Παιδιατρική | Τόμος 68 • Τεύχος 2 • Μάρτιος - Απρίλιος 2005

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TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2005 ¶·È‰È·ÙÚÈ΋ ñ TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2005

www.paediatriki.edu.gr

Volume 68 ñ Number 2 ñ March-April 2005 ISSN 0377-2551

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¶·È‰È·ÙÚÈ΋ ¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜

∆fiÌÔ˜ 68 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2005

¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ™. ÷˚‰¿˜ ∞Ó·Ï. ¢È¢ı. ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ∂. ∞ÓÙˆÓÔÔ‡ÏÔ˘ A. µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë °. µ·ÚÏ¿Ì˘ ª. ∫·Ó¿ÚÈÔ˘ ∂. ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë A. K·ÙÙ¿Ì˘ Ã. ∫ÒÛÙ·ÏÔ˜ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ¶··‰ÔÔ‡ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘ K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ∞ÚÙ¤ÌȉԘ 3 151 25 M·ÚÔ‡ÛÈ TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889

ISSN 0377-2551

¶ÂÚȯfiÌÂÓ· ∞¡∞™∫O¶∏™∂π™ 85 OÈ ¯ËÌÂÈÔΛÓ˜ ÛÙȘ ÓÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ ∞. ª·ÓÔ˘Ú¿, ∂. °·Ï·Ó¿Î˘, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘ 93 ∏ ÛËÌ·Û›· ÙÔ˘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙË ÌÂϤÙË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ∫. ∞. µÔ‡‰Ú˘

µƒ∞µ∂Àª∂¡∏ ∂ƒ°∞™πA 103 ∏ Ê·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÛÙË ÌÂϤÙË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ¡. ∫·Ù˙ËÏ¿Î˘, ∂. ™ÙÂȷοÎË, ∞. ¶··‰¿Î˘, ∂. ¢ËÌËÙÚ›Ô˘, ∫. ª¿Ï·˜, ª. ∫·ÏÌ·ÓÙ‹

∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ 112 °ÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Û ·È‰È¿ Ì ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ì ÔÍηڂ·˙Â›ÓË ª. ∆˙ËÙËÚ›‰Ô˘, £. ¶¿ÓÔ˘, ∂. ¶·˘Ï›‰Ô˘, °. ÕÚÛÔ˜, A. ª·Î·‚fi˜, ∂. ªÈ¯·Ï¤ÙÔ˘, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜ 120 ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË ∂. ∞ÔÛÙfiÏÔ˘, ∂. °·Ï·Ó¿Î˘, °. µÏ·¯¿ÎË, ™. ™ÙÂÊ·Ó¿ÎË, ™. ª·Ú¿ÎË, ∂. ∫fiÎÔÚË, ∞. ∆ÛÈÏÈÌÈÁοÎË, ™. ™Ì˘Ú¿ÎȘ

133 ∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ ª. ÷ÛÈÒÙÔ˘, ∂. ™·ÌÌÔ‡ÙË, °. ¶ÈÙÛÔ˘Ï¿Î˘, ª. µ·Î¿ÎË, C. Van Viet-∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘, ∂. ∫Ô˘‰Ô˘ÌÓ¿Î˘ 140 ¡fiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ¶··‰ËÌËÙÚ›Ô˘, °. ª·Ù·ÊÈ¿, µ. ÷Ù˙ÔÔ‡ÏÔ˘, µ. ªÈÎÚ¿ÎË, ¡. ™ÎÂÓÙ¤Ú˘ 145 ¶ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ Ì ۇӉÚÔÌÔ PHACE Õ. ∆Û›ÙÛÈη, ∂. ºÚ˘Û›Ú·, ∞. §Ô˘Ú›‰·, ¡. ª·ÓˆÏ¿ÎË 150 ™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÂÈÓÂÊÚȉ›ˆÓ Ì ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ÛÔ‚·Ú‹˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ª. ¢·ÛÔÔ‡ÏÔ˘, ª. ∞ÔÛÙfiÏÔ˘, °. ª·ÚÔ‡Ù˘, ∂. ªÈ¯ÂϷοÎË, ∂. §Ô˘Î¿ÙÔ˘, Ã. ∫ÒÛÙ·ÏÔ˜

¶ƒ∞∫∆π∫O £∂ª∞ 155 ∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿ ™. ∞ÓÙˆÓÈ¿‰Ë˜

162 ∫§π¡π∫√ ∫√Àπ∑

163 ¡∂∫ƒ√§√°π∞ ∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™ 128 ¡fiÛÔ˜ Crohn Û ‚ÚÂÊÈ΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ¶··‰ÔÔ‡ÏÔ˘, ∂. ∫·ÙÛÈÁÈ·ÓÓ¿ÎË, ∂. ªÈ¯·ËÏ›‰Ô˘, π. °Ú·ÌÌ·ÙÈο΢, ∂. ª·ÓÙ˙Ô˘Ú¿ÓË

164 ∂¶π™∆√§∏ ¶ƒ√™ ∆∏ ™À¡∆∞•∏

166 NEA ∞¶√ ∆√ ¢π∞¢π∫∆À√

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Paediatriki Bimonthly Publication of the Greek Paediatric Society

Volume 68 ñ Number 2 ñ March-April 2005

President A. Constantopoulos Editorial Board Editor S. Haidas Assistant Editor C. Stefanidis Members P. Avgoustidou-Savvopoulou H. Antonopoulou A. Vazeou-Gerasimidi G. Varlamis M. Kanariou ∂. Katsarou-Pectasides A. Kattamis Ch. Costalos N. Papadopoulos ∞. Papadopoulou A. Siamopoulou-Mavridou M. Tsolia-Pasparaki Manuscript Editing Greek Editing I. Karavranou English Editing S. Nakou Publisher K. Griveas Publishing Coordinator

Contents REVIEW ARTICLES 92 Chemokines in neonatal infections A. Manoura, E. Galanakis, C. Giannakopoulou 102 Electroencephalographic investigation of children with epilepsy K. A. Voudris

111 Spectral imaging study of normal lymphocytes and lymphoblasts of acute lymphoblastic leukaemia in childhood N. Katzilakis, E. Stiakaki, A. Papadakis, H. Dimitriou, K. Balas, M. Kalmanti

ORIGINAL ARTICLES 119 Cognitive functions in children with focal epilepsy and long-term oxcarbazepine therapy M. Tzitiridou, T. Panou, E. Pavlidou, G. Arsos, A. Makavos, E. Michaletou, C. Panteliadis 127 Meningococcal disease in Crete E. Apostolou, E. Galanakis, G. Vlahaki, S. Stefanaki, S. Maraki, E. Kokori, A. Tsilimigaki, S. Sbyrakis

Owner

CASE REPORTS

Annual Subscription All foreign countries: US $ 50

144 Caroli’s disease with congenital hepatic fibrosis. A case report E. Papadimitriou, G. Matafia, V. Hatzopoulou, V. Mikraki, N. Skenteris

AWARD-WINNING ARTICLE

SCIENTIFIC PUBLICATIONS Ltd 3 Artemidos str.

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Greek Paediatric Society© 92 Michalakopoulou str.

GR - 115 28, Athens Tel.: +30 210 7771 140 +30 210 7771 663 Fax: +30 210 7758 354 e-mail: hps@ath.forthnet.gr

139 The neck: a rare site of teratoma in children M. Hasiotou, ∂. Sammouti, G. Pitsoulakis, M. Vakaki, C. van Viet-Konstadinidou, E. Koudoumnakis

149 An infant with PHACE syndrome A. Tsitsika, H. Fryssira, A. Lourida, N. Manolaki 154 Congenital adrenal hypoplasia presenting as severe respiratory failure.

Case report M. Dasopoulou, M. Apostolou, G. Baroutis, H. Michelakakis, E. Loukatou, C. Costalos

PRACTICAL ISSUE 161 Sudden death in children S. Antoniadis

162 CLINICAL QUIZ

163 OBITUARY

164 LETTER TO THE EDITOR 132 Crohn’s disease in infancy: a case report E. Papadopoulou, E. Katsiyiannaki, E. Mihailidou, I. Grammatikakis, E. Mantzouranis

166 NEWS FROM THE INTERNET

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√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™ 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˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜).

2. ∞Ó·ÛÎÔ‹ÛÂȘ.

3. µÚ·‚Â˘Ì¤Ó˜ ÂÚÁ·Û›Â˜.

4. ∂Ú¢ÓËÙÈΤ˜ ÌÂϤÙ˜.

5. ∫ÏÈÓÈο ∫Ô˘›˙ 6. ∂ÈÏÂÁ̤Ó˜ Û˘˙ËÙ‹ÛÂȘ ÛÙÚÔÁÁ˘ÏÒÓ ÙÚ·Â˙ÒÓ.

7. ∂›Î·ÈÚ· ı¤Ì·Ù·.

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

9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ.

10. ™‡ÓÙÔÌ· Ó¤·.

11. µÚ·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ.

12. ∂ÈÛÙÔϤ˜ ÚÔ˜ ÙË Û‡ÓÙ·ÍË.

13. ¶ÂÚÈÏ‹„ÂȘ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜.

14. ∞Ó·ÎÔÈÓÒÛÂȘ ÚÔÛ¯ÒÓ Û˘Ó‰ڛˆÓ Î·È ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜.

H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜ 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·ÛÙ› 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˘. ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ÌËÓ ¤¯Ô˘Ó ÂÓ Ì¤ÚÂÈ ‹ ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ‰ËÌÔÛÈ¢ı› ‹ ˘Ô‚ÏËı› ÁÈ· ÎÚ›ÛË Û ¿ÏÏÔ ÂÚÈÔ‰ÈÎfi. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. ŸÏ˜ ÔÈ ÎÏÈÓÈΤ˜ ¤Ú¢Ó˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó Á›ÓÂÈ 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. E›Û˘, Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÙËÚËı› ÔÈ Ô‰ËÁ›Â˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· ÂÈÚ·Ì·Ùfi˙ˆˆÓ ÙÔ˘ ∂ıÓÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙˆÓ ∏¶∞ (DHEW Publication, NIH, 80-23). OÈ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ Ú¤ÂÈ Ó· ¤¯Ô˘Ó ÂÁÎÚÈı› ·fi ÙËÓ ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ.

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¯ÒÚÈÛË ‰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›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·fi ÙÔÓ EΉfiÙË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ŸÏ˜ ÔÈ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ıˆÚÔ‡ÓÙ·È È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” Î·È Ë ÔÏÈ΋ ‹ ÌÂÚÈ΋

xi

·Ó·‰ËÌÔÛ›Â˘Û‹ ÙÔ˘˜ ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ¤ÁÁÚ·ÊË Û˘ÁηٿıÂÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡.

µ. ™‡ÓÙ·ÍË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ·ÎÔÏÔ˘ıÔ‡Ó “∫ÔÈÓ¤˜ ¶ÚԉȷÁڷʤ˜ ÁÈ· ÃÂÈÚfiÁÚ·Ê· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û µÈÔ˚·ÙÚÈο ¶ÂÚÈÔ‰Èο” (Uniform Requirements for Manuscripts Submitted to Biomedical Journals), ÔÈ Ôԛ˜ ÙÚÔÔÔÈ‹ıËÎ·Ó ÚfiÛÊ·Ù· Î·È ‰ËÌÔÛȇÔÓÙ·È ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf 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 Ù˘ˆÌ¤ÓÔ ÛÙË ÌÈ· fi„Ë Ï¢ÎÔ‡ ¯·ÚÙÈÔ‡ ÌÂÁ¤ıÔ˘˜ 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, ηٿÏÔÁÔ˜ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, 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. 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·: ñ ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ Û 2000-3000 ϤÍÂȘ. ñ ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ Û 250-500 ϤÍÂȘ.

™ÂÏ›‰· Ù›ÙÏÔ˘ ¶Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ: ñ ÙÔÓ Ù›ÙÏÔ (<14 ϤÍÂȘ), ηıÒ˜ Î·È ÙÔÓ ‚Ú·¯‡ Ù›ÙÏÔ (<5 ϤÍÂȘ) ÙÔ˘ ¿ÚıÚÔ˘. ¢ÂÓ ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ. ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋. ñ 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˘ÁÁڷʤ·/ˆÓ (.¯. ȉÈÒÙ˘ ·È‰›·ÙÚÔ˜) Î·È Ô ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙÔ˘˜. ñ 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˘. ñ £· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 200 ϤÍÂȘ, fï˜ ‰ÂÓ ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÂÈ ÙȘ 250 ϤÍÂȘ. ñ ∏ 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 ÛÂ: 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.

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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·ÔÌ¤˜ Î·È ÙÔÓ 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 Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ 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, 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¤˜.

Editors/ Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org Î·È http:// www.icmje.org/icmje.pdf). 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/bsd/uniform_requirements.html)]. ¶·Ú·‰Â›ÁÌ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·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.

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 ÛÙȘ ‰È¢ı‡ÓÛÂȘ: http://www.icmje.org Î·È http://www.icmje.org/icmje.pdf

™˘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:

¶ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù‡Ô˘ ¿ÚıÚÔ˘: 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. µπµ§π∞ ∫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.

ñ ÙȘ 70 ÛÙȘ ·Ó·ÛÎÔ‹ÛÂȘ. ñ ÙȘ 30 ÛÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜. ñ ÙȘ 12 ÛÙ· Â›Î·ÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. ñ ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.

¢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.

H Û‡ÓÙ·ÍË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal

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

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Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

IV. ™∆O ¢π∞¢π∫∆ÀO ÕÚıÚÔ Û ÂÚÈÔ‰ÈÎfi: Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/AJN/2002/june/Wawatch.htm

ªÔÓÔÁÚ·Ê›·: Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html

¶›Ó·Î˜ Î·È EÈÎfiÓ˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó (¤Ó· ÚˆÙfiÙ˘Ô Î·È ‰‡Ô ʈÙÔ·ÓÙ›ÁÚ·Ê·). ¶Ú¤ÂÈ Ó· ¤¯Ô˘Ó Ï¿ÙÔ˜ ›ÛÔ Ì ÙÔ Ï¿ÙÔ˜ ÙÔ˘ ÌÔÓfiÛÙËÏÔ˘ (7,5 cm) ‹ Ì ÙÔ Ï¿ÙÔ˜ fiÏ˘ Ù˘ ÛÂÏ›‰·˜ (15,5 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˜ Î·È ı· Ú¤ÂÈ Ó· Â›Ó·È ¿ÚÈÛÙ˘ ÔÈfiÙËÙ·˜. ™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.

πÛÙÔÛÂÏ›‰Â˜: Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/

°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰ÈÛΤٷ ‹ CD, ηıÒ˜ Î·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-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢.

EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘ԉ›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word, 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‹.

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.

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: ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 115 28 Aı‹Ó·

¶ÚÈÓ ·ÔÛÙ›ÏÂÙ ÙËÓ ÂÚÁ·Û›· Û·˜, ‚‚·Èˆı›Ù fiÙÈ ÂÚÈÏ·Ì‚¿ÓÂÈ: 1. 3 ·ÓÙ›ÁÚ·Ê· ÙÔ˘ ÎÂÈ̤ÓÔ˘ Ù˘ ÂÚÁ·Û›·˜, Ù˘ˆÌ¤Ó· Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜.

2. ¢ÈÛΤٷ ‹ CD Ì fiÏÔ ÙÔ ˘ÏÈÎfi Ù˘ ÂÚÁ·Û›·˜ (ΛÌÂÓÔ, ›Ó·Î˜, ÂÈÎfiÓ˜).

3. ∂ÈÛÙÔÏ‹ ˘Ô‚ÔÏ‹˜ Î·È ‰‹ÏˆÛË ÌË ÚÔÁÂÓ¤ÛÙÂÚ˘ ‰ËÌÔÛ›Â˘Û˘ 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΋, ‰ÔÌË̤ÓË ÛÙȘ ÂÍ‹˜ ·Ú·ÁÚ¿ÊÔ˘˜: ÂÈÛ·ÁˆÁ‹, ̤ıÔ‰ÔÈ, ·ÔÙÂϤÛÌ·Ù· Î·È Û˘ÌÂÚ¿ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ 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˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· Â¿Óˆ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó.

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

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™À¡∆√ª√°ƒ∞ºπ∂™ o

A cal cm cm2 cm3 o C g h IU kg l m mg min mm mol n NS ‹ ª™ osm p SD SE sec U

angstrom ıÂÚÌ›‰· ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢‚ÈÎfi ÂηÙÔÛÙfi ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ ÁÚ·ÌÌ¿ÚÈÔ ÒÚ· ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ¯ÈÏÈfiÁÚ·ÌÌÔ Ï›ÙÚÔ Ì¤ÙÚÔ ¯ÈÏÈfiÁÚ·ÌÌÔ ÏÂÙfi ¯ÈÏÈÔÛÙfiÌÂÙÚÔ ÁÚ·ÌÌÔÌfiÚÈÔ ·ÚÈıÌfi˜ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Èı·ÓfiÙËÙ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ‰Â˘ÙÂÚfiÏÂÙÔ ÌÔÓ¿‰·

™˘Ó‰˘·˙fiÌÂÓ· ÚÔı¤Ì·Ù· 12

tera- (10 ) giga- (109) mega- (106) kilo- (103) hector- (102) deca- (101) deci- (10-1) centi- (10-2) milli- (10-3) micro- (10-6) nano- (10-9) pico- (10-12) femto- (10-15) atto- (10-18)

ABBREVIATIONS

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

angstrom calorie centimeter square centimeter cubic centimeter degree Celsius gram hour international unit kilogram liter meter milligram minute millimeter mole number not significant osmole probability standard deviation standard error second unit

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INSTRUCTIONS TO AUTHORS A. General Information The Greek Paediatric Society is the owner of “Paediatriki”, its official scientific journal, which is distributed to its members. Its objectives are the publication of paediatric scientific work and the continuing education of paediatricians. For this purpose, it publishes a variety of articles, and in particular: 1. Editorials (upon invitation by the Editorial Board).

2. Review articles.

3. Award-winning articles.

4. Original articles.

5. Clinical Quiz 6. Round tables.

7. Current issues.

8. Issues of healthcare management and education.

9. Case reports.

10. News.

11. Brief reports.

12. Letters to the editor.

13. Abstracts.

14. Future congresses and events.

15. Book reviews.

The Editorial Board reserves the right to publish articles of special scientific interest and articles on current issues without observing submission order. In addition it publishes upon decision original papers presented at the Annual Paediatric Conference, presentations of special interest - in whole or in part, and letters - in whole or in part - referring to scientific articles published in the journal.

Regarding papers on current issues, the author’s request for immediate publication should be quoted on the first page. The Editorial Board reserves the right to accept such papers for immediate publication.

All manuscripts should not have been published previously, in whole or in part, and not be under consideration by another publication. Manuscripts should acknowledge any funding, sponsorship or other financial support. All clinical research should have been conducted following informed consent of participants or of their legal representatives according to the Declarations of Helsinki and Tokyo.

In addition, the US National Institute of Health guide for the care and use of laboratory animals (DHEW Publication, NIH, 80-23) should have been observed. Clinical trials should have been approved by the Ethics Committee of the Hospital.

Authors’ opinions and conclusions expressed in the published papers do not necessarily reflect those of the journal. The Greek Paediatric Society, the Editorial Board and the Publisher of the journal do not necessarily approve the content of the advertisements appearing in the journal.

The copyright of all published papers is held by “Paediatriki” and their reproduction in whole or in part is authorized only following written consent of the journal.

B. Manuscript Preparation “Paediatriki” suggests compliance with the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”, recently modified and published on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf The entire paper (including figure legends and tables)

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should be typed on one side of blank paper format A4 (21x29.7 cm), double line spacing and minimum indent 2.5 cm on both sides.

The paper should have the following structure: title page, short title, abstract in Greek and English, list of abbreviations, text, acknowledgements and quoting of grants, sponsorships or other financial support sources, references, tables, figures, figure legends. Each of these sections should be started on a new page. Pages should be numbered consecutively, beginning with the title page.

Text length shall be: ñ review articles 2000-3000 words; ñ original articles and case reports 1500-2500 words; ñ brief reports1000-1500 words; ñ letters 250-500 words.

The title page should include: ñ the title (<14 words) and the short title (<5 words) of the article. No abbreviations are permitted in the title; ñ the name and surname of all authors; ñ the centre (institution, clinic, laboratory) of origin of the paper. If there is no affiliation with a specific centre, the status of the author(s) should be cited (e.g., private paediatrician) and home address; ñ the complete address, e-mail and telephone number of the author to whom correspondence should be addressed.

Abstracts The abstract should summarize the objectives, methodology, main results and conclusions of the study. ñ It should contain at least 200 words, and not exceed 250 words. ñ It should consist of the following paragraphs: background, methods, results and conclusions.

The English abstract should cite at the beginning the title of the paper and the authors’ names in English. The content of the text should consist of the following paragraphs: background, methods, results and conclusions. The abstract in English should not differ in content from the corresponding Greek abstract.

Beneath the Greek and English abstracts, three to five key words in the respective language should be supplied, to be used in the thematic index.

Text Original articles include: introduction, methods, results and discussion. The introduction includes the latest research data on the subject and the main references and the objectives of the paper. The description of the methods should be precise and detailed so as to enable reproduction by other researchers. In addition, the statistical methods of analysis and evaluation of the results should be described.

Results should be presented clearly, together with the appropriate statistical analysis. Discussion should cover the results ensuing from the research, their significance and possible associations with the observations of other researchers.

Case reports comprise a short introduction, case description and brief discussion, with emphasis on differential diagnosis.

The structure of all other articles is free, according to the judgment of the authors.

Thanks or acknowledgements (reference to grants, sponsorships or other sources of financial support) should be quoted at the end of the text, before references.

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Units of measures of laboratory analyses Laboratory analyses should be expressed in the Système International (SI) units and in the metric (Conventional) system in parentheses. See conversion tables on the websites: http://www.icmje.org and http://www.icmje.org/icmje.pdf

II. BOOKS Chapter in book: 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.

Abbreviations All issues of the journal contain internationally established abbreviations. Complex or long terms often repeated in the text may be replaced by abbreviations explained by the authors in a list submitted with the paper. Abbreviations are reported in parentheses only in abstracts.

Book or monograph: Gorlin RJ, Cohen MM, Levin LS. Syndromes of the head and neck. 3rd ed. New York: Oxford University Press; 1990.

References The reference section contains all references numbered in the order in which they appear in the text. In the text, references are to be indicated by Arabic numerals in parentheses. References should be no more than: ñ 70 in review articles; ñ 30 in original articles; ñ 12 in current issues and case reports; ñ 5 in brief reports and letters.

In listing references follow the recently modified standards of the International Committee of Medical Journal Editors/Uniform Requirements for Manuscripts Submitted to Biomedical Journals, (http://www.icmje.org and http:// www.icmje.org/icmje.pdf). Abbreviated names of journals should conform to the Cumulated Index Medicus [List of Journals Indexed in Index Medicus (http://www.nlm.nih.gov/bsd/uniform_requirements.html)].

Examples of reference style I. JOURNALS All authors are cited if they are six or less; if they are 7 or more, the first six are cited, followed by “et al”.

Regular edition: Proesmans W. Bartter syndrome and its neonatal variant. Eur J Pediatr 1997;156:669-679.

Supplement issue: 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.

No author: National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement. Arch Neurol 1988;45:575-578.

Article type specification: 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.

Publication in a volume of proceedings: 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.

Doctoral dissertation: Kaplan SJ. Post hospital home health care: the elderly’s access and utilization [dissertation]. St. Louis (Mo): Washington Univ.; 1995. πππ. CD-ROM Anderson SC, Poulsen KB. Anderson’s electronic atlas of hematology [CD-ROM]. Philadelphia: Lippincott Williams & Wilkins; 2002.

IV. ON THE INTERNET Article in journal Abood S. Quality improvement initiative in nursing homes: the ANA acts in an advisory role. Am J Nurs [Internet]. 2002 Jun: Webpage: http://www.nursingworld.org/ AJN/2002/june/Wawatch.htm

Monograph Foley KM, Gelband H, editors. Improving palliative care for cancer [Monograph, Internet]. Washington: National Academy Press; 2001. Webpage: http://www.nap.edu/books/0309074029/html Websites Cancer-Pain.org [Webpage, Internet]. New York: Association of Cancer Online Resources, Inc.; 2002: http://www.cancer-pain.org/ Tables and Figures Three copies should be submitted (original plus 2 copies). Their width should either be equal to the width of one column (7.5 cm) or to the width of the page (15.5 cm).

Their maximum length, titles included, should not exceed 22 cm.

Tables are numbered with Arabic numerals in the order in which they appear in the text. They should have a short title and abbreviations should be listed at the bottom. Vertical lines in tables should be avoided.

All illustration material is considered as figures (graphs, pictures, etc.). They should be of excellent quality. Also, at the back of every picture, the number of the picture and the name of the first author should be noted in pencil, with an arrow showing the top of the picture. The identity of patients should not be recognizable from their pictures nor should their names be stated.

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C. Manuscript Submission and Publication All manuscripts should be accompanied by a floppy disk or CD, as well as by a letter, signed by all the authors, in which it is stated that the paper has not been published in part or in whole, or is not under consideration by another journal and that the authors accept its publication in “Paediatriki”. Any funding, sponsorship or other financial support should be acknowledged.

Once the manuscript has been accepted, the corrected version, rewritten according to the reviewers’ recommendations should be submitted to the Editorial Board accompanied by a floppy disk or CD, containing the paper in Word format, along with a covering letter specifying in detail the modifications or objections to the reviewers’ suggestions.

Delay in submission of the modified paper exceeding 30 days entails new submission.

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Paediatriki Mar-Apr 05

19-04-05

15:30

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∞¡∞™∫O¶∏™∏

85

OÈ ¯ËÌÂÈÔΛÓ˜ ÛÙȘ ÓÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ ∞. ª·ÓÔ˘Ú¿1, ∂. °·Ï·Ó¿Î˘2, Ã. °È·ÓÓ·ÎÔÔ‡ÏÔ˘1

¶ÂÚ›ÏË„Ë OÈ ¯ËÌÂÈÔΛÓ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÂӉȷʤÚÔ˘Û· ÔÈÎÔÁ¤ÓÂÈ· ÚˆÙÂ˚ÓÒÓ Ì ÔÈΛϘ ‚ÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ. ∏ ηٷÓfiËÛË Ù˘ ÛËÌ·Û›·˜ ÙÔ˘˜ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ‰È·ÊfiÚˆÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ ·ÔÙÂÏ› ·ÓÙÈΛÌÂÓÔ ÂÓÙ·ÙÈ΋˜ ¤Ú¢ӷ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™˘ÌÌÂÙ¤¯Ô˘Ó Û fiÏ· Ù· ÛÙ¿‰È· ·Ó¿Ù˘Í˘ Î·È ÂͤÏÈ͢ ÙˆÓ ÓÂÔÏ·ÛÈÒÓ Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· ÙˆÓ ¯ÚfiÓÈˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ÓfiÛˆÓ. ∫·ıÒ˜ Ì›· ·fi ÙȘ ‰Ú¿ÛÂȘ ÙÔ˘˜ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ Ù˘ ¯ËÌÂÈÔÙ·Í›·˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Ô˘ ·ÔÙÂÏ› Û˘ÓÈÛÙÒÛ· ηıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÛÙË ‰È·‰Èηۛ· Ù˘ ÊÏÂÁÌÔÓ‹˜, ÔÈ ¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢, ÂÓÒ ·Ú¿ÏÏËÏ· Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ‚Ï¿‚˘ ÙˆÓ ÔÚÁ¿ÓˆÓ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÂÚÈÙÒÛÂȘ Û‹„˘. ∂›Ó·È Èı·Ófi fiÙÈ Ë ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Ô˘ ÛÙԯ‡ÂÈ ÛÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË Î¿ÔÈˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ ÌÔÚ› Ó· ·Ó·ÛÙ›ÏÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ÛË„·ÈÌ›·˜. π‰È·›ÙÂÚ· ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Ô˘ ÔÈ ÏÔÈÌÒÍÂȘ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¤¯Ô˘Ó ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·, Ë Î·Ù·ÓfiËÛË ÙÔ˘ ÚfiÏÔ˘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ ıÂÚ·¢ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ ı· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ¤Î‚·Û˘ ÙˆÓ ÂÚÈÁÂÓÓËÙÈÎÒÓ ÏÔÈÌÒ͈Ó.

1 ¡ÂÔÁÓÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ 2 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ AÏÏËÏÔÁÚ·Ê›·: ÃÚÈÛÙ›Ó· °È·ÓÓ·ÎÔÔ‡ÏÔ˘ ∞ÙÏ·ÓÙ›‰Ô˜ 37, ∆.∫. 115 27 ∏Ú¿ÎÏÂÈÔ E-mail: tmanour@in.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-06-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 04-03-2005

§¤ÍÂȘ ÎÏÂȉȿ ÃËÌÂÈÔΛÓ˜, Ïԛ̈ÍË, ÛË„·ÈÌ›·, ÓÂÔÁÓÈ΋ ËÏÈΛ·.

∂ÈÛ·ÁˆÁ‹ ∏ ¯ËÌÂÈÔÙ·Í›·, Ë ÚÔÛ¤Ï΢ÛË ‰ËÏ·‰‹ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜, ·ÔÙÂÏ› Û˘ÓÈÛÙÒÛ· ηıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÛÙË ‰È·‰Èηۛ· Ù˘ ÊÏÂÁÌÔÓ‹˜ Î·È ÛÙËÓ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ÍÂÓÈÛÙ‹ ÛÙË Ïԛ̈ÍË (1). ∏ ÚÔÛ¤Ï΢ÛË ·˘Ù‹ ÙˆÓ Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ Ú˘ıÌ›˙ÂÙ·È ·fi ÙȘ ¯ËÌÂÈÔΛÓ˜, Ì›· ÛÂÈÚ¿ ·fi ¯ËÌÂÈÔÙ·ÎÙÈΤ˜ ΢ÙÙ·ÚÔΛÓ˜, Ë ÛËÌ·Û›· Î·È Ô ÚfiÏÔ˜ ÙˆÓ ÔÔ›ˆÓ ·ÔÙÂÏÔ‡Ó ·ÓÙÈΛÌÂÓÔ ÂÓÙ·ÙÈ΋˜ ¤Ú¢ӷ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (1,2). ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, fiÔ˘ Ë ÛËÌ·Û›· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ¤¯ÂÈ ÌÂÏÂÙËı› ÈηÓÔÔÈËÙÈο, Ô ÚfiÏÔ˜ ÙÔ˘˜ ÛÙȘ ÏÔÈÌÒÍÂȘ Ù˘ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜ Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓ ÛÙÔ ·Ú¯ÈÎfi ·ÎfiÌË ÛÙ¿‰ÈÔ Ù˘ ¤Ú¢ӷ˜. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ÂÚÈÁÚ¿ÊÔÓÙ·È ÌÂ Û˘ÓÙÔÌ›· Ë ‰ÔÌ‹ Î·È ÔÈ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÔÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÁÓÒÛÂȘ ÁÈ· ÙË ÛËÌ·Û›· ÙˆÓ ÌÔÚ›ˆÓ ·˘ÙÒÓ ÛÙË ÊÏÂÁÌÔÓ‹ Î·È ÔÈ Èı·Ó¤˜ ıÂÚ·¢ÙÈΤ˜ ÚÔÔÙÈΤ˜ ÙÔ˘˜ Î·È ÂȯÂÈÚÂ›Ù·È Ì›· ÚÔÛ¤ÁÁÈÛË ÁÈ· ÙÔÓ ÚfiÏÔ ÙÔ˘˜ ÛÙË ÓÂÔÁÓÈ΋ Ïԛ̈ÍË.

¢ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ OÈ ¯ËÌÂÈÔΛÓ˜ Â›Ó·È ÌÈÎÚ¿ ÚˆÙÂ˚ÓÈο ÌfiÚÈ· Ì ÌÔÚÈ·Îfi ‚¿ÚÔ˜ 8-12 kD (1,2). OÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÁÓˆÛÙ¤˜ ¤¯Ô˘Ó ·ÚfiÌÔÈ· ‰ÔÌ‹ Î·È ÂÚȤ¯Ô˘Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ 4 ·ÌÈÓÔͤ· ΢ÛÙ½Ó˘ Û ηıÔÚÈṲ̂-

Ó˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÌÔÚ›Ô˘ ÙÔ˘˜ (2). ∞Ó¿ÏÔÁ· Ì ÙË ı¤ÛË ÙˆÓ ‰‡Ô ÚÒÙˆÓ ·ÌÈÓÔÙÂÏÈÎÒÓ ·ÌÈÓÔͤˆÓ ΢ÛÙ½Ó˘ ÛÙÔ ÌfiÚÈÔ, ‰È·ÎÚ›ÓÔÓÙ·È 4 ÔÈÎÔÁ¤ÓÂȘ, ·fi ÙȘ Ôԛ˜ ÔÈ ·- Î·È ÔÈ ‚-¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó Ù· ÂÚÈÛÛfiÙÂÚ· ̤ÏË (1) (¶›Ó·Î·˜ 1). ∏ ÔÓÔÌ·ÙÔÏÔÁ›· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Â›Ó·È ·ÚÎÂÙ¿ Û˘Áί˘Ì¤ÓË, ·Ó Î·È ÚfiÛÊ·Ù· ¤¯ÂÈ ÚÔÙ·ı› Ë ·ÓÙÈηٿÛÙ·ÛË ÙˆÓ ÔÈÎ›ÏˆÓ ÔÓÔÌ¿ÙˆÓ ÙÔ˘˜ ·fi Ì›· Û˘ÛÙËÌ·ÙÈ΋ ÔÓÔÌ·ÙÔÏÔÁ›·, Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 1 (3,4). ∏ ÚÔÙÂÈÓfiÌÂÓË ÔÓÔÌ·ÙÔÏÔÁ›· ÛÙËÚ›˙ÂÙ·È ÛÔ˘˜ Έ‰ÈÎÔ‡˜ CC, CXC, CX3C Î·È XC, Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ÙÔ ÁÚ¿ÌÌ· L (ligand) ÁÈ· Ù· ÌfiÚÈ· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙÔ ÁÚ¿ÌÌ· R (receptor) ÁÈ· ÙÔ˘˜ ˘ԉԯ›˜ ÙÔ˘˜, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¤Ó·Ó ·‡ÍÔÓÙ· ·ÚÈıÌfi ÁÈ· οı ̤ÏÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (4,5). ¶ÔÏÏ¿ ·fi Ù· ÁÔÓ›‰È· Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ÙȘ ¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó ÂÓÙÔÈÛÙ›. ∆· ÁÔÓ›‰È· ÙˆÓ CC ¯ËÌÂÈÔÎÈÓÒÓ ‚Ú›ÛÎÔÓÙ·È ÛÙÔ 17q11.2-12 Î·È ÙˆÓ CXC ¯ËÌÂÈÔÎÈÓÒÓ ÛÙÔ 4q (2). ∏ ·ÏÏËÏÔ˘¯›· ÙˆÓ ·ÌÈÓÔͤˆÓ ÛÙÔ ·ÌÈÓÔÙÂÏÈÎfi ¿ÎÚÔ, Ù· ÔÔ›· ÚÔËÁÔ‡ÓÙ·È Ù˘ ΢ÛÙ½Ó˘, ·ÔÙÂÏ› ÙÔÓ Î·ıÔÚÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· Ù˘ ‚ÈÔÏÔÁÈ΋˜ ÙÔ˘˜ ‰Ú¿Û˘ Î·È Ù˘ ¯ËÌÈ΋˜ ÙÔ˘˜ Û˘ÁÁ¤ÓÂÈ·˜ (1). ŒÙÛÈ, ÔÈ ·-¯ËÌÂÈÔΛÓ˜ ÌÔÚÔ‡Ó Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó Û fiÛ˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ·ÏÏËÏÔ˘¯›· ÁÏÔ˘Ù·ÌÈÎfi Ô͇-Ï¢ΛÓË-·ÚÁÈÓ›ÓË ÎÔÓÙ¿ ÛÙÔ ·ÌÈÓÔÙÂÏÈÎfi ¿ÎÚÔ ÙÔ˘˜ Î·È ·ÛÎÔ‡Ó ‰Ú¿ÛË ÛÙ· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· (ELR-CXC ¯ËÌÂÈÔΛÓ˜) Î·È Û fiÛ˜ ‰ÂÓ ÙËÓ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È ‰ÚÔ˘Ó ÛÙ· ÏÂÌÊÔ·ÙÙ·Ú· (1). ¶ÚfiÙ˘Ô ÁÈ· ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ·-¯ËÌÂÈÔÎÈÓÒÓ (CXC) ·ÔÙÂÏ› Ë ÈÓÙÂÚÏ¢ΛÓË-8, ¶·È‰È·ÙÚÈ΋ 2005;68:85-91

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·86

86

∞. ª·ÓÔ˘Ú¿ Î·È Û˘Ó.

¶›Ó·Î·˜ 1. OÈ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ OÈÎÔÁ¤ÓÂÈ·

¢ÔÌ‹

∫‡ÚÈ· ‰Ú¿ÛË

¶ÚfiÙ˘Ô Ì¤ÏÔ˜

·-ÃËÌÂÈÔΛÓ˜ (CXC)

∆· ‰‡Ô ÚÒÙ· ·ÌÈÓÔͤ· ΢ÛÙ½Ó˘ ¯ˆÚ›˙ÔÓÙ·È ·fi ¤Ó· ‰È·ÊÔÚÂÙÈÎfi ·ÌÈÓÔ͇

O˘‰ÂÙÂÚfiÊÈÏ· §ÂÌÊÔ·ÙÙ·Ú·

πÓÙÂÚÏ¢ΛÓË-8

‚-ÃËÌÂÈÔΛÓ˜ (CC)

∆· ‰‡Ô ÚÒÙ· ·ÌÈÓÔͤ· ΢ÛÙ½Ó˘ Û˘Ó‰¤ÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜

ªÔÓÔ·ÙÙ·Ú· ∏ˆÛÈÓfiÊÈÏ· µ·ÛÂfiÊÈÏ· §ÂÌÊÔ·ÙÙ·Ú·

MCP-1

XC

¢‡Ô ÌfiÓÔ ·ÌÈÓÔͤ· ΢ÛÙ½Ó˘

∆ ÏÂÌÊÔ·ÙÙ·Ú·

§ÂÌÊÔÙ·ÎÙ›ÓË (lymphotactin)

CXXXC ‹ CX3C

∆· ‰‡Ô ÚÒÙ· ·ÌÈÓÔͤ· ΢ÛÙ½Ó˘ ¯ˆÚ›˙ÔÓÙ·È ·fi ÙÚ›· ·ÌÈÓÔͤ·

º˘ÛÈο ·ÙÙ·Ú·-ÊÔÓ›˜ ªÔÓÔ·ÙÙ·Ú·

ºÚ·ÎÙ·ÏΛÓË (fractalkine)

Ô˘ ·Ú¿ÁÂÙ·È ·fi ÌÂÁ¿ÏË ÔÈÎÈÏ›· ΢ÙÙ¿ÚˆÓ, Û˘ÌÌÂÙ¤¯ÂÈ ÛÙË ‰È·‰Èηۛ· ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙÔ ÂÓ‰Ôı‹ÏÈÔ, ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÁÁÂÈÔÁÂÓÂÙÈ΋ ‰Ú¿ÛË Î·È ÂÌϤÎÂÙ·È ÛÙËÓ ¤ÎÏ˘ÛË ÈÛÙ·Ì›Ó˘ ·fi Ù· ‚·ÛÂfiÊÈÏ· Î·È ÙËÓ ÚÔÛ¤Ï΢ÛË ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (2). ÕÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ·-¯ËÌÂÈÔÎÈÓÒÓ, ηıÒ˜ Î·È Ù· ·ÙÙ·Ú·ÛÙfi¯ÔÈ ÙÔ˘˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2.

OÈ ‚-¯ËÌÂÈÔΛÓ˜ ‰ÂÓ ‰ÚÔ˘Ó ÛÙ· Ô˘‰ÂÙÂÚfiÊÈÏ·, ·ÏÏ¿ ÚÔÛÂÏÎ‡Ô˘Ó ÌÔÓÔ·ÙÙ·Ú·, ˈÛÈÓfiÊÈÏ·, ‚·ÛÂfiÊÈÏ· Î·È ÏÂÌÊÔ·ÙÙ·Ú· (1). Èڛ˙ÔÓÙ·È Û ‰‡Ô ˘ÔÔÌ¿‰Â˜ (1), Ë ÚÒÙË ·fi ÙȘ Ôԛ˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ¤ÓÙ ¯ËÌÂÈÔÙ·ÎÙÈΤ˜ ÚˆÙ½Ó˜ ÁÈ· Ù· ÌÔÓÔ·ÙÙ·Ú· (MCP-1 ¤ˆ˜ MCP-5) Î·È ÙËÓ ËˆÙ·Í›ÓË, ÂÓÒ fiϘ ÔÈ ˘fiÏÔÈ˜ ·ÔÙÂÏÔ‡Ó ÙË ‰Â‡ÙÂÚË ˘ÔÔÌ¿‰· (¶›Ó·Î·˜ 3). ∏ ÚˆÙ½ÓË MCP-1 Â›Ó·È ÙÔ ÚÒÙÔ Ì¤ÏÔ˜ Ô˘ ·ÔÌÔÓÒıËÎÂ, ¤¯ÂÈ ¯ËÌÂÈÔÙ·ÎÙÈ΋ ‰Ú¿ÛË ÛÙ· ÌÔÓÔ·ÙÙ·Ú·, Â¿ÁÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ÈÓÙÂÁÎÚÈÓÒÓ, ÚÔÛÂÏ·ÂÈ Ù· ÂÓÂÚÁÔÔÈË̤ӷ CD4 Î·È CD8 ∆ ÏÂÌÊÔ·ÙÙ·Ú· Î·È Â¿ÁÂÈ ÙËÓ ¤ÎÏ˘ÛË ÈÛÙ·Ì›Ó˘ ·fi Ù· ‚·ÛÂfiÊÈÏ· (2,7-9).

OÈ ˘ԉԯ›˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ OÈ ¯ËÌÂÈÔΛÓ˜ ·ÛÎÔ‡Ó ÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÙ· ·ÙÙ·Ú·-ÛÙfi¯Ô˘˜ ̤ۈ ˘Ô‰Ô¯¤ˆÓ (1). O ‰ÂÛÌfi˜ ¯ËÌÂÈÔΛÓ˘ Î·È ˘Ô‰Ô¯¤· Ô‰ËÁ› Û ̛· ÛÂÈÚ¿ ΢ÙÙ·ÚÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ÙÚÈʈÛÊÔÚÈ΋˜ ÈÓÔÛÈÙfiÏ˘, ÙËÓ ¤ÍÔ‰Ô ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ·Û‚ÂÛÙ›Ô˘, ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÚˆÙÂ˚ÓÈ΋˜ ÎÈÓ¿Û˘ C Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Rho-ÚˆÙÂ˚ÓÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1). Œˆ˜ Û‹ÌÂÚ· ¤¯Ô˘Ó Ù·˘ÙÔÔÈËı› ¤ÍÈ ˘ԉԯ›˜ ÁÈ· ÙȘ ·-¯ËÌÂÈÔΛÓ˜ (CXCR1-CXCR6), ÂÓÓ¤· ˘ԉԯ›˜ ÁÈ· ÙȘ ‚-¯ËÌÂÈÔΛÓ˜ (CCR1-CCR9) Î·È ·fi ¤Ó·˜ ˘Ô‰Ô¯¤·˜ ÁÈ· ÙȘ CXXXC- Î·È XC¯ËÌÂÈÔΛÓ˜ (CX3CR1, XCR1) (1,3,5). OÈ ˘ԉԯ›˜ ·˘ÙÔ› ÂÎÊÚ¿˙ÔÓÙ·È Û ‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ. ÕÏÏÔÈ ÂÎÊÚ¿˙ÔÓÙ·È Û ¤Ó·Ó ÌfiÓÔ Ù‡Ô Ï¢ÎÔ΢ÙÙ¿ÚÔ˘, ÂÓÒ ¿ÏÏÔÈ ¤¯Ô˘Ó ÈÔ Â˘Ú›·

¶·È‰È·ÙÚÈ΋ 2005;68:85-91

ηٷÓÔÌ‹ (1). ¶ÔÏÏÔ› Ù‡ÔÈ Î˘ÙÙ¿ÚˆÓ ÂÎÊÚ¿˙Ô˘Ó ÙÔ˘˜ ˘ԉԯ›˜ ÌfiÓÔ ÌÂÙ¿ ·fi Â·ÁˆÁ‹ ·fi οÔÈÔ ÂÚ¤ıÈÛÌ·, ÂÓÒ Û ¿ÏÏ· ·ÙÙ·Ú· οÔÈÔÈ ÌÂÛÔÏ·‚ËÙ¤˜ ÌÂÈÒÓÔ˘Ó ÙËÓ ¤ÎÊÚ·ÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ·˘ÙÒÓ Î·È Ù· ·ÙÙ·Ú· ¯¿ÓÔ˘Ó ÙËÓ Â˘·ÈÛıËÛ›· ÙÔ˘˜ ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë ¯ËÌÂÈÔΛÓË (1). ∂ÎÙfi˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, ˘ԉԯ›˜ ¯ËÌÂÈÔÎÈÓÒÓ ¤¯Ô˘Ó ‚ÚÂı› Î·È Û Ï›ÛÙ· ¿ÏÏ· ·ÙÙ·Ú·, fiˆ˜ Û Ó¢ÚÒÓ˜, ·ÛÙÚÔ·ÙÙ·Ú·, ÂÈıËÏȷο Î·È ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·, ‡ÚËÌ· Ô˘ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÔÈ ¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó Î·È Ï›ÛÙÔ˘˜ ¿ÏÏÔ˘˜ ÚfiÏÔ˘˜, ·Ú¿ÏÏËÏ· Ì ÙË ¯ËÌÂÈÔÙ·ÎÙÈ΋ ÙÔ˘˜ ‰Ú¿ÛË ÛÙ· Ï¢ÎÔ·ÙÙ·Ú· (1). OÈ ˘ԉԯ›˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‰ÂÓ Â›Ó·È ÂȉÈÎÔ› ÁÈ· Ì›· ÌfiÓÔ ¯ËÌÂÈÔΛÓË, ˆÛÙfiÛÔ ÌÔÚÔ‡Ó Ó· ‰ÂÛÌÂ‡Ô˘Ó ÌfiÓÔ Ì¤ÏË Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ (1,2).

O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Î·È ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ ÛÙȘ ÏÔÈÌÒÍÂȘ O ÛËÌ·ÓÙÈÎfi˜ ÚfiÏÔ˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙËÓ ÔÍ›· Ïԛ̈ÍË Â›Ó·È ÁÓˆÛÙfi˜. ªÂ ÙË Ê·ÁÔ΢ÙÙ¿ÚˆÛË Î·È ÙËÓ ·ÂÏ¢ı¤ÚˆÛË ÔÈÎ›ÏˆÓ ÂȉÈÎÒÓ Î·È ÌË ÂȉÈÎÒÓ ‚·ÎÙËÚÈÔÎÙfiÓˆÓ Ô˘ÛÈÒÓ, Ù· Ô˘‰ÂÙÂÚfiÊÈÏ· ·Ì‡ÓÔÓÙ·È ÂÓ¿ÓÙÈ· ÛÙÔ˘˜ ·ıÔÁfiÓÔ˘˜ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜ (10,11). ∆Ë Û˘ÁΤÓÙÚˆÛË Î·È ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÂϤÁ¯Ô˘Ó Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ÔÈ ¯ËÌÂÈÔΛÓ˜ (2). ∏ ÌÂÁ¿ÏË ·‡ÍËÛË Ù˘ ¤ÎÎÚÈÛ˘ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÊÏÂÁÌÔÓ‹˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÎÏÂÎÙÈ΋ Û˘ÁΤÓÙÚˆÛË Ï¢ÎÔ΢ÙÙ¿ÚˆÓ (2). ∆ËÓ ¤ÎÎÚÈÛË ·˘Ù‹ Â¿ÁÔ˘Ó ÔÈ ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ΢ÙÙ·ÚÔΛÓ˜, fiˆ˜ Ë ÈÓÙÂÚÏ¢ΛÓË 1 (IL-1) Î·È Ô ·Ú¿ÁÔÓÙ·˜ Ó¤ÎÚˆÛ˘ fiÁÎˆÓ ¿ÏÊ· (TNF-·), ÚÔ˚fiÓÙ· ‚·ÎÙËÚȉ›ˆÓ fiˆ˜ ÔÈ ÔÏ˘Û·Î¯·Ú›Ù˜ Î·È ÈÔ› (1,2). ∂ÈϤÔÓ, ÔÈ ¯ËÌÂÈÔΛÓ˜ Â¿ÁÔÓÙ·È ·fi ÙËÓ ÈÓÙÂÚÊÂÚfiÓË-Á Î·È ÙËÓ ÈÓÙÂÚÏ¢ΛÓË-4, ÚÔ˚fiÓÙ· ÙˆÓ ∆1 Î·È ∆2 ‚ÔËıËÙÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ·ÓÙ›ÛÙÔȯ· (2). ∏ Û˘Û¯¤ÙÈÛË Ù˘ ¤ÎÊÚ·Û˘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Ì ÙȘ ·ıÔÊ˘ÛÈÔÏÔÁÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ ¤¯ÂÈ ÂÈÙ¢¯ı› Ì ÌÂϤÙ˜ Û ÂÈÚ·Ì·Ùfi˙ˆ· (1,12). ªÂ ÙËÓ ÂÈÚ·Ì·ÙÈ΋

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·87

87

ÃËÌÂÈÔΛÓ˜ Î·È ÓÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ

¶›Ó·Î·˜ 2. °ÓˆÛÙ¿ ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ·-¯ËÌÂÈÔÎÈÓÒÓ (ÙÚÔÔÔÈË̤ÓÔ ·fi ‚È‚ÏÈÔÁڷʛ˜ 1,2,4) ¶ÚÔÙÂÈÓfiÌÂÓÔ fiÓÔÌ·

∂ÌÂÈÚÈÎfi fiÓÔÌ·

∫‡ÙÙ·Ú·-ÛÙfi¯ÔÈ

CXCL1 CXCL2 CXCL3 CXCL4 CXCL5 CXCL6 CXCL7 CXCL8 CXCL9 CXCL10 CXCL11 CXCL12 CXCL13 CXCL14

GRO-· (MGSA) GRO-‚ (MIP-2a) GRO-Á (MIP-2b) Platelet factor-4 ENA-78 GCP-2 NAP-2 IL-8 MIG IP-10 SCYB9B (IP-9) SDF-1 BLC (BCA-1) BRAK

O˘‰ÂÙÂÚfiÊÈÏ·, ·ÙÙ·Ú· ÌÂÏ·ÓÒÌ·ÙÔ˜ (? ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·) O˘‰ÂÙÂÚfiÊÈÏ· (? ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·) O˘‰ÂÙÂÚfiÊÈÏ· (? ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·) πÓÔ‚Ï¿ÛÙ˜, ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· O˘‰ÂÙÂÚfiÊÈÏ· O˘‰ÂÙÂÚfiÊÈÏ· O˘‰ÂÙÂÚfiÊÈÏ·, ‚·ÛÂfiÊÈÏ· O˘‰ÂÙÂÚfiÊÈÏ·, ∆-ÏÂÌÊÔ·ÙÙ·Ú·, ‚·ÛÂfiÊÈÏ· (? ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·) ¢ÈÂÁÂṲ́ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú· ¢ÈÂÁÂṲ́ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ? ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· ∆ ÏÂÌÊÔ·ÙÙ·Ú·, CD34+ ÚÔ‰ÚÔÌÈο ·ÙÙ·Ú·, µ ÏÂÌÊÔ·ÙÙ·Ú· ? µ ÏÂÌÊÔ·ÙÙ·Ú·

·‰Ú·ÓÔÔ›ËÛË, ÁÈ· ·Ú¿‰ÂÈÁÌ·, Ù˘ ¯ËÌÂÈÔΛÓ˘ ªπƒ-2 ¤¯ÂÈ ‰Âȯı› fiÙÈ Ë ¯ËÌÂÈÔΛÓË ·˘Ù‹ Â›Ó·È ÛËÌ·ÓÙÈ΋ ÁÈ· ÙË Û˘ÁΤÓÙÚˆÛË Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È ÙËÓ ·ÔÌ¿ÎÚ˘ÓÛË ÙˆÓ ‚·ÎÙËÚȉ›ˆÓ Û ÂÈÚ·Ì·ÙÈÎfi ÌÔÓÙ¤ÏÔ Ó¢ÌÔÓ›·˜ ·fi Klebsiella (13). º·›ÓÂÙ·È fiÙÈ ÔÈ ¯ËÌÂÈÔΛÓ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ÎÔÎÎÈÒÌ·ÙÔ˜ Î·È ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙÔ˘ Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Î·È ¤¯ÂÈ ‰Âȯı› fiÙÈ Ë ÌfiÏ˘ÓÛË Ì·ÎÚÔÊ¿ÁˆÓ Ì ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Â¿ÁÂÈ ÙËÓ ¿ÌÂÛË ¤ÎÎÚÈÛË ¯ËÌÂÈÔÎÈÓÒÓ Ô˘ ÌÔÚÔ‡Ó Ó· ·ÓȯÓ¢ıÔ‡Ó ÌfiÏȘ 2 ÒÚ˜ ÌÂÙ¿ (14,15). ∂ÎÙfi˜ ·fi Ù· Ì·ÎÚÔÊ¿Á·, ¿ÏÏ· ·ÙÙ·Ú· Â›Û˘, fiˆ˜ Ù· ·ÓıÚÒÈÓ· ÂÈıËÏȷο ΢„ÂÏȉÈο ·ÙÙ·Ú·, ·Ú¿ÁÔ˘Ó ¯ËÌÂÈÔΛÓ˜ ˆ˜ ·¿ÓÙËÛË ÛÙË Ïԛ̈ÍË ·fi ÙÔ Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ Î·È Û˘ÌÌÂÙ¤¯Ô˘Ó ¤ÙÛÈ ÛÙË Û˘ÛÛÒÚ¢ÛË Î˘ÙÙ¿ÚˆÓ ÛÙË ı¤ÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ (14). ∏ ¢·ÈÛıËÛ›· Û ÔÚÈṲ̂Ó˜ ÏÔÈÌÒÍÂȘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û¯ÂÙ›˙ÂÙ·È ¿ÌÂÛ· Ì ÙËÓ ¤ÏÏÂÈ„Ë Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ¯ËÌÂÈÔÎÈÓÒÓ. OÈ ·ıÔÁfiÓÔÈ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ› Û˘Ó‰¤ÔÓÙ·È Ì ˘ԉԯ›˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÁÈ· Ó· ‚ÚÔ˘Ó ‰›Ô‰Ô ÚÔ˜ ÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· Î·È ÙÔÓ ˘Ú‹Ó· ÙˆÓ Î˘ÙÙ¿ÚˆÓ (1). OÈ ¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó ÎÔÈÓÔ‡˜ ˘ԉԯ›˜ Ì ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛËÌ·ÓÙÈÎÔ‡˜ ·ıÔÁfiÓÔ˘˜ ÁÈ· ÙÔÓ ¿ÓıÚˆÔ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÙÔ Ï·ÛÌÒ‰ÈÔ Ù˘ ÂÏÔÓÔÛ›·˜ (1). OÈ ¯ËÌÂÈÔΛÓ˜ Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ÙÔ˘˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ˘ԉԯ›˜ (RANTES, MIP-1·, MIP-1‚) ηٷϷ̂¿ÓÔ˘Ó ÙȘ ı¤ÛÂȘ Û‡Ó‰ÂÛ˘ ÙÔ˘ ÈÔ‡ Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ Î·È ÂÌÔ‰›˙Ô˘Ó ¤ÙÛÈ ÙËÓ ÚÔÛÎfiÏÏËÛË Î·È ÙËÓ Â›ÛÔ‰fi ÙÔ˘ ÛÙ· ·ÙÙ·Ú· (16,17). ÕÙÔÌ· Ì ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ ÌÔχÓÔÓÙ·È ·fi ÙÔÓ Èfi, ·Ú¿ ÙËÓ Â·ÓÂÈÏËÌ̤ÓË ¤ÎıÂÛ‹ ÙÔ˘˜ Û ·˘ÙfiÓ (18). ∫·È ¿ÏÏÔÈ ÈÔ›, fiˆ˜ ÔÚÈṲ̂ÓÔÈ ÂÚËÙÔ˚Ô›, ÂÎÊÚ¿˙Ô˘Ó ˘ԉԯ›˜ ÔÌfiÏÔÁÔ˘˜ Ì ÙÔ˘˜ ˘ԉԯ›˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ. O ÂÚËÙÔ˚fi˜-8 ¤¯ÂÈ ‚ÚÂı› fiÙÈ Îˆ‰ÈÎÔÔÈ› ¤Ó·Ó ÂÓÂÚÁfi ˘Ô‰Ô¯¤· ¯ËÌÂÈÔÎÈÓÒÓ Ô˘ ‰ÈÂÁ›ÚÂÈ ÙÔÓ Î˘ÙÙ·ÚÈÎfi ÔÏÏ·Ï·ÛÈ·ÛÌfi (19).

∏ ηٷÓfiËÛË Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙȘ ÏÔÈÌÒÍÂȘ ¤¯ÂÈ ˆ˜ ‰˘ÓËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙËÓ Èı·Ó‹ ıÂÚ·¢ÙÈ΋ ÙÔ˘˜ ¯Ú‹ÛË. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ ÔÈ ÌË ÂȉÈÎÔ› Ì˯·ÓÈÛÌÔ› ¿Ì˘Ó·˜ ηٿ ÙˆÓ ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ·ÂÏ¢ı¤ÚˆÛË ÂχıÂÚˆÓ ÚÈ˙ÒÓ, ÚÔηÏÔ‡Ó ‚Ï¿‚Ë Î·È ÛÙÔÓ ÍÂÓÈÛÙ‹, ‚Ï¿‚Ë Ô˘ ÌÔÚ› Ó· Â›Ó·È ÛËÌ·ÓÙÈ΋ (20). ∏ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Â›Ó·È Ô˘ÛÈ҉˘ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ì›·˜ Ïԛ̈͢, ·ÏÏ¿ ·Ú¿ÏÏËÏ· Û˘Ó‰¤ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·ÓÂÈı‡ÌËÙˆÓ ÂÈÙÒÛˆÓ, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ ÔÏ˘ÔÚÁ·ÓÈ΋˜ ¤ÎÙˆÛ˘ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ (21,22). ™ÙÔÓ ÔÚfi ·ÛıÂÓÒÓ Ì ÛË„·ÈÌ›· ¤¯ÂÈ ‰È·ÈÛÙˆı› ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ, fiˆ˜ Ù˘ IL-8, ÙÔ˘ GRO-· Î·È ÙÔ˘ MIP-1·, ÂÓÒ ÛËÌ·ÓÙÈÎfiÙÂÚË ·‡ÍËÛË ÛÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ MIP-1· ‚Ú¤ıËΠ۠ÔÚfi ·ÛıÂÓÒÓ Ì ۋ„Ë Ô˘ η٤ÏËÍ·Ó (23-25).

OˆÛ‰‹ÔÙÂ, Ë ‰È·‰Ô¯È΋ ¤ÎÎÚÈÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ÔÈÎ›ÏˆÓ ÌÂÛÔÏ·‚ËÙÒÓ ‰˘Û¯ÂÚ·›ÓÂÈ ÙfiÛÔ ÙËÓ Ï‹ÚË Î·Ù·ÓfiËÛË Ù˘ ‰È·‰Èηۛ·˜ fiÛÔ Î·È ÙË ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË (26). øÛÙfiÛÔ, ÌÂϤÙ˜ Û ÂÓ‹ÏÈΘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ô ¤ÏÂÁ¯Ô˜ Ù˘ ¯ËÌÂÈÔÙ·Í›·˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÂÈÙÂÏÂ›Ù·È Ì¤Ûˆ ‰‡Ô ΢ڛˆ˜ ˘Ô‰Ô¯¤ˆÓ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ, ÙÔ˘ CXCR1 Î·È ÙÔ˘ CXCR2 (5,27,28). ∏ ΢ÚÈ·Ú¯›· ÙÔ˘ ÂÓfi˜ ÌfiÓÔ ˘Ô‰Ô¯¤·, ÙÔ˘ CXCR1, ηٿ ÙË ÛË„·ÈÌ›· ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Èı·ÓfiÓ Ì›· ıÂÚ·¢ÙÈ΋ ‰¤ÛÌ¢ÛË ÙÔ˘ ˘Ô‰Ô¯¤· ·˘ÙÔ‡ ı· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂȈ̤ÓË ¯ËÌÂÈÔÙ·Í›· ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÚÔ˜ Ù· ‰È¿ÊÔÚ· fiÚÁ·Ó· ηÈ, ηٿ Û˘Ó¤ÂÈ·, ÙÔÓ ÂÚÈÔÚÈÛÌfi Ù˘ ‚Ï¿‚˘ ÙÔ˘˜ (29).

O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Û ¿ÏϘ ·ıÔÊ˘ÛÈÔÏÔÁÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ ∂ÎÙfi˜ ·fi ÙȘ ÏÔÈÌÒÍÂȘ, ÔÈ ¯ËÌÂÈÔΛÓ˜ Û˘ÌÌÂÙ¤¯Ô˘Ó Û ÔÈΛϘ ¿ÏϘ Ê˘ÛÈÔÏÔÁÈΤ˜ Î·È ¶·È‰È·ÙÚÈ΋ 2005;68:85-91

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·88

88

∞. ª·ÓÔ˘Ú¿ Î·È Û˘Ó.

·ıÔÏÔÁÈΤ˜ ‰ÈÂÚÁ·Û›Â˜. OÈ CXC ¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË Î·È Ë ‰Ú¿ÛË ÙÔ˘˜, ·Ó·ÛÙ·ÏÙÈ΋ ‹ ÚÔ·ÁˆÁÈ΋, ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ‡·ÚÍË Ù˘ ·ÏÏËÏÔ˘¯›·˜ ELR (3). OÈ ELR-CXC ¯ËÌÂÈÔΛÓ˜ Â›Ó·È ÈÛ¯˘ÚÔ› ·ÁÁÂÈÔÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, ÂÓÒ ÔÈ ˘fiÏÔÈ˜ CXC ¯ËÌÂÈÔΛÓ˜ ¤¯Ô˘Ó ·Ó·ÛÙ·ÏÙÈ΋ ‰Ú¿ÛË ÛÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË (2,3). ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ ÔÈ ÓÂÔϷۛ˜ Î·È ÔÚÈṲ̂Ó˜ ¯ÚfiÓȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔÈ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙË ‰È·Ù·Ú·¯‹ Ù˘ ÈÛÔÚÚÔ›·˜ ÌÂٷ͇ ÚÔ·ÁˆÁ‹˜ Î·È ·Ó·ÛÙÔÏ‹˜ Ù˘ ·ÁÁÂÈÔÁ¤ÓÂÛ˘ (30-32). ™Â ¯ÚfiÓȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ÓfiÛÔ˘˜, Ë Û˘ÛÛÒÚ¢ÛË ‰È·ÊfiÚˆÓ Ù‡ˆÓ ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ ηıÔÚ›˙ÂÙ·È ·fi ÙËÓ ¤ÎÎÚÈÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ¯ËÌÂÈÔÎÈÓÒÓ (1). ™ÙË Û·ÚÎÔ›‰ˆÛË ¤¯ÂÈ ‰È·ÈÛÙˆı› ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË Ù˘ ¯ËÌÂÈÔΛÓ˘ IP10, ÙfiÛÔ ÛÙÔÓ ÔÚfi fiÛÔ Î·È Û ‚ÚÔÁ¯Ô΢„ÂÏȉÈÎfi ¤ÎÏ˘Ì·, fiÔ˘ Ë ·‡ÍËÛË Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ∆ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (1). ™ÙËÓ ·ÏÏÂÚÁÈ΋ ‰ÂÚÌ·Ù›Ùȉ·, ÙËÓ ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ· Î·È ÙÔ ¿ÛıÌ·, fiÔ˘ ˘¿Ú¯ÂÈ ÂÎÏÂÎÙÈ΋ Û˘ÁΤÓÙÚˆÛË Î·È ÂÓÂÚÁÔÔ›ËÛË ËˆÛÈÓÔÊ›ÏˆÓ Î·È Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ, Ë ËˆÙ·Í›ÓË Î·È ÔÈ ¯ËÌÂÈÔÙ·ÎÙÈΤ˜ ÚˆÙ½Ó˜ ÙˆÓ ÌÔÓÔ΢ÙÙ¿ÚˆÓ (MCP-1 ¤ˆ˜ MCP-4) Ê·›ÓÂÙ·È fiÙÈ ¤¯Ô˘Ó ηıÔÚÈÛÙÈÎfi ÚfiÏÔ Î·È ·ÔÙÂÏÔ‡Ó Èı·ÓÒ˜ ÙÔÓ ÌÔÚÈ·Îfi Û‡Ó‰ÂÛÌÔ ÌÂٷ͇ Ù˘ ¿ÓÔÛ˘ ·ÓÙ›‰Ú·Û˘ ÛÙÔ ·ÓÙÈÁfiÓÔ Î·È Ù˘

ÌÂÙ·Ó¿ÛÙ¢Û˘ ÙˆÓ ËˆÛÈÓÔÊ›ÏˆÓ ÛÙÔ˘˜ ÈÛÙÔ‡˜ (33-35). ™ÙËÓ ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ· Î·È ÙË ÓfiÛÔ Crohn, ÙËÓ „ˆÚ›·ÛË, ÙË ÚÂ˘Ì·ÙÔÂȉ‹ ·ÚıÚ›Ùȉ· Î·È ÙËÓ ·ıËÚÔÛÎÏ‹Ú˘ÓÛË ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ·˘ÍË̤ӷ Â›‰· ‰È·ÊfiÚˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Ô˘ Ê·›ÓÂÙ·È fiÙÈ Î·ıÔÚ›˙Ô˘Ó ÙÔÓ Ù‡Ô ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ‰ÈËıÔ‡Ó ÙÔ˘˜ ÈÛÙÔ‡˜ Û οı ÂÚ›ÙˆÛË (1,36,37). ∏ ÂͤÏÈÍË ÙˆÓ ‰È·ÊfiÚˆÓ ·˘ÙÒÓ ·ı‹ÛÂˆÓ ÌÔÚ›, ıˆÚËÙÈο ÙÔ˘Ï¿¯ÈÛÙÔÓ, Ó· ÙÚÔÔÔÈËı› Ì ÙË ‚Ô‹ıÂÈ· ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ (3). Œ¯ÂÈ ‰Âȯı› ÚfiÛÊ·Ù· fiÙÈ ÔÈ ¯ËÌÂÈÔΛÓ˜ Î·È ÔÈ ˘ԉԯ›˜ ÙÔ˘˜ Û˘ÌÌÂÙ¤¯Ô˘Ó Û fiÏ· Ù· ÛÙ¿‰È· ·Ó¿Ù˘Í˘ Î·È ÂͤÏÈ͢ ÙˆÓ ÓÂÔÏ·ÛÈÒÓ, ·fi ÙËÓ Î·ÚÎÈÓÈ΋ ÌÂÙ·ÙÚÔ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì¤¯ÚÈ ÙË ‰È‹ıËÛË ·ÈÌÔÊfiÚˆÓ Î·È ÏÂÌÊÔÊfiÚˆÓ ·ÁÁ›ˆÓ ·fi ÓÂÔÏ·ÛÌ·ÙÈο ·ÙÙ·Ú· Î·È ÙË ÌÂÙ¿ÛÙ·ÛË Û ¿ÏÏ· fiÚÁ·Ó· (3,38). ◊‰Ë ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ô ÂÚËÙÔ˚fi˜-8 Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Û¿ÚΈ̷ Caposi, Έ‰ÈÎÔÔÈ› ¤Ó·Ó ÂÓÂÚÁfi ˘Ô‰Ô¯¤· ¯ËÌÂÈÔÎÈÓÒÓ. OÚÈṲ̂Ó˜ CXC ¯ËÌÂÈÔΛÓ˜ Ê·›ÓÂÙ·È fiÙÈ ‰ÈÂÁ›ÚÔ˘Ó Û˘Ó¯Ҙ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ˘Ô‰Ô¯¤· CXCR2, Ô‰ËÁÒÓÙ·˜ ÙÂÏÈο Û ηÚÎÈÓÈ΋ ΢ÙÙ·ÚÈ΋ ÌÂÙ·ÙÚÔ‹.

OÈ ¯ËÌÂÈÔΛÓ˜ CXCL8 (IL-8) Î·È GRO-·, -‚, -Á Ê·›ÓÂÙ·È fiÙÈ ‰ÚÔ˘Ó ˆ˜ ·˘ÍËÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÔÚÈṲ̂ӷ ηÎÔ‹ıË Î‡ÙÙ·Ú· (38-41). ∏ ·Ó¿Ù˘ÍË ÙˆÓ Û˘Ì·ÁÒÓ fiÁÎˆÓ Û ‰È¿ÌÂÙÚÔ ÌÂÁ·Ï‡ÙÂÚË ·fi

¶›Ó·Î·˜ 3. °ÓˆÛÙ¿ ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙˆÓ ‚-¯ËÌÂÈÔÎÈÓÒÓ (ÙÚÔÔÔÈË̤ÓÔ ·fi ‚È‚ÏÈÔÁڷʛ˜ 1,2,4)

¶·È‰È·ÙÚÈ΋ 2005;68:85-91

¶ÚÔÙÂÈÓfiÌÂÓÔ fiÓÔÌ·

∂ÌÂÈÚÈÎfi fiÓÔÌ·

∫‡ÙÙ·Ú·-ÛÙfi¯ÔÈ

CCL1 CCL2

I-309 MCP-1

CCL3

MIP-1·

CCL4

MIP-1‚

CCL5

RANTES

CCL7

MCP-3

CCL8

MCP-2

CCL11 CCL13 CCL14 CCL15 CCL16 CCL17 CCL18 CCL19 CCL20 CCL21 CCL22 CCL23 CCL24 CCL25 CCL26 CCL27

Eotaxin MCP-4 HCC-1 ∏CC-2/MIP-1‰ ∏CC-4/LEC TARC DK-CK1 / PARC/AMAC-1 MIP-3‚/ELC / Exodus 3 MIP-3· /LARC/ Exodus-1 SLC/Exodus-2 MDC/STCP-1 MPIF-1 MPIF-2/Eotaxin-2 TECK Eotaxin-3 CTACK/ILC

ªÔÓÔ·ÙÙ·Ú· ªÔÓÔ·ÙÙ·Ú·, ∆ ÏÂÌÊÔ·ÙÙ·Ú· ÌÓ‹Ì˘, ‚·ÛÂfiÊÈÏ·, ·ÈÌÔÔÈËÙÈο ÚÔ‰ÚÔÌÈο ·ÙÙ·Ú· ªÔÓÔ·ÙÙ·Ú·, ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ·ÙÙ·Ú·-ÊÔÓ›˜, ‚·ÛÂfiÊÈÏ·, ˈÛÈÓfiÊÈÏ·, ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú·, ·ÈÌÔÔÈËÙÈο ÚÔ‰ÚÔÌÈο ·ÙÙ·Ú· ªÔÓÔ·ÙÙ·Ú·, ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú·, ·ÙÙ·Ú·ÊÔÓ›˜, ·ÈÌÔÔÈËÙÈο ÚÔ‰ÚÔÌÈο ·ÙÙ·Ú· ∆ ÏÂÌÊÔ·ÙÙ·Ú· ÌÓ‹Ì˘, ˈÛÈÓfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·, ·ÙÙ·Ú·-ÊÔÓ›˜, ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· ªÔÓÔ·ÙÙ·Ú·, ˈÛÈÓfiÊÈÏ·, ∆ ÏÂÌÊÔ·ÙÙ·Ú· ÌÓ‹Ì˘, ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú·, ·ÙÙ·Ú·-ÊÔÓ›˜ ªÔÓÔ·ÙÙ·Ú·, ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ˈÛÈÓfiÊÈÏ·, ‚·ÛÂfiÊÈÏ·, ·ÙÙ·Ú·-ÊÔÓ›˜ ∏ˆÛÈÓfiÊÈÏ· ªÔÓÔ·ÙÙ·Ú·, ∆ ÏÂÌÊÔ·ÙÙ·Ú·, ˈÛÈÓfiÊÈÏ· ªÔÓÔ·ÙÙ·Ú·, ·ÈÌÔÔÈËÙÈο ÚÔ‰ÚÔÌÈο ·ÙÙ·Ú·

∆ ÏÂÌÊÔ·ÙÙ·Ú· ¢ÈÂÁÂṲ́ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú· ¢ÈÂÁÂṲ́ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú· ¢ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· ¢ÈÂÁÂṲ́ӷ ∆ ÏÂÌÊÔ·ÙÙ·Ú· ¢ÂÓ‰ÚÈÙÈο ·ÙÙ·Ú· ∏ˆÛÈÓfiÊÈÏ·

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19-04-05

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ÃËÌÂÈÔΛÓ˜ Î·È ÓÂÔÁÓÈΤ˜ ÏÔÈÌÒÍÂȘ

2 ¯ÈÏÈÔÛÙ¿ Î·È Ë ÂÚ·ÈÙ¤Úˆ Ù·¯Â›· ÙÔ˘˜ ·‡ÍËÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Â·Ú΋ ·ÈÌ¿ÙˆÛ‹ ÙÔ˘˜, Ô˘ Ú˘ıÌ›˙ÂÙ·È ·fi ÙË Û¯ÂÙÈ΋ ¤ÎÎÚÈÛË CXC ·Ó·ÛÙ·ÏÙÈÎÒÓ Î·È ‰ÈÂÁÂÚÙÈÎÒÓ Ù˘ ·ÁÁÂÈÔÁ¤ÓÂÛ˘ ¯ËÌÂÈÔÎÈÓÒÓ ·fi Ù· ·ÙÙ·Ú· ÙÔ˘ fiÁÎÔ˘ Î·È ÙÔ˘ ÛÙÚÒÌ·Ùfi˜ ÙÔ˘˜ (stroma) (38,42). ∏ ‰ÈËıËÙÈÎfiÙËÙ· ÙˆÓ fiÁÎˆÓ ÂÍ·ÚÙ¿Ù·È Î·È ·fi ÙËÓ ÈηÓfiÙËÙ· ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ó· ·Ú¿ÁÔ˘Ó ÚˆÙÂÔÏ˘ÙÈο ¤Ó˙˘Ì·, ÙËÓ ·Ú·ÁˆÁ‹ Î·È ¤ÎÎÚÈÛË ÙˆÓ ÔÔ›ˆÓ Ê·›ÓÂÙ·È fiÙÈ Â¿ÁÔ˘Ó ÔÈ ¯ËÌÂÈÔΛÓ˜ (38). ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙË ‰ËÌÈÔ˘ÚÁ›· Î·È ÂÍ¿ψÛË ÙˆÓ ÓÂÔÏ·ÛÈÒÓ ‰ËÌÈÔ˘ÚÁ› ‰˘Ó·ÙfiÙËÙ˜ ıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ·ÊÂÓfi˜ Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ ·˘ÙÒÓ ÁÈ· ÂÓ›Û¯˘ÛË Ù˘ ·ÓÙÈηÚÎÈÓÈ΋˜ ·ÓÔÛÔÏÔÁÈ΋˜ ·ÓÙ›‰Ú·Û˘ ÙÔ˘ ÍÂÓÈÛÙ‹ ‹ ÁÈ· ÙÚÔÔÔ›ËÛË Ù˘ ÓÂÔ·ÁÁ›ˆÛ˘ ÛÙÔ ÌÈÎÚÔÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ fiÁÎÔ˘ Î·È ·ÊÂÙ¤ÚÔ˘ Ì ÙË ‚Ô‹ıÂÈ· ·ÓÙ·ÁˆÓÈÛÙÒÓ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜, Ì ÛÎÔfi ÙËÓ ·Ú¤Ì‚·ÛË ÛÙÔ˘˜ ¯ËÌÂÈÔÙ·ÎÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ηıÔÚ›˙Ô˘Ó ÙË ÌÂÙ¿ÛÙ·ÛË ÙˆÓ Î·ÚÎÈÓÈÎÒÓ Î˘ÙÙ¿ÚˆÓ (38).

ÃËÌÂÈÔÙ·Í›· Î·È ¯ËÌÂÈÔΛÓ˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· ∆· ÓÂÔÁÓ¿ ˆ˜ ÁÓˆÛÙfiÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÈÔÓÂÎÙÈ΋ ·ÓÙ›‰Ú·ÛË ÛÙȘ ÏÔÈÌÒÍÂȘ Û ۯ¤ÛË Ì ٷ ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ (43). ∏ ÂÏ·Ùو̤ÓË ¯ËÌÂÈÔÙ·Í›· ÙˆÓ ÓÂÔÁÓÈÎÒÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙ˜ ÈÛÙÔ‡˜ ·ÔÙÂÏ› ÙË ÛËÌ·ÓÙÈÎfiÙÂÚË ›Ûˆ˜ ÏÂÈÙÔ˘ÚÁÈ΋ ·ÓˆÌ·Ï›· ÙÔ˘˜ (43). ∏ ‰È·›‰˘ÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ·fi ÙÔ ·›Ì· ÚÔ˜ ÙÔ˘˜ ÈÛÙÔ‡˜ Â›Ó·È Ì›· Û‡ÓıÂÙË ‰È·‰Èηۛ· Ô˘ ··ÈÙ› Û˘Á¯ÚÔÓÈṲ̂ÓË ·ÏÏËÏÂ›‰Ú·ÛË Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ (1) Î·È Ë ÔÔ›· Ú˘ıÌ›˙ÂÙ·È ·fi ÙÚÂȘ ÔÈÎÔÁ¤ÓÂȘ ÌÔÚ›ˆÓ, ÙȘ ÈÓÙÂÁÎÚ›Ó˜, ÙȘ ÛÂÏÂÎÙ›Ó˜ Î·È ÙȘ ¯ËÌÂÈÔΛÓ˜ (1). ∫·È ÔÈ ÙÚÂȘ ·˘Ù¤˜ ÔÈÎÔÁ¤ÓÂȘ ¤¯ÂÈ ‰Âȯı› fiÙÈ Â›Ó·È ·ÓÂ·ÚΛ˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·.

OÈ ÛÂÏÂÎÙ›Ó˜ Ú˘ıÌ›˙Ô˘Ó ÙË Û‡ÏÏË„Ë ÙˆÓ Ï¢ÎÔÎ˘Ù¿ÚˆÓ ·fi ÙÔ ·›Ì· ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÌÂÛÔÏ·‚ËÙ¤˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ¯·Ï·ÚÒÓ ‰ÂÛÌÒÓ ÚÔÛÎfiÏÏËÛ˘ Ì ٷ ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (1,43). Œ¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ÙˆÓ ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ÂÎÊÚ¿˙Ô˘Ó ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ ÏÈÁfiÙÂÚÔ ·fi ÙÔ 50% ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ˘Ô‰Ô¯¤ˆÓ L-ÛÂÏÂÎÙ›Ó˘ ÙˆÓ ÂÓËϛΈÓ, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÌÂÈÔÓÂÎÙÈ΋ ÈηÓfiÙËÙ· ¯·Ï·Ú‹˜ ÚÔÛÎfiÏÏËÛ‹˜ ÙÔ˘˜ ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· (43-45). OÈ ‚2-ÈÓÙÂÁÎÚ›Ó˜ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ Â›Ó·È ˘‡ı˘Ó˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ‰ÂÛÌÒÓ ˘„ËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ ÚÔ˜ ÙÔ ÂÓ‰Ôı‹ÏÈÔ, ‰È·‰Èηۛ· ··Ú·›ÙËÙË ÁÈ· ÙË ‰È·›‰˘ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ

ÚÔ˜ ÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙ˜ ÈÛÙÔ‡˜ (1,43). ªÂϤÙ˜ Û ÓÂÔÁÓ¿ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ÂÎÊÚ¿˙Ô˘Ó Û ËÚÂÌ›· Ôχ ÌÈÎÚfiÙÂÚÔ ·ÚÈıÌfi ˘Ô‰Ô¯¤ˆÓ ÙˆÓ ‚2-ÈÓÙÂÁÎÚ›ÓˆÓ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È fiÙÈ Ô ·ÚÈıÌfi˜ ·˘Ùfi˜ ‰ÂÓ ·˘Í¿ÓÂÈ ÛËÌ·ÓÙÈο Û ÂÚ›ÙˆÛË ‰È¤ÁÂÚÛ˘ (43).

OÈ ¯ËÌÂÈÔΛÓ˜ ıˆÚÂ›Ù·È fiÙÈ ‰›ÓÔ˘Ó ÙÔ Û‹Ì· ÁÈ· ÌÂÙ·ÙÚÔ‹ ÙˆÓ ‰ÂÛÌÒÓ ¯·ÌËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Ì ٷ ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·, Û ‰ÂÛÌÔ‡˜ ˘„ËÏ‹˜ Û˘Ó¿ÊÂÈ·˜, Ì ÌÂÛÔÏ·‚ËÙ¤˜ ÙȘ ÈÓÙÂÁÎÚ›Ó˜ (1). ŸÙ·Ó Ù· Ï¢ÎÔ·ÙÙ·Ú· Ô˘ ÎÈÓÔ‡ÓÙ·È ¿Óˆ ÛÙÔ ·ÁÁÂÈ·Îfi ÙÔ›¯ˆÌ· Ì ÙÔ˘˜ ‰ÂÛÌÔ‡˜ ¯·ÌËÏ‹˜ Û˘Ó¿ÊÂÈ·˜ ÙˆÓ ÛÂÏÂÎÙÈÓÒÓ, Û˘Ó·ÓÙ‹ÛÔ˘Ó ˘„ËÏ‹ Û˘ÁΤÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ, ·˘Í¿ÓÂÙ·È (upregulate) Ë Û˘Ó¿ÊÂÈ· Ì ÙȘ ÈÓÙÂÁÎÚ›Ó˜, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ÛÙ·ıÂÚ‹ ÚÔÛÎfiÏÏËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· Î·È ÙÂÏÈο ÙËÓ ÂÍ·ÁÁ›ˆÛ‹ ÙÔ˘˜ ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹ (1,2). ™ÙË Û˘Ó¤¯ÂÈ·, Ù· ÂÍ·ÁÁÂȈ̤ӷ Ï¢ÎÔ·ÙÙ·Ú· ÎÈÓÔ‡ÓÙ·È ·ÎÔÏÔ˘ıÒÓÙ·˜ Ì›· Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓË Û˘ÁΤÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ Î·È Î·Ù·Ï‹ÁÔ˘Ó ÛÙË ı¤ÛË Ù˘ ̤ÁÈÛÙ˘ Û˘ÁΤÓÙÚˆÛ‹˜ ÙÔ˘˜ (1). ™Ù· ÂÚÈÛÛfiÙÂÚ· fiÚÁ·Ó·, ÛÙÔ˘˜ ÓÂÊÚÔ‡˜, ÛÙ· ·ÁÁ›·, ÛÙȘ ·ÚıÚÒÛÂȘ, ÛÙÔ˘˜ Ó‡ÌÔÓ˜, ÛÙÔ ‰¤ÚÌ·, ÛÙÔÓ ÂÁΤʷÏÔ, ÛÙȘ Ì‹ÓÈÁÁ˜ Î·È ÛÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ ¤¯Ô˘Ó ·ÓȯÓ¢Ù› ¯ËÌÂÈÔΛÓ˜ fiÙ·Ó ÊÏÂÁÌ·›ÓÔ˘Ó. ∏ ÈÓÙÂÚÏ¢ΛÓË 8 Â›Ó·È Ë ÌÔÓ·‰È΋ ¯ËÌÂÈÔΛÓË Ô˘ ¤¯ÂÈ ÌÂÏÂÙËı› ÈηÓÔÔÈËÙÈο ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·. ∆fiÛÔ Ù· ÙÂÏÂÈfiÌËÓ· fiÛÔ Î·È Ù· ÚfiˆÚ· ÓÂÔÁÓ¿ ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ó· ÂÎÎÚ›ÓÔ˘Ó ÙËÓ ¯ËÌÂÈÔΛÓË ·˘Ù‹ Û ÂÚ›ÙˆÛË Ïԛ̈͢ Î·È ¤¯ÂÈ ‹‰Ë ÌÂÏÂÙËı› Û·Ó ÚÒÈÌÔ˜ ‰Â›ÎÙ˘ Ïԛ̈͢ (46-49). ∞ÔÙÂÏ› ¤Ó·Ó ·fi ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ¯ËÌÂÈÔÙ·ÎÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ÛÙÔÓ Ó‡ÌÔÓ· Î·È Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ (50,51). ªÂ ÙËÓ ÂÍ·›ÚÂÛË Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ 8, Ë Û˘ÁΤÓÙÚˆÛË ÙˆÓ ‰È·ÊfiÚˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙÔÓ ÔÚfi ÙˆÓ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ ‰ÂÓ ¤¯ÂÈ ÌÂÏÂÙËı› Â·ÚÎÒ˜ Ô‡Ù Û ˘ÁÈ‹ ÓÂÔÁÓ¿ Ô‡Ù Û ηٷÛÙ¿ÛÂȘ Ïԛ̈͢ (52-54). OÈ ÌÂȈ̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ηٿ ÙËÓ ËÚÂÌ›· Î·È Ë ÌÂȈ̤ÓË Â·ÁˆÁ‹ ¤ÎÎÚÈÛ˘ ηٿ ÙË Ïԛ̈ÍË Û˘Ì‚¿ÏÏÔ˘Ó Â˘ÏfiÁˆ˜ ÛÙËÓ ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂÔÁÓÒÓ ÛÙȘ ÏÔÈÌÒÍÂȘ. ™Â Ì›· ÌÂϤÙË ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙË Û˘ÁΤÓÙÚˆÛË ÙˆÓ ∂¡∞-78, GRO-a, RANTES, MIP-1· Î·È Ù˘ ˈٷ͛Ó˘, ÌÂٷ͇ ÙˆÓ ˘ÁÈÒÓ ÚfiˆÚˆÓ Î·È ÙÂÏÂÈfiÌËÓˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ÂÓËϛΈÓ, ÂÓÒ Û ¿ÏÏË ÌÂϤÙË ‰È·ÈÛÙÒıËÎ·Ó ÌÂȈ̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ˈٷ͛Ó˘ Î·È ∂¡∞-78 (52,53). ªÂȈ̤ÓË ¤ÎÎÚÈÛË ÔÚÈÛÌ¤ÓˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› Î·È Û ÌÔÓÔ·ÙÙ·Ú· ÙÔ˘ ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘ (53). ∂ȉÈÎfiÙÂÚ· ÁÈ· ÙË Ïԛ̈ÍË ·fi ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜, Â›Ó·È ÁÓˆÛÙfi fiÙÈ ¶·È‰È·ÙÚÈ΋ 2005;68:85-91

Paediatriki Mar-Apr 05

19-04-05

15:30

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90

∞. ª·ÓÔ˘Ú¿ Î·È Û˘Ó.

