Exof Paediatriki May-June 05
14-06-05
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TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 3 ñ ª¿ÈÔ˜-πÔ‡ÓÈÔ˜ 2005 ¶·È‰È·ÙÚÈ΋ ñ TfiÌÔ˜ 68 ñ ∆‡¯Ô˜ 3 ñ ª¿ÈÔ˜-πÔ‡ÓÈÔ˜ 2005
www.paediatriki.edu.gr
Volume 68 ñ Number 3 ñ May-June 2005 ISSN 0377-2551
Paediatriki May-June 05
12-07-05
13:08
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¶·È‰È·ÙÚÈ΋ ∆fiÌÔ˜ 68 ñ ∆‡¯Ô˜ 3 ñ ª¿ÈÔ˜-πÔ‡ÓÈÔ˜ 2005 ¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ ∂. ∞ÓÙˆÓÔÔ‡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˜ ¡. ¶··‰fiÔ˘ÏÔ˜ ∞. ¶··‰ÔÔ‡ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ª. ∆ÛÔÏÈ¿-¶·Û·Ú¿ÎË ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ I. K·Ú·‚Ú¿ÓÔ˘
¶ÂÚȯfiÌÂÓ· ∞¡∞™∫O¶∏™∂π™
∂¡¢π∞º∂ƒOÀ™∂™ ¶∂ƒπ¶∆ø™∂π™
169 ∏ ı¤ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙ· ·È‰È¿: ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· °. ∆ÛfiÏ·˜
217 ¶ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔÈËÙÈ΋ ÈÓÔ‰˘ÛÏ·Û›·: Ì›· Û¿ÓÈ· ÓfiÛÔ˜ Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÓfi˜ “˙ˆÓÙ·ÓÔ‡ ·Á¿ÏÌ·ÙÔ˜” O. ¢Ô‡ÙÛ˘, ∞. ∫·Ï·Ìfi΢, ∫. ∆ÛÔ˘Ì¿Î·˜
180 OÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË ∞. ™Î·Ú‰Ô‡ÙÛÔ˘ 189 ∫ÏÈÓÈ΋ Î·È ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿: Ù· ÓÂÔÏ¿ÛÌ·Ù· Û·Ó Ì›· ·fi ÙȘ ·Èٛ˜ ÚfiÎÏËÛ˘ ‰‡ÛÓÔÈ·˜ ¶. ∫Ô˘ÙÚԇ̷, ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘-∞Ó‰ÚÔ˘Ï·Î¿ÎË
222 ™Ô‚·Ú‹ ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË Ì ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó·ÎÔ‹ º. ∫·Î·‚¿, ∫. ¶·¿˙ÔÁÏÔ˘, ¶. ªfiÓÔ˘, ∞. ¢·Ú˙¤ÓÙ·˜, π. ¶··‰¿ÙÔ˜
∂π¢π∫O ∞ƒ£ƒO 226 ∏ ·ÂÈÎfiÓÈÛË ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ· Œ. ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘, ∂. ¶ÂÙÚ›‰Ô˘
199 ∆Ô ÛÔ‚·Úfi Ô͇ ·Ó·Ó¢ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ÛÙ· ·È‰È¿ Ã. ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË, µ. ™Ô‡ÏÔ˘
240 ∫§π¡π∫√ ∫√Àπ∑
K. °ÚÈ‚¤·˜
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™
241 NEA ∞¶√ ∆√ ¢π∞¢π∫∆À√
™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜
204 ∂›Â‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‹ ˘ÂÚÏÈȉ·ÈÌ›·˜ ∞. ª·Î¤‰Ô˘, ª. ∫Ô‡ÚÙË, ∫. ª·Î¤‰Ô˘, ™. §·˙·Ú›‰Ô˘, °. ™. µ·ÚÏ¿Ì˘
EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘
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·ÎÔÔ‡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˘ ∂ÔÙ›·˜ ªª∂: 3889
ISSN 0377-2551
210 ¶·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ ÛÙ· ·È‰È¿ ∫. ∞. µÔ‡‰Ú˘, ª. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘, ∂. ™Ù¤ÊÔ˜, ∂. µ·ÁÈ¿ÎÔ˘
Paediatriki May-June 05
12-07-05
13:08
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Paediatriki Volume 68 ñ Number 3 ñ May-June 2005 Bimonthly Publication of the Greek Paediatric Society President A. Constantopoulos Editorial Board 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
Contents REVIEW ARTICLES
CASE REPORTS
179 The safety and efficacy of statin therapy in children with familial hypercholesterolaemia G. Tsolas
221 Fibrodysplasia ossificans progressiva: a rare disease with the clinical features of a “live statue” O. Doutsis, A. Kalampokis, C. Tsoumakas
188 Acute flaccid paralysis A. Skardoutsou
225 Severe infant botulism with cardiorespiratory arrest F. Kakava, K. Papazoglou, P. Bonou, A. Darzentas, I. Papadatos
198 Clinical and diagnostic approach to dyspnoea in children: neoplasms as an underlying cause P. Koutroumba, S. Polychronopoulou-Androulakaki
Manuscript Editing Greek Editing I. Karavranou English Editing S. Nakou Publisher K. Griveas Publishing Coordinator SCIENTIFIC PUBLICATIONS Ltd 3 Artemidos str. GR - 151 25, Maroussi Tel.: +30 210 87 78 810 Fax: +30 210 87 78 822 Owner 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 Annual Subscription All foreign countries: US $ 50
SPECIAL ARTICLE
203 Severe acute respiratory syndrome in children C. Perdikogianni, V. Spoulou
239 The representation of accidents among children and adolescents in Greek literature E. Poulakou-Rebelakou, E. Petridou
ORIGINAL ARTICLES
240 CLINICAL QUIZ
209 Lipid and lipoprotein levels in children with a family history of cardiovascular disease A. Makedou, M. Kourti, K. Makedou, S. Lazaridou, G. S. Varlamis 216 Factors associated with recurrence of febrile seizures in children K. Voudris, M. Servitzoglou, A. Skardoutsou, E. Stefos, E. Vagiakou
241 NEWS FROM THE INTERNET
Paediatriki May-June 05
12-07-05
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√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜ ∆Ô ÂÚÈÔ‰ÈÎfi “¶·È‰È·ÙÚÈ΋” Â›Ó·È Ë ÂÈÛÙËÌÔÓÈ΋ ¤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‡ ÂÈÛÙËÌÔÓÈÎÔ‡ ¤ÚÁÔ˘ Î·È ÙË Û˘Ó¯‹ ÂÓË̤ڈÛË ÙˆÓ ¶·È‰È¿ÙÚˆÓ. °È· ÙÔ ÛÎÔfi ·˘Ùfi ‰¤¯ÂÙ·È ÁÈ· ‰ËÌÔÛ›Â˘ÛË ÔÈÎÈÏ›· ¿ÚıÚˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ: 1. ÕÚıÚ· Û‡ÓÙ·Í˘ (ÌÂÙ¿ ·fi ÚfiÛÎÏËÛË Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜). 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· Âη›‰Â˘Û˘ Î·È ÔÚÁ¿ÓˆÛ˘ ˘Á›·˜. 9. ∂ӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. 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 ÂÈÛÙËÌÔÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ 15. ∞Ó·ÊÔÚ¤˜ Î·È ÎÚÈÙÈ΋ Ó¤ˆÓ ÂΉfiÛˆÓ, ÂÏÏËÓÈÎÒÓ Î·È Í¤ÓˆÓ, ·È‰È·ÙÚÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜. H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ‰ËÌÔÛȇÂÈ ¿ÚıÚ· Ì ȉȷ›ÙÂÚÔ ÂÈÛÙËÌÔÓÈÎfi ÂӉȷʤÚÔÓ, ηıÒ˜ Î·È ¿ÚıÚ· Ì ›ηÈÚ· ı¤Ì·Ù· ¯ˆÚ›˜ Ó· ÙËÚÂ›Ù·È Ë ÛÂÈÚ¿ ˘Ô‚ÔÏ‹˜. ∂›Û˘, ÌÔÚ› 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 ÂÈÛÙÔÏÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È Û ‰ËÌÔÛÈÂ˘Ì¤Ó· ÂÈÛÙËÌÔÓÈο ¿ÚıÚ· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™ÙȘ ÂÚÁ·Û›Â˜ Ì ›ηÈÚ· 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. ∂ÈϤÔÓ, ÛÙËÓ ÂÚÁ·Û›· ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹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 ÂÎÚÔÛÒˆÓ 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 ÂÈÙÚÔ‹ ∏ıÈ΋˜ Î·È ¢ÂÔÓÙÔÏÔÁ›·˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ. OÈ ·fi„ÂȘ Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Ô˘ ‰È·Ù˘ÒÓÔÓÙ·È ÛÙȘ ‰ËÌÔÛÈÂ˘Ì¤Ó˜ ÂÚÁ·Û›Â˜ ‰ÂÓ ·ÓÙÈηÙÔÙÚ›˙Ô˘Ó ··Ú·›ÙËÙ· ·˘Ù¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. H ηٷ¯ÒÚÈÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙÔ ÂÚÈÔ‰ÈÎfi ‰ÂÓ ˘Ô‰ËÏÒÓÂÈ ÔˆÛ‰‹ÔÙ ¤ÁÎÚÈÛË ÙˆÓ ÂÚȯÔÌ¤ÓˆÓ ÙÔ˘˜ ·fi ÙËÓ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·, ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‹ ·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˘˜ ÂÈÙÚ¤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 Ôԛ˜ ÙÚÔÔÔÈ‹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˘ÌÂÚÈÏ·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 ‰ÈÏfi ‰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 ÂȉÔÙ‹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˜ ÂÚÈÙÒÛÂȘ Û 1500-2500 ϤÍÂȘ. ñ ÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Û 1000-1500 ϤÍÂȘ. ñ ÙȘ ÂÈÛÙÔϤ˜ 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 ÂÈÙÚ¤ÔÓÙ·È Û˘ÓÙÌ‹ÛÂȘ. ñ ÙÔ fiÓÔÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ Î¿ıÂ Û˘ÁÁڷʤ· ÛÙËÓ ÔÓÔÌ·ÛÙÈ΋. ñ ÙÔ ÂÈÛÙËÌÔÓÈÎfi ΤÓÙÚÔ (›‰Ú˘Ì·, ÎÏÈÓÈ΋, ÂÚÁ·ÛÙ‹ÚÈÔ) ·fi fiÔ˘ 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 ÙfiÔ˜ ‰È·ÌÔÓ‹˜ ÙÔ˘/ÙÔ˘˜. ñ ÙËÓ Ï‹ÚË ‰È‡ı˘ÓÛË, e-mail Î·È ÙÔ ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· Ì ÙÔÓ ÔÔ›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˘ÌÂÚ¿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˘ÌÂÚ¿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˘ÌÂÚ¿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· ¯ÚËÛÈÌÔÔÈËıÔ‡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·Ô̤˜ Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂÚÁ·Û›·˜. H ÂÚÈÁÚ·Ê‹ ÙˆÓ ÌÂıfi‰ˆÓ Ú¤ÂÈ Ó· Â›Ó·È ·ÎÚÈ‚‹˜ Î·È ·ÚÎÂÙ¿ ÏÂÙÔÌÂÚ‹˜, ÒÛÙ ӷ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó··Ú·ÁˆÁ‹ ÙÔ˘˜ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∂›Û˘, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂȘ 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˘ÌÂÚ¿ÛÌ·Ù· Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙËÓ ÂÚÁ·Û›·, ÙË ÛËÌ·Û›· Ô˘ ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ÙËÓ Èı·Ó‹ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ·Ú·ÙËÚ‹ÛÂȘ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ. OÈ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ 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 ÂȉÔÙ‹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·Ô̤˜.
Editors/ Uniform Requirements for Manuscripts Sub-mitted 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·ÔÌÒÓ I. ¶∂ƒπO¢π∫∞ AÓ ÔÈ Û˘ÁÁÚ·Ê›˜ Â›Ó·È ¤ˆ˜ ¤ÍÈ, ·Ó·ÁÚ¿ÊÔÓÙ·È fiÏÔÈ, ÂÓÒ ·Ó Â›Ó·È ÂÙ¿ ‹ 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·: ›‰Ú·ÛË ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· 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.
™˘ÌÏËڈ̷ÙÈÎfi 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 ÂÈ‚ÏËı› ‰ÈÂıÓÒ˜, ‰ËÌÔÛȇÔÓÙ·È Û οı Ù‡¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ™‡ÓıÂÙÔÈ Î·È Ì·ÎÚÔÛÎÂÏ›˜ fiÚÔÈ Ô˘ ·ӷϷ̂¿ÓÔÓÙ·È Û˘¯Ó¿ ÛÙÔ Î›ÌÂÓÔ ÌÔÚÔ‡Ó Ó· ·ÓÙÈηı›ÛÙ·ÓÙ·È ·fi Û˘ÓÙÔÌÔÁڷʛ˜ Ô˘ ÂÂÍËÁÔ‡ÓÙ·È ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ Û ÂȉÈÎfi ηٿÏÔÁÔ, Ô ÔÔ›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·Ô̤˜ ™ÙÔ ÙÌ‹Ì· Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ ηٷ¯ˆÚÔ‡ÓÙ·È fiϘ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ Ì ÙË ÛÂÈÚ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. ™ÙÔ Î›ÌÂÓÔ, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ·Ó·Ê¤ÚÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·Ô̤˜ ‰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· ›ηÈÚ· ı¤Ì·Ù· Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ. ñ ÙȘ 5 ÛÙȘ ‚Ú·¯Â›Â˜ ‰ËÌÔÛȇÛÂȘ Î·È ÙȘ ÂÈÛÙÔϤ˜.
¢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·ÔÌÒÓ Á›ÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù· ÙÚÔÔÔÈË̤Ó˜ ÚԉȷÁڷʤ˜ Ù˘ International Committee of Medical Journal
¢È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹: ¶··‰fiÔ˘ÏÔ˜ Ã. ∏ ıÂڷ›· ÙÔ˘ ÛÙÚ·‚ÈÛÌÔ‡ [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ¶·ÓÂÈÛÙ‹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˜ AÔÛÙ¤ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡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 ÂÂÍ‹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 ÔÔ›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/
°. ÀÔ‚ÔÏ‹ Î·È ¢ËÌÔÛ›Â˘ÛË ÙˆÓ ∂ÚÁ·ÛÈÒÓ ŸÏ˜ ÔÈ ÂÚÁ·Û›Â˜ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÔÓÙ·È ÂȘ ÙÚÈÏÔ‡Ó Î·È Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰ÈÛΤٷ ‹ CD, ηıÒ˜ Î·È ·fi ÂÈÛÙÔÏ‹, Ë ÔÔ›· ı· Û˘Ó˘ÔÁÚ¿ÊÂÙ·È ·fi fiÏÔ˘˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÛÙËÓ ÔÔ›· 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΋”. ∂ÈϤÔÓ, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ù˘¯fiÓ ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢. EÊfiÛÔÓ Ë ÂÚÁ·Û›· Á›ÓÂÈ ·Ô‰ÂÎÙ‹, ÙÔ ‰ÈÔÚıˆÌ¤ÓÔ Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ ÙˆÓ ÎÚÈÙÒÓ Î·È ÂÎ Ó¤Ô˘ ‰·ÎÙ˘ÏÔÁÚ·ÊË̤ÓÔ Î›ÌÂÓÔ Ú¤ÂÈ Ó· ˘Ô‚¿ÏÂÙ·È ÛÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, Û˘Óԉ¢fiÌÂÓÔ ·fi ‰ÈÛΤٷ ‹ CD Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÚÁ·Û›· Û ÚfiÁÚ·ÌÌ· Word, ηıÒ˜ Î·È ÂÈÛÙÔÏ‹ fiÔ˘ Ó· ·Ó·Ê¤ÚÔÓÙ·È ·Ó·Ï˘ÙÈο ÔÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ ÔÈ ·ÓÙÈÚÚ‹ÛÂȘ ÛÙȘ ÚÔÙ¿ÛÂȘ ÙˆÓ ÎÚÈÙÒÓ. H ηı˘ÛÙ¤ÚËÛË Ù˘ ·ӢԂÔÏ‹˜ ÙÔ˘ ÙÚÔÔÔÈË̤ÓÔ˘ ÎÂÈ̤ÓÔ˘ ¤Ú·Ó ÙˆÓ 30 ËÌÂÚÒÓ Û˘Ó¿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 ÂÈÛÙÚ¤ÊÔÓÙ·È. MÔÚ› Ó· ÂÈÛÙÚ·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 ÙÚÈÏÔ‡Ó ÛÙË ‰È‡ı˘ÓÛË: ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›· Mȯ·Ï·ÎÔÔ‡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 ÂÒÓ˘ÌÔ Û˘ÁÁڷʤˆÓ (ÔÏÔÁڿʈ˜) Á. ÂÈÛÙËÌÔÓÈÎfi/¿ ΤÓÙÚÔ/· fiÔ˘ ¤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˘ÌÂÚ¿ÛÌ·Ù·, ηıÒ˜ Î·È Ï¤ÍÂȘ ÎÏÂȉȿ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 6. ∫·Ù¿ÏÔÁÔ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 7. ∫›ÌÂÓÔ (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 8. ∂˘¯·ÚÈÛٛ˜ ‹ ·Ó·ÁÓˆÚ›ÛÂȘ (·Ó·ÊÔÚ¿ Û ÂȉÔÙ‹ÛÂȘ-¯ÔÚËÁ›Â˜ ‹ ¿ÏϘ ËÁ¤˜ ˘ÔÛÙ‹ÚÈ͢). 9. µÈ‚ÏÈÔÁÚ·Ê›· (‰ÈÏfi ‰È¿ÛÙËÌ· - ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·). 10. ¶›Ó·Î˜ (Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó. 11. ∂ÈÎfiÓ˜, Ì ‚¤ÏÔ˜ ÛÙÔ ›Ûˆ ̤ÚÔ˜ ÙÔ ÔÔ›Ô Ó· ‰Â›¯ÓÂÈ ÚÔ˜ Ù· ¿ӈ, ·ÚÈıÌË̤Ó˜, ÂȘ ÙÚÈÏÔ‡Ó. 12. ∆›ÙÏÔ˘˜ ÂÈÎfiÓˆÓ (‰ÈÏfi ‰È¿ÛÙËÌ· - Ô Î·ı¤Ó·˜ Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰·) ÂȘ ÙÚÈÏÔ‡Ó.
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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 ÏÂÙfi ¯ÈÏÈÔÛÙfiÌÂÙÚÔ ÁÚ·ÌÌÔÌfiÚÈÔ ·ÚÈıÌfi˜ ÌË ÛËÌ·ÓÙÈÎfi ÔÛÌÒÏÈÔ Èı·ÓfiÙËÙ· ÛÙ·ıÂÚ‹ ·fiÎÏÈÛË ÛÙ·ıÂÚfi ÛÊ¿ÏÌ· ‰Â˘ÙÂÚfiÏÂÙÔ 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
r
∞
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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. Authors will be charged film and reprint expenses, paid upon dispatch of the first proof directly to the printer. Manuscripts of papers which have not been approved for publication are not returned to the author. The accompanying figures and photographs can be returned upon request within six months. Manuscripts submitted for review and publication in “Paediatriki” should be sent in three copies to the following address: Editorial Board Greek Paediatric Society 92, Michalakopoulou Street 115 28 Athens, Greece
Before submitting your paper, make sure it contains: 1. 3 copies of the text of the paper, printed according to instructions. 2. A floppy disk or CD with the entire material of the paper (text, tables, pictures). 3. A covering letter and a statement that the paper has not been previously published. 4. The title page (on a separate page), which includes: a. the title and short title of the paper; b. the name and surname (full name)of the author(s); c. the academic centre(s) of origin; d. the corresponding authors’ name, address and telephone number; 5. English and Greek abstracts, with the following structure: background, methods, results and conclusions (double space, separate page) and keywords. 6. List of abbreviations (double space, separate page). 7. Text (double space, separate page). 8. Acknowledgements and reference to funding, sponsorships or other financial sources. 9. References (double space, separate page). 10. Tables (one per page) in three copies. 11. Figures with an arrow at the back showing the top, numbered, in two copies. 12. Figure titles (double space - on separate pages) in three copies.
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∏ ı¤ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙ· ·È‰È¿: ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· °. ∆ÛfiÏ·˜
¶ÂÚ›ÏË„Ë ∏ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Î·È È‰È·›ÙÂÚ· Ë ·‡ÍËÛË Ù˘ LDL-C ·ÔÙÂÏ› ÙÔÓ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÙÚÔÔÔÈ‹ÛÈÌÔ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ Ô˘ Ô‰ËÁ› Û ·ıËڈ̿وÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Î·È Ì¤Ûˆ ·˘Ù‹˜ Û ηډȷÁÁÂȷ΋ ÓfiÛÔ. ªÂϤÙ˜, ·Ï·ÈfiÙÂÚ· ÓÂÎÚÔÙÔÌÈΤ˜ Î·È ÚfiÛÊ·Ù· Ì ÂÎÙ›ÌËÛË ÙÔ˘ ¿¯Ô˘˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ ÙˆÓ Î·ÚˆÙ›‰ˆÓ Î·È Ù˘ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜, ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ·ıËڈ̷ÙÈ΋ ‰ÈÂÚÁ·Û›· Â›Ó·È ÂÍÂÏÈÎÙÈ΋ ‹‰Ë ·fi ÙËÓ ÚÔÂÊË‚È΋ ÂÚ›Ô‰Ô Î·È, Û˘ÓÂÒ˜, Ë ÚÔÛ¿ıÂÈ· ·Ó¿Û¯ÂÛ‹˜ Ù˘ Ú¤ÂÈ Ó· ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·. ∂Âȉ‹, ÛÙȘ ÛÔ‚·Ú¤˜ ÌÔÚʤ˜ ˘ÂÚÏÈȉ·ÈÌ›·˜, fiˆ˜ ÛÙËÓ ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Ë ÔÔ›· ÚÔÛ‚¿ÏÏÂÈ 1 ·Ó¿ 500 ÂÚ›Ô˘ ¿ÙÔÌ·, Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ̤¯ÚÈ ÙÒÚ· ÂÊ·ÚÌÔ˙fiÌÂÓ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ıÂڷ›·˜ Ì ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹, ¿ÛÎËÛË Î·È ¯ÔÚ‹ÁËÛË ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈÎÒÓ ÚËÙÈÓÒÓ ‰ÂÓ ˘‹ÚÍ Ôχ ÈηÓÔÔÈËÙÈ΋, Ë ‰Â ÈÛÙ‹ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ô‰Â›¯ÙËΠȉȷ›ÙÂÚ· ÚÔ‚ÏËÌ·ÙÈ΋, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÂÏÂÙ¿Ù·È ÂÎÙÂÓÒ˜ Ë ‰˘Ó·ÙfiÙËÙ· ¯ÚËÛÈÌÔÔ›ËÛ˘ Î·È ÛÙ· ·È‰È¿ ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ ˘‰ÚÔ͢-ÌÂı˘ÏÔ-ÁÏÔ˘Ù·Ú˘Ï-CoA ·Ó·ÁˆÁ¿Û˘, ÁÓˆÛÙÒÓ Â˘Ú‡ÙÂÚ· ˆ˜ ÛÙ·ÙÈÓÒÓ, Ô˘ ·ÔÙÂÏÔ‡Ó ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 10 ¯ÚfiÓÈ· ÙË ıÂڷ›· ÂÎÏÔÁ‹˜ ÙˆÓ ‰˘ÛÏÈȉ·ÈÌÈÎÒÓ ÂÓËϛΈÓ. º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, Â›Ó·È ·ÛÊ·Ï›˜ Î·È È‰È·›ÙÂÚ· ·ÔÙÂÏÂÛÌ·ÙÈΤ˜, ·ÊÂÓfi˜ ÂÂȉ‹ ÌÂÈÒÓÔ˘Ó ‰Ú·ÛÙÈο Ù· ›‰· Ù˘ LDL-C, Û ‚·ıÌfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi fi,ÙÈ ÂÈÙ˘Á¯¿ÓÔ˘Ó ÔÈ ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜, ·ÊÂÙ¤ÚÔ˘ ‰ÈfiÙÈ ·ÛÎÔ‡Ó ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË Ô˘ ‚ÂÏÙÈÒÓÂÈ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Î·È ÌÂÈÒÓÂÈ ÙÔ ¿¯Ô˜ ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘, ‰Ú¿ÛË Ë ÔÔ›· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ·ÓÂÍ¿ÚÙËÙË ·fi ÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÙ· ›‰· Ù˘ LDL-C. ∂Ó‰¤¯ÂÙ·È, Û˘ÓÂÒ˜, ÔÈ ÛÙ·Ù›Ó˜ Ó· ηıÈÂÚˆıÔ‡Ó Û‡ÓÙÔÌ·, ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙˆÓ ·Ó·Áη›ˆÓ ÌÂÏÂÙÒÓ, ˆ˜ Ë Ï¤ÔÓ ·ÍÈfiÈÛÙË Ê·Ú̷΢ÙÈ΋ ÂÈÏÔÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È ÛÙËÓ ·È‰È΋ ËÏÈΛ·.
¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ¡›Î·È·˜ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ, ¶ÂÈÚ·È¿˜ AÏÏËÏÔÁÚ·Ê›·: °ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜ ¶¿ÚÓËıÔ˜ 32, ∆.∫. 190 13 ™·ÚˆÓ›‰· ∞ÙÙÈ΋˜ E-mail: geotsol@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 29-03-2005
§¤ÍÂȘ ÎÏÂȉȿ OÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ÛÙ·Ù›Ó˜, ·ıËڈ̿وÛË, ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÚÙËÚÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘, ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜.
™˘ÓÙÔÌÔÁڷʛ˜ C TC HDL LDL VLDL Apo B CK
ÃÔÏËÛÙÂÚfiÏË OÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË §ÈÔÚˆÙ½Ó˜ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜ §ÈÔÚˆÙ½Ó˜ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ §ÈÔÚˆÙ½Ó˜ Ôχ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ∞ÔÏÈÔÚˆÙ½ÓË µ ∫Ú·ÙÈÓÈ΋ ÎÈÓ¿ÛË
∂ÈÛ·ÁˆÁ‹ ∏ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È Ô Û˘ÓËı¤ÛÙÂÚÔ˜ Ù‡Ô˜ ‰˘ÛÏÈȉ·ÈÌÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ™‹ÌÂÚ· Â›Ó·È Ï¤ÔÓ ‚¤‚·ÈÔ fiÙÈ Ë
˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÚfiÎÏËÛË ·ÁÁÂÈ·ÎÔ‡ ·ÔÊÚ·ÎÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ÂΉËψı› ΢ڛˆ˜ Ì ÙË ÌÔÚÊ‹ ηډȷÎÔ‡ ÂÌÊÚ¿ÁÌ·ÙÔ˜, ·ÏÏ¿ Î·È ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ÂÚÈÊÂÚÈÎÔ‡ ·ÁÁÂÈ·ÎÔ‡ ÂÂÈÛÔ‰›Ô˘, ΢ڛˆ˜ ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ. ∂ȉÈÎfiÙÂÚ·, Ë ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙÔ 30-50% ÙˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙËÓ Î‡ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ ÙˆÓ ÂÓËÏ›ÎˆÓ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÔÛÔÛÙfi ¤ˆ˜ Î·È 50% ÂÚ›Ô˘ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ı·Ó¿ÙˆÓ (1,2). ¶·È‰È·ÙÚÈ΋ 2005;68:169-178
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·170
170
°. ∆ÛfiÏ·˜
∏ ·ıÔÏÔÁÈ΋ ÛËÌ·Û›· Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Û˘Ó›ÛÙ·Ù·È ÛÙÔ fiÙÈ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·ıËڈ̿وÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Î·È Ì¤Ûˆ ·˘Ù‹˜ Û ηډȷÁÁÂȷ΋ ÓfiÛÔ. ∞fi ÙÔ˘˜ Ù‡Ô˘˜ Ù˘ ·È‰È΋˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Ô˘ ¤¯Ô˘Ó ·ıÔÏÔÁÈ΋ ÛËÌ·Û›·, Û˘¯ÓfiÙÂÚÔÈ Â›Ó·È Ë ÔÏ˘ÁÔÓȉȷ΋ Î·È Ë ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∂ȉÈÎfiÙÂÚ· Ë ÙÂÏÂ˘Ù·›·, Ë ÔÔ›· ÔÊ›ÏÂÙ·È Û ÌÂÙ·ÏÏ¿ÍÂȘ ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ LDL Î·È ÚÔÛ‚¿ÏÏÂÈ ÙÔ 0,2% ÙÔ˘ ÏËı˘ÛÌÔ‡ (1:500 ¿ÙÔÌ·), ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ LDL-C Î·È Ù˘ ·ÔÏÈÔÚˆÙ½Ó˘ µ, ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È Û˘¯Ó¿ ηٷϋÁÂÈ Û ÚÒÈÌË ·ıËڈ̿وÛË (3,4). ∏ ·ıËڈ̿وÛË Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ ÓfiÛÔ˜, Ë ÔÔ›· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Ù˘ ·ÏÏËÏ›‰Ú·Û˘ ÁÂÓÂÙÈÎÒÓ Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∏ ÎÏ·ÛÈ΋ ¿Ô„Ë Â›Ó·È fiÙÈ Ë ·ıËڈ̿وÛË ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÂÓ·fiıÂÛË ÙˆÓ ÛˆÌ·Ù›ˆÓ Ù˘ LDL ÛÙ· ·ÚÙËÚȷο ÙÔȯÒÌ·Ù·. ¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜, fï˜, ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· ۈ̿ÙÈ· Ù˘ LDL ηıÒ˜ Û˘ÛÛˆÚ‡ÔÓÙ·È ÛÙÔÓ Ì¤ÛÔ ¯ÈÙÒÓ· ÙˆÓ ·ÁÁÂÈ·ÎÒÓ ÙÔȯˆÌ¿ÙˆÓ fiÔ˘ ÔÍÂȉÒÓÔÓÙ·È, ˘ÚÔ‰ÔÙÔ‡Ó ÊÏÂÁÌÔÓÒ‰Ë ·ÓÙ›‰Ú·ÛË, Ë ÔÔ›· ÚÔԉ¢ÙÈο Ô‰ËÁ› Û ¿¯˘ÓÛË ÙÔ˘ ¤Ûˆ Î·È Ì¤ÛÔ˘ ¯ÈÙÒÓ· ÙˆÓ ·ÚÙËÚÈÒÓ Î·È Û ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘ ÙÔ˘˜. ∏ ·ÈÙÈÔÏÔÁÈ΋ ·˘Ù‹ Û˘Û¯¤ÙÈÛË Ù˘ ÊÏÂÁÌÔÓ‹˜ Ì ÙËÓ ·ıËڈ̿وÛË Î·ıÈÛÙ¿ Ê·ÓÂÚfi fiÙÈ Ë ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ì ÛÙfi¯Ô ÙËÓ ·Ó¿Û¯ÂÛË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‰ÈÂÚÁ·Û›·˜ Ú¤ÂÈ Ó· ¤¯ÂÈ ˆ˜ ÛÎÔfi fi¯È ÌfiÓÔ ÙËÓ ÎÏ·ÛÈ΋ Ú·ÎÙÈ΋ Ô˘ ·ÔÛÎÔ› ÛÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ LDL-C, ·ÏÏ¿ Î·È ÙËÓ ÚÔÛ¿ıÂÈ· ·Ó·ÛÙÔÏ‹˜ ÙÔ˘ Û˘ÓfiÏÔ˘ Ù˘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ‰È·‰Èηۛ·˜ (5). ∂ÈϤÔÓ, ÂÂȉ‹ ÔÈ ·ıËڈ̷ÙÈΤ˜ ‚Ï¿‚˜ ÚÔËÁÔ‡ÓÙ·È ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ Î·Ù¿ ·ÚÎÂÙ¿ ¯ÚfiÓÈ· ‹ Î·È ‰ÂηÂٛ˜ Î·È ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë fiÏË ‰È·‰Èηۛ· Â›Ó·È ÂÍÂÏÈÎÙÈ΋ Ì ·ÊÂÙËÚ›· ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· (6), Â›Ó·È ·Ó·Áη›· Ë ¤ÁηÈÚË ·Ó›¯Ó¢ÛË Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Î·È Ë ¤Ó·ÚÍË ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Ù˘ ÚÔÛ¿ıÂÈ·˜ ·ÔηٿÛÙ·Û˘ ÙˆÓ ÏÈȉ›ˆÓ ÛÂ Ê˘ÛÈÔÏÔÁÈο ›‰· ηÈ, Û˘ÓÂÒ˜, ÂÏ¿ÙÙˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ Ù˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ·. ∏ ·ÓÙÈÌÂÙÒÈÛË ·˘Ù‹ Â›Ó·È ‚‚·›ˆ˜ ηْ ·Ú¯¿˜ ‰È·ÈÙËÙÈ΋ (7,8) Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÓ Á¤ÓÂÈ ˘ÈÔı¤ÙËÛË ·fi ̤ÚÔ˘˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ ˘ÁÈÂÈÓÒÓ ÚÔÙ‡ˆÓ Û˘ÌÂÚÈÊÔÚ¿˜, fiˆ˜ Â›Ó·È Ë ¿ıÏËÛË, Ë ·ÔÊ˘Á‹ ÙÔ˘ ηӛÛÌ·ÙÔ˜ Î·È Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ›‰· ·Ô¶·È‰È·ÙÚÈ΋ 2005;68:169-178
‰ÂÎÙ¿ ÁÈ· ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ Î·È ÙÔ ‡„Ô˜ ÙÔ˘ ·ÙfiÌÔ˘ (9). øÛÙfiÛÔ, ÂÂȉ‹ Ë ·ÁˆÁ‹ ·˘Ù‹ Û˘¯Ó¿ ·Ô‰ÂÈÎÓ‡ÂÙ·È ·Ó·Ú΋˜ ·fi ÌfiÓË Ù˘, ȉȷ›ÙÂÚ· ÛÙȘ ÌÔÚʤ˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Ì ˘ÔΛÌÂÓË ÁÂÓÂÙÈ΋ ‰È·Ù·Ú·¯‹, Â›Ó·È Û˘¯Ó¿ ·Ó·Áη›· Ë ÂÊ·ÚÌÔÁ‹ Î·È Ê·Ú̷΢ÙÈ΋˜ ıÂڷ›·˜. ∆· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ¯ÔÚ‹ÁËÛË Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ù· ÌË ÈηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ‰È·ÈÙËÙÈ΋˜ ·ÁˆÁ‹˜ ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 6-12 ÌËÓÒÓ, ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ÓfiÛÔ˘, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ÙËÓ ·ÚÔ˘Û›· ‹ fi¯È ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÚÒÈÌË ·ıËڈ̿وÛË. ∂Ô̤ӈ˜, Ê·Ú̷΢ÙÈ΋ ıÂڷ›· Û˘ÓÈÛÙ¿Ù·È Û ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ Î·È ÂÊfiÛÔÓ, ÌÂÙ¿ ·fi ·Ú΋ ‰›·ÈÙ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 6-12 ÌËÓÒÓ, Ë LDL-C ÂÍ·ÎÔÏÔ˘ı› Ó· ·Ú·Ì¤ÓÂÈ Û ›‰· ˘„ËÏfiÙÂÚ· ÙˆÓ 190 mg/dl. ∂›Û˘, Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ¯ÔÚËÁÂ›Ù·È Î·È Û fiÛ· ·È‰È¿ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ ·Ú·Ì¤ÓÂÈ Ë ÙÈÌ‹ Ù˘ LDL-C Û ›‰· ˘„ËÏfiÙÂÚ· ÙˆÓ 160 mg/dl, ÌÂÙ¿ ·fi ·Ú΋ ‰›·ÈÙ· 6-12 ÌËÓÒÓ, ÂÊfiÛÔÓ ¤¯Ô˘Ó ›Ù ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÂÎÙfi˜ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, fiˆ˜ ÙÔ Î¿ÓÈÛÌ·, Ë ˘¤ÚÙ·ÛË, Ë ¯·ÌËÏ‹ HDL-C, Ë ·¯˘Û·ÚΛ· ‹ Ô Û·Î¯·Ú҉˘ ‰È·‚‹Ù˘ (10). ∆· Ê¿Ú̷η Ô˘ ¤ˆ˜ Û‹ÌÂÚ· Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙ· ·È‰È¿ Â›Ó·È ÔÈ ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜, Ì ·ÚÈÔ˘˜ ÂÎÚÔÛÒÔ˘˜ ÙË ¯ÔÏÂÛÙ˘Ú·Ì›ÓË Î·È ÙËÓ ÎÔÏÂÛÙÈfiÏË. ∆· Ê¿Ú̷η ·˘Ù¿ ¯ÔÚËÁÔ‡ÓÙ·È ·fi ÙÔ ÛÙfiÌ·, Â›Ó·È ·ÛÊ·Ï‹ Î·È ÛÙÂÚÔ‡ÓÙ·È ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. ¶ÚfiÎÂÈÙ·È, fï˜, ÁÈ· Ê¿Ú̷η Ì ‰˘Û¿ÚÂÛÙË Á‡ÛË Î·È ‰‡ÛÎÔÏÔ ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· (3-4 ÊÔÚ¤˜ ËÌÂÚËÛ›ˆ˜), Ì ·ÔÙ¤ÏÂÛÌ· Ó· Â›Ó·È ÚÔ‚ÏËÌ·ÙÈ΋ Ë Û˘ÌÌfiÚʈÛË ÚÔ˜ ÙË ıÂڷ›· ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ, ‰Â‰Ô̤ÓÔ˘ Ì¿ÏÈÛÙ· fiÙÈ Ë ıÂڷ›· ·˘Ù‹ Â›Ó·È - ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÎÚ›ÓÂÙ·È ·Ó·Áη›· Ë ¯ÔÚ‹ÁËÛ‹ Ù˘ - Ì·ÎÚfi¯ÚÔÓË ¤ˆ˜ Î·È ÌfiÓÈÌË. º·›ÓÂÙ·È ·ÎfiÌË fiÙÈ ÔÈ ÚËÙ›Ó˜ ·˘Ù¤˜ ‰ÂÓ ¤¯Ô˘Ó ¿ÏÏË ‰Ú¿ÛË ÂÎÙfi˜ ·fi ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ‰ÂÓ ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙÔ ÎÚ›ÛÈÌÔ ÊÏÂÁÌÔÓ҉˜ ÛΤÏÔ˜ Ù˘ ·ıËڈ̷ÙÈ΋˜ ‰ÈÂÚÁ·Û›·˜ (11-13). ∆· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ Ô‰‹ÁËÛ·Ó ÛÙËÓ ·Ó·˙‹ÙËÛË Î·Ï‡ÙÂÚˆÓ Ê·Ú̷΢ÙÈÎÒÓ Ï‡ÛˆÓ. À¿Ú¯Ô˘Ó ‚¿ÛÈ̘ ÂӉ›ÍÂȘ fiÙÈ ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ ˘‰ÚÔ͢-ÌÂı˘ÏÔ-ÁÏÔ˘Ù·Ú˘ÏÔÛ˘ÓÂÓ˙‡ÌÔ˘ A (HMG-CoA) ·Ó·ÁˆÁ¿Û˘, ÁÓˆÛÙÔ› ¢ڇÙÂÚ· ˆ˜ ÛÙ·Ù›Ó˜, Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·171
171
™Ù·Ù›Ó˜ ÛÙ· ·È‰È¿ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·
ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ì ηϿ ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 10 ¯ÚfiÓÈ·, ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Ì ·ÛÊ¿ÏÂÈ· Î·È ÛÙ· ·È‰È¿. ∆· Ê¿Ú̷η ·˘Ù¿, ÂÎÙfi˜ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÂÏ·ÙÙÒÓÔ˘Ó Ù· ›‰· Ù˘ LDL-C Î·È Ì¿ÏÈÛÙ· Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ·fi fiÛÔ ÂÈÙ˘Á¯¿ÓÔ˘Ó ÔÈ ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜, Ê·›ÓÂÙ·È fiÙÈ ·ÛÎÔ‡Ó Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË, ·ÓÂÍ¿ÚÙËÙË ·fi ÙË ‰Ú¿ÛË ÙÔ˘˜ ÛÙ· ›‰· Ù˘ LDL-C, Ì ÙËÓ ÂÏ¿ÙÙˆÛË ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘, ·Ó·ÛÙ¤ÏÏÔÓÙ·˜ ηْ ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙËÓ ÂͤÏÈÍË Ù˘ ·ıËڈ̿وÛ˘. º·›ÓÂÙ·È, ›Û˘, fiÙÈ Ù· Ê¿Ú̷η ·˘Ù¿ Â›Ó·È ·ÛÊ·Ï‹ ÁÈ· ÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ·È‰ÈÎfi ÔÚÁ·ÓÈÛÌfi (14).
ªË¯·ÓÈÛÌfi˜ ‰Ú¿Û˘ ÙˆÓ ÛÙ·ÙÈÓÒÓ ∏ Û‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘ ‰È¤ÂÙ·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ·fi ÙË ‰Ú¿ÛË ÂÓfi˜ ÂÓ˙‡ÌÔ˘ ÁÓˆÛÙÔ‡ ˆ˜ HMG-CoA ·Ó·ÁˆÁ¿ÛË Ô˘ ‚Ú›ÛÎÂÙ·È ÛÙÔ ‹·Ú. ∆Ô ¤Ó˙˘ÌÔ ·˘Ùfi ηٷχÂÈ ÙËÓ ·ÓÙ›‰Ú·ÛË ÌÂÙ·ÙÚÔ‹˜ ÙÔ˘ ˘‰ÚÔ͢-ÁÏÔ˘Ù·Ú˘ÏÔÛ˘ÓÂÓ˙‡ÌÔ˘ ∞ Û Ì‚·ÏÔÓÈÎfi Ô͇, ÙÔ ÔÔ›Ô ÛÙË Û˘Ó¤¯ÂÈ· ÌÂÙ·‚ÔÏ›˙ÂÙ·È ÚÔ˜ ¯ÔÏËÛÙÂÚfiÏË. √È ÛÙ·Ù›Ó˜ ·Ó·ÛÙ¤ÏÏÔ˘Ó ÙË ‰Ú¿ÛË ÙÔ˘ ÂÓ˙‡ÌÔ˘ HMG-CoA ·Ó·ÁˆÁ¿ÛË, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÚÂÌfi‰ÈÛË Ù˘ Û‡ÓıÂÛ˘ Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ŒÙÛÈ, Ô‰ËÁÔ‡Ó ·ÊÂÓfi˜ Û Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ (TC), Ù˘ LDL-C, Ù˘ Apo B, Ù˘ VLDL-C Î·È ÙˆÓ ÙÚÈÁÏ˘ÎÂÚȉ›ˆÓ, ·ÊÂÙ¤ÚÔ˘ Û ·‡ÍËÛË ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ Ù˘ HDL-C (14).
∂Ӊ›ÍÂȘ - ∫ÏÈÓÈΤ˜ ‰ÔÎÈ̤˜ √È ÛÙ·Ù›Ó˜, ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi 10 ¯ÚfiÓÈ·, ÚÔÙÈÌÔ‡ÓÙ·È ˆ˜ Ê¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÙˆÓ ÂÓËϛΈÓ. ∏ ·Ô‰Â‰ÂÈÁ̤ÓË ·ÛÊ¿ÏÂÈ· Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ ÙÔ˘˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ô‰‹ÁËÛ ÛÙË ÛΤ„Ë fiÙÈ ı· ÌÔÚÔ‡Û·Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó Î·È ÛÙË ıÂڷ›· Ù˘ ·È‰È΋˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜. øÛÙfiÛÔ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÛÙ·Ù›Ó˜ ‰ÂÓ ¤¯Ô˘Ó ·ÎfiÌË Ï¿‚ÂÈ ¤ÁÎÚÈÛË ÁÈ· ·È‰È·ÙÚÈ΋ ¯Ú‹ÛË. ŒÙÛÈ, Ë ıÂڷ›· Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ηٿ ÙËÓ ·È‰È΋ ËÏÈΛ· ‚·Û›˙ÂÙ·È ÛÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ‰›·ÈÙ·, ÂÓÒ Û fiÛ· ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ ÎÚ›ÓÂÙ·È ·Ó·Áη›· Ë ¯ÔÚ‹ÁËÛË Ê·Ú̷΢ÙÈ΋˜
·ÁˆÁ‹˜, ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜, Ì ·ÚÈÔ ÂÎÚfiÛˆÔ ÙË ¯ÔÏÂÛÙ˘Ú·Ì›ÓË. øÛÙfiÛÔ, ÔÈ ÚËÙ›Ó˜ ¤¯Ô˘Ó ̤ÙÚÈ· ·ÔÙÂϤÛÌ·Ù·, ηıÒ˜ ÂÈÙ˘Á¯¿ÓÔ˘Ó ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-C fi¯È ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 1015%, ÂÓÒ ÙfiÛÔ Ë ‰˘Û¿ÚÂÛÙË Á‡ÛË ÙÔ˘˜ fiÛÔ Î·È ÔÈ ÔÏϤ˜ (3 ¤ˆ˜ 4) ‰fiÛÂȘ Ô˘ ··ÈÙÔ‡ÓÙ·È ËÌÂÚËÛ›ˆ˜ ηıÈÛÙÔ‡Ó ÚÔ‚ÏËÌ·ÙÈ΋ ÙË Û˘ÌÌfiÚʈÛË ÙˆÓ ·È‰ÈÒÓ ÚÔ˜ ÙËÓ ·ÁˆÁ‹ (11-13). √È ÛÙ·Ù›Ó˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·fi ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Â›Ó·È Ë ÏÔ‚·ÛÙ·Ù›ÓË, Ë ÛÈÌ‚·ÛÙ·Ù›ÓË, Ë Ú·‚·ÛÙ·Ù›ÓË, Ë ÊÏÔ˘‚·ÛÙ·Ù›ÓË Î·È Ë ·ÙÔÚ‚·ÛÙ·Ù›ÓË. ∏ ¯Ú‹ÛË ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙfiÛÔ Ù˘ ÔÌfi˙˘Á˘ Î·È Î˘Ú›ˆ˜ Ù˘ ÂÙÂÚfi˙˘Á˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, fiÛÔ Î·È ¿ÏÏˆÓ ‰˘ÛÏÈȉ·ÈÌÈÒÓ fiˆ˜ Ë ÌÈÎÙ‹ ‰˘ÛÏÈȉ·ÈÌ›·, Ë ˘ÂÚÙÚÈÁÏ˘ÎÂÚȉ·ÈÌ›·, Ë ‰˘Û‚ËÙ·ÏÈÔÚˆÙÂ˚Ó·ÈÌ›·, ηıÒ˜ Î·È ÛÙËÓ ÚˆÙÔ·ı‹ ‹ Î·È ‰Â˘ÙÂÚÔ·ı‹ ÚfiÏË„Ë Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÂÂÈÛÔ‰›ˆÓ. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ fiϘ ۯ‰fiÓ ÔÈ ÛÙ·Ù›Ó˜ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ÛÙ· ·È‰È¿, ÂÓÙÔ‡ÙÔȘ ÌfiÓÔ Ë ÏÔ‚·ÛÙ·Ù›ÓË ¤¯ÂÈ Ï¿‚ÂÈ ÙËÓ ¤ÁÎÚÈÛË Ù˘ ∂ÈÙÚÔ‹˜ ∆ÚÔÊ›ÌˆÓ Î·È º·ÚÌ¿ÎˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ Ù˘ ∞ÌÂÚÈ΋˜ (Food and Drug Administration - FDA) ÁÈ· ·È‰È·ÙÚÈ΋ ¯Ú‹ÛË. ŒÙÛÈ, ÛÙȘ 21 ºÂ‚ÚÔ˘·Ú›Ô˘ 2002, Ë FDA ÂÓ¤ÎÚÈÓ ÙË ¯Ú‹ÛË Ù˘ ÏÔ‚·ÛÙ·Ù›Ó˘ ˆ˜ Û˘ÌÏËڈ̷ÙÈ΋ ÚÔ˜ ÙË ‰È·ÈÙËÙÈ΋ ·ÁˆÁ‹ ıÂڷ›·, Ì ÛÙfi¯Ô ÙËÓ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ TC, Ù˘ LDL-C Î·È Ù˘ Apo B Û ÂÊ‹‚Ô˘˜ Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ˘fi ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ù· ÎÔÚ›ÙÛÈ· ı· ›¯·Ó ÂÌÊ·Ó›ÛÂÈ ¤ÌÌËÓÔ Ú‡ÛË ÚÈÓ ·fi 1 ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤ÙÔ˜. ∫ÚÈÙ‹ÚÈÔ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ‹Ù·Ó - ÌÂÙ¿ ·fi ‰›·ÈÙ· Ì ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ϛԘ ‰È¿ÚÎÂÈ·˜ 6 ÌËÓÒÓ - ÙÈÌ‹ LDL-C >189 mg/dl ‹ ÙÈÌ‹ LDL-C >160 mg/dl Û ·ÛıÂÓ›˜ ›Ù Ì ‚‚·ÚË̤ÓÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ Ì ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÚÒÈÌË ·ıËڈ̿وÛË (15). ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‚Ú·¯˘ÚfiıÂÛÌË Î·È Ì·ÎÚÔÚfiıÂÛÌË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ·ÛÊ¿ÏÂÈ· ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∆Ô 1996, ÔÈ Lambert Î·È Û˘Ó, Û ̛· ÔÏ˘ÎÂÓÙÚÈ΋, Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË, ¯ÔÚ‹ÁËÛ·Ó ÏÔ‚·ÛÙ·Ù›ÓË Û 69 ¿ÚÚÂÓ˜ ÂÊ‹‚Ô˘˜ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ªÂÙ¿ ·fi Ì›· ÂÚ›Ô‰Ô 4 ‚‰ÔÌ¿‰ˆÓ ηٿ ÙËÓ ÔÔ›· ¶·È‰È·ÙÚÈ΋ 2005;68:169-178
Paediatriki May-June 05
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°. ∆ÛfiÏ·˜
¯ÔÚËÁ‹ıËΠÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ (placebo), ‰fiıËΠÛÙË Û˘Ó¤¯ÂÈ· ÌÂ Ù˘¯·›Ô ÙÚfiÔ ÏÔ‚·ÛÙ·Ù›ÓË ÁÈ· ‰È¿ÛÙËÌ· 8 ‚‰ÔÌ¿‰ˆÓ Û ‰fiÛË 10, 20, 30 ‹ 40 mg/Ë̤ڷ. ∆Ô Ê¿ÚÌ·ÎÔ, Û fiÏ· Ù· ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù· Ì ٷ ÔÔ›· ‰ÔÎÈÌ¿ÛÙËÎÂ, Ô‰‹ÁËÛ Û ÂÏ¿ÙÙˆÛË Ù˘ TC ηٿ 17-29%, Ù˘ LDL-C ηٿ 21-36% Î·È Ù˘ Apo B ηٿ 19-28%. ∏ ·¿ÓÙËÛË ÛÙË ıÂڷ›· ‹Ù·Ó ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË ¤ˆ˜ ÙÔ fiÚÈÔ ÙˆÓ 30 mg/Ë̤ڷ, ¤Ú·Ó ÙÔ˘ ÔÔ›Ô˘ ‰ÂÓ ÛËÌÂÈÒıËΠÂÚ·ÈÙ¤Úˆ ˘Ô¯ÒÚËÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ. ¢ÂÓ Î·Ù·ÁÚ¿ÊËΠη̛· ÛÔ‚·Ú‹ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ·, ÂÎÙfi˜ ·fi ÂÏ·ÊÚ¿ ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ, ÂÓÒ ÙÚÂȘ ·ÛıÂÓ›˜ ·ÚÔ˘Û›·Û·Ó ·ÚÔ‰È΋ Î·È ·Û˘Ìو̷ÙÈ΋ ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ ÎÚ·ÙÈÓÈ΋˜ ÎÈÓ¿Û˘ (CK) (16). ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ‰È·ÈÛÙÒıËÎ·Ó Î·È Û ÌÂϤÙË ÙˆÓ Stein Î·È Û˘Ó. ÃÔÚËÁ‹ıËΠÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ‹ ÏÔ‚·ÛÙ·Ù›ÓË Û ‰È¿ÊÔÚ· ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù·, ·fi 10 ¤ˆ˜ 40 mg/Ë̤ڷ Î·È ÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜ Û 132 ·ÁfiÚÈ· ËÏÈΛ·˜ 10-17 ÂÙÒÓ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. √È ·ÛıÂÓ›˜ Ô˘ ¤Ï·‚·Ó ÏÔ‚·ÛÙ·Ù›ÓË ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-C, Ù˘ ٿ͈˜ ÙÔ˘ 25% ÂÚ›Ô˘ (̤ÛË ÙÈÌ‹ 190,9 mg/dl ·fi 244,8 mg/dl), ¯ˆÚ›˜ Ó· ÛËÌÂȈı› η̛· ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·‡ÍËÛË Î·È ·Ó¿Ù˘Í‹ ÙÔ˘˜ (17). ∞Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù· ÚԤ΢„·Ó Î·È Û ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠڷ‚·ÛÙ·Ù›ÓË ·ÓÙ› Ù˘ ÏÔ‚·ÛÙ·Ù›Ó˘. ∆Ô 1996, ÔÈ Knipscheer Î·È Û˘Ó, Û ‰ÈÏ‹-Ù˘ÊÏ‹ Ù˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË, ¯ÔÚ‹ÁËÛ·Ó ÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ ‹ Ú·‚·ÛÙ·Ù›ÓË Û ‰ÔÛÔÏÔÁÈο Û¯‹Ì·Ù· ÙˆÓ 5, 10 ‹ 20 mg/Ë̤ڷ Û 72 ·È‰È¿ ËÏÈΛ·˜ 8-16 ÂÙÒÓ Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. √È ÙÈ̤˜ Ù˘ TC Î·È LDL-C ÌÂÈÒıËÎ·Ó Û ÔÛÔÛÙfi 24,6% Î·È 32,9% ·ÓÙ›ÛÙÔȯ· Û fiÛ· ·È‰È¿ ¤Ï·‚·Ó Ú·‚·ÛÙ·Ù›ÓË, ·ÓÂÍ·Úًو˜ ‰ÔÛÔÏÔÁ›·˜. ª¿ÏÈÛÙ·, Û 4 ·È‰È¿ ÔÈ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ ·ÔηٷÛÙ¿ıËÎ·Ó Û ÂÓÙÂÏÒ˜ Ê˘ÛÈÔÏÔÁÈο ›‰·, ÂÓÒ ·Ú·ÙËÚ‹ıËΠ̛ˆÛË ÛÙ· ›‰· ÙfiÛÔ Ù˘ VLDL-C fiÛÔ Î·È Ù˘ Apo B. ∆· ›‰· Ù˘ HDL-C ·˘Í‹ıËÎ·Ó ÌfiÓÔ Û ÂΛӷ Ù· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ÙËÓ ˘„ËÏfiÙÂÚË ËÌÂÚ‹ÛÈ· ‰fiÛË ÙˆÓ 20 mg. ™Â ηӤӷ ·È‰› ‰ÂÓ ÛËÌÂÈÒıËΠ·ÍÈÔÛËÌ›ˆÙË ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· (18). ∆Ô 1999, ÔÈ Stefanutti Î·È Û˘Ó Î·Ù¤‰ÂÈÍ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘ Û 16 ·È‰È¿ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ªÂÙ¿ ·fi ‰›·ÈÙ· Ì ¯·ÌËÏ‹ ÂÚÈÂÎÙÈÎfiÙ˶·È‰È·ÙÚÈ΋ 2005;68:169-178
Ù· Û ϛԘ ‰È¿ÚÎÂÈ·˜ 6 ÌËÓÒÓ, Ù· ÌÈÛ¿ ·È‰È¿ Û˘Ó¤¯ÈÛ·Ó ÙËÓ ·ÁˆÁ‹ ÌfiÓÔ Ì ·˘Ù‹ ÙË ‰›·ÈÙ· ÁÈ· ¤Ó· ÂÈϤÔÓ ÂÍ¿ÌËÓÔ, ÂÓÒ ÛÙ· ˘fiÏÔÈ· Ù· ÔÔ›· ÂÂϤÁËÛ·Ó Ù˘¯·›· - ¯ÔÚËÁ‹ıËÎÂ Î·È ÛÈÌ‚·ÛÙ·Ù›ÓË Û ‰fiÛË 10 mg/Ë̤ڷ ÁÈ· ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ‰È¿ÚÎÂÈ·. √È ÂÚ¢ÓËÙ¤˜ ‰È·›ÛÙˆÛ·Ó Ôχ ÌÂÁ·Ï‡ÙÂÚË ÂÏ¿ÙÙˆÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ÙË ÛÈÌ‚·ÛÙ·Ù›ÓË (19). ¶ÚfiÛÊ·ÙË ÌÂϤÙË ÙˆÓ Vohl Î·È Û˘Ó Î·Ù·‰ÂÈÎÓ‡ÂÈ ÂÚ·ÈÙ¤Úˆ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÛÈÌ‚·ÛÙ·Ù›Ó˘. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË ‰È¿ÚÎÂÈ·˜ 6 ‚‰ÔÌ¿‰ˆÓ, ηٿ ÙËÓ ÔÔ›· 63 ·È‰È¿ ËÏÈΛ·˜ 8-17 ÂÙÒÓ ¯ˆÚ›ÛÙËÎ·Ó Ù˘¯·›· Û ‰‡Ô ÔÌ¿‰Â˜, ÛÙË Ì›· ·fi ÙȘ Ôԛ˜ ¯ÔÚËÁ‹ıËΠÂÈÎÔÓÈÎfi Ê¿ÚÌ·ÎÔ Î·È ÛÙËÓ ¿ÏÏË ÛÈÌ‚·ÛÙ·Ù›ÓË Û ‰fiÛË 20 mg ËÌÂÚËÛ›ˆ˜. ∆· ·È‰È¿ Ô˘ ¤Ï·‚·Ó ÙË ÛÈÌ‚·ÛÙ·Ù›ÓË ·ÚÔ˘Û›·Û·Ó ÙÒÛË ÙˆÓ ÙÈÌÒÓ Ù˘ LDL-C Û ÔÛÔÛÙfi Ô˘ Î˘Ì·ÈÓfiÙ·Ó ·fi 31% ¤ˆ˜ 39%, Ì›ˆÛË Ô˘ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚË ·fi fi,ÙÈ ÛÙËÓ ÔÌ¿‰· Ô˘ ¤Ï·‚ ÙÔ placebo (20). ¶·ÚfiÌÔÈ· ·ÔÙÂϤÛÌ·Ù· ¤¯Ô˘Ó ηٷÁÚ·Ê› Î·È Û ¿ÏϘ ÌÂϤÙ˜. ªÂϤÙË Ô˘ ‰ËÌÔÛȇÙËΠÙÔ 2003 ¤‰ÂÈÍ fiÙÈ 40 mg ·ÙÔÚ‚·ÛÙ·Ù›Ó˘ ËÌÂÚËÛ›ˆ˜ Ô‰‹ÁËÛ·Ó Û ÂÏ¿ÙÙˆÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ LDL-C ηٿ 40% ÌÂÙ¿ ·fi ıÂڷ›· 26 ‚‰ÔÌ¿‰ˆÓ Û ۇÁÎÚÈÛË Ì ÙË ‰Ú¿ÛË ÙÔ˘ ÂÈÎÔÓÈÎÔ‡ Ê·ÚÌ¿ÎÔ˘ (21). ÕÏÏË ÌÂϤÙË Ô˘ ‰ËÌÔÛȇÙËΠ›Û˘ ÙÔ 2003 ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË 5 mg ÛÈÌ‚·ÛÙ·Ù›Ó˘ ËÌÂÚËÛ›ˆ˜ Ô‰‹ÁËÛ Û ÂÏ¿ÙÙˆÛË Ù˘ LDL-C Û ÔÛÔÛÙfi 25%, ÂÓÒ ËÌÂÚ‹ÛÈ· ‰fiÛË 10 mg ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÂÏ¿ÙÙˆÛË Ù˘ LDL-C ηٿ 30% Î·È ‰fiÛË ÙˆÓ 20 mg Û˘Ó¤‚·Ï Û Ì›ˆÛË Ù˘ LDL-C Û ÔÛÔÛÙfi 36% (22). ∏ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ÌÂϤÙË ‰Â›¯ÓÂÈ fiÙÈ ÔÈ ÛÙ·Ù›Ó˜ - ·ÎfiÌË Î·È Û ¯·ÌËÏ‹ ‰fiÛË - Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈΤ˜, ÂÓÒ fiϘ ÔÈ ÚÔ·Ó·ÊÂÚı›Û˜ ÌÂϤÙ˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Â›Ó·È Ê¿Ú̷η ·ÛÊ·Ï‹, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· Ù· Ï›Á· ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜, ηıÒ˜ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ÌÂÏÂÙËı› Ï‹Úˆ˜ Ë ·ÒÙÂÚË ·ÛÊ¿ÏÂÈ¿ ÙÔ˘˜ ÛÙ· ·È‰È¿. øÛÙfiÛÔ, ÙÔ ÈÔ ÂӉȷʤÚÔÓ ÛÙÔÈ¯Â›Ô Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ·Ó¿Ï˘ÛË ÙˆÓ ÚfiÛÊ·ÙˆÓ ÌÂÏÂÙÒÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È fiÙÈ Ë ‰Ú¿ÛË ÙÔ˘˜ ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉȷÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ, ·ÏÏ¿ Â›Ó·È ·ÓÙÈÊÏÂÁÌÔÓ҉˘ Î·È Î·Ù’ ¤ÎÙ·ÛË ·ÓÙÈ·ıËڈ̷ÙÈ΋ Ì Ì˯·ÓÈÛÌÔ‡˜ ÂÓ ÔÏÏÔ›˜ ·ÓÂÍ¿ÚÙËÙÔ˘˜ ·fi ÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ÙÔ˘˜ ‰Ú¿ÛË. ŒÙÛÈ, ÔÈ ÛÙ·Ù›Ó˜ ‚ÂÏÙÈÒÓÔ˘Ó ÙË
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·173
173
™Ù·Ù›Ó˜ ÛÙ· ·È‰È¿ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·
ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ Î·È ÌÂÈÒÓÔ˘Ó ÙÔ ¿¯Ô˜ ÙÔ˘ ¤Ûˆ Î·È Ì¤ÛÔ˘ ¯ÈÙÒÓ· ÙˆÓ ·ÚÙËÚÈÒÓ ·ÛıÂÓÒÓ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. ∞˘Ùfi ‰È·ÈÛÙÒıËΠ̠ÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ÌÂϤÙË ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Î·ÚˆÙ›‰ˆÓ Î·È Ù˘ ÎÔÈÏȷ΋˜ ·ÔÚÙ‹˜ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ȉȷ›ÙÂÚ· ÂÓı·ÚÚ˘ÓÙÈο (23-25). ™ËÌÂÈÒÓÂÙ·È fiÙÈ ÔÈ ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜ ÛÙÂÚÔ‡ÓÙ·È Ù˘ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ô˘˜ ·˘Ù‹˜ ‰Ú¿Û˘, Ë ÔÔ›· ¤¯ÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÁÈ· ÙËÓ ·Ó¿Û¯ÂÛË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‰ÈÂÚÁ·Û›·˜, ÂÍ Ô˘ Î·È Ë ÛËÌ·ÓÙÈ΋ ˘ÂÚÔ¯‹ ÙˆÓ ÛÙ·ÙÈÓÒÓ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·ÙfiÌˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÚÒÈÌË ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ. ¶ÚfiÛÊ·ÙË Ù˘¯·ÈÔÔÈË̤ÓË, ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË ·fi ÙËÓ √ÏÏ·Ó‰›· ÂÚȤϷ‚ 214 ·È‰È¿ ËÏÈΛ·˜ 8-18 ÂÙÒÓ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ÛÙ· 106 ·fi Ù· ÔÔ›· ¯ÔÚËÁ‹ıËΠڷ‚·ÛÙ·Ù›ÓË (20-40 mg/Ë̤ڷ) Î·È ÛÙ· ˘fiÏÔÈ· (108 ·È‰È¿) placebo, Ù· ÔÔ›· ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÁÈ· ‰‡Ô ¯ÚfiÓÈ· (26). ¢È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ÙÈÌÒÓ Ù˘ LDL-C ÛÙËÓ ÔÌ¿‰· Ù˘ Ú·‚·ÛÙ·Ù›Ó˘ (-24,1%) ÂÓÒ fiÛ· ·È‰È¿ ¤Ï·‚·Ó placebo ·ÚÔ˘Û›·Û·Ó ÂÏ·ÊÚ¿ ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ Ù˘ LDL-C (+0,3%). ∆Ô ¿¯Ô˜ ÙÔ˘ ¤Ûˆ Î·È Ì¤ÛÔ˘ ¯ÈÙÒÓ· ÙˆÓ Î·ÚˆÙ›‰ˆÓ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó Ú·‚·ÛÙ·Ù›ÓË ·ÚÔ˘Û›·Û ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË (̤ÛË ÂÏ¿ÙÙˆÛË ¿¯Ô˘˜: -0,010 mm), ÂÓÒ ·ÓÙÈı¤Ùˆ˜, Û fiÛ· ·È‰È¿ ‰fiıËΠplacebo Ë ¿¯˘ÓÛË ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ›¯Â ÂÍÂÏÈÎÙÈÎfi ¯·Ú·ÎÙ‹Ú· (̤ÛË ·‡ÍËÛË ¿¯Ô˘˜: +0,005 mm). ∂Í¿ÏÏÔ˘, ‰ÂÓ ‰È·ÈÛÙÒıËΠη̛· ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ÛˆÌ·ÙÈ΋ ·‡ÍËÛË Î·È ·Ó¿Ù˘ÍË, ÛÙËÓ ÚfiÔ‰Ô Ù˘ ÂÓ‹‚ˆÛ˘ Û‡Ìʈӷ Ì ÙËÓ Îϛ̷η Tanner, ÛÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ¤ÌÌËÓ˘ Ú‡Û˘ Î·È ÛÙÔÓ fiÁÎÔ ÙˆÓ fiگˆÓ, ηıÒ˜ Î·È ÛÙȘ ÂÚÁ·ÛÙËÚȷΤ˜ ÔÚÌÔÓÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ‹ ÛÙ· Ë·ÙÈο Î·È Ì˘˚ο ¤Ó˙˘Ì·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙË ‰Ú¿ÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ Â› ÙÔ˘ ¿¯Ô˘˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ ·Ó¿ÏÔÁ· ‹Ù·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Î·È ¿ÏÏˆÓ ÌÂÏÂÙÒÓ, ÔÈ Ôԛ˜ fï˜ ‰ÈÂÍ‹¯ıËÛ·Ó Û ÂÊ‹‚Ô˘˜ Î·È Î˘Ú›ˆ˜ ÂÓËÏ›ÎÔ˘˜ ˘ÂÚÏÈȉ·ÈÌÈÎÔ‡˜ ·ÛıÂÓ›˜ (27,28). ∂Ô̤ӈ˜, Ë ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ Ì ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·, ı· ÌÔÚÔ‡Û fi¯È ÌfiÓÔ Ó· ·Ó·Îfi„ÂÈ ÙËÓ ÂͤÏÈÍË Ù˘ ·ıËڈ̷ÙÈ΋˜ ‰ÈÂÚÁ·Û›·˜, ·ÏÏ¿ ÂӉ¯Ô̤ӈ˜ Ó· ÂÈʤÚÂÈ ¤ˆ˜ Î·È ÙË ÌÂÚÈ΋ ¤ÛÙˆ ˘Ô-
ÛÙÚÔÊ‹ ·˘Ù‹˜. ∞˘Ùfi Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë Ù·¯‡ÙËÙ· ·‡ÍËÛ˘ ÙÔ˘ ¿¯Ô˘˜ ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ ÙˆÓ Î·ÚˆÙ›‰ˆÓ ·È‰ÈÒÓ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Â›Ó·È ÂÓÙ·Ï¿ÛÈ· Û˘ÁÎÚÈÓfiÌÂÓË Ì ÙËÓ Ù·¯‡ÙËÙ· Ì ÙËÓ ÔÔ›· Û˘Ì‚·›ÓÂÈ Ë ¿¯˘ÓÛË ·˘Ù‹ ÛÙÔ˘˜ ÌË ‰˘ÛÏÈȉ·ÈÌÈÎÔ‡˜ Û˘ÓÔÌÈÏ‹ÎÔ˘˜ ÙÔ˘˜ (29-31). ∆¤ÏÔ˜, ÂÎÙfi˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› Î·È ˆ˜ Ê¿Ú̷η ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÙÒÛÂˆÓ ‰Â˘ÙÂÚÔ·ıÔ‡˜ ˘ÂÚÏÈȉ·ÈÌ›·˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÛÙ· ·È‰È¿ Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ, ÌÂÙ¿ ·fi ÌÂÙ·ÌfiÛ¯Â˘ÛË Î·Ú‰È¿˜, ÛÙË ÓfiÛÔ NiemannPick Ù‡Ô˘ C Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Smith-LemliOpitz (32-34).
º·ÚÌ·ÎÔÎÈÓËÙÈ΋ Î·È Ê·ÚÌ·ÎÔ‰˘Ó·ÌÈ΋ ÙˆÓ ÛÙ·ÙÈÓÒÓ ∏ Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋ ÙˆÓ ÛÙ·ÙÈÓÒÓ ¤¯ÂÈ ÌÂÏÂÙËı› ¢ڤˆ˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ÙfiÛÔ Û ˘ÁÈ›˜ fiÛÔ Î·È Û ·ÛıÂÓ›˜ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (35). £· Ú¤ÂÈ, ·ÛÊ·ÏÒ˜, Ó· Á›ÓÔ˘Ó ·Ó¿ÏÔÁ˜ ÌÂϤÙ˜ Î·È ÛÙ· ·È‰È¿, ÚÔÎÂÈ̤ÓÔ˘ Ó· ηıÔÚÈÛÙ› ÙÔ Î·Ï‡ÙÂÚÔ ‰˘Ó·Ùfi ‰ÔÛÔÏÔÁÈÎfi Û¯‹Ì· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. Œˆ˜ Û‹ÌÂÚ· ¤¯Ô˘Ó ‰ÈÂÍ·¯ı› ÌfiÓÔ ‰‡Ô ÌÂϤÙ˜ Û ·È‰È¿, ·ÌÊfiÙÂÚ˜ Ì ÙË ¯ÔÚ‹ÁËÛË Ú·‚·ÛÙ·Ù›Ó˘. ™ÙËÓ ÚÒÙË ¯ÔÚËÁ‹ıËÎ·Ó 10 mg Ú·‚·ÛÙ·Ù›Ó˘ ¿·Í ËÌÂÚËÛ›ˆ˜ Û 20 ·È‰È¿, ËÏÈΛ·˜ 5-16 ÂÙÒÓ, Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (36). ∆Ô Ê¿ÚÌ·ÎÔ ·ÔÚÚÔÊ‹ıËΠٷ¯‡Ù·Ù· Î·È Ë Ì¤ÛË Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛ‹ ÙÔ˘ ‹Ù·Ó 15,7 ng/ml. √ ̤ÛÔ˜ ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ Ù˘ Ú·‚·ÛÙ·Ù›Ó˘ ‹Ù·Ó 1,6 ÒÚ˜, ÂÓÒ 10 ÒÚ˜ ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘, Ù· ›‰¿ ÙÔ˘ ÛÙÔ ·›Ì· ‹Ù·Ó ÌË ·ÓȯÓ‡ÛÈÌ·. ™ÙË ‰Â‡ÙÂÚË ÌÂϤÙË ¯ÔÚËÁ‹ıËÎ·Ó 20 mg Ú·‚·ÛÙ·Ù›Ó˘ Û 24 ·È‰È¿, ËÏÈΛ·˜ 816 ÂÙÒÓ, Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (37). ∏ ̤ÛË Ì¤ÁÈÛÙË Û˘ÁΤÓÙÚˆÛË ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ·Ó‹Ïı Û 52,1 ng/ml ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 810 ÂÙÒÓ Î·È Û 31,7 ng/ml ÛÙ· ·È‰È¿ ËÏÈΛ·˜ 11-16 ÂÙÒÓ. √ ̤ÛÔ˜ ¯ÚfiÓÔ˜ ËÌ›ÛÂÈ·˜ ˙ˆ‹˜ ‹Ù·Ó Î·È ÁÈ· ÙȘ ‰‡Ô ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ 2,5 ÒÚ˜. √È ÂÚ¢ÓËÙ¤˜ Ô˘ Ú·ÁÌ·ÙÔÔ›ËÛ·Ó Î·È ÙȘ ‰‡Ô ÌÂϤÙ˜ η٤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Ê·ÚÌ·ÎÔÎÈÓËÙÈ΋ Ù˘ Ú·‚·ÛÙ·Ù›Ó˘ ‰ÂÓ ‰È·Ê¤ÚÂÈ Ô˘ÛÈ·ÛÙÈο ·fi ÂΛÓË ÙˆÓ ÂÓËϛΈÓ. øÛÙfiÛÔ, Ù· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ‰ÂÓ Ú¤ÂÈ Ó· ıˆÚËı› fiÙÈ ÌÔÚÔ‡Ó Ó· ÈÛ¯‡ÛÔ˘Ó Î·È ÁÈ· ÙÔ˘˜ ¶·È‰È·ÙÚÈ΋ 2005;68:169-178
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·174
174
°. ∆ÛfiÏ·˜
˘fiÏÔÈÔ˘˜ ·Ó·ÛÙÔÏ›˜ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë Ú·‚·ÛÙ·Ù›ÓË ‰ÂÓ ÌÂÙ·‚ÔÏ›˙ÂÙ·È Ì¤Ûˆ ÙÔ˘ ΢ÙÔ¯ÚÒÌ·ÙÔ˜ P450 fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ˘fiÏÔȘ ÛÙ·Ù›Ó˜.
∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ - ∏ ·ÛÊ¿ÏÂÈ· ÙˆÓ ÛÙ·ÙÈÓÒÓ √È ·Ó·ÛÙÔÏ›˜ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘ Â›Ó·È Î·ÏÒ˜ ·ÓÂÎÙÔ› ·fi ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜. √È Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ, ÙfiÛÔ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ fiÛÔ Î·È ÛÙ· ·È‰È¿, ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÎÂÊ·Ï·ÏÁ›· (212%), ˙¿ÏË (0,5-3%), ·¸Ó›· Î·È ·Ú·ÈÛı‹ÛÂȘ (0,5-2%), Ó·˘Ù›· ‹ Î·È Â̤ÙÔ˘˜ (2-7%), ‰È¿ÚÚÔÈ· ‹ ‰˘ÛÎÔÈÏÈfiÙËÙ· (1-6%), ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ (1-5%), ÂÍ¿ÓıËÌ· ‹ Î·È ÎÓËÛÌfi (1-4%) Î·È Ì˘·ÏÁ›Â˜-·ÚıÚ·ÏÁ›Â˜ (1-3%). ™ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ Ù· ·Ú·¿Óˆ Û˘ÌÙÒÌ·Ù· ˘Ô¯ˆÚÔ‡Ó ·˘ÙÔÌ¿Ùˆ˜ ̤۷ ÛÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ·ÁˆÁ‹˜ ¯ˆÚ›˜ Ó· ¯ÚÂÈ·ÛÙ› ÂÏ¿ÙÙˆÛË Ù˘ ‰fiÛ˘ ‹ ‰È·ÎÔ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ªÂϤÙ˜ Û ÂÓËÏ›ÎÔ˘˜ ¤¯Ô˘Ó ˘ÔÏÔÁ›ÛÂÈ fiÙÈ 1-3% ÙˆÓ ·ÛıÂÓÒÓ ·Ó·Áο˙ÂÙ·È Ó· ‰È·Îfi„ÂÈ ÙË ıÂڷ›· ÂÍ·ÈÙ›·˜ ÛËÌ·ÓÙÈ΋˜ ·‡ÍËÛ˘ Ù˘ ÙÈÌ‹˜ ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ‹ ÏfiÁˆ ›ÌÔÓˆÓ Á·ÛÙÚÂÓÙÂÚÈÎÒÓ ÂÓÔ¯ÏËÌ¿ÙˆÓ (14,38). ∂ȉÈÎfiÙÂÚ·, ·‡ÍËÛË Ù˘ ÙÈÌ‹˜ ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ Û ›‰· ÙÚÈÏ¿ÛÈ· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÛÙÔ 0,5-2% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÛÙ·Ù›Ó˜. ∞˘Ù‹ Ë ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ÙˆÓ ·Ó·ÛÙÔϤˆÓ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘ Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓË Î·È Î·Ù¿ ηÓfiÓ· ·Ó·ÛÙÚ¤„ÈÌË ÌÂÙ¿ ·fi Ì›ˆÛË Ù˘ ‰fiÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘. ™Â οı ÂÚ›ÙˆÛË, Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· Ë ÂͤÏÈÍË Ù˘ Ë·ÙÔ΢ÙÙ·ÚÈ΋˜ ‚Ï¿‚˘ Û ˷ÙÈ΋ ·Ó¿ÚÎÂÈ·. ™˘ÓÈÛٿٷÈ, ¿ÓÙˆ˜, Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Ë ÙÈÌ‹ ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ÚÈÓ - ·ÏÏ¿ Î·È 12 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜. ∞ÎÔÏÔ‡ıˆ˜, ÔÈ ÙÈ̤˜ ÙˆÓ Ë·ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ı· Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Î¿ı 6-12 Ì‹Ó˜. £· Ú¤ÂÈ, ›Û˘, Ó· ÚÔÛ‰ÈÔÚ›˙ÂÙ·È Ë ÙÈÌ‹ ÙˆÓ ÙÚ·ÓÛ·ÌÈÓ·ÛÒÓ ÌÂÙ¿ ·fi οı ÙÚÔÔÔ›ËÛË Ù˘ ‰fiÛ˘ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ (14,38,39). ŸÏÔÈ ÔÈ ·Ó·ÛÙÔÏ›˜ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘ ÌÔÚÔ‡Ó Â›Û˘ Ó· ÚÔηϤÛÔ˘Ó Ì˘Ô¿ıÂÈ·, Ë ÔÔ›· Â›Ó·È ‹È· ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜, Ì ·ÚÔ‰ÈΤ˜ Î·È ÂÏ·ÊÚ¤˜ Ì˘·ÏÁ›Â˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜. ™Ô‚·Ú‹ Ì˘ÔÛ›Ùȉ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ 0,8-1% ÙˆÓ ¶·È‰È·ÙÚÈ΋ 2005;68:169-178
·ÛıÂÓÒÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÛÙ·Ù›Ó˜, Ì ¤ÓÙÔÓ˜ Ì˘·ÏÁ›Â˜ Î·È ·‡ÍËÛË ÙˆÓ ÙÈÌÒÓ Ù˘ CK. ∞ÎfiÌË Û·ÓÈfiÙÂÚ·, Ë Ì˘ÔÛ›Ùȉ· ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ڷ‚‰ÔÌ˘fiÏ˘ÛË, Ì˘ÔÛÊ·ÈÚÈÓÔ˘Ú›· Î·È ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ·. ŒÙÛÈ, ÙÔÓ ∞‡ÁÔ˘ÛÙÔ ÙÔ˘ 2001 ·ÔÛ‡ÚıËΠÔÈÎÂÈÔıÂÏÒ˜ ·fi ÙËÓ ·Ú·ÁˆÁfi ÂÙ·ÈÚ›· Ë ÛÙ·Ù›ÓË ÛÂÚÈ‚·ÛÙ·Ù›ÓË, ÏfiÁˆ Ù˘ ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚ˘ Û˘Û¯¤ÙÈÛ‹˜ Ù˘ ÌÂ Ì˘Ô¿ıÂÈ· Î·È Ú·‚‰ÔÌ˘fiÏ˘ÛË, Û˘ÁÎÚÈÓfiÌÂÓË Ì ¿ÏϘ ÛÙ·Ù›Ó˜. ª¿ÏÈÛÙ·, ÙȘ Ë̤Ú˜ Ô˘ Ï·Ì‚·ÓfiÙ·Ó Ë ·Ú·¿Óˆ ·fiÊ·ÛË, Ë FDA ›¯Â Ï¿‚ÂÈ ÁÓÒÛË 31 ÂÚÈÙÒÛÂˆÓ ı·Ó¿ÙÔ˘ ÏfiÁˆ Ú·‚‰ÔÌ˘fiÏ˘Û˘, ÛÙȘ 12 ·fi ÙȘ Ôԛ˜ ÙÔ Ê¿ÚÌ·ÎÔ ·˘Ùfi ¯ÔÚËÁ›ÙÔ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÁÂÌÊÈÌÚÔ˙›ÏË. √ ·ÚÈıÌfi˜ ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ·Ô‰fiıËÎ·Ó Û ·˘Ùfi ÙÔ Ê¿ÚÌ·ÎÔ ˘ÔÏÔÁ›˙ÂÙ·È Û ϤÔÓ ÙˆÓ 100 ·ÁÎÔÛÌ›ˆ˜. ∏ FDA ÂÎÙÈÌ¿ fiÙÈ Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ Ú·‚‰ÔÌ˘fiÏ˘Û˘ ·fi ÙË ÛÂÚÈ‚·ÛÙ·Ù›ÓË Â›Ó·È 16-80 ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚÔ˜ Û ۇÁÎÚÈÛË Ì ÔÔÈ·‰‹ÔÙ ·fi ÙȘ ¿ÏϘ ÛÙ·Ù›Ó˜ (39). ™Â οı ÂÚ›ÙˆÛË Î·È ·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ fiϘ ÔÈ ˘fiÏÔȘ ÛÙ·Ù›Ó˜ ıˆÚÔ‡ÓÙ·È ·ÛÊ·Ï›˜, ı· Ú¤ÂÈ ÙfiÛÔ ÔÈ ›‰ÈÔÈ ÔÈ ·ÛıÂÓ›˜ fiÛÔ Î·È ÔÈ ÁÔÓ›˜ ÙÔ˘˜ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÒÛÙ ӷ ·Ó·Ê¤ÚÔ˘Ó ·Ì¤Ûˆ˜ ÔÔÈÔ‰‹ÔÙ ‡ÔÙÔ Û‡Ìو̷ fiˆ˜ Ì˘·ÏÁ›Â˜, Ì˘˚΋ ·‰˘Ó·Ì›· ‹ ÛÎÔÙÂÈÓfi¯ÚÔ· Ô‡Ú·. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ı· ÂÌÊ·ÓÈÛÙ› οÔÈÔ ·fi Ù· ·Ú·¿Óˆ Û˘ÌÙÒÌ·Ù·, ÂÈ‚¿ÏÏÂÙ·È Ì¤ÙÚËÛË Ù˘ ÙÈÌ‹˜ Ù˘ CK Î·È ¿ÌÂÛË ‰È·ÎÔ‹ Ù˘ ıÂڷ›·˜ ÂÊfiÛÔÓ Ë ÙÈÌ‹ ·˘Ù‹ ˘ÂÚ‚·›ÓÂÈ ÙÔ ‰ÂηϿÛÈÔ Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÙÈÌ‹˜. ∏ÈfiÙÂÚË Û˘Ìو̷ÙÔÏÔÁ›· ‹ ÂÏ·ÊÚ¿ ·‡ÍËÛË Ù˘ CK ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÈÙ›· ‰È·ÎÔ‹˜ Ù˘ ıÂڷ›·˜. ¢ÂÓ ¯ÚÂÈ¿˙ÂÙ·È, ›Û˘, ̤ÙÚËÛË Ù˘ ÙÈÌ‹˜ Ù˘ CK Ô‡Ù ÚÈÓ ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ô‡ÙÂ Î·È ·ÚÁfiÙÂÚ·, Â¿Ó ‰ÂÓ ˘¿Ú¯ÂÈ ‡ÔÙË Û˘Ìو̷ÙÔÏÔÁ›·. √ ΛӉ˘ÓÔ˜ Ì˘Ô¿ıÂÈ·˜ ·˘Í¿ÓÂÙ·È fiÛÔ ÌÂÁ·Ï‡ÙÂÚË Â›Ó·È Ë ‰fiÛË Ù˘ ¯ÔÚËÁÔ‡ÌÂÓ˘ ÛÙ·Ù›Ó˘, ηıÒ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Û˘Á¯ÔÚ‹ÁËÛ˘ ÁÂÌÊÈÌÚÔ˙›Ï˘ ‹ ¿ÏÏ˘ ÊÈÌÚ¿Ù˘ ‹ ¿ÏÏÔ˘ Ê·ÚÌ¿ÎÔ˘ Ô˘ ·Ó·ÛÙ¤ÏÏÂÈ ÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi Ù˘ ÛÙ·Ù›Ó˘. π‰È·›ÙÂÚ˘ ÚÔÛÔ¯‹˜ ¯Ú‹˙Ô˘Ó ÔÈ ·ÏÏËÏÂȉڿÛÂȘ Ì ʿÚ̷η Ô˘ ÌÂÙ·‚ÔÏ›˙ÔÓÙ·È Ì¤Ûˆ ÙÔ˘ ÈÛÔÂÓ˙‡ÌÔ˘ 3∞4 ÙÔ˘ ΢ÙÔ¯ÚÒÌ·ÙÔ˜ ƒ450. ÷ڷÎÙËÚÈÛÙÈο ·Ú·‰Â›ÁÌ·Ù· ·ÔÙÂÏÔ‡Ó Ë Î˘ÎÏÔÛÔÚ›ÓË, Ë ÂÚ˘ıÚÔÌ˘Î›ÓË, Ë ÎÏ·ÚÈıÚÔÌ˘Î›ÓË, Ë ÛÈÌÂÙȉ›ÓË Î·È Ë Ú·ÓÈÙȉ›ÓË (38,39). ÕÏϘ Û·ÓÈfiÙÂÚ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙˆÓ ÛÙ·ÙÈÓÒÓ Â›Ó·È Ë ÂÚÈÊÂÚÈ΋ Ó¢ڛÙȉ· (40,41), ηıÒ˜ Î·È ·ÓÙȉڿÛÂȘ ˘ÂÚ¢·ÈÛıËÛ›·˜. Œ¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› ˆ˜ ·ÓÂÈı‡ÌËÙË
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·175
175
™Ù·Ù›Ó˜ ÛÙ· ·È‰È¿ Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·
ÂÓ¤ÚÁÂÈ· Î·È Ë ÊˆÙÔ¢·ÈÛıËÛ›· Î·È ˆ˜ ÂÎ ÙÔ‡ÙÔ˘ ÔÈ ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÛÙ·Ù›Ó˜ ı· Ú¤ÂÈ Ó· ·ÔʇÁÔ˘Ó ÙËÓ ·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ (38). ∆¤ÏÔ˜, Ë ÂÁ΢ÌÔÛ‡ÓË ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ÛÙ·ÙÈÓÒÓ. ªÔÏÔÓfiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÁÎÂÎÚÈ̤Ó˜ ·Ó·ÊÔÚ¤˜ ÂÚ› ÙÂÚ·ÙÔÁÂÓ¤Ûˆ˜ ÛÙÔÓ ¿ÓıÚˆÔ, Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ÛÙ· ˙Ò· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ΢‹Ûˆ˜ Ô‰‹ÁËÛ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÛÎÂÏÂÙÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô. ™˘ÓÂÒ˜, ÎÔÚ›ÙÛÈ· ηٿ ÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÊ˂›·˜ Î·È Ó¤Â˜ Á˘Ó·›Î˜ ˘fi ıÂڷ›· Ì ·Ó·ÛÙÔÏ›˜ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘, ı· Ú¤ÂÈ Ó· ¢·ÈÛıËÙÔÔÈÔ‡ÓÙ·È ˆ˜ ÚÔ˜ ÙË Û˘Ó‹ ÂÊ·ÚÌÔÁ‹ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ·ÓÙÈÛ˘ÏÏËÙÈÎÒÓ ÌÂıfi‰ˆÓ (38,39).
