔ˘ÚÈÛÙÈο ·Ó·Ù˘ÁÌ¤ÓˆÓ ·Ú·ı·Ï¿ÛÛÈˆÓ ÂÚÈÔ¯ÒÓ ÙÔ˘ ÓËÛÈÔ‡ Î·È ÙˆÓ ·ÁÚÔÙÈÎÒÓ, ÔÚÂÈÓÒÓ Î·È ÏÈÁfiÙÂÚÔ ÙÔ˘ÚÈÛÙÈο ·Ó·Ù˘ÁÌ¤ÓˆÓ ÂÚÈÔ¯ÒÓ, ·Ú¿ÌÂÙÚÔ˜ Ô˘ Û˘Ó˘ÔÏÔÁ›ÛÙËΠÛÙËÓ ÂÈÏÔÁ‹ ÙˆÓ Û¯ÔÏ›ˆÓ. ¶ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘, ¤ÁÈÓ Ï‹Ú˘ ·È‰È·ÙÚÈ΋ ÂͤٷÛË ÛÙÔ Ù˘¯·ÈÔÔÈË̤ÓÔ ‰Â›ÁÌ·

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¶·È‰È·ÙÚÈ΋ 2002;65:66-76

‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Ô˘ ›¯·Ó ÂÈÏÂÁ› ·fi ÙÔ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙˆÓ ÙÚÈÒÓ ÓÔÌÒÓ Ù˘ ∫Ú‹Ù˘. ∏ ÚÒÙË ÂͤٷÛË ¤ÁÈÓ fiÙ·Ó Ù· ·È‰È¿ ‹Ù·Ó ÛÙËÓ ÚÒÙË ‰ËÌÔÙÈÎÔ‡ (™Â٤̂ÚÈÔ˜-¡Ô¤Ì‚ÚÈÔ˜ 1992) Î·È Â·Ó·Ï‹ÊıËΠfiÙ·Ó Ù· ·È‰È¿ ‹Ù·Ó ÛÙËÓ ¤ÎÙË ‰ËÌÔÙÈÎÔ‡ (ª¿ÈÔ˜πÔ‡ÓÈÔ˜ 1998). ∂›Û˘, ¤ÁÈÓ ·ÍÈÔÏfiÁËÛË Î·È ÂӉȿÌÂÛ·, fiÙ·Ó Ù· ·È‰È¿ ‹Ù·Ó ÛÙËÓ ÙÚ›ÙË ‰ËÌÔÙÈÎÔ‡. ¶ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘ ‰fiıËΠÁÚ¿ÌÌ· Û οı ÔÈÎÔÁ¤ÓÂÈ· Ì Ï‹ÚË ÂÚÈÁÚ·Ê‹ ÙˆÓ ÛÙfi¯ˆÓ, ÙˆÓ ÂÍÂÙ¿ÛÂˆÓ Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ·È‰› Î·È ÙˆÓ ·Ó·ÌÂÓfiÌÂÓˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ô˘ ı· ¤·ÈÚÓ·Ó Ù· ·È‰È¿ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÂͤٷÛ˘ Î·È ˙ËÙ‹ıËΠ·fi ÙÔ˘˜ ÁÔÓ›˜ Ó· ˘ÔÁÚ¿„Ô˘Ó fiÙÈ Û˘ÌʈÓÔ‡Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó Ù· ·È‰È¿ ÙÔ˘˜ ÛÙÔ ÚfiÁÚ·ÌÌ·. ∏ Û˘ÏÏÔÁ‹ ÙˆÓ ÛÙÔȯ›ˆÓ ÁÈÓfiÙ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÚˆÈÓÒÓ ÂÈÛΤ„ÂˆÓ ÛÙ· Û¯ÔÏ›· Î·È Î¿ı ̤ڷ ÂÍÂÙ¿˙ÔÓÙ·Ó ÙÔ Ôχ 30 Ì·ıËÙ¤˜ Î·È ÔÈ ÁÔÓ›˜ ÙÔ˘˜ ·fi Ì›· ÌÂÁ¿ÏË ÔÌ¿‰· ‹ ‰‡Ô ÌÈÎÚfiÙÂÚ˜ ÔÌ¿‰Â˜ ÂÎ·È‰Â˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘. ∆· ÛÙÔȯ›· Ô˘ Û˘ÏϤ¯ıËÎ·Ó ·fi Ù· ·È‰È¿ (Î·È ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘) ‹Ù·Ó ÂÎÙÈÌ‹ÛÂȘ ÙˆÓ ÁÓÒÛÂˆÓ ÁÈ· ÙËÓ ˘Á›·, Û˘Ó‹ıÂȘ ‰È·ÙÚÔÊ‹˜, ÏÂÙÔÌÂÚ‹˜ ηٷÁÚ·Ê‹ Ù˘ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ, ‰Â›ÎÙ˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ Î·È ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ ·›Ì·ÙÔ˜. °È· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ Ì·ıËÙÒÓ Û ı¤Ì·Ù· ˘Á›·˜, ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ì ÂÚˆÙ‹ÛÂȘ ÔÏÏ·ÏÒÓ ÂÈÏÔÁÒÓ Î·È ¤Á¯ÚˆÌ˜ ÂÈÎÔÓÔÁÚ·Ê‹ÛÂȘ ÛÙËÓ ·Ú¯‹ Î·È ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÂÍ¿¯ÚÔÓ˘ ·Ú¤Ì‚·Û˘. ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÂÈÎÂÓÙÚÒıËΠÛÙË ‰È·ÙÚÔÊ‹, ÛÙ· ÚÔ˚fiÓÙ· ÙÚÔÊ›ÌˆÓ Î·È ÛÙË ‰È·Ê‹ÌÈÛ‹ ÙÔ˘˜, ÛÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË, ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ·fi ÙÔ Î¿ÓÈÛÌ· Î·È ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ (14). ∆Ô Ì¤ÚÔ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÚÔ·ÁˆÁ‹˜ ˘Á›·˜ “°ÓÒÚÈÛ ÙÔ ÛÒÌ· ÛÔ˘” Ù˘ American Health Foundation (5,6) Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ˘Á›·, ÙÚÔÔÔÈ‹ıËÎÂ, ÚÔÛ·ÚÌfiÛÙËÎÂ Î·È Û˘ÌÏËÚÒıËÎÂ, ÚÔÎÂÈ̤ÓÔ˘ Ó· Â›Ó·È Î·Ù¿ÏÏËÏÔ ÁÈ· ÙÔÓ ‰ÈÎfi Ì·˜ ÏËı˘ÛÌfi. °È· fiϘ ÙȘ Ù¿ÍÂȘ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ‚È‚Ï›· ÂÚÁ·ÛÈÒÓ Ì ÔÈÎÈÏ›· ·Û΋ÛÂˆÓ Ô˘ Î¿Ï˘Ù·Ó Î˘Ú›ˆ˜ ‰È·ÙÚÔÊÈο ı¤Ì·Ù·, ÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ·ÏÏ¿ Î·È ÙËÓ ˘ÁÈÂÈÓ‹ ÙˆÓ ‰ÔÓÙÈÒÓ, ÙË ¯Ú‹ÛË Ó·ÚΈÙÈÎÒÓ Î·È ÙËÓ ÚfiÏË„Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ. ∫¿ı ̷ıËÙ‹˜ ¤·ÈÚÓ ¤Ó· ‚È‚Ï›Ô Î¿ı ¤ÙÔ˜. ∂ÈÚfiÛıÂÙ·, ‰fiıËÎ·Ó Î·È ¿ÏÏ· ‰È‰·ÎÙÈο ‚ÔËı‹Ì·Ù· Ô˘ ·Ú¿¯ıËÎ·Ó ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘, fiˆ˜ ‚È‚Ï›· ÁÈ· ÙÔ˘˜ ηıËÁËÙ¤˜, ηۤÙ˜ Ì ·Ú·Ì‡ıÈ·, ·Ê›Û˜ Î·È ‚È‚Ï›· ·Û΋ÛˆÓ. ∆Ô ÙÌ‹Ì· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ˘Á›· Î·È ÙË ‰È·ÙÚÔÊ‹ ‰È‰¿¯ÙËΠ·fi ÙÔ˘˜ ‰·ÛοÏÔ˘˜ ÙˆÓ Ù¿ÍÂˆÓ Î·È ¤ÁÈÓ Û 13-17 ÒÚ˜/¤ÙÔ˜. ∆Ô ÙÌ‹Ì· Ô˘ ·ÊÔÚÔ‡Û ÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË Â›¯Â ıˆÚËÙÈÎfi (4-6 ÒÚ˜/¤ÙÔ˜ ÛÙËÓ Ù¿ÍË) Î·È Ú·ÎÙÈÎfi ̤ÚÔ˜ Î·È ‰È‰¿¯ıËΠ·fi ηıËÁËÙ¤˜ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‰›ˆÚÔ˘ Ì·ı‹Ì·ÙÔ˜ Ù˘ Á˘ÌÓ·ÛÙÈ΋˜. ∆fiÛÔ ÔÈ ‰¿ÛηÏÔÈ, fiÛÔ Î·È ÔÈ Î·ıËÁËÙ¤˜ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ¤Ó· ÛÂÌÈÓ¿ÚÈÔ ÛÙËÓ ·Ú¯‹ οı ۯÔÏÈ΋˜ ¯ÚÔÓÈ¿˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙËÓ ‡ÏË ÙÔ˘ ÚÔÁÚ¿ÌÌ·-

68

Paediatriki 2002;65:66-76

ÙÔ˜ Î·È ÙÔÓ ÙÚfiÔ ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘. OÈ ÏÂÙÔ̤ÚÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙË ıˆÚËÙÈ΋ ‰ÔÌ‹ ¿Óˆ ÛÙËÓ ÔÔ›· ‚·Û›ÛÙËÎ·Ó Ô Û¯Â‰È·ÛÌfi˜ Î·È Ë ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ú¤Ì‚·Û˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÏÏÔ‡ (3,4). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘, ÔÈ ÁÔÓ›˜ ·Ú›¯·Ó ÏËÚÔÊÔڛ˜ Ì ‰‡Ô ÙÚfiÔ˘˜: ·) Û˘ÌÏËÚÒÓÔÓÙ·˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ ·ÊÔÚÔ‡Û·Ó ÚÔÛˆÈο ÛÙÔȯ›· (ÙËÓ ËÏÈΛ·, ÙËÓ ··Û¯fiÏËÛË, ÙÔ ÌÔÚʈÙÈÎfi Â›‰Ô) Î·È ı¤Ì·Ù· Û¯ÂÙÈο Ì ÙȘ ÁÓÒÛÂȘ Î·È ÙȘ Û˘Ó‹ıÂȘ ÙfiÛÔ ÙȘ ‰ÈΤ˜ ÙÔ˘˜ fiÛÔ Î·È ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Û ı¤Ì·Ù· ˘Á›·˜ Î·È ‚) Û˘ÌÏËÚÒÓÔÓÙ·˜ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Û¯ÂÙÈο Ì ÙȘ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Î·È ÙË Ê˘ÛÈ΋ ÙÔ˘˜ ‰Ú·ÛÙËÚÈfiÙËÙ· ‹ ÙËÓ ·Ô˘Û›· Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ηٿ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ ÙÔ˘˜.

OÈ ÁÔÓ›˜ Û˘ÌÏ‹ÚˆÛ·Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ·ÊÔÚÔ‡Û ÙËÓ Â‚‰ÔÌ·‰È·›· Û˘¯ÓfiÙËÙ· ηٷӿψÛ˘ ‰È·ÊfiÚˆÓ ÙÚÔÊÒÓ ·fi Ù· ·È‰È¿ ÙÔ˘˜, ÂÓÒ ¤Ó· Ù˘¯·›Ô ‰Â›ÁÌ· Ô˘ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ÙÔ 30% Ù˘ ·Ú¯È΋˜ ÔÌ¿‰·˜, ¤‰ˆÛ ηٿÏÔÁÔ ˙˘ÁÈÛÌ¤ÓˆÓ ÙÚÔÊÒÓ Ô˘ ηٷӷÏÒıËÎ·Ó ·fi ÙÔ ·È‰› ÙÔ˘˜ Û ÙÚÂȘ Ë̤Ú˜. ™ÙÔ˘˜ ÁÔÓ›˜ ‰fiıËÎ·Ó ÚÔÊÔÚÈΤ˜ Î·È ÁÚ·Ù¤˜ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÛˆÛÙ‹ Û˘ÌÏ‹ÚˆÛË ÙˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ. ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ‰È·‰Èηۛ·˜ ·Ú·ÎÔÏÔ˘ı‹ıËΠÛÙÂÓ¿ ·fi ‰È·ÈÙÔÏfiÁÔ˘˜ (4). ∆· ‰È·ÙÚÔÊÈο ÛÙÔȯ›· Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ·˘Ù‹ ÙË ÌÂϤÙË ÚÔ‹Ïı·Ó ·fi ÙËÓ Î·Ù·ÁÚ·Ê‹ ˙˘ÁÈÛÌ¤ÓˆÓ Ê·ÁËÙÒÓ ÙÚÈÒÓ ËÌÂÚÒÓ. ∆· ÙÚfiÊÈÌ· Έ‰ÈÎÔÔÈ‹ıËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ‚¿ÛË ÙÚÔÊ›ÌˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, Ô˘ Â›Ó·È ‚·ÛÈṲ̂ÓË ÛÙË ‚¿ÛË ÙÔ˘ ˘Ô˘ÚÁ›Ԣ ÁˆÚÁ›·˜ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ (United States Department of Agriculture, USDA) Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ¯ËÌÈο ·Ó·Ï˘Ì¤Ó· ÂÏÏËÓÈο ÙÚfiÊÈÌ·. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ Ï›Ô˘˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (MUFA), ÙˆÓ ÔÏ˘·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (PUFA) Î·È ÙˆÓ ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ (SFA), ‚·Û›ÛÙËΠÛÙË ¯ËÌÈ΋ ·Ó¿Ï˘ÛË 120 ÂÏÏËÓÈÎÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ·Ú¤¯Ô˘Ó ÙÔ 95% ÙÔ˘ Ï›Ô˘˜ ÛÙËÓ ÂÏÏËÓÈ΋ ‰È·ÙÚÔÊ‹. ∏ ¯ËÌÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ ·fi ÙÔ Wageningen Agricultural University Î·È ÙÔ TNO Nutrition Institute ÛÙËÓ OÏÏ·Ó‰›· ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ TRANSFAIR, ÛÙÔ ÔÔ›Ô Û˘ÌÌÂÙ›¯Â Î·È ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘.

OÈ Ì¤ÙÚȘ ¤ˆ˜ ¤ÓÙÔÓ˜ Â͈ۯÔÏÈΤ˜ ۈ̷ÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙˆÓ ·È‰ÈÒÓ ·ÍÈÔÏÔÁ‹ıËÎ·Ó Ì¤Ûˆ Ì›·˜ Û˘Ó¤ÓÙ¢Í˘, Ë ÔÔ›· ‚·Û›ÛÙËΠ۠ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ Û˘ÌÏËÚÒıËΠ·fi ÙÔ ›‰ÈÔ ÙÔ ·È‰›, ·ÚÔ˘Û›· ÂÓfi˜ ̤ÏÔ˘˜ Ù˘ ÂÚ¢ÓËÙÈ΋˜ ÔÌ¿‰·˜. ∆Ô ›‰ÈÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Û˘ÌÏËÚÒıËΠ·fi ÙÔ˘˜ ÁÔÓ›˜ fiÙ·Ó Ù· ·È‰È¿ ‹Ù·Ó ÛÙËÓ ÚÒÙË Ù¿ÍË. ¶ÂÚ·ÈÙ¤Úˆ ÏÂÙÔ̤ÚÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÍÈÔÈÛÙ›· Î·È ÙËÓ ÂÁ΢ÚfiÙËÙ· ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ‰›‰ÔÓÙ·È ·ÏÏÔ‡ (7). ∏ ·ÍÈÔÏfiÁËÛË Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ·Ú¤Ì‚·ÛË ‚·Û›ÛÙËΠÛÙÔ ÚˆÙfiÎÔÏÏÔ ‰ÔÎÈÌ·ÛÈÒÓ EUROFIT (EUROFIT Tests Protocol) Ô˘ ۯ‰ȿÛÙËΠ·fi ÙËÓ ∂ÈÙÚÔ‹ ∂ȉÈÎÒÓ ÛÙËÓ ŒÚ¢ӷ ÁÈ· ÙÔÓ ∞ıÏËÙÈÛÌfi (Committee of Experts on Sports Research) (8). ∏ ÔÌ¿‰· ÙˆÓ ‰ÔÎÈÌ·ÛÈÒÓ ÂÚÈÂÏ¿Ì‚·ÓÂ:

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·69

¶·È‰È·ÙÚÈ΋ 2002;65:66-76

Paediatriki 2002;65:66-76

·) ¢›ψÛË ·fi ‰ڷ›· ı¤ÛË: Ô Ì·ıËÙ‹˜ ·fi ‰ڷ›· ı¤ÛË Î·ÏÂ›Ù·È Ó· Û·„ÂÈ Î·È Ó· ÊÙ¿ÛÂÈ fiÛÔ ÈÔ Ì·ÎÚÈ¿ Á›ÓÂÙ·È. ‚) ∞Ó·‰ÈÏÒÛÂȘ ·fi ‡ÙÈ· ηٿÎÏÈÛË (ÎÔÈÏÈ·ÎÔ›): Ô Ì¤ÁÈÛÙÔ˜ ·ÚÈıÌfi˜ ÎÔÈÏÈ·ÎÒÓ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Û 30 sec. Á) ÃÂÈÚÔ‰˘Ó·ÌÔ̤ÙÚËÛË: Ô Ì·ıËÙ‹˜ ηÏÂ›Ù·È Ó· ÛÊ›ÍÂÈ, Ì ÙÔ ¯¤ÚÈ Ù˘ ÚÔÙ›ÌËÛ‹˜ ÙÔ˘, fiÛÔ ÈÔ ‰˘Ó·Ù¿ ÌÔÚ› ¤Ó· ¯ÂÈÚÔ‰˘Ó·ÌfiÌÂÙÚÔ. ‰) ÕÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ·: Ô Ì·ıËÙ‹˜ ηÏÂ›Ù·È Ó· οÓÂÈ ¤Ó· fiÛÔ ÙÔ ‰˘Ó·Ùfi ÌÂÁ·Ï‡ÙÂÚÔ ¿ÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ· Î·È Ì ٷ ‰‡Ô fi‰È· Ì·˙›. Â) ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜: Â›Ó·È Ë Û˘Ó‹ı˘ ‰ÔÎÈÌ·Û›· Ô˘ ÂϤÁ¯ÂÈ ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ηٿÛÙ·ÛË Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ∆Ô ÛˆÌ·ÙÈÎfi ‚¿ÚÔ˜ ÌÂÙÚ‹ıËΠ̠ËÏÂÎÙÚÔÓÈÎfi ˙˘Áfi (Seca alpha) Ì ·ÎÚ›‚ÂÈ· ±100 g. ∆· ¿ÙÔÌ· ˙˘Á›ÛÙËÎ·Ó ¯ˆÚ›˜ ÚÔ‡¯· Î·È ·Ô‡ÙÛÈ·, ÌfiÓÔ Ì ٷ ÂÛÒÚÔ˘¯·. ∆Ô ‡„Ô˜ ÌÂÙÚ‹ıËΠ۠fiÚıÈ· ı¤ÛË, ¯ˆÚ›˜ ·Ô‡ÙÛÈ·, Ì ¯·Ï·ÚÔ‡˜ ÒÌÔ˘˜ Î·È Ù· ¯¤ÚÈ· ÂχıÂÚ· ÛÙÔ Ï¿È Ì ÙÔ Û‡ÓËı˜ ·Ó·ÛÙËÌfiÌÂÙÚÔ Î·È Ì ·ÎÚ›‚ÂÈ· <0,5 cm. O ¢Â›ÎÙ˘ ª¿˙·˜ ™ÒÌ·ÙÔ˜ (¢ª™) ˘ÔÏÔÁ›ÛÙËΠ‰È·ÈÚÒÓÙ·˜ ÙÔ ‚¿ÚÔ˜ (kg) Ì ÙÔ ‡„Ô˜ ÛÙÔ ÙÂÙÚ¿ÁˆÓÔ (m2). ªÂÙÚ‹ıËΠÙÔ ¿¯Ô˜ ÙÂÛÛ¿ÚˆÓ ‰ÂÚÌ·ÙÈÎÒÓ Ù˘¯ÒÓ, ÙÔ˘ ‰ÈÎÂÊ¿ÏÔ˘, ÙÔ˘ ÙÚÈÎÂÊ¿ÏÔ˘, Ù˘ ˆÌÔÏ¿Ù˘ Î·È Ë Ï·ÁfiÓÈ· Ì ٷ ¿ÙÔÌ· Û fiÚıÈ· ı¤ÛË, Ì ٷ ¿Óˆ ¿ÎÚ· ¯·Ï·Ú¿, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¤Ó· ‰ÂÚÌ·ÙÔÙ˘¯fiÌÂÙÚÔ Lange (3,4).

OÈ ·ÈÌÔÏË„›Â˜ ¤ÁÈÓ·Ó ÓˆÚ›˜ ÙÔ Úˆ›, ÌÂÙ¿ ·fi ÓËÛÙ›· 12 ˆÚÒÓ. ∞fi ÙÔÓ ÔÚfi ÌÂÙÚ‹ıËÎ·Ó Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC) Î·È Ë HDL-¯ÔÏËÛÙÂÚfiÏË ÙËÓ ›‰È· ̤ڷ. ∏ LDL-¯ÔÏËÛÙÂÚfiÏË ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙÔÓ ·ÎfiÏÔ˘ıÔ Ù‡Ô: LDL-C = TC – (HDL-C + TG/5).

∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ (mixed model analyses) ‚·Û›ÛÙËΠÛÙȘ ÌÂÙ·‚ÔϤ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÚÈÓ Î·È ÌÂÙ¿ ÙÔ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘ ÛÙȘ ÔÌ¿‰Â˜ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘. OÈ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ô˘ ÌÂÙÚ‹ıËÎ·Ó ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ηٿ ÙËÓ ÂÍ·ÂÙ‹ ·Ú¤Ì‚·ÛË ˘ÔÏÔÁ›ÛÙËÎ·Ó Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙȘ ·ÔÎÏ›ÛÂȘ ÌÂٷ͇ ÙˆÓ Û¯ÔÏ›ˆÓ. ŒÁÈÓ·Ó ÙÚÔÔÔÈ‹ÛÂȘ ÛÙÔ ÌÔÓÙ¤ÏÔ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜, ÙÔ Ê‡ÏÔ, ÙÔ Â›Â‰Ô Ù˘ ÂÎ·›‰Â˘Û˘ ÙˆÓ ÁÔÓ¤ˆÓ, ÙËÓ ·‡ÍËÛË ÛÙÔ ‡„Ô˜ Î·È ÙÔÓ ·Ú¯ÈÎfi ¢ª™ ÛÙ· ‚ÈÔ¯ËÌÈο Î·È ÛˆÌ·ÙÔÌÂÙÚÈο ‰Â‰Ô̤ӷ Î·È ÛÙ· ‰Â‰Ô̤ӷ Ù˘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ™Ù· ‰È·ÙÚÔÊÈο ‰Â‰Ô̤ӷ, ÔÈ ÌÂÙ·‚ÔϤ˜ Ô˘ ˘ÔÏÔÁ›ÛÙËÎ·Ó ÙÚÔÔÔÈ‹ıËÎ·Ó ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜, ÙÔ Ê‡ÏÔ Î·È ÙÔÓ ¢ª™. ∆Ô ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS ver 7,5 ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ·Ó¿Ï˘ÛË (mixed model analyses). ¶ÂÚÈÛÛfiÙÂÚ˜ ÏÂÙÔ̤ÚÂȘ ÁÈ· Ù· ÛÙ·ÙÈÛÙÈο ÌÔÓ٤Ϸ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÁÈ· Ó· ·ÍÈÔÏÔÁËıÔ‡Ó ÔÈ ÂȉڿÛÂȘ Ù˘ ·Ú¤Ì‚·Û˘ ‰›‰ÔÓÙ·È ·ÏÏÔ‡ (4). OÈ ·Ú¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘ Û˘ÁÎÚ›ıËÎ·Ó Ì ÙȘ ÌÂÙÚ‹ÛÂȘ ÙˆÓ Ì·ıËÙÒÓ ÂÎÂ›ÓˆÓ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔ ÌË ·Ú·ÌÂÙÚÈÎfi Mann-Whitney test.