Ù· ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË ÂÌÊ·Ó›˙Ô˘Ó ÈÔ ÁÚ‹ÁÔÚË ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ Î·È ¯ÂÈÚfiÙÂÚË ÚfiÁÓˆÛË ·fi Ù· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ (55,56). ∞ӷʤÚıËΠ‹‰Ë fiÙÈ ¿ÙÔÌ· Ì ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ RANTES, MIP-1·, MIP-1‚ ‰ÂÓ ÌÔχÓÔÓÙ·È ·fi ÙÔÓ Èfi, ·Ú¿ ÙËÓ Â·ÓÂÈÏËÌ̤ÓË ¤ÎıÂÛ‹ ÙÔ˘˜ Û ·˘ÙfiÓ (18). ™Â ÌÂϤÙË Ù˘ ¤ÎÎÚÈÛ˘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ·˘ÙÒÓ ·fi ÌÔÓÔ‡ÚËÓ· ·ÙÙ·Ú· ÔÌÊ¿ÏÈÔ˘ ÏÒÚÔ˘, ‚Ú¤ıËΠÌÂȈ̤ÓË ¤ÎÎÚÈÛË Î˘Ú›ˆ˜ Ù˘ ¯ËÌÂÈÔΛÓ˘ RANTES (54). ∏ ÌÂÈÔÓÂÍ›· ·˘Ù‹ ÙˆÓ ÌÔÓÔ‡ÚËÓˆÓ Ì·ÎÚÔÊ¿ÁˆÓ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· ÙˆÓ ÓÂÔÁÓÒÓ ÛÙË Ïԛ̈ÍË Ì ÙÔÓ Èfi Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿ÚÎÂÈ·˜ (53). ™ÙÔÓ ÔÚfi ÓÂÔÁÓÒÓ Ì ÂÚÈÁÂÓÓËÙÈ΋ ¤ÎıÂÛË ÛÙÔÓ Èfi Ô˘ ‰ÂÓ ÌÔχÓıËηÓ, ‚Ú¤ıËÎ·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Â›‰· ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ RANTES, MIP-1· Î·È MIP-1‚ Û ۯ¤ÛË Ì ٷ ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË, Ô˘ ˘Ô‰ËÏÒÓÂÈ ÙËÓ Èı·Ó‹ ÛËÌ·Û›· Ù˘ ¤ÎÎÚÈÛ˘ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ·˘ÙÒÓ ÛÙËÓ ·ÔÙÚÔ‹ Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘ (57).

O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙË ÓÂÔÁÓÈ΋ ÛË„·ÈÌ›· ¤¯ÂÈ ÌÂÏÂÙËı› ÂÏ¿¯ÈÛÙ·. ∏ ÛËÌ·Û›· ÙˆÓ ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ Î·È ÙˆÓ ÔÈÎ›ÏˆÓ ÌÂÛÔÏ·‚ËÙÒÓ Â›Ó·È ÔˆÛ‰‹ÔÙ ԢÛÈ·ÛÙÈ΋ (26). ªÂϤÙ˜ Ì ÂÈÚ·Ì·Ùfi˙ˆ· ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜ Û ۋ„Ë ‰Â›¯ÓÔ˘Ó ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË ¯ËÌÂÈÔÎÈÓÒÓ ÛÙÔ˘˜ Ó‡ÌÔÓ˜, ·Ó¿ÏÔÁË Ì ÂΛÓË Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ·Ó¿ÏÔÁË Û˘ÛÛÒÚ¢ÛË ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ (23). ∏ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÛË„·ÈÌ›·˜ ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ·ÎfiÌË Î·Ù·ÓÔËÙ‹, ˆÛÙfiÛÔ Ê·›ÓÂÙ·È fiÙÈ ÔÈ ¯ËÌÂÈÔΛÓ˜ ·ÔÙÂÏÔ‡Ó Î·È ÛÙ· ÓÂÔÁÓ¿, fiˆ˜ Î·È ÛÙÔ˘˜ ÂÓ‹ÏÈΘ, ‚·ÛÈ΋ Û˘ÓÈÛÙÒÛ· Ù˘ ·ıÔÏÔÁÈ΋˜ ‰ÈÂÚÁ·Û›·˜.

™˘ÌÂÚ¿ÛÌ·Ù· OÈ ¯ËÌÂÈÔΛÓ˜ ·ÔÙÂÏÔ‡Ó Ì›· ÂӉȷʤÚÔ˘Û· ÔÈÎÔÁ¤ÓÂÈ· ÚˆÙÂ˚ÓÒÓ Ì ÔÈΛϘ ‚ÈÔÏÔÁÈΤ˜ ‰Ú¿ÛÂȘ. ∏ ηٷÓfiËÛË Ù˘ ÛËÌ·Û›·˜ ÙÔ˘˜ ÛÙȘ ‰È¿ÊÔÚ˜ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ ¿Ú¯ÈÛ ÌfiÏȘ ÚfiÛÊ·Ù·. O ÚfiÏÔ˜ ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ÛÙË Ïԛ̈ÍË Â›Ó·È Ô˘ÛÈ҉˘, ηıÒ˜ - Û·Ó ¯ËÌÂÈÔÙ·ÎÙÈΤ˜ ΢ÙÙ·ÚÔΛÓ˜ - ÂϤÁ¯Ô˘Ó ÙËÓ Î›ÓËÛË ÙˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Î·È Î·ıÔÚ›˙Ô˘Ó ÙË Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘˜ ÛÙÔ˘˜ ÊÏÂÁÌ·›ÓÔÓÙ˜ ÈÛÙÔ‡˜. ¶·Ú¿ÏÏËÏ·, Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ‚Ï¿‚˘ ÙˆÓ ÔÚÁ¿ÓˆÓ Ô˘ Û˘ÓÙÂÏÂ›Ù·È Î·Ù¿ ÙË ‰È·‰Èηۛ· Ù˘ Û‹„˘. ∂›Ó·È Èı·Ófi fiÙÈ Ë ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Ô˘ ÛÙԯ‡ÂÈ ÛÙËÓ ÂÍÔ˘‰ÂÙ¤ÚˆÛË Î¿ÔÈˆÓ ¯ËÌÂÈÔÎÈÓÒÓ ‹ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ ÙÔ˘˜ ÌÔÚ› Ó· ·Ó·ÛÙ›ÏÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ Û‹„˘. π‰È·›ÙÂÚ· ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· Ô˘ ÔÈ ÏÔÈÌÒÍÂȘ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ¤¯Ô˘Ó ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·, Ë Î·Ù·ÓfiËÛË ÙÔ˘ ÚfiÏÔ˘ ¶·È‰È·ÙÚÈ΋ 2005;68:85-91

ÙˆÓ ¯ËÌÂÈÔÎÈÓÒÓ Î·È Ë ÂÊ·ÚÌÔÁ‹ Ó¤ˆÓ ıÂÚ·¢ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ ı· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‚ÂÏÙ›ˆÛË Ù˘ ¤Î‚·Û˘ ÙˆÓ ÂÚÈÁÂÓÓËÙÈÎÒÓ ÏÔÈÌÒ͈Ó.

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REVIEW ARTICLE

Chemokines in neonatal infections A. Manoura1, E. Galanakis2, C. Giannakopoulou1

Abstract 1 Neonatology Clinic, University of Crete, Heraklion 2 Paediatric Clinic, University of Crete, Heraklion Correspondence: Christine Giannakopoulou 37 Atlantidos str., 115 27, Heraklion, Crete E-mail: tmanour@in.gr Date of submission: 03-06-2004 Date of approval: 04-03-2005

Chemokines, a fascinating family of proteins, appear to be involved in a number of physiological and pathological processes. Their role in the pathophysiology of various diseases is under extensive investigation. They are involved at all stages of tumour development. Chemokines can also modulate angiogenesis, which is associated with several chronic inflammatory diseases. Their role in host response to infection is essential, since they control the attraction of leucocytes to tissues. Chemokines may also be involved in the undesirable sequelae of sepsis, including the multiple organ dysfunction syndrome. There is evidence that neutralization of chemokine activity may be of therapeutic value in the septic process.

Especially in the neonatal period, when sepsis-related morbidity and mortality is high, the understanding of the role of chemokines in the pathophysiology of the septic process along with the new therapeutic targets that this understanding may provide, is expected to improve the prognosis of perinatal infections.

Key words Chemokines, infection, sepsis, neonate.

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93

∏ ÛËÌ·Û›· ÙÔ˘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·Ê‹Ì·ÙÔ˜ ÛÙË ÌÂϤÙË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ∫. ∞. µÔ‡‰Ú˘

¶ÂÚ›ÏË„Ë ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Û˘ÓÈÛÙ¿ ÙÔ Î˘ÚÈfiÙÂÚÔ Ì¤ÛÔ Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ÂÈÏË„›·˜ Î·È ·ÔÙÂÏ› ·Ó·ÓÙÈηٿÛÙ·ÙÔ Ì¤ÛÔ ‰È¿ÁÓˆÛ˘, ÌÂϤÙ˘ Î·È ÚfiÁÓˆÛ˘ Ù˘ ÂÈÏË„›·˜. ªÔÏÔÓfiÙÈ Ë ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜ Â›Ó·È ÎÏÈÓÈ΋ Î·È ÛÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË Ï‹„Ë ÂÓfi˜ ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔÚÈÎÔ‡, ¤Ó· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Ì ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÓÈÛ¯‡ÂÈ ‹ Î·È ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙË ÌÂϤÙË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘, ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ, ÙËÓ ·Ó·ÁÓÒÚÈÛË ÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfïÓ, ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘, ÙËÓ ·ÓÙ·fiÎÚÈÛË ÛÙË ıÂÚ·›· Î·È ÙËÓ Úfi‚ÏÂ„Ë ˘ÔÙÚÔ‹˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. ∏ ·Ú·ÙÂٷ̤ÓË Î·È Û˘Ó‰˘·Ṳ̂ÓË Ì ‚›ÓÙÂÔ-ÔÏ˘ÁÚ·ÊÈ΋ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ηٷÁÚ·Ê‹ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÚ·ÈÙ¤Úˆ ÛÙË ÌÂϤÙË ·È‰ÈÒÓ Ì Â›ÌÔÓ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È È‰È·›ÙÂÚ· ÛÙË ‰È·ÊÔÚÈ΋ ‰È·ÁÓˆÛÙÈ΋ ÌÂٷ͇ ÂÈÏËÙÈÎÒÓ Î·È ÌË ÂÈÏËÙÈÎÒÓ ·ÚÔ͢ÛÌÈÎÒÓ ÎÏÈÓÈÎÒÓ Ê·ÈÓÔ̤ӈÓ. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Â›Ó·È Ì›· ·Î›Ó‰˘ÓË Î·È Û¯ÂÙÈο ÊıËÓ‹ Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈ΋ ̤ıÔ‰Ô˜ Ô˘ ¤¯ÂÈ Ó· ÚÔÛʤÚÂÈ ÔÏÏ¿ ÛÙË ÌÂϤÙË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜, ı· Ú¤ÂÈ ˆÛÙfiÛÔ Ó· Á›ÓÂÙ·È ·fi ¤ÌÂÈÚÔ˘˜ Ù¯ÓÈÎÔ‡˜, Ó· ÌÂÏÂÙ¿Ù·È ·fi ¤ÌÂÈÚÔ˘˜ ÛÙÔ ·È‰ÈÎfi ∏∂° È·ÙÚÔ‡˜ Î·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ¿ÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ.

¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰Ú˘ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” £Ë‚ÒÓ & §Â‚·‰Â›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: kvoudris@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 24-03-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-11-2004

§¤ÍÂȘ ÎÏÂȉȿ ∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·, ÂÈÏË„›·, ·È‰È¿.

™˘ÓÙÔÌÔÁڷʛ˜ ∏∂° ¢º∂

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ¢È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù·

ηٷÁÚ·Ê‹ ÙÔ˘ ∏∂° ηٿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ ÂÈÏËÙÈ΋˜ ÎÚ›Û˘ ÌÔÚ› Ó· ÂȂ‚·ÈÒÛÂÈ ‹ Ó· ·ÔÚÚ›„ÂÈ ÙËÓ ÂÈÏËÙÈ΋ ʇÛË Ì›·˜ ÎÚ›Ûˆ˜, ·ÏÏ¿ ·˘Ùfi Â›Ó·È Û˘¯Ó¿ ·Ó¤ÊÈÎÙÔ Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ Ë ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜ ÛÙËÚ›˙ÂÙ·È Û ÌÂÛÔÎÚÈÙÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ∏∂°.

∂ÈÛ·ÁˆÁ‹ ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°) Û˘ÓÈÛÙ¿ ÙÔ Î˘ÚÈfiÙÂÚÔ Ì¤ÛÔ Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ÂÈÏË„›·˜. ∞fi ÙËÓ ·Ó·Î¿Ï˘„‹ ÙÔ˘ ·fi ÙÔÓ Berger ÙÔ 1929 ̤¯ÚÈ Û‹ÌÂÚ·, ÙÔ ∏∂° ·Ú·Ì¤ÓÂÈ ·Ó·ÓÙÈηٿÛÙ·ÙÔ Ì¤ÛÔ ‰È¿ÁÓˆÛ˘, ÌÂϤÙ˘ Î·È ÚfiÁÓˆÛ˘ Ù˘ ÂÈÏË„›·˜. ∆Ô ∏∂° Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙËÓ ÂÈÏË„›· ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘, ÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ, ÙËÓ ·Ó·ÁÓÒÚÈÛË Î¿ÔÈÔ˘ ÂÈÏËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ Úfi‚ÏÂ„Ë ·ÓÙ·fiÎÚÈÛ˘ ÛÙË ıÂÚ·›· Î·È ÙˆÓ ˘ÔÙÚÔÒÓ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ (1,2). £· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı›, fï˜, fiÙÈ Ë ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜ Â›Ó·È ÎÏÈÓÈ΋ Î·È ÛÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙË Ï‹„Ë ÂÓfi˜ ÏÂÙÔÌÂÚÔ‡˜ ÈÛÙÔÚÈÎÔ‡. øÛÙfiÛÔ, ¤Ó· ∏∂° Ì ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÂÓÈÛ¯‡ÂÈ ‹ Î·È ÂȂ‚·ÈÒÓÂÈ ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË. ∏

°ÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ ∏∂° ÛÙË ÌÂϤÙË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ∆· ΢ÚÈfiÙÂÚ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙÔ ∏∂° Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜, ‰ËÏ·‰‹ Ë ÏÂÁfiÌÂÓË ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ·, Û˘Ó›ÛÙ·ÓÙ·È ·fi ·ÚÔ͢ÛÌÈΤ˜ - ‰ËÏ·‰‹ Ì ·fiÙÔÌË ¤Ó·ÚÍË Î·È ·‡ÛË - ‰Ú·ÛÙËÚÈfiÙËÙ˜, Û·ÊÒ˜ ‰È·¯ˆÚÈ˙fiÌÂÓ˜ ·fi ÙÔ˘˜ ıÂÌÂÏÈÒ‰ÂȘ Ú˘ıÌÔ‡˜. OÈ Î˘ÚÈfiÙÂÚ˜ ·fi ·˘Ù¤˜ ÙȘ ·ÚÔ͢ÛÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Â›Ó·È ÔÈ ·È¯Ì¤˜, ÔÈ ‚Ú·‰Â›Â˜ ·È¯Ì¤˜ ‹ Ù· ·È¯ÌËÚfiÌÔÚÊ· ·̷ٷ, ÔÈ ÔÏ˘·È¯Ì¤˜, Ù· Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ Î·È Ù· Û˘ÌϤÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ (∂ÈÎfiÓ· 1) (1). ∏ ·È¯Ì‹ Â›Ó·È ¤Ó· ·̷ Ì ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· (1070 ms) Î·È Ì ÌÂÁ¿ÏÔ ‰˘Ó·ÌÈÎfi ÌÔÓÔ-, ‰È- ‹ ÙÚÈÊ·ÛÈÎfi. ∏ ‚Ú·‰Â›· ·È¯Ì‹ ‹ ÙÔ ·È¯ÌËÚfiÌÔÚÊÔ Î‡Ì· Â›Ó·È ¤Ó· ·̷ ÙÔ˘ ÔÔ›Ô˘ Ë ‰È¿ÚÎÂÈ· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 70 Î·È 200 ms Î·È ÂÍ·ÈÙ›·˜ ·˘ÙÔ‡ ·›ÚÓÂÈ Ì›· ÌÔÚÊ‹ ÏÈÁfiÙÂÚÔ ÔÍ›·. ∏ ÔÏ˘·È¯Ì‹ ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·94

94

∫. ∞. µÔ‡‰Ú˘

∂ÈÎfiÓ· 1. ∏ ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· Û˘Ó›ÛÙ·Ù·È Î˘Ú›ˆ˜ ·fi ·È¯Ì¤˜, Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜, ÔÏ˘·È¯Ì¤˜ Î·È Û˘ÌϤÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜.

Â›Ó·È Ì›· ·ÎÔÏÔ˘ı›· ÔÏÏÒÓ ·È¯ÌÒÓ. ∆Ô Û‡ÌÏÂÁÌ· ·È¯Ì‹˜-·̷ÙÔ˜ ·ÔÙÂÏÂ›Ù·È ·fi Ì›· ·È¯Ì‹ ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ¤Ó· ‚Ú·‰‡ ·̷. ∂¿Ó Ë Û˘¯ÓfiÙËÙ· ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ·È¯Ì‹˜-·̷ÙÔ˜ Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 2,5 Hz, ÔÓÔÌ¿˙ÂÙ·È ‚Ú·‰‡ Û‡ÌÏÂÁÌ· ·È¯Ì‹˜-·̷ÙÔ˜. ∆Ô Û‡ÌÏÂÁÌ· ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ Â›Ó·È Ì›· ·ÎÔÏÔ˘ı›· Ì›·˜ ÔÏ˘·È¯Ì‹˜ Î·È ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ. ∏ ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ ηٷÁÚ¿ÊÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÈÏËÙÈ΋˜ ÎÚ›Û˘ ‹ ÌÂÛÔÎÚÈÙÈο, ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ Î·È ÙÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ, ·ÏÏ¿ ÌÂÚÈΤ˜ ÊÔÚ¤˜ Ë ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· ÔÈΛÏÏÂÈ ‹ ·ÎfiÌË Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ (1-3). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È Î·È ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Û ¤Ó· ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ·fi 1,4% ¤ˆ˜ 4%. ªÔÏÔÓfiÙÈ Ë ·Ô˘Û›· ÂÈÏËÙfiÌÔÚÊ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂° ÂÓÈÛ¯‡ÂÈ ÙË ÌË ÂÈÏËÙÈ΋ ʇÛË ÂÓfi˜ ·ÚÔ͢ÛÌÈÎÔ‡ Ê·ÈÓÔ̤ÓÔ˘ (4,5), ·ÚÎÂÙÔ› ·ÛıÂÓ›˜ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›· ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙ· ‰È·ÁÚ¿ÌÌ·Ù¿ ÙÔ˘˜ (6,7). OÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÂÈÏË„›·˜, fiˆ˜ Î·È Ë ÓfiÛÔ˜, ¤¯Ô˘Ó ‰È·Ï›ÔÓÙ· ¯·Ú·ÎÙ‹Ú· ηÈ, ÂÔ̤ӈ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÁÚ·Ê› ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ ∏∂° ÂÓfi˜ ·ÛıÂÓÔ‡˜ Ì ÂÈÏË„›·, ··ÈÙÔ‡ÓÙ·È Â·ÓÂÈÏËÌ̤Ó˜ ηٷÁڷʤ˜. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÌfiÓÔ 50% ÙˆÓ ÂÈÏËÙÈÎÒÓ ·ÛıÂÓÒÓ Ì ÚÒÙË ÂÈÏËÙÈ΋ ÎÚ›ÛË ¤¯ÂÈ ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ ∏∂° Ô˘ Á›ÓÂÙ·È ÌÂÙ¿ ·fi Ì›· ‚‰ÔÌ¿‰· ·fi ÙËÓ ÎÚ›ÛË, ·ÏÏ¿, ÙÂÏÈο, ÙÔ 92% ÙˆÓ ·ÛıÂÓÒÓ Ì ÂÈÏË„›· Ô˘ ı· ˘Ô‚ÏËıÔ‡Ó Â·ÓÂÈÏËÌ̤ӈ˜ Û ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ¤ÏÂÁ¯Ô ÁÈ· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ¤ÙÔ˜, ı· ÂÌÊ·Ó›ÛÂÈ Û οÔÈ· Ê¿ÛË ÂÈÏËÙfiÌÔÚÊË ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙÔ ∏∂°. ∂ÈϤÔÓ, ÁÈ· Ó· ·˘ÍËı› Ë Èı·ÓfiÙËÙ· ηٷÁÚ·Ê‹˜ ÂÈÏËÙfiÌÔÚÊ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂°, ··ÈÙÂ›Ù·È Ë ÂÊ·ÚÌÔÁ‹ ÂȉÈÎÒÓ Ù¯ÓÈÎÒÓ, fiˆ˜ Ë ‰ÔÎÈÌ·Û›· ˘¤ÚÓÔÈ·˜ Î·È Ù· ‰È·Ï›ÔÓÙ· ʈÙÂÈÓ¿ ÂÚÂı›ÛÌ·Ù· (¢º∂), Ë ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

ÛÙ¤ÚËÛË ‡ÓÔ˘ Î·È Ô ‡ÓÔ˜, Ë ·Ú·ÙÂٷ̤ÓË ‹ ‚›ÓÙÂÔ-ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ηٷÁÚ·Ê‹ Î.Ï. (1-3). ∆Ô ∏∂°, fiÙ·Ó Û˘Ó‰˘¿˙ÂÙ·È Ì ‚›ÓÙÂÔ-ÔÏ˘ÁÚ·ÊÈΤ˜ ηٷÁڷʤ˜, ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ÂÈÏËÙÈÎÒÓ ‹ ÌË Ê·ÈÓÔ̤ӈÓ, ÛÙËÓ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·È ÙˆÓ ÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Î·È ÛÙËÓ ·ÔÎ¿Ï˘„Ë ˘ÔÎÏÈÓÈÎÒÓ ÎÚ›ÛˆÓ, ·ÏÏ¿ ı· Ú¤ÂÈ ÔÈ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Ó· Â›Ó·È Û˘¯Ó¤˜ ÁÈ· Ó· ηٷÁÚ·ÊÔ‡Ó (3,8,9). £· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ Ë ·Ú·ÙÂٷ̤ÓË Ì ‚›ÓÙÂÔ-ÔÏ˘ÁÚ·ÊÈ΋ ηٷÁÚ·Ê‹ ÙÔ˘ ∏∂° ·ÔÙÂÏ› ÙËÓ ϤÔÓ ¯Ú‹ÛÈÌË Î·Ù·ÁÚ·Ê‹ ÙÔ˘ ∏∂° ÁÈ· ÙË ÌÂϤÙË ·È‰ÈÒÓ Ì ÂÈÏË„›·. ∏ 24ˆÚË ·Ï‹ ηٷÁÚ·Ê‹ ÙÔ˘ ∏∂° ¤¯ÂÈ ÂÚÈÔÚÈṲ̂ÓË ·Í›· ÛÙ· ·È‰È¿, ‰ÈfiÙÈ ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ÛÙȘ ÎÚ›ÛÂȘ Î·È ‰ÈfiÙÈ ÔÈ ÏËÚÔÊÔڛ˜ Ô˘ ·Ú¤¯ÂÈ Â›Ó·È ¤ÌÌÂÛ˜. ∂›Û˘, Ë ¯·ÚÙÔÁÚ¿ÊËÛË ÙÔ˘ ∏∂° ¤¯ÂÈ ÌÈÎÚfi ÎÏÈÓÈÎfi fiÊÂÏÔ˜ ÛÙË ÌÂϤÙË Ù˘ ÂÈÏË„›·˜. ∆Ô Û˘Ì‚·ÙÈÎfi ∏∂° ˘ÛÙÂÚ› ÂÌÊ·ÓÒ˜ Ù˘ ÂÓ‰ÔÎÚ¿ÓÈ·˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋˜ ηٷÁÚ·Ê‹˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·Ó¿‰ÂÈÍË ÙˆÓ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Ì›·˜ ÂÈÏËÙÈ΋˜ ÎÚ›Û˘. ŒÙÛÈ, Û ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Ì ¿ÌÂÛË ÁÂӛ΢ÛË, Ë ÂÓ‰ÔÎÚ¿ÓÈ· ηٷÁÚ·Ê‹ ÌÔÚ› Ó· ηٷ‰Â›ÍÂÈ ÙËÓ ÂÛÙȷ΋ ¤Ó·ÚÍË Ù˘ ÎÚ›Û˘, Ë ÔÔ›· ÌÔÚ› Ó· ÌËÓ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› ·fi ÙÔ Û˘Ì‚·ÙÈÎfi ∏∂°. ∆Ô ÂÓ‰ÔÎÚ¿ÓÈÔ ∏∂°, fï˜, Â›Ó·È ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ Î·È Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ ÁÈ· ÙËÓ ÚÔÂÁ¯ÂÈÚËÙÈ΋ ÌÂϤÙË ÂÈÏËÙÈÎÒÓ ·ÛıÂÓÒÓ (1). ∆Ô ∏∂° ÛÙ· ‚Ú¤ÊË Î·È ÛÙ· ·È‰È¿ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·Ó¿ÌÈÎÙ˜ Û˘¯ÓfiÙËÙ˜. ∞˘Ù‹ Ë ÔÈÎÈÏÔÌÔÚÊ›· Û˘¯ÓÔÙ‹ÙˆÓ ‰ËÌÈÔ˘ÚÁ› Û˘Ó‰˘·ÛÌÔ‡˜ Ù·¯¤ˆÓ Î·È ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ Î·È Û˘¯Ó¿ ÂÎÏ·Ì‚¿ÓÂÙ·È ˆ˜ ·ıÔÏÔÁÈ΋ ·fi ÌË ¤ÌÂÈÚÔ˘˜ ÛÙÔ ·È‰ÈÎfi ∏∂° (1). ∂›Û˘, Ë ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÌÂٷ͇ Ì›·˜ ·È¯Ì‹˜ ‹ ÂÓfi˜ ·È¯ÌËÚÔ‡ ÛÙÔÈ¯Â›Ô˘ Î·È ÂÓfi˜ ·Ú¿ÛÈÙÔ˘ (artifact) ÛÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ‡ÎÔÏË. ∂¿Ó ÌÂÙ¿ ÙËÓ ·È¯Ì‹ ·ÎÔÏÔ˘ı› ‚Ú·‰‡ ·̷ ‹ Â¿Ó ÙÔ ·È¯ÌËÚfi ÛÙÔÈ¯Â›Ô ‰ÂÓ ÁÚ¿ÊÂÙ·È ÌfiÓÔ ·fi ¤Ó· ËÏÂÎÙÚfi‰ÈÔ ·ÏÏ¿ Î·È ·fi ¿ÏÏ· ÁÂÈÙÔÓÈο ËÏÂÎÙÚfi‰È·, ÙfiÙÂ Â›Ó·È Èı·Ófi ÙÔ ·È¯ÌËÚfi ÛÙÔÈ¯Â›Ô Ó· Â›Ó·È ÂÁÎÂÊ·ÏÈ΋˜ ÚÔ¤Ï¢Û˘ (1,2). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ·ÚÔ˘Û›· ÂÈÏËÙfiÌÔÚÊ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂° ·ÛıÂÓÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·‡ÚÂÙˆÓ Û·ÛÌÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÌÂÏÏÔÓÙÈ΋˜ ˘ÔÙÚÔ‹˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ (10,11). ∂›Û˘, Û ÁÂÓÈΤ˜ ÁÚ·Ì̤˜, fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ, ÙfiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë Èı·ÓfiÙËÙ· Ó· ÂÌÊ·Ó›˙ÂÈ ÙÔ ∏∂° ÂÈÏËÙfiÌÔÚÊ· ÛÙÔȯ›·. £· Ú¤ÂÈ Ó· ·Ó·ÊÂÚı›, fï˜, fiÙÈ ÌÔÏÔÓfiÙÈ Ô ·ÚÈıÌfi˜ ÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ Û¯ÂÙ›˙ÂÙ·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ Ì ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ÂÈÏË„›·˜,

Paediatriki Mar-Apr 05

19-04-05

15:30

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95

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È ·È‰È΋ ÂÈÏË„›·

·˘Ùfi ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ, ÁÈ·Ù› ηÏÔ‹ıË Û‡Ó‰ÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, fiˆ˜ Â›Ó·È ÔÈ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È Ë ÚÔÏ¿Ó‰ÂÈ· ÂÈÏË„›·, Û˘¯Ó¿ ¤¯Ô˘Ó ¿ÊıÔÓ˜ ÂÈÏËÙÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ÛÙÔ ∏∂° (1). ∏ ·ÚÔ˘Û›· ‚Ú·‰˘ÚÚ˘ıÌÈÒÓ ‹ ¿ÏÏˆÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ∏∂° ÙˆÓ ·ÙfiÌˆÓ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÈÏË„›·, ȉȷ›ÙÂÚ· Â¿Ó ÂÓÙÔ›˙ÔÓÙ·È ÛÙ·ıÂÚ¿ Û ̛· ÂÚÈÔ¯‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ‹ Â›Ó·È ¿ÊıÔÓ·, ÌÔÚ› Ó· ÛËÌ·ÙÔ‰ÔÙ› ÙËÓ ·ÚÔ˘Û›· ˘ÔΛÌÂÓÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ô˘ ÚÔηÏ› ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ (1-3). ∂ÈϤÔÓ, Ë ‡·ÚÍË ·˘ÙÒÓ ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ÌÂÛÔÎÚÈÙÈÎfi ‰È¿ÁÚ·ÌÌ· ÂÓfi˜ ·ÛıÂÓÔ‡˜ Ì ÂÈÏË„›·, ‰ÂÓ ·ÔÙÂÏ› ηÏfi ÚÔÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Ï‹ÚË ¤ÏÂÁ¯Ô ÙˆÓ ÎÚ›ÛÂˆÓ Ì ÙË ¯ÔÚ‹ÁËÛË ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ‹ ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ÎÚ›ÛÂˆÓ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ıÂÚ·›·˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÚfiÁÓˆÛË Ù˘ ÂÈÏË„›·˜, ·˘Ù‹ ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙÔ ˘ÔΛÌÂÓÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ (3). ∫·ıÒ˜, fï˜, ÙÔ ∏∂° ‚ÔËı¿ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙÔ˘ ˘ÔΛÌÂÓÔ˘ ÂÈÏËÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘, Â›Ó·È ¯Ú‹ÛÈÌÔ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÚfiÁÓˆÛ˘, ÌÔÏÔÓfiÙÈ Ë ÛÔ‚·ÚfiÙËÙ· Ù˘ ÂÈÏË„›·˜ ÔÈΛÏÏÂÈ Û˘¯Ó¿ ÌÂٷ͇ ·ÛıÂÓÒÓ Ì ÙÔ ›‰ÈÔ ÂÈÏËÙÈÎfi Û‡Ó‰ÚÔÌÔ. ∏ ·Ó‡ÚÂÛË ÛÙÔ ∏∂° ÂȉÈÎÒÓ ÂÈÎfiÓˆÓ, fiˆ˜ ÔÈ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÎÊÔÚÙ›ÛÂȘ ·fi Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ 3 Hz ÛÙȘ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ Î·È ÔÈ ÚÔÏ¿Ó‰ÂȘ ·È¯Ì¤˜, ·ÔÙÂÏÔ‡Ó Î·Ïfi ÚÔÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ ·¿ÓÙËÛË ÛÙËÓ ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Î·È ÛÙË ÁÂÓÈÎfiÙÂÚË ÂͤÏÈÍË ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ·˘Ù¤˜ ÙȘ ÌÔÚʤ˜ ÂÈÏË„›·˜. ™Â ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ· fiˆ˜ ÔÈ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, fiÔ˘ Ë ÂÌÊ¿ÓÈÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÔÛfiÙËÙ· ÙˆÓ ÂÈÏËÙfiÌÔÚÊˆÓ ÂÎÊÔÚÙ›ÛˆÓ, ÙÔ ∏∂° ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ÙËÓ ·fiÊ·ÛË ÁÈ· Ì›ˆÛË ‹ ‰È·ÎÔ‹ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ (12,13). ™Â ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Ì ÂÈ̤ÓÔ˘Û˜ ÂÛÙȷΤ˜ ÂÎÊÔÚÙ›ÛÂȘ, Ë ·fiÊ·ÛË ÁÈ· Ì›ˆÛË ‹ ‰È·ÎÔ‹ ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ‰ÂÓ Ú¤ÂÈ Ó· ÛÙËÚ›˙ÂÙ·È ÌfiÓÔ Û ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·, ·ÏÏ¿ ı· Ú¤ÂÈ Ó· ÂÎÙÈÌÒÓÙ·È Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ·fi ÙÔ ÈÛÙÔÚÈÎfi, ηıÒ˜ Î·È Ù· ÎÏÈÓÈο Î·È ¿ÏÏ· ÂÚÁ·ÛÙËÚȷο ‰Â‰Ô̤ӷ ÙÔ˘ ·È‰ÈÔ‡ Ì ÂÈÏË„›·.

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÙˆÓ Î˘ÚÈfiÙÂÚˆÓ ÌÔÚÊÒÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·È ÂÈÏËÙÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ™ÙÔ˘˜ ÓÂÔÁÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÙÔ ∏∂° ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ ‰È¿ÊÔÚ˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ (∂ÈÎfiÓ· 2) ‹ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ·ÎfiÌË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÈÏËÙÈ΋˜

∂ÈÎfiÓ· 2. ¢È¿ÊÔÚ˜ ÌÔÚʤ˜ ÂÈÏËÙfiÌÔÚÊ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ·.

ÎÚ›Û˘. ∏ Û˘¯ÓfiÙÂÚË ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ·ÓˆÌ·Ï›· ÛÙÔ˘˜ ηÏÔ‹ıÂȘ ÓÂÔÁÓÈÎÔ‡˜ Û·ÛÌÔ‡˜ Â›Ó·È ÔÈ ÂÎÊÔÚÙ›ÛÂȘ Î˘Ì¿ÙˆÓ ı‹Ù·, ΢ڛˆ˜ ÂÚÈÚÔÏ·Ó‰Èο, ÔÈ Ôԛ˜ Â›Ó·È Û˘¯Ó¿ ·Û‡Á¯ÚÔÓ˜. ™ÙËÓ ÚÒÈÌË Ì˘ÔÎÏÔÓÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ· Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Ohtahara, ÙÔ ∏∂° ¤¯ÂÈ ÂÈÎfiÓ· Ù‡Ô˘ ÂÎÊfiÚÙÈÛË-Ù·›ӈÛË (∂ÈÎfiÓ· 3) (14). ∏ ÎÏ·ÛÈ΋ ÌÂÛÔÎÚÈÙÈ΋ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ·ÓˆÌ·Ï›· ÛÙÔ˘˜ ‚ÚÂÊÈÎÔ‡˜ Û·ÛÌÔ‡˜ Â›Ó·È Ë ˘„·ÚÚ˘ıÌ›·, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û˘Ó¯‹, ˘„ËÏÔ‡ ‰˘Ó·ÌÈÎÔ‡ ‚Ú·‰¤· ‰¤ÏÙ· ·̷ٷ, ·Ó¿ÌÈÎÙ· Ì ·È¯Ì¤˜ ‹ ·È¯ÌËÚ¿ ·̷ٷ, ¿ÏÏÔÙ ¿ÏÏ˘ ÂÓÙfiÈÛ˘ ‹ ËÌÈÛÊ·ÈÚÈ΋˜ ÂÈÎÚ¿ÙËÛ˘ (∂ÈÎfiÓ· 4) (1,3). O ¯·Ú·ÎÙËÚÈÛÌfi˜ ·Ô‰ÈÔÚÁ·ÓˆÌ¤ÓÔ ‹ ¯·ÔÙÈÎfi ∏∂° Ù·ÈÚÈ¿˙ÂÈ ·fiÏ˘Ù· Ì ·˘ÙfiÓ ÙÔÓ Û˘Ó‰˘·ÛÌfi ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ. ∏ ˘„·ÚÚ˘ıÌ›· ÌÔÚ› Ó· Â›Ó·È ·Û‡ÌÌÂÙÚË ‹ Ó·

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∂ ¶ § À ∞ º ¡

∂ÈÎfiÓ· 3. ∂ÈÎfiÓ· Ù‡Ô˘ ÂÎÊfiÚÙÈÛË-Ù·›ӈÛË (burstsuppression).

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¶·È‰È·ÙÚÈ΋ 2005;68:93-101

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·96

96

∫. ∞. µÔ‡‰Ú˘

∂ÈÎfiÓ· 4. ∂ÈÎfiÓ· ˘„·ÚÚ˘ıÌ›·˜.

Û˘Ó‰˘¿˙ÂÙ·È Ì ÂÛÙȷΤ˜ ÂÎÊÔÚÙ›ÛÂȘ (15). ∏ ÛÙ·ıÂÚ¿ ·Û‡ÌÌÂÙÚË ÂÌÊ¿ÓÈÛ‹ Ù˘ ‹ Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ Û˘Ó‰¤ÔÓÙ·È Û˘¯Ó¿ Ì ˘ÔΛÌÂÓË ÂÛÙȷ΋ ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∏ ÂÈÎfiÓ· Ù˘ ˘„·ÚÚ˘ıÌ›·˜ ÌÔÚ› Ó· ·ÏÏ¿˙ÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ Î·È ÔÈ ·ÚÔ͢ÛÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ó· ÁÚ¿ÊÔÓÙ·È Î·Ù¿ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÚÈ¤˜ Ì ۯÂÙÈ΋ Ì›ˆÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ ÌÂٷ͇ ÙˆÓ ÚÈÒÓ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‚ÚÂÊÈÎÒÓ Û·ÛÌÒÓ, ÛÙÔ ∏∂° ÂÌÊ·Ó›˙ÂÙ·È ÁÂÓÈÎÂ˘Ì¤ÓË ‚Ú·¯Â›· ÚÈ‹ ·fi ‚Ú·‰¤· ·È¯ÌËÚ¿ ·̷ٷ ÌÂÁ¿Ï˘ Ù¿Û˘, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ì›ˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ì ‹ ¯ˆÚ›˜ ÙÒÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ Î·È ÌÂÁ¿Ï˘ Û˘¯ÓfiÙËÙ·˜ ·̷ٷ (∂ÈÎfiÓ· 5). ™Â ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Lennox-Gastaut, ηٷÁÚ¿ÊÔÓÙ·È ÂÎÊÔÚÙ›ÛÂȘ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜Î‡Ì·ÙÔ˜ ÌÂ Û˘¯ÓfiÙËÙ· ÌÈÎÚfiÙÂÚË ·fi 2,5 Hz, ¯ˆÚ›˜ ·ÈÊÓ›‰È· ¤Ó·ÚÍË Î·È ÙÂÚÌ·ÙÈÛÌfi (∂ÈÎfiÓ· 6) (1-3). ∞˘Ù¤˜ ÔÈ ÂÎÊÔÚÙ›ÛÂȘ Â›Ó·È ·ÌÊÔÙÂÚfiÏ¢Ú˜ Ì ·ÚÈ· ÂÓÙfiÈÛË ÛÙȘ ÚfiÛıȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Û˘¯Ó¿ ·Û‡ÌÌÂÙÚ˜, ÂÓÒ Ë ÌÔÚÊÔÏÔÁ›· ÙÔ˘˜, ÙÔ ‡„Ô˜ ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ Î·È Ë Û˘¯ÓfiÙËÙ· ÌÔÚ› Ó· ÔÈΛÏÏÔ˘Ó ·ÎfiÌË Î·È ÛÙËÓ ›‰È· ÚÈ‹ ÙˆÓ ÂÎÊÔÚÙ›ÛˆÓ. ∏ ˘¤ÚÓÔÈ· Î·È Ù· ¢º∂ ‰ÂÓ ÂȉÚÔ‡Ó ÛÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÒÓ ÙˆÓ ÂÎÊÔÚÙ›ÛˆÓ, ·ÏÏ¿ Ô ‡ÓÔ˜ ÌÔÚ› Ó· ÙȘ ÂȉÂÈÓÒ-

∂ÈÎfiÓ· 5. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‚ÚÂÊÈÎÒÓ Û·ÛÌÒÓ ÛÙÔ ∏∂°, ÂÌÊ·Ó›˙ÂÙ·È ÁÂÓÈÎÂ˘Ì¤ÓË ‚Ú·¯Â›· ÚÈ‹ ·fi ‚Ú·‰¤· ·È¯ÌËÚ¿ ·̷ٷ ÌÂÁ¿Ï˘ Ù¿Û˘, Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È ·fi Ì›ˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ì ‹ ¯ˆÚ›˜ ÙÒÛË ÙÔ˘ ‰˘Ó·ÌÈÎÔ‡ Î·È ÌÂÁ¿Ï˘ Û˘¯ÓfiÙËÙ·˜ ·̷ٷ. ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

∂ÈÎfiÓ· 6. ™ÙÔ Û‡Ó‰ÚÔÌÔ Lennox-Gastaut ·Ú·ÙËÚÔ‡ÓÙ·È ‚Ú·‰¤· Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ Ì ÂÈÎÚ¿ÙËÛË ÛÙȘ ÚfiÛıȘ ÂÚÈÔ¯¤˜.

ÛÂÈ. ∆Ô ‚·ÛÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· Û ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Lennox-Gastaut Â›Ó·È ‚Ú·‰˘ÚÚ˘ıÌÈÎfi Î·È ‰È¿ÊÔÚ˜ ÌÔÚʤ˜ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û¯Â‰fiÓ Û fiÏÔ˘˜ ·˘ÙÔ‡˜ ÙÔ˘˜ ·ÛıÂÓ›˜, ΢ڛˆ˜ ÙÔÓÈÎÔ› Û·ÛÌÔ›, ¿Ù˘˜ ·Ê·ÈÚ¤ÛÂȘ Î·È ·ÙÔÓÈΤ˜ ÎÚ›ÛÂȘ (16). ∏ ÂÌÊ¿ÓÈÛË ¿Ù˘ˆÓ ·Ê·ÈÚ¤ÛÂˆÓ Û˘Óԉ‡ÂÙ·È Û˘Ó‹ıˆ˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ·ÓˆÙ¤Úˆ ·Ó·ÊÂÚı¤ÓÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ ÛÙÔ ∏∂°, ÂÓÒ Ë ·ÚÔ˘Û›· ÙÔÓÈÎÒÓ Û·ÛÌÒÓ Û˘Óԉ‡ÂÙ·È Û˘¯Ó¿ ·fi ÂÎÊÔÚÙ›ÛÂȘ ·fi ·̷ٷ Û˘¯ÓfiÙËÙ·˜ 8-30 Hz, ΢ڛˆ˜ ÁÂÓÈÎÂ˘Ì¤Ó˜ (∂ÈÎfiÓ· 7), ‹ ·fi ·ÈÊÓ›‰È· Ì›ˆÛË Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂°. ∆Ô ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ÛÙȘ ·ÙÔÓÈΤ˜ ÎÚ›ÛÂȘ ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ ÂÎÊÔÚÙ›ÛÂȘ ÔÏ˘·È¯ÌÒÓ ‹ Û˘ÌÏÂÁÌ¿ÙˆÓ ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ ‹ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-·̷ÙÔ˜. ∆Ô ÂÈÏËÙÈÎfi Ì˘ÔÎÏÔÓÈÎfi Ê·ÈÓfiÌÂÓÔ ¤¯ÂÈ Û˘Ó‰Âı› - ·fi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈ΋ ¿Ô„Ë - Ì ÙȘ ÂÎÊÔÚÙ›ÛÂȘ ÔÏ˘·È¯ÌÒÓ (1-3). ∆Ô ∏∂° ÛÙȘ ‰È¿ÊÔÚ˜ ÌÔÚʤ˜ Ì˘ÔÎÏÔÓÈ΋˜ ÂÈÏË„›·˜ ‹ Û ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· Ì ÂÈÏËÙÈΤ˜ Ì˘ÔÎÏÔӛ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÎÊÔÚÙ›ÛÂȘ Ì ÔÏ˘·È¯Ì¤˜ ‹ Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ ‹ ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ ÁÂÓÈÎÂ˘Ì¤Ó˜, Û‡Á¯ÚÔÓ˜ Ì ÌÂÙˆÈ·›· ÂÈÎÚ¿ÙËÛË, ÔÈ Ôԛ˜ Û˘¯Ó¿ Û˘Óԉ‡ÔÓÙ·È ÎÏÈÓÈο ·fi Ì˘ÔÎÏÔӛ˜ (∂ÈÎfiÓ· 8). ∞˘Ù¤˜ ÔÈ ÂÎÊÔÚÙ›ÛÂȘ

∂ÈÎfiÓ· 7. OÈ ÙÔÓÈÎÔ› Û·ÛÌÔ› ÛÙÔ Û‡Ó‰ÚÔÌÔ LennoxGastaut Û˘Óԉ‡ÔÓÙ·È Û˘¯Ó¿ ·fi ÁÂÓÈÎÂ˘Ì¤Ó· ·̷ٷ Û˘¯ÓfiÙËÙ·˜ 8-30 Hz.

Paediatriki Mar-Apr 05

19-04-05

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97

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È ·È‰È΋ ÂÈÏË„›·

∂ÈÎfiÓ· 8. ™ÙË Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÎÊÔÚÙ›ÛÂȘ ÔÏ˘·È¯ÌÒÓ Î·È Ù·¯¤ˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-·̷ÙÔ˜.

ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó ÌfiÓ˜ ÙÔ˘˜ Û ηٿ Ù· ¿ÏÏ· Ê˘ÛÈÔÏÔÁÈÎfi ∏∂°, fiˆ˜ Û˘Ì‚·›ÓÂÈ Û ‰È¿ÊÔÚ· ηÏÔ‹ıË Ì˘ÔÎÏÔÓÈο ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ·, ‹ Ì ¿ÏϘ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ‚Ú·‰¤· Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ ‹ Û˘ÌϤÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜, fiˆ˜ ÛÙÔ Û‡Ó‰ÚÔÌÔ LennoxGastaut, ‹ Ì ¿ÊıÔÓ˜ ‚Ú·‰˘ÚÚ˘ı̛˜ Û ‰È¿ÊÔÚ˜ ÂÍÂÏÈÎÙÈΤ˜ Î·È ÌÂÙ·‚ÔÏÈΤ˜ ÂÁÎÂÊ·ÏÔ¿ıÂȘ (1). OÈ ÂÎÊÔÚÙ›ÛÂȘ ·˘Ù¤˜ ÌÔÚ› Ó· ÂȉÂÈÓˆıÔ‡Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ˘¤ÚÓÔÈ·˜, ÛÙËÓ ˘ÓËÏ›· Î·È ÛÙË ‰ÔÎÈÌ·Û›· ÙˆÓ ¢º∂. OÈ ÂÎÊÔÚÙ›ÛÂȘ ·È¯Ì‹˜-·̷ÙÔ˜ ‹ ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ó·ÓÈ΋ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· Â›Ó·È Û˘¯Ó¿ ¿Ù˘˜, ¤¯Ô˘Ó Û˘¯ÓfiÙËÙ· 3 Hz ‹ ÌÂÁ·Ï‡ÙÂÚË, ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙË Ê¿ÛË Ù˘ ˘ÓËÏ›·˜ Î·È ÛÙÔÓ ‡ÓÔ Î·È ÌÔÚ› ÎÏÈÓÈο Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ÙÈÓ¿ÁÌ·Ù·. ∆Ô ‚·ÛÈÎfi ‰È¿ÁÚ·ÌÌ· Û ·ÛıÂÓ›˜ Ì Ó·ÓÈ΋ Ì˘ÔÎÏÔÓÈ΋ ÂÈÏË„›· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi Î·È Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ÊˆÙÔ¢·ÈÛıËÛ›·. ∏ ʈÙÔ·ÚÔ͢ÛÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ∏∂° ·fi ·ÌÊÔÙÂÚfiÏ¢Ú˜ Î·È Û‡Á¯ÚÔÓ˜ ÂÎÊÔÚÙ›ÛÂȘ ·fi ÔÏ˘·È¯Ì¤˜ ‹ Û˘ÌϤÁÌ·Ù· ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ (∂ÈÎfiÓ· 9), ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙȘ Û˘¯ÓfiÙËÙ˜ 14-18 ʈÙÂÈÓÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ ·Ó¿ ‰Â˘ÙÂÚfiÏÂÙÔ Î·È Ì ÙÔ ÎÏ›ÛÈÌÔ ÙˆÓ ÔÊı·ÏÌÒÓ (1). ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ ·fi ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÊˆÙÂÈÓÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È ÔÈ ÂÎÊÔÚÙ›ÛÂȘ ÌÔÚ› Ó· ÂÈ̤ÓÔ˘Ó Ó· ÂÌÊ·Ó›˙ÔÓÙ·È Î·È ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ ¢º∂. ºˆÙÔ·ÚÔ͢ÛÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ Û ·ÛıÂÓ›˜ Ì ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ ÙÔÓÈÎÔÎÏÔÓÈÎÔ‡˜ Û·ÛÌÔ‡˜, Ì˘ÔÎÏÔӛ˜ ‹ ·Ê·ÈÚ¤ÛÂȘ ηÈ, Û·ÓÈfiÙÂÚ·, Û ·ÛıÂÓ›˜ Ì ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ. ∏ ·ÚÔ˘Û›· ʈÙÔ·ÚÔ͢ÛÌÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ‰Â›¯ÓÂÈ fiÙÈ ÔÈ ÚˆÙÔ·ı›˜ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ Û·ÛÌÔ› ÌÔÚ› Ó· ÚÔÎÏËıÔ‡Ó ·fi ¢º∂. £· Ú¤ÂÈ Ó· ÛËÌÂȈı›, ˆÛÙfiÛÔ, fiÙÈ ÊˆÙÔ·ÚÔ͢ÛÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Î·È Ù· Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· Î·È Ë ·ÚÔ˘Û›· Ù˘ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙ› ηْ ·Ó¿ÁÎË ÙËÓ ÂÌÊ¿ÓÈÛË ÂÈÏË„›·˜ (17).

∂ÈÎfiÓ· 9. ∫·Ù¿ ÙË ÊˆÙÔ·ÚÔ͢ÛÌÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÂÎÊÔÚÙ›ÛÂȘ ·fi Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ ‹ ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ Â›Ó·È ‰È·ÊÔÚÂÙÈ΋ ·fi ÂΛÓË ÙˆÓ ¢º∂ Î·È ‰È·ÚÎÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ·fi ·˘Ù¿.

∆Ô ÌÂÛÔÎÚÈÙÈÎfi ∏∂° ÛÙȘ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÚˆÙÔ·ı›˜ ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÎÚ›ÛÂȘ, fiÙ·Ó ‰ÂÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ÂÈÎfiÓ˜ ·fi fiÏÔ ÙÔ Ê¿ÛÌ· Ù˘ ÂÈÏËÙfiÌÔÚÊ˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, fiˆ˜ ·ÌÊÔÙÂÚfiÏ¢Ú˜, ÁÂÓÈÎÂ˘Ì¤Ó˜ Î·È Û˘ÌÌÂÙÚÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-·̷ÙÔ˜, Û˘ÌÏÂÁÌ¿ÙˆÓ ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜, ‹ ÌË ÂȉÈΤ˜ ÂÈÎfiÓ˜, fiˆ˜ ·ÚÔ͢ÛÌÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ·fi ·ÌÊÔÙÂÚfiÏ¢Ú˜ Î·È Û˘ÌÌÂÙÚÈΤ˜ ‚Ú·‰˘ÚÚ˘ı̛˜ (1-3). ™Â ·˘Ù¤˜ ÙȘ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ÌÔÚ› Ó· ˘¿Ú¯ÂÈ ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, Ì ·ÏÏ·Á‹ Û˘¯Ó¿ Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘˜. ªÔÚ› Ó· ˘¿Ú¯ÂÈ ıÂÙÈ΋ ·ÓÙ·fiÎÚÈÛË Î·Ù¿ ÙË ‰ÔÎÈÌ·Û›· ÙˆÓ ¢º∂ Î·È Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ÂÎÊÔÚÙ›ÛÂˆÓ ÂÓÈÛ¯‡ÂÈ ÙË ‰È¿ÁÓˆÛË ÙˆÓ ÂÛÙÈ·ÎÒÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Ì ‰Â˘ÙÂÚÔ·ı‹ ÁÂӛ΢ÛË. ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ë ·Ó‡ÚÂÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ı¤ÙÂÈ Ì ·ÛÊ¿ÏÂÈ· ÙË ‰È¿ÁÓˆÛË (1-3). ∆Ô ∏∂° ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ê·›ÚÂÛ˘ (∂ÈÎfiÓ· 10) ÂÌÊ·Ó›˙ÂÈ ÁÂÓÈÎÂ˘Ì¤Ó˜ Î·È Û˘ÌÌÂÙÚÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-·̷ÙÔ˜ ÌÂ Û˘¯ÓfiÙËÙ· 2,5-4 Hz, Û˘ÓËı¤ÛÙÂÚ· 3 Hz. ∆· ‰˘Ó·ÌÈο ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ‡„Ô˜ ÛÙȘ ÌÂÙˆÈ·›Â˜ ÂÚÈÔ¯¤˜, Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ÌÂÈÒÓÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘ Î·È ÔÈ ÂÎÊÔÚÙ›ÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Î·È ÂÚ·ÙÒÓÔÓÙ·È ·fiÙÔÌ·, ¯ˆÚ›˜ ÙËÓ Î·Ù·ÁÚ·Ê‹ ÌÂÙ·ÎÚÈÙÈÎÒÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ Ê·ÈÓÔ̤ӈÓ. ™ÙÔ ÌÂÛÔÎÚÈÙÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ·ÙfiÌˆÓ ÌÂ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ, ÂÌÊ·Ó›˙ÔÓÙ·È Î·Ù¿ ‰È·ÛÙ‹Ì·Ù· ÔÈ ·ÓˆÙ¤Úˆ ÂÎÊÔÚÙ›ÛÂȘ, Ì ¯·ÌËÏfiÙÂÚÔ fï˜ ÙÔ ‡„Ô˜ ÙˆÓ ‰˘Ó·ÌÈÎÒÓ ÙÔ˘˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘, ÔÈ ÂÎÊÔÚÙ›ÛÂȘ Â›Ó·È ÏÈÁfiÙÂÚÔ Ô̷Ϥ˜ Î·È Ë Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·98

98

∫. ∞. µÔ‡‰Ú˘

∂ÈÎfiÓ· 10. ™ÙȘ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ ·Ú·ÙËÚÔ‡ÓÙ·È ÁÂÓÈÎÂ˘Ì¤Ó˜, Û‡Á¯ÚÔÓ˜ Î·È Û˘ÌÌÂÙÚÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ·fi Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜, Û˘¯Ó¿ Û˘¯ÓfiÙËÙ·˜ 3 Hz, Ì ·ÚÈ· ÂÓÙfiÈÛË ÛÙȘ ÚfiÛıȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

ÌÂÈÒÓÂÙ·È. ™ÙÔ ‰È¿ÁÚ·ÌÌ· ÌÔÚ› Ó· ÂÚȤ¯ÔÓÙ·È ÂÛÙȷΤ˜ ‹ ÁÂÓÈÎÂ˘Ì¤Ó˜ ‚Ú·‰˘ÚÚ˘ı̛˜ ‹ Î·È ¿ÏϘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÔÈ Ôԛ˜ Û˘¯Ó¿ ÂÓ·ÏÏ¿ÛÛÔÓÙ·È ÛÙ· ‰‡Ô ËÌÈÛÊ·›ÚÈ· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ·ÏÏ¿ Ë ‚·ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÂٷ͇ ÙˆÓ ÂÈÏËÙfiÌÔÚÊˆÓ ·ÓˆÌ·ÏÈÒÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. OÈ ÂÎÊÔÚÙ›ÛÂȘ ÛÙȘ Ù˘ÈΤ˜ ·Ê·ÈÚ¤ÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ηٿ ÙË ‰ÔÎÈÌ·Û›· Ù˘ ˘¤ÚÓÔÈ·˜ Î·È ÁÈ’ ·˘Ùfi Ë ‰ÔÎÈÌ·Û›· ˘¤ÚÓÔÈ·˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û fiÏ· Ù· ·È‰È¿ Ì ·Ê·ÈÚ¤ÛÂȘ. ™ÙȘ ·Ê·ÈÚ¤ÛÂȘ Ù˘ ÂÊË‚È΋˜ ËÏÈΛ·˜, ÔÈ ÂÎÊÔÚÙ›ÛÂȘ Û˘Ó‹ıˆ˜ Â›Ó·È Û˘¯ÓfiÙËÙ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 3 Hz Î·È ‰È·ÚÎÔ‡Ó ÏÈÁfiÙÂÚÔ Û ۇÁÎÚÈÛË Ì ·˘Ù¤˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ™ÙȘ ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Ì ÛÙÔȯÂÈÒ‰Ë Û˘Ìو̷ÙÔÏÔÁ›·, ÙÔ ∏∂° ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ·ÎfiÌË Î·È ·Ó ηٷÁÚ¿ÊÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÚ›Û˘. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ı¤ÛË Ù˘ ÂÈÏËÙÔÁfiÓÔ˘ ÂÛÙ›·˜ ÌÔÚ› Ó· Â›Ó·È ‚·ıÈ¿ ÛÙÔÓ ÂÁΤʷÏÔ Ô‡Ùˆ˜ ÒÛÙ ӷ ÌËÓ ÌÔÚ› Ó· ηٷÁÚ·Ê› ·fi Ù· ÂÈÊ·ÓÂȷο ËÏÂÎÙÚfi‰È· ÙÔ˘ Û˘Ì‚·ÙÈÎÔ‡ ∏∂°. ™˘¯ÓfiÙÂÚ· ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· Û ·ÛıÂÓ›˜ Ì ·˘Ù¤˜ ÙȘ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ (∂ÈÎfiÓ· 11) Â›Ó·È Ë ·ÚÔ˘Û›· ÂÛÙÈ·ÎÒÓ ·È¯ÌÒÓ ‹ Û·ÓÈfiÙÂÚ· ·È¯ÌËÚÒÓ ÛÙÔȯ›ˆÓ, Û˘ÌÏÂÁÌ¿ÙˆÓ ·È¯Ì‹˜-·̷ÙÔ˜,

∂ÈÎfiÓ· 11. ∂ÛÙȷΤ˜ ·È¯Ì¤˜ ÂÓÙÔÈ˙fiÌÂÓ˜ ÛÙȘ ‰ÂÍȤ˜ ÚfiÛıȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

Û˘ÌÏÂÁÌ¿ÙˆÓ ÔÏ˘·È¯Ì‹˜-·̷ÙÔ˜ Î·È Ë ÂÓÙÔÈṲ̂ÓË ·ÚÔ˘Û›· ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ ‹ Ù·¯¤ˆÓ Ú˘ıÌÒÓ (1-3). ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ, ÔÈ ÂÎÊÔÚÙ›ÛÂȘ ·ÏÏ¿˙Ô˘Ó ÛÙ·‰È·Î¿ ÌÔÚÊÔÏÔÁ›· ‹/Î·È Û˘¯ÓfiÙËÙ· Î·È ·˘Ùfi ‚ÔËı¿ ÛÙË ‰È¿ÎÚÈÛ‹ ÙÔ˘˜ ·fi ¿ÏϘ ηÏÔ‹ıÂȘ ÂÛÙȷΤ˜ ·È¯ÌËÚfiÌÔÚʘ ηٷÁڷʤ˜ (18). §fiÁˆ Ù˘ ·ÊıÔÓ›·˜ ÙˆÓ ‰ÈËÌÈÛÊ·ÈÚÈÎÒÓ Û˘Ó‰¤ÛˆÓ, ·˘Ù¤˜ ÔÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÌÔÚ› Ó· ηٷÁÚ¿ÊÔÓÙ·È Î·È ÛÙËÓ ÔÌfiÏÔÁË ÂÚÈÔ¯‹ ÙÔ˘ ¿ÏÏÔ˘ ËÌÈÛÊ·ÈÚ›Ô˘. OÈ ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Ì ÛÙÔȯÂÈÒ‰Ë Û˘Ìو̷ÙÔÏÔÁ›· Û˘¯Ó¿ ÁÂÓÈ·ÔÓÙ·È Î·È ÙÔ ∏∂° ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó ·fi ÙȘ ÚˆÙÔÁÂÓ›˜ ÁÂÓÈÎÂ˘Ì¤Ó˜ ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÎÚ›ÛÂȘ. ™ÙÔ ÌÂÛÔÎÚÈÙÈÎfi ∏∂° ÙˆÓ ÂÛÙÈ·ÎÒÓ ÎÚ›ÛÂˆÓ Ì ۇÓıÂÙË Û˘Ìو̷ÙÔÏÔÁ›·, ·Ú·ÙËÚÔ‡ÓÙ·È Î˘Ú›ˆ˜ ·È¯Ì¤˜ ‹ ·È¯ÌËÚ¿ ÛÙÔȯ›· ÛÙȘ ÎÚÔÙ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ (∂ÈÎfiÓ· 12), ÂÙÂÚfiÏ¢ڷ ‹ ·ÌÊÔÙÂÚfiÏ¢ڷ Î·È Û˘¯ÓfiÙÂÚ· ÛÙȘ ÚfiÛıȘ ÎÚÔÙ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ (1-3). ªÔÚ›, fï˜, Û·ÓÈfiÙÂÚ· ÙÔ ∏∂° Ó· ÂÚȤ¯ÂÈ ÂÛÙȷΤ˜ ‹ ‰È¿¯˘Ù˜ ‚Ú·‰˘ÚÚ˘ı̛˜ ‹ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, fiˆ˜ Û˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È ÛÙ· ·È‰È¿ (19). O ‡ÓÔ˜ Î·È - ÏÈÁfiÙÂÚÔ Û˘¯Ó¿ - Ë ˘¤ÚÓÔÈ· ‰È¢ÎÔχÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛË ·˘ÙÒÓ ÙˆÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ Î·È ÁÈ’ ·˘Ùfi ÙÔÓ ÏfiÁÔ, fiÙ·Ó ÙÔ ∏∂° ÂÁÚ‹ÁÔÚÛ˘ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ∏∂° ‡ÓÔ˘. ™ÙÔ ∏∂° Ù˘ ηÏÔ‹ıÔ˘˜ ÂÛÙȷ΋˜ ÂÈÏË„›·˜ Ì ÎÂÓÙÚÔÎÚÔÙ·ÊÈΤ˜ (ÚÔÏ¿Ó‰ÂȘ) ·È¯Ì¤˜, Ô˘ ·ÔÙÂÏ› ÙÔ 15% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜, ·Ú·ÙËÚÔ‡ÓÙ·È ¿ÊıÔÓ˜ ÛÙÂÚÂfiÙ˘˜ ·È¯Ì¤˜ ˘„ËÏÔ‡ ‰˘Ó·ÌÈÎÔ‡ Ì ÔÌ·Ï‹ ÎÔÚ˘Ê‹, Û˘¯Ó¿ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‚Ú·‰‡ ·̷ ÂÚÈÚÔÏ·Ó‰Èο (∂ÈÎfiÓ· 13) (1,3,20). OÈ ÚÔÏ¿Ó‰ÂȘ ·È¯Ì¤˜ ÌÔÚ› Ó· ÁÚ¿ÊÔÓÙ·È ÂÙÂÚfiÏ¢ڷ, ·ÓÂÍ¿ÚÙËÙ· ·ÌÊÔÙÂÚfiÏ¢ڷ ‹ Û·ÓÈfiÙÂÚ· Û‡Á¯ÚÔÓ· Î·È ·ÌÊÔÙÂÚfiÏ¢ڷ. OÈ ÚÔÏ¿Ó‰ÂȘ ·È¯Ì¤˜ ÁÚ¿ÊÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔÓ ‡ÓÔ (21) Î·È Ë Û˘¯Ó‹ Î·È ¿ÊıÔÓË ·ÚÔ˘Û›· ÙÔ˘˜ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙË Û¯ÂÙÈο Û¿ÓÈ· ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ. ∆Ô ‚·ÛÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ·ÚÔ˘ÛÈ¿˙ÂÈ

∂ÈÎfiÓ· 12. ∞ȯ̤˜ Î·È ‚Ú·‰¤· ·̷ٷ ÂÓÙÔÈ˙fiÌÂÓ· ÛÙË ‰ÂÍÈ¿ ÎÚÔÙ·ÊÈ΋ ÂÚÈÔ¯‹ Û ·ÛıÂÓ‹ Ì ۇÓıÂÙ˜ ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ.

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∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È ·È‰È΋ ÂÈÏË„›·

∂ÈÎfiÓ· 13. ƒÔÏ¿Ó‰ÂȘ ·È¯Ì¤˜ ÂÓÙÔÈ˙fiÌÂÓ˜ ÛÙÔ ‰ÂÍÈfi ËÌÈÛÊ·›ÚÈÔ.

ηϋ ÔÚÁ¿ÓˆÛË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜. ∞˘Ù¤˜ ÔÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ ˘Ô¯ˆÚÔ‡Ó, fiˆ˜ Î·È ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ̤¯ÚÈ ÙËÓ ÂÊ˂›·. OÈ ÚÔÏ¿Ó‰ÂȘ ·È¯Ì¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ ÛÂ Ê˘ÛÈÔÏÔÁÈο ¿ÙÔÌ· ‹ ÛÂ Û˘ÁÁÂÓ›˜ ·ÛıÂÓÒÓ Ì ÚÔÏ¿Ó‰ÂÈ· ÂÈÏË„›· Î·È Ë ·Ó‡ÚÂÛ‹ ÙÔ˘˜ ‰ÂÓ ÛËÌ·ÙÔ‰ÔÙ› ηْ ·Ó¿ÁÎË ÙË ÌÂÏÏÔÓÙÈ΋ ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ. ™ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ¶·Ó·ÁȈÙfiÔ˘ÏÔ˘ Î·È ÛÙËÓ ·È‰È΋ ÈÓȷ΋ ÂÈÏË„›· ÙÔ˘ Gastaut (3), ‰‡Ô ηÏÔ‹ıË Û‡Ó‰ÚÔÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÁÚ¿ÊÔÓÙ·È Û˘¯Ó¿ ÂÎÊÔÚÙ›ÛÂȘ ·fi ·È¯Ì¤˜ ‹ Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ (∂ÈÎfiÓ· 14), ΢ڛˆ˜ ÛÙȘ Ô›ÛıȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È È‰›ˆ˜ ÈÓȷο, ÔÈ Ôԛ˜ Û˘¯Ó¿ ÂÍ·Ê·Ó›˙ÔÓÙ·È Ì ÙÔ ¿ÓÔÈÁÌ· ÙˆÓ ÔÊı·ÏÌÒÓ. ∞˘Ù¤˜ ÔÈ ÂÎÊÔÚÙ›ÛÂȘ

∂ÈÎfiÓ· 14. ∞ȯ̤˜ ÂÓÙÔÈ˙fiÌÂÓ˜ ÛÙË ‰ÂÍÈ¿ ÈÓȷ΋ ÂÚÈÔ¯‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘.

ÁÚ¿ÊÔÓÙ·È ÂÙÂÚfiÏ¢ڷ, ·ÓÂÍ¿ÚÙËÙ· ·ÌÊÔÙÂÚfiÏ¢ڷ ‹ Û‡Á¯ÚÔÓ· Î·È ·ÌÊÔÙÂÚfiÏ¢ڷ ÛÙËÓ ÈÓȷ΋ ¯ÒÚ· ÌÂ Û˘¯Ó‹ Â¤ÎÙ·ÛË ÛÙË ‚ÚÂÁÌ·ÙÈ΋ Î·È Ô›ÛıÈ· ÎÚÔÙ·ÊÈ΋ ÂÚÈÔ¯‹ Î·È ÂȉÂÈÓÒÓÔÓÙ·È Û˘¯Ó¿ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘. ¶·ÚfiÌÔȘ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜, ·ÏÏ¿ Ì ÙËÓ ·ÚÔ˘Û›· ‚Ú·‰˘ÚÚ˘ıÌÈÒÓ ‹ ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ‚·ÛÈÎÔ‡ Ú˘ıÌÔ‡ Û‡ÛÙÔȯ·, ·Ú·ÙËÚÔ‡ÓÙ·È Û˘¯Ó¿ Û ÂÈÏËÙÈο ¿ÙÔÌ· Ì ÈÓȷΤ˜ ‚Ï¿‚˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (22). ∞ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ÂÈÏËÙfiÌÔÚʘ ÂÎÊÔÚÙ›ÛÂȘ ·fi ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚ›· ÌË ÁÂÈÙÔÓÈο ËÏÂÎÙÚfi‰È· Î·È Ì ̛· ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÛÙ›· Û οı ËÌÈÛÊ·›ÚÈÔ, ıˆÚÔ‡ÓÙ·È fiÙÈ ¤¯Ô˘Ó ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎfi ‰È¿ÁÚ·ÌÌ· ÔÏÏ·ÏÒÓ ·ÓÂÍ¿ÚÙËÙˆÓ ÂÈÏËÙÈÎÒÓ ÂÛÙÈÒÓ. ™¯Â‰fiÓ fiÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ì ·˘Ù¤˜ ÙȘ ·ÓˆÌ·Ï›Â˜ ¤¯Ô˘Ó ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ, Û˘Ó‹ıˆ˜ ÔÏÏ·ÏÒÓ ÌÔÚÊÒÓ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË (23). ™ÙËÓ Â›ÎÙËÙË ÂÈÏËÙÈ΋ ·Ê·Û›· ‹ Û‡Ó‰ÚÔÌÔ Landau-Kleffner Î·È ÛÙËÓ ÂÈÏË„›· ÌÂ Û˘Ó¯›˜ ÂÎÊÔÚÙ›ÛÂȘ “·È¯Ì‹˜-·̷ÙÔ˜” ÛÙÔÓ nonREM ‡ÓÔ, ÂÌÊ·Ó›˙ÔÓÙ·È ‰È¿¯˘Ù˜, Û˘Ó¯›˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ù‡Ô˘ ·È¯Ì‹˜-·̷ÙÔ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (∂ÈÎfiÓ· 15) (24,25). ™ÙÔ ∏∂° ÂÁÚ‹ÁÔÚÛ˘ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ, ΢ڛˆ˜ ÛÙȘ ÎÚÔÙ·ÊÈΤ˜

∂ÈÎfiÓ· 15. ÕÊıÔÓ˜ ÂÎÊÔÚÙ›ÛÂȘ ·fi ·È¯Ì¤˜ ΢ڛˆ˜ ÛÙȘ ̤Û˜ Î·È Ô›ÛıȘ ÂÚÈÔ¯¤˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ Û ·È‰› Ì ÂȉÂÈÓÔ‡ÌÂÓË ‰˘ÛÊ·Û›·. ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

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100

∫. ∞. µÔ‡‰Ú˘

ÂÚÈÔ¯¤˜. OÈ ·ÓˆÌ·Ï›Â˜ ·˘Ù¤˜ ÛÙÔ ∏∂° Û˘¯Ó¿ ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ·fi ÌÂÚÈο ¯ÚfiÓÈ·. ¶ÂÚÈÔ‰ÈΤ˜, Û¯ÂÙÈο ÛÙÂÚÂfiÙ˘˜, ÂÛÙȷΤ˜ ‹/Î·È ‰È¿¯˘Ù˜ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ·È¯Ì¤˜, ÔÏ˘·È¯Ì¤˜, Ô͇·È¯Ì· ‹ ·ÎfiÌË Î·È ‚Ú·‰¤· ·̷ٷ, ·Ú·ÙËÚÔ‡ÓÙ·È Û ‰È¿ÊÔÚ˜ ÔÍ›˜ ‹ ˘ÔÍ›˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ Â›Ó·È Ë ˘ÔÍ›· ÛÎÏËÚ˘ÓÙÈ΋ ·ÓÂÁÎÂÊ·Ï›Ùȉ· Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ Èfi Ù˘ ÈÏ·Ú¿˜ (∂ÈÎfiÓ· 16). ∏ ÂÓÙfiÈÛË Î·È Ë Î·Ù·ÓÔÌ‹ ÂÍ·ÚÙÒÓÙ·È Î˘Ú›ˆ˜ ·fi ÙËÓ ˘ÔΛÌÂÓË ‚Ï¿‚Ë ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (26). ∆Ô ∏∂° ÛÙÔ˘˜ ·ÏÔ‡˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙÔ Î·È ‰ÂÓ ‚ÔËı¿ ÛÙË ‰È¿ÁÓˆÛË ‹ ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Î·È ‰ÂÓ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ Úfi‚ÏÂ„Ë ÌÂÏÏÔÓÙÈ΋˜ ÂÌÊ¿ÓÈÛ˘ ÂÈÏË„›·˜ (1). µÚ·‰¤· ·̷ٷ, ΢ڛˆ˜ ÛÙȘ Ô›ÛıȘ ÂÁÎÂÊ·ÏÈΤ˜ ÂÚÈÔ¯¤˜, ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ (27). °ÂÓÈÎÂ˘Ì¤Ó˜ ÂÎÊÔÚÙ›ÛÂȘ ·fi ÁÂÓÈÎÂ˘Ì¤Ó· Û˘ÌϤÁÌ·Ù· ·È¯Ì‹˜-·̷ÙÔ˜ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙÔ‡Ó Û ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜, ΢ڛˆ˜ Û ·ÛıÂÓ›˜ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 4 ÂÙÒÓ. ∏ ·ÚÔ˘Û›· ÂÈÏËÙfiÌÔÚÊˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ‹ ÙËÓ ÂÌÊ¿ÓÈÛË ÌÂÏÏÔÓÙÈ΋˜ ÂÈÏË„›·˜. ¶ÈÛÙ‡ÂÙ·È, fï˜, fiÙÈ Ë ·ÚÔ˘Û›· ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ ÙÔ˘ Ù‡Ô˘ ·È¯Ì‹˜-·̷ÙÔ˜ Û ·È‰È¿ Ì ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ì˘ÔÎÏÔÓÈ΋˜ ÂÈÏË„›·˜ (28). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÛÙÔ˘˜ Û‡ÓıÂÙÔ˘˜ ‹ ÂÈÂÏÂÁ̤ÓÔ˘˜ ˘ÚÂÙÈÎÔ‡˜ Û·ÛÌÔ‡˜, ÙÔ ∏∂° ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·Ó›¯Ó¢ÛË ÂÈÏË„›·˜ ‹ ¿ÏÏÔ˘ ˘ÔΛÌÂÓÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Â¿Ó Á›ÓÂÈ ÌÂÙ·ÎÚÈÙÈο Î·È Î·Ù·ÁÚ¿„ÂÈ ÂÛÙȷΤ˜ ‚Ú·‰˘Ú˘ı̛˜ ‹ ·È¯ÌËÚ¿ ·̷ٷ, ·ÏÏ¿ Ë Ï‹„Ë ÙÔ˘ ∏∂° Û ۇÓıÂÙÔ˘˜ ‹ ÂÈÂÏÂÁ̤ÓÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fi Ù· ÎÏÈÓÈο ‰Â‰Ô̤ӷ Î·È ÙËÓ ÎÚ›ÛË ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ È·ÙÚÔ‡. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔ ∏∂° Â›Ó·È Ì›· ·Î›Ó‰˘ÓË Î·È Û¯ÂÙÈο ÊıËÓ‹ Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈ΋ ̤ıÔ‰Ô˜ Ô˘ ¤¯ÂÈ Ó· ÚÔÛʤÚÂÈ ÔÏÏ¿ ÛÙË ÌÂϤÙË Ù˘

∂ÈÎfiÓ· 16. ¶ÂÚÈÔ‰Èο, ÁÂÓÈÎÂ˘Ì¤Ó· Û˘ÌϤÁÌ·Ù· ·fi ‚Ú·‰¤· Î·È ·È¯ÌËÚ¿ ·̷ٷ ÌÂÁ¿Ï˘ Ù¿Û˘ Û ·ÛıÂÓ‹ Ì ˘ÔÍ›· ÛÎÏËÚ˘ÓÙÈ΋ ·ÓÂÁÎÂÊ·Ï›Ùȉ·, ÔÊÂÈÏfiÌÂÓË Û Èfi ÈÏ·Ú¿˜. ¶·È‰È·ÙÚÈ΋ 2005;68:93-101

·È‰È΋˜ ÂÈÏË„›·˜. øÛÙfiÛÔ, ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ·fi ¤ÌÂÈÚÔ˘˜ Ù¯ÓÈÎÔ‡˜, Ó· ÌÂÏÂÙ¿Ù·È ·fi ¤ÌÂÈÚÔ˘˜ ÛÙÔ ·È‰ÈÎfi ∏∂° È·ÙÚÔ‡˜ Î·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ ÈÛÙÔÚÈÎfi, ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È ¿ÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Blume WT, Kaibara M. Atlas of pediatric electroencephalography. 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1999. p. 153-162.

2. ∆ÚÈ·ÓٷʇÏÏÔ˘ ¡π, ª·ÓÙÔ‡‚·ÏÔ˜ µ. µ·ÛÈ΋ ∏∂°Ú·Ê›·. £ÂˆÚ›· Î·È ¿ÙÏ·˜. ∞ı‹Ó·: π·ÙÚÈΤ˜ ∂ΉfiÛÂȘ ¶.Ã. ¶·Û¯·Ï›‰Ë˜; 1998. ÛÂÏ. 275-280.

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∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· Î·È ·È‰È΋ ÂÈÏË„›·

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REVIEW ARTICLE

Electroencephalographic investigation of children with epilepsy K. A. Voudris Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens Correspondence: Konstantinos A. Voudris Department of Neurology, “P. & A. Kyriakou” Children’s Hospital Thivon & Levadias str., 115 27, Athens E-mail: kvoudris@otenet.gr Date of submission: 24-03-2004 Date of approval: 12-11-2004

Abstract Electroencephalography is the basic technique for the neurophysiological investigation of epilepsy and may help in the diagnosis, study and prognosis of epilepsy. Although epilepsy is a clinical diagnosis, electroencephalographic data may play an important role in support of the clinical impression.

Electroencephalography in paediatric epilepsy may be useful for confirmation of the diagnosis, recognition of the types of seizures and underlying epileptic syndromes, and for prediction, both of response to antiepileptic treatment and recurrence of seizures after discontinuation of antiepileptic treatment.

Synchronized video-electroencephalographic monitoring offers improvements in the study of epileptic children with persistent epilepsy, and, in particular, may help in the differential diagnosis between epileptic and non-epileptic paroxysmal clinical events. Electroencephalography is a harmless and relatively inexpensive technique, which may be of great benefit for children with epilepsy when it is performed by experienced technicians and interpreted by specialized doctors, and the findings are correlated with clinical and other laboratory data.

Key words Electroencephalogram, epilepsy, children.

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¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™Â ·˘Ù‹ ÙË ÌÂϤÙË ÚÔÙ›ÓÂÙ·È Ì›· Ó¤· ̤ıÔ‰Ô˜ ‰È¿ÎÚÈÛ˘ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 ÔÍ›·˜ ÏÂÌÊÔ‚Ï·ÛÙÈ΋˜ Ï¢¯·ÈÌ›·˜ (O§§) Ì ÙË Ê·ÛÌ·ÙÈ΋ ·Ó¿Ï˘ÛË Î·È ·ÂÈÎfiÓÈÛË. ∂Âȉ‹ Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Ë ÌÔÚÊÔÏÔÁÈ΋ ‰È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 Â›Ó·È ‰˘Û¯ÂÚ‹˜ Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ, Ë ‰È¿ÎÚÈÛË Î·È Ù·ÍÈÓfiÌËÛË Á›ÓÂÙ·È Ì ‚¿ÛË Î˘ÙÙ·ÚÔ¯ËÌÈο Î·È Î˘ÙÙ·ÚÔÁÂÓÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÌÔÚȷο ‰Â‰Ô̤ӷ Î·È ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∏ ÂÎÙ›ÌËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ˘ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÔÚ› Ó· Á›ÓÂÈ Ì ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ Ô˘ ‚·Û›˙ÂÙ·È ÛÙȘ ·Ú¯¤˜ Ù˘ Ê·ÛÌ·ÙÈ΋˜ ·Ó¿Ï˘Û˘. ∆Ô ÌÈÎÚÔÛÎfiÈÔ ·˘Ùfi Â›Ó·È ÈηÓfi Ó· ·ÂÈÎÔÓ›ÛÂÈ ÌÂÁ¿ÏÔ ·ÚÈıÌfi Ê·ÛÌ·ÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ·ÔÚÚfiÊËÛ˘ Û οı ¤Ó· ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜ Û ̛· ¢Ú›· Ê·ÛÌ·ÙÈ΋ ÂÚÈÔ¯‹, Ë ÔÔ›· ÂÎÙ›ÓÂÙ·È ·fi Ù· 400 nm ÛÙ· 1000 nm. ªÂ ÛÎÔfi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂÎÙ›ÌËÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 O§§, ÌÂÏÂÙ‹ıËÎ·Ó Ì ʷÛÌ·ÙÈ΋ ·Ó¿Ï˘ÛË ÂȯڛÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ 30 ·È‰ÈÒÓ ËÏÈΛ·˜ 2-14 ÂÙÒÓ (12 ·È‰ÈÒÓ Ì O§§ Î·È 18 ·È‰ÈÒÓ Ì ÌË Î·ÎÔ‹ıË ÓÔÛ‹Ì·Ù·, ÛÙ· ÔÔ›· ¤ÁÈÓÂ Ì˘ÂÏfiÁÚ·ÌÌ· ÛÙÔ Ï·›ÛÈÔ ‰ÈÂÚ‡ÓËÛ˘ ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ÂÌ‡ÚÂÙÔ˘ ‹ ·Ó·ÈÌ›·˜ ‹ ıÚÔÌ‚ÔÂÓ›·˜ ‹ Ô˘‰ÂÙÂÚÔÂÓ›·˜), ÌÂÙ¿ ·fi ¯ÚÒÛË Ì May-Grunwald-Giemsa (MGG) ¯ÚˆÛÙÈ΋.

* µ’ ÈڤÌÂÈÔ Œ·ıÏÔ 40fi ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ, 2002 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ 2 πÓÛÙÈÙÔ‡ÙÔ ∏ÏÂÎÙÚÔÓÈ΋˜ ¢ÔÌ‹˜ Î·È Laser, ÿ‰Ú˘Ì· ∆¯ÓÔÏÔÁ›·˜ Î·È ŒÚ¢ӷ˜ (π.∆.∂.), ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ∫·ÏÌ·ÓÙ‹ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜ ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ ∆.∫. 711 10, ∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË ∂-mail: pedhem@med.uoc.gr

∞ÔÙÂϤÛÌ·Ù·: ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ÏÂÌÊÔ‚Ï¿ÛÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ (p<0,00005) Û ۯ¤ÛË Ì ٷ Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· ÛÙËÓ ·Ó›¯Ó¢ÛË, Ù·˘ÙÔÔ›ËÛË Î·È ¯·ÚÙÔÁÚ¿ÊËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ˘ ÛÙ· ‰È¿ÊÔÚ· Ì‹ÎË Î‡Ì·ÙÔ˜. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, Ë Ì¤ÁÈÛÙË Ê·ÛÌ·ÙÈ΋ ·ÔÚÚfiÊËÛË ÁÈ· Ù· Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· ·Ú·ÙËÚ‹ıËΠÛÙ· 535 nm Î·È Ë ·ÓÙ›ÛÙÔÈ¯Ë ·ÔÚÚfiÊËÛË ÁÈ· ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙ˜ ·Ú·ÙËÚ‹ıËΠÛÙ· 545 nm. ∏ ̤ÁÈÛÙË ‰Â ÌÂٷ͇ ÙÔ˘˜ ‰È·ÊÔÚÔÔ›ËÛË Î·Ù·ÁÚ¿ÊËΠÛÙ· 630 nm. ™˘ÌÂÚ¿ÛÌ·Ù·: ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ·Ó¤‰ÂÈÍ·Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ Ê·ÛÌ·ÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ ÁÈ· ·ÚÔ¯‹ ÏËÚÔÊÔÚÈÒÓ Ô˘ ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜ Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ Î·È ÔÈ Ôԛ˜ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‚ÈÔ¯ËÌÈ΋, ÏÂÈÙÔ˘ÚÁÈ΋ Î·È ‰ÔÌÈ΋ ηٿÛÙ·ÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ‰Â‰Ô̤ÓÔ Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ì›·˜ ·ÎfiÌË ÌÂıfi‰Ô˘ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË Î·È Ù·ÍÈÓfiÌËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙËÓ ÔÍ›· Ï¢¯·ÈÌ›·.

§¤ÍÂȘ ÎÏÂȉȿ º·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË, ÔÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›·, ·È‰È΋ ËÏÈΛ·.

™˘ÓÙÔÌÔÁڷʛ˜ O§§ OÍ›· ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Ï¢¯·ÈÌ›· MGG May-Grunwald-Giemsa

∂ÈÛ·ÁˆÁ‹ ∏ ÔÍ›· Ï¢¯·ÈÌ›· ·ÔÙÂÏ› ÙÔ 35-40% ÙˆÓ Î·ÎÔËıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ÷ڷÎÙËÚ›˙Â-

Ù·È ·fi ÙËÓ ÂÈÎÚ¿ÙËÛË ¿ˆÚˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ‹ ÚÔ‰ÚÔÌÈÎÒÓ ÌÔÚÊÒÓ Ù˘ ÏÂÌÊÈ΋˜ ÛÂÈÚ¿˜. ∆·ÍÈÓÔÌÂ›Ù·È ÌÔÚÊÔÏÔÁÈο, ·Ó¿ÏÔÁ· Ì ÙËÓ ÚԤϢÛË ÙÔ˘ ·ıÔÏÔÁÈÎÔ‡ ÎÏÒÓÔ˘, Û ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Î·È Ì˘ÂÏÔÁÂÓ‹, ·ÓÙ›ÛÙÔȯ·. ™ÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÚ›Ô˘ ÙÔ 80% Ù˘ ÔÍ›·˜ Ï¢¯·ÈÌ›·˜ Â›Ó·È ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Î·È ÙÔ 15% Ì˘ÂÏÔÁÂÓ‹˜, ÂÓÒ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÂÚÈÙÒÛÂˆÓ Ù·ÍÈÓÔÌÂ›Ù·È ˆ˜ ·‰È·ÊÔÚÔÔ›ËÙË. ¶·È‰È·ÙÚÈ΋ 2005;68:103-110

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·104

104

¡. ∫·Ù˙ËÏ¿Î˘ Î·È Û˘Ó.