∂›‰Ë Î·È ‰ÔÛÔÏÔÁ›· ÛÙ·ÙÈÓÒÓ ™ÙË Û˘Ó¤¯ÂÈ· ·Ú·Ù›ıÂÓÙ·È ÏËÚÔÊÔڛ˜ ÁÈ· ÙËÓ Î¿ı ̛· ÛÙ·Ù›ÓË Í¯ˆÚÈÛÙ¿, ·Ó·Ê¤ÚÂÙ·È ‰Â Î·È ÙÔ fiÓÔÌ· ÙÔ˘ ÈÔ ÁÓˆÛÙÔ‡ ȉÈÔÛ΢¿ÛÌ·ÙÔ˜, ÙfiÛÔ ÛÙË ¯ÒÚ· Ì·˜ fiÛÔ Î·È ‰ÈÂıÓÒ˜. §Ô‚·ÛÙ·Ù›ÓË (Mevacor): ™ÙËÓ ÂÏÏËÓÈ΋ ·ÁÔÚ¿ ΢ÎÏÔÊÔÚ› Û ‰ÈÛΛ· ÙˆÓ 20 Î·È 40 mg, ÂÓÒ ÛÙȘ ∏.¶.∞. Î·È Û ‰ÈÛΛ· ÙˆÓ 10 mg. ∏ Û˘ÓÈÛÙÒÌÂÓË ËÌÂÚ‹ÛÈ· ‰fiÛË ÁÈ· ÂÊ‹‚Ô˘˜ ËÏÈΛ·˜ 10-17 ÂÙÒÓ Î·È ÁÈ· ÂÓËÏ›ÎÔ˘˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂȉÈÒÎÂÙ·È ÂÏ¿ÙÙˆÛË Ù˘ LDL-C Û ÔÛÔÛÙfi >20% Â›Ó·È 20 mg ¿·Í ËÌÂÚËÛ›ˆ˜. ∏ ËÌÂÚ‹ÛÈ· ‰fiÛË ÌÔÚ› Ó· ·˘ÍËı› ¤ˆ˜ Ù· 40 mg ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ¤ˆ˜ Ù· 80 mg ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Û ̛· ‹ ‰‡Ô ‰fiÛÂȘ ÙËÓ Ë̤ڷ. √È ·ÛıÂÓ›˜ Ô˘ Ï·Ì‚¿ÓÔ˘Ó Î˘ÎÏÔÛÔÚ›ÓË ‹ ¿Û¯Ô˘Ó ·fi ÛÔ‚·Ú‹ ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ı· Ú¤ÂÈ Ó· ·Ú¯›˙Ô˘Ó ÙËÓ ˘ÔÏÈȉ·ÈÌÈ΋ ÙÔ˘˜ ·ÁˆÁ‹ Ì 10 mg ËÌÂÚËÛ›ˆ˜ Î·È Ó· ÌËÓ ˘ÂÚ‚·›ÓÔ˘Ó Ù· 20 mg (15). ™ÈÌ‚·ÛÙ·Ù›ÓË (Zocor): ∫˘ÎÏÔÊÔÚ› ÛÙËÓ ∂ÏÏ¿‰· Û ‰ÈÛΛ· ÙˆÓ 10, 20 Î·È 40 mg, ÂÓÒ ÛÙȘ ∏.¶.∞. ˘¿Ú¯Ô˘Ó Î·È ‰ÈÛΛ· ÙˆÓ 5 Î·È 80 mg. ™ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Ë Û˘ÓÈÛÙÒÌÂÓË ·Ú¯È΋ ‰fiÛË Â›Ó·È 20 mg ¿·Í ËÌÂÚËÛ›ˆ˜, ÂÓÒ Û fiÛÔ˘˜ ¿Û¯Ô˘Ó ·fi ÔÌfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Ë ‰fiÛË Â›Ó·È 40 ‹ Î·È 80 mg Û ‰‡Ô ¤ˆ˜ ÙÚÂȘ ‰fiÛÂȘ ÙËÓ Ë̤ڷ. ™Â ÂÚ›ÙˆÛË Û˘Á¯ÔÚ‹ÁËÛ˘ ΢ÎÏÔÛÔÚ›Ó˘ ‹ ÛÔ‚·Ú‹˜ ÓÂÊÚÈ΋˜ ‚Ï¿‚˘, Ë ·Ú¯È΋ ‰fiÛË Â›Ó·È 5 mg, Ë ‰Â ̤ÁÈÛÙË 10 mg/24ˆÚÔ. ™Â ·È‰È¿ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· ‹ ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ¤¯Ô˘Ó ¯ÔÚËÁËı› 10-20 mg/24ˆÚÔ (19,20,32). ™Â ‰‡Ô ‚Ú¤ÊË, ÂÍ¿ÏÏÔ˘, Ì ۇӉÚÔÌÔ Smith-Lemli-
Opitz ‰ÔÎÈÌ¿ÛÙËΠ̠ÂÈÙ˘¯›· ÙÔ Ê¿ÚÌ·ÎÔ ·˘Ùfi Û ‰fiÛË 0,2-1 mg/kg/24ˆÚÔ (42). ¶Ú·‚·ÛÙ·Ù›ÓË (Pravachol): ™ÙË ¯ÒÚ· Ì·˜ ΢ÎÏÔÊÔÚ› Û ‰ÈÛΛ· ÙˆÓ 20 Î·È 40 mg, ÂÓÒ ÛÙȘ ∏.¶.∞. Î·È Û ‰ÈÛΛ· ÙˆÓ 10 Î·È 80 mg. ∏ ·Ú¯È΋ ‰fiÛË ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Â›Ó·È 40 mg/24ˆÚÔ, ‰fiÛË Ë ÔÔ›· ÌÔÚ› - Â¿Ó ··ÈÙËı› - Ó· ÊÙ¿ÛÂÈ ¤ˆ˜ Î·È Ù· 80 mg ËÌÂÚËÛ›ˆ˜. ∏ ·Ú¯È΋ ‰fiÛË ı· Ú¤ÂÈ Ó· ÌÂȈı› ÛÙ· 10 mg/24ˆÚÔ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ·ÛıÂÓ›˜ Ì ÓÂÊÚÈ΋ ‹ Ë·ÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ‹ ÛÙËÓ ÂÚ›ÙˆÛË Û˘Á¯ÔÚ‹ÁËÛ˘ ΢ÎÏÔÛÔÚ›Ó˘. ™Ù· ˘ÂÚÏÈȉ·ÈÌÈο ·È‰È¿, Ë ÚÔÙÂÈÓfiÌÂÓË ‰fiÛË Î˘Ì·›ÓÂÙ·È ·fi 5 ¤ˆ˜ 20 mg ËÌÂÚËÛ›ˆ˜ (18,34,43). ºÏÔ˘‚·ÛÙ·Ù›ÓË (Lescol): ™ÙË ¯ÒÚ· Ì·˜ ΢ÎÏÔÊÔÚ› Û ο„Ô˘Ï˜ ÙˆÓ 40 mg. ™ÙȘ ∏.¶.∞. ˘¿Ú¯Ô˘Ó, ÂÈϤÔÓ, ο„Ô˘Ï˜ ÙˆÓ 20 mg, ηıÒ˜ Î·È Î¿„Ô˘Ï˜ ·Ú·ÙÂٷ̤Ó˘ ·Ô‰¤ÛÌ¢Û˘ ÙˆÓ 80 mg (Lescol XR). ™ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ë ‰fiÛË Ì ÙËÓ ÔÔ›· ·Ú¯›˙ÂÈ Ë ıÂڷ›· Â›Ó·È 40-80 mg ËÌÂÚËÛ›ˆ˜. ¢ÂÓ ¯ÚÂÈ¿˙ÂÙ·È ÙÚÔÔÔ›ËÛË Ù˘ ‰fiÛ˘ Û ÂÚ›ÙˆÛË ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ (44). ∞ÙÔÚ‚·ÛÙ·Ù›ÓË (Lipitor): ™ÙËÓ ∂ÏÏ¿‰· ΢ÎÏÔÊÔÚ› Û ‰ÈÛΛ· ÙˆÓ 10, 20 Î·È 40 mg, ÂÓÒ ÛÙȘ ∏.¶.∞. ˘¿Ú¯Ô˘Ó Î·È ‰ÈÛΛ· ÙˆÓ 80 mg. ∏ ·Ú¯È΋ ‰fiÛË ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Â›Ó·È 10-20 mg. ∏ ̤ÁÈÛÙË ‰fiÛË Â›Ó·È 80 mg. ¢ÂÓ ··ÈÙÂ›Ù·È ÙÚÔÔÔ›ËÛË Ù˘ ‰fiÛ˘ Û ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¤ÎÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (45). ∏ ¯ÔÚ‹ÁËÛË ÙˆÓ ÛÙ·ÙÈÓÒÓ ‰ÂÓ ÂËÚ¿˙ÂÙ·È ·fi ÙË Ï‹„Ë ÙÚÔÊ‹˜, Ì ÂÍ·›ÚÂÛË ÙË ÏÔ‚·ÛÙ·Ù›ÓË Ë ÔÔ›· ¯ÔÚËÁÂ›Ù·È Ì ٷ Á‡̷ٷ, ÂÂȉ‹ ·˘Ùfi Û˘Ì‚¿ÏÏÂÈ ÛÙËÓ Â›Ù¢ÍË ÌÂÁ·Ï‡ÙÂÚˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ÛÙÔ ·›Ì·. √È ÛÙ·Ù›Ó˜ ÌÔÚÔ‡Ó Ó· ¯ÔÚËÁËıÔ‡Ó ÔÔÈ·‰‹ÔÙ ÒÚ· Ù˘ Ë̤ڷ˜, Â›Ó·È fï˜ ÚÔÙÈÌfiÙÂÚÔ Ë ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ Ó· Á›ÓÂÙ·È Û ̛· ‰fiÛË ÚÈÓ ÙË Ó˘ÎÙÂÚÈÓ‹ ηٿÎÏÈÛË, ÔfiÙ Ϸ̂¿ÓÂÈ ¯ÒÚ· Î·È Ë Ì¤ÁÈÛÙË Û‡ÓıÂÛË Ù˘ ¯ÔÏËÛÙÂÚfiÏ˘. ∆¤ÏÔ˜, ÔÈ ·Ó·ÚÔÛ·ÚÌÔÁ¤˜ Ù˘ ‰fiÛ˘ ı· Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Ì ÌÂÛԉȷÛÙ‹Ì·Ù· fi¯È ÌÈÎÚfiÙÂÚ· ÙÔ˘ ÂÓfi˜ Ì‹Ó· (14,42-45).
™˘ÌÂÚ¿ÛÌ·Ù· √È ·Ó·ÛÙÔÏ›˜ Ù˘ HMG-CoA ·Ó·ÁˆÁ¿Û˘, ÁÓˆÛÙÔ› ¢ڇÙÂÚ· ˆ˜ ÛÙ·Ù›Ó˜, Û˘Ó¤‚·Ï·Ó Ù· ̤ÁÈÛÙ· ÛÙËÓ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ¤¯ÔÓÙ·˜ ¯ÚËÛÈÌÔÔÈËı› ¢ڤˆ˜ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ¶·È‰È·ÙÚÈ΋ 2005;68:169-178
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ÙˆÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ ‰˘ÛÏÈȉ·ÈÌ›·˜ ÙˆÓ ÂÓËϛΈÓ. ∆· Ê¿Ú̷η ·˘Ù¿ ÌÂÈÒÓÔ˘Ó ‰Ú·ÛÙÈο Ù· ›‰· Ù˘ ·ÚÈ·˜ ·ıËڈ̷ÙÔÁfiÓÔ˘ ÏÈÔÚˆÙ½Ó˘, Ù˘ LDL, ÂÓÒ ‚ÂÏÙÈÒÓÔ˘Ó Ô˘ÛÈ·ÛÙÈο Ù· ›‰· Î·È ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ¿ÏÏˆÓ ÏÈÔÚˆÙÂ˚ÓÈÎÒÓ ÎÏ·ÛÌ¿ÙˆÓ (14,46). ∞˘Ù‹ Ë ˘ÔÏÈȉ·ÈÌÈ΋ ‰Ú¿ÛË ÙÔ˘˜ ˘ÂÚÙÂÚ› Û·ÊÒ˜ ·fi ÂΛÓË ÙˆÓ ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈÎÒÓ ÚËÙÈÓÒÓ (47). ∂ÎÙfi˜ fï˜ ·fi ·˘Ù‹ ÙË ‰Ú¿ÛË ÙÔ˘˜, ÔÈ ÛÙ·Ù›Ó˜ ·ÛÎÔ‡Ó Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË, ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙÔ ¿¯Ô˜ Î·È ‚ÂÏÙÈÒÓÔÓÙ·˜ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘, ¤ÙÛÈ ÒÛÙ ӷ ·ÔÙÂÏÔ‡Ó - Û˘ÁÎÚÈÓfiÌÂÓ˜ Ì ÙȘ ÈÔÓÙÔ·ÓÙ·ÏÏ·ÎÙÈΤ˜ ÚËÙ›Ó˜ - Ê¿Ú̷η Ôχ ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈο fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙÂÏÈ΋ ·ÓÙÈ·ıËڈ̷ÙÈ΋ ÙÔ˘˜ ‰Ú¿ÛË. ∏ ‰Â‰Ô̤ÓË ÂÈÙ˘¯›· ÙÔ˘˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ ‰˘ÛÏÈȉ·ÈÌÈÎÔ‡˜ ·ÛıÂÓ›˜, Ô‰‹ÁËÛ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Î·È ÚÔ·ÓÙfi˜ Ù˘ ·ÛÊ¿ÏÂÈ¿˜ ÙÔ˘˜ ÛÙË ıÂڷ›· Ù˘ ·È‰È΋˜ ‰˘ÛÏÈȉ·ÈÌ›·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÚfiÏË„Ë Ù˘ ηډȷÁÁÂȷ΋˜ ÓfiÛÔ˘ ‚Ú›ÛÎÂÙ·È Û ¿ÌÂÛË Û˘Ó¿ÚÙËÛË Ì ÙËÓ ¤ÁηÈÚË ¤Ó·ÚÍË ÔÔÈ·Û‰‹ÔÙ ·ÓÙÈ·ıËڈ̷ÙÈ΋˜ ·ÁˆÁ‹˜ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ·. ™Â ÌÂϤÙ˜ Ô˘ ‰ÈÂÍ‹¯ıËÛ·Ó ÙfiÛÔ Û ·È‰È¿ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· fiÛÔ Î·È Û ·È‰È¿ Ì ‰Â˘ÙÂÚÔ·ı‹ ‰˘ÛÏÈȉ·ÈÌ›·, Û ÔÚÈṲ̂Ó˜ ·fi ÙȘ Ôԛ˜ ¤ÁÈÓ ‹‰Ë ·Ó·ÊÔÚ¿, ηٷ‰Â›¯ıËΠÙfiÛÔ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· fiÛÔ Î·È Ë ·ÛÊ¿ÏÂÈ· ÙˆÓ ÛÙ·ÙÈÓÒÓ. ∞·ÈÙ›ٷÈ, ·ÛÊ·ÏÒ˜, Ë ‰ÈÂÓ¤ÚÁÂÈ· Î·È ¿ÏÏˆÓ ÚÔÔÙÈÎÒÓ ÌÂÏÂÙÒÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏÂÁ¯ı› Ë ·ÒÙÂÚË ·ÛÊ¿ÏÂÈ· ÙˆÓ Ê·ÚÌ¿ÎˆÓ ·˘ÙÒÓ ÛÙȘ ÂÚÈÙÒÛÂȘ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ ·fi ÙËÓ ÚÒÈÌË ·È‰È΋ ËÏÈΛ·. ¢ÂÓ ¤¯ÂÈ ¿ÏψÛÙ ÚÔÛ‰ÈÔÚÈÛÙ› Ë Ï¤ÔÓ Î·Ù¿ÏÏËÏË ËÏÈΛ· ÁÈ· ÙËÓ ¤Ó·ÚÍË ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜. ∞fi ÙȘ ¤ˆ˜ ÙÒÚ· ÌÂϤÙ˜, Ë Ï¤ÔÓ ·ÛÊ·Ï‹˜ ËÏÈΛ· ÁÈ· ÙËÓ ¤Ó·ÚÍË Ù˘ ıÂڷ›·˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ. øÛÙfiÛÔ, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ¤¯ÂÈ ÛËÌÂȈı› ÚÔÛ‚ÔÏ‹ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘ Û ·È‰È¿ Ì ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ‹‰Ë ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ (48), ηıÒ˜ Î·È ÙÔ fiÙÈ ÙÔ ¿¯Ô˜ ÙÔ˘ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ‹‰Ë ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 12 ÂÙÒÓ (29-31), ηıÈÛÙÔ‡Ó ··Ú·›ÙËÙË ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ‰˘Ó·ÙfiÙËÙ·˜ ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘˜ Û ·ÎfiÌË ÌÈÎÚfiÙÂÚË ËÏÈΛ·. ∏ ·Ó·ÌÂÓfiÌÂÓË ÛÙÔ ÂÁÁ‡˜ ̤ÏÏÔÓ Î˘ÎÏÔÊÔÚ›· ÓÂfiÙÂÚˆÓ Î·È ÂÚÈÛÛfiÙÂÚÔ ·ÔÙÂÏÂÛÌ·ÙÈÎÒÓ ÛÙ·ÙÈÓÒÓ (49,50) ÁÂÓÓ¿ ÂÏ›‰Â˜ ÁÈ· ¤Ó· ÈÔ Â˘Ô›ˆÓÔ Ì¤ÏÏÔÓ ÙˆÓ ·È‰ÈÒÓ Ì ÛÔ‚·Ú‹ ‰˘ÛÏȶ·È‰È·ÙÚÈ΋ 2005;68:169-178
ȉ·ÈÌ›·. ™Ùfi¯Ô˜ Â›Ó·È ·˘Ù¿ Ù· ·È‰È¿, ηٿ ÙË ÌÂÙ¤ÂÈÙ· ÂÓ‹ÏÈÎË ˙ˆ‹ ÙÔ˘˜, Ó· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ¯·ÌËÏ¿ ›‰· LDL-C, Ê˘ÛÈÔÏÔÁÈÎfi ¿¯Ô˜ ·ÚÙËÚÈ·ÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·ÁÁÂÈ·ÎÔ‡ ÂÓ‰ÔıËÏ›Ô˘, Ì ÙÔÓ ÌÈÎÚfiÙÂÚÔ ‰˘Ó·Ùfi ΛӉ˘ÓÔ ÌÂÏÏÔÓÙÈ΋˜ ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘. ∏ ÚÔÔÙÈ΋ Ó· ηıÈÂÚˆıÔ‡Ó ÔÈ ÛÙ·Ù›Ó˜ ˆ˜ Ê¿Ú̷η ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛÔ‚·ÚÒÓ Ù‡ˆÓ ·È‰È΋˜ ‰˘ÛÏÈȉ·ÈÌ›·˜ Î·È È‰È·›ÙÂÚ· Ù˘ ÂÙÂÚfi˙˘Á˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜, ÛÙËÓ ÔÔ›· ¿ÏψÛÙ ·Ó·Ê¤ÚÔÓÙ·È ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜, Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ Â›Ó·È Î·È ÙfiÛÔ Ì·ÎÚÈÓ‹.
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¶·È‰È·ÙÚÈ΋ 2005;68:169-178
46. Hennermann JB, Herwig J, Marz W, Asskali F, Bohles HJ. Lipid and lipoprotein profiles in children with familial hypercholesterolaemia: effects of therapy. Eur J Pediatr 1998;157:912-918. 47. Tonstad S, Sivertsen M, Aksnes L, Ose L. Low dose colestipol in adolescents with familial hypercholesterolaemia. Arch Dis Child 1996;74:157-160. 48. Virkola K, Pesonen E, Akerblom HK, Siimes MA. Cholesterol and carotid artery wall in children and adolescents with familial hypercholesterolaemia: a controlled study by ultrasound. Acta Paediatr 1997;86:1203-1207. 49. Stein EA, Strutt K, Southworth H, Diggle PJ, Miller E; HeFH Study Group. Comparison of rosuvastatin versus atorvastatin in patients with heterozygous familial hypercholesterolemia. Am J Cardiol 2003;92: 1287-1293. 50. Jones PH, Davidson MH, Stein EA, Bays HE, McKenney JM, Miller E et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003;92:152-160.
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The safety and efficacy of statin therapy in children with familial hypercholesterolaemia G. Tsolas
Abstract Children with familial hypercholesterolaemia have endothelial dysfunction and increased arterial intima-media thickness, which herald the premature atherosclerotic disease they develop later in life. Ultrasonographically detected intima-media thickening of the carotid arteries and abdominal aorta can be detected in prepubertal children with familial hypercholesterolaemia. Multivariate analysis indicates LDL-cholesterol concentration as a strong independent predictor of carotid artery intimamedia thickness and endothelial dysfunction in these children, which confirms the pivotal role of lowdensity lipoprotein cholesterol in the development of atherosclerosis. Familial hypercholesterolaemia is the genetic model for the role of high LDL-cholesterol levels in the pathology of coronary heart disease, with a frequency of heterozygous familial hypercholesterolaemia of 1 in 500. Because of their high coronary risk, all children with this disorder may begin preventive efforts as early as childhood, with a healthful diet and exercise as the foundation of any regimen. However, because of their genetic predisposition for elevated LDL-C, young persons with familial hypercholesterolaemia may require a degree of cholesterol modification that lifestyle measures alone generally cannot provide. In such cases, up until now bile-acid sequestrants were considered the preferred drug approach in children and adolescents. These drugs are safe for children but unfortunately not always efficient, partly because of their poor palatibility and compliance. The treatment of elevated blood lipid levels has been dramatically altered by the introduction during the last decade of the HMG-CoA reductase inhibitors, also known as the statins. As the use of these agents become more widespread in adults, investigators have begun to study their effects in children. Several studies have demonstrated excellent LDL-C lowering efficacy as well as arterial intima-media thickness regression and endothelial dysfunction improvement from statin therapy in children with familial hypercholesterolaemia, with no adverse effects on growth, sexual maturation, hormone levels, liver function or muscle tissue. Although further longitudinal studies are needed to clarify fully the role of statins in the paediatric population, these agents should become the pivotal therapy in children with familial hypercholesterolaemia.
Paediatric Clinic, “Aghios Panteleimon” General Hospital of Nikea, Piraeus Correspondence: Georgios Tsolas 32 Parnithos str., 190 13, Saronida, Attica E-mail: geotsol@otenet.gr Date of submission: 17-09-2004 Date of approval: 29-03-2005
Key words Familial hypercholesterolaemia, statins, atherosclerosis, arterial endothelial dysfunction, coronary heart disease.
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OÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË ∞. ™Î·Ú‰Ô‡ÙÛÔ˘
µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∞ÁÁÂÏÈ΋ ™Î·Ú‰Ô‡ÙÛÔ˘ µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-11-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 29-03-2005
¶ÂÚ›ÏË„Ë ∏ ÔÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË Â›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ‰È·ÁÈÁÓÒÛÎÂÙ·È ¤ÁηÈÚ· ÂÂȉ‹ ÔÏÏ¿ ·fi Ù· ÓÔÛ‹Ì·Ù· Ô˘ ÙËÓ ·ÔÙÂÏÔ‡Ó Âȉ¤¯ÔÓÙ·È ıÂڷ›·˜, ÂÓÒ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ·Ó·Ó¢ÛÙÈ΋ ·Ú¿Ï˘ÛË. ∞Ó Î·È ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· ÌÔÚ› Ó· ÚÔ‚¿ÏÏÔ˘Ó Ì ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË, Ë ‰È¿ÁÓˆÛË ÂÛÙÈ¿˙ÂÙ·È Î˘Ú›ˆ˜ Û ̛· ÔÌ¿‰· ·fi ›ÎÙËÙ˜ ÊÏÂÁÌÔÓÒ‰ÂȘ Ó¢ÚÔ¿ıÂȘ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔÏÔÁ›·˜, ÔÈ Ôԛ˜ ʤÚÔÓÙ·È Î¿Ùˆ ·fi ÙËÓ ÂÚÈÏËÙÈ΋ ÔÓÔÌ·Û›· Û‡Ó‰ÚÔÌÔ Guillain-Barre (GBS), ηıÒ˜ Î·È ÙËÓ ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·. ∏ Ï·ÛÌ·Ê·›ÚÂÛË fiˆ˜ Î·È Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ Û ¿Û¯ÔÓÙ˜ Ì GBS ÂÈÙ·¯‡ÓÔ˘Ó ÙËÓ ·Ó¿ÚÚˆÛË Î·È ÙËÓ ·ÓÂÍ¿ÚÙËÙË ‚¿‰ÈÛË, ·Ó Î·È ‰ÂÓ Â›Ó·È ÁÓˆÛÙfi Â¿Ó ÌÂÈÒÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Î·È Â¿Ó ÂËÚ¿˙Ô˘Ó ÙËÓ ·ÒÙÂÚË ÚfiÁÓˆÛË. ™ÙËÓ ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ· ¤¯ÂÈ ·Ó·ÊÂÚı› ‚ÂÏÙ›ˆÛË Ì ÙË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘. ™Ù· ·È‰È¿ Ë ÚfiÁÓˆÛË ÁÈ· ÙÔ GBS Â›Ó·È ÂÍ·ÈÚÂÙÈ΋, ÂÊfiÛÔÓ Ù· ÂÚÈÛÛfiÙÂÚ· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ï‹ÚË ›·ÛË ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÈηÓÔÔÈËÙÈ΋ ÎÈÓËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÌÂÙ¿ ·fi ÌÂÚÈÎÔ‡˜ Ì‹Ó˜. §¤ÍÂȘ ÎÏÂȉȿ OÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË, Û‡Ó‰ÚÔÌÔ Guillain-Barre, ÂÓ‰ÔÊϤ‚Ș ·ÓÔÛÔÛÊ·ÈÚ›Ó˜, Ï·ÛÌ·Ê·›ÚÂÛË, ÌÂÙ·ÏÔÈÌ҉˘ Ì˘ÂÏ›ÙȘ, ıÂڷ›· Ì ÛÙÂÚÔÂȉ‹.
∂ÈÛ·ÁˆÁ‹ ∏ ÔÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û¯ÂÙÈο ÁÚ‹ÁÔÚË ÂͤÏÈÍË ÁÂÓÈÎÂ˘Ì¤Ó˘ ·‰˘Ó·Ì›·˜ ‹ Û˘ÌÌÂÙÚÈ΋˜ ·‰˘Ó·Ì›·˜ ÙˆÓ ÌÂÏÒÓ ÙÔ˘ ÛÒÌ·ÙÔ˜. ªÂ ‚¿ÛË ÙÔÓ ¯ÚfiÓÔ ·fi ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘, ‰È·ÎÚ›ÓÂÙ·È Û ٷ¯¤ˆ˜ ÂÍÂÏÈÛÛfiÌÂÓË (ÒÚ˜), ÔÍ›· (Ë̤Ú˜) Î·È ˘ÔÍ›· (̤¯ÚÈ 4 ‚‰ÔÌ¿‰Â˜). ∏ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÂÓÙÔ›˙ÂÙ·È ÛÙÔÓ ÂÚÈÊÂÚÈÎfi ÎÈÓËÙÈÎfi Ó¢ÚÒÓ· (ÚfiÛıÈ· Τڷٷ, ÂÚÈÊÂÚÈο Ó‡ڷ, Ó¢ÚÔÌ˘˚΋ Û‡Ó·„Ë) ‹ ÙÔ˘˜ Ì˘˜. ∆Ô 1916, ÔÈ Guillain-Barre Î·È Stroll ÂÚȤÁÚ·„·Ó Ì›· Ó¢ÚÔ¿ıÂÈ· Ô˘ ¯·Ú·ÎÙËÚÈ˙fiÙ·Ó ·fi Ù·¯¤ˆ˜ ·ÓÈÔ‡Û· ·Ú¿Ï˘ÛË, ηٿÚÁËÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ Î·È ÏÂ˘ÎˆÌ·ÙÔ΢ÙÙ·ÚÈÎfi ‰È¯·ÛÌfi ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi. ∞Ó Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ›¯Â ıˆÚËı› ÁÈ· ÔÏϤ˜ ‰ÂηÂٛ˜ ˆ˜ ÂÓÈ·›· ÔÓÙfiÙËÙ· Ì ‰È¿ÊÔÚ˜ ·Ú·ÏÏ·Á¤˜, ¤Ú¢ӷ ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ ·ÔÙÂÏ› Ì›· ÔÌ¿‰· ·fi ›ÎÙËÙ˜ Ó¢ÚÔ¿ıÂȘ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔÏÔÁ›·˜. ∏ ·˘ÙÔ¿ÓÔÛË ÚÔÛ‚ÔÏ‹ ηÙ¢ı‡ÓÂÙ·È ÛÙ· ·ÙÙ·Ú· Schwann, ÛÙË Ì˘ÂÏ›ÓË, ÛÙÔÓ ¿ÍÔÓ· ‹ Î·È ÛÂ Û˘Ó‰˘·ÛÌfi ·˘ÙÒÓ. ™‹ÌÂÚ·, οو ·fi ÙËÓ ÔÓÔÌ·Û›· Û‡Ó‰ÚÔÌÔ Guillain-Barre (GBS) ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÔÍ›· ÊÏÂÁÌÔÓ҉˘ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Úȶ·È‰È·ÙÚÈ΋ 2005;68:180-187
˙ÔÓ¢ÚÔ¿ıÂÈ· (acute infectious demyelinating polyradiculoneuropathy - AIDP), Ë ÔÍ›· ÎÈÓËÙÈ΋ ·ÍÔÓÈ΋ Ó¢ÚÔ¿ıÂÈ· (acute motor axonal polyneuropathy - AMAN), Ë ÔÍ›· ÎÈÓËÙÈ΋ ·ÈÛıËÙÈ΋ Ó¢ÚÔ¿ıÂÈ· (acute motor sensory neuropathy - AMS∞¡) Î·È ÙÔ Û‡Ó‰ÚÔÌÔ Miller Fisher (¶›Ó·Î·˜ 1). ∏ AIDP Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÂΉ‹ÏˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔÓ ‰˘ÙÈÎfi ÎfiÛÌÔ, ÂÓÒ Ë ∞ª∞¡ Â›Ó·È Û˘¯Ó‹ Û ·È‰È¿ ÛÙËÓ ∫›Ó·, ȉȷ›ÙÂÚ· ÙÔ ı¤ÚÔ˜.
√Í›· ÊÏÂÁÌÔÓ҉˘ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (AIDP) ∂›Ó·È Ë ÎÏ·ÛÈ΋ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÌÔÚÊ‹ ÙÔ˘ GBS. ∂˘ı‡ÓÂÙ·È ÁÈ· ÙÔ 90% ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙË µfiÚÂÈ· ∞ÌÂÚÈ΋, ÙËÓ ∂˘ÚÒË Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·. ∏ Û˘¯ÓfiÙËÙ· Ù˘ AIDP Â›Ó·È 1:100.000 ·È‰È¿ ·Ó¿ ¤ÙÔ˜. ∆· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ Ù˘È΋ AIDP ›ӷÈ: ·) Û˘ÌÌÂÙÚÈ΋ ·‰˘Ó·Ì›· Û fiÏ· Ù· ̤ÏË, ‚) ·Ú·ÈÛıËۛ˜ Î·È ˘·ÈÛıËÛ›· ÛÙ· ¿ÎÚ·, Á) Ì›ˆÛË ‹ ηٿÚÁËÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜, ‰) ÂͤÏÈÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û ÌÂÚÈΤ˜ Ë̤Ú˜ ̤¯ÚÈ ¤Ó· Ì‹Ó· (2) Î·È Â) ·ÔÎÏÂÈÛÌfi˜ ¿ÏÏˆÓ ÓÔÛËÌ¿ÙˆÓ (¶›Ó·Î·˜ 2). ∏ ·Ú¿Ï˘ÛË ÌÔÚ› Ó· ·Ú¯›˙ÂÈ ÂÚÈÊÂÚÈο
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·181
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OÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË
¶›Ó·Î·˜ 1. ºÏÂÁÌÔÓÒ‰ÂȘ Ó¢ÚÔ¿ıÂȘ Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔ Û‡Ó‰ÚÔÌÔ Guillain-Barre √Í›· ÊÏÂÁÌÔÓ҉˘ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (AIDP) √Í›· ÎÈÓËÙÈ΋ ·ÍÔÓÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (AMAN) √Í›· ÎÈÓËÙÈ΋ ·ÈÛıËÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (AMSAN) ™‡Ó‰ÚÔÌÔ Miller Fisher
‹ ÎÂÓÙÚÔÌÂÏÈο Î·È Ù˘Èο Â›Ó·È Û˘ÌÌÂÙÚÈ΋. ªÔÚ› Ó· Â›Ó·È ·ÓÈÔ‡Û·. ∆Ô 30% ÙˆÓ ·Û¯fiÓÙˆÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÊÚÂÓÈÎÔ‡ Ó‡ÚÔ˘ Î·È ¯ÚÂÈ¿˙ÂÙ·È Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË, ÙÔ 50% ·Ú¿Ï˘ÛË ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ Ó‡ڈÓ, Û˘Ó‹ıˆ˜ ÙÔ˘ ÚÔÛˆÈÎÔ‡, ÙÔ 40% fiÓÔ ÛÙË Ú¿¯Ë, ÙÔ 20% ·Ú·ÈÛıËۛ˜ Î·È ÙÔ 50% ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ ·˘ÙfiÓÔÌÔ Û‡ÛÙËÌ·, fiˆ˜ ˘fiÙ·ÛË, ˘¤ÚÙ·ÛË, ηډȷΤ˜ ·ÚÚ˘ı̛˜, Á·ÛÙÚÔ¿ÚÂÛË, ‰˘ÛÎÔÈÏÈfiÙËÙ· Î·È Î·Ù·ÎÚ¿ÙËÛË ÙˆÓ Ô‡ÚˆÓ (1,4,5). ™˘¯Ófi ·Ú¯ÈÎfi Û‡Ìو̷ Â›Ó·È Ë ·Ù·Í›· ÛÙË ‚¿‰ÈÛË (50%) (4). ∂ÎÙfi˜ ·fi ÙËÓ ·Ú·¿Óˆ Ù˘È΋ ÌÔÚÊ‹, ˘¿Ú¯ÂÈ Ì›· ÌÔÚÊ‹ ·ÌÈÁÒ˜ ÎÈÓËÙÈ΋, Ì›· ·ÌÈÁÒ˜ ·ÈÛıËÙÈ΋ Î·È Ì›· Ì ÁÓ‹ÛÈ· ·Ó‰˘Û·˘ÙÔÓÔÌ›· (6). ∏ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ AIDP Â›Ó·È 1,5%, Û˘Ó‹ıˆ˜ ·fi ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· ‹ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜.
∂ÚÁ·ÛÙËÚȷ΋ ‰ÈÂÚ‡ÓËÛË ∏ ÂͤٷÛË ÙÔ˘ ∂¡À Â›Ó·È ··Ú·›ÙËÙË Î˘Ú›ˆ˜ ÁÈ· Ó· ·ÔÎÏÂÈÛÙÔ‡Ó ¿ÏϘ ‰È·ÁÓÒÛÂȘ fiˆ˜ Â›Ó·È ÏÔÈÌÒÍÂȘ, .¯. ÌÔÚÚ¤ÏÈ·, ÔÏ˘ÔÌ˘ÂÏ›ÙȘ ‹ ÏÂÌʈ̷ÙÒ‰ÂȘ ÔÏ˘ÚÈ˙›Ùȉ˜. ∏ ÚˆÙ½ÓË ÙÔ˘ ∂¡À ÎÏ·ÛÈο ·˘Í¿ÓÂÙ·È Û·Ó ·ÔÙ¤ÏÂÛÌ· ‰È·ÚÚÔ‹˜ Ù˘ ·Ï‚Ô˘Ì›Ó˘ ·fi ÙÔ ·›Ì·, ÌÔÚ› fï˜ Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰· Ù˘ ÓfiÛÔ˘. ∆· Ï¢ÎÔ·ÙÙ·Ú· ÛÙÔ ∂¡À Â›Ó·È Û˘Ó‹ıˆ˜ Ê˘ÛÈÔÏÔÁÈο, ·ÏÏ¿ ÌÔÚ› Ó· Â›Ó·È ·˘ÍË̤ӷ ¤ˆ˜ 50 ·ÙÙ·Ú·. ªÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ΢ÙÙ¿ÚˆÓ Û˘ÓËÁÔÚ› ÁÈ· Ïԛ̈ÍË. ™Ù· 2/3 ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÚÔËÁÂ›Ù·È Ïԛ̈ÍË, fiˆ˜ ÌÂ Î·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ jejuni, CMV, EBV ‹ Ì˘ÎfiÏ·ÛÌ· Ù˘ Ó¢ÌÔÓ›·˜ (4). ∏ ·Ó‡ÚÂÛË ·ÓÙÈÛˆÌ¿ÙˆÓ IgM ÛÙÔ ·›Ì· Û ¤Ó·Ó ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÚfiÛÊ·Ù˘ Ïԛ̈͢, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ¯Ú‹ÛÈÌË ÎÏÈÓÈο. ™ÙËÓ Î·ÏÏȤÚÁÂÈ· ÎÔÚ¿ÓˆÓ ÌÔÚ› Ó· ·ÔÌÔÓˆı› ÙÔ Î·Ì˘ÏÔ‚·ÎÙËÚ›‰ÈÔ, ·ÏÏ¿ Ë ıÂڷ›· Ì ·ÓÙÈ‚ÈÔÙÈο Â›Ó·È Èı·Ófi Ó· ÌËÓ ÂËÚ¿˙ÂÈ ÙËÓ ÚfiÁÓˆÛË. ∏ Èı·ÓfiÙËÙ· Ó· ÂΉËψı› GBS ÌÂÙ¿ ·fi ÂÓÙÂÚ›Ùȉ· jejuni Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi 1:2.500. √ ÙÚfiÔ˜ Ì ÙÔÓ ÔÔ›Ô ÔÈ ÏÔÈÌÒÍÂȘ ·˘Ù¤˜ ÚÔηÏÔ‡Ó ÙÔ ÓfiÛËÌ· ‰ÂÓ
Â›Ó·È ·ÎÚÈ‚Ò˜ ÁÓˆÛÙfi˜. ¶Èı·ÓfiÙÂÚË Â›Ó·È Ë ˘fiıÂÛË fiÙÈ ˘¿Ú¯Ô˘Ó ‰ÔÌÈΤ˜ ÔÌÔÈfiÙËÙ˜ ÌÂٷ͇ ÙˆÓ ÏÔÈÌÔÁfiÓˆÓ ·Ú·ÁfiÓÙˆÓ Î·È ÙˆÓ ÚˆÙÂ˚ÓÒÓ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ÓÂ‡ÚˆÓ ÙÔ˘ ÍÂÓÈÛÙ‹ Î·È Ë Ïԛ̈ÍË ˘ÚÔ‰ÔÙ› ÙË ‰ËÌÈÔ˘ÚÁ›· ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ Ì ÙË Ì¤ıÔ‰Ô Ù˘ ÌÔÚȷ΋˜ Ì›ÌËÛ˘ (7). ™Â ¿ÙÔÌ· Ì AIDP ¤¯Ô˘Ó ‚ÚÂı› ·ÓÙÈÛÒÌ·Ù· Û ÔÏÏ¿ ·ÓÙÈÁfiÓ· ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ Ó‡ڈÓ, ΢ڛˆ˜ ·ÓÙÈ-GM1, ˆÛÙfiÛÔ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·Û¯fiÓÙˆÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÓÙÈÛÒÌ·Ù·, ¤ÙÛÈ ÒÛÙÂ Ë ·ıÔÁ¤ÓÂÛË Ù˘ ÓfiÛÔ˘ Ó· Â›Ó·È ·ÎfiÌË Û˘˙ËÙ‹ÛÈÌË. ∆· ·ÓÙÈÛÒÌ·Ù· Ô˘ ¤¯Ô˘Ó ‚ÚÂı›, ˘¿Ú¯Ô˘Ó ›Û˘ Î·È Û ¿ÏÏ· Ó¢ÚÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ‹ ·ÎfiÌË Î·È ÛÂ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì¿ÚÙ˘Ú˜ Î·È ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ÂÈÊ·ÈÓfiÌÂÓ·. ∂ÓÙÔ‡ÙÔȘ, ÌÂÚÈο ·ÓÙÈÛÒÌ·Ù· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ ˘ÔÙ‡Ô˘˜ ÙÔ˘ GBS (8). ∏ ·ÚÔ˘Û›· ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ÙÚÔÔÔÈ› ÙË ıÂڷ›·. √ Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ÙÔ ËÏÂÎÙÚÔÓ¢ÚÔÁÚ¿ÊËÌ· Î·È ÙÔ ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÙË ‰È¿ÁÓˆÛË, ÙËÓ Ù·ÍÈÓfiÌËÛË Î·È - Û ÂÚÈÔÚÈṲ̂ÓÔ ‚·ıÌfi - ÙËÓ ÚfiÁÓˆÛË. ™˘Ì‚¿ÏÏÂÈ, ›Û˘, ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·fi ÙË Ì˘ÔÛ›Ùȉ· Î·È ÙË Ì˘·Ûı¤ÓÂÈ·. ∆Ô ÚÒÈÌÔ ÛËÌÂ›Ô Ù˘ ÔÍ›·˜ ·ÔÌ˘ÂϛӈÛ˘ Â›Ó·È Ë ÂÛÙȷ΋ ‰È·ÎÔ‹ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ (conduction block), ÂÓÒ ¯ÚÂÈ¿˙ÂÙ·È ‰È¿ÛÙËÌ· ÂÚ›Ô˘ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ ÁÈ· Ó· ‰È·ÈÛÙˆı› Ë Ì›ˆÛË Ù˘ Ù·¯‡ÙËÙ·˜ Ù˘ ÎÈÓËÙÈ΋˜ ·ÁˆÁ‹˜, Ë ÔÔ›· ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ·ÔÌ˘ÂϛӈÛË (9). ∞Ù˘¯Ò˜ ÁÈ· ÙËÓ ¤ÁηÈÚË ‰È¿ÁÓˆÛË, Ë ‰È·ÎÔ‹ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ Â›Ó·È ÈÔ Û˘¯Ó‹ ÛÙ· ÂÁÁ‡˜ ÙÌ‹Ì·Ù· ÙˆÓ ÚÈ˙ÒÓ, Ù· ÔÔ›· Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔÛÂÏ·ÛÙÔ‡Ó Î·È Û Ôχ ÂÚÈÊÂÚÈο ÛËÌ›·, ÔfiÙ ÌÈÌÂ›Ù·È ·ÍÔÓÔ¿ıÂÈ·, ¤ÙÛÈ ÒÛÙÂ Â›Ó·È ·‰‡Ó·ÙÔÓ Ó· ‰È·¯ˆÚÈÛÙ› Ë ·ÍÔÓÈ΋ ·fi ÙËÓ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ‚Ï¿‚Ë ÛÙ· ÚÒÈÌ· ÛÙ¿‰È· ÙÔ˘ GBS. ∞ÍÔÓÈ΋ ‚Ï¿‚Ë Î·È ÂÎʇÏÈÛË ÙÔ˘ ¿ÍÔÓ· ÌÔÚ› ›Û˘ Ó· Û˘Ì‚Â› ‰Â˘ÙÂÚÔ·ıÒ˜ ÌÂÙ¿ ·fi ÚˆÙÔ·ı‹ ‚Ï¿‚Ë Ù˘ Ì˘ÂÏ›Ó˘. ™˘Ì‚·›ÓÂÈ ÛÙÔ 3-16% ÙˆÓ ·Û¯fiÓÙˆÓ Ì ∞πDP (4). °›ÓÂÙ·È ÂÌÊ·Ó‹˜ ÎÏÈÓÈο ÌÂÙ¿ ÌÂÚÈΤ˜ ‚‰ÔÌ¿‰Â˜ ·fi ÙËÓ ·ÙÚÔÊ›· Ì˘ÒÓ Î·È ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈο ·fi ÙËÓ ‡·ÚÍË ·ÔÓ‡ڈÛ˘, Ë ÔÔ›· ÛËÌ·›ÓÂÈ Î·È Î·Î‹ ÚfiÁÓˆÛË.
£Âڷ›· ∏ ÚÒÙË ıÂڷ¢ÙÈ΋ ̤ıÔ‰Ô˜ Ô˘ ‰ÔÎÈÌ¿ÛÙËΠ۠ÂÓ‹ÏÈΘ Î·È Û ÌÈÎÚfi ·ÚÈıÌfi ·È‰ÈÒÓ Ô˘ ¤·Û¯·Ó ·fi GBS ‹Ù·Ó Ë Ï·ÛÌ·Ê·›ÚÂÛË. ∏ Ï·ÛÌ·Ê·›ÚÂÛË ·Ô‰Â›¯ÙËΠfiÙÈ - Û ۯ¤ÛË Ì ÙË Û˘Ìو̷ÙÈ΋ ıÂڷ›· - ÌÂÈÒÓÂÈ ÙÔÓ ¯ÚfiÓÔ Ì¤¯ÚÈ ÙËÓ Â·Ó¿ÎÙËÛË Ù˘ ‚¿‰ÈÛ˘ ¶·È‰È·ÙÚÈ΋ 2005;68:180-187
Paediatriki May-June 05
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∞. ™Î·Ú‰Ô‡ÙÛÔ˘
¶›Ó·Î·˜ 2. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ÔÍ›·˜ ¯·Ï·Ú‹˜ ·Ú¿Ï˘Û˘. ∞Ó·ÙÔÌÈ΋ ÚÔÛ¤ÁÁÈÛË (3) 1. ª‡Â˜ (ÔÍ›˜ Ì˘Ô¿ıÂȘ) - ºÏÂÁÌÔÓÒ‰ÂȘ Ì˘Ô¿ıÂȘ (ÔÏ˘Ì˘ÔÛ›ÙȘ, ‰ÂÚÌ·ÙÔÌ˘ÔÛ›ÙȘ), ÙÚȯ›ÓˆÛË - ƒ·‚‰ÔÌ˘fiÏ˘ÛË - ¶ÂÚÈÔ‰ÈΤ˜ ·Ú·Ï‡ÛÂȘ (˘ÔηÏÈ·ÈÌÈ΋, ˘ÂÚηÏÈ·ÈÌÈ΋) - ªÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜ (˘ÔηÏÈ·ÈÌ›·, ˘ÔʈÛÊ·Ù·ÈÌ›·, ˘ÂÚÌ·ÁÓËÛÈ·ÈÌ›·) - ª˘Ô¿ıÂÈ· ·fi ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ı˘ÚÂÔÂȉԇ˜ ‹ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ - ŒÏÏÂÈ„Ë fiÍÈÓ˘ Ì·ÏÙ¿Û˘ - ªÈÙÔ¯ÔÓ‰Úȷο ÓÔÛ‹Ì·Ù· 2. ¡Â˘ÚÔÌ˘˚΋ Û‡Ó·„Ë - ∞ÏÏ·ÓÙ›·ÛË - ¶·Ú¿Ï˘ÛË ·fi Tick - ÕÏϘ ÙÔ͛Ә (ÙÂÙÚ·‰ÔÙÔÍ›ÓË) - √ÚÁ·ÓÔʈÛÊÔÚÈο (ÚÔηÏÔ‡Ó Î·È Ó¢ÚÔ¿ıÂÈ·) - ª˘·Ûı¤ÓÂÈ·, Û‡Ó‰ÚÔÌÔ Eaton Lambert 3. ¡Â‡Ú· Î·È Ú›˙˜ (ÔÏ˘ÚÈ˙ÔÓ¢ÚÔ¿ıÂȘ) - ∞˘ÙÔ¿ÓÔÛ˜ AIDP, CIDP, ·Ú·ÓÂÔÏ·ÛÌ·ÙÈΤ˜, ·Ú·ÚˆÙÂ˚Ó·ÈÌ›· - ∞ÁÁÂÈ›Ùȉ˜: Ô˙҉˘ ÔÏ˘·ÚÙËÚ›ÙȘ, ÎÚ˘ÔÛÊ·ÈÚÈÓ·ÈÌ›·, Ë·Ù›ÙȘ C, ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, Û·ÚÎÔ›‰ˆÛË - ªÂÙ·‚ÔÏÈο: ÔÚÊ˘Ú›· - º¿Ú̷η: ÙÔ͛Ә: ¯ËÌÂÈÔıÂڷ¢ÙÈο (‚ÈÓÎÚÈÛÙ›ÓË, cisplatin, Ù·ÌÔÍÈÊ·›ÓË), ¯Ú˘Ûfi˜, ·ÚÛÂÓÈÎfi, ı¿ÏÏÈÔ, ÌfiÏ˘‚‰Ô˜, glue sniffing - §ÔÈÌÒÍÂȘ, ‰ÈÊıÂÚ›Ùȉ·, HIV, ÌÔÚÚ¤ÏÈ· - ∫ÔÎÎȈ̷ÙÒ‰ÂȘ: Û·ÚÎÔ›‰ˆÛË, Ϥڷ - ∫·ÎÔ‹ıÂÈ·: ÔÍ›· Ï¢¯·ÈÌ›·, ηÚΛӈ̷ (¿ÌÂÛË ‰È›ۉ˘ÛË), ÏÂÙÔÌËÓÈÁÁÈ΋ ·ÁÁÂȈ̿وÛË - ∂ÛÙȷο: ‚Ú·¯ÈfiÓÈ· ‹ ÔÛÊ˘Ô˚ÂÚ¿ ÏÂÍÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ ÈÔ‡ÚȉԘ, ÎÚ·Óȷ΋ ÔÏ˘Ó¢ڛÙȘ 4. ¶ÚfiÛıÈ· Τڷٷ - ¶ÔÏÈÔÌ˘ÂÏ›ÙȘ - ÕÏÏÔÈ Ó¢ÚÔÙÚfiÔÈ ÈÔ› - ™‡Ó‰ÚÔÌÔ ÚfiÛıÈ·˜ ÓˆÙÈ·›·˜ ·ÚÙËÚ›·˜ 5. ¡ˆÙÈ·›Ô˜ Ì˘ÂÏfi˜ - ºÏÂÁÌÔÓÒ‰Ë (ÂÁοÚÛÈ· Ì˘ÂÏ›ÙȘ) - ∞ÔÌ˘ÂϛӈÛË (MS - ADEM) - ŒÌÊÚ·ÎÙÔ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ 6. ∂ÁΤʷÏÔ˜ - µÏ¿‚˜ ÛÙË Á¤Ê˘Ú· (ÎÂÓÙÚÈ΋ ÁÂÊ˘ÚÈ΋ Ì˘ÂÏÈÓfiÏ˘ÛË, ¤ÌÊÚ·ÎÙÔ ‹ ·ÈÌÔÚÚ·Á›·) - ¶ÔÏ˘ÂÛÙȷΤ˜ ‚Ï¿‚˜ (‰È¿Û·ÚÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›ÙȘ ADEM, ÔÏÏ·Ï¿ ¤ÌÊÚ·ÎÙ· ‹ ·ÈÌÔÚÚ·Á›Â˜, .¯. ‰È¿¯˘ÙË ÂÓ‰Ô·ÁÁÂȷ΋ ‹ÍË, ıÚÔÌ‚ˆÙÈ΋ ıÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ, ‚·ÎÙËÚȷ΋ ÂÓ‰Ôηډ›ÙȘ)
¯ˆÚ›˜ ‚Ô‹ıÂÈ· Î·È ÙÔÓ ¯ÚfiÓÔ ·Ú·ÌÔÓ‹˜ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô (4). ∂ÓÙÔ‡ÙÔȘ, ÏfiÁˆ ÙˆÓ Èı·ÓÒÓ ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ fiˆ˜ Ë ˘fiÙ·ÛË Î·È Ë ¯ÚËÛÈÌÔÔ›ËÛË ÌÂÁ¿ÏÔ˘ ÊÏ‚ÈÎÔ‡ ηıÂÙ‹Ú·, ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙ· ·È‰È¿. ∏ ıÂڷ›· ÂÎÏÔÁ‹˜ Û ÔÏϤ˜ ¯ÒÚ˜ Â›Ó·È Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ (IVIg). ∞Ó ¶·È‰È·ÙÚÈ΋ 2005;68:180-187
Î·È ‰ÂÓ ¤¯ÂÈ ÂÎÙÈÌËı› ·ÚÎÒ˜ Û ۯ¤ÛË Ì placebo, ÌÂϤÙ˜ Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ ¤‰ÂÈÍ·Ó fiÙÈ Ë IVIg ¤¯ÂÈ ·ÚfiÌÔÈ· ÚfiÛÊ·ÙË Î·È ·ÒÙÂÚË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ÙËÓ Ï·ÛÌ·Ê·›ÚÂÛË (10-12). √È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÌÂϤÙ˜ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ·¤ÎÏÂÈÛ·Ó Ù· ·È‰È¿, ÙÔ˘˜ ¿Û¯ÔÓÙ˜ Ì Ôχ ‹È· Û˘ÌÙÒÌ·Ù·, ηıÒ˜ Î·È fiÛÔ˘˜ ÓÔÛËχıËÎ·Ó ÌÂÙ¿ ÙȘ ÚÒÙ˜ ‰‡Ô ‚‰ÔÌ¿‰Â˜ Ù˘ ÓfiÛÔ˘. ªÂÚÈΤ˜ ·ÓÔȯ٤˜ ÌÂϤÙ˜ Ì ÌÈÎÚfi ·ÚÈıÌfi ·È‰ÈÒÓ Ì ÙË ÓfiÛÔ Ô˘ ¤Ï·‚·Ó Á-ÛÊ·ÈÚ›ÓË ¤‰ÂÈÍ·Ó ÂÈÙ¿¯˘ÓÛË ÙÔ˘ ¯ÚfiÓÔ˘ Ù˘ ·Ó¿ÚÚˆÛ˘ Î·È Ù˘ ·ÓÂÍ¿ÚÙËÙ˘ ‚¿‰ÈÛ˘ (13-16). ™Â Ì›· ·fi ·˘Ù¤˜ (13), Ë ·Ó¿ÚÚˆÛË ‹Ù·Ó Ù·¯‡ÙÂÚË fiÙ·Ó Ë Û˘ÓÔÏÈ΋ ‰fiÛË ¯ÔÚËÁ‹ıËΠ۠2 Ë̤Ú˜, Û ۇÁÎÚÈÛË Ì ÙȘ 5 Ë̤Ú˜. ¢ÂÓ Â›Ó·È Û·Ê¤˜ ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·Û¯fiÓÙˆÓ Â¿Ó Ë ıÂڷ›· Ì Á-ÛÊ·ÈÚ›ÓË ‚ÂÏÙÈÒÓÂÈ ÙËÓ ·ÒÙÂÚË ÚfiÁÓˆÛË Î·È ÙËÓ ·Ó¿ÁÎË ÁÈ· ·Ó·Ó¢ÛÙÈ΋ ˘ÔÛÙ‹ÚÈÍË. ∏ Û˘Ì‚·ÙÈ΋ ‰fiÛË Â›Ó·È 2 mg/kg ‚¿ÚÔ˘˜ ÛÒÌ·ÙÔ˜ ¯ÔÚËÁÔ‡ÌÂÓË Û 2 Ë̤Ú˜ ‹ Î·È 3-4 Ë̤Ú˜ fiÙ·Ó ÙÔ ·È‰› Â›Ó·È Ôχ ‚·Ú‡. √ Û˘Ó‰˘·ÛÌfi˜ Ù˘ Ï·ÛÌ·Ê·›ÚÂÛ˘ Î·È Ù˘ Á-ÛÊ·ÈÚ›Ó˘ ‰ÂÓ ¤¯ÂÈ Î·Ï‡ÙÂÚ· ·ÔÙÂϤÛÌ·Ù· Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙȘ ıÂڷ›˜ ÌÂÌÔӈ̤ӷ. ∏ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ÁÛÊ·ÈÚ›Ó˘ Û˘ÓÈÛÙ¿Ù·È Û ·È‰È¿ Ô˘ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ‚·‰›ÛÔ˘Ó ¯ˆÚ›˜ ‚Ô‹ıÂÈ· ̤۷ Û 2 ‹ 4 ‚‰ÔÌ¿‰Â˜, ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Ó¢ÚÔ·ıËÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È Û fiÛ· ¤¯Ô˘Ó Û˘ÌÙÒÌ·Ù· ·Ú¯fiÌÂÓ˘ ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ‹ ‰˘ÛηٷÔÛ›· (11). ∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ·Ú·‰fi͈˜ ‰ÂÓ ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ¿ÌÂÛË Ô‡Ù ÙËÓ ·ÒÙÂÚË ÚfiÁÓˆÛË fiÙ·Ó ¯ÔÚËÁËıÔ‡Ó ÌÂÌÔӈ̤ӷ. µÂÏÙ›ˆÛË Û ۯ¤ÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ¤Ó·Ó ÌÈÎÚfi ·ÚÈıÌfi ÂÓËÏ›ÎˆÓ Ì ÙË Û˘Ó‰˘·Ṳ̂ÓË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Á-ÛÊ·ÈÚ›Ó˘. ™Â ÂͤÏÈÍË ‚Ú›ÛÎÔÓÙ·È ÌÂϤÙ˜ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ·Û¯fiÓÙˆÓ Ô˘ ¤Ï·‚·Ó ·˘ÙfiÓ ÙÔÓ Û˘Ó‰˘·ÛÌfi. ∏ ı¤ÛË ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ ÂӉ¯Ô̤ӈ˜ Ó· ·ÓÂÎÙÈÌËı› fiÙ·Ó ÔÈ ÌÂϤÙ˜ ÔÏÔÎÏËÚˆıÔ‡Ó Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÂÓۈ̷وıÔ‡Ó ÛÙË Û˘ÛÙËÌ·ÙÈ΋ ÎÚÈÙÈ΋. ŸÏÔÈ ÔÈ Ù‡ÔÈ GBS ıÂڷ‡ÔÓÙ·È ÔÌÔ›ˆ˜, ·Ó Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÌÈÎÚÒÓ ˘ÔÔÌ¿‰ˆÓ Û˘ÓËÁÔÚÔ‡Ó fiÙÈ Ë IVIg ÌÔÚ› Ó· Â›Ó·È Î·Ï‡ÙÂÚË ·fi ÙËÓ Ï·ÛÌ·Ê·›ÚÂÛË fiÙ·Ó ˘¿Ú¯Ô˘Ó ·ÓÙÈÛÒÌ·Ù· ÛÙÔ ·ÓÙÈÁfiÓÔ Ù˘ Á·ÁÁÏÈÔÛ›‰Ë˜ GM1. ∂¿Ó Ô ¿Û¯ˆÓ ‰ÂÓ ·ÚÔ˘ÛÈ¿ÛÂÈ ‚ÂÏÙ›ˆÛË Û ‰‡Ô ‚‰ÔÌ¿‰Â˜, ÌÔÚ› Ó· ‰ÔÎÈÌ·ÛÙ› ¿ÏÏË Ì›· Û˘Ó‰ڛ· Ù˘ ›‰È·˜ ıÂڷ›·˜, ÂȉÈο fiÙ·Ó
Paediatriki May-June 05
12-07-05
13:08
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OÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË
˘¿Ú¯ÂÈ ‰È·ÎÔ‹ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜. ŒÓ· ÔÛÔÛÙfi 10% ÙˆÓ ·ÛıÂÓÒÓ ÂΉËÏÒÓÂÈ ÚÔÛˆÚÈÓ‹ ÎÏÈÓÈ΋ ˘ÔÙÚÔ‹ Ï›Á˜ ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙËÓ ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË, ȉȷ›ÙÂÚ· fiÛÔÈ ¤Ï·‚·Ó ÓˆÚ›˜ ıÂڷ›· (4). ∞˘Ùfi Û˘Ì‚·›ÓÂÈ Èı·ÓÒ˜ ÂÂȉ‹ Ë ıÂڷ›· ›¯Â ‰È·ÎÔ› ÚÈÓ ÙÔ ˘ÔΛÌÂÓÔ ÓfiÛËÌ· ˘Ô¯ˆÚ‹ÛÂÈ ÙÂÏ›ˆ˜ Î·È ÙÔ ¿ÙÔÌÔ ‰ÂÓ ¤¯ÂÈ ·Ó·ÁηÛÙÈο ¯ÚfiÓÈ· ÊÏÂÁÌÔÓÒ‰Ë ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ·. ™Â ·È‰È¿ Ô˘ ¤Ï·‚·Ó ıÂڷ›· Ì IVIg ·Ú·ÙËÚ‹ıËΠ̷ÎÚÔ¯ÚfiÓÈ· Ì˘˚΋ ·‰˘Ó·Ì›· ÙÔ˘Ï¿¯ÈÛÙÔÓ Û ̛· Ì˘˚΋ ÔÌ¿‰· Û ÔÛÔÛÙfi 020% (16,17). ∏ ·‰˘Ó·Ì›· ‹Ù·Ó ÂÏ·ÊÚ¿ Î·È ‰ÂÓ ÂËÚ¤·˙ ÙË ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Ù˘ ΛÓËÛ˘ (17). ¢˘ÛÌÂÓ›˜ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ‹Ù·Ó Ë ÌÈÎÚ‹ ËÏÈΛ· Î·È Ë ÁÚ‹ÁÔÚË ÂͤÏÈÍË Ù˘ ·‰˘Ó·Ì›·˜.
∂Ì‚ÔÏÈ·ÛÌÔ› Î·È ˘ÔÙÚÔ‹ ∆Ô Û‡Ó‰ÚÔÌÔ Guillain-Barre Â›Ó·È Û¿ÓÈ· ÂÈÏÔ΋ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ ÌÂ Û˘¯ÓfiÙËÙ· 1:1.000.000 ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ (18). ∏ Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙÔ˘ GBS ÌÂÙ¿ ·fi ÂÌ‚ÔÏÈ·ÛÌfi Â›Ó·È 1,2%, ÁÈ’ ·˘Ùfi ‰ÂÓ Û˘ÓÈÛÙÒÓÙ·È ÔÈ ÂÌ‚ÔÏÈ·ÛÌÔ› ηٿ ÙÔÓ ÚÒÙÔ ¯ÚfiÓÔ ÌÂÙ¿ ÙÔ GBS, ·ÏÏ¿ Î·È ÙË CIDP, fiÔ˘ Ë ¯Ú‹ÛË ÙÔ˘ ·ÓÙÈÙÂÙ·ÓÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ¤¯ÂÈ ÚÔηϤÛÂÈ ·ÓËÛ˘¯›Â˜ (18).
√Í›· ÊÏÂÁÌÔÓ҉˘ ÎÈÓËÙÈ΋ ·ÍÔÓÈ΋ Ó¢ÚÔ¿ıÂÈ· (∞ª∞¡) ™Â ·˘ÙfiÓ ÙÔÓ Ù‡Ô ˘¿Ú¯ÂÈ ·˘ÙÔ¿ÓÔÛË ÚÔÛ‚ÔÏ‹ ÙÔ˘ ¿ÍÔÓ· ¯ˆÚ›˜ ÛËÌ·ÓÙÈ΋ ·ÔÌ˘ÂϛӈÛË. ∏ ‚Ï¿‚Ë Â›Ó·È Û˘Ó‹ıˆ˜ ·Ó·ÛÙÚ¤„ÈÌË. ∏ ̤ÁÈÛÙË ·‰˘Ó·Ì›· ÂΉËÏÒÓÂÙ·È Ì¤Û· Û 7 ‚‰ÔÌ¿‰Â˜ Î·È ·ÎÔÏÔ˘ı› Ù·¯Â›· ·Ó¿ÚÚˆÛË ¯ˆÚ›˜ ˘ÔÏ›ÌÌ·Ù·. ∆· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο Û˘¯Ó¿ ‰È·ÙËÚÔ‡ÓÙ·È. √È ËÏÂÎÙÚÔÊ˘ÛÈÔÏÔÁÈÎÔ› ¯·Ú·ÎÙ‹Ú˜ ·˘Ù‹˜ Ù˘ Ó¢ÚÔ¿ıÂÈ·˜ ÙË ‰È·¯ˆÚ›˙Ô˘Ó ·fi ÙËÓ AIDP Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË Ì›ˆÛË ÙÔ˘ ‡„Ô˘˜ ÙˆÓ Ì˘˚ÎÒÓ ÎÈÓËÙÈÎÒÓ ‰˘Ó·ÌÈÎÒÓ Î·È ÙȘ ۯ‰fiÓ Ê˘ÛÈÔÏÔÁÈΤ˜ Ù·¯‡ÙËÙ˜ ÎÈÓËÙÈ΋˜ ·ÁˆÁ‹˜. ™ÙËÓ ·Ú¯‹ Ù˘ ÓfiÛÔ˘, Ô ‰È·¯ˆÚÈÛÌfi˜ Â›Ó·È Û¯Â‰fiÓ ·‰‡Ó·ÙÔ˜. ∆˘Èο, Ë ÔÍ›· ÎÈÓËÙÈ΋ ·ÍÔÓÈ΋ Ó¢ÚÔ¿ıÂÈ· ¢ı‡ÓÂÙ·È ÌfiÓÔ ÁÈ· ÙÔ 5% ÙÔ˘ GBS ÛÙËÓ ∞ÌÂÚÈ΋ Î·È ÙËÓ ∂˘ÚÒË, ÁÈ· ÙÔ 40% ÛÙË §·ÙÈÓÈ΋ ∞ÌÂÚÈ΋ Î·È ÁÈ· ÙÔ 70% ÛÙË ‚fiÚÂÈ· ∫›Ó·, fiÔ˘ ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ¤¯ÂÈ Âԯȷ΋ Û˘Û¯¤ÙÈÛË Ì ÙȘ ÂȉË̛˜ ÙÔ˘ Î·Ì˘ÏÔ‚·ÎÙËÚȉ›Ô˘ jejuni Î·È ÂÚ›Ô˘ ÔÈ ÌÈÛÔ› ¿Û¯ÔÓÙ˜ ¤¯Ô˘Ó ·ÓÙÈÛÒ-
Ì·Ù· ¤Ó·ÓÙÈ ÙˆÓ GM1/GDIa Á·ÁÁÏÈÔÛȉÒÓ. ∏ ıÂڷ›· ÁÈ· ÙÔ ÓfiÛËÌ· ·˘Ùfi Â›Ó·È fiÌÔÈ· Ì ÂΛÓË ÙÔ˘ GBS.
™‡Ó‰ÚÔÌÔ Miller Fisher ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÙÚÈ¿‰· ·Ù·Í›·, ÔÊı·ÏÌÔÏËÁ›· Î·È ·ÒÏÂÈ· ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ. øÛÙfiÛÔ, ÌÔÚ› Ó· Û˘Ó˘¿Ú¯Ô˘Ó ¿ÚÂÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Î·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡ Ù˘ ÎfiÚ˘. ªÂÚÈÎÔ› ¿Û¯ÔÓÙ˜ ¤¯Ô˘Ó ÂÈϤÔÓ Ì˘˚΋ ·‰˘Ó·Ì›· Î·È ÁÈ’ ·˘ÙÔ‡˜ ¤¯ÂÈ ÚÔÙ·ı› Ô fiÚÔ˜ Û‡Ó‰ÚÔÌÔ Miller Fisher/Guillain-Barre. ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘ Â›Ó·È 1,5% ÙÔ˘ GBS (12). ™Â ÌÂÚÈÎÔ‡˜ ¿Û¯ÔÓÙ˜ ¤¯ÂÈ ‰È·ÈÛÙˆı› Ì ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ıÔÏÔÁÈÎfi Û‹Ì· ÛÙÔ Û٤ϯԘ, ÙÔ ÔÔ›Ô ¤¯ÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο Ôȉ‹Ì·ÙÔ˜, ·Ó¿ÏÔÁÔ Ì ÂΛÓÔ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ÂÁÎÂÊ·Ï›Ùȉ· ÙÔ˘ ÛÙÂϤ¯Ô˘˜ (19). ∂ÈϤÔÓ, ÛÙË ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ·ÛıÂÓÒÓ Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ·Ó¢ڛÛÎÂÙ·È ·Óٛۈ̷ ¤Ó·ÓÙÈ Ù˘ Á·ÁÁÏÈÔÛ›‰Ë˜ GQ1b. ∆Ô ·ÓÙÈÁfiÓÔ ÁÈ· ÙÔ GQ1b ¤¯ÂÈ ÂÓÙÔÈÛÙ› Û ·ÈÛıËÙÈÎÔ‡˜ Î·È ÔÊı·ÏÌÔÎÈÓËÙÈÎÔ‡˜ Ó¢ÚÒÓ˜ Î·È Û Ó¢ÚÒÓ˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜, ηıÒ˜ Î·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi Campylobacter jejuni. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ ıˆÚÂ›Ù·È fiÙÈ ÙÔ ÓfiÛËÌ· ·˘Ùfi ÌÔÚ› Ó· ÚÔÛ‚¿ÏÏÂÈ ÙfiÛÔ ÙÔ ÎÂÓÙÚÈÎfi fiÛÔ Î·È ÙÔ ÂÚÈÊÂÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· Î·È Ó· ‰ÒÛÂÈ ·ÚfiÌÔÈ·, ·Ó fi¯È ··Ú¿ÏÏ·ÎÙ·, Û˘ÌÙÒÌ·Ù·. ∏ ÚfiÁÓˆÛË Â›Ó·È ¿ÚÈÛÙË ·ÎfiÌË Î·È ¯ˆÚ›˜ ıÂڷ›·, Ë ÔÔ›· Èı·ÓfiÓ Ó· ¯ÚÂÈ¿˙ÂÙ·È ÌfiÓÔ Û ¿Û¯ÔÓÙ˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì˘˚΋ ·‰˘Ó·Ì›·, fiˆ˜ Á›ÓÂÙ·È ÛÙËÓ AIDP.
ÃÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (CIDP) ∏ ¯ÚfiÓÈ· ÊÏÂÁÌÔÓ҉˘ ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (chronic infectious demyelinating polyneuropathy - CIDP) ÔÌÔÈ¿˙ÂÈ Ì ÙÔ GBS, ÂÍÂÏ›ÛÛÂÙ·È fï˜ ÈÔ ·ÚÁ¿ Î·È ı· Ú¤ÂÈ Ó· Èı·ÓÔÏÔÁÂ›Ù·È Û οı ÂÚ›ÙˆÛË ¯·Ï·Ú‹˜ ·Ú¿Ï˘Û˘ Ô˘ ·Ô‰›‰ÂÙ·È Û ·˘ÙÔ¿ÓÔÛË ÔÏ˘Ó¢ÚÔ¿ıÂÈ·. ∂ΉËÏÒÓÂÙ·È ÌÂ Û˘ÌÌÂÙÚÈ΋ ÎÂÓÙÚÔÌÂÏÈ΋ ‹ ÂÚÈÊÂÚÈ΋ Ì˘˚΋ ·‰˘Ó·Ì›·, Ë ÔÔ›· ÂȉÂÈÓÒÓÂÙ·È ÁÈ· ‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 8 ‚‰ÔÌ¿‰ˆÓ. À¿Ú¯ÂÈ, ›Û˘, Ì›ˆÛË ‹ ηٿÚÁËÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ Î·È ˘·ÈÛıËÛ›· Ô˘ ·ÊÔÚ¿ ȉȷ›ÙÂÚ· ÛÙËÓ ¶·È‰È·ÙÚÈ΋ 2005;68:180-187
Paediatriki May-June 05
12-07-05
13:08
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∞. ™Î·Ú‰Ô‡ÙÛÔ˘
ÎÈÓ·ÈÛıËÛ›· Î·È ÏÈÁfiÙÂÚÔ ÛÙÔÓ fiÓÔ Î·È ÙËÓ ·Ê‹ (20,21). ∏ ˘·ÈÛıËÛ›· Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ·fi ÂΛÓË ÛÙËÓ AIDP. ÕÏϘ ‰È·ÊÔÚ¤˜ ·fi ÙËÓ AIDP Â›Ó·È fiÙÈ Ë ·‰˘Ó·Ì›· ÛÙÔ ÚfiÛˆÔ Â›Ó·È ÏÈÁfiÙÂÚÔ Û˘¯Ó‹ Î·È fiÙÈ ÂÏ¿¯ÈÛÙÔÈ ·ÛıÂÓ›˜ ÚÔ¯ˆÚÔ‡Ó Û ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·. ∏ ÓfiÛÔ˜ ÌÔÚ› Ó· ·Ú¯›ÛÂÈ ·fi ÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, ÔfiÙ ÂΉËÏÒÓÂÙ·È Û·Ó ÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË (21). ∆· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿ ÂΉËÏÒÓÔ˘Ó ÛÔ‚·Ú‹ ·‰˘Ó·Ì›· ÛÙ· οو ¿ÎÚ· Î·È ÛÙȘ ÌÈÛ¤˜ ÂÚÈÙÒÛÂȘ ¯¿ÓÔ˘Ó ÙËÓ ÈηÓfiÙËÙ· Ù˘ ‚¿‰ÈÛ˘ (22,23). ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ ˘¿Ú¯ÂÈ ÌfiÓÔ ¤Ó· ÂÂÈÛfi‰ÈÔ Âȉ›ӈÛ˘ ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ‚ÂÏÙ›ˆÛË (ÌÔÓÔÊ·ÛÈ΋ ÌÔÚÊ‹), ÂÓÒ Û ¿ÏϘ ÂÚÈÙÒÛÂȘ ‰‡Ô ‹ ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· (˘ÔÙÚÔÈ¿˙Ô˘Û· ÌÔÚÊ‹). ™¿ÓÈ· ÌÔÚÊ‹ Â›Ó·È Ë ÚÔԉ¢ÙÈ΋, Ì ‚·ıÌÈ·›· ·˘Í·ÓfiÌÂÓÔ ¤ÏÏÂÈÌÌ· Î·È ¯ˆÚ›˜ ÂÂÈÛfi‰ÈÔ ‚ÂÏÙ›ˆÛ˘ (20,21). ™Â ÔÛÔÛÙfi 16% Ë Ì¤ÁÈÛÙË ‚·Ú‡ÙËÙ· Â›Ó·È Ì¤Û· Û ‰‡Ô Ì‹Ó˜ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ, ÂÓÒ ·Ú¯Èο ÔÈ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Â›Ó·È ·‰È·¯ÒÚÈÛÙ˜ ·fi ÙËÓ AIDP ̤¯ÚȘ fiÙÔ˘ ÂΉËψıÔ‡Ó ÔÈ ˘ÔÙÚÔ¤˜. ∏ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË Ù˘ CIDP Ú¤ÂÈ Ó· ˘ÔÛÙËÚȯı› ·fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ™ÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ·Ú·ÙËÚÂ›Ù·È ÏÂ˘ÎˆÌ·ÙÔ΢ÙÙ·ÚÈÎfi˜ ‰È¯·ÛÌfi˜ ÛÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (20). ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È Î˘Ú›ˆ˜ ÛÙÔ ËÏÂÎÙÚÔÓ¢ÚÔÁÚ¿ÊËÌ·, ÙÔ ÔÔ›Ô ·ÔηχÙÂÈ Ì›ˆÛË Ù˘ ÎÈÓËÙÈ΋˜ Î·È ·ÈÛıËÙÈ΋˜ Ù·¯‡ÙËÙ·˜ ·ÁˆÁ‹˜, ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ÙÂÏÈÎÔ‡ ¯ÚfiÓÔ˘ fiˆ˜ Û˘Ì‚·›ÓÂÈ Î·È Ì ÙȘ ÎÏËÚÔÓÔÌÈΤ˜ ·ÔÌ˘ÂÏÈÓˆÙÈΤ˜ ÔÏ˘Ó¢ÚÔ¿ıÂȘ, ·ÏÏ¿ Ë CIDP ͯˆÚ›˙ÂÈ ·fi ·˘Ù¤˜ ÂÂȉ‹ ˘¿Ú¯ÂÈ ÂÈϤÔÓ ‰È·ÎÔ‹ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ (conduction block), ¯ÚÔÓÈ΋ ‰È·ÛÔÚ¿ (temporal dispersion), fiˆ˜ Î·È ·Û‡ÌÌÂÙÚË ÚÔÛ‚ÔÏ‹ ÂÓ‰ÂÈÎÙÈ΋ ÔÏ˘ÂÛÙȷ΋˜ ‚Ï¿‚˘. ∏ ·¿ÓÙËÛË ÙÔ˘ ·̷ÙÔ˜ F Â›Ó·È Î·ı˘ÛÙÂÚË̤ÓË ‹ ·Ô˘ÛÈ¿˙ÂÈ (24). √È ·Ú·¿Óˆ ·ÓˆÌ·Ï›Â˜ Ú¤ÂÈ Ó· ‰È·ÈÛÙˆıÔ‡Ó Û ÙÔ˘Ï¿¯ÈÛÙÔÓ 3 ‰È·ÊÔÚÂÙÈο ÂÚÈÊÂÚÈο Ó‡ڷ, ÂÂȉ‹ ÌÂÚÈο Ó‡ڷ ·Ú·Ì¤ÓÔ˘Ó Ê˘ÛÈÔÏÔÁÈο ‹ ¤¯Ô˘Ó Ó¢ÚÔÊ˘ÛÈÔÏÔÁ›· ·ÍÔÓÈ΋˜ ‚Ï¿‚˘. ŸÙ·Ó ÂÏÂÁ¯ıÔ‡Ó ÏÈÁfiÙÂÚ· Ó‡ڷ ‹ ‰ÂÓ ·Ó·˙ËÙËı› Ë ‰È·ÎÔ‹ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜ ÛÙ· ÂÁÁ‡˜ ÙÌ‹Ì·Ù· ÙˆÓ Ó‡ڈÓ, Ë ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ. ∏ ‚ÈÔ„›· ÙÔ˘ ÎÓËÌÈ·›Ô˘ Ó‡ÚÔ˘, Ë ÔÔ›· ¯ÚËÛÈÌÔÔÈ‹ıËΠ·Ï·ÈfiÙÂÚ·, ‰ÂÓ Â›Ó·È ‰È·ÁÓˆÛÙÈ΋ ÂÂȉ‹ ÌÔÚ› Ó· ‰Â›ÍÂÈ ÂÎʇÏÈÛË ÙÔ˘ ¿ÍÔÓ· ¯ˆÚ›˜ ·ÔÌ˘ÂϛӈÛË (21). ∏ ̤ÙÚËÛË ·˘ÙÔ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙÔ ·›Ì· ‰ÂÓ Â›Ó·È ¯Ú‹ÛÈÌË. £· Ú¤ÂÈ Ó· ÏËÊıÔ‡Ó ˘’ fi„ÈÓ ÔÈ ÎÏËÚÔÓÔÌÈΤ˜ ·ÔÌ˘ÂÏÈÓˆÙÈΤ˜ ÔÏ˘Ó¢ÚÔ¿ıÂȘ, ¶·È‰È·ÙÚÈ΋ 2005;68:180-187
ÔÈ Ôԛ˜ ÛÙ· ·È‰È¿ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ ·fi ÙË CIDP. ¶ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÎÈÓËÙÈ΋ ·ÈÛıËÙÈ΋ Ó¢ÚÔ¿ıÂÈ· (HMSN π Î·È ππ), ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÂÈÚÚ¤ÂÈ· Û ·Ú¤ÛÂȘ ·fi Û˘Ì›ÂÛË ÙˆÓ Ó‡ڈÓ, ÙË ÓfiÛÔ Krabbe Î·È ÙË ÌÂÙ·¯ÚˆÌ·ÙÈ΋ Ï¢ÎÔ‰˘ÛÙÚÔÊ›·.
£Âڷ›· ŸÏ· Ù· ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‚ÂÏÙ›ˆÛË Ì οÔÈÔ Â›‰Ô˜ ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈ΋˜ ıÂڷ›·˜ fiˆ˜ Â›Ó·È Ë ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘, Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È Ë Ï·ÛÌ·Ê·›ÚÂÛË, Ù· ÔÔ›· ¤¯Ô˘Ó ·ÚfiÌÔÈ· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· (25,26,28,30). ∏ Á-ÛÊ·ÈÚ›ÓË ÚÔÙÈÌ¿Ù·È ÛÙ· ·È‰È¿ ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜ ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. ∏ ‚ÂÏÙ›ˆÛË ·Ú¯›˙ÂÈ Û 7 ÂÚ›Ô˘ Ë̤Ú˜ Î·È Êı¿ÓÂÈ ¤Ó· ̤ÁÈÛÙÔ Ì¤Û· Û 48 ‚‰ÔÌ¿‰Â˜. ∞Ó Î·È ÙÔ 25% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì·ÎÚ¿ ‡ÊÂÛË, Ù· ÂÚÈÛÛfiÙÂÚ· (70%) ˘ÔÙÚÔÈ¿˙Ô˘Ó ÌÂÙ¿ ·fi ‡ÊÂÛË 1-8 ÌËÓÒÓ, ÔfiÙÂ Ë Á-ÛÊ·ÈÚ›ÓË ÌÔÚ› Ó· ·ӷ¯ÔÚËÁËı› Ì ÙËÓ ›‰È· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· (23,25). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Û˘ÓÈÛÙÒÌÂÓÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì· ÛÙ· ·È‰È¿ Ì ¯ÚfiÓÈ· ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· ‰ÂÓ ˘¿Ú¯ÂÈ ‰ÈÂıÓ‹˜ ÔÌÔʈӛ· ÏfiÁˆ ÙÔ˘ ÌÈÎÚÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ÌÂÏÂÙËı¤ÓÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÌË Û˘ÁÎÚ›ÛÈÌˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ. ª›· Ú·ÎÙÈ΋ Ô˘ Û˘ÓÈÛÙ¿Ù·È ·fi ÔÏÏÔ‡˜ Â›Ó·È Ë ·ÎfiÏÔ˘ıË: ¯ÔÚËÁÂ›Ù·È Á-ÛÊ·ÈÚ›ÓË Û ‰fiÛË 2 g/kg ÂÓ‰ÔÊÏ‚›ˆ˜ Û 1-2 Ë̤Ú˜ ‹ Î·È 3-4 Ë̤Ú˜ fiÙ·Ó ÙÔ ·È‰› ¤¯ÂÈ ÌÂÁ¿ÏÔ ‚¿ÚÔ˜, οı 4 ÂÚ›Ô˘ ‚‰ÔÌ¿‰Â˜, ̤¯ÚȘ fiÙÔ˘ ·Ú·ÙËÚËı› Ë Ì¤ÁÈÛÙË ‚ÂÏÙ›ˆÛË. ∂¿Ó Ë Ì˘˚΋ ÈÛ¯‡˜ ·ÔηٷÛÙ·ı› ‹ ‚ÂÏÙȈı› ÈηÓÔÔÈËÙÈο, Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· ‰È·ÎÔ‹˜ ·Ú¯Èο Ì ‰fiÛË 1 g/kg, Ë ÔÔ›· ÌÂÈÒÓÂÙ·È ÚÔԉ¢ÙÈο ηٿ 0,25 g/kg οı 4 ‚‰ÔÌ¿‰Â˜ (26,28,29). ∂¿Ó Ë ‚ÂÏÙ›ˆÛË ‰ÂÓ Â›Ó·È ÈηÓÔÔÈËÙÈ΋ Ì ÙË ¯ÔÚ‹ÁËÛË Ù˘ Á-ÛÊ·ÈÚ›Ó˘, ¯ÔÚËÁÂ›Ù·È Ú‰ÓÈ˙fiÓË ·Ú¯Èο Û ÌÂÁ¿ÏË ‰fiÛË 1-2 mg/kg ÁÈ· ÂÚ›Ô˘ 3 Ì‹Ó˜, ÔfiÙ ÌÔÚ› Ó· ÂÎÙÈÌËı› ÙÔ ·ÔÙ¤ÏÂÛÌ·. ™ÙË Û˘Ó¤¯ÂÈ·, Ë ‰fiÛË Ù˘ Ú‰ÓÈ˙fiÓ˘ ÚÔԉ¢ÙÈο ÌÂÈÒÓÂÙ·È Î·È ‰È·ÎfiÙÂÙ·È ÌÂÙ¿ ·fi ÔÏÏÔ‡˜ Ì‹Ó˜ (910), ·ÊÔ‡ ÚÔËÁÔ˘Ì¤Óˆ˜ ‰È·ÙËÚËı› Ì›· ÌÈÎÚ‹ ‰fiÛË Û ·Ú‹ÌÂÚÔ Û¯‹Ì· ÂÂȉ‹ ÔÏÏ¿ ·È‰È¿ ˘ÔÙÚÔÈ¿˙Ô˘Ó ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙˆÓ ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ (28,30,31). ∂¿Ó ·ÎÔÏÔ˘ı‹ÛÂÈ ˘ÔÙÚÔ‹, Ë ıÂڷ›· Ì Á-ÛÊ·ÈÚ›ÓË Í·Ó·Ú¯›˙ÂÈ Û˘Ó‹ıˆ˜ Ì ÙËÓ ›‰È· ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·, ·ÎfiÌË Î·È ÌÂÙ¿ ·fi ÔÏÏÔ‡˜ Ì‹Ó˜ ‡ÊÂÛ˘. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÔÓÙ·È ·È‰È¿ Ì ·Ú·ÙÂٷ̤ÓË ‡ÊÂÛË ÔÏÏÒÓ ¯ÚfiÓˆÓ ÌÂÙ¿ ÙË
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·185
185
OÍ›· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË
‰È·ÎÔ‹ Ì·ÎÚÔ¯ÚfiÓÈ·˜ ıÂڷ›·˜ Î·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙÔ Â›‰Ô˜ Ù˘. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi ıˆÚÂ›Ù·È fiÙÈ ÌÂÙ¿ ÙË ‚ÂÏÙ›ˆÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÚÔÛ¿ıÂÈ· ÛÙ·‰È·Î‹˜ ‰È·ÎÔ‹˜ οı ıÂڷ›·˜ Û fiÏ· Ù· ·È‰È¿ Ì ¯ÚfiÓÈ· ÊÏÂÁÌÔÓÒ‰Ë ·ÔÌ˘ÂÏÈÓˆÙÈ΋ ÔÏ˘Ó¢ÚÔ¿ıÂÈ· (23). ∏ ÚfiÁÓˆÛË Û ·È‰È¿ Ì CIDP Â›Ó·È ÂÍ·ÈÚÂÙÈ΋ ÂÊfiÛÔÓ ÌfiÓÔ Û ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·fi ·˘Ù¿ (ÂÚ›Ô˘ 20%) ·Ú·Ì¤ÓÂÈ Î¿ÔÈ· Ì˘˚΋ ·‰˘Ó·Ì›· (21,23,24).
√Í›· ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ· ∏ ÔÍ›· ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ· Â›Ó·È ÊÏÂÁÌÔÓ҉˜ ·ÔÌ˘ÂÏÈÓˆÙÈÎfi ÓfiÛËÌ·, ÙÔ ÔÔ›Ô ·ÊÔÚ¿ ÛÙȘ ÎÈÓËÙÈΤ˜ Î·È ·ÈÛıËÙÈΤ˜ ›Ó˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ ·ÌÊÔÙÂÚfiÏ¢ڷ. √ ÛÙfi¯Ô˜ Â›Ó·È Ë Ì˘ÂÏ›ÓË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡. ∆· Û˘ÌÙÒÌ·Ù· Â›Ó·È ·Ú·ÏËÁ›·, ÙÂÙÚ·ÏËÁ›·, ·ÈÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ‰È·Ù·Ú·¯¤˜ ·fi ÙÔ˘˜ ÛÊÈÁÎÙ‹Ú˜. £ÂˆÚÂ›Ù·È ˆ˜ ÂÓÙÔÈṲ̂ÓË ÌÔÚÊ‹ ÌÂÙ·ÏÔÈÌÒ‰Ô˘˜ ÔÍ›·˜ ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·˜ (acute demyelinating encephalomyelitis - ADEM) (32). ™Â ¤Ó· Úfi‰ÚÔÌÔ ÛÙ¿‰ÈÔ, ÙÔ ÔÔ›Ô ‰È·ÚΛ Û˘Ó‹ıˆ˜ 5 Ë̤Ú˜, Ù· Û˘ÓËı¤ÛÙÂÚ· Û˘ÌÙÒÌ·Ù· Â›Ó·È fiÓÔ˜ ÛÙ· ¿ÎÚ· (88%) Î·È ˘ÚÂÙfi˜ (58%). ™ÙÔ ÂfiÌÂÓÔ ÛÙ¿‰ÈÔ ÛÙ·ÛÈÌfiÙËÙ·˜ (plateau) ΢Úȷگ› Û˘Ó‰˘·ÛÌfi˜ ·fi ·Ú·Ï‡ÛÂȘ, ·ÈÛıËÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (80%) Î·È ÔÚıÔ΢ÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ (33,34). µ·ÚÈ¿ ·Ó·Ó¢ÛÙÈ΋ ·Ú¿Ï˘ÛË Ì¤Û· Û ϛÁ˜ ÒÚ˜ Â›Ó·È ‰˘Ó·Ù‹. ∏ ·‰˘Ó·Ì›· ·ÊÔÚ¿ ÛÙ·ıÂÚ¿ ÛÙ· οو ¿ÎÚ· Î·È ÏÈÁfiÙÂÚÔ ÛÙ·ıÂÚ¿ ÛÙ· ¿Óˆ Î·È ÚÔËÁÂ›Ù·È Ù˘ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ÛÊÈÁÎÙ‹ÚˆÓ. ∏ ·Ó¿ÚÚˆÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚·ıÌÈ·›· ‚ÂÏÙ›ˆÛË fiÏˆÓ ÙˆÓ ‰˘ÛÏÂÈÙÔ˘ÚÁÈÒÓ. √È ÛÊÈÁÎÙËÚȷΤ˜ ‰È·Ù·Ú·¯¤˜ ‚ÂÏÙÈÒÓÔÓÙ·È ÙÂÏÂ˘Ù·›Â˜. ™ÙÔ 90% ÙˆÓ ·ÛıÂÓÒÓ ÌÂÙ¿ ÙËÓ ÙÚ›ÙË Ë̤ڷ Ù˘ ÓfiÛÔ˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ ∂¡À ·‡ÍËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ (ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Ì¤¯ÚÈ Î·È 1800/ÌL) Î·È ÛÙÔ 20% ̤ÙÚÈ· ·‡ÍËÛË ÙÔ˘ Ï¢ÎÒÌ·ÙÔ˜ (̤ÛÔ˜ fiÚÔ˜ 210/ÌL) ¯ˆÚ›˜ ÔÏÈÁÔÎÏÔÓÈΤ˜ Ù·Èӛ˜ (33). ™ÙÔ 20% ˘¿Ú¯ÂÈ ÔÚÔÏÔÁÈ΋ ·fi‰ÂÈÍË ÚÔËÁËı›۷˜ Ïԛ̈͢ (·Ïfi˜ ¤Ú˘, ÏÔÈÌ҉˘ ÌÔÓÔ˘Ú‹ÓˆÛË, ·ÓÂÌ¢ÏÔÁÈ¿, ˙ˆÛÙ‹Ú·˜ Î·È ÈÏ·Ú¿) ‹ Î·È ÙÔ ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ¯ÔÚËÁÔ‡ÌÂÓÔ ÂÌ‚fiÏÈÔ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (33,34). ™ÙË Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ Î·È ÛÙËÓ ∆2 ·ÎÔÏÔ˘ı›· ·Ú·ÙËÚÔ‡ÓÙ·È ÂÚÈÔ¯¤˜ ˘„ËÏÔ‡ Û‹Ì·ÙÔ˜ Î·È ÂÓ›ÔÙ ÙÔÈ΋ ‰È‡ڢÓÛË ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ ‹ ÂÛÙȷ΋ ÚfiÛÏË„Ë ÙÔ˘ ÛÎÈ·ÁÚ·ÊÈÎÔ‡ (34,35).
