Pediatr Mar-Apr 06
18-04-06
16:41
™ÂÏ›‰·3
¶·È‰È·ÙÚÈ΋ ∆fiÌÔ˜ 69 ñ ∆‡¯Ô˜ 2 ñ ª¿ÚÙÈÔ˜-∞Ú›ÏÈÔ˜ 2006 ¢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¿ ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ º. ª·˘ÚÔÂȉ‹ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘
¶ÂÚȯfiÌÂÓ· ∂¶π∫∞πƒ∞ £∂ª∞∆∞ 77 ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ 78 ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ 83 ∞Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÎÔηÙË: Ù· Ó¤· ‰Â‰Ô̤ӷ °. ∆ÛfiÏ·˜ 90 ∂ÎÙ›ÌËÛË ÎÈÓ‰‡ÓˆÓ Î·È Û¯Â‰È·ÛÌfi˜ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ∫. ¢Ô‡ÚÔ˜, µ. ∆Û·ÁÚ‹˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘-∫·Ú·ı›Ô˘
∞¡∞™∫O¶∏™∂π™ EΉfiÙ˘ K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ∞ÚÙ¤ÌȉԘ 3 151 25 M·ÚÔ‡ÛÈ TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·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
97 ∏ ˘fiıÂÛË PANDAS (·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË): ̇ıÔ˜ ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ·; µ. ∆Û·ÁÚ‹˜, ∫. ¢Ô‡ÚÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘-∫·Ú·ı›Ô˘ 104 §ÈÛÙÂÚ›ˆÛË Î·Ù¿ ÙËÓ Î‡ËÛË ¶. ª¤ÍË-ªÔ˘ÚÓ¿, ¡. ªÔ˘ÚÓ¿˜ 110 ™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ. ∂ÈÙÒÛÂȘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi ™. ∞ÓÙˆÓÈ¿‰Ë˜ ∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ 118 ¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·: ∞fi„ÂȘ ÂÏÏ‹ÓˆÓ ·È‰È¿ÙÚˆÓ ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘
127 ¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË: ¢È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙÚfiÔÈ ÚÔÛ¤Ï΢Û˘ ∂. ª·ıÚ¤ÏÏÔ˘, ª. °È·ÓÓ·ÎÔ‡ÏÈ·, ¡. µÔ˘Ù˙Ô˘Ú¿Î˘, ¶. ∑‹Û˘, ∞.§. ª·Ù¿Ï·, §.™. ™˘ÓÙÒÛ˘
∂¡¢π∞º∂ƒ√À™∂™ ¶∂ƒπ¶∆ø™∂π™ 134 ∞Ï·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Ì ʷÈÓfiÙ˘Ô Û˘Ó‰ÚfiÌÔ˘ Smith-Lemli-Opitz Î·È Meckel ∞. ∞Ó‰Ú¤Ô˘, µ. ¶··‚·ÛÈÏ›Ԣ, ∞. ™·ÎÂÏÏ·ÚÔÔ‡ÏÔ˘ 138 £·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘ 143 ™¿ÓÈ· ÂÌÊ¿ÓÈÛË ÔÈÎÔÁÂÓÔ‡˜ ÓfiÛÔ˘ Moyamoya Û ·ÛıÂÓ›˜ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜ ∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘, ¡. µ·ÛÈÏ¿ÎË, ™. ∞ÚÒÓË, H. Ikeda, ∞. ¶··‚·ÛÈÏ›Ԣ
¶ƒ∞∫∆π∫O £∂ª∞ 150 H ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿ ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘
160 ∫§π¡π∫√ ∫√Àπ∑
161 ¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ∏ÏÂÎÙÚÔÓÈΤ˜ ‰È¢ı‡ÓÛÂȘ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ ∫. ™ÙÂÊ·Ó›‰Ë˜
Pediatr Mar-Apr 06
18-04-06
16:41
™ÂÏ›‰·5
Paediatriki Volume 69 ñ Number 2 ñ March-April 2006 Bimonthly Publication of the Greek Paediatric Society President A. Constantopoulos Editorial Board Editor-in-Chief 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 Manuscript Editing Greek Editing F. Mavroidi 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
Contents CURRENT ISSUES 77 Measles outbreak A. Constantopoulos
127 Food advertisements targeted at children: nutritional information and appeal E. Bathrellou, M. Yannakoulia, N. Voutzourakis, P. Zisis, A.L. Matalas, L.S. Sidossis
78 National Vaccination Programme National Vaccination Committee
CASE REPORTS
83 Diphtheria, tetanus, acellular pertussis booster vaccination for adolescents: the new data G. Tsolas
134 Aplasia of the cerebellar vermis with Smith-Lemli-Opitz and Meckel syndrome phenotypes A. Andreou, V. Papavassiliou, A. Sakellaropoulou
90 Polio control after certification: evaluating the risks and planning public health policies K. Douros, B. Tsagris, P. Nikolaidou-Karpathiou
138 Lethal multiple pterygium syndrome H. Hatzissevastou-Loukidou, A. Georgountzou 143 Familial Moyamoya disease in two European children H. Bazigou-Fotopoulou, N. Vassilaki, S. Aroni, H. Ikeda, A. Papavassiliou
REVIEW ARTICLES 97 The PANDAS hypothesis (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection): reality or myth? V. Tsagris, K. Douros, P. Nikolaidou-Karpathiou
PRACTICAL ISSUES 150 Haemoptysis in children M.N. Vassilopoulou, N. Myriokefalitakis
104 Listeriosis during pregnancy P. Mexi-Bourna, N. Bournas
160 CLINICAL QUIZ
110 Congenital and acquired heart diseases. Implications for pregnancy, the fetus and the newborn infant S. Antoniadis
161 NEWS FROM THE INTERNET
ORIGINAL ARTICLES 118 Paediatric palliative care: perceptions of Greek pediatricians M. Bouri, D. Papadatou
European Pediatric Societies electronic addresses C. Stefanidis
Pediatr Mar-Apr 06
18-04-06
16:41
™ÂÏ›‰·7
™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏
EDITORIAL BOARD
¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘
Editor-in-Chief
∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·
Constantinos Stefanidis, Athens
À‡ı˘ÓÔÈ ™‡ÓÙ·Í˘ ∂ÍÂȉÈ·ۈÓ
Section Editors
∂ϤÓË ∞ÓÙˆÓÔÔ‡ÏÔ˘, ∞ı‹Ó· ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ - ¶ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜
Eleni Antonopoulou, Athens Developmental and behavioral pediatrics
¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, £ÂÛÛ·ÏÔÓ›ÎË KÏËÚÔÓÔÌÈο ÌÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·
Persefoni Avgoustidou-Savopoulou, Thessaloniki Metabolic disorders
∞Ó‰ÚÈ·Ó‹ µ·˙·›Ô˘-°ÂÚ·ÛÈÌ›‰Ë, ∞ı‹Ó· ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·
Andriani Vazaiou-Gerasimidi, Athens Endocrinology
°ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘, £ÂÛÛ·ÏÔÓ›ÎË ∫·Ú‰ÈÔÏÔÁ›·
George Varlamis, Thessaloniki Cardiology
ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ı‹Ó· ∞ÓÔÛÔÏÔÁ›·
Maria Kanariou, Athens Immunology
∂˘ÛÙ·ı›· ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë, ∞ı‹Ó· ¡Â˘ÚÔÏÔÁ›·
Eustathia Katsarou-Pektasidou, Athens Neurology
∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ı‹Ó· ∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·
Antonis Kattamis, Athens Haematology - √ncology
ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜, ∞ı‹Ó· ¡ÂÔÁÓÔÏÔÁ›·
Christos Kostalos, Athens Neonatology
∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, ∞ı‹Ó· °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ∏·ÙÔÏÔÁ›· - ¢È·ÙÚÔÊ‹
Alexandra Papadopoulou, Athens Gastroenterology - Hepatology - Nutrition
¡ÈÎfiÏ·Ô˜ ¶··‰fiÔ˘ÏÔ˜, ∞ı‹Ó· ∞ÏÏÂÚÁÈÔÏÔÁ›· - ¶Ó¢ÌÔÓÔÏÔÁ›·
Nicos Papadopoulos, Athens Allergology - Pneumonology
∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, πˆ¿ÓÓÈÓ· ƒÂ˘Ì·ÙÔÏÔÁ›·
Antigoni Siamopoulou-Mavridou, Ioannina Rheumatology
ª·Ú›˙· ∆ÛÔÏÈ¿, ∞ı‹Ó· §ÔÈ̈ÍÈÔÏÔÁ›·
Marisa Tsolia, Athens Infectious Diseases
ª¤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board Alexis Arzimanoglou, Paris, France
Enver Hasanoglu, Ankara, Turkey
Ellis D. Avner, Milwaukee, USA
Christer Holmberg, Helsinki, Finland
Swati Bhave, New Delhi, India
Peter Hoyer, Essen, Germany
Alberto Bissot, Panama, Panama
Jan Janda, Prague, Czech Republic
David Branski, Jerusalem, Israel
Jan Kimpen, Ultrecht, Netherlands
Francesco Chiarelli, Chieti, Italy
John Manis, Boston, USA
Chok-Wan Chan, Hong Kong, China
Manuel Moya, Alicante, Spain
Denis Daneman, Toronto, Canada
Hugh O'Brodovich, Toronto, Canada
Jochen Ehrich, Hannover, Germany
Willem Proesmans, Leuven, Belgium
Demetrius Ellis, Pittsburgh, USA
Jose Ramet, Antwerp, Belgium
Yoshikatsu Eto, Tokyo, Japan
Alan Sinaiko, Minneapolis, USA
Richard N. Fine, Stony Brook, USA
Alfred Tenore, Udine, Italy
Margaret C. Fisher, Philadelphia, USA
Alkis Togias, Bethesda, USA
Raif Geha, Boston, USA
Eva Tsalikian, Iowa City, USA
Adenike Grange, Lagos, Nigeria
Catherine Weil-Olivier, Paris, France
Judith G. Hall, Vancouver, Canada
Johannes Zschocke, Heidelberg, Germany
Patricia Hamilton, London, UK
vii
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·15
√¢∏°π∂™ ¶ƒ√™ ∆√À™ ™À°°ƒ∞º∂π™ A. °ÂÓÈΤ˜ ¶ÏËÚÔÊÔڛ˜
∂¶π™∆∏ª√¡π∫∂™ ∂∫¢√™∂π™
∆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˜.
Ó·È Â˘Ì¿‰·˜ us ( ‚‚ÚÔÁÎ·È M. a spp. ÈÛÙÔÚÔ‚ÂÂÊÚÔr/ËÌÂr ËÌ¢ ·fi
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΋
xv
·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˜ Û 1500-2500 ϤÍÂȘ Î·È ÙȘ ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ Û 1000-1500 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.
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·16
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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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™À¡∆√ª√°ƒ∞ºπ∂™ o
A cal cm cm2 cm3 o C g h IU kg l m mg min mm mol n NS ‹ ª™ osm p SD SE sec U
angstrom ıÂÚÌ›‰· ÂηÙÔÛÙfi ÙÂÙÚ·ÁˆÓÈÎfi ÂηÙÔÛÙfi ΢‚ÈÎfi ÂηÙÔÛÙfi ‚·ıÌfi˜ ∫ÂÏÛ›Ô˘ ÁÚ·ÌÌ¿ÚÈÔ ÒÚ· ‰ÈÂıÓ‹˜ ÌÔÓ¿‰· ¯ÈÏÈfiÁÚ·ÌÌÔ Ï›ÙÚÔ Ì¤ÙÚÔ ¯ÈÏÈfiÁÚ·ÌÌÔ 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
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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 1500-2500 words and case reports 1000-1500 words; ñ brief reports 1000-1500 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.
ª·Ú›· ¶··Ê›ÏË °È· ÏËÚÔÊÔڛ˜: www.euran.com ªaria Papafili For information: www.euran.com
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CURRENT ISSUE
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ŒÍ·ÚÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ∫·ıËÁËÙ‹˜ ∞Ó‰Ú¤·˜ ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ∏ ÈÏ·Ú¿ fiˆ˜ Â›Ó·È ÁÓˆÛÙfi, Â›Ó·È ¤Ó· ÏÔÈÌ҉˜ ÓfiÛËÌ· Ì ÌÂÁ¿ÏË ÌÂÙ·‰ÔÙÈÎfiÙËÙ·. ∆Ô 95% ÙÔ˘ ÏËı˘ÛÌÔ‡ ÓÔÛÔ‡Û ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 20 ÂÙÒÓ, ÚÈÓ ·Ú¯›ÛÂÈ Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÁÈ· ÙËÓ ÈÏ·Ú¿ Î·È Î¿ı 5 ÂÚ›Ô˘ ¯ÚfiÓÈ· ÂÌÊ·ÓÈ˙fiÙ·Ó Î·È ÌÈ· ÂȉËÌ›· ÈÏ·Ú¿˜. ∏ ˘„ËÏfiÙÂÚË Â›ÙˆÛË ‹Ù·Ó ÛÙËÓ ËÏÈΛ· ÙˆÓ 5-9 ¯ÚfiÓˆÓ Î·È ÂÓÂÊ¿ÓÈ˙ Âԯȷ΋ ηٷÓÔÌ‹ Ì ·‡ÍËÛË Ù˘ ›وÛ˘ ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ¯ÂÈÌÒÓ· Î·È ÙËÓ ¿ÓÔÈÍË. ∆ËÓ ‰ÂηÂÙ›· ÙÔ˘ 1970 ¿Ú¯ÈÛÂ Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ÈÏ·Ú¿˜ Ì ̛· ‰fiÛË MMR, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜. ∆Ô 1987 ÚÔÛÂÙ¤ıË Î·È Ì›· ‰Â‡ÙÂÚË ‰fiÛË, ·Ú¯Èο, ÛÙËÓ ËÏÈΛ· ÙˆÓ 12 ¯ÚfiÓˆÓ Î·È ·ÚÁfiÙÂÚ·, ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-6 ¯ÚfiÓˆÓ. ¶·Ú¿ ÙËÓ ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙËÓ ÙÂÏÂ˘Ù·›· 25ÂÙ›· ·Ú·ÙËÚ‹ıËÎ·Ó 4 ÂȉË̛˜ ÛÙËÓ ∂ÏÏ¿‰· ÙÔ 1983, 1988, 1992 Î·È ÙÔ 1996. ∞fi ÙÔÓ ÂÚ·Ṳ̂ÓÔ ¡Ô¤Ì‚ÚÈÔ ÙÔ˘ 2005 ·Ú·ÙËÚÂ›Ù·È ÛÙË ¯ÒÚ· Ì·˜ ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ÎÚÔ˘ÛÌ¿ÙˆÓ ÈÏ·Ú¿˜ ΢ڛˆ˜ ÛÙË µfiÚÂÈ· ∂ÏÏ¿‰·, ȉȷ›ÙÂÚ· Û ηٷ˘ÏÈÛÌÔ‡˜ ·ı›ÁÁ·ÓˆÓ. ™ÙË Û˘Ó¤¯ÂÈ·, ÂÍ·ÏÒıËΠÛÙË £ÂÛÛ·ÏÔÓ›ÎË, fiÔ˘ ÓfiÛËÛ ¤Ó·˜ ·È‰›·ÙÚÔ˜, Ì›· ÓÔÛËχÙÚÈ· Î·È Ì›· ÌËÙ¤Ú· ÓÔÛËÏ¢Ô̤ÓÔ˘ ·È‰ÈÔ‡ ÁÈ· ¿ÏÏË ÓfiÛÔ. ∆· ÂfiÌÂÓ· ÎÚÔ‡ÛÌ·Ù· ÂÌÊ·Ó›ÛıËÎ·Ó ÛÙËÓ ∂‡‚ÔÈ· Î·È ÙËÓ ∞ı‹Ó·. √È ËÏÈ˘ Ô˘ ÚÔÛ‚ϋıËÎ·Ó ‹Ù·Ó ΢ڛˆ˜ ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 4 ¯ÚfiÓˆÓ Î·È ÂÓ‹ÏÈΘ 20-30 ¯ÚfiÓˆÓ. ™Â ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· ÂÌÊ·Ó›ÛıËÎ·Ó ÎÚÔ‡ÛÌ·Ù· Î·È ÛÙȘ ¿ÏϘ ËÏÈ˘. ∏ ¤Í·ÚÛË ·˘Ù‹ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ·ÊÔÚÔ‡Û ΢ڛˆ˜ ·ÓÂÌ‚ÔÏ›·ÛÙ· ·È‰È¿ ‹ ·È‰È¿ ÛÙ· ÔÔ›· ‰ÂÓ Â›¯Â ¯ÔÚËÁËı› ‰Â‡ÙÂÚË ‰fiÛË MMR. °È· Ó· ·ÔÊ¢¯ı› Ë ÂÚ·ÈÙ¤Úˆ ¤Í·ÚÛË ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ Û˘ÓÈÛÙÒÓÙ·È Ù· ÂÍ‹˜: 1. ¡· Á›ÓÂÈ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÚÂÊÒÓ Ì MMR ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ. ∏ ‰fiÛË ·˘Ù‹ ÛÙË Û˘Ó¤¯ÂÈ·, ı· ·ÁÓÔËı› Î·È ı· Á›ÓÔ˘Ó ·ÎfiÌË 2 ÂÈÚfiÛıÂÙ˜ ÂÓ¤ÛÂȘ MMR. 2. ŸÏ· Ù· ·È‰È¿ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÓÔÛ‹ÛÂÈ Î·È Â›Ó·È ·ÓÂÌ‚ÔÏ›·ÛÙ· ‹ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·Ûı› Ì ÌÈ· ‰fiÛË ÂÌ‚ÔÏ›Ô˘ MMR Û˘ÓÈÛÙ¿Ù·È Ë ¿ÌÂÛË ¯ÔÚ‹ÁËÛË Ì›·˜ ·ÎfiÌË ‰fiÛ˘ ÂÌ‚ÔÏ›Ô˘ MMR. 3. ŸÛ· ·È‰È¿ ¤¯Ô˘Ó οÓÂÈ Ì›· ‰fiÛË ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-15 ÌËÓÒÓ, ÂÈ‚¿ÏÏÂÙ·È Ë ‰Â‡ÙÂÚË ‰fiÛË Ó· Á›ÓÂÈ ¿ÌÂÛ·, ·ÚΛ Ó· ¤¯Ô˘Ó ÂÚ¿ÛÂÈ 2 ÙÔ˘Ï¿¯ÈÛÙÔÓ Ì‹Ó˜ ·fi ÙËÓ ÚÒÙË ‰fiÛË, ¯ˆÚ›˜ Ó· ÂÚÈ̤ÓÔ˘Ì ӷ Á›ÓÂÈ 4 ¯ÚfiÓˆÓ ÙÔ ·È‰›. 4. ∂Ó‹ÏÈΘ ̤¯ÚÈ 45 ¯ÚfiÓˆÓ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÈÛÙÔÚÈÎfi ÓfiÛËÛ˘ ·fi ÈÏ·Ú¿ ‹ Â›Ó·È ·ÓÂÌ‚ÔÏ›·ÛÙÔÈ ‹ Â›Ó·È ÂÌ‚ÔÏÈ·Ṳ̂ÓÔÈ Ì ̛· ‰fiÛË ÂÌ‚ÔÏ›Ô˘ MMR Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË Ì›·˜ ‰fiÛ˘ MMR. º˘ÛÈο, ·Ó ÂÌ‚ÔÏÈ·ÛıÔ‡Ó fiϘ ·˘Ù¤˜ ÔÈ ÔÌ¿‰Â˜, Ù· ÂÌ‚fiÏÈ· MMR ı· ÂÍ·ÓÙÏËıÔ‡Ó, ÁÈ’ ·˘Ùfi Û ÚÒÙË Ê¿ÛË, ı· Ú¤ÂÈ Ó· ‰Ôı› ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙȘ ·Ú·Î¿Ùˆ ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘: ·. ∆Ô È·ÙÚÔÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ‚. ∆Ô ÚÔÛˆÈÎfi ‚ÚÂÊÔÓËÈ·ÎÒÓ ÛÙ·ıÌÒÓ Á. ºÔÈÙËÙ¤˜ Î·È ÛÔ˘‰·ÛÙ¤˜ Ô˘ οÓÔ˘Ó ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ¿ÛÎËÛË ‰. √È ·ı›ÁÁ·ÓÔÈ Î·È ¿ÏϘ ÔÌ¿‰Â˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÂÌ‚ÔÏÈ·Ûı› ηıfiÏÔ˘.
¶Úfi‰ÚÔ˜ ∂ÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∂Ù·ÈÚ›·˜ µ’ ¶·È‰È·ÙÚÈ΋ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
£· Ú¤ÂÈ Ó· ÁÓˆÚ›˙Ô˘Ì fiÙÈ ÙÔ MMR ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚ˜ ·ÚÂÓ¤ÚÁÂȘ, ÂÎÙfi˜ fiÙ·Ó ¯ÔÚËÁÂ›Ù·È Û ÂÓ‹ÏÈΘ, ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÂÈ Â›ÌÔÓË ·ÚıÚ›Ùȉ·. ¶·Ú¿ Ù·‡Ù· ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È Û ÂÚÈÙÒÛÂȘ ÂȉËÌ›·˜ ‹ ¤Í·ÚÛ˘ Ù˘ ÈÏ·Ú¿˜.
¶·È‰È·ÙÚÈ΋ 2006;69:77
Pediatr Mar-Apr 06
78
18-04-06
16:42
™ÂÏ›‰·78
∂¶π∫∞πƒ√ £∂ª∞
CURRENT ISSUE
∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ ¶Úfi‰ÚÔ˜, ∫·ıËÁËÙ‹˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ªÂ ÙËÓ ·fi 13.1.2006 Û¯ÂÙÈ΋ ÂÁ·ÎÏÈÔ ÙÔ˘ ÀÊ˘Ô˘ÚÁÔ‡ ÀÁ›·˜ Î. ∞ı·Ó¿ÛÈÔ˘ °È·ÓÓfiÔ˘ÏÔ˘ ÂÎÛ˘Á¯ÚÔÓ›˙ÂÙ·È ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ. ∏ ·fiÊ·ÛË ·˘Ù‹, Ô˘ ÂÏ‹ÊıË ÌÂÙ¿ ·fi Û¯ÂÙÈ΋ ÚÔÂÙÔÈÌ·Û›· Î·È ÂÈÛ‹ÁËÛË Ù˘ ∂ıÓÈ΋˜ ∂ÈÙÚÔ‹˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ, ·ÔÙÂÏ› ÌÈ· Ì›˙ÔÓÔ˜ ÛËÌ·Û›·˜ ·Ú¤Ì‚·ÛË ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ ÛÙË ¯ÒÚ· Ì·˜. ∆Ô Ó¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ Â›Ó·È Ï¤ÔÓ ÚÔÛ·ÚÌÔṲ̂ÓÔ ÛÙȘ ÙÂÏÂ˘Ù·›Â˜ ÂÈÛÙËÌÔÓÈΤ˜ ÂÍÂÏ›ÍÂȘ Î·È ‚Ú›ÛÎÂÙ·È Û ϋÚË ·ÓÙÈÛÙÔȯ›· Ì ٷ ÚÔÁÚ¿ÌÌ·Ù· ÙˆÓ ÚÔËÁÌ¤ÓˆÓ Û˘ÛÙËÌ¿ÙˆÓ ˘Á›·˜. ªÂ ÙÔ Ó¤Ô ¶ÚfiÁÚ·ÌÌ· ÙÔ Â›Â‰Ô Ù˘ ·Ú¯fiÌÂÓ˘ ˘ÁÂÈÔÓÔÌÈ΋˜ ÊÚÔÓÙ›‰·˜ ·Ó·‚·ıÌ›˙ÂÙ·È ÛËÌ·ÓÙÈο. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ Ù· ÂÌ‚fiÏÈ· ·ÔÙÂÏÔ‡Ó ¤Ó· ·fi Ù· ‰¤Î· ÌÂÁ·Ï‡ÙÂÚ· ÂÈÙ‡ÁÌ·Ù· ÛÙÔ Â‰›Ô Ù˘ ¢ËÌfiÛÈ·˜ ÀÁ›·˜ Î·È ·ÔÙÂÏÔ‡Ó ¤Ó· ÎÚ›ÛÈÌÔ Ì¤ÛÔ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡, ÙËÓ ¿ÛÎËÛË ÚÔÏËÙÈ΋˜ È·ÙÚÈ΋˜ Î·È ÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ıÓËÛÈÌfiÙËÙ·˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ·. ∏ ÂͤÏÈÍË Ù˘ ‚ÈÔ˚·ÙÚÈ΋˜ Ù¯ÓÔÏÔÁ›·˜ ¤ÙÚ„ ÙËÓ ·Ó·Î¿Ï˘„Ë Î·È ·Ú·ÁˆÁ‹ “Ó¤·˜ ÁÂÓÈ¿˜” ÂÌ‚ÔÏ›ˆÓ Ô˘ ¤¯Ô˘Ó ¯·ÌËÏfi Â›Â‰Ô ·ÓÙȉڷÛÙÈÎfiÙËÙ·˜ Î·È ˘„ËÏ¿ ›‰· ·ÛÊ¿ÏÂÈ·˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜. ÷ڷÎÙËÚÈÛÙÈο ·Ú·‰Â›ÁÌ·Ù· Ù˘ Ù¯ÓÔÏÔÁ›·˜ ·˘Ù‹˜ ·ÔÙÂÏÔ‡Ó ÙÔ ·Î˘ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÎÔηÙË, ÙÔ ÓÂÎÚfi ÂÓÈÛ¯˘Ì¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÔÏ˘ÔÌ˘ÂÏ›Ùȉ·˜, ÙÔ ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ µ, Ù· Û˘˙¢Á̤ӷ ÂÌ‚fiÏÈ· ηٿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘ ‚, ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ Î·È ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ Ù˘ Ó¢ÌÔÓ›·˜, Ù· ÔÏ˘‰‡Ó·Ì· / Û˘Ó‰˘·Ṳ̂ӷ ÂÌ‚fiÏÈ·, Ù· ÂÌ‚fiÏÈ· ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜, Ù˘ Ë·Ù›Ùȉ·˜ ∞ Î·È Ù· ÂÌ‚fiÏÈ· ηٿ Ù˘ Áڛ˘.
√ ÚfiÏÔ˜ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ªÂ ·Ï¿ ÏfiÁÈ·, Ô ÚfiÏÔ˜ ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Â›Ó·È Ó· ‰ÈÂÁ›ÚÔ˘Ó ÙÔ ·ÓÔÛÔÔÈËÙÈÎfi Û‡ÛÙËÌ· ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Ì·˜ ÒÛÙ ӷ ·Ú·Á¿ÁÂÈ ·ÓÔÛȷ΋ ·¿ÓÙËÛË (.¯. ·ÓÙÈÛÒÌ·Ù·) Û ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜. ªÂ ÙËÓ ·Ú·ÁˆÁ‹ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÍ·ÛÊ·Ï›˙ÂÙ·È ÌÂÏÏÔÓÙÈ΋ ÚÔÛÙ·Û›· (·ÓÔÛ›·) ·¤Ó·ÓÙÈ ÛÙÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·˘ÙÔ‡˜ ·Ú¿¶·È‰È·ÙÚÈ΋ 2006;69:78-82
ÁÔÓÙ˜. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Ù· ÂÌ‚fiÏÈ· ÂÚȤ¯Ô˘Ó ›ÙÂ Ê˘ÛÈο Û˘ÛÙ·ÙÈο - ÚÔ˚fiÓÙ· ÙˆÓ ÏÔÈÌÔÁfiÓˆÓ ·˘ÙÒÓ ·Ú·ÁfiÓÙˆÓ, ›Ù ÚÔ˚fiÓÙ· ‚ÈÔÙ¯ÓÔÏÔÁ›·˜ Ô˘ ÌÈÌÔ‡ÓÙ·È Ù· Ê˘ÛÈο Û˘ÛÙ·ÙÈο ÙÔ˘˜. ªÂÙ¿ ·fi ÂȉÈ΋ ÂÂÍÂÚÁ·Û›·, Ù· Ê˘ÛÈο ‹ ‚ÈÔÙ¯ÓÔÏÔÁÈο Û˘ÛÙ·ÙÈο Â›Ó·È ·Ó›Î·Ó· Ó· ÚÔηϤÛÔ˘Ó ÓfiÛËÛË, ÌÔÚÔ‡Ó, fï˜, Ó· ÚÔηϤÛÔ˘Ó ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓÙÈۈ̿وÓ. √ ·ÓıÚÒÈÓÔ˜ ÔÚÁ·ÓÈÛÌfi˜, ¤¯ÔÓÙ·˜ ·Ú·Á¿ÁÂÈ Ù· ηٿÏÏËÏ· ·ÓÙÈÛÒÌ·Ù· ‰È·ÙËÚ› ¤Ó· ÔÏÔÛÙ¿ÛÈÔ Ì ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ÂÍÔ˘‰ÂÙÂÚÒÛÂÈ ÙÔÓ Ê˘ÛÈÎfi ÏÔÈÌÔÁfiÓÔ ·Ú¿ÁÔÓÙ·, ÁÈ· ÙÔÓ ÔÔ›Ô ¤¯ÂÈ ·Ú·Û΢·Ûı› ÙÔ ÂÌ‚fiÏÈÔ fiÙ·Ó ¤ÚıÂÈ Û ·ʋ Ì·˙› ÙÔ˘. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi Ó· ÙÔÓÈÛı› fiÙÈ Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ú¤ÂÈ Ó· Á›ÓÂÙ·È fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÓˆÚ›ÙÂÚ· ÛÙË ˙ˆ‹ ÙˆÓ ·ÓıÚÒˆÓ, ηıÒ˜ ¤ÙÛÈ ·Ó·Ù‡ÛÛÂÙ·È Ë ÚÔÛٷ٢ÙÈ΋ ·ÓÔÛ›·. ™ÙËÓ ËÏÈΛ· ÌÂٷ͇ 3 Î·È 12 ÌËÓÒÓ ÙÔ Â›Â‰Ô ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ô˘ ·ÓȯÓ‡ÔÓÙ·È Â›Ó·È Î˘Ú›ˆ˜ ÌËÙÚÈ΋˜ ÚÔ¤Ï¢Û˘. ∞Ó ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ Ë ÌÂÙ·ÊÔÚ¿ ÚÔÛٷ٢ÙÈ΋˜ ·ÓÔÛ›·˜ ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ‚Ú¤ÊÔ˜ ‰ÂÓ Â›Ó·È Â·Ú΋˜, ÙfiÙ ÂΛÓÔ Ì¤ÓÂÈ ·Î¿Ï˘ÙÔ Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘. ªÂ ÙËÓ ¤Ó·ÚÍË ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ·fi ÙÔÓ 2Ô Ì‹Ó· Ù˘ ˙ˆ‹˜, ÙÔ ‚Ú¤ÊÔ˜ ·ÔÎÙ¿ ·ÚÎÂÙ¿ ÓˆÚ›˜ ˘„ËÏfi Â›Â‰Ô ÂÍÔ˘‰ÂÙÂÚÈÎÒÓ ·ÓÙÈۈ̿وÓ. ∆Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ ¤¯ÂÈ ÂÎÛ˘Á¯ÚÔÓÈÛı› Î·È ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1.
∆È Ú¤ÂÈ Ó· ÚÔÛ¤¯Ô˘Ó ÔÈ ·È‰›·ÙÚÔÈ √È ·È‰›·ÙÚÔÈ Ú¤ÂÈ ‰È·ÚÎÒ˜ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙȘ ÓÂfiÙÂÚ˜ ÂÍÂÏ›ÍÂȘ ÛÙÔÓ ÙÔ̤· ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ñ ¶Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÛˆÛÙ¿ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ·Ó¿ÁÎË Ù‹ÚËÛ˘ ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ Î·È ÙËÓ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ñ ¶Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔ˘Ó Î·È Ó· ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙÔ ‚È‚ÏÈ¿ÚÈÔ ˘Á›·˜ ÙÔ˘ ·È‰ÈÔ‡. ñ ¶Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔ˘Ó ÙȘ ·Ú¯¤˜ ÁÈ· Ù˘¯fiÓ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ηٿ ÙË ¯ÔÚ‹ÁËÛË ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ñ ¶Ú¤ÂÈ Ó· ÂϤÁ¯Ô˘Ó ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ÙˆÓ ·È‰ÈÒÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ.
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·79
79
∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ
¶›Ó·Î·˜ 1. ÕÙÔÌ· Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÛÔ‚·Ú¤˜ Ó¢ÌÔÓÈÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ
¶›Ó·Î·˜ 2. ¶·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ê˘Ì·ÙÈ΋ ÌfiÏ˘ÓÛË/Ê˘Ì·Ù›ˆÛË
ñ ÀÁÈ‹ ‚Ú¤ÊË, ÌÈÎÚ¿ ·È‰È¿ Î·È ÂÓ‹ÏÈΘ >60 ÂÙÒÓ ñ ÕÙÔÌ· ÌÂ Û˘ÁÁÂÓ›˜ ·ÓÙÈۈ̷ÙÈΤ˜ ·Ó¿ÚÎÂȘ (΢ڛˆ˜ ¤ÏÏÂÈ„Ë Ù˘ IgG2) ñ ÕÙÔÌ· Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› Ì ÙÔÓ Èfi HIV ñ ÕÙÔÌ· Ì ›ÎÙËÙË ·ÓÔÛÔηٷÛÙÔÏ‹, ÂÍ·ÈÙ›·˜ ÓÔÛ‹Ì·ÙÔ˜ ‹ ıÂڷ›·˜ ‹ ¿ÏÏ˘ (ÂÎÙfi˜ ÙÔ˘ HIV) ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ñ ÕÙÔÌ· Ì ÌÂÈÔÓÂÎÙÈ΋ ÛÏËÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ‹ ·ÛÏËÓ›· .¯. Ì ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ, Ì ˘ÂÚÛÏËÓÈÛÌfi, Ì ¯ÂÈÚÔ˘ÚÁÈ΋ ·Ê·›ÚÂÛË ÙÔ˘ ÛÏ‹Ó· ñ ÕÙÔÌ· Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ ‹ ¯ÚfiÓÈ· ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ñ ÕÙÔÌ· Ì ۷ί·ÚÒ‰Ë ‰È·‚‹ÙË ñ ÕÙÔÌ· Ì ¯ÚfiÓÈ· Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·Ó¿ÚÎÂÈ·. ñ ÕÙÔÌ· Ì ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ñ ÕÙÔÌ· Ì ‰È·Ê˘Á‹ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô˘ ˘ÁÚÔ‡ ·fi Û˘ÁÁÂÓ›˜ ‹ ›ÎÙËÙ˜ ·Èٛ˜
ñ ªÂÙ·Ó¿ÛÙ˜ ·fi ¯ÒÚ˜ Ì ˘„ËÏfi ‹ ̤ÛÔ ‰Â›ÎÙË ÂÓ‰ËÌÈÎfiÙËÙ·˜. ñ ∫·Ù·˘ÏÈÛÌÔ› ·ı›ÁÁ·ÓˆÓ Î·È ¿ÏÏˆÓ ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô˘ ˙Ô˘Ó ÌÂ Û˘Óı‹Î˜ ÔÌ·‰È΋˜ ‰È·‚›ˆÛ˘. ñ ¶·È‰È¿ Ì Mantoux (-) ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ÙˆÓ ÔÔ›ˆÓ ˘¿Ú¯ÂÈ ¿ÙÔÌÔ ÌÂ Ê˘Ì·Ù›ˆÛË (ıÂÙÈο Ù‡ÂÏ·). ñ ¡ÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ¤¯Ô˘Ó ÌÔÏ˘Óı› Ì ÙÔÓ Èfi HIV (fi¯È ‚Ú¤ÊË Û˘Ìو̷ÙÈο ÁÈ· AIDS). ñ ¡ÂÔÁÓ¿, ÛÙÔ ¿ÌÂÛÔ ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ ÔÔ›ˆÓ, ˘¿Ú¯ÂÈ ¿ÙÔÌÔ ÌÂ Ê˘Ì·Ù›ˆÛË (ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Î·Ù¿ ÙË Á¤ÓÓËÛË).
∆È Ú¤ÂÈ Ó· ÚÔÛ¤¯Ô˘Ó ÔÈ ÁÔÓ›˜ ñ √È ÁÔÓ›˜ Ú¤ÂÈ Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÁÈ· ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ. ñ ¡· Û˘ÓÂÚÁ¿˙ÔÓÙ·È Ì ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜ ÁÈ· ÙËÓ Ù‹ÚËÛË ÙÔ˘ ηٿÏÏËÏÔ˘ ÂÌ‚ÔÏÈ·ÛÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜. ñ ¡· ÌËÓ ·ÌÂÏÔ‡Ó ÙËÓ ¤ÁηÈÚË ¯ÔÚ‹ÁËÛË ÙˆÓ ‰fiÛˆÓ. ñ ¡· ÚÔÛ¤¯Ô˘Ó ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ‚È‚ÏÈ·Ú›Ô˘ ˘Á›·˜ ·fi ÙÔÓ ·È‰›·ÙÚfi ÙÔ˘˜. ∏ Ù‹ÚËÛË ÙÔ˘ ∂ıÓÈÎÔ‡ ¶ÚÔÁÚ¿ÌÌ·ÙÔ˜ ∂Ì‚ÔÏÈ·ÛÌÒÓ Â›Ó·È Ë ·Û›‰· ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜.
∞ÓÙ› ÂÈÏfiÁÔ˘ ∆Ô Ó¤Ô ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ Â›Ó·È ÌÈ· Ô˘ÛÈ·ÛÙÈ΋ Î·È ÂÓ ‰˘Ó¿ÌÂÈ ÂÍ·ÈÚÂÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·Ú¤Ì‚·ÛË ¢ËÌfiÛÈ·˜ ÀÁ›·˜. ¶·ÚfiÏ· ·˘Ù¿ Ë ÂÈÙ˘¯›· ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ ÔÛÔÛÙfi Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ ÙÔ˘ ÏËı˘ÛÌÔ‡. ∂›Ó·È ÁÂÁÔÓfi˜ fï˜, fiÙÈ Ë ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë ‰ÂÓ Â›Ó·È ·ÎfiÌ· ÛÙ· ÂÈı˘ÌËÙ¿ ›‰·. ∞·ÈÙÂ›Ù·È Û˘ÓÂÚÁ·Û›· ÙÔ˘ ∂ıÓÈÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÀÁ›·˜, Ù˘ È·ÙÚÈ΋˜ ÎÔÈÓfiÙËÙ·˜ Î·È ÙˆÓ ÁÔÓ¤ˆÓ ÁÈ· Ó· Êı¿ÛÔ˘Ì ÛÙ· ÂÈı˘ÌËÙ¿ ›‰· ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘ Ù˘ ¯ÒÚ·˜ Ì·˜ Î·È Ó· ÚÔÛÂÁÁ›ÛÔ˘Ì ÙÔÓ ÛÙfi¯Ô ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ ÁÈ· ÙËÓ ÂÍ¿ÏÂÈ„Ë Ù˘ ıÓËÛÈÌfiÙËÙ·˜ Ô˘ ÔÊ›ÏÂÙ·È Û ·ı‹ÛÂȘ ÁÈ· ÙȘ Ôԛ˜ ˘¿Ú¯Ô˘Ó ‰È·ı¤ÛÈÌ· ÂÌ‚fiÏÈ·.
¶›Ó·Î·˜ 3. ∂Ӊ›ÍÂȘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ Ë·Ù›Ùȉ·˜ ∞ Û ¯ÒÚ˜ Ì ¯·ÌËÏ‹ Î·È Ì¤ÛË ÂÓ‰ËÌÈÎfiÙËÙ· ñ ∆·ÍȉÈÒÙ˜ ñ ∂·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ñ ∂·ÁÁÂÏ̷ٛ˜ ‰È·Î›ÓËÛ˘ ÙÚÔÊ›ÌˆÓ ñ ¶ÚÔÛˆÈÎfi È‰Ú˘Ì¿ÙˆÓ ñ ∫ÏÂÈÛÙÔ› ÏËı˘ÛÌÔ›* ñ √ÌÔÊ˘ÏfiÊÈÏÔÈ - ∆ÔÍÈÎÔÌ·Ó›˜ ñ ÕÙÔÌ· Ì ¯ÚfiÓÈ· Ïԛ̈ÍË Ì ÙÔÓ Èfi Ù˘ ∏µ * µÏ. ˘ÔÛËÌ›ˆÛË ¶›Ó·Î· 4
¶›Ó·Î·˜ 4. ∂Ӊ›ÍÂȘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ηٿ Ù˘ Áڛ˘ ¶·ÚÔ˘Û›· ÂÓfi˜ ‹ ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi ÙÔ˘˜ ·Ú·Î¿Ùˆ ÂÈ‚·Ú˘ÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ‹ ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù·: ñ ÕÛıÌ· ‹ ¿ÏϘ ¯ÚfiÓȘ Ó¢ÌÔÓÔ¿ıÂȘ ñ ∫·Ú‰È·Î‹ ÓfiÛÔ˜ Ì ÛÔ‚·Ú¤˜ ηډÈÔ‰˘Ó·ÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ñ ∞ÓÔÛÔηٷÛÙÔÏ‹ (ÂÍ·ÈÙ›·˜ ÓÔÛ‹Ì·ÙÔ˜ ‹ ıÂڷ›·˜) ñ ¢Ú·ÓÔ΢ÙÙ·ÚÈ΋ ÓfiÛÔ˜ (Î·È ¿ÏϘ ·ÈÌÔÛÊ·ÈÚÈÓÔ¿ıÂȘ) ñ ª·ÎÚÔ¯ÚfiÓÈ· Ï‹„Ë ·ÛÈÚ›Ó˘ ·fi ·È‰È¿ (.¯. ÓfiÛÔ˜ Kawasaki) ÁÈ· Ó· ÂÏ·ÙÙˆı› Ô Î›Ó‰˘ÓÔ˜ ÂÌÊ¿ÓÈÛ˘ Û. Reye ÌÂÙ¿ ·fi ÁÚ›Ë ñ ™·Î¯·Ú҉˘ ‰È·‚‹Ù˘ ‹ ¿ÏÏÔ ¯ÚfiÓÈÔ ÌÂÙ·‚ÔÏÈÎfi ÓfiÛËÌ· ñ ÃÚfiÓÈ· ÓÂÊÚÔ¿ıÂÈ· ñ ∫ÏÂÈÛÙÔ› ÏËı˘ÛÌÔ›* ñ ∂·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ñ ∂·ÁÁÂÏ̷ٛ˜ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ԢÏÂÚÈο** ñ ÕÙÔÌ· ËÏÈΛ·˜ 60 ÂÙÒÓ Î·È ¿Óˆ * ¶ÚÔÛˆÈÎfi Î·È ÂÛˆÙÂÚÈÎÔ› ÛÔ˘‰·ÛÙ¤˜ Á˘ÌÓ·Û›ˆÓ Ï˘Î›ˆÓ, ÛÙÚ·ÙȈÙÈÎÒÓ Î·È ·ÛÙ˘ÓÔÌÈÎÒÓ Û¯ÔÏÒÓ, ÂȉÈÎÒÓ Û¯ÔÏ›ˆÓ ‹ Û¯ÔÏÒÓ, ÙÚfiÊÈÌÔÈ Î·È ÚÔÛˆÈÎfi È‰Ú˘Ì¿ÙˆÓ Î.¿. ** √ Èfi˜ Ù˘ Áڛ˘ ÙˆÓ Ô˘ÏÂÚÈÎÒÓ Î·ÓÔÓÈο ‰ÂÓ ÚÔηÏ› ÓfiÛËÛË ÛÙÔÓ ¿ÓıÚˆÔ. ∂›Ó·È ‰˘Ó·ÙfiÓ fï˜, Û ÂÚ›ÙˆÛË Û˘ÏÏԛ̈͢ Ì ÙÔÓ Èfi Ù˘ Áڛ˘ ÙˆÓ ·ÓıÚÒˆÓ Ó· ÚÔ·„ÂÈ ÌÂÙ·ÏÏ·Á̤ÓÔ˜ Èfi˜ Ô˘ Ó· ÚÔÛ‚¿ÏÏÂÈ Î·È ÙÔÓ ¿ÓıÚˆÔ. °È· ÙÔÓ ÏfiÁÔ ·˘Ùfi, Û˘ÓÈÛÙ¿Ù·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ·ÙfiÌˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ԢÏÂÚÈο. ¶·È‰È·ÙÚÈ΋ 2006;69:78-82
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·80
80
°¤ÓÓËÛË
∏ÏÈΛ· ∂Ì‚fiÏÈÔ
∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ
Hep B1
1 ÌËÓfi˜
2 ÌËÓÒÓ
4 ÌËÓÒÓ
6 ÌËÓÒÓ
Hep B2 (1-2 ‰fiÛÂȘ)
12 ÌËÓÒÓ
15 ÌËÓÒÓ
18 ÌËÓÒÓ
24 ÌËÓÒÓ
4-6 ÂÙÒÓ
11-12 ÂÙÒÓ
13-18 ÂÙÒÓ
Hep B
∏·Ù›Ùȉ·˜ µ (∏ep µ)
¢ÈÊıÂÚ›Ùȉ·˜, ∆ÂÙ¿ÓÔ˘, ∫ÔηÙË (D∆aP)4
Hep B
Hep B
DTaP
DTaP
¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ IPV(IPV)6
IPV
IPV
AÈÌfiÊÈÏÔ˘ Ù‡Ô˘ µ7
Hib
Hib
MËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ C (MCC)8
MCC
MCC
¶Ó¢ÌÔÓÈfiÎÔÎÎÔ˘ (PCV)9
PCV
PCV
Hep B DTaP
Hep B (fiϘ ÔÈ ‰fiÛÂȘ) DTaP
DTaP
IPV Hib
∆d5 (1 ‰fiÛË/10ÂÙ›·)
IPV
Hib MCC PCV (PPV)10
PCV
πÏ·Ú¿˜, ¶·ÚˆÙ›Ùȉ·˜, ∂Ú˘ıÚ¿˜ (MMR)11
MMR
AÓÂÌ¢ÏÔÁÈ¿˜ (Var)12
Var
º˘Ì·Ù›ˆÛ˘ (BCG)13
Mantoux
MMR Var Var (1 ‰fiÛË) (2 ‰fiÛÂȘ) Mantoux13·
Mantoux13‚
BCG ∏·Ù›Ùȉ·˜ A (Hep A)14 °Ú›Ë˜ (πNFL)15
Hep A (2 ‰fiÛÂȘ) π¡FL (ÂÙËÛ›ˆ˜)
∂ÈÎfiÓ· 1. ÃÚÔÓԉȿÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. -------- ∆· ÂÌ‚fiÏÈ· οو ·fi ÙË ‰È·ÎÂÎÔÌ̤ÓË ÁÚ·ÌÌ‹ Û˘ÓÈÛÙÒÓÙ·È ÁÈ· ÂÈÏÂÎÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi (‚Ϥ ÂÂÍËÁ‹ÛÂȘ Ù˘ ∂ÈÎfiÓ·˜ 1) ∂‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ™ÙËÓ ·Ú¤ÓıÂÛË ·Ó·ÁÚ¿ÊÔÓÙ·È ÔÈ ‰fiÛÂȘ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ô˘ Á›ÓÔÓÙ·È Û’ ·˘Ùfi ÙÔ Â‡ÚÔ˜ ËÏÈÎÈÒÓ, fiÙ·Ó Â›Ó·È ÂÚÈÛÛfiÙÂÚ˜ ·fi Ì›·. ∆Ô Â‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌÔÓÔ‰‡Ó·Ì· ‹ ÔÏ˘‰‡Ó·Ì· (Û˘Ó‰˘·Ṳ̂ӷ) ÂÌ‚fiÏÈ· ‹/Î·È Û˘Ó‰˘·ÛÌfi˜ ÌÔÓÔ‰‡Ó·ÌˆÓ-Û˘Ó‰˘·Ṳ̂ӈÓ. ∂‡ÚÔ˜ ËÏÈÎÈÒÓ ‰ÈÂÓ¤ÚÁÂÈ·˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ fiÙ·Ó ·˘Ùfi˜ ‰ÂÓ ¤¯ÂÈ ÚÔËÁËı› ηٿ ÙÔ Û˘ÓÈÛÙÒÌÂÓÔ Û¯‹Ì· ˆ˜ ÚÔ˜ ÙËÓ ËÏÈΛ· Î·È ÙȘ ‰fiÛÂȘ (‚Ϥ ÂÂÍËÁ‹ÛÂȘ ¶ÈÓ¿ÎˆÓ 5 Î·È 6).
∂ÂÍËÁ‹ÛÂȘ ÛÙËÓ ∂ÈÎfiÓ· 1 1. HepB = ¡ÂÎÚfi ·Ó·Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ µ. ∏ 1Ë ‰fiÛË ÙÔ‡ HepB ¯ÔÚËÁÂ›Ù·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË ÌfiÓÔÓ fiÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊÔÚ¤·˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ (HBsAg) ‹ fiÙ·Ó Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ÊÔÚ¤·˜ ‹ fi¯È. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹, ·Ó·ÁηÛÙÈο Ë 1Ë ‰fiÛË ÙÔ˘ HepB ¯ÔÚËÁÂ›Ù·È ˆ˜ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ. 2. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ Ë 1Ë ‰fiÛË ¯ÔÚËÁÂ›Ù·È ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÓÔÏÈο 4 ‰fiÛÂȘ ·ÓÙ› 3 ‰fiÛÂȘ (Ë 2Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 1Ô˘ Ì‹Ó· Î·È Ë 3Ë ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ 2Ô˘ Ì‹Ó·). ∆Ô ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ 1˘ Î·È 2˘ ηıÒ˜ Î·È 2˘ Î·È 3˘ ‰fiÛ˘ Â›Ó·È 4 ‚‰ÔÌ¿‰Â˜. ∆Ô ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· ÌÂٷ͇ ÚÔÙÂÏÂ˘Ù·›·˜ (3˘) Î·È ÙÂÏÂ˘Ù·›·˜ (4˘) ‰fiÛ˘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Â›Ó·È 8-16 ‚‰ÔÌ¿‰Â˜ Î·È ‰ÂÓ ¯ÔÚËÁÂ›Ù·È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 24 ‚‰ÔÌ¿‰ˆÓ (6 ÌËÓÒÓ). ¶ÚÔÛÔ¯‹! ™Â ÂÚ›ÙˆÛË Ô˘ ÙÔ ÂÌ‚fiÏÈÔ Ù˘ ∏·Ù›ÙȉԘ µ ¯ÔÚËÁËı› ˆ˜ Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ, Ô ÁÈ·ÙÚfi˜ Ú¤ÂÈ Ó· ÁÓˆÚ›˙ÂÈ fiÙÈ Ù· Û˘Ó‰˘·Ṳ̂ӷ ÂÌ‚fiÏÈ· ‰ÂÓ ¯ÔÚËÁÔ‡ÓÙ·È ÚÈÓ ·fi ÙËÓ 6Ë Â‚‰ÔÌ¿‰· Ù˘ ˙ˆ‹˜. ∂Ô̤ӈ˜, ÙÔ ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· Ô˘ ÌÂÛÔÏ·‚› ·fi ÙË Á¤ÓÓËÛË, Ô˘ ¯ÔÚËÁÂ›Ù·È ÙÔ ÌÔÓÔ‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Ù˘ ∏·Ù›Ùȉ·˜ µ, Â›Ó·È 6 ‚‰ÔÌ¿‰Â˜ ·ÓÙ› 1 Ì‹Ó·˜. ¶·Ú¿ÏÏËÏ· Ì ÙËÓ 1Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, Û fiÏ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ ÊÔÚ¤ˆÓ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ Î·È Ì¤Û· ÛÙȘ ÚÒÙ˜ 12 ÒÚ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË, ¯ÔÚËÁÔ‡ÓÙ·È 0,5 ml ˘ÂÚ¿ÓÔÛ˘ ·ÓÔÛÔÛÊ·ÈÚ›Ó˘ ÁÈ· Ë·Ù›Ùȉ· µ. ∏ ¤ÓÂÛË Á›ÓÂÙ·È Û ‰È·ÊÔÚÂÙÈÎfi ̤ÚÔ˜ ·’ ·˘Ùfi Ô˘ ¤ÁÈÓ (‹ ı· Á›ÓÂÈ) ÙÔ ÂÌ‚fiÏÈÔ. ŸÏ· Ù· ·È‰È¿ Ô˘ ÁÂÓÓ‹ıËÎ·Ó ·fi ÌËÙ¤Ú˜ ÊÔÚ›˜ Î·È ‹Ú·Ó ÙÔ ÂÌ‚fiÏÈÔ Î·È ÙËÓ ˘ÂÚ¿ÓÔÛË ·ÓÔÛÔÛÊ·ÈÚ›ÓË Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ÁÈ· ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ (HBsAg) Î·È ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈ-HBs) ÛÙËÓ ËÏÈΛ· ÙˆÓ 9 ¤ˆ˜ 15 ÌËÓÒÓ. ŸÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ¿ÁÓˆÛÙÔ ·Ó Â›Ó·È ‹ fi¯È ÊÔÚ¤·˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ·ÓÙÈÁfiÓÔ˘ ηٿ ÙÔÓ ÙÔÎÂÙfi Î·È ÛÙË Û˘Ó¤¯ÂÈ· ·Ô‰ÂȯÙ› fiÙÈ ‰ÂÓ Â›Ó·È, ·fi ÙË 2Ë ‰fiÛË Î·È ¤Ú· ·ÎÔÏÔ˘ıÂ›Ù·È ÙÔ Û¯‹Ì· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ÈÛ¯‡ÂÈ ÁÈ· Ù· ÓÂÔÁÓ¿ ÌËÙ¤ÚˆÓ Ô˘ ‰ÂÓ Â›Ó·È ÊÔÚ›˜ ÙÔ˘ HbsAg, ‰ËÏ·‰‹ ·ÁÓÔÂ›Ù·È Ë 1Ë ‰fiÛË. 3. ŸÙ·Ó Ë ÌËÙ¤Ú· Â›Ó·È ·ÚÓËÙÈ΋ ÁÈ· ÂÈÊ·ÓÂÈ·Îfi ·ÓÙÈÁfiÓÔ, Ô ‚·ÛÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÚÈÏ·Ì‚¿ÓÂÈ 3 ‰fiÛÂȘ (‰‡Ô ·Ú¯ÈΤ˜ Ì ÌÂÛԉȿÛÙËÌ· 6-8 ‚‰ÔÌ¿‰ˆÓ Î·È ÌÈ· ÙÚ›ÙË Û ËÏÈΛ· 6-18 ÌËÓÒÓ Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· ·fi ÙË 2Ë ‰fiÛË 8-16 ‚‰ÔÌ¿‰Â˜ Î·È fi¯È ÓˆÚ›ÙÂÚ· ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÌËÓÒÓ). ¶·È‰È·ÙÚÈ΋ 2006;69:78-82
Pediatr Mar-Apr 06
18-04-06
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81
∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ∂Ì‚ÔÏÈ·ÛÌÒÓ
4. DTaP= ¡ÂÎÚfi ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘, ÎÔηÙË Ô˘ ÂÚȤ¯ÂÈ Ù· ÙÔÍÔÂȉ‹ (‹ ·Ó·ÙÔ͛Ә ‰ËÏ. ·ÙÔÍÈΤ˜ ÙÔ͛Ә) ÙÔ˘ ÎÔÚ˘ÓÔ‚·ÎÙËÚȉ›Ô˘ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÙÔ˘ ÎψÛÙËÚȉ›Ô˘ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È ÌfiÓÔ ·ÓÙÈÁfiÓ· Ù˘ µ. pertussis (fi¯È ÔÏfiÎÏËÚÔ ÙÔÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌfi ÓÂÎÚfi, fiˆ˜ Ù· ·Ï·ÈfiÙÂÚ· “ÔÏÔ΢ÙÙ·ÚÈο” ÂÌ‚fiÏÈ·) ÁÈ’ ·˘Ùfi Î·È Î·ÏÂ›Ù·È “·Î˘ÙÙ·ÚÈÎfi” ηٿ ÙÔ˘ ÎÔηÙË (acellular perstussis ‹ ·P) ÂÌ‚fiÏÈÔ. 5. Td= ¡ÂÎÚfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ Ì ÌÈÎÚfiÙÂÚË ‰fiÛË ‰ÈÊıÂÚÈÙÈ΋˜ ·Ó·ÙÔ͛Ӣ. ™˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ Î·È ¿Óˆ (·Ó¿ 10ÂÙ›·) Î·È ·ÊÔ‡ ¤¯Ô˘Ó ÂÚ¿ÛÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 ¯ÚfiÓÈ· ·fi ÙËÓ ÙÂÏÂ˘Ù·›· ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ DTaP. ∆Ô ÂÌ‚fiÏÈÔ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 65 ÂÙÒÓ, fiˆ˜ ÚԂϤÂÙ·È ·fi ÙË Û¯ÂÙÈ΋ ˘ÁÂÈÔÓÔÌÈ΋ ‰È¿Ù·ÍË. 6. IPV= ∂Ó¤ÛÈÌÔ ÓÂÎÚfi ÂÓÈÛ¯˘Ì¤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜. 7. Hib= ¡ÂÎÚfi Û˘˙¢Á̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘ Ù‡Ô˘ ‚. ∂¿Ó Ë ÚˆÙ½ÓË Û‡˙¢Í˘ Â›Ó·È Ë PRP - OMP (ÚˆÙÂ˚ÓÈÎfi Û‡ÌÏÂÁÌ· Ù˘ Â͈ÙÂÚÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘) ÙfiÙÂ Ë 3Ë ·fi ÙȘ 3 ·Ú¯ÈΤ˜ ‰fiÛÂȘ ÌÔÚ› Ó· ·Ú·ÏËÊı› Î·È ÙÔ Û¯‹Ì· Ó· Â›Ó·È (2Ô˜, 4Ô˜ Î·È 12Ô˜-15Ô˜ Ì‹Ó·˜). 8. MCC= ¡ÂÎÚfi, Û˘˙¢Á̤ÓÔ, ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÌËÓÈÁÁÈÙȉfiÎÔÎÎÔ˘ ÔÚÔÔÌ¿‰·˜ C. ™˘ÓÈÛÙ¿Ù·È Ë ¤Ó·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ËÏÈΛ· 2 ÌËÓÒÓ Î·È ·ÎÔÏÔ˘ıÂ›Ù·È Û¯‹Ì· 3 ‰fiÛÂˆÓ - ÔÈ 2 ÚÒÙ˜ ‰fiÛÂȘ Ì ÌÂÛԉȿÛÙËÌ· 2 ÌËÓÒÓ Î·È Â·Ó·ÏËÙÈ΋ ‰fiÛË Û ËÏÈΛ· 15-18 ÌËÓÒÓ. ™Â ÂÚ›ÙˆÛË ¤Ó·Ú͢ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û ËÏÈΛ· >12 ÌËÓÒÓ, ·ÎÔÏÔ˘ıÂ›Ù·È Û¯‹Ì· 1 ‰fiÛ˘. 9. PCV= ¡ÂÎÚfi, Û˘˙¢Á̤ÓÔ, ÔÏ˘Û·Î¯·ÚȉÈÎfi, ÂÙ·‰‡Ó·ÌÔ ÂÌ‚fiÏÈÔ Î·Ù¿ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ Ù˘ Ó¢ÌÔÓ›·˜ (Ó¢ÌÔÓÈfiÎÔÎÎÔ˘). ™˘ÓÈÛÙ¿Ù·È Û fiÏ· Ù· ·È‰È¿ ËÏÈΛ·˜ 2-23 ÌËÓÒÓ. ∏ ÙÂÏÂ˘Ù·›· ‰fiÛË (4Ë) Á›ÓÂÙ·È Û ËÏÈΛ· ≥12 ÌËÓÒÓ. ∆Ô ÂÌ‚fiÏÈÔ ÌÔÚ› Ó· Á›ÓÂÈ Î·È Û ÌÂÁ·Ï‡ÙÂÚË ËÏÈΛ· Î·È È‰È·›ÙÂÚ· Û ¿ÙÔÌ· Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (‚Ϥ ˘ÔÛËÌÂÈÒÛÂȘ 6,7 ÛÙÔ ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙËÓ ‚ÚÂÊÈ΋ ËÏÈΛ·, ¶›Ó·Î˜ 5 Î·È 6). ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË, ÔÈ Â·Ó·ÏËÙÈΤ˜ ‰fiÛÂȘ ÌÔÚ› Ó· Á›ÓÔÓÙ·È Î·È Ì ÙÔ 23‰‡Ó·ÌÔ ÔÏ˘Û·Î¯·ÚȉÈÎfi ÌË Û˘˙¢Á̤ÓÔ ÂÌ‚fiÏÈÔ (PPV). 10. PPV= ¡ÂÎÚfi, ÌË Û˘˙¢Á̤ÓÔ, ÔÏ˘Û·Î¯·ÚȉÈÎfi ÂÌ‚fiÏÈÔ (23‰‡Ó·ÌÔ) ηٿ ÙÔ˘ ÛÙÚÂÙfiÎÔÎÎÔ˘ Ù˘ Ó¢ÌÔÓ›·˜ (Ó¢ÌÔÓÈÔÎfiÎÎÔ˘). ™˘ÓÈÛÙ¿Ù·È ÁÈ· ·ӷÏËÙÈΤ˜ ‰fiÛÂȘ Û ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÛÔ‚·Ú‹ Ó¢ÌÔÓÈÔÎÔÎÎÈ΋ Ïԛ̈ÍË (¶›Ó·Î·˜ 1). 11. MMR= ∑ˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ÈÏ·Ú¿˜, ·ÚˆÙ›Ùȉ·˜, ÂÚ˘ıÚ¿˜. ÃÔÚËÁÂ›Ù·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-15 ÌËÓÒÓ. ™˘ÓÈÛÙ¿Ù·È 2Ë ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-6 ÂÙÒÓ ·ÏÏ¿ Î·È Û ÔÔÈ·‰‹ÔÙ ¿ÏÏË ËÏÈΛ· ·Ó ÁÈ· οÔÈÔ ÏfiÁÔ ·Ú·ÏËÊı› Ë ‰fiÛË ·˘Ù‹ ÛÙËÓ ÚÔÙÂÈÓfiÌÂÓË ËÏÈΛ· ÙˆÓ 4-6 ÂÙÒÓ. √ ·È‰›·ÙÚÔ˜ Ú¤ÂÈ Ó· ÂϤÁ¯ÂÈ ·Ó ¤ÁÈÓ ‹ fi¯È Ë 2Ë ‰fiÛË ÛÙËÓ Â›ÛÎÂ„Ë ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ı· Á›ÓÂÈ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÙÔ˘ Î¿Ï˘„˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ. 12. Var= ZˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜. ™˘ÓÈÛÙ¿Ù·È Û fiÏ· Ù· ·È‰È¿ ÛÙËÓ ËÏÈΛ· ÙˆÓ 12-18 ÌËÓÒÓ Û ̛· ‰fiÛË (ηٿ ÚÔÙ›ÌËÛË ÌÂÙ¿ ÙÔ 15Ô Ì‹Ó·), ·ÏÏ¿ Î·È Û ÔÔÈ·‰‹ÔÙ ¿ÏÏË ËÏÈΛ· ÂÊfiÛÔÓ ÙÔ ¿ÙÔÌÔ ‰ÂÓ ¤¯ÂÈ ÓÔÛ‹ÛÂÈ. ∂¿Ó Á›ÓÂÈ Û ËÏÈΛ· ≥12 ÂÙÒÓ ÙfiÙ ڤÂÈ Ó· Á›ÓÔ˘Ó 2 ‰fiÛÂȘ Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 48 ‚‰ÔÌ¿‰ˆÓ. 13. BCG= ∑ˆÓÙ·Ófi ÂÍ·ÛıÂÓË̤ÓÔ ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ê˘Ì·Ù›ˆÛ˘. ™‡Ìʈӷ Ì ÙȘ ÚfiÛÊ·Ù˜ Ô‰ËÁ›Â˜ Ù˘ ¢ÈÂıÓÔ‡˜ ŒÓˆÛ˘ ηٿ Ù˘ Ê˘Ì·Ù›ˆÛ˘ Î·È Ù˘ ¶·ÁÎfiÛÌÈ·˜ √ÚÁ¿ÓˆÛ˘ ÀÁ›·˜(10), Ë ¯ÒÚ· Ì·˜ ‰ÂÓ ÏËÚÔ› ÙȘ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ·ÓÙÈÊ˘Ì·ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡, Ô ÔÔ›Ô˜ ÂÍ·ÎÔÏÔ˘ı› Ó· Á›ÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ. π‰È·›ÙÂÚË ¤ÌÊ·ÛË Ú¤ÂÈ Ó· ‰Ôı› ΢ڛˆ˜ ÛÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ·Ó‹ÎÔ˘Ó ÛÙȘ ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ (¶›Ó·Î·˜ 2). ¶·Ú¿ÏÏËÏ·, Û˘ÓÈÛÙ¿Ù·È Ì·˙ÈÎfi˜ ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ‰ÂÚÌÔ·ÓÙ›‰Ú·ÛË Mantoux ÛÙȘ ËÏÈ˘ 1, 4-6 ÂÙÒÓ (ÚÈÓ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ì BCG, 13·) Î·È ÛÙ· ·ÓÂÌ‚ÔÏ›·ÛÙ· ·È‰È¿, ÛÙËÓ ËÏÈΛ· 11-12 ÂÙÒÓ (fiÙ·Ó Á›ÓÂÙ·È Ë ÂÎÙ›ÌËÛË Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÙÔ˘˜ Î¿Ï˘„˘, 13‚). 14. Hep A= ¡ÂÎÚfi (·‰Ú·ÓÔÔÈË̤ÓÔ) ÔÏÔ΢ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Ë·Ù›Ùȉ·˜ ∞. ÃÔÚËÁÂ›Ù·È Û ÔÔÈ·‰‹ÔÙ ËÏÈΛ· ¿Óˆ ÙˆÓ 2 ÂÙÒÓ Û 2 ‰fiÛÂȘ, Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 6 ÌËÓÒÓ, Û ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ë·Ù›Ùȉ· ∞ (¶›Ó·Î·˜ 3). 15. INFL= ¡ÂÎÚfi (·‰Ú·ÓÔÔÈË̤ÓÔ) ÔÏÔ΢ÙÙ·ÚÈÎfi ‹ ·Î˘ÙÙ·ÚÈÎfi (ÙÌËÌ·ÙÈÎfi) ÂÌ‚fiÏÈÔ Î·Ù¿ Ù˘ Áڛ˘ Ô˘ Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÂÙËÛ›ˆ˜, Û 1 ‰fiÛË Î·È Û ËÏÈΛ· ¿Óˆ ·fi 6 Ì‹Ó˜. ∂Ӊ›ÎÓ˘Ù·È ÌfiÓÔ ÛÙ· ·È‰È¿ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ Ó· ÓÔÛ‹ÛÔ˘Ó ÛÔ‚·Ú¿ ·fi ÁÚ›Ë (¶›Ó·Î·˜ 4). ¶·È‰È¿ οو ÙˆÓ 8 ÂÙÒÓ Ô˘ ı· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó ÁÈ· ÚÒÙË ÊÔÚ¿ ı· ¿ÚÔ˘Ó 2 ‰fiÛÂȘ ÂÌ‚ÔÏ›Ô˘ (0,25 ml <3 ÂÙÒÓ Î·È 0,5 ml ≥3 ÂÙÒÓ) Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 4 ‚‰ÔÌ¿‰ˆÓ. ∂›Û˘, Û˘ÓÈÛÙ¿Ù·È ÂÙ‹ÛÈÔ˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ ˘ÁÈÒÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ ¿Óˆ ÙˆÓ 60 ÂÙÒÓ Î·È ÙˆÓ ·ÙfiÌˆÓ Ô˘ ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘, ·ÓÂÍ·Úًو˜ ËÏÈΛ·˜. ™Â ÂÚ›ÙˆÛË ·ÏÏ·Á‹˜ ÙˆÓ ÂȉËÌÈÔÏÔÁÈÎÒÓ Û˘ÓıËÎÒÓ (.¯. ÂȉËÌ›·, ·Ó‰ËÌ›·) ÔÈ Û˘ÛÙ¿ÛÂȘ ·ÏÏ¿˙Ô˘Ó.
ŸÏ· Ù· ·È‰È¿ Ú¤ÂÈ Ó· ÂÈÛΤÙÔÓÙ·È ÙÔÓ ÁÈ·ÙÚfi ÙÔ˘˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ (Ù¤ÏÔ˜ ‰ËÌÔÙÈÎÔ‡, ¤Ó·ÚÍË ÊÔ›ÙËÛ˘ ÛÙÔ Á˘ÌÓ¿ÛÈÔ), ÒÛÙ ӷ Á›ÓÂÙ·È ¤ÏÂÁ¯Ô˜ Ù˘ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ ÙÔ˘˜ Î¿Ï˘„˘ Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÛÙËÓ ÂȉÈ΋ ÛÂÏ›‰· ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‚È‚ÏÈ·Ú›Ô˘ ˘Á›·˜.
∫¿ı ÛÔ‚·Ú‹ ·ÓÂÈı‡ÌËÙË ÂÓ¤ÚÁÂÈ· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ô˘ ÂÈÛËÌ·›ÓÂÈ Ô ÎÏÈÓÈÎfi˜ ÁÈ·ÙÚfi˜, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È ÛÙÔÓ ∂√º (Ó· Û˘ÌÏËÚÒÓÂÙ·È Ë Î›ÙÚÈÓË Î¿ÚÙ·). ™ÙÔ˘˜ ¶›Ó·Î˜ 5 Î·È 6 Û˘ÓÔ„›˙ÂÙ·È ÙÔ ¯ÚÔÓԉȿÁÚ·ÌÌ· ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· Ù· ·È‰È¿ Ô˘ ηı˘ÛÙ¤ÚËÛ·Ó Ó· ÂÌ‚ÔÏÈ·ÛÙÔ‡Ó. ¶·È‰È·ÙÚÈ΋ 2006;69:78-82
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·82
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∂ıÓÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ
¶›Ó·Î·˜ 5. ¶ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ ËÏÈΛ·˜ ̤¯ÚÈ 6 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙË Û˘ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ËÏÈΛ· ∂Ì‚fiÏÈÔ
1Ë ‰fiÛË ËÌ/Ó›·
∏·Ù›Ùȉ·˜ µ (Hep B) ¢ÈÊıÂÚ›Ùȉ·˜, ∆ÂÙ¿ÓÔ˘, ∫ÔηÙË (D∆aP) ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ IPV3 ∞ÈÌfiÊÈÏÔ˘ Ù‡Ô˘ ‚ (Hib)4 ªËÓÈÁÁÈÙȉÔÎfiÎÎÔ˘ C (MCC)5 ¶Ó¢ÌÔÓÈoÎfiÎÎÔ˘ (7‰‡Ó·ÌÔ) (PCV)6 πÏ·Ú¿˜, ¶·ÚˆÙ›Ùȉ·˜, ∂Ú˘ıÚ¿˜ (MMR) ∞ÓÂÌ¢ÏÔÁÈ¿˜ (Var)9 º˘Ì·Ù›ˆÛ˘ (BCG)10 º˘Ì·ÙÈÓ·ÓÙ›‰Ú·ÛË11 (Mantoux) ∏·Ù›Ùȉ·˜ ∞ (Hep ∞) °Ú›Ë˜ (INFL)
2Ë ‰fiÛË 3Ë ‰fiÛË 1Ë-2Ë ËÌ/Ó›· 2Ë-3Ë ËÌ/Ó›· ‰fiÛË1 ‰fiÛË1 4 ‚‰. 3 ÌËÓÒÓ 4 ‚‰. 4 ‚‰.
4Ë ‰fiÛË 3Ë-4Ë ËÌ/Ó›· ‰fiÛË1
5Ë ‰fiÛË 4Ë-5Ë ËÌ/Ó›· ‰fiÛË1
6 ÌËÓ.
6 ÌËÓ.2
4 ‚‰. 4 ‚‰. 4 ‚‰.
4 ‚‰. 4 ‚‰. 4 ‚‰.
4 ‚‰. 8 ‚‰. 8 ‚‰.
4 ‚‰.
4 ‚‰.
8 ‚‰.7
4 ‚‰.8
6 ÌËÓ. 4 ‚‰.12
¶›Ó·Î·˜ 6. ¶ÚfiÁÚ·ÌÌ· ÂÌ‚ÔÏÈ·ÛÌÒÓ ÁÈ· ·È‰È¿ ËÏÈΛ·˜ 7-18 ÂÙÒÓ Ô˘ ‰ÂÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó ÛÙËÓ Û˘ÓÈÛÙÒÌÂÓË ·fi ÙÔ ∂ıÓÈÎfi ¶ÚfiÁÚ·ÌÌ· ËÏÈΛ· ∂Ì‚fiÏÈÔ
∏·Ù›Ùȉ·˜ µ (Hep B) ¢ÈÊıÂÚ›Ùȉ·˜, ∆ÂÙ¿ÓÔ˘ (Td) ¶ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ IPV ªËÓÈÁÁÈÙȉÔÎfiÎÎÔ˘ C (MCC) πÏ·Ú¿˜, ¶·ÚˆÙ›Ùȉ·˜, ∂Ú˘ıÚ¿˜ (MMR) ∞ÓÂÌ¢ÏÔÁÈ¿˜ (Var) ∏·Ù›Ùȉ·˜ ∞ (Hep ∞) °Ú›Ë˜ (INFL)
1Ë ‰fiÛË ËÌ/Ó›·
2Ë ‰fiÛË 1Ë-2Ë ËÌ/Ó›· ‰fiÛË1
3Ë ‰fiÛË 2Ë-3Ë ËÌ/Ó›· ‰fiÛË1
4Ë ‰fiÛË 3Ë-4Ë ËÌ/Ó›· ‰fiÛË1
4 ‚‰. 4 ‚‰. 4 ‚‰.
3 ÌËÓ. 6 ÌËÓ. 4 ‚‰.
6 ÌËÓ. 6 ÌËÓ.
4 ‚‰. 4 ‚‰. 6 ÌËÓ.
ÀÔÛËÌÂÈÒÛÂȘ Î·È ÂÂÍËÁ‹ÛÂȘ ÙˆÓ ¶ÈÓ¿ÎˆÓ 5 Î·È 6 1. ÃÚÔÓÈÎfi ‰È¿ÛÙËÌ· ·fi ÙËÓ ÚÔËÁÔ‡ÌÂÓË ‰fiÛË. 2. ∏ 5Ë ‰fiÛË ÌÔÚ› Ó· ·Ú·ÏËÊı› fiÙ·Ó Ë 4Ë Á›ÓÂÈ ÌÂÙ¿ ÙÔ 4Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜. √ ÂÌ‚ÔÏÈ·ÛÌfi˜ Û˘Ó¯›˙ÂÙ·È Ì Td (µÏ¤Â ÂÂÍ‹ÁËÛË 5 ÛÙËÓ ∂ÈÎfiÓ· 1). 3. ÃÔÚËÁÔ‡ÓÙ·È 4 ‰fiÛÂȘ IPV. ∆Ô ÂÌ‚fiÏÈÔ ‰ÂÓ Û˘ÓÈÛÙ¿Ù·È ÁÈ· ¿ÙÔÌ· ËÏÈΛ·˜ ÌÂÁ·Ï‡ÙÂÚ˘ ÙˆÓ 18 ÂÙÒÓ. 4. °›ÓÂÙ·È Û 2 ‰fiÛÂȘ Û ¿ÙÔÌ· ≤12 ÌËÓÒÓ ‹ Û 1 ‰fiÛË ÛÙ· ÌÂÁ·Ï‡ÙÂÚ· ·È‰È¿. ∂¿Ó Á›ÓÂÈ Î¿Ï˘„Ë ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ì 2 ‰fiÛÂȘ Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 12 ÌËÓÒÓ ÙfiÙ Á›ÓÂÙ·È, ÌÂÙ¿ ÙÔ 1Ô ¤ÙÔ˜, Î·È Ì›· ·ӷÏËÙÈ΋ ‰fiÛË. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ ÙÔ˘ ·ÈÌfiÊÈÏÔ˘, Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ 5 ÂÙÒÓ. 5. ∂¿Ó Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Û ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 12 ÌËÓÒÓ, ¯ÔÚËÁÂ›Ù·È Ì›· ÌfiÓÔ ‰fiÛË MCC. ∂¿Ó ÔÈ ÚÒÙ˜ 2 ‰fiÛÂȘ ¤ÁÈÓ·Ó Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 12 ÌËÓÒÓ Á›ÓÂÙ·È Ì›· 3Ë ‰fiÛË. 6, 7. ∂¿Ó Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 7 ÌËÓÒÓ ¯ÔÚËÁÔ‡ÓÙ·È 4 ‰fiÛÂȘ ÙÔ˘ PCV ηٿ ÙÔ Û¯‹Ì· Ô˘ ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 1 (Ë 4Ë ‰fiÛË Ì¤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 15 ÌËÓÒÓ). ∂¿Ó Ë ¤Ó·ÚÍË Á›ÓÂÈ ÌÂٷ͇ 12Ô˘ Î·È 23Ô˘ Ì‹Ó· ¯ÔÚËÁÔ‡ÓÙ·È 2 ‰fiÛÂȘ Ì ÌÂÛԉȿÛÙËÌ· 6-8 ‚‰ÔÌ¿‰Â˜. ∂¿Ó Ë ¤Ó·ÚÍË Á›ÓÂÈ ·fi ÙÔÓ 24Ô Ì‹Ó· Î·È ÌÂÙ¿, ÛÙ· ˘ÁÈ‹ ·È‰È¿ ¯ÔÚËÁÂ›Ù·È Ì›· ÌfiÓÔ ‰fiÛË. ™Ù· ·ÓÔÛÔηٷÛÙ·Ï̤ӷ Î·È Û ·˘Ù¿ Ô˘ ·Ó‹ÎÔ˘Ó ÁÂÓÈο ÛÙȘ ÔÌ¿‰Â˜ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ó¢ÌÔÓÈÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ (¶›Ó·Î·˜ 1) ¯ÔÚËÁÔ‡ÓÙ·È 2 ‰fiÛÂȘ Ì ÌÂÛԉȿÛÙËÌ· 6-8 ‚‰ÔÌ¿‰Â˜. 8. ∏ 2Ë ‰fiÛË ÙÔ˘ MMR Û˘ÓÈÛÙ¿Ù·È Ó· Á›ÓÂÙ·È ÛÙËÓ ËÏÈΛ· ÙˆÓ 4-6 ÂÙÒÓ. ∂¿Ó fï˜, Ë ¤Ó·ÚÍË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Á›ÓÂÈ Û ·˘Ù‹ ÙËÓ ËÏÈΛ·, Ë 2Ë ‰fiÛË ÌÔÚ› Ó· Á›ÓÂÈ Û‡ÓÙÔÌ· Ì ÂÏ¿¯ÈÛÙÔ ÌÂÛԉȿÛÙËÌ· 4 ‚‰ÔÌ¿‰Â˜. 9. ŸÙ·Ó Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ·ÓÂÌ¢ÏÔÁÈ¿˜ Á›ÓÂÈ Û ËÏÈΛ· ÌÂÁ·Ï‡ÙÂÚË ÙˆÓ 12 ÂÙÒÓ Û˘ÓÈÛÙÒÓÙ·È 2 ‰fiÛÂȘ (‚Ϥ ÂÂÍ‹ÁËÛË 13 ÛÙËÓ ∂ÈÎfiÓ· 1). 10, 11. µÏ¤Â ÂÂÍ‹ÁËÛË 14 ÛÙËÓ ∂ÈÎfiÓ· 1. 12. µÏ¤Â ÂÂÍ‹ÁËÛË 16 ÛÙËÓ ∂ÈÎfiÓ· 1. ¶·È‰È·ÙÚÈ΋ 2006;69:78-82
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AÓ·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÎÔηÙË: Ù· Ó¤· ‰Â‰Ô̤ӷ °. ∆ÛfiÏ·˜
¶ÂÚ›ÏË„Ë: ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ηٷÁÚ¿ÊÂÙ·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË ÙfiÛÔ ÛÙȘ ∏.¶.∞. fiÛÔ Î·È Û ¿ÏϘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ÛÙȘ Ôԛ˜ ‰ÈÂÓÂÚÁÂ›Ù·È Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ηٿ Ù˘ ÓfiÛÔ˘ › ÛÂÈÚ¿ ÂÙÒÓ. ∫‡ÚÈ· ·ÈÙ›· Ù˘ ·‡ÍËÛ˘ ·˘Ù‹˜ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÓÔÛ›· ÙËÓ ÔÔ›· ·Ú¤¯ÂÈ ÙÔ ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚fiÏÈÔ Êı›ÓÂÈ Ì ÙÔÓ ¯ÚfiÓÔ. ∆Ô‡ÙÔ Ô‰‹ÁËÛ ÛÙË ÛÙ·‰È·Î‹ ÌÂÙ·‚ÔÏ‹ Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ Ù˘ ÓfiÛÔ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙÔ ÁÂÁÔÓfi˜ fiÙÈ, ¤ˆ˜ Û‹ÌÂÚ·, ··ÁÔÚ¢fiÙ·Ó Ë ¯Ú‹ÛË ÙÔ˘ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÌÂÙ¿ ÙÔÓ 7Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ΢ڛˆ˜ ÂÍ·ÈÙ›·˜ Ù˘ Û˘¯ÓfiÙÂÚ˘ ÂΉ‹ÏˆÛ˘ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ·˘Ù‹ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, ÔÈ Ôԛ˜ ›¯·Ó ·Ô‰Ôı› ÛÙÔ ÔÏÔ΢ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ÙÂÏÂ˘Ù·›· 15 ÂÚ›Ô˘ ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÌÂÙ·ÙfiÈÛË Ù˘ ¢·›ÛıËÙ˘ ËÏÈΛ·˜ ·fi ÙËÓ ·È‰È΋ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÂÓÒ ·Ú·Ì¤ÓÂÈ Â›ÓÔÛË Ë ÚÔ Ù˘ ÔÏÔÎÏ‹ÚˆÛ˘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‚ÚÂÊÈ΋ ËÏÈΛ· ÙˆÓ ÚÒÙˆÓ 6 ÌËÓÒÓ. ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ Â›ÓÔÛˆÓ ÏËı˘ÛÌÈ·ÎÒÓ ÔÌ¿‰ˆÓ Ô‰‹ÁËÛ ÛÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘, ‰Â‰Ô̤Ó˘ Ì¿ÏÈÛÙ· Î·È Ù˘ ÎÏÈÓÈ΋˜ Ù˘ ·Ù˘›·˜ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, Ô˘ ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· Ó· ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜ Î·È Ó· ÌÂÙ·‰›‰ÂÙ·È Â˘ÎÔÏfiÙÂÚ· ÛÙ· ‚Ú¤ÊË. ∆· ·Ú·¿Óˆ, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ·ÛÊ¿ÏÂÈ· ÙÔ˘ ·Î˘ÙÙ·ÚÈÎÔ‡ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘, Ô‰‹ÁËÛ·Ó ÛÙËÓ ·Ú·Û΢‹, fiψ˜ ÚÔÛÊ¿Ùˆ˜, ‰‡Ô Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Tdap adult). ∆· ÂÌ‚fiÏÈ· ·˘Ù¿ Ê·›ÓÂÙ·È fiÙÈ Û‡ÓÙÔÌ· ı· ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó ÙÔ ¤ˆ˜ Û‹ÌÂÚ· ÂÊ·ÚÌÔ˙fiÌÂÓÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ ‰ÈÏfi ÂÌ‚fiÏÈÔ (ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜) Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td adult), ÒÛÙ ӷ ηٷÛÙ› ÂÊÈÎÙfi˜ Ô ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÂÓËÏ›ÎˆÓ Î·Ù¿ ÙÔ˘ ÎÔηÙË Ì ÛÎÔfi ÙËÓ ·ÔÊ˘Á‹ ÌÂÙ¿‰ÔÛ˘ Ù˘ Ïԛ̈͢ ·˘Ù‹˜ ÛÙȘ ϤÔÓ Â˘¿ÏˆÙ˜ ÔÌ¿‰Â˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ Î·È ÙËÓ ÙÂÏÈ΋ Ù˘ ÂÎÚ›˙ˆÛË ÛÙÔ ÎÔÓÙÈÓfi ̤ÏÏÔÓ.
∂ÈÌÂÏËÙ‹˜ ∞’ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ¶. °. ¡ÔÛÔÎÔÌ›Ԣ ¡›Î·È·˜ ¶ÂÈÚ·È¿ “ÕÁÈÔ˜ ¶·ÓÙÂÏ‹̈Ӕ AÏÏËÏÔÁÚ·Ê›·: °ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜ ¶¿ÚÓËıÔ˜ 32, ∆.∫.190 13, ™·ÚˆÓ›‰· ∞ÙÙÈ΋˜ E-mail: geotsol@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 02-09-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 14-12-2005
§¤ÍÂȘ ÎÏÂȉȿ: ∫ÔÎ·Ù˘, ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜, ·Î˘ÙÙ·ÚÈÎfi ÂÌ‚fiÏÈÔ, Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜-·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Ù‡Ô˘ ÂÓËÏ›ÎÔ˘.
Diphtheria, tetanus and acellular pertussis booster vaccination for adolescents: ∆he new data G. Tsolas
Abstract: The number of cases of pertussis continue to increase in the US and other developed countries, despite high immunization coverage rates of infants and young children. As immunity from the primary childhood immunization series wanes, adolescents and adults become susceptible to infection. A large part of the reported increase is thought to be due to increasing physician recognition of pertussis as a cause of nonspecific, persistent cough in adolescents and adults. The spread of infection by adolescents and adults may also place more vulnerable patients, including babies and young infants, at greater risk. In summer 2005, the US Food and Drug Administration (FDA) approved two new combination tetanus, diphtheria, and acellular pertussis (Tdap) vaccines for booster immunization beyond the primary childhood immunization series. These products are intended to replace the current tetanus-diphtheria (Td) booster given at 11-12 years of age. This new Tdap product provides significant increases in pertussis antibody titers and appears to be well tolerated. It has the potential to provide considerable benefit, both in reducing the frequency of pertussis in adolescents and adults and in minimizing the spread of infection to younger high-risk patient populations.
Paediatric Clinic, “Aghios Panteleimon” General Hospital of Nikea, Piraeus, Greece Correspondence: Georgios Tsolas 32, Parnithos Str. 190 13, Saronida, Attica E-mail: geotsol@otenet.gr Date of submission: 02-09-2005 Date of approval: 14-12-2005
Key words: Pertussis, booster vaccination, acellular vaccine, combination tetanus, diphtheria, acellular pertussis vaccine.
¶·È‰È·ÙÚÈ΋ 2006;69:83-89
Pediatr Mar-Apr 06
18-04-06
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°. ∆ÛfiÏ·˜
∂ÈÛ·ÁˆÁ‹ √ ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÎÔηÙË ·ÚÔ˘ÛÈ¿˙ÂÈ ·ÍÈÔÛËÌ›ˆÙË ·‡ÍËÛË Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, ÙfiÛÔ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ ∞ÌÂÚÈ΋˜, fiÛÔ Î·È Û ¿ÏϘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜, ÛÙȘ Ôԛ˜ ÂÊ·ÚÌfi˙ÂÙ·È Ô ·ÓÙÈÎÔÎ΢ÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ‚ÚÂÊÒÓ Î·È ÙˆÓ ÓË›ˆÓ Â‰Ò Î·È ·ÚÎÂÙ¤˜ ‰ÂηÂٛ˜. ∂ȉÈÎfiÙÂÚ· ÛÙȘ ∏.¶.∞, ÙÔ ¤ÙÔ˜ 2004, ‰ËÏÒıËÎ·Ó ÛÙÔ ∫¤ÓÙÚÔ ∂ϤÁ¯Ô˘ Î·È ¶ÚfiÏ˄˘ ¡ÔÛËÌ¿ÙˆÓ (CDC) 18.957 ÂÚÈÙÒÛÂȘ ÎÔηÙË, ·fi ÙȘ Ôԛ˜ ÔÈ 5.000 ·ÊÔÚÔ‡Û·Ó Û ÂÓËÏ›ÎÔ˘˜ (1-5). √ ·ÚÈıÌfi˜ ·˘Ùfi˜, Èı·Ófiٷٷ, ˘ÔÂÎÙÈÌ¿ ÙËÓ Ú·ÁÌ·ÙÈ΋ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÎÔηÙË, ‰Â‰Ô̤Ó˘ Ù˘ ÎÏÈÓÈ΋˜ ·Ù˘›·˜ Ù˘ Ïԛ̈͢ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Ì ·ÔÙ¤ÏÂÛÌ· ÔÏϤ˜ ÂÚÈÙÒÛÂȘ Ó· ÌË ‰È·ÁÈÁÓÒÛÎÔÓÙ·È Î·È Ó· ÌË ‰ËÏÒÓÔÓÙ·È. ∞ÓÙ›ıÂÙ· ÛÙËÓ ∂˘ÚÒË, Ô ·ÚÈıÌfi˜ ÙˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ· ·Ú·Ì¤ÓÂÈ È‰È·›ÙÂÚ· ˘„ËÏfi˜ Î·È ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ‰¤Î· ¯ÚfiÓÈ· ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ (6). ∂Âȉ‹ Ë ·ÓÔÛ›· ÙËÓ ÔÔ›· ·Ú¤¯ÂÈ ÙÔ ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚fiÏÈÔ ÙÔ ÔÔ›Ô ‰ÈÂÓÂÚÁÂ›Ù·È ÛÙË ‚ÚÂÊÈ΋ Î·È ÓËȷ΋ ËÏÈΛ·, Êı›ÓÂÈ Ì ÙÔÓ ¯ÚfiÓÔ Î·È, ¤ˆ˜ Û‹ÌÂÚ· ÙÔ˘Ï¿¯ÈÛÙÔÓ, ··ÁÔÚ‡ÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Î·È È‰È·›ÙÂÚ· ÙÔ˘ ÔÏÔ΢ÙÙ·ÚÈÎÔ‡ ÌÂÙ¿ ÙÔÓ 7Ô ¯ÚfiÓÔ Ù˘ ˙ˆ‹˜, ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë Ê˘ÛÈ΋ ÓfiÛËÛË ·fi ÎÔηÙË ‰ÂÓ ÚÔÛʤÚÂÈ ÈÛfi‚È· ·ÓÔÛ›·, Ë ÂȉËÌÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ¤¯ÂÈ ÌÂÙ·‚ÏËı› Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ÙÂÏÂ˘Ù·›· 15 ÂÚ›Ô˘ ¯ÚfiÓÈ· ·Ú·ÙËÚ‹ıËΠÌÂÙ·ÙfiÈÛË Ù˘ ¢·›ÛıËÙ˘ ËÏÈΛ·˜ ·fi ÙËÓ ·È‰È΋ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹, ÂÓÒ ·Ú·Ì¤ÓÂÈ Â›ÓÔÛË Ë ÓÂÔÁÓÈ΋ Î·È Ë ÚÔ Ù˘ ÔÏÔÎÏ‹ÚˆÛ˘ ÙÔ˘ ‚·ÛÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ‚ÚÂÊÈ΋ ËÏÈΛ· ÙˆÓ ÚÒÙˆÓ 6 ÌËÓÒÓ (7-10). ∏ ‰È·Ù‹ÚËÛË ÙˆÓ ‰‡Ô ·˘ÙÒÓ Â›ÓÔÛˆÓ ËÏÈÎÈ·ÎÒÓ ÔÌ¿‰ˆÓ ÛÂ Û˘Ó‰˘·ÛÌfi Î·È Ì ÙËÓ Â˘ÎÔÏ›· ÌÂÙ¿‰ÔÛ˘ Ù˘ ÓfiÛÔ˘ ·fi ÙÔ˘˜ ηٿ ηÓfiÓ· ·Ù‡ˆ˜ ¿Û¯ÔÓÙ˜ ÂÓËÏ›ÎÔ˘˜ ÛÙ· ÓÂÔÁ¤ÓÓËÙ· Î·È ÌÈÎÚ¿ ‚Ú¤ÊË ·ÔÙÂÏ› ÙË ‚·ÛÈ΋, fi¯È fï˜ Î·È ÙË ÌÔÓ·‰È΋ ·ÈÙ›· Ù˘ ÂÎ Ó¤Ô˘ ·‡ÍËÛ˘ Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ (11). ŒÙÛÈ, Ê·›ÓÂÙ·È fiÙÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÚfiÛÊ·ÙË ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË ¤¯ÂÈ ·›ÍÂÈ Ë Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ È·ÙÚÒÓ Ó· ˘ÔÙ‡ÔÓÙ·È ÙË Ïԛ̈ÍË, ·Ú¿ ÙËÓ ¿Ù˘Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, Û ·ÓÙ›ıÂÛË Ì fi,ÙÈ Û˘Ó¤‚·ÈÓ ηٿ ÙÔ ÚfiÛÊ·ÙÔ ·ÚÂÏıfiÓ, ηٿ ÙÔ ÔÔ›Ô Ë ¶·È‰È·ÙÚÈ΋ 2006;69:83-89
ıÂÒÚËÛË ÙˆÓ ÂÚÈÛÛÔÙ¤ÚˆÓ È·ÙÚÒÓ ·ıÔÏfiÁˆÓ fiÙÈ Ô ÎÔÎ·Ù˘ ·ÔÙÂÏ› “·È‰È΋ ·Ûı¤ÓÂÈ·” Ô‰ËÁÔ‡Û Û ÛËÌ·ÓÙÈ΋ ˘Ô‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙȘ ËÏÈ˘ ¤Ú·Ó Ù˘ ·È‰È΋˜, ÛÙȘ Ôԛ˜ Ô ¿Ù˘Ô˜ ·Ú·ÙÂٷ̤ÓÔ˜ ‚‹¯·˜ ·Ô‰È‰fiÙ·Ó Î·Ù¿ ηÓfiÓ· Û ‚ÚÔÁ¯›Ùȉ·, ÈÁÌÔÚ›Ùȉ· ‹ ¿ÛıÌ·. ™ÙËÓ Î·Ï‡ÙÂÚË ‰È¿ÁÓˆÛË Ì ·ÎfiÏÔ˘ıÔ ÙËÓ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ Ïԛ̈͢ Û˘Ó¤‚·Ï ›Û˘ Î·È Ë ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÙÔ˘ ÎÔηÙË Ì ÙË ¯Ú‹ÛË Ù˘ ·ÓÙ›‰Ú·Û˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ (PCR). ∏ ÌÂÙ·‚ÔÏ‹ ·˘Ù‹ Ù˘ ÂȉËÌÈÔÏÔÁ›·˜ ÙÔ˘ ÎÔηÙË ÂÌÂÚȤ¯ÂÈ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· Ù· ÓÂÔÁÓ¿ Î·È Ù· ÌÈÎÚ¿ ‚Ú¤ÊË ÛÙ· ÔÔ›· Ë ÎÏÈÓÈ΋ ÚÔ‚ÔÏ‹ Ù˘ Ïԛ̈͢ Â›Ó·È ıÔÚ˘‚҉˘ Î·È Ë Èı·ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ÂÈÏÔÎÒÓ ·fi ÙÔ ·Ó·Ó¢ÛÙÈÎfi Î·È ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ· ȉȷ›ÙÂÚ· ·˘ÍË̤ÓË. ∞ÎfiÌË Ì¿ÏÈÛÙ· Î·È ÛÙȘ ÌÂÁ¿Ï˜ ËÏÈ˘, ÂÓ‰¤¯ÂÙ·È Ô ÎÔÎ·Ù˘ Ó· ÚÔ‚¿ÏÂÈ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ Ì ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Î·È ÂÈÏÔΤ˜ (9,10). ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 1,4-7,5% ÙˆÓ ÂÊ‹‚ˆÓ Î·È 3,5-5,7% ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ÎÔηÙË, ¯Ú‹˙Ô˘Ó ÓÔÛËÏ›·˜ (9,10). ∂Í¿ÏÏÔ˘, Û ÌÂϤÙË ÙÔ˘ 2004, ÔÈ Bisgard Î·È Û˘Ó ‰È·›ÛÙˆÛ·Ó fiÙÈ ÛÙÔ 75% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÎÔηÙË Û ‚Ú¤ÊË, Ë ËÁ‹ ÌÂÙ¿‰ÔÛ˘ ‹Ù·Ó ÂÓ‹ÏÈÎÔ ¿ÙÔÌÔ, Û˘Ó‹ıˆ˜ ÔÈ ÁÔÓ›˜, Ô ·Ô‡˜ ‹ Ë ÁÈ·ÁÈ¿ (12). ¶ÚÔÎÂÈ̤ÓÔ˘, ÏÔÈfiÓ, Ó· ·ÓÙÈÌÂÙˆÈÛı› ÔÚÈÛÙÈο ÙÔ Úfi‚ÏËÌ· ·˘Ùfi, ηٿ ÙÔ ‰›ÌËÓÔ ª·˝Ô˘-πÔ˘Ó›Ô˘ ÙÔ˘ 2005, Ë ∂ÈÙÚÔ‹ ∆ÚÔÊ›ÌˆÓ Î·È º·ÚÌ¿ÎˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ Ù˘ ∞ÌÂÚÈ΋˜ (Food and Drug AdministrationFDA), ÂÓ¤ÎÚÈÓ ‰È·‰Ô¯Èο ÙË ¯Ú‹ÛË ‰‡Ô Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË (Tdap) ÁÈ· ÙÔÓ ·Ó·ÌÓËÛÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËϛΈÓ. ∆· ‰‡Ô ·˘Ù¿ Ó¤· ÂÌ‚fiÏÈ· ÚÔÔÚ›˙ÔÓÙ·È Ó· ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó ÙÔ ·fi ÂÙÒÓ ÂÊ·ÚÌÔ˙fiÌÂÓÔ ÛÙËÓ ËÏÈΛ· ÙˆÓ 11-12 ÂÙÒÓ Î·È ·ÎÔÏÔ‡ıˆ˜ ·Ó¿ ‰ÂηÂÙ›·, ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td), ÁÓˆÛÙfi ÛÙË ¯ÒÚ· Ì·˜ Ì ÙËÓ ÔÓÔÌ·Û›· D.T.VAX adult (13). ∆· ‰‡Ô Ó¤· ÂÌ‚fiÏÈ·, Ù· ÔÔ›· ÌfiÏȘ ·Ú·Û΢¿ÛıËÎ·Ó ÛÙȘ ∏.¶.∞., Â›Ó·È ÙÔ Boostrix Ù˘ GlaxoSmithKline, ÙÔ ÔÔ›Ô ¤Ï·‚ ÙË Û¯ÂÙÈ΋ ¿‰ÂÈ· ÛÙȘ 3-5-2005 ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ·ÙfiÌˆÓ ËÏÈΛ·˜ 10-18 ÂÙÒÓ (14,15) Î·È ÙÔ Adacel Ù˘ Sanofi Pasteur, ÙÔ ÔÔ›Ô ¤Ï·‚ ¿‰ÂÈ· ΢ÎÏÔÊÔÚ›·˜ ·fi ÙÔ FDA ÛÙȘ 10-62005, ÚÔÎÂÈ̤ÓÔ˘ Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ·ÙfiÌˆÓ ËÏÈΛ·˜ 11-64 ÂÙÒÓ (16).
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·85
85
∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÔ˘ ÎÔηÙË
™˘ÛÙ·ÙÈο ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ∆· ‰‡Ô Ó¤· ÂÌ‚fiÏÈ· ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÈÎÚ¤˜ ‰È·ÊÔÚ¤˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈÁÔÓÈ΋ ÙÔ˘˜ Û‡ÛÙ·ÛË. ™ÙÔÓ ¶›Ó·Î· 1 ·Ó·ÁÚ¿ÊÂÙ·È Ë ÂÚÈÂÎÙÈÎfiÙËÙ¿ ÙÔ˘˜ Û ÙÔÍ›ÓË ÙÔ˘ ÎÔηÙË (pertussis toxoidPT), ÓËÌ·ÙÔÂȉ‹ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË (filamentous hemagglutinin-FHA), ÂÚÙ·ÎÙ›ÓË (pertactinPRN), ‰ÈÊıÂÚÈÙÈ΋ ÙÔÍ›ÓË (diphtheria toxoid-D), ÙÂÙ·ÓÈ΋ ÙÔÍ›ÓË (tetanus toxoid-T) Î·È ¿ÏÏ· ·ÓÙÈÁÔÓÈο ÛÙÔȯ›·, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· fimbriae 2+3 (FIM) (14-16). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ù· ·Ú·¿Óˆ ·ÓÙÈÁfiÓ· ÂÚȤ¯ÔÓÙ·È ÛÙ· ÂÌ‚fiÏÈ· ·˘Ù¿ ÛÂ Û˘ÁÎÂÓÙÚÒÛÂȘ ÌÈÎÚfiÙÂÚ˜ ·fi Ù· ·ÓÙ›ÛÙÔȯ· ÂÌ‚fiÏÈ· Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÔÓ ‚·ÛÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Ô ÔÔ›Ô˜, ˆ˜ ÁÓˆÛÙfiÓ ÔÊ›ÏÂÈ Ó· ¤¯ÂÈ ÔÏÔÎÏËÚˆı› ¤ˆ˜ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ. ™ËÌÂÈÒÓÂÙ·È, ›Û˘, fiÙÈ ·ÌÊfiÙÂÚ· Ù· ÂÌ‚fiÏÈ· ÂÚȤ¯Ô˘Ó ·ÚÁ›ÏÈÔ. ™ÙÔÓ ¶›Ó·Î· 1 ·Ó·ÁÚ¿ÊÂÙ·È ·Ó·Ï˘ÙÈο Ë Û‡ÛÙ·ÛË ÙˆÓ ‰‡Ô Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ, ÂÓÒ ÛÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È Û˘ÁÎÚÈÙÈο Ë Û‡ÛÙ·ÛË ÙÔ˘ ‹‰Ë ΢ÎÏÔÊÔÚÔ‡ÓÙÔ˜ ÛÙË ¯ÒÚ· Ì·˜ ‰ÈÏÔ‡ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (DT VAX adult) Ù˘ Aventis Pasteur MSD ηıÒ˜ Î·È ÙÔ˘ ÙÚÈÏÔ‡ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘, ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË (Infanrix) Ù˘ GlaxoSmithKline, Ì ÙÔ ÔÔ›Ô ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Ù· ‚Ú¤ÊË Î·È Ù· ·È‰È¿ ËÏÈΛ·˜ ¤ˆ˜ 6 ÂÙÒÓ.