∞ÔÙÂϤÛÌ·Ù· ™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÂÙ·È fiÙÈ ·fi ÙÔ˘˜ 1046 Ì·ıËÙ¤˜ Ô˘ Û˘ÌÌÂÙ›¯·Ó ·Ú¯Èο ÛÙÔ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘, ÔÈ 831 ¤ÊÙ·Û·Ó Ì¤¯ÚÈ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÙÂÏÈ΋˜ ·ÍÈÔÏfiÁËÛ˘. OÈ Ì·ıËÙ¤˜ Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙËÓ ·Ó¿Ï˘ÛË ‹Ù·Ó ÂΛÓÔÈ Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó Î·È ÛÙËÓ ·Ú¯‹ Î·È ÌÂÙ¿ ÙËÓ ÂÍ·ÂÙ‹ ·Ú¤Ì‚·ÛË Î·È ÔÈ ÔÔ›ÔÈ ‰ÂÓ ¿ÏÏ·Í·Ó Û¯ÔÏÂ›Ô Î·Ù¿ ÙË

¶›Ó·Î·˜ 1. ™‡ÁÎÚÈÛË ÙˆÓ ÌÂÙÚ‹ÛÂˆÓ Î·Ù¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÂٷ͇ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· Î·È ÙˆÓ Ì·ıËÙÒÓ Ì Ï‹ÚË ÂÍ·ÂÙ‹ Û˘ÌÌÂÙÔ¯‹1 ªÂÙÚ‹ÛÂȘ ÏÈȉ›ˆÓ ÔÚÔ‡ Î·È ·ÓıÚˆÔÌÂÙÚÈÎÔ› ‰Â›ÎÙ˜

ª·ıËÙ¤˜ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· (n=215) 2 ª¤ÛÔ˜ ± SD

ÃÔÏËÛÙÂÚfiÏË (mmol/L)4 ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mmol/L)5 LDL (mmol/L)4 HDL (mmol/L) µ¿ÚÔ˜ (kg) ⁄„Ô˜ (cm) ¢ª™ (kg/m2) §fiÁÔ˜ ÂÚÈ̤ÙÚÔ˘ ̤Û˘ ÚÔ˜ ÂÚ›ÌÂÙÚÔ ÏÂοÓ˘

4,85 ± 0,71 0,63 ± 0,28 3,04 ± 0,67 1,50 ± 0,35 23,7 ± 5,1 120,0 ± 6,1 16,3 ± 2,5 0,86 ± 0,05

ª·ıËÙ¤˜ Ì Ï‹ÚË Û˘ÌÌÂÙÔ¯‹ (n=831)3 ª¤ÛÔ˜ ± SD 4,74 ± 0,81 0,69 ± 0,30 2,91 ± 0,75 1,54 ± 0,35 23,6 ± 4,7 120,1 ± 5,7 16,3 ± 2,3 0,86 ± 0,05

1

ª¤ÛË ÙÈÌ‹ ± SD, Mann-Whitney p-value ∞fi ÙÔ˘˜ 215 Ì·ıËÙ¤˜ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ·, 119 Ì·ıËÙ¤˜ (55%) ‹Ù·Ó ·ÁfiÚÈ·, 96 Ì·ıËÙ¤˜ (45%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. OÈ 144 (67%) ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ÔÈ 71 (33%) ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. OÈ 179 (83%) Ì·ıËÙ¤˜ ·fi ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· ›¯·Ó ‚ÈÔ¯ËÌÈΤ˜ ÌÂÙÚ‹ÛÂȘ Î·È ÔÈ 168 (78%) ›¯·Ó ·ÓıÚˆÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ 3 ∞fi ÙÔ˘˜ 831 Ì·ıËÙ¤˜ Ô˘ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ·, 427 Ì·ıËÙ¤˜ (51%) ‹Ù·Ó ·ÁfiÚÈ·, 404 Ì·ıËÙ¤˜ (49%) ‹Ù·Ó ÎÔÚ›ÙÛÈ·. OÈ 457 (55%) ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘, 374 (45%) ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. OÈ 758 (91%) ›¯·Ó ‚ÈÔ¯ËÌÈΤ˜ ÌÂÙÚ‹ÛÂȘ Î·È ÔÈ 721 (87%) ›¯·Ó ·ÓıÚˆÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ 4 ™ËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· Î·È ÂÎÂ›ÓˆÓ Ô˘ ‰ÂÓ ÙÔ ÔÏÔÎÏ‹ÚˆÛ·Ó, p<0,05 5 ™ËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· Î·È ÂÎÂ›ÓˆÓ Ô˘ ‰ÂÓ ÙÔ ÔÏÔÎÏ‹ÚˆÛ·Ó, p<0,001 2

69

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·70

¶·È‰È·ÙÚÈ΋ 2002;65:66-76

Paediatriki 2002;65:66-76

¶›Ó·Î·˜ 2. ™˘ÁÎÚ›ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÏÈȉ›ˆÓ ÔÚÔ‡ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ÌÂÙ¿ ÙÔ ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘1 §È›‰È· ÔÚÔ‡ ñ OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÔÚÔ‡ (mmol/L) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ LDL (mmol/L) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ HDL (mmol/L) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ §fiÁÔ˜ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘/HDL OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ §fiÁÔ˜ LDL/HDL OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ∆ÚÈÁÏ˘ÎÂÚ›‰È· (mmol/L) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘

ŒÓ·ÚÍË

§‹ÍË

ªÂÙ·‚ÔÏ‹

95% ‰.Â. ÁÈ· ÙË ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ2

4,91 ± 0,81 4,49 ± 0,76

4,56 ± 0,77 4,49 ± 0,79

-0,27 ± 0,04 -0,12 ± 0,04

ª™

3,07 ± 0,74 2,68 ± 0,72

2,70 ± 0,73 2,70 ± 0,69

-0,30 ± 0,04 -0,08 ± 0,04

p<0,001

1,56 ± 0,33 1,52 ± 0,38

1,50 ± 0,39 1,42 ± 0,38

-0,04 ± 0,02 -0,14 ± 0,02

ª™

3,27 ± 0,87 3,12 ± 0,87

3,20 ± 1,07 3,33 ± 0,90

-0,07 ± 0,05 0,24 ± 0,06

p<0.05

2,08 ± 0,79 1,91 ± 0,77

1,94 ± 0,93 2,04 ± 0,77

-0,13 ± 0,05 0,14 ± 0,05

p<0.05

0,62 ± 0,28 0,63 ± 0,28

0,79 ± 0,33 0,81 ± 0,31

0,16 ± 0,02 0,20 ± 0,02

ª™

1

OÌ¿‰· ·Ú¤Ì‚·Û˘ (n=347), ÔÌ¿‰· ÂϤÁ¯Ô˘ (n=257). OÈ ·Ú¯ÈΤ˜ Î·È ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘È΋ ·fiÎÏÈÛË. OÈ ÌÂÙ·‚ÔϤ˜ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘ÈÎfi ÛÊ¿ÏÌ·. ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠mixed-model GLM ÚÔÛ·ÚÌÔṲ̂ÓÔ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜, ÙÔ Ê‡ÏÔ, ÙÔÓ ·Ú¯ÈÎfi ¢ª™, ÙË ÌÂÙ·‚ÔÏ‹ ÛÙÔ ‡„Ô˜ Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ. ∆· ÛÙÔȯ›· ·ÊÔÚÔ‡Ó ÂΛÓÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ›¯·Ó ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ Î·È ÙÔ 1992 Î·È ÙÔ 1998 2 ∆Ô 95% ‰.Â. ˘ÔÏÔÁ›ÛÙËΠÁÈ· ÙȘ ‰È·ÊÔÚ¤˜ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ (·Ú¤Ì‚·ÛË ¤ÏÂÁ¯Ô˜), fiÔ˘ Ë Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ at ·=0,05 ÛÙÔ GLM

‰È¿ÚÎÂÈ· Ù˘ ·Ú¤Ì‚·Û˘ (787 Ì·ıËÙ¤˜). ªfiÓÔ ÔÈ Ì·ıËÙ¤˜ Ì Ï‹ÚË ÛÙÔȯ›· Û οı ÛÙ¿‰ÈÔ Ù˘ ÌÂϤÙ˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙȘ ·Ó·Ï‡ÛÂȘ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔ˘˜ ¶›Ó·Î˜ 2 ¤ˆ˜ 6.

O ¶›Ó·Î·˜ 1 ‰Â›¯ÓÂÈ, Â›Û˘, fiÙÈ ÔÈ Ì¤Û˜ ÙÈ̤˜ ÙˆÓ Î‡ÚÈˆÓ ÌÂÙÚ‹ÛÂˆÓ ÙˆÓ ÂÍ¿¯ÚÔÓˆÓ Ì·ıËÙÒÓ Ô˘ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· ‰ÂÓ ‰È¤ÊÂÚ·Ó ÁÂÓÈο ·fi ·˘Ù¤˜ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ·. À¿Ú¯Ô˘Ó οÔȘ ÂӉ›ÍÂȘ fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚ˜ ÁÈ· ÂΛÓÔ˘˜ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· (̤ÛÔ˜ 3,04 mmol/L, Ù˘È΋ ·fiÎÏÈÛË 0,67 Û ۇÁÎÚÈÛË Ì 2,91 mmol/L, Ù˘È΋ ·fiÎÏÈÛË 0,75, p<0,05) Î·È ÔÈ ·Ú¯ÈΤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ ÔÚÔ‡ ‹Ù·Ó ¯·ÌËÏfiÙÂÚ˜ ÛÙ· ·È‰È¿ Ô˘ ‰ÂÓ ÔÏÔÎÏ‹ÚˆÛ·Ó ÙÔ ÚfiÁÚ·ÌÌ· (̤ÛÔ˜ 0,63 mmol/L, Ù˘È΋ ·fiÎÏÈÛË 0,28 Û ۇÁÎÚÈÛË Ì 0,69 mmol/L, Ù˘È΋ ·fiÎÏÈÛË 0,30, p<0,01). ™ÙÔÓ ¶›Ó·Î· 2 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ÌÂÙ·‚ÔϤ˜ ÛÙȘ ÌÂÙÚ‹ÛÂȘ ÙˆÓ ÏÈȉ›ˆÓ ÔÚÔ‡ ηٿ ÙËÓ ÂÍ·ÂÙ‹ ÂÚ›Ô‰Ô ·Ú¤Ì‚·Û˘. µÚ¤ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ηٿ ÙËÓ ÂÍ·ÂÙ‹ ÂÚ›Ô‰Ô ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ (p<0,001), ÛÙÔ ÏfiÁÔ TC/HDL (p<0,05) Î·È ÛÙÔ ÏfiÁÔ LDL/HDL (p<0,05), Ì fiÏÔ˘˜ ÙÔ˘˜ ‰Â›ÎÙ˜ Ó· ÌÂÈÒÓÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙȘ È-

70

ı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ηٿ ÙËÓ ·Ú¯È΋ Ê¿ÛË. ∫·È ÁÈ· ÙÔ˘˜ ‰‡Ô ·˘ÙÔ‡˜ ÏfiÁÔ˘˜ ÙˆÓ ÏÈȉ›ˆÓ ÔÚÔ‡, ˘‹ÚÍ Ì›ˆÛË Î·Ù¿ ̤ÛÔ fiÚÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘, ÂÓÒ ˘‹ÚÍ ·‡ÍËÛË ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (·ÎfiÌ· Î·È ÌÂÙ¿ ÙȘ ÙÚÔÔÔÈ‹ÛÂȘ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜ Î·È ¿ÏϘ Û˘ÌÌÂÙ·‚ÏËÙ¤˜). °È· Ù· ¿ÏÏ· ÏÈ›‰È· ÔÚÔ‡ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÂÍ·ÂÙ›·. ™Ù· ۈ̷ÙÔÌÂÙÚÈο ‰Â‰Ô̤ӷ (¶›Ó·Î·˜ 3) ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ‚¿ÚÔ˜, ÛÙÔ ‡„Ô˜, ÛÙÔ ¢ª™, ÛÙË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÔ˘ ‰ÈÎÂÊ¿ÏÔ˘ Î·È ÛÙË ‰ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÔ˘ ÙÚÈÎÂÊ¿ÏÔ˘. ∆· ·È‰È¿ ·fi ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ‚Ú¤ıËΠfiÙÈ Â›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË Ì¤ÛË ·‡ÍËÛË ÛÙÔ ‡„Ô˜ ηٿ ÙËÓ ÂÍ·ÂÙ›·, Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ Ì·ıËÙ¤˜ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ (Ë ÚÔÛ·ÚÌÔṲ̂ÓË Ì¤ÛË ·‡ÍËÛË ‹Ù·Ó 31,3 cm, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,26 ÁÈ· ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È 27,4 cm, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,26 ÁÈ· ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, p<0,001). ¶·ÚfiÌÔȘ ·Ú·ÙËÚ‹ÛÂȘ ¤ÁÈÓ·Ó Î·È ÁÈ· ÙÔ ‚¿ÚÔ˜, Ì ̤Û˜ ·˘Í‹ÛÂȘ 21,6 kg, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,37, Î·È 22,9 kg, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,38, ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, ·ÓÙ›ÛÙÔȯ·. OÈ Ì·ıËÙ¤˜ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ›¯·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÌÂÙ·‚ÔÏ‹ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÛÙÔ

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·71

¶·È‰È·ÙÚÈ΋ 2002;65:66-76

Paediatriki 2002;65:66-76

¶›Ó·Î·˜ 3. ™˘ÁÎÚ›ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙȘ ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ÌÂÙ¿ ÙÔ ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘1 ™ˆÌ·ÙÔÌÂÙÚÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ñ µ¿ÚÔ˜ (kg) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ⁄„Ô˜ (cm) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¢ª™ (kg/m2) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ‰ÈΤʷÏÔ˘ (mm) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ÙÚÈΤʷÏÔ˘ (mm) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ Ï·ÁÔÓ›Ô˘ (mm) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¢ÂÚÌ·ÙÈ΋ Ù˘¯‹ ˆÌÔÏ¿Ù˘ (mm) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘

ŒÓ·ÚÍË

§‹ÍË

ªÂÙ·‚ÔÏ‹

95% ‰.Â. ÁÈ· ÙË ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ2

23,1 ± 4,5 24,3 ± 4,6

45,2 ± 11,2 46,2 ± 11,5

21,6 ± 0,37 22,9 ± 0,38

p<0,05

118,7 ± 5,4 121,5 ± 5,7

150,0 ± 7,8 149,6 ± 7,6

31,3 ± 0,26 27,4 ± 0,26

p<0,001

16,3 ± 2,3 16,3 ± 2,2

19,9 ± 3,9 20,5 ± 4,1

3,68 ± 0,16 4,28 ± 0,16

p<0,05

5,1 ± 2,3 5,4 ± 2,7

8,1±4,2 9,8±5,8

2,97±0,24 4,47±0,24

p<0,001

10,6 ± 4,4 11,6 ± 4,9

17,5 ± 7,7 19,1 ± 8,5

6,46±0,38 7,90±0,39

p<0,05

7,4 ± 5,9 7,3 ± 5,7

20,1 ± 12,3 19,4 ± 11,3

12,3 ± 0,6 12,8 ± 0,6

ª™

7,3 ± 4,3 7,7 ± 5,2

11,9 ± 7,3 12,6 ± 7,7

4,3 ± 0,3 5,4 ± 0,4

ª™

1

OÌ¿‰· ·Ú¤Ì‚·Û˘ (n=356), ÔÌ¿‰· ÂϤÁ¯Ô˘ (n=285). OÈ ·Ú¯ÈΤ˜ Î·È ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘È΋ ·fiÎÏÈÛË. OÈ ÌÂÙ·‚ÔϤ˜ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘ÈÎfi ÛÊ¿ÏÌ·. ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠mixed-model GLM ÚÔÛ·ÚÌÔṲ̂ÓÔ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜, ÙÔ Ê‡ÏÔ, ÙÔÓ ·Ú¯ÈÎfi ¢ª™, ÙË ÌÂÙ·‚ÔÏ‹ ÛÙÔ ‡„Ô˜ Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ. ∆· ÛÙÔȯ›· ·ÊÔÚÔ‡Ó ÂΛÓÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ›¯·Ó ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜ Î·È ÙÔ 1992 Î·È ÙÔ 1998. ∆· Û¯ÔÏ›· ıˆڋıËÎ·Ó ˆ˜ Ù˘¯·›Â˜ ÌÂÙ·‚ÏËÙ¤˜. ∆· ÛÙÔȯ›· ·ÊÔÚÔ‡Ó ÂΛÓÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ›¯·Ó ۈ̷ÙÔÌÂÙÚÈΤ˜ ÌÂÙÚ‹ÛÂȘ Î·È ÙÔ 1992 Î·È ÙÔ 1998 2 ∆Ô 95% ‰.Â. ˘ÔÏÔÁ›ÛÙËΠÁÈ· ÙȘ ‰È·ÊÔÚ¤˜ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ (·Ú¤Ì‚·ÛË ¤ÏÂÁ¯Ô˜), fiÔ˘ Ë Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ at ·=0,05 ÛÙÔ GLM

̤ÛÔ ¢ª™ (Ë ÚÔÛ·ÚÌÔṲ̂ÓË Ì¤ÛË ·‡ÍËÛË ‹Ù·Ó 4,28 kg/m2, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,16 Û ۇÁÎÚÈÛË Ì 3,68 kg/m2, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,16, p<0,05) Î·È ÛÙȘ ‰ÂÚÌ·ÙÈΤ˜ Ù˘¯¤˜ ‰ÈÎÂÊ¿ÏÔ˘ Î·È ÙÚÈÎÂÊ¿ÏÔ˘ (Ë ÚÔÛ·ÚÌÔṲ̂ÓË Ì¤ÛË ÌÂÙ·‚ÔÏ‹ ÁÈ· ÙÔÓ ‰ÈΤʷÏÔ ‹Ù·Ó 4,47 mm, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,24 Û ۇÁÎÚÈÛË Ì 2,97 mm, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,24, p<0,001 Î·È ÁÈ· ÙÔÓ ÙÚÈΤʷÏÔ ‹Ù·Ó 7,90 mm, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,39 Û ۇÁÎÚÈÛË Ì 6,46 mm, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,38, p<0,05) ¤¯ÔÓÙ·˜ οÓÂÈ ÙÚÔÔÔÈ‹ÛÂȘ ÁÈ· ÙȘ ÌÂÙ·‚ÔϤ˜ ÛÙÔ ‡„Ô˜, ÙÔ Ê‡ÏÔ, ÙÔ ÂÎ·È‰Â˘ÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 4, ˘¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ÚfiÛÏ˄˘ ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∏ ·‡ÍËÛË ÛÙË Ì¤ÛË ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (366,8 kCal, Ù˘ÈÎfi ÛÊ¿ÏÌ· 57,5) Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (178,7 kCal, Ù˘ÈÎfi ÛÊ¿ÏÌ· 66,1), p<0,05. ™ÙÔÓ ¶›Ó·Î· 4 Ê·›ÓÂÙ·È, Â›Û˘, fiÙÈ Ë Ì¤ÛË ÚfiÛÏË„Ë ÚˆÙ½Ó˘, ÔÏÈÎÔ‡ Ï›Ô˘˜, ÎÔÚÂÛÌ¤ÓˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ÌÔÓÔ·ÎfiÚÂÛÙˆÓ ÏÈ·ÚÒÓ ÔͤˆÓ ‹Ù·Ó ¿ÏÈ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË

ÛÙÔ˘˜ Ì·ıËÙ¤˜ Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ÌÂÙ¿ ÙȘ ÙÚÔÔÔÈ‹ÛÂȘ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜ Î·È ÙÔ ¢ª™. ™ÙÔÓ ¶›Ó·Î· 5 Ê·›ÓÔÓÙ·È ÔÈ ÌÂÙ·‚ÔϤ˜ Ô˘ ˘‹ÚÍ·Ó ÛÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈÂÚÒıËΠÛÙȘ Â͈ۯÔÏÈΤ˜ ۈ̷ÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ηٿ ÙËÓ ÂÚ›Ô‰Ô ·Ú¤Ì‚·Û˘. OÈ Ì·ıËÙ¤˜ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Â¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈ¤ÚˆÛ·Ó Û ·˘Ù¤˜ ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ηٿ ÙËÓ ÂÍ·ÂÙ‹ ÂÚ›Ô‰Ô Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ÚÔÛ·ÚÌÔṲ̂Ó˜ ̤Û˜ ·˘Í‹ÛÂȘ Ù˘ ٿ͈˜ ÙÔ˘ 281,3 min/‚‰ÔÌ¿‰·, Ù˘ÈÎfi ÛÊ¿ÏÌ· 22,0 Û ۇÁÎÚÈÛË Ì 174,5 min/‚‰ÔÌ¿‰·, Ù˘ÈÎfi ÛÊ¿ÏÌ· 25,7, p<0,0005). ™ÙÔÓ ¶›Ó·Î· 6 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ‰Â›ÎÙ˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘. ∏ ÌfiÓË Èı·Ó‹ Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ Ê·›ÓÂÙ·È ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ Ì ̤ÛË ·‡ÍËÛË 2,5 ÛÙ¿‰È·, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,1 ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Î·È 1,2 ÛÙ¿‰È·, Ù˘ÈÎfi ÛÊ¿ÏÌ· 0,1 ÛÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘, p<0,05. ™˘˙‹ÙËÛË ∆· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ÂÍ·ÂÙÔ‡˜ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜ Ê¿ÓËηÓ

71

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·72

¶·È‰È·ÙÚÈ΋ 2002;65:66-76

Paediatriki 2002;65:66-76

¶›Ó·Î·˜ 4. ™˘ÁÎÚ›ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙËÓ ÚfiÛÏË„Ë ıÚÂÙÈÎÒÓ ÛÙÔȯ›ˆÓ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ÌÂÙ¿ ÙÔ ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘1, Ì ‚¿ÛË ÙËÓ ÙÚÈ‹ÌÂÚË Î·Ù·ÁÚ·Ê‹ ˙˘ÁÈÛÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ £ÚÂÙÈο ÛÙÔȯ›· ñ ∂Ó¤ÚÁÂÈ· (Kcal) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ OÏÈÎfi Ï›Ô˜ (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ªÔÓÔ·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ∫ÔÚÂṲ̂ӷ ÏÈ·Ú¿ Ôͤ· (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ Trans ÏÈ·Ú¿ Ôͤ· (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¶ÚˆÙ½Ó˜ (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ À‰·Ù¿ÓıڷΘ (g) OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘ ñ ¢È·ÈÙËÙÈΤ˜ ›Ó˜ OÌ¿‰· ·Ú¤Ì‚·Û˘ OÌ¿‰· ÂϤÁ¯Ô˘