∏ ÚÔÛÊÔÚ¿ ÙÔ˘ ªRπ Â›Ó·È Ó· ·ÔÎÏ›ÛÂÈ ¯ˆÚÔηٷÎÙËÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜, ÔÈ Ôԛ˜ ··ÈÙÔ‡Ó ¿ÌÂÛË ·Ú¤Ì‚·ÛË, ÂÓÒ ¿ÏÏ· ÓÔÛ‹Ì·Ù· fiˆ˜ Ë ÔÏÏ·Ï‹ ÛÎÏ‹Ú˘ÓÛË Î·È Ë ÈÛ¯·ÈÌ›· ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ ·ÔÎÏ›ÔÓÙ·È ‰‡ÛÎÔÏ·. ŒÓ· ‰È·ÎÚÈÙfi ‡ÚËÌ· ˘¤Ú Ù˘ Ì˘ÂÏ›Ùȉ·˜ Â›Ó·È fiÙÈ ÔÈ ‚Ï¿‚˜ ÛÙÔÓ Î¿ıÂÙÔ ¿ÍÔÓ· ÂÎÙ›ÓÔÓÙ·È Î·Ù¿ Ì‹ÎÔ˜ 3-4 ÛÔÓ‰‡ÏˆÓ, ÂÓÒ ÛÙË ÛÎÏ‹Ú˘ÓÛË Î·Ù¿ Ͽη˜ ηٿ Ì‹ÎÔ˜ 1-2 ÛÔÓ‰‡ÏˆÓ. ™ÙËÓ ÔÏÏ·Ï‹ ÛÎÏ‹Ú˘ÓÛË ÔÈ ‚Ï¿‚˜ Â›Ó·È ÔÏϷϤ˜, ÂÚÈÊÂÚÈΤ˜ Î·È Î·Ù·Ï·Ì‚¿ÓÔ˘Ó ÏÈÁfiÙÂÚÔ ·fi ÙÔ ÌÈÛfi Ù˘ ÂÁοÚÛÈ·˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, ÂÓÒ ÛÙË Ì˘ÂÏ›Ùȉ· Â›Ó·È ÙÔÔıÂÙË̤Ó˜ ÎÂÓÙÚÈο, ηٷϷ̂¿ÓÔ˘Ó ÙÔ Ì¤ÁÈÛÙÔ Ù˘ ÂÁοÚÛÈ·˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ Î·È ‰Â›¯ÓÔ˘Ó ÂÚÈÊÂÚÈ΋ ‰·ÎÙ˘ÏÈÔÂȉ‹ ÂÓ›Û¯˘ÛË Ì ÙÔ ÛÎÈ·ÁÚ·ÊÈÎfi (35,36). ¢ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ªRI ¢ÚËÌ¿ÙˆÓ Î·È Ù˘ ¤Î‚·Û˘. ∞Ó Î·È Ë ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ· ÎÏ·ÛÈο ·ÎÔÏÔ˘ı› ÌÔÓÔÊ·ÛÈ΋ ÔÚ›·, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÙˆÓ ·ÛıÂÓÒÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ‹ ‰‡Ô ˘ÔÙÚÔ¤˜ Û˘Ó‹ıˆ˜ ̤۷ Û ϛÁÔ˘˜ Ì‹Ó˜ ‹ Î·È Û 12 ¯ÚfiÓÈ· ÌÂÙ¿ ÙÔ ·Ú¯ÈÎfi ÂÂÈÛfi‰ÈÔ (37,38). √È ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ‰È·ÊÔÚÔÔÈÔ‡ÓÙ·È ·fi ÙËÓ ÔÏÏ·Ï‹ ÛÎÏ‹Ú˘ÓÛË, ÛÙËÓ ÔÔ›· ‰ÂÓ ÌÂÙ·›ÙÔ˘Ó ·ÎfiÌ· Î·È ÌÂÙ¿ ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·Û¯fiÓÙˆÓ ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· (34,37,39). ™˘ÓÈÛÙ¿Ù·È Ë ·Ú·ÎÔÏÔ‡ıËÛË ·˘ÙÒÓ ÙˆÓ ·È‰ÈÒÓ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ·Ó¿ ÂÍ¿ÌËÓÔ. ™ÙËÓ ADEM ‰ÂÓ ÂÌÊ·Ó›˙ÔÓÙ·È Ó¤Â˜ ‚Ï¿‚˜, ÂÎÙfi˜ Â¿Ó ˘¿ÚÍÂÈ ÎÏÈÓÈ΋ ˘ÔÙÚÔ‹. ¶Ï‹Ú˘ ›·ÛË ÛÙËÓ ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ· ÂÚÈÁÚ¿ÊÂÙ·È Û ÔÛÔÛÙfi 60% ÂÚ›Ô˘, ÂÓÒ ÔÈ ÏÔÈÔ› ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈÔ ÂÏ·ÊÚfi ‹ Î·È Ôχ ÛÔ‚·Úfi ÎÈÓËÙÈÎfi ˘fiÏÂÈÌÌ· (34,37). ∫·Ïfi ıÂڷ¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÌÂÙ¿ ÙË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ Û ÌÂÁ¿Ï˜ ‰fiÛÂȘ 30 mg/kg IV ÁÈ· 5 Ë̤Ú˜ Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ú‰ÓÈ˙fiÓ˘ 1 mg/kg ·fi ÙÔ˘ ÛÙfiÌ·ÙÔ˜ ÁÈ· 2-3 ‚‰ÔÌ¿‰Â˜, ÚÔԉ¢ÙÈο ÌÂÈÔ‡ÌÂÓ˘ ̤۷ Û 4-6 ‚‰ÔÌ¿‰Â˜ (38,39). ™Â ÂÏ¿¯ÈÛÙÔ˘˜ ¿Û¯ÔÓÙ˜ Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙË ¯ÔÚ‹ÁËÛË ÌÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓ˘ ·Ó·Ê¤ÚÂÙ·È ‚ÂÏÙ›ˆÛË Ì ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ (39).
µÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË (infantile botulism) ∏ ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË ÚÔηÏÂ›Ù·È ·fi ÙËÓ ÙÔÍ›ÓË ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ Ù˘ ·ÏÏ·ÓÙ›·Û˘, ÔÈ ÛfiÚÔÈ ÙÔ˘ ÔÔ›Ô˘ ÂÈÛ¤Ú¯ÔÓÙ·È ÛÙÔ ÂÙÈÎfi ¶·È‰È·ÙÚÈ΋ 2005;68:180-187
Paediatriki May-June 05
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∞. ™Î·Ú‰Ô‡ÙÛÔ˘
¶›Ó·Î·˜ 3. °ÂÓÈÎfi ˘fi‰ÂÈÁÌ· ÁÈ· ÙËÓ ÚÔÛ¤ÁÁÈÛË Ù˘ ¯·Ï·Ú‹˜ ·Ú¿Ï˘Û˘ (3) 1. ÷Ϸڋ Û˘ÌÌÂÙÚÈ΋ ÙÂÙÚ·¿ÚÂÛË, ·Ú·Ï‡ÛÂȘ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ Î·È ·Ó·Ó¢ÛÙÈ΋ Û˘ÌÌÂÙÔ¯‹ Ì ηٷÚÁË̤ӷ ÙÂÓfiÓÙÈ· Î·È ÂÏ¿¯ÈÛÙË ˆ˜ ̤ÙÚÈ· ˘·ÈÛıËÛ›·, ·ÏÏ¿ Û˘¯Ó¿ ·Ú·ÈÛıËۛ˜ (fiÓÔ˜, ·›ÛıËÌ· Ó˘ÁÌÒÓ) - √Í›· ÔÏ˘ÚÈ˙ÔÓ¢ÚÔ¿ıÂÈ· 2. ™˘ÌÌÂÙÚÈ΋ ÎÂÓÙÚÔÌÂÏÈ΋ Ì˘˚΋ ·‰˘Ó·Ì›· ¯ˆÚ›˜ ·ÈÛıËÙÈο Û˘ÌÙÒÌ·Ù· ‹ ÛËÌ›· Î·È Ê˘ÛÈÔÏÔÁÈο ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο - √Í›· Ì˘Ô¿ıÂÈ· (ÔÏ˘Ì˘ÔÛ›ÙȘ) 3. ∞‰˘Ó·Ì›· ÌÂÙ¿ ÎfiˆÛË Ì ‰Èψ›·, ÙÒÛË ÙˆÓ ‚ÏÂÊ¿ÚˆÓ Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Î·ÙÒÙÂÚˆÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ - ª˘·Ûı¤ÓÂÈ· Î·È ¿ÏÏ· Ó¢ÚÔÌ˘˚ο ÓÔÛ‹Ì·Ù· 4. ÷Ϸڋ ·Ú·¿ÚÂÛË Ì ·ÈÛıËÙÈÎfi Â›Â‰Ô (Û˘¯Ó¿ Ì ÌÂȈ̤ӷ ÙÂÓfiÓÙÈ· ÛÙ· οو ¿ÎÚ· Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÛÙˆ˜) - £ˆÚ·ÎÈ΋ ‚Ï¿‚Ë ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ (ÂÁοÚÛÈ· Ì˘ÂÏ›Ùȉ·, ¤ÌÊÚ·ÎÙÔ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡) 5. ∫˘Ú›ˆ˜ ÚÔÌËÎÈ΋ Û˘ÌÌÂÙÔ¯‹ - ∞ÏÏ·ÓÙ›·ÛË - ¶ÚÔԉ¢ÙÈ΋ ÚÔÌËÎÈ΋ ·Ú¿Ï˘ÛË (Fazio-Londe’s) - °ÂÊ˘ÚÈ΋ ‚Ï¿‚Ë 6. √Êı·ÏÌÔÏËÁ›· ÌÂ Ì˘˚΋ ·‰˘Ó·Ì›· - ª˘·Ûı¤ÓÂÈ· - ∞ÏÏ·ÓÙ›·ÛË - ¢ËÏËÙËÚ›·ÛË Ì ÔÚÁ·ÓÔʈÛÊÔÚÈο 7. ¶ÚÔÂÍ¿Ú¯Ô˘Û· ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·˘ÙfiÓÔÌÔ˘ - ∞ÏÏ·ÓÙ›·ÛË - ¢ËÏËÙËÚ›·ÛË Ì ÔÚÁ·ÓÔʈÛÊÔÚÈο - ¶·Ú·ÓÂÔÏ·ÛÌ·ÙÈο Û‡Ó‰ÚÔÌ·
Û‡ÛÙËÌ· Ì ÙÔ ¯ÒÌ· Î·È ÙÔ Ì¤ÏÈ. ∏ ÙÔÍ›ÓË Û˘Ó‰¤ÂÙ·È Ì ÌË ·Ó·ÛÙÚ¤„ÈÌÔ ÙÚfiÔ Ì ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ Ù˘ ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘ ÛÙË Ó¢ÚÔÌ˘˚΋ Û‡Ó·„Ë Î·È ÚÔηÏ› ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË Î·È ·Ú¿Ï˘ÛË ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ Ó‡ڈÓ. ∏ ·ÏÏ·ÓÙ›·ÛË ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÙÚÈ¿‰·: ·) Û˘ÌÌÂÙÚÈ΋ ηÙÈÔ‡Û· ¯·Ï·Ú‹ ·Ú¿Ï˘ÛË Ì ÚÔÂÍ¿Ú¯Ô˘Û· ÙËÓ ·Ú¿Ï˘ÛË Ù˘ ˘ÂÚÒ·˜, ‚) ·˘ÚÂÍ›· Î·È Á) ‰È·‡ÁÂÈ· Ù˘ Û˘Ó›‰ËÛ˘. ∏ ·Ú¿Ï˘ÛË Û˘Ó‹ıˆ˜ ·Ú¯›˙ÂÈ ·fi Ù· ÎÚ·Óȷο Ó‡ڷ, Ì ‰Èψ›·, ‰˘ÛÊ·Á›· Î·È ‰˘Û·ÚıÚ›·. ªÔÚ› Ó· ˘¿Ú¯ÂÈ ‰˘ÛÎÔÈÏÈfiÙËÙ·, Ï‹ı·ÚÁÔ˜ ·fi ·Ê˘‰¿ÙˆÛË, ·‰‡Ó·ÙË ÊˆÓ‹, ˘ÔÙÔÓ›· Î·È Û˘¯Ó¿ ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· (41,42). ∆· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο Â›Ó·È Î·Ù·ÚÁË̤ӷ. ŸÙ·Ó ˘¿Ú¯ÂÈ ·ÌÊÔÙÂÚfiÏ¢ÚË ·Ú¿Ï˘ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Î·È ÙˆÓ ÔÊı·ÏÌÔÎÈÓËÙÈÎÒÓ Ó‡ڈÓ, fiˆ˜ Î·È Î·Ù¿ÚÁËÛË ÙÔ˘ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÔ‡ Ù˘ ÎfiÚ˘, Ë Î·Ù¿ÛÙ·ÛË ‰‡ÛÎÔÏ· ͯˆÚ›˙ÂÈ ·fi ÙÔ ÎÒÌ·, ·fi ÙÔ ÔÔ›Ô ‰È·ÊÔÚÔÔÈÂ›Ù·È ÂÂȉ‹ Û˘Óԉ‡ÂÙ·È ·fi Ê˘ÛÈÔÏÔÁÈÎfi ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ·. ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙ· ÎÏȶ·È‰È·ÙÚÈ΋ 2005;68:180-187
ÓÈο Â˘Ú‹Ì·Ù·, ÛÙÔ ÈÛÙÔÚÈÎfi Ï‹„˘ Ù˘ ‡ÔÙ˘ Ô˘Û›·˜ Î·È ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ ‹ Ù˘ ÙÔ͛Ӣ ÛÙ· ÎfiÚ·Ó·, fiˆ˜ Î·È ÛÙ· ÎÏ·ÛÈο ËÏÂÎÙÚÔÌ˘ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù·, Ù· ÔÔ›· fï˜ ‰‡ÛÎÔÏ· Â›Ó·È ·Ó·ÌÊ›‚ÔÏ· ·ıÔÏÔÁÈο (42). ∆Ô ËÏÂÎÙÚÔÌ˘ÔÁÚ¿ÊËÌ· ·ÔÎÏ›ÂÈ ¿ÏϘ ·Èٛ˜ Ó¢ÚÔÏÔÁÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, ÔÈ Ôԛ˜ ÌÈÌÔ‡ÓÙ·È ÙËÓ ·ÏÏ·ÓÙ›·ÛË, fiˆ˜ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ Guillain-Barre Î·È Ë Ì˘·Ûı¤ÓÂÈ·. ∏ ıÂڷ›· Û˘Ó›ÛÙ·Ù·È Û ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ Î·È ·ÚÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì¤¯ÚȘ fiÙÔ˘ ‰ËÌÈÔ˘ÚÁËıÔ‡Ó Ó¤Â˜ Ó¢ÚÔÌ˘˚Τ˜ Û˘Ó¿„ÂȘ, ÁÂÁÔÓfi˜ Ô˘ Ô‰ËÁ› Û ·˘ÙfiÌ·ÙË ›·ÛË. ¡Â˘ÚÔÏÔÁÈο ηٿÏÔÈ· Û¿ÓÈ· ·Ú·ÙËÚÔ‡ÓÙ·È. ªÂÚÈο ·È‰È¿ ¯ÚÂÈ¿˙ÔÓÙ·È Û›ÙÈÛË Ì ηıÂÙ‹Ú· Î·È ÌÂÙ¿ ÙËÓ ¤ÍÔ‰fi ÙÔ˘˜ ·fi ÙÔ ÓÔÛÔÎÔÌ›Ô. ™·ÓÈfiÙÂÚ· ·›ÙÈ· ¯·Ï·Ú‹˜ ·Ú¿Ï˘Û˘ ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. °È· ÙËÓ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰È·ÊÔÚÈ΋˜ ‰È¿ÁÓˆÛ˘ ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ¯Ú‹ÛÈÌÔ Â›Ó·È ¤Ó· ÁÂÓÈÎfi ˘fi‰ÂÈÁÌ· fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 3.
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REVIEW ARTICLE
Acute flaccid paralysis A. Skardoutsou
2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens Correspondence: Aggeliki Skardoutsou 2nd Paediatric Clinic of the University of Athens “P. & A. Kyriakou” Children’s Hospital, Athens Date of submission: 16-11-2004 Date of approval: 29-03-2005
Paediatriki 2005;68:188
Abstract It is important to make an early diagnosis in acute flaccid paralysis, because most of the underlying causes are treatable. The differential diagnosis includes primarily the acquired autoimmune neuropathies, grouped under the name Guillain-Barre syndrome, and transverse myelitis. The clinical, neuropathological features of the Guillain-Barre subtypes and the role of antecedent infections and antiganglioside antibody responses are reviewed. Prospective randomized treatment trials in children with Guillain-Barre syndrome are lacking, but smaller studies suggest that both human immunoglobulins and plasmapheresis enhance the recovery and resumption of independent walking. Transverse myelitis is a localized form of acute postinfectious disseminated encephalomyelitis. The prognosis for recovery in children with the Guillain-Barre syndrome is good, with the majority of children achieving a complete functional recovery within few months. Key words Acute flaccid paralysis, Guillain-Barre syndrome, intravenous immunoglobulins, plasma exchange, acute postinfectious myelitis, steroid therapy.
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∫ÏÈÓÈ΋ Î·È ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿: Ù· ÓÂÔÏ¿ÛÌ·Ù· Û·Ó Ì›· ·fi ÙȘ ·Èٛ˜ ÚfiÎÏËÛ˘ ‰‡ÛÓÔÈ·˜ ¶. ∫Ô˘ÙÚԇ̷, ™. ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘ - ∞Ó‰ÚÔ˘Ï·Î¿ÎË
¶ÂÚ›ÏË„Ë ∏ ‰‡ÛÓÔÈ·, ‰ËÏ·‰‹ ÙÔ ˘ÔÎÂÈÌÂÓÈÎfi ·›ÛıËÌ· ¤ÏÏÂȄ˘ ·¤Ú· Ô˘ ÂÎÊÚ¿˙ÂÙ·È Ì ‰˘ÛÎÔÏ›· ÛÙËÓ ·Ó·ÓÔ‹, ÂΉËÏÒÓÂÙ·È ÛÙ· ·È‰È¿ ΢ڛˆ˜ Ì ٷ¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›·, ¯Ú‹ÛË ÙˆÓ ÂÈÎÔ˘ÚÈÎÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ Î·È - Û ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ - Ì ΢¿ÓˆÛË. ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ‰‡ÛÓÔÈ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ·ÊÔÚÔ‡Ó Û ÏÔÈÌÒÍÂȘ Î·È Î˘Ú›ˆ˜ ÈÔÁÂÓ›˜, ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·, ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, Û˘ÁÁÂÓ›˜ ·ı‹ÛÂȘ Î·È ÓÂÔÏ¿ÛÌ·Ù· Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ‹ ηÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·. ∆· Û˘ÓËı¤ÛÙÂÚ· ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó Û ¤Ó· ·È‰› ‰È·Ù·Ú·¯¤˜ Ù˘ ·Ó·ÓÔ‹˜ Â›Ó·È Ù· ıËÏÒÌ·Ù·, ÂÓÒ ·fi Ù· ηÎÔ‹ıË Û˘¯ÓfiÙÂÚ· Â›Ó·È Ù· ÏÂÌÊÒÌ·Ù· (Hodgkin Î·È ÌË Hodgkin), Ù· Û·ÚÎÒÌ·Ù· Î·È ÙÔ ·‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·. ∆· ·ÚÈ· Û˘ÌÙÒÌ·Ù· Ù˘ ·fiÊڷ͢ ÙˆÓ ·ÓÒÙÂÚˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ ·fi ÓÂÔÏ¿ÛÌ·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Â›ÌÔÓË ‰˘Û¯¤ÚÂÈ· Ù˘ ÚÈÓÈ΋˜ ·Ó·ÓÔ‹˜, ÂÙÂÚfiÏ¢ÚÔ, Û˘Ó‹ıˆ˜, ˘Ò‰Â˜ ÚÈÓÈÎfi ¤ÎÎÚÈÌ·, ›ÌÔÓÔ ‚‹¯·, ‚·ÚËÎÔ˝·, Û˘¯Ó¤˜ ˆÙ›Ùȉ˜ Î·È ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ˜. ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, Ë ÂÚÈÔ¯‹ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È Û˘¯ÓfiÙÂÚ· ·fi ÓÂÔϷۛ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Â›Ó·È ÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Û ·ÓÙ›ıÂÛË Ì ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·, ÙÔ˘˜ ‚ÚfiÁ¯Ô˘˜, Ù· ‚ÚÔÁ¯ÈfiÏÈ· Î·È ÙÔÓ ˘Â˙ˆÎfiÙ· Ô˘ ÚÔÛ‚¿ÏÏÔÓÙ·È Û·ÓÈfiÙÂÚ·. ∆· ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘, ÚˆÙÔ·ı‹ ‹ ÌÂÙ·ÛÙ·ÙÈο, ηÏÔ‹ıË ‹ ηÎÔ‹ıË, ÂΉËÏÒÓÔÓÙ·È ÌÂ Û˘ÌÙÒÌ·Ù· Î·È ÛËÌ›· ÌË ÂȉÈο, ·ÏÏ¿ Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ÏfiÁˆ ›ÂÛ˘ ‹ ·ÚÂÎÙfiÈÛ˘ ÙˆÓ ·Ú·Î›ÌÂÓˆÓ ÔÚÁ¿ÓˆÓ. ∏ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Á›ÓÂÙ·È ÌÂ Û˘Ó‰˘·ÛÌfi ıÂڷ¢ÙÈÎÒÓ ÌÂıfi‰ˆÓ (¯ÂÈÚÔ˘ÚÁÈ΋˜ ·Ê·›ÚÂÛ˘, ¯ËÌÂÈÔıÂڷ›·˜, ·ÎÙÈÓÔ‚ÔÏ›·˜). ¶Ú¤ÂÈ, Ù¤ÏÔ˜, Ó· ÙÔÓÈÛÙ› fiÙÈ Ë ‰È·ÁÓˆÛÙÈ΋ ÂÙÔÈÌfiÙËÙ· ÙˆÓ ·È‰È¿ÙÚˆÓ Ó· ·Ó·ÁÓˆÚ›˙Ô˘Ó ÓÂÔÏ·ÛÌ·ÙÈο ÓÔÛ‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ˘ÔÎÚ‡ÙÔÓÙ·È ›Ûˆ ·fi Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· ÙˆÓ ·È‰ÈÒÓ Î·È Ë ¤ÁηÈÚË ·Ú·ÔÌ‹ ÙÔ˘˜ ÛÙÔÓ ÂȉÈÎfi ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË, ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÛËÌ·ÓÙÈο ÙËÓ ÚfiÁÓˆÛË ÙˆÓ ÛÔ‚·ÚÒÓ ·˘ÙÒÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜.
∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ™ÔÊ›· ¶ÔÏ˘¯ÚÔÓÔÔ‡ÏÔ˘∞Ó‰ÚÔ˘Ï·Î¿ÎË ∆Ì‹Ì· ¶·È‰È·ÙÚÈ΋˜ ∞ÈÌ·ÙÔÏÔÁ›·˜-OÁÎÔÏÔÁ›·˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” £Ë‚ÒÓ & §Â‚·‰›·˜, ∆.∫. 115 27, ∞ı‹Ó· E-mail: sophpol@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 06-05-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 13-04-2005
§¤ÍÂȘ ÎÏÂȉȿ ¢‡ÛÓÔÈ·, ·È‰È΋ ËÏÈΛ·, ÓÂÔÏ¿ÛÌ·Ù·, ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ηÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·.
∂ÈÛ·ÁˆÁ‹ ∏ ·ÚÈ· ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·ÊÔÚ¿ Î·È ÛÙԯ‡ÂÈ ÛÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÙÔ˘ ··ÈÙÔ‡ÌÂÓÔ˘ Ô͢ÁfiÓÔ˘ ÙÔ˘ ·ÙÌÔÛÊ·ÈÚÈÎÔ‡ ·¤Ú· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÈÙÂÏÂÛÙ› Ë ·ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ ÌÂٷ͇ ·˘ÙÔ‡ Î·È ÙÔ˘ ΢ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ·›Ì·ÙÔ˜, ÛÙÔ Â›Â‰Ô Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÌÂÌ‚Ú¿Ó˘. OÈ ÛËÌÂÚÈÓ¤˜ Ì·˜ ÁÓÒÛÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Ú‡ıÌÈÛË Ù˘ ÂοÛÙÔÙ ÈÛÔÚÚÔ›·˜ Ì›·˜ Ê˘ÛÈÔÏÔÁÈ΋˜ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ‚·Û›˙ÔÓÙ·È ÛÙȘ ·ÎfiÏÔ˘ı˜ ‚·ÛÈΤ˜ ·Ú¯¤˜ (1,2): ·) ∆Ô Û‡ÛÙËÌ· ÂϤÁ¯Ô˘ Ù˘ ·Ó·ÓÔ‹˜ Ú˘ıÌ›-
˙ÂÙ·È ·Ï›Ó‰ÚÔÌ· ·fi ¤Ó·Ó ÎÂÓÙÚÈÎfi Ú˘ıÌÈÛÙ‹. ‚) O ÎÂÓÙÚÈÎfi˜ Ú˘ıÌÈÛÙ‹˜ Â›Ó·È ·Ô‰¤ÎÙ˘ ÚÔÛ·ÁˆÁÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Î·È ÏËÚÔÊÔÚÈÒÓ, ·Ó¿ÏÔÁ· Ì ٷ ÔÔ›· ‰ËÌÈÔ˘ÚÁ›, Û˘ÓÙËÚ› ‹ ÙÚÔÔÔÈ› ÙËÓ ·Ó·ÓÔ‹. Á) ∏ ÎÂÓÙÚÈ΋ Ú‡ıÌÈÛË Ì ÙËÓ ÂÂÍÂÚÁ·Û›· ÙˆÓ ÏËÚÔÊÔÚÈÒÓ Î·È ÙȘ ÂÓÙÔϤ˜ Ô˘ ‰›ÓÔÓÙ·È, Á›ÓÂÙ·È ¿ÓÙ· Ì ÈÂÚ·Ú¯ÈÎfi ÙÚfiÔ. ‰) OÈ ·Ó·Ó¢ÛÙÈÎÔ› ̇˜ Î·È ÙÔ ıˆÚ·ÎÈÎfi ÙÔ›¯ˆÌ· Ì ÙÔ˘˜ ˘Ô‰Ô¯Â›˜ ÙÔ˘ ˆÚÈÌ¿˙Ô˘Ó ÚÔԉ¢ÙÈο, ·ÏÏ¿ ÛÙ·‰È·Î¿ ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È Î·Ù¿ Û˘Ó¤ÂÈ·, ·È‰È¿ ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜ ÌÔÚÔ‡Ó Â˘ÎÔÏfiÙÂÚ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÛËÌ›· ÎfiˆÛ˘ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ. ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·190
190
¶. ∫Ô˘ÙÚԇ̷ Î·È Û˘Ó.
Â) ∆Ô ÓÂÔÁ¤ÓÓËÙÔ Î·È ÙÔ ÌÈÎÚfi ·È‰› ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ‰È·ÊÔÚÂÙÈο ÛÙ· ÂÓ‰ÔÁÂÓ‹ ‹ Â͈ÁÂÓ‹ ÂÚÂı›ÛÌ·Ù· Û ۯ¤ÛË Ì ÙÔÓ ÒÚÈÌÔ ÔÚÁ·ÓÈÛÌfi. øÛÙfiÛÔ, ‰È¿ÊÔÚ· ÓÔÛ‹Ì·Ù· Ô˘ Ô‰ËÁÔ‡Ó ÛÂ Û˘Óı‹Î˜ ·fiÊڷ͢ ÙˆÓ ·ÓÒÙÂÚˆÓ ‹ ηÙÒÙÂÚˆÓ ·ÂÚÔÊfiÚˆÓ Ô‰ÒÓ, ‰È·Ù·Ú¿ÛÛÔ˘Ó Î·È ·ÔÚÚ˘ıÌ›˙Ô˘Ó ÙËÓ ÈÛÔÚÚÔ›· Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜. OÈ Û˘Óı‹Î˜ ·fiÊڷ͢ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ‹ ηÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· Ô‰ËÁÔ‡Ó Û ‰˘Û·Ó¿ÏÔÁË ·‡ÍËÛË ÙÔ˘ ¤ÚÁÔ˘ Ù˘ ·Ó·ÓÔ‹˜ Û ۯ¤ÛË Ì ÙË ‰˘Ó·Ù‹ ·Ú¯fiÌÂÓË ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ÂÓ¤ÚÁÂÈ· ·fi ÙȘ η‡ÛÂȘ Ô˘ ÂÈÙÂÏÔ‡ÓÙ·È Î·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ÙÂÏÈο ·ÚÔ˘ÛÈ¿˙ÂÈ Ô ·ÛıÂÓ‹˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ ÂÚÁ҉˘ ·Ó·ÓÔ‹ ‹ ÎÔÈÓÒ˜ “‰‡ÛÓÔÈ·” (3). ∂Î ÙˆÓ ·ÓˆÙ¤Úˆ Â›Ó·È ÂÌÊ·Ó¤˜ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂΉËÏÒÛÂȘ ÙˆÓ ÁÓˆÛÙÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ ÛÙ· ·È‰È¿ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ Ì˯·ÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÙˆÓ Ó¢ÌfiÓˆÓ ÏfiÁˆ ‚Ï·‚ÒÓ ‹ ·ÏÏÔÈÒÛÂÒÓ ÙÔ˘˜ Î·È Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·‡ÍËÛË ÙÔ˘ ¤ÚÁÔ˘ Ù˘ ·Ó·ÓÔ‹˜ Ô˘ ÔÈ ·ÏÏÔÈÒÛÂȘ ·˘Ù¤˜ ÚÔηÏÔ‡Ó. ŒÙÛÈ, Â›Ó·È Èı·Ófi Ù¤ÙÔÈ· ÓÔÛ‹Ì·Ù· ·Ú¯Èο Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ‹È· ·Ó·Ó¢ÛÙÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ì ÂÏ¿¯ÈÛÙË ‹ Î·È Î·ıfiÏÔ˘ ·ÓȯÓ‡ÛÈÌË ‰È·Ù·Ú·¯‹ Ù˘ ·ÓÙ·ÏÏ·Á‹˜ ÙˆÓ ·ÂÚ›ˆÓ. ¶Ôχ Û˘¯Ó¿, fï˜, ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ÛËÌ·ÓÙÈ΋ ¤ÎÙˆÛË Ù˘ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ Î·È ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ‰È·Ù·Ú·¯‹ Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ‹ Ù˘ ÌÂÚÈ΋˜ ›ÂÛ˘ ÙÔ˘ Ô͢ÁfiÓÔ˘ Î·È ÙÔ˘ ‰ÈÔÍÂȉ›Ô˘ ÙÔ˘ ¿Óıڷη ÛÙÔ ·ÚÙËÚÈ·Îfi ·›Ì· (ÙÒÛË Ù˘ pO2 Î·È ·‡ÍËÛË Ù˘ pCO2) (2).
∞›ÙÈ· ‰‡ÛÓÔÈ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· ∆Ô ˘ÔÎÂÈÌÂÓÈÎfi ·›ÛıËÌ· ‰˘ÛÎÔÏ›·˜ ÛÙËÓ ·Ó·ÓÔ‹ Ô˘ ÚÔ·ÙÂÈ ·fi ÙËÓ ·Ó·Ú΋ ÚfiÛÏË„Ë ÙÔ˘ ··ÈÙÔ‡ÌÂÓÔ˘ ·ÓÙÈÎÂÈÌÂÓÈο ‹ ˘ÔÎÂÈÌÂÓÈο ·¤Ú·, ÔÓÔÌ¿˙ÂÙ·È ‰‡ÛÓÔÈ· (“‰›„· ÁÈ· ·¤Ú·”). ∏ ‰‡ÛÓÔÈ· Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ‰È·Ù·Ú·¯ÒÓ ÛÙË Ì˯·ÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ Ó¢ÌfiÓˆÓ Î·È ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜, Ô˘ Ô‰ËÁÔ‡Ó Û ‰È¤ÁÂÚÛË ÙˆÓ ¯ËÌÂÈÔ¸Ô‰Ô¯¤ˆÓ ÎÂÓÙÚÈο, ·˘ÍË̤ÓË Ê˘ÛÈ΋ ÚÔÛ¿ıÂÈ· Î·È ¯Ú‹ÛË ÙˆÓ ÂÈÎÔ˘ÚÈÎÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ (Ù·¯‡ÓÔÈ·, ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ, ÂÈÛÔÏΤ˜ ÌÂÛÔχÚÈˆÓ ‰È·ÛÙËÌ¿ÙˆÓ, ÂÈÁ·ÛÙÚ›Ô˘ ‹ Î·È Ù˘ ÛÊ·Á‹˜, Ù·¯˘Î·Ú‰›·) (1,2). ∆· Û˘¯ÓfiÙÂÚ· ·›ÙÈ· ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿ ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ Û ÏÔÈÌÒÍÂȘ, Ì ·ÚÈÔ ÂÎÚfiÛˆÔ ÙȘ ÈÔÁÂÓ›˜, Û ‚ÚÔÁ¯ÈÎfi ¿ÛıÌ·, ·Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, Û˘ÁÁÂÓ›˜ ·ı‹ÛÂȘ Î·È Û ÓÂÔÏ¿ÛÌ·Ù· Ô˘ ÌÔÚÔ‡Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ‰È·Ù·Ú·¯¤˜ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ‹ Î·È ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ‹ Û ‰È·Ù·Ú·¯¤˜ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (¶›Ó·Î·˜ 1) (3,4). ∏ ‰‡ÛÓÔÈ· ÛÙÔ ·È‰› ÌÔÚ› Ó· ¤¯ÂÈ ÔÈΛÏË ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ›: ·) Ôͤˆ˜, fiÔ˘ ıˆÚÔ‡ÓÙ·È ˆ˜ ϤÔÓ Èı·Ó¿ ·›ÙÈ· ¤Ó· ͤÓÔ ÛÒÌ·, Ë ÔÍ›· ·ÛıÌ·ÙÈ΋ ÎÚ›ÛË, Ô Ó¢ÌÔÓÔıÒڷη˜ ‹ ¤Ó· Ù·¯¤ˆ˜ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÓÂfiÏ·ÛÌ·, Û˘Ó‹ıˆ˜ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ‚) ‚Ú·‰¤ˆ˜, fiÔ˘ ·Ô‰›‰ÂÙ·È Û ÓfiÛÔ˘˜ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È Á) ÌÂÙ¿ ·fi ¿ÛÎËÛË, ÔfiÙ ΢ڛˆ˜ ·Ô‰›‰ÂÙ·È Û ¤Ó· ‹‰Ë ÁÓˆÛÙfi ‹ ˘ÔÎÚ˘ÙfiÌÂÓÔ ¿ÛıÌ·, ÂÓÒ ·ÓÙ›ıÂÙ· Ë ‰‡ÛÓÔÈ· „˘¯ÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜ ÂÍ·Ê·Ó›˙ÂÙ·È ÌÂÙ¿ ·fi ¿ÛÎËÛË. ∆¤ÏÔ˜, ‰‡ÛÓÔÈ· ÌÔÚ› Ó· ÂÎχÂÙ·È ÏfiÁˆ ¤ÎıÂÛ˘ Û ·ÏÏÂÚÁÈÔÁfiÓ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, ÂÊfiÛÔÓ ÚÔ˜ ·˘Ù‹ ÙËÓ Î·Ù‡ı˘ÓÛË ˘Ô‰ÂÈÎÓ‡Ô˘Ó ÔÈ Û˘Óı‹Î˜ ¤Ó·ÚÍ‹˜ Ù˘ Ô˘ ÚÔ·ÙÔ˘Ó ·fi ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÙÔ˘ ·ÛıÂÓÔ‡˜. ∂ȉÈÎfiÙÂÚ·, fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ·›ÙÈ· ·fiÊڷ͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ı· Ú¤ÂÈ Ó· ·Ó·ÊÂÚıÔ‡Ó (3,4): ·) ÔÈ ÏÔÈÌÒÍÂȘ, Ì ·ÚÈÔ˘˜ ÂÎÚÔÛÒÔ˘˜ ÙÔÓ ·Ó·Ó¢ÛÙÈÎfi Û˘Á΢ÙÈ·Îfi Èfi, ÙÔ˘˜ ÈÔ‡˜ Ù˘ ÈÓÊÏÔ˘¤ÓÙ˙·˜ Î·È ·Ú·˚ÓÊÏÔ˘¤ÓÙ˙·˜, ÙÔ˘˜ ·‰ÂÓÔ˚Ô‡˜, ÙÔ˘˜ ÚÈÓÔ˚Ô‡˜ Î.¿., ‚) Ë ¯ÚfiÓÈ· ÚÈÓ›Ùȉ· ‹ ¯ÚfiÓÈ· ÚÈÓÔÊ·Ú˘ÁÁ›Ùȉ· (ÚÈÓÈÎÔ› Ôχԉ˜, ¯ÚfiÓÈ· ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ·, ΢ÛÙÈ΋ ›ÓˆÛË, ·ÏÏÂÚÁÈ΋ ÚÈÓ›Ùȉ·, ͤӷ ÛÒÌ·Ù·, ¯ÚÔÓ›˙Ô˘Û˜ ÏÔÈÌÒÍÂȘ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ, ·Ú›ÛıÌÈˆÓ ·Ì˘Á‰·ÏÒÓ, Û˘ÁÁÂÓ›˜ ‰˘ÛϷۛ˜ Î.¿.), Á) Ë ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘ ¿ÓÔÈ· Î·È Ô ˘ÂÚ·ÂÚÈÛÌfi˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ (˘ÂÚÙÚÔÊ›· ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ, ÙÚÈۈ̛· 21, ·¯˘Û·ÚΛ·, ·Ó·ÙÔÌÈΤ˜ ‰˘ÛϷۛ˜ ÚÔÛˆÈÎÔ‡ ÎÚ·Ó›Ô˘, ·fiÊÚ·ÍË ÚÈÓfi˜, Ï·Ú˘ÁÁÔ̷ϷΛ·, ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜, Ó¢ÚÔÌ˘˚ο ÓÔÛ‹Ì·Ù·, Ï‹„Ë ·Ó·ÈÛıËÙÈÎÒÓ Î·È ËÚÂÌÈÛÙÈÎÒÓ Ê·Ú̿ΈÓ) Î·È ‰) Ë ·ÚÔ˘Û›· ͤÓÔ˘ ÛÒÌ·ÙÔ˜ ÛÙËÓ ·Ó·Ó¢ÛÙÈ΋ Ô‰fi Ô˘ Ú¤ÂÈ Ó· ·ÔÙÂÏ› ¿ÓÙÔÙ ̛· ·fi ÙȘ ÚÒÙ˜ ‰È·ÊÔÚԉȷÁÓˆÛÙÈΤ˜ ÛΤ„ÂȘ ÙÔ˘ ·È‰È¿ÙÚÔ˘ Û ÂÚÈÙÒÛÂȘ ÌÈÎÚÒÓ ·È‰ÈÒÓ Ô˘ ÂΉËÏÒÓÔ˘Ó ·ÈÊÓ›‰È· ÂÂÈÛfi‰È· ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Û˘Óԉ¢fiÌÂÓ· ·fi ÓÈÁÌÔÓ‹, ‚‹¯·, ÛÈÁÌfi ‹ ‚ÚÔÁ¯fiÛ·ÛÌÔ.
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·191
191
¢‡ÛÓÔÈ· Û ·È‰È¿ Ì ÓÂÔϷۛ˜
¶›Ó·Î·˜ 1. ∞›ÙÈ· ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿ §ÔÈÌÒÍÂȘ µÚÔÁ¯ÈÔÏ›Ùȉ· ·fi RSV Î·È ¿ÏÏÔ˘˜ ÈÔ‡˜ ¶Ó¢ÌÔÓ›· §·Ú˘ÁÁ›ÙȘ-ÂÈÁψÙÙ›ÙȘ §·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›ÙȘ (croup) º˘Ì·Ù›ˆÛË-ÈÛÙÔÏ¿Û̈ÛË µÚÔÁ¯ÈÂÎٷۛ˜ µÚÔÁ¯›ÙȘ ∞Ó·ÙÔÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ∞ÁÁÂÈ·ÎÔ› ‰·ÎÙ‡ÏÈÔÈ ¢˘ÛÎÈÓËÛ›· ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘ §·Ú˘ÁÁÔ-ÙÚ·¯ÂÈÔ-̷ϷΛ· ∆Ú·¯ÂÈÔ-ÔÈÛÔÊ·ÁÈο Û˘Ú›ÁÁÈ· °·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ™˘ÁÁÂÓ›˜ ·ı‹ÛÂȘ ∫˘ÛÙÈ΋ ÈÓ҉˘ ÓfiÛÔ˜
∞ÓÔÛÔÏÔÁÈ΋ ·Ó¿ÚÎÂÈ· ÙˆÓ µ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ™˘ÁÁÂÓ‹˜ ηډȷ΋ ·Ó¿ÚÎÂÈ·
™¯fiÏÈ· ∞˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ·Ó›˙Ô˘Ó ¿ÙÔÌ· Ì ·ÏÏÂÚÁÈ΋ ÚԉȿıÂÛË OÍ›· Â̇ÚÂÙË ÓfiÛÔ˜ ÀÏ·Î҉˘ ‚‹¯·˜, Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ ¢ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ ÌÂÛÔıˆÚ·Î›Ô˘ Ô˘ Ȥ˙Ô˘Ó ÙÔ ‚ÚÔÁ¯ÈÎfi ‰¤Ó‰ÚÔ ™˘ÁÁÂÓ›˜ ‹ ›ÎÙËÙ˜ Ô˘ ÂÈÌÔχÓÔÓÙ·È ·fi ÌÈÎÚÔ‚È·ÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ™˘¯ÓfiÙÂÚ· ·ÛıÌ·ÙÔÂȉ‹˜ ‚ÚÔÁ¯›ÙȘ ™˘¯Ó¿ Û˘Ó‰˘¿˙ÔÓÙ·È Ì ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ÃÚfiÓȘ, ·ӷϷ̂·ÓfiÌÂÓ˜ ÏÔÈÌÒÍÂȘ Î·È Èı·Ó‹ ·Ó·ÛÙÚÔÊ‹ ÛÏ¿Á¯ÓˆÓ ™˘Ú›ÙÙÔ˘Û· Î·È ıÔÚ˘‚҉˘ ·Ó·ÓÔ‹ ·fi ÙË Á¤ÓÓËÛË ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ‰˘Û¯ÂÚÒ˜ Î·È Ù· Û˘¯ÓfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Â›Ó·È ÔÈ Û˘¯Ó¤˜ Ó¢ÌÔӛ˜ ÂÍ ÂÈÛÚÔÊ‹Ûˆ˜ ·fi ÙË Á¤ÓÓËÛË ¶Èı·Ó¿ ÂȉÂÈÓÒÓÂÈ ÙȘ ÎÚ›ÛÂȘ ÚÔ¸¿Ú¯ÔÓÙÔ˜ ¿ÛıÌ·ÙÔ˜ ∂Ì̤ÓÔ˘Û· Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙË ‚ÚÂÊÈ΋ ‹ ÓËȷ΋ ËÏÈΛ·, ‰È·Ù·Ú·¯¤˜ ·Ó¿Ù˘Í˘, ÏËÎÙÚÔ‰·ÎÙ˘Ï›·, Û˘¯Ó¤˜ ÏÔÈÌÒÍÂȘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·fi ÛÙÚÂÙfiÎÔÎÎÔ, ¯Ú˘Û›˙ÔÓÙ· ÛÙ·Ê˘ÏfiÎÔÎÎÔ Î·È Â›‰Ë „¢‰ÔÌÔÓ¿‰·˜ ∂·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÏÔÈÌÒÍÂȘ Ó¢ÌfiÓˆÓ Î·È ·Ú·ÚÚ›ÓÈˆÓ ÎfiÏˆÓ ∞Ó‡ÚÂÛË Ê˘ÛËÌ¿ÙˆÓ, ÌÂÁ¿ÏË ‰È·Ê˘Á‹ ·›Ì·ÙÔ˜ ·fi ·ÚÈÛÙÂÚ¿ ÚÔ˜ Ù· ‰ÂÍÈ¿
ÕÏÏ· ∞ÏÏÂÚÁ›·-¿ÛıÌ·, ͤÓÔ ÛÒÌ·, ‰ËÏËÙËÚÈ¿ÛÂȘ, ηÎÒÛÂȘ, „˘¯ÔÁÂÓ‹ ·›ÙÈ·, ÔÍ›˜ ÓfiÛÔÈ ∫¡™, Ó¢ÚÔÏÔÁÈΤ˜-Ì˘˚Τ˜ ‰È·Ù·Ú·¯¤˜, ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù·, ηÎÔ‹ıÂȘ-ηÏÔ‹ıÂȘ fiÁÎÔÈ, ¯ÚfiÓÈ· Ó¢ÌÔÓÈο ÓÔÛ‹Ì·Ù· Î.¿.
¢È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰‡ÛÓÔÈ·˜ ∏ ‰È·ÁÓˆÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ·Ó·Ó¢ÛÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ‰‡ÛÓÔÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ·Ó·Ï‡ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (3,5). ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ô˘ ÚÔ·ÙÂÈ ÂȉÈÎfiÙÂÚ· ·fi ÙÔ Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ Ì ‚·ıÌÈ·›· Âȉ›ӈÛË Î·È Û·ÓÈfiÙÂÚ· Ì ·ÈÊÓ›‰È· ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. ™˘Ó‹ıˆ˜, Ë ÔÍ›· ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ ˘Ô‰ËÏÒÓÂÈ ¤ÎıÂÛË Û ÙÔÍÈÎfi ‹ ‚Ï·ÙÈÎfi ·Ú¿ÁÔÓÙ·, ÂÓÒ ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ¤¯Ô˘Ó, ηٿ ηÓfiÓ·, ÈÔ ‹È· ‰È·‰ÚÔÌ‹. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡¯Ù·˜, ‰È·ÈÛÙÒÓÂÙ·È ÎÏÈÓÈ΋ Âȉ›ӈÛË ÙˆÓ ·ÛıÂÓÒÓ, Ù· ‰Â Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· ·ÔÙÂÏÔ‡Ó Ô ÍËÚfi˜ ‹ ·Ú·ÁˆÁÈÎfi˜ ‚‹¯·˜, Ë ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ‰˘Û¯¤ÚÂÈ· Ù˘ ·Ó·ÓÔ‹˜, Ë Û˘ÓÔ‰fi˜ Û˘Ìو̷ÙÔÏÔÁ›· ·fi ÙÔ Î˘ÎÏÔÊÔÚÈÎfi, Ô
˘ÚÂÙfi˜ Î·È Ù· ÁÂÓÈο Û˘ÌÙÒÌ·Ù· Î·È Û Ôχ ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ Ï‹ÚÔ˘˜ ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜.
∫ÏÈÓÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰‡ÛÓÔÈ·˜ ∏ ÎÏÈÓÈ΋ ÚÔÛ¤ÁÁÈÛË Ù˘ ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿ Â›Ó·È Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜ Î·È ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô˘˜ (1-4): ·) ÙËÓ ÚfiÏË„Ë ÛÔ‚·ÚÒÓ ‰È·Ù·Ú·¯ÒÓ ÙˆÓ ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜ Ô˘ Ô‰ËÁÔ‡Ó Û ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·. ‚) ÙË ÌË ‚‚ȷṲ̂ÓË ·Ú¤Ì‚·ÛË ·fi ÙÔÓ È·ÙÚfi ‹ ÙË ÓÔÛËχÙÚÈ· ÛÙË ÛÙ¿ÛË ÙËÓ ÔÔ›· Ô ·ÛıÂÓ‹˜ ˘ÈÔıÂÙ› ·fi ÌfiÓÔ˜ ÙÔ˘ ÁÈ· Ó· ÂÙ‡¯ÂÈ ÙË Ì›˙ÔÓ· ·Ó·ÎÔ‡ÊÈÛË (·ÁηÏÈ¿ ÌËÙ¤Ú·˜, fiÚıÈ· Î·È fi¯È ‡ÙÈ· ı¤ÛË Î.Ï.). Á) ÙËÓ Ù·¯Â›· ÂÎÙ›ÌËÛË Ù˘ ÂοÛÙÔÙ ·Ó·Ó¢ÛÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ (¶›Ó·Î·˜ ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·192
192
¶. ∫Ô˘ÙÚԇ̷ Î·È Û˘Ó.
¶›Ó·Î·˜ 2. ∫ÏÈÓÈ΋ Î·È ÂÚÁ·ÛÙËÚȷ΋ ‰È·ÁÓˆÛÙÈ΋ ÂÎÙ›ÌËÛË Ù˘ ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿ πÛÙÔÚÈÎfi º˘ÛÈ΋ ÂͤٷÛË
¶·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜
OÍ›· ‹ ¯ÚfiÓÈ· ‰‡ÛÓÔÈ· ¶Èı·Ó¿ ·›ÙÈ· ‰‡ÛÓÔÈ·˜ ÃÚÔÈ¿ ‰¤ÚÌ·ÙÔ˜ ∆‡Ô˜, ‡ÚÔ˜ Î·È Û˘¯ÓfiÙËÙ· ·Ó·ÓÔÒÓ ∞Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ ∂ÈÛÔÏΤ˜ ÌÂÛÔχÚÈˆÓ Ì˘ÒÓ ∞ÎÚÔ·ÛÙÈο Î·È ÂÈÎÚÔ˘ÛÙÈο Â˘Ú‹Ì·Ù· ∞Ó¿Ï˘ÛË ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜ ∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ §ÂÈÙÔ˘ÚÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ·Ó·ÓÔ‹˜ ªÂϤÙË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ‡ÓÔ˘ ªÂϤÙË Ù˘ ÌÂÙ¿ ·fi ¿ÛÎËÛË ·ÓÙ·fiÎÚÈÛ˘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Î˘ÎÏÔÊÔÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ŒÏÂÁ¯Ô˜ ÁÈ· ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ ÙÔ˘ ∫¡™, Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋˜ ·ÏÈÓ‰ÚfiÌËÛ˘ Î.¿.
3), Ô˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÛÎÔfi Ó· ·ÔÊ¢¯ı› Ë ÁÚ‹ÁÔÚË ÎfiˆÛË ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ·Ú·Ù‹ÚËÛË ÙÔ˘ Ú˘ıÌÔ‡ Î·È Ù˘ ¤ÓÙ·Û˘ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ ÎÈÓ‹ÛˆÓ, ÙÔ˘ ¯ÚÒÌ·ÙÔ˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ (Ï‹ı·ÚÁÔ˜, Û‡Á¯˘ÛË ÂÓ·ÏÏ·ÛÛfiÌÂÓË Ì ‰È¤ÁÂÚÛË), ÙËÓ Ù˘¯fiÓ ‡·ÚÍË ¤ÓÙÔÓ˘ ÎÂÊ·Ï·ÏÁ›·˜ (˘ÔÍ·ÈÌ›·-˘ÂÚηӛ·) ‹ ÙÔ ·˘ÍË̤ÓÔ ¤ÚÁÔ ÙˆÓ ÂÈÎÔ˘ÚÈÎÒÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ, ÙËÓ ·ÚÔ˘Û›· „˘¯ÚÒÓ ¿ÎÚˆÓ ÏfiÁˆ Û‡Û·Û˘ ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÁÁ›ˆÓ Î·È ÙË Û˘Ó‡·ÚÍË Û˘ÛÙËÌ·ÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ, Á·ÛÙÚÔÚÚ·Á›·˜, ·ÚÚ˘ıÌÈÒÓ, ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ‹ η΋˜ ıÚ¤„˘. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ fiÙ·Ó Ë ‰‡ÛÓÔÈ· Û˘Óԉ‡ÂÙ·È ·fi ΢¿ÓˆÛË Î·È ÔÈ ÙÈ̤˜ ·ÂÚ›ˆÓ ·ÚÙËÚÈ·ÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ÁÈ· ÌÂÓ ÙËÓ pCO2 ≥40-50 mmHg, ÁÈ· ‰Â ÙËÓ pO2 ≤55 mmHg, ÙfiÙ ÚfiÎÂÈÙ·È ÁÈ· ηٿÛÙ·ÛË ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜ Ô˘ ¯Ú‹˙ÂÈ ¿ÌÂÛ˘ ·ÓÙÈÌÂÙÒÈÛ˘. ‰) ÙË ÌË Î·Ù·ÛÙÔÏ‹ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ì Â͈ÁÂÓ‹ ¯ÔÚ‹ÁËÛË Î·Ù·ÛÙ·ÏÙÈÎÒÓ Î·È ËÚÂÌÈÛÙÈÎÒÓ Ê·Ú̿ΈÓ. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰‡ÛÓÔÈ·˜ Á›ÓÂÙ·È ·Ó¿ÏÔÁ· Ì ÙËÓ Ù·¯‡ÙËÙ· ÂÌÊ¿ÓÈÛ˘, ÙË ‚·Ú‡ÙËÙ· ÙˆÓ Û˘Ìو̿وÓ, ÙÔ Èı·ÓÔÏÔÁÔ‡ÌÂÓÔ ·›ÙÈÔ Î·È Ù· Û˘Ó˘¿Ú¯ÔÓÙ· Û˘ÛÙËÌ·ÙÈο ÚÔ‚Ï‹Ì·Ù·. ∂›Ó·È ÛËÌ·ÓÙÈÎfi ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ·ÈÙ›ˆÓ ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿ Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ¿ÓÙÔÙ ٷ ÓÂÔÏ·ÛÌ·ÙÈο ÓÔÛ‹Ì·Ù·, ÙˆÓ ÔÔ›ˆÓ Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Â›Ó·È ¯·ÌËÏ‹, Ë ÚfiÁÓˆÛ‹ ÙÔ˘˜ ˆÛÙfiÛÔ ÌÔÚ› Ó· ‚ÂÏÙȈı› ÛËÌ·ÓÙÈο Ì ÙËÓ ¤ÁηÈÚË ·Ú·ÔÌ‹ ÙˆÓ ·ÛıÂÓÒÓ ÛÙÔÓ ÂȉÈÎfi ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË. ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
¡ÂÔÏ¿ÛÌ·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È Ì ‰‡ÛÓÔÈ· ÛÙ· ·È‰È¿ ∆· Û˘¯ÓfiÙÂÚ· ÓÂÔÏ¿ÛÌ·Ù· Ô˘ ηıÒ˜ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ‰‡ÛÓÔÈ· ÛÙËÓ ·È‰È΋ ËÏÈΛ·, Â›Ó·È Ù· ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· (ıËÏÒÌ·Ù·), Ù· ÏÂÌÊÒÌ·Ù· (ÌË Hodgkin Î·È Hodgkin), Ù· Û·ÚÎÒÌ·Ù· (Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ Î.¿.), ÙÔ Ca ÚÈÓÔÊ¿Ú˘ÁÁ·, ÂÓÒ Û·ÓÈfiÙÂÚ· ÛÙ· ·È‰È¿ ··ÓÙÒÓÙ·È ÙÔ ÂÈıËÏÈ·Îfi ηÚΛӈ̷ ÚÈÓÔÊ¿Ú˘ÁÁ·, ÙÔ ÌÂϿӈ̷, ÙÔ Î·ÎfiËı˜ ÙÂڿو̷, ÔÈ fiÁÎÔÈ ÛÈÂÏÔÁfiÓˆÓ ·‰¤ÓˆÓ ‚¿Û˘ ÁÏÒÛÛ·˜, ÔÈ Ô‰ÔÓÙÔÁÂÓ›˜ Î·È ÔÛÙÂÔÁÂÓ›˜ fiÁÎÔÈ, ÔÈ Ó¢ÚÔÂÓ‰ÔÎÚÈÓÈÎÔ› fiÁÎÔÈ (·Ú·Á·ÁÁÏ›ˆÌ·, ηÚÎÈÓÔÂȉ¤˜), Ù· ÁÔÓ·‰Ô‚Ï·ÛÙÒÌ·Ù· Î·È ÔÈ ÌÂÙ·ÛÙ·ÙÈÎÔ› fiÁÎÔÈ (·‰ÂÓÔηÚΛӈ̷ ÓÂÊÚÔ‡, ı˘ÚÂÔÂȉԇ˜, Ó¢ÌfiÓˆÓ Î.¿.). ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· (¶›Ó·Î·˜ 4).
¡ÂÔÏ¿ÛÌ·Ù· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ·fiÊڷ͢ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ‚¿ÛÂÈ Ù˘ ÔÔ›·˜ ÚÔ¯ˆÚԇ̠ÛÙË ‰ÈÂÚ‡ÓËÛË Î·È ‰È¿ÁÓˆÛË ÙÔ˘ ˘ÔΛÌÂÓÔ˘ ÓÔÛ‹Ì·ÙÔ˜, ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÔÈÓ‹ Û˘Ìو̷ÙÔÏÔÁ›·, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ÂÈ̤ÚÔ˘˜ ÈÛÙÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ (6,7). ∆· Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Ì ٷ ÔÔ›· ÔÈ ÌÈÎÚÔ› ·ÛıÂÓ›˜ Ì ÓÂÔÏ¿ÛÌ·Ù· ÙÔ˘ ·ÓÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÚÔÛ¤Ú¯ÔÓÙ·È ÛÙÔÓ ·È‰›·ÙÚÔ Â›Ó·È Ë Â›ÌÔÓË ‰˘Û¯¤ÚÂÈ· ÚÈÓÈ΋˜ ·Ó·ÓÔ‹˜, ÔÈ ÂÈÛÙ¿ÍÂȘ, Ë Î·ÎÔÛÌ›· Ô˘ Û˘Ó‹ıˆ˜ Û˘Óԉ‡ÂÙ·È
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·193
193
¢‡ÛÓÔÈ· Û ·È‰È¿ Ì ÓÂÔϷۛ˜
¶›Ó·Î·˜ 3. ∂ÎÙ›ÌËÛË Ù˘ ‚·Ú‡ÙËÙ·˜ Ù˘ ‰‡ÛÓÔÈ·˜ ÛÙ· ·È‰È¿ ∂˘Ú‹Ì·Ù·-Û˘ÌÙÒÌ·Ù·
∞fiÓÙ· ‹ ‹È·
OÌÈÏ›· Ì ϋÚÂȘ ÚÔÙ¿ÛÂȘ ª¤ÁÈÛÙË ÂÎÓ¢ÛÙÈ΋70-90% ÙˆÓ ÂÈÛÓ¢ÛÙÈ΋ ‰˘Ó·ÙfiÙËÙ· ÚÔ‚ÏÂfiÌÂÓˆÓ ÙÈÌÒÓ ∞ÚÈıÌfi˜ ·Ó·ÓÔÒÓ º˘ÛÈÔÏÔÁÈÎfi˜ ‹ ̤¯ÚÈ 30% ¿Óˆ ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ ∂ÁÚ‹ÁÔÚÛË Î.Ê. ÃÚ‹ÛË ÂÈÎÔ˘ÚÈÎÒÓ ∞Ô˘Û›· ‹ ÌÈÎÚÔ‡ ‚·ıÌÔ‡ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ Û‡Û·ÛË ÌÂÛÔχÚÈˆÓ Ì˘ÒÓ OÌÈÏ›·
ÃÚÒÌ· ‰¤ÚÌ·ÙÔ˜ ∞ÎÚÔ·ÛÙÈο Â˘Ú‹Ì·Ù·
∫·Ïfi ªfiÓÔ ÂÎÓ¢ÛÙÈÎÔ› Û˘Ú›ÙÙÔÓÙ˜ ÚfiÁ¯ÔÈ
∫ÔÚÂÛÌfi˜ Ô͢ÁfiÓÔ˘ pCO2 (mmHg)
>95% <35
·fi ÂÙÂÚfiÏ¢ÚÔ ˘Ò‰Â˜ ÚÈÓÈÎfi ¤ÎÎÚÈÌ·, Ë ¤ÓÚÈÓË ÔÌÈÏ›· Î·È Ô Â›ÌÔÓÔ˜ ‚‹¯·˜. ∂›Û˘, Ù· ·È‰È¿ ·˘Ù¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘¯Ó¿ ‚·ÚËÎÔ˝·, ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ¢ÛÙ·¯È·Ó‹˜ Û¿ÏÈÁÁ·˜, ˆÙ›Ùȉ˜ Î·È ·Ú·ÚÚÈÓÔÎÔÏ›Ùȉ˜, ÎÂÊ·Ï·ÏÁ›· Û˘Óԉ¢fiÌÂÓË ·fi ÚˆÈÓÔ‡˜ Â̤ÙÔ˘˜, ˘¤ÚÙ·ÛË, ÛÈÂÏfiÚÚÔÈ· Î·È ‰È·Ù·Ú·¯¤˜ ÛÙËÓ fiÛÊÚËÛË Î·È ÙËÓ Î·Ù¿ÔÛË. µ¤‚·È·, οı ·È‰› Ì ÙËÓ ÚÔ·Ó·ÊÂÚı›۷ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ‰ÂÓ ÛËÌ·›ÓÂÈ fiÙÈ ¿Û¯ÂÈ ÔˆÛ‰‹ÔÙ ·fi ηÎfiËı˜ ÓfiÛËÌ· Ù˘ ÂÚÈÔ¯‹˜, ·Ï¿ ÂÈ‚¿ÏÏÂÙ·È Ì ÙËÓ ·ÓˆÙ¤Úˆ Û˘Ìو̷ÙÔÏÔÁ›· Ó· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Î·È Ù· ÓÂÔÏ·ÛÌ·ÙÈο ÓÔÛ‹Ì·Ù·. ∫ÏÈÓÈο ÛËÌ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú ηÎÔ‹ıÔ˘˜ ÓÔÛ‹Ì·ÙÔ˜ Â›Ó·È Ë ÛÙ·ıÂÚ‹ Î·È ÚÔԉ¢ÙÈ΋ Âȉ›ӈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ‹ Ë ·ÈÊÓ›‰È· Âȉ›ӈÛË ¯ÚÔÓ›ˆ˜ ÚÔ¸¿Ú¯ÔÓÙÔ˜ ÚÔ‚Ï‹Ì·ÙÔ˜, Ë ·ÚÔ˘Û›· ÁÂÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ fiˆ˜ ÎÂÊ·Ï·ÏÁ›·, ηÎÔ˘¯›· Î.¿., Ë ÂÈ̤ÓÔ˘Û· ‰ÈfiÁΈÛË ÏÂÌÊ·‰¤ÓˆÓ Î·È Ë ¿ÚÂÛË ÂÚÈÊÂÚÈÎÒÓ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ Ù˘ ÂÓ ÏfiÁˆ ·Ó·ÙÔÌÈ΋˜ ÂÚÈÔ¯‹˜. ∞fi Ù· ηÏÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· Û˘¯ÓfiÙÂÚ· Â›Ó·È Ù· ıËÏÒÌ·Ù·, ÂÓÒ ·fi Ù· ηÎÔ‹ıË Û˘ÓËı¤ÛÙÂÚ· ··ÓÙÒÓÙ·È Ù· ÏÂÌÊÒÌ·Ù· (Hodgkin Î·È ÌË Hodgkin), Ù· Û·ÚÎÒÌ·Ù·
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OÌÈÏ›· Ì ÊÚ¿ÛÂȘ ‹ ·ÙÂÏ›˜ ÚÔÙ¿ÛÂȘ 50-70% ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ ∞‡ÍËÛË Î·Ù¿ 30-50% ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ Î.Ê. ª¤ÙÚÈ· Û‡Û·ÛË ÌÂÛÔχÚÈˆÓ Ì˘ÒÓ Û˘Óԉ¢fiÌÂÓË ·fi Û‡Û·ÛË ÙˆÓ ÙÚ·¯ÂÈÔÛÙÂÚÓÈÎÒÓ Ì˘ÒÓ. ÃÚ‹ÛË ÛÙÂÚÓÔÎÏÂȉÔÌ·ÛÙÔÂȉÒÓ Ì˘ÒÓ. ∞ÂÚÔÏ‹ıÂÈ· ıÒÚ·ÎÔ˜ (˘ÂÚ·ÂÚÈÛÌfi˜) ø¯Úfi ∂ÈÛÓ¢ÛÙÈÎÔ› Î·È ÂÎÓ¢ÛÙÈÎÔ› Û˘Ú›ÙÙÔÓÙ˜ ÚfiÁ¯ÔÈ 90-95% <40
OÌÈÏ›· Ì ÌÂÌÔӈ̤Ó˜ ϤÍÂȘ ‹ ÌÈÎÚ¤˜ ÊÚ¿ÛÂȘ <50% ÙˆÓ ÚÔ‚ÏÂfiÌÂÓˆÓ ÙÈÌÒÓ ∞‡ÍËÛË ¿Óˆ ÙÔ˘ 50% ÙÔ˘ ̤ÛÔ˘ fiÚÔ˘ ¶Èı·Ó¿ Â›Ó·È ÌÂȈ̤ÓË ª¤ÙÚÈ· Û‡Û·ÛË ÌÂÛÔχÚÈˆÓ Ì˘ÒÓ. ™‡Û·ÛË ÙÚ·¯ÂÈÔÛÙÂÚÓÈÎÒÓ Ì˘ÒÓ Ì ·Ó·¤Ù·ÛË ÚÈÓÈÎÒÓ ÙÂÚ˘Á›ˆÓ ηٿ ÙËÓ ÂÈÛÓÔ‹. ÀÂÚ·ÂÚÈÛÌfi˜ ıÒÚ·ÎÔ˜ ¶Èı·Ó¿ ΢·ÓˆÙÈÎfi ∞Ô˘Û›· ·Ó·Ó¢ÛÙÈÎÒÓ ‹¯ˆÓ <90% >40
Î·È ÙÔ ·‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· (6). π‰È·›ÙÂÚÔ˘ ÂӉȷʤÚÔÓÙÔ˜ ηÎfiËı˜ ÓÂfiÏ·ÛÌ· ÛÙ· ·È‰È¿ Â›Ó·È ÙÔ ·‰ÂÓÔηÚΛӈ̷ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· (8-11). ¶ÚfiÎÂÈÙ·È ÁÈ· Û¿ÓÈ· ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÂÎÚÔÛˆÒÓÙ·˜ ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1% ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ·È‰ÈÎÔ‡ ηÚΛÓÔ˘, ·ÏÏ¿ ·ÔÙÂÏ› ÙÔ 1/3 ÂÚ›Ô˘ ÙˆÓ ÓÂÔÏ·ÛÌ¿ÙˆÓ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·. ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈο Û¯ÂÙ›˙ÂÙ·È Ì ÙË Ïԛ̈ÍË ·fi ÙÔÓ Èfi Epstein-Barr, fiˆ˜ ¤¯ÂÈ ·Ô‰Âȯı› ·fi ÌÔÚȷΤ˜ ÌÂϤÙ˜ ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ fiÔ˘ ¤¯ÂÈ ‚ÚÂı› ÙÔ ÁÔÓȉ›ˆÌ· ÙÔ˘ ÈÔ‡, ÂÓۈ̷و̤ÓÔ ÛÙÔ Á¤ÓˆÌ· ÙˆÓ Î·ÎÔ‹ıˆÓ ΢ÙÙ¿ÚˆÓ. ∫ÏÈÓÈο ÚÔ‚¿ÏÏÂÈ Ì ‰ÈfiÁΈÛË ÙˆÓ Ô›ÛıÈˆÓ ÙÚ·¯ËÏÈÎÒÓ ÏÂÌÊ·‰¤ÓˆÓ Û˘Óԉ¢fiÌÂÓË Î·È ·fi Û˘ÌÙÒÌ·Ù· fiˆ˜ ÎÂÊ·Ï·ÏÁ›·, ›ÛÙ·ÍË, ¯ÚfiÓÈ· ̤ÛË ˆÙ›Ùȉ·, ÌÂÚÈ΋ ‹ ÔÏÈ΋ ¤ÎÙˆÛË Ù˘ ·ÎÔ‹˜, ·Ú·Ï‡ÛÂȘ ÎÚ·ÓÈ·ÎÒÓ ÓÂ‡ÚˆÓ Î·È ÙÚÈÛÌfi. ∏ ÓfiÛÔ˜ Ú¤ÂÈ Î˘Ú›ˆ˜ Ó· ‰È·ÊÔÚԉȷÁÈÁÓÒÛÎÂÙ·È ·fi ÙÔ Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ Î·È Ù· ÌË Hodgkin ÏÂÌÊÒÌ·Ù·. ∏ ıÂڷ›· ÙÔ˘ ηÚΛÓÔ˘ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· Û˘Ó›ÛÙ·Ù·È ÛÂ Û˘Ó‰˘·ÛÌfi ¯ÂÈÚÔ˘ÚÁÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ ·ÎÔÏÔ˘ıÔ‡ÌÂÓ˘ ·fi ·ÎÙÈÓÔıÂڷ›· Î·È ¯ËÌÂÈÔıÂڷ›·. ∂ȉÈÎfiÙÂÚ·, ¯ÂÈÚÔ˘ÚÁÈο ÂȯÂÈÚÂ›Ù·È Î·Ù¿ ÙÔ ‰˘Ó·Ùfi ÔÏÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ fiÁÎÔ˘ ‹ ¿Ïψ˜ Ï‹„Ë ÈÛÙÔÏÔÁÈÎÔ‡ ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·194
194
¶. ∫Ô˘ÙÚԇ̷ Î·È Û˘Ó.
¶›Ó·Î·˜ 4. ∆· Û˘ÓËı¤ÛÙÂÚ· ηÎÔ‹ıË ÓÂÔÏ¿ÛÌ·Ù· ·ÓÒÙÂÚÔ˘ Î·È Î·ÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó¿ ËÏÈΛ· ÛÙ· ·È‰È¿ ¡fiÛËÌ·
∏ÏÈΛ· (¤ÙË) <1
1-3
3-11
>12
∞ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi
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§¤Ìʈ̷ ¡Â˘ÚÔ‚Ï¿Ûو̷ ∆Âڿو̷ ¡ÂÊÚÔ‚Ï¿Ûو̷ ¶Ó¢ÌÔÓÔ‚Ï¿Ûو̷
§Â˘¯·ÈÌ›· §¤Ìʈ̷ ¡Â˘ÚÔ‚Ï¿Ûو̷ ƒ·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ ¡ÂÊÚÔ‚Ï¿Ûو̷
§¤Ìʈ̷ ƒ·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ Ca ÚÈÓÔÊ¿Ú˘ÁÁ· §Â˘¯·ÈÌ›· §¤Ìʈ̷ Û. Ewing ƒ·‚‰ÔÌ˘ÔÛ¿ÚΈ̷
‰Â›ÁÌ·ÙÔ˜ ·fi ÙÔÓ ÚˆÙÔ·ı‹ fiÁÎÔ ‹ ·fi Ù˘¯fiÓ ˘¿Ú¯ÔÓÙ˜ ÌÂÙ·ÛÙ·ÙÈο ‰ÈËıË̤ÓÔ˘˜ ÏÂÌÊ·‰¤Ó˜. ∞ÎÔÏÔ˘ıÔ‡Ó ¯ËÌÂÈÔıÂڷ›· Î·È ·ÎÙÈÓÔ‚fiÏËÛË Û ¤ÎÙ·ÛË Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi Ù· ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù· Î·È ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, ÂÓÒ Ë ÚfiÁÓˆÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÚˆÙÔ·ıÔ‡˜ fiÁÎÔ˘ Î·È ÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ (10,11). ∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Î·È Ë ÔÚ›· Ù˘ ÓfiÛÔ˘ 10 ÌÈÎÚÒÓ ·ÛıÂÓÒÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ‰È·ÁÓÒÛÙËΠηÚΛӈ̷ ÙÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ· Î·È ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó ÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ÙËÓ ÙÂÏÂ˘Ù·›· 15ÂÙ›·, ·ÔÙ˘ÒÓÂÙ·È Û ÌÂϤÙË Ô˘ ‰ËÌÔÛȇÙËΠÚfiÛÊ·Ù· (11). ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ù˘ ÌÂϤÙ˘ ¤Ï·‚·Ó Û˘Ó‰˘·Ṳ̂ÓË ¯ËÌÂÈÔıÂڷ›· Î·È ·ÎÙÈÓÔıÂڷ›· Ì ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù·, ηıÒ˜ 54 Ì‹Ó˜ ÌÂÙ¿ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ 7/10 ·ÛıÂÓ›˜ ·Ú¤ÌÂÓ·Ó ÂÓ ˙ˆ‹, 5 ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ‹Ù·Ó ÂχıÂÚÔÈ ÓfiÛÔ˘ Î·È 2 Ì ÛÙ·ıÂÚ‹ ÓfiÛÔ (11).
¡ÂÔÏ¿ÛÌ·Ù· ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ∆Ô Î·ÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, Ô˘ ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏÔ˘˜ ÙÔ˘˜ ·Ó·ÙÔÌÈÎÔ‡˜ Û¯ËÌ·ÙÈÛÌÔ‡˜ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ·fi ÙÔÓ ˘ÔÊ¿Ú˘ÁÁ· Î·È Î¿Ùˆ, ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚ· ÚÔÛ‚·ÏÏfiÌÂÓÔ ÙÌ‹Ì· Ù˘ ·ÂÚÔÊfiÚÔ˘ Ô‰Ô‡ ·fi ÓÂÔϷۛ˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È È‰È·›ÙÂÚ· Û˘¯Ó¿, ÂÓÒ Û·ÓÈfiÙÂÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È Ù· ÙÔȯÒÌ·Ù· ÙÔ˘ ˘Â˙ˆÎfiÙ·, ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·, ÔÈ ‚ÚfiÁ¯ÔÈ Î·È Ù· ‚ÚÔÁ¯ÈfiÏÈ·. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÔÈΛÏÏÂÈ, ÂÍ·ÚÙÒÌÂÓË ·fi ÙËÓ ÂÓÙfiÈÛË Î·È ÙÔ Â›‰Ô˜ ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜. O ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
Û˘¯Ó¿ ‰ÈÂÓÂÚÁÂ›Ù·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È¢ÎÚÈÓÈÛÙ› - fiÛÔ Â›Ó·È ‰˘Ó·Ùfi - ÙÔ Â›‰Ô˜ Î·È Ë ı¤ÛË ÙÔ˘ ˘ÔΛÌÂÓÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Â›Ó·È ÔÈΛÏÔ˜ ·Ó¿ÏÔÁ· Ì ÙÔ ÈÛÙÔÚÈÎfi Î·È Ù· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ·ÛıÂÓÔ‡˜. ™˘Ó‹ıˆ˜ ‰Â ÂÚÈÏ·Ì‚¿ÓÂÈ ÚÔÛıÈÔ›ÛıÈ· Î·È Ï¿ÁÈ· ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ˘ÔÏÔÁÈÛÙÈ΋ ÙÔÌÔÁÚ·Ê›· Ì ‹ ¯ˆÚ›˜ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· Ù˘ ÂÚÈÔ¯‹˜, ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È Ú·‰ÈÔ˚ÛÔÙÔÈ΋ ÌÂϤÙË. O ˘Ï·Î҉˘ ‚‹¯·˜, ÙÔ ‚Ú¿Á¯Ô˜ ʈӋ˜ Ô˘ Û˘Óԉ‡ÂÙ·È Î·È ·fi ·ÊˆÓ›·, Ë ·ÈÌfiÙ˘ÛË Î·È Ù· ‰˘ÛÓÔ˚ο Ê·ÈÓfiÌÂÓ· ·ÔÙÂÏÔ‡Ó ÙË Û˘Ó‹ıË ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ ‰È‹ıËÛ˘ ÙÔ˘ Ï¿Ú˘ÁÁ· (12-15). ∆· ÓÔÛ‹Ì·Ù· Ô˘ ηٿ ηÓfiÓ· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÈÔ¯‹ Â›Ó·È ÙÔ Î·ÏfiËı˜ ı‹ÏˆÌ· Î·È Ô Î·ÚΛÓÔ˜ ÙÔ˘ Ï¿Ú˘ÁÁ· Ô˘ Û˘ÓÈÛÙ¿ ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔ ÓfiÛËÌ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∏ ‰È¿ÁÓˆÛË ·˘ÙÒÓ ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ù›ıÂÙ·È Ì ¿ÌÂÛË Ï·Ú˘ÁÁÔÛÎfiËÛË Î·È ‚ÈÔ„›· Ù˘ ‡ÔÙ˘ ÂÚÈÔ¯‹˜. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ÙÔ ÓÂfiÏ·ÛÌ· ÂÓÙÔ›˙ÂÙ·È ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÙÚ·¯Â›·˜ Î·È ÙˆÓ ‚ÚfiÁ¯ˆÓ, Ù· Û˘ÌÙÒÌ·Ù· ÂΉËÏÒÓÔÓÙ·È ˆ˜ ·ÔÊÚ·ÎÙÈÎÔ‡ Ù‡Ô˘, Ì ›ÌÔÓÔ ‚‹¯·, Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ Î·È ·Ô‚ÔÏ‹ ίڈÛÌ¤ÓˆÓ Ù˘¤ÏˆÓ (13-16). ∏ ‚·Ú‡ÙËÙ· ÙˆÓ ÎÏÈÓÈÎÒÓ ÛËÌ›ˆÓ Ù˘ ÚÔηÏÔ‡ÌÂÓ˘ ·fiÊڷ͢ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙËÓ Â¤ÎÙ·ÛË ÙÔ˘ ÓÂÔÏ¿ÛÌ·ÙÔ˜ Î·È Î˘Ì·›ÓÂÙ·È ·fi ‹ÈÔ, ·ÏÏ¿ ›ÌÔÓÔ ‚‹¯· ̤¯ÚÈ ÙËÓ ÂÌÊ¿ÓÈÛË Ï‹ÚÔ˘˜ ÂÚÈÊÂÚÈ΋˜ ·ÔÊÚ·ÎÙÈ΋˜ ·ÙÂÏÂÎÙ·Û›·˜ Î·È ÛÔ‚·Ú‹˜ ‰‡ÛÓÔÈ·˜. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› ¿ÓÙˆ˜ fiÙÈ Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ ηı˘ÛÙÂÚ› Ë ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÏfiÁˆ ˘ÔÂÎÙ›ÌËÛ˘ ÙˆÓ Û˘Ìو̿وÓ. ∆Ô ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔ ÓÂfiÏ·ÛÌ· Ô˘ ηٿ ηÓfiÓ· ÚÔηÏ› ÙËÓ ·ÓˆÙ¤Úˆ Û˘Ìو̷ÙÔÏÔÁ›· Â›Ó·È Ô Î·ÚΛÓÔ˜ ÙˆÓ ‚ÚfiÁ¯ˆÓ, Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÔÔ›Ô˘
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·195
195
¢‡ÛÓÔÈ· Û ·È‰È¿ Ì ÓÂÔϷۛ˜
Ù›ıÂÙ·È Ì ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË Î·È ÙËÓ ÈÛÙÔÏÔÁÈ΋ ÂͤٷÛË Ù˘ ‚Ï¿‚˘ (16). ∏ ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Î·È Ù˘ ˘Â˙ˆÎÔÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ ÚÔηÏ› ›ÌÔÓÔ ‚‹¯·, ·ÈÌÔÙ‡ÛÂȘ Î·È ‰˘ÛÓÔ˚ο Ê·ÈÓfiÌÂÓ· (17,18). ™ÙÔ˘˜ ÚˆÙÔ·ı›˜ fiÁÎÔ˘˜ Ô˘ Û˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì· ·Ó‹ÎÔ˘Ó ÙÔ Ó¢ÌÔÓÔ‚Ï¿Ûو̷, Ù· Û·ÚÎÒÌ·Ù· Î·È Ù· ÏÂÌÊÒÌ·Ù·, ÂÓÒ ÔÈ Ù˘¯fiÓ ÂÌÊ·ÓÈ˙fiÌÂÓ˜ ÌÂÙ·ÛÙ¿ÛÂȘ ·ÊÔÚÔ‡Ó ÛÙÔ ÓÂÊÚÔ‚Ï¿Ûو̷, ÛÙÔ˘˜ fiÁÎÔ˘˜ ÙˆÓ ÔÛÙÒÓ Î·È ÛÙ· Û·ÚÎÒÌ·Ù·. ™Â οı ÂÚ›ÙˆÛË, Ë ˘fiÓÔÈ· Ù˘ ÓfiÛÔ˘ Ù›ıÂÙ·È ·fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·È ÙÔÓ ·ÂÈÎÔÓÈÛÙÈÎfi ¤ÏÂÁ¯Ô Î·È ÂȂ‚·ÈÒÓÂÙ·È ·fi ÙËÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ ÂÈÎfiÓ· ÙÔ˘ ÈÛÙÔÏÔÁÈÎÔ‡ ‰Â›ÁÌ·ÙÔ˜. ∂ȉÈÎfiÙÂÚ· ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÓÙÔÈÛÙÔ‡Ó ÔÈΛϷ ÚˆÙÔ·ı‹ ‹ ÌÂÙ·ÛÙ·ÙÈο, ηÏÔ‹ıË ‹ ηÎÔ‹ıË ÓÔÛ‹Ì·Ù· (1923). °È· ÏfiÁÔ˘˜ ‰È·ÁÓˆÛÙÈÎÔ‡˜ Î·È Ú·ÎÙÈÎÔ‡˜, Ô ¯ÒÚÔ˜ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ‰È·ÎÚ›ÓÂÙ·È Û ÙÚÂȘ Ì›˙ÔÓ˜ ·Ó·ÙÔÌÈΤ˜ ÂÚÈÔ¯¤˜ Î·È Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔ ¿Óˆ ÚfiÛıÈÔ (ı‡ÌÔ˜ ·‰¤Ó·˜, ·ÓÈÔ‡Û· ·ÔÚÙ‹, ¿Óˆ ÎÔ›ÏË Î·È ¿˙˘ÁÔ˜ ÊϤ‚·, ÏÂÌÊ·‰¤Ó˜, ϛԘ Î·È Û˘Ó‰ÂÙÈÎfi˜ ÈÛÙfi˜), ÛÙÔ Ô›ÛıÈÔ (Û˘Ì·ıËÙÈο Á¿ÁÁÏÈ·, ÔÈÛÔÊ¿ÁÔ˜, ıˆÚ·ÎÈÎfi˜ fiÚÔ˜, ÏÂÌÊ·‰¤Ó˜, ηÙÈÔ‡Û· ·ÔÚÙ‹, Ó¢ÌÔÓÔÁ·ÛÙÚÈÎfi Ó‡ÚÔ) Î·È ÛÙÔ Ì¤ÛÔ ÌÂÛÔıˆÚ¿ÎÈÔ (ηډȿ, ÙÚ·¯Â›· Î·È ÌÂÁ¿ÏÔÈ ‚ÚfiÁ¯ÔÈ, Ó¢ÌÔÓÈο ·ÁÁ›·, ÏÂÌÊ·‰¤Ó˜, ϛԘ Î·È Û˘Ó‰ÂÙÈÎfi˜ ÈÛÙfi˜). ∆Ô ÙÌ‹Ì· ÛÙÔ ÔÔ›Ô Û˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÔÓÙ·È ÔÈ ÓÂÔÏ·ÛÌ·ÙÈΤ˜ ÂÍÂÚÁ·Û›Â˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Â›Ó·È ÙÔ Ô›ÛıÈÔ (63%) Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ÚfiÛıÈÔ (26%) Î·È ÙÔ Ì¤ÛÔ ÌÂÛÔıˆÚ¿ÎÈÔ (11%). Ÿˆ˜ Û˘Ì‚·›ÓÂÈ Î·È Ì ÙÔ ÏÔÈfi ηÙÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ·, Ù· ÓÂÔÏ¿ÛÌ·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙË Ì›˙ÔÓ· ·˘Ù‹ ÂÚÈÔ¯‹ ÛÙ· ·È‰È¿ ÔÈΛÏÏÔ˘Ó Î·È ‰È·Ê¤ÚÔ˘Ó ÛËÌ·ÓÙÈο ·fi Ù· ÓÂÔÏ¿ÛÌ·Ù· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ™Â ÁÂÓÈΤ˜ ÁÚ·Ì̤˜ Î·È ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ÂÈ̤ÚÔ˘˜ ηٷÓÔÌ‹, ÛÙÔ ÌÂÛÔıˆÚ¿ÎÈÔ ÂÌÊ·Ó›˙ÔÓÙ·È - Ì ÛÂÈÚ¿ Û˘¯ÓfiÙËÙ·˜ - Ó¢ÚÔÁÂÓ›˜ fiÁÎÔÈ, ÏÂÌÊÒÌ·Ù·, Û˘ÁÁÂÓ›˜ ·ÛÙÂȘ, ÁÔÓ·‰Ô‚Ï·ÛÙÒÌ·Ù·, ÌÂÛÂÁ¯˘Ì·ÙÔÁÂÓ›˜ fiÁÎÔÈ Î·È Î·ÚÎÈÓÒÌ·Ù·, ÂÓÒ ÁÂÓÈο ·Ô˘ÛÈ¿˙Ô˘Ó ÛÙ· ·È‰È¿ Ù· ı˘ÌÒÌ·Ù· Î·È ÔÈ ÂÓ‰ÔÎÚÈÓ›˜ fiÁÎÔÈ. OÈ fiÁÎÔÈ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘, ÏfiÁˆ Ù˘ ÛÙÂÓ‹˜ ÁÂÈÙÓ›·Û˘ Ì ÛËÌ·ÓÙÈο fiÚÁ·Ó· Ô˘ ‰È¤Ú¯ÔÓÙ·È ‹ ÂÓÙÔ›˙ÔÓÙ·È ÛÙËÓ ÂÚÈÔ¯‹ ·˘Ù‹, Â›Ó·È ‰˘Ó·Ùfi Ó· ÚÔ‚¿ÏÏÔ˘Ó Ì ̛· ÔÈÎÈÏ›· Û˘ÌÙˆÌ¿ÙˆÓ (19-23). ∆· Û˘ÌÙÒÌ·Ù· ·˘Ù¿ ‰È·-
ÎÚ›ÓÔÓÙ·È: ·) ÛÙ· ÌË ÂȉÈο, ‚) ÛÙ· ‰Â˘ÙÂÚÔÁÂÓ‹ ÏfiÁˆ ›ÂÛ˘ ‹ ·ÚÂÎÙfiÈÛ˘ ·Ú·Î›ÌÂÓˆÓ ÔÚÁ¿ÓˆÓ Î·È Á) ÛÙ· ‰Â˘ÙÂÚÔÁÂÓ‹ ÏfiÁˆ ÂÓ‰ÔÎÚÈÓÔÏÔÁÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. ™Ù· ÚÒÙ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ·ÓÔÚÂÍ›·, Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ë Î·ÎÔ˘¯›·, ÙÔ ·›ÛıËÌ· ‰˘ÛÊÔÚ›·˜ ÛÙÔÓ ıÒڷη Î·È Ô ˘ÚÂÙfi˜. §fiÁˆ ›ÂÛ˘ ÙÔ˘ ÙÚ·¯ÂÈÔ‚ÚÔÁ¯ÈÎÔ‡ ‰¤Ó‰ÚÔ˘, Ô ·ÛıÂÓ‹˜ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÌÊ·Ó›ÛÂÈ Â›ÌÔÓÔ ‚‹¯·, Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹, ‰‡ÛÓÔÈ· Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂›Û˘, ›ÂÛË ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘ ηٷϋÁÂÈ Û ‰˘ÛÊ·Á›·-‰˘ÛηٷÔÛ›·, ‰È‹ıËÛË ÙÔ˘ ·˘¯ÂÓÈÎÔ‡ ϤÁÌ·ÙÔ˜ Û ۇӉÚÔÌÔ Horner, ·Ú¿Ï˘ÛË ÙˆÓ ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ Û ÌÂÚÈ΋ ‹ Ï‹ÚË ·ÊˆÓ›·, ÂÓÒ Ù¤ÏÔ˜, Â›Ó·È Èı·ÓfiÓ Ó· ÚÔÎÏËıÔ‡Ó Î·Ú‰È·Î¤˜ ·ÚÚ˘ı̛˜ ‹ Î·È Î·Ú‰È·Îfi˜ ÂȈ̷ÙÈÛÌfi˜. ∆Ô “Û‡Ó‰ÚÔÌÔ Ù˘ ¿Óˆ ÎÔ›Ï˘ ÊϤ‚·˜” ‹ “Û‡Ó‰ÚÔÌÔ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘” ·ÊÔÚ¿ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÙˆÓ ·ÓÙÈÎÂÈÌÂÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ, Ù· ÔÔ›· ÔÊ›ÏÔÓÙ·È Û ›ÂÛË ÙÔ˘ Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜ ·ÁÁ›Ԣ ·Ú¿ÏÏËÏ· ÌÂ Û˘Ìو̷ÙÔÏÔÁ›· ·fiÊڷ͢ Ù˘ ÙÚ·¯Â›·˜ Î·È ÙÔ˘ ÔÈÛÔÊ¿ÁÔ˘. ∂ȉÈÎfiÙÂÚ· ÛÙ· ·È‰È¿, fiÔ˘ ÙÔ ÙÔ›¯ˆÌ· Ù˘ ¿Óˆ ÎÔ›Ï˘ ÊϤ‚·˜ Â›Ó·È Â˘¤Ó‰ÔÙÔ Î·È ÔÈ ·ÛÎÔ‡ÌÂÓ˜ ÂÓ‰Ô·˘ÏÈΤ˜ ȤÛÂȘ ÌÂÁ¿Ï˜ › Ì·˙ÒÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘, ÔÈ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ ÙÔ˘ “Û˘Ó‰ÚfiÌÔ˘ Ù˘ ¿Óˆ ÎÔ›Ï˘ ÊϤ‚·˜” Î·È ÙÔ˘ “Û˘Ó‰ÚfiÌÔ˘ ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘” Û˘Ì›ÙÔ˘Ó (24,25). ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, ÙÔ Û‡Ó‰ÚÔÌÔ Û˘Ó‹ıˆ˜ ÍÂÎÈÓ¿ Ì ÎÔÈÓ¿ Û˘ÌÙÒÌ·Ù· fiˆ˜ ›ÌÔÓÔ˜ ‚‹¯·˜, ‚Ú¿Á¯Ô˜ ʈӋ˜ Î·È ‰‡ÛÓÔÈ· Ô˘ ÌÔÚ› Ó· ηٷϋÍÂÈ Û ÔÚıfiÓÔÈ· Î·È ıˆÚ·Î·ÏÁ›·. ™·ÓÈfiÙÂÚ·, ÚÔ‚¿ÏÏÂÈ Ì ÈÔ ıÔÚ˘‚Ò‰ÂȘ Î·È Ï¤ÔÓ ‰˘ÛÔ›ˆÓ˜ ÂΉËÏÒÛÂȘ fiˆ˜ ¤ÓÙÔÓË ·ÓËÛ˘¯›·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÂȤ‰Ô˘ Û˘Ó›‰ËÛ˘ (Û˘Á¯˘ÙÈο Ê·ÈÓfiÌÂÓ·, Ï‹ı·ÚÁÔ˜), ÎÂÊ·Ï·ÏÁ›·, ·›ÛıËÌ· ÏËÚfiÙËÙ·˜ ÒÙˆÓ Î·È ‰È·Ù·Ú·¯¤˜ fiÚ·Û˘. ∞Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ù· ·ÓˆÙ¤Úˆ Û˘ÌÙÒÌ·Ù· ÂȉÂÈÓÒÓÔÓÙ·È fiÙ·Ó Ô ·ÛıÂÓ‹˜ ‚ÚÂı› Û ‡ÙÈ· ı¤ÛË, ÁÂÁÔÓfi˜ Ô˘ ¯Ú‹˙ÂÈ È‰È·›ÙÂÚ˘ ÚÔÛÔ¯‹˜ ηٿ ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘. ∞fi ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒÓÂÙ·È Ô›‰ËÌ·, ΢¿ÓˆÛË Î·È ÂÚ˘ıÚfiÙËÙ· ÙÔ˘ ÚÔÛÒÔ˘, ÙÔ˘ ÙÚ·¯‹ÏÔ˘ Î·È ÙˆÓ ¿Óˆ ¿ÎÚˆÓ, ˘ÂÚ·ÈÌ›· ÂÈÂÊ˘ÎfiÙˆÓ, Û˘Ú›ÙÙÔ˘Û· ·Ó·ÓÔ‹ Î·È ¤ÓÙÔÓ˜ ÂÊȉÚÒÛÂȘ. ∆Ô Û‡Ó‰ÚÔÌÔ Ù˘ ¿Óˆ ÎÔ›Ï˘ ÊϤ‚·˜ ÌÔÚ› Ó· ·ÔÙÂÏ› ÂΉ‹ÏˆÛË ÔÈÎ›ÏˆÓ Î·ÎÔ‹ıˆÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ÏÂÌʈ̿وÓ, Ï¢¯·ÈÌ›·˜ ¶·È‰È·ÙÚÈ΋ 2005;68:189-197
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Î·È ‰È·ÊfiÚˆÓ Û˘Ì·ÁÒÓ fiÁÎˆÓ (24,25). ∏ ‰È·ÁÓˆÛÙÈ΋ ÚÔۤϷÛË Ô˘ ÂȯÂÈÚÂ›Ù·È ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ˘ÔΛÌÂÓÔ ÓfiÛËÌ· Î·È ÙËÓ Î·Ù¿ÛÙ·ÛË ÙÔ˘ ·ÛıÂÓÔ‡˜, ÂÓÒ ÛÙË Û˘Ó¤¯ÂÈ· ·ÎÔÏÔ˘ı› Ë ÂÓ‰ÂÈÎÓ˘fiÌÂÓË ÁÈ· οı ÂÚ›ÙˆÛË ıÂڷ›·. ™·ÓÈfiÙÂÚ· Î·È ÂÊfiÛÔÓ ÔÈ Û˘Óı‹Î˜ ‰ÂÓ ÂÈÙÚ¤Ô˘Ó ‰È·ÁÓˆÛÙÈÎÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜ ÏfiÁˆ Ù˘ ‚·ÚÈ¿˜ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ·ÛıÂÓÔ‡˜, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔËÁËı› Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ ÚÔۤϷÛ˘ - ˘fi ÙËÓ ¤ÓÓÔÈ· ÙÔ˘ ›ÁÔÓÙÔ˜ - ·ÎÙÈÓÔ‚ÔÏ›· ‹ Î·È ÂÌÂÈÚÈ΋ ¯ËÌÂÈÔıÂڷ›·. ∫·Ù¿ ηÓfiÓ·, ÔÈ ¯ËÌÂÈÔıÂڷ¢ÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ¯ÔÚËÁÔ‡ÓÙ·È Â›Ó·È Ë ‚ÈÓÎÚÈÛÙ›ÓË, Ë Î˘ÎÏÔʈÛÊ·Ì›‰Ë, ÔÈ ·Óıڷ΢ÎϛӘ Î·È Ù· ÛÙÂÚÔÂȉ‹. ∂› Ï›·Ó ÛÔ‚·ÚÒÓ ÂӉ›ÍˆÓ, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂȯÂÈÚËı› Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜, Ë ÔÔ›· fï˜ ÛÙËÓ ÂÚ›ÙˆÛË ÙˆÓ ÓÂÔÏ·ÛÌ·ÙÈÎÒÓ ‰ÈËı‹ÛÂˆÓ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ ¯Ú‹˙ÂÈ È‰È·›ÙÂÚ˘ ÚÔÛÔ¯‹˜ ‰ÈfiÙÈ ÂÁ΢ÌÔÓ› ÛÔ‚·ÚÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ (26,27).
