Παιδιατρική | Τόμος 67 • Τεύχος 1 • Ιανουάριος - Φεβρουάριος 2004

COVER Jan_Feb 04

10-03-04

15:31

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ISSN 0377-2551

ETO™ 2004

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TOMO™ 67

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REVIEW ARTICLES 2

¶. ∫·Ï·Ì·Ï›Î˘

∆· ÓÂÔÁÓ¿ Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘ º˘Ì·Ù›ˆÛË Î·È Î‡ËÛË: ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡

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AWARD-WINNING ARTICLE 26

Epidemiological and genotypic analysis of Salmonella enteritidis isolates in children with gastroenteritis during the period 1987-1997 P. Sfyridis, A. Markogiannakis

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™

ORIGINAL ARTICLES 33

∫. ™Ô‡ÏË, °. ∫·Ú›Î·˜, π. ∆˙·ÌÔ˘Ú¿ÓË, ∂. ªÈ¯ÂϷοÎË, ™. ∆۷ΛÚ˘

In vivo effects of high blood levels of phenylalanine on Na+K+-ATPase and Mg2+-ATPase activities in phenylketonuric patients K. Schulpis, G. Karikas, I. Tjamouranis, H. Michelakakis, S. Tsakiris

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º. ∫·Ú·¯¿ÏÈÔ˘, ∂. µÏ·¯Ô··‰ÔÔ‡ÏÔ˘, ª. £ÂÔ¯¿ÚË, ™. ªÈ¯·Ï¿ÎÔ˜

™˘¯ÓfiÙËÙ· Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ Û ·È‰È¿ ∞’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ∞ÚÁÔÏ›‰·˜

Tuberculosis and pregnancy: treatment of the mother and neonate A. Manoura, N. Katzilakis

¶. ™Ê˘Ú›‰Ë˜, ∞. ª·ÚÎÔÁÈ·ÓÓ¿Î˘

∞‡ÍËÛË Î·È ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ·ÛıÂÓÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·

Multiple gestation neonates A. Manoura, C. Giannakopoulou

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∏ Â›‰Ú·ÛË ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ÛÙË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ Na+K+-∞∆ƒ¿Û˘ Î·È Ù˘ Mg2+-ATƒ¿Û˘ Û ʷÈÓ˘ÏÎÂÙÔÓÔ˘ÚÈÎÔ‡˜ ·ÛıÂÓ›˜

Apoptosis. New concepts, new therapeutic prospects P. Kalabalikis

∞. ª·ÓÔ˘Ú¿, ¡. ∫·Ù˙ËÏ¿Î˘

∂ȉËÌÈÔÏÔÁÈ΋ Î·È ÁÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÛÙÂϯÒÓ Salmonella enteritidis Û ·È‰È¿ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ 1987-1997

LETTER FROM THE EDITOR

Growth and final height in children with thalassaemia major F. Karachaliou, E. Vlachopapadopoulou, M. Theochari, S. Michalakos

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Frequency and management of sinistrality in first grade of primary school children in the county of Argolida, Greece

¶. ∆·‚Ï·ÓÙ¿˜, ∫. ∆˙È¿ÚÔ˘, ª. ∆·‚Ï·ÓÙ¿, Ã. •˘ÔÏÈ¿, π. ∆·Ú·ÓÙ›Ï˘, π. πˆ¿ÓÓÔ˘, ∫. °Î¿Ù˙ÈÔ˘

P. Tavlantas, K. Tziarou, M. Tavlanta, C. Xypolia, J. Tarantilis, J. Ioannou, K. Gatziou

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

Continuation of table of contents inside title page

Greek Paediatric Society January - F e b r u a r y 200 4 ñ V o l u m e 6 7 ñ No 1

π·ÓÔ˘¿Ú ÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈ Ô˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 1

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

π‰ÈÔ·ı‹˜ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿ Î·È ÁÔÓfiÙ˘Ô˜ Û˘Ó‰ÚfiÌÔ˘ Gilbert

Continuation of table of contents

49

A. Galla-Voumvouraki, S. Kitsiou-Tzeli, A. Tsezou, M. Tzeti, E. Kavazarakis, E. Giannatou, A. Manolaki, O. Grafakou, D. Lazaris, E. Kanavakis

∞. °·ÏÏ¿-µÔ˘Ì‚Ô˘Ú¿ÎË, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË, ∞. ∆Û¤˙Ô˘, ª. ∆˙¤ÙË, ∂. ∫·‚·˙·Ú¿Î˘, ∂. °È·ÓÓ¿ÙÔ˘, ∞. ª·ÓˆÏ¿ÎË, O. °Ú·Ê¿ÎÔ˘, ¢. §¿˙·Ú˘, ∂. ∫·Ó·‚¿Î˘

CASE REPORTS

EN¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ ∫·Ú‰È·Îfi˜ ÂÈˆÌ·ÙÈÛÌfi˜ ˆ˜ ÂÈÏÔ΋ ÎÂÓÙÚÈ΋˜ ÊÏ‚È΋˜ ÁÚ·ÌÌ‹˜ Û ÚfiˆÚÔ ÓÂÔÁÓfi

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Pericardial effusion complicating a central venous catheter in a premature infant

Greek Paediatric Society

G. Mavridis, A. Andreou

°. ª·˘Ú›‰Ë˜, ∞. ∞Ó‰Ú¤Ô˘

™˘Ìو̷ÙÈ΋ Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û ‰›‰˘ÌÔ ÓÂÔÁÓfi ÌÂÙ¿ ·fi Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜

Idiopathic cholelithiasis in children and Gilbert’s syndrome

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Symptomatic congenital cytomegalovirus infection in a twin after recurrent maternal infection

∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔڷοÎË, ∂. ÷Ù˙ˉ¿ÎË, ª. ∞ÁÁÂÏ¿ÎË, ™. ªÈÎÔ˘‚·Ú¿Î˘, ª. ¶··ÁˆÚÁ›Ô˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

A. Manoura, E. Korakaki, E. Hatzidaki, M. Aggelaki, S. Bikouvarakis, M. Papageorgiou, C. Giannakopoulou

£∂ª∞∆∞ ∂∫¶∞π¢∂À™∏™ ∫∞π Oƒ°∞¡ø™∏™ À°∂π∞™

ISSUES ON HEALTHCARE MANAGEMENT AND EDUCATION

∏ ÛÙÚ·ÙËÁÈ΋ Ù˘ ÔÏÔÎÏËڈ̤Ó˘ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜

61

Integrated management of childhood illness: a strategy for developing countries

∫. ¢Ô‡ÚÔ˜

K. Douros

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Continued

Greek Paediatric Society J a n u a r y - F e b r u a r y 200 4 ñ V o l u m e 6 7 ñ No 1

π·ÓÔ˘¿Ú ÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈ Ô˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 1

™˘Ó¤¯ÂÈ· ÂÚȯÔ̤ӈÓ

Continuation of table of contents

¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

68

NEWS FROM THE INTERNET

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72

OBITUARY

¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

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PEDIATRIC NEWS LITERATURE ABSTRACTS

¶∂ƒπ§∏æ∂π™ ∞ƒ£ƒø¡ ∞¶O ∆∏ µπµ§πO°ƒ∞ºπ∞ ™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙÚÈÒÓ Ê˘ÛÈÎÒÓ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙˆÓ ÓÂÔÁÓÒÓ

48

Comparison of three treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome Baroutis G, Liarou T, Papathoma E, Hatzistamatiou Z, Costalos C Greek translation: J. Kaleyias

Baroutis G, Kaleyias J, Liarou T, Papathoma E, Hatzistamatiou Z, Costalos C ∞fi‰ÔÛË ÛÙ· ∂ÏÏËÓÈο: π. ∫·Ï¤ÁÈ·˜

Greek Paediatric Society

¶ÚÔÛ¯‹ ™˘Ó¤‰ÚÈ·

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Scheduled Medical Meetings

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Abbreviations

Greek Paediatric Society J a n u a r y - F e b r u a r y 200 4 ñ V o l u m e 6 7 ñ No 1

π·ÓÔ˘¿ÚÈÔ˜ - ºÂ‚ÚÔ˘¿ÚÈ Ô˜ 200 4 ñ ∆fiÌÔ˜ 6 7 ñ ∆‡¯Ô˜ 1

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

Bimonthly Publication The Official Journal of the Greek 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© Greek Paediatric Society Michalakopoulou 92 Athens 115 28

TËÏ.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Tel.: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

EÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¶Úfi‰ÚÔ˜ : ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ¢È¢ı˘ÓÙ‹˜ : ™. ÷˚‰¿˜ M¤ÏË : º. Aı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ : °. µ·ÚÏ¿Ì˘ : ª. ∏Ï›· : π. ¶··‰¿ÙÔ˜ : ¡. ¶··‰fiÔ˘ÏÔ˜ : ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ : ∫. ¶ÚÔ‡ÓÙ˙Ô˘-∫·ÛÛÈÔ‡ : ∫. ™ÙÂÊ·Ó›‰Ë˜ : ª. ∆ÛÔÏÈ¿ : ™. ºˆÙfiÔ˘ÏÔ˜

Scientific President Editor Members

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

Manuscript Editing

EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘

English Editing S. Nakou

∞ÏÏËÏÔÁÚ·Ê›· ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ªÈ¯·Ï·ÎÔÔ‡ÏÔ˘ 92 ∞ı‹Ó·È 115 28 ∆ËÏ: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

Correspondence Greek Paediatric Society Michalakopoulou 92 Athens 115 28 Tel: 210-7771 140 / 210-7771 663, Fax: 210-7758 354

™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜

Publishing Coordinator

E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶. ∆۷ω¿ÚË 3, 151 22 M·ÚÔ‡ÛÈ TËÏ.: 210-61 41 363-5 Fax: 210-61 41 366

SCIENTIFIC PUBLICATIONS Ltd P. Tsaldari 3, Marousi 151 22 Tel.: 210-61 41 363-5 Fax: 210-61 41 366

Greek Paediatric Society

Greek Paediatric Society

EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹

40

EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜:

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Editorial Board : A. Constantopoulos : S. Haidas : F. Athanassiadou-Piperopoulou : G. Varlamis : M. Ilia : I. Papadatos : N. Papadopoulos : S. Polychronopoulou : K. Prountzou-Kassiou : C. Stefanidis : M. Tsolia : S. Fotopoulos

Greek Editing I. Karavranou

Annual Subscription All foreign countries: US $ 50

Greek Paediatric Society J a n u a r y - F e b r u a r y 200 4 ñ V o l u m e 6 7 ñ No 1

πSSN 0377-2551 i

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

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.

4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.

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

6. ∂›Î·ÈÚ· ı¤Ì·Ù·.

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

8. ∫ÏÈÓÈΤ˜ Î·È ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÙÒÛÂȘ.

9. ™‡ÓÙÔÌ· Ó¤·.

10. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

11. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

12. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

13. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 14. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ 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 Î·ıÒ˜ Î·È ¿ÚıÚ· Ì Â›Î·ÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› Ó· ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙË ‰ËÌÔÛ›Â˘ÛË ÂÚÁ·ÛÈÒÓ Ô˘ ¤¯Ô˘Ó ·ÚÔ˘ÛÈ·Ûı› ÛÙÔ ÂÙ‹ÛÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ·ÚÔ˘ÛÈ¿ÛÂˆÓ È‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Î·È ÙËÓ ÔÏÈ΋ ‹ ÌÂÚÈ΋ ‰ËÌÔÛ›Â˘ÛË ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì Â›Î·ÈÚ· ı¤Ì·Ù· Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÂÙ·È ÛÙËÓ ÚÒÙË ÛÂÏ›‰· Ë ÚfiıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ ÁÈ· ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. ∏ ∂ÈÙÚÔ‹ ™‡ÓÙ·Í˘ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ù˘ ·Ô‰Ô¯‹˜ Ù˘ Ù·¯Â›·˜ ‰ËÌÔÛ›Â˘Û˘. 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 “¶·È‰È·ÙÚÈ΋” ·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 “¶·È‰È·ÙÚÈ΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ - ¯ÔÚË-

Á›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. ∫·ıÒ˜ Î·È fiÙÈ ÙËÚ‹ıËÎ·Ó ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). ™ÙȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È fiÙÈ ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋ ·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 µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals) Ô˘ ‰ËÌÔÛȇÙËÎ·Ó ÛÙÔ JAMA 1997;277:927-934 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‚¿ÏÏÂÙ·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 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 ÊÈÏÌ Î·È ÙˆÓ ·Ó·Ù‡ˆÓ ‚·Ú‡ÓÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Î·È Ú¤ÂÈ Ó· ÏËÚÒÓÔÓÙ·È Ì ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘ ÚÒÙÔ˘ ‰ÔÎÈÌ›Ô˘ ηÙ¢ı›·Ó ÛÙÔÓ Ù˘ÔÁÚ¿ÊÔ.

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

v

A4 (21x29.7 cm) Ì ‰ÈÏfi ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ ÁÚ·ÌÌÒÓ Î·È ÂÚÈıÒÚÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2,5 cm ÛÙȘ ‰‡Ô Ï¢ڤ˜.

TÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ¤¯ÂÈ ÙËÓ ·ÎfiÏÔ˘ıË ‰È¿Ù·ÍË: ÛÂÏ›‰· Ù›ÙÏÔ˘, ‚Ú·¯‡˜ Ù›ÙÏÔ˜, ÂÚ›ÏË„Ë ÛÙ· ÂÏÏËÓÈο Î·È Ù· ·ÁÁÏÈο, 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˘.

H ¤ÎÙ·ÛË ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÁÈ·: ·. ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ‚. ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. Á. ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ‰. ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 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, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›Ô Á›ÓÂÙ·È Ë ·ÏÏËÏÔÁÚ·Ê›·. ¶ÂÚÈÏ‹„ÂȘ H ÂÚ›ÏË„Ë Ú¤ÂÈ Ó· ·Ó·ÎÂÊ·Ï·ÈÒÓÂÈ ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ÂÚÁ·Û›·˜, ÙË ÌÂıÔ‰ÔÏÔÁ›·, Ù· ΢ÚÈfiÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Ù˘ ÌÂϤÙ˘. £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ∏ ÂÚ›ÏË„Ë ÙˆÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙËÓ ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜ Î·È Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ ÛÙ· ·ÁÁÏÈο. TÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ·ÁÁÏÈÎÔ‡ ÎÂÈ̤ÓÔ˘ Ú¤ÂÈ Ó· Â›Ó·È ‰ÔÌË̤ÓÔ Û ÂÈÛ·ÁˆÁ‹ (background), ̤ıÔ‰ÔÈ (methods), ·ÔÙÂϤÛÌ·Ù· (results) Î·È Û˘ÌÂÚ¿ÛÌ·Ù· (conclusions). H ÂÚ›ÏË„Ë ÛÙ· ·ÁÁÏÈο ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÛÙ· ÂÏÏËÓÈο.

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 ÂÈÛ·ÁˆÁ‹ ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÙÂÏÂ˘Ù·›· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì· Ì ÙȘ ΢ÚÈfiÙÂÚ˜ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·-

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

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

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 Î·È ÛÙȘ ÂÈÛÙÔϤ˜.

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

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

Arch Neurol 1988;45:575-578. ¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: ÷ڷϷÌ›‰Ë˜ π, ¶··‰fiÔ˘ÏÔ˜ ∞. ¶·¯˘Û·ÚΛ· Î·È ˘ÂÚÏÈȉ·ÈÌ›· [¶ÂÚ›ÏË„Ë]. 36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1998 5-7 πÔ˘Ó›Ô˘; ¶¿ÊÔ˜, ∫‡ÚÔ˜; 1998. ÛÂÏ. 199.

Schreiner GF, Lange L. Ethanol modulation of macrophage influx in glomerulonephritis [abstract].

J Am Soc Nephrol 1991;2:562.

Should antileukotriene therapies be used instead of inhaled corticosteroids in asthma? [Editorial]. Am J Respir Crit Care Med 1998;158:1697-1701.

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

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

Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. ¶›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˜, Î.Ï.) ¯·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. ¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜ ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜.

2. ¢‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ Ù˘ ÂÚÁ·Û›·˜.

3. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜.

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

5. ¶ÂÚ›ÏË„Ë ÂÏÏËÓÈ΋-·ÁÁÏÈ΋, ϤÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·).

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

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

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

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

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

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

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

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∞Á·ËÙÔ› ™˘Ó¿‰ÂÏÊÔÈ, ∏ ∂ÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ‡¯ÂÙ·È Ó· Û˘Ì‚Â› Û ۷˜ Î·È ÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ Û·˜ fi,ÙÈ Î·Ï‡ÙÂÚÔ ÁÈ· ÙÔÓ Î·ÈÓÔ‡ÚÁÈÔ ¯ÚfiÓÔ, ÙÔÓ ÔÔ›Ô ‹‰Ë ‰È·Ó‡Ô˘ÌÂ.

°È· ÙË ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ O ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫·ı. ™Ù·‡ÚÔ˜ ÷˚‰¿˜

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∞fiÙˆÛË. ¡¤Â˜ ·ÓÙÈÏ‹„ÂȘ, Ӥ˜ ıÂÚ·¢ÙÈΤ˜ ÚÔÔÙÈΤ˜ ¶. ∫·Ï·Ì·Ï›Î˘

Apoptosis. New concepts, new therapeutic prospects P. Kalabalikis

¶ÂÚ›ÏË„Ë: O fiÚÔ˜ ·fiÙˆÛË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· Ó· ÂÚÈÁÚ¿„ÂÈ Ì›· ȉȷ›ÙÂÚË ÌÔÚÊ‹ ΢ÙÙ·ÚÈÎÔ‡ ı·Ó¿ÙÔ˘, ηٿ ÙËÓ ÔÔ›· Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ì›·˜ ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˘, ÁÂÓÂÙÈο ÂÏÂÁ¯fiÌÂÓ˘, ‰È·‰Èηۛ·˜. ∞˘Ùfi˜ Ô ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ˜ ΢ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ ·ÔÙÂÏ› Û‹ÌÂÚ· ¤Ó· ·fi Ù· ϤÔÓ ÂӉȷʤÚÔÓÙ· ‰›· ¤Ú¢ӷ˜ ÛÙÔÓ ¯ÒÚÔ Ù˘ ‚ÈÔÏÔÁ›·˜ Î·È Ù˘ È·ÙÚÈ΋˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ fi¯È ÌfiÓÔ Â›Ó·È Û˘Ó˘Ê·Ṳ̂ÓÔ˜ Ì ÙËÓ ÂͤÏÈÍË Î·È ÙË Á‹Ú·ÓÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ·ÏÏ¿ Û¯ÂÙ›˙ÂÙ·È Î·È Ì ¤Ó·Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÓÔÛËÌ¿ÙˆÓ. ™Â ¤Ó·Ó Ê˘ÛÈÔÏÔÁÈÎfi ·ÓıÚÒÈÓÔ ÔÚÁ·ÓÈÛÌfi ηٷÛÙÚ¤ÊÂÙ·È Î·ıËÌÂÚÈÓ¿ ¤Ó·˜ ÙÂÚ¿ÛÙÈÔ˜ ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, ÂÓÒ ·Ú¿ÏÏËÏ· ÚÔ·ÙÂÈ Ì ̛وÛË ¤Ó·˜ ÂÍ›ÛÔ˘ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ Ó¤ˆÓ ΢ÙÙ¿ÚˆÓ. ¶ÔÏÏ¿ ·fi Ù· Ó¤· ·ÙÙ·Ú· Â›Ó·È ÂÏ·Ùو̷ÙÈο, ÂÓÒ ÔÚÈṲ̂ӷ ·fi Ù· ·Ï·ÈfiÙÂÚ· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚Ï¿‚Ë ÏfiÁˆ Ïԛ̈͢ ‹ ¿ÏÏˆÓ Â͈ÁÂÓÒÓ, ·ÏÏ¿ Î·È ÂÓ‰ÔÁÂÓÒÓ, ·Ú·ÁfiÓÙˆÓ. ∏ ηٷÛÙÚÔÊ‹ ÙˆÓ ÌË ÏÂÈÙÔ˘ÚÁÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È Ë ··ÏÏ·Á‹ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ·fi ·ÙÙ·Ú· Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ‚Ï¿‚Ë Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È Ì ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘. ŒÙÛÈ, ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Û˘ÁÎÂÎÚÈ̤ÓÔÈ ÁfiÓÔÈ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·˘ÙÒÓ Ô˘ ı¤ÙÔ˘Ó Û ÏÂÈÙÔ˘ÚÁ›· ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘, Ô ÔÔ›Ô˜ ı· Ô‰ËÁ‹ÛÂÈ ÙÂÏÈο ÛÙÔÓ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ. ¢È·Ù·Ú·¯¤˜ ÛÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ ¢ı‡ÓÔÓÙ·È ‹ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂͤÏÈÍË ÔÏÏÒÓ ÓÔÛËÌ¿ÙˆÓ. ∏ ·ÓÂ¿ÚÎÂÈ· ·fiÙˆÛ˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Ô‰ËÁ‹ÛÂÈ Û ηÚΛÓÔ ‹ ·˘ÙÔ¿ÓÔÛË ÓfiÛÔ, ÂÓÒ Ë ·˘ÍË̤ÓË ·fiÙˆÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù· Î·È Î·Ú‰ÈÔ¿ıÂȘ. ∏ ·Ú¤Ì‚·ÛË ÛÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ ı· ·ÓÔ›ÍÂÈ Ó¤Ô˘˜ ÔÚ›˙ÔÓÙ˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÛÔ‚·ÚÒÓ ÓÔÛËÌ¿ÙˆÓ.

Abstract: Apoptosis is a term given to describe a specific form of cell death, in which cell destruction is a result of a programmed, genetically controlled procedure. Today programmed cell death has become one of the most interesting research areas in biology and medicine, because it is associated with development and ageing, and with a variety of disease processes. In a normal human organism a huge number of cells are destroyed every day and at the same time an equally large number of cells are produced through mitosis. Many new cells are defective, while some old cells may have been damaged by infection or other extrinsic and intrinsic factors. Destruction of nonfunctional cells and elimination of damaged cells is accomplished through apoptosis. Specific genes in these cells are activated, initiating the mechanism of apoptosis, which finally leads to cell death. Disregulation of apoptosis is either responsible or participates in the progression of many diseases. Deficient apoptosis may result in cancer or auto-immune disease, while excessive apoptosis is associated with neurodegenerative diseases and cardiopathies.

Apoptosis modulation will open new horizons in the treatment of serious diseases.

§¤ÍÂȘ ÎÏÂȉȿ: ·fiÙˆÛË, ΢ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜.

Key words: apoptosis, cell death.

ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·

Intensive Care Unit, “Aghia Sophia” Children’s Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2004;67:2-10

∂ÈÛ·ÁˆÁ‹ ∏ ‰È·Ù‹ÚËÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÓfi˜ ÔÏ˘Î˘ÙÙ¿ÚÈÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ··ÈÙ› ÙËÓ Ù·˘Ùfi¯ÚÔÓË ‰Ú¿ÛË ‰‡Ô ·ÓÙ›ÚÚÔˆÓ Ì˯·ÓÈÛÌÒÓ: ÂÓfi˜ Ì˯·ÓÈÛÌÔ‡ Ô˘ ¤¯ÂÈ ˆ˜ ÛÎÔfi ÙÔÓ ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂÓfi˜ ¿ÏÏÔ˘, Ô ÔÔ›Ô˜ ÂϤÁ¯ÂÈ Ô˘ÛÈ·ÛÙÈο ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ú˘ıÌ›˙ÔÓÙ·˜ ÙËÓ ˆÚ›Ì·ÓÛË, ÙË Á‹Ú·ÓÛË Î·È, ÙÂÏÈο, ÙÔÓ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ. O fiÚÔ˜ “·fiÙˆÛË” ·Ó·Ê¤ÚÂÙ·È Û ̛· ÁÂÓÂÙÈο ηıÔÚÈṲ̂ÓË ‰È·‰Èηۛ· ‚ÈÔ¯ËÌÈÎÒÓ ÌÂÙ·‚ÔÏÒÓ, Ë ÔÔ›· Ô‰ËÁ› ÛÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ΢ÙÙ¿ÚÔ˘ (1,2). ∏ ·fiÙˆÛË Â›Ó·È Ì›· ‰È·‰Èηۛ· ΢ÙÙ·ÚÈ΋˜ “·˘ÙÔηٷÛÙÚÔÊ‹˜” ̤ۈ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Ì˯·ÓÈÛÌÒÓ, ÔÈ ÔÔ›ÔÈ Â›Ó·È Îˆ‰ÈÎÔÔÈË̤ÓÔÈ ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· fiÏˆÓ ÙˆÓ ÂÌ‡ÚËÓˆÓ Î˘ÙÙ¿ÚˆÓ. ∏ ‰È·‰Èηۛ· ·˘Ù‹, οو ·fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, Â›Ó·È ÚˆÙ·Ú¯È΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙË Ê˘ÛÈÔÏÔÁ›· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Î·È Û˘ÓÙÂÏ› ÛÙËÓ ·Ó·Ó¤ˆÛË Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Î˘ÙÙ¿ÚˆÓ. ŸÙ·Ó ·˘Ù‹ ÂÈ‚Ú·‰‡ÓÂÙ·È ‹ ÂÈÙ·¯‡ÓÂÙ·È, Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÛËÌ·ÓÙÈÎÔ‡ ·ÚÈıÌÔ‡ ÓÔÛËÌ¿ÙˆÓ (¶›Ó·Î·˜ 1) (3,4). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ıˆÚÂ›Ù·È fiÙÈ ·ÚÎÂÙ¤˜ ÌÔÚʤ˜ ηÚΛÓÔ˘ ‰ÂÓ ÚÔηÏÔ‡ÓÙ·È ÏfiÁˆ ‰È·Ù·Ú·¯ÒÓ Ù˘ ̛وÛ˘, ·ÏÏ¿ ÔÊ›ÏÔÓÙ·È Û Úfi‚ÏËÌ· ‹, Ì¿ÏÏÔÓ, Û ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·fiÙˆÛ˘. ∞ÓÙ›ıÂÙ·, ÙÔ AIDS Î·È ÔÚÈṲ̂Ó˜ Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈΤ˜ ÓfiÛÔÈ Â›Ó·È Èı·Ófi Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÈÙ¿¯˘ÓÛË Ù˘ ·fiÙˆÛ˘ (3). °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û‹ÌÂÚ·, Ï·Ì‚¿ÓÔ˘Ó ¯ÒÚ· ¤Ú¢Ó˜ Û ¢Ú›· ÎÏ›¶›Ó·Î·˜ 1. ¡fiÛÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯‹ Ù˘ ·fiÙˆÛ˘ ∞˘ÍË̤ÓË ·fiÙˆÛË ¡Â˘ÚÒÓ˜ ∫‡ÙÙ·Ú· Ì˘Ôηډ›Ô˘ ∫‡ÙÙ·Ú· ÊÏ‚ÔÎfiÌ‚Ô˘ ∫‡ÙÙ·Ú· Ô˘ÚÔÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ §ÂÌÊÔ·ÙÙ·Ú· ¡Â˘ÚÔÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù· ª˘ÔηډÈÔ¿ıÂÈ· ™‡Ó‰ÚÔÌÔ ·Ú·ÙÂٷ̤ÓÔ˘ QT À‰ÚÔÓ¤ÊÚˆÛË ªÂ›ˆÛË ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û ÛË„·ÈÌ›· Î·È AIDS ∂Ï·Ùو̤ÓË ·fiÙˆÛË ∂ÈıËÏȷο ·ÙÙ·Ú· ∫‡ÙÙ·Ú· Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ §ÂÌÊÔ·ÙÙ·Ú· ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ∫‡ÙÙ·Ú· ·ÈÌÔÔÈËÙÈÎÔ‡ ∫·ÚÎÈÓÔÁ¤ÓÂÛË ¡fiÛÔ˜ Crohn ∞˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· ∞‡ÍËÛË ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Û ÛË„·ÈÌ›· §¤Ìʈ̷, Ï¢¯·ÈÌ›·

Paediatriki 2004;67:2-10

̷η, Ì ÛÎÔfi ÙËÓ ·Ó·Î¿Ï˘„Ë ÌÂıfi‰ˆÓ ÈηÓÒÓ Ó· ÂÈÙ·¯‡ÓÔ˘Ó ‹ Ó· ÂÈ‚Ú·‰‡ÓÔ˘Ó ÙËÓ ·fiÙˆÛË ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÓÔÛÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ (5,6). πÛÙÔÚÈ΋ ·Ó·‰ÚÔÌ‹ ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’70, Ô Kerr, ÚÔηÏÒÓÙ·˜ ‚Ï¿‚˜ ÛÙÔ ‹·Ú ÂÈÚ·Ì·Ùfi˙ˆˆÓ (·ÔÏÈÓÒÓÔÓÙ·˜ ÎÏ¿‰Ô˘˜ Ù˘ ˘Ï·›·˜ ÊϤ‚·˜ ‹ ¯ÔÚËÁÒÓÙ·˜ ÙÔ͛Ә), ·Ú·Ù‹ÚËÛ Ì ÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ È‰È·›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο Û ÌÂÌÔӈ̤ӷ Ë·ÙÈο ·ÙÙ·Ú· Ô˘ ›¯·Ó ˘ÔÛÙ› Ó¤ÎÚˆÛË, ÙËÓ ÔÔ›· ÔÓfiÌ·Û “Û˘ÚÚÈÎÓˆÙÈ΋ Ó¤ÎÚˆÛË” (shrinkage necrosis) (7). ¶·ÚfiÌÔÈ· ¯·Ú·ÎÙËÚÈÛÙÈο Û ÌÂÌÔӈ̤ӷ ·ÙÙ·Ú· ÂÈÓÂÊÚȉ›ˆÓ ·Ú·ÙËÚ‹ıËÎ·Ó Û ÂÈÚ·Ì·Ùfi˙ˆ· Ô˘ ›¯·Ó ˘Ô‚ÏËı› Û ˘ÔÊ˘ÛÈÂÎÙÔÌ‹ Î·È Û ÂÈÚ·Ì·Ùfi˙ˆ·, ÛÙ· ÔÔ›· ›¯·Ó ¯ÔÚËÁËı› ηÚÎÈÓÔÁfiÓ˜ Ô˘Û›Â˜. ŒÙÛÈ, ÙÔ 1971, Ô Wyllie ıÂÒÚËÛ fiÙÈ ÙfiÛÔ ÔÈ Î·ÚÎÈÓÔÁfiÓ˜ Ô˘Û›Â˜ fiÛÔ Î·È Ë ·ÓÂ¿ÚÎÂÈ· Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÔÚÌÔÓÒÓ Ô‰ËÁÔ‡Ó ÙÔ Î‡ÙÙ·ÚÔ Û ̛· ‰È·‰Èηۛ· ηٷÛÙÚÔÊ‹˜, ηٿ ÙËÓ ÔÔ›· ˘Ê›ÛÙ·Ù·È È‰È·›ÙÂÚ˜ ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ (8). ∆Ô 1972, ÔÈ Kerr Î·È Û˘Ó, ÂÚÈÁÚ¿ÊÔÓÙ·˜ ÙȘ ‰È·‰Ô¯ÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ô˘ ˘Ê›ÛÙ·ÓÙ·È Ù· ·ÙÙ·Ú· ˘ÁÈÒÓ ÈÛÙÒÓ Î·Ù¿ ÙË ‰È·‰Èηۛ· ·˘Ù‹, ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔÓ fiÚÔ “·fiÙˆÛË” (9). ™Ù· ̤۷ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80, o Ellis ÂÚȤÁÚ·„ ٷ ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ ·Ú·Ù‹ÚËÛ Û ÓÂÎÚ¿ ·ÙÙ·Ú· ÙÔ˘ ÓËÌ·Ù¤ÏÌÈÓı· Caenorhabditis elegans Î·È Ù·˘ÙÔÔ›ËÛ ÙÔ˘˜ ˘‡ı˘ÓÔ˘˜ ÁÈ· ÙËÓ Î˘ÙÙ·ÚÈ΋ ηٷÛÙÚÔÊ‹ ÁfiÓÔ˘˜ (ced ÁfiÓÔÈ) (10). ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÌfiÏÔÁÔÈ ÙˆÓ ÁfiÓˆÓ ·˘ÙÒÓ ¤¯Ô˘Ó ‚ÚÂı› Û ·ÙÙ·Ú· ıËÏ·ÛÙÈÎÒÓ. ∫·Ù¿ ÙË ‰ÂηÂÙ›· ÙÔ˘ ’90 ‰È¢ÎÚÈÓ›ÛÙËÎ·Ó ÂÚÈÛÛfiÙÂÚÔ ÙfiÛÔ Ë ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ·fiÙˆÛ˘ fiÛÔ Î·È ÔÈ ÌÔÚÈ·ÎÔ› Ì˯·ÓÈÛÌÔ› ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÂϤÁ¯ÂÙ·È. ∞fiÙˆÛË Î·È Ó¤ÎÚˆÛË ∫˘ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ Â¤Ú¯ÂÙ·È Ì ‰‡Ô ÙÚfiÔ˘˜: ·) Ì ‚Ï¿‚Ë (‰È¿Û·ÛË) Ù˘ ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È ÙÂÏÈο Ó¤ÎÚˆÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ‹ ‚) ÌÂ Û˘ÚÚ›ÎÓˆÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Ô˘ Ô‰ËÁ› Û ·fiÙˆÛË (¶›Ó·Î·˜ 2). ∏ ·fiÙˆÛË Â›Ó·È ÁÂÓÂÙÈο ηıÔÚÈṲ̂ÓË Î·È ·˘ÛÙËÚ¿ ÂÏÂÁ¯fiÌÂÓË ‰È·‰Èηۛ· Ô˘ ··ÈÙ› ÂÓ¤ÚÁÂÈ· ˘fi ÌÔÚÊ‹ ∞∆ƒ ÁÈ· Ó· Ú·ÁÌ·ÙÔÔÈËı›. ∏ ÂͤÏÈÍË ·˘Ù‹ ‰ÂÓ Á›ÓÂÙ·È Ù˘¯·›·, ·ÏÏ¿ ·ÔÙÂÏ› ¤Ó· ›‰Ô˜ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ı·Ó¿ÙÔ˘ Ô˘, οو ·fi Ô̷Ϥ˜ Û˘Óı‹Î˜, ·Ú¯›˙ÂÈ ÌÂÙ¿ ÙËÓ ˆÚ›Ì·ÓÛË, ηٷϋÁÂÈ ÛÙË Á‹Ú·ÓÛË Î·È ÙÂÏÈο ÛÙËÓ “·˘ÙÔηٷÛÙÚÔÊ‹” ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∏ ·fiÙˆÛË ‰ÂÓ ÚÔηÏ› ÊÏÂÁÌÔÓ‹ Û ·Ú·Î›ÌÂÓ· ·ÙÙ·Ú·, Ô‡Ù ÂÓÂÚÁÔÔÈ› ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ “ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›‰Ú·Û˘” (11).

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¶·È‰È·ÙÚÈ΋ 2004;67:2-10

Paediatriki 2004;67:2-10

¶›Ó·Î·˜ 2. ¢È·ÊÔÚ¤˜ ÌÂٷ͇ ·fiÙˆÛ˘ Î·È Ó¤ÎÚˆÛ˘ ∞fiÙˆÛË

¡¤ÎÚˆÛË

™Â Ê˘ÛÈÔÏÔÁÈΤ˜ ‹ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ™˘Ì‚·›ÓÂÈ Û ÌÂÌÔӈ̤ӷ ·ÙÙ·Ú· °ÂÓÂÙÈο ÂÏÂÁ¯fiÌÂÓË ™˘ÚÚ›ÎÓˆÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ∫·Ù·Ó·ÏÒÓÂÙ·È ÂÓ¤ÚÁÂÈ· ¢ÂÓ ÚÔηÏÂ›Ù·È ÊÏÂÁÌÔÓ‹

¶¿ÓÙ· Û ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ™˘Ì‚·›ÓÂÈ Û ÔÌ¿‰· ΢ÙÙ¿ÚˆÓ ªË ÂÏÂÁ¯fiÌÂÓË ÁÂÓÂÙÈο ∂ÍÔ›‰ËÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ¢ÂÓ ··ÈÙÂ›Ù·È ÂÓ¤ÚÁÂÈ· ¶ÚÔηÏÂ›Ù·È ÊÏÂÁÌÔÓ‹

™Ù· ·ÙÙ·Ú· Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ·fiÙˆÛË ·Ú·ÙËÚÂ›Ù·È Ù˘Èο ıÚ˘ÌÌ·ÙÈÛÌfi˜ ÙÔ˘ DNA, Û˘Ì‡ÎÓˆÛË Ù˘ ¯ÚˆÌ·Ù›Ó˘, Û˘ÚÚ›ÎÓˆÛË Ù˘ ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ηÈ, ÙÂÏÈο, ·ÔÛ‡ÓıÂÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘, ÙÔ ÔÔ›Ô ·›ÚÓÂÈ ÙË ÌÔÚÊ‹ ΢ÛÙȉ›Ô˘ Ô˘ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË (12). ™ÙË Ó¤ÎÚˆÛË, Ô Î˘ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ Â¤Ú¯ÂÙ·È Ù˘¯·›·, ¯ˆÚ›˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ‰Ú¿Û˘ Â͈ÁÂÓÒÓ Û˘Ó‹ıˆ˜ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÌÈÎÚÔ‚›ˆÓ, ÙÔÍÈÓÒÓ, ıÂÚÌÈÎÒÓ ‹ Ì˯·ÓÈÎÒÓ Î·ÎÒÛÂˆÓ Î·È ‰ÂÓ ··ÈÙ› ÂÓ¤ÚÁÂÈ· ÁÈ· ÙËÓ Ú·ÁÌ·ÙÔÔ›ËÛ‹ ÙÔ˘. ∫·Ù¿ ÙË ‰È·‰Èηۛ· Ù˘ Ó¤ÎÚˆÛ˘ ·Ú·ÙËÚ›ٷÈ, ·Ú¯Èο, Ô›‰ËÌ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘, Ô˘ Ô‰ËÁ› Û ‰È¿Û·ÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ Î·È ¤ÍÔ‰Ô Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜, Ì ·ÔÙ¤ÏÂÛÌ· ÊÏÂÁÌÔÓ‹ ÙˆÓ Á‡Úˆ ÈÛÙÒÓ. ∂ÊfiÛÔÓ Ë ‰È·‰Èηۛ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi ΢ÙÙ¿ÚˆÓ, ÌÔÚ› Ó· ˘¿ÚÍÂÈ Â¤ÎÙ·ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ ‹ ·ÎfiÌ· Î·È ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ ηٷÚÚ¿ÎÙË Ù˘ “ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·ÓÙ›‰Ú·Û˘” ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ‰Ú¿ÛË, Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ηٷϋÍÂÈ Û ÔÏ˘ÔÚÁ·ÓÈ΋ ·ÓÂ¿ÚÎÂÈ· (1,13). øÛÙfiÛÔ, Ë ·ÓÙ·fiÎÚÈÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Û Â͈ÁÂÓ›˜ ÂÚÂıÈÛÌÔ‡˜ ÂÚȤ¯ÂÈ Ì›· ÔÏ˘ÏÔÎfiÙËÙ·, ÒÛÙÂ Ô ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ ‰È·‰ÈηÛÈÒÓ ·fiÙˆÛ˘ӤÎÚˆÛ˘ Ó· ÌËÓ Â›Ó·È ·fiÏ˘Ù· Û·Ê‹˜. ™˘¯Ó¿, ÙÔ Î‡ÙÙ·ÚÔ ˘Ê›ÛÙ·Ù·È ÔÈΛϘ ‰ÈÂÁ¤ÚÛÂȘ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi Ïԛ̈ÍË, ˘ÔÍ›·, ıÂÚÌÈÎfi ‹ Ì˯·ÓÈÎfi ÂÚÂıÈÛÌfi. ∞ÓÙȉڿ ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ ηÈ, ΢ڛˆ˜, ÙËÓ ¤ÓÙ·ÛË Ù˘ ‰È¤ÁÂÚÛ˘ Ì ÙÚfiÔ ÁÂÓÂÙÈο “ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ”, ÒÛÙ ӷ ÚÔÛٷ٢ٛ ÙÔ ›‰ÈÔ Î·È Ô ÔÚÁ·ÓÈÛÌfi˜ ÁÂÓÈÎfiÙÂÚ·. ŒÙÛÈ, ‹Ș ‹ ̤ÙÚÈ·˜ ‚·Ú‡ÙËÙ·˜ ‰ÈÂÁ¤ÚÛÂȘ ÙÚÔÔÔÈÔ‡Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Î·È ÙËÓ ÚÔÛ·ÚÌfi˙Ô˘Ó ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ·Ó¿ÁΘ. ™Ô‚·ÚfiÙÂÚ· ÂÚÂı›ÛÌ·Ù· ÌÔÚ› Ó· ÂÚÌËÓ¢ÙÔ‡Ó ·fi ÙÔ Î‡ÙÙ·ÚÔ ˆ˜ ·Û‡Ì‚·Ù· Ì ÙËÓ ÂÈ‚›ˆÛË ‹ ÙË ÛˆÛÙ‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ¿ ÙÔ˘ Î·È Ó· ÛËÌ·ÙÔ‰ÔÙ‹ÛÔ˘Ó ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ Ô˘ ı· Ô‰ËÁ‹ÛÂÈ ÛÙÔÓ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ. ∆¤ÏÔ˜, ÛÙȘ ϤÔÓ ÛÔ‚·Ú¤˜ ‰ÈÂÁ¤ÚÛÂȘ, ÙÔ Î‡ÙÙ·ÚÔ ‰ÂÓ ¤¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÔÔÈÔ˘‰‹ÔÙ Ì˯·ÓÈÛÌÔ‡ ÚÔÛÙ·Û›·˜ Î·È Î·Ù·Ï‹ÁÂÈ ÛÙÔÓ ı¿Ó·ÙÔ Ì ӤÎÚˆÛË (14).

4

¶·ıÔÊ˘ÛÈÔÏÔÁ›· °ÔÓȉȷÎfi˜ ¤ÏÂÁ¯Ô˜ Ÿˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ë ÏÂÈÙÔ˘ÚÁ›· Ù˘ ·fiÙˆÛ˘ Â›Ó·È ÁÂÓÂÙÈο ÂÏÂÁ¯fiÌÂÓË. ¶ÔÏϤ˜ ·fi ÙȘ ÚˆÙ½Ó˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·fiÙˆÛË ‰ÂÓ Â˘Ú›ÛÎÔÓÙ·È ÂÍ·Ú¯‹˜ ÛÙÔ Î‡ÙÙ·ÚÔ, ·ÏÏ¿ ·Ú¯›˙Ô˘Ó Ó· Û˘ÓÙ›ıÂÓÙ·È fiÙ·Ó ÂÓÂÚÁÔÔÈËıÔ‡Ó Û˘ÁÎÂÎÚÈ̤ÓÔÈ ÁfiÓÔÈ, ÔÈ ÁfiÓÔÈ Î˘ÙÙ·ÚÈÎÔ‡ ı·Ó¿ÙÔ˘ (cell death genes). ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ˘¿Ú¯Ô˘Ó ÁfiÓÔÈ Ô˘ ÂϤÁ¯Ô˘Ó ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ, ÔÈ Ôԛ˜, ·ÓÙ›ıÂÙ·, ‰ÚÔ˘Ó Î·Ù·ÛÙ·ÏÙÈο ÛÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ (11).

OÈ ÚˆÙ½Ó˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·fiÙˆÛË ¤¯Ô˘Ó ÌÂÏÂÙËı› ‰ÈÂÍÔ‰Èο ÛÙÔÓ ÓËÌ·Ù¤ÏÌÈÓı· C. elegans. ¢È·ÈÛÙÒıËΠfiÙÈ Ô Î˘ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ Ô˘ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙËÓ ÂͤÏÈÍË ·˘ÙÔ‡ ÙÔ˘ ·ÏÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Â›Ó·È ‰È·‰Èηۛ· ·˘ÛÙËÚ¿ ηıÔÚÈṲ̂ÓË ÁÂÓÂÙÈο. ŒÙÛÈ ¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› ·ÚÎÂÙÔ› “ced” ÁfiÓÔÈ (C. elegans death), ÔÌfiÏÔÁÔÈ ÙˆÓ ÔÔ›ˆÓ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Î·È Û ıËÏ·ÛÙÈο (10,11). OÈ ÁfiÓÔÈ ·˘ÙÔ› ÂϤÁ¯Ô˘Ó ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ, ÔÈ Ôԛ˜ ÔÓÔÌ¿˙ÔÓÙ·È Î·Û¿Û˜ Î·È Â›Ó·È ··Ú·›ÙËÙ˜ ÛÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ (15).

OÈ Î·Û¿Û˜ Â›Ó·È ÚˆÙ¿Û˜ Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ÛÙÔ Î‡ÙÙ·ÚÔ ˆ˜ ÚÔ¤Ó˙˘Ì·. ªÂ ÙËÓ ÂÓÂÚÁÔÔ›ËÛ‹ ÙÔ˘˜ ÚÔηÏÔ‡Ó ‰È¿Û·ÛË ÚˆÙÂ˚ÓÒÓ ··Ú·›ÙËÙˆÓ ÁÈ· ÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘. ∂›Û˘, ·‰Ú·ÓÔÔÈÔ‡Ó ¿ÏϘ ÚˆÙ½Ó˜ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ Î‡ÙÙ·ÚÔ ·fi ÙËÓ ·fiÙˆÛË (15,16).

OÈ Î·Û¿Û˜ ηٷÛÙ¤ÏÏÔÓÙ·È ·fi ·Ó·ÛÙÔÏ›˜ Ù˘ ηÛ¿Û˘, fiˆ˜ ·˘ÙÔ› Ô˘ ·Ó‹ÎÔ˘Ó ÛÙËÓ ÔÌ¿‰· Ù˘ ·Ó·ÛÙ·ÏÙÈ΋˜ ÚˆÙ½Ó˘ Ù˘ ·fiÙˆÛ˘ (inhibitor of apoptosis protein - IAP). OÈ ·Ó·ÛÙÔÏ›˜ ·˘ÙÔ› ·‰Ú·ÓÔÔÈÔ‡Ó ÙȘ ÂÓÂÚÁÔÔÈË̤Ó˜ ηÛ¿Û˜. ∂ÊfiÛÔÓ Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓ Î·Û·ÛÒÓ Â›Ó·È ˘„ËÏ‹ Î·È ÔÈ IAPs ‰ÂÓ Â·ÚÎÔ‡Ó ÁÈ· ÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛ‹ ÙÔ˘˜, ÙfiÙ ÂÍÂÏ›ÛÛÂÙ·È Ë ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ (17). ª›· ¿ÏÏË ÔÌ¿‰· ÁfiÓˆÓ Â›Ó·È ÔÈ Bcl-2 (B cell lympoma-2) Ô˘ ÂϤÁ¯Ô˘Ó ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ fiˆ˜ ÔÈ Bcl-2 Î·È Bcl-xL Ô˘ ÂÌÔ‰›˙Ô˘Ó ÙËÓ ·fiÙˆÛË, ·ÏÏ¿ Î·È ÚˆÙÂ˚ÓÒÓ fiˆ˜ ÔÈ Bax, Bad, Bak Î·È Bcl-xs Ô˘ ¢ÓÔÔ‡Ó ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘ (18,19). Œ¯ÂÈ ‚ÚÂı› Û ÂÈÚ·Ì·Ùfi˙ˆ· fiÙÈ Ë

¶·È‰È·ÙÚÈ΋ 2004;67:2-10

·˘ÍË̤ÓË Û‡ÓıÂÛË Bcl-2 Î·È Bcl-xL ÚÔηÏ› ·Ú¿Ù·ÛË Ù˘ ˙ˆ‹˜ Û ·ÓÒÚÈÌ· ÏÂÌÊÔ·ÙÙ·Ú·, ÂÓÒ Ë Î·Ù·ÛÙÔÏ‹ ÙˆÓ ‰‡Ô ·˘ÙÒÓ ÚˆÙÂ˚ÓÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË Ù˘ ÂÈ‚›ˆÛ˘ ÒÚÈÌˆÓ Î·È ·ÓÒÚÈÌˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (20,21). ∆¤ÏÔ˜, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ÁfiÓÔ˜ Ô˘ ¢ԉÒÓÂÈ ÙËÓ ·fiÙˆÛË Â›Ó·È Ô p53. ∞ÓÂ¿ÚÎÂÈ· ‹ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ p53 ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ·ÚÎÂÙ¤˜ ÌÔÚʤ˜ ÓÂÔÏ·Û›·˜ (22). ªË¯·ÓÈÛÌfi˜ ·fiÙˆÛ˘ ∏ ¤Ó·ÚÍË Ù˘ ·fiÙˆÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi Û˘ÁÎÂÎÚÈ̤Ó˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ‹ ·ıÔÏÔÁÈΤ˜ ‰ÈÂÁ¤ÚÛÂȘ, ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó Û 4 ηÙËÁÔڛ˜ (23) (¶›Ó·Î·˜ 3). ™ÙËÓ ÚÒÙË ÔÌ¿‰· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ‰ÈÂÁ¤ÚÛÂȘ Ô˘ ÚÔηÏÔ‡Ó ‚Ï¿‚Ë ÛÙÔ DNA ÙÔ˘ ΢ÙÙ¿ÚÔ˘, fiˆ˜ ·ÎÙÈÓÔ‚ÔÏ›· Î·È ¯ËÌÂÈÔıÂÚ·¢ÙÈο Ê¿Ú̷η. ™ÙË ‰Â‡ÙÂÚË ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘ ‰ÈÂÁ›ÚÔÓÙ·˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ˘ԉԯ›˜ (˘ԉԯ›˜ “Ó¤ÎÚˆÛ˘” - death receptors). OÈ ˘ԉԯ›˜ ·˘ÙÔ› ÂÓÂÚÁÔÔÈÔ‡ÓÙ·È Â›Ù Ì ÙËÓ Â›‰Ú·ÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ, fiˆ˜ Ë TNF-·, ›Ù Ì ÙË ‰È·ÎÔ‹ Ù˘ ‰Ú¿Û˘ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ ÔÈ NGF (nerve growth factor) Î·È IL-3. ∏ ÙÚ›ÙË ÔÌ¿‰· ÂÚÈÏ·Ì‚¿ÓÂÈ Ô˘Û›Â˜ (ʈÛÊ·Ù¿Û˜, ·Ó·ÛÙÔÏ›˜ Ù˘ ÎÈÓ¿Û˘), Ë ‰Ú¿ÛË ÙˆÓ ÔÔ›ˆÓ ·˘Í¿ÓÂÈ ÙË Û‡ÓıÂÛË ÚˆÙÂ˚ÓÒÓ ··Ú·›ÙËÙˆÓ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ·fiÙˆÛ˘. ™ÙËÓ Ù¤Ù·ÚÙË Î·ÙËÁÔÚ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ‰È·Ù·Ú·¯¤˜ Û ÏÈ›‰È·, ÚˆÙ½Ó˜ ‹ ÓÔ˘ÎÏÂ˚ÓÈο Ôͤ· ÙÔ˘ ΢ÙÙ¿ÚÔ˘, fiˆ˜ ıÂÚÌÈΤ˜ ‹ Ì˯·ÓÈΤ˜ ηÎÒÛÂȘ Î·È ÂχıÂÚ˜ Ú›˙˜ Ô͢ÁfiÓÔ˘. ∂¿Ó Ë ¤ÓÙ·ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ Â›Ó·È ÌÂÁ¿ÏË, ÚÔηÏÂ›Ù·È Î˘ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ Ì ӤÎÚˆÛË (23). ∏ ¤Ó·ÚÍË Ù˘ ‰È·‰Èηۛ·˜ Ù˘ ·fiÙˆÛ˘ Ï·Ì‚¿ÓÂÈ ¯ÒÚ·, ηٿ ‚¿ÛË, ̤ۈ ‰‡Ô Ô‰ÒÓ (16) (∂ÈÎfiÓ· 1): ·) Ì ÂÓÂÚÁÔÔ›ËÛË Ù˘ ηÛ¿Û˘-8, Ô˘ ÛÙË Û˘Ó¤¯ÂÈ· ÂÓÂÚÁÔÔÈ› ÙËÓ Î·Û¿ÛË-3, ÒÛÙ ӷ Ô‰ËÁ‹ÛÂÈ ÙÂÏÈο Û ·fiÙˆÛË. ∏ ηÛ¿ÛË-8 ÂÓÂÚÁÔÔÈÂ›Ù·È ·fi ÙȘ ηÏÔ‡ÌÂÓ˜ ΢ÙÙ·ÚÔΛÓ˜ “Ó¤ÎÚˆÛ˘” TNF-· Î·È Fas ligand (FasL), ÔÈ Ôԛ˜ ÌÂÙ·‚È‚¿˙Ô˘Ó ÙË ‰Ú¿ÛË ÙÔ˘˜ Û˘Ó‰ÂfiÌÂÓ˜ Ì ÂȉÈÎÔ‡˜ ˘ԉԯ›˜, Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ Î˘ÙÙ·ÚÈ΋ ÌÂÌ‚Ú¿ÓË ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ Î˘ÙÙ¿ÚˆÓ. OÈ ˘ԉԯ›˜

Paediatriki 2004;67:2-10

·˘ÙÔ› Â›Ó·È ÔÈ p55 (TNF-RI) Î·È p75 (TNF-RII) ÁÈ· ÙËÓ TNF-· Î·È Ô Fas ÁÈ· ÙËÓ FasL. ‚) Ì ‰È¤ÁÂÚÛË ÙˆÓ ÌÈÙÔ¯ÔÓ‰Ú›ˆÓ, Ô˘ ·ÂÏ¢ıÂÚÒÓÔ˘Ó ÙÔ Î˘Ùfi¯ÚˆÌ· c, ÙÔ ÔÔ›Ô Û˘Ó‰¤ÂÈ ÙËÓ Î·Û¿ÛË-9 Ì ¤Ó·Ó ÂȉÈÎfi ·Ú¿ÁÔÓÙ· ÂÓÂÚÁÔÔ›ËÛ˘ (apoptotic protease activating factor-1 - APAF1). ∆Ô Û‡ÌÏÂÁÌ· ·˘Ùfi ÂÓÂÚÁÔÔÈ› ÙËÓ Î·Û¿ÛË3, Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·fiÙˆÛË. ∏ Ô‰fi˜ ·˘Ù‹ ÌÔÚ› Ó· ÂÓÂÚÁÔÔÈËı› ·fi ÔÈΛÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ·ÎÙÈÓÔ‚ÔÏ›·, ¯ËÌÂÈÔıÂÚ·¢ÙÈο, ÂχıÂÚ˜ Ú›˙˜ Ô͢ÁfiÓÔ˘. ªÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ OÈ ÌÔÚÊÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ Ô˘ ˘Ê›ÛÙ·Ù·È ÙÔ Î‡ÙÙ·ÚÔ Î·Ù¿ ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘, ÌÔÚÔ‡Ó Ó· ‰È·ÎÚÈıÔ‡Ó Û ÙÚÂȘ Ê¿ÛÂȘ (23,24): ∫·Ù¿ ÙËÓ ÚÒÙË Ê¿ÛË, ÙÔ Î‡ÙÙ·ÚÔ ·ÔÛ¿Ù·È ·fi Ù· ·Ú·Î›ÌÂÓ· ·ÙÙ·Ú· Ì ·ÒÏÂÈ· ÙˆÓ ÌÈÎÚÔÏ·¯ÓÒÓ Î·È ‰ÂÛÌÔۈ̿وÓ, ÂÓÒ Ë Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË ÙÔ˘ Û˘ÚÚÈÎÓÒÓÂÙ·È. ∏ ¯ÚˆÌ·Ù›ÓË ÙÔ˘ Û˘Ì˘ÎÓÒÓÂÙ·È Î·È ÙÔ DNA ‰È·Û¿Ù·È ·fi ÂȉÈΤ˜ ÂÓ‰ÔÓÔ˘ÎÏ¿Û˜ Û ÙÌ‹Ì·Ù· ¯ÚˆÌ·Ù›Ó˘. ∫·Ù¿ ÙË ‰Â‡ÙÂÚË Ê¿ÛË, ÙÔ Î‡ÙÙ·ÚÔ Û¯ËÌ·Ù›˙ÂÈ „¢‰Ôfi‰È· Ô˘ ÂÚȤ¯Ô˘Ó ÔÚÁ·Ó›ÏÏÈ· ‹ ÙÌ‹Ì·Ù· ¯ÚˆÌ·Ù›Ó˘. ∆· „¢‰Ôfi‰È· ·ÔÛÒÓÙ·È Î·È ‰È·ÌÔÚÊÒÓÔ˘Ó Î˘ÛÙÈÎÔ‡˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ Ô˘ ÂÚÈÎÏÂ›Ô˘Ó ÙË ¯ÚˆÌ·Ù›ÓË, ÂÓÒ ÙÔ ˘fiÏÔÈÔ Î‡ÙÙ·ÚÔ ÂÓ·Ô̤ÓÂÈ Ï›Ô, ÛÊ·ÈÚÈÎfi, ¯ˆÚ›˜ ˘Ú‹Ó· ÂÚÈ‚·ÏÏfiÌÂÓÔ ·fi ÙËÓ Î˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË (·ÔÙˆÙÈÎfi ۈ̿ÙÈÔ). ™ÙËÓ ÙÚ›ÙË Ê¿ÛË, ÙÔ ·ÔÙˆÙÈÎfi ۈ̿ÙÈÔ Î·È Ù· ΢ÛÙ›‰È· ¯ÚˆÌ·Ù›Ó˘ Ê·ÁÔ΢ÙÙ·ÚÒÓÔÓÙ·È Ù·¯‡Ù·Ù·, ¯ˆÚ›˜ Ó· Ú·ÁÔ‡Ó. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi, ·ÔʇÁÂÙ·È Ë ¤ÍÔ‰Ô˜ ΢ÙÙ·ÚÈÎÔ‡ ˘ÏÈÎÔ‡ Ô˘ ı· ÚÔηÏÔ‡Û ÊÏÂÁÌÔÓ‹ ÛÙÔ˘˜ Á‡Úˆ ÈÛÙÔ‡˜. ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ™Ë„·ÈÌ›· ∫·Ù¿ ÙË ÛË„·ÈÌ›·, Ô ÚfiÏÔ˜ Ù˘ ·fiÙˆÛ˘ Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ÙfiÛÔ ÁÈ· Ù· ·ÙÙ·Ú· ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ fiÛÔ Î·È ÁÈ· Ù· ·ÙÙ·Ú· ·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ÔÚÁ¿ÓˆÓ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÌÈÎÚÔ‚È·ÎÒÓ Î·È ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ ·Ú·ÙËÚÂ›Ù·È ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ·‡ÍËÛË Ù˘ ·fiÙˆÛ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (25,26). º·›ÓÂÙ·È, Ì¿ÏÈÛÙ·, fiÙÈ Ë ·fiÙˆÛË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ·

¶›Ó·Î·˜ 3. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂÓÂÚÁÔÔÈÔ‡Ó ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘ ¶·Ú¿ÁÔÓÙ·˜

ªË¯·ÓÈÛÌfi˜ ÂÓÂÚÁÔÔ›ËÛ˘

AÎÙÈÓÔ‚ÔÏ›·, ¯ËÌÂÈÔıÂÚ·›· ∫˘ÙÙ·ÚÔΛÓ˜ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ˘˜ ˘ԉԯ›˜ (TNF-·), ‰È·ÎÔ‹ ·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (TGF, IL-3) ºˆÛÊ·Ù¿Û˜, ·Ó·ÛÙÔÏ›˜ ÎÈÓ¿Û˘ £ÂÚÌÈΤ˜, Ì˯·ÓÈΤ˜ ηÎÒÛÂȘ

µÏ¿‚Ë ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ DNA ∂ÓÂÚÁÔÔ›ËÛË ˘Ô‰Ô¯¤ˆÓ (death receptors) ∞‡ÍËÛË Û‡ÓıÂÛ˘ ηÛ·ÛÒÓ OÏÈ΋ ‚Ï¿‚Ë ÙÔ˘ ΢ÙÙ¿ÚÔ˘

5

¶·È‰È·ÙÚÈ΋ 2004;67:2-10

ÀÔ‰Ô¯¤·˜ Fas/TNF

Paediatriki 2004;67:2-10

∞ÎÙÈÓÔ‚ÔÏ›· ÃËÌÂÈÔıÂÚ·›· ∂χıÂÚ˜ Ú›˙˜ O-

∫˘ÙÙ·ÚÔÏ·ÛÌ·ÙÈ΋ ÌÂÌ‚Ú¿ÓË

∫·Û¿ÛË-8 ªÈÙÔ¯fiÓ‰ÚÈÔ ∫·Û¿ÛË-3

∫·Û¿ÛË-9

APAF-1

∫˘Ùfi¯ÚˆÌ·-C

∞fiÙˆÛË EÈÎfiÓ· 1. ∫‡ÚȘ Ô‰Ô› ¤Ó·Ú͢ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·fiÙˆÛ˘ (APAF-1: ·Ú¿ÁˆÓ ÂÓÂÚÁÔÔ›ËÛ˘ Ù˘ ·ÔÙˆÙÈ΋˜ ÚˆÙ¿Û˘ - apoptotic protease activating factor-1).

ÛË„·ÈÌ›·˜ ·›˙ÂÈ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ ÛÙËÓ ÈÛÔÚÚÔ›· ÌÂٷ͇ ÚÔ- Î·È ·ÓÙÈ-ÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ. ∏ ÈÛÔÚÚÔ›· ·˘Ù‹ ÂÈÙ˘Á¯¿ÓÂÙ·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi Ì ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È, ηٿ Û˘Ó¤ÂÈ·, ÙË Ì›ˆÛË ÙˆÓ ·Ú·ÁfiÌÂÓˆÓ ·fi ·˘Ù¿ ΢ÙÙ·ÚÔÎÈÓÒÓ (27). ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, fï˜, Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÂËÚ¿˙ÂÈ ÙfiÛÔ ÙËÓ Î˘ÙÙ·ÚÈ΋ fiÛÔ Î·È ÙË ¯˘ÌÈ΋ ·ÓÔÛ›·, Ô‰ËÁÒÓÙ·˜ Û ·ÓÔÛÔηٷÛÙÔÏ‹, Ì ‰˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ. À¿Ú¯Ô˘Ó ÌÂϤÙ˜ Û ÛËÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÛÙȘ Ôԛ˜ Ë ÏÂÌÊÔÂÓ›· ÏfiÁˆ ·˘ÍË̤Ó˘ ·fiÙˆÛ˘ Û˘Û¯ÂÙ›ÛÙËΠ̠‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Î‚·ÛË (28,29). ∞ÓÙ›ıÂÙ· Ì ٷ ÏÂÌÊÔ·ÙÙ·Ú·, ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ· ·Ú·ÙËÚÂ›Ù·È Î·Ù·ÛÙÔÏ‹ Ù˘ ·fiÙˆÛ˘ ηÈ, ηٿ Û˘Ó¤ÂÈ·, ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙÔ˘˜ (30). OÈ ÙÔ͛Ә ÙˆÓ ‚·ÎÙËÚ›ˆÓ Î·È ÔÈ Î˘ÙÙ·ÚÔΛÓ˜ Ô˘ ·ÂÏ¢ıÂÚÒÓÔÓÙ·È Î·Ù¿ ÙË ÛË„·ÈÌ›·, ηٷÛÙ¤ÏÏÔ˘Ó ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ. Œ¯ÂÈ ‚ÚÂı›, Ì¿ÏÈÛÙ·, fiÙÈ ÌÂÁ¿ÏË Î·Ù·ÛÙÔÏ‹ Ù˘ ·fiÙˆÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Û¯ÂÙ›˙ÂÙ·È Ì ‚·Ú‡ÙÂÚË ÂÈÎfiÓ· ÛË„·ÈÌ›·˜ (30). ¶ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ΢ÙÙ·ÚÔΛÓ˜ fiˆ˜ ÔÈ IL-1, IL-6, G-CSF Î·È GM-CSF, ηıÒ˜ Î·È Ë ÎÔÚÙÈ˙fiÏË Â˘ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ ÁÈ· ÙËÓ ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ·fiÙˆÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙË ÛË„·ÈÌ›·, ÂÓÒ ·ÓÙ›ıÂÙ· ·ÓÙÈÊÏÂÁÌÔÓÒ‰ÂȘ ΢ÙÙ·ÚÔΛÓ˜ fiˆ˜ Ë IL-10 ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙËÓ ÂÈ‚Ú¿‰˘ÓÛË ·˘Ù‹ (31-34). ªÔÚ› Ó· ˘ÔÙÂı› fiÙÈ Ë Î·Ù·ÛÙÔÏ‹ Ù˘ ·fiÙˆÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙË ÛË„·ÈÌ›·

6

·ÔÛÎÔ› ÛÙËÓ ·Ú·ÙÂٷ̤ÓË ÂÓÂÚÁÔÔ›ËÛ‹ ÙÔ˘˜ Î·È ÛÙË Ì·ÎÚfiÙÂÚË ·Ú·ÌÔÓ‹ ÙÔ˘˜ ÛÙ· ÛËÌ›· Ù˘ ÊÏÂÁÌÔÓ‹˜. ∂ÎÙfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ê·›ÓÂÙ·È fiÙÈ Î·Ù¿ ÙË ÛË„·ÈÌ›· ·˘Í¿ÓÂÙ·È Ë ·fiÙˆÛË Î·È ÛÙ· ·ÚÂÁ¯˘Ì·ÙÈο fiÚÁ·Ó·. ŒÙÛÈ, ÌÂÙ¿ ·fi ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÂÓ‰ÔÙÔ͛Ӣ Û ÂÈÚ·Ì·Ùfi˙ˆ·, ·Ú·ÙËÚÂ›Ù·È ·fiÙˆÛË Û ·ÙÙ·Ú· ÙÔ˘ ‹·ÙÔ˜, ÙˆÓ Ó¢ÌfiÓˆÓ, ÙˆÓ ÓÂÊÚÒÓ Î·È ÙÔ˘ ÂÓÙ¤ÚÔ˘. ¢È·ÈÛÙÒıËÎÂ, Ì¿ÏÈÛÙ·, Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ TNF-· ÔÚÔ‡ Î·È ÙÔ˘ ‚·ıÌÔ‡ ·fiÙˆÛ˘ ÙˆÓ ·ÚÂÁ¯˘Ì·ÙÈÎÒÓ ÔÚÁ¿ÓˆÓ (35). ∞ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ∏ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·fiÙˆÛ˘ ÚÔηÏ› ·˘ÙÔ¿ÓÔÛ˜ ÓfiÛÔ˘˜, ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ· Î·È Î·ÎÔ‹ıÂȘ ÙÔ˘ ·›Ì·ÙÔ˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌ‚Ú˘˚΋˜ ÂͤÏÈ͢, Úfi‰ÚÔ̘ ÌÔÚʤ˜ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÌÂÙ·Ó·ÛÙÂ‡Ô˘Ó ·fi ÙÔÓ Ì˘ÂÏfi ÛÙÔÓ ı‡ÌÔ ·‰¤Ó·. ∆Ô 9095% ·˘ÙÒÓ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ‰ÂÓ ·Ú¿ÁÂÈ ˘ԉԯ›˜ ¤Ó·ÓÙÈ ÙˆÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (T-cell receptors - TCR) Î·È Î·Ù·ÛÙÚ¤ÊÂÙ·È Ì ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘ (36). Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Ë ·Ô˘Û›· TCR ¢ÓÔ› ÙËÓ ¤Ó·ÚÍË Ù˘ ‰È·‰Èηۛ·˜ Ù˘ ·fiÙˆÛ˘. ŒÙÛÈ, ·ÓÒÚÈÌ· µ-·ÙÙ·Ú· (Ô˘ ÛÙÂÚÔ‡ÓÙ·È TCR), Ù· ÔÔ›· ·Ú¿ÁÔ˘Ó ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· ·Ú¯Èο ÛÙÔ ÂÌ‚Ú˘˚Îfi ‹·Ú Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÛÙÔÓ Ì˘ÂÏfi, ηٷÛÙÚ¤ÊÔÓÙ·È Ì ·fiÙˆÛË. À¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Û ÂÈÚ·Ì·Ùfi˙ˆ· fiÙÈ ·˘ÙÔ¿ÓÔÛ· ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›ÙȘ, Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘, ÔÊ›ÏÔÓÙ·È Û ‰È·Ù·Ú·¯‹ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·fiÙˆÛ˘ (37). ∞ÈÌ·ÙÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈο Û‡Ó‰ÚÔÌ· Î·È ·Ï·ÛÙÈ΋ ·Ó·ÈÌ›·, ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ·˘ÍË̤ÓË ·fiÙˆÛË ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ (38). ∫ÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌ‚Ú˘˚΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ∫¡™, ·Ó·Ù‡ÛÛÂÙ·È ÏÂÔÓ¿˙ˆÓ ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ, Û ÔÏÏ¿ ·fi Ù· ÔÔ›· ‰ÂÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Ë Ê˘ÛÈÔÏÔÁÈ΋ ΢ÙÙ·ÚÈ΋ ÂͤÏÈÍË. ∏ ÂÍ¿ÏÂÈ„Ë ÙˆÓ ÏÂÔÓ·˙fiÓÙˆÓ ·˘ÙÒÓ Î˘ÙÙ¿ÚˆÓ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ. ∏ ¤Ó·ÚÍË Ù˘ ·fiÙˆÛ˘ Á›ÓÂÙ·È Ì ÂÓÂÚÁÔÔ›ËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ, fiˆ˜ Ë TNF-·, ‹ Ì ‰È·ÎÔ‹ ÔÚÈÛÌ¤ÓˆÓ ÙÚÔÊÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (nerve growth factor - NGF) (39). ∂›Û˘, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÌÂÙ¿ ·fi ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË, ÈÛ¯·ÈÌ›· ÙÔ˘ ∫¡™ ‹ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓË Û‡ÓıÂÛË ÁÏÔ˘Ù·ÌÈÓÈÎÔ‡ ÔͤԘ, Ô˘ Ô‰ËÁ› Û ‚Ï¿‚Ë ÙˆÓ Ó¢ÚÒÓˆÓ.

¶·È‰È·ÙÚÈ΋ 2004;67:2-10

∆Ô ÁÏÔ˘Ù·ÌÈÓÈÎfi Ô͇ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Â›Ù ‚Ï¿‚Ë ÙÔ˘ Ó¢ÚÒÓ· ÏfiÁˆ ÂÈÛÚÔ‹˜ ¡·+, Cl- Î·È ‡‰·ÙÔ˜ ÛÙÔ Î‡ÙÙ·ÚÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ô›‰ËÌ· Î·È Î˘ÙÙ·ÚÈ΋ Ó¤ÎÚˆÛË, ›Ù “ÂÈ‚Ú·‰˘ÓfiÌÂÓÔ ı¿Ó·ÙÔ ÙÔ˘ Ó¢ÚÒÓ·” (delayed neuronal death - DND). O DND, Ô ÔÔ›Ô˜ ·Ú¯›˙ÂÈ ÌÂÚÈΤ˜ ÒÚ˜ ÌÂÙ¿ ÙÔ Û˘Ì‚¿Ó Î·È ÔÊ›ÏÂÙ·È Û ÂÈÛÚÔ‹ Ca2+ ÛÙÔ Î‡ÙÙ·ÚÔ, ÚÔηÏ› ΢ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ Ì ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘ (40,41). ∆Ô ·Û‚¤ÛÙÈÔ ÂÓÂÚÁÔÔÈ› Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÁfiÓÔ˘˜ ·fiÙˆÛ˘, ÔÈ ÔÔ›ÔÈ ÚÔηÏÔ‡Ó ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ó¢ÚÔÌÂÙ·‚È‚·ÛÙÒÓ Î·È ‰ÈÂÁ›ÚÔ˘Ó ÙË Û‡ÓıÂÛË ÂÓ˙‡ÌˆÓ (ÚˆÙ¿Û˜, ʈÛÊ·Ù¿Û˜, ÂÓ‰ÔÓÔ˘ÎÏ¿Û˜) (41). º·›ÓÂÙ·È fiÙÈ fiÙ·Ó Ô ÂÎÏ˘ÙÈÎfi˜ ·Ú¿ÁˆÓ Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ‚Ï¿‚˘ Â›Ó·È ÛÔ‚·Úfi˜, Ô Î˘ÙÙ·ÚÈÎfi˜ ı¿Ó·ÙÔ˜ ÙˆÓ Ó¢ÚÒÓˆÓ Â¤Ú¯ÂÙ·È Ì ΢ÙÙ·ÚÈ΋ Ó¤ÎÚˆÛË, ÂÓÒ Û ÏÈÁfiÙÂÚÔ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ, Ë Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ Ó¢ÚÒÓˆÓ ÔÊ›ÏÂÙ·È Û ·fiÙˆÛË. ∆¤ÏÔ˜, ¤¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ ‰È·Ù·Ú·¯‹ ÛÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ ÏfiÁˆ ÌÂÙ¿ÏÏ·Í˘ ÁfiÓˆÓ ·fiÙˆÛ˘, Û˘ÓÙÂÏ› ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÚˆÙÔ·ıÒÓ fiÁÎˆÓ ÙÔ˘ ∫¡™. ŒÙÛÈ, Û ·ÛıÂÓ›˜ Ì ·ÛÙÚÔ·Ùو̷, ¤¯ÂÈ ·Ú·ÙËÚËı› ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ ÁfiÓÔ˘ p53 (42). ∫·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· º˘ÛÈÔÏÔÁÈο, ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ·fiÙˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÎÔÏÔÎÔÈÏÈ·ÎÔ‡ ÎfiÌ‚Ô˘. ∂È‚Ú¿‰˘ÓÛË ‹ ·ÓÂ¿ÚÎÂÈ· ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·fiÙˆÛ˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÂÈΛӉ˘Ó˜ ÁÈ· ÙË ˙ˆ‹ ·ÚÚ˘ı̛˜, ÂÓÒ ·ÓÙ›ıÂÙ·, Ë ·˘ÍË̤ÓË ·fiÙˆÛË Â›Ó·È ‰˘Ó·Ùfi Ó· Ô‰ËÁ‹ÛÂÈ Û ‚Ú·‰˘·ÚÚ˘ı̛˜ ‹ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ (43). ∂›Û˘, Û ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ ·Ú·ÙÂٷ̤ÓÔ˘ QT, ¤¯ÂÈ ·Ú·ÙËÚËı› ·‡ÍËÛË Ù˘ ·fiÙˆÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÊÏ‚ÔÎfiÌ‚Ô˘ (43).

OÈ Â·ÓÂÈÏËÌ̤Ó˜ ÂÓ‰ÔÊϤ‚Ș ÂÁ¯‡ÛÂȘ TNF-· Û ÂÈÚ·Ì·Ùfi˙ˆ· ÚÔηÏÔ‡Ó ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ·˘Í¿ÓÔÓÙ·˜ ÙÔÓ Ú˘ıÌfi ·fiÙˆÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Ì˘Ôηډ›Ô˘. ¶·Ú¿ÏÏËÏ·, ÛÙȘ ηډȷΤ˜ Ì˘˚Τ˜ ›Ó˜ ·ÛıÂÓÒÓ Ì ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ¤¯Ô˘Ó ‚ÚÂı› ˘„ËÏ¿ Â›‰· ÙˆÓ ÁfiÓˆÓ ·fiÙˆÛ˘ Bcl-2, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë ·˘ÍË̤ÓË ·fiÙˆÛË Û˘ÓÙÂÏ› ÛÙËÓ ¤ÎÙˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ Î·Ú‰È·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (43).

OÚÈṲ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜, ÔÈ ÔÔ›ÔÈ ‰ÚÔ˘Ó ÙÔÍÈο ÛÙÔ Ì˘ÔοډÈÔ, ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ Ì ӤÎÚˆÛË, ·ÏÏ¿ Î·È Ì ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘. ªÂ ·˘Ùfi ÙÔÓ ÙÚfiÔ, ¯ËÌÂÈÔıÂÚ·¢ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ˘ÔÍ›· ‹ ÈÛ¯·ÈÌ›· Û ÌÂÁ¿ÏË ¤ÓÙ·ÛË ÚÔηÏÔ‡Ó ·¢ı›·˜ ΢ÙÙ·ÚÈ΋ Ó¤ÎÚˆÛË, ÂÓÒ ÔÈ ›‰ÈÔÈ ·Ú¿ÁÔÓÙ˜ Û ÌÈÎÚfiÙÂÚË ¤ÓÙ·ÛË ÂÓÂÚÁÔÔÈÔ‡Ó ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ (43).

Paediatriki 2004;67:2-10

Œ¯ÂÈ ·Ú·ÙËÚËı› Û ·ÛıÂÓ›˜ Ì ÈÛ¯·ÈÌ›· ÙÔ˘ Ì˘Ôηډ›Ô˘ fiÙÈ ÙȘ ÚÒÙ˜ ÒÚ˜ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· ·fiÙˆÛË, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· Î·È fiÛÔ Ë ÈÛ¯·ÈÌ›· Û˘Ó¯›˙ÂÙ·È, ·‡Ô˘Ó Ó· ÂÎÊÚ¿˙ÔÓÙ·È ÁfiÓÔÈ ·fiÙˆÛ˘ ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ηډȷÎÔ‡ Ì˘fi˜ Î·È ·ÎÔÏÔ˘ı› ΢ÙÙ·ÚÈ΋ Ó¤ÎÚˆÛË. ∆¤ÏÔ˜, ηٿ ÙËÓ Â·Ó·ÈÌ¿ÙˆÛË ÙÔ˘ Ì˘Ôηډ›Ô˘, ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘ Î·È ·ÂÏ¢ı¤ÚˆÛË ÂχıÂÚˆÓ ÚÈ˙ÒÓ O2, Ù· ÔÔ›· ÚÔ¿ÁÔ˘Ó ÙËÓ ·fiÙˆÛË, ÚÔηÏÒÓÙ·˜ ηٷÛÙÚÔÊ‹ ÙˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ ÙÔ˘ Ì˘Ôηډ›Ô˘ (44). °·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· OÚÈṲ̂Ó˜ ·ı‹ÛÂȘ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ·fiÙˆÛ˘. °·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi Shigella dysenteriae ÚÔηÏ› ÂÎÙÂٷ̤ÓË ·fiÙˆÛË ÙˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘. º·›ÓÂÙ·È, Â›Û˘, fiÙÈ Ë ÓfiÛÔ˜ Crohn Î·È ÔÚÈṲ̂Ó˜ ÌÔÚʤ˜ ÓÂÔÏ·Û›·˜ ÙÔ˘ ÂÙÈÎÔ‡ Û¯ÂÙ›˙ÔÓÙ·È Ì ηٷÛÙÔÏ‹ Ù˘ ·fiÙˆÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ (23). ™Â ÂÚÈÙÒÛÂȘ ¯ÚfiÓÈ·˜ Ë·Ù›Ùȉ·˜, ÚÔηÏÂ›Ù·È ‚·ıÌÈ·›· ηٷÛÙÚÔÊ‹ ÙˆÓ Ë·ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ì ·fiÙˆÛË. ∆¤ÏÔ˜, ÛÙËÓ ÎÂÚ·˘ÓÔ‚fiÏÔ Ë·Ù›Ùȉ·, ·ÓÒÌ·ÏË ‰È¤ÁÂÚÛË ÙˆÓ Î˘ÙÙ·ÚÔÙÔÍÈÎÒÓ ∆-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÂÓÂÚÁÔÔÈ› Ù·¯¤ˆ˜ ÙÔÓ Ì˯·ÓÈÛÌfi Ù˘ ·fiÙˆÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ‹·ÙÔ˜, Ô‰ËÁÒÓÙ·˜ Û ΢ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ (38).

O˘ÚÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ∞˘ÍË̤ÓË ·fiÙˆÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÛÂÈÚ¿Ì·ÙÔ˜ Ô‰ËÁ› Û ·ÙÚÔÊ›· ÙÔ˘ ÓÂÊÚÔ‡, ÂÓÒ ·‡ÍËÛË Ù˘ ·fiÙˆÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙˆÓ Ô˘ÚÔÊfiÚˆÓ ÛˆÏËÓ·Ú›ˆÓ ¤¯ÂÈ ·Ú·ÙËÚËı› Û ÂÚÈÙÒÛÂȘ ˘‰ÚÔÓ¤ÊÚˆÛ˘ (38). ™ËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙȘ ·ı‹ÛÂȘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Ê·›ÓÂÙ·È fiÙÈ Î·Ù¤¯Ô˘Ó Ù· Â›‰· ÙˆÓ ·ÓÙÈ·ÔÙˆÙÈÎÒÓ ÁfiÓˆÓ Bcl-2. ¶ÔÓÙ›ÎÈ· Ì ·ÓÂ¿ÚÎÂÈ· Bcl-2 ηÈ, ηٿ Û˘Ó¤ÂÈ·, ·˘ÍË̤ÓË ·fiÙˆÛË ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÏ˘Î˘ÛÙÈÎÔ‡˜ ÓÂÊÚÔ‡˜, ÂÓÒ ·ÓÙ›ıÂÙ· ·ÛıÂÓ›˜ Ì ÓÂÔϷۛ˜ ÓÂÊÚÒÓ ÂÌÊ·Ó›˙Ô˘Ó ÌÂȈ̤ÓË ·fiÙˆÛË, ÏfiÁˆ ·˘ÍË̤Ó˘ ¤ÎÊÚ·Û˘ Bcl-2 ÁfiÓˆÓ (45). ∫·ÚΛÓÔ˜ O ηÚΛÓÔ˜ Â›Ó·È Ë ÓfiÛÔ˜ ηٿ ÙËÓ ÔÔ›· Ë Â¤ÎÙ·ÛË ÂÓfi˜ ÎÏÒÓÔ˘ ۈ̷ÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·Ù·ÛÙÚ¤ÊÂÈ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ ÈÛÙÔ‡˜. ™ÙÔ˘˜ ÔÏ˘Î˘ÙÙ¿ÚÈÔ˘˜ ÔÚÁ·ÓÈÛÌÔ‡˜ Ï·Ì‚¿ÓÂÈ Û˘Ó¯Ҙ ¯ÒÚ· ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙËÓ ·Ó·Ó¤ˆÛË ÙˆÓ ·Ï·ÈfiÙÂÚˆÓ Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÂÓÒ ·Ú¿ÏÏËÏ· ÏÂÈÙÔ˘ÚÁ› Ì˯·ÓÈÛÌfi˜ Ô˘ ηٷÛÙ¤ÏÏÂÈ ÙË Á¤ÓÂÛË ÌÂÙ·ÏÏ·ÁÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ. ∂¿Ó Ô Ì˯·ÓÈÛÌfi˜ ·˘Ùfi˜ Â›Ó·È ·ÓÂ·Ú΋˜, Ë ·Ó¿Ù˘ÍË Î·ÚΛÓÔ˘ ıˆÚÂ›Ù·È ·Ó·fiÊ¢ÎÙË (46).