ŒÓ·ÚÍË

§‹ÍË

ªÂÙ·‚ÔÏ‹

95% ‰.Â. ÁÈ· ÙË ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ2

1842,6 ± 433,8 1844,8 ± 437,9

1991,4 ± 530,3 2189,8 ± 519,7

178,7 ± 66,1 366,8 ± 57,5

p<0,05

87,0 ± 23,9 86,8 ± 25,0

92,0 ± 30,5 103,9 ± 31,7

5,9 ± 4,1 18,8 ± 3,5

p<0,05

36,2 ± 11,6 36,9 ± 12,6

39,1 ± 15,3 44,2 ± 16,1

2,7 ± 2,0 8,7 ± 1,8

p<0,05

9,7 ± 3,3 9,4 ± 3,0

10,8 ± 4,2 11,3 ± 4,3

1,0 ± 0,6 2,0 ± 0,5

NS

31,2 ± 9,1 30,6 ± 9,1

31,3 ± 10,3 35,6 ± 10,9

0,8 ± 1,4 5,1 ± 1,2

p<0,05

1,5 ± 0,8 1,6 ± 0,9

2,1 ± 1,4 2,1 ± 1,2

0,8 ± 0,2 0,7 ± 0,1

NS

62,9 ± 17,8 63,4 ± 17,8

70,7 ± 21,4 79,7 ± 21,7

11,3 ± 2,8 16,9 ± 2,4

p<0,05

203,9 ± 57,6 202,0 ± 52,0

224,9 ± 66,0 239,5 ± 59,2

23,4 ± 7,8 37,7 ± 6,9

NS

14,2 ± 5,3 14,1 ± 5,4

14,9 ± 6,1 16,8 ± 6,0

0,7 ± 0,8 3,2 ± 0,7

NS

1

OÌ¿‰· ·Ú¤Ì‚·Û˘ (n=90), ÔÌ¿‰· ÂϤÁ¯Ô˘ (n=86). OÈ ·Ú¯ÈΤ˜ Î·È ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘È΋ ·fiÎÏÈÛË. OÈ ÌÂÙ·‚ÔϤ˜ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘ÈÎfi ÛÊ¿ÏÌ·. ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠mixed-model GLM ÚÔÛ·ÚÌÔṲ̂ÓÔ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜ Î·È ÙÔ Ê‡ÏÔ. ∆· ÛÙÔȯ›· ·ÊÔÚÔ‡Ó ÂΛÓÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Ô˘ ›¯·Ó ηٷÁڷʤ˜ Î·È ÙÔ 1992 Î·È ÙÔ 1998 2 ∆Ô 95% ‰.Â. ˘ÔÏÔÁ›ÛÙËΠÁÈ· ÙȘ ‰È·ÊÔÚ¤˜ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ (·Ú¤Ì‚·ÛË ¤ÏÂÁ¯Ô˜), fiÔ˘ Ë Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ at ·=0,05 ÛÙÔ GLM

‹‰Ë ÓˆÚ›ÙÂÚ·, ηٿ ÙËÓ ·ÍÈÔÏfiÁËÛË ÛÙËÓ ÙÚÈÂÙ›· (3,4). ∆· ÛËÌ·ÓÙÈο ηχÙÂÚ· Â›‰· ÏÈÔÚˆÙÂ˚ÓÒÓ ·›Ì·ÙÔ˜ ÛÙ· ·È‰È¿ Ô˘ ›¯·Ó ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË Î·È ÛÙȘ ‰‡Ô ·ÍÈÔÏÔÁ‹ÛÂȘ ‰Â›¯ÓÔ˘Ó fiÙÈ ÙÔ ÂÎ·È‰Â˘ÙÈÎfi ÚfiÁÚ·ÌÌ· ÂËÚ¤·Û ÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ÙȘ ÂÈÏÔÁ¤˜ ÙÔ˘˜ Û ı¤Ì·Ù· ˘Á›·˜. ™Â ·ÚfiÌÔÈ· ÚÔÁÚ¿ÌÌ·Ù· ÛÙÔ Â͈ÙÂÚÈÎfi ‚Ú¤ıËÎ·Ó ÌÂÙ·‚ÔϤ˜ ÌÈÎÚ‹˜ Îϛ̷η˜ ÛÙ· ÏÈ›‰È· ÔÚÔ‡ Î·È ·ÎfiÌ· ÌÈÎÚfiÙÂÚ˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ (9-12). ™ÙÔ ÚfiÁÚ·ÌÌ· “°ÓÒÚÈÛ ÙÔ ÛÒÌ· ÛÔ˘” ÛÙȘ ∏¶∞ ·Ú·ÙËÚ‹ıËÎ·Ó Ì¤ÙÚȘ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÌÂÙ¿ ·fi ÙÔ ÚÒÙÔ (9) Î·È ÙÔ ¤ÌÙÔ ¤ÙÔ˜ Ù˘ ·Ú¤Ì‚·Û˘ (10). ™ÙÔ ÚfiÁÚ·ÌÌ· “Heart Smart” ·Ú·ÙËÚ‹ıËΠÌfiÓÔ Ì›· ̤ÙÚÈ· ·‡ÍËÛË ÛÙȘ ÙÈ̤˜ Ù˘ HDL-¯ÔÏËÛÙÂÚfiÏ˘ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ (11), ÂÓÒ ‚Ú¤ıËΠ̛ˆÛË Ù˘ ٿ͈˜ ÙÔ˘ 4% ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÛÙÔ ÚfiÁÚ·ÌÌ· “Oslo Youth Study” (12). ªÂÁ·Ï‡ÙÂÚ˜ ÌÂÙ·‚ÔϤ˜ ÛÙËÓ ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË Î·È ÙËÓ LDL-¯ÔÏË-

72

ÛÙÂÚfiÏË ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ÌÂϤÙË “DISC” ÛÙȘ ∏¶∞, Û ·È‰È¿ Ô˘ ›¯·Ó ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù˘ LDL-¯ÔÏËÛÙÂÚfiÏ˘ ηٿ ÙËÓ ·Ú¯È΋ ÂͤٷÛË. ªÂÙ¿ ·fi ÙÚ›· ¯ÚfiÓÈ· ÂÓÙ·ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÚÔ˜ fiÊÂÏÔ˜ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ ÁÈ· ·˘ÙÔ‡˜ ÙÔ˘˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜, ÂÓÒ ‰ÂÓ ˘‹ÚÍ·Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ (13).

OÈ ıÂÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÌÂÙ¿ ·fi ÙÔ ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· Ô˘ ‰È·ÈÛÙÒıËÎ·Ó ÛÙȘ ÏÈÔÚˆÙ½Ó˜ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙÔ˘˜ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ı· ÌÔÚÔ‡Û·Ó Ó· ·Ô‰ÔıÔ‡Ó ÛÙȘ ‰È·ÈÙËÙÈΤ˜ ·ÏÏ·Á¤˜ Î·È ÛÙȘ ·ÏÏ·Á¤˜ ÛÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Ô˘ ÂÂÙ‡¯ıËÛ·Ó ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘. ∞Ó Î·È ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÛÙËÓ ÙÚÈÂÙ›· ‰ÂÓ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÛÏË„Ë ıÚÂÙÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ (4), Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ¤ÍÈ ¯ÚfiÓˆÓ ¤‰ÂÈÍ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÁÈ· ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ‰È·ÈÙËÙÈΤ˜

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·73

¶·È‰È·ÙÚÈ΋ 2002;65:66-76

Paediatriki 2002;65:66-76

¶›Ó·Î·˜ 5. ™˘ÁÎÚ›ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ηٿ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘, ÌÂÙ¿ ÙÔ ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘1 ŒÓ·ÚÍË

§‹ÍË

ñ ª¤ÙÚÈ· ÚÔ˜ ¤ÓÙÔÓË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· (min/week) OÌ¿‰· ·Ú¤Ì‚·Û˘ (n=287) 55,2 ± 116,0 338,3 ± 361,5 OÌ¿‰· ÂϤÁ¯Ô˘ (n=206) 74,6 ± 133,7 244,2 ± 300,6

ªÂÙ·‚ÔÏ‹

95% ‰.Â. ÁÈ· ÙË ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ2

281,3 ± 22,0 174,5 ± 25,7

p<0,05

1

OÈ ·Ú¯ÈΤ˜ Î·È ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘È΋ ·fiÎÏÈÛË. OÈ ÌÂÙ·‚ÔϤ˜ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘ÈÎfi ÛÊ¿ÏÌ·. ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠mixed-model GLM ÚÔÛ·ÚÌÔṲ̂ÓÔ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜, ÙÔ Ê‡ÏÔ, ÙÔÓ ·Ú¯ÈÎfi ¢ª™, ÙË ÌÂÙ·‚ÔÏ‹ ÛÙÔ ‡„Ô˜ Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ. ∆· ÛÙÔȯ›· ·ÊÔÚÔ‡Ó ÂΛÓÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜, ÁÈ· ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ˘‹Ú¯·Ó ‰Â‰Ô̤ӷ Î·È ÙÔ 1992 Î·È ÙÔ 1998 2 ∆Ô 95% ‰.Â. ˘ÔÏÔÁ›ÛÙËΠÁÈ· ÙȘ ‰È·ÊÔÚ¤˜ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ (·Ú¤Ì‚·ÛË ¤ÏÂÁ¯Ô˜), fiÔ˘ Ë Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ at ·=0,05 ÛÙÔ GLM

ÌÂÙ·‚ÏËÙ¤˜. ¶·ÚfiÌÔȘ ÌÂÙ·‚ÔϤ˜ ·Ú·ÙËÚ‹ıËÎ·Ó Î·È Û ¿ÏϘ ÌÂϤÙ˜ (13,14). ∏ Û¯ÂÙÈο ÌÈÎÚfiÙÂÚË ·‡ÍËÛË ÛÙËÓ ÚfiÛÏË„Ë ÂÓ¤ÚÁÂÈ·˜ Î·È ÔÏÈÎÔ‡ Ï›Ô˘˜ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ ÂËÚ¤·Û ıÂÙÈο ÙÔ ·Ó¿ÛÙËÌ· Î·È ·ÚÓËÙÈο ÙÔ˘˜ ‰Â›ÎÙ˜ ·¯˘Û·ÚΛ·˜ ·˘ÙÔ‡. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÛˆÌ·ÙÈ΋ ¿ÛÎËÛË Î·Ù¿ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ, Ë ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·‡ÍËÛË ÛÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈÂÚÒıËΠ۠Â͈ۯÔÏÈΤ˜ ۈ̷ÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ·fi ÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ Û˘ÌʈÓ› Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÌÂϤÙ˘ “CATCH” (15). ∞˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ı· ¤ÚÂ ›Ûˆ˜ Ó· ·Ô‰ÔıÔ‡Ó ÛÙËÓ Â͈ۯÔÏÈ΋ ÂÓı¿ÚÚ˘ÓÛË Ô˘ ÚÔ‹Ïı ·fi ·ÏÏ·Á¤˜ ÛÙË ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤ˆÓ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘. ∂ÈÚfiÛıÂÙ·, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÔÈ Ì·ıËÙ¤˜ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ ‚ÂÏÙÈÒıËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ ÛÙÔ ·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ¶Èı·ÓfiÓ ·˘Ùfi Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ˘„ËÏfiÙÂÚˆÓ ÂÈ¤‰ˆÓ ۈ̷ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ηٿ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ Î·È Ù˘ ·Ó·‰ÈÔÚÁ¿ÓˆÛ˘ ÙˆÓ Û¯ÔÏÈÎÒÓ ˆÚÒÓ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· Â͢ËÚÂÙËıÔ‡Ó ÔÈ ·Ó¿ÁΘ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ (3). ¶·ÚfiÌÔȘ Ù¿ÛÂȘ ÛÙËÓ ·fi‰ÔÛË ÙˆÓ ·È‰ÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙË ÌÂϤÙË “CATCH” (15). ∞˘Ù¿ Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ı· ÌÔÚÔ‡Û·Ó Ó· ÂÍËÁËıÔ‡Ó ·fi ÙËÓ ˘„ËÏ‹ Â›ÙˆÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Î·È ÙˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙË Û˘ÌÂÚÈÊÔÚ¿ ηٿ ÙËÓ ·Ú¯È΋ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ (4,7). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ¤‰ˆÛ ÂÚÈıÒÚÈ· ÁÈ· ‚ÂÏÙ›ˆÛË Î·È ·‡ÍËÛ ÙȘ Èı·ÓfiÙËÙ˜ Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ıÂÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÌÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ú¤Ì‚·Û˘ (2). ∆· ‰Â‰Ô̤ӷ ·fi ÙËÓ ÚÒÙË ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ¤‰ÂÈÍ·Ó ÙȘ ÌÂÁ¿Ï˜ ·ÔÎÏ›ÛÂȘ ÙˆÓ ‰È·ÈÙËÙÈÎÒÓ Û˘ÓËıÂÈÒÓ ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔÓ ·Ú·‰ÔÛÈ·Îfi ÙÚfiÔ ‰È·ÙÚÔÊ‹˜ ÙˆÓ ∫ÚËÙÒÓ ÚÈÓ ·fi

ÌÂÚÈΤ˜ ‰ÂηÂٛ˜ (16). ∆· Â˘Ú‹Ì·Ù· ·ÚfiÌÔÈˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÁˆÁ‹˜ ˘Á›·˜ Ô˘ ÂÊ·ÚÌfiÛÙËÎ·Ó Û ̷ıËÙ¤˜ Ì ¯·ÌËÏfi Î·È Ì¤ÛÔ ÎÔÈÓˆÓÈÎfi-ÔÈÎÔÓÔÌÈÎfi Â›Â‰Ô (11), ηıÒ˜ Î·È Û ̷ıËÙ¤˜ Ì ·˘ÍË̤ÓË ¯ÔÏËÛÙÂÚfiÏË ÔÚÔ‡ (13,17) ‹Ù·Ó Â›Û˘ ıÂÙÈο, ·ÏÏ¿ ÔÈ ÌÂÙ·‚ÔϤ˜ ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ˘ ÌÂÁ¤ıÔ˘˜. ∞ÓÙ›ıÂÙ·, ¿ÏÏ· ÚÔÁÚ¿ÌÌ·Ù· ·Ú¤Ì‚·Û˘ ·Ó¤ÊÂÚ·Ó fiÙÈ Â›¯·Ó ‰˘ÛÎÔϛ˜ Ó· ÂÙ‡¯Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÌÂÙ·‚ÔϤ˜ Û ·ÚfiÌÔÈÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜ Û ·È‰È¿ Ù˘ ›‰È·˜ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ (18-20). ∞˘Ùfi ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› ÌÂÚÈÎÒ˜ ÛÙȘ ÌÈÎÚ¤˜ ‰È·Î˘Ì¿ÓÛÂȘ ÌÂٷ͇ ÙˆÓ ·ÙfiÌˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ˘Á›·˜ Î·È ÙȘ ÌÂÙ·‚ÏËÙ¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ·ÏÏ¿ Î·È ÛÙËÓ ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ ËÏÈΛ· ·Ó¿Ù˘ÍË Ô˘ ÂËÚ¿˙ÂÈ ÙȘ ‰È¿ÊÔÚ˜ ‚ÈÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ (21,23). ª›· ‰Â‡ÙÂÚË ·Ú¿ÌÂÙÚÔ˜ Ô˘ ÂӉ¯Ô̤ӈ˜ Û˘Ó¤‚·Ï ÛÙȘ ÌÂÙ·‚ÔϤ˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‹Ù·Ó Ô ˘„ËÏfi˜ ‚·ıÌfi˜ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È Ë ·Ú¤Ì‚·ÛË ÛÙÔ Û¯ÔÏ›Ô. À¿Ú¯Ô˘Ó ÔÏÏ¿ ÛÙÔȯ›· Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÁÔÓ¤ˆÓ Î·È Û˘ÓÔÏÈο Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û ÚÔÁÚ¿ÌÌ·Ù· ·ÁˆÁ‹˜ ˘Á›·˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÛËÌ·ÓÙÈο ÔʤÏË, ÙfiÛÔ ÛÙÔ˘˜ ‰Â›ÎÙ˜ Û˘ÌÂÚÈÊÔÚ¿˜ fiÛÔ Î·È ÛÙÔ˘˜ ‚ÈÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜ ˘Á›·˜ (9,13,23-25). ∞ÓÙÈı¤Ùˆ˜, Û¯ÔÏÈο ÚÔÁÚ¿ÌÌ·Ù· Ì ÂÚÈÔÚÈṲ̂ÓË ‹ Ì ÌˉÂÓÈ΋ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÁÔÓ¤ˆÓ ·¤Ù˘¯·Ó Ó· ÊÙ¿ÛÔ˘Ó Û ·˘Ùfi ÙÔ Â›Â‰Ô (20,27-30). ŒÓ·˜ ÙÚ›ÙÔ˜ ÏfiÁÔ˜ Ô˘ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙȘ Û·Ê›˜ ıÂÙÈΤ˜ ·ÏÏ·Á¤˜ Â›Ó·È Ô Û¯Â‰È·ÛÌfi˜ Ù˘ ·Ú¤Ì‚·Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ô ÔÔ›Ô˜ Û˘Ó‰‡·˙ ÙÔ ÚfiÁÚ·ÌÌ· ·ÁˆÁ‹˜ ˘Á›·˜ Ì ٷ Ì·ı‹Ì·Ù· Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜, ÂÈÙÚ¤ÔÓÙ·˜ Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ Ó· ˘¿Ú¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ·Ú¤Ì‚·Û˘. ∂ȉÈÎfiÙÂÚ·, Ô ·ÚÈıÌfi˜ ÙˆÓ Û¯ÔÏÈÎÒÓ ˆÚÒÓ Ô˘ ·ÊÈÂÚÒıËÎ·Ó ÛÙËÓ ·Ú¤Ì‚·ÛË ÂÙËÛ›ˆ˜ ÍÂ¤Ú·Û ÙȘ Û˘ÓÈÛÙÒÌÂÓ˜ 4050 ÒÚ˜ ÁÈ· ÈηÓÔÔÈËÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ˘Á›·˜ (31). ™Â ·ÓÙ›ıÂÛË Ì ÙȘ ÌÂϤÙ˜

73

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·74

¶·È‰È·ÙÚÈ΋ 2002;65:66-76

Paediatriki 2002;65:66-76

¶›Ó·Î·˜ 6. ™˘ÁÎÚ›ÛÂȘ ÙˆÓ ÌÂÙ·‚ÔÏÒÓ ÛÙÔ˘˜ ‰Â›ÎÙ˜ Ù˘ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ·Ú¤Ì‚·Û˘ Î·È Ù˘ ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ÌÂÙ¿ ÙÔ ÂÍ·ÂÙ¤˜ ÚfiÁÚ·ÌÌ· ·Ú¤Ì‚·Û˘1 ¢ÔÎÈ̷ۛ˜ Ê˘ÛÈ΋˜ ηٿÛÙ·Û˘

ŒÓ·ÚÍË

ñ ÕÏÌ· Û ̋ÎÔ˜ ¯ˆÚ›˜ ÊfiÚ· (cm) OÌ¿‰· ·Ú¤Ì‚·Û˘ 85,6 ± 15,6 OÌ¿‰· ÂϤÁ¯Ô˘ 84,0 ± 15,5 ñ ∞Ó·‰ÈÏÒÛÂȘ ·fi ‡ÙÈ· ηٿÎÏÈÛË (Â·Ó·Ï‹„ÂȘ) OÌ¿‰· ·Ú¤Ì‚·Û˘ 7,0 ± 5,3 OÌ¿‰· ÂϤÁ¯Ô˘ 7,8 ± 5,7 ñ ¢›ψÛË ·fi ‰ڷ›· ı¤ÛË (cm) OÌ¿‰· ·Ú¤Ì‚·Û˘ 15,2 ± 5,4 OÌ¿‰· ÂϤÁ¯Ô˘ 15,3 ± 5,1 ñ ÃÂÈÚÔ‰˘Ó·ÌÔ̤ÙÚËÛË (kg) OÌ¿‰· ·Ú¤Ì‚·Û˘ 6,8 ± 2,6 OÌ¿‰· ÂϤÁ¯Ô˘ 7,5 ± 2,8 ñ ¶·Ï›Ó‰ÚÔÌÔ ÙÚ¤ÍÈÌÔ ·ÓÙÔ¯‹˜ (ÛÙ¿‰È·) OÌ¿‰· ·Ú¤Ì‚·Û˘ 1,6 ± 0,7 OÌ¿‰· ÂϤÁ¯Ô˘ 1,8 ± 0,9

§‹ÍË

ªÂÙ·‚ÔÏ‹

95% ‰.Â. ÁÈ· ÙË ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ2

143,9 ± 26,7 135,3 ± 23,3

56,3 ± 1,3 51,8 ± 1,3

ª™

18,8 ± 4,6 18,5 ± 4,3

11,3 ± 0,2 10,6 ± 0,2

ª™

9,7 ± 6,8 10,4 ± 6,6

-5,3 ± 0,4 -4,9 ± 0,4

ª™

21,1 ± 4,9 21,0 ± 4,7

13,8 ± 0,2 14,0 ± 0,2

ª™

4,2 ± 2,3 3,0 ± 1,5

2,5 ± 0,1 1,2 ± 0,1

(0,9, 1,6)3

1

OÌ¿‰· ·Ú¤Ì‚·Û˘ (n=295), ÔÌ¿‰· ÂϤÁ¯Ô˘ (n=262). OÈ ·Ú¯ÈΤ˜ Î·È ÙÂÏÈΤ˜ ÌÂÙÚ‹ÛÂȘ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘È΋ ·fiÎÏÈÛË. OÈ ÌÂÙ·‚ÔϤ˜ Â›Ó·È Ì¤ÛÔÈ fiÚÔÈ ± Ù˘ÈÎfi ÛÊ¿ÏÌ·. ∏ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ˘ÔÏÔÁ›ÛÙËΠ̠mixed-model GLM ÚÔÛ·ÚÌÔṲ̂ÓÔ ÁÈ· ÙȘ ·Ú¯ÈΤ˜ ÙÈ̤˜, ÙÔ Ê‡ÏÔ, ÙÔÓ ·Ú¯ÈÎfi ¢ª™, ÙË ÌÂÙ·‚ÔÏ‹ ÛÙÔ ‡„Ô˜ Î·È ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓ¤ˆÓ. ∆· ÛÙÔȯ›· ·ÊÔÚÔ‡Ó ÂΛÓÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜, ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ˘¿Ú¯Ô˘Ó ‰Â‰Ô̤ӷ Î·È ÙÔ 1992 Î·È ÙÔ 1998 2 ∆Ô 95% ‰.Â. ˘ÔÏÔÁ›ÛÙËΠÁÈ· ÙȘ ‰È·ÊÔÚ¤˜ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ·Ú¤Ì‚·Û˘ Î·È ÂϤÁ¯Ô˘ (·Ú¤Ì‚·ÛË ¤ÏÂÁ¯Ô˜), fiÔ˘ Ë Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ‚Ú¤ıËΠfiÙÈ ‹Ù·Ó ÛËÌ·ÓÙÈ΋ Û Â›Â‰Ô ÛËÌ·ÓÙÈÎfiÙËÙ·˜ at ·=0,05 ÛÙÔ GLM 3 À¿Ú¯Ô˘Ó ÂÍ·ÈÚÂÙÈο ÈÛ¯˘Ú¤˜ ÂӉ›ÍÂȘ ÁÈ· Â›‰Ú·ÛË Ù˘ ·Ú¤Ì‚·Û˘ ÛÙÔ mixed GLM, p<0,0001