¢Ú·ÛÙÈÎfiÙËÙ· ÙˆÓ ÂÌ‚ÔÏ›ˆÓ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î·È ÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ ∏ ‰Ú·ÛÙÈÎfiÙËÙ· ÙÔ˘ Tdap (Boostrix) ÌÂÏÂÙ‹ıËΠ·fi ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· ÂÙ·ÈÚ›· Ì ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÌÈ·˜ ÔÏ˘ÎÂÓÙÚÈ΋˜, Ù˘¯·ÈÔÔÈË̤Ó˘ ÌÂϤÙ˘ ÛÙËÓ ÔÔ›· ÂÚÈÂÏ‹ÊıËÛ·Ó 2.516 ¤ÊË‚ÔÈ, ËÏÈΛ·˜ 10-18 ÂÙÒÓ, Î·È Û˘ÁÎÚ›¶›Ó·Î·˜ 1. ™‡ÛÙ·ÛË ÙˆÓ Ó¤ˆÓ Û˘Ó‰˘·ÛÌ¤ÓˆÓ ÂÌ‚ÔÏ›ˆÓ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË ÁÈ· ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÂÊ‹‚ˆÓ Î·È ÂÓËÏ›ÎˆÓ ∞ÓÙÈÁfiÓÔ PT (mcg) FHA (mcg) PRN (mcg) FIM (mcg) D (Lf) T (Lf)
Boostrix
Adacel
8 8 2,5 0 2,5 5
2,5 5 3 5 2 5
¶›Ó·Î·˜ 2. ™‡ÛÙ·ÛË ÙÔ˘ ‰ÈÏÔ‡ ÂÌ‚ÔÏ›Ô˘ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ Î·È ÙÔ˘ ÙÚÈÏÔ‡ ‰ÈÊıÂÚ›Ùȉ·˜, ÙÂÙ¿ÓÔ˘, ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Ô˘ Á›ÓÂÙ·È Û ‚Ú¤ÊË Î·È ·È‰È¿ ¤ˆ˜ 6 ÂÙÒÓ ∞ÓÙÈÁfiÓÔ PT (mcg) D (Lf) T (Lf) PT (mcg) FHA (mcg) PRN (mcg)
DT VAX adult
Infanrix
8 2 10 _ _ _
2,5 7-25 10 25 25 8
ıËΠ̠ÙÔ ·Ú·‰ÔÛÈ·Îfi ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘-‰ÈÊıÂÚ›Ùȉ·˜ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td) (15). ¢È·ÈÛÙÒıËΠ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ Û ۯ¤ÛË Ì ٷ ÚÔ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ›‰· Ù˘ ٿ͈˜ ÙÔ˘ 94,5% ÁÈ· ÙËÓ ÙÔÍ›ÓË ÙÔ˘ ÎÔηÙË (PT), 95,1% ÁÈ· ÙË ÓËÌ·ÙÔÂȉ‹ ·ÈÌÔÛ˘ÁÎÔÏÏËÙ›ÓË (FHA) Î·È 95,4% ÁÈ· ÙËÓ ÂÚÙ·ÎÙ›ÓË (PRN). ¢ÂÓ ‰È·ÈÛÙÒıËΠη̛· ‰È·ÊÔÚ¿ ÌÂٷ͇ Tdap Î·È Td fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ÁÈ· ÙÔÓ Ù¤Ù·ÓÔ Î·È ÙË ‰ÈÊıÂÚ›Ùȉ·. ∂ȉÈÎfiÙÂÚ·, ÈηÓÔÔÈËÙÈ΋ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÔ˘ ÙÂÙ¿ÓÔ˘ ηٷÁÚ¿ÊËΠÛÙÔ 89,7% fiÛˆÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ Tdap Î·È ÛÙÔ 92,5% ÂÎÂ›ÓˆÓ Ô˘ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ Td. ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ Û¯ÂÙÈο Ì ÙË ‰ÈÊıÂÚ›Ùȉ· ‹Ù·Ó 90,6% Î·È 95,9%. ∆Ô 2004, ÔÈ Van Damme Î·È Burgess ‰ËÌÔÛ›Â˘Û·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ‰‡Ô ÌÂÏÂÙÒÓ Ô˘ ¤ÁÈÓ·Ó ÛÙÔ µ¤ÏÁÈÔ Î·È ÙËÓ ∞˘ÛÙÚ·Ï›· Î·È ·ÊÔÚÔ‡Û·Ó Û ÂÓËÏ›ÎÔ˘˜ ÔÈ ÔÔ›ÔÈ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap (17). ∆Ô 1/3 ÂÚ›Ô˘ ·fi Ù· 824 ¿ÙÔÌ· Ù· ÔÔ›· Û˘ÌÌÂÙ›¯·Ó ÛÙË ÌÂϤÙË ‰ÂÓ Â›¯Â ·ÓȯÓ‡ÛÈÌÔ Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ PT Î·È Ù˘ PRN ηٿ ÙËÓ Â›ÛÔ‰Ô ÛÙË ÌÂϤÙË. ™Ù· ÌÈÛ¿ ¿ÙÔÌ· ¯ÔÚËÁ‹ıËΠTdap (Boostrix) Î·È ÛÙ· ˘fiÏÔÈ· Td ÌÂ Ù˘¯·›Ô ÙÚfiÔ. ŒÓ·Ó Ì‹Ó· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, 98,7% ÙˆÓ ·ÙfiÌˆÓ Ù˘ ÔÌ¿‰·˜ Tdap ›¯·Ó ÂÙ‡¯ÂÈ ÚÔÛٷ٢ÙÈÎfi Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ·ÓÙÈÁfiÓˆÓ PT, FHA Î·È PRN. ∏ ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ™˘ÁÎÂÎÚÈ̤ӷ, η٤ÛÙËÛ·Ó ÔÚÔıÂÙÈÎÔ› ¤Ó·ÓÙÈ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ ÙÔ 93% fiÛˆÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap Î·È ÙÔ 93,2% fiÛˆÓ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ ‰ÈÏfi Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td). ∆· ·ÓÙ›ÛÙÔȯ· ÔÛÔÛÙ¿ ÔÚÔıÂÙÈÎfiÙËÙ·˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Ù¤Ù·ÓÔ ‹Ù·Ó 99,8% (Tdap) Î·È 99,5% (Td). ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Adacel ·ÍÈÔÏÔÁ‹ıËΠ·fi ÙËÓ ·Ú·Û΢¿ÛÙÚÈ· ÂÙ·ÈÚ›· Û ¶·È‰È·ÙÚÈ΋ 2006;69:83-89
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·86
86
°. ∆ÛfiÏ·˜
749 ¿ÙÔÌ· ËÏÈΛ·˜ 12-54 ÂÙÒÓ, Û ÙÚÂȘ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜ (16). Ÿˆ˜ ÛÙȘ ÚÔËÁÔ‡ÌÂÓ˜ ÌÂϤÙ˜, ¤ÙÛÈ Î·È ÂÓ ÚÔÎÂÈ̤ӈ, ÔÈ ·ÛıÂÓ›˜ ¯ˆÚ›ÛıËÎ·Ó ÛÂ Ù˘¯·›Â˜ ÔÌ¿‰Â˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó Ì Tdap ‹ Td. O Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ÌÂÙÚ‹ıËΠ¤Ó·Ó Ì‹Ó· ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi. ∞fi Ù· 446 ¿ÙÔÌ· ÛÙ· ÔÔ›· ¯ÔÚËÁ‹ıËΠÙÔ ÂÌ‚fiÏÈÔ Tdap, Ô Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ ‹Ù·Ó Û fiÏ· >0,1 IU/ml, ÙÔ ‰Â 84% ›¯·Ó Ù›ÙÏÔ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ >0,1 IU/ml. ∆· ›‰· ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙˆÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ÎÔηÙË ‹Ù·Ó ÂÊ¿ÌÈÏÏ· ·˘ÙÒÓ Ô˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È ÌÂÙ¿ ·fi ÙȘ ÙÚÂȘ ‰fiÛÂȘ ÙÔ˘ ‚·ÛÈÎÔ‡ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÛÙ· ‚Ú¤ÊË. ™ÙÔ Ù‡¯Ô˜ Ù˘ 22˘ πÔ˘Ó›Ô˘ 2005 ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ JAMA, ‰ËÌÔÛȇıËÎ·Ó Ù· ·ÔÙÂϤÛÌ·Ù· ÚÔÔÙÈ΋˜, Ù˘¯·ÈÔÔÈË̤Ó˘, ‰ÈÏ‹˜Ù˘ÊÏ‹˜ ÌÂϤÙ˘ ÙˆÓ Pichichero Î·È Û˘Ó, ÛÙËÓ ÔÔ›· ÂȯÂÈÚ‹ıËΠۇÁÎÚÈÛË ÌÂٷ͇ ÙÔ˘ Tdap (Adacel) Î·È ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Td (18). ™ÙË ÌÂϤÙË Û˘ÌÌÂÙ›¯·Ó 4.480 ¤ÊË‚ÔÈ Î·È ÂÓËÏ›ÎÔ˘˜ (11-64 ÂÙÒÓ) ·fi 39 ÂÚÈÔ¯¤˜ ÙˆÓ ∏.¶.∞. ∞ÌÊfiÙÂÚ· Ù· ÂÌ‚fiÏÈ· ¤Ù˘¯·Ó ÔÚÔÌÂÙ·ÙÚÔ‹ (‰ËÏ·‰‹ Û˘ÁΤÓÙÚˆÛË ·ÓÙÈÛˆÌ¿ÙˆÓ >0,1 IU/ml) Û ÔÛÔÛÙ¿ ·fi 94,1% ¤ˆ˜ 99,8% ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙË ‰ÈÊıÂÚ›Ùȉ· Î·È 99,8% ¤ˆ˜ 100% ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ÙÔÓ Ù¤Ù·ÓÔ. ™Ù· ¿ÙÔÌ· Ù· ÔÔ›· ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì ÙÔ Tdap ÂÈÙ‡¯ıËÎ·Ó Ù›ÙÏÔÈ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ ÙˆÓ ¤ÓÙ ‚·ÛÈÎÒÓ ·ÓÙÈÁfiÓˆÓ ÙÔ˘ ÎÔηÙË, ÂÊ¿ÌÈÏÏÔÈ ·˘ÙÒÓ Ô˘ ÂÈÙ˘Á¯¿ÓÔÓÙ·È Î·Ù¿ ÙÔÓ ‚·ÛÈÎfi ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi Ù˘ ‚ÚÂÊÈ΋˜ ËÏÈΛ·˜ Î·È ÔÈ ÔÔ›ÔÈ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÚÔÛٷ٢ÙÈÎÔ› ¤Ó·ÓÙÈ Ù˘ Ïԛ̈͢. ∏ Û˘¯ÓfiÙËÙ· ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. √È Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ Tdap ·Ú¤¯ÂÈ Â·Ú΋ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ¤Ó·ÓÙÈ ÙfiÛÔ ÙÔ˘ ÎÔηÙË fiÛÔ Î·È ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜ (18). ∆¤ÏÔ˜, ÔÈ Southern Î·È Û˘Ó. Û˘Ó¤ÎÚÈÓ·Ó ·ÌÊfiÙÂÚ· Ù· ÂÌ‚fiÏÈ· Tdap ·ÏÏ¿ Î·È ÙÔ Td Ì ¤Ó· ÂÈÚ·Ì·ÙÈÎfi ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜, ·Î˘ÙÙ·ÚÈÎÔ‡ ÎÔηÙË Î·È ·‰Ú·ÓÔÔÈË̤ÓÔ˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (TdapIPV) Û 323 ÂÊ‹‚Ô˘˜ ÛÙÔ ∏ӈ̤ÓÔ µ·Û›ÏÂÈÔ (19). ∆· ›‰· Ù›ÙÏˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ ÙÂÙ¿ÓÔ˘ Î·È ‰ÈÊıÂÚ›Ùȉ·˜ ‹Ù·Ó Û˘ÁÎÚ›ÛÈÌ· Î·È ÛÙȘ 4 ÔÌ¿‰Â˜ ÙˆÓ ÂÌ‚ÔÏÈ·Ûı¤ÓÙˆÓ. ™ËÌ·ÓÙÈ΋ ·‡ÍËÛË ÛÙÔÓ Ì¤ÛÔ ÁˆÌÂÙÚÈÎfi Ù›ÙÏÔ ÙˆÓ ·ÓÙÈÎÔÎ΢ÙÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰È·ÈÛÙÒıËΠÙfiÛÔ Ì ٷ ‰‡Ô Tdap ÂÌ‚fiÏÈ· fiÛÔ Î·È Ì ÙÔ ÂÈÚ·Ì·ÙÈÎfi Tdap-IPV. ¢ÂÓ ‰È·ÈÛÙÒıËΠԢ¶·È‰È·ÙÚÈ΋ 2006;69:83-89
ÛÈ·ÛÙÈ΋ ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙË Û˘¯ÓfiÙËÙ· ÂΉ‹ÏˆÛ˘ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÌÂٷ͇ ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÔÌ¿‰ˆÓ. √È Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ù· ‰‡Ô Ó¤· Tdap ÂÌ‚fiÏÈ· Â›Ó·È ÂÊ¿ÌÈÏÏ· Î·È fiÙÈ Ë ÚÔÛı‹ÎË ÙÔ˘ ·Î˘ÙÙ·ÚÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ÙÔ˘ ÎÔηÙË ÛÙÔ ‰ÈÏfi Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td) ‰ÂÓ ÂËÚ¤·Û ·ÚÓËÙÈο ÙËÓ ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË ¤Ó·ÓÙÈ ÙÔ˘ ÙÂÙ¿ÓÔ˘ Î·È Ù˘ ‰ÈÊıÂÚ›Ùȉ·˜.
∞ÓÙÂӉ›ÍÂȘ Î·È ÚÔÊ˘Ï¿ÍÂȘ ∏ ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Tdap ·ÓÙÂӉ›ÎÓ˘Ù·È Û ¿ÙÔÌ· Ì ÁÓˆÛÙ‹ ˘ÂÚ¢·ÈÛıËÛ›· Û οÔÈÔ ·fi Ù· Û˘ÛÙ·ÙÈο ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ‹ Ì ÈÛÙÔÚÈÎfi ÛÔ‚·Ú‹˜ ·ÓÙ›‰Ú·Û˘ Û ÔÔÈÔ‰‹ÔÙ ¿ÏÏÔ ·ÓÙÈÙÂÙ·ÓÈÎfi, ·ÓÙȉÈÊıÂÚÈÙȉÈÎfi, ·ÓÙÈÎÔÎ΢ÙÈÎfi ‹ ¿ÏÏÔ ÂÌ‚fiÏÈÔ Ì ·ÚfiÌÔÈ· Û‡ÓıÂÛË. ∞ÓÙÂӉ›ÎÓ˘Ù·È, ›Û˘, Ë ¯Ú‹ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Û ¿ÙÔÌ· Ì ÈÛÙÔÚÈÎfi ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜, ÂÈÏË„›·˜, ÚÔ˚Ô‡Û·˜ Ó¢ÚÔÏÔÁÈ΋˜ ÓfiÛÔ˘, ηıÒ˜ Î·È fiÙ·Ó ˘¿Ú¯ÂÈ ÈÛÙÔÚÈÎfi ÂÍÂÏÈÎÙÈ΋˜ ÂÁÎÂÊ·ÏÔ¿ıÂÈ·˜ Ë ÔÔ›· ·Ô‰fiıËΠ۠·Ï·ÈfiÙÂÚÔ ·ÓÙÈÎÔÎ΢ÙÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi (15-16). ∂Âȉ‹ ÙÔ ÒÌ· ÙÔ˘ ÊÈ·Ïȉ›Ô˘ Î·È ÛÙ· ‰‡Ô ÚÔ·Ó·ÊÂÚı¤ÓÙ· ÚÔ˚fiÓÙ· ÂÚȤ¯ÂÈ Ï¿ÛÙÈ¯Ô (latex), ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÎÏËı› ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË Û ¿ÙÔÌ· Ì ˘ÂÚ¢·ÈÛıËÛ›·. ™˘ÓÈÛٿٷÈ, ˆ˜ ÂÎ ÙÔ‡ÙÔ˘, Ó· ˘¿Ú¯ÂÈ ‰È·ı¤ÛÈÌË ÂÈÓÂÊÚ›ÓË Î·È Ô ˘fiÏÔÈÔ˜ ·Ó·Áη›Ô˜ ÂÍÔÏÈÛÌfi˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÓÙÈÌÂÙˆÈÛı› Ù˘¯fiÓ ·Ó·Ê˘Ï·ÎÙÈ΋ ·ÓÙ›‰Ú·ÛË Î·Ù¿ ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ Tdap (15-16). ∞ÎfiÌË, ‰ÂÓ Ú¤ÂÈ Ó· ÂÌ‚ÔÏÈ¿˙ÔÓÙ·È Ì Tdap ·ÛıÂÓ›˜ Ì ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ fiÛˆÓ ¿Û¯Ô˘Ó ·fi ıÚÔÌ‚Ô΢ÙÙÔÂÓ›·, ·ÈÌÔÚÚÔÊÈÏ›· ηıÒ˜ Î·È ·˘ÙÒÓ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È Û ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, ÂÎÙfi˜ ‚‚·›ˆ˜ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂÎÂ›ÓˆÓ Î·Ù¿ ÙȘ Ôԛ˜ Ù· ÔʤÏË ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Â›Ó·È Èı·Ófi Ó· ˘ÂÚÙÂÚÔ‡Ó ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÈÌÔÚÚ·Á›·˜ ηٿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡. ∆· ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ¿ÙÔÌ· ÌÔÚÔ‡Ó Ó· ÂÌ‚ÔÏÈ·ÛıÔ‡Ó, Ë ·ÓÙÈۈ̷ÙÈ΋ ·¿ÓÙËÛË fï˜, ı· Â›Ó·È Èı·Ófiٷٷ ˘Ô‰Â¤ÛÙÂÚË ÙÔ˘ ÚÔÛ‰ÔÎÒÌÂÓÔ˘. ¢ÂÓ Û˘ÓÈÛÙ¿Ù·È ÚÔ˜ ÙÔ ·ÚfiÓ Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì Tdap ÙˆÓ ÂÁ·ˆÓ Î·È ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ıËÏ¿˙Ô˘Ó, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯ÂÈ Â·ÚÎÒ˜ ÌÂÏÂÙËı› Ô‡ÙÂ Ë Èı·Ó‹ ÙÂÚ·ÙÔÁfiÓÔ˜ ‰Ú¿ÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ ηٿ ÙËÓ Î‡ËÛË, ·ÏÏ¿ Ô‡ÙÂ Î·È Ô ‚·ıÌfi˜ ¤ÎÎÚÈÛ‹˜ ÙÔ˘ ÛÙÔ ÌËÙÚÈÎfi Á¿Ï· (15,16).
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·87
87
∂Ì‚ÔÏÈ·ÛÌfi˜ ÂÊ‹‚ˆÓ ηٿ ÙÔ˘ ÎÔηÙË
∞ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ∆˘¯·ÈÔÔÈË̤ÓË ÌÂϤÙË ÂϤÁ¯Ô˘ ÙˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ÙÔ˘ Boostrix Ô˘ ÂÚȤϷ‚ 3.080 ÂÊ‹‚Ô˘˜ ÛÙȘ ∏.¶.∞. (15), ÔÈ ÌÈÛÔ› ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap Î·È ÔÈ ˘fiÏÔÈÔÈ Ì Td, η٤‰ÂÈÍ ÙËÓ ·Ô˘Û›· ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ. √È Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚı›Û˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙÔ˘ Tdap ‹Ù·Ó ‹ÈÔ˜ fiÓÔ˜ (75,3%), ÙÔÈ΋ ÂÚ˘ıÚfiÙËÙ· (22,5%) Î·È Ô›‰ËÌ· (21,1%). ∞ӷʤÚıËÎ·Ó Â›Û˘ ˘ÚÂÙfi˜ (13,5%), ÎÂÊ·Ï·ÏÁ›· (43,1%), ÎfiˆÛË (37%) Î·È Á·ÛÙÚÂÓÙÂÚÈο Û˘ÌÙÒÌ·Ù· (26%). ªÂ ÂÍ·›ÚÂÛË ÙÔÓ fiÓÔ ÛÙÔ ÛËÌÂ›Ô ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô ÔÔ›Ô˜ ‹Ù·Ó Û˘¯ÓfiÙÂÚÔ˜ Û ·˘ÙÔ‡˜ Ô˘ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Tdap, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ˘fiÏÔÈˆÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ ‹Ù·Ó ·ÚfiÌÔÈ· ÛÙȘ ‰‡Ô ÔÌ¿‰Â˜. ∞Ó¿ÏÔÁË ÌÂϤÙË Ë ÔÔ›· Û˘Ó¤ÎÚÈÓ ÙÔ Adacel Ì ÙÔ Td ÂÚȤϷ‚ 749 ÂÊ‹‚Ô˘˜ Î·È ÂÓËÏ›ÎÔ˘˜ (16). √È Û˘¯ÓfiÙÂÚ˜ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ÙÔ˘ Tdap ‹Ù·Ó Ô ÙÔÈÎfi˜ fiÓÔ˜ (88,6%), Ë ÂÚ˘ıÚfiÙËÙ· (11,8%) Î·È ÙÔ Ô›‰ËÌ· (16,7%) ÛÙÔ ÛËÌÂ›Ô Ù˘ ¤ÓÂÛ˘ Î·È ·fi ÙȘ Û˘ÛÙËÌ·ÙÈΤ˜, Ë ÎÂÊ·Ï·ÏÁ›· (38,8%), Ë ÎfiˆÛË (20-30%), Ë Ó·˘Ù›· (14,7%), Ú›ÁÔ˜ ‹ ÊÚ›ÎÈ· (12,5%), ‰È¿ÚÚÔȘ (10%), ˘ÚÂÙfi˜ (9,4%), ‰ÈfiÁΈÛË ·ÚıÚÒÛÂˆÓ (9,1%) Î·È ¤ÌÂÙÔÈ (2,4%). √È ·Ú·¿Óˆ ·ÓÂÈı‡ÌËÙ˜ ÂÓ¤ÚÁÂȘ ‹Ù·Ó Û˘ÁÎÚ›ÛÈ̘ Ì ·˘Ù¤˜ Ô˘ ‰È·ÈÛÙÒıËÎ·Ó Û fiÛÔ˘˜ ÂÌ‚ÔÏÈ¿ÛıËÎ·Ó Ì Td. ∞Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù· ‰È·ÈÛÙÒıËÎ·Ó Î·È ÛÙË ÌÂϤÙË ÙˆÓ Pichichero Î·È Û˘Ó (18) Ì ÙÔ Tdap Ó· ÚÔηÏ› Û ۯ¤ÛË Ì ÙÔ Td, Û˘¯ÓfiÙÂÚ· ÌfiÓÔ ÙÔÈÎfi fiÓÔ (Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (rate ratio) 1,10, 95% CI 1,04-1,16)) Î·È ˘ÚÂÙfi (rate ratio 1,85, 95% CI 1,13-3,02). ∞fi ÙË Û˘ÓÂÎÙ›ÌËÛË fiÏˆÓ ÙˆÓ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ Û˘ÌÂÚ·›ÓÂÙ·È fiÙÈ ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ Â›Ó·È ·ÛʷϤ˜ Ì ÙÔ ÔÛÔÛÙfi ÙˆÓ ÛÔ‚·ÚÒÓ ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ Ó· ÌËÓ ˘ÂÚ‚·›ÓÂÈ ÙÔ 2%.
™˘Û΢·Û›· – Û˘ÓÙ‹ÚËÛË – ‰ÔÛÔÏÔÁ›· – ÙÚfiÔ˜ ¯ÔÚ‹ÁËÛ˘ – ÎfiÛÙÔ˜ ∆Ô ÂÌ‚fiÏÈÔ ∆dap ΢ÎÏÔÊÔÚ› ÛÙȘ ∏.¶.∞. Ì ÙȘ ÂÌÔÚÈΤ˜ ÔÓÔ̷ۛ˜ Boostrix Î·È Adacel, Û ÊÈ·Ï›‰È· ¤ÙÔÈÌÔ˘ ‰È·Ï‡Ì·ÙÔ˜ ÙˆÓ 0,5 ml. ∏ ÂÌÂÈÚ›· ·fi Ù· ÚÔËÁÔ‡ÌÂÓ· ·Ó¿ÏÔÁ· ÂÌ‚fiÏÈ· Û˘ÓËÁÔÚ› fiÙÈ ·ÚfiÌÔÈ· ı· Â›Ó·È Ë ÌÔÚÊ‹ Ë ÔÔ›· ı· ΢ÎÏÔÊÔÚ‹ÛÂÈ Î·È ÛÙË ¯ÒÚ· Ì·˜.
∆Ô ÂÌ‚fiÏÈÔ Ú¤ÂÈ Ó· ‰È·ÙËÚÂ›Ù·È ÛÙÔ „˘ÁÂ›Ô (2-8ÆC), ÂÓÒ ··ÁÔÚ‡ÂÙ·È Ë Î·Ù¿„˘ÍË. ∆Ô ÂÌ‚fiÏÈÔ ¯ÔÚËÁÂ›Ù·È ÂÓ‰ÔÌ˘˚ÎÒ˜, ηٿ ÚÔÙ›ÌËÛË ÛÙÔÓ ‰ÂÏÙÔÂȉ‹ Ì˘ (15,16). ∆Ô Tdap ı· ‰ÈÂÓÂÚÁÂ›Ù·È ˆ˜ ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ¤Ó·ÓÙÈ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Î·È ÎÔηÙË ÛÙËÓ ËÏÈΛ· ÙˆÓ 11 ¤ˆ˜ 12 ÂÙÒÓ Î·È ·ÎÔÏÔ‡ıˆ˜ οı ‰¤Î· ¯ÚfiÓÈ·. ¶ÚԂϤÂÙ·È, Û˘ÓÂÒ˜, fiÙÈ ı· ·ÓÙÈηٷÛÙ‹ÛÂÈ ÙÔ ÂÌ‚fiÏÈÔ ÙÂÙ¿ÓÔ˘, ‰ÈÊıÂÚ›Ùȉ·˜ Ù‡Ô˘ ÂÓËÏ›ÎÔ˘ (Td) ÙÔ ÔÔ›Ô ÂÊ·ÚÌfi˙ÂÙ·È ¤ˆ˜ Û‹ÌÂÚ· Ì ÙÔ ›‰ÈÔ ·ÎÚÈ‚Ò˜ ¯ÚÔÓԉȿÁÚ·ÌÌ·. ∞Í›˙ÂÈ, Ù¤ÏÔ˜, Ó· ·Ó·ÊÂÚı› fiÙÈ ÙÔ Tdap fiˆ˜ ¿ÏψÛÙÂ Î·È ÙÔ Td, ‰ÂÓ Â›Ó·È ÂÌ‚fiÏÈ· ηٿÏÏËÏ· ÁÈ· ÙÔÓ ‚·ÛÈÎfi ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ‚ÚÂÊÒÓ Î·È ÓË›ˆÓ (15,16,20). ∆Ô ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì Tdap Ê·›ÓÂÙ·È fiÙÈ ı· Â›Ó·È ÔÏÏ·Ï¿ÛÈÔ ÙÔ˘ Td. H ÙÈÌ‹ ÛÙȘ ∏.¶.∞. ÙÔ˘ Ó¤Ô˘ ÂÌ‚ÔÏ›Ô˘ Â›Ó·È ÂÚ›Ô˘ 35 ¢ÚÒ ($ 44), fiÙ·Ó Ë ÙÈÌ‹ ÙÔ˘ Td (D.T. VAX adult) ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ÌfiÏȘ 1,5 ¢ÚÒ. ∆· ÙÂÏÂ˘Ù·›· ‰‡Ô ¯ÚfiÓÈ· ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÌÂϤÙ˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÔÈÎÔÓÔÌÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÂÓËÏ›ÎˆÓ Ì Tdap (21). ™Â ÌÂϤÙË ÙˆÓ Purdy Î·È Û˘Ó ÛÙȘ ∏.¶.∞. ‚Ú¤ıËΠfiÙÈ Ô ·Ó·ÌÓËÛÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ fiÏˆÓ ÙˆÓ ÂÊ‹‚ˆÓ (10-19 ÂÙÒÓ) Ì Tdap ·ÓÙ› ÙÔ˘ Td, ı· ·ÔÙÚ¤„ÂÈ ÙËÓ ÂΉ‹ÏˆÛË 0,4-1,8 ÂηÙÔÌÌ˘Ú›ˆÓ ÂÚÈÙÒÛÂˆÓ ÎÔηÙË Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÍÔÈÎÔÓfiÌËÛË 0,3 ¤ˆ˜ 1,8 ‰ÈÛÂηÙÔÌÌ˘Ú›ˆÓ ‰ÔÏ·Ú›ˆÓ ∏.¶.∞. Û ÌÈ· ‰ÂηÂÙ›· (22). ™Â ·ÚfiÌÔÈ· ÌÂϤÙË ÙˆÓ Iskedjian Î·È Û˘Ó ÛÙÔÓ ∫·Ó·‰¿ (23), ‚Ú¤ıËΠfiÙÈ ·Ú¿ ÙË ÌÈÎÚ‹ Û¯ÂÙÈο ·‡ÍËÛË ÙÔ˘ ÎfiÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡, Ù· ÔÈÎÔÓÔÌÈο ÔʤÏË ·fi ÙËÓ ÚfiÏË„Ë ÂÚÈÙÒÛÂˆÓ ÎÔηÙË ı· Â›Ó·È ÔÏÏ·Ï¿ÛÈ·. √È Û˘ÁÁÚ·Ê›˜ ˘ÔÏÔÁ›˙Ô˘Ó fiÙÈ Û ۇÓÔÏÔ 144.000 ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 12 ÂÙÒÓ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ Ontario, Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ·˘ÙÒÓ Ì Tdap ı· Ô‰ËÁ‹ÛÂÈ ÛÙËÓ ·ÔÙÚÔ‹ ÂΉ‹ÏˆÛ˘ 4.400 ÂÚÈÙÒÛÂˆÓ ÎÔηÙË Ì¤Û· Û ÌÈ· ‰ÂηÂÙ›· Î·È ÛÙËÓ ·ÔÊ˘Á‹ 50 ÂÈÛ·ÁˆÁÒÓ ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ™ÙÔ Ù‡¯Ô˜ ª·˝Ô˘ 2005 ÙÔ˘ Pediatric Infectious Disease Journal, ÔÈ Caro Î·È Û˘Ó ÌÂϤÙËÛ·Ó ÛÙÔ Ï·›ÛÈÔ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Global Pertussis Initiative, ÙË Û¯¤ÛË ÎfiÛÙÔ˘˜-ÔʤÏÔ˘˜ Ë ÔÔ›· ı· ÚÔ·„ÂÈ ·fi ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi ÙˆÓ ÂÊ‹‚ˆÓ ÙˆÓ ∏.¶.∞. (24). √È Û˘ÁÁÚ·Ê›˜ ηٷϋÁÔ˘Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë Î¿Ï˘„Ë Ì ÙÔ Ó¤Ô ÂÌ‚fiÏÈÔ ÙˆÓ ·ÙfiÌˆÓ ËÏÈΛ·˜ 11 ¤ˆ˜ 18 ÂÙÒÓ Û ÔÛÔÛÙfi 80%, ı· Ô‰ËÁ‹ÛÂÈ Û ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙÔ˘ ÎÔηÙË, ηıÒ˜ Î·È ¶·È‰È·ÙÚÈ΋ 2006;69:83-89
Pediatr Mar-Apr 06
18-04-06
16:42
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°. ∆ÛfiÏ·˜
ÙˆÓ ı·Ó¿ÙˆÓ Ô˘ ÔÊ›ÏÔÓÙ·È Û ·˘ÙfiÓ. ŒÙÛÈ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ı· Û˘Ì‚Ô‡Ó 68.000 ÏÈÁfiÙÂÚ· ÎÚÔ‡ÛÌ·Ù· ÎÔηÙË Î·È ı· ·ÔÊ¢¯ıÔ‡Ó 41 ÙÔ˘Ï¿¯ÈÛÙÔÓ ı¿Ó·ÙÔÈ Ì¤Û· Û ̛· ‰ÂηÂÙ›·. ∆ÔÓ πÔ‡ÏÈÔ 2005, ‰ËÌÔÛȇıËΠÛÙÔ ÂÚÈÔ‰ÈÎfi Pediatrics, Û¯ÂÙÈ΋ Ì ÙÔ ı¤Ì· ÌÂϤÙË ÙˆÓ Lee Î·È Û˘Ó, Ë ÔÔ›· ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙÔ CDC (25). √È ÂÚ¢ÓËÙ¤˜ ˘ÔÏÔÁ›˙Ô˘Ó fiÙÈ Ì ÙËÓ Î·ıȤڈÛË ÙÔ˘ ∆dap ı· ·˘ÍËı› ÌÂÓ ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Û˘ÁÎÚÈÓfiÌÂÓÔ Ì ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÙÔ˘ Td ηٿ ÙÔ˘Ï¿¯ÈÛÙÔÓ 50%, ‰È·ÈÛÙÒÓÔ˘Ó fï˜, fiÙÈ Ë Î¿Ï˘„Ë Û ÔÛÔÛÙfi 76% ÙˆÓ ÂÊ‹‚ˆÓ ËÏÈΛ·˜ 11 ÂÙÒÓ Ì ÙÔ Tdap, ı· ÚÔÏ¿‚ÂÈ 30.800 ÂÚÈÙÒÛÂȘ ÎÔηÙË. ∆Ô ˘ÔÏÔÁÈ˙fiÌÂÓÔ ÎfiÛÙÔ˜ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ·Ó¤Ú¯ÂÙ·È ÛÙÔ ÔÛfi ÙˆÓ $ 1.100 ÁÈ· οı ÂÚ›ÙˆÛË ÎÔηÙË Ô˘ ÚÔÏ·Ì‚¿ÓÂÙ·È.
™ÙÚ·ÙËÁÈΤ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ú·Ó Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ™Â ÚfiÛÊ·ÙË Û˘Ó‰ڛ·ÛË ÙÔ˘ Global Pertussis Initiative (GPI) Û˘˙ËÙ‹ıËΠÙÔ ı¤Ì· Ù˘ ηχÙÂÚ˘ ‰˘Ó·Ù‹˜ ÛÙÚ·ÙËÁÈ΋˜ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ¤Ú·Ó Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ì ÛÙfi¯Ô ÙËÓ ÂÏ¿ÙÙˆÛË Ù˘ ÂÙ‹ÛÈ·˜ ›وÛ˘ ÙÔ˘ ÎÔηÙË. √ Ì·˙ÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ ÂÓËϛΈÓ, Ô ÔÔ›Ô˜ ı· Û˘Ó¤‚·Ï ÛËÌ·ÓÙÈο ÛÙË Ì›ˆÛË Ù˘ ÓÔÛËÚfiÙËÙ·˜ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜ Î·È Ù˘ Û˘Ó·ÎfiÏÔ˘ı˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÎÔηÙË ÛÙ· ÌÈÎÚ¿ ·ÓÂÌ‚ÔÏ›·ÛÙ· ‚Ú¤ÊË, Û˘Ó·ÓÙ¿ ÛÔ‚·Ú¤˜ ‰˘ÛÎÔϛ˜ ÏfiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ÎfiÛÙÔ˘˜ ·ÏÏ¿ Î·È Ù˘ ‰˘ÛÎÔÏ›·˜ ›Ù¢Í˘ ˘„ËÏ‹˜ ÂÌ‚ÔÏÈ·ÛÙÈ΋˜ Î¿Ï˘„˘, Ë ÔÔ›· Â›Ó·È ·Ó·Áη›· ÁÈ· ÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ÂÁ¯ÂÈÚ‹Ì·ÙÔ˜. Œ¯Ô˘Ó ›Û˘ Û˘˙ËÙËı› ÙfiÛÔ Ô ÂÈÏÂÎÙÈÎfi˜ ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙˆÓ Ó¤ˆÓ ÌËÙ¤ÚˆÓ Î·È ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÙˆÓ ÓÂÔÁ¤ÓÓËÙˆÓ, fiÛÔ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÙÔ˘ ÚÔÛˆÈÎÔ‡ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ Î·È Û¯ÔÏ›ˆÓ, Ú·ÎÙÈΤ˜ fï˜ ÔÈ Ôԛ˜ ‰ÂÓ Ê·›ÓÂÙ·È fiÙÈ ı· ÂËÚ¿ÛÔ˘Ó È‰È·›ÙÂÚ· ÙË ÓÔÛËÚfiÙËÙ·. ∏ Ú·ÎÙÈ΋ ÙÔ˘ Ì·˙ÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ (11-18 ÂÙÒÓ), ·Ú¿ ÙÔÓ Î›Ó‰˘ÓÔ ÌÂٷΛÓËÛ˘ Ù˘ ̤ÁÈÛÙ˘ ›وÛ˘ Û ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ¤Ó·ÚÍË ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ‚ÚÂÊÒÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 6 ‚‰ÔÌ¿‰ˆÓ (·ÓÙ› ÙÔ˘ 2Ô˘ ‹ 3Ô˘ Ì‹Ó·), Ê·›ÓÂÙ·È, ÛÙËÓ ·ÚÔ‡Û· ÙÔ˘Ï¿¯ÈÛÙÔÓ Ê¿ÛË, fiÙÈ ·ÔÙÂÏÔ‡Ó ÙȘ ϤÔÓ ÏÔÁÈΤ˜ Ú·ÎÙÈΤ˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ Ù˘ ›وÛ˘ Ù˘ Ïԛ̈͢ Î·È Î˘Ú›ˆ˜ ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ÌÂÙ·‰ÔÛ‹˜ Ù˘ ÛÙȘ ϤÔÓ Â˘¿ÏˆÙ˜ ÔÌ¿‰Â˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ (26,27). ¶·È‰È·ÙÚÈ΋ 2006;69:83-89
™˘Ì¤Ú·ÛÌ· ∏ ™˘Ì‚Ô˘Ï¢ÙÈ΋ ∂ÈÙÚÔ‹ ∂Ì‚ÔÏÈ·ÛÌÒÓ ÙˆÓ ∏.¶.∞. (Advisory Committee on Immunization Practices) ÛÙË Û˘Ó‰ڛ·Û‹ Ù˘ ÛÙȘ 30 πÔ˘Ó›Ô˘ 2005, ·ÔÊ¿ÛÈÛ ÙËÓ Î·ıȤڈÛË ÙÔ˘ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÙˆÓ ÂÓËÏ›ÎˆÓ Ì ÙÔ Û˘Ó‰˘·Ṳ̂ÓÔ ÂÌ‚fiÏÈÔ Tdap ·ÓÙ› ÙÔ˘ ¤ˆ˜ ÙÒÚ· ÂÊ·ÚÌÔ˙fiÌÂÓÔ˘ Td. To ÂÌ‚fiÏÈÔ ·˘Ùfi, Ë ·Ú·Û΢‹ ÙÔ˘ ÔÔ›Ô˘ η٤ÛÙË ÂÊÈÎÙ‹ ÌÂÙ¿ ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ ÔÏÔ΢ÙÙ·ÚÈÎÔ‡ ·ÓÙÈÎÔÎ΢ÙÈÎÔ‡ ÂÌ‚ÔÏ›Ô˘ ·fi ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ·Î˘ÙÙ·ÚÈÎfi, Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfi, ·ÛʷϤ˜ Î·È ı· Ô‰ËÁ‹ÛÂÈ Èı·Ófiٷٷ, Û ÂÏ¿ÙÙˆÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘ ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· Î·È ÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ Î·È Û ·ÓÙ›ÛÙÔÈ¯Ô ÂÚÈÔÚÈÛÌfi Ù˘ ÌÂÙ¿‰ÔÛ‹˜ Ù˘ Û ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ΢ڛˆ˜ ÓÂÔÁÓ¿ Î·È ‚Ú¤ÊË. ∂›Ó·È Ôχ Èı·Ófi fiÙÈ ÙÔ ∆dap ı· ηıÈÂÚˆı› Û‡ÓÙÔÌ· Î·È ÛÙË ¯ÒÚ· Ì·˜, ·ÓÙÈηıÈÛÙÒÓÙ·˜ ÙÔ D.T. VAX adult. ∏ ÂÈÙ˘¯›·, fï˜, Ù˘ ÚÔÛ¿ıÂÈ·˜ ÂÚÈÔÚÈÛÌÔ‡ ÙÔ˘ ÎÔηÙË ÛÙȘ ÌÂÁ¿Ï˜ ËÏÈ˘, ··ÈÙ› ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ È·ÙÚÒÓ fiÏˆÓ ÙˆÓ ÂȉÈÎÔÙ‹ÙˆÓ Î·È fi¯È ÌfiÓÔ ÙˆÓ ·È‰È¿ÙÚˆÓ, ȉȷ›ÙÂÚ· ‰Â ÙˆÓ ·ıÔÏfiÁˆÓ ÂÓËÏ›ÎˆÓ ÛÙÔ ı¤Ì· ÙÔ˘ ·Ó·ÌÓËÛÙÈÎÔ‡ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ÙË Û˘ÓÂȉËÙÔÔ›ËÛË ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ‰È·‰Èηۛ· ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Î·È ÙÔ˘ ·ÓÂÌ‚ÔÏÈ·ÛÌÔ‡ ÙˆÓ ·ÓıÚÒˆÓ ‰ÂÓ ÙÂÏÂÈÒÓÂÈ ÛÙËÓ ËÏÈΛ· ÙˆÓ 18 ÂÙÒÓ, ÔfiÙÂ Î·È ·‡Ô˘Ó Ô˘ÛÈ·ÛÙÈο Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ·fi ÙÔÓ ·È‰›·ÙÚÔ.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Centers for Disease Control and Prevention. Notifiable diseases/ deaths in selected cities weekly information. MMWR Morb Mortal Wkly Rep 2004;53: 1213-1221. 2. Centers for Disease Control and Prevention. Pertussis United States 1997-2000. MMWR Morb Mortal Wkly Rep 2002;51:73-76. 3. Guris D, Strebel PM, Bardenheier B, Brennan M, Tachdjian R, Finch E et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 19901996. Clin Infect Dis 1999;28:1230-1237. 4. Centers for Disease Control and Prevention. Final: 2003 reports of notifiable diseases. MMWR Morb Mortal Wkly Rep 2004;53:687-696. 5. Tanaka M, Vitek CR, Pascual FB, Bisgard KM, Tate JE, Murphy TV. Trends in pertussis among infants in the United States, 1980-1999. JAMA 2003;290: 2968-2975.
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6. Celentano LP, Massari M, Paramatti D, Salmaso S, Tozzi AE; EUVAC-NET Group. Resurgence of pertussis in Europe. Pediatr Infect Dis J 2005;24(9): 761-765. 7. Rothstein E, Edwards K. Health burden of pertussis in adolescents and adults. Pediatr Infect Dis J 2005; 24 (5 Suppl):S44-S47 8. Davis JP. Clinical and economic effects of pertussis outbreaks. Pediatr Infect Dis J 2005;24 (6 Suppl): S109-S116. 9. Lee GM, Lett S, Schauer S, LeBaron C, Murphy TV, Rusinak D et al; Massachusetts Pertussis Study Group. Societal costs and morbidity of pertussis in adolescents and adults. Clin Infect Dis 2004;39: 1572-1580. 10. De Serres G, Shadmani R, Duval B, Boulianne N, Dery P, Douville Fradet M et al. Morbidity of pertussis in adolescents and adults. J Infect Dis 2000;182:174-179. 11. Schellekens J, von Konig CH, Gardner P. Pertussis sources of infection and routes of transmission in the vaccination era. Pediatr Infect Dis J 2005;24 (5 Suppl):S19-S24. 12. Bisgard KM, Pascual FB, Ehresmann KR, Miller CA, Cianfrini C, Jennings CE et al. Infant pertussis: who was the source? Pediatr Infect Dis J 2004;23:985-989. 13. Pichichero ME, Casey JR. Acellular pertussis vaccines for adolescents. Pediatr Infect Dis J 2005;24 (6 Suppl):S117-S126. 14. Chapman TM, Goa KL. Reduced-antigen combined diphtheria-tetanus-acellular pertussis vaccine (Boostrix). Drugs 2003;63:1407-1413. 15. Boostrix prescribing information. GlaxoSmith Kline, May 2005. 16. Adacel prescribing information. Sanofi Pasteur, June 2005. 17. Van Damme P, Burgess M. Immunogenicity of a combined diphtheria-tetanus-acellular pertussis vaccine in adults. Vaccine 2004;22:305-308.
18. Pichichero ME, Rennels MB, Edwards KM, Blatter MM, Marshall GS, Bologa M et al. Combined tetanus-diphtheria, and 5-component pertussis vaccine for use in adolescents and adults. JAMA 2005;293:3003-3011. 19. Southern J, Andrews N, Burrage M, Miller E. Immunogenicity and reactogenicity of combined acellular pertussis/ tetanus/ low dose diphtheria vaccines given as a booster to UK teenagers. Vaccine 2005;23:3829-3835. 20. Humiston SG, Rosenthal SL. Challenges to vaccinating adolescents: vaccine implementation issues. Pediatr Infect Dis J 2005;24 (6 Suppl):S134-S140. 21. Hay JW, Ward JI. Economic considerations for pertussis vaccination in adolescents. Pediatr Infect Dis J 2005;24 (6 Suppl):S127-S133. 22. Purdy KW, Hay JW, Botteman MF, et al. Evaluation of strategies for use of acellular pertussis vaccine in adolescents and adults: a cost-benefit analysis. Clin Infect Dis 2004;39:20-28. 23. Iskedjian M, Walker JH, Hemels ME. Economic evaluation of an extended acellular pertussis vaccine programme for adolescents in Ontario, Canada. Vaccine 2004;22:4215-4227. 24. Caro JJ, Getsios D, El-Hadi W, Payne K, O'Brien JA. Pertussis immunization of adolescents in the United States:an economic evaluation. Pediatr Infect Dis J 2005;24:S75-S82. 25. Lee GM, Lebaron C, Murphy TV, Lett S, Schauer S, Lieu TA. Pertussis in adolescents and adults: should we vaccinate? Pediatrics 2005;15:1675-1684. 26. Campins-Marti M, Cheng HK, Forsyth K, Guiso N, Halperin S, Huang LM et al; International Consensus Group on Pertussis Immunisation. Recommendations are needed for adolescent and adult pertussis immunization; rationale and strategies for consideration. Vaccine 2001;20:641-646. 27. 27. Plotkin S. The global pertussis initiative: process overview. Pediatr Infect Dis J 2005;24 (5 Suppl):S7-S9.
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∂ÎÙ›ÌËÛË ÎÈÓ‰‡ÓˆÓ Î·È Û¯Â‰È·ÛÌfi˜ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÙÙÈÎfiÓ” AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¢Ô‡ÚÔ˜ ¡˘ÌÊÒÓ 7-9 ∆.∫. 111 46, ∞ı‹Ó· E-mail: costasdouros@freemail.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-03-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-03-2006
∫. ¢Ô‡ÚÔ˜, µ. ∆Û·ÁÚ‹˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘ - ∫·Ú·ı›Ô˘
¶ÂÚ›ÏË„Ë: ∞fi ÙÔ 1988, fiÙ·Ó Ë ¶·ÁÎfiÛÌÈ· ™˘Ó¤Ï¢ÛË ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (WHO) ·ÔÊ¿ÛÈÛ ÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÈÔ‡ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ¤¯ÂÈ ÂÈÙ¢¯ı› ÛËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ fiÛÔÓ ·ÊÔÚ¿ ÛÙË ‰È·ÎÔ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡. √ WHO ¤¯ÂÈ ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÌÂÏÂÙ¿ ÙȘ ÔÏÈÙÈΤ˜ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ı· ¯ÚÂÈ·ÛÙ› Ó· ÂÊ·ÚÌÔÛÙÔ‡Ó ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ÂÎÚ›˙ˆÛ˘. ∂›Ó·È ÁÓˆÛÙfi fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ÚÔ¤Ú¯ÂÙ·È ·fi: ·) ÙË Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Î·È ‚) ÙËÓ ·Î·Ù¿ÏÏËÏË ¯Ú‹ÛË ÙˆÓ Ê˘Ï·ÛÛfiÌÂÓˆÓ ·ÔıÂÌ¿ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ. ™Â οı ̛· ·fi ÙȘ ‰‡Ô ·Ú·¿Óˆ ηÙËÁÔڛ˜ ˘¿Ú¯Ô˘Ó ÂÈ̤ÚÔ˘˜ ΛӉ˘ÓÔÈ Ô˘ Ë Ê‡ÛË ÙÔ˘˜ Â›Ó·È Ï¤ÔÓ Û·Ê‹˜, ÂÓÒ Û ÂͤÏÈÍË ‚Ú›ÛÎÔÓÙ·È ÂÚ¢ÓËÙÈΤ˜ ÚÔÛ¿ıÂȘ ÁÈ· ÙoÓ ÏËÚ¤ÛÙÂÚÔ ÔÛÔÙÈÎfi ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘˜. ∏ ·ÎÚÈ‚‹˜ ÁÓÒÛË Ù˘ ʇÛ˘ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ·˘ÙÒÓ ÙˆÓ ÎÈÓ‰‡ÓˆÓ ¤¯ÂÈ È‰È·›ÙÂÚË ·Í›· ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÂÓfi˜ Ï·ÈÛ›Ô˘ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ı· ÂÊ·ÚÌÔÛıÔ‡Ó ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË. ¶¿ÓÙˆ˜, ÙÔ ÂÓ ÏfiÁˆ Ï·›ÛÈÔ ı· Ú¤ÂÈ Ó· ıˆÚËı› ˆ˜ ¤Ó· ‰˘Ó·ÌÈÎfi ÂÚÁ·ÏÂ›Ô Ô˘ ı· ··ÈÙ› Û˘Ó¯‹ ·Ó·ÚÔÛ·ÚÌÔÁ‹ Ì ÙËÓ ÂÓۈ̿وÛË ÏËÚÔÊÔÚÈÒÓ Ô˘ ı· ÚÔ·ÙÔ˘Ó ·fi Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ù˘ ¤Ú¢ӷ˜. À¿Ú¯Ô˘Ó Ù¤ÛÛÂÚȘ ¢Ú›˜ Î·È ·ÏÏËÏÔÛ˘Û¯ÂÙÈ˙fiÌÂÓ˜ ηÙËÁÔڛ˜ ÁÈ· ÙȘ Ôԛ˜ ı· Ú¤ÂÈ Ó· ۯ‰ȷÛıÔ‡Ó ÔÏÈÙÈΤ˜: ·) Ë ¿ÌÂÛË ·Ó›¯Ó¢ÛË Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ÈÒÓ, ‚) ÙÔ Ì¤ÁÂıÔ˜ Î·È ÙÔ Â›‰Ô˜ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Î·È ÔÈ Ì˯·ÓÈÛÌÔ› ·ÓÙ›‰Ú·Û˘, Á) Ë Ê‡Ï·ÍË ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÈÒÓ Î·È ‰) Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ ÚÔ˘Ù›Ó·˜ ÁÈ· ÙËÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·. ∏ ‰È·‰Èηۛ· ÙˆÓ ÙÂÏÈÎÒÓ ·ÔÊ¿ÛÂˆÓ ·Ó·Ì¤ÓÂÙ·È Ó· ·Ú¯›ÛÂÈ ÛÙÔ ÂÁÁ‡˜ ̤ÏÏÔÓ. §¤ÍÂȘ ÎÏÂȉȿ: ¶ÔÏÈÔÌ˘ÂÏ›ÙȘ, ÂÎÚ›˙ˆÛË, ‰ËÌfiÛÈ· ˘Á›·.
Polio control after certification: evaluating the risks and planning public health policies 3rd Pediatric Clinic, University of Athens, “Attikon” General University Hospital Correspondence: Konstantinos Douros 7-9 Nymfon Str. 111 46, Athens, Greece E-mail: costasdouros@freemail.gr Date of submission: 21-03-2005 Date of approval: 22-03-2006
K. Douros, B. Tsagris, P. Nikolaidou – Karpathiou
Abstract: Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, considerable progress has been made towards interrupting the transmission of wild poliovirus globally. As the achievement and certification of polio eradication draws near, WHO is evaluating potential postcertification policies. Since the year 2000, it has been realized that the risks of paralytic poliomyelitis in the post-certification era fall into two general categories: those due to the continued use of the oral poliovirus vaccine (OPV) and those due to future improper handling of wild polioviruses. The specific risks within each category have now been defined and further research is under way in order to be quantified properly. The knowledge of nature and magnitude of these risks is of outmost importance in constructing a framework for the evolution of public health policies for the post certification era. However, this framework must be regarded as a dynamic tool, requiring regular updating as additional information on these risks becomes available. There are four broad (and interrelated) areas for which policies must be designed: detection and notification of circulating polioviruses, biocontainment, vaccine stockpiles and response mechanisms, and routine immunization against polioviruses. The process of final decisions is expected to begin at the near future. Key words: Poliomyelitis, eradication, public health.
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ŒÏÂÁ¯Ô˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË
∂ÈÛ·ÁˆÁ‹ ∆Ô 1988, Ë 41Ë ¶·ÁÎfiÛÌÈ· ™˘Ó¤Ï¢ÛË ÙÔ˘ ¶·ÁÎfiÛÌÈÔ˘ √ÚÁ·ÓÈÛÌÔ‡ ÀÁ›·˜ (WHO) ·ÔÊ¿ÛÈÛ ÙËÓ ¤Ó·ÚÍË ÌÈ·˜ ·ÁÎfiÛÌÈ·˜ ÂÎÛÙÚ·Ù›·˜ Ì ÛÎÔfi ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ̤¯ÚÈ ÙÔ ¤ÙÔ˜ 2000 (1). ∏ ÚfiÔ‰Ô˜ Ô˘ ¤¯ÂÈ ÂÈÙ¢¯ı› ̤¯ÚÈ Û‹ÌÂÚ· Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋. ™˘ÁÎÂÎÚÈ̤ӷ, Ë ÂÙ‹ÛÈ· ›وÛË Ù˘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÂÏ·ÙÙÒıËΠ·fi 350.000 ÎÚÔ‡ÛÌ·Ù· ÙÔ 1988 Û ÌfiÏȘ 784 ÙÔ 2003, ÙÚÂȘ ‰Â ·fi ÙȘ ¶ÂÚÈʤÚÂȘ ÙÔ˘ WHO Î·È Û˘ÁÎÂÎÚÈ̤ӷ, Ë ¶ÂÚÈʤÚÂÈ· Ù˘ ∞ÌÂÚÈ΋˜ ÙÔ 1994, Ë ¶ÂÚÈʤÚÂÈ· ÙÔ˘ ¢˘ÙÈÎÔ‡ ∂ÈÚËÓÈÎÔ‡ ÙÔ 2000 Î·È Ë ¶ÂÚÈʤÚÂÈ· Ù˘ ∂˘ÚÒ˘ ÙÔ 2002, ÈÛÙÔÔÈ‹ıËÎ·Ó ÂχıÂÚ˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ (2). ∏ ÂÎÚ›˙ˆÛË ·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ Î·Ù¤ÛÙË ‰˘Ó·Ùfi Ó· ÔÏÔÎÏËÚˆı› ÙÔ 2000 Î·È Ô Ó¤Ô˜ ÛÙfi¯Ô˜ Ô˘ Ù¤ıËΠ‹Ù·Ó ÁÈ· ÙÔ 2005. ¢˘ÛÙ˘¯Ò˜, fï˜, ÙÔ 2005 ›¯·Ì 1.802 ηٷÁÂÁÚ·Ì̤ӷ ÎÚÔ‡ÛÌ·Ù· ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Ù· ÂÚÈÛÛfiÙÂÚ· ·fi Ù· ÔÔ›· ‹Ù·Ó ÂÈÛ·ÁfiÌÂÓ· Û ¯ÒÚ˜ fiÔ˘ ›¯Â ‰È·ÎÔ› Ë ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡. ¶¿ÓÙˆ˜ Ô ¶√À ¤¯ÂÈ ÂÓÙ·ÙÈÎÔÔÈ‹ÛÂÈ Ï¤ÔÓ ÙȘ ÚÔÛ¿ıÂȘ ÒÛÙ ӷ ıˆÚÂ›Ù·È Ôχ Èı·Ófi fiÙÈ Ë ‰È·ÎÔ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ ı· ÂÈÙ¢¯ı› Ù· ÚÔÛ¯‹ 2-3 ¯ÚfiÓÈ· (3). ∆Ë ‰È·ÎÔ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ı· ·ÎÔÏÔ˘ı‹ÛÔ˘Ó ÙÚ›· ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯ÚfiÓÈ· ÂÓÙ·ÙÈ΋˜ ÂÈÙ‹ÚËÛ˘, ÚÔÙÔ‡ ‰Ôı› Ë ÈÛÙÔÔ›ËÛË Ù˘ ÔÚÈÛÙÈ΋˜ ÂÎÚ›˙ˆÛ˘ Ù˘ ÓfiÛÔ˘ (4,5). ªÂ ‰Â‰Ô̤ÓÔ ÏÔÈfiÓ fiÙÈ Ë ÔÏÈÔÌ˘ÂÏ›Ùȉ· ı· Â›Ó·È ÙÔ ÚÒÙÔ ÏÔÈÌ҉˜ ÓfiÛËÌ· Ô˘ ı· ÂÎÚÈ˙ˆı› ÙÔÓ 21Ô ·ÈÒÓ·, Ë ÚÔÛÔ¯‹ Ù˘ ‰ÈÂıÓÔ‡˜ ÂÈÛÙËÌÔÓÈ΋˜ ÎÔÈÓfiÙËÙ·˜ ¤¯ÂÈ ‹‰Ë ·Ú¯›ÛÂÈ Ó· ÛÙÚ¤ÊÂÙ·È ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÛÙÚ·ÙËÁÈÎÒÓ Ô˘ ı· ··ÈÙËıÔ‡Ó ÌÂÙ¿ ÙË ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡. ∏ ÂÌÂÈÚ›· Ô˘ ¤¯ÂÈ ·ÔÎÙËı› Û ·˘ÙfiÓ ÙÔÓ ÙÔ̤· ·fi ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ¢ÏÔÁÈ¿˜ Â›Ó·È ÔχÙÈÌË, ˆÛÙfiÛÔ, ‰ÂÓ Â·ÚΛ ·fi ÌfiÓË Ù˘ ÁÈ· Ó· ‰ÒÛÂÈ ·¿ÓÙËÛË ÛÙ· Ôχ ÈÔ Û‡ÓıÂÙ· ÚÔ‚Ï‹Ì·Ù· Ô˘ ·Ó·Î‡ÙÔ˘Ó ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Î·È ¤¯Ô˘Ó Ó· οÓÔ˘Ó Ì ٷ ‰È·ÊÔÚÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÂÌ‚ÔÏ›ˆÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÙfiÙÂ Î·È ÙÒÚ·, ηıÒ˜ Î·È ÛÙȘ ÁˆÔÏÈÙÈΤ˜ ‰È·ÊÔÚ¤˜ ÙˆÓ ÂÔ¯ÒÓ ÛÙȘ Ôԛ˜ ÔÈ ‰‡Ô ÂÎÛÙÚ·Ù›˜ ÂÎÚ›˙ˆÛ˘ ¤Ï·‚·Ó ¯ÒÚ·. ∏ ·Ú·Î¿Ùˆ Û˘˙‹ÙËÛË ÂÈÎÂÓÙÚÒÓÂÙ·È ÛÙËÓ ·ÚÔ˘Û›·ÛË ÙˆÓ Ì¤¯ÚÈ ÛÙÈÁÌ‹˜ ‰Â‰ÔÌ¤ÓˆÓ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ ÂÏÏÔ¯Â‡Ô˘Ó Î·ıÒ˜ Î·È ÙÔ˘ Ï·ÈÛ›Ô˘ ̤۷ ÛÙÔ ÔÔ›Ô Ú¤ÂÈ Ó· ÎÈÓÔ‡ÓÙ·È ÔÈ ÛÙÚ·ÙËÁÈΤ˜ ‰ËÌfiÛÈ·˜
˘Á›·˜ Ô˘ ı· ÂÊ·ÚÌÔÛıÔ‡Ó ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘.
∫›Ó‰˘ÓÔÈ Â·ÓÂÌÊ¿ÓÈÛ˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÏfiÁˆ Û˘Ó¯È˙fiÌÂÓ˘ ¯Ú‹Û˘ ÙÔ˘ OPV √È Î›Ó‰˘ÓÔÈ Â·ÓÂÌÊ¿ÓÈÛ˘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ÂÎÚ›˙ˆÛ˘ ÌÔÚÔ‡Ó Ó· Ù·ÍÈÓÔÌËıÔ‡Ó Û ·˘ÙÔ‡˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Î·È Û ·˘ÙÔ‡˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÌË ·ÛÊ·Ï‹ ʇϷÍË ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡. √ ϤÔÓ ÁÓˆÛÙfi˜ ·fi ÙËÓ ÚÒÙË Î·ÙËÁÔÚ›·, Â›Ó·È Ë ÚfiÎÏËÛË ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ·fi ÛÙÂϤ¯Ë ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (Vaccine ∞ssociated Paralytic Poliomyelitis - VAPP) Ô˘ ·¤ÎÙËÛ·Ó Ó¢ÚÔÙÔÍÈÎfiÙËÙ· ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ ÙÔ˘˜ ÛÙÔ ¤ÓÙÂÚÔ ÙÔ˘ ÂÌ‚ÔÏÈ·Ṳ̂ÓÔ˘ ·ÙfiÌÔ˘. √È ÚÔÂÚ¯fiÌÂÓÔÈ ·fi ÙÔ OPV ÈÔ›, Û ·ÓÙ›ıÂÛË Ì ÙÔ˘˜ ¿ÁÚÈÔ˘˜ ÈÔ‡˜, ‰ÂÓ Î˘ÎÏÔÊÔÚÔ‡Ó ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙËÓ ÎÔÈÓfiÙËÙ·. ∞Ó Î·È ¿Óˆ ·fi 30% ÙˆÓ ÂÌ‚ÔÏÈ·˙ÔÌ¤ÓˆÓ ı· ·Ô‚¿ÏÔ˘Ó ÛÙÂϤ¯Ë Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈ· ·‡ÍËÛË Ù˘ Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜, Ë VAPP ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂ Û˘¯ÓfiÙËÙ· Ô˘ Î˘Ì·›ÓÂÙ·È ·fi Ì›· ÂÚ›ÙˆÛË Û οı 750.000 ¤ˆ˜ 1 ÂηÙÔÌ̇ÚÈÔ ·È‰È¿ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ÙËÓ ÚÒÙË ‰fiÛË ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (6,7). ∏ Û˘¯ÓfiÙËÙ· ·˘Ù‹ Â›Ó·È ÛÙ·ıÂÚ‹ Û fiϘ ÙȘ ÂÚÈÔ¯¤˜ fiÔ˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÔ OPV, ¤¯ÂÈ ‰Â ÂÎÙÈÌËı› fiÙÈ 250-500 ÎÚÔ‡ÛÌ·Ù· VAPP Û˘Ì‚·›ÓÔ˘Ó ÂÙËÛ›ˆ˜ Û ·ÁÎfiÛÌÈ· Îϛ̷η. ¢Â‰Ô̤ӷ ·fi ÂÚÈÔ¯¤˜ fiÔ˘ ¤¯ÂÈ ÛÙ·Ì·Ù‹ÛÂÈ Ë Î˘ÎÏÔÊÔÚ›· ÙÔ˘ ÈÔ‡ ·ÏÏ¿ Û˘Ó¯›˙ÂÙ·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì OPV ‰Â›¯ÓÔ˘Ó ˆ˜ Ô Î›Ó‰˘ÓÔ˜ VAPP ·Ú·Ì¤ÓÂÈ ·ÌÂÙ¿‚ÏËÙÔ˜ (8). ŒÓ·˜ Û·ÓÈfiÙÂÚÔ˜ ΛӉ˘ÓÔ˜ Ô˘ ÚfiÛÊ·Ù· ¿Ú¯ÈÛ ӷ Á›ÓÂÙ·È Î·Ù·ÓÔËÙfi˜, ÚÔ·ÙÂÈ ÛÙËÓ ÂÚ›ÙˆÛË fiÔ˘, ̤ۈ Ù˘ ÙÚÔÔÔ›ËÛ˘ ÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ˘ÏÈÎÔ‡, ·˘Í¿ÓÂÙ·È ÂÎÙfi˜ ·fi ÙË Ó¢ÚÔÙÔÍÈÎfiÙËÙ· Î·È Ë ÌÂÙ·‰ÔÙÈÎfiÙËÙ· ÙˆÓ ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘. √È ÈÔ› ·˘ÙÔ›, ÔÈ ÔÔ›ÔÈ, ·Ó Î·È ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙÔ OPV, ¤¯Ô˘Ó ÙËÓ ÈηÓfiÙËÙ· Ù˘ ·Ú·ÙÂٷ̤Ó˘ ΢ÎÏÔÊÔÚ›·˜ (Circulating Vaccine - Derived Polioviruses, cVDPVs), ¤¯Ô˘Ó ¯·Ú·ÎÙËÚÈÛÙÈο ¿ÁÚÈˆÓ ÈÒÓ Î·È Â›Ó·È ÈηÓÔ› Ó· ÚÔηϤÛÔ˘Ó ÂȉË̛˜. ¶ÚÔ·ÙÔ˘Ó ·fi ·Ó·Û˘Ó‰˘·ÛÌfi ÙÔ˘ ÁÔÓȉÈÒÌ·ÙÔ˜ ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ì ÌË oÏÈÔ-ÂÓÙÂÚÔ˚Ô‡˜ (9). ™Â ÏËı˘ÛÌÈ·Îfi ›‰Ô, fiÏ· Ù· ÎÚÔ‡ÛÌ·Ù· ·fi cVDPVs ¤¯Ô˘Ó ÂÌÊ·ÓÈÛı› Û ÂÚÈÔ¯¤˜ fiÔ˘ Ë ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡ ¶·È‰È·ÙÚÈ΋ 2006;69:90-96
Pediatr Mar-Apr 06
18-04-06
16:42
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∫. ¢Ô‡ÚÔ˜ Î·È Û˘Ó.
Ô‰‹ÁËÛ Û ÛÙ·‰È·Î‹ ÂÏ¿ÙÙˆÛË ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ ÚÔ˘Ù›Ó·˜ Ì OPV. √È ÂȉË̛˜ Â›Ó·È ·ÚfiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÈÔ‡˜ Ô˘ ÂÈÛ¿ÁÔÓÙ·È ·fi ÂÓ‰ËÌÈΤ˜ Û ÌË ÂÓ‰ËÌÈΤ˜ ¯ÒÚ˜. ∆ÚÂȘ Ù¤ÙÔȘ ÂȉË̛˜ ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ̤¯ÚÈ ÛÙÈÁÌ‹˜. ∏ ÚÒÙË Î·Ù·ÁÚ¿ÊËΠÙÔ 2000 Û ¤Ó· ÓËÛ› Ù˘ ∫·Ú·˚‚È΋˜, ÙËÓ πÛ·ÓÈfiÏ·, fiÔ˘ 22 ·È‰È¿ ÓfiÛËÛ·Ó ·fi ·Ú·Ï˘ÙÈ΋ ÔÏÈÔÌ˘ÂÏ›Ùȉ· Û ÌÈ· ÂÚ›Ô‰Ô 12 ÌËÓÒÓ (10). ∆Ô ˘Â‡ı˘ÓÔ Û٤ϯԘ ‹Ù·Ó ¤Ó·˜ Ù‡Ô˘ 1 cVDPV. ∏ ‰Â‡ÙÂÚË ÛËÌÂÈÒıËΠÙÔ 2001 ÛÙȘ ºÈÏțӘ, ‰È‹ÚÎÂÛ 4 Ì‹Ó˜, ÔÊÂÈÏfiÙ·Ó Â›Û˘ Û ¤Ó·Ó Ù‡Ô˘ 1 cVDPV Î·È ÚfiÛ‚·Ï 3 ·È‰È¿ (11). ∆Ô 2003 ÌÈ· ÙÚ›ÙË ·ÚfiÌÔÈ· ÌÈÎÚÔÂȉËÌ›· ÔÊÂÈÏfiÌÂÓË Û ¤Ó·Ó Ù‡Ô˘ 2 cVDPV ‰È·ÈÛÙÒıËΠÛÙË ª·‰·Á·ÛοÚË ·Ú·Ï‡ÔÓÙ·˜ 4 ·È‰È¿ Û ÌÈ· ÂÚ›Ô‰Ô ÂÓfi˜ Ì‹Ó· (12). ∫·È ÛÙȘ ÙÚÂȘ ÂÚÈÙÒÛÂȘ Ë ÌÂÙ¿‰ÔÛË ÙÔ˘ ÈÔ‡ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̷̠˙ÈΤ˜ ÂÌ‚ÔÏÈ·ÛÙÈΤ˜ ÂÎÛÙÚ·Ù›˜ Ì OPV Î·È ‰È·ÎfiËΠÁÚ‹ÁÔÚ·. ∂ÈϤÔÓ, ·Ó·‰ÚÔÌÈΤ˜ ·Ó·Ï‡ÛÂȘ ÁÔÓÈ‰ÈˆÌ¿ÙˆÓ ÈÒÓ ·fi ÙËÓ ∞›Á˘ÙÔ ¤‰ÂÈÍ·Ó fiÙÈ ¤Ó·˜ Ù‡Ô˘ 2 cVDPV ΢ÎÏÔÊÔÚÔ‡Û ÛÙË ¯ÒÚ· ·fi ÙÔ 1988 ¤ˆ˜ Î·È ÙÔ 1993, ¤¯ÔÓÙ·˜ ·Ú·Ï‡ÛÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 32 ·È‰È¿ (13). ∞Ó Î·È Ë ÓfiÛËÛË ·fi cVDPVs Â›Ó·È ÚÔ˜ ÙÔ ·ÚfiÓ Ôχ ÈÔ Û¿ÓÈ· ·’ fi,ÙÈ Ì VAPP, Ë Â›ÙˆÛ‹ Ù˘ ÛÙÔ Ì¤ÏÏÔÓ ı· ÂÍ·ÚÙËı› ·fi ÙȘ ÂıÓÈΤ˜ Î·È ‰ÈÂıÓ›˜ ÔÏÈÙÈΤ˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ô˘ ı· ÂÈÎÚ·Ù‹ÛÔ˘Ó. ∞Ó ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Û˘Ó¯ÈÛÙ› Ë ¯Ú‹ÛË ÙÔ˘ OPV, Ì ¯·ÌËÏ‹ fï˜ ÂÌ‚ÔÏÈ·ÛÙÈ΋ Î¿Ï˘„Ë, ı· ˘¿ÚÍÂÈ ˆ˜ ¿ÌÂÛË Û˘Ó¤ÂÈ·, ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ Î·È ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÂȉËÌÈÒÓ ·fi cVDPVs. √ ÙÚ›ÙÔ˜ ‰˘ÓËÙÈÎfi˜ ΛӉ˘ÓÔ˜ ·fi ÙË Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Â›Ó·È Ë ÂӉ¯fiÌÂÓË ‰È·ÛÔÚ¿ ÙÚÔÔÔÈËÌ¤ÓˆÓ ÈÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ Ì ·˘ÍË̤ÓË Ó¢ÚÔÙÔÍÈÎfiÙËÙ· ÚÔÂÚ¯fiÌÂÓˆÓ ·fi ¿ÙÔÌ· Ì ·ÓÔÛÔÏÔÁÈ΋ ·Ó¿ÚÎÂÈ· (immunodeficient long term excretors of Vaccine-Derived Polioviruses - iVDPVs). Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, Ô Èfi˜ ·ÂÎÎÚ›ÓÂÙ·È ÁÈ· 2-6 ‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi Ì OPV. √È ·Ô‚·ÏÏfiÌÂÓÔÈ ÈÔ› ÌÔÚ› Ó· ÌÂÙ·‰ÔıÔ‡Ó Û ¿ÙÔÌ· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È ÔÏϤ˜ ÊÔÚ¤˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÈÎÚ‹ ·‡ÍËÛË Ù˘ Ó¢ÚÔÙÔÍÈÎfiÙËÙ·˜. ∞ÛıÂÓ›˜ Ì ‰È·Ù·Ú·¯¤˜ Ù˘ ¯˘ÌÈ΋˜ ·ÓÔÛ›·˜ ÌÔÚ› Ó· Á›ÓÔ˘Ó ¯ÚfiÓÈÔÈ ÊÔÚ›˜ Î·È Ó· ·Ô‚¿ÏÔ˘Ó ÁÈ· ÌÂÁ¿Ï· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ÙÔÓ Èfi, Ô ÔÔ›Ô˜ Û˘¯Ó¿ ·ÔÎÙ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ¿ÁÚÈÔ˘ Ù‡Ô˘. £ÂˆÚËÙÈο, Ì ·˘Ùfi ÙÔÓ ÙÚfiÔ ı· ÌÔÚÔ‡Û ӷ ·ÓÂÈÛ·¯ı› Ô Èfi˜ ÛÙËÓ Î˘ÎÏÔÊÔÚ›· ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ Î·È ÙË ¶·È‰È·ÙÚÈ΋ 2006;69:90-96
‰È·ÎÔ‹ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ. øÛÙfiÛÔ, Ù¤ÙÔÈÔÈ ¯ÚfiÓÈÔÈ ÊÔÚ›˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔÈ, Ì ÌfiÓÔ 19 ¿ÙÔÌ· Ó· ¤¯Ô˘Ó ·ÓȯÓ¢ı› Ù· ÙÂÏÂ˘Ù·›· 40 ¯ÚfiÓÈ· Ù˘ ¢Ú›·˜ ¯Ú‹Û˘ ÙÔ˘ OPV. ∞fi ÙÔ˘˜ 19, ÌfiÓÔ ÔÈ 2 ‚Ú›ÛÎÔÓÙ·È ÂÓ ˙ˆ‹. ∂ÈϤÔÓ, ‰ÂÓ ¤¯ÂÈ ‰È·ÈÛÙˆı› Ô‡Ù ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÌÂÙ¿‰ÔÛË Ô‡Ù ·Ó·Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ·ÂÎÎÚÈÓfiÌÂÓˆÓ ÈÒÓ Ì ¿ÏÏÔ˘˜ ÂÓÙÂÚÔ˚Ô‡˜. ŸÏ˜ ÔÈ ÂÚÈÙÒÛÂȘ iVDPVs ¤¯Ô˘Ó ·Ú·ÙËÚËı› Û ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Û ¿ÙÔÌ· Ì ÛÔ‚·Ú¤˜ Û˘ÁÁÂÓ›˜ ·ÓÔÛÔ·Ó¿ÚÎÂȘ Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·Ó Ù·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË Á-ÛÊ·ÈÚ›Ó˘ ÁÈ· Ó· ÂÈ‚ÈÒÛÔ˘Ó. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙȘ ÌÂÓ ·Ó·Ù˘ÛÛfiÌÂÓ˜ ¯ÒÚ˜ Ù· ¿ÙÔÌ· ·˘Ù¿ ı· ‹Ù·Ó ·‰‡Ó·ÙÔ Ó· ÂÈ‚ÈÒÛÔ˘Ó ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÛÙȘ ‰Â ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ ·Ú·ÙËÚÂ›Ù·È ÌÈ· ÛÙ·‰È·Î‹ ·ÏÏ·Á‹ ÛÙËÓ ÔÏÈÙÈ΋ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì ˘ÈÔı¤ÙËÛË ÙÔ˘ πPV, ·Ó·Ì¤ÓÂÙ·È ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Ù˘ ›وÛ˘ ÙˆÓ iVDPVs. ŒÙÛÈ, ·˘ÙÔ‡ ÙÔ˘ ›‰Ô˘˜ Ë ‰È·ÛÔÚ¿ ‰ÂÓ ıˆÚÂ›Ù·È fiÙÈ ı· ·ÔÙÂϤÛÂÈ Ú·ÁÌ·ÙÈÎfi Úfi‚ÏËÌ· (14).
∫›Ó‰˘ÓÔÈ Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÌË ·ÛÊ·Ï‹ ʇϷÍË ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ ŒÓ·˜ ÔÚ·Ùfi˜ ΛӉ˘ÓÔ˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË, ·ÊÔÚ¿ ÛÙËÓ ·ÎÔ‡ÛÈ· ·ÂÏ¢ı¤ÚˆÛË ÛÙÂϯÒÓ ÈÒÓ ·fi ÌÔÓ¿‰Â˜ ·Ú·ÁˆÁ‹˜ ÂÌ‚ÔÏ›ˆÓ (IPV) ‹ ÂÚ¢ÓËÙÈο ÂÚÁ·ÛÙ‹ÚÈ·. ∆¤ÙÔÈ· ÂÚÈÛÙ·ÙÈο ¤¯Ô˘Ó Û˘Ì‚Â› ÂÏ¿¯ÈÛÙ˜ ÊÔÚ¤˜ ÛÙÔ ·ÚÂÏıfiÓ. ªfiÓÔ Ì›· ÂÚ›ÙˆÛË ·ÂÏ¢ı¤ÚˆÛ˘ ÈÔ‡ ·fi ÌÔÓ¿‰· ·Ú·ÁˆÁ‹˜ IPV Â›Ó·È ÁÓˆÛÙ‹ ̤¯ÚÈ Û‹ÌÂÚ·. ∆Ô ÂÂÈÛfi‰ÈÔ Û˘Ó¤‚Ë ÙÔ 1992, fiÙ·Ó ¤Ó· Û٤ϯԘ ·Ó·ÊÔÚ¿˜ ÈÔ‡ Ù‡Ô˘ 1 Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ·Ú·ÁˆÁ‹ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘, ·ÔÌÔÓÒıËΠ·fi ¤Ó· ·È‰› Ì ‰È¿ÚÚÔÈ·. ∏ ÂȉËÌÈÔÏÔÁÈ΋ ¤Ú¢ӷ ¤‰ÂÈÍ fiÙÈ Ô ·Ù¤Ú·˜ ÙÔ˘ ·È‰ÈÔ‡ ‹Ù·Ó ˘¿ÏÏËÏÔ˜ ‚ÈÔÌ˯·Ó›·˜ ·Ú·ÁˆÁ‹˜ IPV. ∫ÚÔ‡ÛÌ·Ù· ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÔÊÂÈÏfiÌÂÓ· ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Û٤ϯԘ ‰ÂÓ ·Ú·ÙËÚ‹ıËÎ·Ó (15). ¶ÂÚÈÙÒÛÂȘ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÔÊÂÈÏfiÌÂÓ˘ Û ·ÎÔ‡ÛÈ· ·ÂÏ¢ı¤ÚˆÛË ÛÙÂϤ¯Ô˘˜ ·fi ÂÚ¢ÓËÙÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ, ‰ÂÓ ¤¯Ô˘Ó ÙÂÎÌËÚȈı› ̤¯ÚÈ Û‹ÌÂÚ·. ∂ÓÙÔ‡ÙÔȘ, ηٿ Ù· ¤ÙË 2002-2003, ¤Ó· ÂÚÁ·ÛÙËÚÈ·Îfi Û٤ϯԘ ¿ÁÚÈÔ˘ ÈÔ‡ Ù‡Ô˘ 2 ·ÔÌÔÓÒıËΠ·fi 9 Û˘ÓÔÏÈο ·È‰È¿ Ì ·Ú·Ï˘ÙÈ΋ ÔÏÈÔÌ˘ÂÏ›Ùȉ· ÛÙËÓ πÓ‰›·. ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ ˆ˜ ˘Â‡ı˘ÓÔ ÙÔ MEF-1, ¤Ó· Û˘ÓËıÈṲ̂ÓÔ Û٤ϯԘ ¿ÁÚÈÔ˘ ÈÔ‡ Ù‡Ô˘ 2, Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â˘Ú¤ˆ˜ ÛÙ· ÂÚÁ·ÛÙ‹ÚÈ· Î·È ÛÙȘ
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·93
93
ŒÏÂÁ¯Ô˜ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË
ÌÔÓ¿‰Â˜ ·Ú·ÁˆÁ‹˜ IPV, Î·È ·Ú’ fiÏÔ Ô˘ Ô ÙÚfiÔ˜ Ù˘ ÌÂÙ¿‰ÔÛ‹˜ ÙÔ˘ ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛı› ·ÎfiÌË, ˘¿Ú¯Ô˘Ó οÔÈ· ÛÙÔȯ›· Ô˘ ÂÓÔ¯ÔÔÈÔ‡Ó ÙË ÌfiÏ˘ÓÛË ·ÚÙ›‰ˆÓ √PV Ì ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Û٤ϯԘ (16). ∏ Û·ÓÈfiÙËÙ· ÙˆÓ ·Ú·¿Óˆ ÂÚÈÛÙ·ÙÈÎÒÓ Î·ıÈÛÙ¿ ‰‡ÛÎÔÏÔ ÙÔ ¤ÚÁÔ Ù˘ ÔÛÔÙÈÎÔÔ›ËÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ Ì ÙËÓ ÔÔ›· ·˘Ù¿ ı· ··ÓÙÒÓÙ·È ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘. ¶·Ú’ fiÏ· ·˘Ù¿, ‰ÂÓ ·‡Ô˘Ó Ó· ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ·Ó¿ÁÎË ÁÈ· ˘ÈÔı¤ÙËÛË ·fi fiϘ ÙȘ ¯ÒÚ˜ ÙˆÓ ·˘ÛÙËÚÒÓ Î·ÓfiÓˆÓ Ô˘ ¤¯Ô˘Ó ıÂÛÈÛÙ› ·fi ÙÔÓ WHO ÁÈ· ÙÔÓ ·ÛÊ·Ï‹ ¯ÂÈÚÈÛÌfi Î·È Ê‡Ï·ÍË ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ (17). ª¤¯ÚÈ, ¿ÓÙˆ˜, Î·È ÙÔÓ ¢ÂΤ̂ÚÈÔ ÙÔ˘ 2003, ÔÈ 194 ·fi ÙȘ 214 ¯ÒÚ˜ ÙÔ˘ WHO ›¯·Ó Û˘ÛÙ‹ÛÂÈ ÂıÓÈΤ˜ ÂÈÙÚÔ¤˜ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ·ÓˆÙ¤Úˆ ηÓÔÓÈÛÌÒÓ. ∏ ‰È·‰Èηۛ· ÙÔ˘ ÂϤÁ¯Ô˘ Î·È Ù˘ ηٷÁÚ·Ê‹˜ ÙˆÓ ÂÚÁ·ÛÙËÚ›ˆÓ ¤¯ÂÈ ÔÏÔÎÏËÚˆı› Û 76 ¯ÒÚ˜, ÂÓÒ ¤¯ÂÈ ·Ú¯›ÛÂÈ Û ¿ÏϘ 81. ∏ ÚfiÔ‰Ô˜ Â›Ó·È ÛËÌ·ÓÙÈ΋ Î·È ‰ËÏÒÓÂÈ fiÙÈ Ô Î›Ó‰˘ÓÔ˜ Ù˘ ÂÎÔ‡ÛÈ·˜ ·ÂÏ¢ı¤ÚˆÛ˘ ÙÔ˘ ÈÔ‡ Û˘Ó¯Ҙ ÌÂÈÒÓÂÙ·È (18). ∏ ÌÂÁ·Ï‡ÙÂÚË ˆÛÙfiÛÔ, ·ÂÈÏ‹ ÁÈ· ÙËÓ ÂÎ Ó¤Ô˘ ‰È·ÛÔÚ¿ ¿ÁÚÈˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡, Â›Ó·È Ë ÛÎfiÈÌË ·ÂÏ¢ı¤ÚˆÛ‹ ÙÔ˘ ·fi ¤Ó·Ó ¯ÒÚÔ Ê‡Ï·Í˘. ª¤¯ÚÈ Û‹ÌÂÚ· ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ ÁÓˆÛÙ¿ Ù¤ÙÔÈ· ÂÚÈÛÙ·ÙÈο. √ ÌÂÏÏÔÓÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÂÍ·ÚÙ¿Ù·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙȘ ÂıÓÈΤ˜ Î·È ‰ÈÂıÓ›˜ ·ÔÊ¿ÛÂȘ Ô˘ ı· ·ÊÔÚÔ‡Ó ÛÙÔ˘˜ ÂÌ‚ÔÏÈ·ÛÌÔ‡˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË. À¿Ú¯Ô˘Ó, ˆÛÙfiÛÔ, ÔÏÏÔ› ÏfiÁÔÈ Ô˘ ηıÈÛÙÔ‡Ó ·˘Ùfi ÙÔÓ Î›Ó‰˘ÓÔ fi¯È ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi. ¶ÚÒÙÔÓ, Ë Ïԛ̈ÍË ·fi Èfi ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ¤¯ÂÈ Ôχ ÌÈÎÚ‹ ÓÔÛËÚfiÙËÙ· Î·È ıÓËÛÈÌfiÙËÙ· Û ۯ¤ÛË Ì ¿ÏÏÔ˘˜ ÏÔÈÌÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ÌÔÚÔ‡Ó Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ˆ˜ fiÏ· ‚ÈÔÙÚÔÌÔÎÚ·Ù›·˜ Î·È ÂÈϤÔÓ, Ë ÌÂÙ·ÊÔÚ¿ Î·È ‰È·ÛÔÚ¿ ÙÔ˘ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ ·Ú¯›ÛÂÈ ÂÎ Ó¤Ô˘ Ë ÌÂÙ¿‰ÔÛË Ù˘ ÓfiÛÔ˘, Â›Ó·È È‰È·›ÙÂÚ· ‰‡ÛÎÔÏË. ¢Â‡ÙÂÚÔÓ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ·Ó·Ù˘Á̤Ó˜ ¯ÒÚ˜ Ô˘ ı· ÌÔÚÔ‡Û·Ó Ó· ·ÔÙÂϤÛÔ˘Ó Èı·ÓÔ‡˜ ÛÙfi¯Ô˘˜ ‚ÈÔÙÚÔÌÔÎÚ·ÙÒÓ, ¤¯Ô˘Ó ‹‰Ë ‰È·Ù˘ÒÛÂÈ ÙË ÚfiıÂÛ‹ ÙÔ˘˜ ÁÈ· Û˘Ó¤¯ÈÛË ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ Ì IPV ÒÛÙ ӷ ‰È·ÙËÚ‹ÛÔ˘Ó ÙËÓ ÏËı˘ÛÌȷ΋ ·ÓÔÛ›· Î·È ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ÂÎÚ›˙ˆÛ˘. ∆¤ÏÔ˜, Ô Î›Ó‰˘ÓÔ˜ ÂÎÔ‡ÛÈ·˜ ·ÓÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÈÔ‡ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ, ·Ó Î·È ‰ÂÓ ÌÔÚ› Ó· ÌˉÂÓÈÛı› Ï‹Úˆ˜, ÌÔÚ› Ó· ÂÏ·ÙÙˆı› ÛËÌ·ÓÙÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ·˘ÛÙËÚÒÓ Ì¤ÙÚˆÓ Ê‡Ï·Í˘ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ ÂӉ¯Ô̤ӈ˜ ·ÔÊ·ÛÈÛı› Ó· ‰È·ÙËÚËıÔ‡Ó (19).
∞Ó Î·È fiˆ˜ Ê·›ÓÂÙ·È ·fi Ù· ·Ú·¿Óˆ, ÌÔÚԇ̠ӷ οÓÔ˘Ì οÔȘ ÂÎÙÈÌ‹ÛÂȘ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi Î·È ÛÙËÓ ÔÛÔÙÈÎÔÔ›ËÛË ÙˆÓ ÎÈÓ‰‡ÓˆÓ ÂÌÊ¿ÓÈÛ˘ ÎÚÔ˘ÛÌ¿ÙˆÓ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘ ÁÈ· ÙÔ ¿ÌÂÛÔ Ì¤ÏÏÔÓ, Â›Ó·È Ô˘ÛÈ҉˜ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ì fiÙÈ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ù· ‰Â‰Ô̤ӷ ı· ·ÏÏ¿ÍÔ˘Ó ÛËÌ·ÓÙÈο. √È ‰È·ÊÔÚÔÔÈ‹ÛÂȘ Ô˘ ı· ÚÔ·„Ô˘Ó ı· ÔÊ›ÏÔÓÙ·È ÛÙȘ ·ÔÊ¿ÛÂȘ Ô˘ ı· ÏËÊıÔ‡Ó Û¯ÂÙÈο Ì ÙË Ê‡Ï·ÍË ÙÔ˘ ÈÔ‡, ÙËÓ ÂÈÙ‹ÚËÛË Ù˘ ÓfiÛÔ˘ Î·È ÙËÓ ÂÌ‚ÔÏÈ·ÛÙÈ΋ ÔÏÈÙÈ΋ Û ‰ÈÂıÓ¤˜ ›‰Ô, ηıÒ˜ Î·È ÛÙÔÓ ‚·ıÌfi Ô˘ ÔÈ ·ÔÊ¿ÛÂȘ ·˘Ù¤˜ ı· ˘ÏÔÔÈËıÔ‡Ó Û ÂıÓÈÎfi Î·È ÙÔÈÎfi ›‰Ô. ∂›Û˘, ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ı· ·›ÍÂÈ Ë ÂӉ¯fiÌÂÓË ·Ó¿Ù˘ÍË ÂÚÁ·Ï›ˆÓ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î·ıÂÓfi˜ ·fi ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. °È· ·Ú¿‰ÂÈÁÌ·, Ë ·Ó·Î¿Ï˘„Ë ÂÓfi˜ ·ÓÙÈÈ˚ÎÔ‡ ·Ú¿ÁÔÓÙ· ‰Ú·ÛÙÈÎÔ‡ ¤Ó·ÓÙÈ ÙÔ˘ ÈÔ‡ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ı· ¤Î·Ó ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÙËÓ ·ÓÙ›‰Ú·Û‹ Ì·˜ Û ÂÚ›ÙˆÛË Â·Ó·Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡. ™Â οı ÂÚ›ÙˆÛË ¿ÓÙˆ˜, Ë ÓÔÛËÚfiÙËÙ· ı· Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁË Ì ÙÔ ÔÛÔÛÙfi Ù˘ ·ÓÔÛ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡. √È ÂÈ̤ÚÔ˘˜ ΛӉ˘ÓÔÈ Ô˘ ÛÎÈ·ÁÚ·Ê‹ıËηÓ, Û˘Óı¤ÙÔ˘Ó ¤Ó· ·Ú¯ÈÎfi Ï·›ÛÈÔ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Èı·ÓfiÙËÙ·˜ ·ÓÂÈÛ·ÁˆÁ‹˜ ÙÔ˘ ÈÔ‡ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË. ∞ÎfiÌË fï˜, ÎÈ ·Ó ηٷÛÙ› ‰˘Ó·Ù‹ Ë ·ÎÚÈ‚‹˜ ÔÛÔÙÈÎÔÔ›ËÛË ÙÔ˘ οı ÎÈÓ‰‡ÓÔ˘, ÙÔ ·Ú·¿Óˆ Ï·›ÛÈÔ ‰ÂÓ ı· ·ÔÙÂÏ› ·Ú¿ ¤Ó· ‰˘Ó·ÌÈÎfi ÌÔÓÙ¤ÏÔ, Ë ·Í›· ÙÔ˘ ÔÔ›Ô˘ ı· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Ù·ÎÙÈ΋ Î·È Û¯ÔÏ·ÛÙÈ΋ ÂÓË̤ڈۋ ÙÔ˘ Ì ٷ Ó¤· ‰Â‰Ô̤ӷ Ô˘ Û˘Ó¯Ҙ ı· ÚÔ·ÙÔ˘Ó (19).
¶ÚÔ‚ÏËÌ·ÙÈÛÌÔ› ÛÙÔÓ Û¯Â‰È·ÛÌfi ÔÏÈÙÈÎÒÓ ÁÈ· ÙË ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÂÔ¯‹ ∆Ô Ï·›ÛÈÔ ÂÎÙ›ÌËÛ˘ ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ ÚԷӷʤÚıËΠı· ·ÔÙÂϤÛÂÈ ÙË ‚¿ÛË ÁÈ· ÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÛÙÔ˘˜ ÙÔÌ›˜ Ù˘ ÂÈÙ‹ÚËÛ˘, Ù˘ ʇϷ͢ ÙÔ˘ ÈÔ‡, ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·È ÙˆÓ ·ÔıÂÌ¿ÙˆÓ ÂÌ‚ÔÏ›ˆÓ. ∞Ó Î·È Ë ·Ú·Î¿Ùˆ Û˘˙‹ÙËÛË ı· ·Ó·ÊÂÚı› ͯˆÚÈÛÙ¿ Û ηı¤Ó·Ó ·fi ·˘ÙÔ‡˜ ÙÔ˘˜ ÙÔÌ›˜, Ë ÔÏÈÙÈ΋ Ô˘ ı· ·ÔÊ·ÛÈÛı› ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÓÈ·›·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Î·Ó¤Ó·˜ ‰ÂÓ ÌÔÚ› Ó· ıˆÚËı› ·ÓÂÍ¿ÚÙËÙÔ˜ ·fi ÙÔ˘˜ ˘fiÏÔÈÔ˘˜. ∏ ÂÈÙ‹ÚËÛË Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ̤¯ÚÈ ÙÒÚ· ÛÙËÚ›¯ıËΠÛÙËÓ ·Ó›¯Ó¢ÛË Ù˘ √Í›·˜ ÷Ϸڋ˜ ¶·Ú¿Ï˘Û˘ (√ö). ŒÙÛÈ, ÔÈ ˘ÁÂÈÔÓÔÌÈΤ˜ ¶·È‰È·ÙÚÈ΋ 2006;69:90-96
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·94
94
∫. ¢Ô‡ÚÔ˜ Î·È Û˘Ó.
˘ËÚÂۛ˜ ÙˆÓ ¯ˆÚÒÓ ÛÙȘ Ôԛ˜ ÂÓ‰ËÌ› Ë ÓfiÛÔ˜, ηıÒ˜ Î·È ·˘ÙÒÓ Ô˘ ¤ˆ˜ ÚfiÛÊ·Ù· ‹Ù·Ó ÂÓ‰ËÌÈΤ˜, Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔ˘Ó Î·È Ó· ‰ÈÂÚ¢ÓÔ‡Ó Ï‹Úˆ˜ fiÏ· Ù· ÂÚÈÛÙ·ÙÈο √ö. Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ·ÎfiÌË Î·È Â› ·Ô˘Û›·˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, Ú¤ÂÈ Ó· ·ÓȯÓ‡ÂÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ÂÚÈÛÙ·ÙÈÎfi √ö ·Ó¿ 100.000 ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 15 ÂÙÒÓ, ·Ó¿ ¤ÙÔ˜. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ ÂÈÙ‹ÚËÛ˘ ÛÙËÚ›˙ÂÙ·È ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·Ó·ÊÂÚÔÌ¤ÓˆÓ ÎÚÔ˘ÛÌ¿ÙˆÓ √ö Î·È ÛÙËÓ Â¿ÚÎÂÈ· Ù˘ ‰ÈÂÚ‡ÓËÛ˘ ÙÔ˘ ηıÂÓfi˜ ·fi ·˘Ù¿ (20). ¢ÂÓ ¤¯ÂÈ ·ÔÊ·ÛÈÛı› ·ÎfiÌË ·Ó ı· ‰È·ÙËÚËı› ÙÔ ›‰ÈÔ Û‡ÛÙËÌ· ÂÈÙ‹ÚËÛ˘ ‹ ı· ·ÓÙÈηٷÛÙ·ı› ·fi οÔÈÔ ¿ÏÏÔ. ∆Ô ‚¤‚·ÈÔ Â›Ó·È ¿ÓÙˆ˜, fiÙÈ Ë ÂÈÙ‹ÚËÛË ı· Ú¤ÂÈ Ó· Û˘Ó¯ÈÛı›, Èı·Ófiٷٷ ̤۷ ÛÙÔ Ï·›ÛÈÔ ÙˆÓ ¢ÈÂıÓÒÓ ÀÁÂÈÔÓÔÌÈÎÒÓ ∫·ÓÔÓÈÛÌÒÓ ÙÔ˘ ¶√À (21), ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛı› Ë ÁÚ‹ÁÔÚË ·Ó›¯Ó¢ÛË Î·È ·¿ÓÙËÛË Û ÂÚ›ÙˆÛË Î˘ÎÏÔÊÔÚ›·˜ ÈÔ‡ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜. ∏ ʇϷÍË Î·È Ô ·ÛÊ·Ï‹˜ ¯ÂÈÚÈÛÌfi˜ ÛÙÂϯÒÓ ÙÔ˘ ÈÔ‡ (poliovirus containment) ÛÙË ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÂÔ¯‹, ·ÔÙÂÏ› ¤Ó· ·ÎfiÌ· ‰›Ô ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡. ™ËÌ·ÓÙÈ΋ ÚfiÔ‰Ô˜ ÂÈÙ‡¯ıËΠÛÙÔÓ ÙÔ̤· ·˘Ùfi ÌÂÙ¿ ·fi ÙËÓ ¤Î‰ÔÛË ÙÔ˘ “¶·ÁÎfiÛÌÈÔ˘ ۯ‰›Ô˘ ‰Ú¿Û˘ ÁÈ· ÙËÓ ÂÚÁ·ÛÙËÚȷ΋ ʇϷÍË Î·È ¯ÂÈÚÈÛÌfi ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜” ·fi ÙÔÓ ¶√À, ÙÔ 1999 (17). ∆ÔÓ ›‰ÈÔ ¯ÚfiÓÔ Ë ¶·ÁÎfiÛÌÈ· ™˘Ó¤Ï¢ÛË ÙÔ˘ ¶√À οÏÂÛ fiÏ· Ù· ÎÚ¿ÙË Ì¤ÏË Ó· ·Ú¯›ÛÔ˘Ó ÙË ÛÙ·‰È·Î‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ì¤ÙÚˆÓ Ô˘ ÚԂϤÔÓÙ·Ó ÛÙÔ ·Ú·¿Óˆ Û¯¤‰ÈÔ (22). Ÿˆ˜ ÚԷӷʤÚıËÎÂ, ÔÏϤ˜ ¯ÒÚ˜ ¤¯Ô˘Ó ‹‰Ë ·Ú¯›ÛÂÈ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ۯ‰›Ô˘ ÂϤÁ¯ÔÓÙ·˜ Î·È Î·Ù·ÁÚ¿ÊÔÓÙ·˜ Ù· ÂÚÁ·ÛÙ‹ÚÈ· Ô˘ ¯ÂÈÚ›˙ÔÓÙ·È ¿ÁÚÈ· ÛÙÂϤ¯Ë ‹ ¯ÚËÛÈÌÔÔÈÔ‡Ó ˘ÏÈο ‰˘ÓËÙÈο ÌÔÏ˘Ṳ̂ӷ Ì ÙÔÓ Èfi. ∂ÓÙÔ‡ÙÔȘ, Ù· ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ê‡Ï·ÍË Î·È ÙÔÓ ¯ÂÈÚÈÛÌfi ÙÔ˘ ÈÔ‡ ·Ó·Ì¤ÓÂÙ·È Ó· Á›ÓÔ˘Ó ÈÔ ÔχÏÔη ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Î·È ı· ··ÈÙ‹ÛÔ˘Ó Â˘Ú›· ÔÌÔʈӛ· ÛÙÔ Â›Â‰Ô ·ÛÊ¿ÏÂÈ·˜ Ù˘ ʇϷ͢, fi¯È ÌfiÓÔ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡ ·ÏÏ¿ Î·È ÙˆÓ ÛÙÂϯÒÓ ÙÔ˘ ÂÌ‚ÔÏ›Ô˘. ∞ÎfiÌË, Ë ÚfiÛÊ·ÙË ÂÍ·ÎÚ›‚ˆÛË ÌÈÎÚÔ-ÂȉËÌÈÒÓ ·fi ΢ÎÏÔÊÔÚÔ‡ÓÙ· ÛÙÂϤ¯Ë ÙÔ˘ ÂÌ‚ÔÏ›Ô˘ (cVDPVs) ηıÈÛÙ¿ ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË Ó· ÏËÊı› ˘’ fi„ÈÓ ·˘Ùfi˜ Ô ÌÈÎÚfi˜ ·ÏÏ¿ ˘·ÚÎÙfi˜ ΛӉ˘ÓÔ˜, ηٿ ÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ ÁÈ· ÙË ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË ÂÔ¯‹ (10-13). ∏ ÂÎÚ›˙ˆÛË ÂÓfi˜ ÏÔÈÌÔÁfiÓÔ˘ ·Ú¿ÁÔÓÙ· ‹Ù·Ó Û˘Ó˘Ê·Ṳ̂ÓË Ì¤¯ÚÈ ÚfiÛÊ·Ù· Ì ÙË ‰È·¶·È‰È·ÙÚÈ΋ 2006;69:90-96
ÎÔ‹ ÙˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ (23). øÛÙfiÛÔ, ÌÂÙ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ÎÚÔ˘ÛÌ¿ÙˆÓ ·fi cVDPV Î·È ÙȘ Û¯ÂÙÈΤ˜ Ì ÙË ‚ÈÔÙÚÔÌÔÎÚ·Ù›· ·ÓËÛ˘¯›Â˜, ¤¯ÂÈ ·Ú¯›ÛÂÈ ÂÎ Ó¤Ô˘ ÌÈ· Û˘˙‹ÙËÛË ÛÙÔÓ ¯ÒÚÔ Ù˘ ‰ËÌfiÛÈ·˜ ˘Á›·˜, ÁÈ· ÙÔ Î·Ù¿ fiÛÔ Â›Ó·È Ú·ÁÌ·ÙÈο ÂÊÈÎÙ‹ Ë ‰È·ÎÔ‹ ÙˆÓ ÂÌ‚ÔÏÈ·ÛÌÒÓ Î·Ù¿ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÈΛÌÂÓË ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡ (24). ∫¿ÔÈÔÈ ÂÚ¢ÓËÙ¤˜ Ì¿ÏÈÛÙ·, ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ‰ÂÓ ı· Ú¤ÂÈ Ó· ··ÈÙÂ›Ù·È Ë ‰È·ÎÔ‹ ÙˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· Ó· ıˆڋÛÔ˘Ì fiÙÈ Ë ÂÎÚ›˙ˆÛË Â›Ó·È ÂÈÙ˘¯‹˜. ∆Ô 1998, ÚÈÓ ‰È·ÈÛÙˆı› ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·fi cVDPVs, ÌÈ· Û˘Ó¿ÓÙËÛË ÂȉÈÎÒÓ, Ô˘ ›¯Â Û˘ÁÎÏËı› ·fi ÙÔÓ ¶√À, ›¯Â ηٷϋÍÂÈ fiÙÈ Ë ‰È·ÎÔ‹ ÙÔ˘ ÂÌ‚ÔÏÈ·ÛÌÔ‡ ÚÔ˘Ù›Ó·˜ Ì OPV Â›Ó·È ÂȂ‚ÏË̤ÓË, ÂÓÒ ı· ÌÔÚÔ‡Û ӷ ÛÙ·Ì·Ù‹ÛÂÈ Î·È Ô ÂÌ‚ÔÏÈ·ÛÌfi˜ Ì IPV ÂÊfiÛÔÓ ›Û¯˘·Ó ÔÈ ÂÍ‹˜ ÚÔ¸Ôı¤ÛÂȘ: 1) ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙÔ˘ ¿ÁÚÈÔ˘ ÈÔ‡ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, 2) ·ÛÊ·Ï‹˜ ʇϷÍË ÙˆÓ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ·ÔıÂÌ¿ÙˆÓ ÈÒÓ, 3) ‰È·ÎÔ‹ Ù˘ ΢ÎÏÔÊÔÚ›·˜ ÙˆÓ ÚÔÂÚ¯fiÌÂÓˆÓ ·fi ÙÔ ÂÌ‚fiÏÈÔ ÈÒÓ Û ۇÓÙÔÌÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙË ‰È·ÎÔ‹ ÙÔ˘ OPV (25). ¶·Ú¿ Ù· ·ÓˆÙ¤Úˆ Û˘ÌÂÚ¿ÛÌ·Ù·, Ë ÂÌÊ¿ÓÈÛË Â·ÓÂÈÏËÌÌ¤ÓˆÓ ÂÂÈÛÔ‰›ˆÓ cVDPVs Î·È Ô Êfi‚Ô˜ Ù˘ ‚ÈÔÙÚÔÌÔÎÚ·Ù›·˜ ¤¯Ô˘Ó ·Ó·ÁοÛÂÈ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ Î·È ÙÔ˘˜ ˘Â‡ı˘ÓÔ˘˜ ۯ‰ȷÛÌÔ‡ ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ó· ·Ó·˙ËÙ‹ÛÔ˘Ó ¤Ó· Ó¤Ô Ï·›ÛÈÔ Ô˘ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ fiÏ· Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ ÁÈ· ÙË Ê‡ÛË Î·È ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎÈÓ‰‡ÓˆÓ Ô˘ ‹Úı·Ó ÚfiÛÊ·Ù· ÛÙÔ ÚÔÛ΋ÓÈÔ. ŒÙÛÈ, ÙÔ 2001 ÙÔ ÛÒÌ· ÙˆÓ ÂȉÈÎÒÓ Ô˘ ÂÔÙ‡ÂÈ ÙËÓ ·ÁÎfiÛÌÈ· ÚÔÛ¿ıÂÈ· ÂÎÚ›˙ˆÛ˘ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ÚfiÛıÂÛ ˆ˜ ٤ٷÚÙË ÚÔ¸fiıÂÛË ÙËÓ ‡·ÚÍË ÈηÓÒÓ ·ÔıÂÌ¿ÙˆÓ ÂÌ‚ÔÏ›ˆÓ, ηıÒ˜ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ·ÚÎÔ‡˜ ·Ú·ÁˆÁ‹˜ OPV Û ÂÚ›ÙˆÛË ·Ó›¯Ó¢Û˘ ΢ÎÏÔÊÔÚ›·˜ ¿ÁÚÈÔ˘ ÈÔ‡ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË (26). ¶ÔÏÏ¿ ˙ËÙ‹Ì·Ù· Ô˘ Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· Ì ·˘Ù‹ ÙËÓ ÚÔ¸fiıÂÛË ·Ú·Ì¤ÓÔ˘Ó ÚÔ˜ ÙÔ ·ÚfiÓ ¿Ï˘Ù·, fiˆ˜ ÔÈÔ˜ Â›Ó·È Ô Î·Ù·ÏÏËÏfiÙÂÚÔ˜ Ù‡Ô˜ ÂÌ‚ÔÏ›Ô˘ (ÌÔÓÔ‰‡Ó·ÌÔ ‹ ÙÚȉ‡Ó·ÌÔ), ÔÈ· Â›Ó·È Ë ı¤ÛË ÙÔ˘ IPV, ÔÈÔ˜ ı· Â›Ó·È Ô ‰È·¯ÂÈÚÈÛÙ‹˜ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ, ηıÒ˜ Î·È ÔÈÔ ı· Â›Ó·È ÙÔ Ì¤ÁÂıfi˜ ÙÔ˘˜ Î·È Ò˜ ·˘Ùfi ı· Ú¤ÂÈ Ó· ÌÂÙ·‚¿ÏÏÂÙ·È Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Î·È ÙË ÌÂÙ·‚ÔÏ‹ Ù˘ ·ÓÔÛ›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ (27). ¶·ÚfiÏÔ Ô˘ Â›Ó·È Ï¤ÔÓ ÁÓˆÛÙfi fiÙÈ Ù· ÛÙÂϤ¯Ë cVDPVs ·ÔÙÂÏÔ‡Ó ¤Ó·Ó ˘·ÚÎÙfi ΛӉ˘ÓÔ ÁÈ· ÙËÓ ÚÔÛ¿ıÂÈ· ÂÎÚ›˙ˆÛ˘ Ù˘ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜, ‰ÂÓ ¤¯Ô˘Ó ۯ‰ȷÛı› ̤¯ÚÈ ·˘Ù‹
Pediatr Mar-Apr 06
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ÙË ÛÙÈÁÌ‹ ηıÔÏÈο ·Ô‰ÂÎÙ¤˜ ÛÙÚ·ÙËÁÈΤ˜ ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∏ ÂÍ¿ÏÂÈ„Ë ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ·fi cVDPVs ı· ··ÈÙÔ‡Û ÙËÓ Ù·˘Ùfi¯ÚÔÓË ‰È·ÎÔ‹ Ù˘ ¯ÔÚ‹ÁËÛ˘ OPV ·fi fiϘ ÙȘ ¯ÒÚ˜. ªÈ· Ù¤ÙÔÈ· ΛÓËÛË ı· ÌÔÚÔ‡Û ӷ Á›ÓÂÈ ÌfiÓÔ ÂÊfiÛÔÓ Ë Â˘·ÈÛıËÛ›· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂÈÙ‹ÚËÛ˘ Î·È Ë ·ÓÔÛ›· ÙÔ˘ ÏËı˘ÛÌÔ‡ ›¯·Ó Êı¿ÛÂÈ Û Ôχ ˘„ËÏ¿ ›‰· (Èı·Ófiٷٷ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ ÈÛÙÔÔ›ËÛË Ù˘ ·ÁÎfiÛÌÈ·˜ ÂÎÚ›˙ˆÛ˘ Ù˘ ÓfiÛÔ˘). ∂Âȉ‹ ÔÏϤ˜ ¯ÒÚ˜ Â›Ó·È Èı·Ófi Ó· ÚÔÙÈÌ‹ÛÔ˘Ó Ó· ·ÓÙÈηٷÛÙ‹ÛÔ˘Ó ÙÔ OPV Ì IPV, ·Ú¿ Ó· ÛÙ·Ì·Ù‹ÛÔ˘Ó ÂÓÙÂÏÒ˜ ÙÔÓ ÂÌ‚ÔÏÈ·ÛÌfi, ı· ¯ÚÂÈ·Ûı› ÚÔÛÂÎÙÈÎfi˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Â·ÚÎÒÓ ÔÛÔÙ‹ÙˆÓ IPV. ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÈÙ‹ÚËÛË, ı· Ú¤ÂÈ Ó· Â›Ó·È Û˘Ó¯‹˜ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÒÛÙ ӷ ‰È·ÛÊ·ÏÈÛı› fiÙÈ ÔÔÈ·‰‹ÔÙ ÂÚ›ÙˆÛË Â·Ó·Î˘ÎÏÔÊÔÚ›·˜ ÙÔ˘ ÈÔ‡ ı· ·ÓȯÓ¢ı› ÁÚ‹ÁÔÚ· Î·È ı· ·ÓÙÈÌÂÙˆÈÛı› ˆ˜ ›ÁÔ˘Û· ηٿÛÙ·ÛË ·fi ÙË ‰ÈÂıÓ‹ ÎÔÈÓfiÙËÙ·. ™˘ÓÔ„›˙ÔÓÙ·˜, ı· ÌÔÚÔ‡Û·Ì ӷ ԇ̠fiÙÈ Ô Î›Ó‰˘ÓÔ˜ ·Ú·Ï˘ÙÈ΋˜ ÔÏÈÔÌ˘ÂÏ›Ùȉ·˜ ÌÂÙ¿ ÙËÓ ÂÎÚ›˙ˆÛË Ù˘ ÓfiÛÔ˘, ÂÌ›ÙÂÈ Û ‰‡Ô ηÙËÁÔڛ˜: ·) Û˘Ó¯È˙fiÌÂÓË ¯Ú‹ÛË ÙÔ˘ OPV Î·È ‚) Ï·Óı·Ṳ̂ÓÔÈ ‹ ÂÁÎÏËÌ·ÙÈÎÔ› ¯ÂÈÚÈÛÌÔ› ÙˆÓ Ê˘Ï·ÛÛÔÌ¤ÓˆÓ ·ÔıÂÌ¿ÙˆÓ ¿ÁÚÈˆÓ ÈÒÓ. ∏ ·Ú·¿Óˆ Û˘˙‹ÙËÛË ÂÈÎÂÓÙÚÒıËΠÛÙËÓ ·Ó·ÛÎfiËÛË ÙˆÓ fiÛˆÓ ‰Â‰ÔÌ¤ÓˆÓ ˘¿Ú¯Ô˘Ó ̤¯ÚÈ ·˘Ù‹ ÙË ÛÙÈÁÌ‹ Î·È ·ÊÔÚÔ‡Ó ÛÙÔÓ ÂÓ ÏfiÁˆ ΛӉ˘ÓÔ, ηıÒ˜ Î·È ÛÙÔ˘˜ ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ Ù˘ ‰ÈÂıÓÔ‡˜ ÂÈÛÙËÌÔÓÈ΋˜ ÎÔÈÓfiÙËÙ·˜ ÁÈ· ÙÔÓ Û¯Â‰È·ÛÌfi ÔÏÈÙÈÎÒÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜ Ô˘ ı· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó Ì ¿ÚÎÂÈ· ÙÔ Úfi‚ÏËÌ·. ∏ ‰È·‰Èηۛ· Ï‹„˘ ÙˆÓ ÙÂÏÈÎÒÓ ·ÔÊ¿ÛÂˆÓ ·Ó·Ì¤ÓÂÙ·È Ó· ÂÈÙ·¯˘Óı› ÙÔ 2005 Î·È ı· ÂÍ·ÚÙËı› Û ÌÂÁ¿ÏÔ ‚·ıÌfi ·fi ÙË Ì¤¯ÚÈ ÙfiÙ ÔÚ›· Ù˘ ‰È·‰Èηۛ·˜ ÂÎÚ›˙ˆÛ˘, ·ÏÏ¿ Î·È Ù· ÓÂfiÙÂÚ· ‰Â‰Ô̤ӷ Ô˘ ı· ¤¯Ô˘Ó ÚÔ·„ÂÈ ·fi ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ.