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™˘ÌÂÚ¿ÛÌ·Ù· ∞fi Ù· ·Ú·¿Óˆ Â›Ó·È Ê·ÓÂÚfi fiÙÈ ›Ûˆ ·fi Û˘Ó‹ıË Û˘ÌÙÒÌ·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ fiˆ˜ Â›Ó·È Ô ‚‹¯·˜ Î·È Ë ‰˘Û¯¤ÚÂÈ· Ù˘ ÚÈÓÈ΋˜ ·Ó·ÓÔ‹˜, Ô˘ fï˜ ÂÈ̤ÓÔ˘Ó Î·È ÂȉÂÈÓÒÓÔÓÙ·È ÚÔԉ¢ÙÈο, ÌÔÚ› Ó· ˘ÔÎÚ‡ÙÔÓÙ·È ÓÂÔÏ·ÛÌ·ÙÈο ÓÔÛ‹Ì·Ù·. ¢˘ÛÙ˘¯Ò˜, Û˘¯Ó¿ ηı˘ÛÙÂÚ› Ë ‰È¿ÁÓˆÛË ÙˆÓ ÓÔÛËÌ¿ÙˆÓ ·˘ÙÒÓ, ‰ÈfiÙÈ ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ¿˜ ÙÔ˘˜, ‰È·Ê‡ÁÔ˘Ó ·fi ÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë ÙˆÓ ·È‰È¿ÙÚˆÓ. ¶Ú¤ÂÈ fï˜ Ó· ÙÔÓÈÛÙ› fiÙÈ ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ë ¤ÁηÈÚË ‰È¿ÁÓˆÛË Î·È ·Ú·ÔÌ‹ ÛÙÔÓ ÂȉÈÎfi ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË ÌÔÚ› Ó· ‚ÂÏÙÈÒÛÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÚfiÁÓˆÛË Î·È ÙËÓ ÂÈ‚›ˆÛË ÙˆÓ ÌÈÎÚÒÓ ·ÛıÂÓÒÓ.
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¢‡ÛÓÔÈ· Û ·È‰È¿ Ì ÓÂÔϷۛ˜
Steinberg R, Dlugy E et al. Mediastinal tumors in children: a single institution experience. Clin Pediatr (Phila) 2002;41:219-223. 22. King RM, Telander RL, Smithson WA, Banks PM, Han MT. Primary mediastinal tumors in children. J Pediatr Surg 1982;17:512-520. 23. Temes R, Allen N, Chavez T, Crowell R, Key C, Wernly J. Primary mediastinal malignancies in children: report of 22 patients and comparison to 197 adults. Oncologist 2000;5:179-184. 24. Chen JC, Bongard F, Klein SR. A contemporary perspective on superior vena cava syndrome. Am J Surg 1990;160:207-211.
25. Janin Y, Becker J, Wise L, Schneider K, Schwartz D, So H. Superior vena cava syndrome in childhood and adolescence: a review of the literature and report of three cases. J Pediatr Surg 1982;17:290-295. 26. Robie DK, Gursoy MH, Pokorny WJ. Mediastinal tumors - airway obstruction and management. Semin Pediatr Surg 1994;3:259-266. 27. Lange B, D’Angio G, Ross AJ III, O’Neil JA Jr, Packer RJ. Oncologic emergencies. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. Philadelphia: JB Lippincott Co; 1989. p. 799.
¶·È‰È·ÙÚÈ΋ 2005;68:189-197
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Clinical and diagnostic approach to dyspnoea in children: neoplasms as an underlying cause Department of Paediatric Haematology-Oncology, “Aghia Sophia” Children’s Hospital, Athens Correspondence: Sophia Polychronopoulou Androulakaki Department of Paediatric Haematology-Oncology, “Aghia Sophia” Children’s Hospital Thivon & Levadias str., 115 27, Athens E-mail: sophpol@otenet.gr Date of submission: 06-05-2004 Date of approval: 13-04-2005
P. Koutroumba, S. Polychronopoulou - Androulakaki
Abstract Dyspnoea, the subjective feeling of lacking air, experienced as difficulty in getting one’s breath, is expressed clinically in children mainly by tachypnoea, tachycardia, use of the accessory muscles of respiration and, in severe cases, by cyanosis. The most common causes of dyspnoea in children include infections and especially viral infections, asthma, anatomic malformations, congenital diseases and neoplasms, benign or malignant, in or adjacent to the upper or lower respiratory tract. The most common benign neoplasms of the upper airways that may disturb respiratory function in a child are the papillary tumours, while among malignancies the most frequently observed are the lymphomas (Hodgkin and non Hodgkin), sarcomas and cancer of nasopharynx. The main symptoms of upper respiratory tract obstruction by neoplasms are sustained difficulty in nasal breathing, mucopurulent rhinorrhoea, persistent cough, hearing loss, recurrent episodes of otitis and sinusitis. The mediastinum represents the site of the lower respiratory tract most commonly affected by childhood neoplasms, in contrast to the pleural wall, pulmonary parenchyma, bronchi and bronchioles, which are rarely affected in childhood. Mediastinal masses, primary or metastatic, benign or malignant, manifest themselves in a variety of ways, including signs and symptoms which are either nonspecific or secondary to compression or displacement of the adjacent mediastinal structures. Treatment may include surgical removal, in combination with chemotherapy and radiotherapy, when indicated. The diagnostic alertness of paediatricians in recognizing malignant disease possibly masked by common symptoms of children, and prompt referral to a specialist may improve significantly the prognosis of these malignancies. Key words Dyspnoea, childhood, neoplasms, upper respiratory tract, lower respiratory tract.
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∆Ô ÛÔ‚·Úfi Ô͇ ·Ó·Ó¢ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ÛÙ· ·È‰È¿ Ã. ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË, µ. ™Ô‡ÏÔ˘
¶ÂÚ›ÏË„Ë ∆Ô ÛÔ‚·Úfi Ô͇ ·Ó·Ó¢ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ (SARS) Â›Ó·È Ó¤· ÏÔÈÌ҉˘ ÓfiÛÔ˜ Ì ˘„ËÏ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ·. OÊ›ÏÂÙ·È Û ¤Ó·Ó Ó¤Ô Corona Èfi, ÙÔÓ SARS-CoV, Ô˘ ·ÔÌÔÓÒıËΠ·fi Ù· ÂÎÎڛ̷ٷ ·ÛıÂÓÒÓ Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ÔÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ Ïԛ̈͢ ÛÙ· ·È‰È¿, Ù· ÂÚÁ·ÛÙËÚȷο Î·È ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È ÙÔ ıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÓfiÛÔ˘. ∆· Û˘¯ÓfiÙÂÚ· Û˘ÌÙÒÌ·Ù· ηٿ ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ÛÙ· ÌÈÎÚfiÙÂÚ· ·È‰È¿ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÚÂÙfi, ‚‹¯· Î·È Î·Ù·ÚÚÔ‹, ÂÓÒ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Û˘Ó˘¿Ú¯Ô˘Ó ηÎÔ˘¯›·, Ú›ÁË Î·È Ì˘·ÏÁ›Â˜. ∆Ô Û˘¯ÓfiÙÂÚÔ ·ÎÙÈÓÔÏÔÁÈÎfi ‡ÚËÌ· Â›Ó·È Ë ÂÙÂÚfiÏ¢ÚË ÂÛÙȷ΋ ‹ ÔÏ˘ÂÛÙȷ΋ ‡ÎÓˆÛË. ∏ ÓfiÛÔ˜ ÂÍÂÏ›ÛÛÂÙ·È ËÈfiÙÂÚ· Î·È ¤¯ÂÈ Û˘ÓÙÔÌfiÙÂÚË ‰È¿ÚÎÂÈ· ÛÙ· ·È‰È¿, Ù· ÔÔ›· - Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ - Û¿ÓÈ· ·Ó·Ù‡ÛÛÔ˘Ó Û‡Ó‰ÚÔÌÔ ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜. ∏ ‰È¿ÁÓˆÛË Á›ÓÂÙ·È Ì ÔÚÔÏÔÁÈΤ˜ Î·È ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· Î·È ÈÛÙÔÚÈÎfi ·ʋ˜ Ì ¿Û¯ÔÓÙ· ÂÓ‹ÏÈη ‹ ›Û΄˘ Û ÂÓ‰ËÌÈ΋ ÂÚÈÔ¯‹. ∏ ıÂڷ¢ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË Û˘Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË ÚÈÌ·‚ÈÚ›Ó˘, ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ Î·È ·ÓÙÈÌÈÎÚԂȷ΋˜ ıÂڷ›·˜.
∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ÃÚ˘ÛԇϷ ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË ∞ıËÓ¿˜ 5, ∆.∫. 713 06 ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘ ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 05-03-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 15-02-2005
§¤ÍÂȘ ÎÏÂȉȿ ™Ô‚·Úfi Ô͇ ·Ó·Ó¢ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ, SARS, ·È‰È¿, Corona Èfi˜, Û˘ÌÙÒÌ·Ù·, ıÂڷ›·.
™˘ÓÙÔÌÔÁڷʛ˜ SARS SARS-CoV ¶OÀ ALT LDH CPK
Severe acute respiratory syndrome Corona Èfi˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ SARS ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ ∞Ï·Ó›ÓË ·ÌÈÓÔÙÚ·ÓÛÊÂÚ¿ÛË °·Ï·ÎÙÈ΋ ‰Â¸‰ÚÔÁÂÓ¿ÛË ∫Ú·ٛÓË ÊˆÛÊÔÎÈÓ¿ÛË
™Ô‚·Úfi Ô͇ ·Ó·Ó¢ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ ÛÙ· ·È‰È¿ ∆Ô ÛÔ‚·Úfi Ô͇ ·Ó·Ó¢ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ (Severe acute respiratory syndrome - SARS) Â›Ó·È Ó¤· ÏÔÈÌ҉˘ ÓfiÛÔ˜ Ô˘ ÂÌÊ·Ó›ÛÙËΠÛÙ· Ù¤ÏË ÙÔ˘ 2002 Î·È ÚÔοÏÂÛ ·ÁÎfiÛÌÈÔ ÂӉȷʤÚÔÓ ÏfiÁˆ Ù˘ ·Û˘Ó‹ıÈÛÙ· ˘„ËÏ‹˜ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ·ÚÔ˘Û›·˙ ·ÏÏ¿ Î·È Ù˘ Ù·¯‡Ù·Ù˘ ÂͿψۋ˜ Ù˘. ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ηٷÁÚ·Ê› 8422 Èı·Ó¿ ÎÚÔ‡ÛÌ·Ù· Î·È 916 ı¿Ó·ÙÔÈ Û 29 ¯ÒÚ˜ (1). OÈ ÚÒÙÔÈ ·ÛıÂÓ›˜ Ì SARS ÂÌÊ·Ó›ÛÙËÎ·Ó ÙÔÓ ¡Ô¤Ì‚ÚÈÔ ÙÔ˘ 2002, ÛÙËÓ Â·Ú¯›· Guandgong Ù˘ ∫›Ó·˜, ÌÂ Û˘ÌÙÒÌ·Ù· ÂȉÂÈÓÔ‡ÌÂÓ˘ Ïԛ̈͢ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Ô˘ η٤ÏËÍ Û ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· Î·È ı¿Ó·ÙÔ.
∆ÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2003 ·Ó·Ê¤ÚıËÎ·Ó ·ÚfiÌÔÈ· ÂÚÈÛÙ·ÙÈο ÛÙÔ Hong Kong, ÙÔ ∆ÔÚfiÓÙÔ, ÙÔ µÈÂÙÓ¿Ì Î·È ÙË ™ÈÁηԇÚË, Ì ·ÔÙ¤ÏÂÛÌ· Ë ¶·ÁÎfiÛÌÈ· OÚÁ¿ÓˆÛË ÀÁ›·˜ (¶OÀ) Ó· ÛËÌ¿ÓÂÈ ·ÁÎfiÛÌÈÔ Û˘Ó·ÁÂÚÌfi ÛÙÔ˘˜ ÎÚ·ÙÈÎÔ‡˜ ÊÔÚ›˜ Î·È ÙȘ ˘ËÚÂۛ˜ ˘Á›·˜, Ì ÛÎÔfi ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÂȉËÌ›·˜. ∆·˘Ùfi¯ÚÔÓ· ÍÂΛÓËÛ·Ó Î·È ÔÈ ÚÔÛ¿ıÂȘ Ù·˘ÙÔÔ›ËÛ˘ ÙÔ˘ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ·. ∞˘Ù‹ Ë ·ÁÎfiÛÌÈ· Û˘ÓÂÚÁ·Û›· ›¯Â ÂÓÙ˘ˆÛȷο ·ÔÙÂϤÛÌ·Ù· Î·È Ì¤Û· Û ‰È¿ÛÙËÌ· 3 ÌËÓÒÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÂȉËÌ›·˜ ·ÔÌÔÓÒıËÎÂ Ô Èfi˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ SARS (SARS-CoV) ÛÙËÓ Î˘ÙÙ·ÚÈ΋ ÛÂÈÚ¿ Vero E6, ÛÙËÓ ÔÔ›· ›¯·Ó ÂÓÔÊı·ÏÌ›ÛÂÈ ‰Â›ÁÌ·Ù· ·fi ·›Ì·, ÚÈÓÔÊ·Ú˘ÁÁÈο ÂÎÎڛ̷ٷ Î·È Âί˘Ï›ÛÌ·Ù· ÈÛÙÒÓ ·fi ·ÛıÂÓ›˜ Ì ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ (2). ∏ ·Ó¿Ï˘ÛË ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÙÔ˘ ÈÔ‡ ¤‰ÂÈÍ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ¤Ó·Ó Ó¤Ô Corona Èfi, ÌÂÁ¤ıÔ˘˜ 27-30 Kd (3,4). O SARS-CoV Â›Ó·È RNA Èfi˜ Ì ÛÙ·ıÂÚ‹ ‰ÔÌ‹ Î·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÌÔÚÊÔÏÔÁ›· Ô˘ ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÌÔÈ¿˙ÂÈ Ì ÎÔÚÒÓ· Î·È ‰ÂÓ ·Ó‹ÎÂÈ ÛÙȘ ÁÓˆÛÙ¤˜ ̤¯ÚÈ Û‹ÌÂÚ· ÔÌ¿‰Â˜ (π-πππ) ÙˆÓ Corona ÈÒÓ (∂ÈÎfiÓ· 1). ™ÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘ ʤÚÂÈ ÙË ÁÏ˘ÎÔÚˆÙ½ÓË S, Ë ÔÔ›· ¶·È‰È·ÙÚÈ΋ 2005;68:199-202
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·200
200
Ã. ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË Î·È Û˘Ó.
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∂ÈÎfiÓ· 1. ∏ ‰ÔÌ‹ ÙÔ˘ ÈÔ‡ SARS-CoV, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ (·Ó··Ú·ÁˆÁ‹ ·fi: N Engl J Med 2003 May 15).
Û˘Ó‰¤ÂÙ·È Ì ˘Ô‰Ô¯Â›˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ ÙÔ˘ ÍÂÓÈÛÙ‹, ÂÈÙÚ¤ÔÓÙ·˜ ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ÈÔ‡ ÛÙÔ Î‡ÙÙ·ÚÔ. ¶ÈÛÙ‡ÂÙ·È fiÙÈ ·¤ÎÙËÛ ÚfiÛÊ·Ù· ÙËÓ ÈηÓfiÙËÙ· Ó· ÌÔχÓÂÈ ÙÔÓ ¿ÓıÚˆÔ, ·ÊÔ‡ ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ ‰ÂÓ ¤¯Ô˘Ó ·ÓȯÓ¢ı› Û ·ÓıÚÒÈÓÔ˘˜ ÔÚÔ‡˜ ÚÈÓ ·fi ÙËÓ ÚfiÛÊ·ÙË ÂȉËÌ›· (5). ªÂÙ·‰›‰ÂÙ·È Î˘Ú›ˆ˜ Ì ÛÙ·ÁÔÓ›‰È· ̤ۈ ¿ÌÂÛ˘ ·ʋ˜ Ì ·ÛıÂÓ‹, Â›Ó·È fï˜ Èı·Ófi Ó· ÌÂÙ·‰›‰ÂÙ·È Î·È ·ÂÚÔÁÂÓÒ˜ (Ì ÛÙ·ÁÔÓ›‰È· <10 Ìm). ∏ ·ÔÌfiÓˆÛË ÙÔ˘ ÈÔ‡ ¿ÓÔÈÍ ÙÔÓ ‰ÚfiÌÔ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÌÔÚÈ·ÎÒÓ Î·È ÔÚÔÏÔÁÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ ÁÈ· ÙËÓ Ù·˘ÙÔÔ›ËÛË Ù˘ Ïԛ̈͢ Û ‡ÔÙ· ÎÚÔ‡ÛÌ·Ù·. ∆·˘Ùfi¯ÚÔÓ·, ÂÚÈÁÚ¿ÊËÎÂ Ë ÎÏÈÓÈ΋ ÔÚ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û ÂÓ‹ÏÈΘ (6,7) Î·È ·È‰È¿ (8-10), ·Ó·Ù‡¯ıËΠÙÔ ıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ·ÓÙÈÌÂÙÒÈÛ˘ Ù˘ ÓfiÛÔ˘ Î·È Ù¤ıËÎ·Ó ÔÈ ‚¿ÛÂȘ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÌ‚ÔÏ›Ô˘.
ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ ÂÌÊ·Ó›˙ÂÙ·È ˘ÚÂÙfi˜ Ô˘ ÛÙȘ ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘ Û˘Óԉ‡ÂÙ·È ·fi ‚‹¯· Î·È Î·Ù·ÚÚÔ‹, ÂÓÒ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ ·fi ηÎÔ˘¯›·, Ú›ÁË Î·È Ì˘·ÏÁ›Â˜ (¶›Ó·Î·˜ 1). ∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÚÒÙ˘ ‚‰ÔÌ¿‰·˜ ·Ô‰›‰ÔÓÙ·È ÛÙÔ ˘„ËÏfi ÈÈÎfi ÊÔÚÙ›Ô Î·È Û˘Ó‹ıˆ˜ ˘Ô¯ˆÚÔ‡Ó Û ϛÁ˜ Ë̤Ú˜. ∆ËÓ ·ÚÔ‰È΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·ÎÔÏÔ˘ı› Ó¤· Âȉ›ӈÛË, Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔ‹ ÙÔ˘ ˘ÚÂÙÔ‡, ÂÌÊ¿ÓÈÛË ‰È¿ÚÚÔÈ·˜ Î·È ·Ú¯fiÌÂÓË ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·. ∂Âȉ‹ Ë ÎÏÈÓÈ΋ Âȉ›ӈÛË Ô˘ Û˘Ì‚·›ÓÂÈ ÌÂٷ͇ Ù˘ 7˘ Î·È 10˘ Ë̤ڷ˜, Û˘Ì›ÙÂÈ ¯ÚÔÓÈο Ì ÙËÓ ÙÒÛË ÙÔ˘ ÈÈÎÔ‡ ÊÔÚÙ›Ô˘, ·Ô‰›‰ÂÙ·È ÛÙȘ ÊÏÂÁÌÔÓÒ‰ÂȘ ·ÏÏÔÈÒÛÂȘ Ô˘ ÚÔηÏ› Ë ·ÓÔÛÔÏÔÁÈ΋ ·¿ÓÙËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·. ™‡Ìʈӷ Ì ̛· ÌÂϤÙË, ÌfiÓÔ 2 ·fi Ù· 21 (9,5%) ·È‰È¿ Ô˘ ÓfiÛËÛ·Ó, ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 10 ÂÙÒÓ, ÂÌÊ¿ÓÈÛ·Ó Ô͇ Û‡Ó‰ÚÔÌÔ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ¯ÚÂÈ¿ÛÙËÎ·Ó Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, ÂÓÒ ‰ÂÓ ¤¯ÂÈ Î·Ù·ÁÚ·Ê› ηӤӷ˜ ı¿Ó·ÙÔ˜ ̤¯ÚÈ Û‹ÌÂÚ· (9). ∞ÓÙ›ıÂÙ·, ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÓËÏ›ÎˆÓ ·ÛıÂÓÒÓ Ô˘ ¯ÚÂÈ¿ÛÙËÎ·Ó Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË ·Ó‹Ïı ÛÙÔ 20% Î·È Ë ıÓËÙfiÙËÙ· Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘, fiˆ˜ ÔÈ ËÏÈÎȈ̤ÓÔÈ, ÔÈ ·ÛıÂÓ›˜ Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË Î·È ÔÈ ÊÔÚ›˜ Ù˘ Ë·Ù›Ùȉ·˜ µ, ÛÙÔ 15% (7).
∂ÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ™Ù· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ· ÛÙ· ·È‰È¿ ‹Ù·Ó Ë ÏÂÌÊÔÂÓ›· (57,1%), ÂÓÒ Û˘Ó˘‹Ú¯Â ηÈ
¶›Ó·Î·˜ 1. ∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙÔ˘ ÛÔ‚·ÚÔ‡ ÔͤԘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·È‰È¿ ™‡Ìو̷
∆Ô SARS ÛÙ· ·È‰È¿ ∂Í‹ÓÙ· ‰‡Ô Û˘ÓÔÏÈο Èı·Ó¿ ‹ ‡ÔÙ· ÂÚÈÛÙ·ÙÈο Û ·È‰È¿ ËÏÈΛ·˜ 5,5 ÌËÓÒÓ ¤ˆ˜ 17 ÂÙÒÓ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ̤¯ÚÈ Û‹ÌÂÚ·. ¶·Ú¿ ÙÔÓ ÂÚÈÔÚÈṲ̂ÓÔ Û¯ÂÙÈο ·ÚÈıÌfi ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÛÙÔ˘˜ ·È‰È·ÙÚÈÎÔ‡˜ ÏËı˘ÛÌÔ‡˜ Â›Ó·È Û·Ê¤˜ fiÙÈ Û ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 12 ÂÙÒÓ Ë ÓfiÛÔ˜ ÂÍÂÏ›ÛÛÂÙ·È ËÈfiÙÂÚ· Î·È ¤¯ÂÈ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∏ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· ‰È·ÚΛ 2-3 ‚‰ÔÌ¿‰Â˜. ªÂÙ¿ ·fi ÂÒ·ÛË 2-10 ËÌÂÚÒÓ, ¶·È‰È·ÙÚÈ΋ 2005;68:199-202
¶ÔÛÔÛÙfi (%)*
¶˘ÚÂÙfi˜ ∫·ÎÔ˘¯›· ∞ÓÔÚÂÍ›· ƒ›ÁÔ˜ µ‹¯·˜ ¡·˘Ù›· ƒÈÓfiÚÚÔÈ· ∞fi¯ÚÂÌ„Ë ¢‡ÛÓÔÈ·/Ù·¯‡ÓÔÈ· ∫ÂÊ·Ï·ÏÁ›· ª˘·ÏÁ›Â˜ ¢È¿ÚÚÔÈ· ∫˘Ó¿Á¯Ë ∂Í¿ÓıËÌ· * ™Â Û‡ÓÔÏÔ 21 ·È‰È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ (9)
90,5 61,9 57,1 47,6 42,9 38,1 33,3 14,3 14,3 14,3 9,5 9,5 4,8 4,8
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·201
201
∆Ô SARS ÛÙ· ·È‰È¿
ıÚÔÌ‚ÔÂÓ›· Û ÔÛÔÛÙfi 23,8% (9). ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ (11), Ô ·ÚÈıÌfi˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È Ë ·ÈÌÔÛÊ·ÈÚ›ÓË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ™ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘, ÙÔ 90,5% ÙˆÓ ·È‰ÈÒÓ ÂÌÊ¿ÓÈÛ ÏÂÌÊÔÂÓ›·, ÂÓÒ ‹È· ıÚÔÌ‚ÔÂÓ›· ÂΉËÏÒıËΠÙÂÏÈο ÛÙ· ÌÈÛ¿ ÂÚ›Ô˘ ·È‰È¿. ¶·Ú¿Ù·ÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÂÓÂÚÁÔÔÈË̤Ó˘ ÌÂÚÈ΋˜ ıÚÔÌ‚ÔÏ·ÛÙ›Ó˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÍ›·˜ Ê¿Û˘ Ù˘ ÓfiÛÔ˘ ·Ó·Ê¤ÚıËΠ۠ÔÛÔÛÙfi 28,6% ÙˆÓ ·È‰ÈÒÓ. ∞˘ÍË̤ӷ ›‰· LDH Î·È CPK, ηıÒ˜ Î·È ‹È· ·‡ÍËÛË Ù˘ ALT ̤¯ÚÈ ÙÚÈÏ·ÛÈ·ÛÌÔ‡ ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ÙÈÌÒÓ ·Ú·ÙËÚ‹ıËÎ·Ó Û ·È‰È¿ Ì SARS Û ÔÛÔÛÙ¿ 71,4%, 42,9% Î·È 23,8%, ·ÓÙ›ÛÙÔȯ·. ∏ÏÂÎÙÚÔÏ˘ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ΢ڛˆ˜ ˘ÔÓ·ÙÚÈ·ÈÌ›· Î·È ˘ÔηÏÈ·ÈÌ›·, Û˘Ó˘‹Ú¯·Ó Û ÔÛÔÛÙfi 20-25%. ∏ ÂÚÁ·ÛÙËÚȷ΋ ÂȂ‚·›ˆÛË Ù˘ ‰È¿ÁÓˆÛ˘ Á›ÓÂÙ·È Ì ÔÚÔÏÔÁÈΤ˜ Î·È ÌÔÚȷΤ˜ ÌÂıfi‰Ô˘˜, ·ÏÏ¿ Î·È Ì ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ÈÔ‡ Û ‚ÈÔÏÔÁÈο ‰Â›ÁÌ·Ù· ·fi ‡ÔÙ· ÎÚÔ‡ÛÌ·Ù· (12). ∏ ·Ï˘ÛȉˆÙ‹ ·ÓÙ›‰Ú·ÛË ÔÏ˘ÌÂÚ¿Û˘ ·ÓȯÓ‡ÂÈ ÙÔ RNA ÙÔ˘ ÈÔ‡ ÛÙÔ ·›Ì· Î·È Û ÂÎÎڛ̷ٷ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÙˆÓ ‡ÔÙˆÓ ·ÛıÂÓÒÓ ÙȘ ÚÒÙ˜ 10 Ë̤Ú˜ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ˘ÚÂÙÔ‡. ªÂ ÙȘ ÔÚÔÏÔÁÈΤ˜ ÌÂıfi‰Ô˘˜ (·ÓÔÛÔÂÓ˙˘ÌÈ΋ ̤ıÔ‰Ô˜ Î·È ¤ÌÌÂÛÔ˜ ·ÓÔÛÔÊıÔÚÈÛÌfi˜) ·ÓȯÓ‡ÔÓÙ·È ·ÓÙÈÛÒÌ·Ù· ηٿ ÙÔ˘ ÈÔ‡ ÌÂÙ¿ ÙË 14Ë Ë̤ڷ. ŒÓ· ıÂÙÈÎfi ÔÚÔÏÔÁÈÎfi ·ÔÙ¤ÏÂÛÌ· ÂÚÌËÓ‡ÂÙ·È ˆ˜ ¤Ó‰ÂÈÍË ÚÔËÁËı›۷˜ Ïԛ̈͢ Ì SARS-CoV, ÂÓÒ ÔÚÈÛÙÈο ·ÚÓËÙÈÎfi ıˆÚÂ›Ù·È ÙÔ ·ÔÙ¤ÏÂÛÌ· fiÙ·Ó ‰ÂÓ ·ÓȯÓ‡ÔÓÙ·È ·ÓÙÈÛÒÌ·Ù· ÌÂÙ¿ ÙËÓ 21Ë Ë̤ڷ ·fi ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ‚Ú›ÛÎÔÓÙ·È Û ÛÙ¿‰ÈÔ ÂͤÏÈ͢ Î·È ·ÍÈÔÏfiÁËÛ˘ Î·È - Û‡Ìʈӷ Ì ÙȘ ˘Ô‰Â›ÍÂȘ Ù˘ ¶OÀ - Ù· ·ÔÙÂϤÛÌ·Ù· ı· Ú¤ÂÈ Ó· Û˘ÓÂÎÙÈÌÒÓÙ·È Ì ٷ ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù·, ηıÒ˜ Î·È Ì ÙÔ ÈÛÙÔÚÈÎfi ÚfiÛÊ·Ù˘ ·ʋ˜ Ì ÂÓ‹ÏÈη Ì SARS ‹ Ù·ÍȉÈÔ‡ Û ÂÓ‰ËÌÈ΋ ÂÚÈÔ¯‹.
∞ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∆· ·Ú¯Èο ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· Û ·È‰È¿ Ì SARS Â›Ó·È ÌË ÂȉÈο, ÁÂÁÔÓfi˜ Ô˘ οÓÂÈ ‰˘Û¯ÂÚ‹ ÙËÓ ·ÎÙÈÓÔÏÔÁÈ΋ ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË. ™Â ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ Ô˘ Û ÔÛÔÛÙfi 71-78% ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‡ÎÓˆÛË Ì ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘Ìو̿وÓ, ÛÙ· ·È‰È¿ ‹Ù·Ó ÂÌÊ·Ó›˜ Ó¢ÌÔÓÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ηٿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÌfiÓÔ Û 47,6% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (9).
™ÙȘ ıÂÙÈΤ˜ ·ÎÙÈÓÔÁڷʛ˜, ÚÔÛ‚ÔÏ‹ ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ ÛÙËÓ ÂÚÈʤÚÂÈ· Î·È ÙÔ Û˘¯ÓfiÙÂÚÔ Â‡ÚËÌ· Â›Ó·È Ë ÂÙÂÚfiÏ¢ÚË ÂÛÙȷ΋ ‹ ÔÏ˘ÂÛÙȷ΋ ‡ÎÓˆÛË Û ÔÛÔÛÙfi 9,5-22,6%. ™Â Ôχ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi (4,8%) Ë ‡ÎÓˆÛË ‹Ù·Ó ·ÌÊÔÙÂÚfiÏ¢ÚË. ¶·Ú’ fiÏ· ·˘Ù¿, fiÏÔÈ ÔÈ ·È‰È·ÙÚÈÎÔ› ·ÛıÂÓ›˜ ÂÌÊ¿ÓÈÛ·Ó ·ıÔÏÔÁÈο ·ÎÙÈÓÔÏÔÁÈο Â˘Ú‹Ì·Ù· ηٿ ÙËÓ ÔÚ›· Ù˘ ÓfiÛÔ˘. ∏ Âȉ›ӈÛË Ù˘ ·ÎÙÈÓÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜ ÂÚÈÂÏ¿Ì‚·Ó ¤ÎÙ·ÛË Ù˘ ‚Ï¿‚˘ Ì ÂÌÊ¿ÓÈÛË ÁÂÈÙÔÓÈÎÒÓ Ó¢ÌÔÓÈÎÒÓ ÂÛÙÈÒÓ ‹ ·ÌÊÔÙÂÚfiÏ¢ÚË Î·Ù·ÓÔÌ‹. ¶Ï¢ÚÈÙÈ΋ Û˘ÏÏÔÁ‹ ˘ÁÚÔ‡ ‹Ù·Ó ·Û˘Ó‹ı˘ Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó ‰È¿ÌÂÛ˜ Ó¢ÌÔÓÈΤ˜ ‰ÈËı‹ÛÂȘ. ™ÙË Ê¿ÛË ·˘Ù‹, ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‰È·ÁÓˆÛÙÈÎfi ‡ÚËÌ· ÛÙËÓ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‹Ù·Ó Ë ÂÈÎfiÓ· ÛΛ·Û˘ Ì ÙË ÌÔÚÊ‹ ÙÚÈÌ̤ÓÔ˘ Á˘·ÏÈÔ‡ ÛÙËÓ ÂÚÈʤÚÂÈ· ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ·ÚÔ˘Û›·˙ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi Ù· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ÓfiÛÔ˘, ·ÎfiÌ· Î·È fiÙ·Ó Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ (13).
£Âڷ›· ∆Ô ÚÔÙÂÈÓfiÌÂÓÔ ıÂڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ·È‰ÈÒÓ Ì ‡ÔÙÔ ‹ Èı·Ófi SARS, ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÚÈÌ·‚ÈÚ›Ó˘ Ì ÛÎÔfi ÙËÓ ·Ó·ÛÙÔÏ‹ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘ ÈÔ‡. ∆· ÎÔÚÙÈÎÔÂȉ‹ ¯ÔÚËÁÔ‡ÓÙ·È Û ÂÚÈÙÒÛÂȘ ÂÎÙÂٷ̤Ó˘ ÂÙÂÚfiÏ¢Ú˘ ‹ ·ÌÊÔÙÂÚfiÏ¢Ú˘ Ó¢ÌÔÓÈ΋˜ Û˘ÌÌÂÙÔ¯‹˜, Û ÂÈ̤ÓÔÓÙ· ˘„ËÏfi ˘ÚÂÙfi, ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· ‹ ·ÎÙÈÓÔÏÔÁÈο Î·È ÂÚÁ·ÛÙËÚȷο ÛËÌ›· Âȉ›ӈÛ˘. ∆·˘Ùfi¯ÚÔÓ· ¯ÔÚËÁÔ‡ÓÙ·È Î·È ·ÓÙÈ‚ÈÔÙÈο ÁÈ· ÙË ‰˘ÓËÙÈ΋ Î¿Ï˘„Ë ·fi ¿ÏÏ· ÌÈÎÚԂȷο ·›ÙÈ· Ó¢ÌÔÓ›·˜. ™Â ÂÚÈÙÒÛÂȘ ·Ó¿Ù˘Í˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜, Á›ÓÂÙ·È Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ (¶›Ó·Î·˜ 2). ∏ Û˘ÓÔÏÈ΋ ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 2-4 ‚‰ÔÌ¿‰ˆÓ (14). §fiÁˆ Ù˘ ÌÂÙ·‰ÔÙÈÎfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ÔÈ ·ÛıÂÓ›˜ Ú¤ÂÈ Ó· ÓÔÛËχÔÓÙ·È Û ı·Ï¿ÌÔ˘˜ ·˘ÍË̤Ó˘ ·ÛÊ¿ÏÂÈ·˜, fiˆ˜ ÔÈ ı¿Ï·ÌÔÈ ·ÚÓËÙÈ΋˜ ›ÂÛ˘. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi, Û ÙÌ‹Ì·Ù· ÌÂÁ¿ÏˆÓ ÓÔÛËÏ¢ÙÈÎÒÓ ÌÔÓ¿‰ˆÓ ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› ηٿÏÏËϘ ˘Ô‰Ô̤˜ ÁÈ· ÙË ÓÔÛËÏ›· Èı·ÓÒÓ ‹ ‡ÔÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ. °È· ·È‰È·ÙÚÈÎÔ‡˜ ·ÛıÂÓ›˜, ı¿Ï·ÌÔÈ ·ÚÓËÙÈ΋˜ ›ÂÛ˘ ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”. OÈ ÁÓÒÛÂȘ ÁÈ· ÙÔ SARS ·ÔÎÙ‹ıËÎ·Ó Û ¶·È‰È·ÙÚÈ΋ 2005;68:199-202
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·202
202
Ã. ¶ÂÚ‰ÈÎÔÁÈ¿ÓÓË Î·È Û˘Ó.
¶›Ó·Î·˜ 2. £Âڷ¢ÙÈÎfi ÚˆÙfiÎÔÏÏÔ ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ÛÔ‚·ÚÔ‡ ÔͤԘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÛÙ· ·È‰È¿ ∞ÓÙÈÌÈÎÚԂȷ΋ ıÂڷ›· ∫Ï·ÚÈıÚÔÌ˘Î›ÓË Î·È ·ÌÔ͢ÎÈÏÏ›ÓË-ÎÏ·‚Ô˘Ï·ÓÈÎfi Ô͇ / ∫ÂÊÔÙ·Í›ÌË ƒÈÌ·‚ÈÚ›ÓË Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ƒÈÌ·‚ÈÚ›ÓË (10-14 Ë̤Ú˜) 40 mg/kg ËÌÂÚËÛ›ˆ˜ per os Û 2 ‹ 3 ‰fiÛÂȘ ‹ 20 mg/kg ËÌÂÚËÛ›ˆ˜ i.v. Û 3 ‰fiÛÂȘ ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ (15-30 Ë̤Ú˜) ¶Ú‰ÓÈ˙ÔÏfiÓË 0,5-2 mg/kg ËÌÂÚËÛ›ˆ˜ per os ‹ À‰ÚÔÎÔÚÙÈ˙fiÓË 2 mg/kg οı 6 ÒÚ˜ i.v.
™Â Âȉ›ӈÛË Ù˘ ÎÏÈÓÈ΋˜ Î·È ·ÎÙÈÓÔÏÔÁÈ΋˜ ÂÈÎfiÓ·˜ ªÂı˘ÏÚ‰ÓÈ˙ÔÏfiÓË 10-20 mg/kg i.v. ÂÌ‚fiÏÈÌË ªË¯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜
ÂÓÙ˘ˆÛȷο Û‡ÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Î·È Â›¯·Ó Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙË ‰È·ÎÔ‹ Ù˘ ÂȉËÌ›·˜ ÙÔÓ πÔ‡ÏÈÔ ÙÔ˘ 2003. ¶·Ú’ fiÏ· ·˘Ù¿, ÔÏÏ¿ ÂÚˆÙËÌ·ÙÈο ̤ÓÔ˘Ó ·Ó·¿ÓÙËÙ· Û¯ÂÙÈο Ì ÙȘ ‰È·ÊÔÚ¤˜ Ô˘ Ê·›ÓÂÙ·È Ó· ˘¿Ú¯Ô˘Ó ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ·ÏÏ¿ Î·È ÛÙËÓ ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ Û ÂÓ‹ÏÈΘ Î·È ·È‰È¿. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ ÁÓˆÛÙfi ÁÈ·Ù› Ù· ·È‰È¿ ÚÔÛ‚¿ÏÏÔÓÙ·È Û·ÓÈfiÙÂÚ·, ‰ÂÓ ÌÂÙ·‰›‰Ô˘Ó ÙË ÓfiÛÔ Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ËÈfiÙÂÚË ÎÏÈÓÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∏ ÏÂÙÔÌÂÚ¤ÛÙÂÚË ÁÓÒÛË ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÓfiÛÔ˘, ÙÔ˘ ÙÚfiÔ˘ ÌÂÙ¿‰ÔÛ˘ Î·È Ù˘ ‡·Ú͢ Âԯȷ΋˜ ηٷÓÔÌ‹˜ Î·È ·Û˘Ìو̷ÙÈÎÒÓ ÊÔÚ¤ˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ‰ÈÂÚ‡ÓËÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ ÙÔ˘ ÍÂÓÈÛÙ‹, ı· ‚ÔËı‹ÛÔ˘Ó ÛÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ‰È·ÛÔÚ¿˜ Î·È ÛÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÈÔ‡, ÂÓÒ Â›Ó·È Èı·Ófi Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ·ÔÙÂÏÂÛÌ·ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ (15). ∂›Ó·È ‚¤‚·ÈÔ fiÙÈ Ë ¤ÁηÈÚË ·Ó·Î¿Ï˘„Ë ÙˆÓ Ì˘ÛÙÈÎÒÓ ÙÔ˘ ÈÔ‡ ÌÔÚ› Ó· ÂÌÓ‡ÛÂÈ ·ÈÛÈÔ‰ÔÍ›· ÁÈ· ÙËÓ ÂÈÙ˘¯‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ïԛ̈͢, ÙfiÛÔ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ fiÛÔ Î·È ÛÙ· ·È‰È¿.
∂˘¯·ÚÈÛٛ˜ ∂˘¯·ÚÈÛÙԇ̠ÙËÓ ∞Ó·ÏËÚÒÙÚÈ· ∫·ıËÁ‹ÙÚÈ· ¶·È‰È·ÙÚÈ΋˜ ª·Ú›· £ÂÔ‰ˆÚ›‰Ô˘ ÁÈ· ÙȘ ÔχÙÈ̘ ÂÈÛËÌ¿ÓÛÂȘ Ù˘ ηٿ ÙË Û˘ÁÁÚ·Ê‹ ·˘ÙÔ‡ ÙÔ˘ ¿ÚıÚÔ˘.
µÈ‚ÏÈÔÁÚ·Ê›· 1. World Health Organization Department of Communicable Disease Surveillance and Response: ¶·È‰È·ÙÚÈ΋ 2005;68:199-202
Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). Webpage: http://www.who.int/csr/sars/en/WHOconsensus.pdf 2. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348:1953-1966. 3. Marra MA, Jones SJ, Astell CR, Holt RA, BrooksWilson A, Butterfield YS et al. The Genome sequence of the SARS-associated coronavirus. Science 2003;300:1399-1404. 4. Ruan YJ, Wei CL, Ee AL, Vega VB, Thoreau H, Su ST et al. Comparative full-length genome sequence analysis of 14 SARS coronavirus isolates and common mutations associated with putative origins of infection. Lancet 2003;361:1779-1785. 5. Holmes KV. SARS-associated coronavirus. N Engl J Med 2003;348:1948-1951. 6. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348: 1986-1994. 7. Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet 2003; 361:1767-1772. 8. Hon KL, Leung CW, Cheng WT, Chan PK, Chu WC, Kwan YW et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 2003;361:1701-1703. 9. Chiu WK, Cheung PC, Ng KL, Ip PL, Sugunan VK, Luk DC et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med 2003;4:279-283. 10. Bitnun A, Allen U, Heurter H, King SM, Opavsky MA, Ford-Jones EL et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics 2003;112:e261. 11. Wong RS, Wu A, To KF, Lee N, Lam CW, Wong CK et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ 2003;326:1358-1362. 12. Preiser W, Drosten C. Diagnostic tests. In: Kamps BS, Hoffmann C, editors. SARS Reference. 3rd ed.; 2003. Webpage: http://www.sarsreference.com/ sarsref/tests.htm 13. Babyn PS, Chu WC, Tsou IY, Wansaicheong GK, Allen U, Bitnun A et al. Severe Acute Respiratory Syndrome (SARS): chest radiographic features in children. Pediatr Radiol 2004;34:47-58. 14. So LK, Lau AC, Yam LY, Cheung TM, Poon E, Yung RW et al. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet 2003;361:1615-1617. 15.Gao W, Tamin A, Soloff A, D’Aiuto L, Nwanegbo E, Robbins PD et al. Effects of a SARS-associated coronavirus vaccine in monkeys. Lancet 2003;362:1895-1896.
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Severe acute respiratory syndrome in children C. Perdikogianni, V. Spoulou
Abstract Severe acute respiratory syndrome (SARS) is an emerging infection caused by a newly identified Corona virus (SARS-CoV). In this paper, the clinical presentation, laboratory findings and treatment of paediatric SARS are discussed. Clinical manifestations of the infection in young children include fever, cough and rhinorrhoea, while in adolescents chills and myalgia are also common. The radiological findings include unilateral or bilateral lung opacities. The course of the disease is shorter and milder in children than in adolescents who, in contrast to adults, do not usually develop acute respiratory distress syndrome. The diagnosis is confirmed by specific serological and molecular tests, in combination with clinical criteria and a history of contact with adults with SARS or travel to endemic areas. Treatment includes the use of ribavirin in combination with corticosteroids and antimicrobial agents.
1st Paediatric Clinic of the University of Athens, “Aghia Sophia” Children’s Hospital, Athens Correspondence: Chrissoula Perdikogianni 5 Athinas str., 713 06, Heraklion, Crete Date of submission: 05-03-2004 Date of approval: 15-02-2005
Key words Severe acute respiratory syndrome, SARS, children, Corona virus, diagnosis, treatment.
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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞
∂›Â‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ ‹ ˘ÂÚÏÈȉ·ÈÌ›·˜ 1 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., £ÂÛÛ·ÏÔÓ›ÎË 2 ∂͈ÙÂÚÈÎfi π·ÙÚÂ›Ô ¶ÚfiÏ˄˘ ∫·Ú‰È·ÁÁÂÈ·ÎÒÓ ¡ÔÛËÌ¿ÙˆÓ, µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ∞Ã∂¶∞, £ÂÛÛ·ÏÔÓ›ÎË 3 ¶·È‰ÔηډÈÔÏÔÁÈÎfi ∆Ì‹Ì·, ¢’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£., £ÂÛÛ·ÏÔÓ›ÎË
∞. ª·Î¤‰Ô˘1, ª. ∫Ô‡ÚÙË1, ∫. ª·Î¤‰Ô˘2, ™. §·˙·Ú›‰Ô˘1, °. ™. µ·ÚÏ¿Ì˘3
AÏÏËÏÔÁÚ·Ê›·: ∞ÚÂÙ‹ ª·Î¤‰Ô˘ ¶·ÙÚ. πˆ·ÎÂ›Ì 7 ∆.∫. 546 22, £ÂÛÛ·ÏÔÓ›ÎË ∂-mail: makourti@med.auth.gr
ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó 315 ·È‰È¿ (ÔÌ¿‰· ∞) Ô˘ ÚÔÛ‹Ïı·Ó Î·È ·Ú·ÎÔÏÔ˘ı‹ıËÎ·Ó ÛÙÔ ∂͈ÙÂÚÈÎfi π·ÙÚÂ›Ô ¶ÚfiÏ˄˘ ∫·Ú‰È·ÁÁÂÈ·ÎÒÓ ¶·ı‹ÛÂˆÓ Ù˘ µ’ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ ∞Ã∂¶∞, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· π·ÓÔ˘¿ÚÈÔ˜ 1993 ¤ˆ˜ ¢ÂΤ̂ÚÈÔ˜ 2002. ™Â οı ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ÂϤÁ¯ÔÓÙ·Ó Ë ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (TC), Ù· ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), Ë HDL-¯ÔÏËÛÙÂÚfiÏË, Ë LDL-¯ÔÏËÛÙÂÚfiÏË, Ë ·ÔÏÈÔÚˆÙ½ÓË ∞1 (∞pÔ ∞-1), Ë ·ÔÏÈÔÚˆÙ½ÓË µ-100 (∞pÔ µ-100) Î·È Ë ÏÈÔÚˆÙ½ÓË(·) [(Lp(a)]. ∆ËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ÔÌ¿‰· µ) ·ÔÙ¤ÏÂÛ·Ó 214 ·È‰È¿.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 12-05-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 29-03-2005
¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙÔÓ ÔÚfi ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘, ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ˘ÂÚÏÈȉ·ÈÌ›·˜ Î·È Ë Û‡ÁÎÚÈÛ‹ ÙÔ˘˜ Ì ÂΛӷ ·È‰ÈÒÓ ¯ˆÚ›˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ‹ ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Èı·ÓÒÓ ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË.
∞ÔÙÂϤÛÌ·Ù·: O ̤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ‹Ù·Ó 10,71±5,2 ¤ÙË (‡ÚÔ˜: 4-16 ¤ÙË) Î·È 10,13±3,4 ¤ÙË (‡ÚÔ˜: 5-14 ¤ÙË) ÁÈ· ÙȘ ÔÌ¿‰Â˜ ∞ Î·È µ, ·ÓÙ›ÛÙÔȯ·. OÎÙÒ Û˘ÓÔÏÈο ·È‰È¿ ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó Ì ÁÂÓÂÙÈÎÒ˜ ηıÔÚÈ˙fiÌÂÓË ˘ÂÚÏÈȉ·ÈÌ›·, ‰‡Ô Ì ÔÌfi˙˘ÁË Î·È ¤ÍÈ Ì ÂÙÂÚfi˙˘ÁË. ∞fi Ù· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞, 196 (62,2%) ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÔÈÎÔÁ¤ÓÂȘ Ì ıÂÙÈÎfi ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ (ÔÌ¿‰· ∞1), 47 (14,9%) Ì ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ (ÔÌ¿‰· ∞2) Î·È 72 (22,9%) Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· (ÔÌ¿‰· ∞3). ªÂٷ͇ ·˘ÙÒÓ ‰ÂÓ ˘‹Ú¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ̤Û˜ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ∞ÓÙ›ıÂÙ·, ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÂÌÊ¿ÓÈ˙·Ó ÔÈ Ì¤Û˜ ÙÈ̤˜ ÙˆÓ TC, LDL-C Î·È Lp(a) ÌÂٷ͇ ÙˆÓ ÔÌ¿‰ˆÓ ∞1 Î·È ÂϤÁ¯Ô˘. ™Ù·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ˜ ÙÈ̤˜ TC, TG, LDL-C, ∞pÔ µ-100, Lp(a) Î·È ¯·ÌËÏfiÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ∞pÔ ∞-1 ÂÌÊ¿ÓÈ˙Â Ë ÔÌ¿‰· ∞3 Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ™˘ÌÂÚ¿ÛÌ·Ù·: ∫Ú›ÓÂÙ·È ÛÎfiÈÌÔ˜ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÛÙÂÊ·ÓÈ·›·˜ ÓfiÛÔ˘ ‹ ˘ÂÚÏÈȉ·ÈÌ›·˜ ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË ·È‰ÈÒÓ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ·ıËÚÔÛÎÏ‹ÚˆÛË ‹ ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·.
§¤ÍÂȘ ÎÏÂȉȿ §È›‰È·, ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘, ·ıËÚÔÛÎÏ‹ÚˆÛË, ·È‰È¿.
∂ÈÛ·ÁˆÁ‹ ∏ ·ıËÚÔÛÎÏ‹ÚˆÛË, Ë ÔÔ›· ·ÔÙÂÏ› ÙË ‚·ÛÈ΋ ·ÈÙ›· ÂÌÊ¿ÓÈÛ˘ ηډȷÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ (∫∞¡) fiˆ˜ ¤ÌÊÚ·ÁÌ·, ÛÙËı¿Á¯Ë Î·È ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ·Ú¯›˙ÂÈ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ÂÍÂÏ›ÛÛÂÙ·È Î·Ù¿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (1,2). ªÂϤÙ˜ Ù˘ ¢ÈÂıÓÔ‡˜ ∂Ù·ÈÚ›·˜ ∞ıËÚÔÛÎÏ‹ÚˆÛ˘ η٤‰ÂÈÍ·Ó fiÙÈ ÔÈ ·Ú¯Èο Â̶·È‰È·ÙÚÈ΋ 2005;68:204-208
Ê·ÓÈ˙fiÌÂÓ˜ ‚Ï¿‚˜ Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ·Ú¯›˙Ô˘Ó ÛÙȘ ÛÙÂÊ·ÓÈ·›Â˜ ·ÚÙËڛ˜ ÂÚ›Ô˘ ηٿ ÙÔ 10Ô ¤ÙÔ˜ ˙ˆ‹˜ Î·È ÛÙËÓ ÎÔÈÏȷ΋ ·ÔÚÙ‹ ηٿ ÙÔ 3Ô ¤ÙÔ˜ (3,4). OÈ ÂÈ‚·Ú˘ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Ì‚¿ÏÏÔ˘Ó ÛÙË ‰ÈÂÚÁ·Û›· Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ: ·) ÏÈȉ·ÈÌÈÎÔ‡˜, fiˆ˜ Â›Ó·È Ë ·˘ÍË̤ÓË ÔÏÈ΋ ¯ÔÏËÛÙÂÚfiÏË (∆C), Ù· ·˘ÍË̤ӷ ÙÚÈÁÏ˘ÎÂÚ›‰È· (TG), Ë ¯·ÌËÏ‹ ˘„ËÏ‹˜ ˘ÎÓfiÙËÙ·˜
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∂›Â‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ
¯ÔÏËÛÙÂÚfiÏË (HDL-C), Ë ˘„ËÏ‹ ¯·ÌËÏ‹˜ ˘ÎÓfiÙËÙ·˜ ¯ÔÏËÛÙÂÚfiÏË (LDL-C), ‚) ÌË ÏÈȉ·ÈÌÈÎÔ‡˜, fiˆ˜ ÙÔ Î¿ÓÈÛÌ·, Ë ˘¤ÚÙ·ÛË, Ô ‰È·‚‹Ù˘, Ë ·¯˘Û·ÚΛ· Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˆ˜ ÚÔ˜ Ù· ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· (∫∞¡). ¢Â‰Ô̤ӷ ·fi ÂȉËÌÈÔÏÔÁÈΤ˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ ·ÎfiÌË Î·È Ë ÌÂÌÔӈ̤ÓË ‡·ÚÍË ÏÈȉ·ÈÌÈÎÒÓ ·Ú·ÁfiÓÙˆÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙËÓ ‡·ÚÍË ÙˆÓ ÌË ÏÈȉ·ÈÌÈÎÒÓ, Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ∫∞¡ (5,6). À¿Ú¯ÂÈ, fï˜, ÔÌÔʈӛ· ÌÂٷ͇ ÙˆÓ ÂÚ¢ÓËÙÒÓ ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ fiÛÔ ÓˆÚ›ÙÂÚ· ·Ú¯›˙ÂÈ Ë ÚfiÏË„Ë ÙfiÛÔ Î·Ï‡ÙÂÚ· ·ÔÙÂϤÛÌ·Ù· ÂÈÙ˘Á¯¿ÓÔÓÙ·È. ¢ËÌÔÛÈÂ˘Ì¤Ó˜ Ô‰ËÁ›Â˜ ÙÔ˘ NCEP (National Cholesterol Education Program for Children and Adolescents) ÚÔÙ›ÓÔ˘Ó ÚÔÏËÙÈÎfi ¤ÏÂÁ¯Ô ·È‰ÈÒÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ fiÙ·Ó ˘¿Ú¯ÂÈ: ·) ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌ˘ ÂΉ‹ÏˆÛ˘ ηډȷÁÁÂÈ·ÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ [¤ÌÊÚ·ÁÌ·, ÛÙËı¿Á¯Ë ‹ ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ (∞∂∂) ÛÙÔ˘˜ ÁÔÓ›˜ ‹ ÙÔ˘˜ ·Ô‡‰Â˜ ÙÔ˘˜ Û ËÏÈΛ· <55 ÂÙÒÓ], ‚) ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Û ¤Ó·Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÔÓ¤· (TC >240 mg/dl), Á) ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ fiˆ˜ ˘¤ÚÙ·ÛË, ·¯˘Û·ÚΛ·, οÓÈÛÌ·, ‰›·ÈÙ· Ì ˘„ËÏ‹ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ÏÈ·Ú¿ (7). ™‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ NCEP, Ù· ·È‰È¿ ηٷٿÛÛÔÓÙ·È Û ÙÚÂȘ ηÙËÁÔڛ˜ ‚·ıÌÔ‡ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ (˘„ËÏÔ‡, ̤ÛÔ˘ Î·È ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘) ÁÈ· ÂÌÊ¿ÓÈÛË ∫∞¡, Û‡Ìʈӷ Ì ÙȘ ÙÈ̤˜ Ù˘ TC Î·È Ù˘ LDL-C (¶›Ó·Î·˜ 1) (7). OÈ ÂÈı˘ÌËÙ¤˜ ÙÈ̤˜ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÁÈ· Ù· ·È‰È¿ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÂÙÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2 (7). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ÏÈȉ·ÈÌÈ΋˜ Ù·˘ÙfiÙËÙ·˜ [TC, TG, HDL, LDL, Apo ∞-1, Apo B-100 Î·È Lp(a)] ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ∫∞¡ Û ËÏÈΛ· <55 ÂÙÒÓ ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Î·È Ë Û‡ÁÎÚÈÛ‹ Ù˘ Ì ÂΛÓË ·È‰ÈÒÓ Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Î·È ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Ì ÛÙfi¯Ô ÙËÓ ·Ó·ÁÓÒÚÈÛË ·Ú·ÁfiÓÙˆÓ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ·ıËÚÔÛÎÏ‹ÚˆÛË.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó ·Ó·‰ÚÔÌÈο 315 ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÂÚ¯ÔÏË-
¶›Ó·Î·˜ 1. ∫·ÙËÁÔڛ˜ ‚·ıÌÔ‡ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ Ì ‚¿ÛË ÙȘ ÙÈ̤˜ TC Î·È LDL-C µ·ıÌfi˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ TC (mg/dl) LDL-C (mg/dl) À„ËÏfi˜ ª¤ÛÔ˜ ÷ÌËÏfi˜
>200 171-199 ≤170
≥130 110-129 <110
ÛÙÂÚÔÏ·ÈÌ›·˜ ‹ ∫∞¡ Ô˘ ÚÔÛ‹Ïı·Ó Î·È ·Ú¤ÌÂÈÓ·Ó ÁÈ· ·Ú·ÎÔÏÔ‡ıËÛË ÛÙÔ ∂͈ÙÂÚÈÎfi π·ÙÚÂ›Ô ¶ÚfiÏ˄˘ ∫∞¡ Ù˘ µ’ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∞Ã∂¶∞, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 1993-2002. ∞˘Ù‹ Ë ÔÌ¿‰· ·È‰ÈÒÓ (ÔÌ¿‰· ∞) ¯ˆÚ›ÛÙËΠ۠3 ˘ÔÔÌ¿‰Â˜: ÙËÓ ∞1 (196 ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ (™¡), ÙËÓ ∞2 (47 ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ∞∂∂) Î·È ÙËÓ ∞3 (72 ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ˘ÂÚÏÈȉ·ÈÌ›·). ªÂÙ¿ ·fi 12ˆÚË ÓËÛÙ›· ÁÈÓfiÙ·Ó ÚˆÈÓ‹ ·ÈÌÔÏË„›· Î·È ÂϤÁ¯ÔÓÙ·Ó Ù· ·È‰È¿ Ì ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ Ì ‰‡Ô ‰È·‰Ô¯ÈΤ˜ ÌÂÙÚ‹ÛÂȘ ·Ó¿ Ì‹Ó·, ·ÊÔ‡ ›¯Â ÚÔËÁËı› ‰È·ÈÙËÙÈ΋ ·Ú¤Ì‚·ÛË ÌÂÙ¿ ÙËÓ ÚÒÙË Â›Û΄‹ ÙÔ˘˜, ÁÈ· ÙËÓ ÂȂ‚·›ˆÛË ÙˆÓ ÙÈÌÒÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ ÏÈȉ·ÈÌÈ΋˜ Ù·˘ÙfiÙËÙ¿˜ ÙÔ˘˜. O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ TC, ÙˆÓ TG Î·È Ù˘ HDL ¤ÁÈÓ Ì ÂÓ˙˘Ì·ÙÈ΋ ¯ÚˆÌ·ÙÔÌÂÙÚÈ΋ ̤ıÔ‰Ô. ∏ ÙÈÌ‹ Ù˘ LDL ˘ÔÏÔÁ›ÛÙËΠ̠‚¿ÛË ÙÔÓ Ù‡Ô ÙÔ˘ Friedwald: TC-(TG/5+HDL) (8). OÈ Apo ∞-1, Apo µ-100 Î·È Lp(a) ÚÔÛ‰ÈÔÚ›ÛÙËÎ·Ó Ì ·ÓÔÛÔÓÂÊÂÏÔÌÂÙÚ›·. ∆ËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ÔÌ¿‰· µ) ÁÈ· ηıÂÌ›· ·fi ÙȘ ˘ÔÔÌ¿‰Â˜ ∞1, ∞2 Î·È ∞3 ·ÔÙÂÏÔ‡Û·Ó 214 ·È‰È¿ ·ÓÙ›ÛÙÔȯ˘ ËÏÈΛ·˜, Ô˘ ›¯·Ó ÂÈÛ·¯ı› ÛÙË µ’ ¶·ÓÂÈÛÙËÌȷ΋ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, Ì ·ÚÓËÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ∫∞¡ Î·È ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·, ¯ˆÚ›˜ ¿ÏÏÔ˘˜ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ¯ˆÚ›˜ ÈÛÙÔÚÈÎfi ÚfiÛÊ·ÙÔ˘ Â̇ÚÂÙÔ˘ ‹ ÓÔÛËÌ¿ÙˆÓ ‹·ÙÔ˜, ÓÂÊÚÒÓ Î·È ı˘ÚÂÔÂȉԇ˜ Î·È ¯ˆÚ›˜ Ó· ‚Ú›ÛÎÔÓÙ·È ˘fi Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ÂËÚ¿ÛÔ˘Ó ÙË ÏÈȉ·ÈÌÈ΋ ÙÔ˘˜ Ù·˘ÙfiÙËÙ·.
™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∏ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ¤ÁÈÓ Ì ÙÔ ÛÙ·ÙÈÛÙÈÎfi ÚfiÁÚ·ÌÌ· SPSS v10.0. °È· οı ÌÂÙ·‚ÏËÙ‹ ¤ÁÈÓ ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ̤Û˘ ÙÈÌ‹˜ Î·È Ù˘ Ù˘È΋˜ ·fiÎÏÈÛ˘ (SD). ∏ Û‡ÁÎÚÈÛË ÙˆÓ ÔÈÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ¤ÁÈÓ Ì ÙË ‰ÔÎÈÌ·Û›· Chi-square, ÂÓÒ ÙˆÓ ÔÛÔÙÈÎÒÓ ·Ú·ÌÂÙÚÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ Ì t-test Î·È ∞¡OV∞. ∏ Û˘Û¯¤ÙÈÛË ÙˆÓ ÂȤ‰ˆÓ ÙˆÓ ·Ú·Ì¤ÙÚˆÓ Ù˘ ÏÈȉ·ÈÌÈ΋˜ Ù·˘ÙfiÙËÙ·˜ ¤ÁÈÓ Ì ÙÔÓ Û˘ÓÙÂÏÂÛÙ‹ Û˘Û¯¤ÙÈÛ˘ Pearson. ŸÚÈÔ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ÔÚ›ÛÙËÎÂ Ë ÙÈÌ‹ p<0,05. ¶›Ó·Î·˜ 2. º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ §Èȉ·ÈÌÈ΋ ·Ú¿ÌÂÙÚÔ˜ TC HDL-C LDL-C ∆ÚÈÁÏ˘ÎÂÚ›‰È· Apo A-1 Apo B-100 Lp(a)
º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ <170 mg/dl ≥45 mg/dl <110 mg/dl ≤110 mg/dl 1,1-2 g/dl 0,6-1,4 g/dl ≤25 mg% ¶·È‰È·ÙÚÈ΋ 2005;68:204-208
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·206
206
∞. ª·Î¤‰Ô˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 3. ª¤Û˜ ÙÈ̤˜ (SD) ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ·Ó¿ÌÂÛ· ÛÙȘ ÔÌ¿‰Â˜ OÌ¿‰· A A1 A2 A3 B
TC (SD)
TG (SD)
LDL-C (SD)
212,2 (68,3) 206,6 (66,9) 208,8 (61,9) 225,3 (73,3) 193,24 (70,9)
73,5 (43,3) 77,2 (48,9) 70,8 (35,7) 75,6 (40,3) 64,4 (37,7)
129,9 (67,9) 133,3 (65,9) 160,6 (60,6) 151,0 (76,7) 119,1 (71,1)
∞ÔÙÂϤÛÌ·Ù· ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ 315 ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ∞, 149 (47,3%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 166 (52,7%) ÎÔÚ›ÙÛÈ·. O ̤ÛÔ˜ fiÚÔ˜ ËÏÈΛ·˜ ‹Ù·Ó 10,71±5,2 ¤ÙË (‡ÚÔ˜: 4-16 ¤ÙË) Î·È 10,13±3,4 ¤ÙË (‡ÚÔ˜: 5-14 ¤ÙË) ÁÈ· ÙËÓ ÔÌ¿‰· ∞ Î·È µ, ·ÓÙ›ÛÙÔȯ·. ø˜ ÚÔ˜ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ù· 196 (62,2%) ·È‰È¿ ÚÔ¤Ú¯ÔÓÙ·Ó ·fi ÔÈÎÔÁ¤ÓÂȘ Ì ÈÛÙÔÚÈÎfi ™¡, Ù· 47 (14,9%) Ì ∞∂∂ Î·È Ù· 72 (22,9%) Ì ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. OÈ Ì¤Û˜ ÙÈ̤˜ Î·È Ë SD ÁÈ· οı ·Ú¿ÌÂÙÚÔ Ù˘ ÏÈȉ·ÈÌÈ΋˜ Ù·˘ÙfiÙËÙ·˜ ÁÈ· οı ÔÌ¿‰· ·È‰ÈÒÓ Ê·›ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∏ ηٿٷÍË ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ∞ Ì ‚¿ÛË ÙÔÓ ‚·ıÌfi ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÁÈ· ∫∞¡ Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙÔ˘˜ ηٷÁÚ¿ÊÂÙ·È ÛÙÔÓ ¶›Ó·Î· 4. ™ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó 8 Û˘ÓÔÏÈο ·È‰È¿ Ì ÁÂÓÂÙÈÎÒ˜ ηıÔÚÈ˙fiÌÂÓË ˘ÂÚÏÈȉ·ÈÌ›·, 2 Ì ÔÌfi˙˘ÁË Î·È 6 Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚÏÈȉ·ÈÌ›·. OÈ ÙÈ̤˜ ÙˆÓ Û˘ÁÎÂÓÙÚÒÛÂˆÓ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ‰‡Ô ·È‰ÈÒÓ Ì ÔÌfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚÏÈȉ·ÈÌ›· ÂÍ·ÈÚ¤ıËÎ·Ó ·fi ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. ™‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ÚԤ΢„ fiÙÈ ˘‹Ú¯Â ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙˆÓ ÙÈÌÒÓ Ù˘ TC Ì ÙËÓ LDLC (r=0,956, p=0,02), ÙËÓ HDL-C (r=0,116, p=0,02), ÙËÓ Apo µ-100 (r=0,697, p=0,000) Î·È ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ Apo ∞-1 (r=-0,17, p=0,001). ∆· TG ÂÌÊ¿ÓÈ˙·Ó ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ HDL-C (r=-0,10, p=0,04) Î·È ıÂÙÈ΋ Ì ÙËÓ Apo µ-100 (r=0,21, p=0,00). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Ê‡ÏÔ ‰ÂÓ ˘‹Ú¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ÙÈ̤˜ ÙˆÓ ÏÈ-
HDL-C (SD) Apo A-1 (SD) Apo B-100 (SD) Lp(a) (SD) 57,7 (19,3) 58,4 (21,1) 53,9 (17,6) 59,6 (19,8) 57,8 (18,8)
1,4 (0,3) 1,4 (0,4) 1,3 (0,3) 1,2 (0,4) 1,42 (0,3)
1,1 (0,57) 1,1 (0,58) 1,1 (0,5) 1,2 (0,57) 1,07 (0,55)
37,6 (36,6) 36,6 (20,8) 32,8 (28,7) 38,6 (24,7) 27,01 (21,5)
ȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞ (¶›Ó·Î·˜ 5). ªÂٷ͇ ÙˆÓ ·È‰ÈÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ∞1, ∞2 Î·È ∞3 ‰ÂÓ ˘‹Ú¯·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ̤Û˜ ÙÈ̤˜ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ˘„ËÏfiÙÂÚ˜ ̤Û˜ ÙÈ̤˜ TC, LDL-C Î·È Lp(a) ·Ú·ÙËÚ‹ıËÎ·Ó Û ·È‰È¿ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ™¡ (ÔÌ¿‰· ∞1) ‹ ˘ÂÚÏÈȉ·ÈÌ›·˜ (ÔÌ¿‰· ∞3) Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (p<0,05) (∂ÈÎfiÓ· 1). ¶·Ú¿ÏÏËÏ·, ÛÙËÓ ÔÌ¿‰· ∞3 ‰È·ÈÛÙÒıËÎ·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ˘„ËÏfiÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ TG, Apo µ-100, ηıÒ˜ Î·È ¯·ÌËÏfiÙÂÚ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ Apo ∞-1 Û˘ÁÎÚÈÙÈο Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (p<0,05) (∂ÈÎfiÓ· 1).
™˘˙‹ÙËÛË ∏ ·ıËÚÔÛÎÏ‹ÚˆÛË Â›Ó·È Ì›· ÂÍÂÏÈÎÙÈ΋ ‰È·‰Èηۛ· Ô˘ ÍÂÎÈÓ¿ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· Î·È ÂΉËÏÒÓÂÙ·È Û˘¯Ó¿ Ì ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· ηٿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. √È ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ ·ÔÙÂÏÔ‡Ó ÛËÌ·ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÛÙËÓ ·Ó¿Ù˘Í‹ Ù˘ (1,2,5,6). ∞fi Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ›‰· ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙÔ˘ ÔÚÔ‡ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÔÌ¿‰·˜ ∞ ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ. ∞˘Ùfi ÙÔ Â‡ÚËÌ· Â›Ó·È ÛÂ Û˘Ìʈӛ· Ì ٷ Â˘Ú‹Ì·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (913). ∞ÓÙÈı¤Ùˆ˜, ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ TC, LDL-C Î·È Lp(a) ‰È¤ÊÂÚ·Ó Û ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎfi Â›Â‰Ô ·Ó¿ÌÂÛ· ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞1 (Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ·
¶›Ó·Î·˜ 4. ∫·Ù¿Ù·ÍË ·È‰ÈÒÓ Ì ‚¿ÛË ÙÔÓ ‚·ıÌfi ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÁÈ· ∫∞¡ Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi µ·ıÌfi˜ ÂÈÎÈÓ‰˘ÓfiÙËÙ·˜ ÷ÌËÏfi˜ ª¤ÛÔ˜ À„ËÏfi˜ ¶·È‰È·ÙÚÈ΋ 2005;68:204-208
∞ÚÈıÌfi˜ ·È‰ÈÒÓ (%)
™¡ N=196
∞∂∂ N=47
ÀÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· N=72
107 (33,7%) 75 (23,9%) 133 (42,4%)
61 (31,1%) 48 (24,5%) 87 (44,4%)
13 (27,7%) 11 (23,4%) 23 (48,9%)
15 (20,8%) 21 (29,1%) 36 (50,1%)
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·207
207
∂›Â‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ
¶›Ó·Î·˜ 5. ª¤Û˜ ÙÈ̤˜ Î·È SD ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ Û ۯ¤ÛË Ì ÙÔ Ê‡ÏÔ ÛÙËÓ ÔÌ¿‰· ∞ §È›‰È·
∞ÁfiÚÈ· (SD)
∫ÔÚ›ÙÛÈ· (SD)
p
∏ÏÈΛ· TC TG HDL-C LDL-C Apo A-1 Apo B-100 Lp(a)
10,61 (4,96) 202,84 (68,3) 73,54 (43,3) 57,74 (19,3) 129,96 (67,9) 1,4 (0,4) 1,12 (0,6) 31,79 (28,6)
10,87 (5,59) 201,9 (70) 71,2 (40,6) 56,9 (18,5) 129,8 (68,4) 1,35 (0,3) 1,1 (0,5) 28,5 (26,3)
NS NS NS NS NS NS NS NS
™¡) Î·È ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ µ (ÂϤÁ¯Ô˘). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ Â›Ó·È Û ϋÚË ·ÓÙÈÛÙÔȯ›· Ì ٷ ·ÔÙÂϤÛÌ·Ù· Î·È ¿ÏÏˆÓ ‰ËÌÔÛÈÂ˘Ì¤ÓˆÓ ÌÂÏÂÙÒÓ (13,14). ™Â ·˘Ùfi ÙÔ ÛËÌÂ›Ô ·Í›˙ÂÈ Ó· ÙÔÓÈÛÙ› fiÙÈ Ë Lp(a) Â›Ó·È ÛËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙË ‰ÈÂÚÁ·Û›· Ù˘ ·ıËÚÔÛÎÏ‹ÚˆÛ˘ Î·È Û‡Ìʈӷ Ì ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·ÚÔ˘Û›· Î·È ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ™¡ (15). ™Â Û˘Ó‰˘·ÛÌfi Ì ·˘ÍË̤ÓË LDL-C ·ÔÙÂÏÔ‡Ó ‰˘ÛÌÂÓ¤ÛÙ·ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ∫∞¡, ÂÓÒ Ë Â›‰Ú·Û‹ ÙÔ˘˜ ıˆÚÂ›Ù·È ·Ó·ÛÙÚ¤„ÈÌË ÌÂÙ¿ ·fi ÂÏ¿ÙÙˆÛË Ù˘ LDL-C (16). ∏ ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÏÈȉ·ÈÌ›· Â›Ó·È Ì›· ÎÔÈÓ‹ ‰È·Ù·Ú·¯‹ Ô˘ Û˘Ó·ÓÙ¿Ù·È Û ÔÛÔÛÙfi 1% ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ıˆÚÂ›Ù·È ˘Â‡ı˘ÓË ÁÈ· ÙÔ 10% Ù˘ ÚÒÈÌ˘ ÂΉ‹ÏˆÛ˘ ™¡ (17). ∆· ·È‰È¿ Ì ÎÏËÚÔÓÔÌÔ‡ÌÂÓË ‚Ï¿‚Ë ÛÙÔÓ ÌÂÙ·‚ÔÏÈÛÌfi ÙˆÓ ÏÈȉ›ˆÓ Î·È È‰È·›ÙÂÚ· ÛÙÔ ÁÔÓ›‰ÈÔ ÙÔ˘ LDL ˘Ô‰Ô¯¤· ÂÌÊ·Ó›˙ÔÓÙ·È ˆ˜ ÂÙÂÚÔ˙˘ÁÒÙ˜ ÌÂ Û˘¯ÓfiÙËÙ· 1:500. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÈÌ‹ TC ÂÚ›Ô˘ 300 mg% Î·È ÂΉËÏÒÓÔ˘Ó ∫∞¡ ηٿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹. ∆· 250 √Ì¿‰· ∞1 √Ì¿‰· ∞3 √Ì¿‰· µ
200 150 100 50 0 TC
TG
C
C
L-
LD
L-
H
D
-1 00 -1 oA B p o A Ap
) (a Lp
∂ÈÎfiÓ· 1. ™¯ËÌ·ÙÈ΋ ·ÂÈÎfiÓÈÛË ÙˆÓ Ì¤ÛˆÓ ÙÈÌÒÓ ÙˆÓ ÏÈȉ›ˆÓ Î·È ÙˆÓ ÏÈÔÚˆÙÂ˚ÓÒÓ ÙˆÓ ÔÌ¿‰ˆÓ ∞1, ∞3 Î·È µ.
·È‰È¿ Ì ÔÌÔ˙˘ÁˆÙ›· ÂÌÊ·Ó›˙ÔÓÙ·È Ì ·Ó·ÏÔÁ›· 1:1.000.000. ∆· ›‰· TC Î˘Ì·›ÓÔÓÙ·È ¤ˆ˜ 1000 mg%, ÂÓÒ ÎÏÈÓÈο ÂÌÊ·Ó›˙Ô˘Ó ÙÂÓfiÓÙÈ· Í·ÓıÒÌ·Ù· ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ, ηıÒ˜ Î·È ·ıËÚÔÛÎÏ‹ÚˆÛË ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÚÙËÚÈÒÓ Û˘Ó‹ıˆ˜ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ (18). ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÛÙÔ ∂͈ÙÂÚÈÎfi π·ÙÚÂ›Ô ¶ÚfiÏ˄˘ ∫∞¡, ·Ó·ÁÓˆÚ›ÛÙËÎ·Ó 8 Û˘ÓÔÏÈο ·È‰È¿ Ì ÁÂÓÂÙÈÎÒ˜ ηıÔÚÈ˙fiÌÂÓË ˘ÂÚÏÈȉ·ÈÌ›·, 2 Ì ÔÌfi˙˘ÁË Î·È 6 Ì ÂÙÂÚfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚÏÈȉ·ÈÌ›·. ∞˘Ù¿ Ù· ·È‰È¿ ‚Ú›ÛÎÔÓÙ·È ˘fi ÛÙÂÓ‹ Ù·ÎÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·ıÒ˜ Î·È ‰È·ÈÙËÙÈ΋ ·Ú¤Ì‚·ÛË. ∏ ¯ÔÚ‹ÁËÛË ÛÙ·Ù›Ó˘ ÂÊ·ÚÌfi˙ÂÙ·È ‹‰Ë Û ‰‡Ô ·È‰È¿ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 10 ÂÙÒÓ, ¤Ó· Ì ÔÌfi˙˘ÁË ÔÈÎÔÁÂÓ‹ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›· Ô˘ ˘Ô‚¿ÏÏÂÙ·È ·Ú¿ÏÏËÏ· Û ÂÎÏÂÎÙÈ΋ Ï·ÛÌ·Ê·›ÚÂÛË Ù˘ LDL-C Î·È ¤Ó· Ì ÂÙÂÚfi˙˘ÁË, Ì Ôχ ηϿ ̤¯ÚÈ ÙÒÚ· ·ÔÙÂϤÛÌ·Ù·. °È· ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, Û˘ÛÙ‹ÓÂÙ·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó· ·ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ˆ˜ ÚÔ˜ ÙËÓ ¿ÛÎËÛË Î·È ÙË ‰È·ÙÚÔÊ‹. ∏ ÂÓ¤ÚÁÂÈ· Ô˘ ÚÔÛÏ·Ì‚¿ÓÔ˘Ó Î·ıËÌÂÚÈÓ¿ Ù· ·È‰È¿ ·˘Ù¿ Ú¤ÂÈ Ó· ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ˘‰·Ù¿ÓıڷΘ Î·È ·ÎfiÚÂÛÙ· Ï›Ë Ì ÙËÓ ÚÔÛı‹ÎË ÔÛÚ›ˆÓ, Ï·¯·ÓÈÎÒÓ, ÊÚÔ‡ÙˆÓ, Ì ·ÔÊ˘Á‹ ˙¿¯·Ú˘ Î·È Ì¤ÙÚÈ· ηٷӿψÛË ÂÏ·ÈfiÏ·‰Ô˘. ™˘ÛÙ‹ÓÂÙ·È Ë Î·Ù·Ó¿ÏˆÛË Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ ¯·ÌËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ÏÈ·Ú¿, ÂÓÒ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È Ù· ÎÂÎÔÚÂṲ̂ӷ ÏÈ·Ú¿ (19). ∏ Û˘ÌÌfiÚʈÛË ·˘ÙÒÓ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÙÔ˘˜ ÂϤÁ¯ÂÙ·È Ì ٷÎÙÈÎÔ‡˜ ·ÓÂϤÁ¯Ô˘˜ Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∞∞ƒ (American Academy Ôf ƒediatrics) (20). O ·ÎÚÈ‚‹˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ˘ÂÚÏÈȉ·ÈÌ›·˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ›. £ÂˆÚÂ›Ù·È fiÙÈ ¤¯ÂÈ ÔÏ˘ÁÔÓȉȷ΋ ÁÂÓÂÙÈ΋ ‚¿ÛË Ì ·ÙÂÏ‹ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ· ÛÙ· ·È‰È¿ Î·È Ô Ê·ÈÓfiÙ˘fi˜ Ù˘ ÔÈΛÏÏÂÈ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ˘„ËÏ‹˜ TC, LDL, TG, Apo µ-100 Î·È Lp(a). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ Ù· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ ∞3 (Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÁÈ· ˘ÂÚÏÈȉ·ÈÌ›·) ÂÌÊ¿ÓÈ˙·Ó ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ TC, LDL, TG, Apo µ-100 Î·È Lp(a) Î·È ¯·ÌËϤ˜ Ù˘ Apo ∞-1, Ì ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘ (ÔÌ¿‰· µ). ∆· Â˘Ú‹Ì·Ù· ·˘Ù¿ ‚Ú›ÛÎÔÓÙ·È Û ·ÓÙÈÛÙÔȯ›· Ì ٷ ·ÔÙÂϤÛÌ·Ù· ¿ÏÏˆÓ ÌÂÏÂÙÒÓ (21). ¶·Ú¿ÏÏËÏ·, ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ÔÈÎÔÁÂÓ‹˜ ˘ÂÚÏÈȉ·ÈÌ›· ÌÔÚ› Ó· ÂÌÊ·Ó›˙ÂÈ ÌÂÌÔӈ̤ÓË ‹ Û˘Ó‰˘·Ṳ̂ÓË ·‡ÍËÛË ÙˆÓ TC, LDL, TG, Apo µ-100 Î·È Lp(a) ÛÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ˘˜ ·ÔÁfiÓÔ˘˜ ÙÔ˘˜. ¶·È‰È·ÙÚÈ΋ 2005;68:204-208
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∞. ª·Î¤‰Ô˘ Î·È Û˘Ó.
™˘ÌÂÚ·ÛÌ·ÙÈο, ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ∫∞¡ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÁÂÁÔÓfi˜ Ô˘ ˘Ô‰ËÏÒÓÂÈ fiÙÈ Ë ÚˆÙÔÁÂÓ‹˜ ÚfiÏË„Ë Â›Ó·È Î·ıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜ ÁÈ· ¤Ó·Ó ˘ÁÈ‹ ÂÓ‹ÏÈÎÔ ÏËı˘ÛÌfi. ∆· ‰Â‰Ô̤ӷ ·fi ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜, ÛÙȘ Ôԛ˜ ¤ÁÈÓ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ˘„ËÏÒÓ ÂȤ‰ˆÓ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘ ·fi ÙËÓ ·È‰È΋ ËÏÈΛ· ̤¯ÚÈ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹, ‰›ÓÔ˘Ó ¤ÌÊ·ÛË ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰È·ÙÚ¤¯Ô˘Ó Ô˘ÛÈ·ÛÙÈÎfi ΛӉ˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·˜ ηٿ ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (22). ∫Ú›ÓÂÙ·È ÛÎfiÈÌÔ ÔÈ ·È‰›·ÙÚÔÈ Ó· ‰ÈÂÚ¢ÓÔ‡Ó ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi Û‡Ìʈӷ Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÙÔ˘ NCEP, ÒÛÙ ӷ Á›ÓÂÙ·È ¤ÁηÈÚ· Ë ·Ó·ÁÓÒÚÈÛË ÙˆÓ ·È‰ÈÒÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ·Ó¿Ù˘ÍË ·ıËÚÔÛÎÏ‹ÚˆÛ˘. ∂ÈϤÔÓ, ·fiÁÔÓÔÈ ·ÛıÂÓÒÓ Ì ÚÒÈÌË ÂÌÊ¿ÓÈÛË ∫∞¡ Ú¤ÂÈ Ó· ·Ú·¤ÌÔÓÙ·È ÁÈ· ¤ÏÂÁ¯Ô Ù˘ ÏÈȉ·ÈÌÈ΋˜ ÙÔ˘˜ Ù·˘ÙfiÙËÙ·˜, Ì ÛÎÔfi ÙËÓ ¤ÁηÈÚË Û˘Ì‚Ô˘Ï¢ÙÈ΋ Î·È ‰È·ÈÙËÙÈ΋ ·Ú¤Ì‚·ÛË.
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µÈ‚ÏÈÔÁÚ·Ê›· 1. Klag MJ, Ford DE, Mead LA, He J, Whelton ƒ∫, Liang ∫À et al. Serum cholesterol in young men and subsequent cardiovascular disease. N Engl J Med 1993;328:313-318. 2. Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking. A preliminary report from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. J Am Med Assoc 1990; 264:3018-3024. 3. Strong JP. The natural history of atherosclerosis in childhood. πn: Williams CL, Wynder EL, editors. Hyperlipidemia in childhood and the development of atherosclerosis. New York: New York Academy of Sciences; 1991. p. 9-15. 4. McGill HC Jr, McMahan CA, Malcom GT, Oalmann MC, Strong JP. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc µiol 1997;17:95-106. 5. Castelli WP. Epidemiology of triglycerides: a review from Framingham. Am J Cardiol 1992;70:3-9. 6. Assman G, Schulte ∏. Role of triglycerides in coronary artery disease: lessons from the Prospective Cardiovascular Munster Study. Am J Cardiol 1992; 70:10-13. 7. American Academy of Pediatrics. National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol levels in Children and Adolescents. Pediatrics 1992;89:525-584. 8. Friedewald WT, Levy RI, Fredrickson DS. Estima¶·È‰È·ÙÚÈ΋ 2005;68:204-208
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tion of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502. ∫·‚·˙·Ú¿Î˘ ∂, ∆ÛfiÏ·˜ °, ™ÎÔ‡ÚÔ˘-÷Ù˙Ë·ÚÁ˘ÚÔ‡ ¢, ºÔ˘ÛÙÔ‡ÎÔ˘ ª, ¢‹ÌÔ˘ ™, ¢ÂÏËÁÈ¿ÓÓË µ. ∫·Ù·ÓÔÌ‹ ÔÏÈ΋˜ ¯ÔÏËÛÙÂÚfiÏ˘, ÏÈÔÚˆÙÂ˚ÓÒÓ Î·È ·ÔÏÈÔÚˆÙÂ˚ÓÒÓ Û ‚Ú¤ÊË Î·È ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1998;61:148-160. ∆ÛfiÏ·˜ °, ¢Ú·Î¿ÙÔ˜ ∞, ∆ÛÔ˘Î¿ÙÔ˘ £, ºˆÙÂÈÓÔ‡ ∞, ¶·Ó·ÁÔ‡ÏÈ· ª, ∫·‚·˙·Ú¿Î˘ ∂. ¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ù˘ ˘ÂÚÏÈȉ·ÈÌ›·˜ ÛÙ· ·È‰È¿. ¶·È‰È·ÙÚÈ΋ 1999;62:295-304. ™¿‚‚·˜ ™Ã, ∆ÔÚÓ·Ú›Ù˘ ª, ∂ÈÊ·Ó›Ô˘-™¿‚‚·˜ ª, ∫Ô˘Ú›‰Ë˜ °, ÷Ù˙ËÁˆÚÁ›Ô˘ Ã, ™È·ÌÔ‡ÓÎË ª. ∂›Â‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ Û ÂÊ‹‚Ô˘˜ ÛÙËÓ ∫‡ÚÔ. ™‡ÁÎÚÈÛË Ì ÂÏÏËÓÈο ‰Â‰Ô̤ӷ. ¶·È‰È·ÙÚ µ ∂ÏÏ¿‰Ô˜ 2000;12:195-204. ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË ∂, ¶··‰ÔÔ‡ÏÔ˘-§ÂÁ̤ÏÔ˘ ∫, ∫Ô˘ÏÔ˘Ú›‰· µ. ∂›Â‰· ÏÈȉ›ˆÓ Î·È ÏÈÔÚˆÙÂ˚ÓÒÓ Û ·È‰ÈÎfi ÏËı˘ÛÌfi Ù˘ ‰˘ÙÈ΋˜ £ÂÛÛ·ÏÔӛ΢. ¶·È‰È·ÙÚÈ΋ 2002;65:265-272. Freedman DS, Srinivasan SR, Cresanta JL, Webber LS, Berenson GS. Cardiovascular risk factors from birth to 7 years of age: the Bogalusa Heart Study. Serum lipids and lipoproteins. ƒediatrics 1987;80: 789-796. Kostner GM, Czinner ∞, Pfeiffer ∫∏, Bihari-Varga ª. Lipoprotein(a) concentrations as risk indicators for atherosclerosis. Arch Dis Child 1991;66:10541056. Terres W, Tatsis ∂, Pfalzer µ, Beil FU, Beisiegel U, Hamm CW. Rapid angiographic progression of coronary artery disease in patients with elevated lipoprotein(a). Circulation 1995;91:948-950. Maher VM, Brown BG, Marcovina SM, Hillger LA, Zhao XQ, AIbers JJ. Atherogenic effects of lipoprotein (a) in hyperlipidemic men with coronary disease: benefit Ôf altering LDL- and HDL-cholesterol levels. JAMA 1995;274:1771-1774. Grundy SM, Chait ∞, Brunzell JD. Familial combined hyperlipidemia workshop. ArteriosclerÔsis 1987;7:203-207. Goldstein JL, Schrott HG, Hazzard WR, Bierman EL, Motulsky AG. Hyperlipidemia in coronary heart disease. II. Genetic analysis of lipid levels in 176 families and delineation of a new inherited disorder, combined hyperlipidemia. J Clin Invest 1973;52: 1544-1568. ÛÙÔÁÏÔ˘-ª·Î¤‰Ô˘ ∞. ¶·È‰È΋ ˘ÂÚ¯ÔÏËÛÙÂÚÔÏ·ÈÌ›·. 14Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰·. ∂›Î·ÈÚ· ¶·È‰È·ÙÚÈο £¤Ì·Ù·. £ÂÛÛ·ÏÔÓ›ÎË; 2003. ÛÂÏ. 27-32. American Academy of Pediatrics. Committee on Nutrition. Cholesterol in childhood. ƒediatrics 1998;101:141-147. Hennermann JB, Herwing J, Marz W, Asskali F, Bohles HJ. Lipid and lipoprotein profiles in children with familial hypercholesterolaemia: effects of therapy. Eur J Pediatr 1998;157:912-918. Webber LS, Srinivasan SR, Wattigney WA, Berenson GS. Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. Am J Epidemiol 1991;133:884-899.