“CATCH” (15) Î·È “CHIC” (29) Î·È ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·Ú¤Ì‚·ÛË ÂÈÎÂÓÙÚÒıËΠÂÚÈÛÛfiÙÂÚÔ Û ·ÂÚfi‚Ș ÌÔÚʤ˜ ·Û΋ÛÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘Á›·, Ô ÚˆÙ·Ú¯ÈÎfi˜ ÛÙfi¯Ô˜ ‰ÂÓ ‹Ù·Ó Ó· ˘¿ÚÍÔ˘Ó Ô˘ÛÈ·ÛÙÈΤ˜ ·˘Í‹ÛÂȘ ÛÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈÂÚˆÓfiÙ·Ó Û ̤ÙÚȘ ÚÔ˜ ¤ÓÙÔÓ˜ Ê˘ÛÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Ì·ıËÌ¿ÙˆÓ Á˘ÌÓ·ÛÙÈ΋˜. ∞ÓÙ›ıÂÙ·, Ë ·ÚÔ‡Û· ÌÂϤÙË ÂÈÎÂÓÙÚÒıËΠÛÙË ‰È·ÛΤ‰·ÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙËÓ ÚÔı˘Ì›· ÙÔ˘˜ Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙ· Ì·ı‹Ì·Ù· Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜. °È· ·˘Ùfi ÙÔ ÏfiÁÔ, ‰fiıËΠ¤ÌÊ·ÛË ÛÙË Û˘ÓÔÏÈ΋ Û˘ÌÌÂÙÔ¯‹ Ù˘ Ù¿Í˘ Û ¢¯¿ÚÈÛÙ˜, ÌË ·ÓÙ·ÁˆÓÈÛÙÈΤ˜ ÌÔÚʤ˜ ·Û΋ÛÂˆÓ (3). ∞˘Ù‹ Ë ÛÙÚ·ÙËÁÈ΋, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÓı¿ÚÚ˘ÓÛË ÙˆÓ ÁÔÓ¤ˆÓ Ó· ‚ÔËı‹ÛÔ˘Ó Ù· ·È‰È¿ ÙÔ˘˜ Ó· ·˘Í‹ÛÔ˘Ó ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘˜ Î·È ÂÎÙfi˜ Û¯ÔÏ›Ԣ, ¤¯ÂÈ ·Ô‰Âȯı› Ôχ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÛÙËÓ ÂÓ›Û¯˘ÛË Ù˘ ·ÓÂÍ·ÚÙËÛ›·˜ ÙˆÓ ·È‰ÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰Ú·ÛÙËÚÈfiÙËÙ· (3). ™˘ÓÂÒ˜, ‰fiıËΠ¤ÌÊ·ÛË ÛÙÔ ¯ÚfiÓÔ Ô˘ ·ÊÈÂÚÒıËΠ̤۠ÙÚȘ ¤ˆ˜ ¤ÓÙÔÓ˜ Ê˘ÛÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÎÙfi˜ Û¯ÔÏ›Ԣ, ˆ˜ ‰Â›ÎÙ˘ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÙfiÛÔ ÛÙ· ·È‰È¿ fiÛÔ Î·È ÛÙÔ˘˜ ÁÔÓ›˜. ∂Ô̤ӈ˜, Ë ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ Ì¤ÙÚÈˆÓ ¤ˆ˜ ¤ÓÙÔÓˆÓ Ê˘ÛÈÎÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·Ù¿ ÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ ÛÙËÓ ÔÌ¿‰· ·Ú¤Ì‚·Û˘ Â›Ó·È ¤Ó·˜ ‰Â›ÎÙ˘ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ·Ú¤Ì‚·Û˘ ÛÙË ÛÙ¿ÛË ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÛÙ· ΛÓËÙÚ· ÙˆÓ ·È‰ÈÒÓ ÁÈ· ·˘ÍË̤ÓË Ê˘-

74

ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È Î·Ï‹ Ê˘ÛÈ΋ ηٿÛÙ·ÛË. ∆¤ÏÔ˜, ÛÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ÂÍËÁÔ‡Ó ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ·ÏÏ·ÁÒÓ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ı· Ú¤ÂÈ Ó· ÚÔÛÙÂıÔ‡Ó Î·È Ë Û¯ÂÙÈο ÌÂÁ¿ÏË ‰È¿ÚÎÂÈ· Ù˘ ·Ú¤Ì‚·Û˘, ηıÒ˜ Î·È ÙÔ Â›Â‰Ô Ù˘ Û˘ÓÂÚÁ·Û›·˜ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Ô˘ ‰ÈÂÍ‹Á·Á·Ó ÙÔ ÚfiÁÚ·ÌÌ· (4). Ÿˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë Û¯¤ÛË ÌÂٷ͇ Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ ·Ú¤Ì‚·Û˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ·ÏÏ·ÁÒÓ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ¤¯ÂÈ Û·ÊÒ˜ Ê·Ó› Î·È ÛÙÔ ÚfiÁÚ·ÌÌ· “°ÓÒÚÈÛ ÙÔ ÛÒÌ· ÛÔ˘” (9,10). ™Ô‚·Ú‹ ·‰˘Ó·Ì›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ¤ÏÏÂÈ„Ë ÛÙÂÓ‹˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ¤ÚÁÔ˘ ÙÔ˘ οı ÂÎ·È‰Â˘ÙÈÎÔ‡ ÌÂÙ¿ ·fi Ù· ÛÂÌÈÓ¿ÚÈ· ÛÙËÓ ·Ú¯‹ οı ·Î·‰ËÌ·˚ÎÔ‡ ¤ÙÔ˘˜. ŒÙÛÈ, Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ·Ú¤Ì‚·Û˘ Û ı¤Ì·Ù· ˘Á›·˜ Ì ÂÓÂÚÁËÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ Ì·ıËÙÒÓ Û ÌÈÎÚ¤˜ ÔÌ¿‰Â˜ Î·È Ì ‰È¿ÊÔÚ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ̤۷ Î·È ¤Íˆ ·fi ÙÔ Û¯ÔÏÂ›Ô ÂÍ·ÚÙ‹ıËΠ·ÔÎÏÂÈÛÙÈο ·fi ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ. ª¤Û· ÛÙ· Ï·›ÛÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·˘ÙÔ‡ ‰ÂÓ ·ÍÈÔÏÔÁ‹ıËÎ·Ó ÔÈ ÁÓÒÛÂȘ, Ë ÚÔÂÙÔÈÌ·Û›·, ÙÔ ÂӉȷʤÚÔÓ, Ë ‰È‰·ÎÙÈ΋ ÈηÓfiÙËÙ·, Ë ÈηÓfiÙËÙ· ÂÈÎÔÈÓˆÓ›·˜ Î·È ÔÚÁ¿ÓˆÛ˘ ÌÈÎÚÒÓ ÔÌ¿‰ˆÓ ÂÚÁ·Û›·˜ Î·È Ë Ê·ÓÙ·Û›· ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Ó· ÂÈÓÔ‹ÛÔ˘Ó ÂÏ΢ÛÙÈÎÔ‡˜ Î·È ÚˆÙfiÙ˘Ô˘˜ ÙÚfiÔ˘˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ Ì·ıËÙÒÓ, ÒÛÙ ӷ οÓÔ˘Ó Î·Ï‡ÙÂÚ˜ ÂÈÏÔÁ¤˜ ÛÂ

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ı¤Ì·Ù· ˘Á›·˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ‰ËÏ·‰‹, ‰ÂÓ ¤ÁÈÓ ÔÈÔÙÈ΋ ÂȉËÌÈÔÏÔÁÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·Ú¤Ì‚·Û˘. ∏ ·Ú¤Ì‚·ÛË ·ÍÈÔÏÔÁ‹ıËΠ·ÔÎÏÂÈÛÙÈο Ì ÙÔ ·ÔηÏÔ‡ÌÂÓÔ “Ì·‡ÚÔ ÎÔ˘Ù› Ù˘ ÂȉËÌÈÔÏÔÁ›·˜”. ŸÏ˜, ‰ËÏ·‰‹, ÔÈ ÌÂÙ·‚ÏËÙ¤˜ ·Ó·Ï‡ıËÎ·Ó ÚÈÓ Î·È ÌÂÙ¿ ÙËÓ ÂÎ·È‰Â˘ÙÈ΋ ·Ú¤Ì‚·ÛË, ¯ˆÚ›˜ Ó· ÌÔÚԇ̠̠‚‚·ÈfiÙËÙ· Ó· ·Ô‰ÒÛÔ˘Ì ÙȘ ·ÏÏ·Á¤˜ ÛÙËÓ ·Ú¤Ì‚·Û‹ Ì·˜. ∂Ô̤ӈ˜, Ë ÔÈÔÙÈ΋ ·Ó¿Ï˘ÛË Ù˘ ·Ú¤Ì‚·Û˘ ‹Ù·Ó ÛÔ‚·Úfi ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ÌÂϤÙ˘ Î·È ÚÔÛ·ıԇ̠ÛÙȘ Ӥ˜ ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÂÍÂÙ¿ÛÔ˘Ì ‚·ı‡ÙÂÚ· Î·È Ó· ‰Ô‡Ì ·Ó ÔÈ ·ÏÏ·Á¤˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÂӉȷʤÚÔÓ, Ù· ΛÓËÙÚ· Î·È ÙËÓ ÚÔÛˆÈÎfiÙËÙ· ÙÔ˘ ÂÎ·È‰Â˘ÙÈÎÔ‡. ¶·Ú¿ ÙȘ ·‰˘Ó·Ì›Â˜, Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÙÔÓ›˙Ô˘Ó ÙË ÌÂÁ¿ÏË ÛËÌ·Û›· ·˘ÙÒÓ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÛÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ¯ÚfiÓÈˆÓ ÓÔÛËÌ¿ÙˆÓ. O Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ ˘Á›·˜ Ì ٷ Ì·ı‹Ì·Ù· Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ ‚ÂÏÙÈÛÙÔÔÈ› ÙË Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ÙË Ê˘ÛÈ΋ ηٿÛÙ·ÛË, ηıÒ˜ Â›Û˘ Î·È ÙȘ Û˘ÓÈÛÙÒÛ˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰È·ÙÚÔÊ‹ Î·È ÙËÓ ˘Á›·, ÂÈÙÚ¤ÔÓÙ·˜ ¤ÙÛÈ Ó· ˘¿Ú¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ ÒÚ˜ ·Ú¤Ì‚·Û˘ Ì ٷ ÏÈÁfiÙÂÚ· ‰˘Ó·Ù¿ ÂÌfi‰È· ÛÙÔ ˘fiÏÔÈÔ Û¯ÔÏÈÎfi ÚfiÁÚ·ÌÌ·. ∞Ó Î·È ÔÈ Ì·ÎÚÔÚfiıÂÛ̘ ÂȉڿÛÂȘ ·˘ÙÒÓ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ÌÔÚÔ‡Ó Ó· ‚ÚÂıÔ‡Ó ÌfiÓÔ ·Ó ‰È·¯ÚÔÓÈο ÂÍ·ÎÔÏÔ˘ı‹ÛÂÈ Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÏËı˘ÛÌÔ‡ ·˘ÙÔ‡ ηٿ ÙËÓ ÂÊ˂›· Î·È ÙÂÏÈο ηٿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ¤ÛÙˆ Î·È ‚Ú·¯˘ÚfiıÂÛÌ· Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙË ‰ËÌfiÛÈ· ˘Á›·, ÂÓı·ÚÚ‡ÓÔÓÙ·˜ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·˘ÙÒÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Û¯ÔÏ›ˆÓ Ù˘ ÂÈÎÚ¿ÙÂÈ·˜. ∂˘¯·ÚÈÛٛ˜ ∏ ÌÂϤÙË ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙËÓ Kellogg’s, ÙË °ÂÓÈ΋ °Ú·ÌÌ·Ù›· ∞ıÏËÙÈÛÌÔ‡ Î·È ÙÔ ÀÔ˘ÚÁÂ›Ô ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ. ™ÙË ÌÂϤÙË Û˘Ó¤‚·Ï·Ó ·ÔÙÂÏÂÛÌ·ÙÈο ÔÈ ·ÎfiÏÔ˘ıÔÈ Û˘ÓÂÚÁ¿Ù˜: Œ˘· ª·ÏˆÌÂÓ¿ÎË, °ÈÒÚÁÔ˜ ª·Ì·Ï¿Î˘, Œ˘· ªÔ‡Î·, πˆ¿ÓÓ· ∞ÔÛÙÔÏ¿ÎË, ∂ϤÓË ∫·ÓÙȉ¿ÎË, ºˆÙÂÈÓ‹ ÃÂÈÏ·‰¿ÎË, ∫·ÚÔÏ¿ÈÓ ∫fi‰ÚÈÓÁÎÙÔÓ, ¢ËÌ‹ÙÚ˘ ∞ı·Ó·ÛfiÔ˘ÏÔ˜, •ÂÓÔÊÒÓÙ·˜ ª·ÓÈ¿˜, ÷ڿ °·Ï·Ó¿ÎË, ÃÚ˘ÛԇϷ ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË, ª·ÓfiÏ˘ §ÈÓ·Ú‰¿Î˘, ∂ÈÚ‹ÓË ª¿ÚηÙ˙Ë, ª·Ú›· ÃÔ˘Ú‰¿ÎË Î·È °È¿ÓÓ˘ ªËÙ¿Î˘.

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Donnelly JE, Jacobsen DJ, Whatley JE, Hill JO, Swift LL, Cherrington A et al. Nutrition and physical activity program to attenuate obesity and promote physical and metabolic fitness in elementary school children. Obesity Research 1996;4:229-243.

Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB. Effects of school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: The Cardiovascular Health in Children (CHIC) study. J Pediatr 1996;128:797-805.

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CASE REPORT

¶·ÚÔ‰ÈÎfi ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÙÂÛÛ¿ÚˆÓ ÂÚÈÙÒÛÂˆÓ ª. OÈÎÔÓfiÌÔ˘1, ∞. ∫Ô‡ÛË1, π. ∆Û¿ÙÚ·1, µ. °·Ú˘›‰Ô˘2, ª. ∞ı·Ó·Û›Ô˘-ªÂÙ·Í¿1

Transient lupus anticoagulant in children: report of 4 cases M. Economou1, A. Koussi1, I. Tsatra1, V. Garipidou2, M. Athanassiou-Metaxa1

¶ÂÚ›ÏË„Ë: ∆Ô ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ (LA) ·ÔÙÂÏ› ¤Ó·Ó Â›ÎÙËÙÔ ·Ó·ÛÙÔϤ· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‹Í˘. ™Ù· ·È‰È¿, Ë ·ÚÔ˘Û›· ÙÔ˘ LA Â›Ó·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ηÏÔ‹ı˘ Î·È ·ÚÔ‰È΋, ·Ú·ÙËÚÔ‡ÌÂÓË ÌÂÙ¿ ·fi ÏÔÈÌÒÍÂȘ ‹ Ï‹„Ë Ê·Ú̿ΈÓ. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ÛÙ· ÔÔ›· ‰È·ÈÛÙÒıËΠ·Ú¿Ù·ÛË ÙÔ˘ ∞PTT ˆ˜ ·ÔÙ¤ÏÂÛÌ· ΢ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ χÎÔ˘. ™ÙȘ 3 ÂÚÈÙÒÛÂȘ ·Ó·Ê¤ÚÔÓÙ·Ó ·fi ÙÔ ÈÛÙÔÚÈÎfi Â·ÓÂÈÏËÌ̤ӷ ÂÂÈÛfi‰È· ÏÔÈÌÒÍÂˆÓ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÂ Û˘¯Ó‹ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ë ·Ó‡ÚÂÛË ÙÔ˘ LA ‹Ù·Ó Ù˘¯·›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ™ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË, Ë ·Ó›¯Ó¢ÛË ÙÔ˘ ·Ó·ÛÙÔϤ· Ú·ÁÌ·ÙÔÔÈ‹ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ ·ÈÌÔÚÚ·ÁÈ΋˜ ‰È¿ıÂÛ˘ ÏfiÁˆ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ·ÈÌÔÚÚÔÊÈÏ›·˜. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ, Ë ·ÚÔ˘Û›· ÙÔ˘ LA ‹Ù·Ó ·Û˘Ìو̷ÙÈ΋ Î·È ·ÚÔ‰È΋, Ì Â·ÎfiÏÔ˘ıË ·˘ÙfiÌ·ÙË ·ÔηٿÛÙ·ÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Û ‰È¿ÛÙËÌ· Ï›ÁˆÓ ÌËÓÒÓ.

Abstract: The lupus anticoagulant (LA) is an acquired inhibitor of blood coagulation. The presence of LA in children is usually transitory and benign, commonly induced by infection or drugs.

We report 4 cases of asymptomatic APTT prolongation associated with the development of LA. In 3 cases LA was linked to repeated respiratory infections treated with antibiotics and was identified at screening before adenotonsillectomy. In the 4th case the presence of LA was detected during laboratory investigation due to a family history of hemophilia. In all cases laboratory findings were normalized within a period of a few months.

§¤ÍÂȘ ÎÏÂȉȿ: ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘, Â›ÎÙËÙÔ˜ ·Ó·ÛÙÔϤ·˜, ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù·, ¯ÚfiÓÔ˜ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘.

Key words: lupus anticoagulant, acquired inhibitor, antiphospholipid antibodies, partial thromboplastin time.

∆Ô ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘ (LA) ·ÔÙÂÏ› ¤Ó·Ó Â›ÎÙËÙÔ ·Ó·ÛÙÔϤ· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‹Í˘. ¶ÚfiÎÂÈÙ·È ‰ËÏ·‰‹ ÁÈ· Ì›· ÔÌ¿‰· ·ÓÙÈÛˆÌ¿ÙˆÓ (IgG, IgM ‹ Û˘Ó‰˘·ÛÌfi ·˘ÙÒÓ) Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È ÂÓ·ÓÙ›ÔÓ Û˘ÌÏÂÁÌ¿ÙˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ Î·È ÚˆÙÂ˚ÓÒÓ, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ Ù· ÛÙ¿‰È· Ù˘ ‹Í˘ Ô˘ ÂÍ·ÚÙÒÓÙ·È ·fi ʈÛÊÔÏÈ›‰È· (1). In vitro ÚÔηÏÔ‡Ó ·Ú¿Ù·ÛË ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ‰ÔÎÈÌ·-

ÛÈÒÓ Ù˘ ‹Í˘, Û˘Ó‹ıˆ˜ ÙÔ˘ ¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ (∞ƒ∆∆) Î·È Û ‡·ÚÍË ÈÛ¯˘ÚÔ‡ ·Ó·ÛÙÔϤ·, ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›Ó˘ (ƒ∆). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë ·ÚÔ˘Û›· ÙÔ˘ LA ‹ ¿ÏÏˆÓ ·ÓÙÈʈÛÊÔÏÈȉÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (∞ƒ∞) Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂΉ‹ÏˆÛË ·ÚÙËÚÈ·ÎÒÓ Î·È ÊÏ‚ÈÎÒÓ ıÚÔÌ‚ÒÛˆÓ, ηı’ ¤ÍÈÓ ·Ô‚ÔÏÒÓ Î·È ıÚÔÌ‚ÔÂÓ›·˜.

1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., £ÂÛÛ·ÏÔÓ›ÎË 2 µ’ ¶ÚÔ·È‰Â˘ÙÈ΋ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. ¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “πÔÎÚ¿ÙÂÈÔ”, £ÂÛÛ·ÏÔÓ›ÎË

1 1st Pediatric Clinic of Aristotelion University of Thessaloniki 2 2nd Propaedeutic Internal Medicine Clinic of Aristotelion University of Thessaloniki, “Ippokration” General Hospital, Thessaloniki

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Paediatriki 2002;65:77-80

™Ù· ·È‰È¿, Ë ·ÚÔ˘Û›· ÙÔ˘ LA Â›Ó·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ηÏÔ‹ı˘ Î·È ·ÚÔ‰È΋, ·Ú·ÙËÚÔ‡ÌÂÓË ÌÂÙ¿ ·fi ÏÔÈÌÒÍÂȘ ‹ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ (1,2). ¶ÂÚÈÁÚ¿ÊÔÓÙ·È Ù¤ÛÛÂÚȘ ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ ÛÙ· ÔÔ›· ‰È·ÈÛÙÒıËΠ·Ú¿Ù·ÛË ÙÔ˘ ∞PTT ˆ˜ ·ÔÙ¤ÏÂÛÌ· ΢ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ χÎÔ˘. ∆· ·È‰È¿ ·Ú·¤ÌÊıËÎ·Ó ÛÙÔ Â͈ÙÂÚÈÎfi ·ÈÌ·ÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô - Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 6 ÌËÓÒÓ - ÌÂÙ¿ ·fi Ù˘¯·›· ÂÚÁ·ÛÙËÚȷ΋ ‰È·›ÛÙˆÛË ·Ú¿Ù·Û˘ ∞ƒ∆∆. ™Â fiϘ ÙȘ ÂÚÈÙÒÛÂȘ, Ë ·ÚÔ˘Û›· ÙÔ˘ LA ‹Ù·Ó ·Û˘Ìو̷ÙÈ΋ Î·È ·ÚÔ‰È΋, Ì Â·ÎfiÏÔ˘ıË ·˘ÙfiÌ·ÙË ·ÔηٿÛÙ·ÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Û ‰È¿ÛÙËÌ· Ï›ÁˆÓ ÌËÓÒÓ. ¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÚfiÎÂÈÙ·È ÁÈ· Ù¤ÛÛÂÚ· ·È‰È¿ ËÏÈΛ·˜ 18 ÌËÓÒÓ ¤ˆ˜ 5 ÂÙÒÓ (¶›Ó·Î·˜ 1). ™ÙȘ 3 ·fi ÙȘ 4 ÂÚÈÙÒÛÂȘ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ ·ÈÌÔÚÚ·ÁÈ΋˜ ‰È¿ıÂÛ˘, ÂÓÒ ·fi ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÔÓÙ·Ó Û˘¯Ó¿ ÂÂÈÛfi‰È· ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÂ Û˘¯Ó‹ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÚÒÙË ÂÚ›ÙˆÛË ·Ó·Ê¤ÚıËΠϋ„Ë ÎÂÊÚÔ˙›Ï˘ Ï›Á˜ Ë̤Ú˜ ÚÈÓ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘, ÂÓÒ ÛÙËÓ ÙÚ›ÙË Î·È Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË Â›¯Â ÚÔËÁËı› Â·ÓÂÈÏËÌ̤ÓË ¯Ú‹ÛË ÎÂÊ·ÏÔÛÔÚÈÓÒÓ Î·È Ì·ÎÚÔÏȉÒÓ. ∫·È ÛÙȘ 3 ÂÚÈÙÒÛÂȘ Ë ÂÚÁ·ÛÙËÚȷ΋ ‰È·›ÛÙˆÛË ·Ú¿Ù·Û˘ ∞ƒ∆∆ ‹Ù·Ó Ù˘¯·›· Î·È Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙ· Ï·›ÛÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÂÎÙÔÌ‹˜ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ. ™ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË, ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ‹Ù·Ó ÂχıÂÚÔ, ÂÓÒ Ë ·Ú¿Ù·ÛË ∞ƒ∆∆ ·ÓȯÓ‡ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· ÂϤÁ¯Ô˘ ·ÈÌÔÚÚ·ÁÈ΋˜ ‰È¿ıÂÛ˘ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË ·ÈÌÔÚÚÔÊÈÏ›·˜ ∞ ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ·‰ÂÏÊfi ÙÔ˘. ∫·Ó›˜ ·fi ÙÔ˘˜ ÌÈÎÚÔ‡˜ ·ÛıÂÓ›˜ ‰ÂÓ ·ÚÔ˘Û›·˙ ÎÏÈÓÈο οÔÈÔ ·ıÔÏÔÁÈÎfi ÛËÌÂ›Ô ‹ Û‡Ìو̷. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„ Ôχ ÌÂÁ¿ÏË ·Ú¿Ù·ÛË ∞PTT (¶›Ó·Î·˜ 1) ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ¯ÚfiÓÔ ÚÔıÚÔÌ‚›Ó˘ Î·È Ê˘ÛÈÔÏÔÁÈÎfi ·ÚÈıÌfi ·ÈÌÔÂÙ·Ï›ˆÓ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ. O ¤ÏÂÁ¯Ô˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ππ, VIII, πÃ, Ãπ, Ãππ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÂÓÒ Ë ·Ú¿Ù·ÛË ∞ƒ∆∆ ‰ÂÓ ‰ÈÔÚ-