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∫. ¢Ô‡ÚÔ˜ Î·È Û˘Ó.
21. Hardiman M. The revised International Health Regulations: a framework for global health security. Int J Antimicrob Agents. 2003;21:207-211. 22. World Health Assembly. Poliomyelitis eradication. Geneva: World Health Organization; 1999 [Resolution 52.22]. 23. Dowdle WR. The principles of disease elimination and eradication. In: Global disease elimination and eradication as public health strategies. Proceeding of a conference held in Atlanta, Georgia, USA, 23-25 February 1998. Bull World Health Organ 1998;76 (Suppl 2):22 5. 24. Sutter RW, Càceres VM, Lago P. The role of routine
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polio immunization in the post-certification era. Bull World Health Organ 2004;82:31-39. 25. Global eradication of poliomyelitis. Report of the meeting on the scientific basis for stopping polio immunization, Geneva, 23-25 March 1998, WHO/ EPI/GEN/98.12. 26. Report of the seventh meeting of the Technical Consultative Group (TCG) on the global eradication of poliomyelitis, Geneva, 2002. Geneva: World Health Organization; 2002. 27. Fine PE, Oblapenko G, Sutter RW. Polio control after certification: major issues outstanding. Bull World Health Organ 2004;82:47-52.
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∏ ˘fiıÂÛË PANDAS (·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË): ̇ıÔ˜ ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ·; µ. ∆Û·ÁÚ‹˜, ∫. ¢Ô‡ÚÔ˜, ¶. ¡ÈÎÔÏ·˝‰Ô˘ - ∫·Ú·ı›Ô˘
¶ÂÚ›ÏË„Ë: ∏ Û˘Û¯¤ÙÈÛË ‰È·ÊfiÚˆÓ ÊÏÂÁÌÔÓˆ‰ÒÓ ‰È·Ù·Ú·¯ÒÓ, fiˆ˜ Ô ÚÂ˘Ì·ÙÈÎfi˜ ˘ÚÂÙfi˜, Ë ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ·ÓÙȉڷÛÙÈ΋ ·ÚıÚ›Ùȉ·, ÙÔ Ô˙҉˜ ÂÚ‡ıËÌ· Î·È Ë ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ·, Ì ÚÔËÁËı›Û˜ ÛÙÚÂÙÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ, Â›Ó·È ÁÓˆÛÙ‹ Î·È Î·Ï¿ ÙÂÎÌËÚȈ̤ÓË Î·Ù¿ ÙÔ ·ÚÂÏıfiÓ. ∏ ÚfiÛÊ·ÙË ‰È‡ڢÓÛË ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙˆÓ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ì ÙËÓ ÚÔÛı‹ÎË ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ·˘ÙÔ¿ÓÔÛˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û˘Û¯ÂÙÈ˙fiÌÂÓˆÓ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË (PANDAS), ¤¯ÂÈ ÚÔηϤÛÂÈ ÙÔ ÂӉȷʤÚÔÓ ÙÔ˘ ÎÔÈÓÔ‡, ·ÏÏ¿ Î·È Ù˘ ·ÁÎfiÛÌÈ·˜ ÂÈÛÙËÌÔÓÈ΋˜ ÎÔÈÓfiÙËÙ·˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›·, ÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∏ Èı·ÓfiÙËÙ· Û˘Û¯¤ÙÈÛ˘ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, fiˆ˜ Ë È‰ÂÔ„˘¯·Ó·ÁηÛÙÈ΋ ‰È·Ù·Ú·¯‹ Î·È Ù· ÙÈÎ, Ì ÚÔËÁËı›Û˜ ÛÙÚÂÙÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ ·Ú·Ì¤ÓÂÈ ÔˆÛ‰‹ÔÙ ˘fi ·ÌÊÈÛ‚‹ÙËÛË. ∏ ·Ó·ÛÎfiËÛË Ù˘ ÚfiÛÊ·Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ô‰ËÁ› ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÙÔ PANDAS ÂÍ·ÎÔÏÔ˘ı› Ó· ·Ú·Ì¤ÓÂÈ Ì›· ·Ó·fi‰ÂÈÎÙË ˘fiıÂÛË.
°’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi ¡ÔÛÔÎÔÌÂ›Ô Ã·˚‰·Ú›Ô˘ “∞ÙÙÈÎfiÓ”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: µ·Û›ÏÂÈÔ˜ ∆Û·ÁÚ‹˜ ∞ÚÂÔfiψ˜ 30, ¢¿ÛÔ˜ ÷˚‰·Ú›Ô˘ ∆.∫. 124 62, ∞ı‹Ó· E-mail: billtsag@yahoo.com ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-09-2005
§¤ÍÂȘ ÎÏÂȉȿ: PANDAS, ·˘ÙÔ¿ÓÔÛ˜, Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜, ÛÙÚÂÙfiÎÔÎÎÔ˜, ıÂڷ›·.
The PANDAS hypothesis (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection): reality or myth? V. Tsagris, ∫. Douros, P. Nikolaidou - Karpathiou
Abstract: Various inflammatory disorders have been shown to be associated with preceding streptococcal infections, including acute rheumatic fever, post-streptococcal reactive arthritis, erythema nodosum and post-streptococcal glomerulonephritis. The spectrum of post-streptococcal disease has been expanded with the addition of the paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). PANDAS are a recently described subgroup of childhood disorders, and there has been a great deal of public and physician interest in their pathophysiology, diagnosis and management. The likelihood that neuropsychiatric disorders such as obsessive-compulsive disorder (OCD) and tics are related to a preceding streptococcal infection is certainly controversial. The current literature is reviewed, culminating in the conclusion that PANDAS remains a yet-unproven assumption.
3rd Paediatric Clinic of the University of Athens “Attikon” University Hospital, Haidari, Athens Correspondence: Vassilios Tsagris 30 Areopoleos Str., Dasos Haidariou 124 62, Athens E-mail: billtsag@yahoo.com Date of submission: 17-09-2004 Date of approval: 21-09-2005
Key words: PANDAS, autoimmune, neuropsychiatric, streptococcal, treatment.
∂ÈÛ·ÁˆÁ‹ ∏ ȉÂÔ„˘¯·Ó·ÁηÛÙÈ΋ ‰È·Ù·Ú·¯‹ (πæ¢), ÔÈ ‰È·Ù·Ú·¯¤˜ ÙÈÎ Î·È Ë ¯ÔÚ›· Sydenham (Sydenham’s chorea - SC) ·ÔÙÂÏÔ‡Ó Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·Ô‰È‰fiÌÂÓ˜ Èı·Ófiٷٷ Û ‚Ï¿‚Ë ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∆Ô 1989, ÁÈ· ÚÒÙË ÊÔÚ¿, Ô Kiessling
·Ú·Ù‹ÚËÛ fiÙÈ Ë ¤Í·ÚÛË ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙËÓ ÎÔÈÓfiÙËÙ· Û˘Óԉ‡ÙËΠ·fi ‰ÂηϷÛÈ·ÛÌfi ÙˆÓ ·Ú·ÔÌÒÓ ·È‰ÈÒÓ Û π·ÙÚÂ›Ô ¶·Ú·ÎÔÏÔ‡ıËÛ˘ ∫ÈÓËÙÈÎÒÓ ¢È·Ù·Ú·¯ÒÓ (1). ∆Ô 1998, Ì ÙËÓ ÂÚÈÁÚ·Ê‹ ÛÂÈÚ¿˜ 50 ·È‰ÈÒÓ, ÔÈ Swedo Î·È Û˘Ó ÚfiÙÂÈÓ·Ó ÙËÓ ˘fiıÂÛË fiÙÈ Ë πæ¢ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‹/Î·È Ù· ÙÈÎ ÌÔÚÔ‡Ó Ó· ÚÔÎÏËıÔ‡Ó ÛÙÔ Ï·›ÛÈÔ ¶·È‰È·ÙÚÈ΋ 2006;69:97-103
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µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.
Ì›·˜ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ·˘ÙÔ¿ÓÔÛ˘ ‰ÈÂÚÁ·Û›·˜ (2). OÈ Û˘ÁÁÚ·Ê›˜ ÚfiÙÂÈÓ·Ó ÙÔ ·ÎÚˆÓ‡ÌÈÔ PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection - ¶·È‰È·ÙÚÈΤ˜ ·˘ÙÔ¿ÓÔÛ˜ Ó¢ÚÔ„˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û˘Û¯ÂÙÈ˙fiÌÂÓ˜ Ì ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË). ∏ πæ¢ ·Ó‹ÎÂÈ ÛÙȘ ·Á¯Ò‰ÂȘ ‰È·Ù·Ú·¯¤˜ Î·È ·Ú·ÙËÚÂ›Ù·È Û ÔÛÔÛÙfi 1-2% ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ¯ÚfiÓÈ· ‰È·Ù·Ú·¯‹ ÔÈΛÏ˘ ‚·Ú‡ÙËÙ·˜, ÌÂ Û˘¯Ó¤˜ ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, Ë ÔÔ›· Û ‚·ÚÈ¿ ÌÔÚÊ‹ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ·ÙfiÌÔ˘ ÁÈ· ÎÔÈÓˆÓÈ΋ ‹ ‰È·ÚÔÛˆÈ΋ ·ÏÏËÏ›‰Ú·ÛË. ∆Ô ¿ÙÔÌÔ Ì πæ¢ ·Áȉ‡ÂÙ·È Û ̛· ÛÂÈÚ¿ ·ӷÏËÙÈÎÒÓ ÛΤ„ÂˆÓ (ȉÂÔÏË„›Â˜) Î·È Û˘ÌÂÚÈÊÔÚÒÓ („˘¯·Ó·ÁηÛÌÔ›). ™˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ‰È·Ù·Ú·¯¤˜ fiˆ˜ ÙÈÎ (30%), ηٿıÏÈ„Ë (26%), ‰È·Ù·Ú·¯‹ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ (¢∂¶À) (10%) Î·È ¿ÏϘ ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ (20%) (3). ∏ ıÂڷ›· ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÌÂÚÈÊÔÚÈ΋ „˘¯ÔıÂڷ›· ‹/Î·È Ê·Ú̷΢ÙÈ΋ ıÂڷ›· Ì ÂÎÏÂÎÙÈÎÔ‡˜ ·Ó·ÛÙÔÏ›˜ ·ӷÚfiÛÏ˄˘ ÛÂÚÔÙÔÓ›Ó˘ (SSRIs). √È ˘ÔÙÚÔ¤˜ Â›Ó·È Û˘¯Ó¤˜ ηٿ ÙË ‰È·ÎÔ‹ Ù˘ ıÂڷ›·˜, ˆÛÙfiÛÔ Ï‹Ú˘ ‡ÊÂÛË ÌÔÚ› Ó· ·Ú·ÙËÚËı› ηٿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÂÊ˂›·˜. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈÎÔÁÂÓÂȷΤ˜ ÌÂϤÙ˜ ηٷ‰ÂÈÎÓ‡Ô˘Ó ÎÏËÚÔÓÔÌÈÎfiÙËÙ· Ì ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·ÎÙ‹Ú·, Ë ÌË ·ÔÌfiÓˆÛË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ÁÔÓȉ›Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ·Ó¿Ù˘ÍË ÂÈηÛÈÒÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÔÈÎ›ÏˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ∆· ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ·ÔÙÂÏÔ‡Ó Û·Û̈‰ÈΤ˜, ·ÎÔ‡ÛȘ, ·ӷϷ̂·ÓfiÌÂÓ˜ Î·È ÛÙÂÚÂfiÙ˘Â˜ ÎÈÓ‹ÛÂȘ, ÔÈ Ôԛ˜ ÌÔÚ› Ó· ÂËÚ¿ÛÔ˘Ó Î¿ıÂ Ì˘˚΋ ÔÌ¿‰·. ∆·ÍÈÓÔÌÔ‡ÓÙ·È Û ÙÚÂȘ ηÙËÁÔڛ˜: ·) ·ÚÔ‰Èο ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, Ù· ÔÔ›· ·ÔÙÂÏÔ‡Ó ÙË Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹, Ì ηÏÔ‹ıË ÔÚ›· Î·È ‰È¿ÚÎÂÈ· ÌÈÎÚfiÙÂÚË ÙÔ˘ ¤ÙÔ˘˜, ‚) ¯ÚfiÓÈ· ÎÈÓËÙÈο ÙÈÎ Ô˘ ·Ú·Ì¤ÓÔ˘Ó Î·ı’ fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜ Î·È Á) Û‡Ó‰ÚÔÌÔ Tourette (TS), ÙÔ ÔÔ›Ô - ÂÎÙfi˜ ·fi ÎÈÓËÙÈο - ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÊˆÓËÙÈο ÙÈÎ, Ù· ÔÔ›· ÂÓ›ÔÙ ·›ÚÓÔ˘Ó ÙË ÌÔÚÊ‹ Ù˘ ·ÏÈÏ·Ï›·˜, Ù˘ ˯ÔÏ·Ï›·˜ ‹ Î·È Ù˘ ÎÔÚÔÏ·Ï›·˜. ∆Ô TS Èı·Ófiٷٷ ÌÂÙ·‚È‚¿˙ÂÙ·È Ì ·˘ÙfiÛˆÌÔ ÂÈÎÚ·ÙËÙÈÎfi ¯·Ú·ÎÙ‹Ú·, Ì ÙÔ ˘Â‡ı˘ÓÔ ÁÔÓ›‰ÈÔ Ó· ‰ڿ˙ÂÙ·È ÛÙÔ ¯ÚˆÌfiۈ̷ 18q22.1. ∫·ıÒ˜ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë ÁÔÓȉȷ΋ ‚Ï¿‚Ë ÙÔ˘ TS ÌÔÚ› Ó· ÂÎÊÚ·ÛÙ› ÎÏÈÓÈο Î·È Ì ÙË ÌÔÚÊ‹ ÙˆÓ ·ÚÔ‰ÈÎÒÓ ‹ ¯ÚfiÓÈˆÓ ÎÈÓËÙÈÎÒÓ ÙÈÎ, ‰ÂÓ ·ÔÎÏ›ÂÙ·È ¶·È‰È·ÙÚÈ΋ 2006;69:97-103
ÙÂÏÈο ÔÈ ·Ú·¿Óˆ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜ Ó· ·ÏÏËÏÂÈηχÙÔÓÙ·È. ™˘¯Ó¿, ̤ÚÔ˜ Ù˘ ÎÏÈÓÈ΋˜ ÂÈÎfiÓ·˜ ·ÔÙÂÏÔ‡Ó Ù· ȉÂÔ„˘¯·Ó·ÁηÛÙÈο Û˘ÌÙÒÌ·Ù· ηıÒ˜ Î·È Ë ¢∂¶À. ∏ SC ·ÔÙÂÏ› ÙË ÌÔÓ·‰È΋ Ó¢ÚÔÏÔÁÈ΋ ÂΉ‹ÏˆÛË ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡, ÌÂ Û˘Ó‹ıË ¯ÚfiÓÔ ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂٷ͇ 414 ÂÙÒÓ. ¶·ıÔÊ˘ÛÈÔÏÔÁÈο, ÔÈ ÂΉËÏÒÛÂȘ ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ ·fi ÙÔ ∫¡™ Èı·Ófiٷٷ ÂÚÌËÓ‡ÔÓÙ·È Ì¤Ûˆ Ù˘ ‰ÈÂÚÁ·Û›·˜ ÙÔ˘ ÌÔÚÈ·ÎÔ‡ ÌÈÌËÙÈÛÌÔ‡, Ù˘ ·ÓÔÛÔÏÔÁÈ΋˜ ‰È·‰Èηۛ·˜ ηٿ ÙËÓ ÔÔ›· ·ÓÙÈÛÒÌ·Ù· ηٿ ۈ̷ÙÈÎÒÓ ÂÈÙfiˆÓ ÙÔ˘ ‚-·ÈÌÔÏ˘ÙÈÎÔ‡ ÛÙÚÂÙfiÎÔÎÎÔ˘ ÔÌ¿‰·˜ ∞ (GABHS) ·ÓÙȉÚÔ‡Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ· Ì ڈÙÂ˚ÓÈÎÔ‡˜ ÂÈÙfiÔ˘˜ ȉ›ˆÓ ΢ÙÙ¿ÚˆÓ, ÚÔηÏÒÓÙ·˜ ÙËÓ ˘ÚÔ‰fiÙËÛË Ì›·˜ ÊÏÂÁÌÔÓÒ‰Ô˘˜ ·˘ÙÔ¿ÓÔÛ˘ ‰ÈÂÚÁ·Û›·˜. ∂ȉÈÎfiÙÂÚ·, ·ÓÙÈÛÒÌ·Ù· ηٿ GABHS ·ÓÙȉÚÔ‡Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓ· Ì ÙÔ Î˘ÙÙ·ÚfiÏ·ÛÌ· ΢ÙÙ¿ÚˆÓ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÚÔηÏÒÓÙ·˜ ÊÏÂÁÌÔÓ‹ Î·È Û˘Ó·ÎfiÏÔ˘ıË ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÈÓËÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Ù˘ SC (4). ¢È·ÈÛÙÒıËÎÂ, Ì¿ÏÈÛÙ·, Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ Ù›ÙÏÔ˘ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ (Ù· ÔÔ›· ÔÓÔÌ¿ÛÙËÎ·Ó ·ÓÙÈÓÂ˘ÚˆÓÈο) Î·È Ù˘ ‚·Ú‡ÙËÙ·˜ Î·È ¯ÚÔÓÈfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘. ∞ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜, fiÛÔ Î·È ÌÂϤÙ˜ Û ÓÂÎÚÔÙÔÌÈÎfi ˘ÏÈÎfi, ÂȂ‚·ÈÒÓÔ˘Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ ÛÙËÓ ·ıÔÁ¤ÓÂÛË Ù˘ SC. ∆Ô ¯ÚÔÓÈÎfi ‡ÚÔ˜ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂΉËÏÒÛÂˆÓ ÌÂÙ¿ ·fi ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË Î˘Ì·›ÓÂÙ·È ·fi Ï›Á˜ ‚‰ÔÌ¿‰Â˜ ¤ˆ˜ Î·È 9 Ì‹Ó˜. OÈ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯ÔÚ›·, ˘ÔÙÔÓ›· Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·¿ıÂÈ·, Ì ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Ó· ÂÚÈÁÚ¿ÊÂÙ·È ¤ˆ˜ ÚÔԉ¢ÙÈ΋ ‹ - Û ÔÚÈṲ̂Ó˜ ÂÚÈÙÒÛÂȘ - Î·È ıÔÚ˘‚҉˘. π‰ÂÔ„˘¯·Ó·ÁηÛÙÈο Û˘ÌÙÒÌ·Ù· ·Ú·ÙËÚÔ‡ÓÙ·È Û ÔÛÔÛÙfi ¤ˆ˜ Î·È 70% ·ÛıÂÓÒÓ Ì SC, Û˘¯Ó¿ ÚÔËÁÔ‡ÌÂÓ· Ù˘ ¯ÔÚ›·˜ ηٿ Ë̤Ú˜ ‹ Î·È Â‚‰ÔÌ¿‰Â˜. ⁄ÊÂÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·Ú·ÙËÚÂ›Ù·È Û ‰È¿ÛÙËÌ· ÌËÓÒÓ ¤ˆ˜ Î·È 1-2 ÂÙÒÓ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÓÙËÚËÙÈο ̤ÙÚ· ÛÙȘ ‹È˜ ÂÚÈÙÒÛÂȘ Î·È ¯ÔÚ‹ÁËÛË Ê·ÈÓÔ‚·Ú‚ÈÙ¿Ï˘ ‹ ·ÏÏÔÂÚȉfiÏ˘ ÛÙȘ ÛÔ‚·ÚfiÙÂÚ˜. §fiÁˆ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ηډ›Ùȉ·˜, ÂÓÈÎÈÏ›ÓË ¯ÔÚËÁÂ›Ù·È ÚÔÊ˘Ï·ÎÙÈο ̤¯ÚÈ ÙËÓ ÂÓËÏÈΛˆÛË. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ SC ˆ˜ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi Î·È ÎÏÈÓÈÎfi ÚfiÙ˘Ô, ÔÈ Swedo Î·È Û˘Ó ÚfiÙÂÈÓ·Ó ÙÔ PANDAS ˆ˜ Ì›· Û˘ÁÎÂÎÚÈ̤ÓË Î·È Û·ÊÒ˜ ηıÔÚÈ˙fiÌÂÓË ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·. ¶ÚfiÛÊ·Ù·, ÚÔÙ¿ıËÎÂ Ë ‰È‡ڢÓÛË ÙÔ˘
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·99
99
ÀfiıÂÛË PANDAS
Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ PANDAS, Ì ÙËÓ ÚÔÛı‹ÎË ÔÓÙÔÙ‹ÙˆÓ fiˆ˜ Ë Ó¢ÚÔÁÂÓ‹˜ ·ÓÔÚÂÍ›·, Ë ¢∂¶À, ÔÈ Ì˘ÔÎÏÔӛ˜, Ë ‰˘ÛÙÚÔÊÈ΋ ‰˘ÛÙÔÓ›·, ÔÈ ·ÚÔ͢ÛÌÈΤ˜ ‰˘ÛÎÈÓËۛ˜ Î·È Ë ÔÍ›· ‰È¿Û·ÚÙË ÂÁÎÂÊ·ÏÔÌ˘ÂÏ›Ùȉ·.
ÚˆÓ, Û˘Û¯ÂÙ›˙ÔÓÙ·˜ Ì¿ÏÈÛÙ· ÙË ‚·Ú‡ÙËÙ· Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ì ÙȘ ÙÈ̤˜ ÙÔ˘ Ù›ÙÏÔ˘, ·ÔÙ˘Á¯¿ÓÔÓÙ·˜ ˆÛÙfiÛÔ Ó· ÙÂÎÌËÚÈÒÛÂÈ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ PANDAS ‹ ÙËÓ ·ÚÔ˘Û›· ıÂÙÈÎÒÓ Î·ÏÏÈÂÚÁÂÈÒÓ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ÛÙ· ·È‰È¿ Ù˘ ÔÌ¿‰·˜ Ì ÙÈÎ (6).
∏ ˘fiıÂÛË PANDAS
∆Ô ·ÓÔÛÔÏÔÁÈÎfi ˘fi‚·ıÚÔ ∏ ˘fiıÂÛË ÙÔ˘ ·˘ÙÔ¿ÓÔÛÔ˘ ·ıÔÁÂÓÂÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ÙÔ˘ PANDAS ÂÓÈÛ¯‡ÂÙ·È ·fi Ì›· ÛÂÈÚ¿ ‰Â‰Ô̤ӈÓ: O µ ΢ÙÙ·ÚÈÎfi˜ ‰Â›ÎÙ˘ D8/17, Ô ÔÔ›Ô˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠ·Ú¯Èο ˆ˜ ‰È·ÁÓˆÛÙÈÎfi˜ ‰Â›ÎÙ˘ ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Î·È Ù˘ SC, ·ÔÙÂÏ› ¤Ó· ·ÏÏÔ·ÓÙÈÁfiÓÔ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ Ì›·˜ ˘ÔÔÌ¿‰·˜ HLA-DR ıÂÙÈÎÒÓ µ ΢ÙÙ¿ÚˆÓ Ù˘ ÂÚÈÊÂÚÈ΋˜ ΢ÎÏÔÊÔÚ›·˜, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· ·Ó·ÁÓˆÚÈÛÙ› ·fi ÌÔÓÔÎψÓÈο πgª ·ÓÙÈÛÒÌ·Ù·. ∏ Ù¯ÓÈ΋ ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÂÍÂÚÁ·Û›· ÙˆÓ µ ΢ÙÙ¿ÚˆÓ Ì ÙÔ ·Óٛۈ̷ Î·È Ì¤ÙÚËÛË ÙˆÓ ÛËÌ·ÛÌ¤ÓˆÓ µ ΢ÙÙ¿ÚˆÓ. ∆Ô ıÂÙÈÎfi ·ÔÙ¤ÏÂÛÌ· ÔÚ›˙ÂÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· ÛËÌ·ÛÌ¤ÓˆÓ Î˘ÙÙ¿ÚˆÓ Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ·fi 11,8% (7). O ‰Â›ÎÙ˘ D8/17 ÂÌÊ·Ó›˙ÂÈ ˘„ËÏ‹ ¢·ÈÛıËÛ›· (90%) ÁÈ· ÙÔÓ ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, ·ÓÂÍ¿ÚÙËÙ· ·fi ÙË ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ÓfiÛÔ˘. ™Â ·ÛıÂÓ›˜ Ì ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋ ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ‰È·ÈÛÙÒıËΠ¯·ÌËÏ‹ ¤ÎÊÚ·ÛË ÙÔ˘ ‰Â›ÎÙË, Û ·ÓÙȉȷÛÙÔÏ‹ Ì ÛÙÂÓÔ‡˜ Û˘ÁÁÂÓ›˜ ·ÛıÂÓÒÓ Ì ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi, fiÔ˘ Ë ¤ÎÊÚ·ÛË ‹Ù·Ó ˘„ËÏ‹, ÂÓÈÛ¯‡ÔÓÙ·˜ ¤ÙÛÈ ÙËÓ Èı·ÓfiÙËÙ· ‡·Ú͢ ÁÂÓÂÙÈ΋˜ ÚԉȿıÂÛ˘ ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ˆ˜ ˘fiıÂÛË ÂÚÁ·Û›·˜ ÙËÓ ÎÏÈÓÈ΋ ÔÌÔÈfiÙËÙ· ÌÂٷ͇ Ù˘ SC Î·È ÙˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÔÈ Murphy Î·È Û˘Ó ¤ÏÂÁÍ·Ó ÔÌ¿‰· 31 ·È‰ÈÒÓ Ì TS Î·È πæ¢, ‰È·ÈÛÙÒÓÔÓÙ·˜ ˘„ËÏ‹ ¢·ÈÛıËÛ›· ÙÔ˘ ‰Â›ÎÙË D8/17 ÁÈ· ÙÔ TS Î·È ÙËÓ Iæ¢ (100% Î·È 95%, ·ÓÙ›ÛÙÔȯ·) (8). ™Â ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË 27 ·È‰ÈÒÓ Ì PANDAS Î·È 9 ·È‰ÈÒÓ ÌÂ
∫·Ù¿ ÙÔ˘˜ Swedo Î·È Û˘Ó, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË ÙÔ˘ PANDAS ı· Ú¤ÂÈ Ó· ÏËÚÔ‡ÓÙ·È 5 ÎÚÈÙ‹ÚÈ· (¶›Ó·Î·˜ 1). ∏ ÙÂÎÌËÚ›ˆÛË Ù˘ Ïԛ̈͢ ·fi GABHS ·ÔÙÂÏ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô ‰È·ÁÓˆÛÙÈÎfi Ï›ıÔ Î·È ··ÈÙ› ηٿ‰ÂÈÍË ıÂÙÈ΋˜ ηÏÏȤÚÁÂÈ·˜ Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹/Î·È ·‡ÍËÛË ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÛˆÌ¿ÙˆÓ (ASTO, anti-DNase B). ∫·ıÒ˜ ÙÔ PANDAS Î·È Ë SC ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÎÏÈÓÈΤ˜ ÔÌÔÈfiÙËÙ˜ (Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·¿ıÂÈ·, ‰È·Ù·Ú·¯¤˜ ÚÔÛÔ¯‹˜, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ·‰ÂÍÈfiÙËÙ·, ¯ÔÚÂÈÔ·ıÂÙˆÛÈΤ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ¯ÂÚÈÒÓ Î·È ·ÒÏÂÈ· Ù˘ ÈηÓfiÙËÙ·˜ ÁÈ· ÏÂÙÔ‡˜ ¯ÂÈÚÈÛÌÔ‡˜), ÂÈÛËÌ·›ÓÂÙ·È Ë ·Ó¿ÁÎË ·ÓÙȉȷÛÙÔÏ‹˜ ÌÂٷ͇ Ù˘ Ú·ÁÌ·ÙÈ΋˜ ¯ÔÚ›·˜ Ù˘ SC Î·È ÙˆÓ ÌÂÌÔÓˆÌ¤ÓˆÓ “¯ÔÚÂÈfiÌÔÚʈӔ (choreiform) ÎÈÓ‹ÛÂˆÓ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó ÙÔ PANDAS (2). ∫·Ù¿ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÓÙÔÙ‹ÙˆÓ Û˘ÓÂÈÎÔ˘ÚÂ›Ù·È ·fi ÙËÓ ·Ô˘Û›· ‚·Ï‚ȉÈÎÒÓ ‚Ï·‚ÒÓ ÛÙÔ PANDAS, Û ·ÓÙ›ıÂÛË Ì ÙËÓ SC, fiÔ˘ ··ÓÙÒÓÙ·È ÛÙÔ _ ÙˆÓ ÂÚÈÙÒÛˆÓ. ∆ËÓ ·Ú¯È΋ ÂÚÈÁÚ·Ê‹ ·ÎÔÏÔ‡ıËÛ ÚÔ‰ÚÔÌÈ΋ ÌÂϤÙË, ·fi ·ÓÂÍ¿ÚÙËÙË ÔÌ¿‰·, 12 ·ÛıÂÓÒÓ Ô˘ ıˆڋıËΠfiÙÈ ÏËÚÔ‡Ó Ù· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ PANDAS (5). ∆˘ ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÚÔËÁ‹ıËΠÛÙÚÂÙÔÎÔÎÎÈ΋ Ê·Ú˘ÁÁÔ·Ì˘Á‰·Ï›Ùȉ·, ÂÓÒ ·Ó·Ê¤ÚÂÙ·È ‡ÊÂÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ (πæ¢ Î·È ÙÈÎ) ÌÂÙ¿ ÙËÓ ¤Ó·ÚÍË Ù˘ ηٿÏÏËÏ˘ ·ÓÙÈÌÈÎÚԂȷ΋˜ ·ÁˆÁ‹˜. ™Â ÚfiÛÊ·ÙË Â›Û˘, ÚÔ‰ÚÔÌÈ΋, ÌÂϤÙË, Ô Cardona ÌÂϤÙËÛ ÔÌ¿‰· 150 ·È‰ÈÒÓ Ì ÙÈÎ, ‰È·ÈÛÙÒÓÔÓÙ·˜ ÛËÌ·ÓÙÈο ·˘ÍË̤Ó˜ ÙÈ̤˜ Ù›ÙÏÔ˘ ASTO Û ۯ¤ÛË Ì ÔÌ¿‰· Ì·ÚÙ‡¶›Ó·Î·˜ 1. ¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· PANDAS (ηٿ Swedo et al)
1. ¶·ÚÔ˘Û›· πæ¢ ‹/Î·È ÙÈÎ (ηٿ DSM πππ-R ‹ IV)* 2. ŒÓ·ÚÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÌÂٷ͇ 3 ÂÙÒÓ Î·È ·Ú¯‹˜ ÂÊ˂›·˜ 3. ∞ÈÊÓ›‰È· ¤Ó·ÚÍË Û˘ÌÙˆÌ¿ÙˆÓ ‹ ÔÚ›· ¯·Ú·ÎÙËÚÈ˙fiÌÂÓË ·fi ‰Ú·Ì·ÙÈΤ˜ ÂÍ¿ÚÛÂȘ. ∆· Û˘ÌÙÒÌ·Ù· ˘Ê›ÂÓÙ·È ÌÂٷ͇ ÙˆÓ ÂÍ¿ÚÛÂˆÓ Î·È ÂÓ›ÔÙ ÂÍ·Ê·Ó›˙ÔÓÙ·È ÙÂÏ›ˆ˜ 4. ™˘Û¯¤ÙÈÛË Ì Ïԛ̈ÍË ·fi GABHS: Ë ¤Í·ÚÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ú¤ÂÈ Ó· Û˘Û¯ÂÙ›˙ÂÙ·È Ì Ïԛ̈ÍË ·fi GABHS (.¯. ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ‹/Î·È ·˘ÍË̤ÓÔÈ Ù›ÙÏÔÈ ·ÓÙÈۈ̿وÓ) (ηٿ ÚÔÙ›ÌËÛË Û 2 ‹ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ) 5. ¶·ıÔÏÔÁÈ΋ Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË (˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ¯ÔÚÂȷΤ˜ ÎÈÓ‹ÛÂȘ, ÙÈÎ) ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÂÍ¿ÚÛÂˆÓ * Diagnostic and Statistical Manual of Mental Disorders. 3rd revised/4th ed. American Psychiatry Association ¶·È‰È·ÙÚÈ΋ 2006;69:97-103
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·100
100
µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.
SC, ‰È·ÈÛÙÒıËΠ¢·ÈÛıËÛ›· Ù˘ ÌÂıfi‰Ô˘ Û ÔÛÔÛÙfi 85% Î·È 89%, ·ÓÙ›ÛÙÔȯ· (9), Ì ÌÂȈ̤ÓË ˆÛÙfiÛÔ ÂȉÈÎfiÙËÙ· Î·È ÁÈ· ÙȘ ‰‡Ô ÔÓÙfiÙËÙ˜. ∂›Ó·È, ÂÔ̤ӈ˜, ÚÔÊ·Ó¤˜ fiÙÈ Ë ¤ÎÊÚ·ÛË ÙÔ˘ ‰Â›ÎÙË D8/17 ÌfiÓË ‰ÂÓ ·ÚΛ ÁÈ· ÙË ‰È¿ÎÚÈÛË ÌÂٷ͇ ·È‰ÈÒÓ Ì PANDAS Î·È ·˘ÙÒÓ Ì TS Î·È πæ¢. ∂ÈϤÔÓ, Ë ¯ÚËÛÈÌfiÙËÙ· Ù˘ ÌÂıfi‰Ô˘ ·Ú·Ì¤ÓÂÈ ÂÚÈÔÚÈṲ̂ÓË, ηıÒ˜ ‰ÂÓ ‰È·Ù›ıÂÙ·È ·ÎfiÌË ÂÌÔÚÈο. ∞ÂÈÎÔÓÈÛÙÈΤ˜ ÌÂϤÙ˜ Ì ̷ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ·ÛıÂÓÒÓ Ì SC ¤¯Ô˘Ó ηٷ‰Â›ÍÂÈ ÙËÓ ‡·ÚÍË ‚Ï·‚ÒÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, ΢ڛˆ˜ Ì ÙË ÌÔÚÊ‹ ·‡ÍËÛ˘ ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ÎÂÚÎÔÊfiÚÔ˘ ˘Ú‹Ó·, ÙÔ˘ ÎÂχÊÔ˘˜ Î·È Ù˘ ˆ¯Ú‹˜ ÛÊ·›Ú·˜. ™Â ÌÂϤÙË 34 ·È‰ÈÒÓ Ì PANDAS Î·È 82 Ì·ÚÙ‡ÚˆÓ ‰È·ÈÛÙÒıËΠÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ Î·È ÛÙËÓ ÔÌ¿‰· PANDAS (10). ∏ ·‡ÍËÛË ·˘Ù‹ ·Ô‰fiıËΠ۠ÊÏÂÁÌÔÓÒ‰Ë ‰ÈÂÚÁ·Û›·, ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·˘ÙÔ¿ÓÔÛ˘ ·¿ÓÙËÛ˘ ÛÙËÓ ·Ú¯È΋ ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË. ∏ ÎÏÈÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÌÂÏÂÙÒÓ Ì·ÁÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ ·Ú·Ì¤ÓÂÈ ÂÚÈÔÚÈṲ̂ÓË, ηıÒ˜ Ë Ì¤ıÔ‰Ô˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂȈ̤ÓË Â˘·ÈÛıËÛ›· Î·È ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔ PANDAS Î·È ‰ÂÓ ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÙˆÓ Â˘ÚËÌ¿ÙˆÓ Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘. £Âڷ¢ÙÈ΋ ·Ú¤Ì‚·ÛË ∏ SC ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË ÔÚ›·, Ì ÙË Û˘Ìو̷ÙÔÏÔÁ›· Ó· ˘Ô¯ˆÚ› Û ÌÂÚÈΤ˜ ‚‰ÔÌ¿‰Â˜ ‹ Î·È Ì‹Ó˜. ∆Ô ·ÓÔÛÔÏÔÁÈÎfi ·ıÔÁÂÓÂÙÈÎfi ˘fiÛÙڈ̷ ·ÔÙ¤ÏÂÛ ÙÔ ¤ÚÂÈÛÌ· ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ·ÓÔÛÔÙÚÔÔÔÈËÙÈÎÒÓ ıÂڷ¢ÙÈÎÒÓ ·ÚÂÌ‚¿ÛÂˆÓ Û ·ÛıÂÓ›˜ Ì ¯ÚÔÓ›˙Ô˘Û· ÔÚ›·. ∫ÔÚÙÈÎÔÛÙÂÚÔÂȉ‹, ÂÓ‰ÔÊϤ‚È· Á-ÛÊ·ÈÚ›ÓË (IVIG) Î·È Ï·ÛÌ·Ê·›ÚÂÛË ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı›, Ì ·ÌÊÈÏÂÁfiÌÂÓ· ˆÛÙfiÛÔ ·ÔÙÂϤÛÌ·Ù·. ÃÚËÛÈÌÔÔÈÒÓÙ·˜ ÙËÓ SC ˆ˜ ÚfiÙ˘Ô, Ë ÔÌ¿‰· Ù˘ Swedo ‰ËÌÔÛ›Â˘Û ÙÔ 1999 ÌÂϤÙË 30 ·È‰ÈÒÓ Ì PANDAS, Ù· ÔÔ›· ·ÓÙÈÌÂÙˆ›ÛÙËÎ·Ó Ì IVIG Î·È Ï·ÛÌ·Ê·›ÚÂÛË, ÂÓÒ Ù· ·ÔÙÂϤÛÌ·Ù· ÂϤÁ¯ıËÎ·Ó ¤Ó·ÓÙÈ ÔÌ¿‰·˜ Ô˘ ¤Ï·‚ placebo IVIG (Ì ÙË ÌÔÚÊ‹ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÔÚÔ‡), fi¯È fï˜ Î·È placebo Ï·ÛÌ·Ê·›ÚÂÛ˘ (ÁÈ· ËıÈÎÔ‡˜ ÏfiÁÔ˘˜) (11). ∆· ÎÚÈÙ‹ÚÈ· ÂÈÛ·ÁˆÁ‹˜ ÂÚÈÂÏ¿Ì‚·Ó·Ó ·ÚfiÌÔÈ·, "‚·ÚÈ¿" ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ì ‚¿ÛË ÂȉÈο ‰È·ÌÔÚʈ̤ÓË ÎÏÈÓÈ΋ Îϛ̷η ·ÍÈÔÏfiÁËÛ˘ Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜. ™Â ‰È¿ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜, ·Ó·Ê¤ÚÂÙ·È ÎÏÈÓÈ΋ ‚ÂÏÙ›ˆÛË ÛÙȘ ÔÌ¿‰Â˜ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó IVIG ‹ Ï·ÛÌ·Ê·›ÚÂÛË, ¯ˆÚ›˜ ÌÂÙ·‚ÔÏ‹ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¶·È‰È·ÙÚÈ΋ 2006;69:97-103
ÙˆÓ ·È‰ÈÒÓ Ô˘ ¤Ï·‚·Ó placebo. ™Â ‰È¿ÛÙËÌ· ÂÓfi˜ ¤ÙÔ˘˜, 80% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ¤Ï·‚·Ó IVIG ‹ ˘Ô‚Ï‹ıËÎ·Ó Û ϷÛÌ·Ê·›ÚÂÛË ·Ú¤ÌÂÈÓ Û ‡ÊÂÛË. ∫·ıÒ˜, ˆÛÙfiÛÔ, ÙÔ 50% ·˘ÙÒÓ Û˘Ó¤¯È˙ ӷ Ï·Ì‚¿ÓÂÈ ÙËÓ ·Ú¯È΋ Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ (SSRIs ‹ Ó¢ÚÔÏËÙÈο), Ù· ·ÔÙÂϤÛÌ·Ù· ‹Ù·Ó ‰‡ÛÎÔÏÔ Ó· ·ÍÈÔÏÔÁËıÔ‡Ó. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi, ηıÒ˜ Î·È ÙÔ fiÙÈ Ë ¯ÔÚ‹ÁËÛË IVIG Î·È Ë Ï·ÛÌ·Ê·›ÚÂÛË ·Ú·Ì¤ÓÔ˘Ó Ì¤ıÔ‰ÔÈ ·ÚÂÌ‚·ÙÈΤ˜ Î·È ‰··ÓËÚ¤˜ Î·È Ì ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ·ÓÂÈı‡ÌËÙˆÓ ÂÓÂÚÁÂÈÒÓ, Ô‰‹ÁËÛ Û ¤Î‰ÔÛË Ô‰ËÁ›·˜ ·fi ÙÔ ∞ÌÂÚÈηÓÈÎfi πÓÛÙÈÙÔ‡ÙÔ æ˘¯È΋˜ ÀÁ›·˜ (¡πª∏) ÁÈ· ·ÔÊ˘Á‹ ÙˆÓ ·Ú·¿Óˆ ÌÂıfi‰ˆÓ ̤¯ÚÈ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÌÂÁ·Ï‡ÙÂÚˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÌÂÏÂÙÒÓ ·ÓÔÛÔÙÚÔÔÔÈËÙÈ΋˜ ·Ú¤Ì‚·Û˘. ¶ÚÔʇϷÍË ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚÔÊ˘Ï·ÎÙÈ΋˜ ¯ÔÚ‹ÁËÛ˘ ÂÓÈÎÈÏ›Ó˘ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ ˘ÔÙÚÔÒÓ ÚÂ˘Ì·ÙÈÎÔ‡ ˘ÚÂÙÔ‡ Â›Ó·È ÁÓˆÛÙ‹ Î·È ÙÂÎÌËÚȈ̤ÓË, ÂÓÒ ÛÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ PANDAS ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË. ª›· ÈÏÔÙÈ΋ ‰ÈÏ‹-Ù˘ÊÏ‹ ÌÂϤÙË ÂÚȤϷ‚ 37 ·È‰È¿ Ì PANDAS, ÛÙ· ÔÔ›· ÌÂÏÂÙ‹ıËÎÂ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ¯ÔÚ‹ÁËÛ˘ per os ÂÓÈÎÈÏ›Ó˘ ¤Ó·ÓÙÈ placebo (12). ∞Ó Î·È ÙÔ ÂӉȷʤÚÔÓ ÁÈ· ÙËÓ ¤Î‚·ÛË Ù˘ ÌÂϤÙ˘ ˘‹ÚÍ ·Ú¯Èο ˙ˆËÚfi, ηıÒ˜ ›¯Â ‹‰Ë ÂÎÊÚ·ÛÙ› Ë Èı·ÓfiÙËÙ· ·ıÚÔÈÛÙÈ΋˜ ‰Ú¿ÛË ÙˆÓ Â·Ó·Ï·Ì‚·ÓfiÌÂÓˆÓ ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ÛÙËÓ ÔÚ›· Î·È ÙË ‚·Ú‡ÙËÙ· ÙÔ˘ PANDAS, Ù· ·ÔÙÂϤÛÌ·Ù¿ Ù˘ ‰ÂÓ Î·Ù¤‰ÂÈÍ·Ó ‰È·ÊÔÚ¿ fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ‹ ÛÙË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ Î·È ÙË ‚·Ú‡ÙËÙ· ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÔÌ¿‰ˆÓ. ∞ÓÙ›ıÂÙ·, ‰Â‰Ô̤ӷ ·fi ¿ÏÏË ÌÂϤÙË Î·Ù·‰ÂÈÎÓ‡Ô˘Ó ‚ÂÏÙ›ˆÛË ÙˆÓ ÂÍ¿ÚÛÂˆÓ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ·fi ÚÔÊ˘Ï·ÎÙÈ΋ ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚ÈÔÙÈÎÒÓ (5). ∏ ÌÂϤÙË ·˘Ù‹ ¤¯ÂÈ ‰Â¯ı› ÎÚÈÙÈ΋ fiÛÔÓ ·ÊÔÚ¿ ÛÙÔÓ Û¯Â‰È·ÛÌfi Ù˘, ηıÒ˜ ‰ÂÓ Â›Ó·È Ù˘ÊÏ‹ Î·È ‰ÂÓ ¯ÚËÛÈÌÔÔÈÂ›Ù·È placebo. ∫·ıÒ˜ ÙÔ Ê·ÈÓfiÌÂÓÔ placebo ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿ ÛÙÔ TS Î·È ÛÙËÓ πæ¢ Î·È Ë Ê˘ÛÈ΋ ÙÔ˘˜ ÔÚ›· ÙÔ˘˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, ηı›ÛÙ·Ù·È Èı·Ó‹ Ë Ê·ÈÓÔÌÂÓÈ΋ ÂÈÙ˘¯›· ÔÔÈ·Û‰‹ÔÙ ıÂڷ¢ÙÈ΋˜ ·Ú¤Ì‚·Û˘ ÛÙÔ ÛÙ¿‰ÈÔ ¤Í·ÚÛ˘ Ù˘ ÓfiÛÔ˘. ∏ ‰È‡ڢÓÛË ÙÔ˘ Ê¿ÛÌ·ÙÔ˜ ÙÔ˘ PANDAS ∂ÎÙfi˜ ·fi Ù· ÙÈÎ Î·È ÙËÓ πæ¢, Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ‰È¿ÊÔÚ˜ ÔÓÙfiÙËÙ˜ ¤¯Ô˘Ó ÚÔÙ·ı› ˆ˜
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·101
101
ÀfiıÂÛË PANDAS
˘Ô„‹ÊȘ ÚÔ˜ ¤ÓÙ·ÍË ÛÙÔ ÎÏÈÓÈÎfi Ê¿ÛÌ· ÙÔ˘ PANDAS. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ÂÚÈÁÚ¿ÊÂÙ·È ÔÌ¿‰· 4 ·È‰ÈÒÓ ÛÙ· ÔÔ›· Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ Ó¢ÚÔÁÂÓÔ‡˜ ·ÓÔÚÂÍ›·˜ (¡∞), ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ÏËÚÔ‡Û·Ó Ù· ÎÚÈÙ‹ÚÈ· ÙÔ˘ PANDAS (13). ™Â 2 ·fi ·˘Ù¿ ‰È·ÈÛÙÒıËÎ·Ó Û˘ÌÙÒÌ·Ù· πæ¢, ÂÓÒ Ë ·ÚÂÏıÔ‡Û· ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË ÙÂÎÌËÚÈÒıËΠÛÙË ‚¿ÛË ·˘ÍËÌ¤ÓˆÓ Ù›ÙÏˆÓ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈۈ̿وÓ. ™˘Û¯¤ÙÈÛË ‰È·ÈÛÙÒıËΠÌÂٷ͇ ÂÂÈÛÔ‰›ˆÓ ·Ú·ÚÚÈÓÈÎÔÏ›Ùȉ·˜ Î·È ÂÍ¿ÚÛÂˆÓ Ù˘ Ó¢ÚÔÁÂÓÔ‡˜ ·ÓÔÚÂÍ›·˜, ÂÓÒ Î·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜ Ì ¯ÔÚ‹ÁËÛË ·ÌÔ͢ÎÈÏÏ›Ó˘ ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ô‰‹ÁËÛ Û ·‡ÍËÛË ÙÔ˘ ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Î·È ‡ÊÂÛË ÙˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ Û˘Ìو̿وÓ. ™ËÌ·ÓÙÈΤ˜ ÂÓÛÙ¿ÛÂȘ ÌÔÚÔ‡Ó Ó· ÂÎÊÚ·ÛÙÔ‡Ó fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÙÂÎÌËÚ›ˆÛË Ù˘ ·ÚÂÏıÔ‡Û·˜ ÛÙÚÂÙÔÎÔÎÎÈ΋˜ Ïԛ̈͢ Î·È ÛÙËÓ ÂȯÂÈÚÔ‡ÌÂÓË Û˘Û¯¤ÙÈÛË Ù˘ Âȉ›ӈÛ˘ Ù˘ NA Ì ÙÔÓ ·ÈÙÈÔÏÔÁÈÎfi ·Ú¿ÁÔÓÙ· Ù˘ Ïԛ̈͢, ·Ú¿ Ì ÙËÓ Î·ÎÔ˘¯›· Ô˘ Ë ÙÂÏÂ˘Ù·›· ·Ï¿ ÂÈʤÚÂÈ. øÛÙfiÛÔ, Ë ÌÂϤÙË Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ú¤¯ÂÈ ÚÔ‰ÚÔÌÈο ÛÙÔȯ›· Èηӿ Ó· ˘ÔÛÙËÚ›ÍÔ˘Ó ÙËÓ ‡·ÚÍË Ì›·˜ ˘ÔηÙËÁÔÚ›·˜ ¡∞ Ô˘ ı· ÌÔÚÔ‡Û ӷ Û˘ÌÂÚÈÏËÊı› ÛÙÔ Ê¿ÛÌ· ÙÔ˘ PANDAS. ªÂÙ·ÁÂÓ¤ÛÙÂÚË ÌÂϤÙË Î·Ù¤‰ÂÈÍ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ D8/17 ‰Â›ÎÙË ÛÙÔ 81% ·ÛıÂÓÒÓ Ì NA Ù‡Ô˘ PANDAS, Û ۯ¤ÛË Ì ÔÛÔÛÙfi ÌfiÏȘ 12% Û ÔÌ¿‰· „˘¯È·ÙÚÈÎÒÓ ·ÛıÂÓÒÓ ¯ˆÚ›˜ ‰È·ÙÚÔÊÈΤ˜ ‰È·Ù·Ú·¯¤˜, ·Ó Î·È ÂÚ·ÈÙ¤Úˆ ÎÚÈÙÈ΋ ı· ÌÔÚÔ‡Û ӷ ·ÛÎËı›, ηıÒ˜ ÛÙÔÓ Û¯Â‰È·ÛÌfi ‰ÂÓ ÂÚÈÏ‹ÊıËΠÔÌ¿‰· PANDAS ¯ˆÚ›˜ ‰È·ÙÚÔÊÈΤ˜ ‰È·Ù·Ú·¯¤˜ (14). ∏ ÎÏÈÓÈ΋ Û˘Ó‡·ÚÍË Ù˘ ¢∂¶À Ì ÙËÓ πæ¢ Î·È Ù· ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯Ó¿. ¶ÚfiÛÊ·Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ˆÛÙfiÛÔ, ˘ÔÛÙËÚ›˙Ô˘Ó ÙËÓ ‡·ÚÍË ÌÔÚÊ‹˜ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈ΋˜ ¢∂¶À, ¯ˆÚ›˜ ÛÙÔȯ›· πæ¢ ‹ ÙÈÎ, ˆ˜ ÙÌ‹Ì· ÙÔ˘ "·ÛÙÂÚÈÛÌÔ‡" ÙÔ˘ PANDAS, ηıÒ˜ Î·È ÙËÓ ‡·ÚÍË ıÂÙÈ΋˜ Û˘Û¯¤ÙÈÛ˘ ÌÂٷ͇ ·‡ÍËÛ˘ ÙÔ˘ Ù›ÙÏÔ˘ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Î·È ÙÔ˘ fiÁÎÔ˘ ÙˆÓ ‚·ÛÈÎÒÓ Á·ÁÁÏ›ˆÓ, Û ·ÛıÂÓ›˜ Ì ¢∂¶À (15,16).
∫ÚÈÙÈ΋ ıÂÒÚËÛË ∏ ¤ÎÊÚ·ÛË Ù˘ ˘fiıÂÛ˘ PANDAS ˘ÚÔ‰fiÙËÛ ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÂÚ¢ÓËÙÈÎÒÓ ÚÔÛ·ıÂÈÒÓ ÛÙÔÓ ¯ÒÚÔ ÙˆÓ Ó¢ÚÔ„˘¯È·ÙÚÈÎÒÓ
‰È·Ù·Ú·¯ÒÓ, ÙfiÛÔ Û ÎÏÈÓÈÎfi Â›Â‰Ô fiÛÔ Î·È ÛÂ Â›Â‰Ô ‚·ÛÈÎÒÓ ÂÈÛÙËÌÒÓ. øÛÙfiÛÔ, Ù· ·ÔÙÂϤÛÌ·Ù· Û˘¯Ó¿ ˘‹ÚÍ·Ó ·ÓÙÈÊ·ÙÈο. ™ÎÂÙÈÎÈÛÌfi ÚÔηÏ›, ›Û˘, ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÏÂÈÔÓfiÙËÙ· ÙˆÓ ‰ËÌÔÛȇÛÂˆÓ ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ›‰È· ÙËÓ ÔÌ¿‰· Ù˘ Swedo, ÂÓÒ ÔÈ ·ÓÂÍ¿ÚÙËÙ˜ ÌÂϤÙ˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο ÂÚÈÔÚÈṲ̂Ó˜ Û ·ÚÈıÌfi (5,6,15,17). ∏ ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË ÙˆÓ Kurlan Î·È Kaplan ·ÔÙÂÏ› ÙËÓ ÂÈÙÔÌ‹ ÙˆÓ ·ÓÙÈÚÚ‹ÛÂˆÓ Ô˘ ¤¯Ô˘Ó ÂÎÊÚ·ÛÙ› ̤¯ÚÈ Û‹ÌÂÚ·, Û¯ÂÙÈο Ì ÙËÓ ÙÂÎÌËÚ›ˆÛË Î·È, ÙÂÏÈο, ÙËÓ ‡·ÚÍË ÙÔ˘ PANDAS (18). ∏ ÎÚÈÙÈ΋ ÂÈÎÂÓÙÚÒÓÂÙ·È Î˘Ú›ˆ˜ ÛÙËÓ ·Û¿ÊÂÈ· ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ Ô˘ ¤¯Ô˘Ó ıÂÛÈÛÙ› (¶›Ó·Î·˜ 1). ™˘ÁÎÂÎÚÈ̤ӷ: ·) OÈ ÏfiÁÔÈ Ù˘ ÂÈÏÂÎÙÈ΋˜ ÚÔÛ‚ÔÏ‹˜ Û˘ÁÎÂÎÚÈ̤Ó˘ ËÏÈÎȷ΋˜ ÔÌ¿‰·˜ ·È‰ÈÒÓ ‰ÂÓ ÙÂÎÌËÚÈÒÓÔÓÙ·È Â·ÚÎÒ˜. ŒÙÛÈ, ·˘Ù‹ ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› ÛÙ· ÚfiÙ˘· ·Ú·ÔÌ‹˜ ‹ Î·È ÛÙËÓ ·˘ÍË̤ÓË ¤ÎıÂÛË ÛÙÔÓ GABHS ÛÙÔ Û¯ÔÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ. ™ÙÔÓ ·ÓÙ›ÏÔÁfi ÙÔ˘˜, ÔÈ Swedo Î·È Û˘Ó ÂÈηÏÔ‡ÓÙ·È ÌÂϤÙË ÙÔ˘ Fischetti, Û‡Ìʈӷ Ì ÙËÓ ÔÔ›· Ë ÌÂȈ̤ÓË Û˘¯ÓfiÙËÙ· ÙˆÓ ÌÂÙ·ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÂÈÏÔÎÒÓ ÛÙË ÌÂÙÂÊË‚È΋ ËÏÈΛ· ·Ô‰›‰ÂÙ·È ÛÙËÓ ‡·ÚÍË "ÚÔÛٷ٢ÙÈÎÔ‡" Ù›ÙÏÔ˘ ·ÓÙÈÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙËÓ ¤Ó·ÚÍË Ù˘ ÂÊ˂›·˜ (19,20). øÛÙfiÛÔ, Ë ÂÚÌËÓ›· ·˘Ù‹ ÌÔÚ› Ó· ıˆÚËı› ·‚¿ÛÈÌË, ηıÒ˜ Ë ÏÔÈÌÔÁfiÓÔ˜ ÈηÓfiÙËÙ· ÙÔ˘ GABHS ÂÍ·ÚÙ¿Ù·È Û ÛËÌ·ÓÙÈÎfi ‚·ıÌfi ·fi ÙËÓ ÚˆÙ½ÓË ª ÙÔ˘ ΢ÙÙ·ÚÈÎÔ‡ ÙÔȯÒÌ·ÙÔ˜ Î·È ÙˆÓ ÈÓȉ›ˆÓ ÙÔ˘, Ë Ù·˘ÙfiÙËÙ· Ù˘ ÔÔ›·˜ ηıÔÚ›˙ÂÈ Î·È ÙÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ (¿Óˆ ·fi 80) ÔÚÔÙ‡Ô˘˜ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ™ÙÂϤ¯Ë ÏÔ‡ÛÈ· Û ڈÙ½ÓË ª ÂÌÊ·Ó›˙Ô˘Ó ·ÓÙÔ¯‹ ÛÙË Ê·ÁÔ΢ÙÙ¿ÚˆÛË, ÂÓÒ ÛÙÂϤ¯Ë ÊÙˆ¯¿ Û ڈÙ½ÓË ª fi¯È. ∆Ô ª ÚˆÙÂ˚ÓÈÎfi ·ÓÙÈÁfiÓÔ ‰ÈÂÁ›ÚÂÈ ÙËÓ ·Ú·ÁˆÁ‹ ÚÔÛٷ٢ÙÈÎÒÓ ·ÓÙÈۈ̿وÓ, Ù· ÔÔ›· ˆÛÙfiÛÔ ÂÌÊ·Ó›˙Ô˘Ó ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ÌfiÓÔ ·ÓÙÈÁÔÓÈÎfi Ù‡Ô. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ÔÈ ÛÙÚÂÙÔÎÔÎÎÈΤ˜ ÏÔÈÌÒÍÂȘ ÌÔÚ› Ó· ·ÊÔÚÔ‡Ó Û ¤Ó· ÂÍ·ÈÚÂÙÈο ¢ڇ Ê¿ÛÌ· ÔÚÔÙ‡ˆÓ Î·È Î·ıÒ˜ ·ÎfiÌ· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹ Ë Ù·˘ÙfiÙËÙ· ·˘ÙÒÓ Ô˘ ÌÔÚ› Ó· ¢ı‡ÓÔÓÙ·È ÁÈ· ÙÔ PANDAS, Ë ˘ÔÛÙ‹ÚÈÍË Ù˘ ›Ù¢Í˘ ηıÔÏÈ΋˜ ·ÓÔÛ›·˜ ¤Ó·ÓÙÈ fiÏˆÓ ÙˆÓ ÔÚÔÙ‡ˆÓ ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ ÌÔÈ¿˙ÂÈ ·Ú·ÎÈÓ‰˘ÓÂ˘Ì¤ÓË (21). ‚) O ÔÚÈÛÌfi˜ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ¯·Ú·ÎÙ‹Ú· ¤Ó·Ú͢ ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ˆ˜ ‰È·ÁÓˆÛÙÈÎfi ÎÚÈÙ‹ÚÈÔ ÚÔηÏ› Û‡Á¯˘ÛË, ηıÒ˜ - ÁÈ· ·Ú¿‰ÂÈÁÌ· - Ë ·ÚÔ˘Û›· ÙˆÓ ÙÈÎ ÌÔÚ› Ó· ÔÚÈÛÙ› ¶·È‰È·ÙÚÈ΋ 2006;69:97-103
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·102
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µ. ∆Û·ÁÚ‹˜ Î·È Û˘Ó.
ÌÔÓÔÛ‹Ì·ÓÙ· (·Ï¿ ˘¿Ú¯Ô˘Ó ‹ ‰ÂÓ ˘¿Ú¯Ô˘Ó). ∂›Û˘, ·ÌÊÈ‚Ôϛ˜ ÂÎÊÚ¿˙ÔÓÙ·È ÁÈ· ÙÔ ·Ó Ë ¯·Ú·ÎÙËÚÈÛÙÈ΋, Ì ˘Ê¤ÛÂȘ Î·È ÂÍ¿ÚÛÂȘ, ÎÏÈÓÈ΋ ÔÚ›·, ÂÌÊ·Ó›˙ÂÈ ÂȉÈÎfiÙËÙ· ÁÈ· ÙÔ PANDAS, ηıÒ˜ ·ÚfiÌÔÈ· ÔÚ›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·È ÔÈ Û˘Ì‚·ÙÈÎfiÙÂÚ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, fiˆ˜ Ù· ÌÂÌÔӈ̤ӷ ÙÈÎ ‹ Ë πæ¢. Á) ∏ Û˘Û¯¤ÙÈÛË Ù˘ ¤Í·ÚÛ˘ Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ì ÚÔËÁËı›۷ ÛÙÚÂÙÔÎÔÎÎÈ΋ Ïԛ̈ÍË ·ÔÙÂÏ› ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô ‰È·ÁÓˆÛÙÈÎfi Ï›ıÔ ÙÔ˘ PANDAS. øÛÙfiÛÔ, Ë Û˘Û¯¤ÙÈÛË ·˘Ù‹ ‰ÂÓ ¤¯ÂÈ Ì¤¯ÚÈ Û‹ÌÂÚ· ÂȂ‚·Èˆı› Ì ÚÔ‰ÚÔÌÈΤ˜ ÌÂϤÙ˜. ∂ÈϤÔÓ, Ë ¤ÏÏÂÈ„Ë ÎÏÈÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ‰ËÌÈÔ˘ÚÁ› Û‡Á¯˘ÛË, ηıÒ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ Ì ıÂÙÈ΋ ηÏÏȤÚÁÂÈ· Ê·Ú˘ÁÁÈÎÔ‡ ÂȯڛÛÌ·ÙÔ˜ ÌÔÚ› Ó· ·ÓÙÈÚÔۈ‡ÂÈ ·ÏÔ‡˜ ÊÔÚ›˜, ÂÓÒ Î·È Ô ·˘ÍË̤ÓÔ˜ Ù›ÙÏÔ˜ ·ÓÙÈÛˆÌ¿ÙˆÓ ‰ÂÓ ·ÚΛ ÁÈ· ÙËÓ Î·Ù¿‰ÂÈÍË ÂÓÂÚÁÔ‡ Ïԛ̈͢. ∫·ıÒ˜ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÛÙÚÂÙÔÎÔÎÎÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·Ú·Ì¤ÓÂÈ ÂÍ·ÈÚÂÙÈο ÌÂÁ¿ÏË ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ë ÂȂ‚·›ˆÛË Ù˘ Ïԛ̈͢ ·ÎÔÏÔ˘ı› Ì›· ·Û·ÊÒ˜ ηıÔÚÈ˙fiÌÂÓË Î·È ¯·Ï·Ú‹ ÌÂıÔ‰ÔÏÔÁ›·, Â›Ó·È ÚÔÊ·Ó¤˜ fiÙÈ ÛÙÔ ÎÏÈÓÈÎfi Ê¿ÛÌ· ÙÔ˘ PANDAS ı· ÌÔÚÔ‡Û ‡ÎÔÏ· Ó· ÂÓÙ·¯ı› ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ ·È‰ÈÒÓ. ¶·ÚfiÌÔÈ· "¯·Ï·Ú‹" ÌÂıÔ‰ÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË Â¤ÙÚ„ ÛÂ Û˘ÁÁÚ·Ê›˜ ηٿ ÙÔ ·ÚÂÏıfiÓ Ó· ÂÎÊÚ¿ÛÔ˘Ó ·Ó¿ÏÔÁ˜ ıˆڛ˜ Û¯ÂÙÈο Ì ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ÔÚʇڷ˜ Henoch-Schönlein ‹ Ù˘ ÓfiÛÔ˘ Kawasaki. ∏ ‰ËÌÈÔ˘ÚÁÔ‡ÌÂÓË Û‡Á¯˘ÛË Û¯ÂÙÈο Ì ÙÔÓ ÚfiÏÔ ÙÔ˘ GABHS ı· ÌÔÚÔ‡Û ӷ ¢ԉˆı› ÂÚ·ÈÙ¤Úˆ, Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ ÙËÓ Âȉ›ӈÛË Ù˘ Û˘Ìو̷ÙÔÏÔÁ›·˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È Û ·È‰È¿ Ì ÙÈÎ ‹ πæ¢ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ì›·˜ Â̇ÚÂÙË Ïԛ̈͢, ÏfiÁˆ Ù˘ ηÎÔ˘¯›·˜ Î·È ÙÔ˘ stress. ‰) ™ËÌ·ÓÙÈΤ˜ ·ÌÊÈ‚Ôϛ˜ ÂÁ›ÚÔÓÙ·È Û¯ÂÙÈο Ì ÙËÓ ÂȉÈÎfiÙËÙ· ÙÔ˘ ÙÂÏÂ˘Ù·›Ô˘ ‰È·ÁÓˆÛÙÈÎÔ‡ ÎÚÈÙËÚ›Ô˘, Ù˘ ·ÚÔ˘Û›·˜ ‰ËÏ·‰‹ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·ıÔÏÔÁÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·Ù¿ ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË. OÈ Swedo Î·È Û˘Ó ·ÓÙȉȷÛÙ¤ÏÏÔ˘Ó ÙËÓ Ù˘È΋, ıÔÚ˘‚Ò‰Ë Û˘Ìو̷ÙÔÏÔÁ›· Ù˘ SC Î·È ÙȘ ȉÈfiÌÔÚʘ ÎÈÓËÛȷΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ("¯ÔÚfi˜ ÙÔ˘ ∞Á›Ô˘ µ›ÙÔ˘"), Ì ÙȘ ‹È˜, "¯ÔÚÂÈfiÌÔÚʘ" ("Û·Ó ·›ÍÈÌÔ È¿ÓÔ˘") ‰È·Ù·Ú·¯¤˜ ÙÔ˘ PANDAS. ™˘¯Ó¿, ˆÛÙfiÛÔ, ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÁÚ¿ÊÔÓÙ·È ÌÔÚʤ˜ SC Ì ‹È· ‹ ¿Ù˘Ë Û˘Ìو̷ÙÔÏÔÁ›· (22). ∂ÈϤÔÓ, ηıÒ˜ Ë SC ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ÎÏÈÓÈÎfi Î·È ·ıÔÁÂÓÂÙÈÎfi ÌÔÓÙ¤ÏÔ ÁÈ· ÙÔ PANDAS Î·È ÔÈ ‰‡Ô ÔÓÙfiÙËÙ˜ ÌÔÈÚ¿˙ÔÓÙ·È ÎÔÈÓ¿ ·ÓÔÛÔÏÔÁÈο Î·È ·ÂÈÎÔÓÈÛÙÈο Â˘Ú‹Ì·Ù·, Â›Ó·È ·ÌÊ›‚ÔÏÔ Î·Ù¿ fiÛÔÓ ¤Ó· ÙfiÛÔ ·Û·Ê¤˜ ÎÏÈÓÈÎfi ÎÚȶ·È‰È·ÙÚÈ΋ 2006;69:97-103
Ù‹ÚÈÔ Â·ÚΛ ÁÈ· Ó· ‰È·ÎÚ›ÓÂÈ ÙÔ PANDAS ·fi ÙȘ ¿Ù˘Â˜ ‹ ‹È˜ ÌÔÚʤ˜ Ù˘ SC.
™˘ÌÂÚ¿ÛÌ·Ù· ªÂ ‚¿ÛË Ù· ̤¯ÚÈ Û‹ÌÂÚ· ‰ËÌÔÛÈÂ˘Ì¤Ó· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ, ÙÔ PANDAS ·Ú·Ì¤ÓÂÈ Ì›· ÂÍ·ÈÚÂÙÈο ÂӉȷʤÚÔ˘Û·, ·ÏÏ¿ ·ÎfiÌ· ·Ó·fi‰ÂÈÎÙË ˘fiıÂÛË. §fiÁˆ Ù˘ ·Û¿ÊÂÈ·˜ ÙˆÓ ÚÔÙÂÈÓfiÌÂÓˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ, ÛÙÔ ‰È·ÁÓˆÛÙÈÎfi Ê¿ÛÌ· ÙÔ˘ PANDAS ı· ÌÔÚÔ‡Û·Ó Û¯ÂÙÈο ‡ÎÔÏ· Ó· Ù·ÍÈÓÔÌËıÔ‡Ó ·È‰È¿ ÌÂ Û˘Ì‚·ÙÈÎfiÙÂÚ· ÓÔÛ‹Ì·Ù·, fiˆ˜ Ù· ·Ï¿ Î·È Î·ÏÔ‹ıË ÙÈÎ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ ‹ Ë SC. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ηıÈÛÙ¿ ÙËÓ ‡·ÚÍË ÙÔ˘ PANDAS ·ÌÊ›‚ÔÏË. ∫·ıÒ˜ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ıÂڷ¢ÙÈÎÒÓ ‹ ÚÔÊ˘Ï·ÎÙÈÎÒÓ Ì¤ÙÚˆÓ Ô˘ ¤¯Ô˘Ó ÚÔÙ·ı› ̤¯ÚÈ Û‹ÌÂÚ· ·ÌÊÈÛ‚ËÙÂ›Ù·È ÈÛ¯˘Ú¿, Ë ·Ó·ÌÔÓ‹ ·fi ÙÔÓ ·È‰›·ÙÚÔ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Â˘Ú‡ÙÂÚˆÓ Î·È ÌÂıÔ‰ÔÏÔÁÈο ÏËÚ¤ÛÙÂÚˆÓ ÌÂÏÂÙÒÓ ıˆÚÂ›Ù·È ÙfiÛÔ ·ÛÊ·Ï‹˜ fiÛÔ Î·È ÂȂ‚ÏË̤ÓË.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Kiessling LS. Tic disorders associated with evidence of invasive group A beta hemolytic streptococcal disease. Dev Med Child Neurol 1989;31 (Suppl 59):S48. 2. Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998;155:264-271. 3. Snider LA, Swedo SE. Pediatric obsessive-compulsive disorder. JAMA 2000;284:3104-3106. 4. Husby G, van de Rijn I, Zabriskie JB, Abdin ZH, Williams RC Jr. Antibodies reacting with cytoplasm of subthalamic and caudate nuclei neurons in chorea and acute rheumatic fever. J Exp Med 1976;144:1094-1110. 5. Murphy ML, Pichichero ME. Prospective identification and treatment of children with pediatric autoimmune neuropsychiatric disorder associated with group A streptococcal infection (PANDAS). Arch Pediatr Adolesc Med 2002;156:356-361. 6. Cardona F, Orefici G. Group A streptococcal infections and tic disorders in an Italian pediatric population. J Pediatr 2001;138:71-75. 7. Khanna AK, Buskirk DR, Williams RC Jr, Gibofsky A, Crow MK, Menon A et al. Presence of a non-HLA B cell antigen in rheumatic fever patients and their families as defined by a monoclonal antibody. J Clin Invest 1989;83:1710-1716. 8. Murphy TK, Goodman WK, Fudge MW, Williams RC Jr, Ayoub EM, Dalal M et al. B lymphocyte antigen D8/17: a peripheral marker for childhood-onset
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obsessive-compulsive disorder and Tourette’s syndrome? Am J Psychiatry 1997;154:402-407. Swedo SE, Leonard HL, Mittleman BB, Allen AJ, Rapoport JL, Dow SP et al. Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry 1997;154:110-112. Giedd JN, Rapoport JL, Garvey MA, Perlmutter S, Swedo SE. MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. Am J Psychiatry 2000;157: 281-283. Perlmutter SJ, Leitman SF, Garvey MA, Hamburger S, Feldman E, Leonard HL et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 1999;354:1153-1158. Garvey MA, Perlmutter SJ, Allen AJ, Hamburger S, Lougee L, Leonard HL et al. A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry 1999;45:1564-1571. Sokol MS. Infection-triggered anorexia nervosa in children: clinical description of four cases. J Child Adolesc Psychopharmacol 2000;10:133-145. Sokol MS, Ward PE, Tamiya H, Kondo DG, Houston D, Zabriskie JB. D8/17 expression on B lymphocytes in anorexia nervosa. Am J Psychiatry 2002;159: 1430-1432. Waldrep DA. Two cases of ADHD following GABHS infection: a PANDAS subgroup? J Am Acad
Child Adolesc Psychiatry 2002;41:1273-1274. 16. Peterson BS, Leckman JF, Tucker D, Scahill L, Staib L, Zhang H et al. Preliminary findings of antistreptococcal antibody titers and basal ganglia volumes in tic, obsessive-compulsive, and attention deficit/hyperactivity disorders. Arch Gen Psychiatry 2000;57: 364-372. 17. Pavone P, Bianchini R, Parano E, Incorpora G, Rizzo R, Mazzone L et al. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatr Neurol 2004;30:107-110. 18. Kurlan R, Kaplan EL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician. Pediatrics 2004;113:883-886. 19. Swedo SE, Leonard HL, Rapoport JL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction. Pediatrics 2004;113: 907-911. 20. Fischetti VA. The Streptococcus and the host. Present and future challenges. Adv Exp Med Biol 1997; 418:15-20. 21. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 2000;13:470511. 22. Aron AM, Freeman JM, Carter S. The natural history of Sydenham’s chorea. Review of the literature and long-term evaluation with emphasis on cardiac sequelae. Am J Med 1965;38:83-95.
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§ÈÛÙÂÚ›ˆÛË Î·Ù¿ ÙËÓ Î‡ËÛË 1 ∂ÈÌÂÏ‹ÙÚÈ· ∞’, °’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÙÙÈÎfiÓ” 2 ∂ÈÌÂÏËÙ‹˜ ∞’, °’ ª·È¢ÙÈ΋ Î·È °˘Ó·ÈÎÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¶·ÓÂÈÛÙËÌÈ·Îfi °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÙÙÈÎfiÓ” AÏÏËÏÔÁÚ·Ê›·: ¶·Ó·ÁÈԇϷ ª¤ÍË-ªÔ˘ÚÓ¿, ™ÈÓÒ˘ 4, T.K. 145 72, ¢ÚÔÛÈ¿ E-mail: ymexi@hotmail.com ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 29-03-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 12-09-2005
¶. ª¤ÍË - ªÔ˘ÚÓ¿1, ¡. ªÔ˘ÚÓ¿˜2
¶ÂÚ›ÏË„Ë: ∏ ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ·fi Listeria monocytogenes Â›Ó·È ÌÈ· Û¿ÓÈ· ÓfiÛÔ˜ ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜, Ô˘ ˆÛÙfiÛÔ ÂÌÊ·Ó›˙ÂÈ ‚·ÚÈ¿ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· Î·È ÌÂÁ¿ÏË ıÓËÙfiÙËÙ·. ∏ ÌÂÙ¿‰ÔÛ‹ Ù˘ Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ̤ۈ ÙˆÓ ÙÚÔÊÒÓ. ∂ÓÙÔ›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· Û ·ÓÔÛÔηٷÛÙ·Ï̤ÓÔ˘˜ ·ÛıÂÓ›˜ Î·È ËÏÈÎȈ̤ӷ ¿ÙÔÌ·, ·ÏÏ¿ Î·È Î·Ù¿ ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô, ÚÔÛ‚¿ÏÏÔÓÙ·˜ ΢ڛˆ˜ Ù· ¤Ì‚Ú˘· Î·È Ù· ÓÂÔÁÓ¿. ¡fiÛËÛË Ù˘ ÂÁ·Ԣ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ Î·È ÙÔ˘ ‰Â˘Ù¤ÚÔ˘ ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘, Û˘Ó‹ıˆ˜, Ô‰ËÁ› Û ·Ô‚ÔÏ‹. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÙÚ›ÙÔ˘ ÙÚÈÌ‹ÓÔ˘ ÚÔηÏ› ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÌ‚Ú‡Ô˘, ÚfiˆÚÔ ÙÔÎÂÙfi, ıÓËÛÈÁÂÓ‹ ÓÂÔÁÓ¿ Î·È ÂÌÊ¿ÓÈÛË Ïԛ̈͢ ÛÙÔ ÓÂÔÁÓfi ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ™ÙÔ ÓÂÔÁÓfi Ë ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ˆ˜ ÛË„·ÈÌ›·, Ó¢ÌÔÓ›· ‹ ÌËÓÈÁÁ›Ùȉ·. ∫·Ù¿ÏÏËÏË ıÂڷ›· Ù˘ ÂÁ·Ԣ ÌÔÚ› Ó· ÚÔÏ¿‚ÂÈ ÙËÓ ÂΉ‹ÏˆÛË ·ıÔÏÔÁÈÎÒÓ ÛËÌ›ˆÓ ÛÙÔ ÓÂÔÁÓfi. ¶·ÚfiÙÈ Ë ÏÈÛÙ¤ÚÈ· Â›Ó·È Â˘·›ÛıËÙË Û fiÏ· Ù· ÎÔÈÓ¿ ·ÓÙÈ‚ÈÔÙÈο ÂÎÙfi˜ ·fi ÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜ ÙÚ›Ù˘ ÁÂÓÈ¿˜, Ë ıÂڷ›· Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ ÏÈÛÙÂÚ›ˆÛ˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔ‚Ï‹Ì·Ù·. ∆Ô Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ Â›Ó·È Ë ·ÌÈÎÈÏÏ›ÓË, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÌÈÓÔÁÏ˘ÎÔÛ›‰Â˜ ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ÓÂÔÁÓÈ΋˜ ÓfiÛÔ˘ Î·È Û ÌËÓÈÁÁ›Ùȉ· ·fi ÏÈÛÙ¤ÚÈ·. ¶ÚÔÊ˘Ï·ÎÙÈο ̤ÙÚ· ÁÈ· ÙË ‰È·¯Â›ÚÈÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÚÔÏËÙÈο ̤ÙÚ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ¤¯Ô˘Ó ÌÂÈÒÛÂÈ ‰ÈÂıÓÒ˜ ÙË Û˘¯ÓfiÙËÙ· Ù˘ ÏÈÛÙÂÚ›ˆÛ˘. ∂‰Ò ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ·, Ë ‰È¿ÁÓˆÛË Î·È Ë ıÂڷ›· Ù˘ ÓfiÛÔ˘, ηıÒ˜ Î·È ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘Ù‹Ó. §¤ÍÂȘ ÎÏÂȉȿ: §ÈÛÙ¤ÚÈ· ÌÔÓÔ΢ÙÔÁfiÓÔ˜, ·ËÛË, ÓÂÔÁÓ¿.
Listeriosis during pregnancy 1 Registrar ∞, 3rd Paediatric Clinic, University of Athens, “Attikon” University Hospital, Athens 2 Registrar ∞, 3rd Obstetrics and Gynaecology Clinic, University of Athens, “Attikon” University Hospital, Athens Correspondence: Panagioula Mexi-Bourna, 4 Sinopis Str., 145 72, Drossia E-mail: ymexi@hotmail.com Date of submission: 23-03-2005 Date of approval: 12-09-2005
P. Mexi - Bourna1, N. Bournas2
Abstract: Listeriosis is an uncommon infection, caused by strains of the bacteria Listeria monocytogenes, with a severe clinical presentation, neurological sequelae and a high mortality rate. Contaminated food is the usual source of infection. Listeriosis has a predilection for immunocompromised persons, the elderly, pregnant women, and especially fetuses and neonates. Infection during the first and second trimester of pregnancy leads to miscarriage. Infection in late pregnancy may lead to intrauterine growth retardation, prematurity, stillbirth or death of the infant after birth. In newborn infants invasive disease is manifested as septicaemia, pneumonia and meningitis. The treatment of listeriosis in the pregnant woman has resulted in successful in utero therapy of the fetus. Listeria monocytogenes strains are susceptible to nearly all common antibiotics but therapeutic success is impeded by the particular biological behaviour of these bacteria. High-dose ampicillin is the treatment of choice and gentamicin is added in the case of neonatal disease and meningitis. Surveillance of foodstuffs is the most effective strategy for prevention of the disease. Pregnant consumers should be widely and continually informed about recommendations on handling of food. The epidemiology, diagnosis, and management of Listeria infection in pregnancy are reviewed. Key words: Listeriosis, pregnancy, infant.
∏ Listeria monocytogenes Â›Ó·È ¤Ó· ıÂÙÈÎfi ηٿ Gram ÂÓ‰Ô- Î·È ÂÍˆÎ˘ÙÙ¿ÚÈÔ ‚·ÎÙËÚ›‰ÈÔ. ∞ÔÙÂÏ› ÙÔÓ ÌfiÓÔ Ù‡Ô ÏÈÛÙ¤ÚÈ·˜ Ô˘ Â›Ó·È ·ıÔÁfiÓÔ˜ ÙfiÛÔ ÁÈ· Ù· ˙Ò· fiÛÔ Î·È ÁÈ· ÙÔÓ ¿ÓıÚˆÔ. ∏ ÂÚÈÁÂÓÓËÙÈ΋ Ïԛ̈ÍË Û˘Óԉ‡ÂÙ·È ·fi ÌÂÁ¿ÏÔ Î›Ó‰˘ÓÔ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô Î·È ÛÔ‚·Ú‹ ¶·È‰È·ÙÚÈ΋ 2006;69:104-109
ÓÂÔÁÓÈ΋ ÓfiÛÔ (1). ∏ Listeria monocytogenes ÌÂÙ·‰›‰ÂÙ·È ÛÙÔ˘˜ ·ÓıÚÒÔ˘˜ ΢ڛˆ˜ Ì ٷ ÙÚfiÊÈÌ· (2,3). ™ÙËÓ ·Ó·ÛÎfiËÛ‹ Ì·˜, ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ì ÂȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ÁÈ· ÙËÓ Â›ÙˆÛË Ù˘ ÏÈÛÙ¤ÚÈ·˜ ΢ڛˆ˜ ÛÙËÓ Î‡ËÛË, ÙËÓ ·ıÔÁ¤ÓÂÈ·,
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§ÈÛÙÂÚ›ˆÛË Î·Ù¿ ÙËÓ Î‡ËÛË
ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÛÙȘ ÂÁ·Ԣ˜, ÛÙ· ¤Ì‚Ú˘· Î·È Ù· ÓÂÔÁÓ¿, ηıÒ˜ Î·È ÙË ‰È¿ÁÓˆÛË, ÙË ıÂڷ›· Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÚfiÏ˄˘ Ù˘ ÓfiÛÔ˘. ∂›Û˘ ı· ·Ó·ÊÂÚıԇ̠۠ÛÙÔȯ›· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ÏÈÛÙÂÚ›ˆÛË ÛÙËÓ ∂ÏÏ¿‰·.
¤¯ÂÈ ·Ó·ÊÂÚı› Û ۯÂÙÈ΋ ÌÂϤÙË ·˘ÍË̤ÓË ÊÔÚ›· ÛÙÔÓ ÎfiÏÔ Á˘Ó·ÈÎÒÓ Ì ÈÛÙÔÚÈÎfi ·ÓÂÈÏËÌÌ¤ÓˆÓ ·Ô‚ÔÏÒÓ, (20) ÁÂÁÔÓfi˜ fï˜, Ô˘ ‰ÂÓ ¤¯ÂÈ ÂȂ‚·Èˆı› Û ¿ÏÏË ÌÂϤÙË (21).
¶·ıÔÁ¤ÓÂÈ· ∂ȉËÌÈÔÏÔÁÈο ÛÙÔȯ›· ∏ Listeria monocytogenes Â›Ó·È ¤Ó· gram-ıÂÙÈÎfi ·Ó·ÂÚfi‚ÈÔ ÎÔÎÎÔ‚·ÎÙËÚ›‰ÈÔ. ªÔÚ› Ó· ·ÔÌÔÓˆı› ÛÙÔ ¯ÒÌ·, ÛÙËÓ ÙÚÔÊ‹ ÙˆÓ ˙ÒˆÓ, ÛÙÔ ÓÂÚfi, ÛÙ· ÎfiÚ·Ó·, ÛÙÔ Á¿Ï·, ηıÒ˜ Î·È ÛÙÔ˘˜ ÈÛÙÔ‡˜ ÔÏÏÒÓ ·ÛfiÓ‰˘ÏˆÓ Î·È ÛÔÓ‰˘ÏˆÙÒÓ ˙ÒˆÓ, Û˘ÌÂÚÈÏ·Ì‚·ÓfiÌÂÓÔ˘ Î·È ÙÔ˘ ·ÓıÚÒÔ˘ (4,5). ∂ÈϤÔÓ, Ë Listeria monocytogenes ·ÔÈΛ˙ÂÈ Û˘¯Ó¿ Ù· ÙÚfiÊÈÌ·, ÌÂ Û˘¯ÓfiÙËÙ· ·fi 15-70% (6). T· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· ¤¯Ô˘Ó Û˘¯Ó¿ ÌÂÁ·Ï‡ÙÂÚÔ ÌÔÏ˘ÛÌ·ÙÈÎfi ÊÔÚÙ›Ô ·fi Ù· ¿ÏÏ· ÚÔ˚fiÓÙ· (7). ∏ Listeria ηٷÛÙÚ¤ÊÂÙ·È Ì ÙËÓ ·ÛÙÂÚ›ˆÛË Î·È ÙÔ Ì·Á›ÚÂÌ·. Œ¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È Û ıÂÚÌÔÎÚ·Û›· „˘Á›Ԣ. ∏ ÏÈÛÙÂÚ›ˆÛË, ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÔÚ·‰Èο Î·È Ì ÌÔÚÊ‹ ÂȉËÌÈÒÓ Û fiÏÔ ÙÔÓ ÎfiÛÌÔ. ªÂÁ¿Ï˜ ÂȉË̛˜ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÙȘ ‰˘Ô ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÛÙËÓ ∂˘ÚÒË Î·È ÙȘ ∏.¶.∞. (8-11). ∂Ó‰ÔÓÔÛÔÎÔÌÂȷΤ˜ ÏÔÈÌÒÍÂȘ ÙfiÛÔ Û ÓÂÔÁÓ¿ fiÛÔ Î·È Û ÂÓ‹ÏÈΘ ¤¯Ô˘Ó ›Û˘ ·Ó·ÊÂÚı› (12,13). ™Â ÂȉËÌ›· Ô˘ ÂÓ¤ÛÎË„Â Û ÓÂÔÁÓ¿ ÛÙËÓ ∫fiÛÙ· ƒ›Î·, Ë ÌÂÙ¿‰ÔÛË ÙÔ˘ ‚·ÎÙËÚȉ›Ô˘ ¤ÁÈÓ Ì ÙÔ Ï¿‰È Ô˘ ¯ÚËÛÈÌÔÔÈ›ÙÔ ÁÈ· ÙÔÓ Î·ı·ÚÈÛÌfi ÙˆÓ ÓÂÔÁÓÒÓ (14). ∏ ÌÂÙ¿‰ÔÛË Ù˘ ÏÈÛÙ¤ÚÈ·˜ ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ÓÂÔÁÓfi Á›ÓÂÙ·È ‹ ̤ۈ ÙÔ˘ Ï·ÎÔ‡ÓÙ· ‹ ·ÓÈfiÓÙˆ˜ ·fi ÙÔÓ ÁÂÓÓËÙÈÎfi ۈϋӷ ‹ Ù· ÎfiÚ·Ó· Ù˘ ÌËÙ¤Ú·˜ (15). Œ¯ÂÈ Â›Û˘ ÂÚÈÁÚ·Ê› ÂÚ›ÙˆÛË ÌÂÙ¿‰ÔÛ˘ Ù˘ ÏÈÛÙ¤ÚÈ·˜ Û ÓÂÔÁÓfi ̤ۈ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡Ø ·ÓÂΉÔÙÔÏÔÁÈο ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ¯ÔÚ‹ÁËÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ Á¿Ï·ÎÙÔ˜ ÛÙ· ÛÎ˘Ï¿ÎÈ· ÙÔ˘ ÛÈÙÈÔ‡ ÙÔ˘˜ ÚÔοÏÂÛ ÁÂÓÈÎÂ˘Ì¤ÓË ÏÈÛÙÂÚ›ˆÛË (16). ÕÙÔÌ· ˘ÁÈ‹ ÌÔÚ› Ó· Â›Ó·È ÊÔÚ›˜ ÙÔ˘ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÔ‡, ·ÎfiÌ· Î·È ¿ÙÔÌ· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ fiˆ˜ Â›Ó·È ÔÈ ¤Á΢ÔÈ. ™ÙÔ 1-15% ÙÔ˘ ÏËı˘ÛÌÔ‡, Ë ÏÈÛÙ¤ÚÈ· ·ÔÌÔÓÒÓÂÙ·È ÛÙ· ÎfiÚ·Ó·. (17). √ ·ÔÈÎÈÛÌfi˜ Â›Ó·È ‚Ú·¯˘¯ÚfiÓÈÔ˜ Î·È ÙÔ ‚·ÎÙËÚ›‰ÈÔ ·˘ÙÔÂÚÈÔÚ›˙ÂÙ·È. √È ¤Á΢ÔÈ ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·ÊÔÚÂÙÈ΋ ÊÔÚ›· ÛÙË ÏÈÛÙ¤ÚÈ· ·fi ÙÔÓ ˘fiÏÔÈÔ ÏËı˘ÛÌfi, ÙfiÛÔ ÛÙ· ÎfiÚ·Ó· (18) fiÛÔ Î·È ÛÙÔÓ ÎfiÏÔ Î·È ÙÔÓ ÛÙÔÌ·ÙÔÊ¿Ú˘ÁÁ· (19). ∂ÓÙÔ‡ÙÔȘ,
∏ ÂΉ‹ÏˆÛË ÁÂÓÈÎÂ˘Ì¤Ó˘ ÓfiÛÔ˘ ·fi ÏÈÛÙ¤ÚÈ· Û ¤Ó· ¿ÙÔÌÔ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔÓ Ù‡Ô ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Î·È ÙÔ ÌÔÏ˘ÛÌ·ÙÈÎfi ÊÔÚÙ›Ô Ô˘ ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi, ·ÏÏ¿ ΢ڛˆ˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ˘˜ ·ÓÔÛÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÙÔ˘ ÍÂÓÈÛÙ‹. √È ÔÚfiÙ˘ÔÈ Ù˘ Listeria monocytogenes Ô˘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÁÂÓÈÎÂ˘Ì¤ÓË ÏÈÛÙÂÚ›ˆÛË Â›Ó·È ÔÈ 1/2a Î·È 4b (22). ∏ ÏÈÛÙÂÚ›ˆÛË ··ÓÙ¿Ù·È Î˘Ú›ˆ˜ Û ·ÓÔÛÔηٷÛÙ·Ï̤ӷ ¿ÙÔÌ·, ÛÙȘ ÂÁ·Ԣ˜ Î·È Ù· ÓÂÔÁÓ¿ Ô˘ ›Û˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·Ó¿ÚÎÂÈ· Ù˘ ΢ÙÙ·ÚÈ΋˜ ·ÓÔÛ›·˜. ∏ ÏÈÛÙ¤ÚÈ· ÂÈÛ¤Ú¯ÂÙ·È ÛÙÔÓ ÔÚÁ·ÓÈÛÌfi ÙÔ˘ ÍÂÓÈÛÙ‹ Û˘¯ÓfiÙÂÚ· ·fi ÙÔÓ Á·ÛÙÚÂÓÙÂÚÈÎfi ۈϋӷ. ¶ÔÏÏ·Ï·ÛÈ¿˙ÂÙ·È ÛÙ· ·ÙÙ·Ú· ÙÔ˘ ÂÓÙ¤ÚÔ˘ Î·È ÛÙ· Ì·ÎÚÔÊ¿Á· ¯ˆÚ›˜ Ó· ηٷÛÙÚ¤ÊÂÈ ÙÔ Î‡ÙÙ·ÚÔ ÙÔ˘ ÍÂÓÈÛÙ‹ ÎÈ ¤ÙÛÈ ÌÂÙ·‰›‰ÂÙ·È Û ÁÂÈÙÔÓÈο ·ÙÙ·Ú· (6,23). ∏ ›ÎÙËÙË ·ÓÔÛ›· Â›Ó·È ÂÍ ÔÏÔÎÏ‹ÚÔ˘ ΢ÙÙ·ÚÈ΋ Î·È ÂÍ·ÚÙ¿Ù·È ·fi Ù· CD8 T-ÏÂÌÊÔ·ÙÙ·Ú· (24). ∏ ÏÈÛÙ¤ÚÈ· ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÎÏÂÎÙÈ΋ ÂÓÙfiÈÛË ÛÙÔ ¤ÓÙÂÚÔ, ÛÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ÛÙÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· (25). ™ÙÔ˘˜ ÂÓ‹ÏÈΘ Ì¿ÏÈÛÙ·, Ë ‰ÈÂÈÛ‰˘ÙÈ΋ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ˆ˜ ÌËÓÈÁÁ›Ùȉ· ‹ ÂÁÎÂÊ·Ï›Ùȉ· ‹ ÚÔÌ‚ÂÁÎÂÊ·Ï›Ùȉ· (Rhombencephalitis), Ì ¯·Ú·ÎÙËÚÈÛÙÈ΋ ÚÔ‚ÔÏ‹ ÙÔ˘ ÛÙÂϤ¯Ô˘˜ Î·È Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ (26).
§ÈÛÙÂÚ›ˆÛË ÛÙËÓ Î‡ËÛË ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘ ÛÙȘ ÂÁ·Ԣ˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ôχ ÂÏ·ÊÚ¿ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ˆ˜ “ÁÚÈ҉˘ Û˘Ó‰ÚÔÌ‹” Ì ˘ÚÂÙfi Î·È ·ÚÎÂÙ¤˜ ÊÔÚ¤˜ Ì Á·ÛÙÚÂÓÙÂÚÈΤ˜ ÂÓԯϋÛÂȘ. ªÂÚÈΤ˜ ÊÔÚ¤˜ ·˘Ù¿ Ù· Û˘ÌÙÒÌ·Ù· ·Ô‰›‰ÔÓÙ·È ÂÛÊ·Ï̤ӷ Û ԢÚÔÏԛ̈ÍË (27). ∏ ¤ÁÎ˘Ô˜ ÌÔÚ› Ó· ÚÔÛ‚ÏËı› ·fi ÏÈÛÙ¤ÚÈ· Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘. ∏ Ïԛ̈ÍË Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÚÒÙÔ˘ Î·È ‰Â˘Ù¤ÚÔ˘ ÙÚ›ÌËÓÔ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ·Ô‚ÔÏ‹ (28). ¶ÚÔÛ‚ÔÏ‹ Ù˘ ÂÁ·Ԣ ÛÙÔ ÙÚ›ÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ÚfiˆÚÔ ÙÔÎÂÙfi, ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË ¶·È‰È·ÙÚÈ΋ 2006;69:104-109
Pediatr Mar-Apr 06
18-04-06
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¶. ª¤ÍË-ªÔ˘ÚÓ¿, ¡. ªÔ˘ÚÓ¿˜
¶›Ó·Î·˜. ª¤ÙÚ· ÚfiÏ˄˘ ÏÈÛÙÂÚ›ˆÛ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ∞. °ÂÓÈο ̤ÙÚ· 1. ¡· Ì·ÁÂÈÚ‡ÔÓÙ·È ÚÔÛÂÎÙÈο ÔÈ ˆÌ¤˜ ˙ˆÈΤ˜ ÙÚÔʤ˜ fiˆ˜ ÌÔÛ¯¿ÚÈ, Ô˘ÏÂÚÈο Î·È ¯ÔÈÚÈÓ¿. 2. ¡· ϤÓÔÓÙ·È Ù· ˆÌ¿ Ï·¯·ÓÈο ÚÈÓ ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜. 3. ¡· ·ÔʇÁÂÙ·È ÂÓÙÂÏÒ˜ ÙÔ ÌË ·ÛÙÂÚȈ̤ÓÔ Á¿Ï· Î·È Ù· ÙÚfiÊÈÌ· Ô˘ ÙÔ ÂÚȤ¯Ô˘Ó. 4. ¡· ϤÓÔÓÙ·È ÚÔÛÂÎÙÈο Ù· ¯¤ÚÈ·, Ù· Ì·¯·›ÚÈ· Î·È ÔÈ Û·Ó›‰Â˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ·Ú·Û΢‹ ˆÌÒÓ ÙÚÔÊÒÓ. 5. ¡· ηٷӷÏÒÓÔÓÙ·È ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi Ù· ÂÚÈÛÛ‡̷ٷ ÙÚÔÊÒÓ Î·È Ù· ¤ÙÔÈÌ· ÙÚfiÊÈÌ· ·ÊÔ‡ ·ÓÔȯıÔ‡Ó. µ. ∂ȉÈο ̤ÙÚ· ÁÈ· ÚÔʇϷÍË ·fi ÙË ÏÈÛÙ¤ÚÈ· 1. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È ¤ÙÔÈÌ· ÚÔ˚fiÓÙ· ÎÚ¤·ÙÔ˜ (hot dogs, luncheon meats, ‹ deli meats) ÂÎÙfi˜ ÎÈ ·Ó ÙÔ Í·Ó·˙¤ÛÙ·Ì¿ ÙÔ˘˜ ÂÂÎÙ›ÓÂÙ·È Ì¤¯ÚÈ ÙÔ ‚Ú·ÛÌfi ‹ ÙÔ „‹ÛÈÌÔ. 2. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È Ì·Ï·Î¿ Ù˘ÚÈ¿ ÂÎÙfi˜ ÎÈ ·Ó ÛÙȘ ÂÙÈΤÙ˜ ÙÔ˘˜ Ê·›ÓÂÙ·È Î·ı·Ú¿ fiÙÈ ·Ú·Û΢¿˙ÔÓÙ·È ·fi ·ÛÙÂÚȈ̤ÓÔ Á¿Ï·. 3. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È Î·Ù„˘Á̤Ó˜ ·ÏÔÈʤ˜ ÎÚ¤·ÙÔ˜ (pâtés). 4. ¡· ÌËÓ Î·Ù·Ó·ÏÒÓÔÓÙ·È Î·Ù„˘Á̤ӷ ηÓÈÛÙ¿ ı·Ï·ÛÛÈÓ¿. √È ÎÔÓۤڂ˜ Î·È Ù· Ì·ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ÚÔ˚fiÓÙ· ÎÚ¤·ÙÔ˜ Î·È ı·Ï·ÛÛÈÓÒÓ ÌÔÚÔ‡Ó Ó· ηٷӷψıÔ‡Ó.