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Lipid and lipoprotein levels in children with a family history of cardiovascular disease A. Makedou1, M. Kourti1, K. Makedou2, S. Lazaridou1, G. S. Varlamis3
Abstract Background: The aim of this study was the evaluation of lipid and lipoprotein levels in serum from children with a positive family history of coronary heart disease, cerebrovascular disease or hyperlipidaemia, in comparison with controls, in order to identify risk factors for atherosclerosis. Methods: ∞ group of 315 children with a positive family history, who were monitored at the Outpatient Clinic for Prevention of Cardiovascular Diseases, 2nd ƒaediatric Department, ∞∏∂ƒ∞ University Hospital, from January 1993 to December 2002 (group A), and a control group of 214 children (group B) were evaluated for serum levels of total cholesterol, LDL-C, HDL-C, triglycerides, apolipoprotein µ-100 (Apo µ-100), apolipoprotein ∞-1 (Apo ∞-1) and lipoprotein (a) [Lp(a)]. Results: The mean ages of the children in groups ∞ and µ were 10.71±5.2 years (range: 4-16 years) and 10.13±3.4 years (range: 5-14 years), respectively. Among the group A children, 196 (62.2%), 47 (14.9%) and 72 (22.9%) had a positive family history of coronary heart disease (group ∞1), cerebrovascular disease (group A2) and hyperlipidaemia (group A3), respectively. Eight children were identified with genetically determined dyslipidaemia, two with homozygous and six with heterozygous familial hypercholesterolaemia. Group ∞3 children had statistically significantly higher concentrations of TC, TG, LDL-C, Apo µ-100 and lower concentrations of Apo ∞-1 than controls, while no significant differences were found in concentrations of lipidaemic parameters between the children of groups ∞1, ∞2 and ∞3. Significant differences were observed in the concentrations of TC, LDL-C and Lp(a) between the group A children and controls.
1 2nd Paediatric Clinic of Aristotelion University, Thessaloniki 2 Outpatient Clinic for Prevention of Cardiovascular Diseases, 2nd ƒaediatric Department, ∞∏∂ƒ∞ University Hospital, Thessaloniki 3 Department of Paediatric Cardiology, 4th Paediatric Clinic of the Aristotelion University, Thessaloniki Correspondence: Areti Makedou 7 Patr. Ioakeim str., 546 22, Thessaloniki ∂-mail: makourti@med.auth.gr Date of submission: 12-05-2004 Date of approval: 29-03-2005
Conclusions: Screening the progeny of young patients with coronary heart disease or with familial hyperlipidaemia is worthwhile for identifying young people at increased risk for future atherosclerosis or coronary heart disease.
Key words Lipids, family history, risk factors, atherosclerosis, children.
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∂ƒ∂À¡∏∆π∫∏ ∂ƒ°∞™π∞
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∫. ∞. µÔ‡‰Ú˘1, ª. ™ÂÚ‚ÈÙ˙fiÁÏÔ˘2, ∞. ™Î·Ú‰Ô‡ÙÛÔ˘2, ∂. ™Ù¤ÊÔ˜2, ∂. µ·ÁÈ¿ÎÔ˘3
AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∞. µÔ‡‰Ú˘ ¡Â˘ÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· E-mail: kvoudris@otenet.gr
ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∏ ÌÂϤÙË ÂÚÈÂÏ¿Ì‚·Ó 145 ·È‰È¿ (80 ·ÁfiÚÈ· Î·È 65 ÎÔÚ›ÙÛÈ·) Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ (̤ÛË ËÏÈΛ·: 22,03±7,48 Ì‹Ó˜).
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-06-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 29-03-2005
¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: OÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› (¶™) Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· Û·ÛÌÒÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜, ·ÏÏ¿ Î·È ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘˜ ÁÓˆÚ›ÛÌ·Ù· ÂÍ·ÚÙÒÓÙ·È ·fi ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È ÔÈΛÏÏÔ˘Ó Û ‰È¿ÊÔÚ˜ ¯ÒÚ˜ ÙÔ˘ ÎfiÛÌÔ˘. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Û ·È‰È¿ Ù˘ ¯ÒÚ·˜ Ì·˜ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È È‰È·›ÙÂÚ· Ë ·Ó·ÁÓÒÚÈÛË ·Ú·ÁfiÓÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘ÔÙÚÔ‹ ÙÔ˘˜.
∞ÔÙÂϤÛÌ·Ù·: ∂ÓÂÓ‹ÓÙ· ÂÙ¿ ·È‰È¿ ·ÓÂÎÙÈÌ‹ıËÎ·Ó ÌÂÙ¿ ·fi 12 Ì‹Ó˜ Î·È ˘ÔÙÚÔ‹ ÙˆÓ ¶™ ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ 33 ·È‰È¿ (34,02%). ∏ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ ‰ÂÓ ‰È¤ÊÂÚ ÛËÌ·ÓÙÈο ·Ó¿ÌÂÛ· ÛÙ· ·È‰È¿ Ù· ÔÔ›· ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Î·È Û ·˘Ù¿ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó (̤ÛË ËÏÈΛ·: 21,55±7,58 Î·È 22,16±7,56 Ì‹Ó˜, ·ÓÙÈÛÙÔ›¯ˆ˜). ∞ÓÙ›ıÂÙ·, ÙÔ Ê‡ÏÔ ÙÔ˘ ·È‰ÈÔ‡ Û˘Û¯ÂÙÈ˙fiÙ·Ó Ì ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ¶™, ηıÒ˜ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó 23 ·ÁfiÚÈ· (69,70%), ÂÓÒ Û ÂΛÓË Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹, 28 ·ÁfiÚÈ· (43,75%) (p<0,05). ∏ ÂÈ‚·Ú˘Ì¤ÓË ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜ Î·È Ë ‡·ÚÍË ‹È·˜ „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ÛÙÔ ·È‰› ‰ÂÓ Û˘Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ˘ÔÙÚÔ‹ ¶™. ™˘ÁÎÂÎÚÈ̤ӷ, ÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ Û 30 ·È‰È¿ (90,91%) Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Î·È Û 54 ·È‰È¿ (84,38%) ¯ˆÚ›˜ ˘ÔÙÚÔ‹, ÂÓÒ ‹È· „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË ‰È·ÈÛÙÒıËΠ۠3 ·È‰È¿ (9,09%) Ì ÔÏÏ·Ï¿ ÂÂÈÛfi‰È· ¶™ Î·È Û 3 ·È‰È¿ (4,69%) Ì ¤Ó· ÌfiÓÔ ÂÂÈÛfi‰ÈÔ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™, ıÂÙÈÎfi ›¯·Ó 12 ·È‰È¿ (36,36%) Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Î·È 15 ·È‰È¿ (23,44%) ¯ˆÚ›˜ ˘ÔÙÚÔ‹. ™Â Û¯¤ÛË Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο Â˘Ú‹Ì·Ù· ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ÙˆÓ ¶™, 5 ·È‰È¿ (15,15%) Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Î·È 15 ·È‰È¿ (23,44%) ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ ¶™ ›¯·Ó Û‡ÓıÂÙÔ˘˜ ¶™, 30 ·È‰È¿ (90,91%) Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Î·È 57 ·È‰È¿ (89,06%) ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ ¶™ ÂÌÊ¿ÓÈÛ·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÛÙÔ 1Ô 24ˆÚÔ ÙÔ˘ Â̇ÚÂÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Î·È 22 ·È‰È¿ (66,67%) Ì ÔÏÏ·Ï¿ ÂÂÈÛfi‰È· ¶™ Î·È 40 ·È‰È¿ (62,50%) Ì ¤Ó· ÂÂÈÛfi‰ÈÔ ¶™ ÂÌÊ¿ÓÈÛ·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Ì ˘ÚÂÙfi ¯·ÌËÏfiÙÂÚÔ ÙˆÓ 39,1ÔC. ™˘ÌÂÚ¿ÛÌ·Ù·: ŒÓ· ÛÙ· ÙÚ›· ·È‰È¿ Ù˘ ¯ÒÚ·˜ Ì·˜ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÂÌÊ·Ó›˙ÂÈ Î·È ¿ÏÏÔ ÂÂÈÛfi‰ÈÔ ¶™ Û ¤Ó· ¯ÚfiÓÔ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™. ∆Ô ¿ÚÚÂÓ Ê‡ÏÔ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™. ∏ ›‰Ú·ÛË ·Ú·ÁfiÓÙˆÓ fiˆ˜ Ë ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™, ηıÒ˜ Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ··ÈÙÔ‡Ó ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË.
§¤ÍÂȘ ÎÏÂȉȿ ¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ›, ˘ÔÙÚÔ‹ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ, ·È‰È¿.
™˘ÓÙÔÌÔÁڷʛ˜ ¶™ FS ¶·È‰È·ÙÚÈ΋ 2005;68:210-215
¶˘ÚÂÙÈÎÔ› Û·ÛÌÔ› Febrile seizures
∂ÈÛ·ÁˆÁ‹ OÈ ˘ÚÂÙÈÎÔ› Û·ÛÌÔ› (¶™) Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· Û·ÛÌÒÓ ÛÙ· ·È‰È¿ Î·È ¤Ó· ·fi Ù·
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·211
211
¶·Ú¿ÁÔÓÙ˜ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ
Û˘¯ÓfiÙÂÚ· Ó¢ÚÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ (1,2). ¢È·ÎÚ›ÓÔÓÙ·È ÛÙÔ˘˜ ·ÏÔ‡˜ Î·È ÛÙÔ˘˜ Û‡ÓıÂÙÔ˘˜ ‹ ÂÈÏÂÁ̤ÓÔ˘˜ ¶™. OÈ ·ÏÔ› ¶™, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ Û‡ÓıÂÙÔ˘˜ ¶™, Â›Ó·È ÁÂÓÈÎÂ˘Ì¤ÓÔÈ, ¤¯Ô˘Ó ‰È¿ÚÎÂÈ· ÌÈÎÚfiÙÂÚË ·fi 15 ÏÂÙ¿ Î·È ‰ÂÓ ˘ÔÙÚÔÈ¿˙Ô˘Ó ÛÙÔ ›‰ÈÔ Â̇ÚÂÙÔ ÓfiÛËÌ·. ∏ Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ ÂÍ·ÚÙ¿Ù·È ·fi ÁÂÓÂÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Î·È Î˘Ì·›ÓÂÙ·È Û ‰È¿ÊÔÚ· ̤ÚË ÙÔ˘ ÎfiÛÌÔ˘ ·fi 2% ¤ˆ˜ 14% (2). Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÔÛÔÛÙfi ÂÚ›Ô˘ 30% ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ı· ·ÚÔ˘ÛÈ¿ÛÂÈ Î·È ¿ÏÏÔ ÂÂÈÛfi‰ÈÔ ¶™ ̤۷ ÛÙ· ÂfiÌÂÓ· ¯ÚfiÓÈ· (1-3) ηÈ, ÂÈϤÔÓ, ÔÛÔÛÙfi 4050% ÙˆÓ ·È‰ÈÒÓ Ì ˘ÔÙÚÔ‹ ¶™ ı· ·ÚÔ˘ÛÈ¿ÛÂÈ ·ÎfiÌË ¤Ó· ‹ Î·È ÂÚÈÛÛfiÙÂÚ· ÂÂÈÛfi‰È· ¶™ (1-4). Œ¯ÂÈ, ›Û˘, ·Ó·ÊÂÚı› fiÙÈ ÙÔ 75% ÙˆÓ ˘ÔÙÚÔÒÓ ÙˆÓ ¶™ ÂÌÊ·Ó›˙ÂÙ·È Ì¤Û· Û ¤Ó· ¯ÚfiÓÔ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ (1). OÈ ÌÂϤÙ˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ٷ ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Â›Ó·È Î˘Ú›ˆ˜ ·Ó·‰ÚÔÌÈΤ˜. ªÔÏÔÓfiÙÈ Ù· ‰Â‰Ô̤ӷ ‰ÂÓ Â›Ó·È ÍÂοı·Ú·, ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘¯Ó¿ ¤¯Ô˘Ó ·Ó·ÊÂÚı› fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ Â›Ó·È Ë ÌÈÎÚ‹ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™, ÂÓÒ Û·ÓÈfiÙÂÚ· ¤¯Ô˘Ó ·Ó·ÊÂÚı› Ë ¯·ÌËÏ‹ ıÂÚÌÔÎÚ·Û›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È Ë ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÚÔ Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™, Ù· ÔÏÏ·Ï¿ ÂÂÈÛfi‰È· ¶™ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ Â̇ÚÂÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ Ô˘ Û˘Ó¤‚Ë ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ (1-4). ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÚÔÔÙÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ ÛÙÔȯ›ˆÓ ·fi ÙÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ·ÏÏ¿ Î·È ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ Û ·È‰È¿ Ù˘ ¯ÒÚ·˜ Ì·˜ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È È‰È·›ÙÂÚ· Ë ·Ó·ÁÓÒÚÈÛË ·Ú·ÁfiÓÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ˘ÔÙÚÔ‹ ÙÔ˘˜ ̤۷ Û ¤Ó· ¯ÚfiÓÔ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÏÂÙ‹ıËÎ·Ó 145 ·È‰È¿ Ô˘ ÂÈÛ‹¯ıËÛ·Ó ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ·fi ÙÔÓ OÎÙÒ‚ÚÈÔ ÙÔ˘ 2000 ¤ˆ˜ Î·È ÙÔÓ ºÂ‚ÚÔ˘¿ÚÈÔ ÙÔ˘ 2002. ŸÏ· Ù· ·È‰È¿ ˘Ô‚Ï‹ıËÎ·Ó Û ϋÚË ÎÏÈÓÈ΋ ÂͤٷÛË, ÂÓÒ ÂÏ‹ÊıË ·fi ÙÔ˘˜ ÁÔÓ›˜ ÏÂÙÔÌÂÚ¤˜ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∂ÓÂÓ‹ÓÙ· ÂÙ¿ ·È‰È¿ ·ÓÂϤÁ-
¯ıËÎ·Ó ‰Ò‰Âη Ì‹Ó˜ ÌÂÙ¿ ·fi ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™. OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ÂϤÁ¯ıËÎ·Ó Î·È Û˘Û¯ÂÙ›ÛÙËÎ·Ó Ì ÙËÓ Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ ‹Ù·Ó ÔÈ ·ÎfiÏÔ˘ıÔÈ: ÙÔ Ê‡ÏÔ, Ë ËÏÈΛ· ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™, ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ˘ÚÂÙÈÎÒÓ ‹ ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, Ë „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È ÙÔ ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ÙÔ˘ ·È‰ÈÔ‡, ÙÔ Â›‰Ô˜ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ (·ÏÔ› ‹ Û‡ÓıÂÙÔÈ), ÙÔ ‡„Ô˜ Î·È Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÚÔ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ ηÈ, Ù¤ÏÔ˜, Ë ·ÈÙ›· ÙÔ˘ Â̇ÚÂÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ (.¯. ÈÔÁÂÓ‹˜ ‹ ‚·ÎÙËÚȷ΋ Ïԛ̈ÍË). °È· ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ‰ÔÎÈÌ·Û›· x2. ¢È·ÊÔÚ¿ p<0,05 ıˆڋıËΠˆ˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋.
∞ÔÙÂϤÛÌ·Ù· ∏ ̤ÛË ËÏÈΛ· ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ 145 ·È‰ÈÒÓ Î·Ù¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ‹Ù·Ó 22,03±7,48 Ì‹Ó˜ (ËÏÈΛ· <12 Ì‹Ó˜ ›¯Â ÙÔ 24,14% ÙˆÓ ·È‰ÈÒÓ, 13-24 Ì‹Ó˜ ÙÔ 44,83% ÙˆÓ ·È‰ÈÒÓ Î·È >25 Ì‹Ó˜ ›¯Â ÙÔ 31,03% ÙˆÓ ·È‰ÈÒÓ). ∞fi ·˘Ù¿, 80 ·È‰È¿ (52,17%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 65 (47,83%) ÎÔÚ›ÙÛÈ·. ™·Ú¿ÓÙ· ÙÚ›· ·È‰È¿ (29,66%) ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™, 5 ·È‰È¿ (3,45%) ›¯·Ó ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, 139 ·È‰È¿ (95,86%) ‰ÂÓ ·ÚÔ˘Û›·˙·Ó „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È 16 ·È‰È¿ (11,03%) ›¯·Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™, 25 ·È‰È¿ (17,24%) ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ Û‡ÓıÂÙÔ˘˜ ¶™ Î·È 120 ·È‰È¿ (82,76%) ·ÏÔ‡˜ ¶™, 31 ·È‰È¿ (21,38%) ›¯·Ó ¶™ ηٿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡, 104 ·È‰È¿ (71,72%) ÙË 2Ë-24Ë ÒÚ· ˘ÚÂÙÔ‡ Î·È 10 ·È‰È¿ (6,90%) ÌÂÙ¿ ÙÔ 1Ô 24ˆÚÔ. ∂ÈϤÔÓ, 87 ·È‰È¿ (60%) ›¯·Ó ¶™ Ì ˘ÚÂÙfi ÌÂٷ͇ 38ÔC Î·È 39ÔC Î·È 58 ·È‰È¿ (40%) Ì ˘ÚÂÙfi ˘„ËÏfiÙÂÚÔ ·fi 39ÔC. ™Â 120 ·È‰È¿ (82,76%) Ô ˘ÚÂÙfi˜ ÔÊÂÈÏfiÙ·Ó Û ÈÔÁÂÓ‹ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Û 1 ·È‰› (0,69%) Û ·ÓÂÌ¢ÏÔÁÈ¿, Û 3 ·È‰È¿ (2,07%) Û Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Î·È Û 21 ·È‰È¿ (14,48%) Û ÌÈÎÚԂȷ΋ Ïԛ̈ÍË (ÌÈÎÚÔ‚È·ÈÌ›·, ÔÍ›· ̤ÛË ˆÙ›Ùȉ·, Ô˘ÚÔÏԛ̈ÍË, Ó¢ÌÔÓ›·). ∏ ̤ÛË ËÏÈΛ· ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÙˆÓ 97 ·È‰ÈÒÓ Ô˘ ·ÓÂϤÁ¯ıËÎ·Ó Û 12 Ì‹Ó˜ ‹Ù·Ó 21,95±7,53 Ì‹Ó˜ (ËÏÈΛ· <12 Ì‹Ó˜ ›¯Â ÙÔ 23,71% ÙˆÓ ·È‰ÈÒÓ, 13-24 Ì‹Ó˜ ÙÔ 47,42% ÙˆÓ ·È‰ÈÒÓ Î·È >25 Ì‹Ó˜ ›¯Â ÙÔ 28,87% ÙˆÓ ·È‰ÈÒÓ). ¶ÂÓ‹ÓÙ· ¤Ó· ·È‰È¿ (52,58%) ‹Ù·Ó ·ÁfiÚÈ· Î·È 46 (47,42%) ÎÔÚ›ÙÛÈ·. ∂›ÎÔÛÈ ¤ÍÈ ·È‰È¿ (26,80%) ›¯·Ó ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ¶·È‰È·ÙÚÈ΋ 2005;68:210-215
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·212
212
∫. ∞. µÔ‡‰Ú˘ Î·È Û˘Ó.
ÈÛÙÔÚÈÎfi ¶™, 4 ·È‰È¿ (4,1%) ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ, 91 ·È‰È¿ (93,81%) Ê˘ÛÈÔÏÔÁÈ΋ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË Î·È 13 ·È‰È¿ (13,40%) ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ‰Â‰Ô̤ӷ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™, 20 ·È‰È¿ (20,62%) ›¯·Ó ·ÚÔ˘ÛÈ¿ÛÂÈ Û‡ÓıÂÙÔ˘˜ ¶™ Î·È 77 ·È‰È¿ (79,38%) ·ÏÔ‡˜ ¶™, 20 ·È‰È¿ (20,62%) ÂÌÊ¿ÓÈÛ·Ó ÙÔ˘˜ ¶™ ηٿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡, 67 ·È‰È¿ (69,07%) ·fi ÙË 2Ë24Ë ÒÚ· ˘ÚÂÙÔ‡ Î·È 10 ·È‰È¿ (10,31%) ÌÂÙ¿ ÙÔ 1Ô 24ˆÚÔ. ∂ÈϤÔÓ, 64 ·È‰È¿ (65,98%) ÂÌÊ¿ÓÈÛ·Ó ¶™ Ì ˘ÚÂÙfi ÌÂٷ͇ 38ÔC Î·È 39ÔC Î·È 33 ·È‰È¿ (34,02%) Ì ˘ÚÂÙfi ˘„ËÏfiÙÂÚÔ ·fi 39ÔC. ™Â 82 ·È‰È¿ (84,54%) Ô ˘ÚÂÙfi˜ ÔÊÂÈÏfiÙ·Ó Û ÈÔÁÂÓ‹ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Û 1 ·È‰› (1,03%) Û ·ÓÂÌ¢ÏÔÁÈ¿, Û 2 ·È‰È¿ (2,06%) Û Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Î·È Û 12 ·È‰È¿ (12,36%) Û ÌÈÎÚԂȷ΋ Ïԛ̈ÍË (ÌÈÎÚÔ‚È·ÈÌ›·, ÔÍ›· ̤ÛË ˆÙ›Ùȉ·, Ô˘ÚÔÏԛ̈ÍË,
Ó¢ÌÔÓ›·). ¢ÂÓ ‚Ú¤ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙȘ ·ÓˆÙ¤Úˆ ÌÂÏÂÙËı›Û˜ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂٷ͇ ÙÔ˘ ÔÏÈÎÔ‡ ·ÚÈıÌÔ‡ ÙˆÓ ·È‰ÈÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È ÂΛÓÔ˘ Ì ‰˘Ó·ÙfiÙËÙ· ·Ú·ÎÔÏÔ‡ıËÛ˘ ÁÈ· ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™. ™Â 33 ·fi Ù· 97 ·È‰È¿ (34,02%) Ô˘ ·ÓÂÎÙÈÌ‹ıËÎ·Ó 12 Ì‹Ó˜ ÌÂÙ¿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ‰È·ÈÛÙÒıËΠ˘ÔÙÚÔ‹ ÙˆÓ ¶™. ∏ ̤ÛË ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ÙˆÓ ¶™ ‹Ù·Ó 21,55±7,58 Ì‹Ó˜, ÂÓÒ ·˘ÙÒÓ Ô˘ ‰ÂÓ Â·Ó¤Ï·‚·Ó ¶™ 22,16±7,56 Ì‹Ó˜ (¶›Ó·Î·˜ 1). ∂›ÎÔÛÈ ÙÚ›· ·fi Ù· 97 ·È‰È¿ ·ÚÔ˘Û›·Û·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û ËÏÈΛ· <12 ÌËÓÒÓ Î·È 10 ·È‰È¿ (43,47%) ·fi ·˘Ù¿ ˘ÔÙÚÔ›·Û·Ó. ∞fi Ù· ˘fiÏÔÈ· 74 ·È‰È¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û ËÏÈΛ· >12 ÌËÓÒÓ, ˘ÔÙÚÔ›·Û·Ó 23 ·È‰È¿ (31,08%). ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ¶™ Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·Ó 23 ·ÁfiÚÈ·
¶›Ó·Î·˜ 1. ™˘ÁÎÚÈÙÈο ‰Â‰Ô̤ӷ ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™ (33 ·È‰È¿) Î·È ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ ¶™ (64 ·È‰È¿) ÷ڷÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ∏ÏÈΛ· ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ <12 ÌËÓÒÓ 13-24 ÌËÓÒÓ >25 ÌËÓÒÓ ª¤ÛË ËÏÈΛ· (Ì‹Ó˜) º‡ÏÔ ∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ¶ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô æ˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ OÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ ∆‡Ô˜ Û·ÛÌÒÓ ™‡ÓıÂÙÔÈ ∞ÏÔ› ÃÚÔÓÈ΋ ‰È¿ÚÎÂÈ· ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡ 1Ë ÒÚ· ˘ÚÂÙÔ‡ 2Ë-24Ë ÒÚ· ˘ÚÂÙÔ‡ >1o 24ˆÚÔ ˘ÚÂÙÔ‡ ⁄„Ô˜ ˘ÚÂÙÔ‡ ηٿ ÙÔ 1Ô ÂÂÈÛfi‰ÈÔ ¶™ 38-39ÔC >39ÔC ∞ÈÙ›· Â̇ÚÂÙÔ˘ πÔÁÂÓ‹˜ Ïԛ̈ÍË ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ∞ÓÂÌ¢ÏÔÁÈ¿ °·ÛÙÚÂÓÙÂÚ›Ùȉ· O˘ÚÔÏԛ̈ÍË ªÈÎÚÔ‚È·ÈÌ›· OÍ›· ̤ÛË ˆÙ›Ùȉ· ¶Ó¢ÌÔÓ›· * p=0,027 §ÔȤ˜ ÙÈ̤˜ ÌË ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ¶·È‰È·ÙÚÈ΋ 2005;68:210-215
ªÂ ˘ÔÙÚÔ‹ ¶™
Èڛ˜ ˘ÔÙÚÔ‹ ¶™
30,30% 36,36% 33,34% 21,55±7,58
20,31% 50% 29,69% 22,16±7,56
69,70% 30,30% 9,09% 9,09% 36,36% 3,03%
43,75%* 56,25% 15,62% 4,69% 23,44% 3,12%
15,15% 84,85%
23,44% 76,56%
15,15% 75,76% 9,09%
23,44% 65,62% 10,94%
66,67% 33,33%
62,50% 37,50%
85,96% 0% 3,12% 1,56% 3,12% 6,24% 0%
81,26% 3,12% 0% 9,38% 0% 3,12% 3,12%
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·213
213
¶·Ú¿ÁÔÓÙ˜ ˘ÔÙÚÔÒÓ ÙˆÓ ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ
(69,70%), ÂÓÒ Û ·˘Ù‹Ó Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ¶™ 28 ·ÁfiÚÈ· (43,75%) (p<0,05). ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙËÓ ‡·ÚÍË ÂÈ‚·Ú˘Ì¤ÓÔ˘ ÂÚÈÁÂÓÓËÙÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ‹ „˘¯ÔÎÈÓËÙÈ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ‰ÂÓ ‚Ú¤ıËÎ·Ó ‰È·ÊÔÚ¤˜ ·Ó¿ÌÂÛ· ÛÙ· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Î·È ·˘ÙÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó (¶›Ó·Î·˜ 1). ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ‰ÂÓ ‚Ú¤ıËÎ·Ó ·Ó¿ÌÂÛ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜ Ô‡Ù Û fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™, ÛÙÔÓ ¯ÚfiÓÔ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ¶™ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡, ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ 1Ô˘ ÂÂÈÛÔ‰›Ô˘ ¶™, ‹ ÛÙÔ ‡„Ô˜ ÙÔ˘ ˘ÚÂÙÔ‡ ηٿ ÙÔ 1Ô ÂÂÈÛfi‰ÈÔ ¶™ (¶›Ó·Î·˜ 1).
™˘˙‹ÙËÛË OÈ ¶™ Â›Ó·È Ô Û˘ÓËı¤ÛÙÂÚÔ˜ Ù‡Ô˜ Û·ÛÌÒÓ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ ÔÈΛÏÏÂÈ Û ‰È¿ÊÔÚ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÎfiÛÌÔ˘ (2-5% ÛÙË ¢˘ÙÈ΋ ∂˘ÚÒË Î·È ÙȘ ∏¶∞ Î·È 9-10% ÛÙËÓ π·ˆÓ›·) (2). ∂›Ó·È Û¯ÂÙÈο Û˘¯ÓfiÙÂÚÔÈ ÛÙ· ·ÁfiÚÈ· (1) Î·È Ë Û˘Ó‹ı˘ ËÏÈΛ· ÂÌÊ¿ÓÈÛ‹˜ ÙÔ˘˜ Â›Ó·È ÌÂٷ͇ 5 ÌËÓÒÓ Î·È 5 ÂÙÒÓ Î·È Û˘¯ÓfiÙÂÚ· ÛÙÔ ‰Â‡ÙÂÚÔ ¤ÙÔ˜ Ù˘ ˙ˆ‹˜ (1,2). ¶ÈÛÙ‡ÂÙ·È fiÙÈ ÔÈ ¶™ ÔÊ›ÏÔÓÙ·È Û ·ÏÏËÏ›‰Ú·ÛË ÙÔ˘ ˘ÚÂÙÔ‡ Ì ¿ÏÏÔ˘˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ Â›Ó·È Ë ËÏÈΛ· Î·È Ë ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË (1,2). ∏ ÚfiÁÓˆÛ‹ ÙÔ˘˜, ȉȷ›ÙÂÚ· ÙˆÓ ·ÏÒÓ ¶™, Â›Ó·È Ôχ ηϋ, ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÓÔÛËÚfiÙËÙ·˜ ‹ ıÓËÙfiÙËÙ·˜, ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂȉÚÔ‡Ó ÛÙȘ ÓÔËÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ‹ Ó· ÚÔηÏÔ‡Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ ÂÈÏË„›·˜ ‰ÂÓ ‰È·Ê¤ÚÂÈ Ôχ ·fi ·˘ÙfiÓ ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ (1-4). √È ¶™, ·Ú¿ ÙËÓ Î·Ï‹ ÁÂÓÈο ÚfiÁÓˆÛ‹ ÙÔ˘˜, ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Û ÔÏÏ¿ ·È‰È¿ ·ӷϷ̂¿ÓÔÓÙ·È Ì›· ‹ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ·È‰ÈÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ·ÚÔ˘ÛÈ¿˙ÂÈ Î·È ¿ÏÏ· ÂÂÈÛfi‰È· ¶™ (1-4). OÈ ·Ú¿ÁÔÓÙ˜ Ô˘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ¶™ ÔÈΛÏÏÔ˘Ó Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜. ∏ ÌÈÎÚ‹ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ·Ó·Ê¤ÚÔÓÙ·È Û˘¯ÓfiÙÂÚ· Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ ˆ˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ˘ÔÙÚÔ‹ ¶™, ÂÓÒ Ë ¯·ÌËÏ‹ ıÂÚÌÔÎÚ·Û›· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È Ë ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÚÔ Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™
¤¯Ô˘Ó ·Ó·ÊÂÚı› Û·ÓÈfiÙÂÚ· fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ (1-2). ∂Ï¿¯ÈÛÙ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ó·Ê¤ÚÂÈ, ›Û˘, fiÙÈ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·‡ÚÂÙˆÓ Û·ÛÌÒÓ Î·È Ù· ÔÏÏ·Ï¿ ÂÂÈÛfi‰È· ¶™ ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÌÔÚ› Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ (4). ∏ ÌÈÎÚ‹ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ ıˆÚÂ›Ù·È fiÙÈ Û˘Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ÙÔÓ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ Î·È Û˘ÁÎÂÎÚÈ̤ӷ, Ô Î›Ó‰˘ÓÔ˜ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ ·Ó¤Ú¯ÂÙ·È ÛÙÔ 50% ÙˆÓ ·È‰ÈÒÓ Ì ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ ÌÈÎÚfiÙÂÚË ·fi 12 Ì‹Ó˜ (1,2). O ΛӉ˘ÓÔ˜ ·˘Ùfi˜ ·Ô‰›‰ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙË ÌÂÁ·Ï‡ÙÂÚË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô Î·Ù¿ ÙËÓ ÔÔ›· ÙÔ ·È‰› Ì ÌÈÎÚfiÙÂÚË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ¶™ Â›Ó·È ÂÈÚÚ¤˜ Û ÂÌÊ¿ÓÈÛË ¶™ (5,6). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ë Ì¤ÛË ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ ÙˆÓ ·È‰ÈÒÓ Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™ ηٿ ÙÔ˘˜ 12 Ì‹Ó˜ ·Ú·ÎÔÏÔ‡ıËÛ˘ ‹Ù·Ó 21,55±7,58 Ì‹Ó˜, ÂÓÒ ·˘ÙÒÓ ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ ¶™ ‹Ù·Ó 22,16±7,56 Ì‹Ó˜. ∂ÈϤÔÓ, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, 43,47% ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û ËÏÈΛ· <12 ÌËÓÒÓ ˘ÔÙÚÔ›·ÛÂ, ÂÓÒ ·fi Ù· ·È‰È¿ Ô˘ ·ÚÔ˘Û›·Û·Ó ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û ËÏÈΛ· >12 ÌËÓÒÓ ˘ÔÙÚÔ›·Û ÌfiÓÔ ÙÔ 31,08%. √È ·Ú·¿Óˆ ‰È·ÊÔÚ¤˜ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô fï˜ Èı·Ó¿ ÔÊ›ÏÂÙ·È ÛÙÔÓ Û¯ÂÙÈο ÌÈÎÚfi ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÓÂϤÁ¯ıËÎ·Ó Î·È ÛÙÔ Û¯ÂÙÈο ÌÈÎÚfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· Ù˘ ·Ú·ÎÔÏÔ‡ıËÛ˘. ™‡Ìʈӷ Ì ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ê·›ÓÂÙ·È fiÙÈ ˘Ê›ÛÙ·Ù·È ¤Ó· ÔÏ˘·Ú·ÁÔÓÙÈÎfi ÌÔÓÙ¤ÏÔ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Û ÔÏÏ¿ ·È‰È¿ Ì ¶™, ·Ó Î·È Û ÌÂÚÈο ·È‰È¿ Ë Ù¿ÛË ÁÈ· ¶™ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ·˘ÙÔۈ̷ÙÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú· (1,2). ªÔÏÔÓfiÙÈ ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÂÈÏË„›·˜, ÈÛÙ‡ÂÙ·È fiÙÈ ·˘Ùfi Û˘Û¯ÂÙ›˙ÂÙ·È ÈÛ¯˘Ú¿ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ˘ÔÙÚÔÒÓ ¶™ (5-7). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ›¯Â ÔÛÔÛÙfi 36,36% ÙˆÓ ·È‰ÈÒÓ Ì ·ӷϷ̂·ÓfiÌÂÓ· ÂÂÈÛfi‰È· ¶™, ÂÓÒ ·Ó¿ÏÔÁÔ ÈÛÙÔÚÈÎfi ›¯Â ÌfiÓÔ ÙÔ 23,44% ÙˆÓ ·È‰ÈÒÓ Ì ¤Ó· ÂÂÈÛfi‰ÈÔ ¶™. ªÔÏÔÓfiÙÈ ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ¶™ ‹Ù·Ó ÌÂÁ·Ï‡ÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ì ˘ÔÙÚÔ‹ ÙˆÓ ¶™, Ë ‰È·ÊÔÚ¿ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ Î·È ·˘Ùfi Èı·Ó¿ ÔÊ›ÏÂÙ·È Â›Û˘ ÛÙÔÓ Û¯ÂÙÈο ÌÈÎÚfi ·ÚÈıÌfi ÙˆÓ ·È‰ÈÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶·È‰È·ÙÚÈ΋ 2005;68:210-215
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·214
214
∫. ∞. µÔ‡‰Ú˘ Î·È Û˘Ó.
¶™ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ÛÙË Û¯ÂÙÈο ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· ·Ú·ÎÔÏÔ‡ıËÛ‹˜ ÙÔ˘˜. OÈ ¶™ ÂÌÊ·Ó›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÙÔ ÚÒÙÔ 24ˆÚÔ ·fi ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ˘ÚÂÙÔ‡ (7,8), fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. Œ¯ÂÈ ·Ó·ÊÂÚı› Û ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ fiÙÈ Ë ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÚÔ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È ÙÔ ‡„Ô˜ ÙÔ˘ ˘ÚÂÙÔ‡ ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ (5-8). ™˘ÁÎÂÎÚÈ̤ӷ, Ë ‚Ú·¯Â›· ‰È¿ÚÎÂÈ· ÙÔ˘ ˘ÚÂÙÔ‡ ÚÔ Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È Ô ¯·ÌËÏfi˜ ˘ÚÂÙfi˜ ηٿ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ¶™ (1,2). øÛÙfiÛÔ, Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ ‰ÂÓ Â›Ó·È ÍÂοı·Ú· fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘Û¯¤ÙÈÛË ·˘ÙÒÓ ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™, fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, fiÔ˘ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ Û ·˘Ù¤˜ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ‹ ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ ¶™. Œ¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ 15-35% ÙˆÓ ·È‰ÈÒÓ Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ¤¯ÂÈ Û‡ÓıÂÙÔ˘˜ ¶™ (1,2), ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. O Ù‡Ô˜ ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™, ·ÏÔ› ‹ Û‡ÓıÂÙÔÈ, ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Ó‰¤ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ¶™, fiˆ˜ ‚Ú¤ıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ÌÔÏÔÓfiÙÈ Û¿ÓÈ· ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÔÈ ÔÏÏ·ÏÔ› ¶™ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ›‰ÈÔ˘ Â̇ÚÂÙÔ˘ ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÌÔÚ› Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ (3). ∆¤ÏÔ˜, ÌÔÏÔÓfiÙÈ ÙÔ ıÂÙÈÎfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÂÈÏË„›·˜ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÌÂÏÏÔÓÙÈ΋˜ ÂÈÏË„›·˜ Û ·È‰È¿ Ì ¶™, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó Û˘Û¯¤ÙÈÛË Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ (5-9), ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ˘ÚÂÙÔ‡ Û ·È‰È¿ Ì ¶™ Â›Ó·È ÔÈ ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÂÓÒ ÌÂÚÈΤ˜ ÏÔÈÌÒÍÂȘ, fiˆ˜ Ë Á·ÛÙÚÂÓÙÂÚ›Ùȉ·, ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¶™, ÂÓÒ ¿ÏϘ, fiˆ˜ Ë Ïԛ̈ÍË ·fi ÂÚËÙÔ˚fi 6, ¤¯Ô˘Ó Û˘Ó‰Âı› ÌÂ Û˘¯ÓfiÙÂÚË ÂÌÊ¿ÓÈÛË ¶™ (1,2). øÛÙfiÛÔ, ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› Â¿Ó ÙÔ Â›‰Ô˜ Ù˘ Â̇ÚÂÙ˘ Ïԛ̈͢ ÂËÚ¿˙ÂÈ ÙË Û˘¯ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™. ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, Ù· ÂÚÈÛÛfiÙÂÚ· Â̇ÚÂÙ· ÓÔÛ‹Ì·Ù· ÛÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÔÊ›ÏÔÓÙ·Ó Û ÈÔÁÂÓ›˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È ‰ÂÓ ‰È·ÈÛÙÒıËΠÛ˶·È‰È·ÙÚÈ΋ 2005;68:210-215
Ì·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ì ÈÔÁÂÓ‹ Ïԛ̈ÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ‹ ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ ¶™. ªÔÏÔÓfiÙÈ ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ Ë ‡·ÚÍË Ó¢ÚÔ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·Ù·Ú·¯ÒÓ ÛÙ· ·È‰È¿ Î·È Ë ·ÚÔ˘Û›· ÚÔ‚ÏËÌ¿ÙˆÓ Î·Ù¿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ¶™ Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Ì ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏË„›·˜ ÛÙÔ Ì¤ÏÏÔÓ (1,2), ÔÈ ·Ú¿ÁÔÓÙ˜ ·˘ÙÔ› ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™ (5-10), fiˆ˜ ‰È·ÈÛÙÒıËÎÂ Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ Â›Ó·È Û·Ê¤˜ ·fi ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜ Â¿Ó ÙÔ Ê‡ÏÔ ÙˆÓ ·È‰ÈÒÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ÙÔ ÔÛÔÛÙfi ÙˆÓ ·ÁÔÚÈÒÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ÙˆÓ ¶™ Û ۯ¤ÛË Ì ÙËÓ ÔÌ¿‰· ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ˘ÔÙÚÔ‹ ÙˆÓ ¶™. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë ·ÚÔ‡Û· ÌÂϤÙË ¤‰ÂÈÍ fiÙÈ ¤Ó· ÛÙ· ÙÚ›· ∂ÏÏËÓfiÔ˘Ï· Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ ÂÌÊ·Ó›˙ÂÈ Î·È ¿ÏÏ· ÂÂÈÛfi‰È· ¶™ ÂÓÙfi˜ 12 ÌËÓÒÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘. ∂ÈϤÔÓ, Û‡Ìʈӷ Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓË Èı·ÓfiÙËÙ· ˘ÔÙÚÔ‹˜ ÙˆÓ ¶™, ÂÓÒ Ë Â›‰Ú·ÛË Ù˘ ËÏÈΛ·˜ ηٿ ÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ ÚÒÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ¶™ Î·È ÙÔ˘ ıÂÙÈÎÔ‡ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ¶™ ··ÈÙ› ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. ∏ ÔÚı‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·Ú·Ì¤ÙÚˆÓ ·˘ÙÒÓ Û οı ·È‰› Ì ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ¶™ Î·È Ë ÛˆÛÙ‹ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ Û˘Ì‚¿ÏÏÔ˘Ó ÛËÌ·ÓÙÈο ÛÙË ÛˆÛÙ‹ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ Ì ¶™.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Hirtz DG. Febrile seizures. Pediatr Rev 1997;18:5-8. 2. Shinnar S, Glauser TA. Febrile seizures. J Child Neurol 2002;17 (Suppl 1):S44-S52. 3. Baumer JH. Evidence based guideline for postseizure management in children presenting acutely to secondary care. Arch Dis Child 2004;89:278-280. 4. Duffner PK, Baumann RJ. A synopsis of the American Academy of Pediatrics’ practice parameters on the evaluation and treatment of children with febrile seizures. Pediatr Rev 1999;20:285-287. 5. Offringa M, Bossuyt PM, Lubsen J, Ellenberg JH, Nelson KB, Knudsen FU et al. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five
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studies. J Pediatr 1994;124:574-584. 6. Offringa M, Derksen-Lubsen G, Bossuyt PM, Lubsen J. Seizure recurrence after a febrile seizure: a multivariate approach. Dev Med Child Neurol 1992;34:15-24. 7. Berg AT, Shinnar S, Darefsky AS, Holford TR, Shapiro ED, Salomon ME et al. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med 1997;151:371-378.
8. Berg AT, Shinnar S, Hauser WA, Alemany M, Shapiro ED, Salomon ME et al. A prospective study of recurrent febrile seizures. N Engl J Med 1992;327:1122-1127. 9. Annegers JF, Blakley SA, Hauser WA, Kurland LT. Recurrence of febrile convulsions in a populationbased cohort. Epilepsy Res 1990;5:209-216. 10. Berg AT, Shinnar S. Complex febrile seizures. Epilepsia 1996;37:126-133.
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ORIGINAL ARTICLE
Factors associated with recurrence of febrile seizures in children K. Voudris1, M. Servitzoglou2, A. Skardoutsou2, E. Stefos2, E. Vagiakou3 1 Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens 2 2nd Paediatric Clinic of the University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens 3 Department of Microbiology, “G. Gennimatas” General Hospital, Athens Correspondence: Konstantinos A. Voudris Department of Neurology, “P. & A. Kyriakou” Children’s Hospital, Athens E-mail: kvoudris@otenet.gr Date of submission: 29-06-2004 Date of approval: 29-03-2005
Abstract Background: Febrile seizures (FS) are the most common form of childhood seizures. Their frequency and the other clinical characteristics depend on genetic factors and vary in different countries of the world. The purpose of this prospective study was to evaluate the range of clinical characteristics of Greek children presenting with a first episode of FS, as well as to identify the factors that are associated with the recurrence of FS. Methods: The study group comprised 145 children (80 boys, 65 girls) with a first episode of FS (mean age: 22.03±7.48 months). Ninety seven of them were followed up 12 months after the 1st FS episode. Results: Recurrent FS episodes in this period of time occurred in 33 (34.02%). The mean age of children with and without recurrent FS episodes was comparable (21.55±7.58 and 22.16±7.56 months, respectively). However, a prevalence of boys was found in the group of the children who developed recurrent FS episodes: 23 (69,7%) boys presented with recurrent FS episodes compared with 28 (43.75%) boys who did not (p<0.05). Thirty children with recurrent FS (90.91%) and 54 children with no recurrence of FS (84.38%) had an uneventful postnatal history (pNS). Mild psychomotor delay was present in 3 children (9.09%) with recurrence of FS and in 3 children (4.69%) with only one episode of FS (pNS). A positive family history of FS was recorded in 12 children (36.36%) with recurrent FS and in 15 children (23.44%) with no recurrence (pNS). Regarding the characteristics of the first episode of FS, 5 children (15.15%) with recurrent FS and 15 children (23.44%) without recurrence of FS had complex FS, 30 children (90.91%) with recurrent FS and 57 children (89.06%) without recurrence of FS had their first FS during the first 24 hours of febrile illness, and 22 children (66.67%) with recurrent FS and 40 children (62.50%) with a single FS had their first episode of FS with a temperature <39.1oC (pNS). Conclusions: This study showed that 34% of Greek children who presented with a first episode of FS showed a recurrence of FS within 12 months. The male sex was associated with increased risk for recurrent FS episodes. However, the impact of the younger age at the first episode and the positive family history of FS require further evaluation.
Key words Febrile seizures, recurrent febrile seizures, children.
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¶ÂÚ›ÏË„Ë ∏ ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔÈËÙÈ΋ ÈÓÔ‰˘ÛÏ·Û›· (Fibrodysplasia ossificans progressiva) Â›Ó·È Û¿ÓÈ· ÎÏËÚÔÓÔÌÈ΋ ÓfiÛÔ˜, Ë ÛÔÚ·‰ÈÎfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÔÔ›·˜ ÂÍËÁÂ›Ù·È ·fi ÙÔÓ ·˘ÍË̤ÓÔ ·ÚÈıÌfi ÙˆÓ ·˘ÙfiÌ·ÙˆÓ ÌÂÙ·ÏϿ͈Ó. ∫‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ÚÔԉ¢ÙÈ΋ ·Ó¿Ù˘ÍË ÔÏÏ·ÏÒÓ ¤ÎÙÔˆÓ ÔÛÙÂÔÔÈËÙÈÎÒÓ ÂÛÙÈÒÓ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Î·È ÙˆÓ ÁÚ·Ì̈ÙÒÓ Ì˘ÒÓ Ô˘ ÚÔηÏÔ‡Ó ·Á·ψÛË Î·È ÔÛÙÈΤ˜ ‰˘ÛÌÔÚʛ˜, ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ÙËÓ ÂÈÎfiÓ· ÙÔ˘ “˙ˆÓÙ·ÓÔ‡ ·Á¿ÏÌ·ÙÔ˜”. ∏ ·ÚÈ· ·ÈÙ›· ı·Ó¿ÙÔ˘ Â›Ó·È Ë ·Ó¿Ù˘ÍË ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ Ó¢ÌÔÓÔ¿ıÂÈ·˜ ÏfiÁˆ ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì˘ÒÓ Î·È ·Á·ψÛ˘ ÙÔ˘ ıˆÚ·ÎÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜. ¶·Ú¿ Ù· ÌÔÓ·‰Èο ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘, Ë ·Ú¯È΋ ‰È¿ÁÓˆÛ‹ Ù˘ Â›Ó·È Û˘¯Ó¿ Ï·Óı·Ṳ̂ÓË Î·È Û˘Ó‹ıˆ˜ ηı˘ÛÙÂÚ› ÛËÌ·ÓÙÈο. ∫ÔÚ›ÙÛÈ ËÏÈΛ·˜ 2 ÌËÓÒÓ ÚÔÛ‹Ïı Ì ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔ›ËÛË ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ÂÚÈÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚıÚÒÛÂˆÓ Î·È Û˘ÌÙÒÌ·Ù· Ïԛ̈͢ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. O ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜, ÂÓÒ Ô ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂȂ‚·›ˆÓ ÙȘ ÂÛٛ˜ ¤ÎÙÔ˘ ÔÛÙÂÔÔ›ËÛ˘. ∞Ó·Ï˘ÙÈÎfi˜ ‰È·ÁÓˆÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ıÂڷ¢ÙÈ΋ ·Ú¤Ì‚·ÛË ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ÏfiÁˆ Ù˘ ¿ÚÓËÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ. ∏ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È Î·Î‹, ÂÓÒ Ë ıÂڷ›· ‚Ú›ÛÎÂÙ·È Û ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ.
AÏÏËÏÔÁÚ·Ê›·: ∞Ó·ÛÙ¿ÛÈÔ˜ ∫·Ï·Ìfi΢ ¡ÈÎÔÌ¿¯Ô˘ 69 ∆.∫. 163 41, ∏ÏÈÔ‡ÔÏË E-mail: kalabok@mycosmos.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 16-09-2003 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 04-03-2005
§¤ÍÂȘ ÎÏÂȉȿ ŒÎÙÔË ÔÛÙÂÔÔ›ËÛË, ‚Ï·ÈÛfi˜ ̤Á·˜ ‰¿¯Ù˘ÏÔ˜ Ô‰ÈÔ‡, ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, Ó¢ÌÔÓÔ¿ıÂÈ·, ÂÙȉÚÔÓ¿ÙË.
™˘ÓÙÔÌÔÁڷʛ˜ FOP ™™
Fibrodysplasia ossificans progressiva ™ÔÓ‰˘ÏÈ΋ ÛÙ‹ÏË
∂ÈÛ·ÁˆÁ‹ ∏ ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔÈËÙÈ΋ ÈÓÔ‰˘ÛÏ·Û›· (Fibrodysplasia ossificans progressiva - FOP) Â›Ó·È Ì›· Û¿ÓÈ· ÎÏËÚÔÓÔÌÈ΋ ÓfiÛÔ˜ Ô˘ ÌÂÙ·‰›‰ÂÙ·È Ì ·˘ÙÔÛˆÌÈÎfi ÂÈÎÚ·ÙÔ‡ÓÙ· ¯·Ú·ÎÙ‹Ú·. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ÂȉÈΤ˜ ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, fiˆ˜ ÎÔÓÙ¿ ÌÂÁ¿Ï· ‰¿¯Ù˘Ï· ÙÔ˘ Ô‰ÈÔ‡, Ô˘ Û˘Óԉ‡ÔÓÙ·È ·fi ¤ÎÙÔË ÔÛÙÂÔÔ›ËÛË ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Î·È ÙˆÓ ÁÚ·Ì̈ÙÒÓ Ì˘ÒÓ, ÚÔηÏÒÓÙ·˜ ÚÔԉ¢ÙÈ΋ ·ÎÈÓËÙÔÔ›ËÛË Î·È ‰˘ÛÌÔÚÊ›· ÙˆÓ ·ÚıÚÒÛˆÓ. ∆Ô ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi Ì Èı·Ó‹ FOP ÂÌÊ·Ó›ÛÙËΠÙÔ 1692, fiÙ·Ó Ô Gui Patin ÂÚȤÁÚ·„ ̛· Á˘Ó·›Î· Ô˘ ‚·ıÌÈ·›· ÂÍÂÏ›¯ıËΠdure comme dy bois. ∆Ô 1868, o Von Dush ¯ÚËÛÈÌÔÔ›ËÛ ÁÈ· ÚÒÙË ÊÔÚ¿ ÙËÓ ¤ÎÊÚ·ÛË “myositis
ossificans progressiva”, ÂÓÒ ·ÚÁfiÙÂÚ· Ë ÓfiÛÔ˜ ÂÚÈÁÚ¿ÊËΠˆ˜ FOP, Ô˘ ηıÚ¤ÊÙÈ˙ Ì ÂÚÈÛÛfiÙÂÚË ·ÎÚ›‚ÂÈ· ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ (1). ∂›Ó·È Û¿ÓÈ· ÓfiÛÔ˜. ™˘Ì‚·›ÓÂÈ Û 2 ·Ó¿ 2.000.000 ¿ÙÔÌ·, ÂÓÒ ÂÚÈÁÚ¿ÊÔÓÙ·È 600 ÂÚÈÙÒÛÂȘ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (2). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ÎÔÚÈÙÛÈÔ‡ ÌÂ Ù˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ FOP Î·È Á›ÓÂÙ·È ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Û¯ÂÙÈο Ì ÙËÓ ·ıÔÁ¤ÓÂÈ·, Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙȘ ıÂڷ¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ·˘Ù‹˜ Ù˘ Û¿ÓÈ·˜ ÓfiÛÔ˘.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ £‹Ï˘ ‚Ú¤ÊÔ˜ ËÏÈΛ·˜ 4 ÌËÓÒÓ, ·Ï‚·ÓÈ΋˜ ηٷÁˆÁ‹˜, ÚÔÛ‹Ïı ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙÔ˘ ¶·È‰È·ÙÚÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∫∞∆ Ì ÁÂÓÈÎÂ˘Ì¤ÓË Â˘·ÈÛıËÛ›· ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·ÚıÚÒÛÂȘ ÙÔ˘ ÛÒÌ·ÙÔ˜, Ì ÂÚÈÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈÎfiÙËÙ¿˜ ÙÔ˘˜ Î·È ‰È·Ù·Ú·¯‹ Ù˘ ¶·È‰È·ÙÚÈ΋ 2005;68:217-220
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·218
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O. ¢Ô‡ÙÛ˘ Î·È Û˘Ó.
·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Ô˘ ÂΉËψÓfiÙ·Ó Ì ‚‹¯·, ‰‡ÛÓÔÈ· Î·È ıˆÚ·ÎÈÎfi ¿ÏÁÔ˜. ∫‡ÚÈÔ Â‡ÚËÌ· Ì ÙËÓ ¿ÌÂÛË ÂÈÛÎfiËÛË ‹Ù·Ó Ë ·ÚÔ˘Û›· ¤ÎÙÔˆÓ ÛÎÏËÚÒÓ Î·È ÔȉËÌ·Ùˆ‰ÒÓ Ì·˙ÒÓ Û ÂÚÈÔ¯¤˜ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡, ÙÂÓfiÓÙˆÓ Î·È Ì˘ÒÓ, ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ÔÛÙÈ΋ ‰˘ÛÌÔÚÊ›·. ∆Ô ·È‰› ÁÂÓÓ‹ıËΠÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÙÔÎÂÙfi ·fi ˘ÁÈ›˜ ÁÔÓ›˜ Ó·ڋ˜ ËÏÈΛ·˜ Î·È Ì ËÏÈΛ· ·ËÛ˘ 37-38 ‚‰ÔÌ¿‰ˆÓ (∂ÈÎfiÓ· 1). ◊Ù·Ó ÙÔ ¤ÌÙÔ ·È‰› Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ë ÔÔ›· ‹Ù·Ó ¯·ÌËÏÔ‡ ‚ÈÔÙÈÎÔ‡ ÂȤ‰Ô˘, ¯ˆÚ›˜ fï˜ ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ·fi ÁÂÓÂÙÈ΋˜ ÏÂ˘Ú¿˜. ∆Ô ·È‰› ηٿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘ ·ÚÔ˘Û›·Û ·Ú·ÌfiÚʈÛË ÙˆÓ ‰·ÎÙ‡ÏˆÓ ÙÔ˘ Ô‰ÈÔ‡ Ì ˘ÔÏ·Û›· ÙˆÓ ÌÂٷٷÚÛ›ˆÓ Î·È Î˘ÚÙ¿ ÌÂÁ¿Ï· ‰¿¯Ù˘Ï·, Ì ÙÔ ÌÂÁ¿ÏÔ ‰¿¯Ù˘ÏÔ Û ‚Ï·ÈÛ‹ ı¤ÛË. ¢‡Ô ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ· ·Ó¤Ù˘Í ̛· ·ÓÒ‰˘ÓË ÔȉËÌ·ÙÒ‰Ë ÛÎÏËÚ‹ Ì¿˙· ÛÙÔÓ ·˘¯¤Ó·, Ô˘ Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ›¯Â ÂÂÎÙ·ı› ÛÙË ıˆÚ·ÎÔ-ÔÛÊ˘˚΋ ÂÚÈÔ¯‹ Û¯ËÌ·Ù›˙ÔÓÙ·˜ ¤Ó·Ó “‰Â‡ÙÂÚÔ ıÒڷη Ô˘ ÎÔÏÏÔ‡Û” ¿ӈ ÛÙÔÓ ÂÎ ÁÂÓÂÙ‹˜. ™Â ËÏÈΛ· ÂÚ›Ô˘ 3 ÌËÓÒÓ (∂ÈÎfiÓ· 2) ·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ ·ÒÏÂÈ· Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ Ù˘ ¿ÚıÚˆÛ˘ ÙÔ˘ ÒÌÔ˘ Ì ·ÚÔ˘Û›· ÔÛÙ¤ÈÓˆÓ Ì·˙ÒÓ ÛÙÔ ‚Ú·¯ÈfiÓÈÔ ÔÛÙfi ¯ˆÚ›˜ ¿ÏÁÔ˜ ‹ ÊÏÂÁÌÔÓÒ‰Ë ÛÙÔȯ›·, Ô˘ ÂÂÎÙ¿ıËÎ·Ó Û ·ÓÙÈ‚Ú¿¯ÈÔ Î·È ¿ÎÚ· ¯Â›Ú· ÚÔηÏÒÓÙ·˜ ‰˘Ûη̄›· ÙÔ˘ ¿Óˆ ¿ÎÚÔ˘. ¶·ÚfiÌÔÈ· ÂͤÏÈÍË ¤ÎÙÔ˘ ÔÛÙÂÔÔ›ËÛ˘ ÂÌÊ·Ó›ÛÙËÎÂ Î·È ÛÙ· οو ¿ÎÚ·, ÍÂÎÈÓÒÓÙ·˜ ·fi ÙÔ ÈÛ¯›Ô, Ì ·ÚÔ˘Û›· Ôȉ‹Ì·ÙÔ˜ Î·È ÛÎÏËÚÒÓ Ì·˙ÒÓ Ô˘ ÂÂÎÙ¿ıËÎ·Ó ‚·ıÌÈ·›· ÛÙÔ ÌËÚÈ·›Ô, ÛÙÔ ÁfiÓ·ÙÔ Î·È ÙËÓ Ô‰ÔÎÓËÌÈ΋ ¿ÚıÚˆÛË, ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ÙËÓ ÂÈÎfiÓ· ÙÔ˘ “˙ˆÓÙ·ÓÔ‡ ·Á¿ÏÌ·ÙÔ˜”. ∏ ·ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË Î·Ù¿ Û˘ÛÙ‹Ì·Ù· Ô˘ ¤ÁÈÓ ÛÙÔ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∫∞∆ ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈο ˙ˆÙÈο ÛËÌ›· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ηډȷ΋ ÏÂÈÙÔ˘ÚÁ›·, ÂÓÒ Ô ·ÈÌ·ÙÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ Ì ÌfiÓÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙËÓ ‹È· ·‡ÍËÛË Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘. ∏ Ì˘ÔÛÎÂÏÂÙÈ΋ ÂͤٷÛË ·ÚÔ˘Û›·Û ÂÚÈÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚıÚÒÛˆÓ, ·ÒÏÂÈ· ΛÓËÛ˘ ÙÔ˘ ·˘¯¤Ó·, ıˆÚ·ÎÈ΋ Î·È ÔÛÊ˘˚΋ ÛÎÔÏ›ˆÛË, ÎÔÓÙ¿ ÌÂٷٿÚÛÈ· Î·È ‚Ï·ÈÛfi ̤Á· ‰¿ÎÙ˘ÏÔ ÙÔ˘ Ô‰ÈÔ‡. ∏ Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ηٿ ÙÔÓ ¤ÏÂÁ¯fi Ù˘ ·ÚÔ˘Û›·Û ‹ÈÔ˘ ‚·ıÌÔ‡ ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ Ó¢ÌÔÓÔ¿ıÂÈ·. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÂȂ‚·›ˆÛ ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ¤ÎÙÔ¶·È‰È·ÙÚÈ΋ 2005;68:217-220
∂ÈÎfiÓ· 1. £‹Ï˘ ÓÂÔÁÓfi ËÏÈΛ·˜ 4 ËÌÂÚÒÓ. ªÔÓ·‰È΋ ÛÎÂÏÂÙÈ΋ ·ÓˆÌ·Ï›· ·ÔÙÂÏÔ‡Ó Ù· ÎÔÓÙ¿ ÌÂÁ¿Ï· ‰¿ÎÙ˘Ï· Î·È Ô ‚Ï·ÈÛfi˜ ̤Á·˜ ‰¿ÎÙ˘ÏÔ˜ ÙÔ˘ Ô‰ÈÔ‡, Ù· ÔÔ›· Â›Ó·È ÚÔ¿ÁÁÂÏÔÈ Ù˘ ÓfiÛÔ˘.
ˆÓ ÂÛÙÈÒÓ ÔÛÙÂÔÔ›ËÛ˘ Î·È ÙËÓ ıˆÚ·ÎÔÔÛÊ˘˚΋ ÛÎÔÏ›ˆÛË. ∑ËÙ‹ıËΠ·fi ÙÔ ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ∫∞∆ Ë ‰È·ÁÓˆÛÙÈ΋ Î·È ıÂڷ¢ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·, ÛÈÓıËÚÔÁÚ¿ÊËÌ·, ‚ÈÔ„›· Ì˘fi˜ Î·È ÛÂÈÚÔÌÂÙÚÈÎfi ¤ÏÂÁ¯Ô. ∏ ÔÈÎÔÁ¤ÓÂÈ· ÙÔ˘ ·È‰ÈÔ‡, Ì ‚¿ÛË ÙËÓ ÚfiÁÓˆÛË Î·È ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘, ·ÚÓ‹ıËΠÙÔÓ ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈÎfi ¤ÏÂÁ¯Ô Î·È ÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ÔÚ›·˜ ÙÔ˘ Î·È Â¤ÛÙÚ„ ÛÙËÓ ∞Ï‚·Ó›·. ∆¤ÛÛÂÚȘ Ì‹Ó˜ ·ÚÁfiÙÂÚ· (∂ÈÎfiÓ· 3), Ë ÓfiÛÔ˜ ÂÂÎÙ¿ıËΠÛÙËÓ ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘ Î·È Ë ·ÛıÂÓ‹˜ ÛÈÙÈ˙fiÙ·Ó ÌfiÓÔ Ì Levine. ∆Ô ·È‰› η٤ÏËÍ ·fi Ó¢ÌÔÓ›· Û ÓÔÛÔÎÔÌÂ›Ô Ù˘ ∞Ï‚·Ó›·˜ ÏfiÁˆ ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì˘ÒÓ Î·È ‰˘Ûη̄›·˜ ÙÔ˘ ıÒڷη.
™˘˙‹ÙËÛË ∏ ÓfiÛÔ˜ FOP, ·Ó Î·È Û¿ÓÈ·, Â›Ó·È ˘·ÚÎÙ‹ ÛÙ· ·È‰È¿. ¶·ÚÔ˘ÛÈ¿˙ÂÈ ÔÈΛÏË ÎÏÈÓÈ΋
Paediatriki May-June 05
12-07-05
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¶ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔÈËÙÈ΋ ÈÓÔ‰˘ÛÏ·Û›·
∂ÈÎfiÓ· 2. ∏ ·ÛıÂÓ‹˜ Û ËÏÈΛ· 2 ÌËÓÒÓ. Œ¯ÂÈ ·Ú¯›ÛÂÈ Ë ÚÔԉ¢ÙÈ΋ ¤ÎÙÔË ÔÛÙÂÔÔ›ËÛË ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡.
¤ÎÊÚ·ÛË Î·È ÚÔÛ‚ÔÏ‹ ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ Ì ¤ÎÙÔË ÔÛÙÂÔÔ›ËÛË Î·È ÂÌÊ·Ó›˙ÂÙ·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ, ÂÓÒ ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ, fiˆ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È (3,4). ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·Ó·fi‰ÂÈÎÙË, ·Ó Î·È ÌÔÚ› Ó· ‰È¢ÎÚÈÓÈÛÙ› Ì ÙË ‚·ıÈ¿ ÁÓÒÛË ÙÔ˘ ÙÚfiÔ˘ ‰Ú¿Û˘ ÙˆÓ ÔÛÙÂÔÚÚ˘ıÌÈÛÙÈÎÒÓ ÚˆÙÂ˚ÓÒÓ. ∞ӷʤÚÂÙ·È fiÙÈ Ë ÚÔԉ¢ÙÈ΋ ÂͤÏÈÍË Ù˘ ¤ÎÙÔ˘ ÔÛÙÂÔÔ›ËÛ˘ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÂÌ‚Ú˘ÔÏÔÁÈ΋˜ ÛÎÂÏÂÙÈ΋˜ ·Ó¿Ù˘Í˘, ¤ÙÛÈ ÒÛÙÂ Ë ÂÏ·Ùو̷ÙÈ΋ Ú‡ıÌÈÛË Ù˘ ·ÁˆÁ‹˜ Ù˘ ÔÛÙÂÔÔ›ËÛ˘ Ó· Â›Ó·È Ô ÂÈÎÚ·Ù¤ÛÙÂÚÔ˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·˘Ù‹˜ Ù˘ ·Ûı¤ÓÂÈ·˜ (5). ¶ÚfiÛÊ·Ù·, Ë ‰Ú·Ì·ÙÈ΋ ˘ÂÚ¤ÎÊÚ·ÛË Ì›·˜ Ú˘ıÌÈÛÙÈ΋˜ ÚˆÙ½Ó˘ BMP 4, Ì›· ÔÛÙÈ΋ ÌÔÚÊÔÁÂÓÂÙÈ΋ ÚˆÙ½ÓË, ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Û ÏÂÌÊÔ·ÙÙ·Ú· ·ÛıÂÓÒÓ Ì FOP. ∆Ô ÁÔÓ›‰ÈÔ ÁÈ· ÙËÓ ÚˆÙ½ÓË BMP 4 ¤¯ÂÈ ¯·ÚÙÔÁÚ·ÊËı› ÛÙÔ ¯ÚˆÌfiۈ̷ 14q22-q23 ηÈ, Ê˘ÛÈο, Ë ¤ÎÊÚ·ÛË ÙˆÓ ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔ ÁÔÓ›‰ÈÔ ·ÔÙÂÏ› ·fi‰ÂÈÍË ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘ (6). ∆· ·È‰È¿ ÁÂÓÓÈÔ‡ÓÙ·È ¯ˆÚ›˜ ÔÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ‹ ÂÚÈÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ
∂ÈÎfiÓ· 3. ∏ ·ÛıÂÓ‹˜ Û ËÏÈΛ· 4 ÌËÓÒÓ. ∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋ Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ “˙ˆÓÙ·ÓÔ‡ ·Á¿ÏÌ·ÙÔ˜”.
·ÚıÚÒÛˆÓ. ∏ ÌfiÓË ·Ú·ÌfiÚʈÛË Ô˘ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛÙ› ηٿ ÙË Á¤ÓÓËÛË Î·È ·ÔÙÂÏ› ÙÔÓ ÚÔ¿ÁÁÂÏÔ Ù˘ ÓfiÛÔ˘ Â›Ó·È ÔÈ ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ Ô‰ÈÔ‡, Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ù· ÎÔÓÙ¿ ÌÂÁ¿Ï· ‰¿¯Ù˘Ï·, ÙÔ ·˘ÍË̤ÓÔ Ì¤ÁÂıÔ˜ Î·È ÙË ‚Ï·ÈÛ‹ ı¤ÛË ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‰·¯Ù‡ÏÔ˘ (7), ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ˘‹Ú¯Â ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È. ∞ÚÁfiÙÂÚ·, Ì ÙËÓ ·ÚÔ˘Û›· οÔÈÔ˘ ·ÈÙÈÔÏÔÁÈÎÔ‡ ·Ú¿ÁÔÓÙ· (ÙÚ·‡Ì·, ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË) ‹ ·˘ÙfiÌ·Ù·, ÂÌÊ·Ó›˙ÔÓÙ·È ÂÒ‰˘Ó˜ ‹ ·ÓÒ‰˘Ó˜ ÂÚ˘ıËÌ·ÙÒ‰ÂȘ, ÛÎÏËÚ‹˜ Û‡ÛÙ·Û˘ Ì¿˙˜ Û ٤ÓÔÓÙ˜, Û˘Ó‰¤ÛÌÔ˘˜ Î·È ÂÚÈÙÔӛ˜ Î·È ÂÂÎÙ›ÓÔÓÙ·È ÚÔԉ¢ÙÈο ·fi ÙÔÓ ·˘¯¤Ó· ˙ˆÓÔÂȉҘ ÚÔ˜ Ù· ÂÌÚfi˜, ·fi ÙÔ Î¤ÓÙÚÔ ÚÔ˜ ÙËÓ ÂÚÈʤÚÂÈ· Î·È ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¿ÍÔÓ· Ù˘ ™™ ÛÙÔ Ô˘Ú·›Ô ÙÌ‹Ì· Ù˘. ∆· ¿Óˆ ¿ÎÚ· ÚÔÛ‚¿ÏÏÔÓÙ·È ÚÈÓ ·fi Ù· οو ¿ÎÚ· (8,9). ÕÏϘ ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ù˘ FOP Â›Ó·È Ë ˘ÔÏ·Û›· ÙˆÓ ÌÂٷٷÚÛ›ˆÓ Î·È ÙˆÓ ÌÂٷηڛˆÓ, Ë Ú˯‹ ÎÔÙ‡ÏË Î·È Ë ‰Èۯȉ‹˜ Ú¿¯Ë (10). ∏ ÔÛÙÂÔÔ›ËÛË ÙˆÓ ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì˘ÒÓ Î·È Ë Û˘ÓÔÛÙ¤ˆÛË ÙˆÓ ¯ÔÓ‰ÚÔÏ¢ÚÈÎÒÓ ·ÚıÚÒÛÂˆÓ ÙÔ˘ ıÒڷη Ô‰ËÁÔ‡Ó Û ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘ Ó¢ÌÔÓÔ¿ıÂÈ· Î·È ·˘Í¿ÓÔ˘Ó ÙÔÓ Î›Ó‰˘ÓÔ Ù˘ Ó¢ÌÔÓ›·˜, ‰‡Ô ‚·ÛÈΤ˜ ·Èٛ˜ ÓÔÛËÚfiÙËÙ·˜ ¶·È‰È·ÙÚÈ΋ 2005;68:217-220
Paediatriki May-June 05
12-07-05
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O. ¢Ô‡ÙÛ˘ Î·È Û˘Ó.
Î·È ıÓËÛÈÌfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ∏ ÚÔԉ¢ÙÈ΋ ÔÛÙÂÔÔ›ËÛË ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ‰È¿ÊÚ·ÁÌ·, ÙÔ˘˜ ÂÍÔÊı¿ÏÌÈÔ˘˜ Ì˘˜, ÙÔ ÙÔ›¯ˆÌ· Ù˘ ηډȿ˜ Î·È ÙÔ˘˜ Ï›Ԣ˜ Ì˘˜. ∞ÒÏÂÈ· ·ÎÔ‹˜ ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 25%, ÂÓÒ ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË Û 5% (11). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ¢·ÈÛıËÛ›· Î·È ÂÚÈÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚıÚÒÛÂˆÓ ÙˆÓ ¿ÎÚˆÓ, ÂÓÒ ˘‹Ú¯·Ó Î·È Û˘ÌÙÒÌ·Ù· ÚÔÛ‚ÔÏ‹˜ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÏfiÁˆ Ù˘ ÚÔԉ¢ÙÈ΋˜ ÔÛÙÂÔÔ›ËÛ˘ ÙˆÓ ·Ú·ÛÔÓ‰˘ÏÈÎÒÓ Ì˘ÒÓ ÙÔ˘ ıÒڷη. ∏ ‰È¿ÁÓˆÛË Ù˘ FOP Â›Ó·È ÎÏÈÓÈ΋, ·Ó Î·È ÔÏϤ˜ ÊÔÚ¤˜ ηı˘ÛÙÂÚ› ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ∂¿Ó Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈ΋, Ë ÂȂ‚·›ˆÛË Ì ‚ÈÔ„›· Ì˘fi˜ ·ÓÙÂӉ›ÎÓ˘Ù·È ÁÈ·Ù› ÂÈÙ·¯‡ÓÂÙ·È Ë ‰È·‰Èηۛ· Ù˘ ÔÛÙÂÔÔ›ËÛ˘ Î·È ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ϷÓı·Ṳ̂ÓË ‰È¿ÁÓˆÛË, fiˆ˜ Ú·‚‰ÔÌ˘ÔÛ¿ÚΈ̷ (2). ∆· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Â›Ó·È Ê˘ÛÈÔÏÔÁÈο, ÂÎÙfi˜ ·fi Ì›· ‹È· ·‡ÍËÛË Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÚÈfi‰ˆÓ Ù˘ ¤ÎÙÔ˘ ÔÛÙÂÔÔ›ËÛ˘. O ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·ÏÒ˜ ÂȂ‚·ÈÒÓÂÈ ÙȘ ÂÛٛ˜ ¤ÎÙÔ˘ ÔÛÙÂÔÔ›ËÛ˘ Î·È ÙȘ ÛÎÂÏÂÙÈΤ˜ ‰˘ÛÌÔÚʛ˜. ¶·ÚfiÌÔÈ· ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ˘‹Ú¯·Ó Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È, ÂÓÒ ÂÚ·ÈÙ¤Úˆ ‰È·ÁÓˆÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‰ÂÓ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÏfiÁˆ ¿ÚÓËÛ˘ ÙˆÓ ÁÔÓ¤ˆÓ. ™‹ÌÂÚ· ‰ÂÓ ˘¿Ú¯ÂÈ Û˘ÁÎÂÎÚÈ̤ÓË ıÂڷ›· Ô˘ Ó· ÌÔÚ› Ó· ·ÏÏ¿ÍÂÈ ÙËÓ ÔÚ›· Ù˘ FOP. ∏ ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÛÙËÓ ÂÓÙfiÈÛË Î·È ÛÙÔÓ ¯ÚfiÓÔ ÂÊfi‰Ô˘ Ù˘ ÓfiÛÔ˘ οÓÂÈ ‰‡ÛÎÔÏÔ ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi οÔÈÔ˘ Ù‡Ô˘ ıÂڷ›·˜. ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ ÚÔÙÂÈÓfiÌÂÓÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì· ÁÈ· ÙË FOP ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ Î·È ÙËÓ ÂÙȉÚÔÓ¿ÙË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‰È¿ÊÔÚ˜ ¯ÂÈÚÔ˘ÚÁÈΤ˜ ÂÂÌ‚¿ÛÂȘ ÁÈ· ÙËÓ ÎÈÓËÙÔÔ›ËÛË ÙˆÓ ·ÚıÚÒÛˆÓ. ∆· ÎÔÚÙÈÎÔÛÙÂÚÔÂȉ‹ ÌÔÚ› Ó· Â›Ó·È ¯Ú‹ÛÈÌ· Û ¤ÓÙÔÓ· ÊÏÂÁÌÔÓÒ‰Ë ÂÂÈÛfi‰È·, ·Ú’ fiÏÔ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ·fi‰ÂÈÍË fiÙÈ ÂÚÈÔÚ›˙Ô˘Ó ÙËÓ ¤ÎÙÔË ÔÛÙÂÔÔ›ËÛË (12). ™ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ÙÔ ÌÔÓ·‰ÈÎfi ˘ÔÛ¯fiÌÂÓÔ Ê¿ÚÌ·ÎÔ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ë ÂÙȉÚÔÓ¿ÙË (Û ‰fiÛÂȘ 20 mg/kg), Ô˘ ÌÂÈÒÓÂÈ ÙËÓ ¤ÎÙÔË ÔÛÙÂÔÔ›ËÛË, ·Ó Î·È Ë ¯ÔÚ‹ÁËÛ‹ Ù˘ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÚÔηÏ› Ì›ˆÛË Ù˘ ¿Ì˘Ó·˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ηٿÁÌ·Ù· Î·È Ì˘˚΋ ·‰˘Ó·Ì›· (13). ∏ ¯ÔÚ‹ÁËÛË ·Û‚ÂÛÙ›Ô˘ Î·È ‚ÈÙ·Ì›Ó˘ D ¤¯ÂÈ ·Ô‰ÂȯÙ› fiÙÈ Âȉڿ ÛÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘ (1).
¶·È‰È·ÙÚÈ΋ 2005;68:217-220
∏ FOP Â›Ó·È Û¿ÓÈ· ÓfiÛÔ˜ ÛÙ· ·È‰È¿. ∫‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÁÓÒÚÈÛÌ· Â›Ó·È ÔÈ ÂȉÈΤ˜ ÔÛÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙˆÓ ‰·¯Ù‡ÏˆÓ ÙÔ˘ Ô‰ÈÔ‡ ηٿ ÙË Á¤ÓÓËÛË. ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi Ó· ·Ó·ÁÓˆÚ›˙ÂÙ·È ¤ÁηÈÚ· ·fi ÙÔÓ ·È‰›·ÙÚÔ, ‰ÈfiÙÈ ‰È·ÊÔÚÂÙÈο ÌÔÚ› Ó· ˘¿ÚÍÂÈ Ï·Óı·Ṳ̂ÓË ‰È¿ÁÓˆÛË Î·È ıÂڷ›·.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Fonseca JE, Branco JC, Reis J, Evangelista T, Tavares V, Gomes AR et al. Fibrodysplasia ossificans progressiva: report of two cases. Clin Exp Rheumatol 2000;18:749-752. 2. Smith R. Fibrodysplasia (myositis) ossificans progressiva. Clinical lessons from a rare disease. Clin Orthop Relat Res 1998;346:7-14. 3. Rogers JG, Geho WB. Fibrodysplasia ossificans progressiva. A survey of forty-two cases. J Bone Joint Surg Am 1979;61:909-914. 4. Connor JM, Evans DA. Fibrodysplasia ossificans progressiva. The clinical features and natural history of 34 patients. J Bone Joint Surg Br 1982;64:76-83. 5. Shafritz AB, Shore EM, Gannon FH, Zasloff MA, Taub R, Muenke M et al. Overexpression of an osteogenic morphogen in fibrodysplasia ossificans progressiva. N Engl J Med 1996;335:555-561. 6. Delatycki M, Rogers JG. The genetics of fibrodysplasia ossificans progressiva. Clin Orthop Relat Res 1998;346:15-18. 7. Schroeder HW Jr, Zasloff M. The hand and foot malformations in fibrodysplasia ossificans progressiva. Johns Hopkins Med J 1980;147:73-78. 8. Kaplan FS, McCluskey W, Hahn G, Tabas JA, Muenke M, Zasloff MA. Genetic transmission of fibrodysplasia ossificans progressiva. Report of a family. J Bone Joint Surg Am 1993;75:1214-1220. 9. Rocke DM, Zasloff M, Peeper J, Cohen RB, Kaplan FS. Age- and joint-specific risk of initial heterotopic ossification in patients who have fibrodysplasia ossificans progressiva. Clin Orthop Relat Res 1994;301: 243-248. 10. Shah PB, Zasloff MA, Drummond D, Kaplan FS. Spinal deformity in patients who have fibrodysplasia ossificans progressiva. J Bone Joint Surg Am 1994; 76:1442-1450. 11. O’Reilly M, Renton P. Metaphyseal abnormalities in fibrodysplasia ossificans progressiva. Br J Radiol 1993;66:112-116. 12. Illingworth RS. Myositis ossificans progressiva. Brief review with report of two cases treated with corticosteroids and observed for 16 years. Arch Dis Child 1971;46:264-268. 13. Rogers JG, Dorst JP, Geho WB. Use and complications of high-dose disodium etidronate therapy in fibrodysplasia ossificans progressiva. J Pediatr 1977;91:1011-1014.
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Fibrodysplasia ossificans progressiva: a rare disease with the clinical features of a “live statue” O. Doutsis, A. Kalampokis, C. Tsoumakas
Paediatric Department, KAT Hospital, Attica
Abstract Fibrodysplasia ossificans pogressiva is a rare hereditary disease, sporadic in nature, due to increased spontaneous mutations. The predominant characteristic of the disease is the progressive development of multiple ectopic foci of ossification within the connective tissue and the striated muscle, which cause ankylosis and bone malformations, resulting in the so-called “live statue” appearance. The main cause of death is the development of restrictive type pneumonopathy, due to impaired movement of the paraspinal muscles and ankylosis of the chest wall. Despite the unique clinical characteristics, the initial diagnosis is often mistaken and the disease is usually recognized rather late. The case is presented of a 2 month-old girl, who presented with progressive ossification of soft tissues, restricted joint mobility and symptoms of lower respiratory system infection. Routine laboratory tests were normal, but the radiological evaluation confirmed sites of ectopic ossification. No further diagnostic investigation was made, or therapeutic intervention attempted, according to her parents’ wishes. The prognosis of the disease is disappointing, while treatment is still at the experimental stage.
Correspondence: Anastasios Kalampokis 69 Nikomachou str., 163 41, Ilioupoli E-mail: kalabok@mycosmos.gr Date of submission: 16-09-2003 Date of approval: 04-03-2005
Key words Ectopic ossification, hallux valgus, osteal malformations, pneumonopathy, etidronate.
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¶ÂÚ›ÏË„Ë ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ¿ÚÚÂÓÔ˜ ‚Ú¤ÊÔ˘˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ Ô˘ ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ‚·ÚÈ¿ Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹: ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›·, ·ÓÙ›‰Ú·ÛË ÌfiÓÔ ÛÙ· ÂÒ‰˘Ó· ÂÚÂı›ÛÌ·Ù· Î·È ¿ÓÔÈ·. ¢Ò‰Âη ÒÚ˜ ·ÚÁfiÙÂÚ· ·ÚÔ˘Û›·Û ÂÂÈÛfi‰ÈÔ Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋˜ ·Ó·ÎÔ‹˜ Ô˘ ·Ó·Ù¿¯ıËÎÂ. ™ÙË Û˘Ó¤¯ÂÈ·, ‰È·ÛˆÏËÓÒıËÎÂ Î·È ÂÈÛ‹¯ıË ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ (ª∂£). O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ ‚ÚÂÊÈ΋˜ ·ÏÏ·ÓÙ›·Û˘ Ì ÙËÓ ·Ó‡ÚÂÛË ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ Ù˘ ·ÏÏ·ÓÙ›·Û˘ Î·È Ù˘ ·ÏÏ·ÓÙÈÔÁfiÓÔ˘ ÙÔ͛Ӣ Ù‡Ô˘ ∞ ÛÙ· ÎfiÚ·Ó·. ∏ ıÂڷ›· ‹Ù·Ó ˘ÔÛÙËÚÈÎÙÈ΋ Î·È ÂÚÈÂÏ¿Ì‚·Ó Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi (99 Ë̤Ú˜), ÂÓÙÂÚÈ΋ Û›ÙÈÛË Î·È ÚfiÏË„Ë ÙˆÓ ÏÔÈÌÒ͈Ó. ¶·Ú¿ ÙË ‚·Ú‡Ù·ÙË ÚÔÛ‚ÔÏ‹ Î·È ÙÔÓ ·Ú·ÙÂٷ̤ÓÔ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, Ë ¤Î‚·ÛË ÙÔ˘ ‚Ú¤ÊÔ˘˜ ‹Ù·Ó Ôχ ηϋ. §¤ÍÂȘ ÎÏÂȉȿ µÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË, Ì˯·ÓÈÎfi˜ ·ÂÚÈÛÌfi˜.
∂ÈÛ·ÁˆÁ‹ ∏ ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË Â›Ó·È Ì›· Û¿ÓÈ· Ó¢ÚÔ·Ú·Ï˘ÙÈ΋ ÓfiÛÔ˜, Ë ÔÔ›· ÚÔηÏÂ›Ù·È ·fi ÙËÓ ·ÏÏ·ÓÙÈÔÁfiÓÔ ÙÔÍ›ÓË Ô˘ ·Ú¿ÁÂÙ·È Î˘Ú›ˆ˜ ·fi ÙÔ Clostridium botulinum. ™ÙËÓ ∂˘ÚÒË, Ù· ÙÂÏÂ˘Ù·›· 20 ¯ÚfiÓÈ· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÌfiÓÔ 49 ÂÚÈÙÒÛÂȘ ‚ÚÂÊÈ΋˜ ·ÏÏ·ÓÙ›·Û˘ (1). OÈ ÎÏ·ÛÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ‰˘ÛÎÔÈÏÈfiÙËÙ·, Ë ÚÔÛ‚ÔÏ‹ ÎÚ·ÓÈ·ÎÒÓ Î·È ÂÚÈÊÂÚÈÎÒÓ Ó‡ڈÓ, Ë ˘ÔÙÔÓ›· Î·È Ë ‰È·Ù·Ú·¯‹ Ù˘ ·Ó·ÓÔ‹˜ (2). ¶ÂÚÈÁÚ¿ÊÂÙ·È Ë ÂÚ›ÙˆÛË ‚Ú¤ÊÔ˘˜ ËÏÈΛ·˜ 3 ÌËÓÒÓ Ô˘ ÚÔÛ‹Ïı Ì ÔÍ›· Ó¢ÚÔÏÔÁÈ΋ Û˘Ó‰ÚÔÌ‹ Î·È 12 ÒÚ˜ ·ÚÁfiÙÂÚ· ·ÚÔ˘Û›·Û ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó·ÎÔ‹.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ÕÚÚÂÓ ‚Ú¤ÊÔ˜, ËÏÈΛ·˜ 3 ÌËÓÒÓ, ÂÈÛ‹¯ıË ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ÏfiÁˆ ÓˆıÚfiÙËÙ·˜, ˘ÓËÏ›·˜ Î·È ÌÂȈ̤Ó˘ Ï‹„˘ ÙÚÔÊ‹˜ ·fi 24ÒÚÔ˘. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ‰È·ÈÛÙÒıËΠÂËÚ·Ṳ̂ÓË ÁÂÓÈ΋ ηٿÛÙ·ÛË, ˘ÔÙÔÓ›· Î·È ·ÓÙ›‰Ú·ÛË ÌfiÓÔ ÛÙ· ÂÒ‰˘Ó· ÂÚÂı›ÛÌ·Ù·. ∆Ô ‚Ú¤ÊÔ˜ ‹Ù·Ó ÙÔ Ù¤Ù·ÚÙÔ ·È‰› ÔÌÔÁÂÓÒÓ ·fi ÙË ƒˆÛ›·. ∏ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô˜, ηıÒ˜ Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ Î·È ÛˆÌ·ÙÈ΋ ÂͤÏÈÍ‹ ÙÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∞fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤¶·È‰È·ÙÚÈ΋ 2005;68:222-224
ÚÂÙ·È ÌfiÓÔ ‰˘ÛÎÔÈÏÈfiÙËÙ· ·fi 10Ë̤ÚÔ˘. ∏ Û›ÙÈÛ‹ ÙÔ˘ ‹Ù·Ó ·ÔÎÏÂÈÛÙÈο Ì ÌËÙÚÈÎfi Á¿Ï·. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ·ÂÈÎÔÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ô˘ ¤ÁÈÓ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘ ÛÙËÓ ÎÏÈÓÈ΋ ÂÚÈÂÏ¿Ì‚·Ó ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ‚ÈÔ¯ËÌÈÎfi ¤ÏÂÁ¯Ô, ‰Â›ÎÙ˜ Ïԛ̈͢, ·¤ÚÈ· ·›Ì·ÙÔ˜, U/S Î·È CT ÂÁÎÂÊ¿ÏÔ˘. ∞fi ·˘ÙfiÓ ÙÔÓ ¤ÏÂÁ¯Ô ‰ÂÓ ÚԤ΢„·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ªÂ ÙËÓ ˘Ô„›· Ïԛ̈͢ ÙÔ˘ ∫¡™ ¯ÔÚËÁ‹ıËΠ·Î˘ÎÏÔ‚›ÚË (i.v. 30 mg/kg/24 h) Î·È ÎÂÊÔÙ·Í›ÌË (i.v. 200 mg/kg/24 h). ¶ÂÚ›Ô˘ 12 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÙÔ˘, ÙÔ ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û ·Ú·ÙÂٷ̤ÓË ¿ÓÔÈ·, ˘ÔÍ·ÈÌ›· Î·È Î·Ú‰ÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó·ÎÔ‹. ŒÁÈÓ ηډÈÔ·Ó·Ó¢ÛÙÈ΋ ·Ó·˙ˆÔÁfiÓËÛË (‰È·ÛˆÏ‹ÓˆÛË Ù˘ ÙÚ·¯Â›·˜, ηډȷΤ˜ Ì·Ï¿ÍÂȘ Î·È ¯ÔÚËÁ‹ıËΠ·‰ÚÂÓ·Ï›ÓË ÂÓ‰ÔÊÏ‚›ˆ˜ Û ‰fiÛË 10 Á/kg) Î·È ÙÔ ‚Ú¤ÊÔ˜ ·Ó¤ÓË„Â. ªÂٷʤÚıËΠ‰È·ÛˆÏËӈ̤ÓÔ Î·È Î·Ù·ÛÙ·Ï̤ÓÔ ÛÙË ª∂£ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË. OÈ ÚÒÙ˜ Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ ÂÚÈÂÏ¿Ì‚·Ó·Ó ÛË„·ÈÌ›·, Ïԛ̈ÍË ÙÔ˘ ∫¡™, ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ·, ˘Ôı˘ÚÂÔÂȉÈÛÌfi, ‰ËÏËÙËÚ›·ÛË, ηÎÔÔ›ËÛË Î·È Ì˘·Ûı¤ÓÂÈ·. ŒÁÈÓ ÂÎÙÂٷ̤ÓÔ˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˜ ·˘Ù¤˜ ÙȘ ηÙ¢ı‡ÓÛÂȘ, Ô ÔÔ›Ô˜ ·¤‚Ë ·ÚÓËÙÈÎfi˜. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ÙÔ˘ ·È‰ÈÔ‡ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹ ÛÙË ª∂£ Î·È ·ÊÔ‡ ›¯·Ó ‰È·ÎÔ› Ù· ηٷÛÙ·ÏÙÈο Ê¿Ú̷η Ô˘ ›¯Â Ï¿‚ÂÈ ÁÈ· 4 ÒÚ˜ ‹Ù·Ó Ë ·ÎfiÏÔ˘ıË: ‰ÂÓ ¿ÓÔÈÁ ٷ Ì¿ÙÈ·, ›¯Â Ì˘‰Ú›·ÛË ¿Ìʈ ¯ˆÚ›˜ ·ÓÙ›‰Ú·ÛË ÙˆÓ ÎÔÚÒÓ ÛÙÔ Êˆ˜,
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™Ô‚·Ú‹ ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË
˘ÔÙÔÓ›·, ˘ÔÙ˘Ò‰Ë ÎÈÓËÙÈÎfiÙËÙ· ÛÙ· οو ¿ÎÚ· (ÎÈÓ‹ÛÂȘ ÙˆÓ ‰·ÎÙ‡ÏˆÓ ÌfiÓÔ Û·Ó ÓˆÙÈ·›· ·ÓÙ›‰Ú·ÛË) Î·È Î·Ù·ÚÁË̤ӷ ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο. ∂›Û˘, Ù· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ÙÔ˘ ÛÙÂϤ¯Ô˘˜ ‰ÂÓ ÂÎχÔÓÙ·Ó Î·È ÙÔ test ¿ÓÔÈ·˜ ‹Ù·Ó ·ÚÓËÙÈÎfi (ˆ˜ › ÎÂÓÙÚÈ΋˜ ¿ÓÔÈ·˜). ∆Ô ‚Ú¤ÊÔ˜ ›¯Â ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ¤ÌÔÈ·˙ Ì ÂÁÎÂÊ·ÏÈÎfi ı¿Ó·ÙÔ, ·ÏÏ¿ ÙÔ ∏∂° Î·È ÙÔ MRI ÂÁÎÂÊ¿ÏÔ˘ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ Î·È ·ÊÔ‡ ›¯·Ó ·ÔÎÏÂÈÛÙ› ÔÈ ¿ÏϘ ·ıÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Ô˘ ·Ó·Ê¤ÚıËηÓ, Ù¤ıËΠˆ˜ Èı·Ó‹ ‰È¿ÁÓˆÛË Ë ·ÏÏ·ÓÙ›·ÛË. °È· ÙËÓ ÙÂÎÌËÚ›ˆÛË ·˘Ù‹˜ Ù˘ ‰È¿ÁÓˆÛ˘ ÛÙ¿ÏıËÎ·Ó ÎfiÚ·Ó· ÁÈ· ·Ó‡ÚÂÛË ÙÔ˘ Clostridium botulinum Î·È Ù˘ ·ÏÏ·ÓÙÈÔÁfiÓÔ˘ ÙÔ͛Ӣ Û ÂȉÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ, ÙÔ Central Public Health Laboratory ÙÔ˘ §ÔÓ‰›ÓÔ˘. ∆· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ıÂÙÈο ÁÈ· Cl. botulinum Î·È ÙÔÍ›ÓË Ù‡Ô˘ ∞. ∏ ıÂڷ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜ Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜ ÙÔ˘ ÛÙË ª∂£ ‹Ù·Ó ˘ÔÛÙËÚÈÎÙÈ΋. ¶·Ú¤ÌÂÈÓ ‰È·ÛˆÏËӈ̤ÓÔ Û ϋÚË ÂÏÂÁ¯fiÌÂÓÔ Î·È Û ˘Ô‚ÔËıÔ‡ÌÂÓÔ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi ÁÈ· 99 Ë̤Ú˜. O ÂÓ‰ÔÛÎÔÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ¤ÁÈÓ ÁÈ· Ó· ‰È·ÈÛÙˆı› Â¿Ó ˘‹Ú¯·Ó ‚Ï¿‚˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ÙÚ·¯Â›·˜ Î·È ÙˆÓ ÊˆÓËÙÈÎÒÓ ¯ÔÚ‰ÒÓ ÏfiÁˆ ·Ú·ÙÂٷ̤ÓÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡, ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ∆Ô ‚Ú¤ÊÔ˜ ÂÍ‹Ïı ·fi ÙË ª∂£, ÌÂÙ¿ ·fi 3,5 Ì‹Ó˜ ÓÔÛËÏ›·˜, Ì ‚ÂÏÙȈ̤ÓË Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ·. ∂›¯Â ηÏfi Â›Â‰Ô Û˘Ó›‰ËÛ˘, ¯·ÌÔÁÂÏÔ‡ÛÂ, ¤ÎÏ·ÈÁÂ, ·Ú·ÎÔÏÔ˘ıÔ‡ÛÂ Î·È ¤È·Ó ‰È¿ÊÔÚ· ·ÓÙÈΛÌÂÓ·. ™Ù‹ÚÈ˙ ·ÚÎÂÙ¿ ηϿ ÙÔ ÎÂÊ¿ÏÈ Î·È ÙÔÓ ÎÔÚÌfi ÙÔ˘, ›¯Â ηϋ ÎÈÓËÙÈÎfiÙËÙ· ÛÙ· ¿Óˆ ¿ÎÚ· Î·È ÌÂȈ̤ÓË ÛÙ· οو ¿ÎÚ·. ∆· ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ‹Ù·Ó ÂÏ·Ùو̤ӷ. ™Â ·ÓÂͤٷۋ ÙÔ˘, Ô˘ ¤ÁÈÓ ÂÚ›Ô˘ 5 Ì‹Ó˜ ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘, Ë Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ‹Ù·Ó Ôχ ηϋ, ·Ú¤ÌÂÓ ÌfiÓÔ ÂÏ·Ùو̤ÓË Ë ÂÎÊÚ·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÚÔÛÒÔ˘.