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º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë Î·Ù·ÛÙÔÏ‹ ÌÂÙ·ÏÏ·Á̤ӈÓ-ηÚÎÈӈ̷و‰ÒÓ Î˘ÙÙ¿ÚˆÓ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘ Î·È fiÙÈ Â¿Ó Ô Ì˯·ÓÈÛÌfi˜ ·˘Ùfi˜ ‰È·Ù·Ú·¯ı›, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î·È ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Î·ÚÎÈÓÈο ·ÙÙ·Ú·. OÚÈṲ̂ÓÔÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ‰Ú¿ÛÔ˘Ó ‚Ï·ÙÈο ÛÙÔ Î˘ÙÙ·ÚÈÎfi DNA, fiˆ˜ Ë ˘ÔÍ›·, Ë ÈÛ¯·ÈÌ›· ‹ ηٷÛÙ¿ÛÂȘ stress, ‰ÈÂÁ›ÚÔ˘Ó Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÁfiÓÔ˘˜, ÔÈ ÔÔ›ÔÈ Ì¤Ûˆ ÚˆÙÂ˚ÓÒÓ Ô˘ Û˘ÓÙ›ıÂÓÙ·È, ÛËÌ·ÙÔ‰ÔÙÔ‡Ó ÙËÓ ¤Ó·ÚÍË Ù˘ ·fiÙˆÛ˘. ¶ÚˆÙ½Ó˜ fiˆ˜ Ë Myc Î·È Î˘Ú›ˆ˜ Ë p53, ·ÔÙÂÏÔ‡Ó ÈÛ¯˘ÚÔ‡˜ ‰ÈÂÁ¤ÚÙ˜ Ù˘ ·fiÙˆÛ˘ (22). ∆Ô Î‡ÙÙ·ÚÔ ‰È·ı¤ÙÂÈ ÂÈϤÔÓ Ì˯·ÓÈÛÌfi ·ÔηٿÛÙ·Û˘ ‚Ï¿‚˘ ÙÔ˘ DNA. ŸÙ·Ó Ô Ì˯·ÓÈÛÌfi˜ ·˘Ùfi˜ Â›Ó·È ÂÏÏÈ‹˜, ·ÏÏ¿ ÙÔ Î‡ÙÙ·ÚÔ Â›Ó·È ıÂÙÈÎfi Û p53, ˘¿Ú¯ÂÈ ÌÈÎÚ‹ Èı·ÓfiÙËÙ· ηÚÎÈÓÔÁ¤ÓÂÛ˘, ÂÓÒ ·ÓÙ›ıÂÙ·, fiÙ·Ó ˘¿Ú¯ÂÈ ·ÓÂ¿ÚÎÂÈ· p53 Ô Î›Ó‰˘ÓÔ˜ ηÚΛÓÔ˘ Â›Ó·È ˘„ËÏfi˜ (22). ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÚˆÙ½Ó˜ fiˆ˜ ·˘Ù¤˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Bcl-2 Î·È Bcl-xL (Ô˘ ÂϤÁ¯ÔÓÙ·È ·fi ÙÔ˘˜ ÔÌfiÏÔÁÔ˘˜ ÁfiÓÔ˘˜) ·ÛÎÔ‡Ó ·ÓÙÈ-·ÔÙˆÙÈ΋ ‰Ú¿ÛË, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·Ù‹ÚËÛË ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. Œ¯ÂÈ ·Ú·ÙËÚËı› fiÙÈ Û ·ÚÎÂÙ¤˜ ηÎÔ‹ıÂȘ, fiˆ˜ Ï¢¯·ÈÌ›·, ϤÌʈ̷, ·‰ÂÓÔηÚΛӈ̷, Ó¢ÚÔ‚Ï¿Ûو̷ Î·È ÌÂϿӈ̷, Ù· Â›‰· ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚˆÙÂ˚ÓÒÓ Â›Ó·È ˘„ËÏ¿ (47). £ÂÚ·¢ÙÈΤ˜ ÚÔÔÙÈΤ˜ ∂Âȉ‹, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, Ë ·fiÙˆÛË ·ÚÂÌ‚·›ÓÂÈ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÂÓfi˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÓÔÛËÌ¿ÙˆÓ, Ë ÙÚÔÔÔ›ËÛË ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ‰ËÌÈÔ˘ÚÁ› Ӥ˜ ÚÔÔÙÈΤ˜ ÛÙË ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ·ÓÙÈÌÂÙÒÈÛË. ŒÙÛÈ, Û ÓfiÛÔ˘˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ·˘ÍË̤ÓÔ Î˘ÙÙ·ÚÈÎfi ı¿Ó·ÙÔ, fiˆ˜ Ù· Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù·, Ë ÂÈ‚Ú¿‰˘ÓÛË Ù˘ ·fiÙˆÛ˘ ı· ÂȉÚÔ‡Û ıÂÙÈο. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÔÈ ÓfiÛÔÈ Ô˘ ÔÊ›ÏÔÓÙ·È Û ÌÂȈ̤ÓË ·fiÙˆÛË, fiˆ˜ Ô Î·ÚΛÓÔ˜, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ì ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ·fiÙˆÛ˘ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ. ™‹ÌÂÚ·, Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÚÔÎÏÈÓÈÎÒÓ, ·ÏÏ¿ Î·È ÎÏÈÓÈÎÒÓ ÂÚ¢ÓÒÓ Ô˘ ÛÙÔ¯Â‡Ô˘Ó ÛÙËÓ Î·Ù·ÛÙÔÏ‹ ‹ ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÌÔÚ›ˆÓ, Ù· ÔÔ›· Û˘ÌÌÂÙ¤¯Ô˘Ó Û ‰È¿ÊÔÚ˜ Ê¿ÛÂȘ ÙÔ˘ Ì˯·ÓÈÛÌÔ‡ Ù˘ ·fiÙˆÛ˘. ŒÓ·Ó ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ıÂÚ·›·˜ ·ÔÙÂÏÔ‡Ó ÔÈ ÂȉÈÎÔ› ΢ÙÙ·ÚÈÎÔ› ˘ԉԯ›˜ Ô˘ ‰¤¯ÔÓÙ·È ÙÔ Û‹Ì· ¤Ó·Ú͢ Ù˘ ·fiÙˆÛ˘ (Fas, p55, p75). ¢È·Ï˘ÙÔ› ˘ԉԯ›˜ Fas ›¯·Ó ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Û ÂÚÈÙÒÛÂȘ ηÚΛÓÔ˘, fiÔ˘ ··ÈÙÂ›Ù·È ÂÈÙ¿¯˘ÓÛË Ù˘ ·fiÙˆÛ˘, ÂÓÒ ·ÓÙ›ıÂÙ·, Û Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù· ‰ÔÎÈÌ¿ÛÙËÎ·Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ Fas, ÛÙԯ‡ÔÓÙ·˜ ÛÙË Ì›ˆÛË Ù˘ ·fiÙˆÛ˘ (23).

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ŒÓ·˜ ¿ÏÏÔ˜ ıÂÚ·¢ÙÈÎfi˜ ÛÙfi¯Ô˜ Â›Ó·È Ë Î·Ù·ÛÙÔÏ‹ ÙˆÓ Î·Û·ÛÒÓ, ηıÒ˜ ˘¿Ú¯ÂÈ ÏËıÒÚ· ÓfiÛˆÓ, ÛÙȘ Ôԛ˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ¤¯ÂÈ ÂÊ·ÚÌÔÁ‹ Ë Î·Ù·ÛÙÔÏ‹ ÙˆÓ ÚˆÙÂ˚ÓÒÓ ·˘ÙÒÓ. OÈ ÙÂÙÚ·ÂÙȉÈΤ˜ ·Ï‰Â˛‰Â˜ ¤¯Ô˘Ó ÂÊ·ÚÌÔÛÙ› ÛÙËÓ Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘-1‚ (Interleukin-1b-converting enzyme, ηÛ¿ÛË-1, ICE). OÈ ·Ï‰Â˛‰Â˜ ·˘Ù¤˜ Û˘Ó‰¤ÔÓÙ·È Ì ÙȘ ηÛ¿Û˜, ÙȘ ·ÂÓÂÚÁÔÔÈÔ‡Ó Î·È ÂÌÔ‰›˙Ô˘Ó ÙË ‰È¿Û·ÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ-ÛÙfi¯ˆÓ. ∏ ηٷÛÙÔÏ‹ Ù˘ ICE ÂÈ‚Ú·‰‡ÓÂÈ ÙËÓ ·fiÙˆÛË Î·È ÌÔÚ› Ó· ¤¯ÂÈ ÂÊ·ÚÌÔÁ‹ Û ¯ÚfiÓȘ ÊÏÂÁÌÔÓÒ‰ÂȘ Î·È Ó¢ÚÔÂÎÊ˘ÏÈÛÙÈΤ˜ ÓfiÛÔ˘˜. ∞Ó·ÛÙÔϤ·˜ Ù˘ ICE ¤¯ÂÈ ¯ÔÚËÁËı› ÛÙË ıÂÚ·›· Ù˘ ÚÂ˘Ì·ÙÔÂȉԇ˜ ·ÚıÚ›Ùȉ·˜ (48). ∂›Û˘, ¤Ú¢Ó˜ Û ÂÈÚ·Ì·ÙÈο ÌÔÓ٤Ϸ ¤‰ÂÈÍ·Ó fiÙÈ Ë ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔϤˆÓ Ù˘ ηÛ¿Û˘ ÌÂÈÒÓÂÈ ÙË ‚Ï¿‚Ë Ô˘ ÚÔηÏÂ›Ù·È Û fiÚÁ·Ó· fiˆ˜ Ë Î·Ú‰È¿, ÙÔ ‹·Ú, ÔÈ ÓÂÊÚÔ› Î·È Ô ÂÁΤʷÏÔ˜ ÌÂÙ¿ ·fi ÈÛ¯·ÈÌ›·-Â·Ó·ÈÌ¿ÙˆÛË. ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ ›¯Â ÂÊ·ÚÌÔÁ‹ Û ¿ÏϘ ÂÚÁ·Û›Â˜, ÛÙȘ Ôԛ˜ Ë Ì›ˆÛË Ù˘ ·fiÙˆÛ˘, Ô˘ ÂÈÙ‡¯ıËΠ۠ÂÈÚ·Ì·Ùfi˙ˆ·, ‡ÛÙÂÚ· ·fi ¯ÔÚ‹ÁËÛË ·Ó·ÛÙÔϤˆÓ ηÛ¿Û˘, ›¯Â ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· Û ÌÂÙ·ÌÔۯ‡ÛÂȘ ÔÚÁ¿ÓˆÓ, ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈΤ˜ ηÎÒÛÂȘ Î·È status epilepticus (5). ∆¤ÏÔ˜, ·Ó·ÛÙÔÏ›˜ ηÛ¿Û˘ ‰ÔÎÈÌ¿ÛÙËÎ·Ó Û ÏÔÈÌÒ‰ÂȘ ÓfiÛÔ˘˜ ηÈ, Û˘ÁÎÂÎÚÈ̤ӷ, Û ‚·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· Î·È ÛË„·ÈÌ›· (5). π‰È·›ÙÂÚ· ÂÏȉÔÊfiÚ˜ Â›Ó·È ÔÈ ÚÔÔÙÈΤ˜ ÛÙË ıÂÚ·›· ÙÔ˘ ηÚΛÓÔ˘. ◊‰Ë, Ô Kerr ›¯Â ·Ú·ÙËÚ‹ÛÂÈ fiÙÈ ÔÏÏ¿ ¯ËÌÂÈÔıÂÚ·¢ÙÈο (·Óıڷ΢ÎϛӘ, ·Ï΢ÏȈÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Î.Ï.) ·˘Í¿ÓÔ˘Ó ÙËÓ ·fiÙˆÛË ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ. ¶Ú¿ÁÌ·ÙÈ, ÙfiÛÔ Ë ¯ËÌÂÈÔıÂÚ·›· fiÛÔ Î·È Ë ·ÎÙÈÓÔ‚ÔÏ›· ÚÔηÏÔ‡Ó ‚Ï¿‚Ë ÛÙÔ Î˘ÙÙ·ÚÈÎfi DNA, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ ¤ÎÊÚ·Û˘ ÙÔ˘ p53 Î·È ÙËÓ ÂÈÙ¿¯˘ÓÛË Ù˘ ·fiÙˆÛ˘. ™Â ·ÛıÂÓ›˜, fï˜, Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ÓÂ¿ÚÎÂÈ· p53 ¤¯ÂÈ ·Ú·ÙËÚËı› ·ÓÙÔ¯‹ ÛÙË ¯ËÌÂÈÔıÂÚ·›·. ¶ÂÈÚ·Ì·ÙÈο, ¤¯ÂÈ Á›ÓÂÈ ÚÔÛ¿ıÂÈ·, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÚÂÙÚÔ˚fi, Ó· ÙÂı› ÁfiÓÔ˜ p53 Û ·ÙÙ·Ú· ·‰ÂÓÔηÚÎÈÓÒÌ·ÙÔ˜ Ó‡ÌÔÓ· (49). ªÂÁ¿ÏÔ ÂӉȷʤÚÔÓ, fï˜, ÁÈ· ÙË ıÂÚ·›· ÙÔ˘ ηÚΛÓÔ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ Ô Bcl-2 ÁfiÓÔ˜. Ÿˆ˜ ¤¯ÂÈ ·Ó·ÊÂÚı›, Ë ·ÓÙÈ-·ÔÙˆÙÈ΋ ÚˆÙ½ÓË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Bcl-2 ÚÔÛٷهÂÈ Ù· ·ÙÙ·Ú· ·fi ÙËÓ ·fiÙˆÛË. ∏ ·‡ÍËÛË ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚˆÙÂ˚ÓÒÓ, Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ηÚÎÈÓÈο ·ÙÙ·Ú·, Ù· ηıÈÛÙ¿ ·ÓıÂÎÙÈο ÛÙË ıÂÚ·›·. ¶ÚfiÛÊ·Ù·, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Û¯ÂÙÈΤ˜ Ì ·ÚÂÌ‚¿ÛÂȘ ÛÙÔÓ Bcl-2 ÁfiÓÔ, Ô ÔÔ›Ô˜ Â›Ó·È ˘‡ı˘ÓÔ˜ ÁÈ· ÙË Û‡ÓıÂÛË Ù˘ Bcl-2 ÚˆÙ½Ó˘. ∏ ·Ú¤Ì‚·ÛË Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ÌÈÎÚÔ‡

¶·È‰È·ÙÚÈ΋ 2004;67:2-10

ÙÌ‹Ì·ÙÔ˜ ÌÔÓfiÎψÓÔ˘ DNA (antisense oligonucleotides - ASO), Ë ÛÂÈÚ¿ ÙˆÓ ÓÔ˘ÎÏÂÔÙȉ›ˆÓ ÙÔ˘ ÔÔ›Ô˘ ¤¯ÂÈ Û¯Â‰È·ÛÙ› Ó· Â›Ó·È Û˘ÌÏËڈ̷ÙÈ΋ ·˘Ù‹˜ ÙÔ˘ mRNA, ÒÛÙ ӷ ÌËÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ÌÂÙ¿ÊÚ·ÛË Ù˘ ˘‡ı˘Ó˘ ÚˆÙ½Ó˘, ÛÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË Ù˘ Bcl-2 (5). ¢Â‰Ô̤ÓÔ˘, ÏÔÈfiÓ, fiÙÈ Ë Ù‡¯Ë ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÈÛÔÚÚÔ›· ÌÂٷ͇ ·ÔÙˆÙÈÎÒÓ Î·È ·ÓÙÈ-·ÔÙˆÙÈÎÒÓ ÌÔÚ›ˆÓ, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ Ë Ì›ˆÛË Ù˘ ·ÓÙÈ-·ÔÙˆÙÈ΋˜ Bcl-2 ÚˆÙ½Ó˘ ı· ¢ÓÔ‹ÛÂÈ ÙË ‰È·‰Èηۛ· Ù˘ ·fiÙˆÛ˘. ŒÙÛÈ, ÙÔ Î‡ÙÙ·ÚÔ Î·ı›ÛÙ·Ù·È ÂÚÈÛÛfiÙÂÚÔ Â˘·›ÛıËÙÔ ÛÙËÓ Î˘ÙÙ·ÚÔÙÔÍÈ΋ ‰Ú¿ÛË Ù˘ ¯ËÌÂÈÔıÂÚ·›·˜ Î·È Ù˘ ·ÎÙÈÓÔ‚ÔÏ›·˜. ¶Ú¿ÁÌ·ÙÈ, ·fi 14 ·ÛıÂÓ›˜ Ì ηÎfiËı˜ ÌÂϿӈ̷ Ô˘ ¤Ï·‚·Ó ıÂÚ·›· Ì ASO, ÔÈ 6 (43%) ·ÓÙ·ÔÎÚ›ıËηÓ. ∂›Û˘, Ì ÙËÓ ›‰È· ·ÁˆÁ‹, 9 ·fi 21 ·ÛıÂÓ›˜ (43%) Ì ˘ÔÙÚÔ‹ non-Hodgkin ÏÂÌÊÒÌ·ÙÔ˜ ÛÙ·ıÂÚÔÔÈ‹ıËÎ·Ó Î·È ÔÛÔÛÙfi 14% ·fi ·˘ÙÔ‡˜ ·ÚÔ˘Û›·Û ‚ÂÏÙ›ˆÛË. ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ıÂÚ·›·˜ ¤¯ÂÈ ÂÂÎÙ·ı› Î·È Û ¿ÏϘ ηÎÔ‹ıÂȘ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓË ¤ÎÊÚ·ÛË Bcl-2 (5,6). ™‹ÌÂÚ·, Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ¤Ú¢Ó˜ Û ÂÚÈÙÒÛÂȘ ÔÍ›·˜ Ï¢¯·ÈÌ›·˜, ηÚΛÓÔ˘ ÙÔ˘ Ó‡ÌÔÓ·, ÙÔ˘ ÛÙÔÌ¿¯Ô˘ Î·È ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∏ ÂÎÙÂٷ̤ÓË ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·Ú·¿Óˆ ÌÂıfi‰ˆÓ ıÂÚ·›·˜, ÔÈ Ôԛ˜ ÛËÌÂȈ٤ÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈÎÚ‹ ÙÔÍÈÎfiÙËÙ·, ·ÓÔ›ÁÂÈ Ó¤Ô˘˜ ÔÚ›˙ÔÓÙ˜ ÛÙË ıÂÚ·›· ÙÔ˘ ηÚΛÓÔ˘. µÈ‚ÏÈÔÁÚ·Ê›· 1. Farber E. Programmed cell death: necrosis versus apoptosis. Mod Pathol 1994;7:605-609.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 28-02-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 11-07-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶·Ó·ÁÈÒÙ˘ ∫·Ï·Ì·Ï›Î˘ ¶ª∂¡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó·

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∆· ÓÂÔÁÓ¿ Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘ ∞. ª·ÓÔ˘Ú¿, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Multiple gestation neonates A. Manoura, C. Giannakopoulou

¶ÂÚ›ÏË„Ë: ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ¤¯ÂÈ ·Ú·ÙËÚËı› Ì›· ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙfiÛÔ ÙˆÓ ‰›‰˘ÌˆÓ fiÛÔ Î·È ÙˆÓ ÌÂÁ·Ï‡ÙÂÚ˘ Ù¿Í˘ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ. ∏ ·‡ÍËÛË ·˘Ù‹ ·Ô‰›‰ÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÛÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜, ÛÙËÓ Â͈ۈ̷ÙÈ΋ ÁÔÓÈÌÔÔ›ËÛË, ηıÒ˜ Î·È ÛÙË ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ ‰È¤ÁÂÚÛ˘ ÙˆÓ ˆÔıËÎÒÓ. OÈ Ôχ‰˘Ì˜ ΢‹ÛÂȘ Û˘Óԉ‡ÔÓÙ·È ·fi ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· ÁÈ· ÙȘ ÂÁ·Ԣ˜ Î·È ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· ÁÈ· Ù· ÓÂÔÁÓ¿. ∏ ÚÔˆÚfiÙËÙ· Î·È ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯ÓfiÙÂÚ˜ ÂÈÏÔΤ˜ ÙˆÓ ÓÂÔÁÓÒÓ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ. ¶ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ 20-50% ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ, ÂÓÒ 50% ÂÚ›Ô˘ ÙˆÓ ‰›‰˘ÌˆÓ Î·È ¿Óˆ ·fi 90% ÙˆÓ ÙÚ›‰˘ÌˆÓ Î·È ÙÂÙÚ¿‰˘ÌˆÓ ÓÂÔÁÓÒÓ ÁÂÓÓÈÔ‡ÓÙ·È Ì ‚¿ÚÔ˜ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 2500 g. ∏ ÚÔˆÚfiÙËÙ· ·ÔÙÂÏ› ÙÔÓ Î‡ÚÈÔ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Î·È Ù· ·ÒÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· Ôχ‰˘Ì· ÓÂÔÁÓ¿ Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ¿ ÙÔ˘˜ Â›Ó·È Ôχ ·˘ÍË̤ÓË Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ: 4-5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ÁÈ· Ù· ‰›‰˘Ì· Î·È 6-7 ÊÔÚ¤˜ ÁÈ· Ù· ÙÚ›‰˘Ì·. ∏ Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘ Â›Ó·È Ô ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜ Ì›ˆÛ˘ ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ ÙË Û˘Óԉ‡ԢÓ. ∏ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÌ‚Ú‡ˆÓ Ô˘ Â·Ó·ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙË Ì‹ÙÚ· ÛÙËÓ ÂÚ›ÙˆÛË Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘, ηıÒ˜ Î·È Ë ÚÔÛÂÎÙÈ΋ ¯Ú‹ÛË ÙˆÓ Û΢·ÛÌ¿ÙˆÓ ÚfiÎÏËÛ˘ ˆÔÚÚËÍ›·˜ ·ÔÙÂÏÔ‡Ó ÙËÓ Î·Ï‡ÙÂÚË ÚÔÛ¤ÁÁÈÛË ÛÙËÓ ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘˜.

Abstract: During recent decades, the incidence of twin and higher-order multiple gestation pregnancies has increased significantly. This rise is attributed mainly to assisted reproduction treatment, including use of ovulation-stimulating drugs and in vitro fertilization. Multiple gestation pregnancies are associated with increased maternal morbidity and increased perinatal morbidity and mortality. Prematurity and low birth weight are the most frequent complications of pregnancies with multiple neonates. Premature delivery complicates 20-50% of multiple pregnancies, while 50% of twins and more than 90% of triplets and higher-order multiples weigh less than 2500 g at birth. Prematurity is the main factor contributing to the higher incidence of perinatal morbidity and long-term adverse outcome of multiple births. Perinatal mortality of multiple neonates is significantly higher than that of singletons, four to five times higher for twins and six to seven times for triplets. The most efficient way of reducing the complications of multiple gestations is to reduce their frequency. Decreasing the number of embryos transferred for in vitro fertilization, and careful and controlled treatment with ovulationinducing drugs, comprise the best approaches for reducing the frequency of multiple pregnancy gestations and their complications.

§¤ÍÂȘ ÎÏÂȉȿ: Ôχ‰˘ÌË Î‡ËÛË, ˘Ô‚ÔËıÔ‡ÌÂÓË ·Ó··Ú·ÁˆÁ‹, ¤Î‚·ÛË ÓÂÔÁÓÒÓ.

Key words: multiple pregnancy, assisted reproduction, neonatal outcome.

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

Department of Neonatology, University of Crete

11

¶·È‰È·ÙÚÈ΋ 2004;67:11-18

∂ÈÛ·ÁˆÁ‹ ∏ Á¤ÓÓËÛË ‰›‰˘ÌˆÓ ‹ ÌÂÁ·Ï‡ÙÂÚ˘ Ù¿Í˘ Ôχ‰˘ÌˆÓ ‹Ù·Ó ¤Ó· Û¯ÂÙÈο ·Û˘Ó‹ıÈÛÙÔ ÁÂÁÔÓfi˜ ÛÙÔ ÚfiÛÊ·ÙÔ ·ÚÂÏıfiÓ. ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜, Ë ‰È¿‰ÔÛË ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ ÛÙË ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Ô˘ ÏËÛÈ¿˙ÂÈ ÙÒÚ· ÙÔ 3% ÙÔ˘ Û˘ÓfiÏÔ˘ (1). OÈ Î˘‹ÛÂȘ ·˘Ù¤˜ Â›Ó·È ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì ·˘ÍË̤Ó˜ Èı·ÓfiÙËÙ˜ Ì·È¢ÙÈÎÒÓ Î·È ÂÚÈÁÂÓÓËÙÈÎÒÓ ÂÈÏÔÎÒÓ (1,2). ∆· ÓÂÔÁÓ¿ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÚÈÁÂÓÓËÙÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜, Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛÂˆÓ (1,2). OÈ ÂÈÙÒÛÂȘ ÙˆÓ ÂÚÈÁÂÓÓËÙÈÎÒÓ ÂÈÏÔÎÒÓ ÔÏϤ˜ ÊÔÚ¤˜ Û˘ÓÔ‰Â‡Ô˘Ó Ù· ·È‰È¿ Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘ Û fiÏË ÙÔ˘˜ ÙË ˙ˆ‹. ∏ ·Ó·ÛÎfiËÛË ·˘Ù‹ ÛÎÔfi ¤¯ÂÈ Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ Ù· ¿ÌÂÛ· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÓÂÔÁÓÒÓ Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘, ÙȘ ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ Ô˘ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó, ηıÒ˜ Î·È ÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÚfiÏË„‹˜ ÙÔ˘˜. ∂ȉËÌÈÔÏÔÁ›· ∏ Û˘¯ÓfiÙËÙ· Ù˘ ‰›‰˘Ì˘ ·ËÛ˘ ÂÎÙÈÌ¿Ù·È Û 1/80 ΢‹ÛÂȘ ÂÚ›Ô˘, ÂÓÒ Ù˘ ÙÚ›‰˘Ì˘ Û 1/8000 (3). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ Ù¿Í˘ Ôχ‰˘Ì˘ ·ËÛ˘ ˘ÔÏÔÁ›˙ÂÙ·È Ì ‚¿ÛË ÙËÓ ˘fiıÂÛË Hellin-Zeleny, Û 1/80(¡-1) (3). øÛÙfiÛÔ, Ë Ú·ÁÌ·ÙÈ΋ Û˘¯ÓfiÙËÙ· Û‡ÏÏ˄˘ ‰›‰˘ÌˆÓ Â›Ó·È Ì¿ÏÏÔÓ ÌÂÁ·Ï‡ÙÂÚË, Â¿Ó ÏËÊı› ˘’ fi„ÈÓ ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ÚÒÈÌ˘ Ì›ˆÛ˘ ÙÔ˘ ÂÓfi˜ ‰È‰‡ÌÔ˘ (2,4). ∞ӷʤÚÂÙ·È fiÙÈ ÛÙÔ 10-20% ÙˆÓ ‰›‰˘ÌˆÓ ΢‹ÛÂˆÓ ·Ú·ÙËÚÂ›Ù·È Ì›ˆÛË ÙÔ˘ ÂÓfi˜ ÂÌ‚Ú‡Ô˘ Û ÚÒÈÌË Ê¿ÛË Ù˘ ·ËÛ˘ (2,4,5). ∏ Û˘¯ÓfiÙËÙ· ÌÔÓÔˆÔÁÂÓÔ‡˜ ‰›‰˘Ì˘ ·ËÛ˘ Â›Ó·È 3,5 ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ Î·È Â›Ó·È Û¯ÂÙÈο ÛÙ·ıÂÚ‹ Û ·ÁÎfiÛÌÈÔ Â›Â‰Ô (4). øÛÙfiÛÔ, Ù· ÌÔÓÔ˙˘ÁˆÙÈο ‰›‰˘Ì· ÎÔÚ›ÙÛÈ· ¤¯Ô˘Ó ·˘ÍË̤Ó˜ Èı·ÓfiÙËÙ˜ Ó· οÓÔ˘Ó Î·È ·˘Ù¿ ÌÔÓÔ˙˘ÁˆÙÈο ‰›‰˘Ì· ·È‰È¿ (2,6). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ·Ù¤Ú·, Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ÎÏËÚÔÓÔÌÈ΋ ÚԉȿıÂÛË (2). ∏ Û˘¯ÓfiÙËÙ· ‰ÈˆÔÁÂÓÔ‡˜ ‰›‰˘Ì˘ ·ËÛ˘ Î˘Ì·›ÓÂÙ·È ·fi 4 ¤ˆ˜ 50 ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ Î·È ÂËÚ¿˙ÂÙ·È ·fi ÙË Ê˘Ï‹, ·fi Ì›· ÔÈÎÔÁÂÓÂȷ΋ ÚԉȿıÂÛË Ô˘ ÌÂٷʤÚÂÙ·È ·fi ÙË ÌËÙ¤Ú·, ·fi ÙËÓ ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜, ÙÔÓ ÙfiÎÔ, ÙË ‰È·ÙÚÔÊ‹ ‹ ÙËÓ ÂÔ¯‹ ÙÔ˘ ¯ÚfiÓÔ˘. ∞˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÁÈ· ‰›‰˘ÌË Î‡ËÛË ¤¯Ô˘Ó ÙfiÛÔ ÔÈ ÔχÙÔΘ ÌËÙ¤Ú˜ fiÛÔ Î·È ÔÈ Á˘Ó·›Î˜ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, Ì ÙË Ì¤ÁÈÛÙË Û˘¯ÓfiÙËÙ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 37 ÂÙÒÓ (4). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ¤¯ÂÈ ·˘ÍËı› ‰Ú·Ì·ÙÈο Û fiϘ ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ™ÙȘ ∏.¶.∞., ÔÈ ‰›‰˘Ì˜ ΢‹ÛÂȘ ¤¯Ô˘Ó ·˘ÍËı› ·fi 1,8% ÙÔ 1971 Û 2,7% ÙÔ

12

Paediatriki 2004;67:11-18

1997 (1). ¶ÂÚÈÛÛfiÙÂÚÔ ÂÓÙ˘ˆÛȷ΋ Â›Ó·È Ë ·‡ÍËÛË ÙˆÓ ÌÂÁ·Ï‡ÙÂÚ˘ Ù¿Í˘ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ. ∆· ÙÚ›‰˘Ì· ÓÂÔÁÓ¿ ·fi 296 ·Ó¿ 1 ÂηÙÔÌ̇ÚÈÔ ˙ÒÓÙˆÓ ÁÂÓÓ‹ÛÂˆÓ ÙÔ 1971 ¤ÊÙ·Û·Ó ÙȘ 1584 ·Ó¿ 1 ÂηÙÔÌ̇ÚÈÔ ÙÔ 1997, Ù· ÙÂÙÚ¿‰˘Ì· ·fi 13 ·Ó¿ 1 ÂηÙÔÌ̇ÚÈÔ ÙÔ 1971 ¤ÊÙ·Û·Ó ÙȘ 144 ÙÔ 1996, ÂÓÒ Ù· ÂÓÙ¿‰˘Ì· ·fi 3,8 ·Ó¿ 1 ÂηÙÔÌ̇ÚÈÔ ÙÔ 1971 ¤ÊÙ·Û·Ó ÙȘ 20,8 ÙÔ 1996 (1). ∏ ·‡ÍËÛË ·˘Ù‹ ·Ô‰›‰ÂÙ·È Î·Ù¿ ÙÔ ¤Ó· ÙÚ›ÙÔ ÂÚ›Ô˘ ÛÙË ÌÂÙ·ÙfiÈÛË ÚÔ˜ Ù· ¿Óˆ Ù˘ ̤Û˘ ËÏÈΛ·˜ ÙˆÓ ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ Î·È Î·Ù¿ Ù· ‰‡Ô ÙÚ›Ù· ÛÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ (7). ¶Ôχ‰˘ÌË Î‡ËÛË Î·È Ì¤ıÔ‰ÔÈ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë Â˘Ú›· ¯Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ ¤¯ÂÈ Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙËÓ ·‡ÍËÛË ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Û fiϘ ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (2,7,8). ∏ ıÂÚ·›· ·ÓˆÔÚÚËÎÙÈÎÒÓ Á˘Ó·ÈÎÒÓ Ì ʷÚ̷΢ÙÈο Û΢¿ÛÌ·Ù· Â·ÁˆÁ‹˜ ˆÔÚÚËÍ›·˜ Û¯ÂÙ›˙ÂÙ·È Ì ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ Èı·ÓfiÙËÙ·˜ Ôχ‰˘Ì˘ ·ËÛ˘, Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ê¿ÚÌ·ÎÔ Î·È ÙË ‰fiÛË. ∏ ÎÈÙÚÈ΋ ÎÏÔÌÈÊ·›ÓË Î·È ¿ÏÏ· ·ÓÙÈ-ÔÈÛÙÚÔÁfiÓ· ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ‰›‰˘Ì˘ ·ËÛ˘ Û 10% Î·È ÙÚ›‰˘Ì˘ ·ËÛ˘ Û 1%, ÂÓÒ Û ıÂÚ·›· ÌÂ Û˘Ì‚·ÙÈο Û¯‹Ì·Ù· ÁÔÓ·‰ÔÙÚÔÈÓÒÓ, Ô Î›Ó‰˘ÓÔ˜ Ôχ‰˘Ì˘ ·ËÛ˘ Â›Ó·È ÂÚ›Ô˘ 25% (2,9). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘, Ô Î›Ó‰˘ÓÔ˜ Ôχ‰˘Ì˘ ·ËÛ˘ ·˘Í¿ÓÂÙ·È ·Ó¿ÏÔÁ· Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ Ô˘ Â·Ó·ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙË Ì‹ÙÚ·. ¶ÔÏÏ¿ ΤÓÙÚ· ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜, Û ̛· ÚÔÛ¿ıÂÈ· Ó· ·˘Í‹ÛÔ˘Ó Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ Ù˘ Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘, Â·Ó·ÙÔÔıÂÙÔ‡Ó ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· ÁÔÓÈÌÔÔÈË̤ӷ ˆ¿ÚÈ· ÛÙË Ì‹ÙÚ·. øÛÙfiÛÔ, Ê·›ÓÂÙ·È fiÙÈ Ë Ú·ÎÙÈ΋ ·˘Ù‹, ÂÓÒ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ Ôχ‰˘Ì˘ ·ËÛ˘, ‰ÂÓ ‚ÂÏÙÈÒÓÂÈ ÙÔ ÔÛÔÛÙfi ÂÈÙ˘¯Ô‡˜ ¤Î‚·Û˘ Ù˘ ‰È·‰Èηۛ·˜ (2,9,10). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ Ë Û˘¯ÓfiÙËÙ· Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Û ÂÚÈÙÒÛÂȘ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ Â›Ó·È 20-30% Î·È fiÙÈ ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È ÌÂÙ¿ ·fi Â͈ۈ̷ÙÈ΋ ÁÔÓÈÌÔÔ›ËÛË ÚÔ¤Ú¯ÂÙ·È ·fi Ôχ‰˘Ì˜ ΢‹ÛÂȘ (7). ¶·ıÔÁ¤ÓÂÛË ∏ Ôχ‰˘ÌË Î‡ËÛË Â›Ó·È Û˘Ó‹ıˆ˜ ÙÔ ·ÔÙ¤ÏÂÛÌ· ÁÔÓÈÌÔÔ›ËÛ˘ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤Ó· ˆ·Ú›ˆÓ (‰ÈˆÔÁÂÓ‹ ‰›‰˘Ì·) (2). ∏ ‰È·›ÚÂÛË ÂÓfi˜ ÁÔÓÈÌÔÔÈË̤ÓÔ˘ ˆ·Ú›Ô˘ Û ‰‡Ô ·ÓÔÌÔÈfiÙ˘· ¤Ì‚Ú˘· (ÌÔÓÔˆÔÁÂÓ‹) ·ÔÙÂÏ› ¤Ó·Ó ¿ÏÏÔ Ì˯·ÓÈÛÌfi ‰ËÌÈÔ˘ÚÁ›·˜ ‰È‰‡ÌˆÓ. ∆· ÌÔÓÔˆÔÁÂÓ‹ ‰›‰˘Ì· ·ÔÙÂÏÔ‡Ó ÙÔ 10-18% ÙˆÓ ˙ÒÓÙˆÓ ‰È‰‡ÌˆÓ (1). ∏ ‰È¿ÎÚÈÛË ÌÂٷ͇ ÌÔÓÔˆÔÁÂÓÒÓ Î·È ÔÏ˘ˆÔÁÂÓÒÓ ÂÌ‚Ú‡ˆÓ ›ӷÈ

¶·È‰È·ÙÚÈ΋ 2004;67:11-18

·Ï‹ fiÙ·Ó Â›Ó·È ‰È·ÊÔÚÂÙÈÎÔ‡ ʇÏÔ˘, ·ÏÏ¿ ηı›ÛÙ·Ù·È È‰È·›ÙÂÚ· ‰‡ÛÎÔÏË fiÙ·Ó Ù· ¤Ì‚Ú˘· Â›Ó·È ›‰ÈÔ˘ ʇÏÔ˘. O ‰È·¯ˆÚÈÛÌfi˜ ·˘Ùfi˜ ‰ÂÓ Â›Ó·È ·Ï¿ ·Î·‰ËÌ·˚ÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. À¿Ú¯Ô˘Ó ÛËÌ·ÓÙÈÎfiٷ٘ ‰È·ÊÔÚ¤˜ ÛÙË ÓÔÛËÚfiÙËÙ· Î·È ÙË ıÓËÛÈÌfiÙËÙ·, ·Ó¿ÏÔÁ· Ì ÙÔ ·Ó Ù· ¤Ì‚Ú˘· ÌÔÈÚ¿˙ÔÓÙ·È ÙÔÓ ›‰ÈÔ ·ÌÓÈ·Îfi Û¿ÎÔ ‹ ÙÔÓ ›‰ÈÔ Ï·ÎÔ‡ÓÙ·. ∞ӷʤÚÂÙ·È fiÙÈ Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÁÈ· Ù· ‰È¯ÔÚȷο ‰È·ÌÓȷο ‰›‰˘Ì· Â›Ó·È 4,8%, ÁÈ· Ù· ÌÔÓÔ¯ÔÚȷο ‰È·ÌÓȷο Â›Ó·È 9,6%, ÂÓÒ ÁÈ· Ù· ÌÔÓÔ¯ÔÚȷο ÌÔÓÔ·ÌÓȷο ·Ó¤Ú¯ÂÙ·È ÛÙÔ 29% (11). ∆· ÌÔÓÔ˙˘ÁˆÙÈο Ôχ‰˘Ì· ¤Ì‚Ú˘· ÚÔ·ÙÔ˘Ó ·fi ÙË ‰È·›ÚÂÛË ÙÔ˘ ÁÔÓÈÌÔÔÈË̤ÓÔ˘ ˆ·Ú›Ô˘ ·fi ÙË 2Ë Ì¤¯ÚÈ ÙË 15Ë ÂÚ›Ô˘ Ë̤ڷ ·fi ÙË ÁÔÓÈÌÔÔ›ËÛË (4). ∏ ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ Ù˘ ‰È·›ÚÂÛ˘ ηıÔÚ›˙ÂÈ ÙË ‰È¿Ù·ÍË ÙˆÓ ·ÌÓÈ·ÎÒÓ ˘Ì¤ÓˆÓ Î·È ÙÔ˘ Ï·ÎÔ‡ÓÙ·. ∏ ‰È·›ÚÂÛË ÙÔ˘ ˙˘ÁÒÙË ÌÂٷ͇ Ù˘ Ë̤ڷ˜ 0 Î·È 4 ÌÂÙ¿ ÙË ÁÔÓÈÌÔÔ›ËÛË ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ‰È·ÌÓÈ·ÎÒÓ, ‰È¯ÔÚÈ·ÎÒÓ, ‰ÈÏ·ÎÔ˘ÓÙÈ·ÎÒÓ ÌÔÓÔ˙˘ÁˆÙÈÎÒÓ ÂÌ‚Ú‡ˆÓ. ∞Ó Ë ‰È·›ÚÂÛË Û˘Ì‚Â› ÌÂٷ͇ Ù˘ 4˘ Î·È 8˘ Ë̤ڷ˜, ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ‰È·ÌÓȷο, ‰È¯ÔÚȷο, ÌÔÓÔÏ·ÎÔ˘ÓÙȷο ‰›‰˘Ì·, ÂÓÒ ·Ó Ë ‰È·›ÚÂÛË Û˘Ì‚Â› ÌÂÙ¿ ÙËÓ 8Ë Ë̤ڷ, ÚÔ·ÙÔ˘Ó ÌÔÓÔ·ÌÓȷο, ÌÔÓÔ¯ÔÚȷο, ÌÔÓÔÏ·ÎÔ˘ÓÙȷο ‰›‰˘Ì·. ∞Ó Ë ‰È·›ÚÂÛË Î·ı˘ÛÙÂÚ‹ÛÂÈ, Ô ‰È·¯ˆÚÈÛÌfi˜ Â›Ó·È ·ÙÂÏ‹˜ Î·È ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Ù· ÛÈ·Ì·›· ‰›‰˘Ì· (2). ¶ÚÔ‚Ï‹Ì·Ù· Î·È Î›Ó‰˘ÓÔÈ Ù˘ ÌËÙ¤Ú·˜ ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ Ôχ‰˘Ì˜ ΢‹ÛÂȘ Û˘Óԉ‡ÔÓÙ·È ·fi ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Ù˘ ÌËÙ¤Ú·˜.

OÈ ÂÈÏÔΤ˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙËÓ ¤ÁÎ˘Ô ÂÌÊ·Ó›˙ÔÓÙ·È 3-7 ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· Û ÂÚ›ÙˆÛË Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Û ۯ¤ÛË Ì ÛÙȘ ÌÔÓ‹ÚÂȘ ΢‹ÛÂȘ (2). ∏ ΢ÚÈfiÙÂÚË ÂÈÏÔ΋ Â›Ó·È Ë ˘¤ÚÙ·ÛË, Ì ‹ ¯ˆÚ›˜ ÚˆÙÂ˚ÓÔ˘Ú›· (2). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘, ÔÈ Á˘Ó·›Î˜ ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÚÔÂÎÏ·Ì„›·˜, ·ÎfiÌ· Î·È ·Ó ‰ÂÓ Â›Ó·È ÚˆÙÔÙfiΘ (2). ™ÙËÓ Ôχ‰˘ÌË Î‡ËÛË Ê·›ÓÂÙ·È fiÙÈ Ô ÌÂȈ̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÚÔÂÎÏ·Ì„›·˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙȘ ÔχÙÔΘ Á˘Ó·›Î˜ ÂÍ·Ï›ÊÂÙ·È (2). O ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·Ó·ÈÌ›·˜ Â›Ó·È ‰ÈÏ¿ÛÈÔ˜ ÛÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ (2). ¶·Ú·ÙËÚ›ٷÈ, Â›Û˘, ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ·ÈÌÔÚÚ·Á›·˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ·ÙÔÓ›·˜ ‹/Î·È Ú‹Í˘ Ù˘ Ì‹ÙÚ·˜ Î·È ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ Â›Ó·È ·˘ÍË̤ÓÔ (2). ¶ÚÔ‚Ï‹Ì·Ù· ÓÂÔÁÓÒÓ Ôχ‰˘Ì˘ ·ËÛ˘ ∞. ∂Ó‰ÔÌ‹ÙÚÈ· ·Ó¿Ù˘ÍË ∆Ô ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ÂÈÏÔΤ˜ ÙˆÓ ÓÂÔÁÓÒÓ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ, ·ÊÔ‡ 50% ÂÚ›Ô˘ ÙˆÓ ‰›‰˘ÌˆÓ Î·È ¿Óˆ ·fi 90% ÙˆÓ ÙÚ›‰˘ÌˆÓ Î·È ÙÂÙÚ¿‰˘ÌˆÓ ÁÂÓÓÈÔ‡ÓÙ·È

Paediatriki 2004;67:11-18

Ì ‚¿ÚÔ˜ ÌÈÎÚfiÙÂÚÔ ÙˆÓ 2500 g (1,4). O ΛӉ˘ÓÔ˜ Á¤ÓÓËÛ˘ Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓÔ‡ (<1500 g) Â›Ó·È 6-8% ÁÈ· Ù· ‰›‰˘Ì·, ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô Î›Ó‰˘ÓÔ ÛÙȘ ÌÔÓ‹ÚÂȘ ΢‹ÛÂȘ (0,7-1,6%) (1,2). O ΛӉ˘ÓÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÁÈ· Ù· ÌÔÓÔ¯ÔÚȷο ‰›‰˘Ì· Û ۯ¤ÛË Ì ٷ ‰È¯ÔÚȷο (2,12). ∆Ô ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ·Ô‰›‰ÂÙ·È ÙfiÛÔ ÛÙËÓ ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ fiÛÔ Î·È ÛÙÔÓ Î›Ó‰˘ÓÔ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ (1). ∏ ÂÓ‰ÔÌ‹ÙÚÈ· ·Ó¿Ù˘ÍË ÛÙ· Ôχ‰˘Ì· ¤Ì‚Ú˘· ·ÎÔÏÔ˘ı› ÙȘ ηÌ‡Ï˜ ·Ó¿Ù˘Í˘ ÙˆÓ ÂÌ‚Ú‡ˆÓ ÌÔÓ‹ÚÔ˘˜ ·ËÛ˘ ÂÚ›Ô˘ ̤¯ÚÈ ÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ, ÔfiÙ ÔÈ Î·Ì‡Ï˜ ·Ó¿Ù˘Í˘ ·Ú¯›˙Ô˘Ó Ó· ·ÔÎÏ›ÓÔ˘Ó (1,13). ∏ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙÔÓ Û˘Ó‰˘·ÛÌfi ÂÚÈÔÚÈṲ̂ÓÔ˘ ¯ÒÚÔ˘ Î·È ÂÚÈÔÚÈṲ̂Ó˘ ·ÚÔ¯‹˜ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ ÛÙ· ¤Ì‚Ú˘· Ôχ‰˘Ì˘ ·ËÛ˘ (1). øÛÙfiÛÔ, Ë ÂÍ‹ÁËÛË ·˘Ù‹ ‰ÂÓ Â›Ó·È Ï‹Úˆ˜ ÈηÓÔÔÈËÙÈ΋, ·ÊÔ‡ Ê·›ÓÂÙ·È fiÙÈ Ë ÂÈ‚Ú¿‰˘ÓÛË ÙÔ˘ Ú˘ıÌÔ‡ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘Í˘ ÍÂÎÈÓ¿ ÓˆÚ›˜ ÛÙËÓ Î‡ËÛË, ÂÚ›Ô˘ ÛÙȘ 22 ‚‰ÔÌ¿‰Â˜ (13,14). O ¯·ÌËÏfiÙÂÚÔ˜ Ú˘ıÌfi˜ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘Í˘ ÌÔÚ› Ó· ıˆÚËı› ÂÓ Ì¤ÚÂÈ ·Ô‰ÂÎÙfi˜, ·ÊÔ‡ Ë Ù·¯Â›· ·Ó¿Ù˘ÍË ı· Â¤ÊÂÚ ÂÍ¿ÓÙÏËÛË Ù˘ ·ÚÔ¯‹˜ ıÚÂÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ı· Ô‰ËÁÔ‡Û Û ˘ÂډȿٷÛË Ù˘ Ì‹ÙÚ·˜ Î·È ÚfiˆÚÔ ÙÔÎÂÙfi (1). øÛÙfiÛÔ, Ë ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ·ÔÙÂÏ› ÂÍ›ÛÔ˘ ÈÛ¯˘Úfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÙfiÛÔ ÁÈ· Ù· ‰›‰˘Ì· fiÛÔ Î·È ÁÈ· Ù· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ, ÂÓÒ ÂȉÈο ÁÈ· Ù· ÌÔÓÔ¯ÔÚȷο ‰›‰˘Ì· Ì ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ Ô Î›Ó‰˘ÓÔ˜ ÂÚÈÁÂÓÓËÙÈÎÔ‡ ı·Ó¿ÙÔ˘ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·fi ‰ÈÏ¿ÛÈÔ˜ (15). ∫¿ÔÈÔÈ Û˘ÁÁÚ·Ê›˜ ‰È·›ÛÙˆÛ·Ó ¯·ÌËÏfiÙÂÚË ıÓËÛÈÌfiÙËÙ· ÛÙ· ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ‰›‰˘Ì· ÓÂÔÁÓ¿ Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙÔÈ¯Ô˘ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛÂˆÓ (16,17). ∏ ‰È·›ÛÙˆÛË ·˘Ù‹ ÂÍËÁÂ›Ù·È ·fi ÙË ÌÂÙ·ÙfiÈÛË ÚÔ˜ Ù· οو ÙˆÓ Î·Ì˘ÏÒÓ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ·Ó¿Ù˘Í˘ ÙˆÓ Ôχ‰˘ÌˆÓ ÓÂÔÁÓÒÓ Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ. ŒÙÛÈ, ÁÈ· ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, Ù· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛÂˆÓ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË ËÏÈΛ· ·ËÛ˘ Û ۯ¤ÛË Ì ٷ Ôχ‰˘Ì· ÓÂÔÁÓ¿ (18). ™Â ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰È·ÈÛÙÒıËΠ·ÚfiÌÔÈ· ¤Î‚·ÛË ÁÈ· Ù· Ôχ‰˘Ì· ¯·ÌËÏÔ‡ Î·È Ôχ ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿ Û ۯ¤ÛË Ì ٷ ·ÓÙ›ÛÙÔÈ¯Ô˘ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿ ·fi ·Ϥ˜ ΢‹ÛÂȘ (13,15,19,20). ∆· Ôχ‰˘Ì· ÓÂÔÁÓ¿ ‚Ú›ÛÎÔÓÙ·È Û ΛӉ˘ÓÔ ‰˘Û·Ó·ÏÔÁ›·˜ ‚¿ÚÔ˘˜. ∏ ‰È·ÊÔÚ¿ ‚¿ÚÔ˘˜ ÌÂٷ͇ ÙˆÓ ‰È‰‡ÌˆÓ ÂÎÊÚ¿˙ÂÙ·È Û·Ó ÂηÙÔÛÙÈ·›Ô ÔÛÔÛÙfi Â› ÙÔ˘ ‚¿ÚÔ˘˜ ÙÔ˘ ÌÂÁ·Ï‡ÙÂÚÔ˘ ÂÌ‚Ú‡Ô˘. ¶ÔÛÔÛÙ¿ ·fi 15% ¤ˆ˜ 40% ¤¯Ô˘Ó ηٿ ηÈÚÔ‡˜ ÙÂı› Û·Ó fiÚÈ· ‰È¿ÎÚÈÛ˘ Ê˘ÛÈÔÏÔÁÈ΋˜ Î·È ·ıÔÏÔÁÈ΋˜ ·Ó¿Ù˘Í˘ ÙˆÓ ‰È‰‡ÌˆÓ (1). ∆· ·›ÙÈ· Ù˘ ‰˘Û·Ó·ÏÔÁ›·˜ ‚¿ÚÔ˘˜ ÌÔÚ› Ó· Â›Ó·È ÁÂÓÂÙÈο ‹ Ó· Û¯ÂÙ›˙ÔÓÙ·È ÌÂ

13

¶·È‰È·ÙÚÈ΋ 2004;67:11-18

‰È·ÊÔÚ¤˜ ÛÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ ÂÚÈ‚¿ÏÏÔÓ (1). ∞ӷʤÚÂÙ·È fiÙÈ fiÛÔ ·˘Í¿ÓÂÙ·È Ë ‰˘Û·Ó·ÏÔÁ›· ‚¿ÚÔ˘˜, ·˘Í¿ÓÂÙ·È Î·È Ô Î›Ó‰˘ÓÔ˜ ÂÓ‰ÔÌ‹ÙÚÈÔ˘ ı·Ó¿ÙÔ˘ (21). ∂ȉÈο ÁÈ· Ù· ÚfiˆÚ·, ·Ó·Ê¤ÚÂÙ·È ·˘ÍË̤ÓË ÓÂÔÁÓÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· ÁÈ· ÙÔ ÌÈÎÚfiÙÂÚÔ ÓÂÔÁÓfi Û ÂÚ›ÙˆÛË ‰˘Û·Ó·ÏÔÁ›·˜ ≥30% (22). øÛÙfiÛÔ, Ù›ıÂÙ·È ÙÔ ÂÚÒÙËÌ· ·Ó Ù· ‰˘ÛÌÂÓ¤ÛÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ÔÊ›ÏÔÓÙ·È ÛÙË ‰˘Û·Ó·ÏÔÁ›· ‚¿ÚÔ˘˜ ‹ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ Ô˘ Û˘Ó‹ıˆ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ÌÈÎÚfiÙÂÚÔ ‰›‰˘ÌÔ. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ô‰›‰Ô˘Ó ÙË ‰˘ÛÌÂÓ¤ÛÙÂÚË ¤Î‚·ÛË Î˘Ú›ˆ˜ ÛÙË ÌÈÎÚ‹ ËÏÈΛ· ·ËÛ˘ Î·È ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È fi¯È ÛÙÔÓ ‚·ıÌfi ‰˘Û·Ó·ÏÔÁ›·˜ ‚¿ÚÔ˘˜ (19,23). µ. ¶ÚÔˆÚfiÙËÙ· ∏ ÓÔÛËÚfiÙËÙ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ÓÂÔÁÓÒÓ Ôχ‰˘ÌˆÓ Î·È ·ÏÒÓ Î˘‹ÛˆÓ, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ (2,4,24). ¶ÚfiˆÚÔ˜ ÙÔÎÂÙfi˜ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ 20-50% ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ (1,4). ªÂϤÙ˜ ‰Â›¯ÓÔ˘Ó Ì›· ‰È·ÊÔÚÂÙÈ΋ ηٷÓÔÌ‹ Ù˘ ËÏÈΛ·˜ ·ËÛ˘ ÛÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ Û ۯ¤ÛË Ì ÙȘ ·Ϥ˜, Ì ÙË ‰È¿ÌÂÛË ÙÈÌ‹ ÁÈ· Ù· ‰›‰˘Ì· Ó· Â›Ó·È 37 ‚‰ÔÌ¿‰Â˜, ÛËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ÙÈÌ‹ ÙˆÓ 40 ‚‰ÔÌ¿‰ˆÓ ÁÈ· ÙȘ ·Ϥ˜ ΢‹ÛÂȘ (25). Œ¯ÂÈ ·Ú·ÙËÚËı› ·ÎfiÌ· fiÙÈ Ë ÂÌ‚Ú˘˚΋ Î·È ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ·˘Í¿ÓÔ˘Ó ÛËÌ·ÓÙÈο ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·ËÛ˘, ÂÓÒ Î¿ÔÈÔÈ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë È‰·ÓÈ΋ ‰È¿ÚÎÂÈ· ·ËÛ˘ ÁÈ· Ù· Ôχ‰˘Ì· ÓÂÔÁÓ¿ Â›Ó·È ÌÈÎÚfiÙÂÚË Û ۯ¤ÛË Ì ÙȘ ·Ϥ˜ ΢‹ÛÂȘ (1,26). O ¯·ÌËÏfiÙÂÚÔ˜ ΛӉ˘ÓÔ˜ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ Î·È ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ ·Ú·ÙËÚÂ›Ù·È fiÙ·Ó Ë ‰È¿ÚÎÂÈ· ·ËÛ˘ Â›Ó·È 36-37 ‚‰ÔÌ¿‰Â˜ ÁÈ· Ù· ‰›‰˘Ì· Î·È 34-35 ‚‰ÔÌ¿‰Â˜ ÁÈ· Ù· ÙÚ›‰˘Ì·, ÂÓÒ Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÁÈ· Ù· ‰›‰˘Ì· ÓÂÔÁÓ¿ ÊÙ¿ÓÂÈ ÛÙËÓ ÂÏ¿¯ÈÛÙË ÙÈÌ‹ fiÙ·Ó Ô ÙÔÎÂÙfi˜ Á›ÓÂÙ·È ÛÙȘ 37-38 ‚‰ÔÌ¿‰Â˜ (25,27,28). ∏ ·ÓËÛ˘¯›· ÁÈ· ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·ËÛ˘, ηıÒ˜ Î·È ÁÈ· Èı·Ó¤˜ ÂÈÏÔΤ˜ Û ÂÚ›ÙˆÛË Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÙÔÎÂÙÔ‡ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ Û ÌÂÁ¿ÏË ·‡ÍËÛË ÙÔ˘ ÔÛÔÛÙÔ‡ ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ (1,13). ∆Ô ·˘ÍË̤ÓÔ ÔÛÔÛÙfi Á¤ÓÓËÛ˘ Ì ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Î·ÈÛ·ÚÈ΋ ÙÔÌ‹ ÛÙȘ 36-37 ‚‰ÔÌ¿‰Â˜ Èı·Ó¿ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ ·‡ÍËÛË Ù˘ ÚÔˆÚfiÙËÙ·˜. ∏ Û˘Ì‚ÔÏ‹ Ù˘ ÚÔÁÚ·ÌÌ·ÙÈṲ̂Ó˘ ηÈÛ·ÚÈ΋˜ ÙÔÌ‹˜ ÛÙÔ ·˘ÍË̤ÓÔ ÔÛÔÛÙfi ÚÔˆÚfiÙËÙ·˜ ÁÈ· Ù· ÓÂÔÁÓ¿ Ôχ‰˘ÌˆÓ Î·È ·ÏÒÓ Î˘‹ÛÂˆÓ ÔÈΛÏÏÂÈ ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜. øÛÙfiÛÔ, Â›Ó·È ‚¤‚·ÈÔ fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ÁÈ· ÚfiˆÚÔ ÙÔÎÂÙfi Â›Ó·È ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ˜ ÛÙ· ÓÂÔÁÓ¿ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ, ·ÊÔ‡ ÂÎÙÈÌ¿Ù·È fiÙÈ ÙÔ 5% ÂÚ›Ô˘ ÙˆÓ ‰›‰˘ÌˆÓ Î·È ÙÔ 23% ÙˆÓ ÙÚ›‰˘ÌˆÓ ÁÂÓÓÈÔ‡ÓÙ·È ÚÈÓ ÙȘ 32 ‚‰ÔÌ¿‰Â˜ Û ۯ¤ÛË Ì ÙÔ 1,2% ÙˆÓ ÓÂÔÁÓÒÓ ·ÏÒÓ Î˘‹ÛÂˆÓ (2).

14

Paediatriki 2004;67:11-18

°. £ÓËÛÈÌfiÙËÙ· ∏ ÂÌ‚Ú˘˚΋ ıÓËÛÈÌfiÙËÙ· Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËı› ÁÈ· Ù· Ôχ‰˘Ì· ÓÂÔÁÓ¿, ΢ڛˆ˜ ÂÂȉ‹ ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÔÏϤ˜ ·ÒÏÂȘ ÂÌ‚Ú‡Ô˘ Û ·Ú¯Èο ÛÙ¿‰È· Ù˘ ·ËÛ˘ (1). ∏ ÂÌ‚Ú˘˚΋ ıÓËÛÈÌfiÙËÙ· ÂÎÙÈÌ¿Ù·È Û 4,3 ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ ÁÈ· ÙȘ ·Ϥ˜ ΢‹ÛÂȘ, 15,5 ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ ÁÈ· Ù· ‰›‰˘Ì· Î·È 21 ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ ÁÈ· Ù· ÙÚ›‰˘Ì·, ÂÓÒ ÌÂÁ¿ÏË ÏËı˘ÛÌȷ΋ ÌÂϤÙË ÛÙËÓ π·ˆÓ›· ·Ó·Ê¤ÚÂÈ Û˘¯ÓfiÙËÙ· ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ 133 ·Ó¿ 1000 ‰›‰˘Ì· ¤Ì‚Ú˘· (1). ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ÂÓ‰ÔÌ‹ÙÚÈˆÓ ı·Ó¿ÙˆÓ Ôχ‰˘ÌˆÓ ·ÊÔÚ¿ Û ÌÔÓÔ¯ÔÚȷο Ôχ‰˘Ì· (4). ∏ ·˘ÍË̤ÓË ÂÌ‚Ú˘˚΋ ıÓËÛÈÌfiÙËÙ· ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ Û ·ÁÁÂȷΤ˜ ·Ó·ÛÙÔÌÒÛÂȘ Ì ÌÂٷΛÓËÛË ÌÂÁ¿ÏÔ˘ fiÁÎÔ˘ ·›Ì·ÙÔ˜ ·fi ÙÔ ¤Ó· ¤Ì‚Ú˘Ô ÛÙÔ ¿ÏÏÔ, Û ˘ÌÂÓÒ‰Ë ÚfiÛÊ˘ÛË Ù˘ ÔÌÊ·Ï›‰·˜, ÛÂ Û˘Ì›ÂÛË ‹ ¿ÏÏ· ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ÔÌÊ¿ÏÈˆÓ ÏÒÚˆÓ (4). ™Â ÂÚ›ÙˆÛË ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ ÙÔ˘ ÂÓfi˜ ÂÌ‚Ú‡Ô˘, ÙÔ ¿ÏÏÔ ‚Ú›ÛÎÂÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌ‚Ú˘˚΋˜ ‰˘Û¯¤ÚÂÈ·˜, ·ÓÒÌ·Ï˘ ÚÔ‚ÔÏ‹˜ Î·È ‰˘ÛÙÔΛ·˜, ÂÓÒ Ë ÌËÙ¤Ú· ÎÈÓ‰˘Ó‡ÂÈ ·fi ÙÔÍÈÓ·ÈÌ›· Î·È ‰È¿¯˘ÙË ÂÓ‰·ÁÁÂȷ΋ ‹ÍË. ™Ù· ‰È¯ÔÚȷο ‰›‰˘Ì·, Ô ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÙÔ˘ ÂÓfi˜ ‰È‰‡ÌÔ˘ Û˘Ó‹ıˆ˜ ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› Úfi‚ÏËÌ· ÛÙÔ ¿ÏÏÔ, Ì ÂÍ·›ÚÂÛË ÙÔÓ ÚfiˆÚÔ ÙÔÎÂÙfi (4). ∏ ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Â›Ó·È Â›Û˘ ·˘ÍË̤ÓË ÛÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ. ™Ù· ‰›‰˘Ì· ÓÂÔÁÓ¿, Ë ıÓËÛÈÌfiÙËÙ· Â›Ó·È 4-5 ÊÔÚ¤˜ ·˘ÍË̤ÓË Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ, ÂÓÒ fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ÙÚ›‰˘Ì· ÓÂÔÁÓ¿, Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Â›Ó·È 7 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË (4,29,30). O ΛӉ˘ÓÔ˜ ÂÚÈÁÂÓÓËÙÈÎÔ‡ ı·Ó¿ÙÔ˘ ·˘Í¿ÓÂÙ·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ÛÙ· ÓÂÔÁÓ¿ ˘„ËÏfiÙÂÚ˘ Ù¿Í˘ Ôχ‰˘Ì˘ ·ËÛ˘ (31). ∏ ·‡ÍËÛË ·˘Ù‹ Û¯ÂÙ›˙ÂÙ·È Î˘Ú›ˆ˜ Ì ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘, ÚÔÂÎÏ·Ì„›·˜, ÚfiÙˆÛ˘ ÔÌÊ·Ï›‰·˜ Î·È ¿ÏÏˆÓ ÂÈÏÔÎÒÓ (4,29). ¶·Ú’ fiÏÔ Ô˘ Ù· Ôχ‰˘Ì· ÓÂÔÁÓ¿, Û·Ó ÔÌ¿‰·, ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÂÚÈÁÂÓÓËÙÈÎÔ‡ ı·Ó¿ÙÔ˘ ·fi Ù· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ, fiÙ·Ó ÌÂÏÂÙËı› Ë ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ËÏÈΛ· ·ËÛ˘, ‰ÂÓ ‰È·ÈÛÙÒÓÂÙ·È ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ı·Ó¿ÙÔ˘ ÛÙ· Ôχ‰˘Ì· ÓÂÔÁÓ¿ (25). ∞ÓÙ›ıÂÙ·, ‰È·ÈÛÙÒıËΠfiÙÈ ÚfiˆÚ· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ, Ì ËÏÈΛ· ·ËÛ˘ 28-36 ‚‰ÔÌ¿‰Â˜, ‚Ú›ÛÎÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ ÂÚÈÁÂÓÓËÙÈÎÔ‡ ı·Ó¿ÙÔ˘ ·fi Ù· ·ÓÙ›ÛÙÔȯ˘ ‰È¿ÚÎÂÈ·˜ ·ËÛ˘ Ôχ‰˘Ì· ÓÂÔÁÓ¿ (25).

O Û˘Ó‰˘·ÛÌfi˜ ÚÔˆÚfiÙËÙ·˜ Î·È ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ¢ı‡ÓÂÙ·È Î˘Ú›ˆ˜ Î·È ÁÈ· ÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ù· ‰›‰˘Ì· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·. ∆· ÓÂÔÁÓ¿ ‰›‰˘Ì˘ ·ËÛ˘ ÎÈÓ‰˘ÓÂ‡Ô˘Ó Ó· Âı¿ÓÔ˘Ó 5-6 ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·fi Ù· ‚Ú¤ÊË ·fi ·Ϥ˜ ΢‹ÛÂȘ ÛÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ¯ÚfiÓÔ˘ Ù˘ ˙ˆ‹˜ (2,32,33).

¶·È‰È·ÙÚÈ΋ 2004;67:11-18

¢. ¶ÂÚÈÁÂÓÓËÙÈ΋ ÓÔÛËÚfiÙËÙ· ∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ Î·È ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ Â›Ó·È Î˘Ú›ˆ˜ ˘‡ı˘ÓË ÁÈ· ÙËÓ ·˘ÍË̤ÓË ÓÔÛËÚfiÙËÙ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· Ôχ‰˘Ì· ÓÂÔÁÓ¿ (2). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ Ù· ‰›‰˘Ì· ÓÂÔÁÓ¿ ¯ÚÂÈ¿˙ÔÓÙ·È ÂÓÙ·ÙÈ΋ ÓÔÛËÏ›· 8 ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚ· ·fi Ù· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ, ÂÓÒ Ë ÓÔÛËÏ›· ÙÔ˘˜ ·Ú·Ù›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ·fi 28 Ë̤Ú˜, ÛÂ Û˘¯ÓfiÙËÙ· ÌÂÁ·Ï‡ÙÂÚË Î·Ù¿ 21 ÊÔÚ¤˜ (24). °È· Ù· ˘„ËÏfiÙÂÚ˘ Ù¿Í˘ Ôχ‰˘Ì· ÓÂÔÁÓ¿, Ë ÂÚÈÁÂÓÓËÙÈ΋ ÓÔÛËÚfiÙËÙ· Â›Ó·È ·ÎfiÌ· ÈÔ ·˘ÍË̤ÓË (30,31). OÈ ÌÂϤÙ˜ Ô˘ Û˘ÁÎÚ›ÓÔ˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ÓÂÔÁÓÈΤ˜ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ÛÙ· ÓÂÔÁÓ¿ Ôχ‰˘ÌˆÓ Î·È ·ÏÒÓ Î˘‹ÛÂˆÓ Â›Ó·È Ï›Á˜ (1). øÛÙfiÛÔ, Ê·›ÓÂÙ·È fiÙÈ ·Ó Û˘ÁÎÚÈıÔ‡Ó Ù· ÓÂÔÁÓ¿ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Ì ÓÂÔÁÓ¿ ·Ó¿ÏÔÁÔ˘ ‚¿ÚÔ˘˜ Î·È ËÏÈΛ·˜ ·ËÛ˘ ·fi ·Ϥ˜ ΢‹ÛÂȘ, ‰ÂÓ ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ Ô‡Ù ÛÙË ıÓËÛÈÌfiÙËÙ· Ô‡Ù ÛÙË ÓÔÛËÚfiÙËÙ·, Ì ÂÍ·›ÚÂÛË ÌfiÓÔ ÙËÓ ·˘ÍË̤ÓË Â›ÙˆÛË ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ·˜ Ù˘ ÚÔˆÚfiÙËÙ·˜ ÛÙ· ÙÚ›‰˘Ì· ÓÂÔÁÓ¿ Û ۯ¤ÛË Ì ٷ ‰›‰˘Ì· Î·È Ù· ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛÂˆÓ (1,34). ∂. ∞ÒÙÂÚ˜ ÂÈÏÔΤ˜ OÈ ÂÚÈÁÂÓÓËÙÈΤ˜ ÂÈÏÔΤ˜ Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔÓ ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ Î·È ÂÓ‰ÔÌ‹ÙÚÈ·˜ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ ¤¯Ô˘Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ (2). O ΛӉ˘ÓÔ˜ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ ‚Ú¤ıËΠ0,2%, 1,3% Î·È 7,6% Û ·Ϥ˜, ‰›‰˘Ì˜ Î·È ÙÚ›‰˘Ì˜ ΢‹ÛÂȘ, ·ÓÙ›ÛÙÔȯ· (24,29). ∞˘Ùfi˜ Ô ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙË ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· ÙˆÓ Ôχ‰˘ÌˆÓ ÓÂÔÁÓÒÓ Ó· ¤¯Ô˘Ó ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ·ÊÔ‡ Ô Î›Ó‰˘ÓÔ˜ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ ÁÈ· Ù· ÓÂÔÁÓ¿ ·ÏÒÓ Î·È Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ ›‰ÈÔ˘ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ‰ÂÓ ‰È·Ê¤ÚÂÈ ÛËÌ·ÓÙÈο (24,36). ∂Í·›ÚÂÛË ·ÔÙÂÏÔ‡Ó ÌfiÓÔ Ù· Ôχ‰˘Ì· ÓÂÔÁÓ¿ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 2500 g. ™ÙËÓ ÔÌ¿‰· ·˘Ù‹ ‰È·ÈÛÙÒıËΠ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘, ηıÒ˜ Î·È ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ· Û ۯ¤ÛË Ì ·ÓÙ›ÛÙÔÈ¯Ô˘ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛÂˆÓ (24,35). ™ËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ÒÙÂÚ˜ Ó¢ÚÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ ·ÔÙÂÏ› Ô ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜ ÙÔ˘ ÂÓfi˜ ‰È‰‡ÌÔ˘. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ÙÔ ¤Ó· ¤ÌÙÔ ÙˆÓ ÓÂÔÁÓÒÓ ı· ·ÚÔ˘ÛÈ¿ÛÂÈ ÛÔ‚·Ú¿ Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (35). ∂ȉÈο ÁÈ· ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, Ë Â›ÙˆÛ‹ Ù˘ ·Ó¤Ú¯ÂÙ·È Û¯Â‰fiÓ ÛÙÔ 10%, ‰ËÏ·‰‹ 15 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ‰›‰˘ÌˆÓ Ô˘ ÁÂÓÓ‹ıËÎ·Ó Î·È Ù· ‰‡Ô ˙ˆÓÙ·Ó¿ Î·È 60 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÙˆÓ ÓÂÔÁÓÒÓ ·ÏÒÓ Î˘‹ÛÂˆÓ (24,35). ∞ÎfiÌ· Î·È ·Ó Ù· ‰›‰˘Ì· ÓÂÔÁÓ¿ Â›Ó·È ˘ÁÈ‹, Ô Î·Ù·ÌÂÚÈÛÌfi˜ Ù˘ ÁÔÓÈ΋˜ ÚÔÛÔ¯‹˜, Ë ÙÚÈ·‰È΋ ÂÈÎÔÈÓˆÓ›· Î·È ÔÈ ÌÂٷ͇ ÙˆÓ ‰È‰‡ÌˆÓ Û¯¤ÛÂȘ ÌÔÚ›

Paediatriki 2004;67:11-18

Ó· ÂËÚ¿ÛÔ˘Ó ·ÚÓËÙÈο ÙË ÁψÛÛÈ΋ ÙÔ˘˜ ·Ó¿Ù˘ÍË Î·È Ó· Ô‰ËÁ‹ÛÔ˘Ó ·ÚÁfiÙÂÚ· Û ̷ıËÛȷο ÚÔ‚Ï‹Ì·Ù· (2). ∏ ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË ÙˆÓ ·È‰ÈÒÓ ÌÔÚ› Ó· ηı˘ÛÙÂÚ‹ÛÂÈ ‹ Ó· ÌËÓ ÔÏÔÎÏËÚˆı›, ÂÓÒ Ë ÌÂÁ¿ÏË ÂÍ¿ÚÙËÛË ÌÂٷ͇ ÙˆÓ ‰›‰˘ÌˆÓ ·È‰ÈÒÓ ‹ Ô ¤ÓÙÔÓÔ˜ ·ÓÙ·ÁˆÓÈÛÌfi˜ ·Ó¿ÌÂÛ¿ ÙÔ˘˜ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (2). OÈ ÌËÙ¤Ú˜ Ôχ‰˘ÌˆÓ ÓÂÔÁÓÒÓ ÂÌÊ·Ó›˙Ô˘Ó Û ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ηٷıÏÈÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (2). ™∆. ™˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙ· ÌÔÓÔ˙˘ÁˆÙÈο ‰›‰˘Ì· Â›Ó·È ·˘ÍË̤ÓË Û ۯ¤ÛË ÙfiÛÔ Ì ٷ ÓÂÔÁÓ¿ ÌÔÓ‹ÚˆÓ Î˘‹ÛÂˆÓ fiÛÔ Î·È Ì ٷ ‰È˙˘ÁˆÙÈο ‰›‰˘Ì· (1,4). OÚÈṲ̂Ó˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ ‰È¿Ï·Û˘ (.¯. ·ÙÂÏÒ˜ ‰È·¯ˆÚÈṲ̂ӷ ‰›‰˘Ì·) Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·‰Èηۛ· ‰È·›ÚÂÛ˘ ÙÔ˘ ˙˘ÁÒÙË (4). ÕÏϘ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÓˆÚ›˜ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, fiˆ˜ Ë ÛÂÈÚËÓÔÌÂÏ›·, Ë ÔÏÔÚÔÛÂÁÎÂÊ·Ï›· Î·È Ë ·ÓÂÁÎÂÊ·Ï›·, Â›Ó·È ·˘ÍË̤Ó˜ ÛÙ· ÌÔÓÔ˙˘ÁˆÙÈο ‰›‰˘Ì·, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ Èı·Ó‹ ‡·ÚÍË ÂÓfi˜ ÎÔÈÓÔ‡ ·ÈÙ›Ô˘ ÁÈ· ÙË ‰È·›ÚÂÛË ÙÔ˘ ˙˘ÁÒÙË Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· Ù˘ ·ÓˆÌ·Ï›·˜ ‰È¿Ï·Û˘ (1). ∞˘ÍË̤ÓÔ˜ ›ӷÈ, Â›Û˘, Ô Î›Ó‰˘ÓÔ˜ ÛÙ· ÌÔÓÔ¯ÔÚȷο ÓÂÔÁÓ¿ ÁÈ· ÔÈΛϘ ·ÓˆÌ·Ï›Â˜ ‰È¿Ï·Û˘ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ‰È·Ù·Ú·¯‹ ÛÙËÓ ·ÈÌ¿ÙˆÛË ÂÓfi˜ ÈÛÙÔ‡, ÏfiÁˆ ·ÁÁÂÈ·ÎÒÓ ·Ó·ÛÙÔÌÒÛˆÓ. ∆¤ÙÔÈÔ˘ Ù‡Ô˘ ·ÓˆÌ·Ï›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (ÌÈÎÚÔÎÂÊ·Ï›·, ˘‰Ú·ÓÂÁÎÂÊ·Ï›·, ÔÚÂÁÎÂÊ·ÏÈΤ˜ ·ÛÙÂȘ), ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ Á·ÛÙÚÂÓÙÂÚÈÎfi Û‡ÛÙËÌ· (.¯. ·ÙÚËÛ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘) ‹ Ó¤ÎÚˆÛË ÙÔ˘ ÓÂÊÚÈÎÔ‡ ÊÏÔÈÔ‡ (1,37). ÕÏÏÔ˘ Ù‡Ô˘ ·ÓˆÌ·Ï›Â˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÂ Û˘Ì›ÂÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ÛÙË Ì‹ÙÚ·, ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·ËÛ˘, ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ· Û ÌÔÓÔ˙˘ÁˆÙÈο Î·È ‰È˙˘ÁˆÙÈο ‰›‰˘Ì· Î·È ·ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Û ‰È·Ù·Ú·¯¤˜ ı¤Û˘ ÙÔ˘ ¿ÎÚÔ˘ Ô‰fi˜ (1). ¶ÚfiÏË„Ë O ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi˜ ÙÚfiÔ˜ Ì›ˆÛ˘ ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ Â›Ó·È Ë Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ. ∏ ÂÓÙ˘ˆÛȷ΋ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ ÙȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÔÊ›ÏÂÙ·È Î·Ù¿ Ù· ‰‡Ô ÙÚ›Ù· ÛÙȘ ÌÂıfi‰Ô˘˜ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ (38). ∏ Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÌ‚Ú‡ˆÓ Ô˘ Â·Ó·ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙË Ì‹ÙÚ· ηٿ ÙË ‰È·‰Èηۛ· Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘ Î·È Ì›· ÂÚÈÛÛfiÙÂÚÔ ÂÏÂÁ¯fiÌÂÓË ¯Ú‹ÛË ÙˆÓ ˆÔÚÚËÎÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÌÂÈÒÛÔ˘Ó ÛËÌ·ÓÙÈο ÙÔÓ ·ÚÈıÌfi ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ (1,26). ∏ ¯Ú‹ÛË Û΢·ÛÌ¿ÙˆÓ ÚfiÎÏËÛ˘ ˆÔÚÚËÍ›·˜ Â›Ó·È ˘‡ı˘ÓË ÁÈ· ¤Ó· ÛËÌ·ÓÙÈÎfi ̤ÚÔ˜ ÙˆÓ È·ÙÚÔÁÂÓÒÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ (39,40). ∏ ıÂÚ·›· ·˘Ù‹ ›ӷÈ

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Ôχ ÈÔ ·Ï‹ Î·È ¤¯ÂÈ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ÎfiÛÙÔ˜ ·fi ÙȘ ˘fiÏÔÈ˜ ÌÂıfi‰Ô˘˜ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜. øÛÙfiÛÔ, Ë ˘ÂډȤÁÂÚÛË ÙˆÓ ˆÔıËÎÒÓ Ô‰ËÁ› Û˘¯Ó¿ Û Ôχ‰˘ÌË Î‡ËÛË. O ÂÚÈÔÚÈÛÌfi˜ Ù˘ ¯ÔÚ‹ÁËÛ˘ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ ÌfiÓÔ Û Á˘Ó·›Î˜ ·ÓıÂÎÙÈΤ˜ ÛÙË ıÂÚ·›· Ì ÎÈÙÚÈ΋ ÎÏÔÌÈÊ·›ÓË, Ë ¯ÔÚ‹ÁËÛË ¯·ÌËÏfiÙÂÚˆÓ ‰fiÛÂˆÓ ÁÔÓ·‰ÔÙÚÔÈÓÒÓ Î·È Ë ÂÚÈÔ‰È΋ ‰È·ÎÔ‹ Ù˘ ηıËÌÂÚÈÓ‹˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ ÌÂÈÒÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ ˆÚ›Ì·ÓÛ˘ ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤Ó· ˆÔı˘Ï·Î›ˆÓ, ·Ú¿ÏÏËÏ· fï˜ ÌÂÈÒÓÔ˘Ó ÂÏ·ÊÚ¿ Ù· ÔÛÔÛÙ¿ Â›Ù¢Í˘ ·ËÛ˘ (1,2). ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘, Ë Ì›ˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÌ‚Ú‡ˆÓ Ô˘ Â·Ó·ÙÔÔıÂÙÔ‡ÓÙ·È ÛÙË Ì‹ÙÚ· ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ Ôχ‰˘Ì˘ ·ËÛ˘. ∏ Â·Ó·ÙÔÔı¤ÙËÛË ÔÏÏÒÓ ÂÌ‚Ú‡ˆÓ ÛÙË Ì‹ÙÚ· ¤¯ÂÈ Î·ıÈÂÚˆı› Û·Ó Ú·ÎÙÈ΋, Û ̛· ÚÔÛ¿ıÂÈ· ·‡ÍËÛ˘ ÙÔ˘ ÔÛÔÛÙÔ‡ ÂÈÙ˘¯›·˜ Ù˘ ÌÂıfi‰Ô˘. øÛÙfiÛÔ, ÔÏϤ˜ ÂÚÁ·Û›Â˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÂÌʇÙ¢ÛË ÂÚÈÛÛfiÙÂÚˆÓ ·fi ‰‡Ô ÂÌ‚Ú‡ˆÓ ‰ÂÓ ·˘Í¿ÓÂÈ Ù· ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜, ÂÓÒ ·˘Í¿ÓÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ÙÚ›‰˘Ì˘ ·ËÛ˘ (29,41,42). ™Â ÔÏϤ˜ ¯ÒÚ˜, Û‹ÌÂÚ·, Û˘ÓÈÛÙ¿Ù·È Ë ÂÌ‚Ú˘ÔÌÂÙ·ÊÔÚ¿ ÌfiÓÔ ‰‡Ô ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ, ÂÓÒ ÛÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ, Ë ‚ÂÏÙ›ˆÛË ÙˆÓ ÌÂıfi‰ˆÓ ηٿ„˘Í˘ Î·È Ê‡Ï·Í˘ ÙˆÓ ÁÔÓÈÌÔÔÈËÌ¤ÓˆÓ ˆ·Ú›ˆÓ Î·È Ë Â›Ù¢ÍË ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÙÚfiˆÓ ÂÈÏÔÁ‹˜ “ηϋ˜ ÔÈfiÙËÙ·˜” ‚ÈÒÛÈÌˆÓ ÂÌ‚Ú‡ˆÓ ı· ÂÈÙÚ¤„Ô˘Ó ÙËÓ Î·ıȤڈÛË Ù˘ ÛÙÚ·ÙËÁÈ΋˜ Â·Ó·ÙÔÔı¤ÙËÛ˘ ÂÓfi˜ ÌfiÓÔ ÂÌ‚Ú‡Ô˘ (7,43). ∏ Ì›ˆÛË ÂÌ‚Ú‡ˆÓ Û ÂÚ›ÙˆÛË ˘„ËÏ‹˜ Ù¿Í˘ Ôχ‰˘Ì˘ ·ËÛ˘ Â›Ó·È Ì›· ¿ÏÏË Ú·ÎÙÈ΋ Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÁÈ· Ó· ‚ÂÏÙȈı› Ë ¤Î‚·ÛË ·˘ÙÒÓ ÙˆÓ Î˘‹ÛÂˆÓ (1). ∫¿Ùˆ ·fi ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ηıÔ‰‹ÁËÛË, Á›ÓÂÙ·È ¤Á¯˘ÛË 1-2 ml KCl, 2N, ÛÙÔÓ ıÒڷη ÙˆÓ ÂÌ‚Ú‡ˆÓ, Û ËÏÈΛ· 11-12 ‚‰ÔÌ¿‰ˆÓ ·ËÛ˘ (2,44,45). ∂ÈϤÁÔÓÙ·È Ù· ¤Ì‚Ú˘· Ô˘ ¤¯Ô˘Ó ·˘ÍË̤ÓË ·˘¯ÂÓÈ΋ ‰È·Ê¿ÓÂÈ· ‹ ¿ÏÏ· ˘ÂÚ˯ÔÁÚ·ÊÈο ÛÙÔȯ›· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È ·˘Ù¿ Ô˘ Â›Ó·È Â˘ÎÔÏfiÙÂÚ· ÚÔÛÂÁÁ›ÛÈÌ· (2). ∏ ̤ıÔ‰Ô˜ ·˘Ù‹ ÂÌÂÚȤ¯ÂÈ ÙÔÓ Î›Ó‰˘ÓÔ ·ÒÏÂÈ·˜ Ù˘ ·ËÛ˘, Ô ÔÔ›Ô˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÌ‚Ú‡ˆÓ Î·È ˘ÔÏÔÁ›˙ÂÙ·È Û 7,6% ÁÈ· Ù· ÙÚ›‰˘Ì·, 13% ÁÈ· Ù· ÙÂÙÚ¿‰˘Ì· Î·È 20,9% ÁÈ· Ù· ÂÙ¿‰˘Ì· (46). ªÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ‚ÂÏÙ›ˆÛË Ù˘ ¤Î‚·Û˘ ÙÂÙÚ¿‰˘ÌˆÓ ‹ ˘„ËÏfiÙÂÚ˘ Ù¿Í˘ ΢‹ÛÂˆÓ Ô˘ ˘Ê›ÛÙ·ÓÙ·È ‰È·‰Èηۛ· Ì›ˆÛ˘ Û ‰›‰˘ÌË Î‡ËÛË, ÂÓÒ ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ù˘ ÙÚ›‰˘Ì˘ ·ËÛ˘, ÙÔ fiÊÂÏÔ˜ Èı·ÓfiÓ ‰ÂÓ ·ÓÙÈÛÙ·ıÌ›˙ÂÈ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ù˘ ÌÂıfi‰Ô˘ (1,2,47-51). ∏ ·ÔÊ˘Á‹ ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, Ô˘ ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ·ÈÙ›· Ù˘ ·˘ÍË̤Ó˘ ıÓËÙfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ ÛÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ, Â›Ó·È ¤Ó·˜ ¿ÏÏÔ˜ ÛÙfi¯Ô˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ¤Î‚·Û˘ ÙˆÓ Î˘‹ÛÂˆÓ ·˘ÙÒÓ. ∏ ÚÔÊ˘Ï·ÎÙÈ΋ ÂÚ›‰ÂÛË ÙÔ˘

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ÙÚ·¯‹ÏÔ˘ Î·È ¯ÔÚ‹ÁËÛË ‚-·‰ÚÂÓÂÚÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ Ù›ÓÔ˘Ó Ó· ÂÁηٷÏÂÈÊıÔ‡Ó (1). ™‹ÌÂÚ· ‰›ÓÂÙ·È ÂÚÈÛÛfiÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÙÚÔÔÔ›ËÛË ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜, Ì ÙËÓ ÚÔÛÔ¯‹ Ó· ÂÛÙÈ¿˙ÂÙ·È ÛÙËÓ ·ÔÊ˘Á‹ Ù˘ ÔÚıÔÛÙ·Û›·˜ Î·È ÛÙËÓ ÂÏÂÁ¯fiÌÂÓË ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (1,52). ¶·Ú¿ÏÏËÏ·, Ë ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂÌ‚Ú‡ˆÓ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, ηıÒ˜ Î·È Ë ÚÔÛ¿ıÂÈ· ÁÈ· ¤Ó· ÙÔÎÂÙfi ¯ˆÚ›˜ ÂÈÏÔΤ˜ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ¤Î‚·Û˘ Ù˘ Ôχ‰˘Ì˘ ·ËÛ˘ (26). ™˘ÌÂÚ¿ÛÌ·Ù· ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯ÂÈ ·Ú·ÙËÚËı› Ì›· ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛˆÓ, Ë ÔÔ›· ·Ô‰›‰ÂÙ·È ÛÙË ÌÂÙ·ÙfiÈÛË ÚÔ˜ Ù· ¿Óˆ Ù˘ ̤Û˘ ËÏÈΛ·˜ ÙˆÓ ÂÁ·ˆÓ Á˘Ó·ÈÎÒÓ Î·È Î˘Ú›ˆ˜ ÛÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ (7). OÈ Ôχ‰˘Ì˜ ΢‹ÛÂȘ ·ÔÙÂÏÔ‡Ó Î˘‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ì ·˘ÍË̤ӷ ÚÔ‚Ï‹Ì·Ù· ÙfiÛÔ ÁÈ· ÙȘ ÌËÙ¤Ú˜ fiÛÔ Î·È ÁÈ· Ù· ÓÂÔÁÓ¿. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Â›Ó·È ·˘ÍË̤Ó˜. ∆· ÓÂÔÁÓ¿ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ ‚Ú›ÛÎÔÓÙ·È Û ÛËÌ·ÓÙÈο ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÁÂÓÓËıÔ‡Ó ÚfiˆÚ· Î·È Ì ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ (1). O ΛӉ˘ÓÔ˜ ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ Â›Ó·È ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ ·ÏÒÓ Î˘‹ÛˆÓ. ∏ ÚfiÏË„Ë ÙˆÓ ÂÈÏÔÎÒÓ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ ·ÊÔÚ¿ ÛÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ΢ڛˆ˜ fï˜ ÛÙË Ì›ˆÛË Ù˘ Û˘¯ÓfiÙËÙ¿˜ ÙÔ˘˜. ∏ ÔÚıÔÏÔÁÈÛÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÂıfi‰ˆÓ ˘Ô‚ÔËıÔ‡ÌÂÓ˘ ·Ó··Ú·ÁˆÁ‹˜ ·ÔÙÂÏ› ÙËÓ Î‡ÚÈ· ̤ıÔ‰Ô ÚfiÏ˄˘ ÙˆÓ Ôχ‰˘ÌˆÓ ΢‹ÛÂˆÓ Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙÔ˘˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Warner µB, Kiely JL, Donovan EF. Multiple births and outcome. Clin Perinatol 2000;27:347-361.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 31-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-10-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 713 05, ∏Ú¿ÎÏÂÈÔ

¶·È‰È·ÙÚÈ΋ 2004;67:19-25

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Paediatriki 2004;67:19-25

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º˘Ì·Ù›ˆÛË Î·È Î‡ËÛË: ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡ ∞. ª·ÓÔ˘Ú¿, ¡. ∫·Ù˙ËÏ¿Î˘

Tuberculosis and pregnancy: treatment of the mother and neonate A. Manoura, N. Katzilakis

¶ÂÚ›ÏË„Ë: ∏ ÂȉËÌÈÔÏÔÁ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ¶·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ Î·È ·È‰È¿, ÌÂÙ·‚ÔÏ‹ Ô˘ ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·˘ÍË̤ÓË Â›ÙˆÛË Ù˘ Ïԛ̈͢ ·fi ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, ηıÒ˜ Î·È ÛÙÔÓ ÔÏÔ¤Ó· ·˘Í·ÓfiÌÂÓÔ ·ÚÈıÌfi ÌÂÙ·Ó·ÛÙÒÓ ·fi ¯ÒÚ˜ Ì ˘„ËÏfi ‰Â›ÎÙË ‰È·ÌfiÏ˘ÓÛ˘. ∏ Ê˘Ì·Ù›ˆÛË ÛÙ· ÓÂÔÁÓ¿ ÌÔÚ› Ó· Â›Ó·È Â›ÙÂ Û˘ÁÁÂÓ‹˜, ·Ó Ë ÌfiÏ˘ÓÛË Á›ÓÂÙ·È ÂÓ‰ÔÌ‹ÙÚÈ·, ›Ù Â›ÎÙËÙË. ™ÙË Û˘ÁÁÂÓ‹ Ê˘Ì·Ù›ˆÛË, ÙÔ ¤Ì‚Ú˘Ô ÚÔÛ‚¿ÏÏÂÙ·È ·fi ÙÔÓ ÌÔÏ˘Ṳ̂ÓÔ Ï·ÎÔ‡ÓÙ· ·ÈÌ·ÙÔÁÂÓÒ˜ ̤ۈ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ ‹ ÌÂÙ¿ ·fi ηٿÔÛË ÌÔÏ˘Ṳ̂ÓÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡. ™ÙËÓ Â›ÎÙËÙË ÓfiÛÔ, ÙÔ ÓÂÔÁÓfi Û˘Ó‹ıˆ˜ ÌÔχÓÂÙ·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ì ÂÈÛÓÔ‹ ÌÔÏ˘ÛÌ¤ÓˆÓ ÛÙ·ÁÔÓȉ›ˆÓ ·fi ÌËÙ¤Ú· Ì Ó¢ÌÔÓÈ΋ ÓfiÛÔ Î·È ·ÚÔ˘Û›· ÎÔÈÏÔًوÓ. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙËÓ ¤ÁÎ˘Ô Î·È ÛÙÔ ÓÂÔÁÓfi Û˘¯Ó¿ Â›Ó·È ÌË ÂȉÈΤ˜. ∂Ô̤ӈ˜, Ë ‰ÈÂÚ‡ÓËÛË, Â› ·ÚÔ˘Û›·˜ ¿Ù˘ˆÓ Û˘Ìو̿وÓ, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Î·È ÚÔ˜ ÙËÓ Î·Ù‡ı˘ÓÛË Ù˘ Ê˘Ì·Ù›ˆÛ˘. ªÂ ‚¿ÛË ÙË Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË (Mantoux) Î·È Ù· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù·, Ï·Ì‚¿ÓÂÙ·È Ë ·fiÊ·ÛË ÁÈ· ÙË Ï‹„Ë ıÂÚ·›·˜ ‹ ¯ËÌÂÈÔÚÔʇϷ͢ Ù˘ ÂÁ·Ԣ ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È ÁÈ· ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ‹ fi¯È ÙÔ˘ ÓÂÔÁÓÔ‡ ·fi ÙË ÌËÙ¤Ú·. ∏ ¿Ù˘Ë Û˘Ìو̷ÙÔÏÔÁ›· ÛÙ· ÓÂÔÁÓ¿ Ô‰ËÁ› Û ηı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË, Ì ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓË ıÓËÛÈÌfiÙËÙ·. ∏ ¤ÁηÈÚË ·Ó›¯Ó¢ÛË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È Ë Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂÁ·Ԣ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡ Ù˘ ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ˜ ηıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ÚfiÁÓˆÛË.

Abstract: The epidemiology of tuberculosis has changed over recent years, with an increase of cases in children, young adults and women of childbearing age. The increased incidence of human immunodeficiency virus (HIV) infection and the rise in immigration from countries with a high incidence of tuberculosis are the main factors contributing to this change. Tuberculosis in the newborn infant may be either congenital, acquired in utero, or neonatal. Congenital tuberculosis can be acquired from the infected placenta via the umbilical vein, or by aspiration or ingestion of infected amniotic fluid.

The most common mode of transmission is by inhalation of infected droplets postnatally, from a mother with cavitary pulmonary tuberculosis. The clinical manifestations of tuberculosis in the pregnant woman and the newborn infant are usually non-specific, and the presence of atypical symptoms should arouse the suspicion of tuberculosis, as delayed diagnosis may result in increased infant mortality.

Decision on antituberculous treatment and the separation of the newborn infant from its mother are based on the tuberculin skin test (Mantoux test) and the clinical status and laboratory findings of the pregnant woman and the infant. Diagnosis of the disease in pregnancy and appropriate treatment of the pregnant woman and her newborn infant are associated with an excellent prognosis.

§¤ÍÂȘ ÎÏÂȉȿ: Ê˘Ì·Ù›ˆÛË, ·ËÛË, ÓÂÔÁÓÈ΋ ËÏÈΛ·.

Key words: tuberculosis, pregnancy, neonatal period.

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

Department of Neonatology of the University of Crete, Heraklion, Crete

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∂ÈÛ·ÁˆÁ‹ ∆Ô Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ù˘ Ê˘Ì·Ù›ˆÛ˘ ·Ú·Ì¤ÓÂÈ ¤Ó· ·fi Ù· ·ÚÈ· ·›ÙÈ· ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ·ÁÎÔÛÌ›ˆ˜, ·Ú¿ ÙËÓ ÂͤÏÈÍË ÛÙȘ ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÓÙÈÊ˘Ì·ÙÈ΋˜ ıÂÚ·›·˜ (1). ªÂÙ¿ ·fi ‰ÂηÂٛ˜ ÛÙ·‰È·Î‹˜ Ì›ˆÛ˘ Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (1-3). ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·‡ÍËÛË ÙˆÓ Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ Ê˘Ì·Ù›ˆÛ˘, ·Ú·ÙËÚÂ›Ù·È Î·È ÌÂÙ·ÙfiÈÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÚÔ˜ ¯·ÌËÏfiÙÂÚ˜ ËÏÈ˘, Ì ÔÏÏ¿ Ó¤· ÎÚÔ‡ÛÌ·Ù· Ó· ·ÊÔÚÔ‡Ó Û Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ ηÈ, ÂÔ̤ӈ˜, Û Á˘Ó·›Î˜ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜, ηıÒ˜ Î·È Û ·È‰È¿ (1-5). ∫·Ù¿ Û˘Ó¤ÂÈ·, ÂÓÒ Ì¤¯ÚÈ ÙÔ 1985 Ë Ê˘Ì·Ù›ˆÛË ÛÙËÓ Î‡ËÛË Î·È ÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ‹Ù·Ó ·Û˘Ó‹ı˘, Û‹ÌÂÚ· Ê·›ÓÂÙ·È ˆ˜ ·ÔÙÂÏ› ¤Ó· ÔÏÔ¤Ó· Î·È Û˘¯ÓfiÙÂÚ· ÂÌÊ·ÓÈ˙fiÌÂÓÔ Úfi‚ÏËÌ· (1,3). ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË, ÌÂÙ¿ ·fi Û‡ÓÙÔÌË ·Ó·ÊÔÚ¿ ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· Î·È ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, Û˘ÓÔ„›˙ÔÓÙ·È ÔÈ ·fi„ÂȘ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙËÓ ¤Á΢Ô, ηıÒ˜ Î·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Ù˘. ∂ȉËÌÈÔÏÔÁ›· ™ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ·fi ÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Î·È Ì›ˆÛË ÛÙÔ ËÏÈÎÈ·Îfi Ê¿ÛÌ· Ô˘ ηْ ÂÍÔ¯‹Ó ÚÔÛ‚¿ÏÏÂÙ·È (1,3,6). ™ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜, ·fi ÙÔ 1985 ¤ˆ˜ ÙÔ 1992, ·ÚÔ˘ÛÈ¿ÛÙËΠ·‡ÍËÛË 20% ÛÙ· Û˘ÓÔÏÈο ÎÚÔ‡ÛÌ·Ù· Ù˘ ÓfiÛÔ˘, Ë ÔÔ›· ·Ô‰›‰ÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÙË ÌÂÙ·Ó¿ÛÙ¢ÛË ·fi ¯ÒÚ˜ Ì ˘„ËÏ‹ Â›ÙˆÛË Ê˘Ì·Ù›ˆÛ˘ (8-11). ™ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·Ú·ÙËÚÂ›Ù·È Û ÌÂÙ·Ó¿ÛÙ˜ (2,4,12,13). ™ÙËÓ ÔÌ¿‰· ·˘Ù‹, Ù· ÎÚÔ‡ÛÌ·Ù· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· Û ÂÊ‹‚Ô˘˜ Î·È Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ (3). ∏ ÂȉËÌÈÔÏÔÁÈ΋ ·˘Ù‹ ÌÂÙ·‚ÔÏ‹ ¤¯ÂÈ Ô‰ËÁ‹ÛÂÈ Û ·‡ÍËÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ê˘Ì·Ù›ˆÛ˘ ÛÙȘ Á˘Ó·›Î˜ ·Ó··Ú·ÁˆÁÈ΋˜ ËÏÈΛ·˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙËÓ Î‡ËÛË Î·È, ηٿ Û˘Ó¤ÂÈ·, ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (1,3,10,12,14). ∞ÏÏËÏÂ›‰Ú·ÛË Î‡ËÛ˘ Î·È Ê˘Ì·Ù›ˆÛ˘ OÈ ·fi„ÂȘ ÁÈ· ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË Î‡ËÛ˘ Î·È Ê˘Ì·Ù›ˆÛ˘ ¤¯Ô˘Ó ·ÏÏ¿ÍÂÈ ÚÈ˙Èο Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. O πÔÎÚ¿Ù˘ ˘ÔÛÙ‹ÚÈ˙ fiÙÈ Ë Î‡ËÛË Â›¯Â ıÂÙÈ΋ Â›‰Ú·ÛË ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ (3,15,16). ∏ ¿Ô„Ë ·˘Ù‹ ‰È·ÙËÚ‹ıËΠ·ÌÂÙ¿‚ÏËÙË Ì¤¯ÚÈ Ù· ̤۷ ÙÔ˘ 19Ô˘ ·ÈÒÓ·, ÔfiÙÂ Ô Grisolle ‰È·Ù‡ˆÛ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙËÓ ·ÓÙ›ıÂÙË ¿Ô„Ë

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Paediatriki 2004;67:19-25

(3,15). ∞fi ÙfiÙÂ, ˘ÔÛÙËÚ›¯ÙËΠÙfiÛÔ ¤ÓÙÔÓ· Ë ¿Ô„Ë fiÙÈ Ë Î‡ËÛË ¤¯ÂÈ ‰˘ÛÌÂÓ‹ Â›‰Ú·ÛË ÛÙËÓ ÔÚ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘, ÒÛÙ ÔÈ ÁÈ·ÙÚÔ› Ù˘ ÂÔ¯‹˜ Û˘ÓÈÛÙÔ‡Û·Ó ıÂÚ·¢ÙÈ΋ ¤ÎÙÚˆÛË ÛÙȘ ¤ÁÎ˘Â˜ ·ÛıÂÓ›˜ ÙÔ˘˜. ™ÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’40, ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë Î‡ËÛË ‰ÂÓ Â›¯Â Ô‡Ù ıÂÙÈ΋ Ô‡Ù ·ÚÓËÙÈ΋ Â›‰Ú·ÛË ÛÙË ÓfiÛÔ (3,17). ∆Ô ÂӉȷʤÚÔÓ ÁÈ· ·˘Ùfi ÙÔ ı¤Ì· ÌÂÈÒıËΠ̠ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ıÂÚ·›·˜ (4,18). ªÂ ÙËÓ Î·Ù¿ÏÏËÏË ·ÁˆÁ‹, Ë ¤ÁÎ˘Ô˜ Á˘Ó·›Î· ÌÂ Ê˘Ì·Ù›ˆÛË ¤¯ÂÈ ÙËÓ ›‰È· ηϋ ÔÚ›· Ì ÙËÓ ·ÛıÂÓ‹ ›‰È·˜ ËÏÈΛ·˜ Ô˘ ‰ÂÓ Â›Ó·È ¤ÁÎ˘Ô˜ (1,4). ¶ÔÏϤ˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë Î‡ËÛË, Ô ÙÔÎÂÙfi˜, Ë Ïԯ›· ‹ Ô ıËÏ·ÛÌfi˜ ‰ÂÓ ÂȉÚÔ‡Ó ·ÚÓËÙÈο ÛÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘ Û Á˘Ó·›Î˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ıÂÚ·›· (1). ∏ ÂͤÏÈÍË Ù˘ ·Û˘Ìو̷ÙÈ΋˜ Ïԛ̈͢ Û ÂÓÂÚÁ‹ ÓfiÛÔ Î·Ù¿ ÙËÓ Î‡ËÛË ·ÔÙÂÏ›, ÚÔ˜ ÙÔ ·ÚfiÓ, ·ÓÙÈΛÌÂÓÔ ÌÂϤÙ˘. øÛÙfiÛÔ, Ê·›ÓÂÙ·È ·›ı·ÓÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Î‡ËÛË ‹ Ë Ïԯ›· ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂͤÏÈÍË Ù˘ ÌfiÏ˘ÓÛ˘ Û ÓfiÛÔ (1,3,15). ∏ ¤Î‚·ÛË Ù˘ ·ËÛ˘, fiÙ·Ó Ë ¤ÁÎ˘Ô˜ ÓÔÛ›, ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÛÙ¿‰ÈÔ Î·È ÙËÓ ÂÓÙfiÈÛË Ù˘ ÓfiÛÔ˘, ηıÒ˜ Î·È ·fi ÙË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ Ù˘ ‰È¿ÁÓˆÛ˘ Û ۯ¤ÛË Ì ÙÔÓ ÙÔÎÂÙfi (3). ∏ Ê˘Ì·Ù›ˆÛË ÙˆÓ ÏÂÌÊ·‰¤ÓˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙËÓ ¤Î‚·ÛË (3). ∏ Ó¢ÌÔÓÈ΋ Ê˘Ì·Ù›ˆÛË Â›Ó·È Ë ÌÔÚÊ‹ Ô˘ Û˘Ó‰¤ÂÙ·È Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· (19,20). ™ÙȘ ÂÚÈÙÒÛÂȘ ηı˘ÛÙÂÚË̤Ó˘ ‰È¿ÁÓˆÛ˘, Ë Ì·È¢ÙÈ΋ ÓÔÛËÚfiÙËÙ· ÙÂÙÚ·Ï·ÛÈ¿˙ÂÙ·È Î·È Ë Û˘¯ÓfiÙËÙ· ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡ Â›Ó·È ÂÓÓ¤· ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË (3,21,22). ™Â ¿ÏϘ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ·˘ÍË̤ӷ ÔÛÔÛÙ¿ ·Ô‚ÔÏÒÓ, ÙÔÍÈÓ·ÈÌ›·˜ Î·È ÂÈÏÔÎÒÓ Î·Ù¿ ÙÔÓ ÙÔÎÂÙfi, ηıÒ˜ Î·È ·˘ÍË̤ӷ ÔÛÔÛÙ¿ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È Î·ı˘ÛÙ¤ÚËÛ˘ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ·Ó¿Ù˘ÍË, Ô˘ ÔÊ›ÏÔÓÙ·È Î˘Ú›ˆ˜ ÛÙËÓ Î·ı˘ÛÙÂÚË̤ÓË ‰È¿ÁÓˆÛË Î·È ıÂÚ·›· (21-24). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ‰È¿ÁÓˆÛË Á›ÓÂÙ·È ÓˆÚ›˜ ÛÙËÓ Î‡ËÛË, Ë ÚfiÁÓˆÛË ‰ÂÓ ÂËÚ¿˙ÂÙ·È ·fi ÙË ÓfiÛÔ (1,3,19,23,25,26). ¢È¿ÁÓˆÛË Ïԛ̈͢ ·fi Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ ÛÙËÓ Î‡ËÛË ™ÙÔ ÈÛÙÔÚÈÎfi Ô˘ Ï·Ì‚¿ÓÂÙ·È ·fi ÙËÓ ¤ÁÎ˘Ô ÛÙËÓ ·Ú¯‹ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÚˆÙ‹ÛÂȘ Û¯ÂÙÈο Ì ÚÔËÁËı›۷ ÓfiÛËÛË ‹ ÌfiÏ˘ÓÛË ·fi Ê˘Ì·Ù›ˆÛË, Â·Ê‹ Ì ¿ÙÔÌÔ Ô˘ ÓÔÛ› ‹ ‡·ÚÍË Û˘ÌÙˆÌ¿ÙˆÓ Û˘Ì‚·ÙÒÓ Ì ÙË ÓfiÛÔ. ¶ÔÏÏÔ› Û˘ÓÈÛÙÔ‡Ó Ó· Á›ÓÂÙ·È Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË (Mantoux) Û fiϘ ÙȘ ¤ÁÎ˘Â˜ Á˘Ó·›Î˜. OÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂȉÈÎÔ›, fï˜, ıˆÚÔ‡Ó fiÙÈ Ë Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÌfiÓÔ ÛÙȘ Á˘Ó·›Î˜ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ÓfiÛÔ (3,27,28). ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ ÙÔ

¶·È‰È·ÙÚÈ΋ 2004;67:19-25

ÁÂÁÔÓfi˜ fiÙÈ Ë Ïԛ̈ÍË Ì ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· „¢‰Ò˜ ·ÚÓËÙÈ΋ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË. °È· ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ, ÛÙȘ Á˘Ó·›Î˜ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ïԛ̈ÍË Ì ÙÔÓ Èfi ‹ Û ÂΛӘ Ô˘ ‹‰Ë ¤¯Ô˘Ó ÌÔÏ˘Óı›, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰ÈÂÍÔ‰ÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ÁÈ· Ïԛ̈ÍË Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ (1). ŸÙ·Ó ‰È·ÈÛÙˆı› ıÂÙÈ΋ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË, Â›Ó·È ··Ú·›ÙËÙÔ Ó· Á›ÓÂÙ·È Î·È ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ (1,19). ¶·Ú¿ÏÏËÏ·, ··ÈÙÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi Â͈Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ (19,23). ∏ Â›‰Ú·ÛË Ù˘ ·ËÛ˘ ÛÙËÓ ˘ÂÚ¢·ÈÛıËÛ›· ÛÙË Ê˘Ì·Ù›ÓË ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹. ¶·Ú’ fiÏÔ Ô˘ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ÏÂÌÊÔ΢ÙÙ·ÚÈ΋ ·¿ÓÙËÛË ÛÙË Ê˘Ì·Ù›ÓË in vitro Â›Ó·È ÌÂȈ̤ÓË, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÌʈÓÔ‡Ó fiÙÈ Ë Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË Â›Ó·È ·ÍÈfiÈÛÙË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ (1,3). ¶·ıÔÁ¤ÓÂÈ· ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙËÓ ¤ÁÎ˘Ô Á˘Ó·›Î· ‰ÂÓ ‰È·Ê¤ÚÂÈ ·fi ÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘ ÛÙÔÓ ˘fiÏÔÈÔ ÏËı˘ÛÌfi, ÂÓÒ Ë ÌfiÏ˘ÓÛË Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ Ì ÂÈÛÓÔ‹ ‚·Î›ÏˆÓ (4). ∆· Ì˘ÎÔ‚·ÎÙËÚ›‰È·, ÂÈÛ¤Ú¯ÔÓÙ·È ·fi ÙȘ ΢„ÂÏ›‰Â˜ ÛÙ· ·ÈÌÔÊfiÚ· ·ÁÁ›· Î·È Ù· ÏÂÌÊ·ÁÁ›· Î·È ‰È·Û›ÚÔÓÙ·È Û ÔÏfiÎÏËÚÔ ÙÔÓ ÔÚÁ·ÓÈÛÌfi. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·˘Ù‹˜ Ù˘ Ê¿Û˘, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÌÔÏ˘ÓıÔ‡Ó Ù· ¤Ûˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·, ÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ Î·È Ô Ï·ÎÔ‡ÓÙ·˜ (1). ™˘¯ÓfiÙÂÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È ÔÈ Û¿ÏÈÁÁ˜ (90-100% ÙˆÓ Á˘Ó·ÈÎÒÓ ÌÂ Ê˘Ì·Ù›ˆÛË ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ) Î·È ·ÎÔÏÔ˘ı› ÛÂ Û˘¯ÓfiÙËÙ· Ë Ì‹ÙÚ· (50-60%) (17,19). ∆ÚÂȘ ÌÔÚʤ˜ Ê˘Ì·Ù›ˆÛ˘ Ù˘ ÌËÙ¤Ú·˜ ÌÔÚ› Ó· ı¤ÛÔ˘Ó Û ΛӉ˘ÓÔ ÙÔ ¤Ì‚Ú˘Ô ‹ ÙÔ ÓÂÔÁÓfi: ·) Ë ÂÓÂÚÁ‹ Ó¢ÌÔÓÈ΋ Ê˘Ì·Ù›ˆÛË, ‚) Ë ÚˆÙÔ·ı‹˜ Ïԛ̈ÍË, Ô˘ ηٿ ηÓfiÓ· Û˘Óԉ‡ÂÙ·È ·fi ÏÂÌÊÔ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔÚ¿, ·Û˘Ìو̷ÙÈ΋ ‹ ÎÏÈÓÈο ÂÌÊ·Ó‹ (ÎÂÁ¯ÚÔÂȉ‹˜ Ê˘Ì·Ù›ˆÛË) Î·È Á) Ë Ê˘Ì·ÙÈ҉˘ ÂÓ‰ÔÌËÙÚ›Ùȉ· (19). ∏ Ê˘Ì·Ù›ˆÛË ÛÙÔ ÓÂÔÁÓfi ÌÔÚ› Ó· Â›Ó·È Â›ÙÂ Û˘ÁÁÂÓ‹˜, fiÙ·Ó Ë ÌfiÏ˘ÓÛË ¤¯ÂÈ Û˘Ì‚Â› ÂÓ‰ÔÌ‹ÙÚÈ·, ›Ù Â›ÎÙËÙË, fiÙ·Ó ÙÔ ÓÂÔÁÓfi ÌÔχÓÂÙ·È ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ ·fi ÙË ÌËÙ¤Ú· ÙÔ˘ ‹ ¿ÏÏ· ¿ÙÔÌ· ÙÔ˘ ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙfi˜ ÙÔ˘ (1,3). ∏ ÂÈÛÓÔ‹ ÌÔÏ˘ÛÌ¤ÓˆÓ ÛÙ·ÁÔÓȉ›ˆÓ ·ÔÙÂÏ› ÙÔÓ Û˘ÓËı¤ÛÙÂÚÔ ÙÚfiÔ ÂÚÈÁÂÓÓËÙÈ΋˜ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘ (7). ∏ Û˘ÁÁÂÓ‹˜ Ê˘Ì·Ù›ˆÛË ÚÔ¸Ôı¤ÙÂÈ ÚˆÙÔ·ı‹ Ê˘Ì·Ù›ˆÛË Ù˘ ÌËÙ¤Ú·˜ ‹ Ê˘Ì·ÙÈÒ‰Ë ÂÓ‰ÔÌËÙÚ›Ùȉ· (7,29). OÈ ÌËÙ¤Ú˜ ÓÂÔÁÓÒÓ ÌÂ Û˘ÁÁÂÓ‹ Ê˘Ì·Ù›ˆÛË ÓÔÛÔ‡Ó Î·Ù¿ ÙËÓ Î‡ËÛË ‹ ·Ì¤Ûˆ˜ ÌÂÙ¿, ·fi Ì›· ·fi ÙȘ ÂΉËÏÒÛÂȘ Ù˘ ÚˆÙÔ·ıÔ‡˜ ÏÔ›-

Paediatriki 2004;67:19-25

̈͢ (Ê˘Ì·ÙÈÒ‰Ë ÌËÓÈÁÁ›Ùȉ·, ÎÂÁ¯ÚÔÂȉ‹ Ê˘Ì·Ù›ˆÛË ‹ Ê˘Ì·ÙÈÒ‰Ë Ï¢ڛÙȉ·) (19). ™ÙË Û˘ÁÁÂÓ‹ Ê˘Ì·Ù›ˆÛË ÚÔÛ‚¿ÏÏÂÙ·È, ηْ ·Ú¯¿˜, Ô Ï·ÎÔ‡ÓÙ·˜. ∞ÈÌ·ÙÔÁÂÓ‹˜ ÌÂÙ¿‰ÔÛË ÙˆÓ Ì˘ÎÔ‚·ÎÙËÚȉ›ˆÓ ÛÙÔ ¤Ì‚Ú˘Ô Î·Ù¢ı›·Ó ·fi ÙË ÌËÙÚÈ΋ ΢ÎÏÔÊÔÚ›·, ¯ˆÚ›˜ Ó· ¤¯ÂÈ ÚÔËÁËı› ‰ËÌÈÔ˘ÚÁ›· Ù˘ÚÔÂȉÔÔÈË̤Ó˘ ‚Ï¿‚˘ ÛÙÔÓ Ï·ÎÔ‡ÓÙ·, ‰ÂÓ ¤¯ÂÈ ·Ô‰Âȯı› ÛÙÔÓ ¿ÓıÚˆÔ (1,18). øÛÙfiÛÔ, Ë ÌfiÏ˘ÓÛË ÙÔ˘ Ï·ÎÔ‡ÓÙ· ‰ÂÓ Û˘ÓÂ¿ÁÂÙ·È ··Ú·›ÙËÙ· ÙË ÌfiÏ˘ÓÛË Î·È ÙÔ˘ ÂÌ‚Ú‡Ô˘ (3,7). ∆Ô ¤Ì‚Ú˘Ô ÌÔÚ› Ó· ÌÔÏ˘Óı› Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Â›Ù ·ÈÌ·ÙÔÁÂÓÒ˜, ̤ۈ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ, ›Ù Ì ηٿÔÛË ‹ ÂÈÛÚfiÊËÛË ÌÔÏ˘Ṳ̂ÓÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ (1,3,7). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ÌfiÏ˘ÓÛË Ì¤Ûˆ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ, Ë ÏÂÌÊÔ·ÈÌ·ÙÔÁÂÓ‹˜ ‰È·ÛÔÚ¿ Ù˘ ÓfiÛÔ˘ ÛÙË ÌËÙ¤Ú· ‹, Û·ÓÈfiÙÂÚ·, Ë Ê˘Ì·ÙÈ҉˘ ÂÓ‰ÔÌËÙÚ›Ùȉ· ¤¯Ô˘Ó Ô‰ËÁ‹ÛÂÈ Û ÌfiÏ˘ÓÛË ÙÔ˘ Ï·ÎÔ‡ÓÙ·, ÂÓÒ Ù· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ÚÔÛ‚¿ÏÏÔ˘Ó ÙÔ ¤Ì‚Ú˘Ô Ì¤Ûˆ Ù˘ ÔÌÊ·ÏÈ΋˜ ÊϤ‚·˜. ∆Ô ÚˆÙÔ·ı¤˜ Û‡ÌÏÂÁÌ· ·Ó·Ù‡ÛÛÂÙ·È ÛÙÔ ‹·Ú ÌÂ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ˘Ï·›ˆÓ ÏÂÌÊ·‰¤ÓˆÓ (1,19). øÛÙfiÛÔ, ÔÈ ‚¿ÎÈÏÔÈ ÌÔÚÔ‡Ó, ̤ۈ ÙÔ˘ ‹·ÙÔ˜, Ó· ÂÈÛ¤ÏıÔ˘Ó ÛÙË Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·, Ì ·ÔÙ¤ÏÂÛÌ· Ë ÚˆÙÔ·ı‹˜ ÂÛÙ›· Ó· ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÛÙÔ˘˜ Ó‡ÌÔÓ˜ (1,19). ∆· Ì˘ÎÔ‚·ÎÙËÚ›‰È· ·Ú·Ì¤ÓÔ˘Ó Û ·‰Ú¿ÓÂÈ· ̤¯ÚÈ ÙË Á¤ÓÓËÛË, ÔfiÙ Ì ÙËÓ ·‡ÍËÛË Ù˘ Ô͢ÁfiÓˆÛ˘ Î·È Ù˘ Ó¢ÌÔÓÈ΋˜ ΢ÎÏÔÊÔÚ›·˜ ·Ú¯›˙Ô˘Ó Ó· ÔÏÏ·Ï·ÛÈ¿˙ÔÓÙ·È Î·È Ô‰ËÁÔ‡Ó ÛÙËÓ ÂΉ‹ÏˆÛË Ó¢ÌÔÓÈ΋˜ Ê˘Ì·Ù›ˆÛ˘ ÛÙÔ ÓÂÔÁÓfi (1,19). ∞Ó Û˘Ì‚Â› Ú‹ÍË Ù˘ÚÔÂȉÔÔÈË̤Ó˘ ‚Ï¿‚˘ ÙÔ˘ Ï·ÎÔ‡ÓÙ· ÚÔ˜ ÙËÓ ·ÌÓȷ΋ ÎÔÈÏfiÙËÙ·, ÙÔ ¤Ì‚Ú˘Ô ÌÔÚ› Ó· ÌÔÏ˘Óı› Ì ηٿÔÛË ‹ ÂÈÛÚfiÊËÛË ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÏÏ·Ϥ˜ ÚˆÙÔ·ı›˜ ÂÛٛ˜ ÛÙÔ ¤ÓÙÂÚÔ, ÙÔ˘˜ Ó‡ÌÔÓ˜ Î·È ÙÔ Ì¤ÛÔ Ô˘˜ (1,19). ∫ÏÈÓÈ΋ ÂÈÎfiÓ· ∞. ™ÙËÓ ¤ÁÎ˘Ô ∏ Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙ˜ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ηıÔÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ÂÓÙfiÈÛË Ù˘ ÓfiÛÔ˘ Î·È ÙË ‚·Ú‡ÙËÙ¿ Ù˘. ∏ Û˘¯ÓfiÙÂÚË ÂÓÙfiÈÛË Â›Ó·È Ë Ó¢ÌÔÓÈ΋ Î·È Ù· ÈÔ ÎÔÈÓ¿ Û˘ÌÙÒÌ·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ‚‹¯· (74%), ·ÒÏÂÈ· ‚¿ÚÔ˘˜ (41%), ˘ÚÂÙfi (30%), ·‰˘Ó·Ì›· Î·È Î·ÎÔ˘¯›· (30%) Î·È ·ÈÌfiÙ˘ÛË (19%) (3). ∆Ô 20% ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙˆÓ ·ÛıÂÓÒÓ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Û˘ÌÙÒÌ·Ù· (1,3,22,23). ∏ ‰È¿ÁÓˆÛË Û˘¯Ó¿ ηı˘ÛÙÂÚ›, ηıÒ˜ Ù· ÌË ÂȉÈο Û˘ÌÙÒÌ·Ù· Ù˘ ÓfiÛÔ˘ Û˘Á¯¤ÔÓÙ·È Ì ÙËÓ Î·ÎÔ˘¯›· Ô˘ ·Ú·ÙËÚÂ›Ù·È Î·Ù¿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È, ÂÈϤÔÓ, Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û˘Ó‹ıˆ˜ ·Ó·‚¿ÏÏÂÙ·È ÁÈ· ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi (1,3,23,30,31). ™Â ÌÂÁ¿ÏÔ

21

¶·È‰È·ÙÚÈ΋ 2004;67:19-25

ÔÛÔÛÙfi Á˘Ó·ÈÎÒÓ, Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·ÊÔ‡ ÂΉËψı› Ë ÓfiÛÔ˜ ÛÙÔ ÓÂÔÁÓfi ÙÔ˘˜ (14). ™Â 5-10% ÙˆÓ ÂÁ·ˆÓ ÌÂ Ê˘Ì·Ù›ˆÛË, ‰È·ÈÛÙÒÓÂÙ·È Â͈Ó¢ÌÔÓÈ΋ ÂÓÙfiÈÛË Ù˘ ÓfiÛÔ˘ (1,3). µ. ™ÙÔ ÓÂÔÁÓfi ∏ ÓfiÛÔ˜ ÛÙÔ ÓÂÔÁÓfi ÌÔÚ› Ó· ÂΉËψı› ·fi ÙË Á¤ÓÓËÛË, Û˘Ó‹ıˆ˜ fï˜, Ù· Û˘ÌÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ÙË ‰Â‡ÙÂÚË ‹ ÙÚ›ÙË Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜ (7,19). OÈ Û˘ÓËı¤ÛÙÂÚ˜ ÂΉËÏÒÛÂȘ Â›Ó·È Ë ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, Ô ˘ÚÂÙfi˜, Ë Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È Ë ÏÂÌÊ·‰ÂÓÔ¿ıÂÈ·, ÂÓÒ Ô ÌÂÙˆÚÈÛÌfi˜, Ô Ï‹ı·ÚÁÔ˜ ‹ Ë Â˘ÂÚÂıÈÛÙfiÙËÙ·, ÔÈ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜, ÔÈ ¤ÌÂÙÔÈ Î·È Ô ›ÎÙÂÚÔ˜ Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ ÛËÌ›· (1,4,7,31). ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Â›Ó·È Û˘Ó‹ıˆ˜ ·ıÔÏÔÁÈ΋ (31,32). ªÂÚÈο ÓÂÔÁÓ¿, Ù· ÔÔ›· ÛÙÔ ·Ú¯ÈÎfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ·Ó·Ù‡ÛÛÔ˘Ó ÛÔ‚·Ú¤˜ ·ÎÙÈÓÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙËÓ ÔÚ›· (33). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ê˘Ì·Ù›ˆÛ˘ ÛÙÔ ÓÂÔÁÓfi ‰ÂÓ Â›Ó·È ÂȉÈ΋ Î·È ÌÈÌÂ›Ù·È ÙËÓ ÂÈÎfiÓ· Ù˘ ÌÈÎÚԂȷ΋˜ Ïԛ̈͢ ‹ ÙˆÓ Û˘ÁÁÂÓÒÓ ÈÔÁÂÓÒÓ ÏÔÈÌÒÍÂˆÓ (1,4,31,34). ÀÔ„›· ÁÈ· ÙË ÓfiÛÔ Ú¤ÂÈ Ó· Ù›ıÂÙ·È Û οı ÓÂÔÁÓfi Ì ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û‹„˘ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ÛÙË ıÂÚ·›· Î·È ÛÙÔ ÔÔ›Ô Ô ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ Â›Ó·È ·ÚÓËÙÈÎfi˜ (1,4). ÀÔ„›· Ú¤ÂÈ Ó· Ù›ıÂÙ·È, Â›Û˘, fiÙ·Ó Ë ÌËÙ¤Ú· ¿Û¯ÂÈ ‹ ¤·Û¯Â ·fi Ê˘Ì·Ù›ˆÛË ‹ ·Ó ·Ó‹ÎÂÈ Û ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ÓfiÛÔ (31,34,35). ∏ ˘Ô„›· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÈÔ ¤ÓÙÔÓË fiÙ·Ó Ë ÌËÙ¤Ú· ¿Û¯ÂÈ ·fi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ Ó¢ÌÔÓ›·, ‚ÚÔÁ¯›Ùȉ·, Ï¢ڛÙȉ·, ÌËÓÈÁÁ›Ùȉ· ‹ ÂÓ‰ÔÌËÙÚ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ·, Ï›ÁÔ ÚÈÓ ‹ ·ÎfiÌ· Î·È ÌÂÙ¿ ÙËÓ Î‡ËÛË (36). ∏ ÌË ÂȉÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ÛÙ· ÓÂÔÁÓ¿ Û˘Ó‹ıˆ˜ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ÛÙË ‰È¿ÁÓˆÛË, ÁÂÁÔÓfi˜ Ô˘ ¢ı‡ÓÂÙ·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÁÈ· ÙËÓ ˘„ËÏ‹ ıÓËÛÈÌfiÙËÙ·, Ô˘ ÏËÛÈ¿˙ÂÈ ÙÔ 50% (4). ∞Ó, fï˜, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Â›Ó·È ¿ÌÂÛË, Ë ÚfiÁÓˆÛË Â›Ó·È Ôχ ηϋ (37-39). ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙËÓ ·Ó›¯Ó¢ÛË Ì˘ÎÔ‚·ÎÙËÚȉ›ˆÓ Û ‚ÈÔÏÔÁÈο ˘ÁÚ¿ ‹ ˘ÏÈÎfi ‚ÈÔ„›·˜ (7,40). ∏ ·Ó›¯Ó¢ÛË Á›ÓÂÙ·È Ì ¯ÚÒÛÂȘ Û ¿ÌÂÛÔ ·Ú·Û··ÛÌ·, Ì ηÏÏȤÚÁÂÈ·, ÎÏ·ÛÈ΋ ‹ Ú·‰ÈÔÌÂÙÚÈ΋, ηıÒ˜ Î·È Ì ·Ó·˙‹ÙËÛË ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ Ì ÙË ‚Ô‹ıÂÈ· Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (1,31). ∏ ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux Â›Ó·È ·ÚÓËÙÈ΋ ÛÙ· ÓÂÔÁÓ¿ Î·È Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ‚‰ÔÌ¿‰ˆÓ, ÏfiÁˆ ·ÓˆÚÈÌfiÙËÙ·˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (1,19,21).

O ηıÔÚÈÛÌfi˜ ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔÛ‚ÔÏ‹˜ Î·È Ô ‰È·¯ˆÚÈÛÌfi˜ Ù˘ Ïԛ̈͢ ÛÂ Û˘ÁÁÂÓ‹ ‹ Â›ÎÙËÙË ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ¿ÏË ‰˘ÛÎÔÏ›·. ∆Ô 1935, Ô Beitzke ηıfiÚÈÛ ٷ ÚÒÙ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘

22

Paediatriki 2004;67:19-25

Û˘ÁÁÂÓÔ‡˜ Ê˘Ì·Ù›ˆÛ˘, Ù· ÔÔ›· ·Ó·ıˆڋıËÎ·Ó ÙÔ 1994 (3). ∆· ·Ó·ıˆÚË̤ӷ ÎÚÈÙ‹ÚÈ· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·ԉ‰ÂÈÁ̤ÓË ÓfiÛÔ ÛÙÔ ÓÂÔÁÓfi Î·È ¤Ó· ·fi Ù· ·Ú·Î¿Ùˆ: ·) Ê˘Ì·ÙÈÒ‰ÂȘ ‚Ï¿‚˜ ·fi ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜, ‚) ÚˆÙÔ·ı¤˜ Û‡ÌÏÂÁÌ· ÛÙÔ ‹·Ú, Á) ÙÂÎÌËÚȈ̤ÓË Ê˘Ì·Ù›ˆÛË ÙÔ˘ Ï·ÎÔ‡ÓÙ· ‹ ÙÔ˘ ÂÓ‰ÔÌËÙÚ›Ô˘ ‹ ‰) ·ÔÎÏÂÈÛÌfi Ù˘ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ÙË Á¤ÓÓËÛË (3,14).

O Ï·ÎÔ‡ÓÙ·˜ Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÂÙ·È Î·È Ó· Ï·Ì‚¿ÓÔÓÙ·È Î·ÏÏȤÚÁÂȘ ÁÈ· Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ, fiÙ·Ó ·˘Ùfi Â›Ó·È ÂÊÈÎÙfi. ∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÌËÙ¤Ú·˜ ÌÂ Ê˘Ì·Ù›ˆÛË ÛÙËÓ Î‡ËÛË ∞. ¡ÂÔÁÓfi ÌËÙ¤Ú·˜ Ì ıÂÙÈ΋ Mantoux Î·È Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ∆Ô ÓÂÔÁÓfi ‰ÂÓ ·Ô¯ˆÚ›˙ÂÙ·È ·fi ÙË ÌËÙ¤Ú· ÙÔ˘ Î·È ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È È‰È·›ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË (6,40,42). ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÂÏÂÁ¯ı› ÙÔ ÂÚÈ‚¿ÏÏÔÓ Ì Mantoux ‹ Î·È ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. ∞Ó ‰È·ÈÛÙˆı› ÓfiÛÔ˜ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, ÙÔ ÓÂÔÁÓfi ¯ÚÂÈ¿˙ÂÙ·È Â·Ó¤ÏÂÁ¯Ô Ì Mantoux (1,7). µ. ¡ÂÔÁÓfi ÌËÙ¤Ú·˜ Ì ıÂÙÈ΋ Mantoux Î·È ·ıÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ∆Ô ÓÂÔÁÓfi ·Ô¯ˆÚ›˙ÂÙ·È ·fi ÙË ÌËÙ¤Ú· ̤¯ÚÈ Ó· ÔÏÔÎÏËÚˆı› Ë ‰ÈÂÚ‡ÓËÛË. ∂ÊfiÛÔÓ ‰ÂÓ ‰È·ÈÛÙˆı› ÂÓÂÚÁ‹ ÓfiÛÔ˜ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ù˘ ÌËÙ¤Ú·˜, ÙÔ ÓÂÔÁÓfi ıˆÚÂ›Ù·È fiÙÈ ‚Ú›ÛÎÂÙ·È Û ¯·ÌËÏfi ΛӉ˘ÓÔ ÁÈ· Ïԛ̈ÍË. ∏ ÌËÙ¤Ú· Ú¤ÂÈ Ó· Ï¿‚ÂÈ ¯ËÌÂÈÔÚÔʇϷÍË Î·È Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Û˘ÛÙËÌ·ÙÈο. ™˘ÛÙËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ··ÈÙÂ›Ù·È Î·È ÁÈ· ÙÔ ÓÂÔÁÓfi (1,7). O ÂÈÛÙ¿ÌÂÓÔ˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ (1,40,43). ∂¿Ó Ë ÌËÙ¤Ú· ¿Û¯ÂÈ ·fi ÂÓÂÚÁ‹ ÓfiÛÔ, Ú¤ÂÈ Ó· ·Ú¯›ÛÂÈ ·Ì¤Ûˆ˜ ·ÓÙÈÊ˘Ì·ÙÈ΋ ıÂÚ·›·, ÂÓÒ ÙÔ ÓÂÔÁÓfi Ú¤ÂÈ Ó· ÂÏÂÁ¯ı› ÁÈ· Ê˘Ì·Ù›ˆÛË. ∂ÊfiÛÔÓ ‰ÂÓ ÓÔÛ›, ¯ÔÚËÁÂ›Ù·È ¯ËÌÂÈÔÚÔʇϷÍË ‹ ·Ô¯ˆÚ›˙ÂÙ·È ·fi ÙË ÌËÙ¤Ú· ̤¯ÚȘ fiÙÔ˘ ÂΛÓË ‰ÂÓ ÌÂÙ·‰›‰ÂÈ ϤÔÓ ÙË ÓfiÛÔ. ∏ ¯ËÌÂÈÔÚÔʇϷÍË Ì 10 mg/kg ÈÛÔÓÈ·˙›‰Ë˜ ıˆÚÂ›Ù·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÁÈ· ÙËÓ ÚÔʇϷÍË ÙÔ˘ ÓÂÔÁÓÔ‡, ÂÓÒ ·Ô¯ˆÚÈÛÌfi˜ ·fi ÙË ÌËÙ¤Ú· ··ÈÙÂ›Ù·È ÌfiÓÔ Â¿Ó ÂΛÓË Â›Ó·È ÛÔ‚·Ú¿ ¿ÚÚˆÛÙË Î·È ¯ÚÂÈ¿˙ÂÙ·È ÓÔÛËÏ›· ÛÙÔ ÓÔÛÔÎÔÌ›Ô, Â¿Ó ‰ÂÓ Â›Ó·È Û˘ÓÂÚÁ¿ÛÈÌË fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·›· Ù˘ ‹ Â¿Ó ¿Û¯ÂÈ ·fi ÔÏ˘·ÓıÂÎÙÈο ÛÙÂϤ¯Ë Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ (1,7). ∏ ¯ËÌÂÈÔÚÔʇϷÍË ¯ÔÚËÁÂ›Ù·È ÛÙÔ ‚Ú¤ÊÔ˜ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 3-4 ÌËÓÒÓ (40). ™ÙË Û˘Ó¤¯ÂÈ·, Á›ÓÂÙ·È ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË ÛÙÔ ÓÂÔÁÓfi ηÈ, ÂÊfiÛÔÓ Â›Ó·È ·ÚÓËÙÈ΋, Ë ·ÁˆÁ‹ ‰È·ÎfiÙÂÙ·È Î·È Û˘ÓÈÛÙ¿Ù·È ·Ú·ÎÔÏÔ‡ıËÛË. ∂¿Ó Â›Ó·È ıÂÙÈ΋, ÙÔ ‚Ú¤ÊÔ˜ ÂϤÁ¯ÂÙ·È ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο ÁÈ· Èı·Ó‹ ÓfiÛÔ Î·È Â¿Ó ‰È·ÈÛÙˆı› fiÙÈ ÓÔÛ›, ¯ÔÚËÁ›ٷÈ

¶·È‰È·ÙÚÈ΋ 2004;67:19-25

ıÂÚ·›·. ™Â ·ÓÙ›ıÂÙË ÂÚ›ÙˆÛË, ¯ÔÚËÁÂ›Ù·È ÈÛÔÓÈ·˙›‰Ë ÁÈ· 6-9 Ì‹Ó˜ (1,3,7,40). ∞Ó Ë ÌËÙ¤Ú· ‹ ¿ÏÏÔ ¿ÙÔÌÔ ÙÔ˘ ÛÙÂÓÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÓÔÛ› ·fi ÔÏ˘·ÓıÂÎÙÈÎfi Û٤ϯԘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘, ·Ó ‰ÂÓ Û˘ÌÌÔÚÊÒÓÂÙ·È ÛÙË ıÂÚ·›· Î·È ‰ÂÓ Â›Ó·È ‰˘Ó·Ù‹ Ë ÛÙÂÓ‹ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ›‰È·˜ Î·È ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ù˘, Û˘ÓÈÛÙ¿Ù·È ÙÔ ÓÂÔÁÓfi Ó· ·Ô¯ˆÚÈÛÙ› ·fi ÙÔÓ ÂÓ‹ÏÈη Ô˘ ÓÔÛ› Î·È Ó· ÂÌ‚ÔÏÈ·ÛÙ› Ì BCG (1,7). O ÂÌ‚ÔÏÈ·ÛÌfi˜ ÌÂÈÒÓÂÈ ÙËÓ Â›ÙˆÛË ÙˆÓ ÛÔ‚·ÚÒÓ ÌÔÚÊÒÓ Ù˘ ÓfiÛÔ˘ (1,7,40). øÛÙfiÛÔ, Ô ·Ô¯ˆÚÈÛÌfi˜ ·fi ÙÔÓ ÂÓ‹ÏÈη Ô˘ ÓÔÛ› Î·È Ë ¯ÔÚ‹ÁËÛË Ù˘ ηٿÏÏËÏ˘ ıÂÚ·›·˜ ÛÙÔÓ ›‰ÈÔ Î·È ÙÔ ÓÂÔÁÓfi ·ÔÙÂÏÔ‡Ó ÙËÓ ÚÔÙÈÌfiÙÂÚË ÚÔÛ¤ÁÁÈÛË (1). ∞ÓÙÈÌÂÙÒÈÛË Ù˘ ÂÁ·Ԣ Î·È ÙÔ˘ ÓÂÔÁÓÔ‡ ÌÂ Ê˘Ì·Ù›ˆÛË ∏ ıÂÚ·›· Ù˘ ÂÁ·Ԣ Ì ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η, ȉ›ˆ˜ ηٿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ‰ËÌÈÔ˘ÚÁ› ·ÓËÛ˘¯›· ÁÈ· Èı·Ó‹ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË ÙÔ˘˜. øÛÙfiÛÔ, Ë ıÂÚ·›· Ù˘ ÂÁ·Ԣ Ô˘ ¿Û¯ÂÈ ·fi ÂÓÂÚÁ‹ ÓfiÛÔ Â›Ó·È ·Ó·Áη›· (30,40,44). °È· ÙËÓ ÈÛÔÓÈ·˙›‰Ë Î·È ÙË ÚÈÊ·ÌÈΛÓË, ÌÂϤÙ˜ Û ¤Ì‚Ú˘· ‰ÂÓ ¤¯Ô˘Ó ‰Â›ÍÂÈ ÙÂÚ·ÙÔÁfiÓÔ ‰Ú¿ÛË (30,45,46). °È· ÙËÓ ˘Ú·˙ÈÓ·Ì›‰Ë ‰ÂÓ ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ ÙÂÚ·ÙÔÁ¤ÓÂÛ˘ (1,3). ∏ ÛÙÚÂÙÔÌ˘Î›ÓË ·ÓÙÂӉ›ÎÓ˘Ù·È ÂÂȉ‹ Â›Ó·È ˆÙÔÙÔÍÈÎfi Ê¿ÚÌ·ÎÔ Î·È ¤¯ÂÈ ·Ó·ÊÂÚı› Û˘ÁÁÂÓ‹˜ ÎÒʈÛË Û ÓÂÔÁÓ¿ Ô˘ ÂÎÙ¤ıËÎ·Ó Û ÛÙÚÂÙÔÌ˘Î›ÓË Î·Ù¿ ÙËÓ Î‡ËÛË (3). ™‹ÌÂÚ·, Ë ÚÔÙÂÈÓfiÌÂÓË ıÂÚ·›· Ù˘ Ê˘Ì·Ù›ˆÛ˘ Û ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ Â›Ó·È Ô Û˘Ó‰˘·ÛÌfi˜ ÈÛÔÓÈ·˙›‰Ë˜ Î·È ÚÈÊ·ÌÈΛÓ˘, Ì ÚÔÛı‹ÎË Âı·Ì‚Ô˘ÙfiÏ˘ ¤ˆ˜ fiÙÔ˘ ·Ô‰Âȯı› fiÙÈ ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Â›Ó·È Â˘·›ÛıËÙÔ ÛÙ· ‰‡Ô ÚÒÙ· Ê¿Ú̷η, ÔfiÙÂ Ë Âı·Ì‚Ô˘ÙfiÏË ÌÔÚ› Ó· ‰È·ÎÔ› (40,47). ∏ ¯ÔÚ‹ÁËÛË ˘ÚȉÔ͛Ӣ Â›Ó·È ··Ú·›ÙËÙË (40). ∏ ıÂÚ·›· ‰È·ÚΛ ÙÔ˘Ï¿¯ÈÛÙÔÓ 6 Ì‹Ó˜ (1,40,45). ∏ ıÂÚ·›· Ù˘ ÓfiÛÔ˘ ·fi ÔÏ˘·ÓıÂÎÙÈο ÛÙÂϤ¯Ë ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚË ‰˘ÛÎÔÏ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∂ÓÒ Ë ıÂÚ·›· Ù˘ ÂÓÂÚÁ‹˜ ÓfiÛÔ˘ ηٿ ÙËÓ Î‡ËÛË Â›Ó·È ·‰È·ÌÊÈÛ‚‹ÙËÙË, Ë ·ÓÙÈÌÂÙÒÈÛË ÂÁ·Ԣ Ì ıÂÙÈ΋ Mantoux ¯ˆÚ›˜ ·ıÔÏÔÁÈο ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ‰È·ÊˆÓ›·˜. OÚÈṲ̂ÓÔÈ ÂȉÈÎÔ› ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÂÂȉ‹ Ë ÚfiÛÊ·ÙË Ïԛ̈ÍË ÌÔÚ› Ó· Û˘Óԉ‡ÂÙ·È ·fi ·ÈÌ·ÙÔÁÂÓ‹ ‰È·ÛÔÚ¿ ÛÙÔÓ Ï·ÎÔ‡ÓÙ·, Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ·Ú¯›˙ÂÈ Ë ¯ËÌÂÈÔÚÔʇϷÍË Ì ÈÛÔÓÈ·˙›‰Ë ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ÂÓÒ ¿ÏÏÔÈ Û˘ÛÙ‹ÓÔ˘Ó ÙËÓ ¤Ó·ÚÍË ¯ËÌÂÈÔÚÔʇϷ͢ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi (1,40). ™Â ¤ÁÎ˘Â˜ Á˘Ó·›Î˜, ˆÛÙfiÛÔ, Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂͤÏÈ͢ Ù˘ ÌfiÏ˘ÓÛ˘ Û ÓfiÛÔ, ‰ËÏ·‰‹ ÂΛӘ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› ÚfiÛÊ·Ù·, Ô˘ Â›Ó·È ·ÓÔÛÔηÙÂÛÙ·Ï̤Ó˜

Paediatriki 2004;67:19-25

‹ ¤¯Ô˘Ó ÌÔÏ˘Óı› ·fi ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, Ë ¯ËÌÂÈÔÚÔʇϷÍË Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·Ì¤Ûˆ˜ (40). ∏ ıÂÚ·›· Ù˘ Û˘ÁÁÂÓÔ‡˜ Ê˘Ì·Ù›ˆÛ˘ Î·È Ù˘ Â›ÎÙËÙ˘ ÓfiÛÔ˘ Â›Ó·È ›‰È· Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘Ó‰˘·ÛÌfi ÙÂÛÛ¿ÚˆÓ ·ÓÙÈÊ˘Ì·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (ÈÛÔÓÈ·˙›‰Ë, ÚÈÊ·ÌÈΛÓË, ˘Ú·˙ÈÓ·Ì›‰Ë Î·È Âı·Ì‚Ô˘ÙfiÏË ‹ ÛÙÚÂÙÔÌ˘Î›ÓË) ÁÈ· ÙÔ˘˜ ÚÒÙÔ˘˜ 2 Ì‹Ó˜ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, ÈÛÔÓÈ·˙›‰Ë Î·È ÚÈÊ·ÌÈΛÓË ÁÈ· 4 ¤ˆ˜ 10 Ì‹Ó˜ ·Ó¿ÏÔÁ· Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ (1,14,40). OÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÓÈÛÙÔ‡Ó ıÂÚ·›· ÁÈ· 9 ¤ˆ˜ 12 Ì‹Ó˜, ÏfiÁˆ Ù˘ ÌÂȈ̤Ó˘ ·ÓÔÛÔÏÔÁÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ ‚ÚÂÊÒÓ (1,7). ∆· Û˘Ó‹ıË ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η ıˆÚÔ‡ÓÙ·È ·ÛÊ·Ï‹, Ì ÂÍ·›ÚÂÛË ÙËÓ Âı·Ì‚Ô˘ÙfiÏË, Ë ÔÔ›· ÏfiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÔÙÈ΋˜ Ó¢ڛÙȉ·˜, ¤¯ÂÈ ·ÓÙÈηٷÛÙ·ı› ÛÙ· ÓÂÔÁÓ¿ ·fi ÙË ÛÙÚÂÙÔÌ˘Î›ÓË (14,40,42,48). ™Ù· ‚Ú¤ÊË Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η ··ÈÙÂ›Ù·È Û˘¯Ófi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Ë·ÙÈο ¤Ó˙˘Ì· Î·È Ô˘ÚÈÎfi Ô͇ (43,49). ªËÙÚÈÎfi˜ ıËÏ·ÛÌfi˜ Î·È Ê˘Ì·Ù›ˆÛË ∂Âȉ‹ Ë ıÂÚ·›· Ù˘ Ê˘Ì·Ù›ˆÛ˘ Û˘Ó¯›˙ÂÙ·È Û˘Ó‹ıˆ˜ Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ˘¿Ú¯Ô˘Ó ÂÚˆÙËÌ·ÙÈο fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∆· ÚÒÙ˘ ÁÚ·ÌÌ‹˜ ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· Û ÔÈΛϷ ÔÛÔÛÙ¿ (3,50,51). Œ¯ÂÈ ‰Âȯı› fiÙÈ Ù· ‚Ú¤ÊË Ô˘ ıËÏ¿˙Ô˘Ó ¤¯Ô˘Ó ÛÙÔÓ ÔÚfi Â›‰· ¯·ÌËÏfiÙÂÚ· ·fi ÙÔ 20% ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ·ÓÙÈÊ˘Ì·ÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÁÈ· Ù· ·È‰È¿ (5,50,51). ª¤¯ÚÈ Û‹ÌÂÚ·, ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÙÔÍÈ΋ ‰Ú¿ÛË ÛÙ· ÓÂÔÁÓ¿ Ô˘ ıËÏ¿˙Ô˘Ó ·fi Ù· ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η Ô˘ ·ÂÎÎÚ›ÓÔÓÙ·È ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· (50,51). ∆· Û˘Ó‹ıË ·ÓÙÈÊ˘Ì·ÙÈο Ê¿Ú̷η ıˆÚÔ‡ÓÙ·È Û˘Ì‚·Ù¿ Ì ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ (40,51). ∏ ¯ÔÚ‹ÁËÛË ˘ÚȉÔ͛Ӣ ÛÙ· ıËÏ¿˙ÔÓÙ· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÈÛÔÓÈ·˙›‰Ë Â›Ó·È ··Ú·›ÙËÙË (1). ™˘ÌÂÚ¿ÛÌ·Ù· OÈ ·ÏÏ·Á¤˜ Ô˘ ¤¯Ô˘Ó ·Ú·ÙËÚËı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· Ù˘ Ê˘Ì·Ù›ˆÛ˘, ‰ËÌÈÔ˘ÚÁÔ‡Ó ·ÓËÛ˘¯›· ÁÈ· ÙËÓ Èı·ÓfiÙËÙ· ·‡ÍËÛ˘ Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘ ÛÙȘ ¤ÁÎ˘Â˜ Á˘Ó·›Î˜ Î·È Ù· ÓÂÔÁÓ¿. ∏ ‰ÈÂÚ‡ÓËÛË, Ì ÙË Ï‹„Ë Î·Ù¿ÏÏËÏÔ˘ ÈÛÙÔÚÈÎÔ‡ ·fi fiϘ ÙȘ ¤ÁÎ˘Â˜, ÁÈ· Èı·Ó‹ ¤ÎıÂÛË ‹ ÓfiÛËÛË ·fi ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Ú¤ÂÈ Ó· Û˘ÌÂÚÈÏËÊı› ÛÙÔÓ ¤ÏÂÁ¯Ô ÚÔ˘Ù›Ó·˜ ÛÙËÓ ·Ú¯‹ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∏ Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË ÛÙȘ ÂÚÈÙÒÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ÓfiÛÔ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ fiÔ˘ ¯ÚÂÈ¿˙ÂÙ·È, ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘

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47. Bothamley G. Drug treatment for tuberculosis during pregnancy: safety considerations. Drug Saf 2001;24:553-565.

48. Gogus S, Umer H, Akcoren Z, Sanal O, Osmanlioglu G, Cimbis M. Neonatal tuberculosis. Pediatr Pathol 1993; 13:299-304.

49. Ray M, Goraya JS, Basu S, Parmar V. Perinatal tuberculosis. Indian J Pediatr 2001;68:343-345.

50. Snider DE Jr, Powell KE. Should women taking antituberculosis drugs breast-feed? Arch Intern Med 1984; 144:589-593.

51. American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk.

Pediatrics 1994;93:137-150.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 31-01-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-11-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ÓÙˆÓ›· M·ÓÔ˘Ú¿ ∞. ¶·‡ÏÔ˘ 16, ∆.∫. 712 01, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: tmanour@in.gr

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µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™π∞

Paediatriki 2004;67:26-32

AWARD-WINNING ARTICLE

∂ȉËÌÈÔÏÔÁÈ΋ Î·È ÁÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÛÙÂϯÒÓ Salmonella enteritidis Û ·È‰È¿ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ 1987-1997* ¶. ™Ê˘Ú›‰Ë˜1, ∞. ª·ÚÎÔÁÈ·ÓÓ¿Î˘1,2

Epidemiological and genotypic analysis of Salmonella enteritidis isolates in children with gastroenteritis during the period 1987-1997* P. Sfyridis1, A. Markogiannakis1,2

¶ÂÚ›ÏË„Ë: ∫‡ÚÈÔ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜ ·ÔÙ¤ÏÂÛÂ Ë ÌÂϤÙË ÂÓfi˜ ‰Â›ÁÌ·ÙÔ˜ 96 ÛÙÂϯÒÓ Salmonella enteritidis, Ô˘ ÚÔÂÚ¯fiÙ·Ó ·fi ·È‰È¿ ËÏÈΛ·˜ 0-14 ÂÙÒÓ, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÔ¯‹ ÙˆÓ ÛÙÂϯÒÓ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο, ÛÙË ÁÂÓÂÙÈ΋ ÔÈÎÈÏÔÌÔÚÊ›· ÙÔ˘˜, ÛÙÔÓ Û˘Û¯ÂÙÈÛÌfi ÙÔ˘ ÁÔÓÔÙ‡Ô˘ ÙˆÓ ÛÙÂϯÒÓ Ì ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜, fiˆ˜ Ô Ê·ÈÓfiÙ˘Ô˜ ·ÓÙÔ¯‹˜ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο, ÛÙË ÁˆÁÚ·ÊÈ΋ ÚԤϢÛË ÙˆÓ ÛÙÂϯÒÓ Î·È ÛÙËÓ ‡·ÚÍË ˘ÔΛÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ. ∂ÈϤÔÓ, ÂȯÂÈÚ‹ıËÎÂ Ë Û˘Û¯¤ÙÈÛË Ù˘ ·Ó¿Ù˘Í˘ ‚·ÎÙËÚÈ·ÈÌ›·˜ ÛÙ· ·È‰È¿ Ì ̛· ÛÂÈÚ¿ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, Ë ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Î·È Ë ·˘ÍË̤ÓË ÙÈÌ‹ Ù˘ C-·ÓÙȉÚÒÛ·˜ ÚˆÙ½Ó˘ (CRP). ∞Ú¯Èο, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë Ì¤ıÔ‰Ô˜ ÙˆÓ ‰›ÛÎˆÓ ˆ˜ ‰ÔÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜ ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ Û 17 ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ÛÙÂϤ¯Ë ˘Ô‚Ï‹ıËÎ·Ó Û ÌÔÚȷ΋ Ù˘ÔÔ›ËÛË Ì ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙȘ ÌÂıfi‰Ô˘˜ ÙÔ˘ Fisher exact test Î·È Ù˘ regression stratified ·Ó¿Ï˘Û˘ Ì ¯Ú‹ÛË Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÏÔÁÈÛÌÈÎÔ‡. ¶·Ú·ÙËÚ‹ıËΠ¤Ó· ˘„ËÏfi ÔÛÔÛÙfi ·ÓıÂÎÙÈÎÒÓ Î·È ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ Û ۇÁÎÚÈÛË Ì ¿ÏϘ ¯ÒÚ˜. ªÂ ÙË Ì¤ıÔ‰Ô Ù˘ ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô ÚԤ΢„·Ó Û˘ÓÔÏÈο ¤ÓÙÂη ÁÔÓfiÙ˘ÔÈ (¤ÍÈ Î‡ÚÈÔÈ Ù‡ÔÈ ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô Î·È ÂÙ¿ ˘fiÙ˘ÔÈ). O ∞1 ˘fiÙ˘Ô˜ ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô ·ÔÙ¤ÏÂÛ ÙÔÓ Û˘¯ÓfiÙÂÚ· ·Ú·ÙËÚÔ‡ÌÂÓÔ ÁÔÓfiÙ˘Ô,

Abstract: The aim of this work was the study of a sample consisting of 96 isolates of Salmonella enteritidis, originating from children aged 0-14 years old, with reference to their resistance to antibiotics, their genetic variability, and the correlation between the genotype of the isolates and various parameters such as the resistance phenotype, the geographic origin and the presence of underlying diseases. An attempt was made to correlate the development of bacteraemia in children with specific risk factors such as age, sex, multiresistance to antibiotics and elevated CRP values. Initially, the susceptibility of the isolates to 17 antimicrobial agents was determined, using the disk diffusion method, following which the molecular typing of the isolates was performed, using the pulsed field gel electrophoresis method. Statistical analysis of the results was carried out using the Fisher exact test and regression stratified analysis, with the use of appropriate software. Compared with reports from other countries, high rates of antibiotic resistance and multiple antibiotic resistance were observed among the isolates. A total of 11 restriction patterns (six pulsed field gel electrophoresis method types and seven subtypes) were generated by the pulsed field gel electrophoresis method. Pulsed field gel electrophoresis subtype A1 was the most common genotype. A small number of multiple antibiotic resistant phenotypes belonging to this subtype were responsible for the development of bacteraemia in children aged <3 months. Pulsed field gel electrophoresis subtype A2 was correlated with the

1 ∂ÚÁ·ÛÙ‹ÚÈÔ ªÈÎÚÔ‚ÈÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ∂ıÓÈÎfi ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ™·ÏÌÔÓÂÏÒÓ-™ÈÁÎÂÏÒÓ, Œ‰Ú· ∂Ê·ÚÌÔṲ̂Ó˘ ªÈÎÚÔ‚ÈÔÏÔÁ›·˜ Î·È ∞ÓÔÛÔÏÔÁ›·˜, ∂ıÓÈ΋ ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁ›·˜, ∞ı‹Ó·

1 Laboratory of Microbiology, University of Athens Medical School 2 National Reference Centre for Salmonella-Shigella, Department of Applied Microbiology and Immunology, National School of Public Health, Athens

* µ’ ÈڤÌÂÈÔ Œ·ıÏÔ 41Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2003

* 2nd “Choremio” Award 41st Panhellenic Paediatric Meeting, 2003

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ÔÚÈṲ̂ӷ ÔÏ˘·ÓıÂÎÙÈο ÛÙÂϤ¯Ë ÙÔ˘ ÔÔ›Ô˘ ‹Ù·Ó ˘‡ı˘Ó· ÁÈ· ÙËÓ ÚfiÎÏËÛË ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ‚Ú¤ÊË ËÏÈΛ·˜ <3 ÌËÓÒÓ. O ∞2 ˘fiÙ˘Ô˜ ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ·È‰È¿ Ì ÛÔ‚·Ú¤˜ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜. OÚÈṲ̂ÓÔÈ ÁÔÓfiÙ˘ÔÈ Ê¿ÓËΠӷ Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ ÌÂÈÔÓÔÙ‹ÙˆÓ Î·È ÂÓÙÔ›˙ÔÓÙ·Ó ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜. OÈ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ‹Ù·Ó Ë ËÏÈΛ· <3 ÌËÓÒÓ, Ë ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο (Û¯ÂÙÈ˙fiÌÂÓ˜ ÌÂٷ͇ ÙÔ˘˜ ÌÂÙ·‚ÏËÙ¤˜) Î·È Ë Ï¢ÎÔ΢ÙÙ¿ÚˆÛË/Ï¢ÎÔÂÓ›· (·ÓÂÍ¿ÚÙËÙË ÌÂÙ·‚ÏËÙ‹).

development of bacteraemia in children with serious haematological disorders. Several genotypes seemed to be correlated with certain minority populations and originated from distinct geographic regions. The risk factors shown to be correlated with the development of bacteraemia were an age of <3 months, multiple antibiotic resistance (related variables) and leucocytosis/leucopenia (independent variable).

§¤ÍÂȘ ÎÏÂȉȿ: Salmonella enteritidis, ÂȉËÌÈÔÏÔÁ›·, ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ‚·ÎÙËÚÈ·ÈÌ›·.

Key words: Salmonella enteritidis, epidemiology, multiple antibiotic resistance, risk factors, bacteraemia.

™˘ÓÙÔÌÔÁڷʛ˜

Á) Ó· Û˘ÁÎÚÈıÔ‡Ó Ù˘¯fiÓ ÔÌÔÈfiÙËÙ˜ ‹ ‰È·ÊÔÚ¤˜ Û ۯ¤ÛË Ì ÏËı˘ÛÌȷ΋ ÔÌ¿‰· ÂÓËÏ›ÎˆÓ Ô˘ ¤¯ÂÈ ‹‰Ë ·Ó·Ï˘ı› Ì ∏¶¶, ‰) Ó· Û˘Û¯ÂÙÈÛÙÔ‡Ó ÔÈ ‚·ÎÙËÚÈ·ÎÔ› ÎÏÒÓÔÈ S. enteritidis Ô˘ ÚԤ΢„·Ó ·fi ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô Ì ‰È¿ÊÔÚ˜ ·Ú·Ì¤ÙÚÔ˘˜, fiˆ˜ Ô Ê·ÈÓfiÙ˘Ô˜ ·ÓÙÔ¯‹˜ ÙˆÓ ÛÙÂϯÒÓ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο, Ë ÁˆÁÚ·ÊÈ΋ ÚԤϢÛË ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ, Ë ‡·ÚÍË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ˘ÔΛÌÂÓˆÓ ÓÔÛËÌ¿ÙˆÓ, Ë ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ, Ë ÚfiÎÏËÛË ‹ ÌË ‚·ÎÙËÚÈ·ÈÌ›·˜, Ë ‡·ÚÍË ÂÛÙÈ·ÎÒÓ ÏÔÈÌÒ͈Ó, ηıÒ˜ Î·È Ù˘¯fiÓ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ÙÔ˘˜ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È Â) Ó· ÂÍÂÙ·ÛÙ› Â¿Ó Û˘ÁÎÂÎÚÈ̤ÓÔÈ ·Ú¿ÁÔÓÙ˜ (fiˆ˜ Ë ËÏÈΛ·, ÙÔ Ê‡ÏÔ, Ë ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο, Ë ·˘ÍË̤ÓË CRP Î.¿.) ÌÔÚÔ‡Ó Ó· Û˘Û¯ÂÙÈÛÙÔ‡Ó Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ÛÙ· ·È‰È¿.

∂∫∞™™ ∂™¢À ∏¶¶ ∆∫∂ ªµ Kb CRP

∂ıÓÈÎfi ∫¤ÓÙÚÔ ∞Ó·ÊÔÚ¿˜ ™·ÏÌÔÓÂÏÒÓ-™ÈÁÎÂÏÒÓ ∂ıÓÈ΋ ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ ∏ÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô ∆·¯‡ÙËÙ· ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ªÔÚÈ·Îfi ‚¿ÚÔ˜ Kilobase pairs - ¯ÈÏÈ¿‰Â˜ ˙‡ÁË ‚¿ÛÂˆÓ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË

∂ÈÛ·ÁˆÁ‹ OÈ ÏÔÈÌÒÍÂȘ ·fi Salmonella enteritidis ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·ÔÙÂÏÔ‡Ó ÙËÓ ÈÔ ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÎÚÔ˘ÛÌ¿ÙˆÓ Û·ÏÌÔӤψÛ˘ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ‚ÈÔÌ˯·ÓÈΤ˜ ¯ÒÚ˜ (1-3). ™ÙËÓ ∂ÏÏ¿‰·, Û‡Ìʈӷ Ì ÛÙÔȯ›· ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∞Ó·ÊÔÚ¿˜ ™·ÏÌÔÓÂÏÒÓ-™ÈÁÎÂÏÒÓ (∂∫∞™™) Ù˘ ∂ıÓÈ΋˜ ™¯ÔÏ‹˜ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ (∂™¢À), Ë S. enteritidis ·ÔÙÂÏ› ÙÔÓ ÚÒÙÔ ÛÂ Û˘¯ÓfiÙËÙ· ·ÔÌfiÓˆÛ˘ ÔÚfiÙ˘Ô ÌÂٷ͇ ÙˆÓ ·ÓıÚÒÈÓ˘ ÚÔ¤Ï¢Û˘ ÛÙÂϯÒÓ Û·ÏÌÔӤϷ˜ ·fi ÙÔ 1989, ·Ú’ fiÏË ÙË Ì›ˆÛË Ô˘ ¤¯ÂÈ ·Ú·ÙËÚËı›, ÙfiÛÔ ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ÛÙÂϯÒÓ S. enteritidis fiÛÔ Î·È ÛÙË Û˘¯ÓfiÙËÙ· ·ÔÌfiÓˆÛ‹˜ ÙÔ˘˜ ÌÂÙ¿ ÙÔ 1994 (4,5). ™ÎÔfi Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·ÔÙ¤ÏÂÛÂ Ë ·Ó¿Ï˘ÛË Ì›·˜ ÏËı˘ÛÌȷ΋˜ ÔÌ¿‰·˜ 96 ·È‰ÈÒÓ (0≤14 ÂÙÒÓ) Ô˘ ÚÔÛ‚Ï‹ıËÎ·Ó ·fi Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi S. enteritidis ηٿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ Î·È ϤÔÓ ‰ÂηÂÙ›·˜ (1987-1997), ÚÔÎÂÈ̤ÓÔ˘: ·) Ó· ÂÍÂÙ·ÛÙ› Ë Â˘·ÈÛıËÛ›· ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ Û ¤Ó· ¢ڇ Ê¿ÛÌ· ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ ·Ú·ÁfiÓÙˆÓ, ‚) Ó· ÂÚ¢ÓËı› Ë ÁÂÓÂÙÈ΋ ÔÈÎÈÏÔÌÔÚÊ›· ÙˆÓ ÛÙÂϯÒÓ Ì ÙË Ì¤ıÔ‰Ô ËÏÂÎÙÚÔÊfiÚËÛ˘ Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô (∏¶¶) ÛÙË ‚ÚÂÊÈ΋ Î·È ·È‰È΋ ËÏÈΛ·,

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∆· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë ÚÔ¤Ú¯ÔÓÙ·Ó ·fi Ù· ‰‡Ô ÌÂÁ·Ï‡ÙÂÚ· ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›· Ù˘ ∞ÙÙÈ΋˜ (¡ÔÛÔÎÔÌ›· ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” Î·È “∞Á›· ™ÔÊ›·”). ∆Ô ‰Â›ÁÌ· ıˆÚÂ›Ù·È ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÁÈ· ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, ηıÒ˜ Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÓÔÛÔÎÔÌ›· ‰¤¯ÔÓÙ·È ÂÚÈÛÙ·ÙÈο ·fi fiÏË ÙËÓ ÂÈÎÚ¿ÙÂÈ·. ∆Ô ‰Â›ÁÌ· ÂÏ‹ÊıË ÌÂ Ù˘¯·ÈÔÔÈË̤ÓÔ ÙÚfiÔ (›Ó·Î˜ Ù˘¯·›ˆÓ ·ÚÈıÌÒÓ) ·fi Ù· ·Ú¯Â›· ÙÔ˘ ∂∫∞™™ Ù˘ ∂™¢À Ù˘ ÂÚÈfi‰Ô˘ 1987-1997. ∂ÍÂÙ¿ÛÙËÎ·Ó Û˘ÓÔÏÈο 96 ÌÈÎÚԂȷο ÛÙÂϤ¯Ë Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ·È‰È¿ ËÏÈΛ·˜ 0-14 ÂÙÒÓ. ∆· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë ˘Ô‚Ï‹ıËÎ·Ó ·Ú¯Èο Û ‰ÔÎÈÌ·Û›· ¢·ÈÛıËÛ›·˜ Û 17 ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ì ÙË Ì¤ıÔ‰Ô ÙˆÓ ‰›ÛΈÓ, Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· Ù˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÙˆÓ ∏.¶.∞. ÁÈ· Ù· ∫ÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο ¢Â‰Ô̤ӷ (6).

OÈ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ› ·Ú¿ÁÔÓÙ˜, ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÍÂÙ¿ÛÙËηÓ

27

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Ù· ·Ú·¿Óˆ ÌÈÎÚԂȷο ÛÙÂϤ¯Ë, ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ıÔÈ: ·ÌÈÎÈÏÏ›ÓË, ·ÌÔ͢ÎÈÏÏ›ÓË Î·È ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇, ÎÂÊ·ÏÔı›ÓË, ÎÂÊ·Ì·Ó‰fiÏË, ÎÂÊÙÚÈ·ÍfiÓË, ÎÂÊÙ·˙ÈÓÙ›ÌË, ÎÂÊÔÙ·Í›ÌË, ÛÔ˘ÏÊÔÓ·Ì›‰Â˜, ÎÔÙÚÈÌÔÍ·˙fiÏË, ÓÈÙÚÔÊÔ˘Ú·ÓÙÔ˝ÓË, ‰Ô͢΢ÎÏ›ÓË, Ó·ÏȉÈÍÈÎfi Ô͇, ÛÈÚÔÊÏÔÍ·Û›ÓË, ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË, ÛÙÚÂÙÔÌ˘Î›ÓË, Î·Ó·Ì˘Î›ÓË Î·È ÁÂÓÙ·ÌÈΛÓË. ¶ÔÏ˘·ÓıÂÎÙÈο ıˆڋıËÎ·Ó Ù· ÛÙÂϤ¯Ë Ô˘ ‹Ù·Ó ·ÓıÂÎÙÈο Û ٤ÛÛÂÚȘ ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (7). ™ÙË Û˘Ó¤¯ÂÈ·, fiÏ· Ù· ÛÙÂϤ¯Ë ˘Ô‚Ï‹ıËÎ·Ó ÛÂ Ù˘ÔÔ›ËÛË Ì ËÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ËÏÂÎÙÚÈÎfi ‰›Ô, ÛÂ Û˘Û΢‹ ‰ËÌÈÔ˘ÚÁ›·˜ ÔÌÔÈÔÁÂÓÔ‡˜ ËÏÂÎÙÚÈÎÔ‡ ‰›Ô˘ (BioRad Laboratories, Richmond, Calif.), Ì ¯Ú‹ÛË Ù˘ ÂÚÈÔÚÈÛÙÈ΋˜ ÂÓ‰ÔÓÔ˘ÎÏ¿Û˘ XbaI (5’-TCTAGA-3’) (New England Biolabs, Beverly, Mass.) ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ¯ÚˆÌÔۈ̷ÙÈÎÒÓ ·ÔÙ˘ˆÌ¿ÙˆÓ-ÁÔÓÔÙ‡ˆÓ, Ì ‚¿ÛË ¤Ó· ÂÚÈÁÚ·Ê¤Ó ÚˆÙfiÎÔÏÏÔ (8). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË Ì¤ÙÚËÛË ÙˆÓ ÌÔÚÈ·ÎÒÓ ‚·ÚÒÓ (ªµ) ÙˆÓ ıÚ·˘ÛÌ¿ÙˆÓ DNA ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙÌ‹Ì·Ù· ÙÔ˘ DNA ÙÔ˘ ‚·ÎÙËÚÈÔÊ¿ÁÔ˘ Ï ÁÓˆÛÙÔ‡ ªµ (New England Biolabs), Ì ‰˘Ó·ÙfiÙËÙ· ‰È¿ÎÚÈÛ˘ ·fi 48,5 ¤ˆ˜ 850 kb. ∆· ¯ÚˆÌÔۈ̷ÙÈο ·ÔÙ˘ÒÌ·Ù· ÙˆÓ ÛÙÂϯÒÓ Û˘ÁÎÚ›ÓÔÓÙ·Ó ÔÙÈο, ÂÓÒ Ë Î·Ù¿Ù·Í‹ ÙÔ˘˜ Û هÔ˘˜ Î·È ˘ÔÙ‡Ô˘˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠۇÌʈӷ Ì ‰ËÌÔÛÈÂ˘Ì¤Ó· ÎÚÈÙ‹ÚÈ· (9). ¢‡Ô ÌÈÎÚԂȷο ÛÙÂϤ¯Ë ıˆÚÔ‡ÓÙ·Ó fiÙÈ ·Ó‹Î·Ó ÛÙÔÓ ›‰ÈÔ ∏¶¶ Ù‡Ô fiÙ·Ó ‰È¤ÊÂÚ·Ó ÌÂٷ͇ ÙÔ˘˜ Û ٤ÛÛÂÚ· ‹ ÂÚÈÛÛfiÙÂÚ· ıÚ·‡ÛÌ·Ù· DNA (9). ∞fi Ù· ÛÙÂϤ¯Ë ·˘Ù¿, 85 ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÎfiÚ·Ó· ·È‰ÈÒÓ (88,5% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜), ÂÓÒ 11 ·ÔÌÔÓÒıËÎ·Ó ·fi ÙÔ ·›Ì· (11,5%). ∆· ‰È¿ÊÔÚ· ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· (ËÏÈΛ·, ʇÏÔ) Î·È ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ô˘ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Î·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙˆÓ ·ÛıÂÓÒÓ (·ÚÈıÌfi˜ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, ∆∫∂, CRP, Ù˘¯fiÓ ˘ÔΛÌÂÓÔ ÓfiÛËÌ·, ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ), ÂÏ‹ÊıËÛ·Ó ·fi ÙÔ˘˜ È·ÙÚÈÎÔ‡˜ ʷΤÏÔ˘˜ ÙˆÓ ·ÛıÂÓÒÓ ÙÔ˘ È·ÙÚÈÎÔ‡ ·Ú¯Â›Ô˘ ÙˆÓ ‰‡Ô ÓÔÛÔÎÔÌ›ˆÓ. ∫·Ù¤ÛÙË ‰˘Ó·Ù‹ Ë Û˘ÁΤÓÙÚˆÛË ÛÙÔȯ›ˆÓ ÙˆÓ 94 ·fi Ù· 96 ·È‰È¿. ø˜ ‰˘ÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÚfiÎÏËÛË ‚·ÎÙËÚÈ·ÈÌ›·˜ ÂÍÂÙ¿ÛÙËÎ·Ó Ë ËÏÈΛ· <3 ÌËÓÒÓ, ÙÔ Ê‡ÏÔ, Ë Ï¢ÎÔ΢ÙÙ¿ÚˆÛË (·ÚÈıÌfi˜ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ >15000/mm3) ‹ Ë Ï¢ÎÔÂÓ›· (·ÚÈıÌfi˜ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ <4500/mm3), Ë TKE >30 mm/ÒÚ·, Ë CRP >50 mg/l, Ô ·ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ <150.000/mm3 Î·È Ë ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο. ∂ÈϤÔÓ, ÙÔ ·Ú·¿Óˆ ‰Â›ÁÌ· Û˘ÁÎÚ›ıËΠ̠‰Â›ÁÌ· ÂϤÁ¯Ô˘ 289 ÛÙÂϯÒÓ S. enteritidis Ô˘ ·ÔÌÔÓÒıËÎ·Ó ·fi ¿ÙÔÌ· ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 14 ÂÙÒÓ, Ù· ÔÔ›· ÂÏ‹ÊıËÛ·Ó Â›Û˘ ·fi ÙÔ ·Ú¯Â›Ô ÙÔ˘ ∂∫∞™™ ηٿ ÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· (1987-1997) Î·È ˘Ô‚Ï‹ıËÎ·Ó Û ·Ó¿Ï˘ÛË Ì ∏¶¶ (·‰ËÌÔÛ›Â˘Ù· ‰Â‰Ô̤ӷ). ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Instat (Grahpad Corporation) fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Fisher exact test Î·È Ì ÙÔ ÚfiÁÚ·ÌÌ· Epi Info (Version 5.0B) fiÛÔÓ ·ÊÔÚ¿ ÛÙË regression stratified ·Ó¿Ï˘ÛË. OÈ ÙÈ̤˜ ÙÔ˘ p<0,005 ıˆڋıËÎ·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈΤ˜.