ıÒıËΠ̠test ̛͈˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi Ï¿ÛÌ·. ∏ ·ÚÔ˘Û›· ·ÓÙÈËÎÙÈÎÔ‡ ÙÔ˘ χÎÔ˘ ÂȂ‚·ÈÒıËΠ̠ÙË ‰ÔÎÈÌ·Û›· dRVVT (dilute Russell’s viper venom time). ∆· ·ÓÙÈÛÒÌ·Ù· ·ÓÙÈηډÈÔÏÈ›Ó˘ (ACA) Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì Elisa ‹Ù·Ó ·ÚÓËÙÈο Î·È Ô ÏÔÈfi˜ ·ÓÔÛÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. O Û˘Ó‹ı˘ ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ÁÈ· Epstein Barr, CMV, ÙÔÍfiÏ·ÛÌ·, ·‰ÂÓÔ˚Ô‡˜ Î.Ï.) ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ˘Ô¯ÒÚËÛ·Ó Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ 1 ¤ˆ˜ 4 Ì‹Ó˜ ÌÂÙ¿, ¯ˆÚ›˜ ÔÈ ·ÛıÂÓ›˜ Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÔÔÈÔ‰‹ÔÙ ۇÌو̷ ‹ Ó· Ï¿‚Ô˘Ó Î¿ÔÈ· ıÂÚ·›· ÛÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi. Œˆ˜ Û‹ÌÂÚ·, ¤Ó· ÂÚ›Ô˘ ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÙÈÌÒÓ, ÔÈ ·ÛıÂÓ›˜ ·Ú·Ì¤ÓÔ˘Ó Û ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËı› ˘ÔÙÚÔ‹ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ. ™˘˙‹ÙËÛË ∆· ·ÓÙÈʈÛÊÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù· (∞ƒ∞) ·ÔÙÂÏÔ‡Ó Ì›· ÂÙÂÚÔÁÂÓ‹ ÔÌ¿‰· ·˘ÙÔ·ÓÙÈۈ̿وÓ, Ù· ÔÔ›· ÛÙÚ¤ÊÔÓÙ·È ¤Ó·ÓÙÈ Û˘ÌÏÂÁÌ¿ÙˆÓ ÚˆÙÂ˚ÓÒÓ-ʈÛÊÔÏÈȉ›ˆÓ. ™Ù· ∞ƒ∞ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘, Ù· ·ÓÙÈηډÈÔÏÈȉÈο ·ÓÙÈÛÒÌ·Ù·, ÔÈ ·ÓÙȉڷۛÓ˜ Î·È Ù· ÂȉÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ·ÓÈÔÓÙÈÎÒÓ ‹ ÙˆÓ Ô˘‰¤ÙÂÚˆÓ ÊˆÛÊÔÏÈȉ›ˆÓ (3). ¶·Ú¿ ÙÔ fiÙÈ Ù· ∞ƒ∞ ·Ú¯Èο ıˆڋıËÎ·Ó ˆ˜ Û˘ÓÔ‰fi ‡ÚËÌ· ÙÔ˘ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÂÚ˘ıËÌ·ÙÒ‰Ô˘˜ χÎÔ˘, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· Û˘Ó‰¤ÔÓÙ·È Ì ÔÈÎÈÏ›· ¿ÏÏˆÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛˆÓ, ÂÓÒ ·Ó¢ڛÛÎÔÓÙ·È Î·È Û ˘ÁÈ‹ ¿ÙÔÌ· (¶›Ó·Î·˜ 2) (3-5). °È· ÙË ‰Ú¿ÛË ÙˆÓ ∞ƒ∞ ¤¯Ô˘Ó ÚÔÙ·ı› ‰È¿ÊÔÚ˜ ·fi„ÂȘ, fiˆ˜ Ë ‰È·Ù·Ú·¯‹ Ù˘ ·ÈÌÔÂÙ·Ïȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ë ‰Ú¿ÛË ÙÔ˘˜ ˆ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ‚2 ÁÏ˘ÎÔÚˆÙ½Ó˘ π ‹ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ, Ë ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË ÙÔ˘ ÈÛÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· Î·È Ë ·Ó·ÛÙÔÏ‹ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Ù˘ ÚˆÙ½Ó˘ C, Ë ÔÔ›· ıˆÚÂ›Ù·È Û‹ÌÂÚ· Ë ÂÈÎÚ·Ù¤ÛÙÂÚË ¿Ô„Ë. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, Ë ·ÚÔ˘Û›· ∞ƒ∞ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂΉ‹ÏˆÛË ·ÚÙËÚÈ·ÎÒÓ Î·È ÊÏ‚ÈÎÒÓ ıÚÔÌ‚ÒÛˆÓ, ηı’ ¤ÍÈÓ ·Ô‚ÔÏÒÓ Î·È ıÚÔÌ‚ÔÂÓ›·˜. ∏ ‡·ÚÍË

¶›Ó·Î·˜ 1. ∂˘Ú‹Ì·Ù· ·ÛıÂÓÒÓ Ì ıÂÙÈÎfi LA ∞ÛıÂÓ‹˜ º‡ÏÔ ∏ÏÈΛ· πÛÙÔÚÈÎfi

1

£‹Ï˘ 3 ÂÙÒÓ §ÔÈÌÒÍÂȘ ·ÓÙÈ‚›ˆÛË ∞ƒ∆∆ 38”/80” dRVVT 30”/90” ∞ÔηٿÛÙ·ÛË Â˘ÚËÌ¿ÙˆÓ 3 Ì‹Ó˜

78

2

3

4

ÕÚÚÂÓ 5 ÂÙÒÓ §ÔÈÌÒÍÂȘ ·ÓÙÈ‚›ˆÛË 38”/65” 38”/90” 4 Ì‹Ó˜

£‹Ï˘ 4 ÂÙÒÓ §ÔÈÌÒÍÂȘ ·ÓÙÈ‚›ˆÛË 38”/63” 30”/93” 2 Ì‹Ó˜

£‹Ï˘ 18 ÌËÓÒÓ ∞‰ÂÏÊfi˜ Ì ·ÈÌÔÚÚÔÊÈÏ›· ∞ 30”/60” 32”/70” 1 Ì‹Ó·˜

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·79

¶·È‰È·ÙÚÈ΋ 2002;65:77-80

Paediatriki 2002;65:77-80

¶›Ó·Î·˜ 2. ∫·Ù·ÛÙ¿ÛÂȘ ÛÙȘ Ôԛ˜ ·ÓȯÓ‡ÂÙ·È ÙÔ LA

¶›Ó·Î·˜ 3. ∫ÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ APS*

ƒÂ˘Ì·ÙÈο ÓÔÛ‹Ì·Ù·

∫ÏÈÓÈο ºÏ‚ÈΤ˜ ıÚÔÌ‚ÒÛÂȘ ∞ÚÙËÚȷΤ˜ ıÚÔÌ‚ÒÛÂȘ ÀÔÙÚÔÈ¿˙Ô˘Û˜ ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ ∂ÚÁ·ÛÙËÚȷο IgG ACA >10 GPL £ÂÙÈο LA IgM ACA >10 MPL + £ÂÙÈο LA

§ÔÈÌÒÍÂȘ ∫·ÎÔ‹ıÂȘ

§‹„Ë Ê·Ú̿ΈÓ

ªÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·

ñ ™∂§, ƒ∞, Û‡Ó‰ÚÔÌÔ Sjogren, ‰ÂÚÌ·ÙÔÌ˘ÔÛ›Ùȉ·/ÔÏ˘Ì˘ÔÛ›Ùȉ·, „ˆÚÈ·ÛÈ΋ ·ÚıÚ›Ùȉ·, ·ÁÎ˘ÏˆÙÈ΋ ÛÔÓ‰˘Ï›Ùȉ· ñ πÔÁÂÓ›˜, ÚˆÙÔ˙ˆÈΤ˜, Û‡ÊÈÏË, ÓfiÛÔ˜ Lyme, Ê˘Ì·Ù›ˆÛË ñ ªÔÓ‹Ú˘ fiÁÎÔ˜, Ï¢¯·È̛˜, ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈο ÓÔÛ‹Ì·Ù· ñ º·ÈÓÔıÂÈ·˙›Ó˜, ÚÔη˚Ó·Ì›‰Ë, ¯ÏˆÚÔıÂÈ·˙›Ó˜, ·ÓÙÈÛ˘ÏÏËÙÈο ñ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘

Û˘Ó‰˘·ÛÌÔ‡ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ Û˘ÓÈÛÙ¿ ÙÔ ·ÓÙÈʈÛÊÔÏÈȉÈÎfi Û‡Ó‰ÚÔÌÔ (∞ƒS) (¶›Ó·Î·˜ 3). ™Ù· ·È‰È¿ Ù· ‰Â‰Ô̤ӷ Û¯ÂÙÈο Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ∞ƒ∞ Î·È ÙˆÓ Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ·˘Ù¿ ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È ÂÚÈÔÚÈṲ̂ӷ. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È Ë ÂΉ‹ÏˆÛË ıÚÔÌ‚ÒÛÂˆÓ Û ·È‰È¿ Ì LA Û ÔÛÔÛÙfi Ô˘ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ‡·ÚÍË ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘, ΢ڛˆ˜ ™∂§ (611), ‹ ÙË Û˘Ó‡·ÚÍË ¿ÏÏ˘ ‰È·Ù·Ú·¯‹˜, fiˆ˜ Â›Ó·È Ë ‰È·Ù·Ú·¯‹ Ù˘ ÚˆÙ½Ó˘ S (12,13) Î·È Ë ·ÚÔ˘Û›· ACA (2,12). ¶ÏËÓ ÙˆÓ ıÚÔÌ‚ÒÛˆÓ, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ·ÈÌÔÚÚ·ÁÈΤ˜ ÂΉËÏÒÛÂȘ, Û˘Ó‹ıˆ˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ· Û˘Ó˘¿Ú¯Ô˘Û·˜ ˘ÔÚÔıÚÔÌ‚ÈÓ·ÈÌ›·˜ (2,6,12,14-16). øÛÙfiÛÔ, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Ë ·ÚÔ˘Û›· ÙÔ˘ LA ÛÙ· ·È‰È¿ Â›Ó·È ·Û˘Ìو̷ÙÈ΋ Î·È Ë ·Ó‡ÚÂÛ‹ ÙÔ˘ Ù˘¯·›·, Û˘Ó‹ıˆ˜ ÛÙ· Ï·›ÛÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘ (1,2,17). ™ÙȘ 3 ·fi ÙȘ 4 ÂÚÈÙÒÛÂȘ Ô˘ ÂÚÈÁÚ¿ÊÔÓÙ·È, ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó Â·ÓÂÈÏËÌ̤ӷ ÂÂÈÛfi‰È· ÏÔÈÌÒÍÂˆÓ ÌÂ Û˘¯Ó‹ Ï‹„Ë ·ÓÙÈ‚ÈÔÙÈÎÒÓ Î·È Ë ‰È·›ÛÙˆÛË ¤ÁÈÓ ηٿ ÙË ‰È¿ÚÎÂÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ™ÙËÓ Ù¤Ù·ÚÙË ÂÚ›ÙˆÛË Ë ‰È·›ÛÙˆÛË ‹Ù·Ó Â›Û˘ Ù˘¯·›· Î·È Ô ·ÛıÂÓ‹˜ ·Û˘Ìو̷ÙÈÎfi˜. ∆Ô ÈÛÙÔÚÈÎfi ÙˆÓ ·ÛıÂÓÒÓ Û˘ÌʈÓ› Ì ٷ ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, Û‡Ìʈӷ Ì ٷ ÔÔ›· Ë ·Ó‡ÚÂÛË LA ÛÙ· ·È‰È¿ Â›Ó·È Û˘Ó‹ıˆ˜ Â·ÎfiÏÔ˘ıÔ Ïԛ̈͢ ‹ Ï‹„˘ Ê·ÚÌ¿ÎˆÓ (1,2,18,21). ™Â ÂÚÈÙÒÛÂȘ ·Û˘Ìو̷ÙÈ΋˜ ‰È·›ÛÙˆÛ˘ LA ‰ÂÓ ··ÈÙÂ›Ù·È Î·Ì›· ıÂÚ·›·, ηıÒ˜ Ë ·ÚÔ˘Û›· ÙÔ˘ ıˆÚÂ›Ù·È ·ÚÔ‰È΋ Î·È Î·ÏÔ‹ı˘, ¯ˆÚ›˜ Ó· ·ÎÔÏÔ˘ıÂ›Ù·È ·fi ·ÈÌÔÚÚ·ÁÈΤ˜ ‹ ıÚÔÌ‚ˆÙÈΤ˜ ÂÈÏÔΤ˜ ‹ ÂΉ‹ÏˆÛË ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜ (1,2,3,17). ∂ÈϤÔÓ, Û ÂÚ›ÙˆÛË Ô˘ Ë ·Ó‡ÚÂÛ‹ ÙÔ˘ Â›Ó·È Ù˘¯·›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÚÔÂÁ¯ÂÈÚËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Î·È Ô ·ÛıÂÓ‹˜ Â›Ó·È ·Û˘Ìو̷ÙÈÎfi˜, Â›Ó·È ‰˘Ó·Ù‹ Ë Ú·ÁÌ·ÙÔÔ›ËÛË ÙÔ˘ ¯ÂÈÚÔ˘ÚÁ›Ԣ ·Ú¿ ÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ ∞ƒ∆∆, ¯ˆÚ›˜ Ó· ·Ú·ÙËÚËı› ȉȷ›ÙÂÚË ·ÈÌÔÚÚ·Á›· ‹ ηı˘ÛÙ¤ÚËÛË Ù˘ ÂԇψÛ˘ (21).

*OÈ ·ÛıÂÓ›˜ Ì APS Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ÎÏÈÓÈÎfi Î·È ¤Ó· ÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ·, ÂÓÒ Ù· ∞ƒ∞ ı· Ú¤ÂÈ Ó· Â›Ó·È ıÂÙÈο Û ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÚÔÛ‰ÈÔÚÈÛÌÔ‡˜ Ô˘ ı· ·¤¯Ô˘Ó ÌÂٷ͇ ÙÔ˘˜ ÙÔ ÏÈÁfiÙÂÚÔ 8 ‚‰ÔÌ¿‰Â˜

™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ‰È·›ÛÙˆÛË ·Ú¿Ù·Û˘ ÙˆÓ ¯ÚfiÓˆÓ Ù˘ ‹Í˘ ‰ÂÓ ÔÊ›ÏÂÙ·È ¿ÓÙ· Û ·ÈÌÔÚÚ·ÁÈ΋ ‰È·Ù·Ú·¯‹, ·ÏÏ¿ ÌÔÚ› Ó· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ‡·Ú͢ Â›ÎÙËÙÔ˘ ·Ó·ÛÙÔϤ·, fiˆ˜ Â›Ó·È ÙÔ ·ÓÙÈËÎÙÈÎfi ÙÔ˘ χÎÔ˘. ∏ ·Ó›¯Ó¢ÛË ÙÔ˘ LA ÛÙ· ·È‰È¿ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÚÔ‰È΋ Î·È Ë ÔÚ›· ηÏÔ‹ı˘, ··ÈÙÂ›Ù·È fï˜ ÂÓ‰Âϯ‹˜ ¤ÏÂÁ¯Ô˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ·Ú·ÎÔÏÔ‡ıËÛË, ηıÒ˜ Ë ·ÚÔ˘Û›· ÙÔ˘ LA ÌÔÚ› Ó· ˘ÔÙÚÔÈ¿ÛÂÈ ‹ Ó· ˘ÔÎÚ‡ÙÂÈ Î¿ÔÈ· ÈÔ ÛÔ‚·Ú‹ ‰È·Ù·Ú·¯‹. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ıÂÚÌ¿ ÙËÓ Î. º·Ó‹ ÷Ù˙Ë‚·ÛÈÏ›Ԣ ÁÈ· ÙËÓ ÔχÙÈÌË ‚Ô‹ıÂÈ¿ Ù˘ ÛÙÔ Ù¯ÓÈÎfi ̤ÚÔ˜ Ù˘ ÂÚÁ·Û›·˜ Ì·˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Hoffman R, Benz EJ, Shattil SJ, Furil B, Cohen HJ, Silberstein LE, eds. Inhibitors of blood coagulation. In: Hematology. Basic Principles and Practice. 2nd ed.

Churchill Livingstone Inc; 1995. p. 1746-1755.

2. Male C, Lechner K, Eichinger S, Kyrle PA, Kapiotis S, Wank H. Clinical significance of lupus anticoagulants in children.

J Pediatr 1999;134:199-205.

3. ∆ÛÂÚ‚¤Ó˘ µ. ∞ÓÙÈʈÛÊÔÏÈȉÈÎfi Û‡Ó‰ÚÔÌÔ. ∆fiÌÔ˜ ¶Ú·ÎÙÈÎÒÓ ™ÂÌÈÓ·Ú›Ô˘ ∞ÈÌfiÛÙ·Û˘ - £ÚÔÌ‚ÔÊÈÏ›·˜. £ÂÛÛ·ÏÔÓ›ÎË 8-10 ª·˝Ô˘, ∞ı‹Ó· 29-31 ª·˝Ô˘ 1998:245-253.

4. Roubey RA. Autoantibodies to phospholipid-binding plasma proteins: a new view of lupus anticoagulants and other antiphospholipid autoantibodies.

Blood 1994;84:2854-2867.

5. Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus and in non-SLE disorders.

Prevalence and clinical significance. Ann Intern Med 1990;112:682-698.

6. Molta C, Meyer O, Dosquet C, Montes de Oca M, Babron MC, Danon F et al. Childhood onset SLE: antiphosphlipid autoantibodies in 37 patients and their first degree relatives. Pediatrics 1993;92:849-853.

7. Seaman DE, Londino AV, Kwoh CK, Medsger TA, Manzi S. Antiphospholipid autoantibodies in pediatric SLE. Pediatrics 1995;96:1040-1045.

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8. Montes de Oca MA, Babron MC, Bletry O, Broyer M, Courtecuisse V, Fontaine JL et al. Thrombosis in systemic lupus erythematosus: a French collaboration study. Arch Dis Child 1991;66:713-717.

9. Gattorno M, Buocompagni A, Molinari AC, Barbano GC, Morreale G, Stalla F et al. Antiphospholipid autoantibodies in paediatric SLE, juvenile chronic arthritis and overlap syndromes: SLE patients with both lupus anticoagulants and high-titre anticardiolipin antibodies are at risk for clinical manifestations related to the antiphospholipid syndrome. Br J Rheumatol 1995;34:873-881.

10. Manco J, Nuss R. Lupus anticoagulant in children with thrombosis. Am J Hematol 1995;48:240.

11. Von Scheven E, Athreya BH, Rose CD, Goldsmith DP, Morton L. Clinical characteristics of antiphospholipid antibody syndrome in children. J Pediatr 1996; 129:339-345.

12. Manco-Johnson MJ. Antiphospholipid antibodies in children. Semin Thromb Hemost 1998;24:591-598.

13. Manco J, Nuss R, Key N, Moertel C, Jacobson L, Meech S et al. Lupus anticoagulant and protein S deficiency in children with postvaricella purpura fulminans or thrombosis. J Pediatr 1996;128:319-323.

14. Lee MT, Nardi MA, Hadzi N, Kerpatkin M. Transient hemorrhagic diathesis associated with an inhibitor of prothrombin with lupus anticoagulant in a 1ó year old girl: report of a case and review of literature. Am J Hematol 1996;51:307-314.

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Singh AK, Rao KP, Kizer J, Lazarchick J. Lupus anticoagulants in children. Ann Clin Lab Sci 1988; 18:384-387.

Mingers AM, Sutor AH. Lupus inhibitors in childhood.

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HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-08-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ªÈÚ¿ÓÙ· ∞ı·Ó·Û›Ô˘ ∞Á. ™ÔÊ›·˜ 30, ∆.∫. 546 22, £ÂÛÛ·ÏÔÓ›ÎË

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CASE REPORT

OÍ›· ÂÁÎÂÊ·ÏÈ΋ Û˘Ó‰ÚÔÌ‹ Û ·È‰› ˆ˜ ÂΉ‹ÏˆÛË Ì˘ÍÒÌ·ÙÔ˜ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ ∞. ∫Ô˘ÚÙ¤Û˘1, Ã. ¶·Ê›Ù˘1, ∂. §·ÙÔ‡ÊË, ∂. ¢Ú·ÁÒÁÈ·2, °. ªÚÈ·ÛÔ‡Ï˘, µ. £·ÓfiÔ˘ÏÔ˜3, ª. ∞˙·ÚÈ¿‰Ë˜1

Left atrial myxoma in a child presenting as an acute cerebral episode A. N. Kourtesis1, C. A. Paphitis1, ∂. Latoufi, E. Dragogia2, G. Briasoulis, V. Thanopoulos3, M. Azariades1

¶ÂÚ›ÏË„Ë: ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë ÂÚ›ÙˆÛË ÔÍ›·˜ ÂÁÎÂÊ·ÏÈ΋˜ Û˘Ó‰ÚÔÌ‹˜, ÈÛ¯·ÈÌÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, Û ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 11 ÂÙÒÓ, ·fi ¤Ì‚ÔÏÔ Ì˘ÍÒÌ·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘. ∆Ô ·È‰› ·ÚÔ˘Û›·Û ÙÔ ÂÂÈÛfi‰ÈÔ ÂÓÒ ¯fiÚÂ˘Â Î·È ÚÔÛ‹Ïı ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ Ì ·ÚÈÛÙÂÚ‹ ˘Ú·ÌȉÈ΋ Û˘Ó‰ÚÔÌ‹ (ËÌÈÏËÁ›·), ¿ÚÂÛË ÚÔÛˆÈÎÔ‡ Î·È ÂÚÈÔÚÈÛÌfi ÔÙÈÎÔ‡ ‰›Ô˘ ÙÔ˘ ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡. ∏ ·Ú¯È΋ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË, Ô˘ ÂÚÈÏ¿Ì‚·Ó ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (CT) ÂÁÎÂÊ¿ÏÔ˘ Î·È ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ηډȿ˜, ¤‰ÂÈÍ ÙËÓ ·ÚÔ˘Û›· ÌÈÎÚ‹˜ ˘fi˘ÎÓ˘ ÂÚÈÔ¯‹˜ ÛÙËÓ ¤Ûˆ ο„· ·ÚÈÛÙÂÚ¿ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ·Ï·Èfi ÈÛ¯·ÈÌÈÎfi ÂÂÈÛfi‰ÈÔ, ηıÒ˜ Î·È ÙËÓ ·ÚÔ˘Û›· fiÁÎÔ˘ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ Ù˘ ηډȿ˜ Ô ÔÔ›Ô˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‰È·ÛÙÔÏ‹˜ ÚÔÂ΂¿ÏÏÔÓÙ·Ó, ‰È·Ì¤ÛÔ˘ Ù˘ ÌÈÙÚÔÂȉԇ˜, ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·. ¡¤· ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÌÂÙ¿ ·fi 12 ÒÚ˜ ·ÔÎ¿Ï˘„ ÙËÓ ‡·ÚÍË Ó¤·˜ ÈÛ¯·ÈÌÈ΋˜ ÂÚÈÔ¯‹˜ ÛÙË ¤Ûˆ ο„· ‰ÂÍÈ¿, Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÙËÓ ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· ÙÔ˘ ·È‰ÈÔ‡. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ ‚ÂÏÙÈÒıËΠÛËÌ·ÓÙÈο 9 Ë̤Ú˜ ·ÚÁfiÙÂÚ· Î·È Â¤ÙÚ„ ÙËÓ ·ÛÊ·Ï‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ ÂÓ‰ÔÎÔÏÈÎÔ‡ fiÁÎÔ˘ Ì ÙË ¯Ú‹ÛË Ù˘ Â͈ۈ̷ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜. O fiÁÎÔ˜ ·ÔÙÂÏ›ÙÔ ·fi ‡ıÚ˘ÙÔ Ì‡ÍˆÌ· ‰È·ÛÙ¿ÛÂˆÓ 4x4 cm Î·È ÂÍÔÚÌ¿ÙÔ ·fi ÙÔ ÙÔ›¯ˆÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Â¿Óˆ ·fi ÙËÓ ÚfiÛıÈ· Áψ¯›Ó· Ù˘ ÌÈÙÚÔÂȉԇ˜. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ηϋ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÌÂÙ¿ ·fi 12 Ë̤Ú˜ Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ∏ ÂÌÊ¿ÓÈÛË ÂÓ‰ÔηډȷÎÔ‡ Ì˘ÍÒÌ·ÙÔ˜ Â›Ó·È Û¿ÓÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Û˘¯Ó¿

Abstract: The case of an 11 year old girl is presented, who suffered an acute cerebral ischaemic episode due to embolism from an atrial myxoma. The patient, who suffered the episode while dancing, was admitted to the hospital with signs of left hemiplegia, facial palsy and impairment of vision of the right eye. The initial evaluation on admission, which included computerized tomography (CT) of the brain and echocardiography, revealed a small localized area of reduced density at the region of the left internal capsule of the brain, a picture consistent with an old ischaemic lesion, as well as the presence of a left atrial tumor which protruded through the mitral valve into the left ventricle during diastole. A repeat CT scan, 12 hours later, showed a new ischaemic area at the region of the right internal capsule, a picture consistent with the clinical findings of capsular hemiplegia. Nine days after admission, there was significant improvement of the neurological condition of the patient, and allowed the safe surgical removal of the atrial tumor using cardiopulmonary bypass. The tumor consisted of a friable and villous myxoma 4x4 cm in size, originating from the posterior surface of the left atrium above the mitral valve. The patient made an uneventful recovery and was discharged 12 days later. The presence of atrial myxoma is rare during childhood and often has a stormy initial presentation.

¶ÂÚÈÊÂÚÂÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 1 µ’ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁÈ΋ ∫ÏÈÓÈ΋ 2 ∞Ó·ÈÛıËÛÈÔÏÔÁÈÎfi ∆Ì‹Ì· 3 ∫·Ú‰ÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋

Peripheral General Children’s Hospital “Agia Sophia”, Athens 1 2nd Cardiovascular Surgery Clinic 2 Department of Anesthesiology 3 Cardiology Clinic

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¶·È‰È·ÙÚÈ΋ 2002;65:81-85

Paediatriki 2002;65:81-85

Û˘Óԉ‡ÂÙ·È Ì ıÔÚ˘‚Ò‰Ë Û˘Ìو̷ÙÔÏÔÁ›· ˆ˜ ÚÒÙË ÂΉ‹ÏˆÛË. §¤ÍÂȘ ÎÏÂȉȿ: ̷͈̇ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘, ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ÂÌ‚ÔÏÈÎfi ÂÂÈÛfi‰ÈÔ.

Key words: atrial myxoma, cerebral ischaemic episode, embolic episode.

∂ÈÛ·ÁˆÁ‹ OÈ ÚˆÙÔ·ı›˜ fiÁÎÔÈ Ù˘ ηډȿ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔÈ, ÌÂ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÚ›Ô˘ 0,05% Û ÌÂÙ·ı·Ó¿ÙȘ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈΤ˜ ÛÂÈÚ¤˜. ∞fi ·˘Ùfi ÙÔ ÔÛÔÛÙfi, ÙÔ 50% η٤¯Ô˘Ó Ù· Ì˘ÍÒÌ·Ù· ÙˆÓ ÎfiÏˆÓ. ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ, ËÏÈΛ·˜ <15 ÂÙÒÓ, ÙÔ ÔÛÔÛÙfi ·˘Ùfi Â›Ó·È ·ÎfiÌË ÈÔ ÌÈÎÚfi, fiˆ˜ ÚÔ·ÙÂÈ ·fi ÙË ÌÂϤÙË ÙˆÓ Nadas et al (1) Î·È ÊÙ¿ÓÂÈ ÙÔ 0,027%. ∞fi ÏÂ˘Ú¿˜ ‚ÈÔÏÔÁÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·˘Ù‹ ÙËÓ ÔÌ¿‰·, ÙÔ 90% ÙˆÓ fiÁÎˆÓ Â›Ó·È Î·ÏÔ‹ıÂȘ ÌÂ Û˘¯ÓfiÙÂÚÔ fiÁÎÔ ÙÔ Ú·‚‰Ô̇ˆÌ· Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ÙÂڿو̷, ÙÔ ›ÓˆÌ· Î·È ÙÔ Ì‡ÍˆÌ· (2). ∆Ô Ì‡ÍˆÌ· ÂÍÔÚÌ¿Ù·È ·fi ÙÔ ÂÓ‰ÔοډÈÔ Î·È Û˘ÓËı¤ÛÙÂÚ· ·fi ÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ˆÔÂȉԇ˜ ÙÚ‹Ì·ÙÔ˜ Û·Ó ÔÏ˘ÔÂȉ‹˜ Ì¿˙·. ª·ÎÚÔÛÎÔÈο ¤¯ÂÈ ˙ÂÏ·ÙÈÓÒ‰Ë ‚ÔÙÚ˘ÔÂȉ‹ ÌÔÚÊ‹ Î·È ¯ÚÒÌ· ˘ÔΛÙÚÈÓÔ, Ú¿ÛÈÓÔ ‹ ‰È¿Ê·ÓÔ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ËÏÈΛ·˜ 11 ÂÙÒÓ Ô˘ ÚÔÛ‹Ïı Ì ÔÍ›· ÂÁÎÂÊ·ÏÈ΋ ÈÛ¯·ÈÌÈ΋ Û˘Ó‰ÚÔÌ‹ ÏfiÁˆ ÂÌ‚ÔÏ‹˜ ·fi Ì˘ÍˆÌ·ÙÒ‰Ë ÈÛÙfi, ÚÔÂÚ¯fiÌÂÓÔ˘ ·fi ÙËÓ ·ÚÔ˘Û›· Ì˘ÍÒÌ·ÙÔ˜ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ Ù˘ ηډȿ˜.

Û˘. ∏ ¿ÌÂÛË ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·›ÛÙˆÛ ÙËÓ ·ÚÔ˘Û›· ËÌÈ¿ÚÂÛ˘ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÌfiÚÈÔ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙÒÛË Ù˘ ÁˆÓ›·˜ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ·ÚÈÛÙÂÚ¿. ∆Ô ·È‰› ‰ÈÂÎÔÌ›ÛıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ Î·È ÛÙÔ ÁÂÓfiÌÂÓÔ CT ¤ÏÂÁ¯Ô ÂÁÎÂÊ¿ÏÔ˘ ¢ڤıËÛ·Ó Ù· ·ÎfiÏÔ˘ı·: ·) ÎÔÈÏÈ·Îfi Û‡ÛÙËÌ· ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ‰È·ÛÙ¿ÛÂȘ Î·È ÌÔÚÊÔÏÔÁ›·, ‚) ˘·Ú·¯ÓÔÂȉ‹˜ ¯ÒÚÔ˜ Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·È Á) ˘fi˘ÎÓË ÂÚÈÔ¯‹ ‰È·Ì¤ÙÚÔ˘ <1 cm ÛÙÔ Ô›ÛıÈÔ ÛΤÏÔ˜ Ù˘ ¤Ûˆ ο„˘ ·ÚÈÛÙÂÚ¿, ‡ÚËÌ· Û˘Ì‚·Ùfi Ì ÈÛ¯·ÈÌÈÎÔ‡ Ù‡Ô˘ ·Ï·È¿ ‚Ï¿‚Ë. ∆Ô ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· ·Ó¤‰ÂÈÍ ÙËÓ ·ÚÔ˘Û›· “ÎÈÓËÙÔ‡ ÌÔÚÊÒÌ·ÙÔ˜” ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ, ‰È·ÛÙ¿ÛÂˆÓ 40x40 mm, Ô˘ ÛÙË Ê¿ÛË Ù˘ ‰È·ÛÙÔÏ‹˜ ÚÔÂ΂¿ÏÏÔÓÙ·Ó Ì¤Ûˆ Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· (∂ÈÎfiÓ· 1). ∆Ô ·È‰› ·ÎÔÏÔ‡ıˆ˜ ÂÈÛ‹¯ıË ÛÙË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·Ú·ÎÔÏÔ‡ıËÛË. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ‰È·ÈÛÙÒıËÎÂ Ë ·ÚÔ˘Û›· Û˘ÛÙÔÏÈÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ 2/6 ÛÙËÓ ÂÛÙ›· ·ÎÚÔ¿Ûˆ˜ Ù˘ ÌÈÙÚÔÂȉԇ˜, ‚ÂÏÙ›ˆÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Î·È Ù˘ Ì˘˚΋˜ ÈÛ¯‡Ô˜ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÏÂ˘Ú¿, Î·È Ë ·ÚÔ˘Û›· ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡ Babinsky (+) ÔÌfiÏ¢ڷ. ∏ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Ì›ˆÛË ÙÔ˘ ÔÙÈÎÔ‡ ‰›Ô˘ ·ÚÈÛÙÂÚ¿ Î·È ÈÛ¯·ÈÌ›· ıËÏÔ¯ÚÈ΋˜ ÂÚÈÔ¯‹˜. ™Â Ó¤· CT ÂÁÎÂÊ¿ÏÔ˘ ÌÂÙ¿ ·fi 12 ÒÚ˜ ·ÂÈÎÔÓ›ÛÙËÎ·Ó Ù· ·Ï·ÈfiÙÂÚ· Â˘Ú‹Ì·Ù· ‰ÂÍÈ¿, ηıÒ˜ Î·È Ì›· Ó¤· ÂÚÈÔ¯‹

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 11 ÂÙÒÓ, ÔÌÔÁÂÓ‹˜ ·fi ÙË °ÂˆÚÁ›·, ÙÔ ÔÔ›Ô Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¯ÔÚÔ‡ ÛÙËÓ Î·Ù·Û΋ӈÛË ¤ÂÛ ͷÊÓÈο ÛÙÔ ¤‰·ÊÔ˜ ¯ˆÚ›˜ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ·ÒÏÂÈ· Û˘Ó›‰Ë-

∂ÈÎfiÓ· 1. ÀÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·: ª‡ÍˆÌ· ÂÓÙfi˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ ÎÈÓÔ‡ÌÂÓÔ Î·Ù¿ ÙË Ê¿ÛË Ù˘ ‰È·ÛÙÔÏ‹˜ ÚÔ˜ ÙËÓ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›· ‰È·Ì¤ÛÔ˘ Ù˘ ÌÈÙÚÔÂȉԇ˜.

82

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™ÂÏ›‰·83

¶·È‰È·ÙÚÈ΋ 2002;65:81-85

ÌÂȈ̤Ó˘ ˘ÎÓfiÙËÙ·˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, ¤Ûˆ ο„·˜ ‰ÂÍÈ¿ (∂ÈÎfiÓ· 2). ∞fi ÙÔÓ ÏÔÈfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰ÂÓ ‚Ú¤ıËΠοÙÈ ·ıÔÏÔÁÈÎfi. ÃÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË: ªÂ ¯Ú‹ÛË Â͈ۈ̷ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜, ˘ÔıÂÚÌ›· Î·È Î·Ú‰È·Î‹ ·‡ÛË Ì ¯Ú‹ÛË „˘¯Ú‹˜ ·ÈÌ·ÙËÚ‹˜ ηډÈÔÏËÁ›·˜, ÂÍ·ÈÚ¤ıËÎÂ Ô fiÁÎÔ˜, Ô ÔÔ›Ô˜ ÂÍÔÚÌ¿ÙÔ ·fi ÙËÓ ÔÚÔÊ‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Ì ¢ڇ Ì›Û¯Ô Î·È ÚÔÛ¤ÈÙ ‰È¿ Ù˘ ÌÈÙÚÔÂȉÈ΋˜ ‚·Ï‚›‰·˜ ÛÙËÓ ·ÚÈÛÙÂÚ¿ ÎÔÈÏ›·. O fiÁÎÔ˜ ‹Ù·Ó ‡ıÚ˘ÙÔ˜ Î·È ‚ÔÙÚ˘ÔÂȉ‹˜. OÈ Áψ¯›Ó˜ Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ ‹Ù·Ó Â·¯˘Ṳ̂Ó˜ Ì ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ÚfiÙˆÛË Ù˘ ÚfiÛıÈ·˜ Áψ¯›Ó·˜, ·ÏÏ¿ ¯ˆÚ›˜ ÛËÌ·ÓÙÈ΋ ·ÓÂ¿ÚÎÂÈ·. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ‹Ù·Ó ÔÌ·Ï‹, Ì ٷ¯Â›· ‚ÂÏÙ›ˆÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜. ∆Ô ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi echo ηډȿ˜ ¤‰ÂÈÍ ÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ ¯ˆÚ›˜ ˘fiÏÂÈÌÌ·, ÚfiÙˆÛË ÚfiÛıÈ·˜ Áψ¯›Ó·˜ ÌÈÙÚÔÂȉԇ˜ Ì ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ·ÓÂ¿ÚÎÂÈ· Î·È Ê˘ÛÈÔÏÔÁÈ΋ Û˘ÛÙ·ÏÙÈÎfiÙËÙ· ÙˆÓ ÎÔÈÏÈÒÓ. ∆Ô ·È‰›, ÛÙÔ ‰È¿ÛÙËÌ· Ù˘ 12‹ÌÂÚ˘ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋˜ ÙÔ˘ ·Ú·ÌÔÓ‹˜, ¤Î·Ó ¤ÓÙÔÓË Ê˘ÛÈÎÔıÂÚ·›· Î·È ÎÈÓËÛÈÔıÂÚ·›· Î·È ÂÍ‹Ïı Û Ôχ ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ™˘˙‹ÙËÛË ∏ ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· ÙˆÓ fiÁÎˆÓ Ù˘ ηډȿ˜ ηıÔÚ›˙ÂÙ·È ·fi ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜, ÙË ı¤ÛË ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜, ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È Ì›Û¯Ô˘ Î·È Û·ÓÈfi-

Paediatriki 2002;65:81-85

ÙÂÚ· ·fi ÙËÓ ÈÛÙÔÏÔÁÈ΋ ˘Ê‹ Î·È ‰ÔÌ‹ ÙÔ˘˜. ŒÙÛÈ, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË Ì ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· ·fiÊڷ͢ ÙˆÓ ¯ÒÚˆÓ ÂÍfi‰Ô˘ Ù˘ ‰ÂÍÈ¿˜ ‹ Ù˘ ·ÚÈÛÙÂÚ¿˜ ÎÔÈÏ›·˜ Î·È Ó· ˘¿Ú¯ÂÈ ÂÚÈÔ‰È΋ ÛËÌÂÈÔÏÔÁ›· ¯·ÌËÏ‹˜ ηډȷ΋˜ ·ÚÔ¯‹˜. ∏ ηٿÛÙ·ÛË ·˘Ù‹ Â›Ó·È Ë ÈÔ Û˘¯Ó‹ Î·È È‰È·›ÙÂÚ· ÛÂ Ì˘ÍÒÌ·Ù· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Ô˘ Û˘¯Ó¿ ÚÔ‚¿ÏÏÔ˘Ó ‰È·Ì¤ÛÔ˘ Ù˘ ÌÈÙÚÔÂȉÈ΋˜ ‚·Ï‚›‰·˜ Î·È ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ·ÓÂ¿ÚÎÂÈ· ·˘Ù‹˜. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, fï˜, ‰ÂÓ ·Ó·Ê¤ÚıËΠÛËÌÂÈÔÏÔÁ›· Û˘ÁÎÔÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ÛÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡ (3). ™ÙË Û˘Ó¤¯ÂÈ·, ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ÂÌÊ·Ó›˙Ô˘Ó ÛËÌÂÈÔÏÔÁ›· ÁÂÓÈ΋˜ ·‰È·ıÂÛ›·˜, ˘ÚÂÙÔ‡, ·ÓÔÚÂÍ›·˜ Î·È ·ÒÏÂÈ·˜ ‚¿ÚÔ˘˜, ηٷÛÙ¿ÛÂȘ Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ÛÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË. OÈ Pfammatter JP, Iff T et al (4) ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ·ÚÔ˘Û›· Ì˘ÍÒÌ·ÙÔ˜ Û ·È‰› ËÏÈΛ·˜ 10 ÂÙÒÓ, Ì ÛËÌÂÈÔÏÔÁ›· ¯ÚfiÓÈ·˜ ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ÊÏÂÁÌÔÓ‹˜ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Ù‡Ô˘ ·ÁÁÂÈ›Ùȉ·˜ ‹ ÓfiÛÔ˘ ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ ÏfiÁˆ Ù˘ ·˘ÍË̤Ó˘ ·ÚÔ˘Û›·˜ ÈÓÙÂÚÏ¢ΛÓ˘-6. ∏ ÂÌÊ¿ÓÈÛË ÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ ÏfiÁˆ ÙÔ˘ Û˘Ó‰˘·ÛÌÔ‡ ¢ıÚ·˘ÛÙfiÙËÙ·˜ Î·È ÂÓ‰ÔÎÔÈÏÔÙÈ΋˜ ÂÓÙfiÈÛ˘ Û ÔÛÔÛÙfi Ô˘ ·ÁÁ›˙ÂÈ ÙÔ 50% ÙˆÓ ÂÚÈÙÒÛˆÓ, Û˘ÌÏËÚÒÓÂÈ ÙËÓ ÙÚÈ¿‰· ÙˆÓ ϤÔÓ Û˘¯ÓÒÓ ÎÏÈÓÈÎÒÓ Û˘Ó‰ÚÔÌÒÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÚÔ˘Û›· Ì˘ÍÒÌ·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘. ∏ ·ÚÔ˘Û›· ÙˆÓ ÂÌ‚fiÏˆÓ ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ÙËÓ ÂÓÙfiÈÛË ÙÔ˘ fiÁÎÔ˘, fiˆ˜ Â›Û˘ Î·È Ì ÙËÓ

∂ÈÎfiÓ· 2. CT ÂÁÎÂÊ¿ÏÔ˘ Ì ÙËÓ ÂÚÈÁÚ·ÊfiÌÂÓË ·ıÔÏÔÁ›·.

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™ÂÏ›‰·84

¶·È‰È·ÙÚÈ΋ 2002;65:81-85

·ÚÔ˘Û›· ‹ ·Ô˘Û›· ÂÓ‰ÔηډȷÎÒÓ ÂÈÎÔÈÓˆÓÈÒÓ. ∏ ÈÛ¯·ÈÌÈ΋ Û˘Ó‰ÚÔÌ‹ ¤¯ÂÈ ¿ÌÂÛË Û¯¤ÛË Ì ÙÔ ·ÔÊÚ·¯ı¤Ó ·ÁÁÂ›Ô Î·È ÂÓÙÔ›˙ÂÙ·È È‰È·›ÙÂÚ· ÛÙ· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜, ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÙÂϤ¯Ô˘˜, ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ ‹ ·ÎfiÌË Î·È ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ Ì ÙËÓ ·Ó¿ÏÔÁË ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË. ŒÙÛÈ, ÙÔ Ì‡ÍˆÌ· ÌÔÚ› Ó· ÚˆÙԉȷÁÓˆÛÙ› Ì ·ÊÔÚÌ‹ ÙËÓ ÂÌÊ¿ÓÈÛË ÎÈÓËÙÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ Ù‡Ô˘ ËÌÈÏËÁ›·˜, ¿ÚÂÛ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ Î·È ÌÔÓfiÏ¢Ú˘ Ì›ˆÛ˘ ÔÙÈ΋˜ Ô͇ÙËÙ·˜ ̤¯ÚÈ Ù‡ÊψÛ˘ (5), fiˆ˜ ÛÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË, ‹ ÌÔÓÔÏËÁ›·˜. ∆Ô Ó¢ÚÔÏÔÁÈÎfi ÂÂÈÛfi‰ÈÔ ÌÔÚ› Ó· Â›Ó·È Ë ÚÒÙË Î·È ÌÔÓ·‰È΋ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË ÙÔ˘ fiÁÎÔ˘, fiˆ˜ ·ÎÚÈ‚Ò˜ ÛÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË. ¶ÔÏϤ˜ ÊÔÚ¤˜ Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ·ÈÊÓȉ›ˆ˜, ¤¯Ô˘Ó ‰È·Ï›ÔÓÙ· ¯·Ú·ÎÙ‹Ú· Î·È ÌÔÚ› Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ı¤ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜. ∞fi ÏÂ˘Ú¿˜ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ, ÙÔ Û˘ÓËı¤ÛÙÂÚÔ Â‡ÚËÌ· Â›Ó·È ÌË ÂȉÈΤ˜ ·ÓˆÌ·Ï›Â˜ ηٿ ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜, fiˆ˜ Ë ·ÚÔ˘Û›· Ê˘ÛËÌ¿ÙˆÓ, ÌÂÙ·‚ÔϤ˜ ¤ÓÙ·Û˘ ‰È·ÊfiÚˆÓ Î·Ú‰È·ÎÒÓ ÙfiÓˆÓ, ÚÒÈÌÔ˜ ‰È·ÛÙÔÏÈÎfi˜ ‹¯Ô˜, ÛËÌ›· ·fiÊڷ͢ ÙÔ˘ ¯ÒÚÔ˘ ÂÈÛfi‰Ô˘ ‹ ÂÍfi‰Ô˘ ÙˆÓ ÎÔÈÏÈÒÓ, ÛËÌÂÈÔÏÔÁ›· „¢‰Ô‡˜ ·fiÊڷ͢ Ù˘ ÌÈÙÚÔÂȉÈ΋˜ ‚·Ï‚›‰·˜ Î·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ú˘ıÌÔ‡ (ÛÎÂÏÈÎfi˜ ·ÔÎÏÂÈÛÌfi˜, Ï‹Ú˘ ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜). ∆Ô Û˘¯ÓfiÙÂÚÔ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎfi ‡ÚËÌ· Â›Ó·È Ë ˘ÂÚÙÚÔÊ›· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘, ηٿÛÙ·ÛË Ô˘ ‰È·ÈÛÙÒÓÂÙ·È Â›Û˘ Î·È Ì ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, fiÔ˘ ÌÔÚ› Ó· ‰È·ÈÛÙˆı› Ë Â˘ÌÂÁ¤ı˘ ·ÚÔ˘Û›· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ ‹ ·ÎfiÌË Î·È Ë ·ÚÔ˘Û›· ·Û‚ÂÛÙÒÛˆÓ, fiˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚı› Û ÂÚÈÙÒÛÂȘ Ú·‚‰ÔÌ˘ÒÌ·ÙÔ˜ Î·È ÏÈÒÌ·ÙÔ˜ (6). ∏ ¯Ú‹ÛË Ù˘ ˘ÂÚ˯ÔηډÈÔÁÚ·Ê›·˜ ÌÂÙ¿ ÙÔ 1977 ¤¯ÂÈ Û˘Ì‚¿ÏÂÈ ÛÙË ‰È¿ÁÓˆÛË Û¯Â‰fiÓ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ fiÁÎˆÓ Ù˘ ηډȿ˜. ∏ ‰ÈÔÈÛÔÊ¿ÁÂÈ· ˯ÔηډÈÔÁÚ·Ê›· ·Ú¤¯ÂÈ ÌÂÁ·Ï‡ÙÂÚË ·ÎÚ›‚ÂÈ· Û ̿˙˜ Ù˘ ηډȿ˜ Î·È È‰È·›ÙÂÚ· ÙˆÓ ÔÈÛı›ˆÓ ÎÔÈÏÔÙ‹ÙˆÓ ·˘Ù‹˜ (·ÚÈÛÙÂÚ¤˜ ÎÔÈÏfiÙËÙ˜), ηıÒ˜ Â›Û˘ Î·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ Û˘Ì·ÁÔ‡˜ fiÁÎÔ˘ Î·È ·ÚÔ˘Û›·˜ ıÚfiÌ‚Ô˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ô fiÁÎÔ˜ ¤¯ÂÈ ÛÙÈÎÙ‹ ÂÌÊ¿ÓÈÛË Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ˯ԉȷ˘Á›˜ ÂÚÈÔ¯¤˜ ÏfiÁˆ ·ÈÌÔÚÚ·ÁÈÒÓ Î·È Â›Ó·È Û¿ÓÈ· Ë ·ÚÔ˘Û›· ÙÔ˘ ÛÙÔ Ô›ÛıÈÔ ÙÔ›¯ˆÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘, ÂÓÒ Ô ıÚfiÌ‚Ô˜ Û˘¯Ó¿ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ Ô›ÛıÈÔ ÙÔ›¯ˆÌ·. ŒÙÛÈ, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ù›ıÂÙ·È Ë ‰È¿ÁÓˆÛË ÌfiÓÔ Ì ÙË ‰ÈۉȿÛÙ·ÙË Ë¯ÔηډÈÔÁÚ·Ê›· Î·È Ô ·ÛıÂÓ‹˜ Ô‰ËÁÂ›Ù·È ÛÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ¯ˆÚ›˜ Ó· Â›Ó·È ··Ú·›ÙËÙË Ë ÚÔÂÁ¯ÂÈÚËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›·, Ù·ÎÙÈ΋ Ô˘ ·ÎÔÏÔ˘ı‹ıËÎÂ Î·È ÛÙË