™˘˙‹ÙËÛË ∏ ·ÏÏ·ÓÙ›·ÛË Â›Ó·È Ì›· Û¿ÓÈ·, ‰˘ÓËÙÈο ı·Ó·ÙËÊfiÚ·, Ó¢ÚÔ·Ú·Ï˘ÙÈ΋ ÓfiÛÔ˜. ¶ÚÔηÏÂ›Ù·È ·fi ÙËÓ ·ÏÏ·ÓÙÈÔÁfiÓÔ ÙÔÍ›ÓË Ô˘ ·Ú¿ÁÂÙ·È ·fi ‰È¿ÊÔÚ· ›‰Ë ÎψÛÙËÚȉ›ˆÓ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Cl. botulinum, butiricum, baratii. ∆Ô Cl. botulinum Â›Ó·È Î˘Ú›ˆ˜ ˘Â‡ı˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘. À¿Ú¯Ô˘Ó 7 ›‰Ë ÎψÛÙËÚȉ›ˆÓ (A ¤ˆ˜ G), 5 ·fi Ù· ÔÔ›· Â›Ó·È ˘Â‡ı˘Ó· ÁÈ· ÙË ÓfiÛÔ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ Î·È Î˘Ú›ˆ˜ ÔÈ Ù‡ÔÈ ∞ Î·È µ (2-4). ∏ ·ÏÏ·ÓÙÈÔÁfiÓÔ˜ ÙÔÍ›ÓË
Â›Ó·È Ë ÈÔ ÈÛ¯˘Ú‹ ‚ÈÔÏÔÁÈ΋ ÙÔÍ›ÓË Ô˘ ˘¿Ú¯ÂÈ. ¢fiÛÂȘ ·fi 0,05 Á ¤ˆ˜ 0,1 Á ÌÔÚÔ‡Ó Ó· ÚÔηϤÛÔ˘Ó ı¿Ó·ÙÔ ÛÙÔÓ ¿ÓıÚˆÔ (3,5). ∏ ÓfiÛÔ˜ ÚÔ‚¿ÏÏÂÈ Ì ̛· ·fi ÙȘ 4 ÌÔÚʤ˜: ÙÚÔÊÈ΋, ÙÚ·˘Ì·ÙÈ΋, ‚ÚÂÊÈ΋ Î·È ·Ù·ÍÈÓfiÌËÙË (2,3). ∏ ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË Â›Ó·È Ë Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹, ÂÌÊ·ÓÈ˙fiÌÂÓË ÛÙÔ 60% ÙˆÓ ÂÚÈÙÒÛˆÓ. ¶ÚÔÛ‚¿ÏÏÂÈ ‚Ú¤ÊË ËÏÈΛ·˜ 1 ‚‰ÔÌ¿‰·˜ ¤ˆ˜ 12 ÌËÓÒÓ. ∆Ô 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Â›Ó·È ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÌËÓÒÓ, Ì ÙË ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 2-3 ÌËÓÒÓ (2,4). ∏ ‡ÏË ÂÈÛfi‰Ô˘ Â›Ó·È Ë ÂÙÈ΋ Ô‰fi˜. O ¯ÚfiÓÔ˜ ÂÒ·Û˘ ÙˆÓ ÎψÛÙËÚȉ›ˆÓ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 3 Î·È 30 ËÌÂÚÒÓ. ¶ËÁ¤˜ ÌfiÏ˘ÓÛ˘ Â›Ó·È Û˘Ó‹ıˆ˜ ÙÔ ¯ÒÌ·, Ë ÛÎfiÓË Î·È ÙÔ Ì¤ÏÈ. ∂ȉËÌÈÔÏÔÁÈο, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‚ÚÂÊÈ΋˜ ·ÏÏ·ÓÙ›·Û˘ ÂΉËÏÒÓÔÓÙ·È ÛÙËÓ ∞ÌÂÚÈ΋ (ÂÚ›Ô˘ 70-100 ·Ó¿ ¤ÙÔ˜ Î·È Ë ËÁ‹ ÌfiÏ˘ÓÛ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË ÛÙÔ 85% ÙˆÓ ÂÚÈÙÒÛˆÓ) (2,4). ∆Ô Ì¤ÏÈ ÂÓÔ¯ÔÔÈÂ›Ù·È ÌfiÓÔ ÁÈ· ÙÔ 5% ·˘ÙÒÓ. ™ÙËÓ ∂˘ÚÒË, ·fi ÙÔ 1978 ̤¯ÚÈ ÙÔ 2002 ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÌfiÓÔ 49 ÂÚÈÙÒÛÂȘ, ÔÛÔÛÙfi 60% ÂÎ ÙˆÓ ÔÔ›ˆÓ Û˘Ó‰˘¿˙ÂÙ·È Ì ÙËÓ Î·Ù·Ó¿ÏˆÛË ÌÂÏÈÔ‡ (1). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ‰ÂÓ ·Ó·Ê¤ÚıËΠηٷӿψÛË ÌÂÏÈÔ‡. ¶ËÁ‹ ÌfiÏ˘ÓÛ˘ ‹Ù·Ó Èı·ÓÒ˜ ÙÔ ¯ÒÌ·, ·ÊÔ‡ ÔÈ ÁÔÓ›˜ ·Ó¤ÊÂÚ·Ó fiÙÈ Ë ·‰ÂÚÊ‹ ÙÔ˘ ‚Ú¤ÊÔ˘˜ ¤·È˙ Ì ¯ÒÌ· Î·È ¤È·ÓÂ Î·È ÙÔ ‚Ú¤ÊÔ˜. ªÂÙ¿ ÙÔÓ ·ÔÈÎÈÛÌfi ÙÔ˘ ÂÓÙ¤ÚÔ˘, Ù· ÎψÛÙËÚ›‰È· ·Ú¿ÁÔ˘Ó ÙÔÍ›ÓË, Ë ÔÔ›· ÌÂٷʤÚÂÙ·È ÛÙȘ ÚÔÛ˘Ó·ÙÈΤ˜ Ó¢ÚÈΤ˜ ·ÔÏ‹ÍÂȘ. ∂Λ, Ë ÙÔÍ›ÓË Û˘Ó‰¤ÂÙ·È ÛÙËÓ ÚÔÛ˘Ó·ÙÈ΋ ÌÂÌ‚Ú¿ÓË, ‰ÈÂÈÛ‰‡ÂÈ Ì¤Û· ÛÙÔÓ Ó¢ÚÒÓ· Î·È ÂÌÔ‰›˙ÂÈ ÙËÓ ·ÂÏ¢ı¤ÚˆÛË Ù˘ ·ÎÂÙ˘ÏÔ¯ÔÏ›Ó˘ ÛÙ· Û˘Ì·ıËÙÈο, ·Ú·Û˘Ì·ıËÙÈο Ó‡ڷ Î·È ÛÙË Ó¢ÚÔÌ˘˚΋ Û‡Ó·„Ë, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔÓ Ó¢ÚÔÌ˘˚Îfi ·ÔÎÏÂÈÛÌfi (2,3). ∏ Ó¢ÚÔÏÔÁÈ΋ Û˘Ìو̷ÙÔÏÔÁ›· Î˘Ì·›ÓÂÙ·È ·fi ‹È· ¤ˆ˜ Ôχ ‚·ÚÈ¿. ™ÙȘ ÛÔ‚·Ú¤˜ ÂÚÈÙÒÛÂȘ ÂÌÊ·Ó›˙ÔÓÙ·È ‰˘ÛÎÔϛ˜ ÛÙËÓ ·Ó·ÓÔ‹ Î·È ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ· ÏfiÁˆ ÚÔÛ‚ÔÏ‹˜ ÙˆÓ ·Ó·Ó¢ÛÙÈÎÒÓ Ì˘ÒÓ. ªÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ ÔÛÔÛÙfi 60-70% ÙˆÓ ·È‰ÈÒÓ Ì ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË ¤¯ÂÈ ·Ó¿ÁÎË ·fi Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ·Ó·ÓÔ‹˜ (2,3,6). ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË, Ë Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ‹Ù·Ó ‚·Ú‡Ù·ÙË. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â Ï‹ÚË ÚÔÛ‚ÔÏ‹ fiÏˆÓ ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ Î·È ÂÚÈÊÂÚÈÎÒÓ Ó‡ڈÓ. ∂›¯Â ηٷÚÁË̤ÓË ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Ì ÌË ¶·È‰È·ÙÚÈ΋ 2005;68:222-224
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·224
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º. ∫·Î·‚¿ Î·È Û˘Ó.
ÂÎÏ˘fiÌÂÓ· Ù· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ÙÔ˘ Î·È ÙÔ test ¿ÓÔÈ·˜ ‹Ù·Ó ·ÚÓËÙÈÎfi, ÂÓÒ ÙÔ ∏∂° ‚Ú¤ıËÎÂ Ê˘ÛÈÔÏÔÁÈÎfi. ™ÙȘ ÂÚÈÙÒÛÂȘ Û˘Ó‰ÚfiÌˆÓ Ì ˘Ô„›· ÂÁÎÂÊ·ÏÈÎÔ‡ ı·Ó¿ÙÔ˘, ÂÎÙfi˜ ·fi ÙÔÓ ÎÏÈÓÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÙÂϤ¯Ô˘˜ Ú¤ÂÈ Ó· Á›ÓÔÓÙ·È Î·È ÂÚÁ·ÛÙËÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· Ó· ·ÔÎÏÂÈÛÙ› ‹ Ó· ÂȂ‚·Èˆı› Ô ÂÁÎÂÊ·ÏÈÎfi˜ ı¿Ó·ÙÔ˜. ™Â ·˘Ù¤˜ ·Ó‹ÎÔ˘Ó ÙÔ ∏∂°, Ù· ÚÔÎÏËÙ¿ ‰˘Ó·ÌÈο ÛÙÂϤ¯Ô˘˜, Ô ¤ÏÂÁ¯Ô˜ Ù˘ ·ÈÌ·ÙÈ΋˜ ÚÔ‹˜ Ì ·ÁÁÂÈÔÁÚ·Ê›· ηÈ, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÔÈ Ú·‰ÈÔ˚ÛÔÙÔÈΤ˜ Ù¯ÓÈΤ˜ Î·È ÙÔ ‰È·ÎÚ·ÓÈ·Îfi Doppler (7). À¿Ú¯Ô˘Ó ÌÂϤÙ˜ Û‡Ìʈӷ Ì ÙȘ Ôԛ˜ Û ¤Ó· ÔÛÔÛÙfi 4-20% ‚ÚÂÊÒÓ Ì ۇӉÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ (SIDS) ·ÔÌÔÓÒıËΠpostmortem Ë ·ÏÏ·ÓÙÈÔÁfiÓÔ˜ ÙÔÍ›ÓË ‹ ÙÔ Cl. botulinum (2,8). OÈ ÂÈÏÔΤ˜ Ô˘ ÌÔÚ› Ó· Û˘Ì‚Ô‡Ó ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ˘ÔÍ·ÈÌÈ΋ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ ÔÍ›·˜ ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ (ARDS), ˘ÔÓ·ÙÚÈ·ÈÌ›·, Ó¢ÌÔÓ›· ·fi ÂÈÛÚfiÊËÛË, Ô˘ÚÔÏԛ̈ÍË, ÓÂÎÚˆÙÈ΋ ÂÓÙÂÚÔÎÔÏ›Ùȉ· Î·È „˘¯ÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (2-4). ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ·fi Û‹„Ë, Ïԛ̈ÍË ∫¡™, Û‡Ó‰ÚÔÌÔ Guillain-Barré, Ì˘·Ûı¤ÓÂÈ· Gravis, ÔÏÈÔÌ˘ÂÏ›Ùȉ·, ˘Ôı˘ÚÂÔÂȉÈÛÌfi, ‰ÈÊıÂÚ›Ùȉ·, ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡, ÂÎÊ˘ÏÈÛÙÈο ÓÔÛ‹Ì·Ù· ÙÔ˘ ∫¡™, ·ÁÁÂÈ·Îfi ÂÁÎÂÊ·ÏÈÎfi ÂÂÈÛfi‰ÈÔ, ηÎÔÔ›ËÛË Î·È Û‡Ó‰ÚÔÌÔ Werdnig-Hoffmann (2-4). ∏ ‰È¿ÁÓˆÛË Ù˘ ‚ÚÂÊÈ΋˜ ·ÏÏ·ÓÙ›·Û˘ ‚·Û›˙ÂÙ·È ÛÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ÎψÛÙËÚȉ›ˆÓ Î·È Ù˘ ÙÔ͛Ӣ ÛÙ· ÎfiÚ·Ó·. ™ÙÔÓ ÔÚfi, Ë ÙÔÍ›ÓË ·Ó¢ڛÛÎÂÙ·È ÌfiÓÔ ÛÙÔ 1% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (5). O ÚÔÛ‰ÈÔÚÈÛÌfi˜ Ù˘ ÙÔ͛Ӣ ÌÔÚ› Ó· Á›ÓÂÈ Ì ÙË Ì¤ıÔ‰Ô ELISA (Enzyme-linked immunosorbent assays) ‹ Ì ÙË ‰ÔÎÈÌ·Û›· ÂÍÔ˘‰ÂÙ¤ÚˆÛ‹˜ Ù˘ “in vivo” ÛÙ· ÔÓÙ›ÎÈ·. ∆Ô ∏ª° ÌÔÚ› ›Û˘ Ó· ‚ÔËı‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË. ∆· Û˘¯ÓfiÙÂÚ· ËÏÂÎÙÚÔÌ˘ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÚÔԉ¢ÙÈ΋ ·‡ÍËÛË ÙˆÓ ÚÔÎÏËÙÒÓ Ì˘˚ÎÒÓ ‰˘Ó·ÌÈÎÒÓ ‹ ¿ÊıÔÓ·, ¯·ÌËÏ¿ Ì˘˚ο ‰˘Ó·ÌÈο ÌÂÙ¿ ·fi ¤ÓÙÔÓÔ Ó¢ÚÈÎfi ÂÚÂıÈÛÌfi (2,3). ∏ ıÂڷ›· Ù˘ ·ÏÏ·ÓÙ›·Û˘ Â›Ó·È ˘ÔÛÙËÚÈÎÙÈ΋ Î·È ÂÚÈÏ·Ì‚¿ÓÂÈ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È Ù˘ ıÚ¤„˘ ÙÔ˘ ·ÛıÂÓÔ‡˜, ·Ó·Ì¤ÓÔÓÙ·˜ ÙËÓ ·Ó¿ÚÚˆÛ‹ ÙÔ˘ ·fi ÙÔÓ Ó¢ÚÔÌ˘˚Îfi ·ÔÎÏÂÈÛÌfi. ∆· ‚Ú¤ÊË Ì ·ÏÏ·ÓÙ›·ÛË Ú¤ÂÈ Ó· ÂÈÛ¿ÁÔÓÙ·È ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ∏ ̤ÛË ‰È¿ÚÎÂÈ· ·Ú·ÌÔÓ‹˜ ÛÙÔÓ ·Ó·Ó¢ÛÙ‹Ú· Â›Ó·È ÂÚ›Ô˘ 50 Ë̤Ú˜. ™ÙËÓ ¶·È‰È·ÙÚÈ΋ 2005;68:222-224
∞ÌÂÚÈ΋, Ì›· ‰ÈÏ‹ Ù˘ÊÏ‹ ÌÂϤÙË Ô˘ ¤ÁÈÓ Ì placebo Î·È ·ÓıÚÒÈÓË ÂȉÈ΋ ·ÓÙÈÙÔÍ›ÓË (human derived botulinum antitoxin BIG) Ô˘ ·Ú·Û΢¿ÛÙËΠ·fi ÙÔÓ ÔÚfi ÙˆÓ ·ÓÔÛÔÔÈËÌ¤ÓˆÓ ÂıÂÏÔÓÙÒÓ, ¤‰ÂÈÍ fiÙÈ Ë ¯ÔÚ‹ÁËÛË Ù˘ ·ÓÙÈÙÔ͛Ӣ Ô‰ËÁ› Û ÛËÌ·ÓÙÈ΋ Ì›ˆÛË ÙˆÓ ËÌÂÚÒÓ ÙÔ˘ Ì˯·ÓÈÎÔ‡ ·ÂÚÈÛÌÔ‡ Î·È Ù˘ ÓÔÛËÏ›·˜. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË ‰ÂÓ ¯ÔÚËÁ‹ıËΠÂȉÈ΋ ·ÓıÚÒÈÓË ·ÓÙÈÙÔÍ›ÓË, ‰ÈfiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌË ÛÙË ∂˘ÚÒË. ∏ ıÂڷ›· ‹Ù·Ó ÌfiÓÔ ˘ÔÛÙËÚÈÎÙÈ΋ Î·È ÂÚÈÂÏ¿Ì‚·Ó Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi Î·È ‰ÈÂÓÙÂÚÈ΋ Û›ÙÈÛË Ì¤Ûˆ ÚÈÓÔÁ·ÛÙÚÈÎÔ‡ ηıÂÙ‹Ú·. ∞ÓÙÈ‚ÈÔÙÈο ‰ÂÓ ¯ÔÚËÁÔ‡ÓÙ·È, ·Ú¿ ÌfiÓÔ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ‰Â˘ÙÂÚÔÁÂÓÒÓ ÏÔÈÌÒ͈Ó, ‰ÈfiÙÈ ÚÔηÏÔ‡Ó Ï‡ÛË ÙˆÓ ‚·ÎÙËÚȉ›ˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· ·‡ÍËÛË Ù˘ ÙÔ͛Ӣ Ô˘ ÌÔÚ› Ó· ·ÔÚÚÔÊËı› ·fi ÙÔ ÂÙÈÎfi Û‡ÛÙËÌ·. OÈ ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È, ‰ÈfiÙÈ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ·Ú·Ï˘ÙÈ΋ ‰Ú¿ÛË Ù˘ ÙÔ͛Ӣ. ∆Ô Ì¤ÏÈ ‰ÂÓ Ú¤ÂÈ Ó· ¯ÔÚËÁÂ›Ù·È Û ‚Ú¤ÊË ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙÔ˘ 1 ¤ÙÔ˘˜. ∏ ·ʋ Ì ¿ÙÔÌ· Ì ‚ÚÂÊÈ΋ ·ÏÏ·ÓÙ›·ÛË ‰ÂÓ Û˘Ó¿ÁÂÙ·È ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÌfiÏ˘ÓÛ˘. ∏ ÚfiÁÓˆÛË Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Â›Ó·È Ôχ ηϋ Î·È ÙÔ ÔÛÔÛÙfi ıÓËÙfiÙËÙ·˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi 2% (2,4). O ·ÛıÂÓ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚ›ÙˆÛ˘ ›¯Â Ôχ ηϋ ¤Î‚·ÛË, ·Ú¿ ÙË ‚·Ú‡Ù·ÙË Ó¢ÚÔÏÔÁÈ΋ ÚÔÛ‚ÔÏ‹ Î·È ÙË Û¯ÂÙÈο ·ÚÁ‹ ·Ó¿ÚÚˆÛË.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Aureli P, Franciosa G, Fenicia L. Infant botulism and honey in Europe: a commentary. Pediatr Infect Dis J 2002;21:866-868. 2. Cox N, Hinkle R. Infant botulism. Am Fam Physician 2002;65:1388-1392. 3. Schechter R, Arnon SS. Botulism (Clostridium botulinum). Behrman: Nelson Textbook of Pediatrics. 17th ed. Elsevier; 2004. p. 948-951. 4. Long SS. Infant botulism. Pediatr Infect Dis J 2001; 20:707-709. 5. Weir E. Botulism in Canada. CMAJ 2001;164:538539. 6. Anderson TD, Shah UK, Schreiner MS, Jacobs IN. Airway complications of infant botulism: ten-year experience with 60 cases. Otolaryngol Head Neck Surg 2002;126:234-239. 7. Wijdicks EF. The diagnosis of brain death. N Engl J Med 2001;344:1215-1221. 8. Bartram U, Singer D. Infant botulism and sudden infant death syndrome. Klin Paediatr 2004;216:26-30.
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Severe infant botulism with cardiorespiratory arrest F. Kakava, K. Papazoglou, P. Bonou, A. Darzentas, I. Papadatos
Abstract The case is reported of a 3 month-old infant who was admitted to the hospital with severe neurological compromise and hypotonia, reacting only to pain, and apnoea. Twelve hours after admission he proceeded to cardiorespiratory arrest, but was resuscitated and admitted to the PICU. The clinical suspicion of infant botulism was confirmed by isolation of Cl. botulinum and botulinum toxin type A from the stool. The management was supportive and included mechanical ventilation (99 days) and nutritional support. Despite the severe course of the illness and the prolonged mechanical ventilation, the neurological recovery was very good.
Paediatric Intensive Care Unit, “P. & A. Kyriakou” Children’s Hospital, Athens Correspondence: Kleoniki Papazoglou Paediatric Intensive Care Unit, “P. & A. Kyriakou” Children’s Hospital, Athens Date of submission: 02-03-2004 Date of approval: 21-03-2005
Key words Infant botulism, mechanical ventilation.
Paediatriki 2005;68:225
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∏ ·ÂÈÎfiÓÈÛË ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ· Œ. ¶Ô˘Ï¿ÎÔ˘ - ƒÂÌÂÏ¿ÎÔ˘1, ∂. ¶ÂÙÚ›‰Ô˘2 1 ∂ÚÁ·ÛÙ‹ÚÈÔ πÛÙÔÚ›·˜ Ù˘ π·ÙÚÈ΋˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ 2 ∂ÚÁ·ÛÙ‹ÚÈÔ ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ŒÊË ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ £¤ÌȉԘ 51, ∆.∫. 151 24, ∞ı‹Ó· E-mail: arempel@hol.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 30-07-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-03-2005
¶ÂÚ›ÏË„Ë ∏ ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ· ·ÔÙ‡ˆÛÂ Î·È ÂÍ·ÎÔÏÔ˘ı› Ó· ηٷÁÚ¿ÊÂÈ fiϘ ÙȘ ÂÎÊ¿ÓÛÂȘ ÙÔ˘ ηıËÌÂÚÈÓÔ‡ ‚›Ô˘ ÛÙË ¯ÒÚ· Ì·˜. ∏ ÙÚ·ÁÈÎfiÙËÙ· Î·È Ë Û˘ÁÎÈÓËÛȷ΋ ÊfiÚÙÈÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó Ù· ·È‰Èο ·Ù˘¯‹Ì·Ù· ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ÌËÓ ÂÌÓ‡ÛÔ˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÍÈfiÏÔÁˆÓ ¤ÚÁˆÓ. ∏ ¯ÚÔÓÔÏÔÁÈ΋ ·Ú¿ıÂÛË ÔÚÈÛÌ¤ÓˆÓ ÛÂÏ›‰ˆÓ ÙÔ˘˜ ·ÔÙÂÏ› Ì›· ·ÍÈfiÈÛÙË ·Ó·ÛÎfiËÛË ÙˆÓ Û˘ÓıËÎÒÓ Î·È ÙˆÓ ·ÈÙ›ˆÓ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ÛÙËÓ ·È‰È΋ Î·È ÂÊË‚È΋ ËÏÈΛ·, ηıÒ˜ Î·È ÙÔ˘ ÂοÛÙÔÙ ÙÚfiÔ˘ ˙ˆ‹˜ Ù˘ ÎÔÈÓˆÓ›·˜. ªÂ ·ÊÂÙËÚ›· ÙÔ˘˜ ‰ËÌÈÔ˘ÚÁÔ‡˜ ÙˆÓ ÚÒÙˆÓ ¯ÚfiÓˆÓ ÌÂÙ¿ ÙËÓ ›‰Ú˘ÛË ÙÔ˘ ·ÓÂÍ¿ÚÙËÙÔ˘ ÎÚ¿ÙÔ˘˜ ÂÍÂÙ¿˙ÂÙ·È ·˘Ù‹ Ë ıÂÌ·ÙÈ΋ ÚÔÛ¤ÁÁÈÛË Ì¤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ 20Ô‡ ·ÈÒÓ·, ÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ Ù· ÈÔ ÁÓˆÛÙ¿ ÔÓfiÌ·Ù· Ù˘ ÂÁ¯ÒÚÈ·˜ ÏÔÁÔÙ¯ÓÈ΋˜ ·Ú·ÁˆÁ‹˜. ∞ӷχÔÓÙ·˜ Ù· ÂÈÏÂÁ̤ӷ ·ÔÛ¿ÛÌ·Ù· ÙˆÓ ·Ï·ÈfiÙÂÚˆÓ ÂÔ¯ÒÓ, ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ Î˘ÚÈ·Ú¯Ô‡Ó Ù· ·Ù˘¯‹Ì·Ù· ·ÁÚÔÙÈ΋˜ ‰È·‚›ˆÛ˘ Î·È ·ÎÔÏÔ˘ıÔ‡Ó ÂΛӷ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙËÓ ·ÛÙÈÎÔÔ›ËÛË Î·È ÙËÓ Ù¯ÓÔÏÔÁÈ΋ ÂͤÏÈÍË, Êı¿ÓÔÓÙ·˜ ̤¯ÚÈ ÙË ÛËÌÂÚÈÓ‹ Ì¿ÛÙÈÁ· ÙˆÓ ÙÚÔ¯·›ˆÓ. ∂ÈϤÔÓ, ·ÓÙÈηÙÔÙÚ›˙ÂÙ·È Ì ÙËÓ Â˘·ÈÛıËÛ›· ÙˆÓ ÏÔÁÔÙ¯ÓÒÓ Ô Û˘Ó·ÈÛıËÌ·ÙÈÎfi˜ ÎfiÛÌÔ˜ ÙˆÓ ÁÔÓ¤ˆÓ, ÔÈ Ù‡„ÂȘ, Ë ÂÓÔ¯‹, Ë ·ÂÏÈÛ›· Ô˘ ÚÔηÏÂ›Ù·È ·fi ÙÔÓ ¿‰ÈÎÔ ¯·Ìfi ÂÓfi˜ ·È‰ÈÔ‡. ∆·˘Ùfi¯ÚÔÓ·, Ë ·ÂÈÎfiÓÈÛË Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ̤۷ ·fi ÙÔ Ú›ÛÌ· Ù˘ ÓÔÛÙ·ÏÁ›·˜ Î·È Ù˘ ·Ó·fiÊ¢ÎÙ˘ ˆÚ·ÈÔÔ›ËÛ˘ ‰ÂÓ ·Ú·Ï›ÂÈ ÙȘ ·Ù·Í›Â˜, ÙË ‰È¿ıÂÛË Ê˘Á‹˜, ÂÚȤÙÂÈ·˜ Î·È ÂÍÂÚ‡ÓËÛ˘, ÙËÓ Ù¿ÛË ÚÔ‚ÔÏ‹˜, ›‰ÂÈ͢ Î·È ·fiÛ·Û˘ ı·˘Ì·ÛÌÔ‡ ·fi ÙÔ˘˜ Û˘ÓÔÌËÏ›ÎÔ˘˜, ÂȯÂÈÚÒÓÙ·˜ ÙËÓ ÂÚÌËÓ›· ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Î·È ÂΉËÏÒÓÔÓÙ·˜ ÙËÓ ·ÓËÛ˘¯›· ÁÈ· ÙȘ ‰È·ÛÙ¿ÛÂȘ Ô˘ ‰È·Ê·›ÓÂÙ·È Ó· ÚÔÛÏ·Ì‚¿ÓÂÈ. §¤ÍÂȘ ÎÏÂȉȿ ¶·È‰Èο ·Ù˘¯‹Ì·Ù·, ÙÚÔ¯·›· ·Ù˘¯‹Ì·Ù·, ·È‰È΋ ËÏÈΛ·, ÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·.
∂ÈÛ·ÁˆÁ‹ ∞fi ÙÔ 1830 (¤ÙÔ˜-ÔÚfiÛËÌÔ Ù˘ ›‰Ú˘Û˘ ÙÔ˘ ·ÓÂÍ¿ÚÙËÙÔ˘ ÓÂÔÂÏÏËÓÈÎÔ‡ ÎÚ¿ÙÔ˘˜) ̤¯ÚÈ Û‹ÌÂÚ·, Ë ÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ· ·Ú·Ì¤ÓÂÈ ÂÎÊÚ·ÛÙ‹˜ Ù˘ ÔÚ›·˜ Ù˘ ¯ÒÚ·˜, ÙˆÓ ÈÛÙÔÚÈÎÒÓ Ù˘ ÂÚÈÂÙÂÈÒÓ, ÙˆÓ ÔÏÈÙÈÎÒÓ Ù˘ ÎÏ˘‰ˆÓÈÛÌÒÓ, ·ÏÏ¿ Î·È Ù˘ ηıËÌÂÚÈÓfiÙËÙ·˜ (1). ∫¿Ùˆ ·fi ÙÔ Ú›ÛÌ· ÙÔ˘ ÚÔÌ·ÓÙÈÛÌÔ‡, Ù˘ ËıÔÁÚ·Ê›·˜, ÙÔ˘ Ó·ÙÔ˘Ú·ÏÈÛÌÔ‡ Î·È ÙˆÓ ¿ÏÏˆÓ È‰ÂÔÏÔÁÈÎÒÓ ÚÂ˘Ì¿ÙˆÓ Ô˘ ‰È·‰¤¯ıËÎ·Ó ÙÔ ¤Ó· ÙÔ ¿ÏÏÔ Î·È Â›Ù ÏËÛÌÔÓ‹ıËÎ·Ó Â›Ù ¤˙ËÛ·Ó Û ·ÚÌÔÓÈ΋ Û˘Ó‡·ÚÍË Ì ÓÂfiÙÂÚ·, ¢ÓÔË̤ӷ ·fi ÙȘ ÎÚ·ÙÔ‡Û˜ ·ÓÙÈÏ‹„ÂȘ, Ù· ¤ÚÁ· Ù˘ Ô›ËÛ˘ Î·È Ù˘ Â˙ÔÁÚ·Ê›·˜ Ì ÙËÓ ·‡ÍÔ˘Û· ‰˘Ó·ÌÈ΋ ·Ú·ÁˆÁ‹ ÙÔ˘˜ ·Ú·Ì¤ÓÔ˘Ó Î¿ÙÔÙÚ· ÚÔ‚ÔÏ‹˜ ÙˆÓ ÔÏÏ·ÏÒÓ Î·È ÔÈÎ›ÏˆÓ fi„ÂˆÓ Ù˘ ·ÏËıÈÓ‹˜ ˙ˆ‹˜. ∏ Û¯¤ÛË Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜ Ì ÙÔ ÓÂ˘Ì·ÙÈÎfi ÏÔÁÔÙ¯ÓÈÎfi ‰ËÌÈÔ‡ÚÁËÌ· ÂȂ‚·ÈÒÓÂÙ·È ·fi ·Ú¿ÏÏËϘ Û˘ÁÁÚ·ÊÈΤ˜ ÚÔÛÂÁÁ›¶·È‰È·ÙÚÈ΋ 2005;68:226-238
ÛÂȘ Î·È ‰È·ÈÛو̤Ó˜ ÔÌÔÈfiÙËÙ˜ ·Ó¿ÌÂÛ· ÛÙ· ¤ÚÁ· (2). ∏ ‰È·‰ÚÔÌ‹ Û ÂηÙÔÓÙ¿‰Â˜ Â˙ÔÁÚ·Ê‹Ì·Ù· ÂÍ·ÛÊ·Ï›˙ÂÈ ÛÙÔÓ ·Ó·ÁÓÒÛÙË Ô˘ ÙËÓ ÂȯÂÈÚ› ÙË ı¤· Ì›·˜ ·¤Ú·ÓÙ˘ ÙÔȯÔÁÚ·Ê›·˜ Ù˘ ÎÔÈÓˆÓ›·˜ ¿ÏÏÔÙÂ Î·È ÙÒÚ·, ηıÒ˜ οı ÛÂÏ›‰· ÚÔÛı¤ÙÂÈ Ì›· ÈÓÂÏÈ¿, ¤Ó· ÛΛÙÛÔ, ¤Ó· „ËÊȉˆÙfi, Ì›· ÌÈÎÚ‹ ÂÈÎfiÓ·. ∏ ÁÚ·Ù‹ ηٿıÂÛË ÙˆÓ ‚Ȉ̿وÓ, ÊÈÏÙÚ·ÚÈṲ̂ÓË ·fi ÙȘ ÚÔÛˆÈΤ˜ ¢·ÈÛıËۛ˜ ÙˆÓ ÏÔÁÔÙ¯ÓÒÓ, ‰ËÌÈÔ˘ÚÁ› ¤Ó·Ó ıËÛ·˘Úfi ÂÚÂıÈÛÌ¿ÙˆÓ ÁÈ· Û˘ÁÎÈÓ‹ÛÂȘ Î·È ·ÈÛıËÙÈΤ˜ ·ÔÏ·‡ÛÂȘ. ∞ÏÏ¿ Î·È ÔÈ ·Ú·ÙËÚ‹ÛÂȘ ÙÔ˘˜, ÔÈ ÎÚ›ÛÂȘ ÙÔ˘˜, ÔÈ ÁÓÒ̘ Î·È ÔÈ ·Ó·Ï‡ÛÂȘ ÙÔ˘˜ ·ÔÙÂÏÔ‡Ó ¤Ó· Û‡ÓÔÏÔ Ô˘ ÚÔÛʤÚÂÙ·È Û ÌÂϤÙ˜ ·Ó¿ÏÔÁ˜ Ì ÙË ÛÎÔÈ¿ ‰È·ÊfiÚˆÓ ÂÈÛÙËÌÒÓ, Ì ‰Â‰Ô̤ӷ Ô˘ ¢ÓÔÔ‡Ó ÙË Û˘Ó·ÁˆÁ‹ Û˘ÌÂÚ·ÛÌ¿ÙˆÓ Î·È ÙË ‰È·Ù‡ˆÛË ÂÎÙÈÌ‹ÛˆÓ. ∏ ·È‰È΋ ËÏÈΛ· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ˆÚ·ÈÔÔÈË̤ÓË ·fi ÙÔÓ ¯ÚfiÓÔ Î·È ÊÔÚÙÈṲ̂ÓË ·fi ÙË ÓÔÛÙ·ÏÁÈ΋ ‰È¿ıÂÛË ÙˆÓ Û˘ÁÁڷʤˆÓ, Û·Ó ·Ú·‰ÂÈÛ¤ÓÈÔ˜ ΋Ԙ ·ÈÛıËÌ¿ÙˆÓ Î·È ·ıˆfiÙËÙ·˜,
Paediatriki May-June 05
12-07-05
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¶·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·
Ì ̷ÁÈο ÏÔ˘ÏÔ‡‰È· Î·È ÂÙ·ÏÔ‡‰Â˜ Ô˘ ·ÔÍËÚ·›ÓÔÓÙ·È Û Ï¢ÎÒÌ·Ù·, ·Ó·‰›ÓÔÓÙ·˜ ¿ÓÙ· ÙÔ ¿ÚˆÌ· ÙˆÓ Âȉ˘ÏÏÈ·ÎÒÓ ·˘ÙÒÓ ¯ÚfiÓˆÓ. ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· ·ÔÙÂÏÔ‡Ó ÔÈ ÛÙ›¯ÔÈ ÙÔ˘ √‰˘ÛÛ¤· ∂χÙË (3): ¶·È‰› Ì ÙÔ ÁÚ·ÙÛÔ˘ÓÈṲ̂ÓÔ ÁfiÓ·ÙÔ ªÔÚÙ¿ÎÈ ÙÔ˘ ¿ÛÚÔ˘ Û‡ÓÓÂÊÔ˘! ™Â ·˘ÙÔ‡˜, Ë ÙÚ˘ÊÂÚfiÙËÙ· Ù˘Ï›ÁÂÈ ÙÔ ·È‰› ¯¿ÚȘ ÛÙËÓ ·ÚıÂÓÈÎfiÙËÙ· ÙˆÓ ·Ú·ÛÙ¿ÛÂˆÓ Ì ÙȘ Ôԛ˜ ˘ÔÁÚ·ÌÌ›˙ÂÙ·È Ë ·ÁÓfiÙËÙ· ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·È‰ÈÔ‡. ∆Ô “ÁÚ·ÙÛÔ˘ÓÈṲ̂ÓÔ ÁfiÓ·ÙÔ” Â›Ó·È Ì›· Ú·ÏÈÛÙÈ΋ ÂÈÛ‹Ì·ÓÛË (4) Ô˘ ·Ó·fiÊ¢ÎÙ· Û˘Óԉ‡ÂÈ ÙËÓ ·ÓÂÌÂÏÈ¿, ÙȘ ·Ù·Í›Â˜, ÙË ‰È¿ıÂÛË Ê˘Á‹˜, ÙË Ê·ÓÙ·Û›· Ô˘ ‰›ÓÂÈ ÊÙÂÚ¿, ÙËÓ ·ÎfiÚÂÛÙË ÂÚȤÚÁÂÈ· Ô˘ ˆı› Û ·Ó·˙ËÙ‹ÛÂȘ Î·È ÙË Ì›ÌËÛË fiÏˆÓ ÙˆÓ ı·˘Ì·ÛÙÒÓ ËÚÒˆÓ ÙˆÓ ·Ú·Ì˘ıÈÒÓ. ∫È fiˆ˜ Û fiÏ· Ù· ·Ú·Ì‡ıÈ·, ¤ÙÛÈ Î·È ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ· fiϘ ·˘Ù¤˜ ÔÈ ÂÚȤÙÂȘ ¤¯Ô˘Ó ·ÓÒ‰˘ÓÔ Ù¤ÏÔ˜ Î·È Ì¤ÓÔ˘Ó ÔÈ ÁÚ·ÙÛÔ˘ÓȤ˜ Î·È Ù· ÛËÌ¿‰È· Ó· Ì·ÚÙ˘ÚÔ‡Ó ÛÙÔ ¤Ú·ÛÌ· ÙÔ˘ ¯ÚfiÓÔ˘ Ù· Û˘ÓËıÈṲ̂ӷ ÌÈÎÚÔ·Ù˘¯‹Ì·Ù·.
∆· ·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ˙ˆ‹ Î·È ÛÙȘ ÏÔÁÔÙ¯ÓÈΤ˜ ÛÂÏ›‰Â˜ ∆· ·Ù˘¯‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ Úfi‚ÏËÌ· ˘Á›·˜ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ Î·È ¤¯Ô˘Ó Ï¿‚ÂÈ ‰È·ÛÙ¿ÛÂȘ ÂȉËÌ›·˜ ÛÙË Û‡Á¯ÚÔÓË ∂ÏÏ¿‰·. ∂˘ı‡ÓÔÓÙ·È ÁÈ· ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ı·Ó¿ÙÔ˘˜ Û˘ÁÎÚÈÙÈο Ì ÙȘ ¿ÏϘ ÓÔÛÔÏÔÁÈΤ˜ ηٷÛÙ¿ÛÂȘ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ·È‰È΋˜ ·Ó·ËÚ›·˜. ∂ȉÈÎfiÙÂÚ·, οı ¯ÚfiÓÔ ÛÙÂÚÔ‡Ó ÙË ˙ˆ‹ Û ÂÚ›Ô˘ ¯›ÏÈ· Ó¤· ¿ÙÔÌ· Î·È ·ÎÚˆÙËÚÈ¿˙Ô˘Ó ÙȘ ÂÏ›‰Â˜ Û Ôχ ÂÚÈÛÛfiÙÂÚ·. “∞Ó ˘‹Ú¯Â ¿ÏÏË ·ÚÚÒÛÙÈ· Ô˘ Ó· ÛÎfiÙˆÓ ٷ ·È‰È¿ Ì·˜ Ì ÙfiÛË ÔÚÌ‹ fiÛË Ù· ·Ù˘¯‹Ì·Ù·, Ô ÎfiÛÌÔ˜ fiÏÔ˜ ı· ›¯Â ÍÂÛËΈı› ··ÈÙÒÓÙ·˜ Ó· ÛÙ·Ì·Ù‹ÛÂÈ ·˘Ù‹ Ë ÂηÙfiÌ‚Ë” ¤¯ÂÈ Û¯ÔÏÈ¿ÛÂÈ Ô ∞ÌÂÚÈηÓfi˜ ∫Ú·ÙÈÎfi˜ ∞Ú¯›·ÙÚÔ˜ Everett Koop. To ı¤Ì· ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ ··Û¯ÔÏ› ·ÚÎÂÙ¿ ÙÔ˘˜ Û‡Á¯ÚÔÓÔ˘˜ Î·È ÙÔ˘˜ ·Ï·ÈfiÙÂÚÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÎÈÓËÙÔÔÈÒÓÙ·˜ ÙȘ ¢·›ÛıËÙ˜ ¯ÔÚ‰¤˜ ÙÔ˘˜ ›Ûˆ˜ ÁÈ· ÙËÓ ·‰ÈΛ· Ô˘ ÂÌÂÚȤ¯ÂÙ·È ÛÙÔÓ ¯·Ìfi ÂÓfi˜ ˘ÁÈÔ‡˜ ·È‰ÈÔ‡ Ô˘ ‰È·„‡‰ÂÈ ÙȘ ÚÔÛ‰Ô˘ Î·È Ê‡ÁÂÈ ÚfiˆÚ·, ¿‰Èη, ·Ú¿ÏÔÁ·. ™˘¯Ó¿, ·˘Ù¤˜ ÔÈ ÏÔÁÔÙ¯ÓÈΤ˜ Ì·ÚÙ˘Ú›Â˜ ˙ˆÓÙ·ÓÂ‡Ô˘Ó Ì›· ÂÌÂÈÚ›· ÚÔÛˆÈ΋ Î·È ÌÂٷʤÚÔ˘Ó ·ÙfiÊÈ· ÙËÓ ·ÙÌfiÛÊ·ÈÚ· ÙÔ˘ ‚ÈÒÌ·ÙÔ˜ ‹ ·ÔÙÂÏÔ‡Ó ·fiÂÈÚ˜ Ó· ÂÍÔÚÎÈÛÙ› Ì›· ÂÊÈ·ÏÙÈ΋ ·Ó¿ÌÓËÛË. ™Â ÔÏϤ˜ ·fi ·˘Ù¤˜
·Ó·Ï‡ÔÓÙ·È Ù· ·›ÙÈ· Î·È Á›ÓÂÙ·È ·fiÂÈÚ· ·fi‰ÔÛ˘ ¢ı˘ÓÒÓ, Û˘Ó‹ıˆ˜ fï˜ ÔÈ ÂÚÈÁڷʤ˜ ·ÊÔÚÔ‡Ó ÛÙȘ Û˘Óı‹Î˜ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜, ȉȷ›ÙÂÚ· Â¿Ó Â›Ó·È ı·Ó·ÙËÊfiÚÔ. ∏ ¯ÚÔÓÔÏÔÁÈ΋ ·Ú¿ıÂÛË ÙˆÓ Û¯ÂÙÈÎÒÓ ·ÔÛ·ÛÌ¿ÙˆÓ ÚÔÛÏ·Ì‚¿ÓÂÈ ¯·Ú·ÎÙ‹Ú· ıÂÌ·ÙÈ΋˜ ·Ó·ÛÎfiËÛ˘ ÛÙËÓ ÈÛÙÔÚ›· Ù˘ ÂÏÏËÓÈ΋˜ ÎÔÈÓˆÓ›·˜ Î·È ·ÔÙ˘ÒÓÂÈ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÚfiÔ˘˜ ˙ˆ‹˜ Î·È ÎÈÓ‰‡ÓÔ˘˜, ÙfiÛÔ ·ÚÂÏıÔÓÙÈÎÔ‡˜ Ô˘ ÙÔ˘˜ ÂÍ·Ê¿ÓÈÛÂ Ô ¯ÚfiÓÔ˜ fiÛÔ Î·È Î·ÈÓÔ‡ÚÁÈÔ˘˜ Ô˘ ¤ÊÂÚ ̷˙› Ù˘ Ë Ù¯ÓÔÏÔÁÈ΋ ÂͤÏÈÍË Î·È Ë ¤ÓÙÔÓË ·ÛÙÈÎÔÔ›ËÛË.
∞Ù˘¯‹Ì·Ù· Ù˘ ·Ï·ÈfiÙÂÚ˘ ÂÔ¯‹˜ ∏ ∂ÏÏ¿‰· ÙÔ˘ 19Ô˘ ·ÈÒÓ· ‹Ù·Ó Ì›· ¯ÒÚ· ·ÁÚÔÙÈ΋ Î·È Ó·˘ÙÈ΋, Ì ÙÔÓ ÏËı˘ÛÌfi Ù˘ ‰È·ÛÎÔÚÈṲ̂ÓÔ Û ÌÈÎÚ¤˜ ÎÔÈÓfiÙËÙ˜ ÛÙËÓ ‡·ÈıÚÔ. ∏ ÌfiÓË ÂÊÈÎÙ‹ χÛË ÁÈ· ÙȘ ÌÂÙ·ÎÈÓ‹ÛÂȘ ‹Ù·Ó Ë ¯ÚËÛÈÌÔÔ›ËÛË ÌÂÙ·ÊÔÚÈÎÒÓ ˙ÒˆÓ, ·ÏÏ¿ ·Ú·ÌfiÓ¢ ¿ÓÙÔÙÂ Ô Êfi‚Ô˜ Ù˘ ÙÒÛ˘ ÂÓfi˜ ·È‰ÈÔ‡ ·fi ÙÔ ˙ÒÔ. øÛÙfiÛÔ, ·Ó Î·È Û¿ÓÈ· Ù· ·Ù˘¯‹Ì·Ù· ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜, ‰ÂÓ Â›Ó·È ·Ó‡·ÚÎÙ· (5). ∏ ÚÒÙË Ì·ÚÙ˘Ú›· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ “ÚÒÙÔ ÓÂÔÂÏÏËÓÈÎfi Ì˘ıÈÛÙfiÚËÌ·”, ÙÔÓ “£¿ÓÔ µÏ¤Î·” ÙÔ˘ ¶·‡ÏÔ˘ ∫·ÏÏÈÁ¿ Ô˘ ÂΉfiıËΠÙÔ 1855 Î·È ÂÚÈÁÚ¿ÊÂÈ ÙÔÓ ÙÚ·ÁÈÎfi ı¿Ó·ÙÔ Ù˘ ÌÈÎÚ‹˜ ËÚˆ›‰·˜ ÙÔ˘ (6): ∏ ∂˘ÊÚÔÛ‡ÓË ¤ÂÛÂÓ ÂÎ ÙÔ˘ ›Ô˘ ¯·Ì·› ÚÈÓ ‰˘ÓËı‹ ÙȘ Ó· ÎÚ·Ù‹ÛË ·˘Ù‹Ó ›ÙÔ˘Û·Ó. ◊ Ë ÙÒÛȘ ˘‹ÚÍ ‚·Ú›· Î·È Î·›ÚÈÔÓ Â‹Ïı ÙÚ·‡Ì· ‹ Ô ÙÚfiÌÔ˜... Û˘ÓÂÙ¤ÏÂÛÂÓ ÂȘ ÙÔ‡ÙÔ, Ë ‰˘ÛÙ˘¯‹˜ ∂˘ÊÚÔÛ‡ÓË ¤ÂÛÂÓ ¿ÓÔ˘˜ Î·È ‰ÂÓ ËÁ¤ÚıË Ï¤ÔÓ... ∆· ·È‰È¿ ÎÈÓ‰‡Ó¢·Ó ·fi Ù· ˙Ò· ·ÎfiÌË Î·È fiÙ·Ó ‰ÂÓ ‹Ù·Ó Ù· ›‰È· ·Ó·‚¿Ù˜. ª›· Ù¤ÙÔÈ· ÂÚ›ÙˆÛË ·ÊËÁÂ›Ù·È Ô ¢ËÌ‹ÙÚÈÔ˜ ∫·ÌÔ‡ÚÔÁÏÔ˘ ÛÙÔ ‰È‹ÁËÌ¿ ÙÔ˘ “∏ ΢ڷ-∆ÚÈÛ‡ÁÂÓË”. √ ÚˆÙ·ÁˆÓÈÛÙ‹˜, Ô ÌÈÎÚfi˜ ™ÙÂÊ·Ó‹˜, Ô˘ Â›Ó·È ÔÚÊ·Ófi˜ Î·È ÌÔÓ·‰ÈÎfi˜ ÎÏËÚÔÓfiÌÔ˜ ÌÈ·˜ ·ÏÈ¿˜ ·Ú¯ÔÓÙÈ΋˜ ·ıËÓ·˚΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜, ˙ÂÈ Ì ÙËÓ ËÏÈÎȈ̤ÓË ı›· ∆ÚÈÛ‡ÁÂÓË (7): √ ™ÙÂÊ·Ó‹˜, ÙËÓ ÒÚ· Ô˘ Ë ıÂÈ·-∆ÚÈÛ‡ÁÂÓË ¤„ËÓ ÙÔÓ Î·Ê¤ Ù˘, ÍÂÁÏ›ÛÙÚËÛÂ Î·È ‚Á‹Î ¤Íˆ, Î·È ‚ϤÔÓÙ·˜ ÙÔ ÌÔ˘Ï¿ÚÈ Ô˘ ‚·Û·ÓÈ˙fiÙ·Ó ÁÈ·Ù› ›¯·Ó ÌϤÍÂÈ Ù· fi‰È· ÙÔ˘ ÛÙÔ ÛÎÔÈÓ›, ÙÔ Ï˘‹ıËÎÂ Î·È ‹Á ӷ ÙÔ ÍÂÌϤÍÂÈ, ÎÈ ÂΛÓÔ ÂΉÈ΋ıËΠÙÔÓ ¿ÓıÚˆÔ Î·È ÙÔ˘’ ‰ˆÛ ÌÈ· ÎψÙÛÈ¿ Ì’ fiÏË ÙÔ˘ ÙË ‰‡Ó·ÌË. √ ™ÙÂÊ·Ó‹˜ ¤ÂÛ ْ ·Ó¿ÛÎÂÏ· Î·È ‰ÂÓ Í·Ó·ÛËÎÒıËΠȷ, Û ÙÚÂȘ ̤Ú˜ ¤ı·ÓÂ. °ÂÓÈ΋ ÔÌÈÏ›· Î·È ÛÔ‡ÛÔ˘ÚÔ ÛÙËÓ ∞ı‹Ó· Â›Ó·È Ô ¯·Ìfi˜ ÙÔ˘ ™ÙÂÊ·Ó‹. ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
Paediatriki May-June 05
12-07-05
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Œ. ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ Î·È Û˘Ó.
∫·È ÛÙȘ ‰‡Ô ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ Ô ı¿Ó·ÙÔ˜ ‹Ïı ·Î·ÚÈ·›· ¯ˆÚ›˜ Ù· ‰‡Ô ·È‰È¿ Ó· ·Ó·ÎÙ‹ÛÔ˘Ó ÙȘ ·ÈÛı‹ÛÂȘ ÙÔ˘˜. µ¤‚·È·, Ë Û˘Ì‚›ˆÛË Ì ٷ ˙Ò·, Ë ÂÓ·Û¯fiÏËÛË Ì ÙË Ê‡ÛË Î·È ÔÈ ÂÚÈÏ·Ó‹ÛÂȘ ÛÙËÓ ‡·ÈıÚÔ ‹Ù·Ó ÁÈ· ÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi Ô Î·ÓfiÓ·˜ Ô˘ ÂÚȤÎÏÂÈ ·Ó˘ÔÏfiÁÈÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. ™ÙÔ ‰Â‡ÙÂÚÔ ıÏÈ‚ÂÚfi ÁÂÁÔÓfi˜, ·ÔÊ·ÛÈÛÙÈÎfi ÚfiÏÔ ‰È·‰Ú·Ì¿ÙÈÛÂ Î·È Ô ·Ú¿ÁˆÓ Ù˘ ¯·Ï¿ÚˆÛ˘ Ù˘ ÚÔÛÔ¯‹˜ ÙÔ˘ ÎˉÂÌfiÓ·. ∏ ·Ó¢ı˘ÓfiÙËÙ· Î·È Ë ·Û‡ÁÁÓˆÛÙË ·Ì¤ÏÂÈ· ·fi ÙËÓ ÏÂ˘Ú¿ ÙˆÓ ÂÓËÏ›ÎˆÓ Â›Ó·È Ôχ Û˘¯Ó¿ ÚfiÍÂÓÔÈ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ·˘Ùfi ·ÎÚÈ‚Ò˜ ÂÚÈÁÚ¿ÊÂÈ Ô ∞ϤͷӉÚÔ˜ ¶··‰È·Ì¿ÓÙ˘ ÛÙÔ ‰È‹ÁËÌ· “∆· ‰·ÈÌfiÓÈ· ÛÙÔ Ú¤Ì·”. ∞ÔÙÂÏ› Ì›· ÚÔÛˆÈ΋ ÙÔ˘ ÂÚȤÙÂÈ· Û ËÏÈΛ· 10 ÂÙÒÓ, fiÙ·Ó Û˘Ófi‰Â˘Û ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ - Ô ·Ù¤Ú·˜ ÙÔ˘ ‹Ù·Ó ÈÂÚ¤·˜ - Û ËÌÂÚ‹ÛÈÔ ÚÔÛ·ÓËÌ· Û οÔÈÔ Ì·ÎÚÈÓfi ͈ÎÏ‹ÛÈ, ȇÔÓÙ·˜ ¿ÏÔÁÔ Ô˘ ÙÔ ÎÚ·Ù¿ÂÈ Ì ÛÎÔÈÓ› Ô ·ÁˆÁÈ¿Ù˘, Û‡Ìʈӷ Ì ··›ÙËÛË ÙˆÓ ‰ÈÎÒÓ ÙÔ˘. •·ÊÓÈο, Ô ·ÁˆÁÈ¿Ù˘ ¤Ê˘Á ÁÈ· ¿ÁÓˆÛÙÔ ÏfiÁÔ, ·Ê‹ÓÔÓÙ·˜ ÙÔ ÛÎÔÈÓ› (8): ∏ ÊÔÚ¿‰·, ÌfiÏȘ ËÛı¿ÓıË ÙËÓ ÂÏ¢ıÂÚ›·Ó Ù˘ Ê·›ÓÂÙ·È Î¿Ô˘ ÂÁÓÒÚÈÛÂÓ fiÙÈ ÚÔ˜ ÂΛÓÔ ÙÔ Ì¤ÚÔ˜ ‹Û·Ó Ù· ηٷÙfiÈ· Ù˘ - ‰ÂÓ ÂÎÚ·Ù‹ıË Î’ ÂËÏ¿ÏËÛÂÓ ÂȘ Ù· Ù¤ÛÛÂÚ·, ÙÔÓ Î·Ù‹ÊÔÚÔÓ Î’ ÂÁÒ, ¯ˆÚ›˜ Ó· ¤¯ˆ ÙÔÓ ¯·ÏÈÓfiÓ ÂȘ Ù·˜ ·ÛıÂÓ›˜ ¯Â›Ú·˜ ÌÔ˘, η‚¿Ï· ÛÙÔ Û·Ì¿ÚÈ... √È ÁÔÓ›˜ ÙÔ˘ ·ÓÈÎÔ‚¿ÏÏÔÓÙ·È, ÙÔÓ ÂÓı·ÚÚ‡ÓÔ˘Ó Ó· ÎÚ·ÙËı› fiÛÔ ÌÔÚ› ʈӿ˙ÔÓÙ·˜: - µ·ÛÙ¿ÍÔ˘ ηϿ! ¶·È‰› Ì,’ ‚·ÛÙ¿ÍÔ˘! √ ·Ù¤Ú·˜ ÙÔ˘ ÂȯÂÈÚ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ ÙÔ ·ÁÚÈÂ̤ÓÔ ˙ÒÔ: …¤ÎÊÚˆÓ, ¤ÙÚ¯Â, ÊÔÚÒÓ ÌfiÓÔÓ ÙÔ ˙ˆÛÙÈÎfiÓ ÙÔ˘, ·Û΋˜ ÙËÓ ÎÂÊ·Ï‹Ó, Ì ÙËÓ ÎfiÌËÓ ·ÓÂÌ›˙Ô˘Û·Ó... ·ÏÏ¿ Ë ·fiÛÙ·ÛË ÌÂٷ͇ ÙÔ˘˜ ·˘Í¿ÓÂÙ·È Û˘Ó¯Ҙ. √ ÌÈÎÚfi˜ ∞ϤͷӉÚÔ˜, ˆÛÙfiÛÔ, “ÔÚÌÂÌʇو˜” ÎÚ·ÙÈ¤Ù·È ·fi ÙȘ ‰‡Ô ÚÔÂÍÔ¯¤˜ ÙÔ˘ Û¿ÁÌ·ÙÔ˜ Î·È ÌfiÓÔ ·fi Ù‡¯Ë ‰ÂÓ ¤ÊÙÂÈ “ÂȘ ‚Ú¿¯ÔÓ ‹ ÎÚËÌÓfiÓ ‹ ·Î·ÓıÒ‰ÂȘ ı¿ÌÓÔ˘˜ Î·È ·È¯ÌËÚÔ‡˜ ÎÔÚÌÔ‡˜ ÎÔÌÌ¤ÓˆÓ ‰¤Ó‰ÚˆÓ”. ∞˘ÙÂÓÂÚÁÒÓÙ·˜, ·ÏÏ¿˙ÂÈ ı¤ÛË ÒÛÙÂ Î·È Ù· ‰‡Ô ÙÔ˘ fi‰È· Ó· ‚ÚÂıÔ‡Ó ÛÙËÓ ·ÚÈÛÙÂÚ‹ ÏÂ˘Ú¿ ÙÔ˘ Û·Ì·ÚÈÔ‡ Î·È ÙËÓ Î·Ù¿ÏÏËÏË ÛÙÈÁÌ‹ ηٷʤÚÓÂÈ Ó· ˉ‹ÛÂÈ ÛÙÔ ¤‰·ÊÔ˜ ÛÒÔ˜ Î·È ·‚Ï·‚‹˜. ∆Ô ·›ÛÈÔ Ù¤ÏÔ˜ ÂÈ΢ÚÒÓÂÙ·È Ì ÙËÓ ·Ó·ÊÒÓËÛË ·Ó·ÎÔ‡ÊÈÛ˘ ÙÔ˘ ·Ù¤Ú· “Ô˘ ÌfiÏȘ ˉ‡Ó·ÙÔ Ï¤ÔÓ Ó· ÛÙ·ı› ·fi ÙÔÓ ÎfiÔÓ...” - ¢fiÍ· ÛÔÈ, Ô £Âfi˜! ™ËÌ·ÓÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÛÙËÓ Â˘Ù˘¯‹ ηٿÏËÍË ˘‹ÚÍÂ Ë ·Ó¿ÏË„Ë ÚˆÙÔ‚Ô˘Ï›·˜ ·fi ÙÔ ›‰ÈÔ ÙÔ ·È‰› Ô˘ Û˘ÓÂȉËÙÔÔ›ËÛ fiÙÈ Ô‡Ù ÔÈ ÁÔÓ›˜ ÙÔ˘ Ô‡Ù ηӤӷ˜ ¿ÏÏÔ˜ ‰ÂÓ ÌÔÚÔ‡Û·Ó ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
Ó· ÙÔ ‚ÔËı‹ÛÔ˘Ó. ∏ ÏÂÈÔ„ËÊ›· fï˜ ·˘ÙÒÓ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ‰ÂÓ ¤¯ÂÈ ÙfiÛÔ ·ÓÒ‰˘Ó· ·ÔÙÂϤÛÌ·Ù·.
¶ÓÈÁÌÔ› ™Â Ì›· ¯ÒÚ· Ô˘ ÂÚÈ‚¿ÏÏÂÙ·È ·fi ˘ÁÚfi ÛÙÔÈ¯Â›Ô Î·È ¤¯ÂÈ ‹ÈÔ Îϛ̷ Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ Â·Ê‹ Ì ÙË ı¿Ï·ÛÛ· ÛÙË ÌÂÁ·Ï‡ÙÂÚË ÂÚ›Ô‰Ô ÙÔ˘ ¤ÙÔ˘˜, ÔÈ ÓÈÁÌÔ› Î·È ÔÈ ·Ú’ ÔÏ›ÁÔÓ ÓÈÁÌÔ› ·ÔÙÂÏÔ‡Ó ‰È·¯ÚÔÓÈÎfi Úfi‚ÏËÌ· Î·È ÁÈ· ÙÔÓ ·È‰ÈÎfi ÏËı˘ÛÌfi. √È ÓÈÁÌÔ› ·ÔÙÂÏÔ‡Ó ÙÔÓ ÈÔ ı·Ó·ÙËÊfiÚÔ Ù‡Ô ·Ù˘¯‹Ì·ÙÔ˜. ∏ Û˘¯ÓfiÙËÙ· Î·È Ë ‚·Ú‡ÙËÙ¿ ÙÔ˘˜ ·ÓÙ·Ó·ÎÏÒÓÙ·È ÛÙȘ ÔÏ˘¿ÚÈı̘ ÛÂÏ›‰Â˜ Ù˘ Â˙ÔÁÚ·Ê›·˜ Ô˘ ·ÊÈÂÚÒÓÔÓÙ·È ÛÙÔ ı¤Ì·. ∫·Ù·ÁÚ¿ÊÂÙ·È ·fi ÙÔ˘˜ ÏÔÁÔÙ¤¯Ó˜ Ë ¤ÏÍË Ô˘ ·ÛΛ Ë ı¿Ï·ÛÛ· ÛÙ· ·È‰È¿, ȉȷ›ÙÂÚ· Û fiÛ· ηÙÔÈÎÔ‡Ó Û ÓËÛÈ¿, Ô˘ ÙËÓ ·ÔÏ·Ì‚¿ÓÔ˘Ó ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘ ¯ÚfiÓÔ˘ Î·È Â›Ó·È ÂÍÔÈÎÂȈ̤ӷ Ì·˙› Ù˘ ÎÔÏ˘ÌÒÓÙ·˜, „·Ú‡ÔÓÙ·˜ Î·È ËÁ·›ÓÔÓÙ·˜ ‚fiÏÙ˜ Ì ‚¿ÚΘ, Û˘¯Ó¿ ·Û˘Ófi‰Â˘Ù·. ªÂ ÌÔÓ·‰ÈÎfi ÙÚfiÔ Ô ∞ϤͷӉÚÔ˜ ¶··‰È·Ì¿ÓÙ˘ ˙ˆÓÙ·Ó‡ÂÈ ÛÙ· ¤ÚÁ· ÙÔ˘ ÙÔÓ ÌÈÎÚfiÎÔÛÌÔ ÙÔ˘ ÓËÛÈÔ‡ ÙÔ˘, Ù˘ ™ÎÈ¿ıÔ˘, ÌÂٷʤÚÔÓÙ·˜ ÂÚÈÛÙ·ÙÈο ÓÈÁÌÒÓ Ô˘ Û˘Ó¤‚ËÛ·Ó ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ηÙÔ›ÎÔ˘˜ ÙÔ˘. ∆Ô ‰È‹ÁËÌ· Ô˘ ¯·Ú·ÎÙËÚÈÛÙÈο ÂÈÁÚ¿ÊÂÙ·È “∆Ô Ó›ÍÈÌÔ ÙÔ˘ ·È‰ÈÔ‡” ·Û¯ÔÏÂ›Ù·È ·ÔÎÏÂÈÛÙÈο Ì ¤Ó· Ù¤ÙÔÈÔ ÂÂÈÛfi‰ÈÔ. √ Û˘ÁÁڷʤ·˜ ÂÍËÁ› fiÙÈ ÔÈ ÁÔÓ›˜ ¯ÚÂÈ¿ÛÙËΠӷ ÚÔÛÏ¿‚Ô˘Ó ·È‰ÔÓfiÌÔ ÁÈ· Ó· ÂÈÙËÚ› Ù· ·È‰È¿ ÙÔ˘ ÓËÛÈÔ‡ ÛÙ· ·È¯Ó›‰È· ÙÔ˘˜ Ì ÙË ı¿Ï·ÛÛ·. √ ·È‰ÔÓfiÌÔ˜ ∫ˆÓÛÙ·ÓÙ‹˜ ∆ÛÈÙÛԇη˜ ›¯Â ÂÈ‚¿ÏÂÈ Î·ÓÔÓÈÛÌÔ‡˜ ÁÈ· ÙÔ˘˜ ·ÓËÏ›ÎÔ˘˜ Û¯ÂÙÈο Ì ÙȘ ÒÚ˜ Î·È ÙË ‰È¿ÚÎÂÈ· Ù˘ ÎÔχ̂ËÛ˘ Î·È ÙÔ˘˜ ηٿÏÏËÏÔ˘˜ ÙfiÔ˘˜ Î·È ÙÚfiÔ˘˜ ηٷ‰‡ÛˆÓ, ÂÊ·ÚÌfi˙ÔÓÙ·˜ ¤Ó· Û¯¤‰ÈÔ ÚfiÏ˄˘ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ ·Ô‰Â›¯ıËΠ·ÔÙÂÏÂÛÌ·ÙÈÎfi. ∆Ô ı¤ÚÔ˜, ÌfiÓÔÓ Úˆ› Î·È ‚Ú¿‰˘ ¤ÙÚ ÙÔ ÎÔχ̂ËÌ· ÂȘ Ù· ·È‰›·. ∂Ș ηӤӷ ÌÈÎÚfiÓ ÌÔÛ¯ÔÌ¿ÁÎ·Ó ‰ÂÓ Â¤ÙÚ ӷ ÎÔÏ˘Ì‚¿ ÔÎÙÒ ‹ ‰¤Î· ÊÔÚ¿˜ ÙËÓ Ë̤ڷÓ. ∞ÏÏ¿ Î·È Î·Ó¤Ó ·È‰›ÔÓ ‰ÂÓ Û˘Ó¤‚Ë Ó· ÓÈÁ‹ › ∆ÛÈÙÛԇη ·È‰ÔÓfiÌÔ˘, ÙËÓ ÚÒÙËÓ Î·È ÙËÓ ‰Â˘Ù¤Ú·Ó ¯ÚÔÓÈ¿Ó. Œ¯·ÈÚ ÁÂÓÈ΋˜ ÂÎÙÈÌ‹Ûˆ˜ ÛÙËÓ ÎÔÈÓˆÓ›· Ù˘ Ó‹ÛÔ˘. ∂ÂÙÚ¤ÂÙÔ Ó· ‚Ô˘ÏÈÔ‡Ó, ηıÒ˜ Û˘ÓËı›˙Ô˘Ó ÙȘ ‚¿ÚΘ, ·ÏÏ¿ ÌfiÓÔÓ Ì ÙËÓ ¿‰ÂÈ·Ó ÙÔ˘ ȉÈÔÎÙ‹ÙÔ˘. ∂Ș ηӤӷ ‰ÂÓ ÂÂÙÚ¤ÂÙÔ Ó· “‰›ÓË ‚Ô‡ÙË” ‹ÙÔÈ Ó· ˉ¿ Ì ÙËÓ ÎÂÊ·Ï‹Ó Î¿Ùˆ, ·ÏÏ¿ ÌfiÓÔÓ “Ó· ‰›ÓË ·ÏÔ‡ÎÈ·” ‰ËÏ·‰‹ Ó· ˉ¿ fiÚıÈÔ˜ ·fi ÙÔ ‡„Ô˜ ÙÔ˘ ÙÚ›ÁÎÔ˘, fiˆ˜ Î·È ÙÔ˘ Ì·Ì·-Ê›ÁÎÔ˘, ÙˆÓ ÂȘ
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·229
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¶·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·
ÙÔÓ ÏÈ̤ӷ ·Ú·ÁÌ¤ÓˆÓ Î·Ù¿ ηÈÚÔ‡˜ ÁÔÏÂÙÒÓ Î·È ‚ÚÈΛˆÓ. ªfiÓÔÓ ·fi ÙËÓ Îˆ·ÛÙ‹Ó Î·È ·fi ÙËÓ ¿ÎÚËÓ ÙÔ˘ Ì·ÛÙÔ˘ÓÈÔ‡ Ù˘ ÏÒÚ˘, ÂÂÙÚ¤ÂÙÔ Ó· ‰›ÓÔ˘Ó ‚Ô˘ÙÈ¿. ∆ÔÈÔ‡ÙÔ˜ ‹ÙÔÓ Ô ¿ÁÚ·ÊÔ˜ ηÓÔÓÈÛÌfi˜ ÙÔ˘ ∆ÛÈÙÛԇη, ÙÔÓ ÔÔ›ÔÓ ˘Â¯ÚÂÔ‡ÓÙÔ Ó’ ·ÔÛÙËı›ÛÔ˘Ó Î·È “Ó· ÙÔÓ Í¤ÚÔ˘Ó, ÓÂÚ¿ÎÈ, ·’ fiÍÔ˘” fiÏ· Ù· ·È‰È¿, “Ù· ‰·ÛηÏÔ‡‰È·, ηıÒ˜ Î·È Ù· ͢fiÏËÙ· ÙÔ˘ ‰ÚfiÌÔ˘, Ù’ ·Á˘Èfi·È‰·”. ∆ËÓ ÂfiÌÂÓË ¯ÚÔÓÈ¿, fiÙ·Ó Ô ∆ÛÈÙÛԇη˜ ÂÈÏ‹ÙÙÂÈ ¤Ó· ¿Ù·ÎÙÔ ·È‰› Ô˘ ·Ú·‚È¿˙ÂÈ ÙÔ˘˜ ηÓfiÓ˜, Ô ·Ù¤Ú·˜ ÙÔ˘ ¤Ú¯ÂÙ·È Ó· ˙ËÙ‹ÛÂÈ ÙÔÓ ÏfiÁÔ, Ó· ‰È·ÊˆÓ‹ÛÂÈ Ì ÙȘ ·È‰·ÁˆÁÈΤ˜ ÌÂıfi‰Ô˘˜ Î·È Ó· ÙÔÓ ÂÈÚˆÓ¢Ù› ÁÈ· ÙÔÓ ÙÚfiÔ Ô˘ ·ÛΛ ÙÔ ·Í›ˆÌ¿ ÙÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ô ·È‰ÔÓfiÌÔ˜ Ó· ÂÏ·ÙÙÒÛÂÈ ÙÔÓ ˙‹ÏÔ ÙÔ˘. ∆ËÓ ÙÚ›ÙËÓ ¯ÚÔÓÈ¿Ó, ¤Ó· ‰ÂÈÏÈÓfiÓ, ÙÔÓ πÔ‡ÏÈÔÓ Ì‹Ó·, ÎÚ·˘Á‹ ·ÁˆÓÈÒÓÙÔ˜ ·È‰›Ô˘ ËÎÔ‡ÛıË ÂȘ ÙÔÓ ·ÈÁÈ·ÏfiÓ... ¢‡Ô ÎÚ·˘Á·› Á˘Ó·ÈÎÒÓ, ·fi ¤Ó· ·Ú¿ı˘ÚÔÓ ·ÓÙÈÎÚ‡, Î·È ·fi ¤Ó· ÏȷΈÙfiÓ ·Ú·¤Ú·, ·‹ÓÙËÛ·Ó ÂȘ ÙËÓ ÎÚ·˘Á‹Ó ÙËÓ ÚÒÙËÓ. - °Ï˘ÙÒÛÙ ÙÔ!... °Ï˘ÙÒÛÙ ÙÔ! - ∆Ú¯¿ÙÂ!... ¶Ó›ÁËΠÙÔ ·È‰›! ŒÙÚÂÍ·Ó ÔÈ Â˘ÚÂı¤ÓÙ˜ ÂΛ ÏËÛ›ÔÓ. ¢‡Ô Ó¤ÔÈ Âı·Ï¿ÛÛˆÛ·Ó, ¤Ó·˜ ÙÚ›ÙÔ˜ ‹Á Ì ÙËÓ ‚¿ÚηÓ, ÎÚ·ÙÒÓ ÙÔÓ Á¿ÓÙ˙ÔÓ ¤ÙÔÈÌÔÓ Î·È ÙËÓ ·fi¯ËÓ, ·Ó¤Û˘Ú·Ó ÙÔ ·ÁˆÓÈÒÓ ·È‰›ÔÓ, Î·È ÙÔ ¤ÊÂÚ·Ó ÂȘ ÙËÓ ÍËÚ¿Ó. ∆Ô ¤ÙÚÈ„·Ó, ÙÔ ÂÎÚ¤Ì·Û·Ó ·Ó¿Ô‰·. ªÂÙ‹ÏıÔÓ fiÏ· Ù· Û˘Ó‹ıË ÂÌÂÈÚÈο ‹ Úfi¯ÂÈÚ· ̤۷... ◊ÙÔÓ ·ÚÁ¿. ∆Ô ·È‰›ÔÓ ‹ÙÔ ÓÈÁ̤ÓÔÓ, ÂÓÙÂÏÒ˜ ÓÈÁ̤ÓÔÓ. ∂ÚfiÎÂÈÙÔ ÁÈ· ÙÔ ¿Ù·ÎÙÔ ·È‰›, Ì ÙÔÓ ·Ù¤Ú· ÙÔ˘ ÔÔ›Ô˘ ›¯Â ‰È·ÏËÎÙÈÛÙ› Ô ∆ÛÈÙÛԇη˜ (9). ªÂ ÈÔ ÔÈËÙÈÎfi ÙÚfiÔ ÂÚÈÁÚ¿ÊÂÈ Ô ›‰ÈÔ˜ Û˘ÁÁڷʤ·˜ ÙÔÓ ÓÈÁÌfi Ì›·˜ ÌÈÎÚԇϷ˜ ÛÙÔ ‰È‹ÁËÌ· “∆Ô ª˘ÚÔÏfiÁÈ Ù˘ ÊÒÎÈ·˜” (10). ∏ ÂÓÓÈ¿¯ÚÔÓË ∞ÎÚȂԇϷ ÍÂʇÁÂÈ “ÙËÓ ¿ÁÚ˘ÓÔÓ ÂÈÙ‹ÚËÛÈÓ Ù˘ Ì¿ÓÓ·˜” Î·È ÚÔÛ·ı› Ó· ÊÙ¿ÛÂÈ ÛÙÔÓ ÁÈ·Ïfi fiÔ˘ ϤÓÂÈ Ë ÁÈ·ÁÈ¿ Ù˘, ¯ˆÚ›˜ Ó· ηٷʤÚÂÈ Ó· ·Ó·Î·Ï‡„ÂÈ ÙÔ ÛˆÛÙfi ÌÔÓÔ¿ÙÈ. ∂˘Ú›ÛÎÂÙÔ Â¿Óˆ ÂȘ ÙÔÓ ÔÊÚ‡Ó ÂÓfi˜ ÚÔÂͤ¯ÔÓÙÔ˜ ‚Ú¿¯Ô˘ ˆ˜ ‰‡Ô ·Ó·ÛÙ‹Ì·Ù· ·Ó‰Úfi˜ ˘ÂÚ¿Óˆ Ù˘ ı·Ï¿ÛÛ˘. √ Ô˘Ú·Ófi˜ ÂÛÎÔÙ›ÓÈ·˙Â, Û‡ÓÓÂÊ· ¤ÎÚ˘ÙÔÓ Ù· ¿ÛÙÚ· Î·È ‹Ù·Ó ÛÙËÓ ¯¿ÛÈÓ ÙÔ˘ ÊÂÁÁ·ÚÈÔ‡. ∂ÚÔÛ¿ıËÛÂ Î·È ‰ÂÓ Â‡ÚÈÛÎÂÓ Ï¤ÔÓ ÙÔÓ ‰ÚfiÌÔÓ fiıÂÓ Â›¯Â η٤ÏıÂÈ. ∂Á‡ÚÈÛ ¿ÏÈÓ ÚÔ˜ Ù· οو, ‰ÔΛ̷Û ӷ ηٷ‚‹. ∂ÁÏ›ÛÙÚËÛ ÎÈ ¤ÂÛÂ, ÌÏÔ˘Ì ÂȘ ÙÔ Î‡Ì·. ◊ÙÔ ÙfiÛÔÓ ‚·ı‡ fiÛÔÓ Î·È Ô ‚Ú¿¯Ô˜ ˘„ËÏfi˜. ∫·Ó›˜ ‰ÂÓ Â›‰Â Î·È ‰ÂÓ ¿ÎÔ˘Û Ҙ Ë ı¿Ï·ÛÛ· ηٿÈ ÙÔ ÎÔÚÈÙÛ¿ÎÈ. ª›· ÊÒÎÈ· ·Ó·Î·Ï‡ÙÂÈ ÙÔ ¿„˘¯Ô ÛÒÌ· ÙÔ˘ Î·È ÙÔ ÌÔÈÚÔÏfiÁÈ Ù˘ ηٷϋÁÂÈ ÛÙËÓ ·Û›ÁÓˆÛÙË ··‰È·Ì¿ÓÙÂÈ· ˆ‰fi:
“™·Ó Ó·’ ¯·Ó ÔÙ¤ ÙÂÏÂȈÌfi Ù· ¿ıÈ· Î’ ÔÈ Î·ËÌÔ› ÙÔ˘ ÎfiÛÌÔ˘”. ∆Ô ÂÙ¿¯ÚÔÓÔ ·ÁÔÚ¿ÎÈ fï˜, ‹Úˆ·˜ ÙÔ˘ ‰ÈËÁ‹Ì·ÙÔ˜ “ª·˘ÚÔÌ·ÓÙËÏÔ‡”, ÙÔ˘ ›‰ÈÔ˘ Û˘ÁÁڷʤ·, ÛÙ¿ıËΠÈÔ Ù˘¯ÂÚfi. •ÂʇÁÔÓÙ·˜ ·fi ÙËÓ ÚÔÛÔ¯‹ Ù˘ ÌËÙ¤Ú·˜ ÙÔ˘, ÛηÚÊ·ÏÒÓÂÈ Û „ËÏfi ‚Ú¿¯Ô, ¯¿ÓÂÈ ÙËÓ ÈÛÔÚÚÔ›· ÙÔ˘ Î·È ‚Ú›ÛÎÂÙ·È ÛÙÔ ÓÂÚfi. ∆Ô Î‡Ì· ı· ›¯Â ‚¿ıÔ˜ ϤÔÓ ‹ ‰ÈÏÔ‡Ó ·Ó·ÛÙ‹Ì·ÙÔ˜ ·Ó‰Úfi˜. µ˘ı›˙ÂÙ·È ÂȘ ÙÔÓ fiÓÙÔÓ, Î·È ¿ÏÈÓ ·Ó¤Ú¯ÂÙ·È ÂȘ ÙËÓ ÂÈÊ¿ÓÂÈ·Ó, Î·È ·Û·›ÚÂÈ Î·È ·Ú·‰¤ÚÓÂÈ Î·È Â›Ù· ‚˘ı›˙ÂÙ·È ÂÎ ‰Â˘Ù¤ÚÔ˘. ∂˘Ù˘¯Ò˜, ÔÈ ÊˆÓ¤˜ Ù˘ ÌËÙ¤Ú·˜ ÚÔÛÂÏÎ‡Ô˘Ó ¤Ó·Ó „·Ú¿ Ô˘ ÛÒ˙ÂÈ ÙÔ ·È‰›, ÂÓÒ ¤Ó·˜ ‚ÔÛÎfi˜ ÙÔ‡ ÚÔÛʤÚÂÈ ÙȘ ÚÒÙ˜ ‚Ô‹ıÂȘ (11). √ ›Û˘ ™ÎÈ·ı›Ù˘ ∞ϤͷӉÚÔ˜ ªˆÚ·˚Ù›‰Ë˜ ·Û¯ÔÏÂ›Ù·È Ì ÙÔ ›‰ÈÔ ı¤Ì· ÂÊfiÛÔÓ ÌÔÈÚ¿˙ÂÙ·È ÎÔÈÓ¤˜ ÂÌÂÈڛ˜ Ì ÙÔÓ ¶··‰È·Ì¿ÓÙË. ™ÙÔ Â˙ÔÁÚ·ÊÈÎfi ÙÔ˘ ¤ÚÁÔ ÔÈ ÓÈÁÌÔ› Î·È Ù· ¿ÏÏ· ·Ù˘¯‹Ì·Ù· ÛÙË ı¿Ï·ÛÛ· ·ӤگÔÓÙ·È Û˘¯Ó¿, fiˆ˜ ÛÙÔ ‰È‹ÁËÌ¿ ÙÔ˘ “∞ÏÙ·ÓÔ‡”, fiÔ˘ ÂÚÈÁÚ¿ÊÂÈ ÙȘ Û˘ÌÊÔÚ¤˜ Ì›·˜ ÊÙˆ¯‹˜ ¯‹Ú·˜ Î·È ·Ó¿ÌÂÛ· Û ·˘Ù¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ı¿Ó·ÙÔÈ ÙˆÓ ·È‰ÈÒÓ Ù˘, Ô ¤Ó·˜ ·fi ÓÈÁÌfi (12). ŒÓ· ¿ÏÏÔ ·È‰¿ÎÈ Ù˘ ÌÈÎÚfi, ¤ÓÙ ¯ÚfiÓˆÓ, Ù˘ ÙÔ ¤ÊÂÚÂÓ Ô ÔÚÙ¿Ú˘ ÙÔ˘ ∫¿ÛÙÚÔ˘ ÓÂÎÚfiÓ ÊÔ˘ÛΈ̤ÓÔÓ Û·Ó ÙÔ˘ÏÔ˘Ì¿ÎÈ. ∂›¯Â ηٷ‚‹ ÂȘ ÙËÓ ·ÎÚÔÁÈ·ÏÈ¿Ó Î¿Ùˆ ¯ˆÚ›˜ Ó· ÙÔ È‰Ô‡Ó, Î·È ÒÚÌËÛÂÓ ·Á·ÏÏfiÌÂÓÔÓ Û·Ó ÁÏ·ÚfiÔ˘ÏÔ, Ó· ·›ÍË ·Ó‡ÔÙÔÓ Ì ٷ ηٷÁ¿Ï·Ó· ÓÂÚ¿ Î·È ÂÓ›ÁË. ™ÙÔ ›‰ÈÔ ‰È‹ÁËÌ· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈ ·Ù·Í›Â˜ ÂÓfi˜ ¿ÏÏÔ˘ ·‰ÂÏÊÔ‡ ÙÔ˘ Ô˘ ÎÈÓ‰‡Ó¢Û ›Û˘ ·fi ÓÈÁÌfi, ·ÏÏ¿ ÛÙ¿ıËΠÈÔ Ù˘¯ÂÚfi˜. ∞ηٷӛÎËÙË ÌÔÈ¿˙ÂÈ ÛÙȘ ÛÂÏ›‰Â˜ ÙˆÓ ÏÔÁÔÙ¯ÓÒÓ Ë ¤ÏÍË Ô˘ ·ÛΛ Ë ı¿Ï·ÛÛ· ÛÙ· ·È‰È¿ ÒÛÙ ӷ Ù· ·Ú·ÎÈÓ› Ó· ÍÂʇÁÔ˘Ó ·fi ÙËÓ ÚÔÛÔ¯‹ ÙˆÓ ÌÂÁ¿ÏˆÓ Î·È Ó· Ù· ·Ú·Û‡ÚÂÈ Û ÂÈΛӉ˘Ó· ·È¯Ó›‰È·: ¶·È˜ ·ÎfiÌË, ·È‰¿ÚÈÔÓ ‰ÂηÂÙ¤˜, ÍÂÛÎԇʈÙÔÓ, ͢fiÏËÙÔÓ, ÍÂ̷ӛΈÙÔÓ, ÎÚ˘Ê¿-ÎÚ˘Ê¿ ÂÍÂÙÚ‡ˆÛÂÓ ·fi ÙËÓ ÔÚÙ›ÙÛ·Ó ÙÔ˘ ηٷÁˆÁ›Ô˘, Û·Ó ÎÔÙfiÔ˘ÏÔ, fiÙ·Ó Ë ÌËÙ¤Ú· ÙÔ˘ ¤ÏÂÈ ÂȘ ÙÔÓ ÊÔ‡ÚÓÔÓ, Î·È ›Û· ÂȘ ÙËÓ ı¿Ï·ÛÛ·Ó. √ ÔÚÙ¿Ú˘ ÙÔ˘ ∫¿ÛÙÚÔ˘ Ô Á›ÙÔÓ¿˜ Ù˘, ÔÏϤ˜ ÊÔÚ¤˜ ÙÔ ÂÁϛوÛÂÓ ·fi ÓÈÁÌfiÓ. ŒÙÛÈ ÂÚÈÁÚ¿ÊÂÈ ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ô˘ ¤¯ÂÈ ·ÔÌ›ÓÂÈ ÛÙË ¯‹Ú· ∞ÏÙ·ÓÔ‡, ÙÔÓ ª·ÓÒÏË, Ô˘ ¤¯ÂÈ ¿ıÔ˜ Ì ÙË ı¿Ï·ÛÛ·. ∏ ÌËÙ¤Ú· ÙÔ˘ ÙÔÓ ÛÙ¤ÏÓÂÈ ÛÙÔ Û¯ÔÏ›Ô, ·ÏÏ¿ ·ÔÙÂÏ› ÙÔÓ ÌfiÓÈÌÔ ÛÙfi¯Ô ÙÔ˘ ·È‰ÔÓfiÌÔ˘ ∆ÛÈÙÛԇη (ÙÔ˘ ›‰ÈÔ˘ Ô˘ ÚˆÙ·ÁˆÓÈÛÙ› Î·È ÛÙÔ ‰È‹ÁËÌ· ÙÔ˘ ¶··‰È·Ì¿ÓÙË “∆Ô Ó›ÍÈÌÔ ÙÔ˘ ·È‰ÈÔ‡” Ô˘ ÚԷӷʤÚıËÎÂ) Î·È “Ù˘ ¯ÔÓ‰Ú‹˜, ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·230
230
Œ. ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ Î·È Û˘Ó.