ÙÔ˘ ÂÌ‚Ú‡Ô˘, ıÓËÛÈÁÂÓ‹ ÓÂÔÁÓ¿ Î·È ÂÌÊ¿ÓÈÛË Ïԛ̈͢ ÛÙÔ ÓÂÔÁÓfi ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛË. ∞Ó Ë ¤ÁÎ˘Ô˜ ·ÚÔ˘ÛÈ¿ÛÂÈ ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ· Ô˘ ÔÊ›ÏÂÙ·È Û ÏÈÛÙ¤ÚÈ· ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, Ë ıÂڷ›· Ì ˘„ËϤ˜ ‰fiÛÂȘ ·ÓÙÈ‚ÈÔÙÈÎÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ÚfiˆÚÔ˘ ÙÔÎÂÙÔ‡, ÂÓÒ ÙÔ ÓÂÔÁÓfi ı· ÁÂÓÓËı› ˘ÁȤ˜, ·ÓÙ›ıÂÙ· Ì fiÙÈ Û˘Ì‚·›ÓÂÈ Û ¿ÏÏ˘ ·ÈÙÈÔÏÔÁ›·˜ ¯ÔÚÈÔ·ÌÓÈÔÓ›Ùȉ˜ (15). ∏ ÌÂϤÙË ‰‡Ô ·Ó·ÛÎÔ‹ÛÂˆÓ ·fi ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì ÌÂÁ¿ÏÔ ·ÚÈıÌfi ÂÚÈÛÙ·ÙÈÎÒÓ Î·Ï¿ ÙÂÎÌËÚÈˆÌ¤ÓˆÓ (∂. Mylonakis (17) Î·È Y. Siegman-Igra (29)), ·Ó·Ê¤ÚÔ˘Ó fiÙÈ fiÙ·Ó Ë ¤ÁÎ˘Ô˜ ÌÔÏ˘Óı› ·fi ÏÈÛÙ¤ÚÈ· ¤¯ÂÈ 20% ΛӉ˘ÓÔ ·Ô‚ÔÏ‹˜ ‹ ıÓËÛÈÁÂÓÔ‡˜ ÓÂÔÁÓÔ‡. ∆· ÓÂÔÁÓ¿ ÓÔÛÔ‡Ó Î·Ù¿ 56-68%. ∏ ıÓËÙfiÙËÙ· ÙˆÓ ÓÂÔÁÓÒÓ ·fi ÙËÓ ÓfiÛÔ Â›Ó·È 12%. ¡fiÛËÛË Ù˘ ÌËÙ¤Ú·˜ ¯ˆÚ›˜ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÓÂÔÁÓÔ‡ ··ÓÙ¿Ù·È Û ÔÛÔÛÙfi 10-25%. ™Â ÂÚ›ÙˆÛË Û˘Ó‡·Ú͢ ÏÈÛÙÂÚ›ˆÛ˘ Ì ·ÓÔÛÔηٷÛÙÔÏ‹ ÛÙËÓ Î‡ËÛË, Ë ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ù˘ ÌËÙ¤Ú·˜ ÂÈ‚·Ú‡ÓÂÙ·È. Œ¯ÂÈ ·Ó·ÊÂÚı› ÌËÓÈÁÁ›Ùȉ·, ÂÓ‰Ôηډ›Ùȉ· Î·È ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·. ∞ÎfiÌË ¤¯Ô˘Ó ÂÚÈÁÚ¿ÊÂÈ ‰‡Ô ÂÚÈÛÙ·ÙÈο Ïԛ̈͢ ·fi ÏÈÛÙ¤ÚÈ· Ì ı¿Ó·ÙÔ Ù˘ ÌËÙ¤Ú·˜ Ô˘ ÂÌÊ¿ÓÈ˙ ·ÓÔÛÔηٷÛÙÔÏ‹ (30-33).
§ÈÛÙÂÚ›ˆÛË ÛÙÔ ÓÂÔÁÓfi ™Ù· ÓÂÔÁÓ¿ Ë ÏÈÛÙÂÚ›ˆÛË ÌÔÚ› Ó· ÂΉËψı› ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ (ÚÒÈÌË Ïԛ̈ÍË) ‹ ·ÚÁfiÙÂÚ· ÌÂÙ¿ ÙËÓ 5Ë Ë̤ڷ ˙ˆ‹˜ (fi„ÈÌË Ïԛ̈ÍË). ∫·Ù¿ ÙË ‰È·‰ÚÔÌ‹ Ù˘ ÚÒÈÌ˘ Ïԛ̈͢ ÌÔÚ› Ó· ÂÌÊ·ÓÈÛı› ÎËÏȉԂϷÙȉ҉˜ ‹ Ê˘Û·ÏȉԂϷÙȉ҉˜ ÂÍ¿ÓıËÌ·, ¶·È‰È·ÙÚÈ΋ 2006;69:104-109
Û˘Ó‹ıˆ˜ ÛÙÔ ıÒڷη Î·È Ù· ¿ÎÚ·, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÛÙË ‰È¿ÁÓˆÛË. ∂›Û˘ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ˘¿Ú¯ÂÈ ÂÚ˘ıËÌ·Ù҉˜ ‹ ÊÏ˘ÎÙ·ÈÓ҉˜ ÂÍ¿ÓıËÌ· ÛÙÔÓ Ô›ÛıÈÔ Ê¿Ú˘ÁÁ·. ∏ ÚÒÈÌË ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È ˆ˜ Ó¢ÌÔÓ›· Î·È ÛË„·ÈÌ›· ·ÏÏ¿ Î·È ˆ˜ ÌËÓÈÁÁ›Ùȉ·. ∞ÎfiÌ· ÌÔÚ› Ó· ÂΉËψı› Ì ÎÔÎÎÈÒÌ·Ù· ÛÙÔ ‰¤ÚÌ·, ÙÔ ‹·Ú Î·È ¿ÏÏ· Û˘Ì·Á‹ fiÚÁ·Ó· ÙˆÓ ÓÂÔÁÓÒÓ Î·ıÒ˜ Î·È ÛÙÔÓ Ï·ÎÔ‡ÓÙ· (ÎÔÎÎȈ̿وÛË Ù˘ ÓÂÔÁÓÈ΋˜ ÛË„·ÈÌ›·˜, granulomatosis infantiseptica) (34). ∏ ÎÔÎÎȈ̷Ù҉˘ Ó¢ÌÔÓ›· ¤¯ÂÈ Ôχ ‚·ÚÈ¿ ÔÚ›· Î·È ÌÔÚ› Ó· ¯ÚÂÈ·Ûı› Â͈ۈ̷ÙÈ΋ Ô͢ÁfiÓˆÛË (extracorporeal membrane oxygenation) (35). ∏ ̤ÛË ‰È¿ÚÎÂÈ· ÙÔ˘ ¯ÚfiÓÔ˘ ÂÒ·Û˘ ÁÈ· ÙËÓ ÚÒÈÌË ÓfiÛÔ Â›Ó·È ÌÈ¿ÌÈÛË Ë̤ڷ ÂÓÒ ÁÈ· ÙËÓ fi„ÈÌË 14 Ë̤Ú˜. ∏ fi„ÈÌË Ïԛ̈ÍË ·fi ÏÈÛÙ¤ÚÈ· ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ÙÂÏÂÈfiÌËÓ· ÓÂÔÁÓ¿ Ô˘ ÁÂÓÓÈÔ‡ÓÙ·È Ê˘ÛÈÔÏÔÁÈο Î·È Ë ÌfiÏ˘ÓÛË Á›ÓÂÙ·È Î·Ù¿ ‹ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∞ÒÙÂÚ· Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ÓÂÔÁÓÈÎÒÓ ÏÔÈÌÒÍÂˆÓ ·fi ÏÈÛÙ¤ÚÈ· ·Ú·Ì¤ÓÔ˘Ó ÛÙÔ 12% ÙˆÓ ÓÂÔÁÓÒÓ Ô˘ ÂÈ‚ÈÒÓÔ˘Ó.
¢È¿ÁÓˆÛË ∏ ‰È¿ÁÓˆÛË Ïԛ̈͢ ·fi ÏÈÛÙ¤ÚÈ· ÛÙȘ ÂÁ·Ԣ˜ Î·È Ù· ÓÂÔÁÓ¿ Á›ÓÂÙ·È Ì ÙËÓ ·ÔÌfiÓˆÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘. ∏ ·Ó›¯Ó¢ÛË ÙÔ˘ ÌÈÎÚÔ‚›Ô˘ Ì ÙËÓ ·ÓÙ›‰Ú·ÛË Ù˘ ·Ï˘ÛȉˆÙ‹˜ ÔÏ˘ÌÂÚ¿Û˘ (PCR) ÌÔÚ› Ó· ÂÈÙ·¯‡ÓÂÈ ÙË ‰È¿ÁÓˆÛË (36). √ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÂÓ·ÓÙ›ÔÓ ÙˆÓ ·ÓÙÈÁfiÓˆÓ Ù˘ ÏÈÛÙ¤ÚÈ·˜, ÙfiÛÔ ÙˆÓ ÛˆÌ·ÙÈÎÒÓ √, fiÛÔ Î·È ÙˆÓ ‚ÏÂÊ·ÚȉÈÎÒÓ ∏, ‰ÂÓ ‰›ÓÂÈ ·ÍÈfiÈÛÙ· ·ÔÙÂϤÛÌ·Ù· ‰ÈfiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ
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ÔÏÏ¿ „¢‰Ò˜ ıÂÙÈο Î·È ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù· (.¯. ÌÔÚ› Ó· ·ÚÔ˘ÛÈ·Ûı› ÛÔ‚·Ú‹ Ïԛ̈ÍË Ì ·ÚÓËÙÈο ·ÓÙÈÛÒÌ·Ù· ÁÈ· ÏÈÛÙ¤ÚÈ·) (37). ¶·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ Î·È ·ÓÔÛÔ˚ÛÙÔ¯ËÌÈ΋ ÂͤٷÛË Ï·ÎÔ‡ÓÙˆÓ ·ÔηχÙÂÈ ¯·Ú·ÎÙËÚÈÛÙÈΤ˜ ‚Ï¿‚˜ (·ÔÛÙ‹Ì·Ù· Î·È ÌÈÎÚÔ·ÔÛÙ‹Ì·Ù·) (38).
£Âڷ›· ∏ ‰˘ÛÎÔÏ›· ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ıÂڷ›· Ù˘ ‰ÈÂÈÛ‰˘ÙÈ΋˜ ÏÈÛÙÂÚ›ˆÛ˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ ÂÓ‰Ô- Î·È ÂÍˆÎ˘ÙÙ¿ÚÈÔ ÙÚfiÔ ˙ˆ‹˜ Ù˘ L. monocytogenes Ô˘ ÛËÌ·›ÓÂÈ fiÙÈ Â›Ó·È ‰˘Ó·ÙfiÓ, ÂÓÒ ÙÔ ‚·ÎÙ‹ÚÈÔ ¤¯ÂÈ ÂÍ·Ê·ÓÈÛÙ› ·fi ÙÔÓ ÂÍˆÎ˘ÙÙ¿ÚÈÔ ¯ÒÚÔ, Ó· ‰Ú· ·ÓÂÓfi¯ÏËÙ· ÂÓÙfi˜ ÙÔ˘ ΢ÙÙ¿ÚÔ˘ ÙÔ˘ ÍÂÓÈÛÙ‹ fiÔ˘ ‰ÂÓ Êı¿ÓÔ˘Ó Ù· ·ÓÙÈ‚ÈÔÙÈο. ¶·ÚfiÙÈ fiÏ· ۯ‰fiÓ Ù· ÛÙÂϤ¯Ë L. monocytogenes Ô˘ ·ÔÌÔÓÒÓÔÓÙ·È ·fi ηÏÏȤÚÁÂȘ ·ÛıÂÓÒÓ Î·È ÙÚÔÊ›ÌˆÓ Â›Ó·È Â˘·›ÛıËÙ· Û ÔÏÏ¿ ·ÓÙÈ‚ÈÔÙÈο, ÂÎÙfi˜ ·fi ÙȘ ÎÂÊ·ÏÔÛÔÚ›Ó˜ 3˘ ÁÂÓÈ¿˜, ÛÙȘ Ôԛ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ê˘ÛÈ΋ ·ÓÔ¯‹, Î·È ÙË ÊˆÛÊÔÌ˘Î›ÓË, Ë Û˘¯ÓfiÙËÙ· ıÂڷ›·˜ Â›Ó·È ÌfiÓÔÓ 70%. ∆Ô Ê¿ÚÌ·ÎÔ ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÏÈÛÙÂÚ›ˆÛ˘ Â›Ó·È ˘„ËϤ˜ ‰fiÛÂȘ ·ÌÈÎÈÏÏ›Ó˘. ∏ ÚÔÛı‹ÎË ÁÂÓÙ·ÌÈΛÓ˘ Ô˘ ¤¯ÂÈ Û˘ÓÂÚÁÈ΋ ‰Ú¿ÛË, Â›Ó·È ··Ú·›ÙËÙË ÁÈ· ÙËÓ ıÂڷ›· ÙˆÓ ÓÂÔÁÓÒÓ Î·È ÙˆÓ ÂÁ·ˆÓ ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·. ∏ ‰È¿ÚÎÂÈ· Ù˘ ıÂڷ›·˜ Ú¤ÂÈ Ó· Â›Ó·È ‰˘Ô ¤ˆ˜ ÙÚÂȘ ‚‰ÔÌ¿‰Â˜. ∆Ô Ê¿ÚÌ·ÎÔ ‰Â‡ÙÂÚ˘ ÂÎÏÔÁ‹˜ Â›Ó·È Ë ÙÚÈÌÂıÔÚ›ÌË-ÎÔÙÚÈÌÔÍ·˙fiÏË ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÌÈÎÈÏÏ›ÓË ‹ Î·È ÌfiÓË (39). √È ÓÂfiÙÂÚ˜ ÎÈÓÔÏfiÓ˜ Â›Ó·È Ôχ ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ in vivo Î·È ÔÈ ÏÈÛÙ¤ÚȘ Â›Ó·È 100% ¢·›ÛıËÙ˜ ÛÙËÓ gemifloxacin. ∏ ¯ÔÚ‹ÁËÛË ·ÓÔÛÔÙÚÔÔÔÈËÙÒÓ (immunomodulators) ·˘Í¿ÓÂÈ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂڷ›·˜ (39,40).
¶ÚfiÏË„Ë √È ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ ÚfiÏË„Ë ·fi ÙË ÓfiÛÔ Î·Ù¢ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÔÓ ÙÚfiÔ ‰È·¯Â›ÚÈÛ˘ ÙˆÓ ÙÚÔʛ̈Ó, ÒÛÙ ÙÔ ÚÔ˚fiÓ Ô˘ Êı¿ÓÂÈ ÛÙËÓ Î·Ù·Ó¿ÏˆÛË Ó· ÌËÓ ÂÚȤ¯ÂÈ Î·ıfiÏÔ˘ ·ıÔÁfiÓ· ÌÈÎÚfi‚È·. ŸÛÔÓ ·ÊÔÚ¿ ÛÙȘ ÂÁ·Ԣ˜ ¤¯Ô˘Ó ÚÔÙ·ı› ·fi ÙÔ ∫¤ÓÙÚÔ ∂ϤÁ-
¯Ô˘ §ÔÈÌÒÍÂˆÓ ÙˆÓ ∏ÓˆÌ¤ÓˆÓ ¶ÔÏÈÙÂÈÒÓ ÁÂÓÈο Î·È ÂȉÈο ̤ÙÚ· ÁÈ· ÙË ÏÈÛÙ¤ÚÈ·, Ô˘ Ê·›ÓÔÓÙ·È ÛÙÔÓ ›Ó·Î·. ∂›Ó·È ·Ôχو˜ ··Ú·›ÙËÙÔ Ô Ì·ÈÂ˘Ù‹Ú·˜ Ó· ÏËÚÔÊÔÚ› ÙȘ ÂÁ·Ԣ˜ ÁÈ· Ù· ̤ÙÚ· ·˘Ù¿. ªÈ· ¿ÏÏË ËÁ‹ ÏËÚÔÊfiÚËÛ˘ ı· ÌÔÚÔ‡Û·Ó Ó· Â›Ó·È Ù· ̤۷ Ì·˙È΋˜ ÂÓË̤ڈÛ˘. ¶ÚfiÏË„Ë Ù˘ ‰ÈÂÈÛ‰˘ÙÈ΋˜ ÓfiÛÔ˘ ·fi ÏÈÛÙ¤ÚÈ·, ÙfiÛÔ Û ·ÓıÚÒÔ˘˜ fiÛÔ Î·È Û ˙Ò·, ÌÔÚ› Ó· Á›ÓÂÈ Ì ÂÌ‚ÔÏÈ·ÛÌfi. ∞Ó Î·È ÙÔ ÂÌ‚fiÏÈÔ Â›Ó·È Û ÂÈÚ·Ì·ÙÈÎfi ÛÙ¿‰ÈÔ, ÌÂϤÙ˜ ¤¯Ô˘Ó Ú·ÁÌ·ÙÔÔÈËı› Û ˙Ò· Î·È Û ·ÓıÚÒÔ˘˜ (41,42).
§ÈÛÙÂÚ›ˆÛË ÛÙËÓ ∂ÏÏ¿‰· ªËÓÈÁÁ›Ùȉ· ·fi ÏÈÛÙ¤ÚÈ· ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÛÙËÓ ÂÏÏËÓÈ΋ È·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›· ÙÔ 1967 (43). ª¤¯ÚÈ Û‹ÌÂÚ· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰Âη¤ÓÙ ÂÚÈÛÙ·ÙÈο ÂÚÈÁÂÓÓËÙÈ΋˜ Ïԛ̈͢ (44-47). ¢ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÂȉËÌ›· ·fi ÏÈÛÙ¤ÚÈ· Ô‡Ù ÛÙË ‰ÈÂÈÛ‰˘ÙÈ΋ ÌÔÚÊ‹, Ô‡ÙÂ Û·Ó Á·ÛÙÚÂÓÙÂÚ›Ùȉ· Û ·ÓıÚÒÔ˘˜ ÛÙËÓ ∂ÏÏ¿‰·. ™ËÌÂȈ٤ÔÓ fiÙÈ Ë ÏÈÛÙÂÚ›ˆÛË Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È ÛÙ· ÓÔÛ‹Ì·Ù· ÙˆÓ ÔÔ›ˆÓ Ë ‰‹ÏˆÛË ÛÙÔ ∫¤ÓÙÚÔ ŒÏÂÁ¯Ô˘ §ÔÈÌÒÍÂˆÓ Â›Ó·È ˘Ô¯ÚˆÙÈ΋. ∂ȉË̛˜ ·fi ÏÈÛÙ¤ÚÈ· ÛÙ· ˙Ò· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Û fiÏË ÙËÓ ËÂÈÚˆÙÈ΋ ∂ÏÏ¿‰· Î·È ÛÙ· ÓËÛÈ¿. ™˘¯ÓfiÙÂÚ· ÂÌÊ·Ó›˙ÂÙ·È ÛÙ· ·ÈÁÔÚfi‚·Ù· Î·È È‰›ˆ˜ ÛÙ· ηÙÛ›ÎÈ· (48).
µÈ‚ÏÈÔÁÚ·Ê›· 1. McLauchlin. Human listeriosis in Britain, 1967-85, a summary of 722 cases. 1. Listeriosis during pregnancy and in the newborn. J Epidemiol Infect 1990;104:181-189. 2. Schuchat A, Deaver KA, Wenger JD, Plikaytis BD, Mascola L, Pinner RW, et al Role of foods in sporadic listeriosis. I. Case-control study of dietary risk factors. The Listeria Study Group. JAMA 1992;267: 2041-2045. 3. Schlech WF 3rd. Foodborne listeriosis. Clin Infect Dis 2000;31:770-5. Cooper J, Walker RD. Listeriosis. Vet Clin North Am Food Anim Pract 1998;14:113-125. 4. Weis J, Seeliger HP. Incidence of Listeria monocytogenes in nature. Appl Microbiol 1975;30:29-32. 5. Farber JM, Peterkin PI. Listeria monocytogenes, a food-borne pathogen. Microbiol Rev 1991;55:476511. 6. Goulet V, de Valk H, Pierre O, Stainer F, Rocourt J, Vaillant V et al . Effect of prevention measures on incidence of human listeriosis, France, 1987-1997. ¶·È‰È·ÙÚÈ΋ 2006;69:104-109
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agents against Listeria monocytogenes and coryneform bacteria isolated from clinical samples. Antimicrob Agents Chemother 2001;45:2390-2392. 40. Darji A, Mohamed W, Domann E, Chakraborty T. Induction of immune responses by attenuated isogenic mutant strains of Listeria monocytogenes. Vaccine 2003;21 (2 Suppl):S102-109. 41. Angelakopoulos H, Loock K, Sisul DM, Jensen ER, Miller JF, Hohmann EL. Safety and shedding of an attenuated strain of Listeria monocytogenes with a deletion of actA/plcB in adult volunteers: a dose escalation study of oral inoculation. Infect Immun 2002;70:3592-3601. 42. ¶·˘Ï¿ÙÔ˘ ª, ¢·›ÎÔ˜ °, ¶·Ú·Ì¿ÓË π, ∫·Ú‚ÂÏ¿ ∂. £·Ó·ÙËÊfiÚÔ˜ ÂÚ›ÙˆÛȘ ÌËÓÈÁÁ›ÙȉԘ ÂÎ Listeria monocytogenes. π·ÙÚÈ΋ 1967:396-397. 43. ∞Ó·ÁÓˆÛÙ¿Î˘ ¢, ¶··‰¤Ï˘ º. ¡ÂÔÁÓÈ΋ ÛË„·È-
Ì›· ÂÎ Listeria Monocytogenes. ¢ÂÏÙ›ÔÓ ¶·È‰ ∫ÏÈÓ ¶·Ó ∞ıËÓÒÓ 1975;22:173. 44. ∞Ó‰Ú¤Ô˘ ∞, ∫·Ú·Û·‚‚›‰Ô˘ ∞, ¶··‚·ÛÈÏ›Ԣ√ÚÌ¿ÓË µ, ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂. ¶ÂÚÈÁÂÓÓËÙÈ΋ ÏÈÛÙÂÚ›ˆÛË: ¶ÂÚÈÁÚ·Ê‹ ¤ÍÈ ÂÚÈÛÙ·ÙÈÎÒÓ, ¶·È‰È·ÙÚÈ΋ 1997;60:709-713. 45. ∞ÓÙˆÓÈ¿‰Ô˘ °, ºÚ·ÁÎÔ‡ÏË ∂, ∞ÎÚÈÙ›‰Ô˘ ∂. ¶ÂÚÈÁÂÓÓËÙÈ΋ ÏÈÛÙÂÚ›ˆÛË: §ÈÛÙÂÚ›ˆÛË ÌËÙ¤Ú·˜ Î·È ÓÂÔÁÓÔ‡. ¶ÂÚÈÁÚ·Ê‹ ÌÈ·˜ ÂÚ›ÙˆÛ˘. ∂ÏÏËÓ ª·ÈÂ˘Ù °˘Ó·ÈÎ 1992;5:145-148. 46. P. Mexi Bourna, T. Konitsioti, O. Groutsi, E. Pipidou, V. Galiaki, A. Korkas. Listeriosis in pregnancy may present serious hazards to the newborn. In: Antsaklis A, editor. Proceedings of the XIX European Congress of Perinatal Medicine; 2004. p. 317-321. 47. ° •¤ÓÔ˜. §ÈÛÙÂÚÈÒÛÂȘ ÛÙ· ˙Ò·. ªÈÎÚÔ‚ÈÔÏÔÁÈο ¯ÚÔÓÈο 1990;6:198-120.
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™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ. ∂ÈÙÒÛÂȘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙÔ ¤Ì‚Ú˘Ô Î·È ÙÔ ÓÂÔÁÓfi ¶·È‰ÔηډÈÔÏfiÁÔ˜ – ∫·ıËÁËÙ‹˜ ∞ÓÒÙ·ÙÔ˘ ∆¯ÓÔÏÔÁÈÎÔ‡ ∂Î·È‰Â˘ÙÈÎÔ‡ π‰Ú‡Ì·ÙÔ˜ ∞ıËÓÒÓ AÏÏËÏÔÁÚ·Ê›·: ™Ù¤ÏÈÔ˜ ∞ÓÙˆÓÈ¿‰Ë˜ ∏Ú·ÎÏ›ÙÔ˘ 4, ∫ÔψӿÎÈ, ∆.∫. 106 73, ∞ı‹Ó· E -mail: prdrsant@otenet.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-05-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 30-09-2005
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¶ÂÚ›ÏË„Ë: ∆· ÂÈÙ‡ÁÌ·Ù· ÛÙË ‰È¿ÁÓˆÛË Î·È ÙËÓ ÂÂÌ‚·ÙÈ΋ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÁÁÂÓÒÓ Î˘Ú›ˆ˜ ηډÈÔ·ıÂÈÒÓ, ‰ËÌÈÔ‡ÚÁËÛ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÌÈ· ÚÔԉ¢ÙÈο ·˘Í·ÓfiÌÂÓË ÔÌ¿‰· Á˘Ó·ÈÎÒÓ Ì ηډÈÔ¿ıÂÈ·, ÔÈ Ôԛ˜ Êı¿ÓÔ˘Ó ÛÙËÓ ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ·. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ë ÂÁ΢ÌÔÛ‡ÓË ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÛËÌ·ÓÙÈÎÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ ÁÈ· ÙË ˙ˆ‹ Ù˘ ÌËÙ¤Ú·˜ ‹ ÙÔ˘ ÂÌ‚Ú‡Ô˘. À¿Ú¯Ô˘Ó fï˜ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ Î›Ó‰˘ÓÔÈ Â›Ó·È ·˘ÍË̤ÓÔÈ ¤ˆ˜ Ôχ ·˘ÍË̤ÓÔÈ, Û ‚·ıÌfi Ô˘ Ó· ηıÈÛÙÔ‡Ó ÙË ÌËÙÚfiÙËÙ· ··ÁÔÚ¢ÙÈ΋. ∆· ÌÂÁ·Ï‡ÙÂÚ· ÚÔ‚Ï‹Ì·Ù· Ù· ÔÔ›· ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÙÔ Î‡ËÌ· Â›Ó·È Ô ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, Ë ÚÔˆÚfiÙËÙ·, ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ÔÈ ·ÈÌÔÚÚ·Á›Â˜, Ë ÙÂÚ·ÙÔÁ¤ÓÂÛË Î.Ï. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙË ÌËÙ¤Ú·, ÂÎÙfi˜ ·fi ÙÔÓ Î›Ó‰˘ÓÔ ı·Ó¿ÙÔ˘, ÚÔηÏÔ‡ÓÙ·È ÔÏϤ˜ ÊÔÚ¤˜ ÛÔ‚·Ú¤˜ ¤ˆ˜ Ôχ ÛÔ‚·Ú¤˜ ÂÈÙÒÛÂȘ ÛÙËÓ ·ÈÌÔ‰˘Ó·ÌÈ΋ Ù˘ ¿ıËÛ˘ ·fi ÙËÓ Â›‰Ú·ÛË ÙÔ˘ ÙÔÎÂÙÔ‡ (ηډȷ΋ ·Ó¿ÚÎÂÈ·, ·ÚÚ˘ı̛˜ Î.Ï.). °È· ÙËÓ Î·Ï‡ÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·˘ÙÒÓ Ì ÙÔ˘˜ ÌÈÎÚfiÙÂÚÔ˘˜ ‰˘Ó·ÙÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜, ÙfiÛÔ ÁÈ· ÙË ÌËÙ¤Ú· fiÛÔ Î·È ÁÈ· ÙÔ ¤Ì‚Ú˘Ô, Â›Ó·È ··Ú·›ÙËÙË Ë ¤ÁηÈÚË ÂÓË̤ڈÛË ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ Î·È Ù˘ ›‰È·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÁÈ· Ù· Èı·Ó¿ ÚÔ‚Ï‹Ì·Ù·, Û οı ÂÚ›ÙˆÛË. ∂›Û˘, Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Ë ÁÓÒÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, Ë ÂÎÙ›ÌËÛË Ù˘ ηډÈÔÏÔÁÈ΋˜ ηٿÛÙ·Û˘ ÚÈÓ ·fi ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·ıÒ˜ Î·È Ë Ï‹„Ë ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ÂÂÌ‚·ÙÈÎÒÓ ‹ ıÂڷ¢ÙÈÎÒÓ Ì¤ÙÚˆÓ. ∆Ô ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ Ù˘ ÌËÙ¤Ú·˜ fiˆ˜ Î·È Ë ÎÏËÚÔÓÔÌÈ΋ ÌÂÙ·‚›‚·ÛË ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ÛÔ‚·Ú¿ ˘’ fi„ÈÓ. ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÔÎÂÙfi, Û˘Ó‹ıˆ˜ ÚÔÙÈÌ¿Ù·È Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ Ì ÙË ‚Ô‹ıÂÈ· ÂÌ‚Ú˘Ô˘ÏΛ·˜. ™Â ÂÚÈÛÙ·ÙÈο Ì ۇӉÚÔÌÔ Marfan Î·È Î›Ó‰˘ÓÔ ·Ó¢ڇÛÌ·ÙÔ˜ ÛÙËÓ ·ÔÚÙ‹, fiˆ˜ Î·È ÛÙ· ÚÔ‚Ï‹Ì·Ù· ËÎÙÈÎfiÙËÙ·˜ ÛÙȘ ÌÂÙ·ÏÏÈΤ˜ ‚·Ï‚›‰Â˜ Î.Ï., ÚÔÙÈÌ¿Ù·È Ë Î·ÈÛ·ÚÈ΋ ÙÔÌ‹. ∏ ˘„ËÏÔ‡ ÂȤ‰Ô˘ ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ Ë ÂÁ΢ÌÔÛ‡ÓË ÛÙË ÌËÙ¤Ú· Ì ηډÈÔ¿ıÂÈ· Â›Ó·È ‚¤‚·ÈÔ fiÙÈ ı· Û˘Ì‚¿ÏÂÈ ÛÙË Ì›ˆÛË fiÏˆÓ ÙˆÓ Èı·ÓÒÓ ÎÈÓ‰‡ÓˆÓ Û ·fiÏ˘Ù· ·Ô‰ÂÎÙ¿ fiÚÈ·. §¤ÍÂȘ ÎÏÂȉȿ: ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ, ›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ, ÂÁ΢ÌÔÛ‡ÓË.
Congenital and acquired heart diseases. Implications for pregnancy, the fetus and the newborn infant Paediatric cardiologist – Professor in the Technological Educational Institute of Athens Correspondence: 4, Herakleitou Str., 106 73, Athens E-mail: prdrsant@otenet.gr Date of submission: 17-05-2005 Date of approval: 30-09-2005
¶·È‰È·ÙÚÈ΋ 2006;69:110-117
S. Antoniadis
Abstract: Improvements in the diagnosis, intervention and surgical management of congenital heart disease (CHD) during recent years have led in increasing numbers of women with heart problems reaching childbearing age. In the majority of cases, pregnancy in women with cardiovascular does not cause serious problems to the mother or fetus, but there are cases in which maternity should be discouraged or prohibited. The major problems for the fetus are fetal loss, prematurity, low birth weight and a variety of other problems such as haemorrhage, teratogenesis, etc. Apart from the increased mortality, pregnancy in a woman with cardiovascular disease may cause significant changes in the haemodynamics of the maternal circulation (heart failure, arrhythmia etc.) with need for intensive care by expert doctors and hospital staff. For the optimal management in such cases, early counselling of the patient and those in her environment about the possible problems is very important. It is essential to know the history, to have a recent evaluation of the maternal cardiac functional status before pregnancy and to take appropriate medical or interventional treatment measures. The maternal life expectancy and the recurrence risk should be considered as factors of major importance. Normal vaginal delivery with forceps assistance is
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the birthing choice, except for cases with Marfan syndrome, the possibility of aortic aneurysm or coagulation problems in patients with artificial valves, when caesarian section is preferred. A high level of knowledge of the problems that pregnancy may cause to mothers with cardiovascular disease will certainly minimize the possible dangers of pregnancy to acceptable levels.
Key words: Congenital and acquired heart diseases, pregnancy.
∂ÈÛ·ÁˆÁ‹ √È ÚfiÔ‰ÔÈ Ù˘ ·È‰È·ÙÚÈ΋˜ ηډÈÔÏÔÁ›·˜ Î·È Ù˘ ·È‰ÔηډÈÔ¯ÂÈÚÔ˘ÚÁÈ΋˜ Ù· ÙÂÏÂ˘Ù·›· 25-30 ¯ÚfiÓÈ·, ›¯·Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ·ÏÏ¿ Î·È ÙËÓ ÂÈÌ‹Î˘ÓÛË ÙÔ˘ ÚÔÛ‰fiÎÈÌÔ˘ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÛıÂÓÒÓ Ì ηډÈÔÏÔÁÈο ÚÔ‚Ï‹Ì·Ù· (1,2). ™‹ÌÂÚ· ¤Ó·˜ ÌÂÁ¿ÏÔ˜ ·ÚÈıÌfi˜ Á˘Ó·ÈÎÒÓ, ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û‡ÌÏÔΘ ηډÈÔ¿ıÂȘ, Êı¿ÓÔ˘Ó Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· (3). ∏ ÛÂÍÔ˘·ÏÈ΋ ·ʋ Ì ·ÔÙ¤ÏÂÛÌ· ÌÈ· ·ÓÂÈı‡ÌËÙË ‹ ÂÈı˘ÌËÙ‹ ÂÁ΢ÌÔÛ‡ÓË ·ÔÙÂÏ› ¿ÓÙ· ̤ÚÔ˜ Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜ (4). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÁÈ· ÙË ˙ˆ‹ Ù˘ ÌËÙ¤Ú·˜. ŸÌˆ˜, ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ ÛÙȘ Ôԛ˜ ÔÈ Î›Ó‰˘ÓÔÈ Â›Ó·È ·˘ÍË̤ÓÔÈ, ·ÏÏ¿ Î·È ¿ÏϘ Ô˘ ηıÈÛÙÔ‡Ó ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Û¯Â‰fiÓ ·Ó›ÙÚÂÙË (5-7). ¢ÂÓ Ú¤ÂÈ ˆÛÙfiÛÔ, Ó· Ì·˜ ‰È·Ê‡ÁÂÈ fiÙÈ ÔÈ Î·Ú‰ÈÔ¿ıÂȘ ·ÎfiÌ· ÎÈ ·Ó ‰ÂÓ ·ÔÙÂϤÛÔ˘Ó ·ÈÙ›· ÌËÙÚÈÎÔ‡ ı·Ó¿ÙÔ˘, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔηϤÛÔ˘Ó ÂÈΛӉ˘Ó˜ ηٷÛÙ¿ÛÂȘ, fiˆ˜ ηډȷ΋ ·Ó¿ÚÎÂÈ· ‹ ·ÚÚ˘ı̛˜ ÔÈ Ôԛ˜ ¯ÚÂÈ¿˙ÔÓÙ·È ¿ÌÂÛË Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË (7). ∞fi fiÏ· Ù· ·Ú·¿Óˆ Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÛÔ ÌÂÁ¿ÏË ÛËÌ·Û›· ¤¯ÂÈ Ë ÂÓË̤ڈÛË fiÏˆÓ fiÛˆÓ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙÔÓ ÙÔÎÂÙfi Î·È ÙËÓ ÂÚÈÁÂÓÓËÙÈ΋ ÂÚ›Ô‰Ô (8) (Ì·ÈÂ˘Ù‹Ú˜, ·È‰ÔηډÈÔÏfiÁÔÈ, ηډÈÔÏfiÁÔÈ, ·È‰›·ÙÚÔÈ, ÓÂÔÁÓÔÏfiÁÔÈ, ·Ó·ÈÛıËÛÈÔÏfiÁÔÈ, ÁÂÓÂÙÈÛÙ¤˜, Ì·›Â˜ Î.Ï.). ∏ ÁÓÒÛË ÙˆÓ ·ÏÏ·ÁÒÓ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, fiˆ˜ Î·È Ù˘ ‚·ÛÈ΋˜ ·Ó·ÙÔÌ›·˜ ÙˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ ÔÏϤ˜ ·fi ÙȘ Ôԛ˜ Â›Ó·È Û¿ÓȘ, ·ÏÏ¿ Î·È ÔÈ Èı·ÓfiÙËÙ˜ ‚ÂÏÙ›ˆÛ˘ Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ Ê·Ú̷΢ÙÈο ‹ ·ÎfiÌ· Î·È ÂÂÌ‚·ÙÈο¯ÂÈÚÔ˘ÚÁÈο ÚÈÓ ‹ ηٿ ÙÔÓ ÙÔÎÂÙfi, ¤¯ÂÈ ÙÂÚ¿ÛÙÈ· ÛËÌ·Û›· (9,10). ∂›Û˘, Ôχ ÌÂÁ¿ÏË ÛËÌ·Û›· ¤¯ÂÈ Ë ¤ÁηÈÚË ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ ‹ Î·È Ù˘ ›‰È·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÛÙËÓ ÚÔÂÊË‚È΋ ‹ ÂÊË‚È΋ ËÏÈΛ· ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ Î·È ÙÔÓ ·È‰›·ÙÚÔ ÁÈ· ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÌÈ·˜ Èı·Ó‹˜ ÂÁ΢ÌÔÛ‡Ó˘.
∏ ÂÓË̤ڈÛË ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ Î·Ù¿ÏÏËÏÔ ÁÈ· οı ÂÚ›ÙˆÛË ÙÚfiÔ ·ÓÙÈÛ‡ÏÏ˄˘, ÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ·ÏÏ¿ Î·È ÙË ÁÓÒÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ÛÙÔ ¤Ì‚Ú˘Ô Î·È ÛÙÔ ÓÂÔÁÓfi (11). ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ÙÔ ¤Ì‚Ú˘Ô ‰ÂÓ ÂËÚ¿˙ÂÙ·È, fï˜, Û ¤Ó· Ôχ ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi, ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ Ù˘ ¿ıËÛ˘, ·Ú·ÙËÚÔ‡ÓÙ·È ·Ô‚ÔϤ˜ (20-25%), ηı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘, ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, Á¤ÓÓËÛË ÏÈÔ‚·ÚÒÓ Î·È ÚÔÒÚˆÓ ÂÌ‚Ú‡ˆÓ (ۯ‰fiÓ ÙÔ 100% ÛÙȘ ΢·ÓˆÙÈΤ˜ ÌËÙ¤Ú˜), Á¤ÓÓËÛË ÂÌ‚Ú‡Ô˘ ÌÂ Û˘ÁÁÂÓ‹ ηډÈÔ¿ıÂÈ· Î.Ï. (7). ŸÏ· Ù· ·Ú·¿Óˆ ·Ó·Ï‡ÔÓÙ·È ÛÙË Û˘Ó¤¯ÂÈ· ηٿ ηÙËÁÔÚ›· Î·È ÂÚ›ÙˆÛË. √È Û˘ÁÁÂÓ›˜ Î·È Ôχ Û·ÓÈfiÙÂÚ·, ÔÈ Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ, Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, Â›Ó·È ‰˘Ó·Ùfi ÁÈ· Ú·ÎÙÈÎÔ‡˜ ÏfiÁÔ˘˜ Ó· ‰È·¯ˆÚÈÛÙÔ‡Ó Û ÙÚÂȘ ηÙËÁÔڛ˜: ·) ·ı‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, ‚) ·ı‹ÛÂȘ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘ Î·È Á) ·ı‹ÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ÏfiÁˆ Ù˘ ÔÚÌÔÓÈ΋˜ ›‰Ú·Û˘ ÛÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi Û‡ÛÙËÌ·, ·Ú·ÙËÚÔ‡ÓÙ·È: ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜, ·‡ÍËÛË Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡ Î·È ÙÔ˘ ηٿ ÏÂÙfi fiÁÎÔ˘ ·›Ì·ÙÔ˜. √È ·˘Í‹ÛÂȘ ·˘Ù¤˜ Êı¿ÓÔ˘Ó ÛÙÔ Ì¤ÁÈÛÙÔ Î·Ù¿ ÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ Î·È ‰È·ÚÎÔ‡Ó Ì¤¯ÚÈ ÙÔÓ ÙÔÎÂÙfi. ∂›Û˘, ·Ú·ÙËÚÔ‡ÓÙ·È ÙÒÛË ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ ·ÓÙÈÛÙ¿ÛÂˆÓ Î·È ˘fiÙ·ÛË. ∏ ·ÈÌÔ‰˘Ó·ÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ‰È·ÚΛ ̤¯ÚÈ Î·È ‰‡Ô ‚‰ÔÌ¿‰Â˜ ÂÚ›Ô˘ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi. ∏ ÏÂÙÔÌÂÚ‹˜ ÂÚÈÁÚ·Ê‹ Ù˘ ÁÈ· οı ·ÓˆÌ·Ï›· ‹ Û˘Ó‰˘·ÛÌÔ‡˜ ·ÓˆÌ·ÏÈÒÓ ‚Ú›ÛÎÂÙ·È ¤Ú· ·fi ÙÔ˘˜ ÛÙfi¯Ô˘˜ ÙÔ˘ ¿ÚıÚÔ˘ ·˘ÙÔ‡ (5,12,13).
∞. ¶·ı‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 1. ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË ∏ ÚˆÙÔ·ı‹˜, Ë ‰Â˘ÙÂÚÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Î·È Î˘Ú›ˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Eisenmenger ·ÔÙÂÏÔ‡Ó ÙȘ ·ı‹ÛÂȘ Ì ÙÔÓ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117
Pediatr Mar-Apr 06
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™. ∞ÓÙˆÓÈ¿‰Ë˜
˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ (·ÎfiÌ· Î·È fiÙ·Ó ÔÈ È¤ÛÂȘ ÛÙÔ˘˜ Ó‡ÌÔÓ˜ Â›Ó·È 50% ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ). ∏ ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· ÁÈ· οı ÂÁ΢ÌÔÛ‡ÓË Î˘Ì·›ÓÂÙ·È ÛÙÔ 31%-50% (ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË 30%, ‰Â˘ÙÂÚÔ·ı‹˜ 50%, Û‡Ó‰ÚÔÌÔ Eisenmenger 36%), ¯ˆÚ›˜ Ó· ¤¯ÂÈ ·ÏÏ¿ÍÂÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ ÓÂÔÁÓfi, ÔÈ ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ Â›Ó·È Û˘¯Ó¤˜, fiˆ˜ Î·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 30% ÙˆÓ Î˘‹ÛˆÓ. ∏ ÚÔˆÚfiÙËÙ· Â›Ó·È Â›Û˘ Û˘¯Ó‹, Ë ‰Â ÂÚÈÁÂÓÓËÙÈ΋ ıÓËÛÈÌfiÙËÙ· Êı¿ÓÂÈ ÙÔ 28%. ∏ ÓÂÔÁÓÈ΋ ıÓËÛÈÌfiÙËÙ· ‚Ú›ÛÎÂÙ·È ÛÙÔ 13% (14-16). ªÂ Ù· ÔÛÔÛÙ¿ ·˘Ù¿ Á›ÓÂÙ·È ·ÓÙÈÏËÙfi fiÙÈ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ¤ÁηÈÚË ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ Î·È Ù˘ ·ÛıÂÓÔ‡˜ ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ. ŸÙ·Ó Ë ·ÛıÂÓ‹˜ ‚Ú›ÛÎÂÙ·È Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ·, Â›Ó·È ·fiÏ˘Ù· ··Ú·›ÙËÙÔ Ó· Ï·Ì‚¿ÓÔÓÙ·È Ù· ·ÛʷϤÛÙÂÚ· ηٿ ÂÚ›ÙˆÛË Ì¤ÙÚ· ·ÓÙÈÛ‡ÏÏ˄˘ ‹ Î·È ·ÎfiÌË Î·Ï‡ÙÂÚ· Ó· Á›ÓÂÙ·È ÛÂ Û˘ÓÂÓÓfiËÛË Ì ÙÔÓ Ì·ÈÂ˘Ù‹Ú· ÛÙ›ڈÛË, ·Ú’ fiÏÔ˘˜ ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜. ™Â ÂÚ›ÙˆÛË ÂÁ΢ÌÔÛ‡Ó˘ ı· Ú¤ÂÈ Ó· Û˘ÓÈÛÙ¿Ù·È ‰È·ÎÔ‹ ·ËÛ˘. ™ÙȘ ÌËÙ¤Ú˜ Ô˘ ·ÔÊ·Û›˙Ô˘Ó Û˘Ó¤¯ÈÛË Ù˘ ·ËÛ˘ Ú¤ÂÈ Ó· ÂÍËÁÔ‡ÓÙ·È ÔÈ Î›Ó‰˘ÓÔÈ (Ô ı¿Ó·ÙÔ˜ ·ÔÙÂÏ› Èı·ÓfiÙËÙ· ̤¯ÚÈ Î·È ‰‡Ô ¤ˆ˜ ¤ÍÈ Â‚‰ÔÌ¿‰Â˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi). ∂›Û˘, Â›Ó·È ··Ú·›ÙËÙË Ë ÂÈÛ·ÁˆÁ‹ Û ªÔÓ¿‰· ∫‡ËÛ˘ À„ËÏÔ‡ ∫ÈÓ‰‡ÓÔ˘ Î·È Ë ·ÓÙÈÌÂÙÒÈÛË Ì Ô͢ÁfiÓÔ, ÓÈÙÚÈÎfi Ô͇, Ë·Ú›ÓË, ÚÔÛÙ·ÁÏ·‰›Ó˜ Î·È Èı·ÓÒ˜ ¿ÏÏ· ÓÂfiÙÂÚ· Ê¿Ú̷η, ·ÚfiÏÔ Ô˘ Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· fiÏˆÓ Â›Ó·È ·ÌÊÈÛ‚ËÙ‹ÛÈÌË (17-21). 2. ª˘ÔηډÈÔ¿ıÂȘ ¢È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·: ∞ÔÙÂÏ› ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ì ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Ô˘ Êı¿ÓÂÈ ÙÔ 7% ÂÚ›Ô˘ Î·È ÌÂÁ¿Ï˜ Èı·ÓfiÙËÙ˜ ÂÈ‚¿Ú˘ÓÛ˘ Ù˘ ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘. √È ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ Â›Ó·È Û˘¯Ó¤˜. ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÂÊ·ÚÌfi˙ÔÓÙ·È fiÛ· ·Ó·Ê¤ÚıËÎ·Ó ÛÙËÓ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË Î·È Î˘Ú›ˆ˜, Ó· ‰›ÓÂÙ·È ¤ÌÊ·ÛË ÛÙËÓ ¤ÁηÈÚË ÂÓË̤ڈÛË (22-24). ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·: ¶·ÚfiÏÔ Ô˘ Â›Ó·È Ë Û˘¯ÓfiÙÂÚË Ì˘ÔηډÈÔ¿ıÂÈ·, ÔÏϤ˜ ÊÔÚ¤˜ ΢ڛˆ˜ ÛÙ· ÂÚÈÛÙ·ÙÈο ¯ˆÚ›˜ ·ÚÂÌfi‰ÈÛË Ù˘ ÚÔ‹˜ ÙÔ˘ ·›Ì·ÙÔ˜ ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ë ‰È¿ÁÓˆÛË ÌÔÚ› Ó· ‰È·Ê‡ÁÂÈ ‹ ·ÎfiÌ· Î·È Ó· ÙÂı› Ì ÙËÓ Â˘Î·ÈÚ›· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ™ÙȘ ÂÚÈÙÒÛÂȘ fiÔ˘ ˘¿Ú¯ÂÈ ·fiÊÚ·ÍË (ÌÂÁ¿ÏË ˘ÂÚÙÚÔÊ›·), ηڶ·È‰È·ÙÚÈ΋ 2006;69:110-117
‰È·Î‹ ·Ó¿ÚÎÂÈ·, ·ÚÚ˘ı̛˜, ÔÈ ÂÈÙÒÛÂȘ Ù˘ ·ËÛ˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ôχ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· Î·È ÁÈ’ ·˘Ùfi Ë ·ÔÊ˘Á‹ Ù˘ ·ÔÙÂÏ› ÙË ÛÔÊfiÙÂÚË ÂÈÏÔÁ‹. ™ÙȘ ÂÚÈÙÒÛÂȘ ¯ˆÚ›˜ ·fiÊÚ·ÍË ‹ ¿ÏϘ ÂÈ‚·Ú‡ÓÛÂȘ Ë ÂÁ΢ÌÔÛ‡ÓË Á›ÓÂÙ·È Î·Ï¿ ·ÓÂÎÙ‹, Ë ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Â›Ó·È Û¿ÓÈ· Î·È ÔÈ Î›Ó‰˘ÓÔÈ ÁÈ· ÙÔ ÓÂÔÁÓfi Û˘Ó›ÛÙ·ÓÙ·È Î˘Ú›ˆ˜ ÛÙÔ fiÙÈ ˘¿Ú¯ÂÈ 50% Èı·ÓfiÙËÙ· Ó· ¤¯Ô˘Ó ÙËÓ ›‰È· ¿ıËÛË (25-29). ¶ÂÚÈÁÂÓÓËÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·: ¶·ÚfiÏÔ Ô˘ Â›Ó·È Û¿ÓÈ·, ÂÚÈÁÚ¿ÊÂÙ·È ÏfiÁˆ Ù˘ Û¯¤Û˘ Ù˘ Ì ÙËÓ ÂÁ΢ÌÔÛ‡ÓË. ∂›Ó·È ÌÈ· ¿ıËÛË Ô˘ Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ·ÎfiÌ· ‰ÂÓ ¤¯ÂÈ ‰È¢ÎÚÈÓÈÛÙ› Ï‹Úˆ˜ (Èı·ÓÔÏÔÁÂ›Ù·È Ì˘Ôηډ›Ùȉ· ÈÔÁÂÓÔ‡˜ ·ÈÙÈÔÏÔÁ›·˜). ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ì ÂÂÈÛfi‰È· ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ ÛÙÔÓ ÙÂÏÂ˘Ù·›Ô Ì‹Ó· ÚÈÓ ·fi ÙÔÓ ÙÔÎÂÙfi ηıÒ˜ Î·È ÛÙÔ˘˜ ÂfiÌÂÓÔ˘˜ ¤ÓÙ ̋Ó˜. ∏ ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· ÊÙ¿ÓÂÈ ÙÔ 20%, ÂÓÒ ·ÚfiÏÔ Ô˘ Ë Û˘¯ÓfiÙËÙ· ÙˆÓ ÚfiˆÚˆÓ ÓÂÔÁÓÒÓ Â›Ó·È ·˘ÍË̤ÓË Î·ıÒ˜ Î·È ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘, ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ÛÙÔ ÓÂÔÁÓfi. ∏ ηٿÛÙ·ÛË ÙÔ˘ Ì˘Ôηډ›Ô˘ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi, Ë ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜ Î.Ï., ÂÈÙÚ¤Ô˘Ó ÙËÓ ÚfiÁÓˆÛË Î·È ÙÔÓ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÁÈ· ÂfiÌÂÓ˜ ÂÁ΢ÌÔÛ‡Ó˜ (2,5). 3. ™‡Ó‰ÚÔÌÔ Marfan ∞ÎfiÌ· Î·È fiÙ·Ó ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÈÏÔΤ˜ Ë ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Êı¿ÓÂÈ ÙÔ 1%. ŸÙ·Ó ˘¿Ú¯Ô˘Ó, fiˆ˜ Ë ‰È¿Ù·ÛË Ù˘ Ú›˙·˜ Ù˘ ·ÔÚÙ‹˜ ‹ ·Ó¿ÚÎÂÈ· Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜, ÙÔ Î·Îfi ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, Ë Èı·ÓfiÙËÙ· ·Ó¢ڇÛÌ·ÙÔ˜, ·Ó‚¿˙Ô˘Ó ÙË ÌËÙÚÈ΋ ıÓËÛÈÌfiÙËÙ· Û Ôχ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿. ™Ù· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ Ë ÂÌ‚Ú˘˚΋ ıÓËÛÈÌfiÙËÙ· Êı¿ÓÂÈ ÙÔ 22%. ∞Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË Û˘ÓÈÛÙ¿Ù·È Û˘Ì‚Ô˘Ï‹ ÁÈ· ‰È·ÎÔ‹ Ù˘ ·ËÛ˘ (26-28). 4. ™Ù¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ™Ù· ÂÚÈÛÙ·ÙÈο Ì ÌÈÎÚÔ‡ ‹ ̤ÙÚÈÔ˘ ‚·ıÌÔ‡ ÛÙÂÓÒÛÂȘ (ÎÏ›ÛË ›ÂÛ˘ <50 mm/hg) Ë ÂÁ΢ÌÔÛ‡ÓË Û˘Ó‹ıˆ˜ ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù·. £· Ú¤ÂÈ fï˜ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ fiÙÈ Ë ·Û˘Ìو̷ÙÈ΋ ÛÙ¤ÓˆÛË -Û˘Ó‹ıˆ˜ Û ¤‰·ÊÔ˜ ‰ÈÁÏÒ¯ÈÓÔ˜ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜- ÌÔÚ› Ó· ·ÚÔ˘ÛÈ¿ÛÂÈ Û˘ÌÙÒÌ·Ù· Î·È Â˘Ú‹Ì·Ù· ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ Ù˘ ÎÏ›Û˘ ›ÂÛ˘ ·fi ÙËÓ ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ÙÔ˘ ·›Ì·ÙÔ˜ Î·È ÙÔ˘ ηٿ ÏÂÙfi fiÁÎÔ˘ Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ™Â ·ÛıÂÓ›˜ Ì ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ÂÈ‚¿Ú˘ÓÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·113
113
™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ
Ì ÂÌÊ¿ÓÈÛË Û˘ÌÙˆÌ¿ÙˆÓ (20%) fiˆ˜ ‰‡ÛÓÔÈ·, Ù·¯‡ÓÔÈ·, Ù·¯˘Î·Ú‰›·, ÚÔοډȷ ¿ÏÁË Î.Ï. ∏ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ Â›Ó·È Û˘¯Ó‹ ¿ıËÛË Î·È ÁÈ’ ·˘Ùfi Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌÔ Ó· Á›ÓÂÈ ÁÓˆÛÙfi fiÙÈ Û ÌÂÙÚ›Ô˘ ‹ ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÛÙÂÓÒÛÂȘ, Ë ÂÁ΢ÌÔÛ‡ÓË ı· Ú¤ÂÈ Ó· ·Ó·‚¿ÏÏÂÙ·È Ì¤¯ÚÈ ÙËÓ ÂÂÌ‚·ÙÈ΋ ‹ ¯ÂÈÚÔ˘ÚÁÈ΋ ‰ÈfiÚıˆÛË. ∂¿Ó ·˘Ùfi ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi ·ÎfiÌ· Î·È ÛÙȘ ‰‡ÛÎÔϘ ÂÚÈÙÒÛÂȘ ·›ÚÓÔÓÙ·˜ ̤ÙÚ·, fiˆ˜ ÓÔÛËÏ›· Î·È ·ÔÊ˘Á‹ Ù˘ ·Ú·ÌÈÎÚ‹˜ ÎfiˆÛ˘ ηıÒ˜ Î·È Ë Èı·Ó‹ ¯ÔÚ‹ÁËÛË ‚ã ·Ó·ÛÙÔϤˆÓ Î.Ï., Û˘Ó‹ıˆ˜ ÂÈÙ˘Á¯¿ÓÂÙ·È Ë ÂÚ¿ÙˆÛË ÙÔ˘ ÙÔÎÂÙÔ‡. ªfiÓÔ Û Ôχ ‰‡ÛÎÔϘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Û˘˙ËÙËı› Ë ÂÂÌ‚·ÙÈ΋ ‰ÈfiÚıˆÛË ‹ ·ÎfiÌ· Î·È Ë ÙÔÔı¤ÙËÛË ‚·Ï‚›‰·˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ·ÚfiÏÔ Ô˘ Ô Î›Ó‰˘ÓÔ˜ ÙÔ˘ ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ Êı¿ÓÂÈ ÙÔ 30% (29-32). 5. ¶ÚÔ‚Ï‹Ì·Ù· ÛÙÂÊ·ÓÈ·›ˆÓ ∞Ó Î·È ÚÔ˜ ÙÔ ·ÚfiÓ ·Ú·ÙËÚÔ‡ÓÙ·È Û¿ÓÈ·, Ì ÙËÓ ·‡ÍËÛË Ù˘ ËÏÈΛ·˜ ·ËÛ˘, Ê·›ÓÂÙ·È fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ ı· ·ÔÙÂϤÛÔ˘Ó ÂȉÈ΋ ÔÌ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ (2). 6. ™‡ÌÏÔΘ ΢·ÓˆÙÈΤ˜ ηډÈÔ¿ıÂȘ ™ÙËÓ ÔÌ¿‰· ÙˆÓ ·ı‹ÛÂˆÓ ·˘ÙÒÓ ·Ó‹ÎÔ˘Ó Î˘·ÓˆÙÈΤ˜ ηډÈÔ¿ıÂȘ ÛÙȘ Ôԛ˜ ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜ (ηϋ ÂÍÈÛÔÚÚfiËÛË, ·ÌÊÈ‚Ôϛ˜ ÁÈ· ÙËÓ Â˘ÂÚÁÂÙÈ΋ ›‰Ú·ÛË ÙÔ˘ ¯ÂÈÚÔ˘ÚÁÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ Î.Ï.) ‰ÂÓ ¤¯ÂÈ Á›ÓÂÈ Î·Ì›· ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË ‹ ¤¯ÂÈ Á›ÓÂÈ ÌfiÓÔ ·ÚËÁÔÚËÙÈ΋ ·Ú¿Î·Ì„Ë (shunt). ∏ ·ÚÓËÙÈ΋ ›‰Ú·ÛË Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ ÔÊ›ÏÂÙ·È ÛÙËÓ Âȉ›ӈÛË Ù˘ ‰È·Ê˘Á‹˜ ·fi ‰ÂÍÈ¿ ÚÔ˜ ·ÚÈÛÙÂÚ¿, ÏfiÁˆ Ù˘ ÙÒÛ˘ ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ È¤ÛÂˆÓ Î·È Ù˘ ·‡ÍËÛ˘ ÙÔ˘ ηٿ ÏÂÙfi fiÁÎÔ˘ ·›Ì·ÙÔ˜. ÃÚÂÈ¿˙ÂÙ·È ÌÂÁ¿ÏË ÚÔÛÔ¯‹ ÛÙËÓ ·Ú·ÎÔÏÔ‡ıËÛË, ¤¯ÔÓÙ·˜ ˘’ fi„ÈÓ fiÙÈ Û ÂÚÈÙÒÛÂȘ Ô˘ Ë Ô͢ÁfiÓˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ·›Ì·ÙÔ˜ Â›Ó·È ÌÈÎÚfiÙÂÚË ÙÔ˘ 85%, Ë Èı·ÓfiÙËÙ· Á¤ÓÓËÛ˘ ˙ˆÓÙ·ÓÔ‡ ÓÂÔÁÓÔ‡ ‰ÂÓ ÍÂÂÚÓ¿ÂÈ ÙÔ 12%, ÂÓÒ Û Ô͢ÁÔÓÒÛÂȘ ÌÂÁ·Ï‡ÙÂÚ˜ ÙÔ˘ 90% (οˆ˜ ‰‡ÛÎÔÏÔ) Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘ 90%. ™Â fi,ÙÈ ·ÊÔÚ¿ ÛÙÔ ¤Ì‚Ú˘Ô, Ô ÂÌ‚Ú˘˚Îfi˜ ı¿Ó·ÙÔ˜, ÙÔ ¯·ÌËÏfi ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ Î·È Ë ÚÔˆÚfiÙËÙ· Â›Ó·È Ôχ Û˘¯Ó¿ ÚÔ‚Ï‹Ì·Ù·. ø˜ ÚÔ˜ ÙË ÌËÙ¤Ú·, ÛÙÔ 1/3 ÂÚ›Ô˘ ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚÔηÏÂ›Ù·È ·Ô‰ÈÔÚÁ¿ÓˆÛË Ù˘ ·ÈÌÔ‰˘Ó·ÌÈ΋˜ ÈÛÔÚÚÔ›·˜ (‚ÂÏÙÈÒÓÂÙ·È Ì ÙËÓ ·Ú·ÌÔÓ‹ ÛÙÔ ÎÚ‚¿ÙÈ ÙÔ˘ ÓÔÛÔÎÔÌ›Ԣ), fï˜ Ô ı¿Ó·ÙÔ˜ Û˘Ó‹-
ıˆ˜ ·ÔʇÁÂÙ·È. ™ÙÔÓ ÙÔÎÂÙfi ÚÔÙÈÌ¿Ù·È Ë Î·ÈÛ·ÚÈ΋ ÙÔÌ‹ (33,34).
µ. ¶·ı‹ÛÂȘ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘ 1. ªÂÙ¿ıÂÛË ÌÂÁ¿ÏˆÓ ·ÁÁ›ˆÓ ÌÂÙ¿ ·fi ‰ÈfiÚıˆÛË Ì ÂÂÌ‚¿ÛÂȘ Mustard ‹ Senning ªÔÏÔÓfiÙÈ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÚÔÙÈÌ¿Ù·È Ë ·Ó·ÙÔÌÈ΋ ‰ÈfiÚıˆÛË, Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ÊÙ¿ÓÔ˘Ó Û ·Ó··Ú·ÁˆÁÈ΋ ËÏÈΛ· Û˘Ó‹ıˆ˜ ¤¯Ô˘Ó ·ÓÙÈÌÂÙˆÈÛÙ› Ì ÙȘ ÂÂÌ‚¿ÛÂȘ Mustard ‹ Senning Ô˘ ÂÊ·ÚÌfi˙ÔÓÙ·Ó ·ÏÈfiÙÂÚ· (ÚÈÓ ·fi ÂÚ›Ô˘ 20-25 ¯ÚfiÓÈ·). ∞Ó Î·È Ë ¿ıËÛË Â›Ó·È ÛÔ‚·Ú‹ Î·È ÔÈ ÂÁ¯ÂÈÚ‹ÛÂȘ ‰‡ÛÎÔϘ, Ë ÂÁ΢ÌÔÛ‡ÓË Á›ÓÂÙ·È Û˘Ó‹ıˆ˜ ηϿ ·ÓÂÎÙ‹. √ ΛӉ˘ÓÔ˜ ·ÚÚ˘ıÌ›·˜, ηډȷ΋˜ ·Ó¿ÚÎÂÈ·˜ Î·È Âȉ›ӈÛ˘ Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Ù˘ ηډȿ˜ ÊÙ¿ÓÂÈ ÙÔ 14% (3,35). 2. ªÔÓ‹Ú˘ ÎÔÈÏ›·, ÌÂÙ¿ ·fi ¤̂·ÛË Ù‡Ô˘ Fontan ∆· ΢ÚÈfiÙÂÚ· ÚÔ‚Ï‹Ì·Ù· ÛÙȘ ·ÛıÂÓ›˜ ·˘Ù¤˜ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·fi ÙËÓ ·‰˘Ó·Ì›· Ù˘ ÎÔÈÏ›·˜ Ó· ·˘Í‹ÛÂÈ ÙËÓ Î·Ú‰È·Î‹ ·ÚÔ¯‹ Î·È ·fi ÙȘ Ôχ ÛÔ‚·Ú¤˜ Î·È ‰‡ÛÎÔÏ· ·ÓÙÈÌÂÙˆ›ÛÈ̘ ·ÚÚ˘ı̛˜. √ ΛӉ˘ÓÔ˜ ı·Ó¿ÙÔ˘ ‰ÂÓ Â›Ó·È ÌÂÁ¿ÏÔ˜, fï˜ Ë ·ÔÚ‡ıÌÈÛË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, ÙÔ ˘„ËÏfi ÔÛÔÛÙfi ÂÌ‚Ú˘˚ÎÔ‡ ı·Ó¿ÙÔ˘ (ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ 1/3) ηıÒ˜ Î·È ÙÔ Ì¤ÏÏÔÓ, ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÈÊ˘Ï¿ÍÂȘ ˆ˜ ÚÔ˜ ÙËÓ ·ÚÔ¯‹ ÚÔÁÂÓÓËÙÈÎÒÓ Û˘Ì‚Ô˘ÏÒÓ (ı· Ú¤ÂÈ Ì¿ÏÏÔÓ Ó· ·Ôı·ÚÚ‡ÓÂÙ·È Ë ÂÁ΢ÌÔÛ‡ÓË) (3,36). 3. ∆ÂÙÚ·ÏÔÁ›· Fallot Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ·ÔÙÂÏ› ÙËÓ ÈÔ Û˘¯Ó‹ ΢·ÓˆÙÈ΋ ηډÈÔ¿ıÂÈ·. ∏ ÂÈÙ˘¯‹˜ ‰ÈfiÚıˆÛ‹ Ù˘ Â›Ó·È ÂÊÈÎÙ‹ Â‰Ò Î·È ÔÏϤ˜ ‰ÂηÂٛ˜. ™Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ηϋ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ηٿÛÙ·ÛË ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù·. ™Â ·˘Ù¿ Ô˘ ˘¿Ú¯Ô˘Ó ·ÚÚ˘ı̛˜, ˘ÔÏÂÈÌÌ·ÙÈΤ˜ ‰È·Ê˘Á¤˜, ·Ó¿ÚÎÂÈ· ÛÙÔÓ ¯ÒÚÔ ÂÍfi‰Ô˘ Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ Î.Ï., Ë ÛÔ‚·ÚfiÙËÙ· ÙˆÓ ÂÈÙÒÛÂˆÓ ·˘Í¿ÓÂÙ·È ‹ ÌÂÈÒÓÂÙ·È Î·Ù¿ ÂÚ›ÙˆÛË. 4. πÛıÌÈ΋ ÛÙ¤ÓˆÛË Ù˘ ·ÔÚÙ‹˜ ∂›Ó·È ÌÈ· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ Û˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ. ™‹ÌÂÚ·, ÛÙË ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÚfiÎÂÈÙ·È ÁÈ· ¯ÂÈÚÔ˘ÚÁÈο ‰ÈÔÚıˆÌ¤ÓË ÛÙ¤ÓˆÛË Ô˘ ‰ÂÓ ¤¯ÂÈ È‰È·›ÙÂÚ˜ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·114
114
™. ∞ÓÙˆÓÈ¿‰Ë˜
ÂÈÙÒÛÂȘ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÂÎÙfi˜ Â¿Ó ˘¿Ú¯ÂÈ Â·Ó·ÛÙ¤ÓˆÛË ‹ ˘¤ÚÙ·ÛË Ô˘ ·Ú·Ì¤ÓÂÈ. ™Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰ÈÔÚıˆı›, Ë ·ÚÙËÚȷ΋ ›ÂÛË Ú˘ıÌ›˙ÂÙ·È ‰‡ÛÎÔÏ· ÏfiÁˆ ÙÔ˘ fiÙÈ Ë ÙÒÛË Ù˘ ›ÂÛ˘ ÛÙÔ ¿Óˆ ̤ÚÔ˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (ÚÈÓ ÙË ÛÙ¤ÓˆÛË) ÚÔηÏ› ÌÂÁ¿ÏË ÙÒÛË ÛÙÔ Î¿Ùˆ ̤ÚÔ˜. ∏ ÚÔˆÚfiÙËÙ· Î·È Ë Î·ı˘ÛÙ¤ÚËÛË Ù˘ ۈ̷ÙÈ΋˜ ·Ó¿Ù˘Í˘ ÙÔ˘ ÂÌ‚Ú‡Ô˘ Â›Ó·È Û¯ÂÙÈο Û˘¯Ó¤˜. 5. ™Ù¤ÓˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜ √È ·ÓˆÌ·Ï›Â˜ ÛÙË ÌÈÙÚÔÂȉ‹ ‚·Ï‚›‰· ÌÔÚ› Ó· ÔÊ›ÏÔÓÙ·È ÛÂ Û˘ÁÁÂÓ‹ ÛÙ¤ÓˆÛË ‹ Â›Ó·È ÚÂ˘Ì·ÙÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ (37). ∏ ÚÂ˘Ì·ÙÈ΋ ÓfiÛÔ˜ fï˜, Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· ÛÙÔÓ ·ÓÂÙ˘Á̤ÓÔ ÎfiÛÌÔ. ™Â οı ÂÚ›ÙˆÛË, Ë ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ Ù˘ ηډȷ΋˜ Û˘¯ÓfiÙËÙ·˜, ηıÒ˜ Î·È ÙÔ˘ fiÁÎÔ˘ ·ÏÌÔ‡, ÚÔηÏ› ¿ÓÔ‰Ô ÙˆÓ È¤ÛÂˆÓ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ, Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·, ‰‡ÛÓÔÈ· Î·È Èı·ÓÒ˜ ·ÚÚ˘ıÌ›·. √È Î·Ù·ÛÙ¿ÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ·Ó¿·˘ÛË, ‰ÈÔ˘ÚËÙÈο, ‚-·Ó·ÛÙÔÏ›˜, Ë·Ú›ÓË (ΛӉ˘ÓÔ˜ ‰ËÌÈÔ˘ÚÁ›·˜ ıÚfiÌ‚ˆÓ ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎfiÏÔ). ™Â ‚·ÚȤ˜ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· Û˘˙ËÙËı› ·ÎfiÌ· Î·È ‚·Ï‚ȉÔÏ·ÛÙÈ΋. ∂˘Ù˘¯Ò˜, Ë ¿ıËÛË ‰ÂÓ Â›Ó·È Ôχ Û˘¯Ó‹ Î·È Ì ÙËÓ ¤ÁηÈÚË Û˘Ì‚Ô˘Ï¢ÙÈ΋ ÔÈ ‰˘ÛÎÔϛ˜ ·ÔÛÔ‚Ô‡ÓÙ·È. ª¤¯ÚÈ ÙÒÚ· ‰ÂÓ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÌËÙÚÈÎÔ› ı¿Ó·ÙÔÈ. ∏ ÚfiÙˆÛË Ù˘ ÌÈÙÚÔÂȉԇ˜ ‚·Ï‚›‰·˜, ·Ó Î·È ‰ÂÓ ¤¯ÂÈ Û¯¤ÛË Ì ÙË ÛÙ¤ÓˆÛË, ·Ó·Ê¤ÚÂÙ·È Â‰Ò ÏfiÁˆ Ù˘ Û˘¯ÓfiÙËÙ¿˜ Ù˘, Ë ÔÔ›· ÔÏϤ˜ ÊÔÚ¤˜ ÔÊ›ÏÂÙ·È Û ˘ÂډȿÁÓˆÛË. ™Â οı ÂÚ›ÙˆÛË ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î‡ËÛË. 6. ªÂÙ·ÏÏÈΤ˜ ‚·Ï‚›‰Â˜ Ÿˆ˜ Â›Ó·È ÁÓˆÛÙfi, ÔÈ ·ÛıÂÓ›˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¤¯ÂÈ ÙÔÔıÂÙËı› ÌÂÙ·ÏÏÈ΋ ‚·Ï‚›‰· ·›ÚÓÔ˘Ó ·ÓÙÈËÎÙÈο. ŸÛÔÈ ¤¯Ô˘Ó ‚ÈÔÚÔÛıÂÙÈΤ˜ ‚·Ï‚›‰Â˜ Î·È ‚·Ï‚›‰Â˜ ·fi ÌÔۯ‡̷ٷ ‰ÂÓ ·›ÚÓÔ˘Ó ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Î·È ¤ÙÛÈ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù·. ∆Ô ‰›ÏËÌÌ· ÛÙËÓ ÂÈÏÔÁ‹ ÙÔ˘ ηٷÏÏËÏfiÙÂÚÔ˘ ·ÓÙÈËÎÙÈÎÔ‡ Û¯‹Ì·ÙÔ˜ ·ÎfiÌ· Î·È ÛÙȘ ̤Ú˜ Ì·˜ ÚÔηÏ› ·ÓÙÈı¤ÛÂȘ, ÛÎÂÙÈÎÈÛÌfi Î·È ÚÔ‚ÏËÌ·ÙÈÛÌfi. ¶ÔÏÏ¿ ÂÍ·ÚÙÒÓÙ·È ·fi ÙË ı¤ÛË Î·È ÙÔ Â›‰Ô˜ Ù˘ ‚·Ï‚›‰·˜. ∏ Û˘Ó‹ıˆ˜ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓË ‚·ÚÊ·Ú›ÓË ÚÔηÏ› ‚Ï¿‚˜ ÛÙÔ ¤Ì‚Ú˘Ô, ΢ڛˆ˜ ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ, ÛÙË Ê¿ÛË Ù˘ ÔÚÁ·ÓÔÁ¤ÓÂÛ˘, ÂÓÒ Û fiÏË ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘ ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ·ÈÌÔÚÚ·ÁÈÒÓ (ÂÁÎÂÊ·ÏÈ΋) Î·È ·˘ÙfiÌ·ÙˆÓ ·Ô‚ÔÏÒÓ. ∆Ô ¿Ï¶·È‰È·ÙÚÈ΋ 2006;69:110-117
ÏÔ Ê¿ÚÌ·ÎÔ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ·ÓÙÈËÎÙÈÎfi Â›Ó·È Ë Ë·Ú›ÓË, Ë ÔÔ›· ‰ÂÓ ÂÚÓ¿ÂÈ ÙÔÓ Ï·ÎÔ‡ÓÙ· Î·È ‰ÂÓ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚Ï‹Ì·Ù· ÛÙÔ ¤Ì‚Ú˘Ô, fï˜ Ë ·ÓÙÈËÎÙÈ΋ Ù˘ ‰Ú¿ÛË ‰ÂÓ Â›Ó·È Î·È ÙfiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈ΋. ¶·ÚfiÏÔ Ô˘, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, ·ÎfiÌ· ‰ÂÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ˆ˜ ÚÔ˜ ÙÔ ·ÛʷϤÛÙÂÚÔ Û¯‹Ì·, Ê·›ÓÂÙ·È ˆ˜ ÔÈ ÁÓÒ̘ Û˘ÁÎÏ›ÓÔ˘Ó ÛÙË ¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘ Û ‰fiÛË ÌÈÎÚfiÙÂÚË ‹ ›ÛË ÙˆÓ 5 mg. ™˘ÓÈÛÙ¿Ù·È Ë ¯ÔÚ‹ÁËÛË ·˘Ù‹˜ Ù˘ ‰fiÛ˘ Û fiÏË ÙËÓ ÂÁ΢ÌÔÛ‡ÓË Î·È Ë ÂÎÙ¤ÏÂÛË ÙÔ˘ ÙÔÎÂÙÔ‡ Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹, ÁÈ· fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ·. ŒÓ· ¿ÏÏÔ Û¯‹Ì· Ô˘ ÚÔÙ›ÓÂÙ·È, Û˘ÓÈÛÙ¿ ÙË ¯ÔÚ‹ÁËÛË Ë·Ú›Ó˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÛÈÚ›ÓË ÁÈ· ÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, Ô‡Ùˆ˜ ÒÛÙ ӷ ÌÂȈıÔ‡Ó ÔÈ Î›Ó‰˘ÓÔÈ ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, ÂÓÒ ÁÈ· ÙȘ ÂfiÌÂÓ˜ ‚‰ÔÌ¿‰Â˜ ¿ÏÏÔÈ Û˘ÓÈÛÙÔ‡Ó Û˘Ó¤¯ÈÛË ·˘ÙÔ‡ ÙÔ˘ Û¯‹Ì·ÙÔ˜ ̤¯ÚÈ ÙÔ Ù¤ÏÔ˜ ÙÔ˘ ÙÔÎÂÙÔ‡ Î·È ¿ÏÏÔÈ ÚÔÙÈÌÔ‡Ó ÙË ¯ÔÚ‹ÁËÛË ‚·ÚÊ·Ú›Ó˘ ÂӉȿÌÂÛ·, ·fi ÙÔÓ ÙÚ›ÙÔ Ì‹Ó· ̤¯ÚÈ ÙËÓ 36Ë Â‚‰ÔÌ¿‰·. ŸÔÈÔ Û¯‹Ì· ÎÈ ·Ó ÚÔÙÈÌËı›, ı· Ú¤ÂÈ Ó· ÂÍËÁËı› ÛÙËÓ ¤ÁÎ˘Ô Î·È ÙÔ˘˜ ÔÈΛԢ˜ Ù˘ fiÙÈ ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ Ô˘ Êı¿ÓÂÈ Ì¤¯ÚÈ Î·È ÙÔ 10% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ (38-39).
°. ¶·ı‹ÛÂȘ ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ 1. ªÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›·, ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›·, ·ÓÔȯÙfi˜ ·ÚÙËÚÈ·Îfi˜ fiÚÔ˜ ™ÙȘ ·ı‹ÛÂȘ Ì ‰È·Ê˘Á‹ ·fi ·ÚÈÛÙÂÚ¿ ÚÔ˜ Ù· ‰ÂÍÈ¿, fiÏ· ÂÍ·ÚÙÒÓÙ·È ·fi ÙȘ Ó¢ÌÔÓÈΤ˜ ȤÛÂȘ Î·È ·ÓÙÈÛÙ¿ÛÂȘ, ÙÔ ÔÛfi Ù˘ ‰È·Ê˘Á‹˜ Î·È ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ‚Ï¿‚˘. ™‹ÌÂÚ· Ì ÙËÓ ÚÔÏËÙÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ Î·È ÙÔ˘˜ ·È‰ÔηډÈÔÏfiÁÔ˘˜, ÔÈ ·ı‹ÛÂȘ ·˘Ù¤˜, Ô˘ Â›Ó·È Î·È ÔÈ Û˘¯ÓfiÙÂÚ˜, ‰È·ÁÈÁÓÒÛÎÔÓÙ·È ¤ÁηÈÚ· Î·È ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È. ŒÙÛÈ, ÔÈ ÌÂÁ¿Ï˜ ‰È·Ê˘Á¤˜ Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ηډȷ΋ ·Ó¿ÚÎÂÈ·, Âȉ›ӈÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ˘¤ÚÙ·Û˘ ‹ ·ÚÚ˘ı̛˜ ‰ÂÓ Â›Ó·È Û˘Ó‹ıÂȘ. ∂Í¿ÏÏÔ˘, ÔÈ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ Ì¿ÏÏÔÓ Â›Ó·È ÛˆÛÙfiÙÂÚÔ Ó· ÙÔÔıÂÙËıÔ‡Ó ÛÙËÓ ÔÌ¿‰· ÙˆÓ ·ı‹ÛÂˆÓ ÌÂÙÚ›Ô˘ ÎÈÓ‰‡ÓÔ˘. √È ÌÈÎÚ¤˜ ‰È·Ê˘Á¤˜ Û˘Ó‹ıˆ˜ ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔ‚Ï‹Ì·Ù· ÛÙÔÓ ÙÔÎÂÙfi Î·È ÙÔ ÌfiÓÔ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ·ÓÙÈ‚›ˆÛ˘ ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ ÂÓ‰Ôηډ›Ùȉ·˜. ¶·ÚfiÏÔ Ô˘ ÁÈ· ÙËÓ ÚÔʇϷÍË Ù˘ ÂÓ‰Ôηډ›Ùȉ·˜ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Î·È ·ÓÙÂӉ›ÍÂȘ ‹ ·ÎfiÌ· Î·È ·ÌÊÈÛ‚ËÙ‹ÛÂȘ, Ë ·ÛʷϤÛÙÂÚË Ú·ÎÙÈ΋ Â›Ó·È Ë ¯ÔÚ‹ÁËÛË ÛÂ
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·115
115
™˘ÁÁÂÓ›˜ Î·È Â›ÎÙËÙ˜ ηډÈÔ¿ıÂȘ
fiϘ ÙȘ ÂÚÈÙÒÛÂȘ (Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜, ηÈÛ·ÚÈ΋ ÙÔÌ‹) Ù·ÎÙÈ΋ Ô˘ ·ÎÔÏÔ˘ıÂ›Ù·È Î·È ·fi ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÔÌ¿‰Â˜. £· Ú¤ÂÈ ›Ûˆ˜ Ó· ·Ó·ÊÂÚı› fiÙÈ ·fi ÙȘ ÙÚÂȘ ·ı‹ÛÂȘ Ù˘ ηÙËÁÔÚ›·˜ ·˘Ù‹˜, Ë ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· Â›Ó·È ·˘Ù‹ Ô˘ ‰ËÌÈÔ˘ÚÁ› ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÎÏ‹ÍÂȘ. ªÔÏÔÓfiÙÈ Û‹ÌÂÚ· Ù· ÂÚÈÛÙ·ÙÈο Ô˘ ‰ÂÓ ¤¯Ô˘Ó ‰È·ÁÓˆÛÙ› Â›Ó·È Ôχ Ï›Á·, Û˘¯Ó¿ ¤Ó·˜ fi¯È Â˘Î·Ù·ÊÚfiÓËÙÔ˜ ·ÚÈıÌfi˜ ‚Ú›ÛÎÂÙ·È fiÙÈ ¤¯ÂÈ ‰È·Ê‡ÁÂÈ. ∆Ô Ôχ ‹ÈÔ Ê‡ÛËÌ· Ô˘ ÂÎÏ·Ì‚¿ÓÂÙ·È ˆ˜ ÏÂÈÙÔ˘ÚÁÈÎfi, Ë ¿ÚÈÛÙË ÁÂÓÈ΋ ηٿÛÙ·ÛË Î·È ·Ó¿Ù˘ÍË Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ú·Ï·Ó‹ÛÔ˘Ó ÙÔ˘˜ ·È‰È¿ÙÚÔ˘˜ Ì ·ÔÙ¤ÏÂÛÌ· Ë ÚÒÙË ‰È¿ÁÓˆÛË Ó· Á›ÓÂÈ ÛÙËÓ ÂÁ΢ÌÔÛ‡ÓË, Ì ÙËÓ Â›Ù·ÛË ÙˆÓ Ê˘ÛËÌ¿ÙˆÓ (ʇÛËÌ· ÛÙËÓ Ó¢ÌÔÓÈ΋). ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ ·ÚÚ˘ı̛˜ ÏfiÁˆ Ù˘ ¯ÚfiÓÈ·˜ ÂÈ‚¿Ú˘ÓÛ˘ ÙˆÓ ‰ÂÍÈÒÓ Î·Ú‰È·ÎÒÓ ÎÔÈÏÔÙ‹ÙˆÓ ‹ Î·È ·Ú¿‰ÔÍË ÂÌ‚ÔÏ‹. √È Î›Ó‰˘ÓÔÈ Â›Ó·È ·˘ÍË̤ÓÔÈ ÛÙȘ ÌÂÁ·Ï‡ÙÂÚ˜ ËÏÈ˘. 2. ™Ù¤ÓˆÛË Ó¢ÌÔÓÈ΋˜ ™ÙȘ ‹È˜ ÛÙÂÓÒÛÂȘ Ì ÌÈÎÚ‹ ÎÏ›ÛË ›ÂÛ˘ fiˆ˜ Î·È ÛÙ· ÂÚÈÛÙ·ÙÈο Ô˘ Ë ¿ıËÛË ¤¯ÂÈ ·ÓÙÈÌÂÙˆÈÛÙ› Ì ‚·Ï‚ȉÔÏ·ÛÙÈ΋ Ì ̷ÏfiÓÈ, ‰ÂÓ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î‡ËÛË. ∂Âȉ‹, fï˜, Ë ‚Ï¿‚Ë Â›Ó·È ·fi ÙȘ Û˘¯ÓfiÙÂÚ˜ ÛÙËÓ ·È‰ÔηډÈÔÏÔÁ›·, Û¿ÓÈ· Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÂÚÈÛÙ·ÙÈο Ô˘ ¤¯Ô˘Ó ‰È·Ê‡ÁÂÈ ÏfiÁˆ ÙÔ˘ fiÙÈ ·ÎfiÌ· Î·È Û ‚·ÚȤ˜ ÌÔÚʤ˜, ÔÏϤ˜ ÊÔÚ¤˜ ‰ÂÓ ˘¿Ú¯ÂÈ Î·Ó¤Ó· Û‡Ìو̷. ™Ù· ÂÚÈÛÙ·ÙÈο ·˘Ù¿ Â›Ó·È ÔÚıfiÙÂÚÔ Ó· ·Ó·‚¿ÏÏÂÙ·È Ë ÂÁ΢ÌÔÛ‡ÓË Ì¤¯ÚÈ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË. ŸÔ˘ ·˘Ùfi ‰ÂÓ Â›Ó·È ÂÊÈÎÙfi, ÌÔÚ› Ó· ÂȯÂÈÚËı› ÂÂÌ‚·ÙÈ΋ ‚·Ï‚ȉÔÏ·ÛÙÈ΋ ·ÎfiÌ· Î·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. √È ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ÙÔÔıÂÙËıÔ‡Ó ÛÙËÓ Î·ÙËÁÔÚ›· ÙÔ˘ ÌÂÁ¿ÏÔ˘ ÎÈÓ‰‡ÓÔ˘ (40-42). 3. ∞ÚÚ˘ı̛˜ ∞ӷʤÚÔÓÙ·È Í¯ˆÚÈÛÙ¿, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ‡·ÚÍË Î¿ÔÈ·˜ ‚Ï¿‚˘ Ô˘ ÌÔÚ› Ó· ÚÔηϤÛÂÈ ·ÚÚ˘ıÌ›· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁ΢ÌÔÛ‡Ó˘, ı· Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÂÙ·È ¤ÁηÈÚ·. ™˘Ó‹ıˆ˜ ÔÈ ·ÛıÂÓ›˜ ‚Ú›ÛÎÔÓÙ·È Û ıÂڷ›· ‹ ÂÊ·ÚÌfi˙ÂÙ·È Î¿ÔÈÔ ıÂڷ¢ÙÈÎfi Û¯‹Ì· ·fi ÙËÓ ·Ú¯‹ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ∏ ÂÈÏÔÁ‹ ÙÔ˘ Ê·ÚÌ¿ÎÔ˘ ¯ÚÂÈ¿˙ÂÙ·È ÚÔÛÔ¯‹ ÏfiÁˆ Ù˘ Èı·Ó‹˜ ‚Ï·ÙÈ΋˜ ›‰Ú·Û˘ ÛÙÔ ¤Ì‚Ú˘Ô. ŸÌˆ˜, ı· Ú¤ÂÈ ¿ÓÙ· Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„ÈÓ Ë ‚Ï·ÙÈ΋ ›‰Ú·ÛË Ù˘ ·ÚÚ˘ıÌ›·˜ ÙfiÛÔ ÁÈ· ÙÔ ¤Ì‚Ú˘Ô
fiÛÔ Î·È ÁÈ· ÙË ÌËÙ¤Ú· (ÚfiÎÏËÛË ·ÈÌÔ‰˘Ó·ÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ıÚfiÌ‚ˆÓ Î.Ï.). º¿Ú̷η, fiˆ˜ Ë ‰ÈÁÔÍ›ÓË Î·È ÔÈ ‚-·Ó·ÛÙÔÏ›˜ ıˆÚÔ‡ÓÙ·È ·ÛÊ·Ï‹ ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ÂÌÂÈÚ›·˜ ·fi ÙË Ì·ÎÚÔ¯ÚfiÓÈ· ¯ÔÚ‹ÁËÛË. ÕÏÏ· fiˆ˜ Ë ÛÔÙ·ÏfiÏË, Ë ÏȉÔη˝ÓË, Ë ·‰ÂÓÔÛ›ÓË Î.Ï., ıˆÚÔ‡ÓÙ·È Â›Û˘ Û¯ÂÙÈο ·‚Ï·‚‹ ¯ˆÚ›˜ fï˜ Ó· ˘¿Ú¯ÂÈ ÌÂÁ¿ÏË ÂÌÂÈÚ›· ÛÙË ¯ÔÚ‹ÁËÛ‹ ÙÔ˘˜ ηٿ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË. ∆¤ÏÔ˜, Ë ËÏÂÎÙÚÈ΋ ηډȷ΋ ·Ó¿Ù·ÍË ıˆÚÂ›Ù·È ·ÛÊ·Ï‹˜ (43-44). ∂ȯÂÈÚ‹ıËΠ·Ú·¿Óˆ, Ë ·ÚÔ˘Û›·ÛË ÌÈ·˜ ÌÂÁ¿Ï˘ ÔÌ¿‰·˜ ηډÈÔÏÔÁÈÎÒÓ ·ı‹ÛÂˆÓ Ô˘ ÌÔÚ› Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó ÏÈÁfiÙÂÚÔ ‹ ÂÚÈÛÛfiÙÂÚÔ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î‡ËÛË. ∏ ·Ó·ÊÔÚ¿ Û ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ΢ڛˆ˜ Û¿ÓÈˆÓ Û˘ÁÁÂÓÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ, ηıÒ˜ Î·È ÔÈ ÁÂÓÈÎfiÙÂÚ˜ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ÂÈÙÒÛÂȘ Ù˘ οı ‚Ï¿‚˘, ˘ÂÚ‚·›ÓÂÈ Ù· fiÚÈ· ·˘ÙÔ‡ ÙÔ˘ ¿ÚıÚÔ˘. Ÿˆ˜ Ê¿ÓËÎÂ, ÔÈ Î·Ú‰ÈÔ¿ıÂȘ, ΢ڛˆ˜ ÔÈ Û˘ÁÁÂÓ›˜ Î·È Û·ÓÈfiÙÂÚ· ÔÈ Â›ÎÙËÙ˜, ·Ï¤˜ ‹ Û‡ÌÏÔΘ, Û˘Ó‹ıˆ˜ ‰ÂÓ ·ÔÙÂÏÔ‡Ó ·ÈÙ›· ÛÙ¤ÚËÛ˘ Ù˘ ÔÏ˘fiıËÙ˘ ÌËÙÚfiÙËÙ·˜ ·fi ÙȘ ¿Û¯Ô˘Û˜ Á˘Ó·›Î˜. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, ·ÎfiÌ· Î·È Û ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ Ê¿ÛË, ȉȷ›ÙÂÚ· Û‡ÌÏÔÎˆÓ ·ÓˆÌ·ÏÈÒÓ, ÔÈ Î›Ó‰˘ÓÔÈ ÌËÙÚÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜ ‰ÂÓ Â›Ó·È ··ÁÔÚ¢ÙÈÎÔ›. µ¤‚·È· ˘¿Ú¯Ô˘Ó Î·È ÂÚÈÛÙ·ÙÈο fiˆ˜ ·˘Ù¿ Ì Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË, Ì˘ÔηډÈÔ¿ıÂÈ·, ‚·ÚÈ¿ ΢·ÓˆÙÈ΋ ηډÈÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ Marfan Î.Ï., Ô˘ Ë ÂÁ΢ÌÔÛ‡ÓË ı· Ú¤ÂÈ Ó· ·Ôı·ÚÚ‡ÓÂÙ·È (45-48). ∂ÎÙfi˜ fï˜ ·fi ÙË ıÓËÛÈÌfiÙËÙ·, ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È È‰È·›ÙÂÚ· ˘’ fi„ÈÓ Ë ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ Âȉ›ӈÛË Ù˘ ηٿÛÙ·Û˘ Ù˘ ÌËÙ¤Ú·˜, Ô˘ ¿ÏÏÔÙ ·Ó·Ù¿ÛÛÂÙ·È ÌÂÙ¿ ·fi ÔÏϤ˜ ÚÔÛ¿ıÂȘ ÌÂÁ¿Ï˘ ÔÌ¿‰·˜ ÂȉÈÎÒÓ ÁÈ·ÙÚÒÓ Î·È ¿ÏÏÔÙ ·Ê‹ÓÂÈ ÛÔ‚·Ú¿ ηٿÏÔÈ· Ô˘ ÌÂÏÏÔÓÙÈο ‰ËÌÈÔ˘ÚÁÔ‡Ó ÂÍ·ÈÚÂÙÈο ÂÈΛӉ˘Ó· ÚÔ‚Ï‹Ì·Ù· (49-50). ∂›Û˘, ı· Ú¤ÂÈ ¿ÓÙ· Ó· Ï·Ì‚¿ÓÔÓÙ·È Ôχ ÛÔ‚·Ú¿ ˘’ fi„ÈÓ Ù· ÌÂÁ¿Ï· ÔÛÔÛÙ¿ ÂÌ‚Ú˘˚΋˜ ıÓËÛÈÌfiÙËÙ·˜, ÚÔˆÚfiÙËÙ·˜, ¯·ÌËÏÔ‡ ‚¿ÚÔ˘˜ Á¤ÓÓËÛ˘, ÙÂÚ·ÙÔÁ¤ÓÂÛ˘, ·ÈÌÔÚÚ·ÁÈÒÓ ÛÙÔ ¤Ì‚Ú˘Ô Î.Ï. (51-57). °È· Ó· ÂÏ·ÙÙˆıÔ‡Ó ÛÙÔ ¯·ÌËÏfiÙÂÚÔ ‰˘Ó·Ùfi ÔÛÔÛÙfi ÔÈ Î›Ó‰˘ÓÔÈ Ô˘ ·Ó·Ê¤ÚıËηÓ, ı· Ú¤ÂÈ Ó· ÙËÚÔ‡ÓÙ·È ·˘ÛÙËÚ¿, Ù· ·Ú·Î¿Ùˆ. ¶ÚÒÙ· ·’ fiÏ· Ó· ‰›‰ÂÙ·È Ôχ ÌÂÁ¿ÏË ÛËÌ·Û›· ÛÙËÓ ÂÓË̤ڈÛË. ¶Ú¤ÂÈ Ó· Á›ÓÂÙ·È ¤ÁηÈÚ· ·fi ÙÔÓ ·È‰ÔηډÈÔÏfiÁÔ, ÚÈÓ ·fi ÙËÓ ÂÊ˂›·, Î·È ÔˆÛ‰‹ÔÙ ÚÈÓ ·fi ÙËÓ ÂÁ΢ÌÔÛ‡ÓË (‹ ¤ÛÙˆ Î·È ÌÂÙ¿). °È· ÙËÓ ·ÎÚÈ‚‹ ÂÎÙ›ÌËÛË Ù˘ ηٿÛÙ·Û˘, Â›Ó·È ··Ú·›ÙËÙË Ë ÁÓÒÛË ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë Û˘ÓÂÚÁ·Û›· ÙˆÓ ÂӉȷÊÂÚÔÌ¤ÓˆÓ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·116
116
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ÁÈ·ÙÚÒÓ: ·È‰›·ÙÚÔ˘, ·È‰ÔηډÈÔÏfiÁÔ˘, ·È‰ÔηډÈÔ¯ÂÈÚÔ˘ÚÁÔ‡, ηډÈÔÏfiÁÔ˘, Ì·ÈÂ˘Ù‹Ú·, ·Ó·ÈÛıËÛÈÔÏfiÁÔ˘ (58-60). ¶Ôχ ÛËÌ·ÓÙÈ΋ ›Û˘, Â›Ó·È Ë ÂÎÙ›ÌËÛË Ù˘ ηٿÛÙ·Û˘ Ù˘ ̤ÏÏÔ˘Û·˜ ÌËÙ¤Ú·˜ Ì ÎÏÈÓÈ΋ ÂͤٷÛË, ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·, ¤Á¯ÚˆÌÔ Doppler ‹ fiÔÈ· ¿ÏÏË ÂͤٷÛË ıˆÚÂ›Ù·È ÛÎfiÈÌË (.¯. 24ˆÚÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· - Holter). £· Ú¤ÂÈ ›Ûˆ˜ Ó· Û˘˙ËÙËıÔ‡Ó ÔÈ Èı·ÓfiÙËÙ˜ οÔÈÔ˘ ›‰Ô˘˜ ¤̂·Û˘ Ô˘ ı· ÌÔÚÔ‡Û ӷ ‚ÂÏÙÈÒÛÂÈ ÙËÓ ·Ó·ÙÔÌ›· Î·È Ó· ÌÂÈÒÛÂÈ ÙËÓ ÂÈ‚¿Ú˘ÓÛË ÙÔ˘ ηډȷÎÔ‡ ¤ÚÁÔ˘. ∞ÎfiÌË, ·Ú¿ÁÔÓÙ˜ fiˆ˜ Ë ËÏÈΛ· Ù˘ ÌËÙ¤Ú·˜, ÙÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ‹ ¿ÏÏ· ÚÔ‚Ï‹Ì·Ù·, fiˆ˜ Ë ·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹, ¤¯Ô˘Ó ›Û˘ ÛËÌ·Û›·, ηıÒ˜ Î·È Ë Èı·ÓfiÙËÙ· ÎÏËÚÔÓÔÌÈ΋˜ ÌÂÙ·‚›‚·Û˘ ÛÙÔ ÓÂÔÁÓfi. ∏ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Î·È Ë ·Ó¿Ï˘ÛË ÙˆÓ Èı·ÓÔÙ‹ÙˆÓ ÌÂÙ·‚›‚·Û˘ Ù˘ ÓfiÛÔ˘ - Ô˘ ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÚ›ÙˆÛË ÌÔÚ› Ó· Â›Ó·È ˘„ËϤ˜, ¤ˆ˜ Î·È ‰¤Î· ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·’ fi,ÙÈ Û ˘ÁÈ›˜ ÁÔÓ›˜, ¤ˆ˜ Î·È Ôχ ˘„ËϤ˜ (Û‡Ó‰ÚÔÌÔ Marfan) - Û›ÁÔ˘Ú· ‚ÔËıÔ‡Ó. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·ÔÊ·Û›˙ÂÙ·È Ë ÂÁ΢ÌÔÛ‡ÓË ‹ Ë Û˘Ó¤¯ÈÛ‹ Ù˘, ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÔÓÙ·È Ì ÏÂÙÔ̤ÚÂÈ· ÔÈ Î›Ó‰˘ÓÔÈ, Ë Èı·Ó‹ ÓÔÛËÏ›· Û ÌÔÓ¿‰· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ηıÒ˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ ÙÔ ÓÂÔÁÓfi (61,62). ™Â fi,ÙÈ ·ÊÔÚ¿ ÙÔÓ ÙÔÎÂÙfi, Û˘Ó‹ıˆ˜ ÚÔÙÈÌ¿Ù·È Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ÙÔÎÂÙfi˜ (ÌÈÎÚfiÙÂÚË ·ÒÏÂÈ· ·›Ì·ÙÔ˜, ÏÈÁfiÙÂÚÔ ·fiÙÔ̘ ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ·ÏÏ·Á¤˜). ∏ ¯Ú‹ÛË ÂÌ‚Ú˘Ô˘ÏΛ·˜ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÂÏ·ÙÙÒÓÔÓÙ·˜ ÙȘ ÚÔÛ¿ıÂȘ ÂÍÒıËÛ˘ Ù˘ ÌËÙ¤Ú·˜ Î·È ÙÔÓ ¯ÚfiÓÔ Ù˘ fiÏ˘ ‰È·‰Èηۛ·˜. ™Â ÂÚÈÛÙ·ÙÈο Ì ۇӉÚÔÌÔ Marfan, ÚÔ‚Ï‹Ì·Ù· Ú‡ıÌÈÛ˘ Ù˘ ËÎÙÈÎfiÙËÙ·˜ ÙÔ˘ ·›Ì·ÙÔ˜ Û ÌÂÙ·ÏÏÈΤ˜ ‚·Ï‚›‰Â˜, ·Ó‡ڢÛÌ· ·ÔÚÙ‹˜ Î·È Û οı ÂÚ›ÙˆÛË Ô˘ ı· ÎÚÈı› ·Ó·Áη›·, ÏfiÁˆ ȉȷ›ÙÂÚˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ, Ë Î·ÈÛ·ÚÈ΋ ÙÔÌ‹ ·ÔÙÂÏ› ÙË ÛˆÛÙ‹ χÛË. ∆¤ÏÔ˜, ‰ÂÓ Ú¤ÂÈ Ó· ‰È·Ê‡ÁÂÈ Ù˘ ÚÔÛÔ¯‹˜ fiÙÈ ÔÈ ÌËÙ¤Ú˜ Ú¤ÂÈ Ó· ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ÁÈ· 34 ¤ˆ˜ 7 ÂÈÎÔÛÈÙÂÙÚ¿ˆÚ· ‹ Î·È ÂÚÈÛÛfiÙÂÚÔ, ·Ó¿ÏÔÁ· Ì ÙÔ Â›‰Ô˜ Ù˘ ¿ıËÛ˘ Î·È ÙËÓ ¤Î‚·ÛË Ù˘ fiÏ˘ ‰È·‰Èηۛ·˜ ÂÁ΢ÌÔÛ‡Ó˘ ÙÔÎÂÙÔ‡ (63,64). °ÓˆÚ›˙ÔÓÙ·˜ Ì ‚‚·ÈfiÙËÙ· fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ ı· ·˘ÍËı› Ô ·ÚÈıÌfi˜ ÙˆÓ Á˘Ó·ÈÎÒÓ Ì ηډÈÔ¿ıÂȘ - Î·È Ì¿ÏÈÛÙ·, Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, ȉȷ›ÙÂÚ· Û‡ÌÏÔΘ - Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ÙÔ fiÛÔ ÌÂÁ¿ÏË ÛËÌ·Û›· ¤¯Ô˘Ó fiÏ· ·˘Ù¿ Ô˘ ¶·È‰È·ÙÚÈ΋ 2006;69:110-117
·Ó·Ê¤ÚıËÎ·Ó Ì ηٿ ÙÔ ‰˘Ó·Ùfi Û˘ÓÔÙÈÎfi Î·È ÂÚÈÏËÙÈÎfi ÙÚfiÔ (65,66).
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ORIGINAL ARTICLE
¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·: ·fi„ÂȘ ∂ÏÏ‹ÓˆÓ ·È‰È¿ÙÚˆÓ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ, ∆Ì‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜
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AÏÏËÏÔÁÚ·Ê›·: ¢·Ó¿Ë ¶··‰¿ÙÔ˘ ∫·ıËÁ‹ÙÚÈ· ∫ÏÈÓÈ΋˜ æ˘¯ÔÏÔÁ›·˜ ∆Ì‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜ ¶·ÓÂÈÛÙ‹ÌÈÔ˘ ∞ıËÓÒÓ ¶··‰È·Ì·ÓÙÔÔ‡ÏÔ˘ 123, T.K. 115 27 ∞ı‹Ó· E-mail: dpap@cc.uoa.gr
¶ÂÚ›ÏË„Ë: ∏ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ·ÔÙÂÏ› ¤Ó·Ó ·Ó·Ù˘ÛÛfiÌÂÓÔ ÙÔ̤· Ù˘ ·È‰È·ÙÚÈ΋˜ Ô˘ ·ÊÔÚ¿ ÛÙËÓ ·ÚÔ¯‹ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋˜, „˘¯ÔÎÔÈÓˆÓÈ΋˜ Î·È ÓÂ˘Ì·ÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηٷÏËÎÙÈÎfi ÓfiÛËÌ· Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜, Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙÔ˘˜. ™ÎÔÔ› Ù˘ ·ÚÔ‡Û·˜ ÂÚÈÁÚ·ÊÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó: ·) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÁÓÒÛÂˆÓ ÙˆÓ ·È‰È¿ÙÚˆÓ Ô˘ ÊÚÔÓÙ›˙Ô˘Ó ·È‰È¿ Ì ηٷÏËÎÙÈο ÓÔÛ‹Ì·Ù·, Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Î·È ‚) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ô˘ ·Ú¤¯ÂÙ·È ÛÙ· ÙÌ‹Ì·Ù· fiÔ˘ ÂÚÁ¿˙ÔÓÙ·È. ∆· Â˘Ú‹Ì·Ù· ÂÂÛ‹Ì·Ó·Ó fiÙÈ Ë ÊÈÏÔÛÔÊ›· Î·È ÔÈ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Â·ÚÎÒ˜ ηٷÓÔËÙ¤˜ ·fi ÙÔ˘˜ ŒÏÏËÓ˜ ·È‰›·ÙÚÔ˘˜ ÌÂ Û˘Ó¤ÂÈ· ÙËÓ ÂÏÏÈ‹ Î·È ·Ó·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË. ∏ ÚÔÛ¤ÁÁÈÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ·Ú·Ì¤ÓÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi È·ÙÚÔÎÂÓÙÚÈ΋, ÂÛÙÈ·Ṳ̂ÓË Î˘Ú›ˆ˜ ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ Î·È ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Û˘Ìو̿وÓ, ÂÓÒ Ë „˘¯ÔÎÔÈÓˆÓÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ˘ÔÏ›ÂÙ·È ÛËÌ·ÓÙÈο. √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ·Ó·ÁÓÒÚÈÛ·Ó ÙȘ ÂÏÏÈ›˜ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ ÙÔ Î˘ÚÈfiÙÂÚÔ ÂÌfi‰ÈÔ ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Î·È ÙfiÓÈÛ·Ó ÙËÓ ·Ó¿ÁÎË Î·Ù¿ÏÏËÏ˘ ηٿÚÙÈÛ‹˜ ÙÔ˘˜, fiÛÔ Î·È ÛÙÂϤ¯ˆÛ˘ ÙˆÓ ÙÌËÌ¿ÙˆÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Ì ÂÍÂȉÈÎÂ˘Ì¤ÓÔ È·ÙÚÔÓÔÛËÏ¢ÙÈÎfi ÚÔÛˆÈÎfi ηıÒ˜ Î·È Ì ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜. ∏ Âη›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ·ÔÙÂÏ› ‚·ÛÈ΋ ÚÔ¸fiıÂÛË ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÛÙË ¯ÒÚ· Ì·˜, Ì ÛÎÔfi Ù˘ ÌÂÁÈÛÙÔÔ›ËÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ Ì ·ÂÈÏËÙÈο ÁÈ· ÙË ˙ˆ‹ ÓÔÛ‹Ì·Ù· Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 21-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2005
§¤ÍÂȘ ÎÏÂȉȿ: ∞Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·, ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ı¿Ó·ÙÔ˜, ·È‰È΋ ËÏÈΛ·.