∆· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÔÍ›·˜ Ï¢¯·ÈÌ›·˜ Â›Ó·È ·˘Ù¿ ÙˆÓ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ, ‰ËÏ·‰‹ Û¯ÂÙÈο ·‰È·ÊÔÚÔÔ›ËÙÔ Î‡ÙÙ·ÚÔ Ì ‰È¿¯˘ÙË Î·Ù·ÓÔÌ‹ ˘ÚËÓÈ΋˜ ¯ÚˆÌ·Ù›Ó˘ Ì ¤Ó· ‹ ÂÚÈÛÛfiÙÂÚ· ˘Ú‹ÓÈ· Î·È ‚·ÛÂfiÊÈÏÔ Î˘ÙÙ·ÚfiÏ·ÛÌ·. ∏ ÔÍ›· Ï¢¯·ÈÌ›· Ù·ÍÈÓÔÌÂ›Ù·È - ÂÎÙfi˜ ·fi Ù· ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο - Î·È Ì ΢ÙÙ·ÚÔ¯ËÌÈο, ΢ÙÙ·ÚÔÁÂÓÂÙÈο Î·È ÌÔÚȷο ‰Â‰Ô̤ӷ, ηıÒ˜ Î·È Ì ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ·Ó¿Ï˘ÛË (1). ™˘ÁÎÂÎÚÈ̤ӷ ÎÚÈÙ‹ÚÈ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÔÓ ‰È·¯ˆÚÈÛÌfi ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ ·fi ÙÔ˘˜ Ì˘ÂÏÔ‚Ï¿ÛÙ˜, ÂÓÒ Î·È Ë ÏÂÌÊÔ‚Ï·ÛÙÈ΋ Î·È Ë Ì˘ÂÏÔÁÂÓ‹˜ Ï¢¯·ÈÌ›· Ù·ÍÈÓÔÌÔ‡ÓÙ·È ÂÚ·ÈÙ¤Úˆ Û ˘ÔÔÌ¿‰Â˜ Û‡Ìʈӷ Ì ÙË French-AmericanBritish (FAB) Ù·ÍÈÓfiÌËÛË. ∂ȉÈÎfiÙÂÚ·, Ë O§§ ‰È·ÎÚ›ÓÂÙ·È ÌÔÚÊÔÏÔÁÈο Û 3 ˘ÔÔÌ¿‰Â˜ (L1, L2, L3). ∞fi ·˘Ù¤˜, Ë L1 Â›Ó·È Ë Û˘¯ÓfiÙÂÚË, Û ÔÛÔÛÙfi 85% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (2). ªÔÚÊÔÏÔÁÈο, ÔÈ L1 ÏÂÌÊÔ‚Ï¿ÛÙ˜ Â›Ó·È ÌÈÎÚ¿ ·ÙÙ·Ú· Ì ÔÌÔÈÔÁÂÓ‹ ¯ÚˆÌ·Ù›ÓË ÙÔ˘ ˘Ú‹Ó· ¯ˆÚ›˜ ÔÚ·Ù¿ ‹ ÌfiÏȘ ˘ÔÛËÌ·ÈÓfiÌÂÓ· ˘Ú‹ÓÈ·, ÔÌÔÈfiÌÔÚÊÔ Û¯‹Ì·, ÂÏ¿¯ÈÛÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ·, ‹È· ‹ ̤ÙÚÈ· ‚·ÛÂfiÊÈÏÔ. ∏ ÚÔÛ¿ıÂÈ· Ó· Û˘ÌÂÚÈÏËÊı› Ë ÌÔÚÊÔÏÔÁÈ΋ Ù·ÍÈÓfiÌËÛË ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÛÙË ıÂÚ·¢ÙÈ΋ ÛÙÚ·ÙËÁÈ΋ ‰ÂÓ ¤¯ÂÈ ·Ô‰ÒÛÂÈ ÏfiÁˆ Ù˘ ÂÚÈÔÚÈṲ̂Ó˘ ÂÙÂÚÔÁ¤ÓÂÈ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÛÙÔ ·Ïfi ÌÈÎÚÔÛÎfiÈÔ, ÙˆÓ ˘ÔÎÂÈÌÂÓÈÎÒÓ ‰È·ÊÔÚÒÓ ÌÂٷ͇ ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ˘ÔÙ‡ˆÓ Î·È Ù˘ ÊÙˆ¯‹˜ Û˘Û¯¤ÙÈÛ˘ ÙˆÓ ˘ÔÙ‡ˆÓ Ì ÙËÓ ÎÏÈÓÈ΋ ¤Î‚·ÛË. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ë Û‡Á¯ÚÔÓË ‰È·ÁÓˆÛÙÈ΋ Ù˘ O§§ ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔÓ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô Î·È ÙÔÓ ÁÔÓfiÙ˘Ô ÙˆÓ Î˘ÙÙ¿ÚˆÓ (3). ∏ ·ÎÚ›‚ÂÈ· Î·È Ë ¯ÚËÛÈÌfiÙËÙ· ÙÔ˘ ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˘ ÛÙË ‰È¿ÁÓˆÛË Ù˘ O§§ ¤¯ÂÈ ·ÚÔ˘ÛÈ¿ÛÂÈ ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô Ì ÙË ‰È¿ıÂÛË ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÌÔÓÔÎψÓÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ Ï¢ÎÔ΢ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ, ÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ ·ÓÙȉڷÛÙËÚ›ˆÓ ÊıÔÚÈÛÌÔ‡ ÁÈ· ÙË Û‹Ì·ÓÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÙÔÓ Û¯Â‰È·ÛÌfi ΢ÙÙ·ÚÔÌÂÙÚ›·˜ ÚÔ‹˜. ∞Ó Î·È Â›Ó·È ‰È·ı¤ÛÈÌ· ÌÔÓÔÎψÓÈο ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÌÔÚ›ˆÓ ‰È·ÊÔÚÔÔ›ËÛ˘ ÙˆÓ ·ÓıÚÒÈÓˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ, Ï›Á· ÌfiÓÔ ·fi ·˘Ù¿ ¤¯Ô˘Ó ÂȉÈÎfiÙËÙ· ÁÈ· Û˘ÁÎÂÎÚÈ̤Ó˜ ÛÂÈÚ¤˜, ÁÂÁÔÓfi˜ Ô˘ ‰ËÌÈÔ˘ÚÁ› ·Ó·ÁηÈfiÙËÙ· ÂÈÏÔÁ‹˜ Ì›·˜ ÛÂÈÚ¿˜ ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ‰È¿ÁÓˆÛ˘ Î·È ÙË ‰È¿ÎÚÈÛË ÙˆÓ ·ÓÔÛÔÏÔÁÈÎÒÓ ˘ÔÔÌ¿‰ˆÓ. ¶·Ú¿ ÙÔ fiÙÈ Ë ·ÓÔÛÔÊ·ÈÓÔÙ˘È΋ ÌÂϤÙË ÙˆÓ Ï¢¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ ÛÙË ‰È¿ÁÓˆÛË Î·È Ù·ÍÈÓfiÌËÛË Ù˘ O§§ Û ˘ÔÔÌ¿‰Â˜, ÌÔÚÊÔÏÔÁÈο Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ Ë ‰È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·fi ÏÂÌÊÔ‚Ï¿ÛÙ˜ L1 Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È È‰È·›ÙÂÚ· ‰˘Û¯ÂÚ‹˜. ªÂ ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÌÔÚÊÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ¯ÚËÛÈÌÔÔÈÔ‡¶·È‰È·ÙÚÈ΋ 2005;68:103-110

ÓÙ·È Ì¤ıÔ‰ÔÈ Ê·ÛÌ·ÙÈ΋˜ ·Ó¿Ï˘Û˘ ̤ۈ Û‡Á¯ÚÔÓˆÓ Û˘ÛÙËÌ¿ÙˆÓ ·Ó¿Ï˘Û˘ ÂÈÎfiÓ·˜ ÌÂÙ¿ ·fi Â›ÛÙÚˆÛË Î·È ¯ÚÒÛË, fiˆ˜ ·˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÌÂϤÙË ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ. ∏ ¯ÚÒÛË ÙˆÓ ·Ú·Û΢·ÛÌ¿ÙˆÓ Ì ÂȉÈΤ˜ ¯ÚˆÛÙÈΤ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û˘ÁÎÂÎÚÈ̤ӷ Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘, Ù· ÔÔ›· ÂÚȤ¯Ô˘Ó ·Ó·Ï˘ÙÈ΋ ÏËÚÔÊÔÚ›· ÁÈ· ÙË ‚ÈÔ¯ËÌÈ΋ ηٿÛÙ·ÛË Ù˘ ‰ÔÌ‹˜ ÌÂÙ¿ ÙË ¯ÚÒÛË. °È· Ó· ηٷÁÚ·ÊÔ‡Ó Î·È Ó· ÌÂÏÂÙËıÔ‡Ó ÔÛÔÙÈο Î·È Û˘ÁÎÚÈÙÈο Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ ÌÂÙ¿ ÙË ¯ÚÒÛË, ··ÈÙÔ‡ÓÙ·È Ù¯ÓÈΤ˜ Ê·ÛÌ·ÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘, ÔÈ Ôԛ˜ ı· ÌÔÚÔ‡Ó Ó· ·Ú¤¯Ô˘Ó Ê·ÛÌ·ÙÈ΋ ÏËÚÔÊÔÚ›· ˘„ËÏ‹˜ ·Ó¿Ï˘Û˘ ÁÈ· οı ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ, Ì ‰˘Ó·ÙfiÙËÙ· Ï‹„˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ Î·È ·ÚÔ¯‹˜ Ê¿ÛÌ·ÙÔ˜ ˘„ËÏ‹˜ ·Ó¿Ï˘Û˘ ÁÈ· οı ¤Ó· ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜. ∆Ô Û‡ÛÙËÌ· Â›Ó·È ÈηÓfi Ó· ·Ó·‰Â›ÍÂÈ ÙȘ ÌÈÎÚ¤˜ Ê·ÛÌ·ÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ΢ÙÙ·ÚÈÎÒÓ ‰ÔÌÒÓ ÌÂÙ¿ ·fi ¯ÚÒÛË, ÔÈ Ôԛ˜ ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜ Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ Î·È Ì ÙËÓ Î·Ù¿ÏÏËÏË ÂÈÏÔÁ‹ Ê·ÛÌ·ÙÈÎÒÓ ÂÚÈÔ¯ÒÓ Ó· ηٷÁÚ¿ÊÂÙ·È Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚ¿ ÛÙ· Ê·ÛÌ·ÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·˘ÙÒÓ ÙˆÓ ‰ÔÌÒÓ. ∆Ô ·Ú·¿Óˆ Û‡ÛÙËÌ· ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ·ÈÌÔÔÈËÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË Ì MGG Î·È ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 ÛÙËÓ O§§.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ º·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ º·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ¤ÁÈÓ Ì ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ, ÙÔ ÔÔ›Ô ‚·Û›˙ÂÙ·È Û ¤Ó· Û‡ÛÙËÌ· ʈÙÈÛÌÔ‡ Ì ÌÂÙ·‚ÏËÙfi Ê›ÏÙÚÔ Ô˘ ÙÔÔıÂÙÂ›Ù·È ÛÙË ‰È·‰ÚÔÌ‹ ʈÙÈÛÌÔ‡ ÙÔ˘ ÌÈÎÚÔÛÎÔ›Ô˘. ∆Ô ÌÂÙ·‚ÏËÙfi Ê›ÏÙÚÔ ‰È·‰›‰ÂÈ Êˆ˜ ÛÙËÓ ÂÚÈÔ¯‹ 400 nm-1000 nm. ª›· Â͈ÙÂÚÈ΋ Ï¿Ì· ·ÏÔÁfiÓÔ˘ ÈÛ¯‡Ô˜ 150 W ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙÔÓ ÊˆÙÈÛÌfi. ¢‡Ô fiÌÔȘ Û˘ÛÙÔȯ›Â˜ ÔÙÈÎÒÓ ÈÓÒÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· Ó· ÌÂٷʤÚÔ˘Ó ÙÔ Êˆ˜ ·fi ÙËÓ ËÁ‹ ÛÙÔ Ê›ÏÙÚÔ Î·È ·fi ÙÔ Ê›ÏÙÚÔ ÛÙË ‰È·‰ÚÔÌ‹ ʈÙÈÛÌÔ‡ ÙÔ˘ ÌÈÎÚÔÛÎÔ›Ô˘. ∏ Ï‹„Ë ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ Á›ÓÂÙ·È Ì ÙË ‚Ô‹ıÂÈ· Ì›·˜ 8-bit ·ÛÚfiÌ·˘Ú˘ οÌÂÚ·˜ ˘„ËÏ‹˜ ·Ó¿Ï˘Û˘, Ë Â˘·ÈÛıËÛ›· Î·È Ë ÂÓ›Û¯˘ÛË Ù˘ ÔÔ›·˜ ÂϤÁ¯ÔÓÙ·È ·fi ÙÔÓ ˘ÔÏÔÁÈÛÙ‹ (∂ÈÎfiÓ· 1). ∆Ô Û‡ÛÙËÌ· ÏÂÈÙÔ˘ÚÁ› Û ‰‡Ô Ê¿ÛÂȘ (Ê·ÛÌ·ÙÔÛÎÔ›· Î·È Ê·ÛÌ·ÙÔÌÂÙÚ›·). ∏ ÚÒÙË ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ÂÈÏÔÁ‹˜ ÙÔ˘ Ì‹ÎÔ˘˜ ·̷ÙÔ˜ ·ÂÈÎfiÓÈÛ˘ Î·È Ù˘ ·Ó¿‰ÂÈ͢ Ù˘ ÂÈı˘ÌËÙ‹˜ Ê·ÛÌ·ÙÈ΋˜ ÂÈÎfiÓ·˜, ÂÓÒ Ë ‰Â‡ÙÂÚË Î¿ÓÂÈ Û˘ÓÙÔÓÈṲ̂ÓË Ê·ÛÌ·ÙÈ΋ Û¿ÚˆÛË, Ï‹„Ë ÂÈÎfiÓˆÓ Î·È ÙÂÏÈÎfi ˘ÔÏÔÁÈÛÌfi ÂÓfi˜ Ï‹ÚÔ˘˜ Ê¿ÛÌ·ÙÔ˜ ·ÔÚÚfiÊËÛ˘ Û οı ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜. ™ÙË Ê¿ÛË Ê·ÛÌ·ÙÔÌÂÙÚ›·˜, ÙÔ Û‡ÛÙËÌ· ÂÎÙÂÏ› Û˘Á¯ÚÔÓÈṲ̂ÓË Ú‡ıÌÈÛË Ì‹ÎÔ˘˜ ·̷ÙÔ˜ Ì ϋ„Ë Î·È ·Ôı‹Î¢ÛË Ù˘ ˘fi ·Ó¿Ï˘ÛË ÂÚÈÔ¯‹˜. ∞fi ÙÔ ·ÔıËÎÂ˘Ì¤ÓÔ Û‡ÓÔÏÔ ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·105

105

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∂ÈÎfiÓ· 1. ™‡ÛÙËÌ· Ê·ÛÌ·ÙÈÎÔ‡ ÌÈÎÚÔÛÎÔ›Ô˘.

ÂÈÎfiÓˆÓ (Ê·ÛÌ·ÙÔÛÎÔ›·) ¤Ó· Ê¿ÛÌ· ·ÔÚÚfiÊËÛ˘ (Ê·ÛÌ·ÙÔÌÂÙÚ›·) ÌÔÚ› Ó· ˘ÔÏÔÁÈÛÙ› Î·È Ó· ÂȉÂȯÙ› ÁÈ· οı ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜. ªÂ ÙËÓ ÂÚÈÁÚ·ÊfiÌÂÓË ‰È¿Ù·ÍË Â›Ó·È ‰˘Ó·Ùfi Ó· ÏËÊıÔ‡Ó Î·È Ó· ˘ÔÛÙÔ‡Ó ÂÂÍÂÚÁ·Û›· ¤Ó· ÂηÙÔÌ̇ÚÈÔ Ê¿ÛÌ·Ù· Û ÂÚ›Ô˘ ¤Ó· ÏÂÙfi (4-7).

¶ÔÛÔÙÈ΋ ÂÎÙ›ÌËÛË Ê·ÛÌ·ÙÈÎÒÓ ‰È·ÊÔÚÒÓ ∆Ô Û‡ÛÙËÌ· οÓÂÈ ·˘ÙfiÌ·ÙË Ê·ÛÌ·ÙÈ΋ Û¿ÚˆÛË ÙÔ˘ ˘fi ÂͤٷÛË ·Ú·Û΢¿ÛÌ·ÙÔ˜ Î·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÛÙËÓ ÂÚÈÔ¯‹ 400 nm-1000 nm ÌÂÙÚÔ‡ÓÙ·È ÁÈ· οı ¤Ó· ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜. ∂›Û˘, Ê·ÛÌ·ÙÈΤ˜ ÂÈÎfiÓ˜ ÌÔÚÔ‡Ó Ó· ‰ÂȯÙÔ‡Ó Û οı ̋ÎÔ˜ ·̷ÙÔ˜. ªÂ ‚¿ÛË Ù· Ê¿ÛÌ·Ù· Ô˘ ÌÂÙÚÔ‡ÓÙ·È, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ηıÔÚ›ÛÂÈ ÙȘ ·ÂÈÎÔÓÈÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙË Ì¤ÁÈÛÙË ·ÔÚÚfiÊËÛË ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ‰ÔÌÒÓ Ô˘ ÙÔÓ ÂӉȷʤÚÔ˘Ó Î·È ÛÙË Ì¤ÁÈÛÙË ·ÓÙ›ıÂÛË ÌÂٷ͇ ΢ÙÙ·ÚÈÎÒÓ ‰ÔÌÒÓ Ì ‰È·ÊÔÚÂÙÈ΋ ‚ÈÔ¯ËÌÈ΋ Û‡ÓıÂÛË. ∞ÊÔ‡ ηıÔÚÈÛÙÔ‡Ó ÔÈ Ê·ÛÌ·ÙÈΤ˜ ÂÚÈÔ¯¤˜ (400 nm1000 nm), ÔÈ Ê·ÛÌ·ÙÈΤ˜ ÂÈÎfiÓ˜ Û ·˘Ù¤˜ ÙȘ ÂÚÈÔ¯¤˜ ·Ó·Î·ÏÔ‡ÓÙ·È ·fi ÙÔ ·ÔıËÎÂ˘Ì¤ÓÔ Û‡ÓÔÏÔ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ Î·È Ë Ê·ÛÌ·ÙÈ΋ ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛ˘ Ar(x,y) ‹ ÈÛÔ‰‡Ó·Ì· Ô ÏÔÁ¿ÚÈıÌÔ˜ ÙÔ˘ ÏfiÁÔ˘ ÙˆÓ ÂÓÙ¿ÛÂÒÓ ÙÔ˘˜, ˘ÔÏÔÁ›˙ÂÙ·È Ì ‚¿ÛË ÙËÓ ·ÎfiÏÔ˘ıË Â͛ۈÛË: Ar(x,y) = AÏi(x,y) - AÏj(x,y) = log IÏi(x,y) (1), IÏj(x,y) fiÔ˘ ∞Ïi(x,y), ∞Ïj(x,y) Î·È IÏi(x,y), IÏj(x,y) Â›Ó·È ÔÈ Î·Ù·ÓÔ̤˜ ·ÔÚÚfiÊËÛ˘ Î·È ¤ÓÙ·Û˘ ·ÓÙ›ÛÙÔȯ·, ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ Ô˘ ¤¯Ô˘Ó ÌÂÙÚËı› ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜ Ïi Î·È Ïj, ·ÓÙ›ÛÙÔȯ· (8-12).

∂ȯڛÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (¯ÚÒÛË MayGrunwald-Giemsa, MGG) ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂȯڛÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi 30 ·È‰È¿ ËÏÈΛ·˜ 2-14 ÂÙÒÓ (12 ·È‰È¿ Ì O§§ ÛÙËÓ ÚˆÙԉȿÁÓˆÛË Î·È 18 ·È‰È¿ ÛÙ· ÔÔ›· ÙÔ Ì˘ÂÏfiÁÚ·ÌÌ· ›¯Â Á›ÓÂÈ ÁÈ· ‰ÈÂÚ‡ÓËÛË ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ÂÌ‡ÚÂÙÔ˘ ‹ ·Ó·ÈÌ›·˜ ‹ ıÚÔÌ‚ÔÂÓ›·˜ ‹ Ô˘‰ÂÙÂÚÔÂÓ›·˜). ∏ ¯ÚÒÛË MGG ÙˆÓ ÂȯÚÈÛÌ¿ÙˆÓ ¤ÁÈÓ Û ·ÈÌ·ÙÔÏÔÁÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ Ì ÙÔ Û‡ÓËı˜ ÚˆÙfiÎÔÏÏÔ. ∏ ¯ÚˆÛÙÈ΋ May-Grunwald ·ÔÙÂÏÂ›Ù·È ·fi ΢·ÓÔ‡Ó

ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (methylene blue - MB) Î·È ËˆÛ›ÓË À (eosin Y - EY) ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘ÁÎÂÓÙÚÒÛÂȘ. ∏ ¯ÚˆÛÙÈ΋ Giemsa ·ÔÙÂÏÂ›Ù·È ·fi Ù· ›‰È· Û˘ÛÙ·ÙÈο Ì ÙÔ ÚÒÙÔ Î·È ÂÈϤÔÓ ÔÍÂȉˆÙÈο ·Ú¿ÁˆÁ· ÙÔ˘ ΢·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (MB azures), fiˆ˜ ÙÔ Î˘·ÓÔ‡Ó Ù˘ ·ÓÈÏ›Ó˘ (azure B). ∆Ô ÂÚȯfiÌÂÓÔ Ù˘ Giemsa Û ÔÍÂȉˆÙÈο ·Ú¿ÁˆÁ· ÙÔ˘ ΢·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ ηıÔÚ›˙ÂÈ Ù· ·ÎÚÈ‚‹ Ê·ÛÌ·ÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ·ÔÚÚfiÊËÛ‹˜ Ù˘ (13).

OÈ ¯ÚˆÛÙÈΤ˜ ·fi ÙË MGG ÚÔÛÎÔÏÏÒÓÙ·È ÛÙȘ ΢ÙÙ·ÚÈΤ˜ ‰Ô̤˜ Ì ËÏÂÎÙÚÔÛÙ·ÙÈΤ˜ Î·È ˘‰ÚÔÊÔ‚ÈΤ˜ ·ÓÙȉڿÛÂȘ Î·È ÙÔ ÔÛfi Ù˘ ÚÔÛÏ·Ì‚·ÓfiÌÂÓ˘ ¯ÚˆÛÙÈ΋˜ ηıÔÚ›˙ÂÙ·È ·fi Ù· ‚ÈÔ¯ËÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Î˘ÙÙ¿ÚˆÓ (14,15). µ¿ÛÂÈ ÙˆÓ ·ÓˆÙ¤Úˆ, Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ΢ÙÙ·ÚÈÎÒÓ ‰ÔÌÒÓ Ì ÙËÓ ·Ú·¿Óˆ ¯ÚÒÛË ÂÍ·ÚÙÒÓÙ·È ·fi Ù· ‚ÈÔ¯ËÌÈο Û˘ÛÙ·ÙÈο ÙÔ˘˜. ∏ ÂÎÙ›ÌËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ˘ ‰›ÓÂÈ ÛËÌ·ÓÙÈ΋ ÏËÚÔÊÔÚ›· ÁÈ· ÙË ‚ÈÔ¯ËÌÈ΋ Î·È ‰ÔÌÈ΋ ηٿÛÙ·Û‹ ÙÔ˘˜ Ô˘ ‰ÂÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰È·ÎÚÈı› Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ, Ì ·ÔÙ¤ÏÂÛÌ· Ë Ì¤ıÔ‰Ô˜ ·˘Ù‹ Ó· ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ·Ú¿ÌÂÙÚÔ ÁÈ· ÙËÓ Ù˘ÔÔ›ËÛË Î·È Ù·ÍÈÓfiÌËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

∞ÔÙÂϤÛÌ·Ù· º·ÛÌ·ÙÈ΋ ·Ó¿Ï˘ÛË ÌÂÙ¿ ·fi ¯ÚÒÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ì MGG ∞Ú¯Èο ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ Ù˘ MGG ¯ÚˆÛÙÈ΋˜ Î·È ‰È·ÊfiÚˆÓ Î˘ÙÙ¿ÚˆÓ ·fi ÂȯڛÛÌ·Ù· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·È‰ÈÒÓ ¯ˆÚ›˜ ηÎÔ‹ıÂÈ·. ŒÓ· Ï‹Ú˜ Ê¿ÛÌ· ·ÔÚÚfiÊËÛ˘ ÁÈ· οı ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË ˘ÔÏÔÁ›ÛÙËΠ̠ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ. ™ÙËÓ ∂ÈÎfiÓ· 2 Ê·›ÓÂÙ·È ÙÔ Ê¿ÛÌ· ·ÔÚÚfiÊËÛ˘ ÙˆÓ May-Grunwald Î·È Giemsa ¯ÚˆÛÙÈÎÒÓ. ™ÙË ¯ÚÒÛË May-Grunwald, Ë ËˆÛ›ÓË À (∂À) ·ÔÚÚÔÊ¿ ÛÙ· 515 nm, ÂÓÒ ÛÙË Giemsa ÛÙ· 518 nm. ∆Ô Î˘·ÓÔ‡Ó ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (ªµ) ·ÔÚÚÔÊ¿ ¶·È‰È·ÙÚÈ΋ 2005;68:103-110

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ª‹ÎÔ˜ ·̷ÙÔ˜ (nm) ∂ÈÎfiÓ· 2. ∆· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ May-Grunwald Î·È Giemsa.

ÛÙËÓ MG ÛÙ· 660 nm, ÂÓÒ ÛÙË Giemsa Ù· ÔÍÂȉˆÙÈο ·Ú¿ÁˆÁ· ÙÔ˘ ΢·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (ªµ azure) ÛÙ· 558 nm Î·È 625 nm. ∏ ∂ÈÎfiÓ· 3 ‰Â›¯ÓÂÈ ¤Ó· ‰›Ô ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ·Ú·Û΢¿ÛÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ·fi ·È‰› ¯ˆÚ›˜ ηÎÔ‹ıÂÈ· ÌÂÙ¿ ·fi ¯ÚÒÛË Ì MGG. ∆Ô ‰›Ô ÂÚȤ¯ÂÈ ÏÂÌÊÔ·ÙÙ·ÚÔ, ÂÚ˘ıÚÔ‚Ï¿ÛÙË, ÌÔÓÔ·ÙÙ·ÚÔ, ˈÛÈÓfiÊÈÏÔ, ÔÏ˘ÌÔÚÊÔ‡ÚËÓÔ, ÂÚ˘ıÚo·ÙÙ·ÚÔ. ∏ ÔÛÔÙÈ΋ ̤ÙÚËÛË ÙÔ˘ ¯ÚˆÌ·ÙÈÛÌÔ‡ ·Ó·‰ÂÈÎÓ‡ÂÙ·È ·fi ÙÔ Ê¿ÛÌ· ·ÔÚÚfiÊËÛ˘ Ô˘ ÔÚ›˙ÂÙ·È ÁÈ· ÙÔ Î¿ı ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜. ™ÙËÓ ∂ÈÎfiÓ· 4 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÙÔ˘ ˘Ú‹Ó· Î·È ÙÔ˘ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ù˘ ∂ÈÎfiÓ·˜ 3. ∆· Ê¿ÛÌ·Ù· ‰ÂÓ ¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ ·ÔÚÚfiÊËÛË ÌÂÙ¿ Ù· 800 nm. ∏ Û‡ÁÎÚÈÛË ÙˆÓ Ê·ÛÌ¿ÙˆÓ ·ÔÚÚfi-

∂ÈÎfiÓ· 3. ¶Â‰›Ô Ê˘ÛÈÔÏÔÁÈÎÔ‡ ·ÈÌ·ÙÔÏÔÁÈÎÔ‡ ·Ú·Û΢¿ÛÌ·ÙÔ˜ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ. ¶·È‰È·ÙÚÈ΋ 2005;68:103-110

ÊËÛ˘ Ù˘ MG Î·È Giemsa Ì ٷ Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·Ó¤‰ÂÈÍ ÙȘ ·ÏÏ·Á¤˜ ÙˆÓ È‰ÈÔÙ‹ÙˆÓ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ fiÙ·Ó Û˘Ó‰¤ÔÓÙ·È Ì ٷ Û˘ÛÙ·ÙÈο ÙˆÓ Î˘ÙÙ¿ÚˆÓ. OÈ ‰È·ÎÚÈÙ¤˜ ÎÔÚ˘Ê¤˜ (pick) ÙˆÓ Î·Ì˘ÏÒÓ ÙˆÓ Ê·ÛÌ¿ÙˆÓ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ‰È·Ï˘Ì¿ÙˆÓ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ ÌÂÙ·Û¯ËÌ·Ù›ÛÙËÎ·Ó Û ̛· ÌÔÓ·‰È΋ ÎÔÚ˘Ê‹ ¢Ú›·˜ ÂÚÈÔ¯‹˜ ÌÂٷ͇ 530-570 nm fiÙ·Ó ·˘Ù¤˜ ¤¯Ô˘Ó ·ÓÙȉڿÛÂÈ Ì ٷ ·ÙÙ·Ú· (∂ÈÎfiÓ˜ 2 Î·È 4). ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· Ì‹ÎË Î‡Ì·ÙÔ˜ ̤ÁÈÛÙ˘ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ ˘Ú‹Ó· Î·È Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ÁÈ· οı ·ÙÙ·ÚÔ. ™Ù· ÂÚ˘ıÚo·ÙÙ·Ú·, Ë ·ÈÌÔÛÊ·ÈÚ›ÓË ·ÔÚÚÔÊ¿ ÛÙ· 420 nm, Ë ËˆÛ›ÓË À ÛÙ· 530 nm Î·È Ù· ÔÍÂȉˆÙÈο ·Ú¿ÁˆÁ· ÙÔ˘ ΢·ÓÔ‡ ÙÔ˘ ÌÂı˘ÏÂÓ›Ô˘ (ªµ azures) ÛÙ· 630 nm. ∞fi Ù· ·Ú·¿Óˆ ‰È·ÈÛÙÒıËΠfiÙÈ ÏfiÁˆ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Ù‡ˆÓ ΢ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË, Â›Ó·È ‰È·ÊÔÚÂÙÈο Î·È Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ‹˜ ÙÔ˘˜. ¢È·ÊÔÚ¤˜ ÛÙ· ‚ÈÔ¯ËÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ˘¿Ú¯Ô˘Ó ÙfiÛÔ ÌÂٷ͇ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Ù‡ˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ Î˘ÙÙ¿ÚˆÓ fiÛÔ Î·È ÛÙËÓ ÂÚ›ÙˆÛË ÓÂÔÏ·ÛÌ·ÙÈ΋˜ ÂÍ·ÏÏ·Á‹˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ.

¢È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÌÔÚÊÔÏÔÁ›·˜ L1 Ì ÙË Ê·ÛÌ·ÙÈ΋ ·Ó¿Ï˘ÛË ∏ ̤ıÔ‰Ô˜ Ù˘ Ê·ÛÌ·ÙÈ΋˜ ·Ó¿Ï˘Û˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÙË ‰È¿ÎÚÈÛË Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·fi ÏÂÌÊÔ‚Ï¿ÛÙ˜ ÌÔÚÊÔÏÔÁ›·˜ L1 Û ·Ú·Û΢¿ÛÌ·Ù· Ô˘ ›¯·Ó ÂÈÛÙÚˆı› Î·È ‚·Ê› ÁÈ· ÌÂϤÙË ÛÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ. ∏ ̤ıÔ‰Ô˜ ‚·Û›ÛÙËΠÛÙË Û˘ÁÎÚÈÙÈ΋ ÂÎÙ›ÌËÛË ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ˘

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º·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Û ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÏÂÌÊÔ‚Ï¿ÛÙ˜

107

0,8 §ÂÌÊÔ·ÙÙ·ÚÔ 0,8 ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓÔ 0,8 ªÔÓÔ·ÙÙ·ÚÔ 0,7 0,7 0,7 0,6 0,6 0,6 0,5 0,5 0,5 0,4 0,4 0,4 0,3 0,3 0,3 0,2 0,2 0,2 0,1 0,1 0,1 400 450 500 550 600 650 700 750 800 400 450 500 550 600 650 700 750 800 400 450 500 550 600 650 700 750 800 0,8 ∂Ú˘ıÚÔ‚Ï¿ÛÙË 0,8 ∏ˆÛÈÓfiÊÈÏÔ 0,8 ∂Ú˘ıÚÔ·ÙÙ·ÚÔ 0,7 0,7 0,7 0,6 0,6 0,6 0,5 0,5 0,5 0,4 0,4 0,4 0,3 0,3 0,3 0,2 0,2 0,2 0,1 0,1 0,1 400 450 500 550 600 650 700 750 800 400 450 500 550 600 650 700 750 800 400 450 500 550 600 650 700 750 800 ª‹ÎÔ˜ ·̷ÙÔ˜ (nm)

∂ÈÎfiÓ· 4. ∏ ·ÔÚÚfiÊËÛË ˘Ú‹Ó· Î·È Î˘ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ΢ÙÙ¿ÚˆÓ ÌÂÙ¿ ·fi ¯ÚÒÛË Ì MGG ÁÈ· ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô Ì‹ÎÔ˜ ·̷ÙÔ˜.

ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Û ۯ¤ÛË Ì ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙ˜ Ì ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ. °È· Ó· ηıÔÚÈÛÙÔ‡Ó Ù· Ê·ÛÌ·ÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·Ú·¿Óˆ ‰‡Ô ΢ÙÙ·ÚÈÎÒÓ Ù‡ˆÓ ÌÂÙÚ‹ıËÎ·Ó Ù· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ. ∏ ̤ÛË ÙÈÌ‹ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ ·Ó¿ÏÔÁ· Ì ÙÔ Ì‹ÎÔ˜ ·̷ÙÔ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 5. ∫¿ı ηÌ‡ÏË ·ÔÙ¤ÏÂÛ ÙË Ì¤ÛË ÙÈÌ‹ ·fi Ê¿ÛÌ·Ù· ÛËÌ›ˆÓ Ù˘ ÂÈÎfiÓ·˜ ·fi 150 ÏÂÌÊÔ·ÙÙ·Ú· ·È‰ÈÒÓ ¯ˆÚ›˜ ηÎÔ‹ıÂÈ· Î·È Ê¿ÛÌ·Ù· ·fi 150 ÏÂÌÊÔ‚Ï¿ÛÙ˜ ·È‰ÈÒÓ Ì O§§. ∆· Ê¿ÛÌ·Ù· ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ÂÈηχÙÔ˘Ó ·˘Ù¿ ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ Û fiÏË ÙËÓ ÂÚÈÔ¯‹, ¤¯ÔÓÙ·˜ ÌfiÓÔ ÌÈÎÚ¤˜ Ê·ÛÌ·ÙÈΤ˜ ‰È·ÊÔÚ¤˜. ∏ ̤ÁÈÛÙË ·ÔÚÚfiÊËÛË ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙ· 535 nm Î·È ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ ÛÙ· 545 nm. ∆· ÏÂÌÊÔ·ÙÙ·Ú· ¤¯Ô˘Ó ·˘ÍË̤ÓË Ì¤ÛË ·ÔÚÚfiÊËÛË Û ۯ¤ÛË Ì ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙ˜ Î·È ÛÙ· 630 nm Ë ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙÔ˘˜ ¶›Ó·Î·˜ 1. ª‹ÎË Î‡Ì·ÙÔ˜ (nm) Ì ̤ÁÈÛÙË Ê·ÛÌ·ÙÈ΋ ·ÔÚÚfiÊËÛË ÙÔ˘ ˘Ú‹Ó· Î·È ÙÔ˘ ΢ÙÙ·ÚÔÏ¿ÛÌ·ÙÔ˜ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ΢ÙÙ¿ÚˆÓ ∆‡Ô˜ ΢ÙÙ¿ÚÔ˘

¶˘Ú‹Ó·˜

∫˘ÙÙ·ÚfiÏ·ÛÌ·

§ÂÌÊÔ·ÙÙ·ÚÔ ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓÔ ªÔÓÔ·ÙÙ·ÚÔ ∂Ú˘ıÚÔ‚Ï¿ÛÙË ∏ˆÛÈÓfiÊÈÏÔ ∂Ú˘ıÚÔ·ÙÙ·ÚÔ

535 545 550 545 530, 640 -

570 535 560 570 550 420, 530, 630

¤¯ÂÈ ÙË Ì¤ÁÈÛÙË ÙÈÌ‹. ™Â ·˘Ù‹ ÙË Ê·ÛÌ·ÙÈ΋ ÂÚÈÔ¯‹ ηٷÁÚ¿ÊÂÙ·È Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê·ÛÌ¿ÙˆÓ. ∂ÈϤÔÓ, Ë ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË (standard deviation) Ù˘ ·ÔÚÚfiÊËÛ˘ ·›ÚÓÂÈ ÙËÓ ÂÏ¿¯ÈÛÙË ÙÈÌ‹. ∏ Ê·ÛÌ·ÙÈ΋ ÂÈÎfiÓ· Ù˘ Ï·Ì‚·ÓfiÌÂÓ˘ ‰È·ÊÔÚ¿˜ ÌÂٷ͇ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ O§§ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 6. ™ÙËÓ ÂÈÎfiÓ· ·˘Ù‹ ·ÂÈÎÔÓ›˙ÔÓÙ·È Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· (2∞), O§§ ÏÂÌÊÔ‚Ï¿ÛÙ˜ (2µ) Î·È ¤Ó· ˘ÔÛ‡ÓÔÏÔ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ ÛÙ· 420 nm, 535 nm, 545 nm, 630 nm Î·È 700 nm. ªÂ ‚¿ÛË ÙȘ Ê·ÛÌ·ÙÈΤ˜ ηÌ‡Ï˜ Ù˘ ∂ÈÎfiÓ·˜ 4, ÔÈ ÂÈÎfiÓ˜ ÛÙ· 535 nm Î·È 545 nm ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙË Ì¤ÁÈÛÙË Ê·ÛÌ·ÙÈ΋ ·ÔÚÚfiÊËÛË ÁÈ· ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÏÂÌÊÔ‚Ï¿ÛÙ˜, ·ÓÙ›ÛÙÔȯ·. ™Ù· 630 nm ηٷÁÚ¿ÊÂÙ·È Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙÔ˘˜. ¶·Ú·ÙËÚ‹ıËΠ̛ˆÛË Ù˘ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÏÂÌÊÔ‚Ï·ÛÙÒÓ Û ۯ¤ÛË Ì ÂΛÓË ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ. ™Â ÌÈÎÚfiÙÂÚ· Î·È ÌÂÁ·Ï‡ÙÂÚ· Ì‹ÎË Î‡Ì·ÙÔ˜, Ë ·ÔÚÚfiÊËÛË ÚÔԉ¢ÙÈο ÌÂÈÒÓÂÙ·È. ∞˘Ùfi Â›Ó·È ÂÌÊ·Ó¤˜ ÛÙȘ ÂÈÎfiÓ˜ Ì 420 nm Î·È 700 nm. ∆· ÂÚ˘ıÚÔ·ÙÙ·Ú· ηٷÁÚ¿ÊÔÓÙ·È Ì ̤ÁÈÛÙË ·ÓÙ›ıÂÛË ÛÙ· 420 nm ÂÍ·ÈÙ›·˜ Ù˘ ·˘ÍË̤Ó˘ ·ÔÚÚfiÊËÛ˘ ·fi ÙËÓ ·ÈÌÔÛÊ·ÈÚ›ÓË. °È· Ó· ÂÎÙÈÌËıÔ‡Ó ÔÛÔÙÈο ÔÈ ‰È·ÊÔÚ¤˜ ÙˆÓ ‰‡Ô ΢ÙÙ·ÚÈÎÒÓ ÏËı˘ÛÌÒÓ ÌÂÙÚ‹ıËÎÂ Ë ‰È·ÊÔÚ¿ ÛÙË Ê·ÛÌ·ÙÈ΋ ·ÔÚÚfiÊËÛË (Ar) Ì ‚¿ÛË ÙËÓ Â͛ۈÛË 1 Û 150 ·ÙÙ·Ú· ·fi 18 ·È‰È¿ ¯ˆÚ›˜ ηÎÔ‹ıÂÈ· Î·È Û 150 ·ÙÙ·Ú· ·fi 12 ·È‰È¿ Ì O§§. ∂ÈϤ¯ıËÎÂ Ë ‰È·ÊÔÚ¿ ÛÙËÓ ·ÔÚÚfiÊËÛË ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜ 545 nm Î·È 630 nm. ™ÙËÓ ∂ÈÎfiÓ· 7

¶ · Ê

∆ § ¶ ª ∂ ∏ ∂

¶·È‰È·ÙÚÈ΋ 2005;68:103-110

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·108

108

¡. ∫·Ù˙ËÏ¿Î˘ Î·È Û˘Ó.

Ê·›ÓÂÙ·È ÙÔ ÈÛÙfiÁÚ·ÌÌ· Ù˘ ˘ÔÏÔÁÈ˙fiÌÂÓ˘ ‰È·ÊÔÚ¿˜ ·ÔÚÚfiÊËÛ˘ ÁÈ· ÙÔ˘˜ ‰‡Ô ÏËı˘ÛÌÔ‡˜. ∆Ô ÈÛÙfiÁÚ·ÌÌ· ¤‰ÂÈÍ fiÙÈ Ù· ·ÙÙ·Ú· ‰È·¯ˆÚ›˙ÔÓÙ·È Û 2 Ì›˙ÔÓ˜ ÏËı˘ÛÌÔ‡˜ Ì ‚¿ÛË ÙË Ê·ÛÌ·ÙÈ΋ ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛ˘ ÛÙÔ 545 nm Î·È 630 nm. ∏ ̤ÛË ÙÈÌ‹ ‚Ú¤ıËΠӷ Â›Ó·È 0,149 (SD: 0,064) ÁÈ· Ù· Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· Î·È 0,352 (SD: 0,055) ÁÈ· ÙÔ˘˜ ÏÂÌÊÔ‚Ï¿ÛÙ˜. ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ Ô˘ ·Ú·ÙËÚ‹ıËÎÂ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,00005). ™ÙËÓ ∂ÈÎfiÓ· 8 ‰È·ÎÚ›ÓÔÓÙ·È Ì Ù¯ÓËÙfi ¯ÚˆÌ·ÙÈÛÌfi („¢‰Ô¯ÚˆÌ·ÙÈ΋ ÂÈÎfiÓ·) ÔÈ ‰È·ÊÔÚ¤˜ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (3A) Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ (3µ) ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜ 545 nm Î·È 630 nm, ÔÈ Ôԛ˜ Î˘Ì·›ÓÔÓÙ·È fiˆ˜ Ê·›ÓÂÙ·È Î·È ÛÙËÓ ∂ÈÎfiÓ· 7 Û Îϛ̷η ·fi 0 ¤ˆ˜ 0,5 Ô˘ ÛÙËÓ ¤Á¯ÚˆÌË ÂÈÎfiÓ· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙËÓ ÂÚÈÔ¯‹ ·fi ÙÔ ÌÏ ¤ˆ˜ ÙÔ ÎfiÎÎÈÓÔ. ∆· Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ ¤¯Ô˘Ó ÌÈÎÚ‹ ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛ˘ (̤ÛË ÙÈÌ‹: 0,149) ÏËÛȤÛÙÂÚ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÏÂ, ÂÓÒ ÔÈ ÏÂÌÊÔ‚Ï¿ÛÙ˜ ÌÂÁ·Ï‡ÙÂÚË ‰È·ÊÔÚ¿ ·ÔÚÚfiÊËÛ˘ (̤ÛË ÙÈÌ‹: 0,352) Î·È ÏËÛȤÛÙÂÚ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÎfiÎÎÈÓÔ˘.

™˘˙‹ÙËÛË ∏ ‰ÔÌ‹ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ÂȉÈÎfiÙÂÚ· ÙÔ˘ ˘Ú‹Ó·, Ô˘ÛÈ·ÛÙÈο ·ÓÙ·Ó·ÎÏ¿ ÙË ÌÂÙ·‚ÔÏÈ΋ ηٿÛÙ·ÛË Î·È ÙË Ê˘ÛÈ΋ Û˘Û¯¤ÙÈÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ Û˘ÛÙ·ÙÈÎÒÓ ÙÔ˘. ™ÙËÓ Î·ÎÔ‹ıË ÂÍ·ÏÏ·Á‹ Ï·Ì‚¿ÓÂÈ ¯ÒÚ· Ì›· ÛÂÈÚ¿ ·fi ‰ÔÌÈΤ˜ Î·È ‚ÈÔ¯ËÌÈΤ˜ ÌÂÙ·‚ÔϤ˜ ÛÙÔ DNA, ÛÙÔ RNA, ÛÙȘ ÚˆÙ½Ó˜ Î·È ÛÙ· ·ÓfiÚÁ·Ó· ˘ÏÈο ÙˆÓ Î˘ÙÙ¿ÚˆÓ. ∞˘Ù¤˜ ÔÈ ÌÂÙ·‚ÔϤ˜, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜

ÌÂÙ¿ ·fi ¯ÚÒÛË Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ (16). ªÂ ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ Î·È ÙË Ì¤ıÔ‰Ô Ê·ÛÌ·ÙÈ΋˜ ·Ó¿Ï˘Û˘ Â›Ó·È ÂÊÈÎÙ‹ Ë ‰È¿ÎÚÈÛË ‰È·ÊfiÚˆÓ Ù‡ˆÓ ΢ÙÙ¿ÚˆÓ Ì ‚¿ÛË ÙËÓ ·Ó›¯Ó¢ÛË, Ù·˘ÙÔÔ›ËÛË Î·È ¯·ÚÙÔÁÚ¿ÊËÛË Ù˘ ηٷÓÔÌ‹˜ ÙˆÓ ·ÔÚÚÔÊÔ‡ÌÂÓˆÓ ¯ÚˆÛÙÈÎÒÓ ·fi Ù· ·ÙÙ·Ú·, ηıÒ˜ Î·È ÙˆÓ Ê·ÛÌ·ÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ÔÚÚfiÊËÛ‹˜ ÙÔ˘˜. ∏ ÏËÚÔÊÔÚ›· Ô˘ Ï·Ì‚¿ÓÂÙ·È ‚·Û›˙ÂÙ·È ÛÙË ‚ÈÔ¯ËÌÈ΋, ÏÂÈÙÔ˘ÚÁÈ΋ Î·È ‰ÔÌÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ΢ÙÙ¿ÚÔ˘ Î·È ‰›ÓÂÈ ¤ÙÛÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó¿‰ÂÈ͢ ‰È·ÊÔÚÒÓ Û ·Ú·Ï‹ÛÈ· Ì‹ÎË Î‡Ì·ÙÔ˜ Ô˘ ‰ÂÓ Â›Ó·È ÔÚ·Ù¤˜ Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ. ∆Ô Û˘ÁÎÂÎÚÈ̤ÓÔ Û‡ÛÙËÌ·, Ô˘ ‚·Û›˙ÂÙ·È ÛÙË Û‡Á¯ÚÔÓË Ù¯ÓÔÏÔÁ›·, ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈο ÏÂÔÓÂÎÙ‹Ì·Ù· Ì ΢ÚÈfiÙÂÚ· ÙËÓ Â˘Ú›· Ê·ÛÌ·ÙÈ΋ ÂÚÈÔ¯‹ ÏÂÈÙÔ˘ÚÁ›·˜, ÙËÓ ˘„ËÏ‹ ‰È·ÂÚ·ÙfiÙËÙ· Î·È Ê·ÛÌ·ÙÈ΋ ·Ó¿Ï˘ÛË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ Ù·¯‡Ù·ÙË Ï‹„Ë ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ Ê·ÛÌ·ÙÈÎÒÓ ÂÈÎfiÓˆÓ. ∞˘Ùfi ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÚÔ¯‹ ÏËÚÔÊÔÚ›·˜ Ì ÌÔÚÊ‹ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÂÈÎfiÓˆÓ. OÈ ÂÈÎfiÓ˜ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ Ì‹ÎÔ˘˜ ·̷ÙÔ˜, ÔÈ Ôԛ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙË Ï‹„Ë ÂÚÈÛÛfiÙÂÚˆÓ ·fi ¤Ó· ÂηÙÔÌ̇ÚÈÔ Ê·ÛÌ¿ÙˆÓ, Ì οı ¤Ó· Ó· ·ÓÙÈÛÙÔȯ› Û ¤Ó· ÛËÌÂ›Ô Ù˘ ÂÈÎfiÓ·˜ (17). ∞˘Ùfi ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È ÛËÌ·ÓÙÈÎfi ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ·ÓÔÌÔÈÔÁÂÓÒÓ ÌÈÎÚÔÛÎÔÈÎÒÓ ˘ÏÈÎÒÓ, ·ÊÔ‡ Ë ·Ó·Ï˘ÙÈ΋ ÏËÚÔÊÔÚ›· ÌÔÚ› Ó· ÚÔ¤ÏıÂÈ ·fi οı ÛËÌÂ›Ô ÙÔ˘ ÂÍÂÙ·˙fiÌÂÓÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∏ ¯Ú‹ÛË ‰È·ÊfiÚˆÓ ¯ÚˆÛÙÈÎÒÓ Ô˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ ‰Â›ÎÙ˜, Â›Ó·È ¤Ó· ·fi Ù· ÈÔ ÈÛ¯˘Ú¿ ÂÚÁ·Ï›· ÁÈ· ÙËÓ ·Ó¿Ï˘ÛË ÔÚÁ·ÓÈÎÒÓ ÈÛÙÒÓ. ∏ Ù·¯Â›· ·Ó¿Ù˘ÍË Ó¤ˆÓ Î·È ÂÚÈÛÛfiÙÂÚÔ ÔχÏÔΈÓ, ÔÏÏ·ÏÒÓ ¯ÚˆÌ¿ÙˆÓ,

1,0

§ÂÌÊÔ·ÙÙ·Ú· §ÂÌÊÔ‚Ï¿ÛÙ˜ (√§§)

0,9

AÔÚÚfiÊËÛË

0,8 0,7 0,6 0,5 0,4 545 nm

0,3 0,2

630 nm

0,1 400

450

500

550

600

650

700

ª‹ÎÔ˜ ·̷ÙÔ˜ (nm) ∂ÈÎfiÓ· 5. ª¤ÛÔ˜ fiÚÔ˜ Ê·ÛÌ¿ÙˆÓ ·ÔÚÚfiÊËÛ˘ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ. ¶·È‰È·ÙÚÈ΋ 2005;68:103-110

750

800

Paediatriki Mar-Apr 05

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15:30

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109

º·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Û ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÏÂÌÊÔ‚Ï¿ÛÙ˜

(∞)

420 nm

535 nm

630 nm

700 nm

(B)

420 nm

545 nm

630 nm

700 nm

∂ÈÎfiÓ· 6. ∂ÈÎfiÓ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ (∞), ÏÂÌÊÔ‚Ï·ÛÙÒÓ ·fi O§§ (µ) Î·È Ê·ÛÌ·ÙÈΤ˜ ÂÈÎfiÓ˜ ·ÔÚÚfiÊËÛ˘ ÛÙ· Ì‹ÎË Î‡Ì·ÙÔ˜ 420 nm, 535 nm, 545 nm, 630 nm Î·È 700 nm.

ÊıÔÚÈ˙fiÓÙˆÓ ¯ÚˆÛÙÈÎÒÓ ¤¯ÂÈ ‰ÒÛÂÈ ÌÂÁ¿ÏË ÒıËÛË ÛÙȘ ÌÂıfi‰Ô˘˜ ÌÈÎÚÔÛÎÔ›·˜ ÊıÔÚÈÛÌÔ‡. ∏ Ê·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ·Ú¤¯ÂÈ ÛËÌ·ÓÙÈο ÏÂÔÓÂÎÙ‹Ì·Ù· ÛÙËÓ ·ÂÈÎfiÓÈÛË ÊıÔÚÈÛÌÔ‡ ¤Ó·ÓÙÈ ¿ÏÏˆÓ ÎÏ·ÛÈÎÒÓ ÌÂıfi‰ˆÓ Ô˘ ‚·Û›˙ÔÓÙ·È Û ʛÏÙÚ·. ∆· ΢ÚÈfiÙÂÚ· Â›Ó·È Ë Ì¤ÙÚËÛË Ï‹ÚÔ˘˜ Ê¿ÛÌ·ÙÔ˜, Ë ÔÔ›· ‰›ÓÂÈ Ôχ ÌÂÁ·Ï‡ÙÂÚË ÏËÚÔÊÔÚ›· (ÔÛÔÙÈ΋) ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÌÔÚ›ˆÓ ÙˆÓ ¯ÚˆÛÙÈÎÒÓ ÛÙÔ ˘fi ÂͤٷÛË ‰Â›ÁÌ·, Ë ·ÏÔ‡ÛÙ¢ÛË Ù˘ Ï‹„˘ Ù˘ ÂÈÎfiÓ·˜ ÊıÔÚÈÛÌÔ‡, ·Ú¤¯ÔÓÙ·˜ ÙË ‰˘Ó·ÙfiÙËÙ·, Ì ̛· ÌfiÓÔ Ì¤ÙÚËÛË, ‰È·¯ˆÚÈÛÌÔ‡ Î·È ¯·ÚÙÔÁÚ¿ÊËÛ˘ ÔÏÏÒÓ Ê·ÛÌ·ÙÈο ÂÈÎ·Ï˘ÙfiÌÂÓˆÓ ÊıÔÚÈ˙fiÓÙˆÓ ‰ÂÈÎÙÒÓ Î·È, Ù¤ÏÔ˜, Ë Â›Ï˘ÛË ÔÏÏÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì fi¯È ÂÈı˘ÌËÙfi ÂÈϤÔÓ ÊˆÙÈÛÌfi (background). ∂Ê·ÚÌfi˙ÔÓÙ·˜ ÔχÏÔÎÔ˘˜ ·ÏÁfiÚÈıÌÔ˘˜ ·Ó¿Ï˘Û˘ ‰Â‰Ô̤ӈÓ, ·Ó·Ï‡ÔÓÙ·È Ù·˘Ùfi¯ÚÔÓ· ÔÏϤ˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ê·ÛÌ·ÙÈο.

60

AÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ

50

§ÂÌÊÔ·ÙÙ·Ú· §ÂÌÊÔÊÏ¿ÛÙ˜ (√§§)

40 30 20 10 0 0,0

0,1 0,2 0,3 0,4 0,5 ¢È·ÊÔÚ¿ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ (∞r)

∂ÈÎfiÓ· 7. πÛÙfiÁÚ·ÌÌ· ‰È·ÊÔÚ¿˜ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ ÛÙ· 630 nm Î·È 545 nm ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ÏÂÌÊÔ‚Ï·ÛÙÒÓ.

OÈ Î˘ÙÙ·ÚÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ‚·Û›˙ÔÓÙ·È Û ÎÈÓ‹ÛÂȘ ÌÔÚ›ˆÓ ‰È·Ì¤ÛÔ˘ ÌÂÌ‚Ú·ÓÒÓ, ̤۷ ÛÙȘ ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈΤ˜ ‰Ô̤˜ Î·È ·Ó¿ÌÂÛ· ÛÙ· ·ÙÙ·Ú· (‰È·Î˘ÙÙ·ÚÈ΋ ÂÈÎÔÈÓˆÓ›·). ∏ Ê·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË Ì ÙË ‚Ô‹ıÂÈ· ηٿÏÏËÏˆÓ ÊıÔÚÈ˙fiÓÙˆÓ ‰ÂÈÎÙÒÓ ¤¯ÂÈ Î·ıÈÂÚˆı› ÛÙË ÌÂϤÙË Î·È Î·Ù·ÓfiËÛË Ù·¯¤ˆÓ ‰˘Ó·ÌÈÎÒÓ ‰ÈÂÚÁ·ÛÈÒÓ, ÔÈ Ôԛ˜ ‰ÈÂÓÂÚÁÔ‡ÓÙ·È Ì¤Û·, ·ÏÏ¿ Î·È ·Ó¿ÌÂÛ·, ÛÙ· ·ÙÙ·Ú· (18). ∏ Ê·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË, Â›Û˘, ¤¯ÂÈ ‰ÒÛÂÈ ÒıËÛË ÛÙËÓ ·Ó¿Ï˘ÛË Î·È ‰È¿ÁÓˆÛË ¯ÚˆÌÔÛˆÌÈÎÒÓ ·ÏÏÔÈÒÛÂˆÓ Ì ÙË ¯Ú‹ÛË ÊıÔÚ›˙ÔÓÙÔ˜ ˘‚ÚȉÈÛÌÔ‡ (FISH). ∏ Ù¯ÓÈ΋ FISH Â›Ó·È Ì›· ΢ÙÙ·ÚÔÁÂÓÂÙÈ΋ Ù¯ÓÈ΋ Î·È Ì ÙË ‚Ô‹ıÂÈ· Ù˘ Ê·ÛÌ·ÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ Â›Ó·È ‰˘Ó·Ùfi˜ Ô Ê·ÛÌ·ÙÈÎfi˜ ‰È·¯ˆÚÈÛÌfi˜ ‰È·ÊÔÚÂÙÈÎÒÓ ÊıÔÚÈ˙fiÓÙˆÓ ‰ÂÈÎÙÒÓ ÛÙÔ ˘fi ÂͤٷÛË ÁÂÓÂÙÈÎfi ˘ÏÈÎfi ηÈ, ηٿ Û˘Ó¤ÂÈ·, Ë ·Ú·Ù‹ÚËÛË ‰È·ÊÔÚÂÙÈÎÒÓ ¯ÚˆÌÔÛˆÌ¿ÙˆÓ ¯ˆÚ›˜ ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ô˘ ÂÈ‚¿ÏÏÔ˘Ó Ù· Ê›ÏÙÚ· (19). ª¤¯ÚÈ Û‹ÌÂÚ·, Ë Ê·ÛÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÂÏ¿¯ÈÛÙ· ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ‰È¿ÎÚÈÛË Î˘ÙÙ¿ÚˆÓ (20). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ì ÙÔ Û‡Á¯ÚÔÓÔ Û‡ÛÙËÌ· Ê·ÛÌ·ÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ ÁÈ· ÚÒÙË ÊÔÚ¿ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÏÂÌÊÔ‚Ï¿ÛÙ˜ ÌÔÚÊÔÏÔÁ›·˜ L1 O§§ Ô˘ Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ‰È·ÎÚÈıÔ‡Ó ·fi Ù· Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· Ì ÙÔ ÎÔÈÓfi ÌÈÎÚÔÛÎfiÈÔ. ¶ÂÚÈÁÚ¿ÊËÎÂ Ë ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·fi ÏÂÌÊÔ‚Ï¿ÛÙ˜ L1 Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó ÔÈ ‰È·ÊÔÚ¤˜ ÙÔ˘˜ Ì ÙÔ Ê·ÛÌ·ÙÈÎfi ÌÈÎÚÔÛÎfiÈÔ. ¢È·ÈÛÙÒıËΠfiÙÈ Ù· 535 nm Î·È 545 nm ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙË Ì¤ÁÈÛÙË ·ÔÚÚfiÊËÛË ÁÈ· ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÏÂÌÊÔ‚Ï¿ÛÙ˜, ·ÓÙ›ÛÙÔȯ·. ™Ù· 630 nm ηٷÁÚ¿ÊËÎÂ Ë Ì¤ÁÈÛÙË ‰È·ÊÔÚÔÔ›ËÛË ÌÂٷ͇ ÙÔ˘˜. ∆· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Û˘ÓËÁÔÚÔ‡Ó ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ì¤ıÔ‰Ô˜ Ù˘ Ê·ÛÌ·ÙÈ΋˜ ·ÂÈÎfiÓÈÛ˘ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È·ÁÓˆÛÙÈ΋ ¶·È‰È·ÙÚÈ΋ 2005;68:103-110

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110

¡. ∫·Ù˙ËÏ¿Î˘ Î·È Û˘Ó.

0,5 §ÂÌÊÔ‚Ï¿ÛÙ˜

0,4 0,3

§ÂÌÊÔ·ÙÙ·Ú·

0,2 0,1 0,0

(∞)

(µ)

∂ÈÎfiÓ· 8. 梉ԯڈ̷ÙÈ΋ ÂÈÎfiÓ· Ê·ÛÌ·ÙÈ΋˜ ‰È·ÊÔÚ¿˜ ·ÔÚÚfiÊËÛ˘ (∞r) ÁÈ· Ê˘ÛÈÔÏÔÁÈο ÏÂÌÊÔ·ÙÙ·Ú· (∞) Î·È ÏÂÌÊÔ‚Ï¿ÛÙ˜ O§§ (µ). √È ÌÏ ÂÚÈÔ¯¤˜ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ÌÈÎÚ‹, ÂÓÒ ÔÈ ÎfiÎÎÈÓ˜ ÂÚÈÔ¯¤˜ Û ÌÂÁ¿ÏË ‰È·ÊÔÚ¿ Ê·ÛÌ·ÙÈ΋˜ ·ÔÚÚfiÊËÛ˘ (∞r).

Ì ÙËÓ Î·Ù·ÁÚ·Ê‹ Î·È ‰È¿ÎÚÈÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ˆ˜ ·ÓÙ·Ó¿ÎÏ·ÛË Ù˘ ‰ÔÌ‹˜ ÙÔ˘ ˘Ú‹Ó· Î·È Ù˘ ÔÚÁ¿ÓˆÛ˘ Ù˘ ¯ÚˆÌ·Ù›Ó˘. ∂›Ó·È ‰˘Ó·ÙfiÓ, ÂÔ̤ӈ˜, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙȘ ˘¿Ú¯Ô˘Û˜ ÌÂıfi‰Ô˘˜, Ó· ÚÔÛ‰ÈÔÚ›ÛÂÈ ‹ Î·È Ó· ·ÓȯÓ‡ÛÂÈ ÙËÓ ‡·ÚÍË Ï¢¯·ÈÌÈÎÒÓ Î˘ÙÙ¿ÚˆÓ ‹ ·ÎfiÌË Î·È ÙÔÓ ‚·ıÌfi ‰È‹ıËÛ˘ Û ‰È¿ÊÔÚ˜ Ê¿ÛÂȘ Ù˘ ıÂÚ·›·˜ ·È‰ÈÒÓ Ì ÔÍ›· Ï¢¯·ÈÌ›·, ÛÙȘ Ôԛ˜ Ë ˘ÔÙÚÔ‹ ‰ÂÓ Â›Ó·È ÔÚ·Ù‹ Ì ÏÔÈ¤˜ Û˘Ì‚·ÙÈΤ˜ ÌÂıfi‰Ô˘˜.

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2. Pui CH. Acute lymphoblastic leukemia. Pediatr Clin North Am 1997;44:831-846.

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8. Miller ML, Andringa A, Elliott J, Conwell K 2nd, Dixon K, Carty MP. The morphological and spectral phenotype of apoptosis in HeLa cells varies following exposure to UV-C and the addition of inhibitors of ICE and CPP32. Cell Prolif 1998;31:17-33.

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stained by four histological methods. Histochem J 1998;30: 539-547.

Ornberg RL, Woerner BM, Edwards DA. Analysis of stained objects in histological sections by spectral imaging and differential absorption. J Histochem Cytochem 1999;47:1307-1314.

Siboni G, Rothmann C, Ehrenberg B, Malik Z. Spectral imaging of MC540 during murine and human colon carcinoma cell differentiation. J Histochem Cytochem 2001;49:147-153.

Rothmann C, Cohen AM, Malik Z. Chromatin condensation in erythropoiesis resolved by multipixel spectral imaging: differentiation versus apoptosis. J Histochem Cytochem 1997;45:1097-1108.

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Friedrich K, Seiffert W, Zimmermann HW. Romanowsky dyes and Romanowsky-Giemsa effect. Structural investigations of the purple DNA-AB-EY dye complexes of Romanowsky-Giemsa staining. Histochemistry 1990;93:247256.

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AWARD-WINNING ARTICLE

111

Spectral imaging study of normal lymphocytes and lymphoblasts of acute lymphoblastic leukaemia in childhood* N. Katzilakis1, E. Stiakaki1, A. Papadakis2, H. Dimitriou1, K. Balas2, M. Kalmanti1

Abstract

* 2nd Choremio Award 40th Panhellenic Paediatric Meeting, 2002

Background: In this study a new method is proposed for distinction between normal lymphocytes and L1 lymphoblasts of acute lymphoblastic leukaemia (ALL), using spectral analysis and imaging. In many cases the morphological distinction of normal lymphocytes from L1 lymphoblasts using light microscopy is difficult. The differentiation and classification is based mainly on cytochemical features and on immunologic, cytogenetic and molecular characteristics.

1 Department of Paediatric Haematology-Oncology, University of Crete, Heraklion, Crete 2 Institute of Electronic Structure and Laser, Foundation for Research and Technology, Heraklion, Crete

Methods: The method, which is based on the principles of spectral microscope and imaging, assesses the spectral absorbance characteristics of blood cells with variant biochemical composition, which uptake dye in different ways on routine cytological staining. The spectral microscope system is capable of performing imaging of absorbance in a variety of spectral bands, at any spatial point of the image, in a wide spectral range from 400 nm to 1000 nm. Spectral analysis was performed on bone marrow smears of 30 children aged 2-14 years, 12 with ALL and 18 with non malignant disease (prolonged fever, anaemia, thrombopenia or neutropenia) following staining with May-Grunwald-Giemsa stain (MGG).

Correspondence: Maria Kalmanti Department of Paediatric Haematology-Oncology University Hospital of Heraklion 711 10, Heraklion, Crete ∂-mail: pedhem@med.uoc.gr

Results: The analysis showed a statistically significant difference (p<0.00005) between normal lymphocytes and lymphoblasts, based on the detection, identification and mapping of their spectral absorbance. The wavelengths of 535 nm and 545 mn corresponded with the maximum absorbance for lymphocytes and lymphoblasts respectively. The maximum spectral differentiation was observed at the wavelength of 630 nm.

Conclusions: The results of this study support the potential of spectral imaging to provide new quantitative indices correlated with the biochemical, functional and structural status of the cell, and consequently suggest a new method for cell differentiation and classification in acute leukaemia.

Key words Spectral imaging, acute lymphoblastic leukaemia, childhood.

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°ÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Û ·È‰È¿ Ì ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ì ÔÍηڂ·˙Â›ÓË 1 °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ 2 ∂ÚÁ·ÛÙ‹ÚÈÔ ¶˘ÚËÓÈ΋˜ π·ÙÚÈ΋˜ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ 3 π·ÙÚÔ·È‰·ÁˆÁÈ΋ ÀËÚÂÛ›·, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ AÏÏËÏÔÁÚ·Ê›·: ÃÚ‹ÛÙÔ˜ ¶. ¶·ÓÙÂÏÈ¿‰Ë˜ ∫. ¶·Ï·Ì¿ 4, ∆.∫. 551 33, £ÂÛÛ·ÏÔÓ›ÎË ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-01-2005

ª. ∆˙ËÙËÚ›‰Ô˘1, £. ¶¿ÓÔ˘1, ∂. ¶·˘Ï›‰Ô˘1, °. ÕÚÛÔ˜2, A. ª·Î·‚fi˜3, ∂. ªÈ¯·Ï¤ÙÔ˘3, Ã. ¶·ÓÙÂÏÈ¿‰Ë˜1

¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ·È‰ÈÒÓ ¤ÁÈÓ ·ÓÙÈΛÌÂÓÔ ÔÏÏÒÓ ÌÂÏÂÙÒÓ Î·È ÔÈ ·fi„ÂȘ ‹Ù·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ˜. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Ì ÂȉÈο „˘¯ÔÌÂÙÚÈο ÙÂÛÙ Û ·ÛıÂÓ›˜ Ì ȉÈÔ·ı›˜ ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ì ÔÍηڂ·˙Â›ÓË. ∆ËÓ ÂÚ›Ô‰Ô 1998-2002 ÂϤÁ¯ıËÎ·Ó 43 ·ÛıÂÓ›˜ Î·È 45 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ. O ¤ÏÂÁ¯Ô˜ ÂÚÈÂÏ¿Ì‚·Ó ∏∂°, MRI/CT ÂÁÎÂÊ¿ÏÔ˘, „˘¯ÔÌÂÙÚÈο ÙÂÛÙ (WISC-III, Bender-Santucci, DSMIV) ÚÈÓ ÙËÓ ·ÁˆÁ‹ Î·È Â·Ó¤ÏÂÁ¯Ô 14 Ì‹Ó˜ ÌÂÙ¿ ÙË ıÂÚ·›·. ∞ÔÙÂϤÛÌ·Ù·: ∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ·fi Ù· Ê¿Ú̷η ‰ÂÓ ·Ú·ÙËÚ‹ıËηÓ. ∆· ∏∂°, ·Ó¿ÏÔÁ· Ì ÙÔÓ Ù‡Ô Ù˘ ÂÈÏË„›·˜, ¤‰ÂÈ¯Ó·Ó ÂÛÙȷΤ˜ ·ÏÏÔÈÒÛÂȘ. O „˘¯ÔÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ ¤‰ÂÈÍ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙÔ˘˜ ‰Â›ÎÙ˜ ÓÔËÌÔÛ‡Ó˘ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙË ÛËÌ·ÓÙÈ΋ ÔÌÔÈfiÙËÙ· ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ. ™Â 6/43 ·ÛıÂÓ›˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ê·ÚÌ¿ÎÔ˘, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ Î·È Û 3/45 Ì¿ÚÙ˘Ú˜ ·Ú·ÙËÚ‹ıËÎ·Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜, Ô˘ ÂÓÙÔ›˙ÔÓÙ·Ó ÛÙËÓ ÈηÓfiÙËÙ· ÁÈ· Ì·ıËÌ·ÙÈÎfi Û˘ÏÏÔÁÈÛÌfi, ÛÙË ÏÔÁÈ΋ ·Ê·ÈÚÂÙÈ΋ ÛΤ„Ë Î·È ÛÙËÓ ÔÙÈ΋ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË. ¢Âη٤ÛÛÂÚȘ Ì‹Ó˜ ÌÂÙ¿ ÙË ıÂÚ·›· ·Ú·ÙËÚ‹ıËΠ‚ÂÏÙ›ˆÛË ÛÙÔÓ ¯ÂÈÚÈÛÌfi ·ÊËÚËÌ¤ÓˆÓ ÂÓÓÔÈÒÓ Î·È ÛÙË ÏÂÎÙÈ΋ ηٷÓfiËÛË. ™ÙÔ ÙÂÛÙ Bender-Santucci, ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·ÙËÚ‹ıËΠÌÈÎÚ‹ ‚ÂÏÙ›ˆÛË ÛÙÔÓ ÔÙÈÎÔÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, Ô˘ ‰ÈηÈÔÏÔÁÂ›Ù·È ·fi ÙËÓ ÂÍÔÈΛˆÛË Ì ÙË ‰ÔÎÈÌ·Û›·. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÔÍηڂ·˙Â›ÓË ‰ÂÓ ÂËÚ¿˙ÂÈ ÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ‰ÂÓ ·ÔÙÂÏ› ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ.

§¤ÍÂȘ ÎÏÂȉȿ ∂ÈÏË„›·, ÔÍηڂ·˙Â›ÓË, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜.

™˘ÓÙÔÌÔÁڷʛ˜ ∏∂° MRI/CT OXC ∞∂º

∏ÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ª·ÁÓËÙÈ΋/·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ OÍηڂ·˙Â›ÓË ∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η

∂ÈÛ·ÁˆÁ‹ H Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ (∞∂º) ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ¤ÁÈÓ ı¤Ì· ÂÓÙ·ÙÈ΋˜ ¤Ú¢ӷ˜ Ù· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· Î·È ÔÈ ·fi„ÂȘ ÙˆÓ Û˘ÁÁڷʤˆÓ ‹Ù·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ (1-4). ∏ ÂÙÂÚÔÁ¤ÓÂÈ· ÙÔ˘ ˘ÏÈÎÔ‡, Ë ·ÍÈÔÈÛÙ›· Î·È ÂÁ΢ÚfiÙËÙ· ÙˆÓ „˘¯ÔÌÂÙÚÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, ¶·È‰È·ÙÚÈ΋ 2005;68:112-118

Ë ÂÈÏÔÁ‹ ÙˆÓ ·ÛıÂÓÒÓ Î·È Ë ÔÏ˘ÏÔÎfiÙËÙ· ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Ù·Ó ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÌfi‰ÈÛ·Ó ÙËÓ ÂÍ·ÁˆÁ‹ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ∂ÈϤÔÓ, ‰ÂÓ ‚Ú¤ıËΠ·fi ÙȘ ̤¯ÚÈ Û‹ÌÂÚ· ÌÂϤÙ˜ οÔÈÔ ‰Â›ÁÌ· ÁÓˆÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ÌÔÚÊ‹ ÂÈÏË„›·˜. O ÛÙfi¯Ô˜ Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ıÂÚ·›·˜ ‰ÂÓ Ú¤ÂÈ Ó· Â›Ó·È ÌfiÓÔ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÎÚ›ÛÂˆÓ Î·È Ë ·ÔÊ˘Á‹ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, ·ÏÏ¿ Î·È Ë ‰È·Ù‹ÚËÛË Ù˘ „˘¯Ô‰˘Ó·ÌÈ΋˜ Î·È ÙˆÓ ÁÓˆÛÙÈÎÒÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘ ·ÛıÂÓ‹ (5).

OÈ Ì¤¯ÚÈ Û‹ÌÂÚ· Ó¢ÚÔ„˘¯ÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ ÂËÚ¿˙ÂÈ ‰È¿ÊÔÚ˜ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ (1,2,6,7). OÈ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜ ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÛÙË ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË, ÙËÓ ÚÔÛÔ¯‹, ÙË Û˘ÁΤÓÙÚˆÛË Î·È

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·113

113

∂ÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È ÔÍηڂ·˙Â›ÓË

ÙË ÏÂÎÙÈ΋ ÈηÓfiÙËÙ·, ÂÓÒ ¿ÏϘ Û˘Ó‰¤ÔÓÙ·È Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ (8-10). ∆¤ÙÔȘ ‰È·Ù·Ú·¯¤˜ ÌÔÚÔ‡Ó Ó· ·Ú·ÙËÚËıÔ‡Ó ÙfiÛÔ Û ÌÔÓÔıÂÚ·›· fiÛÔ Î·È Û ·ÛıÂÓ›˜ Ô˘ ıÂÚ·‡ÔÓÙ·È Ì ÂÚÈÛÛfiÙÂÚ· ·fi ¤Ó· ∞∂º ‹ Û ·ÛıÂÓ›˜ Ì ˘„ËÏ¿ Â›‰· ÙˆÓ ∞∂º ÛÙÔÓ ÔÚfi (11). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Ì ‰È¿ÊÔÚ· „˘¯ÔÌÂÙÚÈο ÙÂÛÙ Û ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·ÛıÂÓÒÓ Ì ȉÈÔ·ı›˜ ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È Ì·ÎÚÔ¯ÚfiÓÈ· ıÂÚ·›· Ì ÔÍηڂ·˙Â›ÓË (¤Ó· Û¯ÂÙÈο ηÈÓÔ‡ÚÁÈÔ ∞∂º ‰Â‡ÙÂÚ˘ ÁÂÓÈ¿˜, ÙÔ ÔÔ›Ô ¯ÔÚËÁÂ›Ù·È Û ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Ì ‹ ¯ˆÚ›˜ ÁÂӛ΢ÛË) (12,13). ¶·Ú¿ÁÔÓÙ˜ Ô˘ Û˘ÓÂÙ¤ÏÂÛ·Ó ÛÙË ‰ÈÂÍ·ÁˆÁ‹ ·˘Ù‹˜ Ù˘ ¤Ú¢ӷ˜ ‹Ù·Ó Ë ÚÔÛˆÈ΋ ÂÌÂÈÚ›· Î·È ÔÈ Û˘ÛÙËÌ·ÙÈΤ˜ ·Ú·ÙËÚ‹ÛÂȘ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û ·ÛıÂÓ›˜ Ì ÂÈÏË„›·, ÔÈ Ôԛ˜ ¤‰ÂÈ¯Ó·Ó fiÙÈ ˘¿Ú¯Ô˘Ó ÂÈÙÒÛÂȘ ÛÙÔ Â›Â‰Ô Ù˘ Û˘ÁΤÓÙÚˆÛ˘, Ù˘ ÚÔÛÔ¯‹˜ Î·È Ù˘ Ì·ıËÛȷ΋˜ Â›‰ÔÛ˘.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ∫ÏÈÓÈÎfi˜-ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ·fi ÙÔÓ π·ÓÔ˘¿ÚÈÔ 1998 ¤ˆ˜ ÙÔ 2002 ÂϤÁ¯ıËÎ·Ó 43 ·ÛıÂÓ›˜ (25 ·ÁfiÚÈ· Î·È 18 ÎÔÚ›ÙÛÈ·) ËÏÈΛ·˜ 5 ÂÙÒÓ Î·È 8 ÌËÓÒÓ ¤ˆ˜ 13 ÂÙÒÓ Î·È 9 ÌËÓÒÓ (̤ÛË ËÏÈΛ· ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜ 8 ¤ÙË Î·È 9 Ì‹Ó˜) Ì ȉÈÔ·ı›˜ ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È 45 ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜ (23 ·ÁfiÚÈ· Î·È 22 ÎÔÚ›ÙÛÈ·). ∞ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜ ›¯·Ó Ù· ›‰È· ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ Î·È ÙËÓ ËÏÈΛ· Î·È ·Ó‹Î·Ó ÛÙÔ ›‰ÈÔ ÎÔÈÓˆÓÈÎfi Î·È ÔÏÈÙÈÛÌÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ∆ÚÈ¿ÓÙ· ÙÚÂȘ ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ›¯·Ó ηÏÔ‹ıË ÂÛÙȷ΋ ÂÈÏË„›· Ì ÎÂÓÙÚÔÎÚÔÙ·ÊÈ΋ ÂÛÙ›· (ƒÔÏ¿Ó‰ÂÈÔ) Î·È ‰¤Î· ·Ϥ˜ ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ. ∏ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÈÏË„›·˜ ‹Ù·Ó 5 ¤ÙË Î·È 6 Ì‹Ó˜ ¤ˆ˜ 12 ¤ÙË Î·È 6 Ì‹Ó˜ (̤ÛË ËÏÈΛ· ¤Ó·Ú͢ 8 ¤ÙË Î·È 2 Ì‹Ó˜). ∞fi ÙË ÌÂϤÙË ·ÔÎÏ›ÛÙËÎ·Ó ·È‰È¿ ÌÂ Û˘Ìو̷ÙÈΤ˜ ‹ ÎÚ˘ÙÔÁÂÓ›˜ ÂÈÏË„›Â˜ Î·È Ó¢ÚÔÏÔÁÈΤ˜ ‹ Ó¢ÚÔÌÂÙ·‚ÔÏÈΤ˜ ·ı‹ÛÂȘ, ηıÒ˜ Î·È ·ÛıÂÓ›˜ Ì ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRπ). ™‡Ìʈӷ Ì ÙÔ ÚˆÙfiÎÔÏÏÔ, Û fiÏ· Ù· ·È‰È¿ (ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜) ÂÏ‹ÊıË ÂÚÈÁÂÓÓËÙÈÎfi, ÓÂÔÁÓÈÎfi, ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ¤ÁÈÓ ÏÂÙÔÌÂÚ‹˜ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ∏∂°) Ì ÛÙ¤ÚËÛË ‡ÓÔ˘ Î·È ÙÔÔı¤ÙËÛË 20 ÙÔ˘Ï¿¯ÈÛÙÔÓ ËÏÂÎÙÚÔ‰›ˆÓ Û‡Ìʈӷ Ì ÙÔ ‰ÈÂıÓ¤˜ Û‡ÛÙËÌ· 10-20, Ï‹Ú˘ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË Î·È ¤ÏÂÁ¯Ô˜ ·ÎÔ˘ÛÙÈÎÒÓ ÚÔÎÏËÙÒÓ ‰˘Ó·ÌÈÎÒÓ. ™Â fiÏ· Ù· ·È‰È¿ Ù˘ ÌÂϤÙ˘ ¤ÁÈÓ MRπ ÂÁÎÂÊ¿ÏÔ˘, ÂÓÒ MRI ÂÁÎÂÊ¿ÏÔ˘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ù˘¯·›· Î·È Û 32 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ, Ì ÙË Û‡ÌʈÓË ÁÓÒÌË ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜, ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÌÂϤÙ˘. ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ¤ÁÈÓ ÂÈϤÔÓ ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ËÏÂÎÙÚÔχÙ˜, Ë·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ (ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜) Î·È Î·Ù·ÁÚ·Ê‹ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜. ∏ ‰fiÛË Ù˘ ÔÍηڂ·˙Â›Ó˘ Î˘Ì·ÈÓfiÙ·Ó ÌÂٷ͇ 14,5-23 mg/kg µ™ (̤ÛÔ˜ fiÚÔ˜: 16,8 mg/kg µ™). OÈ ÂfiÌÂÓÔÈ ÎÏÈÓÈÎÔ› Î·È ÂÚÁ·ÛÙËÚÈ·ÎÔ› ¤ÏÂÁ¯ÔÈ ¤ÁÈÓ·Ó ¤Ó· Ì‹Ó· ÌÂÙ¿ ÙËÓ ÙÂÏÈ΋ ‰fiÛË Î·È, ·ÎÔÏÔ‡ıˆ˜, οı 6 Ì‹Ó˜ Ì ÙÔ ›‰ÈÔ ÚˆÙfiÎÔÏÏÔ.

OÈ Ù‡ÔÈ Ù˘ ÂÈÏË„›·˜ ηıÔÚ›ÛÙËÎ·Ó Û‡Ìʈӷ Ì ÙË ‰ÈÂıÓ‹ Ù·ÍÈÓfiÌËÛË (ILAE 1989) (14). ∏ ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜ ÛÙËÚ›¯ıËΠÛÙ· Ù˘Èο ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· Î·È ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ∏∂°.

æ˘¯ÔÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∂ÍÂÙ¿ÛÙËÎ·Ó 43 ·È‰È¿-·ÛıÂÓ›˜, ËÏÈΛ·˜ 6-14 ÂÙÒÓ, Ì ÙËÓ „˘¯ÔÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· WISC-III (Wechsler Intelligence Scale) (ÂÏÏËÓÈ΋ Îϛ̷η) ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ (ÚÒÙÔ ÙÂÛÙ), ÒÛÙ ӷ ÂÚ¢ÓËıÔ‡Ó Ô Û˘ÓÔÏÈÎfi˜ ‰Â›ÎÙ˘ ÓÔËÌÔÛ‡Ó˘, Ô ‰Â›ÎÙ˘ ÓÔËÌÔÛ‡Ó˘ Ù˘ ÏÂÎÙÈ΋˜ Î·È Ú·ÎÙÈ΋˜ Îϛ̷η˜ Î·È Ë Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ ÛÙȘ ÂÈ̤ÚÔ˘˜ Îϛ̷Θ (15). ∆Ô ›‰ÈÔ ÙÂÛÙ ÂÊ·ÚÌfiÛÙËÎÂ Î·È ÛÙ· 45 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∆o WISC-III Â·Ó·Ï‹ÊıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ 14 Ì‹Ó˜ ÌÂÙ¿ ÙË Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (‰Â‡ÙÂÚÔ ÙÂÛÙ), ÒÛÙ ӷ ÂÍÂÙ·ÛÙ› Ë Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ Û ۯ¤ÛË Ì ÙȘ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ Î·È ÙËÓ Â›‰Ú·ÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜. ™˘ÁÎÂÎÚÈ̤ӷ, ÂÚ¢ӋıËÎ·Ó ÔÈ ˘ÔÎϛ̷Θ Ù˘ ÏÂÎÙÈ΋˜ Îϛ̷η˜ (“¶ÏËÚÔÊÔڛ˜”, “OÌÔÈfiÙËÙ˜”, “∞ÚÈıÌËÙÈ΋”, “§ÂÍÈÏfiÁÈÔ”, “∫·Ù·ÓfiËÛË”) Î·È Ù˘ Ú·ÎÙÈ΋˜ Îϛ̷η˜ (“™˘ÌÏ‹ÚˆÛË ÂÈÎfiÓˆÓ”, “∫ˆ‰ÈÎÔÔ›ËÛË”, “™ÂÈÚÔı¤ÙËÛË ÂÈÎfiÓˆÓ”, “™¯¤‰È· Ì ·‚Ô˘˜”, “™˘Ó·ÚÌÔÏfiÁËÛË ·ÓÙÈÎÂÈ̤ӈӔ) ÙÔ˘ WISC-III. ™ÙËÓ ¤Ú¢ӷ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ, Â›Û˘, ÙÔ ÙÂÛÙ Bender-Santucci (16), ÙfiÛÔ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ù˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ fiÛÔ Î·È 14 Ì‹Ó˜ ÌÂÙ¿, Ì ÙÔ ÔÔ›Ô ÂϤÁ¯ıËÎ·Ó Ë ·ÓÙÈÏËÙÈ΋ ÔÚÁ¿ÓˆÛË Ì¤Û· ·fi ÙÔ Û‡ÓÔÏfi Ù˘, ·ÏÏ¿ Î·È ·fi ÙÔ˘˜ ÂÈ̤ÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ (Û¯ÂÙÈ΋ ı¤ÛË, ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜, ÁˆÓ›Â˜), Ô ÔÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜ Î·È Ë ÈηÓfiÙËÙ· Û˘ÁΤÓÙÚˆÛ˘ Ù˘ ÚÔÛÔ¯‹˜. ∆Ô ›‰ÈÔ ÙÂÛÙ ‰fiıËÎÂ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜. °È· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ¯ÔÚËÁ‹ıËΠÙÔ ∞ıËÓ¿ ∆ÂÛÙ ¢È¿ÁÓˆÛ˘ ¢˘ÛÎÔÏÈÒÓ ª¿ıËÛ˘, Ô˘ ·ÔÙÂÏ› ÙËÓ ÂÏÏËÓÈ΋ ÛÙ¿ıÌÈÛË ÙÔ˘ Illinois Test æ˘¯ÔÁψÛÛÈÎÒÓ πηÓÔÙ‹ÙˆÓ - ITPA (17), ÙÔ ÔÔ›Ô ÂϤÁ¯ÂÈ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ÙÔÌ›˜ ·Ó¿Ù˘Í˘, fiˆ˜: ·) ÓÔËÙÈ΋ ÈηÓfiÙËÙ·, ‚) ÌÓ‹ÌË ·ÎÔÏÔ˘ıÈÒÓ, Á) ÔÏÔÎÏ‹ÚˆÛË ·Ú·ÛÙ¿ÛˆÓ, ‰) ÁÚ·ÊÔ-ʈÓÔÏÔÁÈ΋ ÂÓËÌÂÚfiÙËÙ· Î·È Â) Ó¢ÚÔ„˘¯ÔÏÔÁÈ΋ ˆÚÈÌfiÙËÙ·, fiˆ˜ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜, Ï¢ڛˆÛË Î·È ÚÔÛ·Ó·ÙÔÏÈÛÌfi˜ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∆Ô ∞ıËÓ¿ ∆ÂÛÙ ‰fiıËΠÛÙÔ˘˜ ·ÛıÂÓ›˜ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ÌÂϤÙ˘. ªÂ ÙËÓ ¤Ó·ÚÍË Ù˘ ¤Ú¢ӷ˜ (ÚÈÓ ÙË ıÂÚ·›·) ÂÏ‹ÊıË ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, fiÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ DSM-IV (18) ÁÈ· ÙËÓ ‡·ÚÍË „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‹ Û˘ÌÂÚÈÊÔÚÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Î·È ÙÔ˘˜ Ì¿ÚÙ˘Ú˜. ∏ ›‰È· ‰È·‰Èηۛ· ·ÎÔÏÔ˘ı‹ıËΠÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜ 14 Ì‹Ó˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

O ¤ÏÂÁ¯Ô˜ ÙˆÓ „˘¯ÔÌÂÙÚÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ (WISC-III, ∞ıËÓ¿ ∆ÂÛÙ, DSM-IV) Ú·ÁÌ·ÙÔÔÈ‹ıËΠ1-2 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ‹ Ù· ÂfiÌÂÓ· ÂÈÏËÙÈο ÂÂÈÛfi‰È·. ∂ȉÈÎfiÙÂÚ·, Û 31 ·ÛıÂÓ›˜ Ô ¤ÏÂÁ¯Ô˜ ¤ÁÈÓ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ, Û 11 ÌÂÙ¿ ÙÔ ‰Â‡ÙÂÚÔ ÂÂÈÛfi‰ÈÔ Î·È Û 1 ÌÂÙ¿ ÙÔ ÙÚ›ÙÔ. ∏ ÂͤٷÛË ÁÈÓfiÙ·Ó ·fi ÙÔÓ ›‰ÈÔ „˘¯ÔÏfiÁÔ, ÙËÓ ›‰È· ÂÚ›Ô˘ ÚˆÈÓ‹ ÒÚ·. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ÙÂÛÙ BenderSantucci ¤ÁÈÓ ·fi ÙÔÓ ›‰ÈÔ ÂÚÁÔıÂÚ·Â˘Ù‹. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÌË ·Ú·ÌÂÙÚÈ΋ ÛÙ·ÙÈÛÙÈ΋ ‰ÔÎÈÌ·Û›· MannWhitney, ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÙˆÓ Û˘Ó¯ÒÓ ÌÂÙ·‚ÏËÙÒÓ. ∂›Û˘, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‰ÔÎÈÌ·Û›· ¯2 ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ Û˘¯ÓÔًوÓ. OÈ ‰È·ÊÔÚ¤˜ ıˆÚÔ‡ÓÙ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ÁÈ· ÙÈ̤˜ ÙÔ˘ p<0,05. ¶·È‰È·ÙÚÈ΋ 2005;68:112-118

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·114

114

ª. ∆˙ËÙËÚ›‰Ô˘ Î·È Û˘Ó.