28

Paediatriki 2004;67:26-32

∞ÔÙÂϤÛÌ·Ù· ™ËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ÛÙÂϯÒÓ ·ÚÔ˘Û›·Û ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈÎÈÏÏ›ÓË Î·È Û ÌÈÎÚfiÙÂÚÔ ‚·ıÌfi ÛÙË ‰Ô͢΢ÎÏ›ÓË, ÛÙË ÛÙÚÂÙÔÌ˘Î›ÓË Î·È ÛÙȘ ÛÔ˘ÏÊÔÓ·Ì›‰Â˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ·ÓÙÔ¯‹ Û ÎÂÊ·ÏÔÛÔÚ›Ó˜ ·’, ‚’ Î·È Á’ ÁÂÓÈ¿˜ ‹ Û ÎÈÓÔÏfiÓ˜ (Ó·ÏȉÈÍÈÎfi Ô͇, ÛÈÚÔÊÏÔÍ·Û›ÓË). ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÛÙÂϯÒÓ (80,2%) ·ÚÔ˘Û›·Û ·ÓÙÔ¯‹ Û ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ·ÓÙÈ‚ÈÔÙÈο, ÂÓÒ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÛÙÂϯÒÓ ‹Ù·Ó 12,5%. O Û˘¯ÓfiÙÂÚÔ˜ Ê·ÈÓfiÙ˘Ô˜ ·ÓÙÔ¯‹˜ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Ô˘ ·Ú·ÙËÚ‹ıËΠÌÂٷ͇ ÙˆÓ ÛÙÂϯÒÓ ‹Ù·Ó Ë ÌÔÓÔ·ÓÙÔ¯‹ ÛÙËÓ ·ÌÈÎÈÏÏ›ÓË, Ô˘ ·Ú·ÙËÚ‹ıËΠ۠25 ·fi Ù· 96 ÌÈÎÚԂȷο ÛÙÂϤ¯Ë (¶›Ó·Î·˜ 1). ∆· ÛÙÂϤ¯Ë ˘Ô‚Ï‹ıËηÓ, ÛÙË Û˘Ó¤¯ÂÈ·, Û ÌÔÚȷ΋ Ù˘ÔÔ›ËÛË Ì ÙË ‚Ô‹ıÂÈ· Ù˘ ÌÂıfi‰Ô˘ Ù˘ ∏¶¶. ∞ÓȯÓ‡ÙËÎ·Ó ¤ÍÈ ∏¶¶ Ù‡ÔÈ Î·È ÂÙ¿ ˘fiÙ˘ÔÈ, ‰ËÏ. ¤ÓÙÂη Û˘ÓÔÏÈο ‰È·ÊÔÚÂÙÈÎÔ› ÁÔÓfiÙ˘ÔÈ (∂ÈÎfiÓ· 1) (¶›Ó·Î·˜ 1). ∆Ô 88% ·Ó‹Î ÛÙÔÓ Ù‡Ô ∞, ÂÓÒ ÙÔ ˘fiÏÔÈÔ 12% ηٷÌÂÚ›ÛÙËΠ۠5 Ù‡Ô˘˜. O ∏¶¶ ˘fiÙ˘Ô˜ ∞1 ‹Ù·Ó Î·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ô Î˘Ú›·Ú¯Ô˜, fiˆ˜ Î·È ÛÙ· ÛÙÂϤ¯Ë ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÂϤÁ¯Ô˘, Ì ÔÛÔÛÙfi 73,95% Â› ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÌÈÎÚÔ‚È·ÎÒÓ ÛÙÂϯÒÓ. ∞ÍÈÔÛËÌ›ˆÙË Â›Ó·È, Â›Û˘, Ë ‰È·›ÛÙˆÛË fiÙÈ Ë ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ·fi S. enteritidis Â›Ó·È Û˘¯ÓfiÙÂÚË Û ‚·ıÌfi ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ÛÙ· ·È‰È¿, fiˆ˜ ÚÔ·ÙÂÈ ÌÂÙ¿ ·fi Û‡ÁÎÚÈÛË Ì ‰Â›ÁÌ· 289 ÂÓËÏ›ÎˆÓ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, Ô˘ ÔÊÂÈÏfiÙ·Ó Û ÛÙÂϤ¯Ë S. enteritidis Î·È ·ÔÌÔÓÒıËÎ·Ó ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Ì ٷ ÛÙÂϤ¯Ë Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ [11 ÛÙ· 96 ÛÙÂϤ¯Ë ¤Ó·ÓÙÈ 6 ÛÙ· 289 ÛÙÂϤ¯Ë, ·ÓÙ›ÛÙÔȯ·, p=0,0009, OR=5,5 CI 95% (1,9-15,3)]. ∆· ÛÙÂϤ¯Ë Ô˘ ·ÔÌÔÓÒıËÎ·Ó ÛÙÔ ·›Ì· Î·È ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ·È‰È¿, ‰È·ÈÛÙÒıËΠfiÙÈ ·Ó‹Î·Ó ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ ∏¶¶ Ù‡Ô ∞ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔÓ ∏¶¶ ˘fiÙ˘Ô ∞1 Ô˘ ·Ú·ÙËÚ‹ıËΠ·ÔÎÏÂÈÛÙÈο Û ‚Ú¤ÊË ËÏÈΛ·˜ <3 ÌËÓÒÓ Î·È ÛÙÔÓ ∞2 Û ·È‰È¿ ËÏÈΛ·˜ >3 ÌËÓÒÓ, Ù· ÔÔ›· ›¯·Ó ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi ÛÔ‚·ÚÒÓ ·ÈÌ·ÙÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (Ì›· ÂÚ›ÙˆÛË Ì ÔÌfi˙˘ÁË ‚ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Ì›· Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·). ∆Ô ÔÛÔÛÙfi Ù˘ ·Ó¿Ù˘Í˘ ‚·ÎÙËÚÈ·ÈÌ›·˜ ÌÂٷ͇ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ô˘ ÂÍÂÙ¿ÛÙËΠ‹Ù·Ó 11,7%, ÂÓÒ ÌÂٷ͇ ÙˆÓ ‚ÚÂÊÒÓ ËÏÈΛ·˜ <3 ÌËÓÒÓ ÙÔ ÔÛÔÛÙfi ·˘Ùfi ·Ó‹Ïı ÛÙÔ 25,7%. ∏ ηٷÓÔÌ‹ ÙˆÓ ‰È·ÊfiÚˆÓ ÁÔÓÔÙ‡ˆÓ ÌÂٷ͇ ÙˆÓ Ê·ÈÓÔÙ‡ˆÓ ·ÓÙÔ¯‹˜ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∫¿ÔÈÔÈ Û˘ÁÎÂÎÚÈ̤ÓÔÈ ÁÔÓfiÙ˘ÔÈ Ê¿ÓËΠӷ

¶·È‰È·ÙÚÈ΋ 2004;67:26-32

Paediatriki 2004;67:26-32

¶›Ó·Î·˜ 1. ∫·Ù·ÓÔÌ‹ ÙˆÓ ∏¶¶ Ù‡ˆÓ ÌÂٷ͇ ÙˆÓ Ê·ÈÓÔÙ‡ˆÓ ·ÓÙÔ¯‹˜ 96 ÛÙÂϯÒÓ S. enteritidis, Û ·È‰È¿ ËÏÈΛ·˜ 0-14 ÂÙÒÓ, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÚÈfi‰Ô˘ 1987-1997 º·ÈÓfiÙ˘Ô˜ ·ÓÙÔ¯‹˜

A1

A2

∞ªP AMP DOX AMP STM SUM AMP AMC STM SUM· AMP STM SUM FUR· AMP DOX STM SUM· DOX DOX FUR DOX STM SUM DOX STM SUM FUR DOX CFL STM SUM FUR STM/SUM SMX/STM/SUM ∂˘·›ÛıËÙ· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë ™‡ÓÔÏÔ

21 1 1 1 4 3 5 4 8

1

1 1 2 19 71

A3

A4

A5

∏¶¶ Ù‡Ô˜ B C

1

D

E1

E2

F

2

1

2Á

4

1‚

1‚

1

2‰

1

1

1

2

3 1 1

3

9

1

1

1‚ 1

3 5

™‡ÓÔÏÔ 25 2 1 1 4 3 16 4 8 3 1 2 1 2 23 96

∞ªP: ·ÌÈÎÈÏÏ›ÓË, AMC: ·ÌÈÎÈÏÏ›ÓË Î·È ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇, DOX: ‰Ô͢΢ÎÏ›ÓË, STM: ÛÙÚÂÙÔÌ˘Î›ÓË, SUM: ÛÔ˘ÏÊÔÓ·Ì›‰Â˜, SMX: ÎÔÙÚÈÌÔÍ·˙fiÏË, FUR: ÓÈÙÚÔÊÔ˘Ú·ÓÙÔ˝ÓË, CFL: ¯ÏˆÚ·ÌÊ·ÈÓÈÎfiÏË · ¶ÔÏ˘·ÓıÂÎÙÈο ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÌÈÎÚԂȷο ÛÙÂϤ¯Ë Ô˘ ¤¯Ô˘Ó ·ÔÌÔÓˆı› ÛÙÔ ·›Ì· ‚ ∏¶¶ Ù‡ÔÈ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜: Ô Ù‡Ô˜ D Û ·ı›ÁÁ·ÓÔ˘˜, Ô ˘fiÙ˘Ô˜ ∂1 Û ∫Ô‡Ú‰Ô˘˜ Î·È Ô Ù‡Ô˜ µ Û ∞Ï‚·ÓÔ‡˜ ÌÂÙ·Ó¿ÛÙ˜ Á ¢‡Ô ÛÙÂϤ¯Ë Ì ‚·ÎÙËÚÈ·ÈÌ›· Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔÓ ˘fiÙ˘Ô ∞2 Î·È Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ (ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·) ‰ ¢‡Ô ÛÙÂϤ¯Ë Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÂÓ‰ÔÔÈÎÔÁÂÓÂȷ΋ ÂȉËÌ›· ÛÙËÓ ÂÚÈÔ¯‹ ¢ÔÌÔÎÔ‡ ºıÈÒÙȉ·˜

Û¯ÂÙ›˙ÔÓÙ·È ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ Ê·ÈÓÔÙ‡Ô˘˜ ·ÓÙÔ¯‹˜, fiˆ˜ ÔÈ ∏¶¶ Ù‡ÔÈ D Î·È F, ηıÒ˜ Î·È ÔÈ ∏¶¶ ˘fiÙ˘ÔÈ ∂1 Î·È ∂2, ÔÈ ÔÔ›ÔÈ ·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ Û ·ÓıÂÎÙÈο ÛÙË ‰Ô͢΢ÎÏ›ÓË ÛÙÂϤ¯Ë Î·È Ô Ù‡Ô˜ µ Ô˘ ·Ú·ÙËÚ‹ıËΠÌfiÓÔ ÛÙ· ¢·›ÛıËÙ· ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÌÈÎÚԂȷο ÛÙÂϤ¯Ë (¶›Ó·Î·˜ 1). ∂ÈϤÔÓ, ÔÚÈṲ̂ÓÔÈ ÁÔÓfiÙ˘ÔÈ ·Ú·ÙËÚ‹ıËÎ·Ó ÌfiÓÔ ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ Î·È ·fi Û˘ÁÎÂÎÚÈ̤Ó˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜, ÂÓÒ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ Û˘Ó˘‹Ú¯Â Ì ˘ÔΛÌÂÓ· ÓÔÛ‹Ì·Ù·. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ: ·) Ô Ù‡Ô˜ µ ·Ú·ÙËÚ‹ıËΠ۠·Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜ ·ÁfiÚÈ, ËÏÈΛ·˜ 9 ÂÙÒÓ, Ô˘ ‰È¤ÌÂÓ Û ¯ˆÚÈfi Ù˘ ÂÚÈÔ¯‹˜ ÙˆÓ ∆ÚÈÎ¿ÏˆÓ Î·È ¤·Û¯Â ·fi ÛÏ·¯ÓÈ΋ ÏÂ˚ÛÌ·Ó›·ÛË, ‚) Ô ∏¶¶ Ù‡Ô˜ D ·Ú·ÙËÚ‹ıËΠ۠·ÁfiÚÈ ËÏÈΛ·˜ 11 ÂÙÒÓ, Ô˘ ‰È¤ÌÂÓ Û ηٷ˘ÏÈÛÌfi ·ıÈÁÁ¿ÓˆÓ Ù˘ ÂÚÈÔ¯‹˜ ÙˆÓ £Ë‚ÒÓ Î·È ¤·Û¯Â ·fi ‚ÚԢΤÏψÛË, Á) Ô ∏¶¶ ˘fiÙ˘Ô˜ ∂1 ·Ú·ÙËÚ‹ıËΠ۠ÎÔ˘Ú‰È΋˜ ηٷÁˆÁ‹˜ ÎÔÚÈÙÛ¿ÎÈ, ËÏÈΛ·˜ 8 ÂÙÒÓ, Ô˘ ‰È¤ÌÂÓ Û ¯ˆÚÈfi Ù˘ ∫ÔÚ›ÓıÔ˘ Î·È ‰) Ô ∏¶¶ Ù‡Ô˜ F ·Ú·ÙËÚ‹ıËΠ۠‰‡Ô ·È‰È¿ Ù˘ ÂÚÈÔ¯‹˜ ¢ÔÌÔÎÔ‡ ºıÈÒÙȉ·˜, Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÂÓ‰ÔÔÈÎÔÁÂÓÂȷ΋ ÂȉËÌ›·. ™ÙÔÓ ¶›Ó·Î· 2 Û˘ÓÔ„›˙ÔÓÙ·È fiÏÔÈ ÔÈ ‰˘ÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜. ∂ÍÂÙ¿ÛÙËÎ·Ó Û˘ÓÔÏÈο ÔÎÙÒ ·Ú¿ÁÔÓÙ˜, Ì ٤ÛÛÂÚȘ ÂÎ ÙˆÓ ÔÔ›ˆÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi ‚·ıÌfi (ËÏÈΛ· <3 ÌËÓÒÓ, ·˘-

ÍË̤ÓË CRP, Ï¢ÎÔ΢ÙÙ¿ÚˆÛË/Ï¢ÎÔÂÓ›·, ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο). ¶ÂÚ·ÈÙ¤Úˆ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ·Ú·ÁfiÓÙˆÓ ·˘ÙÒÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ regression stratified ·Ó¿Ï˘Û˘, ÂÍÂÙ¿˙ÔÓÙ·˜ ·Ó¿ ‰‡Ô ÙÔ˘˜ ‰˘ÓËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·Ó¿Ù˘Í˘ ‚·ÎÙËÚÈ·ÈÌ›·˜ Û fiÏÔ˘˜ ÙÔ˘˜ ‰˘Ó·ÙÔ‡˜ Û˘Ó‰˘·ÛÌÔ‡˜, ·ÔÎ¿Ï˘„ fiÙÈ Ë ËÏÈΛ· <3 ÌËÓÒÓ Î·È Ë ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Û¯ÂÙ›˙ÔÓÙ·Ó ÌÂٷ͇ ÙÔ˘˜ Û Ôχ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ [OR=41,4; CI (5,78-292,74); p<0,000001]. ŸÏ· Ù· ‚Ú¤ÊË ËÏÈΛ·˜ <3 ÌËÓÒÓ, Ù· ÔÔ›· ·Ó¤Ù˘Í·Ó Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi ÔÏ˘·ÓıÂÎÙÈο ÛÙÂϤ¯Ë S. enteritidis, ·ÚÔ˘Û›·Û·Ó ‚·ÎÙËÚÈ·ÈÌ›·. ∞ÓÙ›ıÂÙ·, Û ηӤӷ ·È‰› ËÏÈΛ·˜ >3 ÌËÓÒÓ Ô˘ ·Ó¤Ù˘Í Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ÂÍ·ÈÙ›·˜ οÔÈÔ˘ ÔÏÈÁÔ·ÓıÂÎÙÈÎÔ‡ ‹ ¢·›ÛıËÙÔ˘ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÛÙÂϤ¯Ô˘˜, ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‚·ÎÙËÚÈ·ÈÌ›·. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È, Â›Û˘, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·˘Ù¿ Ù· ÔÏ˘·ÓıÂÎÙÈο ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÌÈÎÚԂȷο ÛÙÂϤ¯Ë Ô˘ ‹Ù·Ó ˘‡ı˘Ó· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ·Ó‹Î·Ó Û ÙÚÂȘ ÌfiÓÔ Ê·ÈÓÔÙ‡Ô˘˜ ·ÓÙÔ¯‹˜, ÔÈ ÔÔ›ÔÈ ÂÚÈÂÏ¿Ì‚·Ó·Ó ·ÓıÂÎÙÈο ÛÙËÓ ·ÌÈÎÈÏÏ›ÓË ÛÙÂϤ¯Ë ÛÂ Û˘Ó‰˘·ÛÌfi Ì οÔÈÔÓ ·fi ÙÔ˘˜ ·ÎfiÏÔ˘ıÔ˘˜ ·ÓÙÈÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜: ‰Ô͢΢ÎÏ›ÓË, ÛÙÚÂÙÔÌ˘Î›ÓË, ÛÔ˘ÏÊÔÓ·Ì›‰Â˜ Î·È ÓÈÙÚÔÊÔ˘Ú·ÓÙÔ˝ÓË (¶›Ó·Î·˜ 1). ∆¤ÏÔ˜, Û 6 ·fi ÙȘ 94 ÂÚÈÙÒÛÂȘ Ô˘ η٤ÛÙË

29

∏¶¶ - ∆À¶O™ ¡Ô ™∆∂§∂ÃOÀ™

∞ªƒ E AMP AMP FUR DOX AMP DOX DOX DOX DOX AMP DOX/STM SUM ∞1 B C D A2 F A4 A3 E1 E2 A5

º∞π¡O∆À¶O™ ∞¡∆OÃ∏™

Ï 951 418 300 735 724 881 478 605 472 479 295 Ï

∂∆O™

1995 1997 1997 1995 1995 1991 1987 1997 1991 1987 1997

¶·È‰È·ÙÚÈ΋ 2004;67:26-32

436,5 388 339,5 291 242,5 194 145,5 97 48,5 (kb)

∂ÈÎfiÓ· 1. ∆‡ÔÈ Î·È ˘fiÙ˘ÔÈ Ô˘ ÚԤ΢„·Ó ηٿ ÙËÓ ËÏÂÎÙÚÔÊfiÚËÛË Û ·ÏÏfiÌÂÓÔ ‰›Ô (∏¶¶) 96 ÛÙÂϯÒÓ S. enteritidis Ô˘ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ·È‰È¿, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÙÒÓ 1987-1997.

‰˘Ó·Ù‹ Ë Û˘ÁΤÓÙÚˆÛË ÛÙÔȯ›ˆÓ, ‰È·ÈÛÙÒıËΠfiÙÈ ˘‹Ú¯Â οÔÈÔ˘ ›‰Ô˘˜ ˘ÔΛÌÂÓÔ ÓfiÛËÌ· (Â›ÙˆÛË: 6,4%). ∆· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. ™˘˙‹ÙËÛË ∆· ÔÛÔÛÙ¿ ·ÓÙÔ¯‹˜ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÙˆÓ ÛÙÂϯÒÓ S. enteritidis Ô˘ ÂÍÂÙ¿ÛÙËÎ·Ó ‹Ù·Ó ·ÚÎÂÙ¿ ˘„ËÏ¿ Û˘ÁÎÚÈÙÈο Ì ¿ÏϘ ¯ÒÚ˜ (1,7), ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ÛÙÂϤ¯Ë ·˘Ù¿ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ·È‰È¿. ∆Ô ÔÛÔÛÙfi ÙˆÓ ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÛÙÂϯÒÓ Ô˘ ·Ú·ÙËÚ‹ıËΠ‹Ù·Ó Â›Û˘ ˘„ËÏfi, Ì ٷ ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ Ó· Â›Ó·È ·ÓıÂÎÙÈο ÛÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜ Ù˘ ·ÌÈÎÈÏÏ›Ó˘ Ì ÙË ÛÙÚÂÙÔÌ˘Î›ÓË, ÙȘ ÛÔ˘ÏÊÔÓ·Ì›‰Â˜ Î·È ÙË ÓÈÙÚÔÊÔ˘Ú·ÓÙÔ˝ÓË, fiˆ˜ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› Î·È Û ¿ÏϘ ÂÏÏËÓÈΤ˜ ÌÂϤÙ˜ Ô˘ ÂÍ¤Ù·Û·Ó ÙÔÓ ÔÚfiÙ˘Ô ·˘Ùfi (4,5,8,10). øÛÙfiÛÔ, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÓıÂÎÙÈο ÛÙÂϤ¯Ë Û ÎÂÊ·ÏÔÛÔÚ›Ó˜ ·’, ‚’ Î·È Á’ ÁÂÓÈ¿˜, ÁÂÁÔÓfi˜ Ô˘ ‰ÂÓ ÂÚÈÔÚ›˙ÂÈ ÙȘ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ Û ÂÚÈÙÒÛÂȘ ÂÈÏÔÎÒÓ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ

30

Paediatriki 2004;67:26-32

Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Û ÂÚÈÙÒÛÂȘ ·Ó¿Ù˘Í˘ ‚·ÎÙËÚÈ·ÈÌ›·˜, ÛÙȘ Ôԛ˜ ÔÈ ÎÂÊ·ÏÔÛÔÚ›Ó˜ Á’ ÁÂÓÈ¿˜ ·ÔÙÂÏÔ‡Ó ÙÔ ·ÓÙÈ‚ÈÔÙÈÎfi ÂÎÏÔÁ‹˜ Û ·È‰È¿ (11). ∞fi ÙÔ˘˜ ¤ÓÙÂη ÁÔÓÔÙ‡Ô˘˜ Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÌÂٷ͇ ÙˆÓ ÛÙÂϯÒÓ (¤ÍÈ ∏¶¶ Ù‡ÔÈ Î·È ÂÙ¿ ˘fiÙ˘ÔÈ), Ô ∞1 ˘fiÙ˘Ô˜ ·ÓȯÓ‡ıËΠÛÙ· ‰‡Ô ÙÚ›Ù· ÂÚ›Ô˘ ÙˆÓ ÛÙÂϯÒÓ (74%). O ÁÔÓfiÙ˘Ô˜ ·˘Ùfi˜ ·ÔÙÂÏ›, ÙÔ˘Ï¿¯ÈÛÙÔÓ ·fi ÙÔ 1987, ÙÔÓ Î˘Ú›·Ú¯Ô ÁÔÓfiÙ˘Ô ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, fiˆ˜ ¤¯ÂÈ ·Ú·ÙËÚËı› Î·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÂÏÏËÓÈΤ˜ ÌÂϤÙ˜ Ô˘ ÂÍ¤Ù·Û·Ó Â›Ù ·ÓÙÈÚÔÛˆ¢ÙÈÎfi ÁÈ· ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ ‰Â›ÁÌ· (8) ›Ù ÌÂÌÔӈ̤ӷ ÎÚÔ‡ÛÌ·Ù· Á·ÛÙÚÂÓÙÂÚ›Ùȉ·˜ (12) Ô˘ ÔÊ›ÏÔÓÙ·Ó ÛÙÔÓ ˘fi ÌÂϤÙË ÔÚfiÙ˘Ô. O ÚÔ·Ó·ÊÂÚfiÌÂÓÔ˜ ∏¶¶ ˘fiÙ˘Ô˜ ·ÓȯÓ‡ıËΠÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó¤Ù˘Í·Ó ‚·ÎÙËÚÈ·ÈÌ›·. ∂ÈϤÔÓ, οÔÈ· Û˘ÁÎÂÎÚÈ̤ӷ ÔÏ˘·ÓıÂÎÙÈο ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÛÙÂϤ¯Ë ÙÔ˘ ˘ÔÙ‡Ô˘ ·˘ÙÔ‡, Ù· ÔÔ›· ·Ó‹Î·Ó Û ÙÚÂȘ ÌfiÓÔ Ê·ÈÓÔÙ‡Ô˘˜ ·ÓÙÔ¯‹˜ (¶›Ó·Î·˜ 1), ‹Ù·Ó ˘‡ı˘Ó· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ‚Ú¤ÊË ËÏÈΛ·˜ <3 ÌËÓÒÓ. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜. º·›ÓÂÙ·È fiÙÈ Û˘ÁÎÂÎÚÈ̤ӷ ÔÏ˘·ÓıÂÎÙÈο ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ÛÙÂϤ¯Ë Ô˘ ·Ó‹ÎÔ˘Ó Û ¤Ó·Ó Û˘ÁÎÂÎÚÈ̤ÓÔ ÁÔÓfiÙ˘Ô, ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ˜ Èı·ÓfiÙËÙ˜ Ó· ÚÔηϤÛÔ˘Ó ‚·ÎÙËÚÈ·ÈÌ›· Û ·È‰È¿ ηٿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ∞˘Ùfi Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È ÛÙËÓ ·ÙÂÏ‹ ˆÚ›Ì·ÓÛË ÙÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ ÙÔ˘˜ Û˘ÛÙ‹Ì·ÙÔ˜. ¶ÚÔËÁÔ‡ÌÂÓ˜ ÂÚÁ·Û›Â˜ ¤¯Ô˘Ó Û˘Û¯ÂÙ›ÛÂÈ ÌÂÌÔӈ̤ӷ ›Ù ÙËÓ ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο ›Ù ÙËÓ ËÏÈΛ· <3 ÌËÓÒÓ Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ÂÚÈÙÒÛÂȘ Û·ÏÌÔÓÂÏÒÛÂˆÓ (13-16). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ ˘fiÏÔÈÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, ÙfiÛÔ Ë CRP >50 mg/l fiÛÔ Î·È Ë Ï¢ÎÔ΢ÙÙ¿ÚˆÛË/Ï¢ÎÔÂÓ›· Ê¿ÓËΠfiÙÈ ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙ˜ ÌÂÙ·‚ÏËÙ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ÛÙ· ·È‰È¿. ∏ ·˘ÍË̤ÓË CRP ¤¯ÂÈ ‰Âȯı› fiÙÈ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ÌfiÓÔ Û ÂÚÈÙÒÛÂȘ ÂÓÙÂÚÈÎÔ‡ ˘ÚÂÙÔ‡ (17), ÂÓÒ ÂÚÁ·Û›Â˜ Ô˘ Âȯ›ÚËÛ·Ó Ó· Û˘Û¯ÂÙ›ÛÔ˘Ó ÙÔÓ ·Ú¿ÁÔÓÙ· ·˘Ùfi Û ÂÚÈÙÒÛÂȘ ÏÔÈÌÒÍÂˆÓ ·fi ÌË Ù˘ÊÔ·Ú·Ù˘ÊÈÎÔ‡˜ ÔÚÔÙ‡Ô˘˜ Û·ÏÌÔÓÂÏÒÓ, ·¤Ù˘¯·Ó Ó· ·ԉ›ÍÔ˘Ó ÙÔÓ ·Ú·¿Óˆ Û˘Û¯ÂÙÈÛÌfi (18,19). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ Ë ÙÈÌ‹ Ù˘ CRP ·˘Í¿ÓÂÈ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ÊÏÂÁÌÔÓ‹˜ Î·È ÙËÓ Î·Ù·ÛÙÚÔÊ‹ ÙˆÓ ÈÛÙÒÓ Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Î·Ù¿ ÙË ÊÏÂÁÌÔÓÒ‰Ë ‰È·‰Èηۛ·, ·ÏÏ¿ ÌÂÈÒÓÂÙ·È Ì ٷ¯‡ Ú˘ıÌfi, ÂÍ·ÈÙ›·˜ ÙÔ˘ ¯·ÌËÏÔ‡ Û¯ÂÙÈο ¯ÚfiÓÔ˘

¶·È‰È·ÙÚÈ΋ 2004;67:26-32

Paediatriki 2004;67:26-32

¶›Ó·Î·˜ 2. ¢˘ÓËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· 94 ·È‰È¿ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi S. enteritidis Ì ‹ ¯ˆÚ›˜ ‚·ÎÙËÚÈ·ÈÌ›· ¢˘ÓËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ ÕÚÚÂÓ Ê‡ÏÔ ∏ÏÈΛ· <3 ÌËÓÒÓ §Â˘ÎÔ·ÙÙ·Ú· >15000/mm3 ‹ <4500/mm3 TKE >30 mm/ÒÚ· CRP >50 mg/l ÀÔΛÌÂÓÔ ÓfiÛËÌ·** ¶ÔÏ˘·ÓÙÔ¯‹ ÛÙ· ·ÓÙÈ‚ÈÔÙÈο*** ∞ÚÈıÌfi˜ ·ÈÌÔÂÙ·Ï›ˆÓ <150.000/Ìl

¶ÂÚÈÛÙ·ÙÈο Ì ‚·ÎÙËÚÈ·ÈÌ›· (N=11)

¶ÂÚÈÛÙ·ÙÈο ¯ˆÚ›˜ ‚·ÎÙËÚÈ·ÈÌ›· (N=83)

∆ÈÌ‹ P

OR (<95% CI)

5 7* 7 4 8 2 8 5

48 29 12 21 12 4 10 21

0,76 0,075 0,009 0,74 0,005 0,20 0,0025 0,52

0,9 (0,4-1,7) 7,6 (1,5-37,1) 4,8 (1,5-14,8) 1,3 (0,4-4,4) 5,03 (1,7-15,0) 3,3 (0,5-20,3) 6,04 (1,9-18,5) 1,6 (0,5-5,0)

* ŸÏ· Ù· ÂÚÈÛÙ·ÙÈο ·Ó‹Î·Ó ÛÙÔÓ ∞1 ˘fiÙ˘Ô ** ∆· ˘ÔΛÌÂÓ· ÓÔÛ‹Ì·Ù· ÂÚÈÂÏ¿Ì‚·Ó·Ó 3 ÂÚÈÙÒÛÂȘ Ì ÏÔÈÌ҉˜ ÓfiÛËÌ· (1 ÂÚ›ÙˆÛË ‚ÚԢΤÏψÛ˘, 1 ÛÏ·¯ÓÈ΋˜ ÏÂ˚ÛÌ·Ó›·Û˘, 1 Ó¢ÌÔÓ›·˜) Î·È 3 ÂÚÈÙÒÛÂȘ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ (1 ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋˜ ·Ó·ÈÌ›·˜, 1 ÔÌfi˙˘Á˘ ÌÂÛÔÁÂȷ΋˜ ·Ó·ÈÌ›·˜, 1 ¯ÚfiÓÈ·˜ ÓÂÊÚÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜) *** ∞ÓÙÔ¯‹ Û ÙÚÂȘ ‹ ÂÚÈÛÛfiÙÂÚ˜ ηÙËÁÔڛ˜ ·ÓÙÈ‚ÈÔÙÈÎÒÓ

ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Ô˘ ¤¯ÂÈ Î·È Ô˘ Û˘Ó‹ıˆ˜ Î˘Ì·›ÓÂÙ·È ·fi 4 ¤ˆ˜ 7 ÒÚ˜ (18,20,21). º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ Ë ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ Ù˘ ̤ÙÚËÛ˘ Ù˘ CRP ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο Ù· ·ÔÙÂϤÛÌ·Ù·. øÛÙfiÛÔ, ÔÈ Ôχ ˘„ËϤ˜ ÙÈ̤˜ Ù˘ CRP (>50 mg/l) Ô˘ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·È‰È¿ Ô˘ ·Ó¤Ù˘Í·Ó ‚·ÎÙËÚÈ·ÈÌ›·, ÂÈÙÚ¤Ô˘Ó - ·Ó Î·È ÌË ÂȉÈÎfi˜ ‰Â›ÎÙ˘ ÊÏÂÁÌÔÓ‹˜ - Ó· ·ÍÈÔÏÔÁËı› Ì·˙› Ì ¿ÏϘ ·Ú·Ì¤ÙÚÔ˘˜ ˆ˜ ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘ Û ·È‰È¿ Ì Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi S. enteritidis. ∆Ô ›‰ÈÔ Û˘ÌÂÚ·›ÓÂÙ·È Î·È Ì ÙË ıÂÒÚËÛË Ù˘ Ï¢ÎÔ΢ÙÙ¿ÚˆÛ˘/Ï¢ÎÔÂÓ›·˜ ˆ˜ ‰˘ÓËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ·È‰È¿, Ô ÔÔ›Ô˜ ·ÔÙÂÏ›, Â›Û˘, ¤Ó·Ó ÌË ÂȉÈÎfi ‰Â›ÎÙË ÊÏÂÁÌÔÓ‹˜.

O ∏¶¶ ˘fiÙ˘Ô˜ ∞2 Ê¿ÓËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ·È‰È¿ Ì ÛÔ‚·Ú¤˜ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ (ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·). ∞Ó Î·È ÔÈ ÏÔÈÌÒÍÂȘ ·fi Û·ÏÌÔӤϷ Â›Ó·È Û˘¯Ó¤˜ Û ·ÛıÂÓ›˜ Ì ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ÚԤ΢„ ·fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, ηӤӷ˜ Û˘Û¯ÂÙÈÛÌfi˜ ÌÂٷ͇ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·˘ÙÒÓ Î·È ÂÓfi˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÁÔÓÔÙ‡Ô˘ Ô˘ Ó· ·Ó‹ÎÂÈ Û οÔÈÔÓ ÔÚfiÙ˘Ô Û·ÏÌÔӤϷ˜, ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ó·ÊÂÚı›. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËÎÂ, Â›Û˘, fiÙÈ Î¿ÔÈÔÈ Û˘ÁÎÂÎÚÈ̤ÓÔÈ ∏¶¶ Ù‡ÔÈ Î·È ˘fiÙ˘ÔÈ Û˘Ó‰¤ÔÓÙ·È ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ Î·È ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ Ô˘ ·Ó‹Î·Ó Û ‰È¿ÊÔÚ˜ ÌÂÈÔÓfiÙËÙ˜. ™Â ÔÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ· ·fi S. enteritidis Û˘Ó˘‹Ú¯Â Ì ¿ÏÏË ÂÓÙÔÈṲ̂ÓË Ïԛ̈ÍË, fiˆ˜ .¯. ‚ÚԢΤÏψÛË Î·È ÛÏ·¯ÓÈ΋ ÏÂ˚ÛÌ·Ó›·ÛË, ÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÙˆÓ ÔÔ›ˆÓ ÂÓ‰ËÌÔ‡Ó ÛÙȘ ÂÚÈÔ¯¤˜ ·fi ÙȘ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·Ó Ù· ·È-

‰È¿ ·˘Ù¿ (ÂÚÈÔ¯¤˜ ÙˆÓ ∆ÚÈÎ¿ÏˆÓ Î·È Ù˘ £‹‚·˜ ÁÈ· Ù· ÂÚÈÛÙ·ÙÈο Ù˘ ÛÏ·¯ÓÈ΋˜ ÏÂ˚ÛÌ·Ó›·Û˘ Î·È Ù˘ ‚ÚԢΤÏψÛ˘, ·ÓÙ›ÛÙÔȯ·). ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙ· ÌÈÎÚԂȷο ÛÙÂϤ¯Ë S. enteritidis Ô˘ ÂÍÂÙ¿ÛÙËηÓ, ‰È·ÈÛÙÒıËÎ·Ó ˘„ËÏ¿ ÔÛÔÛÙ¿ ·ÓıÂÎÙÈÎÒÓ Î·È ÔÏ˘·ÓıÂÎÙÈÎÒÓ ÛÙÂϯÒÓ. ∆· ÙÂÏÂ˘Ù·›· Û˘Ó‰¤ÔÓÙ·Ó Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ ÛÂ Û˘Û¯ÂÙÈÛÌfi Ì ÙËÓ ËÏÈΛ· <3 ÌËÓÒÓ Î·È ·Ó‹Î·Ó ÛÙÔÓ ∏¶¶ ∞1 ˘fiÙ˘Ô, Ô ÔÔ›Ô˜ Â›Ó·È Î˘Ú›·Ú¯Ô˜ ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ ÌÂٷ͇ ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÔÚÔÙ‡Ô˘ ·˘ÙÔ‡ ·fi ÙÔ 1987 (8). ¢‡Ô ÂÈϤÔÓ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ (CRP >50 mg/l Î·È Ï¢ÎÔ΢ÙÙ¿ÚˆÛË/Ï¢ÎÔÂÓ›·) Û˘Ó‰¤ÔÓÙ·Ó ·ÓÂÍ¿ÚÙËÙ· Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜. O ∏¶¶ ˘fiÙ˘Ô˜ ∞2 Ê¿ÓËΠӷ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ‚·ÎÙËÚÈ·ÈÌ›·˜ Û ·È‰È¿ ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÛÔ‚·Ú¤˜ ·ÈÌ·ÙÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ (ÔÌfi˙˘ÁË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·). ∆¤ÏÔ˜, οÔÈÔÈ ÌÂÌÔӈ̤ÓÔÈ ÁÔÓfiÙ˘ÔÈ Ê¿ÓËΠfiÙÈ Û˘Ó‰¤ÔÓÙ·Ó ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ ηÈ/‹ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ ÌÂÈÔÓÔًوÓ, ÂÓÒ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ Û˘Ó˘‹Ú¯·Ó Ì ÂȉÈΤ˜ ÏÔÈÌÒÍÂȘ, ÔÈ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÙˆÓ ÔÔ›ˆÓ ÂÓ‰ËÌÔ‡Û·Ó ÛÙËÓ ÂÚÈÔ¯‹, fiÔ˘ ·ÔÌÔÓÒıËÎ·Ó Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÂϤ¯Ë S. enteritidis. µÈ‚ÏÈÔÁÚ·Ê›· 1. Fisher IS, on behalf of Salm-Net participants. Salmonella enteritidis and S. typhimurium in Western Europe for 19931995: a surveillance report from Salm-Net. Euro Surveill 1997;2:4-6.

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Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. 4th ed. Approved Standard M7-A4. National Committee for Clinical Laboratory Standards. Wayne, Pa; 1997.

Threlfall EJ, Ward LR, Skinner JA, Rowe B. Increase in multiple antibiotic resistance in nontyphoidal salmonellas from humans in England and Wales: a comparison of data for 1994 and 1996. Microb Drug Resist 1997;3:263-266.

Tassios ƒ∆, Markogiannakis ∞, Vatopoulos AC, Katsanikou ∂, Velonakis ∂¡, Kourea-Kremastinou J et al. Molecular epidemiology of antibiotic resistance of Salmonella enteritidis during a 7-year period in Greece. J Clin Microbiol 1997;35:1316-1321.

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Tierney LM, McPhee SJ, Papadakis ª∞. Current medical diagnosis and treatment. 38th ed. Stanford, Connecticut: Appleton & Lange; 1999. p. 1313-1314.

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12. Hadjichristodoulou C, Nikolakopoulou E, Karabinis K, Karakou E, Markogiannakis A, Panoulis C et al. Outbreak of Salmonella gastroenteritis among attendees of a restaurant opening ceremony in Greece, June 1998. Euro Surveill 1999;4:72-75.

13. Yang YJ, Liu CC, Wang SM, Wu JJ, Huang AH, Cheng CP. High rates of antimicrobial resistance among clinical isolates of nontyphoidal Salmonella in Taiwan. Eur J Clin Microbiol Infect Dis 1998;17:880-883.

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20. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997;16:735-747.

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¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞ÓÙÒÓÈÔ˜ ª·ÚÎÔÁÈ·ÓÓ¿Î˘ ∂Ï›‰Ô˜ 8, ∆.∫. 104 34, ∞ı‹Ó· E-mail: markogiann@ath.forthnet.gr

¶·È‰È·ÙÚÈ΋ 2004;67:33-38

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2004;67:33-38

ORIGINAL ARTICLE

∏ Â›‰Ú·ÛË ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ÛÙË ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ Na+K+-∞∆ƒ¿Û˘ Î·È Ù˘ Mg2+-ATƒ¿Û˘ Û ʷÈÓ˘ÏÎÂÙÔÓÔ˘ÚÈÎÔ‡˜ ·ÛıÂÓ›˜ ∫. ™Ô‡ÏË1, °. ∫·Ú›Î·˜2, π. ∆˙·ÌÔ˘Ú¿ÓË1, ∂. ªÈ¯ÂϷοÎË1, ™. ∆۷ΛÚ˘3

In vivo effects of high blood levels of phenylalanine on Na+K+-ATPase and Mg2+-ATPase activities in phenylketonuric patients K. Schulpis1, G. Karikas2, I. Tjamouranis1, H. Michelakakis1, S. Tsakiris3

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ë ‰Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÂÓ˙‡ÌˆÓ ¡a+∫+∞∆ƒ¿ÛË Î·È Mg2+-ATP¿ÛË ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ·ÛıÂÓÒÓ Ì ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· Î·È Ó· Û˘Û¯ÂÙÈÛÙ› Ì ٷ Â›‰· ÙfiÛÔ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ fiÛÔ Î·È Ù˘ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ÛÙÔ Ï¿ÛÌ·. ∂›ÎÔÛÈ ÙÚÂȘ ·ÛıÂÓ›˜ Ì ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜: ÙËÓ ÔÌ¿‰· ∞ (¡=12), ÛÙËÓ ÔÔ›· ÔÈ ·ÛıÂÓ›˜ ·ÎÔÏÔ˘ıÔ‡Û·Ó ·˘ÛÙËÚ¿ ÙËÓ “ÂȉÈ΋” ıÂÚ·¢ÙÈ΋ ‰›·ÈÙ· Î·È ÙËÓ ÔÌ¿‰· µ (¡=11), fiÔ˘ ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÙË ıÂÚ·›· ÙÔ˘˜ ·˘ÛÙËÚ¿. OÈ ‰Ú·ÛÙÈÎfiÙËÙ˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÌÂÙÚ‹ıËÎ·Ó Ê·ÛÌ·ÙÔʈÙÔÌÂÙÚÈο ÛÙ· 390 nm, Ù· Â›‰· ÙˆÓ ·ÌÈÓÔͤˆÓ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘, Ù˘ÚÔÛ›ÓË Î·È ÙÚ˘ÙÔÊ¿ÓË, ÌÂÙÚ‹ıËÎ·Ó Ì ·˘ÙfiÌ·ÙÔ ·Ó·Ï˘Ù‹ ·ÌÈÓÔͤˆÓ Î·È ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ Ì HPLC. ™ÙËÓ ÔÌ¿‰· µ, Ù· Â›‰· ÙˆÓ ·ÌÈÓÔͤˆÓ, ÔÈ ‚ÈÔÁÂÓ›˜ ·Ì›Ó˜ (·‰ÚÂÓ·Ï›ÓË, ÓÔÚ·‰ÚÂÓ·Ï›ÓË Î·È ÛÂÚÔÙÔÓ›ÓË) Î·È ÔÈ ‰Ú·ÛÙÈÎfiÙËÙ˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο (p<0,001) ÌÂȈ̤ӷ. ∆· ˘„ËÏ¿ Â›‰· Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ‹/Î·È Ù· ¯·ÌËÏ¿ ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ ÛÙÔ Ï¿ÛÌ· ı· ÌÔÚÔ‡Û·Ó Ó· ÂÚÌËÓ‡ÛÔ˘Ó ÙË Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ¡a+∫+-∞∆ƒ¿ÛË Î·È Mg2+-ATP¿ÛË ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ·ÛıÂÓÒÓ Ì ʷÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·. ∏ ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË Ù˘ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ÛÙËÓ Mg2+-ATP¿ÛË Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÁÈ· ÚÒÙË ÊÔÚ¿. ∫·Ù¿ Û˘Ó¤ÂÈ·, Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ı·

Abstract: Phenylketonuria is an inborn error of metabolism characterized by high blood levels of phenylalanine, low levels of tyrosine and tryptophan and reduced concentrations of the biogenic amines adrenaline, noradrenaline, dopamine and serotonin in untreated patients. The aim of this study was to measure Na+K+-ATPase and Mg2+-ATPase activities in erythrocyte membranes from patients with phenylketonuria and to correlate these activities with the plasma biogenic amines and their precursors tyrosine and tryptophan.

Twenty three patients with phenylketonuria were divided into group A (N=12) on a strict diet (phenylalanine 1.57±0.52 mg/dl or 0.10±0.03 mM) and group B (phenylalanine 24.45±1.50 mg/dl or 1.72±0.09 mM) (N=11) on a “loose” diet. Na+K+ATPase and Mg2+-ATPase activities in erythrocyte membranes were assessed spectrophotometrically at 390 nm, amino acid concentrations were measured using an automatic amino-acid analyser and the biogenic amines by HPLC methods.

Na+K+-ATPase and Mg2+-ATPase activities were found inhibited (0.38±0.05, 2.0±0.24 Ìmol Pi/hxmg protein) in group B compared to group A (0.61±0.06, 2.8±0.28 Ìmol Pi/hxmg protein, p<0.001) and controls without phenylketonuria (0.67±0.05, 2.77±0.17 Ìmol Pi/hxmg protein, p<0.001). This inhibitory effect of phenylalanine on Mg2+-ATPase in vivo wasobserved here for the first time. The biogenic amines adrenaline

1 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ªÔÓ¿‰· ∂Ó‰ÔÊϤ‚ÈˆÓ ¢È·Ï˘Ì¿ÙˆÓ Î·È º·ÚÌ·ÎÔÎÈÓËÙÈ΋˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ∂ÚÁ·ÛÙ‹ÚÈÔ ¶ÂÈÚ·Ì·ÙÈ΋˜ º˘ÛÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

1 Institute of Child Health “Aghia Sophia” Children’s Hospital, Athens 2 Division of Intravenous Solutions and Pharmacokinetics “Aghia Sophia” Children’s Hospital, Athens 3 Laboratory of Experimental Physiology University of Athens Medical School

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Paediatriki 2004;67:33-38

ÌÔÚÔ‡Û ӷ ¯ÚËÛÈ̇ÛÂÈ ˆ˜ ÂÚÈÊÂÚÈÎfi˜ ‰Â›ÎÙ˘ ÙÔÍÈÎfiÙËÙ·˜ Ù˘ Ê·ÈÓ˘Ï·Ï·Ó›Ó˘ ÛÙÔÓ ÂÁΤʷÏÔ.

148±68 pmol/l, noradrenaline 1.46±0.5 nmol/l, dopamine 46±32 pmol/l, serotonin 2.1±1.0 nmol/109 plt were lower in group B than in group A (adrenaline 860±148 pmol/l, noradrenaline 2.8±0.06 nmol/l, dopamine 130±25 pmol/l, serotonin 4.26±0.9 nmol/109 plt, p<0.001) or in controls (adrenaline 890±198 pmol/l, noradrenaline 3.2±1.2 nmol/l, dopamine 138±20 pmol/l, serotonin 4.98±0.7 nmol/109 plt, p<0.001). The findings suggest that high plasma levels of phenylalanine or low levels of noradrenaline, dopamine and/or serotonin may indirectly inhibit the erythrocyte membrane Na+K+-ATPase and Mg2+-ATPase in patients with phenylketonuria on a “loose diet”. The reported inhibition of these enzymes serves as a peripheral marker of the neurotoxic cerebral effects of phenylalanine in these patients.

§¤ÍÂȘ ÎÏÂȉȿ: ¡a+∫+-∞∆ƒ¿ÛË, Mg2+-∞∆ƒ¿ÛË, ‚ÈÔÁÂÓ›˜ ·Ì›Ó˜, Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·.

Key words: Na+K+-ATPase, Mg2+-ATPase, biogenic amines, phenylketonuria.

∂ÈÛ·ÁˆÁ‹ ∏ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· (PKU) Â›Ó·È Ì›· ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ·‚ÔÏÈ΋ ÓfiÛÔ˜, ÛÙËÓ ÔÔ›· ·Ú·ÙËÚÂ›Ù·È ·‰˘Ó·Ì›· ÌÂÙ·ÙÚÔ‹˜ ÙÔ˘ ·ÚˆÌ·ÙÈÎÔ‡ ·ÌÈÓÔͤԘ Ê·ÈÓ˘Ï·Ï·Ó›ÓË (Phe) ÛÂ Ù˘ÚÔÛ›ÓË (Tyr). ∏ Tyr Â›Ó·È ÚÔ‰ÚÔÌÈ΋ Ô˘Û›· ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ. ªÔÓ·‰È΋ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ ·ÔÙÂÏ› Ë “ÂȉÈ΋” ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û Phe ‰›·ÈÙ·, Ë ÔÔ›· ·Ú¯›˙ÂÈ ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ Î·È ·ÔÛÎÔ› ÛÙË Ì›ˆÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Phe ÛÙÔ ·›Ì· Î·È ÛÙËÓ ·ÔÊ˘Á‹ ÓÔËÙÈ΋˜ ˘ÛÙ¤ÚËÛ˘, Û·ÛÌÒÓ Î·È ÂÎ˙¤Ì·ÙÔ˜, Ô˘ Â›Ó·È Ë Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ (1-3). ¶ÔÏÏÔ›, fï˜, ·fi ÙÔ˘˜ PKU ·ÛıÂÓ›˜ ·ÎÔÏÔ˘ıÔ‡Ó ¯·Ï·Ú¿ ÙË “‰›·ÈÙ·”, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·‡ÍËÛË ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Phe ÛÙÔ ·›Ì· ÙÔ˘˜ (1,3). ∞ÔÙ¤ÏÂÛÌ· ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Phe Â›Ó·È Ë Ì›ˆÛË ÙÔ˘ Úfi‰ÚÔÌÔ˘ ·ÌÈÓÔͤԘ Tyr ηÈ, Û˘ÓÂÒ˜, Ù˘ ·Ú·ÁˆÁ‹˜ ÙˆÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ ÓÙÔ·Ì›Ó˘ (DA) Î·È ÓÔÚ·‰ÚÂÓ·Ï›Ó˘ (¡A) (4,5). OÈ Krause Î·È Û˘Ó (3) Î·È Ô Blau (6) ·Ú·Ù‹ÚËÛ·Ó ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ DA Î·È Phe Î·È Ì›ˆÛË Ù˘ ÛÂÚÔÙÔÓ›Ó˘ (5HT) ÏfiÁˆ ·ÓÂ·ÚÎÔ‡˜ Û˘ÁΤÓÙÚˆÛ˘ ÙÚ˘ÙÔÊ¿Ó˘ (Try), Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÌÊ¿ÓÈÛË ÂÁÎÂÊ·ÏÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ (7,8). ∆Ô ¤Ó˙˘ÌÔ ÙÚÈʈÛÊ·Ù¿ÛË Ù˘ ·‰ÂÓÔÛ›Ó˘ Ù˘ ·ÓÙÏ›·˜ ¡a, ∫ (¡a+∫+-∞∆ƒ¿ÛË) Â›Ó·È ˘‡ı˘ÓÔ ÁÈ· ÙËÓ ÂÓÂÚÁ‹ ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ¡a+ Î·È ÙÔ˘ ∫+ ‰È·Ì¤ÛÔ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ (9) Î·È ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘˜ ÛÙȘ Û˘Ó¿„ÂȘ, Û˘ÌÌÂÙ¤¯ÔÓÙ·˜ ¤ÙÛÈ ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (10). ™Â ÚÔË-

ÁÔ‡ÌÂÓ˜ in vitro ÌÂϤÙ˜ ·ԉ›¯ıËΠfiÙÈ ˘¿Ú¯ÂÈ Ì›· ÂÍ·ÚÙÒÌÂÓË ·fi ÙË Û˘ÁΤÓÙÚˆÛË Ù˘ Phe Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ¡a+∫+-∞∆ƒ¿ÛË, ÙfiÛÔ Û ‰È¿ÊÚ·ÁÌ· ÔÓÙÈÎÔ‡ fiÛÔ Î·È ÛÙÔÓ ÂÁΤʷÏÔ (11,12). ∞ÓÙ›ıÂÙ·, Ë ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ ÙÚÈʈÛÊ·Ù¿Û˘ Ù˘ ·‰ÂÓÔÛ›Ó˘ Ù˘ ·ÓÙÏ›·˜ ªg2+ (Mg2+-ATP¿Û˘) ‰ÂÓ ÌÂÙ·‚Ï‹ıËΠÛÙȘ ÙfiÙ ÂÈÚ·Ì·ÙÈΤ˜ Û˘Óı‹Î˜, ‰ËÏ·‰‹ ÌÂÙ¿ ·fi ÚÔÂÒ·ÛË ÔÌÔÁÂÓÔÔÈËÌ¿ÙˆÓ ÁÈ· 1 ÒÚ· Ì ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Phe. OÈ Rajanna Î·È Û˘Ó ÂÂÛ‹Ì·Ó·Ó fiÙÈ Ë ÔÔÈ·‰‹ÔÙ ÌÂÙ·‚ÔÏ‹ Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ ÛÙ· Û˘Ó·ÙÔÛÒÌ·Ù· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË Ì›ˆÛË ÚfiÛÏ˄˘ Ù˘ DA, Ô˘ ÂËÚ¿˙ÂÙ·È ·fi Ù· Â›‰· Ù˘ 5∏∆ (13). ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ¡a+∫+-∞∆ƒ¿Û˘ Î·È ªg2+-∞∆ƒ¿Û˘ ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ·ÛıÂÓÒÓ Ì PKU, ˘fi ·˘ÛÙËÚ‹ ‹ ¯·Ï·Ú‹ ıÂÚ·¢ÙÈ΋ ‰›·ÈÙ· Î·È Ë Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ٷ Â›‰· ÙˆÓ Phe, Tyr, Try, NA, D∞ Î·È 5∏∆ ÛÙÔ ·›Ì· ÙÔ˘˜.

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ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∏ ÎÏ·ÛÈ΋ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›· Â›Ó·È ÂΛÓË Ë ÌÔÚÊ‹ PKU, Ù˘ ÔÔ›·˜ ÌÔÓ·‰È΋ ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ·ÔÙÂÏ› Ë Ùˆ¯‹ Û Phe ‰›·ÈÙ·, ÌÂ Û˘ÌÏËڈ̷ÙÈ΋ ¯ÔÚ‹ÁËÛË ‰È·ÈÙËÙÈÎÒÓ È‰ÈÔÛ΢·ÛÌ¿ÙˆÓ Î·È ‚ÈÙ·ÌÈÓÒÓ. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi Ù· ˘„ËÏ¿ Â›‰· Ù˘ Phe (>40 mg/dl) Î·È ÙËÓ ·Î·Ì„›· ÙˆÓ ÙÈÌÒÓ ÙÔ˘ ·ÌÈÓÔͤԘ ÛÙÔ ·›Ì· ÌÂÙ¿ ·fi ÊfiÚÙÈÛË Ì ÙÂÙÚ·¸‰ÚÔÙÂÚ›ÓË (µ∏4). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤Ï·‚·Ó ̤ÚÔ˜ 23 ·ÛıÂÓ›˜ ÌÂ

¶·È‰È·ÙÚÈ΋ 2004;67:33-38

Paediatriki 2004;67:33-38

ÎÏ·ÛÈ΋ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘Ú›·, ÔÈ ÔÔ›ÔÈ ¯ˆÚ›ÛÙËÎ·Ó Û ‰‡Ô ÔÌ¿‰Â˜. OÈ ·ÛıÂÓ›˜ ÛÙËÓ ÔÌ¿‰· ∞ (¡=12), Ì ̤ÛË ËÏÈΛ· Ù· 6,8±1,2 ¤ÙË, ·ÎÔÏÔ˘ıÔ‡Û·Ó ·˘ÛÙËÚ¿ ÙË ıÂÚ·¢ÙÈ΋ ‰›·ÈÙ·, fiˆ˜ Ê·›ÓÂÙ·È Î·È ·fi ÙË Û¯Â‰fiÓ Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ Phe (1,57±0,52 mg/dl ‹ 0,10±0,03 mM) ÛÙÔ ·›Ì·. ∏ ÔÌ¿‰· µ (¡=11) ÂÚÈÂÏ¿Ì‚·Ó ·ÛıÂÓ›˜ Ì ̤ÛË ËÏÈΛ· Ù· 7,2±2,0 ¤ÙË Î·È ˘„ËÏ¿ Â›‰· Phe (28,45±1,50 mg/dl ‹ 1,72±0,09 mM) ÛÙÔ ·›Ì· ÙÔ˘˜, ÔÈ ÔÔ›ÔÈ ·ÎÔÏÔ˘ıÔ‡Û·Ó ¯·Ï·Ú¿ ÙË ıÂÚ·›· ÙÔ˘˜. ∂›ÎÔÛÈ ÙÚ›· ˘ÁÈ‹ ·È‰È¿ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜, Ù· ÔÔ›· ¤Î·Ó·Ó ÚÔÂÁ¯ÂÈÚËÙÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ˆÙÔÚÈÓÔÏ·Ú˘ÁÁÔÏÔÁÈ΋ Â¤Ì‚·ÛË, ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ. OÈ PKU ·ÛıÂÓ›˜ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡.

OÈ ·ÈÌÔÏË„›Â˜ (5,0 ml) ¤ÁÈÓ·Ó ÙËÓ ›‰È· ÒÚ· Î·È Û ¯ÚfiÓÔ Ô˘, ÙfiÛÔ ÔÈ ·ÛıÂÓ›˜ fiÛÔ Î·È ÔÈ Ì¿ÚÙ˘Ú˜, ›¯·Ó Û˘ÓËı›ÛÂÈ ÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÙÔ È·ÙÚÈÎfi ÚÔÛˆÈÎfi.

O ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ ·fi ÙÔ Ï‹Ú˜ Ë·ÚÈÓÈṲ̂ÓÔ ·›Ì· ¤ÁÈÓ fiˆ˜ ÂÚÈÁÚ¿ÊÂÙ·È ·fi ÙÔ˘˜ Galbraith Î·È Watts (14) Î·È ÙÔ˘˜ Kamber Î·È Û˘Ó (15). ∞ÊÔ‡ ÚÒÙ· ÚÔÛ‰ÈÔÚ›ÛÙËÎÂ Ë Û˘ÁΤÓÙÚˆÛË ÚˆÙ½Ó˘ Û‡Ìʈӷ Ì ÙÔ˘˜ Lowry Î·È Û˘Ó (16), ¤ÁÈÓÂ Ë Ì¤ÙÚËÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ¡a+∫+-∞∆ƒ¿Û˘ Î·È Mg2+-ATƒ¿Û˘ ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ (17,18). O ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÌÈÓÔͤˆÓ ¤ÁÈÓ Ì ·˘ÙfiÌ·ÙÔ ·Ó·Ï˘Ù‹ ·ÌÈÓÔͤˆÓ (Biotronic LC 5001) Î·È ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ DA, NA Î·È ·‰ÚÂÓ·Ï›Ó˘ (∞) Ì ̤ıÔ‰Ô HPLC Ì ËÏÂÎÙÚÔ¯ËÌÈÎfi ·ÓȯÓÂ˘Ù‹ (19). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ 5∏∆ ¤ÁÈÓ ÛÙ· ·ÈÌÔÂÙ¿ÏÈ· Ì ̛· ÚfiÛÊ·ÙË HPLC ̤ıÔ‰Ô (20).

™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∆· ·ÔÙÂϤÛÌ·Ù· ·Ó·Ï‡ıËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô ANOVA, Student’s t-test Î·È ÔÈ Û˘Û¯ÂÙ›ÛÂȘ ˘ÔÏÔÁ›ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Spearman ÛÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS 10.0.

∞ÔÙÂϤÛÌ·Ù· Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1, Ù· Â›‰· ÙˆÓ ·ÌÈÓÔͤˆÓ Tyr, Try, ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ DA, NA, A Î·È 5∏∆ ÛÙÔ Ï¿ÛÌ· ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ ∞ ‰ÂÓ ‰È¤ÊÂÚ·Ó ·fi ÂΛӷ Ù˘ ÔÌ¿‰·˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ, fiˆ˜ Â›Û˘ ‰ÂÓ ‰È¤ÊÂÚ·Ó Î·È ÔÈ ‰Ú·ÛÙÈÎfiÙËÙ˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ¡a+∫+-∞∆ƒ¿Û˘ Î·È Mg2+-∞∆ƒ¿Û˘ Ô˘ ÌÂÙÚ‹ıËÎ·Ó ÛÙȘ ÌÂÌ‚Ú¿Ó˜ ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ¿ÚˆÓ ÙÔ˘˜. ∞ÓÙ›ıÂÙ·, ÙfiÛÔ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ·ÌÈÓÔͤˆÓ Î·È ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ ÛÙÔ Ï¿ÛÌ· fiÛÔ Î·È ÔÈ ‰Ú·ÛÙÈÎfiÙËÙ˜ ÙˆÓ ÚÔ·Ó·ÊÂÚfiÌÂÓˆÓ ÂÓ˙‡ÌˆÓ, ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ÌÂȈ̤Ó˜ ÛÙÔ˘˜ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘ÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ µ, ÔÈ ÔÔ›ÔÈ ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÙË ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ‰›·ÈÙ·. ∆· Úfi‰ÚÔÌ· ·ÌÈÓÔͤ· ÛÙË Û‡ÓıÂÛË ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ Tyr Î·È Try Î·È ÔÈ Ó¢Úԉȷ‚È‚·ÛÙ¤˜ DA, NA, A Î·È 5∏∆ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó ıÂÙÈο Ì ÙȘ ÂÓ˙˘ÌÈΤ˜ ‰Ú·ÛÙÈÎfiÙËÙ˜ (¶›Ó·Î·˜ 2). ∞ÚÓËÙÈ΋, fï˜, Û˘Û¯¤ÙÈÛË ‚Ú¤ıËΠÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ Phe ÛÙÔ Ï¿ÛÌ· Î·È ÙˆÓ ‰Ú·ÛÙÈÎÔÙ‹ÙˆÓ Ù˘ ¡a+∫+∞∆ƒ¿Û˘ Î·È Ù˘ Mg2+-∞∆ƒ¿Û˘.

¶›Ó·Î·˜ 1. ∂›‰· ·ÌÈÓÔͤˆÓ, ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ ÛÙÔ Ï¿ÛÌ· Î·È ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ Î·È Mg2+-∞∆ƒ¿Û˘ Û ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘ÚÈÎÒÓ ·ÛıÂÓÒÓ

Phe (mg/dl) Tyr (mg/dl) Try (mg/dl) DA (pmol/l) NA (nmol/l) A (pmol/l) 5-HT (nmol/109plt)* Na+K+-ATP¿ÛË (Ìmol Pi/hxmg ÚˆÙ½Ó˘) Mg2+-ATP¿ÛË (Ìmol Pi/hxmg ÚˆÙ½Ó˘)

OÌ¿‰· A (N=12)

OÌ¿‰· B (N=11)

ª¿ÚÙ˘Ú˜ (N=23)

1,57±0,52· 2,09±0,70· 1,28±0,05· 130±25· 2,80±0,06· 860±148· 4,26±0,90· 0,61±0,06· 2,80±0,28·

28,45±1,50‚ 0,83±0,50‚ 0,79±0,05‚ 46±32‚ 1,46±0,50‚ 148±68‚ 2,1±1,0‚ 0,38±0,05‚ 2,00±0,24‚

1,40±0,60Á 2,13±0,80Á 1,30±0,05Á 138±20Á 3,20±1,20Á 890±198Á 4,98±0,70Á 0,67±0,05Á 2,77±0,17Á

Phe, Tyr, Try, DA, NA, A, 5HT, Na+K+-ATP¿ÛË, Mg2+-ATP¿ÛË: ·/‚, ‚/Á = p<0,001, ·/Á = ÌË ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ÙÈÌ‹ * ¶ÂÚÈÂÎÙÈÎfiÙËÙ· Û 5-∏∆ ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ, fiˆ˜ ÂÎÊÚ¿˙ÂÙ·È Û nmol 5-HT/109 ·ÈÌÔÂÙ·Ï›ˆÓ ¶›Ó·Î·˜ 2. ™˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ ·ÌÈÓÔͤˆÓ Phe, Tyr, Try, ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ DA, NA, A, 5HT Ì ÙȘ ‰Ú·ÛÙÈÎfiÙËÙ˜ ÙˆÓ ÂÓ˙‡ÌˆÓ Na+K+-ATP¿Û˘ Î·È Mg2+-ATP¿Û˘

+

+

Na K -ATP¿ÛË Mg2+-ATP¿ÛË

Phe

Tyr

Try

DA

NA

A

5HT

-0,74*** -0,68***

+0,48** +0,46*

+0,54** +0,49**

+0,58** +0,52**

+0,60*** +0,64***

+0,44* +0,41*

+0,49** +0,53**

∆È̤˜ >+0,40 ‹ <-0,40 ıˆÚÔ‡ÓÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ * p<0,05 ** p<0,01 *** p<0,001

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¶·È‰È·ÙÚÈ΋ 2004;67:33-38

™˘˙‹ÙËÛË O ÂÁΤʷÏÔ˜ Â›Ó·È Ï‹Ú˘ ·fi ·‰ÚÂÓÂÚÁÈΤ˜ Î·È ÛÂÚÔÙÔÓÂÚÁÈΤ˜ ÂÚÈÔ¯¤˜ Ô˘ ÂÌϤÎÔÓÙ·È Î·È Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ‰È·Ù·Ú·¯¤˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (21). ∏ ›ÛÔ‰Ô˜ ÙˆÓ ·ÌÈÓÔͤˆÓ Phe, Tyr Î·È Try ‰È·Ì¤ÛÔ˘ ÙÔ˘ ·ÈÌ·ÙÔÂÁÎÂÊ·ÏÈÎÔ‡ ÊÚ·ÁÌÔ‡ Á›ÓÂÙ·È Ì ÎÔÈÓ‹ ÌÂÙ·ÊÔÚÈ΋ Ô‰fi (4). ª›· ÌÂÁ¿ÏË Û˘ÁΤÓÙÚˆÛË Ù˘ Phe, fiˆ˜ ‚Ú¤ıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì PKU Ù˘ ÔÌ¿‰·˜ µ, ‰ËÌÈÔ˘ÚÁ› ÎÔÚÂÛÌfi ÛÙËÓ ÎÔÈÓ‹ ÌÂÙ·ÊÔÚÈ΋ Ô‰fi, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ·ÚÂÌÔ‰›˙ÂÙ·È Ë ÌÂÙ·ÊÔÚ¿ ÙˆÓ ¿ÏÏˆÓ ·ÌÈÓÔͤˆÓ, Tyr Î·È Try, ÛÙÔÓ ÂÁΤʷÏÔ (4,22). ŒÙÛÈ, Ë ˘„ËÏ‹ ÛÙ¿ıÌË Ù˘ Phe ÛÙÔ ·›Ì· ·ÚÂÌÔ‰›˙ÂÈ ÙËÓ Â›ÛÔ‰Ô Ù˘ Tyr Î·È ÙË ÌÂÙ·ÙÚÔ‹ Ù˘ Û DA, A, NA, fiˆ˜ Â›Û˘ Ù˘ Try Û 5∏∆ (22). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›·, ·Ó Î·È Ù· Â›‰· ÙˆÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ, ÁÈ· ‰ÂÔÓÙÔÏÔÁÈÎÔ‡˜ ÏfiÁÔ˘˜, ÌÂÙÚ‹ıËÎ·Ó ÌfiÓÔ ÛÙÔ ·›Ì· Î·È ‰ÂÓ ¤ÁÈÓ ÔÛÊ˘ÔÓˆÙÈ·›· ·Ú·Î¤ÓÙËÛË ÁÈ· Ó· ÌÂÙÚËıÔ‡Ó ÛÙÔ ∂¡À, ıˆÚÂ›Ù·È fiÙÈ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ˘¿Ú¯Ô˘Û˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÛÙÔ ∂¡À (4,23). O Weil-Maiherbe ˘ÔÏfiÁÈÛ fiÙÈ ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ηÙ¯ÔÏ·ÌÈÓÒÓ ÛÙÔ Ï¿ÛÌ· PKU ·ÛıÂÓÒÓ ¯ˆÚ›˜ ıÂÚ·›· ‹Ù·Ó Û·ÊÒ˜ ÌÂȈ̤Ó˜ Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì ÂΛӘ ÙˆÓ ˘ÁÈÒÓ (24). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Û˘ÌʈÓÔ‡Ó Ì ÂΛӷ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ÔÌ¿‰·˜ µ, Ô˘ ·ÎÔÏÔ˘ıÔ‡Û·Ó ¯·Ï·Ú¿ ÙË ‰›·ÈÙ¿ ÙÔ˘˜ Î·È ÛÙÔ˘˜ ÔÔ›Ô˘˜ Ù· Â›‰· ÙˆÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ DA, NA, A Î·È 5∏∆ ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚ· ·fi ÂΛӷ Ù˘ ÔÌ¿‰·˜ ∞ Î·È ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ™Â ÚÔËÁÔ‡ÌÂÓ˜ in vitro ÌÂϤÙ˜ ·Ú·ÙËÚ‹ıËΠ¿ÌÂÛË Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ Û ¯·ÌËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Phe Î·È ¤ÌÌÂÛË Ì›ˆÛË Û ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙÔ˘ ·ÚˆÌ·ÙÈÎÔ‡ ·ÌÈÓÔͤԘ (11,12). ¢ÈÂÚ¢ÓÒÓÙ·˜ Ù· ¿ÌÂÛ· ·ÔÙÂϤÛÌ·Ù· Ù˘ Phe, Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ Ì›· ·ÓÙ›‰Ú·ÛË ÙÔ˘ ·ÌÈÓÔͤԘ Ì ÙȘ ıÂÙÈο ÊÔÚÙÈṲ̂Ó˜ ı¤ÛÂȘ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ı· ‹Ù·Ó Ë ‚¿ÛË ÁÈ· ÙË ‰Ú¿ÛË ÙÔ˘. ™Â Ì›· ÚfiÛÊ·ÙË ÌÂϤÙË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ·ÛıÂÓÒÓ Ì PKU, ÙÔ ¤Ó˙˘ÌÔ ‚Ú¤ıËΠÂ›Û˘ ·ÓÂÛÙ·Ï̤ÓÔ (25). ¶·Ú’ fiÏÔ Ô˘ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ù· Â›‰· Phe ÛÙÔ ∂¡À Â›Ó·È 2-3 ÊÔÚ¤˜ ¯·ÌËÏfiÙÂÚ· ÂÎÂ›ÓˆÓ ÙÔ˘ ·›Ì·ÙÔ˜, ÔÈ ÂÚÈÊÂÚÈÎÔ› ‰Â›ÎÙ˜, Ô˘ ÂËÚ¿˙ÔÓÙ·È ·fi ÙȘ Û˘ÁÎÂÓÙÚÒÛÂȘ Phe, Â›Ó·È Èı·Ófi Ó· ‰ÒÛÔ˘Ó ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ ÙÔÍÈÎfiÙËÙ¿ Ù˘ ÛÙÔÓ ÂÁΤʷÏÔ. ∏ ¡a+∫+-∞∆ƒ¿ÛË ÛÙÔÓ ÂÁÎÂÊ·ÏÈÎfi ÊÏÔÈfi ÔÓÙÈÎÔ‡ Î·È ÂΛÓË ÙˆÓ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈÎÒÓ ÌÂÌ‚Ú·ÓÒÓ ÛÙÔÓ ¿ÓıÚˆÔ ÂÌÊ·Ó›˙Ô˘Ó È‰È·›ÙÂÚ˜ ÔÌÔÈfiÙËÙ˜ ηÈ, Û˘ÓÂÒ˜, ÙÔ ÈÛÔ¤Ó˙˘ÌÔ ·1 ÛÙÔÓ ÂÁΤʷÏÔ ÙÔ˘ ·ÓıÚÒÔ˘ Ù·˘Ù›˙ÂÙ·È Ì ÂΛÓÔ ÛÙ· ÂÚ˘ıÚÔ·ÙÙ·Ú·. ŒÙÛÈ, οı ‰Ú¿ÛË ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙË ¡a+∫+∞∆ƒ¿ÛË, ı· ÌÔÚÔ‡Û ӷ ·ÓÙ·Ó·ÎÏ¿ Î·È ÛÙË

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Paediatriki 2004;67:33-38

¡a+∫+-∞∆ƒ¿ÛË ÛÙÔ ∫¡™ ÙˆÓ Ê·ÈÓ˘ÏÎÂÙÔÓÔ˘ÚÈÎÒÓ ·ÛıÂÓÒÓ (26). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ‰Ú·ÛÙÈÎfiÙËÙ· Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜, ηıÒ˜ Î·È Ù· Â›‰· ÙˆÓ ·ÌÈÓÔͤˆÓ (ÏËÓ Ù˘ Phe) fiˆ˜ Î·È ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ, ‹Ù·Ó ¯·ÌËÏ¿ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯·Ï·Ú‹ ‰›·ÈÙ· (ÔÌ¿‰· µ), Û˘ÁÎÚÈÓfiÌÂÓ· Ì ÂΛӷ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ·ÎÔÏÔ˘ıÔ‡Û·Ó ·˘ÛÙËÚ¿ ÙË ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ·ÁˆÁ‹ Î·È Ì ÂΛӷ ÙˆÓ Ì·ÚÙ‡ÚˆÓ (27). ∏ Ì›ˆÛË, ÏÔÈfiÓ, Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ ÔÊ›ÏÂÙ·È Èı·ÓfiÓ fi¯È ÌfiÓÔ ÛÙ· ˘„ËÏ¿ Â›‰· Phe ÛÙÔ ·›Ì·, ·ÏÏ¿ Î·È ÛÙ· ÌÂȈ̤ӷ Â›‰· ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ NA, DA (27) ‹ Î·È Ù˘ 5∏∆ (8,28). ∏ Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ Mg2+-ATƒ¿Û˘ ÛÙȘ ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÔÌ¿‰·˜ µ ÔÊ›ÏÂÙ·È Èı·Ófiٷٷ ÛÙË Ì·ÎÚÔ¯ÚfiÓÈ· Â›‰Ú·ÛË ÙˆÓ ˘„ËÏÒÓ ÂÈ¤‰ˆÓ Ù˘ Phe, ÂÓÒ Ù· ¯·ÌËÏ¿ Â›‰· ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ ¡∞, DA Î·È 5∏∆ ı· ÌÔÚÔ‡Û·Ó, Â›Û˘, Ó· Â›Ó·È ˘‡ı˘Ó· ÁÈ· ÙË Ì›ˆÛË Ù˘ ÂÓ˙˘ÌÈ΋˜ ·˘Ù‹˜ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÛÙËÓ ›‰È· ÔÌ¿‰· ·ÛıÂÓÒÓ (27,28). ∏ Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ ¡a+∫+-∞∆ƒ¿Û˘ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘Ó‹ıÂȘ Ì˯·ÓÈÛÌÔ‡˜ Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜, fiˆ˜ Ë Ô˘Ú·ÈÌ›· (30), Ë ÚÂ˘Ì·ÙÔÂȉ‹˜ ·ÚıÚ›ÙȘ (31), Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ (10) Î·È Ë ˘¤ÚÙ·ÛË (32). ∏ ÛÔÁÁ҉˘ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙÔ˘ ÂÓ˙‡ÌÔ˘ ηٿ 40%, fiˆ˜ ÌÂÙÚ‹ıËΠ۠ÂÁΤʷÏÔ ¿Û¯ÔÓÙÔ˜ ÓÂÔÁÓÔ‡, ÌÂ Û˘ÓÔ‰fi ·ÔÙ¤ÏÂÛÌ· ÙË Ì›ˆÛË ¤ÎÏ˘Û˘ ÁÏÔ˘Ù·Ì›Ó˘ (33,34). ∏ Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ Ù˘ Mg2+-ATƒ¿Û˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ¯·ÌËÏ‹ ÂÓ‰Ô΢ÙÙ¿ÚÈ· ÛÙ¿ıÌË ÙÔ˘ Mg2+ ÛÙÔÓ ÂÁΤʷÏÔ, Ô˘ ı· ÌÔÚÔ‡Û ӷ Ô‰ËÁ‹ÛÂÈ Û ÌÂȈ̤ÓË ÚˆÙÂ˚ÓÔÛ‡ÓıÂÛË Î·È Ì›ˆÛË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (35). ™˘ÌÂÚ·ÛÌ·ÙÈο, ·Ú·ÙËÚ‹ıËΠ̛· ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙfiÛÔ Ù˘ ¡a+∫+-∞∆ƒ¿Û˘, fiÛÔ Î·È Ù˘ Mg2+-ATƒ¿Û˘ Û ÂÚ˘ıÚÔ΢ÙÙ·ÚÈΤ˜ ÌÂÌ‚Ú¿Ó˜ ·ÛıÂÓÒÓ Ì PKU Û “¯·Ï·Ú‹” ‰›·ÈÙ·, Ë ÔÔ›· Èı·ÓfiÓ ÔÊ›ÏÂÙ·È Û ¤ÌÌÂÛË Â›‰Ú·ÛË Ù˘ Phe ÛÙ· ¤Ó˙˘Ì·. ∂›Û˘, Ë Ì›ˆÛË ÙˆÓ ‚ÈÔÁÂÓÒÓ ·ÌÈÓÒÓ Î·È ÙˆÓ Úfi‰ÚÔÌˆÓ ·ÌÈÓÔͤˆÓ ÙÔ˘˜ Tyr Î·È Try Â›Ó·È Èı·Ófi Ó· ÔÊ›ÏÂÙ·È fi¯È ÌfiÓÔ ÛÙË Ì›ˆÛË ÙˆÓ ÚÔ·Ó·ÊÂÚfiÌÂÓˆÓ Úfi‰ÚÔÌˆÓ ·ÌÈÓÔͤˆÓ, ·ÏÏ¿ Î·È ÛÙË Ì›ˆÛË Ù˘ ·Ú·ÁˆÁ‹˜ ÙˆÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ ·fi ÙËÓ ¿ÌÂÛË Â›‰Ú·ÛË Ù˘ ·˘ÍË̤Ó˘ ÛÙ¿ıÌ˘ Ù˘ Phe. ∏ ¢ÚÂı›۷ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÙˆÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ Î·È Ù˘ ‰Ú·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ ÂÓ˙‡ÌˆÓ ¡a+∫+-∞∆ƒ¿Û˘ Î·È Mg2+-∞∆ƒ¿Û˘ ı· ÌÔÚÔ‡Û ӷ ÂÚÌËÓ‡ÛÂÈ ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ·ÛıÂÓ›˜ Ì ˘„ËÏ¿ Â›‰· Ù˘ Phe. ∞˘Ù¿

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Ù· in vivo Â˘Ú‹Ì·Ù· ıÂÌÂÏÈÒÓÔ˘Ó ÁÈ· Ì›· ·ÎfiÌË ÊÔÚ¿ ÙË ÛÔ˘‰·ÈfiÙËÙ· Ù˘ “ıÂÚ·¢ÙÈ΋˜ ‰›·ÈÙ·˜” ÙˆÓ ·ÛıÂÓÒÓ Ì PKU, fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÓÔËÙÈ΋ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁ›· Î·È ÛÙËÓ ÚfiÏË„Ë Ì›·˜ „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘. ∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙËÓ Î·. ÕÓÓ· ™Ù·Ì¿ÙË ÁÈ· ÙËÓ ÂÈÌÂÏË̤ÓË ‰·ÎÙ˘ÏÔÁÚ¿ÊËÛË Ù˘ ÂÚÁ·Û›·˜.

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∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 22-04-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 10-12-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ÏÂÔ¿ÙÚ· ™Ô‡ÏË πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ∆.∫. 115 27, ∞ı‹Ó· E-mail: inchildh@otenet.gr

¶·È‰È·ÙÚÈ΋ 2004;67:39-43

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2004;67:39-43

ORIGINAL ARTICLE

∞‡ÍËÛË Î·È ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ·ÛıÂÓÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· º. ∫·Ú·¯¿ÏÈÔ˘, ∂. µÏ·¯Ô··‰ÔÔ‡ÏÔ˘, ª. £ÂÔ¯¿ÚË, ™. ªÈ¯·Ï¿ÎÔ˜

Growth and final height in children with thalassaemia major F. Karachaliou, E. Vlachopapadopoulou, M. Theochari, S. Michalakos

¶ÂÚ›ÏË„Ë: ∏ ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ·ÔÙÂÏ› ¤Ó· ÛËÌ·ÓÙÈÎfi È·ÙÚÈÎfi Úfi‚ÏËÌ· ÙˆÓ ·ÛıÂÓÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ÙÔ ÔÔ›Ô ‰ÂÓ ¤¯ÂÈ ÂÈÏ˘ı› ·ÎfiÌ· Î·È ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ Ù˘ ÂÓÙ·ÙÈ΋˜ ÌÂÙ¿ÁÁÈÛ˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ıÂÚ·›· ·ÔÛȉ‹ÚˆÛ˘. ™ÎÔfi˜ Ù˘ ÂÚÁ·Û›·˜ ‹Ù·Ó Ó· ÂÎÙÈÌËı› Ë ·Ó¿Ù˘ÍË ÙˆÓ ·ÛıÂÓÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙË ªÔÓ¿‰· ªÂÛÔÁÂȷ΋˜ ∞Ó·ÈÌ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”. ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 54 ·ÛıÂÓ›˜ ËÏÈΛ·˜ ·fi 6,2 ¤ˆ˜ 30,5 ¯ÚfiÓˆÓ. ∂›ÎÔÛÈ ÂÙ¿ ·ÛıÂÓ›˜ ›¯·Ó ÊÙ¿ÛÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, ÙÔ ÔÔ›Ô Û˘ÁÎÚ›ıËΠ̠ÙÔ “‡„Ô˜-ÛÙfi¯Ô”, fiˆ˜ ·˘Ùfi ˘ÔÏÔÁ›ÛÙËΠۇÌʈӷ Ì ÙÔ ‡„Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ ‡„Ô˘˜ (ÂÎÊÚ·Ṳ̂Ó˘ ˆ˜ ‚·ıÌfi˜ ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛ˘ ÙÔ˘ ‡„Ô˘˜ - HSDS) ‹Ù·Ó -1,24 Î·È Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ -3,8 Î·È 1,5. ∂›ÎÔÛÈ ¤ÍÈ ·fi ÙÔ˘˜ 54 ·ÛıÂÓ›˜ (48%) ›¯·Ó ‡„Ô˜ οو ·fi ÙËÓ 10Ë ∂£ Î·È 17 ·fi ÙÔ˘˜ 54 (30%) οو ·fi ÙËÓ 3Ë ∂£. ∞fi ·˘Ù¿ Ù· 17 ·È‰È¿, 7 ›¯·Ó ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (GH), ÂÓÒ Ù· ˘fiÏÔÈ· 10 ·ÚÔ˘Û›·˙·Ó Ê˘ÛÈÔÏÔÁÈ΋ ·¿ÓÙËÛË ÛÙȘ ‰ÔÎÈ̷ۛ˜ ÚfiÎÏËÛ˘. ¢ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ HSDS Î·È ÂÈ¤‰ˆÓ ÊÂÚÚÈÙ›Ó˘ (r=0,062). ∏ ̤ÛË ÙÈÌ‹ ÙÂÏÈÎÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÙˆÓ 27 ·ÛıÂÓÒÓ ‹Ù·Ó Â›Û˘ ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚË ·fi ÙË Ì¤ÛË ÙÈÌ‹ ‡„Ô˘˜-ÛÙfi¯Ô˘ (-1,45 sds ¤Ó·ÓÙÈ -0,65 sds, p<0,001). OÈ ·ÛıÂÓ›˜ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ Î·È ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ‡„Ô˜-ÛÙfi¯Ô. O ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›.

Abstract: Growth retardation in children with thalassaemia major constitutes a significant medical and social problem of this disease, and it is a feature which has not been resolved by the introduction of the intensive transfusion regimen and chelation therapy. The aim of this study was to evaluate the growth of patients monitored in the Thalassaemia Unit of the “P. & A. Kyriakou” Children’s Hospital. The study involved 54 patients, aged 6.2 to 30.5 years, 27 of whom had reached their final height. The mean HSDS was -1.24, ranging from -3.8 to 1.5. The height of 26 of the 54 patients (48%) was below the 10th centile and of 17 (30%) below the 3rd centile, 7 of whom had GH deficiency. No correlation between HSDS and ferritin levels was found. The mean final height of the 27 fully-grown patients was significantly lower than their target height. Patients with thalassaemia major frequently suffer from growth retardation, with final height lower than their target height. The pathogenetic mechanisms of growth retardation in this group of patients have not been entirely clarified.

§¤ÍÂȘ ÎÏÂȉȿ: ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ·Ó¿Ù˘ÍË, ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·.

Key words: thalassaemia major, growth, final height.