Paediatric palliative care: perceptions of Greek pediatricians University of Athens, Faculty of Nursing Correspondence: Danai Papadatou Professor of Clinical Psychology University of Athens, Faculty of Nursing 123 Papadiamantopoulou St., 11527, Athens E-mail: dpap@cc.uoa.gr Date of submission: 21-09-2004 Date of approval: 22-07-2005
M. Bouri, D. Papadatou
Abstract: Paediatric palliative care, aimed at the provision of physical, psychosocial and spiritual care for children living with life-limiting diseases and their families, is recognised as an evolving field of paediatrics. In Greece, specialized palliative care services have not yet been developed, although certain elements of such care are being provided in oncology and intensive care settings. The aims of this descriptive study were: a) to investigate the extent of knowledge about paediatric palliative care of Greek paediatricians working in the above settings, and b) to determine their perceptions with regard to the effectiveness of provision of palliative care services in their respective units. The findings revealed that the philosophy and principles of paediatric palliative care have not been fully comprehended by Greek paediatricians, leading to inadequate and inefficient application of palliative care in clinical practice. Their approach remains mainly medically centred, focusing on pain management and symptom control. According to their perceptions, psychosocial and spiritual support is inadequately offered to children and families in their work settings. The participants recognised their lack of knowledge as the major barrier to the application of palliative care. They identified the need for education and training for the effective provision of palliative care and for the staffing of their units with specialized medical, nursing staff and mental health professionals. In conclusion, education in paediatric palliative care is an essential prerequisite for the development of palliative care programmes for terminally ill children and their families in Greece. Key words: Palliative care, terminal care, death, childhood.
¶·È‰È·ÙÚÈ΋ 2006;69:118-126
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·119
119
¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·
∂ÈÛ·ÁˆÁ‹ √ fiÚÔ˜ “·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰·” (pediatric palliative care) ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ ·ÚÔ¯‹ ÔÚÁ·ÓˆÌ¤Ó˘ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋˜, „˘¯ÔÎÔÈÓˆÓÈ΋˜ Î·È ÓÂ˘Ì·ÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηٷÏËÎÙÈÎfi ÓfiÛËÌ· Î·È ÛÙȘ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜, ·fi ‰ÈÂÈÛÙËÌÔÓÈ΋ ÔÌ¿‰· ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (1-5). £ÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ·ÔÙÂÏÔ‡Ó: ·) Ë ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ ·È‰ÈÔ‡ ·fi ÂӉ¯fiÌÂÓÔ fiÓÔ ‹ /Î·È ¿ÏÏ· Û˘ÌÙÒÌ·Ù·, ‚) Ë „˘¯ÔÎÔÈÓˆÓÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ Î·È È‰È·›ÙÂÚ· ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ˙ˆ‹˜ ÙÔ˘, Á) Ë „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡, ‰) Ë ·ÚÔ¯‹ ˘ËÚÂÛÈÒÓ ·fi ‰ÈÂÈÛÙËÌÔÓÈ΋ ÔÌ¿‰· ÒÛÙ ӷ ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È ÏËÚ¤ÛÙÂÚ· ÔÈ ÔχÏ¢Ú˜ ·Ó¿ÁΘ ·È‰ÈÔ‡ Î·È ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È Â) Ë ÂÍÂȉÈÎÂ˘Ì¤ÓË Î·Ù¿ÚÙÈÛË ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ fiÛÔ Î·È Ë Û˘ÛÙËÌ·ÙÈ΋ „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍ‹ ÙÔ˘˜ (1-5, 7). ∏ ·Ó¿ÁÎË ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ·È‰ÈÒÓ Ì ÓfiÛËÌ· Ô˘ ‰ÂÓ ‰‡Ó·Ù·È Ó· ıÂڷ¢ı› Ì ٷ ‰È·ı¤ÛÈÌ· ̤۷ -›Ù ÏfiÁˆ Ù˘ ʇÛ˘ ÙÔ˘ ÓÔÛ‹Ì·ÙÔ˜ ›Ù ÏfiÁˆ ÙˆÓ ÂÈÏÔÎÒÓ Ù˘ ·ÚÚÒÛÙÈ·˜- ·ÔÙ¤ÏÂÛ ÙÔ ·›ÙËÌ· ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË Ù˘ ÂÍÂȉÈÎÂ˘Ì¤Ó˘ ·˘Ù‹˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ηÚΛÓÔ, ∞πDS, ÓÂÊÚÈ΋ ·Ó¿ÚÎÂÈ· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ, ÔÚÈṲ̂ӷ ÌÂÙ·‚ÔÏÈο Î·È Ó¢ÚÔÏÔÁÈο ÓÔÛ‹Ì·Ù· ‹ ¿ÏϘ ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ·Ûı¤ÓÂȘ (4,5,7,9-11). ¶ÚÒÙË Ë Ida Martinson ÙË ‰ÂηÂÙ›· ÙÔ˘ 1970 -Ì ¯ÚËÌ·ÙÔ‰fiÙËÛË ·fi ÙÔ ¡π∏ (National Institute of Health)- ÂÊ¿ÚÌÔÛ ÙȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ì ηÚΛÓÔ Ô˘ ¤ÏÂÍ·Ó Ó· ÓÔÛËÏ¢ÙÔ‡Ó ÛÙÔ Û›ÙÈ ÙËÓ ÙÂÏÈ΋ ÂÚ›Ô‰Ô Ù˘ ˙ˆ‹˜ ÙÔ˘˜ (12). ŒÎÙÔÙ ÔÈ ÚˆÙÔ‚Ô˘Ï›Â˜ Î·È ÔÈ ‰Ô̤˜ ÁÈ· ÙËÓ ·ÚÔ¯‹ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ‰È·ÚÎÒ˜ ÏËı·›ÓÔ˘Ó Û fiÏÔÓ ÙÔÓ ÎfiÛÌÔ, Ì ÙËÓ ·Ó¿Ù˘ÍË ÂȉÈÎÒÓ ÍÂÓÒÓˆÓ ÁÈ· ·È‰È¿ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ·ÚÚÒÛÙÈ·˜ ÙÔ˘˜ (pediatric hospices), ˘ËÚÂÛÈÒÓ Î·Ù’ Ô›ÎÔÓ ÓÔÛËÏ›·˜ (pediatric home care programs) Î·È ÂȉÈÎÒÓ ÙÌËÌ¿ÙˆÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ (palliative care units) Û ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›·. ¶·Ú¿ÏÏËÏ·, ÚÔÛʤÚÔÓÙ·È
‹‰Ë ÌÂÙ·Ù˘¯È·Î¿ ÚÔÁÚ¿ÌÌ·Ù· Û ·È‰È¿ÙÚÔ˘˜ Î·È ¿ÏÏÔ˘˜ ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ Ô˘ ÂÈı˘ÌÔ‡Ó Ó· ÂȉÈ΢ÙÔ‡Ó ÛÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ¯ÒÚÔ (4,6,8,32). ™ÙËÓ ∂ÏÏ¿‰·, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ˘ËÚÂۛ˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿, Ù˘¯¤˜ Ù˘ ÊÚÔÓÙ›‰·˜ ·˘Ù‹˜ ·Ú¤¯ÔÓÙ·È Î˘Ú›ˆ˜ Û ÔÁÎÔÏÔÁÈο ÙÌ‹Ì·Ù· Î·È ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ fiÔ˘ Î·È ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ·È‰È¿ Ì ηٷÏËÎÙÈο ÓÔÛ‹Ì·Ù· (13-14). ™ÎÔÔ› Ù˘ ·ÚÔ‡Û·˜ ÂÚÈÁÚ·ÊÈ΋˜ ÌÂϤÙ˘ ‹Ù·Ó ·) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ÁÓÒÛÂˆÓ Ô˘ ¤¯Ô˘Ó ·È‰›·ÙÚÔÈ Ô˘ ÊÚÔÓÙ›˙Ô˘Ó ·È‰È¿ Ì ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘˜ ·Ûı¤ÓÂȘ Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Î·È ‚) Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÓÙÈÏ‹„ÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Ô˘ ·Ú¤¯ÂÙ·È ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÂÚÁ·Û›·˜ ÙÔ˘˜.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ªÂÙ¿ ·fi ÚÔÛˆÈ΋ ÂÈÎÔÈÓˆÓ›· ÙˆÓ ÂÚ¢ÓËÙÒÓ Ì ÙÔ˘˜ ¢È¢ı˘ÓÙ¤˜ ‰‡Ô √ÁÎÔÏÔÁÈÎÒÓ ∆ÌËÌ¿ÙˆÓ Î·È ÙÚÈÒÓ ªÔÓ¿‰ˆÓ ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ ÙÚÈÒÓ ‰ËÌÔÛ›ˆÓ ¶·È‰È·ÙÚÈÎÒÓ ¡ÔÛÔÎÔÌ›ˆÓ Ù˘ ∞ı‹Ó·˜ Î·È ·ÊÔ‡ ÚÔËÁ‹ıËΠÂÓË̤ڈÛË Ù˘ È·ÙÚÈ΋˜ ÔÌ¿‰·˜ ÁÈ· ÙÔ˘˜ ÛÎÔÔ‡˜ Ù˘ ÌÂϤÙ˘, ÚÔÛÎÏ‹ıËÎ·Ó ÔÈ 39 ·È‰›·ÙÚÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·Ó ÛÙ· Û˘ÁÎÂÎÚÈ̤ӷ ÙÌ‹Ì·Ù· Ó· Û˘ÌÏËÚÒÛÔ˘Ó ·ÓÒÓ˘Ì· ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ. ∆Ô ÔÛÔÛÙfi ··ÓÙËÙÈÎfiÙËÙ·˜ ‹Ù·Ó 82%. ∆Ô ‰Â›ÁÌ· ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi 11 ·È‰È¿ÙÚÔ˘˜ ÔÁÎÔÏfiÁÔ˘˜-·ÈÌ·ÙÔÏfiÁÔ˘˜ Î·È 21 ·È‰È¿ÙÚÔ˘˜-ÂÓÙ·ÙÈÎÔÏfiÁÔ˘˜. ¶ÔÛÔÛÙfi 44% (14) ‹Ù·Ó Á˘Ó·›Î˜ Î·È 56% (18) ‹Ù·Ó ¿Ó‰Ú˜. OÈ ËÏÈ˘ ÙÔ˘˜ Î˘Ì·›ÓÔÓÙ·Ó ˆ˜ ÂÍ‹˜: 30-40 ÂÙÒÓ (22%), 41-50 ÂÙÒÓ (50%) Î·È ¿Óˆ ÙˆÓ 50 ÂÙÒÓ (28%). √È ÂÚÈÛÛfiÙÂÚÔÈ ‹Ù·Ó ·ÓÙÚÂ̤ÓÔÈ (84%) Î·È Â›¯·Ó ·È‰È¿ Û ÔÛÔÛÙfi 78%. √È È·ÙÚÔ› ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ›¯·Ó ÚÔ¸ËÚÂÛ›· ÛÙÔÓ ¯ÒÚÔ Ù˘ ˘Á›·˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ¿Óˆ ÙˆÓ 15 ÂÙÒÓ (62,5%). ∆Ô ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚÈÂÏ¿Ì‚·Ó ·ÓÔȯ٤˜ Î·È ÎÏÂÈÛÙ¤˜ ÂÚˆÙ‹ÛÂȘ Î·È ·ÔÙÂÏ›ÙÔ ·fi ‰‡Ô ̤ÚË. ™ÙÔ ÚÒÙÔ, “°ÂÓÈÎfi ̤ÚÔ˜”, ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÎÏ‹ıËÎ·Ó Ó· ‰ÒÛÔ˘Ó ¤Ó·Ó ÔÚÈÛÌfi Ù˘ ·È‰È·ÙÚÈ΋˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó fiÛÔ ÛËÌ·ÓÙÈ΋ ıˆÚÔ‡Ó ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û ‰È¿ÊÔÚ· ÛÙ¿‰È· Ù˘ ·ÚÚÒÛÙÈ·˜ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙËÓ Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂÒÓ ÙÔ˘˜ Ó· ÙËÓ ·Ú¤¯Ô˘Ó. ¶ÚÔÛÎÏ‹ıËÎ·Ó Â›Û˘, Ó· ·Ó·Ê¤ÚÔ˘Ó ÙȘ ·fi„ÂȘ ÙÔ˘˜ ¿Ó, Ì ÔÈÔ˘˜ ÙÚfiÔ˘˜ Î·È fiÛÔ ·ÔÙÂÏÂÛÌ·ÙÈο, ÙÔ ÙÌ‹Ì· fiÔ˘ ÂÚÁ¿˙ÔÓÙ·È ÚÔÛʤÚÂÈ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ÛÙ· ·È‰È¿. ∆¤ÏÔ˜, η٤ÁÚ·„·Ó ÙȘ ‰˘ÛÎÔϛ˜ Ô˘ Û˘Ó·ÓÙÔ‡Ó ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÚfiÙÂÈÓ·Ó Ì¤ÙÚ· ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘˜. ∆Ô “∂ȉÈÎfi ̤ÚÔ˜” ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ ·ÔÙÂÏ›ÙÔ ·fi ¤ÓÙ ıÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜ Ô˘ ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ˘˜ ¤ÓÙ ‚·ÛÈÎÔ‡˜ ÙÔÌ›˜ ÁÓÒÛÂˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ ¶·È‰È·ÙÚÈ΋ 2006;69:118-126
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·120
120
ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘
Ô˘ Ú¤ÂÈ Ó· ‰È·ı¤ÙÔ˘Ó ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ Ô˘ ·Ú¤¯Ô˘Ó ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· (1-5): ·) ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Î·È ¿ÏÏˆÓ Û˘Ìو̿وÓ, ‚) ÙËÓ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, Á) ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ‰) ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÛÙ‹ÚÈ͢ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜ Ù˘, Î·È Â) ÙË ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›·. °È· οı ¤Ó·Ó ·fi ÙÔ˘˜ ·Ú·¿Óˆ ÙÔÌ›˜, ÔÈ ·È‰›·ÙÚÔÈ ÎÏ‹ıËÎ·Ó Ó· ÚÔÛ‰ÈÔÚ›ÛÔ˘Ó ÙË ÛËÌ·Û›· Ô˘ ÙÔ˘ ·Ô‰›‰Ô˘Ó Î·È Î·ÙfiÈÓ Ó· ·ÍÈÔÏÔÁ‹ÛÔ˘Ó ÙËÓ Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂˆÓ Ô˘ ‰È·ı¤ÙÔ˘Ó ÔÈ ›‰ÈÔÈ, ηıÒ˜ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÙÚ¤¯Ô˘Û·˜ Ú·ÎÙÈ΋˜ ÛÙ· ÙÌ‹Ì·Ù¿ ÙÔ˘˜. ∏ ·Ó¿Ï˘ÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ¤ÁÈÓ Ì ÔÛÔÙÈΤ˜ Î·È ÔÈÔÙÈΤ˜ ÌÂıfi‰Ô˘˜. ÃÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÛÙ·ÙÈÛÙÈÎfi ·Î¤ÙÔ SPSS ÁÈ· Ù· ‰Â‰Ô̤ӷ Ô˘ ÚԤ΢„·Ó ·fi ÙȘ ÎÏÂÈÛÙ¤˜ ÂÚˆÙ‹ÛÂȘ, ÛÙȘ Ôԛ˜ Ë ·ÍÈÔÏfiÁËÛË ÙˆÓ ˘fi ÌÂϤÙË ·Ú·Ì¤ÙÚˆÓ ¤ÁÈÓ Ì ‚¿ÛË ÙËÓ Îϛ̷η Likert (0= ηıfiÏÔ˘ Î·È 5= ¿Ú· Ôχ). ™Ù· ‰Â‰Ô̤ӷ ÙˆÓ ·ÓÔȯÙÒÓ ÂÚˆÙ‹ÛÂˆÓ ÂÊ·ÚÌfiÛıËÎÂ Ë ·Ó¿Ï˘ÛË ÂÚȯÔ̤ÓÔ˘ (content analysis).
∞ÔÙÂϤÛÌ·Ù· ∆· ‰Â‰Ô̤ӷ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Û ¤ÍÈ ÂÓfiÙËÙ˜, Ë ÚÒÙË ·fi ÙȘ Ôԛ˜ ·ÊÔÚ¿ ÛÙȘ ÁÓÒÛÂȘ Î·È ·ÓÙÈÏ‹„ÂȘ ÙˆÓ ·È‰È¿ÙÚˆÓ Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÂÚÁ·Û›·˜ ÙÔ˘˜, ÂÓÒ ÔÈ ÂfiÌÂÓ˜ ¤ÓÙ ÂÓfiÙËÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ˘˜ ·ÓÙ›ÛÙÔÈ¯Ô˘˜ ¤ÓÙ ÙÔÌ›˜ ÁÓÒÛÂˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·Ú·¿Óˆ ˆ˜ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ÙËÓ ·ÚÔ¯‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÊÚÔÓÙ›‰·˜. √ÚÈÛÌfi˜, ·Ó·ÁηÈfiÙËÙ· Î·È ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ∏ ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ (79%) fiÚÈÛ ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ˆ˜ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·È‰ÈÔ‡, Ì ¤ÌÊ·ÛË ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘. ªfiÓÔ ÙÔ 34,5% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó¤ÊÂÚ ÙËÓ ·Ú¿ÏÏËÏË „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡, ÂÓÒ Ë ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û˘ÌÂÚÈÏ‹ÊıËΠÌfiÏȘ Û ÔÛÔÛÙfi 17%. ∏ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ÔÚ›ÛıËΠ۠ÔÛÔÛÙfi 14% ˆ˜ ÂÍ·ÛÊ¿ÏÈÛË “ÔÈfiÙËÙ·˜ ˙ˆ‹˜”, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È ÔÈ ·Ú¿ÌÂÙÚÔÈ ·˘Ù‹˜ (¶›Ó·Î·˜ 1). ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ Ô Ï‹Ú˘ ÔÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ˆ˜ È·ÙÚÈ΋, „˘¯ÔÏÔÁÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ·Ô‰fiıËΠ·fi ¤Ó·Ó ÌfiÓÔ ·È‰›·ÙÚÔ. ¶·È‰È·ÙÚÈ΋ 2006;69:118-126
¶›Ó·Î·˜ 1. ∞fi„ÂȘ ÙˆÓ È·ÙÚÒÓ: √ÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ √ÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ∞ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ Î·È ÙˆÓ ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ æ˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ ™Ù‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ∂Í·ÛÊ¿ÏÈÛË ÔÈfiÙËÙ·˜ ˙ˆ‹˜ π·ÙÚÔÓÔÛËÏ¢ÙÈ΋ ÊÚÔÓÙ›‰· Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ & ÓÂ˘Ì·ÙÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜
% ÙˆÓ ··ÓÙ‹ÛÂˆÓ 79 34,5 17 14 3,5
∏ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ¯·Ú·ÎÙËÚ›ÛÙËΠˆ˜ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ (91%), ηıÒ˜ Î·È fiÙ·Ó ‰È·ÈÛÙÒÓÂÙ·È fiÙÈ ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏË ıÂڷ¢ÙÈ΋ ‰˘Ó·ÙfiÙËÙ· ÁÈ· ÙÔ ·È‰› (87,5%). ™ËÌ·ÓÙÈÎfi ›Û˘ ÔÛÔÛÙfi (90,6%) ·Ó·ÁÓˆÚ›˙ÂÈ ÙË ÛËÌ·Û›· Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ·fi ÙË ‰È¿ÁÓˆÛË ÂÓfi˜ ·ÂÈÏËÙÈÎÔ‡ ÁÈ· ÙË ˙ˆ‹ ÓÔÛ‹Ì·ÙÔ˜, ·Ú¿ÏÏËÏ· Ì ÙË ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹. √È ÂÚˆÙËı¤ÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙËÓ Â¿ÚÎÂÈ· ÙˆÓ ÁÓÒÛÂÒÓ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ˆ˜ “·ÚÎÂÙ‹” Û ÔÛÔÛÙfi 37,5%, ˆ˜ “Ôχ” ¤ˆ˜ “¿Ú· Ôχ” ÌÂÁ¿ÏË Û ÔÛÔÛÙfi 34,5% Î·È ˆ˜ “ÏÈÁÔÛÙ‹” ‹ “·Ó‡·ÚÎÙË” Û ÔÛÔÛÙfi 28%. ø˜ ËÁ¤˜ ÁÓÒÛ˘ Î·È ÂÓË̤ڈۋ˜ ÙÔ˘˜ ·Ó¤ÊÂÚ·Ó ÙȘ Û˘˙ËÙ‹ÛÂȘ ÌÂ Û˘Ó·‰¤ÏÊÔ˘˜ (44%), ÙËÓ È·ÙÚÈ΋ ÙÔ˘˜ Âη›‰Â˘ÛË (41%), ÛÂÌÈÓ¿ÚÈ· ‹ ‰È·Ï¤ÍÂȘ (34%), ÂÓÒ ÔÛÔÛÙfi 6% ·Ó¤ÊÂÚ fiÙÈ ‰ÂÓ Â›¯Â ÏËÚÔÊfiÚËÛË ·fi η̛· ËÁ‹. ∂ÓÒ ÔÈ ·È‰›·ÙÚÔÈ ·¿ÓÙËÛ·Ó fiÙÈ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ·Ú¤¯ÂÙ·È ÛÙ· ÙÌ‹Ì·Ù¿ ÙÔ˘˜ Û˘ÛÙËÌ·ÙÈο Û ÔÛÔÛÙfi 69% Î·È Â˘Î·ÈÚȷο Û ÔÛÔÛÙfi 31%, Ô ÂÚ·ÈÙ¤Úˆ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙÔ˘ ÙÈ ·ÎÚÈ‚Ò˜ ÚÔÛʤÚÂÙ·È ÛÙ· ·È‰È¿ ‰Â›¯ÓÂÈ ÙËÓ Î·Ù’ ÂÍÔ¯‹Ó ÂÈΤÓÙÚˆÛË ÛÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ Î·È ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ·È‰ÈÔ‡. (¶›Ó·Î·˜ 2). ∏ „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Ì·˙› ÙÔ˘, ·Ó·Ê¤ÚıËΠÌfiÓÔ Û ÔÛÔÛÙfi 41%, ÂÓÒ ·ÎfiÌË Û·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚıËÎÂ Ë „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (14%). ∂ȉÈο “È·ÙÚ›· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘” ÁÈ· ÙËÓ ·ÚÔ¯‹ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ·Ó·Ê¤ÚıËÎ·Ó Û 3 ÂÚÈÙÒÛÂȘ. ∆· Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ· ÂÌfi‰È· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ·ÊÔÚÔ‡Û·Ó ÙËÓ ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ Âη›‰Â˘Û˘ Î·È Â˘·ÈÛıËÙÔÔ›ËÛ˘ ÙÔ˘
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·121
121
¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·
¶›Ó·Î·˜ 2. ∆ÚfiÔÈ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜
¶›Ó·Î·˜ 3. ∂Ìfi‰È· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·È‰È·ÙÚÈ΋˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜
∂Ê·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜
∂Ìfi‰È· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜
ÃÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ ‹/ Î·È ¿ÏÏ˘ Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜ ∂ÈÎÔÈÓˆÓ›· Ì ÙÔ ¿ÚÚˆÛÙÔ ·È‰› Î·È „˘¯ÔÏÔÁÈ΋ ˘ÔÛÙ‹ÚÈÍ‹ ÙÔ˘ æ˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜
% ÙˆÓ ··ÓÙ‹ÛÂˆÓ 86 41 14
ÚÔÛˆÈÎÔ‡ (59%), ÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ ΢ڛˆ˜ „˘¯ÔÏfiÁÔ˘, ÎÔÈÓˆÓÈÎÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡ Î·È ÂȉÈÎÒÓ ÛÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·- (55,5%) Î·È ÙËÓ ¤ÏÏÂÈ„Ë ˘Ô‰ÔÌ‹˜ Û ¯ÒÚÔ˘˜ Î·È Î·Ù¿ÏÏËϘ ˘ËÚÂۛ˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ηْ Ô›ÎÔÓ ÊÚÔÓÙ›‰·˜ (38%) (¶›Ó·Î·˜ 3). √È ÚÔÙ¿ÛÂȘ ÁÈ· ÙËÓ ˘¤Ú‚·ÛË ÙˆÓ ÂÌÔ‰›ˆÓ ·˘ÙÒÓ ÂÈÎÂÓÙÚÒıËÎ·Ó ÛÙËÓ ÚfiÛÏË„Ë ÚÔÛˆÈÎÔ‡ (67%), ÙËÓ Âη›‰Â˘ÛË ÙÔ˘ ÚÔÛˆÈÎÔ‡ (48%) Î·È ÙËÓ ÔÚÁ¿ÓˆÛË Ù˘ ηٿÏÏËÏ˘ ˘Ô‰ÔÌ‹˜, Û˘ÌÂÚÈÏ·Ì‚·ÓÔÌ¤ÓˆÓ Ù˘ ‰ËÌÈÔ˘ÚÁ›·˜ ÂȉÈ΋˜ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜, ηْ Ô›ÎÔÓ ÓÔÛËÏ›·˜ Î·È ÂȉÈÎÒÓ ÙÌËÌ¿ÙˆÓ (44,5%). ∞ÓÙÈÌÂÙÒÈÛË fiÓÔ˘ Î·È ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ∆Ô Û‡ÓÔÏÔ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ ·¿ÓÙËÛ fiÙÈ ıˆÚ› “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙÔ ·È‰› Ô˘ ·ÂÈÏÂ›Ù·È Ë ˙ˆ‹ ÙÔ˘ ‹ Âı·›ÓÂÈ. ŸÌˆ˜, ÂÓÒ ‰ËÏÒÓÔ˘Ó fiÙÈ ÛÙÔ ÙÌ‹Ì· Ô˘ ÂÚÁ¿˙ÔÓÙ·È Ô fiÓÔ˜ ÙˆÓ ·È‰ÈÒÓ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È “Ôχ” ‹ “¿Ú· Ôχ” ·ÔÙÂÏÂÛÌ·ÙÈο Û ÔÛÔÛÙfi 81,5% Î·È Ù· ¿ÏÏ· Û˘ÌÙÒÌ·Ù· Û ÔÛÔÛÙfi 72%, ·ÚfiÏ· ·˘Ù¿, ÛËÌ·ÓÙÈο ÔÛÔÛÙ¿ ÁÈ·ÙÚÒÓ ·ÍÈÔÏÔÁÔ‡Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ Û·ÊÒ˜ ÂÚÈÔÚÈṲ̂Ó˜, ȉȷ›ÙÂÚ· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ (53%), ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ fiÓÔ˘ (41%) Î·È ÏÈÁfiÙÂÚÔ ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ‰‡ÛÓÔÈ·˜, ÙˆÓ Û·ÛÌÒÓ Î·ıÒ˜ Î·È ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ (¤ÌÂÙÔÈ, ·ÓÔÚÂÍ›·, ‰È¿ÚÚÔÈ·). ø˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÂÌfi‰ÈÔ ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ·Ó·Ê¤ÚıËÎÂ Ë ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ Âη›‰Â˘Û˘ (63%) Î·È ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ (52%) ˘ÔÁÚ¿ÌÌÈÛ·Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· Û¯ÂÙÈ΋˜ ηٿÚÙÈÛ˘. √ÚÈṲ̂ÓÔÈ ·Ó·Ê¤ÚıËÎ·Ó Â›Û˘, ÛÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡, ÛÙËÓ ¤ÏÏÂÈ„Ë Î·Ù¿ÏÏËÏˆÓ ¯ÒÚˆÓ Î·È ˘Ô‰ÔÌ‹˜, ÂÓÒ ÁÈ· ÙÔ 26% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÂÌfi‰È· ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘.
ŒÏÏÂÈ„Ë ÁÓÒÛÂˆÓ / ¢·ÈÛıËÙÔÔ›ËÛ˘ ŒÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ ŒÏÏÂÈ„Ë ˘Ô‰ÔÌ‹˜-˘ËÚÂÛÈÒÓ ºfiÚÙÔ˜ ÂÚÁ·Û›·˜ ∞Ô˘Û›· ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ ¢ÂÓ ˘¿Ú¯Ô˘Ó ÂÌfi‰È·
% ÙˆÓ ··ÓÙ‹ÛÂˆÓ 59 55,5 38 26 18,5 15
∂ÈÎÔÈÓˆÓ›· Ì ÙÔ ¿ÚÚˆÛÙÔ ·È‰› Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ √È ÂÚˆÙ‹ÛÂȘ ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ÙÚ›· ÛΤÏË, ÛÙÔ Î·ı¤Ó· ·fi Ù· ÔÔ›· ÂÍÂÙ¿˙ÔÓÙ·Ó ¯ˆÚÈÛÙ¿ Ë ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘: ·) ηٿ ÙË ‰È¿ÁÓˆÛË ÌÈ·˜ ·ÂÈÏËÙÈ΋˜ ÁÈ· ÙË ˙ˆ‹ ·Ûı¤ÓÂÈ·˜, ‚) ηٿ ÙËÓ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘ Î·È Á) ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÁÈ·ÙÚÒÓ (94%) ¯·Ú·ÎÙ‹ÚÈÛ ˆ˜ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ÙËÓ ÏËÚÔÊfiÚËÛË ÙˆÓ ÁÔÓÈÒÓ Î·È ÛÙȘ ÙÚÂȘ ·˘Ù¤˜ Ê¿ÛÂȘ. ™¯ÂÙÈο Ì ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡, ·˘Ù‹ ·ÍÈÔÏÔÁ‹ıËΠˆ˜ “Ôχ” ‹ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ηٿ ÙË Ê¿ÛË Ù˘ ‰È¿ÁÓˆÛ˘ Û ÔÛÔÛÙfi 66%, ηٿ ÙËÓ Âȉ›ӈÛË Ù˘ ÓfiÛÔ˘ Û ÔÛÔÛÙfi 50% Î·È ÌfiÓÔ 24% ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ. ∆ÔÓ›˙ÂÙ·È È‰È·›ÙÂÚ·, fiÙÈ Ë ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ Û ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÎÚÈÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘, ·ÍÈÔÏÔÁ‹ıËΠˆ˜ “ηıfiÏÔ˘” ÛËÌ·ÓÙÈ΋ Û ÔÛÔÛÙfi 55%. √È ÂÚÈÛÛfiÙÂÚÔÈ ·È‰›·ÙÚÔÈ (62,5%) ÂÎÙ›ÌËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ ˆ˜ “ÔÏϤ˜” ‹ “¿Ú· ÔÏϤ˜”, ÂÓÒ ÌÂÁ¿ÏÔ Â›Û˘ ÔÛÔÛÙfi (72%) ¯·Ú·ÎÙ‹ÚÈÛ ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ÙËÓ ÔÔ›· ÂÓËÌÂÚÒÓÔ˘Ó ÙÔ˘˜ ÁÔÓ›˜ ˆ˜ “Ôχ” ‹ “¿Ú· Ôχ” ÈηÓÔÔÈËÙÈ΋. ∞ÓÙÈı¤Ùˆ˜, fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡, ÔÈ È·ÙÚÔ› ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ ÂÚÈÔÚÈṲ̂Ó˜ ‹ ·Ó·ÚΛ˜ Û ÔÛÔÛÙfi 50% Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Ì·˙› ÙÔ˘ ˆ˜ ·Ó·Ú΋ ‹ Ôχ ÂÚÈÔÚÈṲ̂ÓË Û ÔÛÔÛÙfi 63%. ø˜ ÂÌfi‰È· ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ ·Ó·ÁÓÒÚÈÛ·Ó ÙËÓ ¤ÏÏÂÈ„Ë ÁÓÒÛÂˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ ÂÈÎÔÈÓˆÓ›·˜ (34,5%), ÙË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË ÙfiÛÔ ÙˆÓ ›‰ÈˆÓ fiÛÔ Î·È ÙˆÓ ÁÔÓÈÒÓ (27,5%), ÙËÓ ¤ÏÏÂÈ„Ë ¯ÚfiÓÔ˘ (27,5%) ηıÒ˜ Î·È ÙËÓ ÚÔ‚ÏËÌ·ÙÈ΋ Û˘ÓÂÚÁ·Û›· ÙˆÓ ÌÂÏÒÓ Ù˘ ÔÌ¿‰·˜ Û¯ÂÙÈο Ì ÙËÓ ·ÚÔ¯‹ Î·È ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÏËÚÔÊfiÚËÛ˘ (24%). ™·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚıËÎ·Ó ˆ˜ ÂÌfi‰È·, Ë ¿ÚÓËÛË ÙˆÓ ÁÔÓÈÒÓ Ó· ·Ô‰Â¯ıÔ‡Ó Î·È Ó· Û˘˙ËÙ‹ÛÔ˘Ó ÙËÓ ¶·È‰È·ÙÚÈ΋ 2006;69:118-126
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·122
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ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘
ÛÔ‚·ÚfiÙËÙ· Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜, ηıÒ˜ Î·È Ë ÎÚÈÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û˘ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ı· ηıÈÛÙÔ‡Û ·‰‡Ó·ÙË ÙËÓ ÂÈÎÔÈÓˆÓ›· Ì·˙› ÙÔ˘. °È· ÔÛÔÛÙfi 14% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Ë ÂÓË̤ڈÛË Á›ÓÂÙ·È ¯ˆÚ›˜ ηӤӷ ÂÌfi‰ÈÔ. √È Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓ˜ ÚÔÙ¿ÛÂȘ ·ÊÔÚÔ‡Û·Ó ÙËÓ Âη›‰Â˘ÛË ÛÙȘ ‰ÂÍÈfiÙËÙ˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙÔ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ ·È‰› Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ ÙÔ˘ (41%), ÙËÓ ÔÚÁ¿ÓˆÛË Î·È Û˘ÓÂÚÁ·Û›· Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜ (34,5%), ÙË ‰ËÌÈÔ˘ÚÁ›· ÔÌ¿‰ˆÓ ÛÙ‹ÚÈ͢ ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ ·ÏÏ¿ Î·È ÔÌ¿‰ˆÓ ÛÙ‹ÚÈ͢ ÁÈ· ÙÔ ÚÔÛˆÈÎfi (17%) Î·È ÙË ‰È¿ıÂÛË Î·Ù¿ÏÏËÏˆÓ ¯ÒÚˆÓ ÁÈ· ÂÓË̤ڈÛË (17%). ∏ıÈο ‰ÈÏ‹ÌÌ·Ù· Î·È Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ∆· Û˘¯ÓfiÙÂÚ· ËıÈο ‰ÈÏ‹ÌÌ·Ù· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó ·ÊÔÚÔ‡Û·Ó ·) ÙËÓ ·fiÊ·ÛË Û¯ÂÙÈο Ì ÙË ÌÂÙ¿‚·ÛË ·fi ÙËÓ ÂÓÂÚÁfi ıÂڷ¢ÙÈ΋ ÛÙËÓ ˘ÔÛÙËÚÈÎÙÈ΋ ·ÁˆÁ‹, ηıÒ˜ Î·È ÙÔ Â›‰Ô˜ ·˘Ù‹˜ (83%), ‚) ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÏËÚÔÊfiÚËÛ˘ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘ (47%) Î·È Á) ÙÔÓ ÚÔ‚ÏËÌ·ÙÈÛÌfi Û¯ÂÙÈο Ì ÙËÓ Â˘ı·Ó·Û›· (10%). √È ÂÚÈÛÛfiÙÂÚÔÈ È·ÙÚÔ› (76%) ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ Â›Ï˘ÛË ˙ËÙËÌ¿ÙˆÓ Ô˘ ·ÊÔÚÔ‡Ó ËıÈο ‰ÈÏ‹ÌÌ·Ù· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ˆ˜ ÂÏ¿¯ÈÛÙ˜ ‹ ·Ó·ÚΛ˜. ¶ÂÚÈÔÚÈṲ̂ÓÔ˜ ·ÚÈıÌfi˜ Û˘ÌÌÂÙ¯fiÓÙˆÓ ·Ó·ÁÓÒÚÈÛ·Ó ÂÌfi‰È· Î·È ¤Î·Ó·Ó ÚÔÙ¿ÛÂȘ ÁÈ· ÙËÓ Â›Ï˘Û‹ ÙÔ˘˜. ∏ Û˘˙‹ÙËÛË ÌÂٷ͇ Û˘Ó·‰¤ÏÊˆÓ ‹Ù·Ó Ô Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓÔ˜ ÙÚfiÔ˜ Â›Ï˘Û˘ ÙˆÓ ËıÈÎÒÓ ˙ËÙËÌ¿ÙˆÓ ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·ÔÙÂÏÔ‡ÛÂ Î·È ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÂÌfi‰ÈÔ fiÙ·Ó ˘‹Ú¯·Ó ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ. ∏ ¤ÏÏÂÈ„Ë Â˘Ú¤ˆ˜ ·Ô‰ÂÎÙÒÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙËÓ ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘ ·ÔÙÂÏÔ‡Û ÙÔ ‰Â‡ÙÂÚÔ ÛÂ Û˘¯ÓfiÙËÙ· ·Ó·ÊÂÚfiÌÂÓÔ ÂÌfi‰ÈÔ, ·ÎÔÏÔ˘ıÔ‡ÌÂÓÔ ·fi ÙËÓ ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ Âη›‰Â˘Û˘. ™·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚıËÎ·Ó ÔÈ ‰È·ÊÔÚÂÙÈΤ˜ ·fi„ÂȘ ·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ Î·È ÁÔÓÈÒÓ ˆ˜ ÚfiÛÎÔÌÌ· ÛÙËÓ Â›Ï˘ÛË ËıÈÎÒÓ ‰ÈÏËÌÌ¿ÙˆÓ Î·È ÙË Ï‹„Ë ·ÔÊ¿ÛˆÓ. æ˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ηٿ ÙËÓ ÔÚ›· Ù˘ ·ÚÚÒÛÙÈ·˜ Î·È ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜ √È ÂÚˆÙ‹ÛÂȘ ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹ ÂÚÈÂÏ¿Ì‚·Ó·Ó ÙÚ›· ÛΤÏË ·ÍÈÔÏÔÁÒÓÙ·˜ ·ÓÙÈÛÙÔ›¯ˆ˜ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ·) ÛÙËÓ ÔÚ›· ¶·È‰È·ÙÚÈ΋ 2006;69:118-126
Ù˘ ÓfiÛÔ˘ ÙÔ˘ ·È‰ÈÔ‡, ‚) ηٿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Î·È Á) ηٿ ÙÔ ¤ÓıÔ˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ∏ ÏÂÈÔ„ËÊ›· (71%) ·ÍÈÔÏfiÁËÛ ˆ˜ “¿Ú· Ôχ” ÛËÌ·ÓÙÈ΋ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û fiÏ· Ù· ·ÓˆÙ¤Úˆ ÛÙ¿‰È·, ·Í›˙ÂÈ fï˜ Ó· ÛËÌÂȈı› fiÙÈ ¤ÛÙˆ Î·È ÏÈÁÔÛÙÔ› ·È‰›·ÙÚÔÈ ¯·Ú·ÎÙ‹ÚÈÛ·Ó ˆ˜ “ηıfiÏÔ˘” ÛËÌ·ÓÙÈΤ˜ ÙËÓ „˘¯ÔÏÔÁÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ ÛÙË ÓfiÛÔ ÙÔ˘ (6%) Î·È ÙË ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙÔ ¤ÓıÔ˜ Ù˘ (12,5%). ø˜ ·ÚÌÔ‰ÈfiÙÂÚÔÈ ÁÈ· ÙËÓ ·ÚÔ¯‹ ÛÙ‹ÚÈ͢ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ ÙÔ˘ ·È‰ÈÔ‡ ıˆڋıËÎ·Ó Ô „˘¯ÔÏfiÁÔ˜ ‹/ Î·È ÎÔÈÓˆÓÈÎfi˜ ÏÂÈÙÔ˘ÚÁfi˜ (97%), ÔÈ ÁÈ·ÙÚÔ› (87,5%), ÔÈ ÓÔÛËÏÂ˘Ù¤˜ (78%) Î·È ÔÈ Ê›ÏÔÈ Î·È Û˘ÁÁÂÓ›˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (69%). ¶·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ÙÔ Â‡ÚËÌ· fiÙÈ ÔÈ ·È‰›·ÙÚÔÈ ıˆÚÔ‡Ó ÏÈÁfiÙÂÚÔ ·ÚÌfi‰ÈÔ ÙÔÓ Â·˘Ùfi ÙÔ˘˜ Ó· ·Ú¤¯Ô˘Ó ÛÙ‹ÚÈÍË ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ (69%) Î·È ·ÎfiÌË ÏÈÁfiÙÂÚÔ Î·Ù¿ ÙËÓ ÂÚ›Ô‰Ô ÙÔ˘ ¤ÓıÔ˘˜ (47%), ηٿ ÙËÓ ÔÔ›· Ô „˘¯ÔÏfiÁÔ˜, Ô ÎÔÈÓˆÓÈÎfi˜ ÏÂÈÙÔ˘ÚÁfi˜, ÔÈ Ê›ÏÔÈ Î·È Û˘ÁÁÂÓ›˜ ÎÚ›ÓÔÓÙ·È ˆ˜ ηٷÏÏËÏfiÙÂÚÔÈ ÁÈ· ÙËÓ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜. ™Â ÔÛÔÛÙfi 13% ·Ó·Ê¤ÚıËÎÂ Ô ·È‰Ô„˘¯›·ÙÚÔ˜ ˆ˜ ·ÚÌÔ‰ÈfiÙÂÚÔ˜ ÁÈ· ÙË ÛÙ‹ÚÈÍË ·È‰ÈÒÓ Î·È ÔÈÎÔÁÂÓÂÈÒÓ. √È ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ˆ˜ “·Ô‡Û˜” ‹ “Ï›Á˜” (48,5%), ÂÓÒ ÂÓÙ˘ˆÛȷο Ï›ÁÔÈ (19,5%) ·Ó¤ÊÂÚ·Ó “Ôχ” ‹ “¿Ú· Ôχ” ÌÂÁ¿ÏË Â¿ÚÎÂÈ· ÁÓÒÛˆÓ. √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ „˘¯ÔÎÔÈÓˆÓÈ΋˜ ÛÙ‹ÚÈ͢ Ô˘ ·Ú¤¯ÂÙ·È ÛÙ· ÙÌ‹Ì·Ù¿ ÙÔ˘˜, ÙfiÛÔ ÛÙË ‰È¿ÚÎÂÈ· Ù˘ ÓfiÛÔ˘ fiÛÔ Î·È Î·Ù¿ ÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ˆ˜ “·Ó·Ú΋” ‹ “ÂÚÈÔÚÈṲ̂ÓË” Û ÔÛÔÛÙfi 44% Î·È “̤ÙÚÈ·” Û ÔÛÔÛÙfi 34,5%. ŸÛÔÓ ·ÊÔÚ¿ ÙË ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂÙ¿ ÙÔ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡, Â›Ó·È ·ÔÎ·Ï˘ÙÈ΋ Ë ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· (90%) Ì ÙËÓ ÔÔ›· ·Ó·Ê¤ÚıËΠ·Ô˘Û›· ÛÙ‹ÚÈ͢ ‹ Ôχ ÂÚÈÔÚÈṲ̂ÓË ·ÚÔ¯‹ Ù˘. ø˜ ΢ÚÈfiÙÂÚ· ÂÌfi‰È· ÛÙËÓ ÂÓfiÙËÙ· ·˘Ù‹, ·Ó·Ê¤ÚıËÎ·Ó Ë ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡ -ȉȷ›ÙÂÚ· „˘¯ÔÏfiÁÔ˘ ‹/ Î·È ÎÔÈÓˆÓÈÎÔ‡ ÏÂÈÙÔ˘ÚÁÔ‡(67%), Ë ·Ó¿ÚÎÂÈ· ÁÓÒÛÂˆÓ (30%), Ë ¤ÏÏÂÈ„Ë ¯ÚfiÓÔ˘ (27%), ηٿÏÏËÏ˘ ˘Ô‰ÔÌ‹˜- Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤Ó˘ Ù˘ ηْ Ô›ÎÔÓ ÊÚÔÓÙ›‰·˜(27%), ·ÏÏ¿ Î·È Ë ·Ó·Ú΋˜ Û˘ÓÂÚÁ·Û›· ÙfiÛÔ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ fiÛÔ Î·È ·Ó¿ÌÂÛ· ÛÙ· ÙÌ‹Ì·Ù· Î·È ÙȘ ˘¿Ú¯Ô˘Û˜ „˘¯ÔÎÔÈÓˆÓÈΤ˜ ˘ËÚÂۛ˜ (23%). °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÂÌÔ‰›ˆÓ
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·123
123
¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·
·˘ÙÒÓ ÚÔÙ¿ıËÎ·Ó Î˘Ú›ˆ˜ Ë ÚfiÛÏË„Ë ÚÔÛˆÈÎÔ‡ Ì ¤ÌÊ·ÛË ÛÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜ „˘¯È΋˜ ˘Á›·˜ (57%), Ë Âη›‰Â˘ÛË ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙˆÓ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (23%) Î·È Ë ‚ÂÏÙ›ˆÛË Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ (20%). ¢ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· ∏ ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· ·ÍÈÔÏÔÁ‹ıËΠˆ˜ “¿Ú· Ôχ” (56%) ‹ “Ôχ” (31%) ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜. øÛÙfiÛÔ, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› (75%) ·¿ÓÙËÛ·Ó fiÙÈ ÌfiÓÔ ÂÚÈÛÙ·Ûȷο ÏÂÈÙÔ˘ÚÁÔ‡Ó ÛÙÔ Ï·›ÛÈÔ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜, ÂÓÒ Û ÔÛÔÛÙfi 16% ·Ó¤ÊÂÚ·Ó fiÙÈ ‰ÂÓ Â›¯·Ó ÔÙ¤ ·ÚfiÌÔÈ· ÂÌÂÈÚ›·. ™ËÌÂÈÒÓÂÙ·È fiÙÈ ·fi Ù· ÙÚ›· ÓÔÛÔÎÔÌ›· Ô˘ Û˘ÌÌÂÙ›¯·Ó ÛÙËÓ ¤Ú¢ӷ, ·È‰Ô„˘¯È·ÙÚÈ΋ ÔÌ¿‰· ˘‹Ú¯Â ÌfiÓÔ Û ¤Ó·. øÛÙfiÛÔ, Î·È ÛÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ˘‹Ú¯Â ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›·, Ë ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ¿ Ù˘ ÂÎÙÈÌ‹ıËΠ΢ڛˆ˜ ˆ˜ “̤ÙÚÈ·” (37,5%) ‹ “ÌÈÎÚ‹” (22%). ŸÛÔÈ ÂÚˆÙËı¤ÓÙ˜ ›¯·Ó ÂÌÂÈÚ›· ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜, ˆ˜ ΢ÚÈfiÙÂÚ˜ ‰˘ÛÎÔϛ˜ ÂÂÛ‹Ì·Ó·Ó ÙËÓ ·Ó·Ú΋ Û˘ÓÂÚÁ·Û›· Î·È ÂÈÎÔÈÓˆÓ›· ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÈÎÔًوÓ, ÙËÓ ¤ÏÏÂÈ„Ë ¯ÚfiÓÔ˘ ÏfiÁˆ ÊfiÚÙÔ˘ ÂÚÁ·Û›·˜, ÙËÓ ¤ÏÏÂÈ„Ë Û¯ÂÙÈ΋˜ Âη›‰Â˘Û˘ Î·È ÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛˆÈÎÔ‡. ∏ ·Ó·ÁηÈfiÙËÙ· Ù˘ ÚÔ·ÁˆÁ‹˜ Ù˘ Û˘ÓÂÚÁ·Û›·˜ ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ ÂȉÈÎÔÙ‹ÙˆÓ ‹Ù·Ó Ë Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓË ÚfiÙ·ÛË ÁÈ· ÙËÓ ˘¤Ú‚·ÛË ÙˆÓ ·ÓˆÙ¤Úˆ ÂÌÔ‰›ˆÓ.
™˘˙‹ÙËÛË ∏ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ϤÔÓ ˆ˜ ·Ó·Ê·›ÚÂÙÔ ‰Èη›ˆÌ· ÙˆÓ ·È‰ÈÒÓ Ì ·ÂÈÏËÙÈο ÁÈ· ÙË ˙ˆ‹ ÓÔÛ‹Ì·Ù· Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜ (1-8). ∫È ÂÓÒ ÔÈ ÚˆÙÔ‚Ô˘Ï›Â˜ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ··Ú·›ÙËÙˆÓ ‰ÔÌÒÓ Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ Ù˘ ·Ú¯fiÌÂÓ˘ ÊÚÔÓÙ›‰·˜ ÛÙÔÓ ·È‰È·ÙÚÈÎfi ·˘Ùfi ÏËı˘ÛÌfi ÏËı·›ÓÔ˘Ó ‰ÈÂıÓÒ˜ (4,6-8), ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ˘¿Ú¯Ô˘Ó ·ÎfiÌ· ÔÚÁ·ÓˆÌ¤Ó˜ ÂÍÂȉÈÎÂ˘Ì¤Ó˜ ˘ËÚÂۛ˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÁÈ· ·È‰È¿. ¶Ù˘¯¤˜ Ù˘ ÊÚÔÓÙ›‰·˜ ·˘Ù‹˜ ÚÔÛʤÚÔÓÙ·È Û ·È‰È·ÙÚÈο ÔÁÎÔÏÔÁÈο ÙÌ‹Ì·Ù· Î·È ÌÔÓ¿‰Â˜ ÂÓÙ·ÙÈ΋˜ ıÂڷ›·˜ fiÔ˘ ÓÔÛËχÔÓÙ·È ·È‰È¿ Ì ‰˘ÓËÙÈο ηٷÏËÎÙÈο ÓÔÛ‹Ì·Ù· (13-14). ™ÙË ·ÚÔ‡Û· ÌÂϤÙË ¤ÁÈÓ ÌÈ· ÚÒÙË ÚÔÛ¿ıÂÈ· ηٷÁÚ·Ê‹˜ ÙˆÓ ÁÓÒÛÂˆÓ Î·È ·fi„Â-
ˆÓ Ô˘ ¤¯Ô˘Ó ŒÏÏËÓ˜ ·È‰›·ÙÚÔÈ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Û √ÁÎÔÏÔÁÈο ∆Ì‹Ì·Ù· Î·È ªÔÓ¿‰Â˜ ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ ·Ó·ÊÔÚÈο Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ Û ·È‰È¿ Ì ·ÂÈÏËÙÈΤ˜ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘˜ ·Ûı¤ÓÂȘ. §fiÁˆ ÙÔ˘ ˘„ËÏÔ‡ ÔÛÔÛÙÔ‡ ·ÓÙ·fiÎÚÈÛ˘ ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È Û ÙÚ›· ÌÂÁ¿Ï· ·È‰È·ÙÚÈο ÓÔÛÔÎÔÌ›· Ù˘ ¯ÒÚ·˜, ıˆÚԇ̠fiÙÈ Ù· ·ÔÙÂϤÛÌ·Ù· ‰ÂÓ ·¤¯Ô˘Ó Ôχ ·fi ÙËÓ ÂÏÏËÓÈ΋ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÛÙÔ ı¤Ì· ·˘Ùfi. H ·ÚÔ‡Û· ÂÚÁ·Û›· ¤‰ÂÈÍÂ: ·) ÙȘ ÂÏÏÈ›˜ ÁÓÒÛÂȘ ÙˆÓ ·È‰È¿ÙÚˆÓ Û¯ÂÙÈο Ì ÙËÓ ·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·, ·ÚfiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ıˆÚÔ‡Ó Ôχ ÛËÌ·ÓÙÈ΋ ÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ Û ÂÚÈÙÒÛÂȘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ, Î·È ‚) ÙËÓ ÂÚÈÔÚÈṲ̂ÓË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ì ÙËÓ ÔÔ›· ·Ú¤¯ÂÙ·È Ë ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· Û ÙÌ‹Ì·Ù· fiÔ˘ ÔÚÈṲ̂Ó˜ Ù˘¯¤˜ ·˘Ù‹˜ ÂÊ·ÚÌfi˙ÔÓÙ·È. ¶ÈÔ ·Ó·Ï˘ÙÈο, Ù· Â˘Ú‹Ì·Ù· ÂÂÛ‹Ì·Ó·Ó fiÙÈ Ë ÊÈÏÔÛÔÊ›· Î·È ÔÈ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ Â·ÚÎÒ˜ ηٷÓÔËÙ¤˜ ·fi ÙÔ˘˜ ŒÏÏËÓ˜ ·È‰È¿ÙÚÔ˘˜. ∂›Ó·È ¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ Ë ÌÂÁ¿ÏË ÏÂÈÔ„ËÊ›· ÔÚ›˙ÂÈ ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ˆ˜ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡, Ì ¤ÌÊ·ÛË ÛÙËÓ ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹. ∏ ·Ó·ÊÔÚ¿ ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË ÙfiÛÔ ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ fiÛÔ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, Ô˘ ›Û˘ ·ÔÙÂÏÔ‡Ó ıÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ˘‹ÚÍ Ôχ ÂÚÈÔÚÈṲ̂ÓË. ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ Ô Ï‹Ú˘ ÔÚÈÛÌfi˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ˆ˜ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋, „˘¯ÔÏÔÁÈ΋ Î·È ÓÂ˘Ì·ÙÈ΋ ÊÚÔÓÙ›‰· ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ·Ô‰fiıËΠ·fi ¤Ó·Ó ÌfiÓÔ ÂÚˆÙËı¤ÓÙ·. ∏ ÂÏÏÈ‹˜ ηٷÓfiËÛË Ù˘ ÊÈÏÔÛÔÊ›·˜ Î·È ÙÔ˘ ÂÚȯÔ̤ÓÔ˘ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ¤¯ÂÈ Â›ÙˆÛË Î·È ÛÙËÓ ÂÊ·ÚÌÔÁ‹ Ù˘ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, fiÔ˘ ‰È·ÈÛÙÒÓÂÙ·È ÂÈΤÓÙÚˆÛË ÛÙË ¯ÔÚ‹ÁËÛË ·Ó·ÏÁËÙÈÎÒÓ Î·È Ê·Ú̷΢ÙÈ΋˜ ·ÁˆÁ‹˜, Ì ÙËÓ ·Ú¿ÏÏËÏË Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÛÙ‹ÚÈÍË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ó· ÂÊ·ÚÌfi˙ÂÙ·È Ôχ ÂÚÈÔÚÈṲ̂ӷ. ŸÌˆ˜, ·Ú¿ ÙËÓ ÂÛÙ›·ÛË ÛÙËÓ ·Ó·ÎÔ‡ÊÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ, Ë ÔÔ›· ÂÎÙÈÌ¿Ù·È Î·Ù¿ ηÓfiÓ· ˆ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋, Ë ÏÂÈÔ„ËÊ›· ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ·Ó·Ê¤ÚÂÈ ÂÚÈÔÚÈṲ̂Ó˜ ÁÓÒÛÂȘ ÛÙÔÓ ÙÔ̤· ·˘Ùfi Î·È ÂÎÊÚ¿˙ÂÈ ÙËÓ ·Ó¿ÁÎË Î·Ù¿ÏÏËÏ˘ ηٿÚÙÈÛ˘. ∆Ô Â‡ÚËÌ· ·˘Ùfi, ·Ó Î·È ¤Ú¯ÂÙ·È Û ·ÓÙ›ıÂÛË Ì ÙÔÓ ¶·È‰È·ÙÚÈ΋ 2006;69:118-126
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·124
124
ª. ªÔ‡ÚË, ¢. ¶··‰¿ÙÔ˘
˘„ËÏfi ‚·ıÌfi ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ Ô˘ ·Ô‰›‰ÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ Û˘Ìو̿وÓ, Û˘ÌʈÓ› Ì ÌÂϤÙ˜ Ô˘ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ·Ó·ÎÔ‡ÊÈÛË ÙÔ˘ fiÓÔ˘ Î·È ¿ÏÏˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Û ·È‰È¿ Ô˘ Âı·›ÓÔ˘Ó, ·Ú·Ì¤ÓÂÈ ÂÏÏÈ‹˜ (3-4,9-11). ∏ ÂÓË̤ڈÛË ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È ÙˆÓ ÁÔÓÈÒÓ ÙÔ˘ Â›Ó·È ¯ˆÚ›˜ ·ÌÊÈ‚ÔÏ›· ÌÈ· ‰‡ÛÎÔÏË ˘fiıÂÛË. ™Â ·ÓÙ›ıÂÛË Ì ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ, Ë ÔÔ›· ·Ó·Ê¤ÚıËΠfiÙÈ ‰ÈÂÍ¿ÁÂÙ·È Î·Ù¿ ηÓfiÓ· ·ÔÙÂÏÂÛÌ·ÙÈο, ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ÙȘ ÁÓÒÛÂȘ Î·È ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÂÓË̤ڈÛ˘ ÙÔ˘ ›‰ÈÔ˘ ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ ˆ˜ ȉȷ›ÙÂÚ· ·Ó·ÚΛ˜. √È Û·ÊÒ˜ ÏÈÁfiÙÂÚ˜ ÁÓÒÛÂȘ Î·È ‰ÂÍÈfiÙËÙ˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙÔ ¿ÚÚˆÛÙÔ ·È‰›, Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÁÔÓ›˜, ·ÔÙÂÏ› ‡ÚËÌ· Ô˘ ·Í›˙ÂÈ Ó· ˘ÔÁÚ·ÌÌÈÛÙ›, Ì ‰Â‰Ô̤ÓË ÙËÓ ·È‰È·ÙÚÈ΋ ÂÍÂȉ›Î¢ÛË ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ. ∂›Ó·È ›Û˘ ·ÍÈÔÛËÌ›ˆÙÔ fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÂÚˆÙËı¤ÓÙ˜ ·ÍÈÔÏfiÁËÛ·Ó ˆ˜ ÌË ÛËÌ·ÓÙÈ΋ ÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰ÈÔ‡ Û ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Û¯ÂÙÈο Ì ÙËÓ ÎÚÈÛÈÌfiÙËÙ· Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘, ‡ÚËÌ· Ô˘ ·ÓÙÈÊ¿ÛÎÂÈ Ï‹Úˆ˜ Ì ٷ Û‡Á¯ÚÔÓ· ‰Â‰Ô̤ӷ Ô˘ ˘ÔÁÚ·ÌÌ›˙Ô˘Ó fiÙÈ ÙÔ ‚·ÚÈ¿ ¿ÚÚˆÛÙÔ ·È‰› ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË ÛÔ‚·ÚfiÙËÙ· Ù˘ ηٿÛÙ·Û‹˜ ÙÔ˘ Î·È Û˘¯Ó¿ ÂÎÊÚ¿˙ÂÈ ÙËÓ ·Ó¿ÁÎË Ó· Û˘˙ËÙ‹ÛÂÈ ÁÈ’ ·˘Ùfi (22,23). ÕÏψÛÙÂ, Û‡Ìʈӷ Ì ٷ ‰ÈηÈÒÌ·Ù· ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ, οı ·È‰› ¤¯ÂÈ ‰Èη›ˆÌ· Û˘ÌÌÂÙÔ¯‹˜ ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ËÏÈΛ· Î·È ÙËÓ ˆÚÈÌfiÙËÙ¿ ÙÔ˘ (4-5,24). ∏ ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ ·È‰› ˆÛÙfiÛÔ, ‰È¤ÂÙ·È ·fi ÂÁÁÂÓ›˜ ‰˘ÛÎÔϛ˜ Î·È ÚÔÎÏ‹ÛÂȘ Ì ‰Â‰Ô̤ÓË ÙËÓ Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÊfiÚÙÈÛË ÙfiÛÔ ÁÈ· ÙÔ˘˜ ›‰ÈÔ˘˜ ÙÔ˘˜ ·ÁÁÂÏ̷ٛ˜, fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ÁÔÓ›˜ Ô˘ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙÔÓ ÂÈΛÌÂÓÔ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡ (15-17). ∏ ÛËÌ·ÓÙÈ΋ ·Ó¿ÚÎÂÈ· Ô˘ ‰È·ÈÛÙÒıËΠfiÛÔÓ ·ÊÔÚ¿ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ÛÙ‹ÚÈÍË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÙÔ˘ ·È‰ÈÔ‡ Ô˘ Âı·›ÓÂÈ, ·ÔÙÂÏ› ÁÂÁÔÓfi˜ Ì ‰˘ÓËÙÈο ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ ÛÙÔ ¤ÓıÔ˜ ÙˆÓ ÁÔÓÈÒÓ, ÙÔ ÔÔ›Ô Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÂËÚ¿˙ÂÙ·È Î·È ·fi ÙȘ Û˘Óı‹Î˜ ̤۷ ÛÙȘ Ôԛ˜ Âı·›ÓÂÈ ÙÔ ·È‰› ÙÔ˘˜ (14,19-21). ™ÙËÓ ·ÚÔ‡Û· ÂÚÁ·Û›· ‹Ù·Ó ¯·Ú·ÎÙËÚÈÛÙÈ΋ Î·È Ë ·Ô˘Û›· ÔÚÁ·ÓˆÌ¤Ó˘ Î·È ·ÔÙÂÏÂÛÌ·ÙÈ΋˜ ÛÙ‹ÚÈ͢ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÌÂÙ¿ ÙÔÓ ı¿Ó·ÙÔ ÙÔ˘ ·È‰ÈÔ‡, ‡ÚËÌ· Ô˘ ·Í›˙ÂÈ Ó· ˘ÔÁÚ·ÌÌÈÛı› Ì ‰Â‰Ô̤Ó˜ ÙȘ ¤Ú¢Ó˜ Ô˘ ÙÔÓ›˙Ô˘Ó fiÙÈ Ô ıÚ‹ÓÔ˜ ÙˆÓ ÁÔÓÈÒÓ Â›Ó·È ·Ú·ÙÂٷ̤ÓÔ˜ fiÛÔ Î·È È‰È·›ÙÂÚ· ÂÈÚÚ‹˜ Û ÂÚÈÏÔΤ˜ (18-20). ¶·È‰È·ÙÚÈ΋ 2006;69:118-126
√È Û˘¯ÓfiÙÂÚÔÈ ËıÈÎÔ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ› Ô˘ ·Ó·Ê¤ÚıËηÓ, Û˘ÌʈÓÔ‡Ó Ì ‰Â‰Ô̤ӷ ¿ÏÏˆÓ ÂÚ¢ÓÒÓ (4,25-26). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Â˘ı·Ó·Û›·, Ô˘ Û¿ÓÈ· ·Ó·Ê¤ÚıËΠˆ˜ ËıÈÎfi˜ ÚÔ‚ÏËÌ·ÙÈÛÌfi˜ ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ‰ÂÓ ¤¯ÂÈ ı¤ÛË ÛÙÔ Ï·›ÛÈÔ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ηıÒ˜ ÔÈ ÚÔÛ¿ıÂȘ Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ ÔÌ¿‰·˜ ÛÙÔ¯Â‡Ô˘Ó Ó· ηχ„Ô˘Ó ÛÊ·ÈÚÈο Î·È Ì ÙÔÓ Î·Ï‡ÙÂÚÔ ‰˘Ó·Ùfi ÙÚfiÔ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (5,7). √È ·Ó·ÊÂÚfiÌÂÓ˜ ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ ·fi„ÂȘ ÌÂٷ͇ ·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜ Î·È Ë ¤ÏÏÂÈ„Ë Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Û¯ÂÙÈο Ì ÙË ÊÚÔÓÙ›‰· ÛÙÔ ÙÂÏÈÎfi ÛÙ¿‰ÈÔ, ı· ÌÔÚÔ‡Û·Ó Ó· ·ÏÏËÏÔÛ˘Ó‰¤ÔÓÙ·È: ÈÛÙ‡ԢÌ fiÙÈ ·Ó ˘‹Ú¯Â ۷ʤ˜ Ï·›ÛÈÔ Û¯ÂÙÈο Ì ÙË ÊÚÔÓÙ›‰· ÙÂÏÈÎÔ‡ ÛÙ·‰›Ô˘, ÔÈ ‰ÈÂÓ¤ÍÂȘ ÛÙËÓ ÔÌ¿‰· Û¯ÂÙÈο Ì ËıÈο ˙ËÙ‹Ì·Ù· ı· ÌÔÚÔ‡Û·Ó Ó· ÌÂȈıÔ‡Ó ‹ Î·È Ó· ·ÔÊ¢¯ıÔ‡Ó (25). ∏ ·ÚÔ‡Û· ÂÚÁ·Û›· ÙfiÓÈÛ ÙËÓ ÂÈÙ·ÎÙÈ΋ ·Ó¿ÁÎË ÚÔ·ÁˆÁ‹˜ Ù˘ ÂÈÎÔÈÓˆÓ›·˜ Î·È Û˘ÓÂÚÁ·Û›·˜ ÌÂٷ͇ ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ‰ÈÂÈÛÙËÌÔÓÈ΋ Û˘ÓÂÚÁ·Û›· ÌÂٷ͇ ·È‰È¿ÙÚˆÓ, ÓÔÛËÏ¢ÙÒÓ Î·È ÂȉÈÎÒÓ Ù˘ „˘¯È΋˜ ˘Á›·˜ ·ÔÙÂÏ› ıÂÌÂÏÈÒ‰Ë ·Ú¯‹ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜, ÂÊfiÛÔÓ Û ·˘Ù‹ ‚·Û›˙ÂÙ·È Ë Î¿Ï˘„Ë ÙˆÓ ÔχÏÂ˘ÚˆÓ ·Ó·ÁÎÒÓ ÙÔ˘ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘, ·ÏÏ¿ Î·È Ë ÛÙ‹ÚÈÍË ÙÔ˘ ÚÔÛˆÈÎÔ‡ (27). ∏ ·Ó¿ÁÎË ÛÙ·ıÂÚ‹˜ Î·È Û˘ÛÙËÌ·ÙÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ Ù˘ È·ÙÚÔÓÔÛËÏ¢ÙÈ΋˜ ÔÌ¿‰·˜ Ì ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜, ̤ۈ ÚfiÛÏ˄˘ ηٿÏÏËÏ· ÂÎ·È‰Â˘Ì¤ÓÔ˘ ÚÔÛˆÈÎÔ‡ ‹ ̤ۈ Ù˘ ·Ó¿Ù˘Í˘ ÙˆÓ ˘ÊÈÛÙ·Ì¤ÓˆÓ ‰ÔÌÒÓ, ·ÔÙ¤ÏÂÛ ¤Ó· ·fi Ù· ‚·ÛÈο ·ÈÙ‹Ì·Ù· ÙˆÓ ÂÚˆÙËı¤ÓÙˆÓ. ∏ ÛËÌ·ÓÙÈ΋ ·Ó¿ÚÎÂÈ· Ù˘ „˘¯ÔÎÔÈÓˆÓÈ΋˜ ÛÙ‹ÚÈ͢ Ô˘ ‰È·ÈÛÙÒıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ˘ÔÁÚ·ÌÌ›˙ÂÈ ÂÚ·ÈÙ¤Úˆ ÙËÓ ·Ó·ÁηÈfiÙËÙ· Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜. √È Û˘ÌÌÂÙ¤¯ÔÓÙ˜, ÁÂÓÈο, ·Ó·ÁÓÒÚÈÛ·Ó ÙËÓ ·Ó¿ÁÎË ÙÔ˘˜ ÁÈ· Âη›‰Â˘ÛË Û¯ÂÙÈο Ì ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·, ηıÒ˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ·Ó¤ÊÂÚ·Ó ÙȘ ÂÚÈÔÚÈṲ̂Ó˜ ÁÓÒÛÂȘ ÙÔ˘˜ ˆ˜ ÙÔ Î˘ÚÈfiÙÂÚÔ ÂÌfi‰ÈÔ ÛÙËÓ ÔÏÔÎÏËڈ̤ÓË ·ÚÔ¯‹ Ù˘ Û˘ÁÎÂÎÚÈ̤Ó˘ ÊÚÔÓÙ›‰·˜, ÂÓÒ ÙÔ ·›ÙËÌ· ÁÈ· ÂÍÂȉÈÎÂ˘Ì¤ÓË Î·Ù¿ÚÙÈÛË ·ÔÙÂÏÔ‡Û ÙË Û˘¯ÓfiÙÂÚ· ·Ó·ÊÂÚfiÌÂÓË ÚfiÙ·Û‹ ÙÔ˘˜. ∆Ô Â‡ÚËÌ· ·˘Ùfi Û˘ÌʈÓ› Ì ‰Â‰Ô̤ӷ ·fi ¿ÏϘ ¤Ú¢Ó˜ fiÔ˘ ηٷÁÚ¿ÊÂÙ·È Ë ÂÏÏÈ‹˜ Âη›‰Â˘ÛË ÙˆÓ È·ÙÚÒÓ ÛÙËÓ ÊÚÔÓÙ›‰· ·È‰ÈÒÓ Û ÙÂÏÈÎfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ (28-31).
Pediatr Mar-Apr 06
18-04-06
16:42
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125
¶·È‰È·ÙÚÈ΋ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·
ÕÏÏ· ÂÌfi‰È· Ô˘ ·Ó·Ê¤ÚıËÎ·Ó Û˘¯Ó¿, ‹Ù·Ó Ë ·Ó¿ÚÎÂÈ· ÚÔÛˆÈÎÔ‡ (Ì ¤ÌÊ·ÛË ÛÙÔ˘˜ ÂȉÈÎÔ‡˜ Ù˘ „˘¯È΋˜ ˘Á›·˜) Î·È Î·Ù¿ÏÏËÏ˘ ˘Ô‰ÔÌ‹˜ -·ÌÊfiÙÂÚ· Ú·ÁÌ·ÙÈο ‰Â‰Ô̤ӷ ÁÈ· Ù· ÂÏÏËÓÈο ÓÔÛÔÎÔÌ›·. ŒÓ·˜ ·fi ÙÔ˘˜ ÂÚÈÔÚÈÛÌÔ‡˜ Ù˘ ÂÚÁ·Û›·˜ ·˘Ù‹˜ Â›Ó·È fiÙÈ ‰ÂÓ ÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙÔ ‰Â›ÁÌ· Î·È ¿ÏÏÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ÏËÓ ÙˆÓ È·ÙÚÒÓ. ∂›Û˘ ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ‰ÈÂÚ¢ÓËıÔ‡Ó ÔÈ ÂÌÂÈڛ˜ Î·È ÔÈ ·fi„ÂȘ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ·ÏÏ¿ Î·È ÙˆÓ ›‰ÈˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ Ô˘ Ï·Ì‚¿ÓÔ˘Ó ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·. ∞ÎfiÌË, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ ÂÍÂÙ¿ÛıËΠÏÂÙÔÌÂÚÒ˜ Ë Ú·ÎÙÈ΋ Û οı ‚·ÛÈ΋ ÂÓfiÙËÙ· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ (.¯. Ë ¯Ú‹ÛË ÙˆÓ Ô‰ËÁÈÒÓ ÙÔ˘ ¶.√.À. ÁÈ· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ fiÓÔ˘ ÛÙ· ·È‰È¿ (3)), ÂÓÒ ‰ÂÓ ·Ó·˙ËÙ‹ıËÎ·Ó Î·È Èı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ÔÌ¿‰·˜ ÙˆÓ ·È‰È¿ÙÚˆÓ ÔÁÎÔÏfiÁˆÓ Î·È ÙˆÓ ·È‰È¿ÙÚˆÓ Ù˘ ÂÓÙ·ÙÈ΋˜ ÌÔÓ¿‰·˜. ∂›Û˘, ı· ›¯Â ÂӉȷʤÚÔÓ Ó· ηٷÁÚ·Ê› ·Ó ˘‹ÚÍ·Ó ‰È·ÊÔÚ¤˜ ÛÙȘ ·fi„ÂȘ ·È‰È¿ÙÚˆÓ ·Ó¿ÏÔÁ· Ì ÙËÓ ‡·ÚÍË Ë ÌË ·È‰Ô„˘¯È·ÙÚÈ΋˜ ÔÌ¿‰·˜ ÛÙÔ ÓÔÛÔÎÔÌ›Ô, ηıÒ˜ Î·È fiÛÔ ·ÍÈÔÔÈ‹ıËÎ·Ó ÔÈ Û˘Ì‚Ô˘Ï¢ÙÈΤ˜- ‰È·Û˘Ó‰ÂÙÈΤ˜ ˘ËÚÂۛ˜ Ù˘ ÔÌ¿‰·˜ ·˘Ù‹˜ ÛÙÔ Ï·›ÛÈÔ Ù˘ ‰ÈÂÈÛÙËÌÔÓÈ΋˜ Û˘ÓÂÚÁ·Û›·˜ Ì ٷ ˘fi ÌÂϤÙË ÙÌ‹Ì·Ù·. ™ÙÔ Ï·›ÛÈÔ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ˆÛÙfiÛÔ, ÚfiıÂÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ ‹Ù·Ó Ó· ÂȯÂÈÚËı› ÌÈ· ÚÒÙË Î·Ù·ÁÚ·Ê‹ ÛÙÔȯ›ˆÓ Û¯ÂÙÈο Ì ÙËÓ ·ÚÔ¯‹ ·È‰È·ÙÚÈ΋˜ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ∂ÏÏ¿‰·. ∏ ÌÂϤÙË ·˘Ù‹ ˘¤‰ÂÈÍ ‚‹Ì·Ù· Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÔ˘Ó ÁÈ· ÙËÓ ¿ÚÙÈ· Î·È Û‡ÌʈÓË Ì ÙȘ ‰ÈÂıÓ›˜ ·Ú¯¤˜ ·ÚÔ¯‹ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜. ¢Â‰Ô̤ÓÔ˘ fiÙÈ ÛÙË ‚·ÛÈ΋ È·ÙÚÈ΋ Âη›‰Â˘ÛË Ë ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ‰È‰¿ÛÎÂÙ·È Â‰Ò Î·È Ï›Á· ¯ÚfiÓÈ· ÌfiÓÔ Û ¤Ó· Ì¿ıËÌ· ÂÈÏÔÁ‹˜, ÔÈ ÁÈ·ÙÚÔ› ‰ÂÓ Â˘·ÈÛıËÙÔÔÈÔ‡ÓÙ·È Â·ÚÎÒ˜ Û¯ÂÙÈο Ì ÙËÓ ÔÏÔÎÏËڈ̤ÓË ÊÚÔÓÙ›‰· ÙˆÓ ·ÛıÂÓÒÓ Ô˘ Âı·›ÓÔ˘Ó Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜, ı¤Ì· Ô˘ ›Û˘ ‰ÂÓ ·Ó·Ù‡ÛÛÂÙ·È Ô‡Ù ÛÙËÓ ÂȉÈ΋ Âη›‰Â˘ÛË ÙˆÓ ·È‰È¿ÙÚˆÓ. ŒÙÛÈ, ‰ÂÓ Î·ÏÏÈÂÚÁÂ›Ù·È ÌÈ· ÔÏÔÎÏËڈ̤ÓË È·ÙÚÈ΋ Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ ÚÔÛ¤ÁÁÈÛË, ÁÂÁÔÓfi˜ Ô˘ ηıÚÂÊÙ›˙ÂÙ·È Î·È ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË: ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÁÈ·ÙÚÔ› ‰ÂÓ ÌfiÚÂÛ·Ó Ó· Û˘Ó‰˘¿ÛÔ˘Ó ÙËÓ È·ÙÚÈ΋ Î·È „˘¯ÔÎÔÈÓˆÓÈ΋ ‰È¿ÛÙ·ÛË ÛÙÔ˘˜ ÔÚÈÛÌÔ‡˜ Ô˘ ¤‰ˆÛ·Ó ÁÈ· ÙËÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰·. ∞Ó ‰ÂÓ ÂÓۈ̷وı› Ë ÊÈÏÔÛÔÊ›· Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ È·ÙÚÈ΋ Âη›‰Â˘ÛË, Ë
ÚÔÛ¤ÁÁÈÛË ÙˆÓ ÁÈ·ÙÚÒÓ ÛÙ· ·È‰È¿ Ô˘ Âı·›ÓÔ˘Ó ı· ·Ú·Ì›ÓÂÈ ‚ÈÔ˚·ÙÚÈο ÚÔÛ·Ó·ÙÔÏÈṲ̂ÓË Î·È ı· ÂÚÈÔÚ›˙ÂÙ·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙˆÓ ÛˆÌ·ÙÈÎÒÓ Û˘Ìو̿وÓ. ∞Ó·ÁÓˆÚ›˙ÔÓÙ·˜ ÙËÓ ·Ó¿ÁÎË Âη›‰Â˘Û˘ ÙˆÓ Â·ÁÁÂÏÌ·ÙÈÒÓ ˘Á›·˜, ÂȉÈο ÂÁ¯ÂÈÚ›‰È· Î·È ÂÎ·È‰Â˘ÙÈο ÚÔÁÚ¿ÌÌ·Ù· Û ÚÔÙ˘¯È·Îfi Î·È ÌÂÙ·Ù˘¯È·Îfi Â›Â‰Ô ¤¯Ô˘Ó ·Ú¯›ÛÂÈ Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ‰ÈÂıÓÒ˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· (6-7,30-32). ™ÙË ¯ÒÚ· Ì·˜, ‰ÈÂÈÛÙËÌÔÓÈο ÚÔÁÚ¿ÌÌ·Ù· ηٿÚÙÈÛ˘ Û¯ÂÙÈο Ì ÙË ÊÚÔÓÙ›‰· ÙÔ˘ ¿ÚÚˆÛÙÔ˘ ·È‰ÈÔ‡ ηıÒ˜ Î·È ÙÔ˘ ·È‰ÈÔ‡ Ô˘ ÂÓı›, ÚÔÛʤÚÔÓÙ·È ·fi ÙÔ 1996 ·fi ÙË “ª¤ÚÈÌÓ·”, ÌÈ· ÂÈÛÙËÌÔÓÈ΋, ÌË ÎÂÚ‰ÔÛÎÔÈ΋ ÂÙ·ÈÚ›· ÁÈ· ÙË ÊÚÔÓÙ›‰· ·È‰ÈÒÓ Î·È ÔÈÎÔÁÂÓÂÈÒÓ ÛÙËÓ ·ÚÚÒÛÙÈ· Î·È ÙÔÓ ı¿Ó·ÙÔ (33). ¢˘ÛÙ˘¯Ò˜ fï˜, Ë ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·Ù¿ÚÙÈÛ˘ ·fi ·È‰È¿ÙÚÔ˘˜ Â›Ó·È Ôχ ÂÚÈÔÚÈṲ̂ÓË Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÓÔÛËÏÂ˘Ù¤˜, „˘¯ÔÏfiÁÔ˘˜ Î·È ÎÔÈÓˆÓÈÎÔ‡˜ ÏÂÈÙÔ˘ÚÁÔ‡˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó. °È· Ó· ·Ó·Ù˘¯ı› Ë ·Ó·ÎÔ˘ÊÈÛÙÈ΋ ÊÚÔÓÙ›‰· ¯ÚÂÈ¿˙ÂÙ·È ÎÔÈÓ‹ ÊÈÏÔÛÔÊ›· ¿Ú·, ‚·ÛÈ΋ Âη›‰Â˘ÛË ·ÏÏ¿ Î·È Û˘Ó¯È˙fiÌÂÓË Î·Ù¿ÚÙÈÛË, ηıÒ˜ Î·È ÛÙ‹ÚÈÍË ÙÔ˘ ÚÔÛˆÈÎÔ‡ Ô˘ ·Ó·Ï·Ì‚¿ÓÂÈ ·˘Ùfi ÙÔ ‰‡ÛÎÔÏÔ ¤ÚÁÔ, ·Ú¿ÏÏËÏ· Ì ÙËÓ ·Ó¿Ù˘ÍË Î·Ù¿ÏÏËÏˆÓ ‰ÔÌÒÓ Î·È ˘ËÚÂÛÈÒÓ Ô˘ Ó· ·ÓÙ·ÔÎÚ›ÓÔÓÙ·È ÛÙȘ ÔχÏ¢Ú˜ ·Ó¿ÁΘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ‚ÈÒÓÔ˘Ó ÌÈ· ·ÂÈÏËÙÈ΋ ·ÚÚÒÛÙÈ· Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜. ∏ ¢·ÈÛıËÙÔÔ›ËÛË Î·È Û˘ÛÙËÌ·ÙÈ΋ Âη›‰Â˘ÛË ÙˆÓ ÁÈ·ÙÚÒÓ ÛÙȘ ıÂÌÂÏÈÒ‰ÂȘ ·Ú¯¤˜ Ù˘ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ Ú¤ÂÈ Ó· ·ÔÙÂϤÛÂÈ ¤Ó· ·fi Ù· ÚÒÙ· ‚‹Ì·Ù· ÙÔ˘ ۯ‰ȷÛÌÔ‡ Î·È Ù˘ ÂÊ·ÚÌÔÁ‹˜ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·Ó·ÎÔ˘ÊÈÛÙÈ΋˜ ÊÚÔÓÙ›‰·˜ Î·È ÛÙË ¯ÒÚ· Ì·˜, Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÔÈfiÙËÙ·˜ ˙ˆ‹˜ ÙˆÓ ÛÔ‚·Ú¿ ¿ÚÚˆÛÙˆÓ ·È‰ÈÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜.
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19. ªÂÏÏ¿ÏË £¿ÏÂÈ·. √ ıÚ‹ÓÔ˜ ÙˆÓ ÁÔÓÈÒÓ ÌÂÙ¿ ÙË ‰ˆÚ¿ ÔÚÁ¿ÓˆÓ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘˜. [‰È‰·ÎÙÔÚÈ΋ ‰È·ÙÚÈ‚‹]. ∞ı‹Ó·: ∆Ì‹Ì· ¡ÔÛËÏ¢ÙÈ΋˜ ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ; 2004. 20. McClowry SG, Davies EB, May KA, Kulenkamp EJ, Martinson I M. The empty space phenomenon: The process of grief in the bereaved family. Death Studies 1987;11:361-374. 21. Mulhern RK, Lauer ME, Hoffman RG. Death of a child at home or in hospital: subsequent psychological adjustment of the family. Pediatrics 1983;71:743-747. 22. Sourkes B. The broken heart: Anticipatory grief in the child facing death. J Palliat Care 1996;12:56-59. 23. Stevens MM. Psychological adaptation of the dying child. In: Doyle D, Hanks GWC, MacDonald N. editors. Oxford Textbook of Palliative Medicine. 2nd ed. Oxford: Oxford University Press; 1998. p. 1045-1055. 24. Association for Children with Life Threatening or Terminal Conditions and Their Families. The ACT Charter for children with life-threatening conditions and their families. 2nd ed. Bristol: ACT; 1995. 25. Masri C, Farrell CA, Lacroix J, Rocker G, Shemie SD. Decision making and end-of-life care in critically ill children. J Palliat Care 2001;(16 Suppl): S45-S52. 26. Levetown M. Ethical aspects of pediatric palliative care. J Palliat Care 1996;12:35-39. 27. Cummings I. The interdisciplinary team. In: Doyle D, Hanks GWC, MacDonald N, editors. Oxford Textbook of Palliative Medicine. 2nd ed. Oxford: Oxford University Press; 1998. p. 19-30. 28. Khaneja S, Milrod B. Educational needs among pediatricians regarding caring for terminally ill children. Arch Pediatr Adolesc Med 1998;152:909-914. 29. Hilden J, Emanuel E, Fairclough D, Link M, Foley K, Clarridge B, et al. Attitudes and practices among pediatric oncologists regarding end-of-life care: results of the 1998 American Society of Clinical Oncology Survey. J Clin Oncol, 2001;19:205-212. 30. Sahler OJ, Frager J, Levetown M, Cohn F, Lipson M. Medical education about end-of-life care in the pediatric setting: principles, challenges and opportunities. Pediatrics 2000;105:575-584. 31. Charlton R. Medical education--addressing the needs of the dying child. Palliat Med 1996;10:240-246. 32. Papadatou D, Corr C, Frager G, Bouri M. Education and training curriculum for pediatric palliative care. Alexandria, VA: National Hospice and Palliative Care Organization; 2003. 33. ª¤ÚÈÌÓ· - ∂Ù·ÈÚ›· ÁÈ· ÙË ºÚÔÓÙ›‰· ¶·È‰ÈÒÓ Î·È √ÈÎÔÁÂÓÂÈÒÓ ÛÙËÓ ∞ÚÚÒÛÙÈ· Î·È ÙÔ £¿Ó·ÙÔ. http://www.merimna.org.gr
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¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË: ‰È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙÚfiÔÈ ÚÔÛ¤Ï΢Û˘ ∂. ª·ıÚ¤ÏÏÔ˘, ª. °È·ÓÓ·ÎÔ‡ÏÈ·, ¡. µÔ˘Ù˙Ô˘Ú¿Î˘, ¶. ∑‹Û˘, ∞.§. ª·Ù¿Ï·, §.™. ™˘ÓÙÒÛ˘
¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ó· ·Ó·Ï‡ÛÂÈ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Ô˘ ÚÔ-
‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË ˆ˜ ÚÔ˜ ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó Î·È Ù· ‰È·ÙÚÔÊÈο ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈο. ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ: ∫·Ù·ÁÚ¿ÊËÎ·Ó Û˘ÓÔÏÈο 968 ‰È·ÊËÌ›ÛÂȘ, Ô˘ ÚÔ‚Ï‹ıËÎ·Ó Û 51 ÒÚ˜ ·È‰È΋˜ ÙËÏÂÔÙÈ΋˜ ˙ÒÓ˘ 2 Û˘Ó¯fiÌÂÓˆÓ ™·‚‚·ÙÔ·ÚȷΈÓ, Î·È ·Ó·Ï‡ıËÎ·Ó ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ ÙÔ˘ ‰È·ÊËÌÈ˙fiÌÂÓÔ˘ ÚÔ˚fiÓÙÔ˜, ÙËÓ Î·ÙËÁÔÚ›· ÙÚÔʛ̈Ó, ηıÒ˜ Î·È ˆ˜ ÚÔ˜ Ù· Ù¯ÓÈο, ÛÎËÓÔıÂÙÈο Î·È ÛÂÓ·Úȷο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘˜. ∞ÔÙÂϤÛÌ·Ù·: ∆Ô 53,7% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó Û ÙÚfiÊÈÌ·. √È ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‚Ú¤ıËΠӷ ¯ÚËÛÈÌÔÔÈÔ‡Ó Û ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi, Û ۯ¤ÛË Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó, ÛÙÔȯ›· Ô˘ ÙȘ ηıÈÛÙÔ‡Ó ÂÏ΢ÛÙÈΤ˜ ÛÙ· ·È‰È¿, fiˆ˜ ÂÚÈÛÛfiÙÂÚ· ηڤ ·Ó¿ ‰È·Ê‹ÌÈÛË (13,1±6,6 ¤Ó·ÓÙÈ 12±7,65, p=0,008), ÁÚËÁÔÚfiÙÂÚË ÂÓ·ÏÏ·Á‹ ÂÈÎfiÓˆÓ (0,67± 0,28 ηڤ/sec ¤Ó·ÓÙÈ 0,64± 0,29 ηڤ/sec, p=0,10), ¯·Ú·ÎÙ‹Ú˜ ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ (66,7% ¤Ó·ÓÙÈ 13,2%, ¯2=232,5, p<0,001) Î·È ıÂÌ·ÙÔÏÔÁ›· ·fi Ù· ÂӉȷʤÚÔÓÙ· ÙˆÓ ·È‰ÈÒÓ. √ ÈÔ ‰ËÌÔÊÈÏ‹˜ ÙÚfiÔ˜ ÚÔÒıËÛ˘ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ‹Ù·Ó Ë ÚÔ‚ÔÏ‹ ÙˆÓ ÔÚÁ·ÓÔÏËÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ (68,3%), Î·È ·ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÈÛ¯˘ÚÈÛÌÔ› ÁÈ· ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË (46,9%) Î·È Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ (40,6%). ∞Ó¿Ï˘ÛË ÙÔ˘ ›‰Ô˘˜ ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔÊ›ÌˆÓ ·Ó¤‰ÂÈÍ ٷ Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· ˆ˜ Ù· ÈÔ Û˘¯Ó¿ ‰È·ÊËÌÈ˙fiÌÂÓ· (31,7%). ∞ÎÔÏÔ˘ıÔ‡Û·Ó Ù· ˙·¯·ÚˆÙ¿ ÁÏ˘Î›ÛÌ·Ù· (21%) Î·È Ù· ÛÔÎÔÏ·ÙÔÂȉ‹ ÚÔ˚fiÓÙ· (11,5%). ∞fi ÙËÓ ·Ó¿Ï˘ÛË Ù˘ ‰È·ÙÚÔÊÈ΋˜ ÙÔ˘˜ ÔÈfiÙËÙ·˜ Ê¿ÓËΠˆ˜ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÚfiÎÂÈÙ·È ÁÈ· ÙÚfiÊÈÌ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˙¿¯·ÚË Î·È Ï›Ô˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·ÚÔ‡Û· ÌÂϤÙË Â›Ó·È Ë ÚÒÙË ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ηٷÁÚ¿ÊÂÈ ÛÙÔȯ›· ÁÈ· ÙÔ Â›‰Ô˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË. ¶ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ë Â›‰Ú·ÛË ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÛÙȘ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ ÙˆÓ ·È‰ÈÒÓ.
∂ÚÁ·ÛÙ‹ÚÈÔ ¢È·ÙÚÔÊ‹˜ Î·È ∫ÏÈÓÈ΋˜ ¢È·ÈÙÔÏÔÁ›·˜, ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜ – ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó·, ∂ÏÏ¿‰· AÏÏËÏÔÁÚ·Ê›·: §¿ÌÚÔ˜ ™˘ÓÙÒÛ˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ¢È·ÙÚÔÊ‹˜ Î·È ∫ÏÈÓÈ΋˜ ¢È·ÈÙÔÏÔÁ›·˜ ∆Ì‹Ì· ∂ÈÛÙ‹Ì˘ ¢È·ÈÙÔÏÔÁ›·˜-¢È·ÙÚÔÊ‹˜ ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ ∂Ï. µÂÓÈ˙¤ÏÔ˘ 70, ∆.∫. 176 71 ∞ı‹Ó· E-mail: lsidossis@hua.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 01-04-2005 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 10-02-2006
§¤ÍÂȘ ÎÏÂȉȿ: ¢È·ÊËÌ›ÛÂȘ, ÙÚfiÊÈÌ·, Ì¿ÚÎÂÙÈÓÁÎ, ‰È·ÙÚÔÊ‹, ·È‰È¿.
Food advertisements targeted at children: nutritional information and appeals E. Bathrellou, M. Yannakoulia, N. Voutzourakis, P. Zisis, A.L. Matalas, L.S. Sidossis
Abstract Background: The aim of the present study was to perform a content and appeal techniques’ analysis of
the television food advertisements targeted at children. Methods: Nine hundred sixty eight advertisements were recorded during 51 hours of children’s
program on 2 consecutive weekends. Data on the type of the advertisement, the food category and appeals in the format and the scenario of the advertisements were collected. Results: More than half (53.7%) of all advertisements were about food. Food advertisements were more likely than non-food advertisements to use techniques, which make them appealing to kids, such as more shots per ad (13.1±6.6 vs. 12±7.65, p=0.018), faster pace (0.67± 0.28 shots/sec vs. 0.64± 0.29 shots/sec, p=0.10), use of cartoon characters (66.7% vs. 13.2%, ¯2=232.5, p<0.001) and scenario inspired from children’s every day life. The most popular appeal method for food advertisements was promotion of the physical properties of the product (68.3%), followed by appeals for mood alteration (46.9%) and premium offers (40.6%). Analysis of the food categories advertised showed that almost one
Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University, Athens, Greece Correspondence: Labros S. Sidossis Laboratory of Nutrition and Clinical Dietetics, Department of Nutrition and Dietetics, Harokopio University 70, El. Venizelou Str. 176 71 Athens, Greece E-mail: lsidossis@hua.gr Date of submission: 01-04-2005 Date of approval: 10-02-2006
¶·È‰È·ÙÚÈ΋ 2006;69:127-133
Pediatr Mar-Apr 06
18-04-06
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∂. ª·ıÚ¤ÏÏÔ˘ Î·È Û˘Ó.
third (31.7%) of the food advertisements were for dairy products. Other most advertised food categories were confectionary snacks (21%) and chocolate products (11.5%). Nutritional value analysis revealed that the majority of the foods advertised were high in sugar and fat. Conclusions: The present study sets the framework for further thinking and research concerning the relationship of food advertisements and dietary habits in children.
Key words: Advertisements, food, marketing, nutrition, children.
∂ÈÛ·ÁˆÁ‹ √ ÚfiÏÔ˜ Ù˘ ÙËÏÂı¤·Û˘ ˆ˜ ·Ú¿ÁÔÓÙ· ÎÈÓ‰‡ÓÔ˘ ·¯˘Û·ÚΛ·˜ Î·È ˘ÈÔı¤ÙËÛ˘ ÌË ˘ÁÈÂÈÓÒÓ ‰È·ÙÚÔÊÈÎÒÓ ÂÈÏÔÁÒÓ ÛÙ· ·È‰È¿ ¤¯ÂÈ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÔÏÏÒÓ ÂÚ¢ÓËÙÈÎÒÓ ÌÂÏÂÙÒÓ. ∏ ÙËÏÂı¤·ÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ·¯˘Û·ÚΛ·˜ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (1-4), ÂËÚ¿˙ÔÓÙ·˜ fi¯È ÌfiÓÔ ÙȘ ‰È·ÈÙËÙÈΤ˜ Û˘Ó‹ıÂȘ, ·ÏÏ¿ Î·È ÙȘ Û˘Ó‹ıÂȘ Ê˘ÛÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜. ø˜ ÚÔ˜ ÙËÓ ÚÒÙË ·Ú¿ÌÂÙÚÔ, Ë ÙËÏÂı¤·ÛË ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› ÙfiÛÔ Ì ·˘ÍË̤ÓË ÂÓÂÚÁÂȷ΋ ÚfiÛÏË„Ë (4,5), fiÛÔ Î·È Î·Ù·Ó¿ÏˆÛË, ÚÔÙ›ÌËÛË ‹ ·fiÚÚÈ„Ë Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ (6-9). ŒÓ·˜ ·fi ÙÔ˘˜ ÈÛ¯˘ÚfiÙÂÚÔ˘˜ ÙÚfiÔ˘˜ ÂÈÚÚÔ‹˜ Ù˘ ÙËÏÂı¤·Û˘ ÛÙȘ ÙÚÔÊÈΤ˜ ÂÈÏÔÁ¤˜ ÙˆÓ ·È‰ÈÒÓ ıˆÚÂ›Ù·È Ë ‰È·Ê‹ÌÈÛË. ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ·ÔÙÂÏÔ‡Ó ÁÈ· ÙË ‚ÈÔÌ˯·Ó›· ÙÚÔÊ›ÌˆÓ ÌÈ· ÛËÌ·ÓÙÈ΋ ÔÌ¿‰·-ÛÙfi¯Ô, ÂÍ·ÈÙ›·˜ Ù˘ ÂÈÚÚÔ‹˜ Ô˘ ·ÛÎÔ‡Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, Ù˘ ·ÁÔÚ·ÛÙÈ΋˜ ÙÔ˘˜ ‰‡Ó·Ì˘ Î·È Ù˘ ÌÂÏÏÔÓÙÈ΋˜ ÙÔ˘˜ ȉÈfiÙËÙ·˜ ˆ˜ ηٷӷψ٤˜ (10). ªÂϤÙ˜ ÛÙÔ ı¤Ì· Ù˘ ›‰Ú·Û˘ Ù˘ ‰È·Ê‹ÌÈÛ˘ ÛÙËÓ Â·ÎfiÏÔ˘ıË Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ¤ÎıÂÛË Û ÌÈ· ‰È·Ê‹ÌÈÛË ÙÚÔÊ›ÌÔ˘ ·˘Í¿ÓÂÈ ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘ (11-13) Î·È ÙÔ ·›ÙËÌ· ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ ÁÈ· ·ÁÔÚ¿ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ (14,15). ∆Ô ÛËÌ·ÓÙÈÎfi ÂÚÒÙËÌ· Ô˘ ÚÔ·ÙÂÈ Û¯ÂÙÈο Ì ÙË ‰È·ÙÚÔÊ‹ ·ÊÔÚ¿ ÛÙËÓ ÔÈfiÙËÙ· ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÚÔ˚fiÓÙˆÓ. ŒÚ¢Ó˜ Û¯ÂÙÈο Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÛÙËÓ ·È‰È΋ ˙ÒÓË Î·Ù·Ï‹ÁÔ˘Ó ˆ˜ ·˘Ù¿ Â›Ó·È Î˘Ú›ˆ˜ ÚÔ˚fiÓÙ· ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ˙¿¯·ÚË Î·È ÏÈ›‰È· Î·È ‰ÂÓ ÏËÚÔ‡Ó ÙȘ ÚÔ¸Ôı¤ÛÂȘ ÁÈ· ˘ÁÈÂÈÓ‹ ‰È·ÙÚÔÊ‹ (16-20). ∂ӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó, ›Û˘, Ù· ÁÂÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ·Â˘ı‡ÓÔÓÙ·È ÛÙ· ·È‰È¿ (‰È¿ÚÎÂÈ·, Û˘¯ÓfiÙËÙ·, ̤ıÔ‰ÔÈ ÚÔÛ¤Ï΢Û˘). ∆Ô ÔÛÔÛÙfi ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·È‰È΋˜ ˙ÒÓ˘ Â›Ó·È Î·Ù¿ ̤ÛÔÓ ¶·È‰È·ÙÚÈ΋ 2006;69:127-133
fiÚÔ 57% (‡ÚÔ˜ 35%-71%) (7) Î·È Ê·›ÓÂÙ·È Ó· ÚÔ‚¿ÏÏÔ˘Ó ÂÚÈÛÛfiÙÂÚÔ ÙË ‰È·ÛΤ‰·ÛË Û ۯ¤ÛË Ì ÙÔ ÚÔ˚fiÓ, ·Ú¿ ÙË ıÚÂÙÈ΋ ÙÔ˘ ·Í›· (11,18). ™ÙËÓ ∂ÏÏ¿‰· Ì›· ÌfiÓÔ ÌÂϤÙË ¤¯ÂÈ ‰ÈÂÚ¢ӋÛÂÈ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÛÙËÓ ·È‰È΋ ˙ÒÓË, ÛÙÔ Ï·›ÛÈÔ ÌÈ·˜ ‰È·ÎÚ·ÙÈ΋˜ ¤Ú¢ӷ˜ Ô˘ ÂÚÈÏ¿Ì‚·Ó ‰¤Î· Â˘Úˆ·˚Τ˜ ¯ÒÚ˜, ÙËÓ ∞˘ÛÙÚ·Ï›· Î·È ÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ (21). ™ÙË ÌÂϤÙË ·˘Ù‹, ηٷÁÚ¿ÊËÎ·Ó 22,5 ÒÚ˜ ·È‰È΋˜ ˙ÒÓ˘ ™·‚‚·ÙÔ·ÚÈ·ÎÔ˘ ·fi ¤Ó· ȉȈÙÈÎfi ηӿÏÈ. ∆Ô 60% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·, Î·È ·fi ·˘Ù¤˜ ۯ‰fiÓ ÔÈ ÌÈÛ¤˜ (45,7%) ‹Ù·Ó ÁÈ· ÁÏ˘Î›ÛÌ·Ù·, ‰›ÓÔÓÙ·˜ ÛÙË ¯ÒÚ· Ì·˜ ÙËÓ ÚÒÙË ı¤ÛË ÌÂٷ͇ ÙˆÓ ˘ÔÏÔ›ˆÓ ¯ˆÚÒÓ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ·˘ÙÒÓ ÙˆÓ ÚÔ˚fiÓÙˆÓ. øÛÙfiÛÔ, ‰ÂÓ Û˘ÏϤ¯ıËÎ·Ó ÛÙÔȯ›· ÁÈ· ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÔÈ ‰È·ÊËÌ›ÛÂȘ. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ‹Ù·Ó Ó· ·Ó·Ï‡ÛÂÈ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ˙ÒÓ˘ ˆ˜ ÚÔ˜ ÙÔ Â›‰Ô˜ ÙˆÓ ÙÚÔʛ̈Ó, ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó, ÙfiÛÔ ÛÂ Â›Â‰Ô ıÂÌ·ÙÔÏÔÁ›·˜ Î·È ÛÎËÓÔıÂÛ›·˜ fiÛÔ Î·È ÛÂ Â›Â‰Ô Ù¯ÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ‰È·Ê‹ÌÈÛ˘, Î·È Ó· Ù· Û˘ÁÎÚ›ÓÂÈ Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó.
ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ∫·Ù·ÁÚ·Ê‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ √È ‰È·ÊËÌ›ÛÂȘ Ù˘ ·È‰È΋˜ ˙ÒÓ˘ ÙÚÈÒÓ (3) ÂÏÏËÓÈÎÒÓ È‰ÈˆÙÈÎÒÓ Î·Ó·ÏÈÒÓ Î·È ÂÓfi˜ (1) ÎÚ·ÙÈÎÔ‡ ηٷÁÚ¿ÊËÎ·Ó Û ‚ÈÓÙÂÔηۤÙ˜ ÁÈ· 2 Û˘Ó¯fiÌÂÓ· ™·‚‚·ÙÔ·Úȷη ÙÔÓ ∞Ú›ÏÈÔ ÙÔ˘ 2002. ∆Ô ™·‚‚·ÙÔ·ÚÈ·ÎÔ ÂÈϤ¯ıËÎÂ, ‰ÈfiÙÈ ıˆÚÂ›Ù·È ÂÚ›Ô‰Ô˜ ˘„ËÏ‹˜ ÙËÏÂı¤·Û˘ ÁÈ· Ù· ·È‰È¿. ∏ ‰È¿ÚÎÂÈ· Ù˘ ·È‰È΋˜ ˙ÒÓ˘ ‹Ù·Ó ·fi 2,5 ¤ˆ˜ 5,5 ÒÚ˜, ·Ó¿ÏÔÁ· Ì ÙÔ Î·Ó¿ÏÈ. ∫·ÙËÁÔÚÈÔÔ›ËÛË ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Î·È ·Ó¿Ï˘ÛË ÂÚȯÔ̤ÓÔ˘ °È· οı ‰È·Ê‹ÌÈÛË Ô˘ ÚÔ‚Ï‹ıËÎÂ Û˘ÏϤ¯ıËÎ·Ó Î·È Î·Ù·ÁÚ¿ÊËÎ·Ó Ù· ·Ú·Î¿Ùˆ ÛÙÔȯ›·:
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129
¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË
1. ∆‡Ô˜ Ù˘ ‰È·Ê‹ÌÈÛ˘. ∂ÍÂÙ¿ÛÙËΠ·Ó Ë ‰È·Ê‹ÌÈÛË ·ÊÔÚÔ‡Û ÙÚfiÊÈÌÔ ‹ ÌË ÙÚfiÊÈÌÔ. 2. ∂›‰Ô˜ ÙÚÔÊ›ÌÔ˘. ∫·Ù·ÁÚ¿ÊËÎÂ Ë Î·ÙËÁÔÚ›· ÛÙËÓ ÔÔ›· ·Ó‹Î ÙÔ ÙÚfiÊÈÌÔ [Á·Ï·ÎÙÔÎÔÌÈο (Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, ·ÁˆÙfi), ÛÔÎÔÏ¿Ù· Î·È ÛÔÎÔÏ·ÙÔÁÎÔÊÚ¤Ù˜, ¯˘ÌÔ› Î·È ·Ó·„˘ÎÙÈο, ÛÓ·Î Ù‡Ô˘ Á·Úȉ¿ÎÈ·, ÙÛ›¯Ï˜ Î·È ˙·¯·ÚˆÙ¿, ‰ËÌËÙÚȷο ÚˆÈÓÔ‡, ·ÚÙÔÔÈ‹Ì·Ù· Î·È ÎÚÔ˘·Û¿Ó, ¤ÙÔÈÌÔ Î·È ÁÚ‹ÁÔÚÔ Ê·ÁËÙfi (Ê·ÛÙ ÊÔ˘ÓÙ), ¿ÏÏÔ Â›‰Ô˜]. 3. ¢È·ÙÚÔÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ ÙÚÔÊ›ÌÔ˘. ∂ÍÂÙ¿ÛÙËÎÂ Â¿Ó ÙÔ ÙÚfiÊÈÌÔ: ·) ‹Ù·Ó light (ÂÚÈ›¯Â ηٿ 30% ÏÈÁfiÙÂÚ˜ ıÂÚÌ›‰Â˜ Û ۯ¤ÛË Ì ÙÔ Û˘Ì‚·ÙÈÎfi ÙÚfiÊÈÌÔ), ‚) Ì ˘„ËÏfi ÔÛÔÛÙfi ÏÈȉ›ˆÓ (ÂÚÈ›¯Â ÂÚÈÛÛfiÙÂÚÔ ·fi 30 ÁÚ. Ï›Ô˘˜/100 ÁÚ. ÙÚÔÊ›ÌÔ˘), Á) Ì ÚfiÛıÂÙË ˙¿¯·ÚË Î·È ‰) ÂÌÏÔ˘ÙÈṲ̂ÓÔ, fiˆ˜ ÚԤ΢Ù ·fi ÙË ‰È·ÙÚÔÊÈ΋ Û‹Ì·ÓÛË ÙˆÓ ÚÔ˚fiÓÙˆÓ ‹ ÙÔ˘˜ ›Ó·Î˜ Û˘Óı¤Ûˆ˜ ÙÚÔʛ̈Ó. 4. ∆¯ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ‰È·Ê‹ÌÈÛ˘. ∂ÎÙÈÌ‹ıËÎ·Ó Ë Û˘¯ÓfiÙËÙ·, Ë ‰È¿ÚÎÂÈ·, Ù· Ï¿Ó· (ηڤ) Î·È Ô Ú˘ıÌfi˜ ÙˆÓ Ï¿ÓˆÓ (Ï¿Ó· ÚÔ˜ ÙË ‰È¿ÚÎÂÈ·) Ù˘ ‰È·Ê‹ÌÈÛ˘. ∆· ‰‡Ô ÙÂÏÂ˘Ù·›· ¯·Ú·ÎÙËÚÈÛÙÈο ·Ó·Ê¤ÚÔÓÙ·È ÛÙËÓ ÂÓ·ÏÏ·Á‹ Î·È ÙÔÓ Ú˘ıÌfi ÂÓ·ÏÏ·Á‹˜ ÙˆÓ ÂÈÎfiÓˆÓ, ‰ËÏ·‰‹ ÙˆÓ ÔÙÈÎÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ Ù˘ ‰È·Ê‹ÌÈÛ˘, Î·È ·ÔÙÂÏÔ‡Ó ·Ú·Ì¤ÙÚÔ˘˜ ÙÔ˘ ÁÂÓÈÎfiÙÂÚÔ˘ Ú˘ıÌÔ‡ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ (22). 5. ÷ڷÎÙ‹Ú˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È. ∂ÍÂÙ¿ÛÙËΠ·Ó ÔÈ ¯·Ú·ÎÙ‹Ú˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·Ó ‹Ù·Ó Ú·ÁÌ·ÙÈÎÔ› ‹ ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ·Ó ‹Ù·Ó ·È‰È¿ ‹ ÂÓ‹ÏÈΘ, ηıÒ˜ Î·È ÙÔ Ê‡ÏÔ ÙÔ˘˜. 6. £ÂÌ·ÙÔÏÔÁ›·. ∂ÎÙÈÌ‹ıËÎÂ Ô ÙÔ̤·˜ Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜, ·fi ÙÔÓ ÔÔ›Ô ÂÌÓ‡ÛÙËÎÂ Ë ‰È·Ê‹ÌÈÛË ‹ ÛÙÔÓ ÔÔ›Ô ·Ó·ÊÂÚfiÙ·Ó (ÁÈ· ·Ú¿‰ÂÈÁÌ· ÔÈÎÔÁÂÓÂÈ·Îfi, ·ÁÁÂÏÌ·ÙÈÎfi, Û¯ÔÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ, Ê›ÏÔÈ, ·ıÏËÙÈÛÌfi˜, ‡·ÈıÚÔ˜). 7. ª¤ıÔ‰ÔÈ ÚÔÒıËÛ˘. ∂ÍÂÙ¿ÛÙËΠ·Ó ÛÙË ‰È·Ê‹ÌÈÛË ÂÚȤ¯ÔÓÙ·Ó ÔÈ ·Ú·Î¿Ùˆ ̤ıÔ‰ÔÈ ÚÔÒıËÛ˘: ·) ™¯ÂÙÈΤ˜ Ì ÙÔ ÚÔ˚fiÓ (ÌfiÓÔ ÁÈ· ÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·): ·Ó·ÊÔÚ¿ ÛÙ· ÔÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο (.¯. Û¯‹Ì·, Á‡ÛË, ¯ÚÒÌ·, ̤ÁÂıÔ˜ Î.Ï.) ‹ ÛÙ· ıÚÂÙÈο Û˘ÛÙ·ÙÈο. ‚) ™¯ÂÙÈΤ˜ Ì ÔÈÎÔÓÔÌÈο ÔʤÏË: ·Ó·ÊÔÚ¿ Û ·ÛÊ¿ÏÂÈ· / ÂÁÁ‡ËÛË, ·Í›· ÙÔ˘ ÚÔ˚fiÓÙÔ˜, ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ Î·È Û˘ÌÌÂÙÔ¯‹ Û ‰È·ÁˆÓÈÛÌÔ‡˜ Ì ÙËÓ ·ÁÔÚ¿ ÙÔ˘ ÚÔ˚fiÓÙÔ˜. Á) ™¯ÂÙÈΤ˜ Ì ¿ÏÏ· ÔʤÏË Ô˘ ÂÈηÏ›ٷÈ: ÈÛ¯˘ÚÈÛÌÔ› fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ‚ÔËı¿ ÙÔÓ Î·Ù·Ó·ÏˆÙ‹ Ó·: i. Ù·˘ÙÈÛÙ› Ì ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÎÔÈÓˆÓÈÎfi Û‡ÓÔÏÔ, Ó· Á›ÓÂÈ ÈÔ ·Ô‰ÂÎÙfi˜ ‹ ›ÎÂÓÙÚÔ Ù˘ ·Ú¤·˜, ii. ‚ÂÏÙÈÒÛÂÈ ÙËÓ ˘Á›· ‹ ÙËÓ ÔÌÔÚÊÈ¿ ÙÔ˘, iii. ‚ÂÏÙÈÒÛÂÈ ÙË ‰È¿ıÂÛ‹ ÙÔ˘, Ó· ¿ÚÂÈ ÂÓ¤ÚÁÂÈ· Î·È ‰‡Ó·ÌË, Ó· ˙‹ÛÂÈ ÂÚȤÙÂÈ· Î·È ‰Ú¿ÛË, iv. Á›ÓÂÈ ÂÈÙ˘¯Ë̤ÓÔ˜ Î·È Ó· ·ÔÎÙ‹ÛÂÈ Î‡ÚÔ˜, Ó· ‚ÚÂÈ Ï‡ÛÂȘ Û ÚÔ‚Ï‹Ì·Ù·.
∞ÔÙÂϤÛÌ·Ù· ™˘ÓÔÏÈο ·ÍÈÔÏÔÁ‹ıËÎ·Ó 968 ‰È·ÊËÌ›ÛÂȘ, ÔÈ Ôԛ˜ ÚÔ‚Ï‹ıËÎ·Ó Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· 51
ˆÚÒÓ ·È‰È΋˜ ˙ÒÓ˘. ªÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ηٷÁÚ¿ÊËηÓ, 53,7% ·ÊÔÚÔ‡Û·Ó Û ÙÚfiÊÈÌ·. √ Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ‰È·ÊËÌ›ÛÂˆÓ ·Ó¿ ÒÚ· ‹Ù·Ó 10,2 ÁÈ· Ù· ÙÚfiÊÈÌ· Î·È 8,8 ÁÈ· Ù· ÌË ÙÚfiÊÈÌ·. ∞fi ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ‚Ú¤ıËΠfiÙÈ ‰ÂÓ ˘‹Ú¯Â ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔÊ›ÌˆÓ (20,2±7,4 sec Î·È 21,1±14,1 sec ·ÓÙ›ÛÙÔȯ·, p=0,268). ¶ÂÚ·ÈÙ¤Úˆ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ù¯ÓÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ¤‰ÂÈÍ fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Û ۇÁÎÚÈÛË Ì ÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ÂÚÈ›¯·Ó ÂÚÈÛÛfiÙÂÚ· ηڤ ·Ó¿ ‰È·Ê‹ÌÈÛË (13,3±6,5 ηڤ/‰È·Ê‹ÌÈÛË Î·È 12±7,7 ηڤ/‰È·Ê‹ÌÈÛË ·ÓÙÈÛÙÔ›¯ˆ˜, p=0,008) Î·È Â›¯·Ó ÌÂÁ·Ï‡ÙÂÚÔ Ú˘ıÌfi, fiˆ˜ ·ÍÈÔÏÔÁÂ›Ù·È ·fi ÙÔÓ ·ÚÈıÌfi ÙˆÓ Î·Ú¤ ·Ó¿ sec (0,67±0,28 ηڤ/sec Î·È 0,64±0,29 ηڤ/sec ·ÓÙ›ÛÙÔȯ·, p=0,10). ∞fi ÙËÓ ÂÂÍÂÚÁ·Û›· ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÙÔ˘ ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Ô˘ ·ÊÔÚÔ‡Û·Ó Ù· ÛÎËÓÔıÂÙÈο ÛÙÔȯ›· ÙˆÓ ‰È·ÊË̛ۈÓ, ‚Ú¤ıËÎÂ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ·˘ÙÒÓ Î·È ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ (ÙÚfiÊÈÌÔ - ÌË ÙÚfiÊÈÌÔ). ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, ÙÔ 66,7% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ¯·Ú·ÎÙ‹Ú˜ ÎÈÓÔ˘Ì¤ÓˆÓ Û¯Â‰›ˆÓ, ›Ù ·ÔÎÏÂÈÛÙÈο ›Ù ÛÂ Û˘Ó‰˘·ÛÌfi Ì ڷÁÌ·ÙÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜, ÂÓÒ ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ‹Ù·Ó 13,2% (x2=232,5, p<0,001). ™ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÂÌÊ·Ó›˙ÔÓÙ·Ó ·È‰È¿ Û ÔÛÔÛÙfi 83%, ÂÓÒ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ Û ÔÛÔÛÙfi 63% (x2=35,3, p<0,001). ∂›Û˘, ÙÔ 42,3% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÂÚÈ›¯·Ó ˙Ò· ÛÙÔ˘˜ ·ÚÔ˘ÛÈ·˙fiÌÂÓÔ˘˜ ¯·Ú·ÎÙ‹Ú˜ ÙÔ˘˜ Û ۇÁÎÚÈÛË Ì ÙÔ 13% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÌË ÙÚÔÊ›ÌˆÓ (x2=78,9, p<0,001). ™˘Û¯¤ÙÈÛË, ›Û˘, ‚Ú¤ıËΠÌÂٷ͇ ÙÔ˘ ›‰Ô˘˜ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ Î·È ÙÔ˘ ÙÚfiÔ˘ ÚÔÒıËÛ‹˜ ÙÔ˘ ÛÙÔ˘˜ Èı·ÓÔ‡˜ ·ÁÔÚ·ÛÙ¤˜. ªÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ ÔÈ ÙÚÂȘ ÈÔ Û˘¯Ó¿ ÂÌÊ·ÓÈ˙fiÌÂÓÔÈ ÙÚfiÔÈ ÚÔÒıËÛ˘ ‹Ù·Ó Ù· ÔÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο (68,3%), Ë ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË (46,9%) Î·È Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ (40,6%). ∞ÓÙ›ıÂÙ·, ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ÔÈ ‰ËÌÔÊÈϤÛÙÂÚÔÈ ÙÚfiÔÈ ÚÔÒıËÛ˘ ‹Ù·Ó Ë ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË (47,2%), Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ (38,9%) Î·È Ô ÈÛ¯˘ÚÈÛÌfi˜ fiÙÈ Ë Î·Ù·Ó¿ÏˆÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ı· ‚ÔËı‹ÛÂÈ ÙÔÓ ·ÁÔÚ·ÛÙ‹ Ó· ÂÈÙ‡¯ÂÈ Î¿ÔÈÔ ÛÎÔfi (38,7%). ™ÙÔÓ ¶›Ó·Î· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ ÌÂıfi‰ˆÓ ÚÔÒıËÛ˘ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔʛ̈Ó. ¶·È‰È·ÙÚÈ΋ 2006;69:127-133
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·130
130
∂. ª·ıÚ¤ÏÏÔ˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 1. ™˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ ÌÂıfi‰ˆÓ ÚÔÒıËÛ˘ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔʛ̈Ó
√ÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο £ÚÂÙÈο Û˘ÛÙ·ÙÈο πÛ¯˘ÚÈÛÌÔ› ∞ÛÊ¿ÏÂÈ·-ÂÁÁ‡ËÛË ¢ÒÚ· √ÈÎÔÓÔÌÈο ΛÓËÙÚ· ∫ÔÈÓˆÓÈ΋ ÚÔÛÊÔÚ¿ ¢È¿ıÂÛË ÀÁ›· √ÌÔÚÊÈ¿ ∂Ó¤ÚÁÂÈ· ¶ÂÚȤÙÂÈ· ∂ÈÙ˘¯›· §‡ÛÂȘ ¶·Ú¤·
¢È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó
¢È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó
68,6 19,7 27,7 8,5 40,6 0 3,8 46,9 21,7 0,4 21,9 12,1 14,0 1,2 22,8
2,5 0,9 28,5 7,2 38,9 14,4 15,7 47,2 13,5 17,5 13,3 8,6 38,7 12,8 30,4
∆Ô ÂÚÈ‚¿ÏÏÔÓ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠÂÚÈÛÛfiÙÂÚÔ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‹Ù·Ó ÙÔ “ÊÈÏÈÎfi” (30,6%), ÂÓÒ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ ÙÔ “ÔÈÎÔÁÂÓÂÈ·Îfi” (14,6%). ∞fi ÙËÓ ¿ÏÏË, ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÛÙȘ Ôԛ˜ ¯ÚËÛÈÌÔÔÈ‹ıËΠۯÔÏÈÎfi, ·ıÏËÙÈÎfi, ÊÈÏÈÎfi, ˘·›ıÚÈÔ Î·È Â͈Á‹ÈÓÔ ÂÚÈ‚¿ÏÏÔÓ, Ë ÏÂÈÔ„ËÊ›· ‹Ù·Ó ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ (71,7%, 73,1%, 80,7%, 84,5%, 90%, ·ÓÙÈÛÙÔ›¯ˆ˜). ∞ÓÙÈı¤Ùˆ˜, ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÔÈÎÔÁÂÓÂÈ·Îfi, ÂÚˆÙÈÎfi Î·È Â·ÁÁÂÏÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ‹Ù·Ó ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔÊ›ÌˆÓ (56,5%, 69,4%, 78,3%, ·ÓÙÈÛÙÔ›¯ˆ˜). ∆¤ÏÔ˜, ÙÔ 54,1% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÌË ÙÚÔʛ̈Ó
‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó Î·Ó¤Ó· ·fi Ù· ı¤Ì·Ù· Ô˘ ÂϤÁ¯ıËηÓ. ø˜ ÚÔ˜ Ù· ÂÈϤÔÓ ÛÂÓ·Úȷο ÛÙÔȯ›·, Ë Ê·ÓÙ·Û›· ÂÌÊ·Ó›ÛÙËΠÛÙÔ 57,9% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ ¯ÈÔ‡ÌÔÚ Û ÔÛÔÛÙfi 26,7%. ¶·ÚfiÏÔ Ô˘ Ë ‚›· ˘‹Ú¯Â ÌfiÓÔ ÛÙÔ 2,9% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔʛ̈Ó, ÂÓÙÔ‡ÙÔȘ, ÙÔ 68,2% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ÙË ¯ÚËÛÈÌÔÔ›ËÛ·Ó ‹Ù·Ó ‰È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó. ∆Ô ›‰ÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· Ù· ¿ÏÏ· ‰‡Ô ÛÂÓ·Úȷο ÛÙÔȯ›·, fiÔ˘ Ë ÏÂÈÔ„ËÊ›· ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ Ù· ¯ÚËÛÈÌÔÔ›ËÛ·Ó ·ÊÔÚÔ‡Ó ÙÚfiÊÈÌ· (70,2% ÁÈ· ÙÔ ¯ÈÔ‡ÌÔÚ, 82,2% ÁÈ· ÙË Ê·ÓÙ·Û›·). ∆Ô 70,8% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÌË ÙÚÔÊ›ÌˆÓ ‰ÂÓ ¯ÚËÛÈÌÔÔ›ËÛ·Ó Î·Ó¤Ó· ·fi ·˘Ù¿ Ù· ÛÙÔȯ›·.
°·Ï·ÎÙÔÎÔÌÈο
31,7
Ã˘ÌÔ›-∞Ó·„˘ÎÙÈο
5,8
™ÔÎÔÏ·ÙÔÂȉ‹
11,8
¶·Ù·Ù¿ÎÈ· & Û˘Ó·Ê‹
11
∆Û›¯Ï˜-∫·Ú·Ì¤Ï˜
21
∞ÚÙÔÔÈ‹Ì·Ù·-∫ÚÔ˘·Û¿Ó
4
¢ËÌËÙÚȷο ÚˆÈÓÔ‡
2,7
º·ÛÙ ÊÔ˘ÓÙ
6,7
ÕÏÏ·
5,6 0
5
10
15
20 ¶ÔÛÔÛÙfi (%)
25
30
35
∂ÈÎfiÓ· 1. ™˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙÚÔÊ›ÌˆÓ ÌÂٷ͇ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·. ¶·È‰È·ÙÚÈ΋ 2006;69:127-133
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·131
131
¢È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË
™ÙËÓ ∂ÈÎfiÓ· 1 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙÚÔÊ›ÌˆÓ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ·ÊÔÚÔ‡Û·Ó ÙÚfiÊÈÌ·. ∆· ·ÔÙÂϤÛÌ·Ù· ‰Â›¯ÓÔ˘Ó fiÙÈ Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ· ‹Ù·Ó Ù· ÈÔ Û˘¯Ó¿ ‰È·ÊËÌÈ˙fiÌÂÓ· ‰È·ÙÚÔÊÈο ÚÔ˚fiÓÙ·, ηχÙÔÓÙ·˜ ÙÔ 31,7% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔʛ̈Ó. ∞ÎÔÏÔ˘ıÔ‡Û·Ó ÔÈ ÙÛ›¯Ï˜ Î·È ÔÈ Î·Ú·Ì¤Ï˜ (21%), ÔÈ ÛÔÎÔÏ¿Ù˜ Î·È Ù· Û¯ÂÙÈο ÚÔ˚fiÓÙ· (11,5%), Î·È Ù· ·Ù·Ù¿ÎÈ· Î·È Ù· Û˘Ó·Ê‹ ÛÓ·Î (11%). ∞Ó¿Ï˘ÛË Ù˘ ‰È·ÙÚÔÊÈ΋˜ ÔÈfiÙËÙ·˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ‰È·ÊËÌ›˙ÔÓÙ·Ó ¤‰ÂÈÍ fiÙÈ 37,3% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó ÚÔ˚fiÓÙ· Ì ÔÛÔÛÙfi Ï›Ô˘˜ ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 30%. ∂›Û˘, 63,8% ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û·Ó ÚÔ˚fiÓÙ· Ì ÚfiÛıÂÙË ˙¿¯·ÚË, ÂÓÒ 10,4% ÙÚfiÊÈÌ·, ÛÙ· ÔÔ›· ¤¯ÂÈ Á›ÓÂÈ ÚÔÛı‹ÎË ‚ÈÙ·ÌÈÓÒÓ ‹/Î·È ·ÓfiÚÁ·ÓˆÓ ÛÙÔȯ›ˆÓ. ™Ù·ÙÈÛÙÈο ÛËÌ·ÓÙÈΤ˜ ‰È·ÊÔÚ¤˜ ·Ú·ÙËÚ‹ıËÎ·Ó Î·È ÛÙË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔʛ̈Ó. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ, Ë ·Ó¿Ï˘ÛË Ù˘ ‰È·Î‡Ì·ÓÛ˘ ¤‰ÂÈÍ fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ Ì ÙË ÌÈÎÚfiÙÂÚË ‰È¿ÚÎÂÈ· ‹Ù·Ó ÂΛӘ Ô˘ ·ÊÔÚÔ‡Û·Ó Ù· ˙·¯·ÚˆÙ¿ ÁÏ˘Î›ÛÌ·Ù· (14,8±5,5 sec), ÂÓÒ ·˘Ù¤˜ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‹Ù·Ó ÁÈ· Ù· ÚÔ˚fiÓÙ· Ù‡Ô˘ fast food (25,5±1 sec). ∏ ̤ÛË ‰È¿ÚÎÂÈ· ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ˙·¯·ÚˆÙÒÓ ÁÏ˘ÎÈÛÌ¿ÙˆÓ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÈÎÚfiÙÂÚË ·fi ·˘Ù‹ ÙˆÓ ÂÚÈÛÛfiÙÂÚˆÓ ¿ÏÏˆÓ Î·ÙËÁÔÚÈÒÓ, fiˆ˜ ÙˆÓ Á·Ï·ÎÙÔÎÔÌÈÎÒÓ ÚÔ˚fiÓÙˆÓ (21,4±7, sec, p<0,001), ÙˆÓ ¯˘ÌÒÓ Î·È ÙˆÓ ·Ó·„˘ÎÙÈÎÒÓ (22,3±4,6 sec, p<0,001), Ù˘ ÛÔÎÔÏ¿Ù·˜ Î·È ÙˆÓ Û˘Ó·ÊÒÓ ÚÔ˚fiÓÙˆÓ (21,7±6,6 sec, p<0,001), ÙˆÓ ÛÓ·Î Ù‡Ô˘ “·Ù·Ù¿ÎÈ·-Á·Úȉ¿ÎÈ·” (22,7±8,9 sec, p<0,001), ÙˆÓ ‰ËÌËÙÚÈ·ÎÒÓ ÚˆÈÓÔ‡ (21,4±4,4 sec, p<0,001) Î·È ÙˆÓ ÚÔ˚fiÓÙˆÓ Ù‡Ô˘ fast food (25,5±1 sec, p<0,016). ∆¤ÏÔ˜, Ô Ú˘ıÌfi˜ ÙˆÓ Ï¿ÓˆÓ (ηڤ/sec) ‰È¤ÊÂÚ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈο ÌÂٷ͇ ÙˆÓ ‰È·ÊfiÚˆÓ Î·ÙËÁÔÚÈÒÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ (F=21,132, p<0,001), Ì ‡ÚÔ˜ ÙÈÌÒÓ ·fi 0,42±0,15 ¤ˆ˜ 0,88±0,1 ηڤ/sec, fiÔ˘ Ë ÌÈÎÚfiÙÂÚË ÙÈÌ‹ ·ÓÙÈÛÙÔȯ› ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÁÈ· Ù· ·ÚÙÔÔÈ‹Ì·Ù· Î·È ÎÚÔ˘·Û¿Ó Î·È Ë ÌÂÁ·Ï‡ÙÂÚË ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÁÈ· Ù· ‰ËÌËÙÚȷο ÚˆÈÓÔ‡.
™˘˙‹ÙËÛË ∏ ·ÚÔ‡Û· ÌÂϤÙË Â›Ó·È Ë ÚÒÙË ÛÙËÓ ∂ÏÏ¿‰· Ô˘ ηٷÁÚ¿ÊÂÈ ÛÙÔȯ›· ÁÈ· ÙÔ Â›‰Ô˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÚÔÛ¤Ï΢Û˘ ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË. ™Â Û˘Ìʈӛ· Ì ٷ ·ÔÙÂϤ-
ÛÌ·Ù· ·ÓÙ›ÛÙÔȯˆÓ ÌÂÏÂÙÒÓ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (7,21), Ë ·ÚÔ‡Û· ÌÂϤÙË ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÛÙËÓ ÏÂÈÔ„ËÊ›· ÙÔ˘˜ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ Â›Ó·È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÌÈÛ¤˜ ‰È·ÊËÌ›ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È Û˘ÓÔÏÈο ÛÙËÓ ·È‰È΋ ˙ÒÓË. ∆· ÛÎËÓÔıÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Ô˘ ·Â˘ı‡ÓÔÓÙ·È ÛÙ· ·È‰È¿ ‹Ù·Ó Ù¤ÙÔÈ· Ô˘ Ó· ÙȘ ηıÈÛÙÔ‡Ó ÂÏ΢ÛÙÈΤ˜ Û ·˘Ù¿. √È ÌÈÛ¤˜ ÂÚ›Ô˘ ¯ÚËÛÈÌÔÔ›ËÛ·Ó ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ÙÚÂȘ ÊÔÚ¤˜ ÂÚÈÛÛfiÙÂÚÔ ·’ fi,ÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÌË ÙÚÔʛ̈Ó, Î·È ÂÚÈÛÛfiÙÂÚ˜ ·fi ÙȘ ÌÈÛ¤˜, Ê·ÓÙ·Û›·. ∆Ô ›‰ÈÔ Ê·›ÓÂÙ·È Ó· Â͢ËÚÂÙÔ‡Ó Ë Û˘ÌÌÂÙÔ¯‹ ·È‰ÈÒÓ Î·È Ë ¯Ú‹ÛË ˙ÒˆÓ ÛÙÔ˘˜ ·ÚÔ˘ÛÈ·˙fiÌÂÓÔ˘˜ ¯·Ú·ÎÙ‹Ú˜. ∞Ó¿Ï˘ÛË ‰È·ÊËÌ›ÛÂˆÓ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ ∞ÌÂÚÈ΋˜ Î·È ÙË ªÂÁ¿ÏË µÚÂÙ·Ó›· ¤‰ÂÈÍ fiÙÈ ÂȉÈο ÔÈ ¯·Ú·ÎÙ‹Ú˜ ˙ÒˆÓ ˆ˜ ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È· ÂÌÊ·Ó›˙ÔÓÙ·È Û¯Â‰fiÓ Û fiϘ ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ (19). Ÿˆ˜ Â›Ó·È ÏÔÁÈο ·Ó·ÌÂÓfiÌÂÓÔ, Ë ıÂÌ·ÙÔÏÔÁ›· ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ‚Ú¤ıËΠӷ ·ÓÙÏÂ›Ù·È ·fi ÙÔ Î·ıËÌÂÚÈÓfi ÂÚÈ‚¿ÏÏÔÓ Î·È Ù· ÂӉȷʤÚÔÓÙ· ÙˆÓ ·È‰ÈÒÓ, Ì ΢ڛ·Ú¯Ô ı¤Ì· ÙÔ˘˜ Ê›ÏÔ˘˜. ∫·È ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ηٷÁÚ¿ÊÔ˘Ó fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÛÙËÓ ·È‰È΋ ˙ÒÓË, Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙˆÓ ÌË ÙÚÔʛ̈Ó, ¯ÚËÛÈÌÔÔÈÔ‡Ó ÂÚÈÛÛfiÙÂÚÔ ÎÈÓÔ‡ÌÂÓ· Û¯¤‰È·, ÏÔ΋ ÈÛÙÔÚ›·˜ Î·È ¯ÈÔ‡ÌÔÚ (18), ·ÏÏ¿ Î·È ÌÔ˘ÛÈ΋ Î·È ÊÚ¿ÛÂȘ ˆ˜ ηٷÎÏ›‰· (19). ªÂٷ͇ ÙˆÓ ÙÚfiˆÓ Ô˘ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· Ó· ηٷÛÙÔ‡Ó ÈÔ ÂÓÙ˘ˆÛȷΤ˜ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÛÙ· ·È‰È¿, ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ‚›·. √È Rajecki Î·È Û˘ÓÂÚÁ¿Ù˜ (23) η٤ÁÚ·„·Ó ÙË ‚›· ˆ˜ Ôχ ‰ËÌÔÊÈÏ‹ ıÂÌ·ÙÔÏÔÁ›· ÙˆÓ ·È‰ÈÎÒÓ ‰È·ÊËÌ›ÛÂˆÓ (62%), οÙÈ Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË. ∏ ÌÂÁ¿ÏË ·˘Ù‹ ‰È·ÊÔÚ¿ ÌÔÚ› ›Ûˆ˜ Ó· ·Ô‰Ôı› Î·È ÛÙÔÓ ‰È·ÊÔÚÂÙÈÎfi ÔÚÈÛÌfi Ù˘ ‚›·˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ÌÂÏÂÙÒÓ. √È ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‚Ú¤ıËÎ·Ó Ó· ¤¯Ô˘Ó ÂÚÈÛÛfiÙÂÚ· ηڤ ·Ó¿ ‰È·Ê‹ÌÈÛË Û ۯ¤ÛË Ì ·˘Ù¤˜ ÙˆÓ ÌË ÙÚÔÊ›ÌˆÓ Î·È ÌÂÁ·Ï‡ÙÂÚÔ Ú˘ıÌfi Ï¿ÓˆÓ (ηڤ/sec). ∏ ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ ¤ÎıÂÛË ÛÙ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· ÙˆÓ Ì¤ÛˆÓ Ì·˙È΋˜ ÂÓË̤ڈÛ˘ Î·È ÙË ‰È¿ÚÎÂÈ· ÚÔÛÔ¯‹˜ ÙˆÓ ·È‰ÈÒÓ ·Ó·Ê¤ÚÂÈ fiÙÈ fiÛÔ ÈÔ ÁÚ‹ÁÔÚÔ˜ Ô Ú˘ıÌfi˜ ÂÓ·ÏÏ·Á‹˜ ÙˆÓ ÂÈÎfiÓˆÓ, ÙfiÛÔ ÈÔ Ôχ Ù· ·È‰È¿ ÚÔÛËÏÒÓÔÓÙ·È ÛÙÔ ÔÙÈÎfi ÂÚ¤ıÈÛÌ·, ÁÈ’ ·˘Ùfi Î·È ˘ÈÔıÂÙÂ›Ù·È ÂȉÈο ·fi Ù· ȉȈÙÈο ÙËÏÂÔÙÈο ÚÔÁÚ¿ÌÌ·Ù· (24). À¿Ú¯ÂÈ, fï˜, ¤Ó· ÛËÌÂ›Ô ¿Óˆ ·fi ÙÔ ÔÔ›Ô Ë ÚÔÛÔ¯‹ ÌÂÈÒÓÂÙ·È, ‰ÈfiÙÈ Ô Ú˘ıÌfi˜ ÚÔ‚ÔÏ‹˜ ÙÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ·fi ÙÔÓ Ú˘ıÌfi ÂÂÍÂÚÁ·Û›·˜ Ù˘ ÏËÚÔÊÔÚ›·˜ ¶·È‰È·ÙÚÈ΋ 2006;69:127-133
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·132
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∂. ª·ıÚ¤ÏÏÔ˘ Î·È Û˘Ó.
·fi ÙÔÓ ı·ً (25). ™Â ·˘Ùfi Û˘Ó˘ÔÏÔÁ›˙ÂÙ·È Î·È ÙÔ fiÙÈ ÌfiÏȘ ÛÙËÓ ËÏÈΛ· ÙˆÓ Ô¯ÙÒ ÂÙÒÓ, fiˆ˜ Ê·›ÓÂÙ·È ·fi ¤Ú¢Ó˜ Û¯ÂÙÈο Ì ÙË ÁÓˆÛȷ΋ ·Ó¿Ù˘ÍË, Ù· ·È‰È¿ ·ÓÙÈÏ·Ì‚¿ÓÔÓÙ·È ÙËÓ ÚfiıÂÛË ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ Ó· Ô˘Ï‹ÛÔ˘Ó ¤Ó· ÚÔ˚fiÓ, ÂÓÒ ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ ‰Ò‰Âη ÂÙÒÓ ‰ÂÓ ·Ó·Ì¤ÓÂÙ·È Ó· ÌÔÚÔ‡Ó ·˘ıfiÚÌËÙ·, ¯ˆÚ›˜ ‰ËÏ·‰‹ οÔÈ· Â͈ÙÂÚÈ΋ ÂÓ›Û¯˘ÛË, Ó· ·Ú¿ÁÔ˘Ó ÛΤ„ÂȘ Ô˘ ı· ·ÍÈÔÏÔÁÔ‡Ó ÂÔÈÎÔ‰ÔÌËÙÈο ÙȘ ‰È·ÊËÌ›ÛÂȘ (26). ∂ÈϤÔÓ, Ù· ·È‰È¿ ‰ÂÓ ÌÔÚÔ‡Ó ¿ÓÙ· Ó· ηٷÓÔ‹ÛÔ˘Ó Ù· Ù¯ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Î·È Ë ÚÔÛÔ¯‹ ÙÔ˘˜ ÛÙÔ ÏÂÎÙÈÎfi ÂÚȯfiÌÂÓÔ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ÌÔÚ› Ó· ·ÔÛ·Ûı› ·fi ·ÏÏ·Á¤˜ ÛÙ· ÔÙÈο ÂÚÂı›ÛÌ·Ù· (27). §·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„ÈÓ fiϘ ·˘Ù¤˜ ÙȘ ·Ú·ÙËÚ‹ÛÂȘ, ÌÔÚԇ̠ӷ Ô‰ËÁËıԇ̠ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ¯Ú‹ÛË ÂÚÈÛÛfiÙÂÚˆÓ Î·È ÁÚËÁÔÚfiÙÂÚˆÓ ÂÓ·ÏÏ·ÁÒÓ ÂÈÎfiÓˆÓ ÛÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÙȘ ηıÈÛÙÔ‡Ó ÈÔ ÂÏ΢ÛÙÈΤ˜ Î·È ›Ûˆ˜ ·ÔÚÔÛ·Ó·ÙÔÏÈÛÙÈΤ˜. ∆¯ÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, fiˆ˜ Ô ·ÚÈıÌfi˜ Î·È Ô Ú˘ıÌfi˜ ÙˆÓ Î·Ú¤, ‰ÂÓ ¤¯Ô˘Ó Í·Ó·ÌÂÏÂÙËı› ˆ˜ ÚÔ˜ ÙÔ Â¿Ó ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ‰È·ÊËÌ›ÛÂˆÓ ÙÚÔÊ›ÌˆÓ Î·È ÌË ÙÚÔÊ›ÌˆÓ Î·È Ë Âͤٷۋ ÙÔ˘˜ ·ÔÙÂÏ› ÚˆÙÔÙ˘›· Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. ™¯ÂÙÈο Ì ÙȘ ÌÂıfi‰Ô˘˜ ÚÔÒıËÛ˘, Ù· ·ÔÙÂϤÛÌ·Ù· Ù˘ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ ÔÈ ‰ËÌÔÊÈϤÛÙÂÚÔÈ ÙÚfiÔÈ ‹Ù·Ó Ë ·ÏÏ·Á‹ ÛÙË ‰È¿ıÂÛË Ô˘ ˘fiÛ¯ÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ ÚÔ˚fiÓÙÔ˜ Î·È Ë ÚÔÛÊÔÚ¿ ‰ÒÚˆÓ. °È· ÙȘ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ÂȉÈÎfiÙÂÚ·, Ô ÂÚÈÛÛfiÙÂÚÔ ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓÔ˜ ÙÚfiÔ˜ ÚÔÒıËÛ˘ ‹Ù·Ó Ë ÚÔ‚ÔÏ‹ ÙˆÓ ÔÚÁ·ÓÔÏËÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ÙÔ˘ ÙÚÔÊ›ÌÔ˘. ∞˘Ùfi Ê·›ÓÂÙ·È Ó· Û˘Ì‚·›ÓÂÈ, ‰ÈfiÙÈ Ù· ÔÚÁ·ÓÔÏËÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·ÊÔÚÔ‡Ó È‰ÈfiÙËÙ˜ ÙÔ˘ ÙÚÔÊ›ÌÔ˘ Ô˘ ÌÔÚÔ‡Ó Â‡ÎÔÏ· Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÛÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ̤ۈ ÂÈÎfiÓˆÓ. ªÂ ·˘Ùfi ÙÔÓ ÙÚfiÔ, fï˜, Ë ·Í›· Î·È ·Ô‰Ô¯‹ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ÂËÚ¿˙ÔÓÙ·È ÛËÌ·ÓÙÈο ·fi ÙȘ ÔÚÁ·ÓÔÏËÙÈΤ˜ ÙÔ˘ ȉÈfiÙËÙ˜, ·Ô‰˘Ó·ÌÒÓÔÓÙ·˜ ¤ÙÛÈ ÙË ıÚÂÙÈ΋ ·Í›· ÙÔ˘ ÙÚÔÊ›ÌÔ˘. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ‰È·ÊËÌ›ÛÂȘ ÙÚÔÊ›ÌˆÓ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ÔÈÎÔÓÔÌÈο ΛÓËÙÚ·. ∞˘Ùfi ›Ûˆ˜ ÔÊ›ÏÂÙ·È ÛÙËÓ ··ÁfiÚ¢ÛË Ô˘ ˘¿Ú¯ÂÈ ·fi ÙÔÓ ¢ÈÂıÓ‹ ∫Ò‰Èη ¢È·ÊËÌÈÛÙÈ΋˜ ¶Ú¿Í˘ Î·È ·ÊÔÚ¿ fiϘ ÙȘ ‰È·ÊËÌ›ÛÂȘ Ô˘ ·Â˘ı‡ÓÔÓÙ·È Û ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 14 ÂÙÒÓ, Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ÔÔ›Ô˘ ‰ÂÓ ı· Ú¤ÂÈ Ó· ·Ó·Ê¤ÚÂÙ·È Ë ÙÈÌ‹ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ‹ ÔÈÎÔÓÔÌÈÎÔ› ÈÛ¯˘ÚÈÛÌÔ› Ô˘ Ó· ‰ËÏÒÓÔ˘Ó fiÙÈ ÙÔ ÚÔ˚fiÓ ÌÔÚ› Ó· ·ÁÔÚ·ÛÙ› ·fi οı ÓÔÈÎÔ΢ÚÈfi (21). ŸÛÔÓ ·ÊÔÚ¿ ÛÙÔ Â›‰Ô˜ ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÙÚÔʛ̈Ó, Ù· ÂÚÈÛÛfiÙÂÚÔ ‰È·ÊËÌÈ˙fiÌÂÓ· ¶·È‰È·ÙÚÈ΋ 2006;69:127-133
ÚÔ˚fiÓÙ· ‹Ù·Ó Ù· Á·Ï·ÎÙÔÎÔÌÈο (¤Ó· ÙÚ›ÙÔ ÙˆÓ Û˘ÓÔÏÈο ‰È·ÊËÌÈ˙ÔÌ¤ÓˆÓ ÙÚÔʛ̈Ó) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÔÈ ÙÛ›¯Ï˜ Î·È Î·Ú·Ì¤Ï˜. ∆Ô Â‡ÚËÌ· ·˘Ùfi ¤Ú¯ÂÙ·È ·Ú¯ÈÎÒ˜ Û ·ÓÙ›ıÂÛË Ì ٷ ·ÔÙÂϤÛÌ·Ù· ·fi ÙË ÌÂϤÙË ÙÔ˘ ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ ¢ÈÂıÓ‹˜ ∫·Ù·Ó·ÏˆÙÒÓ (Consumers International) (21), fiÔ˘ ÙÔ ÚÒÙÔ ‰È·ÊËÌÈ˙fiÌÂÓÔ ÚÔ˚fiÓ ÛÙË ¯ÒÚ· Ì·˜ ‹Ù·Ó Ù· ÁÏ˘Î›ÛÌ·Ù·, ηχÙÔÓÙ·˜ ۯ‰fiÓ ÙȘ ÌÈÛ¤˜ ‰È·ÊËÌ›ÛÂȘ ÙÚÔʛ̈Ó. ø˜ ÁÏ˘Î›ÛÌ·Ù·, fï˜, ıˆÚÔ‡ÓÙ·Ó Ù· ÛÔÎÔÏ·ÙÔÂȉ‹ Î·È Ù· ˙·¯·ÚˆÙ¿. √fiÙÂ, ÙÔ ÔÛÔÛÙfi ·˘Ùfi Ú¤ÂÈ Ó· Û˘ÁÎÚÈı› Ì ÙÔ ¿ıÚÔÈÛÌ· Ù˘ ηÙËÁÔÚ›·˜ “ÙÛ›¯Ï˜-ηڷ̤Ϙ” Î·È Ù˘ ηÙËÁÔÚ›·˜ “ÛÔÎÔÏ¿Ù· Î·È ÛÔÎÔÏ·ÙÔÂȉ‹ ÛӷΔ ·fi ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ. ™Â ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ù· ÁÏ˘Î›ÛÌ·Ù· ‰È·ÊËÌ›˙ÔÓÙ·Ó Û ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ‰È·ÊË̛ۈÓ, ÍÂÂÚÓÒÓÙ·˜ Ù· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·. ∆· Á·Ï·ÎÙÔÎÔÌÈο ÚÔ˚fiÓÙ·, ¿ÓÙˆ˜, ÛÙËÓ ¤Ú¢ӷ ÙÔ˘ 1996 ·ÚÔ˘ÛÈ¿˙ÔÓÙ·Ó ÂÚ›Ô˘ Ù¤ÛÛÂÚȘ ÊÔÚ¤˜ ÏÈÁfiÙÂÚÔ ·’ fi,ÙÈ ÛÙËÓ ·ÚÔ‡Û·. ™Â οı ÂÚ›ÙˆÛË, Ù· Â˘Ú‹Ì·Ù· Ù˘ ·ÚÔ‡Û·˜ ¤Ú¢ӷ˜ ¤Ú¯ÔÓÙ·È Û ·ÓÙ›ıÂÛË Î·È Ì ÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, fiÔ˘ Ê·›ÓÂÙ·È fiÙÈ ÙÔ ÈÔ ‰È·ÊËÌÈ˙fiÌÂÓÔ ÙÚfiÊÈÌÔ Â›Ó·È Ù· ‰ËÌËÙÚȷο ÚˆÈÓÔ‡ (7,14,17,18,28). ∏ ‰È·ÊÔÚ¿ ·˘Ù‹ ›Ûˆ˜ Ó· ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ù· ‰ËÌËÙÚȷο ¤¯Ô˘Ó ÌÂÈ ÛÙË ‰›·ÈÙ· ÙˆÓ ÌÈÎÚÒÓ Î·Ù·Ó·ÏˆÙÒÓ Ù˘ ¯ÒÚ·˜ Ì·˜ ÌfiÏȘ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·. ø˜ ÚÔ˜ ÙËÓ ÔÈfiÙËÙ· ÙˆÓ ‰È·ÊËÌÈ˙fiÌÂÓˆÓ ÚÔ˚fiÓÙˆÓ, Ù· ‰‡Ô ÙÚ›Ù· ÂÚ›Ô˘ ÂÚÈ›¯·Ó ÚfiÛıÂÙË ˙¿¯·ÚË Î·È ÂÚ›Ô˘ ÙÔ ¤Ó· ÙÚ›ÙÔ ‹Ù·Ó ˘„ËÏ‹˜ ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Û ϛԘ, fiˆ˜ ¿ÏψÛÙ ¤¯ÂÈ ‚ÚÂı› Î·È Û ·ÓÙ›ÛÙÔȯ˜ ÌÂϤÙ˜ ÛÙÔ Â͈ÙÂÚÈÎfi (16,17,20). √È ‰È·ÊËÌ›ÛÂȘ ÙˆÓ ÛÓ·Î Ù‡Ô˘ fast food, ·ÚfiÏÔ Ô˘ ‰ÂÓ ·Ó‹ÎÔ˘Ó ÛÙ· ÈÔ ‰È·ÊËÌÈ˙fiÌÂÓ· ÚÔ˚fiÓÙ·, Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÙË ÌÂÁ·Ï‡ÙÂÚË ‰È¿ÚÎÂÈ·. ∏ ‰ÈÂıÓ‹˜ ‚È‚ÏÈÔÁÚ·Ê›· ·Ó·Ê¤ÚÂÈ fiÙÈ Ë ÔÛÔÛÙÈ·›· Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ “‡ÎÔÏÔ˘ Ê·ÁËÙÔ‡” ÛÙ· ‰È·ÊËÌÈ˙fiÌÂÓ· ÙÚfiÊÈÌ· ¤¯ÂÈ ·˘ÍËı› Ú·Á‰·›· ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· (18,28). À‹Ú¯Â, ›Û˘, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ÙÚÔʛ̈Ó, Ù· ÔÔ›· ‹Ù·Ó ÂÌÏÔ˘ÙÈṲ̂ӷ Ì ‚Èٷ̛Ә ‹/Î·È ·ÓfiÚÁ·Ó· ÛÙÔȯ›·, ÁÈ· Ù· ÔÔ›· Ë ‚È‚ÏÈÔÁÚ·Ê›· ‰ÂÓ Ê·›ÓÂÙ·È Ó· οÓÂÈ ÏfiÁÔ. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ, fï˜, ÔÛÔÛÙfi ÙˆÓ ‰È·ÊËÌ›ÛÂˆÓ ·ÊÔÚÔ‡Û ÙÚfiÊÈÌ· ÏÔ‡ÛÈ· Û ıÂÚÌ›‰Â˜ Î·È Ì ÌÈÎÚ‹ ıÚÂÙÈ΋ ·Í›·. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ‰È·ÊËÌ›ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È ÛÙËÓ ·È‰È΋ ˙ÒÓË ·ÊÔÚÔ‡Ó Û ÙÚfiÊÈÌ·, Ë ÔÈfiÙËÙ· ÙˆÓ ÔÔ›ˆÓ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘ÌʈÓ› Ì ÙȘ ÁÂÓÈΤ˜ Û˘ÛÙ¿ÛÂȘ ÁÈ· ÈÛÔÚÚÔË̤ÓË ‰È·ÙÚÔÊ‹. ∆Ô Â‡ÚËÌ·
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·˘Ùfi ÛÂ Û˘Ó‰˘·ÛÌfi Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÌÂÏÂÙÒÓ Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË Ù˘ ‰È·Ê‹ÌÈÛ˘ ÛÙË ‰È·ÈÙËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ, ηıÈÛÙ¿ ·Ó·Áη›· ÙË ÓÔÌÔıÂÙÈ΋ Ú‡ıÌÈÛË ÙˆÓ ıÂÌ¿ÙˆÓ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‰È·Ê‹ÌÈÛË. ¶ÂÚ·ÈÙ¤Úˆ ¤Ú¢ӷ ··ÈÙÂ›Ù·È ÁÈ· ÙË Û¯¤ÛË ‰fiÛ˘-·ÔÙÂϤÛÌ·ÙÔ˜ ˆ˜ ÚÔ˜ ÙËÓ ¤ÎıÂÛË ÛÙË ‰È·Ê‹ÌÈÛË, ηıÒ˜ Î·È ÙÔ˘˜ ÙÚfiÔ˘˜ ÂÓ›Û¯˘Û˘ Ù˘ ¿Ì˘Ó·˜ ÙˆÓ ·È‰ÈÒÓ ·¤Ó·ÓÙÈ ÛÙ· ÌËӇ̷ٷ ÙˆÓ ‰È·ÊË̛ۈÓ.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Dietz WH Jr, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics 1985;75:807-812. 2. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH. Television viewing as a cause of increasing obesity among children in the United States, 1986-1990. Arch Pediatr Adolesc Med 1996;150:356-362. 3. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: results from the Third National Health and Nutrition Examination Survey. JAMA 1998;279:938-942. 4. Crespo CJ, Smit E, Troiano RP, Bartlett SJ, Macera CA, Andersen RE. Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2001;155:360-365. 5. Boynton-Jarrett R, Thomas TN, Peterson KE, Wiecha J, Sobol AM, Gortmaker SL. Impact of television viewing patterns on fruit and vegetable consumption among adolescents. Pediatrics 2003;112:1321-1326. 6. Woodward DR, Cumming FJ, Ball PJ, Williams HM, Hornsby H, Boon JA. Does television affect teenagers' food choices? J Hum Nutr Diet 1997;10:229-235. 7. Coon KA, Goldberg J, Rogers BL, Tucker KL. Relationships between use of television during meals and children's food consumption patterns. Pediatrics 2001;107:E7. 8. Matheson DM, Killen JD, Wang Y, Varady A, Robinson TN. Children's food consumption during television viewing. Am J Clin Nutr 2004;79:1088-1094. 9. Yannakoulia M, Karayiannis D, Terzidou M, Kokkevi A, Sidossis LS. Nutrition-related habits of Greek adolescents. Eur J Clin Nutr 2004;58:580-586. 10. Story M, French S. Food Advertising and Marketing Directed at Children and Adolescents in the US. Int J Behav Nutr Phys Act 2004;1:3. 11. Gorn GJ, Goldberg ME. Behavioral evidence of the effects of televised food messages on children. J Consumer Res 1982;9:200-205. 12. Borzekowski DL, Robinson TN. The 30-second
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AÏÏËÏÔÁÚ·Ê›·: µ¿Ûˆ ¶··‚·ÛÈÏ›Ԣ ÃÚ˘ÛÔÛÙfiÌÔ˘ ™Ì‡ÚÓ˘ 6-8, ∆ÚÈ·Ó‰Ú›·, T.K. 553 37, £ÂÛÛ·ÏÔÓ›ÎË
¶ÂÚ›ÏË„Ë: ∆Ô 1987 ÔÈ Casamassima et al ÂÚȤÁÚ·„·Ó ¤Ó· Ó¤Ô Û‡Ó‰ÚÔÌÔ Ì ÂΉËÏÒÛÂȘ Ô˘ ı˘Ì›˙Ô˘Ó Ù· Û‡Ó‰ÚÔÌ· Smith-Lemli-Opitz (ÛSLO) Î·È Meckel (ÛM), ÌÂ Û˘Ó‡·ÚÍË ·ÚÂÁÎÂÊ·ÏȉÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜. ¶ÂÚÈÁÚ¿ÊÔ˘Ì ¤Ó· ‚Ú¤ÊÔ˜ ¿ÚÚÂÓ, Ô˘ Ù·ÈÚÈ¿˙ÂÈ ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚȤÁÚ·„·Ó ÔÈ Casamassima et al. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Î·È Ê·ÈÓfiÙ˘Ô ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛSLO Ù‡Ô˘ ππ, ¯ˆÚ›˜ ÙȘ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÛSLO.
∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-09-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘ 08-09-2005
§¤ÍÂȘ ÎÏÂȉȿ: ÀÔÏ·Û›· ÛÎÒÏËη, Û‡Ó‰ÚÔÌÔ SLO, Û‡Ó‰ÚÔÌÔ Meckel.
Aplasia of the cerebellar vermis with Smith-Lemli-Opitz and Meckel syndrome phenotypes Department of Neonatology, NHS, Ippokrateion Hospital, Thessaloniki Correspondence: Vasso Papavassiliou Chryssostomou Smyrnis 6-8 553 37, Thessaloniki Date of submission: 03-09-2004 Date of approval: 08-09-2005
A. Andreou, V. Papavassiliou, A. Sakellaropoulou
Abstract: In 1987 Casamassima and colleagues described a new syndrome, with an appearance resembling the Smith-Lemli-Opitz syndrome (SLOs) and the Meckel syndrome (Ms), associated with the presence of cerebellar deficit. The case is described of a male infant which matches the clinical appearance of this syndrome. The infant had hypoplasia of the cerebellar vermis and phenotype of the SLOs type II, but without the biochemical abnormalities of SLOs. Key words: Vermis hypoplasia, SLO syndrome, Meckel syndrome.
™˘ÓÙÔÌÔÁڷʛ˜ ™‡Ó‰ÚÔÌÔ Smith-Lemli-Opitz: ÛSLO ™‡Ó‰ÚÔÌÔ Meckel: ÛM
∂ÈÛ·ÁˆÁ‹ ∏ Û˘Ó‡·ÚÍË ·Ï·Û›·˜/˘ÔÏ·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ Û˘Ó‰ÚfiÌˆÓ SLO Î·È Meckel ÂÚÈÁÚ¿ÊËΠÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1987 ·fi ÙÔ˘˜ Casamassima Î·È Û˘Ó (1) Û ÙÚ›· ·‰¤ÏÊÈ·, Ô˘ ÂÌÊ¿ÓÈ˙·Ó ·ÓˆÌ·Ï›Â˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ fiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ›¯·Ó ÂÚÈÁÚ·Ê› ÛÙÔ Û‡Ó‰ÚÔÌÔ Joubert. √ Casamassima ıÂÒÚËÛ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· Ó¤Ô Û‡Ó‰ÚÔÌÔ, ÌÈ· ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË ‰È·Ù·Ú·¯‹. ™ÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi ıˆڋıËΠfiÙÈ ·Ó‹ÎÔ˘Ó ‰‡Ô ·‰ÂÏʤ˜ Ì ʷÈÓfiÙ˘Ô ÛSLO Î·È ÛM Î·È Û˘ÓÔ‰fi ‰È·ÓÔËÙÈ΋ ηı˘ÛÙ¤ÚËÛË, Ë·ÙÈ΋ ›ÓˆÛË Î·È ÓÂÊÚÈΤ˜ ·ÛÙÂȘ, Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ÙÔ 1986 ·fi ÙÔ˘˜ Thomson Î·È Baraitser (2), ηıÒ˜ Î·È ‰‡Ô ¶·È‰È·ÙÚÈ΋ 2006;69:134-137
·‰¤ÏÊÈ· Ì ʷÈÓfiÙ˘Ô ÛM Î·È Û˘ÓÔ‰¤˜ ÓÂÊÚÈΤ˜ Î·È Ë·ÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ηıÒ˜ Î·È ‰È·Ì·Úٛ˜ ÙÔ˘ ∫¡™ Ô˘ ÂÚÈÁÚ¿ÊËÎ·Ó ÙÔ 1974 ·fi ÙÔ˘˜ Hunter Î·È Û˘Ó (3). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÓÂÔÁÓfi Ì ٷ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ó¤Ô˘ ·˘ÙÔ‡ Û˘Ó‰ÚfiÌÔ˘ ÁÈ· ÙË Û·ÓÈfiÙËÙ¿ ÙÔ˘.
¶ÂÚÈÁÚ·Ê‹ ÂÚÈÛÙ·ÙÈÎÔ‡ ¶ÚfiÎÂÈÙ·È ÁÈ· ÓÂÔÁÓfi, ·ÁfiÚÈ, ÚÒÙÔ ·È‰› Ê·ÈÓÔÌÂÓÈο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ô˘ ÌÂٷʤÚıËΠÛÙËÓ ÎÏÈÓÈ΋ Ì·˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙË Á¤ÓÓËÛ‹ ÙÔ˘, ÏfiÁˆ ÚÔˆÚfiÙËÙ·˜, ·Ó·Ó¢ÛÙÈ΋˜ ‰˘Û¯¤ÚÂÈ·˜ Î·È ÔÏÏ·ÏÒÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ. ∏ ÌËÙ¤Ú·, 39 ÂÙÒÓ Î·È Ô ·Ù¤Ú·˜, 47 ÂÙÒÓ, ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. ∆Ô ÂÚÈÁÂÓÓËÙÈÎfi ÈÛÙÔÚÈÎfi ‹Ù·Ó ÂχıÂÚÔ, ¯ˆÚ›˜ ÚÔËÁÔ‡ÌÂÓ˜ ·˘ÙfiÌ·Ù˜ ·Ô‚ÔϤ˜ ‹ ÂÎÙÚÒÛÂȘ. ∏ Û‡ÏÏË„Ë ¤ÁÈÓ Ì ÛÂÚÌ·Ù¤Á¯˘ÛË. ∆o ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ ‹Ù·Ó
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∞Ï·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜
Ê˘ÛÈÔÏÔÁÈÎfi Î·È Ë ¯ÚˆÌ·ÙÔÛˆÌÈ΋ ·Ó¿Ï˘ÛË ÙÔ˘ ·ÌÓÈ·ÎÔ‡ ˘ÁÚÔ‡ ¤‰ÂÈÍ ηڢfiÙ˘Ô 46ÃY. ∏ ·ËÛË ÂÂÏ¿ÎÂÈ ·fi ˘‰Ú¿ÌÓÈÔ Î·È ÚfiˆÚ˜ Û˘Û¿ÛÂȘ, Ô˘ ¿Ú¯ÈÛ·Ó ÙËÓ 35Ë Â‚‰ÔÌ¿‰· ·ËÛ˘. ÃÔÚËÁ‹ıËΠ̛· ‰fiÛË ÎÔÚÙÈÎÔÂȉÒÓ Î·È Ë Î‡ËÛË ÂÚ·ÙÒıËΠÙËÓ 36Ë Â‚‰ÔÌ¿‰·, Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹, ÏfiÁˆ ÙÔ˘ ˘‰Ú·ÌÓ›Ô˘ Î·È ÔχÙÈÌ˘ ·ËÛ˘. ∆Ô ÓÂÔÁÓfi ÁÂÓÓ‹ıËΠ΢·ÓˆÙÈÎfi Ì ¿ÚÚ˘ıÌË ·Ó·ÓÔ‹. ∏ ‚·ıÌÔÏÔÁ›· Apgar ‹Ù·Ó 2 ÛÙÔ 1Ô ÏÂÙfi Î·È 4 ÛÙÔ 5Ô Î·È 20fi ÏÂÙfi. ŒÁÈÓ ·Ó·˙ˆÔÁfiÓËÛË Ì ÂÓ‰ÔÙÚ·¯Âȷ΋ ‰È·ÛˆÏ‹ÓˆÛË Î·È ¯ÔÚ‹ÁËÛË Ô͢ÁfiÓÔ˘ ÛÙËÓ ·›ıÔ˘Û· ÙÔÎÂÙÔ‡ Î·È ÌÂÙ·ÊÔÚ¿ ÛÙË ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ ¡ÔÛËÏ›·˜ ¡ÂÔÁÓÒÓ, fiÔ˘ Ù¤ıËΠ·Ì¤Ûˆ˜ Û Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, ÏfiÁˆ ‚·ÚÈ¿˜ ·Ó·Ó¢ÛÙÈ΋˜ ·Ó¿ÚÎÂÈ·˜. ∫·Ù¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ µ™ ‹Ù·Ó 2430 ÁÚ. (25Ë-50Ë ÂηÙÔÛÙÈ·›· ı¤ÛË), ÙÔ ª™ 51 ÂÎ. (>90‹ ÂηÙÔÛÙÈ·›· ı¤ÛË), Î·È Ë ¶∫ 31 ÂÎ. (2550‹ ÂηÙÔÛÙÈ·›· ı¤ÛË). ∆Ô ÚÔÛˆÂ›Ô ‹Ù·Ó ȉȿ˙ÔÓ, Ì ·ÓÂÛÙÚ·Ì̤ÓÔ˘˜ ÚÒıˆÓ˜, ¢Ú›· ‚¿ÛË ÚÈÓfi˜, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹ ÊÔÚ¿ Î·È ·˘ÍË̤ÓÔ Ì‹ÎÔ˜ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ·˘ÍË̤ÓË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ¤Íˆ ηÓıÒÓ, ÌÈÎÚÔÁÓ·ı›·, ˘ÂÚˆÔÛ¯ÈÛÙ›·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ Î·È ÌÂÁ¿ÏË ÚfiÛıÈ· ËÁ‹ ÙÔ˘ ÎÚ·Ó›Ô˘ (∂ÈÎfiÓ· 1). ™Ù· ¿ÎÚ· ˘‹Ú¯Â Ì›· ¯ÂÈÚÔÌ·ÓÙÈ΋ ÁÚ·ÌÌ‹, ¤Íˆ ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ, ·ÌÊÔÙÂÚfiÏ¢ÚË Û˘Ó‰·ÎÙ˘Ï›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ÙÚ›ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ, Î·È ·˘ÍË̤ÓÔ Ì‹ÎÔ˜ οو ¿ÎÚˆÓ (18,5 ÂÎ.) Î·È ·Ï¿Ì˘ (∂ÈÎfiÓ· 3). ∆· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó· ‹Ù·Ó ·ÌÊ›‚ÔÏ·, Ì ÌÈÎÚfi ̤ÁÂıÔ˜ ¤Ô˘˜, ‰Èۯȉ¤˜ fiÛ¯ÂÔ, ·„ËÏ¿ÊËÙÔ˘˜ fiÚ¯ÂȘ, ‰ÂÍÈ¿ ‚Ô˘‚ˆÓÔ΋ÏË Î·È ‚¿Ï·ÓÔ-Â˚Îfi ˘ÔÛ·-
∂ÈÎfiÓ· 1. π‰È¿˙ÔÓ ÚÔÛˆÂ›Ô ÙÔ˘ ÓÂÔÁÓÔ‡, Ì ·ÓÂÛÙÚ·Ì̤ÓÔ˘˜ ÚÒıˆÓ˜, ¢Ú›· ‚¿ÛË ÚÈÓfi˜, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹ ÊÔÚ¿ Î·È ·˘ÍË̤ÓÔ Ì‹ÎÔ˜ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ·˘ÍË̤ÓË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ¤Íˆ ηÓıÒÓ, ÌÈÎÚÔÁÓ·ı›· Î·È ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ.
‰›· (∂ÈÎfiÓ· 2). ∏ Ó¢ÚÔÌ˘˚΋ ÂͤٷÛË ¤‰ÂÈÍ ÂÏ·Ùو̤ÓÔ Ì˘˚Îfi ÙfiÓÔ, ̤ÙÚÈ· ·ÓÙ›‰Ú·ÛË ÛÙ· ÂÚÂı›ÛÌ·Ù· Î·È ÂÍ·ÛıÂÓË̤ӷ ·Ú¯¤ÁÔÓ· Î·È ÙÂÓfiÓÙÈ· ·ÓÙ·Ó·ÎÏ·ÛÙÈο. ∏ ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη ›¯Â ıÔÏÂÚfiÙËÙ˜ Î·È ÂÚÈÔ¯¤˜ ˘Ô·ÂÚÈÛÌÔ‡ ÛÙÔÓ Ì¤ÛÔ Î·È ÛÙÔÓ Î¿Ùˆ ÏÔ‚fi ÙÔ˘ ‰ÂÍÈÔ‡ Ó‡ÌÔÓ·. √ ˘ÂÚ˯ÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÎÔÈÏÈ¿˜ Î·È ÙˆÓ ÓÂÊÚÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ¤‰ÂÈÍ ¢Ú›· ÂÚÈÌÂÌ‚Ú·ÓÒ‰Ë ÌÂÛÔÎÔÈÏȷ΋ ÂÈÎÔÈÓˆÓ›· Ì ÂÊ›Â˘ÛË Ù˘ ·ÔÚÙ‹˜ › ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡ ‰È·ÊÚ¿ÁÌ·ÙÔ˜, ¢ڇ ·ÓÔȯÙfi ·ÚÙËÚÈ·Îfi fiÚÔ Ì ÛËÌÂ›Ô ¤ÎÊ˘Û˘ ÌÂٷ͇ Ù˘ ·ÚÈÛÙÂÚ‹˜ ηڈٛ‰·˜ Î·È Ù˘ ·ÚÈÛÙÂÚ‹˜ ˘ÔÎÏÂȉ›Ô˘. √ ·ÈÌ·ÙÔÏÔÁÈÎfi˜ Î·È ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∆ËÓ 17Ë Ë̤ڷ ˙ˆ‹˜, Ë ˘ÂÚË‚È΋ ηÏÏȤÚÁÂÈ· Ô‡ÚˆÓ ·Ó¤Ù˘Í Hafnia alvei, Ô˘ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠‰ÈÏ‹ ·ÓÙÈ‚ÈÔÙÈ΋ ·ÁˆÁ‹. √ ·ÎÙÈÓÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Ô˘ ÚÔÁÚ·ÌÌ·Ù›ÛıËΠ‰ÂÓ ¤ÁÈÓ ‰˘Ó·ÙfiÓ Ó· Ú·ÁÌ·ÙÔÔÈËı› ÏfiÁˆ Âȉ›ӈÛ˘ Ù˘ ÁÂÓÈ΋˜ ηٿÛÙ·Û˘ Î·È ı·Ó¿ÙÔ˘ ÙÔ˘ ÓÂÔÁÓÔ‡. √ ÔÛÔÙÈÎfi˜ ÚÔÛ‰ÈÔÚÈÛÌfi˜ ÙˆÓ ÙÈÌÒÓ Ù˘ 7-‰Â¸‰ÚÔ-¯ÔÏËÛÙÂÚfiÏ˘, ‰ÂÛÌÔÛÙÂÚfiÏ˘, Ï·ıÔÛÙÂÚfiÏ˘, ¯ÔÏÂÛÙ·ÓfiÏ˘, Ï·ÓÔÛÙÂÚfiÏ˘, 8(9)-¯ÔÏÂÛÙÂÓfiÏ˘ Î·È Ù˘ 8-‰Â¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ ÙÔ˘ ·›Ì·ÙÔ˜, ¤ÁÈÓ ÛÙÔ Institute of Child Health and Great Ormond Street Hospital for Children, University College London Î·È ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. √ ηڢfiÙ˘Ô˜ ·fi ÙÔ ·›Ì· ÙÔ˘ ÓÂÔÁÓÔ‡ ‹Ù·Ó 46ÃÀ. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ ·ÔÎ¿Ï˘„ ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ÂÈÎÔÈÓˆÓ›· ·Ó¿ÌÂÛ· ÛÙË 4Ë ÎÔÈÏ›· Î·È ÛÙË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (∂ÈÎfiÓ· 4). ∆· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Ô ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ¤ıÂÛ·Ó ÙË
∂ÈÎfiÓ· 2. ªÈÎÚfi ̤ÁÂıÔ˜ ¤Ô˘˜, ‚¿Ï·ÓÔ-Â˚Îfi˜ ˘ÔÛ·‰›·˜ Î·È ·ÓÒÌ·ÏÔ fiÛ¯ÂÔ ÙÔ˘ ÓÂÔÁÓÔ‡. ¶·È‰È·ÙÚÈ΋ 2006;69:134-137
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∞. ∞Ó‰Ú¤Ô˘ Î·È Û˘Ó.
∂ÈÎfiÓ· 4. ∞ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘: ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ÂÈÎÔÈÓˆÓ›· ·Ó¿ÌÂÛ· ÛÙË 4Ë ÎÔÈÏ›· Î·È ÛÙË ÌÂÁ¿ÏË ‰ÂÍ·ÌÂÓ‹ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘. ∂ÈÎfiÓ· 3. ŒÍˆ ÛÙÚÔÊ‹ ÙÔ˘ ÌÂÁ¿ÏÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ Î·È ·ÌÊÔÙÂÚfiÏ¢ÚË Û˘Ó‰·ÎÙ˘Ï›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ÙÚ›ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ.
‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ˘ÔÏ·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÎÏÈÓÈο ÁÓˆÚ›ÛÌ·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ SLO Ù‡Ô˘ ππ. √ÎÙÒ ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÈÛ·ÁˆÁ‹, ÙÔ ÓÂÔÁÓfi ·ÚÔ˘Û›·Û ÙÔÓÈΤ˜ Û˘Û¿ÛÂȘ ÙˆÓ ¿ÎÚˆÓ Î·È ÙÔ˘ ÎÔÚÌÔ‡, ÁÂÓÈÎÂ˘Ì¤ÓË ˘ÔÙÔÓ›· Î·È ÂÍ·Ûı¤ÓÈÛË ÙˆÓ ÙÂÓfiÓÙÈˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ. ∏ ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Î·È Ë ÁÂÓÈ΋ ηٿÛÙ·ÛË ·ÚÔ˘Û›·Û·Ó Û˘Ó¯‹ Âȉ›ӈÛË Î·È ÙË 19Ë Ë̤ڷ ˙ˆ‹˜ ÙÔ ÓÂÔÁÓfi ·Â‚›ˆÛ ·fi ‚·ÚÈ¿ ·Ó·Ó¢ÛÙÈ΋ ·Ó¿ÚÎÂÈ·. √È ÁÔÓ›˜ ·ÚÓ‹ıËÎ·Ó ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÓÂÎÚÔÙÔÌ‹˜.
™˘˙‹ÙËÛË ∆Ô ÂÚÈÛÙ·ÙÈÎfi Ì·˜ ›¯Â ÔÏÏ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙÔ˘ Û SLO Ù‡Ô˘ ππ (4,5), Î·È ÌÂÚÈο ÙÔ˘ Ê·ÈÓÔÙ‡Ô˘ ÙÔ˘ Û Meckel (6,7). ∞ÂÈÎÔÓÈÛÙÈο, ›¯Â ˘ÔÏ·Û›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜. ∆· ·ÚÈ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó ÙË ‰È¿ÁÓˆÛË ÛSLO Ù‡Ô˘ ππ ‹Ù·Ó Ë Û˘Ó‰·ÎÙ˘Ï›· ÙÔ˘ ‰Â‡ÙÂÚÔ˘ Î·È ÙÚ›ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ÙˆÓ Ô‰ÈÒÓ, Ô ˘ÔÛ·‰›·˜ Î·È Ô „¢‰ÔÂÚÌ·ÊÚÔ‰ÈÙÈÛÌfi˜ ÙÔ˘ ¿ÚÚÂÓÔ˜ (4). ∆· ¿ÏÏ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÙfiÛÔ ÛÙÔ Û SLO fiÛÔ Î·È ÛÙÔ ÛM ÂÎÙfi˜ ·fi ÙËÓ ˘ÂÚˆÔÛ¯ÈÛÙ›·, Ô˘ ‰ÂÓ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ ÛSLO, ·ÏÏ¿ ·Ó·Ê¤ÚÂÙ·È ÛÙÔ Ûª (7). ∏ ‰È¿ÁÓˆÛË ÙÔ˘ ÛSLO Ù›ıÂÙ·È Û‹ÌÂÚ· Ì ÙËÓ ·Ó‡ÚÂÛË ÂÏ·ÙÙˆÌ¤ÓˆÓ ÂȤ‰ˆÓ ¯ÔÏËÛÙÂÚfiÏ˘ Î·È ·˘ÍËÌ¤ÓˆÓ ÂȤ‰ˆÓ 7-‰Â¸‰ÚÔ¯ÔÏËÛÙÂÚfiÏ˘ ÛÙÔ Ï¿ÛÌ· ÙˆÓ ·ÛıÂÓÒÓ (8). ∏ ÌË ·Ó‡ÚÂÛË ·˘ÙÒÓ ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ·¤ÎÏÂÈÛ ÙÔ ÛSLO ÛÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi. ™ÙÔ ÛM, ÙÔ ÈÔ Û˘¯Ófi ‡ÚËÌ· Â›Ó·È Ë ˘ÔÏ·Û›· ÙˆÓ ¤Íˆ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ ÙÔ˘ ¿ÚÚ¶·È‰È·ÙÚÈ΋ 2006;69:134-137
ÓÔ˜ Î·È Ë ÎÚ˘„ÔÚ¯›·, ¯ˆÚ›˜ ·ÌÊ›‚ÔÏ· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·, ÂÓÒ Ë Û˘Ó‰·ÎÙ˘Ï›· Â›Ó·È Û¿ÓÈ·. ÕÏÏ· Û˘¯Ó¿ Â˘Ú‹Ì·Ù· Â›Ó·È Ë ÈÓȷ΋ ÂÁÎÂÊ·ÏÔ΋ÏË, ÔÈ ‰˘ÛÏ·ÛÙÈÎÔ›, ΢ÛÙÈÎÔ› ÓÂÊÚÔ›, Ë ÌÈÎÚÔÊı·ÏÌ›·, Ë ˘ÂÚˆÔÛ¯ÈÛÙ›·, ÔÈ ·ÓˆÌ·Ï›Â˜ Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ fiˆ˜ ˘ÔÏ·Û›· ‹ ·ÁÂÓÂÛ›· ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ·ÁÂÓÂÛ›· ÙÔ˘ ÂÁÎÂÊ·ÏÈÎÔ‡ ÛÙÂϤ¯Ô˘˜, ÌÂÁ¿Ï˜ ·ÓˆÌ·Ï›Â˜ Ù˘ ̤Û˘ ÁÚ·ÌÌ‹˜ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (6). ∆· ·ÚÈ· ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· ÛÙÔ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi ‰ÂÓ Ù·ÈÚÈ¿˙Ô˘Ó Ì ÙÔ Ûª. ™Â ‰È¿ÚÎÂÈ· ÙˆÓ 18 ÂÙÒÓ ÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ÓÂÔÁÓÔÏÔÁÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ¤¯Ô˘Ì ‰ÂÈ, Ì·˙› Ì ÙÔ ·ÚfiÓ, 3 ÂÚÈÛÙ·ÙÈο Ì ʷÈÓfiÙ˘Ô ÛSLO. ∆Ô ÚÒÙÔ ÂÚÈÛÙ·ÙÈÎfi, ÓÔÛËχÙËΠÙËÓ ÂÔ¯‹ Ô˘ ‰ÂÓ ‹Ù·Ó ·ÎfiÌ· ÁÓˆÛÙ¤˜ ÔÈ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ‰È·ÁÓÒÛıËΠˆ˜ ÛSLO Ì ‚¿ÛË Ù· ÎÏÈÓÈο ¯·Ú·ÎÙËÚÈÛÙÈο (9). ∆Ô ‰Â‡ÙÂÚÔ ÂÚÈÛÙ·ÙÈÎfi, ÓÔÛËχÙËΠÈÔ ÚfiÛÊ·Ù· Î·È Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÛSLO Ù¤ıËΠ̠·Ó‡ÚÂÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ (10). ∆Ô ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi, ÙÔ ÙÚ›ÙÔ, ›¯Â Ê·ÈÓfiÙ˘Ô ÛSLO Ù‡Ô˘ ππ ¯ˆÚ›˜ ÙȘ ‰È·ÁÓˆÛÙÈΤ˜ ‚ÈÔ¯ËÌÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÛSLO. ∏ Û˘Ó‡·ÚÍË ˘ÔÏ·Û›·˜ ÙÔ˘ ÛÎÒÏËη Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜ Î·È ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ô˘ ··ÓÙÔ‡Ó Î·È ÛÙÔ Ûª, Û˘ÓËÁÔÚÔ‡Ó ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚȤÁÚ·„·Ó ÔÈ Casamassima Î·È Û˘Ó (1). ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ıˆÚÂ›Ù·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈÔ. À¿Ú¯Ô˘Ó ÌfiÓÔ ÙÚÂȘ ‰ËÌÔÛȇÛÂȘ ·fi ÙËÓ ÚÔÛÈÙ‹ Û ÂÌ¿˜ ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›·, fiÔ˘ ÂÚÈÁÚ¿ÊÔÓÙ·È 7 ÂÚÈÛÙ·ÙÈο (1, 2, 3, √ªπª: 213010). ¶ÚÈÓ ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, Ë ‰È¿ÁÓˆÛË ÙÔ˘ ÛSLO ÁÈÓfiÙ·Ó ÌfiÓÔ Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÈ ÌÂÁ¿ÏË ÔÈÎÈÏÔÌÔÚÊ›·. ∏ Û˘¯ÓfiÙËÙ· ÙÔ˘ ÛSLO ÙËÓ ÂÔ¯‹ ÂΛÓË ˘ÔÏÔÁÈ˙fiÙ·Ó Û 1:10000-1:40000 ˙ÒÓÙ·
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ÓÂÔÁÓ¿ (5) Î·È ‹Ù·Ó Û·ÊÒ˜ ÌÂÁ·Ï‡ÙÂÚË ·fi ÙË Û˘¯ÓfiÙËÙ· Ô˘ ÚԤ΢„ fiÙ·Ó Ë ‰È¿ÁÓˆÛË Ù¤ıËΠ̠‚¿ÛË Ù· ‚ÈÔ¯ËÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο, Î·È ˘ÔÏÔÁ›ÛÙËΠ۠1:60000-1:100000 ˙ÒÓÙ· ÓÂÔÁÓ¿ (11). ∏ ÌÂÁ¿ÏË ·˘Ù‹ ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· Èı·Ófiٷٷ ÔÊ›ÏÂÙ·È Û ˘ÂډȿÁÓˆÛË ÙÔ˘ ÛSLO ÛÙËÓ ÂÚ›Ô‰Ô ÚÈÓ ÙËÓ ·Ó‡ÚÂÛË ÙˆÓ ‚ÈÔ¯ËÌÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Î·È Èı·ÓfiÓ ÔÚÈṲ̂ӷ ·fi Ù· ÂÚÈÛÙ·ÙÈο Ù˘ ÂÚÈfi‰Ô˘ ÂΛӢ, ȉȷ›ÙÂÚ· ·˘Ù¿ Ô˘ ›¯·Ó ·Ï·Û›· Ù˘ ·ÚÂÁÎÂÊ·Ï›‰·˜, Ó· ·Ó‹Î·Ó ÛÙÔ ÚÔ·Ó·ÊÂÚfiÌÂÓÔ Û‡Ó‰ÚÔÌÔ. ∆Ô Û‡Ó‰ÚÔÌÔ ·˘Ùfi ·ÔÙÂÏ› Ì›· ͯˆÚÈÛÙ‹ ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ·ÓÂÍ¿ÚÙËÙË ·fi Ù· Û‡Ó‰ÚÔÌ· SLO Î·È Meckel. ∏ ‰È·ÊÔÚÂÙÈ΋ Ê·ÈÓÔÙ˘È΋ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û 3 ·È‰È¿ Ù˘ ›‰È·˜ ÔÈÎÔÁ¤ÓÂÈ·˜, fiÔ˘ Ù· ‰‡Ô ÂÌÊ¿ÓÈ˙·Ó ¯·Ú·ÎÙËÚÈÛÙÈο ÛSLO Î·È ÙÔ ¤Ó· ¯·Ú·ÎÙËÚÈÛÙÈο Ûª, ıˆڋıËΠfiÙÈ ÔÊ›ÏÂÙ·È Û ÏÂÈÔÙÚÔÈ΋ ‰Ú¿ÛË ÙÔ˘ ›‰ÈÔ˘ ÌÂÙ·ÏÏ·Á̤ÓÔ˘ ÁÔÓȉ›Ô˘ (1). ∆Ô Û‡Ó‰ÚÔÌÔ Ê·›ÓÂÙ·È fiÙÈ ÎÏËÚÔÓÔÌÂ›Ù·È Î·Ù¿ ÙÔÓ ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈÌÌ·ÙÈÎfi ÙÚfiÔ (1). ¶ÚÔÁÂÓÓËÙÈ΋, ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘, ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› Î·È ıˆÚÂ›Ù·È ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡ÛÎÔÏË, ÏfiÁˆ ÚÔ‚ÏËÌ¿ÙˆÓ ÛÙËÓ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË Ù˘ ·ÁÂÓÂÛ›·˜ ÙÔ˘ ÛÎÒÏËη, ȉȷ›ÙÂÚ· Ù˘ ÙÌËÌ·ÙÈ΋˜ (12).
µÈ‚ÏÈÔÁÚ·Ê›· 1. Casamassima AC, Mamunes P, Gladstone IM Jr, Solomon S, Moncure C. A new syndrome with features of the Smith-Lemli-Opitz and Meckel-Gruber syndromes in a sibship with cerebellar defects. Am J Med Genet 1987;26:321-336.
2. Thompson E, Baraitser M. An autosomal recessive mental retardation syndrome with hepatic fibrosis and renal cysts. Am J Med Genet 1986 May;24: 151-158. 3. Hunter AG, Rothman SJ, Hwang WS, Deckelbaum RJ. Hepatic fibrosis, polycystic kidney, colobomata and encephalopathy in siblings. Clin. Genet 1974; 6:82-89. 4. Cunniff C, Kratz LE, Moser A, Natowicz MR, Kelley RI. Clinical and biochemical spectrum of patients with RSH/Smith-Lemli-Opitz syndrome and abnormal cholesterol metabolism. Am J Med Genet 1997; 68:263-269. 5. Kelley RI, Hennekam RC. The Smith-Lemli-Opitz syndrome. J Med Genet 2000;37:321-335. 6. Paavola P, Salonen R, Baumer A, Schinzel A, Boyd PA, Gould S et al. Clinical and genetic heterogeneity in Meckel syndrome. Hum Genet 1997;101:88-92. 7. Lowry RB. Editorial comment: Variability in the Smith-Lemli-Opitz syndrome: overlap with the Meckel Syndrome. Am J Med Genet 1983;14: 429-433. 8. Tint GS, Irons M, Elias ER, Batta AK, Frieden R, Chen TS et al. Defective cholesterol biosynthesis associated with the Smith-Lemli-Opitz syndrome. N Engl J Med 1994;330:107-113. 9. ∞Ó‰Ú¤Ô˘ ∞, ∞Ó·ÛÙ·ÛÈ¿‰Ô˘-∫·Ú·ÁˆÚÁÔÔ‡ÏÔ˘ ∂, °ÂˆÚÁ›Ô˘ π, ™È·Î·‚¤Ï·˜ ∫. ¶ÂÚÈÁÚ·Ê‹ ÓÂÔÁÓÔ‡ Ì ۇӉÚÔÌÔ Smith-Lemli-Opitz. ¶·È‰È·ÙÚÈ΋ 1990; 53:303-307. 10. ∞Ó‰Ú¤Ô˘ ∞, °Ô˘‰ÂÛ›‰Ô˘ ª, ¶··‚·ÛÈÏ›Ԣ µ, ™·Ú·ÓÙ¿ÚË Ã. µÈÔ¯ËÌÈ΋ ‰È¿ÁÓˆÛË Û˘Ó‰ÚfiÌÔ˘ Smith-Lemli-Opitz. ¶·È‰È·ÙÚÈ΋ 2002;65:447-451. 11. Ryan AK, Bartlett K, Clayton P, Eaton S, Mills L, Donnai D et al. Smith-Lemli-Opitz syndrome: a variable clinical and biochemical phenotype. J Med Genet 1998;35:558-565. 12. Zalel Y, Seidman DS, Brand N, Lipitz S, Achiron R. The development of the fetal vermis: an in utero sonographic evaluation. Ultrasound Obstet Gynaecol 2002;19:136-139.
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ORIGINAL ARTICLE
£·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ °ÂÓÈÎfi ¶ÂÚÈÊÂÚÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “πÔÎÚ¿ÙÂÈÔ”, £ÂÛÛ·ÏÔÓ›ÎË
AÏÏËÏÔÁÚ·Ê›·: Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ∂ÚÁ·ÛÙ‹ÚÈÔ ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋˜ ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ∞.¶.£. °.¶.¡. “πÔÎÚ¿ÙÂÈÔ” £ÂÛÛ·ÏÔӛ΢ ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49, ∆.∫. 546 42, £ÂÛÛ·ÏÔÓ›ÎË ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 17-12-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 22-07-2005
Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡ - §Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘
¶ÂÚ›ÏË„Ë: ∆Ô ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· (Lethal Multiple Pterygium Syndrome, LMPS) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÌ‚Ú˘˚Îfi ı¿Ó·ÙÔ, ·fi ÂÌ‚Ú˘˚Îfi ‡‰Úˆ· ηÈ/‹ ΢ÛÙÈÎfi ‡Áڈ̷ Î·È ·fi ÙËÓ ·ÚÔ˘Û›· ÔÏÏ·ÏÒÓ ÙÂÚ˘Á›ˆÓ ‹ ‰ÂÚÌ·ÙÈÎÒÓ ÎÚËÌÓÒÓ ‰›ÎËÓ ÙÂÚ˘Á›Ô˘ Û ÌÂÁ¿Ï˜ ·ÚıÚÒÛÂȘ Û ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ÂÚÈÔ¯¤˜ ÙÔ˘ ÛÒÌ·ÙÔ˜, Ô˘ ¿ÓÙ· Û˘Óԉ‡ÔÓÙ·È ·fi Û˘Û¿ÛÂȘ ÙˆÓ ·ÚıÚÒÛˆÓ. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ‹ Ã-Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú·. ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ù‹ ÛÙȘ ΢‹ÛÂȘ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ì ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ·fi ÙËÓ 14Ë-16Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘ ÁÈ· ÙË ‰È·›ÛÙˆÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ·Ó·ÙÔÌÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ ÙÔ˘ Î·È Ù˘ ÂͤÏÈÍ‹˜ ÙÔ˘˜. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ì›· ÔÈÎÔÁ¤ÓÂÈ· Ù˘ ÔÔ›·˜ ÙÔ 1Ô ¿ÚÚÂÓ Ù¤ÎÓÔ Â›¯Â ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·. °›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Ô˘ ‰fiıËΠÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, ÛÙ· ·‰¤ÏÊÈ· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÚfiÛÊ·Ù·, ÛÙ· ˘ÁÈ‹ ·‰¤ÏÊÈ· ÙÔ˘ ÂÊË‚È΋˜ ËÏÈΛ·˜. §¤ÍÂȘ ÎÏÂȉȿ: £·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·, ÂÌ‚Ú˘˚Îfi Ô›‰ËÌ·, ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË, ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË.
Lethal multiple pterygium syndrome 1st Paediatric Clinic, Aristotle University, “Ippokration” General Hospital, Thessaloniki Correspondence: H. Hatzissevastou-Loukidou Laboratory of Cytogenetics 1st Paediatric Clinic, Aristotle University, “Ippokration” General Hospital, Thessaloniki 49 Konstantinoupoleos Str., 546 42, Thessaloniki Date of submission: 17-12-2004 Date of approval: 22-07-2005
H. Hatzissevastou - Loukidou, ∞. Georgountzou
Abstract: Lethal multiple pterygium syndrome (LMPS) is characterized by hydrops fetalis, and intrauterine death, where the fetus has multiple pterygia or wing-like webs of skin across joints, which are always associated with joint contractures. The inheritance is either autosomal or X-linked recessive. In high risk pregnancies prenatal diagnosis is possible by ultrasound examination at 14 to 16 weeks’ gestation, which relies on identification of the characteristic fetal anatomical abnormalities and their evolution. A family is reported whose first male child was affected with fatal LMPS. Genetic counselling was provided to his parents, his parents’ siblings and recently to his adolescent siblings. Key words: Lethal multiple pterygium syndrome, prenatal diagnosis, hydrops fetalis, genetic counselling.
™˘ÓÙÔÌÔÁڷʛ˜ LMPS £·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· ∞FP ·-ÂÌ‚Ú˘˚΋ ÚˆÙ½ÓË
∂ÈÛ·ÁˆÁ‹ ∆Ô ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· (LMPS) Â›Ó·È ÌÈ· Ôχ Û¿ÓÈ· ηٿÛÙ·ÛË (1,2) Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ÚÔÁÂÓÓËÙÈο ·fi ‡‰Úˆ·, ΢ÛÙÈο ˘ÁÚÒÌ·Ù·, ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· ÛÙȘ ÌÂÁ¿Ï˜ ·ÚıÚÒÛÂȘ Î·È ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ ÛÙÔ ‚ã ‹ ÓˆÚ›˜ ÛÙÔ Áã ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘ (3,4). ¶ÂÚÈÏ·Ì‚¿ÓÂÈ Â›Û˘ ‰˘ÛÌÔÚʛ˜ ÙÔ˘ ÚÔÛÒÔ˘, ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ¶·È‰È·ÙÚÈ΋ 2006;69:138-142
˘ÔÏ·Û›· ÙˆÓ Ó¢ÌfiÓˆÓ Î·È Ù˘ ηډȿ˜. ™ÙȘ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÚÔÛÒÔ˘ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ˘ÂÚÙÂÏÔÚÈÛÌfi˜, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹˜ ÊÔÚ¿ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, Ï·ÙÈ¿ ·Ó·ÛËΈ̤ÓË Ì‡ÙË, ÌÈÎÚÔÁÓ·ı›·, ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ Î·È Û¯ÈÛÙ›· ˘ÂÚÒ·˜. √È ÛÎÂÏÂÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Û˘Ó‹ıˆ˜ ˘ÔÏ·Û›· Ù˘ ˆÌÔÏ¿Ù˘, Ù˘ ˘¤ÏÔ˘ Î·È ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ, ·ÔÏ·Ù˘Ṳ̂Ó˜ ‹ ˘ÔÏ·ÛÙÈΤ˜ Ï¢ڤ˜, ‰˘ÛÏ·Û›· Î·È Û˘ÓÙ‹ÍÂȘ ÙˆÓ ÛÔÓ‰‡ÏˆÓ. ™Â ‰ËÌÔÛȇÛÂȘ ÂÚÈÁÚ¿ÊÔÓÙ·È ÛÔÚ·‰Èο ‰È¿ÊÔÚ˜ ¿ÏϘ ·ÓˆÌ·Ï›Â˜ fiˆ˜, ÛÎÔÏ›ˆÛË, ‰È·ÊÚ·ÁÌ·ÙÔ΋ÏË, ÏÂÙfi ‰È¿ÊÚ·ÁÌ·, ·ÌÊ›‚ÔÏ· ¤Íˆ ÁÂÓÓËÙÈο fiÚÁ·Ó·, ·ÓÒÌ·ÏË ‹ ·ÙÂÏ‹˜ ÂÚÈÛÙÚÔÊ‹ ÙˆÓ ÛÏ¿Á¯ÓˆÓ, ·ÙÚËÛ›· ÙÔ˘ ÎfiÏÔ˘, Ó¢ÚÔ·ıÔÏÔÁÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·139
139
£·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·
ÂÁÎÂÊ¿ÏÔ˘ Î·È ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡, ˘‰ÚÔÓ¤ÊÚˆÛË Î·È ‚Ú·¯‡˜ ÔÌÊ¿ÏÈÔ˜ ÏÒÚÔ˜. ∫ÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ‹ Ê˘ÏÔÛ‡Ó‰ÂÙÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·Ú·ÎÙ‹Ú· (1,4-6). √È ∏all Î·È Û˘Ó (1984) Âȯ›ÚËÛ·Ó ÌÈ· ‰È·›ÚÂÛË Û ÙÚÂȘ ÔÌ¿‰Â˜ Ì ‚¿ÛË ÙÔÓ ¯ÚfiÓÔ ¤Ó·Ú͢ Ù˘ ÂÓ‰ÔÌ‹ÙÚÈ·˜ ‰˘ÛÙÚÔÊ›·˜, ÙÔÓ ¯ÚfiÓÔ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ·˘¯ÂÓÈÎÔ‡ Ôȉ‹Ì·ÙÔ˜ Î·È ÙËÓ ·ÚÔ˘Û›· ‹ ·Ô˘Û›· ÔÛÙÈÎÒÓ Û˘Óً͈Ó. ™‡Ìʈӷ ÏÔÈfiÓ Ì ·˘Ù‹ ÙË ‰È·›ÚÂÛË ‰È·ÎÚ›ÓÔÓÙ·È ÙÚÂȘ Ù‡ÔÈ: o ÚÒÙÔ˜ ¯ˆÚ›˜ ÔÛÙÈΤ˜ Û˘ÓÙ‹ÍÂȘ, Ô ‰Â‡ÙÂÚÔ˜ Ì ۇÓÙËÍË Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È Ô ÙÚ›ÙÔ˜ Ì ÔÛÙÈΤ˜ Û˘ÓÙ‹ÍÂȘ, ÂÎÙfi˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ (7). √È de Die-Smulders Î·È Û˘Ó (1990) ·Ó·ÛÎfiËÛ·Ó ·fi ÙË ‚È‚ÏÈÔÁÚ·Ê›· 36 ÂÚÈÙÒÛÂȘ ÙÔ˘ LMPS Î·È ÙÔ ‰È·›ÚÂÛ·Ó Û ÙÚÂȘ ÔÌ¿‰Â˜: “ÚÒÈÌÔ LPMS”, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ ÛÙÔ 2Ô ‹ 3Ô ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘ Î·È ·ÚÔ˘Û›· ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· ‹/ Î·È Î˘ÛÙÈÎÔ‡ ˘ÁÚÒÌ·ÙÔ˜, “fi„ÈÌÔ LMPS” ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ÂÈ‚›ˆÛË ÙÔ˘ ÂÌ‚Ú‡Ô˘ ̤¯ÚÈ ÙÔ 3Ô ÙÚ›ÌËÓÔ Î·È ·Ô˘Û›· ÂÌ‚Ú˘˚ÎÔ‡ ‡‰Úˆ· Î·È Ù¤ÏÔ˜ ÙÔÓ “ÊÈÓÏ·Ó‰ÈÎfi Ù‡Ô”, ¯·Ú·ÎÙËÚÈ˙fiÌÂÓÔ ·fi ÂÌ‚Ú˘˚Îfi ‡‰Úˆ· ·fi ÙËÓ 15Ë Â‚‰ÔÌ¿‰· Ù˘ ·ËÛ˘, ·fi ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ Î·Ù¿ ̤ÛÔÓ fiÚÔ ÙËÓ 29Ë Â‚‰ÔÌ¿‰· Î·È ·fi ÂȉÈο Ó¢ÚÔ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· (8). ¶ÂÚÈÁÚ¿ÊÂÙ·È ÌÈ· ÔÈÎÔÁ¤ÓÂÈ· Ù˘ ÔÔ›·˜ ÙÔ 1o ¿ÚÚÂÓ Ù¤ÎÓÔ Â›¯Â ı·Ó·ÙËÊfiÚÔ Û‡Ó‰ÚÔÌÔ Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ·. °›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙË ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Ô˘ ‰fiıËΠÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘, ÛÙ· ·‰¤ÏÊÈ· ÙˆÓ ÁÔÓ¤ˆÓ Î·È ÚfiÛÊ·Ù· ÛÙ· ˘ÁÈ‹ ·‰¤ÏÊÈ· ÙÔ˘ ÂÊË‚È΋˜ ËÏÈΛ·˜. ∏ ÂÚ›ÙˆÛË Â›Ó·È Ë ÚÒÙË Ô˘ ‰ËÌÔÛȇÂÙ·È ÛÙËÓ ÂÏÏËÓÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·.
¶ÂÚÈÁÚ·Ê‹ ÂÚ›ÙˆÛ˘ ∑¢Á¿ÚÈ Ó·ÚÒÓ ∂ÏÏ‹ÓˆÓ ÚÔÛ‹Ïı ÁÈ· ÚÒÙË ÊÔÚ¿ ÙÔ 1988 ÁÈ· ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË, ÂÂȉ‹ Ë ÌËÙ¤Ú· ‹Ù·Ó ¤ÁÎ˘Ô˜ Û ‰Â‡ÙÂÚË Î‡ËÛË, ‚ÚÈÛÎfiÙ·Ó ÛÙË 10Ë Â‚‰ÔÌ¿‰· Î·È Â›¯Â ÈÛÙÔÚÈÎfi ÂÓfi˜ ıÓËÛÈÁÂÓÔ‡˜ ‰˘ÛÌÔÚÊÈÎÔ‡ ÓÂÔÁÓÔ‡ ÚÔ ‰ÈÂÙ›·˜, ÙÔ˘ ÔÔ›Ô˘ ÚÔÛÂÎfiÌÈÛ·Ó ÊˆÙÔÁڷʛ˜ (∂ÈÎfiÓ˜ 1,2,3). ∆Ô ÈÛÙÔÚÈÎfi Ù˘ ÚÒÙ˘ ·ËÛ˘ ›¯Â ˆ˜ ÂÍ‹˜: ÔÈ ÁÔÓ›˜ ‹Ù·Ó ˘ÁÈ›˜, ‰ÂÓ ‹Ù·Ó Û˘ÁÁÂÓ›˜ ÌÂٷ͇ ÙÔ˘˜ Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÙÔ˘˜ ÙfiÙÂ, ‹Ù·Ó ÂχıÂÚÔ. √ ·Ù¤Ú·˜ ‹Ù·Ó 29 Î·È Ë ÌËÙ¤Ú· 26 ÂÙÒÓ (∂ÈÎfiÓ˜ 4, III(1) Î·È III(5)) ·ÓÙ›ÛÙÔȯ·. ∞fi ÙȘ ·Ú¯¤˜ ÙÔ˘ ‚ã ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘ ·-
∂ÈÎfiÓ· 1. º·›ÓÂÙ·È Ë ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙÔ˘ ·˘ÙÈÔ‡, ÔÈÛıÔ-ÌÈÎÚÔÁÓ·ı›·, Ë ·Ó·ÛËΈ̤ÓË Ì‡ÙË, Ù· ÙÂÚ‡ÁÈ· ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛˆÓ.
Ú·ÙËÚ‹ıËΠÔÏ˘¿ÌÓÈÔ. ∏ ÌËÙ¤Ú· ·Ó¤ÊÂÚ ÌÂȈ̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ù˘. ŒÁÈÓ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È Ù· Â˘Ú‹Ì·Ù· ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó “·Û·Ê‹”. ¢ÈÂÓÂÚÁ‹ıËΠ·ÌÓÈԷڷΤÓÙËÛË Î·È Ô ¯ÚˆÌÔÛˆÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì G-banding ¤‰ÂÈÍÂ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘Ô ¿ÚÚÂÓÔ˜ (46, ÃÀ). ∏ ·ËÛË Û˘Ó¯›ÛÙËÎÂ Î·È ÌÂÙ¿ ·fi ·˘ÙfiÌ·ÙË Ú‹ÍË ÙˆÓ ˘Ì¤ÓˆÓ ÁÂÓÓ‹ıËΠ¤Ó· ÙÂÏÂÈfiÌËÓÔ ıÓËÛÈÁÂÓ¤˜ ¿ÚÚÂÓ ‰˘ÛÌÔÚÊÈÎfi ÓÂÔÁÓfi (EÈÎfiÓ· 4, πV(3)). ∆Ô ·ÌÓÈ·Îfi ˘ÁÚfi ‹Ù·Ó ίڈṲ̂ÓÔ. ¢ÂÓ ¤ÁÈÓ ÓÂÎÚÔ„›·. ∞fi ÙȘ ʈÙÔÁڷʛ˜ Ê¿ÓËΠfiÙÈ ÙÔ ÓÂÔÁÓfi ›¯Â ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·, ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· Û ο̄Ë, Û˘ÌÌÂÙÚÈο ÙÂÚ‡ÁÈ· ÙˆÓ ·ÁÎÒÓˆÓ Î·È ÙˆÓ Î·Ù’ ÈÛ¯›ˆÓ ·ÚıÚÒÛˆÓ, ηÌÙÔ‰·ÎÙ˘Ï›· ¯ÂÈÚÒÓ, ¤Ûˆ ÛÙÚÔÊ‹ ÙˆÓ ÂÏÌ¿ÙˆÓ, ‰È¿Ù·ÛË Ù˘ ÎÔÈÏ›·˜, ÌÂÁ¿ÏË ·fiÛÙ·ÛË ÌÂٷ͇ ÙˆÓ ıËÏÒÓ, ‚Ú·¯‡ Ï·ÈÌfi, ÂÌÊ·ÓÒ˜ ¯·ÌËÏ‹ ÚfiÛÊ˘ÛË ÙˆÓ ·˘ÙÈÒÓ, ˘ÂÚÙÂÏÔÚÈÛÌfi, ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹ ÊÔÚ¿ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ·ÓÔȯÙfi ÛÙfiÌ·, ÔÈÛıÔ-ÌÈÎÚÔÁÓ·ı›·, Ï·ÙÈ¿ ·Ó·ÛËΈ̤ÓË Ì‡ÙË, ¢ÌÂÁ¤ıË 2Ô Î·È 3Ô ‰¿ÎÙ˘ÏÔ Ô‰ÈÒÓ, ÌÂÁ¿ÏË ·fiÛÙ·ÛË ÌÂٷ͇ 1Ô˘ Î·È 2Ô˘ ‰·ÎÙ‡ÏÔ˘ ÙÔ˘ Ô‰ÈÔ‡, ¿‰ÂÈÔ ¶·È‰È·ÙÚÈ΋ 2006;69:138-142
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·140
140
Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘
∂ÈÎfiÓ· 2. º·›ÓÂÙ·È Ë ·ÓÙÈÌÔÁÁÔÏÔÂȉ‹˜ ÊÔÚ¿ ÙˆÓ ‚ÏÂÊ·ÚÈÎÒÓ Û¯ÈÛÌÒÓ, ÙÔ ·ÓÔȯÙfi ÛÙfiÌ·, Ë Ï·ÙÈ¿ ·Ó·ÛËΈ̤ÓË Ì‡ÙË, Ô Â˘ÌÂÁ¤ı˘ 2Ô˜ ‰¿ÎÙ˘ÏÔ˜, ÎÂÓfi fiÛ¯ÂÔ, Ù· ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚ· Û ο̄Ë, Ë ¤Ûˆ ÛÙÚÔÊ‹ ÙˆÓ ÂÏÌ¿ÙˆÓ.
∂ÈÎfiÓ· 3. º·›ÓÂÙ·È ÙÔ ÙÂÚ‡ÁÈÔ ÙÔ˘ ·ÚÈÛÙÂÚÔ‡ ·ÁÎÒÓ·, Ê˘Û·Ï›‰· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÒÌÔ ÂÓ‰ÂÈÎÙÈ΋ ÙÔ˘ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ Ôȉ‹Ì·ÙÔ˜.
™˘˙‹ÙËÛË fiÛ¯ÂÔ. ∞fi ÙÔ ÈÛÙÔÚÈÎfi Ù˘ ·ËÛ˘ ·ÏÏ¿ Î·È ·fi Ù· Ê·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ ÓÂÔÁÓfi ÏËÚÔ‡Û ٷ ÎÏÈÓÈο ÎÚÈÙ‹ÚÈ· ÙÔ˘ LMPS. √È ÁÔÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙËÓ ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È ÙÔÓ Î›Ó‰˘ÓÔ Â·Ó¿Ï˄˘ ÛÙÔ˘˜ ·ÔÁfiÓÔ˘˜ ÙÔ˘˜. ∆Ô˘˜ Û˘ÛÙ‹ıËΠ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ·ÚÔ‡Û·˜ 2˘ ·ÏÏ¿ Î·È Î¿ı ÌÂÏÏÔÓÙÈ΋˜ ·ËÛ˘ ÌÂ Û˘¯Ó¿ ˘ÂÚ˯ÔÁÚ·Ê‹Ì·Ù· Î·È ÚÔÛ‰ÈÔÚÈÛÌfi ÙˆÓ ÂȤ‰ˆÓ Ù˘ ∞FP ÛÙÔÓ ÔÚfi Ù˘ ÌËÙ¤Ú·˜. ∞fi ÙË ‰Â‡ÙÂÚË Î‡ËÛË ÁÂÓÓ‹ıËΠ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ, 16 ÂÙÒÓ Û‹ÌÂÚ· (EÈÎfiÓ· 4, IV(4)). ∞ÎÔÏÔ‡ıËÛÂ Î·È ÙÚ›ÙË ÂÁ΢ÌÔÛ‡ÓË, ÙËÓ ÔÔ›· ·Ú·ÎÔÏÔ‡ıËÛ·Ó Û‡Ìʈӷ Ì ÙȘ ›‰È˜ Ô‰ËÁ›Â˜ Î·È ÁÂÓÓ‹ıËΠ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 12 ÂÙÒÓ Û‹ÌÂÚ· (EÈÎfiÓ· 4, IV(5)). ∞ӷʤÚÂÙ·È Î·È Ì›· ٤ٷÚÙË Î‡ËÛË (EÈÎfiÓ· 4, πV(6)) ÙËÓ ÔÔ›· ‰È¤ÎÔ„·Ó ËıÂÏË̤ӷ (¤ÎÙÚˆÛË), ÏfiÁˆ Êfi‚Ô˘ Ù˘ ÌËÙ¤Ú·˜ ÁÈ· ÂӉ¯fiÌÂÓË Â·ÓÂÌÊ¿ÓÈÛË ÙÔ˘ LMPS. ¶ÚfiÛÊ·Ù· ÔÈ ÁÔÓ›˜ ·ӋÏı·Ó ˙ËÙÒÓÙ·˜ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Û¯ÂÙÈο Ì ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙˆÓ ˘ÁÈÒÓ ·È‰ÈÒÓ ÙÔ˘˜ ÂÊË‚È΋˜ ËÏÈΛ·˜. ¶·È‰È·ÙÚÈ΋ 2006;69:138-142
∫·ıÒ˜ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Ô ÂÓ‰ÔÌ‹ÙÚÈÔ˜ ı¿Ó·ÙÔ˜, ÔÈ Froster Î·È Û˘Ó (1997), ÚÔÙ›ÓÔ˘Ó ÁÈ· ÙËÓ ·ÎÚÈ‚‹ ‰È¿ÁÓˆÛ‹ ÙÔ˘ Î·È ·ÎÔÏÔ‡ıˆ˜, ÁÈ· ÙË ÛˆÛÙ‹ ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË ÙˆÓ ÁÔÓ¤ˆÓ, ÙÔ˘˜ ·Ú·Î¿Ùˆ ¯ÂÈÚÈÛÌÔ‡˜ ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi: ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ıÓËÛÈÁÂÓÔ‡˜ ÓÂÔÁÓÔ‡, ·ÎÙÈÓÔÁڷʛ˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ ÙÔ˘, ÓÂÎÚÔ„›· ÁÈ· ¤ÏÂÁ¯Ô ‡·Ú͢ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ Î·È ÁÈ· ¤ÏÂÁ¯Ô ÙÔ˘ ‰È·ÊÚ¿ÁÌ·ÙÔ˜. ™ÙȘ ÂÚÈÙÒÛÂȘ Ì ‚·ÚÈ¿ ·˘ÙfiÏ˘ÛË Û˘ÓÈÛÙ¿Ù·È ‚ÈÔ„›· Ì˘fi˜ ÁÈ· Ù·˘ÙÔÔ›ËÛË Ù˘ ÂÎʇÏÈÛ˘ ÙˆÓ Ì˘ÒÓ, Ó¢ÚÔ˚ÛÙÔÏÔÁÈΤ˜ ÌÂϤÙ˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ÌÂÁ¿ÏˆÓ ‚Ï·‚ÒÓ ÙÔ˘ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ηٷÁÚ·Ê‹ ÙˆÓ Ê·ÈÓÔÙ˘ÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ì Ôχ ηϋ ʈÙÔÁÚ¿ÊËÛË ÁÈ· ÙËÓ ÙÂÎÌËÚ›ˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Î·È Û‡ÁÎÚÈÛË Ì ¿ÏϘ ·ÚfiÌÔȘ ÂÚÈÙÒÛÂȘ Î·È Ù¤ÏÔ˜ ηڢfiÙ˘Ô (4,8). ∆Ô ÓÂÔÁÓfi ÛÙȘ ʈÙÔÁڷʛ˜ ·ÚÔ˘Û›·˙ ٷ Ù˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο ÙÔ˘ LMPS, Û˘ÁÎÂÎÚÈ̤ӷ: ÁÂÓÈÎÂ˘Ì¤ÓÔ Ô›‰ËÌ·, Û˘ÌÌÂÙÚÈο ÙÂÚ‡ÁÈ· ÌÂÁ¿ÏˆÓ ·ÚıÚÒÛÂˆÓ Û ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ
Pediatr Mar-Apr 06
18-04-06
16:42
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8
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18
9
23
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4
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1
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∂ÈÎfiÓ· 4. √ÈÎÔÁÂÓÂÈ·Îfi ‰¤Ó‰ÚÔ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜: IV(3): ÙÔ ÓÂÔÁÓfi Ì LMPS III(1) Î·È III(5): ·Ù¤Ú·˜ Î·È ÌËÙ¤Ú· ÙÔ˘ ÓÂÔÁÓÔ‡, ·ÓÙ›ÛÙÔȯ· III(6) Î·È III(7): ·‰ÂÏÊ‹ Î·È ·‰ÂÏÊfi˜ Ù˘ ÌËÙ¤Ú·˜, ·ÓÙ›ÛÙÔȯ· III(2): ·‰ÂÏÊfi˜ ÙÔ˘ ·Ù¤Ú· IV(4): ˘ÁÈ‹˜ ·‰ÂÏÊfi˜ Î·È IV(5): ˘ÁÈ‹˜ ·‰ÂÏÊ‹ ÙÔ˘ ÓÂÔÁÓÔ‡, 16 Î·È 12 ÂÙÒÓ Û‹ÌÂÚ·, ·ÓÙ›ÛÙÔȯ· πV(7) Î·È πV (8): ˘ÁÈ‹ ·È‰È¿ ÙÔ˘ ·‰ÂÏÊÔ‡ Ù˘ ÌËÙ¤Ú·˜ IV(9), IV(10), IV(11): ˘ÁÈ‹ ·È‰È¿ Ù˘ ·‰ÂÏÊ‹˜ Ù˘ ÌËÙ¤Ú·˜ IV(1), IV(2): ˘ÁÈ‹ ·È‰È¿ ÙÔ˘ ·‰ÂÏÊÔ‡ ÙÔ˘ ·Ù¤Ú·.