΋˜ ·ÁˆÁ‹˜, ÌfiÓÔ 5 ·ÛıÂÓ›˜ ›¯·Ó °ÂÓÈÎfi ¢¡ οو ·fi Ù· Ê˘ÛÈÔÏÔÁÈο Â›‰· Î·È 4 ·fi ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ (¶›Ó·Î·˜ 1). øÛÙfiÛÔ, ·Ú’ fiÏÔ Ô˘ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ Â›¯Â Ê˘ÛÈÔÏÔÁÈÎfi ¢¡, ·ÚÎÂÙ¿ ·È‰È¿ ·ÚÔ˘Û›·˙·Ó ¯·ÌËÏ‹ Â›‰ÔÛË ÛÙȘ ÂÈ̤ÚÔ˘˜ ˘ÔÎϛ̷Θ Ù˘ §ÂÎÙÈ΋˜ Î·È ¶Ú·ÎÙÈ΋˜ Îϛ̷η˜, ÁÂÁÔÓfi˜ Ô˘ ÈÛÙÔÔÈ› ÙËÓ ‡·ÚÍË ÁÓˆÛÙÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, ηٿ ̤ÛÔ fiÚÔ 15/43 ·ÛıÂÓ›˜ ›¯·Ó Â›‰ÔÛË Î¿Ùˆ ·fi Ù· Ê˘ÛÈÔÏÔÁÈο Â›‰· (¢¡ <79) ÛÙȘ ˘ÔÎϛ̷Θ “OÌÔÈfiÙËÙ˜”“∞ÚÈıÌËÙÈ΋”, ÔÌÔ›ˆ˜ ÛÙȘ ˘ÔÎϛ̷Θ “∫Ò‰ÈΘ”-“™¯¤‰È· Ì ·‚Ô˘˜” (¶›Ó·Î˜ 2 Î·È 3). ™ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÔÈ ‰˘ÛÎÔϛ˜ ÂÈÎÂÓÙÚÒÓÔÓÙ·Ó ÛÙȘ ˘ÔÎϛ̷Θ “∞ÚÈıÌËÙÈ΋”, “∫Ò‰ÈΘ”, “™¯¤‰È· Ì ·‚Ô˘˜”. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙËÓ Â›‰ÔÛË ÙˆÓ ·ÛıÂÓÒÓ ·Ú·ÙËÚÂ›Ù·È ÛÙȘ ˘ÔÎϛ̷Θ “OÌÔÈfiÙËÙ˜” (p<0,043), “∫Ò‰ÈΘ” (p<0,047) Î·È “™¯¤‰È· Ì ·‚Ô˘˜” (p<0,076), fiÔ˘ ÔÈ ·ÛıÂÓ›˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ ‰˘ÛÎÔϛ˜ ÛÙËÓ ·ÊËÚË̤ÓË ÏÔÁÈ΋ ÛΤ„Ë, ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ÛÙËÓ ÔÙÈÎÔ-·ÓÙÈÏËÙÈ΋ ÈηÓfiÙËÙ· Î·È ÛÙËÓ ÔÙÈ΋ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË. ™ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, ÔÈ ‰˘ÛÎÔϛ˜ ÂÈÎÂÓÙÚÒÓÔÓÙ·Ó ÛÙÔÓ ·ÚÈıÌËÙÈÎfi Û˘ÏÏÔÁÈÛÌfi Î·È ÛÙËÓ ÈηÓfiÙËÙ· ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡. ªÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·ÙËÚÂ›Ù·È (¶›Ó·Î·˜ 4) ‚ÂÏÙ›ˆÛË ÛÙËÓ ÈηÓfiÙËÙ· ¯ÂÈÚÈÛÌÔ‡ ·ÊËÚËÌ¤ÓˆÓ ÂÓÓÔÈÒÓ Î·È ÛÙË ‰È·ÏÔÁÈÛÙÈ΋ ÈηÓfiÙËÙ· (“OÌÔÈfiÙËÙ˜”, p<0,043). ∏ ÌÈÎÚ‹ ·˘Ù‹ ‚ÂÏÙ›ˆÛË ÂÍËÁÂ›Ù·È ·fi ÙË ÁÓˆÛÙÈ΋ ˆÚ›Ì·ÓÛË Ô˘ Û˘ÓÙÂÏÂ›Ù·È Ì ÙË ‚ÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ οı ·È‰ÈÔ‡. ∂›Û˘, ·Ú·ÙËÚÂ›Ù·È ‚ÂÏÙ›ˆÛË ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, Ì ‚ÂÏÙ›ˆÛË Ù˘ Ù·¯‡ÙËÙ·˜ ÂÎÙ¤ÏÂÛ˘ Î·È ÁÓˆÛÙÈ΋˜ ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È ÛÙË ÛÂÈÚÔıÂÙÈ΋ ÈηÓfiÙËÙ· (“™˘ÌÏ‹ÚˆÛË ÂÈÎfiÓˆÓ”, p<0,047, “™ÂÈÚÔı¤ÙËÛË ÂÈÎfiÓˆÓ”, p<0,033). ∏ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÙÂÛÙ Bender-Santucci ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ¤‰ÂÈÍ fiÙÈ 26/43 ·ÛıÂÓ›˜ ·ÚÔ˘Û›·˙·Ó ‰˘ÛÎÔϛ˜ ÛÙËÓ ÈηÓfiÙËÙ· ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ÛÙÔÓ ¯ˆÚÈÎfi ÚÔÛ·Ó·ÙÔÏÈÛÌfi Î·È ÛÙËÓ ÈηÓfiÙËÙ· Û˘ÁΤÓÙÚˆÛ˘. ∞ÓÙ›ÛÙÔȯ·, ÛÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ, 24/45 ÂÌÊ¿ÓÈ˙·Ó ‰˘ÛÎÔϛ˜, ÂÓÒ Ë Â›‰ÔÛË Û 4 ·fi ·˘ÙÔ‡˜

∞ÔÙÂϤÛÌ·Ù· ∫ÏÈÓÈÎfi˜-ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ∞fi ÙÔ ÈÛÙÔÚÈÎfi, Ë Î‡ËÛË Î·È Ë ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ Û fiÏ· Ù· ·È‰È¿ (·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜). ∂ÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ·Ó·Ê¤ÚıËÎ·Ó Û ÙÚÂȘ ÂÚÈÙÒÛÂȘ. ™Â 7 ·È‰È¿ ·fi ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ Î·È Û 3 ·fi ÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ, ·Ú·ÙËÚ‹ıËÎ·Ó Û‡Ìʈӷ Ì ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 4 ÂÙÒÓ. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË ÚÈÓ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ (οı 6 Ì‹Ó˜) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Î·È Ù· ∏∂° ÛÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ (ÁÂÓÈ΋ ·›Ì·ÙÔ˜, Ë·ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜, ËÏÂÎÙÚÔχÙ˜) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, ÙfiÛÔ ÚÈÓ ÙËÓ ¤Ó·ÚÍË fiÛÔ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÌÂϤÙ˘. ™Â 18 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ‚Ú¤ıËΠ̠ÙÔ ∏∂° ÂÛÙ›· ÛÙÔ ‰ÂÍÈfi ËÌÈÛÊ·›ÚÈÔ, Û 14 ÛÙÔ ·ÚÈÛÙÂÚfi Î·È Û 11 ·ÛıÂÓ›˜ Î·È ÛÙ· ‰‡Ô ËÌÈÛÊ·›ÚÈ· (¿ÏÏÔÙ ‰ÂÍÈ¿, ¿ÏÏÔÙ ·ÚÈÛÙÂÚ¿ Ì ٿÛË ÁÂÓ›Î¢Û˘). ÀÔÙÚÔ¤˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ ·Ú·ÙËÚ‹ıËÎ·Ó Û 9/43 ·ÛıÂÓ›˜, ÔÈ Ôԛ˜ ÂϤÁ¯ıËÎ·Ó Ì ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ ËÌÂÚ‹ÛÈ·˜ ‰fiÛ˘. ∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, fiˆ˜ ÎÂÊ·Ï·ÏÁ›·, Û˘¯ÓÔ˘Ú›·, ˘ÓËÏ›·, Ó¢ÚÈÎfiÙËÙ· Î·È ·‡ÍËÛË Ù˘ fiÚÂ͢, ·Ú·ÙËÚ‹ıËÎ·Ó Û 10 ·È‰È¿ Î·È ‹Ù·Ó ·ÚÔ‰ÈΤ˜. ™Â 35 ·fi Ù· ·È‰È¿ Ô˘ Ï¿Ì‚·Ó·Ó ÔÍηڂ·˙Â›ÓË, Ë ıÂÚ·›· ‰È·ÎfiËΠÌÂÙ¿ ·fi 3-4 ¯ÚfiÓÈ·, Ì ‚¿ÛË ÙËÓ ÔÚ›·, ÙÔ ÂχıÂÚÔ ÎÚ›ÛÂˆÓ ‰È¿ÛÙËÌ· Î·È ÙËÓ ÔÌ·ÏÔÔ›ËÛË ÙÔ˘ ∏∂°. æ˘¯ÔÌÂÙÚÈÎfi˜ ¤ÏÂÁ¯Ô˜ ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÓÔËÙÈ΋˜ ÂÎÙ›ÌËÛ˘ ÙÔ˘ °ÂÓÈÎÔ‡ ¢Â›ÎÙË ¡ÔËÌÔÛ‡Ó˘ (¢¡) Î·È ÙˆÓ ¢ÂÈÎÙÒÓ Ù˘ §ÂÎÙÈ΋˜ Î·È ¶Ú·ÎÙÈ΋˜ Îϛ̷η˜ (¶›Ó·Î·˜ 1), ·Ó¿ÌÂÛ· ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ Î·È ÛÙËÓ ÔÌ¿‰· Ì·ÚÙ‡ÚˆÓ ‰ÂÓ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜, ÁÂÁÔÓfi˜ Ô˘ ·Ô‰ÂÈÎÓ‡ÂÈ ÙË ÛËÌ·ÓÙÈ΋ ÔÌÔÈfiÙËÙ· ÙˆÓ ‰ÂÈÁÌ¿ÙˆÓ (p<0,118). ªÂ ‚¿ÛË ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ WISC-III ÙˆÓ ·ÛıÂÓÒÓ, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·È ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ù˘ Ê·Ú̷΢ÙÈ-

¶›Ó·Î·˜ 1. ™˘ÁÎÚÈÙÈο ·ÔÙÂϤÛÌ·Ù· ¢ÂÈÎÙÒÓ ¡ÔËÌÔÛ‡Ó˘ WISC-IIπ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¡ÔËÙÈΤ˜ ηÙËÁÔڛ˜ 110-119 90-109 80-89 70-79 <69 ¶·È‰È·ÙÚÈ΋ 2005;68:112-118

°ÂÓÈ΋ ÓÔËÌÔÛ‡ÓË ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ n=43 n=45 13 22 3 4 1

12 25 4 4 -

§ÂÎÙÈ΋ ÓÔËÌÔÛ‡ÓË ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ n=43 n=45 7 29 4 2 1

14 21 6 4 -

¶Ú·ÎÙÈ΋ ÓÔËÌÔÛ‡ÓË ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ n=43 n=45 14 19 4 4 2

12 28 1 4 -

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·115

115

∂ÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È ÔÍηڂ·˙Â›ÓË

¶›Ó·Î·˜ 2. ™˘ÁÎÚÈÙÈο ·ÔÙÂϤÛÌ·Ù· ¢ÂÈÎÙÒÓ ¡ÔËÌÔÛ‡Ó˘ ÛÙȘ ˘ÔÎϛ̷Θ Ù˘ §ÂÎÙÈ΋˜ ∫ϛ̷η˜ ÙÔ˘ WISC-IIπ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¡ÔËÙÈΤ˜ ηÙËÁÔڛ˜

110-119 90-109 80-89 70-79 <69

¶ÏËÚÔÊÔڛ˜ OÌÔÈfiÙËÙ˜ ∞ÚÈıÌËÙÈ΋ §ÂÍÈÏfiÁÈÔ ∫·Ù·ÓfiËÛË (Information) (Similarities) (Arithmetical) (Vocabulary) (Comprehension) ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45 3 16 14 5 5

9 21 8 4 3

1 20 12 10 -

2 26 11 5 1

1 15 13 10 4

Î˘Ì·ÈÓfiÙ·Ó ÂÎÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ (Ô °ÂÓÈÎfi˜, ¶Ú·ÎÙÈÎfi˜ Î·È §ÂÎÙÈÎfi˜ ¢¡ ÙˆÓ ÙÂÛÛ¿ÚˆÓ ·˘ÙÒÓ ·È‰ÈÒÓ ‹Ù·Ó <79). ™ÙÔ˘˜ 14 Ì‹Ó˜ ÌÂÙ¿ ÙË Ï‹„Ë ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÔÈ ÂȉfiÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔ Bender-Santucci ‚ÂÏÙÈÒıËÎ·Ó ÛÙ· 19/26 ·È‰È¿ Ô˘ ÂÌÊ¿ÓÈ˙·Ó ‰˘ÛÎÔϛ˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙȘ ·Ú·¿Óˆ ‰ÔÎÈ̷ۛ˜, ÂÓÒ ÛÙ· 7/26 ·È‰È¿ Ë Â›‰ÔÛË Î˘Ì·ÈÓfiÙ·Ó ÂÎÙfi˜ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÔÚ›ˆÓ. £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ·fi ÙÔ˘˜ ·Ú·¿Óˆ 7 ·ÛıÂÓ›˜, ÔÈ 5 ›¯·Ó °ÂÓÈÎfi, §ÂÎÙÈÎfi Î·È ¶Ú·ÎÙÈÎfi ¢¡ <79 Û‡Ìʈӷ Ì ÙÔ WISC-III, ÔfiÙ ‰ÈηÈÔÏÔÁÂ›Ù·È Î·È Ë ¯·ÌËÏ‹ Â›‰ÔÛ‹ ÙÔ˘˜ ÛÙÔ Bender-Santucci ÙÂÛÙ.

OÈ ·Ó·Ï‡ÛÂȘ ÙˆÓ ÂÓ‰Ô·ÙÔÌÈÎÒÓ ‰È·ÊÔÚÒÓ Î¿ı ·È‰ÈÔ‡ Û‡Ìʈӷ Ì ÙÔ ∞ıËÓ¿ ∆ÂÛÙ ‰Â›¯ÓÔ˘Ó ÙËÓ ‡·ÚÍË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Û 6/43 ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ÙˆÓ ·ÛıÂÓÒÓ (13,95%) Î·È Û 3/45 Ù˘ ÔÌ¿‰·˜ Ì·ÚÙ‡ÚˆÓ (6,67%). ŸÏ· Ù· ·È‰È¿ ÂÌÊ¿ÓÈ˙·Ó ‰˘ÛÎÔϛ˜ ÛÙË ‰È¿ÎÚÈÛË ÁÚ·ÊËÌ¿ÙˆÓ, ÛÙË ‰È¿ÎÚÈÛË Î·È Û‡ÓıÂÛË ÊıfiÁÁˆÓ, ÛÙȘ ÁψÛÛÈΤ˜ ·Ó·ÏÔÁ›Â˜ Î·È ÛÙË ÌÓ‹ÌË ·ÚÈıÌÒÓ Î·È ÂÈÎfiÓˆÓ. ∂›Û˘, 3 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ›¯·Ó ‰˘ÛÎÔϛ˜ Ï¢ڛˆÛ˘ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡. ∆· ·È‰È¿ (·ÛıÂÓ›˜ Î·È Ì¿ÚÙ˘Ú˜) Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ÂÍÂÙ¿ÛÙËÎ·Ó Î·È Û Â›Â‰Ô ·Ó¿ÁÓˆÛ˘ Î·È ÁÚ·Ê‹˜, fiÔ˘ ‰È·ÁÓÒÛÙËΠ‰È·Ù·Ú·¯‹ Ù˘ ·Ó¿ÁÓˆÛ˘ (Ù‡Ô˘ ‰˘ÛÏÂÍ›·˜) Û 2 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜. ™‡Ìʈӷ Ì ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ test ¯2, Ë ‰È·ÊÔÚ¿ ÛÙ· ‰‡Ô ‰Â›ÁÌ·Ù· ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,438). ∆Ô

3 23 11 8 -

4 27 8 4 -

4 24 9 6 2

4 31 4 4 -

7 25 9 3 1

·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ‰Â›¯ÓÂÈ fiÙÈ Ë ‡·ÚÍË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ ·ÔÙÂÏ› Ù˘¯·›Ô ÁÂÁÔÓfi˜. £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ fiÏ· Ù· ·È‰È¿ Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ Î·È ÛÙȘ ÙÚÂȘ Îϛ̷Θ ÙÔ˘ WISC-III (°ÂÓÈÎfi˜, §ÂÎÙÈÎfi˜, ¶Ú·ÎÙÈÎfi˜ ¢¡ >95). ™ÙÔÓ Â·Ó¤ÏÂÁ¯Ô ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ú·ÙËÚ‹ıËΠfiÙÈ ÛÙ· 6 ·È‰È¿ ÔÈ ‰˘ÛÎÔϛ˜ Ì·ıËÛÈ·ÎÔ‡ Ù‡Ô˘ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· ˘¿Ú¯Ô˘Ó. ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ DSM-IV Î·È ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ, ÙfiÛÔ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ ¤Ú¢ӷ˜ fiÛÔ Î·È ÌÂÙ¿ ·fi 14 Ì‹Ó˜, ‰ÂÓ ‰Â›¯ÓÔ˘Ó ÙËÓ ‡·ÚÍË „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈÎÒÓ ‹ Û˘ÌÂÚÈÊÔÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ.

™˘˙‹ÙËÛË OÈ ÂÚÈÛÛfiÙÂÚ˜ Ó¢ÚÔ„˘¯ÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ·Û¯ÔÏ‹ıËÎ·Ó Ì ÙËÓ ÂÈÏË„›· ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Î·È ÙȘ ÂÈÙÒÛÂȘ Ù˘ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ıÂÚ·›·˜ ÛÙË ÓÔËÌÔÛ‡ÓË Î·È ÙË Û¯ÔÏÈ΋ Â›‰ÔÛË. ∆Ô Ì¤ÁÂıÔ˜, fï˜, ÙˆÓ ÂÈÙÒÛÂˆÓ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÂÍ·ÚÙ¿Ù·È Î·Ù¿ ηÓfiÓ· ·fi ÙÔÓ Ù‡Ô Ù˘ ÂÈÏË„›·˜, ÙÔ Â›‰Ô˜ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, ÙËÓ ˘ÔΛÌÂÓË ‚Ï¿‚Ë Î·È ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓ‹. OÈ Ù‡ÔÈ ÂÈÏË„›·˜ Ô˘ ÂÈϤ¯ıËÎ·Ó ÁÈ· ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯Ó¿ ÛÙËÓ ·È‰È΋ ËÏÈΛ· (14-16% ÂÚ›Ô˘), ¤¯Ô˘Ó Ù˘È΋ ÎÏÈÓÈ΋ ÛËÌÂÈÔÏÔÁ›· Î·È ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈΤ˜

¶›Ó·Î·˜ 3. ™˘ÁÎÚÈÙÈο ·ÔÙÂϤÛÌ·Ù· ¢ÂÈÎÙÒÓ ¡ÔËÌÔÛ‡Ó˘ ÛÙȘ ˘ÔÎϛ̷Θ Ù˘ ¶Ú·ÎÙÈ΋˜ ∫ϛ̷η˜ ÙÔ˘ WISC-III ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ ¡ÔËÙÈΤ˜ ηÙËÁÔڛ˜

110-119 90-109 80-89 70-79 <69

™˘ÌÏ‹ÚˆÛË ∫Ò‰ÈΘ ™ÂÈÚÔı¤ÙËÛË ™¯¤‰È· ™˘Ó·ÚÌÔÏfiÁËÛË ÂÈÎfiÓˆÓ (Coding) ÂÈÎfiÓˆÓ Ì ·‚Ô˘˜ ·ÓÙÈÎÂÈÌ¤ÓˆÓ (Picture completion) (Picture arrangement) (Block design) (Object assembly) ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ ∞ÛıÂÓ›˜ ª¿ÚÙ˘Ú˜ n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45 n=43 n=45 6 15 13 6 3

15 21 7 2 -

4 19 8 9 3

6 15 14 5 5

6 20 10 6 1

8 18 13 5 1

4 17 12 8 2

4 25 8 4 4

2 23 11 1 6

2 24 11 6 2 ¶·È‰È·ÙÚÈ΋ 2005;68:112-118

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·116

116

ª. ∆˙ËÙËÚ›‰Ô˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 4. ™Ù·ÙÈÛÙÈο ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ WISC-III Ù˘ Â›‰ÔÛ˘ ·ÛıÂÓÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ WISC-III °ÂÓÈÎfi˜ ¢¡ §ÂÎÙÈÎfi˜ ¢¡ ¶ÏËÚÔÊÔڛ˜ OÌÔÈfiÙËÙ˜ ∞ÚÈıÌËÙÈ΋ §ÂÍÈÏfiÁÈÔ ∫·Ù·ÓfiËÛË ¶Ú·ÎÙÈÎfi˜ ¢¡ ™˘ÌÏ‹ÚˆÛË ÂÈÎfiÓˆÓ

¶·Ú¿ÌÂÙÚÔÈ ÂϤÁ¯Ô˘

§ÂÎÙÈ΋ ηٷÓfiËÛË, Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË, ÈηÓfiÙËÙ· Ì¿ıËÛ˘ §ÔÁÈ΋ ·Ê·ÈÚÂÙÈ΋ ÛΤ„Ë, ÏÂÎÙÈ΋ ηٷÓfiËÛË ∞ÚÈıÌËÙÈÎfi˜ Û˘ÏÏÔÁÈÛÌfi˜, Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË §ÂÎÙÈ΋ ηٷÓfiËÛË, ÏÔÁÈ΋ ·Ê·ÈÚÂÙÈ΋ ÛΤ„Ë §ÂÎÙÈ΋ ηٷÓfiËÛË

OÙÈÎÔ-¯ˆÚÈ΋ ÔÚÁ¿ÓˆÛË, Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË ∫ˆ‰ÈÎÔÔ›ËÛË OÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜, ÔÙÈÎÔ-¯ˆÚÈ΋ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË ™¯¤‰È· Ì ·‚Ô˘˜ OÙÈÎÔ-ÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜, ÔÙÈÎÔ-¯ˆÚÈ΋ ÔÚÁ¿ÓˆÛË ™ÂÈÚÔı¤ÙËÛË ÂÈÎfiÓˆÓ OÙÈÎÔ-¯ˆÚÈ΋ ÔÚÁ¿ÓˆÛË, ÛÂÈÚÔıÂÙÈ΋ ÈηÓfiÙËÙ·, ÔÙÈ΋ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË ™˘Ó·ÚÌÔÏfiÁËÛË OÙÈÎÔ-¯ˆÚÈ΋ ÔÚÁ¿ÓˆÛË, ·ÓÙÈÎÂÈÌ¤ÓˆÓ ÛÂÈÚÔıÂÙÈ΋ ÈηÓfiÙËÙ·

·ÏÏÔÈÒÛÂȘ (19) Î·È Â›Ó·È ÎÏ·ÛÈÎfi ·Ú¿‰ÂÈÁÌ· ÁÈ· ¤ÏÂÁ¯Ô ÁÓˆÛÙÈÎÒÓ ·Ú·Ì¤ÙÚˆÓ (20). ∂ÈϤÔÓ, ÔÈ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈΤ˜ ·ÏÏÔÈÒÛÂȘ ˘Ê›ÛÙ·ÓÙ·È ÁÈ· ÌÂÁ¿ÏË ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ· Î·È ·ÔÙÂÏÔ‡Ó ÛÙÔÈ¯Â›Ô ÂӉ¯fiÌÂÓ˘ Â›‰Ú·Û˘, fiˆ˜ ÈÛ¯˘Ú›˙ÔÓÙ·È ÔÚÈṲ̂ÓÔÈ Û˘ÁÁÚ·Ê›˜ (21,22). ∂ÚÁ·Û›Â˜ ÂϤÁ¯Ô˘ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Û ·ÛıÂÓ›˜ ÚÈÓ ÙË Ï‹„Ë ıÂÚ·›·˜ ‰ÂÓ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Û 35 ·È‰È¿ Ô˘ Ï¿Ì‚·Ó·Ó ÔÍηڂ·˙Â›ÓË Ë ıÂÚ·›· ‰È·ÎfiËΠ̠‚¿ÛË ÙËÓ ÔÚ›·, ÙÔ ÂχıÂÚÔ ÎÚ›ÛÂˆÓ ‰È¿ÛÙËÌ· Î·È ÙËÓ ÔÌ·ÏÔÔ›ËÛË ÙÔ˘ ∏∂°. ∏ ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ÛÙÔ˘˜ ·Ú·¿Óˆ ·ÛıÂÓ›˜ (35/43) Î˘Ì·ÈÓfiÙ·Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ƒÔÏ¿Ó‰ÂÈ· ÂÈÏË„›· ·fi 2 ¤ˆ˜ 3,5 ¯ÚfiÓÈ·, ÂÓÒ ÛÙ· ·È‰È¿ Ì ·Ϥ˜ ÂÛÙȷΤ˜ ÎÚ›ÛÂȘ Û 3-4 ¯ÚfiÓÈ·. ™ÙȘ ÌÂϤÙ˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Û ·ÛıÂÓ›˜ ÌÂ Û˘Ìو̷ÙÈ΋ ÂÈÏË„›· ‚Ú¤ıËΠfiÙÈ Ú¿ÁÌ·ÙÈ ˘¿Ú¯Ô˘Ó ÂÏÏ›ÌÌ·Ù· ÛÙȘ ÁÓˆÛÙÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, Ì ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ ¯·ÌËÏfiÙÂÚÔ ·’ fi,ÙÈ Û ·È‰È¿ Ì ȉÈÔ·ı›˜ ÂÈÏË„›Â˜ (1,10). OÈ ·ÛıÂÓ›˜ Ì ȉÈÔ·ı›˜ ÂÈÏË„›Â˜ Î·È ÂȉÈÎfiÙÂÚ· Ì ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· (ÎÂÓÙÚÔÎÚÔÙ·ÊÈ΋ ÂÛÙ›·) ›¯·Ó ηٿ ̤ÛÔ fiÚÔ Ê˘ÛÈÔÏÔÁÈÎfi ¢¡ (21). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ô ¤ÏÂÁ¯Ô˜ (ÎÏÈÓÈÎfi˜ Î·È ÓÔËÙÈÎfi˜) ¤ÁÈÓ Û ÌÂÁ¿ÏË ÔÌ¿‰· ·È‰ÈÒÓ Ì ȉÈÔ·ı›˜ ÂÛÙȷΤ˜ ÂÈÏË„›Â˜ Ì ÌÔÓÔıÂÚ·›· Ì ÔÍηڂ·˙Â›ÓË (OXC) ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. ∆· ·ÔÙÂϤÛÌ·Ù· ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ ÚÈÓ ÙË ¯ÔÚ‹¶·È‰È·ÙÚÈ΋ 2005;68:112-118

1Ë ÂͤٷÛË mean (SD)

2Ë ÂͤٷÛË mean (SD)

p

97,78 (17,33) 98,39 (18,19)

104,72 (14,94) 102,50 (10,61)

<0,030 NS

87,22 (11,01)

92,22 (10,03)

NS

83,61 (11,35)

89,72 (12,77)

<0,043

83,89 (13,99)

87,22 (13,42)

NS

93,89 (15,86) 95,83 (15,55) 98,11 (18,19)

92,50 (8,45) 98,33 (14,95) 105,61 (17,67)

NS NS <0,048

90,56 (21,27)

98,89 (12,19)

<0,047

85,00 (15,72)

83,61 (19,01)

NS

90,00 (13,93)

92,00 (26,95)

NS

86,67 (18,63)

98,33 (20,44)

<0,033

86,67 (18,63)

95,56 (15,52)

NS

ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ›¯Â Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ (35/43 ·È‰È¿ ›¯·Ó °ÂÓÈÎfi ¢¡ >90) Î·È fiÙÈ ‰ÂÓ ÂËÚ¿˙ÔÓÙ·È Î·Ù¿ ηÓfiÓ· ÔÈ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Ô˘ ¤¯Ô˘Ó Û¯¤ÛË ¿ÌÂÛ· Ì ÙË Û¯ÔÏÈ΋ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ. ∆Ô Û˘Ì¤Ú·ÛÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ÂΛӷ Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ (7,23-25). ∂›Û˘, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È ÙˆÓ ·ÛıÂÓÒÓ ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ·ÁˆÁ‹˜. ™Â Ì›· ‰ÈÏ‹ Ù˘ÊÏ‹ ÌÂϤÙË ÂϤÁ¯ıËÎ·Ó ÔÈ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Û 12 ˘ÁÈ›˜ ÂıÂÏÔÓÙ¤˜ Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙË Ï‹„Ë OXC, Û ‰fiÛÂȘ ÙˆÓ 150 mg, 300 mg Î·È 600 mg/Ë̤ڷ, ·Ú¿ÏÏËÏ· Ì placebo. ™Â Î·Ó¤Ó·Ó ·fi ÙÔ˘˜ ÂıÂÏÔÓÙ¤˜ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È·Ù·Ú·¯¤˜ Ù˘ ·ÓÙ›Ï˄˘, Ù˘ ÁÚ·Ê‹˜ Î·È ÙÔ˘ ÂÈ¤‰Ô˘ ÂÁÚ‹ÁÔÚÛ˘ (24). ™Â ‰ÈÏ‹ Ù˘ÊÏ‹ Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË Ì ÌÔÓÔıÂÚ·›· Ì OXC Î·È ˘‰·ÓÙÔ˝ÓË Û 29 ·ÛıÂÓ›˜, ¤Ó·Ó ¯ÚfiÓÔ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ·Ú·¿Óˆ Ê·ÚÌ¿ÎˆÓ ‰ÂÓ ‚Ú¤ıËΠ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô Ê·ÚÌ¿ÎˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ „˘¯ÔÎÈÓËÙÈΤ˜ ÂȉfiÛÂȘ, ÙË ÌÓ‹ÌË Î·È ÙËÓ ÚÔÛÔ¯‹ (25). ™Â ¿ÏÏË ÂÚÁ·Û›· Ô˘ ¤ÁÈÓ Û 10 ·ÛıÂÓ›˜ Ì ıÂÚ·›· Ì OXC (960 mg/Ë̤ڷ) ‰ÂÓ ·Ú·ÙËÚ‹ıËΠη̛· ‰È·ÊÔÚ¿ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ ÚÈÓ Î·È ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË (12). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Û‡Ìʈӷ Ì ÙÔ WISC-III, ÔÈ ·ÛıÂÓ›˜ 14 Ì‹Ó˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·ÓÙÈÂÈÏËÙÈ΋˜ ·ÁˆÁ‹˜ ‚ÂÏÙ›ˆÛ·Ó ÛËÌ·ÓÙÈο ÙËÓ ÈηÓfiÙËÙ· ¯ÂÈÚÈÛÌÔ‡ ·ÊËÚËÌ¤ÓˆÓ ÂÓÓÔÈÒÓ Î·È ÙË ‰È·ÏÔÁÈÛÙÈ΋ ÈηÓfiÙËÙ·. ∏ ÌÈÎÚ‹ ·˘Ù‹ ‚ÂÏÙ›ˆÛË ‰ÂÓ ÌÔÚ› Ó·

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·117

117

∂ÛÙȷΤ˜ ÂÈÏË„›Â˜ Î·È ÔÍηڂ·˙Â›ÓË

·Ô‰Ôı› ÛÙÔ Ê¿ÚÌ·ÎÔ, ηıÒ˜ ÂÍËÁÂ›Ù·È ·fi ÙË ÁÓˆÛÙÈ΋ ˆÚ›Ì·ÓÛË Ô˘ Û˘ÓÙÂÏÂ›Ù·È Ì ÙË ‚ÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ οı ·È‰ÈÔ‡.

OÈ Tich Î·È Pereon (3) ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Ù· ∞∂º Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÌÔÓÔıÂÚ·›· (ÂÎÙfi˜ ·fi ÙË Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË) ‰ÂÓ ÂËÚ¿˙Ô˘Ó ÙË ÁÓˆÛÙÈ΋ Î·È ‚ÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡. ™Â ¿ÏÏË ÌÂϤÙË fiÔ˘ ¯ÔÚËÁ‹ıËΠÌÔÓÔıÂÚ·›· Û ÌÂÁ¿ÏÔ ‰Â›ÁÌ· ·ÛıÂÓÒÓ Ì ÂÛÙȷ΋ ÂÈÏË„›· (Ê·ÈÓ˘ÙÔ˝ÓË, ηڂ·Ì·˙Â›ÓË Î·È ÔÍηڂ·˙Â›ÓË), ÔÈ ÂÚ¢ÓËÙ¤˜ η٤ÏËÍ·Ó fiÙÈ Ë ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó ʷÈÓ˘ÙÔ˝ÓË ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÛÙËÓ ÈηÓfiÙËÙ· Ù˘ ÏÂÎÙÈ΋˜ ·ÔÌÓËÌfiÓ¢Û˘ Î·È ÛÙËÓ ÈηÓfiÙËÙ· ÚÔÛÔ¯‹˜ Î·È Û˘ÁΤÓÙÚˆÛ˘, Û ۇÁÎÚÈÛË Ì ÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï¿Ì‚·Ó·Ó OXC (22). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Û‡Ìʈӷ Ì ÙÔ ÙÂÛÙ BenderSantucci, ÔÈ ·ÛıÂÓ›˜ ÚÈÓ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ·ÁˆÁ‹˜ ›¯·Ó Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ‰˘ÛÎÔϛ˜ ÛÙËÓ ÈηÓfiÙËÙ· ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ Î·È ‰˘ÛÎÔϛ˜ Ï¢ڛˆÛ˘. ∞˘Ù¤˜ ÌÔÚ› Ó· ·Ô‰ÔıÔ‡Ó ÙfiÛÔ ÛÙËÓ ÂÈÏË„›· fiÛÔ Î·È Û ÓÔËÙÈ΋ ·ÓˆÚÈÌfiÙËÙ· (26-28). ™ÙÔ˘˜ 14 Ì‹Ó˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‚ÂÏÙÈÒıËÎ·Ó ÔÈ ÂȉfiÛÂȘ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi, ÛÙËÓ ·ÓÙÈÏËÙÈ΋ ÔÚÁ¿ÓˆÛË, ÛÙËÓ ÔÙÈÎÔ-¯ˆÚÈ΋ ÈηÓfiÙËÙ· Î·È ÛÙËÓ ÔÙÈ΋ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË. ∏ ‚ÂÏÙ›ˆÛË ·Ô‰›‰ÂÙ·È ÛÙËÓ ËÏÈÎȷ΋ ÂͤÏÈÍË, ÛÙË ÓÔËÙÈ΋ ˆÚ›Ì·ÓÛË ÙˆÓ ·È‰ÈÒÓ Î·È ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛˆÓ.

OÈ Picirilli Î·È Û˘Ó (8,22) ÛÙȘ ÌÂϤÙ˜ ÙÔ˘˜ Û ·È‰È¿ Ì ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· ‰È·›ÛÙˆÛ·Ó fiÙÈ Û ÂÛÙȷΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ËÌÈÛÊ·ÈÚ›Ô˘ ˘¿Ú¯Ô˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ·ÓÙÈÏËÙÈ΋ ÈηÓfiÙËÙ·, ·’ fi,ÙÈ Û ÂÛÙȷΤ˜ ÙÔ˘ ‰ÂÍÈÔ‡ ËÌÈÛÊ·ÈÚ›Ô˘ ‹ ·ÌÊÔÙÂÚfiÏ¢Ú˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·Ú·ÙËÚ‹ıËΠfiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÌÂÛË Û˘Û¯¤ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÂÛÙ›· Ù˘ ÂÈÏËÙÈ΋˜ ÎÚ›Û˘ Î·È ÛÙËÓ ÈηÓfiÙËÙ· ÁÓˆÛÙÈ΋˜ ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ÂÚÂıÈÛÌ¿ÙˆÓ. øÛÙfiÛÔ, ·Ú·ÙËÚÂ›Ù·È Ì›· Ù¿ÛË Ù· ·È‰È¿ Ì ÂÛÙ›· ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙËÓ ÈηÓfiÙËÙ· ÁÈ· ·Ó·Ï˘ÙÈÎfi, ÛÂÈÚÔıÂÙÈÎfi Î·È ÏÔÁÈÎfi ÙÚfiÔ ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ, ‰ÈÂÚÁ·Û›· ÁÈ· ÙËÓ ÔÔ›· ˘‡ı˘ÓÔ Â›Ó·È ÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ÂÓ‰Ô·ÙÔÌÈÎÒÓ ‰È·ÊÔÚÒÓ Ì ‚¿ÛË ÙÔ ∞ıËÓ¿ ∆ÂÛÙ ¤‰ÂÈÍ fiÙÈ 6/43 ·ÛıÂÓ›˜ ›¯·Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜. ∞˘Ù‹ Ë ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘Û›·˙ ÛËÌ·ÓÙÈΤ˜ ‰˘ÛÎÔϛ˜ ÛÙË ‰È¿ÎÚÈÛË ÁÚ·ÊËÌ¿ÙˆÓ, ÛÙË ‰È¿ÎÚÈÛË Î·È Û‡ÓıÂÛË ÊıfiÁÁˆÓ, ÛÙȘ ÁψÛÛÈΤ˜ ·Ó·ÏÔÁ›Â˜, ÛÙË ÌÓ‹ÌË ·ÚÈıÌÒÓ Î·È ÂÈÎfiÓˆÓ, ÛÙËÓ ÈηÓfiÙËÙ· ÁÈ· Ì·ıËÌ·ÙÈÎÔ‡˜ Û˘ÏÏÔÁÈÛÌÔ‡˜ Î·È ÛÙË ÏÔÁÈ΋ ·Ê·ÈÚÂÙÈ΋ ÛΤ„Ë. ∂›Û˘, 3 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ›¯·Ó ‰˘ÛÎÔϛ˜ Ï¢ڛˆÛ˘ Î·È ÔÙÈÎÔ-ÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡. ¶·Úfi-

ÌÔȘ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ·Ó·Ê¤ÚÔÓÙ·È Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Û ·È‰È¿ Ì ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· (5,6,9,10,26,28-30). ∂ÈϤÔÓ, ·Ú·ÙËÚ‹ıËÎ·Ó ‰˘ÛÎÔϛ˜ ÛÙË Ì·ÎÚfi¯ÚÔÓË ÌÓ‹ÌË, ÔÈ Ôԛ˜ Èı·ÓfiÓ ‰ÈηÈÔÏÔÁÔ‡ÓÙ·È ·fi Ù· ¯·ÌËÏ¿ ΛÓËÙÚ· Â›Ù¢Í˘ Î·È ÙË Û¯ÔÏÈ΋ ·‰È·ÊÔÚ›·. ∆· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘Û›·˙·Ó ‰˘ÛÎÔϛ˜ ÛÙËÓ ÔÙÈ΋ ‚Ú·¯‡¯ÚÔÓË ÌÓ‹ÌË, ÛÙËÓ ÔÙÈ΋ ÛÂÈÚÔı¤ÙËÛË Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ‰˘ÛÎÔÏ›· ÛÙËÓ ·ÓÙ›ÏË„Ë Ù˘ ¤ÓÓÔÈ·˜ ÙÔ˘ ¯ÚfiÓÔ˘. ™Â 2 ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ÂÌÊ¿ÓÈ˙·Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ‰È·ÁÓÒÛÙËΠ‰È·Ù·Ú·¯‹ Ù˘ ·Ó¿ÁÓˆÛ˘ (Ù‡Ô˘ ‰˘ÛÏÂÍ›·˜) Î·È Û˘ÛÙ‹ıËΠÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ Ó· ·Ú·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÂȉÈÎfi ÂÎ·È‰Â˘ÙÈÎfi ÚfiÁÚ·ÌÌ·. £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ fiÏ· Ù· ·È‰È¿ Ì ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ›¯·Ó Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘. ∏ ÂÊ·ÚÌÔÁ‹ ·ÍÈfiÈÛÙˆÓ „˘¯ÔÌÂÙÚÈÎÒÓ ‰ÔÎÈÌ·ÛÈÒÓ, ÛÙ·ıÌÈÛÌ¤ÓˆÓ ÛÙÔÓ ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi, ¤‰ˆÛ ÙË ‰˘Ó·ÙfiÙËÙ· ÁÈ· ÏÂÙÔÌÂÚ‹ ¤ÏÂÁ¯Ô ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Û ·È‰È¿ Ì ÂÛÙȷΤ˜ ÂÈÏË„›Â˜. ∏ ÁÓˆÛÙÈ΋ Î·È Ì·ıËÛȷ΋ ÂÎÙ›ÌËÛË ·Ó¤‰ÂÈÍ ̷ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Û 6 ·È‰È¿ ·fi ÙËÓ ÔÌ¿‰· ÙˆÓ ·ÛıÂÓÒÓ Î·È Û 3 ·fi ÙËÓ ÔÌ¿‰· ÙˆÓ Ì·ÚÙ‡ÚˆÓ. ∞˘Ù¤˜, Û‡Ìʈӷ Ì ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ‰ÂÓ Â›¯·Ó ¿ÌÂÛË Û¯¤ÛË Ì ÙËÓ ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Î·È ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ Ì·ıËÙÈÎÔ‡ ÏËı˘ÛÌÔ‡. ∏ ‰È¿ÁÓˆÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ ·˘ÙÒÓ Û˘Ó¤‚·Ï ÛÙËÓ ÂÓË̤ڈÛË Î·È Î·ıÔ‰‹ÁËÛË ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Î·È ÛÙËÓ „˘¯ÔÏÔÁÈ΋ ÂÓ›Û¯˘Û‹ ÙÔ˘˜. ¶·Ú·Ì¤ÓÂÈ Ô ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÛÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ· ÁÈ· ηıȤڈÛË Ì›·˜ ÛÙÚ·ÙËÁÈ΋˜ ÂϤÁ¯Ô˘ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Ì¤Û· ·fi „˘¯ÔÌÂÙÚÈΤ˜ ‰ÔÎÈ̷ۛ˜ Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ì ÂÛÙȷΤ˜ Î·È È‰ÈÔ·ı›˜ ÂÈÏË„›Â˜, Ì ÛÙfi¯Ô Ó· ‰È·ÁÓˆÛÙÔ‡Ó ÚÒÈÌ· Î·È Ó· ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ·ÔÙÂÏÂÛÌ·ÙÈο.

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2. Meador KJ, Loring DW, Huh K, Gallagher BB, King DW. Comparative cognitive effects of anticonvulsants. Neurology 1990;40:391-394.

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Cognitive functions in children with focal epilepsy and long-term oxcarbazepine therapy M. Tzitiridou1, T. Panou1, E. Pavlidou1, G. Arsos2, A. Makavos3, E. Michaletou3, C. Panteliadis1

Abstract Background: Children with epilepsy function quite satisfactorily with appropriate antiepileptic therapy, but they are reported to be at risk of developing cognitive disabilities.

Methods: This study was conducted during the period 1998-2002 in order to evaluate the effect of oxcarbazepine (OXC) on the cognitive function of school-age children with new onset epilepsy. This study included 43 children aged 6-14 years, suffering from either simple idiopathic or focal epilepsy, and 45 matched controls. Cognitive functions were evaluated by two tests: a) WISC-III, and b) Bender-Santucci.

The patients and the children in the control group were examined neurologically, both clinically and by CT, MRI imaging, with normal findings. All the tests were performed at the beginning of the study and repeated after 14 months, during which the children with epilepsy were being treated with OXC. No differences were found between the patients and the control group on IQ evaluation pre-treatment.

Results: Six of the 43 patients and three of the 45 children in the control group had learning disabilities.

These children had deficits in computational skill and in visual short-term memory and had poor reading skills. Scores for total, verbal and performance IQ of the children with learning disabilities were within the normal range. At re-examination 14 months later both groups showed improvement in logical abstract thinking and in verbal comprehension, which are dependent on cognitive and mental maturation. These findings show that OXC does not effect long-term acquisition and information retrieval. The BenderSantucci test showed increase in the opticokinetic perception, as the children became familiar with the test.

1 3rd Paediatric Clinic of Aristotle University, Ippokration General Hospital, Thessaloniki 2 Laboratory of Nuclear Medicine, Aristotle University, Ippokration General Hospital, Thessaloniki 3 Learning Disabilities Medical Service, Ippokration General Hospital, Thessaloniki Correspondence: Christos Panteliadis 4 K. Palama str., 551 33, Thessaloniki Date of submission: 17-10-2003 Date of approval: 18-01-2005

Conclusions: In summary, no effect of OXC on cognitive function was detected. Learning disabilities in a few children were unrelated occurrences.

Key words Epilepsy, oxcarbazepine, cognitive functions, learning disabilities.

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∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË ∂. ∞ÔÛÙfiÏÔ˘1, ∂. °·Ï·Ó¿Î˘1, °. µÏ·¯¿ÎË2, ™. ™ÙÂÊ·Ó¿ÎË3, ™. ª·Ú¿ÎË4, ∂. ∫fiÎÔÚË2, ∞. ∆ÛÈÏÈÌÈÁοÎË3, †™. ™Ì˘Ú¿ÎȘ1,5

¶ÂÚ›ÏË„Ë 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ 2 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ 3 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ 4 ∂ÚÁ·ÛÙ‹ÚÈÔ µ·ÎÙËÚÈÔÏÔÁ›·˜¶·Ú·ÛÈÙÔÏÔÁ›·˜∑ˆÔÓfiÛˆÓ Î·È °ÂˆÁÚ·ÊÈ΋˜ π·ÙÚÈ΋˜, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ 5 ª∂£ ¶·›‰ˆÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∏Ú·ÎÏ›Ԣ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘ ∆Ì‹Ì· π·ÙÚÈ΋˜, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ∆.£. 2208, T.K. 710 03, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: egalanak@med.uoc.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-10-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 10-01-2005

∂ÈÛ·ÁˆÁ‹: O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ·ÔÙÂÏ› Ì›· ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÌËÓÈÁÁ›Ùȉ·˜ Î·È ‚·ÎÙËÚÈ·ÈÌ›·˜ Î·È ·Ú¿ ÙȘ ·‰È·ÌÊÈÛ‚‹ÙËÙ˜ ıÂÚ·¢ÙÈΤ˜ ÚÔfi‰Ô˘˜, ÂÍ·ÎÔÏÔ˘ı› Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ˘„ËÏ‹ ıÓËÙfiÙËÙ·. ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ Ì·ÎÚÔ¯ÚfiÓÈˆÓ Ù¿ÛÂˆÓ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÛÙËÓ ∫Ú‹ÙË. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó Ù· ÂȉËÌÈÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ 67 ·È‰ÈÒÓ ·fi ÙÔ˘˜ ÓÔÌÔ‡˜ ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏ›Ԣ Î·È §·ÛÈı›Ô˘ Ô˘ ÓÔÛËχÙËÎ·Ó Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ Û ÙÚÂȘ ¶·È‰È·ÙÚÈΤ˜ ∫ÏÈÓÈΤ˜ Î·È Ì›· ª∂£ ¶·›‰ˆÓ, ηٿ ÙÔ ‰È¿ÛÙËÌ· ÙˆÓ 13 ÂÙÒÓ 1990-2002. ∏ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ·fi 1 ÌËÓfi˜ ¤ˆ˜ 13 ÂÙÒÓ (̤ÛË ËÏÈΛ· 4,66 ¤ÙË). ∞ÔÙÂϤÛÌ·Ù·: ªÂÁ·Ï‡ÙÂÚË ÓÔÛËÚfiÙËÙ· ÛËÌÂÈÒıËΠÙÔ˘˜ ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜. ∏ ̤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ‹Ù·Ó 5,54/100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ ηÈ, ·Ó·Ï˘ÙÈÎfiÙÂÚ·, ÁÈ· ÙÔ˘˜ ÓÔÌÔ‡˜ ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏ›Ԣ Î·È §·ÛÈı›Ô˘ ‹Ù·Ó 7,85/100.000, 5,26/100.000 Î·È 4,23/100.000 ÏËı˘ÛÌÔ‡, ·ÓÙ›ÛÙÔȯ·. ∏ Â›ÙˆÛË ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚË ÛÙ· ‚Ú¤ÊË, fiÔ˘ ÂÈÎÚ·ÙÔ‡ÛÂ Ë ÔÚÔÔÌ¿‰· µ. ∞fi Ù· 29 ÂÚÈÛÙ·ÙÈο ÛÙ· ÔÔ›· ¤ÁÈÓÂ Ù˘ÔÔ›ËÛË ÙÔ˘ ÛÙÂϤ¯Ô˘˜, Ù· 14 (48%) ·Ô‰fiıËÎ·Ó ÛÙËÓ ÔÚÔÔÌ¿‰· µ Î·È ¿ÏÏ· 12 (41,3%) ÛÙËÓ ÔÚÔÔÌ¿‰· C. ¢È·ÈÛÙÒıËÎ·Ó ‰‡Ô ÂÚ›Ô‰ÔÈ ·˘ÍË̤Ó˘ Â›ÙˆÛ˘, Ë ÚÒÙË Î·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999 Ì ÂÈÎÚ¿ÙËÛË Ù˘ ÔÚÔÔÌ¿‰·˜ C Î·È Ë ‰Â‡ÙÂÚË ÙÔ 2002 Ì ÂÈÎÚ¿ÙËÛË Ù˘ ÔÚÔÔÌ¿‰·˜ µ. ∏ ıÓËÙfiÙËÙ· ·Ó‹Ïı ÛÙÔ 9% ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ Û˘Û¯¤ÙÈÛË Ì οÔÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÔÚÔÔÌ¿‰·. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ˘ÔÏÔÁ›ÛÈÌË ÓÔÛËÚfiÙËÙ· Î·È ıÓËÙfiÙËÙ· ÛÙÔ˘˜ ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘ ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘. ∏ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ÙˆÓ Ù¿ÛÂˆÓ Ù˘ Â›ÊԂ˘ ·˘Ù‹˜ Ïԛ̈͢ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙË ÛˆÛÙ‹ ¯Ú‹ÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ.

§¤ÍÂȘ ÎÏÂȉȿ ∂Ì‚fiÏÈ·, ÂȉËÌÈÔÏÔÁ›·, ∫Ú‹ÙË, ÌËÓÈÁÁ›Ùȉ·, ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜.

∂ÈÛ·ÁˆÁ‹ O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ (Neisseria meningitidis) ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ·ÈÙ›· ÌËÓÈÁÁ›Ùȉ·˜ Î·È ‚·ÎÙËÚÈ·ÈÌ›·˜ ·ÁÎÔÛÌ›ˆ˜ Î·È Ë ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ÂÍ·ÎÔÏÔ˘ı› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈ΋ ıÓËÙfiÙËÙ·. ∏ ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ÙfiÛÔ Ì ÂÓ‰ËÌÈ΋ ÌÔÚÊ‹, fiÛÔ Î·È ÌÂ Û˘ÛÛˆÚ‡ÛÂȘ ÎÚÔ˘ÛÌ¿ÙˆÓ Î·È ÂȉË̛˜. ∏ ÂÙ‹ÛÈ· Â›ÙˆÛ‹ Ù˘ ˘ÔÏÔÁ›˙ÂÙ·È Û 0,9-1,5/100.000 ÏËı˘ÛÌÔ‡ ÛÙȘ ∏¶∞ Î·È 1-3/100.000 ÛÙËÓ ∂˘ÚÒË, ÂÓÒ Û οÔȘ ¯ÒÚ˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘ Êı¿ÓÂÈ ¤ˆ˜ 1025/100.000 (1-3). O ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi˜ ¤¯ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 13 ÔÚÔÔÌ¿‰Â˜, 20 ÔÚÔÙ‡Ô˘˜, 10 ÔÚÔ¸ÔÙ‡Ô˘˜ Î·È 13 ·ÓÔÛÔÙ‡Ô˘˜ (1,4). ™Â ·ÁÎfiÛÌÈ· Îϛ̷η, ÔÈ ÔÚÔÔÌ¿‰Â˜ Ô˘ ¢ı‡ÓÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ÔÈ A, ¶·È‰È·ÙÚÈ΋ 2005;68:120-126

B, C, Y Î·È W135 Ì ÁˆÁÚ·ÊÈΤ˜, ÂԯȷΤ˜ Î·È ËÏÈÎȷΤ˜ ‰È·ÊÔÚÔÔÈ‹ÛÂȘ (5,6). ™ÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, Ë ÓfiÛÔ˜ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙȘ ÔÚÔÔÌ¿‰Â˜ µ Î·È C, ÂÓÒ Ë ÔÚÔÔÌ¿‰· ∞ Î·È ÚÔÛÊ¿Ùˆ˜ ÔÈ Y Î·È W135 ΢ÚÈ·Ú¯Ô‡Ó ÛÙȘ ¯ÒÚ˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘ (2,4,6). ∏ ÓfiÛÔ˜ Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙ· ‚Ú¤ÊË (7). ∏ ıÓËÙfiÙËÙ·, ·Ú¿ ÙËÓ ‡·ÚÍË ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ, ÔÈΛÏÏÂÈ ·fi 6% ¤ˆ˜ 21% Î·È Û ÂÚÈÙÒÛÂȘ Ô˘ Ë ÓfiÛÔ˜ Û˘Óԉ‡ÂÙ·È ·fi ηٷÏËÍ›· ÌÔÚ› Ó· ÊÙ¿ÛÂÈ ÙÔ 20-45% (8-11). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙÔ ÂӉȷʤÚÔÓ ¤¯ÂÈ ÛÙÚ·Ê› ÛÙËÓ ÚÔÛ¿ıÂÈ· ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘ Ì ÙË ¯Ú‹ÛË ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÂÌ‚ÔÏ›ˆÓ (2,12). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ‹Ù·Ó Ë ÌÂϤÙË Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Î·È ÙˆÓ Ù¿ÛÂˆÓ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi Ù˘ ∫Ú‹Ù˘ Ù· ÙÂÏÂ˘Ù·›· 13 ¤ÙË.

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·121

121

ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ

∞ÔÙÂϤÛÌ·Ù·

∏ ÌÂϤÙË ‹Ù·Ó ·Ó·‰ÚÔÌÈ΋ Î·È ÂÚȤϷ‚ fiÏ· Ù· ‚Ú¤ÊË Î·È Ù· ·È‰È¿ ËÏÈΛ·˜ ·fi 1 ÌËÓfi˜ ¤ˆ˜ 14 ÂÙÒÓ, Ô˘ ÓÔÛËχÙËÎ·Ó Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ Î·Ù¿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 01-01-1990 ¤ˆ˜ 31-12-2002 Û ÙÚÂȘ ¶·È‰È·ÙÚÈΤ˜ ∫ÏÈÓÈΤ˜ Î·È Ì›· ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ (ª∂£) ¶·›‰ˆÓ ÛÙËÓ ∫Ú‹ÙË. ™ÙȘ ÙÚÂȘ ¶·È‰È·ÙÚÈΤ˜ ∫ÏÈÓÈΤ˜ (¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ, ∞’ Î·È µ’ µÂÓÈ˙¤ÏÂÈÔ˘ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ∏Ú·ÎÏ›Ԣ) ÓÔÛËχÔÓÙ·È ·È‰È¿ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ ·fi ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘ (ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏ›Ԣ, §·ÛÈı›Ô˘) Î·È ÛÙË ª∂£ ¶·›‰ˆÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌÈ·ÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ·È‰È¿ ·fi fiÏË ÙËÓ ∫Ú‹ÙË. ∏ ÌÂϤÙË ‰ÂÓ Û˘ÌÂÚȤϷ‚ ÓÂÔÁÓ¿, Ô‡Ù ·È‰È¿ Ô˘ ÓÔÛËχÙËÎ·Ó ÌÂÓ ÛÙ· ·Ú·¿Óˆ ∆Ì‹Ì·Ù·, ·ÏÏ¿ ‰ÂÓ ‹Ù·Ó οÙÔÈÎÔÈ ÙˆÓ ÙÚÈÒÓ ·˘ÙÒÓ ÓÔÌÒÓ Ù˘ ∫Ú‹Ù˘. ∫·Ù¿ Ù· ÙÂÏÂ˘Ù·›· 4 ¤ÙË Ù˘ ÌÂϤÙ˘ ¤ÁÈÓ ‰È·ÛÙ·‡ÚˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Ù˘ ÓfiÛÔ˘ Ì ٷ ÛÙÔȯ›· ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¶·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¶·Ú¤Ì‚·Û˘ (∂∫∂¶∞¶) (13). ∏ ‰È¿ÁÓˆÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ‚·Û›ÛÙËΠÛÙË Û˘Ì‚·Ù‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ·fi ¤Ó· Ê˘ÛÈÔÏÔÁÈο ÛÙ›ÚÔ ˘ÏÈÎfi, fiˆ˜ Â›Ó·È ÙÔ ·›Ì·, ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi (∂¡À) ‹ ¿ÏÏÔ ¿ÛËÙÔ ˘ÏÈÎfi, ÙËÓ ·Ó‡ÚÂÛË Gram(-) ‰ÈÏfiÎÔÎÎˆÓ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi, ÙÔÓ ıÂÙÈÎfi ÔÚÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô (Latex) Î·È Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ Ù˘ ÔÏ˘ÌÂÚ¿Û˘ (polymerase chain reaction PCR) ÙÔ˘ ∂¡À ‹ ÙÔ˘ ·›Ì·ÙÔ˜ (14,15). ªËÓÈÁÁ›Ùȉ· ÔÚ›ÛÙËÎÂ Ë ·ÚÔ˘Û›· >10 Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ηÈ/‹ ·ԉ‰ÂÈÁ̤ÓË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·fi ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡˜, fiˆ˜ ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· ∂¡À, ıÂÙÈ΋ PCR, gram-¯ÚÒÛË ÙÔ˘ ∂¡À ‹ ·Ó›¯Ó¢ÛË ÙÔ˘ ·ÓÙÈÁfiÓÔ˘ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡. ™ÙË ÌÂϤÙË Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó Î·È 4 ·È‰È¿ Ì ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘, ‰ËÏ·‰‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Û‹„˘ ‹ ÌËÓÈÁÁ›Ùȉ·˜ Ì ÙÔ Ù˘ÈÎfi ·ÈÌÔÚÚ·ÁÈÎfi-ÂÙ¯ÂÈ҉˜ ÂÍ¿ÓıËÌ·, ·ÏÏ¿ ¯ˆÚ›˜ Ù·˘ÙÔÔ›ËÛË Ô‡Ù ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Ô‡Ù ¿ÏÏÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ·. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ ›¯·Ó ·ÓÙÈÌÂÙˆÈÛÙ› ÎÏÈÓÈο ·fi ¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ·ÙÚfi Ù˘ ÂÚ¢ÓËÙÈ΋˜ ÔÌ¿‰·˜. ∫·Ù·ÁÚ¿ÊËÎ·Ó Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· ÙˆÓ ·ÛıÂÓÒÓ, ÔÈ ÔÚÔÔÌ¿‰Â˜ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Ô˘ ·ÔÌÔÓÒıËÎ·Ó Î·È Ë ¤Î‚·ÛË Ù˘ ÓfiÛÔ˘ ÙˆÓ ·ÛıÂÓÒÓ. °È· ÙÔÓ ˘ÔÏÔÁÈÛÌfi Ù˘ Â›ÙˆÛ˘ ÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ·È‰ÈÒÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· ·ÓÙ›ÛÙÔȯ· ‰È¿ÌÂÛ· ÏËı˘ÛÌȷο ‰Â‰Ô̤ӷ Ì ‚¿ÛË ÙȘ ·ÔÁڷʤ˜ ÙÔ˘ 1991 Î·È ÙÔ˘ 2001. °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù· 95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘ ÁÈ· ÙË ÌÂϤÙË Ù˘ Â›ÙˆÛ˘ Î·È Ë ‰ÔÎÈÌ·Û›· ¯2 ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÔÈÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ.

∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô 01-01-1990 ¤ˆ˜ 3112-2002 ηٷÁÚ¿ÊËÎ·Ó 67 Û˘ÓÔÏÈο ÂÚÈÙÒÛÂȘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È §·ÛÈı›Ô˘. ∏ ̤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË ÁÈ· ÙÔ˘˜ ÙÚÂȘ ·˘ÙÔ‡˜ ÓÔÌÔ‡˜ ˘ÔÏÔÁ›ÛÙËΠ۠5,54/100.000 ·È‰ÈÎÔ‡ ÏËı˘ÛÌÔ‡ (¶›Ó·Î·˜ 1). ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È, Â›Û˘, ÔÈ ÂÈÙÒÛÂȘ ηٿ ʇÏÔ, ËÏÈÎȷ΋ ÔÌ¿‰· Î·È ÓÔÌfi ‰È·ÌÔÓ‹˜.

OÈ ËÏÈ˘ ÙˆÓ ·È‰ÈÒÓ Î˘Ì·›ÓÔÓÙ·Ó ·fi 1 Ì‹Ó· ¤ˆ˜ 13 ¤ÙË, Ì ̤ÛË ËÏÈΛ· Ù· 4,66 ¤ÙË. ∏ ηٷÓÔÌ‹ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1. ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ ‹Ù·Ó ˘„ËÏfiÙÂÚË ÛÙ· ‚Ú¤ÊË ËÏÈΛ·˜ 1 ÌËÓfi˜ ¤ˆ˜ 1 ¤ÙÔ˘˜, (17 ÂÚÈÙÒÛÂȘ, 25,4% ÙÔ˘ Û˘ÓfiÏÔ˘) Î·È ·ÚÔ˘Û›·˙ ÂÌÊ·Ó‹ Ì›ˆÛË ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ. ∆Ô ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÔÈ ÂÚÈÙÒÛÂȘ ‚·ÎÙËÚȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙÔÓ ›‰ÈÔ ·È‰ÈÎfi ÏËı˘ÛÌfi ·fi Ó¢ÌÔÓÈfiÎÔÎÎÔ Î·È ·ÈÌfiÊÈÏÔ Ù˘ ÈÓÊÏÔ˘¤Ó˙·˜ Ù‡Ô˘ b ‹Ù·Ó 17 Î·È 14, ·ÓÙ›ÛÙÔȯ·.

O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ·ÔÌÔÓÒıËΠ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ∂¡À Û 19 (28,3%) ÂÚÈÙÒÛÂȘ Î·È ·fi ÙËÓ Î·ÏÏȤÚÁÂÈ· ·›Ì·ÙÔ˜ Û 13 (19,4%), ÂÓÒ Û 6 (8,9%) ÂÚÈÙÒÛÂȘ ·ÔÌÔÓÒıËΠÙfiÛÔ ·fi ÙȘ ηÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ fiÛÔ Î·È ∂¡À. Gram(-) ‰ÈÏfiÎÔÎÎÔ˜ ‚Ú¤ıËΠÛÙÔ ¿ÌÂÛÔ ·Ú·Û··ÛÌ· ÙÔ˘ ∂¡À Û 6 (8,9%) ÂÚÈÙÒÛÂȘ Î·È Û ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ Û 3 (4,5%). ™Â 16 ·È‰È¿ (23,9%) ÔÈ Î·ÏÏȤÚÁÂȘ ‹Ù·Ó ÛÙ›Ú˜ Î·È ÔÈ ¯ÚÒÛÂȘ ·ÚÓËÙÈΤ˜, ·ÏÏ¿ Ë PCR ·›Ì·ÙÔ˜ ‹Ù·Ó ıÂÙÈ΋. ™Â 4 (5,9%) ÂÚÈÙÒÛÂȘ ‰ÂÓ ·ÓȯÓ‡ıËΠÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜. ªÂ ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ÚÔÛ‚ÔÏ‹ ÙˆÓ ÌËÓ›ÁÁˆÓ Ì ‹ ¯ˆÚ›˜ Û‹„Ë ÂÎÙÈÌ‹ıËΠfiÙÈ ˘‹Ú¯Â ÛÙȘ 64 ÂÚÈÙÒÛÂȘ (95,5%). ∂ÎÙÈÌ‹ıËΠ·‰Ú¿ fiÙÈ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· Ì ‹ ¯ˆÚ›˜ ÌËÓÈÁÁ›Ùȉ· ›¯·Ó 42 (62,7%) ·È‰È¿. O ·Ú·¿Óˆ ˘ÔÏÔÁÈÛÌfi˜ ÂÚȤ¯ÂÈ ÙÔÓ Â˘ÓfiËÙÔ ÂÚÈÔÚÈÛÌfi fiÙÈ ÛÙË Ïԛ̈ÍË ·fi ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ Â›Ó·È Û˘¯Ó‹ Ë ÂÈÎ¿Ï˘„Ë Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ÌËÓÈÁÁ›Ùȉ·˜ Î·È ÛË„·ÈÌ›·˜. ∂Âȉ‹ ‰ÂÓ Â›Ó·È ¿ÓÙ·

¶›Ó·Î·˜ 1. ∂›ÙˆÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ Û ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘ ηٿ ÙÔ ‰È¿ÛÙËÌ· 1990-2002

™‡ÓÔÏÔ ·È‰ÈÒÓ 0-14 ÂÙÒÓ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· 0-4 ÂÙÒÓ 5-9 ÂÙÒÓ 10-14 ÂÙÒÓ ƒ¤ı˘ÌÓÔ ∏Ú¿ÎÏÂÈÔ §·Û›ıÈ

¶ÂÚÈÙÒÛÂȘ (%)

¶ÏËı˘ÛÌfi˜

∂›ÙˆÛË/100.000

95% ‰È·ÛÙ‹Ì·Ù· ÂÌÈÛÙÔÛ‡Ó˘

67 (100) 40 (60) 27 (40) 38 (56,7) 18 (26,9) 11 (16,4) 16 (23,8) 43 (64,2) 8 (12)

93.031 47.794 45.237 27.213 31.151 34.667 15.676 62.809 14.546

5,54 6,44 4,6 10,74 4,44 2,44 7,85 5,26 4,23

4,29-7,10 4,59-8,76 3,02-6,68 7,6-14,7 2,63-7,02 1,21-4,36 4,48-12,8 3,81-7,09 1,83-8,34 ¶·È‰È·ÙÚÈ΋ 2005;68:120-126

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·122

122

∂. ∞ÔÛÙfiÏÔ˘ Î·È Û˘Ó.

18 16

¶ÂÚÈÙÒÛÂȘ

14 12 10 8 6 4 2 0 1

2

3

4

5

6

7

8

9

10

11

12

13

14

∏ÏÈΛ· Û ¤ÙË ∂ÈÎfiÓ· 1. ∏ÏÈÎȷ΋ ηٷÓÔÌ‹ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ Û 67 ·È‰È¿.

‡ÎÔÏÔ˜ ·˘Ùfi˜ Ô ‰È·¯ˆÚÈÛÌfi˜, Ë Ïԛ̈ÍË ·fi ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ ·Ó·Ê¤ÚÂÙ·È ˆ˜ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ (1). ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¿ÏϘ ÂΉËÏÒÛÂȘ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘, fiˆ˜ ¯ÚfiÓÈ· ‚·ÎÙËÚÈ·ÈÌ›·. ∆˘ÔÔ›ËÛË ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ¤ÁÈÓ Û 29 (48%) ÂÚÈÙÒÛÂȘ. ∞ÓȯÓ‡ÙËÎ·Ó 14 (48,3%) ÛÙÂϤ¯Ë Ù˘ ÔÚÔÔÌ¿‰·˜ µ Î·È 12 (41,4%) Ù˘ ÔÚÔÔÌ¿‰·˜ C. ∞ÓȯÓ‡ÙËηÓ, Â›Û˘, 2 (6,9%) ÛÙÂϤ¯Ë Ù˘ ÔÚÔÔÌ¿‰·˜ ∞ Î·È 1 (3,4%) Ù˘ ÔÚÔÔÌ¿‰·˜ W135. ∏ Âԯȷ΋ ηٷÓÔÌ‹ Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ¤‰ÂÈÍ ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË Î·Ù¿ ÙÔ˘˜ ÊıÈÓÔˆÚÈÓÔ‡˜ Î·È ¯ÂÈÌÂÚÈÓÔ‡˜ Ì‹Ó˜. ∆Ô ÂÍ¿ÌËÓÔ ™Â٤̂ÚÈÔ˜-ºÂ‚ÚÔ˘¿ÚÈÔ˜ ·Ú·ÙËÚ‹ıËÎ·Ó 43 (64%) ÂÚÈÙÒÛÂȘ, ¤Ó·ÓÙÈ 20 (36%) ÂÚÈÙÒÛÂˆÓ Î·Ù¿ ÙÔ ÂÍ¿ÌËÓÔ ª¿ÚÙÈÔ˜-∞‡ÁÔ˘ÛÙÔ˜ (∂ÈÎfiÓ· 2). ∫·Ù¿ ÙÔ ‰È¿ÛÙËÌ· Ù˘ ÌÂϤÙ˘, ·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ÂÚ›Ô‰ÔÈ ·˘ÍË̤Ó˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘ (∂ÈÎfiÓ· 3), Ë ÚÒÙË Î·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999, Ì ̤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË 9,6/100.000 Î·È Ë ‰Â‡ÙÂÚË Î·Ù¿ ÙÔ ¤ÙÔ˜ 2002 fiÙ·Ó

Ë Â›ÙˆÛË ·Ó‹Ïı ÛÙÔ 19,34/100.000 ÏËı˘ÛÌÔ‡. ∫·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999, 75% ÙˆÓ Ù·˘ÙÔÔÈËÌ¤ÓˆÓ ÛÙÂϯÒÓ ·Ó‹Î ÛÙËÓ ÔÚÔÔÌ¿‰· C (∂ÈÎfiÓ· 4). ∆Ô ¤ÙÔ˜ 2002 ·fi Ù· 10 ÛÙÂϤ¯Ë Ô˘ Ù·˘ÙÔÔÈ‹ıËηÓ, 6 (60%) ·Ó‹Î·Ó ÛÙËÓ ÔÌ¿‰· µ, 2 (20%) ÛÙËÓ ÔÚÔÔÌ¿‰· C Î·È ·fi 1 ÛÙȘ ÔÌ¿‰Â˜ ∞ Î·È W135. ¶·Ú·ÙËÚ‹ıËÎ·Ó ‰È·ÊÔÚ¤˜ ÛÙËÓ Î·Ù·ÓÔÌ‹ ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰·. ™Ù· ‚Ú¤ÊË (1-12 ÌËÓÒÓ), ·fi Ù· 8 ÛÙÂϤ¯Ë Ô˘ Ù·˘ÙÔÔÈ‹ıËηÓ, Ù· 6 ·Ó‹Î·Ó ÛÙËÓ ÔÚÔÔÌ¿‰· µ, ÂÓÒ ÛÙ· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙÔ˘ 1 ¤ÙÔ˘˜ Ù·˘ÙÔÔÈ‹ıËÎ·Ó 23 ÛÙÂϤ¯Ë, ·fi Ù· ÔÔ›· ÌfiÓÔ Ù· 7 ·Ó‹Î·Ó ÛÙËÓ ÔÚÔÔÌ¿‰· µ (75% ¤Ó·ÓÙÈ 30,4%, p<0,05). ™Â 6 (8,95%) ·È‰È¿, Ë ÓfiÛÔ˜ ›¯Â ÌÔÈÚ·›· ¤Î‚·ÛË. ∆· ·È‰È¿ Ô˘ ·‚›ˆÛ·Ó ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο ηٿ Ù· ¿ÏÏ· Î·È ‰ÂÓ Â›¯Â ·Ó·ÊÂÚı› οÔÈÔ ˘ÔΛÌÂÓÔ ÓfiÛËÌ·. ∆· ·È‰È¿ Ô˘ ·‚›ˆÛ·Ó ‹Ù·Ó ËÏÈΛ·˜ 1-13 ÂÙÒÓ (̤ÛË ËÏÈΛ· 6 ¤ÙË). ∏ ıÓËÙfiÙËÙ· ‰ÂÓ Û˘Û¯ÂÙ›ÛÙËΠ̠οÔÈ· Û˘ÁÎÂÎÚÈ̤ÓË ÔÚÔÔÌ¿‰·, ·ÏÏ¿ ÔÈ 4 ·fi ÙÔ˘˜ 6 ı·Ó¿ÙÔ˘˜

14 12

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πÔ‡Ó.

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∞‡Á.

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∂ÈÎfiÓ· 2. ∂ԯȷ΋ ηٷÓÔÌ‹ ÙˆÓ 67 ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÌÂϤÙ˘. ¶·È‰È·ÙÚÈ΋ 2005;68:120-126

¢ÂÎ.

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·123

123

ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË

20 18

¶ÂÚÈÙÒÛÂȘ

16 14 12 10 8 6 4 2 0 1990

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ŒÙÔ˜ ∂ÈÎfiÓ· 3. ∫·Ù·ÓÔÌ‹ 67 ÂÚÈÙÒÛÂˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ηٿ ¤ÙÔ˜ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ∏Ú·ÎÏ›Ԣ, ƒÂı‡ÌÓÔ˘ Î·È §·ÛÈı›Ô˘, 1990-2002 (‰È·ÁÓˆÛÙÈ΋ ¯Ú‹ÛË Ù˘ PCR ÌÂÙ¿ ÙÔ 2001).

ÓÈ· Î·È ÔÈΛÏÏÂÈ ·fi 1-3/100.000 ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ¤ˆ˜ 10-25/100.000 ÏËı˘ÛÌÔ‡ ÛÙȘ ¯ÒÚ˜ ÙÔ˘ ÙÚ›ÙÔ˘ ÎfiÛÌÔ˘ (1-3). ™ÙË “˙ÒÓË Ù˘ ÌËÓÈÁÁ›Ùȉ·˜” ÛÙȘ ¯ÒÚ˜ οو ·fi ÙËÓ ¤ÚËÌÔ ™·¯¿Ú·, Ô˘ ÂÎÙ›ÓÂÙ·È ·fi ÙË ∑¿ÌÈ· ˆ˜ ÙËÓ ∞ÈıÈÔ›·, ·Ú·ÙËÚÔ‡ÓÙ·È ÂȉË̛˜ οı 8-12 ¯ÚfiÓÈ·, Ì ÙËÓ Â›ÙˆÛË Ó· ÊÙ¿ÓÂÈ ¤ˆ˜ 1.000/100.000 ÏËı˘ÛÌÔ‡ (2,6).

O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ‹Ù·Ó Ô Î‡ÚÈÔ˜ ·ÈÙÈÔÏÔÁÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ‚·ÎÙËÚȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÛÙÔ˘˜ ÙÚÂȘ ÓÔÌÔ‡˜ Ù˘ ∫Ú‹Ù˘ Ô˘ ÌÂÏÂÙ‹ıËηÓ. O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ·ÔÙÂÏÔ‡Û ÛËÌ·ÓÙÈÎfi ·›ÙÈÔ ‚·ÎÙËÚȷ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ Î·È ÛÙ· ·È‰È¿ Ù˘ ˘fiÏÔÈ˘ ∂ÏÏ¿‰·˜ Î·È Ù˘ ∂˘ÚÒ˘ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1990 Î·È ‹Ù·Ó Ì¿ÏÈÛÙ· ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ÙËÓ ÙÂÏÂ˘Ù·›· ÂÓÙ·ÂÙ›·, ÌÂÙ¿ ·fi ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙ·ÙË ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘

Û˘Ó¤‚ËÛ·Ó ÙË ‰ÈÂÙ›· 1997-1998. ∞˘Ù‹ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Ù· ·È‰È¿ Ô˘ ·‚›ˆÛ·Ó ‹Ù·Ó ËÏÈΛ·˜ 3-8 ÂÙÒÓ (̤ÛË ËÏÈΛ· 5,5 ¤ÙË) Î·È Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Î·Ó¤Ó· ·fi Ù· 4 ·È‰È¿ ‰ÂÓ Â›¯Â ÂÌ‚ÔÏÈ·ÛÙ› Ì ÙÔ ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ. ™Â ¤Ó· ·È‰› Ô˘ ·‚›ˆÛ ÙÔ 2001, ËÏÈΛ·˜ 1 ¤ÙÔ˘˜, ·ÔÌÔÓÒıËΠÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ Ù˘ ÔÌ¿‰·˜ µ. ™Ù· 5 ·fi Ù· 6 ·È‰È¿, Ô ı¿Ó·ÙÔ˜ Â‹Ïı ÌÂÙ¿ ·fi ÎÂÚ·˘ÓÔ‚fiÏÔ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË, Û ‰È¿ÛÙËÌ· Ï›ÁˆÓ ˆÚÒÓ ·fi ÙËÓ Â›ÛÔ‰Ô ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ÂÓÒ Û ¤Ó· ·È‰› ÌÂÙ¿ ·fi ‰‡Ô 24ˆÚ· ÓÔÛËÏ›·˜.

™˘˙‹ÙËÛË ∏ Â›ÙˆÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ÛËÌ·ÓÙÈο Ù· ÙÂÏÂ˘Ù·›· 30 ¯Úfi12 µ

™ÙÂϤ¯Ë ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘

10

C

A, Y, W135, ·Ù·˘ÙÔÔ›ËÙÔÈ

8 6 4 2 0 1990

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∂ÈÎfiÓ· 4. ∂Ù‹ÛÈ· ηٷÓÔÌ‹ ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘: 67 ÂÚÈÙÒÛÂȘ ÛÙÔ˘˜ ÓÔÌÔ‡˜ ƒÂı‡ÌÓÔ˘, ∏Ú·ÎÏ›Ԣ Î·È §·ÛÈı›Ô˘. ¶·È‰È·ÙÚÈ΋ 2005;68:120-126

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·124

124

∂. ∞ÔÛÙfiÏÔ˘ Î·È Û˘Ó.