∆Ì‹Ì· ∞‡ÍËÛ˘ Î·È ∞Ó¿Ù˘Í˘ Î·È ªÔÓ¿‰· ªÂÛÔÁÂȷ΋˜ ∞Ó·ÈÌ›·˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

Department of Growth and Development and Thalassaemia Unit “P. & A. Kyriakou” Children’s Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2004;67:39-43

™˘ÓÙÔÌÔÁڷʛ˜ HSDS Hb IGF-I IGFBP-3 TH sds

µ·ıÌfi˜ ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛ˘ ‡„Ô˘˜ ∞ÈÌÔÛÊ·ÈÚ›ÓË πÓÛÔ˘ÏÈÓfiÌÔÚÊÔ˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ π ™˘Ó‰ÂÙÈ΋ ÚˆÙ½ÓË 3 ÙÔ˘ ÈÓÛÔ˘ÏÈÓfiÌÔÚÊÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· π ⁄„Ô˜-ÛÙfi¯Ô˜ µ·ıÌfi˜ ÛÙ·ıÂÚ‹˜ ·fiÎÏÈÛ˘

∂ÈÛ·ÁˆÁ‹ ∏ ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Û ·È‰È¿ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ·ÔÙÂÏ› Ì›· ηϿ ·Ó·ÁÓˆÚÈṲ̂ÓË ÂÈÏÔ΋ Ù˘ ÓfiÛÔ˘. ¶·Ú¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ÚˆÙÔÎfiÏÏÔ˘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÓÙ·ÙÈΤ˜ ÌÂÙ·ÁÁ›ÛÂȘ Î·È ıÂÚ·›· ·ÔÛȉ‹ÚˆÛ˘ Ì ‰ÂÛÊÂÚÈÔÍ·Ì›ÓË, ¤Ó· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Û˘Ó¯›˙ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÂÊ˂›·. OÈ Ì˯·ÓÈÛÌÔ› Ô˘ ¢ı‡ÓÔÓÙ·È ÁÈ’ ·˘Ù‹ ÙËÓ Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›, ·Ó Î·È Î·Ù¿ ηÈÚÔ‡˜ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› Ë ¯ÚfiÓÈ· ·Ó·ÈÌ›·, Ë ¤ÏÏÂÈ„Ë „¢‰·ÚÁ‡ÚÔ˘, Ë ÙÔÍÈÎfiÙËÙ· ÙÔ˘ Ûȉ‹ÚÔ˘, Ë ÙÔÍÈÎfiÙËÙ· Ù˘ ‰ÂÛÊÂÚÈÔÍ·Ì›Ó˘, Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ÂÊ˂›·˜, Ô ˘ÔÁÔÓ·‰ÈÛÌfi˜, Ô ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, Ë ·ÓÂ¿ÚÎÂÈ· GH ηÈ/‹ ¯·ÌËÏ¿ Â›‰· ÈÓÛÔ˘ÏÈÓfiÌÔÚÊÔ˘ ·˘ÍËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· π (IGF-I), ·Ú¿ ÙËÓ ·ÚÔ˘Û›· Ê˘ÛÈÔÏÔÁÈ΋˜ ¤ÎÎÚÈÛ˘ GH, ›Ù - ÂÓ‰ÂÈÎÙÈο - ÏfiÁˆ ÌÂÚÈ΋˜ ·ÓÙ›ÛÙ·Û˘ ÛÙË ‰Ú¿ÛË Ù˘ GH ›Ù ÏfiÁˆ Ó¢ÚÔÂÎÎÚÈÙÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÎÙÈÌËı› Ë ·Ó¿Ù˘ÍË ÙˆÓ ·ÛıÂÓÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ηıÒ˜ Î·È ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ·˘ÙÒÓ Ô˘ ›¯·Ó ÔÏÔÎÏËÚÒÛÂÈ ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜, ÂȉÈο Û ۯ¤ÛË Ì ÙÔ ÁÂÓÂÙÈο ·Ó·ÌÂÓfiÌÂÓÔ ‡„Ô˜-ÛÙfi¯Ô. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∞fi ÙÔ˘˜ 63 ·ÛıÂÓ›˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó ÛÙË ªÔÓ¿‰· ªÂÛÔÁÂȷ΋˜ ∞Ó·ÈÌ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ, 3 ¤·Û¯·Ó ·fi ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, 2 ·fi ÌÈÎÚÔ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ Î·È ÔÈ ˘fiÏÔÈÔÈ 58 ·fi ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·. ∆¤ÛÛÂÚȘ ·fi ·˘ÙÔ‡˜ ‰ÂÓ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ÁÈ· ÚÔÛˆÈÎÔ‡˜ ÏfiÁÔ˘˜. ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 54 ·ÛıÂÓ›˜ (26 ¿Ó‰Ú˜ Î·È 28 Á˘Ó·›Î˜) Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ËÏÈΛ·˜ ·fi 6,2 ¤ˆ˜ 30,8 ÂÙÒÓ (‰È¿ÌÂÛË ÙÈÌ‹: 16,5 ¯ÚfiÓÈ·). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ٷÎÙÈΤ˜ ÌÂÙ·ÁÁ›ÛÂȘ ·›Ì·ÙÔ˜ ÁÈ· Ó· ‰È·ÙËÚÔ‡Ó ÙË Û˘ÁΤÓÙÚˆÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘ (Hb) ÚÈÓ ÙË ÌÂÙ¿ÁÁÈÛË ÛÙ· Â›‰· ÙÔ˘ 9,5 g/dl. ŸÏÔÈ Ï¿Ì‚·Ó·Ó Ê˘ÏÏÈÎfi Ô͇ Î·È ıÂÚ·›· ·ÔÛȉ‹ÚˆÛ˘ Ì ‰ÂÛÊÂÚÈÔÍ·Ì›ÓË, Û ‰fiÛË Ô˘ Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ 30 Î·È 50 mg/kg/‰fiÛË, ·Ó¿ÏÔÁ· Ì ٷ Â›‰· ÊÂÚÚÈÙ›Ó˘. ∆· Â›‰· ÊÂÚÚÈÙ›Ó˘ Î˘Ì·›ÓÔÓÙ·Ó ÌÂٷ͇ 530 Î·È 6000 ng/ml (‰È¿ÌÂÛË ÙÈÌ‹: 1825 ng/ml) Î·È ¤¯Ô˘Ó ˘ÔÏÔÁÈÛÙ› ˆ˜ Ë Ì¤ÛË ÙÈÌ‹ 4-5 ÌÂÙÚ‹ÛÂˆÓ Î·Ù¿ Ù· ÙÂÏÂ˘Ù·›· 3 ¯ÚfiÓÈ·.

40

Paediatriki 2004;67:39-43

™Â fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂÙÚ‹ıËΠÙÔ ‡„Ô˜ Û fiÚıÈ· ı¤ÛË Î·È Ô ÏfiÁÔ˜ ¿Óˆ/οو ËÌÈÌÔÚ›Ô˘ ÛÒÌ·ÙÔ˜. ∂›Û˘, ÌÂÙÚ‹ıËΠÙÔ ‡„Ô˜ ÙˆÓ ÁÔÓ¤ˆÓ fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË Î·È ˘ÔÏÔÁ›ÛÙËΠÁÈ· fiÏÔ˘˜ ÙÔ ‡„Ô˜ÛÙfi¯Ô˜ [(‡„Ô˜ ·Ù¤Ú· + ‡„Ô˜ ÌËÙ¤Ú·˜ / 2) +6,5 cm ÁÈ· Ù· ·ÁfiÚÈ· ‹ -6,5 cm ÁÈ· Ù· ÎÔÚ›ÙÛÈ·]. ∆Ô ÛÙ¿‰ÈÔ Ù˘ ÂÊ˂›·˜ ÂÎÙÈÌ‹ıËΠ̠ÙË ÛÙ·‰ÈÔÔ›ËÛË Î·Ù¿ Tanner. ø˜ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ıˆڋıËΠÙÔ ‡„Ô˜ ÙˆÓ ·ÛıÂÓÒÓ Ì ·ÎÙÈÓÔÏÔÁÈ΋ ·fi‰ÂÈÍË Ï‹ÚÔ˘˜ Û‡ÁÎÏÂÈÛ˘ ÙˆÓ ÂÈʇÛÂˆÓ Î·È/‹ ÙÔ ‡„Ô˜ Ô˘ ›¯·Ó ÊÙ¿ÛÂÈ fiÙ·Ó ϤÔÓ Ë Ù·¯‡ÙËÙ· ·Ó¿Ù˘Í˘ ‹Ù·Ó ÌÈÎÚfiÙÂÚË ·fi 1 cm/¤ÙÔ˜. ™‡Ìʈӷ Ì ·˘Ù¿ Ù· ÎÚÈÙ‹ÚÈ·, 27 ·ÛıÂÓ›˜ ›¯·Ó ÊÙ¿ÛÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·. ™Â fiÏ· Ù· ·È‰È¿ Ì HSDS οو ·fi ÙËÓ 3Ë ∂£, ¤ÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ¤ÎÎÚÈÛ˘ Ù˘ GH ÌÂÙ¿ ·fi ‰È¤ÁÂÚÛË (Û˘Ó‹ıˆ˜ Ì ¯ÔÚ‹ÁËÛË LDOPA Î·È ÈÓÛÔ˘Ï›Ó˘). ∏ GH ÚÔÛ‰ÈÔÚ›ÛÙËΠ̠ÙË Ì¤ıÔ‰Ô ¯ËÌÂÈÔʈٷ‡ÁÂÈ·˜ (Nichols Advantage), ÌÂ Û˘ÓÙÂÏÂÛÙ‹ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ Û οı ̤ıÔ‰Ô 4,8% Î·È ÌÂٷ͇ ÙˆÓ ÌÂıfi‰ˆÓ 5,8% Î·È Ì ¢·ÈÛıËÛ›· 0,1 ng/ml. ∆· Â›‰· IGF-I Î·È IGFBP-3 ÛÙÔÓ ÔÚfi ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ Â›¯·Ó ÊÙ¿ÛÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· Î·È ‰ÂÓ ·ÚÔ˘Û›·˙·Ó ·ÓÂ¿ÚÎÂÈ· GH, ÔÈ ÔÔ›ÔÈ ÂÚÈÂÏ¿Ì‚·Ó·Ó 13 ·È‰È¿ ÂÊË‚È΋˜ Î·È 10 ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜ (6,2-16 ÂÙÒÓ). OÈ ÙÈ̤˜ ÙÔ˘˜ Û˘ÁÎÚ›ıËÎ·Ó Ì ·˘Ù¤˜ Ì›·˜ ÔÌ¿‰·˜ ˘ÁÈÒÓ ·È‰ÈÒÓ, ·ÓÙ›ÛÙÔȯˆÓ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ·. ∆· Â›‰· IGF-I Î·È IGFBP-3 ÌÂÙÚ‹ıËÎ·Ó Ì ڷ‰ÈÔ·ÓÔÛÔÏÔÁÈ΋ ̤ıÔ‰Ô (Nichols Institute, San Juan Capistrano, USA). O ̤ÛÔ˜ Û˘ÓÙÂÏÂÛÙ‹˜ ÌÂÙ·‚ÏËÙfiÙËÙ·˜ Û οı ̤ıÔ‰Ô Î·È ÌÂٷ͇ ÙÔ˘˜ ‹Ù·Ó 7,6% Î·È 5,2% ÁÈ· ÙÔ IGF-I Î·È 8,5% Î·È 8,6% ÁÈ· ÙÔ IGFBP-3, ·ÓÙ›ÛÙÔȯ·. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙÔ Û‡ÛÙËÌ· SPSS.

∞ÔÙÂϤÛÌ·Ù· ∏ ̤ÛË ÙÈÌ‹ ÙÔ˘ HSDS fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó -1,24, Î˘Ì·ÈÓfiÌÂÓË ÌÂٷ͇ -3,8 Î·È -1,5 (‰È¿ÌÂÛË ÙÈÌ‹: -1,3) (∂ÈÎfiÓ· 1). ¶·Ú·ÙËÚ‹ıËΠ̛· ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ HSDS Î·È Ù˘ ËÏÈΛ·˜ ÙˆÓ ·ÛıÂÓÒÓ (r=-0,68, p<0,01). ∂›ÎÔÛÈ ¤ÍÈ ·fi ÙÔ˘˜ 54 ·ÛıÂÓ›˜ (48%) ›¯·Ó ‡„Ô˜ οو ·fi ÙË 10Ë ∂£ Î·È 17 ·ÛıÂÓ›˜ (30%) οو ·fi ÙËÓ 3Ë ∂£. ¶·ıÔÏÔÁÈÎfi ·Ó¿ÛÙËÌ· Û ηıÈÛÙ‹ ı¤ÛË ·Ú·ÙËÚ‹ıËΠ۠40% ÙˆÓ ·ÛıÂÓÒÓ, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÏfiÁÔ ¿Óˆ/οو ËÌÈÌÔÚ›Ô˘ ÛÒÌ·ÙÔ˜ οو ·fi ÙË 10Ë ∂£. ∆Ô ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Ì ·ıÔÏÔÁÈÎfi ·Ó¿ÛÙËÌ· Û ηıÈÛÙ‹ ı¤ÛË ‹Ù·Ó ·ÚfiÌÔÈÔ ÌÂٷ͇ ÙˆÓ ·ÛıÂÓÒÓ Ì ¯·ÌËÏfi Î·È ·˘ÙÒÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ·Ó¿ÛÙËÌ·. ∞fi ÙÔ˘˜ 17 ·ÛıÂÓ›˜ Ì ¯·ÌËÏfi ·Ó¿ÛÙËÌ·, ÔÈ 16 ›¯·Ó ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 10 ÂÙÒÓ Î·È Â›¯·Ó ÂÈÛ¤ÏıÂÈ ÛÙËÓ ÂÊ˂›· (·˘ıfiÚÌËÙ· ‹ ÌÂÙ¿ ·fi Â·ÁˆÁ‹). ∂›Û˘, ·fi ÙÔ˘˜ 17 ·˘ÙÔ‡˜ ·ÛıÂÓ›˜, ÔÈ 7 (40%) ·ÚÔ˘Û›·˙·Ó ·ÓÂ¿ÚÎÂÈ· GH Ì ÙÈÌ‹ ·È¯Ì‹˜ GH <10 ng/ml Û ‰‡Ô ‰ÔÎÈ̷ۛ˜ ÚfiÎÏËÛ˘. ™Â 5 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ·ÓÂ¿ÚÎÂÈ· GH Û˘Ó˘‹Ú¯Â ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi˜ ˘ÔÁÔÓ·‰ÈÛÌfi˜

¶·È‰È·ÙÚÈ΋ 2004;67:39-43

Paediatriki 2004;67:39-43

2

2 1

1

-1

0 HSDS

HSDS

0

-2 -3

-1

-4 -5 N=

-2 3 3 4 3 11 13 10 7 6-8 8-10 10-12 12-1414-16 16-1818-20 >20 ∏ÏÈΛ· (¤ÙË)

∂ÈÎfiÓ· 1. HSDS ÙˆÓ 54 ·ÛıÂÓÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·.

Ì ¯·ÌËϤ˜ ‚·ÛÈΤ˜ ÙÈ̤˜ FSH Î·È LH, ÔÈ Ôԛ˜ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·Ó ÛÙË ‰È¤ÁÂÚÛË Ì GnRH. ŒÓ·˜ ·ÎfiÌË ·ÛıÂÓ‹˜ ·fi ÙËÓ ÔÌ¿‰· ·˘ÙÒÓ Ô˘ ›¯·Ó ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ›¯Â ˘ÔÁÔÓ·‰ÔÙÚÔÊÈÎfi ˘ÔÁÔÓ·‰ÈÛÌfi Î·È 4 ¿ÏÏÔÈ ·ÚÔ˘Û›·˙·Ó ηı˘ÛÙ¤ÚËÛË Ù˘ ÂÊ˂›·˜. ¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ HSDS Î·È Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÊÂÚÚÈÙ›Ó˘ (r=0,062) (∂ÈÎfiÓ· 2). ¶·ÚÔÌÔ›ˆ˜, ‰ÂÓ ‚Ú¤ıËΠÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ HSDS Î·È Ù˘ ËÏÈΛ·˜ ¤Ó·Ú͢ Ù˘ ıÂÚ·›·˜ ·ÔÛȉ‹ÚˆÛ˘, ηıÒ˜ Î·È Ù˘ ‰È¿ÚÎÂÈ·˜ Ù˘ ·ÔÛȉ‹ÚˆÛ˘ ‹ Ù˘ ‰fiÛ˘ Ù˘ ‰ÂÛÊÂÚÈÔÍ·Ì›Ó˘. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ˘˜ 27 ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ÊÙ¿ÛÂÈ ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ·, Ë Ì¤ÛË ÙÈÌ‹ ÙÔ˘ ‹Ù·Ó -1,45 sds, Î˘Ì·ÈÓfiÌÂÓÔ ÌÂٷ͇ -2,8 sds Î·È 1,3 sds. OÎÙÒ ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜ (30%) ›¯·Ó ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· οو ·fi ÙËÓ 3Ë ∂£. ∆Ô ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ¯·ÌËÏfiÙÂÚÔ ·fi ÙÔ ‡„Ô˜-ÛÙfi¯Ô (-1,45 sds ¤Ó·ÓÙÈ -0,65 sds, p<0,001), 0,8 sds ηÙÒÙÂÚÔ ·fi ÙÔ Ì¤ÛÔ ·Ó¿ÛÙËÌ· ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ·fi ÙÔ ‡„Ô˜ÛÙfi¯Ô ‰ÂÓ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ٷ Â›‰· ÊÂÚÚÈÙ›Ó˘ (r=0,097). ∆· Â›‰· IGF-I ‹ IGFBP-3 ÙˆÓ ÚÔÂÊË‚ÈÎÒÓ ·È‰ÈÒÓ Ì ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· ‹Ù·Ó ¯·ÌËÏfiÙÂÚ· ·fi ÂΛӷ ÙˆÓ Ì·ÚÙ‡ÚˆÓ (58,5 ¤Ó·ÓÙÈ 147,3 ng/ml, p<0,05 Î·È 1,3 ¤Ó·ÓÙÈ 2,3 mg/l, p<0,01, ·ÓÙ›ÛÙÔȯ·).

OÈ ·ÛıÂÓ›˜ Ô˘ ›¯·Ó ÂÈÛ¤ÏıÂÈ ÛÙËÓ ÂÊ˂›· ›¯·Ó Â›Û˘ ¯·ÌËÏfiÙÂÚ˜ ÙÈ̤˜ IGF-I Î·È IGFBP-3 Û˘ÁÎÚÈÙÈο Ì ÙÔ˘˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ (ı·Ï·ÛÛ·ÈÌÈÎÔ› ·ÛıÂÓ›˜ ¤Ó·ÓÙÈ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ: 124±48 ng/ml ¤Ó·ÓÙÈ 150±43 ng/ml, p>0,05 ÛÙ· ·ÁfiÚÈ· Î·È 278±89 ng/ml ¤Ó·ÓÙÈ 310±90 ng/ml, p>0,05 ÛÙ· ÎÔÚ›ÙÛÈ·), fi¯È fï˜ Û ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈÎfi Â›‰Ô.

-3 2,8

r=0,062 p=NS 3,0

3,2

3,4

3,6

3,8

4,0

∂›‰· ÊÂÚÚÈÙ›Ó˘ (ng/ml) ∂ÈÎfiÓ· 2. ŒÏÏÂÈ„Ë Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ÙÔ˘ HSDS Î·È ÙˆÓ ÂÈ¤‰ˆÓ ÊÂÚÚÈÙ›Ó˘.

¢ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ HSDS Î·È Ù˘ Û˘ÁΤÓÙÚˆÛ˘ IGF-I ‹ IGFBP-3, ·ÓÙ›ÛÙÔȯ· (r=-0,03 Î·È r=0,05, p>0,05). ™˘˙‹ÙËÛË ¶·Ú¿ ÙË Û˘ÛÙËÌ·ÙÈ΋ ÌÂÙ¿ÁÁÈÛË Î·È ÙË ıÂÚ·›· ·ÔÛȉ‹ÚˆÛ˘, Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ ·Ú·Ì¤ÓÂÈ Û˘¯Ófi Úfi‚ÏËÌ· ÙˆÓ ·ÛıÂÓÒÓ Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ȉȷ›ÙÂÚ· ÌÂÙ¿ ÙËÓ ÂÊ˂›·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ·ÓȯÓ‡ÙËΠ۠ÔÛÔÛÙfi 30% ÙˆÓ ·ÛıÂÓÒÓ. OÈ 16 ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ 17 ·ÛıÂÓ›˜ ›¯·Ó ÂÈÛ¤ÏıÂÈ ÛÙËÓ ÂÊ˂›·. ∂ÈϤÔÓ, Ë ·ÓÙ›ÛÙÚÔÊË Û˘Û¯¤ÙÈÛË Ô˘ ·Ú·ÙËÚÂ›Ù·È ÌÂٷ͇ ÙÔ˘ HSDS fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ù˘ ËÏÈΛ·˜, ·ÔÙÂÏ› ·fi‰ÂÈÍË fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ·. ∏ Â›ÙˆÛË ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÌÊ·Ó›˙ÂÙ·È ·ÚfiÌÔÈ· Ì ·˘Ù‹ Ô˘ ·Ó·Ê¤ÚÂÙ·È Û ¿ÏÏË ÌÂϤÙË Ô˘ ¤ÁÈÓ ÛÙËÓ ∂ÏÏ¿‰· ÙÔ 1990 Î·È ÂÚÈÂÏ¿Ì‚·Ó 405 ·È‰È¿, fiÔ˘ 29% ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘Û›·˙ ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ (4). ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ·Ó·Ê¤ÚÔÓÙ·È Û ¿ÏϘ ÌÂϤÙ˜ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ∫ÈÓ¤˙Ô˘˜ Î·È ∆Ô‡ÚÎÔ˘˜ ·ÛıÂÓ›˜, ÂÓÒ Û ̛· ÌÂϤÙË ·fi ÙËÓ πÙ·Ï›· Ë Â›ÙˆÛË ·ÛıÂÓÒÓ Ì ¯·ÌËÏfi ·Ó¿ÛÙËÌ· ·Ó¤Ú¯ÂÙ·È Û 62% ÙˆÓ ·Ó‰ÚÒÓ Î·È 35% ÙˆÓ Á˘Ó·ÈÎÒÓ (5). ∏ ˘„ËÏ‹ ·˘Ù‹ Â›ÙˆÛË ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ ÂÍËÁÂ›Ù·È ÂÓ Ì¤ÚÂÈ Î·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 250 πÙ·ÏÔ› ¤ÊË‚ÔÈ, ηıÒ˜ ÛÙËÓ ÂÊ˂›· Ë Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ ·Ó·Ì¤ÓÂÙ·È Û ˘„ËÏfi ÔÛÔÛÙfi. ∆· ·›ÙÈ· Ù˘ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ ›ӷÈ

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ÔÏ˘·Ú·ÁÔÓÙÈο Î·È ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›. °ÂÓÈο, ÈÛÙ‡ÂÙ·È fiÙÈ Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ÙÔÍÈ΋ Â›‰Ú·ÛË Ù˘ ˘ÂÚÊfiÚÙˆÛ˘ Ì ۛ‰ËÚÔ. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fï˜, ‰ÂÓ ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÊÂÚÚÈÙ›Ó˘ Î·È ÙÔ˘ ·Ó·ÛÙ‹Ì·ÙÔ˜ ‹ Î·È ÌÂٷ͇ ÙˆÓ ÂÈ¤‰ˆÓ ÊÂÚÚÈÙ›Ó˘ Î·È ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜ (Û ۯ¤ÛË Ì ÙÔÓ Ì¤ÛÔ fiÚÔ ÁÈ· ÙËÓ ËÏÈΛ· Î·È ÙÔ Ê‡ÏÔ). ∆Ô Â‡ÚËÌ· ·˘Ùfi Â›Ó·È Û˘Ì‚·Ùfi Ì ÙȘ ·Ú·ÙËÚ‹ÛÂȘ ÙˆÓ Sanctis Î·È Û˘Ó, ÔÈ ÔÔ›ÔÈ ‚Ú‹Î·Ó fiÙÈ Ë Ù·¯‡ÙËÙ· ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ ÌÂ Û˘¯Ó¤˜ ÌÂÙ·ÁÁ›ÛÂȘ Î·È ÚÒÈÌË ¤Ó·ÚÍË ·ÔÛȉ‹ÚˆÛ˘ ‹Ù·Ó ¯·ÌËÏfiÙÂÚË ·fi ÂΛÓË ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Û·Ó ÙfiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ÌÂÙ·ÁÁ›ÛÂˆÓ Î·È ·ÔÛȉ‹ÚˆÛ˘ (6). ∏ ÔÚÌÔÓÈ΋ ·ÈÙ›· Ù˘ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ Û ·È‰È¿ Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Â›Ó·È ÔχÏÔÎË. ∏ ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ÈÛÙ‡ÂÙ·È fiÙÈ ·ÔÙÂÏ› Ì›· ·fi ÙȘ ·ÚȘ ·Èٛ˜. ∂ÓÙÔ‡ÙÔȘ, ˘¿Ú¯Ô˘Ó ÌÂϤÙ˜ Ô˘ ·Ó·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈ΋ ·ÓÂ¿ÚÎÂÈ· (2,7-9) Î·È ¿ÏϘ Ô˘ ·Ó·Ê¤ÚÔ˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (10,11). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ·ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ ·ÚÔ˘Û›·˙ ÙÔ 40% ÙˆÓ ·ÛıÂÓÒÓ Ì ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘, ÂÓÒ ˘ÔÁÔÓ·‰ÈÛÌfi˜ Î·È Î·ı˘ÛÙ¤ÚËÛË ÂÊ˂›·˜ ·Ú·ÙËÚ‹ıËΠ۠10 ·fi ÙÔ˘˜ 17 ·ÛıÂÓ›˜ Ì ·Ó¿ÛÙËÌ· οو ·fi ÙËÓ 3Ë ∂£. ™˘ÓÔÏÈο, ÂÓ‰ÔÎÚÈÓÔ¿ıÂÈ· ‰È·ÈÛÙÒıËΠ۠70% ÙˆÓ ·ÛıÂÓÒÓ Ì ηı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘. ∏ Û˘ÁΤÓÙÚˆÛË ÙˆÓ IGF-I Î·È IGFBP-3 ÛÙÔÓ ÔÚfi ‚Ú¤ıËΠ¯·ÌËÏ‹ Û ۯ¤ÛË Ì ˘ÁÈ‹ ·È‰È¿, fiˆ˜ ·Ó·Ê¤ÚÂÙ·È Î·È Û ¿ÏϘ ÌÂϤÙ˜ (1,2,12, 13). ∏ ¯·ÌËÏ‹ ·˘Ù‹ Û˘ÁΤÓÙÚˆÛË ÙÔ˘ IGF-I ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Ê˘ÛÈÔÏÔÁÈ΋ ¤ÎÎÚÈÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘, Ô‰‹ÁËÛ ÛÙËÓ ˘fiıÂÛË fiÙÈ Ë ·ÓÙ›ÛÙ·ÛË ÛÙË ‰Ú¿ÛË Ù˘ ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ Î·È Ë Ó¢ÚÔÂÎÎÚÈÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· Ù˘ ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ·Ó¿Ù˘Í˘ ÛÙ· ·È‰È¿ Ì ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· (3). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ‰ÔÎÈÌ·Û›· ‰È¤ÁÂÚÛ˘ ÙÔ˘ IGF-I ÌÂÙ¿ ·fi ¯ÔÚ‹ÁËÛË ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ (IGF-I generation test) ÁÈ· Ó· ÂÍÂÙ·ÛÙ› ·˘Ù‹ Ë Èı·ÓfiÙËÙ·. ∂ÓÙÔ‡ÙÔȘ, Ë ¤ÏÏÂÈ„Ë Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ IGF-I, IGFBP-3 Î·È HSDS ·ÔÙÂÏ› ¤Ó‰ÂÈÍË fiÙÈ Ë Î·ı˘ÛÙ¤ÚËÛË ·Ó¿Ù˘Í˘ ‰ÂÓ ÌÔÚ› ·ÔÎÏÂÈÛÙÈο Ó· ÂÚÌËÓ¢Ù› Î·È Ó· ·Ô‰Ôı› Û ‰È·Ù·Ú·¯‹ ÙÔ˘ ¿ÍÔÓ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘-·˘ÍËÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ™Â 40% ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·Ú·ÙËÚ‹ıËÎÂ, Â›Û˘, Ì›ˆÛË ÙÔ˘ ÏfiÁÔ˘ ¿Óˆ/οو ËÌÈÌÔÚ›Ô˘ Û ۯ¤ÛË Ì ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi, Ô˘ Â›Ó·È ÁÓˆÛÙfi fiÙÈ ·Ú·ÙËÚÂ›Ù·È Û ı·Ï·ÛÛ·ÈÌÈÎÔ‡˜ ·ÛıÂÓ›˜ (14). øÛÙfiÛÔ, Ë Ì›ˆÛË ·˘Ù‹ ‰ÂÓ ·ÔÙÂ-

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Ï› ÙËÓ ·ÈÙ›· ÙÔ˘ ¯·ÌËÏÔ‡ ·Ó·ÛÙ‹Ì·ÙÔ˜, ·ÊÔ‡ ¯·ÌËÏfi˜ ÏfiÁÔ˜ ·ÓÒÙÂÚÔ˘/ηÙÒÙÂÚÔ˘ ËÌÈÌÔÚ›Ô˘ ÛÒÌ·ÙÔ˜ ·Ú·ÙËÚ‹ıËΠÂÍ›ÛÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ¯·ÌËÏfi Î·È Ê˘ÛÈÔÏÔÁÈÎfi ·Ó¿ÛÙËÌ·. ŸÙ·Ó ÂÍÂÙ¿ÛÙËÎÂ Ë Û¯¤ÛË ÙÔ˘ ¯·ÌËÏÔ‡ ÏfiÁÔ˘ ¿Óˆ/οو ËÌÈÌÔÚ›Ô˘ Ì ÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ‹‚˘ ÙˆÓ ı·Ï·ÛÛ·ÈÌÈÎÒÓ ·ÛıÂÓÒÓ, ·Ú·ÙËÚ‹ıËΠfiÙÈ Ô ÏfiÁÔ˜ ·˘Ùfi˜ ‹Ù·Ó ¯·ÌËÏfi˜ Û ÔÛÔÛÙfi 38% ÙˆÓ ·ÛıÂÓÒÓ ÂÊË‚È΋˜ ËÏÈΛ·˜ Î·È Û ÔÛÔÛÙfi 44% ·˘ÙÒÓ ÚÔÂÊË‚È΋˜ ËÏÈΛ·˜. ∏ ·Ú·Ù‹ÚËÛË ·˘Ù‹ ÂÓÈÛ¯‡ÂÈ ÙËÓ ˘fiıÂÛË fiÙÈ ÁÈ· ÙË ‰˘Û·Ó·ÏÔÁ›· ÙÔ˘ ÎÔÚÌÔ‡ ÙˆÓ ·ÛıÂÓÒÓ ·˘ÙÒÓ ÂÓ¤¯ÂÙ·È - ÂÎÙfi˜ ·fi ÙËÓ ÙÔÍÈÎfiÙËÙ· ÙÔ˘ Ûȉ‹ÚÔ˘ Î·È Ù˘ ıÂÚ·›·˜ ·ÔÛȉ‹ÚˆÛ˘ - Î·È Ë Î·ı˘ÛÙ¤ÚËÛË ÂÊ˂›·˜. ™˘ÓÔ„›˙ÔÓÙ·˜, ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÙˆÓ ·ÛıÂÓÒÓ ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÎÚ›ÓÂÙ·È ÈηÓÔÔÈËÙÈÎfi, ·ÊÔ‡ ÙÔ 70% ÙˆÓ ·ÛıÂÓÒÓ Â›¯Â ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ÂÓÙfi˜ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. ∂ÓÙÔ‡ÙÔȘ, ÙÔ ÙÂÏÈÎfi ·Ó¿ÛÙËÌ· ηٿ ̤ÛÔ fiÚÔ ‹Ù·Ó Û·ÊÒ˜ ηÙÒÙÂÚÔ ·fi ÙÔ ·Ó¿ÛÙËÌ·-ÛÙfi¯Ô. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ¤Ó·ÚÍË ·ÁˆÁ‹˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ¤Ó· ηÏfi ·ÔÙ¤ÏÂÛÌ·. ∏ ·˘ÍËÙÈ΋ ÔÚÌfiÓË ÌfiÓË Ù˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛÙÂÚÔÂȉ‹ ÙÔ˘ ʇÏÔ˘, ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ‡„Ô˘˜ Û ·È‰È¿ Ì ÎÔÓÙfi ·Ó¿ÛÙËÌ· Ì ·ÓÂ¿ÚÎÂÈ· Û ·˘Ù‹Ó, ÂÓÒ ¯·ÌËϤ˜ ‰fiÛÂȘ ÛÙÂÚÔÂȉÒÓ ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó Û ·È‰È¿ Ì ηı˘ÛÙ¤ÚËÛË Ù˘ ÂÊ˂›·˜ (15,16). ∆¤ÏÔ˜, ‚ÂÏÙȈ̤ÓË ·ÁˆÁ‹ ·ÔÛȉ‹ÚˆÛ˘ Î·È Û˘¯ÓÒÓ ÌÂÙ·ÁÁ›ÛÂˆÓ ı· Ú¤ÂÈ ¿ÓÙ· Ó· ÂÊ·ÚÌfi˙ÂÙ·È Û ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜. µÈ‚ÏÈÔÁÚ·Ê›· 1. Saenger P, Schwartz E, Markenson AL, Graziano JH, Levine LS, New MI et al. Depressed serum somatomedin activity in beta-thalassemia. J Pediatr 1980;96:214-218.

2. Oerter KE, Kamp GA, Munson PJ, Nienhuis AW, Cassorla FG, Manasco PK. Multiple hormone deficiencies in children with hemochromatosis. J Clin Endocrinol Metab 1993;76: 357-361.

3. Shehadeh N, Hazani A, Rudolf MC, Peleg I, Benderly A, Hochberg Z. Neurosecretory dysfunction of growth hormone secretion in thalassemia major. Acta Paediatr Scand 1990;79:790-795.

4. Kattamis C, Liakopoulou T, Kattamis A. Growth and development in children with thalassaemia major. Acta Paediatr Scand 1990;366 (Suppl):S111-S117.

5. Borgna-Pignatti C, De Stefano P, Zonta L, Vullo C, De Sanctis V, Melevendi C et al. Growth and sexual maturation in thalassemia major. J Pediatr 1985;106:150-155.

6. De Sanctis V, Katz M, Vullo C, Bagni B, Ughi M, Wonke B. Effect of different treatment regimes on linear growth and final height in beta-thalassaemia major. Clin Endocrinol 1994;40:791-798.

7. Costin G, Kogut MD, Hyman CB, Ortega JA. Endocrine abnormalities in thalassemia major. Am J Dis Child 1979; 133:497-502.

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8. Cavallo L, De Mattia G, Lottore G, Pisapia D, Giobbe S, Sabato V. Growth hormone reserve in growth deficient polytransfused thalassemia major. Horm Res 1983;39:86-90.

9. Abisu M, Clofent R, Potau N, Gussinye M, Ibanez L, VicensCalvet E. Impaired growth and multiple endocrinopathies in patients with thalassemia. Acta Pediatr Scand 1990;366 (Suppl):140A. 10. Masala A, Alagna S, Gallisai D, Rovasio PP, Burrai C, Ginnani A et al. Long term treatment with biosynthetic growth hormone (GH) of patients with thalassemia major.

Eur J Nucl Med 1992;19:682-685.

11. Masala A, Meloni T, Gallisai D, Alagna S, Rovasio PP, Rassu S et al. Endocrine functioning in multitransfused prepubertal patients with homozygous beta-thalassemia. J Clin Endocrinol Metab 1984;58:667-670.

12. Kwan EY, Lee AC, Li AM, Tam SC, Chan CF, Lau YL et al. A cross-sectional study of growth, puberty and endocrine function in patients with thalassaemia major in Hong Kong.

J Paediatr Child Health 1995;31:83-87.

13. Low LC, Postel-Vinay MC, Kwan EY, Cheung PT. Serum growth hormone (GH) binding protein, IGF-I and IGFBP-3 in

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patients with beta-thalassaemia major and the effect of GH treatment. Clin Endocrinol 1998;48:641-646.

14. Rodda CP. Body proportions in patients with homozygous beta-thalassaemia. Acta Paediatr 1994;406 (Suppl):S107S108.

15. Theodoridis C, Ladis V, Papatheodorou A, Berdousi H, Palamidou F, Evagelopoulou C et al. Growth and management of short stature in thalassaemia major. J Pediatr Endocrinol Metab 1998;11 (Suppl 3):S835-S844.

16. Richman RA, Kirsch LR. Testosterone treatment in adolescent boys with constitutional delay in growth and development. N Engl J Med 1988;319:1563-1567.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-04-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 31-10-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ºˆÙÂÈÓ‹-∂ϤÓË ∫·Ú·¯¿ÏÈÔ˘ ∆Ì‹Ì· ∞‡ÍËÛ˘ Î·È ∞Ó¿Ù˘Í˘ ªÂÛÔÁ›ˆÓ 24, ∆.∫. 115 27, ∞ı‹Ó·

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Paediatriki 2004;67:44-48

ORIGINAL ARTICLE

™˘¯ÓfiÙËÙ· Î·È ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ Û ·È‰È¿ ∞’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ∞ÚÁÔÏ›‰·˜ ¶. ∆·‚Ï·ÓÙ¿˜1, ∫. ∆˙È¿ÚÔ˘1, ª. ∆·‚Ï·ÓÙ¿1, Ã. •˘ÔÏÈ¿2, π. ∆·Ú·ÓÙ›Ï˘1, π. πˆ¿ÓÓÔ˘1, ∫. °Î¿Ù˙ÈÔ˘1

Frequency and management of sinistrality in first grade of primary school children in the county of Argolida, Greece P. Tavlantas1, K. Tziarou1, M. Tavlanta1, C. Xypolia2, J. Tarantilis1, J. Ioannou1, K. Gatziou1

¶ÂÚ›ÏË„Ë: ™ÙȘ ‰È¿ÊÔÚ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÙÔ˘ ·ÓıÚÒÔ˘, Ë ¯Ú‹ÛË ÙÔ˘ ‰ÂÍÈÔ‡ ‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¯ÂÚÈÔ‡ ÎÏÈÌ·ÎÒÓÂÙ·È ·fi ÙËÓ ·fiÏ˘ÙË ‰ÂÍÈÔ¯ÂÈÚ›· ‹ ÙËÓ ·ÌÊȯÂÈÚ›· ̤¯ÚÈ ÙËÓ ·fiÏ˘ÙË ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·. ∞ÈÙÈÔÏÔÁÈο, ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ‰È¿ÊÔÚÔÈ ·Ú¿ÁÔÓÙ˜: ·Ó·ÙÔÌÈÎÔ›, ÎÏËÚÔÓÔÌÈÎÔ›, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ›, ·ÎfiÌ· Î·È ·ıÔÏÔÁÈÎÔ›. ∆· ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ··Û¯ÔÏÔ‡Ó ÙÔ˘˜ ÁÔÓ›˜, ÙÔ˘˜ ‰·ÛοÏÔ˘˜, ·ÏÏ¿ Î·È ÂȉÈÎÔ‡˜ ÂÈÛÙ‹ÌÔÓ˜ (·È‰È¿ÙÚÔ˘˜, Ó¢ÚÔÊ˘ÛÈÔÏfiÁÔ˘˜, ÎÔÈÓˆÓÈÔÏfiÁÔ˘˜ Î·È „˘¯ÔÏfiÁÔ˘˜). ∏ ÛˆÛÙ‹ ÂÓË̤ڈÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ ·ÔÙÂÏ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ·Ú¿ÁÔÓÙ· ÛÙÔ Ï·›ÛÈÔ ·ÚÔ¯‹˜ ‚Ô‹ıÂÈ·˜ ÛÙ· ¿ÙÔÌ· Ì ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·. ™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÂÍÂÙ¿ÛÙËÎ·Ó 1048 ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ, 500 ·ÁfiÚÈ· (47,7%) Î·È 548 ÎÔÚ›ÙÛÈ· (52,3%). ∂‚‰ÔÌ‹ÓÙ· ¤Ó· ·fi ·˘Ù¿ ‚Ú¤ıËÎ·Ó ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ (6,77%). ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ‰¿ÛηÏÔÈ Î·È ÔÈ ÁÔÓ›˜ ‰ÂÓ ·ÛÎÔ‡Ó ϤÔÓ ›ÂÛË ÛÙ· ·È‰È¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·, ıˆÚÒÓÙ·˜ ÙËÓ È‰È·ÈÙÂÚfiÙËÙ· Î·È fi¯È ·ıÔÏÔÁÈ΋ ηٿÛÙ·ÛË.

Abstract: The variety of a person’s activities conducted with the right or the left hand reveals a range from clear dextromanuality, through amphidextrality to absolute sinistrality. Many factors have been implicated: anatomical, hereditary, environmental and even pathological. Problems related to sinistral preference are of great interest to parents, schoolteachers and health professionals (paediatricians, neurophysiologists, sociologists, psychologists). The provision of accurate information for families and teachers is the most important factor for helping children with sinistral preference.

In this study 1048 first grade primary schoolchildren were tested, 500 boys (47.7%) and 548 girls (52.3%) of whom 71 were found to have sinistral preference (6.77%). It is of major importance in the management that teachers and parents do not exert pressure on these children, because preference for the left hand is treated as an individual feature and not as a pathological condition.

§¤ÍÂȘ ÎÏÂȉȿ: ·È‰È΋ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·, ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·, ÚÔ‚Ï‹Ì·Ù· ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜.

Key words: sinistrality in children, sinistrality, problems of sinistrality.

∂ÈÛ·ÁˆÁ‹ OÈ ÂÚÈÛÛfiÙÂÚÔÈ ¿ÓıÚˆÔÈ ÛÙȘ ‰È¿ÊÔÚ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ ‰ÂÍ› ÙÔ˘˜ ¯¤ÚÈ. ∏ ÚÔÙ›ÌËÛË ÙÔ˘ ‰ÂÍÈÔ‡ ¯ÂÚÈÔ‡ ¤Ó·ÓÙÈ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ·ÔÙÂÏ› Û‡ÓËı˜ Ê·ÈÓfiÌÂÓÔ. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ‰ÈÂıÓÒ˜ ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 10%. ™ÙËÓ ·ÙÚ›‰· Ì·˜, Ë Û˘¯ÓfiÙËÙ· ·˘Ù‹ ·ÁÁ›˙ÂÈ ÙÔ 6%. OÈ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ ˙Ô˘Ó Û ¤Ó·Ó ÎfiÛÌÔ Ô˘ Â‰Ò Î·È ·ÈÒÓ˜ Â›Ó·È ÊÙÈ·Á̤ÓÔ˜ ·ÔÎÏÂÈÛÙÈο ÁÈ·

‰ÂÍÈfi¯ÂÈÚ˜, Û ¤Ó· ÂÚÈ‚¿ÏÏÔÓ Ô˘ “fiÏ· Á˘Ú›˙Ô˘Ó ‰ÂÍÈ¿”. ∏ ˙ˆ‹ ÙÔ˘˜ ‰ÂÓ Â›Ó·È ÙfiÛÔ ·Ï‹, ÙfiÛÔ ÏfiÁˆ ÙˆÓ ÌÈÎÚÔ‰˘ÛÎÔÏÈÒÓ Ù˘ ηıËÌÂÚÈÓfiÙËÙ·˜ fiÛÔ Î·È ÏfiÁˆ Ù˘ ÚÔηٿÏ˄˘ Ô˘ ÂÈÎÚ·ÙÔ‡Û ·Ó¤Î·ıÂÓ ÁÈ· ÙÔ “ηÎfi ·ÚÈÛÙÂÚfi”. ª›· ÚÔηٿÏË„Ë ÚÔÂÚ¯fiÌÂÓË ·fi ÙË Ï·Óı·Ṳ̂ÓË ·ÓÙ›ÏË„Ë fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· οÙÈ ÌË Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ÚÔηٿÏË„Ë ·˘Ù‹ ›¯Â Û·Ó ·ÔÙ¤ÏÂÛÌ· ÔÏÏÔ› ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Ó· ˘ÔÛÙÔ‡Ó ȤÛÂȘ ·fi ÁÔÓ›˜ ‹ ‰·ÛοÏÔ˘˜

1 ∫¤ÓÙÚÔ ÀÁ›·˜ §˘ÁÔ˘ÚÈÔ‡, ∞ÚÁÔÏ›‰· 2 ¢ËÌÔÙÈÎfi ™¯ÔÏÂ›Ô ∞ÛÎÏËÈ›Ԣ, ∞ÚÁÔÏ›‰·

1 Health Centre of Lygourio, Argolida 2 Elementary School of Asclepieion, Argolida

44

¶·È‰È·ÙÚÈ΋ 2004;67:44-48

ÚÔÎÂÈ̤ÓÔ˘ Ó· ¯ÚËÛÈÌÔÔÈ‹ÛÔ˘Ó ÙÔ ‰ÂÍ› ÙÔ˘˜ ¯¤ÚÈ, ÙfiÛÔ ÛÙË ÁÚ·Ê‹ fiÛÔ Î·È ÛÙȘ ηıËÌÂÚÈÓ¤˜ ÙÔ˘˜ ÂÚÁ·Û›Â˜. ∏ ‰ÂÍÈfiÙËÙ· ÁÈ· ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ¯ÂÚÈÒÓ ÎÏÈÌ·ÎÒÓÂÙ·È ·fi ÙËÓ ·fiÏ˘ÙË ‰ÂÍÈÔ¯ÂÈÚ›·, ÙËÓ ·ÌÊȯÂÈÚ›· ¤ˆ˜ ÙËÓ ·fiÏ˘ÙË ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·. ™¯ÂÙÈÎfi Ì ÙËÓ ˘ÂÚÔ¯‹ ÙÔ˘ ‰ÂÍÈÔ‡ ‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¯ÂÚÈÔ‡ Â›Ó·È Î·È ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ΢ÚÈ·Ú¯›·˜ ÙÔ˘ ‰ÂÍÈÔ‡ ‹ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ Ì·ÙÈÔ‡, Ô‰ÈÔ‡ ‹ ·˘ÙÈÔ‡, ÁÂÁÔÓfi˜ Ô˘ ÂÍËÁÂ›Ù·È ·fi ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ Ï¢ڛˆÛ˘ (1-3). O fiÚÔ˜ “Ï¢ڛˆÛË” ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ÂÍÂȉ›Î¢ÛË Ì›·˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙË Ì›· ÏÂ˘Ú¿ ÙÔ˘ ÛÒÌ·ÙÔ˜, Ë ÔÔ›· ÂΉËÏÒÓÂÙ·È ˆ˜ ·Û˘ÌÌÂÙÚ›· ÙˆÓ ÎÈÓËÙÈÎÒÓ, ·ÈÛıËÙÈÎÒÓ ‹ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ. OÈ ·Û˘ÌÌÂÙڛ˜ ·˘Ù¤˜ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ‰È·ÊÔÚÔÔÈË̤ÓË ÂÍÂȉ›Î¢ÛË ÙˆÓ ‰‡Ô ÂÁÎÂÊ·ÏÈÎÒÓ ËÌÈÛÊ·ÈÚ›ˆÓ. ∂ȉÈÎfiÙÂÚ·, Ë ÁψÛÛÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÔÈ ·Ó·Ï˘ÙÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ Î·È ÔÈ ÎÈÓËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ‰ÂÍÈ¿˜ ÏÂ˘Ú¿˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ ÂϤÁ¯ÔÓÙ·È ·fi ÙÔ ·ÚÈÛÙÂÚfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ, ÂÓÒ ÙÔ ‰ÂÍ› ËÌÈÛÊ·›ÚÈÔ ÂϤÁ¯ÂÈ ÙȘ ÌË ÏÂÎÙÈΤ˜, ÔÙÈÎÔ¯ˆÚÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ Î·È ÙȘ ÎÈÓËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÏÂ˘Ú¿˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (3,4). ™ÙÔȯ›· ÁÈ· ÙËÓ Î˘ÚÈ·Ú¯›· ÙÔ˘ ‰ÂÍÈÔ‡ ¯ÂÚÈÔ‡ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ·fi ÙËÓ ÂÔ¯‹ ÙÔ˘ ÚÔ˚ÛÙÔÚÈÎÔ‡ ·ÓıÚÒÔ˘. ™ÙËÓ ¶·Ï·È¿ ¢È·ı‹ÎË ·Ó·Ê¤ÚÂÙ·È Ë ‡·ÚÍË ÔÏÏÒÓ ·ÚÈÛÙÂÚfi¯ÂÈÚˆÓ ÛÙË Ê˘Ï‹ ÙÔ˘ µÂÓÈ·Ì›Ó (1). ™ÙË µ›‚ÏÔ Á›ÓÔÓÙ·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 100 ·Ó·ÊÔÚ¤˜ ÁÈ· ÙÔ ‰ÂÍ› ¯¤ÚÈ, ÂÓÒ ÂÏ¿¯ÈÛÙ˜ ÁÈ· ÙÔ ·ÚÈÛÙÂÚfi (5). ∏ ÚÔηٿÏË„Ë ÁÈ· ÙÔ ·ÚÈÛÙÂÚfi ¯¤ÚÈ ‰ÂÓ ·ÔÙÂÏ› ¯·Ú·ÎÙËÚÈÛÙÈÎfi ·ÔÎÏÂÈÛÙÈο ÙÔ˘ ‰˘ÙÈÎÔ‡ ÔÏÈÙÈÛÌÔ‡. ¢È¿ÊÔÚÔÈ ÔÏÈÙÈÛÌÔ› Î·È Ê˘Ï¤˜ ¤¯Ô˘Ó ¯·Ú·ÎÙËÚ›ÛÂÈ ÙÔ ·ÚÈÛÙÂÚfi ¯¤ÚÈ ˆ˜ “·Ó·ÍÈfiÈÛÙÔ”, “·Ó˘fiÏËÙÔ”, “ÂÁÎÏËÌ·ÙÈÎfi”, “·Î¿ı·ÚÙÔ”. ∞ÎÚÈ‚Ò˜ ÏfiÁˆ ·˘Ù‹˜ Ù˘ ¤ÓÙÔÓ˘ ·ÚÓËÙÈ΋˜ ·ÓÙÈÌÂÙÒÈÛ˘ ·¤Ó·ÓÙÈ ÛÙË ¯Ú‹ÛË ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ¯ÂÚÈÔ‡, Ë „˘¯ÔÎÔÈÓˆÓÈ΋ Â›‰Ú·ÛË ÛÙËÓ ÂΉ‹ÏˆÛË ‹ ÙËÓ Î·Ù·ÛÙÔÏ‹ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ Á›ÓÂÙ·È ÂÌÊ·Ó‹˜. ∏ ÛÙ¿ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ÙÔ˘ Û¯ÔÏ›Ԣ Î·È Ù˘ ÎÔÈÓˆÓ›·˜ ÁÂÓÈÎfiÙÂÚ· ·›˙ÂÈ Î·ıÔÚÈÛÙÈÎfi ÚfiÏÔ, ·Ó fi¯È ÁÈ· ÙËÓ ·ÈÙÈÔÏÔÁ›·, ·Ó·ÌÊ›‚ÔÏ· ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ‹ fi¯È Ì›·˜ “ÂÓ ‰˘Ó¿ÌÂÈ” ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ (4). ∞ÈÙÈÔÏÔÁ›· °È· ÙË ÌË ÈÛÔ‰‡Ó·ÌË ¯Ú‹ÛË ÙˆÓ ¯ÂÚÈÒÓ ¤¯Ô˘Ó ‰È·Ù˘ˆı› ‰È¿ÊÔÚ˜ ıˆڛ˜ Î·È ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÔÈΛÏÔÈ ·Ú¿ÁÔÓÙ˜, ÔÈ Î˘ÚÈfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ıˆÚÔ‡ÓÙ·È ÔÈ ÂÍ‹˜: ·) °ÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜. ŒÓ‰ÂÈÍË ÁÈ· Ì›· ÚÒÈÌË ‡·ÚÍË ÂÁÎÂÊ·ÏÈ΋˜ ·Û˘ÌÌÂÙÚ›·˜ Ô˘ ‚·Û›˙ÂÙ·È Û ‰Â‰Ô̤ӷ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÎÈÓËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÔÏÏÒÓ ‚ÚÂÊÒÓ Â›Ó·È ·Û‡ÌÌÂÙÚË. ∆ÔÓÈÎfi ·ÓÙ·Ó·ÎÏ·ÛÙÈÎfi ÙÔ˘ ·˘¯¤Ó·: ‚Ú¤ÊË (0-3 ÌËÓÒÓ) Û ‡ÙÈ· ı¤ÛË, Ì ÙÔ ÎÂÊ¿ÏÈ ÙÔ˘˜ Û˘Ó‹ıˆ˜ ÛÙÚ·Ì̤ÓÔ ÚÔ˜

Paediatriki 2004;67:44-48

ÙË Ì›· ÏÂ˘Ú¿. ∆Ô ¯¤ÚÈ Î·È ÙÔ fi‰È Ù˘ ÏÂ˘Ú¿˜ ÛÙËÓ ÔÔ›· Â›Ó·È Á˘ÚÈṲ̂ÓÔ ÙÔ ÎÂÊ¿ÏÈ ‚Ú›ÛÎÂÙ·È Û ¤ÎÙ·ÛË, ÂÓÒ ÙÔ ·ÓÙ›ıÂÙÔ ¯¤ÚÈ Î·È fi‰È Û ı¤ÛË Î¿Ì„Ë˜. ∆· ÂÚÈÛÛfiÙÂÚ· ‚Ú¤ÊË ÛÙÚ¤ÊÔ˘Ó ÙÔ ÎÂÊ¿ÏÈ ÚÔ˜ ÙË ‰ÂÍÈ¿ ÏÂ˘Ú¿ Î·È ÂÍÂÏ›ÛÛÔÓÙ·È Û ‰ÂÍÈfi¯ÂÈÚ˜, ÂÓÒ Ë ÌÂÈÔ„ËÊ›· ÙˆÓ ‚ÚÂÊÒÓ ¤¯ÂÈ ÛÙÚ·Ì̤ÓÔ ÙÔ ÎÂÊ¿ÏÈ ÚÔ˜ Ù· ·ÚÈÛÙÂÚ¿ Î·È ·˘Ù¿ Ù· ‚Ú¤ÊË ÂÍÂÏ›ÛÛÔÓÙ·È Û ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ (6,7). ™Â Ì›· ÌÂϤÙË, ÛÙËÓ ÔÔ›· Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó 100 ‚Ú¤ÊË ËÏÈΛ·˜ 5-12 ÌËÓÒÓ, Ù· ÎÔÚ›ÙÛÈ· ¤‰ÂÈÍ·Ó ÌÔÓfiÏ¢ÚË ÚÔÙ›ÌËÛË ÛÙË ¯Ú‹ÛË ÙÔ˘ ‰ÂÍÈÔ‡ ¯ÂÚÈÔ‡ ÁÈ· ÙÔ È¿ÛÈÌÔ ·ÓÙÈÎÂÈ̤ÓÔ˘ Û ËÏÈΛ· 5-8 ÌËÓÒÓ, ÂÓÒ Ù· ·ÁfiÚÈ· ¤‰ÂÈÍ·Ó ·˘Ù‹ ÙË ÌÔÓfiÏ¢ÚË ÚÔÙ›ÌËÛË ÙÔ˘ ¯ÂÚÈÔ‡ Û ËÏÈΛ· 9-12 ÌËÓÒÓ (8). ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÚÔÙ›ÌËÛË ÙÔ˘ ÂÓfi˜ ‹ ÙÔ˘ ¿ÏÏÔ˘ ¯ÂÚÈÔ‡ ‰ÂÓ Â‰Ú·ÈÒÓÂÙ·È Ï‹Úˆ˜ ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ. ‚) ∂ÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë. ∏ ¿Ô„Ë ·˘Ù‹ ÛÙËÚ›˙ÂÙ·È ÛÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ ÛÙÔ˘˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜, Û ۇÁÎÚÈÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi, ˘¿Ú¯ÂÈ ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÂÈÏËÙÈÎÒÓ, ‰˘ÛÏÂÎÙÈÎÒÓ, ηıÒ˜ Î·È ·ÙfiÌˆÓ Ì ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË. ¶ÚÔÁÂÓÓËÙÈΤ˜ Î·È ÂÚÈÁÂÓÓËÙÈΤ˜ ‚Ï¿‚˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ÔÓÙÔÁ¤ÓÂÛË Ù˘ ·ıÔÏÔÁÈ΋˜ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ (9,10). ∞˘Ùfi, Ê˘ÛÈο, ‰ÂÓ Û˘ÓÂ¿ÁÂÙ·È fiÙÈ fiÏÔÈ ÔÈ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ ¤¯Ô˘Ó οÔÈ· ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë. Á) ∞Ó·ÙÔÌÈΤ˜ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·ÊÔÚ¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∆· ‰‡Ô ËÌÈÛÊ·›ÚÈ· Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ ÌÂÛÔÏfi‚ÈÔ, ÙÔ ÔÔ›Ô ÂÈÙÚ¤ÂÈ ÙËÓ ·˘ÙfiÌ·ÙË ÂÈÎÔÈÓˆÓ›· ÌÂٷ͇ ÙˆÓ ‰‡Ô ËÌÈÛÊ·ÈÚ›ˆÓ. ∫¿ı ËÌÈÛÊ·›ÚÈÔ ·ÔÙÂÏ› ¤Ó· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ fiÚÁ·ÓÔ ÛΤ„˘. ∆Ô ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ Â›Ó·È ÈÔ ÂÓÂÚÁfi Û ÔÚÈṲ̂ӷ ¿ÙÔÌ·, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔ¿ÁÔÓÙ·È ÔÈ ÁψÛÛÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ÂÓÒ Û ¿ÏÏ· ¿ÙÔÌ· ˘ÂÚ¤¯ÂÈ ÙÔ ‰ÂÍ› ËÌÈÛÊ·›ÚÈÔ Â˘ÓÔÒÓÙ·˜ ÙȘ ‰ÂÍÈfiÙËÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÓÙ›ÏË„Ë Î·È ÙÔÓ ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÛÙÔÓ ¯ÒÚÔ. ŸÌˆ˜, ˘¿Ú¯ÂÈ „˘¯ÔÏÔÁÈ΋ Î·È Ê˘ÛÈÔÏÔÁÈ΋ ¤Ó‰ÂÈÍË fiÙÈ ÔÈ ¿ÓıÚˆÔÈ ‰È·Ê¤ÚÔ˘Ó ÛÙË Û¯ÂÙÈ΋ ÈÛÔÚÚÔ›· ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ‰‡Ô ËÌÈÛÊ·ÈÚ›ˆÓ (7,11). ∂Ú¢ÓËÙ¤˜ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÙÔ ÌÂÛÔÏfi‚ÈÔ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÛÙÔ˘˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Î·È ÛÙÔ˘˜ ·ÌÊ›¯ÂÈÚ˜, Û˘ÁÎÚÈÓfiÌÂÓÔ Ì ·˘Ùfi ÙˆÓ ‰ÂÍÈfi¯ÂÈÚˆÓ (12). ‰) OÚÌÔÓÈΤ˜ ÂȉڿÛÂȘ. OÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ‰È·ÊÔÚ¤˜ ÛÙ· Â›‰· ÔÚÌÔÓÒÓ, ȉȷ›ÙÂÚ· Ù˘ ÙÂÛÙÔÛÙÂÚfiÓ˘, ηٿ ÙËÓ ÂÌ‚Ú˘˚΋ ÂÚ›Ô‰Ô ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· Ù˘ ‰È·ÊÔÚÔÔÈË̤Ó˘ Ï¢ڛˆÛ˘ (13). ∞ӷʤÚÂÙ·È fiÙÈ ÙÔ ÏÂfiÓ·ÛÌ· ÙÂÛÙÔÛÙÂÚfiÓ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÌ‚Ú˘˚΋˜ ·Ó¿Ù˘Í˘ ÂÈ‚Ú·‰‡ÓÂÈ ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÌÂÙ·Ó¿ÛÙ¢ÛË Ó¢ÚÒÓˆÓ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ηı˘ÛÙÂÚ› ÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘, ·ÏÏ¿ Î·È ÙËÓ ˆÚ›Ì·ÓÛË ÙÔ˘ ·Ó·Ù˘ÛÛfiÌÂÓÔ˘ ·ÓÔÛÔÔÈËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜.

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¶·È‰È·ÙÚÈ΋ 2004;67:44-48

O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ‰ÂÍÈÔ¯ÂÈÚ›·˜ ‹ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ÂÓfi˜ ·ÙfiÌÔ˘ ÌÔÚ› Ó· Á›ÓÂÈ Ì ‰È¿ÊÔÚ˜ Ù¯ÓÈΤ˜. OÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ¯·Ú·ÎÙËÚ›˙Ô˘Ó Î¿ÔÈÔÓ ˆ˜ ‰ÂÍÈfi¯ÂÈÚ· ‹ ·ÚÈÛÙÂÚfi¯ÂÈÚ· ·Ó¿ÏÔÁ· Ì ÙËÓ Ù¿ÛË Ô˘ ¤¯ÂÈ Ó· ¯ÚËÛÈÌÔÔÈ› ÙÔ ‰ÂÍ› ‹ ÙÔ ·ÚÈÛÙÂÚfi ¯¤ÚÈ ÁÈ· Ó· ÂÎÙÂϤÛÂÈ Î·ÈÓÔ‡ÚÁȘ ÂÚÁ·Û›Â˜, ·Ó¿ÏÔÁ· Ì ÙËÓ Â›‰Ú·ÛË Î¿ı ¯ÂÚÈÔ‡ ÛÙË ¯Ú‹ÛË ‰˘Ó·ÌfiÌÂÙÚˆÓ ‹ Ì ÎÈÓ‹ÛÂȘ Ù·¯‡ÙËÙ·˜ (1). ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ, ÎÚÈÙ‹ÚÈÔ Î·ıÔÚÈÛÌÔ‡ Ù˘ ‰ÂÍÈÔ¯ÂÈÚ›·˜ ‹ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ·ÔÙÂÏ› ÙÔ ¯¤ÚÈ Ì ÙÔ ÔÔ›Ô ÁÚ¿ÊÂÈ ¤Ó· ¿ÙÔÌÔ, ·ÊÔ‡ Ï›ÁÔÈ ÌfiÓÔ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ ÁÚ¿ÊÔ˘Ó Î·È Ì ÙÔ ‰ÂÍ› ¯¤ÚÈ (14). ∫·Ù¿ ηÓfiÓ·, fï˜, Ô ¯·Ú·ÎÙËÚÈÛÌfi˜ Ù˘ ‰ÂÍÈÔ¯ÂÈÚ›·˜ ‹ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ Ù›ıÂÙ·È ·Ó¿ÏÔÁ· Ì ÙÔ ÔÈÔ Â›Ó·È ÙÔ Î˘Ú›·Ú¯Ô ¯¤ÚÈ ÛÙËÓ ÂÎÙ¤ÏÂÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ‰Ú·ÛÙËÚÈÔًوÓ, fiˆ˜ .¯. ÁÚ¿„ÈÌÔ, È¿ÛÈÌÔ ÎÔ˘Ù·ÏÈÔ‡, ¯Ú‹ÛË „·ÏȉÈÔ‡, ¤Ù·ÁÌ· ·ÓÙÈÎÂÈ̤ÓÔ˘, ‚Ô‡ÚÙÛÈÛÌ· ‰ÔÓÙÈÒÓ, ÛÎÔ‡ÈÛÌ·, ¿Ó·ÌÌ· Û›ÚÙÔ˘ Î.Ï. (1,15,16). ™ËÌ·ÓÙÈÎfi Â›Ó·È Ó· Á›ÓÂÈ ·Ó·ÊÔÚ¿ Î·È ÛÙÔ˘˜ ·ÌÊ›¯ÂÈÚ˜, ÔÈ ÔÔ›ÔÈ ¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È Ù· ‰‡Ô ¯¤ÚÈ·, ·ÏÏ¿ Î·È Û ÂΛÓÔ˘˜ Ô˘ ·ÏÏ¿˙Ô˘Ó ¯¤ÚÈ ÚÔÙ›ÌËÛ˘ ÔÔÙ‰‹ÔÙÂ, fi¯È ÏfiÁˆ ›Û˘ ‰ÂÍÈfiÙËÙ·˜, ·ÏÏ¿ ÏfiÁˆ “Ï¢ÚÈ΋˜ ‰ÈÛÙ·ÎÙÈÎfiÙËÙ·˜”, Ë ÔÔ›· Ô‰ËÁ› Û ·‰ÂÍÈfiÙËÙ· Î·È ÊÙˆ¯fi Û˘ÓÙÔÓÈÛÌfi (5). ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙÔÓ ‰ÈÂıÓ‹ ¯ÒÚÔ ¤¯Ô˘Ó Á›ÓÂÈ ÔÏϤ˜ ¤Ú¢Ó˜, ÙfiÛÔ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ·ÈÙÈÔÏÔÁ›·˜ fiÛÔ Î·È ÁÈ· ÙËÓ ÂȉËÌÈÔÏÔÁ›· Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜. ™ÙËÓ ·ÙÚ›‰· Ì·˜, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ¤¯Ô˘Ó Á›ÓÂÈ ÚÔÛ¿ıÂȘ ÁÈ· ÙË ÌÂϤÙË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ Î·È ¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› ·ÍÈfiÏÔÁ˜ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ (14,15). ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ÂȉÈÒÎÂÈ Ó· Û˘Ì‚¿ÏÂÈ ÛÙË ÌÂϤÙË ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜, ÂÍÂÙ¿˙ÔÓÙ·˜ ÙfiÛÔ ÙË Û˘¯ÓfiÙËÙ· fiÛÔ Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ÛÙ· ·È‰È¿ Ù˘ ∞’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ∞ÚÁÔÏ›‰·˜. ∂ÂϤÁËÛ·Ó Ì·ıËÙ¤˜ ·˘Ù‹˜ Ù˘ ËÏÈΛ·˜, ÁÈ·Ù› ÂÓÒ Ë ‰ÂÍÈÔ¯ÂÈÚ›·/·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ÌÔÚ› Ó· ·Ó·ÁÓˆÚÈÛÙ› ·fi ÙÔÓ ‰Â‡ÙÂÚÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, Û˘Ó‹ıˆ˜ ‰ڷÈÒÓÂÙ·È Î·Ù¿ ÙÔÓ 5Ô ‹ 6Ô ¯ÚfiÓÔ. ™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÂÍÂÙ¿ÛÙËÎ·Ó 1048 Ì·ıËÙ¤˜ Ù˘ ∞’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ∞ÚÁÔÏ›‰·˜ (Â·Ú¯›Â˜ ¡·˘Ï›·˜ Î·È ÕÚÁÔ˘˜), ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ 500 ‹Ù·Ó ·ÁfiÚÈ· (47,7%) Î·È 548 ÎÔÚ›ÙÛÈ· (52,3%). ∏ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ ¤ÁÈÓ Ì ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË, ÂÓÒ ÙÔ˘˜ ˙ËÙ‹ıËΠӷ οÓÔ˘Ó ‰È¿ÊÔÚ˜ ÂÚÁ·Û›Â˜ (ÁÚ¿„ÈÌÔ, ˙ˆÁÚ·ÊÈ΋, ¯Ú‹ÛË ÁÔÌÔÏ¿ÛÙȯ·˜, ۋΈ̷ ÂÓfi˜ ÌÔÏ˘‚ÈÔ‡, ¤Ù·ÁÌ· Ì¿Ï·˜, ¯Ù¤ÓÈÛÌ·, ‚Ô‡ÚÙÛÈÛÌ· ‰ÔÓÙÈÒÓ), ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÁÚ·Ê› ÔÈÔ ¯¤ÚÈ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó. ∑ËÙ‹ıËΠ·fi ÙÔ˘˜ ‰·ÛοÏÔ˘˜ Ó· Û˘ÌÏËÚÒÛÔ˘Ó ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ÙÔ ÔÔ›Ô ÂÚÈÂÏ¿Ì‚·Ó ٷ ÂÍ‹˜ ÂÚˆÙ‹Ì·Ù·: ·) Ô‡ ıˆÚÔ‡Ó fiÙÈ ÔÊ›ÏÂÙ·È Ë ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· (ÎÏËÚÔÓÔÌÈÎÔ› ·Ú¿ÁÔÓÙ˜- ÂÚÈ‚¿ÏÏÔÓ), ‚) ·Ó ¤¯Ô˘Ó ·Û΋ÛÂÈ ›ÂÛË Û ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Ì·ıËÙ¤˜ Ó· ·ÏÏ¿ÍÔ˘Ó ¯¤ÚÈ ÁÚ·Ê‹˜, Á) ·Ó ıˆÚÔ‡Ó ÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ÌÂÈÔÓ¤ÎÙËÌ·, ÏÂÔÓ¤ÎÙËÌ· ‹ Ê˘-

46

Paediatriki 2004;67:44-48

ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ, ‰) ·Ó Ù· ·È‰È¿ Ì ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó, ηٿ ÙË ÁÓÒÌË ÙÔ˘˜, Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ‹ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÚÔÛ·ÚÌÔÁ‹˜ Î·È Â) ·Ó Â›Ó·È ÂÓËÌÂڈ̤ÓÔÈ ÁÈ· ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜.

OÈ ÁÔÓ›˜ Û˘ÌÌÂÙ›¯·Ó Û ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË, ÛÙËÓ ÔÔ›· ηٷÁÚ¿ÊËÎ·Ó ÔÈ ·fi„ÂȘ ÙÔ˘˜ ÁÈ· ÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· Ì ٷ ·ÎfiÏÔ˘ı· ÂÚˆÙ‹Ì·Ù·: ·) ·Ó ÂÓÔ¯ÏÔ‡ÓÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜, ‚) Û ÔÈ· ËÏÈΛ· ηٿϷ‚·Ó fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜, Á) ·Ó ˘¿Ú¯ÂÈ ¿ÏÏÔ˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ‰) ·Ó ›¯·Ó οÔÈ· ÂÓË̤ڈÛË Î·È Ò˜ ·ÔÎÙ‹ıËÎÂ, Â) ·Ó ÁÓˆÚ›˙Ô˘Ó Ô‡ ÔÊ›ÏÂÙ·È Ë ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·, ÛÙ) ·Ó ıˆÚÔ‡Ó fiÙÈ Ë ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ·ÔÙÂÏ› ÌÂÈÔÓ¤ÎÙËÌ·, ˙) ·Ó ıˆÚÔ‡Ó fiÙÈ ÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ ·‰ÈΛ ÙÔ˘˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜, Ë) ·Ó Ú¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó ÂȉÈο ·È¯Ó›‰È· Î·È ÂÚÁ·Ï›· ÁÈ· ÙÔ˘˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Î·È ·Ó ¤¯Ô˘Ó ÔÈ ›‰ÈÔÈ Ù¤ÙÔÈ· ·È¯Ó›‰È·, ı) ·Ó Û˘ÓÂÚÁ¿ÛÙËÎ·Ó Ì ÙÔ˘˜ ‰·ÛοÏÔ˘˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ·Ó ‚Ú‹Î·Ó ·ÓÙ·fiÎÚÈÛË ÛÙÔ Úfi‚ÏËÌ¿ ÙÔ˘˜ Î·È È) ·Ó ÚÔÛ¿ıËÛ·Ó Ó· ›ÛÔ˘Ó Ù· ·È‰È¿ ÙÔ˘˜ Ó· ·ÏÏ¿ÍÔ˘Ó ¯¤ÚÈ ÁÚ·Ê‹˜.

∞ÔÙÂϤÛÌ·Ù· ™ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÂÍÂÙ¿ÛÙËÎ·Ó 1048 Ì·ıËÙ¤˜ Ù˘ ∞’ Ù¿Í˘ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ ÙÔ˘ ¡ÔÌÔ‡ ∞ÚÁÔÏ›‰·˜ (Â·Ú¯›Â˜ ¡·˘Ï›·˜ Î·È ÕÚÁÔ˘˜), 500 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ·ÁfiÚÈ· (47,7%) Î·È 548 ‹Ù·Ó ÎÔÚ›ÙÛÈ· (52,3%). µÚ¤ıËÎ·Ó 71 ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Ì·ıËÙ¤˜ (6,77%), 46 ÂÎ ÙˆÓ ÔÔ›ˆÓ ‹Ù·Ó ·ÁfiÚÈ· (9,2%) Î·È 25 ÎÔÚ›ÙÛÈ· (4,56%). ∂›Û˘, Â› ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ Ì·ıËÙÒÓ Ô˘ ÂÍÂÙ¿ÛÙËηÓ, 4 ‹Ù·Ó ·ÌÊ›¯ÂÈÚ˜ (0,38%).

OÈ ‰¿ÛηÏÔÈ, ‚¿ÛÂÈ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ô˘ ÙÔ˘˜ ‰fiıËÎÂ, Û ÔÛÔÛÙfi 76% ‰¤¯ÔÓÙ·È ÙÔÓ ÚfiÏÔ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜, ÂÓÒ ÔÛÔÛÙfi 98% ·˘ÙÒÓ ÂÎÙÈÌ¿ fiÙÈ Ë ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ·ÔÙÂÏ› Ê˘ÛÈÔÏÔÁÈÎfi Ê·ÈÓfiÌÂÓÔ. ∆Ô Û‡ÓÔÏÔ ÙˆÓ ‰·ÛÎ¿ÏˆÓ ‰ÂÓ ·Ó·Ê¤ÚÂÈ fiÙÈ ¤¯ÂÈ ·Û΋ÛÂÈ Î¿ÔÈÔ˘ ›‰Ô˘˜ ›ÂÛË, ۈ̷ÙÈ΋ ‹ „˘¯È΋, ÛÙ· ·È‰È¿ Ì ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·. ∂›Û˘, ·¿ÓÙËÛ·Ó fiÙÈ Ù· Û˘ÁÎÂÎÚÈ̤ӷ ·È‰È¿ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÚÔÛ·ÚÌÔÁ‹˜ ‹ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÚÔ˜ ÙÔ ·ÚfiÓ Î·È Â›Ó·È Ôχ ηÏÔ› Ì·ıËÙ¤˜. ∂ÈϤÔÓ, ÔÛÔÛÙfi 96% ÙˆÓ ‰·ÛÎ¿ÏˆÓ ıˆÚ› fiÙÈ Â›Ó·È Î·Ï¿ ÂÓËÌÂڈ̤ÓÔ ÁÈ· ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜.

OÈ ÁÔÓ›˜, ‚¿ÛÂÈ ÙˆÓ ÂÚˆÙËÌ¿ÙˆÓ Ô˘ Ù¤ıËÎ·Ó Û ÚÔÊÔÚÈ΋ Û˘Ó¤ÓÙ¢ÍË, ‰‹ÏˆÛ·Ó ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜ fiÙÈ ‰ÂÓ ÂÓÔ¯ÏÔ‡ÓÙ·È ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ·È‰› ÙÔ˘˜ Â›Ó·È ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜. ¶ÔÛÔÛÙfi 87% ÙˆÓ ÁÔÓ¤ˆÓ ηٿϷ‚ fiÙÈ ÙÔ ·È‰› ¯ÚËÛÈÌÔÔÈ› ÙÔ ·ÚÈÛÙÂÚfi ¯¤ÚÈ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ, ÔÛÔÛÙfi 11% ·ÓÙÈÏ‹ÊıËΠ·˘Ùfi ÙÔ ÁÂÁÔÓfi˜ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÂÙÒÓ, ÂÓÒ ÔÛÔÛÙfi 2% ÙˆÓ ÁÔÓ¤ˆÓ ÂÓËÌÂÚÒıËΠ·fi ÙÔ ÓËÈ·ÁˆÁ›Ô. ™Â ÔÛÔÛÙfi 6%

¶·È‰È·ÙÚÈ΋ 2004;67:44-48

˘‹Ú¯Â Î·È ¿ÏÏÔ˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ™ÙÔ Û‡ÓÔÏfi ÙÔ˘˜, ÔÈ ÁÔÓ›˜ ‹Ù·Ó ÂÓËÌÂڈ̤ÓÔÈ ÁÈ· ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ·fi ÙÔ˘˜ ‰ÈÎÔ‡˜ ÙÔ˘˜ ÁÔÓ›˜, ·fi Ù· ̤۷ ÂÓË̤ڈÛ˘, ·fi ‚È‚Ï›· Î·È ·fi ÙÔ Û¯ÔÏ›Ô, ÂÓÒ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ë ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ÔÊ›ÏÂÙ·È Û ÎÏËÚÔÓÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ŸÏÔÈ ıˆÚÔ‡Ó fiÙÈ ‰ÂÓ Â›Ó·È Î¿ÙÈ ÙÔ ·ıÔÏÔÁÈÎfi, ·ÏÏ¿ Ì›· ȉȷÈÙÂÚfiÙËÙ·. ªfiÏȘ 9% ÙˆÓ ÁÔÓ¤ˆÓ ·Ó·Ê¤ÚÂÈ fiÙÈ ÙÔ ÎÔÈÓˆÓÈÎfi ÂÚÈ‚¿ÏÏÔÓ ·‰ÈΛ ÙÔ˘˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜. °ÂÓÈ΋ ¿Ô„‹ ÙÔ˘˜ Â›Ó·È fiÙÈ Ú¤ÂÈ Ó· ˘¿Ú¯Ô˘Ó ÂȉÈο ·È¯Ó›‰È· Î·È ÂÚÁ·Ï›· ÁÈ· Ù· ·È‰È¿ ·˘Ù¿, ÂÓÒ ÔÈ ›‰ÈÔÈ, ·Ó Î·È ÚÔÛ·ıÔ‡Ó, ‰ÂÓ Ù· ‚Ú›ÛÎÔ˘Ó ÁÈ· Ó· Ù· ÚÔÌËı¢ÙÔ‡Ó. ∂›Û˘, ÔÈ ÁÔÓ›˜ ¤¯Ô˘Ó ‰È·Ú΋ Û˘ÓÂÚÁ·Û›· Ì ÙÔÓ ‰¿ÛηÏÔ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜ Î·È ÛÙÔ Û‡ÓÔÏfi ÙÔ˘˜ ‚Ú‹Î·Ó ıÂÙÈ΋ ·ÓÙ·fiÎÚÈÛË. ¶ÔÛÔÛÙfi 98% ·Ó·Ê¤ÚÂÈ fiÙÈ ÔÙ¤ ‰ÂÓ ÚÔÛ¿ıËÛ ӷ ÚÔηϤÛÂÈ ·ÏÏ·Á‹ ÛÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· Î·È ÌfiÏȘ 2% Âȯ›ÚËÛ ӷ ›ÛÂÈ ÙÔ ·È‰› Ó· ·ÏÏ¿ÍÂÈ ¯¤ÚÈ ÁÚ·Ê‹˜. ™˘˙‹ÙËÛË ∏ ̤ÛË Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÚÈÛÙÂÚfi¯ÂÈÚˆÓ Ì·ıËÙÒÓ Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ (6,77%) Â›Ó·È Û¯Â‰fiÓ ›‰È· Ì ÙË Û˘¯ÓfiÙËÙ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÂÚ¢ÓÒÓ ÛÙË ¯ÒÚ· Ì·˜ (4), ÂÓÒ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi ÂΛÓË Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (ÂÚ›Ô˘ 10%). ∞˘Ùfi ÌÔÚ› Ó· ÂÚÌËÓ¢Ù› ÙfiÛÔ ·fi ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Î·È ÙˆÓ ÎÚÈÙËÚ›ˆÓ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ fiÛÔ Î·È ·fi ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ (15). OÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ·ÚÈÛÙÂÚfi¯ÂÈÚˆÓ ·ÁÔÚÈÒÓ ·Ú¿ ÎÔÚÈÙÛÈÒÓ (10,14,17), ÂÓÒ ¿ÏϘ ÌÂϤÙ˜ ‰ÂÓ Ê·ÓÂÚÒÓÔ˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ (15). ∆· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ Â›Ó·È ·Ó¿ÏÔÁ· Ì ÂΛӷ ÚÔËÁÔ‡ÌÂÓˆÓ ÂÚ¢ÓÒÓ ÛÙËÓ ∂ÏÏ¿‰·. ∂›Ó·È ıÂÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ·È‰È¿ Ô˘ Â›Ó·È ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ ·ÈÛı¿ÓÔÓÙ·È ÈÛfiÙÈÌ· Ì ٷ ¿ÏÏ·, ÂÓÒ Â›Ó·È ÂÓı·ÚÚ˘ÓÙÈÎfi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ‰¿ÛηÏÔÈ Î·È Ë ÔÈÎÔÁ¤ÓÂÈ· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· Û·Ó ‰È·ÊÔÚÔÔ›ËÛË Î·È fi¯È Û·Ó ÂÏ¿Ùو̷ (4,18). ™Â ÂÏ¿¯ÈÛÙ˜ ÂÚÈÙÒÛÂȘ (2%) ·Û΋ıËΠ›ÂÛË ·fi ÙÔ˘˜ ÁÔÓ›˜, Û ·ÓÙ›ıÂÛË Ì ·Ï·ÈfiÙÂÚ˜ ÂÔ¯¤˜, fiÔ˘ Ù· ·È‰È¿ Ô˘ ‹Ù·Ó ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ ˘Ô‚¿ÏÏÔÓÙ·Ó ·ÎfiÌË Î·È Û ÊÚȯ٤˜ ۈ̷ÙÈΤ˜ ÙÈ̈ڛ˜. ∏ Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙˆÓ ‰·ÛÎ¿ÏˆÓ ıˆÚ› ÛˆÛÙfi Ó· ÁÚ¿ÊÂÈ ÙÔ ·È‰› Ì ÙÔ ¯¤ÚÈ Ô˘ ÙÔ˘ ‰›ÓÂÈ ÙË ÌÂÁ·Ï‡ÙÂÚË ¿ÓÂÛË Î·È ‰ÂÓ ·ÛÎÔ‡Ó ›ÂÛË ÒÛÙ ӷ ·ÏÏ¿ÍÂÈ Ë ÚÔÙ›ÌËÛË ÙÔ˘ ¯ÂÚÈÔ‡ ÁÚ·Ê‹˜ ÙˆÓ Ì·ıËÙÒÓ. °È· ÙËÓ ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÈÛÙÂÚÔ-

Paediatriki 2004;67:44-48

¯ÂÈÚ›·˜ ··ÈÙÂ›Ù·È ˘‡ı˘ÓË ÂÓË̤ڈÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Ë Î·Ï‹ Û˘ÓÂÚÁ·Û›· Ì ÙÔ Û¯ÔÏÂ›Ô (19). ŒÓ·˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜ Ú¤ÂÈ Ó· ÌÔÚ› ·ÓÂËÚ¤·ÛÙ· Ó· ‰ÔÎÈÌ¿˙ÂÈ Î·È Ó· ηıÔ‰ËÁ› ÔÔÈ·‰‹ÔÙ ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ Ì fiÔÈÔ ¯¤ÚÈ ÂÈı˘Ì›. ∆Ô ·È‰› Ô˘ ÁÚ¿ÊÂÈ Î·È ÂÚÁ¿˙ÂÙ·È Ì ÙÔ ·ÚÈÛÙÂÚfi ÙÔ˘ ¯¤ÚÈ ¤¯ÂÈ ·fiÏ˘ÙÔ ‰Èη›ˆÌ· Ó· ÂÓı·ÚÚ˘Óı› ÒÛÙ ӷ ¯ÚËÛÈÌÔÔÈ› ÙÔ ÈÔ Âȉ¤ÍÈÔ ¯¤ÚÈ ÙÔ˘. ŒÓ· ·È‰› Ô˘ ·Ó·Áο˙ÂÙ·È Ó· ÂÚÁ·ÛÙ› Ì ÙÔ ‰ÂÍ› ¯¤ÚÈ, ÂÓ¿ÓÙÈ· Û ·˘Ùfi Ô˘ Â›Ó·È Î·ıÔÚÈṲ̂ÓÔ ÁÈ· ÙÔ ›‰ÈÔ, ˘Ô‚¿ÏÏÂÙ·È Û ԢÛÈ·ÛÙÈÎfi ΛӉ˘ÓÔ. ∫¿ı ̷ıËÙ‹˜ Î·È ‰¿ÛηÏÔ˜ ÙÔ˘ Û¯ÔÏ›Ԣ ÔÊ›ÏÂÈ Ó· ÂÓËÌÂÚˆı› ÁÈ· ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ηٿ ÙÔ ÁÚ¿„ÈÌÔ, ÁÈ· ÙȘ Û˘Ó¤ÂȘ Ù˘ ·ÏÏ·Á‹˜ Û ‰ÂÍÈÔ¯ÂÈÚ›·, ηıÒ˜ Î·È ÁÈ· ÙȘ ÌÂıfi‰Ô˘˜ Ù˘ ·ÚÈÛÙÂÚfi¯ÂÈÚ˘ ÁÚ·Ê‹˜.