ÏÂÎÙ‹˜ Ì¿ÛÙÈÁ·˜, ηڷ‚›ÛÈ·˜ Ì¿ÛÙÈÁ·˜, ÌÈ·˜ Û·Ï·Ì¿ÛÙÚ·˜ ÊÔ‚ÂÚ¿˜”. - ¡· ÙÔÓ Î¿Ì˘ „·Ú¿! ∂›ÂÓ Ô ‰È‰¿ÛηÏÔ˜, ·ÚËÁÔÚÒÓ ËÌ¤Ú·Ó ÙÈÓ¿ ÙËÓ ÁÚ·›·Ó, ÂÙÔÈÌ¿˙Ô˘Û·Ó ÙËÓ Ì¿ÛÙÈÁ· Ì ÔÚÁ‹Ó ·Ú¿ÊÔÚÔÓ. - ∆·¯È¿ ı· ¿Áˆ, Ì¿ÓÓ·, Ù·¯È¿ ı· ¿Áˆ ÛÙÔ ÛÎÔÏÂÈfi! ∂ÊÒÓ·˙ ÌÂÙ¿ ‰·ÎÚ‡ˆÓ Ô ª·ÓÒÏ˘, ·ÔʇÁˆÓ Ô‡Ùˆ ÙËÓ Ì·ÛÙ›ÁˆÛÈÓ. ∞ÏÏ¿ “Ù·¯È¿” ¿ÏÈÓ Ô ·È‰ÔÓfiÌÔ˜ Ô ∆ÛÈÙÛԇη˜ Ì ÙËÓ Û·Ï·Ì¿ÛÙÚ·Ó ÙÔ˘, ¿ÏÈÓ ÙÔÓ ª·ÓÒÏËÓ Î·Ù‰›ˆÎÂÓ ÂȘ Ù·˜ ÂÈÎÈÓ‰‡ÓÔ˘˜ ÂΛӷ˜ ·Ú·Ï›·˜. ∞Ó Î·È Ë ÌËÙ¤Ú· ÙÔ˘ ÙÔÓ ÛÙ¤ÏÓÂÈ Ó· Á›ÓÂÈ ‚ÔÛÎfi˜ ÁÈ· Ó· ÙÔÓ ·ÔÌ·ÎÚ‡ÓÂÈ ·fi ÙËÓ ÂÈΛӉ˘ÓË ı¿Ï·ÛÛ·, ˆÛÙfiÛÔ Ô ª·ÓÒÏ˘ Û ÂÊË‚È΋ ËÏÈΛ· ‰ÂÓ ·ÔʇÁÂÈ ÙË ÌÔ›Ú· ÙÔ˘ Î·È Ó›ÁÂÙ·È fiÙ·Ó ‚˘ı›˙ÂÙ·È Ë Ûη̷‚›· ÙÔ˘, ÙÔ ÚÒÙÔ ÙÔ˘ ÛοÊÔ˜. ŒÓ·˜ ¿ÏÏÔ˜ ¤ÊË‚Ô˜, Ô µ·ÚηÚÔÁÈ¿ÓÓ˘, Â›Ó·È Â›Û˘ ‹Úˆ·˜ ÔÌÒÓ˘ÌÔ˘ ‰ÈËÁ‹Ì·ÙÔ˜ ÙÔ˘ ∞ϤͷӉÚÔ˘ ªˆÚ·˚Ù›‰Ë Ô˘ Ó›ÁÂÙ·È ÂÁÎψ‚ÈṲ̂ÓÔ˜ ÛÙËÓ ·Ó·Ô‰ÔÁ˘ÚÈṲ̂ÓË ‚¿Úη ÙÔ˘, ı‡Ì· ÂÓfi˜ ΋ÙÔ˘˜ (13): ...Ó¤Ô˜ ÛÂÈÛÌÈÎfi˜ Ù˘ Ï¤Ì‚Ô˘ Û˘ÁÎÏÔÓÈÛÌfi˜ ·fi Ù˘ ÙÚfiȉԘ οو ·Ó¤ÙÚ„ÂÓ ·˘Ù‹Ó. √ µ·ÚηÚÔÁÈ¿ÓÓ˘ ¢ڤıË ÙfiÙ ˘fi ÙËÓ ÎÔÈÏ›·Ó Ù˘ Ï¤Ì‚Ô˘, ÂÓÒ Û˘Á¯ÚfiÓˆ˜ ›¯Â ÍÂÓÂÚ›ÛÂÈ ·fi ÙÔ ·ÓÙ›ıÂÙÔÓ Ì¤ÚÔ˜ ÊÔ‚ÂÚfi˜ Ê˘ÛËÙ‹Ú... ∂˘ÚÂı›˜ ÏÔÈfiÓ Ô Ù·Ï·›ˆÚÔ˜ Ô‡Ùˆ ˆ˜ Ì ¿Ï˘Ù· ‰ÂÛÌ¿ ‰Â‰Â̤ÓÔ˜, ‰ÂÓ ËÌfiÚÂÛ ӷ οÌË Î·ÌÌ›·Ó ¯Ú‹ÛÈÓ Ù˘ ÙfiÏÌ˘, Î·È ÌÂÙ’ ÔÏ›ÁÔÓ Û‡۷ÓÙ˜ ÔÈ ¿ÏÏÔÈ ·ÏÈ›˜ › ÙfiÔ˘, ÚÔ·ÈÛı·Óı¤ÓÙ˜ ÙÔ ‰˘ÛÙ‡¯ËÌ· ·fi ÙËÓ ·ÈÊÓȉ›·Ó ηٿۂÂÛÈÓ ÙÔ˘ ˘ÚÔÊ·Ó›Ô˘, ÂÍ‹Á·ÁÔÓ ·˘ÙfiÓ ÌÂÙ¿ ÎfiÔ˘ ÔÏÏÔ‡, ‡ÛÙÂÚÔÓ ·fi ·ÚÎÂÙ‹Ó ÒÚ·Ó, ÓÂÎÚfiÓ, ¿ÓÔ˘Ó, ÓÈÁ̤ÓÔÓ Ì¤Û· ÂȘ ÙÔ ¯·‚Ô‡ÓÈ ÙÔ˘. ∞˘Ù‹ ÙË Ì·Á›· Ô˘ ·ÛΛ ÙÔ ˘ÁÚfi ÛÙÔÈ¯Â›Ô Î·È ÛÙ· ·È‰È¿ Ù˘ fiÏ˘ ·ÔÙ˘ÒÓÂÈ Ë ¶ËÓÂÏfiË ¢¤ÏÙ· Û ¤Ó· ·fiÛ·ÛÌ· ÙÔ˘ Ì˘ıÈÛÙÔÚ‹Ì·ÙÔ˜ “∆ÚÂÏ·ÓÙÒÓ˘”. √ ÔÎÙ¿¯ÚÔÓÔ˜ ‹Úˆ·˜ ∞ÓÙÒÓ˘, ·‰ÂÏÊfi˜ Ù˘ Û˘ÁÁڷʤˆ˜, ·È‰› ÌÂÁ·ÏÔ·ÛÙÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜ - Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ªÂÓ¿ÎË - ·Ú·ıÂÚ›˙ÂÈ ÛÙÔÓ ¶ÂÈÚ·È¿ ÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ·. ∆Ô ı¤·Ì· Ù˘ ·ÁÚÈÂ̤Ó˘ ı¿Ï·ÛÛ·˜ Î·È ÔÈ ‚¿ÚΘ Ô˘ Ûη̷Ӥ‚·ÈÓ·Ó “ÙÔÓ ËÏÂÎÙÚ›˙Ô˘Ó”. ¢ÂÓ ·ÚÁ› Ó· ‚ÁÂÈ ÎÚ˘Ê¿ ·fi ÙÔ Û›ÙÈ ÙÔ˘, Ó· ÌÂÈ Ì¤Û· Û ̛· ·fi ·˘Ù¤˜, ·Ú·Û‡ÚÔÓÙ·˜ Ì·˙› ÙÔ˘ ¤Ó· ÌÈÎÚfi ÁÂÈÙÔÓfiÔ˘ÏÔ, Ó· χÛÂÈ ÙÔ ÛÎÔÈÓ› Î·È Ó· ·ÓÔȯÙ› ÛÙÔ ¤Ï·ÁÔ˜. ™‡ÓÙÔÌ·, ¯¿ÓÔ˘Ó Ù· ÎÔ˘È¿ Î·È ‚Ú›ÛÎÔÓÙ·È Û Ôχ ‰‡ÛÎÔÏË ı¤ÛË, ·‚Ô‹ıËÙÔÈ ÛÙÔ ·Î˘‚¤ÚÓËÙÔ ÏÂÔ‡ÌÂÓÔ. √ ∞ÓÙÒÓ˘ ·ÈÛı¿ÓÂÙ·È Ó· ÏËÛÈ¿˙ÂÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘. ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
∂›¯Â ·Ú·Ù‹ÛÂÈ ÙÔ ÙÈÌfiÓÈ Î·È, Ì ٷ ¯¤ÚÈ· Âӈ̤ӷ ·Ó¿ÌÂÛ· ÛÙ· ÁfiÓ·Ù¿ ÙÔ˘ ÎÔ›Ù·˙ ٷ ÊÒÙ· Ô˘ ¿Ó·‚·Ó Î·È Ï‹ı·ÈÓ·Ó ÛÙËÓ ÚÔÎ˘Ì·›·, ‰Â›¯ÓÔÓÙ·˜ ÙÔ ÌÔ‡¯ÚˆÌ· fiÏÔ Î·È ÈÔ ÛÎÔÙÂÈÓfi. √ ¯·Ìfi˜ ÙˆÓ ·È‰ÈÒÓ ı· ‹Ù·Ó ·Ó·fiÊ¢ÎÙÔ˜, Â¿Ó ‰ÂÓ Â›¯Â ‰ÈÔÚÁ·Óˆı› Ì›· Âȯ›ÚËÛË ÛˆÙËÚ›·˜ Î·È ‰ÂÓ Â›¯Â ÂÈÛÙÚ·Ù¢Ù› Ì›· ·Ù̿ηÙÔ˜ Î·È ¿ÏϘ ‚¿ÚΘ, ÒÛÙÂ Ë ÂÚȤÙÂÈ· Ó· ¤¯ÂÈ ·›ÛÈ· ηٿÏËÍË (14). ¢È·ÊÔÚÂÙÈ΋ Â›Ó·È Ë ÂÚ›ÙˆÛË Ô˘ ÂÚȤ¯ÂÙ·È ÛÙÔ Ì˘ıÈÛÙfiÚËÌ· Ù˘ ∂˘ÁÂÓ›·˜ º·Î›ÓÔ˘ “∞ÛÙÚ·‰ÂÓ‹”, Ë ‰Ú¿ÛË ÙÔ˘ ÔÔ›Ô˘ ÂÎÙ˘Ï›ÛÛÂÙ·È ÛÙÔ ÓËÛ› Ù˘ ™‡Ì˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓÈÁÌfi˜ Ô˘ ‰ÂÓ Û˘Ì‚·›ÓÂÈ ÛÙË ı¿Ï·ÛÛ·, ·ÏÏ¿ Û ̛· ÌÈÎÚ‹ Ù¯ÓËÙ‹ Ï›ÌÓË Ô˘ ›¯·Ó ηٷÛ΢¿ÛÂÈ ÔÈ ‚ÔÛÎÔ› ÁÈ· Ó· ÔÙ›˙Ô˘Ó Ù· ˙Ò· ÙÔ˘˜ (15). ªÈ· ̤ڷ, ÕÓÔÈÍË ‹Ù·ÓÂ, ÙÔÓ Ê¤Ú·Ó ÓÈÁ̤ÓÔÓ. ™Ù¿˙·Ó ·ÎfiÌ· ·’ Ù· ÚÔ˘¯·Ï¿ÎÈ· ÙÔ˘ ÓÂÚ¿... ∫ÔÈÙ·˙fiÙ·Ó ÛÙÔ ÓÂÚfi Ù˘ Ï›ÌÓ˘ ÎÈ ¤ÊÙÈ·¯Ó ÙË ¯ˆÚ›ÛÙÚ· ÙÔ˘, ˙·Ï›ÛÙËÎÂ... ¤ÂÛÂ... Î·È Ó›ÁËÎÂ... ∫·È Ó· ÂȘ ˆ˜ Â›Ó·È ‚·ıÈ¿ Ë Ï›ÌÓË... ¢˘Ô ̤ÙÚ· ÓÂÚfi ÙÔ ’¯ÂÈ ‰ÂÓ ÙÔ ’¯ÂÈ... √‡ÙÂ Î·È Ô˘ Â›Ó·È ·ÏËıÈÓ‹ Ï›ÌÓË. √È ‚ÔÛÎÔ› ÙË ÊÙÈ¿Í·Ó ÁÈ· Ó· ÔÙ›˙Ô˘Ó Ù· ˙ˆÓÙ·Ó¿. ∫¿Ó·Ó ÌÈ· ÌÂÁ¿ÏË ÁÔ‡‚· Î·È ÛÙËڛͷÓ ٷ ¯ÒÌ·Ù· Á‡Úˆ Á‡Úˆ Ì ¤ÙÚ˜. √È Î›Ó‰˘ÓÔÈ ÛÙË ı¿Ï·ÛÛ· ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙÔ˘˜ ÓÈÁÌÔ‡˜, ·ÏÏ¿ ÂÂÎÙ›ÓÔÓÙ·È Î·È Û ÙÚ·˘Ì·ÙÈÛÌÔ‡˜ - ÂÓ›ÔÙ ı·Ó¿ÛÈÌÔ˘˜ - ·fi ηٷ‰‡ÛÂȘ. √È ı·̷ÙÈΤ˜ ‚Ô˘ÙȤ˜ ıˆÚÔ‡ÓÙ·È Î·ÙÔÚıÒÌ·Ù· Î·È ÚÔηÏÔ‡Ó ÙÔÓ ı·˘Ì·ÛÌfi Î·È ÙË ˙‹ÏÈ· ÙˆÓ Û˘ÓÔÌËϛΈÓ. ™ÙË Û˘ÏÏÔÁ‹ ‰ÈËÁËÌ¿ÙˆÓ “£ÂÚÌ¿ ı·Ï¿ÛÛÈ· ÏÔ˘ÙÚ¿” ÙÔ˘ Û˘ÁÁڷʤ· ∏. Ã. ¶··‰ËÌËÙÚ·ÎfiÔ˘ÏÔ˘ ÂÚÈÁÚ¿ÊÂÙ·È Ì›· ÚÔÔÏÂÌÈ΋ ·گȷ΋ ÏÔ˘ÙÚfiÔÏË Î·È Ô ‹Úˆ¿˜ Ù˘, ¤Ó· Ó·Úfi ÚÔÛÊ˘ÁfiÔ˘ÏÔ ·fi ÙË ƒˆÛ›·, Á›ÓÂÙ·È ·ÓÙÈΛÌÂÓÔ ı·˘Ì·ÛÌÔ‡ ÁÈ· ÙȘ ÂÓÙ˘ˆÛȷΤ˜ ‚Ô˘ÙȤ˜ ÙÔ˘. ŸÌˆ˜, Ì›· ∫˘Úȷ΋, ηıÒ˜ ÂȯÂÈÚ› Ó· ˉ‹ÍÂÈ Ì ÊfiÚ· ÛÙË ı¿Ï·ÛÛ· (16): ŒÌÂÈÓ ÂΛ, ηÚʈ̤ÓÔ˜ Û οÔÈÔÓ Û·Ṳ̂ÓÔ ¿ÛÛ·ÏÔ. ŒÙÚÂÍ ÎfiÛÌÔ˜ Î·È ÎÔÛÌ¿Î˘, ·Ï·Ï¿˙ÔÓÙ·˜. ∆ÂÏÈο ‹Úı·Ó ‰‡Ô „·Ú¿‰Â˜ Î·È ÙÔÓ ÙÚ¿‚ËÍ·Ó. ¶¤ı·Ó ÌfiÏȘ ÙÔÓ ·ÎÔ‡ÌËÛ·Ó ÛÙËÓ ·ÌÌÔ˘‰È¿. ™ÙÔ Û‡ÓÙÔÌÔ ·˘Ùfi ‰È‹ÁËÌ· ‰È·Ê·›ÓÂÙ·È Ë Ù¿ÛË Â›‰ÂÈ͢ ÙˆÓ ÂÊ‹‚ˆÓ, fiÙ·Ó ‰È·ı¤ÙÔ˘Ó ‰ÂÍÈfiÙËÙ˜ Î·È Ù·Ï¤ÓÙ· Ô˘ Ì·˙› Ì ÙË ‰È¿ıÂÛË Ó· ÚÈ„ÔÎÈÓ‰˘ÓÂ‡Ô˘Ó ÙÔ˘˜ ˆıÔ‡Ó Û ˘ÂÚ‚¿ÛÂȘ ÙˆÓ ÔÚ›ˆÓ, ÂÓ›ÔÙ Ì ÔϤıÚÈ· ·ÔÙÂϤÛÌ·Ù·. ∆Ô Ê·ÈÓfiÌÂÓÔ ·ÓȯÓ‡ÂÙ·È Î·È Û ÂÊ‹‚Ô˘˜ ÓÂfiÙÂÚˆÓ ÂÔ¯ÒÓ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜ ÁÈ· Ó· ‰ÈÔ¯ÂÙ‡ÛÔ˘Ó ÙËÓ ÎÏ›ÛË ÙÔ˘˜ ÛÙÔ “˙ËÓ ÂÈÎÈÓ‰‡Óˆ˜”, fiˆ˜ ı· ‰Â›ÍÔ˘Ó Ù· Û‡Á¯ÚÔÓ· ÏÔÁÔÙ¯ÓÈο ·ÔÛ¿ÛÌ·Ù·
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·231
231
¶·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·
Û¯ÂÙÈο Ì ÙȘ “ÎfiÓÙÚ˜” Î·È ÙÔ˘˜ ÂÏÈÁÌÔ‡˜ Ì ÙȘ Ì˯·Ó¤˜.
¶ÙÒÛË Û ÊÚ¤·Ù· √È ÛˆÌ·ÙÈΤ˜ ‚Ï¿‚˜ ·fi ÙÒÛÂȘ ·ÔÙÂÏÔ‡Ó ÙÔÓ Û˘¯ÓfiÙÂÚÔ Ù‡Ô ·Ù˘¯‹Ì·ÙÔ˜ Î·È Â˘ı‡ÓÔÓÙ·È ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ ÚÔÛ¤Ú¯ÔÓÙ·È ÁÈ· È·ÙÚÈ΋ ‚Ô‹ıÂÈ· ÛÙ· Â͈ÙÂÚÈο È·ÙÚ›· ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ÓÔÛÔÎÔÌ›ˆÓ. √ Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ‰fiÌËÛ˘ ÙˆÓ Î·ÙÔÈÎÈÒÓ Î·È Ù· ηٷӷψÙÈο ÚÔ˚fiÓÙ· ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡ ·ÔÙÂÏÔ‡Ó ÁÈ· ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙËÓ Â͈ÙÂÚÈ΋ ·ÈÙ›· ÚfiÎÏËÛ˘ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜. ¢ÂÓ Â›Ó·È Û¿ÓȘ ÔÈ ÙÒÛÂȘ Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÂÂȉ‹ Ù· ÌÈÎÚ¿ ·È‰È¿ ÚÔÛ·ıÔ‡Ó Ó· ÌÈÌËıÔ‡Ó ÙȘ ˘ÂÚ‚·ÙÈΤ˜ ‰˘Ó¿ÌÂȘ Û‡Á¯ÚÔÓˆÓ ËÚÒˆÓ, fiˆ˜ Ô Superman Î·È Ó· ÂÙ¿ÍÔ˘Ó ·fi ÙÔ ·Ú¿ı˘ÚÔ. ª¤¯ÚÈ Ù· ̤۷ ÙÔ˘ 20Ô‡ ·ÈÒÓ· Ë ‡‰Ú¢ÛË ·ÔÙÂÏÔ‡Û ‰‡ÛÎÔÏÔ Úfi‚ÏËÌ· ÙfiÛÔ ÛÙȘ fiÏÂȘ fiÛÔ Î·È ÛÙËÓ ‡·ÈıÚÔ. ∏ ·ÓfiÚ˘ÍË ÂÓfi˜ ÊÚ¤·ÙÔ˜ ·ÔÙÂÏÔ‡Û ÙË Û˘¯ÓfiÙÂÚË Ï‡ÛË ÁÈ· ÙËÓ ÚÔÌ‹ıÂÈ· ÓÂÚÔ‡ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ·ÏÏ¿ Ù·˘Ùfi¯ÚÔÓ· Ì›· ÌfiÓÈÌË ·ÂÈÏ‹ ‰ÈfiÙÈ ··ÈÙÔ‡Û ·ÁÚ‡ÓËÛË ÛÙÔ Ó· ·Ú·Ì¤ÓÂÈ ¿ÓÙÔÙ ÎÏÂÈÛÙfi ÙÔ ÛÙfiÌÈfi ÙÔ˘, ·ÔÎÏ›ÔÓÙ·˜ ÙËÓ ÚfiÛ‚·ÛË ·È‰ÈÒÓ ÛÙÔ ¿ÓÔÈÁÌ¿ ÙÔ˘. √ ∞ϤͷӉÚÔ˜ ¶··‰È·Ì¿ÓÙ˘ ÂÍÈÛÙÔÚ› ÙÚ›· Ù¤ÙÔÈ· ÙÚ·ÁÈο Û˘Ì‚¿ÓÙ·, ‰ËÏ·‰‹ ı·Ó·ÙËÊfiÚ˜ ÙÒÛÂȘ ·È‰ÈÒÓ Û ËÁ¿‰È· ÛÙ· ·ÓÙ›ÛÙÔȯ· ‰ÈËÁ‹Ì·Ù· “∏ ÙÂÏÂ˘Ù·›· ‚·ÙÈÛÙÈ΋” (17), “∏ Ù‡¯Ë ·’ ÙËÓ ∞̤ÚÈη” Î·È “ºfiÓÈÛÛ·”. ™ÙÔ ÚÒÙÔ ·fi ·˘Ù¿, ÙÔ ı‡Ì· Â›Ó·È Ë ÌfiÏȘ 2 ÂÙÒÓ ™ÔÊԇϷ, Ô˘ ÂÈÛΤÙÂÙ·È ÙË ÓÔÓ¿ Ù˘ ÙË ªÂÁ¿ÏË ¶¤ÌÙË ÁÈ· Ó· ·Ú·Ï¿‚ÂÈ ÙËÓ ¶·Û¯·ÏÈÓ‹ ÎÔ˘ÏÔ‡Ú·. ∏ ÂÈÙ‹ÚËÛË Ù˘ ÌÈÎÚ‹˜ ¤¯ÂÈ ·Ó·ÙÂı› ÛÙËÓ 20¯ÚÔÓË “‰Ô˘Ï‡ÙÚ·” ∞ıËÓÈÒ Ô˘ ‰È·Ú¿ÙÙÂÈ ‰‡Ô ÛÔ‚·Ú¿ ÛÊ¿ÏÌ·Ù·. ¶ÚÒÙÔÓ ÏËÛÌÔÓ› ÙÔ Î·ı‹ÎÔÓ Ô˘ Ù˘ ¤¯ÂÈ ·Ó·ÙÂı›: ...ÂÂȉ‹ ÂȘ Ù·˜ Â˙ԇϷ˜ ÂοıËÓÙÔ Ù¤ÛÛ·Ú˜ ‹ ¤ÓÙ ÁÂÈÙfiÓÈÛÛ˜, Î·È ÁÓˆÚ›˙ÔÌÂÓ fiÛÔÓ ÂÚÈÛÔ‡‰·ÛÙÔ˜ Â›Ó·È Ë Û˘Ó‰È¿ÏÂÍȘ ÙˆÓ ·¤ÚÁˆÓ Á˘Ó·ÈÎÒÓ ÂοıÈÛ ÏËÛ›ÔÓ ·˘ÙÒÓ... Î·È ‰Â‡ÙÂÚÔÓ ‰È·Ú¿ÙÙÂÈ ¤Ó· ÔϤıÚÈÔ ÛÊ¿ÏÌ·: ¶·Ú·ÁÁÂÏı›۷ ˘fi Ù˘ ΢ڛ·˜ Ù˘ Ó· ·ÓÙÏ‹ÛË ‡‰ˆÚ ÂÎ ÙÔ˘ ÊÚ¤·ÙÔ˜, ÂÁ¤ÌÈÛ ÌÂÓ ÙËÓ ÛÙ¿ÌÓ·Ó, ·ÏÏ¿ ‰ÂÓ ÂÊÚfiÓÙÈÛ ӷ ÎÏ›ÛË ÙÔ ÛÙfiÌÈÔÓ ÙÔ˘ ÊÚ¤·ÙÔ˜, fiˆ˜ ÙÔ Â‡Ú ÎÂÎÏÂÈṲ̂ÓÔÓ, ÙÔ ¿ÊËÛ ‰Â ·ÓÔÈÎÙfiÓ. ∞ÚÔÛÂÍ›· ÂȘ ËÓ Ô˘‰¤ÔÙ ı· ˘¤ÈÙÂÓ Ë ÁÚ·›· ™ÔÊԇϷ ‹ ¿ÏÏË ÊÚfiÓÈÌÔ˜ Á˘Ó‹. ªË ÙȘ ‰Â ·ÌÊÈ‚¿ÏË fiÙÈ ÙËÓ Û‡ÛÙ·ÛÈÓ Ù·‡ÙËÓ Ë ÁÚ·›· ¤Î·ÌÂ
¯ÈÏÈ¿ÎȘ ÂȘ ÙËÓ ‰Ô˘Ï‡ÙÚ·Ó Ù˘, ·ÏÏ’ Ë ∞ıËÓÈÒ ‰ÂÓ ‹ÙÔ ÂÍ ÂÎÂ›ÓˆÓ ÙˆÓ Á˘Ó·ÈÎÒÓ, ·›ÙÈÓ˜ ηı›ÛÙ·ÓÙ·È ÚÔÛÂÎÙÈη›. ∆Ô ·Ù‡¯ËÌ· ‰ÂÓ ¿ÚÁËÛ ӷ Û˘Ì‚Â›. √È ÎÚ·˘Á¤˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ô ıfiÚ˘‚Ô˜ Ù˘ ÙÒÛ˘ ·Ê˘Ó›˙Ô˘Ó ÙȘ Á˘Ó·›Î˜, ·ÏÏ¿ ÚÒÙË Û‡‰ÂÈ Ë ÁËÚ·È¿ ÓÔÓ¿. ...¤ÓÙÚÔÌÔ˜, ·Ó˘fi‰ËÙÔ˜, Ì ÙȘ οÏÙÛ˜ ÌfiÓÔÓ, Á˘ÌÓÒÏÂÓÔ˜, Ì ٷ˜ ¯Â›Ú·˜ ˙˘Ì·ÚˆÌ¤Ó·˜, ¤ÙÚÂÍ ÚÔ˜ ÙÔ ÊÚ¤·Ú ÎÚ¿˙Ô˘Û·: - ∆Ô ÎÔÚ›ÙÛÈ! ∆Ô ÎÔÚ›ÙÛÈ! ∏ Û‡Á¯˘ÛË Î·È Ô ·ÓÈÎfi˜ ÂÌÔ‰›˙Ô˘Ó ÙȘ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÂÓ¤ÚÁÂȘ ‰È¿ÛˆÛ˘ ηÈ, fiÙ·Ó ÙÂÏÈο ·Ó·Û‡ÚÂÙ·È Ì ·‰ÈηÈÔÏfiÁËÙË Î·ı˘ÛÙ¤ÚËÛË ÙÔ ·È‰›, Â›Ó·È È· ÓÂÎÚfi. ∏ ÎÂÊ·Ï‹ ‹ÙÔ ‰ÂÈÓÒ˜ ̈ψÈṲ̂ÓË. ∫·ÙÂÓ¯ı›۷ ÛÊÔ‰ÚÒ˜ ÂȘ ÙÔ ‡‰ˆÚ ›¯Â ÎÙ˘‹ÛÂÈ Â› ÙÔ˘ Ï›ıÔ˘, Â˙·Ï›ÛıË, η٤È Ôχ ÓÂÚfiÓ, Î·È ‰ÂÓ ·Ó‹Ïı ٷ¯¤ˆ˜ ÂȘ ÙËÓ ÂÈÊ¿ÓÂÈ·Ó. ™ÙÔ ‰Â‡ÙÂÚÔ ‰È‹ÁËÌ· ÙÔ ı‡Ì· Â›Ó·È Ë ÂÙ¿¯ÚÔÓË ƒÔ‰·˘Á‹, ÎfiÚË ÔÏ˘ÌÂÏÔ‡˜ Î·È ÊÙˆ¯‹˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ‰ÂÓ ¤¯ÂÈ Â·Ú΋ ÂÈÙ‹ÚËÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ Ù˘ (18). ¶·Á›‰Â˜ ·ÓÔÈÎÙ¤˜, fiˆ˜ ËÁ¿‰È·, Ï¿ÎÎÔÈ Î·È ÎÔÈÏÒÌ·Ù·, ‰ËÌÈÔ˘ÚÁÔ‡Ó Â›Û˘ ÙȘ ÚÔ¸Ôı¤ÛÂȘ ÙÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ ‡ÛÙÂÚ· ·fi Ì›· Ú·Á‰·›· Û˘Ó¯‹ ‚ÚÔ¯‹. ...¢ÚÈÛÎÔ̤ÓË ÂȘ ÙËÓ ·˘Ï‹Ó ÌÂÁ¿Ï˘ ÁÂÈÙÔÓÈ΋˜ ÔÈΛ·˜ ›¯Â ·„ÂÈ ÂȘ ÙÔ ¯Â›ÏÔ˜ ‚·ı¤Ô˜ ÊÚ¤·ÙÔ˜... Ë ·È‰›ÛÎË ¤Û΢„ ÔÏ›ÁÔÓ ÙÈ ‚·ı‡ÙÂÚ· ÂÁÏ›ÛÙÚËÛ ÎÈ ¤ÂÛ ηٿ ÎÂÊ·Ï‹˜ ̤۷ ÂȘ ÙÔ ÓÂÚfiÓ... ∂Ù¿Ú·Í ¤Ï¢ÛÂÓ, ÂÛ·ÚÙ¿ÚËÛÂ. ªÂÙ’ ÔÏ›Á· ÏÂÙ¿ ÙËÓ ·Ó¤Û˘Ú·Ó ÓÂÎÚ¿Ó. ªÂ ÏÈÙ¿ ÂÎÊÚ·ÛÙÈο ̤۷ Ô Û˘ÁÁڷʤ·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ Ì›· ˙ÔÊÂÚ‹ ÂÈÎfiÓ· Ù˘ ȉȷ›ÙÂÚ˘ ·ÙÚ›‰·˜ ÙÔ˘, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÙȘ Û˘Óı‹Î˜ ‰È·‚›ˆÛ˘ ÙÔ˘ ÏËı˘ÛÌÔ‡, ÙËÓ ÏËÌÌÂÏ‹ ÂÈÙ‹ÚËÛË ÙˆÓ ·È‰ÈÒÓ, ÙËÓ ÂÓ›· Î·È ÙËÓ ÂÍ·ıÏ›ˆÛË ·ÏÏ¿ Î·È ÙËÓ ·‰È·ÊÔÚ›· ÙˆÓ ˘Â˘ı‡ÓˆÓ Î·È ÙˆÓ È‰ÈˆÙÒÓ ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ·ÓËϛΈÓ. ™˘ÓÂÒ˜, ÔÏÏ¿ ·fi Ù· ηıËÌÂÚÈÓ¿ ·Ù˘¯‹Ì·Ù· ı· ÌÔÚÔ‡Û·Ó Ó· ›¯·Ó ·ÔÊ¢¯ı›. ™ÙÔ ·ÚÈÛÙÔ‡ÚÁËÌ¿ ÙÔ˘, ÙË “ºfiÓÈÛÛ·” (19), Ô ¶··‰È·Ì¿ÓÙ˘ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌfiÓÔ Ì›· ÛÂÈÚ¿ ‰ÔÏÔÊÔÓÈÒÓ ÌÈÎÚÒÓ ÎÔÚÈÙÛÈÒÓ Î·È ıËÏ˘ÎÒÓ ‚ÚÂÊÒÓ, ·ÏÏ¿ ·Ú·‰fi͈˜ ·Ó¿ÌÂÛ¿ ÙÔ˘˜ Î·È ¤Ó· ·Ù‡¯ËÌ·. ∏ ËÚˆ›‰· ÙÔ˘, Ë ºÚ·ÁÎÔÁÈ·ÓÓÔ‡, Ë ËÌÈ·Ú¿ÊÚˆÓ ÊfiÓÈÛÛ·, ‰ÂÓ ÚÔÏ·‚·›ÓÂÈ Ó· “··ÏÏ¿ÍÂÈ” ¿ÏÏË Ì›· ÊÙˆ¯‹ ÔÈÎÔÁ¤ÓÂÈ· ·fi ÙÔ ‚¿ÚÔ˜ ÂÓfi˜ ·ÎfiÌË ·ÓÂÈı‡ÌËÙÔ˘ ıËÏ˘ÎÔ‡, ‰ÈfiÙÈ ¤Ó· ·Ù‡¯ËÌ· Á›ÓÂÙ·È Ë ·ÈÙ›· Ó· ¯¿ÛÂÈ ÙË ˙ˆ‹ Ù˘ Ë ÂÙ¿¯ÚÔÓË •ÂÓԇϷ, ¯ˆÚ›˜ Ó· ¯ÚÂÈ·ÛÙ› Ë ‰È΋ Ù˘ ·Ú¤Ì‚·ÛË. ∏ ·È‰ÔÎÙfiÓÔ˜ Û˘Ó·ÓÙ¿ ÙÚ›· ÌÈÎÚ¿ ÎÔÚ›ÙÛÈ·, Ô˘ ηÓ›˜ ‰ÂÓ ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·232
232
Œ. ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ Î·È Û˘Ó.
ÂÈÙËÚ›, Ó· ·›˙Ô˘Ó Á‡Úˆ ·fi ¤Ó· ËÁ¿‰È ÊÚ·Á̤ÓÔ Ì ۿȘ Û·Ó›‰Â˜. ∆Ô ÛÎËÓÈÎfi Â›Ó·È ¤ÙÔÈÌÔ ÁÈ· ÙÔ ‰Ú¿Ì· Ô˘ ı· ·ÎÔÏÔ˘ı‹ÛÂÈ. ™ÙÈÁÌ‹Ó ÙÈÓ·, Ù· ‰‡Ô ¿ÏÏ· ÎÔÚ¿ÛÈ· ¤ÙÚÂÍ·Ó ¤Íˆ Ù˘ ·˘Ï‹˜, Ë ‰Â •ÂÓԇϷ Ì›ӷ۷ ¤Î˘ÙÂÓ ÂȘ ÙÔ ÊÚ¤·Ú ÎÈ Â˙ËÙÔ‡Û Ì ̛·Ó ‚¤ÚÁ·Ó Ó· Êı¿ÛË Î·È Ó· ¯·Ú¿ÍË ÙÔ ÓÂÚfiÓ. ŒÎ˘ÙÂÓ ÂÈÌfiÓˆ˜ ·ÏÏ¿ Ë ‚¤ÚÁ· ‹ÙÔ Ôχ ÎÔÓÙ‹ Î·È ‰ÂÓ ¤Êı·ÓÂ. - ∂! £Â ÌÔ˘ Î·È Ó· ’ÂÊÙ˜ ̤۷, •ÂÓԇϷ! ∂›Â Ì ·ÏÏfiÎÔÙÔÓ Á¤ÏˆÙ· Ë ºÚ·ÁÎÔÁÈ·ÓÓÔ‡. ∆È Ï¢ıÂÚÈ¿ ı· ’ηÓ˜ Ù˘ Ì¿Ó·˜ ÛÔ˘! √ Û˘ÁÁڷʤ·˜ ÂÚÈÁÚ¿ÊÂÈ Ì ÏÂÙÔ̤ÚÂȘ ÙÔÓ Ï·Óı·Ṳ̂ÓÔ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô Â›Ó·È ÛηṲ̂ÓÔ ÙÔ ËÁ¿‰È, ÙË ÊıÔÚ¿ ÙˆÓ Û·Ó›‰ˆÓ ÙÔ˘ Î·È ÙË ÛÎÔ˘ÚÈ¿ ÙˆÓ Î·ÚÊÈÒÓ ÙÔ˘, ÂÈÛËÌ·›ÓÔÓÙ·˜ ÙȘ ¢ı‡Ó˜ ÙˆÓ È‰ÈÔÎÙËÙÒÓ Î·È ÙˆÓ ÁÔÓ¤ˆÓ. ∫·ıÒ˜ ¤Î˘„ÂÓ Ë ·È‰›ÛÎË, ÂÛÙËÚ›¯ıË fiÏË, Ì ÙÔ ‚¿ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ › Ù˘ ·ÚÈÛÙÂÚ¿˜ ¯ÂÈÚfi˜, ¿ӈ ÂȘ ·˘Ù‹Ó ÙËÓ Û·Ó›‰·, ÂÁÏ›ÛÙÚËÛÂÓ, Ë Û·Ó›˜ ÂÓ¤‰ˆÎÂÓ, ÂÍÂÎfiÏÏËÛÂÓ ·fi ÙËÓ ÌÈ·Ó ¿ÎÚ·Ó, Î·È Ë •ÂÓԇϷ ¤ÂÛ ηٷΤʷϷ ̤۷ ÂȘ ÙÔ ¯¿ÛÎÔÓ ÛÙfiÌ· ÙÔ˘ ÊÚ¤·ÙÔ˜. √È Î›Ó‰˘ÓÔÈ ‰ÂÓ ·Ú·ÌÔÓÂ‡Ô˘Ó ÌfiÓÔ ÛÙËÓ ‡·ÈıÚÔ Î·È ÛÙ· ·ÔÌ·ÎÚ˘Ṳ̂ӷ ¯ˆÚÈ¿, ·ÏÏ¿ Î·È ÛÙË ÌÈÎÚ‹ ÚˆÙÂ‡Ô˘Û· Î·È È‰È·›ÙÂÚ· ÛÙȘ ˘Ô‚·ıÌÈṲ̂Ó˜ Û˘ÓÔÈ˘ Ù˘. ∆Ô ÛÎÔÙ¿‰È Ô˘ ÂÈÎÚ·ÙÔ‡Û ÙȘ Ó‡¯Ù˜ ÛÙÔ˘˜ ‰ÚfiÌÔ˘˜ Ù˘ ∞ı‹Ó·˜ ¢ÓÔÔ‡Û ·Ù˘¯‹Ì·Ù· Î·È ¿ÏÏ· ·ÚfiÔÙ·. ∑ˆÓÙ·Ó‹ ÂÚÈÁÚ·Ê‹ ‰›ÓÂÈ Ô ∂ÌÌ·ÓÔ˘‹Ï ƒÔ˝‰Ë˜ ÛÙÔ ‰È‹ÁËÌ¿ ÙÔ˘ “∆Ô ·Ú¿ÔÓÔ ÙÔ˘ ÓÂÎÚÔı¿ÙÔ˘” (20), fiÔ˘ ¤Ó·˜ ÊÙˆ¯fi˜ ÓÂÎÚÔı¿ÊÙ˘, ¤¯ÔÓÙ·˜ ¯¿ÛÂÈ Ù· ¤ÍÈ ·fi Ù· ÂÊÙ¿ ·È‰È¿ ÙÔ˘, „¿¯ÓÂÈ ·ÂÁÓˆṲ̂ӷ ÙË ÌÔÓ·‰È΋ ÎfiÚË Ô˘ ÙÔ˘ ·Ô̤ÓÂÈ, ηıÒ˜ ¤Ó· ‚Ú¿‰˘ ‰ÂÓ ÂÈÛÙÚ¤ÊÂÈ ÛÙÔ Û›ÙÈ Ù˘: ∂Á‡ÚÈÛ· ÂȘ ÙÔ Û›ÙÈ ÂÏ›˙ÔÓÙ·˜ Ó· ÙËÓ Â‡Úˆ ÂΛ... ∂‹Á· ÙfiÙ ӷ Í˘Ó‹Ûˆ ‰‡Ô ÁÂÈÙfiÓÔ˘˜ Î·È ·Ó¿„·Ì ʷӿÚÈ· Ó· ȉԇÌ ̋ˆ˜ ÂÁÏ›ÛÙÚËÛ Û ηӤӷ ·fi Ù· ‚¿Ú·ıÚ· Î·È ÍÂÚÔ‹Á·‰· Ù˘ µ¿ıÂÈ·˜, Ô˘ ηٷ›ÓÔ˘Ó ·ÓıÚÒÔ˘˜ οı ÛÎÔÙÂÈÓ‹ Ó‡ÎÙ·. ∆· ÂÍÂÙ¿Û·ÌÂÓ fiÏ· Î·È ‰ÂÓ Â›‰·ÌÂÓ Ù›ÔÙ˜. ∂Í‹‰ËÛ· ¤ÂÈÙ· ÂȘ ÙËÓ ·ÛÙ˘ÓÔÌ›·Ó Ó· ÂÚˆÙ‹Ûˆ ÔÈÔ‡˜ ÂÏ¿ÎˆÛ·Ó ·fi ÙÔ Úˆ› ÔÈ ·Ì·Í¿‰Â˜. ∆ËÓ ËÌ¤Ú·Ó ÂΛÓËÓ ‰ÂÓ Â›¯·Ó Ï·ÎÒÛÂÈ Î·Ó¤Ó·, Î·È ÌfiÓÔ Ô ÛȉÂÚfi‰ÚÔÌÔ˜ ¤Ó· ‚fi‰È. ∆· ·ÏÈ¿ Û›ÙÈ· ÛÙ· ¯ˆÚÈ¿ ‹Ù·Ó Û˘¯Ó¿ ‰›·Ù· Î·È Ô Î¿Ùˆ fiÚÔÊÔ˜ ¯ÚË̢ۛ ˆ˜ ·Ôı‹ÎË, ηÙÔÈΛ· ˙ÒˆÓ ‹ ÙfiÔ˜ ·ÁÚÔÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ, ÂÓÒ ÔÈ Î·Ù··ÎÙ¤˜, Ù· ·Ù¿ÚÈ· Î·È ÔÈ ·˘ÙÔÛ¯¤‰È˜ ÛοϘ Á›ÓÔÓÙ·Ó Û˘¯Ó¿ ÚfiÍÂÓÔÈ ÛÔ‚·ÚÒÓ ·Ù˘¯ËÌ¿ÙˆÓ. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·ÊËÁÂ›Ù·È Ë ∑˘Ú¿ÓÓ· ∑·Ù¤ÏË ÛÙÔ Ì˘ıÈÛÙfiÚËÌ¿ Ù˘ ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
“∫·È Ì ÙÔ Êˆ˜ ÙÔ˘ χÎÔ˘ ·ӤگÔÓÙ·È” (21), ÙÔ ÌÔÓ·‰ÈÎfi ÎÔÚÈÙÛ¿ÎÈ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ô˘ ‹Ù·Ó Ë ¯·˚‰Â̤ÓË ÂÓfi˜ ·˘ÛÙËÚÔ‡ ·Ù¤Ú· ‚Ú›ÛÎÂÈ ÙÚ·ÁÈÎfi ı¿Ó·ÙÔ, ÂÓÒ ÂΛÓÔ˜ Û˘Ó¯›˙ÂÈ Ó· ˙ÂÈ Ì ÙȘ ÈÛfi‚Ș Ù‡„ÂȘ Ô˘ ‰ÂÓ ÙÔ˘ ÂÈÙÚ¤Ô˘Ó Ó· Í·Ó·Ì·ÏÒÛÂÈ ÔÙ¤ ·È‰›: ŒÂÛÂ Ë ÎfiÚË ÙÔ˘ ·’ ÙËÓ ÁÎÏ·‚·Ó‹, ¤Â̘۠ ÛÙÔ ÛÔ˘Û¿ÌÈ, ÛÙÔÓ Ì‡ÏÔ Ô˘ ¿ÏÂıÂ... Ë ¯·˚‰Â̤ÓË ÙÔ˘, ÙÔ ÌÔÓ·¯Ô·›‰È... ª·ÚÈÁÒ ÙËÓ ¤ÏÂÁ·Ó... ™ÙÔ ÎÔÚÈÙÛ¿ÎÈ ‚Á‹Î·Ó Ù· Ì¿ÙÈ·... ¤Ó· ÎÔÚÈÙÛ¿ÎÈ Ó· ÙÔ ¯·›ÚÂÛ·È. ∫·È ‚Á‹Î·Ó Ù· Ì¿ÙÈ·, ¤ı·ÓÂ. ∞fi ÙfiÙÂ Ô Ì·Ì¿˜ Ù˘ ¤ÁÈÓ ·ÚÓ›. √È ÙÒÛÂȘ ·fi ‰¤ÓÙÚ· ‰ÂÓ Â›Ó·È Û¿ÓȘ, ηıÒ˜ Ù· ·È‰È¿ ÛηÚÊ·ÏÒÓÔ˘Ó ·ÎfiÌË Î·È ÛÙ· „ËÏfiÙÂÚ· ÎÏ·‰È¿ ÙÔ˘˜. ∆· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ Â›Ó·È ¿ÓÙÔÙ ·ÓÒ‰˘Ó· Î·È ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È Û ·Ï¿ ηٿÁÌ·Ù·. √ ∞ϤͷӉÚÔ˜ ¶··‰È·Ì¿ÓÙ˘ ÛÙÔ ‰È‹ÁËÌ· “∏ ʈӋ ÙÔ˘ ¢Ú¿ÎÔ˘” ÂÚÈÁÚ¿ÊÂÈ Ì›· Ù¤ÙÔÈ· ı·Ó·ÙËÊfiÚ· ÙÒÛË ÙÔ˘ 15¯ÚÔÓÔ˘ ∫ÒÙÛÔ˘, Ô˘ ˘Ê›ÛÙ·Ù·È ÙȘ ÏÔȉÔڛ˜ ÙˆÓ Û˘ÓÔÌËÏ›ÎˆÓ ÙÔ˘ ÂÂȉ‹ Â›Ó·È ÓfiıÔ˜. √ Û˘ÁÁڷʤ·˜ ηٷÁÚ¿ÊÂÈ ÙË ÌÂÈÔÓÂÎÙÈ΋ Î·È ÂÚÈıˆÚȷ΋ ηٿÛÙ·ÛË Î·È ÙÔ ÛÙ›ÁÌ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ Ù· ·È‰È¿ ÂÎÙfi˜ Á¿ÌÔ˘, ηıÒ˜ Î·È ÙÔÓ ÂÚÈ·ÈÎÙÈÎfi, ÚÔÛ‚ÏËÙÈÎfi Î·È Û˘¯Ó¿ Ù˘Ú·ÓÓÈÎfi ÙÚfiÔ Ô˘ ÙÔ˘˜ ʤÚÔÓÙ·È ÔÈ ¿ÏÏÔÈ Û˘ÓÔÌ‹ÏÈÎÔÈ (22). ŸÙ·Ó ¤ÁÈÓ ‰Âη¤ÓÙ ÂÙÒÓ, ›¯ÂÓ ·Ó·ÚÚȯËı› Ì›· ÙˆÓ ËÌÂÚÒÓ ÂȘ ˘ÂÚ‡„ËÏÔÓ ‰¤Ó‰ÚÔÓ, ÏÂ‡Î·Ó Î˘·ÚÈÛÛÔÂȉ‹ ·fi Ù·˜ ÔÔ›·˜ ηٷÛ΢¿˙Ô˘Ó Ù· ηٿÚÙÈ· ÙˆÓ ÏÔ›ˆÓ. √ ∫ÒÙÛÔ˜ ÂÏËÛ›·˙ ӷ Êı¿ÛË ÂȘ ÙËÓ ÎÔÚ˘Ê‹Ó, fiÙ·Ó ÂÓ ·È‰›ÔÓ, ÙÔ ÔÔ›ÔÓ ÔÏÏ¿ÎȘ ÙÔÓ Â›¯ÂÓ ÂÓԯϋÛÂÈ, ‰È‹Ïı ÙÚ¤¯ÔÓ ·Ôοو, Î·È Â‡ÚÂÓ Â˘Î·ÈÚ›·Ó Ó· ʈӿÍË ÚÔ˜ ÙÔÓ ·Ó·ÚÚȯÒÌÂÓÔÓ ÙÔ Û‡ÓËı˜ ˘‚ÚÈÛÙÈÎfiÓ fiÓÔÌ·... ªÂÙ’ ÔÏ›Á· ‰Â˘ÙÂÚfiÏÂÙ· Ô ∫ÒÙÛÔ˜ ¤ÈÙ οو ÂȘ ÙËÓ ÁËÓ, ·fi ‡„Ô˘˜ ›ÎÔÛÈ Ì¤ÙÚˆÓ. ∂›¯Â ÍÂÈ·Ûı‹ Ì ÙËÓ Ì›·Ó ¯Â›Ú· Î·È Â›¯Â ÎÔÈÙ¿ÍÂÈ ÔÚÁ›ÏÔ˜ ÚÔ˜ Ù· οو. º·›ÓÂÙ·È fiÙÈ Ë ‡‚ÚȘ ÙÔ˘ ‰ÈÂÏıfiÓÙÔ˜ ·È‰›Ô˘ ÙÔÓ Â›¯ÂÓ ÂÚÂı›ÛÂÈ ˘ÂṲ́ÙÚˆ˜ Î·È ÙÔÓ Â›¯ÂÓ Î¿ÌÂÈ Ó· ¯¿ÛË ÙËÓ Ï·‚‹Ó... √ ¿Ù˘¯Ô˜ ∫ÒÙÛÔ˜ ¤˙ËÛÂÓ ÔÏ›Á·˜ ÒÚ·˜ ·Ó·›ÛıËÙÔ˜ Î·È Â›Ù· ÂͤÓ¢ÛÂÓ...
∫ÂÚ·˘ÓÔÏË͛˜ - ¶˘ÚηÁȤ˜ - ∂ÎÚ‹ÍÂȘ ªÂٷ͇ ÙˆÓ ÔÏÏÒÓ ÎÈÓ‰‡ÓˆÓ Ù˘ ˘·›ıÚÔ˘ Ô˘ ·Ú·ÌfiÓ¢·Ó Ù· ·È‰È¿ ‹Ù·Ó Ë ÎÂÚ·˘ÓÔÏËÍ›·, Ê·ÈÓfiÌÂÓÔ Û¿ÓÈÔ ‚¤‚·È·, ·ÏÏ¿ ˘·ÚÎÙfi. ∆Ô ·Ó·Ê¤ÚÂÈ Ô ÂıÓÈÎfi˜ ÔÈËÙ‹˜ ¢ÈÔÓ‡ÛÈÔ˜ ™ÔψÌfi˜ ÛÙÔ Ô›ËÌ¿ ÙÔ˘ “∏ ÙÚÂÏ‹ Ì¿Ó· ‹ ÙÔ ÎÔÈÌËÙ‹ÚÈ”, Ì ı‡Ì·Ù· ‰‡Ô ÌÈÎÚ¿ ·‰¤ÏÊÈ· (23):
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·233
233
¶·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·
¢‡Ô ·‰¤ÏÊÈ· ‰‡ÛÙ˘¯· ∫ÔÈÌÔ‡ÓÙ·È Î¿ÙÔ˘ ∆ÔÓ ·ÓÂ͇ÓËÙÔÓ ⁄ÓÔÓ ı·Ó¿ÙÔ˘, ∫È’ ¤¯·ÛÂ Ë Ì¿Ó· ÙÔ˘˜ ∆· ÏÔÁÈο. ∆· Ì·‡Ú· ·›˙·Ó ∂Λ fiÔ˘ ÛÙ¤ÎÂÈ √ ‡ÚÁÔ˜, ÎÈ ¤ÂÛ ∆’·ÛÙÚÔÂϤÎÈ ∫È ¿„˘¯· Ù’¿ÊËÛ ∆· ıÏÈ‚ÂÚ¿ ÕÏÏË Ì›· ÂÚ›ÙˆÛË ÎÂÚ·˘ÓÔÏËÍ›·˜ ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ ‰È‹ÁËÌ· Ù˘ ∑˘Ú¿ÓÓ·˜ ∑·Ù¤ÏË “∏ ¶ÂÚÛÂÊfiÓË - Î·È Ì›· ¿ÏÏË ÈÛÙÔÚ›·” (24). ∞Ó·Û‡ÚÂÈ ·fi ÙȘ ·È‰ÈΤ˜ Ù˘ ·Ó·ÌÓ‹ÛÂȘ ÛÙÔ ¯ˆÚÈfi Ù˘ ÙÔ ÊÔ‚ÂÚfi ı¤·Ì· ÂÓfi˜ Ó·ÚÔ‡ ·È‰ÈÔ‡ Ô˘ ÙÔ ¯Ù‡ËÛ ÎÂÚ·˘Ófi˜ Û ̛· ηÏÔηÈÚÈÓ‹ ηٷÈÁ›‰· Î·È ÌÂٷʤÚÂÙ·È Ì ¤Ó· ÊÔÚÙËÁfi ÛÙÔ ÓÔÛÔÎÔÌ›Ô: ...̤۷ ÛÙÔ ÊÔÚÙËÁfi, ÛÙË ı¤ÛË ‰›Ï· ÛÙÔÓ Ô‰ËÁfi... ·˘Ùfi˜ Ô˘ ÔÈ ÎÚ·˘Á¤˜ ÙÔ˘ ¤‚Á·ÈÓ·Ó fi¯È ·fi Ù· ÛˆıÈο ÙÔ˘, Ì· ›ÛÈ· ·’ Ù· ¤Áηٷ Ù˘ Á˘. ŒÓ· ÌÚ¿ÙÛÔ, Ì ηÌ̤Ó˜ Û¿ÚΘ Ó· ÎÚ¤ÌÔÓÙ·È Û·Ó ÎÔ˘Ú¤ÏÈ·, ÎÏ˘‰ˆÓ›˙ÔÓÙ·Ó ÛÙÔÓ ·¤Ú·, Ì ÙÚfiÔ Û· Ó¿ıÂÏ ӷ Û˘ÓÙÚ›„ÂÈ ÙÔ Û‡Ì·Ó, Ì· ·˘Ùfi Ô˘ ÛÎÂÊÙfiÛÔ˘Ó Ì ÊÚ›ÎË ¤ÙÛÈ fiˆ˜ Ùfi‚Ϙ ‹Ù·Ó ·fi ÛÙÈÁÌ‹ Û ÛÙÈÁÌ‹ ı· ÎÔ› ·’ ÙÔÓ ÒÌÔ Î·È ı· ¤ÛÂÈ. ∫·È ÙÔ ÎÂÊ¿ÏÈ ÙÔ˘ ÙÔ ı˘Ì¿Ì·È. ∞ÛÙÚ·È·›· ¤Ú·Û ÙÔ ÊÔÚÙËÁfi ·fi ÌÚÔÛÙ¿ Ì·˜, Ì· ÚfiÏ·‚· Î·È ÙÔ Â›‰·: ηÌ̤ÓÔ Î·È Ì·ÙˆÌ¤ÓÔ, ÎfiÎÎÈÓÔ-Ì·‡ÚÔ. °‰·Ṳ́ÓÔ, ¯ˆÚ›˜ ¯·Ú·ÎÙËÚÈÛÙÈο, ¯ˆÚ›˜ Ì·ÏÏÈ¿, ÌfiÓÔ Ùڇ˜ Î·È Ú˘¿ÎÈ·. ◊Ù·Ó Ô ¡¤ÛÙÔÚ·˜. ◊Ù·Ó ÛÙ· ¯ˆÚ¿ÊÈ· Î·È ÙÔÓ ¤Î·„ ·ÛÙÚ·‹. ¢ÂÓ ÙÔÓ ¿ÊËÛ ÛÙÔÓ ÙfiÔ. ∆Ô ÊÔÚÙËÁfi ÙÔÓ ‹Á·ÈÓ ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô - Ó· οÓÔ˘Ó ÙÈ ÔÈ ÁÈ·ÙÚÔ›; √ ¡¤ÛÙÔÚ·˜ Í„‡¯ËÛ ϛÁÔ ÌÂÙ¿ Ô˘ ¤Ú·Û ·’ ÙËÓ ·ÁÔÚ¿. ª·˜ ·Ô¯·ÈÚ¤ÙËÛ Ì ÙÔ ¯¤ÚÈ ÙÔ˘, fiˆ˜ ηÓ›˜ ¿ÏÏÔ˜. √È ÎÂÚ·˘ÓÔÏË͛˜ Û ·È‰È¿ ¤¯Ô˘Ó ۯ‰fiÓ ÌˉÂÓÈÛÙ› ÛÙË Û‡Á¯ÚÔÓË ∂ÏÏ¿‰·, ·ÊÔ‡ Ù· ·È‰È¿ ηٷӷÏÒÓÔ˘Ó ÙÔÓ ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ Ù˘ Ë̤ڷ˜ ÛÙÔ Î·Ù¿ ÙÂÎÌ‹ÚÈÔ ÚÔÛÙ·ÙÂ˘Ì¤ÓÔ ÔÈÎÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. ¶·Ú’ fiÏ· ·˘Ù¿, Ë ·È‰È΋ ÂÚȤÚÁÂÈ· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ¤ÏÏÂÈ„Ë ÂÈÌÂÏÔ‡˜ ÂÈÙ‹ÚËÛ˘ Î·È ÙȘ ÚÈ„ÔΛӉ˘Ó˜ Û˘ÌÂÚÈÊÔÚ¤˜ ÙˆÓ ÂÓËϛΈÓ, fiˆ˜ ÙÔ Î¿ÓÈÛÌ·, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ˘Â‡ı˘Ó˜ ÁÈ· ÙËÓ ·ÒÏÂÈ· ¤ÓÙ ÂÈϤÔÓ ·È‰ÈÎÒÓ ˙ˆÒÓ ·Ó¿ ¤ÙÔ˜ ·fi ·Ù˘¯‹Ì·Ù· ÏfiÁˆ ÂÎÚËÎÙÈÎÒÓ ‹ ˘ÚηÁÈ¿˜ ÛÙË ¯ÒÚ· Ì·˜. ŒÓ· ·ÏËıÈÓfi ÁÂÁÔÓfi˜ ÌÂٷʤÚÂÈ ÛÙÔ ‰È‹ÁËÌ¿ ÙÔ˘ “∆· ηË̤ӷ” Ô Â˙ÔÁÚ¿ÊÔ˜ ª¤-
Ó˘ ∫Ô˘Ì·ÓÙ·Ú¤·˜ (25) ÁÈ· ÙÔÓ ÙÚ·ÁÈÎfi ı¿Ó·ÙÔ ‰‡Ô ·È‰ÈÒÓ, ÙÔ˘ ∆Û›¯ÏÈ· Î·È ÙÔ˘ ¶·Ú·Û΢¿ (Ô ›‰ÈÔ˜ Ù· ¯·Ú·ÎÙËÚ›˙ÂÈ ˆ˜ ÊÙˆ¯Ô·Ï‹Ù˜) Ô˘ ÙÚÈÁ˘Ú›˙Ô˘Ó ¿ÛÎÔ· Î·È ‚Ú›ÛÎÔ˘Ó Î·Ù·Ê‡ÁÈÔ Û ¤Ó· ·Ú·Á̤ÓÔ Î·˝ÎÈ. ∞fi ¿ÁÓˆÛÙË ·ÈÙ›· ÂΉËÏÒÓÂÙ·È ÊˆÙÈ¿ ÛÙÔ ÌÈÎÚfi ÛοÊÔ˜ Î·È Ù· ‰‡Ô ·Ó‹ÏÈη ‚Ú›ÛÎÔ˘Ó ÙÚ·ÁÈÎfi ı¿Ó·ÙÔ. ™˘ÁÎÂÓÙÚÒÓÂÙ·È Ï‹ıÔ˜ Ô˘ ÚÔÛ·ı› Ì οı ̤ÛÔÓ Ó· ÙË Û‚‹ÛÂÈ, ·ÏÏ¿ ÛÙË ÁÂÓÈ΋ Û‡Á¯˘ÛË Ô˘ ÂÈÎÚ·Ù› ÔÈ ˘ÚÔÛ‚ÂÛÙ‹Ú˜ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È Î·È, ·ÊÔ‡ ‚ÚÂıÔ‡Ó, ‰ÂÓ ÏÂÈÙÔ˘ÚÁÔ‡Ó, ʤÚÓÔ˘Ó Ì¿ÓÈΘ, ·ÎfiÌË Î·È ÓÂÚfi Ì ÎÔ˘‚¿‰Â˜. ŸÙ·Ó ÔÈ ÊÏfiÁ˜ ˘Ô¯ˆÚÔ‡Ó, ·Ó·Î·Ï‡ÙÔÓÙ·È Ù· ÙÒÌ·Ù·: ∆ÔÓ ¤Ó·Ó ÙÔÓ ‚Ú‹Î·Ó ÛÙ’ ·Ì¿ÚÈ... ͷψ̤ÓÔÓ ÌÚÔ‡Ì˘Ù·, ‰ÂÓ ÚfiηÌ ¤ÌÂÈÓ ·fi ·ÛÊ˘Í›·. µÚ‹Î·Ó ٷ ÚÔ‡¯· ÙÔ˘ Ú¿ÎË, ÙË Û¿Úη ·ÁÓÒÚÈÛÙË, ‰ÂÓ ‹Ù·Ó ¿ÓıÚˆÔ˜, ÙÛÈÁ¿ÚÔ ı· ÌÔÚÔ‡Û˜ Ó· ÙÔÓ ÂÚ¿ÛÂȘ ͯ·Ṳ̂ÓÔ Ó· η›ÂÈ. ∫È Ô ¿ÏÏÔ˜; √ ¿ÏÏÔ˜ Ô ÌÈÎÚfi˜, Ê·›ÓÂÙ·È, ÚfiÏ·‚ ‹‰ËÛ ÛÙË ı¿Ï·ÛÛ·, ÌÈÛÔηË̤ÓÔ˜ ÎÈ ·˘Ùfi˜, ¿Ï·È„ ӷ Ì›ÓÂÈ ÛÙÔÓ ·ÊÚfi, Û· ‰ÂȘ ÙËÓ ÏÒÚË ÙÔ˘ η˚ÎÈÔ‡, Ù‡ˆÌ· ¤¯Ô˘Ó Ì›ÓÂÈ ÔÈ Û¿ÚΘ ÙˆÓ ¯ÂÚÈÒÓ ÙÔ˘, ÔÏ¿ÎÂÚ· ÍÂÊÙ›‰È·. ∆ÂÏÈο ‰ÂÓ ¿ÓÙÂÍÂ... ª›· Û˘ÁÎÏÔÓÈÛÙÈ΋ ÛÎËÓ‹ ˘ÚηÁÈ¿˜ Û ÎÂÓÙÚÈÎfi ·ıËÓ·˚Îfi ÍÂÓÔ‰Ô¯Â›Ô ÛÙ· Ù¤ÏË ÙÔ˘ 19Ô˘ ·ÈÒÓ· ÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙÔ Ì˘ıÈÛÙfiÚËÌ· ÙÔ˘ πˆ¿ÓÓË ∫ÔÓ‰˘Ï¿ÎË “√È ÕıÏÈÔÈ ÙˆÓ ∞ıËÓÒÓ” (26). ™ÙËÓ ·Ó·ÛٿوÛË Î·È ÙÔÓ ·ÓÈÎfi Ô˘ ÂÈÎÚ·Ù›, ÙÔ ¤Ó· ·fi Ù· ‰‡Ô ·È‰È¿ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ÏÔ‡ÛÈÔ˘ ÔÌÔÁÂÓÔ‡˜ Î. ºÏ·ÌÔ‡ÚË ÂÁÎψ‚›˙ÂÙ·È ·fi ÙÔ˘˜ ηÓÔ‡˜ Î·È ÙȘ ÊÏfiÁ˜. √ ‰‡ÛÙ˘¯Ô˜ ·Ù¤Ú·˜ ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙËÓ ·Ô˘Û›· ÙÔ˘. - ∆Ô ·È‰› ÌÔ˘! ∆Ô ·È‰› ÌÔ˘ ¤ÌÂÈÓ ¿Óˆ! √ ‹Úˆ·˜ ÙÔ˘ ÏÔÁÔÙ¯ÓÈÎÔ‡ ¤ÚÁÔ˘, Ô 12¯ÚÔÓÔ˜ ÌÈÎÚfi˜ ÏÔ‡ÛÙÚÔ˜ ∆¿ÛÔ˜ ‰ÂÓ ‰ÈÛÙ¿˙ÂÈ Ó· ÔÚÌ‹ÛÂÈ Ì¤Û· ÛÙÔ ÊÏÂÁfiÌÂÓÔ ÎÙ‹ÚÈÔ. ø˜ ·ÛÙÚ·‹ ·Ó¤‚Ë ÙËÓ Îϛ̷η ÙÔ˘ ÍÂÓÔ‰Ô¯Â›Ô˘. ∞ÏÏ’ ¿ӈ ·‹ÓÙËÛ ÂÌfi‰ÈÔÓ ·Ó˘¤Ú‚ÏËÙÔÓ. ∆Ô ˘Ú ›¯ÂÓ Âͷψı› ÂȘ ÙÔÓ ‰È¿‰ÚÔÌÔÓ Î·È ·È ı‡Ú·È ÙˆÓ ‰ˆÌ·Ù›ˆÓ ÂȘ Ù· ÔÔ›· ‰È¤ÌÂÓÂÓ Ë ÔÈÎÔÁ¤ÓÂÈ· ºÏ·ÌÔ‡ÚË ‹Û·Ó ·ÚÔۤϷÛÙÔÈ. ∂ÎÙfi˜ ÙÔ˘ fiÙÈ ·È ÊÏfiÁ˜ ÚÔÂÎÙÂÈÓfiÌÂÓ·È ÂÛ¯ËÌ¿ÙÈ˙ÔÓ ‡ÚÈÓÔÓ Ù›¯Ô˜ ÚÔ Ù˘ ı‡Ú·˜, ÙÔ ‰¿Â‰ÔÓ ‰È·‚Úˆı¤Ó ˘fi ÙÔ˘ ˘Úfi˜ ı· ˘Â¯ÒÚÂÈ Î·È ˘fi ÙÔ ¿ÙËÌ· ÙËÓÔ‡. ∂Ș Ì¿ÙËÓ ÔÈ ˘ËÚ¤Ù·È ÙÔ˘ ÍÂÓÔ‰Ô¯Â›Ô˘ ·Ó‚›‚·˙ÔÓ Î¿‰Ô˘˜ ‡‰·ÙÔ˜ Î·È ÙÔ˘˜ ÂÎΤÓÔ˘Ó Â› Ù˘ η̛ÓÔ˘ ÂΛӢ, ·È ÊÏfiÁ˜ ηı›ÛÙ·ÓÙÔ ÂÓÙÔÓfiÙÂÚ·È Î·È ‹‰Ë ÎÔÚ˘ÊÔ‡ÌÂÓ·È ÂÚȤÏÂȯÔÓ Î·È ÙËÓ ˘ÂÚÎÂÈ̤ÓËÓ ÔÚÔÊ‹Ó... ∫·È Ô ‰È¿‰ÚÔÌÔ˜ ÂÏËÚÔ‡ÙÔ ‚fiÌ‚Ô˘ Î·È ÙÚÈÁÌÒÓ ··ÈÛ›ˆÓ. ∞fi ÙËÓ ÎfiÏ·ÛË ·˘Ù‹ ηٷʤÚÓÔ˘Ó Ó· ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·234
234
Œ. ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ Î·È Û˘Ó.
‚ÁÔ˘Ó ÛÒÔÈ Î·È Ô ∆¿ÛÔ˜ Î·È ÙÔ ÂÁÎψ‚ÈṲ̂ÓÔ ÌÈÎÚfi ·È‰¿ÎÈ. ÃÂÈÚÔÎÚÔÙ‹Ì·Ù· Î·È Â¢ÊËÌ›·È ˘Â‰¤¯ıËÛ·Ó ÙÔÓ ∆¿ÛÔÓ, fiÙ·Ó ÂÎ Ó¤Ô˘ ÂÓÂÊ·Ó›ÛıË ÂȘ ÙÔÓ ÂÍÒÛÙËÓ ÎÚ·ÙÒÓ ÙÔ Ù¤ÎÓÔÓ ÙÔ˘ Î. ºÏ·ÌÔ‡ÚË. ∂Ó Ùˆ ÌÂٷ͇ ‰Â ›¯ÔÓ Êı¿ÛÂÈ ÔÈ ˘ÚÔÛ‚¤ÛÙ·È Î·È ·Ó·‚¿ÓÙ˜ ‰È· Ù˘ Îϛ̷ÎÔ˜ ηÙ‚›‚·Û·Ó ÙÔÓ ÏÔ‡ÛÙÚÔÓ Î·È ÙÔ Ù¤ÎÓÔÓ ÙÔ˘ Î. ºÏ·ÌÔ‡ÚË. µ¤‚·È·, ··ÈÙ‹ıËΠӷ ÓÔÛËÏ¢Ù› Ô ÌÈÎÚfi˜ ‹Úˆ·˜ ∆¿ÛÔ˜ ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÙˆÓ ÔÏÏ·ÏÒÓ ÂÁη˘Ì¿ÙˆÓ ÙÔ˘. ™Ò˙ÔÓÙ·˜ ÙÔ ÌÈÎÚfiÙÂÚÔ ·È‰› ·fi ‚¤‚·ÈÔ ı¿Ó·ÙÔ ˘Ê›ÛÙ·Ù·È Ô ›‰ÈÔ˜ ÂÎÔ‡ÛÈ· ÙȘ Û˘Ó¤ÂȘ ÂÓfi˜ ÁÂÁÔÓfiÙÔ˜ Ô˘ ı· ÌÔÚÔ‡Û ӷ ÙÔ˘ Û˘Ì‚Â› ˆ˜ ·Ù‡¯ËÌ·. ŒÓ· ȉȷ›ÙÂÚÔ Â›‰Ô˜ ·Ù˘¯ËÌ¿ÙˆÓ Ô˘ ·Ó‹ÎÂÈ ÛÙË ÌÂÙ·ÔÏÂÌÈ΋ Î·È ÌÂÙÂÌÊ˘Ïȷ΋ ÂÔ¯‹ Â›Ó·È ÔÈ ·ÎÚˆÙËÚÈ·ÛÌÔ›, ÔÈ Ù˘ÊÏÒÛÂȘ Î·È ÔÈ ı¿Ó·ÙÔÈ ·È‰ÈÒÓ ·fi ÂÎÚ‹ÍÂȘ ·Ï·ÈÒÓ Í¯·ÛÌ¤ÓˆÓ Ó·ÚÎÒÓ Î·È ¯ÂÈÚÔ‚ÔÌ‚›‰ˆÓ. ™ÙÔ ‰È‹ÁËÌ· Ô˘ ÂÈÁÚ¿ÊÂÙ·È “∏ Ô‚›˜”, Ô ∏. Ã. ¶··‰ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ Ì·˙› Ì ¤Ó· Ê›ÏÔ ÙÔ˘ ·Ó·ÔÏÔ‡Ó Ù· ·È‰Èο ÙÔ˘˜ ¯ÚfiÓÈ· (27): £˘ÌËı‹Î·Ì ÙÔÓ ÙfiÔ Ì·˜ ÌÂÙ¿ ÙËÓ ∫·ÙÔ¯‹, ÙÈ Ì·Í¤˜ ÛˆÛÙfi˜ ›¯Â Á›ÓÂÈ ·fi ·È¯Ó›‰È·. ¶fiÛ· Ú¿ÁÌ·Ù· ‚ڋηÌ ÙfiÙÂ, ÙÈ ˘ÚÔÌ·¯Èο ÎÔ˘‚·Ï‹Û·Ì ̤۷ ·fi ÔÈÎfi‰·, ¯ˆÚ¿ÊÈ· Î·È Ù¿ÊÚÔ˘˜. ∆Ș Ó¿ÚΘ ÙȘ ÌÂٷʤڷÌ ·ÁηÏÈ¿ Û· Ï¿¯·Ó· ÁÈ· Ó· ¿ÚÔ˘Ì ÙÔ ‰˘Ó·Ì›ÙË Ô˘ ›¯·Ó ̤۷. ªÂÚÈο ·È‰È¿ ÛÎÔÙÒıËηÓ, ·ÏÏ¿ Ù· ÂÚÈÛÛfiÙÂÚ· ÁÏ›ÙˆÛ·Ó Ì ÌÈÎÚfiÙÂÚ˜ ˙ËÌȤ˜ - Ô £·Ó¿Û˘ ¯¿ÓÔÓÙ·˜ ÙÔ Ì¿ÙÈ ÙÔ˘, Ô ¶Úfi‰ÚÔÌÔ˜ ÙÔ ¯¤ÚÈ ÙÔ˘.
∫·Ù·Ï¿ÎˆÛË ‚ÚÂÊÒÓ ·fi ÙË ÌËÙ¤Ú· À·ÚÎÙfi˜ ‹Ù·Ó Î·È Ô Î›Ó‰˘ÓÔ˜ Ù˘ ·ÛÊ˘Í›·˜ ÙˆÓ ‚ÚÂÊÒÓ, ‰ÈfiÙÈ ‰ÂÓ Ù· ÎÔ›ÌÈ˙·Ó ¿ÓÙÔÙ ÛÙËÓ ÎÔ‡ÓÈ· ÙÔ˘˜, ·ÏÏ¿ Û˘¯Ó¿ ÛÙÔ ÎÚ‚¿ÙÈ ÙˆÓ ÁÔÓ¤ˆÓ. ∂›Ó·È Ë ÂÚ›ÙˆÛË ÙÔ˘ ÈÔ ‰È¿ÛËÌÔ˘ ·Ù˘¯‹Ì·ÙÔ˜ Ù˘ ¡ÂÔÂÏÏËÓÈ΋˜ §ÔÁÔÙ¯ӛ·˜, ÙÔ ·Û›ÁÓˆÛÙÔ ‰È‹ÁËÌ· ÙÔ˘ °ÂˆÚÁ›Ô˘ µÈ˙˘ËÓÔ‡ “∆Ô ·Ì¿ÚÙËÌ· Ù˘ ÌËÙÚfi˜ ÌÔ˘”. √ Û˘ÁÁڷʤ·˜ Ì ‰Ú·Ì·ÙÈ΋ ÏÈÙfiÙËÙ· ÍÂÙ˘Ï›ÁÂÈ ÙËÓ ÈÛÙÔÚ›· Ì›·˜ ÌËÙ¤Ú·˜ Ô˘ ˙ÂÈ Ì ÙȘ Ù‡„ÂȘ Ù˘ ˘ÈÔıÂÙÒÓÙ·˜ Û˘Ó¯Ҙ ÔÚÊ·Ó¿ ÎÔÚ›ÙÛÈ· ÁÈ· Ó· ÂÍÈψı› Î·È ÊÙ¿ÓÂÈ Ì¤¯ÚÈ ÙÔÓ ¶·ÙÚÈ¿Ú¯Ë ÛÙËÓ ∫ˆÓÛÙ·ÓÙÈÓÔ‡ÔÏË ÁÈ· Ó· ÂÍÔÌÔÏÔÁËı› ÙÔ ÊÔ‚ÂÚfi Ì˘ÛÙÈÎfi Ù˘ ˙ˆ‹˜ Ù˘, ÙÔÓ ·ÎÔ‡ÛÈÔ ÊfiÓÔ ÙÔ˘ ÌÔÓ·‰ÈÎÔ‡ ÎÔÚÈÙÛÈÔ‡ Ô˘ ·¤ÎÙËÛ (28). ∏ ·ÔÎ¿Ï˘„Ë ÙÔ˘ “·Ì·ÚÙ‹Ì·ÙÔ˜” ÛÙÔ ·È‰› Ù˘ Â›Ó·È Û˘ÁÎÏÔÓÈÛÙÈ΋: ...ÙÔ ¤‚·Ï· ÎÔÓÙ¿ ÌÔ˘, ̤ے ÛÙÔ ÛÙÚÒÌ·, Î·È ÙÔ˘ ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
’‰ˆÛ· ÙË ÚfiÁ· ÛÙÔ ÛÙfiÌ· ÙÔ˘. ∂Λ Ì ͷӷ‹ÚÂ Ô ‡ÓÔ˜. ¢ÂÓ Ë͇ڈ fiÛËÓ ÒÚ·Ó ‹ıÂÏÂÓ ˆ˜ ÙÔ Ô˘ÚÓfi. ª· ÂΛ Ô˘ ‹Á· Ó· ÛËΈıÒ, ÙÈ Ó· ‰ˆ! ∆Ô ·È‰› ‰ÂÓ ÂÛ¿Ï¢Â! ∂͇ÓËÛ· ÙÔÓ ·Ù¤Ú· ÛÔ˘, ÙÔ ÍÂÊ·ÛÎÈÒÛ·ÌÂ, ÙÔ ˙ÂÛÙ¿Ó·ÌÂ, ÙÔ˘ ÂÙÚ›„·Ì ÙÔ ÌÔ˘ÛÔ‡‰È ÙÔ˘, Ù›ÔÙÂ! ◊Ù·Ó Âı·Ì¤ÓÔ. ªÂ ÙÔ ›‰ÈÔ ı¤Ì· ÁÚ¿ÊÙËΠÙÔ Ô›ËÌ· “ºfiÓÈÛÛ· Ì¿Ó·” ÙÔ˘ °ÂˆÚÁ›Ô˘ ª·ÚÙÈÓ¤ÏÏË Ô˘ ›Û˘ ‰›ÓÂÈ ÌÂÁ¿ÏË ÛËÌ·Û›· ÛÙȘ ÈÛfi‚Ș Ù‡„ÂȘ Ù˘ ÌËÙ¤Ú·˜ Ô˘ ÚÔηÏ› ηٿ Ï¿ıÔ˜ ·Ù‡¯ËÌ· ÛÙÔ ·È‰› Ù˘ (29): ∏ ÌÔ›Ú· Ù’ ·ÔÊ¿ÛÈÛÂ: Ë Ì·‡ÚË ·ÔÎÔÈÌÈ¤Ù·È ∫·È Ù’ ·ÎÚÈ‚fi Ù˘ ÏËÛÌÔÓ¿ - ÙÔ˘ Û·ÏÔ˘ ‰Â‡ÙÂÚË ÊÔÚ¿ Ô ıÚ‹ÓÔ˜ ·ÁÚÔÈÎȤٷÈ. flÚ· η΋ ÛÙÔÓ ‡ÓÔ Ù˘ ÚÔ‰ÔÙÈο ÙË ÛÌ›ÁÂÈ - ∆ÚÈÙÒÓÂÈ Ô Û·ÏÔ˜ - ·ÏÏ’·˘Ù‹ ‚·ÚÂÈ¿ ÎÔÈÌ¿Ù·È, ‰ÂÓ ÓÔ› ˆ˜ ÙÔ ·È‰› Ù˘ Ó›ÁÂÈ. (...) ª· ÙÔ‡ÙË Ë Ì·‡ÚË, Ì ηËÌfi ı’ ·ÎÔ‡ÂÈ Ó‡¯Ù·-̤ڷ ÂÓfi˜ ·ÁÁ¤ÏÔ˘ ÙË ÊˆÓ‹ ̘ ÛÙËÓ Î·Ú‰È¿ Ù˘ Ó· Ù˘ ÂÈ - ªÂ ÊfiÓ„˜, ÌËÙ¤Ú·.
∞Ù˘¯‹Ì·Ù· Ì ˙Ò· (‰‹ÁÌ·Ù·, Ó˘ÁÌÔ›, ÙÚ·‡Ì·Ù·) ¢È·¯ÚÔÓÈΤ˜ Â›Ó·È ÔÈ ·Ó·ÊÔÚ¤˜ Ù˘ ÓÂÔÂÏÏËÓÈ΋˜ ÏÔÁÔÙ¯ӛ·˜ ÛÙ· ·Ù˘¯‹Ì·Ù· Ì ˙Ò·. ∆· ‰·ÁÎÒÌ·Ù· ÊȉÈÒÓ Î·È Û·ψÓ, ηıÒ˜ Î·È Ù· ÙÛÈÌ‹Ì·Ù· ÂÓÙfiÌˆÓ Â›Ó·È ÙÚ›· ¯·Ú·ÎÙËÚÈÛÙÈο ‰Â›ÁÌ·Ù·. ∆Ô ÚÒÙÔ ˘¿Ú¯ÂÈ ÛÙÔ Ì˘ıÈÛÙfiÚËÌ· Ù˘ ∂˘ÁÂÓ›·˜ º·Î›ÓÔ˘ “∞ÛÙÚ·‰ÂÓ‹”, ·ÏÏ¿ Ì·˙› Î·È Ë ÂÈÙ˘¯‹˜ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ ·fi ÙÔÓ Ú·ÎÙÈÎfi ÁÈ·ÙÚfi ÛÙÔ ÓËÛ› ™‡ÌË (30). ∏ 10¯ÚÔÓË ËÚˆ›‰· ÙÔ˘ Ì˘ıÈÛÙÔÚ‹Ì·ÙÔ˜ ÂÎÏ·Ì‚¿ÓÂÈ ¤Ó· Ê›‰È ÁÈ· Ï·ÛÙȯ¤ÓÈÔ ÛˆÏ‹Ó· Î·È ·Ó‚·›ÓÂÈ ¿Óˆ ÙÔ˘ Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÙË ‰·ÁÎÒÛÂÈ. ªÈ· ‰·ÁΈÓÈ¿ ÛÙÔ fi‰È... Û·Ó ÙÛ›ÌËÌ· ·fi ‰‡Ô ηÚÊ›ÙÛ˜ ‰›Ï· ‰›Ï·. ™‹ÎˆÛ· ÙÔÓ ÎfiÛÌÔ ·fi ÙȘ ʈӤ˜. ∆Ô Ê›‰È ÙÔ ÛÎfiÙˆÛ·Ó. ◊Ù·Ó Ô¯È¿. ∏ Ì¿Ó· ÌÔ˘ ¿Ú¯ÈÛ ӷ ÎÏ·›ÂÈ. ŒÓÙÚÔÌÔÈ ÔÈ ‰ÈÎÔ› Ù˘ ʤÚÓÔ˘Ó ÙÔÓ Ú·ÎÙÈÎfi ÁÈ·ÙÚfi ªÂÚÎÔ˘Ú¿ Ô˘ ÂÍÔ˘‰ÂÙÂÚÒÓÂÈ Ù· ‰ËÏËÙ‹ÚÈ· Ì ٷ Û‡ÓÂÚÁ¿ ÙÔ˘, Í˘Ú·Ê¿ÎÈ· Î·È Ô‡˙Ô, ¤ÛÙˆ Î·È ·Ó Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÌÂıfi‰ˆÓ ·˘ÙÒÓ ·ÌÊÈÛ‚ËÙÂ›Ù·È ·fi ÙË Û‡Á¯ÚÔÓË È·ÙÚÈ΋ ÎÔÈÓfiÙËÙ·. ¶Ôχ ·Ú·ÛÙ·ÙÈο, Ë Û˘ÁÁڷʤ·˜ ÂÚÈÁÚ¿ÊÂÈ ÙË Ì¤ıÔ‰fi ÙÔ˘: √ ªÂÚÎÔ˘Ú¿˜ ‹Ù·Ó ηχÙÂÚÔ˜ ÎÈ ·fi ÁÈ·ÙÚfi.
Paediatriki May-June 05
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¶·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·
¶ÂÚÈ˙‹ÙËÙÔ˜. ƒÔ‡Ê·Á ÙÔ ‰ËÏËÙ‹ÚÈÔ Ù˘ ԯȿ˜. ∂ÁÒ ÓfiÌÈ˙· fiÙÈ ˙·ÏÈ˙fiÌÔ˘Ó·... fiÙÈ ¤ı·ÈÓ·... ªÂ ÙÔ Í˘Ú·Ê¿ÎÈ ÙÚ¿‚ËÍ ‰˘Ô ¯·Ú·ÎȤ˜... ªÂÙ¿ ÚÔ‡ÊËÍ ‰˘Ô ÁÔ˘ÏȤ˜ Ô‡˙Ô. ¢ÂÓ ÙÔ Î·Ù¤‚·ÛÂ, ÙÔ ¤Î·Ó ÁÏÔ˘-ÁÏÔ˘ ÛÙÔ ÛÙfiÌ· ÙÔ˘. ⁄ÛÙÂÚ· ¤‚·Ï ÙÔ ÛÙfiÌ· ÙÔ˘ ¿Óˆ ÛÙË ‰·ÁΈ̷ÙÈ¿ ÎÈ ¿Ú¯ÈÛ ӷ ‚˘˙·›ÓÂÈ. µ‡˙·ÈÓ ÙÔ ‰ËÏËÙ‹ÚÈÔ Ù˘ ԯȿ˜ Ì·˙› Ì ÙÔ ·›Ì· Î·È ÙÔ ’ÊÙ˘ÓÂ. ¶¿ÏÈ ¤‚·˙ ԇ˙Ô ÛÙÔ ÛÙfiÌ· ÙÔ˘ Î·È ¿ÏÈ ‚‡˙·ÈÓÂ. ∆Ô ‰Â‡ÙÂÚÔ Â›‰Ô˜ ‰·ÁÎÒÌ·ÙÔ˜ ¤¯ÂÈ ı‡Ì· ÙÔÓ ∞ÓÙÒÓË, ‹Úˆ· ÙÔ˘ ÚÔ·Ó·ÊÂÚı¤ÓÙÔ˜ Ì˘ıÈÛÙÔÚ‹Ì·ÙÔ˜ Ù˘ ¶ËÓÂÏfi˘ ¢¤ÏÙ· “√ ∆ÚÂÏ·ÓÙÒÓ˘” (31). ¢Ú¿ÛÙ˘ Â›Ó·È Ô ¡ÙÔÓ, ·Á·Ë̤ÓÔ˜ Û·ÏÔ˜ ÙÔ˘ ‚·ÛÈÏÈ¿ °ÂˆÚÁ›Ô˘ ∞ã, ηıÒ˜ Ë ‚·ÛÈÏÈ΋ ÔÈÎÔÁ¤ÓÂÈ· ·Ú·ıÂÚ›˙ÂÈ ÎÔÓÙ¿ ÙÔ˘˜ ÛÙÔÓ ¶ÂÈÚ·È¿. √ ˙ˆËÚfi˜ ∞ÓÙÒÓ˘ ÚÔÛ·ı› Ó· ¿ÚÂÈ ÙÔ ÎfiÎηÏÔ ÙÔ˘ ¡ÙÔÓ ÎÈ ÂΛÓÔ˜ ·ÓÙȉÚÒÓÙ·˜ ÙÔÓ ‰·ÁÎÒÓÂÈ ÛÙ· ¯Â›ÏË. ∂Âȉ‹ ÔÈ ÁÔÓ›˜ ÙÔ˘ ·Ô˘ÛÈ¿˙Ô˘Ó ÛÙÔ Â͈ÙÂÚÈÎfi, ÔÈ ı›ÔÈ Î·È ÔÈ ı›˜ ÙÔ˘ ·ÓÈÎÔ‚¿ÏÏÔÓÙ·È. √ ı›Ԙ °ÈÒÚÁ˘ Ô˘ Â›Ó·È ÁÈ·ÙÚfi˜ Û˘ÓÙÔÓ›˙ÂÈ ÙȘ ÂÓ¤ÚÁÂȘ. ªÂÁ¿ÏÔ ÛÔ‡ÛÔ˘ÚÔ ·ÎÔÏÔ‡ıËÛÂ. √ ı›Ԙ °ÈÒÚÁ˘ ‚Ô˘ÙÔ‡Û ÎÔÌÚ¤Û˜ Û ¤Ó· ΛÙÚÈÓÔ ˘ÁÚfi Î·È ÙÔ˘ ÙȘ ¿ÏˆÓ ÛÙ· ¯Â›ÏÈ·. √ ¿ÏÏÔ˜ ı›Ԙ ËÁ·›ÓÂÈ ÛÙË ‚·ÛÈÏÈ΋ ÂÍÔ¯È΋ ηÙÔÈΛ·. - √ µ·ÛÈϤ·˜ ‰È¤Ù·Í ӷ ‰¤ÛÔ˘Ó ÙÔÓ ¡ÙÔÓ Î·È Ó· ÙÔÓ ·Ú·Ê˘Ï¿ÁÔ˘Ó! ∆· ·‰¤ÏÊÈ· ÙÔ˘ ∞ÓÙÒÓË ‰ÂÓ ÌÔÚÔ‡Ó Ó· ηٷϿ‚Ô˘Ó Ù· ÏfiÁÈ· Ù˘ ı›·˜: - ∫·Ï¿ Î·È ‹Ù·Ó Ô Û·ÏÔ˜ ÙÔ˘ µ·ÛÈϤ·. ª›· ‚‰ÔÌ¿‰· ·ÚÁfiÙÂÚ· ÙÔ˘˜ ÂÈÛΤÙÔÓÙ·È Ù· ÁÂÈÙÔÓfiÔ˘Ï· ·fi ÙÔ ‰ÈÏ·Ófi Û›ÙÈ Î·È ÌÂٷʤÚÔ˘Ó fiϘ ÙȘ Ï·˚Τ˜ ‰Ôͷۛ˜ Î·È ÚÔÏ‹„ÂȘ Û¯ÂÙÈο Ì ÙË Ï‡ÛÛ·, Ô˘ ÙȘ ›¯·Ó ·ÎÔ‡ÛÂÈ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ ·fi ÙÔ ˘ËÚÂÙÈÎfi ÚÔÛˆÈÎfi: - ™Ô˘ ¤Î·ÓÂ, ϤÂÈ, ÎÈËÌ¿ ÙÔ ÚfiÛˆÔ. ∫·È ÎfiÓÙ„˜ Ó· Ï˘ÛÛ¿ÍÂȘ... ∆fiÛÔ ÙÚfiÌ·ÍÂ Ë ı›· Û·˜ ª·ÚȤٷ, Ô˘ ¤ÛÙÂÈÏ ÙÔ ıÂ›Ô Û·˜ ÛÙÔ µ·ÛÈϤ· Ó· ÙÔ˘ ÂÈ Ó· ÛÎÔÙÒÛÂÈ ÙÔ ¡ÙÔÓ. ∫·È Â›Â Ô µ·ÛÈϤ·˜ “ˆ˜ Ï˘Ô‡Ì·È Ôχ ÁÈ’ ·˘Ùfi Ô˘ Û˘Ó¤‚ËÎÂ! ¡· ›ÛÙ ‚¤‚·ÈÔ˜ ˆ˜ ı· ‰¤ÛÔ˘Ì ÙÔÓ ¡ÙÔÓ Î·È ı· ÙÔÓ ·Ú·Ê˘Ï¿ÍÔ˘ÌÂ!” ∫·È οı ̤ڷ ÌËÓÔ‡Û ˆ˜ Ô ¡ÙÔÓ ‹È Ôχ ÓÂÚfi... °È·Ù›, ·Ó ‹Ù·Ó Ï˘ÛÛ·Ṳ̂ÓÔ˜, ‰Â ı· ¤ÈÓ ÓÂÚfi. ∫·È Ô ∞ÓÙÒÓ˘ ı· ‰¿ÁηÓ fiÏÔ ÙÔÓ ÎfiÛÌÔ Î·È ı· ¤ÂÊÙ ÍÂÚfi˜. ∆Ú›ÙË ÈÛÙÔÚ›· Ì ¤ÓÙÔÌ· Â›Ó·È ·˘Ù‹ ÙÔ˘ ¶·ÓÙÂÏ‹ ¶Ú‚ÂÏ¿ÎË ÛÙÔ ¤ÚÁÔ ÙÔ˘ “√ ‹ÏÈÔ˜ ÙÔ˘ ı·Ó¿ÙÔ˘” Ì ÙȘ ·È‰ÈΤ˜ ÙÔ˘ ·Ó·ÌÓ‹ÛÂȘ. ª›· ÔÌ¿‰· ·È‰ÈÒÓ ÚÔηÏ› ¤Ó· ÛÌ‹ÓÔ˜ ÛʋΘ
Ô˘ ÛÙÔ ·È¯Ó›‰È ÂÎÏ·Ì‚¿ÓÔÓÙ·È ˆ˜ ¯ıÚÈο ·ÂÚÔÏ¿Ó·. ŸÏÔÈ ÔÈ Û˘ÓÔÌ‹ÏÈÎÔÈ ÚÔÛ¤Ú¯ÔÓÙ·È Î·Ù¿ÏÏËÏ· ÓÙ˘Ì¤ÓÔÈ Ì ÎÂÊ·ÏÔÌ¿ÓÙËÏ· Î·È “„ËÏ¿ Ô‰‹Ì·Ù·”, ÂÍÔÏÈṲ̂ÓÔÈ Ì ÎÏ·‰È¿ ÂÏÈ¿˜, Ô ›‰ÈÔ˜ fï˜ ·ÚÔÂÙԛ̷ÛÙÔ˜, ˘Ê›ÛÙ·Ù·È ·ÏÏ¿ÏÏËÏ· ÙÛÈÌ‹Ì·Ù· Î·È ÙÔÓ ÌÂٷʤÚÔ˘Ó ÛÙ· ÌÂÙfiÈÛıÂÓ (32). ªÈ· ÓÔÛÔÎfiÌ· ¤Û΢„ ·fi ¿Óˆ ÌÔ˘. ªÔ˘ ·ÎÔ˘ÌÔ‡Û ¤Ó· ÎÚ‡Ô Û›‰ÂÚÔ ÛÙ· ‚Ϥʷڷ... ∆Ë ÁÓÒÚÈÛ· Ô˘ ‹Ù·Ó Ë ı›· ÌÔ˘... ŒÓȈ۷ ˆ˜ ¿ÛÙˆÓ ÙÔ ÎÂÊ¿ÏÈ ÌÔ˘ Ì ‚ÚÂ̤ӷ ÎÏËÌ·ÙfiÊ˘ÏÏ·, ˆ˜ ·ÙÔ‡Û ÙËÓ ÎÏÂȉ·ÚÈ¿ Ù˘ ·˘ÏfiÔÚÙ·˜ ¿Óˆ ÛÙ· ÙÛÈÌ‹Ì·Ù·. ™ÈÁ¿-ÛÈÁ¿ Û˘Ó¤ÊÂÚÓ·, οÙÈ ¯·Ú·Ì·ÙȤ˜ Ûο۷Ó ÛÙ· Ì¿ÙÈ· ÌÔ˘. Œ‚Ï· ʈ˜, Í·Ó·ÁÂÓÓÈfiÌÔ˘Ó.