Ù˘ ÁÚ›˘ Ù‡Ô˘ b (14,16-21). ∏ ˘ÔÏÔÁÈ˙fiÌÂÓË Ì¤ÛË ÂÙ‹ÛÈ· Â›ÙˆÛË ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ Â›Ó·È 10,7 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ·È‰È¿ ËÏÈΛ·˜ <14 ÂÙÒÓ (15,22). π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Ù¿ÛË ·‡ÍËÛ˘ Ù˘ ÓfiÛÔ˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™ÙËÓ ∂ÏÏ¿‰· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ Ù˘ ÓfiÛÔ˘ ·fi ÙÔ 1993-1997, ˘ÂÚ‚·›ÓÔÓÙ·˜ ÙȘ 3 ÂÚÈÙÒÛÂȘ ·Ó¿ 100.000 ÏËı˘ÛÌÔ‡ ηٿ ÙË ‰ÈÂÙ›· 1998-1999, ÂÓÒ Ë ¯ÒÚ· Ì·˜ ηٷٿÛÛÂÙ·È ÛÙȘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ ˘„ËÏ‹˜ Â›ÙˆÛ˘, Ì·˙› Ì ÙËÓ ∞ÁÁÏ›·, ÙË ™ÎˆÙ›·, ÙÔ µ¤ÏÁÈÔ, ÙËÓ OÏÏ·Ó‰›· Î·È ÙË ª¿ÏÙ· (16,17,23). ¶·Ú·Ì¤ÓÂÈ ·Ó·¿ÓÙËÙÔ ÂÚÒÙËÌ· ηٿ fiÛÔ ·˘Ù‹ Ë ·‡ÍËÛË Â›Ó·È Ú·ÁÌ·ÙÈ΋ ‹ Â›Ó·È ·fiÙÔÎÔ˜ Ù˘ ηχÙÂÚ˘ ηٷÁÚ·Ê‹˜ Î·È ÙˆÓ ‚ÂÏÙÈˆÌ¤ÓˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ, fiˆ˜ Â›Ó·È Ë PCR Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó›¯Ó¢ÛË ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ·ÎfiÌ· Î·È Û ÂÚÈÙÒÛÂȘ Ì ·ÚÓËÙÈ΋ ηÏÏȤÚÁÂÈ· (15,24,25). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Î·È ÔÈ 16 ÂÚÈÙÒÛÂȘ Ô˘ ·ÓȯÓ‡ıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË Ì PCR ‰È·ÁÓÒÛÙËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¤ÙË 2001-2002. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ·Ó·ÊÔÚ¿ ÙˆÓ ∫·ÓÈÙÛ¿ÎË Î·È Û˘Ó (19) ÁÈ· ÙË ÓÔÛËÚfiÙËÙ· ÛÙÔ ÓÔÌfi ÷ӛˆÓ, ÙÔÓ Ù¤Ù·ÚÙÔ ‰ËÏ·‰‹ ÓÔÌfi Ù˘ ∫Ú‹Ù˘, Ô˘ ‰ÂÓ ¤¯ÂÈ Û˘ÌÂÚÈÏËÊı› ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ¶ÂÚ›Ô˘ ÛÙÔ ›‰ÈÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, ÛÙÔ ÓÔÌfi ÷ӛˆÓ ηٷÁÚ¿ÊËÎ·Ó 3,9 ÎÚÔ‡ÛÌ·Ù· ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÌËÓÈÁÁ›Ùȉ·˜ ÂÙËÛ›ˆ˜ Ô˘ - Ì ‚¿ÛË ÙÔÓ ÙÔÈÎfi ·È‰ÈÎfi ÏËı˘ÛÌfi ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û Â›ÙˆÛË 13,6/100.000/¤ÙÔ˜. ∏ Â›ÙˆÛË ·˘Ù‹ Â›Ó·È Ë ˘„ËÏfiÙÂÚË ÁÈ· ÙËÓ ∫Ú‹ÙË Î·È ‰Â›¯ÓÂÈ Ì›· ·‡ÍËÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ ·fi Ù· ·Ó·ÙÔÏÈο ÚÔ˜ Ù· ‰˘ÙÈο ÙÔ˘ ÓËÛÈÔ‡. ∂ȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Ô˘ ÛÙËÚ›˙ÔÓÙ·È ÛÙË ÌÔÚȷ΋ ÁÂÓÂÙÈ΋, ‰Â›¯ÓÔ˘Ó fiÙÈ Û˘ÁÎÂÎÚÈ̤ӷ Û˘ÌϤÁÌ·Ù· ·fi ˘ÂÚÏÔÈÌÔÁfiÓ· ÛÙÂϤ¯Ë ¤¯Ô˘Ó ÚÔηϤÛÂÈ ÂȉË̛˜ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· (2). ¶ÚfiÛÊ·Ù· ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÂȉË̛˜ ·fi ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ Ù˘ ÔÌ¿‰·˜ ∞ ÛÙȘ ¯ÒÚ˜ Ù˘ ∞ÊÚÈ΋˜, ηıÒ˜ Î·È ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙËÓ ÔÚÔÔÌ¿‰· W135 Û ÚÔÛ΢ÓËÙ¤˜ ÛÙË ª¤Îη (1,2,4). Œ¯ÂÈ, Â›Û˘, ÂÚÈÁÚ·Ê› ˘ÂÚÂÓ‰ËÌÈ΋ Î·È ÂÓ‰ËÌÈ΋ ÓfiÛÔ˜ ·fi ÛÙÂϤ¯Ë Ù˘ ÔÚÔÔÌ¿‰·˜ µ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙÔ Û‡ÌÏÂÁÌ· ∂∆-5. ∆Ë ‰ÂηÂÙ›· ÙÔ˘ 1990 ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙËÓ ÔÚÔÔÌ¿‰· C ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ∂∆-37, Ë ÔÔ›· ÂÌÊ·Ó›ÛÙËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙÔÓ ∫·Ó·‰¿ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Û fiÏÔ ÙÔÓ ÎfiÛÌÔ (15,26). ™ÙËÓ ∫Ú‹ÙË ·Ú·ÙËÚ‹ıËÎ·Ó ‰‡Ô ·̷ٷ ·˘ÍË̤Ó˘ Â›ÙˆÛ˘. ∫·Ù¿ ÙË ‰ÈÂÙ›· 1998-1999 ÂÈÎÚ¿ÙËÛÂ Ë ÔÚÔÔÌ¿‰· C. ∆ËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô, Û‡Ìʈӷ Ì ٷ ‰Â‰Ô̤ӷ ÙÔ˘ ∫¤ÓÙÚÔ˘ ∞Ó·ÊÔÚ¿˜ ªËÓÈÁÁ›Ùȉ·˜, ‰È·ÈÛÙÒıËΠ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ Ïԛ̈͢ Û fiÏË ÙËÓ ∂ÏÏ¿‰·, Ô˘ ÔÊÂÈÏfiÙ·Ó ÛÙËÓ ÔÚÔÔÌ¿¶·È‰È·ÙÚÈ΋ 2005;68:120-126

‰· C Î·È È‰È·›ÙÂÚ· ÛÙÔ˘˜ ÔÚÔÙ‡Ô˘˜ 2a:P1,2 Î·È P1,5 ÙÔ˘ Û˘ÌϤÁÌ·ÙÔ˜ ∂∆-15/∂∆-37 (15,17,18, 26,27). ∞˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· Ù˘ ÔÚÔÔÌ¿‰·˜ C ·Ú·ÙËÚ‹ıËÎÂ Î·È Û ¿ÏϘ ÂÚÈÔ¯¤˜ Ù˘ ∂˘ÚÒ˘ Î·È Ù˘ ∞ÌÂÚÈ΋˜ ηٿ ÙË ‰ÂηÂÙ›· ÙÔ˘ 1990 (26,28,29), ˆÛÙfiÛÔ Û ¿ÏϘ ¯ÒÚ˜, fiˆ˜ Ë πÙ·Ï›·, ·Ú·ÙËÚ‹ıËΠÂÈÎÚ¿ÙËÛË Ù˘ ÔÚÔÔÌ¿‰·˜ µ (30). ∫·Ù¿ ÙË ¯ÚÔÓÈ΋ ·˘Ù‹ ÂÚ›Ô‰Ô, Ó¤ÔÈ ÔÚfiÙ˘ÔÈ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ·ÔÌÔÓÒıËÎ·Ó ÙfiÛÔ ÛÙËÓ ∂ÏÏ¿‰· fiÛÔ Î·È ÛÙËÓ ∆Û¯›· Î·È ÙËÓ ∞ÁÁÏ›· Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ô ÎÏÒÓÔ˜ ∂∆-15 Ô˘ ÚÔ‹Ïı ·fi ÙÔ Û٤ϯԘ ∂∆-37 (4,15,17,31). ™ÙË ‰Â‡ÙÂÚË ¤Í·ÚÛË Ù˘ ÓfiÛÔ˘, ηٿ ÙÔ ¤ÙÔ˜ 2002, ·Ú·ÙËÚ‹ıËΠۯÂÙÈ΋ ÂÈÎÚ¿ÙËÛË Ù˘ ÔÚÔÔÌ¿‰·˜ µ, ·ÏÏ¿ Î·È ·ÔÌfiÓˆÛË, ÁÈ· ÚÒÙË ÊÔÚ¿, Ù˘ ÔÚÔÔÌ¿‰·˜ W135 Î·È ÌË Ù˘ÔÔÈ‹ÛÈÌˆÓ ÛÙÂϯÒÓ. ∞˘Ù‹ Ë ·‡ÍËÛË Ù˘ Â›ÙˆÛ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ Î·Ù¿ fiÛÔ Â›Ó·È Ú·ÁÌ·ÙÈ΋ ‹ ÔÊ›ÏÂÙ·È ÛÙËÓ Î·Ï‡ÙÂÚË Î·Ù·ÁÚ·Ê‹ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ, ·ÊÔ‡ ·fi ÙÔ ¤ÙÔ˜ 2001 ÂÊ·ÚÌfi˙ÂÙ·È Ë Ì¤ıÔ‰Ô˜ PCR. ∆· ÂÚÈÛÙ·ÙÈο Ì ÌË Ù˘ÔÔÈ‹ÛÈÌ· ÛÙÂϤ¯Ë, ηıÒ˜ Î·È ·˘Ù¿ Ù˘ ÔÌ¿‰·˜ W135 ‰È·ÁÓÒÛÙËÎ·Ó Ì ÙË Ì¤ıÔ‰Ô PCR (15). ªÂÙ¿ ÙËÓ ¤Í·ÚÛË Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÙË ‰ÈÂÙ›· 1998-1999, ·Ú·ÙËÚ‹ıËΠÛÙËÓ ∂ÏÏ¿‰· ·‡ÍËÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ÙÔ ˘¿Ú¯ÔÓ ÙfiÙ ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ C. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÌÂϤÙ˘ ˘ÔÏÔÁ›ÛÙËΠfiÙÈ ÛÙËÓ ·Ú¯‹ ÙÔ˘ 1999 ÙÔ 31% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 2-6 ÂÙÒÓ Î·È ÙÔ 52% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 7-14 ÂÙÒÓ Â›¯·Ó Ï¿‚ÂÈ ÙÔ ·Ïfi ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ (A+C) (33). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi Û˘Ó‰˘¿ÛÙËΠ̠ÛËÌ·ÓÙÈ΋ ÂÏ¿ÙÙˆÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ·˘Ù‹ ÙËÓ ÔÚÔÔÌ¿‰· ÛÙ· ÂfiÌÂÓ· ¤ÙË, ÙfiÛÔ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹ fiÛÔ Î·È Û ¿ÏϘ ¯ÒÚ˜ Ù˘ ∂˘ÚÒ˘ (16,17,33,34). ∞Í›˙ÂÈ ‚‚·›ˆ˜ Ó· ÛËÌÂȈı› fiÙÈ Ë ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ Ù˘ ÔÌ¿‰·˜ C ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÓ‰ËÌÈ΋ Î·È ˘ÂÚÂÓ‰ËÌÈ΋ ÌÔÚÊ‹, Ë ÔÔ›· ÌÔÚ› Ó· ÎÚ·Ù‹ÛÂÈ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· Î·È ‰ÂÓ ÌÔÚ› Ó· ÚÔ‚ÏÂÊı› Ô ÙÂÚÌ·ÙÈÛÌfi˜ Ù˘ (2,15). ∂›Ó·È Èı·Ófi Ë ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ïԛ̈͢ ·fi ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ Ù˘ ÔÚÔÔÌ¿‰·˜ C, Ô˘ ‰È·ÈÛÙÒıËΠٷ ·Ì¤Ûˆ˜ ÂfiÌÂÓ· ¤ÙË, Ó· ÌËÓ ‹Ù·Ó ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡, ·ÏÏ¿ ›Ù Ù˘ ÂÚÈÔ‰ÈÎfiÙËÙ·˜ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘, ›Ù Ù˘ Û˘ÏÏÔÁÈ΋˜ ·ÓÔÛ›·˜ Ô˘ ·Ó·Ù‡¯ıËΠÛÙÔÓ ÏËı˘ÛÌfi ÌÂÙ¿ ·fi ÙËÓ ¤ÎıÂÛË Û ·˘Ùfi ÙÔÓ ÔÚfiÙ˘Ô (15,31,33). ∫·ıÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¤ÙË ¤¯Ô˘Ó ·Ú·ÙËÚËı› ÂȉË̛˜ ·fi W135 ÛÙË “˙ÒÓË Ù˘ ÌËÓÈÁÁ›Ùȉ·˜” ÛÙËÓ ∞ÊÚÈ΋, ·‡ÍËÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi ÙÔÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ À ÛÙËÓ AÌÂÚÈ΋ (1,6) Î·È ·fi ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘˜ Ô˘ ‰ÂÓ ·Ó‹ÎÔ˘Ó ÛÙȘ ÁÓˆÛÙ¤˜ ÔÚÔÔÌ¿‰Â˜, ¤¯ÂÈ ÂÎÊÚ·ÛÙ› Êfi‚Ô˜ fiÙÈ Ô Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ›Ûˆ˜ Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·125

125

ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ˜ ÛÙËÓ ∫Ú‹ÙË

ÂÈÎÚ¿ÙËÛË ¿ÏÏˆÓ ÔÚÔÔÌ¿‰ˆÓ (2,34,35). O ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˜ ‰È·ı¤ÙÂÈ ÌÂÁ¿ÏË ÈηÓfiÙËÙ· ÁÂÓÂÙÈ΋˜ ‰È·ÊÔÚÔÔ›ËÛ˘ Î·È ÔÚÈ˙fiÓÙÈ·˜ ÁÂÓÂÙÈ΋˜ ·ÓÙ·ÏÏ·Á‹˜ ÁÔÓȉ›ˆÓ Ô˘ Έ‰ÈÎÔÔÈÔ‡Ó ¤Ó˙˘Ì· ˘‡ı˘Ó· ÁÈ· ÙË Û‡ÓıÂÛË Ù˘ ο„·˜. ∞˘Ù‹ Ë È‰ÈfiÙËÙ· ÂÈÙÚ¤ÂÈ ÙËÓ ·ÓÙÈÁÔÓÈ΋ ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ ÎÏÒÓˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÍ¿ψÛ˘ Ù˘ ÓfiÛÔ˘ Î·È ·˘Ùfi ¤¯ÂÈ ‹‰Ë ÙÂÎÌËÚȈı› ÌÂٷ͇ ÙˆÓ µ Î·È C ÛÙÂϯÒÓ (35-37). ™Â ¯ÒÚ˜ fiÔ˘ ÂÊ·ÚÌfi˙ÂÙ·È ‹‰Ë Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ C, fiˆ˜ Ë ∞ÁÁÏ›· Î·È Ë πÛ·Ó›·, ‰ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› ÚÔ˜ ÙÔ ·ÚfiÓ Î¿ÙÈ Ù¤ÙÔÈÔ (39,40). ∏ ıÓËÙfiÙËÙ· ·fi ÙË ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÓfiÛÔ ÂÍ·ÚÙ¿Ù·È ÙfiÛÔ ·fi ÙÔÓ ÔÚfiÙ˘Ô ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ fiÛÔ Î·È ·fi ÙËÓ ·ÓÔÛÔÏÔÁÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È ·Ú·Ì¤ÓÂÈ ˘„ËÏ‹, ·ÎfiÌ· Î·È Ì ٷ Û‡Á¯ÚÔÓ· ıÂÚ·¢ÙÈο Î·È ˘ÔÛÙËÚÈÎÙÈο ̤۷. ∏ ıÓËÙfiÙËÙ· ‰ÈÂıÓÒ˜ ˘ÔÏÔÁ›˙ÂÙ·È Û 7% ÁÈ· fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜, ·ÏÏ¿ ÊÙ¿ÓÂÈ ¤ˆ˜ ÙÔ 21% Û ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó Û ·È‰È¿ Î·È ÌÔÚ› Ó· ÊÙ¿ÛÂÈ ÙÔ 40% fiÙ·Ó Ë ÓfiÛÔ˜ Û˘Óԉ‡ÂÙ·È ·fi ηٷÏËÍ›· (8,11,41). ∏ ıÓËÙfiÙËÙ· Û ÔÛÔÛÙfi 8,95% Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÌÂϤÙ˘ Â›Ó·È ·Ó¿ÏÔÁË Ì ÙË Ì¤ÛË Â˘Úˆ·˚΋ (16,20,23,24,26,38,41). ¶ÚfiÛÊ·Ù·, ÙÔ ÂӉȷʤÚÔÓ ¤¯ÂÈ ÂÛÙÈ·ÛÙ› ȉȷ›ÙÂÚ· ÛÙË ‰ËÌÈÔ˘ÚÁ›· ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÂÌ‚ÔÏ›ˆÓ ÁÈ· ÙËÓ ÚÔÛÙ·Û›· ·fi ÙÔÓ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ. ∏ ·Ó¿Ù˘ÍË ÙÔ˘ ÌÔÓÔ‰‡Ó·ÌÔ˘ Û˘˙¢Á̤ÓÔ˘ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ Ù˘ ÔÚÔÔÌ¿‰·˜ C ·ÔÙ¤ÏÂÛ ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô. ∏ ∞ÁÁÏ›· ‹Ù·Ó Ë ÚÒÙË ¯ÒÚ· Ô˘ ÂÈÛ‹Á·Á ÙÔÓ Ì·˙ÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Ì ÙÔ Û˘˙¢Á̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ C, Ì ·ÔÙ¤ÏÂÛÌ· ÙË ı·̷ÙÈ΋ ÂÏ¿ÙÙˆÛË Î·È Ù˘ ÓÔÛËÚfiÙËÙ·˜ (¤ˆ˜ 86,7%) Î·È Ù˘ ıÓËÙfiÙËÙ·˜ ·fi ·˘Ù‹ ÙËÓ ÔÚÔÔÌ¿‰· (39). ∞ÎÔÏÔ‡ıËÛ·Ó Î·È ¿ÏϘ ¯ÒÚ˜, fiˆ˜ Ë πÛ·Ó›·, Ì ·Ó¿ÏÔÁ· ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· (39,40,42). ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ‰˘Ó·Ù‹ Ë ·Ú·Û΢‹ οÔÈÔ˘ ÈηÓÔÔÈËÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ¤Ó·ÓÙÈ Ù˘ ÔÚÔÔÌ¿‰·˜ µ, fiÔ˘ Ë ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ Â͈ÙÂÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙˆÓ ÛÙÂϯÒÓ, ‰ÂÓ ÂÈÙÚ¤ÂÈ Ó· Û˘ÌÂÚÈÏËÊıÔ‡Ó fiϘ Û ¤Ó· ÂÌ‚fiÏÈÔ (1,2,43). ™˘ÌÂÚ·ÛÌ·ÙÈο, ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÌÂϤÙ˘ Ë ÓÔÛËÚfiÙËÙ· Ù˘ ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋˜ ÓfiÛÔ˘ ÛÙËÓ ∫Ú‹ÙË ‹Ù·Ó ÛËÌ·ÓÙÈ΋, ÂÓÒ Ë ıÓËÙfiÙËÙ· ‹Ù·Ó Ë ·Ó·ÌÂÓfiÌÂÓË ÁÈ· Ù· Â˘Úˆ·˚ο Â›‰·. ¶·Ú¿ ÙËÓ ‡·ÚÍË ÈÛ¯˘ÚÒÓ ·ÓÙÈÌÈÎÚÔ‚È·ÎÒÓ, Ë ·ÂÈÏ‹ Ù˘ ÓfiÛÔ˘ ı· ÂÍ·ÎÔÏÔ˘ı‹ÛÂÈ Ó· ·Ú·Ì¤ÓÂÈ, ¤ˆ˜ fiÙÔ˘ ÂÊ·ÚÌÔÛÙ› ηıÔÏÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì ·ÔÙÂÏÂÛÌ·ÙÈο ÂÌ‚fiÏÈ·, fiˆ˜ ¤¯ÂÈ Á›ÓÂÈ ‹‰Ë ÂÊÈÎÙfi Ì ÙÔÓ H. influenzae type b (44,45). ∏ ηٷÓfiËÛË Î·È Ë ÌÂϤÙË ÙˆÓ ÙÔÈÎÒÓ ‰È·ÊÔÚÔÔÈ‹ÛÂˆÓ Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Î·È Ù˘ ηٷÓÔÌ‹˜ ÙˆÓ ÔÚÔÔÌ¿‰ˆÓ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ·-

Ú¤¯Ô˘Ó ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Î·È Î·Ù¢ı‡ÓÛÂȘ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ·˘ÙÔ‡ ÙÔ˘ ÛËÌ·ÓÙÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ˘Á›· Î·È ÙË ˙ˆ‹ ÙˆÓ ·È‰ÈÒÓ.

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6. World Health Organization. Meningococcal disease.

WHO Report on global surveillance of epidemic-prone infectious diseases. Chapter 5. 2000.

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8. Thorburn K, Baines P, Thomson A, Hart CA. Mortality in severe meningococcal disease. Arch Dis Child 2001;85:382385.

9. Pollard AJ, Britto J, Nadel S, DeMunter C, Habibi P, Levin M. Emergency management of meningococcal disease.

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11. Castellanos-Ortega A, Delgado-Rodriguez M. Comparison of the performance of two general and three specific scoring systems for meningococcal septic shock in children.

Crit Care Med 2000;28:2967-2973.

12. Rosenstein NE, Fischer M, Tappero JW. Meningococcal vaccines. Infect Dis Clin North Am 2001;15:155-169.

13. ∂ȉËÌÈÔÏÔÁÈÎfi ¢ÂÏÙ›Ô §ÔÈ̈‰ÒÓ ¡ÔÛËÌ¿ÙˆÓ ∂ÏÏ¿‰Ô˜. ªËÓÈ·›· ŒÎ‰ÔÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ∫¤ÓÙÚÔ˘ ∂ȉËÌÈÔÏÔÁÈ΋˜ ¶·Ú·ÎÔÏÔ‡ıËÛ˘ Î·È ¶·Ú¤Ì‚·Û˘ (∂∫∂¶∞¶) ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ÀÁ›·˜ Î·È ¶ÚfiÓÔÈ·˜.

14. Ragunathan L, Ramsay M, Borrow R, Guiver M, Gray S, Kaczmarski EB. Clinical features, laboratory findings and management of meningococcal meningitis in England and Wales: report of a 1997 survey. Meningococcal meningitis: 1997 survey report. J Infect 2000;40:74-79.

15. Tsolia MN, Theodoridou M, Tzanakaki G, Kalabalikis P, Urani E, Mostrou G et al. The evolving epidemiology of invasive meningococcal disease: a two-year prospective, population-based study in children in the area of Athens.

FEMS Immunol Med Microbiol 2003;36:87-94.

16. Cartwright K, Noah N, Peltola H. Meningococcal Disease Advisory Board. Meningococcal disease in Europe: epidemiology, mortality, and prevention with conjugate vaccines. Report of a European advisory board meeting Vienna, Austria, 6-8 October 2000. Vaccine 2001;19:43474356.

17. Kremastinou J, Tzanakaki G, Kansouzidou A, Pagalis A, Danielides V, Kouppari G et al. Recent emergence of serogroup C meningococcal disease in Greece. FEMS Immunol Med Microbiol 1999;23:49-55. ¶·È‰È·ÙÚÈ΋ 2005;68:120-126

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∂. ∞ÔÛÙfiÏÔ˘ Î·È Û˘Ó.

18. ∫·ÊÂÙ˙‹˜ ¢. ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ Ïԛ̈ÍË. ¶·È‰È·ÙÚÈ΋ 1998;61:233-238.

19. ªËÙÛ¤ÏÔ˜ Ã, ª·˘ÚÔÌÌ¿Ù˘ £, ∏ÏÈÔÔ‡ÏÔ˘ ª, ™˘ÚÔÁÈ·ÓÓfiÔ˘ÏÔ˜ °. µ·ÎÙËÚȷ΋ ÌËÓÈÁÁ›Ùȉ· ÛÙ· ·È‰È¿ Ù˘ ÓÔÙÈÔ‰˘ÙÈ΋˜ ∂ÏÏ¿‰·˜: ÏËı˘ÛÌȷ΋ ÌÂϤÙË. ¶·È‰È·ÙÚÈ΋ 1999;62:131-136.

20. ∫·ÓÈÙÛ¿Î˘ ∞, ∆ÛÈ¿ÏÏ· ∞, ¢Â‰Ô‡ÛË O, ∞ı·Ó·ÛfiÔ˘ÏÔ˜ ¢, µ·ÛÈÏÂÈ¿‰Ë ∞, ∫·Ù¿ÎË ∞ Î·È Û˘Ó. ªÈÎÚԂȷ΋ ÌËÓÈÁÁ›Ùȉ· ·È‰È΋˜ ËÏÈΛ·˜ ÙË ‰ÂηÂÙ›· 1992-2001. ∆fiÌÔ˜ ÂÚÈÏ‹„ÂˆÓ ∞Ó·ÎÔÈÓÒÛˆÓ. 11Ô ¶·ÁÎÚ‹ÙÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ; 1-3 ¡ÔÂÌ‚Ú›Ô˘ 2002; ÷ÓÈ¿: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ÷ӛˆÓ; 2002. ÛÂÏ. 82.

21. Antignac A, Ducos-Galand M, Guiyoule A, Pires R, Alonso JM, Taha MK. Neisseria meningitidis strains isolated from invasive infections in France (1999-2002): phenotypes and antibiotic susceptibility patterns. Clin Infect Dis 2003;37:912-920.

22. ¶·˘ÏÔÔ‡ÏÔ˘ π, ∞ÏÂÍ¿Ó‰ÚÔ˘ ∂, ¢·›ÎÔ˜ °, ¶ÂÙÚ›‰Ô˘ ∂, ¶¿ÁηÏË ∞, £ÂÔ‰ˆÚ›‰Ô˘ ª Î·È Û˘Ó. ºÔÚ›· Neisseria meningitidis Û ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜: ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È ¯·Ú·ÎÙËÚÈÛÙÈο ·ÔÌÔÓˆı¤ÓÙˆÓ ÛÙÂϯÒÓ. ¶·È‰È·ÙÚÈ΋ 2003;66:188-194.

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25. Carrol ED, Thomson AP, Riordan FA, Fellick JM, Shears P, Sills JA et al. Increasing microbiological confirmation and changing epidemiology of meningococcal disease on Merseyside, England. Clin Microbiol Infect 2000;6:259-262.

26. Connolly M, Noah N. Is group C meningococcal disease increasing in Europe? A report of surveillance of meningococcal infection in Europe 1993-6. European Meningitis Surveillance Group. Epidemiol Infect 1999;122:41-49.

27. ¶ÂÙÚ›‰Ô˘ ™, ∑¢Á·Ú›‰Ô˘ ∂, ∂˘ı˘Ì›Ô˘ ∞, ¡¿ÓÔ˘ ∞, ∫·‚·ÏÈÒÙ˘ π. ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÌËÓÈÁÁ›Ùȉ·: ·Ú·ÙËÚ‹ÛÂȘ Û 1070 ·ÛıÂÓ›˜. ¶·È‰È·ÙÚÈ΋ 2002;65:248-255.

28. Trotter C, Borrow R, Andrews N, Miller E. Seroprevalence of meningococcal serogroup C bactericidal antibody in England and Wales in the pre-vaccination era. Vaccine 2003;21:1094-1098.

29. Alcala B, Salcedo C, Arreaza L, Berron S, De La Fuente L, Vazquez JA. The epidemic wave of meningococcal disease in Spain in 1996-1997: probably a consequence of strain displacement. J Med Microbiol 2002;51:1102-1106.

30. Faustini A, Fabrizi E, Sangalli M, Bordi E, Cipriani P, Fiscarelli E et al. Role of laboratories in population-based surveillance of invasive diseases in Lazio, Italy, 1998-2000. Eur J Clin Microbiol Infect Dis 2002;21:824-826.

31. ∆Û·ÁηÚÔÔ‡ÏÔ˘-™Ù›Áη ∏. ªËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ Ïԛ̈ÍË: ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ- ÂÌ‚ÔÏÈ·ÛÌfi˜. ¶·È‰È·ÙÚÈ΋ 1998;61:543-545.

¶·È‰È·ÙÚÈ΋ 2005;68:120-126

32. Tzanakaki G, Urwin R, Musilek M, Kriz P, Kremastinou J, Pangalis A et al. Phenotypic and genotypic approaches to characterization of isolates of Neisseria meningitidis from patients and their close family contacts. J Clin Microbiol 2001;39:1235-1240.

33. Sbyrakis S, Galanakis E. Meningococcal vaccine and herd immunity. Lancet 1999;354:1733.

34. Fernandez S, Arreaza L, Santiago I, Malvar A, Berron S, Vazquez JA et al. Impact of meningococcal vaccination with combined serogroups A and C polysaccharide vaccine on carriage of Neisseria meningitidis C. J Med Microbiol 2003;52:75-77.

35. Swartley JS, Marfin AA, Edupuganti S, Liu LJ, Cieslak P, Perkins B et al. Capsule switching of Neisseria meningitidis. Proc Natl Acad Sci USA 1997;94:271-276.

36. Jensen ES, Berthelsen L, Lind I, Fussing V, Sorensen HT, Schonheyder HC. Period prevalence and case-fatality rate associated with distinctive clone complexes of Neisseria meningitidis serogroups B and C. Eur J Clin Microbiol Infect Dis 2002;21:506-512.

37. Shlush LI, Behar DM, Zelazny A, Keller N, Lupski JR, Beaudet AL et al. Molecular epidemiological analysis of the changing nature of a meningococcal outbreak following a vaccination campaign. J Clin Microbiol 2002;40:3565-3571.

38. Goldacre MJ, Roberts SE, Yeates D. Case fatality rates for meningococcal disease in an English population, 1963-98: database study. BMJ 2003;327:596-597.

39. Balmer P, Borrow R, Miller E. Impact of meningococcal C conjugate vaccine in the UK. J Med Microbiol 2002;51:717-722.

40. Salleras L, Dominguez A, Cardenosa N. Impact of mass vaccination with polysaccharide conjugate vaccine against serogroup C meningococcal disease in Spain. Vaccine 2003;21:725-728.

41. ∫·Ï·Ì·Ï›Î˘ ¶, ¡·ÚÏ›ÔÁÏÔ˘ ª, ∑¿‚Ú·˜ ¡, ¶·Ú¿Û¯Ô˘ ¢, ªÈ·ÛÔ‡Ï˘ °, ÷Ù˙‹˜ ∞. ¶·Ú·ÎÔÏÔ‡ıËÛË Î·È ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ Ì ÌËÓÈÁÁÈÙȉÔÎÔÎÎÈ΋ ÛË„·ÈÌ›· Û ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜. ¶·È‰È·ÙÚÈ΋ 2000;63: 382-390.

42. Salleras L, Dominguez A, Cardenosa N. Dramatic decline of serogroup C meningococcal disease in Catalonia (Spain) after a mass vaccination campaign with meningococcal C conjugated vaccine. Vaccine 2003;21:729-733.

43. Cripps AW, Foxwell R, Kyd J. Challenges for the development of vaccines against Haemophilus influenzae and Neisseria meningitidis. Curr Opin Immunol 2002;14:553-557.

44. £ÂÔ‰ˆÚ›‰Ô˘ ª, ¶·˘ÏÔÔ‡ÏÔ˘ π, ¶¿ÁηÏË ∞, ªÔÛÙÚÔ‡ °, ∆Û›ÊÙ˘ °, ∫·ÓfiÔ˘ÏÔ˜ Ã Î·È Û˘Ó. ªËÓÈÁÁ›Ùȉ· ·fi ·ÈÌfiÊÈÏÔ Ù‡Ô˘ b: ™˘¯ÓfiÙËÙ· ÚÈÓ Î·È ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ¶·È‰È·ÙÚÈ΋ 1999;62:366-370.

45. ∆ÛÔÏÈ¿ ª, £ÂÔ‰ˆÚ›‰Ô˘ ª, ªÔÛÙÚÔ‡ °, ¶·Ú·ÛοÎË ∂, ¶¿ÁηÏË ∞, °ÂÏÂṲ̂ ∞ Î·È Û˘Ó. ∂ȉËÌÈÔÏÔÁ›· Û˘ÛÙËÌ·ÙÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·fi H. influenzae Ù‡Ô˘ b ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈ΋˜. ¶·È‰È·ÙÚÈ΋ 1999;62:12-18.

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ORIGINAL ARTICLE

127

Meningococcal disease in Crete E. Apostolou1, E. Galanakis1, G. Vlahaki2, S. Stefanaki3, S. Maraki4, E. Kokori2, A. Tsilimigaki3, †S. Sbyrakis1,5

Abstract Background: Neisseria meningitidis is a common cause of meningitis and septicaemia worldwide.

Despite significant progress in its management, invasive meningococcal disease remains a threat for children of all ages. The aim of this study was to investigate the incidence of meningococcal disease in Crete over a 13-year period.

Methods: The study included all 67 children, residents of the prefectures of Iraklio, Rethimno and Lasithi, who were hospitalized for meningococcal disease in the three local Paediatric Departments and the Paediatric Intensive Care Unit in the period 1990-2002. The children were aged from 1 month to 13 years (mean age 4.66 years).

Results: Morbidity was increased during the winter months. The mean annual incidence was estimated at 5.54/100,000. The local rates for the prefectures of Rethimno, Iraklio and Lasithi were 7.85/100,000, 5.26/100,000 and 4.23/100,000 respectively. The prevalence was higher in infants, where serogroup B was more common. The serogroups was determined in 29 cases, serogroups B and C accounting for 48% and 41.3% respectively. Two periods of increased incidence of meningococcal disease were observed, the first in 1998-1999 with a predominance of serogroup C, and the second in 2002 with a predominance of group B. The fatality rate was estimated at 9%, with no correlation with the serogroup.

Conclusions: Meningococcal disease caused considerable morbidity and mortality in the three prefectures of Crete studied. Monitoring of the epidemiologic trends of this threatening infection is required to ensure rational use of the new vaccines.

Key words Epidemiology, Crete, meningitis, Neisseria meningitidis, vaccination.

1 Paediatric Clinic, University General Hospital of Heraklion, Crete 2 1st Paediatric Clinic, Venizelion General Hospital of Heraklion, Crete 3 2nd Paediatric Clinic, Venizelion General Hospital of Heraklion, Crete 4 Department of Clinical Bacteriology-ParasitologyZoonosis and Geographical Medicine, University General Hospital of Heraklion, Crete 5 Children’s Intensive Care Unit, University General Hospital of Heraklion, Crete Correspondence: Emmanouil Galanakis School of Medicine, University of Crete P.O. Box 2208 710 03, Heraklion, Crete E-mail: egalanak@med.uoc.gr Date of submission: 20-10-2003 Date of approval: 10-01-2005

Paediatriki 2005;68:127

Paediatriki Mar-Apr 05

128

19-04-05

15:30

™ÂÏ›‰·128

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

¡fiÛÔ˜ Crohn Û ‚ÚÂÊÈ΋ ËÏÈΛ·: ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ¶··‰ÔÔ‡ÏÔ˘1, ∂. ∫·ÙÛÈÁÈ·ÓÓ¿ÎË2, ∂. ªÈ¯·ËÏ›‰Ô˘1, π. °Ú·ÌÌ·ÙÈο΢3, ∂. ª·ÓÙ˙Ô˘Ú¿ÓË1 1 ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ 2 °·ÛÙÚÂÓÙÂÚÔÏÔÁÈÎfi ∆Ì‹Ì· µ’ ¶·ıÔÏÔÁÈÎÔ‡ ∆Ô̤·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ ∞ÂÈÎfiÓÈÛ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ AÏÏËÏÔÁÚ·Ê›·: ∂Ï¢ıÂÚ›· ¶··‰ÔÔ‡ÏÔ˘ O‡Ï·Ê ¶¿ÏÌ 228 ∆.∫. 714 10, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ E-mail: bm-pjhkka@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 08-07-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-12-2004

¶ÂÚ›ÏË„Ë ∏ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Crohn ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Â›Ó·È È‰È·›ÙÂÚ· Û¿ÓÈ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜, ËÏÈΛ·˜ ÔÎÙÒ ÌËÓÒÓ, Ô˘ ‰ÈÂÚ¢ӋıËΠÁÈ· ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ηٿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó·. ∏ ÂÌÊ¿ÓÈÛË ‚ÏÂÓÓÔ·ÈÌ·ÙËÚÒÓ ÎÂÓÒÛÂˆÓ Ô‰‹ÁËÛ ÛÙËÓ ÂÎÙ¤ÏÂÛË ÎÔÏÔÓÔÛÎfiËÛ˘ Î·È ÛÙË Ï‹„Ë ˘ÏÈÎÔ‡ ÁÈ· ‚ÈÔ„›· ·fi ÙÔ ·¯‡ ¤ÓÙÂÚÔ (Ù˘ÊÏfi-ÔÚıfi) ÙËÓ 35Ë Ë̤ڷ ÓÔÛËÏ›·˜, ÌÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ȉÈÔ·ı‹ ÊÏÂÁÌÔÓÒ‰Ë ÂÓÙÂÚÔ¿ıÂÈ·. ∆ËÓ 45Ë Ë̤ڷ ÓÔÛËÏ›·˜ ·ÔÌÔÓÒıËΠÛÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ Campylobacter jejuni. ÃÔÚËÁ‹ıËΠ·ÌÈÎÈÏÏ›ÓË/ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇ Ì ‚¿ÛË ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ· ÁÈ· Ù¤ÛÛÂÚȘ Ë̤Ú˜ ¯ˆÚ›˜ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË. ∆ËÓ 50‹ Ë̤ڷ ÓÔÛËÏ›·˜ ¯ÔÚËÁ‹ıËÎÂ Û˘Ó‰˘·ÛÌfi˜ ÛÈÚÔÊÏÔÍ·Û›Ó˘ Î·È ÌÂÙÚÔÓȉ·˙fiÏ˘ Î·È 10 Ë̤Ú˜ ·ÚÁfiÙÂÚ· ÙÔ ‚Ú¤ÊÔ˜ ¤ÌÂÈÓ ·‡ÚÂÙÔ. ∆Ë 12Ë Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ‰ÈÏÔ‡ ·ÓÙÈ‚ÈÔÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ÚÔÛÙ¤ıËΠÛÔ˘ÏÊ·Û·Ï·˙›ÓË. ∆Ô ‚Ú¤ÊÔ˜ ¤Ï·‚ ÙÔ ‰ÈÏfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· ÁÈ· ÙÚÂȘ Ì‹Ó˜ Î·È Û˘ÓÂÛÙ‹ıË ÛÔ˘ÏÊ·Û·Ï·˙›ÓË ÁÈ· ¤Ó· ¯ÚfiÓÔ. ¶·Ú¤ÌÂÈÓ ·‡ÚÂÙÔ, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÎÂÓÒÛÂȘ Î·È Ì ÈηÓÔÔÈËÙÈ΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ ÁÈ· ÔÎÙÒ Ì‹Ó˜, ÔfiÙ ·ÚÔ˘Û›·Û ÂÎ Ó¤Ô˘ ˘ÚÂÙfi Î·È ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ. ŒÁÈÓ ÂÓ‰ÔÛÎfiËÛË Î·È Ï‹„Ë ˘ÏÈÎÔ‡ ÁÈ· ‚ÈÔ„›· ·fi ÙÔ ÏÂÙfi Î·È ·¯‡ ¤ÓÙÂÚÔ, Ô˘ ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Crohn. O ·ÛıÂÓ‹˜, ¤ÎÙÔÙÂ, Ï·Ì‚¿ÓÂÈ ÌÂÛ·Ï·˙›ÓË Î·È ·Ú·Ì¤ÓÂÈ ÂχıÂÚÔ˜ Û˘Ìو̿وÓ.

§¤ÍÂȘ ÎÏÂȉȿ ¡fiÛÔ˜ Crohn, ‚ÚÂÊÈ΋ ËÏÈΛ·, ˘ÚÂÙfi˜ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜, Campylobacter jejuni.

∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ Crohn ·ÔÙÂÏ› ¯ÚfiÓÈ·, ȉÈÔ·ı‹ ÊÏÂÁÌÔÓÒ‰Ë ‰È·Ù·Ú·¯‹ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ¢ÂÓ Â›Ó·È Û˘¯Ó‹ ÛÙËÓ ÚÒÙË ·È‰È΋ ËÏÈΛ· Î·È ıˆÚÂ›Ù·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· ÛÙ· ‚Ú¤ÊË. O ˘ÚÂÙfi˜ Î·È Ë ÛÙ·ÛÈÌfiÙËÙ· ‚¿ÚÔ˘˜ ÂÓ›ÔÙ ÚÔ¸¿Ú¯Ô˘Ó Û ۯ¤ÛË Ì ÙËÓ ·ÚÔ˘Û›· ÛÔ‚·ÚÒÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ Û˘Ìو̿وÓ. ™Â ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, Ë ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi Ì·ÎÚfi¯ÚÔÓË ·Ú·ÎÔÏÔ‡ıËÛË, ÏfiÁˆ ·Ô˘Û›·˜ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·Ù¿ ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‹ ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô (1). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Û¿ÓÈ· ÂÚ›ÙˆÛË Ù˘ ÓfiÛÔ˘ Crohn Û ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ ÔÎÙÒ ÌËÓÒÓ, Ô˘ ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· ‰ÈÂÚ‡ÓËÛË ÛÙ·ÛÈÌfiÙËÙ·˜ ‚¿ÚÔ˘˜, ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ˘ÚÂÙÔ‡ Î·È ‚ÏÂÓÓÔ·ÈÌ·ÙËÚÒÓ ÎÂÓÒÛˆÓ. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤Ï·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ Î·È Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙËÓ ÚfiÛÊ·ÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È È‰È·›ÙÂÚ· Û fi,ÙÈ ·ÊÔÚ¿ ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË Î·È ÙËÓ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ÕÚÚÂÓ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ ÔÎÙÒ ÌËÓÒÓ ÂÈÛ‹¯ıË ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÏfiÁˆ ÂÌ‡ÚÂÙÔ˘ ÓÔ¶·È‰È·ÙÚÈ΋ 2005;68:128-131

Û‹Ì·ÙÔ˜ Î·È ÛÙ·ÛÈÌfiÙËÙ·˜ ‚¿ÚÔ˘˜. ∏ ·ÚÔ‡Û· ÓfiÛÔ˜ ›¯Â ·Ú¯›ÛÂÈ 18 Ë̤Ú˜ ÚÔ Ù˘ ÂÈÛ·ÁˆÁ‹˜, Ì ÂÌÊ¿ÓÈÛË Î·ıËÌÂÚÈÓ‹˜ ˘ÚÂÙÈ΋˜ ΛÓËÛ˘ ¤ˆ˜ 38,2ÔC ¯ˆÚ›˜ ÂÌÊ·Ó‹ ÂÛÙ›· Ïԛ̈͢, ·ÓÔÚÂÍ›· Î·È ·ÒÏÂÈ· ‚¿ÚÔ˘˜. ∞ӷʤÚıËÎÂ Ë ·ÚÔ˘Û›· ¯·Ï·ÚÒÓ ÎÂÓÒÛÂˆÓ Ì ÙËÓ ¤Ó·ÚÍË Ù˘ Û˘Ó‰ÚÔÌ‹˜, Ô˘ fï˜ ˘Ô¯ˆÚÔ‡Û·Ó ÛÙË Û˘Ó¤¯ÂÈ·. ∂›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. ∆Ô ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚıËΠÂχıÂÚÔ. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ηٿ Û˘ÛÙ‹Ì·Ù· ÂͤٷÛË ‰ÂÓ ·ÔÎ¿Ï˘„ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆Ô ‚Ú¤ÊÔ˜ ÂÎÙfi˜ ˘ÚÂÙÔ‡ ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË. ¢È·ÈÛÙÒıËΠ·ÒÏÂÈ· ‚¿ÚÔ˘˜ ηٿ ÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· Ì ÙÒÛË Ù˘ ηÌ‡Ï˘ ·‡ÍËÛ˘ ÙÔ˘ ‚¿ÚÔ˘˜ ·fi ÙËÓ 90‹ ∂£ ÛÙÔÓ 7Ô Ì‹Ó·, ÌÂٷ͇ 25˘ Î·È 50‹˜ ∂£ ÛÙÔÓ 8Ô Ì‹Ó· (∂ÈÎfiÓ· 1). ∆Ô ‡„Ô˜ Î·È Ë ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜ ‚Ú›ÛÎÔÓÙ·Ó ÛÙËÓ 90‹ Î·È ÙËÓ 75Ë ∂£, ·ÓÙ›ÛÙÔȯ·. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ÂȂ‚·ÈÒıËÎÂ Ë Î·ıËÌÂÚÈÓ‹ ÂÌÊ¿ÓÈÛË ˘ÚÂÙÔ‡ Î·È ÂÎÙÂϤÛÙËΠÂÎÙÂٷ̤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÛÙÔ Ï·›ÛÈÔ ‰ÈÂÚ‡ÓËÛ˘ ˘ÚÂÙÔ‡ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. O ·‰Úfi˜ ·Ú¯ÈÎfi˜ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ·ÈÌÔÛÊ·ÈÚ›ÓË 10,8 g/dL, ·ÈÌ·ÙÔÎÚ›ÙË 32,7%, RDW 16,1%, MCV 80,6 fl, MCH 26,5 pg, ·ÚÈıÌfi Ï¢ÎÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ 12.900/mm3 (26% Ô˘‰ÂÙÂÚfiÊÈÏ·, 69% ÏÂÌÊÔ·ÙÙ·Ú·, 3% ÌÔÓÔ·ÙÙ·Ú· Î·È 2% ˈÛÈÓfiÊÈÏ·), ·ÈÌÔÂÙ¿ÏÈ· 493.000/mm3, ¢∂∫

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·129

129

¡fiÛÔ˜ Crohn Û ‚Ú¤ÊÔ˜

µ¿ÚÔ˜ ÛÒÌ·ÙÔ˜ (Û ÁÚ·ÌÌ¿ÚÈ·)

0,7% Î·È Coombs (-). O ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ (ÈÔÓÙfiÁÚ·ÌÌ·, ̤ÙÚËÛË ÏÂ˘ÎˆÌ¿ÙˆÓ ÔÚÔ‡) ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Î·È ÔÈ Î·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ·ÚÓËÙÈΤ˜. ∏ Mayer ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈ΋. OÈ ‰Â›ÎÙ˜ ÔÍ›·˜ ÊÏÂÁÌÔÓ‹˜ ‹Ù·Ó Û¯ÂÙÈο ˘„ËÏÔ› (TKE: 43 mm, ·2 Ì·ÎÚÔÛÊ·ÈÚ›ÓË: 456 mg/dl Î·È ·ÙÔÛÊ·ÈÚ›ÓË: 335 mg/dl). ∏ ·/· ıÒڷη ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ Î·È Ë Mantoux ·ÚÓËÙÈ΋. OÈ Î·ÏÏȤÚÁÂȘ Î·È ÔÈ ·Ú·ÛÈÙÔÏÔÁÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈΤ˜. O ÔÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÈÔ‡˜, ‚·ÎÙËÚ›‰È·, ÛÂÈÚÔ¯·›Ù˜, ¯Ï·Ì‡‰È·, ÚÈΤÙÛȘ, ̇ÎËÙ˜ Î·È ·Ú¿ÛÈÙ· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ¢ÂÓ ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó ·ÓÙÈÛÒÌ·Ù· ηٿ ·ÌÔÈ‚¿‰ˆÓ. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·˘ÙÔ¿ÓÔÛ· Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· (∞¡∞, ∞¡CA, anti-DNA, ·ÙÙ·Ú· χÎÔ˘, C3, C4, RF, ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ IgM, IgA Î·È IgG) ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∏ ËÏÂÎÙÚÔÊfiÚËÛË ÚˆÙÂ˚ÓÒÓ ¤‰ÂÈÍ ÌÈÎÚ‹ ·‡ÍËÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ ·2-ÛÊ·ÈÚÈÓÒÓ (15,9%) Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜ ÙˆÓ Á-ÛÊ·ÈÚÈÓÒÓ (9,8%). O ¤ÏÂÁ¯Ô˜ ÁÈ· ÈÚȉÔ΢ÎÏ›Ùȉ· Ì ۯÈÛÌÔÂȉ‹ Ï˘¯Ó›· ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆Ô Ì˘ÂÏfiÁÚ·ÌÌ· Î·È Ë Ì¤ÙÚËÛË VMA Û 24ˆÚË Û˘ÏÏÔÁ‹ Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∏ ‰ÔÎÈÌ·Û›· ȉÚÒÙ· ‹Ù·Ó ‰‡Ô ÊÔÚ¤˜ ·ÚÓËÙÈ΋ ÁÈ· ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, Ì Â·Ú΋ ÔÛfiÙËÙ· ȉÚÒÙ·. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È Î·Ú‰È¿˜, MRI ÂÁÎÂÊ¿ÏÔ˘/ÎÔÈÏ›·˜) ‰ÂÓ ·ÔÎ¿Ï˘„ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÏÈÓÈ΋˜ Î·È ÂÚÁ·ÛÙËÚȷ΋˜ ‰ÈÂÚ‡ÓËÛ˘, Ô ·ÛıÂÓ‹˜ Û˘Ó¤¯ÈÛ ӷ ÂÌÊ·Ó›˙ÂÈ ˘ÚÂÙfi ηıËÌÂÚÈÓ¿, ¯ˆÚ›˜ ¿ÏÏ· Û˘ÌÙÒÌ·Ù· ‹ ÌÂÙ·‚ÔÏ‹ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜. ∂›ÎÔÛÈ Ù¤ÛÛÂÚȘ Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ·ÚÔ˘Û›·Û ¤Í·ÚÛË ÙÔ˘ ˘ÚÂÙÔ‡ Ì ٷ˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ‚ÏÂÓÓÔ·ÈÌ·ÙËÚÒÓ ÎÂÓÒÛˆÓ. ∏ ÔÏÈ΋ IgE Î·È Ë ÂȉÈ΋ IgE Û ÙÚÔʤ˜ (RAST) ‹Ù·Ó Ê˘-

ÛÈÔÏÔÁÈΤ˜. ∞ÓÙÈÛÒÌ·Ù· ÁÈ· ÎÔÈÏÈÔοÎË (·ÓÙÈÁÏÔÈ·‰ÈÓÈο, ¤Ó·ÓÙÈ ÙÔ˘ ÂÓ‰Ô̇ÈÔ˘ Î·È Ù˘ ‰ÈÎÙ˘ˆÙ‹˜ Ô˘Û›·˜) ‹Ù·Ó ·ÚÓËÙÈο. ∂ÎÙÂϤÛÙËΠÎÔÏÔÓÔÛÎfiËÛË, Ë ÔÔ›· ¤‰ÂÈÍ ԛ‰ËÌ· Î·È ÂÈÊ·ÓÂȷΤ˜ ηٿ ÙfiÔ˘˜ ÂÍÂÏÎÒÛÂȘ ÛÙÔ ·ÓÈfiÓ, ÂÁοÚÛÈÔ Î·È Î·ÙÈfiÓ ÎfiÏÔÓ Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÙËÓ ÂÚÈÔ¯‹ Ù˘ ÂÈÏÂÔÙ˘ÊÏÈ΋˜ ‚·Ï‚›‰·˜. ∏ ‚ÈÔ„›· ÂÓÙ¤ÚÔ˘ ‹Ù·Ó ÂÓ‰ÂÈÎÙÈ΋ ÁÈ· ȉÈÔ·ı‹ ÊÏÂÁÌÔÓÒ‰Ë ÂÓÙÂÚÔ¿ıÂÈ·. ™Â Ӥ˜ ηÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ·ÔÌÔÓÒıËΠCampylobacter jejuni. ªÂ ‚¿ÛË ÙÔ ·ÓÙÈ‚ÈfiÁÚ·ÌÌ·, ¯ÔÚËÁ‹ıËΠÙËÓ 45Ë Ë̤ڷ ÓÔÛËÏ›·˜ ·ÌÈÎÈÏÏ›ÓË Ì ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇, ¯ˆÚ›˜ fï˜ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË ÌÂÙ¿ ·fi ÙÂÙÚ·‹ÌÂÚË ·ÁˆÁ‹. ÃÔÚËÁ‹ıËÎÂ, ÙfiÙÂ, Û˘Ó‰˘·ÛÌfi˜ ÛÈÚÔÊÏÔÍ·Û›Ó˘-ÌÂÙÚÔÓȉ·˙fiÏ˘ ÁÈ· 10 Ë̤Ú˜ Ô˘ Ô‰‹ÁËÛ Û ·˘ÚÂÍ›· ÌÂÙ¿ ·fi 79 Ë̤Ú˜ ˘ÚÂÙÔ‡.

O ·ÛıÂÓ‹˜ ÂÍ‹Ïı Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, Ì ԉËÁ›Â˜ Ó· Ï¿‚ÂÈ ÙÔ ‰ÈÏfi ·ÓÙÈ‚ÈÔÙÈÎfi Û¯‹Ì· ÁÈ· ÙÚÂȘ Ì‹Ó˜, ηıÒ˜ Î·È ÛÔ˘ÏÊ·Û·Ï·˙›ÓË (50 mg/kg/24 h Û ‰‡Ô ‰fiÛÂȘ) ÁÈ· ¤Ó· ¯ÚfiÓÔ.

O Ù·ÎÙÈÎfi˜ ÌËÓÈ·›Ô˜ Â·Ó¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ÈηÓÔÔÈËÙÈ΋ ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ (∂ÈÎfiÓ· 1), ÂÓÒ Ô ·ÛıÂÓ‹˜ ¤ÌÂÈÓ ·‡ÚÂÙÔ˜ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÎÂÓÒÛÂȘ. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜ Ì ·ÔηٿÛÙ·ÛË Ù˘ ·ÈÌÔÛÊ·ÈÚ›Ó˘, ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÔÍ›·˜ Ê¿Û˘ Î·È ÙˆÓ ÎÏ·ÛÌ¿ÙˆÓ ËÏÂÎÙÚÔÊfiÚËÛ˘ ÚˆÙÂ˚ÓÒÓ ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰·.

OÎÙÒ Ì‹Ó˜ ·ÚÁfiÙÂÚ·, Ô ·ÛıÂÓ‹˜ Â·ÓÂÌÊ¿ÓÈÛ ˘ÚÂÙfi, ‚ÏÂÓÓÔ·ÈÌ·ÙËÚ¤˜ ÎÂÓÒÛÂȘ Î·È ·ÓÔÚÂÍ›·. OÈ Î·ÏÏȤÚÁÂȘ ÎÔÚ¿ÓˆÓ ‹Ù·Ó ·ÚÓËÙÈΤ˜ Î·È ‰ÂÓ ¯ÔÚËÁ‹ıËΠ·ÓÙÈ‚›ˆÛË. ∏ ‰È¿‚·ÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘ ¤‰ÂÈÍ ÔÌ·Ï‹ ÌÔÚÊÔÏÔÁ›· Î·È ‚·ÙfiÙËÙ· Ì ·ÂÈÎfiÓÈÛË ÛÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi (Û ¤ÎÙ·ÛË 3-4 cm ·fi ÙËÓ ÂÈÏÂÔÙ˘ÊÏÈ΋ ‚·Ï‚›‰·)

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∏ÏÈΛ· Û ̋Ó˜ ∂ÈÎfiÓ· 1. ∫·Ì‡ÏË ‚¿ÚÔ˘˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ÙË Á¤ÓÓËÛË Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 23 ÌËÓÒÓ. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ‚¤ÏÔ˜ ˘Ô‰ÂÈÎÓ‡ÂÈ ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙÔ ÌÈÎÚfiÙÂÚÔ ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ·ÁˆÁ‹˜ Ì ÛÈÚÔÊÏÔÍ·Û›ÓË/ÌÂÙÚÔÓȉ·˙fiÏË Î·È ÛÔ˘ÏÊ·Û·Ï·˙›ÓË. ¶·È‰È·ÙÚÈ΋ 2005;68:128-131

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·130

130

∂. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

ÂÚÈÔ¯‹˜ Ì ÌfiÏȘ ˘ÔÛËÌ·ÈÓfiÌÂÓË ¿¯˘ÓÛË ÙˆÓ Ù˘¯ÒÓ Î·È Û˘Ó˘¿Ú¯Ô˘Û· ÌÈÎÚÔÔ˙Ò‰Ë ‰È·ÌfiÚʈÛË Ù˘ ‚ÏÂÓÓÔÁÔÓÈ΋˜ ·Ú˘Ê‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi ‹Ù·Ó Û˘Ì‚·Ùfi Ì ÚÒÈÌË ·ÂÈÎÔÓÈÛÙÈ΋ ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘ Crohn (∂ÈÎfiÓ· 2). ∞fi ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ÚԤ΢„ ÂÈÎfiÓ· ¯ÚÔÓ›˙Ô˘Û·˜, ̤ÙÚÈ·˜ ÔÈÛÔÊ·Á›Ùȉ·˜ Ì ÌÈÎÚÔ‡ ¤ˆ˜ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ ·‡ÍËÛË Ù˘ ·Ó·ÁÂÓÓËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Î·È Ì ˘ÂÚ·ÈÌ›·. ∂›Û˘, ÂÈÎfiÓ· ‹È·˜, ÌË ÂȉÈ΋˜ Á·ÛÙÚ›Ùȉ·˜ Ì ÂÛÙȷο Ê·ÈÓfiÌÂÓ· ·Úfi͢ÓÛ˘ (focally enhanced gastritis). µÏÂÓÓÔÁfiÓÔ˜ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘ Ì ÙÌ‹Ì· ÙÔ˘ ˘Ô‚ÏÂÓÓÔÁÔÓ›Ô˘ Ì ·ÚÔ˘Û›· ÔÏÏÒÓ Á·ÁÁÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ. ¶·Ú·ÙËÚ‹ıËΠ‹È· ˆ˜ ̤ÙÚÈ· ¯ÚÔÓ›˙Ô˘Û· ‰ˆ‰Âη‰·ÎÙ˘Ï›Ùȉ· Ô˘ ‹Ù·Ó ÂÛÙȷο ÈÔ ¤ÓÙÔÓË. OÈ ‚ÈÔ„›Â˜ ÙÔ˘ ·¯¤Ô˜ ÂÓÙ¤ÚÔ˘ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ¯fiÚÈÔ ·ÚÔ˘Û›·˙ ̤ÙÚÈÔ ¤ˆ˜ ÛËÌ·ÓÙÈÎfi Ô›‰ËÌ· Ì ·ÈÌÔÚÚ·ÁÈΤ˜ ‰ÈËı‹ÛÂȘ. ∆· ÏÂÌÊÔ·ÙÙ·Ú· Î·È Ù· Ï·ÛÌ·ÙÔ·ÙÙ·Ú· ‹Ù·Ó ̤ÙÚÈ· ¤ˆ˜ ÛËÌ·ÓÙÈο ·˘ÍË̤ӷ Ì ·ÓÔÌÔÈÔÁÂÓ‹ ηٷÓÔÌ‹ Î·È Ì ‡·ÚÍË ·ÚÎÂÙÒÓ ÔÏ˘ÌÔÚÊÔ˘Ú‹ÓˆÓ. ¶·Ú·ÙËÚ‹ıËÎ·Ó ‰È¿Û·ÚÙ˜ ÌÈÎÚÔÔÌ¿‰Â˜ ÈÛÙÈÔ΢ÙÙ¿ÚˆÓ Ô˘ Û¯ËÌ¿ÙÈ˙·Ó ÎÔÎÎÈÒÌ·Ù·, ÂÈÎfiÓ· ÂÓ‰ÂÈÎÙÈ΋ Ù˘ ÓfiÛÔ˘ Crohn. ∂ÈϤ¯ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ÌÂÛ·Ï·˙›Ó˘ (60 mg/kg/24 h), Ì ‰Â‰Ô̤ÓË ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, ηıÒ˜ Î·È ÙÔ˘ ÌÈÎÚfiÙÂÚÔ˘ ÔÛÔÛÙÔ‡ ·ÓÙȉڿÛÂˆÓ ˘ÂÚ¢·ÈÛıËÛ›·˜ Û˘ÁÎÚÈÙÈο Ì ÙË ÛÔ˘ÏÊ·Û·Ï·˙›ÓË (2) Î·È Ë ·ÓÙ·fiÎÚÈÛË ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋. ∏ ηٿÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ¤Ó· ¯ÚfiÓÔ ·ÚÁfiÙÂÚ· ·Ú·Ì¤ÓÂÈ Î·Ï‹, ¯ˆÚ›˜ Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ ÂÙÈÎfi ‹ ¿ÏϘ Â͈ÂÓÙÂÚÈΤ˜ ÂΉËÏÒÛÂȘ, ÂÓÒ Ë ÚfiÛÏË„Ë ‚¿ÚÔ˘˜ Â›Ó·È Â·Ú΋˜ (∂ÈÎfiÓ· 1).

∂ÈÎfiÓ· 2. ∞ÓÙÈÚÔÛˆ¢ÙÈ΋ ÂÈÎfiÓ· ·fi ÙË ‰È¿‚·ÛË ÙÔ˘ ÏÂÙÔ‡ ÂÓÙ¤ÚÔ˘, Ô˘ ·ÂÈÎÔÓ›˙ÂÈ ÛÙÔÓ ÙÂÏÈÎfi ÂÈÏÂfi Î·È Û ¤ÎÙ·ÛË 3-4 cm ·fi ÙËÓ ÂÈÏÂÔÙ˘ÊÏÈ΋ ‚·Ï‚›‰· ÂÚÈÔ¯‹ Ì ÌfiÏȘ ˘ÔÛËÌ·ÈÓfiÌÂÓË ¿¯˘ÓÛË ÙˆÓ Ù˘¯ÒÓ Î·È Û˘Ó˘¿Ú¯Ô˘Û· ÌÈÎÚÔÔ˙Ò‰Ë ‰È·ÌfiÚʈÛË Ù˘ ‚ÏÂÓÓÔÁÔÓÈ΋˜ ·Ú˘Ê‹˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘. ¶·È‰È·ÙÚÈ΋ 2005;68:128-131

™˘˙‹ÙËÛË ∏ ȉÈÔ·ı‹˜ ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÂÚÈÁÚ¿ÊÂÙ·È Û¿ÓÈ· ηٿ ÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Î·È Ì¤¯ÚÈ Û‹ÌÂÚ· ·Ú·Ì¤ÓÔ˘Ó ÂÚÈÔÚÈṲ̂Ó˜ ÔÈ ÁÓÒÛÂȘ Û¯ÂÙÈο Ì ÙËÓ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ Û ËÏÈ˘ οو ÙˆÓ 2 ÂÙÒÓ (3,4). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ Crohn ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi Â›Ó·È 34/100.000 Î·È Ô ÂÈÔÏ·ÛÌfi˜ Ù˘ 30-100/100.000 (5). ™Â Â˘Úˆ·˚΋ ÌÂϤÙË, Ë Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ Crohn ÛÙËÓ ∫Ú‹ÙË ‚Ú¤ıËΠ7,5/100.000 Î·È ÛÙ· πˆ¿ÓÓÈÓ· 1/100.000 (6). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÛÙÔ 25-30% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ‰È¿ÁÓˆÛË ·ÊÔÚ¿ Û ·È‰È¿ (4). ∏ ÓfiÛÔ˜ ¤¯ÂÈ Ì¤ÁÈÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi ηٿ ÙË Ì¤ÛË Î·È ÚÔ¯ˆÚË̤ÓË ÂÊ˂›·, ÂÓÒ ·fi ÂȉËÌÈÔÏÔÁÈ΋ ÌÂϤÙË, Ô˘ ¤ÁÈÓ ÛÙË ªÂÁ¿ÏË µÚÂÙ·Ó›·, ÚÔ·ÙÂÈ fiÙÈ ÔÛÔÛÙfi ÌfiÏȘ 4% ÙˆÓ ·È‰ÈÒÓ Ì ȉÈÔ·ı‹ ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘ Â›Ó·È ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 5 ÂÙÒÓ (7). ™Â ÚfiÛÊ·ÙË Î·Ó·‰È΋ ÌÂϤÙË ·Ó·ÛÎÔ‹ıËÎ·Ó 830 ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ô˘ ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1978-2000. ™Â 7 ·fi Ù· ·È‰È¿ ·˘Ù¿ (4 ı‹Ï· Î·È 3 ¿ÚÚÂÓ·) ›¯Â ÙÂı› Ë ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Crohn ÚÈÓ Ù· 2 ¤ÙË ˙ˆ‹˜, ÔÛÔÛÙfi Ô˘ ·ÓÙÈÛÙÔȯ› ÛÙÔ 1% ÂÚ›Ô˘ ÙÔ˘ Û˘ÓfiÏÔ˘, ÂÓÒ Ë Ì¤ÛË ËÏÈΛ· ηٿ ÙÔÓ ¯ÚfiÓÔ Ù˘ ÈÛÙÔÏÔÁÈ΋˜ ‰È¿ÁÓˆÛ˘ ‹Ù·Ó 9,2 Ì‹Ó˜ (‡ÚÔ˜ 2-21 Ì‹Ó˜). ∞fi ÙËÓ ›‰È· ¤Ú¢ӷ Ê·›ÓÂÙ·È fiÙÈ Û˘ÌÙÒÌ·Ù· ÌÔÚ› Ó· ÂΉËψıÔ‡Ó Î·È Û ‚Ú¤ÊË Ô˘ ‰È·ÙÚ¤ÊÔÓÙ·È ·ÔÎÏÂÈÛÙÈο Ì ÌËÙÚÈÎfi ıËÏ·ÛÌfi (8). OÈ Cohen Î·È Û˘Ó ·Ó·Ê¤ÚÔ˘Ó ÙËÓ ·ÚÔ˘Û›· ÙÂÛÛ¿ÚˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‚ÚÂÊÈ΋˜ ÓfiÛÔ˘ Crohn Û ÔÈÎÔÁ¤ÓÂÈ· µÂ‰Ô˘›ÓˆÓ (9). À¿Ú¯Ô˘Ó, Â›Û˘, ‰‡Ô ÛηӉÈÓ·‚ÈΤ˜ ÌÂϤÙ˜ Ô˘ ·Ú¤¯Ô˘Ó Û¯ÂÙÈο ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›·. ™Â ÛԢˉÈ΋ ÌÂϤÙË ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È 639 ·È‰È¿ Ì ÊÏÂÁÌÔÓÒ‰Ë ÓfiÛÔ ÙÔ˘ ÂÓÙ¤ÚÔ˘, 3 ÂÎ ÙˆÓ ÔÔ›ˆÓ (0,5%) ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ. ŒÓ· ·fi ·˘Ù¿ ›¯Â ÓfiÛÔ Crohn (10). ™Â ·Ó¿ÏÔÁË ‰·ÓÈ΋ ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È fiÙÈ Û ۇÓÔÏÔ 103 ÓÔÛÔ‡ÓÙˆÓ ·È‰ÈÒÓ, 5 ·fi ·˘Ù¿ (5%), Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÂÓfi˜ Ì ÓfiÛÔ Crohn, ‹Ù·Ó ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 2 ÂÙÒÓ (11). ∂›Û˘, ˘¿Ú¯ÂÈ ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÊÔÚ¿ ·fi ÙËÓ πÙ·Ï›· ÓfiÛÔ˘ Crohn Ì ¤Ó·ÚÍË ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ˙ˆ‹˜ (12). ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÂÓÂÙÈÎÔ›, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› Î·È ·ÓÔÛÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜, ·ÏÏ¿ Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ Crohn ·Ú·Ì¤ÓÂÈ Ì¿ÏÏÔÓ ·Û·Ê‹˜ (5). ∂ȉÈÎfiÙÂÚ· ‰Â ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ (˘ÂÚÛ›ÓÈ·, Ì˘ÎÔ‚·ÎÙËÚ›‰ÈÔ, ηÌ˘ÏÔ‚·ÎÙËÚ›‰ÈÔ, ¯Ï·Ì‡‰È· Î.¿.) Ê·›ÓÂÙ·È Ó· Û˘ÌÌÂÙ¤¯ÂÈ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, ¯ˆÚ›˜ fï˜ Ó· ¤¯ÂÈ ÂȂ‚·Èˆı› ÁÈ· ηӤӷ ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ‡˜ Ë ·ÔÎÏÂÈÛÙÈÎfiÙËÙ· Ù˘ ·ÈÙÈÔ·ıÔÁÂÓÂÙÈ΋˜ ·˘Ù‹˜ Û˘Û¯¤ÙÈÛ˘ (13).

Paediatriki Mar-Apr 05

19-04-05

15:30

™ÂÏ›‰·131

131

¡fiÛÔ˜ Crohn Û ‚Ú¤ÊÔ˜

ªÂ ‚¿ÛË ÙËÓ ˘fiıÂÛË Ù˘ “ÌÔÚȷ΋˜ ·ÔÌ›ÌËÛ˘” (molecular mimicry), Ë Â›ÛÔ‰Ô˜ ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ·ıÔÁfiÓˆÓ, Ô˘ ÂÚȤ¯Ô˘Ó ÚˆÙ½Ó˜ (·ÓÙÈÁfiÓ·) Ì ÛËÌ·ÓÙÈ΋ ÔÌÔÏÔÁ›· Ì ·ÓıÚÒÈÓ˜ ÚˆÙ½Ó˜ (Helicobacter pylori ‹ Campylobacter jejuni - Ô˘ ·ÔÌÔÓÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË), ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÙÂÏÈο Û ̛· ·˘ÙÔ¿ÓÔÛË ‰È·‰Èηۛ· (14). ™Â ¤Ó· ¿ÙÔÌÔ Ì ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË, Ë Ú‡ıÌÈÛË Ù˘ ηٷÛÙÔÏ‹˜ Ù˘ ÊÏÂÁÌÔÓ‹˜ ÛÙÔ ÙÔ›¯ˆÌ· ÙÔ˘ ÂÓÙ¤ÚÔ˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ Ïԛ̈͢ Á›ÓÂÙ·È ·ÓÂ·ÚÎÒ˜ Î·È ·˘Ùfi ˘ÚÔ‰ÔÙ› Ì›· ·˘ÙÔ¿ÓÔÛË ‰È·‰Èηۛ· ·˘ÙÔ·˘Í·ÓfiÌÂÓ˘ ÙÚÔÊÔ‰fiÙËÛ˘ (13). £ÂˆÚÂ›Ù·È Èı·ÓfiÓ fiÙÈ ‰È·Ù·Ú¿ÛÛÂÙ·È Ë ·ÓÔÛÔÏÔÁÈ΋ ÈÛÔÚÚÔ›· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È È‰È·›ÙÂÚ· Ë Û¯ÂÙÈ˙fiÌÂÓË Ì ٷ ∆1‚ÔËıËÙÈο ÏÂÌÊÔ·ÙÙ·Ú· (15,16). ∞Ó·ÊÔÚ¤˜ Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· Èı·Ó¿ ÌÔÚÔ‡Ó Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙȘ ÚÔÛ¿ıÂȘ ηٷÓfiËÛ˘ Ù˘ ·ıÔÁ¤ÓÂÈ¿˜ Ù˘, ηıÒ˜ Î·È ·Ó·ÁÓÒÚÈÛ˘ ÙˆÓ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, Ô˘ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ ÚÒÈÌË ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘. ¶·Ú¿ ÙË Û·ÓÈfiÙËÙ¿ Ù˘, Ë È‰ÈÔ·ı‹˜ ÊÏÂÁÌÔÓ҉˘ ÓfiÛÔ˜ ÙÔ˘ ÂÓÙ¤ÚÔ˘ ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Û ÌÈÎÚ¿ ‚Ú¤ÊË, Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· fiˆ˜ ¯ÚfiÓÈ· ‹ ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ÚÚÔÈ·, ‰˘Û·ÔÚÚfiÊËÛË Î·È Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ·‡ÍËÛË ‚¿ÚÔ˘˜ ‹ ˘ÚÂÙfi ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜. ™ËÌÂÈÒÓÂÙ·È, fï˜, fiÙÈ ÛÙË ÓfiÛÔ Crohn Ô ˘ÚÂÙfi˜ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ·Ô˘Û›· ÛÔ‚·ÚÒÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Ó· ‰È·ÁÓˆÛÙ› ·Ú¯Èο ˆ˜ “˘ÚÂÙfi˜ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜”. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÏÎÒ‰Ë ÎÔÏ›Ùȉ· Ô ˘ÚÂÙfi˜ ÂÌÊ·Ó›˙ÂÙ·È Î˘Ú›ˆ˜ ηٿ ÙËÓ ·ÚÔ˘Û›· ÎÂÚ·˘ÓÔ‚fiÏÔ˘ ÓfiÛÔ˘ (1). ∏ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·‡ÍËÛË ‚¿ÚÔ˘˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔ 20-30% ÙˆÓ ·È‰ÈÒÓ Ì ÓfiÛÔ Crohn Î·È ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÙËÓ ·Ú¯È΋ Ù˘ ÂΉ‹ÏˆÛË (1). ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, Ê·›ÓÂÙ·È fiÙÈ Ë ÛÈÚÔÊÏÔÍ·Û›ÓË ÌfiÓË Ù˘ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ÌÂÙÚÔÓȉ·˙fiÏË ÌÔÚ› Ó· ·›ÍÂÈ ÚfiÏÔ ˆ˜ Ê¿ÚÌ·ÎÔ ÚÒÙ˘ ÁÚ·ÌÌ‹˜ ÛÙË ıÂÚ·›· Ù˘ ÓfiÛÔ˘ Crohn. ™Â ÂÓ‹ÏÈΘ ·ÛıÂÓ›˜, Ô˘ ··ÓÙÔ‡Ó Û ۯ‹Ì· Û˘Á¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ ÁÈ· 3 Ì‹Ó˜, Èı·Ó¿ Ô Ì˯·ÓÈÛÌfi˜ Ó· Û¯ÂÙ›˙ÂÙ·È Ì Ì›ˆÛË ÙÔ˘ ·ÓÙÈÁÔÓÈÎÔ‡ ÊÔÚÙ›Ô˘ ηÈ, ÂÔ̤ӈ˜, Ì›ˆÛË Î·È Ù˘ ÂÓÙÂÚÈ΋˜ ÊÏÂÁÌÔÓ‹˜, ÂÓÒ Ô ·Ú·ÙÂٷ̤ÓÔ˜ ·˘Ùfi˜ Û˘Ó‰˘·ÛÌfi˜ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ ÂÓ·ÏÏ·ÎÙÈ΋ ıÂÚ·›· ÛÙ· ÛÙÂÚÔÂȉ‹ ηٿ ÙËÓ ÔÍ›· Ê¿ÛË Ù˘ ÓfiÛÔ˘. ∂›Û˘, Ë ÛÈÚÔÊÏÔÍ·Û›ÓË ıˆÚÂ›Ù·È fiÙÈ ¤¯ÂÈ ·ÓÔÛÔηٷÛÙ·ÏÙÈΤ˜ ȉÈfiÙËÙ˜ Ô˘ ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó ÙË ÊÏÂÁÌÔÓÒ‰Ë ‰Ú·ÛÙËÚÈfiÙËÙ· (17,18). ∆fiÛÔ ·fi ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È fiÛÔ Î·È ·fi ÙȘ ÌÂϤÙ˜ Ô˘ ÚԷӷʤÚıËÎ·Ó Ê·›ÓÂÙ·È fiÙÈ Ë ÌÈÎÚ‹ ËÏÈΛ· ηٿ ÙË ‰È¿ÁÓˆÛË ‰ÂÓ Û˘Ó‰¤ÂÙ·È ··Ú·›ÙËÙ· Ì ÊÙˆ¯‹ ÚfiÁÓˆÛË (8).

¶Èı·ÓÒ˜, fiˆ˜ ÈÛ¯‡ÂÈ Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÙfiÛÔ Ë ¤ÎÙ·ÛË fiÛÔ Î·È Ë ‚·Ú‡ÙËÙ¿ Ù˘ Â›Ó·È ·˘Ù¤˜ Ô˘ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ÙËÓ ¤Î‚·Û‹ Ù˘.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Hyams JS. Inflammatory bowel disease. Pediatr Rev 2000;21:291-295.

2. Hyams JS. The digestive system. In: Behrman R, Kliegman R, Jenson H, editors. Inflammatory bowel disease. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: W.B. Saunders; 2004. p. 1252-1255.

3. Farmer RG, Michener WM. Prognosis of Crohn’s disease with onset in childhood or adolescence. Dig Dis Sci 1979;24:752-757.

4. Harboe ZB, Paerregaard A, Hansen BF, Hesselfeldt P. Crohn disease in early childhood. J Pediatr Gastroenterol Nutr 2001;32:224-225.

5. Hyams JS. Crohn’s disease in children. Pediatr Clin North Am 1996;43:255-277.

6. Shivananda S, Lennard-Jones J, Logan R, Fear N, Price A, Carpenter L et al. Incidence of inflammatory bowel disease across Europe: is there a difference between north and south? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut 1996;39:690-697.

7. Sawczenko A, Sandhu BK, Logan RF, Jenkins H, Taylor CJ, Mian S et al. Prospective survey of childhood inflammatory bowel disease in the British Isles. Lancet 2001;357:1093-1094.

8. Marx G, Seidman EG, Martin SR, Deslandres C. Outcome of Crohn’s disease diagnosed before two years of age. J Pediatr 2002;140:470-473.

9. Cohen Z, Weizman Z, Kurtzbart E, Newman N, Kapuller V, Maor E et al. Infantile colonic Crohn’s disease: a report of four cases in one family. J Pediatr Gastroenterol Nutr 2000;30:461-463.

10. Lindberg E, Lindquist B, Holmquist L, Hildebrand H. Inflammatory bowel disease in children and adolescents in Sweden, 1984-1995. J Pediatr Gastroenterol Nutr 2000;30: 259-264.

11. Langholz E, Munkholm P, Krasilnikoff PA, Binder V. Inflammatory bowel diseases with onset in childhood. Clinical features, morbidity, and mortality in a regional cohort.

Scand J Gastroenterol 1997;32:139-147.

12. Baldi A, Di Marino MP, Vicidomini G, Baldi F. Crohn’s disease in infancy: a case report. Int Surg 1998;83:154-156.

13. Karlinger K, Gyorke T, Mako E, Mester A, Tarjan Z. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol 2000;35:154-167.

14. Moran AP, Prendergast MM. Molecular mimicry in Campylobacter jejuni and Helicobacter pylori lipopolysaccharides: contribution of gastrointestinal infections to autoimmunity. J Autoimmun 2001;16:241-256.

15. Shi HN, Walker A. Bacterial colonization and the development of intestinal defences. Can J Gastroenterol 2004;18: 493-500.

16. Ohkusa T, Nomura T, Sato N. The role of bacterial infection in the pathogenesis of inflammatory bowel disease. Intern Med 2004;43:534-539.

17. Prantera C, Zannoni F, Scribano ML, Berto E, Andreoli A, Kohn A et al. An antibiotic regimen for the treatment of active Crohn’s disease: a randomized, controlled clinical trial of metronidazole plus ciprofloxacin. Am J Gastroenterol 1996;91:328-332.

18. Ishikawa T, Okamura S, Oshimoto H, Kobayashi R, Mori M. Metronidazole plus ciprofloxacin therapy for active Crohn’s disease. Intern Med 2003;42:318-321. ¶·È‰È·ÙÚÈ΋ 2005;68:128-131

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CASE REPORT

Crohn’s disease in infancy: a case report E. Papadopoulou1, E. Katsiyiannaki2, E. Mihailidou1, I. Grammatikakis3, E. Mantzouranis1

Abstract 1 Paediatric Clinic of the University of Crete, Heraklion 2 Department of Gastroenterology, 2nd Clinic of Internal Medicine, “Aghia Sophia” Children’s Hospital, Athens 3 Laboratory of Clinical Imaging, University of Crete, Heraklion Correspondence: Eleftheria Papadopoulou 228 Ulof Palme str., 714 10, Heraklion, Crete E-mail: bm-pjhkka@otenet.gr Date of submission: 08-07-2003 Date of approval: 22-12-2004

Paediatriki 2005;68:132

Crohn’s disease is very rare in infancy. The case is presented of an 8 month-old boy who was hospitalized because of fever of undetermined origin and weight loss over the preceding month. A colonoscopy was carried out on the 35th day of hospitalization after episodes of bloody diarrhoea. The biopsy specimens were indicative of inflammatory bowel disease. Campylobacter jejuni was isolated from the stool culture on the 45th day of the hospitalization. Amoxycillin/clavulanic acid was administered for four days, based on the antibiotic sensitivity test, with no clinical response. On the 50th day of hospitalization ciproxin plus metronidazole treatment was started, and the infant became afebrile after ten days. Sulphasalazine was added 12 days later. The ciproxin plus metronidazole was continued for three months and sulphasalazine for one year. The infant remained without fever for eight months, with normal stools and normal weight gain. After a relapse he was rehospitalized at which time colonoscopy and biopsy confirmed the diagnosis of Crohn’s disease. Since then the patient has been under treatment with mesalazine, and has remained symptom-free.

Key words Crohn’s disease, infancy, fever of unknown origin, Campylobacter jejuni.

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∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ÛÙ· ·È‰È¿ ª. ÷ÛÈÒÙÔ˘1, ∂. ™·ÌÌÔ‡ÙË2, °. ¶ÈÙÛÔ˘Ï¿Î˘1, ª. µ·Î¿ÎË2, C. van Viet - ∫ˆÓÛÙ·ÓÙÈÓ›‰Ô˘3, ∂. ∫Ô˘‰Ô˘ÌÓ¿Î˘4

¶ÂÚ›ÏË„Ë ∆· Û˘ÁÁÂÓ‹ ÙÂÚ·ÙÒÌ·Ù· ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Â›Ó·È Û¿ÓÈ· ÓÂÔÏ¿ÛÌ·Ù·. ∞ÊÔÚÔ‡Ó Û ¤Ó· ÔÛÔÛÙfi 3% ÙˆÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∞Ó Î·È ÛÙËÓ ÏÂÈÔÓfiÙËÙ¿ ÙÔ˘˜ ·ÊÔÚÔ‡Ó Û ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù·, Û˘Ó‰˘¿˙ÔÓÙ·È Ì ˘„ËÏfi ÔÛÔÛÙfi ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÔÊ›ÏÂÙ·È ÛÙ· ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ· Ô˘ ÚÔηÏÔ‡Ó ÛÙËÓ ·ÂÚÔÊfiÚÔ Ô‰fi. ∏ ıÂÚ·›· ÂÎÏÔÁ‹˜ ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂڷو̿وÓ, Ù· ÔÔ›· ¤¯Ô˘Ó Û˘Ó‹ıˆ˜ ÌÂÁ¿ÏÔ Ì¤ÁÂıÔ˜, Â›Ó·È Ë Ï‹Ú˘ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛ‹ ÙÔ˘˜. O ÚÔÂÁ¯ÂÈÚËÙÈÎfi˜ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ ÁÈ· ÙËÓ ·ÎÚÈ‚‹ ‰È¿ÁÓˆÛË Î·È ÙÔÓ ¯ÂÈÚÔ˘ÚÁÈÎfi ۯ‰ȷÛÌfi. ™Â ·˘Ù‹ ÙËÓ ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ù· ·ÂÈÎÔÓÈÛÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο 5 ·È‰ÈÒÓ (4 ·ÁfiÚÈ·, 1 ÎÔÚ›ÙÛÈ) Ì ÙÚ·¯ËÏÈÎfi ÙÂڿو̷. ŸÏ· Ù· ·È‰È¿ ¯ÂÈÚÔ˘ÚÁ‹ıËÎ·Ó ¿ÌÂÛ· ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘˜ Î·È Ë ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ÙÂڿو̷. ¢‡Ô ·È‰È¿ ·‚›ˆÛ·Ó Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô.

1 ∆Ì‹Ì· ∞ÍÔÓÈÎÔ‡ Î·È ª·ÁÓËÙÈÎÔ‡ ∆ÔÌÔÁÚ¿ÊÔ˘, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 2 ∞ÎÙÈÓÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 3 ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· 4 ø.ƒ.§. ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ÷ÛÈÒÙÔ˘ ¶ÂÏÔÔÓÓ‹ÛÔ˘ 55, ∆.∫. 153 41, ∞Á. ¶·Ú·Û΢‹

§¤ÍÂȘ ÎÏÂȉȿ ∆Ú·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù·, ·È‰È¿, ·ÂÈÎfiÓÈÛË.

∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-01-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 18-01-2005

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ÀÂÚ˯ÔÁÚ¿ÊËÌ· ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ∞ÎÙÈÓÔÁÚ·Ê›·

∂ÈÛ·ÁˆÁ‹ ∆· ÙÂÚ·ÙÒÌ·Ù· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Â›Ó·È Ì›· ·fi ÙȘ Û·ÓÈfiÙÂÚ˜ ·Èٛ˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ ÛÙË ÓÂÔÁÓÈ΋ ËÏÈΛ· (1). ∞ÓÙÈÚÔÛˆÂ‡Ô˘Ó ÂÚ›Ô˘ ÙÔ 3% ÙˆÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ (2). ∆· ·ÙÙ·Ú· ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÔÏ˘‰‡Ó·Ì· ·Ú¯¤ÁÔÓ· ÁÂÓÂÙÈο ·ÙÙ·Ú· Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÔÏÏÔ‡˜ ÈÛÙÔ‡˜, ‰È¿ÊÔÚÔ˘˜ ·fi ÙÔ fiÚÁ·ÓÔ ·fi ÙÔ ÔÔ›Ô ÂÍÔÚÌÒÓÙ·È (1,3). ™˘Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ¢ÌÂÁ¤ıÂȘ ÂÍÂÚÁ·Û›Â˜ Î·È Û ÔÛÔÛÙfi ÂÚ›Ô˘ 19% ·Ó·Ê¤ÚÂÙ·È ÔÏ˘˘‰Ú¿ÌÓÈÔ Î·Ù¿ ÙËÓ Î‡ËÛË (4-6). ∏ ‰È¿ÁÓˆÛË ÌÔÚ› Ó· Á›ÓÂÈ Î·È ·fi ÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (3,4). ™˘Ó‹ıˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, ÏfiÁˆ Ù˘ Û˘¯Ó‹˜ ·ÚÔ˘Û›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, Ë ÚÒÙË ÂÓ¤ÚÁÂÈ· Â›Ó·È Ë ‰È·ÛˆÏ‹ÓˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ (˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›·) (1-3) Â›Ó·È Î·ıÔÚÈÛÙÈÎfi˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙÔÓ ÚÔÂÁ¯ÂÈÚËÙÈÎfi ۯ‰ȷÛÌfi, ηıfiÛÔÓ Ë ıÂÚ·›· ÂÎÏÔÁ‹˜ Â›Ó·È Ë Ï‹Ú˘ ÂÍ·›ÚÂÛË ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜ (3,4). Èڛ˜ ıÂÚ·›·, Ë ıÓËÙfiÙËÙ· ·Ó¤Ú¯ÂÙ·È Û ÔÛÔÛÙfi 80-100% (1).

¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ÙˆÓ ·ÂÈÎÔÓÈÛÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ (·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›·, ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·) fiÏˆÓ ÙˆÓ Û˘ÁÁÂÓÒÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” ÛÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1993-2003. ∞ӷʤÚÔÓÙ·È, Â›Û˘, ÙÔ Ê‡ÏÔ, Ë ËÏÈΛ·, ÛÙÔȯ›· ·fi ÙËÓ Î‡ËÛË Î·È ÙÔÓ ÙÔÎÂÙfi, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙˆÓ ÓÂÔÁÓÒÓ, Ë ıÂÚ·¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Ù· ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù·.

OÈ ·ÛıÂÓ›˜ ‹Ù·Ó ¤ÓÙÂ. ŸÏ· Ù· ÓÂÔÁÓ¿ ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜ (4 ÔÏÈ΋, 1 ˘ÊÔÏÈ΋). ∆· ‰‡Ô ÓÂÔÁÓ¿ ·‚›ˆÛ·Ó Û‡ÓÙÔÌ· ÌÂÙ¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ Â¤Ì‚·ÛË (¶›Ó·Î·˜ 1).

¶ÂÚÈÁÚ·Ê‹ ÂÚÈÙÒÛÂˆÓ ¶ÂÚ›ÙˆÛË ÚÒÙË ÕÚÚÂÓ ÓÂÔÁÓfi, 40 ‚‰ÔÌ¿‰ˆÓ ΢‹Ûˆ˜, ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3400 g. ∏ ·ËÛË ‹Ù·Ó ÔÌ·Ï‹. ∫·Ù¿ ÙÔÓ ÙÔÎÂÙfi ·Ó·Ê¤ÚÂÙ·È Ú‹ÍË ·ÌÓ›Ô˘. ∂ÈÛÎÔÈÎÒ˜, ηٿ ÙË Á¤ÓÓËÛË ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· ÛÎÏËÚ‹ ‰ÈfiÁΈÛË ‰È·ÛÙ¿ÛÂˆÓ 8x5 cm ÂÚ›Ô˘. ∆Ô ÓÂÔÁÓfi ‰ÂÓ ·ÚÔ˘Û›·˙ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. ªÂٷʤÚıËΠ·fi ÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ŒÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘ Ô˘ ¤‰ÂÈÍ Ôχ¯ˆÚÔ Î˘ÛÙÈÎfi ÌfiÚʈ̷ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· Ì ‰È·ÊÚ·ÁÌ¿ÙÈ· Î·È Èı·Ó‹ ¶·È‰È·ÙÚÈ΋ 2005;68:133-138

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·134

134

¶·È‰È·ÙÚÈ΋ 2005;68:133-138

£¿Ó·ÙÔ˜ flÚÈÌÔ ÙÂڿو̷ 3Ë Ë̤ڷ

∂¤˙ËÛ ՈÚÔ ÙÂڿو̷ 25Ë Ë̤ڷ

£¿Ó·ÙÔ˜ flÚÈÌÔ ÙÂڿو̷ 1Ë Ë̤ڷ

∂¤˙ËÛ ՈÚÔ ÙÂڿو̷ 3Ë Ë̤ڷ

∂¤˙ËÛ ՈÚÔ ÙÂڿو̷ 5Ë Ë̤ڷ

(+) CT 6x4x3 2900 ÕÚÚÂÓ

‰È¿ÁÓˆÛË ÏÂÌÊ·ÁÁÂÈÒÌ·ÙÔ˜ (∂ÈÎfiÓ· 1). ∞ÎÔÏÔ‡ıËÛ ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘ Ô˘ ¤‰ÂÈÍ ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÍÂÚÁ·Û›· 9x6 cm ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· Ì ΢ÛÙÈο Î·È Û˘Ì·Á‹ ÛÙÔȯ›·. ∂›Û˘, ˘‹Ú¯·Ó ˘¤Ú˘ÎÓ· (·ÈÌÔÚÚ·ÁÈο) ÛÙÔȯ›· Î·È Â˘ÌÂÁ¤ı˘ ·ÔÙÈÙ¿ÓˆÛË. ™ÙÔ ‡„Ô˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ·‰¤Ó·, Ë ÂÍÂÚÁ·Û›· ÂÚÓÔ‡Û ÙË Ì¤ÛË ÁÚ·ÌÌ‹ Î·È ·ˆıÔ‡Û ÙËÓ ÙÚ·¯Â›· ÚÔ˜ Ù· ‰ÂÍÈ¿. ∏ Èı·Ó‹ ‰È¿ÁÓˆÛË ‹Ù·Ó ÙÂڿو̷ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ (∂ÈÎfiÓ· 2). ∏ ÙÈÌ‹ Ù˘ ·-ÊÂÙÔÚˆÙ½Ó˘ ‹Ù·Ó 1815 ng/ml, ÂÓÒ Ù· Â›‰· Ù˘ ‚-¯ÔÚȷ΋˜ ÁÔÓ·‰ÔÙÚÔ›Ó˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ∞ÎÔÏÔ‡ıËÛ Ï‹Ú˘ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘ Î·È Ë ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ¿ˆÚÔ Û˘ÁÁÂÓ¤˜ ÙÂڿو̷. ∆Ô ÓÂÔÁÓfi ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ ·fi 15 Ë̤Ú˜.

38 5Ë

¶ÔÏ˘˘‰Ú¿ÌÓÈÔ

∫·ÈÛ·ÚÈ΋ ÙÔÌ‹

(-) US+CT 7x5,5x3,5 3200 ÕÚÚÂÓ 40 4Ë

º˘ÛÈÔÏÔÁÈ΋

º˘ÛÈÔÏÔÁÈÎfi˜

(+) ∞Ï‹ ·/·+CT 7x4,5x4 1770 ÕÚÚÂÓ 35 3Ë

¶ÔÏ˘˘‰Ú¿ÌÓÈÔ

∫·ÈÛ·ÚÈ΋ ÙÔÌ‹

(+) CT 4,5x3,5x2,5 3400 £‹Ï˘ 38 2Ë

ÀÂÚÒÚÈÌÔ˜ Ï·ÎÔ‡˜

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(-) US+CT 9x6x4 3400 ÕÚÚÂÓ 40 1Ë

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º‡ÏÔ ∏ÏÈΛ· ·ËÛ˘ (‚‰ÔÌ¿‰Â˜)

∆ÔÎÂÙfi˜

∂ÈÎfiÓ· 1. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘. ¶Ôχ¯ˆÚÔ Î˘ÛÙÈÎfi ÌfiÚʈ̷ Ì ‰È·ÊÚ·ÁÌ¿ÙÈ· ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ·.

∫‡ËÛË ¶ÂÚÈÙÒÛÂȘ

¶›Ó·Î·˜ 1. ™ÙÔȯ›· ¤ÓÙ ÂÚÈÙÒÛÂˆÓ Û˘ÁÁÂÓÒÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂڷو̿وÓ

µ¿ÚÔ˜ Á¤ÓÓËÛ˘ (g)

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∞Ó·Ó¢ÛÙÈ΋ ÃÚfiÓÔ˜ ‰˘Û¯¤ÚÂÈ· ¯ÂÈÚÔ˘ÚÁ›Ԣ

πÛÙÔÏÔÁÈ΋

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ª. ÷ÛÈÒÙÔ˘ Î·È Û˘Ó.

∂ÈÎfiÓ· 2. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘. ∂˘ÌÂÁ¤ı˘ ÙÚ·¯ËÏÈ΋ ÂÍÂÚÁ·Û›· Ì ΢ÛÙÈΤ˜ ÂÚÈÔ¯¤˜, ·ÈÌÔÚÚ·ÁÈο ÛÙÔȯ›· Î·È ÌÈÎÚÔ·ÔÙÈÙ·ÓÒÛÂȘ ÛÙÔÓ ÚÔÛÔÓ‰˘ÏÈÎfi ¯ÒÚÔ.

Paediatriki Mar-Apr 05

19-04-05

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∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜

¶ÂÚ›ÙˆÛË ‰Â‡ÙÂÚË £‹Ï˘, 38 ‚‰ÔÌ¿‰ˆÓ ΢‹Ûˆ˜, ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3400 g. ∞fi ÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔȯ›· ˘ÂÚˆÚÈÌfiÙËÙ·˜ ÙÔ˘ Ï·ÎÔ‡ÓÙ·. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚ fiÙÈ ÓfiÛËÛ ·fi ·ÓÂÌÔ‚ÏÔÁÈ¿ ηٿ ÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ·ËÛ˘. ∆Ô ÓÂÔÁÓfi ÌÂٷʤÚıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘ Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÏfiÁˆ ÌÔÚÊÒÌ·ÙÔ˜ Ô˘ ÚÔ¤‚·Ï ·fi ÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. ∞fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÂÓÙÔ›ÛÙËÎ·Ó ÙÚ›· ÂÓ‰ÔÛÙÔÌ·ÙÈο ÌÔÚÊÒÌ·Ù·, ÙÔ ÚÔ¤¯ÔÓ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘ Î·È ‰‡Ô ·Ó·ÏfiÁÔ˘ ˘Ê‹˜, ÌÈÎÚfiÙÂÚ·, ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ. ŒÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘, Ô˘ ¤‰ÂÈÍ ÌfiÚʈ̷ ‰È·ÛÙ¿ÛÂˆÓ 4,5x3,5x2,5 cm, Ì ΢ÛÙÈο Î·È Û˘Ì·Á‹ ÛÙÔȯ›· ÛÙÔÓ ˘ÔÁÏÒÛÛÈÔ ¯ÒÚÔ Î·È Ï¤Ù˘ÓÛË ÙÔ˘ ÎÏ¿‰Ô˘ Ù˘ οو ÁÓ¿ıÔ˘ ·ÚÈÛÙÂÚ¿. ∞ÎÔÏÔ‡ıËÛ Ï‹Ú˘ ·Ê·›ÚÂÛË fiÏˆÓ ÙˆÓ ÌÔÚʈ̿وÓ. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ¿ˆÚÔ Û˘ÁÁÂÓ¤˜ ÙÂڿو̷ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ·. ∆Ô ÓÂÔÁÓfi ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ ·fi 12 Ë̤Ú˜.