ÂÚÈÔ¯¤˜ ÙÔ˘ ÛÒÌ·ÙÔ˜ (·ÁÎÒÓ˜ Î·È ÈÛ¯›·), Î¿Ì„Ë ÙˆÓ ·ÚıÚÒÛˆÓ, ÌÔÚÊÔÏÔÁÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÙÔ˘ ÚÔÛÒÔ˘ (∂ÈÎfiÓ˜ 1-3), Â˘Ú‹Ì·Ù· Ù· ÔÔ›· ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔÓ ÂÓ‰ÔÌ‹ÙÚÈÔ ı¿Ó·ÙÔ, ÙËÓ ·Ó·ÊÂÚfiÌÂÓË ·fi ÙË ÌËÙ¤Ú· ÌÂȈ̤ÓË ÂÓ‰ÔÌ‹ÙÚÈ· ÎÈÓËÙÈÎfiÙËÙ·, ÙËÓ ·ÚÔ˘Û›· ÔÏ˘¿ÌÓÈÔ˘ Î·È ÙÔÓ Ê˘ÛÈÔÏÔÁÈÎfi ηڢfiÙ˘o, Û˘Ó¤‚·Ï·Ó ÛÙË ‰È¿ÁÓˆÛË Î·È ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ¿ÏÏˆÓ Û˘Ó‰ÚfiÌˆÓ Ô˘ Û˘Óԉ‡ÔÓÙ·È Ì ÔÏÏ·Ï¿ ÙÂÚ‡ÁÈ· (9). ∏ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È ¿ÁÓˆÛÙË. ø˜ Èı·ÓÔ› Ì˯·ÓÈÛÌÔ› ·Ó·Ê¤ÚÔÓÙ·È Ë ÚˆÙÔ·ı‹˜ ·Ï·Û›· ÙˆÓ ·Ó·Ù˘ÛÛfiÌÂÓˆÓ Ì˘˚ÎÒÓ ÈÓÒÓ (9,10), ÔÈ ‰È·Ù·Ú·¯¤˜ ÛÙË Û‡ÓıÂÛË ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘, Ë ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ÚˆÙÂ˚ÓÒÓ Ù˘ ıÂÚÌÔÏËÍ›·˜ (heat shock proteins) (11), Ô Û˘Ó‰˘·ÛÌfi˜ ÂÌ‚Ú˘˚΋˜ ·ÎÈÓËÛ›·˜ ‹ ˘ÔÎÈÓËÛ›·˜ (fetal akinesia deformation sequence (FADS)) Î·È Ù˘ ·ÚÔ˘Û›·˜ ÂÌ‚Ú˘˚ÎÔ‡ Ôȉ‹Ì·ÙÔ˜, Ô˘ ÔÊ›ÏÂÙ·È Û ·fiÊÚ·ÍË ÙˆÓ ÛÊ·ÁÈÙȉÈÎÒÓ ÏÂÌÊ·ÁÁ›ˆÓ (jugular lymphatic obstruction sequence (JLOS)) (10). ∞Ó Î·È ‰ÂÓ ¤¯ÂÈ Ù·˘ÙÔÔÈËı› ÌÈ· ÂȉÈ΋ ÁÔÓȉȷ΋ ‚Ï¿‚Ë, Ê·›ÓÂÙ·È fiÙÈ Ùo Û‡Ó‰ÚÔÌÔ ÎÏËÚÔÓÔÌÂ›Ù·È Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ ·˘ÙÔۈ̷ÙÈÎfi ¯·Ú·ÎÙ‹Ú· ‹ Ì ÙÔÓ ˘ÔÏÂÈfiÌÂÓÔ Ã-Ê˘ÏÔÛ‡Ó‰ÂÙÔ ¯·Ú·ÎÙ‹Ú· (1,4-6). ∞Ó·ÛÎfiËÛË 27 ÔÈÎÔÁÂÓÂÈÒÓ ‰Â›¯ÓÂÈ ÌÈ· Û¯¤ÛË ·ÚÚ¤ÓˆÓ/ı‹Ï· 1.3:1 (12). √È Meyer Î·È Û˘Ó (1999) ·Ó·ÛÎÔÒ-
ÓÙ·˜ ÙË ‚È‚ÏÈÔÁÚ·Ê›· ‚Ú‹Î·Ó ¤ÍÈ ÔÈÎÔÁ¤ÓÂȘ Ì ÂÚÈÛÛfiÙÂÚ· ÙÔ˘ ÂÓfi˜ ¿Û¯ÔÓÙ· ¿ÚÚÂÓ· ÓÂÔÁÓ¿ (6). ∏ ‰È¿ÎÚÈÛË ÙÔ˘ ÙÚfiÔ˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ ··ÈÙ› ·Ó¿Ï˘ÛË ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ‰¤Ó‰ÚÔ˘, ÂÂȉ‹ ‰ÂÓ ˘¿Ú¯Ô˘Ó οÔÈ· Û˘ÁÎÂÎÚÈ̤ӷ ÌÔÚÊÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ Ó· ‰È·ÎÚ›ÓÔ˘Ó ÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜ Ù˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ™ÙËÓ ·ÚÔ‡Û· ÔÈÎÔÁ¤ÓÂÈ· ‰ÂÓ ˘‹Ú¯Â Û˘ÁÁ¤ÓÂÈ· ÙˆÓ ÁÔÓ¤ˆÓ, Ô ·Ù¤Ú·˜ ÚÔÂÚ¯fiÙ·Ó ·fi ÌÈ· ÔÏ˘ÌÂÏ‹ ÔÈÎÔÁ¤ÓÂÈ·, ÙÔ ÓÂÔÁÓfi ‹Ù·Ó ¿ÚÚÂÓ ÎÈ ¤ÙÛÈ ‰ÂÓ ‹Ù·Ó ‰˘Ó·ÙfiÓ Ó· ·ÔÎÏÂÈÛı›, Ô‡ÙÂ Ë ·˘ÙÔۈ̷ÙÈ΋ ˘ÔÏÂÈfiÌÂÓË, Ô‡ÙÂ Ë Ã-Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ·. ∏ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Â›Ó·È ‰˘Ó·Ù‹ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ·, ÙÔ ÔÔ›Ô ·ÔηχÙÂÈ ÙÔ ÔÏ˘¿ÌÓÈÔ, ÙÔ ÂÌ‚Ú˘˚Îfi Ô›‰ËÌ· (‡‰Úˆ· ‹/Î·È Î˘ÛÙÈÎfi ‡Áڈ̷), ÙËÓ ÂÏ·Ùو̤ÓË ÂÓ‰ÔÌ‹ÙÚÈ· ÎÈÓËÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÚÔ˘Û›· ·ıÔÏÔÁÈÎÒÓ ÛˆÌ·ÙÈÎÒÓ ·Ó·ÏÔÁÈÒÓ, ȉȷ›ÙÂÚ· ηٿ ÙÔ ‰Â‡ÙÂÚÔ ÙÚ›ÌËÓÔ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘. ªÂ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÚÔ˘Ù›Ó·˜ Â›Ó·È ·›ı·ÓÔ Ó· ‰È·ÁÓˆÛÙ› Ë ·ÚÔ˘Û›· ÙˆÓ ÙÂÚ˘Á›ˆÓ (13). ªÂ ÙËÓ ÂͤÏÈÍË Ù˘ ‰È·ÎÚÈÙÈ΋˜ ÈηÓfiÙËÙ·˜ ÙˆÓ ˘ÂÚ‹¯ˆÓ, Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰È·ÈÛÙˆıÔ˘Ó Ù· ÙÂÚ‡ÁÈ· Î·È Ë ÂÏ·Ùو̤ÓË ÎÈÓËÙÈÎfiÙËÙ· ÙÔ˘ ÂÌ‚Ú‡Ô˘ Ì ‰È·ÎÔÏÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ·. ∞ӷʤÚÂÙ·È Ì¿ÏÈÛÙ· ·fi ÙÔ˘˜ Sciarrone Î·È Û˘Ó (1998) Û¯ÂÙÈο ÚÒÈÌË ÛÙË 19Ë Â‚‰ÔÌ¿‰· ·ËÛ˘ ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ‰È¿ÁÓˆÛË ÙˆÓ ÙÂÚ˘Á›ˆÓ ÛÙȘ ÌÂÁ¿Ï˜ ¶·È‰È·ÙÚÈ΋ 2006;69:138-142
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·142
142
Ã. ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘, ∞. °ÂˆÚÁÔ‡ÓÙ˙Ô˘
·ÚıÚÒÛÂȘ (1). Œ¯Ô˘Ó ·Ó·ÊÂÚı› ˘ÂÚ˯ÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û ¤Ì‚Ú˘Ô 13 ‚‰ÔÌ¿‰ˆÓ (΢ÛÙÈÎfi ‡Áڈ̷, ·Ú·ÌÔÚÊÒÛÂȘ ÙˆÓ Ì·ÎÚÒÓ ÔÛÙÒÓ, ·ÓˆÌ·Ï›Â˜ Ù˘ ÛÔÓ‰˘ÏÈ΋˜ ÛÙ‹Ï˘ Î·È ˘ÂÚÙÂÏÔÚÈÛÌfi˜). ªÂ ‚¿ÛË ·˘Ù¿ Â›Ó·È Èı·Ófi Ë ·Ó¿Ù˘ÍË ÙˆÓ ÙÂÚ˘Á›ˆÓ Ó· ·Ú¯›˙ÂÈ ÛÙÔ ÚÒÙÔ ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘, ¯ˆÚ›˜ fï˜ Ó· Â›Ó·È ÁÓˆÛÙfi ·Ó ·˘Ùfi ÈÛ¯‡ÂÈ Û fiϘ ÙȘ ÂÚÈÙÒÛÂȘ Î·È ·Ó fiÏ· Ù· ÙÂÚ‡ÁÈ· ·Ó·Ù‡ÛÛÔÓÙ·È Î·Ù¿ ÙËÓ ›‰È· ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô (1). ™ÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÙËÓ ·Ú·¿Óˆ ÓÔÛÔÏÔÁÈ΋ ÔÓÙfiÙËÙ·, Ô Î·Ú˘fiÙ˘Ô˜ Â›Ó·È ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ™ÙËÓ ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË Û˘Ì‚¿ÏÏÂÈ Î·È Ë ÂÎÙ›ÌËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ∞FP ÙÔ˘ ÔÚÔ‡ Ù˘ ÂÁ·Ԣ. √È ÁÔÓ›˜ ÙÔ˘ ˘fi Û˘˙‹ÙËÛË ÓÂÔÁÓÔ‡ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙÔÓ Î›Ó‰˘ÓÔ Â·Ó¿Ï˄˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û οı ÌÂÏÏÔÓÙÈÎfi ·fiÁÔÓfi ÙÔ˘˜ ‚¿ÛÂÈ ÙÔ˘ ‰È·ÊÔÚÂÙÈÎÔ‡ ÙÚfiÔ˘ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ô ÔÔ›Ô˜ ›ӷÈ: 25% ÁÈ· ÙËÓ ÂÚ›ÙˆÛË Ù˘ ·˘ÙÔۈ̷ÙÈ΋˜ ˘ÔÏÂÈfiÌÂÓ˘ Î·È 50% ÁÈ· Ù· ·ÁfiÚÈ· ÛÙË Ê˘ÏÔÛ‡Ó‰ÂÙË. ∂›Û˘ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙË ‰˘Ó·ÙfiÙËÙ· Ù˘ ÚÔÁÂÓÓËÙÈ΋˜ ‰È¿ÁÓˆÛ˘ Ì ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· Î·È Ì ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÂȤ‰ˆÓ Ù˘ ∞FP ÙÔ˘ ÔÚÔ‡ Ù˘ ÂÁ·Ԣ ÛÙȘ ·Ú¯¤˜ ÙÔ˘ ‚ã ÙÚÈÌ‹ÓÔ˘ Ù˘ ·ËÛ˘. ∞ÍÈÔÔÈÒÓÙ·˜ ·˘Ù¤˜ ÙȘ ÏËÚÔÊÔڛ˜ ·¤ÎÙËÛ·Ó ‰‡Ô ·È‰È¿ Î·È ¤¯Ô˘Ó Û‹ÌÂÚ· ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ·ÁfiÚÈ Î·È ¤Ó· Ê˘ÛÈÔÏÔÁÈÎfi ÎÔÚ›ÙÛÈ, 16 Î·È 12 ÂÙÒÓ ·ÓÙ›ÛÙÔȯ·. ªÂÙ¿ ·fi ÁÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ë ·‰ÂÏÊ‹ Ù˘ ÌËÙ¤Ú·˜ ·¤ÎÙËÛ ÙÚ›· ˘ÁÈ‹ ·È‰È¿, ¤Ó· ÎÔÚ›ÙÛÈ Î·È ‰‡Ô ·ÁfiÚÈ·, ËÏÈΛ·˜ 12, 8 Î·È 6 ÂÙÒÓ ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 4, IV(9),IV(10),IV(11)), ÂÓÒ Ô ·‰ÂÏÊfi˜ Ù˘ ÌËÙ¤Ú·˜ ·¤ÎÙËÛ ‰‡Ô ˘ÁÈ‹ ·ÁfiÚÈ·, ËÏÈΛ·˜ 7 Î·È 5 ÂÙÒÓ, (∂ÈÎfiÓ· 4, VI(7) Î·È VI(8)) ·ÓÙ›ÛÙÔȯ·. ∆¤ÏÔ˜ Ô ·‰ÂÏÊfi˜ ÙÔ˘ ·Ù¤Ú· ̤¯ÚÈ Û‹ÌÂÚ· ¤¯ÂÈ ·ÔÎÙ‹ÛÂÈ ‰‡Ô ˘ÁÈ‹ ·È‰È¿, ¤Ó· ÎÔÚ›ÙÛÈ Î·È ¤Ó· ·ÁfiÚÈ ËÏÈΛ·˜ 8 Î·È 5 ÂÙÒÓ ·ÓÙ›ÛÙÔȯ· (∂ÈÎfiÓ· 4,VI (1),VI(2)). ™¯ÂÙÈο Ì ÙËÓ ÎÏËÚÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË ÙˆÓ ‰‡Ô ˘ÁÈÒÓ ·È‰ÈÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Ô ÁÈo˜ ÙÔ˘˜ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÂÎÙfi˜ ÎÈÓ‰‡ÓÔ˘ Ó· ·ÔÎÙ‹ÛÂÈ ÌÂÏÏÔÓÙÈÎÔ‡˜ ·ıÔÏÔÁÈÎÔ‡˜ ·ÔÁfiÓÔ˘˜, Ì ÔÔÈÔÓ‰‹ÔÙ ·fi ÙÔ˘˜ ‰‡Ô Ù‡Ô˘˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ŸÛÔÓ ·ÊÔÚ¿ ÙË Ã-Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ· ‰ÂÓ ÌÔÚ› Ó· Â›Ó·È ÊÔÚ¤·˜, ÂÓÒ Ì ÙËÓ ˘ÔÏÂÈfiÌÂÓË ·˘ÙÔۈ̷ÙÈ΋, ·ÎfiÌ· ÎÈ ·Ó Â›Ó·È ÊÔÚ¤·˜, Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ·ÌÂÏËÙ¤Ô˜, ÏfiÁˆ Ù˘ Û·ÓÈfiÙËÙ·˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. ∏ ÎfiÚË ÙÔ˘˜ fï˜, ÌÔÚ› Ó· Â›Ó·È ÊÔÚ¤·˜ Ì ÙÔÓ ¤Ó· ‹ ÙÔÓ ¿ÏÏÔ Ù‡Ô ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜. ªÂ ÙËÓ ˘ÔÏÂÈfiÌÂÓË, ·Ó ¶·È‰È·ÙÚÈ΋ 2006;69:138-142
Â›Ó·È ÊÔÚ¤·˜, Ô Î›Ó‰˘ÓÔ˜ Â›Ó·È ·ÌÂÏËÙ¤Ô˜, fiˆ˜ Î·È ÁÈ· ÙÔÓ ·‰ÂÏÊfi Ù˘. ªÂ ÙË Ê˘ÏÔÛ‡Ó‰ÂÙË ÎÏËÚÔÓÔÌÈÎfiÙËÙ· fï˜, ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ Ó· ·ÔÎÙ‹ÛÂÈ ·ıÔÏÔÁÈÎfi ·fiÁÔÓÔ, Ì Èı·ÓfiÙËÙ· ¤ˆ˜ 50%. ø˜ ÂÎ ÙÔ‡ÙÔ˘ Û˘ÛÙ‹ıËΠÛÙËÓ ÎfiÚË, Û ÂӉ¯fiÌÂÓË ÌÂÏÏÔÓÙÈ΋ ÂÁ΢ÌÔÛ‡ÓË, ˘ÂÚ˯ÔÁÚ·ÊÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË Î·È ¤ÏÂÁ¯Ô˜ Ù˘ ∞FP ÙÔ˘ ÔÚÔ‡ Ù˘ ·fi ÙȘ ·Ú¯¤˜ Ù˘ ÂÁ΢ÌÔÛ‡Ó˘.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Sciarrone A, Verdiglione P, Botta G, Franceschini P, Todros T. Prenatal diagnosis of lethal multiple pterygium syndrome in mid- pregnancy [Letter to the Editor]. Ultrasound Obstet Gynecol 1998;12:218-219. 2. Tolmie JL, Patrick A, Yates JR. A Lethal multiple pterygium syndrome with apparent X- linked recessive inheritance. Am J Med Genet 1987;27:913-919. 3. Brink DS, Luisiri A, Grange DK. Case report: lethal multiple pterygium syndrome. Pediatric Pathol Mol Med 2003;22:461-470. 4. Froster UG, Stallmach T, Wisser J, Hebisch G, Robbiani MB, Huch R et al. Lethal multiple pterygium syndrome: suggestion for a consistent pathological workup and review of reported cases [Brief clinical report]. Am J Med Genet 1997;68:82-85. 5. Martin NJ, Hill JB, Cooper DH, O'Brien GD, Masel JP. Lethal multiple pterygium syndrome: three consecutive cases in one family. Am J Med Genet 1986; 24:295-304. 6. Meyer-Cohen J, Dillon A, Pai GS, Conradi S. Lethal multiple pterygium syndrome in four male fetuses in a family: evidence for an X-linked recessive subtype? [Letter to the Editor]. Am J Med Genet 1999; 82:97-99. 7. Hall JG. The lethal multiple pterygium syndromes. Am J Med Genet 1984;17:803-807. 8. de Die-Smulders CE, Schrander-Stumpel CT, Fryns JP. The lethal multiple pterygium syndrome: A nosological approach. Genet Couns 1990;1:13-23. 9. Spearritt DJ, Tannenberg AE, Payton DJ. Lethal multiple pterygium syndrome: report of a case with neurogical anomalies. Am J Med Genet 1993;47:45-49. 10. Gericke GS. Fragile collagen and the lethal multiple pterygium syndrome: does heat stress play a role? Am J Med Genet 1991;38:630-631. 11. Moerman P, Fryns JP. The fetal akinesia deformation sequence: A fetopathological approach. Genet Couns 1990;1:25-33. 12. Online Mendelian Inheritance in Man, OMIM John Hopkins University, Baltimore, MD, MIM Number: 253290, 1/19/99. World Wide Web URL: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db= OMIM 13. Lockwood C, Irons M, Troiani J, Kawada C, Chaudhury A, Cetrulo C. The prenatal diagnosis of lethal multiple pterygium syndrome: A heritable cause of recurrent abortion. Am J Obstet Gynecol 1998;159: 474-476.
Pediatr Mar-Apr 06
18-04-06
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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏
CASE REPORT
143
™¿ÓÈ· ÂÌÊ¿ÓÈÛË ÔÈÎÔÁÂÓÔ‡˜ ÓfiÛÔ˘ Moyamoya Û ·ÛıÂÓ›˜ Ù˘ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜ ∂. ª·˙›ÁÔ˘ - ºˆÙÔÔ‡ÏÔ˘1, ¡. µ·ÛÈÏ¿ÎË1, ™. ∞ÚÒÓË2, H. Ikeda3, ∞. ¶··‚·ÛÈÏ›Ԣ1
¶ÂÚ›ÏË„Ë: ∏ ÓfiÛÔ˜ ªÔyamoya (MM) ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÛÙ¤ÓˆÛË ‹ ·fiÊÚ·ÍË ÙˆÓ Î‡ÚÈˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ. ªÔÏÔÓfiÙÈ Ë ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ¿ÁÓˆÛÙË, ˘¿Ú¯Ô˘Ó ÛÔ‚·Ú¤˜ ÂӉ›ÍÂȘ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÔÏ˘·Ú·ÁÔÓÙÈÎfi ÓfiÛËÌ·. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰‡Ô ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÔ‡˜ ÌÔÚÊ‹˜ ªª Û ¿ÙÔÌ· Â˘Úˆ·˚΋˜ ηٷÁˆÁ‹˜, ÁÈ· Ó· ÙÔÓ›ÛÔ˘Ì ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ Û¿ÓÈ·˜ ·˘Ù‹˜ ÓfiÛÔ˘ Î·È Û ¿ÙÔÌ· Ù˘ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜, ÏËÓ Ù˘ ·ÛÈ·ÙÈ΋˜, ηıÒ˜ Î·È ÙËÓ ·ÚÔ˘Û›· ÎÏËÚÔÓÔÌÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘. ™ÙËÓ ÚÒÙË ·ÛıÂÓ‹, Ô˘ Â›Ó·È ∂ÏÏËÓ›‰·, ‰È·ÈÛÙÒıËÎ·Ó ÂÈϤÔÓ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜. ¶·ÚfiÌÔȘ ‰È·Ù·Ú·¯¤˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ë ÌËÙ¤Ú· Ù˘, Ô˘ ›Û˘ ¿Û¯ÂÈ ·fi ÓfiÛÔ ªª, ηıÒ˜ Î·È ¿ÙÔÌ· Ù˘ ÌËÙÚÈ΋˜ ÔÈÎÔÁ¤ÓÂÈ·˜. √ ‰Â‡ÙÂÚÔ˜ ·ÛıÂÓ‹˜, ¤Ó· ·ÁfiÚÈ ·fi ÙË ™ÎˆÙ›·, ·ÔÙÂÏ› ÌÔÓ·‰È΋ ÂÚ›ÙˆÛË, ηıfiÛÔÓ Ë ÓfiÛÔ˜ ªª ¤¯ÂÈ ÚÔÛ‚¿ÏÏÂÈ ¤ÓÙ ¿ÙÔÌ· Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜ Ù˘ ÌËÙÚÈ΋˜ ÙÔ˘ ÔÈÎÔÁ¤ÓÂÈ·˜. §¤ÍÂȘ ÎÏÂȉȿ: √ÈÎÔÁÂÓ‹˜ Moyamoya, ·È‰È¿, η˘Î¿ÛÈ· Ê˘Ï‹.
1 ¡Â˘ÚÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ 2 ∆Ì‹Ì· ∞ÈÌÔÚÚ·ÁÈÎÒÓ ¢È·ı¤ÛÂˆÓ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” 3 Kohnan Hospital, Department of Neurosurgery, Sendai Japan AÏÏËÏÔÁÚ·Ê›·: ∂ϤÓË ºˆÙÔÔ‡ÏÔ˘ §Â˘ÎˆÛ›·˜ 1, ¶. ¶ÂÓÙ¤ÏË T.K. 15236 ∞ı‹Ó· E-mail: fotopoul@hol.gr ∏ÌÂÚÔÌËÓ›· ˘Ô‚ÔÏ‹˜: 03-12-2004 ∏ÌÂÚÔÌËÓ›· ¤ÁÎÚÈÛ˘: 21-10-2005
Familial Moyamoya disease in two European children H. Bazigou - Fotopoulou1, N. Vassilaki1, S. Aroni2, H. Ikeda3, A. Papavassiliou1
Abstract: Moyamoya disease (MMD) is characterised by stenosis or occlusion of the main cerebral arteries detected on cerebral angiography. Although the aetiology is still unknown, there is extensive evidence that MMD may follow a multifactorial pattern of inheritance. Two cases are presented of familial MMD in children of European descent, in order to emphasize the occurrence of this rare disease in not only Oriental but also other races, and to stress the hereditary factors in its pathogenesis. The first patient, a Greek girl, has additional coagulation disorders. Her mother, who also suffers from MMD, and various other members of her family, have similar coagulation disorders. The second patient, a Scottish boy, represents a unique case of familial MMD, as five members of three consecutive generations of his maternal family also suffer from MMD. Key words: Familial Moyamoya, children, Caucasian race.
∂ÈÛ·ÁˆÁ‹ ∏ ÓfiÛÔ˜ ªª ÂÚÈÁÚ¿ÊËΠÚÒÙË ÊÔÚ¿ ÛÙËÓ π·ˆÓ›· ÙÔ 1956 ·fi ÙÔ˘˜ Takenchi Î·È Shimizu ˆ˜ ·ÌÊÔÙÂÚfiÏ¢ÚË ˘ÔÏ·Û›· ÙˆÓ Î·ÚˆÙ›‰ˆÓ (1). ∆Ô 1969 ÔÈ Suzuki Î·È Takaku ÂÈÛ‹Á·Á·Ó ÙÔÓ fiÚÔ Moyamoya ·fi ÙËÓ ·ÁÁÂÈÔÁÚ·ÊÈ΋ ÂÈÎfiÓ· Ù˘ ÓfiÛÔ˘, Ô˘ ÛÙ· π·ˆÓÈο ÛËÌ·›ÓÂÈ “Û‡ÓÓÂÊÔ Î·ÓÔ‡” (2). ª¤¯ÚÈ ÙËÓ ÂÔ¯‹ ÂΛÓË, ÂÈÎÚ·ÙÔ‡ÛÂ Ë ¿Ô„Ë fiÙÈ Ë ÓfiÛÔ˜ ·ÊÔÚÔ‡Û ·ÔÎÏÂÈÛÙÈο ÙËÓ ·ÛÈ·ÙÈ΋ Ê˘Ï‹ (3). ŒÎÙÔÙ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ Î·È ÛÙËÓ Î·˘Î¿ÛÈ· Ê˘Ï‹, Ì ۷ÊÒ˜ fï˜ ÌÈÎÚfiÙÂÚË Û˘¯ÓfiÙËÙ· (4). ™ÙË ÓfiÛÔ ªª
1 Neurology Clinic, General Children’s Hospital of Penteli 2 Department of Haemorragic Dispositions, “Aghia Sofia” Children’s Hospital 3 Kohnan Hospital, Department of Neurosurgery, Sendai Japan Correspondence: Heleni Fotopoulou 1 Lefkosias Str., P. Penteli 15236 Athens E-mail: fotopoul@hol.gr Date of submission: 03-12-2004 Date of approval: 21-10-2005
·Ú·ÙËÚÂ›Ù·È ‰˘ÛÏ·Û›· ÙÔ˘ ¤Ûˆ ¯ÈÙÒÓ· ÙˆÓ ¿ˆ ÙÌËÌ¿ÙˆÓ ÙˆÓ ¤Ûˆ ηڈٛ‰ˆÓ Î·È ÙˆÓ ÂÁÁ‡˜ ÙÌËÌ¿ÙˆÓ ÙˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Ô˘ Ô‰ËÁ› Û ÛÙ¤ÓˆÛË ‹ ·fiÊÚ·Í‹ ÙÔ˘˜ Ì ÚÔԉ¢ÙÈ΋ ÂÌÊ¿ÓÈÛË ·Ú¿Ï¢Ú˘ ΢ÎÏÔÊÔÚ›·˜. ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ∏ ÔÈÎÔÁÂÓ‹˜ ÂÌÊ¿ÓÈÛ‹ Ù˘, Û ÔÛÔÛÙfi 7-10%, Ë ÂÈÎÚ¿ÙËÛ‹ Ù˘ ÛÙËÓ ·ÛÈ·ÙÈ΋ Ê˘Ï‹ Î·È Ù· ÂÓı·ÚÚ˘ÓÙÈο Â˘Ú‹Ì·Ù· ·fi ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÌÔÚÊÒÓ, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë ÂÓfi˜ ÁÂÓÂÙÈÎÔ‡ ηٿ ‚¿ÛË ÓÔÛ‹Ì·ÙÔ˜ (3, 4-6). ∏ ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È Û˘Ó‹ıˆ˜ Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ· ÙˆÓ ‰‡Ô ÂÙÒÓ, ·ÏÏ¿ Î·È Û ÂÓ‹ÏÈΘ. ™ÙËÓ ·È‰È΋ ËÏÈΛ· ÎÏÈÓÈο ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¶·È‰È·ÙÚÈ΋ 2006;69:143-149
Pediatr Mar-Apr 06
18-04-06
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∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ Î·È Û˘Ó.
Û·ÛÌÔ‡˜ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÈÛ¯·ÈÌÈο ÂÂÈÛfi‰È·, ÂÓÒ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ ·fi ˘·Ú·¯ÓÔÂȉ›˜ ·ÈÌÔÚÚ·Á›Â˜. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ì ‰‡Ô ÂÚÈÙÒÛÂȘ ÔÈÎÔÁÂÓÔ‡˜ ÓfiÛÔ˘ ªª Û ‰‡Ô Î·È ÙÚÂȘ ÁÂÓ¤˜ ·ÓÙ›ÛÙÔȯ·. ∏ ÚÒÙË ÂÚ›ÙˆÛË Ô˘ ·ÊÔÚ¿ ÎÔÚ›ÙÛÈ ËÏÈΛ·˜ 11 ÌËÓÒÓ, ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜, ıˆÚÂ›Ù·È ·Û˘Ó‹ı˘ ÏfiÁˆ ÙÔ˘ Ó·ÚÔ‡ Ù˘ ËÏÈΛ·˜ Ù˘ Î·È ÙˆÓ Û˘ÓÔ‰ÒÓ ‰È·Ù·Ú·¯ÒÓ ‹Íˆ˜ ÛÙËÓ ›‰È· ηıÒ˜ Î·È Û ÚÒÙÔ˘ Î·È ‰Â˘Ù¤ÚÔ˘ ‚·ıÌÔ‡ Û˘ÁÁÂÓ›˜ Ù˘. ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛË Ô˘ ·ÊÔÚ¿ ·ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ, ÛΈÙÛ¤˙È΢ ηٷÁˆÁ‹˜, Â›Ó·È Ë ÌÔÓ·‰È΋ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·, Ì ¤ÓÙ ¿Û¯ÔÓÙ· ¿ÙÔÌ· Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜.
¶ÂÚ›ÙˆÛË π ¶ÚfiÎÂÈÙ·È ÁÈ· ı‹Ï˘ ËÏÈΛ·˜ 11 ÌËÓÒÓ, ÂÏÏËÓÈ΋˜ ηٷÁˆÁ‹˜, Ô˘ ÚÔÛÎÔÌ›ÛıËΠÛÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì·˜ ÁÈ· ‰ÈÂÚ‡ÓËÛË ‰ÂÍÈ¿˜ ËÌÈÏËÁ›·˜ Ô˘ ÂÁηٷÛÙ¿ıËΠ·Ì¤Ûˆ˜ ÌÂÙ¿ ·fi ÔÌfiÏ¢ÚÔ˘˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ‰È¿ÚÎÂÈ·˜ Ï›ÁˆÓ ‰Â˘ÙÂÚÔϤوÓ. ∂›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ·fi ÁÔÓ›˜ Ô˘ ‰ÂÓ Â›¯·Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. √ ÙÔÎÂÙfi˜ ¤ÁÈÓ Ì ηÈÛ·ÚÈ΋ ÙÔÌ‹, ÂÂȉ‹ Ë ÌËÙ¤Ú·, Ô˘ ¤·Û¯Â Î·È ·˘Ù‹ ·fi ÓfiÛÔ ªª, ·ÚÔ˘Û›·Û ˘¤ÚÙ·ÛË ÛÙÔ ÙÂÏÂ˘Ù·›Ô ÙÚ›ÌËÓÔ Ù˘ ·ËÛ˘. ∏ ÓfiÛÔ˜ ÛÙË ÌËÙ¤Ú· Ù˘ ·ÛıÂÓÔ‡˜ ‰È·ÁÓÒÛÙËΠ۠ËÏÈΛ· 9ó ÂÙÒÓ Î·È ·ÓÙÈÌÂÙˆ›ÛÙËΠ¯ÂÈÚÔ˘ÚÁÈο Ì ÂÈÙ˘¯›· ÛÙËÓ ËÏÈΛ· ·˘Ù‹ (¶›Ó·Î·˜ 1). ∏ ·ÛıÂÓ‹˜ Û ËÏÈΛ· 9 ÌËÓÒÓ ·ÚÔ˘Û›·Û ÁÈ· ÚÒÙË ÊÔÚ¿ ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜ ‰È¿ÚÎÂÈ·˜ ‰Â˘ÙÂÚÔϤوÓ. ∏ Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (ªRI) Î·È ÙÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· (∏∂°) Ô˘ ¤ÁÈÓ·Ó ÛÙÔ ÂÂÈÛfi‰ÈÔ ·˘Ùfi ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈο. ŒÎÙÔÙÂ, Ë ·ÛıÂÓ‹˜ ‚ÚÈÛÎfiÙ·Ó Û ÛÙÂÓ‹ È·ÙÚÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË. ∏ „˘¯ÔÎÈÓËÙÈ΋ ÂͤÏÈÍË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 11 ÌËÓÒÓ. ™ÙËÓ ËÏÈΛ· ·˘Ù‹ ·ÚÔ˘Û›·ÛÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ, ·ÚfiÌÔÈÔ Ì ÙÔ ÚÒÙÔ Î·È ÂÈÛ‹¯ıË ÛÙÔ ÓÔÛÔÎÔÌ›Ô. ™ÙË Ó¢ÚÔÏÔÁÈ΋ ÂͤٷÛË Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ‰ÂÍÈ¿ ËÌÈÏËÁ›· Ì ȉȷ›ÙÂÚË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ¿Óˆ ¿ÎÚÔ˘. ∏ ˘fiÏÔÈË Ê˘ÛÈ΋ ÂͤٷÛË ‹Ù·Ó ¯ˆÚ›˜ Â˘Ú‹Ì·Ù·. ∞fi ÙÔÓ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô Ô˘ ¤ÁÈÓÂ, ‰È·ÈÛÙÒıËÎ·Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ·Ú·ÁfiÓÙˆÓ ‹Íˆ˜ ÙfiÛÔ ÛÙËÓ ›‰È· fiÛÔ Î·È Û ̤ÏË Ù˘ ÌËÙÚÈ΋˜ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ (¶›Ó·Î·˜ 2). ™˘ÁÎÂÎÚÈ̤ӷ: ·) Ë ¶·È‰È·ÙÚÈ΋ 2006;69:143-149
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1 ¶›Ó·Î·˜ 1. ∆Ô ÁÂÓ·ÏÔÁÈÎfi ‰¤ÓÙÚÔ Ù˘ ÚÒÙ˘ ·ÛıÂÓÔ‡˜ (ÌËÙ¤Ú· ÚÔ˜ ÎfiÚË) º‡ÏÔ
∏ÏÈΛ· ÂÌÊ¿ÓÈÛ˘ Ù˘ ÓfiÛÔ˘
1. ∞ÛıÂÓ‹˜ 2. ªËÙ¤Ú· ·ÛıÂÓÔ‡˜
9 ÌËÓÒÓ 9ó ÂÙÒÓ
·ÛıÂÓ‹˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ FV Leiden Î·È FII 20210∞, ‚) Ë ÌËÙ¤Ú· Ù˘ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙȘ ·Ú·¿Óˆ ÌÂÙ·ÏÏ¿ÍÂȘ ηıÒ˜ Î·È ÁÈ· ÙÔ ÁÔÓ›‰ÈÔ MTHFR, Á) Ë ·‰ÂÏÊ‹ Ù˘ ÌËÙ¤Ú·˜ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙÔ ÁÔÓ›‰ÈÔ FV Leiden Î·È ‰) Ë ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ Â›Ó·È ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ MTHFR Î·È FII 20210A. ∆o ∏∂° ¤‰ÂÈÍ ‚Ú·‰¤· ·̷ٷ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ Ì ‰È¿Û·ÛË Ù˘ ·Ú¯ÈÙÂÎÙÔÓÈ΋˜ ‰ÔÌ‹˜ ÙÔ˘ ‡ÓÔ˘ Î·È ·Ô˘Û›· ·ÚÔ͢ÛÌÈÎÒÓ ÂÎÊÔÚÙ›ÛˆÓ. ∏ ªRI ÂÁÎÂÊ¿ÏÔ˘, Ô˘ ¤ÁÈÓ 24 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË Ù˘ ËÌÈÏËÁ›·˜, ¤‰ÂÈÍ ¤ÌÊÚ·ÎÙ· ÛÙÔÓ ·ÚÈÛÙÂÚfi ÎÚÔÙ·ÊÈÎfi Î·È ‚ÚÂÁÌ·ÙÈÎfi ÏÔ‚fi, ηıÒ˜ Î·È ÛÙÔÓ ‰ÂÍÈfi ÈÓÈ·Îfi Î·È ÎÚÔÙ·ÊÈÎfi ÏÔ‚fi. ∞ÎÔÏÔ‡ıËÛ ̷ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ (MRA), Ë ÔÔ›· ¤ıÂÛ ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Î·È ¤‰ÂÈÍ ÛÙ¤ÓˆÛË Ù˘ ˘ÂÚÎÏÈÓÔÂȉԇ˜ ÌÔ›Ú·˜ Ù˘ ‰ÂÍÈ¿˜ ¤Ûˆ ηڈٛ‰·˜, ÌÂÁ¿ÏÔ˘ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË Ù˘ ˘ÂÚÎÏÈÓÔÂȉԇ˜ ÌÔ›Ú·˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ¤Ûˆ ηڈٛ‰·˜ Î·È Ù˘ ·Ú¯‹˜ Ù˘ ·ÚÈÛÙÂÚ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜, ηıÒ˜ Î·È ÛËÌ·ÓÙÈ΋ ˘ÂÚÙÚÔÊ›· ÙˆÓ Ê·ÎÔÚ·‚‰ˆÙÒÓ ·ÚÙËÚÈÒÓ. √È MRI ÂÁÎÂÊ¿ÏÔ˘ Ù˘ ÌËÙÚÈ΋˜ ÁÈ·ÁÈ¿˜ Î·È ÌËÙÚÈ΋˜ ·‰ÂÏÊ‹˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ∏ ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠·ÓÙÈËÎÙÈ΋ ·ÁˆÁ‹ Ì ˷ڛÓË ¯·ÌËÏÔ‡ ÌÔÚÈ·ÎÔ‡ ‚¿ÚÔ˘˜ Û ‰fiÛË 75 U/Kgr Î·È ·ÛÈÚ›ÓË Û ‰fiÛË 50 mgr/24ˆÚÔ, ·Ú΋ ÂÓ˘‰¿ÙˆÛË Î·È ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Ì ηڂ·Ì·˙›ÓË. ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÓÔÛËÏ›·˜
Pediatr Mar-Apr 06
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™¿ÓÈ· ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Moyamoya
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¶›Ó·Î·˜ 2. ¢È·Ù·Ú·¯¤˜ ‹Íˆ˜ Ù˘ ÚÒÙ˘ ·ÛıÂÓÔ‡˜ Î·È ÙˆÓ Û˘ÁÁÂÓÒÓ Ù˘ 1. ∞ÛıÂÓ‹˜: ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ F.V. Leiden Î·È FII 20210∞ 2. ªËÙ¤Ú· ·ÛıÂÓÔ‡˜: ÂÙÂÚÔ˙˘ÁÒÙ˘ ÁÈ· F.V. Leiden, FII 20210A Î·È MTHFR 3. ªËÙÚÈ΋ ·‰ÂÚÊ‹: F.V. Leiden 4. ªËÙÚÈ΋ ÁÈ·ÁÈ¿: MTHFR Î·È FII 20210A
·ÚÔ˘Û›·˙Â Û˘Ó¯‹ ‚ÂÏÙ›ˆÛË. ∫·Ù¿ ÙËÓ ¤ÍÔ‰Ô Û˘ÛÙ‹ıËÎÂ Û˘Ó¤¯ÈÛË Ù˘ ·ÓÙÈËÎÙÈ΋˜ ·ÁˆÁ‹˜ ÁÈ· ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ Ì‹Ó˜ ̤¯ÚÈ ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘, ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Î·È ¤Ó·ÚÍË Ê˘ÛÈÔıÂڷ›·˜. ∏ ·ÛıÂÓ‹˜ ÙÔ˘˜ ÂfiÌÂÓÔ˘˜ ¤ÓÙ ̋Ó˜ ·ÚÔ˘Û›·Û ÔÌ·Ï‹ ÔÚ›·, fiÛÔÓ ·ÊÔÚ¿ ÙË ÓfiÛÔ Ù˘ Î·È ÙËÓ „˘¯ÔÎÈÓËÙÈ΋ Ù˘ ÂͤÏÈÍË. ™Â ËÏÈΛ· 16 ÌËÓÒÓ Î·È ÂÓÒ ÓÔÛËÏ¢fiÙ·Ó Û ΤÓÙÚÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡ ÁÈ· ÙËÓ ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË ¯ÂÈÚÔ˘ÚÁÈ΋ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÓfiÛÔ˘ Ù˘, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·Û ·ÈÊÓȉ›ˆ˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ·ÚÈÛÙÂÚ¿, Ì ·ÎfiÏÔ˘ıË ÔÌfiÏ¢ÚË ËÌÈÏËÁ›· Î·È ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ ÚÔÊÔÚÈÎfi ÏfiÁÔ. ∏ MRI ÂÁÎÂÊ¿ÏÔ˘ ¤‰ÂÈÍÂ Ó¤Ô ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹ (∂ÈÎfiÓ˜ 1,2), ÂÓÒ Ë ÙÔÌÔÁÚ·Ê›· Ì ÂÎÔÌ‹ ÔÛÈÙÚÔÓ›ˆÓ (ƒ∂∆ positron emission tomography) ¤‰ÂÈÍ ÂÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÙ·‚ÔÏÈÛÌÔ‡ ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ Î·È ÛÙË ‰ÂÍÈ¿ ‚ÚÂÁÌ·ÙÔ˚Óȷ΋ ÂÚÈÔ¯‹. ¢Âη¤ÓÙ Ë̤Ú˜ ÌÂÙ¿ ÙÔ ÙÂÏÂ˘Ù·›Ô ÂÂÈÛfi‰ÈÔ, ¤ÁÈÓ ·Ó·ÛÙfïÛË ÎÏ¿‰ˆÓ ÙˆÓ ¤Ûˆ Î·È ¤Íˆ ηڈٛ‰ˆÓ. ∏ ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· ˘‹ÚÍ ÔÌ·Ï‹ Î·È Ë ·ÛıÂÓ‹˜ ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô Ì ÙË Û‡ÛÙ·ÛË Ó· ·Ú¯›ÛÂÈ Ê˘ÛÈÔıÂڷ›·, ÂÚÁÔıÂڷ›· Î·È ÏÔÁÔıÂڷ›·. ∏ ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ ηٿ ÙËÓ ¤ÍÔ‰Ô Û˘Ó›ÛÙ·ÙÔ Û ·ÛÈÚ›ÓË, ηڂ·Ì·˙›ÓË Î·È Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË. ∏ MRI ÂÁÎÂÊ¿ÏÔ˘, ÔÎÙÒ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, ¤‰ÂÈÍ ÙËÓ ·ÚÔ˘Û›· ·Ï·ÈÔ‡ ÂÌÊÚ¿ÎÙÔ˘ ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔÎÚÔÙ·ÊÔ‚ÚÂÁÌ·ÙÈ-
∂ÈÎfiÓ˜ 1,2. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ Ù˘ ÚÒÙ˘ ·ÛıÂÓÔ‡˜, Ë ÔÔ›· ‰Â›¯ÓÂÈ ¤ÌÊÚ·ÎÙ· ÛÙÔ˘˜ ÎÚÔÙ·ÊÈÎÔ‡˜ ÏÔ‚Ô‡˜, ÛÙÔÓ ‚ÚÂÁÌ·ÙÈÎfi ÏÔ‚fi ·ÚÈÛÙÂÚ¿ Î·È ÛÙÔÓ ÈÓÈ·Îfi ÏÔ‚fi ‰ÂÍÈ¿.
΋ ÂÚÈÔ¯‹ Î·È ‰È¿Û·ÚÙ˜ ÂÛٛ˜ ÂÁÎÂÊ·ÏÔÌ·Ï¿Î˘ÓÛ˘. ∆·˘Ùfi¯ÚÔÓË MRA ÂÁÎÂÊ¿ÏÔ˘ ·ÂÎ¿Ï˘„ ÛËÌ·ÓÙÈÎÔ‡ ‚·ıÌÔ‡ ÛÙ¤ÓˆÛË ÙÔ˘ ˘ÂÚÎÏÈÓÔÂȉԇ˜ ÙÌ‹Ì·ÙÔ˜ ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ ¤Ûˆ ηڈٛ‰ˆÓ, ·ÂÈÎfiÓÈÛË ÙˆÓ ÚÔÛı›ˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ·ÚÙËÚÈÒÓ Î·È Ù˘ ·ÚÈÛÙÂÚ‹˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜, ·Ó·ÛÙfïÛË ÙÔ˘ ÂÚÈÊÂÚÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ Ù˘ ‰ÂÍÈ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Ì ÎÏ¿‰Ô Ù˘ ‰ÂÍÈ¿˜ ¤Íˆ ηڈٛ‰·˜ Î·È ·Ó¿Ù˘ÍË ÓÂfiÏ·ÛÙˆÓ ·ÁÁ›ˆÓ. ¶·È‰È·ÙÚÈ΋ 2006;69:143-149
Pediatr Mar-Apr 06
18-04-06
16:42
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∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ Î·È Û˘Ó.
¢ÂηÔÎÙÒ Ì‹Ó˜ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, Ë ·ÛıÂÓ‹˜ Û ËÏÈΛ· 3ó ÂÙÒÓ, ·ÚÔ˘ÛÈ¿˙ÂÈ ÛËÌ·ÓÙÈ΋ ‚ÂÏÙ›ˆÛË ÛÙÔÓ ÎÈÓËÙÈÎfi ÙÔ̤· ·ÏÏ¿ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ÂͤÏÈÍË ÙÔ˘ ÚÔÊÔÚÈÎÔ‡ ÏfiÁÔ˘. ∏ ıÂڷ¢ÙÈ΋ ·ÁˆÁ‹ Û˘Ó¯›˙ÂÙ·È Ì ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘ 100 mg ËÌÂÚËÛ›ˆ˜ Î·È Î·Ú‚·Ì·˙›Ó˘. ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË Ù˘ ·ÛıÂÓÔ‡˜ Î·È ÙˆÓ ÛÙÂÓÒÓ Û˘ÁÁÂÓÒÓ Û ÂÍÂȉÈÎÂ˘Ì¤ÓÔ Î¤ÓÙÚÔ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡, ‰ÂÓ ¤‰ÂÈÍ ·ÓˆÌ·Ï›Â˜ ÛÙ· ÁÔÓ›‰È· CHL1, IL5AR, ILOC51185 Î·È ITRP1 ÛÙÔ ¯ÚˆÌfiۈ̷ 3p26. ∏ ·Ó¿Ï˘ÛË fï˜, ÙÔ˘ ÌÈÙÔ¯ÔÓ‰ÚÈ·ÎÔ‡ DNA Î·È À ÁÔÓfiÙ˘Ô˘ ¤‰ÂÈÍ fiÙÈ Ù· ÚÔۂ‚ÏË̤ӷ ¿ÙÔÌ· Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ›¯·Ó ÙËÓ ›‰È· ·ÏÏËÏÔ˘¯›· ÙÔ˘ ÙÌ‹Ì·ÙÔ˜ ª∆3 Ù˘ ·Á·Ï˘ D Ì ȿˆÓ˜ ·ÛıÂÓ›˜ Ù˘ ÔÈÎÔÁÂÓÔ‡˜ ÌÔÚÊ‹˜. ¢È·ÈÛÙÒıËΠ›Û˘, ·ÓÙÈηٿÛÙ·ÛË Ì›·˜ ÌfiÓÔ ‚¿Û˘ ÛÙËÓ ÂÚÈÔ¯‹ CRS263 (A→G), ‡ÚËÌ· ÙÔ ÔÔ›Ô Â›Ó·È Û¿ÓÈÔ ÛÙ· ¿ÙÔÌ· Ù˘ η˘Î¿ÛÈ·˜ Ê˘Ï‹˜ Ì ÓfiÛÔ ªª.
¶ÂÚ›ÙˆÛË πI ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÁfiÚÈ ËÏÈΛ·˜ 5 ÂÙÒÓ, ÛΈÙÛ¤˙È΢ ηٷÁˆÁ‹˜, ÙÔ ÔÔ›Ô Î·Ù¿ ÙȘ ηÏÔηÈÚÈÓ¤˜ ÙÔ˘ ‰È·ÎÔ¤˜ ÛÙËÓ ∂ÏÏ¿‰·, Ï›Á˜ ÒÚ˜ ÌÂÙ¿ ·fi ·Ú·ÙÂٷ̤ÓË ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ, Ì ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜ 42ÆC, ·ÚÔ˘Û›·Û ÚÔԉ¢ÙÈ΋ ·‰˘Ó·Ì›· ÛÙÔ ·ÚÈÛÙÂÚfi ¿Óˆ Î·È Î¿Ùˆ ¿ÎÚÔ. ∂›Ó·È ÙÔ ÙÚ›ÙÔ Ù¤ÎÓÔ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Ì ÂχıÂÚÔ ÂÚÈÁÂÓÓËÙÈÎfi Î·È ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi. √È ÁÔÓ›˜ ‰ÂÓ ¤¯Ô˘Ó Û˘ÁÁ¤ÓÂÈ· ÌÂٷ͇ ÙÔ˘˜. ∞fi ÙÔ ÎÏËÚÔÓÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ë ·‰ÂÏÊ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜, Ë ÌËÙÚÈ΋ ·‰ÂÏÊ‹ Î·È Ë ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ ¿Û¯Ô˘Ó ·fi Û˘Ìو̷ÙÈ΋ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ ªª, ÂÓÒ Ë ÌËÙ¤Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜ ·fi ·Û˘Ìو̷ÙÈ΋ ÌÔÚÊ‹ (¶›Ó·Î·˜ 3). ∏ Ó¢ÚÔÏÔÁÈ΋ ÂÈÎfiÓ· ηٿ ÙËÓ Â›ÛÔ‰Ô, ¤‰ÂÈÍ ·ÚÈÛÙÂÚ‹ ËÌÈÏËÁ›· Ì ÌÂÁ·Ï‡ÙÂÚË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ¿Óˆ ¿ÎÚÔ˘ ηıÒ˜ Î·È ¿ÚÂÛË ÙÔ˘ ÔÌfiÏ¢ÚÔ˘ ÚÔÛˆÈÎÔ‡ Ó‡ÚÔ˘ ÎÂÓÙÚÈÎÔ‡ Ù‡Ô˘. ∏ ˘fiÏÔÈË ÎÏÈÓÈ΋ ÂͤٷÛË ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ∏ ªRI ÂÁÎÂÊ¿ÏÔ˘ ·Ó¤‰ÂÈÍ ÂÎÙÂٷ̤ÓË ÈÛ¯·ÈÌ›· ÛÙÔ Â‰›Ô ‰È·ÓÔÌ‹˜ Ù˘ ‰ÂÍÈ¿˜ ̤Û˘ ÂÁÎÂÊ·ÏÈ΋˜ ·ÚÙËÚ›·˜ Î·È ÛÙÔ Û‡ÛÙÔÈ¯Ô Ê·ÎÔÂȉ‹ Î·È ÎÂÚÎÔÊfiÚÔ ˘Ú‹Ó· Ì ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘ ÓfiÛÔ˘ ªª (∂ÈÎfiÓ· 3). ∏ MRA ÂȂ‚·›ˆÛ ÙË ‰È¿ÁÓˆÛË. ∞fi ÙÔÓ ˘fiÏÔÈÔ ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô, Û˘¶·È‰È·ÙÚÈ΋ 2006;69:143-149
¶›Ó·Î·˜ 3. °ÂÓ·ÏÔÁÈÎfi ‰¤Ó‰ÚÔ Ù˘ ‰Â‡ÙÂÚ˘ ÂÚ›ÙˆÛ˘ ∞Ú. 1 - ÌËÙÚÈ΋ ÁÈ·ÁÈ¿ (52 ÂÙÒÓ) ∞Ú. 2 - ÌËÙÚÈ΋ ·‰ÂÏÊ‹ (19 ÂÙÒÓ) ∞Ú. 3 - ÌËÙ¤Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜ (·Û˘Ìو̷ÙÈ΋, 38 ÂÙÒÓ) ∞Ú. 4 - ·ÛıÂÓ‹˜ ∞Ú. 5 - ·‰ÂÏÊ‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ (6 ÂÙÒÓ)
ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ Î·È ÙÔ˘ ÂϤÁ¯Ô˘ ıÚÔÌ‚ÔÊÈÏ›·˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠοÙÈ ÙÔ ·ıÔÏÔÁÈÎfi, ÙfiÛÔ ÛÙÔÓ ·ÛıÂÓ‹ fiÛÔ Î·È ÛÙË ÌËÙ¤Ú· ÙÔ˘. √ ·ÛıÂÓ‹˜ ÂÓ˘‰·ÙÒıËÎÂ Î·È Ù¤ıËΠ۠·ÁˆÁ‹ Ì ʷÈÓ˘ÓÙÔ˝ÓË Î·È ·ÛÈÚ›ÓË (60 mg ËÌÂÚËÛ›ˆ˜, 3 mg/kg/24ˆÚÔ). ∆Ô ∏∂° ¤‰ÂÈÍ ÁÂÓÈÎÂ˘Ì¤ÓË ÂÌÊ¿ÓÈÛË ‚Ú·‰¤ˆÓ Î˘Ì¿ÙˆÓ Ì ÂÈÎÚ¿ÙËÛ‹ ÙÔ˘˜ ÛÙÔ ‰ÂÍÈfi ËÌÈÛÊ·›ÚÈÔ. ªÂÙ¿ ·fi ÓÔÛËÏ›· ÔÎÙÒ ËÌÂÚÒÓ Î·È ÚÔԉ¢ÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ÙÔ˘ ÂÈÎfiÓ·˜, Ô ·ÛıÂÓ‹˜ ÂÍ‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÁÈ· Ó· ÌÂÙ·‚› ÛÙËÓ È‰È·›ÙÂÚË ·ÙÚ›‰· ÙÔ˘ ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÔηٿÛÙ·ÛË Î·È ‰ÈÂÚ‡ÓËÛË. ∞fi ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÛÙË ÌËÙ¤Ú· ÙÔ˘ ·ÛıÂÓÔ‡˜, ¤¯ÂÈ Á›ÓÂÈ ÁÓˆÛÙfi fiÙÈ ·ÚÔ˘ÛÈ¿˙ÂÈ ‰È·Ù·Ú·¯¤˜ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi D¡∞ (C0tRNALys ÂÓ‰ÔÁÂÓ‹ 9 bp ¤ÏÏÂÈ„Ë) ‡ÚËÌ· ·Û‡ÓËı˜ ÛÙÔ˘˜ ∫·˘Î¿ÛÈÔ˘˜ (7). ∏ ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÙˆÓ ˘ÔÏÔ›ˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Û˘Ó¯›˙ÂÙ·È.
™˘˙‹ÙËÛË °È·Ù› Ë ÓfiÛÔ˜ Moyamoya (MM) ÂÌÊ·Ó›˙ÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙÔ˘˜ ∞ÛÈ¿Ù˜ Î·È fi¯È ÙfiÛÔ Û˘¯Ó¿ ÛÙÔ˘˜ ∫·˘Î¿ÛÈÔ˘˜; ∏ ¯Ú‹ÛË ÌË ÂÂÌ‚·ÙÈÎÒÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ, fiˆ˜ Â›Ó·È Ë Ì·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· (MRI) Î·È Ë Ì·ÁÓËÙÈ΋ ·ÁÁÂÈÔÁÚ·Ê›· (MRA), Ô‰‹ÁËÛ Û ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ Ó¤ˆÓ ÛÔÚ·‰ÈÎÒÓ, ÔÈÎÔÁÂÓÒÓ, ·ÏÏ¿ Î·È ·Û˘Ìو̷ÙÈÎÒÓ ÌÔÚÊÒÓ Ù˘ ÓfiÛÔ˘ Î·È ¿ÓÔÈÍ ÙÔÓ
Pediatr Mar-Apr 06
18-04-06
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™¿ÓÈ· ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Moyamoya
∂ÈÎfiÓ· 3. ª·ÁÓËÙÈ΋ ÙÔÌÔÁÚ·Ê›· ÂÁÎÂÊ¿ÏÔ˘ ÙÔ˘ ‰Â‡ÙÂÚÔ˘ ·ÛıÂÓÔ‡˜, Ë ÔÔ›· ‰Â›¯ÓÂÈ ÂÎÙÂٷ̤ÓÔ ¤ÌÊÚ·ÎÙÔ ÛÙË ‰ÂÍÈ¿ ÎÚÔÙ·ÊÔ‚ÚÂÁÌ·ÙÔ˚Óȷ΋ ÂÚÈÔ¯‹ Ì ˘ÔÊÏÔÈÒ‰Ë ·ÙÚÔÊ›· ÛÙË ‰ÂÍÈ¿ ÌÂÙˆÔ‚ÚÂÁÌ·ÙÈ΋ ÂÚÈÔ¯‹.
‰ÚfiÌÔ, Ì·˙› Ì ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË, ÁÈ· Ó· ··ÓÙËı› ÛÙÔ Ì¤ÏÏÔÓ ÙÔ ·Ú·¿Óˆ ÂÚÒÙËÌ· (8). MoÏÔÓfiÙÈ Ë ÓfiÛÔ˜ ÂÈÎÚ·Ù› ÌÂٷ͇ ÙˆÓ π·ÒÓˆÓ, Ӥ˜ ÂÚÈÙÒÛÂȘ ·Ó·ÎÔÈÓÒÓÔÓÙ·È Û˘Ó¯Ҙ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Î·È ÌÂٷ͇ ÙˆÓ ∫·˘Î¿ÛȈÓ. ¶ÂÓ‹ÓÙ· ÙÔȘ ÂηÙfi (50%) ÙˆÓ Ó¤ˆÓ ÂÚÈÙÒÛÂˆÓ ÂÓÙÔ›˙ÔÓÙ·È ÂÎÙfi˜ ÙˆÓ È·ˆÓÈÎÒÓ Û˘ÓfiÚˆÓ (9). ∆ÚÈ·ÎfiÛȘ ÂÚ›Ô˘ ÂÚÈÙÒÛÂȘ ‚‚·ÈˆÌ¤Ó˘ ‹ Èı·Ó‹˜ ÓfiÛÔ˘ Moyamoya ·Ó·Ê¤ÚÔÓÙ·È Û fiϘ ÙȘ ÂıÓÈÎfiÙËÙ˜ ÛÙȘ ∏ӈ̤Ó˜ ¶ÔÏÈÙ›˜ Ù˘ ∞ÌÂÚÈ΋˜ Î·È ÂÚÈÛÛfiÙÂÚ˜ ·fi 6000 ·ÁÎÔÛÌ›ˆ˜ (10). √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ MM Â›Ó·È ÛÔÚ·‰ÈΤ˜ Î·È ÌfiÓÔ 7-10% Â›Ó·È ÔÈÎÔÁÂÓ›˜, ÛÙȘ Ôԛ˜ ÚÔÛ‚¿ÏÏÔÓÙ·È Û˘Ó‹ıˆ˜ ‰‡Ô ¿ÙÔÌ· ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. ∏ ÓfiÛÔ˜ ÛÙȘ ÔÈÎÔÁÂÓ›˜ ÌÔÚʤ˜, ÂÌÊ·Ó›˙ÂÙ·È Û ÔÛÔÛÙfi 70% ÌÂٷ͇ ·‰ÂÏÊÒÓ Î·È Û 24% ÌÂٷ͇ ÁÔÓ¤ˆÓ Î·È Ù¤ÎÓˆÓ (8). √È ‰‡Ô ÔÈÎÔÁÂÓ›˜ ÂÚÈÙÒÛÂȘ Ì·˜ Û η˘Î¿ÛÈÔ˘˜ ·ÛıÂÓ›˜ ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· Ù˘ ÓfiÛÔ˘ Î·È Û ¿ÏϘ Ê˘Ï¤˜ ÏËÓ Ù˘ ·ÛÈ·ÙÈ΋˜ Î·È ÂÓÈÛ¯‡Ô˘Ó ÙÔÓ ÎÏËÚÔÓÔÌÈÎfi Ù˘ ¯·Ú·ÎÙ‹Ú·. ∏ ‰Â‡ÙÂÚË ÂÚ›ÙˆÛ‹ Ì·˜, Â›Ó·È Ë ‰Â‡ÙÂÚË ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· Ì ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜, ·ÏÏ¿ Â›Ó·È ÌÔÓ·‰È΋ ÛÙÔ fiÙÈ, Ù· ¤ÓÙ ÚÔۂ‚ÏË̤ӷ ¿ÙÔÌ· ·ÔÙÂÏÔ‡Ó ÙÔÓ ÌÂÁ·Ï‡ÙÂÚÔ ·ÚÈıÌfi ·ÙfiÌˆÓ Ì ÙË ÓfiÛÔ ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· (7,14). ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ·Ú·-
̤ÓÂÈ ·ÎfiÌË ¿ÁÓˆÛÙË ·Ú¿ ÙȘ ·ÍÈfiÏÔÁ˜ ¤Ú¢Ó˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÂȉËÌÈÔÏÔÁ›·, ÙË Û˘Ìو̷ÙÔÏÔÁ›·, ÙË Ó¢ÚÔ·ÂÈÎfiÓÈÛË Î·È ÙËÓ ·ıÔÏÔÁÔ·Ó·ÙÔÌÈ΋ Ù˘ ÂÈÎfiÓ·. √ ÎÏËÚÔÓÔÌÈÎfi˜ ‹ ›ÎÙËÙÔ˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ ÓfiÛÔ˘ ‰ÂÓ ¤¯ÂÈ ·ÎfiÌË ‰È¢ÎÚÈÓÈÛÙ›. ∏ ıˆڛ· Ô˘ ÂÓÔ¯ÔÔÈÔ‡Û Èı·Ó‹ ›‰Ú·ÛË ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ‰ÂÓ ¤¯ÂÈ ÙÂÎÌËÚȈı› ·fi ·Ó¿ÏÔÁ˜ ÌÂϤÙ˜ (8). ∏ Û˘Ó¯‹˜ ·‡ÍËÛË ÙˆÓ ÔÈÎÔÁÂÓÒÓ ÌÔÚÊÒÓ, Ë Û˘Ó‡·ÚÍ‹ ÙÔ˘˜ Ì ¿ÏÏ· ÎÏËÚÔÓÔÌÈο ÓÔÛ‹Ì·Ù· fiˆ˜ Â›Ó·È Ë Ó¢ÚÔ˚ӈ̿وÛË Ù‡Ô˘ 1, Ë ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·, ÙÔ Û‡Ó‰ÚÔÌÔ Down, ηıÒ˜ Î·È Ë ˘ÂÚÔ¯‹ Ù˘ ÓfiÛÔ˘ ÛÙÔÓ È·ˆÓÈÎfi Ï·fi, ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ ÁÂÓÂÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Èı·ÓfiÓ Ó· ÂÌϤÎÔÓÙ·È ÛÙËÓ ·ıÔÁ¤ÓÂÈ¿ Ù˘ Ì ÔÏ˘·Ú·ÁÔÓÙÈÎfi ÙÚfiÔ (11,12). ¶ÚfiÛÊ·ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË Û ÔÈÎÔÁÂÓ‹ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ η٤‰ÂÈÍ ÙËÓ ‡·ÚÍË ÁÔÓȉ›Ô˘ ÛÙÔ ¯ÚˆÌfiۈ̷ 3p24.2-26 (8). ™Â ¿ÏÏË ·ÚfiÌÔÈ· ÌÂϤÙË, ‰È·ÈÛÙÒıËΠfiÙÈ ˘¿Ú¯ÂÈ Èı·Ó‹ Û˘Û¯¤ÙÈÛË Ù˘ ÓfiÛÔ˘ Ì ÔÚÈṲ̂ӷ ·ÏÏËÏfiÌÔÚÊ· ÁÔÓ›‰È· ÙˆÓ ·ÓıÚÒÈÓˆÓ Ï¢ÎÔ΢ÙÙ·ÚÈÎÒÓ ·ÓÙÈÁfiÓˆÓ (HLA) ÛÙ· ¯ÚˆÌÔÛÒÌ·Ù· 6 Î·È 17 (6). ™ÙËÓ ÚÒÙË Ì·˜ ÂÚ›ÙˆÛË, Ë ÁÂÓÂÙÈ΋ ·Ó¿Ï˘ÛË ¤‰ÂÈÍ ‰È·Ù·Ú·¯¤˜ ·ÚfiÌÔȘ Ì ÂΛӘ ÛÙÔ˘˜ È¿ˆÓ˜ ·ÛıÂÓ›˜ fiÛÔÓ ·ÊÔÚ¿ ÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA Î·È À ÁÔÓfiÙ˘Ô, ÂÓÒ ÛÙÔ ¯ÚˆÌfiۈ̷ 3p26 ‰ÂÓ ·ÂÎ¿Ï˘„ ·ÓˆÌ·Ï›Â˜ ÛÙÔ˘˜ ÁfiÓÔ˘˜ ¶·È‰È·ÙÚÈ΋ 2006;69:143-149
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∂. ª·˙›ÁÔ˘-ºˆÙÔÔ‡ÏÔ˘ Î·È Û˘Ó.
CHL1, IL5AR, LOC51185 Î·È ITRP1, ·ÏÏ¿ ‰È·ÈÛÙÒıËΠ·ÓÙÈηٿÛÙ·ÛË Ì›·˜ ÌfiÓÔ ‚¿Û˘ ÛÙËÓ ÂÚÈÔ¯‹ CRS263(A→G), ‡ÚËÌ· Û¿ÓÈÔ ÛÙËÓ Î·˘Î¿ÛÈ· Ê˘Ï‹. ∏ ÂÚ›ÙˆÛË ·˘Ù‹ Â›Ó·È Ë ‰Â‡ÙÂÚË ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘ Ô˘ ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ ∂ÏÏ¿‰· (13). ∆· Â˘Ú‹Ì·Ù· Ù˘ ÌÔÚȷ΋˜ ·Ó¿Ï˘Û˘ ÛÙȘ ‰‡Ô ÂÏÏËÓÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ Â›Ó·È ‰È·ÊÔÚÂÙÈο. ™ÙËÓ ÚÒÙË, ‰È·ÈÛÙÒıËÎÂ Û˘Û¯¤ÙÈÛË ÛÙË ı¤ÛË D3A ÛÙÔ ¯ÚˆÌfiۈ̷ 3p24.2-26, ÌÂȈ̤Ó˘ ‰ÈÂÈÛ‰˘ÙÈÎfiÙËÙ·˜. ™ÙË ‰È΋ Ì·˜ ÂÚ›ÙˆÛË Ù¤ÙÔÈ· Û˘Û¯¤ÙÈÛË ‰ÂÓ ‚Ú¤ıËÎÂ. ™ÙË ‰Â‡ÙÂÚË ÂÚ›ÙˆÛ‹ Ì·˜, ÛÙË ÛΈÙÛ¤˙ÈÎË ÔÈÎÔÁ¤ÓÂÈ·, Ô ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ ÌËÙ¤Ú·˜ ¤‰ÂÈÍ ÛÙÔ ÌÈÙÔ¯ÔÓ‰ÚÈ·Îfi DNA ÂÓ‰ÔÁÂÓ¤˜ 9-bp ¤ÏÏÂÈÌÌ· ÛÙÔ COIIRNA, οÙÈ Ô˘ ̤¯ÚÈ ÚfiÛÊ·Ù· ·ÔÙÂÏÔ‡Û ÂȉÈÎfi ‡ÚËÌ· ÛÙÔÓ ·ÛÈ·ÙÈÎfi ÏËı˘ÛÌfi. √ ÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ˘ÔÏÔ›ˆÓ ÚÔۂ‚ÏËÌ¤ÓˆÓ ÌÂÏÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Â›Ó·È Û ÂͤÏÈÍË. ∆· ÎÔÈÓ¿ ̤¯ÚÈ ÙÒÚ· Â˘Ú‹Ì·Ù· ·fi ÙË ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÛÙÔ˘˜ ‰‡Ô ·ÛıÂÓ›˜ Ì·˜, Ù· ÔÔ›· Â›Ó·È ·ÚfiÌÔÈ· Ì ÂΛӷ ÙˆÓ π·ÒÓˆÓ, ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó ÛÙËÓ ˘fiıÂÛË Èı·Ó‹˜ ÎÔÈÓ‹˜ ÁÔÓȉȷ΋˜ ‰È·Ù·Ú·¯‹˜ Ë ÔÔ›·, fï˜, Â›Ó·È Û¿ÓÈ· ÛÙËÓ Î·˘Î¿ÛÈ· Ê˘Ï‹. ∏ ‰È¿ÁÓˆÛË ÛÙÔ Ì¤ÏÏÔÓ ÂÚÈÛÛÔÙ¤ÚˆÓ ·ÛıÂÓÒÓ Î·È Ë Û˘ÓÂÚÁ·Û›· ÂÈÛÙËÌfiÓˆÓ Û ‰ÈÂıÓ¤˜ ›‰Ô, ı· Û˘Ì‚¿ÏÏÂÈ ÛËÌ·ÓÙÈο ÛÙË ‰È·Ï‡ηÓÛË Ù˘ ·ıÔÁ¤ÓÂÈ·˜ Ù˘ Û¿ÓÈ·˜, ·ÏÏ¿ Î·È ÙfiÛÔ ÂӉȷʤÚÔ˘Û·˜ ·˘Ù‹˜ ÓfiÛÔ˘. ∏ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ Û Ó·ڿ Î·È ÂÓ‹ÏÈη ¿ÙÔÌ· ÛÙËÓ ›‰È· ÔÈÎÔÁ¤ÓÂÈ· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ˘fiıÂÛË fiÙÈ Î·È ÔÈ ‰‡Ô Ù‡ÔÈ Ù˘ MM Èı·Ófiٷٷ ÚÔηÏÔ‡ÓÙ·È ·fi ÙÔÓ ›‰ÈÔ ÁÂÓÂÙÈÎfi ·Ú¿ÁÔÓÙ· (4). ∏ ÔÚ›· Î·È Ë ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ ËÏÈΛ· ÂÌÊ¿ÓÈÛ˘ ÙˆÓ ÚÒÙˆÓ Û˘Ìو̿وÓ. ™Â ·È‰È¿ οو ÙˆÓ 4 ÂÙÒÓ, Ë ÓfiÛÔ˜ Â›Ó·È Û¯ÂÙÈο Û¿ÓÈ· Î·È Ì ‰˘ÛÌÂÓ‹ ÚfiÁÓˆÛË, ηıfiÛÔÓ Û˘Óԉ‡ÂÙ·È Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·fi ˘ÔÙÚÔ‹ ÈÛ¯·ÈÌÈÎÒÓ ‹ ·ÈÌÔÚÚ·ÁÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ, ·fi ÌfiÓÈÌ· Ó¢ÚÔÏÔÁÈο ηٿÏÔÈ· Î·È ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË (8). ™‡Ìʈӷ Ì ٷ ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ, Ë ÚÒÈÌË ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ËÏÈΛ· ÙˆÓ 9 ÌËÓÒÓ, Ë Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ ÈÛ¯·ÈÌÈÎÒÓ ÂÌÊÚ¿ÎÙˆÓ Î·È Ë ·ÚÔ˘Û›· Ó¢ÚÔÏÔÁÈÎÒÓ Î·Ù·ÏÔ›ˆÓ ÛÙËÓ ÚÒÙË ·ÛıÂÓ‹, ÙËÓ Î·Ù·Ù¿ÛÛÔ˘Ó ÛÙ· Û¯ÂÙÈÎÒ˜ Û¿ÓÈ· ÂÚÈÛÙ·ÙÈο. ∏ ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ ‹Íˆ˜ ÛÙËÓ ÚÒÙË ÔÈÎÔÁ¤ÓÂÈ· ·ÔÙÂÏ› ›Û˘, ȉȷ›ÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯Ô˘Ó ÂÚÈÙÒÛÂȘ MM ÌÂ Û˘ÓÔ‰¤˜ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜, ÔÈ Ôԛ˜ ·ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ ÛÙÔÓ ·Ûı¶·È‰È·ÙÚÈ΋ 2006;69:143-149
Ó‹ (1,15). ∂Í fiÛˆÓ ÁÓˆÚ›˙Ô˘ÌÂ, Ë ÂÚ›ÙˆÛ‹ Ì·˜ Â›Ó·È Ë ÌÔÓ·‰È΋ ÔÈÎÔÁÂÓ‹˜ ÌÔÚÊ‹ ÛÙËÓ ÔÔ›· ·Ó·Ê¤ÚÔÓÙ·È ÔÏϷϤ˜ ‰È·Ù·Ú·¯¤˜ ‹Íˆ˜ (FV-Leiden, MTHFR Î·È FII 20210A ÌÂÙ·ÏÏ¿ÍÂȘ) Ô˘ ·ÊÔÚÔ‡Ó Î·È ¿ÏÏ· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, Û ÙÚÂȘ ‰È·‰Ô¯ÈΤ˜ ÁÂÓ¤˜. ∆Ô ÂÚÒÙËÌ· Ô˘ Ú¤ÂÈ Ó· ··ÓÙËı› ÛÙÔ Ì¤ÏÏÔÓ Â›Ó·È ·Ó ÔÈ ‰È·Ù·Ú·¯¤˜ Ù˘ ‹Íˆ˜ ¤¯Ô˘Ó Û¯¤ÛË Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ ‹ ·ÔÙÂÏÔ‡Ó Ù˘¯·›Ô ÁÂÁÔÓfi˜. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÔÈ ‰‡Ô ·˘Ù¤˜ ÂÚÈÙÒÛÂȘ: ·) ÂȂ‚·ÈÒÓÔ˘Ó ÙËÓ ÂÈÊ˘Ï·ÎÙÈ΋ ÚfiÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙ· Ôχ Ó·ڿ ¿ÙÔÌ·, ‚) ÙÂÎÌËÚÈÒÓÔ˘Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘ Î·È Û ¿ÏϘ Ê˘Ï¤˜, ÏËÓ Ù˘ ·ÛÈ·ÙÈ΋˜ Î·È Á) ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ‡·ÚÍË ÁÂÓÂÙÈÎÔ‡ ·Ú¿ÁÔÓÙ· ÛÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘. ¶ÔÏ˘ÎÂÓÙÚÈΤ˜ ÎÏÈÓÈΤ˜ ÁÂÓÂÙÈΤ˜ ÌÂϤÙ˜ ·ÔÙÂÏÔ‡Ó ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÁÈ· ÙËÓ Î·Ù¿Ù·ÍË Ù˘ ÓfiÛÔ˘ ÛÙ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù·. ∏ Ù·˘Ùfi¯ÚÔÓË ·ÚÔ˘Û›· ‰È·Ù·Ú·¯ÒÓ Ù˘ ‹Íˆ˜ Û ·ÚÎÂÙ¤˜ ÂÚÈÙÒÛÂȘ ªª ÙÔÓ›˙Ô˘Ó ÙËÓ ·Ó·ÁηÈfiÙËÙ· ÂÚ·ÈÙ¤Úˆ ÌÂÏÂÙÒÓ ÁÈ· Ó· ‰È¢ÎÚÈÓÈÛÙ› Ô Èı·Ófi˜ ÙÔ˘˜ ÚfiÏÔ˜ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÓfiÛÔ˘.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Akgun D, Yilmaz S, Senbil N, Aslan B, Gurer Y. Moyamoya syndrome with protein S deficiency. Eur J Paediatr Neurol 2000;4:185-188. 2. Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 1969;20:288-299. 3. Gosalakkal JA. Moyamoya disease: A Review. Neurol India 2002;50:6-10. 4. Shetty-Alva N, Alva S. Familial moyamoya disease in Caucasians. Pediatr Neurol 2000;23:445-447. 5. Houkin H, Tanaka N, Takahashi A, Kamiyama H, Abe H, Kajii N. Familial occurrence of moyamoya disease. Magnetic resonance angiography as a screening test for high-risk subjects. Childs Nerv Syst 1994;10:421-425. 6. Inoue T, Ikezaki K, Sasazuki T, Matsushima T, Fukui M. Linkage analysis of moyamoya disease on chromosome 6. J Child Neurol 2000;15:179-182. 7. Muir K, Tolmie J, Stephenson J, Petty R, Bone I. Moyamoya in Three Generations of a Scottish Family: Association with a Mitochondrial DNA Polymorphism Typical of Asian Population. Ann Neurol 1999;9 (Suppl):481. 8. Ikeda H, Sasaki T, Yoshimoto T, Fukui M, Arinami T. Mapping of a familial moyamoya disease gene to chromosome 3p24.2-p26. Am J Hum Genet 1999;64(2):533-537. 9. Caldarelli M, Di Rocco C, Gaglini P. Surgical treat-
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ment of moyamoya disease in pediatric age. J Neurosurg Sci 2001;45:83-91. 10. Ikezaki K. Rational Approach to Treatment of Moyamoya Disease in Childhood. J Child Neurol 2000; 15:350-356. 11. Sencer S, Poyanli A, Kiris T, Sencer A, Minareci O. Recent experience with Moyamoya disease in Turkey. Eur Radiol 2000;10:569-572. 12. Aydin K, Okuyaz C, Gucuyener K, Serdaroglu A, Akpek S. Moyamoya Disease Presented with migrainelike headache in a 4-year old girl. J Child Neurol 2003;18:361-363.
13. Zafeiriou DI, Ikeda H, Anastasiou A, Vargiami E, Vougiouklis N, Katzos G et al. Familial Moyamoya disease in a Greek family. Brain Dev 2003;25:288-290. 14. Kaneko Y, Imamoto N, Mannoji H, Fukui M. Familial occurrence of moyamoya disease in the mother and four daughters including identical twins. Neurol Med Chir (Tokyo) 1998;38:349-354. 15. Tsuda H, Hattori S, Nishioka S, Matsushima T, Ikezaki K, Fukui M et al. Thrombophilia found in patients with moyamoya disease. Clin Neurol Neurosurg 1997;99 (Suppl 2):S229-233.
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¶ÂÚ›ÏË„Ë: ∏ ·ÈÌfiÙ˘ÛË ·ÔÙÂÏ› Û¿ÓÈ· ÂΉ‹ÏˆÛË Î·Ù¿ ÙËÓ ·È‰È΋ ËÏÈΛ·. ∞Ú¯Èο Ú¤ÂÈ Ó· ÂȂ‚·Èˆı› fiÙÈ ÚfiÎÂÈÙ·È Ú¿ÁÌ·ÙÈ ÁÈ· ·ÈÌfiÙ˘ÛË Î·È fi¯È ÁÈ· ·ÈÌ·Ù¤ÌÂÛË ‹ ›ÛÙ·ÍË. ∏ ·ÈÌfiÙ˘ÛË Â›Ó·È ‰˘Ó·Ùfi Ó· ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÛÔ‚·Ú‹˜ ÓfiÛÔ˘, Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ÌÔÈÚ·›· Â¿Ó ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛÙ› ηٿÏÏËÏ·. ∏ oÍ›· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÔÙÂÏ› ÙÔ Û˘ÓËı¤ÛÙÂÚÔ ·›ÙÈÔ. ÕÏÏ· Û˘¯Ó¿ ·›ÙÈ· Â›Ó·È Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, Ë ÂÓÙÔÈṲ̂ÓË ‚Ï¿‚Ë ÙˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È Ù· ηډÈÔÏÔÁÈο ÓÔÛ‹Ì·Ù·, ÂÓÒ ·ÚÎÂÙ¿ Û·ÓÈfiÙÂÚ· Â›Ó·È Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ‹ Ù· Ó¢ÌÔÓÔÓÂÊÚÈο Û‡Ó‰ÚÔÌ·, ÛÙ· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜, ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture, Ë ÎÔÎÎȈ̿وÛË Wegener, Ë ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ· Î·È Ë ·Ó·Ê˘Ï·ÎÙÔÂȉ‹˜ ÔÚʇڷ. √ ¤ÏÂÁ¯Ô˜ Ì ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Â›Ó·È ÂȂ‚ÏË̤ÓÔ˜, ·Ó Î·È ÛÙÔ ¤Ó· ÙÚ›ÙÔ ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÌfiÙ˘ÛË, ·˘Ù‹ ı· Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋. ∏ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Î·È Ë ÂÎÙ¤ÏÂÛË ‚ÚÔÁ¯ÔÛÎfiËÛ˘ Ì ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË, ÚÔÛʤÚÔ˘Ó È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ‚Ô‹ıÂÈ· ÛÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ·ÈÌfiÙ˘Û˘. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ·ÈÌfiÙ˘ÛË ˘Ô¯ˆÚ› ·˘ÙfiÌ·Ù· ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË. ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ˘ÔΛÌÂÓË ·ÈÙÈÔÏÔÁ›· Î·È ·fi ÙËÓ ¤ÎÙ·ÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜. ∏ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ì·˙È΋˜ ·ÈÌfiÙ˘Û˘ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË Ì ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ, ÙËÓ ÂÌ‚ÔÏ‹ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ·ÁÁ›Ԣ Î·È ÙËÓ Ó¢ÌÔÓÂÎÙÔÌ‹. §¤ÍÂȘ ÎÏÂȉȿ: ∞ÈÌfiÙ˘ÛË, ÏÔÈÌÒÍÂȘ ·Ó·Ó¢ÛÙÈÎÔ‡, ·È‰È΋ ËÏÈΛ·.
Haemoptysis in children 1 Paediatrician, ICU, Resident Penteli Children’s Hospital, Athens 2 Director, 1st Paediatric Clinic, Penteli Children’s Hospital, Athens Correspondence: Vassilopoulou Maria, 3, Kifissou Str., 152 34, Chalandri, Greece Date of submission: 20-04-2005 Date of approval: 10-02-2006
M.N. Vassilopoulou1, N. Myriokefalitakis2
Abstract: Haemoptysis is rare during childhood. In its management it is first important to distinguish between haemoptysis and haematemesis or epistaxis. Haemoptysis may indicate the presence of severe disease, which could be fatal if not treated appropriately. ∞cute lower respiratory tract infection is the most common cause. Other common causes are cystic fibrosis, localised airway lesions and heart disease. More rare causes include idiopathic pulmonary haemosiderosis and the pulmonary-renal syndromes, which include systemic lupus erythematosus, Goodpasture’s syndrome, Wegener’s granulomatosis, microscopic polyangiitis and Henoch-Schonlein purpura. A plain chest radiograph is mandatory, although one third of children with haemoptysis have a normal chest radiograph. Thorax computed tomography and bronchoalveolar lavage are of great assistance in the investigation. In the majority of children the haemoptysis resolves spontaneously, without the need for invasive measures. The treatment of the child with haemoptysis depends on the underlying aetiology and on the extent of the bleeding. Bronchoscopy with a rigid bronchoscope, embolization of the suspected vessel and surgical resection of the affected lung segment might be required in case of massive bleeding. Key words: Haemoptysis, respiratory tract infections, childhood.
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SLE/™∂§ SIDS ∆∫∂ WG
™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ ™‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ ∆·¯‡ÙËÙ· ηı›˙ËÛ˘ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ∫ÔÎÎȈ̿وÛË Wegener
∂ÈÛ·ÁˆÁ‹ ø˜ ·ÈÌfiÙ˘ÛË ÔÚ›˙ÂÙ·È Ë ·Ô‚ÔÏ‹ ·›Ì·ÙÔ˜ Ì ÙÔÓ ‚‹¯· ‹ Ë ·ÚÔ˘Û›· ·›Ì·ÙÔ˜ ÛÙ· Ù‡ÂÏ·. ™˘Ó‹ıˆ˜ Ë ·ÈÌfiÙ˘ÛË Â›Ó·È ‹È·˜ ‚·Ú‡ÙËÙ·˜ Î·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓË, Û¿ÓÈ· fï˜ Ë ·ÈÌÔÚÚ·Á›· ÌÔÚ› Ó· Â›Ó·È Ì·˙È΋ (>8 ml/Kg/24ˆÚÔ) Î·È Ó· ·ÂÈÏ‹ÛÂÈ ÙË ˙ˆ‹ (1). ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı› fiÙÈ ÛÙËÓ ·ÁÁ›ˆÛË ÙˆÓ Ó¢ÌfiÓˆÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ÔÈ Ó¢ÌÔÓÈΤ˜ ·ÚÙËڛ˜ (Ó¢ÌÔÓÈ΋ ΢ÎÏÔÊÔÚ›·) Î·È ÔÈ ‚ÚÔÁ¯ÈΤ˜ ·ÚÙËڛ˜ (Û˘ÛÙËÌ·ÙÈ΋ ΢ÎÏÔÊÔÚ›·). ŸÙ·Ó Ë ·ÈÌÔÚÚ·Á›· ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ Ó¢ÌÔÓÈΤ˜ ·ÚÙËڛ˜ (Û‡ÛÙËÌ· ¯·ÌËÏÒÓ È¤ÛˆÓ), Ë ·ÈÌfiÙ˘ÛË Â›Ó·È Û˘Ó‹ıˆ˜ ÌÈÎÚÔ‡ fiÁÎÔ˘, ÂÓÒ fiÙ·Ó ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ ‚ÚÔÁ¯ÈΤ˜ (Û‡ÛÙËÌ· ˘„ËÏÒÓ È¤ÛˆÓ), Ù›ÓÂÈ Ó· Â›Ó·È Ì·˙È΋ (2). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·ÈÌfiÙ˘Û˘ ÛÙÔÓ ÁÂÓÈÎfi ·È‰È·ÙÚÈÎfi ÏËı˘ÛÌfi Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÚÔÛ‰ÈÔÚÈÛÙ› Ì ·ÎÚ›‚ÂÈ·, ·ÊÔ‡ Ù· ·È‰È¿ ËÏÈΛ·˜ ÌÈÎÚfiÙÂÚ˘ ÙˆÓ 6 ÂÙÒÓ Û·ÓÈfiٷٷ ÚÔÛ¤Ú¯ÔÓÙ·È Ì ÚÔÂÍ¿Ú¯ÔÓ Û‡Ìو̷ ÙËÓ ·ÈÌfiÙ˘ÛË, ηıÒ˜ ¤¯Ô˘Ó ÙËÓ Ù¿ÛË Ó· ηٷ›ÓÔ˘Ó Ù· Ù‡ÂÏ¿ ÙÔ˘˜ (1).
¶›Ó·Î·˜ 1. ∞›ÙÈ· ·ÈÌfiÙ˘Û˘ Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘ ÛÙ· ·È‰È¿ ™˘Ó‹ıË ñ ∂ÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ñ §Ô›ÌˆÍË - ∆Ú·¯ÂÈÔ‚ÚÔÁ¯›Ùȉ· - ¶Ó¢ÌÔÓ›· (ÌÈÎÚԂȷ΋ - Ì˘ÎËÙÈ·ÛÈ΋ Ê˘Ì·ÙÈ҉˘ - ·Ú·ÛÈÙÈ΋) - ¶Ó¢ÌÔÓÈÎfi ·fiÛÙËÌ· ñ µÚÔÁ¯ÂÎÙ·Û›· (ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, ‰˘ÛÎÈÓËÛ›· ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘, ·ÓÔÛÔ·Ó¿ÚÎÂÈ·,·fiÙÔÎË Ïԛ̈͢ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡) ∞Û˘Ó‹ıË ·ÏÏ¿ fi¯È Û¿ÓÈ· ñ ∆Ú·‡Ì· ñ ¶·ı‹ÛÂȘ Ù˘ ηډȿ˜ - ™˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· (·fiÊÚ·ÍË ÙˆÓ ·ÚÈÛÙÂÚÒÓ ÎÔÈÏÔًوÓ) - ¶Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË - ¶Ó¢ÌÔÓÈ΋ ÂÌ‚ÔÏ‹ ™¿ÓÈ· ñ ŸÁÎÔÈ - ªÂÙ·ÛÙ·ÙÈÎfi ÓÂfiÏ·ÛÌ· - ∞‰¤ÓˆÌ· ‚ÚfiÁ¯ˆÓ - ∫·ÚÎÈÓÔÂȉ¤˜ ñ ™˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ÙˆÓ Ó¢ÌfiÓˆÓ ¶Ó¢ÌÔÓÈ΋ ·ÚÙËÚÈÔÊÏ‚҉˘ ‰˘ÛÏ·Û›·, ‚ÚÔÁ¯ÔÁÂÓ‹˜ ·ÛÙË, Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì·, ·ÈÌ·ÁÁ›ˆÌ· ñ ∞ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË ¢Â˘ÙÂÚÔ·ı‹˜ Û ·ÓÔÛÔηÙÂÛÙ·Ï̤ӷ ·È‰È¿
™˘ÓÔÙÈο, ÔÈ Î·Ù·ÛÙ¿ÛÂȘ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÚÔ˘Û›· ·ÈÌfiÙ˘Û˘ ÛÙ· ·È‰È¿, ·Ú·Ù›ıÂÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆·ÍÈÓÔÌÔ‡ÓÙ·È Ì ÎÚÈÙ‹ÚÈÔ ÙË Û˘¯ÓfiÙËÙ· Ì ÙËÓ ÔÔ›· ·˘Ù¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È (3).
∂Í·ÈÚÂÙÈÎÒ˜ Û¿ÓÈ· ñ π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ñ ∞ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ ñ ∞ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· ηٿ ÙˆÓ ·ÁÁ›ˆÓ Ó¢ÌfiÓˆÓ Î·È ÓÂÊÚÒÓ - ™‡Ó‰ÚÔÌÔ Goodpasture - ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ - ∫ÔÎÎȈ̿وÛË Wegener - MÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂi›Ùȉ· - ¶ÔÚʇڷ Henoch-Schonlein ñ ∞ÈÌfiÙ˘ÛË “ηٿ Ê·ÓÙ·Û›·Ó”
™˘Ó‹ıË ·›ÙÈ· ∏ ÔÍ›· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ·ÔÙÂÏ› ÙÔ Û˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ·ÈÌfiÙ˘Û˘ ‹È·˜ ‚·Ú‡ÙËÙ·˜ (¤ˆ˜ Î·È 40% ÙˆÓ ÂÚÈÙÒÛˆÓ) (1). ∏ ¯ÚfiÓÈ· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, ȉ›ˆ˜ fiÙ·Ó ·˘Ù‹ Û˘Ó‰˘¿˙ÂÙ·È Ì ‚ÚÔÁ¯ÂÎٷۛ˜, ÂΉËÏÒÓÂÙ·È Û˘¯Ó¿ ˆ˜ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ (4). ∏ Û˘¯ÓfiÙÂÚË ·ÈÙ›· ‚ÚÔÁ¯ÂÎÙ·Û›·˜ ÛÙÔÓ ·ÓÂÙ˘Á̤ÓÔ ÎfiÛÌÔ Â›Ó·È Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜. ¶ÂÚ›Ô˘ 5%
ÙˆÓ ·ÛıÂÓÒÓ Ì ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ı· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó Ì·˙È΋ ·ÈÌfiÙ˘ÛË. ÕÏÏ· Û·ÓÈfiÙÂÚ· ·›ÙÈ· ‚ÚÔÁ¯ÂÎÙ·Û›·˜ Â›Ó·È ÏÔÈÌÒÍÂȘ, fiˆ˜ Ô ÎÔÎ·Ù˘, Ë ÈÏ·Ú¿, Ë Ê˘Ì·Ù›ˆÛË, ‰È¿ÊÔÚ· Û‡Ó‰ÚÔÌ· ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜, Ë ¤ÏÏÂÈ„Ë Ù˘ ·1-·ÓÙÈıÚ˘„›Ó˘ Î·È ÙÔ Û‡Ó‰ÚÔÌÔ ‰˘ÛÎÈÓËÛ›·˜ ÙÔ˘ ÎÚÔÛÛˆÙÔ‡ ÂÈıËÏ›Ô˘. ∏ ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓÈ΋ Ê˘Ì·Ù›ˆÛË ·ÔÙÂÏ› ·›ÙÈÔ ·ÈÌfiÙ˘Û˘ Û ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1% (2).