∆ÚÔ¯·›· ·Ù˘¯‹Ì·Ù· ∆· ·Ù˘¯‹Ì·Ù· ÛÙÔ Û›ÙÈ Î·È ÛÙÔÓ ÂχıÂÚÔ ¯ÚfiÓÔ ·ÔÙÂÏÔ‡Ó ÙÔÓ Û˘¯ÓfiÙÂÚÔ Ù‡Ô ·Ù˘¯ËÌ¿ÙˆÓ, ·ÏÏ¿ Ù· ÙÚÔ¯·›· Â›Ó·È Ù· ÛÔ‚·ÚfiÙÂÚ· ·Ù˘¯‹Ì·Ù· ÛÙȘ Ó·ڤ˜ ËÏÈ˘. √ ÊfiÚÔ˜ ·ÛÊ¿ÏÙÔ˘ ·fi ·È‰È¿ Î·È Ó¤Ô˘˜ ̤¯ÚÈ 24 ÂÙÒÓ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È Û·Ó Ó· ÛÎÔÙÒÓÂÙ·È Î¿ı ‰ÂηÂÓı‹ÌÂÚÔ Ì›· Û¯ÔÏÈ΋ Ù¿ÍË (ÂÚ›Ô˘ 25 ˙ˆ¤˜). ∆· ·È‰È¿ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙÔ ·Ù‡¯ËÌ· Û˘Ó‹ıˆ˜ ˆ˜ Û˘ÓÂÈ‚¿Ù˜ ÙÚÔ¯ÔÊfiÚˆÓ, ·ÏÏ¿ ‰ÂÓ Â›Ó·È ·ÌÂÏËÙ¤Ô˜ Ô Î›Ó‰˘ÓÔ˜ ÂÌÏÔ΋˜ Û ¤Ó· ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· ÌÈÎÚÒÓ ·È‰ÈÒÓ, Ô˘ ¯¿ÓÔ˘Ó ÙË ˙ˆ‹ ÙÔ˘˜ ÙËÓ ÒÚ· ÙÔ˘ ͤÓÔÈ·ÛÙÔ˘ ·ÈÁÓȉÈÔ‡ ÛÙÔÓ ‰ÚfiÌÔ Î¿ÔÈ·˜ ÊÙˆ¯ÔÁÂÈÙÔÓÈ¿˜. ◊‰Ë ·fi ÙÔÓ ÚÔËÁÔ‡ÌÂÓÔ ·ÈÒÓ· Û ÔÏÏ¿ ΛÌÂÓ· Ù˘ ÏÔÁÔÙ¯ӛ·˜ ·ÓȯÓ‡ÔÓÙ·È ·Ù˘¯‹Ì·Ù· ·fi Ù· ÌÂÙ·ÊÔÚÈο ̤۷ Ù˘ ÂÔ¯‹˜. √ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ÷Ù˙fiÔ˘ÏÔ˜ ÛÙÔ ‰È‹ÁËÌ· “∆¿Ûˆ” (33) ÂÚÈÁÚ¿ÊÂÈ ÙËÓ ·Ó·ÙÚÔ‹ Ì›·˜ ÛÔ‡ÛÙ·˜ ηٿ ÙËÓ ÂÈÛÙÚÔÊ‹ Ù˘ ·fi ·ÓËÁ‡ÚÈ, ÊÔÚو̤ÓË Ì ·È‰È¿ Î·È Ì ÌÂı˘Ṳ̂ÓÔ Ô‰ËÁfi: ∫·È ÛÙÔ Á˘ÚÈÛÌfi ÙËÓ ·Ó·Ô‰ÔÁ‡ÚÈÛ Û οÔÈÔ ¯·ÓÙ¿ÎÈ ÙÔ˘ οÌÔ˘ ÎÈ Ô ‰fiÏÈÔ˜ Ô °ÈˆÚÁ›ÎÔ˜ ¤ÌÂÈÓ ÛÙÔÓ ÙfiÔ Ì ۷Ṳ̂ÓÔ ÙÔ ÎÂÊ¿ÏÈ. ™ÙËÓ ∞ı‹Ó·, Ù· ÙÚÔ¯·›· Â›Ó·È ÂÚÈÛÛfiÙÂÚ·, Û ÛËÌÂ›Ô ÒÛÙ ÔÈ ÈÔ ‰ÈÔÚ·ÙÈÎÔ› Ù˘ ÂÔ¯‹˜, fiˆ˜ Ô ∂ÌÌ·ÓÔ˘‹Ï ƒÔ˝‰Ë˜, Ó· ÚÔ‚ÏËÌ·Ù›˙ÔÓÙ·È Î·È Ó· Û¯ÔÏÈ¿˙Ô˘Ó ÙËÓ Î·Ù¿ÛÙ·ÛË. ™ÙÔ ‰È‹ÁËÌ· Ô˘ ÚԷӷʤÚıËÎÂ, “∆Ô ·Ú¿ÔÓÔ ÙÔ˘ ÓÂÎÚÔı¿ÙÔ˘”, ÂÍÈÛÙÔÚ› ÙËÓ ÙÚ·ÁÈ΋ ÂÚ›ÙˆÛË ÂÓfi˜ ÔχÙÂÎÓÔ˘ ·Ù¤Ú· Ô˘ ¯¿ÓÂÈ Ù· ·È‰È¿ ÙÔ˘ fiÙ ·fi ·ÚÚÒÛÙȘ Î·È fiÙ ·fi ¿ÏϘ Û˘ÌÊÔÚ¤˜ (34). ∆Ô ¤ÌÙÔ ·È‰› Ô˘ ¯¿ÓÂÈ Â›Ó·È Ô °È¿ÓÓ˘. ∆ÔÓ Â›¯Â ÛÙ›ÏÂÈ Ë Ì¿ÓÓ· ÙÔ˘ Ó· „Ô˘Ó‹ÛË Î·È ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·236
236
Œ. ¶Ô˘Ï¿ÎÔ˘-ƒÂÌÂÏ¿ÎÔ˘ Î·È Û˘Ó.
ÙÔÓ ÂϿΈÛ ¤Ó·˜ ·Ì·Í¿˜, Ô˘ ¤ÙÚÂ¯Â Û·Ó Î˘ÓËÁË̤ÓÔ˜ Ï·Áfi˜ Û ÛÙÂÓfi ‰ÚfiÌÔ ÁÂÌ¿ÙÔ ÎfiÛÌÔ. √ °È¿ÓÓ˘ ¤ı·Ó ÌÂÙ¿ ‰˘Ô ÒÚ˜. ŸÏÔÈ ÙÔÓ ¤ÎÏ·È·Ó ÎÈ ·Ó·ıÂÌ¿ÙÈ˙·Ó Ù· ·Ì¿ÍÈ· Î·È ÙËÓ ·ÛÙ˘ÓÔÌ›·. √ ÓÂÎÚÔÛÎfiÔ˜ Ì·˜ ¤ÏÂÁ ˆ˜ ¤Î·Ì ÏÔÁ·ÚÈ·ÛÌfi Î·È ˆ˜ ·Ó¿ÏÔÁ· ÙÔ˘ ÏËı˘ÛÌÔ‡ ÂÚÈÛÛÔÙ¤ÚÔ˘˜ ·ÓıÚÒÔ˘˜ ÛÎÔÙÒÓÔ˘Ó ÔÈ ·Ì·Í¿‰Â˜ ÂȘ Ù·˜ ∞ı‹Ó·˜ ·Ú¿ ·È Ù›ÁÚÂȘ ÂȘ Ù·˜ πÓ‰›·˜. °È·Ù› fï˜ Ó· ÌË Î¿ÌË ÙÔ Î¤ÊÈ ÙÔ˘ Î·È Ô ·Ì·Í¿˜ ·ÊÔ‡ ¤¯ÂÈ ÎÈ ÂΛÓÔ˜ ÚÔÛÙ·Û›·, ÙÔ ‰Èη›ˆÌ· ‰ËÏ·‰‹ Ó· Ì·˜ ۷ηÙÂ‡Ë Ì ÙÔ ·Ì¿ÍÈ ÙÔ˘, ηıÒ˜ Ô ¯·Û¿Ë˜ ÎÈ Ô Ì·Ó¿‚˘ Ó· Ì·˜ ·ÚÚˆÛÙÔ‡Ó Ì ÙË Û·›Ï· Î·È ÙËÓ ·ÔÊÔÚ¿ ÙÔ˘˜; ∫·È ÛÙËÓ fiÏË Î·È ÛÙËÓ ÂÍÔ¯‹ ÙÔ Ô‰‹Ï·ÙÔ ‹Ù·Ó ¿ÓÙÔÙ ÙÔ fiÓÂÈÚÔ ÙˆÓ ·È‰ÈÒÓ Î·È ÙÔ Ì¤ÛÔ ÚÔ‚ÔÏ‹˜ Î·È Î·Ù·Í›ˆÛ˘ ÌÂٷ͇ ÙˆÓ Û˘ÓÔÌËÏ›ÎˆÓ ÙÔ˘˜. ™˘¯Ó¿ fï˜ Â›Ó·È Ù· ·Ù˘¯‹Ì·Ù· Ô˘ Û˘Ì‚·›ÓÔ˘Ó ÛÙÔ˘˜ ÌÈÎÚÔ‡˜ ·Ó·‚¿Ù˜, ›Ù ·fi ÙÒÛÂȘ ÛÙËÓ ÂÍÔ¯‹ ›Ù ·fi ÙÚÔ¯·›· ÛÙ· ·ÛÙÈο ΤÓÙÚ·. √ ∂χÙ˘ ÛÙÔ Ô›ËÌ¿ ÙÔ˘ “∏ ¶Ô‰ËÏ¿ÙÈÛÛ·” ‰›ÓÂÈ Ì ˘ÂÚÚ·ÏÈÛÙÈÎfi ‡ÊÔ˜ ÙËÓ ÂÈÎfiÓ· ÂÓfi˜ Ù¤ÙÔÈÔ˘ ·Ù˘¯‹Ì·ÙÔ˜: ∆Ô ‰ÚfiÌÔ Ï¿È ÛÙË ı¿Ï·ÛÛ· ÂÚ¿ÙËÛ· Ô˘ ’ηÓ οı ̤ڷ Ë Ô‰ËÏ¿ÙÈÛÛ· µÚ‹Î· Ù· ÊÚÔ‡Ù· Ô˘ ’¯Â ÙÔ ·Ó¤ÚÈ Ù˘ ÙÔ ‰·¯Ù˘Ï›‰È Ô˘ ’ÂÛ ·’ ÙÔ ¯¤ÚÈ Ù˘ µÚ‹Î· ÙÔ ÎÔ˘‰Ô˘Ó¿ÎÈ Î·È ÙÔ Û¿ÏÈ Ù˘ ÙȘ Úfi‰Â˜, ÙÔ ÙÈÌfiÓÈ, ÙÔ ÂÓÙ¿ÏÈ Ù˘ (35). ªÂ ÙÔÓ ‰ÈÎfi ÙÔ˘ ÙÚfiÔ ·ÚÔ˘ÛÈ¿˙ÂÈ Ô ∞ÓÙÒÓ˘ ™·Ì·Ú¿Î˘ ¤Ó· ÙÚÔ¯·›Ô ·Ù‡¯ËÌ· Ì ԉ‹Ï·ÙÔ, ÛÙËÓ ÚÒÙË ÎÈfiÏ·˜ ‚fiÏÙ· ÙÔ˘ ÌÈÎÚÔ‡ ÚˆÙ·ÁˆÓÈÛÙ‹ ÙÔ˘ ‰ÈËÁ‹Ì·ÙÔ˜ “∆Ô Ô‰‹Ï·ÙÔ” (36). ÕÚ¯ÈÛ ÙȘ ·ÎÚÔ‚·Û›Â˜ Û ϛÁÔ. ŒÙÚ¯ ¯ˆÚ›˜ Ó· ‚·ÛÙ¿ÂÈ ÙÔ ÙÈÌfiÓÈ ÙÒÚ·. ∆Ô ·ÁfiÚÈ ˙‡ÁˆÓ ÙÒÚ· ÛÙËÓ ÎÔÚÊ‹ ÙÔ˘ ıÚÈ¿Ì‚Ô˘ ÙÔ˘! ŒÙÚ¯Â, ¤ÙÚ¯Â... ∫·È ÎÔ›Ù·˙ ÙÔ˘˜ ·ÓıÚÒÔ˘˜ Ô˘ ‹Ù·Ó ÂΛ, ¤‚Ï ٷ ¯¤ÚÈ· ÙÔ˘˜ Ô˘ ۷χ·Ó „ËÏ¿... Î·È ÙË ÛÙÈÁÌ‹ Ô˘ ηÙËÊfiÚÈ˙ ÙÔ ÊÔÚÙËÁfi ÙˆÓ ÙÚÈÒÓ ÙfiÓˆÓ ÔÈ ¿ÓıÚˆÔÈ ÙÔ Â›‰·ÓÂ, Ì· ÙÔ ·ÁfiÚÈ ‰ÂÓ ÙÔ Â›‰Â... ¿Í·ÊÓ· ¤Ó· ÎfiÎÎÈÓÔ ÙÚÈ·ÓÙ¿Ê˘ÏÏÔ ‹Úı ÌÚÔÛÙ¿ ÛÙ· Ì¿ÙÈ· ÙÔ˘, ¿Í·ÊÓ· ÔÏ¿ÎÂÚÔ˜ Ô ÎfiÛÌÔ˜ Á›ÓËΠ¤Ó· ÎfiÎÎÈÓÔ ÙÚÈ·ÓÙ¿Ê˘ÏÏÔ. ∆Ô fiÓÂÈÚÔ ÙÔ˘ Ô‰ËÏ¿ÙÔ˘ ÛÙË ÛËÌÂÚÈÓ‹ ÂÔ¯‹ ¤¯ÂÈ ÌÂÙ·Û¯ËÌ·ÙÈÛÙ›, ȉ›ˆ˜ ·fi ÙÔ˘˜ Ó·ÚÔ‡˜ ÂÊ‹‚Ô˘˜, Û Ì˯·Ó‹ Ì fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÂÁ·Ï‡ÙÂÚÔ Î˘‚ÈÛÌfi. ∏ ‰È·ÊÔÚÈ΋ ·˘Ù‹ ηٿ ʇÏÔ ÚÔÙ›ÌËÛË Ô˘ ·ÓÙ·Ó·ÎÏ¿Ù·È Û ˘ÂÚ-‰ÂηϿÛÈ· Û˘¯ÓfiÙËÙ· ı·Ó·ÙËÊfiÚˆÓ ÙÚÔ¯·›ˆÓ ·Ó¿ÌÂÛ· ÛÙÔ˘˜ Ó·ÚÔ‡˜ ¿Ó‰Ú˜, ¤¯ÂÈ ·ÔÙ˘ˆı› ·fi ÙÔ˘˜ ÓÂfiÙÂÚÔ˘˜ ÏÔÁÔÙ¤¯Ó˜ Ô˘ ηٷÁÚ¿ÊÔ˘Ó ÙË Û‡Á¯ÚÔÓË Ú·ÁÌ·ÙÈÎfiÙ˶·È‰È·ÙÚÈ΋ 2005;68:226-238
Ù· Î·È ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙÔ ı¤Ì· ̤۷ ·fi Ù· ÚÔÛˆÈο ÙÔ˘˜ ‚ÈÒÌ·Ù· Î·È ÂΛӷ ÙˆÓ Û˘ÓÔÌËÏ›ÎˆÓ ÙÔ˘˜. √ ∫ˆÛÙ‹˜ °ÎÈÌÔÛÔ‡Ï˘ ÛÙÔ ‚È‚Ï›Ô ÙÔ˘ “√ ÕÁÁÂÏÔ˜ Ù˘ Ì˯·Ó‹˜” ÌÂٷʤÚÂÈ ÙÔÓ ·Ó·ÁÓÒÛÙË ÛÙË Û‡Á¯ÚÔÓË ∞ı‹Ó· Î·È ‰›ÓÂÈ ÙÔ ÔÚÙÚ·›ÙÔ ÂÓfi˜ ÂÊ‹‚Ô˘, ÙÔ˘ ÕÁÁÂÏÔ˘ Ô˘ ˙ÂÈ Ì ÙË ÌËÙ¤Ú· Î·È ÙÔÓ ·ÙÚÈfi ÙÔ˘ ‰ËÌÈÔ˘ÚÁÒÓÙ·˜ Û˘Ó¯Ҙ ÚÔ‚Ï‹Ì·Ù·. ™ÙÔ Û¯ÔÏÂ›Ô Â›¯Â ÁÓˆÚ›ÛÂÈ ¤Ó·Ó ¿ÏÏÔ Ó¤Ô, ÙÔÓ ¶·˚Ú‹. ∆· Û›ÙÈ· ÙÔ˘˜ ‹Ù·Ó ÎÔÓÙ¿. ∞Ó·Î¿Ï˘„·Ó fiÙÈ Â›¯·Ó Î·È ÙËÓ ›‰È· ÙڤϷ ÁÈ· Ù· Ì˯·Ó‹Ì·Ù·. √ ¶·˚Ú‹˜ ›¯Â ¿ÚÂÈ ¤Ó· Ì˯·Ó¿ÎÈ. ∆Ô ¤Ï˘Ó·Ó Û ‚›‰Â˜. ∆Ô˘ ¤Î·Ó·Ó ÌÂÙ·ÙÚÔ¤˜. ¶‹Á·ÈÓ·Ó ÙËÓ ∫˘Úȷ΋ ÛÙÔ Á‹Â‰Ô... ∫Ô˘Ì¿ÓÙÔ Ì¤¯ÚÈ ÙfiÙ ÛÙËÓ ·Ú¤· ¤Î·Ó ¤Ó·˜ Ù‡Ô˜, Ô ™ÂÚ›Ê˘. √ ™ÂÚ›Ê˘ ‹Ù·Ó ‰˘Ô-ÙÚ›· ¯ÚfiÓÈ· ÌÂÁ·Ï‡ÙÂÚfi˜ ÙÔ˘˜. ∫·‚·ÏÔ‡Û ÌÈ· ÿÚÏÂ˚ ¡Ù¿‚ÈÓÙÛÔÓ ÎÈ ¤Î·Ó ÌÂÁ¿ÏË ·›ÛıËÛË. °˘¿ÏÈ˙ ÛÙ· Ì¿ÙÈ· Ù˘ Û΢ÏÔ·Ú¤·˜ (37). √ ÕÁÁÂÏÔ˜ ·ÎÔÏÔ˘ı› ÙȘ Û˘Ó‹ıÂȘ Ù˘ Ì˯·Ófi‚È·˜ ·Ú¤·˜, ·ÏÏ¿ Û‡ÓÙÔÌ· ‚Ú›ÛÎÂÈ ÙÔÓ ı¿Ó·ÙÔ ¤ÊÙÔÓÙ·˜ Ì ÙË ‰È΋ ÙÔ˘ Ì˯·Ó‹ ¿Óˆ Û ÛÙ·ıÌÂ˘Ì¤ÓÔ ·˘ÙÔΛÓËÙÔ. √ °ÈÒÚÁÔ˜ πˆ¿ÓÓÔ˘ ‰›ÓÂÈ Ì›· ¿ÏÏË fi„Ë ÙÔ˘ ÙÈÌ‹Ì·ÙÔ˜ Ù˘ ·Á¿Ë˜ ÙˆÓ ÛËÌÂÚÈÓÒÓ Ó¤ˆÓ ÁÈ· ÙȘ Ì˯·Ó¤˜, ı›ÁÔÓÙ·˜ Ù·˘Ùfi¯ÚÔÓ· ÔÏϤ˜ ÎÔÈÓˆÓÈΤ˜ fi„ÂȘ ÙÔ˘ ı¤Ì·ÙÔ˜ (38). £‡Ì· Î·È Ô ›‰ÈÔ˜ ÙÚÔ¯·›Ô˘ ·Ù˘¯‹Ì·ÙÔ˜, ηٷÁÚ¿ÊÂÈ ÙȘ ÂÌÂÈڛ˜ ÙÔ˘ ·fi ÙÔ “¡ÔÛÔÎÔÌÂ›Ô ∞Ù˘¯ËÌ¿ÙˆÓ”, fiÔ˘ ÓÔÛËχıËΠÁÈ· ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÔÏÏÒÓ ÌËÓÒÓ ÛÙÔ ‚È‚Ï›Ô ÙÔ˘ “¶ÔÏÏ·Ï¿ ηٿÁÌ·Ù·”. ™ÙÔ ¿ÏÏÔ ÎÚ‚¿ÙÈ Î›ÙÂÙ·È ¤Ó·˜ Ó·Úfi˜ Ô˘ ηٷÎÔÌÌ·ÙÈ¿ÛıËΠ̠ÙÔ Ì˯·Ó¿ÎÈ. ∆Ô˘ οÓÔ˘Ó Û˘Ó¯Ҙ ÂÓ¤ÛÂȘ Î·È ·ÏÏ·Á¤˜... ∆· ÍËÌÂÚÒÌ·Ù· ÎÔ˘‚·ÏÔ‡Ó Ì ÙÔ ÊÔÚÂ›Ô ¤Ó· Ó·Úfi Ô˘ ÎÚ·˘Á¿˙ÂÈ. ¶¿Óˆ ÛÙÔ ÊÔÚÂ›Ô ÙÔ˘ ÎÔ˘‰Ô˘Ó›˙Ô˘Ó Ù· ÂÌ‚Ï‹Ì·Ù· ÙÔ˘ ÎÈÓ‰‡ÓÔ˘, ÔÚfi˜ Î·È ·›Ì·... ∆ËÓ ¿ÏÏË Ì¤Ú· ʤڷÓ ÛÙÔ ‰ÈÏ·Ófi ÎÚ‚¿ÙÈ ¤Ó· Ó·Úfi ¯Ù˘Ë̤ÓÔ ÛÙÔ ÎÂÊ¿ÏÈ Î·È ÙÔ ÂÚÈÛÛfiÙÂÚÔ ‰È¿ÛÙËÌ· ‚ÚÈÛÎfiÙ·Ó Û ϋı·ÚÁÔ. ∆ÔÓ ‚ڋηÓ ÂṲ̂ÓÔ ÎÈ ·Ó·›ÛıËÙÔ ÛÙËÓ ¿ÎÚË ÂÓfi˜ ÛÎÔÙÂÈÓÔ‡ ‰ÚfiÌÔ˘. ∆ÔÓ ¯Ù‡ËÛ οÔÈÔ ·˘ÙÔΛÓËÙÔ Î·È ÙÔÓ ÂÁη٤ÏÂÈ„Â... ∆ËÓ ¿ÏÏË Ì¤Ú· ʤڷÓ ÛÙÔ ‰ÈÏ·Ófi ÎÚ‚¿ÙÈ ¤Ó· Ó·Úfi. ŒÙÚ¯ Ì Ì˯·Ó¿ÎÈ Û ¤Ó·Ó ÂÍÔ¯ÈÎfi ‰ÚfiÌÔ ÛÙÔ ¶fiÚÙÔ-ƒ¿ÊÙË Î·È Û ÌÈ· ‰È·ÛÙ·‡ÚˆÛË ÙÔÓ ¯Ù‡ËÛ ·˘ÙÔΛÓËÙÔ. º˘ÛÈο ‰ÂÓ ‹ÍÂÚ ÔÈfi˜ ÙÔÓ ¯Ù‡ËÛ - ¤¯ÂÈ Á›ÓÂÈ Î·ÓfiÓ·˜ Ë ÂÁηٿÏÂÈ„Ë ÙˆÓ ı˘Ì¿ÙˆÓ. ∆Ô ÙÂÏÂ˘Ù·›Ô ·fiÛ·ÛÌ· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔÓ Û˘ÁÁڷʤ· µ·ÁÁ¤ÏË ƒ·ÙfiÔ˘ÏÔ Î·È ÙÔ ‚È‚Ï›Ô ÙÔ˘ “∆· ‰Èfi‰È·”, Ô˘ ÂÚȤ¯ÂÈ ÙȘ ÂÚȤÙÂȘ Ì›·˜ ÔÌ¿‰·˜ ÙÂÏÂÈfiÊÔÈÙˆÓ ÙÔ˘ §˘Î›Ԣ ÛÙËÓ ∞ı‹Ó· Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80, ÔÈ ÔÔ›ÔÈ ‚Ú›ÛÎÔÓÙ·È ·ÓÙÈ̤وÔÈ Ì ÙË ‰ÔÎÈÌ·Û›· ÙˆÓ
Paediatriki May-June 05
12-07-05
13:08
™ÂÏ›‰·237
237
¶·È‰Èο ·Ù˘¯‹Ì·Ù· ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ·
¶·ÓÂÏÏËÓ›ˆÓ ∂ÍÂÙ¿ÛˆÓ. ∏ Ì·Ó›· Ì ÙȘ Ì˯·Ó¤˜ ‹Ù·Ó ·ÏÈ¿ ÁÈ· ÙËÓ ·Ú¤· ·˘Ù‹, ·’ ÙÔ Á˘ÌÓ¿ÛÈÔ ·ÎfiÌ·: ...Î·È ·Ú’ fiÏÔ Ô˘ ˘‹Ú¯Â ¤Ó· ÌÔ‡‰È·ÛÌ· ÛÙÔÓ ·¤Ú·, ÁÈ·Ù› Ô µ·Û›Ï˘ Ô˘’ ¯Â ηٷʤÚÂÈ Ó· ¿ÚÂÈ, ›¯Â Ê¿ÂÈ Ù· ÌÔ‡ÙÚ· ÙÔ˘ Ì ÙË Ì˯·Ó‹, ÂÙ¿Á·Ì ÙË ÛÎÔ‡ÊÈ· Ì·˜ ÁÈ· ÎfiÓÙÚ˜ Î·È Ù· Ú¤ÛÙ· (39). ™Â Ì›· ·fi ÙȘ ‚Ú·‰ÈÓ¤˜ ÙÔ˘˜ ‚fiÏÙ˜, ¤¯ÔÓÙ·˜ ·Ê‹ÛÂÈ ›Ûˆ ÙȘ ∆ÚÂȘ °¤Ê˘Ú˜, ÂÚÓÒÓÙ·˜ ÙÔ Ê·Ó¿ÚÈ Ù¤ÚÌ· ∞¯·ÚÓÒÓ, Á›ÓÔÓÙ·È Ì¿ÚÙ˘Ú˜ Ì›·˜ ÎfiÓÙÚ·˜ ·Ó¿ÌÂÛ· Û ‰‡Ô ÌÔÓÔÌ¿¯Ô˘˜ Ô˘ ÊÔÚÔ‡Û·Ó ÎÚ¿ÓË, ÌfiÙ˜ Î·È Á¿ÓÙÈ· Î·È Â›¯·Ó ÎÈfiÏ·˜ η‚·Ï‹ÛÂÈ ÙȘ Ì˯·Ó¤˜. §›ÁÔ ·ÚÁfiÙÂÚ·, Ô ¤Ó·˜ ı· ‚ÚÂı› ÂṲ̂ÓÔ˜ ÛÙËÓ ¿ÛÊ·ÏÙÔ: ¶¿Óˆ ·fi ÙËÓ Ï¿ÙË ÙÔ˘ ›‰·Ì ¯·Ú·ÎȤ˜ ÛÙ· Ì¿ÁÔ˘Ï·, ÙÔ Û·ÁfiÓÈ ÚËṲ̂ÓÔ, Ù· Ì·ÏÏÈ¿ ‚Ô˘ÙËÁ̤ӷ ÛÙ· ·›Ì·Ù· Î·È Ù· Ì¿ÙÈ· ÔÚı¿ÓÔȯٷ Û· Ê·Ó¿ÚÈ·. ™ÙȘ ÎfiÚ˜ ηıÚÂÊÙÈ˙fiÙ·Ó ÙÔ Êˆ˜ ÙÔ˘ ‰ÚfiÌÔ˘ ÁÎÚ›˙Ô Û·Ó ·ÙÛ¿ÏÈ. ∆Ô ‰ÂÍ› ÙÔ˘ fi‰È ‹Ù·Ó Ì·ÁΈ̤ÓÔ ÛÙ· Û›‰ÂÚ·. º¤Ú·Ó ÎÏÂȉȿ Î·È Ù· ÍÂÛÙÚ¿‚ˆÛ·Ó. ∏ ‰Â‡ÙÂÚË Ì˯·Ó‹ ›¯Â οÓÂÈ ÛÙÚÔÊ‹ ÛÙÔ ‚¿ıÔ˜ Î·È Á‡ÚÈ˙ ›Ûˆ. Èڛ˜ ›ÏÈÁÁÔ Î·È ¯ˆÚ›˜ Ì·Á›·, Ì ÛÙÚÈÁÎÏ›ÛÌ·Ù· Î·È ÎÚfiÙÔ˘˜ ·fi ÛÙÚ··ÙÛ·ÚÈṲ̂ӷ ̤ٷÏÏ·, Ì ÙËÓ Í˘Ó›Ï· ÙÔ˘ ηÌ̤ÓÔ˘ Ï¿ÛÙÈ¯Ô˘.
™˘ÌÂÚ¿ÛÌ·Ù· ∞fi Ù· ÏÔÁÔÙ¯ÓÈο ÎÔÌÌ¿ÙÈ· Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËηÓ, ‰È·ÎÚ›ÓÔÓÙ·È Ù· ÛÙÔȯ›· ÂΛӷ Ô˘ Û˘ÁÎÈÓÔ‡Ó Î·È ÂÌÓ¤Ô˘Ó ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜: ·) ∏ ÂÓÔ¯‹ ÙˆÓ ÁÔÓ¤ˆÓ. ªÂ ÎÚÈÙÈ΋, ‰ÈÂÈÛ‰˘ÙÈ΋ Ì·ÙÈ¿, ·ÏÏ¿ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË ‰›ÓÂÙ·È ÙÔ „˘¯ÔÁÚ¿ÊËÌ¿ ÙÔ˘˜ Î·È ÔÈ ·ÓÙȉڿÛÂȘ ÙÔ˘˜, Ì›· Îϛ̷η Ô˘ Î˘Ì·›ÓÂÙ·È ·fi ÙÔ ·ÓÔÌÔÏfiÁËÙÔ Û˘ÓÂȉËÛÈ·Îfi ‚¿ÚÔ˜ Ô˘ ‰ÂÓ Â͈ÙÂÚÈ·ÂÙ·È, ̤¯ÚÈ ÙȘ ȉ¤Â˜ ‹ ÙËÓ ·fiÂÈÚ· ·˘ÙÔÎÙÔÓ›·˜. ‚) ∏ ·È‰È΋ „˘¯ÔÛ‡ÓıÂÛË. ™ÎÈ·ÁÚ·ÊÂ›Ù·È Ë ÚÔÛˆÈÎfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Ì ٷ ȉȷ›ÙÂÚ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘, ÙË ‰È¿ıÂÛË Ê˘Á‹˜ Î·È ÂÚȤÙÂÈ·˜, ÙËÓ ÂÚȤÚÁÂÈ·, ÙËÓ ·Ó¿ÁÎË Â›‰ÂÈ͢ Î·È ËÚˆÈÛÌÔ‡, ÙÔÓ ÌÈÌËÙÈÛÌfi (40,41). π‰È·›ÙÂÚË ·Ó·ÊÔÚ¿ Á›ÓÂÙ·È ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÂÊ‹‚ˆÓ, Ì ·ÚÈ· ÛÙÔȯ›· ÙËÓ ÂÚÈÊÚfiÓËÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘, ÙËÓ ·Ó¿ÁÎË ÚÔ‚ÔÏ‹˜, ÙËÓ ·ÔÊ˘Á‹ Û˘ÓÙËÚËÙÈÛÌÔ‡ Î·È ÙËÓ Ù¿ÛË ·˘ÙÔηٷÛÙÚÔÊ‹˜ (42). ÿÛˆ˜ fiϘ ·˘Ù¤˜ ÔÈ ÂÈÛËÌ¿ÓÛÂȘ Ó· ·ÔÙÂÏÔ‡Ó ÎÏÂȉȿ ÛÙËÓ ÂÚÌËÓ›· Ù˘ ·ıÔÁ¤ÓÂÛ˘ ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ. √È ÏÔÁÔÙ¤¯Ó˜ Ù˘ ·Ï·ÈfiÙÂÚ˘ ÂÔ¯‹˜, ·ÏÏ¿ Î·È ÔÈ Û‡Á¯ÚÔÓÔÈ ·Ô‰›‰Ô˘Ó Ì ¢·ÈÛıËÛ›· Ù· ·›ÙÈ·, ÙȘ Û˘Óı‹Î˜ Î·È Ù· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ·È‰ÈÎÒÓ ·Ù˘¯ËÌ¿ÙˆÓ Î·È ··ı·-
Ó·Ù›˙Ô˘Ó Ì ÙÔÓ ÙÚfiÔ ÙÔ˘˜ Ù· ¿Ù˘¯· Ï¿ÛÌ·Ù· Ô˘ ¤ÁÈÓ·Ó ÚˆÙ·ÁˆÓÈÛÙ¤˜ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ‰ÈËÁ‹ÛˆÓ.
µÈ‚ÏÈÔÁÚ·Ê›· 1. ƒËÁ¿ÙÔ˜ °∞. ∞ÚÚÒÛÙȘ Î·È ı¿Ó·ÙÔ˜ ·È‰ÈÒÓ ÛÙË ÓÂÔÂÏÏËÓÈ΋ ÏÔÁÔÙ¯ӛ· (1821-1922). ∞ı‹Ó·-πˆ¿ÓÓÈÓ·: ¢ˆ‰ÒÓË; 1987. ÛÂÏ. 15-16. 2. ¢ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ º∞. √ ÓÂÔÂÏÏËÓÈÛÌfi˜ ÛÙË §ÔÁÔÙ¯ӛ· 19Ô˜-20Ô˜ ·È. ∞ı‹Ó·; 1985. ÛÂÏ. 18. 3. ∂χÙ˘ √. ◊ÏÈÔ˜ Ô ÚÒÙÔ˜. ∞ı‹Ó·: ¶Ô›ËÛË ÿηÚÔ˜; 2002. ÛÂÏ. 84. 4. Vitti M. √‰˘ÛÛ¤·˜ ∂χÙ˘ (1Ë ·Ó·Ù.) ∞ı‹Ó·: ∂ÚÌ‹˜; 1986. ÛÂÏ. 140. 5. Petridou E, Kedikoglou S, Belechri M, Ntouvelis E, Dessypris N, Trichopoulos D. The mosaic of equestrian-related injuries in Greece. J Trauma 2004;56: 643-647. 6. ∫·ÏÏÈÁ¿˜ ¶. £¿ÓÔ˜ µÏ¤Î·˜ (1Ë ÂΉ. 1855). ∞ı‹Ó·: °·Ï·Í›·˜; 1962. ÛÂÏ. 202. 7. ∫·ÌÔ‡ÚÔÁÏÔ˘ ¢°. ∏ ΢ڷ-∆ÚÈÛ‡ÁÂÓË (1Ë ÂΉ. 1924). √ ÙÚÂÏfi˜ Ù˘ ∞ı‹Ó·˜ Î·È ¿ÏÏ· ‰ÈËÁ‹Ì·Ù·. ∞ı‹Ó·: ™ÙÈÁÌ‹; 1987. ÛÂÏ. 20-21. 8. ¶··‰È·Ì¿ÓÙ˘ ∞. ∆· ‰·ÈÌfiÓÈ· ÛÙÔ Ú¤Ì· (1900). 3Ô˜ Ù. ∞ı‹Ó·: Õ·ÓÙ·, ¢fiÌÔ˜; 1982-1985. ÛÂÏ. 238240. 9. ¶··‰È·Ì¿ÓÙ˘ ∞. ∆Ô Ó›ÍÈÌÔ ÙÔ˘ ·È‰ÈÔ‡ (1900). Ô.. ÛËÌ. 7. ÛÂÏ. 275-279. 10. ¶··‰È·Ì¿ÓÙ˘ ∞. ∆Ô Ì˘ÚÔÏfiÁÈ Ù˘ ÊÒÎÈ·˜ (1908). Ô.. ÛËÌ. 7. 4Ô˜ Ù. ÛÂÏ. 298-300. 11. ¶··‰È·Ì¿ÓÙ˘ ∞. ∏ ª·˘ÚÔÌ·ÓÙËÏÔ‡ (1891). Ô.. ÛËÌ. 7. 2Ô˜ Ù. ÛÂÏ. 162-168. 12. ªˆÚ·˚Ù›‰Ë˜ ∞. ∞ÏÙ·ÓÔ‡. ∆· ‰ÈËÁ‹Ì·Ù· (1899). Ù. µ’. ∞ı‹Ó·: °ÓÒÛË-™ÙÈÁÌ‹; 1990-1993. ÛÂÏ. 279-288. 13. ªˆÚ·˚Ù›‰Ë˜ ∞. µ·ÚηÚÔÁÈ¿ÓÓ˘ (1928). Ô.. ÛËÌ. 11. Ù. °’. ÛÂÏ. 365-367. 14. ¢¤ÏÙ· ¶. ∆ÚÂÏ·ÓÙÒÓ˘ (1932). 25Ë ÂΉ. ∞ı‹Ó·: ∂ÛÙ›·; 1987. ÛÂÏ. 148-156. 15. º·Î›ÓÔ˘ ∂. ∞ÛÙÚ·‰ÂÓ‹. ∞ı‹Ó·: ∫¤‰ÚÔ˜; 1982. ÛÂÏ. 250-251. 16. ¶··‰ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ ∏Ã. £ÂÚÌ¿ ı·Ï¿ÛÛÈ· ÏÔ˘ÙÚ¿. ™˘ÏÏÔÁ‹ ‰ÈËÁËÌ¿ÙˆÓ. ∞ı‹Ó·: ∫›ÌÂÓ·; 1985. ÛÂÏ. 61-62. 17. ¶··‰È·Ì¿ÓÙ˘ ∞. ∏ ÙÂÏÂ˘Ù·›· ‚·ÙÈÛÙÈ΋ (1888). Ô.. ÛËÌ. 7. 2Ô˜ Ù. ÛÂÏ. 92-94. 18. ¶··‰È·Ì¿ÓÙ˘ ∞. ∏ Ù‡¯Ë ·’ ÙËÓ ∞̤ÚÈη (1901). Ô.. ÛËÌ. 7. 3Ô˜ Ù. ÛÂÏ. 336. 19. ¶··‰È·Ì¿ÓÙ˘ ∞. ∏ ºfiÓÈÛÛ· (1903). Ô.. ÛËÌ. 7. 3Ô˜ Ù. ÛÂÏ. 470-471. 20. ƒÔ˝‰Ë˜ ∂. ∆Ô ·Ú¿ÔÓÔ ÙÔ˘ ÓÂÎÚÔı¿ÙÔ˘ (1Ë ÂΉ. 1895). ∞ÊËÁËÌ·ÙÈο ∫›ÌÂÓ·. ∞ı‹Ó·: ¡ÂÔÂÏÏËÓÈ΋ µÈ‚ÏÈÔı‹ÎË ÿ‰Ú˘Ì· ∫ˆÓ/ÓÔ˘ Î·È ∂ϤÓ˘ √˘Ú¿ÓË; 1995. ÛÂÏ. 429-430. 21. ∑·Ù¤ÏË ∑. ∫·È Ì ÙÔ Êˆ˜ ÙÔ˘ χÎÔ˘ ·ӤگÔÓÙ·È. ∞ı‹Ó·: ∫·ÛÙ·ÓÈÒÙ˘; 1993. ÛÂÏ. 343. 22. ¶··‰È·Ì¿ÓÙ˘ ∞. ∏ ʈӋ ÙÔ˘ ¢Ú¿ÎÔ˘ (1904). Ô.. ÛËÌ. 7. 3Ô˜ Ù. ÛÂÏ. 611. 23. ™ÔψÌfi˜ ¢. ∏ ÙÚÂÏ‹ Ì¿Ó· ‹ ÙÔ ÎÔÈÌËÙ‹ÚÈ. §¿ÌÚÔ˜. Õ·ÓÙ·. 2Ô˜ Ù. ∞ı‹Ó·: ª¤ÚÌËÁη˜; 1976. ÛÂÏ. 66. ¶·È‰È·ÙÚÈ΋ 2005;68:226-238
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24. ∑·Ù¤ÏË ∑. ∏ ¶ÂÚÛÂÊfiÓË-Î·È Ì›· ¿ÏÏË ÈÛÙÔÚ›·. ¶ÂÚÛÈÓ‹ ·ÚÚ·‚ˆÓÈ·ÛÙÈÎÈ¿. ∞ı‹Ó·: ™ÈÁ·Ú¤Ù·; 1984. ÛÂÏ. 48-49. 25. ∫Ô˘Ì·ÓÙ·Ú¤·˜ ª. ∆· ηË̤ӷ. 3Ë ÂΉ. ∞ı‹Ó·: ∫¤‰ÚÔ˜; 1979. ÛÂÏ. 43-48. 26. ∫ÔÓ‰˘Ï¿Î˘ π. √È ÕıÏÈÔÈ ÙˆÓ ∞ıËÓÒÓ (1Ë ÂΉ. 1894). ∞ı‹Ó·: °·Ï·Í›·˜; 1964. ÛÂÏ. 315-319. 27. ¶··‰ËÌËÙÚ·ÎfiÔ˘ÏÔ˜ ∏Ã. ∏ Ô‚›˜. Ô.. ÛËÌ. 15. ÛÂÏ. 22-23. 28. µÈ˙˘ËÓfi˜ °. ∆Ô ·Ì¿ÚÙËÌ· Ù˘ ÌËÙÚfi˜ ÌÔ˘. ∆Ô ·Ì¿ÚÙËÌ· Ù˘ ÌËÙÚfi˜ ÌÔ˘ Î·È ¿ÏÏ· ‰ÈËÁ‹Ì·Ù·. ∞ı‹Ó·: ∂ÛÙ›·. ÛÂÏ. 35. 29. ƒËÁ¿ÙÔ˜ °. Ô.. ÛËÌ 1. ÛÂÏ. 194-196. 30. º·Î›ÓÔ˘ ∂. Ô.. ÛËÌ. 14. ÛÂÏ. 37-38. 31. ¢¤ÏÙ· ¶. Ô.. ÛËÌ. 13. ÛÂÏ. 138-140. 32. ¶Ú‚ÂÏ¿Î˘ ¶. √ ‹ÏÈÔ˜ ÙÔ˘ ı·Ó¿ÙÔ˘. 4Ë ÂΉ. ∞ı‹Ó·: ∂ÛÙ›·; 1984. ÛÂÏ. 70-72. 33. ÷Ù˙fiÔ˘ÏÔ˜ ∫. ∆¿Ûˆ. ∆· ¢ÈËÁ‹Ì·Ù·. ∞ı‹Ó·: ™˘Ó¤¯ÂÈ·; 1989. ÛÂÏ. 104-105. 34. ƒÔ˝‰Ë˜ ∂. Ô.. ÛËÌ. 19. ÛÂÏ. 426-427.
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The representation of accidents among children and adolescents in Greek literature E. Poulakou - Rebelakou1, E. Petridou2
Abstract Greek literature has reproduced in the past, and continues to express in words, every aspect of everyday life in this country. The dramatic and emotional state in an environment conducive to accidents among children and adolescents has always been an inspiration for writers in creating notable literary works. Arranged in chronological order the Greek literary achievements provide a reliable review of the circumstances of childhood accidents, the underlying causes and the sequential lifestyles of the society. The thematic approach is examined, starting from the first authors, right after the establishment of the Greek independent nation and progressing to those of the end of the 20th century, and including the most famous names of the Greek literary scene. Analysis of selected fragments of the earlier times depicts accidents connected to the agricultural way of life. These are followed by accidents related to urbanization of the population and technological evolution and later to the contemporary problem of motor vehicle injuries. Furthermore, the sensitivity of the poets and novelists to the emotional world of the parents is reflected; the guilt they feel, as well as the despair that accompanies the loss of a child. The literary representation of childhood through the prism of nostalgia with an unavoidable tendency to beautify does not exclude the disobedience of children, their desire to escape, to explore and to experience danger and adventures, their need for the approval and admiration of their peers, in authors’ attempts to interpret the phenomenon of childhood accidents and their expression of anxiety at the increasing frequency.
1 Laboratory of History of Medicine, Athens University Medical School 2 Laboratory of Hygiene and Epidemiology, Athens University Medical School Correspondence: Effie Poulakou-Rebelakou 51 Themidos str. 151 24, Athens E-mail: arempel@hol.gr Date of submission: 30-07-2004 Date of approval: 21-03-2005
Key words Accidents in childhood and adolescence, road traffic accidents, childhood, Greek literature.
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∫§π¡π∫O ∫OÀπ∑ ŒÓ· ÓÂÔÁÓfi Ì ·ÓÔ˘Ú›· ∫. π. ™ÙÂÊ·Ó›‰Ë˜, ∞. ™ÈÒÌÔ˘
¡ÂÊÚÔÏÔÁÈÎfi ∆Ì‹Ì·, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ”¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ π. ™ÙÂÊ·Ó›‰Ë˜ E-mail: stefanid@hol.gr
¡ÂÔÁÓfi ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 4 ËÌÂÚÒÓ ÌÂٷʤÚıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ·Ù› ·ÚÔ˘Û›·˙ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È ·ÓÔ˘Ú›· ·fi ÙË Á¤ÓÓËÛË, ·Ú¿ ÙË ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ Î·È ‰ÈÔ˘ÚËÙÈÎÔ‡. ¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔ ÚÒÙÔ ·È‰› ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, ÌË Û˘ÁÁÂÓÒÓ ÌÂٷ͇ ÙÔ˘˜, Ô˘ ÁÂÓÓ‹ıËΠÙÂÏÂÈfiÌËÓÔ, Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÔÏÈÁÔ¸‰Ú·ÌÓ›Ô˘ Î·È ÂÌ‚Ú˘˚΋˜ ‰˘ÛÚ·Á›·˜. ∏ ‚·ıÌÔÏfiÁËÛË Apgar ÛÙÔ ÚÒÙÔ ÏÂÙfi ‹Ù·Ó 9 Î·È ÛÙÔ ¤ÌÙÔ 10. ¢ÂÓ ·Ó·Ê¤ÚÂÙ·È Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·Ù¿ ÙËÓ Î‡ËÛË. ™ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÛÙËÓ 30‹ ‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ ‰È·ÈÛÙÒıËΠÂÏ·Ùو̤ÓÔ˜ fiÁÎÔ˜ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡. ™ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ ÓÂÔÁÓfi ›¯Â ‚¿ÚÔ˜ 2,9 kg (Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 2,8 kg), Ì‹ÎÔ˜ 48 cm Î·È ÂÚ›ÌÂÙÚÔ ÎÂÊ·Ï‹˜ 33 cm. ∏ ıÂÚÌÔÎÚ·Û›· ‹Ù·Ó 36,4ÔC, Ë Î·Ú‰È·Î‹ Û˘¯ÓfiÙËÙ· 120/min, ÔÈ ·Ó·ÓÔ¤˜ 42/min Î·È Ë ·ÚÙËÚȷ΋ ›ÂÛË 62/41 mmHg. ∆Ô ÓÂÔÁÓfi ‹Ù·Ó ˙ˆËÚfi, Ì ÈηÓÔÔÈËÙÈ΋ ÂÓ˘‰¿ÙˆÛË, ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËΠ‰˘ÛÌÔÚÊÈÎfi ÚÔÛˆÂ›Ô ‹ οÔÈÔ ¿ÏÏÔ ·ıÔÏÔÁÈÎfi Ê·ÈÓÔÙ˘ÈÎfi ‡ÚËÌ·. ŒÁÈÓ ηıÂÙËÚÈ·ÛÌfi˜ Ù˘ Ô˘ÚÔ‰fi¯Ô˘ ·ÛÙ˘ Î·È ‰È·ÈÛÙÒıËΠfiÙÈ ‹Ù·Ó ÎÂÓ‹. O ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍ ·ÈÌÔÛÊ·ÈÚ›ÓË 14,7
g/dL, ÏÂ˘Î¿ ·ÈÌÔÛÊ·›ÚÈ· 12.700 mm3 ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi Ù‡Ô Î·È Ê˘ÛÈÔÏÔÁÈο ·ÈÌÔÂÙ¿ÏÈ·. ∏ C·ÓÙȉÚÒÛ· ÚˆÙ½ÓË (CRP) ‹Ù·Ó ·ÚÓËÙÈ΋. ∏ ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ‹Ù·Ó 3,4 mg/dL Î·È ÌÂÙ¿ ·fi 24 ÒÚ˜ ·fi ÙËÓ ÂÈÛ·ÁˆÁ‹ 4,9 mg/dL. ∞fi ÙÔÓ ˘fiÏÔÈÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ‰È·ÈÛÙÒıËÎÂ: ·Û‚¤ÛÙÈÔ ÔÚÔ‡ 8,2 mg/dL, ʈÛÊfiÚÔ˜ 6,2 mg/dL, Ô˘ÚÈÎfi Ô͇ 8,4 mg/dL, Ó¿ÙÚÈÔ 137 mEq/L, οÏÈÔ 6,2 mEq/L, pH: 7,23 Î·È ‰ÈÙÙ·ÓıÚ·ÎÈο 13 mEq/L. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¤‰ÂÈÍ ÓÂÊÚÔ‡˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÌÂÁ¤ıÔ˘˜ Ì ̤ÙÚÈ· ·‡ÍËÛË Ù˘ ˯ÔÁ¤ÓÂÈ¿˜ ÙÔ˘˜, ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó Î‡ÛÙÂȘ Ô‡Ù ‰È¿Ù·ÛË ÙˆÓ ˘ÂÏÔÎ·Ï˘ÎÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Î·È Ë Ô˘ÚÔ‰fi¯Ô˜ ·ÛÙË ‹Ù·Ó ÎÂÓ‹. ∂›Û˘, ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ÛÙË ÌÂϤÙË ÙˆÓ ÓÂÊÚÈÎÒÓ ·ÁÁ›ˆÓ Ì Doppler. ™ÙËÓ ÂͤٷÛË ÓÂÊÚÈÎÔ‡ ÈÛÙÔ‡ ‰È·ÈÛÙÒıËÎÂ Û˘ÛÛÒÚ¢ÛË ÙˆÓ ÛÂÈÚ·Ì¿ÙˆÓ ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›·. ∆· ÂÁÁ‡˜ ÂÛÂÈڷ̤ӷ ÛˆÏËÓ¿ÚÈ· ‹Ù·Ó ·ÓÒÚÈÌ· Ì ÂÛÙȷ΋ ‰È¿Ù·ÛË. ¢ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ‰˘ÛÏ·ÛÙÈο ÛÙÔȯ›· ‹ ·ÛÙÂȘ. O ‰È¿ÌÂÛÔ˜ ÈÛÙfi˜ ·ÚÔ˘Û›·˙ ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ ›ÓˆÛË, ÂÓÒ Ù· ·ÁÁ›· ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. ∞ÁÁÂÈÔÎÈÓËÙÈ΋ ÓÂÊÚÔ¿ıÂÈ· 2. ∞ÌÊÔÙÂÚfiÏ¢ÚË ÓÂÊÚÈ΋ ‰˘ÛÏ·Û›·-˘ÔÏ·Û›· 3. ∞ÔÊÚ·ÎÙÈ΋ Ô˘ÚÔ¿ıÂÈ· 4. ∞ÌÊÔÙÂÚfiÏ¢ÚË ıÚfiÌ‚ˆÛË ÓÂÊÚÈÎÒÓ ÊÏ‚ÒÓ 5. ¡ÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁ¤ÓÂÛË 6. ™ÂÈÚ·Ì·ÙÔ΢ÛÙÈ΋ ÓÂÊÚÈ΋ ÓfiÛÔ˜
∂ÈÎfiÓ·. ¡ÂÊÚÈÎfi˜ ÈÛÙfi˜ ÌÂ Ê˘ÛÈÔÏÔÁÈο ÛÂÈÚ¿Ì·Ù· Î·È ÂÏ¿ÙÙˆÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ ÛˆÏËÓ·Ú›ˆÓ (ÃÚÒÛË Ì ˈۛÓË - ·ÈÌ·ÙÔÍ˘Ï›ÓË, ÌÂÁ¤ı˘ÓÛË Ã 100).
∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 243
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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√
¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜, ¶·È‰›·ÙÚÔ˜ - ∞ÏÏÂÚÁÈÔÏfiÁÔ˜
The Royal College of Pediatrics and Child’s Health - À„ËÏÔ‡ ÂȤ‰Ô˘ ËÏÂÎÙÚÔÓÈΤ˜ ˘ËÚÂۛ˜ ÛÙËÓ ·È‰È·ÙÚÈ΋ - http://www.rcpch.ac.uk/index.html
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µ‘ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ¡›ÎÔ˜ ¶··‰fiÔ˘ÏÔ˜ E-mail: ngp@allergy.gr
¶ÚfiÎÂÈÙ·È ÁÈ· ÙÔÓ Â›ÛËÌÔ ‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ‚ÚÂÙ·ÓÈÎÔ‡ ÂÎ·È‰Â˘ÙÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ Royal College of Pediatrics and Child’s Health (RCPCH), Ô ÔÔ›Ô˜ ¤¯ÂÈ ˆ˜ ·ÚÈÔ ÛÙfi¯Ô ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ·È‰È·ÙÚÈ΋˜, ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Î·È ÙËÓ Âη›‰Â˘ÛË. ¶ÚfiÎÂÈÙ·È, ¿ÏψÛÙÂ, ÁÈ· ÙÔÓ ÔÚÁ·ÓÈÛÌfi Ô˘ ‰ÈÂÎÂÚ·ÈÒÓÂÈ ÂÍÂÙ¿ÛÂȘ ÂȉÈÎfiÙËÙ·˜ ÛÙËÓ ∞ÁÁÏ›·. ™ÙÔÓ ÙfiÔ ·˘Ùfi ÌÔÚ› Ó· ‚ÚÂÈ Î·Ó›˜ Ô‰ËÁ›Â˜ Î·È Î·ÓfiÓ˜ Û¯ÂÙÈÎÔ‡˜ Ì ÙËÓ ¿ÛÎËÛË Ù˘ ÂȉÈÎfiÙËÙ·˜ ÛÙËÓ ∞ÁÁÏ›·. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÔÈ ˘ÔÙÚÔʛ˜ Î·È Ù· ‚Ú·‚›·, Ô˘ Û˘¯Ó¿ ·Â˘ı‡ÓÔÓÙ·È Û ·È‰È¿ÙÚÔ˘˜ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ Ô˘ ı· ‹ıÂÏ·Ó Ó· ÂÈÛÎÂÊıÔ‡Ó ÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ. ¶ÏËÚÔÊÔڛ˜ Û¯ÂÙÈΤ˜ Ì ÂΉËÏÒÛÂȘ Î·È ÂÎ·È‰Â˘ÙÈο ÛÂÌÈÓ¿ÚÈ· ·fi ÔÏϤ˜ ‰È·ÊÔÚÂÙÈΤ˜ ËÁ¤˜ ÌÔÚÔ‡Ó, ›Û˘, Ó· ‚ÚÂıÔ‡Ó ÂΛ. °È· fiÏÔ˘˜ ÙÔ˘˜ Û˘Ó·‰¤ÏÊÔ˘˜ Ô˘ ÂӉȷʤÚÔÓÙ·È Ó· ÂÍÂÙ·ÛÙÔ‡Ó ÁÈ· Ù· ‰ÈÏÒÌ·Ù· Âȉ›Î¢Û˘ MRCPCH ˘¿Ú¯Ô˘Ó ÏÂÙÔÌÂÚ›˜ ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ·ÈÙ‹ÛÂȘ, ÙÔ˘˜ ηÓÔÓÈÛÌÔ‡˜, Ù· ÙÈÌÔÏfiÁÈ· Î.Ï. ∂ȉÈ΋ ηÙËÁÔÚ›· ·Ó·Ê¤ÚÂÙ·È ÛÙȘ ‰ÈÂıÓ›˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ∏ ËÏÂÎÙÚÔÓÈ΋ ‚È‚ÏÈÔı‹ÎË ÙÔ˘ RCPCH ÂÚȤ¯ÂÈ ÏÔ‡ÛÈÔ ˘ÏÈÎfi ·fi Ӥ˜ Î·È ·Ï·ÈfiÙÂÚ˜ ÂΉfiÛÂȘ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÂÎ·È‰Â˘ÙÈο Î·È ÂÈÛÙËÌÔÓÈο ÂÁ¯ÂÈÚ›‰È· Î·È Ô‰ËÁ›Â˜ ÚÔ˜ Ó¤Ô˘˜ ‰È·ÁˆÓÈ˙fiÌÂÓÔ˘˜, ·ÚÎÂÙ¿ ÂÎ ÙˆÓ ÔÔ›ˆÓ ¿ÌÂÛ· ÚÔÛ‚¿ÛÈÌ· ̤ۈ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘. ∂ÎÙfi˜ ·fi ÙËÓ ÏÔ‹ÁËÛË ÛÙȘ ÂÈ̤ÚÔ˘˜ ıÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜ ÙÔ˘ RCPCH, Ô ¯Ú‹ÛÙ˘ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ·Ó·˙‹ÙËÛ˘ ‰ÈÎÙ˘·ÎÒÓ ÙfiˆÓ Ì ·ÚÂÌÊÂÚ¤˜ ÂÚȯfiÌÂÓÔ, fiˆ˜ ·Î·‰ËÌ·˚ο ȉڇ̷ٷ, ÂÈÛÙËÌÔÓÈÎÔ‡˜ ÔÚÁ·ÓÈÛÌÔ‡˜ Î.¿.
Health for All Children - ∂ÈÛÙËÌÔÓÈÎfi˜ ÂÍÔÏÈÛÌfi˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô http://shop.healthforallchildren.co.uk ∞ÔÙÂÏ› ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ¤Î‰ÔÛË Ù˘ ÔÌÒÓ˘Ì˘ ·ÁÁÏÈ΋˜ ¤Î‰ÔÛ˘, Ë ÔÔ›· ·Ú¯Èο ‰ËÌÈÔ˘ÚÁ‹ıËΠÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË Ù˘ ¤ÓÙ˘Ë˜ ÌÔÚÊ‹˜ ηÈ, ÛÙË Û˘Ó¤¯ÂÈ·, ÂÍÂÏ›¯ıËΠÛÙÔ ËÏÂÎÙÚÔÓÈÎfi ηٿÛÙËÌ· Ù˘ ÂÙ·ÈÚ›·˜ Harlow Healthcare. ∆· ÚÔ˚fiÓÙ· Ù˘ ÂÙ·ÈÚ›·˜ ·ÊÔÚÔ‡Ó Û ÂΉfiÛÂȘ Î·È ÂÁ¯ÂÈÚ›‰È· ·È‰È·ÙÚÈ΋˜, ÚÔÁÚ¿ÌÌ·Ù· ÏÔÁÈÛÌÈÎÔ‡ Î·È ËÏÂÎÙÚÔÓÈÎfi ÂÍÔÏÈÛÌfi ÎÏÈÓÈ΋˜ Î·È Ú·ÎÙÈ΋˜ ·È‰È·ÙÚÈ΋˜, ηıÒ˜ Î·È Û˘Ó¯È˙fiÌÂÓ˘ È·ÙÚÈ΋˜ Âη›‰Â˘Û˘. ∂ÎÙfi˜ ·fi ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ·ÁÔÚ¿, ÌÔÚ› Ó· ‚ÚÂÈ Î·Ó›˜ ¶·È‰È·ÙÚÈ΋ 2005;68:241-242
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ÏËÚÔÊÔڛ˜ ÁÈ· Ó¤· ÂÎ·È‰Â˘ÙÈο Û˘ÛÙ‹Ì·Ù· µ¢, fiˆ˜ ÙÔ ÚfiÁÚ·ÌÌ· Growth On-line. ™ÙÔ˘˜ ·Ô‰¤ÎÙ˜ Ù˘ ÂÙ·ÈÚ›·˜, ÂÎÙfi˜ ·fi ÙÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ Î·È ·È‰È¿ÙÚÔ˘˜, ·Ó‹ÎÔ˘Ó Î·È ÔÈ ÁÔÓ›˜ ̤۷ ·fi ÂȉÈ΋ ıÂÌ·ÙÈ΋ ÂÓfiÙËÙ· - ·Ó Î·È fi¯È ·fiÏ˘Ù· ÔÏÔÎÏËڈ̤ÓË - ÚÔÛʤÚÔÓÙ·˜ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Î·È Û˘Ì‚Ô˘Ï¤˜, fiˆ˜ Â›Ó·È ÔÈ Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙÔ Û‡Ó‰ÚÔÌÔ Down. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì¿ÏÏÔÓ Ì¤ÙÚÈ· ÈÛÙÔÛÂÏ›‰· fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÚÔ˘Û›·ÛË Î·È ÙËÓ ÏÔ‹ÁËÛË, ¤¯ÂÈ fï˜ ÂӉȷʤÚÔÓ ÏfiÁˆ Ù˘ ÂÈΤÓÙÚˆÛ‹˜ Ù˘ ÛÙ· ı¤Ì·Ù· ·Ó¿Ù˘Í˘.
Child Advocacy International - ŒÓ·˜ ‰ÈÂıÓ‹˜ ËÏÂÎÙÚÔÓÈÎfi˜ Û˘Ó‹ÁÔÚÔ˜ ÁÈ· Ù· ‰ÈηÈÒÌ·Ù· ÙˆÓ ·È‰ÈÒÓ - http://www.childadvocacyinternational.co.uk/index.htm ªÂ ¤‰Ú· ÙÔ §ÔÓ‰›ÓÔ, Ô ÌË Î˘‚ÂÚÓËÙÈÎfi˜ ÔÚÁ·ÓÈÛÌfi˜ Child Advocacy International (CAI) ÂÚÁ¿˙ÂÙ·È ÁÈ· ÙËÓ ÚÔ¿ÛÈÛË ÙˆÓ ‰ÈÎ·ÈˆÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÌËÙ¤ÚˆÓ ÛÙȘ ˘Ô·Ó¿Ù˘ÎÙ˜ ¯ÒÚ˜. ™Ù· ÔÎÙÒ ¯ÚfiÓÈ· Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘, ¤¯ÂÈ Î¿ÓÂÈ ·ÈÛıËÙ‹ ÙËÓ ·ÚÔ˘Û›· ÙÔ˘ Û ÂÚÈÔ¯¤˜ Ô˘ ¤¯Ô˘Ó ÏËÁ› ·fi Ê˘ÛÈΤ˜ ηٷÛÙÚÔʤ˜, ÔϤÌÔ˘˜, ›ӷ, ÊÙÒ¯ÂÈ·, ÌÂÙ·Ó¿ÛÙ¢ÛË Î.¿. µ·Û›˙ÂÙ·È ÛÙËÓ ·Ú¯‹ ÙÔ˘ ÂıÂÏÔÓÙÈÛÌÔ‡ Î·È Ì›· ·fi ÙȘ ΢ÚÈfiÙÂÚ˜ ‰Ú·ÛÙËÚÈfiÙËÙ¤˜ ÙÔ˘ Â›Ó·È Ë Û˘ÁΤÓÙÚˆÛË ÔÈÎÔÓÔÌÈ΋˜ ‚Ô‹ıÂÈ·˜ ÁÈ· ÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ “·‰‡Ó·ÌˆÓ ÛÙfi¯ˆÓ” (ÌËÙ¤Ú˜, ·È‰È¿) ÛÙȘ ÏËÁ›Û˜ ÂÚÈÔ¯¤˜ ÙÔ˘ Ï·Ó‹ÙË. ™ÙËÓ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ CAI Â›Ó·È ‰È·ı¤ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ Ì ÙÔ˘˜ ÔÔ›Ô˘˜ ÌÔÚ› Ô Î¿ı ÂӉȷÊÂÚfiÌÂÓÔ˜ Ó· ÚÔÛʤÚÂÈ ‰ˆÚ¿ Î·È Ó· ÂÓËÌÂÚˆı›, Ó· ÂÈϤÍÂÈ Î·È Ó· Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙ· ÙÚ¤¯ÔÓÙ· ÚÔÁÚ¿ÌÌ·Ù· ÔÈÎÔÓÔÌÈ΋˜ ÂÓ›Û¯˘Û˘ Û ˘Ô·Ó¿Ù˘ÎÙ˜ ÂÚÈÔ¯¤˜. Èڛ˜ Ó· Â›Ó·È È‰È·›ÙÂÚ· ·ÓÂÙ˘Á̤ÓË, ·ÏÏ¿ Ì ÌÔÓÙ¤ÚÓÔ Û¯Â‰È·ÛÌfi, Ë ÈÛÙÔÛÂÏ›‰· ÙÔ˘ CAI ÚÔÛʤÚÂÈ ¿ÌÂÛË Î·È Â‡ÎÔÏË ÏÔ‹ÁËÛË ÛÙÔÓ ¯Ú‹ÛÙË, Ô ÔÔ›Ô˜ ·Ó·˙ËÙ› ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ‰Ú¿ÛË Î·È ÙȘ ÚˆÙÔ‚Ô˘Ï›Â˜ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡, ÙÔ ÈÛÙÔÚÈÎfi ÙÔ˘, ÙË Û˘ÁΤÓÙÚˆÛË fiÚˆÓ, ȉ¤Â˜ ÁÈ· ÙË ‰ÈÔÚÁ¿ÓˆÛË ÂΉËÏÒÛÂˆÓ Î·È ÙȘ Û˘ÓÂÚÁ·Û›Â˜ Û ÂıÓÈÎfi Î·È ‰ÈÂıÓ¤˜ ›‰Ô.
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∫ÏÈÓÈÎfi QUIZ ŒÓ· ÓÂÔÁÓfi Ì ·ÓÔ˘Ú›· ∞¶∞¡∆∏™∏ ¶Èı·Ó‹ ‰È¿ÁÓˆÛË: ¡Ô 5. ¡ÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁ¤ÓÂÛË
™¯fiÏÈÔ ∏ ˘Ô„›· Ù˘ ‰È¿ÁÓˆÛ˘ Ù˘ ÓÂÊÚÈ΋˜ ÛˆÏËÓ·Úȷ΋˜ ‰˘ÛÁ¤ÓÂÛ˘ Ú¤ÂÈ Ó· Ù›ıÂÙ·È Û οı ÓÂÔÁÓfi Ì ·ÓÔ˘Ú›· ·‰È¢ÎÚ›ÓÈÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜ ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ̤ÁÂıÔ˜ ÓÂÊÚÒÓ ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ÈÛÙÔÚÈÎfi ÔÏÈÁÔ¸‰Ú·ÌÓ›Ô˘ (1). ∏ ‰È¿ÁÓˆÛË ·˘Ù‹ ÂȂ‚·ÈÒıËΠ̠ٷ Â˘Ú‹Ì·Ù· Ù˘ ÓÂÊÚÈ΋˜ ‚ÈÔ„›·˜. ∏ ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÛÙ· ÓÂÔÁÓ¿ ‰ÂÓ Â›Ó·È ¤Ó· Û¿ÓÈÔ Úfi‚ÏËÌ·, ·ÊÔ‡ ‰È·ÈÛÙÒÓÂÙ·È ÂÚ›Ô˘ ÛÙÔ 8% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ (2). ∂›Ó·È Û˘Ó‹ıˆ˜ ·ÔÙ¤ÏÂÛÌ· ·ÛÊ˘Í›·˜ Î·È Û˘¯Ó¿ Û˘Ó˘¿Ú¯ÂÈ Ïԛ̈ÍË ‹/Î·È Ï‹„Ë ÓÂÊÚÔÙÔÍÈÎÒÓ Ê·Ú̿ΈÓ. ø˜ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÁÂÓÈο ıˆÚÂ›Ù·È Ë ·Ú·ÙÂٷ̤ÓË ·‡ÍËÛË Ù˘ ÎÚ·ÙÈÓ›Ó˘ ÔÚÔ‡ Û ›‰· ˘„ËÏfiÙÂÚ· ÙÔ˘ 1,5 mg/dl (132,5 Ìmol/l). ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÔÍ›· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ‰ÂÓ Û˘Óԉ‡ÂÙ·È ¿ÓÙ· ·fi ÔÏÈÁÔ˘Ú›· ‹ ·ÓÔ˘Ú›· (2). ∏ ·ÁÁÂÈÔÎÈÓËÙÈ΋ ÓÂÊÚÔ¿ıÂÈ· (AN), Ë Û˘¯ÓfiÙÂÚË ·ÈÙ›· ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜ ÛÙË ÓÂÔÁÓÈ΋ ÂÚ›Ô‰Ô, Ú¤ÂÈ Ó· ·ÔÙÂÏ› ÙËÓ ÚÒÙË ‰È·ÁÓˆÛÙÈ΋ ÛΤ„Ë. ¶·Ï·ÈfiÙÂÚ·, Ë AN ÔÓÔÌ·˙fiÙ·Ó ÔÍ›· ÛˆÏËÓ·Úȷ΋ Ó¤ÎÚˆÛË. OÊ›ÏÂÙ·È Û ÂÏ¿ÙÙˆÛË Ù˘ ÓÂÊÚÈ΋˜ ·ÈÌ¿ÙˆÛ˘ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÓÂÊÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ì ‹ Î·È ¯ˆÚ›˜ ·ÚÂÁ¯˘Ì·ÙÈ΋ ‚Ï¿‚Ë. ∏ ÌË ¤ÁηÈÚË ·ÔηٿÛÙ·ÛË Ù‹˜ ∞¡ ÌÔÚ› Ó· ÂÍÂÏȯı› Û ÌfiÓÈÌË ÓÂÊÚÈ΋ ‚Ï¿‚Ë (3). ∏ ∞¡ Û˘Ó‹ıˆ˜ ÔÊ›ÏÂÙ·È ÛÂ: ·) ÀÔÔÁηÈÌ›·. °ÂÓÈο ¢ı‡ÓÂÙ·È ÁÈ· ÙÔ 80% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÓÂÔÁÓÈ΋˜ ÔÍ›·˜ ÓÂÊÚÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ™ÙÔ ÓÂÔÁÓfi Ô˘ ·Ó·ÊÂÚı‹Î·Ì ‰ÂÓ ˘‹Ú¯·Ó ÂӉ›ÍÂȘ Û˘ÛÙÔÏ‹˜ ÙÔ˘ ÂÓ‰·ÁÁÂÈ·ÎÔ‡ fiÁÎÔ˘ ‹ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜. ∂›Û˘, ÙÔ ÓÂÔÁÓfi ‰È·ÙËÚÔ‡ÛÂ Ê˘ÛÈÔÏÔÁÈ΋ ·ÚÙËÚȷ΋ ›ÂÛË Î·È Â›¯Â ÈηÓÔÔÈËÙÈ΋ ÂÓ˘‰¿ÙˆÛË. ‚) ¶ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›·. ∏ ‚·ıÌÔÏfiÁËÛË Apgar ÙÔ˘ ÓÂÔÁÓÔ‡ Ô˘ ·Ó·ÊÂÚı‹Î ‰ÂÓ ‹Ù·Ó ÂÓ‰ÂÈÎÙÈ΋ ÂÚÈÁÂÓÓËÙÈ΋˜ ·ÛÊ˘Í›·˜ Î·È ‰ÂÓ ·ÚÔ˘Û›·˙ ·Ó·Ó¢ÛÙÈÎfi Úfi‚ÏËÌ·. Á) ™Ë„·ÈÌ›·. ∞fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Î·È
ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô ÙÔ˘ ÓÂÔÁÓÔ‡ ‰ÂÓ ˘‹Ú¯·Ó ÂӉ›ÍÂȘ Ïԛ̈͢. ‰) ÀÔıÂÚÌ›·. ∆Ô ÓÂÔÁÓfi ›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ıÂÚÌÔÎÚ·Û›·. Â) ÃÔÚ‹ÁËÛË Ê·ÚÌ¿ÎˆÓ ÛÙËÓ Î‡ËÛË (·Ó·ÛÙÔÏ›˜ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘, ·Ó·ÛÙÔÏ›˜ Ù˘ Û‡ÓıÂÛ˘ ÚÔÛÙ·ÁÏ·Ó‰ÈÓÒÓ). ¢ÂÓ ·Ó·Ê¤ÚıËΠϋ„Ë Ê·ÚÌ¿ÎˆÓ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∆· Â˘Ú‹Ì·Ù· ÙÔ˘ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·ÙÔ˜ ÓÂÊÚÒÓ ÛÙÔ ÓÂÔÁÓfi ·¤ÎÏÂÈÛ·Ó ÙË ‰È¿ÁÓˆÛË Ù˘ ·ÌÊÔÙÂÚfiÏ¢Ú˘ ÓÂÊÚÈ΋˜ ‰˘ÛÏ·Û›·˜-˘ÔÏ·Û›·˜ ‹ ÙËÓ ·ÔÊÚ·ÎÙÈ΋ Ô˘ÚÔ¿ıÂÈ·. ∆· ÓÂÔÁÓ¿ Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ıÚfiÌ‚ˆÛË ÓÂÊÚÈÎÒÓ ÊÏ‚ÒÓ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ì·ÎÚÔÛÎÔÈ΋ ·ÈÌ·ÙÔ˘Ú›· Î·È ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ‰È·ÈÛÙÒÓÂÙ·È ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÓÂÊÚÒÓ Î·È ‰È·Ù·Ú·¯¤˜ ÛÙË ÚÔ‹ ·›Ì·ÙÔ˜ ÛÙË ÌÂϤÙË Ì Doppler. ∏ ¤ÁηÈÚË ‰È¿ÁÓˆÛË Ù˘ ıÚfiÌ‚ˆÛ˘ ÓÂÊÚÈÎÒÓ ÊÏ‚ÒÓ Â›Ó·È ÛËÌ·ÓÙÈ΋, ÁÈ·Ù› Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÓÙÈÌÂÙˆÈÛÙ› ·ÔÙÂÏÂÛÌ·ÙÈο. ∏ ÛÂÈÚ·Ì·ÙÔ΢ÛÙÈ΋ ÓÂÊÚÈ΋ ÓfiÛÔ˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÓÂÔÁÓÈ΋ ·ÓÔ˘Ú›· ·‰È¢ÎÚ›ÓÈÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜, Ì ·˘ÍË̤ÓÔ Ì¤ÁÂıÔ˜ ÓÂÊÚÒÓ ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È ÈÛÙÔÚÈÎfi ÔÏÈÁÔ¸‰Ú·ÌÓ›Ô˘ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·ËÛ˘. ∂›Û˘, Û˘Ó˘¿Ú¯ÂÈ ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· ·Ú¿ÏÏËÏ· Ì ٷ ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Potter (¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ·˘ÙÈÒÓ, ÂȤ‰ˆÛË ÙÔ˘ ·ÎÚÔÚÈÓ›Ô˘, ˘ÂÚÙÂÏÔÚÈÛÌfi˜, ÌÈÎÚÔÁÓ·ı›· Î·È ·ÓˆÌ·Ï›Â˜ ÙˆÓ ¿ÎÚˆÓ). øÛÙfiÛÔ, ÚfiÛÊ·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰‡Ô ÓÂÔÁÓ¿ Ì ÙË ÓfiÛÔ ·˘Ù‹, Ô˘ ‰ÂÓ ·ÚÔ˘Û›·Û·Ó ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ô‡Ù ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÓÂÊÚÒÓ (3). ™Ù· ÓÂÔÁÓ¿ ·˘Ù¿ ‰È·ÈÛÙÒıËÎÂ, fï˜, ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ËÁÒÓ Ì ‰È¿ÛÙ·ÛË ÙˆÓ ÎÚ·ÓÈ·ÎÒÓ Ú·ÊÒÓ. ¶·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù·, ›Û˘, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Û ÓÂÔÁÓ¿ Ì ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁ¤ÓÂÛË (4). ∏ ÛÂÈÚ·Ì·ÙÔ΢ÛÙÈ΋ ÓÂÊÚÈ΋ ÓfiÛÔ˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Û ̤ÏË Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ÂÈÎÚ·ÙÔ‡ÓÙ· ۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú·. ∆· Â˘Ú‹Ì·Ù· Ù˘ ÛÂÈÚ·Ì·ÙÔ΢ÛÙÈ΋˜ ÓÂÊÚÈ΋˜ ÓfiÛÔ˘ Î·È Ù˘ ÓÂÊÚÈ΋˜ ÛˆÏËÓ·Úȷ΋˜ ‰˘ÛÁ¤ÓÂÛ˘ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó Î·È Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ٷ Â˘Ú‹Ì·Ù· Ù˘ ÓÂÊÚÈ΋˜ ‚ÈÔ„›·˜, fiÔ˘ ‰È·ÈÛÙÒÓÂÙ·È Î˘ÛÙÈ΋ ‰È¿Ù·ÛË Ù˘ ο„·˜ ÙÔ˘ Bowman. ∆· ¶·È‰È·ÙÚÈ΋ 2005;68:240, 243-244
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ÈÛÙÔÏÔÁÈο ·˘Ù¿ Â˘Ú‹Ì·Ù· ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ÛÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ·Ó·ÊÂÚı‹Î·ÌÂ. ∏ ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁ¤ÓÂÛË Â›Ó·È Ì›· Û¿ÓÈ· ·ÈÙ›· ÓÂÔÁÓÈ΋˜ ·ÓÔ˘Ú›·˜, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Û˘ÁÁÂÓ‹ ·ÓˆÌ·Ï›· Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ÂÁÁ‡˜ ÂÛÂÈÚ·Ì¤ÓˆÓ ÛˆÏËÓ·Ú›ˆÓ Î·È ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ÛˆÌ·ÙÈÎfi ¯·Ú·ÎÙ‹Ú· (5). À¿Ú¯ÂÈ ¿ÓÙ· ÈÛÙÔÚÈÎfi ÔÏÈÁÔ¸‰Ú·ÌÓ›Ô˘ ÛÙÔ Ù¤ÏÔ˜ Ù˘ ·ËÛ˘, Û˘Ó‹ıˆ˜ ÌÂÙ¿ ·fi ÙËÓ 20‹-25Ë Â‚‰ÔÌ¿‰· ·ËÛ˘, Ô˘ Û˘Ó‹ıˆ˜ ÚÔηÏ› ÛÔ‚·Ú‹ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ì Ó¢ÌÔÓÈ΋ ˘ÔÏ·Û›· Î·È Ù· ¿ÏÏ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Potter (6). ∆Ô Ì¤ÁÂıÔ˜ ÙˆÓ ÓÂÊÚÒÓ Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ÛÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ·Ó Î·È ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÓÂÔÁÓ¿ ¯ˆÚ›˜ Ó¢ÌÔÓÈο ÚÔ‚Ï‹Ì·Ù· Î·È Û‡Ó‰ÚÔÌÔ Potter (4), Èı·ÓÒ˜ ÏfiÁˆ ‚Ú·¯‡¯ÚÔÓ˘ ·ÚÔ˘Û›·˜ ÙÔ˘ ÔÏÈÁÔ¸‰Ú·ÌÓ›Ô˘. ∆· ›‰È· ÎÏÈÓÈο Î·È ÈÛÙÔÏÔÁÈο Â˘Ú‹Ì·Ù· Ì ÙË ÓÂÊÚÈ΋ ÛˆÏËÓ·Úȷ΋ ‰˘ÛÁ¤ÓÂÛË ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È Û ‰›‰˘Ì· ÓÂÔÁÓ¿ Ì ÂÌ‚Ú˘Ô-ÂÌ-
µÈ‚ÏÈÔÁÚ·Ê›· 1. Haycock GB. Management of acute and chronic renal failure in the newborn. Semin Neonatol 2003;8:325-334. 2. Toth-Heyn P, Drukker A, Guignard JP. The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 2000;14:227-239. 3. Landau D, Shalev H, Shulman H, Barki Y, Maor E, Zmora E. Oligohydramnion, renal failure and no pulmonary hypoplasia in glomerulocystic kidney disease. Pediatr Nephrol 2000;14:319-321.
¶·È‰È·ÙÚÈ΋ 2005;68:240, 243-244
‚Ú˘˚΋ ÌÂÙ¿ÁÁÈÛË ‹ Û ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ì ÈÛÙÔÚÈÎfi Ï‹„˘ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ÈÓ‰ÔÌÂı·Î›Ó˘ ‹ ·Ó·ÛÙÔϤˆÓ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ‹ ·Ó·ÛÙ·ÏÙÒÓ ÙˆÓ ˘Ô‰Ô¯¤ˆÓ 1 Ù˘ ·ÁÁÂÈÔÙÂÓÛ›Ó˘ ππ (7). ŒÙÛÈ ıˆÚÂ›Ù·È fiÙÈ ÔÈ ÈÛÙÔÏÔÁÈΤ˜ ‚Ï¿‚˜ fiÏˆÓ ·˘ÙÒÓ ÙˆÓ ÎÏÈÓÈÎÒÓ ÔÓÙÔÙ‹ÙˆÓ Â›Ó·È ÙÔ ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÈÛ¯·ÈÌÈ΋˜ ‚Ï¿‚˘ Ù˘ ÓÂÊÚÈ΋˜ ÌÈÎÚÔ΢ÎÏÔÊÔÚ›·˜ ÛÙËÓ ÂÌ‚Ú˘˚΋ ÂÚ›Ô‰Ô. ∏ ÚÔÁÂÓÓËÙÈ΋ ¤ÁηÈÚË ‰È¿ÁÓˆÛË ‰ÂÓ Â›Ó·È ÂÊÈÎÙ‹, ·ÊÔ‡ ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ù˘ ÓfiÛÔ˘ (ÔÏÈÁÔ¸‰Ú¿ÌÓÈÔ) ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ŸÌˆ˜, Ë ·ÚÔ˘Û›· ÔÏÈÁÔ¸‰Ú·ÌÓ›Ô˘ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙˆÓ ÁÔÓ¤ˆÓ Ú¤ÂÈ Ó· ı¤ÙÔ˘Ó ÙËÓ ˘Ô„›· ÁÈ· ÙË ÓfiÛÔ. øÛÙfiÛÔ, ÚfiÛÊ·Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÚÈÛÙ·ÙÈο ¯ˆÚ›˜ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi (4). ∆¤ÏÔ˜, fiÙ·Ó Ë ‰È¿ÁÓˆÛË ÙÂÎÌËÚȈı› Ì ÙË ÓÂÊÚÈ΋ ‚ÈÔ„›·, Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÔÈ ÁÔÓ›˜ fiÙÈ Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘ Û οı ÂfiÌÂÓÔ ·È‰› Â›Ó·È 25%. 4. Morris S, Akima S, Dahlstrom JE, Ellwood D, Kent A, Falk MC. Renal tubular dysgenesis and neonatal hemochromatosis without pulmonary hypoplasia. Pediatr Nephrol 2004;19:341-344. 5. Allanson JE, Hunter AG, Mettler GS, Jimenez C. Renal tubular dysgenesis: a not uncommon autosomal recessive syndrome: a review. Am J Med Genet 1992;43:811-814. 6. Querfeld U, Ortmann M, Vierzig A, Roth B. Renal tubular dysgenesis: a report of two cases. J Perinatol 1996;16:498-500. 7. Prasad N, Gulati S, Jain M, Tewari P. An unusual case of neonatal anuria. Indian Pediatr 2003;40:258-260.
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11Ô ¶·ÓÂ˘Úˆ·˚Îfi ™˘Ó¤‰ÚÈÔ °ÂÓÈ΋˜ π·ÙÚÈ΋˜ •ÂÓÔ‰Ô¯Â›Ô Kipriotis Village ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· °ÂÓÈ΋˜ π·ÙÚÈ΋˜ ¶ÏËÚÔÊÔڛ˜: ∂§∂°∂π∞ ∆ËÏ.: +30 2310 550 048, 2310 539 995 Fax: +30 2310 539 995 E-mail: elegeia@otenet.gr
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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· ¶··‰ÔÔ‡ÏÔ˘ ∆ËÏ.: +30 210 7726 355, 6945 29 30 71 E-mail: papadop5@otenet.gr
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The History of Diabetes Mellitus ¢ÔÚ˘ÊÔÚÈÎfi ™˘ÌfiÛÈÔ 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: www.easdsymposium2005.com
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10-13 ™ÂÙÂÌ‚Ú›Ô˘ 2005 39th Annual Meeting of the European Society for Paediatric Nephrology ¶ÏËÚÔÊÔڛ˜: Flap Tours ∆ËÏ.: +90 (312) 454 00 00 Fax: +90 (312) 454 00 01 Website: www.espn2005.org
Istanbul, Turkey
14-17 ™ÂÙÂÌ‚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: www.istanbul-umemps2005.org
Istanbul, Turkey
Paediatriki May-June 05
12-07-05
13:09
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23-25 ™ÂÙÂÌ‚Ú›Ô˘ 2005 ∂˘Úˆ·˚Îfi ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ “∞fi ÙÔ˘˜ °ÔÓ›˜ ÛÙ· ¶·È‰È¿" ¶ÔÏ˘¯ÒÚÔ˜ ∞ıËÓ·˝˜ “OÈ ÂÈÙÒÛÂȘ Ù˘ „˘¯È΋˜ ‰È·Ù·Ú·¯‹˜ ÙˆÓ ÁÔÓ¤ˆÓ ÛÙ· ·È‰È¿” ¶ÏËÚÔÊÔڛ˜: C&C International, Conventions and Congresses ∆ËÏ.: +30 210 6889 100 Fax: +30 210 6844 777 Website: www.parentsonchildren.gr
∞ı‹Ó·
28 ™ÂÙÂÌ‚Ú›Ô˘1 √ÎÙˆ‚Ú›Ô˘ 2005
Pre-event to 1st European Conference on 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: www.cc.uoa.gr/health/socmed/hygien/pre_event
∂Ú¤ÙÚÈ·
8-9 OÎÙˆ‚Ú›Ô˘ 2005
16th Congress of the European Society of Ambulatory Pediatrics (2005) ¶ÏËÚÔÊÔڛ˜: Grupo Pacifico S.A. Fax: +34 93 23 87 488 E-mail: midelsohn@pacifico-meetings.com Website: www.sepa-esap.org
Barcelona
22-23 OÎÙˆ‚Ú›Ô˘ 2005
5Ë ¢ÈËÌÂÚ›‰· Ù˘ ∂ÏÏËÓÈ΋˜ ∂Ù·ÈÚ›·˜ ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ Î·È ¶ÚÔ·ÁˆÁ‹˜ Ù˘ ÀÁ›·˜ ¶·Ú¿ÚÙËÌ· £ÂÛÛ·Ï›·˜ ∂∂∫¶¶À ¶ÓÂ˘Ì·ÙÈÎfi ∫¤ÓÙÚÔ Ù˘ ªËÙÚfiÔÏ˘ ¶ÏËÚÔÊÔڛ˜: ∞Ó·ÛÙ·Û›Ô˘ ∞Ó·ÛÙ·Û›· ∆ËÏ.: +30 6937 6767 25, +30 24210 31341-2
µfiÏÔ˜
24-27 ¡ÔÂÌ‚Ú›Ô˘ 2005
13Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ OÁÎÔÏÔÁ›·˜ •ÂÓÔ‰Ô¯Â›Ô Divani Caravel ¶ÏËÚÔÊÔڛ˜: Œ„ÈÏÔÓ Congress ∆ËÏ.: +30 210 7254 360-2 Fax: +30 210 7254 363 E-mail: info@epsiloncongress.gr Website: www.epsiloncongress.gr
∞ı‹Ó·
3-5 ª·˝Ô˘ 2006
24th Annual Meeting of the European Society for Paediatric Infectious Diseases - ESPID ¶ÏËÚÔÊÔڛ˜: Kenes International / ESPID 2006 ∆ËÏ.: +41 22 908 0488 Fax: +41 22 732 2850 E-mail: espid@kenes.com Website: www.kenes.com/espid/index2006.asp
Basel, Switzerland