Î·È ‰˘Û¯¤ÚÂÈ· ‰Èfi‰Ô˘ ÙÔ˘ ηıÂÙ‹Ú· ·fi ÙÔÓ ‰ÂÍÈfi ÚÒıˆÓ·. ∞ÎÔÏÔ‡ıËÛ ‰È·ÛˆÏ‹ÓˆÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Î·È Î·ıÂÙËÚÈ·ÛÌfi˜ Ù˘ ÔÌÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜. ∏ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘/ıÒڷη ¤‰ÂÈÍ ÌfiÚʈ̷ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· Ì ¢ÌÂÁ¤ıÂȘ ·ÔÙÈÙ·ÓÒÛÂȘ (∂ÈÎfiÓ· 4). ∞ÎÔÏÔ‡ıËÛ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘ Ô˘ ¤‰ÂÈÍ ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÍÂÚÁ·Û›· ‰È·ÛÙ¿ÛÂˆÓ 7x4,5x4 cm ÌÂ Û˘Ì·Á‹ ÛÙÔȯ›·, ·ÔÙÈÙ·ÓÒÛÂȘ, ÂÚÈÔ¯¤˜ Ï›Ô˘˜ Î·È ·Ó¿‰ÂÈÍË ‰ÔÌÒÓ Ô˘ ı‡ÌÈ˙·Ó ÂÁÎÂÊ·ÏÈÎfi ·Ú¤Á¯˘Ì· Î·È Èı·Ó‹ ‰È¿ÁÓˆÛË ÙÂÚ·ÙÒÌ·ÙÔ˜. ∞ÎÔÏÔ‡ıËÛ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ ÂÍÂÚÁ·Û›·˜ (∂ÈÎfiÓ· 5) Î·È ‰È·ÈÛÙÒıËΠÏ‹Ú˘ ÂÈÎÔÈÓˆÓ›· ÛÙÔÌ·ÙÈ΋˜ Î·È ÚÈÓÈ΋˜ ÎÔÈÏfiÙËÙ·˜. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ÒÚÈÌÔ ÙÂڿو̷ ÚÈÓÔÊ¿Ú˘ÁÁ·. ∆Ô ÓÂÔÁÓfi ·ÈÌÔÚÚ·ÁÔ‡ÛÂ Û˘Ó¯Ҙ, ÂÌÊ¿ÓÈÛ ‚Ú·‰˘Î·Ú‰›· Î·È Î·Ù¤ÏËÍ 8 ÒÚ˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË (∂ÈÎfiÓ· 5). O ı¿Ó·ÙÔ˜ ÙÔ˘ ÓÂÔÁÓÔ‡ Ú¤ÂÈ Ó· ·Ô‰Ôı› ÛÙËÓ ¤ÓÙÔÓË ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Ô˘ Ô‰‹ÁËÛ Û ηډȷ΋ ο̄Ë, ÛÙȘ Û˘Ó˘¿Ú¯Ô˘Û˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ÛÙȘ ÌÂÁ¿Ï˜ ‰È·ÛÙ¿ÛÂȘ ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜, ·Ú¿ ÛÙÔÓ ÈÛÙÔÏÔÁÈÎfi Ù‡Ô (ÒÚÈÌÔ) ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜.

¶ÂÚ›ÙˆÛË ÙÚ›ÙË ÕÚÚÂÓ ÓÂÔÁÓfi, 35 ‚‰ÔÌ¿‰ˆÓ ΢‹Ûˆ˜, ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÔÏ˘˘‰Ú·ÌÓ›Ô˘, Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 1170 g. ∏ ÌËÙ¤Ú· Ô‰ËÁ‹ıËΠÛÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô ÏfiÁˆ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. ∞ӷʤÚÔÓÙ·È ‰‡Ô ÂÓ‰ÔÌ‹ÙÚÈ· ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ‰˘ÛÌÔÚÊ›· ΢‹Ì·ÙÔ˜. ªÂÙ¿ ÙË Á¤ÓÓËÛË ·Ú·ÙËÚ‹ıËΠÎÈÓËÙfi ÌfiÚʈ̷ Ô˘ ÂÍÂÚ¯fiÙ·Ó ·fi ÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Î·È ¤ÊÂÚÂ Ì›Û¯Ô Ì‹ÎÔ˘˜ ÂÚ›Ô˘ 2 cm (∂ÈÎfiÓ· 3). ¶ÂÚÈÁÚ¿ÊÂÙ·È fiÙÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÔÎÂÙÔ‡ ·fi ÙË ÌËÙ¤Ú· ÂÍ‹Ïı ÌfiÚʈ̷ Ì ¯¤ÚÈ, Ô˘ Èı·ÓfiÓ ÂÚfiÎÂÈÙÔ ÁÈ· ¤Ì‚Ú˘Ô Û ¤Ì‚Ú˘Ô. ∆Ô ÓÂÔÁÓfi Û ‚·ÚÈ¿ ηٿÛÙ·ÛË ÌÂٷʤÚıËΠÛÙÔ ÓÔÛÔÎÔÌ›Ô. ™˘Ó˘‹Ú¯Â Û¯ÈÛÙ›· ˘ÂÚÒ·˜, Ï·ÁÒ¯ÂÈÏÔ

¶ÂÚ›ÙˆÛË Ù¤Ù·ÚÙË ÕÚÚÂÓ ÓÂÔÁÓfi, ËÏÈΛ·˜ 25 ËÌÂÚÒÓ, ÌÂٷʤÚıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÙÚ·¯ËÏÈ΋˜ ‰ÈfiÁΈÛ˘

∂ÈÎfiÓ· 3. ∂˘Ì¤ÁÂı˜ ÌfiÚʈ̷ Ô˘ ÂͤگÂÙ·È ·fi ÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ· Ì ÙÚ›¯Â˜ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘. ∆Âڿو̷.

∂ÈÎfiÓ· 4. ∞ÎÙÈÓÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘-ıÒÚ·ÎÔ˜. ªfiÚʈ̷ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· Ì ¢ÌÂÁ¤ıË ·ÔÙÈÙ¿ÓˆÛË. ¶·È‰È·ÙÚÈ΋ 2005;68:133-138

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ª. ÷ÛÈÒÙÔ˘ Î·È Û˘Ó.

∂ÈÎfiÓ· 5. ÃÂÈÚÔ˘ÚÁÈÎfi ·Ú·Û··ÛÌ·. ∆Âڿو̷ ÚÈÓÔÊ¿Ú˘ÁÁ·.

‰ÂÍÈ¿ Î·È ‰˘Û¯¤ÚÂÈ· Û›ÙÈÛ˘. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠÌÂÙ¿ ·ËÛË 40 ‚‰ÔÌ¿‰ˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 3200 g. ŒÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘ Ô˘ ¤‰ÂÈÍ ÌfiÚʈ̷ ÌÈÎÙ‹˜ Û˘ÛÙ¿Ûˆ˜ ÛÙË ‰ÂÍÈ¿ ÙÚ·¯ËÏÈ΋ ¯ÒÚ·, Ì οıÔ‰Ô ÚÔ˜ ÙË ıˆÚ·ÎÈ΋ ÎÔÈÏfiÙËÙ·. À‹Ú¯·Ó ÛÙÈÎÙ¤˜ ·ÔÙÈÙ·ÓÒÛÂȘ. ∏ Èı·Ó‹ ‰È¿ÁÓˆÛË ‹Ù·Ó ÙÂڿو̷ ‹ ΢ÛÙÈÎfi ‡Áڈ̷ (∂ÈÎfiÓ· 6). ∞ÎÔÏÔ‡ıËÛ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Ô˘ ¤‰ÂÈÍ ‰›¯ˆÚË ÂÍÂÚÁ·Û›· ‰È·ÛÙ¿ÛÂˆÓ 7x5,5x3,5 cm ÛÙË ‰ÂÍÈ¿ ÙÚ·¯ËÏÈ΋ ¯ÒÚ· Ì ΢ÛÙÈο, Û˘Ì·Á‹ ÛÙÔȯ›· Î·È ·ÔÙÈÙ·ÓÒÛÂȘ. ∆Ô ¤Ó· ÙÌ‹Ì· ÙÔ˘ fiÁÎÔ˘ ηÙÂÚ¯fiÙ·Ó ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Ì¤¯ÚÈ ÙÔ ‡„Ô˜ ÙÔ˘ ‰È¯·ÛÌÔ‡ Ù˘ ÙÚ·¯Â›·˜ ‰ÂÍÈ¿ Î·È ÙÔ ¿ÏÏÔ ÚÔ˜ ÙË Ì·Û¯·ÏÈ·›· ÎÔÈÏfiÙËÙ·. ™ÙÔ ‡„Ô˜ ÙˆÓ ÎÏÂȉÒÓ, Ë ÂÍÂÚÁ·Û›· ÂÚÓÔ‡Û ÙË Ì¤ÛË ÁÚ·ÌÌ‹ Î·È ·ˆıÔ‡Û ÙÔÓ ÔÈÛÔÊ¿ÁÔ Î·È ÙËÓ ÙÚ·¯Â›· ·ÚÈÛÙÂÚ¿ Î·È ÙÔÓ ı‡ÌÔ ÚÔÛı›ˆ˜. ∏ Èı·Ó‹ ‰È¿ÁÓˆÛË ‹Ù·Ó ÙÚ·¯ËÏÈÎfi ÙÂڿو̷ Ì ηıÔ‰È΋ ÔÚ›· ÚÔ˜ ÙË ıˆÚ·ÎÈ΋ ÎÔÈÏfiÙËÙ·. ∞ÎÔÏÔ‡ıËÛ Ï‹Ú˘ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË. ∏ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ¿ˆÚÔ ÙÂڿو̷. ∆Ô ·È‰› ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌÂÙ¿ ·fi 12 Ë̤Ú˜.

∂ÈÎfiÓ· 6. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÙÚ·¯‹ÏÔ˘. ∂ÈÌ‹Î˘ ÙÔÌ‹. ªfiÚʈ̷ ÌÂ Û˘Ì·Á‹ Î·È Î˘ÛÙÈο ÛÙÔȯ›·. ¶·ÚÔ˘Û›· ·ÔÙÈÙ·ÓÒÛÂˆÓ Ì ·ÎÔ˘ÛÙÈ΋ ÛÎÈ¿. ¶·È‰È·ÙÚÈ΋ 2005;68:133-138

¶ÂÚ›ÙˆÛË ¤ÌÙË ÕÚÚÂÓ ÓÂÔÁÓfi, ËÏÈΛ·˜ 38 ‚‰ÔÌ¿‰ˆÓ, ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÔÏ˘˘‰Ú·ÌÓ›Ô˘ Î·È ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 2900 g. ∆o ÓÂÔÁÓfi ›¯Â ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ˘‹Ú¯Â ÌfiÚʈ̷ Ô˘ ÚÔ¤‚·Ï ·fi ÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. ∆Ô ÓÂÔÁÓfi ÌÂٷʤÚıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Î·È ‰È·ÛˆÏËÓÒıËÎÂ. ŒÁÈÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘ Ô˘ ¤‰ÂÈÍ ¯ˆÚÔηٷÎÙËÙÈ΋ ÂÍÂÚÁ·Û›· ‰È·ÛÙ¿ÛÂˆÓ 6x4x3 cm Ì ·Û·Ê‹ fiÚÈ· ÛÙÔÓ ‰ÂÍÈfi ˘ÔÁÏÒÛÛÈÔ ¯ÒÚÔ, Ì Â¤ÎÙ·ÛË ·ÊÂÓfi˜ ÚÔ˜ ÙËÓ ˘ÔÁÂÓ›‰È· ÂÚÈÔ¯‹ Î·È ·ÊÂÙ¤ÚÔ˘ ÚÔ˜ ÙÔÓ ÛÙÂÚÓÔÎÏÂȉÔÌ·ÛÙÔÂȉ‹ Ì˘. ∏ ÂÍÂÚÁ·Û›· ‹Ù·Ó ·ÓÔÌÔÈÔÁÂÓ‹˜, Ì ˘fi˘ÎÓ˜ ÂÚÈÔ¯¤˜ Î·È ÛÙÔȯ›· Ï›Ô˘˜. ∞ˆıÔ‡ÛÂ Î·È ›Â˙ ÙÔÓ Î¿ıÂÙÔ ÎÏ¿‰Ô Ù˘ οو ÁÓ¿ıÔ˘ ‰ÂÍÈ¿, ÙË Ì·Ï·Î‹ ˘ÂÚÒ· Î·È ÙË ÁÏÒÛÛ· ÚÔ˜ Ù· ¿Óˆ Î·È ÚfiÛˆ (∂ÈÎfiÓ· 7). ∞ÎÔÏÔ‡ıËÛ ˘ÊÔÏÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Î·È Ë ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ¤‰ÂÈÍ ÒÚÈÌÔ ÙÂڿو̷. ∆Ô ÓÂÔÁÓfi ·‚›ˆÛ 8 Ë̤Ú˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô. ∏ ·ÈÙ›· ı·Ó¿ÙÔ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ Ú¤ÂÈ Ó· ·Ô‰Ôı› ÛÙËÓ ·‰˘Ó·Ì›· ¿ÚÛˆ˜ ÙˆÓ ÈÂÛÙÈÎÒÓ Ê·ÈÓÔÌ¤ÓˆÓ Â› Ù˘ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ·fi ÙÔ ÙÂڿو̷ ÏfiÁˆ ı¤Ûˆ˜ ÛÙÔ˘˜ ÂÓ Ùˆ ‚¿ıÂÈ ÈÛÙÔ‡˜ Î·È Ù˘ ˘ÊÔÏÈ΋˜ ÂÍ·›ÚÂÛ‹˜ ÙÔ˘.

™˘˙‹ÙËÛË ∆· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· Â›Ó·È Û¿ÓÈ· Î·È ·ÔÙÂÏÔ‡Ó ÔÛÔÛÙfi ÂÚ›Ô˘ 3% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ÙÂڷو̿وÓ. ∆· ¤ÓÙ ÂÚÈÛÙ·ÙÈο

∂ÈÎfiÓ· 7. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÛÏ·¯ÓÈÎÔ‡ ÎÚ·Ó›Ô˘. ∂ÍÂÚÁ·Û›· ÛÙÔÓ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· ‰ÂÍÈ¿ Ì ΢ÛÙÈο Î·È Û˘Ì·Á‹ ÛÙÔȯ›·. ∞ÒıËÛË Ù˘ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ·ÚÈÛÙÂÚ¿ Î·È ÈÂÛÙÈÎfi ÂÓÙ‡ˆÌ· ÛÙÔÓ ÎÏ¿‰Ô Ù˘ ÁÓ¿ıÔ˘ ‰ÂÍÈ¿.

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∆Ú¿¯ËÏÔ˜: Û¿ÓÈ· ÂÓÙfiÈÛË ÙÂÚ·ÙÒÌ·ÙÔ˜

Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ÊÔÚÔ‡Ó Û ¤Ó· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 10 ÂÙÒÓ (1993-2003). ªÂÁ¿Ï· ÙÂÚ·ÙÒÌ·Ù· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Â›Ó·È ·ÈÙ›· ÁÈ· ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Â›Ó·È ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ· (1). ∆Ô ˘„ËÏfi ÔÛÔÛÙfi ıÓËÛÈÌfiÙËÙ·˜ ηٿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ ÛÙ· ¤ÓÙÔÓ· ÈÂÛÙÈο Ê·ÈÓfiÌÂÓ· Â› Ù˘ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡, ÛÙȘ Û˘Ó˘¿Ú¯Ô˘Û˜ Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜ Î·È ÏÈÁfiÙÂÚÔ ÛÙËÓ ÈÛÙÔÏÔÁÈ΋ ʇÛË ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜ (ÒÚÈÌÔ ‹ ¿ˆÚÔ). ™Ô‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ¿ÌÂÛË ·Ó¿ÁÎË ‰È·ÛˆÏ‹ÓˆÛ˘ ˘‹Ú¯Â Û 3 ·fi Ù· 5 ÓÂÔÁÓ¿ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜. ∆· ‰‡Ô ÓÂÔÁÓ¿ ·‚›ˆÛ·Ó ÙÔ ¤Ó· 8 ÒÚ˜ ÌÂÙ¿ ÙÔ ¯ÂÈÚÔ˘ÚÁÂ›Ô Î·È ÙÔ ¿ÏÏÔ ÙËÓ 8Ë ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ë̤ڷ. ∂¿Ó Ù· ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛÙÔ‡Ó ¤ÁηÈÚ· Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË, ÙÔ ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ Â›Ó·È Ôχ ˘„ËÏfi Î·È ÊÙ¿ÓÂÈ ÙÔ 80-100% (1,7). ∆Ô ÔÏ˘˘‰Ú¿ÌÓÈÔ Î·È Ô ‚·ıÌfi˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÙÂÚ·ÙÒÌ·ÙÔ˜. ªÂÁ¿Ï˜ ÂÍÂÚÁ·Û›Â˜ ÚÔηÏÔ‡Ó ˘ÂÚ¤ÎÙ·ÛË ÙÔ˘ ·˘¯¤Ó· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Î·È Ô‰ËÁÔ‡Ó Û ·fiÊÚ·ÍË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘, ‰È·Ù·Ú·¯‹ ÛÙËÓ Î·Ù¿ÔÛË Î·È ·ÚÔ˘Û›· ÔÏ˘˘‰Ú·ÌÓ›Ô˘ (4-6). ∆Ô ÔÏ˘˘‰Ú¿ÌÓÈÔ ·Ó·Ê¤ÚÂÙ·È Û ÔÛÔÛÙfi 19% ·fi ÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜ (6,8). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ÊÔÚÔ‡Û ÛÙ· 2 ·fi Ù· 5 ÓÂÔÁÓ¿ (ÔÛÔÛÙfi 40%), Ù· ÔÔ›· ›¯·Ó Û¯ÂÙÈο ÌÂÁ¿ÏˆÓ ‰È·ÛÙ¿ÛÂˆÓ Ì¿˙˜ Ì ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ÂÓÙfiÈÛË Î·È ÛÙ· ÔÔ›·, ·Ú¿ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÍ·›ÚÂÛË Ù˘ Ì¿˙·˜, Ë ÂͤÏÈÍË ‹Ù·Ó ‰˘ÛÌÂÓ‹˜ (ı¿Ó·ÙÔ˜). πÛÙÔÏÔÁÈÎÒ˜, Ù· ÙÂÚ·ÙÒÌ·Ù· Â›Ó·È fiÁÎÔÈ ÂÎ ‚Ï·ÛÙÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ÂÚȤ¯Ô˘Ó ÛÙÔȯ›· Î·È ·fi Ù· ÙÚ›· ‚Ï·ÛÙÈο ‰¤ÚÌ·Ù· Ì ÚÔ¤¯ÔÓÙ· Ù· Ó¢ÚÈο ÛÙÔȯ›· (1,3). πÛÙÔÏÔÁÈ΋ ·ÓˆÚÈÌfiÙËÙ· ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ηÎÔ‹ıÂÈ· (1). ™Ù· 2 ÓÂÔÁÓ¿ Ô˘ ·‚›ˆÛ·Ó ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë ÈÛÙÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË ¤‰ÂÈÍ “ÒÚÈÌÔ ÙÂڿو̷”. ∫·ÎÔ‹ıÂÈ· ÛÙ· ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· ··ÓÙ¿ Û ¤Ó· ÔÛÔÛÙfi ÂÚ›Ô˘ 10% Î·È ·ÊÔÚ¿ Û˘Ó‹ıˆ˜ Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚˆÓ ËÏÈÎÈÒÓ Î·È Û ÂÓ‹ÏÈΘ (3). ™Â ÔÚÈṲ̂Ó˜ ·fi ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ·Ó·Ê¤ÚÂÙ·È Î·È ·ÚÔ˘Û›· ÌÂÙ·ÛÙ¿ÛÂˆÓ Ó¢ÌÔÓÈÎÒÓ Î·È Ë·ÙÈÎÒÓ (3,4). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÙÚ›· ÙÂÚ·ÙÒÌ·Ù· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ·fi ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË ˆ˜ ¿ˆÚ·. ∏ ·ÚÔ˘Û›· ·ÒÚˆÓ ÂÌ‚Ú˘˚ÎÒÓ ÛÙÔȯ›ˆÓ Û ¤Ó· ÙÂڿو̷ ηıÈÛÙ¿ ··Ú·›ÙËÙÔ ÙÔÓ ÂÚÈÔ‰ÈÎfi ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Î·È ÙË Ì¤ÙÚËÛË Ù˘ ·ÊÂÙÔÚˆÙ½Ó˘ (9). ∂›Û˘, Ë ÈÛÙÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË “¿ˆÚÔ ÙÂڿو̷” ··ÈÙ› ÛÙ·‰ÈÔÔ›ËÛË ÁÈ· Ù˘¯fiÓ ÌÂÙ·ÛÙ·ÙÈ΋ ÓfiÛÔ, ·Ó Î·È Ë Î·ÎÔ‹ı˘ ÂÍ·ÏÏ·Á‹ ÙˆÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ··ÓÙ¿Ù·È Û ·È‰È¿ ¤Ú·Ó Ù˘ ÓÂÔÁÓÈ΋˜ ËÏÈΛ·˜ (3). ™Â

¤Ó· ·fi Ù· ÓÂÔÁÓ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ë ·ÊÂÙÔÚˆÙ½ÓË Î·Ù¿ ÙË ‰È¿ÁÓˆÛË ‹Ù·Ó Û ˘„ËÏ¿ Â›‰·. ∆· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· Û˘¯Ó¿ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ·fi ÙÔ ÂÓ‰ÔÌ‹ÙÚÈÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· (3,4,10). ∞Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÙÚ·¯‹ÏÔ˘ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ‰Â›¯ÓÂÈ Ì¿˙· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Ì ·ÚÔ˘Û›· ·ÔÙÈÙ·ÓÒÛÂˆÓ Û ÔÛÔÛÙfi ÂÚ›Ô˘ 50% (3,8). ™ÙËÓ ·Ï‹ ·ÎÙÈÓÔÁÚ·Ê›· Ô˘ ¤ÁÈÓ Û ¤Ó· ·fi Ù· ÓÂÔÁÓ¿ ˘‹Ú¯Â ÌÂÁ¿ÏË Ì¿˙· Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÙÚ·¯ËÏÈ΋ ¯ÒÚ·, Ì ·ÔÙÈٷӈ̤ÓÔ ÌfiÚʈ̷ Ì ÌÔÚÊÔÏÔÁ›· ÛÔÓ‰‡ÏÔ˘. ∆· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· ÚÔ‚¿ÏÏÔ˘Ó ˆ˜ ÌÔÓ‹Ú˘ ÙÚ·¯ËÏÈ΋ ‰ÈfiÁΈÛË. ∞ӷʤÚÔÓÙ·È fï˜ Î·È ÔÏ˘ÂÛÙȷΤ˜ (11) ÂÓÙÔ›ÛÂȘ, fiˆ˜ Û ¤Ó· ·fi Ù· ÓÂÔÁÓ¿ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ fiÔ˘ Ë ÚÔ¤¯Ô˘Û· ÂÍÂÚÁ·Û›· ‹Ù·Ó ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘, ·ÏÏ¿ Û˘Ó˘‹Ú¯·Ó ‰‡Ô ÌÈÎÚfiÙÂÚ˜ ·Ó¿ÏÔÁ˘ ÈÛÙÔÏÔÁÈ΋˜ ˘Ê‹˜ Ì¿˙˜ ÛÙËÓ ¿Óˆ ÁÓ¿ıÔ. £· Ú¤ÂÈ Ó· Á›ÓÂÈ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ÙÚ·¯ËÏÈÎÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ Î˘Ú›ˆ˜ ·fi ÙÔ Î˘ÛÙÈÎfi ‡Áڈ̷ Î·È Û¿ÓÈ· ·fi ÓÂÔÏ¿ÛÌ·Ù· ÂÎ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ Ô˘ ··ÓÙÒÓÙ·È Û˘Ó‹ıˆ˜ Û ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ Î·È ·ÂÈÎÔÓÈÛÙÈο Â›Ó·È Û˘Ì·ÁÔ‡˜ ˘Ê‹˜ ÂÍÂÚÁ·Û›Â˜. ∏ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ·fi ΢ÛÙÈÎfi ‡Áڈ̷ ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ¢¯ÂÚ‹˜, ·Ó ÏËÊı› ˘’ fi„ÈÓ fiÙÈ Î·È Ù· ‰‡Ô ÓÂÔÏ¿ÛÌ·Ù· ·ÊÔÚÔ‡Ó Û ·ÛıÂÓ›˜ Ù˘ ›‰È·˜ ËÏÈΛ·˜, ¤¯Ô˘Ó ·ÚfiÌÔÈÔ Ì¤ÁÂıÔ˜, ·ÚfiÌÔÈ· ÂÓÙfiÈÛË, ÎÔÈÓ‹ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ·ÚfiÌÔÈ· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· (1-3,12). ∞Ó Î·È Ù· ÏÂÌÊ·ÁÁÂÈÒÌ·Ù· Û˘Ó‹ıˆ˜ ÂÍÔÚÌÒÓÙ·È ·fi ÙÔ Ô›ÛıÈÔ ÙÚ·¯ËÏÈÎfi ÙÚ›ÁˆÓÔ, fiÙ·Ó ¤¯Ô˘Ó ÌÂÁ¿Ï˜ ‰È·ÛÙ¿ÛÂȘ ‰ÂÓ Â›Ó·È Â‡ÎÔÏÔ Ó· ‚ÚÂı› ÙÔ ·ÎÚÈ‚¤˜ ÛËÌÂ›Ô ÂÍÔÚÌ‹ÛÂÒ˜ ÙÔ˘˜. ∆fiÛÔ Ù· ÙÂÚ·ÙÒÌ·Ù· fiÛÔ Î·È Ù· ÏÂÌÊ·ÁÁÂÈÒÌ·Ù· ·ÔÙÂÏÔ‡ÓÙ·È ·fi ΢ÛÙÈο Î·È Û˘Ì·Á‹ ÛÙÔȯ›·. ∞˘Ù‹ ÙË ÌÔÚÊÔÏÔÁ›· ·ÚÔ˘Û›·˙ ·ÂÈÎÔÓÈÛÙÈο (˘ÂÚ˯ÔÁÚ¿ÊËÌ·-·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·) ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÍÂÚÁ·ÛÈÒÓ ÙˆÓ ·ÛıÂÓÒÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ∆Ô ÙÚ·¯ËÏÈÎfi ÙÂڿو̷ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÈÛ¤Ú¯ÂÙ·È ÛÙË ıˆÚ·ÎÈ΋ ÎÔÈÏfiÙËÙ·, fiˆ˜ Û ̛· ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ‹ Ó· ÂÚÓ¿ ÙË Ì¤ÛË ÁÚ·ÌÌ‹, fiˆ˜ Û ‰‡Ô ·fi ÙȘ ·Ó·ÊÂÚfiÌÂÓ˜ ÂÚÈÙÒÛÂȘ. ∏ ·ÚÔ˘Û›· ÂÚÈÔ¯ÒÓ Ï›Ô˘˜ Î·È ·ÔÙÈÙ·ÓÒÛÂˆÓ ‰È¢ÎÔχÓÂÈ ÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÂÚ·ÙÒÌ·ÙÔ˜ ·fi ΢ÛÙÈÎfi ‡Áڈ̷. ™Ù· ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È ·ÔÙÈÙ·ÓÒÛÂȘ Û ÔÛÔÛÙfi 50% (3,8). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ·ÔÙÈÙ·ÓÒÛÂȘ ˘‹Ú¯·Ó Û 3 ÓÂÔÁÓ¿ (ÔÛÔÛÙfi 60%) Î·È ÂÚÈÔ¯¤˜ Ï›Ô˘˜ Û 2 (ÔÛÔÛÙfi 40%). ¶ÚÒÙË ·ÂÈÎÔÓÈÛÙÈ΋ ̤ıÔ‰Ô˜ Â›Ó·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·. ∞ÎÔÏÔ˘ı› Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÙÚ·¯‹ÏÔ˘. ∫·È ÔÈ ‰‡Ô ̤ıÔ‰ÔÈ ÂÎÙÈÌÔ‡Ó ÙÔ ¶·È‰È·ÙÚÈ΋ 2005;68:133-138

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138

ª. ÷ÛÈÒÙÔ˘ Î·È Û˘Ó.

̤ÁÂıÔ˜ Î·È ÙËÓ ˘Ê‹ Ù˘ ÂÍÂÚÁ·Û›·˜. ∆Ô ˘„ËÏfi ÔÛÔÛÙfi ·ÚÔ˘Û›·˜ ·ÔÙÈÙ·ÓÒÛÂˆÓ ÛÙ· ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù· ηıÈÛÙ¿ ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ̤ıÔ‰Ô ÂÎÏÔÁ‹˜ ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ Û˘ÁÁÂÓÒÓ ÙÂÚ·ÙˆÌ¿ÙˆÓ ÙÔ˘ ÙÚ·¯‹ÏÔ˘. ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ë ‰È¿ÁÓˆÛË ·fi ÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· Û˘ÌʈÓÔ‡Û Ì ÙËÓ ÈÛÙÔÏÔÁÈ΋ ‰È¿ÁÓˆÛË (1-4). °È· ÙËÓ Î·Ï‡ÙÂÚË ÚÔÂÁ¯ÂÈÚËÙÈ΋ ¯·ÚÙÔÁÚ¿ÊËÛË, Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÌÔÚ› Ó· Û˘ÌÏËÚˆı› Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÚ·¯‹ÏÔ˘ Ô˘ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÔÏ˘Â›‰˘ ·ÂÈÎfiÓÈÛ˘ Ì ˘„ËÏ‹ ÈÛÙÈ΋ ‰È·ÎÚÈÙÈ΋ ‰˘Ó·ÙfiÙËÙ·, ¯ˆÚ›˜ Ó· ÂÎı¤ÙÂÈ ÙÔ ÓÂÔÁÓfi Û ·ÎÙÈÓÔ‚ÔÏ›· (1,13). ∏ Ï‹Ú˘ Î·È ¤ÁηÈÚË ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË Â›Ó·È Ë ÂӉ‰ÂÈÁ̤ÓË ıÂÚ·›· ÛÙ· Û˘ÁÁÂÓ‹ ÙÚ·¯ËÏÈο ÙÂÚ·ÙÒÌ·Ù·. ™˘ÓÂÒ˜, Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Â›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙË ‰È¿ÁÓˆÛË Î·È ÙÔÓ ÚÔÂÁ¯ÂÈÚËÙÈÎfi ۯ‰ȷÛÌfi.

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Literature review and proposed classification. J Pediatr Surg 1988;23:583-591.

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Welch KJ. The oropharynx and jaws. In: Welch KJ, Randolph JG, Ravitch MM et al, editors. Pediatric surgery. Vol 1. 4th ed. Chicago: Year Book; 1986. p. 513-515.

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CASE REPORT

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The neck: a rare site of teratoma in children M. Hasiotou1, ∂. Sammouti2, G. Pitsoulakis1, M. Vakaki2, C. van Viet - Konstadinidou3, E. Koudoumnakis4

Abstract Congenital cervical teratomas are rare, representing 3% of teratomas in childhood. Although mostly benign, because of their location they are associated with a high mortality rate due to respiratory distress, and require immediate surgical excision. Imaging investigation is essential for the exact diagnosis and to assist in preoperative planning. The imaging characteristics of 5 cases (4 boys and 1 girl) of cervical teratoma are presented. All children were operated on and histopathology confirmed the diagnosis of teratoma. Two of the children died soon after surgery.

Key words Cervical teratomas, children, imaging.

1 CT and MRI Department, “Aghia Sophia” Children’s Hospital, Athens 2 Radiology Department, ”Aghia Sophia” Children’s Hospital, Athens 3 Pathology Department, ”Aghia Sophia” Children’s Hospital, Athens 4 Department of Otolaryngology, ”Aghia Sophia” Children’s Hospital, Athens Correspondence: Maria Hasiotou 55 Peloponisou str., 153 41, Ag. Paraskevi, Athens Date of submission: 16-01-2004 Date of approval: 18-01-2005

Paediatriki 2005;68:139

Paediatriki Mar-Apr 05

140

19-04-05

15:31

™ÂÏ›‰·140

∂¡¢π∞º∂ƒOÀ™∞ ¶∂ƒπ¶∆ø™∏

¡fiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∂. ¶··‰ËÌËÙÚ›Ô˘, °. ª·Ù·ÊÈ¿, µ. ÷Ù˙ÔÔ‡ÏÔ˘, µ. ªÈÎÚ¿ÎË, ¡. ™ÎÂÓÙ¤Ú˘ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ £ÂÛÛ·Ï›·˜ AÏÏËÏÔÁÚ·Ê›·: ∂ϤÓË ¶··‰ËÌËÙÚ›Ô˘ °ÂˆÚÁ›Ô˘ ™Ù·‡ÚÔ˘ 14 ∆.∫. 412 21, §¿ÚÈÛ· ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-03-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 03-01-2005

¶ÂÚ›ÏË„Ë ∏ ÓfiÛÔ˜ Caroli Â›Ó·È Û¿ÓÈÔ ÎÏËÚÔÓÔÌÈÎfi ÓfiÛËÌ·. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ΢ÛÙÈΤ˜ ‰È·Ù¿ÛÂȘ ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ Î·È Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË Î·È Î˘ÛÙÈ΋ ÓfiÛÔ ÙˆÓ ÓÂÊÚÒÓ. ∆Ô Û‡Ó‰ÚÔÌÔ Û¿ÓÈ· ‰È·ÁÈÁÓÒÛÎÂÙ·È Û ·È‰È¿ Î·È Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È ·fi Û˘ÌÙÒÌ·Ù· Ë·ÙÈ΋˜ ‹ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ô˘ÎÚ·ÓÈ΋˜ ηٷÁˆÁ‹˜, ÙÔ ÔÔ›Ô - ·fi ÙËÓ ÚÒÙË ‚ÚÂÊÈ΋ ËÏÈΛ· - ·ÚÔ˘Û›·˙Â Û˘¯Ó¤˜ Ô˘ÚÔÏÔÈÌÒÍÂȘ. ™ÙÔ Ï·›ÛÈÔ ÙÔ˘ ·ÂÈÎÔÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ›¯·Ó ‰È·ÈÛÙˆı› ‰˘ÛÏ·ÛÙÈÎÔ›, ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÓÂÊÚÔ›. ™Â ËÏÈΛ· 2,5 ÂÙÒÓ ·ÚÔ˘Û›·Û ·ÓÂÍ‹ÁËÙË ÂÈ̤ÓÔ˘Û· Ë·ÙÔÌÂÁ·Ï›·. ŒÁÈÓ ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Ô˘ ‰ÂÓ ·ÔÎ¿Ï˘„ ÙËÓ ·ÈÙ›· Ù˘ Ë·ÙÔÌÂÁ·Ï›·˜. ™ÙËÓ ∫ÏÈÓÈ΋ ÚÔÛÎÔÌ›ÛÙËΠ̠·Ú·ÙÂÈÓfiÌÂÓÔ ˘ÚÂÙfi Û ËÏÈΛ· 11 ÂÙÒÓ. ¶·ÚÔ˘Û›·˙Â Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË, ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›· Î·È ·ÚÓËÙÈ΋ ηٿ Ù· ¿ÏÏ· ÎÏÈÓÈ΋ ÂͤٷÛË. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈ΋ Ë·ÙÈ΋ Î·È ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. O ¤ÏÂÁ¯Ô˜ Ì ˘ÔÏÔÁÈÛÙÈ΋ Î·È Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ Î·È Î¿Ùˆ ÎÔÈÏ›·˜ ·Ó¤‰ÂÈÍÂ Â˘Ú‹Ì·Ù· Û˘Ì‚·Ù¿ Ì ÓfiÛÔ Caroli. ∏ ·ÛıÂÓ‹˜ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ·Ó¿ ÂÍ¿ÌËÓÔ. ∂ÌÊ·Ó›˙ÂÈ ˘Ï·›· ˘¤ÚÙ·ÛË Ì ÎÈÚÛÔ‡˜ ÔÈÛÔÊ¿ÁÔ˘ 1Ô˘ ‚·ıÌÔ‡ Î·È ·ÈÌ·ÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ˘ÂÚÛÏËÓÈÛÌÔ‡. ¶·Ú¿ÏÏËÏ·, ‚Ú›ÛÎÂÙ·È Û ÚfiÁÚ·ÌÌ· ÌÂÏÏÔÓÙÈ΋˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ‹·ÙÔ˜, ÏfiÁˆ ·˘ÍË̤Ó˘ Èı·ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ¯ÔÏ·ÁÁÂÈÔηÚÎÈÓÒÌ·ÙÔ˜.

§¤ÍÂȘ ÎÏÂȉȿ ¡fiÛÔ˜ Caroli, Û˘ÁÁÂÓ‹˜ Ë·ÙÈ΋ ›ÓˆÛË, ·ÛÙÂȘ ¯ÔÏˉfi¯Ô˘.

∂ÈÛ·ÁˆÁ‹ ø˜ ÓfiÛÔ˜/Û‡Ó‰ÚÔÌÔ Caroli ¯·Ú·ÎÙËÚ›˙ÂÙ·È Ë Û˘ÁÁÂÓ‹˜, ΢ÛÙÈ΋, ÌË ·ÔÊÚ·ÎÙÈ΋ ‰È¿Ù·ÛË ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ. ∆Ô Û‡Ó‰ÚÔÌÔ Caroli ‰È·ÊÔÚÔÔÈÂ›Ù·È ·fi ÙË ÓfiÛÔ Caroli ‚¿ÛÂÈ Ù˘ Û˘Ó‡·Ú͢ ÛÙÔ Û‡Ó‰ÚÔÌÔ Ù˘ ‰È¿Ù·Û˘ ÙˆÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ, Ù˘ Û˘ÁÁÂÓÔ‡˜ Ë·ÙÈ΋˜ ›ÓˆÛ˘ Î·È ˘Ï·›·˜ ˘¤ÚÙ·Û˘. ∫·È ÔÈ ‰‡Ô ÔÓÙfiÙËÙ˜ Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó Ì ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ÂÎÙ·Û›· (ÛÔÁÁÒ‰Ë ÓÂÊÚfi) ‹ ¿ÏÏÔ˘˜ Ù‡Ô˘˜ ΢ÛÙÈÎÒÓ ÓfiÛˆÓ ÙˆÓ ÓÂÊÚÒÓ Î·È Èı·ÓfiÓ ÙÔ˘ ·ÁÎÚ¤·ÙÔ˜. ¶·ıÔÁÂÓÂÙÈο ·Ô‰›‰ÔÓÙ·È Û ‰˘ÛÏ·Û›· ηٿ ÙËÓ ÂÌ‚Ú˘ÔÁ¤ÓÂÛË Î·È ıˆÚÂ›Ù·È fiÙÈ ÎÏËÚÔÓÔÌÔ‡ÓÙ·È Î·Ù¿ ÙÔÓ ·˘ÙÔۈ̷ÙÈÎfi ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú·. ∏ ÓfiÛÔ˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ¯ÔÏÔÏÈı›·Û˘, ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ¯ÔÏ·ÁÁÂÈ›Ùȉ·˜ Î·È ÙËÓ ·Ó¿Ù˘ÍË ¯ÔÏ·ÁÁÂÈÔηÚÎÈÓÒÌ·ÙÔ˜ Ôχ Û˘¯ÓfiÙÂÚ· Û ۯ¤ÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (100:1). ™ÙÔ Û‡Ó‰ÚÔÌÔ Caroli ÚÔÛÙ›ıÂÙ·È ÛÙ· ·Ú·¿Óˆ Î·È Ë ˘Ï·›· ˘¤ÚÙ·ÛË. ∏ ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È ÂÚ›Ô˘ Ù· 20 ¤ÙË, ˆÛÙfiÛÔ Â›Ó·È ‰˘Ó·Ù‹ Ë ÂΉ‹ÏˆÛ‹ ÙÔ˘˜ Î·È ÓˆÚ›ÙÂÚ·, ·ÎfiÌË Î·È Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ÂȉÈο ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘¿Ú¯ÂÈ Î·È Û˘ÁÁÂÓ‹˜ Ë·ÙÈ΋ ›ÓˆÛË. ¶·È‰È·ÙÚÈ΋ 2005;68:140-143

À¿Ú¯Ô˘Ó ‰‡Ô ·Ó·ÊÔÚ¤˜ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· ÛÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Caroli (1,2). ∆Ô Û‡Ó‰ÚÔÌÔ Caroli ıˆÚÂ›Ù·È Û˘¯ÓfiÙÂÚÔ Ù˘ ÓfiÛÔ˘ Î·È ÂÌÊ·Ó›˙ÂÙ·È Ì ˘Ï·›· ˘¤ÚÙ·ÛË Û˘Ó‹ıˆ˜ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÓËȷ΋˜ ‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ Ì ÓfiÛÔ Caroli, Ë ÔÔ›· ‰È·ÁÓÒÛÙËΠηٿ ÙË ‰ÈÂÚ‡ÓËÛË ÂÌ‡ÚÂÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 11 ÂÙÒÓ, Ô˘ÎÚ·ÓÈ΋˜ ηٷÁˆÁ‹˜, ÚÔÛÎÔÌ›ÛÙËΠÛÙÔ ∆Ì‹Ì· ∂ÂÈÁfiÓÙˆÓ ¶ÂÚÈÛÙ·ÙÈÎÒÓ Ù˘ ∫ÏÈÓÈ΋˜ ÏfiÁˆ ˘„ËÏÔ‡, ·Ú·ÙÂÈÓfiÌÂÓÔ˘ ˘ÚÂÙÔ‡ Î·È ÎÔÈÏÈ·ÎÔ‡ ¿ÏÁÔ˘˜. ∂ÚfiÎÂÈÙÔ ÁÈ· ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ. ∏ ·ËÛË, Ô ÙÔÎÂÙfi˜ Î·È Ë ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ ·Ó·Ê¤ÚÔÓÙ·Ó Ê˘ÛÈÔÏÔÁÈο. ∞fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÌËÓÒÓ ÂÌÊ¿ÓÈ˙Â Û˘¯Ó¿ ÂÂÈÛfi‰È· Ô˘ÚÔÏÔÈÌÒÍÂˆÓ Î·È Ô ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÛÙËÓ O˘ÎÚ·Ó›· ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË ‰˘ÛÏ·ÛÙÈÎÒÓ ÓÂÊÚÒÓ. ™Â ËÏÈΛ· 2,5 ÂÙÒÓ ÂÌÊ¿ÓÈÛ Ë·ÙÔÌÂÁ·Ï›·, Ë ÔÔ›· ·Ô‰fiıËΠ۠ÙÔÍÈ΋ Ë·Ù›Ùȉ·. ∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È

Paediatriki Mar-Apr 05

19-04-05

15:31

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141

¡fiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË

ΛÚÚˆÛË ‹·ÙÔ˜ ÛÙÔÓ ·Ô‡ Î·È ÙË ı›· ÙÔ˘ ·È‰ÈÔ‡ ·fi ÙËÓ ÏÂ˘Ú¿ Ù˘ ÌËÙ¤Ú·˜. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ·ÔÎ¿Ï˘„ fiÙÈ ÙÔ ÎÔÚ›ÙÛÈ Â›¯Â ηϋ ·Ó¿Ù˘ÍË, ‹Ù·Ó ˆ¯Úfi Î·È Î·ÎԉȿıÂÙÔ, Ì ÛÏ‹Ó· „ËÏ·ÊËÙfi ~8 cm, ÛÎÏËÚ‹˜ ˘Ê‹˜ Î·È ÂÒ‰˘ÓÔ Î·È ‹·Ú Â›Û˘ „ËÏ·ÊËÙfi ~5 cm Î·È ·ÓÒ‰˘ÓÔ. ∞ÛÙ·ı¤˜ ‡ÚËÌ· ‹Ù·Ó ¢·ÈÛıËÛ›· ÛÙËÓ Ï‹ÍË Ù˘ ÓÂÊÚÈ΋˜ ¯ÒÚ·˜ ·ÚÈÛÙÂÚ¿ [Û.

Giordano (±)]. ∞fi Ù· ˘fiÏÔÈ· Û˘ÛÙ‹Ì·Ù· ‰ÂÓ ˘‹Ú¯·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∆Ë ‰Â‡ÙÂÚË Ë̤ڷ ÓÔÛËÏ›·˜ ÙÔ ·È‰› ¤ÌÂÈÓ ·‡ÚÂÙÔ, ¯ˆÚ›˜ Ó· ¤¯ÂÈ ÂÓÙÔÈÛÙ› Û˘ÁÎÂÎÚÈ̤ÓË ÂÛÙ›· Ïԛ̈͢. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‚Ú¤ıËΠ̛ˆÛË fiÏˆÓ ÙˆÓ Î˘ÙÙ·ÚÈÎÒÓ ÛÂÈÚÒÓ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙ· ηÙÒÙÂÚ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Î·È ÂÏ·ÊÚ¿ ·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÚÔıÚÔÌ‚›Ó˘. O ÏÔÈfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, fiˆ˜ ‹Ù·Ó Î·È Ë ÁÂÓÈ΋ Î·È Ë Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ. ™˘ÁÎÂÎÚÈ̤ӷ: §Â˘Î¿: 5400/mm3 (¶: 77%, §: 13%, ªª: 8%), Hb: 11,1 g/dl, Ht: 34,5%, PLT: 130000/mm3, ∆∫∂: 7 mm/1Ë ÒÚ·, CRP: 1,54 mg/dl, ۷ί.: 85 mg/dl, Ô˘Ú›·: 41 mg/dl, ÎÚ·ÙÈÓ›ÓË: 0,86 mg/dl, SGOT: 16 U/L, SGPT: 13 U/L, ÁGT: 29 U/L, ÔÏÈ΋/¿ÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 0,9/0,13 mg/dl, ALP: 174 U/L, Na+: 139 mmol/L, K+: 3,9 mmol/L, Ï¢ÎÒÌ·Ù· ÔÏÈο: 8,0 g/dl, ÏÂ˘ÎˆÌ·Ù›ÓË: 5,21 g/dl, PT: 13,25 sec, INR: 1,31, APPT: 28 sec, ÈÓˆ‰ÔÁfiÓÔ: 382,8 mg/dL). ™Â ˘ÂÚ˯ÔÙÔÌÔÁÚ¿ÊËÌ· (U/S) ¿Óˆ ÎÔÈÏ›·˜ÓÂÊÚÒÓ ·Ú·ÙËÚ‹ıËΠ‰È¿Ù·ÛË ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ Ì ÔÏÏ·Ϥ˜ ΢ÛÙÈΤ˜ ‰È·Ù¿ÛÂȘ. ∆· Â͈Ë·ÙÈο ¯ÔÏËÊfiÚ· ›¯·Ó Ê˘ÛÈÔÏÔÁÈ΋ ‰È¿ÌÂÙÚÔ Î·È ‰ÂÓ ˘‹Ú¯Â ·›ÙÈÔ ·fiÊڷ͢. ∆Ô Ë·ÙÈÎfi ·Ú¤Á¯˘Ì· ·ÚÔ˘Û›·˙ ·‰Ú‹ ˯ԉÔÌ‹ Ì ۯÂÙÈο ·˘ÍË̤Ó˜ ·Ó·ÎÏ¿ÛÂȘ Ô˘ ¤ıÂÙ·Ó ÙËÓ ˘fiÓÔÈ· ›ÓˆÛ˘, ÂÓÒ ÛÙÔ ÚfiÛıÈÔ Î¿Ùˆ ÙÌ‹Ì· ÙÔ˘ ‰ÂÍÈÔ‡ ÏÔ‚Ô‡ ÙÔ˘ ‹·ÙÔ˜ ˘‹Ú¯Â ÛÙÚÔÁÁ˘Ïfi˜ ˘fi˯Ԙ fi˙Ô˜ Ì ‰È¿ÌÂÙÚÔ 1,75 cm Î·È Û·Ê‹ fiÚÈ·. µÚ¤ıËΠÈηÓÔ‡ ‚·ıÌÔ‡ ÛÏËÓÔÌÂÁ·Ï›· ¯ˆÚ›˜ ÂÛÙȷΤ˜ ·ÏÏÔÈÒÛÂȘ, ÂÓÒ ·fi ÙË ¯ÔÏˉfi¯Ô ·ÛÙË Î·È ÙÔ ¿ÁÎÚ·˜ ‰ÂÓ ˘‹Ú¯·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∞ÌÊfiÙÂÚÔÈ ÔÈ ÓÂÊÚÔ› ›¯·Ó ·˘ÍË̤ÓÔ Ì¤ÁÂıÔ˜, ‰È¿Û·ÚÙ˜ ·ÔÙÈÙ·ÓÒÛÂȘ ÛÙË Ì˘ÂÏÒ‰Ë ÌÔ›Ú· ÙÔ˘˜ Î·È Î·Ù¿ ÙfiÔ˘˜ ϤÙ˘ÓÛË ÙÔ˘ ÊÏÔÈÔ‡. OÈ Î˘ÛÙÈΤ˜ ‰È·Ù¿ÛÂȘ ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÈÎfiÓ· ÙˆÓ ÛÔÁÁÔÂȉÒÓ ÓÂÊÚÒÓ ¤ıÂÛ·Ó ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Caroli. ∏ ˘ÔÏÔÁÈÛÙÈ΋ (CT) Î·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó, ÂȂ‚·›ˆÛ·Ó Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ (∂ÈÎfiÓ· 1). §fiÁˆ Ù˘ ¿ÚÈÛÙ˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡, Ë ÌËÙ¤Ú· ·ÚÓ‹ıËΠÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË Î·È ‰ÂÓ ÚÔÛÎfiÌÈÛ ÙËÓ ·ÛıÂÓ‹ ÁÈ· ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ Â·Ó·ÏËÙÈÎfi ¤ÏÂÁ¯Ô. ŒÓ·Ó ¯ÚfiÓÔ ·ÚÁfiÙÂÚ· Ë ·ÛıÂÓ‹˜ ÂÌÊ¿ÓÈÛ ¤ÓÙÔÓÔ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜, ÂÓÙÔÈṲ̂ÓÔ ÛÙÔ (∞)

˘Ô¯fiÓ‰ÚÈÔ Î·È ÛÙÔÓ (∞) Ï·ÁfiÓÈÔ ‚fiıÚÔ, Û˘Óԉ¢fiÌÂÓÔ ·fi ÔÛÊ˘˚Îfi ¿ÏÁÔ˜ (∞) Î·È ‹È· Ó·˘Ù›·, ¯ˆÚ›˜ Â̤ÙÔ˘˜ Î·È ˘ÚÂÙfi. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËΠ·‡ÍËÛË ÙˆÓ ÔÚ›ˆÓ ÙÔ˘ ‹·ÙÔ˜ (~5 cm) Î·È ÙÔ˘ ÛÏËÓfi˜ (~10 cm), ÂÓÒ ÙÔ Û. Giordano ‹Ù·Ó ¤ÓÙÔÓ· ıÂÙÈÎfi (∞). ∞fi ÙÔÓ ·ÈÌ·ÙÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô ·˘Ù‹ ÙË ÊÔÚ¿ ‰È·ÈÛÙÒıËΠ۷ʋ˜ ·Á΢ÙÙ·ÚÔÂÓ›· [§Â˘Î¿: 1900/mm3, (¶: 63%, §: 27%, ªª: 8%, ∏: 2%), Hb: 10,0 g/dL, Ht: 30,4%, PLT: 77000/mm3, ¢∂∫: 1,25%], ÂÓÒ ·fi ÙÔÓ ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô ‰ÂÓ ÚԤ΢„·Ó ‰È·Ù·Ú·¯¤˜ ÛÙËÓ Ë·ÙÈ΋ Î·È ÓÂÊÚÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ™ÙË ÁÂÓÈ΋ Ô‡ÚˆÓ ‚Ú¤ıËÎ·Ó Ï›Á· ˘ÔÛÊ·›ÚÈ· Î·È ÂÚ˘ıÚ¿ ·ÈÌÔÛÊ·›ÚÈ· Î·È Ë Î·ÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ‹Ù·Ó ÛÙ›ڷ. ∫‡ÚÈ· Â˘Ú‹Ì·Ù· ÙÔ˘ Â·Ó·ÏËÙÈÎÔ‡ ˘ÂÚ˯ÔÙÔÌÔÁÚ·Ê‹Ì·ÙÔ˜ ‹Ù·Ó Ë ‰È¿¯˘Ù· ·‰ÚÔÎÔÎÎ҉˘ ˘Ê‹ ÙÔ˘ Ë·ÙÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È ÔÈ ·˘ÍË̤Ó˜ - Û˘ÁÎÚÈÙÈο Ì ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ¤ÏÂÁ¯Ô - ‰È·ÛÙ¿ÛÂȘ ÙÔ˘ ˘fi˘ÎÓÔ˘ ÌÔÚÊÒÌ·ÙÔ˜ (2,4x2,7x2 cm). ∆Ô Doppler ¤‰ÂÈÍ fiÙÈ Ô ÛÏËÓÔ˘Ï·›Ô˜ ¿ÍÔÓ·˜ ‹Ù·Ó ‚·Ùfi˜, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ‡ÚÔ˜ (1,1 cm), Ê˘ÛÈÔÏÔÁÈÎfi Ê¿ÛÌ· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ηÙ‡ı˘ÓÛË ÚÔ‹˜ ·›Ì·ÙÔ˜. OÈ Ë·ÙÈΤ˜ ÊϤ‚˜ ‚Ú¤ıËÎ·Ó ‚·Ù¤˜, Ì ·Ú¯fiÌÂÓ˜ ‰È·Ù·Ú·¯¤˜ Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ Ù‡Ô˘ ÙˆÓ ‰È¿¯˘ÙˆÓ ÈÓÔÛÎÏËÚ˘ÓÙÈÎÒÓ Ë·ÙÈÎÒÓ ÓfiÛˆÓ. OÈ ÓÂÊÚÔ› ·ÚÔ˘Û›·˙·Ó ·˘ÍË̤ÓÔ Ì¤ÁÂıÔ˜ Î·È Â˘Ú‹Ì·Ù· ¤ÓÙÔÓ˘ ÓÂÊÚ·Û‚¤ÛÙˆÛ˘. ∂ÈϤÔÓ, ¤ÁÈÓ Á·ÛÙÚÔÛÎfiËÛË Ô˘ ·Ó¤‰ÂÈÍ ÎÈÚÛÔ‡˜ ÔÈÛÔÊ¿ÁÔ˘ 1Ô˘ ‚·ıÌÔ‡ Î·È ÔÏÏ·Ï¿ ÂÈÊ·ÓÂȷο ¤ÏÎË ÛÙÔÓ ‚ÔÏ‚fi ÙÔ˘ ‰ˆ‰Âη‰·ÎÙ‡ÏÔ˘. µÈÔ„›· ÁÈ· H. pylori ‰ÂÓ ÂÏ‹ÊıË ÏfiÁˆ ‰È·Ù·Ú·¯ÒÓ ËÎÙÈÎfiÙËÙ·˜. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜, Ë ·ÛıÂÓ‹˜ Ù¤ıËΠÛÂ Û˘ÛÙËÌ·ÙÈ΋ ¯ÔÚ‹ÁËÛË Û·ÛÌÔÏ˘ÙÈÎÒÓ Î·È ·Ó·ÏÁËÙÈÎÒÓ Ê·Ú̿ΈÓ. ∫·Ù¿ ÙËÓ ¤ÍÔ‰fi Ù˘, Û˘ÛÙ‹ıËΠ·ÁˆÁ‹ Ì ·Ó·ÛÙÔÏ›˜ Ù˘ ·ÓÙÏ›·˜ ÚˆÙÔÓ›ˆÓ ÁÈ· ‰È¿ÛÙËÌ· 2 ÌËÓÒÓ, ηıÒ˜

∂ÈÎfiÓ· 1. ÀÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· ¿Óˆ-οو ÎÔÈÏ›·˜ Î·È ÔÈÛıÔÂÚÈÙÔÓ·›Ô˘. ¶·Ú·ÙËÚÔ‡ÓÙ·È Î˘ÛÙÈΤ˜ ‰È·Ù¿ÛÂȘ Ô˘ ÂÈÎÔÈÓˆÓÔ‡Ó Ì ٷ ÂÓ‰ÔË·ÙÈο ¯ÔÏËÊfiÚ· ·ÁÁ›·. ¶·È‰È·ÙÚÈ΋ 2005;68:140-143

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·142

142

∂. ¶··‰ËÌËÙÚ›Ô˘ Î·È Û˘Ó.

Î·È ¯ÔÚ‹ÁËÛË ¿ÊıÔÓˆÓ ˘ÁÚÒÓ. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ·ÛıÂÓÔ‡˜ ‚ÂÏÙÈÒıËΠÂÓ Ì¤ÚÂÈ, ¯ˆÚ›˜ fï˜ Ï‹ÚË ‡ÊÂÛË ÙˆÓ Û˘Ìو̿وÓ. ∏ ·ÛıÂÓ‹˜ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ·Ó¿ 6 Ì‹Ó˜ Î·È Â›Ó·È Û ÚfiÁÚ·ÌÌ· ÌÂÏÏÔÓÙÈ΋˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ‹·ÙÔ˜.

™˘˙‹ÙËÛË ∏ ÓfiÛÔ˜ Caroli Â›Ó·È Ì›· Û¿ÓÈ· Û˘ÁÁÂÓ‹˜ ‰È·Ù·Ú·¯‹ ÌÂ Û˘¯ÓfiÙËÙ· 1:1.000.000 (3). À¿Ú¯Ô˘Ó ‰‡Ô Ù‡ÔÈ Ù˘ ÓfiÛÔ˘ Caroli. O Ù‡Ô˜ Ô˘ ·Ú¯Èο ÂÚÈÁÚ¿ÊËΠ·fi ÙÔÓ Caroli (4), ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ΢ÛÙÈ΋, ÌË ·ÔÊÚ·ÎÙÈ΋ ‰È¿Ù·ÛË ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ Î·È ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 13% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5). √ ÈÔ ÎÔÈÓfi˜ Ù‡Ô˜ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË Î·È ·Ó·Ê¤ÚÂÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Û·ÓÈfiÙÂÚ· ˆ˜ Û‡Ó‰ÚÔÌÔ Caroli (5) Î·È Û˘¯ÓfiÙÂÚ·, ˆ˜ ÓfiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË. ∂›Û˘, ÌÔÚ› Ó· ÔÚ›˙ÂÙ·È ‚¿ÛÂÈ Ù˘ Ù·ÍÈÓfiÌËÛ˘ Todani ÙˆÓ ¯ÔÏˉfi¯ˆÓ ·ÛÙÂˆÓ ˆ˜ Ù‡Ô˜ V ‹ ˆ˜ Ù‡Ô˜ IV ∞ ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Û˘Û¯ÂÙ›˙ÂÙ·È Ì Â͈Ë·ÙÈΤ˜ ·ÛÙÂȘ ¯ÔÏˉfi¯Ô˘, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô Û˘Ì‚·›ÓÂÈ ÛÙÔ 21% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5,6), ‹ ÌÔÚ› Ó· ÂÓÙÔ›˙ÂÙ·È ÌfiÓÔ Û ¤Ó· ÏÔ‚fi ‹ ÙÌ‹Ì· ÙÔ˘ ‹·ÙÔ˜, Û˘¯ÓfiÙÂÚ· ·ÚÈÛÙÂÚ¿ (7). ŸÙ·Ó ÂÓÙÔ›˙ÂÙ·È ÛÙÔÓ ¤Ó· ÏÔ‚fi, Ë ÓfiÛÔ˜ Caroli Û˘Ó‹ıˆ˜ ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË (8).

O Ù‡Ô˜ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ÔÈΛÏÏÂÈ (9). ¶ÔÏÏÔ› ÈÛÙÂ‡Ô˘Ó fiÙÈ Ë ÂÓÙÔÈṲ̂ÓË ÓfiÛÔ˜ Caroli ‰ÂÓ Â›Ó·È ÎÏËÚÔÓÔÌÔ‡ÌÂÓË Î·È ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÓÂÊÚÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÂÓÒ Ë ÓfiÛÔ˜ Caroli ÌÂ Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË ÌÔÚ› Ó· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙfiÛˆÌÔ, ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· Î·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÓÂÊÚÈΤ˜ ‚Ï¿‚˜ Ô˘ ÔÈΛÏÏÔ˘Ó ·fi ÙË ÛˆÏËÓ·Úȷ΋ ÂÎÙ·Û›· ¤ˆ˜ ÙÔÓ ÔÏ˘Î˘ÛÙÈÎfi ÓÂÊÚfi, ‹ Ó· ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (10). ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ÈÛÙ‡ÂÙ·È fiÙÈ ÔÊ›ÏÂÙ·È Û ‰È·ÎÔ‹ Ù˘ ·Ó·‰fiÌËÛ˘ ÙÔ˘ ÂÌ‚Ú˘ÔÓÈÎÔ‡ fiÚÔ˘ ÙˆÓ ÌÂÁ¿ÏˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ fiÚˆÓ (9). ∏ ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Â›Ó·È ÂÚ›Ô˘ Ù· 20 ¤ÙË (10), ˆÛÙfiÛÔ, Â›Ó·È ‰˘Ó·Ù‹ Ë ÂΉ‹ÏˆÛ‹ ÙÔ˘˜ Î·È Î·Ù¿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô (11), ÂȉÈο ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ Ë ÓfiÛÔ˜ Û˘Óԉ‡ÂÙ·È ·fi Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË. ∏ ¯ÔÏ·ÁÁÂÈ›Ùȉ· Â›Ó·È ÙÔ ÚÔÂÍ¿Ú¯ÔÓ Û‡Ìو̷ ÛÙÔ 64% ÙˆÓ ·ÛıÂÓÒÓ, Ë ˘Ï·›· ˘¤ÚÙ·ÛË ÛÙÔ 22%, ÙÔ ˘ÔÙÚÔÈ¿˙ÔÓ ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ ÛÙÔ ‰ÂÍÈfi ¿Óˆ ÙÂÙ·ÚÙËÌfiÚÈÔ ÛÙÔ 18%, Ë ˘ÂÏÔÓÂÊÚ›Ùȉ·, Ë ·ÚÙËÚȷ΋ ˘¤ÚÙ·ÛË Î·È Ë ·ÈÌ·ÙÔ˘Ú›· ÛÙÔ 2% (10). øÛÙfiÛÔ, ÌÂÚÈÎÔ› ·ÛıÂÓ›˜ - ÂȉÈο fiÛÔÈ ‰ÂÓ Ê¤ÚÔ˘Ó Û˘ÁÁÂÓ‹ Ë·ÙÈ΋ ›ÓˆÛË - ÌÔÚ› Ó· ·Ú·Ì›ÓÔ˘Ó ·Û˘Ìو̷ÙÈÎÔ› ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 70 ÂÙÒÓ (7). ∏ Ë·ÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÌÔ¶·È‰È·ÙÚÈ΋ 2005;68:140-143

Ú› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ‹ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ¯ÔÏÔÛÙ·ÙÈ΋ ÂÈÎfiÓ·. ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ·Ó˯Ô˚ÎÒÓ Î˘ÛÙÈÎÒÓ ÂÚÈÔ¯ÒÓ ÂÓ‰ÔË·ÙÈο ÛÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÂͤٷÛË ÙÔ˘ ‹·ÙÔ˜, ‹ ˘‰ÚÈ΋˜ ˘ÎÓfiÙËÙ·˜ ·ÛÙÂˆÓ ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÔÈ Ôԛ˜ ¿ÓÙÔÙ ÂÈÎÔÈÓˆÓÔ‡Ó Ì ÙÔ ¯ÔÏËÊfiÚÔ ‰¤Ó‰ÚÔ, ÛÙÔÈ¯Â›Ô ÙÔ ÔÔ›Ô Â›Ó·È ÛËÌ·ÓÙÈÎfi ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·Ó¿ÌÂÛ· ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÔÓÙfiÙËÙ· Î·È ¿ÏϘ fiˆ˜ ÙËÓ ÔÏ˘Î˘ÛÙÈ΋ Ë·ÙÈ΋ ÓfiÛÔ, ÙȘ ·Ϥ˜ Ë·ÙÈΤ˜ ·ÛÙÂȘ, ÙÔ ÏÂÌÊ·ÁÁ›ˆÌ· ‹ Ù· ÔÏÏ·Ï¿ Ë·ÙÈο ·ÔÛÙ‹Ì·Ù·. ∆Ô ·Ú·¿Óˆ ‡ÚËÌ· ÂȂ‚·ÈÒÓÂÙ·È Û˘Ó‹ıˆ˜ Ì ¯ÔÏÔË·ÙÈÎfi HIDA ÛÈÓıËÚÔÁÚ¿ÊËÌ·, Ì ¿ÌÂÛË ÂÈÛÎfiËÛË ÙÔ˘ ¯ÔÏËÊfiÚÔ˘ ‰¤Ó‰ÚÔ˘ Ì ÂÓ‰ÔÛÎÔÈ΋ ¯ÔÏ·ÁÁÂÈÔ·ÁÎÚ·ÙÔÁÚ·Ê›· (ERCP) ‹ Ì ˘Ô‰fiÚÈ· ‰ÈË·ÙÈ΋ ¯ÔÏ·ÁÁÂÈÔÁÚ·Ê›· (PTC). ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ÛËÌÂȈı› fiÙÈ ÌÂÚÈÎÔ› ÌÂÏÂÙËÙ¤˜ ÈÛÙÂ‡Ô˘Ó fiÙÈ ERCP ‹ PTC ‰ÂÓ ı· Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Û ·Û˘Ìو̷ÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÓfiÛÔ Caroli, ‰ÈfiÙÈ ˘¿Ú¯ÂÈ ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ ¯ÔÏËÊfiÚÔ˘ Û‹„˘ (12). ª›· Ó¤·, ÌË ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜, ÈηӋ Ó· ·ÂÈÎÔÓ›ÛÂÈ ÙÔ ¯ÔÏËÊfiÚÔ Û‡ÛÙËÌ· Â›Ó·È Ë MRI (13). ∏ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì “ÛÔÁÁÔÂȉ‹ ÓÂÊÚfi”, ·ÛÙÂȘ (ÂÎٷۛ˜) Ù˘ ÚÔ-ÊÏÔÈÈ΋˜ ÌÔ›Ú·˜, ηıÒ˜ Î·È ·ÔÙÈÙ·ÓÒÛÂȘ Ù˘ ıËÏÒ‰Ô˘˜ ÌÔ›Ú·˜. ∂›Ó·È ÂӉȷʤÚÔÓ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË Î˘ÚÈ·Ú¯Ô‡Ó Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ Ô˘ÚÔÔÈËÙÈÎfi ÂÓÒ Ù· Â˘Ú‹Ì·Ù· Ù˘ ˘Ï·›·˜ ˘¤ÚÙ·Û˘ ÂÚÈÔÚ›˙ÔÓÙ·È Û ÎÈÚÛÔ‡˜ ÔÈÛÔÊ¿ÁÔ˘ 1Ô˘ ‚·ıÌÔ‡, ÛÏËÓÔÌÂÁ·Ï›· Î·È ·ÈÌ·ÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· ˘ÂÚÛÏËÓÈÛÌÔ‡. ™ÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË, Ë ˘fiÓÔÈ· Ù˘ ÓfiÛÔ˘ Ù¤ıËΠ̠˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›·, fiÔ˘ Ë ‰È¿Ù·ÛË ÙˆÓ ÂÓ‰ÔË·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ Î·È Ë ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ Î˘ÛÙÈÎÒÓ ¯ÒÚˆÓ ıˆÚÂ›Ù·È ·ıÔÁÓˆÌÔÓÈ΋ (6) Î·È ÙÂÎÌËÚÈÒıËΠ̠MRI ¯ÔÏ·ÁÁÂÈÔÁÚ·Ê›·. ∏ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¯ÔÏ·ÁÁÂÈÔηÚÎÈÓÒÌ·ÙÔ˜ Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ Caroli Â›Ó·È 100 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Û ۯ¤ÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Â¿Ó Ë ÓfiÛÔ˜ ÂÚÈÔÚ›˙ÂÙ·È Û ¤Ó·Ó ÏÔ‚fi, Ë ÌÂÚÈ΋ Ë·ÙÂÎÙÔÌ‹ ·ÔÙÂÏ› ÙÂÏÈ΋ ıÂÚ·›·, ÂÓÒ ÛÙȘ ‰È¿¯˘Ù˜ ˆ˜ Èı·Ó‹ χÛË ·Ó·Ê¤ÚÂÙ·È Ë ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜ (12). ∏ ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È ·Ó¿ 6 Ì‹Ó˜ Î·È Ù¤ıËΠ۠ÚfiÁÚ·ÌÌ· ÌÂÏÏÔÓÙÈ΋˜ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ‹·ÙÔ˜.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Bratu I, Laberge JM, Khalife S, Sinsky A. Regression of antenatally diagnosed localized Caroli’s disease. J Pediatr

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2. Stringer MD, Dhawan A, Davenport M, Mieli-Vergani G, Mowat AP, Howard ER. Choledochal cysts: lessons from a 20 year experience. Arch Dis Child 1977;73:528-531.

3. Gillet M, Favre S, Fontolliet C, Halkic N, Mantion G, Heyd B. Monolobar Caroli's disease. Apropos of 12 cases.

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4. Caroli J, Couinaud C, Soupault R, Porcher P, Eteve J. A new disease, undoubtedly congenital, of the bile ducts: unilobar cystic dilation of the hepatic ducts. Sem Hop Paris 1958;34:496-502.

5. Barros JL, Polo JR, Sanabia J, Garcia-Sabrido JL, GomezLorenzo FJ. Congenital cystic dilatation of the intrahepatic bile ducts (Caroli’s disease): report of a case and review of the literature. Surgery 1995;85:589-592.

6. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263-269.

7. Taylor AC, Palmer KR. Caroli’s disease. Eur J Gastroenterol Hepatol 1998;10:105-108.

8. Boyle MJ, Doyle GD, McNulty JG. Monolobar Caroli’s disease. Am J Gastroenterol 1989;84:1437-1444.

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10. Tsuchida Y, Sato T, Sanjo K, Etoh T, Hata K, Terawaki K et al. Evaluation of long-term results of Caroli’s disease: 21 years’ observation of a family with autosomal “dominant” inheritance, and review of the literature. Hepatogastroenterology 1995;42:175-181.

11. Pinto RB, Lima JP, da Silveira TR, Scholl JG, de Mello ED, Silva G. Caroli’s disease: report of 10 cases in children and adolescents in southern Brazil. J Pediatr Surg 1998;33: 1531-1535.

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CASE REPORT

Caroli’s disease with congenital hepatic fibrosis. A case report E. Papadimitriou, G. Matafia, V. Hatzopoulou, V. Mikraki, N. Skenteris Paediatric Clinic of the University of Thessaly Correspondence: Eleni Papadimitriou 14 Georgiou Stavrou str.

412 21, Larissa Date of submission: 01-03-2004 Date of approval: 03-01-2005

Abstract Caroli’s disease is a rare congenital disorder consisting of non-communicating cystic dilatation of the intrahepatic biliary ducts, very often associated with congenital hepatic fibrosis and polycystic kidneys. It is rarely diagnosed during childhood, usually presenting with symptoms of liver or kidney dysfunction.

The case is presented of a girl of Ukrainian origin with a history of recurrent urinary tract infections during infancy. Imaging studies had at that time revealed large dysplastic kidneys. At the age of 2.5 years she presented with hepatomegaly of undetermined origin. She was referred for the first time to our clinic at the age of 11 years, for evaluation of prolonged fever. She was well developed, and her physical examination was unremarkable except for hepatosplenomegaly. The liver and kidney blood biochemistry findings were within the normal range, but the CT and MRI findings were consistent with Caroli’s disease. The patient has follow-up visits every six months. She has developed portal hypertension with first degree oesophageal varices and mild cytopenias due to hypersplenism. She is scheduled to undergo liver transplantation since Caroli’s disease carries an increased risk of development of bile duct carcinoma.

Key words Caroli’s disease, congenital hepatic fibrosis, choledochal cysts.

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¶ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ Ì ۇӉÚÔÌÔ PHACE Õ. ∆Û›ÙÛÈη, ∂. ºÚ˘Û›Ú·, ∞. §Ô˘Ú›‰·, ¡. ª·ÓˆÏ¿ÎË

¶ÂÚ›ÏË„Ë ∆· ¢ÌÂÁ¤ıË ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ ÌÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó Ì ‰˘ÛϷۛ˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Î·È ÙˆÓ ÔÊı·ÏÌÒÓ (Û‡Ó‰ÚÔÌÔ PHACE). ∏ ÔÓÔÌ·Û›· PHACE ÚÔ·ÙÂÈ ·fi Ù· ·Ú¯Èο ÁÚ¿ÌÌ·Ù· ÙˆÓ Ï¤ÍÂˆÓ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙȘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·ÁÁÏÈ΋ ÁÏÒÛÛ·. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ·ÁÔÚÈÔ‡ ËÏÈΛ·˜ 8 ÌËÓÒÓ Ì ÂÙÂÚfiÏ¢ÚÔ, ÌÂÁ¿Ï˘ ¤ÎÙ·Û˘ ·ÈÌ·ÁÁ›ˆÌ· ÚÔÛÒÔ˘, Û‡Ó‰ÚÔÌÔ Dandy-Walker, Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË, ÛÙÚ·‚ÈÛÌfi Î·È ‚ÏÂÊ·ÚfiÙˆÛË Û˘ÛÙÔ›¯ˆ˜. ™ÙÔ ·È‰› ›¯Â ¯ÔÚËÁËı› ıÂÚ·›· Ì ÎÔÚÙÈÎÔÂȉ¤˜ Î·È ˘‹ÚÍ ·ÚÔ‰È΋ ‚ÂÏÙ›ˆÛË Î·È ·Ó·ÛÙÔÏ‹ Ù˘ Â¤ÎÙ·Û˘ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜. ªÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ·ÁˆÁ‹˜, ·Ú·ÙËÚ‹ıËΠ˘ÔÙÚÔ‹ Î·È ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ÂÎ Ó¤Ô˘. ÃÔÚËÁ‹ıËΠÈÓÙÂÚÊÂÚfiÓË-· ˘Ô‰ÔÚ›ˆ˜ Û ‰fiÛË 3x106 U/M2 ÁÈ· ¤Ó· ¤ÙÔ˜, Ì ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù·. ¶·Ú¿ÏÏËÏ·, ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÔÈ ÏÔÈ¤˜ Û˘Ó˘¿Ú¯Ô˘Û˜ ·ÓˆÌ·Ï›Â˜. O ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ÏËÚÔ› Ù· ÎÚÈÙ‹ÚÈ· Î·È ·Ó·ÎÔÈÓÒÓÂÙ·È ˆ˜ Èı·Ófi Û‡Ó‰ÚÔÌÔ PHACE, ÂÓÒ Û˘˙ËÙÔ‡ÓÙ·È Ë ·ıÔÁ¤ÓÂÈ·, Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, ÔÈ ‰È·ÁÓˆÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ Î·È Ë ıÂÚ·¢ÙÈ΋ ·Ú¤Ì‚·ÛË Û¯ÂÙÈο Ì ÙÔ Û‡Ó‰ÚÔÌÔ. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÙÔÓ›˙ÂÙ·È fiÙÈ Ù· ÂÙÂÚfiÏ¢ڷ, ÁÈÁ·ÓÙÈ·›· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ ÂÓ‰¤¯ÂÙ·È Ó· Û˘Ó‰˘¿˙ÔÓÙ·È Ì ÙȘ ·Ú·¿Óˆ ‰˘ÛϷۛ˜ Î·È Û˘ÓÂÒ˜, Ô ¤ÏÂÁ¯Ô˜ Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ ı· Ú¤ÂÈ ··Ú·Èًو˜ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÂÈÎÔÓÈÛÙÈ΋ ÂÁÎÂÊ¿ÏÔ˘, ηډÈÔÏÔÁÈ΋ Î·È ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË.

∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ÕÚÙÂÌȘ ∆Û›ÙÛÈη ∞Ï·Ì¿Ó·˜ 33 & ∂Ú¯ı›Ԣ, ∫·Ï·Ì¿ÎÈ ∆.∫. 174 55, ∞ı‹Ó· ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-01-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-11-2004

§¤ÍÂȘ ÎÏÂȉȿ AÈÌ·ÁÁ›ˆÌ·, Û‡Ó‰ÚÔÌÔ Dandy-Walker, Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË, ÔÊı·ÏÌÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ, ÈÓÙÂÚÊÂÚfiÓË-·.

∂ÈÛ·ÁˆÁ‹ ∆· ÂÎÙÂٷ̤ӷ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ ÌÔÚ› Û¿ÓÈ· Ó· Û˘Ó‰˘¿˙ÔÓÙ·È Î·È Ì ¿ÏÏÔ˘ Ù‡Ô˘ ‰˘ÛϷۛ˜. ªÂÙ¿ ·fi ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ó·ÛÎfiËÛË 43 ÎÏÈÓÈÎÒÓ ÂÚÈÙÒÛÂˆÓ Ì ÁÈÁ·ÓÙÈ·›· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ Î·È Û˘Ó˘¿Ú¯Ô˘Û˜ ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· (΢ڛˆ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ Î·È ÂȉÈο ÙÔ Û‡Ó‰ÚÔÌÔ Dandy-Walker), ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ· Î·È ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜, ÚÔÙ¿ıËÎÂ Ë ÔÓÔÌ·Û›· PHACE ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ ·ÛıÂÓÒÓ Ô˘ ÏËÚÔ‡Ó Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ·. ∆Ô ·ÎÚˆÓ‡ÌÈÔ PHACE Û¯ËÌ·Ù›˙ÂÙ·È ·fi Ù· ·Ú¯Èο ÁÚ¿ÌÌ·Ù· ÙˆÓ Ï¤ÍÂˆÓ Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙȘ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙËÓ ·ÁÁÏÈ΋ ÁÏÒÛÛ·: Posterior fossa malformations, Hemangiomas, Arterial anomalies, Coarctation of the aorta - cardiac defects, Eye abnormalities (1). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ Ì ÙÔ ·Ú·¿Óˆ Û‡Ó‰ÚÔÌÔ.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∞ÁfiÚÈ ËÏÈΛ·˜ 8 ÌËÓÒÓ, ÙÔ ÚÒÙÔ ·È‰› Ó·ÚÒÓ Î·È ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ¯ˆÚ›˜ Û˘ÁÁÂÓÈ΋ Û¯¤ÛË ÌÂٷ͇ ÙÔ˘˜ Î·È ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ÁÂÓÂÙÈ΋˜ ÂÈ‚¿Ú˘ÓÛ˘ ÛÙȘ ‰‡Ô ÔÈÎÔÁ¤ÓÂȘ, ÁÂÓÓ‹ıËΠÙÂÏÂÈfi-

ÌËÓÔ, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ¯ˆÚ›˜ ÂÈÏÔΤ˜. ∞̤ۈ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ·Ú·ÙËÚ‹ıËΠÌÈÎÚ‹˜ ¤ÎÙ·Û˘ ·ÈÌ·ÁÁ›ˆÌ· (1x2 cm) ÛÙË ‰ÂÍÈ¿ ·ÚÂÈ¿, ‚ÏÂÊ·ÚfiÙˆÛË Î·È ÛÙÚ·‚ÈÛÌfi˜ ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÔÊı·ÏÌÔ‡. OÈ ÁÔÓ›˜ ·Ó¤ÊÂÚ·Ó Â¤ÎÙ·ÛË ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜ ηٿ ÙȘ ÚÒÙ˜ ‚‰ÔÌ¿‰Â˜ ˙ˆ‹˜ Î·È ÚÔԉ¢ÙÈ΋ Î¿Ï˘„Ë fiÏ˘ Ù˘ ‰ÂÍÈ¿˜ ·ÚÂȷ΋˜ ¯ÒÚ·˜ Û ËÏÈΛ· ‰‡Ô ÌËÓÒÓ. ™ÙË Ê¿ÛË ·˘Ù‹ ¤ÁÈÓÂ Ë ÚÒÙË ÂÎÙ›ÌËÛË ÙÔ˘ ·ÛıÂÓ‹ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ Ù˘ ÂÚÈÔ¯‹˜ fiÔ˘ ‰È¤ÌÂÓÂ. §fiÁˆ ÙÔ˘ ÂÍ·ÈÚÂÙÈο ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜, Û˘ÛÙ‹ıËÎÂ Î·È ¤ÁÈÓ ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂÁÎÂÊ¿ÏÔ˘ Ì ̷ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (MRI) ÚÔ˜ ·ÔÎÏÂÈÛÌfi ÂÓ‰ÔÎÚ·ÓÈ·ÎÒÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ Î·È ·ÁÁÂÈ·ÎÒÓ ‰˘ÛÏ·ÛÈÒÓ. ¢È·ÈÛÙÒıËΠ·Ú·ÏÏ·Á‹ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ DandyWalker (˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËÎÔ˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Ì ΢ÛÙÈ΋ ‰È·ÌfiÚʈÛË ÙÔ˘ Ô›ÛıÈÔ˘ ÎÚ·ÓÈ·ÎÔ‡ ‚fiıÚÔ˘ Û ÂÈÎÔÈÓˆÓ›· Ì ÙËÓ 4Ë ÎÔÈÏ›·), ηıÒ˜ Î·È ·Ú¯fiÌÂÓÔ˜ ˘‰ÚÔΤʷÏÔ˜ (∂ÈÎfiÓ· 1). ∆Ô ‚Ú¤ÊÔ˜ ˘Ô‚Ï‹ıËΠ۠Â¤Ì‚·ÛË ÎÔÈÏÈÔÂÚÈÙÔÓ·˚΋˜ ·ÚÔ¯¤Ù¢Û˘, ÚÔ˜ ·ÔÊ˘Á‹Ó ÂÈÏÔÎÒÓ ÏfiÁˆ Ù˘ Èı·Ó‹˜ ÂͤÏÈ͢ ÙÔ˘ ˘‰ÚÔÎÂÊ¿ÏÔ˘. ¶·Ú¿ÏÏËÏ·, ˘Ô‚Ï‹ıËΠ۠·ÁˆÁ‹ Ì ÎÔÚÙÈÎÔÂȉ‹ (ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË 2 mg/kg µ™ ËÌÂÚËÛ›ˆ˜ per os) ÁÈ· ‰È¿ÛÙËÌ· 4 ÌËÓÒÓ. ¶·Ú¿ ÙËÓ ·Ú¯È΋ ‚ÂÏÙ›ˆÛË Ù˘ ÂÈÎfiÓ·˜ ηٿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂÚ·›·˜, ÙÔ ·ÈÌ·ÁÁ›ˆÌ· Û˘Ó¤¯ÈÛ ӷ ¶·È‰È·ÙÚÈ΋ 2005;68:145-148

Paediatriki Mar-Apr 05

19-04-05

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Õ. ∆Û›ÙÛÈη Î·È Û˘Ó.

∂ÈÎfiÓ· 1. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘. ∂˘ÌÂÁ¤ı˘ ·ÛÙË ÙÔ˘ ‰ÂÍÈÔ‡ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ Û ·¢ı›·˜ ÂÈÎÔÈÓˆÓ›· Ì ÙËÓ 4Ë ÎÔÈÏ›·. ∞ˆı› ÙÔ ‰ÂÍÈfi ÂÁÎÂÊ·ÏÈÎfi ËÌÈÛÊ·›ÚÈÔ ÚÔÛı›ˆ˜ Î·È ¿Óˆ. O ÛÎÒÏËη˜ ·Ô˘ÛÈ¿˙ÂÈ. ™˘Ó˘¿Ú¯ÂÈ ˘‰ÚÔΤʷÏÔ˜.

ÂÂÎÙ›ÓÂÙ·È Î·È ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙˆÓ ‰È·ÛÙ¿ÛÂÒÓ ÙÔ˘, ΢ڛˆ˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘.