OÈ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜, Û˘¯Ó¿, ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙË ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ·ÓÙÈÎÂÈ̤ӈÓ, Û˘Û΢ÒÓ Î·È ÂÚÁ·Ï›ˆÓ, ηıÒ˜ ·˘Ù¿ Â›Ó·È Î·Ù·Û΢·Ṳ̂ӷ ÁÈ· ÙÔ˘˜ ‰ÂÍÈfi¯ÂÈÚ˜, .¯. Ù· ÌÔÓÔı¤ÛÈ· ıÚ·Ó›· ‰˘ÛÎÔÏÂ‡Ô˘Ó ÛÙÔ ÁÚ¿„ÈÌÔ ÙÔ˘˜ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜. £· ÌÔÚÔ‡Û·Ó Ó· ηٷÛ΢¿˙ÔÓÙ·È ıÚ·Ó›· ÁÈ· ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 6%, ÛÙËÓ ·Ó·ÏÔÁ›·, ‰ËÏ·‰‹, ÙˆÓ ·ÙfiÌˆÓ Ô˘, Û‡Ìʈӷ Ì ٷ ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ, ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ ·ÚÈÛÙÂÚfi ¯¤ÚÈ ÛÙË ÁÚ·Ê‹. ∞fi ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ ÚÔ·ÙÂÈ fiÙÈ Ë ÔÈÎÔÁ¤ÓÂÈ· Î·È Ë Û¯ÔÏÈ΋ ÎÔÈÓfiÙËÙ· ·Ô‰¤¯ÔÓÙ·È ÙËÓ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·, ÂÓÒ ÔÈ ·ÚÈÛÙÂÚfi¯ÂÈÚ˜ Ì·ıËÙ¤˜ Î·È ÌÂÙ¤ÂÈÙ· ÂÓ‹ÏÈΘ Ú¤ÂÈ Ó· ˘ÔÛÙËÚ›˙ÔÓÙ·È. µÈ‚ÏÈÔÁÚ·Ê›· 1. ∫·ÛÈÒÏ·˜ ∂. ∞ÚÈÛÙÂÚÔ¯ÂÈÚ›·-‰ÂÍÈÔ¯ÂÈÚ›·. ™ÙÔ: ¶·È‰·ÁˆÁÈ΋ æ˘¯ÔÏÔÁÈ΋ ∂Á΢ÎÏÔ·›‰ÂÈ· - §ÂÍÈÎfi. 2Ô˜ ÙfiÌÔ˜. ∞ı‹Ó·: ∂ÏÏËÓÈο °Ú¿ÌÌ·Ù·; 1989. ÛÂÏ. 719-721.

2. ¶·Ú·Û΢ÔÔ‡ÏÔ˘ π¡. ∂ÍÂÏÈÎÙÈ΋ „˘¯ÔÏÔÁ›·. ™ÙÔ: ¶ÚÔÛ¯ÔÏÈ΋ ∏ÏÈΛ· (‚Ï. Ï¢ڛˆÛË). 2Ô˜ ÙfiÌÔ˜. ∞ı‹Ó·: ∂ΉfiÛÂȘ °ÚËÁfiÚË; 1985. ÛÂÏ. 23-25.

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14. ∫ÂÚ·ÛÈÒÙË-∫·Ú·Î·ÙÛ¿ÓË ∑, °ÈÔ˘ÚÔ‡ÎÔ˜ ™, ∫·Ú·Î·ÙÛ¿Ó˘ £, ª·ÙÛ·ÓÈÒÙ˘ ¡. ∏ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›· ÛÙËÓ ∂ÏÏ¿‰·. ¢ÂÏÙ›Ô ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 1986;33:32-45.

15. ¢ÂÏÏ·ÙfiÏ·˜ °, §·˙·Ú¿ÙÔ˘ ∂. ª¤ÙÚËÛË Î·È Û˘¯ÓfiÙËÙ· Ù˘ ·ÚÈÛÙÂÚÔ¯ÂÈÚ›·˜ ÛÙËÓ ∂ÏÏ¿‰·. π·ÙÚÈ΋ 1989;56:257-264.

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19. ¢ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ ¢. ∂›Ì·È ·ÚÈÛÙÂÚfi¯ÂÈÚ·˜. £ÂÛÛ·ÏÔÓ›ÎË: Art of Text ∞∂; 2000. ÛÂÏ. 147-149.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 26-08-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-11-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ¶ÚÔÎfiÈÔ˜ ∆·‚Ï·ÓÙ¿˜ ∆.∫. 210 52, §˘ÁÔ˘ÚÈfi ∞ÚÁÔÏ›‰·˜

¶ÂÚ›ÏË„Ë ¿ÚıÚÔ˘ ·fi ÙË µÈ‚ÏÈÔÁÚ·Ê›· ™˘ÁÎÚÈÙÈ΋ ÌÂϤÙË ÙÚÈÒÓ Ê˘ÛÈÎÒÓ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÙˆÓ ÓÂÔÁÓÒÓ1 ™ÎÔfi˜: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Û‡ÁÎÚÈÛË ÙÚÈÒÓ Ê˘ÛÈÎÒÓ ÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ (∂¶) ‰È·ÊÔÚÂÙÈ΋˜ Û‡ÛÙ·Û˘ Î·È ÚÔ¤Ï¢Û˘ [Alveofact (Surfactant A=SA), Poractant (Surfactant B=SB Î·È Beractant (Surfactant C=SC)] ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (™∞¢) ÙˆÓ ÓÂÔÁÓÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ÀÏÈÎfi Ù˘ ÌÂϤÙ˘ ‹Ù·Ó ÚfiˆÚ· ÓÂÔÁÓ¿ ≤32 ‚‰ÔÌ¿‰ˆÓ ·ËÛ˘ Ì ™∞¢, Ù· ÔÔ›· ¯ÚÂÈ¿ÛÙËÎ·Ó Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ Ì ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛ˘ FiO2≥0,3. ™Ù· ÓÂÔÁÓ¿ ¯ÔÚËÁ‹ıËÎ·Ó Ù˘¯·ÈÔÔÈË̤ӷ ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 ‰fiÛÂȘ SA, SB ‹ SC (100 mg/kg ·Ó¿ ‰fiÛË). ∆· ÓÂÔÁÓ¿ Ô˘ ·Ú¤ÌÂÈÓ·Ó ÛÙÔÓ ·Ó·Ó¢ÛÙ‹Ú· Ì ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛ˘ FiO2≥0,3 ¤Ï·‚·Ó ÂÈϤÔÓ Ì¤¯ÚÈ Î·È ¿ÏϘ 2 ‰fiÛÂȘ ÙÔ˘ ›‰ÈÔ˘ ∂¶. ∞ÔÙÂϤÛÌ·Ù·: ¢ÂÓ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙȘ 3 ÔÌ¿‰Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó¿ÁÎË ¯ÔÚ‹ÁËÛ˘ ÂÚÈÛÛfiÙÂÚˆÓ ÙˆÓ 2 ‰fiÛÂˆÓ ∂¶ (18,5% SA, 14,8% SB, 23% SC, p=ns). ∆· ÓÂÔÁÓ¿ ÙˆÓ ÔÌ¿‰ˆÓ SA Î·È SB Û ۯ¤ÛË Ì ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ SC ·Ú¤ÌÂÈÓ·Ó ÏÈÁfiÙÂÚ˜ Ë̤Ú˜ ÛÙÔÓ ·Ó·Ó¢ÛÙ‹Ú· [̤ÛË ‰È¿ÚÎÂÈ· Ì˯·ÓÈ΋˜ ˘ÔÛÙ‹ÚÈ͢ Ù˘ ·Ó·ÓÔ‹˜ (±SD): SA=6,6±2,1, SB=5,7±1,5, SC=11,5±2,3, p-value SA/SB 0,7, SA/SC 0,05, SB/SC 0,043], ¯ÚÂÈ¿ÛÙËÎ·Ó ÏÈÁfiÙÂÚ˜ Ë̤Ú˜ Ô͢ÁÔÓÔıÂÚ·›·˜ [̤ÛË ‰È¿ÚÎÂÈ· Ô͢ÁÔÓÔıÂÚ·›·˜ (±SD): SA=8,7±3,2, SB=9,9±4,1,

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SC=16±5,73, p-value SA/SB 0,65, SA/SC 0,05, SB/SC 0,04] Î·È ÏÈÁfiÙÂÚ˜ Ë̤Ú˜ ÓÔÛËÏ›·˜ [Ë̤Ú˜ ÓÔÛËÏ›·˜ (±SD): SA=62±20, SB=48±15, SC=81±28, p-value SA/SB 0,65, SA/SC 0,04, SB/SC 0,027]. ¢ÂÓ ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙȘ 3 ÔÌ¿‰Â˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ıÓËÛÈÌfiÙËÙ· (SA 25,9%, SB 18,5%, SC 23%, p=ns), ÙË ¯ÚfiÓÈ· Ó¢ÌÔÓÈ΋ ÓfiÛÔ, ÙË ‰È·Ê˘Á‹ ·¤Ú·, ÙË ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÙËÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉÔ¿ıÂÈ· Ù˘ ÚÔˆÚfiÙËÙ·˜ Î·È ÙËÓ ÂÁÎÂÊ·ÏÈ΋ ·ÈÌÔÚÚ·Á›·. ™˘ÌÂÚ¿ÛÌ·Ù·: OÈ ÔÌ¿‰Â˜ Alveofact Î·È Poractant ¯ÚÂÈ¿ÛÙËÎ·Ó ÏÈÁfiÙÂÚ˜ Ë̤Ú˜ ·Ó·Ó¢ÛÙÈ΋˜ ˘ÔÛÙ‹ÚÈ͢, Ô͢ÁÔÓÔıÂÚ·›·˜ Î·È ÓÔÛËÏ›·˜ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· Beractant, ¯ˆÚ›˜ fï˜ Ó· ‰È·ÈÛÙˆı› ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙȘ 3 ÔÌ¿‰Â˜ ÛÙË ıÓËÛÈÌfiÙËÙ· Î·È ÙË ÓÔÛËÚfiÙËÙ·.

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Baroutis G, Kaleyias J, Liarou T, Papathoma E, Hatzistamatiou Z, Costalos C Comparison of three treatment regimens of natural surfactant preparations in neonatal respiratory distress syndrome Eur J Pediatr 2003;162:476-480 πˆÛ‹Ê ∫·Ï¤ÁÈ·˜ ¶·È‰›·ÙÚÔ˜-¡ÂÔÁÓÔÏfiÁÔ˜

¶·È‰È·ÙÚÈ΋ 2004;67:49-53

∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞

Paediatriki 2004;67:49-53

ORIGINAL ARTICLE

π‰ÈÔ·ı‹˜ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿ Î·È ÁÔÓfiÙ˘Ô˜ Û˘Ó‰ÚfiÌÔ˘ Gilbert ∞. °·ÏÏ¿ - µÔ˘Ì‚Ô˘Ú¿ÎË1, ™. ∫›ÙÛÈÔ˘ - ∆˙¤ÏË2, ∞. ∆Û¤˙Ô˘1, ª. ∆˙¤ÙË2, ∂. ∫·‚·˙·Ú¿Î˘1, ∂. °È·ÓÓ¿ÙÔ˘1, ∞. ª·ÓˆÏ¿ÎË3, O. °Ú·Ê¿ÎÔ˘1, ¢. §¿˙·Ú˘4, ∂. ∫·Ó·‚¿Î˘2

Idiopathic cholelithiasis in children and Gilbert’s syndrome A. Galla - Voumvouraki1, S. Kitsiou - Tzeli2, A. Tsezou1, M. Tzeti2, E. Kavazarakis1, E. Giannatou1, A. Manolaki3, O. Grafakou1, D. Lazaris4, E. Kanavakis2

¶ÂÚ›ÏË„Ë: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ÂÏÂÁ¯ı› Â¿Ó ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ È‰ÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿. ∞ӷχıËÎÂ Ë ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ÁÈ· ÙËÓ UDP-ÁÏ˘ÎÔ˘ÚÔÓÔÛ˘ÏÙÚ·ÓÛÊÂÚ¿ÛË 1 (UGT1A1), Ô˘ ¤¯ÂÈ Û˘Û¯ÂÙÈÛÙ› Ì ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert, Û 30 ·È‰È¿ Ì ȉÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË Î·È Û 40 ˘ÁÈ‹ ·È‰È¿ ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘. °È· ÙËÓ ·Ó‡ÚÂÛË Ù˘ Û¯¤Û˘ ÙˆÓ ÙÚÈÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÁÔÓÔÙ‡ˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert [(∆∞)6/(∆∞)6, (∆∞)6/(∆∞)7, (∆∞)7/(∆∞)7] ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·È‰ÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÛÙ·ÙÈÛÙÈ΋ ‰ÔÎÈÌ·Û›· ¯2. ¢È·ÈÛÙÒıËΠfiÙÈ ÛÙ· ·È‰È¿ Ì ÙË ¯ÔÏÔÏÈı›·ÛË Ô ÁÔÓfiÙ˘Ô˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert (∆∞)7/(∆∞)7 ‹Ù·Ó ÛËÌ·ÓÙÈο Û˘¯ÓfiÙÂÚÔ˜ Û ۇÁÎÚÈÛË Ì ÙËÓ ÔÌ¿‰· ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ (p=0,048). ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ Ê·›ÓÂÙ·È fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ÌÔÚ› Ó· ıˆÚËı› fiÙÈ ·ÔÙÂÏ› ·ıÔÁÂÓÂÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ¤Ó·ÚÍË Û¯ËÌ·ÙÈÛÌÔ‡ ¯ÔÏÔÏ›ıˆÓ Û ·È‰È¿ ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜.

Abstract: The aim of this study was to test the hypothesis that Gilbert’s syndrome is associated with idiopathic cholelithiasis in children. The promoter region of UDP-glucuronosyltransferase 1 gene (UGT1A1) of Gilbert’s syndrome was analysed in a total of 30 children with symptomatic cholelithiasis not due to any of the well-known predisposing factors, as well as in 40 healthy children matched for age and sex and with normal liver and biliary ultrasonography, who served as controls. Chi-square test was used for the correlation of the three different UGT1A1 promoter group Gilbert’s syndrome genotypes [(TA)6/(TA)6, (TA)6/(TA)7, (TA)7/(TA)7] between the two groups of children examined. It was observed that the Gilbert’s syndrome genotype (TA)7/(TA)7 was significantly higher in the group of children with cholelithiasis than in the controls (p=0.048). The results of this study indicate that the (TA)7/(TA)7 genotype is an underlying factor acting as a trigger for formation of gallstone in otherwise healthy children.

§¤ÍÂȘ ÎÏÂȉȿ: Û‡Ó‰ÚÔÌÔ Gilbert, ÁÔÓfiÙ˘Ô˜, ȉÈÔ·ı‹˜ ¯ÔÏÔÏÈı›·ÛË, ·È‰È¿.

Key words: Gilbert’s syndrome, genotype, idiopathic cholelithiasis, children.

1 ∂ÚÁ·ÛÙ‹ÚÈÔ °ÂÓÂÙÈ΋˜, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 4 ∞’ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ª·È¢ÙÈ΋˜ Î·È °˘Ó·ÈÎÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó·

1 Laboratory of Genetics, 2nd Paediatric Clinic of University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens 2 Laboratory of Medical Genetics, University of Athens, “Aghia Sophia” Children’s Hospital, Athens 3 1st Paediatric Clinic of University of Athens, “Aghia Sophia” Children’s Hospital, Athens 4 1st Obstetrics and Gynaecology Clinic of University of Athens, “Alexandra” Hospital, Athens

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¶·È‰È·ÙÚÈ΋ 2004;67:49-53

∂ÈÛ·ÁˆÁ‹ ∏ ¯ÔÏÔÏÈı›·ÛË ÛÙ· ·È‰È¿ ·ÔÙÂÏ› Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·, ·Ó Î·È Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰È·ÁÈÁÓÒÛÎÂÙ·È ÈÔ Û˘¯Ó¿ ÏfiÁˆ Ù˘ ÙÂÏÂÈÔÔ›ËÛ˘ ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÛÙË ‰ÈÂÚ‡ÓËÛË ÙÔ˘ ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜, ȉȷ›ÙÂÚ· fiÙ·Ó ·˘Ùfi ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‰ÂÍÈÔ‡ ˘Ô¯ÔÓ‰Ú›Ô˘ ‹ ÁÂÓÈÎfiÙÂÚ· ÛÙËÓ ¿Óˆ ÎÔÈÏȷ΋ ¯ÒÚ· (1).

OÈ ¯ÔÏfiÏÈıÔÈ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È fiÙ·Ó, ÁÈ· οÔÈÔ ÏfiÁÔ, ·ÏÏ¿ÍÂÈ Ë Û‡ÓıÂÛË Ù˘ ¯ÔÏ‹˜, ÂÓÒ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚ¢ÓËÙ¤˜ Û˘ÌʈÓÔ‡Ó fiÙÈ Ë ÌË Û˘Ó‰Â‰Â̤ÓË ¯ÔÏÂÚ˘ıÚ›ÓË Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙÔ˘˜. ™Ù· ‚Ú¤ÊË Î·È ÛÙ· ·È‰È¿, ÔÈ ¯ÔÏfiÏÈıÔÈ ·ÔÙÂÏÔ‡ÓÙ·È Î˘Ú›ˆ˜ ·fi ¿Ï·Ù· ·Û‚ÂÛÙ›Ô˘ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (calcium bilirubinate), ÂÓÒ Ë ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ Û ¯ÔÏËÛÙÂÚfiÏË Î·È ·ÓıÚ·ÎÈÎfi ·Û‚¤ÛÙÈÔ ÔÈΛÏÏÂÈ (1).

OÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔÈ ·Ú¿ÁÔÓÙ˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ¯ÔÏÔÏ›ıˆÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙȘ ·ÈÌÔÏ˘ÙÈΤ˜ ·Ó·È̛˜, ÙËÓ ÚÔˆÚfiÙËÙ· (·ËÛË <30 ‚‰ÔÌ¿‰ˆÓ), ÙÔÓ ·Ú·ÙÂٷ̤ÓÔ ÓÂÔÁÓÈÎfi ›ÎÙÂÚÔ, ÙËÓ Ë·ÙÔ¿ıÂÈ·, ÙË ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÙË ÓfiÛÔ ÙÔ˘ Crohn, ÙËÓ ÂÎÙÔÌ‹ ÙÔ˘ ÂÈÏÂÔ‡, ÙȘ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ, ηıÒ˜ Î·È ÙËÓ ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹ (1-3). ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ˘Ê›ÛÙ·ÓÙ·È ·˘ÙÔ› ÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ë ·Ó¿Ù˘ÍË ÙˆÓ ¯ÔÏÔÏ›ıˆÓ ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙËÓ ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· Ù˘ ¯ÔÏ‹˜ Û ÌË Û˘Ó‰Â‰Â̤ÓË ¯ÔÏÂÚ˘ıÚ›ÓË (4). ™Ù· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Gilbert ¤¯ÂÈ ‰È·ÈÛÙˆı› ÂÏ¿ÙÙˆÛË Î·Ù¿ 70% Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙÔ˘ ‹·ÙÔ˜ ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÁÏ˘ÎÔ˘ÚÔÓȉ›ˆÓ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Ì ·ÔÙ¤ÏÂÛÌ· ·ÊÂÓfi˜ ÙËÓ ·˘ÍË̤ÓË ÂÚÈÂÎÙÈÎfiÙËÙ· Ù˘ ¯ÔÏ‹˜ Û ÌË Û˘Ó‰Â‰Â̤ÓË ¯ÔÏÂÚ˘ıÚ›ÓË, ·ÊÂÙ¤ÚÔ˘ ÙËÓ ·˘ÍË̤ÓË Î·Ù¿ 30% ÂÚÈÂÎÙÈÎfiÙËÙ¿ Ù˘ Û ÌÔÓÔÁÏ˘ÎÔ˘ÚÔÓ›‰È· Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, Ù· ÔÔ›· Â›Ó·È ÏÈÁfiÙÂÚÔ ˘‰·ÙÔ‰È·Ï˘Ù¿ Û ۯ¤ÛË Ì ٷ Û¯ËÌ·ÙÈ˙fiÌÂÓ·, ˘fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜, ‰ÈÁÏ˘ÎÔ˘ÚÔÓ›‰È· Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (5-7). ∞˘Ù‹ Ë ÂÏ·Ùو̤ÓË ‰Ú·ÛÙËÚÈfiÙËÙ· ÙÔ˘ ‹·ÙÔ˜ ÛÙ· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Gilbert Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ¯·ÌËÏÒÓ ÂÈ¤‰ˆÓ ÙÔ˘ ÂÓ˙‡ÌÔ˘ UDP-ÁÏ˘ÎÔ˘ÚÔÓÔÛ˘ÏÙÚ·ÓÛÊÂÚ¿ÛË 1 Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘ (bilirubin UDP-glucuronosyltransferase 1 - UGT1A1). ∏ ÁÂÓÂÙÈ΋ ‚¿ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert Â›Ó·È Ë ÔÈÎÈÏÔÌÔÚÊ›· (ÔÏ˘ÌÔÚÊÈÛÌfi˜) ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 Ô˘ ÂÓÙÔ›˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ ≠ 2 (2q37). ™˘ÁÎÂÎÚÈ̤ӷ, ÂÓÒ ÛÙ· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· Ô ÂÎÎÈÓËÙ‹˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 1∞ (∆∞∆∞∞ box) ÂÚȤ¯ÂÈ 6 Â·Ó·Ï‹„ÂȘ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ [∞(∆∞)6∆∞∞], ÛÙ· ¿ÙÔÌ· Ì ۇӉÚÔÌÔ Gilbert ˘¿Ú¯Ô˘Ó ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· ∆∞ Ì ·Ô-

50

Paediatriki 2004;67:49-53

Ù¤ÏÂÛÌ· 7 ·ÓÙ› ÙˆÓ Û˘Ó‹ıˆÓ 6 Â·Ó·Ï‹„ÂˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛÂˆÓ (5). ∂ÎÙfi˜ ·fi ·˘Ù‹ ÙËÓ ÔÈÎÈÏÔÌÔÚÊ›· Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÙfiÌˆÓ Ì ۇӉÚÔÌÔ Gilbert, Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ·ÙfiÌˆÓ Ù˘ ·ÛÈ·ÙÈ΋˜ Ê˘Ï‹˜ ¤¯Ô˘Ó ·ÓȯÓ¢ı› Î·È ÛËÌÂȷΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 (7). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ·Ó·˙‹ÙËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ·ÏÏËÏ›Ô˘ (∆∞)7 ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert Û ·È‰È¿ Ì ȉÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË, ηıÒ˜ Î·È Û ÔÌ¿‰· ˘ÁÈÒÓ ·È‰ÈÒÓ Ù˘ ›‰È·˜ ÂıÓÈÎfiÙËÙ·˜, ·Ó¿ÏÔÁ˘ ËÏÈΛ·˜ Î·È Ê‡ÏÔ˘ Ì ÙÔ˘˜ ·ÛıÂÓ›˜ (ÔÌ¿‰· ÂϤÁ¯Ô˘). ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó 30 ·È‰È¿, 13 ·ÁfiÚÈ· Î·È 17 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 12 ÌËÓÒÓ ¤ˆ˜ 15 ÂÙÒÓ (̤ÛË ËÏÈΛ·: 6,8±0,7 ¤ÙË) Ì ¯ÔÏÔÏÈı›·ÛË, Ë ÔÔ›· ‰È·ÈÛÙÒıËΠÌÂÙ¿ ·fi ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ‹·ÙÔ˜ Î·È ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ. ŸÏ· Ù· ·È‰È¿ ÁÂÓÓ‹ıËÎ·Ó ÌÂÙ¿ ·fi ÙÂÏÂÈfiÌËÓË Î‡ËÛË, ÂÓÒ ‰ÂÓ ˘‹Ú¯Â ÛÙÔ ·ÙÔÌÈÎfi ÙÔ˘˜ ÈÛÙÔÚÈÎfi ÚÔˆÚfiÙËÙ·, ·Ú·ÙÂٷ̤ÓÔ˜ ÓÂÔÁÓÈÎfi˜ ›ÎÙÂÚÔ˜, Ë·Ù›Ùȉ· A, B, C, ·ÈÌÔÏ˘ÙÈ΋ ·Ó·ÈÌ›·, ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓ˙‡ÌÔ˘ ÁÏ˘ÎÔ˙Ô6-ʈÛÊ·Ù¿ÛË (G-6-PD), ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ·, ÓfiÛÔ˜/ÂÎÙÔÌ‹ ÙÔ˘ ÂÈÏÂÔ‡, Û˘ÁÁÂÓ‹˜ ‰È·Ì·ÚÙ›· ÙˆÓ ¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ, Ô‡Ù ›¯·Ó Ï¿‚ÂÈ ÔÏÈ΋ ·ÚÂÓÙÂÚÈ΋ ‰È·ÙÚÔÊ‹. ™ÙË ÌÂϤÙË ÂÚÈÂÏ‹ÊıËÛ·Ó, Â›Û˘, 40 ˘ÁÈ‹ ÙÂÏÂÈfiÌËÓ· ·È‰È¿, 18 ·ÁfiÚÈ· Î·È 22 ÎÔÚ›ÙÛÈ·, ËÏÈΛ·˜ 2 ¤ˆ˜ 10 ÂÙÒÓ (̤ÛË ËÏÈΛ·: 5,4±0,5 ¤ÙË) ÌË ÂÈÏÂÁ̤ӷ Ì ÎÚÈÙ‹ÚÈÔ Ù· Â›‰· Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, ¯ˆÚ›˜ ¯ÔÏÔÏÈı›·ÛË, Ë·ÙÔ¿ıÂÈ· ‹ ·Ó·ÈÌ›·, fiˆ˜ ‰È·ÈÛÙÒıËΠ·fi ÙÔÓ ·Ú·ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎÂ, Ù· ÔÔ›· ·ÔÙ¤ÏÂÛ·Ó ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È, ·Ó·Ï˘ÙÈο, ÛÙÔȯ›· ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘. OÈ ·Ú·ÎÏÈÓÈΤ˜ ÂÍÂÙ¿ÛÂȘ Ô˘ ¤ÁÈÓ·Ó Û fiÏ· Ù· ·È‰È¿ ‹Ù·Ó ÔÈ ÂÍ‹˜: ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ¢∂∫, ·ÓÙ›ÛÙ·ÛË ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ, ËÏÂÎÙÚÔÊfiÚËÛË ·ÈÌÔÛÊ·ÈÚ›Ó˘, ¯ÔÏÂÚ˘ıÚ›ÓË (ÔÏÈ΋, ¿ÌÂÛË, ¤ÌÌÂÛË), SGOT, SGPT, Á-GT, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË Î·È U/S ‹·ÙÔ˜/¯ÔÏËÊfiÚˆÓ ·ÁÁ›ˆÓ. ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙÔ˘ DNA ¤ÁÈÓ Û fiÏ· Ù· ·È‰È¿ Ù˘ ÌÂϤÙ˘ ÌÂÙ¿ ·fi ·ÔÌfiÓˆÛË ÙÔ˘ ÁÔÓȉȈ̷ÙÈÎÔ‡ DNA (genomic DNA) ·fi Ï¢ÎÔ·ÙÙ·Ú· ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ·›Ì·ÙÔ˜. °È· ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ DNA ¯ÚËÛÈÌÔÔÈ‹ıËΠPUROGENE DNA extraction kit (Gentra Systems). ∆· ‰Â›ÁÌ·Ù· ÙÔ˘ DNA ÔÏÏ·Ï·ÛÈ¿ÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô Ù˘ ¶›Ó·Î·˜ 1. ¶·È‰È¿ Ù˘ ÌÂϤÙ˘ n

ñ ¶·È‰È¿ Ì 30 ¯ÔÏÔÏÈı›·ÛË ñ ÀÁÈ‹ ·È‰È¿ 40 (ÔÌ¿‰· ÂϤÁ¯Ô˘) ™‡ÓÔÏÔ 70

∞ÁfiÚÈ·/ ª¤ÛË ÙÈÌ‹ ÂÌ. ª¤ÛË ∫ÔÚ›ÙÛÈ· ¯ÔÏÂÚ˘ıÚ›Ó˘ ËÏÈΛ· (¤ÙË) 13/17 18/22 31/39

0,78±0,21

6,8±0,7 5,4±0,5

¶·È‰È·ÙÚÈ΋ 2004;67:49-53

Paediatriki 2004;67:49-53

·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) Ì ‰‡Ô ÂÎÎÈÓËÙ¤˜-Û˘ÓıÂÙÈο ÔÏÈÁÔÓÔ˘ÎÏÂÔÙ›‰È· (primers): F: 5’-GTCACGTGACACAGTCAAAC-3’ Î·È R: 5’-TTTGCTC-CTGCCAGAGGTT-3’, Ù· ÔÔ›· ÔÏÏ·Ï·ÛÈ¿˙Ô˘Ó ÙÌ‹Ì·Ù· DNA ÌÂÁ¤ıÔ˘˜ 98-100 ˙¢ÁÒÓ ‚¿ÛÂˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘. °È· ÙË Û‹Ì·ÓÛË ÙÔ˘ ÂÎÎÈÓËÙ‹ F ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÊıÔÚ›˙Ô˘Û· Ô˘Û›· Cy5.5 ‹ Ë Texas red.

OÈ Û˘Óı‹Î˜ Ù˘ ·ÓÙ›‰Ú·Û˘ PCR ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ı˜: ı¤ÚÌ·ÓÛË ÛÙÔ˘˜ 95ÔC ÁÈ· 15 min Î·È ÛÙË Û˘Ó¤¯ÂÈ· 35 ·ÎÏÔÈ ·Ú¯›˙ÔÓÙ·˜ Ì 95ÔC ÁÈ· 30 sec, 55ÔC ÁÈ· 40 sec, 72ÔC ÁÈ· 40 sec ηÈ, Ù¤ÏÔ˜, 10 min ÛÙÔ˘˜ 72ÔC. ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1 ¤ÁÈÓ ÌÂÙ¿ ·fi ËÏÂÎÙÚÔÊfiÚËÛË Û ‹Îو̷ ·ÎÚ˘Ï·Ì›‰Ë˜ (6%) Ì ÙË ¯Ú‹ÛË ÙˆÓ ·˘ÙfiÌ·ÙˆÓ ·Ó·Ï˘ÙÒÓ (VISTRA 725 version 2.0 Î·È GeneObjects, Visible Genetics). T· 100 ˙‡ÁË ‚¿ÛÂˆÓ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ ·ÏÏËÏfiÌÔÚÊÔ ∞(∆∞)7∆∞∞. ¶ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ÔÈ ·ÎfiÏÔ˘ıÔÈ ÁÔÓfiÙ˘ÔÈ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert: (TA)7/(TA)7: ÔÌÔ˙˘ÁÒÙ˜, (∆∞)6/(∆∞)7: ÂÙÂÚÔ˙˘ÁÒÙ˜, (∆∞)6/(∆∞)6: Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ·. °È· ÙËÓ ·Ó‡ÚÂÛË Ù˘ Û¯¤Û˘ ÙˆÓ ÙÚÈÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÁÔÓÔÙ‡ˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ÌÂٷ͇ ·˘ÙÒÓ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ·È‰ÈÒÓ, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÛÙ·ÙÈÛÙÈ΋ ‰ÔÎÈÌ·Û›· ¯2.

∞ÔÙÂϤÛÌ·Ù· ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ÙÚÈÒÓ ÁÔÓÔÙ‡ˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ÙËÓ È‰ÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË Î·ıÒ˜ Î·È ÛÙ· ˘ÁÈ‹ ·È‰È¿ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2 Î·È ÛÙËÓ ∂ÈÎfiÓ· 1. ¢È·ÈÛÙÒıËΠfiÙÈ: ·) ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ¯ÔÏÔÏÈı›·ÛË, 11/30 ·È‰È¿ (36,7%) ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ (∆∞)7/(∆∞)7 ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert, 10/30 ·È‰È¿ (33,3%) ‹Ù·Ó ÂÙÂÚÔ˙˘ÁÒÙ˜ (∆∞)6/(∆∞)7, ÂÓÒ Ù· ˘fiÏÔÈ· 9/30 (30%) ›¯·Ó ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÁÔÓfiÙ˘Ô (∆∞)6/(∆∞)6 Î·È ‚) ÛÙËÓ ÔÌ¿‰· ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ, 6/40 ·È‰È¿ (15%) ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert [ÁÔÓfiÙ˘Ô˜ (∆∞)7/(∆∞)7], 11/40 ·È‰È¿ (27,5%) ‹Ù·Ó ÂÙÂÚÔ˙˘ÁÒÙ˜ [ÁÔÓfiÙ˘Ô˜ (∆∞)6/(∆∞)7)], ÂÓÒ Ù· ˘fiÏÔÈ· 23/40 ·È‰È¿ (57,5%) ›¯·Ó ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ÁÔÓfiÙ˘Ô (∆∞)6/(∆∞)6. ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ fiÙÈ Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÏÏËÏfiÌÔÚÊÔ˘ (∆∞)7 ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ȉÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË Û ۇÁÎÚÈÛË Ì ٷ ˘ÁÈ‹ ·È‰È¿ (p=0,048).

60 50 40 30

¶·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË

20

ÀÁÈ‹ ·È‰È¿

10 0

(TA)6/(TA)6 (TA)6/(TA)7 (TA)7/(TA)7

EÈÎfiÓ· 1. πÛÙfiÁÚ·ÌÌ· Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ¶›Ó·Î· 2.

™˘˙‹ÙËÛË ∏ ¯ÔÏÔÏÈı›·ÛË ·ÔÙÂÏ› Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· ÛÙ· ·È‰È¿. ™Â ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, Ë Û˘¯ÓfiÙËÙ¿ Ù˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î˘Ì·›ÓÂÙ·È ·fi 0,13% ¤ˆ˜ 1,9% (9,10). £ÂˆÚ›ٷÈ, fï˜, fiÙÈ Ë ¯ÔÏÔÏÈı›·ÛË ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú¿ ˘’ fi„ÈÓ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÂÚÈÙÒÛÂˆÓ ·È‰ÈÒÓ Ì Â›ÌÔÓ· Á·ÛÙÚÂÓÙÂÚÈο ÂÓԯϋ̷ٷ ‹ ¿ÏÁÔ˜ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ‰ÂÍÈÔ‡ ˘Ô¯ÔÓ‰Ú›Ô˘ ‹ Ù˘ ¿Óˆ ÎÔÈÏȷ΋˜ ¯ÒÚ·˜, ȉȷ›ÙÂÚ· Ì¿ÏÈÛÙ· Â¿Ó ˘¿Ú¯Ô˘Ó ¤Ó·˜ ‹ ÂÚÈÛÛfiÙÂÚÔÈ ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ·Ó¿Ù˘ÍË ¯ÔÏÔÏ›ıˆÓ Î·È Î˘Ú›ˆ˜ ·ÈÌÔÏ˘ÙÈΤ˜ ·Ó·È̛˜, ÔÈ Ôԛ˜ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ 80% Ù˘ ·Ó¿Ù˘Í˘ ¯ÔÏÔÏÈı›·Û˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (1,2). ∞fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ófi Î·È ·ÔÙÂÏ› ηÏÔ‹ıË ÎÏËÚÔÓÔÌÈ΋ ηٿÛÙ·ÛË ¤ÌÌÂÛ˘ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, ¯ˆÚ›˜ ÛÙÔȯ›· Ë·ÙÔ¿ıÂÈ·˜ ‹ ·ÈÌfiÏ˘Û˘, ÂÓÒ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÂÈÛfi‰È· ÂÏ·ÊÚÔ‡ Î·È ˘ÔÙÚÔÈ¿˙ÔÓÙÔ˜ ÈÎÙ¤ÚÔ˘ (¯ÔÏÂÚ˘ıÚ›ÓË ≥1 mg/dl). ¶Ôχ Û˘¯Ó¿ ˘ԉȷÁÈÁÓÒÛÎÂÙ·È ÏfiÁˆ Ù˘ ‹È·˜ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Ù‡Ô Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ï·ÈfiÙÂÚ˜ ‚ÈÔ¯ËÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ÔÈÎÔÁÂÓÂÈÒÓ Ì ۇӉÚÔÌÔ Gilbert ¤‰ÂÈÍ·Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙËÙÈÎfi ÓfiÛËÌ· Ì ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·, Ì ‚¿ÛË ÙËÓ ·Ú·Ù‹ÚËÛË fiÙÈ ÌfiÓÔ Û 27,5% ÙˆÓ ·‰ÂÏÊÒÓ ·Û¯fiÓÙˆÓ Î·È Û 16,2% ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ‰È·ÈÛÙÒıËΠۇӉÚÔÌÔ Gilbert (11,12). OÈ Owens Î·È Ritter (1992) ÂͤÊÚ·Û·Ó ÙËÓ ¿Ô„Ë ÙÔ˘ ·˘ÙÔۈ̷ÙÈÎÔ‡ ˘ÔÏÂÈfiÌÂÓÔ˘ Ù‡Ô˘

¶›Ó·Î·˜ 2. °ÔÓÔÙ˘È΋ ·Ó¿Ï˘ÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ÛÙ· ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË Î·È ÛÙ· ˘ÁÈ‹ ·È‰È¿ ¶·È‰È¿ Ù˘ ÌÂϤÙ˘

n

(∆∞)6/(∆∞)6 n (%)

¶·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË ÀÁÈ‹ ·È‰È¿

30 40

9 (30) 23 (57,5)

°ÔÓfiÙ˘Ô˜ Û˘Ó‰ÚfiÌÔ˘ Gilbert (∆∞)6/(∆∞)7 (TA)7/(TA)7 n (%) n (%) 10 (33,3) 11 (27,5)

11 (36,7)* 6 (15)

* p=0,048

51

¶·È‰È·ÙÚÈ΋ 2004;67:49-53

ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜, ·Ó Î·È ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ˘‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ÂȂ‚·›ˆÛ ÙÔÓ ÂÈÎÚ·ÙËÙÈÎfi Ù‡Ô. ªÂٷ͇ ÙˆÓ ÎÏËÚÔÓÔÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÌÂÙ·‚ÔÏÈÛÌÔ‡ Ù˘ ¯ÔÏÂÚ˘ıÚ›Ó˘, ·ÔÙÂÏ› ÙÔÓ Û˘¯ÓfiÙÂÚÔ Ù‡Ô ‰È·Ù·Ú·¯ÒÓ (13,14). ∆Ô ÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ¤¯ÂÈ ϤÔÓ ‰È¢ÎÚÈÓÈÛÙ›. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ÛÙ· ¿ÙÔÌ· Ù˘ Ï¢΋˜ Ê˘Ï‹˜ Û˘Ó‹ıˆ˜ ÔÊ›ÏÔÓÙ·È Û ÔÏ˘ÌÔÚÊÈÛÌfi ÙÔ˘ DNA, Û ÔÌfi˙˘ÁË Î·Ù¿ÛÙ·ÛË ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÂÎÎÈÓËÙ‹ ÙÔ˘ ÁÔÓȉ›Ô˘ UGT1A1. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙ· ¿ÙÔÌ· Ì ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert, Ô ÂÎÎÈÓËÙ‹˜ ÙÔ˘ ÂÍÔÓ›Ô˘ 1A (TATAA box) ÂÚȤ¯ÂÈ ‰‡Ô ÂÈϤÔÓ ÓÔ˘ÎÏÂÔÙ›‰È· ∆∞ [(∆∞)7/(∆∞)7], Ì ·ÔÙ¤ÏÂÛÌ· 7 ·ÓÙ› ÙˆÓ Û˘Ó‹ıˆÓ 6 Â·Ó·Ï‹„ÂˆÓ ·ÏÏËÏÔ˘¯ÈÒÓ ‚¿ÛˆÓ. ∞˘Ùfi˜, ·ÎÚÈ‚Ò˜, Ô ÔÏ˘ÌÔÚÊÈÛÌfi˜ ÚÔηÏ› ‰È·Ù·Ú·¯‹ ÛÙËÓ ¤Ó·ÚÍË ÌÂÙ·ÁÚ·Ê‹˜ ÙÔ˘ ÁÔÓȉ›Ô˘ (gene transcription initiation) (5). ™Â ÂÏÏËÓÈÎfi ·È‰ÈÎfi ÏËı˘ÛÌfi, ·Ï·ÈfiÙÂÚË ÂÚÁ·Û›· Ì·˜ Ô˘ ·ÊÔÚÔ‡Û Û 105 ˘ÁÈ‹ ∂ÏÏËÓfiÔ˘Ï· ËÏÈΛ·˜ 2 ¤ˆ˜ 10 ÂÙÒÓ, ¤‰ÂÈÍ fiÙÈ 18,6% ›¯Â ÙÔ ·ÏÏ‹ÏÈÔ (∆∞)7 Û ÔÌfi˙˘ÁË Î·Ù¿ÛÙ·ÛË (15). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÙÔ˘ ·ÏÏËÏ›Ô˘ (∆∞)7 ÛÙ· ·È‰È¿ Ì ȉÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË Û ۇÁÎÚÈÛË Ì ¿ÏÏË ÔÌ¿‰· ˘ÁÈÒÓ ·È‰ÈÒÓ. ∂ȉÈÎfiÙÂÚ·, ‰È·ÈÛÙÒıËΠfiÙÈ 11/30 (36,7%) ·È‰È¿ Ì ȉÈÔ·ı‹ ¯ÔÏÔÏÈı›·ÛË Î·È 6/40 (15%) ˘ÁÈ‹ ·È‰È¿ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ [(∆∞)7/(∆∞)7] ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ˘Ô‰ËÏÒÓÔ˘Ó ÁÈ· ÚÒÙË ÊÔÚ¿ Û ·È‰ÈÎfi ÏËı˘ÛÌfi Ô˘ ÂϤÁ¯ÂÙ·È Ì DNA ·Ó¿Ï˘ÛË ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏ› ·ÔÎÏÂÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË ¯ÔÏÔÏÈı›·Û˘ ÛÙ· ·È‰È¿. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ, ·Ï·ÈfiÙÂÚ·, ÔÈ Peel Î·È Ritchie (1974) Î·È Orlando Î·È Û˘Ó (1981) ›¯·Ó ÌÂÏÂÙ‹ÛÂÈ ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚȷο, ¯ˆÚ›˜ fï˜ ·Ó¿Ï˘ÛË DNA, ·ÛıÂÓ›˜ Ì ¯ÔÏÔÏÈı›·ÛË Î·È Û‡Ó‰ÚÔÌÔ Gilbert (16,17). ∂›Û˘, ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù·, ·ÏÏ¿ Û ‰È·ÊÔÚÂÙÈΤ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ÌÂÏÂÙ‹ıËΠۯÂÙÈο ÚfiÛÊ·Ù· Û ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË, ÔÌfi˙˘ÁË/ÂӉȿÌÂÛË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›· Î·È Û˘ÁÁÂÓ‹ ‰˘ÛÂÚ˘ıÚÔÔÈËÙÈ΋ ·Ó·ÈÌ›· Ù‡Ô˘ ππ (congenital dyserythropoietic anemia, type II) (7,18,19). ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÔÈ Del Giudice Î·È Û˘Ó (1999) ‰È·›ÛÙˆÛ·Ó fiÙÈ Ë ¯ÔÏÔÏÈı›·ÛË ‹Ù·Ó ηٿ 4,5 ÊÔÚ¤˜ Û˘¯ÓfiÙÂÚË ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ ÛÊ·ÈÚÔ΢ÙÙ¿ÚˆÛË Ô˘ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙÔ ·ÏÏ‹ÏÈÔ (∆∞)7 ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert (7). ∂›Û˘, ·fi ÙÔ˘˜ Galanello Î·È Û˘Ó (2001) ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ¯ÔÏÔÏÈı›·Û˘ ÛÂ

52

Paediatriki 2004;67:49-53

·ÛıÂÓ›˜ Ì ÔÌfi˙˘ÁË/ÂӉȿÌÂÛË ‚-ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ÔÈ ÔÔ›ÔÈ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙÔ ·ÏÏ‹ÏÈÔ (∆∞)7 ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert (18). ∂ÈϤÔÓ, ÔÈ Perrotta Î·È Û˘Ó (2000) ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Î·È ÔÈ ·ÛıÂÓ›˜ ÌÂ Û˘ÁÁÂÓ‹ ‰˘ÛÂÚ˘ıÚÔÔÈËÙÈ΋ ·Ó·ÈÌ›· Ù‡Ô˘ ππ, ÔÈ ÔÔ›ÔÈ Â›Ó·È ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙÔ ·ÏÏ‹ÏÈÔ (∆∞)7 ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert, ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Î·Ù¿ 4,75 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ·Ó·Ù‡ÍÔ˘Ó ¯ÔÏÔÏÈı›·ÛË Î·È Ì¿ÏÈÛÙ· Û ÌÈÎÚfiÙÂÚË ËÏÈΛ· (19). ∆¤ÏÔ˜, ÔÈ Passon Î·È Û˘Ó (2001), Û ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ‰È·›ÛÙˆÛ·Ó fiÙÈ Ù· ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· Ô˘ ‹Ù·Ó ÔÌÔ˙˘ÁÒÙ˜ ÁÈ· ÙÔ ·ÏÏ‹ÏÈÔ (∆∞)7 ›¯·Ó ˘ÔÛÙ› ¯ÔÏÔ΢ÛÙÂÎÙÔÌ‹ Ì ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۇÁÎÚÈÛË Ì ٷ ·È‰È¿ Ì ‰ÚÂ·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›· Ô˘ ‹Ù·Ó ›Ù ÂÙÂÚÔ˙˘ÁÒÙ˜ ÁÈ· ÙÔ ·ÏÏ‹ÏÈÔ (∆∞)7 ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Gilbert ‹ ›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ÁÔÓfiÙ˘Ô (20). ™˘ÌÂÚ·ÛÌ·ÙÈο, ·fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ Â˘Ú‹Ì·Ù· ·fi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ Û¯ÂÙÈ΋˜ ‚È‚ÏÈÔÁÚ·Ê›·˜, Ê·›ÓÂÙ·È fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert ÌÔÚ› Ó· ıˆÚËı› ˆ˜ ÚԉȷıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ·Ó¿Ù˘Í˘ ¯ÔÏÔÏÈı›·Û˘ ÛÙ· ·È‰È¿. ∂Ô̤ӈ˜, Ô ·È‰›·ÙÚÔ˜ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÂÈ Ù· ·È‰È¿ Ì ¯ÔÏÔÏÈı›·ÛË ÁÔÓÔÙ˘Èο ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ Gilbert, ·ÊÔ‡ ·ÔÎÏÂÈÛÙÔ‡Ó ÔÈ ÁÓˆÛÙÔ› ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ¯ÔÏÔÏÈı›·Û˘. ∂˘¯·ÚÈÛٛ˜ OÈ Û˘ÁÁÚ·Ê›˜ ıˆÚÔ‡Ó ÛÎfiÈÌÔ Ó· ¢¯·ÚÈÛÙ‹ÛÔ˘Ó ÙÔÓ Î. ¶··ÓÈÎÔÏ¿Ô˘ ∞ı·Ó¿ÛÈÔ, π·ÙÚfi-∞ÎÙÈÓÔÏfiÁÔ ÁÈ· ÙËÓ ÔχÙÈÌË ‚Ô‹ıÂÈ¿ ÙÔ˘ ÛÙË Û˘ÏÏÔÁ‹ ÙÔ˘ ˘ÏÈÎÔ‡ Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜.

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Galanello R, Piras S, Barella S, Leoni GB, Cipollina MD, Perseu L et al. Cholelithiasis and Gilbert’s syndrome in homozygous beta-thalassaemia. Br J Haematol 2001;115: 926-928.

Perrotta S, del Giudice EM, Carbone R, Servedio V, Schettini F Jr, Nobili B et al. Gilbert’s syndrome accounts for the phenotypic variability of congenital dyserythropoietic anemia type II (CDA-II). J Pediatr 2000;136: 556-559.

Passon RG, Howard TA, Zimmerman SA, Schultz WH, Ware RE. Influence of bilirubin uridine diphosphateglucuronosyltransferase 1A promoter polymorphisms on serum bilirubin levels and cholelithiasis in children with sickle cell anemia. J Pediatr Hematol Oncol 2001; 23:448-451.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 23-04-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 09-01-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∞. °·ÏÏ¿-µÔ˘Ì‚Ô˘Ú¿ÎË ∂ÚÁ·ÛÙ‹ÚÈÔ °ÂÓÂÙÈ΋˜ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” E-mail: acgalla@yahoo.gr

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∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

Paediatriki 2004;67:54-56

CASE REPORT

∫·Ú‰È·Îfi˜ ÂÈˆÌ·ÙÈÛÌfi˜ ˆ˜ ÂÈÏÔ΋ ÎÂÓÙÚÈ΋˜ ÊÏ‚È΋˜ ÁÚ·ÌÌ‹˜ Û ÚfiˆÚÔ ÓÂÔÁÓfi °. ª·˘Ú›‰Ë˜, ∞. ∞Ó‰Ú¤Ô˘

Pericardial effusion complicating a central venous catheter in a premature infant G. Mavridis, A. Andreou

¶ÂÚ›ÏË„Ë: ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÓÂÔÁÓÔ‡ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 695 g, Ô˘ ˘¤ÛÙË Î·Ú‰È·Îfi ÂÈˆÌ·ÙÈÛÌfi ·fi ‰È¿ÙÚËÛË ÙÔ˘ ηډȷÎÔ‡ ÎfiÏÔ˘ ·fi ÎÂÓÙÚÈÎfi ÊÏ‚ÈÎfi ηıÂÙ‹Ú·. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒıËΠ·fi ÙËÓ ·Ó·ÚÚfiÊËÛË, ̤ۈ ‚ÂÏfiÓ˘, ˘ÁÚÔ‡ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ ·fi ÙËÓ ÂÚÈηډȷ΋ ÎÔÈÏfiÙËÙ·. ∆Ô ÓÂÔÁÓfi ‰ÈÂÛÒıË ¯¿ÚȘ ÛÙËÓ ¤ÁηÈÚË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË. ∏ ˘Ô„›· ‰ËÌÈÔ˘ÚÁ›·˜ ηډȷÎÔ‡ ÂÈˆÌ·ÙÈÛÌÔ‡ Ú¤ÂÈ Ó· Ù›ıÂÙ·È Û οı ·ÛıÂÓ‹ Ô˘ ¤¯ÂÈ ÎÂÓÙÚÈÎfi ÊÏ‚ÈÎfi ηıÂÙ‹Ú· Î·È Ë Î·Ù¿ÛÙ·Û‹ ÙÔ˘ ÂȉÂÈÓÒÓÂÙ·È Ú·Á‰·›·. °È· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¿ÌÂÛ· ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη Î·È ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·. ™Â ÂÚÈÙÒÛÂȘ Ô˘ Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓ‹ ÂȉÂÈÓÒÓÂÙ·È Û˘Ó¯Ҙ, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‰È·ÁÓˆÛÙÈ΋, ·ÏÏ¿ - Û˘Á¯ÚfiÓˆ˜ - Î·È ıÂÚ·¢ÙÈ΋ ÂÚÈηډÈÔΤÓÙËÛË, ¯ˆÚ›˜ Ó· ·Ó·Ì¤ÓÔÓÙ·È ¿ÏϘ ‰È·ÁÓˆÛÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ.

Abstract: The case is reported of a 695 g infant suffering from cardiac tamponade, which resulted from atrial perforation by a central venous catheter. ∆he diagnosis was confirmed by needle aspiration of parenteral fluid from the pericardial cavity. The infant survived due to timely therapeutic intervention. Cardiac tamponade should be suspected in any patient with a central venous catheter whose condition deteriorates suddenly. Immediate chest X ray and echocardiogram may be performed to support the diagnosis; but when the condition of the patient is deteriorating rapidly, a diagnostic (and also therapeutic) pericardiocentesis should be performed without waiting for other diagnostic measures.

§¤ÍÂȘ ÎÏÂȉȿ: ‰È¿ÙÚËÛË ‰ÂÍÈÔ‡ ηډȷÎÔ‡ ÎfiÏÔ˘, ÎÂÓÙÚÈÎfi˜ ÊÏ‚ÈÎfi˜ ηıÂÙ‹Ú·˜, ηډȷÎfi˜ ÂÈˆÌ·ÙÈÛÌfi˜.

Key words: right atrium perforation, cardiac tamponade, central venous catheter.

∂ÈÛ·ÁˆÁ‹ OÈ ÎÂÓÙÚÈÎÔ› ÊÏ‚ÈÎÔ› ηıÂÙ‹Ú˜ (∫º∫) ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Â˘Ú¤ˆ˜ ÛÙȘ ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ì·ÎÚÔ¯ÚfiÓÈ·˜ ÊÏ‚È΋˜ ÚfiÛ‚·Û˘ Î·È ¯ÔÚ‹ÁËÛ˘ ÂÓ‰ÔÊϤ‚ÈˆÓ ˘ÂÚˆÛ̈ÙÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ. ∏ ¯Ú‹ÛË ÙˆÓ ∫º∫ Û˘Óԉ‡ÂÙ·È ·fi ·ÚÎÂÙ¤˜ ÂÈÏÔΤ˜, fiˆ˜ ·fiÊÚ·ÍË, Ïԛ̈ÍË, ıÚfiÌ‚ˆÛË, Ú‹ÍË ‹ ÌÂٷΛÓËÛË ÙÔ˘ ηıÂÙ‹Ú· Û ÌË ÂÈı˘ÌËÙ‹ ı¤ÛË (1). ª›· ÁÓˆÛÙ‹, Û¿ÓÈ· ÂÈÏÔ΋ Â›Ó·È Ô Î·Ú‰È·Îfi˜ ÂÈˆÌ·ÙÈÛÌfi˜ Ô˘ Û˘Ì‚·›ÓÂÈ ÌÂÙ¿ ·fi ‰È¿ÙÚËÛË ÙÔ˘ ηډȷÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ¤Á¯˘ÛË ÙÔ˘

·ÚÂÓÙÂÚÈÎÔ‡ ‰È·ÙÚÔÊÈÎÔ‡ ‰È·Ï‡Ì·ÙÔ˜ ÛÙÔ ÂÚÈοډÈÔ. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, Ë ¿ÎÚË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÊÏ‚ÈÎÔ‡ ηıÂÙ‹Ú· ‚Ú›ÛÎÂÙ·È Ì¤Û· ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ. ∏ Ú·ÎÙÈ΋ Ù˘ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ¿ÎÚÔ˘ ÙÔ˘ ∫º∫ ̤۷ ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ ıˆÚÂ›Ù·È ·Ô‰ÂÎÙ‹, ·Ó Î·È - ÙÂÏÂ˘Ù·›· - ·ÚÎÂÙÔ› Û˘ÛÙ‹ÓÔ˘Ó ÙËÓ ·ÔÊ˘Á‹ Ù˘. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ ηډȷÎÔ‡ ÂÈˆÌ·ÙÈÛÌÔ‡ Â›Ó·È ‰Ú·Ì·ÙÈ΋, Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ‰‡ÛÎÔÏË Î·È Ë ıÓËÙfiÙËÙ· ˘„ËÏ‹ (2). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÂÓfi˜ ˘ÂÚ‚ÔÏÈο ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÚfiˆÚÔ˘ ÓÂÔÁÓÔ‡, ÙÔ ÔÔ›Ô ·Ó¤Ù˘Í ηډȷÎfi ÂÈˆÌ·ÙÈÛÌfi ÌÂÙ¿

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì· ∂.™.À., πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢

Division of Neonatology, “Ippokration” General Hospital, Thessaloniki

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·fi ÙÔÔı¤ÙËÛË ∫º∫ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÂÚÈηډÈÔΤÓÙËÛË. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¡ÂÔÁÓfi ı‹Ï˘, ÙÔ ÚÒÙÔ ·fi ÙÚ›‰˘Ì· Â͈ۈ̷ÙÈ΋˜ ÁÔÓÈÌÔÔ›ËÛ˘, ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÙËÓ 27Ë Â‚‰ÔÌ¿‰· ·ËÛ˘. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 6 ÛÙÔ 1Ô ÏÂÙfi Î·È 7 ÛÙÔ 5Ô ÏÂÙfi. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ‹Ù·Ó 695 g, ÙÔ Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ 32 cm Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ 24 cm. ∞̤ۈ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ÙÔ ÓÂÔÁÓfi ÙÔÔıÂÙ‹ıËΠ۠Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È ÙÔ˘ ¯ÔÚËÁ‹ıËΠÂÈÊ·ÓÂÈÔ‰Ú·ÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ̤ۈ ÙÚ·¯ÂÈ·ÎÔ‡ ۈϋӷ. ∏ ÔÌÊ·ÏÈ΋ ÊϤ‚· ηıÂÙËÚÈ¿ÛÙËÎÂ Î·È ÙÔ Ì‹ÎÔ˜ ÂÈÛfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ˘ÔÏÔÁ›ÛÙËÎÂ, Û‡Ìʈӷ Ì ÓÔÚÌfiÁÚ·ÌÌ·, ¤ÙÛÈ ÒÛÙÂ Ë ¿ÎÚË ÙÔ˘ ηıÂÙ‹Ú· Ó· ‚Ú›ÛÎÂÙ·È ˘„ËÏ¿ ÛÙËÓ Î¿Ùˆ ÎÔ›ÏË ÊϤ‚·, ¿Óˆ ·fi ÙÔ ‰È¿ÊÚ·ÁÌ·. ¢ÂÓ ¤ÁÈÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ı¤Û˘ ÙÔ˘ ηıÂÙ‹Ú·. ∞fi ÙËÓ ÚÒÙË Ë̤ڷ ˙ˆ‹˜ ¿Ú¯ÈÛÂ Ë ¯ÔÚ‹ÁËÛË, ̤ۈ ÙÔ˘ ÔÌÊ·ÏÈÎÔ‡ ηıÂÙ‹Ú·, ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Ì ‰È¿Ï˘Ì· ·ÌÈÓÔͤˆÓ, ÁÏ˘Îfi˙˘ Î·È Ï›Ô˘˜. ∆ËÓ ¤ÌÙË Ë̤ڷ ˙ˆ‹˜ ¤ÁÈÓ ·ÔۈϋӈÛË Î·È ÙÔÔı¤ÙËÛË Û ÚÈÓÈÎfi CPAP. §›Á˜ ÒÚ˜ ·ÚÁfiÙÂÚ·, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ¿ÓÔÈ·, ‚Ú·‰˘Î·Ú‰›·, ÁÂÓÈÎÂ˘Ì¤ÓË ˆ¯ÚfiÙËÙ· Î·È Î·Î‹ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›· (ÙÚȯÔÂȉÈ΋ Â·Ó·ÊÔÚ¿ >5 sec). ¢È·ÛˆÏËÓÒıËΠͷӿ, ÙÔÔıÂÙ‹ıËΠ۠Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, Ï‹ÊıËÎ·Ó Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ Î·È ¯ÔÚËÁ‹ıËΠ·ÓÙÈÌÈÎÚԂȷ΋ ·ÁˆÁ‹. ∏ ̤ÛË ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó Û˘Ó¯Ҙ ÌÂÁ·Ï‡ÙÂÚË ·fi 30 mmHg. O Ht ‹Ù·Ó 41%. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ó‡ÌÔÓ˜ Î·È ÛˆÛÙ‹ ı¤ÛË ÙÔ˘ ÙÚ·¯ÂÈÔۈϋӷ. ∏ ηډȷ΋ ÛÎÈ¿ ‹Ù·Ó ÌÂÁ¿ÏË Î·È ÛÊ·ÈÚÈ΋ Î·È Ë ¿ÎÚË ÙÔ˘ ÔÌÊ·ÏÈÎÔ‡ ηıÂÙ‹Ú· ‹Ù·Ó ̤۷ ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ (∂ÈÎfiÓ· 1). ™Â Û‡ÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ·ÚÔ˘Û›·Û ڷÁ‰·›· Âȉ›ӈÛË, Ì ÌÂÁ¿ÏË ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (̤¯ÚÈ ÙÔ ÛËÌÂ›Ô Ô˘ ‰ÂÓ ÌÔÚÔ‡Û ӷ ÚÔÛ‰ÈÔÚÈÛÙ›), ·Ú·ÈÔ‡˜ ηډȷÎÔ‡˜ ÙfiÓÔ˘˜ Î·È Î·Ú‰È·Î‹ ·Ó·ÎÔ‹. ŒÁÈÓ ·Ó·˙ˆÔÁfiÓËÛË Ì ·ÂÚÈÛÌfi Ì 100% Ô͢ÁfiÓÔ, ηډȷΤ˜ Ì·Ï¿ÍÂȘ Î·È ÂÓ‰ÔÙÚ·¯Âȷ΋ ¯ÔÚ‹ÁËÛË ·‰ÚÂÓ·Ï›Ó˘ Ì Ùˆ¯‹ ·¿ÓÙËÛË. ∞ÎÔÏÔ‡ıËÛÂ Ù˘ÊÏ‹ ·Ú·Î¤ÓÙËÛË Ù˘ ηډȿ˜ ÁÈ· ÂÓ‰Ôηډȷ΋ ¯ÔÚ‹ÁËÛË ·‰ÚÂÓ·Ï›Ó˘. ¶ÚÈÓ ÙËÓ Â›ÛÔ‰Ô ÛÙËÓ Î·Ú‰È·Î‹ ÎÔÈÏfiÙËÙ· ·Ó·ÚÚÔÊ‹ıËηÓ, ÚÔÊ·ÓÒ˜ ·fi ÙËÓ ÂÚÈηډȷ΋ ÎÔÈÏfiÙËÙ·, 4 ml Á·Ï·ÎÙfi¯ÚÔÔ˘ ˘ÁÚÔ‡, ·ÚfiÌÔÈÔ˘ Û ÂÌÊ¿ÓÈÛË Î·È ˘Ê‹ Ì ·˘Ùfi Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜. ∞ÎÔÏÔ‡ıˆ˜, Ë ¿ÎÚË Ù˘ ‚ÂÏfiÓ·˜ ÚÔˆı‹ıËΠÛÙËÓ Î·Ú‰È·Î‹ ÎÔÈÏfiÙËÙ·, fiÔ˘ ÂÓ¤ıËÎ·Ó 2 ml ‰È·Ï‡Ì·ÙÔ˜ ·‰ÚÂÓ·Ï›Ó˘ 1/10.000. OÈ ÛʇÍÂȘ Î·È ÔÈ ·Ó·ÓÔ¤˜ ·ÔηٷÛÙ¿ıËÎ·Ó ·Ì¤Ûˆ˜ Î·È Ôχ ÁÚ‹ÁÔÚ· ‚ÂÏÙÈÒıËÎÂ Ë Â-

Paediatriki 2004;67:54-56

ÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›·, Ì ٷ˘Ùfi¯ÚÔÓË ·ÔηٿÛÙ·ÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰·. ™˘Á¯ÚfiÓˆ˜, ·Ê·ÈÚ¤ıËÎÂ Ô ÔÌÊ·ÏÈÎfi˜ ηıÂÙ‹Ú·˜. ∏ Ó¤· ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ¤‰ÂÈÍ Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Ù˘ ηډȷ΋˜ ÛÎÈ¿˜ Î·È Ê˘ÛÈÔÏÔÁÈÎfi Û¯‹Ì· Û ۇÁÎÚÈÛË Ì ÂΛÓË Ô˘ ¤ÁÈÓ ÚÈÓ ÙËÓ Î·Ú‰È·Î‹ ·Ú·Î¤ÓÙËÛË. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ Ô˘ ¤ÁÈÓ ÙËÓ ÂfiÌÂÓË Ë̤ڷ, fiˆ˜ Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍ·Ó Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∏ ÌÂÙ¤ÂÈÙ· ÎÏÈÓÈ΋ ÔÚ›· ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó ÔÌ·Ï‹ Î·È ÂÍ‹Ïı ·fi ÙËÓ ÎÏÈÓÈ΋ Û ËÏÈΛ· 3,5 ÌËÓÒÓ, Ì ‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜ 2715 g Î·È Î·Ï‹ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ™Â ËÏÈΛ· 17 ÌËÓÒÓ, Ë „˘¯ÔÎÈÓËÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ™˘˙‹ÙËÛË ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ÂÈˆÌ·ÙÈÛÌÔ‡, ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, ÛÙËÚ›¯ıËΠÛÙ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· (ÛÙ·‰È·Î‹ Âȉ›ӈÛË Ù˘ ΢ÎÏÔÊÔÚ›·˜ Ì ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ηډȷ΋ ·Ó·ÎÔ‹ Î·È Ù·¯Â›· ·ÔηٿÛÙ·ÛË ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ÂÚÈηډȷÎÔ‡ ˘ÁÚÔ‡), ÛÙ· ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· (·‡ÍËÛË Î·Ú‰È·Î‹˜ ÛÎÈ¿˜ Ì ·ÔÛÙÚÔÁÁ˘ÏˆÌ¤ÓË ÂÚÈʤÚÂÈ·, ¿ÎÚÔ ∫º∫ ̤۷ ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ, ·ÔηٿÛÙ·ÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È ÙÔ˘ Û¯‹Ì·ÙÔ˜ Ù˘ ηډȷ΋˜ ÛÎÈ¿˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ·Ê·›ÚÂÛË ÙÔ˘ ÂÚÈηډȷÎÔ‡ ˘ÁÚÔ‡) ηÈ, ΢ڛˆ˜, ÛÙËÓ ·Ó·ÚÚfiÊËÛË Á·Ï·ÎÙfi¯ÚÔÔ˘ ˘ÁÚÔ‡ ·fi ÙÔ ÂÚÈοډÈÔ.

O ηډȷÎfi˜ ÂÈˆÌ·ÙÈÛÌfi˜ Â›Ó·È Ì›· ÁÓˆÛÙ‹, ÛÔ‚·Ú‹ ÂÈÏÔ΋ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ÊÏ‚ÈÎÔ‡ ηıÂÙËÚÈ·ÛÌÔ‡, Ô˘ Û˘Ì‚·›ÓÂÈ Û ÔÛÔÛÙfi 1-5% ηÈ

∂ÈÎfiÓ· 1. ∞ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ ηٿ ÙÔ ÂÂÈÛfi‰ÈÔ ÙÔ˘ ηډȷÎÔ‡ ÂÈˆÌ·ÙÈÛÌÔ‡. º·›ÓÂÙ·È Ë ‰ÈfiÁΈÛË Ù˘ ηډȿ˜ Î·È Ë ·ÔÛÙÚÔÁÁ‡ÏˆÛË ÙˆÓ ÔÚ›ˆÓ Ù˘.

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Û˘Óԉ‡ÂÙ·È ·fi ˘„ËÏ‹ ıÓËÙfiÙËÙ· (65%) (2,3). ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙ· ÚfiˆÚ· Î·È Ù· ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘ ÓÂÔÁÓ¿, ÏfiÁˆ ÙˆÓ ÏÂÙÒÓ Î·Ú‰È·ÎÒÓ ÙÔȯˆÌ¿ÙˆÓ Ô˘ ‰È·ı¤ÙÔ˘Ó.

O ÂÈˆÌ·ÙÈÛÌfi˜ ‰ËÌÈÔ˘ÚÁÂ›Ù·È fiÙ·Ó Ë ¿ÎÚË ÙÔ˘ ηıÂÙ‹Ú· ÂÈÛ¤Ú¯ÂÙ·È ÛÙȘ ηډȷΤ˜ ÎÔÈÏfiÙËÙ˜ (2). ∏ ÙÔÔı¤ÙËÛË ÙÔ˘ ∫º∫ Ì ÙËÓ ¿ÎÚË ÙÔ˘ ̤۷ ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ ·ÔÙÂÏ› Ì›· ·Ô‰ÂÎÙ‹ Ú·ÎÙÈ΋, ·Ó Î·È - ÙÂÏÂ˘Ù·›· - Û˘ÛÙ‹ÓÂÙ·È Ë ·ÔÊ˘Á‹ Ù˘ ı¤Û˘ ·˘Ù‹˜ (2,4). ŸÙ·Ó Ô Î·ıÂÙ‹Ú·˜ ‚Ú›ÛÎÂÙ·È Ì¤Û· ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ, Ë ¿ÎÚË ÙÔ˘ ·ÁÁ›˙ÂÈ Ù· ηډȷο ÙÔȯÒÌ·Ù·, Ù· ÔÔ›· Â›Ó·È ÏÂÙ¿, ȉȷ›ÙÂÚ· ÛÙ· ÓÂÔÁÓ¿ Ì Ôχ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ˘ÂÚˆÛ̈ÙÈÎfiÙËÙ· ÙˆÓ ÂÁ¯ÂfiÌÂÓˆÓ ‰È·Ï˘Ì¿ÙˆÓ Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜ Î·È ÙË ‰È·Ú΋ Ê˘ÛÈÔÏÔÁÈ΋ (Û˘ÛÙÔÏ‹-‰È·ÛÙÔÏ‹) ΛÓËÛË ÙˆÓ ÙÔȯˆÌ¿ÙˆÓ Ù˘ ηډȿ˜ ηٿ ÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘, ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÙÔÈ΋ ÊÏÂÁÌÔÓ‹, Ó¤ÎÚˆÛË Î·È ÙÂÏÈο ‰È¿ÙÚËÛË ÙÔ˘ ηډȷÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ì ¤Á¯˘ÛË ÙÔ˘ ·ÚÂÓÙÂÚÈÎÔ‡ ˘ÁÚÔ‡ ÛÙËÓ ÂÚÈηډȷ΋ ÎÔÈÏfiÙËÙ· Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÈˆÌ·ÙÈÛÌÔ‡ (2). ∏ Ù˘¯fiÓ ‰ËÌÈÔ˘ÚÁ›· ÁˆÓ›ˆÛ˘ ÛÙÔ ¿ÎÚÔ ÙÔ˘ ∫º∫ Ô˘ ‚Ú›ÛÎÂÙ·È Ì¤Û· ÛÙÔÓ ‰ÂÍÈfi ÎfiÏÔ Î·È Ë ¯Ú‹ÛË ÛÎÏËÚÒÓ Î·È ¿Î·ÌÙˆÓ ∫º∫ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Â˘ÎÔÏfiÙÂÚ· ÙÚ·˘Ì·ÙÈÛÌfi ÙˆÓ Î·Ú‰È·ÎÒÓ ÙÔȯˆÌ¿ÙˆÓ (5). ÕÏÏÔÈ Û¿ÓÈÔÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ÚfiÎÏËÛË ÂÈˆÌ·ÙÈÛÌÔ‡ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈÎÚÔıÚfiÌ‚ˆÓ ·fi ÙÔ Ù·ÏÎ Ô˘ ˘¿Ú¯ÂÈ ÛÙ· ¯ÂÈÚÔ˘ÚÁÈο Á¿ÓÙÈ·, fiˆ˜ Î·È ÙËÓ Ù·¯Â›· ¤Á¯˘ÛË ÌÂÁ¿Ï˘ ÔÛfiÙËÙ·˜ ÛÎÈ·ÛÙÈÎÔ‡ ‹ ¿ÏÏˆÓ ˘ÁÚÒÓ Ì¤Ûˆ ÙÔ˘ ∫º∫ (6). ∏ ‰È¿ÙÚËÛË ÙÔ˘ ηډȷÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ ÌÔÚ› Ó· Û˘Ì‚Â› Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ηıÂÙËÚÈ·ÛÌÔ‡ ÙˆÓ ÔÌÊ·ÏÈÎÒÓ ·ÁÁ›ˆÓ. ™˘Ó‹ıˆ˜, fï˜, ··ÈÙÂ›Ù·È ·ÚÎÂÙfi˜ ¯ÚfiÓÔ˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· Ù˘. ªÂÚÈΤ˜ ÊÔÚ¤˜, Ë ¿ÎÚË ÙÔ˘ ∫º∫ ÌÔÚ› Ó· Â›Ó·È ÙÔÔıÂÙË̤ÓË ÚÈÓ ·fi ÙÔÓ ‰ÂÍÈfi ÎfiÏÔ Î·È Ó· Á›ÓÂÈ ·˘ÙfiÌ·ÙË, ÛÙ·‰È·Î‹ ÌÂÙ·ÙfiÈÛË ÙÔ˘ ∫º∫ ̤¯ÚÈ ÙËÓ Â›ÛÔ‰Ô ÛÙÔÓ ÎfiÏÔ (5). ∏ ÂÈ‚›ˆÛË ÛÙȘ ÂÚÈÙÒÛÂȘ ÂÈˆÌ·ÙÈÛÌÔ‡ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ Ù·¯‡ÙËÙ· ÂÍ·ÁÁ›ˆÛ˘, ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘ Î·È ÙË ÁÚ‹ÁÔÚË Î·È ÂÙ˘¯Ë̤ÓË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË (7).

OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ηډȷÎÔ‡ ÂÈˆÌ·ÙÈÛÌÔ‡ ‰ÂÓ Â›Ó·È ÂȉÈΤ˜, ·ÏÏ¿ Â›Ó·È ·ÚfiÌÔȘ Ì ٷ ÚÔ‚Ï‹Ì·Ù· Î·È ÙȘ ÂÈÏÔΤ˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ÚfiˆÚ· ÓÂÔÁÓ¿, Ì ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ‰‡ÛÎÔÏË Ë ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË, ·Ó Û˘Ó˘ÔÏÔÁÈÛÙ› Î·È Ë Û·ÓÈfiÙËÙ· Ù˘ ¿ıËÛ˘ (6). ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·, Û¿ÓÈ· ·Ó·Ê¤ÚÂÙ·È ‰È¿ÁÓˆÛË ÂÈˆÌ·ÙÈÛÌÔ‡ ÚÈÓ Ó· Û˘Ì‚Â› ηډȷ΋ ·Û˘ÛÙÔÏ›· (6). ∆· Û˘ÌÙÒÌ·Ù· Ô˘ Ú¤ÂÈ Ó· ı¤ÛÔ˘Ó ÙËÓ ˘Ô„›· ÁÈ· ÂÈˆÌ·ÙÈÛÌfi Â-

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ÚÈÏ·Ì‚¿ÓÔ˘Ó Î˘¿ÓˆÛË, η΋ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›·, ¿ÓÔÈ·, Ù·¯˘Î·Ú‰›· ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ‚Ú·‰˘Î·Ú‰›·, ·Ú¿‰ÔÍÔ ÛÊ˘ÁÌfi, ‚‡ıÈÔ˘˜ ηډȷÎÔ‡˜ ÙfiÓÔ˘˜ Î·È ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ (6). ∏ ‰È¿ÁÓˆÛË ÂÓÈÛ¯‡ÂÙ·È - Û˘Ó‹ıˆ˜ Ôχ ·ÚÁ¿ ·fi ÙËÓ ·ÎÙÈÓÔÏÔÁÈ΋ ·Ó‡ÚÂÛË ·˘ÍËÌ¤ÓˆÓ ÔÚ›ˆÓ Ù˘ ηډȷ΋˜ ÛÎÈ¿˜, ·fi ÙÔ ¯·ÌËÏfi ‰˘Ó·ÌÈÎfi ÙÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜, ·fi ÙËÓ ¤Á¯˘ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡ ̤ۈ ÙÔ˘ ηıÂÙ‹Ú· Î·È ·fi ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜. ∏ ‰È¿ÁÓˆÛË ÙÂÎÌËÚÈÒÓÂÙ·È ·fi ÙËÓ ·Ó·ÚÚfiÊËÛË ˘ÁÚÔ‡, ·ÚfiÌÔÈÔ˘ Ì ·˘Ùfi Ù˘ ·ÚÂÓÙÂÚÈ΋˜ ‰È·ÙÚÔÊ‹˜, Ì ÙËÓ ÂÚÈηډÈÔΤÓÙËÛË, fiˆ˜ Û˘Ó¤‚Ë Î·È ÛÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi (6). ∏ ‰ËÌÈÔ˘ÚÁ›· ηډȷÎÔ‡ ÂÈˆÌ·ÙÈÛÌÔ‡ ·fi ÙË ¯Ú‹ÛË ∫º∫ Â›Ó·È Ì›· È·ÙÚÔÁÂÓ‹˜ ÂÈÏÔ΋ ηÈ, Û˘ÓÂÒ˜, ÌÔÚ› Ó· ÚÔ‚ÏÂÊı›, Ó· ·ÔÊ¢¯ı› ‹ Ó· ÂÏ·¯ÈÛÙÔÔÈËı›. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ÚÔÙ›ÓÔÓÙ·È ‰È¿ÊÔÚ˜ ÛÙÚ·ÙËÁÈΤ˜, fiˆ˜ Ë ÌË ÙÔÔı¤ÙËÛË ÙÔ˘ ¿ÎÚÔ˘ ÙÔ˘ ∫º∫ ̤۷ ÛÙÔÓ ÎfiÏÔ Î·È Ô Û˘¯Ófi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ı¤Û˘ ÙÔ˘ ∫º∫ Ì ·ÎÙÈÓÔÁڷʛ˜, ÂÓÒ Ë ˘Ô„›· ÁÈ· ÙËÓ ¿ıËÛË ÌÔÚ› Ó· ÙÂı› ÛÙȘ ÂÚÈÙÒÛÂȘ shock Ô˘ ‰ÂÓ ·Ó·Ù¿ÛÛÂÙ·È Ì ·Ó·˙ˆÔÁfiÓËÛË (4,7). µÈ‚ÏÈÔÁÚ·Ê›· 1. Nadroo AM, al-Sowailem AM. Extravasation of parenteral alimentation fluid into the renal pelvis: a complication of central venous catheter in a neonate. J Perinatol 2001;21:465-466.

2. Darling JC, Newell SJ, Mohamdee O, Uzun O, Cullinane CJ, Dear PR. Central venous catheter tip in the right atrium: a risk factor for neonatal cardiac tamponade. J Perinatol 2001;21: 461-464.

3. Beattie PG, Kuschel CA, Harding JE. Pericardial effusion complicating a percutaneous central venous line in a neonate. Acta Paediatr 1993;82:105-107.

4. Sasidharan P, Billman D, Heimler R, Nelin L. Cardiac arrest in an extremely low birth weight infant: complication of percutaneous central venous catheter hyperalimentation. J Perinatol 1996;16:123-126.

5. Cade A, Puntis JW. Pericardial parenteral nutrition infusion following acute angulation of a neonatal polyurethane central venous catheter tip. Clin Nutr 1997;16:263-264.

6. Agarwal KC, Khan MA, Falla A, Amato J. Cardiac perforation from central venous catheters: survival after cardiac tamponade in an infant. Pediatrics 1984;73:333-338.

7. Wirrell EC, Pelausa EO, Allen AC, Stinson DA, Hanna BD. Massive pericardial effusion as a cause for sudden deterioration of a very low birthweight infant. Am J Perinatol 1993;10:419-423.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-03-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-12-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: °ÂÒÚÁÈÔ˜ ª·˘Ú›‰Ë˜ ªÚԇʷ 14, ∆.∫. 546 41, £ÂÛÛ·ÏÔÓ›ÎË

¶·È‰È·ÙÚÈ΋ 2004;67:57-60

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CASE REPORT

™˘Ìو̷ÙÈ΋ Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û ‰›‰˘ÌÔ ÓÂÔÁÓfi ÌÂÙ¿ ·fi Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ∞. ª·ÓÔ˘Ú¿, ∂. ∫ÔڷοÎË, ∂. ÷Ù˙ˉ¿ÎË, ª. ∞ÁÁÂÏ¿ÎË, ™. ªÈÎÔ˘‚·Ú¿Î˘, ª. ¶··ÁˆÚÁ›Ô˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘

Symptomatic congenital cytomegalovirus infection in a twin after recurrent maternal infection A. Manoura, E. Korakaki, E. Hatzidaki, M. Aggelaki, S. Bikouvarakis, M. Papageorgiou, C. Giannakopoulou

¶ÂÚ›ÏË„Ë: O ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ ÛÙÔÓ ¿ÓıÚˆÔ Î·È, Û ·ÓÙ›ıÂÛË Ì ·ÚÎÂÙÔ‡˜ ¿ÏÏÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, ÌÔÚ› Ó· ÌÂÙ·‰Ôı› ÛÙÔ ¤Ì‚Ú˘Ô ·Ú¿ ÙËÓ ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· Ù˘ ÌËÙ¤Ú·˜. øÛÙfiÛÔ, Ù· ÌËÙÚÈο ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ÈÔ‡ ·Ú¤¯Ô˘Ó ÛËÌ·ÓÙÈ΋ ÚÔÛÙ·Û›· ÛÙÔ ¤Ì‚Ú˘Ô Î·È Ë Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË Ô˘ ÔÊ›ÏÂÙ·È Û Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ Î·È Â›Ó·È ÎÏÈÓÈο ÂÌÊ·Ó‹˜ ‹‰Ë ·fi ÙË Á¤ÓÓËÛË, Â›Ó·È Û¿ÓÈ·. ™Â ÂÚ›ÙˆÛË ‰›‰˘Ì˘ ·ËÛ˘, Ë Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ÌÔÚ› Ó· ¤¯ÂÈ ‰È·ÊÔÚÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÛÙ· ‰‡Ô ¤Ì‚Ú˘·. OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙËÓ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‰ÂÓ Â›Ó·È ÁÓˆÛÙÔ›, ˆÛÙfiÛÔ ÊÚ·ÁÌÔ› Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ Ï·ÎÔ‡ÓÙ· ‹ Î·È ÙÔ ›‰ÈÔ ÙÔ ¤Ì‚Ú˘Ô Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Û˘Ìو̷ÙÈ΋˜ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ Û ¤Ó· ÌfiÓÔ ·fi ‰›‰˘Ì· ÓÂÔÁÓ¿ ÌËÙ¤Ú·˜ Ì ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· ÛÙÔÓ Èfi Î·È Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

Abstract: Cytomegalovirus is the most common cause of congenital infection and, in contrast to various other infections, it can be transmitted to the fetus even when the mother has prior immunity to the virus. Preconceptional immunity provides partial protection to the fetus and congenital cytomegalovirus infection clinically apparent at birth, resulting from recurrent maternal infection, is rare. In twin pregnancies, each fetus may react differently to maternal infection. Factors regulating the transmission of cytomegalovirus to the fetus are poorly understood, but protective barriers in the placenta or the fetus itself appear to play an important role. A case of symptomatic congenital cytomegalovirus infection in one twin after recurrent maternal infection is reported and recent literature is reviewed.

§¤ÍÂȘ ÎÏÂȉȿ: ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜, Â·Ó·Ïԛ̈ÍË, ‰›‰˘ÌË Î‡ËÛË.

Key words: cytomegalovirus, recurrent infection, twin pregnancy.

∂ÈÛ·ÁˆÁ‹ O ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜ ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ ÛÙÔÓ ¿ÓıÚˆÔ, ÌÂ Û˘¯ÓfiÙËÙ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÚÔÛ‚ÔÏ‹˜ Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 0,2% ¤ˆ˜ 2,5% (1). ™Â ·ÓÙ›ıÂÛË Ì ·ÚÎÂÙ¤˜ ¿ÏϘ ÏÔÈÌÒÍÂȘ, Ë ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· Ù˘ ÌËÙ¤Ú·˜ ‰ÂÓ ÚÔÛٷهÂÈ ÙÔ ¤Ì‚Ú˘Ô, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ÌÔÏ˘Óı› ›Ù ÌÂÙ¿ ·fi ÚˆÙÔ·ı‹ Ïԛ̈ÍË Â›Ù ÌÂÙ¿ ·fi Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ (1-3). T· ÓÂÔÁÓ¿ ÌÂ Û˘ÁÁÂÓ‹ Ïԛ̈ÍË Â›Ó·È Û˘Ó‹-

ıˆ˜ ·Û˘Ìو̷ÙÈο ηٿ ÙË Á¤ÓÓËÛË, ˆÛÙfiÛÔ ÔÛÔÛÙfi 5-17% ·fi ·˘Ù¿ ı· ·ÚÔ˘ÛÈ¿ÛÂÈ ·ÚÁfiÙÂÚ· Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝·, ¯ÔÚÈÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉ›Ùȉ·, ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ‹ οÔÈÔ Ó¢ÚÔÏÔÁÈÎfi ¤ÏÏÂÈÌÌ· (1,2). ∏ ·ÓÔÛ›· Ù˘ ÌËÙ¤Ú·˜ Ê·›ÓÂÙ·È fiÙÈ ÌÂÈÒÓÂÈ ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌÂÙ¿‰ÔÛ˘ Î·È fiÙÈ ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÚÔÛÙ·Û›· ·fi ÙȘ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘ Ù˘ (1,2,4). ∏ Û˘Ìو̷ÙÈ΋ ÛÙË Á¤ÓÓËÛË Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi, ÌÂÙ¿ ·fi

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

Department of Neonatology, University of Crete, Heraklion, Crete

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Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜, Â›Ó·È Û¿ÓÈ· (1,2,4,5).