84

Paediatriki 2002;65:81-85

‰È΋ Ì·˜ ÂÚ›ÙˆÛË. ∏ ÌÂÁ¿ÏË Â˘·ÈÛıËÛ›· Ù˘ ‰ÈۉȿÛÙ·Ù˘ ˯ÔηډÈÔÁÚ·Ê›·˜ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ‰È¿ÁÓˆÛË ÙˆÓ Ì˘ÍˆÌ¿ÙˆÓ (7). ∏ ¯Ú‹ÛË Ù˘ ˘ÔÏÔÁÈÛÙÈ΋˜ ÙÔÌÔÁÚ·Ê›·˜ (CT) ÁÈ· ÙË ‰È¿ÁÓˆÛË fiÁÎˆÓ Î·Ú‰È¿˜ ‰ÂÓ ˘ÂÚÙÂÚ› Ù˘ ˯ÔηډÈÔÁÚ·Ê›·˜, ·ÏÏ¿ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ‰È‹ıËÛ˘ Ì˘Ôηډ›Ô˘, ÂÚÈηډ›Ô˘ ‹ Â͈ηډȷÎÒÓ Û¯ËÌ·ÙÈÛÌÒÓ. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Î·È È‰È·›ÙÂÚ· Ë Ù¯ÓÈ΋ Spin-echo (8) ÂÓÙÔ›˙ÂÈ fi,ÙÈ Î·È Ë Ë¯ÔηډÈÔÁÚ·Ê›·, ·ÏÏ¿ ¤¯ÂÈ ÙÔ ÏÂÔÓ¤ÎÙËÌ· Ù˘ ۷ʤÛÙÂÚ˘ ·ÂÈÎfiÓÈÛ˘ Ù˘ ÚfiÙˆÛ˘ ÙÔ˘ fiÁÎÔ˘, Ù˘ ÚÔηÏÔ‡ÌÂÓ˘ ‚·Ï‚ȉÈ΋˜ ·fiÊڷ͢ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ηډȷ΋˜ ÎÔÈÏfiÙËÙ·˜. O ηıÂÙËÚÈ·ÛÌfi˜ Ù˘ ηډȿ˜ Î·È Ë ·ÁÁÂÈÔÁÚ·Ê›· Û˘Ó‹ıˆ˜ ‰ÂÓ ÂӉ›ÎÓ˘ÓÙ·È Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ fiÁÎˆÓ Ù˘ ηډȿ˜, ‰Â‰Ô̤Ó˘ Ù˘ ·ÍÈÔÈÛÙ›·˜ ÙˆÓ ·Ó·›Ì·ÎÙˆÓ ÌÂıfi‰ˆÓ, ·ÏÏ¿ ΢ڛˆ˜ ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÂÌ‚ÔÏÒÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘. ∂È‚¿ÏÏÔÓÙ·È, fï˜, Û ÂÚÈÙÒÛÂȘ Ô˘ Ë ·Ó·›Ì·ÎÙË ‰È·ÁÓˆÛÙÈ΋ ‰È·‰Èηۛ· ‰ÂÓ ‰›ÓÂÈ Û·Ê›˜ ··ÓÙ‹ÛÂȘ, fiˆ˜: ·) ·ÓÂ·Ú΋˜ ÂÓÙfiÈÛË ‹ ÚfiÛÊ˘ÛË ÙÔ˘ fiÁÎÔ˘, ‚) ·ÓÂ·Ú΋˜ ·ÂÈÎfiÓÈÛË Î·È ÙˆÓ 4 ηډȷÎÒÓ ÎÔÈÏÔًوÓ, Á) ˘fiÓÔÈ· ηÎÔ‹ıÂÈ·˜ fiÁÎÔ˘ Î·È ‰) Û˘Ó‡·ÚÍË ¿ÏÏˆÓ ‚Ï·‚ÒÓ Ô˘ Èı·ÓfiÓ ¯Ú‹˙Ô˘Ó Ù·˘Ùfi¯ÚÔÓ˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ıÂÚ·›·˜. ∫·Ù¿ ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË, Ù· Ì˘ÍÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È ˙ÂÏ·ÙÈÓÒ‰Ë, Ï›·, ÛÙÚÔÁÁ˘Ï¿ Ì ÛÙÈÏÓ‹ ÂÈÊ¿ÓÂÈ· ‹ Û ‰È·ÊÔÚÂÙÈÎfi ‚·ıÌfi ‡ıÚ˘Ù· Î·È Û¿ÓÈ· ·ÓÒÌ·Ï· ‹ ÔÏ˘ÔÂȉ‹. ∂›Ó·È ÌÈÛ¯ˆÙ¿ Ì ‰È·ÎÚÈÙfi Ì›Û¯Ô Ô˘ ÌÔÚ› Ó· Â›Ó·È Ê·Ú‰‡˜ ‹ ÛÙÂÓfi˜. ™Â ÔÛÔÛÙfi 90%, Ë ‚¿ÛË ÚÔÛÎfiÏÏËÛ‹˜ ÙÔ˘˜ Â›Ó·È ÙÔ ÌÂÛÔÎÔÏÈÎfi ‰È¿ÊÚ·ÁÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ˆÔÂȉԇ˜ ‚fiıÚÔ˘. ∆Ô ˘fiÏÔÈÔ 10% ÙˆÓ Ì˘ÍˆÌ¿ÙˆÓ ÚÔÛÎÔÏÏ¿Ù·È Û ‰È¿ÊÔÚ· ̤ÚË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘, fiˆ˜ Î·È ÛÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË, fiÔ˘ Ô fiÁÎÔ˜ ÂÍÔÚÌ¿ÙÔ ·fi ÙÔ Ô›ÛıÈÔ ÙÔ›¯ˆÌ· ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ÎfiÏÔ˘ Â¿Óˆ ·fi ÙËÓ ÚfiÛıÈ· Áψ¯›Ó· Ù˘ ÌÈÙÚÔÂȉÈ΋˜ ‚·Ï‚›‰·˜. ∏ ‰È¿ÁÓˆÛË ÙÔ˘ Ì˘ÍÒÌ·ÙÔ˜ Á›ÓÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î˘ÙÙ·ÚÈÎÒÓ Û¯ËÌ·ÙÈÛÌÒÓ Ô˘ Â›Ó·È ‚˘ıÈṲ̂ӷ ÛÂ Ì˘ÍÔÂȉ¤˜ ÛÙÚÒÌ·, ÏÔ‡ÛÈÔ Û ÁÏ˘ÎÔ˙·ÌÈÓÔÁÏ˘Î¿Ó˜. ∏ ıÂÚ·›· ÂÎÏÔÁ‹˜ Â› ηÏÔ‹ıˆÓ ηډȷÎÒÓ fiÁÎˆÓ Â›Ó·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË, Ë ÔÔ›· ·ÔÙÂÏ› Î·È ÙËÓ ÔÚÈÛÙÈ΋ ›·ÛË ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ ¤ÓÓÔÈ· Ù˘ ηÏÔ‹ıÂÈ·˜ Û ηډȷÎÔ‡˜ fiÁÎÔ˘˜ ‰ÂÓ Î·ıÔÚ›˙ÂÙ·È ÌfiÓÔ ·fi ÙËÓ ÈÛÙÔÏÔÁÈ΋ ˘Ê‹ ÙÔ˘ fiÁÎÔ˘, ·ÏÏ¿ Î·È ·fi ÙË ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚÔ ÂͤÏÈÍË Î·È ÔÚ›· ÙÔ˘˜ ˆ˜ ·ÔÙ¤ÏÂÛÌ·

JAN-FEB 2002 DONE

14-05-03

10:53

™ÂÏ›‰·85

¶·È‰È·ÙÚÈ΋ 2002;65:81-85

ÔͤˆÓ Û˘ÌÙˆÌ¿ÙˆÓ fiˆ˜ Ë ÂÌÊ¿ÓÈÛË ÔÍ›·˜ ‚·Ï‚ȉÈ΋˜ ·fiÊڷ͢, ÂÚÈÊÂÚÈ΋˜ ÂÌ‚ÔÏ‹˜ Î·È ‰È·Ù·Ú·¯ÒÓ ·ÁˆÁÈÌfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. ŒÙÛÈ, ·Ó·Ê¤ÚÔÓÙ·È ÂÚÈÙÒÛÂȘ ÌÔÈÚ·›·˜ ηٿÏË͢ ‹ ‚·ÚÈ¿˜ ÂÈÏÔ΋˜ ÂÓ ·Ó·ÌÔÓ‹ Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ıÂÚ·›·˜. ∂Ô̤ӈ˜, Ë Â¤Ì‚·ÛË Ú¤ÂÈ Ó· ‰ÈÂÓÂÚÁÂ›Ù·È ¿ÌÂÛ·, Ì ÂÍ·›ÚÂÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÎÂ›ÓˆÓ Ô˘ Û˘Óԉ‡ÔÓÙ·È Ì ÔÍ›· ‚·ÚÈ¿ ÈÛ¯·ÈÌÈ΋ ÂÁÎÂÊ·ÏÈ΋ Û˘Ó‰ÚÔÌ‹ ÂÌ‚ÔÏÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜, fiÔ˘ ÚÔÙÈÌ¿Ù·È Ë ·Ó·ÌÔÓ‹ ÁÈ· ‡ÊÂÛË Î·È ‚ÂÏÙ›ˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ Û˘Ó‰ÚÔÌ‹˜ ÚÈÓ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË. ∏ Ù·ÎÙÈ΋ ·˘Ù‹, ÙËÓ ÔÔ›· Î·È ÂÌ›˜ ·ÎÔÏÔ˘ı‹Û·Ì Ì ÂÈÙ˘¯›·, ·ÔÙÚ¤ÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÈÌÔÚÚ·ÁÈÎÔ‡ ÂÌÊÚ¿ÎÙÔ˘ Î·È ÂÁÎÂÊ·ÏÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ ÏfiÁˆ Ù˘ ¯Ú‹Û˘ Â͈ۈ̷ÙÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ ÛÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ÈÛ¯·ÈÌ›·˜. ªfiÓÔ Û ÂÚÈÙÒÛÂȘ ÌÈÎÚÒÓ ÂÌÊÚ¿ÎÙˆÓ Û˘˙ËÙÂ›Ù·È Ë ¿ÌÂÛË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË (9).

O ÌÂÁ¿ÏÔ˜ ΛӉ˘ÓÔ˜ ηٿ ÙËÓ Â¤Ì‚·ÛË Â›Ó·È Ë ·fiÛ·ÛË ÙÂÌ·¯È‰›ˆÓ ·fi ÙÔÓ fiÁÎÔ Î·È Ë ÚfiÎÏËÛË ÂÌ‚ÔÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÂÔ̤ӈ˜ ÔÈ ¯ÂÈÚÈÛÌÔ› ÚÈÓ ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ ·ÔÚÙ‹˜ Ú¤ÂÈ Ó· Â›Ó·È ÔÈ ·Ôχو˜ ·Ó·Áη›ÔÈ. ∆· Ì˘ÍÒÌ·Ù· ˘ÔÙÚÔÈ¿˙Ô˘Ó Û ÔÛÔÛÙfi 1-5% (10). OÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ˘ÔÙÚÔ‹˜ Â›Ó·È Ë ·ÙÂÏ‹˜ ·Ê·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘ ‹ Ë ·ÚÔ˘Û›· ‰Â‡ÙÂÚ˘ “ÚÔÔÁÎÈ΋˜” ÂÛÙ›·˜. ¶ÚÔ˜ ·ÔÊ˘Á‹ Ù¤ÙÔÈˆÓ Î·Ù·ÛÙ¿ÛˆÓ, Á›ÓÂÙ·È Â˘Ú›· ·Ê·›ÚÂÛË Ù˘ ÂÚÈÔ¯‹˜ ÂÚ› ÙÔ ˆÔÂȉ¤˜ ‚ÔıÚ›Ô Î·È ÙÔÔı¤ÙËÛË ÌÔۯ‡̷ÙÔ˜ ·fi ÔÌfiÏÔÁÔ ÂÚÈοډÈÔ ÁÈ· Û‡ÁÎÏÂÈÛË Ù˘ ÚÔηÏÔ‡ÌÂÓ˘ ÌÂÛÔÎÔÏÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜. π‰È·›ÙÂÚË ÂÚ›ÙˆÛË, ·fi ÏÂ˘Ú¿˜ ‰È¿ÁÓˆÛ˘ Î·È ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ·fi ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Ì˘ÍÒÌ·ÙÔ˜, ·ÔÙÂÏ› Ë ÌÔÚÊ‹ ÙÔ˘ “ÔÈÎÔÁÂÓÔ‡˜ ηډȷÎÔ‡ Ì˘ÍÒÌ·ÙÔ˜” Î·È Ù˘ Û‡Á¯ÚÔÓ˘ ·ÚÔ˘Û›·˜ ÔÏÏ·ÏÒÓ fiÁΈÓ, fiÔ˘ ÙÔ ÔÛÔÛÙfi ˘ÔÙÚÔ‹˜ Â›Ó·È ÂÚ›Ô˘ 12-22% (11,12). ™Â ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Û˘ÓÈÛÙ¿Ù·È ÏÂÙÔÌÂÚ¤ÛÙÂÚÔ˜ ÚÔÂÁ¯ÂÈÚËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÈÔ ÂÎÙÂÓ‹ ÂÎÙÔÌ‹ ÙÔ˘ ˘ÔΛÌÂÓÔ˘ ÂÓ‰Ôηډ›Ô˘ Î·È ÙÔ˘ ÌÂÛÔÎÔÏÈÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ˯ÔηډÈÔÁÚ·ÊÈ΋ ÌÂϤÙË Û˘ÓÈÛÙ¿Ù·È Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ÁÈ· ‰¤Î· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÙË.

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µÈ‚ÏÈÔÁÚ·Ê›· 1. Nadas AS, Ellison RC. Cardiac tumors in infancy. Am J Cardiol 1968;21:363-367.

2. Mc Allister HA Jr, Fenoglio JJ Jr. Tumors of the cardiovascular system. In: Hartman WH, Cowan WR, editors. Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology; 1978. p. 432-441.

3. Ha JW, Rim SJ, Chang BC, Chung N, Cho SY. A mitral valve myxoma prolapsing into the left ventricular outflow tract. Clin Cardiol 2001;24:570-573.

4. Pfammatter JP, Iff T, Schupbach P. Imitation of chronic recurrent inflammatory illness by cardiac myxoma. Eur J Pediatr 1996;155:637-639.

5. Salehian O, Demers C, Patel A. Atrial myxoma presenting as isolated unilateral blindness: a case report and review of the literature. Can J Cardiol 2001;17:898-900.

6. Bickford BJ, Egan M, Bryce AG. Surgical treatment of tumors of the heart: a report of two cases. Br J Surg 1956;43:514-517.

7. Dennis MA, Appareti K, Manco-Johnson ML, Clewell W, Wiggins J. The echocardiographic diagnosis of multiple fetal cardiac tumors. J Ultrasound Med 1985;4:327-331.

8. µÂÓ¤Ù˘ Ã. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ηډȿ˜. ∫·Ú‰ÈÔÏÔÁÈο £¤Ì·Ù·. 1999;131-145.

9. Ota T, Okumura S, Matsuba K, Yamasita M, Ushimaru K. A case of surgically treated left atrial myxoma early after cerebral embolism. Kyobu Geka 1996;49:1094-1096.

10. Waller DA, Ettles DF, Saunders NR, Williams G. Recurrent cardiac myxoma: The surgical implications of two distinct groups of patients. Thorac Cardiovasc Surg 1989;37:226-230.

11. Kigawa I, Fukuda S, Marat D, Tanaka J, Ikeda S, Okiyama M et al. A case of familial cardiac myxoma. Kyobu Geka 1996;49:323-326.

12. Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.

Medicine (Baltimore) 2001;80:159-172.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-10-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 29-11-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. N. ∫Ô˘ÚÙ¤Û˘ ∫·Ú‰ÈÔ¯ÂÈÚÔ˘ÚÁfi˜ - ∂ÈÌÂÏËÙ‹˜ µ’ ∂™À µ. ∞ı·Ó·Û›Ô˘ 65, ¶ÂÈڷȇ˜, ∆.∆. 185 39

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2002;65:86-88

CASE REPORT

¡fiÛÔ˜ ÙÔ˘ Kohler. ™¿ÓÈ·, ·ÏÏ¿ ˘·ÚÎÙ‹ ÓfiÛÔ˜ ÛÙ· ·È‰È¿ ∫. ∆ÛÔ˘Ì¿Î·˜, ∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. ª›¯·-°ÂˆÚÁÈÔÔ‡ÏÔ˘

∫Ôhler’s disease. A rare condition in children C. Tsoumakas, A. Papadopoulou, P. Miha-Georgiopoulou

¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ ÙÔ˘ Kohler Â›Ó·È Û¿ÓÈ· ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÚÔ‚¿ÏÏÔ˘Û· ÎÏÈÓÈÎÒ˜ ÌÂÓ Ì ¿ÏÁÔ˜ Î·È Ô›‰ËÌ· ÛÙË ÂÚÈÔ¯‹ ÙÔ˘ ¤ÏÌ·ÙÔ˜, ·ÎÙÈÓÔÏÔÁÈÎÒ˜ ‰Â Ì ‡ÎÓˆÛË ‹ Û˘Ì›ÂÛË ÙÔ˘ ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡. ∂ÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·ÁfiÚÈ· Î·È Ê·›ÓÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Û Ì˯·ÓÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘ÓÂ¿ÁÔÓÙ·È ÙËÓ ÂÍ¿ÛÎËÛË ›ÂÛ˘ ÛÙÔ ÔÛÙÔ‡Ó ÚÈÓ ÔÏÔÎÏËÚˆı› Ë ÔÛÙÂÔÔ›ËÛ‹ ÙÔ˘. ¶ÔÏϤ˜ ÊÔÚ¤˜ Û˘Ó‰˘¿˙ÂÙ·È Î·È Ì ·ÓÒÌ·ÏË ÔÛÙÂÔÔ›ËÛË. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ Ì ÓfiÛÔ ÙÔ˘ Kohler Î·È Û˘˙ËÙÂ›Ù·È Ë ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›·.

Abstract: Kohler’s disease is a rare disease of the tarsal navicular bone that is characterized by pain and swelling of the affected area, and Ôn radiographic examination, by flattening and sclerosis of the affected bone. It occurs more frequently in boys and there is evidence that it is due to mechanical factors due to compression of the bone before its ossification. Frequently it is associated with abnormal ossification. We describe the case of a 6 year old boy with Kohler’s disease.

§¤ÍÂȘ ÎÏÂȉȿ: ÓfiÛÔ˜ ÙÔ˘ ∫ohler, ÛηÊÔÂȉ¤˜ ÔÛÙÔ‡Ó, ·È‰È΋ ËÏÈΛ·.

Key words: Kohler’s disease, scaphoid, childhood.

∂ÈÛ·ÁˆÁ‹ ™ÙȘ ·Ú¯¤˜ ÙÔ˘ 20Ô˘ ·ÈÒÓ·, Ô Kohler ÂÚȤÁÚ·„ ̛· Û¿ÓÈ·, ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÓfiÛÔ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÈ¤‰ˆÛË, ÛÎÏ‹Ú˘ÓÛË Î·È Û·Ó›ˆ˜ οٷÁÌ· ÙÔ˘ ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡ (1). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ôχ Û˘¯ÓfiÙÂÚ· ÛÙ· ·ÁfiÚÈ· (7580%) Î·È Ë Ì¤ÛË ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È Ù· 4 ¤ÙË ÁÈ· Ù· ÎÔÚ›ÙÛÈ· Î·È ¤Ó·˜ ¯ÚfiÓÔ˜ ·ÚÁfiÙÂÚ· ÁÈ· Ù· ·ÁfiÚÈ· (2,3). ™ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ÓfiÛÔ˜ ÚÔÛ‚¿ÏÏÂÈ Î·È Ù· ‰‡Ô οو ¿ÎÚ·. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 6 ÂÙÒÓ ÚÔÛ‹Ïı ÛÙ· ∂͈ÙÂÚÈο π·ÙÚ›· ÙÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∫∞∆ Ì ¤ÓÙÔÓÔ ¿ÏÁÔ˜ Î·È Ô›‰ËÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¤ÏÌ·ÙÔ˜, Û˘Ìو̷ÙÔÏÔÁ›· Ô˘ ›¯Â ·fi ‰ÈÌ‹ÓÔ˘. ∆Ô ·È‰› ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ›¯Â ÔÌ·Ï‹ ÂÚÈÁÂÓÓËÙÈ΋ ÔÚ›·, Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È

ÂχıÂÚÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi. O ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓ Ì ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÁÈ· ‰ÈÂÚ‡ÓËÛË ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ ·ÚıÚ›Ùȉ·˜ ‹ ÓÔÛËÌ¿ÙˆÓ ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ÂÚÈÏ¿Ì‚·Ó ·ÎÙÈÓÔÁÚ·Ê›· οو ¿ÎÚˆÓ Î·ıÒ˜ Î·È Ï‹ÚË ·ÈÌ·ÙÔÏÔÁÈÎfi, ‚ÈÔ¯ËÌÈÎfi Î·È ·ÓÔÛÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∏ ÂÈÌÔÓ‹ ÙÔ˘ ¿ÏÁÔ˘˜ ÁÈ· ‰È¿ÛÙËÌ· ‰‡Ô ÌËÓÒÓ, Â¤‚·Ï ÙËÓ Â·Ó¿ÏË„Ë ÙÔ˘ ·ÎÙÈÓÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ ·fi ÙÔÓ ÔÔ›Ô ‰È·ÈÛÙÒıËΠ‡ÎÓˆÛË ÙÔ˘ ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡ (∂ÈÎfiÓ· 1). ∞ÎÔÏÔ‡ıËÛ ÛÈÓıËÚÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ÂȂ‚·›ˆÛ ÙËÓ ·ÚÔ˘Û›· ÔÛÙÂÔ¯ÔÓ‰Ú›Ùȉ·˜ ÛÙËÓ ›‰È· ÂÚÈÔ¯‹ (∂ÈÎfiÓ· 2). ∏ ÎÏÈÓÈ΋ Î·È Ë ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· ‹Ù·Ó ÂÓ‰ÂÈÎÙÈΤ˜ Ù˘ ÓfiÛÔ˘ ÙÔ˘ Kohler. O ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÂÊ·ÚÌÔÁ‹ Á‡„ÈÓÔ˘ Âȉ¤ÛÌÔ˘ Î·È ¯ÚËÛÈÌÔÔ›ËÛË ‚·ÎÙËÚÈÒÓ Ì·Û¯¿Ï˘ ηٿ ÙË ‚¿‰ÈÛË. ¢ÂÓ ¯ÚËÛÈÌÔÔÈ‹ıËΠʷÚ̷΢ÙÈ΋ ·ÁˆÁ‹, ÂÎÙfi˜ ·fi ·Ó·ÏÁËÙÈο. ªÂÙ¿ ÙËÓ ·Ú¤Ï¢ÛË ÂÍ·Ì‹ÓÔ˘, ‰È·ÈÛÙÒıËΠÏ‹Ú˘ ˘Ô¯ÒÚËÛË ÙÔ˘ ¿ÏÁÔ˘˜ Î·È ÙÔ˘ Ôȉ‹Ì·ÙÔ˜

¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆, ∞ÙÙÈ΋

Pediatric Division, KAT Hospital, Attiki

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∂ÈÎfiÓ· 2. OÛÙÂÔ¯ÔÓ‰Ú›Ùȉ· ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡ (·Ú.) Û ÛÈÓıËÚÔÊÚ·ÊÈÎfi ¤ÏÂÁ¯Ô.

∂ÈÎfiÓ· 1. ¶‡ÎÓˆÛË ÙÔ˘ ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡ (·Ú.) Û ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· οو ¿ÎÚˆÓ.