O ·ÛıÂÓ‹˜ ÂÈÛ‹¯ıË ÛÙËÓ ÎÏÈÓÈ΋ Û ËÏÈΛ· 8 ÌËÓÒÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· Á›ÓÂÈ Â·ÓÂÎÙ›ÌËÛË Î·È Ó¤· ıÂÚ·¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ‰È·ÈÛÙÒıËΠÁÈÁ·ÓÙÈ·›Ô ·ÈÌ·ÁÁ›ˆÌ· Ô˘ Î¿Ï˘Ù ÙÔ ‰ÂÍÈfi ËÌÈÌfiÚÈÔ ÙÔ˘ ÚÔÛÒÔ˘ Ì Â¤ÎÙ·ÛË ÛÙË Û‡ÛÙÔÈ¯Ë Ï¿ÁÈ· ÙÚ·¯ËÏÈ΋ ¯ÒÚ·. ∏ ‚Ï¿‚Ë Â›¯Â ·ÓÔÌÔÈÔÁÂÓ¤˜ ÛÎÔ‡ÚÔ ÂÚ˘ıÚfi ¯ÚÒÌ· Î·È ·ÚÔ˘Û›·˙ ÂÏ·ÊÚ¿ ˘¤ÁÂÚÛË Î·ı’ fiÏË ÙËÓ ¤ÎÙ·Û‹ Ù˘ (∂ÈÎfiÓ· 2). ∂ÈϤÔÓ, ·Ú·ÙËÚ‹ıËΠ‚ÏÂÊ·ÚfiÙˆÛË, Ô›‰ËÌ· ‚ÏÂÊ¿ÚˆÓ Î·È ·ÔÎÏ›ÓˆÓ ÛÙÚ·‚ÈÛÌfi˜ ÙÔ˘ ‰ÂÍÈÔ‡ ÔÊı·ÏÌÔ‡. ∆· ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›· ÙÔ˘ ‹Ù·Ó ·Ô‰ÂÈÎÙÈο ·ÓÂ·ÚÎÔ‡˜ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ (‚¿ÚÔ˜ ÛÒÌ·ÙÔ˜: 6 kg, <3Ë ∂£, Ì‹ÎÔ˜ ÛÒÌ·ÙÔ˜: 62 cm, <3Ë ∂£ Î·È ÂÚ›ÌÂÙÚÔ˜ ÎÂÊ·Ï‹˜: 41 cm, 3Ë ∂£), Ô˘ Û˘Óԉ‡ÔÓÙ·Ó ·fi ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ˘ÔÙÔÓ›· Î·È ‹È· ÎÈÓËÙÈ΋ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÂͤٷÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (·Ô˘Û›· Ê˘Û‹Ì·ÙÔ˜, Ê˘ÛÈÔÏÔÁÈÎfi˜ ÂÚÈÊÂÚÈÎfi˜ ÛÊ˘ÁÌfi˜ Î·È Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÛÙ· Ù¤ÛÛÂÚ· ¿ÎÚ·). ¶·È‰È·ÙÚÈ΋ 2005;68:145-148

O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜, Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. Èڛ˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ‹Ù·Ó Î·È Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ηڢfiÙ˘Ô. ™ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ‰È·ÈÛÙÒıËΠÓ¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË (ÙÈÌ‹ ›ÂÛ˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜: 45 mmHg ÌÂ Ê˘ÛÈÔÏÔÁÈο fiÚÈ· 20-25 mmHg), Ë ÔÔ›· ¯·Ú·ÎÙËÚ›ÛÙËΠ‹È· Î·È Û˘ÛÙ‹ıËΠÌfiÓÔ Ù·ÎÙÈ΋ ηډÈÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜. ∏ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ÂȂ‚·›ˆÛ ÙËÓ ‹‰Ë ‰È·ÈÛÙˆı›۷ ‚ÏÂÊ·ÚfiÙˆÛË Ì Ì›ˆÛË Ù˘ ‚ÏÂÊ·ÚÈ΋˜ Û¯ÈÛÌ‹˜ Î·È ÙÔÓ ·ÔÎÏ›ÓÔÓÙ· ÛÙÚ·‚ÈÛÌfi. ¢ÂÓ ‚Ú¤ıËÎ·Ó ‰˘ÛϷۛ˜ ·ÁÁ›ˆÓ ÙÔ˘ ÔÊı·ÏÌÔ‡. ™˘ÛÙ‹ıËÎÂ Î¿Ï˘„Ë ÙÔ˘ ˘ÁÈÔ‡˜ ÔÊı·ÏÌÔ‡ ÁÈ· 2-3 ÒÚ˜ ËÌÂÚËÛ›ˆ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› Ë ·Ì‚Ï˘ˆ›· Î·È Ë ·ÒÏÂÈ· fiÚ·Û˘ ÙÔ˘ ¿Û¯ÔÓÙÔ˜ ÔÊı·ÏÌÔ‡. ¢Â‰Ô̤Ó˘ Ù˘ η΋˜ ·ÓÙ·fiÎÚÈÛ˘ ÛÙ· ÎÔÚÙÈÎÔÂȉ‹, ¯ÔÚËÁ‹ıËΠÈÓÙÂÚÊÂÚfiÓË-· Û ËÌÂÚ‹ÛÈ· ‰fiÛË 3x106 U/M2 ˘Ô‰ÔÚ›ˆ˜. O ·ÛıÂÓ‹˜ ÂÍÂÙ·˙fiÙ·Ó ÌËÓÈ·›ˆ˜ Î·È ÁÈÓfiÙ·Ó Ô ··Ú·›ÙËÙÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜. ∏ ıÂÚ·›· ‹Ù·Ó ηÏÒ˜ ·ÓÂÎÙ‹ Î·È Û˘Ó¯›ÛÙËΠÁÈ· 12 Ì‹Ó˜. ∫·Ù¿ ÙÔÓ ÂÚÈÔ‰ÈÎfi Â·Ó¤ÏÂÁ¯Ô, ‰ÂÓ ‰È·ÈÛÙÒıËΠÂÚ·ÈÙ¤Úˆ Â¤ÎÙ·ÛË ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜, ÂÓÒ Ë ˘¿Ú¯Ô˘Û· ÂÛÙ›· ÛÙ·‰È·Î¿ ·ÚÔ˘Û›·Û ÂÚÈÔ¯¤˜ χÛ˘. ∫·Ù¿ ÙËÓ Î·Ú‰ÈÔÏÔÁÈ΋ Â·ÓÂÎÙ›ÌËÛË (ÌÂÙ¿ ·fi 6 Î·È 12 Ì‹Ó˜), ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠ·‡ÍËÛË Ù˘ ›ÂÛ˘ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Ù˘ ηډȿ˜ Î·È ÙˆÓ ·ÁÁ›ˆÓ ‹Ù·Ó ÈηÓÔÔÈËÙÈ΋. O ·ÛıÂÓ‹˜ Â›Ó·È Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ˆÛÙfiÛÔ ·Ú·Ì¤ÓÔ˘Ó Ù· ÚÔ‚Ï‹Ì·Ù· ·Ó¿Ù˘Í˘ Î·È „˘¯ÔÎÈÓËÙÈ΋˜ ÂͤÏÈ͢.

™˘˙‹ÙËÛË ∆· ·ÈÌ·ÁÁÂÈÒÌ·Ù· Â›Ó·È Î·ÏÔ‹ıÂȘ fiÁÎÔÈ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·ÚÎÂÙ¿ Û˘¯Ó¿ ÛÙ· ·È‰È¿ (·Ú·ÙËÚÔ‡ÓÙ·È Û 3-5% ÙˆÓ ÓÂÔÁÓÒÓ Î·È 10% ÙˆÓ ‚ÚÂÊÒÓ ÚÈÓ Û˘ÌÏËÚÒÛÔ˘Ó ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ˙ˆ‹˜). ™˘ÓÂÒ˜, οıÂ Û˘Û¯¤ÙÈÛË ÙˆÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ ÌÂ Û˘Ó˘¿Ú¯Ô˘Û˜ ‰˘ÛϷۛ˜ Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ηٷÁÚ¿ÊÂÙ·È Î·È Ó· ÂÚÈÁÚ¿ÊÂÙ·È Ì ¤ÌÊ·ÛË (2). ∏ Û˘Ó‡·ÚÍË ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ Î·È ‰˘ÛÏ·ÛÈÒÓ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (∫¡™) ·Ó·ÎÔÈÓÒıËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1978 ·fi ÙÔÓ Pascual-Castroviejo (3). ™Ù· ¯ÚfiÓÈ· Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó, Ë ·Ú·¿Óˆ Û¯¤ÛË (η›ÙÔÈ Û¿ÓÈ·) ÂÓÈÛ¯‡ıËÎÂ Î·È ·fi ¿ÏϘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ó·ÊÔÚ¤˜, ÂÓÒ ·Ú¿ÏÏËÏ· Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ÂÚÈÁÚ¿ÊËÎ·Ó ÔÚÈṲ̂Ó˜ ÂÈϤÔÓ ·ÓˆÌ·Ï›Â˜ (4-6). ∆o 1996, ÌÂÙ¿ ·fi ÌÂϤÙË 43 ÂÚÈÙÒÛÂˆÓ (41 ÂÚÈÙÒÛÂȘ ·Ó·ÊÂÚfiÌÂÓ˜ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Î·È ‰‡Ô

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·147

147

µÚ¤ÊÔ˜ Ì ۇӉÚÔÌÔ PHACE

∂ÈÎfiÓ· 2. ∂ÎÙÂٷ̤ÓÔ ·ÈÌ·ÁÁ›ˆÌ· ‰ÂÍÈÔ‡ ËÌÈÌÔÚ›Ô˘ ÚÔÛÒÔ˘ Û ËÏÈΛ· 8 ÌËÓÒÓ.

Ô˘ ·Ó·ÎÔÈÓÒıËÎ·Ó ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜), ¯ÚËÛÈÌÔÔÈ‹ıËΠÙÔ ·ÎÚˆÓ‡ÌÈÔ PHACE ÁÈ· ÙËÓ ÔÓÔÌ·Û›· Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· (΢ڛˆ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘), ÙËÓ Î·Ú‰È¿, Ù· ·ÁÁ›· Î·È ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÌÂÁ¿Ï˘ ¤ÎÙ·Û˘ ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘. ∆Ô Û‡Ó‰ÚÔÌÔ Èı·ÓÒ˜ ÔÊ›ÏÂÙ·È Û ÂÓ‰ÔÌ‹ÙÚÈ· ·ÓˆÌ·Ï›· Ù˘ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ ηٿ ÙÔÓ ÙÚ›ÙÔ Ì‹Ó· Ù˘ ·ËÛ˘, fiÙ·Ó Û¯ËÌ·Ù›˙ÔÓÙ·È Ù· ·ÁÁ›·, Ô ÛÎÒÏËη˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È Ë ÔÙÈ΋ Û¯ÈÛÌ‹ (1). £· Ú¤ÂÈ Ó· Á›ÓÂÈ Û·Ê¤˜ fiÙÈ fiÏ· Ù· ·ÈÌ·ÁÁÂÈÒÌ·Ù· ‰ÂÓ Â›Ó·È ÙÔ ›‰ÈÔ ‡ÔÙ· ÁÈ· ˘ÔΛÌÂÓ˜ ·ÓˆÌ·Ï›Â˜. ™˘Ó‹ıˆ˜ Ù· ÁÈÁ·ÓÙÈ·›·, ÂÙÂÚfiÏ¢ڷ Î·È Ì ˘¤ÁÂÚÛË ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ Â›Ó·È ÂΛӷ Ô˘ Ú¤ÂÈ Ó· ıÔÚ˘‚Ô‡Ó Î·È ÌÔÚ› Ó· ˘ÔÎÚ‡ÙÔ˘Ó Û‡Ó‰ÚÔÌÔ PHACE (7). O ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ÏËÚÔ› Ù· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ·Ú·¿Óˆ ÎÚÈÙ‹ÚÈ· Î·È ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ Èı·Ófi Û‡Ó‰ÚÔÌÔ PHACE. ∆Ô Û‡Ó‰ÚÔÌÔ PHACE Ê·›ÓÂÙ·È Ó· ·ÊÔÚ¿ Û·ÓÈfiÙÂÚ· ÛÙ· ·ÁfiÚÈ·, ·ÊÔ‡ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÁÚ¿ÊÔÓÙ·È Û ÎÔÚ›ÙÛÈ·. ∏ Û˘¯ÓfiÙÂÚË ·Ó·ÊÂÚfiÌÂÓË ‰˘ÛÏ·Û›· ÙÔ˘ ∫¡™ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ Dandy-Walker, fiˆ˜ Î·È ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË (1). ∆o Û‡Ó‰ÚÔÌÔ Dandy-Walker ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÁÂÓÂÛ›· ‹ ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È Î˘ÛÙÈ΋ ‰È·ÌfiÚʈÛË ÙÔ˘ Ô›ÛıÈÔ˘ ‚fiıÚÔ˘ Û ÂÈÎÔÈÓˆÓ›· Ì ÙËÓ 4Ë ÎÔÈÏ›·. ¶ÔÏÏÔ› ·fi ÙÔ˘˜ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ÎÚÔÎÂÊ·Ï›· ÏfiÁˆ ÙÔ˘ ˘‰ÚÔÎÂÊ¿ÏÔ˘, Ô ÔÔ›Ô˜ ·ÔÙÂÏ› ÂÍ·ÈÚÂÙÈο Û˘¯Ó‹ ÂÈÏÔ΋, ·Ú’ fiÙÈ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙ· ‚·ÛÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. O ˘‰ÚÔΤʷÏÔ˜ ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ì ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË ÛÙÔ˘˜ ÙÚÂȘ Ì‹Ó˜ ˙ˆ‹˜ Î·È Û˘Ó‹ıˆ˜ ··ÈÙÂ›Ù·È Â¤Ì‚·ÛË ÎÔÈÏÈÔÂÚÈÙÔÓ·˚΋˜ ·ÚÔ¯¤Ù¢Û˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛÙ›. °ÂÓÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Û¿ÓÈ· ÂÌϤÎÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Dandy-Walker, ÂÓÒ ‰ÂÓ ¤¯Ô˘Ó ηٷÁÚ·Ê› ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ ‹ ÎÏËÚÔÓÔÌÈÎfi-

ÙËÙ· οÔÈÔ˘ Ù‡Ô˘. O Ê˘ÛÈÔÏÔÁÈÎfi˜ ηڢfiÙ˘Ô˜ ÙÔ˘ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ٷ ·Ú·¿Óˆ. ∏ ‹È· ˘ÔÙÔÓ›· Î·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ÎÈÓËÙÈ΋˜ ÂͤÏÈ͢ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Èı·Ófiٷٷ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ Û‡Ó‰ÚÔÌÔ Dandy-Walker Î·È ¤¯Ô˘Ó ηٷÁÚ·Ê› ˆ˜ Û˘¯Ó¤˜ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∞Ó Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÔ‚·Ú¤˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÛÎÒÏËη, ·˘Ùfi ‰ÂÓ ÂÎÊÚ¿˙ÂÙ·È ÎÏÈÓÈο Ì ‚¿ÛË ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, ·ÏÏ¿ Î·È ÙËÓ ÂÌÂÈÚ›· Ì·˜. ¡ÔËÙÈÎfi ËÏ›ÎÔ (IQ) >80 ÛËÌÂÈÒıËΠ۠ÔÛÔÛÙfi 60% ÛÂÈÚ¿˜ ·ÛıÂÓÒÓ Ì ۇӉÚÔÌÔ Dandy-Walker ÌÂÙ¿ ·fi Ì·ÎÚ¿ ·Ú·ÎÔÏÔ‡ıËÛË, fï˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·Ó¿ÏÔÁ· ÛÙÔȯ›· ÁÈ· ÙÔ Û‡Ó‰ÚÔÌÔ PHACE (8). ∏ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙÔÓ ·ÛıÂÓ‹ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ·Ô‰›‰ÂÙ·È Û ‰ÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ·ÁÁ›ˆÓ. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¿ÏÏÔ˘ Ù‡Ô˘ ‰˘ÛϷۛ˜ Ù˘ ηډȿ˜ ‹ ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, Û ·ÓÙ›ıÂÛË Ì ÔÏϤ˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ‚È‚ÏÈÔÁÚ·ÊÈο: ÔÛÔÛÙfi 26% ÛÂÈÚ¿˜ ·ÛıÂÓÒÓ Ì PHACE ·ÚÔ˘Û›·˙ ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ Î·Ú‰È¿ ‹ ÙËÓ ·ÔÚÙ‹ (΢ڛˆ˜ ÈÛıÌÈ΋ ÛÙ¤ÓˆÛË), ÂÓÒ 41% Ù˘ ›‰È·˜ ÛÂÈÚ¿˜ ›¯Â ‰˘ÛϷۛ˜ ÛÙ· ·ÁÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (1). ∏ ‰È¿ÁÓˆÛË ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ·ÓˆÌ·ÏÈÒÓ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó Á›ÓÂÙ·È Ì ηıÂÙËÚÈ·ÛÌfi Ù˘ ηډȿ˜ ‹/Î·È ·ÁÁÂÈÔÁÚ·Ê›· ηڈٛ‰ˆÓ fiÙ·Ó ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ·fi ÙÔÓ ÎÏÈÓÈÎfi, ÙÔÓ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi ‹ ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ù· ·Ú¯Èο Â˘Ú‹Ì·Ù· ·fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Ù·Ó ÈηÓÔÔÈËÙÈο (·Ô˘Û›· Ê˘Û‹Ì·ÙÔ˜, Ê˘ÛÈÔÏÔÁÈÎfi˜ ÂÚÈÊÂÚÈÎfi˜ ÛÊ˘ÁÌfi˜ Î·È Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ Î·È ÛÙ· Ù¤ÛÛÂÚ· ¿ÎÚ·), ÂÓÒ ‰ÂÓ ˘‹Ú¯·Ó ·ÓˆÌ·Ï›Â˜ ·ÁÁ›ˆÓ ÛÙËÓ MRI ÂÁÎÂÊ¿ÏÔ˘. ∫·Ù¿ ÙËÓ Î·Ú‰ÈÔÏÔÁÈ΋ Â·ÓÂÎÙ›ÌËÛË (ÌÂÙ¿ ·fi 6 Î·È 12 Ì‹Ó˜), ‰ÂÓ ‰È·ÈÛÙÒıËΠ·‡ÍËÛË Ù˘ ›ÂÛ˘ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î·È ‰Â‰Ô̤Ó˘ Ù˘ ·Ô˘Û›·˜ ·ıÔÏÔÁÈÎÒÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ·ÎÙÈÓÔÁÚ·Ê›·˜ ıÒÚ·ÎÔ˜, Ô ¤ÏÂÁ¯Ô˜ ‰ÂÓ ÚÔ¯ÒÚËÛ ÂÚ·ÈÙ¤Úˆ. OÈ ·È‰ÔηډÈÔÏfiÁÔÈ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ÚÔ¯ˆÚÔ‡Ó Û ηıÂÙËÚÈ·ÛÌfi Î·È ıÂÚ·›· fiÙ·Ó Ë ›ÂÛË ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ˘ÂÚ‚·›ÓÂÈ Ù· 50 mmHg. øÛÙfiÛÔ, ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ˙‹ÙËÌ· ÚÔ‚ÏËÌ·Ù›˙ÂÈ Î·È ÙÔ ·È‰› ı· Â·ÓÂÎÙÈÌ¿Ù·È ÂÚÈÔ‰Èο, Â›Ó·È ‰Â Ôχ Èı·Ófi Ó· ˘Ô‚ÏËı› Û‡ÓÙÔÌ· Û ηıÂÙËÚÈ·ÛÌfi ηډȿ˜ Â¿Ó Ë Î·Ù¿ÛÙ·ÛË ‰ÂÓ ‚ÂÏÙȈı›. ∆Ô Û‡Ó‰ÚÔÌÔ PHACE Û˘¯Ó¿ ÂÚÈÏ·Ì‚¿ÓÂÈ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙÔ˘˜ ÔÊı·ÏÌÔ‡˜: ÔÛÔÛÙfi 23% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ·fi ÙÔ˘˜ Frieden Î·È Û˘Ó Â›¯Â Ù¤ÙÔȘ ·ÓˆÌ·Ï›Â˜ (1). ∆· ÈÔ Û˘¯Ó¿ ÔÊı·ÏÌÔÏÔÁÈο Â˘Ú‹Ì·Ù· Â›Ó·È Ô ÌÈÎÚfiÊı·ÏÌÔ˜, Ô Î·Ù·ÚÚ¿ÎÙ˘, Ë ˘ÔÏ·Û›· ÙÔ˘ ¶·È‰È·ÙÚÈ΋ 2005;68:145-148

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·148

148

Õ. ∆Û›ÙÛÈη Î·È Û˘Ó.

ÔÙÈÎÔ‡ Ó‡ÚÔ˘, Ô ÛÙÚ·‚ÈÛÌfi˜ Î·È Ë ‚ÏÂÊ·ÚfiÙˆÛË (5). ∞Ó Î·È ÙÔ ÁÏ·‡ÎˆÌ· ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙȘ ÔÊı·ÏÌÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ ÙÔ˘ PHACE, ÚfiÛÊ·Ù· ‰ËÌÔÛȇÙËÎÂ Ë Û˘Ó‡·ÚÍË ÁÏ·˘ÎÒÌ·ÙÔ˜ Ì ÙȘ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (9). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ‰È·ÈÛÙÒıËΠÛÙÚ·‚ÈÛÌfi˜ Î·È ‚ÏÂÊ·ÚfiÙˆÛË Î·È ÂÊ·ÚÌfiÛÙËÎÂ Î¿Ï˘„Ë ÙÔ˘ ˘ÁÈÔ‡˜ ÔÊı·ÏÌÔ‡ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› Ë ·ÒÏÂÈ· fiÚ·Û˘ ÏfiÁˆ ·Ì‚Ï˘ˆ›·˜, Ì›·˜ Û˘¯Ó‹˜ ÔÊı·ÏÌÔÏÔÁÈ΋˜ ÂÈÏÔ΋˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (10). ∏ ۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË ‰ÂÓ ÂËÚ¿˙ÂÙ·È ¿ÓÙÔÙ ÛÙÔ Û‡Ó‰ÚÔÌÔ PHACE. ∏ Ì·ÎÚÔÎÂÊ·Ï›· Â›Ó·È ·ÚÎÂÙ¿ Û˘¯Ó‹ Î·È Û¯ÂÙ›˙ÂÙ·È Ì ˘ÔΛÌÂÓÔ ˘‰ÚÔΤʷÏÔ, ÂÓÒ ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ Ì ¯·ÌËÏ¿ ۈ̷ÙÔÌÂÙÚÈο ÛÙÔȯ›·, fiˆ˜ Î·È ÛÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ·ÛıÂÓ‹ (1,7,11). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ÔÈ ÁÔÓ›˜ ·Ó¤ÊÂÚ·Ó ·ÓÔÚÂÍ›·, ˆÛÙfiÛÔ ‰ÂÓ ˘‹ÚÍ·Ó ¤ÌÂÙÔÈ, fiˆ˜ Û ÔÚÈṲ̂ÓÔ˘˜ ·ÛıÂÓ›˜ Ì ۇӉÚÔÌÔ Dandy-Walker (8). ∏ ıÂÚ·›· Ì ÎÔÚÙÈÎÔÂȉ‹ Ô˘ ›¯Â ÚÔËÁËı›, ·Ó Î·È Û‡ÓÙÔÌË, ÂÓ‰¤¯ÂÙ·È Ó· ·ÔÙÂÏ› ÂÈϤÔÓ ·Ú¿ÁÔÓÙ· ηı˘ÛÙ¤ÚËÛ˘ Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË. °ÂÓÈÎfiÙÂÚ·, Ô Ê·ÈÓfiÙ˘Ô˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ PHACE Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ ÌÂÁ¿ÏÔ Ê¿ÛÌ· ÎÏÈÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È ÔÏÏ·ÏÔ› Û˘Ó‰˘·ÛÌÔ› ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·˘ÙÒÓ ÌÔÚ› Ó· ·Ú·ÙËÚËıÔ‡Ó. ¶ÚfiÛÊ·ÙË Â›Ó·È Ë ÂÓÙ˘ˆÛȷ΋ ÂÚÈÁÚ·Ê‹ ·ÛıÂÓÔ‡˜ Ì ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Û˘Ó‰˘·ÛÌÔ‡ Û˘Ó‰ÚfiÌˆÓ Marfan Î·È PHACE (12). ∏ ıÂÚ·›· Ì ÈÓÙÂÚÊÂÚfiÓË-· (INF-·) ¤¯ÂÈ ÂÊ·ÚÌÔÛÙ› Û ÂÚÈÙÒÛÂȘ ÂÈıÂÙÈÎÒÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÂȉÒÓ. O Ì˯·ÓÈÛÌfi˜ ¢·ÈÛıËÛ›·˜ ÙˆÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ ÛÙËÓ ÈÓÙÂÚÊÂÚfiÓË-· ‰ÂÓ ¤¯ÂÈ ·Ôχو˜ ‰È¢ÎÚÈÓÈÛÙ›, Ê·›ÓÂÙ·È ˆÛÙfiÛÔ Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ È‰ÈfiÙËÙ¿ Ù˘ Ó· ·Ó·ÛÙ¤ÏÏÂÈ ÙË ÌÂÁ¿ÏË ·Ó¿Ù˘ÍË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ Ù· ·ÈÌ·ÁÁÂÈÒÌ·Ù· (13,14). ∏ ÚÔÙÂÈÓfiÌÂÓË ‰fiÛË Â›Ó·È 3 ÂηÙÔÌ̇ÚÈ· U/M2 ˘Ô‰ÔÚ›ˆ˜, ¿·Í ËÌÂÚËÛ›ˆ˜, ÂÓÒ Ë ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÎÏÈÓÈ΋ ·ÓÙ·fiÎÚÈÛË Î·È ÙȘ Èı·Ó¤˜ ·ÚÂÓ¤ÚÁÂȘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ∏ ¯ÔÚ‹ÁËÛË ÈÓÙÂÚÊÂÚfiÓ˘-· ·ÔÊ·Û›ÛÙËΠÛÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ÏfiÁˆ ÙÔ˘ ÁÈÁ·ÓÙÈ·›Ô˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘ Ù·¯‡Ù·Ù˘ ÂͤÏÈ͢ ÙÔ˘ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜, ηıÒ˜ Î·È Ù˘ ˘ÔÙÚÔ‹˜ ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ·Ú¯È΋˜ ıÂÚ·›·˜ Ì ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜, ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ·ÚÂÓ¤ÚÁÂȘ Î·È ‰ÂÓ ˘‹ÚÍ ÌÂÙÚ‹ÛÈÌË Â¤ÎÙ·ÛË Ù˘ ˘¿Ú¯Ô˘Û·˜ ÂÛÙ›·˜. ªÂÙ¿ ·fi 12 Ì‹Ó˜ ıÂÚ·›·˜ Ì ÙËÓ ·Ú·¿Óˆ ‰fiÛË, Ë ‚Ï¿‚Ë Â›Ó·È Û·ÊÒ˜ ÏÈÁfiÙÂÚÔ ¤ÓÙÔÓË Î·È ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚÈÔ¯¤˜ χÛ˘. πηÓÔÔÈËÙÈ΋ ·ÓÙ·fiÎÚÈÛË Û ·Ó¿ÏÔÁË ¶·È‰È·ÙÚÈ΋ 2005;68:145-148

·ÁˆÁ‹ ·Ó·Ê¤ÚÂÙ·È Î·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (1,7). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ê·›ÓÂÙ·È fiÙÈ Ë Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ·È‰ÈÒÓ Ì ¢ÌÂÁ¤ıË ·ÈÌ·ÁÁÂÈÒÌ·Ù· ÚÔÛÒÔ˘ Â›Ó·È ÛËÌ·ÓÙÈ΋. ∏ ÏÂÙÔÌÂÚ‹˜ Ó¢ÚÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË, Ë Ù·ÎÙÈ΋ ̤ÙÚËÛË Ù˘ ÂÚÈ̤ÙÚÔ˘ ÎÂÊ·Ï‹˜ Î·È Ë ÚÔÛÂÎÙÈ΋ ÂͤٷÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Û˘ÛÙ‹ÓÔÓÙ·È ÂÌÊ·ÙÈο. ∏ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂÎÙ›ÌËÛË Â›Ó·È, Â›Û˘, ÂÍ›ÛÔ˘ ··Ú·›ÙËÙË. ™ÙȘ ÂÚÈÙÒÛÂȘ ·ıÔÏÔÁÈÎÒÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ‹/Î·È Ù·¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓˆÓ ·ÈÌ·ÁÁÂÈˆÌ¿ÙˆÓ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÙÔ˘ ∫¡™, Ù˘ ηډȿ˜, ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ Î·È ÙˆÓ ÔÊı·ÏÌÒÓ ¤¯ÔÓÙ·˜ ¿ÓÙ· ˘’ fi„ÈÓ ÙÔ Û‡Ó‰ÚÔÌÔ PHACE.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Frieden IJ, Reese V, Cohen D. PHACE syndrome. The association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. Arch Dermatol 1996;132:307-311.

2. Burns AJ, Kaplan LC, Mulliken JB. Is there an association between hemangioma and syndromes with dysmorphic features? Pediatrics 1991;88:1257-1267.

3. Pascual-Castroviejo I. Vascular and nonvascular intracranial malformation associated with external capillary hemangiomas. Neuroradiology 1978;16:82-84.

4. Reese V, Frieden IJ, Paller AS, Esterly NB, Ferriero D, Levy ML et al. Association of facial hemangiomas with DandyWalker and other posterior fossa malformations. J Pediatr 1993;122:379-384.

5. Fernandez GR, Munoz FJ, Padron C, Munoz M. Microphthalmos, facial capillary hemangioma and Dandy-Walker malformation. Acta Ophthalmol Scand 1995;73:173-175.

6. Goh WH, Lo R. A new 3C syndrome: cerebellar hypoplasia, cavernous haemangioma and coarctation of the aorta.

Dev Med Child Neurol 1993;35:637-641.

7. Quecedo E, Gil-Mateo MP, Pont V, Febrer MI, Aliaga A. Giant hemifacial angioma and PHACE syndrome. Br J Dermatol 1997;136:649-650.

8. Hirsch JF, Pierre-Kahn A, Renier D, Sainte-Rose C, Hoppe-Hirsch E. The Dandy-Walker malformation. A review of 40 cases. J Neurosurg 1984;61:515-522.

9. Coats DK, Paysse EA, Levy ML. PHACE: a neurocutaneous syndrome with important ophthalmologic implications: case report and literature review. Ophthalmology 1999;106:1739-1741.

10. Haik BG, Karcioglu ZA, Gordon RA, Pechous BP. Capillary hemangioma (infantile periocular hemangioma). Surv Ophthalmol 1994;38:399-426.

11. Rizzo R, Micali G, Incorpora G, Parano E, Pavone L. A very aggressive form of facial hemangioma. Pediatr Dermatol 1988;5:263-265.

12. Slavotinek AM, Dubovsky E, Dietz HC, Lacbawan F. Report of a child with aortic aneurysm, orofacial clefting, hemangioma, upper sternal defect, and marfanoid features: possible PHACE syndrome. Am J Med Genet 2002;110: 283-288.

13. White CW, Wolf SJ, Korones DN, Sondheimer HM, Tosi MF, Yu A. Treatment of childhood angiomatous diseases with recombinant interferon alfa-2a. J Pediatr 1991;118: 59-66.

14. Brouty-Boye D, Zetter BR. Inhibition of cell motility by interferon. Science 1980;208:516-518.

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An infant with PHACE syndrome A. Tsitsika, H. Fryssira, A. Lourida, N. Manolaki

Abstract Large facial haemangiomas may be found in combination with dysplasias of the central nervous system (primarily, the Dandy-Walker malformation), the cardiovascular system and the eyes. The name PHACE (an acronym) was proposed for the syndrome of patients whose deformities meet the above criteria. The case reported is of an 8 month-old boy who had a giant, unilateral, plaque-like facial haemangioma, with a coexisting Dandy-Walker variant malformation, pulmonary hypertension, eyelid ptosis and strabismus of the eye on the affected side. The child had received oral corticosteroids as treatment for the rapidly growing facial lesion and at first a slight improvement was observed. After discontinuation of treatment there was a relapse and the baby was referred for further evaluation and treatment. Interferon-alfa was administered at daily dosage of 3x106 U/M2 subcutaneously for 12 months with satisfying results. The coexisting anomalies were also treated. This patient is described as a possible PHACE case, and the pathogenesis, the clinical features, the diagnosis and the treatment options of the syndrome are discussed.

It is emphasized that large, unilateral facial haemangiomas may be associated with the anomalies described, and in cases of abnormal findings or rapidly progressing haemangiomatosis further brain, cardiac and ocular investigation is indicated, as the diagnosis of PHACE syndrome must be considered.

1st Paediatric Clinic of the University of Athens, “Aghia Sophia” Children’s Hospital, Athens Correspondence: Artemis Tsitsika 33 Alamanas & Erexthiou str., 174 55, Kalamaki, Athens Date of submission: 16-01-2004 Date of approval: 15-11-2004

Key words Haemangiomas, Dandy-Walker malformation, pulmonary hypertension, interferon-alfa.

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™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÂÈÓÂÊÚȉ›ˆÓ Ì ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ÛÔ‚·Ú‹˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ 1 ¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô "∞ÏÂÍ¿Ó‰Ú·", ∞ı‹Ó· 2 ∆Ì‹Ì· ∂Ó˙˘ÌÔÏÔÁ›·˜ Î·È ∫˘ÙÙ·ÚÈ΋˜ §ÂÈÙÔ˘ÚÁ›·˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ "∞Á›· ™ÔÊ›·", ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ¢·ÛÔÔ‡ÏÔ˘ ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘ 11 ∆.∫. 115 28, πÏ›ÛÛÈ·, ∞ı‹Ó· E-mail: kpaplos@med.uoa.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-03-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-02-2005

ª. ¢·ÛÔÔ‡ÏÔ˘1, ª. ∞ÔÛÙfiÏÔ˘1, °. ª·ÚÔ‡Ù˘1, ∂. ªÈ¯ÂϷοÎË2, ∂. §Ô˘Î¿ÙÔ˘1, Ã. ∫ÒÛÙ·ÏÔ˜1

¶ÂÚ›ÏË„Ë ∏ Û˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ ·ÔÙÂÏ› Û¿ÓÈ· ÓfiÛÔ, Ë ÔÔ›· ÂÌÊ·Ó›˙ÂÙ·È ÌÂ Û˘¯ÓfiÙËÙ· 1 ·Ó¿ 12500 ÁÂÓÓ‹ÛÂȘ. ∫‡ÚȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Â›Ó·È Û·ÛÌÔ› ÏfiÁˆ ˘ÔÁÏ˘Î·ÈÌ›·˜, ¤ÌÂÙÔÈ, ‰˘ÛÎÔÏ›· Û›ÙÈÛ˘ Î·È Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ηٿ ÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô. ∏ Û˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ ÌÔÚ› Ó· ÂΉËψı› Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ‹ Î·È ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ‰˘ÛÏ·Û›· ÛÙ· Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿. ∏ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ˆ˜ ÂΉ‹ÏˆÛË Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Â›Ó·È Û¿ÓÈ· Î·È ÌÔÚ› Ó· ¤¯ÂÈ Î·Î‹ ÚfiÁÓˆÛË Û ÂÚ›ÙˆÛË Ô˘ ‰ÂÓ ‰È·ÁÓˆÛÙ› ¤ÁηÈÚ· Î·È ‰ÂÓ ÂÊ·ÚÌÔÛÙ› Ë Î·Ù¿ÏÏËÏË ıÂÚ·¢ÙÈ΋ ·ÁˆÁ‹. ∂ÈıÂÙÈ΋ ıÂÚ·›· Ì ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Ú¤ÂÈ Ó· ÍÂÎÈÓ¿ ·Ì¤Ûˆ˜, ÂÂȉ‹ Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ¤¯ÂÈ Èı·ÓÒ˜ ÌÔÈÚ·›· ¤Î‚·ÛË.

§¤ÍÂȘ ÎÏÂȉȿ ™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÂÈÓÂÊÚȉ›ˆÓ, ÓÂÔÁÓfi, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·.

∂ÈÛ·ÁˆÁ‹ ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Ì ‰È·ÈÛو̤ÓÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋, ·ÊÔ‡ Ë ÓfiÛÔ˜ ÌÔÚ› Ó· ÂΉËψı› - ·Ó Î·È Û¿ÓÈ· - ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô Ì ¿Ù˘Ë ÛËÌÂÈÔÏÔÁ›·, Ô˘ ÌÔÚ› Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi, fiˆ˜ ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È. ∏ ˘Ô„›· Ù˘ ÓfiÛÔ˘ Ú¤ÂÈ Ó· ÎÈÓËÙÔÔÈ› ¤ÁηÈÚ· ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¤Ó·ÚÍË ıÂÚ·›·˜ ˘ÔηٿÛÙ·Û˘ Ì ÎÔÚÙÈÎÔÂȉ‹, Ë ÔÔ›· ÌÔÚ› Ó· ·Ԃ› ÛˆÙ‹ÚÈ· ÁÈ· ÙÔ ÓÂÔÁÓfi.

¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÙÂÏÂÈfiÌËÓÔ˘ ¿ÚÚÂÓÔ˜ ÓÂÔÁÓÔ‡, ËÏÈΛ·˜ ·ËÛ˘ 41 ‚‰ÔÌ¿‰ˆÓ, ÙÔ ÔÔ›Ô ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ·fi ÁÔÓ›˜ ÌÔω·‚È·Ó‹˜ ηٷÁˆÁ‹˜, ÔÈ ÔÔ›ÔÈ Â›¯·Ó ÂχıÂÚÔ ÔÈÎÔÁÂÓÂÈ·Îfi Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∆Ô ÚÒÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È ı‹Ï˘, ηı’ fiÏ· ˘ÁȤ˜. ∆Ô ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ‹È· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È ¯ÚÂÈ¿ÛÙËΠÔ͢ÁfiÓÔ 30% ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰‡Ô ÚÒÙˆÓ ËÌÂÚÒÓ Ù˘ ˙ˆ‹˜. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ¶·ÚÔ˘Û›·ÛÂ Ê˘ÛÈÔÏÔÁÈÎfi ›ÎÙÂÚÔ, Ô ÔÔ›Ô˜ ˘Ô¯ÒÚËÛ ÙËÓ 6Ë Ë̤¶·È‰È·ÙÚÈ΋ 2005;68:150-153

Ú· ˙ˆ‹˜, ÔfiÙÂ Î·È ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ∆Ô ÓÂÔÁÓfi Â·ÓÂÈÛ‹¯ıË ÙË 10Ë Ë̤ڷ ˙ˆ‹˜ Ì ٷ¯‡ÓÔÈ·, ›ÎÙÂÚÔ, ˘¤Ú¯ÚˆÛË ‰¤ÚÌ·ÙÔ˜, ˘fiÙ·ÛË (∞¶: 34/29, ª∞¶: 32) Î·È Â̤ÙÔ˘˜. O ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ (¶›Ó·Î·˜ 1) ÂÚÈÂÏ¿Ì‚·Ó Ï‹ÚË ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ïԛ̈͢, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ O¡¶ Î·È ˘ÂÚË‚È΋˜ ηÏÏȤÚÁÂÈ·˜ Ô‡ÚˆÓ, Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ¶·Ú¿ ÙËÓ ¤Ó·ÚÍË ·ÓÙÈÛË„·ÈÌÈ΋˜ ·ÁˆÁ‹˜, Ë Î·Ù¿ÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ Û˘Ó¤¯È˙ ӷ ÂȉÂÈÓÒÓÂÙ·È. O ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘ÁÁÂÓ›˜ ÏÔÈÌÒÍÂȘ (ÙÔÍfiÏ·ÛÌ·, ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi˜, ÂÚ˘ıÚ¿, ¤Ú˘), HIV Î·È Ë·Ù›Ùȉ· µ Î·È C ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∏ ÔÍÂÔ‚·ÛÈ΋ ÈÛÔÚÚÔ›· ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi pH ·›Ì·ÙÔ˜, ÙÔ ÔÔ›Ô ‰È·ÙËÚ‹ıËÎÂ Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘. ∆Ô ¯¿ÛÌ· ·ÓÈfiÓÙˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙȘ ÙÈ̤˜ Na, K Î·È Cl (98 mmol/l) ÛÙÔÓ ÔÚfi.

O ·Ú¯ÈÎfi˜ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÔÎ¿Ï˘„ ˘ÂÚ¯ÔÏÂÚ˘ıÚÈÓ·ÈÌ›·. ∆· Ë·ÙÈο ¤Ó˙˘Ì· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, Ì ·˘ÍË̤ӷ Ù· Â›‰· ÙˆÓ ÁGT, LDH, CPK Î·È ALP, Ô˘ Â·Ó‹Ïı·Ó ÛÙ· Ê˘ÛÈÔÏÔÁÈο fiÚÈ· Ì›· ‚‰ÔÌ¿‰· ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË ıÂÚ·›·˜. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‹·ÙÔ˜ Î·È Â͈Ë·ÙÈÎÒÓ ¯ÔÏËÊfiÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·˙ ˘ÔÁÏ˘Î·ÈÌ›·, Ô˘ fï˜ ‰ÂÓ Â·Ó·Ï‹ÊıËΠÛÙ· ÂfiÌÂÓ· ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘ ÙÔ˘ ÏfiÁˆ ¯ÔÚ‹ÁËÛ˘ ‰È·Ï‡Ì·ÙÔ˜ ÁÏ˘Îfi˙˘ ÂÓ‰ÔÊÏ‚›ˆ˜. ∂›Û˘, ·Ú¿ ÙË ¯ÔÚ‹ÁËÛË ËÏÂÎÙÚÔÏ˘ÙÒÓ ÂÓ‰ÔÊÏ‚›ˆ˜ Î·È ÂÓÒ ÙÔ ÈÔÓÙfiÁÚ·ÌÌ· ÂÈÛfi‰Ô˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi,

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·151

™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÓÂÔÁÓfi Ì ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·

¿Ú¯È˙ ӷ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔԉ¢ÙÈο ˘ÔÓ·ÙÚÈ·ÈÌ›· Ì ˘ÂÚηÏÈ·ÈÌ›· Î·È ¯·ÌËÏ‹ Ô˘Ú›·. OÈ ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ·˘Í‹ıËÎ·Ó ·fi ÙÔ ÙÚ›ÙÔ 24ˆÚÔ Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘, ηıÒ˜ Ë ÎÏÈÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÂȉÂÈÓˆÓfiÙ·Ó (Na: 125 mmol/l, K: 4,7 mmol/l, Ô˘Ú›·: 6 mg/dl). ∆· Â›‰· ·Ì̈ӛ·˜ ÙÔ˘ ÔÚÔ‡ ‚Ú¤ıËÎ·Ó ˘„ËÏ¿, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi Ô˘ÚÈÎfi Ô͇ ηٿ ÙËÓ ÚÒÈÌË Ê¿ÛË Ù˘ ÓfiÛÔ˘, fiÔ˘ ÙÔ ÓÂÔÁÓfi ÂÍ·ÎÔÏÔ˘ıÔ‡Û ÂÓ Ì¤ÚÂÈ Ó· ÙÚ¤ÊÂÙ·È ÂÓÙÂÚÈο. ŒÁÈÓ ÂÎÙÂÓ‹˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÎÏÔ˘ Ù˘ Ô˘Ú›·˜, ηıÒ˜ Î·È ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘. ∆· ·ÌÈÓÔÍÂÔÁÚ¿ÌÌ·Ù· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο, ηıÒ˜ Î·È Ô ¤ÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘. ∆· ÏÈ›‰È· ÔÚÔ‡ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο (ÙÚÈÁÏ˘ÎÂÚ›‰È·: 35 Ìg/dl, HDL: 58 mg/dl, LDL: 39 mg/dl). ∞fi ÙÔÓ ˘fiÏÔÈÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, ÔÈ ·Ó·ÁˆÁÈΤ˜ Ô˘Û›Â˜ Ô‡ÚˆÓ ‹Ù·Ó ·ÚÓËÙÈΤ˜, ÔÈ ÎÂÙfiÓ˜ Ô‡ÚˆÓ ·ÚÓËÙÈΤ˜ Î·È ÙÔ pH Ô‡ÚˆÓ 6,0. O ¤ÏÂÁ¯Ô˜ ÁÈ· Ï˘ÛÔÛˆÌȷο Î·È ˘ÂÚÔÍÂÈÛˆÌȷο ÓÔÛ‹Ì·Ù· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, Ë Î·ÚÓÈÙ›ÓË ÔÚÔ‡

151

‹Ù·Ó 74,18 nmol/ml (73±20) Î·È Ë ÂχıÂÚË Î·ÚÓÈÙ›ÓË 40 nmol/ml (58±15), ·ÔÎÏ›ÔÓÙ·˜ ¤ÙÛÈ ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·. O ¤ÏÂÁ¯Ô˜ ÁÈ· ·1·ÓÙÈıÚ˘„›ÓË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ÔÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ªÂ ÙËÓ ˘Ô„›· ÂÈÓÂÊÚȉȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜, ¤ÁÈÓ ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ACTH (Synacten test), ÂÓÒ Ë ÎÏÈÓÈ΋ ηٿÛÙ·ÛË ÙÔ˘ ÓÂÔÁÓÔ‡ ÂȉÂÈÓˆÓfiÙ·Ó ÛÙ·ıÂÚ¿ Î·È Ô ·ÛıÂÓ‹˜ ¤Ì·ÈÓ ϤÔÓ ÛÙËÓ ÙÂÏÈ΋ Ê¿ÛË Î·Ù¤ÚÚÂȄ˘. ∆Ô ÓÂÔÁÓfi ÚÔԉ¢ÙÈο Ô‰ËÁ‹ıËΠ۠ÎÒÌ·, ·ÚÔ˘Û›·Û Û·ÛÌÔ‡˜ Î·È ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·, Ë ÔÔ›· ÂΉËÏÒıËΠ̠ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ Û Ô͢ÁfiÓÔ. ÃÚÂÈ¿ÛÙËΠÌ˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜, ÂÓÒ ·Ú¿ÏÏËÏ· ÍÂΛÓËÛ ıÂÚ·›· Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË 25-50 mg/m2, ÊıÔÚÈÔ-˘‰ÚÔÎÔÚÙÈ˙fiÓË 0,1 mg/ËÌÂÚËÛ›ˆ˜ Î·È NaCl, ˆ˜ ıÂÚ·›· ˘ÔηٿÛÙ·Û˘, ηıÒ˜ ÙÔ Na ¤ÊÙ·Û ÛÙÔ ¯·ÌËÏfiÙÂÚÔ Â›Â‰Ô (Na: 100 mmol/l), ¯ˆÚ›˜ Ó· ¤¯ÂÈ ·ÎfiÌË ÙÂı› Ë ÙÂÏÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘. ∆Ô

¶›Ó·Î·˜ 1. ¶›Ó·Î·˜ ·Ú·ÎÏÈÓÈÎÒÓ ÂÍÂÙ¿ÛÂˆÓ ñ °ÂÓÈ΋ ·›Ì·ÙÔ˜: GB: 15,1, HCT: 45,6%, WBC: 10.600 (Gr: 34%, L: 47,85), PLT:420.000 OÏÈ΋ ¯ÔÏÂÚ˘ıÚ›ÓË: 17,4 mg/dl ÕÌÂÛË ¯ÔÏÂÚ˘ıÚ›ÓË: 2,7 mg/dl SGOT: 32 U/L, SGPT: 11 U/L, ÁGT: 842 U/L, LDH: 1029 U/L, CPK: 1682 U/L, ALP: 73 U/L ∏ÏÂÎÙÚÔχÙ˜ ÂÈÛfi‰Ô˘: K: 5,7 mmol/l, Na: 142, Ô˘Ú›·: 25 mg/dl, ÎÚ·ÙÈÓ›ÓË: 0,1 mg/dl, ÁÏ˘Îfi˙Ë ÔÚÔ‡: 30mg/dl Î/· ·›Ì·ÙÔ˜: ÛÙ›ڷ ñ °ÂÓÈ΋ ∂¡À: ·ÙÙ·Ú·: 10, ÁÏ˘Îfi˙Ë ÔÚÔ‡: 43 mg/dl, χΈ̷: 135 mg/dl Î/· ∂¡À: ÛÙ›ڷ ñ Î/· Ô‡ÚˆÓ: ÛÙ›ڷ ñ OÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÍfiÏ·ÛÌ·, ÌÂÁ·ÏÔ΢ÙÙ·ÚÔ˚fi, ÂÚ˘ıÚ¿, ¤ÚËÙ·, HIV, Ë·Ù›Ùȉ· µ Î·È C: ·ÚÓËÙÈÎfi˜ ñ OÍÂÔ‚·ÛÈ΋ ÈÛÔÚÚÔ›·: pH: 7,41 mmHg, PCO2: 32,7 mmHg, PO2: 64,3 mmHg, Bic: 20,7, BE: -2,4 ÿÛÌ· ·ÓÈfiÓÙˆÓ: 12 mmol/l ∞Ì̈ӛ·: 113-173 Ìmol/l O˘ÚÈÎfi Ô͇: 1,3 mg/dl ∞Ó·ÁˆÁÈΤ˜ Ô‡ÚˆÓ: ·ÚÓËÙÈΤ˜ ∫ÂÙfiÓ˜ Ô‡ÚˆÓ: ·ÚÓËÙÈΤ˜ pH Ô‡ÚˆÓ: 6,0 ñ ∞ÌÈÓÔÍÂfiÁÚ·ÌÌ· ·›Ì·ÙÔ˜ Î·È Ô‡ÚˆÓ: Ê˘ÛÈÔÏÔÁÈÎfi ñ ŒÏÂÁ¯Ô˜ ÁÈ· ‰È·Ù·Ú·¯¤˜ ÁÏ˘ÎÔ˙˘Ï›ˆÛ˘: ·ÚÓËÙÈÎfi˜ ñ ·1-·ÓÙÈıÚ˘„›ÓË: 121 mg/dl ñ ∫·ÚÓÈÙ›ÓË ÔÚÔ‡: 74,18 nmol/ml ∂χıÂÚË Î·ÚÓÈÙ›ÓË: 40 nmol/ml ñ ŒÏÂÁ¯Ô˜ ÁÈ· Ï˘ÛÔÛÛˆÌȷο Î·È ˘ÂÚÔÍÂÈÛˆÌȷο ÓÔÛ‹Ì·Ù·: ·ÚÓËÙÈÎfi˜ ñ OÊı·ÏÌÔÏÔÁÈ΋ ÂͤٷÛË: Ê˘ÛÈÔÏÔÁÈ΋ ñ ÀÂÚ˯ÔÁÚ¿ÊËÌ· ‹·ÙÔ˜, ¯ÔÏËÊfiÚˆÓ: Ê˘ÛÈÔÏÔÁÈÎfi ñ ∏ÏÂÎÙÚÔχÙ˜ ηٿ ÙËÓ 5Ë Ë̤ڷ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹: ∫: 5,9 mmol/l, ¡a: 100 mmol/l, Cl: 119 mmol/l, Ô˘Ú›·: 12 mg/dl, ÎÚ·ÙÈÓ›ÓË 0,1 mg/dl ñ ¢ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ACTH (Synacten test): ACTH ÚÈÓ ÙËÓ ÚfiÎÏËÛË: 893 pg/ml, ACTH ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË: >1500 pg/ml ∫ÔÚÙÈ˙fiÏË ÔÚÔ‡ ÚÈÓ ÙËÓ ÚfiÎÏËÛË: 57,1 nmol/l, ÎÔÚÙÈ˙fiÏË ÔÚÔ‡ ÌÂÙ¿ ÙËÓ ÚfiÎÏËÛË: 67 nmol/l ñ ŒÏÂÁ¯Ô˜ ÁÈ· ·ÔÎÏÂÈÛÌfi Û˘ÁÁÂÓÔ‡˜ ˘ÂÚÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ S-DHA: 25 ng/ml, DHEA: 0,25 ng/ml, 17-OH ÚÔÁÂÛÙÂÚfiÓË: 0,30 ng/ml, ÚÔÁÂÛÙÂÚfiÓË: 0,30 ng/ml, ÙÂÛÙÔÛÙÂÚfiÓË: 48 ng/ml, ·Ó‰ÚÔÛÙÂÓ‰ÈfiÓË: 0,15 ng/ml, 11-‰ÂÔ͢ÎÔÚÙÈ˙fiÏË: 2,80 ng/ml, ÚÂÓ›ÓË Ï¿ÛÌ·ÙÔ˜: 759 pg/ml, ·Ï‰ÔÛÙÂÚfiÓË Ï¿ÛÌ·ÙÔ˜: 9 ng/ml ñ ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÂÈÓÂÊÚȉ›ˆÓ: Ê˘ÛÈÔÏÔÁÈÎfi ñ MRI ÂÁÎÂÊ¿ÏÔ˘: Ê˘ÛÈÔÏÔÁÈ΋ ˘fiÊ˘ÛË

¶·È‰È·ÙÚÈ΋ 2005;68:150-153

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·152

152

ª. ¢·ÛÔÔ‡ÏÔ˘ Î·È Û˘Ó.

ÓÂÔÁÓfi ·ÓÙ·ÔÎÚ›ıËΠ¿ÌÂÛ· ÛÙË ıÂÚ·›·, Ì ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÙÔ˘ ÏÂÈÙÔ˘ÚÁ›·˜. ∆Ô ÌˆÚfi ·ÔÛˆÏËÓÒıËΠ24 ÒÚ˜ ·ÚÁfiÙÂÚ·, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·Ú·ÙËÚ‹ıËΠ¿ÓÔ‰Ô˜ Ù˘ ÙÈÌ‹˜ ÙÔ˘ Na ÛÙÔÓ ÔÚfi. ∆Ô ÂfiÌÂÓÔ 24ˆÚÔ ‹Ù·Ó ˙ˆËÚfi, Ì ηϋ ·˘ÙfiÌ·ÙË ÎÈÓËÙÈÎfiÙËÙ·, ··ÓÙÔ‡Û ÛÙ· ÂÚÂı›ÛÌ·Ù· Î·È Â›¯Â ηϤ˜ ıËÏ·ÛÙÈΤ˜ ÎÈÓ‹ÛÂȘ. ∆· ·ÔÙÂϤÛÌ·Ù· ·fi ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ACTH ÂȂ‚·›ˆÛ·Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ÂÈÓÂÊÚȉȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ì ¯·ÌËÏ¿ ‚·ÛÈο Â›‰· ÎÔÚÙÈ˙fiÏ˘ ÔÚÔ‡ ÚÈÓ Î·È ÌÂÙ¿ ÙË ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘. ∆Ô ÓÂÔÁÓfi ˘Ô‚Ï‹ıËΠ‰‡Ô ÊÔÚ¤˜ Û ¤ÏÂÁ¯Ô ÁÈ· Û˘ÁÁÂÓ‹ ˘ÂÚÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Ô˘ ·‰›¯ıË ·ÚÓËÙÈÎfi˜. ∏ ÚÂÓ›ÓË Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó ·˘ÍË̤ÓË Î·È Ë ·Ï‰ÔÛÙÂÚfiÓË Ï¿ÛÌ·ÙÔ˜ ‹Ù·Ó ¯·ÌËÏ‹. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ·ÔÎ¿Ï˘„Â Ê˘ÛÈÔÏÔÁÈο ÂÈÓÂÊÚ›‰È· Î·È Ë MRI ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈ΋ ˘fiÊ˘ÛË. ™ÙË Ê¿ÛË Ù˘ ·Ó¿ÚÚˆÛ˘, ¤ÁÈÓ ÚÔÛ¿ıÂÈ· Ó· ÂÏ·ÙÙˆı› ÚÔԉ¢ÙÈο Ë ‰fiÛË Ù˘ ˘‰ÚÔÎÔÚÙÈ˙fiÓ˘, ·ÏÏ¿ ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ȉÚÒÙ˜, Â̤ÙÔ˘˜, ˘ÂÚ˘ÚÂÍ›·, ·‰˘Ó·Ì›· ÚfiÛÏ˄˘ ‚¿ÚÔ˘˜ Î·È ‰È¿ÚÚÔȘ. ∏ ·‡ÍËÛË Ù˘ ÊıÔÚÈÔ-˘‰ÚÔÎÔÚÙÈ˙fiÓ˘ Û ‰ÈÏ¿ÛÈ· ‰fiÛË Ù˘ Û˘Ó‹ıÔ˘˜ (0,1 mg ‰‡Ô ÊÔÚ¤˜ ÙËÓ Ë̤ڷ), ‚ÂÏÙ›ˆÛ ÙËÓ ·ÓÙ·fiÎÚÈÛ‹ ÙÔ˘ ÛÙË ıÂÚ·›·. ∆ÂÏÈο, Ë ıÂÚ·›· Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË 10-20 mg/m2/ËÌÂÚËÛ›ˆ˜ Û ÙÚÂȘ ‰È·ÈÚÂ̤Ó˜ ‰fiÛÂȘ, Ì·˙› Ì 9·-ÊıÔÚÈÔ-˘‰ÚÔÎÔÚÙÈ˙fiÓË (Florinef) 0,1 mg/ËÌÂÚËÛ›ˆ˜ Û ‰‡Ô ‰È·ÈÚÂ̤Ó˜ ‰fiÛÂȘ Û˘Ó¯›ÛÙËΠÛÙË Ê¿ÛË ÛÙ·ıÂÚÔÔ›ËÛ˘ ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÂÈÙ˘¯›·. ™Â ËÏÈΛ· 3 Î·È 6 ÌËÓÒÓ ÂÌÊ¿ÓÈÛ ¿ÏÏ· ‰‡Ô ÂÂÈÛfi‰È· Â·ÓÂÈÏËÌÌ¤ÓˆÓ Â̤وÓ, ÂÊ›‰ÚˆÛ˘ Î·È ÙÒÛ˘ Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ¯ˆÚ›˜ fï˜ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÔÈ ‰fiÛÂȘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ¯ÚÂÈ¿ÛÙËÎ·Ó ÂÚÈÛÙ·Ûȷο ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ì ·‡ÍËÛË Ù˘ ÊıÔÚÈÔ- Î·È ˘‰ÚÔÎÔÚÙÈ˙fiÓ˘. ŒÎÙÔÙÂ, ÙÔ ·È‰› Â›Ó·È Î·Ï¿ Î·È ÛÈÙ›˙ÂÙ·È Ì ÂÈÙ˘¯›·.

™˘˙‹ÙËÛË ∏ Û˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ·Ó Î·È Û¿ÓÈ· ÓfiÛÔ˜, Ú¤ÂÈ Ó· ·ÔÙÂÏ› ̤ÚÔ˜ Ù˘ ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ Û ÂÚ›ÙˆÛË ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ·ÓÂ¿ÚÎÂÈ·˜ Ì ËÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ‹/Î·È ˘ÔÁÏ˘Î·ÈÌ›· Û ‚·ÚÈ¿ ÓÔÛÔ‡Ó ÓÂÔÁÓfi. ∏ ¤ÁηÈÚË ¤Ó·ÚÍË Ù˘ ηٿÏÏËÏ˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ Â›Ó·È ˙ˆÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ÙËÓ ¤Î‚·ÛË ÙˆÓ ·Û¯fiÓÙˆÓ ÓÂÔÁÓÒÓ. ∏ ÓfiÛÔ˜ ıˆÚÂ›Ù·È Ê˘ÏÔÛ‡Ó‰ÂÙË ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ÁÂÈÙÔÓÈÎÔ‡ ÁÔÓȉ›Ô˘ Î·È Û˘Óԉ‡ÂÙ·È ·fi Ì˘˚΋ ‰˘ÛÙÚÔÊ›· (ÓfiÛÔ˜ ÙÔ˘ Duchenne) ‹/Î·È ·ÓÂ¿ÚÎÂÈ· Ù˘ ÎÈÓ¿Û˘ Ù˘ ÁÏ˘ÎÂÚfiÏ˘ (1,2). ∂›Û˘, ¤¯ÂÈ ÂÚÈÁÚ·Ê› Ë ÌÔÚÊ‹ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ¶·È‰È·ÙÚÈ΋ 2005;68:150-153

·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙÔ‡ÓÙ· (3) ‹ ˘ÔÏÂÈfiÌÂÓÔ Ù‡Ô, ηıÒ˜ Î·È Ë Ê˘ÏÔÛ‡Ó‰ÂÙË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, Ô˘ ÔÊ›ÏÂÙ·È Û ¤ÏÏÂÈ„Ë ‹ ÛËÌÂȷ΋ ÌÂÙ¿ÏÏ·ÍË ÙÔ˘ DAX-1 ÁÔÓȉ›Ô˘, Ì ٷ Ù˘Èο ÌÂÁ¿Ï· ÎÂÓÔÙfiÈ· ÛÙ· ÂÈÓÂÊÚȉȷο ·ÙÙ·Ú·, ·Ó¿ÏÔÁ· ÂÌ‚Ú˘˚ÎÒÓ ÂÈÓÂÊÚȉȷÎÒÓ Î˘ÙÙ¿ÚˆÓ, ηıÒ˜ Î·È ÙËÓ ·Ô˘Û›· ‰È·¯ˆÚÈÛÙÈ΋˜ ÁÚ·ÌÌ‹˜ ÙÔ˘ ÂÈÓÂÊÚȉȷÎÔ‡ ÊÏÔÈÔ‡ (4-6). ∆Ô ÓÂÔÁÓfi Ô˘ ÂÚÈÁÚ¿ÊËΠÈı·Ófiٷٷ ›¯Â ÙË Ê˘ÏÔÛ‡Ó‰ÂÙË ÌÔÚÊ‹ (DAX-1 gene) Ù˘ ÓfiÛÔ˘, ·Ó Î·È Ù· ·˘ÍË̤ӷ Â›‰· Ù˘ ÎÚ·ÙÈÓÈ΋˜ ÎÈÓ¿Û˘ ÌÔÚ› Ó· ˘Ô‰ËÏÒÓÔ˘Ó ÙË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÈÙÔÓÈÎfi ÁÔÓ›‰ÈÔ (contiguous gene syndrome). ∏ ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÚfiÛÊ·Ù· Û ̛· ·ÎfiÌË ÂÚ›ÙˆÛË, ˆ˜ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ (7) Î·È ÁÈ’ ·˘Ùfi ÙÔÓ ÏfiÁÔ ÙÔ ÂÚÈÛÙ·ÙÈÎfi ıˆÚÂ›Ù·È Û¿ÓÈÔ. ∂›Û˘, ˘¿Ú¯ÂÈ ·Ó·ÊÔÚ¿ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· Ù˘ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ Ù˘ Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Î·È Ù˘ ¯ÚfiÓÈ·˜ ÂÍ¿ÚÙËÛ˘ ·fi ÙÔ Ô͢ÁfiÓÔ (8) ‹ Ù˘ ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋˜ ‰˘ÛÏ·Û›·˜ (9) Û Ôχ ÌÈÎÚÔ‡ ‚¿ÚÔ˘˜ ÓÂÔÁÓ¿. ∏ ¤ÎÎÚÈÛË ÎÔÚÙÈ˙fiÏ˘ ÌÔÚ› ÙÂÏÈο Ó· ·›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ÌÂÏÏÔÓÙÈ΋ ·Ó¿Ù˘ÍË Î·È ˆÚ›Ì·ÓÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ηٿ ÙËÓ ÚÒÈÌË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, ·ÏÏ¿ ·˘Ùfi ¯Ú‹˙ÂÈ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛ˘.

O ÌÈÎÚfi˜ ·ÛıÂÓ‹˜, ·Ó Î·È ÙÂÏÂÈfiÌËÓÔ ÓÂÔÁÓfi Ô˘ ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi, ·Ó¤Ù˘Í ‹È· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ ÙÔ˘ Ù· Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi ‹Ù·Ó Ù· ÂÈÎÚ·ÙÔ‡ÓÙ·. ∏ ˘ÔÁÏ˘Î·ÈÌ›·, ·Ó Î·È ¤Î‰ËÏË Û ̛· ÌfiÓÔ Ê¿ÛË Ù˘ ÔÚ›·˜ Ù˘ ÓfiÛÔ˘, ‰ÂÓ ÚÔÂ͋گ ˆ˜ ‡ÚËÌ·. ∆Ô ÚÔÂÍ¿Ú¯ÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ· ‹Ù·Ó Ë ˘ÔÓ·ÙÚÈ·ÈÌ›·, ÂÍ·ÈÙ›·˜ Ù˘ ·ÒÏÂÈ·˜ ¿Ï·ÙÔ˜. ∂›Û˘, ¯·Ú·ÎÙËÚÈÛÙÈ΋ ‹Ù·Ó Ë ˘¤Ú¯ÚˆÛË ÙÔ˘ ‰¤ÚÌ·ÙÔ˜. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÙ·È ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· ÎÚ˘„ÔÚ¯›·˜ Û ·ÛıÂÓ›˜ Ì ˘ÔÁÔÓ·‰ÔÙÚÔÈÎfi ˘ÔÁÔÓ·‰ÈÛÌfi (10), ·ÏÏ¿ Ô ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ‰ÂÓ ·ÚÔ˘Û›·˙ ·ÓˆÌ·Ï›Â˜ ·fi ÙÔ˘˜ fiÚ¯ÂȘ. O ·Ú·ÙÂÈÓfiÌÂÓÔ˜ ›ÎÙÂÚÔ˜ ‹Ù·Ó Â›Û˘ ¤Ó· ·fi Ù· ¿Ù˘· Û˘ÌÙÒÌ·Ù·. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔÓÈÛÙ› Ë ·Ó·ÁηÈfiÙËÙ· ¿ÌÂÛ˘ ¤Ó·Ú͢ ıÂÚ·›·˜ Ì ˘‰ÚÔÎÔÚÙÈ˙fiÓË Û ˘Ô„›· Û˘ÁÁÂÓÔ‡˜ ˘ÔÏ·Û›·˜ ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ, ¯ˆÚ›˜ Ó· ·Ó·Ì¤ÓÂÙ·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙÔ˘ ÔÚÌÔÓÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Ô˘ ı· ÂȂ‚·ÈÒÛÂÈ ÙË ‰È¿ÁÓˆÛË.

O Û˘ÓÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ÓÂÔÁÓÔ‡ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ‹Ù·Ó ÂÍ·ÈÚÂÙÈο ‚Ú·¯‡˜, ·ÊÔ‡ Ë ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÂϤÁ¯Ô˘ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 5 ËÌÂÚÒÓ Î·È Ë ‰ÔÎÈÌ·Û›· ÚfiÎÏËÛ˘ Ì ACTH ¤ÁÈÓÂ

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™˘ÁÁÂÓ‹˜ ˘ÔÏ·Û›· ÙˆÓ ÂÈÓÂÊÚȉ›ˆÓ Û ÓÂÔÁÓfi Ì ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ·

¤ÁηÈÚ· ÛÙË Ê¿ÛË ·‰˘Ó·Ì›·˜ ·ÔηٿÛÙ·Û˘ ÙˆÓ ËÏÂÎÙÚÔÏ˘ÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ¤¯ÔÓÙ·˜ ·ÔÎÏ›ÛÂÈ ¿ÏÏ· ÓÔÛ‹Ì·Ù·.

µÈ‚ÏÈÔÁÚ·Ê›· 1. Cole DE, Clarke LA, Riddell DC, Samson KA, Seltzer WK, Salisbury S. Congenital adrenal hypoplasia, Duchenne muscular dystrophy, and glycerol kinase deficiency: importance of laboratory investigations in delineating a contiguous gene deletion syndrome. Clin Chem 1994;40: 2099-2103.

2. McCabe ER, Towbin J, Chamberlain J, Baumbach L, Witkowski J, van Ommen GL et al. Complementary DNA probes for the Duchenne muscular dystrophy locus demonstrate a previously undetectable deletion in a patient with dystrophic myopathy, glycerol kinase deficiency, and congenital adrenal hypoplasia. J Clin Invest 1989;83:95-99.

3. Ferey S, Merzoug V, Linglart A, Chaussain JL, Kalifa G. A peculiar form of neonatal adrenal insufficiency: the IMAGe association. Two new cases. J Radiol 2003;84:323-325.

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4. Lalli E, Bardoni B, Zazopoulos E, Wurtz JM, Strom TM, Moras D et al. A transcriptional silencing domain in DAX1 whose mutation causes adrenal hypoplasia congenita.

Mol Endocrinol 1997;11:1950-1960.

5. Tabarin A. Congenital adrenal hypoplasia and DAX-1 gene mutations. Ann Endocrinol 2001;62:202-206.

6. Chrousos GP. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 1995; 332:1351-1362.

7. Schwarz K, Thwaites R, Minford A, Day C, Butler G. Congenital adrenal hypoplasia presenting as a chronic respiratory condition. Arch Dis Child 2003;88:261-262.

8. Watterberg KL, Scott SM, Backstrom C, Gifford KL, Cook KL. Links between early adrenal function and respiratory outcome in preterm infants: airway inflammation and patent ductus arteriosus. Pediatrics 2000;105:320-324.

9. Watterberg KL, Scott SM. Evidence of early adrenal insufficiency in babies who develop bronchopulmonary dysplasia. Pediatrics 1995;95:120-125.

10. Tabarin A, Achermann JC, Recan D, Bex V, Bertagna X, Christin-Maitre S et al. A novel mutation in DAX1 causes delayed-onset adrenal insufficiency and incomplete hypogonadotropic hypogonadism. J Clin Invest 2000;105: 321-328.

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CASE REPORT

Congenital adrenal hypoplasia presenting as severe respiratory failure. Case report M. Dasopoulou1, M. Apostolou1, G. Baroutis1, H. Michelakakis2, E. Loukatou1, C. Costalos1 1 Department of Neonatology, "Alexandra" University Hospital, Athens 2 Department of Enzymology and Cellular Function, Institute of Child Health, "Aghia Sophia" Children’s Hospital, Athens Correspondence: Maria Dasopoulou 11 Papadiamantopoulou str., 115 28, Ilissia, Athens E-mail: kpaplos@med.uoa.gr Date of submission: 16-03-2004 Date of approval: 02-02-2005

Paediatriki 2005;68:154

Abstract Congenital adrenal hypoplasia is a rare condition, which occurs with an incidence of approximately 1 in 12,500 live births, usually presenting with hypoglycaemic convulsions, vomiting, failure to thrive or even collapse in early life. Links between early adrenal insufficiency and adverse respiratory outcome or even bronchopulmonary dysplasia in very low birth weight neonates have also been described. Respiratory problems in the early postnatal period are a rare manifestation of congenital adrenal hypoplasia and could be fatal unless early diagnosis is established, followed by prompt treatment. Aggressive treatment with corticosteroids should start immediately because of the unpredictable outcome of such a serious condition.

Key words Congenital adrenal hypoplasia, newborn, respiratory distress.

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∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿ ™. ∞ÓÙˆÓÈ¿‰Ë˜

¶ÂÚ›ÏË„Ë O ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ·ÔÙÂÏ› ¤Ó· ·fi Ù· ÛÔ‚·ÚfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ™ÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛˆÓ, Ë ·ÈÙÈÔÏÔÁ›· Â›Ó·È Î·Ú‰ÈÔÏÔÁÈ΋. ∆· ÂÚÈÛÙ·ÙÈο ÌÔÚ› Ó· Â›Ó·È ‰È·ÁÓˆṲ̂Ó˜ ‹ ÌË Î·È ¯ÂÈÚÔ˘ÚÁË̤Ó˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Ì ÔÛÔÛÙ¿ ı·Ó¿ÙÔ˘ ȉȷ›ÙÂÚ· ·˘ÍË̤ӷ. ™Â fiÛÔ˘˜ ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ‰‡ÛÎÔÏ·, Ô ı¿Ó·ÙÔ˜ Û˘¯ÓfiÙÂÚ· Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¿ıÏËÛ˘ ‹ ‚·ÚÈ¿˜ ۈ̷ÙÈ΋˜ ÎfiˆÛ˘. OÈ Ì˘ÔηډÈÔ¿ıÂȘ - Î·È Î˘Ú›ˆ˜ Ë ˘ÂÚÙÚÔÊÈ΋ - ·ÔÙÂÏÔ‡Ó Ì›· ȉȷ›ÙÂÚ· ÂÈΛӉ˘ÓË Î·ÙËÁÔÚ›·, ÂÓÒ ÔÈ Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ ·ÔÙÂÏÔ‡Ó Â›Û˘ ¤Ó· ÛËÌ·ÓÙÈÎfi ÙÌ‹Ì· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ∂ÎÙfi˜, fï˜, ·fi ÙȘ ηÙËÁÔڛ˜ ·˘Ù¤˜, Û οı ÂÚ›ÙˆÛË ÔÈ ·ÚÚ˘ı̛˜ Ê·›ÓÂÙ·È fiÙÈ ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· Ô˘ ÚÔηÏ› ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. ∞ÎfiÌË Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ (Î·È ÌÂÙ¿ ÙË ÓÂÎÚÔÙÔÌÈ΋ ÂͤٷÛË), ıˆÚÂ›Ù·È fiÙÈ ÔÈ ·ÚÚ˘ı̛˜ ·›˙Ô˘Ó Î˘Ú›·Ú¯Ô ÚfiÏÔ. ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ÙË ıÂÚ·›· ÙˆÓ ÁÓˆÛÙÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ, ·ÏÏ¿ ΢ڛˆ˜ ÙÔÓ ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô. ¶Ú¤ÂÈ ··Ú·Èًو˜ Ó· ÂϤÁ¯ÂÙ·È Î¿ı ·È‰› Ô˘ ı· ·Û¯ÔÏËı› Ì ÙÔÓ ·ıÏËÙÈÛÌfi-ÚˆÙ·ıÏËÙÈÛÌfi, ηıÒ˜ Î·È Î¿ı ÂÚ›ÙˆÛË ÛÙËÓ ÔÔ›· Ô ·È‰›·ÙÚÔ˜ ‰È·ÈÛÙÒÓÂÈ Î¿ÙÈ ‡ÔÙÔ (ʇÛËÌ·, Èı·Ó‹ ‰È·Ù·Ú·¯‹ Ú˘ıÌÔ‡) ‹ ·Ó·Ê¤ÚÂÙ·È - ·fi ÙÔ ·È‰› ‹ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ - Û˘Ìو̷ÙÔÏÔÁ›· ‹ Û˘Ì‚¿ÓÙ· fiˆ˜ ÏÈÔı˘Ì›·, ÚÔοډȷ ¿ÏÁË Î.Ï. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÓˆÛÙ‹˜ ¿ıËÛ˘ ‹ ‡·Ú͢ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Ï·Ì‚¿ÓÂÙ·È, Â›Û˘, ÛÔ‚·Ú¿ ˘’ fi„ÈÓ. ∏ ˘ÔÁÚ·Ê‹ ÈÛÙÔÔÈËÙÈÎÔ‡ ÁÈ· ¿ıÏËÛË, ·ÏÏ¿ Î·È Î¿ı ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È ·fi ·È‰ÔηډÈÔÏfiÁÔ, Ì ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙˆÓ ··Ú·›ÙËÙˆÓ ÂÍÂÙ¿ÛˆÓ, fiˆ˜ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, ¤Á¯ÚˆÌÔ Doppler (Triplex), Èı·Ófi 24ˆÚÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· (Holter) Î·È fi,ÙÈ ¿ÏÏÔ ÎÚÈı› fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È. ∏ ¤Î‰ÔÛË ÈÛÙÔÔÈËÙÈÎÒÓ Î·È Ë Èı·Ó‹ ‰È¿ÁÓˆÛË ·fi ÌË ÂȉÈÎÔ‡˜ ÎÚ›ÓÂÙ·È È‰È·›ÙÂÚ· ÂÈΛӉ˘ÓË. ¶ÚÔÛˆÚÈÓ¿, Ô ¤ÏÂÁ¯Ô˜ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ‰ÂÓ ıˆÚÂ›Ù·È ··Ú·›ÙËÙÔ˜. øÛÙfiÛÔ, Ë Èı·ÓfiÙËÙ· Î·È ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ¯ÚËÛÈÌfiÙËÙ¿˜ ÙÔ˘ ı· ÂÍ·ÚÙËıÔ‡Ó ·fi Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ÌÂÁ¿ÏˆÓ ÚÔÔÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÂͤÏÈÍË.

¶·È‰ÔηډÈÔÏfiÁÔ˜, ∫·ıËÁËÙ‹˜ ∞ÓÒÙ·ÙÔ˘ ∆¯ÓÔÏÔÁÈÎÔ‡ ∂Î·È‰Â˘ÙÈÎÔ‡ π‰Ú‡Ì·ÙÔ˜ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ™Ù˘ÏÈ·Ófi˜ ∞ÓÙˆÓÈ¿‰Ë˜ ∏Ú·ÎÏ›ÙÔ˘ 4, ∫ÔψӿÎÈ ∆.∫. 106 73, ∞ı‹Ó· E-mail: prdrsant@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 20-06-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 02-02-2005

§¤ÍÂȘ ÎÏÂȉȿ ¶·È‰È¿, ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜, ηډÈÔÏÔÁÈÎfi Úfi‚ÏËÌ·, ¤ÏÂÁ¯Ô˜, ÚfiÏË„Ë.

∂ÈÛ·ÁˆÁ‹ ∫¿ı ¯ÚfiÓÔ ¤Ó·˜ fi¯È Â˘Î·Ù·ÊÚfiÓËÙÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Âı·›ÓÔ˘Ó ÛÙË ¯ÒÚ· Ì·˜ ΢ڛˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ¿ıÏËÛ˘, ·ÏÏ¿ Î·È Û ËÚÂÌ›·. ™ÙË ÛËÌÂÚÈÓ‹ ÂÔ¯‹, Ì ÙË ÁÂÓÈÎfiÙÂÚË ¤ÌÊ·ÛË Ô˘ ¤¯ÂÈ ‰Ôı› ÛÙÔÓ ·ıÏËÙÈÛÌfi, Ë ·Ó·ÛÎfiËÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ı¤Ì·ÙÔ˜ Î·È Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ ›Ûˆ˜ Â›Ó·È Â›Î·ÈÚË ÂÚÈÛÛfiÙÂÚÔ ·fi οı ¿ÏÏË ÊÔÚ¿.

™˘¯ÓfiÙËÙ· O ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· Û˘¯Ófi˜. ¶·Ú’ fiÏ· ·˘Ù¿, ÔÛÔÛÙfi 10% ÙˆÓ ı·Ó¿ÙˆÓ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙÔ˘ ÂÓfi˜ ¤ÙÔ˘˜ Â›Ó·È ·ÈÊÓ›‰ÈÔÈ. OÈ ÌÈÛÔ› ·fi ·˘ÙÔ‡˜ ÔÊ›ÏÔÓÙ·È Û ÚÔËÁÔ˘Ì¤Óˆ˜ ÁÓˆÛÙ¿ ·›ÙÈ·, ΢ڛˆ˜ ηډÈÔ¿ıÂȘ. ∂›Û˘, ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ηٷٿÛÛÂÙ·È

Û ı·Ó¿ÙÔ˘˜ ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ ÏfiÁˆ ·Ô˘Û›·˜ ¢ÚËÌ¿ÙˆÓ ÛÙË ÓÂÎÚÔ„›·. ∂¿Ó, fï˜, ÏËÊı› ˘’ fi„ÈÓ fiÙÈ Ë ·ÚÚ˘ıÌ›· ‰ÂÓ ·Ê‹ÓÂÈ ÓÂÎÚÔÙÔÌÈο ÛËÌ¿‰È·, ÂÓÒ ·ÔÙÂÏ› Ì›· ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜, Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ Ë Î·Ú‰ÈÔÏÔÁÈ΋ ·ÈÙÈÔÏÔÁ›· ·˘Í¿ÓÂÙ·È Î·Ù·ÎfiÚ˘Ê· Û·Ó Èı·ÓfiÙËÙ· (1-4).

∞›ÙÈ· ∂Âȉ‹, fiˆ˜ ‹‰Ë ·Ó·Ê¤ÚıËÎÂ, Ù· ηډÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙËÓ Î˘ÚÈfiÙÂÚË Î·È Û˘¯ÓfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ· ·È‰È¿, ÛÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‰›ÓÂÙ·È È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÙÔ Ê¿ÛÌ· ÙˆÓ ·ı‹ÛÂˆÓ Ô˘ ÌÔÚ› Ó· ·ÔÙÂϤÛÔ˘Ó ·›ÙÈÔ ÚfiÎÏËÛ˘. π‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ, Â›Û˘, Ë ËÏÈΛ·. ™Ù· ÓÂÔÁÓ¿ Î·È Ù· ‚Ú¤ÊË, ÔÈ ·ı‹ÛÂȘ ÙÔ˘ ΢ÎÏÔÊÔÚÈÎÔ‡ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù·, fï˜ Û fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ ˘ÔÛÎÂÏ›˙ÔÓÙ·È ·fi ÙȘ Ôχ Û˘¯ÓfiÙÂÚ˜ ÏÔÈÌÒÍÂȘ ‹ ·ÎfiÌ· ¶·È‰È·ÙÚÈ΋ 2005;68:155-160

Paediatriki Mar-Apr 05

19-04-05

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156

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Î·È ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› Â·ÚÎÒ˜. ªÂÙ¿ ·fi ·˘Ù¤˜ ÙȘ ËÏÈ˘, ÔÈ Î·Ú‰ÈÔ¿ıÂȘ η٤¯Ô˘Ó ÙËÓ ÚÒÙË ı¤ÛË (5,6). ∞Ú¯Èο, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ‰È¿ÎÚÈÛË Û ¤ÓÙ ‚·ÛÈΤ˜ ηÙËÁÔڛ˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ÌÔÚ› Ó· ·Ô‚ÈÒÛÔ˘Ó ·ÈÊÓ›‰È· ·fi ηډÈÔÏÔÁÈο ·›ÙÈ·: ·) ÂΛӷ Ô˘ ¤¯Ô˘Ó ηډÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· Î·È ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ›, ‚) ·È‰È¿ Ì ÌË ¯ÂÈÚÔ˘ÚÁË̤ÓË Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, Á) ·È‰È¿ Ì ¯ÂÈÚÔ˘ÚÁË̤ÓË Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, ‰) ·È‰È¿ ÌÂ Ì˘ÔηډÈÔ¿ıÂȘ Î·È Â) ·È‰È¿ Ì ·ÚÚ˘ı̛˜.

¶·È‰È¿ Ì ·‰È¿ÁÓˆÛÙÔ Î·Ú‰ÈÔÏÔÁÈÎfi Úfi‚ÏËÌ· O ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ‰È·ÚÎÒ˜ ÌÂÈÒÓÂÙ·È ÏfiÁˆ Ù˘ ÛËÌ·Û›·˜ Ô˘ ‰›ÓÂÙ·È ·fi ÙË Û‡Á¯ÚÔÓË ·È‰È·ÙÚÈ΋ ÛÙËÓ ÚfiÏË„Ë, ÙˆÓ ˘Ô¯ÚˆÙÈÎÒÓ ÚÔÏËÙÈÎÒÓ ÂϤÁ¯ˆÓ ·fi ÙÔ ÀÔ˘ÚÁÂ›Ô ÀÁ›·˜ (Ú¿ÛÈÓÔ ¯·ÚÙ›), ·ÏÏ¿ Î·È ÏfiÁˆ Ù˘ ··›ÙËÛ˘ ·fi ÔÏÏ¿ ·ıÏËÙÈο ۈ̷Ù›· Î·È Û˘ÏÏfiÁÔ˘˜ ÁÈ· ÚÔÛÎfiÌÈÛË ÈÛÙÔÔÈËÙÈÎÒÓ ·fi ·È‰ÔηډÈÔÏfiÁÔ. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Ì ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Ê˘ÛËÌ¿ÙˆÓ - ·ÎfiÌË Î·È ·˘ÙÒÓ Ô˘ Ê·›ÓÔÓÙ·È ·ıÒ· - ·ÏÏ¿ Î·È Ì ÙÔÓ ¤ÏÂÁ¯Ô οı ·ıÏËÙ‹ ‹ ÌÂÏÏÔÓÙÈÎÔ‡ ÚˆÙ·ıÏËÙ‹, Ù· Ú¿ÁÌ·Ù· ¤¯Ô˘Ó Û·ÊÒ˜ ‚ÂÏÙȈı› (7-9). ∏ ˘¢ı˘ÓfiÙËÙ· ÙˆÓ Á˘ÌÓ·ÛÙÒÓ-ÚÔÔÓËÙÒÓ ·›˙ÂÈ, Â›Û˘, ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∆¤ÏÔ˜, ·ÎfiÌË Î·È ÔÈ ›‰ÈÔÈ ÔÈ ÁÔÓ›˜, Û ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ϤÔÓ, ¤¯Ô˘Ó ·ÔÎÙ‹ÛÂÈ ÙËÓ ÂÔ›ıËÛË ÙÔ˘ ··Ú·›ÙËÙÔ˘ ÂϤÁ¯Ô˘ ·fi ÂȉÈÎfi ÚÈÓ ȤÛÔ˘Ó ÙÔ ·È‰› ÙÔ˘˜ ÁÈ· ·ıÏ‹Ì·Ù· Î·È ÂȉfiÛÂȘ (10,11). º˘ÛÈο, Ë ÂÎÙ¤ÏÂÛË ÙˆÓ ÂÍÂÙ¿ÛÂˆÓ ·fi ÂȉÈÎÔ‡˜ ıˆÚÂ›Ù·È “ÂÎ ÙˆÓ ˆÓ ԢΠ¿Ó¢”.

OÈ Î˘ÚÈfiÙÂÚ˜ ·ı‹ÛÂȘ Ô˘ ·Ó‹ÎÔ˘Ó Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· Â›Ó·È ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ Î·È ÔÈ ÚˆÙÔ·ı›˜ ·ÚÚ˘ı̛˜, Ô˘ ÂÂȉ‹ Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, ·ÔÙÂÏÔ‡Ó ·Á›‰· ÁÈ· ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜. ÕÏÏË Û˘¯Ó‹ ·ÈÙ›· Â›Ó·È Ë ÛÙ¤ÓˆÛË ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ (‚·Ï‚ȉÈ΋, ˘Ô- ˘ÂÚ-‚·Ï‚ȉÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜, Û‡Ó‰ÚÔÌÔ Williams), Ô˘ Û ÔÚÈṲ̂ӷ ÂÚÈÛÙ·ÙÈο ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ. ∆¤ÏÔ˜, ÔÈ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Â›Ó·È ÌÂÓ Û¿ÓȘ, ·ÏÏ¿ Ôχ ÂÈΛӉ˘Ó˜, fï˜ Ë ‰È¿ÁÓˆÛ‹ ÙÔ˘˜ Â›Ó·È ‰‡ÛÎÔÏË Î·È Û˘¯Ó¿ ·ÔÙÂÏÔ‡Ó ÓÂÎÚÔÙÔÌÈÎfi ‡ÚËÌ·. ¶·È‰È¿ Ì ÌË ¯ÂÈÚÔ˘ÚÁË̤ÓË Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· ∏ Èı·ÓfiÙËÙ· ı·Ó¿ÙÔ˘ Û ·È‰› Ì ÁÓˆÛÙ‹ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, Ô˘ ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο ·fi ·È‰ÔηډÈÔÏfiÁÔ, Â›Ó·È ÌÈÎÚ‹. ¶·Ú’ fiÏ· ·˘Ù¿, ˘¿Ú¯ÂÈ ¤Ó·˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ô˘ Âı·›ÓÔ˘Ó Â›Ù ÁÈ·Ù› ‰ÂÓ ·ÎÔÏÔ˘ıÔ‡Ó ÈÛÙ¿ ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÁÈ·ÙÚÔ‡, ΢ڛˆ˜ Û fi,ÙÈ ·ÊÔÚ¿ ÙËÓ Îfiˆ¶·È‰È·ÙÚÈ΋ 2005;68:155-160

ÛË, ¿ıÏËÛË Î.Ï., ›Ù ÁÈ·Ù› ·ÌÂÏÔ‡Ó ÙËÓ Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛ‹ ÙÔ˘˜. °È· Ù· ·Ú·¿Óˆ Û˘¯Ó¿ ¢ı‡ÓÂÙ·È Ë „˘¯ÔÏÔÁ›·, ΢ڛˆ˜ ÙˆÓ ÂÊ‹‚ˆÓ ‹ ÙˆÓ ÌÂÁ·Ï‡ÙÂÚˆÓ Û ËÏÈΛ· ·ÛıÂÓÒÓ, ·ÏÏ¿ Î·È Ë ÎÔ‡Ú·ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ù· ÚÔ‚Ï‹Ì·Ù· ·fiÛÙ·Û˘, Ë ÂÈÏÔÁ‹ ÌË Î·Ù¿ÏÏËÏˆÓ ÁÈ·ÙÚÒÓ ‹ ·ÎfiÌ· Î·È Û˘ÁÎÂÎÚÈ̤Ó˜ ÎÔÈÓˆÓÈΤ˜, ÔÈÎÔÓÔÌÈΤ˜ Î·È ÔÈÎÔÁÂÓÂȷΤ˜ ηٷÛÙ¿ÛÂȘ. ∏ ·Ú·Ì¤ÏËÛË ‹ Ë ÌË Ù·ÎÙÈ΋ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È Ë ·ÚÔı˘Ì›· ÁÈ· οÔÈ· ÂͤٷÛË (.¯. ·ÈÌÔ‰˘Ó·ÌÈ΋ ÌÂϤÙË) ÏfiÁˆ Êfi‚Ô˘, ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÂÈÚfiÛıÂÙ· ÚÔ‚Ï‹Ì·Ù· (12).