O Ì˯·ÓÈÛÌfi˜ Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌÂÙ¿‰ÔÛ˘ ‰ÂÓ Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙfi˜, ˆÛÙfiÛÔ Ë ‰È·ÊÔÚÂÙÈ΋ ‰È·‰ÚÔÌ‹ Ù˘ ÚˆÙÔ·ıÔ‡˜ Ïԛ̈͢ Ù˘ ÌËÙ¤Ú·˜ Û ‰›‰˘Ì· ÓÂÔÁÓ¿ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÊÚ·ÁÌÔ› Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ Ï·ÎÔ‡ÓÙ· ‹ Î·È ÙÔ ›‰ÈÔ ÙÔ ¤Ì‚Ú˘Ô ‰È·‰Ú·Ì·Ù›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ (5,6). ∂Ó‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ÂÓfi˜ ‹ Î·È ÙˆÓ ‰‡Ô ‰›‰˘ÌˆÓ ÓÂÔÁÓÒÓ ÌÂÙ¿ ·fi ÚˆÙÔ·ı‹ Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. øÛÙfiÛÔ, Ïԛ̈ÍË ÙÔ˘ ÂÓfi˜ ÌfiÓÔ ‰›‰˘ÌÔ˘ ÓÂÔÁÓÔ‡ ÌÂÙ¿ ·fi Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ÌfiÓÔ Û ̛· ÂÚ›ÙˆÛË (7). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÂÚ›ÙˆÛË Û˘Ìو̷ÙÈ΋˜ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ ÛÙÔ ¤Ó· ÌfiÓÔ ·fi Ù· ‰›‰˘Ì· ÓÂÔÁÓ¿ ÌËÙ¤Ú·˜ Ì ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· ÛÙÔÓ Èfi Î·È Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÚfiÎÂÈÙ·È ÁÈ· ‰È¯ÔÚȷο ‰È·ÌÓȷο ‰›‰˘Ì· ÓÂÔÁÓ¿ ·fi Â͈ۈ̷ÙÈ΋ ÁÔÓÈÌÔÔ›ËÛË, Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÚfiˆÚ˘ ¤Ó·Ú͢ ÙÔÎÂÙÔ‡, ÌÂÙ¿ ·fi ·ËÛË 32 ‚‰ÔÌ¿‰ˆÓ. ∆· ÓÂÔÁÓ¿ ‹Ù·Ó ¿ÚÚÂÓ·, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1890 g ÙÔ ÚÒÙÔ Î·È 1630 g ÙÔ ‰Â‡ÙÂÚÔ. °ÂÓÓ‹ıËÎ·Ó Ì Apgar score 7 Î·È 9 ÙÔ 1Ô Î·È 5Ô ÏÂÙfi ·ÓÙ›ÛÙÔȯ· Î·È ÌÂٷʤÚıËÎ·Ó ÛÙË ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË. ∏ ÌËÙ¤Ú· ‹Ù·Ó 32 ÂÙÒÓ, ˘ÁÈ‹˜ Î·È ‰Â˘ÙÂÚÔÙfiÎÔ˜. ™ÙÔÓ Ù·ÎÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ηٿ ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ ‰È·ÈÛÙÒıËÎ·Ó ıÂÙÈο IgM Î·È IgG ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡ (IgM: 1.789, IgG: >250 Au/ml). ∫·Ù¿ ÙÔÓ ·ÓÙ›ÛÙÔÈ¯Ô ¤ÏÂÁ¯Ô ÛÙËÓ ÚÒÙË Î‡ËÛË, ›¯·Ó ‰È·ÈÛÙˆı› ıÂÙÈο IgG ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡. ªÂ ÙË ‰È¿ÁÓˆÛË Ù˘ Â·ÓÂÓÂÚÁÔÔ›ËÛ˘ ‹ Ù˘ Â·Ó·Ïԛ̈͢ ·fi ÙÔÓ Èfi ‰ÂÓ ¤ÁÈÓ ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜, ÌÂÙ¿ Ù· ÔÚÔÏÔÁÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ ‰Â‡ÙÂÚ˘ ·ËÛ˘. ∆Ô ÚÒÙÔ ÓÂÔÁÓfi ‹Ù·Ó ·ÁfiÚÈ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1890 g [(50‹ ÂηÙÔÛÙÈ·›· ı¤ÛË (∂£)], Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜ 42 cm (50‹ ∂£) Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 29,2 cm (50‹ ∂£). ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ÂÓÒ ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠıÚÔÌ‚ÔÂÓ›· (38.000 ·ÈÌÔÂÙ¿ÏÈ· Î.Î.¯.), Ô˘‰ÂÙÂÚÔÂÓ›· (1100 Ô˘‰ÂÙÂÚfiÊÈÏ· Î.Î.¯.) Î·È ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· (ÔÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË 1Ô˘ 24ÒÚÔ˘: 9,9 mg/dl, Ì ¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË 3,15 mg/dl). ∆Ș ÂfiÌÂÓ˜ Ë̤Ú˜ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ‰È·ÈÛÙÒıËΠÛÙ·‰È·Î‹ ·‡ÍËÛË ÙˆÓ ÔÚ›ˆÓ ÙÔ˘ ‹·ÙÔ˜ Î·È ÙÔ˘ ÛÏ‹Ó·, ·ıÔÏÔÁÈÎÔ› ‰Â›ÎÙ˜ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (SGOT: 314 IU/L, SGPT: 72 IU/L, ÁGT: 197 IU/L) Î·È ÂÈÌÔ-

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Paediatriki 2004;67:57-60

Ó‹ Ù˘ ıÚÔÌ‚ÔÂÓ›·˜ (ÂÏ¿¯ÈÛÙË ÙÈÌ‹: 20.000 ·ÈÌÔÂÙ¿ÏÈ· Î.Î.¯.) Î·È Ù˘ ¿ÌÂÛ˘ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·˜, ÂÓÒ Ë Ô˘‰ÂÙÂÚÔÂÓ›· ÛÙ·‰È·Î¿ ·ÔηٷÛÙ¿ıËÎÂ. OÈ ¯ÚfiÓÔÈ ‹Í˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎÔ›. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ¤‰ÂÈÍ ıÂÙÈο IgG ·ÓÙÈÛÒÌ·Ù· (>250 IU/ml) ¤Ó·ÓÙÈ ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡, ÂÓÒ Ë Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ Ô˘ ¤ÁÈÓ ÙÔ 9Ô 24ˆÚÔ ˙ˆ‹˜ ‹Ù·Ó ıÂÙÈ΋ ÁÈ· ÙÔÓ Èfi. ∏ ·Ó›¯Ó¢ÛË ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ‰ÂÓ ‹Ù·Ó ÂÊÈÎÙ‹ ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÓÔÛÔÎÔÌ›Ô. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ÎÚ·Ó›Ô˘ Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÂÁÎÂÊ¿ÏÔ˘ Î·È ÎÔÈÏ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍ ÌÈÎÚ¤˜ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÚÈÔ¯¤˜ 2 mm ÂÚÈÎÔÈÏȷο ÛÙË Ï¢΋ Ô˘Û›· Î·È ·Ú¿ ÙÔ ÛÒÌ· Ù˘ ‰ÂÍÈ¿˜ Ï¿ÁÈ·˜ ÎÔÈÏ›·˜. ∆ËÓ 20‹ Ë̤ڷ ˙ˆ‹˜, ÂÓÒ Ë ıÚÔÌ‚ÔÂÓ›· ›¯Â ‚ÂÏÙȈı› (78.000 ·ÈÌÔÂÙ¿ÏÈ· Î.Î.¯.), ¤ÁÈÓ ¤Ó·ÚÍË ·ÁˆÁ‹˜ Ì Á·ÓÛÈÎÏÔ‚›ÚË Û ‰fiÛË 5 mg/kg/12ˆÚÔ. ª›· ‚‰ÔÌ¿‰· ·ÚÁfiÙÂÚ·, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ÛÔ‚·Ú‹ Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ Ì ˘ÚÂÙfi, Ù·¯‡ÓÔÈ·, ÁÔÁÁ˘ÛÌfi Î·È ÂÏ·Ùو̤ÓÔ Ì˘˚Îfi ÙfiÓÔ, ÂÓÒ ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËΠÂȉ›ӈÛË Ù˘ ıÚÔÌ‚ÔÂÓ›·˜ (25.000 ·ÈÌÔÂÙ¿ÏÈ· Î.Î.¯.), ıÂÙÈ΋ C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË Î·È ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ (Klebsiella pneumoniae). ∏ Á·ÓÛÈÎÏÔ‚›ÚË ‰È·ÎfiËÎÂ Î·È ¯ÔÚËÁ‹ıËΠ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹ ÁÈ· 10 24ˆÚ·. ∆Ô ÓÂÔÁÓfi ÂÍ‹Ïı Û ËÏÈΛ· 8 ‚‰ÔÌ¿‰ˆÓ Ì Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ıÚÔÌ‚ÔÂÓ›· (∞ª¶: 80.000 Îί), ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· (ÔÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË: 8,5 mg/dl, ¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 3,44 mg/dl) Î·È ·ıÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (SGOT: 202 IU/L, SGPT: 56 IU/L, ÁGT: 159 IU/L). O ÔÊı·ÏÌÔÏÔÁÈÎfi˜ Î·È ·ÎÔÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓ Û ËÏÈΛ· 3 ÌËÓÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ™Â ËÏÈΛ· 4 ÌËÓÒÓ, ÙÔ ‚Ú¤ÊÔ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û ӷ ¤¯ÂÈ ‹È· Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›· Î·È ·ıÔÏÔÁÈÎÔ‡˜ ‰Â›ÎÙ˜ Ë·ÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (ÔÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË: 9,4 mg/dl, ¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 4,7 mg/dl, SGOT: 165 IU/L, SGPT: 107 IU/L, ÁGT: 150 IU/L), ÂÓÒ Ë ıÚÔÌ‚ÔÂÓ›· ›¯Â ˘Ô¯ˆÚ‹ÛÂÈ. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È Ë ÛˆÌ·ÙÈ΋ ·Ó¿Ù˘Í‹ ÙÔ˘, ÛÙËÓ ËÏÈΛ· ·˘Ù‹, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∆Ô ‰Â‡ÙÂÚÔ ‰›‰˘ÌÔ ÓÂÔÁÓfi ÓÔÛËχÙËΠÁÈ· 30 Ë̤Ú˜. ∆· ·ÓÙÈÛÒÌ·Ù· ÁÈ· ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ‹Ù·Ó ·ÚÓËÙÈο, fiˆ˜ Î·È Ë Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ Ô˘ ¤ÁÈÓ ÙËÓ 22Ë Ë̤ڷ ˙ˆ‹˜. ™ÙËÓ ËÏÈΛ· ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÌËÓÒÓ, ÙÔ ‚Ú¤ÊÔ˜ ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË. ™˘˙‹ÙËÛË O ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi˜, Û ·ÓÙ›ıÂÛË Ì ¿ÏÏÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó Û˘ÁÁÂÓ‹ Ïԛ̈ÍË fiˆ˜ Ô Èfi˜ Ù˘ ÂÚ˘ıÚ¿˜ Î·È ÙÔ ÙÔÍfiÏ·ÛÌ·, ÌÔÚ› Ó· ÌÂÙ·‰Ôı› ÛÙÔ ¤Ì‚Ú˘Ô ·Ú¿ ÙËÓ

¶·È‰È·ÙÚÈ΋ 2004;67:57-60

ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· Ù˘ ÌËÙ¤Ú·˜ (1,2). ∆fiÛÔ Ë ·Ó·˙ˆ‡ÚˆÛË ÙÔ˘ ÈÔ‡ fiÛÔ Î·È Ë Â·Ó·Ïԛ̈ÍË ÌÂ Ó¤Ô Û٤ϯԘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÂÓ‰ÔÌ‹ÙÚÈ· ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘ (1,2). ¶·Ú¿ ÙËÓ ·ÙÂÏ‹ ÚÔÛÙ·Û›· Ô˘ ·Ú¤¯Ô˘Ó Ù· ÌËÙÚÈο ·ÓÙÈÛÒÌ·Ù·, Â›Ó·È ÁÂÓÈο ·Ô‰ÂÎÙfi fiÙÈ ÌÂÈÒÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ Î·È ÂÚÈÔÚ›˙Ô˘Ó ÛËÌ·ÓÙÈο ÙÔÓ Î›Ó‰˘ÓÔ ÛÔ‚·Ú‹˜ Û˘ÁÁÂÓÔ‡˜ ÓfiÛÔ˘ (1,4). O ΛӉ˘ÓÔ˜ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡ Î˘Ì·›ÓÂÙ·È ·fi 31% ¤ˆ˜ 45%, ÌÂÙ¿ ·fi ÚˆÙÔ·ı‹ Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜, ÂÓÒ Û ÂÚ›ÙˆÛË Â·Ó·Ïԛ̈͢ ˘ÔÏÔÁ›˙ÂÙ·È ÌÈÎÚfiÙÂÚÔ˜ ·fi 1% (1,2). ™˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ÎÏÈÓÈο ÂÌÊ·Ó‹˜ ÛÙË Á¤ÓÓËÛË ·Ú·ÙËÚÂ›Ù·È ÌfiÓÔ ÛÙÔ 10% ÙˆÓ ÂÓ‰ÔÌ‹ÙÚÈ· ÚÔۂ‚ÏËÌ¤ÓˆÓ ÓÂÔÁÓÒÓ Î·È ·ÊÔÚ¿ ΢ڛˆ˜ Û ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ÚˆÙÔ·ı‹ Ïԛ̈ÍË (1,4). ∆· ÂÚÈÛÛfiÙÂÚ· ·fi ·˘Ù¿ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ·ÒÙÂÚ˜ ÂÈÏÔΤ˜ Ù˘ ÓfiÛÔ˘, Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝·, ¯ÔÚÈÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉ›Ùȉ· Î·È „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, ÂÓÒ ·Ó¿ÏÔÁË ÂÈÎfiÓ· ı· ÂÌÊ·Ó›ÛÂÈ Î·È ÙÔ 5-17% ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÛÙË Á¤ÓÓËÛË ÓÂÔÁÓÒÓ (1,4). ¶·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë Û˘Ìو̷ÙÈ΋ Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi Û˘Ì‚·›ÓÂÈ Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ÌÂÙ¿ ·fi ÚˆÙÔ·ı‹ Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È fiÙÈ Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· Â›Ó·È Û˘Ó‹ıˆ˜ ·Û˘Ìو̷ÙÈο ηٿ ÙË Á¤ÓÓËÛË (4,8). ∆Ô ÓÂÔÁÓfi Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Â›¯Â Û˘ÁÁÂÓ‹ ÓfiÛÔ ÎÏÈÓÈο ÂÌÊ·Ó‹ ÛÙË Á¤ÓÓËÛË, ·Ú’ fiÏÔ Ô˘ Ë ÌËÙ¤Ú· ÙÔ˘ ›¯Â ·ÓÔÛ›· ÛÙÔÓ Èfi. OÈ ÂÚÈÙÒÛÂȘ Û˘Ìو̷ÙÈ΋˜ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ Û ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· Ô˘ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Â›Ó·È Ï›Á˜, ˆÛÙfiÛÔ ˘Ô‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë Èı·ÓfiÙËÙ· ÛÔ‚·Ú‹˜ Ïԛ̈͢ ·fi ÙÔÓ Èfi ‰ÂÓ ÂÍ·Ï›ÊÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÌËÙÚÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (7,9-11). ∂›Ó·È Èı·Ófi fiÙÈ Ë ÎÏÈÓÈ΋ ÛËÌ·Û›· Ù˘ ·Ó·˙ˆ‡ÚˆÛ˘ ‹ Ù˘ Â·Ó·Ïԛ̈͢ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ¤¯ÂÈ ˘ÔÂÎÙÈÌËı›. ∆ÚÂȘ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ÛËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌfiÏ˘ÓÛ˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È ÛÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÒÙÂÚˆÓ ÂÈÏÔÎÒÓ Û ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ÚÔ¸¿Ú¯Ô˘Û· ·ÓÔÛ›· ÛÙÔÓ Èfi (3,5,12). ¢ÂÓ ¤¯ÂÈ, ÚÔ˜ ÙÔ ·ÚfiÓ, ‰È¢ÎÚÈÓÈÛÙ› ·Ó Ë ÂÓ‰ÔÌ‹ÙÚÈ· ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ Î·È Ë ÎÏÈÓÈ΋ Ù˘ ¤ÎÊÚ·ÛË Û¯ÂÙ›˙ÔÓÙ·È Ì ·Ó·˙ˆ‡ÚˆÛË ÙÔ˘ ‹‰Ë ˘¿Ú¯ÔÓÙ· Û ϷÓı¿ÓÔ˘Û· ηٿÛÙ·ÛË Î˘ÙÙ·ÚÔÌÂÁ·ÏÔ˚Ô‡ ‹ Ì Â·Ó·Ïԛ̈ÍË ·fi ‰È·ÊÔÚÂÙÈÎfi Û٤ϯԘ. øÛÙfiÛÔ, Ô Î›Ó‰˘ÓÔ˜ Ê·›ÓÂÙ·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË (3). ∏ Û˘Ìو̷ÙÈ΋ Û˘ÁÁÂÓ‹˜ Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ÂΉËÏÒÓÂÙ·È Ì ÔÈΛϷ Î·È ÌË ÂȉÈο Û˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù·, Ù· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·, ›ÎÙÂÚÔ, ÂÙ¤¯ÂȘ ‹

Paediatriki 2004;67:57-60

ÔÚÊ˘ÚÈÎfi ÂÍ¿ÓıËÌ·, ÌÈÎÚÔÎÂÊ·Ï›·, ıÚÔÌ‚ÔÂÓ›·, ¯ÔÚÈÔ·ÌÊÈ‚ÏËÛÙÚÔÂȉ›Ùȉ·, ÂÓ‰ÔÎÚ¿ÓȘ ·ÔÙÈÙ·ÓÒÛÂȘ Î·È ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘ (1,2). ∆Ô ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È Â›¯Â ›ÎÙÂÚÔ, Â›ÌÔÓË ıÚÔÌ‚ÔÂÓ›·, Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ÂÓ‰ÔÎÚ¿ÓȘ ·ÈÌÔÚÚ·ÁÈΤ˜ ÂÛٛ˜, ÂÓÒ Ë ÂÓ‰ÔÌ‹ÙÚÈ· ·Ó¿Ù˘Í‹ ÙÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ Ó¢ÚÔ·ÈÛıËÙ‹ÚÈ· ‚·ÚËÎÔ˝· ·ÔÙÂÏ› ÙË ÛËÌ·ÓÙÈÎfiÙÂÚË ÂÈÏÔ΋ Î·È ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 50% ÛÙ· ·È‰È¿ ÌÂ Û˘Ìو̷ÙÈ΋ Ïԛ̈ÍË Î·È Û ÂÚ›Ô˘ 7% ÛÙ· ·È‰È¿ Ì ·Û˘Ìو̷ÙÈ΋ Û˘ÁÁÂÓ‹ Ïԛ̈ÍË (2). ∆Ô ÓÂÔÁÓfi Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Â›¯Â Ê˘ÛÈÔÏÔÁÈÎfi ·ÎÔfiÁÚ·ÌÌ· Û ËÏÈΛ· 3 ÌËÓÒÓ. øÛÙfiÛÔ, Â›Ó·È ÁÓˆÛÙfi fiÙÈ Ôχ Û˘¯Ó¿ Ë ‚·ÚËÎÔ˝· ÂÌÊ·Ó›˙ÂÙ·È ‹ ÂȉÂÈÓÒÓÂÙ·È ÌÂÙ¿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜ (2). ∏ ‰È¿ÁÓˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ ¤ÁÈÓ Ì ηÏÏȤÚÁÂÈ· ÙÔ˘ ÈÔ‡ ÛÙ· Ô‡Ú· ÙËÓ 9Ë Ë̤ڷ ˙ˆ‹˜. ∏ ·ÔÌfiÓˆÛË ÙÔ˘ ÈÔ‡ ÛÙ· Ô‡Ú· Î·È ÛÙÔÓ Û›ÂÏÔ Â›Ó·È Ë ÈÔ ·ÍÈfiÈÛÙË Ì¤ıÔ‰Ô˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ fiÙ·Ó Á›ÓÂÙ·È Ì¤Û· ÛÙȘ ÚÒÙ˜ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜ ˙ˆ‹˜ (1). ∆· ÂȉÈο IgM ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ ‰ÂÓ Û˘Ì‚¿ÏÏÔ˘Ó ¿ÓÙ· ÛÙË ‰È¿ÁÓˆÛË, ηıÒ˜ Â›Ó·È ·ÚÓËÙÈο Û ÔÛÔÛÙfi 10% ÙˆÓ ÓÂÔÁÓÒÓ ÌÂ Û˘Ìو̷ÙÈ΋ Û˘ÁÁÂÓ‹ Ïԛ̈ÍË Î·È Û 30% ÙˆÓ ·Û˘Ìو̷ÙÈÎÒÓ ÓÂÔÁÓÒÓ (13). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ù· IgM ·ÓÙÈÛÒÌ·Ù· ‹Ù·Ó ·ÚÓËÙÈο. °È· ÙË ıÂÚ·›· Ù˘ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë Á·ÓÛÈÎÏÔ‚›ÚË, Û ‰fiÛË 8-12 mg/kg ÁÈ· ‰È¿ÛÙËÌ· 6 ‚‰ÔÌ¿‰ˆÓ ¤ˆ˜ Î·È 12 ÌËÓÒÓ (17-19). ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· ÙÂÎÌËÚȈı› ¤Ó· ıÂÚ·¢ÙÈÎfi Û¯‹Ì· ÁÈ· Ù· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË, ˆÛÙfiÛÔ, ¤¯ÂÈ ¯ÔÚËÁËı› ÂÌÂÈÚÈο Û ÓÂÔÁÓ¿ Ì ÛÔ‚·Ú‹ Û˘ÁÁÂÓ‹ ÓfiÛÔ, Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (17-19). OÈ Û˘ÓËı¤ÛÙÂÚ˜ ·ÚÂÓ¤ÚÁÂȘ Ô˘ ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ıÚÔÌ‚ÔÂÓ›·, ÙËÓ Ô˘‰ÂÙÂÚÔÂÓ›· Î·È ÙËÓ ·‡ÍËÛË ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ (18). ™ÙÔ ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ¯ÔÚËÁ‹ıËΠÁ·ÓÛÈÎÏÔ‚›ÚË, Ë ÔÔ›· ‰È·ÎfiËΠÌÂÙ¿ ·fi Ì›· ‚‰ÔÌ¿‰·, ÏfiÁˆ Ù˘ ıÚÔÌ‚ÔÂÓ›·˜ Ô˘ ÂΉËÏÒıËΠÛÂ Û˘Ó‰˘·ÛÌfi Ì ÛË„·ÈÌ›·. ∏ ÂÓ‰ÔÌ‹ÙÚÈ· Ïԛ̈ÍË ·fi ΢ÙÙ·ÚÔÌÂÁ·ÏÔ˚fi ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ Ôχ‰˘Ì˘ ·ËÛ˘ ÌÂÙ¿ ·fi ÚˆÙÔ·ı‹ Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ (6,14-16). ™˘ÁÁÂÓ‹˜ Ïԛ̈ÍË Û ‰›‰˘ÌÔ ÓÂÔÁÓfi ÌÂÙ¿ ·fi Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ¤¯ÂÈ ·Ó·ÊÂÚı› ¤ˆ˜ ÙÒÚ· Û ̛· ÌfiÓÔ ÂÚ›ÙˆÛË ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (7). ™ÙȘ Ôχ‰˘Ì˜ ΢‹ÛÂȘ, Û ÂÚ›ÙˆÛË ‰È˙˘ÁˆÙÈÎÒÓ ‰È‰‡ÌˆÓ, Ë ÚÔÛ‚ÔÏ‹ ÌÔÚ› Ó· ·ÊÔÚ¿ ›Ù ÛÙÔ ¤Ó· ›ÙÂ Î·È ÛÙ· ‰‡Ô ÓÂÔÁÓ¿, ÂÓÒ Û ÂÚ›ÙˆÛË ÌÔÓÔ˙˘ÁˆÙÈÎÒÓ ‰È‰‡ÌˆÓ ¤¯Ô˘Ì ÚÔÛ‚ÔÏ‹ Û˘Ó‹ıˆ˜ Î·È ÙˆÓ ‰‡Ô ÓÂÔÁÓÒÓ (6). OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙË ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·fi

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ÙË ÌËÙ¤Ú· ÛÙÔ ¤Ì‚Ú˘Ô, ηıÒ˜ Î·È ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÈÔ‡ ÛÙÔ ·Ó·Ù˘ÛÛfiÌÂÓÔ ¤Ì‚Ú˘Ô, ‰ÂÓ Â›Ó·È Â·ÚÎÒ˜ ηٷÓÔËÙÔ› (5). ∏ ‰È·ÊÔÚÂÙÈ΋ ·ÓÙ›‰Ú·ÛË ÙˆÓ Ôχ‰˘ÌˆÓ ÓÂÔÁÓÒÓ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ô Ï·ÎÔ‡ÓÙ·˜ ¤¯ÂÈ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ÛÙËÓ ÚÔÛÙ·Û›· ÙÔ˘ ÂÌ‚Ú‡Ô˘, ·fi fi,ÙÈ Ë ÌËÙÚÈ΋ ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË, ÂÓÒ Î·È ·Ì˘ÓÙÈÎÔ› ÊÚ·ÁÌÔ› ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙË ‰È·ÊÔÚÔÔ›ËÛË ·˘Ù‹˜ Ù˘ ·ÓÙ›‰Ú·Û˘ (5,14). ∏ ÚfiÏË„Ë Ù˘ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢ ·fi ÙÔÓ Èfi ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ¤Ú¢ӷ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ∏ ·Ó¿Ù˘ÍË ÂÓfi˜ ÂÌ‚ÔÏ›Ô˘ ı· ÂÚÈfiÚÈ˙ ÙȘ ÂÈÙÒÛÂȘ Ù˘ ÚˆÙÔ·ıÔ‡˜ Ïԛ̈͢ (1). øÛÙfiÛÔ, Ë ‰˘Ó·ÙfiÙËÙ· ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ Î·È Û˘ÁÁÂÓÔ‡˜ ÓfiÛÔ˘, ·ÎfiÌË Î·È Ì ÙËÓ ·Ó·˙ˆ‡ÚˆÛË ‹ ÙËÓ Â·Ó·Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜, ‰ËÌÈÔ˘ÚÁ› ‰˘ÛÎÔϛ˜ Î·È ÂÚˆÙËÌ·ÙÈο ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ (5). ∏ ·‰˘Ó·Ì›· Úfi‚Ï„˘ ÙˆÓ ÂÈÙÒÛÂˆÓ Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ ÛÙÔ ¤Ì‚Ú˘Ô ÌÂÈÒÓÂÈ ÙÔ fiÊÂÏÔ˜ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ó›¯Ó¢Û˘ Ù˘ Ïԛ̈͢ ÛÙȘ ÂÁ·Ԣ˜ Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·‡ÍËÛË ÙÔ˘ ¿Á¯Ô˘˜ ÙˆÓ ÁÔÓ¤ˆÓ Î·È Û ÌË ··Ú·›ÙËÙ˜ ‰È·ÎÔ¤˜ ·ËÛ˘ (1,5). ∏ Ù‹ÚËÛË ÙˆÓ Î·ÓfiÓˆÓ ˘ÁÈÂÈÓ‹˜ ·fi ÙȘ ÂÁ·Ԣ˜ Î·È Ë ·ÔÊ˘Á‹ ÛÙÂÓ‹˜ Â·Ê‹˜ ÙÔ˘˜ Ì ÂÎÎÚ›ÛÂȘ ·È‰ÈÒÓ ·ÔÙÂÏÔ‡Ó, ÚÔ˜ ÙÔ ·ÚfiÓ, ÙÔÓ ·ÏÔ‡ÛÙÂÚÔ ÙÚfiÔ ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘ (1,5). ∏ ·Ó¿Ù˘ÍË ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ·ÓÙÈ-ÈÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡ Ô˘ ı· ÂÚÈÔÚ›˙Ô˘Ó ÙȘ ·ÒÙÂÚ˜ ÂÈÙÒÛÂȘ Ù˘ Û˘ÁÁÂÓÔ‡˜ Ïԛ̈͢, ÌÔÚ› Ó· ηٷÛÙ‹ÛÂÈ ÛÙÔ Ì¤ÏÏÔÓ ÛËÌ·ÓÙÈÎfi ¤Ó· ·ÓȯÓ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· Ô˘ ı· ÂÓÙÔ›˙ÂÈ Î·È ı· ıÂÚ·‡ÂÈ Ù· ÚÔۂ‚ÏË̤ӷ ÓÂÔÁÓ¿ (5).

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Stagno S, Pass RF, Dworsky ME, Henderson RE, Moore EG, Walton PD et al. Congenital cytomegalovirus infection: the relative importance of primary and recurrent maternal infection. N Engl J Med 1982;306:945-949.

Morris DJ, Sims D, Chiswick M, Das VK, Newton VE. Symptomatic congenital cytomegalovirus infection after maternal recurrent infection. Pediatr Infect Dis J 1994; 13:61-64.

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Stagno S, Tinker MK, Elrod C, Fuccillo DA, Cloud G, O’Beirne AJ. Immunoglobulin M antibodies detected by enzyme-linked immunosorbent assay and radioimmunoassay in the diagnosis of cytomegalovirus infections in pregnant women and newborn infants. J Clin Microbiol 1985;21:930-935.

Duvekot JJ, Theewes BA, Wesdorp JM, Roumen FJ, Bouckaert PX. Congenital cytomegalovirus infection in a twin pregnancy: a case report. Eur J Pediatr 1990;149: 261-262.

Schneeberger PM, Groenendaal F, de Vries LS, van Loon AM, Vroom TM. Variable outcome of a congenital cytomegalovirus infection in a quadruplet after primary infection of the mother during pregnancy. Acta Paediatr 1994;83:986-989.

Seguin J, Cho CT. Congenital cytomegalovirus infection in one monozygotic twin. JAMA 1988;260:3277.

Michaels MG, Greenberg DP, Sabo DL, Wald ER. Treatment of children with congenital cytomegalovirus infection with ganciclovir. Pediatr Infect Dis J 2003;22:504-509.

Whitley RJ, Cloud G, Gruber W, Storch GA, Demmler GJ, Jacobs RF et al. Ganciclovir treatment of symptomatic congenital cytomegalovirus infection: results of a phase II study. J Infect Dis 1997;175:1080-1086.

Nigro G, Scholz H, Bartmann U. Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two-regimen experience. J Pediatr 1994;124: 318-322.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-05-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 16-01-2004 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 115 27, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: tmanour@in.gr

¶·È‰È·ÙÚÈ΋ 2004;67:61-67

£∂ª∞∆∞ ∂∫¶∞π¢∂À™∏™ ∫∞π Oƒ°∞¡ø™∏™ À°∂π∞™

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ISSUES ON HEALTHCARE MANAGEMENT AND EDUCATION

∏ ÛÙÚ·ÙËÁÈ΋ Ù˘ ÔÏÔÎÏËڈ̤Ó˘ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ∫. ¢Ô‡ÚÔ˜

Integrated management of childhood illness: a strategy for developing countries K. Douros

¶ÂÚ›ÏË„Ë: ∫¿ı ¯ÚfiÓÔ, ÂÚ›Ô˘ 11 ÂηÙÔÌ̇ÚÈ· ·È‰È¿ Âı·›ÓÔ˘Ó ÚÈÓ Û˘ÌÏËÚÒÛÔ˘Ó ÙÔ 5Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ ÙÔ˘˜. ∆Ô 70% ·˘ÙÒÓ ÙˆÓ ı·Ó¿ÙˆÓ, Ë ÌÂÁ¿ÏË ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ Û˘Ì‚·›ÓÂÈ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, ÔÊ›ÏÂÙ·È Û ¤ÓÙ ·Èٛ˜ Ô˘ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰È¿ÚÚÔÈ·, ÙȘ ÔÍ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ÙËÓ ÂÏÔÓÔÛ›·, ÙËÓ Î·Î‹ ıÚ¤„Ë Î·È ÙËÓ ÈÏ·Ú¿. ™ÙȘ ·Ú¯¤˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ 1990, Ë ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ (WHO) Î·È Ë UNICEF ·Ó¤Ù˘Í·Ó ÛÙÚ·ÙËÁÈ΋ Ô˘ Â›Ó·È ÁÓˆÛÙ‹ ˆ˜ “ÔÏÔÎÏËڈ̤ÓË ÚÔÛ¤ÁÁÈÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡” (Integrated Management of Childhood Illness IMCI). ™ÎÔfi˜ Ù˘ ‹Ù·Ó Ó· ÂÏ·ÙÙÒÛÂÈ ÙËÓ ·È‰È΋ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· ̤ۈ Ì›·˜ ¢ڇÙÂÚ˘ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È fi¯È ̤ۈ Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ οı ÓÔÛ‹Ì·ÙÔ˜ ͯˆÚÈÛÙ¿. ∏ ÛÙÚ·ÙËÁÈ΋ ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚÂȘ ·ÚÈÔ˘˜ ¿ÍÔÓ˜: ·) ‚ÂÏÙ›ˆÛË Ù˘ ÈηÓfiÙËÙ·˜ ÙˆÓ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜ (È·ÙÚÒÓ Î·È ÌË) ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÛıÂÓÂÈÒÓ ÙˆÓ ·È‰ÈÒÓ, ̤ۈ Ù˘ ·ÚÔ¯‹˜ ηÙ¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ, ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ÚÔÛ·ÚÌÔÛÙÔ‡Ó ÛÙȘ ȉȷ›ÙÂÚ˜ ·Ó¿ÁΘ οı ¯ÒÚ·˜, ‚) ‚ÂÏÙÈÒÛÂȘ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ˘Á›·˜ ÙˆÓ ¯ˆÚÒÓ Î·È Á) ‚ÂÏÙ›ˆÛË ÙˆÓ ÂÊ·ÚÌÔ˙fiÌÂÓˆÓ Ú·ÎÙÈÎÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ, ̤۷ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÛÙËÓ ÎÔÈÓfiÙËÙ·. ∞Ó Î·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÔÏÔÎÏËÚˆı›, ÈÛÙ‡ÂÙ·È, Ì ‚¿ÛË ÙȘ ˘¿Ú¯Ô˘Û˜ ·Ó·ÊÔÚ¤˜, fiÙÈ ı· ·ÔÙÂϤÛÂÈ ¤Ó· ÛËÌ·ÓÙÈÎfi ÂÚÁ·ÏÂ›Ô ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜.

Abstract: Each year, approximately 11 million children in developing countries die before their fifth birthday. Seventy per cent of these deaths are caused by five preventable and treatable diseases, namely malaria, diarrhoea, pneumonia, measles and malnutrition, either alone or in combination. In the early 1990s, the World Health Organization (WHO) and UNICEF developed the Integrated Management of Childhood Illness (IMCI) strategy.

IMCI aims to reduce childhood morbidity and mortality through an approach which emphasizes overall child health and not, as used to be the case, the management of single diseases. This strategy has three main goals: a) to provide flexible guidelines that can be adjusted to each country’s special needs, b) to help countries improve their health systems, and c) to improve family and community practices related to children’s health.

Although the evaluation of this strategy has not yet been completed, it is believed on the basis of early reports that it will offer a robust model for the improvement of the health of children in developing countries.

§¤ÍÂȘ ÎÏÂȉȿ: ÂÓÔÔÈË̤ÓË, ÛÙÚ·ÙËÁÈ΋, ˘Á›·, ·È‰›, ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜.

Key words: integrated, strategy, health, childhood, developing countries.

∂ıÓÈ΋ ™¯ÔÏ‹ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ Î·È ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì· °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “£ÚÈ¿ÛÈÔ”, ∂ÏÂ˘Û›Ó·

National School of Public Health and Paediatric Department “Thriassio” General Hospital, Elefsina

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∂ÈÛ·ÁˆÁ‹ ∆· ÙÂÏÂ˘Ù·›· 35 ¯ÚfiÓÈ·, Ë ·È‰È΋ ıÓËÛÈÌfiÙËÙ· Û˘ÓÔÏÈο ÛËÌÂÈÒÓÂÈ Û˘Ó¯‹ ÙÒÛË, Ì ÙË Ì›ˆÛË Ó· ÊÙ¿ÓÂÈ Î·Ù¿ ̤ÛÔ fiÚÔ ÙÔ 1% ·Ó¿ ¤ÙÔ˜ (1,2). O ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ Ô˘ Âı·›ÓÔ˘Ó ¤¯ÂÈ ÌÂȈı› ·fi 15 ÂηÙÔÌ̇ÚÈ· ÙÔ 1980 Û ÂÚ›Ô˘ 11 ÂηÙÔÌ̇ÚÈ· ÛÙÔ Ù¤ÏÔ˜ Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’90. ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ì›ˆÛË ·˘Ù‹ Û˘Ó¤‚Ë ·Ú¿ ÙËÓ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÁÂÓÓ‹ÛˆÓ, ÙË Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓË ·ÓÙ›ÛÙ·ÛË ÛÙ· ÎÔÈÓ¿ ·ÓÙÈ‚ÈÔÙÈο Î·È Ù· ·ÓıÂÏÔÓÔÛȷο Ê¿Ú̷η ηÈ, ΢ڛˆ˜, ·Ú¿ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·Ó‰ËÌ›·˜ ÙÔ˘ AIDS. ∂ÓÙÔ‡ÙÔȘ, ·fi Ì›· ÏÂÙÔÌÂÚ‹ ÂͤٷÛË ·˘ÙÒÓ ÙˆÓ ÛÙÔȯ›ˆÓ ÚÔ·ÙÂÈ fiÙÈ Ë ÚfiÔ‰Ô˜ ‰ÂÓ Â›Ó·È ÔÌÔÈfiÌÔÚÊ· ηٷÓÂÌË̤ÓË. ∏ ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Û ÌÂÚÈΤ˜ ¯ÒÚ˜ ¤¯ÂÈ ÛÙ·Ì·Ù‹ÛÂÈ, ÂÓÒ Û οÔȘ ¿ÏϘ Ë Ù¿ÛË ¤¯ÂÈ ·ÓÙÈÛÙÚ·Ê›. ∆Ô 1998, Ë ıÓËÛÈÌfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ οو ÙˆÓ 5 ÂÙÒÓ Û 50 ¯ÒÚ˜ ‹Ù·Ó ¿Óˆ ·fi 100 ı¿Ó·ÙÔÈ ·Ó¿ 1000 ÁÂÓÓ‹ÛÂȘ. ™Â 12 ¯ÒÚ˜, 11 ·fi ÙȘ Ôԛ˜ ‚Ú›ÛÎÔÓÙ·È ÛÙËÓ ∞ÊÚÈ΋, 1 ÛÙ· 5 ·È‰È¿ ‰ÂÓ Êı¿ÓÂÈ ÔÙ¤ ÛÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ. ∞fi ÙÔ˘˜ 11 ÂηÙÔÌ̇ÚÈ· ı·Ó¿ÙÔ˘˜ ·È‰ÈÒÓ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ Ô˘ Û˘Ì‚·›ÓÔ˘Ó Î¿ı ¯ÚfiÓÔ, ÙÔ 70% ÔÊ›ÏÂÙ·È Û ¤ÓÙ ÌfiÓÔ ÓÔÛ‹Ì·Ù· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÔÍ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ (΢ڛˆ˜ Ó¢ÌÔÓ›·), ‰È¿ÚÚÔÈ·, ÈÏ·Ú¿, ÂÏÔÓÔÛ›· Î·È Î·Î‹ ıÚ¤„Ë ‹ Û˘Ó‰˘·ÛÌÔ‡˜ ·˘ÙÒÓ (1,2). ∂ȉÈÎfiÙÂÚ·, Ë Î·Î‹ ıÚ¤„Ë Ê·›ÓÂÙ·È fiÙÈ Û˘Ì‚¿ÏÏÂÈ ÛÙÔ 50% ÂÚ›Ô˘ ÙˆÓ ı·Ó¿ÙˆÓ (3). ∞Ó¿Ï˘ÛË Ô˘ ¤ÁÈÓ Ì ‚¿ÛË Ù· ÛÙÔȯ›· ÙÔ˘ 1990 ¤‰ÂÈÍ fiÙÈ Ù· ÓÔÛ‹Ì·Ù· ·˘Ù¿ ı· Û˘Ó¯›ÛÔ˘Ó Ó· ·ÔÙÂÏÔ‡Ó ÙȘ ·ÚȘ ·Èٛ˜ ·È‰È΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì¤¯ÚÈ Î·È ÙÔ 2020, ÂÎÙfi˜ Â¿Ó ÏËÊıÔ‡Ó ‰Ú·ÛÙÈο ̤ÙÚ· ÁÈ· ÙÔÓ ¤ÏÂÁ¯fi ÙÔ˘˜ (4). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·ÓˆÙ¤Úˆ, ÌfiÓÔ ÙÔ 2% ·ÓÙÈÛÙÔȯ› ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (5). ∞fi Ù· ˘¿Ú¯ÔÓÙ· ÛÙÔȯ›· ÚÔ·ÙÂÈ fiÙÈ Â›Ó·È ÂÈÙ·ÎÙÈ΋ Ë ÙÚÔÔÔ›ËÛË Ù˘ ÔÏÈÙÈ΋˜ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È Ì¤¯ÚÈ Û‹ÌÂÚ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ‚ÂÏÙȈı› Ë ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ıÓËÛÈÌfiÙËÙ·˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜. ∆¤ÏÔ˜, Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Û˘ÁηٷϤÁÂÙ·È ÛÙȘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚ˜ ·ÚÂÌ‚¿ÛÂȘ, fiÛÔÓ ·ÊÔÚ¿ ÛÙÔ ÎfiÛÙÔ˜-fiÊÂÏÔ˜, ÛÙȘ ¯·ÌËÏÔ‡ Î·È Ì¤ÛÔ˘ ÂÈÛÔ‰‹Ì·ÙÔ˜ ¯ÒÚ˜ (6). ∏ ·Ó¿Ù˘ÍË Ù˘ ÔÏÔÎÏËڈ̤Ó˘ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ∏ ÔÏÔÎÏËڈ̤ÓË ÚÔÛ¤ÁÁÈÛË Û˘Ó›ÛÙ·Ù·È ÛÙÔÓ Û˘ÓÙÔÓÈÛÌfi ‰È·ÊfiÚˆÓ ‰Ú·ÛÙËÚÈÔًوÓ, Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÛÙËÓ ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ˘Á›·˜. ™ÙȘ ‰ÂηÂٛ˜ ÙÔ˘ ’50 ηÈ

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ÙÔ˘ ’60, ÔÈ ÛÙÚ·ÙËÁÈΤ˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ‰È·ÊfiÚˆÓ ÓÔÛËÌ¿ÙˆÓ Û ÔÏϤ˜ ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜ Î·È Ù˘ ∞Û›·˜ ÂÛÙÈ¿ÛÙËÎ·Ó Û οıÂÙ· ÚÔÁÚ¿ÌÌ·Ù·. ∆· οıÂÙ· ÚÔÁÚ¿ÌÌ·Ù· Â›Ó·È Ì›· ÛÂÈÚ¿ ‰ÔÌÒÓ, ˘‡ı˘ÓˆÓ ÁÈ· ÙËÓ ÔÚÁ¿ÓˆÛË ÂÓfi˜ Û˘ÓfiÏÔ˘ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Î·È ‰È·¯Â›ÚÈÛ˘ fiÚˆÓ, Ô˘ ·ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Û ¤Ó· ÌfiÓÔ Úfi‚ÏËÌ· ˘Á›·˜ (7). ∏ ÏÔÁÈ΋ ·˘Ù‹ ‹Ù·Ó ‰ÈηÈÔÏÔÁË̤ÓË, ηıÒ˜ Ù· οıÂÙ· ÚÔÁÚ¿ÌÌ·Ù· ·ÔÙÂÏÔ‡Û·Ó ÙË ÌfiÓË Ú·ÏÈÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÁÈ· ÙË ÁÚ‹ÁÔÚË ÂÏ¿ÙÙˆÛË ÙfiÛÔ Ù˘ ÓÔÛËÚfiÙËÙ·˜ fiÛÔ Î·È Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Û˘ÁÎÂÎÚÈ̤ӷ ÓÔÛ‹Ì·Ù·, ÔÈ Ôԛ˜ ‹Ù·Ó ȉȷ›ÙÂÚ· ·˘ÍË̤Ó˜. ∫¿ÔÈ· ·fi Ù· οıÂÙ· ÚÔÁÚ¿ÌÌ·Ù·, fiˆ˜ Ù· ÂÎÙÂٷ̤ӷ ÚÔÁÚ¿ÌÌ·Ù· ÁÈ· ÙËÓ ÂÓÂÚÁËÙÈ΋ ·ÓÔÛÔÔ›ËÛË Î·È ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÂÏÔÓÔÛ›·˜, ‹Ù·Ó ÂÈÙ˘¯Ë̤ӷ Û ·ÚÎÂÙ¤˜ ¯ÒÚ˜, ÂÓÒ Û ¿ÏϘ ˘‹Ú¯·Ó ÛËÌ·ÓÙÈÎÔ› ÂÚÈÔÚÈÛÌÔ› ÛÙËÓ ·ÚfiÛÎÔÙË ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜, ÏfiÁˆ Ù˘ ‰˘ÛÎÔÏ›·˜ ÛÙËÓ Â͇ÚÂÛË ÙˆÓ ··Ú·›ÙËÙˆÓ fiÚˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ Úfi‚ÏËÌ· ÙˆÓ ÓÔÛËÌ¿ÙˆÓ, ÛÙ· ÔÔ›· ÂÛÙÈ¿˙ÔÓÙ·Ó Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÚÔÁÚ¿ÌÌ·Ù·, Ó· ·Ú·Ì¤ÓÂÈ. ™ÙË °Î¿Ó·, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ›¯·Ó ÂÊ·ÚÌÔÛÙ› ·ÚÎÂÙ¿ οıÂÙ· ÚÔÁÚ¿ÌÌ·Ù·, fiˆ˜ ÙÔ ÂÎÙÂٷ̤ÓÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ, ÚÔÁÚ¿ÌÌ·Ù· ÂϤÁ¯Ô˘ ÁÈ· ÙȘ ‰È·ÚÚÔ˚Τ˜ ÓfiÛÔ˘˜, ÙÔ AIDS, ÙËÓ ÂÏÔÓÔÛ›·, ÙË Ï¤Ú· Î·È ÙË Ê˘Ì·Ù›ˆÛË. ∂ÓÙÔ‡ÙÔȘ, ÙÔ 1991, Ë ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ (WHO) ·Ó¤ÊÂÚ fiÙÈ Â›¯Â ÛËÌÂȈı› ÌÈÎÚ‹ ÌfiÓÔ ‚ÂÏÙ›ˆÛË ÛÙÔ Â›Â‰Ô ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ Ù˘ ¯ÒÚ·˜. ŒÓ· ·fi Ù· ÚÔ‚Ï‹Ì·Ù· ‹Ù·Ó Ë ¤ÏÏÂÈ„Ë Û˘ÓÙÔÓÈÛÌÔ‡ ·Ó¿ÌÂÛ· ÛÙ· ‰È·ÊÔÚÂÙÈο ÚÔÁÚ¿ÌÌ·Ù· (8). ∂›Û˘, Û‡Ìʈӷ Ì ·Ó·ÊÔÚ¤˜ ·fi ÙËÓ ∆·Ó˙·Ó›· Î·È ÙÔ ∑·˝Ú, ÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÁÈ· ÙËÓ ÈÏ·Ú¿ ·¤Ù˘¯Â Ó· ÌÂÈÒÛÂÈ ÙË ıÓËÛÈÌfiÙËÙ· ÛÙȘ ËÏÈ˘ οو ÙˆÓ 5 ÂÙÒÓ, ÂÍ·ÈÙ›·˜ Ù˘ Û˘Ó‡·Ú͢ ÂÏÔÓÔÛ›·˜ Î·È ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ Ô˘ ‰ÂÓ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·Ó Ì ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÚÔÛ¤ÁÁÈÛË (9). Œ¯ÂÈ Á›ÓÂÈ ÂÌÊ·Ó¤˜, ϤÔÓ, fiÙÈ Ë ·ÓÂÈı‡ÌËÙË Û˘Ó¤ÂÈ· Ù˘ οıÂÙ˘ ÚÔÛ¤ÁÁÈÛ˘ ÛÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ Â›Ó·È Ë Î·Ù¿ÙÌËÛË ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ˘ËÚÂÛÈÒÓ Û ÂÍÂȉÈÎÂ˘Ì¤Ó· ÎÔÌÌ¿ÙÈ·. ∏ ηٿÙÌËÛË ·˘Ù‹ ÌÔÚ› Ó· ÂÏ·ÙÙÒÛÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÚÔ¯‹˜ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ̤ۈ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È ÙˆÓ ‰˘ÛÎÔÏÈÒÓ ÛÙËÓ Â›‚ÏÂ„Ë Î·È ÛÙË ÏÔÁÈÛÙÈ΋ ‰È·¯Â›ÚÈÛË. ∞·ÈÙÂ›Ù·È ÂÚÈÛÛfiÙÂÚÔ ÚÔÛˆÈÎfi ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· fiÏˆÓ ÙˆÓ ˘ËÚÂÛÈÒÓ, ÂÓÒ ÔÈ ¯Ú‹ÛÙ˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‰··ÓÔ‡Ó Ôχ ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ Û ۇÁÎÚÈÛË Ì ÙË Û˘ÓÔÏÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘˜ ·fi ¤Ó· ÌfiÓÔ ÎÔÌÌ¿ÙÈ ÙÔ˘. ∂ÈϤÔÓ, Ù· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ÂÌÊ·Ó›˙ÔÓÙ·È ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›· ·ÚÚÒÛÙȘ. ∞˘Ù‹ Ë ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë

¶·È‰È·ÙÚÈ΋ 2004;67:61-67

ÛËÌ·›ÓÂÈ fiÙÈ Ì›· ÌÔÓ·‰È΋ ‰È¿ÁÓˆÛË Â›Ó·È Û˘¯Ó¿ ·‰‡Ó·ÙË ‹ ·Î·Ù¿ÏÏËÏË, ‰Â‰Ô̤Ó˘ Ù˘ Û·ÓÈfiÙËÙ·˜ ÙˆÓ ˘Ô‰ÔÌÒÓ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ ÂϤÁ¯Ô˘ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, Ù˘ Û˘¯Ó‹˜ Û˘Ó‡·Ú͢ ‰È·ÊÔÚÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙ· ·È‰È¿ ·˘ÙÒÓ ÙˆÓ ¯ˆÚÒÓ Î·È ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ıÂÚ·›· ÌÔÚ› Ó· Á›ÓÂÈ ÔχÏÔÎË ·fi ÙËÓ ·Ó¿ÁÎË Û˘Ó‰˘·ÛÌÔ‡ Ê·ÚÌ¿ÎˆÓ ÁÈ· ‰È·ÊÔÚÂÙÈΤ˜ ηٷÛÙ¿ÛÂȘ (9). ª›· ÌÂϤÙË Ô˘ ‹Úı ӷ ÂȂ‚·ÈÒÛÂÈ fiÏ· ·˘Ù¿, ¤ÁÈÓ ÙÔ 1991 ÛÙÔ ª·Ï¿Ô˘È Î·È ¤‰ÂÈÍ ÙËÓ ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ Ó¢ÌÔÓ›·˜ Î·È Ù˘ ÂÏÔÓÔÛ›·˜, ηıÒ˜ Î·È ÙÔ fiÙÈ ÔÈ ‰‡Ô ·˘Ù¤˜ ηٷÛÙ¿ÛÂȘ ı· ÌÔÚÔ‡Û·Ó Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ù·˘Ùfi¯ÚÔÓ· Î·È ·ÔÙÂÏÂÛÌ·ÙÈο ÌfiÓÔ Ì ÎÔÙÚÈÌÔÍ·˙fiÏË (10). ∆Ô 1990, Ë WHO Â¤ÛÙËÛ ÙËÓ ÚÔÛÔ¯‹ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÂÚ·ÈÙ¤Úˆ ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi ‰È¿ÚÚÔÈ· ‰ÂÓ ÌÔÚÔ‡Û ϤÔÓ Ó· ‚·ÛÈÛÙ› ÌfiÓÔ ÛÙËÓ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚ‹ÁËÛË ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ï˘Ì¿ÙˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ‰È·Ï‡Ì·Ù· ·˘Ù¿ ›¯·Ó ÌÈÎÚ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Û ‰‡Ô ÌÂÁ¿Ï˜ ÔÌ¿‰Â˜ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ, ÔÈ Ôԛ˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó ·È‰È¿ Ì ¯ÚfiÓÈ· ‰È¿ÚÚÔÈ· Î·È ·È‰È¿ Ì ‰˘ÛÂÓÙÂÚ›· Î·È ·ÔÙÂÏÔ‡Û·Ó ÙÔ 35% Î·È ÙÔ 15% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·Û¯fiÓÙˆÓ ·fi ‰È¿ÚÚÔÈ· ·È‰ÈÒÓ, ·ÓÙ›ÛÙÔȯ·. °È· ÙËÓ ÚÒÙË ÔÌ¿‰· ··ÈÙÔ‡ÓÙ·Ó Ì›· ÚÔÛ¤ÁÁÈÛË ‚·ÛÈṲ̂ÓË ÛÙË ‰›·ÈÙ·, ÂÓÒ ÁÈ· ÙË ‰Â‡ÙÂÚË Ì›· ıÂÚ·›· Ì ÙÔ Î·Ù¿ÏÏËÏÔ ·ÓÙÈ‚ÈÔÙÈÎfi. ŒÙÛÈ, ÔÈ ÚÔÛ¿ıÂȘ ÁÈ· ÙË Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ·fi Ù· ‰È·ÚÚÔ˚ο ÓÔÛ‹Ì·Ù· ̤ۈ Ù˘ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÂÓ˘‰¿ÙˆÛ˘ ı· ¤ÚÂ ӷ ÂÓۈ̷وıÔ‡Ó Û ̛· ¢ڇÙÂÚË ÚÔÛ¤ÁÁÈÛË (9,11). ∆Ô Ì¤ÁÂıÔ˜ Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙȘ ¤ÓÙ ·ÚȘ ·Èٛ˜ Ô˘ ÚԷӷʤÚıËηÓ, ‰ÂÓ ·ÔÙ¤ÏÂÛ ·fi ÌfiÓÔ ÙÔ˘ ÙËÓ ·ÈÙ›· ÁÈ· ÙËÓ ·ÏÏ·Á‹ Ù˘ ÔÏÈÙÈ΋˜ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜. ∆· ‰Â‰Ô̤ӷ Ô˘ Û˘ÛÛˆÚ‡ÙËÎ·Ó ÌÂÙ¿ ·fi ¯ÚfiÓÈ· ¯Ú‹Û˘ οıÂÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÏÏ·Á‹ ÚÔ˜ ¤Ó· ÂÓÔÔÈË̤ÓÔ ÌÔÓÙ¤ÏÔ, ÙÔ ÔÔ›Ô ı· ÛÙfi¯Â˘Â ¢ڇÙÂÚ· ·fi ÙËÓ Î¿ı ÓfiÛÔ Í¯ˆÚÈÛÙ¿ Î·È ı· ·ÓÙÈÌÂÙÒÈ˙ ÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ ˆ˜ ¤Ó· ÂÓÈ·›Ô Û‡ÓÔÏÔ, ‹Ù·Ó ÂȂ‚ÏË̤ÓË. ŒÙÛÈ, ÌÂÙ¿ ·fi Û˘ÓÂÚÁ·Û›· Ù˘ WHO Ì ÙËÓ UNICEF ÚԤ΢„ ̛· ÛÙÚ·ÙËÁÈ΋, ÁÓˆÛÙ‹ ˆ˜ “ÔÏÔÎÏËڈ̤ÓË ÚÔÛ¤ÁÁÈÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡” (Integrated Management of Childhood Illness IMCI). ∞Ó Î·È ÙÔ Î˘ÚÈfiÙÂÚÔ ÂÚ¤ıÈÛÌ· ÁÈ· ÙËÓ ·Ó¿Ù˘Í‹ Ù˘ ‹Ù·Ó Ë ·Ó¿ÁÎË ıÂÚ·¢ÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Ë ÛÙÚ·ÙËÁÈ΋ ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ - ÂÎÙfi˜ ·fi ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ - ÙËÓ ˘ÔÛÙ‹ÚÈÍË Ù˘ ıÚ¤„˘ Î·È Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘, ηıÒ˜ Î·È ¿ÏÏ· ÛÙÔȯ›· ÚfiÏ˄˘ Î·È ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜.

O ·ÓÙÈÎÂÈÌÂÓÈÎfi˜ Ù˘ ÛÙfi¯Ô˜ Â›Ó·È Ë ÂÏ¿ÙÙˆÛË Ù˘ Û˘ÓÔÏÈ΋˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Î·È Ë ‚ÂÏÙ›ˆÛË Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ·È‰ÈÒÓ.

Paediatriki 2004;67:61-67

∫‡ÚÈÔÈ ¿ÍÔÓ˜ ·Ú¤Ì‚·Û˘ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ™ÙÔÓ ˘Ú‹Ó· Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ‚Ú›ÛÎÂÙ·È Ë ÔÏÔÎÏËڈ̤ÓË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÛÛfiÙÂÚÔ ÎÔÈÓÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ Û˘Ó·ÓÙÒÓÙ·È ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, Ì ȉȷ›ÙÂÚË ÂÈΤÓÙÚˆÛË Û ·˘Ù¿ Ô˘ ·ÔÙÂÏÔ‡Ó ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·Èٛ˜ ı·Ó¿ÙÔ˘. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ¤Ó·Ó ÌÂÁ¿ÏÔ ·ÚÈıÌfi ıÂÚ·¢ÙÈÎÒÓ Î·È ÚÔÏËÙÈÎÒÓ Ú·ÎÙÈÎÒÓ ÁÈ· ÂÊ·ÚÌÔÁ‹ fi¯È ÌfiÓÔ ÛÙȘ ÌÔÓ¿‰Â˜ ˘Á›·˜, ·ÏÏ¿ Î·È Ì¤Û· ÛÙȘ ÎÔÈÓfiÙËÙ˜ Î·È Ù· Û›ÙÈ·. ∏ ÛÙÚ·ÙËÁÈ΋ ÚԂϤÂÙ·È Ó· ‰È¢ڢÓı› ÛÙÔ Ì¤ÏÏÔÓ, ¤ÙÛÈ ÒÛÙ ӷ Û˘ÌÂÚÈÏ¿‚ÂÈ Ï‹Úˆ˜ Î·È ¿ÏϘ ÏÂÈÙÔ˘ÚÁ›Â˜, fiˆ˜ Ë ÛˆÌ·ÙÈ΋ Î·È „˘¯È΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡, Ë ·Ú·Ì¤ÏËÛË Î·È Î·ÎÔÔ›ËÛË, Ë ÓÂÔÁÓÈ΋ ÊÚÔÓÙ›‰·, ÙÔ AIDS Î.Ï. ªÂ ·˘Ù¤˜ ÙȘ ÂÈϤÔÓ ÚÔÛı‹Î˜, Ë ÛÙÚ·ÙËÁÈ΋ ı· ÌÔÚ› Ó· ıˆÚËı› Û·Ó Ì›· ÌÂÁ¿ÏË ÔÌڤϷ Ô˘ ı· ¤¯ÂÈ ÂÊ·ÚÌÔÁ‹ fi¯È ÌfiÓÔ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜, ·ÏÏ¿ Î·È ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, fiÔ˘ οı ¯ÒÚ· ı· ÌÔÚ› Ó· ‰È·Ï¤ÁÂÈ ÂΛӷ Ù· ÛÙÔȯ›· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ô˘ Û˘ÌʈÓÔ‡Ó Ì ÙȘ ÂıÓÈΤ˜ Ù˘ ÚÔÙÂÚ·ÈfiÙËÙ˜. ™ÙËÓ ·ÚÔ‡Û· Ù˘ ÌÔÚÊ‹ ÌÔÚ› Ó· ¯ˆÚÈÛÙ› Û ÙÚÂȘ ·ÚÈÔ˘˜ ¿ÍÔÓ˜ (9): ·) µÂÏÙ›ˆÛË ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙˆÓ ÏÂÈÙÔ˘ÚÁÒÓ ˘Á›·˜ (È·ÙÚÈÎÔ‡ Î·È ÌË È·ÙÚÈÎÔ‡ ÚÔÛˆÈÎÔ‡) ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ̤ۈ Ù˘ Û‡ÓÙ·Í˘ ηÙ¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Û¯ÂÙÈο Ì ÙËÓ ÔÏÔÎÏËڈ̤ÓË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·È‰È΋˜ ÓfiÛÔ˘. ¶ÚԂϤÔÓÙ·È Û˘ÁÎÂÎÚÈ̤Ó˜ ÂÎ·È‰Â˘ÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË Î·È ÙËÓ ÔÚı‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÂÓ ÏfiÁˆ Ô‰ËÁÈÒÓ. ‚) µÂÏÙÈÒÛÂȘ ÛÙ· Û˘ÛÙ‹Ì·Ù· ˘Á›·˜, ÔÈ Ôԛ˜ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÚ·ÙËÁÈ΋˜. Á) µÂÏÙ›ˆÛË ÙˆÓ Ú·ÎÙÈÎÒÓ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È ·fi ÙȘ ÔÈÎÔÁ¤ÓÂȘ Î·È ÙȘ ÙÔÈΤ˜ ÎÔÈӈӛ˜ Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ. ∫·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ (9,12,13) O ÚˆÙ·Ú¯ÈÎfi˜ ÛÎÔfi˜ ÁÈ· ÙË Û‡ÓÙ·ÍË ÙˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ‹Ù·Ó Ë ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂÚ·›· ÙˆÓ ÔÍÂÈÒÓ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ù˘ ‰È¿ÚÚÔÈ·˜, Ù˘ ÈÏ·Ú¿˜, Ù˘ ÂÏÔÓÔÛ›·˜ Î·È Ù˘ η΋˜ ıÚ¤„˘. OÈ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÛÙËÚȯı› Û ̛· ‚·ÛÈṲ̂ÓË Û ÂӉ›ÍÂȘ (evidence based) ÚÔÛ¤ÁÁÈÛË Î·È ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ÔÚıÔÏÔÁÈ΋ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ Î·È ‰È·ÁÓˆÛÙÈÎÒÓ ÂÚÁ·Ï›ˆÓ. ∏ ‚·ÛÈṲ̂ÓË Û ÂӉ›ÍÂȘ È·ÙÚÈ΋ ˘ÔÛÙËÚ›˙ÂÈ ÙË ÛËÌ·Û›· Ù˘ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÛÙÔȯ›ˆÓ ·fi ÙËÓ ¤Ú¢ӷ Î·È ·ÔÙÚ¤ÂÈ ÙË ¯Ú‹ÛË Ù˘ ‰È·›ÛıËÛ˘, Ù˘ ÌË Û˘ÛÙËÌ·ÙÈ΋˜ ÎÏÈÓÈ΋˜ ÂÌÂÈÚ›·˜ Î·È ÙˆÓ ÌË ·ԉ‰ÂÈÁÌ¤ÓˆÓ ·ıÔÊ˘ÛÈÔÏÔÁÈÎÒÓ Û˘ÏÏÔÁÈÛÌÒÓ ÛÙË ‰È·‰Èηۛ· Ï‹„˘ È·ÙÚÈÎÒÓ ·ÔÊ¿ÛÂˆÓ (14). ™ÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜, Ë ÂÚÁ·ÛÙËÚȷ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ‰È¿ÁÓˆÛ˘ Â›Ó·È ÂÏ¿¯ÈÛÙË

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‹ Î·È ·Ó‡·ÚÎÙË. ∞˘Ùfi˜ Ô˘ ı· ÎÏËı› Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙÔ Úfi‚ÏËÌ·, Ô ÔÔ›Ô˜ ÔÏϤ˜ ÊÔÚ¤˜ ‰ÂÓ Â›Ó·È ÁÈ·ÙÚfi˜, ı· Ú¤ÂÈ Ó· ÛÙËÚȯÙ› ÌfiÓÔ ÛÙÔ ÈÛÙÔÚÈÎfi, ÛÙ· ÛËÌ›· Î·È ÛÙ· Û˘ÌÙÒÌ·Ù·. ŒÙÛÈ, ÔÈ Ô‰ËÁ›Â˜ ·˘Ù¤˜ ¤¯Ô˘Ó ‰ÔÌËı› Ì ‚¿ÛË Ì›· ÛÂÈÚ¿ ·ÏÒÓ ÂÚˆÙ‹ÛÂˆÓ ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Â‡ÎÔÏ· ·Ó·ÁÓˆÚ›ÛÈÌˆÓ ÛËÌ›ˆÓ Î·È Û˘Ìو̿وÓ. µ¤‚·È·, ÔÈ Ô‰ËÁ›Â˜ ·˘Ù¤˜ Â›Ó·È ·ÚÎÂÙ¿ ÁÂÓÈΤ˜ ηÈ, ÚÈÓ ·Ú¯›ÛÔ˘Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È, ı· Ú¤ÂÈ Ó· ÚÔÛ·ÚÌÔÛÙÔ‡Ó ÛÙȘ ·Ó¿ÁΘ Ù˘ οı ¯ÒÚ·˜. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi, ¤¯ÂÈ Û˘ÓÙ·¯ı› ·fi ÙËÓ WHO ÂȉÈÎfi˜ Ô‰ËÁfi˜ (15). ∏ ÚÔÛ·ÚÌÔÁ‹ ··ÈÙÂ›Ù·È ¤ÙÛÈ ÒÛÙ ÔÈ ‰È·‰Èηۛ˜ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI Ó· Â›Ó·È Û‡ÌʈÓ˜ Ì ÙËÓ ÙÔÈ΋ ÂȉËÌÈÔÏÔÁ›·. ™·Ó ·Ú·‰Â›ÁÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Ë ÂÈÏÔÁ‹ ÚÒÙ˘ Î·È ‰Â‡ÙÂÚ˘ ÁÚ·ÌÌ‹˜ ·ÓıÂÏÔÓÔÛÈ·ÎÒÓ Ê·ÚÌ¿ÎˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ ·Ú·Û›ÙÔ˘ ÛÙË ¯ÒÚ·, Ë ÂÈÏÔÁ‹ ÙÚÔÊÒÓ ÁÈ· ¯ÔÚ‹ÁËÛË ‰È·ÈÙËÙÈ΋˜ ·ÁˆÁ‹˜ Ô˘ Ó· ÌËÓ Â›Ó·È Í¤Ó˜ Ì ÙȘ ÙÔÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ Û˘Ó‹ıÂȘ Î·È Ë ¯Ú‹ÛË ÙÔÈÎÒÓ fiÚˆÓ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË ÂÈÎÔÈÓˆÓ›· Ì ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ·È‰ÈÔ‡. ∏ ‰È·‰Èηۛ· ÚÔÛ·ÚÌÔÁ‹˜ ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ¿ÏÏ· ÓÔÛ‹Ì·Ù·. ™ÙË ¡∞ ∞Û›·, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ¯ÒÚ˜ ¤¯Ô˘Ó Û˘ÌÂÚÈÏ¿‚ÂÈ ÙÔÓ ‰¿ÁÎÂÈÔ ·ÈÌÔÚÚ·ÁÈÎfi ˘ÚÂÙfi ÛÙÔ ÙÌ‹Ì· ÙˆÓ Ô‰ËÁÈÒÓ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ˘ÚÂÙÔ‡, ÂÓÒ Û ¿ÏϘ ÂÚÈÙÒÛÂȘ ¤¯ÂÈ Û˘ÌÂÚÈÏËÊı› Ë ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ ÌÂ Û˘ÚÈÁÌfi (9). OÈ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ‚·Û›˙ÔÓÙ·È ÛÙȘ ·ÎfiÏÔ˘ı˜ ·Ú¯¤˜ (12,13,16): ·) ŸÏ· Ù· ¿ÚÚˆÛÙ· ·È‰È¿, ÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ ÙˆÓ ‚ÚÂÊÒÓ, Ú¤ÂÈ Ó· ÂÍÂÙ¿˙ÔÓÙ·È ÁÈ· ÁÂÓÈο ÛËÌ›· ÎÈÓ‰‡ÓÔ˘, Ù· ÔÔ›· ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· ¿ÌÂÛË ·Ú·ÔÌ‹ Î·È ÂÈÛ·ÁˆÁ‹ Û ¤Ó· ÓÔÛÔÎÔÌ›Ô. ‚) ŸÏ· Ù· ¿ÚÚˆÛÙ· ·È‰È¿ ËÏÈΛ·˜ ·fi 2 ÌËÓÒÓ ¤ˆ˜ 5 ÂÙÒÓ ı· Ú¤ÂÈ Ó· ÂÎÙÈÌÒÓÙ·È ÁÈ· Ù· “·ÚÈ· Û˘ÌÙÒÌ·Ù·”, ‰ËÏ·‰‹ ‚‹¯· ‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ‰È¿ÚÚÔÈ· Î·È ˘ÚÂÙfi. ∂›Û˘, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÎÙ›ÌËÛË ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË ıÚ¤„˘ Î·È ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë. Á) ÃÚËÛÈÌÔÔÈÂ›Ù·È ÌfiÓÔ ¤Ó·˜ ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ, Ô˘ ¤¯Ô˘Ó ÂÈÏÂÁ› ÚÔÛÂÎÙÈο, Ì ‚¿ÛË ÙËÓ Â˘·ÈÛıËÛ›· Î·È ÙËÓ ÂȉÈÎfiÙËÙ¿ ÙÔ˘˜ ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÓfiÛˆÓ. ‰) O Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÛËÌ›ˆÓ Ô‰ËÁ› ÛÙËÓ “Ù·ÍÈÓfiÌËÛË” ÙÔ˘ ·È‰ÈÔ‡ Î·È fi¯È ··Ú·›ÙËÙ· ÛÙË ‰È¿ÁÓˆÛË. ∏ Ù·ÍÈÓfiÌËÛË ·ÔÙÂÏ› ÏÂÈÙÔ˘ÚÁÈÎfi fiÚÔ Î·È Â›Ó·È ·˘Ù‹ Ô˘ ı· ‰ÒÛÂÈ ÙȘ ηÙ¢ı‡ÓÛÂȘ ÁÈ· ÙË ıÂÚ·›· Î·È ÁÂÓÈÎfiÙÂÚ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ∏ Ù·ÍÈÓfiÌËÛË ˘Ô‰ÂÈÎÓ‡ÂÈ ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È ÙȘ ÂÓ¤ÚÁÂȘ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙË ÌÂÙ·ÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ Û ¤Ó· ΤÓÙÚÔ ˘„ËÏfiÙÂÚ˘ ‚·ıÌ›‰·˜, ÙË ¯ÔÚ‹ÁËÛË ÂȉÈ΋˜ ıÂÚ·›·˜ Â› ÙfiÔ˘ ‹ ÙËÓ ·ÚÔ¯‹ Ô‰ËÁÈÒÓ ÛÙÔ˘˜ ÁÔÓ›˜ Î·È ÙËÓ ÂÈÛÙÚÔÊ‹ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Û›ÙÈ. ∏ Ù·ÍÈÓfiÌËÛË Â›Ó·È

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Έ‰ÈÎÔÔÈË̤ÓË Ì ¯ÚÒÌ·Ù·: ÙÔ ÎfiÎÎÈÓÔ ÛËÌ·›ÓÂÈ ·Ú·ÔÌ‹ Û ÓÔÛÔÎÔÌ›Ô, ÙÔ Î›ÙÚÈÓÔ ¤Ó·ÚÍË ıÂÚ·›·˜ Â› ÙfiÔ˘ Î·È ÙÔ Ú¿ÛÈÓÔ ‰ËÏÒÓÂÈ fiÙÈ ÙÔ ·È‰› ÌÔÚ› Ó· ÂÈÛÙÚ¤„ÂÈ ÛÙÔ Û›ÙÈ ÙÔ˘. Â) OÈ Ô‰ËÁ›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·ÚȘ ·Èٛ˜ Ô˘ ʤÚÓÔ˘Ó ¤Ó· ·È‰› ÛÙÔ È·ÙÚ›Ô. ∏ ÛÙÚ·ÙËÁÈ΋ IMCI ÂÛÙÈ¿˙ÂÙ·È ÛÙ· ΢ÚÈfiÙÂÚ· ÓÔÛ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ÌÂÁ¿ÏË ıÓËÛÈÌfiÙËÙ· Î·È ÁÈ· Ù· ÔÔ›· ˘¿Ú¯ÂÈ ıÂÚ·›· Ì ıÂÙÈ΋ Û¯¤ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜. ŒÓ· ·È‰›, fï˜, ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙ› Ì ̛· ¯ÚfiÓÈ· ηٿÛÙ·ÛË Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙȘ Ô‰ËÁ›Â˜, ÔfiÙ ı· ··ÈÙËı› ȉȷ›ÙÂÚË ÌÂÙ·¯Â›ÚÈÛË. OÈ Ô‰ËÁ›Â˜, Â›Û˘, ‰ÂÓ Î·Ï‡ÙÔ˘Ó ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜, ηıÒ˜ Î·È ¿ÏÏˆÓ ÂÂÈÁÔ˘ÛÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·Ù˘¯‹Ì·Ù·. ÛÙ) ∏ ÛÙÚ·ÙËÁÈ΋ IMCI ÚÔˆı› Ì›· ÍÂοı·ÚË ÔÏÈÙÈ΋ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ıÂÛÈÌfiÙËÙ· ÂÓfi˜ ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ ··Ú·›ÙËÙˆÓ Ê·Ú̿ΈÓ, ÛÙËÓ ÔÚıÔÏÔÁÈ΋ ÙÔ˘˜ ¯Ú‹ÛË Î·È ÛÙËÓ Î·Ù¿ÏÏËÏË ıÂÚ·›·, Ô˘ ÌÔÚ› Ó· Â›Ó·È Î·È Û˘Ó‰˘·Ṳ̂ÓË, ÁÈ· fiϘ ÙȘ ·ÚȘ ÓfiÛÔ˘˜. ˙) ŒÓ· ÛËÌ·ÓÙÈÎfi ÎÔÌÌ¿ÙÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ ·ÔÙÂÏ› Ë ·ÚÔ¯‹ Û·ÊÒÓ Ô‰ËÁÈÒÓ ÛÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ Ê·Ú̿ΈÓ, ÙˆÓ ˘ÁÚÒÓ, Ù˘ ÙÚÔÊ‹˜, ηıÒ˜ Î·È ÁÈ· Ù˘¯fiÓ Â·Ó¤ÏÂÁ¯Ô. Ë) OÈ Ô‰ËÁ›Â˜ ÙÔÓ›˙Ô˘Ó ÙËÓ ·Ó¿ÁÎË Â·ÓÂͤٷÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ¤¯ÂÈ ÛÙ·Ï› Û›ÙÈ ‹ ¤¯ÂÈ ÂͤÏıÂÈ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ Ù˘ ·ÁˆÁ‹˜, ÁÈ·Ù› ·˘Ùfi ÌÔÚ› Ó· Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÂͤÏÈ͢ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜. ı) ¶¤Ú· ·fi ÙÔÓ Î‡ÚÈÔ ÛÙfi¯Ô Ù˘, Ô˘ Â›Ó·È Ë ÂÏ¿ÙÙˆÛË Ù˘ ·È‰È΋˜ ıÓËÛÈÌfiÙËÙ·˜, Ë ÛÙÚ·ÙËÁÈ΋ IMCI ‰›ÓÂÈ Ì›· ÌÂÁ¿ÏË Â˘Î·ÈÚ›· ÁÈ· ÙË ÁÂÓÈÎfiÙÂÚË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÛËÌ·ÓÙÈΤ˜ ÚÔÏËÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ, fiˆ˜ ÔÈ ÂÌ‚ÔÏÈ·ÛÌÔ›, Ë ‚ÂÏÙ›ˆÛË Ù˘ ‰È·ÙÚÔÊ‹˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Î·È ÙÔ˘ ·È‰ÈÔ‡ (Â‰Ò ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ÚÔ·ÁˆÁ‹ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡), Ë ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Ù˘ ÌËÙ¤Ú·˜ Î·È Ë ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙÔ˘˜ ηχÙÂÚÔ˘˜ ÙÚfiÔ˘˜ ·Ó·˙‹ÙËÛ˘ È·ÙÚÈ΋˜ ‚Ô‹ıÂÈ·˜. È) ∏ ÛÙÚ·ÙËÁÈ΋ IMCI ·ÊÔÚ¿ Û ¤Ó· Û‡ÓÔÏÔ ·ÚÂÌ‚¿ÛÂˆÓ Î·È ‰Ú·ÛÙËÚÈÔًوÓ, fiˆ˜ ÔÈ ÂÌ‚ÔÏÈ·ÛÌÔ› Î·È Ë ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ ∞ Î·È Ê·ÚÌ¿ÎˆÓ ÁÈ· Ì›· ÛÂÈÚ¿ ÓfiÛˆÓ. ¶ÔÏϤ˜ ·fi ·˘Ù¤˜ ¤¯Ô˘Ó Û¯¤ÛË Ì ¿ÏÏ· οıÂÙ· ÚÔÁÚ¿ÌÌ·Ù· Ô˘ ‚Ú›ÛÎÔÓÙ·È ‹‰Ë Û ÂÊ·ÚÌÔÁ‹. ∏ ÛÙÚ·ÙËÁÈ΋ IMCI ‰ÂÓ ÛÎÔ‡ÂÈ Ó· ·Ó·Ï¿‚ÂÈ ÙËÓ Â˘ı‡ÓË Ù˘ ÂÎÙ¤ÏÂÛ˘ ·˘ÙÒÓ ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, ˆÛÙfiÛÔ, ÛÙԯ‡ÂÈ ÛÙÔÓ ÛˆÛÙfi Û˘ÓÙÔÓÈÛÌfi ÙÔ˘˜ Î·È ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜, ¤ÙÛÈ ÒÛÙ ӷ Û˘ÓÂÈÛʤÚÔ˘Ó ÛÙËÓ ÔÏÔÎÏËڈ̤ÓË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜.