∞ÈÙÈÔÏÔÁ›·
¶·È‰È·ÙÚÈ΋ 2006;69:150-159
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·152
152
ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘
∏ ¯ÚfiÓÈ· Ïԛ̈ÍË ÙÔ˘ ηÙÒÙÂÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ ÌÔÚ› ›Û˘ Ó· Û˘Ó‰˘¿˙ÂÙ·È Ì ¤Ó· ͤÓÔ ÛÒÌ· Ô˘ ¤¯ÂÈ ÂÈÛÚÔÊËı› ¯ˆÚ›˜ ·˘Ùfi Ó· ¤¯ÂÈ Á›ÓÂÈ ·ÓÙÈÏËÙfi. ∞Ó Î·È Ë ÂÈÛÚfiÊËÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ Â›Ó·È Û¯ÂÙÈο Û˘¯Ó‹ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ȉ›ˆ˜ Û ·ÁfiÚÈ· 1-3 ÂÙÒÓ, ·ÈÌfiÙ˘ÛË ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È È‰È·›ÙÂÚ· Û˘¯Ó¿, ·ÎfiÌË Î·È Ì ÙËÓ ÂÈÛÚfiÊËÛË Ô͇·È¯ÌˆÓ ·ÓÙÈÎÂÈ̤ӈÓ, fiˆ˜ Â›Ó·È ÔÈ ÈÓ¤˙˜, ÔÈ Î·ÚÊ›ÙÛ˜ Î.¿. ∏ ·ÈÌÔÚÚ·Á›· Û˘Ì‚·›ÓÂÈ Û˘Ó‹ıˆ˜ ηٿ ÙËÓ ·Ê·›ÚÂÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘, ÙÔ ÔÔ›Ô ¤¯ÂÈ ·Ú·Ì›ÓÂÈ ÛÙÔÓ Ó‡ÌÔÓ· ÁÈ· ·ÚÎÂÙfi ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÒÛÙ ӷ ÂÈϷΛ Ì Ïԛ̈ÍË (3). ∞Û˘Ó‹ıË ·ÏÏ¿ fi¯È Û¿ÓÈ· ·›ÙÈ· √ ¿ÌÂÛÔ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘ ıÒڷη ÏfiÁˆ ÙÚÔ¯·›Ô˘ ·Ù˘¯‹Ì·ÙÔ˜ ‹ ·fi ¿ÏÏÔ ·›ÙÈÔ, ÌÔÚ› Ó· ÚÔηϤÛÂÈ ıÏ¿ÛË ÙÔ˘ Ó‡ÌÔÓ· Î·È ÂÓ›ÔÙ Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›·. ™Â ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ‚ÚÂÊÒÓ Ô˘ η٤ÏËÍ·Ó ÏfiÁˆ Û˘Ó‰ÚfiÌÔ˘ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ (SIDS), ‰È·ÈÛÙÒıËΠ̠ÙË ÓÂÎÚÔ„›· ‡·ÚÍË ·›Ì·ÙÔ˜ ›Ù ÛÙÔ ÛÙfiÌ· ›Ù ÛÙÔ˘˜ Ó‡ÌÔÓ˜ (5). º·›ÓÂÙ·È fiÙÈ Ë ·ÛÊ˘Í›· - ›ÙÂ Ù˘¯·›·, ›Ù ÛÙ· Ï·›ÛÈ· ·È‰È΋˜ ηÎÔÔ›ËÛ˘ - ·ÔÙÂÏ› ¤Ó· ·fi Ù· Û˘ÓËı¤ÛÙÂÚ· ·›ÙÈ· ÙÚ·˘Ì·ÙÈ΋˜ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ ÛÙ· ·È‰È¿. ™ËÌ·ÓÙÈ΋ ·ÈÙ›· ·ÈÌfiÙ˘Û˘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ë ˘¤ÚÙ·ÛË Ù˘ Ó¢ÌÔÓÈ΋˜ ·ÚÙËÚ›·˜ ‹ Ù˘ Ó¢ÌÔÓÈ΋˜ ÊϤ‚·˜ ÏfiÁˆ ›ÎÙËÙ˘ ‹ Û˘ÁÁÂÓÔ‡˜ ηډÈÔ¿ıÂÈ·˜ (.¯. ÛÙ¤ÓˆÛË ÌÈÙÚÔÂȉԇ˜) (4). ™·ÓÈfiÙÂÚ·, Ë Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È ÙÔ ÚÒÙÔ Û‡Ìو̷ Û ¤Ó· ·È‰› Ì ȉÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ˘¤ÚÙ·ÛË. ∂›Û˘, ·ÈÌfiÙ˘ÛË ÌÔÚ› Ó· ·Ú·ÙËÚËı› ÏfiÁˆ Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜ Û ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÛÔ‚·Úfi ˘ÔΛÌÂÓÔ ÓfiÛËÌ· (ηډÈÔ¿ıÂÈ·, ‰È·Ù·Ú·¯¤˜ Ù˘ ‹Í˘, ηÎÔ‹ıÂÈ· ÙÔ˘ ·ÈÌÔÔÈËÙÈÎÔ‡ ÈÛÙÔ‡ Û ·ÁˆÁ‹ Ì ¯ËÌÂÈÔıÂڷ›·, ‰Ú·ÓÔ΢ÙÙ·ÚÈ΋ ·Ó·ÈÌ›·) ‹ ÚԉȷıÂÛÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ (ηıÂÙ‹Ú· ÎÂÓÙÚÈ΋˜ ÊϤ‚·˜, ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (6). ™¿ÓÈ· ·›ÙÈ· ªÂٷ͇ ÙˆÓ Û¿ÓÈˆÓ ·ÈÙ›ˆÓ Ù· ÔÔ›· ÔÊ›ÏÂÈ Ó· ‰ÈÂÚ¢ӋÛÂÈ Î·Ó›˜ ˆ˜ Èı·Ófi ·›ÙÈÔ ·ÈÌfiÙ˘Û˘ Â›Ó·È ÔÈ fiÁÎÔÈ. ™˘Ó‹ıˆ˜ ÚfiÎÂÈÙ·È ÁÈ· ÌÂÙ·ÛÙ·ÙÈο ÓÂÔÏ¿ÛÌ·Ù· - ÓÂÊÚÔ‚Ï¿Ûو̷, ÔÛÙÂÔÂȉ¤˜ Û¿ÚΈ̷, Ë·ÙÔ‚Ï¿Ûو̷ Î·È Û·ÓÈfiÙÂÚ· ÁÈ· ÚˆÙÔ·ı‹, fiˆ˜ ÙÔ ‚ÚÔÁ¯ÈÎfi ηÚÎÈÓÔÂȉ¤˜ Û‡Ó‰ÚÔÌÔ ‹ ÙÔ Ó¢ÌÔÓÈÎfi
¶·È‰È·ÙÚÈ΋ 2006;69:150-159
·‰¤ÓˆÌ· (1). ∞ÊÔÚÔ‡Ó Û˘Ó‹ıˆ˜ Û ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜. ∏ Û˘¯ÓfiÙËÙ· ·ÈÌfiÙ˘Û˘ Ô˘ ÔÊ›ÏÂÙ·È Û οÔÈÔ fiÁÎÔ Î˘Ì·›ÓÂÙ·È ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·fi 2,6%-6% (4). ∂›Û˘, Â›Ó·È ‰˘Ó·Ùfi Ó· ÂΉËψıÔ‡Ó Ì ·ÈÌfiÙ˘ÛË ÔÚÈṲ̂Ó˜ Û˘ÁÁÂÓ›˜ ‰È·Ì·Úٛ˜ ηٿ ÙË ‰È¿Ï·ÛË ÙˆÓ Ó¢ÌfiÓˆÓ, fiˆ˜ ÔÈ ‚ÚÔÁ¯ÔÁÂÓ›˜ ·ÛÙÂȘ (7), ÙÔ Ó¢ÌÔÓÈÎfi ·fiÏ˘Ì·, ÔÈ ÔÏϷϤ˜ ·ÚÙËÚÈÔ-ÊÏ‚҉ÂȘ ÂÈÎÔÈӈӛ˜, ÔÈ Ôԛ˜ ÛÙÔ 50% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÎÏËÚÔÓÔÌÈ΋ ·ÈÌÔÚÚ·ÁÈ΋ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Û‡Ó‰ÚÔÌÔ Rendu-OslerWeber) (8) Î·È Ë ·ÈÌ·ÁÁÂȈ̿وÛË ÙˆÓ Ó¢ÌÔÓÈÎÒÓ ÙÚȯÔÂȉÒÓ (9). ¢È¿¯˘ÙË Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›· ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔ 5% ÙˆÓ ·ÓÔÛÔηÙÂÛÙ·ÏÌ¤ÓˆÓ ·È‰ÈÒÓ Ô˘ ¤¯Ô˘Ó ˘ÔÛÙ› ÌÂÙ·ÌfiÛ¯Â˘ÛË Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ (10) ηٿ ÙÔ Ù¤ÏÔ˜ Ù˘ ÚÒÈÌ˘ ÌÂÙ·ÌÔÛ¯Â˘ÙÈ΋˜ ÂÚÈfi‰Ô˘ (11). √ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·˘Ù‹˜ Ù˘ ÂÈÏÔ΋˜ ‰ÂÓ ¤¯ÂÈ Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛı›. √È ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘Ó‹ıˆ˜ ÔÍ›· ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ· Ì ˘ÔÍ·ÈÌ›· Î·È Û·ÓÈfiÙÂÚ· ·ÈÌfiÙ˘ÛË. ¶Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ· ·È‰È¿ ÏfiÁˆ ÚˆÙÔ·ıÔ‡˜ ·ÈÌ·ÙÔÏÔÁÈ΋˜ ‰È·Ù·Ú·¯‹˜ Â›Ó·È ÙÂÏ›ˆ˜ ·Û˘Ó‹ı˘. ∂Í·ÈÚÂÙÈο Û¿ÓÈ· ·›ÙÈ· ™·ÓÈfiÙÂÚ·, Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ· ·È‰È¿ ·Ú·ÙËÚÂ›Ù·È ÛÙ· Ï·›ÛÈ· Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÛȉ‹ÚˆÛ˘. ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈ΋ Û˘Ó‰ÚÔÌ‹, Ë ÂÈÎfiÓ· Ù˘ ÔÔ›·˜ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ‚‹¯·, ‰‡ÛÓÔÈ·, ·ÈÌfiÙ˘ÛË, ÛȉËÚÔÂÓÈ΋ ·Ó·ÈÌ›· Î·È ‰È¿¯˘Ù˜ ‰ÈËı‹ÛÂȘ ÛÙËÓ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚÂȘ ·ÓÂÍ¿ÚÙËÙ˜ ÎÏÈÓÈΤ˜ ÔÓÙfiÙËÙ˜: 1) ÙËÓ È‰ÈÔ·ı‹ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË, 2) ÙËÓ ·ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙÔ Á¿Ï· ·ÁÂÏ¿‰·˜ Î·È 3) ÙËÓ ·ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· ηٿ ÙˆÓ ·ÁÁ›ˆÓ Ó¢ÌfiÓˆÓ Î·È ÓÂÊÚÒÓ ÛÙ· Ï·›ÛÈ· ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜. π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË Ÿˆ˜ ÚԷӷʤÚıËÎÂ, Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ·ÔÙÂÏ› Û¿ÓÈ· ηٿÛÙ·ÛË, ¿ÁÓˆÛÙ˘ ·ÈÙÈÔÏÔÁ›·˜, ÛÙËÓ ÔÔ›· Ë ·ıÔÏÔÁ›· ÂÚÈÔÚ›˙ÂÙ·È ÛÙÔ˘˜ Ó‡ÌÔÓ˜ Î·È ‰ÂÓ ˘¿Ú¯ÂÈ ÓÂÊÚÈ΋ ‹ Û˘ÛÙËÌ·ÙÈ΋ Û˘ÌÌÂÙÔ¯‹. ∏ ÂÙ‹ÛÈ· ›وۋ Ù˘ Î˘Ì·›ÓÂÙ·È ÌÂٷ͇ 0,241,23 ÂÚÈÙÒÛÂˆÓ ·Ó¿ ¤Ó· ÂηÙÔÌ̇ÚÈÔ ·È‰È¿ (12). ∏ π¶∞, ̤¯ÚÈ ÚfiÙÈÓÔ˜, ÈÛÙ¢fiÙ·Ó fiÙÈ ¤¯ÂÈ Ôχ η΋ ÚfiÁÓˆÛË, Ê·›ÓÂÙ·È fï˜, fiÙÈ Ë
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·153
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∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿
ÚfiÁÓˆÛ‹ Ù˘ ÙÂÏÂ˘Ù·›· ¤¯ÂÈ ‚ÂÏÙȈı› ¯¿ÚË ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË ·ÓÙÈÌÂÙÒÈÛ‹ Ù˘ (13,14). ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ˘ÔÙÚÔ¤˜ ·ÈÌfiÙ˘Û˘, Ì ¤Ó·ÚÍË ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ Û ËÏÈΛ· <6 ÂÙÒÓ Î·È ÔÈΛÏÔ˘ ‚·ıÌÔ‡ ·Ó·ÈÌ›·. ∏ ‚·Ú‡ÙËÙ· Ù˘ ·ÈÌfiÙ˘Û˘ Î˘Ì·›ÓÂÙ·È ·fi ·ÈÌÔÚÚ·Á›· ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹, ¤ˆ˜ ‰È·ÏÂ›Ô˘Û· ·Ô‚ÔÏ‹ ·ÈÌ·ÙËÚÒÓ Ù˘¤ÏˆÓ. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÎÚ›ÛˆÓ, ÔÈ Ôԛ˜ ‰È·ÚÎÔ‡Ó Û˘Ó‹ıˆ˜ 2-4 Ë̤Ú˜, ÔÈ ·ÛıÂÓ›˜ ÂÓ‰¤¯ÂÙ·È Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘ÚÂÙfi, ‰‡ÛÓÔÈ·, ˘ÔÍ›· Î·È ÂÈÎfiÓ· ¯ÚfiÓÈ·˜ ÎfiˆÛ˘, ÂÓÒ Â›Ó·È ÂχıÂÚÔÈ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ· ÌÂÛԉȷÛÙ‹Ì·Ù· ÙˆÓ ˘ÔÙÚÔÒÓ. ∏ ·Ó¿ÚÚˆÛË ÌÔÚ› Ó· Â›Ó·È ÂÎÏËÎÙÈο Ù·¯Â›· Î·È Ï‹Ú˘, ÂÎÙfi˜ ‚¤‚·È· ·fi ÙȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÂÍ·ÈÙ›·˜ Ù˘ ÛȉËÚÔÂÓÈ΋˜ ·Ó·ÈÌ›·˜ Ô˘ ÂÓ‰¤¯ÂÙ·È Ó· ¤¯ÂÈ Î·È ·Ó·ÏfiÁˆ˜ Ì ÙÔÓ ‚·ıÌfi Ù˘. ™Ù· ·È‰È¿ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜, ÛÙ· ÔÔ›· Â›Ó·È ‰˘Ó·Ù‹ Ë ÂÎÙ¤ÏÂÛË ‰ÔÎÈÌ·ÛÈÒÓ Ó¢ÌÔÓÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ù· Â˘Ú‹Ì·Ù· Â›Ó·È Û˘Ì‚·Ù¿ Ì Ó¢ÌÔÓÔ¿ıÂÈ· ÂÚÈÔÚÈÛÙÈÎÔ‡ Ù‡Ô˘. ∏ ‰È¿ÁÓˆÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ÎÏÈÓÈ΋ ÂÈÎfiÓ·, ÛÙËÓ ·Ó‡ÚÂÛË ÛȉËÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ ÛÙȘ ‚ÚÔÁ¯ÈΤ˜ ‹ Á·ÛÙÚÈΤ˜ ÂÎÎÚ›ÛÂȘ 3-14 Ë̤Ú˜ ÌÂÙ¿ ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ ÎÚ›Û˘ Î·È ÛÙÔÓ ·ÔÎÏÂÈÛÌfi ÙˆÓ ÏÔÈÒÓ ·ÈÙ›ˆÓ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÁÂÁÔÓfi˜ ÙÔ ÔÔ›Ô Û¿ÓÈ·, ··ÈÙ› ‚ÈÔ„›· Ó‡ÌÔÓ·. πηÓÔÔÈËÙÈο ·ÔÙÂϤÛÌ·Ù· ·Ó·Ê¤ÚÔÓÙ·È Ì ÙË ¯ÔÚ‹ÁËÛË Ú‰ÓÈ˙ÔÏfiÓ˘ ‹ ÒÛÂˆÓ ÌÂı˘Ï-Ú‰ÓÈ˙ÔÏfiÓ˘, ˘‰ÚÔ͢¯ÏˆÚÔΛÓ˘, ΢ÙÙ·ÚÔÙÔÍÈÎÒÓ ÌfiÓˆÓ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì Ú‰ÓÈ˙ÔÏfiÓË (3,13-15). ™Â ·ÛıÂÓ›˜ Ô˘ ·Ó·ÚÚÒÓÔ˘Ó ·fi π¶∞, Ë Ó¢ÌÔÓÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÌÔÚ› Ó· Â›Ó·È ·Ôχو˜ Ê˘ÛÈÔÏÔÁÈ΋, ÂÊfiÛÔÓ ‰ÂÓ ·ÚÔ˘ÛÈ·ÛÙ› ˘ÔÙÚÔ‹ Ù˘ ·ÈÌÔÚÚ·Á›·˜. ™Â ÚfiÛÊ·ÙË Û¯ÂÙÈο ÌÂϤÙË ·Ó·Ê¤ÚÂÙ·È ÂÓÙ·ÂÙ‹˜ ÂÈ‚›ˆÛË Ô˘ Êı¿ÓÂÈ ÙÔ 86% (13), Û ·ÓÙȉȷÛÙÔÏ‹ Ì ·Ï·ÈfiÙÂÚ˜ ÌÂϤÙ˜ ÛÙȘ Ôԛ˜ Ë ıÓËÛÈÌfiÙËÙ· ‹Ù·Ó Ù˘ Ù¿Í˘ ÙÔ˘ 50-60% (3). ¶ÚˆÙÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ˘ÂÚ¢·ÈÛıËÛ›· ÛÙÔ Á¿Ï· Ù˘ ·ÁÂÏ¿‰·˜ (™. Heiner) ¶ÚfiÎÂÈÙ·È ÁÈ· ÎÏÈÓÈ΋ ÔÓÙfiÙËÙ· ÛÙËÓ ÔÔ›· ÔÈ ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÙËÓ Ù˘È΋ ÂÈÎfiÓ· Ù˘ π¶∞, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ¯ÚfiÓÈ· ÚÈÓ›Ùȉ·, ˘ÔÙÚÔÈ¿˙Ô˘Û· ̤ÛË ˆÙ›Ùȉ·, Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ÂÙÈÎfi, ηı˘ÛÙ¤ÚËÛË Ù˘ ·‡ÍËÛ˘ Î·È ·ÚÔ˘-
Û›· ÛÙÔÓ ÔÚfi ·ÓÙÈÛˆÌ¿ÙˆÓ IgG ¤Ó·ÓÙÈ ÚˆÙÂ˚ÓÒÓ ÙÔ˘ ·ÁÂÏ·‰ÈÓÔ‡ Á¿Ï·ÎÙÔ˜ (milk precipitins). Œ¯ÂÈ Î·Ï‡ÙÂÚË ÚfiÁÓˆÛË ·fi ÙËÓ π¶∞. ∞ÈÌÔÛȉ‹ÚˆÛË Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ·ÓÔÛÔÛ˘ÌϤÁÌ·Ù· ηٿ ÙˆÓ ·ÁÁ›ˆÓ Ó¢ÌfiÓˆÓ Î·È ÓÂÊÚÒÓ (Ó¢ÌÔÓÔÓÂÊÚÈο Û‡Ó‰ÚÔÌ·) ™ÙËÓ Î·ÙËÁÔÚ›· ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture, Ô Û˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜ (™∂§), Ë ÎÔÎÎȈ̿وÛË Wegener, Ë ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ· Î·È Ë ·Ó·Ê˘Ï·ÎÙÈ΋ ÔÚʇڷ (¶›Ó·Î·˜ 2). ™ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture Î·È ÛÙÔÓ ™∂§ ·Ú·ÙËÚÂ›Ù·È ‰È¿¯˘ÙË Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ÛÙ· Ï·›ÛÈ· Ó¢ÌÔÓÈ΋˜ ·ÁÁÂÈ›Ùȉ·˜, ÂÓÒ ÛÙËÓ ÎÔÎÎȈ̿وÛË Wegener Î·È ÛÙË ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ· Ë ·ÈÌÔÚÚ·Á›· ÚÔ¤Ú¯ÂÙ·È Î˘Ú›ˆ˜ ·fi ÛËÏ·ÈÒ‰ÂȘ ‚Ï¿‚˜. ∆· “ÌË ÂȉÈο Ó¢ÌÔÓÔ-ÓÂÊÚÈο” Û‡Ó‰ÚÔÌ·, ·ÊÔÚÔ‡Ó ·È‰È¿ Ì ÓÂÊÚÔ¿ıÂÈ·, ÛÙ· Ï·›ÛÈ· Ù˘ ÔÔ›·˜ ÂÓ‰¤¯ÂÙ·È Ó· ÚÔÛ‚ÏËıÔ‡Ó Î·È ÔÈ Ó‡ÌÔÓ˜ (‚Ï. Ó¢ÌÔÓÈÎfi Ô›‰ËÌ·, ÂÌ‚ÔÏ‹ ‹ Ïԛ̈ÍË Û ·È‰› Ì ÓÂÊÚˆÛÈÎfi Û‡Ó‰ÚÔÌÔ) (17). ™‡Ó‰ÚÔÌÔ Goodpasture: ∆Ô Û‡Ó‰ÚÔÌÔ Goodpasture Â›Ó·È ¤Ó· ·˘ÙÔ¿ÓÔÛÔ ÓfiÛËÌ· ÙÔ ÔÔ›Ô ÔÊ›ÏÂÙ·È ÛÙÔÓ Û¯ËÌ·ÙÈÛÌfi ·ÓÔÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ. ¶ÚÔÛ‚¿ÏÏÔÓÙ·È Û¯Â‰fiÓ ·ÔÎÏÂÈÛÙÈο ÔÈ ÓÂÊÚÔ› Î·È ÔÈ Ó‡ÌÔÓ˜. √È ·ÛıÂÓ›˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· Î·È Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›·. ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ÛÙÔÓ ÔÚfi ·ÓÙÈÛˆÌ¿ÙˆÓ Î·Ù¿ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜ ÙˆÓ ÓÂÊÚÒÓ, ÂÓÒ Û¿ÓÈ· Â›Ó·È ·Ó·Áη›· Ë ‚ÈÔ„›· ÙÔ˘ ÓÂÊÚÔ‡ ‹ ÙÔ˘ Ó‡ÌÔÓ·. ∞Ó Î·È Â›Ó·È Û˘ÓËı¤ÛÙÂÚÔ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ÙÔ Û‡Ó‰ÚÔÌÔ Goodpasture ¤¯ÂÈ ·Ú·ÙËÚËı› ÙËÓ ÙÂÏÂ˘Ù·›· 20ÂÙ›· Î·È ÛÙ· ·È‰È¿, ÌÂ Ù˘Èο ÎÏÈÓÈο Î·È ·ÓÔÛÔÏÔÁÈο Â˘Ú‹Ì·Ù· (18). ∏ ·ÓÙÈÌÂÙÒÈÛ‹ ÙÔ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯Ú‹ÛË Ï·ÛÌ·Ê·›ÚÂÛ˘ Î·È ÎÔÚÙÈÎÔÛÙÂÚÔÂȉÒÓ. ∏ ·ÓÙ·fiÎÚÈÛË, ÂÊfiÛÔÓ Ë ıÂڷ›· ·Ú¯›˙ÂÈ ÛÙËÓ ·Ú¯È΋ Ê¿ÛË Ù˘ ÓfiÛÔ˘, Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Î·Ï‹, ·Ó Î·È ˘¿Ú¯Ô˘Ó Ï›Á˜ ·Ó·ÊÔÚ¤˜ Û¯ÂÙÈο Ì ÙËÓ ¤Î‚·Û‹ Ù˘ ÛÙ· ·È‰È¿. ™˘ÛÙËÌ·ÙÈÎfi˜ ÂÚ˘ıËÌ·Ù҉˘ χÎÔ˜: ∆Ô 8% ÂÚ›Ô˘ ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈÎfi ÂÚ˘ıËÌ·ÙÒ‰Ë Ï‡ÎÔ Â›Ó·È ·È‰È¿ ‹ ¤ÊË‚ÔÈ, ÂÓÒ ÙÔ 90% ·˘ÙÒÓ Â›Ó·È ÎÔÚ›ÙÛÈ·. ∏ ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÓfiÛÔ˘ Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ù· 11 ¤ÙË (19). √È ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙ· ·È‰È¿ Â›Ó·È ·ÚfiÌÔȘ Ì ·˘Ù¤˜ ÙˆÓ ÂÓËÏ›ÎˆÓ Î·È ¶·È‰È·ÙÚÈ΋ 2006;69:150-159
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·154
154
ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘
¶›Ó·Î·˜ 2. ÷ڷÎÙËÚÈÛÙÈο ÁÓˆÚ›ÛÌ·Ù· ÙˆÓ Ó¢ÌÔÓÔ-ÓÂÊÚÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ (3) ™‡Ó‰ÚÔÌÔ ™˘ÛÙËÌ·ÙÈÎfi˜ ∫ÔÎÎȈ̿وÛË ªÈÎÚÔÛÎÔÈ΋ ¶ÔÚʇڷ Goodpasture ∂Ú˘ıËÌ·Ù҉˘ Wegener ¶ÔÏ˘·ÁÁ›ÈÙȉ· Henoch-Schonlein §‡ÎÔ˜ ¶Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· ++++ ™ÂÈÚ·Ì·ÙÔÓÂÊÚ›Ùȉ· ++++ ™˘ÌÌÂÙÔ¯‹ ·ÓÒÙÂÚÔ˘ 0 ·Ó·Ó¢ÛÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¢ÂÚÌ·ÙÈÎfi ÂÍ¿ÓıËÌ· 0/+ ∞ÚıÚ·ÏÁ›· 0 ∆∫∂ 0/+ ™˘ÌÌÂÙÔ¯‹ ÂÙÈÎÔ‡ 0 £ÂÙÈÎÔÔ›ËÛË Anti-GBM, ÔÚÔÏÔÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ p-ANCA (Û¿ÓÈ·) ∞ÓÙÈÌÂÙÒÈÛË
∫/™ ∫/∆ ¶Ï·ÛÌ·Ê·›ÚÂÛË
+/++ +++/++++ +/++
+++ ++++ ++++
+++ ++++ ++
+ ++++ 0
++++ ++++ ++++ 0 ∞¡∞, Anti-ds DNA, p-ANCA (Û¿ÓÈ·) ∫/™ ∫/∆
+++ +++ ++++ 0 c-ANCA, p-ANCA (Û¿ÓÈ·)
+++ +++ ++++ 0 p-ANCA, c-ANCA
++++ ++++ + ++++ IgA+ IgM+
∫/™ ∫/∆
∫/™ ∫/∆;
∫/™
Anti-GBM: ∞ÓÙÈÛÒÌ·Ù· ηٿ Ù˘ ‚·ÛÈ΋˜ ÌÂÌ‚Ú¿Ó˘ ÙÔ˘ ÛÂÈÚ¿Ì·ÙÔ˜, ∞¡∞: ∞ÓÙÈ˘ÚËÓÈο ·ÓÙÈÛÒÌ·Ù·, ds DNA: ¢ÈÏ‹˜ ¤ÏÈη˜ DNA, ANCA: ∞ÓÙÈÔ˘‰ÂÙÂÚÔÊÈÏÈο ΢ÙÙ·ÚÔÏ·ÛÌ·ÙÈο ·ÓÙÈÛÒÌ·Ù·, ∫/™: ∫ÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹, ∫/∆: ∫˘ÙÙ·ÚÔÙÔÍÈο
¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙËÓ ·ÚÔ˘Û›· Â̇ÚÂÙÔ˘, ·ÚıÚ›Ùȉ·˜, ÂÍ·Óı‹Ì·ÙÔ˜ Î·È ÓÂÊÚÔ¿ıÂÈ·˜. ∏ Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜ ÂΉËÏÒÓÂÙ·È Û˘Ó‹ıˆ˜ ˆ˜ Ï¢ڛÙȉ·. ¢È¿¯˘ÙË Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›· ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÙÔ 6% ÙˆÓ ·È‰ÈÒÓ Ì ™∂§ (19,20). ∏ ‰È¿ÁÓˆÛË ÂȂ‚·ÈÒÓÂÙ·È Ì ÙËÓ ·Ó‡ÚÂÛË ∞¡∞ Î·È anti-ds DNA ÛÙÔÓ ÔÚfi. ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÌË-ÛÙÂÚÈÓÔÂȉÒÓ ·ÓÙÈÊÏÂÁÌÔÓˆ‰ÒÓ Ê·ÚÌ¿ÎˆÓ ‹ ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ. ™Â ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜, fiˆ˜ Â›Ó·È Ë Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›·, ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÒÛÂȘ ÌÂı˘ÏÔÚÂÓ‰È˙ÔÏfiÓ˘ Î·È Î˘ÎÏÔʈÛÊ·Ì›‰Ë˜, ÂÓÒ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ‚ÔËı¿ Ë Ï·ÛÌ·Ê·›ÚÂÛË. ∏ ÚfiÁÓˆÛË ÛÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜, ÙÔ˘Ï¿¯ÈÛÙÔÓ ÛÙÔ˘˜ ÂÓËÏ›ÎÔ˘˜, ‹Ù·Ó η΋ (21,22). ∫ÔÎÎȈ̿وÛË Wegener Î·È ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁÂÈ›Ùȉ·: ¶ÚfiÎÂÈÙ·È ÁÈ· ۯ‰fiÓ Ù·˘ÙfiÛË̘ ηٷÛÙ¿ÛÂȘ, ÔÈ Ôԛ˜ ‰È·ÎÚ›ÓÔÓÙ·È ÌÂٷ͇ ÙÔ˘˜ Ì ÌfiÓÔ ÎÚÈÙ‹ÚÈÔ ÙË ıÂÙÈÎÔÔ›ËÛË ‹ ÌË ÂȉÈÎÒÓ ÔÚÔÏÔÁÈÎÒÓ ÂÍÂÙ¿ÛˆÓ. ™ÙË ÌÈÎÚÔÛÎÔÈ΋ ÔÏ˘·ÁÁ›Ùȉ· (MP) ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔÓ ÔÚfi Ù· p-ANCA Î·È Ù· c-ANCA ·ÓÙÈÛÒÌ·Ù·, ÂÓÒ ÛÙËÓ ÎÔÎÎȈ̿وÛË Wegener ·Ó¢ڛÛÎÔÓÙ·È Û˘Ó‹ıˆ˜ ÌfiÓÔ Ù· cANCA. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· Â›Ó·È ·˘Ù‹ Ù˘ Ó¢ÌÔÓÈ΋˜ ÎÔÎÎȈ̿وÛ˘, Ì ‰ËÌÈÔ˘ÚÁ›· ÛËÏ·›ˆÓ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜, ‚Ï¿‚˜ ÙˆÓ ·ÓˆÙ¤¶·È‰È·ÙÚÈ΋ 2006;69:150-159
ÚˆÓ ·ÂÚ·ÁˆÁÒÓ Î·È Û˘ÓÔ‰¤˜ ‚Ï¿‚˜ ÙˆÓ ·ÁÁ›ˆÓ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ ÓÂÊÚÒÓ. ∞ÈÌfiÙ˘ÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÏfiÁˆ ·ÈÌÔÚÚ·Á›·˜ ·fi ÙȘ ÛËÏ·ÈÒ‰ÂȘ ‚Ï¿‚˜ (17) Û ÔÛÔÛÙfi Ô˘ Î˘Ì·›ÓÂÙ·È ÛÙȘ ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ·fi 5% ¤ˆ˜ 45% (22). ∏ ·ÁˆÁ‹ Ô˘ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ¯ÔÚ‹ÁËÛË ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉÒÓ Î·È Î˘ÎÏÔʈÛÊ·Ì›‰Ë˜. √È ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¤Ó·ÚÍË Ù˘ ÓfiÛÔ˘ ÛÙËÓ ·È‰È΋ ËÏÈΛ·, ÂÌÊ·Ó›˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ÂÈÏÔΤ˜ fiˆ˜ ˘ÔÁψÙÙȉÈ΋ ÛÙ¤ÓˆÛË Î·È ÚÈÓÈ΋ ‰˘ÛÌÔÚÊ›· - Û ۯ¤ÛË Ì ÙÔ˘˜ ˘fiÏÔÈÔ˘˜ (23). ∞Ó·Ê˘Ï·ÎÙÔÂȉ‹˜ ÔÚʇڷ (ÔÚʇڷ HenochSchonlein): ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi Ù˘ÈÎfi ÂÍ¿ÓıËÌ· ÙˆÓ Î¿Ùˆ ¿ÎÚˆÓ, ÎÔÈÏÈ·Îfi ¿ÏÁÔ˜ Î·È Û˘ÌÙÒÌ·Ù· ÛÙȘ ·ÚıÚÒÛÂȘ. √È ÂΉËÏÒÛÂȘ ·˘Ù¤˜ Û˘Ó‹ıˆ˜ ˘Ê›ÂÓÙ·È ·˘ÙfiÌ·Ù· ‹ Û ·¿ÓÙËÛË ıÂڷ›·˜ Ì ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ·Ó¿ÁÎË. ¶ÂÚÈÛÙ·Ûȷο, Ë ÓfiÛÔ˜ Â›Ó·È ÈÔ ÛÔ‚·Ú‹, Ì ÓÂÊÚÈ΋ Û˘ÌÌÂÙÔ¯‹, ÂÓÒ Û Ôχ Û¿ÓȘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ÂΉËψı› ‰È¿¯˘ÙË Î˘„ÂÏȉÈ΋ ·ÈÌÔÚÚ·Á›·. ™ÔÚ·‰Èο, ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÚÈÙÒÛÂȘ ·È‰ÈÒÓ Ì ·Ó·Ê˘Ï·ÎÙÔÂȉ‹ ÔÚʇڷ Î·È Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· Î·È ·ÚfiÏÔ Ô˘ Ù· ·È‰È¿ ·˘Ù¿ ‹Ù·Ó Û Ôχ ÛÔ‚·Ú‹ ηٿÛÙ·ÛË, Ë ¤Î‚·Û‹ ÙÔ˘˜ ‹Ù·Ó Ôχ ηϋ ÌÂÙ¿ ÙË ıÂڷ›· Ì ÎÔÚÙÈÎÔÛÙÂÚÈÓÔÂȉ‹ ‹ ΢ÙÙ·ÚÔÙÔÍÈο Ê¿Ú̷η (16,24).
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∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿
“∫·Ù¿ Ê·ÓÙ·Û›·Ó” ·ÈÌfiÙ˘ÛË ¶ÚfiÎÂÈÙ·È ÁÈ· ηٿÛÙ·ÛË Ë ÔÔ›· ·ÊÔÚ¿ ÂÊ‹‚Ô˘˜, ·ÛÙ·ı›˜ Û˘Ó·ÈÛıËÌ·ÙÈο. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ Ô˘ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·ÊÔÚÔ‡Ó Î˘Ú›ˆ˜ ÂÓËÏ›ÎÔ˘˜ Ì ÌÈ· ÌÔÚÊ‹ Û˘Ó‰ÚfiÌÔ˘ Munchausen, ÙÔ ÔÔ›Ô ÂΉ‹ÏˆÛ·Ó ˆ˜ “·ÈÌfiÙ˘ÛË”. ŸÛÔÓ ·ÊÔÚ¿ ÛÙ· ·È‰È¿, ˘¿Ú¯Ô˘Ó ÏÈÁfiÙÂÚ˜ ·Ó·ÊÔÚ¤˜. ÷ڷÎÙËÚÈÛÙÈο ·Ú·Ù›ıÂÙ·È ÙÔ ÂÚÈÛÙ·ÙÈÎfi ÂÓfi˜ 12¯ÚÔÓÔ˘ ÎÔÚÈÙÛÈÔ‡ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËΠ·Ú¯Èο Ì ÈÛÙÔÚÈÎfi ˘ÔÙÚÔÈ¿˙Ô˘Û·˜ ·ÈÌ·Ù¤ÌÂÛ˘ Î·È ·ÚÁfiÙÂÚ· Ì ·ÈÌfiÙ˘ÛË, ÁÈ· ÙË ‰ÈÂÚ‡ÓËÛË Ù˘ ÔÔ›·˜ ˘Ô‚Ï‹ıËΠ۠ϋıÔ˜ ÂÍÂÙ¿ÛˆÓ. ∆ÂÏÈο ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·ÛıÂÓ‹˜ “‰¿ÁΈÓ” Ù· ¯Â›ÏË Ù˘ Î·È ¤‚·˙ ٷ ‰¿¯Ù˘Ï¿ Ù˘ ÛÙ· ÚÔ˘ıÔ‡ÓÈ· Ù˘ (25).
¶ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË ∂›Ó·È ÛËÌ·ÓÙÈÎfi Ó· ‰È¢ÎÚÈÓÈÛÙ› ·fi ÙËÓ ·Ú¯‹ fiÙÈ ÚfiÎÂÈÙ·È Ú¿ÁÌ·ÙÈ ÁÈ· ·ÈÌfiÙ˘ÛË Î·È fi¯È ÁÈ· ·ÈÌ·Ù¤ÌÂÛË ‹ ÁÈ· ·fi¯ÚÂÌ„Ë ·›Ì·ÙÔ˜ ÏfiÁˆ ›ÛÙ·Í˘. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ›ÛÙ·Í˘ ÙÔ ·›Ì· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi Û‡ÛÙËÌ· (.¯. ÚÈÓÔÚÚ·Á›·, ÊÏÂÁÌÔÓ‹ ·Ú›ÛıÌÈˆÓ ·Ì˘Á‰·ÏÒÓ ‹ ·‰ÂÓÔÂȉÒÓ Â΂ϷÛÙ‹ÛˆÓ, Ô˘Ï›Ùȉ·, ÂÍÂÏÎÒÛÂȘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜). °È· ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ Â›Ó·È ··Ú·›ÙËÙË Ë ÚÔÛÂÎÙÈ΋ ÂÈÛÎfiËÛË Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Î·È ÙÔ˘ ÚfiÛıÈÔ˘ Î·È Ô›ÛıÈÔ˘ ÚÈÓÔÊ¿Ú˘ÁÁ·. ™ÙËÓ ÂÚ›ÙˆÛË Ù˘ ·ÈÌ·Ù¤ÌÂÛ˘ ÙÔ ·Ô‚·ÏÏfiÌÂÓÔ ·›Ì· ¤¯ÂÈ ‚·ı‡ ÎfiÎÎÈÓÔ ‹ ηʤ ¯ÚÒÌ·, fiÍÈÓÔ pH Î·È ÂӉ¯Ô̤ӈ˜ ÂÚȤ¯ÂÈ ˘ÔÏ›ÌÌ·Ù· ÙÚÔÊ‹˜, ÂÓÒ ·fi ÙÔ ÈÛÙÔÚÈÎfi Û˘Ó‹ıˆ˜ ·Ó·Ê¤ÚÂÙ·È fiÙÈ ÚÔËÁ‹ıËΠӷ˘Ù›·. ∞ÓÙ›ıÂÙ·, ÛÙËÓ ÂÚ›ÙˆÛË Ù˘ ·ÈÌfiÙ˘Û˘ ÙÔ ·›Ì· ¤¯ÂÈ ˙ˆËÚfi ÂÚ˘ıÚfi ¯ÚÒÌ·, ·ÏηÏÈÎfi pH Î·È ÌÔÚ› Ó· Â›Ó·È ·Ó·ÌÈÁ̤ÓÔ Ì ۛÂÏÔ. ∂Í¿ÏÏÔ˘, Ë ·ÈÌfiÙ˘ÛË Û˘Óԉ‡ÂÙ·È ·fi ‚‹¯· Î·È ÂÓ›ÔÙ ÌÔÚ› Ó· ·ÎÔ˘ÛÙ› ‹¯Ô˜ Û·Ó ÎÂÏ¿Ú˘ÛÌ· (¶›Ó·Î·˜ 3) (26). ∂ÊfiÛÔÓ ·Ô‰ÂȯÙ› fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ·ÈÌfiÙ˘ÛË Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘, ÙÔ ÂfiÌÂÓÔ
‚‹Ì· Â›Ó·È Ë Ï‹„Ë ÈÛÙÔÚÈÎÔ‡. ™ÙÔȯ›· ·fi ÙÔ ÈÛÙÔÚÈÎfi Ô˘ ÂӉȷʤÚÔ˘Ó Â›Ó·È Ë ·ÚÔ˘Û›· ˘ÚÂÙÔ‡, Ë ·ÒÏÂÈ· ‚¿ÚÔ˘˜, Ù· ÂÂÈÛfi‰È· ÂÈΛÌÂÓ˘ ÓÈÁÌÔÓ‹˜, Ù˘¯fiÓ ÏÔÈÌÒ‰Ë ÓÔÛ‹Ì·Ù· ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, Ô ÚfiÛÊ·ÙÔ˜ ÙÚ·˘Ì·ÙÈÛÌfi˜, Ù· Ù·Í›‰È·, Ë ¯Ú‹ÛË Ê·ÚÌ¿ÎˆÓ (·ÛÈÚ›ÓË, ·ÓÙÈËÎÙÈο, ÚÔ˘Ï-ıÂÈԢڷΛÏË) Î·È Ë ¯Ú‹ÛË ÎÔη˝Ó˘ ‹ ηÓÔ‡. £· ·Ó·˙ËÙËıÔ‡Ó Â›Û˘ ÛÙÔȯ›· Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ¯ÚfiÓÈÔ Ó¢ÌÔÓÈÎfi ÓfiÛËÌ·, fiˆ˜ Ë ‡·ÚÍË ¯ÚfiÓÈÔ˘ ·Ú·ÁˆÁÈÎÔ‡ ‚‹¯· ‹ Û˘ÚÈÁÌÔ‡ ‹ ÔÈ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ Ó¢ÌÔӛ˜. ∏ ‡·ÚÍË ˘ÚÂÙÔ‡ Ì ‚‹¯· Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ÔÍ›·˜ Ïԛ̈͢ ÙÔ˘ ηو٤ÚÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡, Ë ‡·ÚÍË ıˆÚ·ÎÈÎÔ‡ ¿ÏÁÔ˘˜ Â›Ó·È ÂÓ‰ÂÈÎÙÈ΋ ›Ù ÙÚ·˘Ì·ÙÈÛÌÔ‡, ›Ù ÔÍ›·˜ Ïԛ̈͢, ›Ù Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· ÂÚ›ÙˆÛË Û˘¯Ó¿ Û˘Ó˘¿Ú¯Ô˘Ó ÈÛÙÔÚÈÎfi ÚfiÛÊ·Ù˘ ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘, fiÓÔ˜ ηٿ ÙË Á·ÛÙÚÔÎÓËÌ›·, ·Ú·ÙÂٷ̤ÓË ·ÎÈÓËÛ›· (2). ∏ Û˘Û¯¤ÙÈÛË ÙÔ˘ ÂÂÈÛÔ‰›Ô˘ ·ÈÌfiÙ˘Û˘ Ì ÙËÓ ¤ÌÌËÓÔ Ú‡ÛË ÛÙȘ ¤Ê˂˜, ı¤ÙÂÈ ÙËÓ ˘Ô„›· Ù˘ ηٷ̋ÓÈ·˜ ·ÈÌfiÙ˘Û˘ ÏfiÁˆ ÂÓ‰ÔıˆÚ·ÎÈ΋˜ ÂÓ‰ÔÌËÙÚ›ˆÛ˘ (2). ∏ ‡·ÚÍË Ù¤ÏÔ˜ ·ÈÌ·ÙÔ˘Ú›·˜, ı· ı¤ÛÂÈ ÙÔ ÂӉ¯fiÌÂÓÔ ÌÈ·˜ Ó¢ÌÔÓÔ-ÓÂÊÚÈ΋˜ ·ÁÁÂÈ›Ùȉ·˜ (3). ŸÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÎÏÈÓÈ΋ ÚÔÛ¤ÁÁÈÛË, ÂÊfiÛÔÓ ÚfiÎÂÈÙ·È ÁÈ· Ì·˙È΋, ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹ ·ÈÌfiÙ˘ÛË, ·˘Ù‹ ı· Ú¤ÂÈ ·Ú¯Èο Ó· ÂÛÙÈ·ÛÙ› ÛÙË ‰È·Ù‹ÚËÛË Ù˘ ‚·ÙfiÙËÙ·˜ ÙˆÓ ·ÂÚ·ÁˆÁÒÓ, Ù˘ ·ÚÎÔ‡˜ ·Ó·Ó¢ÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È Ù˘ ·ÚÎÔ‡˜ ΢ÎÏÔÊÔÚ›·˜. ∂ÊfiÛÔÓ Ô ¤ÏÂÁ¯Ô˜ ÙˆÓ ˙ˆÙÈÎÒÓ ÛËÌ›ˆÓ ˘Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ÂÂÈÛfi‰ÈÔ ·ÈÌfiÙ˘Û˘ ÌÈÎÚ‹˜ ‚·Ú‡ÙËÙ·˜, ¿ÌÂÛ· ÌÔÚ› Ó· ·ÎÔÏÔ˘ı‹ÛÂÈ Ë ÏÂÙÔÌÂÚ‹˜ Ê˘ÛÈ΋ ÂͤٷÛË, Ì ÙËÓ ÔÔ›· ı· ·Ó·˙ËÙËıÔ‡Ó Ë ‡·ÚÍË ˘ÚÂÙÔ‡, ÂÈÛÎÔÈο Ë ‡·ÚÍË ÏËÎÙÚÔ‰·ÎÙ˘Ï›·˜, ÂÓ‰ÂÈÎÙÈ΋ ¯ÚfiÓÈ·˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜, ·ÚÙËÚÈÔÊÏÂ‚Ò‰Ô˘˜ ‰˘ÛÏ·Û›·˜ ‹ ΢·ÓˆÙÈ΋˜ ηډÈÔ¿ıÂÈ·˜, ˆ¯ÚfiÙËÙ·˜, ÂÓ‰ÂÈÎÙÈ΋ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ‹ Ù˘ ¯ÚÔÓÈfiÙËÙ·˜ Ù˘ ˘ÔΛÌÂÓ˘ ÓfiÛÔ˘, Âί˘ÌÒÛÂˆÓ ‹ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÛÙÔÓ ıÒڷη Î·È ÙËÏ·ÁÁÂÈÂÎÙ·Û›·˜ ‹ ·ÈÌ·ÁÁÂÈÒÌ·ÙÔ˜
¶›Ó·Î·˜ 3. ¢È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ·ÈÌfiÙ˘Û˘ - ·ÈÌ·Ù¤ÌÂÛ˘ (26)
∫ÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ πÛÙÔÚÈÎfi ∞fi¯ÚÂÌ„Ë p∏ ·fi¯ÚÂ̄˘ ªÈÎÚÔÛÎÔÈ΋ ÂͤٷÛË ·fi¯ÚÂ̄˘
∞ÈÌfiÙ˘ÛË
∞ÈÌ·Ù¤ÌÂÛË
¶ÚÔËÁÂ›Ù·È ‚‹¯·˜ ¶Ó¢ÌÔÓÔ¿ıÂÈ· ∞ÊÚ҉˘ ∑ˆËÚfi ÂÚ˘ıÚfi ¯ÚÒÌ· ∞ÏηÏÈÎfi ª·ÎÚÔÊ¿Á· Î·È Ô˘‰ÂÙÂÚfiÊÈÏ·
¶ÚÔËÁÂ›Ù·È Ó·˘Ù›·, Ù¿ÛË ÁÈ· ¤ÌÂÙÔ ¡fiÛÔ˜ ÛÙÔÌ¿¯Ô˘-‹·ÙÔ˜ ø˜ ÎfiÎÎÔÈ Î·Ê¤ ∫·Ê¤ ÛÎÔ‡ÚÔ ¯ÚÒÌ· ŸÍÈÓÔ ∆ÚÔÊ‹ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159
Pediatr Mar-Apr 06
18-04-06
16:42
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ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘
Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ·ÚÙËÚÈÔÊÏÂ‚Ò‰Ô˘˜ ‰˘ÛÏ·Û›·˜. ÕÏÏ· ÛÙÔȯ›· ·fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË Ô˘ ÂӉȷʤÚÔ˘Ó, Â›Ó·È Ë ÂÓÙÔÈṲ̂ÓË Ì›ˆÛË ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ „Èı˘Ú›ÛÌ·ÙÔ˜, Ë ¿ÓÈÛË ÎÈÓËÙÈÎfiÙËÙ· ÙˆÓ ‰‡Ô ËÌÈıˆÚ·Î›ˆÓ ÌÂ Û˘ÓÔ‰fi ÌÂȈ̤ÓË Â›ÛÔ‰Ô ·¤Ú·, fiˆ˜ › ÂÈÛÚfiÊËÛ˘ ͤÓÔ˘ ÛÒÌ·ÙÔ˜, Ô ÂÓÙÔÈṲ̂ÓÔ˜ Û˘ÚÈÁÌfi˜ Û ÂÓ‰Ô‚ÚÔÁ¯ÈΤ˜ ‚Ï¿‚˜ Î·È Û ͤӷ ÛÒÌ·Ù·, ÔÈ ÏÂÙÔ› ˘ÁÚÔ› ÚfiÁ¯ÔÈ Û Ó¢ÌÔÓ›· ‹ ÓÔÛ‹Ì·Ù· ÙÔ˘ ÎÔÏÏ·ÁfiÓÔ˘ Î·È Ù¤ÏÔ˜, Ë ‡·ÚÍË Î·Ù¿ ÙËÓ ·ÎÚfi·ÛË Ù˘ ηډȿ˜ Ê˘Û‹Ì·ÙÔ˜ ÂÓ‰ÂÈÎÙÈÎÔ‡ ÛÙ¤ÓˆÛ˘ Ù˘ ÌÈÙÚÔÂȉԇ˜ ‹ Ù˘ ·ÔÚÙÈ΋˜ ‚·Ï‚›‰·˜. ∆¤ÏÔ˜, ı· ÂÏÂÁ¯ı› Ë ·ÚÔ˘Û›· Ù˘¯fiÓ ‰ÈÔÁÎˆÌ¤ÓˆÓ ÏÂÌÊ·‰¤ÓˆÓ ÛÙÔÓ ÙÚ¿¯ËÏÔ, ÛÙÔ˘˜ ˘ÂÚÎÏ›‰ÈÔ˘˜ Î·È ÛÙÔ˘˜ Ì·Û¯·ÏÈ·›Ô˘˜ ‚fiıÚÔ˘˜. ¢˘ÛÙ˘¯Ò˜, fï˜, Ô‡Ù ÙÔ ÈÛÙÔÚÈÎfi Ô‡ÙÂ Ë Ê˘ÛÈ΋ ÂͤٷÛË, Â›Ó·È Èı·Ófi Ó· ı¤ÛÔ˘Ó ÙËÓ ÔÚÈÛÙÈ΋ ‰È¿ÁÓˆÛË, ÂÎÙfi˜ ‚¤‚·È· ·fi ÙȘ ÂÚÈÙÒÛÂȘ ÂΛӘ fiÔ˘ Ë ·ÈÌfiÙ˘ÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È Û ·È‰› Ì ‹‰Ë ÁÓˆÛÙfi ÈÛÙÔÚÈÎfi ÈÓÔ΢ÛÙÈ΋˜ ÓfiÛÔ˘ ‹ ¿ÏÏÔ˘ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›·. ™Â fiϘ ۯ‰fiÓ ÙȘ ¿ÏϘ ÂÚÈÙÒÛÂȘ ı· ¯ÚÂÈ·ÛÙ› ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜. √ ·Ú¯ÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ Ù· ÂÍ‹˜: ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, ƒ∆, ƒ∆∆, ηÏÏȤÚÁÂÈ· Ù˘¤ÏˆÓ ÁÈ· ‚·ÎÙ‹ÚÈ·, ̇ÎËÙ˜ Î·È Ì˘ÎÔ‚·ÎÙËÚ›‰È· (ÛÙ· ·È‰È¿ ÌÈÎÚ‹˜ ËÏÈΛ·˜ Ù· ‰Â›ÁÌ·Ù· Ù˘¤ÏˆÓ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ÏËÊıÔ‡Ó Ì ÚÈÓÔÙÚ·¯Âȷ΋ ·Ó·ÚÚfiÊËÛË), ÁÂÓÈ΋ Ô‡ÚˆÓ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ·ÈÌ·ÙÔ˘Ú›·˜- ΢ÏÈÓ‰ÚÔ˘Ú›·˜, Ô˘Ú›· Î·È ÎÚ·ÙÈÓ›ÓË ÔÚÔ‡ ÁÈ· ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ÓÂÊÚÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ê˘Ì·ÙÈÓÔ·ÓÙ›‰Ú·ÛË Mantoux. ∏ Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰ÂÓ ·ÔÙÂÏ› ÂÁÁ‡ËÛË Ù˘ Â͈Ó¢ÌÔÓÈ΋˜ ·ÈÙÈÔÏÔÁ›·˜ Ù˘ ·ÈÌfiÙ˘Û˘, ηıÒ˜ Ê˘ÛÈÔÏÔÁÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ 30% ÙˆÓ ·È‰ÈÒÓ Ì ·ÈÌfiÙ˘ÛË (1). ∂ÊfiÛÔÓ ˘¿Ú¯Ô˘Ó Â˘Ú‹Ì·Ù·, ·˘Ù¿ Â›Ó·È Û˘Ó‹ıˆ˜ ·ÙÂÏÂÎٷۛ˜ ‹ ΢„ÂÏȉÈΤ˜ ‹ ‰È¿ÌÂÛ˜ ·ÚÂÁ¯˘Ì·ÙÈΤ˜ ‰ÈËı‹ÛÂȘ. ÕÏÏ· ÛÙÔȯ›· Ô˘ ı· Ú¤ÂÈ Ó· ·Ó·˙ËÙËıÔ‡Ó Â›Ó·È Ë ·ÚÔ˘Û›· ·Ú·˘Ï·›·˜ ·‰ÂÓÔ¿ıÂÈ·˜, Ô˙ȉ›Ô˘ ÛÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·, ηډÈÔÌÂÁ·Ï›·˜ Î·È ·˘ÍË̤Ó˘ ·ÁÁ›ˆÛ˘ ÙˆÓ ¿Óˆ Ó¢ÌÔÓÈÎÒÓ ÏÔ‚ÒÓ. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ˘Ô„›· ÂÈÛÚfiÊËÛ˘ ͤÓÔ˘ ÛÒÌ·ÙÔ˜, ··ÈÙÂ›Ù·È Û˘ÁÎÚÈÙÈ΋ ÂͤٷÛË ÙˆÓ ·ÎÙÈÓÔÁÚ·ÊÈÒÓ Û ‰‡Ô Ê¿ÛÂȘ Ù˘ ·Ó·ÓÔ‹˜. ∞Ó·ÏfiÁˆ˜ ÙˆÓ ÂӉ›ÍÂˆÓ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË, ı· ··ÈÙËı› ÂȉÈÎfiÙ¶·È‰È·ÙÚÈ΋ 2006;69:150-159
ÚÔ˜ ¤ÏÂÁ¯Ô˜: ‰ÔÎÈÌ·Û›· ȉÚÒÙ· (˘Ô„›· ÈÓÔ΢ÛÙÈ΋˜ ÓfiÛÔ˘), πgE ÔÚÔ‡ Î·È È˙ËÌ·Ù›Ó˜ ¤Ó·ÓÙÈ ∞spergillus fumigatus (˘Ô„›· ·ÛÂÚÁ›ÏψÛ˘), ˈÛÈÓfiÊÈÏ· Î·È IgE ÔÚÔ‡ (·˘ÍË̤Ó˜ ÙÈ̤˜ Û ·Ú·Û›ÙˆÛË), ·ÓÔÛÔÛÊ·ÈÚ›Ó˜ ÔÚÔ‡ (˘Ô„›· Û˘Ó‰ÚfiÌÔ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜), ÂͤٷÛË ‰ÂÈÁÌ¿ÙˆÓ Á·ÛÙÚÈÎÔ‡ ˘ÁÚÔ‡ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛË ÛȉËÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ Î·È ÁÈ· ηÏÏȤÚÁÂÈ· (1). ∂ÊfiÛÔÓ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ¤¯ÂÈ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Ë ÂͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË, Â›Ó·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· (1). ∏ ÂÓ‰ÔÊϤ‚È· ¯Ú‹ÛË ÛÎÈ·ÁÚ·ÊÈÎÔ‡ ı· ‚ÔËı‹ÛÂÈ ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ·ÁÁÂÈ·ÎÒÓ ‰ÔÌÒÓ ÎÈ Â›Ó·È È‰È·›ÙÂÚ· ¯Ú‹ÛÈÌË ÛÙËÓ ÂÚ›ÙˆÛË ·ÚÙËÚÈÔÊÏ‚ÈÎÒÓ ‰˘ÛÏ·ÛÈÒÓ. ∂ͤٷÛË ÂÎÏÔÁ‹˜ ÁÈ· ÙËÓ ·ÂÈÎfiÓÈÛË ÙÔ˘ Ó¢ÌÔÓÈÎÔ‡ ·ÚÂÁ¯‡Ì·ÙÔ˜ Â›Ó·È Ë ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. ∏ ªRI ˘ÂÚ¤¯ÂÈ ÛÙËÓ ·ÂÈÎfiÓÈÛË ÙˆÓ Ì·Ï·ÎÒÓ ÌÔÚ›ˆÓ, ηıÒ˜ ›Û˘ ÙÔ˘ ÌÂÛÔıˆÚ·Î›Ô˘ Î·È ÙˆÓ ˘ÏÒÓ, ÂÓÒ ‰ÂÓ ‰›ÓÂÈ È‰È·›ÙÂÚ˜ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÙÔ Ó¢ÌÔÓÈÎfi ·Ú¤Á¯˘Ì·. ™ÙËÓ ÂÚ›ÙˆÛË Ô˘ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ÂÓ‰ÂÈÎÙÈο Ó¢ÌÔÓÈÎÔ‡ ÓÔÛ‹Ì·ÙÔ˜ Î·È Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋, ηıÒ˜ Î·È ÛÙËÓ ÂÚ›ÙˆÛË Ô˘ Ô ÚÔ·Ó·ÊÂÚfiÌÂÓÔ˜ ¤ÏÂÁ¯Ô˜ Ì ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›· ıÒÚ·ÎÔ˜ ‰ÂÓ Î·Ù¢ı‡ÓÂÈ ÛÂ Û˘ÁÎÂÎÚÈ̤ÓË ‰È¿ÁÓˆÛË (2), ÙÔ ÂfiÌÂÓÔ ‚‹Ì· ηıÔÚÈÛÙÈ΋˜ ÛËÌ·Û›·˜, Â›Ó·È Ë ÂÎÙ¤ÏÂÛË ‚ÚÔÁ¯ÔÛÎfiËÛ˘ Ì ‡ηÌÙÔ ÈÓÔÙÈÎfi ‚ÚÔÁ¯ÔÛÎfiÈÔ. ∆Ô ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ ¯ÚËÛÈÌÔÔÈÂ›Ù·È Â›Ù ÁÈ· ÙËÓ ·Ê·›ÚÂÛË Í¤ÓÔ˘ ÛÒÌ·ÙÔ˜ ›Ù ÛÙËÓ ÂÚ›ÙˆÛË Ì·˙È΋˜ ·ÈÌÔÚÚ·Á›·˜, ÔfiÙ ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‰È·ÙËÚËı› ·Î¤Ú·ÈË Ë ‚·ÙfiÙËÙ· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡ Î·È Ù·˘Ùfi¯ÚÔÓ· Ó· Á›ÓÔÓÙ·È ·Ó·ÚÚÔÊ‹ÛÂȘ. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ·ÈÌÔÚÚ·Á›·, Ì ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÓÙÔÈÛÙ› Ì ۯÂÙÈ΋ ·ÎÚ›‚ÂÈ· Ë ı¤ÛË Ù˘. ŸÙ·Ó, fï˜, Ë ·ÈÌÔÚÚ·Á›· ¤¯ÂÈ ‹‰Ë ÛÙ·Ì·Ù‹ÛÂÈ Î·È Î·Ù¿ ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË ‰ÂÓ ·Ó¢ڛÛÎÂÙ·È Î¿ÔÈÔ ÂÌÊ·Ó¤˜ ·›ÙÈÔ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜, ÙfiÙ ı· Ú¤ÂÈ Ó· Á›ÓÂÙ·È ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË (bronchoalveolar lavage-BAL), ÒÛÙ ӷ ÂÏÂÁ¯ı› Ë Ù˘¯fiÓ ·ÚÔ˘Û›· Û ·˘Ùfi Ì·ÎÚÔÊ¿ÁˆÓ ΢ÙÙ¿ÚˆÓ Ì ·ÈÌÔÛȉËÚ›ÓË (“ÛȉËÚÔÊ¿ÁˆÓ”). ∏ ·ÚÔ˘Û›· ÙÔ˘˜ ·ÔÙÂÏ› ¤Ó‰ÂÈÍË ÚÔËÁËı›۷˜ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜. ∞fi Ï›Á˜ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Ô˘ ˘¿Ú¯Ô˘Ó, Ê·›ÓÂÙ·È fiÙÈ Ù· ÛȉËÚÔÊ¿Á· ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È ·Ú¿
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·157
157
∏ ·ÈÌfiÙ˘ÛË ÛÙ· ·È‰È¿
∞ÈÌfiÙ˘ÛË Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘
ªÂ ÂӉ›ÍÂȘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ ∞/· ıÒÚ·ÎÔ˜ ·ıÔÏÔÁÈ΋
CT £ÒÚ·ÎÔ˜
Èڛ˜ ÂӉ›ÍÂȘ Ó¢ÌÔÓÈ΋˜ ÓfiÛÔ˘ ∞/· ıÒÚ·ÎÔ˜ Ê˘ÛÈÔÏÔÁÈ΋ µÚÔÁ¯ÔÛÎfiËÛË
Ê˘ÛÈÔÏÔÁÈ΋
¶·ıÔÏÔÁÈ΋
¶·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·
Èڛ˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·
∂ȉÈÎfi˜ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ·Ó·ÏfiÁˆ˜ ÙˆÓ ÂӉ›ÍÂˆÓ ∫·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË µ¶∂ ·fi 3Ë-14Ë Ë̤ڷ (--) ÁÈ· ÛȉËÚÔÊ¿Á·
µ¶∂ ·fi 3Ë-14Ë Ë̤ڷ (+) ÁÈ· ÛȉËÚÔÊ¿Á·
¶·Ú·ÎÔÏÔ‡ıËÛË
∂› ˘ÔÙÚÔ‹˜ ·ӤÏÂÁ¯Ô˜
µ¶∂ >14Ë Ë̤ڷ ÌÂÙ¿ ·ÈÌÔÚÚ·Á›·
∫·Ù¿ÏÏËÏË ·ÓÙÈÌÂÙÒÈÛË
ECHO ∫·Ú‰È¿˜
¶·ıÔÏÔÁÈÎfi
¶Èı·Ó‹ ηډÈÔÏÔÁÈ΋ ÓfiÛÔ˜
º˘ÛÈÔÏÔÁÈÎfi
∂ÍÂÙ¿ÛÂȘ ÁÈ· ·ÈÌÔÚÚ·ÁÈ΋ ‰È¿ıÂÛË
∂ÍÂÙ¿ÛÂȘ ÁÈ· Ó¢ÌÔÓÔÓÂÊÚÈÎfi Û‡Ó‰ÚÔÌÔ ·˘ÙÔ¿ÓÔÛ˘ ·ÈÙÈÔÏÔÁ›·˜ Èڛ˜ Â˘Ú‹Ì·Ù· π¶∞
∂ÈÎfiÓ· 1. ¶ÚÔÛ¤ÁÁÈÛË ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË Ó¢ÌÔÓÈ΋˜ ÚÔ¤Ï¢Û˘. π∫¡= πÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, µ¶∂= µÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË, π¶∞= π‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË, ∞/·= ∞ÎÙÈÓÔÁÚ·Ê›·, CT= AÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·
50 ÒÚ˜ ÌÂÙ¿ ÙËÓ ÔÍ›· ·ÈÌÔÚÚ·Á›· Î·È ·Ú·Ì¤ÓÔ˘Ó ¤ˆ˜ Î·È 5-6 Ë̤Ú˜ ÌÂÙ¿ (ηÙ' ¿ÏÏÔ˘˜ ̤¯ÚÈ 10 Ë̤Ú˜), ÂÓÒ ‰ÂÓ ·Ó¢ڛÛÎÔÓÙ·È Î·Ù¿ ÙË 15Ë Ë̤ڷ ÌÂÙ¿ ÙËÓ Ó¢ÌÔÓÈ΋ ·ÈÌÔÚÚ·Á›· (27). ∂ÊfiÛÔÓ Ë ·ÎÙÈÓÔÁÚ·Ê›· ıÒÚ·ÎÔ˜, Ë ‚ÚÔÁ¯ÔÛÎfiËÛË Î·È Ë ‚ÚÔÁ¯ÔÓ¢ÌÔÓÈ΋ ¤ÎÏ˘ÛË (Ô˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ÌÂٷ͇ 3˘-14˘ Ë̤ڷ˜ ÌÂÙ¿ ÙËÓ ·ÈÌÔÚÚ·Á›·) ‰ÂÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·, Â›Ó·È ÛÎfiÈÌÔ Ó· ·Ó·Ì¤ÓÂÙ·È ÙÔ Ó¤Ô ÂÂÈÛfi‰ÈÔ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Î·È ÂÊfiÛÔÓ ÂΉËψı›, Ó· ‰ÈÂÚ¢ÓËı› Ì ·ÚfiÌÔÈÔ ÙÚfiÔ. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ¤Ó‰ÂÈÍË Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ (BAL ıÂÙÈÎfi), ÂÓÒ Ì ÙË ‚ÚÔÁ¯ÔÛÎfiËÛË ‰ÂÓ ÂÓÙÔ›˙ÂÙ·È ‚Ï¿‚Ë ÛÙÔ˘˜ ·ÂÚ·ÁˆÁÔ‡˜
Î·È ÙÔ ·È‰› ‰ÂÓ ¤¯ÂÈ ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ ‹ ‚ÚÔÁ¯ÂÎٷۛ˜ ·fi ¿ÏÏ· ·›ÙÈ·, ı· Ú¤ÂÈ Ó· Á›ÓÂÈ Ï‹Ú˘ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ì ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜. ∂¿Ó Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο, ÙfiÙ ı· Á›ÓÂÈ ‰ÈÂÚ‡ÓËÛË ÁÈ· Èı·Ó‹ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË ÛÙ· Ï·›ÛÈ· ·˘ÙÔ¿ÓÔÛÔ˘ ÓÔÛ‹Ì·ÙÔ˜, Ô˘ ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ¤ÏÂÁ¯Ô Ì ∞¡∞, anti-ds DNA, anti-GBM, c-ANCA, p-ANCA. √ ¤ÏÂÁ¯Ô˜ ·˘Ùfi˜ ‚¤‚·È· Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÚÔËÁËı›, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÁÓˆÛÙfi ÈÛÙÔÚÈÎfi Û˘ÛÙËÌ·ÙÈ΋˜ ÓfiÛÔ˘ ‹ ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó ¿ÏÏ· ÛÙÔȯ›·, fiˆ˜ ÂÍ¿ÓıËÌ·, ·ÈÌ·ÙÔ˘Ú›· ‹ ΢ÏÈÓ‰ÚÔ˘Ú›·. ∂ÊfiÛÔÓ ‰ÂÓ ˘¿Ú¯Ô˘Ó ÛÙÔȯ›· ˘¤Ú ÌÈ·˜ Û˘ÛÙËÌ·ÙÈ΋˜ ¿ıËÛ˘, ÙfiÙ ÙÔ ·›ÙÈÔ Ù˘ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159
Pediatr Mar-Apr 06
18-04-06
16:42
™ÂÏ›‰·158
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ª.¡. µ·ÛÈÏÔÔ‡ÏÔ˘, ¡. ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘
Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜ Èı·ÓfiÓ Ó· Â›Ó·È Ë È‰ÈÔ·ı‹˜ Ó¢ÌÔÓÈ΋ ·ÈÌÔÛȉ‹ÚˆÛË, Ù˘ ÔÔ›·˜ Ú·ÎÙÈο Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ÂÍ ·ÔÎÏÂÈÛÌÔ‡. ™Â ·È‰È¿ Ì π¶∞, Û·Ó›ˆ˜ ¯ÚÂÈ¿˙ÂÙ·È Ó· Á›ÓÂÈ ‚ÈÔ„›· Ó‡ÌÔÓ·. ∂˘Ú‹Ì·Ù· ·fi ÙË ‚ÈÔ„›· Ù· ÔÔ›· Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú π¶∞, Â›Ó·È Ë ·ÚÔ˘Û›· ÔÏÏÒÓ ÂÚ˘ıÚÒÓ ·ÈÌÔÛÊ·ÈÚ›ˆÓ ÂÓÙfi˜ ÙˆÓ Î˘„ÂÏ›‰ˆÓ Î·È ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙfi, ÂÊfiÛÔÓ ˘¿Ú¯ÂÈ ÂÓÂÚÁfi˜ ·ÈÌÔÚÚ·Á›·, Î·È Ë ·Ô˘Û›· ÛÙÔȯ›ˆÓ ·ÁÁÂÈ›Ùȉ·˜. ∂¿Ó Ë ‚ÈÔ„›· Ú·ÁÌ·ÙÔÔÈËı› ÌÂÙ¿ ¿ÚÔ‰Ô Î¿ÔÈˆÓ ËÌÂÚÒÓ ·fi ÙÔ ÂÂÈÛfi‰ÈÔ Ù˘ ·ÈÌÔÚÚ·Á›·˜, ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‡ÚËÌ· ı· Â›Ó·È Ë ·ÚÔ˘Û›· Ì·ÎÚÔÊ¿ÁˆÓ Ì ·ÈÌÔÛȉËÚ›ÓË ÛÙȘ ΢„ÂÏ›‰Â˜ Î·È ÛÙÔÓ ‰È¿ÌÂÛÔ ÈÛÙfi. ∆¤ÏÔ˜, › ˘Ô„›·˜ Ó¢ÌÔÓÈ΋˜ ÂÌ‚ÔÏ‹˜ ÂӉ›ÎÓ˘Ù·È Û˘Ó‹ıˆ˜ ÙÔ ÛÈÓıËÚÔÁÚ¿ÊËÌ· ·ÂÚÈÛÌÔ‡-·ÈÌ¿ÙˆÛ˘.
∞ÓÙÈÌÂÙÒÈÛË ∏ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ·ÈÌfiÙ˘ÛË ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ‰‡Ô ·Ú¿ÁÔÓÙ˜: 1) ÙËÓ ˘ÔΛÌÂÓË ·ÈÙÈÔÏÔÁ›· Î·È 2) ÙËÓ ¤ÎÙ·ÛË Ù˘ ·ÈÌÔÚÚ·Á›·˜. ŸÙ·Ó Ë ˘ÔΛÌÂÓË ·ÈÙÈÔÏÔÁ›· Â›Ó·È ÁÓˆÛÙ‹, Ï·Ì‚¿ÓÔÓÙ·È Ù· ηٿÏÏËÏ· ıÂڷ¢ÙÈο ̤ÙÚ·. ™ÙËÓ ÏÂÈÔ„ËÊ›· ÙˆÓ ·È‰ÈÒÓ, Ë ·ÈÌfiÙ˘ÛË ˘Ô¯ˆÚ› ·˘ÙfiÌ·Ù·, ¯ˆÚ›˜ ·Ú¤Ì‚·ÛË. ∂ÊfiÛÔÓ ÚfiÎÂÈÙ·È ÁÈ· Ì·˙È΋ ·ÈÌfiÙ˘ÛË, ·ÂÈÏËÙÈ΋ ÁÈ· ÙË ˙ˆ‹, ı· Ú¤ÂÈ ¿ÌÂÛ· Ó· ÏËÊıÔ‡Ó Ì¤ÙÚ· ›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛ˘, Ù· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ¯ÔÚ‹ÁËÛË √2, ÙËÓ ÂÓ‰ÔÊϤ‚È· ¯ÔÚ‹ÁËÛË ˘ÁÚÒÓ ‹ ÙË ÌÂÙ¿ÁÁÈÛË ·›Ì·ÙÔ˜ Î·È ÙÔÓ Ì˯·ÓÈÎfi ·ÂÚÈÛÌfi, fiÔ˘ ¯ÚÂÈ¿˙ÂÙ·È, Ì ۇÁ¯ÚÔÓÔ ¤ÏÂÁ¯Ô ÙˆÓ ·ÂÚ›ˆÓ ·›Ì·ÙÔ˜. ∞ÊÔ‡ ÂÍ·ÛÊ·ÏÈÛÙ› Ë ‚·ÙfiÙËÙ· ÙÔ˘ ·ÂÚ·ÁˆÁÔ‡, Á›ÓÂÙ·È ÚÔÛÂÎÙÈο ·Ó·ÚÚfiÊËÛË ÒÛÙ ӷ ·ÔÊ¢¯ı› Ô ÙÚ·˘Ì·ÙÈÛÌfi˜ ÙÔ˘. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ı· ‹Ù·Ó ¯Ú‹ÛÈÌË Ë ÂÎÙ¤ÏÂÛË ‚ÚÔÁ¯ÔÛÎfiËÛ˘ Ì ¿Î·ÌÙÔ ‚ÚÔÁ¯ÔÛÎfiÈÔ, ÒÛÙ ӷ ÂÓÙÔÈÛÙ› ÙÔ ÛËÌÂ›Ô Ù˘ ·ÈÌÔÚÚ·Á›·˜, Ó· ‰È·ÙËÚËı› ·ÓÔÈÎÙfi˜ Ô ·ÂÚ·ÁˆÁfi˜ Î·È Ù·˘Ùfi¯ÚÔÓ· Ó· Á›ÓÔÓÙ·È Ï‡ÛÂȘ Ì ·ÁˆÌ¤ÓÔ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi. ¶ÂÚÈÛÙ·Ûȷο ÁÈ· Ó· ÛÙ·Ì·Ù‹ÛÂÈ Ë ·ÈÌÔÚÚ·Á›·, ··ÈÙÂ›Ù·È ÂÓ‰ÔÛÎÔÈο ÂȈ̷ÙÈÛÌfi˜ Ì ÙË ¯Ú‹ÛË Î·ıÂÙ‹Ú· Ì ·ÂÚÔı¿Ï·ÌÔ (28). ∂¿Ó ·Ú¿ Ù· ·Ú·¿Óˆ ̤ÙÚ· Ë ·ÈÌÔÚÚ·Á›· Û˘Ó¯›˙ÂÙ·È, ÙÔ ÂfiÌÂÓÔ ‚‹Ì· Â›Ó·È Ë ÂÌ‚ÔÏ‹ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ·ÁÁ›Ԣ. ¶ÚÈÓ Á›ÓÂÈ ÂÌ‚ÔÏ‹, Â›Ó·È ÂȂ‚ÏË̤ÓÔ˜ Ô ¤ÏÂÁ¯Ô˜ Ì ÂÎÏÂÎÙÈ΋ ‚ÚÔÁ¯È΋ ·ÚÙËÚÈÔÁÚ·Ê›·, ηıÒ˜ Ë ÂÌ‚ÔÏ‹ ÙˆÓ ¶·È‰È·ÙÚÈ΋ 2006;69:150-159
‚ÚÔÁ¯ÈÎÒÓ ·ÚÙËÚÈÒÓ ·ÓÙÂӉ›ÎÓ˘Ù·È fiÙ·Ó ·fi ·˘Ù¤˜ ÂÎʇÔÓÙ·È ·ÚÙËڛ˜ ÙÔ˘ ÓˆÙÈ·›Ô˘ Ì˘ÂÏÔ‡ (1). ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi Â›Ó·È ‰˘Ó·Ùfi Ó· ÛÙ·Ì·Ù‹ÛÂÈ ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ó¢ÌÔÓÈ΋˜ ·ÈÌÔÚÚ·Á›·˜. ∂ÊfiÛÔÓ ˘¿Ú¯ÂÈ ·ÓÙ¤Ó‰ÂÈÍË ÛÙËÓ ÂÌ‚ÔÏ‹ ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ·ÁÁ›Ԣ, ÙÔ ÂfiÌÂÓÔ ‚‹Ì· Â›Ó·È Ë ¯ÂÈÚÔ˘ÚÁÈ΋ ÂÎÙÔÌ‹ ÙÔ˘ ÚÔۂ‚ÏË̤ÓÔ˘ Ó¢ÌÔÓÈÎÔ‡ ÙÌ‹Ì·ÙÔ˜ ‹ ÏÔ‚Ô‡. ∏ Ó¢ÌÔÓÂÎÙÔÌ‹ ·ÔÙÂÏ› ÙË ıÂڷ›· ÂÎÏÔÁ‹˜ ÁÈ· ·ÛıÂÓ›˜ Ô˘ ¤¯Ô˘Ó ˘ÔÙÚÔÈ¿˙ÔÓÙ· ÂÂÈÛfi‰È· Ì·˙È΋˜ ·ÈÌfiÙ˘Û˘.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Pianosi P, Al-Sadoon H. Hemoptysis in children. Pedi·tr Rev 1996;17:344-348. 2. Bidwell JL, Pachner RW. Hemoptysis: Diagnosis and management. Am Fam Physician 2005;72:1253-1260. 3. Godfrey S. Pulmonary hemorrhage/hemoptysis in children. Pediatr Pulmonol 2004;37:476-484. 4. Coss-Bu JA, Sachdeva RC, Bricker JT, Harrison GM, Jefferson LS. Hemoptysis: a 10-year retrospective study. Pediatrics 1997;100:7. 5. Southall DP, Plunkett MC, Banks MW, Falkov AF, Samuels MP. Covert video recordings of life-threatening child abuse: lessons for child protection. Pediatrics 1997;100:735-760. 6. Evans DA, Wilmott RW. Pulmonary embolism in children. Pediatr Clin North Am 1994;41:569-584. 7. Nusair S, Salameh-Giryes S, Springer C, Izhar U. Congenital bronchial cyst with recurrent submassive hemoptysis. J Thorac Cardiovasc Surg 2003;125: 972-973. 8. Swanson KL, Prakash UB, Stanson AW. Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997. Mayo Clinic Proc 1999;74:671-680. 9. Abrahams NA, Colby TV, Pearl RH, Chipps BE, Juris AL, Leslie KO. Pulmonary hemangiomas of infancy and childhood: report of 2 cases and review of the literature. Ped Dev Pathol 2002;5:283-292. 10. Ben-Abraham R, Paret G, Cohen R, Szold O, Cindalli G, Toren A et al. Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children. Chest 2003;124:660-664. 11. Heggen J, West C, Olson E, Olson T, Teague G, Fortenberry J et al. Diffuse alveolar hemorrhage in pediatric hematopoietic cell transplant patients. Pediatrics 2002;109:965-971. 12. Dearborn DG. Pulmonary Hemosiderosis. In Behrman RE, Kliegman RM, Janson HB, editors. Nelson Textbook of Pediatrics, 17th ed. Philadelphia: Saunders; 2004. p. 1455-1457. 13. Saeed MM, Woo MS, MacLaughlin EF, Margetis MF, Keens TG. Prognosis in pediatric idiopathic pulmonary hemosiderosis. Chest 1999;116:721-725. 14. Le Clainche L, Le Bourgeois M, Fauroux B, Forenza N, Dommergues JP, Desbois JC et al. Long-term
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outcome of idiopathic pulmonary hemosiderosis in children. Medicine (Baltimore) 2000;79:318-326. Kiper N, Gocmen A, Ozcelik U, Dilber E, Anadol D. Long-term course of patients with idiopathic pulmonary hemosiderosis (1979-1994): prolonged survival with low-dose corticosteroid therapy. Pediatr Pulmonol 1999;27:180-184. Vats KR, Vats A, Kim Y, Dassenko D, Sinaiko AR. Henoch-Schonlein purpura and pulmonary hemorrhage: a report and literature review. Pediatr Nephrol 1999;13:530-534. von Vigier RO, Trummler SA, Laux-End R, Sauvain MJ, Truttmann AC, Bianchetti MG. Pulmonary renal syndrome in childhood: a report of twenty-one cases and a review of the literature. Pediatr Pulmonol 2000;29:382-388. Martini A, Binda S, Mariani G, Scotta MS, Ruberto G. Goopasture’s syndrome in a child: natural history and effect of treatment. Acta Paediatr Scand 1981;70:435-439. Font J, Cervera R, Espinosa G, Pallares L, RamosCasals M, Jimenez S, Garcia-Carrasco M. Systemic lupus erythematosus (SLE) in childhood: analysis of clinical and immunological findings in 34 patients and comparison with SEL characteristics in adults. Ann Rheum Dis 1998;57:456-459.
20. Miller RW, Salcedo JR, Fink RJ, Murphy TM, Magilavy DB. Pulmonary hemorrhage in pediatric patients with systemic lupus erythematosus. J Pediatr 1986;108:576-579. 21. Badsha H, Edwards C. Intravenous pulses of methylprednisolone for systemic lupus erythematosus. Semin Arthritis Rheum 2003;32:370-377. 22. Colby TV, Specks U. Wegener’s granulomatosis in the 1990’s, a pulmonary pathologist’s perspective. Monogr Pathol 1993;36:195-218. 23. Belostotsky VM, Shah V, Dillon MJ. Clinical features in 17 paediatric patients with Wegener granulomatosis. Pediatr Nephrol 2002;17:754-761. 24. Al-Harbi NN. Henoch-Schonlein nephritis complicated with pulmonary hemorrhage but treated successfully. Pediatr Nephrol 2002;17:762-764. 25. Bjornson CL, Kirk VG. Munchausen’s syndrome presenting as hemoptysis in a12-year-old girl. Can Respir J 2001;8:439-442. 26. Corder R. Hemoptysis. Emerg Med Clin North Am 2003;21:421-435. 27. Epstein CE, Elidemir √, Colasurdo GN, Fan LL. Time course of hemosiderin production by alveolar macrophages in a murine model. Chest 2001;120: 2013-2020. 28. Tam LWC, Weisman RA, Handler SD. Hemoptysis in children. Ann Otolaryngol 1980;89:419.
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¡ÂÔÁÓÔÏÔÁÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô “∞ÏÂÍ¿Ó‰Ú·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ÃÚ‹ÛÙÔ˜ ∫ÒÛÙ·ÏÔ˜, E-mail: ccostalos@yahoo.gr
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¡ÂÔÁ¤ÓÓËÙÔ ·ÁfiÚÈ Ì ‚¿ÚÔ˜ Á¤ÓÓËÛ˘ 4.900 ÁÚ·ÌÌ¿ÚÈ· Ô˘ ÁÂÓÓ‹ıËΠ̠ηÈÛ·ÚÈ΋ ÙÔÌ‹ ÏfiÁˆ ÎÂÊ·ÏÔ-˘ÂÏÈ΋˜ ‰˘Û·Ó·ÏÔÁ›·˜, ÂÌÊ¿ÓÈÛ ÛÔ‚·Ú‹ ˘ÔÁÏ˘Î·ÈÌ›· ̤۷ ÛÙȘ ÚÒÙ˜ ÒÚ˜ ˙ˆ‹˜ (ÁÏ˘Îfi˙Ë ·›Ì·ÙÔ˜ 18 mg%), ÁÈ· ÙËÓ ÔÔ›· ··ÈÙ‹ıËÎÂ Ë ¯ÔÚ‹ÁËÛË 12 mg/kg/min ÁÏ˘Îfi˙˘, ÂÓ‰ÔÊÏ‚›ˆ˜, Û ‰È¿Ï˘Ì· 10%. ∏ ·ÚÙËÚȷ΋ ›ÂÛË ‹Ù·Ó ›Û˘ ¯·ÌËÏ‹ Î·È ··ÈÙ‹ıËÎÂ Ë ¯ÔÚ‹ÁËÛË ÓÙÔ·Ì›Ó˘ ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË, Û ÔÛfiÙËÙ· 10 Ìg/kg. ∆Ô ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ ¤‰ÂÈÍ ˷ÙÔÌÂÁ·Ï›· Î·È ÓÂÊÚÔÌÂÁ·Ï›·, ÂÓÒ ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ (∂ÈÎfiÓ· 1), ¤‰ÂÈÍ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ¢ÂÓ ˘‹Ú¯Â ÛÙË ÌËÙ¤Ú· ÈÛÙÔÚÈÎfi ۷ί·ÚÒ‰Ô˘˜ ‰È·‚‹ÙË. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ηٿ ÙË Ê¿ÛË Ù˘ ˘ÔÁÏ˘Î·ÈÌ›·˜ ¤‰ÂÈÍ ·˘ÍË̤ӷ ›‰· ÈÓÛÔ˘Ï›Ó˘ (9,1 mU/l) Î·È C ÂÙȉ›Ô˘ (401 mU/l), ¯·ÌËÏ¿ ›‰· ÏÈ·ÚÒÓ ÔͤˆÓ Î·È ‚ ˘‰ÚÔ͢‚Ô˘Ù˘ÚÈÎÔ‡ Î·È Ê˘ÛÈÔÏÔÁÈο ›‰· ÎÔÚÙÈ˙fiÏ˘ Î·È ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘. ¶·Ú¿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ÁÏ˘Îfi˙˘, Ù· ›‰· Ù˘
ÁÏ˘Îfi˙˘ ·›Ì·ÙÔ˜ ÂÍ·ÎÔÏÔ˘ıÔ‡Û·Ó Ó· Â›Ó·È Û¯ÂÙÈο ¯·ÌËÏ¿ (35 mg%) Î·È ÁÈ· ÙÔÓ ÏfiÁÔ ·˘Ùfi ¯ÔÚËÁ‹ıËΠ·Ú¯Èο ÁÏ˘Î·ÁfiÓË ÂÓ‰ÔÊÏ‚›ˆ˜, ÛÂ Û˘Ó¯‹ ¤Á¯˘ÛË (1 mg/kg/h) Î·È ÛÙË Û˘Ó¤¯ÂÈ· ÔÎÙÚÂÔÙ›‰ÈÔ (10 Ìg/kg/Ë̤ڷ). °È· ÙË ıÂڷ›· Ù˘ Ì˘ÔηډÈÔ¿ıÂÈ·˜ ÙÔ‡ ‰fiıËΠÚÔÚ·ÓÔÏfiÓË. ªÂ ÙË ıÂڷ›· ·˘Ù‹ ¤‰ÂÈÍ ı·̷ÙÈ΋ ‚ÂÏÙ›ˆÛË Î·È Ì›ˆÛË ÙˆÓ ·Ó·ÁÎÒÓ Û ÁÏ˘Îfi˙Ë. •ÂΛÓËÛ Á‡̷ٷ Á¿Ï·ÎÙÔ˜ Ô˘ Ù· ·Ó¤¯ıËΠÈηÓÔÔÈËÙÈο. ŒÁÈÓ ÚÔԉ¢ÙÈ΋ ‰È·ÎÔ‹ ÙˆÓ Ê·ÚÌ¿ÎˆÓ ÛÙËÓ ËÏÈΛ· ÙˆÓ 21 ËÌÂÚÒÓ, ¯ˆÚ›˜ ˘ÔÙÚÔ‹ ÙˆÓ Û˘Ìو̿وÓ. ∂Í‹Ïı ·fi ÙÔ ÓÔÛÔÎÔÌÂ›Ô ÛÙËÓ ËÏÈΛ· ÙˆÓ 4 ‚‰ÔÌ¿‰ˆÓ ˘fi ıÂڷ›· Ì ÚÔÚ·ÓÔÏfiÓË. ∂·Ó·ÏËÙÈÎfi ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ηډȿ˜ ÛÙËÓ ËÏÈΛ· ÙˆÓ 3 ÌËÓÒÓ ¤‰ÂÈÍ ϋÚË ·ÔηٿÛÙ·ÛË Ù˘ ηډȿ˜ ÛÙÔ Ê˘ÛÈÔÏÔÁÈÎfi. ∏ η̇ÏË ÊfiÚÙÈÛ˘ Ù˘ ÌËÙ¤Ú·˜ Ì ÁÏ˘Îfi˙Ë ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. ¶ÔÈ· Â›Ó·È Ë Èı·Ó‹ ‰È¿ÁÓˆÛË;
∏ ·¿ÓÙËÛË ·ÎÔÏÔ˘ı› ÛÙË ÛÂÏ›‰· 164 ¶·È‰È·ÙÚÈ΋ 2006;69:160, 164
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¢È¢ı˘ÓÙ‹˜ ¡ÂÊÚÔÏÔÁÈÎÔ‡ ∆Ì‹Ì·ÙÔ˜ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. Î·È ∞. ∫˘ÚÈ·ÎÔ‡”
∏ÏÂÎÙÚÔÓÈΤ˜ ‰È¢ı‡ÓÛÂȘ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ √ÌÔÛÔÓ‰›· ∂˘Úˆ·›ˆÓ ∂ȉÈÎÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ - http://www.cesp-eap.org
AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ E-mail: stefanid@hol.gr
H √ÌÔÛÔÓ‰›· ∂˘Úˆ·›ˆÓ ∂ȉÈÎÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ (Confederation of European Specialists in Paediatrics, CESP) Â›Ó·È Ô ÎÏ¿‰Ô˜ Ù˘ ¶·È‰È·ÙÚÈ΋˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ π·ÙÚÈÎÒÓ ∂ȉÈÎÔÙ‹ÙˆÓ (European Union of Medical Specialties, UEMS) ÙˆÓ ÎÚ·ÙÒÓ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘. ¶ÚfiÛÊ·Ù· ¤¯ÂÈ Û˘ÌÂÚÈÏËÊı› ÛÙËÓ ÔÓÔÌ·Û›· Ù˘ CESP Î·È Ô Ù›ÙÏÔ˜ ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜ (European Academy of Paediatrics), ÁÈ· Ó· ¯·Ú·ÎÙËÚÈÛı› Î·È Ô ·Î·‰ËÌ·˚Îfi˜ ¯·Ú·ÎÙ‹Ú·˜ Ù˘ ∂Ù·ÈÚ›·˜. ™ÙÔÓ ÚfiÛÊ·Ù· ۯ‰ȷṲ̂ÓÔ ‰ÈÎÙ˘·Îfi ÙfiÔ Ù˘ CESP ÌÔÚ›Ù ӷ ‚Ú›Ù ÙÔ˘˜ ÛÙfi¯Ô˘˜ Ù˘ ∂Ù·ÈÚ›·˜. ªÂٷ͇ ÙˆÓ ÛÙfi¯ˆÓ Â›Ó·È Î·È Ë ÂÍ·ÛÊ¿ÏÈÛË ˘„ËÏÔ‡ ÂȤ‰Ô˘ Âη›‰Â˘Û˘ ÛÙËÓ ·È‰È·ÙÚÈ΋ ÛÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘. ∂›Û˘ ȉȷ›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ·ÏÏËÏÂÁÁ‡Ë ÌÂٷ͇ ÙˆÓ Â˘Úˆ·›ˆÓ ·È‰È¿ÙÚˆÓ Î·È Ë ÂÓۈ̿وÛË ÙˆÓ ¶·È‰È·ÙÚÈÎÒÓ ÀÔÂȉÈÎÔًوÓ. H √ÌÔÛÔÓ‰›· ÂÚÈÏ·Ì‚¿ÓÂÈ ÔÌ¿‰Â˜ ÂÚÁ·Û›·˜ ÁÈ· ÚˆÙÔ‚¿ıÌÈ·, ‰Â˘ÙÂÚÔ‚¿ıÌÈ· Î·È ÙÚÈÙÔ‚¿ıÌÈ· ·È‰È·ÙÚÈ΋ ÊÚÔÓÙ›‰· Î·È Â›Ó·È Û ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›· Ì ÙËÓ ŒÓˆÛË ∂ıÓÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ (UNEPSA) Î·È Ì ÙȘ ∂˘Úˆ·˚Τ˜ ∂Ù·ÈÚ›˜ ÀÔÂȉÈÎÔًوÓ.
ŒÓˆÛË ∂ıÓÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ - http://www.unepsa.org ∏ ŒÓˆÛË ∂ıÓÈÎÒÓ ∂˘Úˆ·˚ÎÒÓ ¶·È‰È·ÙÚÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ (Union of National European Paediatric Societies and Associations, UNEPSA) ¤¯ÂÈ ˆ˜ ÛÙfi¯Ô ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Â˘Úˆ·˚ÎÔ‡ ÛÒÌ·ÙÔ˜ ·È‰È¿ÙÚˆÓ ·fi fiÏË ÙËÓ ∂˘ÚÒË Î·È ‰›‰ÂÈ È‰È·›ÙÂÚË ¤ÌÊ·ÛË ÛÙËÓ ÂÓۈ̿وÛË ÙˆÓ ·È‰È¿ÙÚˆÓ Ù˘ ∫ÂÓÙÚÈ΋˜ Î·È ∞Ó·ÙÔÏÈ΋˜ ∂˘ÚÒ˘. ™ÙËÓ ÈÛÙÔÛÂÏ›‰· ı· ‚Ú›Ù ÔÏϤ˜ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜. ∏ UNEPSA Û˘ÓÂÚÁ¿˙ÂÙ·È Ì ÙËÓ √ÌÔÛÔÓ‰›· ∂˘Úˆ·›ˆÓ ∂ȉÈÎÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ (CESP) Û ÎÔÈÓÔ‡˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÛÙfi¯Ô˘˜. ™Â Ì›· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË Ù˘ ∂Ù·ÈÚ›·˜ ηٷÁÚ¿ÊÔÓÙ·È Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ÛÙËÓ ∂˘ÚÒË: Katz ª, Rubino ∞, Collier J, Rosen J, Ehrich JHH, Demography of Pediatric Primary Care in Europe: Delivery of Care and Training. Pediatrics 2002;109:788-796. http://pediatrics.aappublications.org/cgi/content/full/109/5/788
∂˘Úˆ·˚΋ ∞η‰ËÌ›· ∞ÏÏÂÚÁÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ - http://www.EAACI.net ∏ ∂˘Úˆ·˚΋ ∞η‰ËÌ›· ∞ÏÏÂÚÁÔÏÔÁ›·˜ Î·È ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ (European Academy of Allergology and Clinical Immunology, EAACI) ‰ËÌÈÔ˘ÚÁ‹ıËΠ·fi ÙË Û˘ÓÂÚÁ·Û›· 39 ∂˘Úˆ·˚ÎÒÓ ∂ıÓÈÎÒÓ ∂Ù·ÈÚÂÈÒÓ Î·È ÂÚÈÛÛÔÙ¤ÚˆÓ ·fi 3.500 ·Î·‰ËÌ·˚ÎÒÓ, ÂÚ¢ÓËÙÒÓ Î·È ÎÏÈÓÈÎÒÓ È·ÙÚÒÓ. π‰Ú‡ıËΠÙÔ ¶·È‰È·ÙÚÈ΋ 2006;69:161-163
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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√
∆Ì‹Ì·, 1956 Î·È ÔÚÁ·ÓÒÓÂÈ Î¿ı ¯ÚfiÓÔ ¤Ó· ÙÂÙÚ·‹ÌÂÚÔ Û˘Ó¤‰ÚÈÔ. √ ·È‰È·ÙÚÈÎfi˜ Ù˘ ÙÔ̤·˜¡ÂÊÚÔÏÔÁÈÎfi Â›Ó·È È‰È·›Ù¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ Ú· ‰Ú·ÛÙ‹ÚÈÔ˜ Î·È ÔÚÁ·ÓÒÓÂÈ Î¿ı ¯ÚfiÓÔ ™˘Ó¤‰ÚÈÔ ∞ÏÏÂÚÁÈÔÏÔÁ›·˜ ÛÙËÓ ∂˘ÚÒË. “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ E-mail: stefanid@hol.gr
∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ http://www.eurospe.org ∏ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·˜ (European Organisation for Paediatric Endocrinology, ESPE) Â›Ó·È ¤Ó·˜ ‰ÈÂıÓ‹˜ ÔÚÁ·ÓÈÛÌfi˜ Ì ÂηÙÔÓÙ¿‰Â˜ ̤ÏË ·fi 45 ¯ÒÚ˜. ªÂ ÂȉÈ΋ ¤ÌÊ·ÛË ÛÙËÓ Âη›‰Â˘ÛË ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·. π‰Ú‡ıËΠÙÔ 1962 Î·È ÔÚÁ·ÓÒÓÂÈ Î¿ı ¯ÚfiÓÔ Û˘Ó¤‰ÚÈÔ.
∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ¡ÂÊÚÔÏÔÁ›·˜ - http://espn.uwcm.ac.uk √ ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ ¶·È‰È·ÙÚÈ΋˜ ¡ÂÊÚÔÏÔÁ›·˜ (European Society for Paediatric Nephrology, ESPN) ÂÚȤ¯ÂÈ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ∂Ù·ÈÚ›·˜. ªÔÚ› Ó· ‚Ú›Ù ÂÚÈÏ‹„ÂȘ ·fi ·Ó·ÎÔÈÓÒÛÂȘ ÛÂ Û˘Ó¤‰ÚÈ· Î·È ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜. π‰È·›ÙÂÚ· ¯Ú‹ÛÈ̘ Â›Ó·È ÔÈ ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜ Ù˘ ∂˘Úˆ·˚΋˜ √Ì¿‰·˜ ∂ÚÁ·Û›·˜ ∂͈ÓÂÊÚÈ΋˜ ∫¿ı·ÚÛ˘ (European Paediatric Dialysis Working Group): http://espn.uwcm.ac.uk/eppdwg.htm ™Â Ì›· ÚfiÛÊ·ÙË ‰ËÌÔÛ›Â˘ÛË Ù˘ ∂Ù·ÈÚ›·˜ ηٷÁÚ¿ÊÔÓÙ·È Ù· ‰ËÌÔÁÚ·ÊÈο ÛÙÔȯ›· Ù˘ ·È‰È·ÙÚÈ΋˜ ÊÚÔÓÙ›‰·˜ ÙˆÓ ·È‰ÈÒÓ Ì ÓÂÊÚÔ¿ıÂȘ ÛÙËÓ ∂˘ÚÒË. Ehrich JH, El Gendi AA, Drukker A, Janda J, Stefanidis C, Verrier-Jones K, Collier J, Katz M. Demography of paediatric renal care in Europe: organization and delivery. Nephrol Dial Transplant. 2005;20(2):297-305. http://ndt.oxfordjournals.org/cgi/reprint/20/2/297.pdf
∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ¡ÂÔÁÓÔÏÔÁ›·˜ Î·È ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ - http://www.espnic.org/ ∏ ∂˘Úˆ·˚΋ ∂Ù·ÈÚ›· ¶·È‰È·ÙÚÈ΋˜ ¡ÂÔÁÓÔÏÔÁ›·˜ Î·È ∂ÓÙ·ÙÈ΋˜ £Âڷ›·˜ (European Society of Paediatric neonatal and Intensive Care, ESPNIC) ÂÚÈÏ·Ì‚¿ÓÂÈ ¤Ó·Ó È·ÙÚÈÎfi ÎÏ¿‰Ô Î·È ¤Ó·Ó ÁÈ· ÓÔÛËÏÂ˘Ù¤˜, Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ÛÙÂÓ‹ Û˘ÓÂÚÁ·Û›·. ∞ÔÙÂÏÂ›Ù·È ·fi 800 ̤ÏË ·fi 30 Â˘Úˆ·˚Τ˜ ¯ÒÚ˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ¤¯Ô˘Ó ÔÈ ÏËÚÔÊÔڛ˜ ÙÔ˘ ‰ÈÎÙ˘·ÎÔ‡ ·˘ÙÔ‡ ÙfiÔ˘ Û¯ÂÙÈο Ì ÔÏ˘ÎÂÓÙÚÈΤ˜ ÌÂϤÙ˜ Î·È ÎÏÈÓÈΤ˜ Ô‰ËÁ›Â˜.
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PRINTO - http://www.printo.it/pediatric-rheumatology/ ∏ PRINTO Â›Ó·È ¤Ó· ÌË ÎÂÚ‰ÔÛÎÔÈÎfi ‰ÈÂıÓ¤˜ ‰›ÎÙ˘Ô, Ì ÛÙfi¯Ô Ó· ÂÓı·ÚÚ‡ÓÂÈ, Ó· ‰È¢ÎÔχÓÂÈ Î·È Ó· Û˘ÓÙÔÓ›˙ÂÈ ÙË ‰ÈÂÍ·ÁˆÁ‹ ÌÂÏÂÙÒÓ Ô˘ ·ÍÈÔÏÔÁÔ‡Ó ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Î·È ÙËÓ ·ÛÊ¿ÏÂÈ· Ê·Ú̷΢ÙÈÎÒÓ ıÂڷ¢ÙÈÎÒÓ Û¯ËÌ¿ÙˆÓ, ÙËÓ ÔÈfiÙËÙ· ˙ˆ‹˜ Î·È ÙËÓ ¤Î‚·ÛË ÙˆÓ ·È‰ÈÒÓ Ì ÚÂ˘Ì·ÙÈο ÓÔÛ‹Ì·Ù·. ∏ PRINTO ·ÔÙÂÏÂ›Ù·È ·fi ·Î·‰ËÌ·˚ο ‹/Î·È ÎÏÈÓÈο ΤÓÙÚ· Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó ÂÓÂÚÁ¿ ÛÙËÓ ¤Ú¢ӷ Î·È ÙËÓ ÎÏÈÓÈ΋ ÂÚ›ı·Ï„Ë ·È‰ÈÒÓ Ì ÚÂ˘Ì·ÙÈο ÓÔÛ‹Ì·Ù·. ∞˘Ùfi˜ Ô ‰ÈÎÙ˘·Îfi˜ ÙfiÔ˜ Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Û˘ÓÂÚÁ·Û›·˜ ÌÂٷ͇ Ù˘ ¢ÈÂıÓÔ‡˜ √ÚÁ¿ÓˆÛ˘ ªÂÏÂÙÒÓ ÛÙËÓ ¶·È‰È·ÙÚÈ΋ ƒÂ˘Ì·ÙÔÏÔÁ›· (PRINTO) Î·È Ù˘ ¶·È‰È·ÙÚÈ΋˜ ƒÂ˘Ì·ÙÔÏÔÁÈ΋˜ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ (Paediatric Rheumatology European Society, PR∂S: http://www.pres.org.uk). ªÔÚ›Ù ӷ ‚Ú›Ù Ôχ ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Î·È ÛÙ· ∂ÏÏËÓÈο. ∆Ô ÚÒÙÔ ÙÌ‹Ì·, ÛÙԯ‡ÂÈ Ó· ÂÓËÌÂÚÒÛÂÈ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· Ù· ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ÈÔ ÛËÌ·ÓÙÈÎÒÓ ·È‰È·ÙÚÈÎÒÓ ÚÂ˘Ì·ÙÔÏÔÁÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ∆Ô ‰Â‡ÙÂÚÔ ÙÌ‹Ì· ‰›ÓÂÈ ÙȘ ‰È¢ı‡ÓÛÂȘ ÙˆÓ ·È‰È·ÙÚÈÎÒÓ ÚÂ˘Ì·ÙÔÏÔÁÈÎÒÓ Î¤ÓÙÚˆÓ, ÙˆÓ ÔÔ›ˆÓ ÔÈ È·ÙÚÔ› Â›Ó·È Ì¤ÏË Ù˘ PRINTO ‹/Î·È Ù˘ PRES. ∆Ô ÙÚ›ÙÔ ÙÌ‹Ì· ‰›ÓÂÈ ÙȘ ‰È¢ı‡ÓÛÂȘ ÙˆÓ Û˘ÏÏfiÁˆÓ Ô˘ ÚÔÛʤÚÔ˘Ó ‚Ô‹ıÂÈ· ÛÙȘ ÔÈÎÔÁ¤ÓÂȘ ÙˆÓ ÚÂ˘Ì·ÙÔ·ıÒÓ ·È‰ÈÒÓ.
ª·Ú›· ¶··Ê›ÏË °È· ÏËÚÔÊÔڛ˜: www.euran.com ªaria Papafili For information: www.euran.com
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CLINICAL QUIZ ∫ÏÈÓÈÎfi QUIZ ∞¶∞¡∆∏™∏
∏ ‰È¿ÁÓˆÛË Â›Ó·È ·ÚÔ‰ÈÎfi˜ ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ Ì ̷ÎÚÔۈ̛· Î·È ˘ÂÚÙÚÔÊÈ΋ ·ÔÊÚ·ÎÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ∏ ¿ıËÛË ·˘Ù‹ ·Ú·ÙËÚÂ›Ù·È Û ÓÂÔÁÓ¿ ‰È·‚ËÙÈÎÒÓ ÌËÙ¤ÚˆÓ, Û ·Û˘Ì‚·ÙfiÙËÙ· Rh, Û ÓÂÔÁÓ¿ Ì ÂÚÈÁÂÓÓËÙÈ΋ ·ÛÊ˘Í›· ‹ ÂÓ‰ÔÌ‹ÙÚÈ· ηı˘ÛÙ¤ÚËÛË Ù˘ ·Ó¿Ù˘Í˘, ηıÒ˜ Î·È ÛÙÔ Û‡Ó‰ÚÔÌÔ Beckwith. √ ·ÚÔ‰ÈÎfi˜ ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ ‰È·ÚΛ ·fi ÌÂÚÈΤ˜ Ë̤Ú˜ ̤¯ÚÈ Î·È Ì‹Ó˜. ∞ÓÙ›ıÂÙ·, Ô ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌfi˜ Ô˘ Û˘Óԉ‡ÂÈ Ù· ÓÂÔÁ¤ÓÓËÙ· ‰È·‚ËÙÈ΋˜ ÌËÙ¤Ú·˜, ‰È·ÚΛ
ÌfiÏȘ Ï›Á˜ ÒÚ˜. ∆Ô Û‡Ó‰ÚÔÌÔ Beckwith ÂÎÙfi˜ ·fi ˘ÔÁÏ˘Î·ÈÌ›·, ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÍÒÌÊ·ÏÔ, Ì·ÎÚÔÁψÛÛ›·, ÔÚÁ·ÓÔÌÂÁ·Ï›·, ÁÈÁ·ÓÙÈÛÌfi Î·È ÔÊ›ÏÂÙ·È Û ÌÂÙ¿ÏÏ·ÍË ÛÙÔ ¯ÚˆÌfiۈ̷ 11p 15.4. ™Â ·ÓÙ›ıÂÛË Ì ÙË ÌfiÓÈÌË ÌÔÚÊ‹ ˘ÂÚÈÓÛÔ˘ÏÈÓÈÛÌÔ‡ Ô˘ Û˘Óԉ‡ÂÙ·È ·fi ÌÂÙ¿ÏÏ·ÍË 5 ÁÔÓȉ›ˆÓ (Ì ΢ÚÈfiÙÂÚ˜ ÙȘ ÌÂÙ·ÏÏ¿ÍÂȘ ÙˆÓ ÁÔÓȉ›ˆÓ SUR1 Î·È ∫πR6.2), ÛÙËÓ ·ÚÔ‰È΋ ÌÔÚÊ‹, ‰ÂÓ ¤¯Ô˘Ó ‚ÚÂı› ¯ÚˆÌÔÛˆÌȷΤ˜ ·ÓˆÌ·Ï›Â˜ Î·È ÙÔ ·›ÙÈÔ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙÔ.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Nold JL, Georgieff MK. Infants of diabetic mothers [Review]. Pediatr Clin North Am. 2004 Jun; 51(3):619-637. 2. Breitweser JA, Meyer RA, Sperling MA, Tsang RC, Kaplan S. Cardiac septal hypertrophy in
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hyperinsulinemic infants. Part II. J Pediatr 1980; 96:535-539. 3. Gutgesell HP, Speer ME, Rosenberg HS. Characterization of the cardiomyopathy in infants of diabetic mothers. Circulation 1980;61:441-450.
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26-29 ∞ÚÈÏ›Ô˘ 2006
XVIIth Annual Congress of the European ∞ı‹Ó· Society for Paediatric Urology •ÂÓÔ‰Ô¯Â›Ô Athens Hilton ¶ÏËÚÔÊÔڛ˜: Erasmus Conferences Tours & Travel S.A. ∆ËÏ.: 210 7257 693 Fax: 210 7257 532 E-mail: info@espu2006.com Website: www.espu2006.com
1-6 ª·˝Ô˘ 2006
Paediatric Update Conference ¶ÏËÚÔÊÔڛ˜: Brenda Rau ∆ËÏ.: 416 813 8122 Fax: 416 813 5230 E-mail: brenda.rau@sickkids.ca
Toronto, Canada
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
9-13 ª·˝Ô˘ 2006
32Ô ¶·ÓÂÏÏ‹ÓÈÔ π·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ª¤Á·ÚÔ ªÔ˘ÛÈ΋˜ ∞ıËÓÒÓ ¢ÈÔÚÁ¿ÓˆÛË: π·ÙÚÈ΋ ∂Ù·ÈÚ›· ∞ıËÓÒÓ ∆ËÏ.: 210 7211 845, 7243 161, 7215 082 ∂-mail: vpapag@nednet.gr
∞ı‹Ó·
12-14 ª·˝Ô˘ 2006
36Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰Ô‰ÔÓÙÈÎfi ™˘Ó¤‰ÚÈÔ ™˘Ó‰ÚÈ·Îfi ∫¤ÓÙÚÔ £ÂÛÛ·Ï›·˜ ¶ÏËÚÔÊÔڛ˜: η §›˙· ¶··ÁÈ·ÓÓÔ‡ÏË ∆ËÏ: 210 7461 019, 7461 219 E-mail: hspd@enternet.gr Website: www.hspd.gr
µfiÏÔ˜
13-14 ª·˝Ô˘ 2006
15Ë ¢ÈËÌÂÚ›‰· ¶·È‰È·ÙÚÈÎÒÓ ∞Ó·Ó¢ÛÙÈÎÒÓ ¶·ı‹ÛÂˆÓ ∞ÌÊÈı¤·ÙÚÔ ∂∫∫º∂ “¢ËÌfiÎÚÈÙÔ˜” ¢ÈÔÚÁ¿ÓˆÛË: ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì· °.¡. ¶·›‰ˆÓ ¶ÂÓÙ¤Ï˘ ¶ÏËÚÔÊÔڛ˜: Triaena Tours ∆ËÏ.: 210 7499 304 Fax: 210 7705 752 E-mail: congress@triaenatours.gr
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23 ª·˝Ô˘ 2006
Teach-In/Medical Update - Paediatrics ¶ÏËÚÔÊÔڛ˜: The Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ Christina Pottinger ∆ËÏ.: 44 0 1 312 257 324 Fax: 44 0 1 312 203 939 E-mail: c.pottinger@rcpe.ac.uk
Edinburgh, Scotland, UK
Pediatr Mar-Apr 06
18-04-06
16:43
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xxvi
24-27 ª·˝Ô˘ 2006
41st Annual Meeting of the Association for Basel, European Paediatric Cardiology (AEPC) Switzerland ¶ÏËÚÔÊÔڛ˜: Dr. Ingrid Oberhänsli-Weiss Ph.D, AEPC Secretary-general, 31 Route de Florissant, CH-1206 Geneva Switzerland TËÏ.: 41 22 347 10 56 / 43 1 370 81 75 Fax: 41 22 347 10 56 E-mail: secr@aepc.org / ingrid.oberhaensli@bluewin.ch
9-11 πÔ˘Ó›Ô˘ 2006
44o ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: C&C International SA Conventions & Congresses ¶·Ú·‰Â›ÛÔ˘ 16, 151 25 ∞ı‹Ó· ∆ËÏ.: 210 6889 100 Fax: 210 6844 777 E-mail: registrations@cnc.gr Website: www.pediatric2006.gr
ƒfi‰Ô˜, Rodos Palace
10-14 πÔ˘Ó›Ô˘ 2006
XXV Congress of the European Academy of Allergology and Clinical Immunology ¶ÏËÚÔÊÔڛ˜: Congrex Sweden ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: eaaci2006@congrex.se Website: www.congrex.com/eaaci2006
Vienna, Austria
30 πÔ˘Ó›Ô˘-3 πÔ˘Ï›Ô˘ 2006 45th Annual Meeting of the European Society for Paediatric Endocrinology ¶ÏËÚÔÊÔڛ˜: Congrex Sweden AB ∆ËÏ.: +46 8 459 66 00 Fax: +46 8 661 91 25 E-mail: espe2006@congrex.se Website: www.espe2006.org
Rotterdam, The Netherlands
8-11 πÔ˘Ï›Ô˘ 2006
7th International Congress on Pediatric Pulmonology ¶ÏËÚÔÊÔڛ˜: Annie Bidart, MD ∆ËÏ.: +33 0 497 038 597 Fax: +33 0 497 038 598 E-mail: cipp@cipp-meeting.com Website: www.cipp-meeting.com
Montreal, Canada
7-10 √ÎÙˆ‚Ú›Ô˘ 2006
40th Meeting of the European Society of Paediatric Nephrology ¶ÏËÚÔÊÔڛ˜: E.DI.PO. s.r.l.Via della Libertà, 103 - 90143 Palermo ∆ËÏ.: ++39 091 340255 Fax: ++39 091 340440 E-mail: edi.po@tiscali.it Website: www.espn2006.org/
Palermo, Italy