¶·È‰È¿ Ì ¯ÂÈÚÔ˘ÚÁË̤ÓË Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· ™‹ÌÂÚ·, Ô˘ Ë Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ ÌÔÚ› Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ÂÂÌ‚·ÙÈο ‹ ¯ÂÈÚÔ˘ÚÁÈο, Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ·˘Ù‹ ÙËÓ Î·ÙËÁÔÚ›· ÔÏÔ¤Ó· Î·È ·˘Í¿ÓÂÙ·È. ∂›Ó·È Ê˘ÛÈο ¢ÓfiËÙÔ fiÙÈ fiÛÔ ÈÔ Û‡ÌÏÔÎË Â›Ó·È Ë ¿ıËÛË Î·È fiÛÔ ÈÔ ÌÈÎÚ‹ Â›Ó·È Ë ËÏÈΛ· ÙÔ˘ ·ÛıÂÓ‹ ηٿ ÙËÓ Â¤Ì‚·ÛË ÙfiÛÔ ÂÚÈÛÛfiÙÂÚ· Â›Ó·È Ù· ÚÔ‚Ï‹Ì·Ù·. ∆Ô Â›Â‰Ô Ù˘ ·È‰ÔηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ Î·È Ô ‚·ıÌfi˜ ÂÈÙ˘¯›·˜ ÙˆÓ ÂÂÌ‚¿ÛÂˆÓ ÛÙËÓ ÂοÛÙÔÙ ¯ÒÚ· ·ÔÙÂÏÔ‡Ó ÂÈÚfiÛıÂÙÔ ·Ú¿ÁÔÓÙ·. ∂›Û˘, Ú¤ÂÈ ¿ÓÙ· Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Î·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ·ÚΛ Ë ·Ó·ÙÔÌÈ΋ ·ÔηٿÛÙ·ÛË, ·ÏÏ¿ ¤¯Ô˘Ó ¿Ú· Ôχ ÌÂÁ¿ÏË ÛËÌ·Û›· Î·È ÔÈ Èı·Ó¤˜ ‚Ï¿‚˜ Ô˘ ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› ‹ ÔÈ ÌÈÎÚÔÏÂÙÔ̤ÚÂȘ Ô˘ ‰ÂÓ ¤¯Ô˘Ó Ú˘ıÌÈÛÙ› Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ·ÎÚ›‚ÂÈ·, ÔÈ ÂÈÙÒÛÂȘ ÙˆÓ ÔÔ›ˆÓ ı· Ê·ÓÔ‡Ó Ì ÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘. ∏ ΢ÚÈfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÛÙ· ¯ÂÈÚÔ˘ÚÁË̤ӷ ·È‰È¿, Ô˘ ·ÔÙÂÏÔ‡Ó Û‹ÌÂÚ· Î·È ÙËÓ ÔÌ¿‰· ˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘, Â›Ó·È ÔÈ ÌÂÙÂÁ¯ÂÈÚËÙÈΤ˜ ·ÚÚ˘ı̛˜ (13), ÔÈ Ôԛ˜ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÌÂÙ¿ ·fi Ï›Á· ‹ ÂÚÈÛÛfiÙÂÚ· ¯ÚfiÓÈ· (ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹). OÈ ·ÚÚ˘ı̛˜ ·˘Ù¤˜ ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ·ÈÊÓ›‰È· Î·È Ó· ÚÔηϤÛÔ˘Ó ÙÔÓ ı¿Ó·ÙÔ, ·ÏÏ¿ Ô ı¿Ó·ÙÔ˜ ÌÔÚ› Ó· Û˘Ì‚Â› ·ÎfiÌ· Î·È Û ·È‰È¿ ‹ Ó·ÚÔ‡˜ ÂÓ‹ÏÈΘ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ì ÂÈ̤ÏÂÈ·. ∞ÈÙ›· ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·ÚÚ˘ı̛˜ ·˘Ù¤˜ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ôχ ‰‡ÛÎÔÏ· Ì ٷ ·ÓÙÈ·ÚÚ˘ıÌÈο Ê¿Ú̷η, ·Ú’ fiϘ ÙȘ Ì·ÎÚÔ¯ÚfiÓȘ ÂÓ·ÏÏ·Á¤˜ ‹ ÙÔ˘˜ Û˘Ó‰˘·ÛÌÔ‡˜.

OÈ Î˘ÚÈfiÙÂÚ˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Ù· Û˘¯ÓfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ›ӷÈ: ·) Ë ÙÂÙÚ·ÏÔÁ›· Fallot, ÛÙËÓ ÔÔ›· - fiˆ˜ Ê·›ÓÂÙ·È ¤¯ÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· Ë ·ÏÈÓ‰ÚfiÌËÛË ÛÙËÓ Ó¢ÌÔÓÈ΋ ·ÚÙËÚ›· Î·È ÔÈ ÂÈÙÒÛÂȘ Ù˘ ÛÙË ‰ÂÍÈ¿ ÎÔÈÏ›· (14), ‚) Ë ÌÂÙ¿ıÂÛË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, ΢ڛˆ˜ ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯ÂÈ Á›ÓÂÈ Ë Â¤Ì‚·ÛË Senning ‹ Mustard, fiˆ˜ Û˘ÓËıÈ˙fiÙ·Ó

Paediatriki Mar-Apr 05

19-04-05

15:31

™ÂÏ›‰·157

157

∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿

·Ï·ÈfiÙÂÚ· (ÏÈÁfiÙÂÚÔÈ ·fi ÙÔ˘˜ ÌÈÛÔ‡˜ ·ÛıÂÓ›˜ ÌÂÙ¿ ÙËÓ ·Ú¤Ï¢ÛË Ì›·˜ ÂÓÙ·ÂÙ›·˜ ¤¯Ô˘Ó Ê˘ÛÈÔÏÔÁÈÎfi Ú˘ıÌfi) (15) Î·È Á) Ë ÌÔÓ‹Ú˘ ÎÔÈÏ›· ÌÂÙ¿ ·fi ÂÁ¯Â›ÚËÛË Fontan (16). OÈ ·ı‹ÛÂȘ Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜, Ë ÈÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜, Ë ·ÙÚËÛ›· Ó¢ÌÔÓÈ΋˜ ‚·Ï‚›‰·˜, Ë ‰ÈÏÔ¤ÍÔ‰Ë ‰ÂÍÈ¿ ÎÔÈÏ›·, Ë ‰ÈÔÚıˆÌ¤ÓË ÌÂÙ¿ıÂÛË ÙˆÓ ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ, Ë ·ÓˆÌ·Ï›· Ebstein ·ÏÏ¿ Î·È ¿ÏϘ Û·ÓÈfiÙÂÚ˜ ·ı‹ÛÂȘ Ê·›ÓÂÙ·È fiÙÈ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÛËÌ·ÓÙÈο ÚÔ‚Ï‹Ì·Ù·, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ı· Ê·Ó› Û ÂÚ¢ÓËÙÈΤ˜ ÌÂϤÙ˜ Ô˘ ‰ÈÂÚ¢ÓÔ‡Ó ·˘Ùfi ÙÔ ı¤Ì·, ÙfiÛÔ ÛÙËÓ ·È‰È΋ ËÏÈΛ· fiÛÔ Î·È ÛÙÔ˘˜ Ó·ÚÔ‡˜ ‹ ÌÂÁ·Ï‡ÙÂÚÔ˘˜ ÂÓ‹ÏÈΘ.

ª˘ÔηډÈÔ¿ıÂȘ ªÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÌÔÚÊÒÓ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÛÙÔ ı¤Ì· ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ΢ڛ·Ú¯Ô ÚfiÏÔ ¤¯ÂÈ Ë ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· (1721). ™ÙËÓ ·È‰È΋ ËÏÈΛ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ı·Ó¿ÙˆÓ ‰ÂÓ Â›Ó·È È‰È·›ÙÂÚ· ÌÂÁ¿ÏÔ, ·˘Í¿ÓÂÙ·È fï˜ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ∏ ÂÌÊ¿ÓÈÛË Û˘ÁÎÔÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÔÈ ÎÔÈÏȷΤ˜ ·ÚÚ˘ı̛˜ ηıÒ˜ Î·È Ë ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ˘ÂÚÙÚÔÊ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ·ÔÙÂÏÔ‡Ó ·Ú¿ÁÔÓÙ˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘. ∆· ·È‰È¿ Û˘Ó‹ıˆ˜ Â›Ó·È ·Û˘Ìو̷ÙÈο, ÂÓÒ Ô ÌÂÁ¿ÏÔ˜ ΛӉ˘ÓÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ¿ıÏËÛ˘, Á˘ÌÓ·ÛÙÈ΋˜ ‹ ȉȷ›ÙÂÚ˘ ÎfiˆÛ˘ (22). ™Â ÂÚÈÙÒÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ë ÙÔÔı¤ÙËÛË ·˘ÙfiÌ·ÙˆÓ ·ÈÓȉˆÙÒÓ Ê·›ÓÂÙ·È fiÙÈ ¤¯ÂÈ Ù· ηχÙÂÚ· ·ÔÙÂϤÛÌ·Ù·. ™Â οı ÎÏÈÓÈ΋ ‹ ÓÂÎÚÔÙÔÌÈ΋ ‰È¿ÁÓˆÛË ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ı· Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È Î·È Ù· ˘fiÏÔÈ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÏfiÁˆ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ·Ú’ fiÏÔ Ô˘ ÌÔÚ› Ë ÂÚ›ÙˆÛË Ó· ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË Î·È Ó· ÌËÓ ‚ÚÂı› ¿ÏÏÔ Ì¤ÏÔ˜ Ô˘ ¿Û¯ÂÈ (23,24). ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ¿ÏϘ Ì˘ÔηډÈÔ¿ıÂȘ, ÛÙË ‰È·Ù·ÙÈ΋ Ô ı¿Ó·ÙÔ˜ Û˘Ó‹ıˆ˜ ‰ÂÓ Â›Ó·È ·ÈÊÓ›‰ÈÔ˜ (25-32). ∏ Û˘ÌÊÔÚËÙÈ΋ Â›Ó·È Û¿ÓÈ· ÛÙ· ·È‰È¿, ÂÓÒ ÔÈ ¿ÏϘ ÌÔÚʤ˜, fiˆ˜ Ë ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ Ì˘ÔηډÈÔ¿ıÂÈ· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ‹ ÙÔ ÌË Û˘Ì·Á¤˜ Ì˘ÔοډÈÔ, Â›Ó·È ·ÎfiÌ· Û·ÓÈfiÙÂÚ˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È Î˘Ú›ˆ˜ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘ (33-36). ∆¤ÏÔ˜, Ë Ì˘Ôηډ›Ùȉ·, ·fi ÙËÓ ÔÔ›· ÌÔÚ› Ó· ÚÔÛ‚ÏËı› ¤Ó· ·È‰› Ì ÚÔËÁÔ˘Ì¤Óˆ˜ ˘ÁÈ‹ ηډȿ, ÌÔÚ› Â›Û˘ Ó· ·ÔÙÂϤÛÂÈ ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ΢ڛˆ˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ·ÚÚ˘ıÌÈÒÓ, ÔÈ Ôԛ˜ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÚÔÛÂÎÙÈο Î·È Ù·ÎÙÈο, Ì ÙÔÔı¤ÙËÛË 24ˆÚÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ (Holter) Î·È ¿ÏϘ ÌÂıfi‰Ô˘˜ (37-39). ∞ÚÚ˘ı̛˜ ∞ÔÙÂÏÔ‡Ó Ì›· ·fi ÙȘ ΢ÚÈfiÙÂÚ˜ ·Èٛ˜ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘. º·›ÓÂÙ·È fiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›·

ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓÔ ÈÛÙÔÚÈÎfi Î·È ¯ˆÚ›˜ ÓÂÎÚÔÙÔÌÈο Â˘Ú‹Ì·Ù·, Ô ı¿Ó·ÙÔ˜ ÔÊ›ÏÂÙ·È Û ·ÚÚ˘ıÌ›· (40). ∂ÎÙfi˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î·È ¯ÂÈÚÔ˘ÚÁÈΤ˜ ‹ ¿ÏϘ ÂÂÌ‚¿ÛÂȘ, ÔÈ ·‰È¿ÁÓˆÛÙ˜ ÔÏϤ˜ ÊÔÚ¤˜, ÚˆÙÔ·ı›˜ ·ÚÚ˘ı̛˜ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ôχ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· (41-44). ∞fi ÙȘ ÚˆÙÔ·ı›˜ ·ÚÚ˘ı̛˜, ÔÈ Û˘¯ÓfiÙÂÚ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ·˘Ù¤˜ Ô˘ ÔÊ›ÏÔÓÙ·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Wolff-Parkinson-White (WPW). øÛÙfiÛÔ, ·Ú¿ ÙËÓ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ·, Ô ·ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ Û˘Ì‚·›ÓÂÈ Û¿ÓÈ· Î·È ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ÎÔÈÏȷ΋ Ì·ÚÌ·Ú˘Á‹ (45,46). ™Â ÂÚÈÛÙ·ÙÈο Ô˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û˘ÌÙÒÌ·Ù·, ÙÔ Û‡Ó‰ÚÔÌÔ ÌÔÚ› Ó· ·Ú·Ì›ÓÂÈ ·‰È¿ÁÓˆÛÙÔ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ·. ¶Ôχ Û˘¯Ó¿ ·Ó·ÁÓˆÚ›˙ÂÙ·È Û ·Û˘Ìو̷ÙÈο ·È‰È¿ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘¯·›·˜ ÂͤٷÛ˘ ÁÈ· ¤Î‰ÔÛË ÈÛÙÔÔÈËÙÈÎÒÓ ‹ Ì ÙËÓ Â˘Î·ÈÚ›· οÔÈÔ˘ Ê˘Û‹Ì·ÙÔ˜. ™Ù· ·È‰È¿ ·˘Ù¿ Û˘ÓÈÛÙ¿Ù·È ÌfiÓÔ ·Ú·ÎÔÏÔ‡ıËÛË (47,48). ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù· (Ù·¯˘Î·Ú‰›Â˜), ¯ÚÂÈ¿˙ÂÙ·È Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË, ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ·. ŸÙ·Ó fï˜ Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÓÙÈÌÂÙÒÈÛ˘ ‰ÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈο ·Ú’ fiÏË ÙËÓ ÂÈÌÔÓ‹ Î·È ÙËÓ ·ÏÏ·Á‹ Ê·Ú̿ΈÓ, ÌÔÚ› Ó· Á›ÓÂÈ ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈ΋ ÌÂϤÙË Î·È Èı·ÓÒ˜ Î·Ù¿Ï˘ÛË. ∂Âȉ‹, fï˜, Ë Î·Ù¿Ï˘ÛË Â›Ó·È Ì›· ÂÂÌ‚·ÙÈ΋ ̤ıÔ‰Ô˜ ÛÙËÓ ÔÔ›· ˘¿Ú¯Ô˘Ó ÛÔ‚·ÚÔ› ΛӉ˘ÓÔÈ, ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÌfiÓÔ ÌÂÙ¿ ·fi ÒÚÈÌË ÛΤ„Ë, Û ηٿÏÏËÏÔ Î¤ÓÙÚÔ Î·È ·fi ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ·È‰ÔηډÈÔÏfiÁÔ Î·È ÔÌ¿‰· (49-51). ∆Ô Û‡Ó‰ÚÔÌÔ ÙÔ˘ Ì·ÎÚÔ‡ QT Â›Ó·È Ì›· ¿ÏÏË ÚˆÙÔ·ı‹˜ ÔÏϤ˜ ÊÔÚ¤˜ Û˘ÁÁÂÓ‹˜ (39%) ÔÓÙfiÙËÙ· Ô˘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤Î·Ó ȉȷ›ÙÂÚË ·›ÛıËÛË ÛÙÔÓ ·È‰È·ÙÚÈÎfi ÎfiÛÌÔ. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·Ó¢ڛÛÎÂÙ·È ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ÙÔÓ ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·, ÁÈ’ ·˘Ùfi Î·È ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ŸÙ·Ó ‰ÂÓ ·Ó·Î·Ï‡ÙÂÙ·È ÎÏËÚÔÓÔÌÈÎfiÙËÙ·, ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ÌÂÙ¿ÏÏ·Í˘. ™Â οı ÂÚ›ÙˆÛË, ÚÈÓ ÙÂı› Ë ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· ·ÔÎÏ›ÔÓÙ·È ¿ÏÏ· Èı·Ó¿ ·›ÙÈ· ÁÈ· ÙËÓ ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ QT, fiˆ˜ Ù· ÌÂÙ·‚ÔÏÈο Î·È Ù· Ê¿Ú̷η (Â›ÎÙËÙÔ Û‡Ó‰ÚÔÌÔ Ì·ÎÚÔ‡ QT) (52,53). O ı¿Ó·ÙÔ˜ ÌÔÚ› Ó· ÚÔ·„ÂÈ ·ÈÊÓ›‰È· ÏfiÁˆ ÎÔÈÏȷ΋˜ Ù·¯˘Î·Ú‰›·˜. O ΛӉ˘ÓÔ˜ Û˘Ó‹ıˆ˜ Â›Ó·È ÌÂÁ¿ÏÔ˜. ∏ ·ÓÙÈÌÂÙÒÈÛË ÌÔÚ› Ó· Á›ÓÂÈ Ì ʿÚ̷η, fiˆ˜ ‚-·Ó·ÛÙÔÏ›˜, ·ÏÏ¿ Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› ·ÎfiÌ· Î·È Ó· ¯ÚÂÈ·ÛÙ› Ë ÙÔÔı¤ÙËÛË ‚ËÌ·ÙÔ‰fiÙË ‹ ·˘ÙfiÌ·ÙÔ˘ ·ÈÓȉˆÙ‹ (Ô ‚ËÌ·ÙÔ‰fiÙ˘ ÂÌÊ˘Ù‡ÂÙ·È ÏfiÁˆ Ù˘ ‚Ú·‰˘Î·Ú‰È·Î‹˜ ‰Ú¿Û˘ ÙˆÓ Ê·ÚÌ¿ÎˆÓ Î·È fi¯È ˆ˜ ıÂÚ·›·) (54,55). ª›· ¿ÏÏË ·ÚÎÂÙ¿ Û˘¯Ó‹ ·ÈÙ›· Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÈÊÓ›‰ÈÔ ı¿Ó·ÙÔ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ¶·È‰È·ÙÚÈ΋ 2005;68:155-160

Paediatriki Mar-Apr 05

19-04-05

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158

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Â›Ó·È Ô Ï‹Ú˘ ÎÔÏÔÎÔÈÏÈ·Îfi˜ ·ÔÎÏÂÈÛÌfi˜. ¶·Ú’ fiÏÔ Ô˘ Û‹ÌÂÚ· Û˘Ó‹ıˆ˜ Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ (Û˘¯Ó‹ ·ÈÙ›· Ô ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ Ù˘ ÌËÙ¤Ú·˜), ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÙÒÛÂȘ Ô˘ ‰È·Ê‡ÁÔ˘Ó Î·È ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Ï›ÁÔ ‹ Ôχ ·ÚÁfiÙÂÚ·. O ΛӉ˘ÓÔ˜ Û¯ÂÙ›˙ÂÙ·È Î˘Ú›ˆ˜ Ì ÙËÓ Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ·. ™˘¯ÓfiÙËÙ˜ ÌÈÎÚfiÙÂÚ˜ ÙˆÓ 55/min ÛÙ· ‚Ú¤ÊË Î·È ÙˆÓ 50/min ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ··ÈÙÔ‡Ó ÙËÓ ÙÔÔı¤ÙËÛË ‚ËÌ·ÙÔ‰fiÙË, ·ÎfiÌË Î·È ÛÙ· ÙÂÏ›ˆ˜ ·Û˘Ìو̷ÙÈο ·È‰È¿. º˘ÛÈο, Ù· ·È‰È¿ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù·, Â›Û˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÙÔ Ù·¯‡ÙÂÚÔ ‚ËÌ·ÙÔ‰fiÙË, ‰ÈfiÙÈ Û οı ÂÚ›ÙˆÛË Ë Èı·ÓfiÙËÙ· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Â›Ó·È ˘·ÚÎÙ‹ Î·È ÛËÌ·ÓÙÈ΋. OÈ ˘fiÏÔÈ˜ ·ÚÚ˘ı̛˜ Â›Ó·È Ôχ Û¿ÓȘ ÛÙ· ·È‰È¿ Î·È ÁÈ’ ·˘Ùfi ‰ÂÓ ıˆÚÂ›Ù·È ÛÎfiÈÌË Ë ÂÚÈÁÚ·Ê‹ ÙÔ˘˜ (56,57).

§ÈÔı˘ÌÈο (Û˘ÁÎÔÙÈο) ÂÂÈÛfi‰È· ∆· ÂÂÈÛfi‰È· ·ÒÏÂÈ·˜ Û˘Ó›‰ËÛ˘ Ì ÙȘ ‰È¿ÊÔÚ˜ ÌÔÚʤ˜, ÙË ‰È¿ÚÎÂÈ· Î·È ÙȘ ȉȷÈÙÂÚfiÙËÙ¤˜ ÙÔ˘˜, ·ÔÙÂÏÔ‡Ó Û˘¯Ó¿ Úfi‚ÏËÌ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ·È‰È·ÙÚÈ΋ Ú¿ÍË. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÙÔ ÌÔÓ·‰ÈÎfi ÂÂÈÛfi‰ÈÔ Û˘Ì‚·›ÓÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ·ÈÌÔÏË„›·˜ ‹ Û ÎÏÂÈÛÙÔ‡˜ ¯ÒÚÔ˘˜, .¯. ÛÙËÓ ÂÎÎÏËÛ›· ÚÈÓ ·fi ÙË ÌÂÙ¿ÏË„Ë, Ì ¿‰ÂÈÔ ÛÙÔÌ¿¯È, ÌÂÙ¿ ·fi ÓËÛÙ›· Î.Ï., ÌÔÚ› Ë Î·Ù¿ÛÙ·ÛË Ó· ÌËÓ Â›Ó·È È‰È·›ÙÂÚ· ÛÔ‚·Ú‹, ·ÊÔ‡ ˘¿Ú¯ÂÈ Î¿ÔÈ· ·ÈÙÈÔÏÔÁ›·. ™Â οı ÂÚÈÛÙ·ÙÈÎfi, fï˜, Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·ÈÙÈÔÏÔÁ›· Î·È ÙÔ ÔÔ›Ô Û˘Ì‚·›ÓÂÈ ·ÈÊÓ›‰È· - ΢ڛˆ˜ ηٿ ‹ ÌÂÙ¿ ·fi ÎfiˆÛË - ‹ ˘¿Ú¯ÂÈ ·›ÛıËÌ· ·ÏÌÒÓ, ÂÈ‚¿ÏÏÂÙ·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· οı ·È‰› Ô˘ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓ ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ‹ ·ÎÔ‡ÁÂÙ·È Î¿ÔÈÔ Ê‡ÛËÌ·, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â¿Ó ÌÔÈ¿˙ÂÈ Ì ÏÂÈÙÔ˘ÚÁÈÎfi ‹ fi¯È. ™Â fiϘ ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ Â›Ó·È Â˘ÓfiËÙÔ fiÙÈ Ô Ï‹Ú˘ ·È‰ÔÓ¢ÚÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÔÎÏÂÈÛÌfi ÂÈÏË„›·˜ ‹ ¿ÏÏÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ (58-62). O ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi ÂȉÈÎfi ·È‰ÔηډÈÔÏfiÁÔ, Ì ÎÏÈÓÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· Î·È ¤Á¯ÚˆÌÔ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ· (Triplex). ∂¿Ó ÎÚÈı› ÛÎfiÈÌÔ, ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Â›Ó·È Î·È Ë ÙÔÔı¤ÙËÛË 24ˆÚÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ (Holter). ∆Ô ÙÂÛÙ ÎfiˆÛ˘, Â¿Ó ‰ÈÂÓÂÚÁËı› Ì ÚÔÛÔ¯‹, ÌÔÚ› Â›Û˘ Ó· ‚ÔËı‹ÛÂÈ. ∆· ΢ÚÈfiÙÂÚ· ·›ÙÈ· Â›Ó·È ÔÈ Ì˘ÔηډÈÔ¿ıÂȘ (΢ڛˆ˜ Ë ˘ÂÚÙÚÔÊÈ΋), Ë ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜ Î·È Ë ÈÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜.

OÈ ‰È¿ÊÔÚ˜ ÌÔÚʤ˜ ·ÚÚ˘ıÌ›·˜ ·ÔÙÂÏÔ‡Ó, Â›Û˘, ¤Ó· Û˘¯Ófi Î·È ÂÈΛӉ˘ÓÔ ·›ÙÈÔ. ™Â οı ÂÚ›ÙˆÛË, ı· Ú¤ÂÈ Ó· ÙÂı› Ë Ï‹Ú˘ ‰È¿ÁÓˆÛË ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ - ηٿ ÙÔ ÂÊÈÎÙfi - Ô ·ÔÎÏÂÈÛÌfi˜ ·ıÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ Î·È Ó· ÂÊ·ÚÌÔÛÙ› Ë ·ÓÙÈÌÂÙÒÈÛË Ô˘ ¯ÚÂÈ¿˙ÂÙ·È (63-67). ¶·È‰È·ÙÚÈ΋ 2005;68:155-160

™˘ÌÂÚ¿ÛÌ·Ù· ∏ ΢ÚÈfiÙÂÚË Î·È Û˘¯ÓfiÙÂÚË ·ÈÙ›· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ÙfiÛÔ ÛÙȘ ‰È·ÁÓˆṲ̂Ó˜ fiÛÔ Î·È ÛÙȘ ·‰È¿ÁÓˆÛÙ˜ ÂÚÈÙÒÛÂȘ, Â›Ó·È Ë ·ÚÚ˘ıÌ›·. OÈ ·ÚÚ˘ı̛˜ Â›Ó·È È‰È·›ÙÂÚ· ÂÈΛӉ˘Ó˜ ÏfiÁˆ Ù˘ ÌË Â‡ÎÔÏ˘ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘˜, ΢ڛˆ˜ ÛÙȘ ¯ÂÈÚÔ˘ÚÁË̤Ó˜ ÁÈ· Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· ÂÚÈÙÒÛÂȘ (·Ϥ˜ ‹ Û‡ÌÏÔΘ). ªÂ ÙËÓ ÚfiÔ‰Ô Ù˘ ·È‰ÔηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜, Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÔÏÔ¤Ó· Î·È ·˘Í¿ÓÂÙ·È, ÂÓÒ ‰ÂÓ ˘¿Ú¯Ô˘Ó Ì·ÎÚÔ¯ÚfiÓȘ ÛÙ·ÙÈÛÙÈΤ˜ ·ÊÔ‡ ÔÏϤ˜ ·fi ·˘Ù¤˜ ÙȘ ÂÂÌ‚¿ÛÂȘ ‰ÂÓ ¤¯Ô˘Ó ·ÚÂÏıfiÓ ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 20-25 ¯ÚfiÓˆÓ. ∂›Û˘, Ô Î›Ó‰˘ÓÔ˜ ·˘Í¿ÓÂÙ·È Î·È ·fi ÙËÓ ·Ó˘·ÚÍ›·, Ôχ Û˘¯Ó¿, ÚÔÂȉÔÔÈËÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ ¢ÚËÌ¿ÙˆÓ. °›ÓÂÙ·È, ÂÔ̤ӈ˜, ·ÓÙÈÏËÙ‹ Ë ÌÂÁ¿ÏË ÛËÌ·Û›· Ô˘ ¤¯ÂÈ Ë ÚÔÛÂÎÙÈ΋, Ù·ÎÙÈ΋ Î·È ÛˆÛÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË. ¶·ÚÔÌÔ›ˆ˜, Ë ‡·ÚÍË ·ÚÚ˘ıÌ›·˜ Û ·È‰È¿ ¯ˆÚ›˜ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ·, fiˆ˜ ‹‰Ë ·Ó·Ï‡ıËÎÂ, ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÌÂÁ¿ÏÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· ÂÏÏÔ¯Â‡Ô˘Ó ¿ÏÏÔÙ ÌÂÁ·Ï‡ÙÂÚÔÈ (.¯. ÛÙ¤ÓˆÛË ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜) Î·È ¿ÏÏÔÙ ÌÈÎÚfiÙÂÚÔÈ, ·ÏÏ¿ ¿ÓÙ· ˘·ÚÎÙÔ›, ΛӉ˘ÓÔÈ. µ¤‚·È·, ÔÈ Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ Â›Ó·È Â›Û˘ ÂÈΛӉ˘Ó˜ (Û‡Ó‰ÚÔÌÔ Kawasaki). ŸÏ˜ ÔÈ Î·ÙËÁÔڛ˜ ·˘ÙÒÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ì ÌÂÁ¿ÏË ÚÔÛÔ¯‹, ̤¯ÚÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋ ‹ Ê·Ú̷΢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÏÈÔı˘ÌÈο ÂÂÈÛfi‰È· ¯ˆÚ›˜ ÂÌÊ·Ó‹ ·ÈÙÈÔÏÔÁ›·. ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi Ó· ÙÔÓÈÛÙ› fiÙÈ Î¿ı ·È‰› Ô˘ ·Ó‹ÎÂÈ Û ̛· ·fi ÙȘ ÂÈΛӉ˘Ó˜ ηÙËÁÔڛ˜, ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÂ›Ù·È Ù·ÎÙÈο Î·È Ì ÌÂÁ¿ÏË ÚÔÛÔ¯‹ ·fi ·È‰ÔηډÈÔÏfiÁÔ. øÛÙfiÛÔ, ηıÒ˜ ·ÚÎÂÙ¤˜ ·fi ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙȘ ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÌÔÚ› Ó· ÌËÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÌÙÒÌ·Ù· ‹ ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ‹ Î·È Ó· ˘¿Ú¯ÂÈ ¤Ó· Ê·ÈÓÔÌÂÓÈο ·ıÒÔ Ê‡ÛËÌ· ‹ Ì›· ÏÈÔı˘Ì›·, ı· Ú¤ÂÈ Î·È Û ·˘Ù¿ Ó· Ï·Ì‚¿ÓÔÓÙ·È Ù· ··Ú·›ÙËÙ· ̤ÙÚ·. ∞˘Ù¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙÔÓ Ï‹ÚË ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ı· ·Û¯ÔÏËıÔ‡Ó Ì ·ıÏËÙÈÛÌfi, ÚˆÙ·ıÏËÙÈÛÌfi ‹ ¤ÓÙÔÓË Á˘ÌÓ·ÛÙÈ΋, ·ÊÔ‡ Ù· fiÚÈ· ‰ÂÓ Â›Ó·È ÔÏϤ˜ ÊÔÚ¤˜ ·fiÏ˘Ù· ηıÔÚÈṲ̂ӷ. O ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ fiÏˆÓ ·ÓÂÍ·ÈÚ¤Ùˆ˜ ÙˆÓ ·È‰ÈÒÓ Ì ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜ ¤¯ÂÈ ÍÂÎÈÓ‹ÛÂÈ Ôχ ÚfiÛÊ·Ù·, ÁÈ’ ·˘Ùfi Î·È ·ÎfiÌË ‰ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê‹ Û˘ÌÂÚ¿ÛÌ·Ù·. ¶·Ú’ fiÏ· ·˘Ù¿, Û οı ÂÚ›ÙˆÛË Ô˘ ˘¿Ú¯ÂÈ Î¿ÙÈ ‡ÔÙÔ ÛÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‹ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ô ¤ÏÂÁ¯Ô˜ ‰ÂÓ ıˆÚÂ›Ù·È ˘ÂÚ‚ÔÏ‹ (68).

Paediatriki Mar-Apr 05

19-04-05

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∞ÈÊÓ›‰ÈÔ˜ ı¿Ó·ÙÔ˜ ÛÙ· ·È‰È¿

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PRACTICAL ISSUE

161

Sudden death in children S. Antoniadis

Abstract In sudden death in childhood the cause, in the vast majority of cases, is of cardiac origin. In many cases the underlying cause is congenital heart disease, which may or may not have been diagnosed, and may or may not have been operated on. The death rate is particularly high in post-operative patients where the management is difficult. Sudden death usually occurs during sports or in conditions of extreme fatigue.

The cardiomyopathies and especially the hypertrophic form, constitute another high risk category.

Acquired heart diseases also play a major part. Apart from these diagnosed causes, it is well known that arrhythmias carry the highest risk in incidents of sudden death when the aetiology remains unknown even after necropsy. For management of the problem, the follow up and treatment of patients known to have heart disease is of paramount importance, along with general preventive measures. A cardiovascular check up is absolutely necessary in every child who is going to be involved in competitive sports and championships, and in any child when the paediatricians have identified suspicious findings including heart murmurs, rhythm disturbances, symptoms or events such as chest pain, syncope, etc. Also a family history of heart disease or sudden death should be taken into account. All the evaluations should be performed and the relevant certificates be issued by a specialist paediatric cardiologist, after clinical examination and tests such as electrocardiogram, colour Doppler and, whenever necessary, 24-hour Holter monitoring or other tests. The issue of certificates given by doctors unrelated to paediatric cardiology could be dangerous. For the time being, screening tests for all children are not considered necessary, but this will be reconsidered following the findings of various large-scale projects currently in progress on the subject.

Paediatric Cardiologist, Professor of the Highest Technological Educational Institution of Athens Correspondence: Stilianos Antoniadis 4 Iraklitou str., Kolonaki 106 73, Athens E-mail: prdrsant@otenet.gr Date of submission: 20-06-2003 Date of approval: 02-02-2005

Key words Children, sudden death, cardiac problem, follow up, prevention.

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∫§π¡π∫O ∫OÀπ∑ Ã. ∫ÒÛÙ·ÏÔ˜

¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·” AÏÏËÏÔÁÚ·Ê›·: ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜ E-mail: ccostalos@yahoo.gr

¡ÂÔÁ¤ÓÓËÙÔ ·ÁfiÚÈ ËÏÈΛ·˜ 9 ËÌÂÚÒÓ ÚÔÛÎÔÌ›˙ÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ÛÙ· Â›ÁÔÓÙ· ÙÔ˘ ÂÊËÌÂÚ‡ÔÓÙÔ˜ ÓÔÛÔÎÔÌ›Ԣ ÏfiÁˆ ·ÈÊÓ›‰È·˜ η٤ÚÂȄ˘. πÛÙÔÚÈÎfi: ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ, ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi. ∆Ô ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ ‹Ù·Ó 3400 g Î·È ÙÔ Apgar score 9 ÛÙÔ 1Ô ÏÂÙfi ˙ˆ‹˜. ◊Ù·Ó ÙÔ ‰Â‡ÙÂÚÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∆Ô ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ. ∆Ô ÓÂÔÁÓfi ¤Ï·‚ ÌËÙÚÈÎfi Á¿Ï· ηÈ, ÂÎÙfi˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÂÏ·ÊÚÔ‡ ÈÎÙ¤ÚÔ˘, Ë ÔÚ›· ÙÔ˘ ÛÙÔ Ì·ÈÂ˘Ù‹ÚÈÔ ‹Ù·Ó ηϋ. ∂Í‹Ïı ÙËÓ 4Ë Ë̤ڷ ˙ˆ‹˜. ™ÙÔ Û›ÙÈ Û˘Ó¤¯ÈÛ ӷ ıËÏ¿˙ÂÈ ·fi ÙÔ ÛÙ‹ıÔ˜ οı 2-3 ÒÚ˜ Î·È Â›¯Â Ù·ÎÙÈΤ˜ ÎÂÓÒÛÂȘ. ∆ËÓ Ë̤ڷ Ù˘ ÂÈÛ·ÁˆÁ‹˜ ·ÚÔ˘Û›·Û ӈıÚfiÙËÙ·, ·ÛıÂÓ¤˜ ÎÏ¿Ì·, ˆ¯ÚfiÙËÙ· Î·È ¿ÚÓËÛË ıËÏ·ÛÌÔ‡ Ô˘ ÂÍÂÏ›¯ıËΠ۠ϋı·ÚÁÔ. ∫·Ù¿ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË, ÙÔ ‚Ú¤ÊÔ˜ ›¯Â fi„Ë ¿Û¯ÔÓÙÔ˜, ‹Ù·Ó ˆ¯Úfi Ì ΢·ÓˆÙÈο ¿ÎÚ· Î·È ·ÓÙȉÚÔ‡Û ÂÏ¿¯ÈÛÙ· ÛÙ· ÂÚÂı›ÛÌ·Ù·. ∏ ıÚ¤„Ë ÙÔ˘ ‹Ù·Ó ηϋ, ·ÚÔ˘Û›·˙ fï˜ Ù·¯‡ÓÔÈ· (·Ó·ÓÔ¤˜ 72/min) Ì ·Ó·¤Ù·ÛË ÙˆÓ ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ. ∏ ıÂÚÌÔÎÚ·Û›· ÔÚıÔ‡ ‹Ù·Ó 37,4ÔC. ¢ÂÓ Â›¯Â ‰ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ·. ∆· ¿ÎÚ· ÙÔ˘ ‹Ù·Ó ΢·ÓˆÙÈο Î·È „˘¯Ú¿, Ì ·ÛıÂÓ›˜ ÂÚÈÊÂÚÈΤ˜ ÛʇÍÂȘ Î·È Î·Î‹ ÂÚÈÊÂÚÈ΋ ΢ÎÏÔÊÔÚ›· (¯ÚfiÓÔ˜ Â·Ó·Ï‹ÚˆÛ˘ >5ãã). ∏ ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó 35/18. ¶·ÚÔ˘Û›·˙Â, Â›Û˘, Ù·¯˘Î·Ú‰›· (ÛʇÍÂȘ 185/min). OÈ Î·Ú‰È·ÎÔ› ÙfiÓÔÈ ‹Ù·Ó ‚‡ıÈÔÈ, ¯ˆÚ›˜ fï˜ Ê˘Û‹Ì·Ù·. ¢ÂÓ

›¯Â „ËÏ·ÊËÙÔ‡˜ ÏÂÌÊ·‰¤Ó˜. OÈ Ó‡ÌÔÓ˜ ‹Ù·Ó ηı·ÚÔ›. ∆Ô ‹·Ú ‹Ù·Ó „ËÏ·ÊËÙfi 5 cm, Ô ÛÏ‹Ó·˜ fï˜ ‰ÂÓ ‹Ù·Ó „ËÏ·ÊËÙfi˜. ∞ÓÙÈÌÂÙÒÈÛË: ∆Ô ‚Ú¤ÊÔ˜ ‰È·ÛˆÏËÓÒıËΠ¿ÌÂÛ· Î·È Ù¤ıËΠ۠Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ Ì 100% Ô͢ÁfiÓÔ. ∏ ΢ÎÏÔÊÔÚ›· ÙÔ˘ ÂÓÈÛ¯‡ıËΠ̠ÈÛfiÙÔÓÔ ‰È¿Ï˘Ì· ¯ÏˆÚÈÔ‡¯Ô˘ Ó·ÙÚ›Ô˘ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, Ì ÔÏÈÎfi ·›Ì·. ÃÔÚËÁ‹ıËÎÂ, Â›Û˘, ÓÙÔ·Ì›ÓË ÂÓ‰ÔÊϤ‚È·, ηıÒ˜ Î·È ·ÌÈÎÈÏÏ›ÓË Ì ÓÂÙÚÔÌ˘Î›ÓË. ∂ÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ: ∫·ÏÏȤÚÁÂȘ ·›Ì·ÙÔ˜, ∂¡À, Ô‡ÚˆÓ ·ÚÓËÙÈΤ˜. °ÂÓÈ΋ ·›Ì·ÙÔ˜: ·ÈÌÔÛÊ·ÈÚ›ÓË 13 g/dL, ÏÂ˘Î¿ 8600 (45% ÔÏ˘ÌÔÚÊÔ‡ÚËÓ·), ·ÈÌÔÂÙ¿ÏÈ· 145.000. ∂¡À: ·ÙÙ·Ú· 25 (ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· 40%), χΈ̷ 90 mg, ÁÏ˘Îfi˙Ë 45 mg. CPK 783 U/L, ·ÏηÏÈ΋ ʈÛÊ·Ù¿ÛË 170 U, AST 51 U, ALT 50 U. ¡¿ÙÚÈÔ 135, οÏÈÔ 5,9, ¯ÏÒÚÈÔ 103, ·Û‚¤ÛÙÈÔ 8,5 mg, ʈÛÊfiÚÔ˜ 4,5 mg, Ô˘Ú›· 15 mg, Ï¢ÎÒÌ·Ù· 7,1 g, ÁÏ˘Îfi˙Ë 59 mg, Á·Ï·ÎÙÈÎfi 13,5, ·Ì̈ӛ· 85 Ìg/dL. ∆Ô ∏∫° ¤‰ÂÈÍ ÙÒÛË ÙÔ˘ ST Î·È ¯·ÌËÏ¿ R ÛÙȘ ·ÚÈÛÙÂÚ¤˜ ÚÔοډȘ ··ÁˆÁ¤˜. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ (∂ÈÎfiÓ·) ¤‰ÂÈÍ ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È ‰˘ÛÎÈÓËÛ›· ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜ ÔÊÂÈÏfiÌÂÓË ÛÂ Ô˘Ï‹. ∆Ô ÎÏ¿ÛÌ· ‚Ú¿¯˘ÓÛ˘ ‹Ù·Ó 10% (Ê˘ÛÈÔÏÔÁÈο >30%). ™Â ·˘Ù‹ ÙË Ê¿ÛË, ¤ÁÈÓ ̛· ÂȉÈ΋ ÂͤٷÛË Ô˘ ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË. ∫ÏÈÓÈ΋ ÔÚ›·: ¶·Ú¿ ÙȘ ÚÔÛ¿ıÂȘ, ÙÔ ÓÂÔÁÓfi η٤ÏËÍ 6 Ë̤Ú˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘.

∂ÈÎfiÓ·. ÀÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜.

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°È¿ÓÓ˘ ª·ıÈÔ˘‰¿Î˘ ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ŒÊ˘Á ·fi ÎÔÓÙ¿ Ì·˜, Û˘Óԉ‡ÔÓÙ·˜ ÙËÓ ·Á·Ë̤ÓË ÙÔ˘ Û‡˙˘ÁÔ ∂ϤÓË, Ô ÂÎÏÂÎÙfi˜ Û˘Ó¿‰ÂÏÊÔ˜, ∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜, °È¿ÓÓ˘ ª·ıÈÔ˘‰¿Î˘. ∏ ›‰ËÛË ¤ÂÛÂ Û·Ó ÎÂÚ·˘Ófi˜ Û ÂÌ¿˜ ÙÔ˘˜ Ê›ÏÔ˘˜ Î·È Û˘ÓÂÚÁ¿Ù˜ Ù˘ µ’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ·ÏÏ¿ Î·È ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” Î·È Û ÔÏfiÎÏËÚË ÙËÓ È·ÙÚÈ΋ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiÙËÙ·. ∆Ô ÎÂÓfi Ô˘ ¿ÊËÛ ›Ûˆ ÙÔ˘ Ô °È¿ÓÓ˘ Â›Ó·È ‰˘Û·Ó·Ï‹ÚˆÙÔ. ∏ ¢ı‡ÙËÙ·, Ë Â˘ı˘ÎÚÈÛ›·, ¢Á¤ÓÂÈ· Î·È ÙÔ ‹ıÔ˜ ÙÔ˘ ˆ˜ ÁÈ·ÙÚÔ‡ Î·È ˆ˜ ‰·ÛοÏÔ˘ ı· ·ÔÙÂÏÔ‡Ó ÊˆÙÂÈÓfi ·Ú¿‰ÂÈÁÌ· ÁÈ· fiÛÔ˘˜ ÙÔÓ ÁÓÒÚÈ˙·Ó, ÁÈ· fiÛÔ˘˜ ‰Ô‡Ï„·Ó Ì·˙› ÙÔ˘. ∆Ô ¿ıÔ˜ ÙÔ˘ ÁÈ· ÙËÓ ÂÎ·›‰Â˘ÛË Î·È Ë ÔÈfiÙËÙ· Ù˘ ‰È‰·Ûηϛ·˜ ÙÔ‡ ¤‰ˆÛ·Ó ‰ÈηȈ̷ÙÈο fiÏË ÙËÓ Â˘ı‡ÓË Ù˘ ÂÎ·›‰Â˘Û˘ Ù˘ ÎÏÈÓÈ΋˜, Ì›· ¢ı‡ÓË Ô˘ ‰ÂÓ ÙÔ˘ ·Ú·¯ÒÚËÛ ηÓ›˜, ·ÏÏ¿ ÙËÓ ‹Ú ÌfiÓÔ˜ ÙÔ˘. ŒÊ˘Á ÙËÓ Ë̤ڷ Ù˘ ÁÈÔÚÙ‹˜ ÙÔ˘, Û˘Óԉ‡ÔÓÙ·˜ ÙË Û‡˙˘Áfi ÙÔ˘ Ô˘ ¤Ê˘Á ‰‡Ô Ë̤Ú˜ ÓˆÚ›ÙÂÚ· Î·È ÂÌ›˜ Ì›ӷÌ ›Ûˆ ÛÙÔÓ ¯ÒÚÔ Ù˘ ‰Ô˘ÏÂÈ¿˜, ÁÈ· Ó· ÙÔÓ ı˘ÌfiÌ·ÛÙ ¿ÓÙ· ˆ˜ Ì›· ÁÏ˘ÎÈ¿ ·Ó¿ÌÓËÛË. ¶·Ó. ™˘Ú›‰Ë˜ ∞Ó. ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜

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∂¶π™∆O§∏ ¶ƒO™ ∆∏ ™À¡∆∞•∏ ∆· 32 ¯ÚfiÓÈ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ “¶·È‰È·ÙÚÈ΋” ÃÚ‹ÛÙÔ˜ ™. ª·ÚÙÛfiη˜

OÌfiÙÈÌÔ˜ ∫·ıËÁËÙ‹˜ ¶·È‰È·ÙÚÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ

¶·È‰È·ÙÚÈ΋ 2005;68:164-165

£· ‹ıÂÏ· Ó· Û·˜ Û˘Á¯·ÚÒ ÁÈ· ÙËÓ ·Ó·‚¿ıÌÈÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Î·È Ì ÙËÓ Â˘Î·ÈÚ›· ·˘Ù‹ Ó· Û·˜ ˘ÂÓı˘Ì›Ûˆ οÔÈ· ÂӉȷʤÚÔÓÙ· ÛÙÔȯ›· ·fi ÙËÓ ÈÛÙÔÚ›· ÙÔ˘. ∆Ô ÂÚÈÔ‰ÈÎfi Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜, Ô˘ ΢ÎÏÔÊÔÚ› Û‹ÌÂÚ· Ì ÙËÓ ÂˆÓ˘Ì›· “¶·È‰È·ÙÚÈ΋”, Û˘ÌÏ‹ÚˆÛ 72 ¯ÚfiÓÈ· ˙ˆ‹˜ ÛÙȘ 20 ∞˘ÁÔ‡ÛÙÔ˘ 2004. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ë ›‰Ú˘ÛË Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ·ÔÊ·Û›ÛÙËΠÛÙȘ 25 ºÂ‚ÚÔ˘·Ú›Ô˘ 1931 ·fi 22 ·È‰È¿ÙÚÔ˘˜, ÔÈ ÔÔ›ÔÈ Û˘ÁÎÂÓÙÚÒıËÎ·Ó ÛÙÔ ÁÚ·ÊÂ›Ô ÙÔ˘ °ÂˆÚÁ›Ô˘ ¡. ª·Îο, ∫·ıËÁËÙ‹ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ Î·È ÛÙË Û˘Ó¤¯ÂÈ·, ÛÙȘ 29 ∞ÚÈÏ›Ô˘ 1931, Û Ӥ· Û˘ÁΤÓÙÚˆÛË, ÂÁÎÚ›ıËΠÙÔ Î·Ù·ÛÙ·ÙÈÎfi, ÙÔ ÔÔ›Ô Î˘ÚÒıËΠ·fi ÙÔ ÂÓ ∞ı‹Ó·È˜ ¶ÚˆÙÔ‰ÈΛÔ, ·fiÊ·ÛË ˘’ ·ÚÈı. 4648 Ù˘ 19˘ ª·˝Ô˘ 1931. ∆Ô ÚÒÙÔ ‰ÈÔÈÎËÙÈÎfi Û˘Ì‚Ô‡ÏÈÔ Ù˘ ∂¶∂ ··ÚÙ›ÛÙËΠ·fi ÙÔÓ ∫·ıËÁËÙ‹ °. ª·Îο ˆ˜ ¶Úfi‰ÚÔ, ÙÔÓ ™. §Ô‡ÚÔ, ∞ÓÙÈÚfi‰ÚÔ, ÙÔÓ ¶. ªËÙÚfiÔ˘ÏÔ, ∆·Ì›·, ÙÔÓ ∫. ™·ÚfiÁÏÔ˘, °ÂÓÈÎfi °Ú·ÌÌ·Ù¤·, ÙÔÓ ∑. ∫ÔÎÎÈÓ¿ÎË, ∂ȉÈÎfi °Ú·ÌÌ·Ù¤· Î·È ÙÔ˘˜ ™. µ¤Ú·, ª. ¶·Ï·ÈÔÏfiÁÔ Î·È °. £. ™·ÓÔ‡‰Ë ˆ˜ ™˘Ì‚Ô‡ÏÔ˘˜. ∞ÎÔÏÔ‡ıËÛ·Ó Ù¤ÛÛÂÚȘ ÊÈÏÈΤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Û ٷ‚¤ÚÓ· Ù˘ Ô‰Ô‡ ∞¯·ÚÓÒÓ Î·È Ù¤ÛÛÂÚȘ Ù·ÎÙÈΤ˜ Î·È Ì›· ¤ÎÙ·ÎÙË - ÂÈÛÙËÌÔÓÈΤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ. ™‡Ìʈӷ Ì ÙÔ Î·Ù·ÛÙ·ÙÈÎfi, ÔÈ ÂÈÛÙËÌÔÓÈΤ˜ ·Ó·ÎÔÈÓÒÛÂȘ ÙˆÓ Û˘Ó‰ÚÈ¿ÛÂˆÓ Ù˘ ∂Ù·ÈÚ›·˜ ¤ÚÂ ӷ ‰ËÌÔÛȇÔÓÙ·È ÂÓÙfi˜ ÌËÓfi˜ ·fi Ù˘ ·Ó·ÎÔÈÓÒÛÂÒ˜ ÙÔ˘˜. ™Â ¿ÚıÚÔ Û˘Óٿ͈˜ ÙÔ˘ ÚÒÙÔ˘ Ù‡¯Ô˘˜ ÙÔ˘ ¢ÂÏÙ›Ô˘ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ (1) ·Ó·Ê¤ÚÂÙ·È ˆ˜ ·›ÙÈÔ Ù˘ ηı˘ÛÙÂÚË̤Ó˘ ‰ËÌÔÛȇۈ˜ “Ë ‰È·Ù¿Ú·ÍË ÙˆÓ ÁÂÓÈÎÒÓ ÔÈÎÔÓÔÌÈÎÒÓ Û˘ÓıËÎÒÓ” Î·È ÂÎÊÚ¿˙ÂÙ·È Ë ÂÏ›‰· fiÙÈ ı· ÚÔ¯ˆÚ‹ÛÂÈ Û‡ÓÙÔÌ· Ë ‰ËÌÔÛ›Â˘ÛË ÙˆÓ ·Ó·ÎÔÈÓÒÛÂˆÓ ÙÔ˘ ÚÔËÁÔ‡ÌÂÓÔ˘ ¤ÙÔ˘˜. ™ÙÔ Î·Ù·ÛÙ·ÙÈÎfi Ù˘ ∂¶∂ ˘¿Ú¯Ô˘Ó ‰‡Ô ·Ó·ÊÔÚ¤˜ ÛÙÔ ¢ÂÏÙ›Ô. ™‡Ìʈӷ Ì ÙÔ ¿ÚıÚÔ 4, ·Ú¿ÁÚ·ÊÔ˜ Á, ÙÔ˘ ∫ÂÊ·Ï·›Ô˘ ∞ã ÙÔ˘ ηٷÛÙ·ÙÈÎÔ‡ Ù˘ ∂¶∂ ·Ó·Ê¤ÚÂÙ·È fiÙÈ: “Á) ‰ËÌÔÛȇÂÈ Ù· Ú·ÎÙÈο ÙˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ Û˘Ó‰ÚÈ¿ÛÂˆÓ ·˘Ù‹˜ ÂȘ Ù‡¯Ë ÂÓÙfi˜ ÙÔ˘ ÚÒÙÔ˘ ÌÂÙ¿ ÙËÓ Û˘Ó‰ڛ·ÛÈÓ ÙÔ˘ ÌËÓfi˜ Î·È ‰È·Ó¤ÌÂÈ Ù·‡Ù· ‰ˆÚ¿Ӕ. ™ÙÔ ÎÂÊ¿Ï·ÈÔ πã (¶fiÚÔÈ Ù˘ ∂Ù·ÈÚ›·˜), ¿ÚıÚÔ 1, ·Ú¿ÁÚ·ÊÔ˜ Á: “∆· ¤ÛÔ‰· ÙÔ˘ ¢ÂÏÙ›Ô˘ ÙˆÓ ¶Ú·ÎÙÈÎÒÓ Ù˘ ™˘Ó‰ÚÈ¿Ûˆ˜ (‰ËÌÔÛȇÛÂȘ, ·ÁÁÂÏ›·È)...”. ŒÙÛÈ, ÛÙȘ 20 ∞˘ÁÔ‡ÛÙÔ˘ 1932 ΢ÎÏÔÊÔÚ› ÙÔ ÚÒÙÔ Ù‡¯Ô˜ ÙÔ˘ ¢ÂÏÙ›Ô˘ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜. ∏ ÚÒÙË ÂÚÁ·Û›· Ô˘ ‰ËÌÔÛȇÂÙ·È Â›Ó·È ÙˆÓ °. ¡. ª·Îο Î·È ¡. °. ∑ÂÚ‚Ô‡ Ì ı¤Ì·: “ªÂÙ·‰ÈÊıÂÚÈÙÈη› ·Ú·Ï‡ÛÂȘ Î·È ıÂÚ·›· ·˘ÙÒÓ” (2). ∏ ÂÚÁ·Û›· ·˘Ù‹ ·ÊÔÚ¿ Û ·Ó·ÎÔ›ÓˆÛË ÛÙË Û˘Ó‰ڛ·ÛË Ù˘ ∂¶∂ ÛÙȘ 25 ¡ÔÂÌ‚Ú›Ô˘ 1931. ™ÙȘ ÙÂÏÂ˘Ù·›Â˜ ÛÂÏ›‰Â˜ οı Ù‡¯Ô˘˜ ‰ËÌÔÛȇÔÓÙ·È ÂÚÈÏ‹„ÂȘ ÙˆÓ ÂÚÁ·ÛÈÒÓ, οو ·fi ÙÔÓ Á·ÏÏÈÎfi Ù›ÙÏÔ: “Bulletin de la Société Hellénique de Pédiatrie”. ∞fi ÙfiÙÂ, ÙÔ ¢ÂÏÙ›Ô Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ÂΉȉfiÙ·Ó Û ٷÎÙ¿ ‰È·ÛÙ‹Ì·Ù·, Ì ÌÈÎÚ‹ ηı˘ÛÙ¤ÚËÛË ÛÙ· ‰‡ÛÎÔÏ· ¯ÚfiÓÈ· Ù˘ ηÙÔ¯‹˜, ÔfiÙÂ Î·È ÔÈ ÂÚÈÏ‹„ÂȘ ÙˆÓ ÂÚÁ·ÛÈÒÓ ‹Ù·Ó ÛÙ· ÁÂÚÌ·ÓÈο. Èڛ˜ ÂÈÙÚÔ‹ Û‡ÓÙ·Í˘, ÔÈ ÂÚÁ·Û›Â˜ ·Ú·‰›‰ÔÓÙ·Ó ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ·Ó·ÎÔ›ÓˆÛ‹ ÙÔ˘˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ›Ù ÛÙÔÓ °Ú·ÌÌ·Ù¤· ÙÔ˘ ¢ÈÔÈÎËÙÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘ Ù˘ ∂¶∂, ›Ù ÛÙÔÓ ˘¿ÏÏËÏÔ Ù˘ ∂Ù·ÈÚ›·˜, Ô ÔÔ›Ô˜ ÊÚfiÓÙÈ˙ ÁÈ· ÙËÓ ·ÔÛÙÔÏ‹ ÙÔ˘˜ ÛÙÔ Ù˘ÔÁÚ·ÊÂ›Ô Î·È ÙËÓ ÚÔÒıËÛË ÁÈ· ‰ÈfiÚıˆÛË ÙˆÓ ‰ÔÎÈÌ›ˆÓ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜. ∏ ÌÂÙ·ÔÏÂÌÈ΋ Â·Ó¿ÛÙ·ÛË ÛÙȘ ÂÍÂÏ›ÍÂȘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ηıÈÛÙ¿ ¤Î‰ËÏË ÙËÓ ·Ó¿ÁÎË ‰ËÌÈÔ˘ÚÁ›·˜ ÂÓfi˜ ÔÚÁ¿ÓÔ˘ ÂÈÛÙËÌÔÓÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ ÙˆÓ ·È‰È¿ÙÚˆÓ. ∆Ô ÌÔÓ·‰ÈÎfi ·È‰È·ÙÚÈÎfi ÂÚÈÔ‰ÈÎfi, ÂÎÙfi˜ ÙÔ˘ ¢ÂÏÙ›Ô˘ Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜, Â›Ó·È ÙÔ ¢ÂÏÙ›Ô Ù˘ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. øÛÙfiÛÔ, ·fi ÙÔ ¢ÂÏÙ›Ô Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ ·Ô˘ÛÈ¿˙ÂÈ Ë ÔÈfiÙËÙ·, Ë ÎÚ›ÛË ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ ÙˆÓ ÂÚÁ·ÛÈÒÓ Î·È, ‰˘ÛÙ˘¯Ò˜, ÔÈ ‰ÈÔÚıˆÙÈΤ˜ ‚ÂÏÙÈÒÛÂȘ ÙˆÓ ÎÂÈÌ¤ÓˆÓ ÙˆÓ ‰ËÌÔÛÈ¢ÔÌ¤ÓˆÓ ÂÚÁ·ÛÈÒÓ, ÂÊfiÛÔÓ Ô˘ÛÈ·ÛÙÈο ·ÓÙÈÚÔÛˆÂ‡Ô˘Ó Ú·ÎÙÈο ·Ó·ÎÔÈÓÒÛˆÓ. ∆ÂÏÈο, ÙÔ 1973, ÙÔ ˘fi ÙËÓ ÚÔ‰ڛ· Ù˘ ÀÊËÁ‹ÙÚÈ·˜ Î. §‹‰·˜ ∑¿ÓÓÔ˘-ª·ÚÈÔϤ· Û˘Ì‚Ô‡ÏÈÔ Ù˘ ∂¶∂, ·ÔÊ·Û›˙ÂÈ ÙËÓ ·ÈÛıËÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ¤Î‰ÔÛ˘, ÙËÓ ÚÔÛı‹ÎË ÂÚÈÏ‹„ÂˆÓ ÂȘ ÙËÓ ·ÁÁÏÈ΋, ÙË ÌÂÙÔÓÔÌ·Û›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Û “¶·È‰È·ÙÚÈ΋” Î·È ÙËÓ ·Ó¿ıÂÛË Ù˘ Û‡ÓÙ·Í˘ ÛÙÔÓ ÃÚ. ª·ÚÙÛfiη, Ô ÔÔ›Ô˜ ÌÂÙ¿ ·fi 10 ¯ÚfiÓÈ· ·Ú¤‰ˆÛ ÙË ÛÎ˘Ù¿ÏË ÛÙË Û˘Ó¿‰ÂÏÊÔ ∂ϤÓË µ·Ï¿ÛÛË-∞‰¿Ì. ™ÙÔ Ï·›ÛÈÔ Ù˘ ·ÈÛıËÙÈ΋˜ ‚ÂÏÙ›ˆÛ˘ ¤ÚÂ ӷ “ηÏψÈÛÙ›” Î·È ÙÔ ÂÍÒÊ˘ÏÏÔ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ªÂÙ¿ ·fi ÂÚÈËÁ‹ÛÂȘ Ù˘ Î. ∑¿ÓÓÔ˘ Î·È ÙÔ˘ Î. ª·ÚÙÛfiη ÛÙ· ªÔ˘Û›· ÙˆÓ ∞ıËÓÒÓ, ÂÂϤÁË Ó· ÂÚÈÏËÊı› ÂÈÎfiÓ· ·Á·ÏÌ·Ùȉ›Ô˘ Á˘Ó·›Î·˜ Ô˘ ÎÚ·Ù¿ ‚Ú¤ÊÔ˜, Û Á·Ï¿˙ÈÔ ÊfiÓÙÔ (3).

Paediatriki Mar-Apr 05

21-04-05

15:03

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LETTER TO THE EDITOR

165

∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ·fi ÙÔ ÚÒÙÔ Ù‡¯Ô˜ ÙÔ˘ 1974 Ë “¶·È‰È·ÙÚÈ΋” Û˘Ó¯Ҙ ‚ÂÏÙÈÒÓÂÙ·È, η٤¯Ô˘Û· ϤÔÓ Â›˙ËÏË ı¤ÛË ÌÂٷ͇ ÙˆÓ ÂÏÏËÓÈÎÒÓ È·ÙÚÈÎÒÓ ÂÚÈÔ‰ÈÎÒÓ. ∆· ¿ÚıÚ· Ô˘ ‰ËÌÔÛȇÔÓÙ·È Â›Ó·È ˘„ËÏÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ÂÈ¤‰Ô˘ Î·È ÙÔ ÂÚÈÔ‰ÈÎfi Ì·˜ ‰ÂÓ ¤¯ÂÈ Ó· ˙ËϤ„ÂÈ Û ÂÌÊ¿ÓÈÛË Î¿ÙÈ ·fi Ù· ͤӷ ÂÚÈÔ‰Èο. ∏ ÂÚÈÔÚÈṲ̂ÓË, fï˜, ¯Ú‹ÛË Ù˘ ÂÏÏËÓÈ΋˜ ÁÏÒÛÛ·˜ ·Ó¿ ÙÔÓ ÎfiÛÌÔ ·ÔÙÂÏ› ÙÔ ÌÂÁ¿ÏÔ ÌÂÈÔÓ¤ÎÙËÌ· ÁÈ· ÙË ‰ÈÂıÓ‹ ÚÔ‚ÔÏ‹ Ù˘ ÂÏÏËÓÈ΋˜ ·È‰È·ÙÚÈ΋˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ÚÔÛ¤Ï΢ÛË ‰ËÌÔÛȇÛÂˆÓ ·fi ¿ÏϘ ¯ÒÚ˜. ∂›Ó·È ·Ù¿ Ù· ÂÈÙ˘¯‹ ·Ú·‰Â›ÁÌ·Ù· ¿ÏÏˆÓ ¯ˆÚÒÓ, fiˆ˜ Ë ∆Ô˘ÚΛ·, Ô˘ ÂΉ›‰Ô˘Ó ·ÁÁÏfiʈӷ ·È‰È·ÙÚÈο ÂÚÈÔ‰Èο, ·ÏÏ¿ Î·È Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜, Ë ÔÔ›· Ì ÙÔ ÂÚÈÔ‰ÈÎfi “Hormones” ¤¯ÂÈ ÂÈÙ‡¯ÂÈ ÛËÌ·ÓÙÈο ‚‹Ì·Ù· ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘ÌÂÚÈÏËÊı› ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·. ∆È ¯ÚÂÈ¿˙ÂÙ·È Ë “¶·È‰È·ÙÚÈ΋”; ∫·Ù¿ ÙËÓ Ù·ÂÈÓ‹ ÌÔ˘ ÁÓÒÌË ı· Ú¤ÂÈ ·Ú¿ÏÏËÏ· Ó· ÂΉ›‰ÔÓÙ·È Ù‡¯Ë ˘„ËÏÔ‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ÂÈ¤‰Ô˘ ÛÙËÓ ·ÁÁÏÈ΋ ÁÏÒÛÛ·, Ì ·˘ÛÙËÚ‹ ÎÚÈÙÈ΋ ÂÈÏÔÁ‹ ÙˆÓ ‰ËÌÔÛÈ¢ÔÌ¤ÓˆÓ ÂÚÁ·ÛÈÒÓ. ∂›Ó·È ··Ú·›ÙËÙÔ Ë ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È Ó· ¯ÚËÛÈÌÔÔÈ› ˆ˜ ÎÚÈÙ¤˜ ÂÚÁ·ÛÈÒÓ Î·Ù·ÍȈ̤ÓÔ˘˜ ŒÏÏËÓ˜ ·È‰È¿ÙÚÔ˘˜ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡. ªfiÓÔ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ı· ˘¿ÚÍÂÈ ‰È¤ÍÔ‰Ô˜ Ù˘ ÂÏÏËÓÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÛÙË ‰ÈÂıÓ‹ ÂÈÛÙËÌÔÓÈ΋ ·Ú¤Ó·!

µÈ‚ÏÈÔÁÚ·Ê›· 1. ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·. ¢ÂÏÙ›Ô Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ 1932;1:1-2.

2. ª·Îο °¡, ∑ÂÚ‚Ô‡ ¡°. ªÂÙ·‰ÈÊıÂÚÈÙÈη› ·Ú·Ï‡ÛÂȘ Î·È ıÂÚ·›· ·˘ÙÒÓ. ¢ÂÏÙ›Ô Ù˘ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›·˜ 1932;1:13-22.

3. ∏ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹. ∆˘ Û˘Óٿ͈˜. ¶·È‰È·ÙÚÈ΋ 1974;37:1-2.

¶·È‰È·ÙÚÈ΋ 2005;68:164-165

Paediatriki Mar-Apr 05

166

µ‘ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜ E-mail: ngp@allergy.gr

19-04-05

15:31

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√

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

NAPNAP - °È· ˘„ËÏ‹˜ ÂÍÂȉ›Î¢Û˘ ÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi - http://www.napnap.org ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔÓ ‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ·ÌÂÚÈηÓÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡, ÌË-ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, National Association of Pediatric Nurse Practitioners (NAPNAP), Ì ·ÓÙÈΛÌÂÓÔ ÙËÓ ÂÓË̤ڈÛË Î·È ÂÎ·›‰Â˘ÛË Û ı¤Ì·Ù· °ÂÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜, fiˆ˜ Ë ÚfiÏË„Ë Î·È Ë ıÂÚ·›· ÙˆÓ ·È‰ÈÎÒÓ ÓfiÛˆÓ. ∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ NAPNAP ÚÔÛʤÚÂÈ ÏËÚÔÊÔÚÈ·Îfi ˘ÏÈÎfi Û¯ÂÙÈο Ì ÙȘ ‰Ú¿ÛÂȘ Î·È Ù· ÚÔÁÚ¿ÌÌ·Ù· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, fiˆ˜ ÙÔ “NAPNAP Prevention Initiative”, ÁÈ· ÙËÓ ÂÎ·›‰Â˘ÛË Û Ӥ˜ ÌÂıfi‰Ô˘˜ ·ÓÔÛÔÔ›ËÛ˘ ÂÓ¿ÓÙÈ· ÛÙ· Û˘ÓËı¤ÛÙÂÚ· ·È‰Èο ÓÔÛ‹Ì·Ù·. ∂ÈϤÔÓ, ÛÙËÓ ÎÂÓÙÚÈ΋ ÛÂÏ›‰· ÙÔ˘ NAPNAP ˘¿Ú¯Ô˘Ó ÂȉÈο ·ÊÈÂÚÒÌ·Ù· Û ‰È·ÊÔÚÂÙÈο οı ÊÔÚ¿ ÓÔÛ‹Ì·Ù·, ηıÒ˜ Î·È Û˘Ì‚Ô˘Ï¤˜ Û ı¤Ì·Ù· ·È‰È΋˜ ‰È·ÙÚÔÊ‹˜ Î·È ¿ÛÎËÛ˘. ª¤Ûˆ Ù˘ ËÏÂÎÙÚÔÓÈ΋˜ ·ÚÔ˘Û›·˜ ÙÔ˘, Ô ÔÚÁ·ÓÈÛÌfi˜ NAPNAP ÛÙԯ‡ÂÈ ÛÙËÓ Î¿Ï˘„Ë Ì›·˜ ¢Ú›·˜ Áο̷˜ ıÂÌ¿ÙˆÓ Ú·ÎÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÁÈ· ÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ ÓÔÛËÏÂ˘Ù¤˜ ·È‰ÈÒÓ. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi, Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ‚ÚÂÈ ·Ó·ÊÔÚ¤˜ ÛÙÔ˘˜ ‚·ÛÈÎÔ‡˜ ÓfiÌÔ˘˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜, ÎÔ˘›˙ ÚÔʇϷ͢ ·fi ÙË ÁÚ›Ë, Ô‰ËÁ›Â˜ ·Ó·˙‹ÙËÛ˘ ¯ÔÚËÁÈÒÓ Î·È Û˘ÓÂÚÁ·Û›·˜ Ì ʷÚ̷΢ÙÈΤ˜ ‚ÈÔÌ˯·Ó›Â˜, È·ÙÚÈΤ˜ Û˘‚Ô˘Ï¤˜ ÚÔ˜ ÙÔ˘˜ ÁÔÓ›˜ ·ÏÏ¿ Î·È ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜. OÈ Â·ÁÁÂÏ̷ٛ˜ ¤¯Ô˘Ó ÂÈϤÔÓ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙȘ ‰Ú¿ÛÂȘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ̤۷ ·fi ÂȉÈ΋ ıÂÌ·ÙÈ΋ ÂÓfiÙËÙ· (Clinical Expert Panel), ÂÓÒ ÛÙÔ ∫¤ÓÙÚÔ ™˘Ó¯È˙fiÌÂÓ˘ ∂Î·›‰Â˘Û˘ ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌÔ ˘ÏÈÎfi, ÚÔÁÚ¿ÌÌ·Ù· Î·È ËÏÂÎÙÚÔÓÈΤ˜ ÂÊËÌÂÚ›‰Â˜ ¶·È‰È·ÙÚÈ΋˜. ¶·Ú¿ ÙȘ ·‰˘Ó·Ì›Â˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙËÓ ÏÔ‹ÁËÛË Î·È ÙËÓ ÂÓË̤ڈÛË - οÔȘ ˘ÔÂÓfiÙËÙ˜ ‰ÂÓ ÏÂÈÙÔ˘ÚÁÔ‡Ó Ï‹Úˆ˜ - Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ ÙÔ˘ NAPNAP ·ÔÙÂÏ› ¤Ó· ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÏËÚÔÊfiÚËÛ˘ Î·È ·Ú¿‰ÂÈÁÌ· ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÂÍÂȉ›Î¢Û˘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ¡ÔÛËÏ¢ÙÈ΋.

Infectious Diseases in Children - ∆· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÛÙÔ ÌÈÎÚÔÛÎfiÈÔ http://idinchildren.com ∏ ËÏÂÎÙÚÔÓÈ΋ ¤Î‰ÔÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Infectious Diseases in Children ¤¯ÂÈ ˆ˜ ·ÓÙÈΛÌÂÓÔ Ù· ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· Î·È ·¢ı‡ÓÂÙ·È Û Â·ÁÁÂÏ̷ٛ˜ Î·È ÂÚ¢ÓËÙ¤˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ∏ Û˘ÓÙ·ÎÙÈ΋ ÔÌ¿‰· ·ÔÙÂÏÂ›Ù·È ·fi ‰È·ÎÂÎÚÈ̤ÓÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È Â·ÁÁÂÏ̷ٛ˜ ·fi ÙÔÓ ¯ÒÚÔ Ù˘ ¶·È‰È·ÙÚÈ΋˜ ÛÙȘ ∏¶∞, ÔÈ ÔÔ›ÔÈ ·Ó·ÓÂÒÓÔ˘Ó ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ Û ÌËÓÈ·›· ‚¿ÛË. ∏ ÏÔ‹ÁËÛË ÛÙÔÓ ‰ÈÎÙ˘·Îfi ÙfiÔ Ù˘ ÂÊËÌÂÚ›‰·˜ Â›Ó·È Â‡ÎÔÏË Î·È ¿ÌÂÛË, ·ÏÏ¿ ‰ˆÚÂ¿Ó ·Ú¤¯ÂÙ·È ÌfiÓÔ ÙÔ ÚÒÙÔ Â›Â‰Ô Ù˘ ÏËÚÔÊÔÚ›·˜, ‰ËÏ·‰‹ Ù· ÂÚȯfiÌÂÓ· ÙÔ˘ ÙÚ¤¯ÔÓÙÔ˜ Ù‡¯Ô˘˜. ∏ ¶·È‰È·ÙÚÈ΋ 2005;68:166-167

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¡EWS FROM THE INTERNET

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Ï‹Ú˘ ÚfiÛ‚·ÛË ÂÈÙÚ¤ÂÙ·È ÌfiÓÔ ÛÂ Û˘Ó‰ÚÔÌËÙ¤˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë ÂÓfiÙËÙ· ÁÈ· ÙË ™˘Ó¯È˙fiÌÂÓË π·ÙÚÈ΋ ∂Î·›‰Â˘ÛË, ¢ڤˆ˜ ÚÔÛ‚¿ÛÈÌË, fiÔ˘ Ô ¯Ú‹ÛÙ˘ ÌÔÚ› Ó· ‚ÚÂÈ Ì›· ‚È‚ÏÈÔı‹ÎË ıÂÌ¿ÙˆÓ Û¯ÂÙÈο Ì ÙȘ ÂÍÂÏ›ÍÂȘ Î·È ÙȘ ÚÔÔÙÈΤ˜ ÛÙ· ·È‰Èο ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù·. ∂ÎÙfi˜ ·fi ÙÔ ÂÚȯfiÌÂÓÔ ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ Ù‡¯Ô˘˜ Ù˘ ÂÊËÌÂÚ›‰·˜, ˘¿Ú¯ÂÈ Î·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó·˙‹ÙËÛ˘ ·Ï·ÈfiÙÂÚˆÓ ¿ÚıÚˆÓ - ·fi ÙÔ 1996 - ̤۷ ·fi ÙÔ ·Ú¯Â›Ô.

Archives of Disease in Childhood - ª›· ‰ÈÂÈÛ‰˘ÙÈ΋ Ì·ÙÈ¿ ÛÙ· ·Ú¯Â›· Ù˘ ·È‰È·ÙÚÈ΋˜ http://adc.bmjjournals.com ¶ÚfiÎÂÈÙ·È ÁÈ· ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ¤Î‰ÔÛË ÙÔ˘ ÁÓˆÛÙÔ‡ Û fiÏÔ˘˜ ÂÚÈÔ‰ÈÎÔ‡ Archives of Disease in Chidlhood ÙÔ˘ Royal College of Paediatrics and Child Health. ∞¢ı‡ÓÂÙ·È ÛÙÔ˘˜ Â·ÁÁÂÏ̷ٛ˜ Î·È ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ·fi ÙÔÓ ¯ÒÚÔ Ù˘ ¶·È‰È·ÙÚÈ΋˜. ∂Í·ÈÚÂÙÈο ÂӉȷʤÚÔ˘Û· Â›Ó·È Ë ÂÓfiÙËÙ· “∞گ›·” ÛÙËÓ ÎÂÓÙÚÈ΋ ÛÂÏ›‰· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, fiÔ˘ Â›Ó·È ‰È·ı¤ÛÈÌ· Ù‡¯Ë ·fi ÙÔ 1974. ∂ÈϤÔÓ, Ô ¯Ú‹ÛÙ˘ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÚÔÂÈÛÎfiËÛ˘ ÙÔ˘ ÂfiÌÂÓÔ˘ Ù‡¯Ô˘˜, ÂÓÒ ÌÔÚ› Ó· ‰ÂÈ Î·È ÛÙ·ÙÈÛÙÈΤ˜ ·Ó·ÊÔÚ¤˜ ÁÈ· Ù· 10 ÈÔ ‰ËÌÔÊÈÏ‹ ¿ÚıÚ· ÙÔ˘ ÂÚ·Ṳ̂ÓÔ˘ ¤ÙÔ˘˜. °È· ÙÔ˘˜ Â›‰ÔÍÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÂÎÙfi˜ ·fi Ô‰ËÁ›Â˜ Û˘ÁÁÚ·Ê‹˜ ¿ÚıÚˆÓ, ˘¿Ú¯ÂÈ Î·È ÂȉÈÎfiÙÂÚË ·Ó·ÊÔÚ¿-Ô‰ËÁ›· Û fiÛÔ˘˜ ÂÈı˘ÌÔ‡Ó Ó· Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË µ·ÛÈṲ̂ÓË Û ¢Â‰Ô̤ӷ ¶·È‰È·ÙÚÈ΋. ∆Ô Archives, ‚¤‚·È·, Â›Ó·È Ì¤ÏÔ˜ ÙÔ˘ ÔÌ›ÏÔ˘ British Medical Journal (BMJ) Î·È ÚÔÛʤÚÂÈ ·¢ı›·˜ Û‡Ó‰ÂÛË Û fiÏ· Ù· ÂÚÈÔ‰Èο ÙÔ˘ BMJ, ηıÒ˜ Î·È ÚfiÛ‚·ÛË ÛÙÔ ÙÌ‹Ì· Ù˘ ∏ÏÂÎÙÚÔÓÈ΋˜ µÈ‚ÏÈÔı‹Î˘ ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ¤Ú¢ӷ. Ÿˆ˜ Û fiϘ ÙȘ ÈÛÙÔÛÂÏ›‰Â˜ ÙÔ˘ ÔÌ›ÏÔ˘, Ë ÏÔ‹ÁËÛË Â›Ó·È ÔÌ·Ï‹ Î·È ·ÚfiÛÎÔÙË.

¶·È‰È·ÙÚÈ΋ 2005;68:166-167

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CLINICAL QUIZ ∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏ ∏ ÂȉÈ΋ ÂͤٷÛË Ô˘ ¤ÁÈÓ ‹Ù·Ó Ë ·Ó›¯Ó¢ÛË ÙÔ˘ RNA ÂÓÙÂÚÔ˚ÒÓ Ì PCR ÛÙÔ ·›Ì· Î·È ÙÔ ∂¡À ÙÔ˘ ÓÂÔÁÓÔ‡. ∏ ÂͤٷÛË ·¤‚Ë ıÂÙÈ΋ ÁÈ· ÙÔÓ Èfi Coxsackie B1. O Ù›ÙÏÔ˜ ÙˆÓ ÂȉÈÎÒÓ IgM ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÈÔ‡ ÛÙÔÓ ÔÚfi Ù˘ ÌËÙ¤Ú·˜ ‹Ù·Ó, Â›Û˘, ıÂÙÈÎfi˜. OÈ ÂÓÙÂÚÔ˚Ô› Î·È ÂȉÈο Ô Coxsackie Û˘¯Ó¿ ¢ı‡ÓÔÓÙ·È ÁÈ· ÙËÓ ÚfiÎÏËÛË Ì˘Ôηډ›Ùȉ·˜, ÂÚÈηډ›Ùȉ·˜ Î·È Ï¢ÚÔ‰˘Ó›·˜. ∏ ÌÂȈ̤ÓË Û˘ÛÙ·ÏÙÈÎfiÙËÙ· Î·È ‰È¿Ù·ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, fiˆ˜ Î·È Ë ·ÚÔ˘Û›· Ô˘Ï‹˜ ÛÙÔ ÌÂÛÔÎÔÈÏÈ·Îfi ‰È¿ÊÚ·ÁÌ·, Û˘ÓËÁÔÚÔ‡Ó ÁÈ· Û˘ÁÁÂÓ‹ ÈÔÁÂÓ‹ Ì˘Ôηډ›Ùȉ· ˆ˜ ·ÈÙ›· Ù˘ η٤ÚÂȄ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. ÕÏÏ· ·›ÙÈ· η٤ÚÂȄ˘ Û ·˘Ù‹ ÙËÓ ËÏÈΛ· Â›Ó·È Ë ÛË„·ÈÌ›·, Ë ÂÚÈÁÂÓÓËÙÈ-

µÈ‚ÏÈÔÁÚ·Ê›· 1. Inwald D, Franklin O, Cubitt D, Peters M, Goldman A, Burch M. Enterovirus myocarditis as a cause of neonatal collapse. Arch Dis Child Fetal Neonatal Ed 2004;89:F461F462.

¶·È‰È·ÙÚÈ΋ 2005;68:162,168

΋ ·ÛÊ˘Í›·, Ë ·ÓÒÌ·ÏË ¤ÎÊ˘ÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜, Ë ˘ÔÏ·ÛÙÈ΋ ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·, ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, ÂÈÓÂÊÚȉȷ΋ ·ÓÂ¿ÚÎÂÈ· Î·È Î·Ú‰È·Î¤˜ ·ÚÚ˘ı̛˜. ∏ ÚfiÁÓˆÛË Ù˘ ¿ıËÛ˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ ‚·ıÌfi ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ‰‡Ô ÎÔÈÏÈÒÓ. ∂¿Ó ÚÔÛ‚¿ÏÏÂÙ·È ÌfiÓÔ Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·, ÙfiÙ ¯ÔÚËÁÂ›Ù·È ÚÔÛÙ·ÁÏ·Ó‰›ÓË ∂1 ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÙËÚËı› ·ÓÔÈÎÙfi˜ Ô ‚ÔÙ¿ÏÂÈÔ˜ fiÚÔ˜, ̤ۈ ÙÔ˘ ÔÔ›Ô˘ ÙÚÔÊÔ‰ÔÙÂ›Ù·È Ë Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›· ¤ˆ˜ fiÙÔ˘ ·Ó·ÚÚÒÛÂÈ Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›·. ™Â ÛÔ‚·Ú‹ ˘ÔÍ·ÈÌ›·, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË. ™‹ÌÂÚ·, ¯ÚËÛÈÌÔÔÈÂ›Ù·È Î·È ÙÔ ÂȉÈÎfi ·ÓÙÈÈÎfi Ê¿ÚÌ·ÎÔ pleconaril.

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4-8 ª·˝Ô˘ 2005

17Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ °ÂÓÈ΋˜ π·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Athos Palace ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· °ÂÓÈ΋˜ π·ÙÚÈ΋˜ ¶ÏËÚÔÊÔڛ˜: Œ„ÈÏÔÓ Congress ∆ËÏ.: +30 210 7254 360-2 Fax: +30 210 7254 363 E-mail: 17geniatr@epsiloncongress.gr Website: http://www.epsiloncongress.gr

∫·ÏÏÈı¤· ÷ÏÎȉÈ΋˜

10-15 ª·˝Ô˘ 2005

3Ô ¢ÈÂıÓ¤˜ π·ÙÚÈÎfi πÔÚ‰·ÓÔÂÏÏËÓÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: Morning Star Travel Agency ∆ËÏ.: +30 2310 227 251, 2310 229 863, 2310 227 891 Fax: +30 2310 280 537 E-mail: morning.star@galileo.gr

Amman, Jordan

17-21 ª·˝Ô˘ 2005

31Ô ∂Ù‹ÛÈÔ ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: +30 210 7211 845, 210 7243 161 Fax: +30 210 7215 082 E-mail: iea@mednet.gr Website: http://www.mednet.gr

∞ı‹Ó·

1-4 πÔ˘Ó›Ô˘ 2005

14Ô ¶·ÓÂ˘Úˆ·˚Îfi ™˘Ó¤‰ÚÈÔ ¶·¯˘Û·ÚΛ·˜ ECO 2005 ∞ı‹Ó· ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ∂ÏÏËÓÈ΋ π·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶·¯˘Û·ÚΛ·˜ ¶ÏËÚÔÊÔڛ˜: Triaena Tours ∆ËÏ.: +30 210 7499 300 Fax: +30 210 7705 752 E-mail: congress@triaenatours.gr

17-19 πÔ˘Ó›Ô˘ 2005

43Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ •ÂÓÔ‰Ô¯Â›Ô Kipriotis Village ∂ÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ ∂Ù·ÈÚ›· ¶ÏËÚÔÊÔڛ˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100 Fax. +30 210 6844 777 E-mail: pediatric2005@cnc.gr Website: http://www.pediatric2005.gr

∫ˆ˜

26 πÔ˘Ó›Ô˘1 πÔ˘Ï›Ô˘ 2005

World Allergy Congress 2005 ¶ÏËÚÔÊÔڛ˜: Congrex Sweden AB ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: wac2005@congrex.se Website: http://www.congrex.com/wac2005

Munich, Germany

4-9 ™ÂÙÂÌ‚Ú›Ô˘ 2005

ESPGHAN Summer School on Nutrition “Research Challenges in Clinical Nutrition” Eden Beach Hotel Club European Society for Paediatric Gastroenterology, Hepatology and Nutrition ¶ÏËÚÔÊÔڛ˜: ∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 7726 355, 6945 29 30 71 E-mail: papadop5@otenet.gr

∞Ó¿‚˘ÛÛÔ˜

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The History of Diabetes Mellitus ¢ÔÚ˘ÊÔÚÈÎfi ™˘ÌfiÛÈÔ ÚÈÓ ·fi ÙÔ ÂÙ‹ÛÈÔ Û˘Ó¤‰ÚÈÔ Ù˘ EASD ¶ÏËÚÔÊÔڛ˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100 Fax: +30 210 6844 777 E-mail: easdsymposium2005@cnc.gr Website: http://www.easdsymposium2005.com

¢ÂÏÊÔ›

9-11 ™ÂÙÂÌ‚Ú›Ô˘ 2005

1Ô ¢È··ÓÂÈÛÙËÌÈ·Îfi ¢È·ÓÔÛÔÎÔÌÂÈ·Îfi ™˘Ó¤‰ÚÈÔ °˘Ó·ÈÎÔÏÔÁ›·˜ •ÂÓÔ‰Ô¯Â›Ô “∫·ÏË̤ڷ ∫Ú‹ÙË” ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 7711 673, 210 7756 336 Fax: +30 210 7711 289 E-mail: secretariat@prctravel.gr

ÃÂÚÛfiÓËÛÔ˜, ∫Ú‹ÙË

14-18 ™ÂÙÂÌ‚Ú›Ô˘ 2005 29th UMEMPS - Union Middle Eastern & Mediterranean Pediatric Societies Congress •ÂÓÔ‰Ô¯Â›Ô Hilton ¶ÏËÚÔÊÔڛ˜: Pr. Enver Hasanoglu Fax: +90 312 2237 469, +90 216 3477 095 E-mail: enverh@gazi.edu.tr Website: http://www.istanbul-umemps2005.org

Istanbul, Turkey

25-27 ™ÂÙÂÌ‚Ú›Ô˘ 2005 1Ô ¢ÈÂıÓ¤˜ ∂ÈÛÙËÌÔÓÈÎfi ™˘ÌfiÛÈÔ & 7Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ÁÈ· ÙË ™ÎÏ‹Ú˘ÓÛË Î·Ù¿ ¶Ï¿Î·˜ •ÂÓÔ‰Ô¯Â›Ô Hyatt Regency ¶ÏËÚÔÊÔڛ˜: Artion Conferences & Events ∆ËÏ.: +30 2310 250 927, 2310 252 330 Fax: +30 2310 277 964, 2310 272 276 E-mail: ms@artion.com.gr Website: http://www.greekmssociety.gr

£ÂÛ/Ó›ÎË

28 ™ÂÙÂÌ‚Ú›Ô˘1 √ÎÙˆ‚Ú›Ô˘ 2005

Pre-event to 1st European Conference on ∂Ú¤ÙÚÈ· Injury Prevention and Safety Promotion “Increasing efficiency in injury prevention” •ÂÓÔ‰Ô¯Â›Ô Malaconda ¶ÏËÚÔÊÔڛ˜: ∫∂¶¶∞ ∆ËÏ.: +30 210 7462 187 Fax: +30 210 7462 105 E-mail: preevent@med.uoa.gr Website: http://www.cc.uoa.gr/health/socmed/hygien/pre_event

22 √ÎÙˆ‚Ú›Ô˘ 2005

8th Athens Breast Cancer Symposium ∞ÌÊÈı¤·ÙÚÔ ¡πª∆™ ªÔÓ¿‰· ª·ÛÙÔ‡ Ù˘ µ’ ¶ÚÔ·È‰Â˘ÙÈ΋˜ ÃÂÈÚÔ˘ÚÁÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ∂ıÓÈÎÔ‡ Î·È ∫·Ô‰ÈÛÙÚÈ·ÎÔ‡ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¶ÏËÚÔÊÔڛ˜: PRC Congress & Travel ∆ËÏ.: +30 210 7711 673 Fax: +30 210 7711 289 E-mail: info@prctravel.gr

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