¶·È‰È·ÙÚÈ΋ 2004;67:61-67

È·) OÈ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ηχÙÔ˘Ó, Â›Û˘, ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ¤¯ÂÈ ·Ú·ÂÌÊı› Û ÓÔÛÔÎÔÌÂ›Ô Î·È ‰›ÓÔ˘Ó È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÙËÓ Â›ÁÔ˘Û· ‰È·ÏÔÁ‹ Î·È ÂÎÙ›ÌËÛË ÙˆÓ ÂÚÈÙÒÛˆÓ, ÛÙÔÓ ÙÚfiÔ Ï‹„˘ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÛÙË Ê˘ÛÈ΋ ÂͤٷÛË, ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ‚‹¯· ‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ·Ê˘‰¿ÙˆÛË ·fi ‰È¿ÚÚÔÈ·, ÛÔ‚·Úfi ÂÌ‡ÚÂÙÔ ÓfiÛËÌ·, ‰˘ÛÙÚÔÊ›·, ÛÔ‚·Ú‹ ·Ó·ÈÌ›·, AIDS, ηıÒ˜ Î·È ÛÙÔ ‚·Ú¤ˆ˜ ¿Û¯ÔÓ ‚Ú¤ÊÔ˜. ∂ÈϤÔÓ, ÔÈ Ô‰ËÁ›Â˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰È·‰Èηۛ· ˘ÔÛÙ‹ÚÈ͢ ÙÔ˘ ·È‰ÈÔ‡, ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂͤÏÈ͢ Ù˘ ÓfiÛÔ˘, Û Ú·ÎÙÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ Î·È ÛÙȘ ‰ÔÛÔÏÔÁ›Â˜ ÙˆÓ Ê·ÚÌ¿ÎˆÓ (17,18). ∂Î·›‰Â˘ÛË ÛÙËÓ ¿ÛÎËÛË Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ∏ ÂÎ·›‰Â˘ÛË ÛÙËÚ›˙ÂÙ·È Û ¤Ó· ÛÂÌÈÓ¿ÚÈÔ ‰È¿ÚÎÂÈ·˜ 11 ËÌÂÚÒÓ, ÛÙÔ ÔÔ›Ô ÌÔÚÔ‡Ó Ó· Ï¿‚Ô˘Ó Ì¤ÚÔ˜ ÙfiÛÔ ÁÈ·ÙÚÔ› fiÛÔ Î·È ÓÔÛËÏ¢ÙÈÎfi Î·È ·Ú·˚·ÙÚÈÎfi ÚÔÛˆÈÎfi Ô˘ ˘ËÚÂÙ› Û οı ›‰Ô˘˜ ÌÔÓ¿‰Â˜ ˘Á›·˜. ∏ ‰È¿ÚÎÂÈ· fiˆ˜ Î·È ÙÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÛÂÌÈÓ·Ú›Ô˘ ÌÔÚÔ‡Ó Ó· ÙÚÔÔÔÈËıÔ‡Ó Û‡Ìʈӷ Ì ÙȘ ·Ó¿ÁΘ Ù˘ οı ¯ÒÚ·˜, Ì ‚¿ÛË, fï˜, ¿ÓÙ· ÙȘ Ô‰ËÁ›Â˜ Ô˘ ¤¯Ô˘Ó ÂΉÔı› ·fi ÙËÓ WHO (21). ¶ÂÚ›Ô˘ 30% ÙÔ˘ ¯ÚfiÓÔ˘ Â›Ó·È ·ÊÈÂڈ̤ÓÔ ÛÙËÓ ÎÏÈÓÈ΋ ¿ÛÎËÛË. OÈ ÂÎ·È‰Â˘fiÌÂÓÔÈ ÂÈÛΤÙÔÓÙ·È ÎÏÈÓÈΤ˜ Î·È È·ÙÚ›·, fiÔ˘ ˘fi ÙËÓ Â›‚ÏÂ„Ë ÙˆÓ ÂÎ·È‰Â˘ÙÒÓ ÙÔ˘˜ - ηÏÔ‡ÓÙ·È Ó· ·ÓÙÈÌÂÙˆ›ÛÔ˘Ó ÎÏÈÓÈο ÚÔ‚Ï‹Ì·Ù· Ì ‚¿ÛË ÙȘ Ô‰ËÁ›Â˜ Ù˘ IMCI. ∏ ıˆÚËÙÈ΋ ÂÎ·›‰Â˘ÛË, ¤Ú· ·fi ÙËÓ ÎÏ·ÛÈ΋ ‰È‰·Ûηϛ·, ÂÚÈÏ·Ì‚¿ÓÂÈ ¯Ú‹ÛË ‚›ÓÙÂÔ, ʈÙÔÁÚ·ÊÈÒÓ Î·È Âȉ›ÍˆÓ. ŒÓ· ηÈÓÔÙfiÌÔ ÛÙÔÈ¯Â›Ô Ù˘ ÂÎ·›‰Â˘Û˘ Â›Ó·È fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì›· Â›ÛÎÂ„Ë ÙˆÓ ÂÎ·È‰Â˘ÙÒÓ ÛÙÔÓ ÙfiÔ ÂÚÁ·Û›·˜ ÙÔ˘ οı ÂÎ·È‰Â˘fiÌÂÓÔ˘, 4-6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÛÂÌÈÓ·Ú›Ô˘. O ÛÎÔfi˜ ·˘ÙÒÓ ÙˆÓ ÂÈÛΤ„ÂˆÓ Â›Ó·È Ë ·ÚÔ¯‹ ‚Ô‹ıÂÈ·˜ ÛÙËÓ Ô˘ÛÈ·ÛÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÓÂÔ·ÔÎÙËıÂÈÛÒÓ ‰ÂÍÈÔًوÓ, Ë ÂÓ›Û¯˘ÛË ÙˆÓ ÁÓÒÛÂˆÓ Ô˘ ·ÔÎÙ‹ıËηÓ, ηıÒ˜ Î·È Ô ÂÓÙÔÈÛÌfi˜ Î·È Ë Â›Ï˘ÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ ÛÙËÓ Ú¿ÍË. ∂›Û˘, Â›Ó·È Ì›· ¢ηÈÚ›· ÁÈ· Û˘ÏÏÔÁ‹ ÏËÚÔÊÔÚÈÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÚ·ÙËÁÈ΋˜. ª¤¯ÚÈ ÙÒÚ·, ÔÈ ·Ó·ÊÔÚ¤˜ ‰È·ÈÛÙÒÓÔ˘Ó ÈηÓÔÔÈËÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·Ú·¿Óˆ ‰ÂÍÈÔÙ‹ÙˆÓ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÂÚÁ·Û›·, ·Ú¿ ÙËÓ ‡·ÚÍË ÌÈÎÚÔÚÔ‚ÏËÌ¿ÙˆÓ (22). ∏ ÂÌÂÈÚ›· ·fi ÙËÓ ¤ˆ˜ ÙÒÚ· ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ˘Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ó¿ÁÎË Ó· Á›ÓÂÙ·È Ë ÂÎ·›‰Â˘ÛË ÚÈÓ ·Ú¯›ÛÂÈ Î¿ÔÈÔ˜ Ó· ÂÚÁ¿˙ÂÙ·È Û ÌÔÓ¿‰· ˘Á›·˜. ∞Ó ÙÔ È·ÙÚÈÎfi Î·È ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ·ÔÎÙÔ‡Û ÙȘ ÈηÓfiÙËÙ˜ Ô˘ ··ÈÙ› Ë IMCI ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ‚·ÛÈ΋˜ ÙÔ˘ ÂÎ·›‰Â˘Û˘, ı· ˘‹Ú¯Â Î·È ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎfiÛÙÔ˘˜ Î·È Î·Ï‡ÙÂÚË ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ÛÙȘ ‰ËÌfi-

Paediatriki 2004;67:61-67

ÛȘ Î·È È‰ÈˆÙÈΤ˜ ÌÔÓ¿‰Â˜ ˘Á›·˜. ¶ÔÏϤ˜ ¯ÒÚ˜ ¤¯Ô˘Ó ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÂÈÚ·Ì·Ù›˙ÔÓÙ·È ÚÔ˜ ·˘Ù‹ ÙËÓ Î·Ù‡ı˘ÓÛË, ÂÓÒ Ë ÂÌÂÈÚ›· ÙÔ˘˜ ·Ó·Ì¤ÓÂÙ·È Ó· ·ÔÙÂϤÛÂÈ ÙË ‚¿ÛË ÁÈ· ÙËÓ ·Ó·ÌfiÚʈÛË ÙÔ˘ Û˘ÓfiÏÔ˘ Ù˘ ÂÎ·È‰Â˘ÙÈ΋˜ ‰È·‰Èηۛ·˜. µÂÏÙÈÒÛÂȘ ÛÙÔ Û‡ÛÙËÌ· ˘Á›·˜ ∏ ÌÂÁ·Ï‡ÙÂÚË ÚÔÛ¿ıÂÈ· ÛÙÔ Ï·›ÛÈÔ Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ ¤¯ÂÈ ÂÛÙÈ·ÛÙ› ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙÔ˘ ¿ÌÂÛ· ·Û¯ÔÏÔ‡ÌÂÓÔ˘ Ì ÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ ÚÔÛˆÈÎÔ‡, ̤ۈ ÙˆÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Î·È Ù˘ ÂÎ·›‰Â˘Û˘. °È· Ó· ˘¿ÚÍÂÈ, fï˜, Ú·ÁÌ·ÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ ·Ú¯fiÌÂÓˆÓ ˘ËÚÂÛÈÒÓ, ·˘Ùfi ı· Ú¤ÂÈ Ó· Û˘Óԉ¢Ù› ·fi Ì›· ÁÂÓÈÎfiÙÂÚË ‚ÂÏÙ›ˆÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘Á›·˜ Û οı ¯ÒÚ·. ™ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÙˆÓ ˘ÊÈÛÙ¿ÌÂÓˆÓ Û˘ÛÙËÌ¿ÙˆÓ ˘Á›·˜ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÂÏÏ›„ÂȘ ÔÏÏÒÓ ‚·ÛÈÎÒÓ Ê·Ú̿ΈÓ, ·Ó˘·ÚÍ›· ÎÈÓ‹ÙÚˆÓ ÁÈ· ÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ÚÔ‚ÏËÌ·ÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÛÙÚ·ÙËÁÈ΋˜, ·Ô˘Û›· ÂÓfi˜ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó·ÊÔÚ¿˜ Î·È Ì›· ÏÂÈ¿‰· ÔÚÁ·ÓˆÙÈÎÒÓ ˙ËÙËÌ¿ÙˆÓ (9). ∂ȉÈÎfiÙÂÚ· ÁÈ· Ù· Ê¿Ú̷η, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ··ÈÙÂ›Ù·È Î·ıËÌÂÚÈÓ‹ Ï‹Ú˘ ‰È·ıÂÛÈÌfiÙËÙ· ÛÙȘ ÚˆÙÔ‚¿ıÌȘ ÌÔÓ¿‰Â˜ ˘Á›·˜ ·˘ÙÒÓ Ô˘ ıˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ·. ∞Ó Î·È Ë IMCI ··ÈÙ› ÌfiÓÔ ¤Ó·Ó ÂÚÈÔÚÈṲ̂ÓÔ ·ÚÈıÌfi Ê·ÚÌ¿ÎˆÓ (·fi 16 ¤ˆ˜ 20, ·Ó¿ÏÔÁ· Ì ÙËÓ ÚÔÛ·ÚÌÔÁ‹ Ô˘ ¤¯ÂÈ Á›ÓÂÈ Û οı ¯ÒÚ·), Ù· Û‡ÓıÂÙ· Î·È ·ÏÏËÏÔÛ˘Û¯ÂÙÈ˙fiÌÂÓ· ˙ËÙ‹Ì·Ù· Ù˘ ÚÔÌ‹ıÂÈ·˜ Î·È Ù˘ ‰È·ÓÔÌ‹˜ ÙÔ˘˜ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ¤Ó· Ôχ ÛÔ‚·Úfi ÂÌfi‰ÈÔ Û fiϘ ÙȘ ¯ÒÚ˜ Ô˘ ÂÊ·ÚÌfi˙Ô˘Ó ÙË ÛÙÚ·ÙËÁÈ΋. π‰È·›ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ Ê·ÚÌ¿ÎˆÓ ‰Â‡ÙÂÚ˘ ÁÚ·ÌÌ‹˜, ηıÒ˜ Î·È ·˘ÙÒÓ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ú¯È΋ Â› ÙfiÔ˘ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡, ÚÈÓ ·˘Ùfi ·Ú·ÂÌÊı› ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∞Ó Î·È ÚÔÛˆÚÈÓ¤˜ χÛÂȘ, fiˆ˜ Ë ¯Ú‹ÛË ÙÔÈÎÒÓ ÎÂÊ·Ï·›ˆÓ ÁÈ· ÙËÓ ·ÁÔÚ¿ Ê·ÚÌ¿ÎˆÓ Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ ‹ Ë Î·ıȤڈÛË ÂÓfi˜ ÂȉÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‰È·ÓÔÌ‹˜ ÌfiÓÔ ÁÈ· Ù· Ê¿Ú̷η Ô˘ ÂÓÙ¿ÛÛÔÓÙ·È ÛÙËÓ IMCπ, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‚ÚÂıÔ‡Ó, Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Â·ÚÎÔ‡Ó ÁÈ· Ó· χÛÔ˘Ó ÙÔ Úfi‚ÏËÌ· (20). ™ÙÔ Ì¤ÏÏÔÓ ı· Ú¤ÂÈ Ó· ηıÔÚÈÛÙÔ‡Ó Ú·ÎÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜ ÁÈ· Ó· ÂÍ·ÛÊ·ÏÈÛÙ› Ë ÛÙ·ıÂÚ‹ ‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ Ê·Ú̿ΈÓ. ∏ ‚ÂÏÙ›ˆÛË Ù˘ ÊÚÔÓÙ›‰·˜ ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Â›Â‰Ô Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Ù˘ ÎÔÈÓfiÙËÙ·˜ °È· Ó· ÌÂÁÈÛÙÔÔÈËıÔ‡Ó Ù· ıÂÙÈο ·ÔÙÂϤÛÌ·Ù· Ù˘ ÛÙÚ·ÙËÁÈ΋˜, ÔÈ ‚ÂÏÙÈÒÛÂȘ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ˘Á›·˜ ı· Ú¤ÂÈ Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ÛÙÔ Â›Â‰Ô Ù˘ ÎÔÈÓfiÙËÙ·˜ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, οÙÈ Ô˘ ›Ûˆ˜ ·ÔÙÂÏ› Î·È ÙÔ ÈÔ ··ÈÙËÙÈÎfi ÎÔÌÌ¿ÙÈ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ IMCI.

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ŸÏ˜ ÔÈ ÔÈÎÔÁ¤ÓÂȘ ı· Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ó Ò˜ Ó· ÙÚ¤ÊÔ˘Ó ÛˆÛÙ¿ Ù· ·È‰È¿ ÙÔ˘˜, Ò˜ Ó· ÚÔÏ·Ì‚¿ÓÔ˘Ó Î·È Ó· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Û˘ÓËıÈṲ̂ӷ ÓÔÛ‹Ì·Ù· ηÈ, Ù¤ÏÔ˜, Ò˜ Ó· ·ÎÔÏÔ˘ıÔ‡Ó ÙȘ Ô‰ËÁ›Â˜ Ô˘ ÙÔ˘˜ ‰›ÓÂÈ Ô ÁÈ·ÙÚfi˜ ÙÔ˘˜. ∏ ÛÙÚ·ÙËÁÈ΋ IMCI ÚÔÛ·ı› Ó· ÂÎÌÂÙ·ÏÏ¢Ù› ÙËÓ ˘¿Ú¯Ô˘Û· ÂÌÂÈÚ›· Û ·˘ÙfiÓ ÙÔÓ ÙÔ̤·, Ë ÔÔ›· ¤¯ÂÈ ·ÔÎÙËı› ·fi ÙȘ ·Ï·ÈfiÙÂÚ˜ οıÂÙ˜ ÛÙÚ·ÙËÁÈΤ˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰È·ÚÚÔ˚ÎÒÓ ÓfiÛˆÓ Î·È ÙˆÓ ÔͤˆÓ ÓÔÛËÌ¿ÙˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡. ¶¿Óˆ Û ·˘Ù‹ ÙË ‚¿ÛË, ÚÔÛ·ı› Ó· ÂÓÈÛ¯‡ÛÂÈ ÙȘ ÚÔÛ¿ıÂȘ Ô˘ ÛÙÚ¤ÊÔÓÙ·È ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ Î·È Ù˘ ıÚ¤„˘ ÙÔ˘ ·È‰ÈÔ‡. OÈ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙȘ ÚˆÙÔ‚¿ıÌȘ ÌÔÓ¿‰Â˜ ˘Á›·˜ Â›Ó·È Û¯Â‰È·Ṳ̂Ó˜ ¤ÙÛÈ ÒÛÙ ӷ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ÂÈÎÔÈÓˆÓ›· Ì ÙȘ ÌËÙ¤Ú˜. ∏ ÚÔÛ·ÚÌÔÁ‹ ÙÔ˘˜ Û οı ¯ÒÚ· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯Ú‹ÛË ÙÔÈÎÒÓ fiÚˆÓ Î·ıÒ˜ Î·È ‰È·ÙÚÔÊÈΤ˜ Û˘ÛÙ¿ÛÂȘ Ô˘ Â›Ó·È Û‡ÌʈÓ˜ Ì ÙȘ Û˘Ó‹ıÂȘ οı Ϸԇ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÎ·›‰Â˘Û‹˜ ÙÔ˘˜, ÔÈ ÏÂÈÙÔ˘ÚÁÔ› ˘Á›·˜ ‰È‰¿ÛÎÔÓÙ·È Î·È ÂÊ·ÚÌfi˙Ô˘Ó ÙȘ ‚·ÛÈΤ˜ ·Ú¯¤˜ Á‡Úˆ ·fi ÙËÓ ·ÚÔ¯‹ Û˘Ì‚Ô˘ÏÒÓ ÁÈ’ ·˘Ù¿ Ù· ˙ËÙ‹Ì·Ù·. ŒÙÛÈ, οı ·È‰› ÂÎÙÈÌ¿Ù·È ÁÈ· ÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ıÚ¤„˘ ÙÔ˘ ηÈ, fiÙ·Ó ÎÚÈı› ··Ú·›ÙËÙÔ, ‰›ÓÔÓÙ·È Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘Ì‚Ô˘Ï¤˜ ÛÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙË ÛˆÛÙ‹ ‰È·ÙÚÔÊ‹, ÔÈ Ôԛ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È Ô‰ËÁ›Â˜ ÁÈ· ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∞ӤΉÔÙ˜ ·Ó·ÊÔÚ¤˜ ·fi ÙȘ ¯ÒÚ˜ Ô˘ ÂÊ·ÚÌfi˙Ô˘Ó ÙË ÛÙÚ·ÙËÁÈ΋ IMCI ·Ó·Ê¤ÚÔ˘Ó fiÙÈ Ë ÔÈfiÙËÙ· Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÔ‡˜ ˘Á›·˜ ÌÂÙ¿ ·fi ÙËÓ ÂÎ·›‰Â˘Û‹ ÙÔ˘˜ ÛÙË ÛÙÚ·ÙËÁÈ΋ IMCI Î·È ÛÙÔ˘˜ ÁÔÓ›˜ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ÚÔ˜ ÙÔ Î·Ï‡ÙÂÚÔ Î·È fiÙÈ ÔÈ ÁÔÓ›˜ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ıÂÙÈο Û ·˘Ù‹ ÙËÓ ·ÏÏ·Á‹ (20). ∫¿ÔȘ ¯ÒÚ˜, Ì¿ÏÈÛÙ·, ·Ó·Ê¤ÚÔ˘Ó ·˘ÍË̤ÓË ÚÔۤϢÛË ÛÙȘ ÚˆÙÔ‚¿ıÌȘ ÌÔÓ¿‰Â˜ ˘Á›·˜ ÙȘ Ë̤Ú˜ Ô˘ ˘ËÚÂÙÔ‡Ó Û ·˘Ù¤˜ ¿ÙÔÌ· ÂÎ·È‰Â˘Ì¤Ó· ÛÙË ÛÙÚ·ÙËÁÈ΋ IMCI. ∞ӤΉÔÙ˜ ·Ó·ÊÔÚ¤˜ ÂÈÛËÌ·›ÓÔ˘Ó ·ÊÂÓfi˜ fiÙÈ ÔÈ ÁÔÓ›˜ ÂÎÏ‹ÛÛÔÓÙ·È Â˘¯¿ÚÈÛÙ· ·fi ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ÁÈ·ÙÚÒÓ ÁÈ· ÙË ‰È·ÙÚÔÊ‹ Î·È ÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ, ·ÊÂÙ¤ÚÔ˘ fiÙÈ ÔÈ ›‰ÈÔÈ Â›Ó·È ÈηÓÔ› Ó· Û˘ÌÌÔÚʈıÔ‡Ó Ì ÙȘ Ô‰ËÁ›Â˜ Ô˘ ÙÔ˘˜ ‰›ÓÔÓÙ·È. ¶ÚÔ‚Ï‹Ì·Ù· Î·È ÎfiÛÙÔ˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ¿Ú¯ÈÛ ÙÔ 1997, ÂÓÒ ÚÈÓ ·fi ÙÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2001 ›¯Â ·Ú¯›ÛÂÈ Ó· ÂÂÎÙ›ÓÂÙ·È Û 102 ¯ÒÚ˜. øÛÙfiÛÔ, ÌfiÓÔ 33 ·fi ·˘Ù¤˜ ÙËÓ ¤¯Ô˘Ó ÂÊ·ÚÌfiÛÂÈ Û ¢Ú›· Îϛ̷η. ŒÙÛÈ, Â›Ó·È Ôχ ÓˆÚ›˜ ÁÈ· Ó· ÂÎÙÈÌËı› Ë Ú·ÁÌ·ÙÈ΋ ÂÏ¿ÙÙˆÛË ÛÙË ıÓËÛÈÌfiÙËÙ·. ª›· ÛËÌ·ÓÙÈ΋ ·Ú·Ù‹ÚËÛË ·fi ¯ÒÚ˜ Ô˘ ¤¯Ô˘Ó ÂÓÙ¿ÍÂÈ ÙË ÛÙÚ·ÙËÁÈ΋ IMCI ÛÙÔ Û‡ÛÙËÌ· ˘Á›·˜ ÙÔ˘˜ Â›Ó·È fiÙÈ, ·Ú’ fiÏÔ Ô˘ ·ÔÙÂÏ› ·‰È·ÌÊÈÛ‚‹ÙËÙË ÚfiÔ‰Ô, ˘¿Ú¯Ô˘Ó ·ÚÎÂÙ¿ ·ÎfiÌË Ô˘

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Ú¤ÂÈ Ó· Á›ÓÔ˘Ó. ∂ȉÈÎfiÙÂÚ·, Û ¯ÒÚ˜ fiÔ˘ ›¯Â ‹‰Ë ÂÈÙ¢¯ı› ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜, ˆ˜ Ì›˙ÔÓ Úfi‚ÏËÌ· ·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ϤÔÓ ÔÈ ı¿Ó·ÙÔÈ ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô. ∏ ÛÙÚ·ÙËÁÈ΋ IMCI ·ÓÙÈÌÂÙˆ›˙ÂÈ ÌfiÓÔ ¤Ó· ÌÈÎÚfi ̤ÚÔ˜ ·fi Ù· ÂÚÈÁÂÓÓËÙÈο ÚÔ‚Ï‹Ì·Ù·. ™‡ÓÙÔÌ· ·Ó·Ì¤ÓÔÓÙ·È ‚ÂÏÙÈÒÛÂȘ ÛÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜, ¤ÙÛÈ ÒÛÙ ӷ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˜ Ô ¯ÂÈÚÈÛÌfi˜ ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙ· ÓÂÔÁÓ¿ Î·È ÛÙ· ÌÈÎÚ¿ ‚Ú¤ÊË. ¶·Ú¿ÏÏËÏ·, ÛÙÔ ÛÙ¿‰ÈÔ Ù˘ ÚÔÂÙÔÈÌ·Û›·˜ ‚Ú›ÛÎÔÓÙ·È Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È ÙÔÓ ÙÔÎÂÙfi, ÔÈ Ôԛ˜ Â›Û˘ ı· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÚÔ·ÙÔ˘Ó ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜. ª›· ·ÎfiÌË ¤ÏÏÂÈ„Ë Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ Î·Ï‡ÙÂÈ ÙÔ ÙÚ·‡Ì· Î·È ¿ÏϘ Â›ÁÔ˘Û˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ηٷÛÙ¿ÛÂȘ. °È· Ó· Ú·ÁÌ·ÙÔÔÈËı› Ë Â¤ÎÙ·ÛË Ù˘ ÛÙÚ·ÙËÁÈ΋˜ Î·È Û ·˘ÙfiÓ ÙÔÓ ÙÔ̤·, ı· Ú¤ÂÈ ÚÒÙ· Ó· ηٷÁÚ·Ê› Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ‰È·ÊfiÚˆÓ ÂÂÈÁÔ˘ÛÒÓ ¯ÂÈÚÔ˘ÚÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ ηÈ, ·ÎÔÏÔ‡ıˆ˜, Ó· ·Ó·˙ËÙËıÔ‡Ó ·ÏÔ› Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎÔ› ÙÚfiÔÈ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ™ËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜ ̤ۈ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ·ÔÙÂÏ› Ë ·Ó‰ËÌ›· ÙÔ˘ HIV. ∏ ÚfiÔ‰Ô˜ Ô˘ ›¯Â ÂÈÙ¢¯ı› Û οÔȘ ¯ÒÚ˜, ȉȷ›ÙÂÚ· ÛÙËÓ ∞ÊÚÈ΋, ÎÈÓ‰˘Ó‡ÂÈ Ó· ÂÍ·ÓÂÌÈÛÙ› ÏfiÁˆ ÙÔ˘ ∞πDS. ¶·Ú’ fiÏÔ Ô˘ οÔÈ· ·fi Ù· ÂÂÈÛfi‰È· ÔÍ›·˜ ÓfiÛÔ˘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔÓ HIV ÛÙ· ·È‰È¿ ÌÔÚÔ‡Ó Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó Ì¤Ûˆ Ù˘ IMCI ÚÔÛ¤ÁÁÈÛ˘, ··ÈÙÂ›Ù·È Ó· Á›ÓÔ˘Ó Ôχ ÂÚÈÛÛfiÙÂÚ· Ú¿ÁÌ·Ù· Û ¯ÒÚ˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ Â›ÎÂÓÙÚÔ Ù˘ ·Ó‰ËÌ›·˜, ÒÛÙ ӷ ÂÈÙ¢¯ı› Ì›· Ô˘ÛÈ·ÛÙÈ΋ ÂÏ¿ÙÙˆÛË Ù˘ ıÓËÛÈÌfiÙËÙ·˜.

OÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ Ú·ÎÙÈΤ˜ Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·È ÛÙË ÛÙÚ·ÙËÁÈ΋ Â›Ó·È ·ԉ‰ÂÈÁ̤Ó˘ ·Í›·˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ ÛÙËÓ Ó¢ÌÔÓ›· Î·È ÙË ‰˘ÛÂÓÙÂÚ›·, Ë ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È Ë ÂÓ‰ÔÊϤ‚È· ÂÓ˘‰¿ÙˆÛË ÛÙË ‰È¿ÚÚÔÈ·, Ë ıÂÚ·›· Ù˘ ÂÏÔÓÔÛ›·˜ Î.Ï. ŒÙÛÈ, ‰ÂÓ ÚÔηÏ› ¤ÎÏËÍË ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ·˘ÙÔ› Ô˘ ¤¯Ô˘Ó ÙËÓ Â˘ı‡ÓË Ù˘ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡ Û¿ÓÈ· ·ÌÊÈÛ‚ËÙÔ‡Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÛÙÚ·ÙËÁÈ΋˜. ™˘Ó‹ıˆ˜ Û˘ÌʈÓÔ‡Ó Ì ÙȘ ıÂÚ·¢ÙÈΤ˜ Ô‰ËÁ›Â˜ Î·È ÂÎÙÈÌÔ‡Ó ÙË Û˘ÛÙËÌ·ÙÈÎÔÔ›ËÛË Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÙÔ˘˜ ÂÚÁ·Û›· (9). ŒÓ· ¿ÏÏÔ ÂÚÒÙËÌ· Ô˘ ÚÔ·ÙÂÈ Â›Ó·È ·Ó ÙÔ È·ÙÚÈÎfi-ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ·ÏÏ¿˙ÂÈ Ú·ÁÌ·ÙÈο ÙËÓ Ù·ÎÙÈ΋ ÙÔ˘ ÌÂÙ¿ ·fi ÙËÓ ÂÎ·›‰Â˘ÛË ÛÙËÓ IMCI. ¶ÚÒÈÌ· ·ÔÙÂϤÛÌ·Ù· ·fi ÙÚÂȘ ¯ÒÚ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ·˘Ùfi Ú¿ÁÌ·ÙÈ Û˘Ì‚·›ÓÂÈ (9). ŒÓ· ÁÂÓÈÎfiÙÂÚÔ ÂÚÒÙËÌ· Ô˘ ·ÊÔÚ¿ ÛÙË Û¯¤ÛË ÎfiÛÙÔ˘˜-·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Û ۇÁÎÚÈÛË ÌÂ

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ÚÔËÁÔ‡ÌÂÓ˜ ·ÚfiÌÔȘ ÛÙÚ·ÙËÁÈΤ˜ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ··ÓÙËı›, ‰Â‰Ô̤ÓÔ˘ fiÙÈ fiÛ˜ ÛÙÚ·ÙËÁÈΤ˜ ›¯·Ó ÂÊ·ÚÌÔÛÙ› ̤¯ÚÈ ÙÒÚ· ·ÊÔÚÔ‡Û·Ó ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÓfi˜ ÌfiÓÔ ÓÔÛ‹Ì·ÙÔ˜ Î·È fi¯È ÛÙË Û˘ÓÔÏÈ΋ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡, Ì ·ÔÙ¤ÏÂÛÌ· ÔÔÈ·‰‹ÔÙ ۇÁÎÚÈÛË Ó· ·Ó·Ê¤ÚÂÙ·È Û ·ÓfiÌÔȘ ÚÔÛÂÁÁ›ÛÂȘ. ª›· ÌÂϤÙË Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÔÏϤ˜ ¯ÒÚ˜ Î·È ÊÈÏÔ‰ÔÍ› Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËÓ ÂÊ·ÚÌÔÁ‹ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI ‚Ú›ÛÎÂÙ·È ‹‰Ë Û ÂͤÏÈÍË (23). ¶ÚÔηٷÚÎÙÈο ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ Â›Ó·È Î·Ï‡ÙÂÚË Û ÌÔÓ¿‰Â˜ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È Ë IMCI Û ۇÁÎÚÈÛË Ì ¿ÏϘ Ô˘ ‰ÂÓ ÂÊ·ÚÌfi˙ÂÙ·È Î·È fiÙÈ Ë ÔÈfiÙËÙ· ÙˆÓ ·Ú¯fiÌÂÓˆÓ ˘ËÚÂÛÈÒÓ ÛÙȘ ÌÔÓ¿‰Â˜ ˘Á›·˜ ÙˆÓ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ ¯ˆÚÒÓ Â›Ó·È ÌÂÓ ¯·ÌËÏ‹, ·ÏÏ¿ Â›Ó·È Èı·Ófi fiÙÈ ı· ‚ÂÏÙȈı› Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÚ·ÙËÁÈ΋˜ IMCI. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì¤¯ÚÈ ÙÒÚ· ÂÌÂÈÚ›· ‰Â›¯ÓÂÈ fiÙÈ Ë ÛÙÚ·ÙËÁÈ΋ IMCI ·Ú¤¯ÂÈ Ì›· ¢ηÈÚ›· ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ó· ·Ó·ÌÔÚÊÒÛÔ˘Ó ÙËÓ ÔÏÈÙÈ΋ ÙÔ˘˜ ÛÙÔ ˙‹ÙËÌ· Ù˘ ÊÚÔÓÙ›‰·˜ ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡. ªÂ ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘, Ë ÛÙÚ·ÙËÁÈ΋ ÌÔÚ› Ó· ·Ó·ÌÔÚʈı› Û ̛· ÁÂÓÈÎfiÙÂÚË ÔÏÈÙÈ΋ ‰ËÌfiÛÈ·˜ ˘Á›·˜, ¤ÙÛÈ ÒÛÙ ӷ ·ÓÙÈÌÂÙˆ›˙ÂÈ ·ÎfiÌË ÈÔ ÛÊ·ÈÚÈο ÙËÓ ˘Á›· Î·È ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡. µÈ‚ÏÈÔÁÚ·Ê›· 1. Claeson M, Waldman RJ. The evolution of child health programmes in developing countries: from targeting diseases to targeting people. Bull World Health Organ 2000;78:1234-1245.

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10. Bloland PB, Redd SC, Kazembe P, Tembenu R, Wirima JJ, Campbell CC. Co-trimoxazole for childhood febrile illness in malaria-endemic regions. Lancet 1991;337:518-520.

11. Black RE. Persistent diarrhea in children of developing countries. Pediatr Infect Dis J 1993;12:751-761.

12. World Health Organization. Integrated management of the sick child. Bull World Health Organ 1995;73:735-740.

13. Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview.

The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 1997;75 (Suppl 1):S7-S24.

14. Chessare JB. Teaching clinical decision-making to pediatric residents in an era of managed care. Pediatrics 1998;101:762-766.

15. WHO. IMCI Adaptation Guide. Version 5. Geneva: WHO; 1998.

16. Patwari AK, Raina N. Integrated Management of Childhood Illness (IMCI): a robust strategy. Indian J Pediatr 2002;69:41-48.

17. Gove S, Tamburlini G, Molyneux E, Whitesell P, Campbell H. Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project. Arch Dis Child 1999;81:473-477.

18. Tamburlini G, Di Mario S, Maggi RS, Vilarim JN, Gove S. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child 1999;81:478-482.

19. WHO Department of Child and Adolescent Health and Development (CAH). IMCI training course for first-level health workers: linking integrated care and prevention.

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20. Lambrechts T, Bryce J, Orinda V. Integrated management of childhood illness: a summary of first experiences. Bull World Health Organ 1999;77:582-594.

21. WHO Department of Child and Adolescent Health and Development (CAH). Adaptation of the IMCI technical guidelines and training materials. Geneva: WHO; 1999.

22. Odhacha A, Orone H, Pambala M, Odongo R, Lungapher J, Kituye A et al. Health worker performance after training in integrated management of childhood illness - Western Province, Kenya, 1996-1997. MMWR Morb Mortal Wkly Rep 1998;47:998-1002.

23. WHO. The multi-country evaluation of IMCI: overview and progress report. Geneva: WHO; May 1999. ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 09-04-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 17-11-2003 ¢È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¢Ô‡ÚÔ˜ ¡˘ÌÊÒÓ 7-9, ∆.∫. 111 46, ∞ı‹Ó· E-mail: costasdouros@freemail.gr

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¡∂∞ ∏ ∞ÌÂÚÈηÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ·ÏÏ¿˙ÂÈ ÙȘ Û˘ÛÙ¿ÛÂȘ Ù˘ ÁÈ· ÙÔ ÛÈÚfiÈ ÈÂηÎÔ˘¿Ó·˜ ÛÙȘ ‰ËÏËÙËÚÈ¿ÛÂȘ µ·Û›ÏÂÈÔ˜ ¶··‰¿Î˘, ¶·È‰›·ÙÚÔ˜

™ÙÔ ÚfiÛÊ·ÙÔ Û˘Ó¤‰ÚÈÔ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ‰fiıËÎ·Ó Ó¤Â˜ Û˘ÛÙ¿ÛÂȘ Ô˘ ηÏÔ‡Û·Ó ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ó· ÛÙ·Ì·Ù‹ÛÔ˘Ó ÙË ¯Ú‹ÛË ÛÈÚÔÈÔ‡ ÈÂηÎÔ˘¿Ó·˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ‰ËÏËÙËÚÈ¿ÛÂˆÓ (Committee on Injury, Violence, and Poison Prevention.

Poison Treatment in the Home. Pediatrics 2003;112:1182-1185). ∆Ô ÛÈÚfiÈ ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È ϤÔÓ ·fi Ù· ΤÓÙÚ· ÂϤÁ¯Ô˘ ‰ËÏËÙËÚÈ¿ÛˆÓ, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ÓÔÛÔÎÔÌ›ˆÓ Î·È ‰ÂÓ Û˘ÛÙ‹ÓÂÙ·È Ó· ˘¿Ú¯ÂÈ ÛÙÔ Ê·ÚÌ·ÎÂ›Ô ÙÔ˘ ÛÈÙÈÔ‡. ∂ÓÒ ÙÔ ÛÈÚfiÈ Ù˘ ÈÂηÎÔ˘¿Ó·˜ Â›Ó·È Ôχ ·ÛʷϤ˜ Ê¿ÚÌ·ÎÔ, Ô ¤ÌÂÙÔ˜ Ô˘ Â¿ÁÂÈ Â›Ó·È È‰È·›ÙÂÚ· ‰˘Û¿ÚÂÛÙÔ˜ Î·È Â›Ó·È Èı·Ófi Ó· ˘¿ÚÍÔ˘Ó ·ÚÂÓ¤ÚÁÂȘ, fiˆ˜ ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ¤ÌÂÙÔ˜, ‰È¿ÚÚÔÈ· Î·È Ï‹ı·ÚÁÔ˜. ∂›Û˘, ÌÔÚ› Ó· ·ÏÏËÏÂȉڿ Ì ¿ÏÏ· ̤۷ Î·È Ê¿Ú̷η Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÂÚ›ÙˆÛË ‰ËÏËÙËÚ›·Û˘.

OÈ ¤ÓÙ ‚·ÛÈΤ˜ Û˘ÛÙ¿ÛÂȘ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙȘ ‰ËÏËÙËÚÈ¿ÛÂȘ ÛÙ· ·È‰È¿ ¤¯Ô˘Ó ˆ˜ ·ÎÔÏÔ‡ıˆ˜: ñ ∏ ÂÓË̤ڈÛË ÁÈ· ÙËÓ ÚfiÏË„Ë ÙˆÓ ‰ËÏËÙËÚÈ¿ÛÂˆÓ Ú¤ÂÈ Ó· Â›Ó·È Ì¤ÚÔ˜ ÙˆÓ Ô‰ËÁÈÒÓ Ô˘ ‰›ÓÂÈ Ô ·È‰›·ÙÚÔ˜ ÛÙÔ˘˜ ÁÔÓ›˜. ñ ∆Ô ÛÈÚfiÈ ÈÂηÎÔ˘¿Ó·˜ ‰ÂÓ Ú¤ÂÈ ϤÔÓ Ó· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û·Ó ÚÒÙÔ Ì¤ÛÔ ·ÓÙÈÌÂÙÒÈÛ˘ ‰ËÏËÙËÚÈ¿ÛÂˆÓ ÛÙÔ Û›ÙÈ. ñ ¶Ú¤ÂÈ Ó· Û˘ÛÙ‹ÓÂÙ·È ÛÙÔ˘˜ ÁÔÓ›˜ Ó· ÂÙ¿ÍÔ˘Ó ·Ôı¤Ì·Ù· ·fi ÛÈÚfiÈ ÈÂηÎÔ˘¿Ó·˜ Ô˘ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ÛÙÔ Û›ÙÈ. ñ ∏ Û‡Á¯ÚÔÓË ¤Ú¢ӷ ‰ÂÓ ˘ÔÛÙËÚ›˙ÂÈ ÙË ¯Ú‹ÛË ÂÓÂÚÁÔÔÈË̤ÓÔ˘ ¿Óıڷη ÛÙÔ Û›ÙÈ. ñ OÈ ÁÔÓ›˜ ‹ fiÔÈÔ˜ ¿ÏÏÔ˜ ÚÔÛ¤¯ÂÈ ¤Ó· ·È‰› Ô˘ ˘Ô„È¿˙ÂÙ·È fiÙÈ ¤¯ÂÈ ¤ÚıÂÈ Û Â·Ê‹ Ì ̛· ÙÔÍÈ΋ Ô˘Û›·, Ú¤ÂÈ Ó· ÂÈÎÔÈÓˆÓ› ¿ÌÂÛ· Ì ÙÔ ÙÔÈÎfi ∫¤ÓÙÚÔ ¢ËÏËÙËÚÈ¿ÛˆÓ. ª¿ÏÈÛÙ·, Û˘˙ËÙÂ›Ù·È Î·Ù¿ fiÛÔÓ Ú¤ÂÈ ϤÔÓ ÙÔ Ê¿ÚÌ·ÎÔ ·˘Ùfi Ó· ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌÔ ÚÔ˜ ÒÏËÛË. µ¤‚·È·, ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ‚È‚ÏÈÔÁÚ·ÊÈο ÙÂÎÌËÚȈ̤ÓË ÂÌÂÈÚ›· Ì ‚¿ÛË ÙËÓ ÔÔ›· ÂÈ‚¿ÏÏÂÙ·È Ó· Â›Ó·È ¿ÌÂÛ· ‰È·ı¤ÛÈÌÔ ·˘Ùfi ÙÔ ÛÈÚfiÈ ÛÙÔ Û›ÙÈ. º·›ÓÂÙ·È fiÙÈ ¤ÊÙ·Û ÙÔ Ù¤ÏÔ˜ ÂÔ¯‹˜ ÁÈ· ¤Ó· ·ÎfiÌË Ê¿ÚÌ·ÎÔ Î·È Ì›· Ú·ÎÙÈ΋ Ì·˜. http://www.pediatrics.aappublications.org/ ∂·Ó·Ï·Ì‚·ÓfiÌÂÓ· ηٿÁÌ·Ù· Î·È ÔÛÙÂÔfiÚˆÛË ÛÙ· ·È‰È¿ µ·Û›ÏÂÈÔ˜ ¶··‰¿Î˘, ¶·È‰›·ÙÚÔ˜

™ÙÔ ÚfiÛÊ·ÙÔ Û˘Ó¤‰ÚÈÔ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ÛÙË ¡¤· OÚÏ¿ÓË, ¤ÁÈÓ ̛· ÛËÌ·ÓÙÈ΋ ·ÚÔ˘Û›·ÛË (Wildstein et al. Medical University of South Carolina, Charlston SC). OÈ ÂÚ¢ÓËÙ¤˜ ÌÂϤÙËÛ·Ó 447 ·È‰È¿ ËÏÈΛ·˜ 6 ¤ˆ˜ 13 ¯ÚfiÓˆÓ, Ù· ÔÔ›· ·ÚÔ˘Û›·Û·Ó ÔÛÙÈο ηٿÁÌ·Ù· ÌÂÙ¿ ÂÏ¿¯ÈÛÙÔ ÙÚ·‡Ì·. ∂Í‹ÓÙ· ÂÙ¿ ·È‰È¿ ›¯·Ó ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ηٿÁÌ·Ù·, ÂÓÒ 14 ·È‰È¿ ›¯·Ó ÙÚ›· ηٿÁÌ·Ù·. ∫·Ó¤Ó·˜ ·ÛıÂÓ‹˜ ‰ÂÓ Â›¯Â ¿ÏÏË ˘ÔΛÌÂÓË ÓfiÛÔ Î·È ‰ÂÓ Â›¯Â Ï¿‚ÂÈ ÛÙÂÚÔÂȉ‹. ™ÙÔ˘˜ ·ÛıÂÓ›˜ ·˘ÙÔ‡˜, Ì ٷ ÔÏÏ·Ï¿

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ηٿÁÌ·Ù·, ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Ì Ù¯ÓÈ΋ ‰ÈÏ‹˜ ʈÙÔÓȷ΋˜ ·ÔÚÚÔÊËÛÈÔ̤ÙÚËÛ˘ (DEXA: dual-energy x-ray absorptiometry) Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ·Ó·Ï‡ıËÎ·Ó Ì ‚¿ÛË ÓÔÚÌÔÁÚ¿ÌÌ·Ù· Î·È ÂηÙÔÛÙÈ·›Â˜ ı¤ÛÂȘ Ô˘ ›¯·Ó ·Ú¿ÁÂÈ ÔÈ ÂÚ¢ÓËÙ¤˜ ·fi ·ÓÙ›ÛÙÔÈ¯Ô ÏËı˘ÛÌfi Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ. ∞fi Ù· ·È‰È¿ Ì ÔÏÏ·Ï¿ ηٿÁÌ·Ù·, ÔÛÔÛÙfi 67% ‚Ú¤ıËΠӷ ¤¯ÂÈ ÌÂȈ̤ÓË ÔÛÙÈ΋ ˘ÎÓfiÙËÙ·. ™Â ·˘Ù¿ Ù· ·È‰È¿ ‰›ÓÔÓÙ·Ó Û˘ÛÙ¿ÛÂȘ ·Ú¤Ì‚·Û˘. ª¿ÏÈÛÙ·, ÔÈ ›‰ÈÔÈ ÂÚ¢ÓËÙ¤˜ ÌÂÏÂÙÔ‡Ó ÙËÓ ·ÛÊ¿ÏÂÈ· Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ ‰ÈʈÛʈÓÈÎÔ‡ alendronate ÛÙ· ·È‰È¿ Î·È Ë ÌÂϤÙË ÙÔ˘˜ ¯ÚËÌ·ÙÔ‰ÔÙÂ›Ù·È ·fi ÙÔ NIH. ¶ÚÈÓ, fï˜, ·fi οı ·Ú¤Ì‚·ÛË Â›Ó·È ··Ú·›ÙËÙÔ˜ Ô ¤ÏÂÁ¯Ô˜ ·fi ·È‰›·ÙÚÔ-ÂÓ‰ÔÎÚÈÓÔÏfiÁÔ Î·È Ë Î·Ù·ÁÚ·Ê‹ Ù˘ ¿ıÏËÛ˘ Î·È ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ. ∂Âȉ‹ ÙÔ 90% Ù˘ ÔÛÙÈ΋˜ Ì¿˙·˜ ÔÏÔÎÏËÚÒÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-19 ÂÙÒÓ, fiÛÔ ÂÚÈÛÛfiÙÂÚË ÔÛÙÈ΋ Ì¿˙· ‰È·ÌÔÚÊÒÓÂÈ Î·È ·ÔıË·ÂÈ Ô Î¿ı ÔÚÁ·ÓÈÛÌfi˜ ÂÊ‹‚Ô˘ ÛÙȘ ËÏÈ˘ ·˘Ù¤˜, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚË ı· Â›Ó·È Ë ÚÔÛÙ·Û›· ÙÔ˘ ·fi ÙËÓ ÔÛÙÂÔfiÚˆÛË ÛÙȘ ÂfiÌÂÓ˜ ‰ÂηÂٛ˜. ™ËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÛÙË ‰È·ÌfiÚʈÛË ÔÛÙÈ΋˜ Ì¿˙·˜ Â›Ó·È Ë ‰È·ÙÚÔÊ‹ Î·È Ë ¿ıÏËÛË. http://www.medscape.com/viewarticle/463878 ¡ÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi (RSV) µ·Û›ÏÂÈÔ˜ ¶··‰¿Î˘, ¶·È‰›·ÙÚÔ˜

°È· ÙÔÓ Èfi RSV, Ô˘ Û˘Ó¯›˙ÂÈ Ó· ·ÔÙÂÏ› ·ÈÙ›· ÛËÌ·ÓÙÈ΋˜ ÓÔÛËÚfiÙËÙ·˜, ȉȷ›ÙÂÚ· Û ‚Ú¤ÊË Î·È ÌÈÎÚ¿ ·È‰È¿, ¤¯Ô˘Ó ˘¿ÚÍÂÈ ÓÂfiÙÂÚ˜ ÂÍÂÏ›ÍÂȘ. ¢È¿ÁÓˆÛË ∏ ÁÚ‹ÁÔÚË Î·È ·ÍÈfiÈÛÙË ‰È¿ÁÓˆÛË Ù˘ Ïԛ̈͢ ·fi RSV ·Ú·Ì¤ÓÂÈ ÛËÌÂ›Ô ÎÂÊ·Ï·ÈÒ‰Ô˘˜ ÛËÌ·Û›·˜. ª¤¯ÚÈ ÙÒÚ·, Ë Î·ÏÏȤÚÁÂÈ· ÙÔ˘ ÈÔ‡ ‹Ù·Ó Ë Î·Ï‡ÙÂÚË Ì¤ıÔ‰Ô˜ (̤ıÔ‰Ô˜ ·Ó·ÊÔÚ¿˜). ∏ Ú·ÎÙÈÎfiÙËÙ· Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ Î·È Ë Ù·¯‡ÙËÙ· ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘, fï˜, ‹Ù·Ó ÚÔ‚ÏËÌ·ÙÈΤ˜. ¶ÚfiÛÊ·Ù·, ÂÚ¢ӋıËÎÂ Ë ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ÙÔ˘ ÈÔ‡ Ì ¿ÌÂÛË ¯ÚÒÛË ÊˆÛÊÔÚ›˙ÔÓÙÔ˜ ·ÓÙÈÛÒÌ·ÙÔ˜ (DFA direct fluorescent antibody staining test) Î·È Ë ¯Ú‹ÛË Ù¤ÙÔÈ·˜ Ù¯ÓÈ΋˜ Û ۇÁÎÚÈÛË Ì ΢ÙÙ·ÚÈΤ˜ ηÏÏȤÚÁÂȘ (Shetty et al. Pediatr Infect Dis J 2003;22:789-794).

OÈ ‰‡Ô ·˘Ù¤˜ Ù¯ÓÈΤ˜ ¤‰ˆÛ·Ó ÙÔ ›‰ÈÔ ·ÔÙ¤ÏÂÛÌ· Û ÔÛÔÛÙfi 98%. ∏ ¢·ÈÛıËÛ›· Î·È Ë ÂȉÈÎfiÙËÙ· Ù˘ Ù¯ÓÈ΋˜ DFA ‹Ù·Ó 90% Î·È 99% Û ۯ¤ÛË Ì ÙËÓ ÎÏ·ÛÈ΋ ̤ıÔ‰Ô. ™ËÌ·ÓÙÈÎfi ‹Ù·Ó ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ù¯ÓÈ΋ Ù˘ ΢ÙÙ·ÚÔηÏÏȤÚÁÂÈ·˜ ‰ÂÓ ¤‰ˆÛ ÔÙ¤ ·ÔÙÂϤÛÌ·Ù· Ô˘ Ú·ÁÌ·ÙÈο ı· ¿ÏÏ·˙·Ó ÙȘ ·ÔÊ¿ÛÂȘ ıÂÚ·›·˜ ÙˆÓ ÎÏÈÓÈÎÒÓ È·ÙÚÒÓ. ¶·Ú¿ÏÏËÏ·, ·Ó·Ù‡ÛÛÂÙ·È Ù¯ÓÈ΋ ·Ó›¯Ó¢Û˘ ÙÔ˘ ÈÔ‡ ‚·ÛÈṲ̂ÓË Û Ù¯ÓÈ΋ ·Ï˘ÛˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (polymerase chain reaction - PCR). ∏ Ù¯ÓÈ΋ ·˘Ù‹ Â›Ó·È ϤÔÓ Â˘·›ÛıËÙË Î·Ù¿ 60% ·fi Ù¯ÓÈΤ˜ ELISA Î·È ÌÔÚ› Ó· ‰ÒÛÂÈ ·ÍÈfiÈÛÙ· ·ÔÙÂϤÛÌ·Ù· ̤۷ Û ÒÚ˜ ·fi ÙË Ï‹„Ë ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (Mente et al. J Med Microbiol 2003;52:893-896). ¶ÚÔʇϷÍË ¶ÚfiÛÊ·Ù˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ë ÚÔʇϷÍË ÂȉÈÎÒÓ ÔÌ¿‰ˆÓ ·ÛıÂÓÒÓ Ì ÙË ¯ÔÚ‹ÁËÛË ·ÓıÚˆÔÔÈË̤ÓÔ˘ ÌÔÓÔÎÏÔÓÈÎÔ‡ ·ÓÙÈÛÒÌ·ÙÔ˜ ηٿ ÙÔ˘ ÈÔ‡ RSV (palivizumab) Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, Ì ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (Pedraz et al. Pediatr Infect Dis J 2003;22:823-827). ª›· ÚfiÛÊ·ÙË ¤Ú¢ӷ ¤‰ÂÈÍ 45%

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¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

Ì›ˆÛË ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÏfiÁˆ RSV Ïԛ̈͢ Û ·È‰È¿ ÌÂ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ. ∞˘Ùfi ¤‰ˆÛ ÒıËÛË ÛÙËÓ ·Ó·ıÂÒÚËÛË ÙˆÓ Û˘ÛÙ¿ÛÂˆÓ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙËÓ ÚÔʇϷÍË ·ÛıÂÓÒÓ ËÏÈΛ·˜ οو ÙˆÓ 24 ÌËÓÒÓ Ì ΢·ÓˆÙÈ΋ Î·È ÌË Î˘·ÓˆÙÈ΋ ηډȷ΋ ÓfiÛÔ. ¶ÚÔʇϷÍË ÁÈ· ÙÔÓ Èfi RSV Û˘ÓÈÛٿٷÈ, Â›Û˘, Û ‚Ú¤ÊË Ô˘ ÁÂÓÓ‹ıËÎ·Ó Ì ÂÌ‚Ú˘˚΋ ËÏÈΛ· οو ÙˆÓ 32 ‚‰ÔÌ¿‰ˆÓ Î·È Ù· ÔÔ›· Â›Ó·È ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜. ™˘ÓÔÙÈο, ÓÂfiÙÂÚ˜ ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Î·È ÛÙÚ·ÙËÁÈΤ˜ ÚÔʇϷ͢ ·fi ÙÔÓ Èfi RSV ı· ‰È·‰Ú·Ì·Ù›ÛÔ˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ Ì ˘„ËÏ‹ Èı·ÓfiÙËÙ· ÂÈÏÔÎÒÓ ÌÂÙ¿ ·fi Ïԛ̈ÍË Ì ÙÔÓ Èfi RSV. http://www.aap.org/policy/rsvpolicy.pdf ÷ÌËÏ¿ Â›‰· ÈÓÙÂÚÊÂÚfiÓ˘-Á Î·È CD14 ÛÙÔÓ ÔÚfi ‚ÚÂÊÒÓ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÂÂÈÛÔ‰›ˆÓ Û˘ÚÈÁÌÔ‡ (wheezing) µ·Û›ÏÂÈÔ˜ ¶··‰¿Î˘, ¶·È‰›·ÙÚÔ˜

¶ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË Û˘Û¯ÂÙ›˙ÂÈ Ù· ¯·ÌËÏ¿ Â›‰· IFN-Á Î·È ‰È·Ï˘ÙÔ‡ CD14 ÛÙÔÓ ÔÚfi ‚ÚÂÊÒÓ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÔÏÏ·ÏÒÓ ÂÂÈÛÔ‰›ˆÓ Û˘ÚÈÁÌÔ‡. Ÿˆ˜ ·Ó·Ê¤ÚÂÈ Î·È Ô Û˘ÁÁڷʤ·˜ Dr. Wright ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ ∞ÚÈ˙fiÓ·, ·ÓÔÛÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÓˆÚ›˜ ÛÙË ˙ˆ‹ ÌÔÚ› Ó· ÚÔ‰ÈοÛÔ˘Ó ÂÌÊ¿ÓÈÛË ÓÔÛËÌ¿ÙˆÓ (Am J Respir Crit Care Med 2004;169:70-76).

OÈ ·ÛıÂÓ›˜ Ì ¯·ÌËÏ¿ Â›‰· IFN-Á ›¯·Ó 4,5 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ÂÌÊ·Ó›ÛÔ˘Ó Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÂÂÈÛfi‰È· Û˘ÚÈÁÌÔ‡. ∂›Ó·È Èı·ÓfiÓ Ó· ÂÓÙÔ›ÛÔ˘Ì ÂÚÈ‚·ÏÏÔÓÙÔÏÔÁÈΤ˜ ÂÎı¤ÛÂȘ ÓˆÚ›˜ ÛÙË ˙ˆ‹ ÙˆÓ ·È‰ÈÒÓ, Ô˘ Ó· ·ÏÏ¿˙Ô˘Ó ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ÙÔ˘˜ ·¿ÓÙËÛË, ÁÂÁÔÓfi˜ Ô˘ ı· ÌÔÚ¤ÛÂÈ Ó· Ì·˜ ‚ÔËı‹ÛÂÈ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ ÛÙËÓ ÎÏÈÓÈ΋. ∏ ÁÓÒÛË, ¿ÓÙˆ˜, ÙˆÓ Û¯¤ÛÂˆÓ ·ÓÔÛÔÏÔÁÈÎÔ‡ ÚÔÊ›Ï Î·È ÓfiÛÔ˘ Â›Ó·È ·ÎfiÌË Û ÂÌ‚Ú˘˚Îfi ÛÙ¿‰ÈÔ.

Reuters Health Information

ŒÓ·˜ Ó¤Ô˜ Èfi˜ ¢ı‡ÓÂÙ·È ÁÈ· ‚·ÚȤ˜ ·Ó·Ó¢ÛÙÈΤ˜ ÏÔÈÌÒÍÂȘ ÛÙ· ·È‰È¿ µ·Û›ÏÂÈÔ˜ ¶··‰¿Î˘, ¶·È‰›·ÙÚÔ˜

O ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜ (human metapneumovirus) Â›Ó·È ¤Ó· ·ıÔÁfiÓÔ Ô˘ ·ÔÌÔÓÒıËΠÙÔ 2001. ™‡Ìʈӷ Ì ¤Ó· ÛËÌ·ÓÙÈÎfi ¿ÚıÚÔ Ô˘ ‰ËÌÔÛȇıËΠÛÙÔ ÂÚÈÔ‰ÈÎfi New England Journal of Medicine Ù˘ 29˘ π·ÓÔ˘·Ú›Ô˘, ÛÙÔÓ Èfi ·˘Ùfi ÔÊ›ÏÂÙ·È ÙÔ 12% ÙˆÓ ÏÔÈÌÒÍÂˆÓ Ù˘ ηÙÒÙÂÚ˘ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ÙˆÓ ÌÈÎÚÒÓ ·È‰ÈÒÓ. ∏ ÁÓÒÛË ·˘Ù‹ ¤Ú¯ÂÙ·È Ó· Û˘ÌÏËÚÒÛÂÈ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Î·È Ó· ÌÂÈÒÛÂÈ ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÏÔÈÌÒÍÂˆÓ ·˘ÙÒÓ, ÛÙȘ Ôԛ˜ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ·ÔÌÔÓˆı› ÂȉÈÎfi˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜.

O Dr. Crowe JR Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘ ·fi ÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Vanderbilt ¤ÏÂÁÍ·Ó ÙËÓ ‡·ÚÍË ÌÂÙ·Ó¢ÌÔÓÔ˚Ô‡ Û ÚÈÓÈο ÂÎχ̷ٷ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ Ïԛ̈ÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· 25 ¯ÚfiÓˆÓ. ™ÙÔ ‰È¿ÛÙËÌ· ·˘Ùfi, 321 ·È‰È¿ ›¯·Ó ·Ó·Ó¢ÛÙÈ΋ Ïԛ̈ÍË ÙˆÓ Î·ÙÒÙÂÚˆÓ Ô‰ÒÓ Î·È Û 248 ·fi ·˘Ù¿ ˘‹Ú¯·Ó ‰È·ı¤ÛÈÌ· ÚÈÓÈο ÂÎχ̷ٷ. ™Â 49

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¡∂∞ ∞¶O ∆O ¢π∞¢π∫∆ÀO

·fi ·˘Ù¿ Ù· ·È‰È¿ (20%) ·ÓȯÓ‡ıËΠ·ÓıÚÒÈÓÔ˜ ÌÂÙ·Ó¢ÌÔÓÔ˚fi˜, ‰ËÏ·‰‹ ÛÙÔ 12% fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ›‰È· ÓfiÛÔ (·Ó·Ó¢ÛÙÈ΋ Ïԛ̈ÍË ÙˆÓ Î·ÙÒÙÂÚˆÓ Ô‰ÒÓ). ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·ÛıÂÓÒÓ ‹Ù·Ó 11,6 Ì‹Ó˜, ÂÓÒ Ù· ·ÁfiÚÈ· ‹Ù·Ó ÂÚÈÛÛfiÙÂÚ· (·Ó·ÏÔÁ›· 2:1). ∫ÏÈÓÈο, ÔÈ ·ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó ‚ÚÔÁ¯ÈÔÏ›Ùȉ· (59%) Î·È ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ Ï·Ú˘ÁÁ›Ùȉ· ‹ Âȉ›ӈÛË ÁÓˆÛÙÔ‡ ¿ÛıÌ·ÙÔ˜. ∂›Û˘, Ô Èfi˜ ·˘Ùfi˜ ‚Ú¤ıËΠ۠15% ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ·È‰ÈÒÓ Ì Ïԛ̈ÍË ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, ÂÓÒ ‹Ù·Ó Û¿ÓÈÔ˜ Û ·Û˘Ìو̷ÙÈο ·È‰È¿. ªÂ ‚¿ÛË ÙËÓ ¤ˆ˜ ÙÒÚ· ÁÓÒÛË, ‰ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ¿ÏÏË, ÂȉÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ Ì Ïԛ̈ÍË ·fi ÌÂÙ·Ó¢ÌÔÓÔ˚fi, ÂÓÒ fiÙ·Ó ı· Â›Ó·È ‰È·ı¤ÛÈÌË ‰ÔÎÈÌ·Û›· ·Ó›¯Ó¢Û˘ ÙÔ˘ ÈÔ‡, ı· ÌÔÚ› Ó· ·ÔʇÁÂÙ·È Ë ¿ÛÎÔË ¯Ú‹ÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ.

N Engl J Med 2004;350:431-433

∏§∂∫∆ƒO¡π∫∂™ ¢π∂À£À¡™∂π™ The Harriet Lane Links - http://derm.med.jhmi.edu/poi/ O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Harriet Lane (ÚÔËÁÔ‡ÌÂÓ· ·Ó·ÊÂÚfiÌÂÓÔ˜ ˆ˜ Pediatric Points of Interest) ·Ú¤¯ÂÈ Ì›· ÔÏÔÎÏËڈ̤ÓË Û˘ÏÏÔÁ‹ ·È‰È·ÙÚÈÎÒÓ ÈÛÙÔÛÂÏ›‰ˆÓ ÛÙÔ ‰È·‰›ÎÙ˘Ô (6180 links). ™˘ÓÙËÚÂ›Ù·È Î·È ÂÓËÌÂÚÒÓÂÙ·È ·fi ÙÔ John Hopkins University. ∞˘Ù‹ Ë ÈÛÙÔÛÂÏ›‰· ÂÚȤ¯ÂÈ ¤Ó·Ó Ï‹ÚË Î·Ù¿ÏÔÁÔ Ì ·Ó·ÛÎÔ‹ÛÂȘ, ¿ÚıÚ· Î·È Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ô˘ ·ÊÔÚÔ‡Ó Û fiϘ ÙȘ ·È‰È·ÙÚÈΤ˜ ˘ÔÂȉÈÎfiÙËÙ˜.

On line ‚È‚ÏÈÔı‹ÎË - http://www.amedeo.com/

O ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Amedeo.com ·ÔÙÂÏ› Ì›· on line ‚È‚ÏÈÔı‹ÎË Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· È·ÙÚÈο ÂÚÈÔ‰Èο ÁÈ· Ù· ÔÔ›· ˘¿Ú¯ÂÈ ÂχıÂÚË ÚfiÛ‚·ÛË ÛÙÔ ‰›ÎÙ˘Ô, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Î·È Ì›· ÌÂÁ¿ÏË ÛÂÈÚ¿ ·È‰È·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ. ™ÙËÓ ÈÛÙÔÛÂÏ›‰· ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ˘ËÚÂÛ›· Free Medical Journals.com, fiÔ˘ ‚Ú›ÛÎÔÓÙ·È Î·Ù·¯ˆÚË̤ÓÔÈ ÔÈ Ù›ÙÏÔÈ ÙˆÓ ÂÚÈÔ‰ÈÎÒÓ Ì ·ÏÊ·‚ËÙÈ΋ ÛÂÈÚ¿. O ÂÈÛΤÙ˘ ÌÔÚ› Ó· ¿ÚÂÈ Û ÌÔÚÊ‹ .pdf Ù· ¿ÚıÚ· Ô˘ ÙÔÓ ÂӉȷʤÚÔ˘Ó. ∞ÓÙ›ÛÙÔȯ·, ̤ۈ ÙÔ˘ Freebooks4doctors.com, Â›Ó·È ÂχıÂÚË Ë ÚfiÛ‚·ÛË Û ȷÙÚÈο ‚È‚Ï›· Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ ‰È·‰›ÎÙ˘Ô.

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Paediatriki 2004;67:72

OBITUARY

™Ù¤ÏÈÔ˜ ™Ì˘Ú¿ÎȘ (1936 - 2003) ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ∏ π·ÙÚÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ ÂÓı›. O ı¿Ó·ÙÔ˜ ÙÔ˘ ™Ù¤ÏÈÔ˘ ™Ì˘Ú¿ÎÈ ‹Ù·Ó ·ÒÏÂÈ· ÁÈ· fiÏÔ˘˜ fiÛÔ˘˜ ÙÔÓ ¤˙ËÛ·Ó ·fi ÎÔÓÙ¿, ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘, ÙÔ˘˜ Ê›ÏÔ˘˜ ÙÔ˘, ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘, ÙÔ˘˜ Ì·ıËÙ¤˜ ÙÔ˘. O ™Ù¤ÏÈÔ˜ ™Ì˘Ú¿ÎȘ ‹Ù·Ó Ô ÚÒÙÔ˜ ∫·ıËÁËÙ‹˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ Ù˘ ∫Ú‹Ù˘ Î·È Ì¤Û· ·fi ÔÏϤ˜ ‰˘ÛÎÔϛ˜ ÔÚÁ¿ÓˆÛÂ Î·È ÏÂÈÙÔ‡ÚÁËÛ ̛· ÚfiÙ˘Ë ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋. OÚÁ¿ÓˆÛÂ Î·È ÏÂÈÙÔ‡ÚÁËÛÂ, Â›Û˘, ÙËÓ ∫ÏÈÓÈ΋ ¡ÂÔÁÓÒÓ Î·È ÙÚ›· ¯ÚfiÓÈ· ÚÈÓ, ¯¿ÚË Û ‰ˆÚ¿ Ô˘ ÚÔÛ›Ï΢Û Ì ÙËÓ ÚÔÛˆÈÎfiÙËÙ¿ ÙÔ˘, ›‰Ú˘ÛÂ Î·È ÏÂÈÙÔ‡ÚÁËÛ ÙËÓ ÙfiÛÔ ··Ú·›ÙËÙË ª.∂.£. ·È‰ÈÒÓ. ∏ ÂÎÏÔÁ‹ ÙÔ˘ ™Ù¤ÏÈÔ˘ ™Ì˘Ú¿ÎÈ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ‹Ù·Ó Ë ÂÈÙ˘¯‹˜ ηٿÏËÍË Ì›·˜ ·ÓÔ‰È΋˜ ÔÚ›·˜. ¶Ù˘¯ÈÔ‡¯Ô˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ÙÔ 1962 Î·È ¢È‰¿ÎÙÔÚ·˜ Ù˘ ›‰È·˜ Û¯ÔÏ‹˜ ÙÔ 1974, ÌÂÙ¿ ÙË ÛÙÚ·ÙȈÙÈ΋ ÙÔ˘ ıËÙ›· Î·È ÙÔ ·ÁÚÔÙÈÎfi, ¤Ï·‚ ÙËÓ ÂȉÈÎfiÙËÙ· Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á. ™ÔÊ›·”. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÚÁ¿ÛÙËÎÂ Û·Ó ∂ÈÌÂÏËÙ‹˜ Î·È ·fi ÙÔ 1980 ̤¯ÚÈ ÙÔ 1985 ‰ÈÂÙ¤ÏÂÛ ¢È¢ı˘ÓÙ‹˜ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ Î·È ·ÚÁfiÙÂÚ· ¶Úfi‰ÚÔ˜ ÙÔ˘ ¢.™. ÙÔ˘ ¶·È‰Ô„˘¯È·ÙÚÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶ÂÓÙ¤Ï˘. ∆Ô 1985 ÂÍÂϤÁË ∞Ó·ÏËÚˆÙ‹˜ ∫·ıËÁËÙ‹˜ Î·È ·Ó¤Ï·‚ ÙË ‰È‡ı˘ÓÛË Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ÙÔ˘ ∏Ú·ÎÏ›Ԣ Î·È ÙÔ 1991 ÂÍÂϤÁË ∆·ÎÙÈÎfi˜ ∫·ıËÁËÙ‹˜. ∏ ÌÂÙÂÎ·›‰Â˘Û‹ ÙÔ˘ ÛÙËÓ ∞ÁÁÏ›·, ÙË ™Ô˘Ë‰›· Î·È ÙȘ ∏.¶.∞. Û˘Ó¤‚·Ï ÛÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÙÔ˘ ÔÏÔÎÏ‹ÚˆÛË, ÂÓÒ ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ÙÔ˘ ‰ËÌÔÛȇÛÂȘ Û ¤ÁÎÚÈÙ· ÂÚÈÔ‰Èο ÙÔ˘ ÎÏ¿‰Ô˘ ›¯·Ó ‰ÈÂıÓ‹ ·‹¯ËÛË Î·È Ì¿ÏÈÛÙ· ÔÈ ·Ó·ÊÂÚfiÌÂÓ˜ Û ı¤Ì·Ù· ÙÔ˘ ȉȷ›ÙÂÚÔ‡ ÙÔ˘ ÂӉȷʤÚÔÓÙÔ˜ Ô˘ ÂÛÙÈ·˙fiÙ·Ó Û ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù· Î·È ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙÔ˘ ·Û‚ÂÛÙ›Ô˘. ™ÙÔ ∏Ú¿ÎÏÂÈÔ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıËÙ›·˜ ÙÔ˘, ÚfiÛÊÂÚ ÛËÌ·ÓÙÈΤ˜ ˘ËÚÂۛ˜ ˆ˜ ¶Úfi‰ÚÔ˜ Ù˘ ∂ÈÛÙËÌÔÓÈ΋˜ ∂ÈÙÚÔ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ, ∞Ó·ÏËÚˆÙ‹˜ ¶Úfi‰ÚÔ˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘ Î·È ∞ÓÙÈÚfi‰ÚÔ˜ ÙÔ˘ ¢.™. ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ Î·È ÙÔ˘ π·ÙÚÈÎÔ‡ ™˘ÏÏfiÁÔ˘ ÙÔ˘ ∏Ú·ÎÏ›Ԣ. ™Â fiÏÔ˘˜ ÂÌ¿˜ ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜, ÙÔ˘˜ Ê›ÏÔ˘˜ Î·È ÙÔ˘˜ Ì·ıËÙ¤˜ ÙÔ˘, Ô ™Ù¤ÏÈÔ˜ ı· Ì›ÓÂÈ ·Í¤¯·ÛÙÔ˜ ÁÈ· ÙÔ ‹ıÔ˜, ÙËÓ ÂÓÙÈÌfiÙËÙ·, ÙË ÁÏ˘Î‡ÙËÙ·, ÙË ‰ËÌÔÎÚ·ÙÈÎfiÙËÙ· Î·È ÙË ÁÂÓÓ·ÈfiÙËÙ· Ù˘ „˘¯‹˜ ÙÔ˘. O ™Ù¤ÏÈÔ˜ ‹Ù·Ó ¿Óˆ ·’ fiÏ· ∫ÚËÙÈÎfi˜ Î·È Û·Ó ∫ÚËÙÈÎfi ÙÔÓ ·Ô¯·ÈÚÂÙÒ Ì ÙË Ì·ÓÙÈÓ¿‰· Ô˘ Ô ·Ù¤Ú·˜ ÂÓfi˜ ·È‰ÈÔ‡ ¤ÁÚ·„ ÁÈ· ÙÔÓ ı¿Ó·Ùfi ÙÔ˘: “’fiı·Ó˜, Ô˘ ‰ÂÓ ¤ÚÂ ÔÙ¤ ÛÔ˘ Ó’ ·Ôı¿ÓÂȘ, ÌÔÓ’ ¤ÚÂ ÂÛ‡ Ó· ˙ÂȘ, ¿ÓÙ· ηÏfi Ó· οÓÂȘ”. ª·Ú›· ∫·ÏÌ·ÓÙ‹ ∫·ıËÁ‹ÙÚÈ· ¢È¢ı‡ÓÙÚÈ· ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

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¶∞π¢π∞∆ƒπ∫∏ ∂¡∏ª∂ƒø™∏

Paediatriki 2004;67:73-74

PEDIATRIC NEWS

A. ªÂ ȉȷ›ÙÂÚË ¯·Ú¿ ηψÛÔÚ›˙Ô˘Ì ̛· Ó¤· ˘ÔÂȉÈÎfiÙËÙ· Ù˘ ¶·È‰È·ÙÚÈ΋˜, ÙËÓ “∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· πÛÙÔÚ›·˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜”. ™·˜ ÁÓˆÚ›˙Ô˘Ì fiÙÈ È‰Ú‡ıËÎÂ Î·È ÂÁÎÚ›ıËΠ̠ÙËÓ ˘’ ·Ú. 2867/03 ·fiÊ·ÛË ÙÔ˘ ªÔÓÔÌÂÏÔ‡˜ ¶ÚˆÙÔ‰ÈΛԢ ∞ıËÓÒÓ Ë ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· πÛÙÔÚ›·˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ∆Ô ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ ∂Ù·ÈÚ›·˜ ÁÈ· ÙËÓ ÚÒÙË ‰ÈÂÙ›· ··ÚÙ›˙ÂÙ·È ˆ˜ ·ÎÔÏÔ‡ıˆ˜: ¶Úfi‰ÚÔ˜: ∞ÓÙÈÚfi‰ÚÔ˜: °. °Ú·ÌÌ·Ù¤·˜: ∆·Ì›·˜: ª¤ÏË:

¢ËÌ‹ÙÚÈÔ˜ ∫·Ú·ÌÂÚfiÔ˘ÏÔ˜ §¿˙·ÚÔ˜ µÏ·‰›ÌËÚÔ˜ ŒÊË ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ ™Ù·‡ÚÔ˜ ™Ô˘Ú¿˜ ª·Ú›· ª¿Ó‰˘Ï·-∫Ô˘ÛÔ˘Ó‹ ÃÚ›ÛÙÔ˜ OÈÎÔÓÔÌfiÔ˘ÏÔ˜ ª·Ùı·›Ô˜ ∞ÁÁÂÏ¿Î˘

°È· ÙÔ ¢.™.

O ¶Úfi‰ÚÔ˜ Ù˘ ∂.¶.∂. ∫·ı. ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

B. ∆Ô ∫¤ÓÙÚÔ ŒÚ¢ӷ˜ Î·È ¶ÚfiÏ˄˘ ¶·È‰ÈÎÒÓ ∞Ù˘¯ËÌ¿ÙˆÓ (∫.∂.¶.¶.∞.) ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÙÔ˘, ÔÚÁ¿ÓˆÛ ̛· ÏÔ‡ÛÈ· ‚È‚ÏÈÔı‹ÎË, Ì ÛÙfi¯Ô ÙËÓ ÚfiÏË„Ë ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ÎÔÈÓÔ‡. ∏ ‚È‚ÏÈÔı‹ÎË ÂÚÈÏ·Ì‚¿ÓÂÈ ‰ËÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ·, ÎÂÊ¿Ï·È· ‚È‚Ï›ˆÓ, ηۤÙ˜ ‹¯Ô˘, ·ÚÔ˘ÛÈ¿ÛÂȘ ÙÔ˘ ∫.∂.¶.¶.∞. ÛÂ Û˘Ó¤‰ÚÈ· Î·È ÔÌÈϛ˜ ÛÙËÓ ∂ÏÏ¿‰· Î·È ÙÔ Â͈ÙÂÚÈÎfi, ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÁÈ· ÂÚ¢ÓËÙÈÎÔ‡˜ ÛÎÔÔ‡˜, cd-rom, ‰È·ÙÚÈ‚¤˜, ·Ê›Û˜, ‰ÂÏÙ›·, ÂÊËÌÂÚ›‰Â˜, ÂÚÈÔ‰Èο, ‚È‚Ï›·, ÔÌÈϛ˜ Î·È ÚÔÁÚ¿ÌÌ·Ù· Û˘Ó‰ڛˆÓ, ‚ÈÓÙÂÔηۤÙ˜, ·Ó·ÊÔÚ¤˜, ‚È‚ÏÈ·Ú¿ÎÈ· Î·È Ê˘ÏÏ¿‰È·, ηıÒ˜ Î·È ¿ÚıÚ· ANEC (European Association for the co-ordination of Consumer Representation in Standardization) ÂÈÛÙËÌÔÓÈÎÔ‡ Î·È ÂÎ·È‰Â˘ÙÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘, Ù· ÔÔ›· ·Ó·Ê¤ÚÔÓÙ·È Û fiÏ· Ù· ›‰Ë ·Ù˘¯ËÌ¿ÙˆÓ Î·È Î·Ï‡ÙÔ˘Ó fiÏÔ˘˜ ÙÔ˘˜ Èı·ÓÔ‡˜ ÙÚfiÔ˘˜ ÚfiÎÏËÛ‹˜ ÙÔ˘˜. ∏ ‚È‚ÏÈÔı‹ÎË Â›Ó·È ÛÙË ‰È¿ıÂÛË ÙÔ˘ ÎÔÈÓÔ‡ ·fi ¢Â˘Ù¤Ú· ¤ˆ˜ ¶·Ú·Û΢‹ Î·È ÒÚ˜ 08:00 - 16:00 ηÙfiÈÓ Ú·ÓÙ‚ԇ. ∆ËÏ. ÂÈÎÔÈÓˆÓ›·˜: 210 7462219 & 210 7462187 ∂-mail: epapak@med.uoa.gr

∏ ∂ÈÛÙËÌÔÓÈ΋ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ Ù˘ ¶∞π¢π∞∆ƒπ∫∏™ ÔÌfiʈӷ ¯·ÈÚÂÙ›˙ÂÈ ÙËÓ ›‰Ú˘ÛË µÈ‚ÏÈÔı‹Î˘ ·fi ÙÔ ∫.∂.¶.¶.∞. Î·È ÙË Û˘ÛÙ‹ÓÂÈ Û οı ÂӉȷÊÂÚfiÌÂÓÔ. °È· ÙË ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ O ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫·ı. ™Ù·‡ÚÔ˜ ÷˚‰¿˜

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¶·È‰È·ÙÚÈ΋ 2004;67:73-74

Paediatriki 2004;67:73-74

°. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ÁÔÓ¤ˆÓ Û ¯ÚfiÓȘ ·ı‹ÛÂȘ Â›Ó·È Ôχ ÌÂÁ¿ÏË. ¶·Ú¿ÏÏËÏ· Ì ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÂÍÂȉÈ·ÛÂˆÓ Ù˘ ·È‰È·ÙÚÈ΋˜, ·Ó·Ù‡ÛÛÔÓÙ·È Î·È ÛˆÌ·Ù›· ÁÔÓ¤ˆÓ Ô˘ ÛÎÔfi ¤¯Ô˘Ó Ó· ˘ÔÛÙËÚ›˙Ô˘Ó Î·È Ó· ÚÔˆıÔ‡Ó ÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË Ù˘ ·ÚÚÒÛÙÈ·˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜. ∆¤ÙÔÈÔ˘ ›‰Ô˘˜ Û˘ÓÂÚÁ·Û›Â˜ ÁÈ·ÙÚÒÓ - ÁÔÓ¤ˆÓ Â›Ó·È ¿ÍȘ Û˘Á¯·ÚËÙËÚ›ˆÓ. ◊‰Ë, Û·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰‡Ô Ó¤· ۈ̷Ù›· ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·: 1. ™ˆÌ·ÙÂ›Ô “O ª›ÙÔ˜ Ù˘ ∞ÚÈ¿‰Ó˘”. ªË ÎÂÚ‰ÔÛÎÔÈÎfi ۈ̷ÙÂ›Ô ÁÈ· ÙËÓ ÚÒÈÌË Î·È ÂÓÙ·ÙÈ΋ ·Ú¤Ì‚·ÛË ‚¿ÛÂÈ ÂÊ·ÚÌÔṲ̂Ó˘ ·Ó¿Ï˘Û˘ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ·˘ÙÈÛÙÈÎÒÓ ·È‰ÈÒÓ. OÈ ÛÙfi¯ÔÈ ÙÔ˘ ۈ̷Ù›Ԣ ›ӷÈ: ∂Î·›‰Â˘ÛË: ñ ∂Î·È‰Â˘Ù‹ÚÈ· Ì·ıËÙÒÓ. ñ ∂Î·È‰Â˘ÙÈο ÛÂÌÈÓ¿ÚÈ· ÁÔÓ¤ˆÓ Î·È ·ÙfiÌˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙÔÓ Ì·ıËÙ‹. ñ ∂Î·È‰Â˘ÙÈο ÛÂÌÈÓ¿ÚÈ· ÁÈ· ÊÔÈÙËÙ¤˜ Î·È Â·ÁÁÂÏ̷ٛ˜ ÙˆÓ ¯ÒÚˆÓ „˘¯È΋˜ ˘Á›·˜ Î·È ÂÎ·›‰Â˘Û˘ ÛÙË ıˆÚËÙÈ΋ Î·È Ú·ÎÙÈ΋ ηٿÚÙÈÛË, ·fi ηıËÁËÙ¤˜ ÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙËÓ ∂Ê·ÚÌÔṲ̂ÓË ∞Ó¿Ï˘ÛË ™˘ÌÂÚÈÊÔÚ¿˜. ñ ∂Î·È‰Â˘ÙÈο ÛÂÌÈÓ¿ÚÈ· ÁÈ· ‰·ÛοÏÔ˘˜ ÁÂÓÈ΋˜ Î·È ÂȉÈ΋˜ ÂÎ·›‰Â˘Û˘, ÒÛÙ ӷ ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ¤ÓÙ·ÍË ÙˆÓ Ì·ıËÙÒÓ Ì·˜ ÛÙ· ÎÔÈÓ¿ Û¯ÔÏ›·. ŒÓÙ·ÍË: ñ ÕÌÂÛË, ÛˆÛÙ‹, ηıÔÏÈ΋ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ∂ÏÏËÓÈÎÔ‡ ¡ÔÌÔıÂÙÈÎÔ‡ ¶Ï·ÈÛ›Ô˘ ÁÈ· ÙËÓ ¤ÓÙ·ÍË ÙˆÓ Ì·ıËÙÒÓ Ì·˜ ÙfiÛÔ ÛÙ· ÎÔÈÓ¿ Û¯ÔÏ›· fiÛÔ Î·È ÛÙÔ ÁÂÓÈÎfiÙÂÚÔ ÎÔÈÓˆÓÈÎfi Û‡ÓÔÏÔ. ñ ∂›ÛË̘ ·ÚÔ˘ÛÈ¿ÛÂȘ ÛÙÔ˘˜ ·ÚÌfi‰ÈÔ˘˜ ÊÔÚ›˜ Ì ÂÚÁ·Û›Â˜-˘ԉ›ÍÂȘ ÁÈ· Ó· ˘ÔÛÙËÚȯı› ÙÔ ¤ÚÁÔ Ù˘ ¤ÓÙ·Í˘. ∆ÈÌÔÏfiÁÈÔ: ñ ŒÓÙ·ÍË Ù˘ ∂Ê·ÚÌÔṲ̂Ó˘ ∞Ó¿Ï˘Û˘ ™˘ÌÂÚÈÊÔÚ¿˜ ÛÙÔ ÎÚ·ÙÈÎfi ÙÈÌÔÏfiÁÈÔ. °ÂÓÈο: ñ ÀÔÛÙ‹ÚÈÍË Î·È ÚÔÒıËÛË Î¿ı ¤Ú¢ӷ˜ Ô˘ ·ÊÔÚ¿ ÛÙËÓ ¿ÚÈÛÙË ÂÎ·›‰Â˘ÛË ÙˆÓ Ì·ıËÙÒÓ ÛÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ. ñ ÀÔÛÙ‹ÚÈÍË ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÙÔ˘ ÁÂÓÈÎfiÙÂÚÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙˆÓ Ì·ıËÙÒÓ. ñ OÌ¿‰Â˜ ÂıÂÏÔÓÙÈÛÌÔ‡. ñ ∞ıÏËÙÈΤ˜, „˘¯·ÁˆÁÈΤ˜, ÔÌ·‰ÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÁÈ· ÙÔ˘˜ Ì·ıËÙ¤˜. ñ µÈ‚ÏÈÔı‹ÎË ∂Ê·ÚÌÔṲ̂Ó˘ ∞Ó¿Ï˘Û˘ ™˘ÌÂÚÈÊÔÚ¿˜. ¶ÏËÚÔÊÔڛ˜: ñ ¡ÔÌÈ΋ Œ‰Ú·: ∂Ï¢ıÂÚˆÙÒÓ 27, ∆.∫. 172 37, ÀÌËÙÙfi˜ ¢.O.À. ¢¿ÊÓ˘ ∞.º.ª.: 099016810 ∆ËÏ.: 210 9715177 Fax: 210 9715177 E-mail: flynntan7@netonline.gr ñ ∂Î·È‰Â˘Ù‹ÚÈ·: ∆¿ÎË 6-8, ∞ı‹Ó·, ÂÚÈÔ¯‹ æ˘ÚÚ‹ ñ ∆ËÏ. ÁÚ·Ì̤˜ ÂÓË̤ڈÛ˘: 210 6747643, η. ∆˙¤ËÓ ∆·ÓÈÛΛ‰Ô˘ 210 9715177, η. §˘‰›· ¢ÂÏÂʤ 210 2386682, η. ∫˘Úȷ΋ ™˘Ú›ÁÔ˘ 2. ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ¢˘ÛÏÂÍ›·˜ ¶ÏËÚÔÊÔڛ˜: ∆ËÏ.: 210 9590035 Website: www.dyslexia.gr E-mail: dyslexia1984@yahoo.gr ™Â ÂÚ›ÙˆÛË Ô˘ ¤¯ÂÙ ·È‰› Ì ·˘ÙÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ‹ ‰˘ÛÏÂÍ›·, ÌÔÚ›Ù ӷ ˙ËÙ‹ÛÂÙ ÏËÚÔÊÔڛ˜ ·fi Ù· ·ÓÙ›ÛÙÔȯ· ۈ̷Ù›·. °È· ÙÔ ¢.™.

O ¶Úfi‰ÚÔ˜ Ù˘ ∂.¶.∂. ∫·ı. ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜

74

¶PO™EXH ™YNE¢PIA 5-7 ºÂ‚ÚÔ˘·Ú›Ô˘ 2004 4-6 ª·ÚÙ›Ô˘ 2004

Evaluation of Medicinal Products in Children Brussels, Belgium (A Post Graduate Course for Physicians, Pharmacists and other Scientists) European Society for Developmental Perinatal & Paediatric Pharmacology (ESDP) ¶ÏËÚÔÊÔڛ˜: Nadine PONS Pharmacologie Clinique-Hôpital St Vincent de Paul (Paris) Tel.: +33 (0)1 40 48 82 22 E-mail: sec_esdp_eudipharm@hotmail.com Website: http://www.md.ucl.ac.be/iufc/esdp_eudipharm

13-14 ª·ÚÙ›Ô˘ 2004

3Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ÀÔÂȉÈÎÔÙ‹ÙˆÓ Ù˘ ¶·È‰È·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International ∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: ped-subspec2004@cnc.gr Website: www.ped-subspec2004.gr

∞ı‹Ó·

23-25 ∞ÚÈÏ›Ô˘ 2004

16Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ “¶·È‰› Î·È ∞ıÏËÙÈÛÌfi˜” ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜ π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: ∂‡Ë ∞Ù˙¤ÌË, ÃÚ‡Û· ª·˘Ú›‰Ô˘ Tel.: 22410-99101 Website: www.socped.gr

ƒfi‰Ô˜

27 ∞ÚÈÏ›Ô˘1 ª·˝Ô˘ 2004

30fi ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: 210-72 11 845 Fax: 210-72 15 082 E-mail: iea@mednet.gr

∞ı‹Ó·

29 ∞ÚÈÏ›Ô˘1 ª·˝Ô˘ 2004

12Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ∂∂ªªO ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ªÂϤÙ˘ ªÂÙ·‚ÔÏÈÛÌÔ‡ ÙˆÓ OÛÙÒÓ ¶ÏËÚÔÊÔڛ˜: Convin Conventions & Incentives ∆ËÏ.: +30 210-33 92 232-3 Fax: +30 210-33 92 276 E-mail: talex@convin.gr Website: www.convin.gr

§‹ÌÓÔ˜

6-8 ª·˝Ô˘ 2004

2nd International Congress on Adult Consequences of Childhood Endocrine Diseases ¶ÏËÚÔÊÔڛ˜: ÕÓÓ· °È·Ï·ÓÙ˙‹ Tel.: (0030) 2310-447 444 Fax: (0030) 2310-447 444 & 2310-282 476 E-mail: info@ghsociety.gr Website: www.ghsociety.gr

∞ı‹Ó·

xi

¶PO™EXH ™YNE¢PIA 13-16 ª·˝Ô˘ 2004

II Eastern Mediterranean Meeting on Cerebral Palsy & Developmental Medicine ¶ÏËÚÔÊÔڛ˜: ERA Ltd Tel.: +30 210-36 34 944 & 36 32 950 Fax: +30 210-36 31 690 E-mail: info@era.gr Website: www.era.gr/emcpdm2004.htm

™·ÓÙÔÚ›ÓË

28-30 ª·˝Ô˘ 2004

42Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Creta Maris ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International ∆ËÏ.: 210-68 89 100 Fax: 210-68 44 777 E-mail: pediatric2004@cnc.gr Website: www.pediatric2004.gr

∫Ú‹ÙË

6-9 πÔ˘Ó›Ô˘ 2004

7Ô ¶·ÁÎfiÛÌÈÔ ™˘Ó¤‰ÚÈÔ ÁÈ· ÙËÓ ¶ÚfiÏË„Ë ∞Ù˘¯ËÌ¿ÙˆÓ Î·È ÙËÓ ¶ÚÔ·ÁˆÁ‹ ÀÁ›·˜/∞ÛÊ¿ÏÂÈ·˜ ¶ÏËÚÔÊÔڛ˜: ∫∂¶¶∞ ∆ËÏ.: 210-74 62 187 & 74 62 201 Fax: 210-74 62 105 Website: www.safety2004.info

Vienna, Austria

28-31 ∞˘ÁÔ‡ÛÙÔ˘ 2004

6th Balkan Meeting on Human Genetics (BMHG 2004) ¶ÏËÚÔÊÔڛ˜: TOPLINE Travel and Tourism Tel.: +30 2310-538 001 Fax: +30 2310-566 713 E-mail: info@toplinetravel.gr

£ÂÛÛ·ÏÔÓ›ÎË

24-28 ™ÂÙÂÌ‚Ú›Ô˘ 2004

XXXth World Congress of the International Society of Hematology (ISH) ¶ÏËÚÔÊÔڛ˜: Alper Sahinoglu Tel.: 90-3-124-383-721 Fax: 90-3-124-383-723 E-mail: ish2004@ish2004.org

Istanbul, Turkey

26 ™ÂÙÂÌ‚Ú›Ô˘1 OÎÙˆ‚Ú›Ô˘ 2004

XII Meeting of the European Association for Haematopathology ¶ÏËÚÔÊÔڛ˜: Triaena Tours & Congress ∆ËÏ.: +30 2310-25 61 94-5 Fax: +30 2310-25 61 96 E-mail: salonica@triaenatours.gr

£ÂÛÛ·ÏÔÓ›ÎË

xii

™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

xiv

™˘ÓÙÔÌÔÁڷʛ˜

EÏÏËÓÈÎÔ› fiÚÔÈ

AÁÁÏÈÎÔ› fiÚÔÈ

p.o.

RIA RNA RDS sec s.c. ‹ À.¢.

SD SE U

·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¿‰·

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

™˘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

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

xv