Î·È Ï‹Ú˘ ·ÔηٿÛÙ·ÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ ·ÎÙÈÓÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘. ∞Ê·ÈÚ¤ıËÎÂ Ô Á‡„ÈÓÔ˜ Â›‰ÂÛÌÔ˜ Î·È Ô ·ÛıÂÓ‹˜ Â·Ó‹Ïı ÛÙËÓ ·Ú¯È΋ ÙÔ˘ ÂÓÂÚÁfi ‰Ú·ÛÙËÚÈfiÙËÙ·. ™˘˙‹ÙËÛË ∏ ÓfiÛÔ˜ ÙÔ˘ Kohler, ·Ó Î·È Û¿ÓÈ·, Â›Ó·È ˘·ÚÎÙ‹ ÛÙ· ·È‰È¿. À¿Ú¯Ô˘Ó ÔÏϤ˜ ÂӉ›ÍÂȘ fiÙÈ Ù· ·›ÙÈ¿ Ù˘ Â›Ó·È Î·Ù¿ ‚¿ÛË Ì˯·ÓÈο (∂ÈÎfiÓ· 3). ∆Ô ÛηÊÔÂȉ¤˜ ‚Ú›ÛÎÂÙ·È ÛÙËÓ ÎÔÚ˘Ê‹ Ù˘ η̿ڷ˜ Î·È ˘Ê›ÛÙ·Ù·È Û˘Ó¯‹ Î·È ÛÙ·ıÂÚ‹ ›ÂÛË Î·Ù¿ ÙË ‚¿‰ÈÛË. ∂›Ó·È ‰Â ÙÔ ÙÂÏÂ˘Ù·›Ô ·fi Ù· ÔÛÙ¿ ÙÔ˘ Ô‰ÈÔ‡ Ô˘ ÔÛÙÂÔÔÈ›ٷÈ. O ˘Ú‹Ó·˜ ÔÛÙÂÒÛÂÒ˜ ÙÔ˘ ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ÌÂÓ ÎÔÚ›ÙÛÈ· ÛÙËÓ ËÏÈΛ· 1824 ÌËÓÒÓ, ÛÙ· ‰Â ·ÁfiÚÈ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 24-30 ÌËÓÒÓ Î·È ‰ÂÓ Â›Ó·È Û¿ÓȘ ÔÈ ·ÓˆÌ·Ï›Â˜ Ù˘ ÔÛÙÂÔÔ›ËÛ˘ ·˘ÙÔ‡. ∆fiÛÔ Ô Karp, fiÛÔ Î·È Ô Waugh η٤ÏËÍ·Ó fiÙÈ ÛÙ· ·ÁfiÚÈ· ηı˘ÛÙÂÚ› Ë ÔÛÙÂÔÔ›ËÛË Î·È Û˘¯Ó¿ ·ÎÔÏÔ˘ı› ·ÓÒÌ·ÏË ÔÚ›· (3,4). º·›ÓÂÙ·È fiÙÈ Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ÔÛÙÂÔÔ›ËÛ˘ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·ÓˆÌ·ÏÈÒÓ, ÔÈ Ôԛ˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ¿Î·ÈÚ˘ Î·È Î·Î‹˜ ›ÂÛ˘ Ô˘ ˘Ê›ÛÙ·Ù·È Ô Î·ı˘ÛÙÂÚË̤ÓÔ˜ ˘Ú‹Ó·˜ Û ̛· ÎÚÈÙÈ΋, ÁÈ· ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘, Ê¿ÛË. ∏ Û˘Ì›ÂÛË ·˘Ù‹ ΢ڛˆ˜ ·ÔÎÏ›ÂÈ ÙËÓ ·ÈÌ¿ÙˆÛË Î·È Ô‰ËÁ› Û ¿ÛËÙË Ó¤ÎÚˆÛË ÙÔ˘ ÔÛÙÔ‡ (5-7). ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË, ÌÂÙ¿ ·fi ‚ÈÔ„›· ‹ ·Ê·›ÚÂÛË ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÔÛÙÔ‡, ¤‰ÂÈÍ ÓÂÎڈ̤Ó˜ ÂÚÈÔ¯¤˜, ÂÚÈÔ¯¤˜ fiÔ˘ ·ÔÚÚÔÊÒÓÙ·È Ù· ÓÂÎڈ̤ӷ ÛÙÔȯ›· Î·È ÂÚÈÔ¯¤˜ ÔÛÙÈ΋˜ ·Ó·Á¤ÓÓËÛ˘ (8,9). ∏ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ ÓfiÛÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·Ú¯Èο ·ÓÙÈ·ÏÁÈ΋ ı¤ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜, ÛÙÚÔÊ‹ ÙÔ˘ οو ¿ÎÚÔ˘ ÚÔ˜ ÙÔ Ï¿È ÒÛÙ ӷ ·ÔʇÁÂÙ·È Ë

ÂÒ‰˘ÓË ÂÚÈÔ¯‹ ÙÔ˘ ¤ÏÌ·ÙÔ˜, ηıÒ˜ Î·È ÛÎÏ‹Ú˘ÓÛË Î·È Ô›‰ËÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÛηÊÔÂȉԇ˜ Ô˘ ÂÂÎÙ›ÓÂÙ·È ÔÏϤ˜ ÊÔÚ¤˜ Î·È ÛÙÔÓ ÚÔÛʇÔÓÙ· Ô›ÛıÈÔ ÎÓËÌÈ·›Ô Ù¤ÓÔÓÙ·. ™ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ Ù˘ Ô‰ÔÎÓËÌÈ΋˜ ¿ÚıÚˆÛ˘, Ô Ì¤ÛÔ˜ Î·È Ô Î¿Ùˆ Ù·ÚÛÈ·›Ô˜ Û‡Ó‰ÂÛÌÔ˜ ÎÈÓÔ‡ÓÙ·È ¯ˆÚ›˜ ‰˘ÛÎÔÏ›· ÚÔ˜ fiϘ ÙȘ ηÙ¢ı‡ÓÛÂȘ, ÁÂÁÔÓfi˜ Ô˘ ‰È·ÊÔÚÔÔÈ› ÙË ÓfiÛÔ ÙÔ˘ ∫ohler ·fi ÙËÓ ÔÍ›· ·ÚıÚ›Ùȉ· Ù‡Ô˘ ÚÂ˘Ì·ÙÔÂȉԇ˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, Ô ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ¤ÓÙÔÓÔ ¿ÏÁÔ˜ Î·È Ô›‰ËÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¤ÏÌ·ÙÔ˜, ÂÓÒ Ë ÎÈÓËÙÈÎfiÙËÙ· Ù˘ Ô‰ÔÎÓËÌÈ΋˜ ¿ÚıÚˆÛ˘ ‹Ù·Ó ÂχıÂÚË. ∏ ·ÎÙÈÓÔÏÔÁÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋. ∆Ô ÛηÊÔÂȉ¤˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÈ‰ˆÌ¤ÓÔ Ì ÌÂȈ̤ÓË ÚÔÛıÔ›ÛıÈ· ‰È¿ÌÂÙÚÔ, ·ÓÒÌ·ÏË ·Ú·›ˆÛË Î·È ÛÎÏ‹Ú˘ÓÛË ÙÔ˘ ÔÛÙ›ÙË ÈÛÙÔ‡. £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Û ÔÏÏ¿ Ê˘ÛÈÔÏÔÁÈο ¿ÎÚ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·ÓÒÌ·ÏË ÔÛÙÂÔÔ›ËÛË, Ë ÔÔ›· ı· Ú¤ÂÈ Ó· ‰È·ÊÔÚԉȷÁÈÁÓÒÛÎÂÙ·È ·fi ÙË ÓfiÛÔ ÙÔ˘ ∫ohler. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Î·È ÛÙ· ‰‡Ô οو ¿ÎÚ· ÁÈ·Ù›, fi¯È Û¿ÓÈ·, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ ›‰È˜ ÛÔ‚·Ú¤˜ ‚Ï¿‚˜ Û ¿ÎÚ· ·Û˘Ìو̷ÙÈο. OÈ Scaglietti Î·È Û˘Ó ÌÂϤÙËÛ·Ó ÙȘ ·ÎÙÈÓÔÏÔÁÈΤ˜ ÂÈÎfiÓ˜ 100 ÂÚÈÙÒÛÂˆÓ ÓfiÛÔ˘ ÙÔ˘ ∫ohler Î·È 100 Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ. ¢È·›ÛÙˆÛ·Ó fiÙÈ Ô ·ÛÙÚ¿Á·ÏÔ˜ ÚÔ¤‚·Ï ÚÔ˜ Ù· ÂÌÚfi˜ Î·È ÂÂÎÙÂÈÓfiÙ·Ó ¤Ú· ·fi ÙËÓ Ù¤ÚÓ· Û ÔÛÔÛÙfi 82% ÙˆÓ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ, ÌÂÈÒÓÔÓÙ·˜ ¤ÙÛÈ ÙÔ ·Ó·ÙÔÌÈÎfi ‰È¿ÛÙËÌ· ÙÔ˘ ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡ (10). ™ÙÔÓ ·ÛıÂÓ‹ Ô˘ ÂÚÈÁÚ¿ÊËÎÂ, ·Ú·ÙËÚ‹ıËΠ‡ÎÓˆÛË ÙÔ˘ ÛηÊÔÂȉԇ˜ ÛÙÔÓ ·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô, ¯ˆÚ›˜ ·ÓÒÌ·ÏË ÔÛÙÂÔÔ›ËÛË. ∏ ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ (6,7,11). ™Â ̤ÙÚÈÔ fiÓÔ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÚÈ·ÙËÙÈÎÔ› Ó¿ÚıËΘ Ô˘

87

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™ÂÏ›‰·88

¶·È‰È·ÙÚÈ΋ 2002;65:86-88

Paediatriki 2002;65:86-88

µÈ‚ÏÈÔÁÚ·Ê›·

∂ÈÎfiÓ· 3. ™¯ËÌ·ÙÈ΋ ·Ú¿ÛÙ·ÛË ÙˆÓ ÔÛÙÒÓ ÙÔ˘ ¿ÎÚÔ˘ Ô‰ÈÔ‡.

ÂÊ·ÚÌfi˙ÔÓÙ·È ÁÈ· 6-8 ‚‰ÔÌ¿‰Â˜, ÂÓÒ ÙȘ ÚÒÙ˜ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ Ë ‚¿‰ÈÛË ˘Ô‚ÔËıÂ›Ù·È Ì ‚·ÎÙËڛ˜ Ì·Û¯¿Ï˘. ™Â ·Û˘Ìو̷ÙÈο ¿ÎÚ· ‹ Ì ÂÏ·ÊÚ‡ fiÓÔ, ÂÊ·ÚÌfi˙ÔÓÙ·È Á‡„ÈÓ· ÙfiÍ· Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ Î·Ì¿Ú·. ∏ ÂÓÙ·ÙÈ΋ ¿ÛÎËÛË, ÙÔ Ì·ÎÚ‡ ÂÚ¿ÙËÌ· Î·È ÔÈ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ·ÔʇÁÔÓÙ·È. ∫·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊËÎÂ, Ë ·ÓÙÈÌÂÙÒÈÛË ‹Ù·Ó Ë ÚÔ·Ó·ÊÂÚfiÌÂÓË, Ì ÙÔÔı¤ÙËÛË Á‡„ÈÓÔ˘ Ó¿ÚıËη, ÂÓÒ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Î·È ‚·ÎÙËڛ˜ Ì·Û¯¿Ï˘. ∏ ÚfiÁÓˆÛË ÛÙË ÓfiÛÔ ÙÔ˘ ∫ohler Â›Ó·È Ôχ ηϋ Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·ÓˆÙ¤Úˆ ·ÁˆÁ‹˜. ∆Ô ÛηÊÔÂȉ¤˜ Â·Ó¤Ú¯ÂÙ·È ÛÙË Ê˘ÛÈÔÏÔÁÈ΋ ÙÔ˘ ηٿÛÙ·ÛË Û ‰È¿ÛÙËÌ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 6 Ì‹Ó˜ ¤ˆ˜ 3 ¯ÚfiÓÈ·. ™Â ÔÏÏ¿ ·È‰È¿, Ë ·ÔηٿÛÙ·ÛË Á›ÓÂÙ·È ÚÈÓ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ÔÛÙÂÔÔ›ËÛ˘ Î·È ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ‰˘ÛÌÔÚÊ›· ‹ ·ÓÈηÓfiÙËÙ·. ™ÙËÓ ÂÚÈÁÚ·ÊfiÌÂÓË ÂÚ›ÙˆÛË, Ë ·ÔηٿÛÙ·ÛË ¤ÁÈÓ ÛÙÔ ‚Ú·¯‡ÙÂÚÔ ·Ó·ÊÂÚfiÌÂÓÔ ‰È¿ÛÙËÌ· ÙÔ˘ 6Ì‹ÓÔ˘ Î·È ·˘Ùfi ÔÊ›ÏÂÙ·È ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÂÓ‰ÂÈÎÓ˘fiÌÂÓ˘ ıÂÚ·¢ÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘. ∏ ÓfiÛÔ˜ ÙÔ˘ ∫ohler Â›Ó·È Û¿ÓÈ·, ·ÏÏ¿ ˘·ÚÎÙ‹ ÓfiÛÔ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ ·ıÔÁÓˆÌÔÓÈ΋ ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ Ô‰ËÁ› ‡ÎÔÏ· ÛÙË ‰È¿ÁÓˆÛË, ·ÚΛ Ó· ‚Ú›ÛÎÂÙ·È ÛÙË ÛΤ„Ë ÙÔ˘ ·È‰È¿ÙÚÔ˘.

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Mûnchen Med Wschr 1908;55:1923.

2. °·ÚÔÊ·Ï›‰Ô˘ £, ÷ÚÙÔÊ˘Ï·Î›‰Ô˘-°·ÚÔÊ·Ï›‰Ô˘ °, ƒËÁÔÔ‡ÏÔ˘ Ã. OÛÙÈÎÔ› ÓfiÛÔÈ ·ԉȉfiÌÂÓÔÈ Û ·ÁÁÂȷΤ˜ ‰È·Ù·Ú·¯¤˜. OÛÙÂÔ¯ÔÓ‰Ú›ÙȘ ÙÔ˘ ÛηÊÔÂȉԇ˜ ÔÛÙÔ‡ ÙÔ˘ Ù·ÚÛÔ‡. ™‡Á¯ÚÔÓÔ˜ OÚıÔ‰È΋. 3Ë ŒÎ‰. 1973. ÛÂÏ. 121.

3. Karp M. Kohler’s disease of the tarsal scaphoid. J Bone Joint Surg 1937;19:84.

4. Waugh W. The ossification and vascularization of the tarsal navicular and their relation to Kohler’s disease. J Bone Joint Surg 1958;40-B:765.

5. Behrman RE, Kliegman RM, Arvin AM. The foot and toes: osteochondroses. In: Nelson Textbook of Pediatrics. 15th Ed. Philadelphia: WB Saunders Co; 1996. p. 1922.

6. Morrissy RT, Weinstein SL. Osteochondroses. In: Lovell and Winter’s Pediatric Orthopaedics. 4th Ed. LippincottRaven Publishers; 1996. p. 1101.

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8. Speed K. Kohler’s disease of the tarsal scaphoid bone.

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10. Scaglietti O, Stringa G, Mizzau M. Plus-variant of the astragalus and subnormal scaphoid space, two important findings in ∫ohler’s scaphoid necrosis. Acta Orthop Scand 1962;32:500.

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Common Orthopedic Problems II. 1996;43:1104.

HÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-05-2001 HÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 06-12-2001 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∆ÛÔ˘Ì¿Î·˜ ¢È¢ı˘ÓÙ‹˜ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆, ∞ÙÙÈ΋ ¡›Î˘ 2, 145 61, ∫ËÊÈÛÈ¿

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¶PO™EXH ™YNE¢PIA

17-19 π·ÓÔ˘·Ú›Ô˘ 2002

20th Annual Sleep Disorders in Infancy and Childhood ¶ÏËÚÔÊÔڛ˜: Alice Clark ∆ËÏ.: 760-773-4514 E-mail: registration@annenberg.net

Rancho Mirage California, U.S.A

21-23 π·ÓÔ˘·Ú›Ô˘ 2002

31st International Symposium of Pediatric Surgery ¶ÏËÚÔÊÔڛ˜: Prof. Dr. Ernst Horcher ∆ËÏ.: 431-404-006-837 E-mail: ernst.horcher@akh.wien.ac.at

Obergurgl, Austria

9-10 ºÂ‚ÚÔ˘·Ú›Ô˘ 2002

3Ë ¶·È‰ÔÓ¢ÌÔÓÔÏÔÁÈ΋ ∏ÌÂÚ›‰· ¶¿ÙÚ· ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·Ó/Ì›Ô˘ ¶·ÙÚÒÓ £¤Ì·: “§ÔÈÌÒÍÂȘ Î·È ·ÏÏÂÚÁÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜” ¶ÏËÚÔÊÔڛ˜: ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜-TYPORAMA ∆ËÏ.: (0610) 999 544, 999 612 Fax: (0610) 994 533

18-21 ºÂ‚ÚÔ˘·Ú›Ô˘ 2002

CIPP International Congress on Pediatric Pulmonology ¶ÏËÚÔÊÔڛ˜: Annie Bidart ∆ËÏ.: 33-0-497-038-597 Fax: 33-0-497-038-598 E-mail: cipp@cipp-meeting.com

Nice, France

8-10 ª·ÚÙ›Ô˘ 2002

7Ô ™˘Ó¤‰ÚÈÔ ÁÈ· ÙÔ ∂ÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ¶˘ÏˆÚÔ‡ •ÂÓÔ‰Ô¯Â›Ô HOLIDAYS ¶ÏËÚÔÊÔڛ˜: C&C International SA ∆ËÏ.: 010-68.89.100

∂Ú¤ÙÚÈ·

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21-24 ª·ÚÙ›Ô˘ 2002

29Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ Î·È ªÂÙ·‚ÔÏÈÛÌÔ‡ •ÂÓÔ‰Ô¯Â›Ô Du Lac ∆ËÏ.: 010-77.74.370

πˆ¿ÓÓÈÓ·

23-24 ª·ÚÙ›Ô˘ 2002

6Ë ∂ÈÛÙËÌÔÓÈ΋ ™˘Ó¿ÓÙËÛË ¶·È‰È¿ÙÚˆÓ ∞Ó·ÙÔÏÈ΋˜ ª·Î‰ÔÓ›·˜ & £Ú¿Î˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¢ËÌÔÎÚ›ÙÂÈÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ £Ú¿Î˘ ¶ÏËÚÔÊÔڛ˜: Minerva Fairs and Congresses ∆ËÏ.: 010-32.17.456, 32.17.474 Fax: 010-32.20.595 E-mail: minerva@medianet.gr

∫ÔÌÔÙËÓ‹

19-21 ∞ÚÈÏ›Ô˘ 2002

8Ô ∂ÈÛÙËÌÔÓÈÎfi ™˘Ó¤‰ÚÈÔ ºÔÈÙËÙÒÓ π·ÙÚÈ΋˜ ∂ÏÏ¿‰Ô˜ ¶·ÓÂÈÛÙ‹ÌÈÔ πˆ·ÓÓ›ÓˆÓ ∆ËÏ.: 06510-97.719

πˆ¿ÓÓÈÓ·

21-24 ∞ÚÈÏ›Ô˘ 2002

VIII International Congress on Immunorehabilitation “Allergy, Immunology and Global Network” Congress Secretariat Tel.: (++7-095) 336-5000 Fax: (++7-095) 336-5000 E-mail: acicis@ibch.ru Web site: http://www.isir.ru

Cannes, France

26-28 ∞ÚÈÏ›Ô˘ 2002

1st Mediterranean Congress of Neurology ¶ÏËÚÔÊÔڛ˜: Demos Antoniou ∆ËÏ.: 357-5-749919 Fax: 357-5-749744 E-mail: info@medneuro2002.com

Limassol, Cyprus

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™ÂÏ›‰·91

™YNTOMO°PAºIE™

ABBREVIATIONS

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

AIDS

Û‡Ó‰ÚÔÌÔ Â›ÎÙËÙ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜

AMP, ADP, ATP

ÌÔÓÔ-, ‰È-, ÙÚÈʈÛÊÔÚÈ΋ ·‰ÂÓÔÛ›ÓË

ATPase cal CSF ‹ ENY CNS ‹ ∫¡™ cm CoA cmÑ cm2 cAMP ÆC CRP DNA ECG ‹ ∏∫° EEG ‹ ∏∂° ELISA ESR ‹ ∆∫∂ EDTA g Hct Hb HLA

ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ ıÂÚÌ›‰· ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ÂηÙÔÛÙfi Û˘Ó¤Ó˙˘ÌÔ ∞ ΢‚ÈÎfi ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢ÎÏÈÎfi AMP ‚·ıÌfi˜ KÂÏÛ›Ô˘ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË ‰ÂÔ͢ÚÈ‚Ô˙ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¤Ó˙˘ÌÔ-Û˘Ó‰¤Ù˘ ·ÓÔÛÔÚÔÛÚfiÊËÛ˘ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù·¯‡ÙËÙ· ηıÈ˙‹Ûˆ˜ ÂÚ˘ıÚÒÓ Âı˘ÏÂÓԉȷÌÈÓÔÙÂÙÚ·ÔÍÂ˚Îfi Ô͇ ÁÚ·ÌÌ¿ÚÈo ·ÈÌ·ÙÔÎÚ›Ù˘ ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÓÙÈÁfiÓÔ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜

Ig ICU ‹ ª∂£ IU i.m. ‹ ∂.ª. i.p. ‹ ∂.¶. i.v. ‹ ∂.º.

L log mol ªW ‹ MB MCH MCV mRNA m min n N NS ‹ ª™ Ôsm % PCR pH PCO2 PO2 p

·ÓÔÛÔÛÊ·ÈÚ›ÓË ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ıÂÚ·›·˜ ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ÂÓ‰ÔÌ˘˚ο ÂÓ‰ÔÂÚÈÙÔÓ·˚ο ÂÓ‰ÔÊϤ‚È· Ï›ÙÚÔ(·) ÏÔÁ¿ÚÈıÌÔ˜ ÁÚ·ÌÌÔÌfiÚÈÔ ÌÔÚÈ·Îfi ‚¿ÚÔ˜ ̤ÛË ·ÈÌÔÛÊ·ÈÚ›ÓË ÂÚ˘ıÚÒÓ Ì¤ÛÔ˜ fiÁÎÔ˜ ÂÚ˘ıÚÒÓ ·ÁÁÂÏÈÔÊfiÚÔ˜ RNA ̤ÙÚÔ ÏÂÙfi ·ÚÈıÌfi˜ Ó¢ÙÒÓÈÔ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Â› ÙÔȘ ÂηÙfi ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ Û˘ÁΤÓÙÚˆÛË ÈfiÓÙˆÓ ˘‰ÚÔÁfiÓÔ˘ ÌÂÚÈ΋ Ù¿ÛË CO2 ÌÂÚÈ΋ Ù¿ÛË Ô͢ÁfiÓÔ˘ Èı·ÓfiÙËÙ·

acquired immunodeficiency syndrome adenosine 5mono-, di-, triphosphate adenosine triphosphatase calorie cerebrospinal fluid central nervous system centimeter coenzyme A cubic centimeter square centimeter cyclic AMP degree(s) Celsius C-reactive protein deoxyribonucleic acid electrocardiogram electroencephalogram enzyme-linked immunoabsorbent assay erythrocyte sedimentation rate ethylenediaminetetracetate gram haematocrit haemoglobin (human) histocompatibility leucocyte antigen immunoglobulin intensive care unit international Unit intramuscular intraperitoneal intravenous liter logarithm mole molecular weight mean corpuscular haemoglobin mean corpuscular volume messenger RNA meter minute number newton not significant osmole percent polymerase chain reaction potentia hydrogenii carbon dioxide pressure oxygen pressure probability

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JAN-FEB 2002 DONE

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10:53

™ÂÏ›‰·92

™˘ÓÙÔÌÔÁڷʛ˜

·fi ÙÔ ÛÙfiÌ· Ú·‰ÈÔ·ÓÔÛÔ·ÔÚÚÔÊËÙÈ΋ ‰ÔÎÈÌ·Û›· ÚÈ‚ÔÓÔ˘ÎÏÂ˚ÓÈÎfi Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÈ·˜ ‰Â˘ÙÂÚfiÏÂÙÔ ˘Ô‰fiÚÈ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ÌÔÓ¿‰·

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (10 ) mega-(10 ) kilo- (10 ) hecto(10 ) deca (10 ) deci (10 ) centi- (10 ) milli(10 ) micro (10 ) nano (10 ) pico (10 ) femto (10 ) atto (10 ) 9

6

3

2

1

-1

-2

-3

-6

-9

-12

-15

-18

xviii

EÏÏËÓÈÎÔ› fiÚÔÈ

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

AÁÁÏÈÎÔ› fiÚÔÈ by mouth radioimmunoassay ribonucleic acid respiratory distress syndrome second subcutaneous standard deviation standard error unit